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

• Refer for audiology evaluation — audiology testing is a reasonable adjunct to exclude hearing loss but does not address the developmental concern on its own
• Repeat screening in 6 months — delaying referral when red flags are present is not appropriate; early intervention significantly improves outcomes
• 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

Why the others are wrong

• Apply fluoride varnish — a useful adjunct that remineralizes early lesions but does not remove the ongoing nighttime sugar exposure driving the disease (trap)
• Extract the affected primary teeth — not indicated for early white-spot lesions and does not address the cause (trap)
• Brush teeth after each bottle — good hygiene advice, but this child falls asleep with the bottle, so milk continues to pool against the teeth for hours after any brushing and the acid exposure is unchanged (trap: adding hygiene instead of removing the exposure)

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

• 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
• Introduce honey at 6 months — honey should be avoided until age 1 due to infant botulism risk
• Introduce cow's milk as the primary drink at 6 months — whole cow's milk is introduced at 12 months

Why DTaP, IPV, Hib, PCV (PCV15 or PCV20), HepB, and rotavirus is correct

• The 2-month visit includes DTaP, inactivated polio (IPV), Haemophilus influenzae type b (Hib), pneumococcal conjugate, hepatitis B (dose 2), and oral rotavirus.
• The routine infant pneumococcal series now uses PCV15 or PCV20; PCV13 is no longer the product for a new series.
• Hepatitis B schedule: dose 1 at birth, dose 2 at 1–2 months, dose 3 at 6–18 months.

Why the others are wrong

• MMR, varicella, hepatitis A, and HPV series — MMR, varicella, and hepatitis A begin at 12 months; HPV begins at 11–12 years.
• DTaP, IPV, Hib, PCV (PCV15 or PCV20), HepB, and influenza — influenza vaccine is not given until 6 months of age, and this list substitutes it for the oral rotavirus dose that is actually due today.
• Influenza, hepatitis A, and second dose of MMR — influenza starts at 6 months and hepatitis A/MMR at 12 months; none are given at the 2-month visit.

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

• Walks independently — independent walking typically occurs at 12–15 months
• Says two words with meaning — the first true word appears around 12 months and a two- to three-word vocabulary by 12–15 months; a 10-month-old babbles mama/dada nonspecifically
• Stacks two blocks — stacking two blocks is a 15-month fine motor skill; a 10-month-old is still refining the pincer grasp

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 nonexudative conjunctival injection, oral mucosal changes, rash, extremity changes, cervical lymphadenopathy), with coronary involvement already present.
• Standard treatment is IVIG 2 g/kg plus aspirin. IVIG is the component established to reduce coronary-artery aneurysms (from ~25% to <5%); aspirin is adjunctive (anti-inflammatory, then antiplatelet).

Why the others are wrong

• Oral prednisone — added as adjunctive therapy only in high-risk or IVIG-resistant cases, not as initial treatment.
• Intravenous ceftriaxone — Kawasaki disease is not bacterial; antibiotics do not affect coronary risk.
• Oral acetaminophen — provides only symptomatic fever control and leaves the vasculitis untreated.

Additional high-yield points

• Aspirin dosing (high vs moderate) varies across accepted protocols and is not itself the aneurysm-preventing component; IVIG is.