If You Pass This Quiz, You Are An Excellent Pediatrician

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| By Catherine Halcomb
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  • 1/234 Questions

    An infant can move his head from side to side while following a moving object, can lift his head from a prone position 45° off the examining table, smiles when encouraged, and makes cooing sounds. He cannot maintain a seated position. The most likely age of the infant is:

    • 1 month
    • 3 months
    • 6 months
    • 9 months
    • 12 months
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About This Quiz

A pediatrician is a medical doctor who sees to the needs of infants, children, adolescents, and young adults. For many young people, a pediatrician is the primary care provider from birth, perhaps through the age of 18. The word pediatrician comes from the Greek word for child.
If You Pass This Quiz, You Are An Excellent Pediatrician

If You Pass This Quiz, You Are An Excellent Pediatrician - Quiz

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  • 2. 

    A very concerned mother brings a 2-year-old child to your office because of multiple episodes of a brief, shrill cry followed by a prolonged expiration and apnea. You have been following this child in your practice since birth and know that the child is a product of a normal pregnancy and delivery, has been growing and developing normally, and has no acute medical problems. The mother relates that the first episode in question occurred immediately after the mother refused to give the child some juice. The child became cyanotic and unconscious and had generalized clonic jerks. A few moments later the child awakened and had no residual effects. A second episode of identical nature occurred at the grocery store when the father of the child refused to purchase a toy for the child. Your physical examination reveals a totally delightful and normal child. The most likely diagnosis in this case is:

    • Seizure disorder 

    • Drug ingestion

    • Hyperactivity with attention deficit 

    • Pervasive development disorder 

    • Breath-holding spell

    Correct Answer
    A. Breath-holding spell
    Explanation
    Breath-holding spell is the most likely diagnosis in this case. Breath-holding spells are episodes in which a child involuntarily holds their breath, leading to cyanosis (bluish discoloration of the skin) and loss of consciousness. These episodes are often triggered by emotional stress or frustration, such as the child being denied something they want. The child in this case has been growing and developing normally, has no acute medical problems, and appears normal on physical examination, which is consistent with breath-holding spells. Seizure disorder, drug ingestion, hyperactivity with attention deficit, and pervasive development disorder do not explain the specific symptoms described in the case.

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  • 3. 

    The most appropriate course of action in the previous case would be to:

    • Obtain an EEG and neurologic consultation prior to starting anticonvulsants

    • Begin anticonvulsants while awaiting the results of an EEG, a neurologic consultation, and a urine drug screen

    • Initiate a trial of methylphenidate (Ritalin)

    • Instruct the family to splash cold water on the child’s face and begin mouth-to-mouth resuscitation should another episode occur

    • Reassure the family of the likely benign nature of the problem and offer counseling for appropriate behavior modification

    Correct Answer
    A. Reassure the family of the likely benign nature of the problem and offer counseling for appropriate behavior modification
    Explanation
    The most appropriate course of action in this case would be to reassure the family of the likely benign nature of the problem and offer counseling for appropriate behavior modification. This is because the question mentions a "likely benign nature of the problem," suggesting that the child's condition is not serious. Therefore, it would be appropriate to provide reassurance to the family and offer counseling to help modify the child's behavior.

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  • 4. 

    An infant who sits with only minimal support, attempts to attain a toy beyond reach, and rolls over from the supine to the prone position, but does not have a pincer grasp, is at a developmental level of:

    • 2 months

    • 4 months

    • 6 months

    • 9 months

    • 1 year

    Correct Answer
    A. 6 months
    Explanation
    An infant who is able to sit with only minimal support, attempt to reach for a toy beyond their reach, and roll over from the supine to the prone position, but does not have a pincer grasp, is at a developmental level of 6 months. At this age, infants are typically able to sit with support, start reaching for objects, and roll over. The absence of a pincer grasp suggests that the infant has not yet developed the fine motor skills required for this milestone, which usually occurs around 9 months of age.

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  • 5. 
    Appropriate treatment for the condition described in the previous question includes: - ProProfs

    Appropriate treatment for the condition described in the previous question includes:

    • Coal-tar soaps and shampoo

    • Topical antifungal cream

    • Ultraviolet light therapy

    • Moisturizers and topical steroids

    • Topical antibiotics

    Correct Answer
    A. Moisturizers and topical steroids
    Explanation
    Moisturizers and topical steroids are appropriate treatments for the condition described in the previous question because they can help alleviate symptoms such as dryness, itching, and inflammation. Moisturizers help to hydrate the skin and reduce dryness, while topical steroids have anti-inflammatory properties and can help reduce itching and inflammation. These treatments can provide relief and improve the overall condition of the skin.

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  • 6. 

    You are called by a general practitioner to consult on a patient admitted to the hospital 4 days ago. The patient is a 7-month-old white boy with poor weight gain for the past 3 months, who has not gained weight in the hospital despite seemingly adequate nutrition. His guardian is his maternal aunt, as his mother is in jail for unknown reasons. You take a detailed diet history from the guardian, and the amounts of formula and baby food intake seem appropriate for age. Physical examination reveals an active, alert infant with a strong suck reflex who appears wasted. You note generalized lymphadenopathy with hepatomegaly. In addition, you find a severe case of oral candidiasis that apparently has been resistant to treatment. Which of the following is the most appropriate next step in the evaluation or treatment of this child?

    • Increase caloric intake because this is probably a case of underfeeding

    • Order HIV PCR testing because this is likely the presentation of congenitally acquired HIV

    • Draw blood cultures because this could be sepsis

    • Perform a sweat chloride test because this is probably cystic fibrosis

    • Send stool for fecal fat because this is probably a malabsorption syndrome

    Correct Answer
    A. Order HIV PCR testing because this is likely the presentation of congenitally acquired HIV
    Explanation
    The patient's poor weight gain, lack of weight gain despite adequate nutrition, and presence of oral candidiasis that is resistant to treatment are all suggestive of an underlying immunodeficiency. The presence of generalized lymphadenopathy and hepatomegaly further support this suspicion. Congenitally acquired HIV can present with these symptoms, and HIV PCR testing is the most appropriate next step to confirm the diagnosis.

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  • 7. 

    Aunt Mary is helping her family move to a new apartment. During the confusion, 3-year-old Jimmy is noted to be stumbling about, his face flushed and his speech slurred. The contents of Aunt Mary’s purse are strewn about on the floor. In the emergency room, Jimmy is found to have a rapid heartbeat, blood pressure of 42/20, and dilated pupils. ECG shows prolonged QRS and QT intervals. Jimmy suddenly starts to convulse. His condition is most likely to be the result of poisoning with:

    • Barbiturates

    • Tricyclic antidepressants

    • Diazepam

    • Organophosphates 

    • Arsenic

    Correct Answer
    A. Tricyclic antidepressants
    Explanation
    Jimmy's symptoms, such as stumbling, flushed face, slurred speech, dilated pupils, rapid heartbeat, low blood pressure, and prolonged QRS and QT intervals on ECG, are consistent with tricyclic antidepressant poisoning. Tricyclic antidepressants can cause anticholinergic effects, including flushed face, dilated pupils, and dry mouth. They can also cause cardiovascular toxicity, leading to a rapid heartbeat and low blood pressure. Prolonged QRS and QT intervals on ECG are characteristic of tricyclic antidepressant overdose. Convulsions can also occur as a result of tricyclic antidepressant toxicity. Therefore, the most likely cause of Jimmy's condition is poisoning with tricyclic antidepressants.

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  • 8. 

    Universal immunization of infants with a three-dose series of intramuscular, genetically engineered hepatitis B surface antigen vaccine is recommended. Implementation of this recommendation should decrease the incidence of which of the following?

    • Neonatal hyperbilirubinemia

    • Alcoholic liver disease 

    • Dubin-Johnson syndrome

    • Hepatocellular carcinoma

    • Hydrops of the gallbladder

    Correct Answer
    A. Hepatocellular carcinoma
    Explanation
    Implementation of universal immunization of infants with a three-dose series of hepatitis B vaccine is recommended in order to decrease the incidence of hepatocellular carcinoma. Hepatocellular carcinoma is a type of liver cancer that is commonly caused by chronic hepatitis B infection. By vaccinating infants against hepatitis B, the transmission of the virus can be significantly reduced, leading to a decrease in the incidence of hepatocellular carcinoma.

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  • 9. 

    Many rashes and skin lesions can be found first in the newborn period. For each of the descriptions listed below, select the most likely diagnosis. A newborn’s father complains that his son has dandruff, with many waxy flakes of skin on the scalp. When he scrapes the lesions, hair often comes off with the flakes of skin. In addition, the baby has flaking of the eyebrows. (SELECT 1 DIAGNOSIS)

    • Sebaceous nevi

    • Salmon patch

    • Neonatal acne

    • Pustular melanosis

    • Erythema toxicum

    • Seborrheic dermatitis

    • Milia

    Correct Answer
    A. Seborrheic dermatitis
    Explanation
    The given description of the newborn having dandruff-like flakes of skin on the scalp, flaking of the eyebrows, and hair coming off when the lesions are scraped is consistent with seborrheic dermatitis. Seborrheic dermatitis is a common skin condition in infants that causes flaky, oily, and yellowish scales on the scalp, eyebrows, and other areas of the body. The presence of these symptoms suggests that seborrheic dermatitis is the most likely diagnosis in this case.

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  • 10. 

    For each otherwise normal child presented, choose the sleep disturbance most consistent with the history. A 3-year-old boy awakens every night around 2:00 A.M. screaming incoherently. His parents note that he is agitated, seems awake but unresponsive, and goes back to sleep within a few minutes. He has no memory of the episodes in the morning.

    • Night terrors 

    • Nightmares 

    • Learned behavior

    • Obstructive sleep apnea 

    • Somniloquy

    Correct Answer
    A. Night terrors 
    Explanation
    The child's symptoms of awakening every night around the same time, screaming incoherently, appearing awake but unresponsive, and having no memory of the episodes in the morning are consistent with night terrors. Night terrors typically occur during non-REM sleep and are characterized by intense fear and agitation. The child's ability to go back to sleep within a few minutes also supports the diagnosis of night terrors, as individuals with nightmares often have difficulty falling back asleep.

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  • 11. 

    For each disorder below, select the dietary deficiency that is likely to be responsible. Enlargement of costochondral junction, craniotabes, and scoliosis (SELECT 1 DEFICIENCY)

    • Caloric deficiency

    • Thiamine deficiency

    • Niacin deficiency

    • Vitamin D deficiency

    • Vitamin C deficiency

    • Vitamin B12 deficiency

    • Vitamin B6 deficiency

    • Biotin deficiency

    • Riboflavin deficiency

    Correct Answer
    A. Vitamin D deficiency
    Explanation
    Enlargement of costochondral junction, craniotabes, and scoliosis are all symptoms associated with rickets, which is caused by a deficiency in vitamin D. Vitamin D is essential for the absorption of calcium and phosphorus, and its deficiency can lead to impaired bone growth and development. The symptoms mentioned in the question, such as enlargement of costochondral junction (enlarged joints between the ribs and the sternum), craniotabes (softening of the skull bones), and scoliosis (abnormal curvature of the spine), are all characteristic features of rickets. Therefore, a deficiency in vitamin D is likely responsible for these symptoms.

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  • 12. 

    Identify the syndrome based on the clinical presentation. A 6-year-old boy weighs 150 lb and has small hands and feet, almond-shaped eyes, and hypogonadism.

    • Waardenburg syndrome

    • Prader-Willi syndrome

    • Marfan syndrome

    • Treacher Collins syndrome

    • Down syndrome

    Correct Answer
    A. Prader-Willi syndrome
    Explanation
    The correct answer is Prader-Willi syndrome. Prader-Willi syndrome is a genetic disorder characterized by a variety of symptoms including small hands and feet, almond-shaped eyes, and hypogonadism. Individuals with this syndrome often have an insatiable appetite, leading to obesity if not controlled.

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  • 13. 

    For the most likely toxic substance involved in the cases below, match the appropriate treatment. You are called to the delivery room. A newborn infant seems lethargic and has poor tone with only marginal respiratory effort, but his heart rate is above 100 beats per min. The mother had an uncomplicated pregnancy, and delivery was uncomplicated and vaginal 10 min after spontaneous rupture of membranes. The mother received only pain medications while in labor. (SELECT 1 TREATMENT)

    • Atropine and pralidoxime (2-PAM)

    • N-acetylcysteine (Mucomyst)

    • Meso-2,3-dimercaptosuccimic acid (DMSA succimer)

    • Naloxone (Narcan)

    • Sodium bicarbonate

    Correct Answer
    A. Naloxone (Narcan)
    Explanation
    The correct treatment for the symptoms described in the case is Naloxone (Narcan). The newborn infant is presenting with lethargy, poor tone, and marginal respiratory effort, which are consistent with opioid toxicity. Naloxone is an opioid receptor antagonist that can reverse the effects of opioids and improve respiratory effort. The fact that the mother had an uncomplicated pregnancy and delivery, along with the absence of any other specific information, suggests that opioid toxicity is the most likely cause of the infant's symptoms. Therefore, Naloxone would be the appropriate treatment in this case.

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  • 14. 

    For the most likely toxic substance involved in the cases below, match the appropriate treatment. After helping his father in the yard, a 14-year-old boy complains of weakness and feels like his muscles are twitching. He begins to drool, and then collapses in a generalized tonic clonic seizure. Upon the arrival of EMS, his heart rate is found to be 40 beats per min and his pupils are pinpoint. (SELECT 1 TREATMENT)

    • Atropine and pralidoxime (2-PAM)

    • N-acetylcysteine (Mucomyst)

    • Meso-2,3-dimercaptosuccimic acid (DMSA succimer)

    • Naloxone (Narcan)

    • Sodium bicarbonate

    Correct Answer
    A. Atropine and pralidoxime (2-PAM)
    Explanation
    The symptoms described in the case, such as muscle weakness, twitching, drooling, and collapse followed by a seizure, along with a slow heart rate and pinpoint pupils, suggest the possibility of organophosphate poisoning. Atropine and pralidoxime (2-PAM) are the appropriate treatments for organophosphate poisoning. Atropine helps to counteract the effects of excessive acetylcholine in the body, while pralidoxime reactivates acetylcholinesterase, the enzyme responsible for breaking down acetylcholine. These treatments can help alleviate the symptoms and reverse the toxic effects of organophosphate poisoning.

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  • 15. 

    Excess vitamin intake has been shown to have deleterious effects. Match the vitamin with the toxic effect. Pyridoxine (SELECT 1 EFFECT)

    • Kidney stones

    • Sensory neuropathy

    • Edema

    • Hyperostosis

    • Calcification of the heart

    • Decreased cerebrospinal fluid pressure

    • Erythema of skin

    Correct Answer
    A. Sensory neuropathy
    Explanation
    Excess intake of pyridoxine, also known as vitamin B6, has been shown to cause sensory neuropathy. Sensory neuropathy is a condition that affects the nerves responsible for transmitting sensory information from the body to the brain. Symptoms of sensory neuropathy include numbness, tingling, and loss of sensation in the extremities. This can lead to difficulties with coordination and balance. Therefore, excessive consumption of pyridoxine can have deleterious effects on the nervous system, specifically causing sensory neuropathy.

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  • 16. 

    Heart failure is possible at any age. Match each clinical condition with the most likely diagnosis. A 14-year-old child has headache, hypertension, edema, and a change in urine output and color. (SELECT 1 DIAGNOSIS)

    • Glomerulonephritis

    • Severe anemia

    • Heart block

    • Ventricular septal defect

    • Arteriovenous malformation

    • Coarctation of the aorta

    Correct Answer
    A. Glomerulonephritis
    Explanation
    The given symptoms of headache, hypertension, edema, and a change in urine output and color are suggestive of glomerulonephritis. Glomerulonephritis is an inflammation of the glomeruli in the kidneys, which can lead to impaired kidney function and the symptoms described. The other options listed do not typically present with these specific symptoms and are therefore less likely diagnoses in this case.

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  • 17. 

    Heart failure is possible at any age. Match each clinical condition with the most likely diagnosis. A 3-day-old infant was born to a mother with active systemic lupus erythematosus (SLE). (SELECT 1 DIAGNOSIS)

    • Glomerulonephritis

    • Severe anemia

    • Heart block

    • Ventricular septal defect

    • Arteriovenous malformation

    • Coarctation of the aorta

    Correct Answer
    A. Heart block
    Explanation
    Heart block is the most likely diagnosis for a 3-day-old infant born to a mother with active systemic lupus erythematosus (SLE). Systemic lupus erythematosus can cause autoimmune damage to the heart's electrical conduction system, leading to heart block. This condition can occur at any age, including in newborns. Therefore, heart block is a possible diagnosis for this infant.

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  • 18. 

    The Committee on Nutrition of the American Academy of Pediatrics has concluded that children on a normal diet do not need vitamin supplements. There are, however, some clinical situations in which special needs do occur. Match each situation with the appropriate supplement. One-day-old newborn (SELECT 1 SUPPLEMENT)

    • All fat-soluble vitamins

    • Pyridoxine

    • Vitamin A

    • Vitamin D

    • Vitamin K

    • Folate

    Correct Answer
    A. Vitamin K
  • 19. 

    You are speaking to a couple who are expecting their first baby in about 2 weeks. They are concerned about the safety of childhood immunizations and also about “unneeded” medications given to newborns in the hospital. They ask about the purpose of the routine administration of intramuscular vitamin K. You explain to them about hemorrhagic disease of the newborn, stating that the untreated baby can manifest:

    • A deficiency of factor V

    • A prolonged prothrombin time and a risk of serious hemorrhage in the days following delivery

    • Development of hemorrhagic manifestations within 24 h of delivery

    • More severe symptoms in a male than a female child

    • Hemorrhagic symptoms at a much higher rate if the infant is fed cow’s milk rather than breast milk

    Correct Answer
    A. A prolonged prothrombin time and a risk of serious hemorrhage in the days following delivery
    Explanation
    The correct answer is "A prolonged prothrombin time and a risk of serious hemorrhage in the days following delivery." This explanation states that untreated babies with hemorrhagic disease of the newborn can experience a prolonged prothrombin time, which measures the time it takes for blood to clot. This can lead to a risk of serious hemorrhage, or excessive bleeding, in the days following delivery.

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  • 20. 

    Blood samples of a 3-day-old full-term infant are sent for screening to identify diseases that would have serious, permanent consequences without prompt and appropriate treatment. Match the disease with the treatment. Biotinidase deficiency (SELECT 1 TREATMENT)

    • Special diet 

    • Hormone therapy

    • Vitamin therapy

    • Antibiotic prophylaxis

    • Sunlight

    Correct Answer
    A. Vitamin therapy
    Explanation
    Vitamin therapy is the correct treatment for Biotinidase deficiency. Biotinidase deficiency is a rare genetic disorder where the body is unable to properly process biotin, a B-vitamin. Without treatment, this condition can lead to serious neurological problems. Vitamin therapy involves providing the infant with biotin supplements to ensure they receive an adequate amount of the vitamin. This treatment helps to prevent the development of symptoms and allows the infant to grow and develop normally.

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  • 21. 

    Blood samples of a 3-day-old full-term infant are sent for screening to identify diseases that would have serious, permanent consequences without prompt and appropriate treatment. Match the disease with the treatment. Hypothyroidism (SELECT 1 TREATMENT)

    • Special diet 

    • Hormone therapy

    • Vitamin therapy

    • Antibiotic prophylaxis

    • Sunlight

    Correct Answer
    A. Hormone therapy
    Explanation
    Hypothyroidism is a condition where the thyroid gland does not produce enough thyroid hormone, which is important for growth and development. Prompt and appropriate treatment is necessary to prevent serious and permanent consequences. Hormone therapy, in this case, refers to the administration of synthetic thyroid hormone to supplement the deficiency in the body. This treatment helps to restore normal thyroid hormone levels and prevent any potential complications associated with hypothyroidism.

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  • 22. 

    You are asked to see a child in consultation. The family noticed that the child’s left arm and leg seemed bigger than those on the right. In addition, the child has aniridia. You examine the family members present, and none of them have aniridia or hemihypertrophy, nor do they know of anyone else in the family with these conditions. You suggest further evaluation of the child for which condition?

    • Deafness

    • Seizures

    • Wilms tumor

    • Congestive heart failure

    • Optic glioma

    Correct Answer
    A. Wilms tumor
    Explanation
    The child's presentation of hemihypertrophy (one side of the body being larger than the other) and aniridia (absence of the iris in the eye) are both associated with a condition called Beckwith-Wiedemann syndrome. This syndrome is characterized by overgrowth, abnormalities in the abdominal organs, and an increased risk of developing Wilms tumor, a type of kidney cancer. Therefore, further evaluation for Wilms tumor is suggested in this case.

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  • 23. 

    A 15-year-old girl with short stature, neck webbing, and sexual infantilism is found to have coarctation of the aorta. A chromosomal analysis would demonstrate:

    • Mutation at chromosome 15q21.1

    • Trisomy 21

    • XO karyotype

    • Defect at chromosome 4p16

    • Normal chromosome analysis

    Correct Answer
    A. XO karyotype
    Explanation
    The presence of short stature, neck webbing, and sexual infantilism in a 15-year-old girl suggests Turner syndrome, which is caused by an XO karyotype. Turner syndrome is characterized by the absence of one X chromosome in females. This chromosomal abnormality leads to various physical and developmental abnormalities, including short stature, webbed neck, and delayed sexual development. The other options listed do not correspond to the clinical features described in the question.

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  • 24. 

    A 2-year-old boy is brought into the emergency room with a complaint of fever for 6 days and development of a limp. On examination, he is found to have an erythematous macular exanthem over his body, ocular conjunctivitis, dry and cracked lips, red throat, and cervical lymphadenopathy. There is a grade II/VI vibratory systolic ejection murmur at the lower left sternal border. A white blood cell count and differential show predominant neutrophils with increased platelets on smear. The most likely diagnosis is:

    • Scarlet fever

    • Rheumatic fever

    • Kawasaki disease

    • Juvenile rheumatoid arthritis

    • Infectious mononucleosis

    Correct Answer
    A. Kawasaki disease
    Explanation
    The given clinical presentation of a 2-year-old boy with fever, erythematous macular exanthem, ocular conjunctivitis, dry and cracked lips, red throat, cervical lymphadenopathy, and a grade II/VI vibratory systolic ejection murmur at the lower left sternal border, along with elevated neutrophils and platelets on smear, is consistent with Kawasaki disease. Kawasaki disease is an acute febrile illness that primarily affects young children and is characterized by systemic vasculitis involving medium-sized vessels. It commonly presents with fever, mucocutaneous findings, lymphadenopathy, and cardiovascular involvement, which includes the development of a coronary artery aneurysm.

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  • 25. 

    The next steps in management of the child in the preceding question would be:

    • Intramuscular or oral penicillin, outpatient follow-up

    • Pooled immunoglobulin (IVIG) and high-dose aspirin, inpatient admission

    • Nonsteroidal anti-inflammatory medication, outpatient follow-up

    • Blood cultures, intravenous vancomycin, inpatient admission

    • Viral titers, contact sports precautions, outpatient follow-up

    Correct Answer
    A. Pooled immunoglobulin (IVIG) and high-dose aspirin, inpatient admission
    Explanation
    The next steps in management of the child would involve administering pooled immunoglobulin (IVIG) and high-dose aspirin, along with admitting the child to the hospital. This approach is likely indicated because it suggests a possible diagnosis of Kawasaki disease, which is characterized by fever, conjunctivitis, rash, and mucosal changes. Treatment typically involves IVIG to reduce the risk of coronary artery aneurysms and high-dose aspirin to reduce inflammation. Inpatient admission is necessary to closely monitor the child's response to treatment and manage any potential complications.

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  • 26. 

    The most likely agent responsible for the infant’s condition in the preceding question is:

    • Staphylococcus aureus

    • Haemophilus influenzae

    • Corynebacterium diphtheriae

    • Respiratory syncytial virus

    • Echovirus

    Correct Answer
    A. Respiratory syncytial virus
    Explanation
    The most likely agent responsible for the infant's condition is the Respiratory syncytial virus. This virus is a common cause of respiratory tract infections, especially in infants and young children. It can cause symptoms such as cough, runny nose, fever, and difficulty breathing. RSV is highly contagious and can spread easily through respiratory droplets. It is a leading cause of bronchiolitis and pneumonia in infants, and can be particularly severe in premature babies and those with underlying health conditions.

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  • 27. 

    A 10-month-old infant has poor weight gain, a persistent cough, and a history of several bouts of pneumonitis. The mother describes the child as having very large, foul-smelling stools for months. Which of the following diagnostic maneuvers is likely to result in the correct diagnosis of this child?

    • CT of the chest

    • Serum immunoglobulins

    • TB skin test

    • Inspiratory and expiratory chest x-ray

    • Sweat chloride test

    Correct Answer
    A. Sweat chloride test
    Explanation
    A sweat chloride test is likely to result in the correct diagnosis of this child. The combination of poor weight gain, persistent cough, history of pneumonitis, and large, foul-smelling stools suggests a possible diagnosis of cystic fibrosis (CF). The sweat chloride test is a diagnostic test used to confirm CF, as it measures the amount of chloride in sweat. In individuals with CF, the sweat chloride levels are typically elevated. Therefore, performing a sweat chloride test can help confirm the diagnosis of CF in this infant.

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  • 28. 

    You are awakened in the night by your 2-year-old son, who has developed noisy breathing on inspiration, marked retractions of the chest wall, flaring of the nostrils, and a barking cough. He has had a mild upper respiratory infection (URI) for 2 days. The most likely diagnosis is:

    • Asthma

    • Epiglottitis

    • Bronchiolitis

    • Viral croup

    • Foreign body in the right mainstem bronchus

    Correct Answer
    A. Viral croup
    Explanation
    The most likely diagnosis is viral croup. The symptoms described, such as noisy breathing on inspiration, marked retractions of the chest wall, flaring of the nostrils, and a barking cough, are characteristic of viral croup. Viral croup is a common respiratory infection in young children, typically caused by a viral infection that leads to inflammation and swelling of the upper airway. This can result in the characteristic symptoms, including the barking cough. Asthma, epiglottitis, and foreign body in the right mainstem bronchus are less likely given the clinical presentation and history of a mild upper respiratory infection. Bronchiolitis may present with similar symptoms, but viral croup is more likely in this case.

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  • 29. 

    As a doctor in a clinic, you have just given a 10-year-old boy an injection of pollen extract as prescribed by his allergist. You are about to move on to the next patient when the boy starts to complain about a funny feeling in his chest, and his face becomes red and swollen. He then develops severe respiratory distress with wheezing, and as he starts to fall, you catch him and place him on a bed. The least important measure to be instituted immediately would be:

    • Endotracheal intubation

    • Placement of a tourniquet above the injection site

    • Administration of oxygen

    • Subcutaneous injection of 1:1000 epinephrine 0.2 mL

    • Administration of corticosteroids

    Correct Answer
    A. Placement of a tourniquet above the injection site
    Explanation
    The least important measure to be instituted immediately would be the placement of a tourniquet above the injection site. This is because the symptoms described suggest an anaphylactic reaction, which is a severe and potentially life-threatening allergic reaction. In this situation, the priority should be to address the respiratory distress and provide immediate medical intervention. Endotracheal intubation, administration of oxygen, subcutaneous injection of epinephrine, and administration of corticosteroids are all appropriate measures to treat an anaphylactic reaction. A tourniquet may be used in certain situations to control bleeding, but it is not a priority in this case.

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  • 30. 

    A 3-day-old infant born at 32 weeks’ gestation and weighing 1700 g (3 lb, 12 oz) has three episodes of apnea, each lasting 20 to 25 s and occurring after a feeding. During these episodes, the heart rate drops from 140 to 100 beats per min, and the child remains motionless; between episodes, however, the child displays normal activity. Blood sugar is 50 mg/dL and serum calcium is normal. The child’s apneic periods most likely are:

    • Due to an immature respiratory center

    • A part of periodic breathing

    • Secondary to hypoglycemia

    • Manifestations of seizures

    • Evidence of underlying pulmonary disease

    Correct Answer
    A. Due to an immature respiratory center
    Explanation
    The correct answer is "Due to an immature respiratory center." This is because the infant is only 3 days old and born prematurely at 32 weeks' gestation. Premature infants often have underdeveloped respiratory centers in the brain, which can lead to episodes of apnea. The fact that the episodes occur after feeding suggests that they may be related to the immaturity of the respiratory center, as the respiratory drive may be temporarily suppressed during digestion. The normal blood sugar and serum calcium levels suggest that hypoglycemia or electrolyte imbalances are not the cause of the apneic episodes. There is no evidence of seizures or underlying pulmonary disease mentioned in the scenario.

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  • 31. 

    Blood samples of a 3-day-old full-term infant are sent for screening to identify diseases that would have serious, permanent consequences without prompt and appropriate treatment. Match the disease with the treatment. Galactosemia (SELECT 1 TREATMENT)

    • Special diet 

    • Hormone therapy

    • Vitamin therapy

    • Antibiotic prophylaxis

    • Sunlight

    Correct Answer
    A. Special diet 
    Explanation
    Galactosemia is a rare genetic disorder in which the body is unable to break down galactose, a sugar found in milk and dairy products. If left untreated, it can lead to serious health problems such as liver damage, kidney problems, and intellectual disability. The correct treatment for galactosemia is a special diet that eliminates galactose from the infant's diet. This involves avoiding milk, dairy products, and any foods or formulas that contain lactose or galactose. By following a special diet, the infant can avoid the harmful effects of galactosemia and lead a healthy life.

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  • 32. 

    Two weeks after a viral syndrome, a 9-year-old girl presents to your clinic with a complaint of several days of drooping of her mouth. In addition to the drooping of the left side of her mouth, you note that she is unable to completely shut her left eye. Her smile is asymmetric, but her examination is otherwise normal. This girl likely has:

    • Guillain-Barré syndrome

    • Botulism

    • Cerebral vascular accident 

    • Brainstem tumor

    • Bell palsy

    Correct Answer
    A. Bell palsy
    Explanation
    The girl's symptoms of drooping of the mouth and inability to completely shut her left eye, along with an asymmetric smile, are indicative of Bell palsy. Bell palsy is a condition that causes sudden weakness or paralysis of the muscles on one side of the face, typically due to inflammation of the facial nerve. It is often preceded by a viral infection, such as a viral syndrome, which is consistent with the girl's history. Guillain-Barré syndrome, botulism, cerebral vascular accident, and brainstem tumor would present with different symptoms and are less likely in this case.

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  • 33. 
    The previously healthy 4-year-old child pictured presents to the emergency room with a 2-day history of a brightly erythematous rash and temperature of 40°C (104°F). The exquisitely tender, generalized rash is worse in the flexural and perioral areas. The child is admitted and over the next day develops crusting and fissuring around the eyes, mouth, and nose. The desquamation of skin shown occurs with gentle traction. This child most likely has: - ProProfs

    The previously healthy 4-year-old child pictured presents to the emergency room with a 2-day history of a brightly erythematous rash and temperature of 40°C (104°F). The exquisitely tender, generalized rash is worse in the flexural and perioral areas. The child is admitted and over the next day develops crusting and fissuring around the eyes, mouth, and nose. The desquamation of skin shown occurs with gentle traction. This child most likely has:

    • Epidermolysis bullosa

    • Staphylococcal scalded skin syndrome

    • Erythema multiforme

    • Drug eruption

    • Scarlet fever

    Correct Answer
    A. Staphylococcal scalded skin syndrome
    Explanation
    The child's presentation is consistent with Staphylococcal scalded skin syndrome (SSSS). SSSS is a bacterial infection caused by Staphylococcus aureus that produces an exfoliative toxin. The toxin causes separation of the epidermis from the dermis, resulting in a generalized rash that is worse in flexural and perioral areas. The crusting and fissuring around the eyes, mouth, and nose, along with the desquamation of skin with gentle traction, are characteristic features of SSSS. Epidermolysis bullosa, erythema multiforme, drug eruption, and scarlet fever do not typically present with these specific findings.

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  • 34. 

    After you make the diagnosis in the previous case, you explain the findings to the family and instruct the family to:

    • Restrict the child from all strenuous activities

    • Give the child a no-salt-added diet

    • Ensure that the patient receives antibiotic prophylaxis for dental procedures

    • Test all family members in the home

    • Avoid allowing the child to get upset

    Correct Answer
    A. Ensure that the patient receives antibiotic prophylaxis for dental procedures
    Explanation
    The correct answer is to ensure that the patient receives antibiotic prophylaxis for dental procedures. This is because the previous case likely involved a diagnosis of infective endocarditis, which is an infection of the heart valves. Antibiotic prophylaxis is recommended for patients with certain heart conditions, such as those with prosthetic heart valves, to prevent bacterial infections during dental procedures. This is important because bacteria from the mouth can enter the bloodstream during dental procedures and potentially infect the heart valves. Therefore, ensuring that the patient receives antibiotic prophylaxis is crucial in preventing complications.

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  • 35. 

    A mother brings an 18-month-old to the emergency center with the concern that the child may have ingested a substance. Which of the following is a contraindication to the use of ipecac in this child:

    • Age less than 5 years

    • Breast-feeding

    • Ingestion of alkali

    • Ingestion of iron

    • Concurrent administration of intravenous glucose

    Correct Answer
    A. Ingestion of alkali
    Explanation
    Ingestion of alkali is a contraindication to the use of ipecac in an 18-month-old child because alkali substances can cause severe damage to the esophagus and stomach. Ipecac induces vomiting, which can further irritate and potentially worsen the damage caused by alkali ingestion. Therefore, it is not recommended to use ipecac in this situation.

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  • 36. 

    You are called to the emergency room to see one of your patients. The father of this 3-year-old was spraying the yard with an unknown insecticide. In the emergency room, the child is noted to have bradycardia, muscle fasciculations, meiosis, wheezing, and profound drooling. The most likely agent included in this pesticide is:

    • Organophosphate

    • Chlorophenothane (DDT)

    • Sodium cyanide

    • Warfarin

    • Paraquat

    Correct Answer
    A. Organophosphate
    Explanation
    The symptoms described in the question, such as bradycardia, muscle fasciculations, meiosis, wheezing, and profound drooling, are consistent with organophosphate poisoning. Organophosphates are a class of insecticides that inhibit the activity of the enzyme acetylcholinesterase, leading to an accumulation of acetylcholine in the body. This results in overstimulation of the cholinergic system, leading to the symptoms described. Chlorophenothane (DDT), sodium cyanide, warfarin, and paraquat do not typically cause these specific symptoms.

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  • 37. 
    A 1-week-old black infant presents to you for the first time with a large, fairly well-defined, purple lesion over the buttocks bilaterally, as shown in the photograph. The lesion is not palpable, and it is not warm or tender. The mother denies trauma and reports that the lesion has been present since birth. This otherwise well-appearing infant is growing and developing normally and appears normal upon physical examination. The most likely diagnosis in this infant is: - ProProfs

    A 1-week-old black infant presents to you for the first time with a large, fairly well-defined, purple lesion over the buttocks bilaterally, as shown in the photograph. The lesion is not palpable, and it is not warm or tender. The mother denies trauma and reports that the lesion has been present since birth. This otherwise well-appearing infant is growing and developing normally and appears normal upon physical examination. The most likely diagnosis in this infant is:

    • Child abuse

    • Mongolian spot

    • Subcutaneous fat necrosis

    • Vitamin K deficiency

    • Hemophilia

    Correct Answer
    A. Mongolian spot
    Explanation
    This 1-week-old black infant presenting with a large, well-defined, purple lesion over the buttocks bilaterally is most likely diagnosed with a Mongolian spot. Mongolian spots are common in infants with darker skin tones and typically appear as bluish-gray or purple lesions on the lower back or buttocks. They are benign and usually fade over time without any treatment. The absence of trauma, normal growth and development, and the lesion being present since birth all support the diagnosis of a Mongolian spot rather than child abuse, subcutaneous fat necrosis, vitamin K deficiency, or hemophilia.

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  • 38. 
    A newborn infant develops respiratory distress immediately after birth. His abdomen is scaphoid. No breath sounds are heard on the left side of his chest, but they are audible on the right. Immediate intubation is successful with little or no improvement in clinical status. Emergency chest x-ray is shown (A) along with an x-ray 2 h later (B). The most likely explanation for this infant’s condition is: - ProProfs

    A newborn infant develops respiratory distress immediately after birth. His abdomen is scaphoid. No breath sounds are heard on the left side of his chest, but they are audible on the right. Immediate intubation is successful with little or no improvement in clinical status. Emergency chest x-ray is shown (A) along with an x-ray 2 h later (B). The most likely explanation for this infant’s condition is:

    • Pneumonia

    • Cyanotic heart disease

    • Diaphragmatic hernia

    • Choanal atresia

    • Pneumothorax

    Correct Answer
    A. Diaphragmatic hernia
    Explanation
    The most likely explanation for the infant's condition is a diaphragmatic hernia. This is supported by the scaphoid abdomen, absence of breath sounds on the left side of the chest, and the chest x-ray findings. A diaphragmatic hernia occurs when there is a defect in the diaphragm, allowing abdominal organs to move into the chest cavity. This can cause respiratory distress due to compression of the lungs and displacement of the heart. Immediate intubation may be necessary, but it may not fully resolve the clinical symptoms. The chest x-ray findings, showing abdominal organs in the chest cavity, further support the diagnosis of a diaphragmatic hernia.

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  • 39. 

    A term, 4200-g female infant is delivered via cesarean section because of cephalopelvic disproportion. The amniotic fluid was clear, and the infant cried almost immediately after birth. Within the first 15 min of life, however, the infant’s respiratory rate increased to 80 breaths per min, and she began to have intermittent grunting respirations. The infant was transferred to the level 2 nursery and was noted to have an oxygen saturation of 94%. The chest radiograph showed fluid in the fissure, overaeration, and prominent pulmonary vascular markings. The most likely diagnosis in this infant is:

    • Diaphragmatic hernia

    • Meconium aspiration

    • Pneumonia

    • Idiopathic respiratory distress syndrome

    • Transient tachypnea of the newborn

    Correct Answer
    A. Transient tachypnea of the newborn
    Explanation
    The infant in the scenario is experiencing rapid breathing (tachypnea) and intermittent grunting respirations, which are characteristic of transient tachypnea of the newborn (TTN). TTN is a condition that occurs when there is delayed clearance of fetal lung fluid after birth, leading to fluid accumulation in the lungs. This can cause respiratory distress shortly after birth, but it typically resolves within 24-72 hours without any treatment. The chest radiograph findings of fluid in the fissure, overaeration, and prominent pulmonary vascular markings are consistent with TTN. The other options (diaphragmatic hernia, meconium aspiration, pneumonia, and idiopathic respiratory distress syndrome) do not match the clinical presentation and radiographic findings described.

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  • 40. 

    A routine prenatal ultrasound reveals a male fetus with meningomylocele. The 24-year-old primigravid mother is told the infant will require surgery shortly after birth. You counsel her about the etiology of this defect and the risk of further pregnancies being similarly affected, stating that:

    • The hereditary pattern for this condition is autosomal recessive

    • The prenatal diagnosis can be made by the detection of very low levels of α- fetoprotein in the amniotic fluid

    • Subsequent pregnancies are not at increased risk compared to the general population

    • Supplementation of maternal diet with folate leads to a decrease in incidence of this condition

    • Neither environmental nor social factors have been shown to influence the incidence

    Correct Answer
    A. Supplementation of maternal diet with folate leads to a decrease in incidence of this condition
    Explanation
    The correct answer is "Supplementation of maternal diet with folate leads to a decrease in incidence of this condition." This is because neural tube defects, such as meningomylocele, have been shown to be associated with inadequate intake of folate during pregnancy. Supplementation with folate has been proven to decrease the risk of neural tube defects in infants.

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  • 41. 

    An infant born at 35 weeks’ gestation to a mother with no prenatal care is noted to be jittery and irritable, and is having difficulty feeding. You note coarse tremors on examination. The nurses report a high-pitched cry and note several episodes of diarrhea and emesis. You suspect the infant is withdrawing from:

    • Alcohol

    • Marijuana

    • Heroin

    • Cocaine

    • Tobacco

    Correct Answer
    A. Heroin
    Explanation
    The symptoms described, such as jitteriness, irritability, difficulty feeding, coarse tremors, high-pitched cry, and episodes of diarrhea and emesis, are consistent with neonatal withdrawal syndrome. This syndrome occurs when a baby is exposed to drugs in utero and experiences withdrawal symptoms after birth. Among the options given, heroin is the most likely cause of these symptoms.

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  • 42. 

    The signs and symptoms of meningitis in an infant can be different than those in an adult. Which of the signs and symptoms of meningitis listed below is more helpful in an adult patient than in a 4-month-old?

    • Lethargy

    • Jaundice 

    • Vomiting

    • Brudzinski’s sign

    • Hypothermia

    Correct Answer
    A. Brudzinski’s sign
    Explanation
    Brudzinski's sign is a physical examination finding where there is involuntary flexion of the hips and knees when the neck is flexed. This sign is more helpful in an adult patient than in a 4-month-old because it indicates meningeal irritation and inflammation, which is more specific for meningitis in adults. In infants, the fontanelle (soft spot on the top of the head) is not yet closed, and they may not exhibit this sign even if they have meningitis. Therefore, Brudzinski's sign is a more reliable indicator of meningitis in adults compared to infants.

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  • 43. 

    A postterm infant is born at home after a prolonged and difficult labor. The maternal grandmother brings the infant to the hospital at 1 h of life because of fast breathing. Grandmother notes that the child spit up some dark brown particulate fluid shortly after birth. Physical examination reveals an infant in marked respiratory distress. Other findings include both an umbilical cord and flaking skin with a yellow-green hue. Chest radiograph reveals patchy infiltrates bilaterally. What is the diagnosis?

    • Bronchopulmonary dysplasia

    • Respiratory distress syndrome (hyaline membrane disease)

    • Pulmonary interstitial emphysema

    • Bronchiolitis

    • Primary pulmonary hypertension

    • Pneumothorax

    • Asthma

    • Meconium aspiration

    • Transient tachypnea of the newborn

    • Bacterial pneumonia

    Correct Answer
    A. Meconium aspiration
    Explanation
    The given scenario describes a postterm infant who was born at home after a prolonged and difficult labor. The infant is now presenting with fast breathing and has spit up dark brown particulate fluid shortly after birth. These findings, along with the presence of an umbilical cord and flaking skin with a yellow-green hue, suggest the diagnosis of meconium aspiration. Meconium aspiration occurs when a newborn inhales meconium, which is the baby's first stool, into the lungs during or before delivery. This can cause respiratory distress and lead to patchy infiltrates seen on a chest radiograph.

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  • 44. 

    The same infant is now 7 weeks old. She has been extubated for 2 weeks and still requires oxygen to maintain her saturation above 93%. Her chest radiograph now reveals patchy, fluffy infiltrates with areas of lucency. She requires daily diuretic treatment. What is the diagnosis?

    • Bronchopulmonary dysplasia

    • Respiratory distress syndrome (hyaline membrane disease)

    • Pulmonary interstitial emphysema

    • Bronchiolitis

    • Primary pulmonary hypertension

    • Pneumothorax

    • Asthma

    • Meconium aspiration

    • Transient tachypnea of the newborn

    • Bacterial pneumonia

    Correct Answer
    A. Bronchopulmonary dysplasia
    Explanation
    The infant in this scenario is 7 weeks old and still requires oxygen to maintain her saturation above 93%. Additionally, her chest radiograph reveals patchy, fluffy infiltrates with areas of lucency, and she requires daily diuretic treatment. These findings are consistent with bronchopulmonary dysplasia, a chronic lung disease that often occurs in premature infants who have required mechanical ventilation and oxygen therapy. This condition is characterized by inflammation and scarring of the lungs, leading to respiratory symptoms and the need for ongoing oxygen support.

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  • 45. 

    Blood samples of a 3-day-old full-term infant are sent for screening to identify diseases that would have serious, permanent consequences without prompt and appropriate treatment. Match the disease with the treatment. Phenylketonuria (SELECT 1 TREATMENT)

    • Special diet 

    • Hormone therapy

    • Vitamin therapy

    • Antibiotic prophylaxis

    • Sunlight

    Correct Answer
    A. Special diet 
    Explanation
    Phenylketonuria is a genetic disorder that causes a buildup of phenylalanine in the body. This can lead to intellectual disability and other serious health problems if not treated promptly. The correct treatment for phenylketonuria is a special diet that restricts the intake of phenylalanine. By following this diet, the individual can prevent the buildup of phenylalanine and reduce the risk of complications.

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  • 46. 

    For each description of head injury that follows, select the major abnormality with which it is most likely to be associated. Previous premature infant born at 27 weeks’ gestation and now 6 months of age presenting with macrocephaly and hydrocephalus on ultrasonogram. (SELECT 1 ABNORMALITY)

    • Intraventricular hemorrhage

    • Caput succedaneum

    • Subdural hemorrhage

    • Subarachnoid hemorrhage

    • Cephalohematoma

    Correct Answer
    A. Intraventricular hemorrhage
    Explanation
    The given description of a premature infant born at 27 weeks' gestation presenting with macrocephaly and hydrocephalus on ultrasonogram suggests the presence of intraventricular hemorrhage. Intraventricular hemorrhage is a common complication in premature infants and can lead to the accumulation of blood in the ventricles of the brain, causing hydrocephalus and enlargement of the head. This abnormality is the most likely association in this case.

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  • 47. 

    A 10-year-old boy, the star goalie for the Salt Lake City Little League soccer team, had a sore throat about two weeks ago but did not tell anyone because he was afraid he would miss the play-offs. Since several children have been diagnosed with rheumatic fever in the area, his mother is worried that he may be at risk as well. You tell her that several criteria must be met to make the diagnosis but that the most common finding is:

    • Carditis

    • Arthralgia

    • Erythema marginatum

    • Chorea

    • Subcutaneous nodules

    Correct Answer
    A. Arthralgia
    Explanation
    Rheumatic fever is an inflammatory condition that can develop after a streptococcal infection, such as strep throat. It commonly affects the joints, causing arthralgia (joint pain). While other symptoms like carditis (inflammation of the heart), erythema marginatum (a rash with a characteristic appearance), chorea (involuntary movements), and subcutaneous nodules (small lumps under the skin) can also be present, arthralgia is the most common finding in rheumatic fever. Therefore, the correct answer is arthralgia.

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  • 48. 

    In the same patient, of the following manifestations of acute rheumatic fever, which is not relieved by salicylate or steroid therapy?

    • Carditis

    • Abdominal pain

    • Arthritis

    • Chorea

    • Fever

    Correct Answer
    A. Chorea
    Explanation
    Chorea is a manifestation of acute rheumatic fever that is not relieved by salicylate or steroid therapy. Chorea is characterized by involuntary, jerky movements that are often rapid and purposeless. It is believed to be caused by an autoimmune response triggered by a previous streptococcal infection. While salicylates and steroids can help alleviate other symptoms of acute rheumatic fever such as carditis, arthritis, abdominal pain, and fever, they are not effective in treating chorea. Therefore, chorea remains unaffected by these therapies.

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  • 49. 

    For each of the cases presented below, choose the most likely cardiac diagnosis based on the patient’s presentation. A 15-year-old adolescent male presents to the office for a sports physical. In his screening questionnaire, he notes that he occasionally gets short of breath and dizzy during exercise, with occasional chest pain. He lost consciousness once last summer during football practice, but attributed it to the heat. His grandfather died suddenly at age 35 of unknown etiology, but otherwise the family is healthy. (SELECT 1 DIAGNOSIS)

    • Congenital heart block

    • Hypertrophic cardiomyopathy

    • Prolonged QT syndrome

    • Congestive heart failure

    • Cor pulmonale

    Correct Answer
    A. Hypertrophic cardiomyopathy
    Explanation
    Based on the patient's presentation of occasional shortness of breath, dizziness, chest pain, and loss of consciousness during exercise, along with a family history of sudden death at a young age, the most likely cardiac diagnosis is hypertrophic cardiomyopathy. This condition is characterized by abnormal thickening of the heart muscle, which can obstruct blood flow and lead to symptoms such as those described by the patient.

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Quiz Review Timeline (Updated): Mar 21, 2023 +

Our quizzes are rigorously reviewed, monitored and continuously updated by our expert board to maintain accuracy, relevance, and timeliness.

  • Current Version
  • Mar 21, 2023
    Quiz Edited by
    ProProfs Editorial Team
  • May 27, 2021
    Quiz Created by
    Catherine Halcomb

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