review of Peds for PA Programm

1. You're treating someone whose asthma has been maintained (and stable) for a long time on
albuterol and low-dose fluticasone (Flovent). In the last several weeks, this person has had to use
his rescue inhaler more frequently, up to two to three times a day. In addition to searching for
potential environmental triggers, what intervention would you suggest?
DOSE THE ALBUTEROL THROUGHOUT THE DAY.
ADD ANOTHER INHALED STEROID.
ADD A LONGER-ACTING BETA AGONIST.
PURCHASE A NEBULIZER MACHINE.

2.  What pathogen is the most common etiology of a community-acquired
pneumonia?

3.  Streptococcus pneumoniae

4.  You're dealing with a 16-year-old boy who presents with a sore throat. His
symptoms have been occurring for approximately the past two days. On physical
examination, the young man has a temperature of 38.9°C (102°F) and has
significant cervical adenopathy of the anterior chains as well as whitish exudates
along the tonsillar crypts. Which of the following statements is true concerning the
treatment and management of the patient's condition?

5.  It's most likely caused by a virus.
 For those allergic to penicillin, an appropriate second choice would be
erythromycin.
 This person should refrain from contact sports for the next few weeks.
 Complications of this condition include the development of hepatitis.
 You would see eosinophilia on lab work.

6. Answer
 For those allergic to penicillin, an appropriate second choice would be
erythromycin.

7.  You're evaluating a person with refractory sinusitis. Despite several courses of
antibiotics, antihistamines, and decongestants, the person still experiences facial
pain and nasal stuffiness. On examination the patient complains of tenderness
along the maxillary sinus area. What would be your next step in managing this
patient?
 Radiograph of sinuses
 MRI of sinuses
 Start fluconazole (Diflucan)
 CT scan of sinuses

8. Answer
 CT scan of sinuses

9. Which of the following patients would fit
the criteria for mild persistent asthma?
 female who only uses her albuterol inhaler once a week, if that
 male who uses a nebulizer machine on a daily basis
 female who has asthma flare-ups a couple of times a week
 male who suffers from wheezing whenever he begins to work out
 male who has gastric reflux causing wheezing every night when sleeping

10.  female who has asthma flare-ups a couple of times a week
 When dealing with asthma questions, one key to figuring out what kind of asthma
the person has is the frequency of exacerbations. If the person uses his or her
inhaler several times a week but less than daily

11. Which of the following is a potential side
effect of acyclovir (Zovirax)?
 Hyperglycemia
 Hypokalemia
 Colitis and diarrhea
 Nephrotoxicity
 Desquamative skin lesions

12. Answer
 The risks of acyclovir (Zovirax) are nephrotoxicity and neurotoxicity

13. By what age do you expect a child to
stand on his own two feet?
 3 Months
 6 Months
 9 Months
 12 months
 18 months

14.  By 1 year of age, a child should be able to stand on his own two feet. This
question is an example of why it's important to familiarize yourself with the major
pediatric milestones.

15. What is the recommended age for a child
to get his or her first measles-mumps-
rubella (MMR) vaccine?
 3 Months
 6 Months
 9 Months
 12 months
 18 months

16.  At 1 year, a child should receive his or her measles-mumps-rubella (MMR) vaccine.
In addition to some major pediatric milestones, being familiar with major pediatric
immunizations is useful for the PANCE.

17. You're evaluating an 18-year-old female
who states that she has been sexually
active for the last two years. What's the
latest age that you would recommend she
get a Pap smear?
 18
 19
 20
 21
 23

18.  Women under 21 should not be screened for abnormal cells on the cervix,
regardless of the age of sexual initiation or other risk factors. At age 21, screening
with cytology every 3 years is recommended.

19. Which of the following cardiac
medications is contraindicated in a patient
with Wolff-Parkinson-White (WPW)
syndrome?
 Sotalol (Betapace)
 Amiodarone (Cordarone)
 Quinidine
 Metoprolol (Lopressor)
 Procainamide (Procaine)

20. Answer
 Wolff-Parkinson-White (WPW) syndrome can occur with arrhythmias, especially
atrial fibrillation. The one caveat with treating WPW is that treatment with
anything that slows down the AV node can increase the activity pathway. So you
need to avoid calcium channel blockers and beta blockers like metoprolol
(Lopressor)

21.  You're evaluating a 24-year-old woman for amenorrhea. She states that she hasn't
had a period in over three months. She tells you that she has auditioned to be a
model but was told she was "too fat." She denies any self-induced vomiting, but
she does admit to sometimes taking laxatives to keep herself regular. She admits
to losing approximately 10 pounds over the last few weeks. You ask her if she may
be pregnant, and she says "Who would want to be seen with someone as fat as
me?" On examination, her body mass index (BMI) is less than 20. She has no
parotid gland enlargement, and her dentition seems fine. What is the most likely
reason for her amenorrhea?

22. Answer
 Anorexia nervosa

23. Which of the following is a criterion for
rheumatic fever?
 Presence of lung involvement
 Characteristic erythema chronicum migrans skin lesion
 Choreiform movements
 Hematuria
 Elevated anti-nuclear antibody (ANA) level

24. Answer
 To answer this question correctly, recall the Jones criteria for the diagnosis of
rheumatic fever. Cardiac involvement should be present, not pulmonary
involvement, Choice (A). Erythema chronicum migrans, Choice (B), is the
characteristic skin lesion for Lyme disease, not rheumatic fever. Choreiform
movements, Choice (C), are a major criterion for rheumatic fever. Hematuria,
Choice (D), isn't a criterion for rheumatic fever. An elevated anti-nuclear antibody
(ANA) level, Choice (E), is positive in many autoimmune diseases, including
systemic lupus erythematosus (SLE). It isn't a criterion for rheumatic fever.
 https://www.youtube.com/watch?v=ohi6S7aduSg

25. Which of the following is used in the
treatment of Lyme disease in children?
 Rifampin
 Methotrexate (Rheumatrex)
 Tetracyclines
 Ceftriaxone (Rocephin)
 Colchicine

26.  Ceftriaxone (Rocephin)

27. What is the most common pathologic
agent causing croup?
 Respiratory syncytial virus (RSV)
 Influenza virus
 Haemophilus influenzae b
 Group A beta hemolytic strep (GABHS)
 Parainfluenza virus

28. The parainfluenza virus

29.  You're evaluating a 4-year-old male for recurrent ear infections. Per his mother, it
seems that as soon as a course of antibiotics is completed, he begins to have
symptoms of ear pain and low-grade fever. She recounts that in the past six
months, he has had four ear infections. Which of the following interventions would
you recommend at this time?

30.  Quantitative immunoglobulin levels to evaluate for a humoral deficiency
 CT scan of the Eustachian tubes
 Evaluation for possible acoustic neuroma
 Myringotomy tube placement
 Antimicrobial prophylaxis for otitis

31.  Recurrent ear infections can be a chronic problem in children. Because this child
has had more than three recurrences in a six month period, he fits the criteria for
placement of myringotomy tubes (T-tubes)

32. Which of the following medical conditions
is associated with external otitis?
 Hypertension
 Hypothyroidism
 Anemia
 Diabetes mellitus
 Adrenal insufficiency

33. External otitis is usually associated with
diabetes mellitus.

34. Which of the following forms of arthritis is
associated with HLA-B27 positivity?
 Rheumatoid arthritis (RA)
 Osteoarthritis (OA)
 Reactive arthritis
 Gouty arthritis
 Septic arthritis

35.  Reactive arthritis is associated with HLA-B27 positivity. Other medical conditions
associated with this antigen include inflammatory bowel disease (IBD), Fifths
Disease, and ankylosing spondylitis. None of the other conditions listed are
associated with this antigen.

36. You're evaluating a young adult with a
skin lesion like the one shown here. What
is this lesion?

37. Impetigo
 What is the standard first-line therapy for impetigo?

38. Mupirocin (Bactroban)

39. What would you do next for a patient with
leg muscle pressures indicative of an
acute compartment syndrome?
 Take serial Doppler pulses of the lower extremities.
 Administer intravenous (IV) heparin
 Take the patient to the operating room for an emergent fasciotomy
 Take the patient to the operating room for a vascular bypass operation
 Take the patient to the vascular lab for a thrombectomy or embolectomy

40.  Because the patient has an acute compartment syndrome, he needs to go to the
operating room for an emergent fasciotomy

41. What is the recommended treatment for
trichomonas vaginitis?
 Amoxicillin (Amoxil)
 Benzathine penicillin
 Azithromycin (Z-Pak)
 Fluconazole (Diflucan)
 Metronidazole (Flagyl)

42. The treatment of trichomonas vaginitis is
metronidazole (Flagyl)

43. Which of the following medications would
you recommend for the treatment of an
esophageal spasm?
 Nitroglycerin
 Metoprolol (Lopressor)
 Lisinopril (Zestril)
 Hydrochlorothiazide
 Spironolactone (Aldactone)

44. Nitrates, a vasodilator, and calcium
channel blockers are the mainstays of
treatment for an esophageal spasm.

45. Which of the following can be used in the
medical treatment of an ectopic
pregnancy?
 Cyclosporine (Neoral)
 Methotrexate (Rheumatrex)
 Mycophenolate (CellCept)
 Hydroxychloroquine (Plaquenil)
 Dexamethasone (Decadron)

46.  Methotrexate (Rheumatrex) can be used in treating an ectopic pregnancy. It's also
used to treat rheumatologic disorders.

47.  You're rounding on a preterm infant who was diagnosed with patent ductus
arteriosus (PDA). The infant is tachypneic, and on cardiac auscultation you hear a
continuous murmur. The chest radiograph shows an enlarged cardiac silhouette.
Which of the following medications could be used in treating the PDA?

48.  Aspirin
 Indomethacin (Indocin)
 Prednisone
 Lisinopril (Zestril)
 Misoprostol (Cytotec)

49.  Prostaglandins keep the patent ductus arteriosus (PDA) open, so one treatment is
the use of an antiprostaglandin, such as indomethacin (Indocin), which is an
NSAID

50. Which of the following conditions would
be an example of conductive hearing loss?
 Gentamicin ototoxicity
 Otitis media
 Schwannoma
 Salicylate use
 Presbycusis

51.  When someone has hearing loss, the first order of business is to determine
whether you're dealing with a conductive or a sensorineural hearing loss. Otitis
media is a common example of conductive hearing loss. All the other choices are
examples of sensorineural hearing loss.

52.  A patient presents with a fever and change in mental status; she is barely
arousable. In the ER she was started on a broad-spectrum antibiotic for possible
meningitis. MRI demonstrates swelling of the temporal lobes. An
electroencephalograph (EEG) demonstrates temporal lobe abnormalities as well.
The results of a lumbar puncture (LP) are pending. Which of the following
medications would you add at this point?
 Amphotericin B
 Dexamethasone (Decadron)
 Clindamycin (Cleocin)
 Acyclovir (Zovirax)

53.  When studying for the PANCE, in addition to studying about meningitis, be
familiar with the specific findings concerning herpes simplex encephalitis, which is
what the person in the question most likely has. As noted in the question,
electroencephalograph (EEG) and MRI can both show abnormalities in the
temporal lobes. The treatment for this bad, bad disease is high doses of acyclovir
(Zovirax), Choice (E).

54. Which of the following is used in the
treatment of bacterial meningitis?
 Clindamycin (Cleocin)
 Oral vancomycin (Vancocin)
 Amoxicillin (Trimox)
 Rocephin (Ceftriaxone)
 Amphotericin B

55.  Rocephin (Ceftriaxone), Choice (D), is used in the treatment of bacterial meningitis.
Intravenous (IV) vancomycin is used in the treatment of bacterial meningitis, but
oral vancomycin (Vancocin), Choice (B), is used in the treatment of Clostridium
difficile colitis. Ampicillin, not amoxicillin (Trimox), Choice (C), is used in the
treatment of bacterial meningitis. Amphotericin B, Choice (E), is an antifungal
agent that isn't used in the treatment of bacterial meningitis.

56. Which of the following is a potential side
effect related to
trimethoprim/sulfamethoxazole (Bactrim)?
 Hyponatremia
 Hypercalcemia
 Hyperkalemia
 Hypomagnesemia
 Hypophosphatemia

57.  Hyperkalemia is a common electrolyte abnormality seen with the use of
trimethoprim/sulfamethoxazole (Bactrim). You need to be aware of this side effect
because this antibiotic is commonly prescribed.

58.  A 25-year-old male had a chest tube placed for a pneumothorax 48 hours ago. He
now has worsening swelling around the chest cavity, and when you touch the skin
it makes a crackling noise. You note that the skin feels like tissue paper. What is
the most likely diagnosis?
 Superior vena cava (SVC) syndrome
 Centrilobular emphysema
 Necrotizing fasciitis
 Panniculitis
 Subcutaneous emphysema

59.  The key to this question is the fact that the skin feels like tissue paper. This
characteristic is a hallmark of subcutaneous emphysema, The symptom occurs
when the patient experiences an air leak around the chest tube.

60.  You're evaluating a 20-year-old female who complains of a 10-pound weight loss
and insomnia over the last three weeks. She had been fine since the birth of her
child eight months ago, but she has been feeling anxious recently. She also
describes feeling palpitations and wonders whether she has an irregular heartbeat.
What is her most likely diagnosis?
 Postpartum depression
 Postpartum thyroiditis
 Hashimoto's thyroiditis
 Apathetic hyperthyroidism
 Graves' disease

61.  Within 6 to 12 months after giving birth, a woman can develop postpartum
thyroiditis

62. Secondary hypothyroidism is due to a
problem with which endocrine gland?
 Thyroid
 Anterior pituitary
 Posterior pituitary
 Hypothalamus
 Adrenal

63.  Think of hormone secretion as a pathway involving connected organs. Secondary
hypothyroidism involves a problem with the anterior pituitary

64. Which of the following would you do for a
patient with a peritonsillar abscess?
 Prescribe azithromycin (Zithromax Z-pak).
 Ask him to gargle with salt water.
 Start him on oral prednisone to reduce swelling.
 Order a chest radiograph.
 Tell him to go to the hospital emergently.

65.  This situation is a medical emergency. He needs to be taken to the hospital for
surgical intervention and drainage of the pustular abscess.

66.  You are evaluating a 23-year-old gentleman presenting with left leg swelling. He
overdosed on benzodiazepines and alcohol in an apparent suicide attempt. He was
found on the ground and apparently hadn't moved for hours. On examination, the left
leg is swollen and edematous but non-pitting. Pulses are decreased in the left leg. He
isn't awake enough to provide you with any more information. What do you do next?
 Obtain a Doppler ultrasound of the leg veins.
 Obtain a CT scan of the leg.
 Check a CT scan of the abdomen and pelvis
 Obtain an MRI of the leg with gadolinium
 Measure the pressures within the muscles of the leg

67.  This person very likely has an acute compartment syndrome. The key is in the
setting. The person was found on the ground several hours after a medication
overdose and likely hadn't moved from the one position he was in. This situation
presents an emergency, so before you do any imaging studies, which take time,
you need to measure the pressures in the different muscle compartments to make
sure no compartment syndrome exists.

68.  A 16-year-old female presents with a history of resistant hypertension. She is thin,
athletic, and plays softball. Her blood pressure is 168/116 in the right arm and
152/110 in the left arm. She has good palpable pulses distally, and she has no
cutaneous rash or erythema. She undergoes an angiogram, which shows a
narrowing in the distal part of the left renal artery. The radiologist comments to
you that the artery looks like a string of beads. What condition are you most likely
dealing with?
 Atherosclerosis
 Vasculitis
 Kawasaki disease
 Fibromuscular dysplasia (FMD)

69.  The PANCE may include some questions concerning renovascular disease, so you
need to be familiar with it. In a young person or teenager with an angiogram
showing distal narrowing and an artery that looks like a string of beads, you
should think of fibromuscular dysplasia (FMD)

70.  Sxs: high fever, conjunctivitis, injected pharynx or strawberry tongue, erythema on
palm/soles, rash, cervical lymphadenopathy
 Leads to risk of coronary artery aneurysm

71.  Kawasaki’s Disease
 Tx : hospitalization, high dose ASA, IVIG (intravenous immunoglobulin)

72.  S/Sx : fever, cough, coryza, conjunctivitis
 – Maculopapular rash “Koplik spots”
 Incubation period 1‐2 weeks
 Contagious period 2 days before to 4 days
 after rash appears

73. Measles

74.  S/Sx : fever with inflammation and swelling of
 parotid glands, +/‐ orchitis
 Contagious 2 days before to 6 days after
 parotid swelling
 Incubation is 2‐3 weeks

75. MUMPS

76.  S/Sx : fever, lymphadenopathy (posterior
 cervical chain), arthralgia's
 Rash : light pink spots on head and behind
 ears progressing to full body rash

77. Rubella
 German Measles
 Birth defect if rubella is acquired in early
 pregnancy

78.  A 2-month-old male infant presents with projectile vomiting and a general failure
to thrive. He is being bottle fed, and his parents have been trying different
formulas without much success. When asked about the nature of the vomiting, it
seems to be a forceful vomiting. On examination you feel a mass in the belly.
What is the infant's most likely diagnosis?
 Hirschsprung's disease
 Intussusception
 Cystic fibrosis
 Pyloric stenosis
 Volvulus

79. This infant has the projectile vomiting
often seen with pyloric stenosis

80.  If left untreated and undiagnosed, conduct disorder as a child could develop into
which personality disorder as an adult?
 Post-traumatic stress
 Borderline
 Schizotypal
 Antisocial
 Passive-aggressive

81.  A child diagnosed with conduct disorder can display antisocial behavior early on,
and, if left unchecked, it can lead to the development of antisocial personality
disorder

82. What is this?

83. Paronychia
 This person has an infection of the nail bed, and you're dealing with a paronychia

84.  You're looking at the peripheral smear of a 6-year-old male with microcytic
anemia and notice the presence of basophilic stippling. Which of the following
would you ask the patient's parents?
 "How old is the house that you're living in?“
 "Is there a family history of bleeding from polyps?“
 "Is your son a strict vegetarian?“
 "Does your son have sickle cell disease?“
 "Does your son have any chronic medical conditions?"

85. Lead Poisoning
 Basophilic stippling is seen in lead poisoning, so your first question would be
regarding the age of the house the patient lives in,

86.  Which of the following is a typical cause of respiratory infections in cystic fibrosis?
 Klebsiella pneumonia
 Proteus mirabilis
 Staphylococcus aureus
 Parainfluenza
 Candida albicans

87.  Staphylococcus aureus, Haemophilus influenzae, and Pseudomonas aeruginosa
are common causes of respiratory infections in those with cystic fibrosis

88. Which of the following is an
extrapulmonary manifestation of cystic
fibrosis?
 Cardiomyopathy
 Nephritis
 Diabetes
 Colitis
 Osteomyelitis

89.  Extrapulmonary manifestations of cystic fibrosis include pancreatic insufficiency —
hence diabetes — with consequent malabsorption. Testicular atrophy can also be
present. In addition to pancreatic exocrine insufficiency, which causes
malabsorption and the need for pancreatic enzymes, a pancreatic endocrine
insufficiency also exists and can manifest as diabetes.

90.  Which of the following is a sign that a child should be evaluated for autism?
 The child interacts well with other children.
 The child smiles.
 The child has appropriate language skills for his or her age.
 The child doesn't respond to his or her name.
 The child isn't able to fixate on one particular object.

91.  For the PANCE, you should be able to identify the signs and symptoms of autism.
Interacting well with other children, smiling, speaking appropriately, and not
fixating on a particular object

92. In what age group is a Babinski reflex
considered normal?
 It's always a pathologic reflex.
 In adults greater than 18
 Up until 24 months of age
 Prior to 5 years of age
 After the age of 70

93.  After 24 months of age, the Babinski reflex (upgoing toes in response to plantar
stimulation) is no longer physiologic.

94.  You're evaluating a 5-year-old male with a history of trisomy 21 (Down's
syndrome). In addition to a thorough history and physical, which of the following
should you screen for as the condition in question can affect his morbidity and
mortality?
 Lung Disease
 Heart Disease
 Kidney Disease
 Liver Disease
 Pancreatic Disease

95.  Up to half of the individuals diagnosed with trisomy 21 (Down's syndrome) can be
affected by a cardiac anomaly, or heart disease

96.  You're evaluating a young man in the ER who comes in with acute epistaxis. It
began after blowing his nose. What area of the nose is affected by anterior
epistaxis?
 Sinus venous plexus
 Kiesselbach's plexus
 Brachial plexus
 Anterior nasal plexus
 Posterior nasal plexus

97.  The anatomic area affected by anterior epistaxis is Kiesselbach's plexus

98. If left untreated, which of the following
can impetigo cause?
 Pericarditis
 Endocarditis
 Peridontal abscess
 Nephritis
 Menningitis

99.  Impetigo caused by Streptococcus is a major cause of poststreptococcal nephritis,
which is usually secondary to a hypersensitivity immune-mediated reaction.

100.  Which portion of the gastrointestinal (GI) tract is most frequently affected by
volvulus?
 Ascending Colon
 Cecum
 Transverse Colon
 Ileum
 Sigmoid Colon

101.  The sigmoid colon is the most common place to have a volvulus.

102.  You're evaluating a 17-year-old male for an injury to his right eye. He states he was
playing hockey when he was hit in the right eye with a hockey puck. He states that
everything seems blurry in his right eye. On physical examination all his cranial nerves
are intact. You notice however, that he has blood in the anterior chamber of his eye.
Which of the following conditions are you most likely dealing with?
 Corneal Abrasion
 Iritis
 Hyphema
 Conjunctivitis
 Chalazion

103.  Blood in the anterior chamber of the eye is called a hyphema

104.  The Philadelphia chromosome is seen in which type of hematologic disorder?
 Chronic myelogenous leukemia (CML)
 Chronic lymphocytic leukemia (CLL)
 Hodgkin's lymphoma
 Non-Hodgkin's lymphoma
 Multiple myeloma

105.  The Philadelphia chromosome is seen a lot in chronic myelogenous leukemia
(CML)

106.  You're evaluating a 3-year-old child who presents with facial swelling and pain. His
parents don't trust childhood immunizations, so he hasn't had any. On examination he
has a temperature of 38.3°C (101°F). The child is in obvious discomfort, and the left
side of his face is swollen. He has significant enlargement of his left parotid gland, and
it's tender to palpation. What medical condition is most likely?
 Measles
 Mumps
 Rubella
 Fifth Disease
 Roseola

107.  This child has mumps. Mumps can initially affect the parotid gland and other
salivary glands. It can present with facial swelling, a fever, and sometimes a
cutaneous rash.

108.  What's the most common cause of viral gastroenteritis in children?
 Norwalk
 Adenovirus
 Respiratory syncytial virus (RSV)
 Rotavirus
 Influenza

109.  The rotavirus, Choice (D), is a common cause of diarrhea in infants and children