Pediatrics EOR
End of Rotation Examination
Comprehensive Review Examination
Detailed Rationales Included
100 Multiple-Choice Questions
2026/2027
,1. A 12-month-old infant is brought for a well-child visit. The parents report the child can pull to a stand, cruise
along furniture, and say 'mama' and 'dada' with meaning. Which of the following is the most appropriate next
developmental milestone expected for this age?
A. Walking independently without support
B. Stacking four blocks [CORRECT]
C. Using a spoon to feed self
D. Drawing a circle on request
Correct Answer: B
Rationale: Correct because stacking four blocks is expected by 12-15 months and represents fine-motor progression.
Walking independently typically emerges closer to 15 months for many infants, while using a spoon and drawing a circle are
later milestones. This matches the expected developmental trajectory for a 12-month-old.
2. A 3-day-old newborn presents with jaundice noted on the face and chest. The infant is breastfeeding well,
stooling yellow seedy stools, and is active. Total serum bilirubin is 12 mg/dL. What is the most appropriate next
step in management?
A. Initiate phototherapy immediately
B. Obtain direct and indirect bilirubin fractionation
C. Continue breastfeeding and reassess in 24 hours [CORRECT]
D. Discontinue breastfeeding for 48 hours and supplement with formula
Correct Answer: C
Rationale: Correct because this infant has physiologic jaundice presenting within the first week of life with adequate feeding
and stooling. The bilirubin level is below phototherapy thresholds for a full-term infant at 3 days of age. This matches the
expectant management approach for breastfeeding jaundice in a thriving newborn.
3. A 2-month-old infant is due for routine vaccinations. The mother reports the child had an anaphylactic
reaction to the previous dose of DTaP. Which of the following is the most appropriate action regarding the DTaP
vaccine?
A. Administer DTaP with prophylactic antihistamines
B. Substitute DTaP with DT (diphtheria and tetanus toxoids only)
C. Defer DTaP and administer only IPV and PCV13 today
D. Contraindicate further doses of pertussis-containing vaccines and use DT for remaining doses [CORRECT]
Correct Answer: D
Rationale: Correct because a history of anaphylaxis to a previous vaccine dose is a contraindication to further doses of that
vaccine. Since the reaction was to DTaP, the pertussis component is presumed responsible, and DT should replace DTaP for
subsequent doses. This matches CDC contraindication guidelines for pertussis-containing vaccines.
4. A 15-month-old child is diagnosed with acute otitis media. The child has a temperature of 39.2C, ear pain, and
a bulging, erythematous tympanic membrane with decreased mobility on pneumatic otoscopy. Amoxicillin 90
mg/kg/day is prescribed. At what point should the antibiotic be changed if there is no clinical improvement?
A. After 24 hours of therapy
B. After 48-72 hours of therapy [CORRECT]
C. After 5 days of therapy
D. After 7 days of therapy
Correct Answer: B
Rationale: Correct because current guidelines recommend assessing clinical response at 48-72 hours after initiating
antibiotics for acute otitis media. If there is no improvement by that time, a change to high-dose amoxicillin-clavulanate
should be considered. This matches the American Academy of Pediatrics treatment guidelines for AOM.
A 7-year-old boy with a history of recurrent wheezing presents to the clinic with cough and shortness of breath for the
past 2 days. He has been using his albuterol inhaler with partial relief. On examination, he has expiratory wheezing
bilaterally with a respiratory rate of 28/min and oxygen saturation of 93% on room air.
1
, 5. A 7-year-old boy with a history of recurrent wheezing presents to the clinic with cough and shortness of
breath for the past 2 days. He has been using his albuterol inhaler with partial relief. On examination, he has
expiratory wheezing bilaterally with a respiratory rate of 28/min and oxygen saturation of 93% on room air.
Which of the following is the most appropriate next step in management?
A. Start oral prednisolone and continue albuterol every 4 hours [CORRECT]
B. Add an inhaled corticosteroid to his daily regimen
C. Administer a one-time dose of ipratropium bromide only
D. Observe and reassess in 48 hours without medication changes
Correct Answer: A
Rationale: Correct because this child presents with a moderate acute asthma exacerbation requiring systemic
corticosteroids in addition to short-acting beta-agonists. Oral prednisolone is the standard of care for moderate
exacerbations to reduce airway inflammation and prevent relapse. This matches the National Asthma Education and
Prevention Program guidelines for acute exacerbation management.
6. A 2-week-old infant is noted to have a harsh, holosystolic murmur at the lower left sternal border that
radiates to the apex. The infant is feeding well and has no respiratory distress. Echocardiography confirms a
moderate-sized ventricular septal defect. Which of the following is the most likely clinical course for this infant?
A. Development of congestive heart failure within the first month requiring surgical closure
B. Spontaneous closure of the defect within the first year of life [CORRECT]
C. Development of Eisenmenger syndrome by 6 months of age
D. Progressive aortic regurgitation requiring valve replacement
Correct Answer: B
Rationale: Correct because moderate-sized ventricular septal defects have a significant chance of spontaneous closure
within the first year of life, particularly muscular defects. This matches the natural history of VSD, where many small to
moderate defects close or decrease in size as the infant grows.
7. A 4-year-old boy with known sickle cell disease presents with fever of 39.5C, right arm pain, and swelling. He
appears ill and is unable to move his right arm. Laboratory studies show a white blood cell count of 28,000/mm3
and hemoglobin of 7.2 g/dL. Blood cultures are obtained. Which of the following is the most appropriate next
step in management?
A. Administer ceftriaxone and provide fluid resuscitation [CORRECT]
B. Obtain a bone scan to evaluate for osteomyelitis before starting antibiotics
C. Discharge with oral amoxicillin and follow-up in 24 hours
D. Administer intramuscular penicillin and arrange outpatient follow-up
Correct Answer: A
Rationale: Correct because any child with sickle cell disease and fever must be evaluated for sepsis and treated empirically
with broad-spectrum intravenous antibiotics such as ceftriaxone. This child also has findings concerning for acute
osteomyelitis, which requires prompt IV antibiotic therapy. Priority is immediate parenteral antibiotic administration and
fluid resuscitation.
8. An 18-month-old child presents with a 2-day history of watery diarrhea and vomiting. The child is mildly
dehydrated with decreased tears, dry mucous membranes, and decreased urine output. Which of the following
is the most appropriate initial management?
A. Administer oral rehydration solution in small frequent volumes [CORRECT]
B. Start intravenous fluids with normal saline bolus of 20 mL/kg
C. Prescribe loperamide to reduce stool frequency
D. Recommend clear liquids such as apple juice and sports drinks
Correct Answer: A
Rationale: Correct because oral rehydration therapy with an oral rehydration solution is the first-line treatment for mild to
moderate dehydration in children with gastroenteritis. Small frequent volumes of 5 mL every 1-2 minutes are recommended
to minimize vomiting. This matches the American Academy of Pediatrics guidelines for dehydration management.
2
End of Rotation Examination
Comprehensive Review Examination
Detailed Rationales Included
100 Multiple-Choice Questions
2026/2027
,1. A 12-month-old infant is brought for a well-child visit. The parents report the child can pull to a stand, cruise
along furniture, and say 'mama' and 'dada' with meaning. Which of the following is the most appropriate next
developmental milestone expected for this age?
A. Walking independently without support
B. Stacking four blocks [CORRECT]
C. Using a spoon to feed self
D. Drawing a circle on request
Correct Answer: B
Rationale: Correct because stacking four blocks is expected by 12-15 months and represents fine-motor progression.
Walking independently typically emerges closer to 15 months for many infants, while using a spoon and drawing a circle are
later milestones. This matches the expected developmental trajectory for a 12-month-old.
2. A 3-day-old newborn presents with jaundice noted on the face and chest. The infant is breastfeeding well,
stooling yellow seedy stools, and is active. Total serum bilirubin is 12 mg/dL. What is the most appropriate next
step in management?
A. Initiate phototherapy immediately
B. Obtain direct and indirect bilirubin fractionation
C. Continue breastfeeding and reassess in 24 hours [CORRECT]
D. Discontinue breastfeeding for 48 hours and supplement with formula
Correct Answer: C
Rationale: Correct because this infant has physiologic jaundice presenting within the first week of life with adequate feeding
and stooling. The bilirubin level is below phototherapy thresholds for a full-term infant at 3 days of age. This matches the
expectant management approach for breastfeeding jaundice in a thriving newborn.
3. A 2-month-old infant is due for routine vaccinations. The mother reports the child had an anaphylactic
reaction to the previous dose of DTaP. Which of the following is the most appropriate action regarding the DTaP
vaccine?
A. Administer DTaP with prophylactic antihistamines
B. Substitute DTaP with DT (diphtheria and tetanus toxoids only)
C. Defer DTaP and administer only IPV and PCV13 today
D. Contraindicate further doses of pertussis-containing vaccines and use DT for remaining doses [CORRECT]
Correct Answer: D
Rationale: Correct because a history of anaphylaxis to a previous vaccine dose is a contraindication to further doses of that
vaccine. Since the reaction was to DTaP, the pertussis component is presumed responsible, and DT should replace DTaP for
subsequent doses. This matches CDC contraindication guidelines for pertussis-containing vaccines.
4. A 15-month-old child is diagnosed with acute otitis media. The child has a temperature of 39.2C, ear pain, and
a bulging, erythematous tympanic membrane with decreased mobility on pneumatic otoscopy. Amoxicillin 90
mg/kg/day is prescribed. At what point should the antibiotic be changed if there is no clinical improvement?
A. After 24 hours of therapy
B. After 48-72 hours of therapy [CORRECT]
C. After 5 days of therapy
D. After 7 days of therapy
Correct Answer: B
Rationale: Correct because current guidelines recommend assessing clinical response at 48-72 hours after initiating
antibiotics for acute otitis media. If there is no improvement by that time, a change to high-dose amoxicillin-clavulanate
should be considered. This matches the American Academy of Pediatrics treatment guidelines for AOM.
A 7-year-old boy with a history of recurrent wheezing presents to the clinic with cough and shortness of breath for the
past 2 days. He has been using his albuterol inhaler with partial relief. On examination, he has expiratory wheezing
bilaterally with a respiratory rate of 28/min and oxygen saturation of 93% on room air.
1
, 5. A 7-year-old boy with a history of recurrent wheezing presents to the clinic with cough and shortness of
breath for the past 2 days. He has been using his albuterol inhaler with partial relief. On examination, he has
expiratory wheezing bilaterally with a respiratory rate of 28/min and oxygen saturation of 93% on room air.
Which of the following is the most appropriate next step in management?
A. Start oral prednisolone and continue albuterol every 4 hours [CORRECT]
B. Add an inhaled corticosteroid to his daily regimen
C. Administer a one-time dose of ipratropium bromide only
D. Observe and reassess in 48 hours without medication changes
Correct Answer: A
Rationale: Correct because this child presents with a moderate acute asthma exacerbation requiring systemic
corticosteroids in addition to short-acting beta-agonists. Oral prednisolone is the standard of care for moderate
exacerbations to reduce airway inflammation and prevent relapse. This matches the National Asthma Education and
Prevention Program guidelines for acute exacerbation management.
6. A 2-week-old infant is noted to have a harsh, holosystolic murmur at the lower left sternal border that
radiates to the apex. The infant is feeding well and has no respiratory distress. Echocardiography confirms a
moderate-sized ventricular septal defect. Which of the following is the most likely clinical course for this infant?
A. Development of congestive heart failure within the first month requiring surgical closure
B. Spontaneous closure of the defect within the first year of life [CORRECT]
C. Development of Eisenmenger syndrome by 6 months of age
D. Progressive aortic regurgitation requiring valve replacement
Correct Answer: B
Rationale: Correct because moderate-sized ventricular septal defects have a significant chance of spontaneous closure
within the first year of life, particularly muscular defects. This matches the natural history of VSD, where many small to
moderate defects close or decrease in size as the infant grows.
7. A 4-year-old boy with known sickle cell disease presents with fever of 39.5C, right arm pain, and swelling. He
appears ill and is unable to move his right arm. Laboratory studies show a white blood cell count of 28,000/mm3
and hemoglobin of 7.2 g/dL. Blood cultures are obtained. Which of the following is the most appropriate next
step in management?
A. Administer ceftriaxone and provide fluid resuscitation [CORRECT]
B. Obtain a bone scan to evaluate for osteomyelitis before starting antibiotics
C. Discharge with oral amoxicillin and follow-up in 24 hours
D. Administer intramuscular penicillin and arrange outpatient follow-up
Correct Answer: A
Rationale: Correct because any child with sickle cell disease and fever must be evaluated for sepsis and treated empirically
with broad-spectrum intravenous antibiotics such as ceftriaxone. This child also has findings concerning for acute
osteomyelitis, which requires prompt IV antibiotic therapy. Priority is immediate parenteral antibiotic administration and
fluid resuscitation.
8. An 18-month-old child presents with a 2-day history of watery diarrhea and vomiting. The child is mildly
dehydrated with decreased tears, dry mucous membranes, and decreased urine output. Which of the following
is the most appropriate initial management?
A. Administer oral rehydration solution in small frequent volumes [CORRECT]
B. Start intravenous fluids with normal saline bolus of 20 mL/kg
C. Prescribe loperamide to reduce stool frequency
D. Recommend clear liquids such as apple juice and sports drinks
Correct Answer: A
Rationale: Correct because oral rehydration therapy with an oral rehydration solution is the first-line treatment for mild to
moderate dehydration in children with gastroenteritis. Small frequent volumes of 5 mL every 1-2 minutes are recommended
to minimize vomiting. This matches the American Academy of Pediatrics guidelines for dehydration management.
2
