Physician Assistant Pediatric 2 — Questions and Answers
Question 1: A 3-year-old presents with barky cough, stridor at rest, and low-grade fever. Which treatment is first-line?
- Nebulized racemic epinephrine
- Dexamethasone 0.6 mg/kg IM/PO (Correct answer)
- Albuterol nebulization
- Heliox inhalation
Correct answer: Dexamethasone 0.6 mg/kg IM/PO
Dexamethasone is the first-line treatment for croup, reducing airway edema with a single dose.
Question 2: Which vaccine is contraindicated in a 6-month-old with a severe egg allergy?
- MMR
- Influenza (egg-based) (Correct answer)
- DTaP
- Hepatitis B
Correct answer: Influenza (egg-based)
Egg-based influenza vaccines contain egg protein and are contraindicated in severe egg allergy; cell-based alternatives should be used.
Question 3: A 10-year-old has recurrent episodes of severe headache with photophobia, nausea, and vomiting lasting 4-6 hours. What is the most likely diagnosis?
- Tension headache
- Cluster headache
- Migraine without aura (Correct answer)
- Intracranial hypertension
Correct answer: Migraine without aura
Pediatric migraine presents with unilateral or bilateral throbbing headache accompanied by nausea, vomiting, photophobia, and phonophobia.
Question 4: A neonate develops jaundice within the first 24 hours of life. What is the most concerning etiology?
- Physiologic jaundice
- Breast milk jaundice
- Hemolytic disease (ABO/Rh incompatibility) (Correct answer)
- Neonatal hepatitis
Correct answer: Hemolytic disease (ABO/Rh incompatibility)
Jaundice appearing within 24 hours of birth is always pathological and most commonly caused by hemolytic disease from ABO or Rh incompatibility.
Question 5: A 5-year-old with sickle cell disease presents with sudden onset of left-sided weakness and slurred speech. What is the immediate next step?
- Hydroxyurea therapy
- Exchange transfusion (Correct answer)
- IV hydration and pain management
- Lumbar puncture
Correct answer: Exchange transfusion
Acute stroke in sickle cell disease requires urgent exchange transfusion to rapidly reduce HbS levels below 30%.
Question 6: Which finding on urinalysis is most consistent with nephrotic syndrome in a 4-year-old with edema?
- Hematuria with RBC casts
- Heavy proteinuria (3+ or greater) (Correct answer)
- Pyuria with bacteriuria
- Glucosuria with ketonuria
Correct answer: Heavy proteinuria (3+ or greater)
Nephrotic syndrome is characterized by massive proteinuria (>3.5 g/day in adults, >40 mg/m²/hr in children) along with hypoalbuminemia and edema.
Question 7: A 2-year-old swallows a button battery. What is the most critical concern?
- Aspiration into the airway
- Esophageal perforation from electrical current (Correct answer)
- Heavy metal toxicity
- Intestinal obstruction
Correct answer: Esophageal perforation from electrical current
Button batteries lodged in the esophagus generate an electrical current causing liquefactive necrosis and perforation within hours, requiring emergency endoscopic removal.
Physician Assistant Pediatric 2
A 3-year-old presents with barky cough, stridor at rest, and low-grade fever.
Which treatment is first-line?