PEDIATRICS NBME 2024 EXAM
QUESTIONS WITH CORRECT
SOLUTIONS |GRADED A+
PART 1:
A 3-year-old boy is brought for a well-child examination. His
mother states that his belly seems big. His vital signs are within
normal limits. Examination shows aniridia. There is a palpable
mass in the right flank. The remainder of the examination shows
no abnormalities. Which of the following is the most appropriate
next step in diagnosis?
A. Measurement of serum catecholamine concentration
B. Measurement of urine vanillylmandelic acid and homovanillic
acid concentrations (wrong choice)
C. X-ray of the abdomen
D. X-ray of the chest
E. Ultrasonography of the abdomen - ANSWER ✔ WAGR
syndrome -> abdominal US to detect Wilms tumor
A 5-year-old boy is brought to the physician because of a 4-day
history of increasing difficulty breathing. His temperature is 37.5C,
pulse is 116/min, respirations are 36/min, and blood pressure is
116/80mmHg. Examination shows jugular venous distention and
mild swelling of the face and upper extremities. There are
moderate intercostal retractions. Inspiratory and expiratory
wheezes are heard bilaterally. An x-ray of the chest shows a
mass in the superior mediastinum and a large pleural effusion in
the right hemithorax. Thoracentesis yields 400mL of reddish
brown serosanguineous fluid containing numerous erythrocytes.
,Which of the following is the most likely cause of the pleural
effusion?
A. Congestive heart failure
B. Malignant pleural effusion
C. Nephrotic syndrome
D. Traumatic hemothorax
E. Tuberculous pleural effusion - ANSWER ✔ Serosanguinous
pleural effusions are always malignant! This is a very classic
presentation for non-Hodgkin's lymphoma (which is often an
anterior mediastinal mass that can cause painless LAD, SVC
syndrome, and respiratory distress - per BRS)
a 4-day-old newborn is brought to the physician b/c of a 2-day
history of progressive jaundice. He was born at 36 weeks'
gestation to a 27-year-old woman, gravid2, para 2, following an
uncomplicated pregnancy and delivery and weighed 2608 g(5lb
12oz). The newborn's blood group is O, Rh-positive, and the
mother's blood group is B, Rh-positive. He has been breast-fed
since birth and receives 1 to 2 ounces of a supplemental soy milk-
based formula every day. His mother says that he has had about
seven wet diapers daily, and his stools are yellow and seedy. At
discharge 2 days ago, his weight as 2495 g; he now weights 2608
g. His temp is 36.9C, pulse 138/min, respirations 32/min, BP
65/40. Exam shows scleral icterus and jaundice from the face to
the lower abdomen. The liver edge is palpated 2 cm below the
right costal margin. Laboratory studies at 36 hours of age and
now show:
at 36hrs of age Now
hct 54% 52%
serum
Biliru - ANSWER ✔ This is physiologic jaundice! He is eating and
pooping well and still within the first week of life.
, a 1 month old infant has had a 12x8 cm, red, raised, well-defined
lesion that is lobulated and compressible overlying the buttocks
since birth. Examination also shows multiple petechiae and
bruises. Which of the following is the most likely explanation for
these findings.
a) DIC
b) high-output congestive heart failure
c) impaired tissue growth due to altered vascular supply
d) increased tissue growth due to increased vascular supply
e) thrombocytopenia from platelet sequestration - ANSWER ✔ E!
A healthy 16-year-old girl comes to the physician for an
examination prior to participation in school sports. She had
chickenpox at age 3, but has no history of serious illness. Her
immunizations were up-to-date when she began kindergarten; the
only immunization she has received since then is a diphtheria-
tetanus toxoid at the age of 10 years for a laceration on her leg.
She has been sexually active for the past year w/ two male
partners who have used condoms consistently. She is 163cm and
weights 54kg; BMI 21. Vital signs are w/in normal limits.
Examination shows no abnormalities. Administration of which of
the following vaccines is most appropriate at this time?
a) hepatitis B, diphtheria-tetanus-toxoid, HPV
B) HPV, meningococcal, TdaP
c) MMR, TdaP, hepatitis B
d) PCV, PCV-7, IPV, hepatitis B
e) PCV 7, IPV, MMR
f) Td, meningococcal, MMR - ANSWER ✔ B!
an 18-month girl is brought to the emergency department 1 hour
after the onset of vomiting and drooling. She had been left alone
in the bathroom of her home for a few minutes before the onset of
, the symptoms. The family keeps nasal decongestants,
acetaminophen, ibuprofen, diphenhydramine, and drain cleaner,
and insecticide spray in the bathroom. During the past 5 days,
she has had an upper respiratory traction infection treated w/ a
nasal decongestant containing pseudoephedrine and
acetaminophen. She is agitated and drooling. Her temperature is
37C, pulse is 120/min, respirations are 26/min, and BP IS 80/60.
Examination shows two small superficial ulcers on the lips and
tongue. the remainder of the examination shows no abnormalities.
the most likely cause of these findings is ingestion of which of the
following?
a) acetaminophen
b) diphenhydramine
c) drain cleaner
d) ibuprofen
e) organophosphate
f) pseudoephedrine - ANSWER ✔ C! Drain cleaner - look up!
An 8yo girl is brought to the physician because of a diffuse rash
for 24hr. She has had cough, congestion, eye discharge, and
fever for 4 days. The rash initially began on her face and chest
but has spread to involve her abdomen, back, and lower
extremities. Her temprature is 38.9 (102.1F), pulse is 100/min, RR
16/min, and BP is 115/70. Examination shows diffuse red,
macular and papular rash involving the face, trunk, and
extremities; there are no leasions on the palms or soles. Which of
the following is the most likely diagnosis?
a) Ehrlichiosis
b) HSP
c) Id reaction
d) Kawasaki disease
e) Pityriasis rosea
f) RMSF
