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AC Practice Exam
Question 1. Which of the following is the most appropriate initial step when obtaining a health history from a non‑verbal 3‑month‑old infant presenting with fever? A) Ask the mother to describe the infant’s feeding pattern B) Perform a detailed review of systems with the infant C) Directly ask the infant about pain location D) Use a standardized pain scale with the infant Answer: A Explanation: Infants cannot provide a history; caregivers are the primary source. Feeding patterns can give clues to underlying infection or dehydration. Question 2. A 7‑year‑old presents with acute onset wheezing after exposure to a cat. Which assessment tool is most appropriate for quantifying the severity of his asthma exacerbation? A) Modified Borg Scale B) Pediatric Asthma Severity Score (PASS) C) Wong‑Baker FACES Pain Scale D) Glasgow Coma Scale Answer: B Explanation: PASS is validated for children with asthma and incorporates wheeze, retractions, and oxygen saturation. Question 3. Which growth chart is recommended for monitoring weight gain in a premature infant corrected to 2 months gestational age? A) WHO growth standards for children 0‑ 5 years B) CDC growth charts for ages 2‑ 20 years
AC Practice Exam
C) Fenton preterm growth chart D) National Center for Health Statistics (NCHS) growth chart Answer: C Explanation: The Fenton chart is specifically designed for preterm infants and uses corrected gestational age. Question 4. A 4‑year‑old with a history of recurrent otitis media is evaluated for speech delay. Which developmental domain should be assessed first? A) Gross motor B) Fine motor C) Language D) Social‑emotional Answer: C Explanation: Speech delay directly relates to the language domain; assessment should begin there. Question 5. Which of the following environmental risk factors most strongly predisposes a child to developing asthma? A) Exposure to secondhand tobacco smoke B) Living at high altitude C) Frequent use of humidifiers D) Low‑protein diet Answer: A
AC Practice Exam
Question 8. A 12‑year‑old with sickle cell disease presents with acute chest syndrome. Which diagnostic study is essential to confirm the diagnosis? A) Complete blood count (CBC) only B) Chest radiograph C) Serum electrolytes D) Urinalysis Answer: B Explanation: A new infiltrate on chest X‑ray together with respiratory symptoms defines acute chest syndrome. Question 9. Which laboratory test is most useful for differentiating bacterial from viral meningitis in a child? A) Serum C‑reactive protein (CRP) B) Cerebrospinal fluid (CSF) glucose level C) CSF white blood cell differential with neutrophil predominance D) Blood urea nitrogen (BUN) Answer: C Explanation: CSF neutrophil predominance suggests bacterial meningitis; lymphocytic predominance points to viral etiology. Question 10. A 6‑month‑old infant presents with bronchiolitis. Which of the following is the best initial imaging study? A) Chest CT scan B) Chest X‑ray
AC Practice Exam
C) Lung ultrasound D) No imaging is routinely required Answer: D Explanation: Bronchiolitis is a clinical diagnosis; routine imaging is not indicated unless complications are suspected. Question 11. Which of the following is the most appropriate dose of epinephrine for an anaphylactic reaction in a 20‑kg child? A) 0.01 mg/kg intramuscularly B) 0.1 mg/kg intramuscularly C) 0.01 mg/kg intravenously over 10 minutes D) 0.5 mg fixed dose intramuscularly Answer: A Explanation: The recommended epinephrine dose for anaphylaxis in children is 0.01 mg/kg IM (max 0.3 mg per dose). Question 12. Which of the following statements best describes the pathophysiology of septic shock in children? A) Primary loss of myocardial contractility without vasodilation B) Excessive vasodilation leading to relative hypovolemia and tissue hypoperfusion C) Predominant hypercoagulable state causing microthrombi D) Direct bacterial invasion of the aortic valve Answer: B
AC Practice Exam
Question 15. A 9‑month‑old infant is evaluated for failure to thrive. Which laboratory assessment is most appropriate as a first step? A) Serum ferritin level B) Serum albumin and pre‑albumin C) Comprehensive metabolic panel (CMP) D) Serum thyroid‑stimulating hormone (TSH) Answer: C Explanation: A CMP screens for electrolyte, renal, hepatic, and glucose abnormalities that can contribute to poor growth. Question 16. Which of the following is a contraindication to the use of non‑invasive positive pressure ventilation (NIPPV) in a child with acute respiratory failure? A. Mild hypercapnia with pH 7. B. Facial trauma preventing mask seal C. Moderate hypoxemia responding to supplemental O₂ D. History of obstructive sleep apnea Answer: B Explanation: Facial trauma that prevents an adequate seal makes NIPPV ineffective and potentially harmful. Question 17. A 5‑year‑old presents with a high‑grade fever, neck stiffness, and a petechial rash. Which empiric antibiotic regimen is most appropriate pending culture results? A) Ceftriaxone alone B. Vancomycin plus ceftriaxone
AC Practice Exam
C. Ampicillin plus gentamicin D. Azithromycin Answer: B Explanation: The presentation suggests meningococcal meningitis; vancomycin plus ceftriaxone provides broad coverage for resistant organisms. Question 18. Which of the following findings on a peripheral blood smear is most indicative of hemolytic anemia in a child with sickle cell disease? A) Spherocytes B. Howell‑Jolly bodies C. Target cells D. Schistocytes Answer: D Explanation: Schistocytes (fragmented RBCs) are characteristic of intravascular hemolysis. Question 19. A 14‑year‑old with type 1 diabetes presents in diabetic ketoacidosis (DKA). Which of the following is the initial fluid of choice? A) 0.9% Normal saline bolus 20 mL/kg over 30 minutes B) 0.45% saline at 10 mL/kg/h C) Lactated Ringer’s solution bolus 10 mL/kg D) Dextrose‑containing solution immediately Answer: A
AC Practice Exam
A) Gallstones B) Trauma C) Viral infection (e.g., mumps) D) Medications (e.g., valproic acid) Answer: B Explanation: Physical trauma is the leading cause of acute pancreatitis in children, whereas gallstones predominate in adults. Question 23. A 3‑year‑old with a known ventricular septal defect (VSD) presents with worsening cyanosis and a new holosystolic murmur. Which complication is most likely? A) Eisenmenger syndrome B) Endocarditis C) Pulmonary hypertension leading to right‑to‑left shunt reversal D) Aortic coarctation Answer: C Explanation: Progression to pulmonary hypertension can cause reversal of shunt flow (right‑to‑left), leading to cyanosis. Question 24. Which of the following is the most appropriate method for assessing pain in a non‑verbal 2‑year‑old post‑operative patient? A) Visual Analog Scale (VAS) B) Wong‑Baker FACES Scale C) FLACC (Face, Legs, Activity, Cry, Consolability) Scale D) Numeric Rating Scale (NRS)
AC Practice Exam
Answer: C Explanation: The FLACC scale is validated for infants and young children who cannot self‑report pain. Question 25. Which of the following signs is pathognomonic for meningitis in a neonate? A) Bulging fontanelle B) Persistent cough C) Diarrhea D) Skin rash Answer: A Explanation: A bulging anterior fontanelle is a classic sign of increased intracranial pressure in neonatal meningitis. Question 26. A 10‑year‑old with a known history of asthma presents with an acute severe exacerbation. Which medication should be administered first? A) Oral prednisone B) Intravenous magnesium sulfate C) High‑flow nasal cannula oxygen D) Short‑acting β 2 ‑agonist (SABA) via nebulizer Answer: D Explanation: Rapid bronchodilation with a SABA is the first‑line treatment for acute asthma exacerbations.
AC Practice Exam
B) Start empiric broad‑spectrum antibiotics and evaluate for catheter‑related infection C) Observe without treatment as coagulase‑negative Staph is a contaminant D) Initiate antifungal therapy Answer: B Explanation: Coagulase‑negative Staph can cause catheter‑related bloodstream infections; start empiric therapy and assess catheter necessity. Question 30. Which of the following is the most appropriate initial management for a child with suspected septic arthritis of the knee? A) Immediate arthrocentesis and intravenous antibiotics B) Oral antibiotics and observation for 48 hours C) NSAIDs and rest only D) MRI before any invasive procedure Answer: A Explanation: Prompt joint aspiration for diagnosis and initiation of IV antibiotics are essential to prevent joint destruction. Question 31. A 2‑month‑old infant is evaluated for bronchiolitis. Which of the following is the most appropriate respiratory support if the child demonstrates worsening hypercapnia despite supplemental oxygen? A) High‑flow nasal cannula (HFNC) B) Continuous positive airway pressure (CPAP) C) Invasive mechanical ventilation D) No additional support; observe
AC Practice Exam
Answer: B Explanation: CPAP provides both oxygenation and ventilation support, addressing hypercapnia in bronchiolitis when HFNC is insufficient. Question 32. Which of the following is the most reliable marker for monitoring the effectiveness of treatment in a child with acute bacterial meningitis? A) Serial white blood cell (WBC) counts B) Decrease in CSF protein levels C) Normalization of CSF glucose D) Clinical improvement and resolution of fever Answer: D Explanation: Clinical response (improved mental status, afebrile state) is the primary indicator of therapeutic success; CSF parameters may lag. Question 33. A 5‑year‑old presents with a severe burn covering 30% of total body surface area (TBSA). Which fluid resuscitation formula is most appropriate in the first 24 hours? A) Parkland formula (4 mL × body weight kg × %TBSA) B) Holliday‑Segar formula (100 mL/kg) C) 10 mL/kg bolus of normal saline only D) No fluid resuscitation needed for burns < 35% TBSA Answer: A Explanation: The Parkland formula is standard for burn resuscitation, providing 4 mL per kg per %TBSA burned.
AC Practice Exam
B) Chest X‑ray showing catheter tip location C) Measuring central venous pressure (CVP) immediately after insertion D) Observation of blood return only Answer: B Explanation: A post‑placement chest radiograph verifies tip position and rules out pneumothorax. Question 37. A 4‑year‑old with a known allergy to penicillin presents with cellulitis. Which antibiotic is the best alternative? A) Cefazolin B) Vancomycin C) Clindamycin D) Amoxicillin‑clavulanate Answer: C Explanation: Clindamycin covers MRSA and streptococci and is safe in penicillin‑allergic patients. Question 38. Which of the following best describes the typical presentation of Henoch‑Schönlein purpura (IgA vasculitis) in children? A) Palpable purpura on the lower extremities, abdominal pain, arthritis, and renal involvement B) Diffuse petechial rash with severe thrombocytopenia C) Vesicular rash on the trunk with high fever D) Bullous lesions on the oral mucosa Answer: A
AC Practice Exam
Explanation: Classic tetrad includes palpable purpura, abdominal pain, arthralgias, and IgA nephropathy. Question 39. Which of the following is the most appropriate initial medication for a child with status epilepticus who has failed benzodiazepine therapy? A) Phenytoin loading dose B) Phenobarbital loading dose C) Levetiracetam loading dose D) Valproic acid loading dose Answer: B Explanation: Phenobarbital is a second‑line agent after benzodiazepines for refractory status epilepticus in children. Question 40. A 9‑month‑old infant is found to have a serum sodium of 120 mmol/L. Which of the following is the most appropriate initial management? A) Rapid infusion of 3% hypertonic saline B) Fluid restriction only C) Slow correction with isotonic saline, aiming for ≤ 8 mmol/L rise per 24 hours D) No treatment; observe Answer: C Explanation: Hyponatremia should be corrected slowly to avoid osmotic demyelination; isotonic fluids are used with careful monitoring. Question 41. Which of the following clinical findings is most suggestive of aortic coarctation in an infant?
AC Practice Exam
Answer: B Explanation: Immediate safety assessment and inpatient admission are required for acute suicidal ideation. Question 44. Which of the following is the most appropriate dosage of intrathecal methotrexate for a child with acute lymphoblastic leukemia (ALL) undergoing CNS prophylaxis? A) 2 mg/m² B) 6 mg/m² C) 12 mg/m² D) 15 mg/m² Answer: B Explanation: Standard intrathecal methotrexate dose for CNS prophylaxis in pediatric ALL is 6 mg/m². Question 45. A 3‑year‑old with a recent diagnosis of Kawasaki disease is receiving high‑dose IVIG. Which of the following is the most common cardiac complication if untreated? A) Mitral valve prolapse B) Coronary artery aneurysm C) Atrial septal defect D) Hypertrophic cardiomyopathy Answer: B Explanation: Untreated Kawasaki disease can lead to coronary artery aneurysms, the most serious complication.
AC Practice Exam
Question 46. Which of the following is the most appropriate first‑line therapy for a child with newly diagnosed type 2 diabetes mellitus presenting with mild hyperglycemia? A) Metformin monotherapy B) Insulin infusion C) Sulfonylurea therapy D) Lifestyle modification only Answer: A Explanation: Metformin is the preferred initial pharmacologic agent for pediatric type 2 diabetes. Question 47. A 12‑year‑old with a history of epilepsy is started on carbamazepine. Which laboratory test should be obtained periodically to monitor for adverse effects? A) Serum calcium B) Liver function tests (AST, ALT) C) Serum amylase D) Urinalysis Answer: B Explanation: Carbamazepine can cause hepatotoxicity; periodic liver function monitoring is required. Question 48. Which of the following is the most appropriate method for assessing fluid status in a critically ill child with suspected hypovolemic shock? A) Central venous pressure (CVP) measurement alone B) Physical exam findings (capillary refill, skin turgor) combined with lactate level C) Chest X‑ray
