MED720 Pediatrics Clerkship Exam Prep – Real Practice Questions, Answers &
Detailed Rationales (Updated 2026) | Pediatric Assessment & Growth
Milestones, Neonatal & Infant Care, Childhood Diseases & Infections, Developmental
Disorders, Pediatric Pharmacology, Vaccination Schedules, Emergency Pediatric
Care, Nutrition & Fluid Management, Clinical Rotations & Shelf Exam Review
Question 1: A 3-day-old term infant presents with yellow discoloration of the skin
and sclera. The bilirubin level is 12 mg/dL, predominantly unconjugated. The infant
is feeding well, has normal stool color, and is afebrile. What is the most
appropriate next step in management?
A. Phototherapy
B. Exchange transfusion
C. Observation and reassurance
D. Intravenous immunoglobulin
CORRECT ANSWER: C. Observation and reassurance
Rationale: This infant has physiologic jaundice, which typically appears after 24 hours
of life, peaks around days 3-5, and resolves spontaneously. The bilirubin level of 12
mg/dL at day 3 in a well-appearing, feeding term infant is below the threshold for
phototherapy per AAP guidelines. Observation, ensuring adequate feeding, and parental
reassurance are appropriate. Phototherapy is indicated for higher bilirubin levels based
on age-specific nomograms. Exchange transfusion is reserved for severe
hyperbilirubinemia with risk of kernicterus. IVIG is used in isoimmune hemolytic
disease, which is not suggested here.
Question 2: A 6-month-old infant is brought for a well-child visit. The parent reports
the infant can sit without support, transfer objects hand-to-hand, and babbles
"mama" and "dada" nonspecifically. Which developmental milestone is this infant
expected to achieve NEXT?
A. Pincer grasp
B. Walking independently
C. Saying three words with meaning
D. Building a tower of two cubes
CORRECT ANSWER: A. Pincer grasp
Rationale: At 6 months, infants typically sit without support, transfer objects, and
babble. The next fine motor milestone is the pincer grasp (using thumb and forefinger),
which typically emerges around 9-12 months. Walking independently occurs around 12-
15 months. Saying three words with meaning is a 12-18 month language milestone.
Building a tower of two cubes is a 15-18 month fine motor skill. Understanding
developmental sequences is essential for anticipatory guidance and early identification
of delays.
Question 3: A 2-year-old child presents with a 2-day history of fever, cough, and
rhinorrhea. On examination, the child has inspiratory stridor, a barking cough, and
,mild suprasternal retractions. Oxygen saturation is 97% on room air. What is the
most appropriate initial pharmacologic treatment?
A. Nebulized epinephrine
B. Oral dexamethasone
C. Intravenous antibiotics
D. Albuterol nebulizer
CORRECT ANSWER: B. Oral dexamethasone
Rationale: This child has croup (laryngotracheitis), characterized by barking cough,
stridor, and preceding URI symptoms. Corticosteroids (e.g., oral dexamethasone 0.6
mg/kg) are first-line therapy to reduce airway edema and decrease hospitalization rates.
Nebulized epinephrine is reserved for moderate to severe croup with significant
respiratory distress. Antibiotics are not indicated as croup is typically viral
(parainfluenza). Albuterol is used for bronchospasm in asthma, not upper airway
edema.
Question 4: A 4-year-old child presents with acute onset of high fever, sore throat,
drooling, and preference to sit upright with neck extended. The child appears toxic
and anxious. What is the most critical next step in management?
A. Obtain a rapid streptococcal test
B. Administer intravenous antibiotics
C. Secure the airway in a controlled setting
D. Perform a lateral neck radiograph
CORRECT ANSWER: C. Secure the airway in a controlled setting
Rationale: This presentation is classic for epiglottitis, a life-threatening emergency
characterized by fever, sore throat, drooling, dysphagia, and tripod positioning. Airway
obstruction can progress rapidly. The priority is securing the airway via intubation in an
operating room with ENT and anesthesia support. Examination of the throat or
procedures that agitate the child may precipitate complete obstruction. Antibiotics
(e.g., ceftriaxone) are given after airway stabilization. Radiographs are not
recommended if epiglottitis is strongly suspected due to risk of deterioration during
transport.
Question 5: A 9-month-old infant has a temperature of 39.5°C (103.1°F) for 24 hours
with no focal signs of infection. The infant is well-appearing, feeding normally, and
has normal vital signs otherwise. What is the most appropriate management?
A. Immediate lumbar puncture
B. Urine culture and empiric antibiotics
C. Antipyretics and close outpatient follow-up
D. Complete blood count and blood culture
CORRECT ANSWER: C. Antipyretics and close outpatient follow-up
,Rationale: In a well-appearing, immunized infant 6-24 months with fever without a
source, the risk of serious bacterial infection is low. Current guidelines support
symptomatic management with antipyretics, ensuring hydration, and close follow-up
within 24-48 hours. Routine laboratory evaluation or empiric antibiotics are not
indicated without concerning features (e.g., ill appearance, focal findings, incomplete
immunizations). Lumbar puncture is reserved for infants with meningeal signs or high-
risk features. Urine culture may be considered in uncircumcised males <12 months or
females <24 months, but is not universally required in well-appearing infants.
Question 6: A 5-year-old child with known asthma presents with increased cough,
wheezing, and shortness of breath for 2 days. The child uses albuterol every 4
hours with minimal relief. On exam, the child has tachypnea, wheezing throughout,
and oxygen saturation of 92% on room air. What is the most appropriate initial
treatment in the emergency department?
A. Oral prednisolone
B. Nebulized albuterol plus ipratropium
C. Intravenous magnesium sulfate
D. Subcutaneous epinephrine
CORRECT ANSWER: B. Nebulized albuterol plus ipratropium
Rationale: For moderate to severe acute asthma exacerbations, initial management
includes frequent or continuous short-acting beta-agonists (albuterol) plus an
anticholinergic (ipratropium) via nebulizer to achieve maximal bronchodilation.
Systemic corticosteroids (oral or IV) should be administered early but are adjunctive,
not the initial bronchodilator therapy. IV magnesium sulfate is reserved for severe
exacerbations not responding to initial therapy. Subcutaneous epinephrine is used in
anaphylaxis or severe bronchospasm when nebulizers are ineffective or unavailable.
Question 7: A 3-week-old infant presents with projectile, non-bilious vomiting after
feeds. The infant is hungry after vomiting and has not gained weight appropriately.
On examination, a small, olive-shaped mass is palpable in the epigastrium. What is
the diagnostic test of choice?
A. Abdominal ultrasound
B. Upper gastrointestinal series
C. Abdominal CT scan
D. Esophageal pH monitoring
CORRECT ANSWER: A. Abdominal ultrasound
Rationale: This presentation is classic for hypertrophic pyloric stenosis, which typically
presents at 3-6 weeks with projectile non-bilious vomiting, visible peristalsis, and a
palpable "olive" mass. Abdominal ultrasound is the diagnostic test of choice, with
pyloric muscle thickness >4 mm and channel length >14 mm being diagnostic. Upper GI
series may show the "string sign" but is less sensitive and involves radiation. CT is not
, indicated. pH monitoring evaluates for GERD, which causes regurgitation, not projectile
vomiting.
Question 8: A 2-year-old child presents with a 3-day history of fever, irritability, and
refusal to bear weight on the right leg. The knee is warm, swollen, and painful with
passive motion. White blood cell count is 18,000/mm³ with left shift. What is the
most appropriate next diagnostic step?
A. Plain radiograph of the knee
B. Joint aspiration for Gram stain and culture
C. MRI of the knee
D. Bone scan
CORRECT ANSWER: B. Joint aspiration for Gram stain and culture
Rationale: This child has signs suggestive of septic arthritis: fever, refusal to bear
weight, joint swelling, warmth, and pain with motion. Joint aspiration is critical for
diagnosis, allowing Gram stain, culture, and cell count to confirm infection and guide
antibiotic therapy. Delaying aspiration risks permanent joint damage. Plain radiographs
may show soft tissue swelling but are not diagnostic. MRI or bone scan may be
considered if diagnosis is uncertain or for evaluating osteomyelitis, but aspiration takes
precedence when septic arthritis is suspected.
Question 9: A 7-year-old child presents with a 1-week history of periorbital edema,
tea-colored urine, and hypertension. Urinalysis shows 3+ protein, 3+ blood, and red
blood cell casts. What is the most likely diagnosis?
A. Minimal change disease
B. Post-streptococcal glomerulonephritis
C. IgA nephropathy
D. Alport syndrome
CORRECT ANSWER: B. Post-streptococcal glomerulonephritis
Rationale: The classic triad of periorbital edema, hypertension, and cola-colored urine
with hematuria, proteinuria, and RBC casts on urinalysis is characteristic of acute post-
streptococcal glomerulonephritis (PSGN). PSGN typically occurs 1-3 weeks after a
streptococcal pharyngitis or skin infection. Minimal change disease presents with
nephrotic syndrome (heavy proteinuria, hypoalbuminemia, edema) without hematuria
or hypertension. IgA nephropathy often presents with gross hematuria concurrent with
URI symptoms. Alport syndrome is a genetic disorder with hematuria, hearing loss, and
ocular abnormalities, typically without acute nephritic features.
Question 10: A 14-year-old adolescent presents with a 2-week history of polyuria,
polydipsia, weight loss, and fatigue. Random blood glucose is 350 mg/dL.
Urinalysis shows glucosuria and ketonuria. What is the most appropriate initial
management?
Detailed Rationales (Updated 2026) | Pediatric Assessment & Growth
Milestones, Neonatal & Infant Care, Childhood Diseases & Infections, Developmental
Disorders, Pediatric Pharmacology, Vaccination Schedules, Emergency Pediatric
Care, Nutrition & Fluid Management, Clinical Rotations & Shelf Exam Review
Question 1: A 3-day-old term infant presents with yellow discoloration of the skin
and sclera. The bilirubin level is 12 mg/dL, predominantly unconjugated. The infant
is feeding well, has normal stool color, and is afebrile. What is the most
appropriate next step in management?
A. Phototherapy
B. Exchange transfusion
C. Observation and reassurance
D. Intravenous immunoglobulin
CORRECT ANSWER: C. Observation and reassurance
Rationale: This infant has physiologic jaundice, which typically appears after 24 hours
of life, peaks around days 3-5, and resolves spontaneously. The bilirubin level of 12
mg/dL at day 3 in a well-appearing, feeding term infant is below the threshold for
phototherapy per AAP guidelines. Observation, ensuring adequate feeding, and parental
reassurance are appropriate. Phototherapy is indicated for higher bilirubin levels based
on age-specific nomograms. Exchange transfusion is reserved for severe
hyperbilirubinemia with risk of kernicterus. IVIG is used in isoimmune hemolytic
disease, which is not suggested here.
Question 2: A 6-month-old infant is brought for a well-child visit. The parent reports
the infant can sit without support, transfer objects hand-to-hand, and babbles
"mama" and "dada" nonspecifically. Which developmental milestone is this infant
expected to achieve NEXT?
A. Pincer grasp
B. Walking independently
C. Saying three words with meaning
D. Building a tower of two cubes
CORRECT ANSWER: A. Pincer grasp
Rationale: At 6 months, infants typically sit without support, transfer objects, and
babble. The next fine motor milestone is the pincer grasp (using thumb and forefinger),
which typically emerges around 9-12 months. Walking independently occurs around 12-
15 months. Saying three words with meaning is a 12-18 month language milestone.
Building a tower of two cubes is a 15-18 month fine motor skill. Understanding
developmental sequences is essential for anticipatory guidance and early identification
of delays.
Question 3: A 2-year-old child presents with a 2-day history of fever, cough, and
rhinorrhea. On examination, the child has inspiratory stridor, a barking cough, and
,mild suprasternal retractions. Oxygen saturation is 97% on room air. What is the
most appropriate initial pharmacologic treatment?
A. Nebulized epinephrine
B. Oral dexamethasone
C. Intravenous antibiotics
D. Albuterol nebulizer
CORRECT ANSWER: B. Oral dexamethasone
Rationale: This child has croup (laryngotracheitis), characterized by barking cough,
stridor, and preceding URI symptoms. Corticosteroids (e.g., oral dexamethasone 0.6
mg/kg) are first-line therapy to reduce airway edema and decrease hospitalization rates.
Nebulized epinephrine is reserved for moderate to severe croup with significant
respiratory distress. Antibiotics are not indicated as croup is typically viral
(parainfluenza). Albuterol is used for bronchospasm in asthma, not upper airway
edema.
Question 4: A 4-year-old child presents with acute onset of high fever, sore throat,
drooling, and preference to sit upright with neck extended. The child appears toxic
and anxious. What is the most critical next step in management?
A. Obtain a rapid streptococcal test
B. Administer intravenous antibiotics
C. Secure the airway in a controlled setting
D. Perform a lateral neck radiograph
CORRECT ANSWER: C. Secure the airway in a controlled setting
Rationale: This presentation is classic for epiglottitis, a life-threatening emergency
characterized by fever, sore throat, drooling, dysphagia, and tripod positioning. Airway
obstruction can progress rapidly. The priority is securing the airway via intubation in an
operating room with ENT and anesthesia support. Examination of the throat or
procedures that agitate the child may precipitate complete obstruction. Antibiotics
(e.g., ceftriaxone) are given after airway stabilization. Radiographs are not
recommended if epiglottitis is strongly suspected due to risk of deterioration during
transport.
Question 5: A 9-month-old infant has a temperature of 39.5°C (103.1°F) for 24 hours
with no focal signs of infection. The infant is well-appearing, feeding normally, and
has normal vital signs otherwise. What is the most appropriate management?
A. Immediate lumbar puncture
B. Urine culture and empiric antibiotics
C. Antipyretics and close outpatient follow-up
D. Complete blood count and blood culture
CORRECT ANSWER: C. Antipyretics and close outpatient follow-up
,Rationale: In a well-appearing, immunized infant 6-24 months with fever without a
source, the risk of serious bacterial infection is low. Current guidelines support
symptomatic management with antipyretics, ensuring hydration, and close follow-up
within 24-48 hours. Routine laboratory evaluation or empiric antibiotics are not
indicated without concerning features (e.g., ill appearance, focal findings, incomplete
immunizations). Lumbar puncture is reserved for infants with meningeal signs or high-
risk features. Urine culture may be considered in uncircumcised males <12 months or
females <24 months, but is not universally required in well-appearing infants.
Question 6: A 5-year-old child with known asthma presents with increased cough,
wheezing, and shortness of breath for 2 days. The child uses albuterol every 4
hours with minimal relief. On exam, the child has tachypnea, wheezing throughout,
and oxygen saturation of 92% on room air. What is the most appropriate initial
treatment in the emergency department?
A. Oral prednisolone
B. Nebulized albuterol plus ipratropium
C. Intravenous magnesium sulfate
D. Subcutaneous epinephrine
CORRECT ANSWER: B. Nebulized albuterol plus ipratropium
Rationale: For moderate to severe acute asthma exacerbations, initial management
includes frequent or continuous short-acting beta-agonists (albuterol) plus an
anticholinergic (ipratropium) via nebulizer to achieve maximal bronchodilation.
Systemic corticosteroids (oral or IV) should be administered early but are adjunctive,
not the initial bronchodilator therapy. IV magnesium sulfate is reserved for severe
exacerbations not responding to initial therapy. Subcutaneous epinephrine is used in
anaphylaxis or severe bronchospasm when nebulizers are ineffective or unavailable.
Question 7: A 3-week-old infant presents with projectile, non-bilious vomiting after
feeds. The infant is hungry after vomiting and has not gained weight appropriately.
On examination, a small, olive-shaped mass is palpable in the epigastrium. What is
the diagnostic test of choice?
A. Abdominal ultrasound
B. Upper gastrointestinal series
C. Abdominal CT scan
D. Esophageal pH monitoring
CORRECT ANSWER: A. Abdominal ultrasound
Rationale: This presentation is classic for hypertrophic pyloric stenosis, which typically
presents at 3-6 weeks with projectile non-bilious vomiting, visible peristalsis, and a
palpable "olive" mass. Abdominal ultrasound is the diagnostic test of choice, with
pyloric muscle thickness >4 mm and channel length >14 mm being diagnostic. Upper GI
series may show the "string sign" but is less sensitive and involves radiation. CT is not
, indicated. pH monitoring evaluates for GERD, which causes regurgitation, not projectile
vomiting.
Question 8: A 2-year-old child presents with a 3-day history of fever, irritability, and
refusal to bear weight on the right leg. The knee is warm, swollen, and painful with
passive motion. White blood cell count is 18,000/mm³ with left shift. What is the
most appropriate next diagnostic step?
A. Plain radiograph of the knee
B. Joint aspiration for Gram stain and culture
C. MRI of the knee
D. Bone scan
CORRECT ANSWER: B. Joint aspiration for Gram stain and culture
Rationale: This child has signs suggestive of septic arthritis: fever, refusal to bear
weight, joint swelling, warmth, and pain with motion. Joint aspiration is critical for
diagnosis, allowing Gram stain, culture, and cell count to confirm infection and guide
antibiotic therapy. Delaying aspiration risks permanent joint damage. Plain radiographs
may show soft tissue swelling but are not diagnostic. MRI or bone scan may be
considered if diagnosis is uncertain or for evaluating osteomyelitis, but aspiration takes
precedence when septic arthritis is suspected.
Question 9: A 7-year-old child presents with a 1-week history of periorbital edema,
tea-colored urine, and hypertension. Urinalysis shows 3+ protein, 3+ blood, and red
blood cell casts. What is the most likely diagnosis?
A. Minimal change disease
B. Post-streptococcal glomerulonephritis
C. IgA nephropathy
D. Alport syndrome
CORRECT ANSWER: B. Post-streptococcal glomerulonephritis
Rationale: The classic triad of periorbital edema, hypertension, and cola-colored urine
with hematuria, proteinuria, and RBC casts on urinalysis is characteristic of acute post-
streptococcal glomerulonephritis (PSGN). PSGN typically occurs 1-3 weeks after a
streptococcal pharyngitis or skin infection. Minimal change disease presents with
nephrotic syndrome (heavy proteinuria, hypoalbuminemia, edema) without hematuria
or hypertension. IgA nephropathy often presents with gross hematuria concurrent with
URI symptoms. Alport syndrome is a genetic disorder with hematuria, hearing loss, and
ocular abnormalities, typically without acute nephritic features.
Question 10: A 14-year-old adolescent presents with a 2-week history of polyuria,
polydipsia, weight loss, and fatigue. Random blood glucose is 350 mg/dL.
Urinalysis shows glucosuria and ketonuria. What is the most appropriate initial
management?
