PEDSS LATEST UPDATED 2025 REAL FINAL EXAM WITH
COMPLETE DETAILED QUESTIONS AND CORRECT VERIFIED
ANSWERS ALREADY A+ GRADED
4-year-old boy brought to clinic for eval of scrotal swelling. His mother first noticed swelling near right
testicle after giving him a bath 2 days ago. Mass is not painful, the patient has had no difficulty urinating.
He has had no recent testicular trauma & patient is otherwise healthy & takes no meds. Temp is 37.1C
(98.8F). Initial BP: 160/96; a repeat assessment is 152/92. GU exam reveals Tanner stage 1 development
with bilateral testicles within the scrotum. There is a palpable, contender, soft, coiled mass superior to
the right testicle. The mass does not transilluminate & does not decrease in size when patient is supine.
Remainder of PE is normal. UA reveals no blood, nitrites or leukocyte esterase. Which is next best step in
management of this patient?
A. Bx of scrotal mass
B. reassurance & observation only
C. surgical orchiectomy
D. US of abdomen
E. urine culture
ANSWER-D. US of abdomen
a secondary varicocele should be suspected in a prepubertal boy with a soft, coiled ("bag of worms"),
right-sided scrotal mass that fails to decompress when supine. Abdominal US is indicated to evaluate for
anatomical causes leading to venous compression (such as venous thrombus or abdominal mass)
9-year-old boy brought to ED by his babysitter after having a seizure at home. The patient takes
carbamazepine for epilepsy & has not had a seizure in years. It has been a stressful time for him as his
parents are going through a divorce & he has been splitting time between 2 homes. The boy also just
returned from a week-long stay at his grandparents' house. VS are normal. On PE, patient is drowsy but
able to answer questions and follow directions. Pupils are equal & reactive to light. Cardiopulmonary
exam is normal. The abdomen is soft & without hepatosplenomegaly. Muscle tone & strength are
normal in all extremities. Which of the following is the best next step in evaluating this patient?
,A. check LFTs & ammonia levels
B. evaluate for inborn errors of metabolism
C. measure serum carbamazepine level
D. order CT of head
E. perform ECG
ANSWER-C. check carbamazepine levels
non adherence to meds is a major cause of breakthrough seizures in patients with epilepsy. Prompt
measurement of serum anti epileptic drug concentrations is an important part of the initial workup for
these patients.
8-year-old boy is brought to ED by paramedics with a reported ingestion about 4 hours ago. The patient
had an accidental ingestion of "antifreeze" after mistaking it for a beverage in the garage. Which exam
fining is most likely to be found in this patient?
A. dry skin & mucosal surfaces
B. irregular HR
C. excessive salivation
D. pupillary dilation
E. rapid & deep breathing
ANSWER-E. rapid & deep breathing
Ethylene glycol ingestion leads to a severe anion gap metabolic acidosis. This causes a typical rapid &
deep breathing known as Kussmaul's respiration.
13-year old boy brought to the clinic by his parents due to copious, purulent discharge from his right
eye. The patient's eye was crusted shut this morning. His father was able to open the eye by wiping it
with a damp washcloth. The patient has had no fever, ocular pain, visual changes or sick contacts. He
has mild myopic and wears contact lenses. VS are normal. Exam shows conjunctival erythema & yellow
exudate in the right eye. The conjunctiva of the left eye is also erythematous, but there are no
,secretions. Visual acuity testing with contacts removed shows 20/80 vision in both eyes, which is
unchanged from the last well-child visit at age 12. If left untreated, this patient is at greatest risk for
what?
A. cavernous sinus thrombosis
B. endopthalmitis
C. hordeolum
D. Keratitis
E. uveitis
ANSWER-D. keratitis
bacterial conjunctivitis typically presents with erythema & copious yellow or white purulent discharge in
a single eye, but can involve both eyes. If left untreated a rare but vision-threatening complication of
bacterial conjunctivitis is infectious keratitis or inflammation of the cornea
16-year-old comes to the office in October due to right knee swelling that began yesterday following
soccer practice. He has mild associated stiffness. Over the last several months, he has had fatigue with
occasional flulike illnesses & pain occurring in variable joints. The patient spent the summer in Maine.
He is sexually active & uses condoms. VS is normal. The patient can bear weight. The right knee is
tender, warm & has a large effusion. All other joints are normal. Joint aspiration fluid has a leukocyte
count of 20,000/mm3 (50% neutrophils) & no organisms on Gram stain. What is most likely cause of
patient's knee swelling?
A. Borrelia burgdorferi infection
B. disseminated gonococcal infection
C. prior Chlamydia trachoma's infection
D. prior streptococcal throat infection
E. Staph joint infection
ANSWER-A. Borrelia burgdorferi infection
Lyme arthritis is the hallmark of late Lyme disease due to Borrelia burgdorferi infection. The
presentation is most commonly a monoarticular arthritis of the knee that occurs in a weight-bearing,
afebrile patient. Synovial fluid analysis shows inflammation but Gram stain & culture are usually
negative
, 5-year-old boy brought to the clinic due to persistent purulent right ear discharge for a month, not
relieved by topical or oral ABX. He has had no fever, ear pain, dizziness or tinnitus. The patient was born
with a cleft palate that was prepared in infancy. Due to bilateral persistent middle ear effusions,
tympanostomy tubes were also placed. 3 years ago, the tympanostomy tubes were removed, after
which audiometry was normal. He has no other medical conditions. Temp 37.2C (99F). There is scant,
yellow, malodorous insufflation & appears intact. There is retraction of the superior portion of the TM &
a pearly white mass. The left TM is mobile & normal appearance. Audiometry reveals conductive hearing
loss on the right side. Gait is normal. What is most likely responsible for this patient's presentation?
A. cholesteatoma
B. foreign body
C. otitis externa
D. otitis media
E. vestibular schwannoma
ANSWER-A. cholesteatoma
cholesteatomas result from the accumulation of keratin debris & squamous epithelial cells within a TM
retraction pocket. Sx include persistent otorrhea & conductive hearing loss & exam often reveals a
pearly white mass behind an intact TM.
a 4-hour-old boy is evaluated in the nursery for routine newborn care. The patient was born at 38 weeks
gestation via spontaneous vaginal delivery to an 18-year-old woman who did not receive prenatal care.
Birth weight is 3.6kg (8lb). VS are normal. Exam shows a sleeping infant in no distress. There is molding
of the occiput. A soft mass inferior to the umbilical stump is 1.4cm in diameter & covered by skin. The
mass increases in size when the infant cries & reduces into the abdominal cavity with gentle pressure.
The mass does not seem tender to palpation. The rest of PE is normal. What is the next best step in
management?
A. abdominal US
B. immediate surgery
C. karyotype analysis
COMPLETE DETAILED QUESTIONS AND CORRECT VERIFIED
ANSWERS ALREADY A+ GRADED
4-year-old boy brought to clinic for eval of scrotal swelling. His mother first noticed swelling near right
testicle after giving him a bath 2 days ago. Mass is not painful, the patient has had no difficulty urinating.
He has had no recent testicular trauma & patient is otherwise healthy & takes no meds. Temp is 37.1C
(98.8F). Initial BP: 160/96; a repeat assessment is 152/92. GU exam reveals Tanner stage 1 development
with bilateral testicles within the scrotum. There is a palpable, contender, soft, coiled mass superior to
the right testicle. The mass does not transilluminate & does not decrease in size when patient is supine.
Remainder of PE is normal. UA reveals no blood, nitrites or leukocyte esterase. Which is next best step in
management of this patient?
A. Bx of scrotal mass
B. reassurance & observation only
C. surgical orchiectomy
D. US of abdomen
E. urine culture
ANSWER-D. US of abdomen
a secondary varicocele should be suspected in a prepubertal boy with a soft, coiled ("bag of worms"),
right-sided scrotal mass that fails to decompress when supine. Abdominal US is indicated to evaluate for
anatomical causes leading to venous compression (such as venous thrombus or abdominal mass)
9-year-old boy brought to ED by his babysitter after having a seizure at home. The patient takes
carbamazepine for epilepsy & has not had a seizure in years. It has been a stressful time for him as his
parents are going through a divorce & he has been splitting time between 2 homes. The boy also just
returned from a week-long stay at his grandparents' house. VS are normal. On PE, patient is drowsy but
able to answer questions and follow directions. Pupils are equal & reactive to light. Cardiopulmonary
exam is normal. The abdomen is soft & without hepatosplenomegaly. Muscle tone & strength are
normal in all extremities. Which of the following is the best next step in evaluating this patient?
,A. check LFTs & ammonia levels
B. evaluate for inborn errors of metabolism
C. measure serum carbamazepine level
D. order CT of head
E. perform ECG
ANSWER-C. check carbamazepine levels
non adherence to meds is a major cause of breakthrough seizures in patients with epilepsy. Prompt
measurement of serum anti epileptic drug concentrations is an important part of the initial workup for
these patients.
8-year-old boy is brought to ED by paramedics with a reported ingestion about 4 hours ago. The patient
had an accidental ingestion of "antifreeze" after mistaking it for a beverage in the garage. Which exam
fining is most likely to be found in this patient?
A. dry skin & mucosal surfaces
B. irregular HR
C. excessive salivation
D. pupillary dilation
E. rapid & deep breathing
ANSWER-E. rapid & deep breathing
Ethylene glycol ingestion leads to a severe anion gap metabolic acidosis. This causes a typical rapid &
deep breathing known as Kussmaul's respiration.
13-year old boy brought to the clinic by his parents due to copious, purulent discharge from his right
eye. The patient's eye was crusted shut this morning. His father was able to open the eye by wiping it
with a damp washcloth. The patient has had no fever, ocular pain, visual changes or sick contacts. He
has mild myopic and wears contact lenses. VS are normal. Exam shows conjunctival erythema & yellow
exudate in the right eye. The conjunctiva of the left eye is also erythematous, but there are no
,secretions. Visual acuity testing with contacts removed shows 20/80 vision in both eyes, which is
unchanged from the last well-child visit at age 12. If left untreated, this patient is at greatest risk for
what?
A. cavernous sinus thrombosis
B. endopthalmitis
C. hordeolum
D. Keratitis
E. uveitis
ANSWER-D. keratitis
bacterial conjunctivitis typically presents with erythema & copious yellow or white purulent discharge in
a single eye, but can involve both eyes. If left untreated a rare but vision-threatening complication of
bacterial conjunctivitis is infectious keratitis or inflammation of the cornea
16-year-old comes to the office in October due to right knee swelling that began yesterday following
soccer practice. He has mild associated stiffness. Over the last several months, he has had fatigue with
occasional flulike illnesses & pain occurring in variable joints. The patient spent the summer in Maine.
He is sexually active & uses condoms. VS is normal. The patient can bear weight. The right knee is
tender, warm & has a large effusion. All other joints are normal. Joint aspiration fluid has a leukocyte
count of 20,000/mm3 (50% neutrophils) & no organisms on Gram stain. What is most likely cause of
patient's knee swelling?
A. Borrelia burgdorferi infection
B. disseminated gonococcal infection
C. prior Chlamydia trachoma's infection
D. prior streptococcal throat infection
E. Staph joint infection
ANSWER-A. Borrelia burgdorferi infection
Lyme arthritis is the hallmark of late Lyme disease due to Borrelia burgdorferi infection. The
presentation is most commonly a monoarticular arthritis of the knee that occurs in a weight-bearing,
afebrile patient. Synovial fluid analysis shows inflammation but Gram stain & culture are usually
negative
, 5-year-old boy brought to the clinic due to persistent purulent right ear discharge for a month, not
relieved by topical or oral ABX. He has had no fever, ear pain, dizziness or tinnitus. The patient was born
with a cleft palate that was prepared in infancy. Due to bilateral persistent middle ear effusions,
tympanostomy tubes were also placed. 3 years ago, the tympanostomy tubes were removed, after
which audiometry was normal. He has no other medical conditions. Temp 37.2C (99F). There is scant,
yellow, malodorous insufflation & appears intact. There is retraction of the superior portion of the TM &
a pearly white mass. The left TM is mobile & normal appearance. Audiometry reveals conductive hearing
loss on the right side. Gait is normal. What is most likely responsible for this patient's presentation?
A. cholesteatoma
B. foreign body
C. otitis externa
D. otitis media
E. vestibular schwannoma
ANSWER-A. cholesteatoma
cholesteatomas result from the accumulation of keratin debris & squamous epithelial cells within a TM
retraction pocket. Sx include persistent otorrhea & conductive hearing loss & exam often reveals a
pearly white mass behind an intact TM.
a 4-hour-old boy is evaluated in the nursery for routine newborn care. The patient was born at 38 weeks
gestation via spontaneous vaginal delivery to an 18-year-old woman who did not receive prenatal care.
Birth weight is 3.6kg (8lb). VS are normal. Exam shows a sleeping infant in no distress. There is molding
of the occiput. A soft mass inferior to the umbilical stump is 1.4cm in diameter & covered by skin. The
mass increases in size when the infant cries & reduces into the abdominal cavity with gentle pressure.
The mass does not seem tender to palpation. The rest of PE is normal. What is the next best step in
management?
A. abdominal US
B. immediate surgery
C. karyotype analysis
