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, Neonatal Care, Clinical Decision-Making,
Evidence-Based Pediatrics, Detailed Rationales,
Complete Review
Question 1: A 2-week-old exclusively breastfed infant presents with poor
feeding, lethargy, and a weak cry. On examination, the infant is afebrile, has
poor muscle tone, and is noted to have a prominent tongue. Which of the
following maternal conditions is most strongly associated with this infant's
presentation?
A. Gestational diabetes mellitus
B. Maternal hypothyroidism
C. Maternal vitamin D deficiency
D. Maternal phenylketonuria
CORRECT ANSWER: B. Maternal hypothyroidism
Rationale: The infant's presentation of macroglossia, poor feeding, lethargy, and
hypotonia is classic for congenital hypothyroidism. While most cases are sporadic,
maternal hypothyroidism, particularly if untreated, can be associated with transient
neonatal hypothyroidism due to maternal anti-thyroid antibodies or medications.
Maternal phenylketonuria is associated with microcephaly and intellectual disability, not
this presentation.
Question 2: A 6-year-old boy is brought to the clinic with a 3-day history of
fever, cough, and conjunctivitis. On examination, he has an erythematous
maculopapular rash that started on his face and is now spreading to his trunk.
He also has small, white, elevated lesions on his buccal mucosa. What is the
most appropriate immediate public health intervention?
A. Isolation with airborne precautions
B. Administration of acyclovir
C. Notification of the state health department
D. Vaccination of all household contacts
CORRECT ANSWER: A. Isolation with airborne precautions
Rationale: The child has measles (rubeola), characterized by the classic prodrome of
fever, cough, coryza, conjunctivitis (the "3 Cs") and Koplik spots, followed by a
cephalocaudal rash. Measles is highly contagious via airborne transmission and requires
airborne precautions. While reporting is required, the most immediate public health
action is isolation to prevent further spread.
,Question 3: A full-term newborn is noted to have a palpable, hard mass over
the right parietal bone that does not cross the suture line. The mass was not
present at birth but was noted 12 hours later. Which of the following is the
most appropriate management?
A. Needle aspiration of the mass
B. Observation and parental reassurance
C. Emergent CT scan of the head
D. Referral for surgical excision
CORRECT ANSWER: B. Observation and parental reassurance
Rationale: The description is classic for a cephalohematoma, which is a subperiosteal
hemorrhage that does not cross suture lines and appears within the first 24 hours of life.
The vast majority resolve spontaneously over weeks to months without intervention.
Needle aspiration is contraindicated due to the risk of infection and abscess formation.
Question 4: A 14-year-old girl presents with a 6-month history of secondary
amenorrhea, headache, and visual field deficits. She has a history of normal
pubertal development but has not had a menstrual period for 6 months. MRI
reveals a suprasellar mass. Which of the following is the most likely diagnosis?
A. Polycystic ovarian syndrome
B. Craniopharyngioma
C. Prolactinoma
D. Ovarian teratoma
CORRECT ANSWER: B. Craniopharyngioma
Rationale: Craniopharyngiomas are the most common sellar/suprasellar tumors in
children. They typically present with signs of increased intracranial pressure (headache),
visual field defects (classically bitemporal hemianopsia), and endocrine dysfunction
(growth hormone deficiency, hypogonadism, or diabetes insipidus). A prolactinoma
would present with galactorrhea and hyperprolactinemia, but the presence of a
solid/cystic suprasellar mass points toward craniopharyngioma.
Question 5: A 4-year-old boy is brought to the emergency department with a 1-
day history of stridor, drooling, and fever. He is sitting in a tripod position and
appears anxious. He has not received any routine immunizations. Which of the
following is the most appropriate next step?
A. Direct laryngoscopy in the operating room
B. Nebulized epinephrine in the emergency department
C. Obtain a lateral neck radiograph
D. Immediate intravenous antibiotics
CORRECT ANSWER: A. Direct laryngoscopy in the operating room
Rationale: This is a classic presentation of acute epiglottitis, characterized by the sudden
onset of high fever, stridor, drooling, and the tripod position. The most critical step is to
,secure the airway in a controlled setting (operating room) with an anesthesiologist and
otolaryngologist present. Manipulation of the airway (including radiographs or direct
visualization in the ED) can precipitate complete airway obstruction and is
contraindicated.
Question 6: A 9-month-old infant is found to have severe iron deficiency
anemia. Which of the following dietary practices is most likely the primary
contributing factor?
A. Exclusive breastfeeding without iron supplementation
B. Consumption of cow's milk as the primary beverage
C. Introduction of iron-fortified cereals at 6 months
D. Daily consumption of honey
CORRECT ANSWER: B. Consumption of cow's milk as the primary beverage
Rationale: Cow's milk is a leading cause of iron deficiency anemia in infants and
toddlers. It is low in iron, binds iron, and can cause occult gastrointestinal blood loss.
Additionally, it displaces iron-rich solid foods in the diet. Exclusive breastfeeding without
supplementation can cause iron deficiency after 4-6 months if solids are not introduced,
but the primary driver in a 9-month-old is often cow's milk intake.
Question 7: A 16-year-old male athlete presents with acute onset of severe
testicular pain that began 2 hours ago during a basketball game. He has nausea
and vomiting. On examination, the left testis is tender and elevated. The
cremasteric reflex is absent on the left side. Which of the following is the most
appropriate next step?
A. Scrotal ultrasound with Doppler
B. Urinalysis and culture
C. Immediate surgical exploration
D. Administration of antibiotics and analgesics
CORRECT ANSWER: C. Immediate surgical exploration
Rationale: The presentation of acute, severe testicular pain in an adolescent with an
absent cremasteric reflex is a surgical emergency consistent with testicular torsion. The
"golden period" for salvage is 4-6 hours. While Doppler ultrasound can confirm, it should
not delay surgical exploration. Immediate urologic consultation and surgical detorsion
are required to salvage the testis.
Question 8: A 5-year-old child with a history of recurrent respiratory
infections is noted to have a cardiac murmur. Echocardiography reveals a
continuous, machine-like murmur best heard at the left upper sternal border.
Which of the following is the most likely diagnosis?
A. Ventricular septal defect
B. Atrial septal defect
, C. Patent ductus arteriosus
D. Pulmonary valve stenosis
CORRECT ANSWER: C. Patent ductus arteriosus
Rationale: A continuous, "machine-like" murmur heard best at the left upper sternal
border is the classic auscultatory finding of a patent ductus arteriosus (PDA). The
murmur is continuous because aortic pressure is higher than pulmonary artery pressure
throughout systole and diastole.
Question 9: A 2-year-old child presents with a history of chronic constipation,
failure to thrive, and a palpable abdominal mass. Rectal examination reveals a
tight anal sphincter with an empty rectum, and a barium enema shows a
transition zone in the rectosigmoid area. Which of the following is the most
appropriate initial management?
A. High-fiber diet and stool softeners
B. Botulinum toxin injection into the internal anal sphincter
C. Daily enemas and laxatives
D. Rectal suction biopsy
CORRECT ANSWER: D. Rectal suction biopsy
Rationale: The clinical picture is classic for Hirschsprung disease (congenital aganglionic
megacolon), presenting with failure to thrive, chronic constipation, and a transition zone
on barium enema. The gold standard for diagnosis is a rectal suction biopsy showing the
absence of ganglion cells. Initial management is surgical, but diagnosis must be
confirmed first.
Question 10: A 10-year-old girl is evaluated for short stature. Her height is
below the 3rd percentile, and her growth rate is 2 cm/year. She has a webbed
neck, low posterior hairline, and cubitus valgus. Which of the following is the
most likely diagnosis?
A. Turner syndrome
B. Noonan syndrome
C. Growth hormone deficiency
D. Hypothyroidism
CORRECT ANSWER: A. Turner syndrome
Rationale: The classic features of short stature, webbed neck (pterygium colli), low
posterior hairline, and cubitus valgus are characteristic of Turner syndrome (45,XO).
These phenotypic features, combined with growth failure, make Turner syndrome the
most likely diagnosis. Noonan syndrome has similar features but includes pulmonic
stenosis and is genetically distinct.
Question 11: A 3-day-old newborn is noted to have jaundice that has
progressed from the face to the chest and abdomen. The mother is blood type
| Comprehensive Study Guide, Practice Exam,
Questions & Answers, Exam Prep Test Bank, Pediatric
Primary Care, Newborn Care, Growth & Development,
Pediatric Pharmacology, Immunization, Childhood
Disorders, Neonatal Care, Clinical Decision-Making,
Evidence-Based Pediatrics, Detailed Rationales,
Complete Review
Question 1: A 2-week-old exclusively breastfed infant presents with poor
feeding, lethargy, and a weak cry. On examination, the infant is afebrile, has
poor muscle tone, and is noted to have a prominent tongue. Which of the
following maternal conditions is most strongly associated with this infant's
presentation?
A. Gestational diabetes mellitus
B. Maternal hypothyroidism
C. Maternal vitamin D deficiency
D. Maternal phenylketonuria
CORRECT ANSWER: B. Maternal hypothyroidism
Rationale: The infant's presentation of macroglossia, poor feeding, lethargy, and
hypotonia is classic for congenital hypothyroidism. While most cases are sporadic,
maternal hypothyroidism, particularly if untreated, can be associated with transient
neonatal hypothyroidism due to maternal anti-thyroid antibodies or medications.
Maternal phenylketonuria is associated with microcephaly and intellectual disability, not
this presentation.
Question 2: A 6-year-old boy is brought to the clinic with a 3-day history of
fever, cough, and conjunctivitis. On examination, he has an erythematous
maculopapular rash that started on his face and is now spreading to his trunk.
He also has small, white, elevated lesions on his buccal mucosa. What is the
most appropriate immediate public health intervention?
A. Isolation with airborne precautions
B. Administration of acyclovir
C. Notification of the state health department
D. Vaccination of all household contacts
CORRECT ANSWER: A. Isolation with airborne precautions
Rationale: The child has measles (rubeola), characterized by the classic prodrome of
fever, cough, coryza, conjunctivitis (the "3 Cs") and Koplik spots, followed by a
cephalocaudal rash. Measles is highly contagious via airborne transmission and requires
airborne precautions. While reporting is required, the most immediate public health
action is isolation to prevent further spread.
,Question 3: A full-term newborn is noted to have a palpable, hard mass over
the right parietal bone that does not cross the suture line. The mass was not
present at birth but was noted 12 hours later. Which of the following is the
most appropriate management?
A. Needle aspiration of the mass
B. Observation and parental reassurance
C. Emergent CT scan of the head
D. Referral for surgical excision
CORRECT ANSWER: B. Observation and parental reassurance
Rationale: The description is classic for a cephalohematoma, which is a subperiosteal
hemorrhage that does not cross suture lines and appears within the first 24 hours of life.
The vast majority resolve spontaneously over weeks to months without intervention.
Needle aspiration is contraindicated due to the risk of infection and abscess formation.
Question 4: A 14-year-old girl presents with a 6-month history of secondary
amenorrhea, headache, and visual field deficits. She has a history of normal
pubertal development but has not had a menstrual period for 6 months. MRI
reveals a suprasellar mass. Which of the following is the most likely diagnosis?
A. Polycystic ovarian syndrome
B. Craniopharyngioma
C. Prolactinoma
D. Ovarian teratoma
CORRECT ANSWER: B. Craniopharyngioma
Rationale: Craniopharyngiomas are the most common sellar/suprasellar tumors in
children. They typically present with signs of increased intracranial pressure (headache),
visual field defects (classically bitemporal hemianopsia), and endocrine dysfunction
(growth hormone deficiency, hypogonadism, or diabetes insipidus). A prolactinoma
would present with galactorrhea and hyperprolactinemia, but the presence of a
solid/cystic suprasellar mass points toward craniopharyngioma.
Question 5: A 4-year-old boy is brought to the emergency department with a 1-
day history of stridor, drooling, and fever. He is sitting in a tripod position and
appears anxious. He has not received any routine immunizations. Which of the
following is the most appropriate next step?
A. Direct laryngoscopy in the operating room
B. Nebulized epinephrine in the emergency department
C. Obtain a lateral neck radiograph
D. Immediate intravenous antibiotics
CORRECT ANSWER: A. Direct laryngoscopy in the operating room
Rationale: This is a classic presentation of acute epiglottitis, characterized by the sudden
onset of high fever, stridor, drooling, and the tripod position. The most critical step is to
,secure the airway in a controlled setting (operating room) with an anesthesiologist and
otolaryngologist present. Manipulation of the airway (including radiographs or direct
visualization in the ED) can precipitate complete airway obstruction and is
contraindicated.
Question 6: A 9-month-old infant is found to have severe iron deficiency
anemia. Which of the following dietary practices is most likely the primary
contributing factor?
A. Exclusive breastfeeding without iron supplementation
B. Consumption of cow's milk as the primary beverage
C. Introduction of iron-fortified cereals at 6 months
D. Daily consumption of honey
CORRECT ANSWER: B. Consumption of cow's milk as the primary beverage
Rationale: Cow's milk is a leading cause of iron deficiency anemia in infants and
toddlers. It is low in iron, binds iron, and can cause occult gastrointestinal blood loss.
Additionally, it displaces iron-rich solid foods in the diet. Exclusive breastfeeding without
supplementation can cause iron deficiency after 4-6 months if solids are not introduced,
but the primary driver in a 9-month-old is often cow's milk intake.
Question 7: A 16-year-old male athlete presents with acute onset of severe
testicular pain that began 2 hours ago during a basketball game. He has nausea
and vomiting. On examination, the left testis is tender and elevated. The
cremasteric reflex is absent on the left side. Which of the following is the most
appropriate next step?
A. Scrotal ultrasound with Doppler
B. Urinalysis and culture
C. Immediate surgical exploration
D. Administration of antibiotics and analgesics
CORRECT ANSWER: C. Immediate surgical exploration
Rationale: The presentation of acute, severe testicular pain in an adolescent with an
absent cremasteric reflex is a surgical emergency consistent with testicular torsion. The
"golden period" for salvage is 4-6 hours. While Doppler ultrasound can confirm, it should
not delay surgical exploration. Immediate urologic consultation and surgical detorsion
are required to salvage the testis.
Question 8: A 5-year-old child with a history of recurrent respiratory
infections is noted to have a cardiac murmur. Echocardiography reveals a
continuous, machine-like murmur best heard at the left upper sternal border.
Which of the following is the most likely diagnosis?
A. Ventricular septal defect
B. Atrial septal defect
, C. Patent ductus arteriosus
D. Pulmonary valve stenosis
CORRECT ANSWER: C. Patent ductus arteriosus
Rationale: A continuous, "machine-like" murmur heard best at the left upper sternal
border is the classic auscultatory finding of a patent ductus arteriosus (PDA). The
murmur is continuous because aortic pressure is higher than pulmonary artery pressure
throughout systole and diastole.
Question 9: A 2-year-old child presents with a history of chronic constipation,
failure to thrive, and a palpable abdominal mass. Rectal examination reveals a
tight anal sphincter with an empty rectum, and a barium enema shows a
transition zone in the rectosigmoid area. Which of the following is the most
appropriate initial management?
A. High-fiber diet and stool softeners
B. Botulinum toxin injection into the internal anal sphincter
C. Daily enemas and laxatives
D. Rectal suction biopsy
CORRECT ANSWER: D. Rectal suction biopsy
Rationale: The clinical picture is classic for Hirschsprung disease (congenital aganglionic
megacolon), presenting with failure to thrive, chronic constipation, and a transition zone
on barium enema. The gold standard for diagnosis is a rectal suction biopsy showing the
absence of ganglion cells. Initial management is surgical, but diagnosis must be
confirmed first.
Question 10: A 10-year-old girl is evaluated for short stature. Her height is
below the 3rd percentile, and her growth rate is 2 cm/year. She has a webbed
neck, low posterior hairline, and cubitus valgus. Which of the following is the
most likely diagnosis?
A. Turner syndrome
B. Noonan syndrome
C. Growth hormone deficiency
D. Hypothyroidism
CORRECT ANSWER: A. Turner syndrome
Rationale: The classic features of short stature, webbed neck (pterygium colli), low
posterior hairline, and cubitus valgus are characteristic of Turner syndrome (45,XO).
These phenotypic features, combined with growth failure, make Turner syndrome the
most likely diagnosis. Noonan syndrome has similar features but includes pulmonic
stenosis and is genetically distinct.
Question 11: A 3-day-old newborn is noted to have jaundice that has
progressed from the face to the chest and abdomen. The mother is blood type
