DHA EXAM FOR PEDIATRICIANS – MOCK TEST – 1

1. A mother brings her 18-month-old son for a routine check-up. She is concerned because her friend’s child of the same age is already speaking in short sentences. On examination, the child is interactive, points to objects when named, and uses about 15 single words. He walks independently and can build a tower of 3-4 cubes.
Based on this information, which of the following is the MOST appropriate advice to give the mother regarding her son’s language development?
a) Her son is significantly delayed and needs immediate referral to a speech therapist.
b) Her son’s language development appears to be within the normal range for his age.
c) She should start teaching him to form sentences through flashcards and repetition.
d) Her son might have an underlying neurological issue and needs further investigation.

2. A 13-year-old girl presents for her annual physical exam. She reports that she got her first menstrual period 6 months ago. On examination, she is at Tanner stage 4 for breast development and Tanner stage 3 for pubic hair. Her height has increased by 8 cm in the past year.
Based on this information, which of the following statements about her pubertal development is MOST accurate?
a) She is experiencing precocious puberty and needs endocrine evaluation.
b) Her pubertal progression is slower than average for her age.
c) Her current stage of pubertal development is within the expected range for her age.
d) She has likely completed her growth spurt.

3. A 7-year-old boy is brought in by his parents who are concerned about his short stature. His height is below the 3rd percentile for his age and sex. His weight is at the 50th percentile. His past medical history is unremarkable.
Which of the following is the MOST important next step in evaluating this child’s growth?
a) Order a growth hormone stimulation test.
b) Obtain a detailed family history of growth patterns and calculate the mid-parental height.
c) Start him on a high-calorie diet to promote growth.
d) Reassure the parents that some children are just naturally smaller.

4. A 5-year-old child is observed during a play session. He is able to sort objects by color and size, understands the concept of counting up to ten, and can answer questions like “What will happen if you drop this ball?”.
According to Piaget’s stages of cognitive development, which stage is this child MOST likely in?
a) Sensorimotor stage
b) Preoperational stage
c) Concrete operational stage
d) Formal operational stage.

5. A mother brings her 20-month-old daughter for a well-child visit. She expresses concern that her daughter only says about 10 words and does not combine words. The child follows simple one-step commands and points to familiar objects when named. She interacts well with her parents.
Which of the following is the MOST appropriate next step in managing this child’s language development?
a) Reassure the mother that this is within the normal range for language development.
b) Recommend immediate referral to a speech and language therapist for evaluation.
c) Advise the mother to start using sign language to facilitate communication.
d) Suggest a hearing test to rule out any auditory issues.

6. A 15-year-old male is concerned about his height. He reports that he has not grown much in the past year. On examination, he has facial hair, a deepened voice, and Tanner stage 5 for genital development.
Based on this information, which of the following statements about his growth is MOST likely to be true?
a) He is likely to have a significant amount of growth remaining.
b) He has probably reached or is very close to his adult height.
c) He is experiencing delayed puberty and needs endocrine evaluation.
d) His growth pattern is unusual for his stage of pubertal development.

7. A 3-year-old child is at a well-child visit. The pediatrician observes the child attempting to draw a person. The drawing consists of a circle with a few lines coming out of it.
Which of the following stages of drawing development is this child MOST likely in?
a) Scribbling stage
b) Preschematic stage
c) Schematic stage
d) Realistic stage.

8. A 16-year-old girl expresses confusion about her future goals and feels pressure from her parents to choose a specific career path. She feels uncertain about her identity and her place in the world.
According to Erikson’s stages of psychosocial development, this adolescent is MOST likely experiencing which of the following?
a) Industry vs. Inferiority
b) Initiative vs. Guilt
c) Autonomy vs. Shame and Doubt
d) Identity vs. Role Confusion.

9. A 17-year-old male presents with complaints of feeling tired all the time, even after sleeping for 10-12 hours each night. He also reports difficulty concentrating in school and has noticed a decrease in his grades. He denies any substance use or significant medical history.
Which of the following is the MOST important initial step in evaluating this patient?
a) Prescribe a stimulant medication to improve his concentration.
b) Obtain a detailed sleep history and consider a sleep study if indicated.
c) Recommend he reduce his extracurricular activities to get more rest.
d) Refer him to a psychiatrist for evaluation of depression.

10. A school nurse reports to you that a 15-year-old student has been frequently absent from classes and has been seen with a group of older students known to use drugs.
Which of the following is the MOST appropriate initial approach to address this situation?
a) Immediately suspend the student from school.
b) Contact the student’s parents without speaking to the student first.
c) Schedule a private meeting with the student to discuss the nurse’s observations and concerns.
d) Report the older students to the police.

11. A 14-year-old female is brought in by her mother who is concerned about her daughter’s recent weight loss and preoccupation with her appearance. The daughter reports feeling fat despite being underweight and restricts her food intake significantly.
Which of the following is the MOST important initial assessment to perform?
a) Calculate her Body Mass Index (BMI) and compare it to age-appropriate norms.
b) Inquire about her exercise habits and dietary patterns in detail.
c) Assess for signs and symptoms of an eating disorder, including body image concerns and restrictive behaviors.
d) Order blood tests to rule out any underlying medical conditions causing weight loss.

12. During a routine health screening, a 16-year-old male reports feeling down and losing interest in activities he used to enjoy for the past few months.
Which of the following is the MOST appropriate next step?
a) Reassure him that these feelings are normal during adolescence.
b) Administer a standardized depression screening tool, such as the PHQ-9.
c) Advise him to spend more time with friends and engage in more activities.
d) Recommend that he talk to his parents about his feelings.

13. A 17-year-old male is brought in by his parents who are concerned about his excessive gaming and social isolation. During the consultation, he acknowledges that he spends most of his time playing video games and has limited social interaction outside of online gaming.
Using motivational interviewing techniques, which of the following questions would be MOST appropriate to initiate a discussion about his behavior?
a) “Don’t you think you are spending too much time playing video games?”
b) “Why can’t you just stop playing so much and go out with your friends?”
c) “On a scale of 1 to 10, how important is it for you to make some changes in your current routine?”
d) “Your parents are very worried about you; you need to cut down on your gaming.”

14. A 13-year-old girl presents with a history of sudden, rapid, recurrent, non-rhythmic motor movements and vocalizations that have been occurring multiple times a day for the past 6 weeks.
Based on this history, which of the following is the MOST likely initial diagnosis?
a) Obsessive-compulsive disorder
b) Tourette syndrome
c) Chronic motor or vocal tic disorder
d) Provisional tic disorder.

15. During a health education session for adolescents, a student asks about the best way to prevent sexually transmitted infections.
Which of the following would be the MOST comprehensive and accurate response?
a) “Abstinence is the only 100% effective way to prevent STIs.”
b) “Using condoms consistently and correctly during every sexual encounter is highly effective in reducing the risk of STIs.”
c) “Getting vaccinated against HPV is the most important step in preventing all STIs.”
d) “As long as you and your partner are in a monogamous relationship, you don’t need to worry about STIs.”

16. A 3-week-old male infant is brought to the clinic with a history of progressively worsening vomiting after each feeding. The vomiting is forceful and non-bilious. On physical examination, the infant appears hungry and has visible peristaltic waves in the upper abdomen.
What is the MOST likely diagnosis?
a) Gastroesophageal reflux disease (GERD)
b) Pyloric stenosis
c) Intussusception
d) Milk protein allergy.

17. A 10-year-old girl with a history of recurrent abdominal pain, bloating, and diarrhea is being evaluated for possible celiac disease. Her initial blood tests show elevated levels of tissue transglutaminase (tTG) antibodies.
What is the next BEST step in confirming the diagnosis of celiac disease?
a) Start her on a gluten-free diet and monitor her symptoms.
b) Perform an endoscopic biopsy of the small intestine.
c) Order genetic testing for HLA-DQ2 and HLA-DQ8.
d) Repeat the tTG antibody test in 4 weeks.

18. A 4-year-old boy presents with chronic diarrhea, abdominal distension, and failure to thrive. His parents report that his symptoms started after they introduced cow’s milk into his diet. Stool studies are negative for infection.
Which of the following dietary interventions is MOST likely to improve his symptoms?
a) Elimination of gluten-containing grains from his diet.
b) Strict avoidance of all dairy products.
c) Reduction of high-fiber foods in his diet.
d) Limiting his intake of sugary drinks.

19. A 2-week-old male infant has not passed meconium since birth. He has abdominal distension and has been vomiting bilious contents. A rectal examination reveals an empty rectum.
What is the MOST likely underlying condition?
a) Meconium ileus
b) Intussusception
c) Hirschsprung’s disease
d) Pyloric stenosis.

20. A 15-year-old boy with a known history of Crohn’s disease presents to the emergency department with severe abdominal pain, fever, and bloody diarrhea. On examination, his abdomen is distended and tender to palpation.
Which of the following is the MOST concerning potential complication in this scenario?
a) Small bowel obstruction
b) Appendicitis
c) Toxic megacolon
d) Pancreatitis.

21. A 1-year-old child develops sudden onset of vomiting, watery diarrhea, and low-grade fever. Several other children at his daycare have similar symptoms.
Which of the following is the MOST likely causative agent of this illness?
a) Salmonella enterica
b) Shigella dysenteriae
c) Rotavirus
d) Escherichia coli O157:H7.

22. A healthy term newborn is being examined in the delivery room. The pediatrician notes that the infant passed a dark, tarry stool within the first 12 hours of life.
What is the significance of this finding?
a) It suggests a possible intestinal obstruction.
b) It is a normal physiological occurrence.
c) It indicates potential for future gastrointestinal problems.
d) It warrants immediate further investigation with imaging studies.

23. A 2-year-old child with moderate dehydration due to acute gastroenteritis is brought to the emergency department. The child is alert but thirsty, with dry mucous membranes and decreased urine output.
What is the MOST appropriate initial management for this child’s dehydration?
a) Administer a rapid intravenous bolus of normal saline.
b) Provide oral rehydration solution in small, frequent sips.
c) Start maintenance intravenous fluids with dextrose.
d) Administer anti-diarrheal medication to reduce fluid loss.

24. A 6-year-old child is brought to the emergency department by ambulance after being found unresponsive at home. His mother reports that he had a high fever and had been complaining of a severe headache and neck pain earlier in the day. On arrival, he is obtunded, with a temperature of 39.5°C and neck stiffness.
What is the MOST critical immediate intervention for this child?
a) Obtain a detailed history from the mother.
b) Initiate broad-spectrum intravenous antibiotics.
c) Perform a lumbar puncture to analyze cerebrospinal fluid.
d) Order a CT scan of the head to rule out other intracranial pathology.

25. A 2-month-old infant is brought to the emergency department with a 2-day history of poor feeding, lethargy, and irritability. On examination, the infant is pale, has a temperature of 35.5°C, and is breathing rapidly.
What is the MOST likely underlying condition?
a) Viral upper respiratory infection
b) Infantile colic
c) Sepsis
d) Gastroesophageal reflux.

26. An 8-year-old child with a known history of asthma presents to the emergency department with severe shortness of breath, marked wheezing, and the inability to speak in full sentences. His oxygen saturation is 88% on room air.
What is the MOST appropriate initial treatment for this child?
a) Administer oxygen to maintain saturation above 94% and give a nebulized short-acting beta-agonist.
b) Immediately intubate the child and place him on mechanical ventilation.
c) Administer intravenous corticosteroids and monitor his respiratory status.
d) Give a long-acting beta-agonist via inhaler to prevent further bronchospasm.

27. A 12-year-old boy collapses on the basketball court during practice. He is unresponsive and has no palpable pulse.
What is the FIRST step that should be taken in this situation?
a) Check for breathing.
b) Begin chest compressions.
c) Call for emergency medical services (EMS) and get an automated external defibrillator (AED).
d) Open the airway using a head-tilt chin-lift maneuver.

28. A newborn infant is born at 28 weeks gestation and develops respiratory distress within the first hour of life, characterized by grunting, nasal flaring, and retractions.
What is the MOST likely cause of this respiratory distress?
a) Transient tachypnea of the newborn
b) Meconium aspiration syndrome
c) Respiratory distress syndrome
d) Congenital pneumonia.

29. A 5-year-old child in the pediatric intensive care unit (PICU) has a central venous catheter in place for medication administration. Over the past 24 hours, the child has developed a fever and the insertion site appears red and tender.
What is the MOST likely complication associated with the central venous catheter?
a) Arterial thrombosis
b) Catheter-related bloodstream infection
c) Peripheral nerve injury
d) Air embolism.

30. A 3-year-old child is brought to the emergency department by his parents who found him with an empty bottle of liquid acetaminophen. They estimate he ingested it about 2 hours ago.
What is the MOST important initial management step for this child?
a) Induce vomiting with syrup of ipecac.
b) Administer activated charcoal orally.
c) Obtain a serum acetaminophen level.
d) Observe the child for signs of liver toxicity.

31. A 6-month-old infant presents with irritability, poor feeding, and a bulging anterior fontanelle. The mother reports that the infant has been vomiting frequently.
These signs and symptoms are MOST suggestive of which of the following?
a) Dehydration
b) Increased intracranial pressure
c) Viral gastroenteritis
d) Normal infant behavior.

32. A premature infant in the neonatal intensive care unit (NICU) develops sudden abdominal distension, bloody stools, and lethargy. The infant’s vital signs show bradycardia and hypotension.
What is the MOST likely diagnosis in this neonate?
a) Transient tachypnea of the newborn
b) Necrotizing enterocolitis
c) Meconium aspiration syndrome
d) Physiologic jaundice.

33. A previously healthy 7-year-old child is brought to the emergency department after a motor vehicle accident. The child is hypotensive and tachycardic, with signs of poor perfusion.
What is the MOST appropriate initial fluid resuscitation strategy for this child?
a) Administer 5 ml/kg of crystalloid solution intravenously.
b) Administer 10 ml/kg of colloid solution intravenously.
c) Administer 20 ml/kg of isotonic crystalloid solution intravenously.
d) Administer 40 ml/kg of hypertonic saline intravenously.

34. A newborn screening result shows a significantly elevated level of galactose. The infant is 5 days old and has been exclusively breastfed. On examination, the infant is jaundiced and has hepatomegaly.
What is the MOST likely diagnosis?
a) Phenylketonuria
b) Congenital hypothyroidism
c) Galactosemia
d) Maple syrup urine disease.

35. A 3-week-old infant is brought to the clinic for a follow-up after a positive newborn screening for congenital hypothyroidism. The infant appears healthy but the mother reports that he feeds poorly and seems less active than her other children.
What is the MOST appropriate next step in managing this infant?
a) Repeat the newborn screening test.
b) Start the infant on thyroid hormone replacement therapy (levothyroxine).
c) Order a thyroid ultrasound to evaluate the thyroid gland.
d) Refer the infant to a geneticist for further evaluation.

36. A 13-year-old girl presents to the emergency department with complaints of excessive thirst, frequent urination, and weight loss over the past month. She also reports feeling very tired. A random blood glucose level is found to be 350 mg/dL.
What is the MOST likely initial diagnosis?
a) Type 2 diabetes mellitus
b) Type 1 diabetes mellitus
c) Diabetes insipidus
d) Gestational diabetes.

37. A 9-year-old boy with newly diagnosed Type 1 diabetes mellitus is being educated on insulin administration.
Which of the following statements by the child indicates a correct understanding of his insulin therapy?
a) “I should only take insulin when my blood sugar is high.”
b) “I need to take insulin injections every day, even if I feel well and my blood sugar is normal.”
c) “I can stop taking insulin once my blood sugar levels are consistently within the normal range.”
d) “I only need to take long-acting insulin; I don’t need the short-acting one.”

38. A 15-year-old boy presents with short stature and delayed puberty. He has no history of anosmia. His physical examination reveals normal findings except for his height being below the 3rd percentile for his age and his testes being small for his age.
Which of the following conditions is MOST likely?
a) Kallmann syndrome
b) Klinefelter syndrome
c) Constitutional delay of growth and puberty
d) Cushing’s syndrome.

39. A newborn female infant has ambiguous genitalia. Her newborn screening reveals elevated levels of 17-hydroxyprogesterone.
What is the MOST likely underlying endocrine disorder?
a) Congenital hypothyroidism
b) Congenital adrenal hyperplasia
c) Galactosemia
d) Turner syndrome.

40. A 10-year-old child with poorly controlled Type 1 diabetes mellitus complains of blurred vision.
Which of the following is the MOST likely cause of this symptom?
a) Diabetic ketoacidosis
b) Hypoglycemia
c) Cataract formation
d) Diabetic retinopathy.

41. A newborn screening result indicates a low level of free thyroxine (T4) and an elevated thyroid-stimulating hormone (TSH).
What is the MOST likely interpretation of these results?
a) Normal thyroid function
b) Primary hyperthyroidism
c) Secondary hypothyroidism
d) Primary hypothyroidism.

42. A 5-year-old child develops hives, lip swelling, and difficulty breathing within minutes of eating a cookie that contained peanuts.
What is the MOST appropriate immediate treatment for this reaction?
a) Administer oral antihistamine.
b) Administer inhaled albuterol.
c) Inject intramuscular epinephrine.
d) Apply topical corticosteroid cream.

43. A 2-year-old child with a history of multiple severe bacterial infections since birth is being evaluated for a possible immunodeficiency. Laboratory tests reveal very low levels of both B and T lymphocytes.
Which of the following immunodeficiency disorders is MOST likely?
a) Selective IgA deficiency
b) Common variable immunodeficiency
c) Severe combined immunodeficiency (SCID)
d) DiGeorge syndrome.

44. A 7-year-old child presents with a generalized vesicular rash, fever, and malaise. The mother reports that his older sibling had a similar illness two weeks ago.
What is the MOST likely causative agent of this child’s illness?
a) Measles virus
b) Rubella virus
c) Varicella-zoster virus
d) Parvovirus B19.

45. A 9-year-old child presents with a sore throat, fever, and headache. On physical examination, his tonsils are erythematous with exudates. A rapid streptococcal antigen test is positive.
What is the MOST appropriate treatment for this child?
a) Supportive care with analgesics and fluids.
b) A 10-day course of oral penicillin or amoxicillin.
c) A single dose of intramuscular benzathine penicillin.
d) Azithromycin for 5 days.

46. A healthy 2-month-old infant is brought in for routine vaccinations.
Which of the following vaccines is typically administered at this age?
a) Measles, mumps, and rubella (MMR)
b) Varicella
c) Rotavirus
d) Hepatitis A.

47. A 4-year-old child presents with a high fever for 5 days, a diffuse erythematous rash, conjunctivitis without exudate, and cracked, red lips.
Which of the following is the MOST likely diagnosis?
a) Scarlet fever
b) Measles
c) Kawasaki disease
d) Roseola.

48. A 6-month-old infant develops a cough, runny nose, and difficulty breathing. On examination, the infant has diffuse wheezing and increased work of breathing.
What is the MOST likely causative agent of this condition?
a) Streptococcus pneumoniae
b) Haemophilus influenzae
c) Respiratory syncytial virus (RSV)
d) Mycoplasma pneumoniae.

49. A 12-year-old child with HIV infection and a low CD4+ T-cell count develops a persistent cough, fever, and shortness of breath. Chest X-ray shows bilateral interstitial infiltrates.
Which of the following opportunistic infections is the MOST likely cause of these symptoms?
a) Cytomegalovirus pneumonia
b) Tuberculosis
c) Pneumocystis jirovecii pneumonia
d) Invasive fungal infection.

50. A 3-year-old child with a history of a severe allergic reaction to eggs is scheduled to receive the influenza vaccine.
What is the MOST appropriate approach for administering the influenza vaccine in this child?
a) Administer the standard inactivated influenza vaccine in the clinic with close observation.
b) Administer the recombinant influenza vaccine, which is egg-free.
c) Administer the live attenuated influenza vaccine, as it contains a very small amount of egg protein.
d) Refer the child to an allergist for vaccination in a controlled setting.

51. A newborn infant is noted to have central cyanosis. On auscultation, a continuous, machinery-like murmur is heard at the left upper sternal border. The peripheral pulses are bounding.
Which of the following congenital heart defects is MOST likely?
a) Atrial septal defect
b) Ventricular septal defect
c) Tetralogy of Fallot
d) Patent ductus arteriosus.

52. A 6-year-old child is being evaluated for a heart murmur detected during a routine physical exam. The murmur is a loud, harsh, holosystolic murmur heard best at the left lower sternal border. The child is asymptomatic and growing well.
Which of the following is the MOST likely underlying cardiac condition?
a) Atrial septal defect
b) Ventricular septal defect
c) Pulmonary stenosis
d) Aortic stenosis.

53. An 8-year-old child presents with fever, joint pain, and a new heart murmur. The child had a sore throat about 3 weeks ago that was not treated with antibiotics.
Which of the following is the MOST likely diagnosis?
a) Viral myocarditis
b) Bacterial endocarditis
c) Rheumatic fever
d) Kawasaki disease.

54. A 3-year-old child is noted to have higher blood pressure in the arms compared to the legs. On physical examination, the femoral pulses are weak.
Which of the following congenital heart defects is MOST likely?
a) Tetralogy of Fallot
b) Transposition of the great arteries
c) Coarctation of the aorta
d) Atrial septal defect.

55. A premature infant in the NICU is diagnosed with a hemodynamically significant patent ductus arteriosus (PDA).
Which of the following medications is commonly used to promote closure of the PDA in premature infants?
a) Prostaglandin E1
b) Indomethacin
c) Digoxin
d) Furosemide.

56. A 1-year-old child is diagnosed with a small ventricular septal defect (VSD). The child is asymptomatic and growing normally.
What is the typical long-term prognosis for this child?
a) The VSD will likely require surgical repair in early childhood.
b) The VSD will likely close spontaneously without intervention.
c) The child will likely develop pulmonary hypertension.
d) The child will require lifelong antibiotic prophylaxis for dental procedures.

57. A 5-year-old child presents with fever for 6 days, a red rash, and swelling of the hands and feet. Coronary artery aneurysms are detected on echocardiogram.
Which of the following is the MOST likely diagnosis?
a) Rheumatic fever
b) Kawasaki disease
c) Viral exanthem
d) Scarlet fever.

58. A 3-year-old child presents with pallor, fatigue, and frequent infections. A complete blood count shows pancytopenia (low red blood cells, white blood cells, and platelets).
Which of the following is the MOST likely underlying condition?
a) Iron deficiency anemia
b) Thalassemia major
c) Aplastic anemia
d) Hemolytic anemia.

59. A 7-year-old child is diagnosed with acute lymphoblastic leukemia (ALL).
Which of the following is the MOST common presenting symptom of ALL in children?
a) Painless lymphadenopathy
b) Unexplained bleeding or bruising
c) Persistent cough and shortness of breath
d) Abdominal mass.

60. A 10-year-old boy with hemophilia A sustains a minor injury to his ankle during a soccer game and develops significant swelling and pain in the joint.
What is the MOST appropriate initial management for this joint bleed?
a) Apply heat to the ankle.
b) Encourage active range of motion exercises.
c) Administer factor VIII concentrate.
d) Prescribe a nonsteroidal anti-inflammatory drug (NSAID).

61. A 1-year-old child who has been exclusively breastfed presents with pallor, irritability, and poor weight gain. A complete blood count shows microcytic, hypochromic anemia.
What is the MOST likely cause of this child’s anemia?
a) Thalassemia minor
b) Sickle cell trait
c) Iron deficiency
d) Vitamin B12 deficiency.

62. A 5-year-old child presents with fever, bone pain, and enlarged lymph nodes in the neck. A peripheral blood smear reveals the presence of blast cells.
This finding is MOST consistent with which of the following diagnoses?
a) Idiopathic thrombocytopenic purpura
b) Acute lymphoblastic leukemia
c) Juvenile idiopathic arthritis
d) Systemic lupus erythematosus.

63. A 9-year-old child with sickle cell disease develops sudden onset of severe pain in his chest and back, along with fever and cough.
Which of the following complications of sickle cell disease is MOST likely?
a) Aplastic crisis
b) Splenic sequestration
c) Vaso-occlusive crisis (pain crisis)
d) Acute chest syndrome.

64. A 2-year-old child presents with an abdominal mass that is smooth, firm, and does not cross the midline.
Which of the following is the MOST likely diagnosis?
a) Neuroblastoma
b) Wilms tumor
c) Hepatoblastoma
d) Rhabdomyosarcoma.

65. A 4-year-old child presents with easy bruising, petechiae, and a low platelet count on complete blood count. The child is otherwise well.
What is the MOST likely diagnosis?
a) Hemophilia A
b) Von Willebrand disease
c) Idiopathic thrombocytopenic purpura
d) Disseminated intravascular coagulation.

66. A 7-month-old infant suddenly develops repetitive, symmetrical flexion and extension movements of the head, trunk, and extremities occurring in clusters.
Which of the following is the MOST likely diagnosis?
a) Absence seizures
b) Infantile spasms
c) Myoclonic seizures
d) Tonic-clonic seizures.

67. A 4-year-old child is brought to the emergency department after experiencing a generalized tonic-clonic seizure that lasted for about 5 minutes. The child’s temperature is 39°C.
What is the MOST likely type of seizure in this scenario?
a) Absence seizure
b) Complex partial seizure
c) Febrile seizure
d) Atonic seizure.

68. A 2-year-old child who recently recovered from a viral illness suddenly develops difficulty walking, appears unsteady, and has rapid, involuntary eye movements.
What is the MOST likely diagnosis?
a) Bacterial meningitis
b) Acute cerebellar ataxia
c) Brain tumor
d) Stroke.

69. A newborn infant is noted to have an abnormally large head circumference and a tense, bulging anterior fontanelle.
These findings are MOST suggestive of which of the following?
a) Microcephaly
b) Hydrocephalus
c) Craniosynostosis
d) Normal variation.

70. A 9-year-old child with Down syndrome presents with a new onset of staring spells with eye blinking that last for about 10-15 seconds.
What type of seizure is this child MOST likely experiencing?
a) Tonic-clonic seizure
b) Absence seizure
c) Myoclonic seizure
d) Focal seizure without loss of awareness.

71. A 14-year-old boy reports experiencing recurrent, severe headaches that are localized to one side of his head and are often accompanied by nausea and sensitivity to light and sound.
What is the MOST likely diagnosis?
a) Tension headache
b) Migraine headache
c) Cluster headache
d) Trigeminal neuralgia.

72. A 1-year-old child who was born prematurely at 28 weeks gestation is noted to have increased tone in his legs, scissoring of his legs when held upright, and delayed motor milestones.
These findings are MOST consistent with which of the following conditions?
a) Muscular dystrophy
b) Cerebral palsy
c) Peripheral neuropathy
d) Spinal muscular atrophy.

73. A newborn infant develops seizures within the first 24 hours of life. The mother’s pregnancy was complicated by placental abruption.
What is the MOST likely cause of these neonatal seizures?
a) Hypoglycemia
b) Hypocalcemia
c) Hypoxic-ischemic encephalopathy
d) Meningitis.

74. A 6-year-old child presents with facial swelling, decreased urine output, and dark-colored urine that started about 2 weeks after a bout of strep throat. His blood pressure is elevated.
What is the MOST likely diagnosis?
a) Nephrotic syndrome
b) Urinary tract infection
c) Acute post-streptococcal glomerulonephritis
d) Hemolytic uremic syndrome.

75. A 4-year-old child presents with significant swelling in both legs and around her eyes. Her urine dipstick shows 3+ protein.
What is the MOST likely diagnosis?
a) Acute glomerulonephritis
b) Nephrotic syndrome
c) Urinary tract infection
d) Renal tubular acidosis.

76. A 7-year-old girl presents with dysuria, frequency, and suprapubic pain. A urine dipstick is positive for nitrites and leukocyte esterase.
What is the MOST likely diagnosis?
a) Glomerulonephritis
b) Nephrotic syndrome
c) Urinary tract infection
d) Vesicoureteral reflux.

77. A 14-year-old boy who is very active in sports complains of pain and swelling in his left knee, particularly after running. On examination, there is tenderness and a prominent tibial tuberosity.
What is the MOST likely diagnosis?
a) Slipped capital femoral epiphysis
b) Osgood-Schlatter disease
c) Patellar tendonitis
d) Juvenile rheumatoid arthritis.

78. A 6-month-old infant is noted to have unequal thigh folds and limited abduction of the left hip on routine physical examination.
What is the MOST likely diagnosis?
a) Transient synovitis of the hip
b) Developmental dysplasia of the hip
c) Legg-Calve-Perthes disease
d) Slipped capital femoral epiphysis.

79. A 3-year-old child with a history of recurrent urinary tract infections is being evaluated. A voiding cystourethrogram (VCUG) shows reflux of urine from the bladder into the ureters and kidneys.
What is this condition known as?
a) Renal agenesis
b) Vesicoureteral reflux
c) Posterior urethral valves
d) Ureteropelvic junction obstruction.

80. A 15-year-old girl is noted to have an abnormal curvature of her spine during a school screening examination. On physical examination, there is a visible lateral curve of the spine when she bends forward.
What is the MOST likely diagnosis?
a) Lordosis
b) Kyphosis
c) Scoliosis
d) Spondylolisthesis.

81. The parents of a 16-year-old Jehovah’s Witness patient with a life-threatening illness refuse a blood transfusion that is deemed medically necessary. The adolescent expresses a desire to receive the transfusion.
What is the MOST ethically appropriate course of action for the pediatrician?
a) Respect the parents’ decision as they are the legal guardians.
b) Override the parents’ decision and proceed with the blood transfusion.
c) Engage in further discussion with the parents and the adolescent, and consider seeking legal counsel or involving the hospital ethics committee.
d) Transfer the patient to another hospital that does not have religious restrictions on blood transfusions.

82. A pediatrician is caring for a 10-year-old patient. The patient’s parents are divorced, and the non-custodial parent requests detailed information about the child’s medical condition and treatment plan.
What is the MOST ethically appropriate response from the pediatrician?
a) Provide all the requested information to the non-custodial parent.
b) Refuse to share any information with the non-custodial parent due to confidentiality.
c) Obtain consent from the custodial parent before sharing any medical information with the non-custodial parent, unless there is a court order specifying otherwise.
d) Share only basic information about the child’s well-being but withhold specific medical details.

83. A pediatrician suspects that a child is being physically abused by their parents.
What is the pediatrician’s ethical and legal responsibility in this situation?
a) Confront the parents directly about the suspicion.
b) Document the findings in the medical record but take no further action unless there is clear proof of abuse.
c) Report the suspicion to the appropriate child protective services agency.
d) Discuss the case with colleagues to gather more opinions before taking any action.

84. During a consultation with a 15-year-old patient, the patient discloses that they are sexually active and requests information about contraception. The patient does not want their parents to know.
What is the MOST ethically appropriate approach for the pediatrician?
a) Refuse to provide information about contraception without parental consent.
b) Provide confidential counseling and information about contraception, respecting the adolescent’s right to privacy and autonomy, while encouraging communication with parents if appropriate.
c) Immediately inform the patient’s parents about their sexual activity and request for contraception.
d) Provide only information about abstinence as the sole method of contraception.

85. A pediatrician receives a promotional gift from a pharmaceutical company. The gift is a pen with the company’s logo.
According to ethical guidelines, is it acceptable for the pediatrician to accept this gift?
a) Yes, as long as the gift is of nominal value and does not influence prescribing practices.
b) Yes, because pharmaceutical companies often provide valuable educational materials along with gifts.
c) No, accepting any gift from a pharmaceutical company is unethical.
d) It depends on the pediatrician’s personal financial situation.

86. A nurse is preparing to administer medication to a hospitalized pediatric patient. The medication order is written as “Amoxicillin 250mg PO q8h”.
Which of the following steps is crucial for ensuring patient safety before administering the medication?
a) Administer the medication based on the written order without further verification.
b) Ask another nurse to double-check the medication name, dose, route, and frequency against the original order.
c) Rely on the patient’s identification bracelet without confirming the medication details.
d) Assume the dose is correct based on the patient’s age.

87. A hospitalized toddler is noted to be attempting to climb out of the crib.
Which of the following is the MOST appropriate immediate action to ensure the child’s safety?
a) Place restraints on the child to prevent them from climbing.
b) Raise all four side rails of the crib.
c) Move the child to a regular bed with side rails.
d) Assess the child’s risk for falls and implement appropriate fall prevention strategies, such as lowering the crib mattress and providing close supervision.

88. A healthcare worker is about to insert an intravenous (IV) catheter into a pediatric patient.
Which of the following is the MOST important step to prevent healthcare-associated infections during this procedure?
a) Wearing gloves is sufficient for infection prevention.
b) Performing hand hygiene immediately before and after the procedure.
c) Cleaning the skin with an antiseptic solution for a very short duration.
d) Reusing IV catheters for multiple patients to reduce waste.

89. A medication error occurs in the pediatric ward where a patient receives the wrong dose of medication.
What is the MOST important step to take immediately after recognizing the error?
a) Blame the individual who made the error.
b) Document the error in the patient’s chart and notify the attending physician.
c) Try to rectify the error without reporting it to avoid disciplinary action.
d) Focus on preventing similar errors in the future by analyzing the root cause of the incident.

90. During a shift change in the neonatal intensive care unit (NICU), the outgoing nurse is giving a report to the incoming nurse about a critically ill premature infant.
Which of the following elements is ESSENTIAL to include in this handoff communication to ensure patient safety?
a) The nurse’s personal opinions about the patient’s prognosis.
b) Detailed information about the family’s social history.
c) The infant’s current medical status, recent changes, and any outstanding tasks or concerns.
d) A general overview of the infant’s condition without specific details.

91. A 1-year-old child presents with a sudden onset of a harsh, barking cough, stridor at rest, and mild respiratory distress. The child is afebrile.
What is the MOST likely diagnosis?
a) Bronchiolitis
b) Pneumonia
c) Croup (laryngotracheobronchitis)
d) Epiglottitis.

92. A 10-year-old child develops a persistent cough, fever, and chest pain. A chest X-ray shows a right lower lobe infiltrate.
What is the MOST likely diagnosis?
a) Viral bronchitis
b) Asthma exacerbation
c) Pneumonia
d) Pulmonary embolism.

93. A 7-year-old child with cystic fibrosis is experiencing increased cough, sputum production, and shortness of breath.
What is the MOST important component of managing this acute pulmonary exacerbation?
a) Administering antihistamines to reduce inflammation.
b) Restricting oral fluids to decrease mucus production.
c) Initiating aggressive airway clearance techniques and appropriate antibiotics.
d) Avoiding chest physiotherapy to prevent fatigue.

94. A 5-year-old child with a history of asthma presents with wheezing, shortness of breath, and chest tightness that started after playing outdoors.
What is the MOST appropriate initial treatment?
a) Administer oral corticosteroids.
b) Administer a long-acting beta-agonist.
c) Administer a short-acting beta-agonist via nebulizer or inhaler.
d) Start the child on prophylactic inhaled corticosteroids.

95. The parents of a 2-month-old infant are concerned about the best sleeping position to prevent sudden infant death syndrome (SIDS).
Which of the following recommendations should the pediatrician provide?
a) Place the infant to sleep on their stomach.
b) Place the infant to sleep on their side.
c) Place the infant to sleep on their back.
d) Allow the infant to sleep in any position they seem comfortable in.

96. A 16-year-old presents to the emergency department with sudden onset of sharp chest pain and shortness of breath. On examination, breath sounds are significantly decreased on the left side.
What is the MOST likely diagnosis?
a) Pneumonia
b) Asthma exacerbation
c) Pneumothorax
d) Pulmonary embolism.

97. A 3-year-old child with mild croup is brought to the emergency department. The child has a barking cough but no stridor at rest and is breathing comfortably.
What is the MOST appropriate initial management for this child?
a) Administer oral antibiotics.
b) Administer intravenous corticosteroids.
c) Administer nebulized epinephrine.
d) Provide humidified air and supportive care.

98. A 6-year-old child has been experiencing a chronic cough that occurs mostly at night and is often triggered by exercise. The child denies fever or other systemic symptoms.
What is the MOST likely underlying cause of this chronic cough?
a) Postnasal drip
b) Gastroesophageal reflux disease
c) Asthma
d) Chronic bronchitis.

99. A premature infant born at 26 weeks gestation has been on mechanical ventilation in the NICU for several weeks and continues to require significant oxygen support. Chest X-ray shows chronic lung changes.
What is the MOST likely diagnosis in this infant?
a) Transient tachypnea of the newborn
b) Respiratory distress syndrome
c) Bronchopulmonary dysplasia
d) Meconium aspiration syndrome.

100. A 4-year-old child presents with a high fever, sore throat, and difficulty swallowing. On examination, the child is drooling and appears anxious, sitting in a “tripod” position.
What is the MOST concerning diagnosis to consider in this scenario?
a) Viral pharyngitis
b) Bacterial tonsillitis
c) Epiglottitis
d) Peritonsillar abscess.

Other Useful Links

DHA License Exam Syllabus for Pediatricians
https://www.mihiraa.com/dha-license-exam-syllabus-for-pediatricians/