PEDIATRIC FINAL EXAM
1. A 2-week-old neonate presents with poor feeding, lethargy, and a temperature of
100.8°F (38.2°C). No focal findings on exam. What is the most appropriate next step?
A. Prescribe oral amoxicillin and send home.
B. Admit for full sepsis workup including lumbar puncture.
C. Recommend acetaminophen and follow up in 24 hours.
D. Obtain a chest X-ray to rule out pneumonia.
Correct Answer: B
Rationale: A febrile neonate without a clear source requires hospital admission and a
complete sepsis evaluation (blood, urine, CSF cultures) due to high risk of serious
bacterial infection.
2. A 4-year-old has a 3-day history of fever, rhinorrhea, and cough. On day 4, fever
resolves, but she develops a fine, erythematous, maculopapular rash on her trunk and
face. The most likely diagnosis is:
A. Measles
B. Scarlet fever
C. Roseola infantum
D. Fifth disease
Correct Answer: C
Rationale: Roseola (HHV-6) classically presents with high fever for 3–5 days followed by
a rash that appears as the fever defervesces.
3. Which of the following scenarios is most suspicious for non-accidental trauma (child
abuse)?
A. A 2-year-old with a bruised shin after tripping on a toy.
B. A 4-month-old with a spiral fracture of the humerus reported to have occurred when
the parent grabbed the arm to prevent a fall.
C. A 6-year-old with a linear bruise on the forearm from being hit by a swing.
D. A 10-year-old with a fractured clavicle after falling off a bicycle.
Correct Answer: B
Rationale: A spiral fracture in a non-ambulatory infant, especially with a mechanism
that does not match the injury, raises high suspicion for abuse.
4. A 7-year-old boy presents with a pruritic, erythematous, annular lesion with central
clearing on his forearm. His older sister has a similar rash. The most appropriate
treatment is:
,A. Oral acyclovir
B. Topical clotrimazole
C. Topical hydrocortisone
D. Oral cephalexin
Correct Answer: B
Rationale: The description matches tinea corporis (ringworm), a fungal infection treated
with topical antifungals such as clotrimazole.
5. A 14-month-old experiences a brief, generalized tonic-clonic seizure during a febrile
illness (temperature 104°F). The child returns to baseline immediately after. Which of the
following is most important to rule out?
A. Hypoglycemia
B. Meningitis
C. Otitis media
D. Urinary tract infection
Correct Answer: B
Rationale: Although this appears to be a simple febrile seizure, meningitis must be
excluded, especially if the child is very young or has persistent altered mental status.
6. An 8-year-old returns from summer camp with intense scalp itching. On exam, you
see nits firmly attached to hair shafts near the scalp and a few moving insects. What is
the first-line treatment?
A. Oral ivermectin
B. Permethrin 1% cream rinse
C. Malathion lotion
D. Shaving the head
Correct Answer: B
Rationale: Pediculosis capitis (head lice) is initially treated with over-the-counter
permethrin 1% or pyrethrins, combined with meticulous nit removal.
7. A 3-month-old is brought in with fever (102°F), irritability, and vomiting for 12 hours.
The physical exam is non-focal. According to standard guidelines, what is the most
appropriate diagnostic test?
A. Throat swab for rapid strep
B. Lumbar puncture
C. Chest X-ray
D. Stool culture
,Correct Answer: B
Rationale: Any febrile infant under 2–3 months (or ill-appearing older infant) requires a
lumbar puncture to rule out meningitis as part of a sepsis evaluation.
8. A 5-year-old has a 2-day history of fever, sore throat, and headache. On exam, you
see tonsillar exudates, palatal petechiae, and an erythematous, sandpaper-like rash on
the trunk. The most likely pathogen is:
A. Group A Streptococcus
B. Adenovirus
C. Epstein-Barr virus
D. Mycoplasma pneumoniae
Correct Answer: A
Rationale: The combination of exudative pharyngitis, palatal petechiae, and sandpaper
rash is classic for scarlet fever caused by Group A Streptococcus.
9. A 2-year-old is brought to the emergency department after ingesting an unknown
amount of liquid laundry detergent from a brightly colored pod. He is coughing and
gagging. What is the most immediate concern?
A. Metabolic acidosis
B. Chemical pneumonitis and airway injury
C. Hypernatremia
D. Delayed neurotoxicity
Correct Answer: B
Rationale: Laundry detergent pods are highly alkaline and can cause severe chemical
pneumonitis, laryngeal edema, and airway compromise upon aspiration or direct injury.
10. A fully immunized 6-year-old presents with barking cough, inspiratory stridor, and
low-grade fever that worsens at night. Symptoms improved after a few minutes in a
steamy bathroom. The most likely diagnosis is:
A. Bacterial tracheitis
B. Epiglottitis
C. Croup (laryngotracheobronchitis)
D. Retropharyngeal abscess
Correct Answer: C
Rationale: Croup is characterized by a barking cough, stridor, and symptoms that
improve with humidified air or mist. It is typically viral in origin (parainfluenza).
11. A 6-month-old infant is brought in for poor weight gain. He has a history of
recurrent otitis media and two episodes of pneumonia. On exam, you note absence of
, palatine tonsils. Which study is most diagnostic?
A. Chest X-ray
B. Sweat chloride test
C. Lymphocyte subset analysis
D. Serum immunoglobulin levels
Correct Answer: D
Rationale: Recurrent infections with absence of tonsils suggests humoral
immunodeficiency (e.g., X-linked agammaglobulinemia). Serum immunoglobulins (IgG,
IgA, IgM) are the initial diagnostic test.
12. A 2-year-old presents with a palpable, purpuric rash on the buttocks and lower
extremities, plus non-bloody, colicky abdominal pain and arthralgias. Urinalysis shows
hematuria. The most likely diagnosis is:
A. Idiopathic thrombocytopenic purpura (ITP)
B. Henoch-Schönlein purpura (IgA vasculitis)
C. Hemolytic uremic syndrome
D. Meningococcemia
Correct Answer: B
Rationale: The triad of palpable purpura (lower extremities/buttocks), arthralgias, and
abdominal pain with hematuria is classic for IgA vasculitis (Henoch-Schönlein purpura).
13. A full-term newborn develops jaundice at 18 hours of life. Total bilirubin is 12
mg/dL. Direct Coombs test is positive. The mother is blood type O negative. What is the
most appropriate next step?
A. Exchange transfusion
B. Phototherapy
C. Intravenous immunoglobulin (IVIG)
D. Phenobarbital
Correct Answer: B
Rationale: Early jaundice with positive Coombs test indicates hemolytic disease (ABO or
Rh incompatibility). Phototherapy is indicated at this level based on age-specific
nomograms.
14. A 10-year-old obese boy presents with right upper quadrant pain, nausea, and a
palpable liver edge. ALT and AST are elevated (3x normal). Ultrasound shows echogenic
liver. He denies alcohol use. The most likely diagnosis is:
A. Autoimmune hepatitis
B. Wilson disease
1. A 2-week-old neonate presents with poor feeding, lethargy, and a temperature of
100.8°F (38.2°C). No focal findings on exam. What is the most appropriate next step?
A. Prescribe oral amoxicillin and send home.
B. Admit for full sepsis workup including lumbar puncture.
C. Recommend acetaminophen and follow up in 24 hours.
D. Obtain a chest X-ray to rule out pneumonia.
Correct Answer: B
Rationale: A febrile neonate without a clear source requires hospital admission and a
complete sepsis evaluation (blood, urine, CSF cultures) due to high risk of serious
bacterial infection.
2. A 4-year-old has a 3-day history of fever, rhinorrhea, and cough. On day 4, fever
resolves, but she develops a fine, erythematous, maculopapular rash on her trunk and
face. The most likely diagnosis is:
A. Measles
B. Scarlet fever
C. Roseola infantum
D. Fifth disease
Correct Answer: C
Rationale: Roseola (HHV-6) classically presents with high fever for 3–5 days followed by
a rash that appears as the fever defervesces.
3. Which of the following scenarios is most suspicious for non-accidental trauma (child
abuse)?
A. A 2-year-old with a bruised shin after tripping on a toy.
B. A 4-month-old with a spiral fracture of the humerus reported to have occurred when
the parent grabbed the arm to prevent a fall.
C. A 6-year-old with a linear bruise on the forearm from being hit by a swing.
D. A 10-year-old with a fractured clavicle after falling off a bicycle.
Correct Answer: B
Rationale: A spiral fracture in a non-ambulatory infant, especially with a mechanism
that does not match the injury, raises high suspicion for abuse.
4. A 7-year-old boy presents with a pruritic, erythematous, annular lesion with central
clearing on his forearm. His older sister has a similar rash. The most appropriate
treatment is:
,A. Oral acyclovir
B. Topical clotrimazole
C. Topical hydrocortisone
D. Oral cephalexin
Correct Answer: B
Rationale: The description matches tinea corporis (ringworm), a fungal infection treated
with topical antifungals such as clotrimazole.
5. A 14-month-old experiences a brief, generalized tonic-clonic seizure during a febrile
illness (temperature 104°F). The child returns to baseline immediately after. Which of the
following is most important to rule out?
A. Hypoglycemia
B. Meningitis
C. Otitis media
D. Urinary tract infection
Correct Answer: B
Rationale: Although this appears to be a simple febrile seizure, meningitis must be
excluded, especially if the child is very young or has persistent altered mental status.
6. An 8-year-old returns from summer camp with intense scalp itching. On exam, you
see nits firmly attached to hair shafts near the scalp and a few moving insects. What is
the first-line treatment?
A. Oral ivermectin
B. Permethrin 1% cream rinse
C. Malathion lotion
D. Shaving the head
Correct Answer: B
Rationale: Pediculosis capitis (head lice) is initially treated with over-the-counter
permethrin 1% or pyrethrins, combined with meticulous nit removal.
7. A 3-month-old is brought in with fever (102°F), irritability, and vomiting for 12 hours.
The physical exam is non-focal. According to standard guidelines, what is the most
appropriate diagnostic test?
A. Throat swab for rapid strep
B. Lumbar puncture
C. Chest X-ray
D. Stool culture
,Correct Answer: B
Rationale: Any febrile infant under 2–3 months (or ill-appearing older infant) requires a
lumbar puncture to rule out meningitis as part of a sepsis evaluation.
8. A 5-year-old has a 2-day history of fever, sore throat, and headache. On exam, you
see tonsillar exudates, palatal petechiae, and an erythematous, sandpaper-like rash on
the trunk. The most likely pathogen is:
A. Group A Streptococcus
B. Adenovirus
C. Epstein-Barr virus
D. Mycoplasma pneumoniae
Correct Answer: A
Rationale: The combination of exudative pharyngitis, palatal petechiae, and sandpaper
rash is classic for scarlet fever caused by Group A Streptococcus.
9. A 2-year-old is brought to the emergency department after ingesting an unknown
amount of liquid laundry detergent from a brightly colored pod. He is coughing and
gagging. What is the most immediate concern?
A. Metabolic acidosis
B. Chemical pneumonitis and airway injury
C. Hypernatremia
D. Delayed neurotoxicity
Correct Answer: B
Rationale: Laundry detergent pods are highly alkaline and can cause severe chemical
pneumonitis, laryngeal edema, and airway compromise upon aspiration or direct injury.
10. A fully immunized 6-year-old presents with barking cough, inspiratory stridor, and
low-grade fever that worsens at night. Symptoms improved after a few minutes in a
steamy bathroom. The most likely diagnosis is:
A. Bacterial tracheitis
B. Epiglottitis
C. Croup (laryngotracheobronchitis)
D. Retropharyngeal abscess
Correct Answer: C
Rationale: Croup is characterized by a barking cough, stridor, and symptoms that
improve with humidified air or mist. It is typically viral in origin (parainfluenza).
11. A 6-month-old infant is brought in for poor weight gain. He has a history of
recurrent otitis media and two episodes of pneumonia. On exam, you note absence of
, palatine tonsils. Which study is most diagnostic?
A. Chest X-ray
B. Sweat chloride test
C. Lymphocyte subset analysis
D. Serum immunoglobulin levels
Correct Answer: D
Rationale: Recurrent infections with absence of tonsils suggests humoral
immunodeficiency (e.g., X-linked agammaglobulinemia). Serum immunoglobulins (IgG,
IgA, IgM) are the initial diagnostic test.
12. A 2-year-old presents with a palpable, purpuric rash on the buttocks and lower
extremities, plus non-bloody, colicky abdominal pain and arthralgias. Urinalysis shows
hematuria. The most likely diagnosis is:
A. Idiopathic thrombocytopenic purpura (ITP)
B. Henoch-Schönlein purpura (IgA vasculitis)
C. Hemolytic uremic syndrome
D. Meningococcemia
Correct Answer: B
Rationale: The triad of palpable purpura (lower extremities/buttocks), arthralgias, and
abdominal pain with hematuria is classic for IgA vasculitis (Henoch-Schönlein purpura).
13. A full-term newborn develops jaundice at 18 hours of life. Total bilirubin is 12
mg/dL. Direct Coombs test is positive. The mother is blood type O negative. What is the
most appropriate next step?
A. Exchange transfusion
B. Phototherapy
C. Intravenous immunoglobulin (IVIG)
D. Phenobarbital
Correct Answer: B
Rationale: Early jaundice with positive Coombs test indicates hemolytic disease (ABO or
Rh incompatibility). Phototherapy is indicated at this level based on age-specific
nomograms.
14. A 10-year-old obese boy presents with right upper quadrant pain, nausea, and a
palpable liver edge. ALT and AST are elevated (3x normal). Ultrasound shows echogenic
liver. He denies alcohol use. The most likely diagnosis is:
A. Autoimmune hepatitis
B. Wilson disease
