25. A 6-year-old boy is proud to show off the first tooth he lost but his mother is concerned because the tooth was one of his canines and a permanent tooth seems to be erupting in this area. Which of the following best describes the correct sequence for eruption of permanent teeth?

16. At a 2-month well child visit, a mother states her family has a history of cow milk protein allergies and wonders if soy formula would be better for her baby. Which of the following statements regarding soy formula is correct?

18. A 15-kg toddler with group A coxsackievirus infection is refusing to drink. His serum potassium is normal. For maintenance of intravenous fluids, what concentration of KCl should be added?

11. An 8-year-old child presents to the emergency department with a 3-day history of fever and new altered mental status. Her parents report that they have been camping several times and she has sustained a lot of mosquito bites. Mosquitoes are recognized as vectors in the transmission of encephalitis of which of the following viruses?

10. A 4-year-old child is brought to the urgent care by parents who were concerned because the child suddenly developed unusual posture and movements. Examination reveals an alert child who holds the head in a tilted position and has uncontrolled, writhing movements of the hands and arms. The examination is otherwise normal. When questioned regarding medications at home, parents state they do have routine cold medicine, acetaminophen, and some kind of antiemetic medication in an unlocked medicine cabinet. At this time you should do which of the following?

66. A 7-year-old unimmunized child presents with fever and vesicular rash. You notice about 300 lesions, some of which were crusted. You suspect varicella infection. Which of the following is a TRUE statement about varicella?

Which of the following sets of blood gas values is most compatible with acute aspirin poisoning in a 16-month-old child?

7. A 4-year-old with a history of renal failure, encopresis, and asthma is brought to the emergency room because of lethargy and difficulty breathing. She has been taking her usual breathing treatment and has not had any respiratory symptoms or fevers. She had recently been severely constipated and her parents have been administering multiple enemas to try to help her stool with no result. Which of the following is the most likely cause of her lethargy and respiratory distress?

24. The patient remains febrile and has worsening abdominal pain despite 72 hours of antibiotic therapy. At this time what is the best next step?

67. A mother of a 3-day-old newborn, born at home with a midwife, is calling your office because she is concerned about constipation. You are deciding whether to evaluate this infant for Hirschsprung disease and ask her about meconium passage. Meconium passage delayed beyond which of the following time points to the diagnosis of Hirshsprung disease?

58. A 2-month-old infant is in your office for a well-child examination. The mother is asking you about a red macule on the infant’s cheek. She describes it as getting larger over the past few weeks. You suspect this is a capillary hemagioma. The natural history of an elevated capillary or cavernous hemangioma is best described by which of the following statements?

40. A 7-year-old boy has abdominal pain and a rash that started several days ago. On examination, you notice a palpable purpuric rash over his calves and buttocks with swelling of both ankles. Abdominal examination is unremarkable. What is the most likely laboratory finding?

20. An 8-year-old boy is referred for new-onset seizures. Which of the following would mostly support a diagnosis of complex partial (psychomotor) seizures?

48. A previously healthy 5-year-old girl has acute onset of edema and oliguria. Laboratory studies reveal hypoalbuminemia and hypercholesterolemia. Which of the following is the major cause for mortality with this condition?

25. You are obtaining the history of a 7-year-old male, who presents to your office with a several-week history of ataxia and visual changes. Previously he has been treated for attention deficit disorder. As you are about to examine the child he begins to seize. An X-linked peroxisomal disease is suspected. Plasma elevation of which of the following substances confirms your suspicions?

1. A 13-year-old female presents to the emergency department with a 3-day history of fever above 104°F (40°C); vomiting; diarrhea; and diffuse, erythematous rash. She is found to have orthostatic hypotension. Laboratory evaluation reveals decreased platelets and elevated liver and renal function tests. The mother of the child informs you that the child is currently menstruating. You suspect that this child has a toxin mediated infection. What is the most likely etiology of this toxin mediated infection?

84. A14-year-old presents to your office with 2 week history of cough and purulent rhinorrhea. He now has 2-day history of fever and frontal headache. On examination he is tender to palpation over his maxillary sinuses and his mother tells you that he appears swollen over that area. You make the clinical diagnosis of acute sinusitis. He has no allergies to medication. What is the first-line therapy for this child?

2. A2-year-old is found with an opened empty bottle of acetaminophen tablets and has pill fragments in his mouth. The major cause of morbidity and mortality in acute poisoning with acetaminophen is which of the following?

35. Which of the following statements regarding drowning and near-drowning is correct?

29. Syrup of ipecac should be administered in the home to which of the following children?

88. Hydrocephalus, chorioretinitis, and diffuse cerebral calcifications are present in a newborn male. Of the following pets, which is most likely to be the source of this zoonotic congenital infection?

4. The pediatric surgeon is requesting an echocardiogram on a hospitalized newborn with a congenital defect of the gastrointestinal tract. Which of the following defects has the highest incidence of associated cardiac defects?

34. A healthy term infant is circumcised and experiences excessive blood loss eventually requiring transfusion. The most likely diagnosis is which of the following?

50. A newborn infant has micrognathia, glossoptosis, and cleft soft palate. These findings are consistent with Pierre Robin sequence. Which of the following life-threatening events is associated with these findings?

59. The mother of a 2-year-old girl wonders if her daughter’s motor skills are age appropriate. Which of the following is a motor skill that most 2-year-olds have attained?

23. You are following a child with ADHD. His teacher requests information on diet and ADHD. In particular, she is interested in the role of ingestion of sugar in this condition. Which of the following statements is true regarding controlled studies of the effects of sucrose ingestion in children?

6. A pregnant African-American woman plans to breastfeed her baby. She has read of the nutritional, psychologic, and immunologic advantages, but recalled breastfed babies might still require vitamin supplementation. The most current nutritional recommendations indicate she should supplement the baby’s nutrition with which vitamin?

16. An 8-month-old Caucasian male is brought with concerns of a 4-day history of fever and decreased food intake. The mother states that he has slept most of the day. On examination, the patient is febrile with otherwise normal vital signs. He does not open his eyes during the examination. The liver is noted to be slightly enlarged. His laboratory values show normal electrolytes without acidosis. The serum glucose is 33 mg/dL. Liver enzymes as well as ammonia are slightly elevated. Serum insulin is undetectable. A simultaneous urine sample is negative for ketones. Which of the following conditions is the most likely diagnosis?

15. On tuberculin skin testing, a well 5-year-old who traveled last year to Mexico is found to have 8 mm of induration to 5 tuberculin units (TU) of purified protein. There is no history suggestive of contact with tuberculosis. What does this reaction likely indicate?

35. A 12-year-old child developed fever about 1 week after visiting relatives in India. The fever has persisted for about 10 days. Diarrhea was present for a few days, and then cleared. The child is now constipated. The child appears moderately acutely ill. The liver and spleen are enlarged. There are palpable, small (2–4 mm) erythematous spots on the trunk only. What is the most likely cause of this child’s infection?