NCCPA Pediatric Care 3 — Questions and Answers
Question 1: A 3-year-old presents with fever, drooling, and refusal to swallow. She is leaning forward in the 'sniffing position.' What is the MOST likely diagnosis?
- Epiglottitis (Correct answer)
- Croup
- Peritonsillar abscess
- Foreign body aspiration
Correct answer: Epiglottitis
Epiglottitis presents with high fever, drooling, dysphagia, and the tripod/sniffing position due to supraglottic inflammation, and is a airway emergency.
Question 2: Which developmental milestone should a typically developing 12-month-old be able to perform?
- Walk with one hand held and say 1-2 words (Correct answer)
- Run independently
- Use 2-word phrases
- Draw a circle
Correct answer: Walk with one hand held and say 1-2 words
At 12 months, infants typically walk with support and produce 1-2 meaningful words beyond 'mama/dada.'
Question 3: A neonate born at 36 weeks develops respiratory distress within 4 hours of birth. Chest X-ray shows bilateral ground-glass opacities with air bronchograms. The MOST likely diagnosis is:
- Respiratory distress syndrome (RDS) (Correct answer)
- Transient tachypnea of the newborn
- Meconium aspiration syndrome
- Congenital pneumonia
Correct answer: Respiratory distress syndrome (RDS)
RDS results from surfactant deficiency in premature infants and presents with early respiratory distress and bilateral ground-glass infiltrates on X-ray.
Question 4: A 6-year-old with newly diagnosed ALL is found to have a WBC of 120,000/µL. Which complication requires immediate prophylactic intervention?
- Tumor lysis syndrome (Correct answer)
- Febrile neutropenia
- Disseminated intravascular coagulation
- Hyperleukocytosis-related stroke
Correct answer: Tumor lysis syndrome
Tumor lysis syndrome is the most immediate concern with high-burden ALL; IV hydration, allopurinol or rasburicase, and electrolyte monitoring are initiated before chemotherapy.
Question 5: A 2-month-old presents for well-child care. Which vaccines are due at this visit per the ACIP schedule?
- DTaP, Hib, IPV, PCV15, HepB, RV (Correct answer)
- MMR, varicella, hepatitis A
- Influenza and meningococcal
- Tdap and HPV
Correct answer: DTaP, Hib, IPV, PCV15, HepB, RV
At 2 months, infants receive DTaP, Hib, IPV, PCV15 (or PCV20), HepB (second dose), and rotavirus vaccine per the ACIP schedule.
Question 6: A 15-year-old athlete presents with anterior knee pain worsened by stair climbing and kneeling. There is tenderness over the tibial tubercle. The MOST likely diagnosis is:
- Osgood-Schlatter disease (Correct answer)
- Patellofemoral pain syndrome
- Patellar tendinopathy
- Juvenile idiopathic arthritis
Correct answer: Osgood-Schlatter disease
Osgood-Schlatter disease is traction apophysitis at the tibial tubercle from repetitive quadriceps stress, common in adolescent athletes during growth spurts.
Question 7: Which finding is MOST characteristic of Kawasaki disease in a 3-year-old with 5 days of fever?
- Bilateral non-exudative conjunctivitis, strawberry tongue, and rash (Correct answer)
- Exudative pharyngitis and posterior cervical lymphadenopathy
- Vesicular rash on palms, soles, and oral mucosa
- Maculopapular rash beginning on the face and spreading caudally
Correct answer: Bilateral non-exudative conjunctivitis, strawberry tongue, and rash
Kawasaki disease requires fever plus 4 of 5 criteria: rash, conjunctival injection, oral changes (strawberry tongue/cracked lips), cervical lymphadenopathy, and extremity changes.
NCCPA Pediatric Care 3
A 3-year-old presents with fever, drooling, and refusal to swallow.
She is leaning forward in the 'sniffing position.' What is the MOST likely diagnosis?