FAAP – Fellow of the American Academy of Pediatrics
| Comprehensive Study Guide, Practice Exam,
Questions & Answers, Pediatrics Exam Prep, Pediatric
Primary Care, Newborn Care, Growth & Development,
Immunization, Pediatric Pharmacology, Childhood
Disorders, Neonatal Care, Clinical Decision-Making,
Evidence-Based Pediatrics, Detailed Rationales,
Complete Review
Question 1: A 4-week-old full-term infant presents with poor feeding, vomiting,
and lethargy for 24 hours. Serum electrolytes reveal hyponatremia (Na 125
mEq/L), hyperkalemia (K 6.8 mEq/L), and hypoglycemia. Which of the
following is the most likely diagnosis?
A. Congenital adrenal hyperplasia
B. Pyloric stenosis
C. Sepsis
D. Breastfeeding jaundice
CORRECT ANSWER: A. Congenital adrenal hyperplasia
Rationale:This classic presentation of a salt-wasting crisis in a male infant (often with
ambiguous genitalia) is characteristic of congenital adrenal hyperplasia (CAH), most
commonly due to 21-hydroxylase deficiency. The combination of hyponatremia,
hyperkalemia, and hypoglycemia results from aldosterone and cortisol deficiency.
Pyloric stenosis typically presents with non-bilious projectile vomiting, hypochloremic
metabolic alkalosis, and paradoxical aciduria. Sepsis can cause similar symptoms but
does not classically produce this specific electrolyte pattern.
Question 2: A 6-month-old infant is brought in for a well-child visit. On
examination, you note a single, palpable, firm, non-tender mass in the left
upper quadrant of the abdomen. The infant is otherwise healthy and thriving.
What is the most likely diagnosis?
A. Neuroblastoma
B. Wilms tumor
C. Hydronephrosis
D. Splenomegaly
CORRECT ANSWER: B. Wilms tumor
Rationale:A Wilms tumor (nephroblastoma) is the most common renal malignancy in
children and typically presents as an asymptomatic, unilateral, firm, non-tender
abdominal mass in a child aged 2-5 years. It can, however, present in infancy.
Neuroblastoma usually presents with an irregular, nodular mass and may have systemic
symptoms. Hydronephrosis and splenomegaly are possible but less likely in a healthy,
thriving infant without signs of obstruction or hematologic disease.
,Question 3: A 2-year-old child presents with a 3-day history of fever, cough,
and runny nose. On examination, you note a harsh, barking cough and
inspiratory stridor that is worse at night. The child is afebrile and well-
appearing in the office. Which of the following is the most appropriate initial
management?
A. Nebulized epinephrine and dexamethasone
B. Oral antibiotics
C. Chest X-ray
D. Immediate intubation
CORRECT ANSWER: A. Nebulized epinephrine and dexamethasone
Rationale:This presentation of croup (laryngotracheobronchitis) with a barking cough
and inspiratory stridor, particularly worse at night, is characteristic of a viral-induced
upper airway obstruction. In a child who is well-appearing and afebrile, the mainstay of
treatment is a single dose of oral or intramuscular dexamethasone to reduce airway
inflammation. Nebulized epinephrine is reserved for moderate to severe cases with
significant stridor at rest or respiratory distress.
Question 4: A 15-year-old female presents with secondary amenorrhea for 6
months. She is a competitive gymnast and reports a history of stress fractures.
On examination, she is thin and has bradycardia. Which of the following is the
most likely underlying diagnosis?
A. Polycystic ovary syndrome (PCOS)
B. Anorexia nervosa
C. Hypothyroidism
D. Pregnancy
CORRECT ANSWER: B. Anorexia nervosa
Rationale:The triad of amenorrhea, eating disorder, and osteoporosis (or stress
fractures) in a young female athlete is classic for the Female Athlete Triad, which is often
associated with underlying anorexia nervosa or disordered eating. PCOS typically
presents with hirsutism and oligomenorrhea. Hypothyroidism would present with other
symptoms like weight gain and cold intolerance. Pregnancy is ruled out by the history of
secondary amenorrhea but is a standard differential.
Question 5: A 10-day-old neonate is noted to have a yellow-orange
discoloration of the skin and sclera. The infant is breastfeeding well, has
normal stool and urine, and is otherwise healthy. The bilirubin level is 15
mg/dL (predominantly unconjugated). What is the most likely cause of this
jaundice?
A. Biliary atresia
B. Breastfeeding jaundice
C. Crigler-Najjar syndrome
D. Glucose-6-phosphate dehydrogenase (G6PD) deficiency
,CORRECT ANSWER: B. Breastfeeding jaundice
Rationale:Breastfeeding jaundice, also known as "suboptimal intake" jaundice, occurs in
the first week of life due to inadequate milk intake and subsequent dehydration and
decreased stool output, leading to increased enterohepatic circulation of bilirubin. The
infant is typically healthy and well-appearing. Biliary atresia presents with conjugated
hyperbilirubinemia and pale stools. Crigler-Najjar syndrome is a rare genetic disorder
causing severe unconjugated hyperbilirubinemia. G6PD deficiency can cause hemolytic
anemia and jaundice, but the clinical history here is more consistent with breastfeeding
jaundice.
Question 6: A 7-year-old boy is brought to the clinic with a 2-week history of a
limp and pain in his right hip. He is otherwise healthy. On examination, he
holds his right leg in external rotation and has limited internal rotation. An AP
and frog-leg radiograph of the pelvis shows a slipped capital femoral epiphysis
(SCFE). What is the most appropriate next step in management?
A. Immediate surgical pinning of the hip
B. Bed rest for 4 weeks
C. Physical therapy for strengthening
D. A hip spica cast
CORRECT ANSWER: A. Immediate surgical pinning of the hip
Rationale:SCFE is an orthopedic emergency. The goal of management is to prevent
further slippage and potential avascular necrosis. The standard treatment is surgical
fixation with a single screw placed across the physis to stabilize the epiphysis. Bed rest
or physical therapy is not appropriate as the primary treatment and could lead to further
displacement. A hip spica cast is rarely used for acute SCFE and is not the standard of
care.
Question 7: A 4-year-old child presents with a 3-day history of high fever,
conjunctival injection, red cracked lips, and a strawberry tongue. He also has a
polymorphous rash and edematous hands and feet. Which of the following is
the most serious complication of this condition?
A. Coronary artery aneurysms
B. Meningitis
C. Hepatitis
D. Renal failure
CORRECT ANSWER: A. Coronary artery aneurysms
Rationale:This presentation is classic for Kawasaki disease, an acute vasculitis of
medium-sized arteries. The most serious complication of Kawasaki disease is the
development of coronary artery aneurysms, which can lead to myocardial infarction and
sudden death. Prompt treatment with intravenous immunoglobulin (IVIG) and aspirin is
crucial to reduce this risk.
, Question 8: A 12-year-old girl presents with a 6-month history of fatigue,
pallor, and a history of heavy menstrual bleeding. Her complete blood count
shows a microcytic, hypochromic anemia. Which of the following is the most
appropriate initial test to diagnose her condition?
A. Serum ferritin
B. Serum vitamin B12
C. Reticulocyte count
D. Hemoglobin electrophoresis
CORRECT ANSWER: A. Serum ferritin
Rationale:The presentation of fatigue, pallor, and microcytic hypochromic anemia in a
menstruating adolescent is most consistent with iron deficiency anemia. The most cost-
effective and specific initial test to confirm this is a low serum ferritin, which reflects low
iron stores. Vitamin B12 deficiency causes macrocytic anemia. Reticulocyte count would
be low in iron deficiency but is not as specific. Hemoglobin electrophoresis is used to
diagnose hemoglobinopathies.
Question 9: A 2-month-old infant is noted to have a single, midline, firm, non-
tender mass on the hard palate. The infant feeds well and has no other
abnormalities. What is the most likely diagnosis?
A. Epstein pearls
B. Cleft palate
C. Ranula
D. Natal tooth
CORRECT ANSWER: A. Epstein pearls
Rationale:Epstein pearls are small, keratin-filled cysts that are commonly found on the
hard palate of newborns and young infants. They are benign and require no treatment,
usually resolving spontaneously within a few weeks. A cleft palate is a structural defect.
A ranula is a mucocele on the floor of the mouth. Natal teeth are teeth present at birth.
Question 10: A 16-year-old male presents with a sudden onset of severe, sharp
chest pain and shortness of breath. On examination, he is tall and thin, with
decreased breath sounds on the left side and hyperresonance to percussion.
Which of the following is the most likely diagnosis?
A. Spontaneous pneumothorax
B. Acute asthma exacerbation
C. Pneumonia
D. Pulmonary embolism
CORRECT ANSWER: A. Spontaneous pneumothorax
Rationale:A spontaneous pneumothorax is a common condition in tall, thin adolescent
males. The sudden onset of severe chest pain and shortness of breath, coupled with
decreased breath sounds and hyperresonance, is classic for a pneumothorax. Asthma
| Comprehensive Study Guide, Practice Exam,
Questions & Answers, Pediatrics Exam Prep, Pediatric
Primary Care, Newborn Care, Growth & Development,
Immunization, Pediatric Pharmacology, Childhood
Disorders, Neonatal Care, Clinical Decision-Making,
Evidence-Based Pediatrics, Detailed Rationales,
Complete Review
Question 1: A 4-week-old full-term infant presents with poor feeding, vomiting,
and lethargy for 24 hours. Serum electrolytes reveal hyponatremia (Na 125
mEq/L), hyperkalemia (K 6.8 mEq/L), and hypoglycemia. Which of the
following is the most likely diagnosis?
A. Congenital adrenal hyperplasia
B. Pyloric stenosis
C. Sepsis
D. Breastfeeding jaundice
CORRECT ANSWER: A. Congenital adrenal hyperplasia
Rationale:This classic presentation of a salt-wasting crisis in a male infant (often with
ambiguous genitalia) is characteristic of congenital adrenal hyperplasia (CAH), most
commonly due to 21-hydroxylase deficiency. The combination of hyponatremia,
hyperkalemia, and hypoglycemia results from aldosterone and cortisol deficiency.
Pyloric stenosis typically presents with non-bilious projectile vomiting, hypochloremic
metabolic alkalosis, and paradoxical aciduria. Sepsis can cause similar symptoms but
does not classically produce this specific electrolyte pattern.
Question 2: A 6-month-old infant is brought in for a well-child visit. On
examination, you note a single, palpable, firm, non-tender mass in the left
upper quadrant of the abdomen. The infant is otherwise healthy and thriving.
What is the most likely diagnosis?
A. Neuroblastoma
B. Wilms tumor
C. Hydronephrosis
D. Splenomegaly
CORRECT ANSWER: B. Wilms tumor
Rationale:A Wilms tumor (nephroblastoma) is the most common renal malignancy in
children and typically presents as an asymptomatic, unilateral, firm, non-tender
abdominal mass in a child aged 2-5 years. It can, however, present in infancy.
Neuroblastoma usually presents with an irregular, nodular mass and may have systemic
symptoms. Hydronephrosis and splenomegaly are possible but less likely in a healthy,
thriving infant without signs of obstruction or hematologic disease.
,Question 3: A 2-year-old child presents with a 3-day history of fever, cough,
and runny nose. On examination, you note a harsh, barking cough and
inspiratory stridor that is worse at night. The child is afebrile and well-
appearing in the office. Which of the following is the most appropriate initial
management?
A. Nebulized epinephrine and dexamethasone
B. Oral antibiotics
C. Chest X-ray
D. Immediate intubation
CORRECT ANSWER: A. Nebulized epinephrine and dexamethasone
Rationale:This presentation of croup (laryngotracheobronchitis) with a barking cough
and inspiratory stridor, particularly worse at night, is characteristic of a viral-induced
upper airway obstruction. In a child who is well-appearing and afebrile, the mainstay of
treatment is a single dose of oral or intramuscular dexamethasone to reduce airway
inflammation. Nebulized epinephrine is reserved for moderate to severe cases with
significant stridor at rest or respiratory distress.
Question 4: A 15-year-old female presents with secondary amenorrhea for 6
months. She is a competitive gymnast and reports a history of stress fractures.
On examination, she is thin and has bradycardia. Which of the following is the
most likely underlying diagnosis?
A. Polycystic ovary syndrome (PCOS)
B. Anorexia nervosa
C. Hypothyroidism
D. Pregnancy
CORRECT ANSWER: B. Anorexia nervosa
Rationale:The triad of amenorrhea, eating disorder, and osteoporosis (or stress
fractures) in a young female athlete is classic for the Female Athlete Triad, which is often
associated with underlying anorexia nervosa or disordered eating. PCOS typically
presents with hirsutism and oligomenorrhea. Hypothyroidism would present with other
symptoms like weight gain and cold intolerance. Pregnancy is ruled out by the history of
secondary amenorrhea but is a standard differential.
Question 5: A 10-day-old neonate is noted to have a yellow-orange
discoloration of the skin and sclera. The infant is breastfeeding well, has
normal stool and urine, and is otherwise healthy. The bilirubin level is 15
mg/dL (predominantly unconjugated). What is the most likely cause of this
jaundice?
A. Biliary atresia
B. Breastfeeding jaundice
C. Crigler-Najjar syndrome
D. Glucose-6-phosphate dehydrogenase (G6PD) deficiency
,CORRECT ANSWER: B. Breastfeeding jaundice
Rationale:Breastfeeding jaundice, also known as "suboptimal intake" jaundice, occurs in
the first week of life due to inadequate milk intake and subsequent dehydration and
decreased stool output, leading to increased enterohepatic circulation of bilirubin. The
infant is typically healthy and well-appearing. Biliary atresia presents with conjugated
hyperbilirubinemia and pale stools. Crigler-Najjar syndrome is a rare genetic disorder
causing severe unconjugated hyperbilirubinemia. G6PD deficiency can cause hemolytic
anemia and jaundice, but the clinical history here is more consistent with breastfeeding
jaundice.
Question 6: A 7-year-old boy is brought to the clinic with a 2-week history of a
limp and pain in his right hip. He is otherwise healthy. On examination, he
holds his right leg in external rotation and has limited internal rotation. An AP
and frog-leg radiograph of the pelvis shows a slipped capital femoral epiphysis
(SCFE). What is the most appropriate next step in management?
A. Immediate surgical pinning of the hip
B. Bed rest for 4 weeks
C. Physical therapy for strengthening
D. A hip spica cast
CORRECT ANSWER: A. Immediate surgical pinning of the hip
Rationale:SCFE is an orthopedic emergency. The goal of management is to prevent
further slippage and potential avascular necrosis. The standard treatment is surgical
fixation with a single screw placed across the physis to stabilize the epiphysis. Bed rest
or physical therapy is not appropriate as the primary treatment and could lead to further
displacement. A hip spica cast is rarely used for acute SCFE and is not the standard of
care.
Question 7: A 4-year-old child presents with a 3-day history of high fever,
conjunctival injection, red cracked lips, and a strawberry tongue. He also has a
polymorphous rash and edematous hands and feet. Which of the following is
the most serious complication of this condition?
A. Coronary artery aneurysms
B. Meningitis
C. Hepatitis
D. Renal failure
CORRECT ANSWER: A. Coronary artery aneurysms
Rationale:This presentation is classic for Kawasaki disease, an acute vasculitis of
medium-sized arteries. The most serious complication of Kawasaki disease is the
development of coronary artery aneurysms, which can lead to myocardial infarction and
sudden death. Prompt treatment with intravenous immunoglobulin (IVIG) and aspirin is
crucial to reduce this risk.
, Question 8: A 12-year-old girl presents with a 6-month history of fatigue,
pallor, and a history of heavy menstrual bleeding. Her complete blood count
shows a microcytic, hypochromic anemia. Which of the following is the most
appropriate initial test to diagnose her condition?
A. Serum ferritin
B. Serum vitamin B12
C. Reticulocyte count
D. Hemoglobin electrophoresis
CORRECT ANSWER: A. Serum ferritin
Rationale:The presentation of fatigue, pallor, and microcytic hypochromic anemia in a
menstruating adolescent is most consistent with iron deficiency anemia. The most cost-
effective and specific initial test to confirm this is a low serum ferritin, which reflects low
iron stores. Vitamin B12 deficiency causes macrocytic anemia. Reticulocyte count would
be low in iron deficiency but is not as specific. Hemoglobin electrophoresis is used to
diagnose hemoglobinopathies.
Question 9: A 2-month-old infant is noted to have a single, midline, firm, non-
tender mass on the hard palate. The infant feeds well and has no other
abnormalities. What is the most likely diagnosis?
A. Epstein pearls
B. Cleft palate
C. Ranula
D. Natal tooth
CORRECT ANSWER: A. Epstein pearls
Rationale:Epstein pearls are small, keratin-filled cysts that are commonly found on the
hard palate of newborns and young infants. They are benign and require no treatment,
usually resolving spontaneously within a few weeks. A cleft palate is a structural defect.
A ranula is a mucocele on the floor of the mouth. Natal teeth are teeth present at birth.
Question 10: A 16-year-old male presents with a sudden onset of severe, sharp
chest pain and shortness of breath. On examination, he is tall and thin, with
decreased breath sounds on the left side and hyperresonance to percussion.
Which of the following is the most likely diagnosis?
A. Spontaneous pneumothorax
B. Acute asthma exacerbation
C. Pneumonia
D. Pulmonary embolism
CORRECT ANSWER: A. Spontaneous pneumothorax
Rationale:A spontaneous pneumothorax is a common condition in tall, thin adolescent
males. The sudden onset of severe chest pain and shortness of breath, coupled with
decreased breath sounds and hyperresonance, is classic for a pneumothorax. Asthma
