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)
• Continue current bedtime routine — perpetuates the exposure causing the caries (trap)

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.
• Tdap, meningococcal conjugate, and HPV series — these are adolescent vaccines.
• 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
• Speaks in 3-word sentences — full sentences are a 2-year milestone
• 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 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.