NU 632
Healthcare of Infants, Children &
Adolescents
Proctored Midterm Exam
2026
(With Solutions)
Multiple Choice (MCQs)
1. A 10-month-old infant presents with a persistent fussiness, poor feeding, and
vomiting. On exam, you note a palpable "olive" mass in the right upper
abdomen. Which is the most likely diagnosis? A) Intussusception B) Pyloric
stenosis C) GERD D) Hirschsprung disease Answer: B) Pyloric stenosis Rationale:
The classic presentation of hypertrophic pyloric stenosis includes projectile
vomiting, palpable "olive" hypertrophied pyloric muscle, and visible peristalsis.
2. An adolescent with type 1 diabetes mellitus presents with abdominal pain,
Kussmaul respirations, and confusion. Which lab finding would be most
supportive of diabetic ketoacidosis (DKA)? A) Hyperglycemia >250 mg/dL B)
Elevated serum bicarbonate C) Metabolic alkalosis D) Hyperkalemia with
muscle weakness Answer: A) Hyperglycemia >250 mg/dL Rationale: DKA is
marked by hyperglycemia, metabolic acidosis, and ketonemia; elevated
bicarbonate and metabolic alkalosis do not fit.
3. A 5-year-old presents with fever, sore throat, and drooling. She is sitting
leaning forward with neck hyperextended. What is the next best step? A)
Throat culture B) Start oral antibiotics and observe C) Secure airway
immediately D) Chest x-ray Answer: C) Secure airway immediately Rationale:
Classic signs of epiglottitis require urgent airway management due to risk of
airway obstruction.
4. What is the most appropriate first-line treatment for a 9-year-old diagnosed
with moderate persistent asthma? A) SABA only as needed B) Daily low-dose
inhaled corticosteroids (ICS) C) Oral corticosteroids daily D) Leukotriene
receptor antagonist alone Answer: B) Daily low-dose ICS Rationale: ICS is
mainstay for persistent asthma control; SABA is rescue only.
5. At what age should an FNP recommend the first dose of the MMR vaccine
according to CDC guidelines? A) 2 months B) 6 months C) 12-15 months D) 4-6
years Answer: C) 12-15 months Rationale: MMR is first given at 12-15 months,
with a second dose at 4-6 years.
, True/False Questions
6. True or False: The presence of a fever in a neonate (under 28 days) should
always prompt immediate hospitalization for sepsis evaluation. Answer: True
Rationale: Neonates have immature immune systems; fever can be the only
sign of serious infection.
7. True or False: Kawasaki disease is self-limiting and does not require treatment
to prevent coronary artery aneurysms. Answer: False Rationale: IVIG and
aspirin reduce risk of coronary aneurysms; untreated disease can lead to
cardiac complications.
8. True or False: Adolescents with depression often present primarily with
irritability and somatic complaints rather than classic sadness. Answer: True
Rationale: Teen depression often manifests less obviously, needing careful
assessment.
9. True or False: Breastfeeding mothers should delay immunizations for their
infants until 6 months of age. Answer: False Rationale: Vaccinations are safe
and recommended based on age, regardless of breastfeeding status.
10.True or False: Failure to thrive can result from inadequate caloric intake,
malabsorption, or chronic disease. Answer: True Rationale: Multiple etiologies
can cause growth failure; thorough workup is essential.
Short Answer Questions
11. Name three clinical features that help distinguish viral bronchiolitis from
bacterial pneumonia in infants. Answer:
• Gradual onset with wheezing rather than focal crackles
• Low-grade or absent fever vs. high fever in bacterial pneumonia
• Lack of significant leukocytosis or lobar infiltrates on chest x-ray
Rationale: Bronchiolitis is primarily viral, characterized by wheezing; bacterial
pneumonia presents with consolidation and higher inflammatory markers.
12.Explain why hydrocephalus can present with a bulging fontanelle in infants.
Answer: Increased CSF accumulation raises intracranial pressure, causing
outward bulging of the still-open fontanelle in infants.
13.List two contraindications for live vaccines in immunocompromised children.
Answer:
• Severe combined immunodeficiency (SCID)
• Recent chemotherapy or immunosuppressive therapy
14.Describe the difference between functional abdominal pain and organic
causes in pediatric patients. Answer: Functional pain lacks identifiable
structural or biochemical abnormalities; organic pain is linked to diseases such
as IBD or infections.
15.What is the first-line pharmacologic treatment for nocturnal enuresis in
children older than 6? Answer: Desmopressin (DDAVP) or behavioral
interventions.
Matching (Match Condition to Most Appropriate Diagnostic Test)
Healthcare of Infants, Children &
Adolescents
Proctored Midterm Exam
2026
(With Solutions)
Multiple Choice (MCQs)
1. A 10-month-old infant presents with a persistent fussiness, poor feeding, and
vomiting. On exam, you note a palpable "olive" mass in the right upper
abdomen. Which is the most likely diagnosis? A) Intussusception B) Pyloric
stenosis C) GERD D) Hirschsprung disease Answer: B) Pyloric stenosis Rationale:
The classic presentation of hypertrophic pyloric stenosis includes projectile
vomiting, palpable "olive" hypertrophied pyloric muscle, and visible peristalsis.
2. An adolescent with type 1 diabetes mellitus presents with abdominal pain,
Kussmaul respirations, and confusion. Which lab finding would be most
supportive of diabetic ketoacidosis (DKA)? A) Hyperglycemia >250 mg/dL B)
Elevated serum bicarbonate C) Metabolic alkalosis D) Hyperkalemia with
muscle weakness Answer: A) Hyperglycemia >250 mg/dL Rationale: DKA is
marked by hyperglycemia, metabolic acidosis, and ketonemia; elevated
bicarbonate and metabolic alkalosis do not fit.
3. A 5-year-old presents with fever, sore throat, and drooling. She is sitting
leaning forward with neck hyperextended. What is the next best step? A)
Throat culture B) Start oral antibiotics and observe C) Secure airway
immediately D) Chest x-ray Answer: C) Secure airway immediately Rationale:
Classic signs of epiglottitis require urgent airway management due to risk of
airway obstruction.
4. What is the most appropriate first-line treatment for a 9-year-old diagnosed
with moderate persistent asthma? A) SABA only as needed B) Daily low-dose
inhaled corticosteroids (ICS) C) Oral corticosteroids daily D) Leukotriene
receptor antagonist alone Answer: B) Daily low-dose ICS Rationale: ICS is
mainstay for persistent asthma control; SABA is rescue only.
5. At what age should an FNP recommend the first dose of the MMR vaccine
according to CDC guidelines? A) 2 months B) 6 months C) 12-15 months D) 4-6
years Answer: C) 12-15 months Rationale: MMR is first given at 12-15 months,
with a second dose at 4-6 years.
, True/False Questions
6. True or False: The presence of a fever in a neonate (under 28 days) should
always prompt immediate hospitalization for sepsis evaluation. Answer: True
Rationale: Neonates have immature immune systems; fever can be the only
sign of serious infection.
7. True or False: Kawasaki disease is self-limiting and does not require treatment
to prevent coronary artery aneurysms. Answer: False Rationale: IVIG and
aspirin reduce risk of coronary aneurysms; untreated disease can lead to
cardiac complications.
8. True or False: Adolescents with depression often present primarily with
irritability and somatic complaints rather than classic sadness. Answer: True
Rationale: Teen depression often manifests less obviously, needing careful
assessment.
9. True or False: Breastfeeding mothers should delay immunizations for their
infants until 6 months of age. Answer: False Rationale: Vaccinations are safe
and recommended based on age, regardless of breastfeeding status.
10.True or False: Failure to thrive can result from inadequate caloric intake,
malabsorption, or chronic disease. Answer: True Rationale: Multiple etiologies
can cause growth failure; thorough workup is essential.
Short Answer Questions
11. Name three clinical features that help distinguish viral bronchiolitis from
bacterial pneumonia in infants. Answer:
• Gradual onset with wheezing rather than focal crackles
• Low-grade or absent fever vs. high fever in bacterial pneumonia
• Lack of significant leukocytosis or lobar infiltrates on chest x-ray
Rationale: Bronchiolitis is primarily viral, characterized by wheezing; bacterial
pneumonia presents with consolidation and higher inflammatory markers.
12.Explain why hydrocephalus can present with a bulging fontanelle in infants.
Answer: Increased CSF accumulation raises intracranial pressure, causing
outward bulging of the still-open fontanelle in infants.
13.List two contraindications for live vaccines in immunocompromised children.
Answer:
• Severe combined immunodeficiency (SCID)
• Recent chemotherapy or immunosuppressive therapy
14.Describe the difference between functional abdominal pain and organic
causes in pediatric patients. Answer: Functional pain lacks identifiable
structural or biochemical abnormalities; organic pain is linked to diseases such
as IBD or infections.
15.What is the first-line pharmacologic treatment for nocturnal enuresis in
children older than 6? Answer: Desmopressin (DDAVP) or behavioral
interventions.
Matching (Match Condition to Most Appropriate Diagnostic Test)
