PACKRAT Peds Exam with Complete Solutions
6 y/o male presents w/ hemarthrosis of the L knee. Coag studies: PT 12.5s (normal12-14 sec),
INR 1.0, aPTT 58s (normal 18-28 sec), platelet 430,000/microliter (normal 150,000-
450,000/microliter), & bleeding time 4m (normal 2-12m). Which is the best tx ...
PACKRAT Peds Exam with Complete Solutions
6 y/o male presents w/ hemarthrosis of the L knee. Coag studies: PT 12.5s (normal12-14 sec),
INR 1.0, aPTT 58s (normal 18-28 sec), platelet 430,000/microliter (normal 150,000-
450,000/microliter), & bleeding time 4m (normal 2-12m). Which is the best tx option for this pt?
A. Desmopressin acetate
B. Corticosteroids
C. Vitamin K
D. Cryoprecipitate CORRECT ANSWER-1) (u) A. Desmopressin acetate is indicated in von
Willebrand's disease, which presents with a prolonged bleeding time.
(u) B. Corticosteroids are indicated in immune-mediated thrombocytopenia.
(u) C. Vitamin K deficiency will prolong the PT greater than the aPTT. Vitamin K supplement is
not indicated in this patient.
(c) D.Hemophilia A presents with a prolonged aPTT and normal platelet count and function.
Hemophilia A is treated with factor VIII concentrate or cryoprecipitate.
A newborn weighs 8 pounds at birth. On average, what should the infant weigh at 1 year of
age?
A. 16 pounds
B. 20 pounds
C. 24 pounds
D. 28 pounds CORRECT ANSWER-2) (u) A. See C for explanation.
(u) B. See C for explanation.
(c) C. An infant will triple birth weight within the first year of life. A newborn that weighs 8
pounds at birth will weigh approximately 24 pounds at 1 year of age.
, PACKRAT Peds Exam with Complete Solutions
(u) D. See C for explanation.
Which of the following is a common symptom associated with laryngotracheobronchitis (viral
croup)?
A. Drooling
B. High fever
C. "Hot potato" voice
D. Barking cough CORRECT ANSWER-3) (u) A. Drooling and a "hot potato" voice are seen
with epiglottitis, not viral croup.
(u) B. Fever is usually absent or low-grade in patients with viral croup.
(u) C. See A for explanation.
(c) D. Viral croup is characterized by a history of upper respiratory tract symptoms followed by
onset of a barking cough and stridor.
A 3 year-old boy is seen in the office with a 5-day history of fever, erythema, edema of the
hands and feet, a generalized rash over the body, bilateral conjunctival injections, fissuring and
erythema of the lips, and cervical adenopathy. Antistreptolysin A (ASO) titer and throat culture
are negative. The most serious systemic complication associated with this disorder is
A. renal.
B. cardiac.
C. pulmonary.
D. hepatic. CORRECT ANSWER-u) A. See B for explanation.
, PACKRAT Peds Exam with Complete Solutions
(c) B. The patient most likely has Kawasaki syndrome. The major complication with this disorder
is coronary artery aneurysms, which are reported in up to 20% of affected children. The etiology
of this disorder is uncertain, although a bacterial toxin with super antigen properties may be
involved.
(u) C. See B for explanation.
(u) D. Children with Kawasaki syndrome may have associated hydrops of the gallbladder, but
liver involvement is not part of this disorder.
A 2 month-old infant presents for a routine health maintenance visit. The mother has been
concerned about the infant's hearing since birth. Physical examination reveals no apparent
response to a sudden loud sound. Which of the following is the most appropriate diagnostic
evaluation?
A. audiometry
B. tympanometry
C. acoustic reflectometry
D. auditory-evoked potentials CORRECT ANSWER-5) (u) A. Pure tone audiometry can be
used to screen for hearing deficits in children over the age of 3 years.
(u) B. Tympanometry is used to identify an effusion as the cause of hearing loss, but in infants
over the age of months.
(u) C. Acoustic reflectometry measures the spectral gradient of the tympanic membrane, but is
not used clinically due to concerns about its reliability.
(c) D. Brainstem auditory-evoked potentials evaluate the sensory pathway and identify the site
of any anatomical disruption. The test does not require any active response from the patient
and is useful in the evaluation of suspected hearing loss in an infant.
, PACKRAT Peds Exam with Complete Solutions
Annual blood pressure determinations should be obtained beginning at the age of
A. 3 years.
B. 5 years.
C. 12 years.
D. 18 years.. CORRECT ANSWER-6) (c) A. Periodic measurements of blood pressure
should be part of routine preventive health assessments beginning at the age of 3 years.
(u) B. See A for explanation.
(u) C. See A for explanation.
(u) D. See A for explanation
In infants, the eyes should move in parallel without deviation by the age of
A. 2 weeks.
B. 3 months.
C. 6 months.
D. 1 year. CORRECT ANSWER-7) (u) A. See C for explanation.
(u) B. See C for explanation.
(c) C. Intermittent alternating convergent strabismus is frequently noted for the first 6 months
of life, but referral is indicated if it persists beyond 6 months.
(u) D. See C for explanation
A 24 year-old male presents for routine physical examination. On physical examination, you find
that the patient's upper extremity blood pressure is higher than the blood pressure in the lower
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