SMARTY PANCE - PEDS QUESTIONS AND ANSWERS
A 14-year-old male, who recently immigrated with his parents from the Dominican
Republic, presents with a 2-day history of fever, malaise, and sore throat. Immunization
records are unavailable. His temperature is 38.5°C (100.3°F), pulse is 100/min,
respirations are 16/min, and blood pressure is 110/80 mmHg. His physical exam shows
a severely swollen neck and unilateral cervical adenopathies. Which of the following
additional findings on physical examination would be typical of this patient's condition?
A. pharyngeal pseudomembrane
B. Sister Mary Joseph nodule
C. Janeway lesions
D. Forschheimer spots - Answers - pharyngeal pseudomembrane
A 13-year-old boy is brought to the emergency department after he was bitten by his
neighbor's dog. The patient is currently doing well and has a dog bite on his left distal
forearm. His temperature is 98.7°F, blood pressure is 110/60 mmHg, pulse is 118/min,
respirations are 20/min, and oxygen saturation is 99% on room air. The wound is
thoroughly irrigated in the emergency department. Which of the following is the best
next step in management?
A. Closure of the wound
B. Euthanasia of the animal
C. Quarantine and observe the animal
D. Rabies vaccine and rabies immunoglobulin - Answers - Quarantine and observe the
animal
A 6-year-old male is brought to your office by his mother with painful mouth/gums with
lesions on his lips and buccal mucosa for the past 2 days. The patient has been irritable
and for the last 24 hours has refused to eat or drink. His vital signs are as follows: T
99.1, HR 112, BP 92/62, RR 17, SpO2 98%. Physical examination is significant for
vesicular lesions noted on the tongue, gingiva, and lips, with some vesicles having
ruptured and ulcerated, as well as palpable cervical and submandibular
lymphadenopathy. Which of the following is the most likely causative organism in this
patient's presentation?
A. CMV
B. EBV
C. HSV1
D. HSV2
E. Parvovirus - Answers - HSV1
A 6-year old boy presents with fever, tender posterior auricular and suboccipital
adenitis, and a pink maculopapular rash which started on the face and has now moved
to the trunk and extremities within 24 hours. The child was recently adopted and has not
had routine pediatric care. His temperature is 100.3°F, blood pressure is 108/74 mmHg,
pulse is 99/min, respirations are 19/min, and oxygen saturation is 99% on room air. The
,child is playing quietly in your office and appears generally well. Which of the following
is the most likely diagnosis?
A. Rubella
B. Varicella
C. Roseola
D. Rubeola
E. Kawaski Disease - Answers - Rubella
A 6-year-old child is brought to the emergency room for a complaint of high fevers and a
rash. His mother reports that she thought he had "just a cold" approximately one week
ago—he had a mild fever, runny nose, conjunctivitis, and cough. Then he developed a
rash that started on his face and gradually spread downward. The child has no
significant past medical history, however, he was adopted from Nigeria at age 5, and his
medical history prior to adoption is unknown. On examination, the child appears
lethargic and has a temperature of 104.3. There is a mild injection of his conjunctiva and
a generalized macular rash. White macules are noted on his buccal mucosa. What is
the most likely diagnosis?
A. Rocky Mountain Spotted Fever
B. Roseola
C. Rubella
D. Rubeola - Answers - Rubeola
A 4-year-old girl is brought by her mother complains of genital and anal itching,
especially at night when she is going to bed. The girl is otherwise healthy and her
vaccinations are up to date. Her temperature is 97.8°F, blood pressure is 110/75
mmHg, pulse is 88/min, respirations are 15/min, and oxygen saturation is 99% on room
air. Physical exam is notable for excoriations over the girl's anus and near her vagina.
Which of the following is the most likely infectious etiology?
A. Candida albicans
B. Enterobius vermicularis
C. Gardnerella vaginalis
D. HSV - Answers - Enterobius vermicularis
An 11-month old boy presents with a generalized body rash of 2 days duration. His
mother gives a history of high fever, which started 6 days ago and ended 3 days ago. It
was associated with 2 episodes of seizures. Examination shows generalized rose-pink
maculopapular rash. Which is the most likely diagnosis?
A. Rubeola
B. Roseola
C. Varicella
D. Rubella - Answers - Roseola
A 17-year old presents to you with complaints of bloody diarrhea, abdominal pain,
vomiting, and headache for the past 4 days. Eight hours prior to the onset of symptoms,
he ingested 3 raw eggs. Which of the following is most likely responsible for his
diarrhea?
, A. Salmonella
B. Staphylococci
C. C. perfringens
D. Giardia lamblia - Answers - Salmonella
A 12 month-old child with tetralogy of Fallot is most likely to have which of the following
clinical features?
A. chest pain
B. cyanosis
C. convulsions
D. palpitations - Answers - cyanosis
An 8 year-old boy is brought to a health care provider complaining of dyspnea and
fatigue. On physical examination, a continuous machinery murmur is heard best in the
second left intercostal space and is widely transmitted over the precordium. The most
likely diagnosis is
A. ventricular septal defect
B. atrial septal defect
C. congenital aortic stenosis
D. patent ductus arteriosus - Answers - patent ductus arteriosus
The most common arrhythmia encountered in patients with mitral stenosis is
A. atrial flutter
B. atrial fibrillation
C. paroxysmal atrial tachycardia
D. atrio-ventricular dissociation - Answers - atrial fibrillation
A 6-year-old is brought to the office by her mother. The child has had a low-grade fever,
headache, and sore throat for the past week. Four days ago, she suddenly developed a
bright red rash on her cheeks, which during the past two days has spread to the trunk,
arms, and legs. On physical examination, the child has erythema of the cheeks and a
maculopapular rash with central clearing on the trunk spreading to the extremities.
There are no other significant findings. Other than supportive care what additional
instructions should give to this patient and her mother?
A. She should remain out of school until the rash resolves
B. She may return to school but avoid PE due to the risk of splenic injury
C. She should wash her hands as this rash is caused by a virus spread via the fecal-
oral route
D. She may resume normal activities as her energy level improves - Answers - She may
resume normal activities as her energy level improves
A 9-year old girl is brought to the clinic by her mother on account of fever. She has red
skin lesions on the trunk and proximal extremities, and also small, non-tender lumps
located over the joints. On further inquiry, she reports a history of a sore throat which
occurred about 4 weeks ago. Which of the following diagnostic tests would support the
diagnosis of acute rheumatic fever?
A 14-year-old male, who recently immigrated with his parents from the Dominican
Republic, presents with a 2-day history of fever, malaise, and sore throat. Immunization
records are unavailable. His temperature is 38.5°C (100.3°F), pulse is 100/min,
respirations are 16/min, and blood pressure is 110/80 mmHg. His physical exam shows
a severely swollen neck and unilateral cervical adenopathies. Which of the following
additional findings on physical examination would be typical of this patient's condition?
A. pharyngeal pseudomembrane
B. Sister Mary Joseph nodule
C. Janeway lesions
D. Forschheimer spots - Answers - pharyngeal pseudomembrane
A 13-year-old boy is brought to the emergency department after he was bitten by his
neighbor's dog. The patient is currently doing well and has a dog bite on his left distal
forearm. His temperature is 98.7°F, blood pressure is 110/60 mmHg, pulse is 118/min,
respirations are 20/min, and oxygen saturation is 99% on room air. The wound is
thoroughly irrigated in the emergency department. Which of the following is the best
next step in management?
A. Closure of the wound
B. Euthanasia of the animal
C. Quarantine and observe the animal
D. Rabies vaccine and rabies immunoglobulin - Answers - Quarantine and observe the
animal
A 6-year-old male is brought to your office by his mother with painful mouth/gums with
lesions on his lips and buccal mucosa for the past 2 days. The patient has been irritable
and for the last 24 hours has refused to eat or drink. His vital signs are as follows: T
99.1, HR 112, BP 92/62, RR 17, SpO2 98%. Physical examination is significant for
vesicular lesions noted on the tongue, gingiva, and lips, with some vesicles having
ruptured and ulcerated, as well as palpable cervical and submandibular
lymphadenopathy. Which of the following is the most likely causative organism in this
patient's presentation?
A. CMV
B. EBV
C. HSV1
D. HSV2
E. Parvovirus - Answers - HSV1
A 6-year old boy presents with fever, tender posterior auricular and suboccipital
adenitis, and a pink maculopapular rash which started on the face and has now moved
to the trunk and extremities within 24 hours. The child was recently adopted and has not
had routine pediatric care. His temperature is 100.3°F, blood pressure is 108/74 mmHg,
pulse is 99/min, respirations are 19/min, and oxygen saturation is 99% on room air. The
,child is playing quietly in your office and appears generally well. Which of the following
is the most likely diagnosis?
A. Rubella
B. Varicella
C. Roseola
D. Rubeola
E. Kawaski Disease - Answers - Rubella
A 6-year-old child is brought to the emergency room for a complaint of high fevers and a
rash. His mother reports that she thought he had "just a cold" approximately one week
ago—he had a mild fever, runny nose, conjunctivitis, and cough. Then he developed a
rash that started on his face and gradually spread downward. The child has no
significant past medical history, however, he was adopted from Nigeria at age 5, and his
medical history prior to adoption is unknown. On examination, the child appears
lethargic and has a temperature of 104.3. There is a mild injection of his conjunctiva and
a generalized macular rash. White macules are noted on his buccal mucosa. What is
the most likely diagnosis?
A. Rocky Mountain Spotted Fever
B. Roseola
C. Rubella
D. Rubeola - Answers - Rubeola
A 4-year-old girl is brought by her mother complains of genital and anal itching,
especially at night when she is going to bed. The girl is otherwise healthy and her
vaccinations are up to date. Her temperature is 97.8°F, blood pressure is 110/75
mmHg, pulse is 88/min, respirations are 15/min, and oxygen saturation is 99% on room
air. Physical exam is notable for excoriations over the girl's anus and near her vagina.
Which of the following is the most likely infectious etiology?
A. Candida albicans
B. Enterobius vermicularis
C. Gardnerella vaginalis
D. HSV - Answers - Enterobius vermicularis
An 11-month old boy presents with a generalized body rash of 2 days duration. His
mother gives a history of high fever, which started 6 days ago and ended 3 days ago. It
was associated with 2 episodes of seizures. Examination shows generalized rose-pink
maculopapular rash. Which is the most likely diagnosis?
A. Rubeola
B. Roseola
C. Varicella
D. Rubella - Answers - Roseola
A 17-year old presents to you with complaints of bloody diarrhea, abdominal pain,
vomiting, and headache for the past 4 days. Eight hours prior to the onset of symptoms,
he ingested 3 raw eggs. Which of the following is most likely responsible for his
diarrhea?
, A. Salmonella
B. Staphylococci
C. C. perfringens
D. Giardia lamblia - Answers - Salmonella
A 12 month-old child with tetralogy of Fallot is most likely to have which of the following
clinical features?
A. chest pain
B. cyanosis
C. convulsions
D. palpitations - Answers - cyanosis
An 8 year-old boy is brought to a health care provider complaining of dyspnea and
fatigue. On physical examination, a continuous machinery murmur is heard best in the
second left intercostal space and is widely transmitted over the precordium. The most
likely diagnosis is
A. ventricular septal defect
B. atrial septal defect
C. congenital aortic stenosis
D. patent ductus arteriosus - Answers - patent ductus arteriosus
The most common arrhythmia encountered in patients with mitral stenosis is
A. atrial flutter
B. atrial fibrillation
C. paroxysmal atrial tachycardia
D. atrio-ventricular dissociation - Answers - atrial fibrillation
A 6-year-old is brought to the office by her mother. The child has had a low-grade fever,
headache, and sore throat for the past week. Four days ago, she suddenly developed a
bright red rash on her cheeks, which during the past two days has spread to the trunk,
arms, and legs. On physical examination, the child has erythema of the cheeks and a
maculopapular rash with central clearing on the trunk spreading to the extremities.
There are no other significant findings. Other than supportive care what additional
instructions should give to this patient and her mother?
A. She should remain out of school until the rash resolves
B. She may return to school but avoid PE due to the risk of splenic injury
C. She should wash her hands as this rash is caused by a virus spread via the fecal-
oral route
D. She may resume normal activities as her energy level improves - Answers - She may
resume normal activities as her energy level improves
A 9-year old girl is brought to the clinic by her mother on account of fever. She has red
skin lesions on the trunk and proximal extremities, and also small, non-tender lumps
located over the joints. On further inquiry, she reports a history of a sore throat which
occurred about 4 weeks ago. Which of the following diagnostic tests would support the
diagnosis of acute rheumatic fever?
