1. What is the most common bacterial pathogen identified in febrile infants between 1 and 3 months of age [1] ?

   A. Group B strep
   B. S. pneumoniae
   C. Listeria
   D. E. Coli
   E. M. tuberculosis

2. A 2 day-old infant starts having a generalized tonic clonic seizure. After you secure the airway, what is your next step [2] ?

   A. Check calcium: replete if low
   B. Phenytoin 20 mg/kg IV
   C. Lorazepam 0.1 mg/kg IV
   D. Obtain D-stick (test of serum glucose level): bolus with glucose if D-stick result is low
   E. Paraledyde: 0.3-0.5 ml/kg rectally

3. Which of the following vaccinations is not contraindicated [3] ?

   A. MMR during pregnancy
   B. VZV 35 days after MMR administration
   C. VZV while on oral steroids
   D. MMR with anaphylaxis to eggs
   E. HBV in patients with high titers of HBsAb

4. A 4 year-old boy presents with 1 day of severe intermittent abdominal pain. Radiographs show a paucity of gas in the right lower quadrant. Ultrasound reveals an ileo-ceccal intussusception. Which of the following is an appropriate therapy?

   A. Surgical exploration
   B. Air contrast enema
   C. Endoscopy
   D. Expectant management
   E. Cisapride (Propulsid®) therapy

5. A 15 year-old girl has just immigrated to the US from Honduras. She arrives in your office for her first physical examination. You note a soft systolic murmur over the pulmonic area. Next you notice that the second heart sound is widely split with no respiratory variation. She has no dyspnea on exertion, orthopnea, or shortness of breath. Which cardiac condition is the girl likely to have [5] ?

   A. Rheumatic heart disease
   B. Tetralogy of Fallot
   C. Atrial Septal Defect
   D. Ventricular Septal Defect
   E. Transposition of the Great Arteries

6. A 4 year old boy presents with his second episode of staphylococcal pneumonia. He has had one episode of otitis media at age 18 months. What additional test would suggest his underlying diagnosis [6] ?

   A. T-cell subsets
   B. Quantitative immunoglobulins
   C. Sweat test
   D. Ciliary motility
   E. CD55 and CD59 levels

7. A 5 year old girl presents with fever, red rough truncal rash, swollen red tongue, cervical lymphadenopathy, and petechiae in the axillary folds. The child should be prescribed which medication [7] ?

   A. Penicillin
   B. High dose aspirin
   C. Intravenous Immune Globulin (IVIg)
   D. Glucocorticoids (corticosteroids)
   E. Methotrexate

8. A child was noted to have a microcytic anemia. Which of the following is unlikely to be the cause?

   A. Plumbism
   B. Thalassemia
   C. Sickle Cell Anemia
   D. G6PD Deficiency
   E. Iron deficiency

9. You see a 4 year old boy back in the office 1 week after he was prescribed cefaclor for fever, sore throat and ear infection. Now he has migratory arthralgias in her knees and elbows. His otitis has resolved. The most likely diagnosis is which of the following [9] ?

   A. Drug Reaction
   B. Rheumatic Fever
   C. Still's Disease
   D. Parvovirus B19
   E. Mumps

10. An obese 10 year old boy develops right sided knee pain and limp. On examination, knees appear normal but the motion of his right hip is limited in external rotation. A plain radiograph of his right knee is normal. He has no systemic symptoms. What does this boy most likely have [10] ?

    A. Septic arthritis
    B. Osteosarcoma
    C. Avascular necrosis
    D. Slipped capitofemoral epiphysis
    E. Osteomyelitis

Answers

1. B
2. D
3. B
4. B
5. C
6. C
7. A (Scarlet Fever)
8. E
9. A
10. D