Family Practice Exam Pediatric Care 5 — Questions and Answers
Question 1: A 3-year-old has a temperature of 40°C and a petechial rash spreading rapidly from the trunk. She appears toxic. What is the most urgent concern?
- Immune thrombocytopenic purpura (ITP)
- Viral exanthem with thrombocytopenia
- Meningococcemia (Correct answer)
- Rocky Mountain spotted fever
Correct answer: Meningococcemia
Rapidly spreading petechiae or purpura with high fever and a toxic appearance in a child is meningococcemia until proven otherwise, requiring immediate empiric antibiotics.
Question 2: Which of the following is the leading cause of death in children ages 1-18 in the United States?
- Cancer
- Congenital anomalies
- Unintentional injuries (Correct answer)
- Homicide
Correct answer: Unintentional injuries
Unintentional injuries (primarily motor vehicle accidents, drowning, and falls) are the single leading cause of death in children ages 1-18 in the US.
Question 3: A 14-year-old male presents with knee pain worsened by activity. There is tenderness over the tibial tubercle with a visible prominence. What is the most likely diagnosis?
- Patellar tendinopathy
- Osgood-Schlatter disease (Correct answer)
- Osteosarcoma
- Septic arthritis of the knee
Correct answer: Osgood-Schlatter disease
Osgood-Schlatter disease is a traction apophysitis at the tibial tubercle, common in active adolescents during growth spurts, causing anterior knee pain and a bony prominence.
Question 4: Which of the following is a CONTRAINDICATION to breastfeeding in the United States?
- Maternal hepatitis B infection
- Maternal HIV infection (Correct answer)
- Maternal cytomegalovirus (CMV) infection
- Maternal mastitis without abscess
Correct answer: Maternal HIV infection
Maternal HIV infection is a contraindication to breastfeeding in the US because safe infant formula is readily available and HIV can be transmitted through breast milk.
Question 5: A 7-year-old presents with a 'slapped cheek' facial rash and a lacy reticular rash on the trunk and extremities. She has been afebrile for 3 days. What is the causative organism?
- Human herpesvirus 6
- Parvovirus B19 (Correct answer)
- Rubella virus
- Group A Streptococcus
Correct answer: Parvovirus B19
Erythema infectiosum (fifth disease) is caused by Parvovirus B19 and presents with the classic slapped-cheek appearance followed by a lacy reticular rash.
Question 6: A 13-month-old is found to have a blood lead level of 15 µg/dL on routine screening. What is the most appropriate next step?
- Chelation therapy with DMSA immediately
- Environmental investigation and repeat testing in 1 month (Correct answer)
- Dietary calcium supplementation only
- Hospitalization for urgent chelation
Correct answer: Environmental investigation and repeat testing in 1 month
For blood lead levels 5-44 µg/dL, the priority is identifying and removing the lead source through environmental investigation; chelation is reserved for levels ≥45 µg/dL.
Question 7: A mother brings her 18-month-old because he does not respond when his name is called and lost words he had previously acquired. What developmental concern should be immediately addressed?
- Hearing loss alone
- Autism spectrum disorder screening and evaluation (Correct answer)
- Selective mutism
- Normal late talker variant
Correct answer: Autism spectrum disorder screening and evaluation
Regression of previously acquired language skills combined with failure to respond to name by 12 months are critical red flags for autism spectrum disorder requiring immediate evaluation.
Family Practice Exam Pediatric Care 5
A 3-year-old has a temperature of 40°C and a petechial rash spreading rapidly from the trunk.
She appears toxic.
What is the most urgent concern?