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PEDS MIDTERM 6541 EXAM |VERIFIED QUSTIONS
AND ANSWERS 2026\
Appropriate advice for a mother of a 2-week-old child here for a "well child" visit includes which of the following? - Answers: Sleep in the supine position is recommended Parents bring their 6-month-old son to see you. He is symmetrically less than the 5th percentile for height, weight and head circumference. He was born at 30 weeks' gestation and weighed 1000g. He was a planned pregnancy, and his mother's prenatal course was uneventful until an automobile accident initiated the labor. He was ventilated for 3 days in the intensive care unit but otherwise did well without ongoing problems. He was discharged at 8 weeks of life. Which of the following is the most likely explanation for his small size? - Normal ex-preemie infant growth A Mantoux test in a child with no risk factors is considered positive with a reaction of - at least 15 mm induration A 4-year-old believes there is more juice in a tall, thin glass than a shorter, wider one. The child has not yet achieved which of the principles of Piaget? - Conservation I can roll over, grasp a rattle, and reach for things and have begun feeding myself finger foods, but I can't wave bye-bye yet. How old am I? - 6 months A 4-month-old child has poor weight gain. Her current weight is less than the 5th percentile, height about the 10th percentile, and head circumference at the 50th percentile. The planned pregnancy resulted in a normal, spontaneous, vaginal delivery; mother and child were discharged after a 48-hour hospitalization. Feeding is via breast and bottle; the quantity seems sufficient. The child has had no illness. The examination is unremarkable except for the child's small size. Screening laboratory shows the hemoglobin and hematocrit are 11 mg/dL and 33% respectively, with a platelet count of 198,000/mm3. Serum electrolyte levels are sodium 140, chloride 105, potassium 3.5, bicarbonate 17, blood urea nitrogen 15, and creatinine 0.3. Liver function tests are normal. Urinalysis reveals a pH of 8 with occasional epithelial cells but no white blood cells,
bacteria, protein, ketones, or reducing substances. Which of the follow - Oral supplementation with bicarbonate Which of the following vaccines is routinely recommended at 4 months of age? - Diphtheria, tetanus, acellular pertussis (DTaP) I can walk well on tiptoes, my speech is 50% understandable, I know six body parts, but I cannot balance on one foot for 1 second. I am - 2-1/2 years old (30 months) You see a healthy 18-month-old for a well-child visit. At the 12-month visit he received the diphtheria, tetanus, and acellular pertussis (DTaP) third dose; hepatitis B second dose; measles, mumps, and rubella (MMR) first dose; injected poliovirus (IPV) second dose; pneumococcal conjugate (PCV13) fourth dose; and Haemophilus influenzae type B (Hib) fourth dose. Which of the following do you order today? - DTaP, varicella, hepatitis A, and hepatitis B Which is the correct order for introduction of solid foods to an infant? - Cereal, vegetables, fruits, and meats I like to use my pincer grasp that involves the ability to pick up a small object such as a raisin or piece of cereal with the thumb and forefinger, and that is mastered around what age? - 9 months The first sign of the onset of female puberty is usually - Breast buds A mother of a 6-month-old asks you about normal sleep patterns for an infant this age. The best response is: - 10 hours at night and 3-4 hours during the day Medicaid provides health insurance coverage to - Certain categories of people whose personal income falls below a certain percentage of the federal poverty level.
The parents of a 7-year-old are concerned their son does not want to attend school. Which of the historical findings are not usually associated with the diagnosis of school phobia? - Chronic medical illness Chelsea, age 8, complains that she feels as if something is stuck in her ear. What action is contraindicated? - Flushing the ear with water You see a 7-year-old with complaints of "having accidents at night." Physical exam and history are unremarkable. Urinalysis, urine culture, and specific gravity are normal. His parents ask about the best treatment for this problem. The best response is - Fluid restriction and voiding prior to the night may be effective You are doing a kindergarten physical on a 5-year-old girl. Which of the following scenarios would suggest the child is not ready to start kindergarten in the fall? - Counts to 4 and draws a person with three parts. Upon eye examination of a newborn, you note inner canthal folds and Brushfield spots. What do you suspect? - Down syndrome I like to use my pincer grasp that involves the ability to pick up a small object such as a raisin or piece of cereal with the thumb and forefinger, and that is mastered around what age? - 9 months Mark, a 10-year-old, has a lot of ear pain. He does not want anyone to touch it and is crying in pain. The ear canal is swollen and exudate is present. The TM is normal. What is the proper management for his patient? - Topical Fluoroquinolone The diagnostic criteria for autism spectrum disorder include all of the following except - Tolerance of flexibility with routines
Luke, a 17-month-old, failed treatment with amoxicillin for otitis media. At the twoweek recheck, his TM was still erythematous and you cannot see the landmarks. He has persistent nasal congestion, he is not sleeping at night, and he has a 101°F fever. What is the next best step for Luke? - A 10 day course of Augmentin Which of the following would not suggest an eating disorder with a purging component? - Diarrhea Role-play with equipment during the course of the physical exam would be the most beneficial with which age group? - Preschoolers While assessing the skin of an infant, you note cafe-au-lait spots. Which disease should be ruled out? - Neurofibromatosis An expected milestone of a 4-year-old is the ability to - Copy a cross You receive a phone call from the mother of a 2-year-old. She states her child has sleep refusal. You suggest the child should be able to: - Set his own bedtime based on his internal clock. A healthy, well-developed 6-year-old child arrives as a new patient to your clinic. His immunization card reveals that he received immunization at birth and some when he was 2 months old, but none since. Which of the following statements about him is correct? - He is too old to receive the Haemophilus influenzae Type B vaccine Which of the following issues or concepts is relevant to the school-age child? - Erikson's initiative versus guilt You would be concerned about the language development of a child who - Stutters when excited or tired at the age of 7
with a platelet count of 198,000/mm3. Serum electrolyte levels are sodium 140, chloride 105, potassium 3.5, bicarbonate 17, blood urea nitrogen 15, and creatinine 0.3. Liver function tests are normal. Urinalysis reveals a pH of 8 with occasional epithelial cells but no white blood cells, bacteria, protein, ketones, or reducing substances. Which of the follow - Oral supplementation with bicarbonate Which of the following signs may indicate a baby is not receiving sufficient breastmilk? - Sleepiness, jaundice, and vomiting By what age should most children be able to sit well without support? - 9 months I can roll over, grasp a rattle, and reach for things and have begun feeding myself finger foods, but I can't wave bye-bye yet. How old am I? - 6 months Parents bring their 16-year-old daughter for a "well-child" checkup. She looks normal on examination. As part of your routine care you plan a urinalysis. The father pulls you aside and asks you to secretly run a UDS on his daughter. Which of the following is the most appropriate course of action? - Explore the reasons for the request with the parents and the adolescent and perform a UDS with the adolescent's permission if the history warrants. A teenage female who is overweight has moderate acne on the face and chest and irregular menses. Elevation of which laboratory test provides the test evidence of polycystic ovarian syndrome? - free testosterone Which of the following complication of strep pharyngitis cannot be prevented with antibiotics? - Glomerulonephritis A fifteen-year-old female makes a statement to you during a well visit. Which of the following statements should not be kept confidential? - "Sometimes I feel like ending my life."
Which of the following screenings should adolescents have done annually? - Psychosocial screening, blood pressure, body mass index Which of the following substances is associated with pupillary constriction? - Heroin The appropriate lab tests in the assessment of cervical adenitis include all of the following except
- Blood culture What method can be safely used to remove cerumen in a 15-month-old child's ear? - Irrigation using warm water from a soft bulb syringe Max, a 9-year-old boy, is a very active child with limited self-control. He is easily distracted and has difficulty staying on task. You determine that he should have a neurodevelopmental evaluation because he is showing signs of - ADHD A mother states that her 4-year-old son constantly grinds his teeth at night. You document this as
- Bruxism The father of a 3-year-old is concerned because the child stutters. What should your approach be?
- Explain that this can be normal until 4 years of age. A mother of a 6-month-old asks you about normal sleep patterns for an infant this age. The best response is - 10 hours at night and 3-4 hours during the day Josh, age 13, has some enlargement of the scrotum and testes, a reddened scrotal sac, and some hair texture alteration. His penis is not enlarged. He is in Tanner stage - II Which of the following eye findings would be considered an ophthalmic emergency? - Unilateral vesicular lesions on the upper eyelid in a 3-week old.
Which of the following would most likely explain this child's small size? - Congenital cytomegalovirus infection Which of the following represents normal sequencing of development in a toddler? - Feeds self, can undress self with help, washes hands, imitates housework A 7-year-old boy with mental retardation was born at home at 26 weeks gestation to a 28- year- old mother who had received no prenatal care. An evaluation is likely to suggest his MR is related to which of the following? - Complications of prematurity A child's head circumference is routinely measured on each well visit until what age? - 2 years I can walk well on tiptoes, my speech is 50% understandable, I know six body parts, but I cannot balance on one foot for 1 second. I am - 2-1/2 years old (30 months) An 8-year-old female is brought into the office by her mother. She has complaints of fever and sore throat for the past 2 days. She denies difficulty swallowing but has loss of appetite and mild diarrhea. A few classmates have similar symptoms. A review of systems reveals clear nasal drainage, dry cough, and hoarseness. On exam she has a 101.5 temperature, 3+ erythematous tonsils, and anterior cervical lymphadenopathy. What is the likely diagnosis? - Viral pharyngitis Sam has otitis media. He also presents with conjunctivitis. This is due to which organism? - Haemophilus influenza Blood pressure should be measured at well-child visits starting at age - 3 years Sandy, age 18 months, crosses her legs when lifted from behind rather than pulling them up. Her legs are also hard to separate, making diaper changing difficult. She persistently uses only one hand. What condition do you suspect? - Cerebral palsy
Appropriate anticipatory guidance for the parents of an 8-year-old girl includes - Information that the child will start to value personal idols and role models Which of the following statements is true regarding lying and stealing by the school-age child? - They represent a common, transient problem. Epiglottitis has decreased due to which immunization? - HiB A 7-year-old has just been diagnosed with attention deficit hyperactivity disorder (ADHD). Her parents report that she is doing poorly in school and is disruptive in the classroom. They ask you what they can do. Your best response is - "Use a consistent approach with behavioral cues both at home and at school." A 2-day-old infant has significant nasal and rectal bleeding. He was delivered by a midwife at home; the pregnancy was without complications. His Apgar scores were 9 at 1 minute and 9 at 5 minutes. He has breastfed well and has not required a health care professional visit since birth. Which of the following vitamin deficiencies might explain his condition? - Vitamin K A 14-year old has ataxia. He is brought to the local emergency department, where he appears euphoric, emotionally labile, and disoriented. Many notice his abusive language. Which of the following agents is most likely responsible for his condition? - Alcohol An 11-year-old girl has dizziness, pupillary dilation, nausea, fever, tachycardia, and facial flushing. She says she can "see" sound and "hear" colors. The agent likely to be responsible is which of the following? - Lysergic acid diethylamide (LSD) You are performing an examination of a 3-year-old who is new to your office. Which finding requires immediate further evaluation? - An equal A-P and transverse chest diameter.
During a domestic health assessment, the CDC recommends screening every refugee child for which of the following diseases? - tuberculosis A 2-day-old newborn with conjunctivitis is likely due to - Chemical irritation from eye drops You see a 13-year-old who reports she is learning some basic geometry (areas, volume etc.). The ability to successfully master these concepts occurs during which Piaget developmental stage? - Formal operational A mother brings her 4-week-old infant into the office because she noticed small yellow-white glistening bumps on her infant's gums. She says they look like teeth but is concerned that they may be cancer. You diagnose these bumps as - Epstein's pearls Fluorescein staining of the eye is used to detect a Selected Answer - Corneal abrasion A new mom calls the NP on postpartum day 5. She reports her newborn wants to nurse for 30 minutes every 1-1/2 to 2 hours. Which of these is the best response? - "This is a very healthy breastfeeding pattern. Be sure to rest when you can. You are doing a great job." Tammy, age 3, is at the office for her well-child visit. She has trouble removing her own shirt as requested. Her mother yanks off her shirt after smacking her wrist and saying, "you must do as you're told quickly." Which action is indicated? - Observe Tammy for signs of child abuse. Which of the following injuries is most likely to be caused by the abuse of a toddler? - A displaced posterior rib fracture Hannah, age 4, is brought into the office by her father. She complains of a sore throat, difficulty swallowing, copious oral secretions, stridor, and a temperature of 102F. She does not have pharyngeal erythema or cough. What do you suspect? - Epiglottitis
Miguel, age 14, was hit in the eye with a baseball and developed eye pain, decreased visual acuity, and injection of the globe. Upon exam, you note blood in the anterior chamber and confirm a diagnosis of hyphema. What treatment do you recommend while Miguel is waiting to see the ophthalmologist - Apply bilateral eye patches Which of the following children has abnormal language development? - Speech is 50% understandable at 36 months of age The parent of a 2-year-old tells you her daughter recently started having breath-holding spells. She tells you the older sibling "did the same thing" and asks you for help. You advise her that after a breath-holding event - Act as if nothing abnormal happened You assess a 15-year-old's visual acuity and note her vision to be 20/50 in the right eye. She asks you what that means and you respond - "You can see at 20 feet with your right eye what most people can see at 50 feet." Head and chest circumferences should be equal at - 1 year of age A common feature of 2-year-old behavior is - Negativism You receive a phone call from the mother of a 2-year-old. She states her child has sleep refusal. You suggest the child should be able to - Set his own bedtime based on his internal clock. A typically developing 8-year-old girl will have which of the following genital development? - No pubic hair at all A breastfed infant is expected to have a lower incidence of which of the following? - Diarrhea
The mother of a 5 year old informs you that her daughter cheats when playing board games. What is the best response? - Explain that this is developmentally normal until the child is old enough to understand complex game rules. You see a 5-month-old who is fussy, has interrupted sleep and is drooling. You note large lower lateral incisor bulges. You recommend - Acetaminophen 10-15mg/kg/dose every 4 to 6 hours as needed and gum massages with a cold washcloth. Which of the following children has abnormal language development? - Speech is 50% understandable at 36 months of age A 7 mnth old male is found to have a spiral fracture of the femur that his father says he got by climbing onto a chair and then jumping off. Which of the statements is true? - You can be held legally liable for failing to report child abuse. Most children can independently get dressed by themselves by age - 5
