Pediatrics practice questions

PREP Questions Week of August 14

1. A 6-year-old boy presents to the emergency department with an 8-hour history of fever and
respiratory difficulty. During the physical examination, the boy is seated in his mother's arms and
appears toxic. He has a temperature of 104F (40C), a heart rate of 130 beats/min, and a
respiratory rate of 35 breaths/min. In addition, he is drooling. Each time you approach him, he
starts crying, and his respiratory difficulty worsens.
A.
B.
C.
D.
E.

Of the following, the MOST likely diagnosis is

diphtheria
epiglottitis
foreign body aspiration
laryngotracheobronchitis
pneumonia

2. A 3-year-old boy presents with a 48-hour history of dysphagia. His mother

explains that he also has been drooling and has had a high fever. He developed
stridor this morning. On physical examination, he sits upright and appears
uncomfortable.
Of the following, the MOST appropriate next step is to
A. administer intramuscular dexamethasone
B. obtain computed tomography of the neck
C. order nasopharyngoscopy for evaluation of the airway
D. perform a rapid strep test
E. perform intubation under controlled circumstances

3. You are evaluating a 16-year-old boy who is a member of his high school football team. He is
190.2 cm tall and weighs 99 kg. Both his father and paternal grandfather have hypertension that is
treated with medication. Findings on his physical examination are normal, although his blood
pressure is 140/85 mm Hg. To obtain this measurement, you used the largest blood pressure cuff in
your office. The bladder in the cuff covered about 50% of the circumference of his upper arm.
Of the following, the BEST course of action for this patient is to
A. begin oral antihypertensive therapy
B. measure the blood pressure in his other arm
C. refer him to a pediatric cardiologist
D. repeat the blood pressure measurement with a larger cuff

E. restrict the boy from competitive sports until his blood pressure is better controlled

4. You are evaluating a 4-year-old healthy girl at her annual health supervision visit. You note clear
breath sounds, strong pulses, a quiet precordium, and a murmur. Your partner noted a murmur at
last years visit.
Of the following, the finding MOST consistent with the diagnosis of an innocent murmur is
A. continuous machinery murmur under the left clavicle
B. harsh systolic murmur at the right upper sternal border
C. high-pitched systolic murmur in the back between the scapulae
D. low-pitched,long, diastolic murmur in the left axilla
E. low-pitched,vibratory systolic murmur at the left sternal border

5. You receive a telephone call from the mother of an 11-year-old girl who had an atrial septal defect
(ASD) closed by a transcatheter device placement 2 years ago. The mother asks whether the girl
requires antibiotic prophylaxis prior to the routine dental cleaning for which she is scheduled
tomorrow morning.
Of the following, your BEST response is that the girl
A. always requires antibiotic prophylaxis because she has a device in her heart
B. does not require antibiotic prophylaxis
C. may require antibiotic prophylaxis, depending on the type of device that was placed
D. requires antibiotic prophylaxis only if she has a dental cavity filled
E. requires antibiotic prophylaxis only if she has a residual atrial shunt