Aquifer Pediatrics End of Case Questions With Complete
Solutions Graded A+
A 36-month-old presents for a well child visit. The parents would like to know if
the child's development is progressing appropriately. The child passed a hearing
test at birth, and other than a few URIs, has been generally healthy. The child has
not had any hospitalizations or serious illnesses. The child is able to run well,
walk up stairs, walk slowly down stairs, uses more words than the parents are
able to count, but can only use them in short, two or three-word sentences. The
child's speech is understandable and the child can draw a circle, but not a cross.
Neurological examination reveals normal cranial nerves, normal sensitivity,
normal motor reflexes, and no Babinski sign. Which of the following is the next
best step in management of this child?
A. Perform a brain-stem auditory evoked potential hearing screen
B. Perform a screening exam for autism
C. Reassure the parents that the boy's development appears normal
D. Refer the child to a developmental specialist for comprehensive evaluation
E. Refer the child to a specialist for evaluation of his delayed motor development
The answer is C. From Peds 02.
Sammy is a healthy male child brought into your office by his mother for a well-
child examination. As part of your evaluation you assess his developmental
milestones. He is able to run, make a tower of 2 cubes, has 6 words in his
vocabulary, and can remove his own garments. What would you estimate
Sammy's age to be based upon his developmental milestones?
A. 12 months
B. 15 months
C. 18 months
D. 30 months
E. 36 months
The answer is C. From Peds 02.
A 5-month-old male is brought to the urgent care clinic with a 3 day history of
rhinorrhea and non-productive cough. At birth the baby was large for gestational
age and exam at the time was notable for macrocephaly, macroglossia, and
hypospadias. Vital signs are stable on physical exam at this time. There is
copious nasal discharge, but lungs are clear to auscultation. On abdominal exam,
you palpate an abdominal mass on the right side just below the subcostal margin.
It is 7 cm in diameter and does not cross the midline. The abdomen is soft and
non-tender with active bowel sounds. What is the most likely cause of his mass?
A. Hepatoblastoma
B. Renal cell carcinoma
C. Teratoma
D. Wilms' tumor
, The answer is D. From Peds 02.
An asymptomatic, healthy 9-month-old is found to have a palpable RUQ mass on
exam. After further imaging and lab studies, the mass is diagnosed as a
neuroblastoma that has involvement in the bone marrow as well. The mother is
worried about the prognosis. Which of the following is true about the prognosis
of neuroblastoma in this child?
A. Children who are older than 12 months have a better prognosis than younger
children
B. Favorable histology does not play a role in prognosis
C. Lymph node involvement is a poor prognostic factor
D. Non-amplification of the n-myc gene is a favorable prognostic factor
E. Prognosis of neuroblastoma is predictable
The answer is D. From Peds 02.
A 9-month old comes to the clinic for a well-child visit. The child is at the 50th
percentile for weight, length, and head circumference and is reaching all
developmental milestones appropriately. The mother has no concerns at this
visit. The child has previously received the following vaccines: 3 doses of DTaP,
3 doses of Hib, 2 doses of HepB, 3 doses of RotaV, 2 doses of IPV and 3 doses of
PCV13, and no influenza vaccines. Which vaccines should the child receive at
today's visit?
A. Hep B, DTaP, IPV
B. Hep B, IPV, and MMR
C. Influenza, Hep B, IPV
D. Influenza, Hep B, IPV, DTaP
E. Influenza, IPV
The answer is C. From Peds 02.
A 33-year-old G1P0 female with a history of medically controlled seizures gives
birth vaginally to a boy with IUGR at 38 weeks' gestation. The newborn is noted to
have dysmorphic cranial features and his head circumference is 28.5 cm (< 5th
percentile). What is another associated abnormality you might expect to see in
this newborn?
A. Hepatosplenomegaly
B. Cardiac defects
C. Absent red reflex
D. Chorioretinitis
E. Tremors
The answer is B. From Peds 01.
A 19-year-old female in her 38th week of pregnancy goes into active labor. Shortly
after birth her baby is noted to have a high-pitched cry, tremulousness,
hypertonicity, and feeding difficulties. The baby is otherwise developmentally
normal and the remainder of the physical exam also is normal. What is the drug
the baby's mother likely used during her pregnancy?
A. Heroin
B. Alcohol
Solutions Graded A+
A 36-month-old presents for a well child visit. The parents would like to know if
the child's development is progressing appropriately. The child passed a hearing
test at birth, and other than a few URIs, has been generally healthy. The child has
not had any hospitalizations or serious illnesses. The child is able to run well,
walk up stairs, walk slowly down stairs, uses more words than the parents are
able to count, but can only use them in short, two or three-word sentences. The
child's speech is understandable and the child can draw a circle, but not a cross.
Neurological examination reveals normal cranial nerves, normal sensitivity,
normal motor reflexes, and no Babinski sign. Which of the following is the next
best step in management of this child?
A. Perform a brain-stem auditory evoked potential hearing screen
B. Perform a screening exam for autism
C. Reassure the parents that the boy's development appears normal
D. Refer the child to a developmental specialist for comprehensive evaluation
E. Refer the child to a specialist for evaluation of his delayed motor development
The answer is C. From Peds 02.
Sammy is a healthy male child brought into your office by his mother for a well-
child examination. As part of your evaluation you assess his developmental
milestones. He is able to run, make a tower of 2 cubes, has 6 words in his
vocabulary, and can remove his own garments. What would you estimate
Sammy's age to be based upon his developmental milestones?
A. 12 months
B. 15 months
C. 18 months
D. 30 months
E. 36 months
The answer is C. From Peds 02.
A 5-month-old male is brought to the urgent care clinic with a 3 day history of
rhinorrhea and non-productive cough. At birth the baby was large for gestational
age and exam at the time was notable for macrocephaly, macroglossia, and
hypospadias. Vital signs are stable on physical exam at this time. There is
copious nasal discharge, but lungs are clear to auscultation. On abdominal exam,
you palpate an abdominal mass on the right side just below the subcostal margin.
It is 7 cm in diameter and does not cross the midline. The abdomen is soft and
non-tender with active bowel sounds. What is the most likely cause of his mass?
A. Hepatoblastoma
B. Renal cell carcinoma
C. Teratoma
D. Wilms' tumor
, The answer is D. From Peds 02.
An asymptomatic, healthy 9-month-old is found to have a palpable RUQ mass on
exam. After further imaging and lab studies, the mass is diagnosed as a
neuroblastoma that has involvement in the bone marrow as well. The mother is
worried about the prognosis. Which of the following is true about the prognosis
of neuroblastoma in this child?
A. Children who are older than 12 months have a better prognosis than younger
children
B. Favorable histology does not play a role in prognosis
C. Lymph node involvement is a poor prognostic factor
D. Non-amplification of the n-myc gene is a favorable prognostic factor
E. Prognosis of neuroblastoma is predictable
The answer is D. From Peds 02.
A 9-month old comes to the clinic for a well-child visit. The child is at the 50th
percentile for weight, length, and head circumference and is reaching all
developmental milestones appropriately. The mother has no concerns at this
visit. The child has previously received the following vaccines: 3 doses of DTaP,
3 doses of Hib, 2 doses of HepB, 3 doses of RotaV, 2 doses of IPV and 3 doses of
PCV13, and no influenza vaccines. Which vaccines should the child receive at
today's visit?
A. Hep B, DTaP, IPV
B. Hep B, IPV, and MMR
C. Influenza, Hep B, IPV
D. Influenza, Hep B, IPV, DTaP
E. Influenza, IPV
The answer is C. From Peds 02.
A 33-year-old G1P0 female with a history of medically controlled seizures gives
birth vaginally to a boy with IUGR at 38 weeks' gestation. The newborn is noted to
have dysmorphic cranial features and his head circumference is 28.5 cm (< 5th
percentile). What is another associated abnormality you might expect to see in
this newborn?
A. Hepatosplenomegaly
B. Cardiac defects
C. Absent red reflex
D. Chorioretinitis
E. Tremors
The answer is B. From Peds 01.
A 19-year-old female in her 38th week of pregnancy goes into active labor. Shortly
after birth her baby is noted to have a high-pitched cry, tremulousness,
hypertonicity, and feeding difficulties. The baby is otherwise developmentally
normal and the remainder of the physical exam also is normal. What is the drug
the baby's mother likely used during her pregnancy?
A. Heroin
B. Alcohol
