1. An 18-month-old uncircumcised boy with no signif- Paraphimosis
icant past medical history presents to the ED. His
parents report increasing fussiness throughout the
day and he seemed to be itching or playing with his
diaper region more than usual. While changing his
diaper this evening they noticed significant swelling
of his foreskin and he vigorously fought having his
diaper area cleaned. He is still producing wet diapers
and has been eating fine. He has otherwise been
healthy with no fevers or recent illnesses. On physical
exam, the patient has notable swelling of the distal
foreskin and a band of tissue proximal to the head of
the penis appears constricting. Both the glans penis
and the distal foreskin are swollen and exquisitely
tender to manipulation. The penile shaft appears flac-
cid and normal. Which of the following is the most
likely diagnosis?
2. A 2-month-old girl born at 34 weeks gestation pre- Moderate acute ill-
sents with her parents for a routine well-check and ness without fever
vaccinations. She had no significant adverse reac-
tions to her previous hepatitis B vaccination. Her
mother was positive for group B Streptococcus dur-
ing pregnancy but was adequately treated during
delivery. The infant has no other significant medical
history and is fussy but consolable on presentation.
Her parents report she started having acute watery
diarrhea today and hasn't been feeding well, how-
ever, she is afebrile. They are hesitant to start her
immunizations for a number of reasons, including
the fact that her 3-year-old brother is currently being
evaluated for autism. Which of the following is a valid
reason to delay her 2-month immunizations?
3. A 5-year-old boy with a recent history of constipation Begin polyethyl-
is seen by a pediatrician for a chief complaint of stool ene glycol and
leaking onto his underwear. He was toilet-trained continue for at
when he was three, but since then has had occasional least 6 months
periods of constipation which his mother has been
, Pediatrics EOR Exam
treating with apple juice mixed with polyethylene gly-
col as needed. She believes the treatment works, but
sometimes she doesn't know when to start giving it
to the patient. Since he is more independent on the
toilet now, she didn't realize he was having problems
but noticed he had soiled his underwear and is con-
cerned there is a new problem. Per the patient, he did
not have a bowel movement today or yesterday and
he cannot recall when the last bowel movement was.
He does report the last time he had a stool it was
painful. Rectal examination confirms the presence
of hard, retained stool. Which of the following is the
most appropriate next step in management?
4. A 13-year-old boy presents with four days of sore Supportive care
throat, low grade fever, and generalized malaise. He
denies significant nasal congestion or cough. On
examination, he has 2+ erythematous tonsils cov-
ered in white exudate, bilateral posterior cervical
adenopathy, as well as shotty axillary and inguinal
lymphadenopathy. Which of the following is indicat-
ed?
5. Which of the following best describes the effects of Blood flow through
fetal coarctation of the aorta in utero? the patent ductus
arteriosus bypass-
es the coarctation,
resulting in hemo-
dynamic stability
6. A 17-year-old girl presents with the complaint of a Refer to a burn
skin rash. She began treatment two days ago for a center
urinary tract infection and was given sulfamethoxa-
zole-trimethoprim. On physical exam, bullae are seen
covering 40% of her body and are present in her
mouth as well. What is the best step in managing the
patient?
7. A 4-month-old infant presents with three days of Bronchiolitis
cough and nasal congestion. Today, the parents note
, Pediatrics EOR Exam
that he has been breathing faster and harder. On ex-
amination, he is tachypneic with moderate subcostal
retractions and nasal flaring. He has diffuse crackles
and scattered expiratory wheezes. What is the most
likely diagnosis?
8. A 1-day-old term infant is seen at his mother's bed- Duodenal atreasia
side in the postnatal ward for a newborn exam. His
mother reports he vomited a few hours after the first
feeding and has been fussy but consolable. She has
not noticed any other problems. She reports a normal
pregnancy. On examination, the infant has a mildly
distended abdomen. An abdominal film is ordered
and notable for two prominent air bubbles in the
stomach and duodenum. Which of the following is the
most likely diagnosis?
9. A five-year-old boy presents to the clinic with his par- Propranolol 2.9
ents, who state he had a syncopal episode which last- mg/kg/day
ed less than one minute and spontaneously resolved.
The syncope happened while the child was running in
the house. An ECG is performed and shows QT seg-
ment duration of 500 milliseconds. Family history is
positive for a paternal grandfather who died suddenly
in his fifties of unspecified cardiac problems. Which
of the following represents the best initial therapeutic
choice for this patient?
10. Which of the following findings would be expected on Parotitis
physical exam of a child presenting to the clinic with
suspected mumps?
11. A 10-year-old boy with a known history of environ- Asthma symp-
mental allergies and diagnosis of mild intermittent toms three nights
asthma presents for a routine visit and medication re- per month
fill. He is currently managed on an albuterol inhaler as
needed. Which of the following, if reported by the fam-
ily, would indicate a need to advance his management
to include a daily low-dose inhaled glucocorticoid?
, Pediatrics EOR Exam
12. A 5-year-old girl presents with persistent rhinorrhea Intranasal glu-
and chronic mild cough. On examination, she has cocorticoids
clear nasal discharge, a bluish hue to her nasal mu-
cosa, a crease across her nasal bridge, and clear
secretions in the posterior pharynx. Which of the fol-
lowing medications is most appropriate to treat her
condition?
13. A 2-year-old girl presents with her grandmother to Lack of ganglion
clinic due to constipation. The grandmother observes cells in the submu-
that since birth and despite recurrent use of stool cosal and myen-
softeners, the child only moves her bowels once a teric plexus
week. There is no fecal soiling or diarrhea noted. She
was born full term and her mother had an unremark-
able prenatal history. Her grandmother states that
the child was not discharged immediately after birth
since she did not pass any stool for 48 hours after
birth. However, she was well thereafter and has not
been in the hospital since. Which of the following
would best explain the girl's symptoms?
14. A 7-month-old boy presents to clinic after recent Fecal elastase
adoption from a Romanian orphanage. He has been
having bulky stools several times each day. He also
has a persistent cough and his parents were told
that he was once treated for pneumonia. Additional
medical history is unavailable. His weight-for-height
is less than the 5th percentile, but he eats very well.
Examination is remarkable for a thin child with tem-
poral wasting, wet-sounding cough, scattered pul-
monary rales, greasy stool in the diaper, and trace
pedal edema. Which of the following tests is most
likely to be positive in this patient?
15. A 15-year-old previously healthy boy presents with Bacterial conjunc-
a complaint of his right eye being stuck shut in tivitis
the morning, with discharge from the eye continuing
throughout the day. On physical exam, the conjunc-
tiva is erythematous with a copious purulent, green
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