MCQ Quiz: Advanced Topics in Pediatrics

Advanced pediatric pharmacotherapy involves managing complex, chronic, and critical conditions that require specialized knowledge beyond routine care. For PharmD students, mastering these advanced topics is crucial for providing care to the most vulnerable young patients. This quiz will challenge your understanding of complex disease states such as cystic fibrosis and congenital heart disease, as well as specialized areas like neonatal critical care, parenteral nutrition, and the intricacies of IV drug therapy in infants and children. Delve into these advanced scenarios to test your ability to apply complex clinical knowledge to unique pediatric populations, ensuring medication safety and efficacy in high-stakes environments.

1. A 7-year-old patient with cystic fibrosis has a G551D mutation. Which class of medication would be appropriate to treat the underlying cause of their disease?

• a) Pancreatic enzyme replacement therapy
• b) Inhaled tobramycin
• c) CFTR modulators (e.g., ivacaftor)
• d) Inhaled dornase alfa

Answer: c) CFTR modulators (e.g., ivacaftor)

2. When calculating a parenteral nutrition (PN) formula for a neonate, what is the maximum recommended daily dose of intravenous fat emulsion (IVFE) to prevent hypertriglyceridemia?

• a) 1 g/kg/day
• b) 2 g/kg/day
• c) 3 g/kg/day
• d) 4 g/kg/day

Answer: c) 3 g/kg/day

3. A premature infant is diagnosed with a patent ductus arteriosus (PDA). Which of the following medications is commonly used to induce pharmacological closure of the PDA?

• a) Prostaglandin E1
• b) Furosemide
• c) Indomethacin
• d) Alprostadil

Answer: c) Indomethacin

4. A child with refractory epilepsy is being considered for ketogenic diet therapy. What is the pharmacist’s role in this non-pharmacologic treatment?

• a) Prescribing the diet plan.
• b) Ensuring all the patient’s medications (e.g., suspensions, syrups) are low in carbohydrates.
• c) Administering the meals to the patient.
• d) Monitoring the patient’s seizure activity via EEG.

Answer: b) Ensuring all the patient’s medications (e.g., suspensions, syrups) are low in carbohydrates.

5. Which of the following is a significant risk associated with prolonged propylene glycol exposure from IV medications in neonates?

• a) Hypertension
• b) Hyperlactatemia and seizures
• c) Hypoglycemia
• d) Hair loss

Answer: b) Hyperlactatemia and seizures

6. A pediatric patient with Tetralogy of Fallot, a cyanotic congenital heart disease, is undergoing a dental procedure. What is the primary reason they might require antibiotic prophylaxis?

• a) To prevent dental caries.
• b) To prevent a common cold.
• c) To prevent infective endocarditis.
• d) To reduce pain from the procedure.

Answer: c) To prevent infective endocarditis.

7. A child in the pediatric intensive care unit (PICU) is in status epilepticus. After benzodiazepines fail, what is a common second-line agent?

• a) Acetaminophen
• b) Fosphenytoin or levetiracetam
• c) Lorazepam
• d) Ibuprofen

Answer: b) Fosphenytoin or levetiracetam

8. What is the primary purpose of dornase alfa (Pulmozyme®) in the management of cystic fibrosis?

• a) To kill Pseudomonas aeruginosa.
• b) To correct the defective CFTR protein.
• c) To cleave extracellular DNA in sputum, reducing its viscosity.
• d) To treat pancreatic insufficiency.

Answer: c) To cleave extracellular DNA in sputum, reducing its viscosity.

9. A neonate is born to a mother with a history of opioid use and is showing signs of Neonatal Abstinence Syndrome (NAS). Which medication is commonly used to manage the symptoms?

• a) Naloxone
• b) Morphine or methadone
• c) Diazepam
• d) Phenobarbital

Answer: b) Morphine or methadone

10. What is a major challenge when preparing IV medications for pediatric patients compared to adults?

• a) The need for a wider variety of drug classes.
• b) The need for precise, small-volume measurements and dilutions, which increases the risk of error.
• c) Children are more likely to have allergies to IV medications.
• d) There are no significant differences.

Answer: b) The need for precise, small-volume measurements and dilutions, which increases the risk of error.

11. A child with short stature is being treated with somatropin. What is this medication?

• a) A type of insulin.
• b) A recombinant form of human growth hormone.
• c) A thyroid hormone.
• d) A corticosteroid.

Answer: b) A recombinant form of human growth hormone.

12. Inhaled tobramycin for cystic fibrosis is often administered in cycles of:

• a) 7 days on, 7 days off.
• b) 14 days on, 14 days off.
• c) 28 days on, 28 days off.
• d) Continuous daily therapy without breaks.

Answer: c) 28 days on, 28 days off.

13. Kawasaki disease is a vasculitis that primarily affects young children. What is the standard of care for its treatment?

• a) Oral antibiotics and ibuprofen.
• b) Intravenous immunoglobulin (IVIG) and high-dose aspirin.
• c) High-dose corticosteroids alone.
• d) Observation and supportive care only.

Answer: b) Intravenous immunoglobulin (IVIG) and high-dose aspirin.

14. When administering IV medications to a child through a peripheral line, what does “infiltration” mean?

• a) The medication is administered too quickly.
• b) The cannula has dislodged from the vein, and fluid is leaking into the surrounding tissue.
• c) The patient has developed an allergic reaction.
• d) The IV bag has run empty.

Answer: b) The cannula has dislodged from the vein, and fluid is leaking into the surrounding tissue.

15. A child with phenylketonuria (PKU) must follow a special diet that is low in phenylalanine to prevent:

• a) Chronic lung infections.
• b) Severe intellectual disability and neurological problems.
• c) Heart defects.
• d) Kidney failure.

Answer: b) Severe intellectual disability and neurological problems.

16. Prostaglandin E1 (alprostadil) is used in neonates with certain ductal-dependent congenital heart defects for what purpose?

• a) To close the ductus arteriosus.
• b) To keep the ductus arteriosus open until corrective surgery can be performed.
• c) To lower blood pressure.
• d) To treat heart failure.

Answer: b) To keep the ductus arteriosus open until corrective surgery can be performed.

17. What is a “smart pump” in the context of IV infusions?

• a) A pump that automatically selects the correct medication.
• b) An infusion pump with a drug library and dose error reduction software.
• c) A pump that does not require electricity.
• d) A pump that can be controlled by a smartphone app.

Answer: b) An infusion pump with a drug library and dose error reduction software.

18. What is the primary concern with the use of ceftriaxone in neonates, especially if they are hyperbilirubinemic?

• a) It causes severe rash.
• b) It is ineffective in this population.
• c) It can displace bilirubin from albumin, increasing the risk of kernicterus.
• d) It causes permanent hearing loss.

Answer: c) It can displace bilirubin from albumin, increasing the risk of kernicterus.

19. A pediatric patient on long-term corticosteroid therapy should be monitored for which of the following adverse effects?

• a) Accelerated bone growth.
• b) Growth suppression and adrenal insufficiency.
• c) Improved immune function.
• d) Weight loss.

Answer: b) Growth suppression and adrenal insufficiency.

20. Palivizumab (Synagis) is a monoclonal antibody used for the prevention of:

• a) Influenza in all children.
• b) Severe respiratory syncytial virus (RSV) disease in high-risk infants and children.
• c) Otitis media.
• d) Community-acquired pneumonia.

Answer: b) Severe respiratory syncytial virus (RSV) disease in high-risk infants and children.

21. A “vessicant” is an IV medication that can cause:

• a) Mild, localized rash.
• b) A feeling of warmth at the injection site.
• c) Severe tissue damage and necrosis if it extravasates.
• d) A rapid drop in blood pressure.

Answer: c) Severe tissue damage and necrosis if it extravasates.

22. Which of the following is a common sign of digoxin toxicity in an infant?

• a) Hyperactivity
• b) Increased appetite
• c) Vomiting and bradycardia
• d) High fever

Answer: c) Vomiting and bradycardia

23. In pediatric TPN, what is the purpose of adding cysteine to the amino acid solution?

• a) To improve the flavor.
• b) To increase the pH and enhance calcium/phosphate solubility.
• c) It is an essential amino acid for neonates.
• d) Both B and C are correct.

Answer: d) Both B and C are correct.

24. A child with sickle cell disease presents with a vaso-occlusive crisis. The cornerstone of management includes:

• a) Aggressive hydration, analgesia, and sometimes oxygen.
• b) Immediate blood transfusion in all cases.
• c) A course of broad-spectrum antibiotics.
• d) High-dose aspirin.

Answer: a) Aggressive hydration, analgesia, and sometimes oxygen.

25. Which of the following is an example of an advanced topic in pediatric self-care?

• a) Recommending acetaminophen for a fever.
• b) Counseling on the use of a blood glucose meter for a newly diagnosed type 1 diabetic child.
• c) Suggesting a band-aid for a small cut.
• d) Recommending drinking water for dehydration.

Answer: b) Counseling on the use of a blood glucose meter for a newly diagnosed type 1 diabetic child.

26. Which formulation of pancreatic enzymes is designed to release in the more alkaline pH of the small intestine?

• a) Immediate-release tablets
• b) Enteric-coated microspheres or microtablets
• c) Chewable tablets
• d) Oral solution

Answer: b) Enteric-coated microspheres or microtablets

27. A major long-term complication of Kawasaki disease if left untreated is:

• a) Chronic kidney disease.
• b) Coronary artery aneurysms.
• c) Liver failure.
• d) Permanent vision loss.

Answer: b) Coronary artery aneurysms.

28. Why is therapeutic drug monitoring (TDM) particularly important for aminoglycosides in pediatric patients?

• a) To ensure the medication tastes good.
• b) Because they have a wide therapeutic index.
• c) To optimize efficacy while minimizing the risk of nephrotoxicity and ototoxicity.
• d) Because the drug is only given orally.

Answer: c) To optimize efficacy while minimizing the risk of nephrotoxicity and ototoxicity.

29. The initial management of severe sepsis or septic shock in a pediatric patient includes:

• a) Waiting for culture results before starting any treatment.
• b) Aggressive fluid resuscitation and empiric broad-spectrum antibiotics.
• c) Administering an oral antipyretic.
• d) Starting a low-dose vasopressor.

Answer: b) Aggressive fluid resuscitation and empiric broad-spectrum antibiotics.

30. A child with growth hormone deficiency is administered somatropin via which route?

• a) Oral
• b) Intravenous
• c) Transdermal
• d) Subcutaneous

Answer: d) Subcutaneous

31. What is the primary reason for using a filter during the administration of most TPN solutions?

• a) To warm the solution.
• b) To remove air bubbles.
• c) To remove particulate matter and microorganisms, especially to catch calcium/phosphate precipitates.
• d) To slow the infusion rate.

Answer: c) To remove particulate matter and microorganisms, especially to catch calcium/phosphate precipitates.

32. For a child with congenital adrenal hyperplasia (CAH), lifelong treatment with which class of medication is necessary?

• a) Beta-blockers
• b) Diuretics
• c) Corticosteroids
• d) Antibiotics

Answer: c) Corticosteroids

33. The “double-check” system in pediatric pharmacy practice involves:

• a) Two pharmacists checking every prescription.
• b) A pharmacist and a technician both checking the prescription.
• c) An independent verification of a high-risk task (like a dose calculation) by a second qualified individual.
• d) The patient double-checking their own medication.

Answer: c) An independent verification of a high-risk task (like a dose calculation) by a second qualified individual.

34. A child with suspected juvenile idiopathic arthritis (JIA) is most likely to be treated initially with which class of medication?

• a) Opioids
• b) Nonsteroidal anti-inflammatory drugs (NSAIDs)
• c) Acetaminophen
• d) Inhaled corticosteroids

Answer: b) Nonsteroidal anti-inflammatory drugs (NSAIDs)

35. In pediatric patients, the metabolism of caffeine is significantly slower in neonates compared to adults, leading to a much longer half-life. This is due to:

• a) Immature CYP1A2 enzyme activity.
• b) Enhanced renal clearance.
• c) Lower body fat percentage.
• d) Higher protein binding.

Answer: a) Immature CYP1A2 enzyme activity.

36. A child requires an oral liquid formulation of a drug that is only commercially available as a tablet. The process of preparing this liquid is known as:

• a) Reconstitution
• b) Extemporaneous compounding
• c) Titration
• d) Trituration

Answer: b) Extemporaneous compounding

37. Which of the following is a critical counseling point for a family of a child with cystic fibrosis receiving inhaled antibiotics via a nebulizer?

• a) The nebulizer equipment does not need to be cleaned.
• b) The medication should be administered after chest physiotherapy.
• c) The medication can be mixed with other nebulized drugs.
• d) The medication is only used during acute exacerbations.

Answer: b) The medication should be administered after chest physiotherapy.

38. Which of the following is a sign of Persistent Pulmonary Hypertension of the Newborn (PPHN)?

• a) High blood oxygen levels.
• b) Severe cyanosis and respiratory distress.
• c) Low blood pressure.
• d) A loud heart murmur.

Answer: b) Severe cyanosis and respiratory distress.

39. Treatment for PPHN may include which of the following specialized therapies?

• a) Inhaled nitric oxide (iNO)
• b) Oral amoxicillin
• c) Intravenous glucose
• d) High-dose aspirin

Answer: a) Inhaled nitric oxide (iNO)

40. A child with a complex congenital heart defect may be prescribed a diuretic like furosemide to manage:

• a) High blood pressure.
• b) Symptoms of fluid overload and heart failure.
• c) A slow heart rate.
• d) An infection.

Answer: b) Symptoms of fluid overload and heart failure.

41. The use of valproic acid in young children, particularly those under 2, carries a black box warning for:

• a) Severe rash.
• b) Fatal hepatotoxicity.
• c) Aplastic anemia.
• d) Permanent vision loss.

Answer: b) Fatal hepatotoxicity.

42. Why must caution be used when selecting multi-dose vials for use in neonates?

• a) They are more expensive.
• b) They often contain preservatives that can be toxic to neonates.
• c) They are difficult to access.
• d) The drug concentration is too low.

Answer: b) They often contain preservatives that can be toxic to neonates.

43. A pharmacist is reviewing a TPN order for a pediatric patient. Which two components are most likely to precipitate if mixed improperly?

• a) Sodium and potassium
• b) Dextrose and amino acids
• c) Calcium and phosphate
• d) Lipids and electrolytes

Answer: c) Calcium and phosphate

44. A pediatric patient with Crohn’s disease may be treated with which of the following biologic agents?

• a) Insulin
• b) Albuterol
• c) Infliximab
• d) Digoxin

Answer: c) Infliximab

45. What is the primary goal of care for a neonate with Hirschsprung’s disease?

• a) Medical management with laxatives.
• b) Long-term parenteral nutrition.
• c) Surgical resection of the aganglionic segment of the colon.
• d) A gluten-free diet.

Answer: c) Surgical resection of the aganglionic segment of the colon.

46. Which resource is often used by pharmacists to find information on extemporaneous formulations for pediatric patients?

• a) The FDA’s Orange Book
• b) The CDC’s Pink Book
• c) Pediatric & Neonatal Dosage Handbook (Lexicomp)
• d) Goodman & Gilman’s

Answer: c) Pediatric & Neonatal Dosage Handbook (Lexicomp)

47. A child with attention-deficit/hyperactivity disorder (ADHD) is started on methylphenidate. What is an essential role for the pharmacist?

• a) Diagnosing ADHD.
• b) Counseling the family on potential side effects like appetite suppression and monitoring the child’s growth.
• c) Performing psychological testing.
• d) Adjusting the dose without consulting the prescriber.

Answer: b) Counseling the family on potential side effects like appetite suppression and monitoring the child’s growth.

48. A child is receiving chemotherapy and develops febrile neutropenia. This is considered:

• a) A mild, expected side effect.
• b) A medical emergency requiring immediate hospitalization and empiric antibiotics.
• c) A condition that can be managed at home with oral antibiotics.
• d) A sign that the chemotherapy is working well.

Answer: b) A medical emergency requiring immediate hospitalization and empiric antibiotics.

49. Why is it important to use the most concentrated solution available when preparing IV medications for fluid-restricted pediatric patients?

• a) Concentrated solutions are cheaper.
• b) To minimize the total volume of fluid administered.
• c) Concentrated solutions are less likely to cause phlebitis.
• d) It is not important; any concentration can be used.

Answer: b) To minimize the total volume of fluid administered.

50. What is a key difference in the presentation of seizures in neonates compared to older children?

• a) Neonatal seizures are always generalized tonic-clonic events.
• b) Seizures in neonates can be very subtle, such as eye deviation, lip-smacking, or pedaling movements.
• c) Neonates do not experience seizures.
• d) Neonatal seizures do not require treatment.

Answer: b) Seizures in neonates can be very subtle, such as eye deviation, lip-smacking, or pedaling movements.