Pediatrics Exam Master Questions With Correct
// // // // //
Answers
// //
A //3-month-old //male //infant //presented //for //his //first //well-child //visit. //He //was //born //at //32
//weeks //gestation //and //experienced //hyperbilirubinemia //in //the //nursery, //requiring
//phototherapy //and //exchange //transfusion. //He //has //had //rhinorrhea //without //fever //for //2
//days. //Physical //examination //revealed //a //normal-appearing //infant //at //the //25th //percentile
//for //height //and //weight. //Vital //signs //were //normal. //There //was //mild //clear //rhinorrhea
//without //respiratory //distress. //2 //types //of //immunizations //against //rotavirus //are //available:
//RotaTeq //and //Rotarix.
Should //you //administer //rotavirus //vaccine //at //this //point?
No, //since //the //child //has //an //upper //respiratory //infection
No, //since //the //child //was //born //prematurely
Begin //either //immunization //series //now
Initiate //the //RotaTeq //series
No, //since //the //rotavirus //series //was //not //initiated //at //2 //months //of //age //- //CORRECT
ANSWERS(S)✔✔Begin //either //immunization //series //now //
//
Rotavirus //is //the //most //common //cause //of //gastroenteritis //and //diarrhea //under //2 //years //of
//age, //especially //between //3 //and //15 //months //of //age. //2 //types //of //immunizations //are
//available: //Rotarix, //which //is //administered //orally //at //2 //and //4 //months, //and //RotaTeq, //which
//is //given //orally //at //2, //4, //and //6 //months. //Either //series //can //be //initiated //after //6 //weeks //and
//before //15 //weeks. //Both //immunizations //are //approximately //75% //effective //in //reducing //the
//number //of //cases //of //gastroenteritis //due //to //rotavirus, //which //account //for //nearly //all
//severe //cases //and //hospitalizations //due //to //rotavirus.
,In //the //winter, //an //11-month-old //infant //presents //with //a //2-day //history //of //vomiting,
//diarrhea, //and //fever. //His //temperature //is //104° //Fahrenheit. //Clinically, //he //is //significantly
//dehydrated; //his //white //blood //cell //count //is //5400 //cells/mm3 //with //a //normal //differential.
//His //stool //and //urine //are //negative //for //white //blood //cells.
What //is //the //most //likely //cause //of //gastroenteritis //in //this //child?
Escherichia //coli
Clostridium //difficile
Norwalk //virus
Rotavirus
Shigella //- //CORRECT //ANSWERS(S)✔✔Rotavirus //
A //viral //etiology //is //suspected //in //a //patient //with //a //normal //white //blood //cell //count. //In //the
//1st //2 //years //of //life, //especially //in //the //winter //months, //rotavirus //is //a //common //cause //of
//gastroenteritis. //Epidemics //are //not //uncommon; //therefore, //rotavirus //vaccinations //are //now
//considered //standard //at //2, //4, //and //6 //months //of //age.
A //7-year-old //boy //presents //with //a //6-day //history //of //a //rash //on //his //right //flank. //It //is //painful
//and //appears //blistered //in //some //areas. //His //mother //states //that //his //right //flank //became
//painful //a //few //days //prior //to //the //onset //of //the //rash. //He //is //up //to //date //on //his
//immunizations. //He //had //chicken //pox //at //the //age //of //18 //months. //He //has //been //well
//recently, //his //past //medical //history //is //unremarkable, //and //he //has //no //known //drug
//allergies.
On //exam, //the //boy //has //a //vesiculobullous //rash //on //his //right //flank //in //a //continuous //band
//from //the //middle //of //his //back //spreading //around //to //his //mid-axillary //line. //No //other
//lesions //are //present. //He //does //have //some //right //axillary //lymphadenopathy //as //well. //What
//is //the //most //appropriate //treatment //option?
,Symptomatic //treatment //and //prevention //of //secondary //infection
Oral //acyclovir
Intravenous //varicella-zoster //immune //globulin
Oral //cephalexin
Aspirin //- //CORRECT //ANSWERS(S)✔✔Symptomatic //treatment //and //prevention //of //secondary
//infection //
In //a //normal //child, //symptomatic //treatment //and //prevention //of //secondary //infection //are
//the //mainstays //of //treatment.
A //3-year-old, //HIV-positive //boy //has //contracted //varicella //infection. //He //has //not //shown //a
//satisfactory //response //to //treatment //with //acyclovir. //He //is //suspected //of //having //an
//acyclovir //resistant //varicella //zoster //infection.
What //is //the //alternate //drug //appropriate //for //treatment //of //varicella //in //this //child?
Zidovudine
Ribavirin
Oseltamivir
Foscarnet
Nevirapine //- //CORRECT //ANSWERS(S)✔✔Foscarnet //
Foscarnet //is //the //appropriate //drug //for //treatment //of //varicella //in //the //above //child.
//Acyclovir //resistant //varicella-zoster //virus //(VZV) //infection //has //been //identified //in //children
//infected //with //HIV. //These //children //may //be //treated //with //intravenous //foscarnet //120
//mg/kg/day, //divided //every //8 //hours //for //up //to //3 //weeks. //The //dose //needs //to //be //modified
//in //the //presence //of //renal //insufficiency. //When //foscarnet //is //used //to //treat //VZV //infection //in
//acquired //immunodeficiency //syndrome //(AIDS) //patients, //it //also //decreases //HIV //viral //load,
//but //it //is //not //used //primarily //for //HIV //infection.
, A //5-year-old //boy //presents //with //6-day //history //of //fever, //fatigue, //and //rash. //He //has //no
//significant //past //medical //history. //He //is //current //with //his //vaccinations, //except //for //varicella,
//which //his //parents //have //refused //in //the //past. //On //exam, //his //temperature //is //101.3º //F;
//heart //rate //is //110, //and //blood //pressure //is //94. //He //has //bilateral //conjunctival //injection, //an
//erythematous //pharynx //without //exudate, //cracked //red //lips, //and //an //erythematous //right
//tympanic //membrane. //He //has //shotty //enlarged //anterior //cervical //lymph //nodes //bilaterally,
//the //largest //nodes //measuring //1.6 //cm //on //the //right //side //and //1.5 //cm //on //the //left //side. //His
//lungs //are //clear, //and //his //heart //has //a //regular //rhythm. //His //abdomen //is //soft. //He //is //in //no
//acute //distress, //and //he //has //a //generalized //maculopapular //rash.
What //are //some //other //possible //findings //associated //with //his //probable //diagnosis?
Sterile //pyuria, //meningismus
Peripheral //neuropathy, //thrombocytopenia
Epistaxes, //hematuria
Colonic //poly //- //CORRECT //ANSWERS(S)✔✔Sterile //pyuria, //meningismus //
This //patient //meets //the //diagnostic //criteria //for //Kawasaki //disease, //which //includes //fever //for
//at //least //5 //days, //and //at //least //4 //of //the //5 //following //signs:
bilateral //conjunctival //injection, //generally //nonpurulent
changes //in //the //mucosa //of //the //oropharynx
changes //of //the //peripheral //extremities
rash
cervical //adenopathy //>1.5 //cm, //usually //unilateral
// // // // //
Answers
// //
A //3-month-old //male //infant //presented //for //his //first //well-child //visit. //He //was //born //at //32
//weeks //gestation //and //experienced //hyperbilirubinemia //in //the //nursery, //requiring
//phototherapy //and //exchange //transfusion. //He //has //had //rhinorrhea //without //fever //for //2
//days. //Physical //examination //revealed //a //normal-appearing //infant //at //the //25th //percentile
//for //height //and //weight. //Vital //signs //were //normal. //There //was //mild //clear //rhinorrhea
//without //respiratory //distress. //2 //types //of //immunizations //against //rotavirus //are //available:
//RotaTeq //and //Rotarix.
Should //you //administer //rotavirus //vaccine //at //this //point?
No, //since //the //child //has //an //upper //respiratory //infection
No, //since //the //child //was //born //prematurely
Begin //either //immunization //series //now
Initiate //the //RotaTeq //series
No, //since //the //rotavirus //series //was //not //initiated //at //2 //months //of //age //- //CORRECT
ANSWERS(S)✔✔Begin //either //immunization //series //now //
//
Rotavirus //is //the //most //common //cause //of //gastroenteritis //and //diarrhea //under //2 //years //of
//age, //especially //between //3 //and //15 //months //of //age. //2 //types //of //immunizations //are
//available: //Rotarix, //which //is //administered //orally //at //2 //and //4 //months, //and //RotaTeq, //which
//is //given //orally //at //2, //4, //and //6 //months. //Either //series //can //be //initiated //after //6 //weeks //and
//before //15 //weeks. //Both //immunizations //are //approximately //75% //effective //in //reducing //the
//number //of //cases //of //gastroenteritis //due //to //rotavirus, //which //account //for //nearly //all
//severe //cases //and //hospitalizations //due //to //rotavirus.
,In //the //winter, //an //11-month-old //infant //presents //with //a //2-day //history //of //vomiting,
//diarrhea, //and //fever. //His //temperature //is //104° //Fahrenheit. //Clinically, //he //is //significantly
//dehydrated; //his //white //blood //cell //count //is //5400 //cells/mm3 //with //a //normal //differential.
//His //stool //and //urine //are //negative //for //white //blood //cells.
What //is //the //most //likely //cause //of //gastroenteritis //in //this //child?
Escherichia //coli
Clostridium //difficile
Norwalk //virus
Rotavirus
Shigella //- //CORRECT //ANSWERS(S)✔✔Rotavirus //
A //viral //etiology //is //suspected //in //a //patient //with //a //normal //white //blood //cell //count. //In //the
//1st //2 //years //of //life, //especially //in //the //winter //months, //rotavirus //is //a //common //cause //of
//gastroenteritis. //Epidemics //are //not //uncommon; //therefore, //rotavirus //vaccinations //are //now
//considered //standard //at //2, //4, //and //6 //months //of //age.
A //7-year-old //boy //presents //with //a //6-day //history //of //a //rash //on //his //right //flank. //It //is //painful
//and //appears //blistered //in //some //areas. //His //mother //states //that //his //right //flank //became
//painful //a //few //days //prior //to //the //onset //of //the //rash. //He //is //up //to //date //on //his
//immunizations. //He //had //chicken //pox //at //the //age //of //18 //months. //He //has //been //well
//recently, //his //past //medical //history //is //unremarkable, //and //he //has //no //known //drug
//allergies.
On //exam, //the //boy //has //a //vesiculobullous //rash //on //his //right //flank //in //a //continuous //band
//from //the //middle //of //his //back //spreading //around //to //his //mid-axillary //line. //No //other
//lesions //are //present. //He //does //have //some //right //axillary //lymphadenopathy //as //well. //What
//is //the //most //appropriate //treatment //option?
,Symptomatic //treatment //and //prevention //of //secondary //infection
Oral //acyclovir
Intravenous //varicella-zoster //immune //globulin
Oral //cephalexin
Aspirin //- //CORRECT //ANSWERS(S)✔✔Symptomatic //treatment //and //prevention //of //secondary
//infection //
In //a //normal //child, //symptomatic //treatment //and //prevention //of //secondary //infection //are
//the //mainstays //of //treatment.
A //3-year-old, //HIV-positive //boy //has //contracted //varicella //infection. //He //has //not //shown //a
//satisfactory //response //to //treatment //with //acyclovir. //He //is //suspected //of //having //an
//acyclovir //resistant //varicella //zoster //infection.
What //is //the //alternate //drug //appropriate //for //treatment //of //varicella //in //this //child?
Zidovudine
Ribavirin
Oseltamivir
Foscarnet
Nevirapine //- //CORRECT //ANSWERS(S)✔✔Foscarnet //
Foscarnet //is //the //appropriate //drug //for //treatment //of //varicella //in //the //above //child.
//Acyclovir //resistant //varicella-zoster //virus //(VZV) //infection //has //been //identified //in //children
//infected //with //HIV. //These //children //may //be //treated //with //intravenous //foscarnet //120
//mg/kg/day, //divided //every //8 //hours //for //up //to //3 //weeks. //The //dose //needs //to //be //modified
//in //the //presence //of //renal //insufficiency. //When //foscarnet //is //used //to //treat //VZV //infection //in
//acquired //immunodeficiency //syndrome //(AIDS) //patients, //it //also //decreases //HIV //viral //load,
//but //it //is //not //used //primarily //for //HIV //infection.
, A //5-year-old //boy //presents //with //6-day //history //of //fever, //fatigue, //and //rash. //He //has //no
//significant //past //medical //history. //He //is //current //with //his //vaccinations, //except //for //varicella,
//which //his //parents //have //refused //in //the //past. //On //exam, //his //temperature //is //101.3º //F;
//heart //rate //is //110, //and //blood //pressure //is //94. //He //has //bilateral //conjunctival //injection, //an
//erythematous //pharynx //without //exudate, //cracked //red //lips, //and //an //erythematous //right
//tympanic //membrane. //He //has //shotty //enlarged //anterior //cervical //lymph //nodes //bilaterally,
//the //largest //nodes //measuring //1.6 //cm //on //the //right //side //and //1.5 //cm //on //the //left //side. //His
//lungs //are //clear, //and //his //heart //has //a //regular //rhythm. //His //abdomen //is //soft. //He //is //in //no
//acute //distress, //and //he //has //a //generalized //maculopapular //rash.
What //are //some //other //possible //findings //associated //with //his //probable //diagnosis?
Sterile //pyuria, //meningismus
Peripheral //neuropathy, //thrombocytopenia
Epistaxes, //hematuria
Colonic //poly //- //CORRECT //ANSWERS(S)✔✔Sterile //pyuria, //meningismus //
This //patient //meets //the //diagnostic //criteria //for //Kawasaki //disease, //which //includes //fever //for
//at //least //5 //days, //and //at //least //4 //of //the //5 //following //signs:
bilateral //conjunctival //injection, //generally //nonpurulent
changes //in //the //mucosa //of //the //oropharynx
changes //of //the //peripheral //extremities
rash
cervical //adenopathy //>1.5 //cm, //usually //unilateral
