Pediatrics Final Exam Latest Complete
Frequently Tested Questions and 100%
Correct Answers (verified)
‣ A four year old presents with low-grade fever, intermittent crampy abdominal pain with
emesis and swollen knees of 3 days duration. A purpuric rash distributed below the
knees of both lower extremities is noted on physical examination. This patient most
likely has:
A. Meningococcemia
B. Idiopathic thrombocytopenic purpura
C. Henoch-Scholein purpura
D. SLE E. Juvenile Rheumatoid arthritis -✓✓2 C.
HSP is a common vasculitis among children and presents with the classic findings of
abdominal pain with or without rectal bleeding, vasculitis rash, arthritis and nephritis.
The platelet count is normal. Gastrointestinal involvement may progress to
intussusception.
Source: Nelson's Textbook of Pediatrics 19th edition p868
‣ A 3 year old female presents with 1 week history of daily (quotidian) fever associated
with arthritis of both ankles and her right knee. Her mother notes that she has
decreased activity and also notes rashes that come and go in different parts of her body
but not on the face. On physical examination, salmon colored patches were noted on
the trunk and extremities. Palpation revealed splenomegaly. What is the diagnosis?
A. Henoch Schoenlein Purpura
B. Systemic Lupus Erythematosus
C. Juvenile Rheumatoid arthritis
D. Juvenile Dermatomyositis
E. Dengue fever -✓✓3 C.
Don't forget to study rheumatic diseases of childhood even if it's not your favorite topic.
Familiarize yourself with the relatively common ones like JRA, SLE and
dermatomyositis, HSP and scleroderma. Pay attention to the characteristics of the rash
and other features. (Don't fall for the trap of rash + arthritis = SLE.. It's not always SLE!)
JRA - Salmon colored patch, evanescent, spares the face
SLE - Malar rash, photosensitive
Dermatomyositis - heliotrope (periorbital) rash, gottron papules (rash on the knuckles)
HSP - purpura in dependent portions
For JRA, know the differences between subtypes (oligoarticular vs polyarticular vs
systemic onset)
,This case in particular is a case of systemic onset Juvenile Rheumatoid arthritis (also
called Still's Disease)
Source: Nelson's Textbook of Pediatrics 19th edition p830
‣ A 4 yr old boy presents with his third episode of painful cervical lymphadenitis. Each
was treated with incision and drainage and grew S. aureus. He also experiences
recurrent skin infections. A year ago, he was hospitalized for osteomyelitis. The most
important laboratory test is:
A. PCR for ADA deficiency
B. Nitroblue tetrazolium test
C. MAC-I assay
D. Neutrophil count
E. Genetic chromosomal analysis -✓✓4 B. This is a case of chronic granulomatous
disease (CGD) wherein patients are susceptible to catalase positive organisms like S.
aureus. The nitroblue tetrazolium tests the neutrophils ability to generate superoxide
anion and thus kill ingested bacteria.
Source: Nelson's Textbook of Pediatrics 19th edition p746
‣ Which among the following is not a prominent feature of Wiskott-Aldrich syndrome?
A. X-linked recessive inheritance
B. Atopic dermatitis
C. Thrombocytopenia
D. Recurrent infections with encapsulated bacteria
E. Leukopenia -✓✓5 E.
Note: The prominent immunologic impairment in Wiskott Aldrich Syndrome is against
polysaccharides of encapsulated organisms
Source: Nelson's Textbook of Pediatrics 19th edition p734
‣ A 12 year old seeks consult for 1 day history of sneezing, clear rhinorrhea and nasal
itching not associated with fever or any other systemic symptoms. PE reveals boggy,
pale nasal edema with a clear discharge. The most likely diagnosis is?
A. Foreign body
B. Vasomotor rhinitis
C. Allergic rhinitis
D. Neutrophilic rhinitis
E. Rhinitis medicamentosa -✓✓6 C.
Allergic rhinitis is often seasonal and associated with allergic conjunctivitis. Eosinophils
predominate in the nasal secretions. It is classified as:
Seasonal (cyclical) or perennial (all year)
,Intermittent (symptoms occur <4 days per week or <4 consecutive weeks) or persistent
(symptoms occur >4 days per week or >4 consecutive weeks)
Mild-moderate (no impairment) or severe (with impairment of daily living/sleep)
Source: Nelson's Textbook of Pediatrics 19th edition p775
‣ The Kasai procedure is indicated for which of the following?
A. Neonatal hepatitis
B. Biliary atresia
C. Metabolic liver disease
D. Fulminant hepatic failure
E. None of the above -✓✓7 B.
Despite initial success of the Kasai operation, patients with biliary atresia eventually get
liver transplantation.
Source: Nelson's Textbook of Pediatrics 19th edition 1387
‣ An 8 month old manifests with fussiness and emesis and refuses to eat. 1 week ago,
he was brought for consult and was diagnosed with URTI. On the morning of consult,
his mother noted currant jelly like material on his diaper. On PE, a sausage shaped
mass was palpable in the abdomen. There is likewise abdominal distention and rectal
exam reveals blood in the stool. The most likely diagnosis is:
A. Viral diarrhea
B. Duodenal atresia
C. Intussusception
D. Hypertrophic pyloric stenosis
E. Intestinal adenoma -✓✓8 C.
Aside from that, intussusception may present with lethargy out of proportion to the
intestinal signs and symptoms. Intussusception in children is usually due to lymphoid
hyperplasia in the intestines. This becomes the lead point. The most common location is
ileocolic.
Source: Nelson's Textbook of Pediatrics 19th edition p1288
‣ A 3 year old female presents to your office with unilateral nasal discharge. The
discharge is described by the caretaker to be malodorous and lately has been blood
tinged. The most likely diagnosis is:
A. Tertiary syphilis
B. Unilateral choanal atresia
C. Nasopharyngeal carcinoma
D. Foreign body
E. Angiosarcoma of the nose -✓✓9 D.
, Source: Nelson's Textbook of Pediatrics 19th edition p 1431
‣ A 3 year old is brought to the ER. On PE, inspiratory stridor and a barking cough were
noted. There is mild respiratory distress, tachypnea, and fever. The signs and
symptoms are aggravated by agitation and crying. The most likely diagnosis is
A. Tracheomalacia
B. Laryngotracheobronchitis
C. Epiglottitis
D. Bacterial tracheitis
E. Peritonsillar abscess -✓✓10 B. This is a case of croup and is common in this age
group.
Barking cough = croup
Epiglotitis and bacterial tracheitis patients are more toxic appearing and not in merely
mild respiratory distress
Source: Nelson's Textbook of Pediatrics 19th edition p1446
‣ A newborn was noted to be cyanotic. Unfortunately the imaging facilities are
unavailable for the day. A hyperoxia test was thus done which showed no improvement
of PaO2 after administration of 100% O2. The next step in the management of this
neonate is:
A. Low tidal volume mechanical ventilation
B. Positive pressure ventilation
C. Digoxin
D. Emergency laparotomy
E. Prostaglandin E -✓✓11 E.
The hyperoxia test is used to differentiate whether the etiology of cyanosis is cardiac or
not. PaO2 does not improve in cardiac etiologies. In the absence of imaging for
definitive diagnosis of the congenital heart disease, the clinician should not hesistate to
administer prostaglandin in case the patient has a ductus dependent congenital heart
disease. Prostaglandin prevents the ductus from closing.
Source: Nelson's Textbook of Pediatrics 19th edition p1572
‣ A patient was diagnosed with Tetralogy of Fallot. His chest x-ray reveals the classic Le
Couer en Sabot. Which of the following components of TOF is responsible for this
shape?
A. Pulmonary stenosis
B. VSD
C. RVH
D. Overriding of the aorta
E. Right sided aorta -✓✓12 C.
Frequently Tested Questions and 100%
Correct Answers (verified)
‣ A four year old presents with low-grade fever, intermittent crampy abdominal pain with
emesis and swollen knees of 3 days duration. A purpuric rash distributed below the
knees of both lower extremities is noted on physical examination. This patient most
likely has:
A. Meningococcemia
B. Idiopathic thrombocytopenic purpura
C. Henoch-Scholein purpura
D. SLE E. Juvenile Rheumatoid arthritis -✓✓2 C.
HSP is a common vasculitis among children and presents with the classic findings of
abdominal pain with or without rectal bleeding, vasculitis rash, arthritis and nephritis.
The platelet count is normal. Gastrointestinal involvement may progress to
intussusception.
Source: Nelson's Textbook of Pediatrics 19th edition p868
‣ A 3 year old female presents with 1 week history of daily (quotidian) fever associated
with arthritis of both ankles and her right knee. Her mother notes that she has
decreased activity and also notes rashes that come and go in different parts of her body
but not on the face. On physical examination, salmon colored patches were noted on
the trunk and extremities. Palpation revealed splenomegaly. What is the diagnosis?
A. Henoch Schoenlein Purpura
B. Systemic Lupus Erythematosus
C. Juvenile Rheumatoid arthritis
D. Juvenile Dermatomyositis
E. Dengue fever -✓✓3 C.
Don't forget to study rheumatic diseases of childhood even if it's not your favorite topic.
Familiarize yourself with the relatively common ones like JRA, SLE and
dermatomyositis, HSP and scleroderma. Pay attention to the characteristics of the rash
and other features. (Don't fall for the trap of rash + arthritis = SLE.. It's not always SLE!)
JRA - Salmon colored patch, evanescent, spares the face
SLE - Malar rash, photosensitive
Dermatomyositis - heliotrope (periorbital) rash, gottron papules (rash on the knuckles)
HSP - purpura in dependent portions
For JRA, know the differences between subtypes (oligoarticular vs polyarticular vs
systemic onset)
,This case in particular is a case of systemic onset Juvenile Rheumatoid arthritis (also
called Still's Disease)
Source: Nelson's Textbook of Pediatrics 19th edition p830
‣ A 4 yr old boy presents with his third episode of painful cervical lymphadenitis. Each
was treated with incision and drainage and grew S. aureus. He also experiences
recurrent skin infections. A year ago, he was hospitalized for osteomyelitis. The most
important laboratory test is:
A. PCR for ADA deficiency
B. Nitroblue tetrazolium test
C. MAC-I assay
D. Neutrophil count
E. Genetic chromosomal analysis -✓✓4 B. This is a case of chronic granulomatous
disease (CGD) wherein patients are susceptible to catalase positive organisms like S.
aureus. The nitroblue tetrazolium tests the neutrophils ability to generate superoxide
anion and thus kill ingested bacteria.
Source: Nelson's Textbook of Pediatrics 19th edition p746
‣ Which among the following is not a prominent feature of Wiskott-Aldrich syndrome?
A. X-linked recessive inheritance
B. Atopic dermatitis
C. Thrombocytopenia
D. Recurrent infections with encapsulated bacteria
E. Leukopenia -✓✓5 E.
Note: The prominent immunologic impairment in Wiskott Aldrich Syndrome is against
polysaccharides of encapsulated organisms
Source: Nelson's Textbook of Pediatrics 19th edition p734
‣ A 12 year old seeks consult for 1 day history of sneezing, clear rhinorrhea and nasal
itching not associated with fever or any other systemic symptoms. PE reveals boggy,
pale nasal edema with a clear discharge. The most likely diagnosis is?
A. Foreign body
B. Vasomotor rhinitis
C. Allergic rhinitis
D. Neutrophilic rhinitis
E. Rhinitis medicamentosa -✓✓6 C.
Allergic rhinitis is often seasonal and associated with allergic conjunctivitis. Eosinophils
predominate in the nasal secretions. It is classified as:
Seasonal (cyclical) or perennial (all year)
,Intermittent (symptoms occur <4 days per week or <4 consecutive weeks) or persistent
(symptoms occur >4 days per week or >4 consecutive weeks)
Mild-moderate (no impairment) or severe (with impairment of daily living/sleep)
Source: Nelson's Textbook of Pediatrics 19th edition p775
‣ The Kasai procedure is indicated for which of the following?
A. Neonatal hepatitis
B. Biliary atresia
C. Metabolic liver disease
D. Fulminant hepatic failure
E. None of the above -✓✓7 B.
Despite initial success of the Kasai operation, patients with biliary atresia eventually get
liver transplantation.
Source: Nelson's Textbook of Pediatrics 19th edition 1387
‣ An 8 month old manifests with fussiness and emesis and refuses to eat. 1 week ago,
he was brought for consult and was diagnosed with URTI. On the morning of consult,
his mother noted currant jelly like material on his diaper. On PE, a sausage shaped
mass was palpable in the abdomen. There is likewise abdominal distention and rectal
exam reveals blood in the stool. The most likely diagnosis is:
A. Viral diarrhea
B. Duodenal atresia
C. Intussusception
D. Hypertrophic pyloric stenosis
E. Intestinal adenoma -✓✓8 C.
Aside from that, intussusception may present with lethargy out of proportion to the
intestinal signs and symptoms. Intussusception in children is usually due to lymphoid
hyperplasia in the intestines. This becomes the lead point. The most common location is
ileocolic.
Source: Nelson's Textbook of Pediatrics 19th edition p1288
‣ A 3 year old female presents to your office with unilateral nasal discharge. The
discharge is described by the caretaker to be malodorous and lately has been blood
tinged. The most likely diagnosis is:
A. Tertiary syphilis
B. Unilateral choanal atresia
C. Nasopharyngeal carcinoma
D. Foreign body
E. Angiosarcoma of the nose -✓✓9 D.
, Source: Nelson's Textbook of Pediatrics 19th edition p 1431
‣ A 3 year old is brought to the ER. On PE, inspiratory stridor and a barking cough were
noted. There is mild respiratory distress, tachypnea, and fever. The signs and
symptoms are aggravated by agitation and crying. The most likely diagnosis is
A. Tracheomalacia
B. Laryngotracheobronchitis
C. Epiglottitis
D. Bacterial tracheitis
E. Peritonsillar abscess -✓✓10 B. This is a case of croup and is common in this age
group.
Barking cough = croup
Epiglotitis and bacterial tracheitis patients are more toxic appearing and not in merely
mild respiratory distress
Source: Nelson's Textbook of Pediatrics 19th edition p1446
‣ A newborn was noted to be cyanotic. Unfortunately the imaging facilities are
unavailable for the day. A hyperoxia test was thus done which showed no improvement
of PaO2 after administration of 100% O2. The next step in the management of this
neonate is:
A. Low tidal volume mechanical ventilation
B. Positive pressure ventilation
C. Digoxin
D. Emergency laparotomy
E. Prostaglandin E -✓✓11 E.
The hyperoxia test is used to differentiate whether the etiology of cyanosis is cardiac or
not. PaO2 does not improve in cardiac etiologies. In the absence of imaging for
definitive diagnosis of the congenital heart disease, the clinician should not hesistate to
administer prostaglandin in case the patient has a ductus dependent congenital heart
disease. Prostaglandin prevents the ductus from closing.
Source: Nelson's Textbook of Pediatrics 19th edition p1572
‣ A patient was diagnosed with Tetralogy of Fallot. His chest x-ray reveals the classic Le
Couer en Sabot. Which of the following components of TOF is responsible for this
shape?
A. Pulmonary stenosis
B. VSD
C. RVH
D. Overriding of the aorta
E. Right sided aorta -✓✓12 C.
