Childhood Illness

American Board of Family Medicine
Knowledge Self-Assessment Questions: Childhood

Illness KSA
Note: The order in which these questions are listed is the order in which they will be presented the first time through the
Knowledge Self-Assessment. On subsequent visits to the assessment, the questions will be presented in groups organized by
competency (content area).
1. A 6-week-old infant is brought to your office with a 3-day history of projectile,

nonbilious vomiting at every feeding. He appears healthy and has a normal
abdominal examination. A CBC and electrolyte panel are normal.
Which one of the following should be ordered initially?
A) A plain film of the abdomen
B) An upper GI series
C) Ultrasonography
D) CT of the abdomen
E) Nuclear scintigraphy
Expert Panel on Pediatric Imaging: Vomiting in infants up to 3 months of age. American College of Radiology (ACR)
Appropriateness Criteria, 2011, pp 1-9.
Pandya S, Heiss K: Pyloric stenosis in pediatric surgery: an evidence-based review. Surg Clin North Am
2012;92(3):527-539, vii-viii.
(Last Modified: February 2009)
2. A 5-year-old African-American male has a kerion on his scalp. True statements

about this common dermatophyte infection include which of the following? (Mark
all that are true.)
Ketoconazole and griseofulvin are equally acceptable treatments
When griseofulvin is prescribed, a 2-week course is recommended
Griseofulvin is best absorbed when taken with food
Oral corticosteroids are an acceptable adjunct treatment
Treatment with a topical antifungal agent is an acceptable alternative to oral
medications
Copyright 2016 American Board of Family Medicine, Inc.

Document Last Modified: August 2016
Kao GF: Tinea capitis. eMedicine. 2008.

Gupta AK, Drummond-Main C: Meta-analysis of randomized, controlled trials comparing particular doses of
griseofulvin and terbinafine for the treatment of tinea capitis. Pediatr Dermatol 2013;30(1):1-6.
3. A 3-year-old female is brought to your office holding her left elbow to her side. Her
father tells you the problem began when he was playing with her and pulled her
left arm. On examination she looks frightened and refuses to move her left arm at
all. Her elbow is held at slight flexion and her wrist is held in pronation. There is no
swelling, point tenderness, or ecchymosis at the elbow joint. Radial and ulnar
pulses are intact, and there is no loss of sensation in the fingers.
Which one of the following is true regarding this patients condition?
A) The peak incidence of this injury occurs at 5 years of age
B) The injury is more common in boys
C) The classic mechanism of this injury is a fall on an outstretched hand
D) Hyperpronation of the wrist is an effective maneuver for treating this problem
E) Radiographs should be obtained before treatment is initiated
Lent GS: Joint reduction, radial head subluxation. eMedicine. 2007.
Macias CG, Bothner J, Wiebe R: A comparison of supination/flexion to hyperpronation in the reduction of radial head
subluxations. Pediatrics 1998;102(1):e10.
4. A 10-year-old female presents with a 1-day history of sore throat. She has an oral
temperature of 39.0C (102.2F) and swollen anterior cervical lymph nodes. Her
pharynx is red and she has a purulent tonsillar exudate.
True statements regarding her condition include which of the following? (Mark all
that are true.)
She is more likely to have streptococcal pharyngitis than viral pharyngitis
A negative rapid streptococcal antigen test is sufficient to rule out streptococcal
pharyngitis in this patient
Throat cultures should be performed on asymptomatic family members
If streptococcal pharyngitis is diagnosed, the treatment of choice is oral
penicillin V for 10 days

Finnish Medical Society Duodecim: Tonsillitis and pharyngitis in children, in EBM Guidelines: Evidence-Based
Medicine. Wiley Interscience, 2007 (published on CD).
Acute pharyngitis in children 218 years old. Michigan Quality Improvement Consortium, 2011.
Shulman ST, Bisno AL, Clegg HW, et al: Clinical practice guideline for the diagnosis and management of group A
streptococcal pharyngitis: 2012 update by the Infectious Diseases Society of America. Clin Infect Dis
2012;55(10):e86-e102.
van Driel ML1, De Sutter AI, Keber N, et al: Different antibiotic treatments for group A streptococcal pharyngitis.
Cochrane Database Syst Rev 2013;(4):CD004406.
5. Red flags indicating the need for immediate complete evaluation for autism
spectrum disorders include which of the following? (Mark all that are true.)
No babbling, pointing, or use of other gestures by 12 months of age
No single words by 16 months of age
No spontaneous two-word phrases by 24 months of age
Loss or regression of language or social skills at any age
Johnson CP, Myers SM, American Academy of Pediatrics Council on Children With Disabilities: Identification and
evaluation of children with autism spectrum disorders. Pediatrics 2007;120(5):1183-1215.
Prater CD, Zylstra RG: Autism: A medical primer. Am Fam Physician 2002;66(9):1667-1674.
6. At a well-care visit, the parents of a 4-year-old child describe a recent gradual

onset of snoring, mouth breathing, irritability, and nighttime awakenings. The
physical examination is normal except for tonsillar hypertrophy.
What is the most likely diagnosis?
A) Laryngomalacia
B) Aspiration
C) Obstructive sleep apnea
D) Asthma
E) Epiglottitis
Marcus CL, Brooks LJ, Draper KA, et al; American Academy of Pediatrics: Diagnosis and management of childhood
obstructive sleep apnea syndrome. Pediatrics 2012;130(3):e714-e755.
(Last Modified: April 2013)
7. A 2-year-old female is brought in by her parents because she has become clumsy
and has a poor appetite. They report that occasionally she seems to have
abdominal pain and constipation. Her weight is at the 25th percentile and was
previously at the 50th percentile for age. The remainder of her examination is
normal. Further testing reveals a blood lead level of 60 g/dL (N <10).
True statements regarding this situation include which of the following? (Mark all
that are true.)
Blood lead levels usually rise starting at 1 year of age and peak at 2 years of
age
Lead toxicity is associated with a lower IQ score, even at levels of 10 g/dL
No treatment is necessary at this time, other than investigation into
environmental sources of lead
If lead-containing paint is identified in the home, the parents should remove or
neutralize as much of it as they can on their own
American Academy of Pediatrics Committee on Environmental Health: Lead exposure in children: Prevention,
detection, and management. Pediatrics 2005;116(4):1036-1046.
Centers for Disease Control and Prevention (CDC) Advisory Committee on Childhood Lead Poisoning Prevention:
Interpreting and managing blood lead levels <10 micrograms/dL in children and reducing childhood exposures to
lead: Recommendations of CDCs Advisory Committee on Childhood Lead Poisoning Prevention. MMWR Recomm
Rep 2007;56(RR-8):1-16.
Blood lead levels in children aged 1-5 years - United States, 1999-2010.MMWR Morb Mortal Wkly Rep
2013;62(13):245-248.
8. True statements regarding obsessive-compulsive disorder (OCD) in children include

which of the following? (Mark all that are true.)
Most adults with OCD report that symptoms began in childhood or adolescence
Specific screening questions should be asked if OCD is suspected in a child
A trial of cognitive-behavioral therapy is recommended prior to starting
medication
Clomipramine (Anafranil) is the drug of choice for the treatment of OCD
Medication for OCD should be continued for 6 months after remission in
children
Heyman I, Mataix-Cols D, Fineberg NA: Obsessive-compulsive disorder. BMJ 2006;333(7565);424-429.
National Collaborating Centre for Mental Health: Obsessive-compulsive disorder: Core interventions in the treatment
of obsessive-compulsive disorder and body dysmorphic disorder. National Institute for Health and Clinical
Excellence, clinical guideline no 31, 2005.

Storch EA, Bussing R, Small BJ, Geffken GR, et al: Randomized, placebo-controlled trial of cognitive-behavioral
therapy alone or combined with sertraline in the treatment of pediatric obsessive-compulsive disorder. Behav Res
Ther 2013;51(12):823-829.
9. An 18-month-old female is brought to your office by her mother because of a red,

dry, itchy rash over her neck and cheeks. The mother has been cleaning the
affected area with alcohol, but she thinks this has only made the rash worse.
You suspect eczema. True statements regarding this condition include which of the
following? (Mark all that are true.)
Pruritus must be present for the diagnosis to be made
It is typically exudative
When seen in infants it is usually due to food allergy
The use of alcohol is making the rash worse
The childs DTaP vaccine should be delayed until the rash clears
Santer M, Lewis-Jones S, Fahey T: Childhood eczema. BMJ 2005;331(7515):497.
10. A 12-month-old male has delayed motor milestones. He is just starting to crawl,
using his arms to pull himself along and dragging his legs behind him. The parents
report that changing his diapers is difficult because he seems to be resistant to
spreading his hips apart. When he is held under his arms his legs tend to cross,
and when putting weight on his legs he always stands on his tiptoes. The parents
report no other motor or developmental difficulties.
The child was born after 25 hours of labor at 38 weeks gestation following an
uneventful pregnancy. Apgar scores at 1 and 5 minutes were 7 and 8. Mild
meconium staining was present at birth. His neonatal and early childhood course
have been otherwise uneventful. Tests for phenylketonuria and thyroid function
were normal at birth. His family history is negative for similar difficulties.
Which of the following should be considered in the evaluation of this child? (Mark
all that are true.)
Screening for coagulation disorders

Metabolic testing
Genetic testing for chromosomal disorders
An EEG to detect seizure activity
MRI of the brain
MRI of the spinal cord
Ashwal S, Russman BS, Blasco PA, et al: Practice parameter: Diagnostic assessment of the child with cerebral palsy:
Report of the Quality Standards Subcommittee of the American Academy of Neurology and the Practice Committee
of the Child Neurology Society. Neurology 2004;62(6):851-863.
11. You see a 3-year-old child in the office with an acute febrile illness. He is
uncomfortable because of sores in his mouth, and has not been able to eat or
drink comfortably for the past 2 days. His mother says that his energy level is way
down. She also says that hand, foot, and mouth disease is going around at his
day-care facility.
On examination the child appears tired. He has a temperature of 39.3C (102.8F)
and is mildly tachycardic. He has some vesicular lesions and some ulcerated
lesions on his tonsils, buccal mucosa, gingiva, roof of the mouth, and lips. There is
no rash on his skin, including his palms and soles. He has bilateral anterior
cervical adenopathy. The examination is otherwise normal.
What is the most likely diagnosis?
A) Group A streptococcal pharyngitis
B) Nongroup A streptococcal infection
C) Herpes simplex stomatitis
D) Hand, foot, and mouth disease
E) Herpangina
Herpetic stomatitis. MedlinePlus ADAM Medical Encyclopedia, 2008.
Rizzolo D, Chiodo TA: Painful sores in a young boys mouth: Herpetic stomatitis. JAAPA 2008;21(2):16.
12. Studies of acetaminophen toxicity in children have shown which of the following?
(Mark all that are true.)

Oral and written instructions about the correct use of acetaminophen should
be incorporated into well child visits
Failure to read and follow label instructions is a common cause of
unintentional overdosing
Use of an incorrect measuring device or preparation is a common cause of
unintentional overdosing
Rectal administration of acetaminophen is less likely to lead to overdosing
than oral administration
Patients can be observed at home if the dose ingested is less than 200 mg/kg
and they are asymptomatic
American Academy of Pediatrics Committee on Drugs: Acetaminophen toxicity in children. Pediatrics
2001;108(4):1020-1024.
Dart RC, Erdman AR, Olson KR, et al: Acetaminophen poisoning: An evidence-based consensus guideline for
out-of-hospital management. Clin Toxicol (Phila) 2006;44(1):1-18.
13. True statements concerning autoimmune thyroiditis (Hashimotos thyroiditis)

include which of the following? (Mark all that are true.)
It is the most common cause of goiter in children in the United States
A biopsy of the thyroid gland is necessary to make the diagnosis
Antithyroglobulin antibodies are present in 90%95% of patients with
Hashimotos thyroiditis
Levothyroxine (Synthroid) is currently recommended for replacement therapy
Bindra A, Braunstein GD: Thyroiditis. Am Fam Physician 2006;73(10):1769-1776.
Slatosky J, Shipton B, Wahba H: Thyroditis: Differential diagnosis and management. Am Fam Physician
2000;61(4):1047-1052, 1054.
14. True statements regarding screening for depression in children include which of
the following? (Mark all that are true.)
The American Academy of Pediatrics recommends that pediatricians ask
questions about depression as part of routine history-taking throughout
adolescence
The U.S. Preventive Services Task Force recommends that children and
adolescents be screened for depressive disorders on a routine basis
The positive predictive value of screening instruments for depression is lower

in children than in adults
Evidence indicates that screening children for depression in primary care
settings improves treatment outcomes
Screening and Treatment for Major Depressive Disorder in Children and Adolescents: Recommendation Statement.
US Preventive Services Task Force, 2009.
Simon GR, BakerC, Barden GA 3rd, et al; Committee on Practice and Ambulatory Medicine; Bright Futures Periodicity
Schedule Workgroup: 2014 recommendations for pediatric preventive health care. Pediatrics 2014;133(3):568-570.
15. A 3-month-old male is brought to your office with a fever of 40.0C (104.0F). The
childs activity level and appetite have both been decreased today, and he has
vomited once. There were no preceding upper respiratory symptoms.
Vital signs include a rectal temperature of 39.8C (103.6F), a pulse rate of 140
beats/min, a respiratory rate of 28/min, and a blood pressure of 76/50 mm Hg.
The child is responsive only to painful stimulation. The lungs are clear with no
retractions, and the heartbeat is regular with no murmurs. Peripheral pulses are
palpable and bounding. The skin is warm and slightly mottled, and capillary refill
time is 4 seconds.
Which one of the following is true regarding this situation?
A) Fluid resuscitation can be safely delayed
B) Intraosseous access should be obtained if peripheral intravenous access
cannot be obtained
C) Intravenous fluids should be started with a solution containing dextrose
D) A -lactam and an aminoglycoside are the initial antibiotics of choice
E) Laboratory testing, including blood cultures and a lumbar puncture, should
always be done prior to antibiotic administration
ECC Committee, Subcommittees and Task Forces of the American Heart Association: 2005 American Heart
Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Part 12: Pediatric
advanced life support. Circulation 2005;112(24 Suppl):IV-167-IV-187.
Paul M, Lador A, Grozinsky-Glasberg S, Leibovici L: Beta lactam antibiotic monotherapy versus beta
lactam-aminoglycoside antibiotic combination therapy for sepsis. Cochrane Database Syst Rev 2014;(1):CD003344.
16. True statements regarding Little League elbow include which of the following?

It is an ulnar neuritis of the elbow
To prevent this condition, the USA Baseball Medical and Safety Advisory
Committee recommends limiting the number of pitches per week and per
outing
Complete rest from throwing for 710 days, followed by a return to pitching in
23 weeks, is recommended in the management of this condition
A soft-tissue corticosteroid injection is useful in patients who wish to return to
play and whose pain persists for more than 4 weeks
Cassas KJ, Cassettari-Wayhs A: Childhood and adolescent sports-related overuse injuries. Am Fam Physician
2006;73(6):1014-1022.
17. A 7-year-old male has a 3-day history of nasal congestion, rhinorrhea,

nonproductive cough, and low-grade fever. On examination his temperature is
37.8C (100.0F), pulse rate 100 beats/min, respirations 22/min, and blood
pressure 104/62 mm Hg. He is in no distress and is responsive and playful, but is
somewhat whiny.
His tympanic membranes are pearlescent and slightly retracted with minimal
injection over the long arm of the malleus in both ears; there is no effusion. You
note yellowish coryza from both nostrils. His oropharynx is injected, with no
exudate. The lungs are clear to auscultation and percussion.
True statements regarding treatment of this patients symptoms include which of
Antihistamines significantly reduce rhinorrhea
Intranasal ipratropium (Atrovent) relieves nasal congestion and rhinorrhea
Multiple studies have shown that codeine safely reduces the severity of cough
Echinacea reduces the severity and duration of symptoms
Kligler B: Echinacea. Am Fam Physician 2003;67(1):77-80.
Simasek M, Blandino DA: Treatment of the common cold. Am Fam Physician 2007;75(4):515-520.

18. A 2-year-old male is brought to your office with a 2-week history of a runny nose
and bad breath. On examination you note a foul-smelling drainage from the right
nostril.
This is a classic presentation for
A) sinusitis
B) nasal polyp
C) nasal foreign body
D) nasal vestibulitis
E) unilateral adenoid hypertrophy
Heim SW, Maughan KL: Foreign bodies in the ear, nose, and throat. Am Fam Physician 2007;76(8):1185-1189.
19. A 5-year-old female has recently been wetting the bed 34 nights weekly. Before
this time she had been wetting the bed 23 nights per week, and has never been
dry throughout the night for a long period of time. She has no recent history of
daytime enuresis. Her mother asks if you can prescribe something to treat the
enuresis, as she expects future sleep-over invitations once the girl begins school.
Further history reveals that the mother has recently remarried, and that her
husband has two children of his own. The mother reports that the girl seems to be
adjusting to her new family better than expected, but is a bit more clingy than in
the past. A review of systems is otherwise unremarkable. Growth and
development are completely normal for her age.
True statements regarding this problem include which of the following? (Mark all
that are true.)
Bed wetting should be considered normal until 6 years of age
The bed wetting will likely resolve without treatment
The absence of daytime enuresis indicates a lower likelihood of underlying
structural or organic etiology
The local child protective services agency should be contacted to report
presumptive sexual abuse
Less than one-third of enuretic children become dry during a 3-month course
of treatment with a tricyclic antidepressant

Enuresis alarms are no more effective than placebo treatment
Huang T, Shu X, Huang YS, Cheuk DKL: Complementary and miscellaneous interventions for nocturnal enuresis in
children. Cochrane Database Syst Rev 2011;(12):CD005230.
Glazener CMA, Evans JHC, Peto R: Tricyclic and related drugs for nocturnal enuresis in children. Cochrane Database
Syst Rev 2003;(3):CD002117.
Deshpande AV, Caldwell PHY, Sureshkumar P: Drugs for nocturnal enuresis in children (other than desmopressin and
tricyclics). Cochrane Database Syst Rev 2012;(12):CD002238.
Kellogg N, American Academy of Pediatrics Committee on Child Abuse and Neglect: The evaluation of sexual abuse
in children. Pediatrics 2005;116(2):506-512.
20. Evidence-based strategies for preventing childhood drowning include which of the
Vigilant adult supervision
Use of approved personal flotation devices around water
CPR training
Use of fencing around residential swimming pools
Schnitzer PG: Prevention of unintentional childhood injuries. Am Fam Physician 2006;74(11):1864-1869.
21. Which one of the following is true regarding juvenile rheumatoid arthritis (JRA)?
A) It typically presents with painless joint inflammation
B) It is most effectively managed with NSAIDs
C) A positive antinuclear antibody (ANA) test is associated with a decreased
incidence of eye involvement
D) Uveitis typically presents with eye pain and photophobia in patients with JRA
Hashkes PJ, Laxer RM: Medical treatment of juvenile idiopathic arthritis. JAMA 2005;294(13):1671-1684.
Junnila JL, Cartwright VW: Chronic musculoskeletal pain in children: Part II. Rheumatic causes. Am Fam Physician
2006;74(2):293-300.
22. A 7-year-old male is brought to your office by his parents because he is failing in
school. His teacher reports that he often does not pay attention to details, has
difficulty concentrating on tasks, does not seem to listen when spoken to, is often
forgetful, loses school supplies, and is easily distracted. His developmental and
medical histories are unremarkable and a physical examination is normal.

that are true.)
A direct report of symptoms from the parents alone is sufficient to make the
diagnosis of attention-deficit/hyperactivity disorder (ADHD)
The diagnosis of ADHD is made using DSM-V criteria
The Connors Parent Rating scale, an ADHD-specific instrument, is reliable for
establishing the diagnosis
Global teacher rating scales, such as the Global Problem Index 1997, are
reliable instruments for establishing the diagnosis
The child should be checked for hypothyroidism
Subcommittee on Attention-Deficit/Hyperactivity Disorder; Steering Committee on Quality Improvement and
Management: ADHD: Clinical practice guideline for the diagnosis, evaluation, and treatment of
attention-deficit/hyperactivity disorder in children and adolescents. Pediatrics 2011;128(5):1007-1022.
23. An 8-year-old female is brought to your office because of an itchy scalp. When
you examine her you find head lice.
After treatment with permethrin (Nix), what advice do you give to the mother
about returning the child to school?
A) Other children in the childs class should be screened for lice
B) Information about this childs infestation should be provided to other
members of the class
C) The child should be kept out of school as long as there are nits in her hair
D) The child should not be excluded from school because of head lice
Mumcuoglu KY, Barker SC, Burgess IE, et al: International guidelines for effective control of head louse infestations. J
Drugs Dermatol 2007;6(4):409-414.
Devore CD, Schutze GE; Council on School Health and Committee on Infectious Diseases, American Academy of
Pediatrics: Head lice. Pediatrics 2015;135(5):e1355-1365.
24. A 5-year-old female is brought to your office with a 36-hour history of nonbloody
diarrhea (7 watery stools daily), without vomiting. Her mother says the childs
temperature has been around 38.3C (100.9F), and she has not had a cough or
nasal congestion.
On examination the girl is fussy but is easily calmed by her mother. She is thirsty
and eager to drink. Her axillary temperature is 37.7C (99.9F), and her pulse
rate, respiratory rate, and blood pressure are appropriate for her age. Her eyes
are slightly sunken, her mouth is dry, and skinfold recoil is less than 2 seconds.
Which one of the following would be most appropriate initially?
A) A serum electrolyte panel
B) Advising the mother to withhold the girls regular diet for 24 hours
C) Advising the mother to offer the child apple juice ad lib
D) Oral rehydration solution, 50100 mL/kg over 34 hrs
E) Bismuth subsalicylate (Pepto-Bismol)
Hartling L, Bellemare S, Wiebe N, et al: Oral versus intravenous rehydration for treating dehydration due to
gastroenteritis in children. Cochrane Database Syst Rev 2006;3:CD004390.
Managing acute gastroenteritis among children: Oral rehydration, maintenance, and nutritional therapy. MMWR
2003;52(RR-16):1-13.
25. A 14-year-old female is brought to your office by her father for follow-up after an
urgent-care visit 2 days earlier for uncontrolled epistaxis after minor trauma to
her nose. A review of her chart reveals that she has been healthy, apart from
occasional childhood infections and mild allergies. Growth and development have
been normal. Her family history is benign except for Hashimotos thyroiditis in her
mother and depression in her older sister.
She saw you 10 days ago for a febrile upper respiratory infection that resolved
without complications. She has not had another nosebleed since the urgent-care
visit, but did have the onset of an unusually heavy menstrual period yesterday,
with cramping relieved by ibuprofen.
On examination the only significant finding is petechiae around her eyes. A CBC
shows a WBC count of 7200/mm3 (N 450011,000), a hemoglobin level of 14.0
mg/dL (N 12.016.0), a hematocrit of 40.7% (N 36.046.0), and a platelet count of
32,000/mm3 (N 150,000300,000).
Which one of the following is true regarding this case?

A) She has likely had thrombocytopenia for a long time
B) The test of choice in this situation is serum antiplatelet antibodies
C) The test of choice in this situation is bone marrow biopsy
D) The recent infection is the most likely cause of these findings
E) Child abuse is the most likely cause of these findings
Nugent DJ: Immune thrombocytopenic purpura of childhood. Hematology Am Soc Hematol Educ Program
2006:97-103.
D'Orazio JA, Neely J, Farhoudi N: ITP in children: pathophysiology and current treatment approaches. J Pediatr
Hematol Oncol 2013;35(1):1-13.
26. Early signs of a learning disability include which of the following? (Mark all that
are true.)
Inability to speak a 3-word sentence by age 2 years
More than 50% of speech being unintelligible at age 3 years
Inability to sit still while reading a story by age 4 years
Inability to tie shoelaces or button clothes by age 5 years
Parry TS: Assessment of developmental learning and behavioural problems in children and young people. Med J Aust
2005;183(1):43-48.
(Last Modified: March 2010)
27. True statements regarding cystic fibrosis include which of the following? (Mark all
that are true.)
Most patients have a family history of the disease
The salt content of sweat is decreased
The prevalence of nasal polyps is increased
Patients are more likely than the general population to have airway
colonization with Staphylococcus aureus or Pseudomonas aeruginosa
Vitamin supplementation is recommended
Davis PB: Cystic fibrosis since 1938. Am J Respir Crit Care Med 2006;173(5):475-482.
28. A 4-month-old male whose family has recently moved to your community is
brought to your office for a well child visit. You discover that he has an
undescended left testicle.
Problems and sequelae associated with this problem include which of the
Inguinal hernia
Testicular torsion
Testicular neoplasms
Reduced sperm counts
Docimo SG, Silver RI, Cromie W: The undescended testicle: Diagnosis and management. Am Fam Physician
2000;62(9):2037-2044, 2047-2048.
29. True statements regarding glucose-6-phosphate dehydrogenase (G-6-PD)

deficiency include which of the following? (Mark all that are true.)
The highest prevalence in the United States is found in African-American
males
Affected individuals may experience acute or chronic hemolytic anemia
Affected individuals may have hyperbilirubinemia
Drugs are the most common cause of acute hemolysis
Testing for G-6-PD deficiency during episodes of acute hemolysis may produce
false-negative results
Frank JE: Diagnosis and management of G6PD deficiency. Am Fam Physician 2005;72(7):1277-1282.
30. You see a 2-month-old term female for a routine well-child check. A physical
examination is normal except that her weight is at the 3rd percentile. At 2 weeks
of age she was at the 25th percentile.
Which one of the following is true regarding this situation?
A) A follow-up visit should be scheduled in 2 weeks for further evaluation
B) Further laboratory testing is necessary to determine the etiology of the
weight loss
C) This problem can usually be managed by changing feeding behaviors or with
nutritional interventions
D) This child will not need any additional calories in her diet
Krugman SD, Dubowitz H: Failure to thrive. Am Fam Physician 2003;68(5):879-884.
31. True statements regarding obesity in children and adolescents include which of
Obesity in childhood is an independent risk factor for adult obesity
Adolescent obesity increases future adult health risk regardless of the
eventual adult BMI
Studies have demonstrated discrimination against overweight children
Behavioral therapy is most effective when the obese child is seen without a
parent
Increasing physical activity results in greater weight reduction than does
dietary modification
Waters E, de Silva-Sanigorski A, Burford BJ, et al: Interventions for preventing obesity in children. Cochrane
Database Syst Rev 2011;(12):CD001871.
32. A 7-year-old male develops the rapid onset of a red, swollen right shin. He is on a
youth football team, and two teammates recently had boils on their legs that were
culture-positive for methicillin-resistant Staphylococcus aureus (MRSA). The boy
has a hot, tender, 55-cm area of erythema on the right lateral shin where his
football pants rub the skin.
Which one of the following antibiotics is the best agent to treat this patients
infection?
A) Amoxicillin/clavulanate (Augmentin)
B) Doxycycline
C) Vancomycin (Vancocin)
D) Trimethoprim/sulfamethoxazole (Bactrim, Septra)
E) Cephalexin (Keflex)
F) Levofloxacin (Levaquin)
Stevens DL, Bisno AL, Chambers HF, et al: Practice guidelines for the diagnosis and management of skin and soft
tissue infections: 2014 update by the Infectious Diseases Society of America. Clin Infect Dis 2014;59(2):e10-e52.
33. A 6-month-old male is brought to your office by his mother because she was told
that two staff members at his day-care center came down with hepatitis. He has
been attending the day-care center for 3 months. You call the center and confirm
that two adult staff members were diagnosed with acute hepatitis A.
The child is healthy, and his physical examination is completely normal. He lives
with his mother, father, 18-month-old sister, and 6-year-old brother.
Appropriate actions at this point include which of the following? (Mark all that are
true.)
Order a hepatitis A IgM antibody titer for the infant now, and repeat in 6
weeks
Administer the first dose of hepatitis A vaccine to the infant as soon as
possible
Administer immune globulin (IG) at a dose of 0.02 mL/kg to the infant as soon
as possible
Recommend that all family members who live in the household receive IG
Recommend that unvaccinated older siblings receive hepatitis A vaccine
American Academy of Pediatrics Committee on Infectious Diseases: Hepatitis A vaccine recommendations.
Pediatrics 2007;120(1):189-199.
Prevention of hepatitis A through active or passive immunization: Recommendations of the Advisory Committee on
Immunization Practices (ACIP). MMWR 2006;55(RR07):1-23.
Update: Prevention of hepatitis A after exposure to hepatitis A virus and in international travelers: Updated
recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR 2007;56(41):1080-1084.
34. A 6-year-old male was bitten by a dog on his left hand about 24 hours ago. The
bite was provoked, and the dog is his familys pet and is up to date on its
immunizations. The child has received all indicated well care, including
immunizations, and has no known drug allergies.
Your examination reveals two tender, erythematous puncture wounds on the
dorsal aspect of the hand. There is some regional lymphangitis.

Which of the following would be appropriate treatment? (Mark all that are true.)
Ceftriaxone (Rocephin)
Doxycycline
Amoxicillin/clavulanate (Augmentin)
Clindamycin (Cleocin) and trimethoprim/sulfamethoxazole (Bactrim, Septra)
Ciprofloxacin (Cipro) and clindamycin
Presutti RJ: Prevention and treatment of dog bites. Am Fam Physician 2001;63(8):1567-1572.
35. Which of the following children should undergo urinary system ultrasonography
after the first documented urinary tract infection? (Mark all that are true.)
An afebrile 4-month-old female
An afebrile 1-year-old male
A 20-month-old female who had a fever to 101F (38.3C) with her infection
A 9-month-old male who had a fever to 101.5F (38.6C) with his infection
A 4-year-old female who was afebrile with her infection
Subcommittee on Urinary Tract Infection, Steering Committee on Quality Improvement and Management, Roberts
KB: Urinary tract infection: Clinical practice guideline for the diagnosis and management of the initial UTI in febrile
infants and children 2 to 24 months. Pediatrics 2011;128(3):595-610.
Wan J, Skoog SJ, Hulbert WC, et al; Executive Committee, Section on Urology, American Academy of Pediatrics:
Section on Urology response to new Guidelines for the diagnosis and management of UTI. Pediatrics
2012;129(4):e1051-e1053.
White B: Diagnosis and treatment of urinary tract infections in children. Am Fam Physician 2011;83(4):409-415.
(Last Modified: August 2016)
36. A 3-year-old male presents with a 1-day history of right ear pain. He is eating and
drinking normally. On examination the child appears nontoxic, with a rectal
temperature of 38.3C (100.9F), and a bulging, red right tympanic membrane.
He has no allergies or past history of otitis media.
Which one of the following is true regarding his treatment?
A) Observation without use of antibacterial agents is an appropriate option

B) The initial antibiotic of choice is amoxicillin/clavulanate (Augmentin)

C) A child who does not respond to 2472 hours of therapy with amoxicillin
should receive trimethoprim/sulfamethoxazole (Bactrim, Septra)
D) Antibiotic treatment makes analgesia unnecessary
Lieberthal AS, Carroll AE, Chonmaitree T, et al: The diagnosis and management of acute otitis media. Pediatrics
2013;131(3):e964-e99.
37. A 4-year-old male is brought to your office for a well child evaluation. His family
recently moved across town, so you are seeing him for the first time. He has a
history of mild lower limb weakness, but today his parents report that the
weakness is increasing and that over the past 6 months he has developed
shortness of breath with running and difficulty with daily activities like climbing
stairs. The parents have also noted that he is easily fatigued.
His last visit with his previous physician was 6 months ago and did not reveal any
cause for his problems. Since that time he has lost 2 lb (1 kg) and developed a
chronic cough. The nonproductive cough is now accompanied by occasional
nausea and vomiting, as well as orthopnea. Bowel movements are regular.
On examination, his blood pressure is 95/60 mm Hg, his pulse rate is 100
beats/min, and his respiratory rate is 20/min. He is not cyanotic. The lungs are
clear to auscultation and no murmur or arrhythmia is evident. Muscle strength is
reduced to 4 out of 5 diffusely. When he stands up, he pushes his hands against
his thighs to finally assume a lordotic posture. His calf muscles are
proportionately too large and his thighs are proportionately too small.
The recent escalation of this patients symptoms is most likely a consequence of
which one of the following?
A) Renal failure
B) Cardiomyopathy
C) Gastroenteropathy
D) Reversible airway disease
E) Peripheral neuropathy
American Academy of Pediatrics Section on Cardiology and Cardiac Surgery: Cardiovascular health supervision for

individuals affected by Duchenne or Becker muscular dystrophy. Pediatrics 2005;116(6):1569-1573.

38. A 2-year-old Mexican-American male is brought to your office with a 5-day history
of fever above 102F (39C). On examination he has erythema of the palms and
soles, a generalized maculopapular rash, bilateral conjunctival injection, a
strawberry tongue, and firm, nonfluctuant, left-sided lymphadenopathy, with
several lymph nodes enlarged to 2 cm in diameter.
Appropriate actions at this point include which of the following? (Mark all that are
true.)
Echocardiography as soon as possible
Treatment with high-dose aspirin
Treatment with oral prednisolone
Treatment with intravenous -globulin
Echocardiography at monthly intervals for 1 year
Newburger JW, Takahashi M, Gerber MA, et al: Diagnosis, treatment, and long-term management of Kawasaki
disease: A statement for health professionals from the Committee on Rheumatic Fever, Endocarditis, and Kawasaki
Disease, Council on Cardiovascular Disease in the Young, American Heart Association. Pediatrics
2004;114(6):1708-1733.
39. A 2-year-old male is brought to your office in October with a 2-day history of
low-grade fever, runny nose, and a barking cough. He has a rectal temperature of
38.9C (102.0F) and does not appear toxic. He has a respiratory rate of 35/min
and is not wheezing. Oxyhemoglobin saturation (SpO2) is 95% on room air.
Which one of the following is indicated?
A) Treatment with humidified air
B) Inhalation of supplemental oxygen
C) Treatment with nebulized racemic epinephrine
D) Oral glucocorticoids
E) Oral amoxicillin
Knutson D, Aring A: Viral croup. Am Fam Physician 2004;69(3):535-540.
Moore M, Little P: Humidified air inhalation for treating croup. Cochrane Database Syst Rev 2006;(3):CD002870.
Russell KF, Liang Y, O'Gorman K, et al: Glucocorticoids for croup. Cochrane Database Syst Rev 2011;(1):CD001955.
40. A 4-year-old male tripped and fell while running in his back yard and cut his left
lower arm on an aluminum soda can. The parents applied pressure to stop the
bleeding and immediately brought him to the office for further treatment. He is up
to date on his immunizations and has no known drug allergies.
Your examination reveals a sharply demarcated, simple, 4.5-cm laceration of the
anterior left lower arm. Circulation and sensation in the limb are normal.
Which of the following would be appropriate management in this case? (Mark all
that are true.)
Irrigating the wound with tap water
Applying povidone-iodine to the wound
Administering ceftriaxone (Rocephin) intramuscularly for 5 days
Administering a tetanus vaccine booster
Halaas GW: Management of foreign bodies in the skin. Am Fam Physician 2007;76(5):683-688.
Fernandez R, Griffiths R: Water for wound cleansing. Cochrane Database Syst Rev 2012;(2):CD003861.
41. A 3-year-old female with Down syndrome is brought to your office for her annual
well care visit. She has had the usual preventive health care, as well as screening
in accordance with practice guidelines for patients with Down syndrome.
Which of the following would be appropriate at this visit? (Mark all that are true.)
Cervical spine radiographs
A TSH level
Vision testing
Hearing testing
Screening for celiac disease
Karyotyping
Echocardiography
Bull MJ; Committee on Genetics: Health supervision for children with Down syndrome. Pediatrics

2011;128(2):393-406.
(Last Modified: August 2012)
42. A 5-year-old female has a 12-day history of nighttime and daytime cough,
low-grade fever, and nasal drainage that has substantially increased in amount
and gradually changed from yellow to greenish. Her growth and development
have been normal, and she has no chronic illnesses.
Which one of the following would provide the strongest evidence of acute
bacterial sinusitis?
A) The increase in the amount of nasal drainage
B) The change in color of the nasal drainage
C) A symptom duration of more than 10 days without improvement
D) Mucosal thickening in a paranasal sinus, confirmed on CT
Chow AW, Benninger MS, Brook I, et al; Infectious Diseases Society of America:IDSA clinical practice guideline for
acute bacterial rhinosinusitis in children and adults. Clin Infect Dis. 2012;54(8):e72-e112.
43. A 4-year-old male is brought to your office with the chief complaint of a limp for 2
days. You determine that the limp is due to hip pain. Ultrasonography shows
bulging around the anterior hip capsule.
Which of the following would suggest transient synovitis of the hip (toxic
tenosynovitis) rather than septic arthritis of the hip? (Mark all that are true.)
The ability to bear weight on the affected hip
A history of a fever of 103.5F (39.7C)
A WBC count of 16,500/mm3
An erythrocyte sedimentation rate of 55 mm/hr
A hip aspirate with 15,000 WBCs/mm3 and 45% polymorphonuclear
leukocytes
Barry H: Septic arthritis or transient synovitis of the hip? Am Fam Physician 2004;70(12):2357.
Whitelaw CC, Schikler KN: Transient synovitis. eMedicine. 2006.
Scarfone RJ: Pediatric septic arthritis clinical presentation. eMedicine. 2011.

44. An 8-year-old female is brought to your office by her parents. They tell you that
since she started third grade 2 months ago she has not been sleeping well, and
they often find her awake late at night reading books in bed. They report that the
childs teacher is worried that her behavior at school has been energetic and
erratic. The mother, who has bipolar disorder, wonders if her daughter might have
the same diagnosis.
that are true.)
Based on the given information, this child has bipolar disorder
Symptoms of irritability, reckless behaviors, and increased energy are specific
for bipolar disorder
There are no genetic tests that can confirm a diagnosis of bipolar disorder,
even with a positive family history
Valproate and/or atypical antipsychotic agents are appropriate treatment
choices for mania in children with bipolar disorder
McClellan J, Kowatch R, Findling RL, et al: Practice parameter for the assessment and treatment of children and
adolescents with bipolar disorder. J Am Acad Child Adolesc Psychiatry 2007;46(1):107-125.
45. A 5-year-old male has episodes of muteness accompanied by drooling and what
he describes as a funny taste in his mouth. The episodes last 35 minutes, and
he has no loss of consciousness or postictal state. His father had similar episodes
when he was a child. Treatment with carbamazepine (Tegretol) provides relief of
symptoms.
The most likely diagnosis is
A) febrile seizures
B) complex partial epilepsy
C) benign focal epilepsy
D) juvenile myoclonic epilepsy
E) video gamerelated epilepsy
McAbee GN, Wark JE: A practical approach to uncomplicated seizures in children. Am Fam Physician
2000;62(5):1109-1116.

46. A 12-year-old female presents with a history of several days of fever, headache, a
sore on her right lower arm, and a knot under the skin near her right elbow. She
lives with her parents in an urban apartment and got a new kitten about a month
ago. On examination she has a 3-mm reddish brown papule on the lateral aspect
of the right lower arm, a 2-cm tender epitrochlear node in the same arm, and a
temperature of 38.9C (102.0F). There are no other unusual findings.
What is the most likely cause of her illness?
A) Bartonella henselae infection
B) Pasteurella multocida infection
C) Borrelia burgdorferi infection
D) Chlamydia trachomatis infection
E) Sarcoidosis
Spoonemore KJ: Catscratch disease. eMedicine. 2008.
47. A 9-month-old previously healthy male is brought to the emergency department

by his mother. She tells you that approximately 5 hours ago the child suddenly
began to cry inconsolably. Since then he has experienced paroxysms of
screaming in apparent pain, and pulls his legs up to his abdomen. These episodes
are interspersed with periods of lethargy. He has had vomiting and diarrhea, and
in the past hour has passed stool with dark blood in it. You examine the child and
feel a cylindrical mass in the right lower quadrant.
Which one of the following would be most appropriate at this point?
A) Ultrasonography
B) An air or barium contrast enema
C) Rigid sigmoidoscopy
D) Flexible sigmoidoscopy
E) Surgery
Chahine AA: Intussusception. eMedicine. 2008.
Pineda C, Hardasmalani M: Pediatric intussusception: A case series and literature review. Internet J Pediatr Neonatol
2008;11(1).
48. A 10-year-old female is brought to your office by her mother with a complaint of
perineal pain. Examination reveals only a healed tear of the hymen and perianal
bruising. She has a sexual maturity rating (Tanner stage) of 3. Neither the mother
nor the daughter provides any clue as to the cause of the trauma.
that are true.)
Approximately two-thirds of sexually abused girls have abuse-related physical
findings in the perineal or anal regions at the time of presentation
This case must be reported to local child protective services
The presence of bacterial vaginosis should prompt a child abuse report
Trichomonas vaginalis on a vaginal swab would be highly suspicious for child
abuse
Chlamydia trachomatis on a rectal swab is diagnostic of child abuse
Kellogg N, American Academy of Pediatrics Committee on Child Abuse and Neglect: The evaluation of sexual abuse
in children. Pediatrics 2005;116(2):506-512.
49. Which of the following patients should be admitted to the hospital for additional
workup and/or treatment? (Mark all that are true.)
A 21-day-old infant with a rectal temperature of 38.3C (100.9F) who appears
nontoxic
A 60-day-old infant with a fever of 38.5C (101.3F) who appears nontoxic and
has a WBC count of 12,000/mm3 with no bands, and a negative urinalysis
A 12-month-old infant with a fever of 38.3C (100.9F) who appears nontoxic
A 2-year-old child with a fever of 38.3C (100.9F) who appears toxic
Sur DK, Bukont EL: Evaluating fever of unidentifiable source in young children. Am Fam Physician
2007;75(12):1805-1811.
Evidence-based care guideline for fever of uncertain source in infants 60 days of age or less. Cincinnati Childrens
Hospital Medical Center, 2010, pp 1-15.
Pusic MV: Clinical management of fever in children younger than three years of age. Paediatr Child Health
2007;12(6):469-472.

50. A 9-month-old male is brought to your office for the first time by his parents, who
have recently moved to your town. His past history has been unremarkable, his
growth and development have been normal, and his immunizations are up to
date. However, his parents are concerned that his right eye consistently has
turned outward since birth and they ask if this is normal. A corneal light reflex
test is asymmetric and a cover-uncover test reveals exotropia.
that are true.)
Ophthalmology consultation should be considered
A recommended initial treatment is placement of an adhesive patch over the
unaffected eye for a prescribed period of time each day
Therapy using atropine in the unaffected eye has been useful in children who
cannot comply with occlusive therapy
The amblyopic eye should be rested as much as possible during therapy
Doshi NR, Rodriguez ML: Amblyopia. Am Fam Physician 2007;75(3):361-367.
Ottra E: Amblyopia treatment modalities. American Academy of Ophthalmology, 2015.
51. The mother of a 6-year-old male has recently noticed fecal soiling evident in the
childs underwear once or twice weekly. When she asks her son about this
problem he quickly changes the subject to avoid the discussion. She is concerned
that this sudden change must indicate a serious physical or psychological
problem, which concerns her because her currently estranged husband has just
been diagnosed with bipolar disorder.
The child started first grade 4 months ago and appears to be doing well in school.
His teacher reports no behavioral problems, and when the mother spoke with the
teacher she said she has not noticed any behavior or odor that might suggest
fecal soiling during the school day.
The mother had a normal prenatal course and delivery, and the childs infancy
and early childhood have been normal. Developmental milestones were met in a
timely fashion, and the child was breastfed exclusively until 6 months of age and
continued until 18 months of age. He had 45 soft stools daily as an infant, with a
gradual reduction in frequency until he was fully toilet trained at 2 years of age.
He eats a normal American diet, and other than school meals there has been no
recent change in his diet.
True statements regarding this clinical scenario include which of the following?
After 5 years of age, childhood encopresis is more common in males than in
females
The sudden onset of fecal soiling 2 years after toilet training strongly suggests
a psychological etiology
The most effective treatment plans include medical and behavioral
components
A low-residue diet has been shown to reduce the frequency and amount of
stool leakage in children with encopresis
Biofeedback bowel training has been proven to reduce the frequency of fecal
soiling in children over the age of 5 years
Biggs WS, Dery WH: Evaluation and treatment of constipation in infants and children. Am Fam Physician
2006;73(3):469-477.
Brazzelli M, Griffiths P, Cody JD, Tappin D: Behavioural and cognitive interventions with or without other treatments
for the management of faecal incontinence in children. Cochrane Database Syst Rev 2011;(12):CD002240.
Joinson C, Heron J, Butler U, et al: Psychological differences between children with and without soiling problems.
Pediatrics 2006;117(5):1575-1584.
Loening-Baucke V, Miele E, Staiano A: Fiber (glucomannan) is beneficial in the treatment of childhood constipation.
Pediatrics 2004;113(3 Pt 1):e259-e264.
52. True statements regarding food allergies in children include which of the
Children who are sensitive to cows milk are very likely to have a sensitivity to
goats milk and sheeps milk
Sensitivity to eggs, wheat, and milk tends to remit in late childhood
Because food allergies tend to resolve over time, a food challenge should be
given to patients even if there is a history of anaphylaxis
Peanut allergy is frequently associated with anaphylaxis
American College of Allergy, Asthma, & Immunology: Food allergy: A practice parameter. Ann Allergy Asthma
Immunol 2006;96(3 Suppl 2):S1-S68.

53. A 5-year-old female complains of intense perineal and perianal itching, especially
at night. You examine the area and see nothing unusual. You suspect pinworms.
that are true.)
Pinworms sometimes cause appendicitis
A definitive diagnosis requires a stool sample for ova and parasites
A CBC is recommended to check for anemia from chronic pinworm infection
Eosinophilia is likely to be seen on a CBC
The only available treatment is mebendazole
All the patients clothes and bed linens should be washed
Treatment of family members should be considered
Kucik CJ, Martin GL, Sortor BV: Common intestinal parasites. Am Fam Physician 2004;69(5):1161-1168.
54. A 5-month-old male has a 4-month history of random, nonprojectile vomiting 24

times/day. Because of his parents work schedules, the child breastfeeds only
twice a day and ingests appropriate amounts of bottled breast milk or formula for
other feedings. He also eats 2 small jars of baby food every day. He is
developmentally normal and growing well, and smiles or giggles frequently. His
physical examination is normal, including the abdominal and neurologic
examinations.
Which one of the following is the best advice to the parents for reducing the
childs vomiting episodes?
A) Elevate his head when he sleeps
B) Place him in a prone position for sleep
C) Start him on metoclopramide (Reglan)
D) Thicken his feedings with rice cereal
E) Give him a dose of antacid following each meal
Craig WR, Hanlon-Dearman A, Sinclair C, et al: Metoclopramide, thickened feedings, and positioning for
gastro-oesophageal reflux in children under two years. Cochrane Database Syst Rev 2004;(4):CD003502.

Orenstein SR, McGowan JD: Efficacy of conservative therapy as taught in the primary care setting for symptoms
suggesting infant gastroesophageal reflux. J Pediatr 2008;152(3):310-314.
55. A 14-year-old male with sickle cell disease is admitted to the hospital with an
episode of painful vaso-occlusive crisis. He is initially treated with intravenous
fluids and narcotics, along with oxygen via nasal cannula. During the first 24
hours he has a good response to therapy, but on the second hospital day his
condition deteriorates. He complains of increasing pain in his arms and legs, and
develops a fever, tachypnea, and chest pain.
On examination his temperature is 38.8C (101.8F), his respiratory rate is
40/min, and he has bibasilar rales. A chest radiograph shows bibasilar lobar
consolidation. His hemoglobin level is 7.0 mg/dL (N 13.018.0) and his white blood
cell count is 23,000/mm3 (N 450011,000).
True statements regarding this condition include which of the following? (Mark all
that are true.)
It is the leading cause of death among patients with sickle cell disease
Initial empiric therapy should include a third-generation cephalosporin and a
macrolide antibiotic
The patient should receive a blood transfusion
Bronchodilators are useful only if the patient is wheezing
Most patients who progress to respiratory failure do not recover
American Academy of Pediatrics Section on Hematology/Oncology Committee on Genetics: Health supervision for
children with sickle cell disease. Pediatrics 2002;109(3):526-535.
Vichinsky EP, Neumayr LD, Earles AN, et al: Causes and outcomes of the acute chest syndrome in sickle cell
disease. National Acute Chest Syndrome Study Group. N Engl J Med 2000;342(25):1855-1865.
56. During a routine well-care visit you discover a heart murmur in an asymptomatic,
normally developing 4-year-old female. It is a grade 3/6 systolic ejection murmur
at the upper left sternal border, with a fixed, widely split second heart sound.
There is no diastolic murmur, and pulses are normal. The murmur does not
change with position.
What is the most likely cause of this murmur?
A) Atrial septal defect

B) Mitral stenosis with right bundle branch block
C) Bicuspid aortic stenosis
D) Ventricular septal defect
E) Stills murmur
Gessner IH: Atrial septal defect, astium secundum. eMedicine. 2006.
McConnell ME, Adkins SB III, Hannon DW: Heart murmurs in pediatric patients: When do you refer? Am Fam
Physician 1999;60(2):558-565.
Frank JE, Jacobe KM: Evaluation and management of heart murmurs in children. Am Fam Physician
2011;84(7):793-800.
Saito T1, Ohta K, Nakayama Y, Hashida Y, et al: Natural history of medium-sized atrial septal defect in pediatric
cases. J Cardiol 2012;60(3):248-251.
57. An 8-year-old male has a 2-year history of severe, recurrent, right-sided

headaches that occur without warning, are accompanied by photophobia and
phonophobia, occasionally cause vomiting, and are promptly relieved by sleep.
The headaches occur about every 2 months. He has no other physical problems
and has an active lifestyle.
Because of the increasing demands of school and sports, he and his parents ask
whether there is any medication that might prove to be as effective as sleep in
relieving his headaches.
Medications with good evidence of effectiveness for acute treatment of these
types of headaches in childhood include which of the following? (Mark all that are
true.)
Ibuprofen orally
Acetaminophen orally
Sumatriptan (Imitrex) orally
Sumatriptan nasal spray
Rizatriptan (Maxalt) orally
Cyproheptadine orally
Clonidine (Catapres) orally
Lewis D, Ashwal S, Hershey A, et al: Practice parameter: Pharmacological treatment of migraine headache in
children and adolescents: Report of the American Academy of Neurology Quality Standards Subcommittee and the
Practice Committee of the Child Neurology Society. Neurology 2004;63(12):2215-2224.
58. A 3-year-old toddler grabbed a hot waffle iron and has a second degree burn over
the fingers and palm of his left hand. Which one of the following burn treatments
is CONTRAINDICATED?
A) Silver sulfadiazine cream
B) Topical bacitracin ointment
C) Chlorhexidine-impregnated paraffin gauze dressing
D) Polyurethane film
E) Hydrocolloid dressing
Benson A, Dickson WA, Boyce DE: Burns. BMJ 2006;332(7542):649-652.
Barajas-Nava LA, Lpez-Alcalde J, Roqu i Figuls M, et al: Antibiotic prophylaxis for preventing burn wound infection.
Cochrane Database Syst Rev 2013;6:CD008738.
59. Which one of the following is true regarding the management of bronchiolitis?
A) Chest physiotherapy has been shown to be beneficial
B) Supplemental oxygen is indicated in every case
C) Ribavirin (Rebetol) is recommended as first-line treatment
D) Adrenergic agents can be useful in some patients
E) Corticosteroids are routinely indicated
American Academy of Pediatrics Subcommittee on Diagnosis and Management of Bronchiolitis: Diagnosis and
management of bronchiolitis. Pediatrics 2006;118(4):1774-1793.
60. True statements regarding anxiety during childhood and adolescence include
which of the following? (Mark all that are true.)
The prevalence of childhood anxiety disorders is much greater than parental
reports would indicate
Anxiety presenting during kindergarten is a valid predictor of poor-quality
teacher-child relationships in subsequent grade levels
Cognitive-behavioral therapy has been shown to be effective for alleviating
childhood anxiety disorders

Approximately 25% of all childhood anxiety disorders will resolve
spontaneously
Blanchard LT, Gurka MJ, Blackman JA: Emotional, developmental, and behavioral health of American children and
their families: A report from the 2003 National Survey of Childrens Health. Pediatrics 2006;117(6):e1202-1212.
Brendgen M, Wanner B, Vitaro F: Verbal abuse by the teacher and child adjustment from kindergarten through
grade 6. Pediatrics 2006;117(5):1585-1598.
James AC, James G, Cowdrey FA, et al: Cognitive behavioural therapy for anxiety disorders in children and
adolescents. Cochrane Database Syst Rev 2013;(6):CD004690.


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American Board of Family Medicine

Knowledge Self-Assessment Questions: Childhood

1. A 6-week-old infant is brought to your office with a 3-day history of projectile,

2. A 5-year-old African-American male has a kerion on his scalp. True statements

Copyright 2016 American Board of Family Medicine, Inc.

Kao GF: Tinea capitis. eMedicine. 2008.

Copyright 2016 American Board of Family Medicine, Inc.

6. At a well-care visit, the parents of a 4-year-old child describe a recent gradual

8. True statements regarding obsessive-compulsive disorder (OCD) in children include

Copyright 2016 American Board of Family Medicine, Inc.

9. An 18-month-old female is brought to your office by her mother because of a red,

Copyright 2016 American Board of Family Medicine, Inc.

Copyright 2016 American Board of Family Medicine, Inc.

13. True statements concerning autoimmune thyroiditis (Hashimotos thyroiditis)

The positive predictive value of screening instruments for depression is lower

(Mark all that are true.)

17. A 7-year-old male has a 3-day history of nasal congestion, rhinorrhea,

Copyright 2016 American Board of Family Medicine, Inc.

of treatment with a tricyclic antidepressant

medical histories are unremarkable and a physical examination is normal.

Which one of the following is true regarding this case?

29. True statements regarding glucose-6-phosphate dehydrogenase (G-6-PD)

dorsal aspect of the hand. There is some regional lymphangitis.

Copyright 2016 American Board of Family Medicine, Inc.

B) The initial antibiotic of choice is amoxicillin/clavulanate (Augmentin)

Copyright 2016 American Board of Family Medicine, Inc.

individuals affected by Duchenne or Becker muscular dystrophy. Pediatrics 2005;116(6):1569-1573.

Copyright 2016 American Board of Family Medicine, Inc.

Copyright 2016 American Board of Family Medicine, Inc.

Copyright 2016 American Board of Family Medicine, Inc.

(Last Modified: February 2009)

47. A 9-month-old previously healthy male is brought to the emergency department

(Last Modified: April 2013)

Copyright 2016 American Board of Family Medicine, Inc.

Copyright 2016 American Board of Family Medicine, Inc.

(Last Modified: February 2009)

54. A 5-month-old male has a 4-month history of random, nonprojectile vomiting 24

Copyright 2016 American Board of Family Medicine, Inc.

A) Atrial septal defect

57. An 8-year-old male has a 2-year history of severe, recurrent, right-sided

childhood anxiety disorders

Copyright 2016 American Board of Family Medicine, Inc.

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