Peds Questions:

A new patient to your practice, a happy 10-year-old girl has a history of

hyperextensible skin and easy bruising. She often has sprains and joint
dislocations when she exercises. What is the cardiovascular defect with
which the examination findings are most likely to be associated?
A) Coarctation of the aorta
B) ASD
C) Mitral valve prolapse
D) Pulmonic stenosis
E) Tetraolgy of Fallot
Explanation:
Mitral valve prolapse is seen in patients with Ehlers-Danlos syndrome. Patients with
Ehlers-Danlos syndrome have hyperextensibility and easy bruising, joint hypermobility
(leading to joint dislocations and sprains), skin that is velvety to touch, and tissue
fragility.

A 14-year-old boy presents with the complaint of "breast swelling." The boy
reports that he has been in good health and without other problems, but has
noticed over the past month or so that his left breast has been "achy" and
that he has now noticed some mild swelling under the nipple. He has never
seen discharge; the other breast has not been swelling; and he denies
trauma. Your examination demonstrates a quarter-sized area of breast
tissue under the left nipple that is not tender and has no discharge. The right
breast has no such tissue. He has a normal genitourinary examination, and is
Tanner stage 3. Which of the following is the best next course of action?
A) CT scan of the pituitary
B) Measurement of serum LH and FSH
C) Measurement of free testosterone
D) Reassurance of the normalcy of the condition
E) Chromosomal analysis
Explanation: Gynecomastia is a common occurrence in adolescent boys, especially
during Tanner stage 2 or 3. It can occur unilaterally or bilaterally, and can affect one

breast more significantly than the other. It is thought to be caused by a temporary

reduction in the testosterone to estradiol ratio. Spontaneous regression usually occurs.

A term, 4200-g (9-lb, 4-oz) female infant is delivered via cesarean section
because of cephalopelvic disproportion. The amniotic fluid was clear, and the
infant cried almost immediately after birth. Within the first 15 minutes of life,
however, the infant's respiratory rate increased to 80 breaths per minute,
and she began to have intermittent grunting respirations. The infant was
transferred to the level 2 nursery and was noted to have an oxygen
saturation of 94%. Which of the following is the most likely diagnosis?
A) Diaphragmatic hernia
B) Meconium aspiration
C) Neonatal Pneumonia
D) Neonatal respiratory distress syndrome
E) Transient tachypnea of the newborn
Explanation: Transient tachypnea of the newborn is usually seen after a normal
vaginal or, especially, after a cesarean delivery. The condition is a result of retained
fetal lung fluid. These patients have tachypnea, retractions, grunting, and sometimes
cyanosis. The chest examination is usually normal. Therapy is supportive, with
maintenance of normal oxygen saturation. Resolution usually occurs in the first 3 days
of life.

What is the injury with which hyperextension of the thumb and sprains of the
anterior cruciate ligament are most commonly associated?
A) A 15-year-old competitive swimmer
B) A 17-year-old high school quarterback
C) A 17-year-old starting center for a high school basketball team
D) A 16-year-old high school wrestling champion
E) A 14-year-old snow skier
F) An 18-year-old college hockey star
Explanation: Availability of better equipment has resulted in a decrease in the number
of serious skiing injuries. Thumb injuries during a fall, skier's thumb (abduction and

hyperextension of the thumb, causing a sprain of the ulnar collateral ligament),

remains the most common injury seen.

A 16-year-old adolescent female comes to be evaluated for syncopal

episodes. Her only other medical problem is congenital deafness. She notes
through a signing interpreter that syncopal episodes happen during stressful
or emotional situations and that they started only within the past year or so.
What is the most likely diagnosis based on the patient's presentation?
A) Congenital heart block
B) Prolonged QT syndrome
C) Menieners Disease
D) Cor pulmonale
E) Multiple Sclerosis
Explanation: Prolonged QT syndrome occurs in 1:10,000 to 1:15,000 children, usually
first causing syncopal episodes in late childhood or adolescence. During the syncope
episode arrhythmias may be noted, including ventricular fibrillation. These episodes
may result in death. QT intervals are elongated on ECG. An autosomal recessive form
associated with deafness.

A well-appearing, 3200-g (7-lb, 1-oz) black female newborn is noted to have

fifth finger (postaxial) polydactyly. The extra digit has no skeletal duplications
and is attached to the rest of the hand by a threadlike soft tissue pedicle.
Appropriate treatment for this condition includes which of the following?
A) Chromosomal analysis
B) Excision of extra digit
C) Skeletal survey for other skeletal abnormalities
D) Renal ultrasound
Explanation: Fifth-finger polydactyly is 10 times more common in black than in white
children and is typically familial. This finding in otherwise healthy black children should

raise no special concern. In a white child, careful examination of the cardiac system is
warranted.

An 18-month-old infant is found with the contents of a bottle of drain cleaner

in his mouth. Which of the following treatment options is most appropriate?
A) Induce immediate emesis
B) Endoscopic examination within the first 12 to 24 hours
C) Decontamination by activated charcoal
D) Neutralization by drinking a solution of the opposite pH
Explanation: Endoscopic examination of the esophagus and stomach is a diagnostic
method of determining the extent of the mucosal injury after ingestion of a caustic
substance.

A 15-month-old toddler continues to wake up crying every night. Her parents

give her a nighttime bottle, rock her, and sing to her to help her go back to
sleep. Her parents are exhausted and ask you if she is having bad dreams.
What is the sleep disturbance most consistent with this history?
A) Night terrors
B) Learned behavior
C) Central sleep apnea
D) Somniloquy
Explanation: Unfortunately, children learn remarkably well how to get what they
want, and the parents' concessions only make the problem worse. Learned behavior is
the root of many sleep disturbances in young children.

The recent suicide of a well-known high school quarterback in your

community has generated an enormous amount of community concern and
media coverage. A girl who was close friends with the deceased makes an
appointment and comes in to your office to discuss the event with you. You
ask, and she denies suicidal ideation, but she has many questions about
suicide. Correct statements about adolescent suicide include which of the
following?
A) Girls tend to use more lethal means.
B) The number of attempted suicides is much higher among boys.

C) Those who are successful have a history of a prior attempt or

prior serious suicidal ideation.
D) Inquiry by pediatricians, high school teachers, parents, or friends about
suicidal thoughts typically precipitates the act.
Explanation: Suicide among teenagers has increased steadily since 1950 and is now
the third leading cause of adolescent death, following accidents and homicides. Suicide
attempts occur more often in girls, but in all age groups males outnumber females in
completed suicides because boys tend to use more lethal means, such as firearms,
hanging, jumping, and inhalation of carbon monoxide. Most suicide attempters and
completers (where history can be established) have a history of a prior attempt or prior
serious suicidal ideation.

A 4-year-old boy presents with ataxia, lethargy, and obstructive

hydrocephalus. Which type of tumor might explain these symptoms?
A)
B)
C)
D)
E)

Medulloblastoma
Oligodendroglioma
Carcinomatous meningitis
Choriocarcinoma
Metastatic carcinoma

Explanation: Medulloblastomas are one of the most common pediatric brain

tumors and can often obstruct CSF flow leading to hydrocephalus.