FAAP – Fellow of the American Academy of Pediatrics
| Comprehensive Study Guide, Practice Exam,
Questions & Answers, Exam Prep Test Bank, Pediatric
Primary Care, Newborn Care, Growth & Development,
Pediatric Pharmacology, Immunization, Childhood
Disorders, Clinical Decision-Making, Evidence-Based
Practice, Detailed Rationales, Complete Review
Question 1: A 2-week-old term neonate presents with persistent jaundice,
acholic stools, and dark urine. Which initial diagnostic test is most critical to
differentiate biliary atresia from neonatal hepatitis?
A. Direct (conjugated) bilirubin level
B. Serum alanine aminotransferase (ALT)
C. Abdominal ultrasound
D. Percutaneous liver biopsy
CORRECT ANSWER: A. Direct (conjugated) bilirubin level
Rationale:The key initial step in evaluating neonatal cholestasis is to measure
fractionated bilirubin. A direct (conjugated) bilirubin >1.0 mg/dL or >20% of the total
bilirubin indicates cholestasis and warrants further investigation for biliary atresia. While
ultrasound and biopsy are important, the fractionated bilirubin is the essential screening
test that directs the workup.
Question 2: A 5-year-old presents with acute onset of ataxia, dysarthria, and
nystagmus following a viral illness. Which of the following is the most likely
diagnosis?
A. Guillain-Barré syndrome
B. Acute disseminated encephalomyelitis (ADEM)
C. Acute cerebellar ataxia
D. Brainstem glioma
CORRECT ANSWER: C. Acute cerebellar ataxia
Rationale:Acute cerebellar ataxia is the most common cause of acute ataxia in young
children, typically occurring 2-3 weeks after a viral infection. It presents with sudden-
onset gait disturbance, truncal ataxia, nystagmus, and dysarthria. ADEM often includes
encephalopathy, and Guillain-Barré presents with ascending weakness.
Question 3: A 2-month-old infant is noted to have a "whooping" cough
followed by post-tussive emesis. Which laboratory finding is most
characteristic of this infection?
,A. Absolute lymphocytosis
B. Neutrophilia
C. Eosinophilia
D. Thrombocytopenia
CORRECT ANSWER: A. Absolute lymphocytosis
Rationale:Pertussis (whooping cough) classically causes a marked absolute
lymphocytosis due to lymphocytosis-promoting factor. This is a hallmark finding,
especially in infants, and aids in distinguishing it from viral infections.
Question 4: Which of the following clinical features is most suggestive of an
intussusception in a 9-month-old infant?
A. Bilious emesis and a palpable olive-shaped mass
B. "Currant jelly" stools and a sausage-shaped abdominal mass
C. Paroxysmal abdominal pain and a palpable left upper quadrant mass
D. High fever and diffuse abdominal guarding
CORRECT ANSWER: B. "Currant jelly" stools and a sausage-shaped abdominal
mass
Rationale:The classic triad of intussusception includes paroxysmal abdominal pain, a
sausage-shaped abdominal mass (usually in the right upper quadrant), and "currant jelly"
stools (blood and mucus). This is the most characteristic presentation in infants.
Question 5: A 14-year-old female with type 1 diabetes presents with nausea,
vomiting, and abdominal pain. Labs show glucose 450 mg/dL, pH 7.15, and
bicarbonate 10 mEq/L. Which finding would indicate impending cerebral
edema during treatment?
A. Serum sodium of 145 mEq/L
B. Serum potassium of 3.0 mEq/L
C. A sudden headache and change in mental status
D. Serum phosphorus of 2.5 mg/dL
CORRECT ANSWER: C. A sudden headache and change in mental status
Rationale:In diabetic ketoacidosis (DKA), the most critical sign of impending cerebral
edema is a sudden onset of headache, altered mental status, lethargy, or irritability. This
is a medical emergency and is the leading cause of death in pediatric DKA.
Question 6: A 6-month-old is being evaluated for failure to thrive. On exam, he
has a protuberant tongue, umbilical hernia, and dry skin. Which congenital
condition is most likely?
,A. Phenylketonuria
B. Congenital hypothyroidism
C. Cystic fibrosis
D. Galactosemia
CORRECT ANSWER: B. Congenital hypothyroidism
Rationale:Congenital hypothyroidism presents with macroglossia (protuberant tongue),
umbilical hernia, hypotonia, constipation, dry skin, and prolonged jaundice. It is critical
to diagnose early through newborn screening to prevent intellectual disability.
Question 7: A 4-year-old presents with a fever, barky cough, and stridor that
worsens at night. What is the most appropriate initial management?
A. Intravenous antibiotics
B. Nebulized epinephrine and dexamethasone
C. Heliox therapy
D. Endotracheal intubation
CORRECT ANSWER: B. Nebulized epinephrine and dexamethasone
Rationale:This presentation is classic for croup (laryngotracheobronchitis). Moderate-
to-severe croup is treated with nebulized epinephrine (for rapid airway constriction
relief) and corticosteroids (to reduce inflammation). Antibiotics are ineffective as it is
typically viral.
Question 8: A 12-year-old boy has a painful swelling of the scrotum with an
absent cremasteric reflex on the affected side. What is the most likely
diagnosis and required next step?
A. Hydrocele; reassurance
B. Inguinal hernia; surgery
C. Testicular torsion; immediate surgery
D. Epididymitis; antibiotics
CORRECT ANSWER: C. Testicular torsion; immediate surgery
Rationale:Testicular torsion is a surgical emergency. The hallmark signs are acute onset
of severe scrotal pain, a high-riding testis, and the absence of the cremasteric reflex.
Immediate surgical exploration is required to salvage the testis.
Question 9: Which immunization is contraindicated in a patient with a history
of a severe anaphylactic reaction to eggs?
A. MMR (Measles, Mumps, Rubella)
B. Varicella
, C. Influenza (inactivated)
D. DTaP (Diphtheria, Tetanus, Pertussis)
CORRECT ANSWER: C. Influenza (inactivated)
Rationale:While the MMR vaccine is no longer considered contraindicated in egg
allergy due to negligible ovalbumin content, the inactivated influenza vaccine is still
recommended only with caution or contraindicated in severe anaphylactic egg allergy
due to ovalbumin presence (though some guidelines now allow it). Among these options,
influenza poses the highest risk.
Question 10: A 3-year-old presents with a cough and rhinorrhea. On exam, you
note tachypnea, intercostal retractions, and wheezing. A chest x-ray shows
hyperinflation and peribronchial cuffing. What is the most likely etiologic
agent?
A. Streptococcus pneumoniae
B. Mycoplasma pneumoniae
C. Respiratory syncytial virus (RSV)
D. Haemophilus influenzae
CORRECT ANSWER: C. Respiratory syncytial virus (RSV)
Rationale:RSV is the most common cause of bronchiolitis in children under 2 years,
presenting with cough, wheezing, and respiratory distress. Chest x-ray findings include
hyperinflation and peribronchial thickening. Bacterial pneumonia typically shows lobar
consolidation.
Question 11: A 7-year-old with acute pharyngitis develops hematuria and
periorbital edema 10 days later. What is the most likely underlying pathogen?
A. Group A Streptococcus
B. Group B Streptococcus
C. Staphylococcus aureus
D. Epstein-Barr virus
CORRECT ANSWER: A. Group A Streptococcus
Rationale:Post-streptococcal glomerulonephritis (PSGN) typically occurs 7-14 days
after a Group A Streptococcal pharyngitis or skin infection. It presents with hematuria,
edema, and hypertension.
Question 12: Which finding in a newborn's umbilical cord blood is most
suggestive of congenital syphilis?
| Comprehensive Study Guide, Practice Exam,
Questions & Answers, Exam Prep Test Bank, Pediatric
Primary Care, Newborn Care, Growth & Development,
Pediatric Pharmacology, Immunization, Childhood
Disorders, Clinical Decision-Making, Evidence-Based
Practice, Detailed Rationales, Complete Review
Question 1: A 2-week-old term neonate presents with persistent jaundice,
acholic stools, and dark urine. Which initial diagnostic test is most critical to
differentiate biliary atresia from neonatal hepatitis?
A. Direct (conjugated) bilirubin level
B. Serum alanine aminotransferase (ALT)
C. Abdominal ultrasound
D. Percutaneous liver biopsy
CORRECT ANSWER: A. Direct (conjugated) bilirubin level
Rationale:The key initial step in evaluating neonatal cholestasis is to measure
fractionated bilirubin. A direct (conjugated) bilirubin >1.0 mg/dL or >20% of the total
bilirubin indicates cholestasis and warrants further investigation for biliary atresia. While
ultrasound and biopsy are important, the fractionated bilirubin is the essential screening
test that directs the workup.
Question 2: A 5-year-old presents with acute onset of ataxia, dysarthria, and
nystagmus following a viral illness. Which of the following is the most likely
diagnosis?
A. Guillain-Barré syndrome
B. Acute disseminated encephalomyelitis (ADEM)
C. Acute cerebellar ataxia
D. Brainstem glioma
CORRECT ANSWER: C. Acute cerebellar ataxia
Rationale:Acute cerebellar ataxia is the most common cause of acute ataxia in young
children, typically occurring 2-3 weeks after a viral infection. It presents with sudden-
onset gait disturbance, truncal ataxia, nystagmus, and dysarthria. ADEM often includes
encephalopathy, and Guillain-Barré presents with ascending weakness.
Question 3: A 2-month-old infant is noted to have a "whooping" cough
followed by post-tussive emesis. Which laboratory finding is most
characteristic of this infection?
,A. Absolute lymphocytosis
B. Neutrophilia
C. Eosinophilia
D. Thrombocytopenia
CORRECT ANSWER: A. Absolute lymphocytosis
Rationale:Pertussis (whooping cough) classically causes a marked absolute
lymphocytosis due to lymphocytosis-promoting factor. This is a hallmark finding,
especially in infants, and aids in distinguishing it from viral infections.
Question 4: Which of the following clinical features is most suggestive of an
intussusception in a 9-month-old infant?
A. Bilious emesis and a palpable olive-shaped mass
B. "Currant jelly" stools and a sausage-shaped abdominal mass
C. Paroxysmal abdominal pain and a palpable left upper quadrant mass
D. High fever and diffuse abdominal guarding
CORRECT ANSWER: B. "Currant jelly" stools and a sausage-shaped abdominal
mass
Rationale:The classic triad of intussusception includes paroxysmal abdominal pain, a
sausage-shaped abdominal mass (usually in the right upper quadrant), and "currant jelly"
stools (blood and mucus). This is the most characteristic presentation in infants.
Question 5: A 14-year-old female with type 1 diabetes presents with nausea,
vomiting, and abdominal pain. Labs show glucose 450 mg/dL, pH 7.15, and
bicarbonate 10 mEq/L. Which finding would indicate impending cerebral
edema during treatment?
A. Serum sodium of 145 mEq/L
B. Serum potassium of 3.0 mEq/L
C. A sudden headache and change in mental status
D. Serum phosphorus of 2.5 mg/dL
CORRECT ANSWER: C. A sudden headache and change in mental status
Rationale:In diabetic ketoacidosis (DKA), the most critical sign of impending cerebral
edema is a sudden onset of headache, altered mental status, lethargy, or irritability. This
is a medical emergency and is the leading cause of death in pediatric DKA.
Question 6: A 6-month-old is being evaluated for failure to thrive. On exam, he
has a protuberant tongue, umbilical hernia, and dry skin. Which congenital
condition is most likely?
,A. Phenylketonuria
B. Congenital hypothyroidism
C. Cystic fibrosis
D. Galactosemia
CORRECT ANSWER: B. Congenital hypothyroidism
Rationale:Congenital hypothyroidism presents with macroglossia (protuberant tongue),
umbilical hernia, hypotonia, constipation, dry skin, and prolonged jaundice. It is critical
to diagnose early through newborn screening to prevent intellectual disability.
Question 7: A 4-year-old presents with a fever, barky cough, and stridor that
worsens at night. What is the most appropriate initial management?
A. Intravenous antibiotics
B. Nebulized epinephrine and dexamethasone
C. Heliox therapy
D. Endotracheal intubation
CORRECT ANSWER: B. Nebulized epinephrine and dexamethasone
Rationale:This presentation is classic for croup (laryngotracheobronchitis). Moderate-
to-severe croup is treated with nebulized epinephrine (for rapid airway constriction
relief) and corticosteroids (to reduce inflammation). Antibiotics are ineffective as it is
typically viral.
Question 8: A 12-year-old boy has a painful swelling of the scrotum with an
absent cremasteric reflex on the affected side. What is the most likely
diagnosis and required next step?
A. Hydrocele; reassurance
B. Inguinal hernia; surgery
C. Testicular torsion; immediate surgery
D. Epididymitis; antibiotics
CORRECT ANSWER: C. Testicular torsion; immediate surgery
Rationale:Testicular torsion is a surgical emergency. The hallmark signs are acute onset
of severe scrotal pain, a high-riding testis, and the absence of the cremasteric reflex.
Immediate surgical exploration is required to salvage the testis.
Question 9: Which immunization is contraindicated in a patient with a history
of a severe anaphylactic reaction to eggs?
A. MMR (Measles, Mumps, Rubella)
B. Varicella
, C. Influenza (inactivated)
D. DTaP (Diphtheria, Tetanus, Pertussis)
CORRECT ANSWER: C. Influenza (inactivated)
Rationale:While the MMR vaccine is no longer considered contraindicated in egg
allergy due to negligible ovalbumin content, the inactivated influenza vaccine is still
recommended only with caution or contraindicated in severe anaphylactic egg allergy
due to ovalbumin presence (though some guidelines now allow it). Among these options,
influenza poses the highest risk.
Question 10: A 3-year-old presents with a cough and rhinorrhea. On exam, you
note tachypnea, intercostal retractions, and wheezing. A chest x-ray shows
hyperinflation and peribronchial cuffing. What is the most likely etiologic
agent?
A. Streptococcus pneumoniae
B. Mycoplasma pneumoniae
C. Respiratory syncytial virus (RSV)
D. Haemophilus influenzae
CORRECT ANSWER: C. Respiratory syncytial virus (RSV)
Rationale:RSV is the most common cause of bronchiolitis in children under 2 years,
presenting with cough, wheezing, and respiratory distress. Chest x-ray findings include
hyperinflation and peribronchial thickening. Bacterial pneumonia typically shows lobar
consolidation.
Question 11: A 7-year-old with acute pharyngitis develops hematuria and
periorbital edema 10 days later. What is the most likely underlying pathogen?
A. Group A Streptococcus
B. Group B Streptococcus
C. Staphylococcus aureus
D. Epstein-Barr virus
CORRECT ANSWER: A. Group A Streptococcus
Rationale:Post-streptococcal glomerulonephritis (PSGN) typically occurs 7-14 days
after a Group A Streptococcal pharyngitis or skin infection. It presents with hematuria,
edema, and hypertension.
Question 12: Which finding in a newborn's umbilical cord blood is most
suggestive of congenital syphilis?
