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Pediatrics — Set 1
10 questions • Milestones, vaccines, fever, common conditions
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Question 1
A 2-year-old presents for a well-child visit. Which developmental milestone would you MOST expect to be present?
Correct: C. Uses 2-word phrases. By age 2, children typically use 2-word phrases (e.g., "more milk"). 4-word sentences are expected around age 4. Riding a tricycle and copying a square are 3-year milestones.
Question 2
A 6-week-old infant is brought in for a well visit. Which vaccine is due at this visit per the CDC immunization schedule?
Correct: C. At 2 months (and 6 weeks is close to the 2-month visit), the CDC schedule includes DTaP, IPV, Hib, PCV13, Rotavirus, and HepB (if not given at birth). MMR and Varicella are given at 12-15 months. HPV begins at 11-12 years.
Question 3
A 3-year-old has a temperature of 39.5C (103.1F), runny nose, and barky cough that worsens at night. The child is anxious but has no stridor at rest. What is the MOST likely diagnosis?
Correct: C. Croup. Classic presentation: barky "seal-like" cough, stridor, worse at night, ages 6 months - 3 years, often caused by parainfluenza virus. Epiglottitis presents with high fever, toxic appearance, drooling, and tripod positioning. Treatment: cool mist, dexamethasone, racemic epinephrine for severe cases.
Question 4
A 4-month-old is brought in by parents concerned about fever (38.5C rectally). The child appears well, is feeding normally, and has no source found on exam. What is the BEST next step?
Correct: C. Infants under 3 months with fever ≥38C require a full sepsis workup (CBC, blood culture, UA/urine culture, LP). For infants 3-6 months with fever, the approach depends on clinical appearance, but a full workup is still often warranted. This 4-month-old falls in a gray zone — most guidelines recommend workup and admission.
Question 5
Which finding on ear exam is MOST consistent with acute otitis media (AOM)?
Correct: B. AOM: bulging, erythematous, opacified tympanic membrane with decreased or absent mobility on pneumatic otoscopy. Option A describes otitis media with effusion (OME). Option C also suggests OME. Option D suggests a ruptured AOM or chronic otitis media.
Question 6
A 10-year-old with a BMI at the 97th percentile is seen for a well-child visit. Fasting glucose is 108 mg/dL, and HbA1c is 5.8%. What is this child's diagnosis?
Correct: B. Prediabetes. Fasting glucose 100-125 mg/dL = impaired fasting glucose. HbA1c 5.7-6.4% = prediabetes. Diabetes is fasting glucose ≥126 or HbA1c ≥6.5%. Lifestyle intervention and weight management are first-line. Screen at-risk obese children every 2-3 years starting at age 10 (AAP guidelines).
Question 7
A 5-year-old is started on treatment for strep pharyngitis. 48 hours later, parents call saying the child still has fever and sore throat. The child has been on amoxicillin. What is the MOST appropriate action?
Correct: C. Strep pharyngitis typically improves within 2-3 days of antibiotics. Fever and symptoms may persist 48 hours — this is expected. Amoxicillin remains first-line (10-day course). Switching too early contributes to resistance. If no improvement by 72 hours, then reassess.
Question 8
At which well-child visit should developmental surveillance include a formal autism spectrum disorder (ASD) screening tool (M-CHAT-R)?
Correct: B. 18 and 24 months. AAP recommends universal ASD screening with the M-CHAT-R (Modified Checklist for Autism in Toddlers, Revised) at the 18- and 24-month well-child visits, in addition to developmental surveillance at every visit.
Question 9
A 7-year-old presents with a 3-day history of honey-crusted lesions around the nose and mouth. The lesions are non-painful and non-itchy. What is the FIRST-LINE treatment?
Correct: C. Topical mupirocin. This describes impetigo (non-bullous), most commonly caused by S. aureus or S. pyogenes. For localized disease, topical mupirocin or retapamulin is first-line. Oral antibiotics (cephalexin or amoxicillin-clavulanate) are reserved for extensive or spreading disease.
Question 10
A 6-year-old is noted to have a heart murmur during a well visit. It is soft (II/VI), musical or vibratory in quality, heard best at the left lower sternal border, louder when supine, and disappears when sitting up. What type of murmur is this?
Correct: C. Still's murmur (innocent). Classic features of Still's murmur: low-pitched vibratory or musical quality, grade I-III/VI, left lower sternal border, loudest when supine, decreases or disappears when sitting or standing, no radiation. No workup needed unless clinical concern. Most common innocent murmur in children ages 3-7.