APEA Pediatric Primary Care 2 — Questions and Answers
Question 1: A 15-month-old child is not yet walking independently. What is the most appropriate next step?
- Immediate neurology referral
- Reassurance that this is within normal developmental limits (Correct answer)
- Order brain MRI
- Refer to early intervention physical therapy immediately
Correct answer: Reassurance that this is within normal developmental limits
Independent walking is typically achieved between 9-15 months, with the upper limit of normal being 18 months, so a 15-month-old not yet walking warrants reassurance and close monitoring.
Question 2: Which vaccine is contraindicated in a child with a severe anaphylactic egg allergy?
- MMR (measles, mumps, rubella)
- Varicella (chickenpox)
- Yellow fever (Correct answer)
- Hepatitis B
Correct answer: Yellow fever
Yellow fever vaccine is produced in eggs and contains significant egg protein, making it contraindicated in individuals with severe egg anaphylaxis; MMR is safe despite the egg allergy misconception.
Question 3: A 2-year-old presents with a seal-like barking cough and inspiratory stridor, worse at night. What is the most likely diagnosis?
- Epiglottitis
- Croup (laryngotracheobronchitis) (Correct answer)
- Bronchiolitis
- Pertussis
Correct answer: Croup (laryngotracheobronchitis)
Croup is characterized by the classic barky, seal-like cough, inspiratory stridor, and hoarseness caused by subglottic edema, most often due to parainfluenza virus and typically worse at night.
Question 4: Which BMI-for-age percentile defines obesity in children aged 2-19 years?
- ≥75th percentile
- ≥85th percentile
- ≥95th percentile (Correct answer)
- ≥99th percentile
Correct answer: ≥95th percentile
A BMI-for-age at or above the 95th percentile defines obesity in children; the 85th to less than 95th percentile is classified as overweight.
Question 5: A 3-year-old girl has had three urinary tract infections in the past year. What imaging study should be obtained?
- CT scan of the abdomen and pelvis
- Voiding cystourethrogram (VCUG) (Correct answer)
- Renal cortical scintigraphy only
- Intravenous pyelogram
Correct answer: Voiding cystourethrogram (VCUG)
A voiding cystourethrogram (VCUG) is indicated to evaluate for vesicoureteral reflux, the most common anatomic abnormality associated with recurrent UTIs in young children.
Question 6: What is the most common cause of bacterial meningitis in children between 1 month and 18 years of age?
- Group B Streptococcus
- Listeria monocytogenes
- Neisseria meningitidis
- Streptococcus pneumoniae (Correct answer)
Correct answer: Streptococcus pneumoniae
Streptococcus pneumoniae is the leading cause of bacterial meningitis in children beyond the neonatal period, followed by Neisseria meningitidis which predominates in adolescents.
Question 7: An 8-month-old infant still demonstrates significant head lag when pulled from supine to sitting position. This finding is most consistent with:
- Normal developmental variation
- Hypotonia requiring further neuromuscular evaluation (Correct answer)
- Confirmed diagnosis of cerebral palsy
- Autism spectrum disorder
Correct answer: Hypotonia requiring further neuromuscular evaluation
Head lag should normally disappear by 4-6 months; persistence at 8 months suggests hypotonia and warrants further neurological evaluation to identify underlying causes.
APEA Pediatric Primary Care 2
A 15-month-old child is not yet walking independently.
What is the most appropriate next step?