Sample Exam Questions: Pediatrics Written Exam

These multiple choice, “choose the one best answer” questions have been used on the Pediatrics Written Exam in the past, but have since been retired. The Written Exam contains some matching sets, and approximately one-quarter of the questions use visual exhibits. There are no true/false, K-type or negatively-worded “except” questions on the exam. These items are not meant to be a study guide, but rather samples of the type of questions seen on the certification and osteopathic continuous certification exams.

1. An afebrile 18-month-old presents to the emergency department with the sudden inability to move the right arm. There is no history of trauma. The next step is to:

A) notify social services.
B) extend and externally rotate the right forearm.
C) x-ray the clavicle.
D) do a skeletal survey.
E) order a serum calcium and phosphate level.

2. Scheuermann disease, also know as vertebral epiphysitis, results in:

A) thoracic scoliosis.
B) lumbar lordosis.
C) cervical kyphosis.
D) lumbar scoliosis.
E) thoracic kyphosis.

3. The bone age of a child is judged by the:

A) presence or absence of various ossification centers as compared to known standards.
B) radio-density of the long bones as compared to known standards.
C) width-length ratios of the wrist bones as compared to known standards.
D) chondral development compared to cortical thickening.
E) width-length ratios of the long bones as compared to known standards

4. A 10-day course of antibiotic therapy is indicated for children with:

A) sterile pyuria.
B) hemorrhagic cystitis due to the adenovirus.
C) bacterial colonization of the urine without obstructive uropathy.
D) recurrent urinary tract infections with a functionally and anatomically normal urinary tract.
E) persistent trace proteinuria.

5. A 2½-month-old afebrile infant presents with a staccato cough, tachypnea and conjunctivitis. Auscultation of the lungs reveals sparse, fine inspiratory rales throughout both lung fields. Chest x-ray reveals patchy infiltrates bilaterally. Which of the following is most likely the etiologic agent?

A) Chlamydia trachomatis
B) Cytomegalovirus
C) Bordetella pertussis
D) Staphylococcus aureus
E) Ureaplasma urealyticum

6. A 2-year-old female presents with fever, swelling and tenderness of the right anterior cervical nodes. The nodes feel firm. The most likely pathogen involved is:

A) Hemophilus influenzae.
B) Epstein Barr virus.
C) Staphylococcus aureus.
D) Streptococcus pneumoniae.
E) Mycobacterium avium intracellulare.

7. A 3-week-old female has jaundice. The baby was the product of a normal pregnancy and delivery; birth weight was 3100 gm. The mother states that the baby has been feeding well since birth, but the stools have been getting lighter in color during the past two weeks. On examination, the liver edge is palpable 3 cm below the right costal margin. Total serum bilirubin is 9.8 mg/dL (167.5 µmol/L) with a direct bilirubin of 3.2 mg/dL (54.7 µmol/L). The most likely diagnosis is:

A) breast milk jaundice.
B) neonatal hepatitis.
C) maple syrup urine disease.
D) ABO incompatibility.
E) glucose-6-phosphate dehydrogenase deficiency.

8. A barium swallow is negative for reflux. Of the following choices, which is considered the “gold standard” assisting in the diagnosis of gastro-esophageal reflux?

A) a trial of prokinetic agents.
B) esophagoscopy.
C) pneumocardiogram.
D) esophageal pH probe.
E) upper GI series.

9. A thriving 4½-year-old male is brought to the office due to fecal soiling and chronic constipation. History reveals that his stool habits were normal until “potty training” was initiated. Height and weight are at the 75th percentile. Physical examination reveals a mass in the lower left quadrant and a fecal-filled rectum. The next step in management is:

A) barium enema.
B) saline enema.
C) Epsom salt enema.
D) tap water enema.
E) rectal biopsy.

10. An 18-month-old female presents to the emergency department with marked respiratory distress associated with inspiratory and expiratory wheezing and a barking cough. Her history reveals that she had an upper respiratory infection for 2-3 days when she awoke from sleep with inspiratory stridor. Which of the following is most helpful in differentiating this as croup rather than bronchiolitis?

A) High grade fevers
B) The child’s age of 18 months
C) Improvement in symptoms with an aerosol of racemic epinephrine
D) Biphasic wheezing
E) The history of a preceding URTI

11. An injectable vaccine that is a potential risk for egg-sensitive individuals is:

(A) oral polio vaccine (OPV)
(B) diphtheria, tetanus, pertussis (DTaP)
(C) inactivated polio vaccine (IPV)
(D) influenza
(E) Haemophilus influenzae type b (Hib)

12. The etiologic agent responsible for most urinary tract infections is:

A) Proteus.
B) Klebsiella pneumoniae.
C) Escherichia coli.
D) Mycoplasma hominis.
E) Chlamydia trachomatis.

13. Cri du chat (cat cry) syndrome is associated with:

A) hip dysplasia and gonadoblastomas.
B) ambiguous genitalia in males, Wilm’s tumor.
C) microencephaly, epicanthal folds, micrognathia.
D) pyloric stenosis, wide-spaced nipples.
E) macroencephaly, webbed neck, skeletal malformations.

14. Early sexual maturation following radiation therapy to the brain:

A) is seen primarily in girls treated at a young age.
B) occurs with equal frequency among boys and girls.
C) is seen rarely and only after very high doses of radiation.
D) is seen primarily in boys treated at a young age.
E) has not been observed.

15. Hashimoto’s thyroiditis is:

A) not seen in children.
B) caused by exposure to excessive radiation.
C) associated with Turner and Down syndromes.
D) a frequent cause of congenital hypothyroidism.
E) an auto-immune disease of the thyroid.

16. In leukemia, common sites of extramedullary involvement include the:

A) liver.
B) testicle.
C) lung.
D) heart.
E) kidney.

17. Leukemoid reaction with lymphocytosis is associated with:

A) eczema.
B) Kawasaki disease.
C) infectious mononucleosis.
D) epiglottitis.
E) neurosyphilis.

18. Of the following physical stigmata, which would be most characteristic of Turner syndrome?

A) increased span to height ratio
B) metatarsus varus
C) low-set ears
D) webbed neck
E) narrow chest with wide spaced nipples

19. Purulent pericarditis in children is most commonly caused by:

A) Haemophilus influenzae or â-hemolytic streptococcus.
B) Staphylococcus aureus or Moraxella catarrhalis.
C) Streptococcus pneumoniae or â-hemolytic streptococcus.
D) Haemophilus influenzae or Staphylococcus epidermidis.
E) Haemophilus influenzae or Staphylococcus aureus.

20. The animal reservoir and corresponding vector for Lyme disease is:

A) deer/deer tick.
B) wood rat/flea.
C) mouse/deer tick.
D) raccoon/flea.
E) skunk/deer tick.