Pediatric EM Certification Exam Qbank

Pediatric Emergency Medicine

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Questions

Fully reviewed and updated for 2025. Aligned with the American Board of Pediatrics format. Authored & peer-reviewed by fellowship-trained clinicians.

Each question is written to resemble the format and topics on the exam, meaning you won’t see any negatively phrased questions, no “all of the following except,” no “A and B”…you know what we mean. Most importantly, all questions include selective distractors (incorrect answer choices), which will help you think critically.

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Question

A 7-year-old boy presents to the emergency department with a sore throat. His temperature is 38.5°C. The remainder of his vital signs are within the normal ranges. On examination, he appears ill but nontoxic. There is a fine, raised, generalized morbilliform rash mainly over his trunk and upper body with a sandpaper-like feel. Which of the following represents the causative agent for the most likely diagnosis?

A Beta-hemolytic gram-positive cocci in chains

B Beta-hemolytic gram-positive cocci in clusters

C Gram-negative rods

D Non-beta-hemolytic gram-positive cocci in chains

Correct Answer Distractors

This child is presenting with signs and symptoms of scarlet fever, a bacterial infection caused by an erythrogenic toxin produced by Streptococcus pyogenes. This bacteria appears as beta-hemolytic gram-positive cocci in chains and is also known as group A Streptococcus (GAS). Scarlet fever is characterized by a fine, morbilliform rash that feels like sandpaper, accompanied by high fever and a sore throat. This diagnosis does not carry a worse prognosis when compared to streptococcal infections without rash. There is often sparing of the rash around the mouth. Other findings include tongue erythema and hypertrophy of the papillae, known as strawberry tongue, and erythematous lines within the axillae or antecubital fossa, known as Pastia lines. The rash can last 3–5 days, followed by peeling and flaking of the skin.

While this diagnosis is typically made clinically, a rapid streptococcal test should be done, and a throat culture sent if the rapid test is negative, to confirm the infection. Treatment is with IM penicillin or PO amoxicillin, which also prevents the development of rheumatic fever and heart disease.

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Question

What are the major criteria associated with acute rheumatic fever?

Reveal Answer

Scarlet Fever

Streptococcus pyogenes (group A beta-hemolytic Streptococcus)
Sx: sandpaper rash, strawberry tongue, circumoral pallor, Pastia lines (petechiae in skin folds)
Tx: PCN
Complications: poststreptococcal glomerulonephritis, rheumatic fever

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