Pediatric Acute Care Mastery: 150-
Question Comprehensive Exam
2025/2026
1. A 3-year-old presents with fever, cough, and inspiratory stridor.
What is the most likely diagnosis?
A. Asthma exacerbation
B. Croup
C. Epiglottitis
D. Foreign body aspiration
Rationale: Croup commonly presents in children 6 months to 3 years
with a barking cough, stridor, and low-grade fever.
2. Which of the following is the first-line treatment for mild croup?
A. Antibiotics
B. Dexamethasone
C. Epinephrine
D. Oxygen therapy
Rationale: Corticosteroids like dexamethasone reduce airway
inflammation and are first-line for mild croup.
3. A 6-month-old presents with sudden-onset pallor, lethargy, and
poor feeding. Which is the most concerning initial action?
A. Start oral antibiotics
B. Assess airway, breathing, and circulation
C. Schedule outpatient follow-up
D. Obtain stool for occult blood
,Rationale: In infants with acute lethargy and pallor, immediate ABC
assessment is critical to prevent morbidity and mortality.
4. Which of the following vaccines is contraindicated in a child with a
severe egg allergy?
A. DTaP
B. Yellow fever vaccine
C. IPV
D. Hib
Rationale: Yellow fever vaccine contains egg proteins and can trigger
severe allergic reactions.
5. A 5-year-old with asthma presents with wheezing and mild
dyspnea. What is the first-line management?
A. Oral corticosteroids
B. Short-acting beta-agonist (SABA) inhaler
C. Antibiotics
D. Long-acting beta-agonist
Rationale: SABAs like albuterol are first-line for acute mild asthma
exacerbations.
6. What is the most common cause of bronchiolitis in infants?
A. Influenza virus
B. Adenovirus
C. Respiratory syncytial virus (RSV)
D. Rhinovirus
Rationale: RSV is the leading cause of bronchiolitis in infants and
young children.
7. A 10-year-old presents with a petechial rash, fever, and neck
stiffness. What is the most appropriate initial action?
A. Schedule outpatient follow-up
, B. Obtain blood cultures and start empiric IV antibiotics
C. Administer oral antibiotics at home
D. Order chest X-ray
Rationale: These symptoms are concerning for meningococcemia or
meningitis, requiring urgent empiric IV antibiotics.
8. Which electrolyte abnormality is most commonly associated with
pyloric stenosis?
A. Hyperkalemia
B. Hypernatremia
C. Hypokalemic, hypochloremic metabolic alkalosis
D. Hyponatremia
Rationale: Vomiting in pyloric stenosis leads to loss of gastric H+ and
Cl-, resulting in hypokalemic, hypochloremic metabolic alkalosis.
9. A 4-year-old has a fever of 102°F, sore throat, and strawberry
tongue. Which organism is most likely responsible?
A. Staphylococcus aureus
B. Streptococcus pyogenes
C. Epstein-Barr virus
D. Influenza virus
Rationale: Streptococcus pyogenes causes scarlet fever, characterized
by fever, sore throat, and a strawberry tongue.
10. Which intervention is most appropriate for a child with
moderate dehydration?
A. IV antibiotics
B. Oral rehydration solution
C. Immediate surgery
D. Corticosteroids
, Rationale: Moderate dehydration in children is typically managed
with oral rehydration therapy unless the child cannot tolerate fluids.
11. What is the hallmark ECG finding in hypokalemia?
A. Peaked T waves
B. Flattened T waves and U waves
C. ST-segment elevation
D. Shortened QT interval
Rationale: Hypokalemia commonly produces flattened T waves, ST
depression, and prominent U waves on ECG.
12. Which condition presents with “currant jelly” stools in
infants?
A. Hirschsprung disease
B. Gastroenteritis
C. Intussusception
D. Appendicitis
Rationale: Intussusception can lead to intestinal ischemia and
bleeding, producing characteristic “currant jelly” stools.
13. A 2-month-old presents with persistent vomiting after feeds
and poor weight gain. Which diagnostic test is most appropriate
initially?
A. CT scan
B. Abdominal ultrasound
C. MRI
D. Upper endoscopy
Rationale: Ultrasound is the first-line imaging for pyloric stenosis in
infants.
14. Which pathogen is the most common cause of neonatal
sepsis?
Question Comprehensive Exam
2025/2026
1. A 3-year-old presents with fever, cough, and inspiratory stridor.
What is the most likely diagnosis?
A. Asthma exacerbation
B. Croup
C. Epiglottitis
D. Foreign body aspiration
Rationale: Croup commonly presents in children 6 months to 3 years
with a barking cough, stridor, and low-grade fever.
2. Which of the following is the first-line treatment for mild croup?
A. Antibiotics
B. Dexamethasone
C. Epinephrine
D. Oxygen therapy
Rationale: Corticosteroids like dexamethasone reduce airway
inflammation and are first-line for mild croup.
3. A 6-month-old presents with sudden-onset pallor, lethargy, and
poor feeding. Which is the most concerning initial action?
A. Start oral antibiotics
B. Assess airway, breathing, and circulation
C. Schedule outpatient follow-up
D. Obtain stool for occult blood
,Rationale: In infants with acute lethargy and pallor, immediate ABC
assessment is critical to prevent morbidity and mortality.
4. Which of the following vaccines is contraindicated in a child with a
severe egg allergy?
A. DTaP
B. Yellow fever vaccine
C. IPV
D. Hib
Rationale: Yellow fever vaccine contains egg proteins and can trigger
severe allergic reactions.
5. A 5-year-old with asthma presents with wheezing and mild
dyspnea. What is the first-line management?
A. Oral corticosteroids
B. Short-acting beta-agonist (SABA) inhaler
C. Antibiotics
D. Long-acting beta-agonist
Rationale: SABAs like albuterol are first-line for acute mild asthma
exacerbations.
6. What is the most common cause of bronchiolitis in infants?
A. Influenza virus
B. Adenovirus
C. Respiratory syncytial virus (RSV)
D. Rhinovirus
Rationale: RSV is the leading cause of bronchiolitis in infants and
young children.
7. A 10-year-old presents with a petechial rash, fever, and neck
stiffness. What is the most appropriate initial action?
A. Schedule outpatient follow-up
, B. Obtain blood cultures and start empiric IV antibiotics
C. Administer oral antibiotics at home
D. Order chest X-ray
Rationale: These symptoms are concerning for meningococcemia or
meningitis, requiring urgent empiric IV antibiotics.
8. Which electrolyte abnormality is most commonly associated with
pyloric stenosis?
A. Hyperkalemia
B. Hypernatremia
C. Hypokalemic, hypochloremic metabolic alkalosis
D. Hyponatremia
Rationale: Vomiting in pyloric stenosis leads to loss of gastric H+ and
Cl-, resulting in hypokalemic, hypochloremic metabolic alkalosis.
9. A 4-year-old has a fever of 102°F, sore throat, and strawberry
tongue. Which organism is most likely responsible?
A. Staphylococcus aureus
B. Streptococcus pyogenes
C. Epstein-Barr virus
D. Influenza virus
Rationale: Streptococcus pyogenes causes scarlet fever, characterized
by fever, sore throat, and a strawberry tongue.
10. Which intervention is most appropriate for a child with
moderate dehydration?
A. IV antibiotics
B. Oral rehydration solution
C. Immediate surgery
D. Corticosteroids
, Rationale: Moderate dehydration in children is typically managed
with oral rehydration therapy unless the child cannot tolerate fluids.
11. What is the hallmark ECG finding in hypokalemia?
A. Peaked T waves
B. Flattened T waves and U waves
C. ST-segment elevation
D. Shortened QT interval
Rationale: Hypokalemia commonly produces flattened T waves, ST
depression, and prominent U waves on ECG.
12. Which condition presents with “currant jelly” stools in
infants?
A. Hirschsprung disease
B. Gastroenteritis
C. Intussusception
D. Appendicitis
Rationale: Intussusception can lead to intestinal ischemia and
bleeding, producing characteristic “currant jelly” stools.
13. A 2-month-old presents with persistent vomiting after feeds
and poor weight gain. Which diagnostic test is most appropriate
initially?
A. CT scan
B. Abdominal ultrasound
C. MRI
D. Upper endoscopy
Rationale: Ultrasound is the first-line imaging for pyloric stenosis in
infants.
14. Which pathogen is the most common cause of neonatal
sepsis?
