Questions and Answers for Medical Students- Pediatrics- 1

Q- A 4-year-old boy has had fever for 6 days, red eyes without discharge, cracked red lips, a strawberry tongue, a rash, swollen hands and feet, and a large cervical lymph node. Which complication is most important to prevent?

A- Coronary artery aneurysm

B- Glomerulonephritis

C- Rheumatic heart disease

D- Sensorineural hearing loss

A- Coronary artery aneurysm. This is Kawasaki disease, a medium-vessel vasculitis of young children. Treat with IV immunoglobulin and aspirin to reduce the risk of coronary aneurysms, and follow with echocardiography. Kawasaki disease is one of the few indications for aspirin in children.

Q- A 9-month-old boy has episodes of severe crying with his legs drawn up, vomiting, and a stool that looks like currant jelly. A sausage-shaped mass is felt in the right upper abdomen. What is the best initial diagnostic test?

A- Abdominal ultrasound

B- CT scan of the abdomen

C- Upper GI barium swallow

D- Colonoscopy

A- Abdominal ultrasound. This is intussusception, most common between 6 and 36 months. Ultrasound shows a target (doughnut) sign. An air or contrast enema is both diagnostic and therapeutic if there are no signs of perforation or peritonitis. A Meckel diverticulum is a common lead point in older children.

Q- A 3-week-old firstborn boy has projectile, nonbilious vomiting after every feed and is hungry right after vomiting. An olive-shaped mass is felt in the epigastrium. Which lab finding is expected?

A- Hyperchloremic metabolic acidosis

B- Hypochloremic, hypokalemic metabolic alkalosis

C- Respiratory alkalosis

D- Anion gap metabolic acidosis

B- Hypochloremic, hypokalemic metabolic alkalosis. This is hypertrophic pyloric stenosis. Repeated vomiting of gastric acid causes loss of HCl and volume, leading to metabolic alkalosis and hypokalemia. Correct fluids and electrolytes first, then perform pyloromyotomy.

Q- A healthy child walks alone, uses “mama” and “dada” specifically, and picks up small objects with a fine pincer grasp. What is the most likely age of this child?

A- 6 months

B- 9 months

C- 12 months

D- 18 months

C- 12 months. Typical 12-month milestones are walking alone (or with one hand held), a mature pincer grasp, saying 1 to 2 words plus “mama” and “dada” specifically, and stranger anxiety. At 6 months children sit with support, and at 18 months they run and say about 10 to 20 words.

Q- A newborn develops jaundice 18 hours after birth. The mother is blood type O positive and the baby is A positive. What is the most likely cause?

A- Physiologic jaundice

B- Hemolysis from ABO incompatibility

C- Breast milk jaundice

D- Biliary atresia

B- Hemolysis from ABO incompatibility. Jaundice in the first 24 hours of life is always pathologic. Maternal anti-A IgG from a type O mother crosses the placenta and causes hemolysis. Physiologic jaundice appears on days 2 to 3, breast milk jaundice after the first week, and biliary atresia causes conjugated hyperbilirubinemia with pale stools at 2 to 8 weeks.