Pediatrics EOR practice questions

Why Refer to developmental pediatrics is correct

• The triad of social communication deficits, restricted interests, and repetitive behaviors is consistent with autism spectrum disorder (ASD)
• American Academy of Pediatrics (AAP) recommends universal ASD screening at 18 and 24 months; concerning findings prompt referral to developmental pediatrics and early intervention
• Early intervention (applied behavior analysis (ABA), speech, occupational therapy (OT)) significantly improves outcomes

Why the others are wrong

• C) Refer for audiology evaluation — audiology testing is a reasonable adjunct to exclude hearing loss but does not address the developmental concern on its own
• B) Repeat screening in 6 months — delaying referral when red flags are present is not appropriate; early intervention significantly improves outcomes
• D) Order brain MRI imaging — brain MRI is not indicated as an initial step in evaluating for ASD

Why Discontinue the bedtime bottle is correct

• Early childhood (nursing-bottle) caries is caused by prolonged exposure of primary teeth to fermentable carbohydrates during sleep
• Bacteria metabolize sugars to acid, causing demineralization
• The primary intervention is eliminating bottle feeding at bedtime

Additional high-yield points

• Fluoride varnish is adjunctive
• Referral to pediatric dentistry is appropriate

Why Introduce pureed foods at 6 months is correct

• The American Academy of Pediatrics (AAP) recommends exclusive breastfeeding for the first 6 months, then introduction of complementary pureed foods

Why the others are wrong

• B) Avoid all allergenic foods until age 2 — current evidence (LEAP trial) supports early introduction of allergenic foods starting at 6 months to reduce allergy risk
• C) Introduce honey at 6 months — honey should be avoided until age 1 due to infant botulism risk
• D) Introduce cow's milk as the primary drink at 6 months — whole cow's milk is introduced at 12 months

Why DTaP, IPV, Hib, PCV13, HepB, and rotavirus is correct

• The 2-month American Academy of Pediatrics (AAP) immunization schedule includes: diphtheria, tetanus, acellular pertussis (DTaP); inactivated polio vaccine (IPV); Haemophilus influenzae type b (Hib); pneumococcal conjugate (PCV13); hepatitis B (HepB, 2nd dose); and rotavirus (RV, oral)
• HepB dose schedule: #1 at birth, #2 at 1–2 months, #3 at 6–18 months

Why the others are wrong

• B) MMR, varicella, and HPV — measles, mumps, rubella (MMR) and varicella are given at 12–15 months; human papillomavirus (HPV) starts at 11–12 years
• C) Tdap and meningococcal conjugate — tetanus, diphtheria, acellular pertussis (Tdap) and meningococcal conjugate are adolescent/adult vaccines
• D) Influenza vaccine alone — influenza vaccine is not given at the 2-month visit as the sole immunization

Why pulls to stand is correct

• Pulling to stand is an expected gross motor milestone at 10 months
• Other 10-month milestones: cruising furniture, sitting independently (gross motor); developing pincer grasp — index finger + thumb (fine motor); babbling with consonant-vowel combinations such as mama/dada nonspecific (language); stranger anxiety and object permanence (social)

Why the others are wrong

• D) Walks independently — independent walking typically occurs at 12–15 months
• B) Speaks in 3-word sentences — full sentences are a 2-year milestone
• A) Copies a cross — copying a cross is a milestone around 4 years

Additional high-yield points

• Red flags at 12 months: not babbling, no gestures, no pointing

Why intravenous immunoglobulin plus high-dose aspirin is correct

• This child meets criteria for Kawasaki disease: fever ≥5 days plus at least 4 of 5 features (bilateral conjunctival injection, oral mucosal changes, rash, extremity changes, and cervical lymphadenopathy)
• Coronary artery involvement is already present (mild dilation of the left coronary artery)
• Standard treatment is a single infusion of intravenous immunoglobulin (IVIG) 2 g/kg plus high-dose aspirin
• This regimen reduces the risk of coronary aneurysm from roughly 25% to under 5%

Why the others are wrong

• B) Oral prednisone — added only as adjunctive therapy in high-risk or IVIG-resistant cases; not the initial treatment of choice
• C) Intravenous ceftriaxone — treats bacterial infection; Kawasaki disease is not bacterial, so antibiotics do nothing for the coronary risk
• D) Oral acetaminophen — provides only symptomatic fever control and leaves the vasculitis and aneurysm risk untreated