APEA Predictor Exam Questions and Answers
100% Verified
Question:
A 1-month-old presents with reported recurrent diarrhea, screaming, and drawing up of the
legs followed by periods of lethargy. On physical examination, a "sausage- like" mass in the
upper right quadrant of the distended abdomen. Which of the following is the most likely
diagnosis? Volvulus Crohn's disease Foreign body in the GI tract Intussusception
Answer:
Intussusception explanation: Intussusception is one of the most common causes of
abdominal obstruction in children prior 2 years of age; is best described as a portion of
the intestine which telescopes into a more distal intestinal segment. The classic triad of
intussusception include crampy (intermittent, also known as colicky) abdominal pain,
vomiting, and bloody stools. The patient may pull up his knees with crying. The patient
may develop vomiting with bilious emesis. Progressive lethargy/altered level of
consciousness and pallor is common. The etiology of this lethargic presentation is not
known, but it tends to occur in younger infants. As intussusception progresses, a
palpable, sausage- shape mass may develop. Some hypothesize that this is due to
release of endogenous opioids or endotoxins released from ischemic bowel.
Intussusception in a child presenting with lethargy is often difficult to diagnose since
other causes of lethargy such as dehydration, hypoglycemia, sepsis, toxic ingestion,
post-ictal state, etc., must also be considered. Ultrasound is the preferred diagnostic test.
Enemas is considered the first line of treatment prior surgery. Volvulus occurs more
frequently in middle-aged and elderly men. Crohn's is most often diagnosed between 13
- 30 years of age.
, Question:
A 3 y/o has enlarged, warm, tender cervical lymph nodes, indicating: Infection proximal to
the nodes . A possible cancer diagnosis Shorty nodes, a common normal variant in children
An infectious process distal to the nodes
Answer:
Infection proximal to the nodes explanation: size of lymph nodes is important. Nodes > 1
cm are significant and should be asses carefully. Nodes > 5 cm are almost always
neoplastic. Tenderness of a node usually suggest inflammation. Cancerous nodes
frequently are larger, non-tender, and stone-like in consistency. Nodes are pea-sized,
non-tender, mobile, discrete and reflect pre-existent infection.
Question:
A 6 y/o presents w/ complaints of sore throat and fever for 2 days. He has multiple
vesiculated ulcerations on his tonsils and uvula. There are no other remarkable findings.
What is the most likely diagnosis? a. Viral pharyngitis b. Herpangina Epiglottitis Tonsillitis
Answer:
Herpangina Explanation: Herpangina is a viral infection common in toddlers and young
children caused by Coxsackie virus. The clinical findings of numerous, small (1-2 mm)
ulcerations on the tonsils and uvula are typical of herpangina. The ulcerations can be
very painful but usually resolve in 7 to 10 days. Treatment is symptomatic.
100% Verified
Question:
A 1-month-old presents with reported recurrent diarrhea, screaming, and drawing up of the
legs followed by periods of lethargy. On physical examination, a "sausage- like" mass in the
upper right quadrant of the distended abdomen. Which of the following is the most likely
diagnosis? Volvulus Crohn's disease Foreign body in the GI tract Intussusception
Answer:
Intussusception explanation: Intussusception is one of the most common causes of
abdominal obstruction in children prior 2 years of age; is best described as a portion of
the intestine which telescopes into a more distal intestinal segment. The classic triad of
intussusception include crampy (intermittent, also known as colicky) abdominal pain,
vomiting, and bloody stools. The patient may pull up his knees with crying. The patient
may develop vomiting with bilious emesis. Progressive lethargy/altered level of
consciousness and pallor is common. The etiology of this lethargic presentation is not
known, but it tends to occur in younger infants. As intussusception progresses, a
palpable, sausage- shape mass may develop. Some hypothesize that this is due to
release of endogenous opioids or endotoxins released from ischemic bowel.
Intussusception in a child presenting with lethargy is often difficult to diagnose since
other causes of lethargy such as dehydration, hypoglycemia, sepsis, toxic ingestion,
post-ictal state, etc., must also be considered. Ultrasound is the preferred diagnostic test.
Enemas is considered the first line of treatment prior surgery. Volvulus occurs more
frequently in middle-aged and elderly men. Crohn's is most often diagnosed between 13
- 30 years of age.
, Question:
A 3 y/o has enlarged, warm, tender cervical lymph nodes, indicating: Infection proximal to
the nodes . A possible cancer diagnosis Shorty nodes, a common normal variant in children
An infectious process distal to the nodes
Answer:
Infection proximal to the nodes explanation: size of lymph nodes is important. Nodes > 1
cm are significant and should be asses carefully. Nodes > 5 cm are almost always
neoplastic. Tenderness of a node usually suggest inflammation. Cancerous nodes
frequently are larger, non-tender, and stone-like in consistency. Nodes are pea-sized,
non-tender, mobile, discrete and reflect pre-existent infection.
Question:
A 6 y/o presents w/ complaints of sore throat and fever for 2 days. He has multiple
vesiculated ulcerations on his tonsils and uvula. There are no other remarkable findings.
What is the most likely diagnosis? a. Viral pharyngitis b. Herpangina Epiglottitis Tonsillitis
Answer:
Herpangina Explanation: Herpangina is a viral infection common in toddlers and young
children caused by Coxsackie virus. The clinical findings of numerous, small (1-2 mm)
ulcerations on the tonsils and uvula are typical of herpangina. The ulcerations can be
very painful but usually resolve in 7 to 10 days. Treatment is symptomatic.
