FLORIDA BOARD OF MEDICINE PEDIATRICS
CERTIFICATION EXAM WITH ACTUAL
QUESTIONS AND VERIFIED ANSWERS,
PLUS EXPLAINED RATIONALES/EXPERT
VERIFIED FOR GUARANTEED 100% PASS
2026/LATEST UPDATE/INSTANT
DOWNLOAD PDF
1.
A 2-month-old infant is brought to the emergency department with a
temperature of 38.4°C (101.1°F). The infant was born at term after an
uncomplicated pregnancy and appears mildly irritable but consolable.
Examination reveals no focal source of infection. Which of the
following is the most appropriate next step?
A. Discharge with oral amoxicillin and close follow-up
B. Obtain blood, urine, and cerebrospinal fluid studies and initiate
empiric intravenous antibiotics
C. Obtain a chest radiograph and discharge if negative
D. Perform a rapid viral respiratory panel and defer treatment
E. Observe the infant for 6 hours without laboratory evaluation
Answer: B. Obtain blood, urine, and cerebrospinal fluid studies and
initiate empiric intravenous antibiotics
Rationale: A febrile infant younger than 3 months, particularly one
younger than 28 days, requires careful evaluation for serious bacterial
infection. In a 2-month-old with a temperature ≥38°C and no clear
source, age, clinical appearance, inflammatory markers, and urine
testing guide management, but an ill-appearing infant requires a full
sepsis evaluation and empiric therapy. The key concern is occult
bacteremia, urinary tract infection, or meningitis.
1
,2.
A 6-month-old infant has recurrent episodes of crying, drawing the legs
toward the abdomen, and vomiting. Between episodes, the infant
appears relatively comfortable. The parents report a stool containing
blood and mucus. A sausage-shaped abdominal mass is palpated in the
right upper quadrant. What is the most likely diagnosis?
A. Pyloric stenosis
B. Intussusception
C. Hirschsprung disease
D. Malrotation with volvulus
E. Meckel diverticulum
Answer: B. Intussusception
Rationale: Intussusception classically presents with intermittent,
severe colicky abdominal pain, vomiting, lethargy, and eventually
bloody or “currant jelly” stools. A sausage-shaped abdominal mass
may be palpable. Ultrasound typically demonstrates the characteristic
target or doughnut sign. In a hemodynamically stable child without
perforation or peritonitis, pneumatic or hydrostatic reduction is
generally both diagnostic and therapeutic.
3.
A 3-week-old infant develops progressively worsening, projectile,
nonbilious vomiting after feeds. The infant remains hungry after
vomiting and has poor weight gain. Which metabolic abnormality is
most likely?
A. Hyperkalemic metabolic acidosis
B. Hypochloremic, hypokalemic metabolic alkalosis
C. Hyperchloremic metabolic acidosis
2
,D. Respiratory alkalosis
E. Hypernatremic metabolic acidosis
Answer: B. Hypochloremic, hypokalemic metabolic alkalosis
Rationale: Infantile hypertrophic pyloric stenosis causes progressive
projectile, nonbilious vomiting because the obstruction occurs distal to
the stomach but proximal to the duodenum. Loss of gastric
hydrochloric acid produces hypochloremic metabolic alkalosis, while
secondary renal potassium losses can produce hypokalemia.
Ultrasound is the preferred diagnostic study.
4.
A 4-year-old child has fever, sore throat, tender anterior cervical
lymphadenopathy, tonsillar exudates, and no cough. Which pathogen is
most likely responsible?
A. Epstein-Barr virus
B. Adenovirus
C. Group A Streptococcus
D. Respiratory syncytial virus
E. Mycoplasma pneumoniae
Answer: C. Group A Streptococcus
Rationale: Group A Streptococcus commonly causes abrupt fever, sore
throat, tonsillar exudates, and tender anterior cervical nodes without
cough. Viral symptoms such as cough, rhinorrhea, conjunctivitis, or
oral ulcers make streptococcal pharyngitis less likely. Appropriate
testing is recommended before antibiotics in most children because
clinical findings alone are insufficient to distinguish all cases.
5.
3
, A 7-year-old child presents with fever, migratory polyarthritis, and a
new murmur approximately 3 weeks after an untreated sore throat.
Which mechanism best explains the underlying disease?
A. Direct bacterial invasion of the myocardium
B. Immune-mediated cross-reactivity following Streptococcus pyogenes
infection
C. Viral destruction of cardiac myocytes
D. Deposition of immune complexes caused by Staphylococcus aureus
E. Toxin-mediated myocardial injury
Answer: B. Immune-mediated cross-reactivity following
Streptococcus pyogenes infection
Rationale: Acute rheumatic fever is an immune-mediated complication
of group A streptococcal pharyngitis. Molecular mimicry leads
antibodies and T cells directed against streptococcal antigens to cross-
react with host tissues, particularly cardiac, synovial, and neurologic
tissues. Carditis, migratory polyarthritis, chorea, erythema
marginatum, and subcutaneous nodules constitute the major
manifestations of the Jones criteria.
6.
A 2-year-old child has a barking cough, hoarseness, and inspiratory
stridor that worsens at night. The child has a low-grade fever and no
drooling. Which treatment is most appropriate for moderate croup?
A. Oral amoxicillin
B. Nebulized albuterol
C. Dexamethasone with nebulized epinephrine
D. Immediate bronchoscopy
E. Intravenous vancomycin
Answer: C. Dexamethasone with nebulized epinephrine
4
CERTIFICATION EXAM WITH ACTUAL
QUESTIONS AND VERIFIED ANSWERS,
PLUS EXPLAINED RATIONALES/EXPERT
VERIFIED FOR GUARANTEED 100% PASS
2026/LATEST UPDATE/INSTANT
DOWNLOAD PDF
1.
A 2-month-old infant is brought to the emergency department with a
temperature of 38.4°C (101.1°F). The infant was born at term after an
uncomplicated pregnancy and appears mildly irritable but consolable.
Examination reveals no focal source of infection. Which of the
following is the most appropriate next step?
A. Discharge with oral amoxicillin and close follow-up
B. Obtain blood, urine, and cerebrospinal fluid studies and initiate
empiric intravenous antibiotics
C. Obtain a chest radiograph and discharge if negative
D. Perform a rapid viral respiratory panel and defer treatment
E. Observe the infant for 6 hours without laboratory evaluation
Answer: B. Obtain blood, urine, and cerebrospinal fluid studies and
initiate empiric intravenous antibiotics
Rationale: A febrile infant younger than 3 months, particularly one
younger than 28 days, requires careful evaluation for serious bacterial
infection. In a 2-month-old with a temperature ≥38°C and no clear
source, age, clinical appearance, inflammatory markers, and urine
testing guide management, but an ill-appearing infant requires a full
sepsis evaluation and empiric therapy. The key concern is occult
bacteremia, urinary tract infection, or meningitis.
1
,2.
A 6-month-old infant has recurrent episodes of crying, drawing the legs
toward the abdomen, and vomiting. Between episodes, the infant
appears relatively comfortable. The parents report a stool containing
blood and mucus. A sausage-shaped abdominal mass is palpated in the
right upper quadrant. What is the most likely diagnosis?
A. Pyloric stenosis
B. Intussusception
C. Hirschsprung disease
D. Malrotation with volvulus
E. Meckel diverticulum
Answer: B. Intussusception
Rationale: Intussusception classically presents with intermittent,
severe colicky abdominal pain, vomiting, lethargy, and eventually
bloody or “currant jelly” stools. A sausage-shaped abdominal mass
may be palpable. Ultrasound typically demonstrates the characteristic
target or doughnut sign. In a hemodynamically stable child without
perforation or peritonitis, pneumatic or hydrostatic reduction is
generally both diagnostic and therapeutic.
3.
A 3-week-old infant develops progressively worsening, projectile,
nonbilious vomiting after feeds. The infant remains hungry after
vomiting and has poor weight gain. Which metabolic abnormality is
most likely?
A. Hyperkalemic metabolic acidosis
B. Hypochloremic, hypokalemic metabolic alkalosis
C. Hyperchloremic metabolic acidosis
2
,D. Respiratory alkalosis
E. Hypernatremic metabolic acidosis
Answer: B. Hypochloremic, hypokalemic metabolic alkalosis
Rationale: Infantile hypertrophic pyloric stenosis causes progressive
projectile, nonbilious vomiting because the obstruction occurs distal to
the stomach but proximal to the duodenum. Loss of gastric
hydrochloric acid produces hypochloremic metabolic alkalosis, while
secondary renal potassium losses can produce hypokalemia.
Ultrasound is the preferred diagnostic study.
4.
A 4-year-old child has fever, sore throat, tender anterior cervical
lymphadenopathy, tonsillar exudates, and no cough. Which pathogen is
most likely responsible?
A. Epstein-Barr virus
B. Adenovirus
C. Group A Streptococcus
D. Respiratory syncytial virus
E. Mycoplasma pneumoniae
Answer: C. Group A Streptococcus
Rationale: Group A Streptococcus commonly causes abrupt fever, sore
throat, tonsillar exudates, and tender anterior cervical nodes without
cough. Viral symptoms such as cough, rhinorrhea, conjunctivitis, or
oral ulcers make streptococcal pharyngitis less likely. Appropriate
testing is recommended before antibiotics in most children because
clinical findings alone are insufficient to distinguish all cases.
5.
3
, A 7-year-old child presents with fever, migratory polyarthritis, and a
new murmur approximately 3 weeks after an untreated sore throat.
Which mechanism best explains the underlying disease?
A. Direct bacterial invasion of the myocardium
B. Immune-mediated cross-reactivity following Streptococcus pyogenes
infection
C. Viral destruction of cardiac myocytes
D. Deposition of immune complexes caused by Staphylococcus aureus
E. Toxin-mediated myocardial injury
Answer: B. Immune-mediated cross-reactivity following
Streptococcus pyogenes infection
Rationale: Acute rheumatic fever is an immune-mediated complication
of group A streptococcal pharyngitis. Molecular mimicry leads
antibodies and T cells directed against streptococcal antigens to cross-
react with host tissues, particularly cardiac, synovial, and neurologic
tissues. Carditis, migratory polyarthritis, chorea, erythema
marginatum, and subcutaneous nodules constitute the major
manifestations of the Jones criteria.
6.
A 2-year-old child has a barking cough, hoarseness, and inspiratory
stridor that worsens at night. The child has a low-grade fever and no
drooling. Which treatment is most appropriate for moderate croup?
A. Oral amoxicillin
B. Nebulized albuterol
C. Dexamethasone with nebulized epinephrine
D. Immediate bronchoscopy
E. Intravenous vancomycin
Answer: C. Dexamethasone with nebulized epinephrine
4
