Pediatric Residency Interview Questions and Answers

Medical Residency Application & Interview Preparation Specialists

Interviews for a Medical Residency in Pediatrics can require a breadth of knowledge and attributes. Here, we present 10 specific questions and answer suitable for candidates to a Peds Medical Residency in the US. These focus in on specialty knowledge – further questions can be found in our Medical Residency Interview Question Bank

Broad Knowledge & The Career

What is the path through residency and into fellowships for paediatric medicine?

After the three years of residency, the majority of fellowships take three years, with some only taking two, and medical genetics taking as much as four years. Subspecialties are varied and include adolescent medicine, paediatric critical care medicine, neonatal medicine, etc. 

What subspecialties are you interested in?

I am particularly interested in paediatric critical care. I believe that the curriculum will suit my interests and strengths; experience in anaesthesia, PICUs, and paediatric CICUs will enable me to work in high-pressure, yet ultimately rewarding, environments, with a range of other professionals. Teamwork and communication skills are vital, yet communication with parents and children remains just as important; I am excited both by the prospect of being able to learn much about general Medicine during my residency – as applied to paediatrics – and then specialising in critical care. I truly cannot think of an area that one can have more of a positive impact in than peds critical care. 

Is there any scientific data that supports vaccines causing autism?

Andrew Wakefield’s initial hypothesis on the MMR vaccine was, in brief, that the measles virus triggered inflammatory lesions in the colon, disrupting its permeability and allowing the passage of neurotoxic proteins, which in turn reached the bloodstream and brain, causing autism. Then followed mainstream coverage, and a widespread push from parents, politicians, and public figures. However, Wakefield’s study was seriously flawed, with conflicting interests, research misconduct, and likely outright lies. The Lancet retracted its publication of the article, and Wakefield was the subject of disciplinary action by the BMA. Since Wakefield, dozens of studies have found that decreasing exposure to MMR did not lead to a correlatory decrease in autism incidence. In fact, despite more parents choosing not to have their children vaccinated, rates of autism continued to rise. As such, the only ‘scientific’ data supporting vaccines causing autism is deeply unscientific.

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Development of the Child

When do the anterior and posterior fontanels close? What do you know about the embryology of the skull?

The fontanelles will ossify completely within 9-18 months after birth. The skull begins to form prior to week 12 of embryogenesis; a cartilaginous mould begins to grow and is then replaced through intramembranous ossification. The roof of the skull will typically grow earlier, whilst the base will grow a little later. The cartilaginous frame will be entirely replaced by bone by week 37, with only the two fontanelles remaining as cartilaginous at that point.

What is involved in a basic newborn screen?

There are various factors involved in a newborn screen. The primary screening is done through a blood test. This involves taking  a blood sample, which is used to screen for inheritable disorders – the blood is obtained within 24-48 hours of birth. A heel-prick is used to take the blood, with this sent for processing. Hearing may be screened through otoacoustic emissions or auditory brainstem response testing. Congenital heart defects are screened using peripheral pulse oximetry.

What are the developmental milestones from 0-2 years?

Some key developmental milestones in this period are as follows (note that there are some more, but this would certainly be a good summary):
– 6 months: stranger anxiety, rolling over, babbling, bringing objects to the mouth
– Nine months: separation anxiety, standing on hands and feet, sitting without support, pincer grasp, understanding no, pointing with a finger, able to say two-syllable words, crawls
– Twelve months: puts out an arm to get dressed, cries when family leave, stands, responds to simple commands, makes gestures, bangs things together
– Eighteen months: pretend play, hugs familiar people, walks alone, can walk up steps, eats with utensils, can say some individual words, can scribble, can point to a body part
– 24 months: plays with other children, kicks a ball, 2-4 word sentences, points to drawings in a book, stacks four or more blocks, can follow 2-step instructions

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DIsease States in Pediatric Patients

How would a child with DKA present?

Typical symptoms of DKA – which may be more or less identifiable by the child depending on age – include palpitations, nausea, vomiting, sweating, leg cramps, and thirst, with associated weight loss. Signs include tachycardia, hypotension, reduced skin turgor, dry mucous membranes, a reduced urine output, altered consciousness, and Kussmaul breathing. There may be a superimposed infection that has triggered the episode, in which case the patient may show signs of infection, e.g. cough, fever. The patient may also be hypothermic or febrile if there is an infectious cause. There may be a ‘fruity’ smell on the breath, indicative of acetone. In severe cases, there may be drowsiness and altered mental state (not unlike a state of drunkenness in an adult).

How would a patient with meningitis typically present? What interventions are used to manage the condition?

The classical presentation of meningitis is a triad of fever, neck stiffness, and altered mental state. However, this is not specific in children. Initial signs and symptoms may be vague, with fever, headache, lethargy, nausea or vomiting, muscle pain, or even diarrhoea and abdominal pain. More specific later indicators include a bulging fontanelle, neck stiffness, Kernig’s sign, Brudzinski’s sign, a non-blanching rash, photophobia, mottled skin, prolonged capillary refill time, shock, and neurological manifestations including seizures.

The approach to management includes supportive treatment (fluids, nutrition, analgesia, antipyretics), treatment of the causative agent, and treatment of complications. All cases are treated as bacterial until proven otherwise – investigations must be conducted before optimal management can be decided, including lumbar puncture. Initial empirical therapy for children is IV ceftriaxone, with IV dexamethasone indicated in some situations (e.g. frankly purulent CSF).

What is the aetiology and pathophysiology of pyloric stenosis? What would you expect to find in the history and on examination of a child with pyloric stenosis?

There is hypertrophy and hyperplasia of the muscle layers in the pylorus, which in turn results in the lumen of the gastric outlet becoming more narrow. The length of the pylorus will also increase. The lumen will then become obstructed, which results in projectile vomiting after feeding (a tell-tale sign of the condition). The exact cause of the condition is unclear, although some evidence suggests a neurogenic cause. From the history, one might learn that the child has been vomiting, with the vomit being non-bilious. The child will typically be 2-6 weeks old. The vomiting may be resulting in weight loss, constipation, lethargy, and failure to thrive. On examination, one might find that the child is dehydrated, thin, hungry, has a palpable pyloric mass in the epigastric region, and has visible gastric peristalsis.

What are the most common etiologies for a UTI in a paediatric patient? How should they be managed?

Most UTIs in children are caused by gram negative coliform bacteria. E Coli accounts for more than 80% of cases, with Klebsiella, Proteus, Enterobacter and Enterococcus also all common causes. Management is with a third generation cephalosporin or amoxicillin-clavulanate. If the child is hemodynamically unstable or immunocompromised, parenteral antibiotic therapy is recommended. 

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