100+ Free AOBP Pediatrics Practice Questions

General Pediatrics & Preventive Care

Well-child care visits per Bright Futures (newborn, 3-5 days, 2 weeks, 1/2/4/6/9/12/15/18/24 months, then annual). Growth monitoring (WHO 0-2 years, CDC ≥2 years). Developmental milestones (CDC 'Learn the Signs Act Early'). AAP/ACIP routine immunization schedule (DTaP, IPV, Hib, PCV20 or PCV15+PPSV23, RV, HepB, MMR at 12-15 months, varicella, HepA, HPV starting at 9-12 years (catchup through 26), Tdap at 11-12, MenACWY at 11-12 with booster at 16, MenB shared decision-making, influenza annually, COVID-19 per current ACIP, RSV prevention -- nirsevimab for infants <8 mo entering RSV season or maternal RSV vaccine 32-36 weeks). Anticipatory guidance (car seats, swimming, firearms, sleep safety, screen time). Screening -- lead, vision and hearing, M-CHAT-R/F autism at 18 and 24 months. Child abuse and abusive head trauma identification (subdural hematomas of varying ages, retinal hemorrhages -- mandatory CPS report). SIDS prevention (supine sleep, firm flat surface, room-share without bed-sharing). Adolescent confidentiality framework.

Infectious Diseases

Common pediatric infections: AOM (high-dose amoxicillin 80-90 mg/kg/day BID first-line; cefdinir/clindamycin alternatives; watchful waiting for ≥2 yr non-severe unilateral disease per AAP). Croup (dexamethasone + nebulized racemic epinephrine; steeple sign). Bronchiolitis (RSV -- supportive care per AAP; AVOID routine bronchodilators/steroids/antibiotics/chest PT; nirsevimab and maternal RSV vaccine for prevention). Pertussis (paroxysmal cough, whoop, post-tussive vomiting; macrolide; PEP for close contacts). Viral exanthems (measles -- Koplik spots + 3 Cs, public health report; roseola HHV-6/7; fifth disease parvovirus B19 'slapped cheek'; varicella; HFM Coxsackie A16). Kawasaki disease (IVIG 2 g/kg + high-dose aspirin; echo at diagnosis and 6-8 weeks). Bacterial meningitis (vancomycin + ceftriaxone; dexamethasone for H. influenzae). Septic arthritis (surgical drainage + IV antibiotics). Neonatal sepsis (≤28 days -- FULL workup + ampicillin + gentamicin/cefotaxime). Pediatric UTI (per AAP imaging guidelines). Congenital infections TORCH (toxoplasmosis, rubella, CMV, herpes, syphilis). Primary immunodeficiencies: SCID (newborn TREC screen, urgent referral, stem cell transplant), XLA (recurrent encapsulated bacterial after 6 months, IVIG), DiGeorge, hyper-IgE.

Neonatology & Newborn Care

Newborn nursery (APGAR, neonatal exam, vitamin K, ophthalmic erythromycin, HepB-1, hearing screen, congenital heart screen, newborn metabolic and TREC SCID screen). Transient tachypnea of newborn (resolves 24-48 hours). RDS in preterm (surfactant). Bronchopulmonary dysplasia (BPD). Necrotizing enterocolitis (NEC -- pneumatosis intestinalis, NPO + IV antibiotics + surgical consult). IVH grading (head US). ROP screening in preterm. Neonatal jaundice (AAP nomogram for phototherapy and exchange transfusion thresholds by gestational age, hours, and risk). Neonatal sepsis (GBS, E. coli, Listeria; ampicillin + gentamicin/cefotaxime). CHD presentations -- cyanotic (TGA 'egg on a string', ToF 'boot-shaped heart' and 'tet spells', tricuspid atresia, TAPVR, truncus -- start PGE1 for ductal-dependent), acyanotic (VSD, ASD, PDA -- pharmacologic closure with indomethacin/ibuprofen in preterm; transcatheter device closure). Hyperoxia test (cyanotic CHD if no improvement on 100% O2). Neonatal abstinence syndrome (NAS -- Finnegan scoring, morphine/methadone). Polycythemia (Hct >65-70% with symptoms -- partial exchange transfusion). Neonatal surgical conditions -- duodenal atresia ('double bubble', Down syndrome), malrotation with midgut volvulus ('corkscrew' UGI series, surgical emergency), pyloric stenosis (4-6 weeks projectile vomiting, olive mass, hypokalemic hypochloremic metabolic alkalosis -- pyloromyotomy after fluid correction), Hirschsprung (failure to pass meconium, rectal biopsy diagnostic).

Cardiology

Congenital heart disease anatomy and physiology. Acyanotic: VSD (most common; small VSDs often close spontaneously), ASD (fixed split S2), PDA (continuous machine-like murmur; indomethacin/ibuprofen in preterm; device closure if persistent), coarctation of aorta (BP discrepancy upper vs lower extremities; Turner syndrome association). Cyanotic: TGA (presents day 1 with cyanosis not responsive to O2; PGE1, balloon atrial septostomy, arterial switch), tetralogy of Fallot (RVOT obstruction, VSD, overriding aorta, RVH; 'tet spells' managed with knee-chest, O2, morphine, fluids, phenylephrine), tricuspid atresia, TAPVR ('snowman' sign), truncus arteriosus, hypoplastic left heart. Innocent murmurs (Still murmur, venous hum). Pathologic murmurs require evaluation. Kawasaki disease coronary involvement (Z-score ≥2.5 -- IVIG + aspirin; long-term follow-up). Rheumatic fever (Jones criteria -- major: migratory polyarthritis, carditis, chorea, erythema marginatum, subcutaneous nodules; minor: fever, arthralgia, elevated ESR/CRP, prolonged PR; evidence of preceding GAS). Hypertrophic cardiomyopathy (most common cause of SCD in young athletes; echo for screening; HCM Risk-SCD score for ICD). Arrhythmias (SVT -- vagal maneuvers then adenosine; LQTS; WPW). Pediatric hypertension (AAP 2017 percentile-based by age/sex/height). 14-element AHA sports preparticipation screening.

Pulmonology & Allergy

Asthma per GINA pediatric -- daily low-dose ICS first-line for persistent disease; SABA + low-dose ICS for intermittent; ICS/LABA for moderate; biologics for severe (omalizumab anti-IgE allergic ≥6 years; mepolizumab anti-IL-5 ≥6 with eosinophilic; dupilumab anti-IL-4Rα ≥6; benralizumab/tezepelumab ≥12). Cystic fibrosis (sweat chloride >60; CFTR modulators -- ELEXACAFTOR/TEZACAFTOR/IVACAFTOR (Trikafta) for ≥2 years with F508del has transformed care; pancreatic enzyme replacement; airway clearance; multidisciplinary CF center). Bronchiolitis (RSV peaks fall-spring; AAP -- supportive care, AVOID routine bronchodilators/steroids/antibiotics; admit for severe distress/hypoxia/dehydration; nirsevimab and maternal RSV vaccine for prevention). Pediatric pneumonia (CAP -- amoxicillin first-line per AAP for typical bacterial; macrolide for atypical). Pertussis (whooping cough; macrolide; vaccinate with Tdap during pregnancy 27-36 weeks). Allergic rhinitis (intranasal corticosteroid most effective). Anaphylaxis (epinephrine IM 0.01 mg/kg lateral thigh; max 0.3 mg pediatric, 0.5 mg adult; biphasic reactions; auto-injectors). Atopic dermatitis (emollients, topical steroids, topical calcineurin inhibitors; dupilumab for moderate-severe). Food allergy -- LEAP and EAT studies support EARLY introduction of allergens (peanut at 4-6 months in high-risk infants reduces allergy by 80%).

Gastroenterology

Functional constipation (PEG 3350 Miralax for disimpaction and maintenance; behavioral; high fiber). Hirschsprung disease (failure to pass meconium <48 hours, chronic constipation, empty rectal vault with explosive 'squirt sign', contrast enema transition zone, rectal suction biopsy ABSENT ganglion cells, surgical pull-through). Pyloric stenosis (4-6 weeks projectile non-bilious vomiting, olive mass, hypokalemic hypochloremic metabolic alkalosis; US confirms; pyloromyotomy after fluid/electrolyte correction). Intussusception (age 3 months-3 years; paroxysmal pain, currant jelly stools, sausage-shaped mass, US target/donut sign; air enema reduction ~85-90% success). Meckel diverticulum ('Rule of 2s', painless lower GI bleeding; Tc-99m pertechnetate scan). Malrotation with midgut volvulus (bilious vomiting in neonate -- SURGICAL EMERGENCY; UGI corkscrew sign; Ladd procedure). Celiac disease (tTG-IgA + total IgA; upper endoscopy with duodenal biopsy; gluten-free diet for life). Pediatric IBD -- Crohn (EEN exclusive enteral nutrition first-line for induction in pediatrics, immunomodulators, anti-TNF biologics infliximab/adalimumab, anti-IL-12/23 ustekinumab/risankizumab); UC (mesalamine 5-ASA first-line, step-up to steroids and biologics). Physiologic GER in infants (conservative management; AVOID PPIs without complications). Infantile colic ('Rule of 3s' -- >3 hr/day, >3 days/week, >3 weeks in well infant; parental support, soothing). Abdominal pain (functional vs organic; appendicitis diagnostic US/laparoscopic appendectomy).

Endocrinology

Type 1 diabetes mellitus (autoimmune insulin deficiency; presents with polyuria, polydipsia, weight loss; A1c <7% goal; insulin basal-bolus 0.5 U/kg/day total; CGM and pump therapy increasingly standard). DKA in children (hyperglycemia + ketones + acidosis pH <7.3; IV NS, then insulin drip 0.05-0.1 U/kg/h after K replete; cautious K replacement; monitor closely for CEREBRAL EDEMA -- pediatric-specific risk, mannitol or hypertonic saline if suspected). Type 2 diabetes (rising in adolescents with obesity; metformin first-line; lifestyle). Congenital adrenal hyperplasia (21-hydroxylase deficiency most common; classic ambiguous genitalia in female newborns, salt-wasting; elevated 17-OHP; treatment hydrocortisone + fludrocortisone with stress dosing; non-classic presents in adolescence with hyperandrogenism). Hashimoto thyroiditis (acquired primary hypothyroidism; levothyroxine; anti-TPO antibodies). Congenital hypothyroidism (newborn screen; levothyroxine ASAP to prevent intellectual disability). Turner syndrome (45,X; short stature, webbed neck, shield chest, bicuspid AV/coarctation; GH for short stature, estrogen for puberty induction; routine surveillance). Klinefelter (47,XXY). Complete androgen insensitivity syndrome (CAIS, 46,XY female phenotype, blind vagina, no axillary/pubic hair). Precocious puberty (before age 8 girls/9 boys; MRI brain; GnRH analog -- leuprolide depot, histrelin implant). Adolescent PCOS (hyperandrogenism + irregular menses; lifestyle, metformin, OCPs).

Hematology & Oncology

Iron-deficiency anemia (most common pediatric anemia; supplementation; screen at 12 months). B12 deficiency. Hemolytic anemia (G6PD deficiency, hereditary spherocytosis). Sickle cell disease (HbSS): penicillin prophylaxis from 2 months to age 5 (functional asplenia/pneumococcal sepsis prevention); pneumococcal vaccines (PCV20, PPSV23) and meningococcal; hydroxyurea starting at 9 months (BABY HUG); folate; multidisciplinary care; manage acute crises (vaso-occlusive, acute chest syndrome -- transfusion, antibiotics, oxygen; splenic sequestration -- urgent transfusion; aplastic -- parvovirus B19, supportive). ITP (isolated thrombocytopenia, often post-viral; observation if mild, steroids/IVIG for active bleeding). Hemophilia A (factor VIII deficiency; prophylactic factor VIII or emicizumab bispecific antibody; avoid IM injections and NSAIDs). HUS (Shiga toxin-producing E. coli O157:H7 -- supportive care; AVOID ANTIBIOTICS in typical HUS as they may worsen disease; eculizumab for atypical HUS). HSP/IgA vasculitis (palpable purpura lower extremities, arthritis, abdominal pain, renal involvement; supportive +/- steroids; monitor renal long-term). Pediatric oncology: ALL (B-cell most common; multi-agent COG chemotherapy with risk stratification; CNS prophylaxis intrathecal methotrexate; 85% cure; CAR-T for relapsed); AML (induction or HMA + venetoclax); Wilms tumor (nephroblastoma, age 2-5, abdominal mass); neuroblastoma (most common extracranial solid tumor, abdominal/adrenal mass, urine VMA/HVA); medulloblastoma (most common malignant brain tumor, posterior fossa); Hodgkin lymphoma (adolescents; ABVD/AHOD; >90% cure); rhabdomyosarcoma. Febrile neutropenia (medical emergency -- broad-spectrum IV antibiotics within 60 minutes).

Rheumatology & Immunology

Juvenile idiopathic arthritis (JIA, age <16, >=6 weeks): oligoarticular (≤4 joints, ANA+ associated with asymptomatic uveitis -- slit lamp every 3 months screening; NSAIDs and intra-articular steroid injections first-line); polyarticular (≥5 joints; RF+ resembles adult RA -- methotrexate first-line, biologics anti-TNF/IL-6/JAK); systemic (Still disease -- fever, evanescent rash, hepatosplenomegaly, MAS macrophage activation syndrome; anti-IL-1/IL-6 biologics); enthesitis-related; psoriatic. Pediatric SLE (ACR/EULAR criteria; lupus nephritis common; hydroxychloroquine baseline; immunosuppression for organ involvement -- mycophenolate, cyclophosphamide, rituximab, voclosporin, belimumab, anifrolumab). HSP (IgA vasculitis -- discussed in heme). Dermatomyositis (proximal muscle weakness, heliotrope rash, Gottron papules, elevated CK; high-dose steroids + immunomodulators). Vasculitis -- Kawasaki, polyarteritis nodosa, ANCA-associated, Takayasu. Primary immunodeficiencies (discussed in ID): SCID newborn screen, XLA Bruton, DiGeorge, hyper-IgE Job, CVID, complement deficiencies, chronic granulomatous disease. Langerhans cell histiocytosis.

Neurology

Febrile seizures (simple: ≤15 min, generalized, single in 24 hours, normal neuro exam, age 6 mo-5 yr; AAP -- routine LP NOT indicated in well-appearing >12 months without meningitis signs; routine EEG/MRI NOT indicated; no chronic anticonvulsant; complex: >15 min, focal, or recurrent in 24 hours -- consider further workup if any concerning features). West syndrome (infantile spasms, onset 3-12 months; triad of spasms + hypsarrhythmia on EEG + developmental regression; ACTH IM, oral high-dose corticosteroid, vigabatrin first-line for tuberous sclerosis; pediatric neurology). Absence epilepsy (3 Hz generalized spike-wave on EEG; ethosuximide first-line). Benign rolandic epilepsy. Migraine. Cerebral palsy (multidisciplinary; PT/OT, intrathecal baclofen for spasticity, botulinum toxin). Concussion (gradual return-to-play protocol). Abusive head trauma (mandatory reporting). Guillain-Barré syndrome (ascending weakness, areflexia, CSF albuminocytologic dissociation; IVIG or PLEX; monitor respiratory, autonomic; ICU if severe). Cerebellar ataxia. Posterior fossa tumors (medulloblastoma -- morning headache, vomiting, ataxia, papilledema). Neonatal seizures (different etiology and treatment than adults).

Nephrology

Post-streptococcal glomerulonephritis (PSGN): nephritic syndrome (hematuria, RBC casts, hypertension, proteinuria, edema) 1-3 weeks after GAS pharyngitis or skin infection; elevated ASO/anti-DNase B titer; LOW C3; supportive care (BP control with CCB or ACEi/ARB, fluid/sodium restriction); usually self-resolves with C3 normalization in 6-8 weeks. Minimal change disease (most common cause of pediatric nephrotic syndrome ~80%; bland urinary sediment, selective proteinuria; EMPIRIC PREDNISONE 60 mg/m2/day for 4-6 weeks; biopsy NOT routinely required in initial presentation; steroid-resistant warrants biopsy for FSGS or other diagnoses). FSGS (more common in adolescents and African-American; steroid-dependent or resistant; calcineurin inhibitors). HSP nephritis (monitor with UA/BP/creatinine). Pediatric UTI per AAP 2011 (reaffirmed): oral antibiotics (cephalexin, TMP-SMX, amoxicillin-clavulanate per local sensitivities) for uncomplicated; renal/bladder US for all febrile UTIs in 2-24 months; VCUG only for recurrent UTI or specific findings (abnormal US, atypical UTI). Pediatric hypertension (AAP 2017 percentile-based BP for age/sex/height; >=95th percentile).

Developmental-Behavioral & Adolescent Medicine

Developmental milestones (CDC ages 2 mo to 5 years -- 'Learn the Signs Act Early'). Autism spectrum disorder: M-CHAT-R/F at 18 and 24 months for autism screening (positive screen -- refer for comprehensive evaluation and early intervention services); diagnosis by DSM-5 criteria; treatment -- applied behavioral analysis (ABA), speech therapy, OT; risperidone and aripiprazole FDA-approved for irritability/aggression associated with autism (start low, monitor metabolic). ADHD per AAP 2019: behavioral parent training first-line under age 6; behavioral therapy + stimulants (methylphenidate, amphetamine classes) first-line 6-12; non-stimulants atomoxetine, guanfacine ER, clonidine ER. Speech and language delay (refer for SLP evaluation and early intervention). Eating disorders -- anorexia nervosa (inpatient medical stabilization if bradycardia, hypotension, electrolytes; cautious refeeding to prevent refeeding syndrome -- hypophosphatemia/hypokalemia/hypomagnesemia; family-based therapy Maudsley first-line for adolescents); bulimia (fluoxetine FDA-approved); ARFID. Adolescent depression (fluoxetine and escitalopram FDA-approved -- start low, monitor for suicidality first 4 weeks, FDA boxed warning; combined with CBT or IPT per TADS). Self-harm/NSSI (non-judgmental assessment; refer for mental health; DBT effective). Bipolar disorder. Adolescent confidentiality (state-specific; sensitive services -- sexual/reproductive, mental health, substance use; mandatory reporting if abuse, imminent safety risk). Adolescent sexual health -- LARC + condom dual protection; HPV vaccination starting at age 9-12 (2-dose series if <15); HIV/STI screening; PrEP for high-risk; emergency contraception. Substance use (CRAFFT screening; SUD treatment).

Osteopathic Principles & Practice (OMM)

Four tenets of osteopathic medicine applied to pediatric care: (1) body is a unit; (2) self-regulatory mechanisms; (3) structure-function reciprocal interrelationship; (4) rational treatment based on these. Pediatric OMT considerations: use gentle, age-appropriate techniques; indirect techniques (counterstrain, BLT, FPR), myofascial release, and cranial-respiratory motion are preferred over HVLA in young children; gentle articulatory techniques are also appropriate. Pediatric applications: otitis media with effusion (Galbreath mandibular drainage, Muncie intra-oral, suboccipital release, lymphatic techniques -- may improve eustachian tube function); constipation (visceral techniques); colic (myofascial release, suboccipital decompression); post-respiratory infections (lymphatic pump, rib raising, thoracic inlet release); somatic dysfunction. Contraindications -- HVLA in acute fracture, severe osteoporosis (rare in peds), malignancy at site, active infection at site. OMT integrates with standard evidence-based pediatric care; never replaces antibiotics or other indicated therapies.