NCCPA Pediatric Care 2 — Questions and Answers
Question 1: A 2-year-old presents with a barky cough, stridor at rest, and low-grade fever. Which treatment is first-line for moderate croup?
- Oral dexamethasone 0.6 mg/kg (Correct answer)
- IV methylprednisolone
- Nebulized albuterol
- Oral amoxicillin
Correct answer: Oral dexamethasone 0.6 mg/kg
Oral dexamethasone 0.6 mg/kg is first-line for moderate-to-severe croup due to its anti-inflammatory effect on subglottic edema.
Question 2: Which finding on newborn exam is MOST associated with congenital hypothyroidism?
- Enlarged anterior fontanelle, prolonged jaundice, and hypotonia (Correct answer)
- Microcephaly and hearing loss
- Cleft palate and micrognathia
- Widely spaced eyes and low-set ears
Correct answer: Enlarged anterior fontanelle, prolonged jaundice, and hypotonia
Congenital hypothyroidism classically presents with large fontanelles, prolonged jaundice, poor feeding, and hypotonia due to reduced metabolic activity.
Question 3: A 7-year-old with sickle cell disease develops sudden onset priapism lasting 3 hours. What is the INITIAL management?
- Oral hydration, analgesia, and pseudoephedrine (Correct answer)
- Penile aspiration and irrigation
- Exchange transfusion
- IV morphine only
Correct answer: Oral hydration, analgesia, and pseudoephedrine
Initial management of stuttering or early priapism in sickle cell disease includes oral hydration, analgesia, and oral pseudoephedrine before escalating to procedural interventions.
Question 4: A 4-week-old male presents with projectile non-bilious vomiting after feeds and visible peristalsis. The MOST likely diagnosis is:
- Pyloric stenosis (Correct answer)
- Duodenal atresia
- Malrotation with volvulus
- Gastroesophageal reflux
Correct answer: Pyloric stenosis
Pyloric stenosis presents at 3-6 weeks with forceful non-bilious vomiting and visible gastric peristalsis due to hypertrophied pyloric muscle.
Question 5: Which vaccine is CONTRAINDICATED in a 6-month-old infant with a known severe egg allergy?
- None — MMR and influenza are safe with egg allergy (Correct answer)
- MMR
- Influenza (IIV)
- Hepatitis A
Correct answer: None — MMR and influenza are safe with egg allergy
Current guidelines indicate MMR and influenza vaccines can be given safely to children with egg allergy, including severe reactions, without special precautions.
Question 6: A 10-year-old presents with a painless limp. X-ray shows flattening and fragmentation of the femoral head. Which condition is MOST likely?
- Legg-Calvé-Perthes disease (Correct answer)
- Slipped capital femoral epiphysis
- Transient synovitis
- Septic arthritis
Correct answer: Legg-Calvé-Perthes disease
Legg-Calvé-Perthes disease is avascular necrosis of the femoral head occurring in children 4-8 years, presenting with painless limp and X-ray fragmentation.
Question 7: A 5-year-old is evaluated for enuresis. Which finding warrants further workup beyond reassurance?
- Daytime wetting with urinary urgency and dysuria (Correct answer)
- Nighttime-only bedwetting without daytime symptoms
- Family history of enuresis in a parent
- No dry nights by age 5
Correct answer: Daytime wetting with urinary urgency and dysuria
Daytime wetting with urgency and dysuria suggests an organic cause such as UTI, bladder dysfunction, or anatomical abnormality requiring further evaluation.
NCCPA Pediatric Care 2
A 2-year-old presents with a barky cough, stridor at rest, and low-grade fever.
Which treatment is first-line for moderate croup?