NBME Pediatrics 2 — Questions and Answers
Question 1: A 15-month-old child cannot walk independently, says only 'mama,' and does not point to objects. Which developmental domain is MOST concerning?
- Fine motor
- Gross motor (Correct answer)
- Language
- Social-adaptive
Correct answer: Gross motor
Walking independently is a 12-month milestone; failure at 15 months signals gross motor delay requiring evaluation.
Question 2: A 3-year-old presents with fever, drooling, and muffled voice. She refuses to move her neck. CT shows a rim-enhancing fluid collection posterior to the pharynx. Most likely organism?
- Staphylococcus aureus (Correct answer)
- Streptococcus pyogenes
- Haemophilus influenzae type b
- Anaerobic mixed flora
Correct answer: Staphylococcus aureus
Retropharyngeal abscesses in children are most commonly caused by Staphylococcus aureus, including MRSA.
Question 3: A 7-year-old with asthma has daytime symptoms 4 days/week, nighttime awakenings 2 nights/week, and uses SABA daily. How is severity classified?
- Intermittent
- Mild persistent
- Moderate persistent (Correct answer)
- Severe persistent
Correct answer: Moderate persistent
Moderate persistent asthma is defined by daily symptoms, nighttime awakenings >1/week, and daily SABA use.
Question 4: A newborn is noted to have a cardiac murmur. Echo shows blood flowing from the aorta to the pulmonary artery. Which structure has failed to close?
- Foramen ovale
- Ductus venosus
- Ductus arteriosus (Correct answer)
- Truncus arteriosus
Correct answer: Ductus arteriosus
Persistent patent ductus arteriosus (PDA) allows left-to-right shunting from the aorta into the pulmonary artery.
Question 5: A 5-year-old boy has painless gross hematuria and a large, non-tender abdominal mass that does not cross the midline. Most likely diagnosis?
- Neuroblastoma
- Wilms tumor (nephroblastoma) (Correct answer)
- Hepatoblastoma
- Rhabdomyosarcoma
Correct answer: Wilms tumor (nephroblastoma)
Wilms tumor presents in young children with a smooth unilateral flank mass and hematuria without crossing the midline.
Question 6: A 10-day-old formula-fed neonate develops bilious vomiting. X-ray shows a 'double bubble' sign. The most likely diagnosis is:
- Pyloric stenosis
- Duodenal atresia (Correct answer)
- Midgut volvulus
- Hirschsprung disease
Correct answer: Duodenal atresia
The double bubble sign (dilated stomach + proximal duodenum) is pathognomonic for duodenal atresia.
Question 7: A 4-year-old presents with periorbital edema, frothy urine, and hypoalbuminemia. Urine dipstick shows 4+ protein with no blood. Most likely diagnosis?
- IgA nephropathy
- Minimal change disease (Correct answer)
- Focal segmental glomerulosclerosis
- Post-streptococcal GN
Correct answer: Minimal change disease
Minimal change disease is the most common cause of nephrotic syndrome in children aged 1–8 and responds to steroids.
NBME Pediatrics 2
A 15-month-old child cannot walk independently, says only 'mama,' and does not point to objects.
Which developmental domain is MOST concerning?