Pediatrics Test

Question 1

A 4-year-old boy squeals and cries but uses no words.
His gross and fine motor skills are well developed.
He is preoccupied with objects and does not play with other children.
The child responds normally to sounds but appears disinterested and detached.
For each child brought for a well-child examination, select the most likely diagnosis

Accepted Answer

Autistic disorder

Answer

Ankyloglossia (tongue-tie)

Answer

Attention-deficit/hyperactivity disorder

Answer

Hearing loss

Answer

Neurodegenerative disorder

Answer

Normal language development

Answer

Mental retardation

Answer

Parental neglect

Answer

Selective mutism

Answer

Serous otitis media

Question 2

A 16-month-old infant babbled at 6 months, began to mimic sounds at 10 months, and began to use a few recognizable words between 12 and 14 months. At 16 months, the child is continuing to use single words but is not using simple two-word phrases. For each child brought for a well-child examination, select the most likely diagnosis.

Accepted Answer

Normal language development

Answer

Ankyloglossia (tongue-tie)

Answer

Attention-deficit/hyperactivity disorder

Answer

Autistic disorder

Answer

Hearing loss

Answer

Neurodegenerative disorder

Answer

Mental retardation

Answer

Parental neglect

Answer

Selective mutism

Answer

Serous otitis media

Question 3

A 2-month-old infant has a 5-cm strawberry hemangioma on the cheek that is increasing in size. No other lesions are noted. Which of the following is the most appropriate next step in management?

Accepted Answer

Observation of the lesion

Answer

Solid carbon dioxide application to the lesion

Answer

Intralesional corticosteroid treatment

Answer

Laser therapy to the lesion

Answer

Surgical removal of the lesion

Question 4

A previously healthy 15-year-old girl comes to the physician because of increasing left ear pain during the past 3 days. Vital signs are within normal limits. Examination of the left ear shows edema and erythema of the auditory canal with a greenish discharge. Manipulation of the left pinna elicits pain. The tympanic membrane can only partially be visualized, and examination of what can be seen appears normal with normal mobility. Examination of the right ear shows no abnormalities. Which of the following is the most likely diagnosis?

Accepted Answer

Otitis externa

Answer

Acute otitis media

Answer

Furunculosis

Answer

Mastoiditis

Answer

Tympanic membrane perforation

Question 5

A 3175-g (7-lb) newborn is delivered at term to a 21-year-old woman, gravida 1, para 1. Pregnancy, labor, and delivery were uncomplicated. Examination shows ambiguous genitalia. Which of the following is the most appropriate physician response to the parents regarding their newborn’s gender?

Accepted Answer

“Your baby looks healthy, but we will not know the gender until we run additional tests.”

Answer

“The decision about your child’s gender is entirely yours.”

Answer

“You have a beautiful new daughter.”

Answer

“Your baby is a boy, but his genitals are not yet fully developed.”

Question 6

One week after a “breathing treatment” in the emergency department for an initial episode of coughing and wheezing, a 10-year-old girl is brought to the physician for a follow-up examination. She has a 3-year history of nasal allergies; both her parents have allergic rhinitis. She is afebrile. The lungs are clear to auscultation. An x-ray of the chest shows normal findings. Which of the following medications is most appropriate on an as-needed basis?

Accepted Answer

Inhaled β-adrenergic agonist

Answer

Inhaled corticosteroids

Answer

Inhaled cromolyn sodium

Answer

Oral β-adrenergic agonist

Answer

Oral theophylline

Question 7

A 4-year-old boy is brought to the physician by his parents because of a 2-month history of difficulty sleeping. His parents report that he typically awakens 1 hour after going to sleep and cries loudly. When his parents come to his room, he appears frightened and is unaware of their attempts to comfort him. In the morning, he has no memory of these episodes. Physical examination shows no abnormalities. Which of the following is the most likely diagnosis?

Accepted Answer

Sleep terror disorder

Answer

Factitious disorder

Answer

Oppositional defiant disorder

Answer

Seizure disorder

Answer

Separation anxiety disorder

Question 8

A male newborn is born to a 32-year-old woman by cesarean delivery at 38 weeks’ gestation and weighs 4309 g (9 lb 8 oz). The pregnancy was complicated by gestational diabetes that was difficult to manage. Apgar scores are 6 and 8 at 1 and 5 minutes, respectively. This newborn is at increased risk for developing which of the following within the next 24 hours?

Accepted Answer

Hypoglycemia

Answer

Hypercalcemia

Answer

Hyperglycemia

Answer

Hyperkalemia

Answer

Hypokalemia

Answer

Hypothermia

Question 9

A 14-year-old girl is brought to the physician for a well-child examination. She reports that she occasionally feels sad because “everyone else is confident except me.” She notes that she likes a new boy in her class, but she is afraid that “he doesn’t know that I exist.” She sometimes worries that she will attract his attention, but this is not a constant worry. She adds, “I know he likes this really pretty singer on TV, and I could never measure up to her. I am not sure that anyone can really relate to my situation.” She generally gets along well with friends and family. She is in the eighth grade and maintains a B average. She plays on the school soccer team and is an active member of the Girl Scouts. She does not drink alcohol or use illicit drugs. She is not sexually active. She is at the 60th percentile for height and 50th percentile for weight. She is casually dressed. Physical examination shows no abnormalities. On mental status examination, she is cooperative with a mildly anxious mood and a full range of affect. She says she is not depressed. Which of the following is the most likely diagnosis?

Accepted Answer

Normal development

Answer

Generalized anxiety disorder

Answer

Histrionic personality disorder

Answer

Narcissistic personality disorder

Question 10

A previously healthy 6-year-old boy is brought to the physician because of a 1-week history of right knee pain and swelling. He also has had occasional chills and muscle pain for 1 week. He went camping with his father in eastern Pennsylvania approximately 2 months ago. Two weeks after the trip, he had a solid red rash that slowly spread over most of his right thigh and resolved spontaneously 2 weeks later. Examination of the right knee shows swelling, an effusion, and mild tenderness to palpation. Which of the following is most likely to confirm the diagnosis?

Accepted Answer

Serum Lyme (Borrelia burgdorferi) antibody assay

Answer

Complete blood count

Answer

Determination of erythrocyte sedimentation rate

Answer

Serum antinuclear antibody assay

Answer

Serum rheumatoid factor assay

Answer

X-ray of the right knee