PAEA PEDIATRICS PRACTICE EXAMS QUESTIONS
AND ANSWERS SET A+
✔✔what is the most likely etiology of a 18-50 yr old with bacterial meningitis? tx? - ✔✔-
*s. pneumo* (MC 50%), n. meningitidis, h. influenzae, listeria, GNR
-tx: ceftriaxone + vancomycin
✔✔what is the most likely etiology of a >50 yr olds with bacterial meningitis? tx? - ✔✔-
*s. pneumo, listeria*, GNR
-tx: ampicillin + ceftriaxone
✔✔what are the MC causes of viral meningitis and encephalitis? tx? biggest difference
in sx's? - ✔✔-meningitis: enterovirus family (echovirus, coxsackie) & arboviruses - tx is
supportive
-encephalitis: *HSV-1* - tx w/ *valcyclovir*
encephalitis has abnormal cerebral fxn (extreme lethargy, AMS)
✔✔Dx? chromosome count 45 XO, flattened nasal bridge/epicanthal folds, webbing of
neck, widened internipple distance, malformed ears, short stature, primary ovarian
failure, amenorrhea, delayed 2ndary sex characteristics; workup? tx? - ✔✔-dx: turner
syndrome
-workup: inc FSH/LH (pituitary response to>), low estrogen (ovaries failing), TFTs, CMP,
growth hormone, EKG/echo (most have coarctation of aorta or bicuspid AV), renal US
(r/o horseshoe kidney or renal agenesis), celiac panel
-tx: hormone replacement therapy
✔✔what is the pathophysiology behind down syndrome? - ✔✔nondisjunction in meiosis
phase I in chromosome 21 = trisomy
✔✔what screening should children with down syndrome receive annually/periodically? -
✔✔-periodic: echo (almost all have some sort of anomaly- MC VSD), GI screening (r/o
duodenal atresia)
, -annual: CBC (inc r/o ALL), TFTs (hypothyroidism), CMP (DM), PT/OT (macroglossia =
messy eaters)
✔✔age appropriate guidance given to parents on diet, injury prevention, developmental
and behavioral issues, and health promotion - ✔✔anticipatory guidance
✔✔an infant with vomiting, irritability, retinal hemorrhages, frontal fontanelle should be
evaluated for - ✔✔shaken baby syndrome- do head CT to r/o traumatic brain injury and
eval for other extremity fractures
✔✔a 5 yo boy comes into your clinic with parents complaining of behavioral outbursts
when a change to routine has been made. the boy does not make eye contact with you
and does not speak other than echoing phrases while he puts together a puzzle. his
parents state he does things very repetitively and has hard time being aware of his
surroundings. what do you suspect? - ✔✔ASD (autism spectrum d/o)- signs include:
-social interaction difficulties (emotional discomfort/detachment- avoiding eye contact,
no response to cuddling/affection
-impaired communication (difficulty understanding things not said straightforward,
sometimes non-verbal)
-restricted, repetitive, stereotyped behaviors
-insistence on routine
-restricted interests of abnml intensity or focus
-hyper or hyporeactivity to sensory input
✔✔how is ASD (autism spectrum d/o) treated? - ✔✔referral for neuropsychologic
testing, behavior modification strategies, tx comorbidities w/ meds (ADHD, anxiety,
depression)
✔✔oppositional defiant disorder is defined as a persistent pattern of negative, hostile &
defiant behavior towards adults and must last at least ____ months with the following 3
components: 1. angry/irritable mood 2. argumentative/defiant behavior 3. vindictiveness;
what is the tx? - ✔✔6 mos
tx: behavioral modifications/therapy
✔✔conduct disorder is defined as a persistent pattern of behaviors that deviate sharply
from the age-appropriate norms and violate the rights of other in what 4 main areas? -
✔✔1. serious violations of laws
2. aggressive/cruel to animals
3. deceitfulness (stealing, lying, lacking guilt/remorse)
4. destruction of property (sets fires, etc.)
-these pts also have social and academic difficulty
-40% develop antisocial personality d/o (age 18)
AND ANSWERS SET A+
✔✔what is the most likely etiology of a 18-50 yr old with bacterial meningitis? tx? - ✔✔-
*s. pneumo* (MC 50%), n. meningitidis, h. influenzae, listeria, GNR
-tx: ceftriaxone + vancomycin
✔✔what is the most likely etiology of a >50 yr olds with bacterial meningitis? tx? - ✔✔-
*s. pneumo, listeria*, GNR
-tx: ampicillin + ceftriaxone
✔✔what are the MC causes of viral meningitis and encephalitis? tx? biggest difference
in sx's? - ✔✔-meningitis: enterovirus family (echovirus, coxsackie) & arboviruses - tx is
supportive
-encephalitis: *HSV-1* - tx w/ *valcyclovir*
encephalitis has abnormal cerebral fxn (extreme lethargy, AMS)
✔✔Dx? chromosome count 45 XO, flattened nasal bridge/epicanthal folds, webbing of
neck, widened internipple distance, malformed ears, short stature, primary ovarian
failure, amenorrhea, delayed 2ndary sex characteristics; workup? tx? - ✔✔-dx: turner
syndrome
-workup: inc FSH/LH (pituitary response to>), low estrogen (ovaries failing), TFTs, CMP,
growth hormone, EKG/echo (most have coarctation of aorta or bicuspid AV), renal US
(r/o horseshoe kidney or renal agenesis), celiac panel
-tx: hormone replacement therapy
✔✔what is the pathophysiology behind down syndrome? - ✔✔nondisjunction in meiosis
phase I in chromosome 21 = trisomy
✔✔what screening should children with down syndrome receive annually/periodically? -
✔✔-periodic: echo (almost all have some sort of anomaly- MC VSD), GI screening (r/o
duodenal atresia)
, -annual: CBC (inc r/o ALL), TFTs (hypothyroidism), CMP (DM), PT/OT (macroglossia =
messy eaters)
✔✔age appropriate guidance given to parents on diet, injury prevention, developmental
and behavioral issues, and health promotion - ✔✔anticipatory guidance
✔✔an infant with vomiting, irritability, retinal hemorrhages, frontal fontanelle should be
evaluated for - ✔✔shaken baby syndrome- do head CT to r/o traumatic brain injury and
eval for other extremity fractures
✔✔a 5 yo boy comes into your clinic with parents complaining of behavioral outbursts
when a change to routine has been made. the boy does not make eye contact with you
and does not speak other than echoing phrases while he puts together a puzzle. his
parents state he does things very repetitively and has hard time being aware of his
surroundings. what do you suspect? - ✔✔ASD (autism spectrum d/o)- signs include:
-social interaction difficulties (emotional discomfort/detachment- avoiding eye contact,
no response to cuddling/affection
-impaired communication (difficulty understanding things not said straightforward,
sometimes non-verbal)
-restricted, repetitive, stereotyped behaviors
-insistence on routine
-restricted interests of abnml intensity or focus
-hyper or hyporeactivity to sensory input
✔✔how is ASD (autism spectrum d/o) treated? - ✔✔referral for neuropsychologic
testing, behavior modification strategies, tx comorbidities w/ meds (ADHD, anxiety,
depression)
✔✔oppositional defiant disorder is defined as a persistent pattern of negative, hostile &
defiant behavior towards adults and must last at least ____ months with the following 3
components: 1. angry/irritable mood 2. argumentative/defiant behavior 3. vindictiveness;
what is the tx? - ✔✔6 mos
tx: behavioral modifications/therapy
✔✔conduct disorder is defined as a persistent pattern of behaviors that deviate sharply
from the age-appropriate norms and violate the rights of other in what 4 main areas? -
✔✔1. serious violations of laws
2. aggressive/cruel to animals
3. deceitfulness (stealing, lying, lacking guilt/remorse)
4. destruction of property (sets fires, etc.)
-these pts also have social and academic difficulty
-40% develop antisocial personality d/o (age 18)
