NR602 Advanced Pediatric Care Week 6 Final
Exam Comprehensive Case Studies &
Rationales
Practice Exam – Version 1
1. A 4-year-old child presents with fever, strawberry tongue, cracked lips, and a polymorphous rash.
What is the most likely diagnosis?
A. Scarlet fever
B. Kawasaki disease
C. Measles
D. Rubella
Correct Answer: B
Rationale: Kawasaki disease is characterized by fever lasting ≥5 days, strawberry
tongue, cracked lips, polymorphous rash, conjunctivitis, and cervical
lymphadenopathy. Scarlet fever causes a sandpaper-like rash and strawberry
tongue but lacks conjunctivitis and cracked lips. Measles causes Koplik spots and a
cephalocaudal rash. Rubella causes a fine pink rash and lymphadenopathy.
2. A 2-month-old infant presents with a heart murmur, poor feeding, and diaphoresis during feeds.
Which congenital heart defect should be suspected?
A. Ventricular septal defect
B. Tetralogy of Fallot
C. Patent ductus arteriosus
D. Atrial septal defect
Correct Answer: A
Rationale: Ventricular septal defect (VSD) is the most common congenital heart
defect and can cause heart failure symptoms such as poor feeding, diaphoresis,
and murmur. Tetralogy of Fallot causes cyanotic spells. Patent ductus arteriosus
causes a continuous machine-like murmur. Atrial septal defect is often
asymptomatic in infancy.
,3. A 6-year-old child presents with periorbital edema, hematuria, and hypertension. What is the most
likely diagnosis?
A. Nephrotic syndrome
B. Acute glomerulonephritis
C. Urinary tract infection
D. Henoch-Schönlein purpura
Correct Answer: B
Rationale: Acute glomerulonephritis classically presents with periorbital edema,
hematuria, hypertension, and recent streptococcal infection. Nephrotic syndrome
causes generalized edema, proteinuria, and hypoalbuminemia without hematuria.
UTI causes dysuria and fever. Henoch-Schönlein purpura causes palpable purpura
and abdominal pain.
4. A 3-year-old child presents with a barking cough, inspiratory stridor, and hoarseness. What is the
most likely diagnosis?
A. Epiglottitis
B. Croup
C. Bronchiolitis
D. Asthma
Correct Answer: B
Rationale: Croup (laryngotracheobronchitis) presents with a barking cough,
inspiratory stridor, and hoarseness, often following a viral upper respiratory
infection. Epiglottitis causes drooling, dysphagia, and tripod positioning.
Bronchiolitis causes wheezing and crackles in infants. Asthma causes wheezing
and shortness of breath.
5. A 5-year-old child presents with a sudden onset of severe abdominal pain, vomiting, and currant
jelly stools. What is the most likely diagnosis?
A. Appendicitis
B. Intussusception
C. Gastroenteritis
D. Pyloric stenosis
Correct Answer: B
,Rationale: Intussusception classically presents with sudden severe abdominal pain,
vomiting, and currant jelly stools (blood and mucus). Appendicitis causes right
lower quadrant pain and fever. Gastroenteritis causes diarrhea and vomiting.
Pyloric stenosis causes projectile vomiting in infants.
6. A 2-week-old infant presents with projectile vomiting after feeds and a palpable olive-shaped mass
in the epigastrium. What is the most likely diagnosis?
A. Pyloric stenosis
B. Gastroesophageal reflux
C. Intussusception
D. Malrotation
Correct Answer: A
Rationale: Pyloric stenosis presents with projectile vomiting, a palpable olive-
shaped mass, and visible gastric peristaltic waves. Gastroesophageal reflux causes
spitting up but not projectile vomiting. Intussusception causes currant jelly stools.
Malrotation causes bilious vomiting.
7. A 4-year-old child presents with fever, drooling, and tripod positioning. What is the most
concerning diagnosis?
A. Croup
B. Epiglottitis
C. Tonsillitis
D. Laryngitis
Correct Answer: B
Rationale: Epiglottitis presents with fever, drooling, dysphagia, and tripod
positioning and is a medical emergency. Croup causes barking cough and stridor.
Tonsillitis causes sore throat and fever. Laryngitis causes hoarseness.
8. A 7-year-old child presents with a new onset of seizures. Which imaging study should be ordered
first?
A. CT scan of the head without contrast
B. MRI of the brain with contrast
C. EEG
D. PET scan
, Correct Answer: A
Rationale: A non-contrast CT scan of the head is the initial imaging study for new-
onset seizures to rule out acute hemorrhage, mass, or structural abnormality. MRI
may be ordered subsequently. EEG evaluates electrical activity. PET scan is not
first-line.
9. A 10-year-old child presents with fatigue, pallor, and pica. Which laboratory finding is most
consistent with iron deficiency anemia?
A. Elevated ferritin
B. Low ferritin
C. Elevated vitamin B12
D. Low MCV and low ferritin
Correct Answer: D
Rationale: Iron deficiency anemia is characterized by microcytic (low MCV) anemia
with low ferritin, low serum iron, and elevated TIBC. Elevated ferritin suggests iron
overload or inflammation. Vitamin B12 deficiency causes macrocytic anemia.
10. A 6-month-old infant presents with a history of recurrent ear infections. Which anatomical factor
predisposes infants to otitis media?
A. Short, horizontal eustachian tube
B. Long, vertical eustachian tube
C. Large adenoids
D. Small tonsils
Correct Answer: A
Rationale: Infants have a short, horizontal eustachian tube that allows bacteria
and fluid to easily reach the middle ear, predisposing them to otitis media. Older
children and adults have a longer, more vertical eustachian tube.
11. A 3-year-old child presents with a rash that starts on the face and spreads downward, along with
Koplik spots. What is the most likely diagnosis?
A. Rubella
B. Measles
C. Scarlet fever
D. Roseola
Exam Comprehensive Case Studies &
Rationales
Practice Exam – Version 1
1. A 4-year-old child presents with fever, strawberry tongue, cracked lips, and a polymorphous rash.
What is the most likely diagnosis?
A. Scarlet fever
B. Kawasaki disease
C. Measles
D. Rubella
Correct Answer: B
Rationale: Kawasaki disease is characterized by fever lasting ≥5 days, strawberry
tongue, cracked lips, polymorphous rash, conjunctivitis, and cervical
lymphadenopathy. Scarlet fever causes a sandpaper-like rash and strawberry
tongue but lacks conjunctivitis and cracked lips. Measles causes Koplik spots and a
cephalocaudal rash. Rubella causes a fine pink rash and lymphadenopathy.
2. A 2-month-old infant presents with a heart murmur, poor feeding, and diaphoresis during feeds.
Which congenital heart defect should be suspected?
A. Ventricular septal defect
B. Tetralogy of Fallot
C. Patent ductus arteriosus
D. Atrial septal defect
Correct Answer: A
Rationale: Ventricular septal defect (VSD) is the most common congenital heart
defect and can cause heart failure symptoms such as poor feeding, diaphoresis,
and murmur. Tetralogy of Fallot causes cyanotic spells. Patent ductus arteriosus
causes a continuous machine-like murmur. Atrial septal defect is often
asymptomatic in infancy.
,3. A 6-year-old child presents with periorbital edema, hematuria, and hypertension. What is the most
likely diagnosis?
A. Nephrotic syndrome
B. Acute glomerulonephritis
C. Urinary tract infection
D. Henoch-Schönlein purpura
Correct Answer: B
Rationale: Acute glomerulonephritis classically presents with periorbital edema,
hematuria, hypertension, and recent streptococcal infection. Nephrotic syndrome
causes generalized edema, proteinuria, and hypoalbuminemia without hematuria.
UTI causes dysuria and fever. Henoch-Schönlein purpura causes palpable purpura
and abdominal pain.
4. A 3-year-old child presents with a barking cough, inspiratory stridor, and hoarseness. What is the
most likely diagnosis?
A. Epiglottitis
B. Croup
C. Bronchiolitis
D. Asthma
Correct Answer: B
Rationale: Croup (laryngotracheobronchitis) presents with a barking cough,
inspiratory stridor, and hoarseness, often following a viral upper respiratory
infection. Epiglottitis causes drooling, dysphagia, and tripod positioning.
Bronchiolitis causes wheezing and crackles in infants. Asthma causes wheezing
and shortness of breath.
5. A 5-year-old child presents with a sudden onset of severe abdominal pain, vomiting, and currant
jelly stools. What is the most likely diagnosis?
A. Appendicitis
B. Intussusception
C. Gastroenteritis
D. Pyloric stenosis
Correct Answer: B
,Rationale: Intussusception classically presents with sudden severe abdominal pain,
vomiting, and currant jelly stools (blood and mucus). Appendicitis causes right
lower quadrant pain and fever. Gastroenteritis causes diarrhea and vomiting.
Pyloric stenosis causes projectile vomiting in infants.
6. A 2-week-old infant presents with projectile vomiting after feeds and a palpable olive-shaped mass
in the epigastrium. What is the most likely diagnosis?
A. Pyloric stenosis
B. Gastroesophageal reflux
C. Intussusception
D. Malrotation
Correct Answer: A
Rationale: Pyloric stenosis presents with projectile vomiting, a palpable olive-
shaped mass, and visible gastric peristaltic waves. Gastroesophageal reflux causes
spitting up but not projectile vomiting. Intussusception causes currant jelly stools.
Malrotation causes bilious vomiting.
7. A 4-year-old child presents with fever, drooling, and tripod positioning. What is the most
concerning diagnosis?
A. Croup
B. Epiglottitis
C. Tonsillitis
D. Laryngitis
Correct Answer: B
Rationale: Epiglottitis presents with fever, drooling, dysphagia, and tripod
positioning and is a medical emergency. Croup causes barking cough and stridor.
Tonsillitis causes sore throat and fever. Laryngitis causes hoarseness.
8. A 7-year-old child presents with a new onset of seizures. Which imaging study should be ordered
first?
A. CT scan of the head without contrast
B. MRI of the brain with contrast
C. EEG
D. PET scan
, Correct Answer: A
Rationale: A non-contrast CT scan of the head is the initial imaging study for new-
onset seizures to rule out acute hemorrhage, mass, or structural abnormality. MRI
may be ordered subsequently. EEG evaluates electrical activity. PET scan is not
first-line.
9. A 10-year-old child presents with fatigue, pallor, and pica. Which laboratory finding is most
consistent with iron deficiency anemia?
A. Elevated ferritin
B. Low ferritin
C. Elevated vitamin B12
D. Low MCV and low ferritin
Correct Answer: D
Rationale: Iron deficiency anemia is characterized by microcytic (low MCV) anemia
with low ferritin, low serum iron, and elevated TIBC. Elevated ferritin suggests iron
overload or inflammation. Vitamin B12 deficiency causes macrocytic anemia.
10. A 6-month-old infant presents with a history of recurrent ear infections. Which anatomical factor
predisposes infants to otitis media?
A. Short, horizontal eustachian tube
B. Long, vertical eustachian tube
C. Large adenoids
D. Small tonsils
Correct Answer: A
Rationale: Infants have a short, horizontal eustachian tube that allows bacteria
and fluid to easily reach the middle ear, predisposing them to otitis media. Older
children and adults have a longer, more vertical eustachian tube.
11. A 3-year-old child presents with a rash that starts on the face and spreads downward, along with
Koplik spots. What is the most likely diagnosis?
A. Rubella
B. Measles
C. Scarlet fever
D. Roseola
