Family Practice Exam Pediatric Care 4 — Questions and Answers
Question 1: A 4-year-old presents with scrotal swelling that transilluminates and is non-tender. The mass does not reduce. What is the most likely diagnosis?
- Inguinal hernia
- Testicular torsion
- Hydrocele (Correct answer)
- Epididymo-orchitis
Correct answer: Hydrocele
A non-tender, transilluminating scrotal mass in a young child is characteristic of a hydrocele, caused by fluid accumulation around the testis.
Question 2: A 10-year-old boy with asthma uses his albuterol inhaler more than 2 days per week. How should his asthma be classified?
- Intermittent asthma
- Mild persistent asthma (Correct answer)
- Moderate persistent asthma
- Severe persistent asthma
Correct answer: Mild persistent asthma
Symptoms more than 2 days per week but not daily, with nighttime awakenings 3-4 times per month, classify asthma as mild persistent per NAEPP guidelines.
Question 3: A 15-year-old female presents with primary amenorrhea. She has breast development but no pubic hair and a blind vaginal pouch. Karyotype is 46,XY. What is the most likely diagnosis?
- Turner syndrome
- Androgen insensitivity syndrome (Correct answer)
- Mullerian agenesis (MRKH)
- Congenital adrenal hyperplasia
Correct answer: Androgen insensitivity syndrome
Complete androgen insensitivity syndrome (CAIS) presents with 46,XY karyotype, absent pubic hair, blind vaginal pouch, and normal breast development due to peripheral estrogen conversion.
Question 4: Which finding on a newborn hip exam suggests developmental dysplasia of the hip (DDH)?
- Galeazzi sign (unequal knee heights) and positive Ortolani test (Correct answer)
- Positive Babinski reflex
- Asymmetric Moro reflex
- Hip flexion contracture with positive Thomas test
Correct answer: Galeazzi sign (unequal knee heights) and positive Ortolani test
DDH is detected by the Ortolani (reduction of dislocated hip with abduction) and Barlow (dislocation with adduction) maneuvers, along with Galeazzi sign showing unequal knee heights.
Question 5: A 2-year-old presents with episodes of breath-holding, turning blue, and then losing consciousness briefly. The episodes always follow minor frustration or pain. What is the most appropriate management?
- EEG and neurology referral
- Cardiac monitoring and echocardiogram
- Parental reassurance and behavioral guidance (Correct answer)
- Antiepileptic medication
Correct answer: Parental reassurance and behavioral guidance
Cyanotic breath-holding spells in toddlers are benign, self-limited, and triggered by emotional upset; they require only parental education and reassurance as no intervention prevents them.
Question 6: What is the recommended treatment for a 5-year-old with uncomplicated acute otitis media (AOM) and no penicillin allergy?
- Azithromycin for 5 days
- Amoxicillin 80-90 mg/kg/day for 10 days (Correct answer)
- Observation without antibiotics for 48-72 hours
- Amoxicillin-clavulanate for 5 days
Correct answer: Amoxicillin 80-90 mg/kg/day for 10 days
High-dose amoxicillin (80-90 mg/kg/day) is the first-line antibiotic for AOM in children; children under 2 years or with severe symptoms should be treated rather than observed.
Question 7: A 6-week-old presents with yellowish skin and sclera. Stool is acholic (clay-colored) and urine is dark. What is the most likely diagnosis?
- Breastfeeding jaundice
- Physiologic neonatal jaundice
- Biliary atresia (Correct answer)
- Crigler-Najjar syndrome
Correct answer: Biliary atresia
Biliary atresia presents with conjugated hyperbilirubinemia, acholic stools, and dark urine; it is a surgical emergency requiring Kasai procedure before 60 days of life.
Family Practice Exam Pediatric Care 4
A 4-year-old presents with scrotal swelling that transilluminates and is non-tender.
The mass does not reduce.
What is the most likely diagnosis?