Peds Aquifer Exam Questions With Solved Solutions.
An 8-year-old healthy obese African American male with no past medical history
is found to have a blood pressure of 125/90 mmHg on all four extremities on
routine evaluation during an office visit for well-child care. Review of symptoms
is negative. A physical exam and screening bloodwork are performed. Both are
normal, with the exception of his blood pressure and obesity. What is the most
likely diagnosis?
A. Primary hypertension
B. Renal artery stenosis
C. Coarctation of the aorta
D. Pheochromocytoma
E. Hyperthyroidism
A. The sole physical finding is hypertension. Given the mild hypertension and the
patient's age, symptoms are unlikely to be present. Other etiologies should be ruled out,
but review of symptoms, physical examination, and laboratory studies do not suggest
other etiologies.
An 8-year-old boy is brought to clinic by his parents because they are concerned
that he has not been doing his homework. His teacher recently called the parents
to say that their son seems distracted in class, constantly interrupts other
children when they are speaking, and is very fidgety. When you speak with the
boy, he tells you that he did not know about the homework assignments and that
he tries hard to pay attention in class. What is the next best step in management?
A. Prescribe a stimulant medication for ADHD
B. Suggest behavior modification for the child and parenting classes
C. Group therapy for the child
D. Do nothing, as this child's behavior is normal
E. Contact the teacher to find out more about his behavior. Find out more about
the child's behavior at home
E. Contacting the teacher to find out more about the child's behavior at school and
learning more about his behavior at home are the best ways to determine if 6 of the
symptoms are present in 2 or more settings, which is required to make the diagnosis of
ADHD. It also will be important to learn more about other aspects of this child's life, as
there are several factors that can lead to acting out (including learning disability, hearing
disability, family stress, and abuse).
Billy, a 7-year-old boy, presents to the clinic with complaints of headaches and
episodes of feeling sweaty and flushed. He also reports that at times he feels as if
his heart is racing. Billy was full term, had an uncomplicated birth, and has been
otherwise healthy until now. On exam his BP is 120/80 mmHg and is the same in
his upper and lower extremities. His weight and height are in the 50th percentile
for his age. What is a likely cause of Billy's hypertension?
,A. Coarctation of the aorta
B. Renal vascular disease
C. Renal insufficiency due to renal scarring
D. Catecholamine excess
E. Primary hypertension
D. Catecholamine excess (pheochromocytoma or neuroblastoma) should be suspected
in a child who is hypertensive and has episodes of sudden sweating, flushing, or feels
that his heart is racing. Billy is exhibiting these signs and a urine catecholamine testing
would be appropriate in this case.
Jane is an 8-year-old girl who presents to your clinic for follow-up after being
hospitalized for status asthmaticus. She has just completed a 10-day course of
systemic steroids. Given her history of moderate persistent asthma, her
outpatient regimen includes Advair, a combined steroid and bronchodilator. She
was also diagnosed with ADHD one year ago and was started on Concerta, 18 gm
PO once a day. Her BMI today is at the 83rd percentile for her age, and her blood
pressure is at the 98th percentile for her age. What is the most likely cause of her
stage I hypertension?
A. Obesity
B. The blood pressure cuff is too big
C. Medications
D. Renal insufficiency
E. Neurofibromatosis 1
C. Both steroids and CNS stimulants can cause increases in blood pressure, especially
when used in combination. Steroids increase blood pressure by mimicking endogenous
cortisol and the sympathetic fight or flight response. Stimulants mimic norepinephrine,
stimulating alpha and beta adrenergic receptors, causing an overall increase in blood
pressure.
George is a 7-year-old boy frequently in trouble at school for being disruptive and
inappropriately talkative in class, not following directions set by his teacher, and
not working well with classmates during group activities. His mother relates that
at home George is always on the go, sleeping only 6 to 7 hours a night. He does
not follow her rules all the time either, including not doing his homework, and
sometimes putting himself in danger by doing things she tells him not to do, such
as running away unaccompanied. Which of the following is the most likely
diagnosis?
A. Bipolar mood disorder
B. Anti-social personality disorder
C. Conversion disorder
D. ADHD
E. Rett syndrome
D. ADHD is characterized by the triad of impulsivity, hyperactivity, and inattention. Other
symptoms include motor impairment and emotional labiality. ADHD is typically
diagnosed before the age of 7 but persists into adulthood. Intelligence is usually normal,
,but individuals with ADHD commonly perform more poorly academically than would be
expected for their IQ.
You are seeing a 36-month-old boy for his well-child visit. His parents are anxious
about ensuring that his development is appropriate. He passed a hearing screen
at birth and, other than a few colds, has been generally healthy. He has never
been hospitalized or had any serious illness. He is able to run well, walk up stairs,
and walk slowly down stairs. He uses more words than the parents are able to
count, but can use them only in short, two or three-word sentences. His speech is
understandable. He can draw a circle, but not a cross. Neurologic examination
shows normal cranial nerves, normal sensitivity, normal motor reflexes, and no
Babinski sign. Which of the following is the most appropriate next step in the
management of this patient?
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
C. The developmental milestones mentioned in the vignette are within the range of
normal for a 36-month-old child. In the absence of any other evidence of significant
impairment, there is no indication for referral at this point.
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
C. At 18 months, a child should be able to walk backward, and 50-90% of children can
run at this stage. An 18-month-old should be able to scribble, build a tower of 2 cubes,
have 3-6 words in her or his vocabulary, and be able to help in the house and remove
garments.
Mark is a 5-month-old male who is brought to the urgent care clinic with a three-
day history of rhinorrhea and non-productive cough. When he was born he was
large for gestational age, and his exam then was notable for macrocephaly,
macroglossia, and hypospadias. On physical exam now his vitals signs are
stable. He has copious nasal discharge, but his 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. Wilms' tumor
B. Teratoma
C. Renal cell carcinoma
D. Hepatoblastoma
A. Wilms' tumor is commonly associated with Beckwith-Wiedemann syndrome, a
genetic overgrowth syndrome. Other features that may be seen in children with this
syndrome include omphalocele, hemihypertrophy, hypoglycemia, large for gestational
age, and other dysmorphic features.
An asymptomatic, healthy 9-month-old female 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. Lymph node involvement is a poor prognostic factor
B. Prognosis of neuroblastoma is predictable
C. Children who are older than 12 months have a better prognosis than younger
children
D. Favorable histology does not play a role in prognosis
E. Non-amplification of the n-myc gene is a favorable prognostic factor.
E. Non-amplification of the n-myc gene is one of the favorable genetics in
neuroblastoma.
A 9-month old baby boy comes to the clinic for a well-child visit. The child is at
the 50th percentile for weight, length, and head circumference. He 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. Influenza, Hep B, IPV, DTaP
B. Influenza, IPV
C. Influenza, Hep B, IPV
D. Hep B, DTaP, IPV
E. Hep B, IPV, and MMR
C. Influenza, Hep B, IPV is correct. The patient needs a third Hep B, a third IPV, and a
yearly flu shot starting at 6 months of age.
A 10-month-old asymptomatic infant presents with a RUQ mass. Work-up reveals
a normocytic anemia, elevated urinary HVA/VMA, and a large heterogeneous
mass with scant calcifications on CT. A bone marrow biopsy is performed. Which
of the following histologic findings on bone marrow biopsy is most consistent
with your suspected diagnosis?
An 8-year-old healthy obese African American male with no past medical history
is found to have a blood pressure of 125/90 mmHg on all four extremities on
routine evaluation during an office visit for well-child care. Review of symptoms
is negative. A physical exam and screening bloodwork are performed. Both are
normal, with the exception of his blood pressure and obesity. What is the most
likely diagnosis?
A. Primary hypertension
B. Renal artery stenosis
C. Coarctation of the aorta
D. Pheochromocytoma
E. Hyperthyroidism
A. The sole physical finding is hypertension. Given the mild hypertension and the
patient's age, symptoms are unlikely to be present. Other etiologies should be ruled out,
but review of symptoms, physical examination, and laboratory studies do not suggest
other etiologies.
An 8-year-old boy is brought to clinic by his parents because they are concerned
that he has not been doing his homework. His teacher recently called the parents
to say that their son seems distracted in class, constantly interrupts other
children when they are speaking, and is very fidgety. When you speak with the
boy, he tells you that he did not know about the homework assignments and that
he tries hard to pay attention in class. What is the next best step in management?
A. Prescribe a stimulant medication for ADHD
B. Suggest behavior modification for the child and parenting classes
C. Group therapy for the child
D. Do nothing, as this child's behavior is normal
E. Contact the teacher to find out more about his behavior. Find out more about
the child's behavior at home
E. Contacting the teacher to find out more about the child's behavior at school and
learning more about his behavior at home are the best ways to determine if 6 of the
symptoms are present in 2 or more settings, which is required to make the diagnosis of
ADHD. It also will be important to learn more about other aspects of this child's life, as
there are several factors that can lead to acting out (including learning disability, hearing
disability, family stress, and abuse).
Billy, a 7-year-old boy, presents to the clinic with complaints of headaches and
episodes of feeling sweaty and flushed. He also reports that at times he feels as if
his heart is racing. Billy was full term, had an uncomplicated birth, and has been
otherwise healthy until now. On exam his BP is 120/80 mmHg and is the same in
his upper and lower extremities. His weight and height are in the 50th percentile
for his age. What is a likely cause of Billy's hypertension?
,A. Coarctation of the aorta
B. Renal vascular disease
C. Renal insufficiency due to renal scarring
D. Catecholamine excess
E. Primary hypertension
D. Catecholamine excess (pheochromocytoma or neuroblastoma) should be suspected
in a child who is hypertensive and has episodes of sudden sweating, flushing, or feels
that his heart is racing. Billy is exhibiting these signs and a urine catecholamine testing
would be appropriate in this case.
Jane is an 8-year-old girl who presents to your clinic for follow-up after being
hospitalized for status asthmaticus. She has just completed a 10-day course of
systemic steroids. Given her history of moderate persistent asthma, her
outpatient regimen includes Advair, a combined steroid and bronchodilator. She
was also diagnosed with ADHD one year ago and was started on Concerta, 18 gm
PO once a day. Her BMI today is at the 83rd percentile for her age, and her blood
pressure is at the 98th percentile for her age. What is the most likely cause of her
stage I hypertension?
A. Obesity
B. The blood pressure cuff is too big
C. Medications
D. Renal insufficiency
E. Neurofibromatosis 1
C. Both steroids and CNS stimulants can cause increases in blood pressure, especially
when used in combination. Steroids increase blood pressure by mimicking endogenous
cortisol and the sympathetic fight or flight response. Stimulants mimic norepinephrine,
stimulating alpha and beta adrenergic receptors, causing an overall increase in blood
pressure.
George is a 7-year-old boy frequently in trouble at school for being disruptive and
inappropriately talkative in class, not following directions set by his teacher, and
not working well with classmates during group activities. His mother relates that
at home George is always on the go, sleeping only 6 to 7 hours a night. He does
not follow her rules all the time either, including not doing his homework, and
sometimes putting himself in danger by doing things she tells him not to do, such
as running away unaccompanied. Which of the following is the most likely
diagnosis?
A. Bipolar mood disorder
B. Anti-social personality disorder
C. Conversion disorder
D. ADHD
E. Rett syndrome
D. ADHD is characterized by the triad of impulsivity, hyperactivity, and inattention. Other
symptoms include motor impairment and emotional labiality. ADHD is typically
diagnosed before the age of 7 but persists into adulthood. Intelligence is usually normal,
,but individuals with ADHD commonly perform more poorly academically than would be
expected for their IQ.
You are seeing a 36-month-old boy for his well-child visit. His parents are anxious
about ensuring that his development is appropriate. He passed a hearing screen
at birth and, other than a few colds, has been generally healthy. He has never
been hospitalized or had any serious illness. He is able to run well, walk up stairs,
and walk slowly down stairs. He uses more words than the parents are able to
count, but can use them only in short, two or three-word sentences. His speech is
understandable. He can draw a circle, but not a cross. Neurologic examination
shows normal cranial nerves, normal sensitivity, normal motor reflexes, and no
Babinski sign. Which of the following is the most appropriate next step in the
management of this patient?
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
C. The developmental milestones mentioned in the vignette are within the range of
normal for a 36-month-old child. In the absence of any other evidence of significant
impairment, there is no indication for referral at this point.
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
C. At 18 months, a child should be able to walk backward, and 50-90% of children can
run at this stage. An 18-month-old should be able to scribble, build a tower of 2 cubes,
have 3-6 words in her or his vocabulary, and be able to help in the house and remove
garments.
Mark is a 5-month-old male who is brought to the urgent care clinic with a three-
day history of rhinorrhea and non-productive cough. When he was born he was
large for gestational age, and his exam then was notable for macrocephaly,
macroglossia, and hypospadias. On physical exam now his vitals signs are
stable. He has copious nasal discharge, but his 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. Wilms' tumor
B. Teratoma
C. Renal cell carcinoma
D. Hepatoblastoma
A. Wilms' tumor is commonly associated with Beckwith-Wiedemann syndrome, a
genetic overgrowth syndrome. Other features that may be seen in children with this
syndrome include omphalocele, hemihypertrophy, hypoglycemia, large for gestational
age, and other dysmorphic features.
An asymptomatic, healthy 9-month-old female 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. Lymph node involvement is a poor prognostic factor
B. Prognosis of neuroblastoma is predictable
C. Children who are older than 12 months have a better prognosis than younger
children
D. Favorable histology does not play a role in prognosis
E. Non-amplification of the n-myc gene is a favorable prognostic factor.
E. Non-amplification of the n-myc gene is one of the favorable genetics in
neuroblastoma.
A 9-month old baby boy comes to the clinic for a well-child visit. The child is at
the 50th percentile for weight, length, and head circumference. He 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. Influenza, Hep B, IPV, DTaP
B. Influenza, IPV
C. Influenza, Hep B, IPV
D. Hep B, DTaP, IPV
E. Hep B, IPV, and MMR
C. Influenza, Hep B, IPV is correct. The patient needs a third Hep B, a third IPV, and a
yearly flu shot starting at 6 months of age.
A 10-month-old asymptomatic infant presents with a RUQ mass. Work-up reveals
a normocytic anemia, elevated urinary HVA/VMA, and a large heterogeneous
mass with scant calcifications on CT. A bone marrow biopsy is performed. Which
of the following histologic findings on bone marrow biopsy is most consistent
with your suspected diagnosis?
