Physician Assistant Pediatric 4 — Questions and Answers
Question 1: A 2-year-old is brought in with burns on both buttocks and feet in a stocking-glove distribution with clear demarcation lines. What is the most appropriate next step?
- Apply silver sulfadiazine and discharge with wound care instructions
- Admit for burn care and notify child protective services (Correct answer)
- Obtain blood cultures and start antibiotics
- Perform a skin biopsy to rule out staphylococcal scalded skin syndrome
Correct answer: Admit for burn care and notify child protective services
Symmetric, sharply demarcated burns in a stocking-glove pattern in a toddler are highly suspicious for non-accidental trauma (immersion burn) and mandate mandatory reporting.
Question 2: A 1-year-old is found to have a hemoglobin of 9.2 g/dL with microcytic hypochromic anemia. The child drinks 30 oz of cow's milk daily. What is the best initial treatment?
- Blood transfusion
- Oral iron supplementation and reduce cow's milk intake (Correct answer)
- B12 supplementation
- Erythropoietin injection
Correct answer: Oral iron supplementation and reduce cow's milk intake
Iron deficiency anemia from excessive cow's milk intake (which is low in iron and impairs iron absorption) is treated with oral ferrous sulfate and limiting milk to <24 oz/day.
Question 3: A 15-year-old presents with fever, migratory polyarthritis, and a new heart murmur 3 weeks after untreated strep pharyngitis. What is the most likely diagnosis?
- Systemic lupus erythematosus
- Juvenile idiopathic arthritis
- Acute rheumatic fever (Correct answer)
- Reactive arthritis (Reiter syndrome)
Correct answer: Acute rheumatic fever
Acute rheumatic fever follows Group A strep infection and presents with carditis, migratory polyarthritis, chorea, erythema marginatum, and subcutaneous nodules (Jones criteria).
Question 4: Which condition is associated with a "sail sign" on chest X-ray in a neonate?
- Pneumothorax
- Thymic shadow (Correct answer)
- Cardiomegaly
- Mediastinal lymphoma
Correct answer: Thymic shadow
The thymus in neonates and infants can appear as a triangular sail-shaped opacity on the right side of the chest X-ray, which is a normal finding.
Question 5: A 5-year-old with known asthma presents with wheezing, respiratory rate of 38, accessory muscle use, and SpO2 of 91%. After 3 albuterol treatments and ipratropium, there is minimal improvement. What is the next medication?
- Theophylline IV
- IV magnesium sulfate (Correct answer)
- Oral montelukast
- Subcutaneous terbutaline only
Correct answer: IV magnesium sulfate
IV magnesium sulfate is recommended for severe acute asthma exacerbations unresponsive to initial bronchodilator therapy due to its bronchodilatory effects.
Question 6: A 4-month-old has a head circumference crossing two percentile lines upward over 2 months. The anterior fontanelle is bulging. CT scan shows enlarged ventricles. What is the diagnosis?
- Craniosynostosis
- Hydrocephalus (Correct answer)
- Megalencephaly
- Subdural hematoma
Correct answer: Hydrocephalus
Hydrocephalus presents with rapidly increasing head circumference, bulging fontanelle, sunset sign of the eyes, and ventricular enlargement on neuroimaging.
Question 7: An 8-year-old presents with painless scrotal swelling that transilluminates. Ultrasound confirms fluid collection around the testis. What is the diagnosis?
- Testicular torsion
- Epididymo-orchitis
- Hydrocele (Correct answer)
- Varicocele
Correct answer: Hydrocele
A hydrocele is a fluid collection between the tunica vaginalis layers that presents as painless scrotal swelling that transilluminates on exam.
Physician Assistant Pediatric 4
A 2-year-old is brought in with burns on both buttocks and feet in a stocking-glove distribution with clear demarcation lines.
What is the most appropriate next step?