Pediatric Board Review Question - 2 month old boy who had 2 episodes of vomiting over the past 4 days.
Posted by Stuart C. Silverstein, MD, FAAP Author " Laughing Your Way to Passing the Pediatric Boards " ( R) on Mar 22nd 2023
The following Clinical Vignette is an example of the type of question you might face on the Pediatric Boards or the MOCA Peds quarterly module for the Maintenance of Certification.
Read the clinical scenario first and answer the questions before scrolling down for the answer. In addition to the answers we provide a method for breaking down the question to its components where they keys to answering the question can be found.
If you apply this method on the exam or the MOCA module you will increase your chances of successfully choosing the correct answer every time !
Today's vignette is about a 2 month old infant with 2 episodes of vomiting over the past 4 days !
This case is excerpted from our Clinical Vignettes series
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How to Analyze a Pediatric Board Multiple Choice Question Systematically
Analyzing and breaking the questions down to their components systematically will be important, especially for questions you are not quite sure about. In this case, they note that the vomitting is forceful and projectile which might mislead you to believe the correct answer is pyloric stenosis. However, on the boards , whenever something is in " quotes" and as reported by ( parent or grandparent) you can be sure , it is an attempt to mislead you to the incorrect answer.
You will either be told a child is afebrile or you will be provided with a temperature denoting the same. Regardless either make a mental note, or write down " afebrile" which will usually r/o and infectious etiology. They are also describing what be a seizure, leading you to think about meningitis. However again the patient is afebrile.
The infant is arching his back which should lead you to write down " dystonic reaction " . They note that rectal diazepam does not stop the dystonic reaction, making a bonafide seizure the incorrect choice.
Now that the question is broken down you can see how easy it can be to see the correct answers clearly and not get diverted by red herrings and other diversions.
And Now Here are the Correct Answers and Explanations 
