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ENPC 7TH EDITION EXAM/ENPC 7TH EDITION
Exam Preparation With Complete Questions And
Correct Answers With Rationales Already Graded
A+ Brand New Version!!
QUESTION 1
A 6-year-old child is brought to the emergency department with a fever
of 39.2°C, nuchal rigidity, and photophobia. The child appears irritable
and is difficult to console. Which of the following diagnostic procedures
is most definitive for confirming the suspected diagnosis?
A) Complete blood count with differential
B) Blood cultures
C) Lumbar puncture with cerebrospinal fluid analysis
D) Computed tomography of the head
Answer: C) Lumbar puncture with cerebrospinal fluid analysis
Explanation: The clinical presentation of fever, nuchal rigidity, and
photophobia in a child is highly suspicious for meningitis. While blood
cultures and CBC with differential provide supportive evidence, the
definitive diagnosis of meningitis requires cerebrospinal fluid analysis
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obtained via lumbar puncture. CSF analysis includes cell count, glucose,
protein, Gram stain, and culture, which can differentiate between
bacterial and viral etiologies. Head CT may be considered prior to LP if
there are concerns for increased intracranial pressure, but it is not
diagnostic for meningitis itself.
QUESTION 2
A 2-year-old child presents with stridor, barking cough, and subcostal
retractions. The child's parents report that symptoms began suddenly
at night and are worse when the child is lying down. What is the most
appropriate initial management for this child?
A) Nebulized racemic epinephrine
B) Oral dexamethasone
C) Humidified oxygen
D) Intramuscular ceftriaxone
Answer: B) Oral dexamethasone
Explanation: This presentation is classic for croup
(laryngotracheobronchitis), a viral illness causing subglottic airway
edema. The mainstay of treatment for mild to moderate croup is
corticosteroids, with oral dexamethasone being the preferred agent due
to its long half-life and anti-inflammatory effects. While nebulized
racemic epinephrine is used for moderate to severe croup with stridor at
rest, it is not the first-line initial management. Humidified oxygen may
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provide comfort but does not address the underlying inflammation.
Ceftriaxone is not indicated as croup is typically viral in origin.
QUESTION 3
A 10-year-old child involved in a motor vehicle collision presents with
abdominal pain, hypotension, and tachycardia. Focused assessment
with sonography for trauma (FAST) reveals free fluid in the right upper
quadrant. Which of the following is the most appropriate next step in
management?
A) Serial abdominal examinations
B) Diagnostic peritoneal lavage
C) Immediate surgical consultation
D) Computed tomography of the abdomen and pelvis
Answer: C) Immediate surgical consultation
Explanation: In a hemodynamically unstable child with blunt abdominal
trauma and a positive FAST examination indicating free fluid,
immediate surgical consultation is indicated. This presentation suggests
intra-abdominal hemorrhage, likely from solid organ injury such as the
liver or spleen. The unstable patient should not undergo CT scanning as
it delays definitive care and may require transport away from the
resuscitation area. Diagnostic peritoneal lavage is rarely used in the
pediatric population due to its invasive nature and the availability of
less invasive modalities.
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QUESTION 4
A 4-month-old infant is brought to the emergency department with a
history of poor feeding, lethargy, and vomiting. The infant is afebrile
but appears dehydrated. Serum laboratory results reveal sodium of 119
mEq/L, potassium of 3.2 mEq/L, and glucose of 90 mg/dL. Which of the
following is the most likely underlying etiology?
A) Syndrome of inappropriate antidiuretic hormone
B) Congenital adrenal hyperplasia
C) Gastroenteritis with dehydration
D) Diabetes insipidus
Answer: B) Congenital adrenal hyperplasia
Explanation: The combination of hyponatremia, hyperkalemia, and
dehydration in a young infant should raise suspicion for congenital
adrenal hyperplasia, an autosomal recessive disorder causing
deficiencies in cortisol and aldosterone synthesis. The lack of
aldosterone leads to salt wasting, resulting in hyponatremia and
hyperkalemia. SIADH would cause hyponatremia but not hyperkalemia.
Gastroenteritis with dehydration typically causes both sodium and
potassium losses, not isolated hyponatremia with hyperkalemia.
Diabetes insipidus would present with hypernatremia due to free water
loss.
QUESTION 5
ENPC 7TH EDITION EXAM/ENPC 7TH EDITION
Exam Preparation With Complete Questions And
Correct Answers With Rationales Already Graded
A+ Brand New Version!!
QUESTION 1
A 6-year-old child is brought to the emergency department with a fever
of 39.2°C, nuchal rigidity, and photophobia. The child appears irritable
and is difficult to console. Which of the following diagnostic procedures
is most definitive for confirming the suspected diagnosis?
A) Complete blood count with differential
B) Blood cultures
C) Lumbar puncture with cerebrospinal fluid analysis
D) Computed tomography of the head
Answer: C) Lumbar puncture with cerebrospinal fluid analysis
Explanation: The clinical presentation of fever, nuchal rigidity, and
photophobia in a child is highly suspicious for meningitis. While blood
cultures and CBC with differential provide supportive evidence, the
definitive diagnosis of meningitis requires cerebrospinal fluid analysis
,2|Page
obtained via lumbar puncture. CSF analysis includes cell count, glucose,
protein, Gram stain, and culture, which can differentiate between
bacterial and viral etiologies. Head CT may be considered prior to LP if
there are concerns for increased intracranial pressure, but it is not
diagnostic for meningitis itself.
QUESTION 2
A 2-year-old child presents with stridor, barking cough, and subcostal
retractions. The child's parents report that symptoms began suddenly
at night and are worse when the child is lying down. What is the most
appropriate initial management for this child?
A) Nebulized racemic epinephrine
B) Oral dexamethasone
C) Humidified oxygen
D) Intramuscular ceftriaxone
Answer: B) Oral dexamethasone
Explanation: This presentation is classic for croup
(laryngotracheobronchitis), a viral illness causing subglottic airway
edema. The mainstay of treatment for mild to moderate croup is
corticosteroids, with oral dexamethasone being the preferred agent due
to its long half-life and anti-inflammatory effects. While nebulized
racemic epinephrine is used for moderate to severe croup with stridor at
rest, it is not the first-line initial management. Humidified oxygen may
,3|Page
provide comfort but does not address the underlying inflammation.
Ceftriaxone is not indicated as croup is typically viral in origin.
QUESTION 3
A 10-year-old child involved in a motor vehicle collision presents with
abdominal pain, hypotension, and tachycardia. Focused assessment
with sonography for trauma (FAST) reveals free fluid in the right upper
quadrant. Which of the following is the most appropriate next step in
management?
A) Serial abdominal examinations
B) Diagnostic peritoneal lavage
C) Immediate surgical consultation
D) Computed tomography of the abdomen and pelvis
Answer: C) Immediate surgical consultation
Explanation: In a hemodynamically unstable child with blunt abdominal
trauma and a positive FAST examination indicating free fluid,
immediate surgical consultation is indicated. This presentation suggests
intra-abdominal hemorrhage, likely from solid organ injury such as the
liver or spleen. The unstable patient should not undergo CT scanning as
it delays definitive care and may require transport away from the
resuscitation area. Diagnostic peritoneal lavage is rarely used in the
pediatric population due to its invasive nature and the availability of
less invasive modalities.
, 4|Page
QUESTION 4
A 4-month-old infant is brought to the emergency department with a
history of poor feeding, lethargy, and vomiting. The infant is afebrile
but appears dehydrated. Serum laboratory results reveal sodium of 119
mEq/L, potassium of 3.2 mEq/L, and glucose of 90 mg/dL. Which of the
following is the most likely underlying etiology?
A) Syndrome of inappropriate antidiuretic hormone
B) Congenital adrenal hyperplasia
C) Gastroenteritis with dehydration
D) Diabetes insipidus
Answer: B) Congenital adrenal hyperplasia
Explanation: The combination of hyponatremia, hyperkalemia, and
dehydration in a young infant should raise suspicion for congenital
adrenal hyperplasia, an autosomal recessive disorder causing
deficiencies in cortisol and aldosterone synthesis. The lack of
aldosterone leads to salt wasting, resulting in hyponatremia and
hyperkalemia. SIADH would cause hyponatremia but not hyperkalemia.
Gastroenteritis with dehydration typically causes both sodium and
potassium losses, not isolated hyponatremia with hyperkalemia.
Diabetes insipidus would present with hypernatremia due to free water
loss.
QUESTION 5
