Family Practice Exam Pediatric Care 3 — Questions and Answers
Question 1: A 9-month-old has a fever of 39.5°C, bulging fontanelle, and irritability. Which organism is the most common cause of bacterial meningitis at this age?
- Neisseria meningitidis
- Streptococcus pneumoniae (Correct answer)
- Listeria monocytogenes
- Group B Streptococcus
Correct answer: Streptococcus pneumoniae
Streptococcus pneumoniae is the leading cause of bacterial meningitis in infants older than 3 months and young children.
Question 2: Which blood pressure threshold defines hypertension in a 10-year-old child?
- ≥120/80 mmHg
- ≥130/80 mmHg
- ≥95th percentile for age, sex, and height on three separate visits (Correct answer)
- ≥140/90 mmHg
Correct answer: ≥95th percentile for age, sex, and height on three separate visits
Pediatric hypertension is defined as blood pressure at or above the 95th percentile for age, sex, and height measured on three separate occasions.
Question 3: A 3-year-old boy is brought in for concern about speech delay. He has 10 words but no two-word phrases, limited eye contact, and repetitive hand-flapping. What is the most appropriate next step?
- Reassure and recheck at age 4
- Refer for formal developmental and autism evaluation (Correct answer)
- Order thyroid function tests only
- Start speech therapy and observe for 6 months
Correct answer: Refer for formal developmental and autism evaluation
Red flags for autism spectrum disorder (ASD) — including limited eye contact, no two-word phrases by 24 months, and repetitive behaviors — warrant immediate formal developmental evaluation.
Question 4: A neonate at 36 hours of life develops jaundice. Total bilirubin is 14 mg/dL in a term infant. What is the most appropriate next step?
- Immediate exchange transfusion
- Initiate phototherapy based on Bhutani nomogram (Correct answer)
- Discharge with primary care follow-up in 1 week
- Start phenobarbital
Correct answer: Initiate phototherapy based on Bhutani nomogram
Neonatal jaundice management is guided by the Bhutani hour-specific bilirubin nomogram to determine phototherapy thresholds for term and near-term infants.
Question 5: A 6-year-old girl presents with recurrent urinary tract infections. What is the most important evaluation to consider?
- Renal ultrasound and voiding cystourethrogram (VCUG) (Correct answer)
- Urine culture alone
- CT abdomen with contrast
- Cystoscopy under general anesthesia
Correct answer: Renal ultrasound and voiding cystourethrogram (VCUG)
Recurrent UTIs in young children warrant evaluation for vesicoureteral reflux (VUR) with renal ultrasound and VCUG to prevent renal scarring.
Question 6: A 2-month-old is brought to the ER after being found unresponsive. Examination shows retinal hemorrhages and subdural hematoma without a history of trauma. What should be suspected?
- Glutaric aciduria type I
- Non-accidental trauma (abusive head trauma) (Correct answer)
- Osteogenesis imperfecta
- Accidental fall from bed
Correct answer: Non-accidental trauma (abusive head trauma)
The triad of subdural hematoma, retinal hemorrhages, and absent consistent history is classic for abusive head trauma (shaken baby syndrome).
Question 7: Which of the following best describes the murmur of a ventricular septal defect (VSD) in a child?
- Continuous machine-like murmur at the left upper sternal border
- Harsh holosystolic murmur at the left lower sternal border (Correct answer)
- Systolic ejection click followed by late systolic murmur
- Diastolic rumble at the apex
Correct answer: Harsh holosystolic murmur at the left lower sternal border
A VSD produces a harsh, holosystolic (pansystolic) murmur heard best at the left lower sternal border due to blood shunting from left to right ventricle.
Family Practice Exam Pediatric Care 3
A 9-month-old has a fever of 39.5°C, bulging fontanelle, and irritability.
Which organism is the most common cause of bacterial meningitis at this age?