SPEX Pediatrics 3 — Questions and Answers
Question 1: A 9-month-old is brought in for recurrent otitis media. Which organism is the MOST common cause of acute otitis media in children?
- Haemophilus influenzae
- Streptococcus pneumoniae (Correct answer)
- Moraxella catarrhalis
- Staphylococcus aureus
Correct answer: Streptococcus pneumoniae
Streptococcus pneumoniae remains the most common bacterial cause of acute otitis media in children despite widespread vaccination.
Question 2: A toddler swallowed a button battery 2 hours ago. X-ray confirms it is lodged in the esophagus. What is the most appropriate next step?
- Observe and repeat X-ray in 24 hours
- Emergent endoscopic removal (Correct answer)
- Induce vomiting immediately
- Administer activated charcoal
Correct answer: Emergent endoscopic removal
Esophageal button batteries require immediate endoscopic removal due to risk of rapid liquefactive necrosis and perforation.
Question 3: A 5-year-old with sickle cell disease presents with fever of 38.8°C. What is the most critical immediate action?
- Obtain blood culture and give empiric IV cephalosporin (Correct answer)
- Prescribe oral amoxicillin and follow up in 48 hours
- Administer hydroxyurea
- Start IV hydration only
Correct answer: Obtain blood culture and give empiric IV cephalosporin
Febrile children with sickle cell disease are at high risk for overwhelming sepsis from encapsulated organisms and require immediate blood cultures and empiric IV antibiotics.
Question 4: Which finding on fundoscopic exam is most concerning for non-accidental trauma (shaken baby syndrome)?
- Papilledema
- Retinal hemorrhages (Correct answer)
- Copper wiring
- Arteriovenous nicking
Correct answer: Retinal hemorrhages
Retinal hemorrhages, particularly when bilateral and extending to the periphery, are highly associated with abusive head trauma.
Question 5: A 3-year-old presents with a limp and refusal to walk. X-ray shows avascular necrosis of the femoral head. What is the diagnosis?
- Septic arthritis
- Transient synovitis
- Legg-Calvé-Perthes disease (Correct answer)
- Slipped capital femoral epiphysis
Correct answer: Legg-Calvé-Perthes disease
Legg-Calvé-Perthes disease is idiopathic avascular necrosis of the femoral head, typically affecting boys aged 4–8 years.
Question 6: A 12-year-old obese male presents with a limp and knee pain. X-ray shows posterior and inferior displacement of the femoral head. What is the diagnosis?
- Legg-Calvé-Perthes disease
- Transient synovitis
- Slipped capital femoral epiphysis (SCFE) (Correct answer)
- Osteosarcoma
Correct answer: Slipped capital femoral epiphysis (SCFE)
SCFE occurs in overweight adolescents when the femoral head slips off the growth plate, causing hip or referred knee pain.
Question 7: A 6-month-old presents with episodes of sudden flexion of the trunk and extremities lasting seconds, occurring in clusters. EEG shows hypsarrhythmia. What is the diagnosis?
- Absence seizures
- Febrile seizures
- Infantile spasms (West syndrome) (Correct answer)
- Juvenile myoclonic epilepsy
Correct answer: Infantile spasms (West syndrome)
West syndrome (infantile spasms) presents in the first year of life with spasm clusters and hypsarrhythmia on EEG, often signaling underlying brain pathology.
SPEX Pediatrics 3
A 9-month-old is brought in for recurrent otitis media.
Which organism is the MOST common cause of acute otitis media in children?