LATEST PEDIATRIC EMERGENCY MEDICINE
CERTIFICATION EXAM OFFERED BY
AMERICAN BOARD OF PEDIATRICS |
COMPLETE EXAM Q&A WITH RATIONALES
1. A 6-month-old infant presents to the emergency
department with fever (39.5°C), irritability, and a
bulging fontanelle. Lumbar puncture shows 500
WBC/μL (90% neutrophils), glucose 20 mg/dL (serum
90 mg/dL), and protein 150 mg/dL. Gram stain shows
gram-positive cocci in pairs and chains. What is the
most likely pathogen?
A) Group B Streptococcus (Streptococcus
agalactiae)
B) Streptococcus pneumoniae
C) Neisseria meningitidis
D) Listeria monocytogenes
Correct answer: A
Rationale: In a 6-month-old, Group B Streptococcus
(GBS) is a common cause of bacterial meningitis,
especially if the infant is unvaccinated. S.
pneumoniae (B) is more common after 2 months of
age, but GBS is still prevalent in young infants.
,2. A 2-year-old child presents with acute onset of
stridor, barking cough, and low-grade fever.
Symptoms are worse at night. On examination, the
child is sitting upright, alert, with no drooling. What is
the most appropriate next step?
A) Lateral neck radiograph
B) Direct laryngoscopy in the operating room
C) Corticosteroids (dexamethasone) and supportive
care
D) Intravenous antibiotics and racemic epinephrine
Correct answer: C
Rationale: Viral croup (laryngotracheobronchitis) is
treated with dexamethasone (0.6 mg/kg orally or IM).
Racemic epinephrine (D) is for moderate-to-severe
croup with respiratory distress. Drooling suggests
epiglottitis.
3. A 3-year-old child presents with fever, pharyngitis,
and a sandpaper-like rash on the trunk and
extremities. The rash spares the face, and there is
circumoral pallor. What is the most likely diagnosis?
A) Scarlet fever (Group A Streptococcus)
B) Measles (rubeola)
C) Kawasaki disease
,D) Erythema infectiosum (fifth disease)
Correct answer: A
Rationale: Scarlet fever (Group A Strep) presents
with sandpaper rash, circumoral pallor, strawberry
tongue, and Pastia lines (hyperpigmented lines in
skin folds). Rapid strep test or throat culture is
diagnostic.
4. A 4-week-old infant presents with poor feeding,
lethargy, and vomiting. On examination, the infant is
jaundiced and has hepatomegaly. Laboratory studies
show direct hyperbilirubinemia (conjugated 5 mg/dL,
total 12 mg/dL), elevated ALT (200 U/L), and
thrombocytopenia (50,000/μL). What is the most likely
diagnosis?
A) Galactosemia (GALT deficiency)
B) Biliary atresia
C) Neonatal hepatitis (viral)
D) Alagille syndrome
Correct answer: A
Rationale: Galactosemia presents after milk ingestion
(breast or formula) with jaundice, hepatomegaly,
vomiting, lethargy, and E. coli sepsis. Conjugated
hyperbilirubinemia. Reducing substances in urine.
, Biliary atresia (B) typically presents later (2-8 weeks)
with acholic stools.
5. A 5-year-old child presents with a painful limp,
refusal to bear weight on the left leg, and a low-grade
fever (38°C). The child had a viral upper respiratory
infection 2 weeks ago. On examination, the left hip is
held in flexion, abduction, and external rotation. What
is the most appropriate initial imaging study?
A) Hip ultrasound
B) X-ray of the pelvis and left hip
C) MRI of the hip
D) CT scan of the hip
Correct answer: B
Rationale: X-ray of the hip is first-line imaging to rule
out fracture, dislocation, Perthes disease, or slipped
capital femoral epiphysis (SCFE). Ultrasound (A) is
used to detect effusion (transient synovitis vs. septic
arthritis).
6. A 2-day-old newborn presents with respiratory
distress, cyanosis, and decreased breath sounds on
the left side. Chest X-ray shows a hyperlucent left
hemithorax with mediastinal shift to the right. The
CERTIFICATION EXAM OFFERED BY
AMERICAN BOARD OF PEDIATRICS |
COMPLETE EXAM Q&A WITH RATIONALES
1. A 6-month-old infant presents to the emergency
department with fever (39.5°C), irritability, and a
bulging fontanelle. Lumbar puncture shows 500
WBC/μL (90% neutrophils), glucose 20 mg/dL (serum
90 mg/dL), and protein 150 mg/dL. Gram stain shows
gram-positive cocci in pairs and chains. What is the
most likely pathogen?
A) Group B Streptococcus (Streptococcus
agalactiae)
B) Streptococcus pneumoniae
C) Neisseria meningitidis
D) Listeria monocytogenes
Correct answer: A
Rationale: In a 6-month-old, Group B Streptococcus
(GBS) is a common cause of bacterial meningitis,
especially if the infant is unvaccinated. S.
pneumoniae (B) is more common after 2 months of
age, but GBS is still prevalent in young infants.
,2. A 2-year-old child presents with acute onset of
stridor, barking cough, and low-grade fever.
Symptoms are worse at night. On examination, the
child is sitting upright, alert, with no drooling. What is
the most appropriate next step?
A) Lateral neck radiograph
B) Direct laryngoscopy in the operating room
C) Corticosteroids (dexamethasone) and supportive
care
D) Intravenous antibiotics and racemic epinephrine
Correct answer: C
Rationale: Viral croup (laryngotracheobronchitis) is
treated with dexamethasone (0.6 mg/kg orally or IM).
Racemic epinephrine (D) is for moderate-to-severe
croup with respiratory distress. Drooling suggests
epiglottitis.
3. A 3-year-old child presents with fever, pharyngitis,
and a sandpaper-like rash on the trunk and
extremities. The rash spares the face, and there is
circumoral pallor. What is the most likely diagnosis?
A) Scarlet fever (Group A Streptococcus)
B) Measles (rubeola)
C) Kawasaki disease
,D) Erythema infectiosum (fifth disease)
Correct answer: A
Rationale: Scarlet fever (Group A Strep) presents
with sandpaper rash, circumoral pallor, strawberry
tongue, and Pastia lines (hyperpigmented lines in
skin folds). Rapid strep test or throat culture is
diagnostic.
4. A 4-week-old infant presents with poor feeding,
lethargy, and vomiting. On examination, the infant is
jaundiced and has hepatomegaly. Laboratory studies
show direct hyperbilirubinemia (conjugated 5 mg/dL,
total 12 mg/dL), elevated ALT (200 U/L), and
thrombocytopenia (50,000/μL). What is the most likely
diagnosis?
A) Galactosemia (GALT deficiency)
B) Biliary atresia
C) Neonatal hepatitis (viral)
D) Alagille syndrome
Correct answer: A
Rationale: Galactosemia presents after milk ingestion
(breast or formula) with jaundice, hepatomegaly,
vomiting, lethargy, and E. coli sepsis. Conjugated
hyperbilirubinemia. Reducing substances in urine.
, Biliary atresia (B) typically presents later (2-8 weeks)
with acholic stools.
5. A 5-year-old child presents with a painful limp,
refusal to bear weight on the left leg, and a low-grade
fever (38°C). The child had a viral upper respiratory
infection 2 weeks ago. On examination, the left hip is
held in flexion, abduction, and external rotation. What
is the most appropriate initial imaging study?
A) Hip ultrasound
B) X-ray of the pelvis and left hip
C) MRI of the hip
D) CT scan of the hip
Correct answer: B
Rationale: X-ray of the hip is first-line imaging to rule
out fracture, dislocation, Perthes disease, or slipped
capital femoral epiphysis (SCFE). Ultrasound (A) is
used to detect effusion (transient synovitis vs. septic
arthritis).
6. A 2-day-old newborn presents with respiratory
distress, cyanosis, and decreased breath sounds on
the left side. Chest X-ray shows a hyperlucent left
hemithorax with mediastinal shift to the right. The
