PNP Exam Questions

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Achondroplasia refers to a growth delay that is: A. Due to malabsorption B. Associated with Noonan syndrome C. Associated with endocrine disorders D. Manifested by disproportionately short stature

Families of children with congenital adrenal hyperplasia must be educated about: A. The self limiting aspect of the disorder B. The need for genetic counseling C. Dietary restrictions D. The need for strict replacement therapy

A four-year-old child with a history of myelomeningocele and ventriculoperitonesl shunt presents to the clinic with a headache, nausea, vomiting, and lethargy. The most probable diagnosis is: A: Viral gastroenteritis B: Shunt malfunction C. Meningitis D: Shunt infection

A child presents with a flattened philtrum, then upper lip, micrognathia, strabismus, and a ventricular septal defect. What is the most likely diagnosis? A. Congenital toxoplasmosis B. Congenital syphilis C. Fetal alcohol syndrome D. Edwards syndrome

A six-year-old child has +4 reflexes, toe walking, and a clumsy gate. Which of the following diagnostic testing would be helpful in making a diagnosis of cerebral palsy? A. Skull x-ray B. CT of the head C. MRI of the head D. MRI of the lumbar sacral spine

A five month old boy, a former 28 week Premature infant, is being evaluated in your practice because of a concern about delayed development. In formulating the differential diagnosis, you keep in mind that spastic cerebral palsy is characterized by: A: Increased deep tendon reflexes and sustained clonus B: Dystonic posturing C: Abnormal involuntary movements D: nystagmus

A five-year-old girl presents for a school physical with a complaint of hyperactivity, A mild developmental delay, aversion of gaze, hand mannerism, a long thin face with a slightly dysmorphic ear. What is the most likely diagnosis? A. Fragile X B. Turner's syndrome C. Fetal alcohol syndrome D. Williams syndrome

A macular, salmon to red colored rash with irregular borders and central clearing is typical of which of the following? A: Systemic juvenile arthritis B: Lyme disease C: Systemic lupus erythematosus D: rheumatic fever

A newborn presents with microcephaly, low-set ears, prominent occiput, micrognathia, heart murmur, and clenched hands with overriding fingers and crossed thumb. What is the best diagnostic test? A. Karyotype B. Amino acid urine screen C. Newborn screening D. Methylation rest

A two month old child presents after an episode of sepsis for a follow-up visit. He has gained 2 pounds since birth and has a decrease in head circumference from the 50th to the 25th percentile. In addition, he has and inguinal and axillary adenopathy of 1 cm, decrease in head, and has hepatomegaly. Which of the following is included in the infectious disease differential? A. Herpes simplex type 2 infection B. Human immunodeficiency virus infection C. Chlamydia infection D. Congenital gonorrhea

And 11-year-old girl presents at a well child visit with symptoms of polyuria and polydipsia. Which of the following diagnoses must be ruled out A. Diabetes mellitus B. Hyperthyroidism C. Adrenalcortical insufficiency D. Nephrotic syndrome

In a child with suspected meningitis, Lumbar puncture should be delayed and a CT scan obtained first in which of the following circumstances? A. There are signs of increased ICP B. The child has tachycardia C. The child has a negative brudzinski D. The WBC is > 10,000/mm3

In working with a child with Tourette syndrome and his family, the nurse practitioner should be aware that: A. Symptoms become more unpredictable during adolescence B. Boys are more likely than girls to exhibit behavioral problems such as obsessive compulsive disorder C. Sleep disturbance from tics increases with age D. There are several medications now available to control the tics without interfering with daily functioning

Mrs. C has brought her two-year-old daughter April to the clinic with complaints of anorexia and irritability for the past several weeks. You know that she is afebrile And appears pale. Based on the signs and symptoms, which initial action is appropriate? A. Ask Mrs. C to describe April's diet, including the specific foods she's eating, prior to the onset of the symptoms B. Prescribe supplemental iron therapy to be given three times a day C. Order laboratory work to assess red blood cell count and indices D. Referrer April to a pediatrician for further evaluation

Primary dysmenorrhea is due to: A. Elevated prostaglandin levels B. Pelvic inflammatory disease C. Endometriosis D. Fibroids

Primary immunization is of paramount importance for preventing meningitis especially in young children that is caused by: A. Hib B. Neisseria meningitidis C. E. Coli D. Klebsiella pneumonia

Routine lab studies have revealed that a two-year-old child has a decreased level of serum ferritin. Red cell count and indices are within normal limits for age. Based on this information, you may assume that the child: A. May have stage I iron deficiency anemia B. Likely has stage II iron deficiency anemia C. Likely has stage III iron deficiency anemia D. Does not have any stage of anemia

Systematically develop statements to assist practitioner and patient about appropriate care for specific clinical outcomes are called: A. Clinical practice guideline B. Benchmarking C. Protocol requirements D. Written collaborative agreement

The mobilization , monitoring, and control of resources used by a patient over the course of an illness is called: A. Case management B. Quality improvement C. Quality assurance D. Risk management

The mother of a well-developed, full-term three week old boy brings him to the clinic because he has been fussy and not eating well for the past week. A CBC reveals that he is anemic. When exploring the etiology of the anemia, is important to know that which of the following is not a common cause of anemia in the newborn? A. Dietary iron deficiency B. Blood loss C. Hemolysis D. Decreased RBC production

The pathophysiology of type one diabetes is: A. Autoimmune destruction of the pancreatic beta cells B. Primary insulin receptor resistance C. Increased hepatic glucose production D. Reduce glucose uptake by target tissue

The routine screening of a newborn in your practice indicates that the baby has congenital hypothyroidism and is in need of a referral to a pediatric endocrinologist. The treatment of choice for congenital acquired hypothyroidism is: A. Levothyroxine B. Propylthiouracil C. Potassium iodide D. Radiation therapy

Upon examination of a two-month-old boy, you noticed a swelling in the right inguinal canal. Your differential diagnosis would not include: A. Diastasis recti B. Hydrocele of the spermatic cord C. Inguinal hernia D. Lymphadenopathy

When lab results reveal hypochromic, microcytic anemia in a two-year-old child, differential diagnosis must include: A. Lead poisoning B. Pernicious anemia C. Hemophilia D. Folic acid deficiency

Which of the following is a measure of childhood intelligence? A. Wechsler scales B. Denver II C. Bayley scales D. Vineland scakes

Which of the following is a nontreponemal test for syphilis? A. Venereal disease research laboratory microscopic slide test B. Fluorescent treponemal antibody absorbed C. Treponema pallium particle agglutination D. TORCH titer

Which of the following is an absolute contraindication for use of combined hormonal contraceptives and adolescent women: A. Hx of thromboembolism B. Diabetes C. Smokes 5 cigarettes per day D. Sickle cell dz

Which of the following is not true with regard to hypospadias? A. The meatus is formed along the dorsum of the penis B. It is one of the most common penile abnormalities C. Circumcision should be deferred D. A referral for an endocrine evaluation may be indicated

Which of the following is the primary diagnostic tool used in the evaluation of seizure disorder? A: EEG B: Cerebral blood flow studies C: CT scan D: MRI

Which of the following is true with regard to advance practice licensure? A. It is granted by some states based on specialty certification B. It will guarantee reimbursement C. It may be obtained on a national basis D. It is a federal process verifying that a PNP has met standards for specialty practice

Which of the following signs is not characteristic of generalized seizures? A: Unilateral motor manifestations B: disturbance of consciousness C: tonic stiffening of the trunk D: Simultaneous and symmetric cerebral hemisphere discharge

While evaluating the CBC results of a three-year-old child, the practitioner notes that in addition to hypochromia and microcytosis of the red cell, there are many poikilocytes and target cells. Based on this finding, differential diagnoses must include: A. Thalassemia major B. Iron deficiency anemia C. Pernicious anemia D. Vitamin B 12 deficiency

You have prescribed iron supplements for a three-year-old child. When instructing the parents about how to give the iron preparation, it is important to tell them that iron: A. Is best absorbed on an empty stomach B. Is best absorbed when given with meals C. Is the best absorbed when given with milk D. Should not be given near bedtime

Which of the following signs or symptoms is not associated with congenital adrenal hyperplasia: A. Hypernatremia B. Progressive weight loss C. Dehydration D. Hyperkalemia

A ( Hyponatremia is a sign of CAH as there is excess of sodium loss through the kidneys and an inability to maintain serum electrolyte balance)

TC who is three years of age presents with a history of fever for the past several days pain in his left leg and refusal to bear weight on the left leg. 10 days ago he fell from a slide and bruised his leg his WBC count is slightly elevated. You suspect either toxic synovitis or osteomyelitis. Which finding supports a diagnosis of osteomyelitis more so than toxic synovitis? A: Recent injury B: leg pain C: Non-weight bearing D: elevated white blood count

A (Osteomyelitis is associated with local trauma wild toxic synovitis is associated with recebt upper respiratory illness)

A 2 and a half year-old child presents with macrocephaly, developmental delay, course facial features, large tongue, kyphosis, hip dislocation, tonsillar and adenoidal hypertrophy and hepatomegaly. She is receiving early intervention services without improvement. What is the next best step? A. Referral to genetics for further evaluation B. Follow up in three months C. Reassure the parents D. Follow up in six months

A (This child has many of the signs of Hurler's syndrome. Given the lack of progress in early intervention and the physical assessment findings a referral to genetics will be the best approach in this child)

Payment by capitation means that: A. Financial risk is shifted from payers to providers B. Care is provided on a fee-for-service basis C. Care resources are rationed D. Target populations have unlimited access to healthcare

A (and capitation providers are responsible for target population which they receive an age-and gender-adjusted budget)

A foul-smelling vaginal discharge that emits a fishy odor when combined with 10% potassium hydroxide is most likely due to: A. Gardnerella vaginalis B. Candida albicans C. Chlamydia trachomatis D. N. Gonorrhoeae

A (bacterial vaginosis, often caused by an overgrowth of GV, is suspected on the basis of malodorous vaginal discharge and positive "whiff" test when mixing the discharge w/ potassium hydroxide.)

Tonya, at five years of age, has sickle cell disease. To decrease the risk of vaso-occlusive crisis, it is important to stress which of the following to Tonya and her parents? A. The need for frequent handwashing B. The need for a diet high in iron C. Avoidance of the use of mothballs in the house D. Limitation of milk intake to one glass a day

A (vaso-occlusive crisis is usually associated with infection, dehydration, acidosis or exposure to cold)

Jay is a nine-year-old boy who has had no significant health problems by history, but his mother is very concerned because he's wetting himself. As you begin your history and physical exam, you keep in mind that the most common type of in enuresis in school age children is: A. Primary nocturnal enuresis B. Occasional daytime enuresis C. Secondary nocturnal enuresis D. Primary diurnal enuresis

A [Primary nocturnal enuresis occurs and 90% of enuretic children (For example they are wet only at night during sleep and have never had a sustained period of dryness)]

Which of the following is the most helpful in confirming a diagnosis of chlamydia pneumoniae in a one-month-old child with a cough? A. Chest chest x-ray showing lobar consolidation B. Decrease serum immunoglobulins C. Lymphocytosis D. Mother with no prenatal care

While examining a four-month-old boy you are unable to palpate one of the testes. The next most appropriate step is to: A. Reassure the parents that this is a normal finding B. Refer the child to an endocrinologist C. Reexamine the baby in two months D. Refer the child to a urologist

While taking the history of 6-month old E.M. you learn that she is not sleeping through the night and will not fall back to sleep without the parents rocking or feeding her. This is an example of: a. somnambulism b. pavor nocturnus c. learned behavior d. delayed sleep phase

Which of the following signs is not scored in the Glasgow coma scale? A. Eye opening B. Verbal response C. Upper limb response D. Fine motor responses

A two-year-old girl has lymphedema of the hands and foot, with a lower posterior hairline, cubitus valgus, and a history of intrauterine growth retardation. Which of the following defects is most common among the children with this genetic syndrome? A. Aortic valve stenosis B. Coarctation of the aorta C. Mitral valve prolapse D. Dissecting aortic aneurysm

A 10-year-old boy comes to your clinic for evaluation of a suspected urinary tract infection (UTI). Which of the following signs would lead you to include diagnoses other than UTI in the differential? A. Increased frequency B. Penile discharge C. Costovertebral tenderness D. Dysuria

A 12-year-old girl presents to your clinic with symptoms of vaginitis, including older, dysuria, frequency, and discomfort. Which of the following causes of vaginitis is most likely due to sexual transmission? A. Candida B. Chlamydia C. Pinworms D. Gardnerella

A 17-year-old, sexually active girl with chancres in the genital area is noted to have a positive venereal disease research laboratory test. The next step should be to: A. Treat w/ ceftriaxone B. Perform a specific treponemal anti-body test C. Culture for c. Trachomatis D. Discuss saber sex practices

According to the consensus model for APRN regulation, which of the following is most consistent with the definition of advanced practice registered nursing? A. Optional national certification B. A significant component of education and practice focuses on direct care of individuals C. Accountability excludes prescription pharmacological and nonpharmacological interventions D. Level of rolled autonomy is unchanged

H.O. is a 5 yo Vietnamese child who has fallen off of his growth curve. The best intervention would be to: a. Suggest high-calorie breakfast drinks as supplements b. incorporate traditional foods into a management plan that will provide increased calories and nutrients c. educate the family on the need for increased calories and nutrients d. refer the family to growth clinic for evaluation

In most states, a learning disability is defined based on: A. The child's IQ as determined by a psychological evaluation B. A discrepancy between the child's actual and expected achievement C. A diagnosis of attention deficits D. Achievement test scores

Infants with IUGR are prone to hypoglycemia primarily because they: A. Have a decreased metabolic rate B. Have little glucose stores in the form of glycogen and fats C. Become acidotic D. Are prone to sepsis

Mr. Harris calls the pediatric clinic to say that Josh, his 2-year-old son, has tripped on the sidewalk and hit his head on concrete.Which of the following symptoms reported by Mr. Harris would require that Josh be seen in the emergency room? A. Uncontrollable crying B. Loss of consciousness C. Scalp laceration D. Hx of febrile sz

The PNP is teaching high school students about prevention of iron deficiency anemia. To teach prevention of the most common cause of iron deficiency in this age group, it is important to emphasize: A. Avoidance of all aspirin containing products B. A Diet high in iron rich foods C. Avoidance of ingestion of carbonated beverages D. Avoidance of high fiber foods

Treatment of true (central) precocious puberty is best achieved with: A. Synthetic follicular stimulating hormone B. Gonadotropin releasing hormone C. Dexamethasone D. Thyroid hormone

Which chromosomal abnormality is associated with short stature and girls? A. Down syndrome B. Turner syndrome C. Klinefelter's syndrome D. Prader-Willi syndrome

Which of the following is found more commonly in children with a meningomyelocele? A. Congenital heart disease B. Latex allergy C. Intestinal malformations D. Cleft palate

Which of the following is the purpose of certification? A. To review and approve educational degree programs in nursing B. To assure the public that an individual has mastered a body of knowledge and acquired skills in a particular body of knowledge C. All of the above D. None of the above

An 18-year-old college freshman is seen in the student clinic with a complaint of migraine headaches. In collecting the history, you would expect him to say he experiences pain: A. Throughout his head without any localization B. Restricted to one side of his head during an episode C. Mostly in the occipital area D. Across his head from one temporal side to another

B (After puberty, migraine headache pain is restricted to one side of the head but may switch sides from one headache episode to another)

Which of the following suggests internal tibial torsion rather than internal femoral torsion in a two-year-old child presenting with an in -toeing gate? A: sitting in "w" position B: knees face forward when walking C: Generalized ligament laxity D: Limited external rotation of hip

B (The patella will rotate in word if the problem is above the knee)

The differential diagnosis of dysfunctional uterine bleeding includes all but which of the following? A. Pregnancy-related disorders B. Anemia C. Foreign body D. Endometriosis

B (anemia is considered to be a complication of dysfunctional uterine bleeding rather than a part of the differential diagnosis)

Dan is a healthy 17-year-old student. He's thinking about having sex, but asks for more information about condoms. You give him all of the following advice except: A. Male condoms are the more effective barrier method B. Latex condoms are the most recommended and are heat tolerant C. Condoms have a theoretical failure rate of 3% D. It is only safe to use water-based lubricant with latex condoms

B (heat can cause latex condoms to break down)

A nine month old child of Jewish parents presents with increasing irritability and noise sensitivity. What is the next best step? A. Encourage mom to decrease environmental stimuli B. Refer to a pediatrician C. Refer for further developmental screening D. Reevaluate at the 12 month examination

B (tay-Sachs disease is seen in families of Jewish descent and is characterized by degenerative CNS signs and hyperreaction to noise. A consultation with the pediatrician is indicated due to the possibility of Tay-Sachs disease)

It is important to look for evidence of a preceding streptococcal infection when ruling out acute nephritis. This is best done by: A. Throat culture B. Skim exam C. ASO titer D. ESR

C (ASO a tighter is elevated and 80% of patients with a preceding streptococcal infection)

A 12 month old, whose parents have a history of noncompliance for routine care, presents to the clinic with fever, irritability, and nuchal rigidity. The most critical diagnostic step in the child with suspected meningitis is: A. The hx B. The physical exam C. Evaluation of the CSF D. blood cx

A 15yo girl, who had menarche at 13, complains of monthly menstrual pain on the first day of her periods for 1 yr. she has never been sexually active. Which of the following is not a characteristic of dysmenorrhea? A. Increase production of uterine prostaglandins Be. Pain usually starts within hours of menstrual flow or may proceed followed by up to two days C. Anovulatory cycles D. Crampy, spasmodic pain in the lower abdominal area, which might radiate to inner thighs

A PNP may obtain certification from the PNCB and which other association? A. American college of nurse practitioners B. American Academy of nurse practitioners C. American nurses credentialing center D. American nurses Association

A child in your clinic is being evaluated for short stature. Pertinent findings include delayed bone age, delayed onset of puberty, and a stature that is normal for the child's bone age. In addition, the mother states that the child's father grew taller in college and wonders if this will happen with their son. The most likely cause of these findings is: A. Familial short stature B. Chromosomal abnormality C. Constitutional delay of growth and puberty D. Endocrine abnormality

A social worker brings a child in prior to placement with a chief complaint of copious vaginal discharge. A culture is positive for chlamydia. From the social perspective what is the next best step? A. Reassure the social worker that this is a prenatal transmission B. Tell the social worker the results and allow her to decide the next step C. Tell the social worker the result and inform her of the likelihood of sexual abuse D. Call the foster family with the result

Amanda is a six month old infant recovering from a viral illness. At the peak of her illness two days ago, she spiked a temperature of 104 and experienced a febrile seizure. Amanda's mother is young and Inexperienced, but is very open to teaching. She wants to know if the seizure will do anything to Amanda. While teaching this new mother about simple febrile seizures , it would be accurate to say that Amanda: A: is at increased risk for epilepsy as an adult B: Would benefit from Phenytyoin prophylaxis C: May experience repeated seizures D. Would benefit from phenobarbital prophylaxis

An apparently healthy child, who is enrolled in Headstart, is suspected of having developmental delays based on Denver II results at two separate clinic visits. The most appropriate next step would be to: A: Request developmental Evaluation from the head start program B: Repeat the Denver II in six months C: Refer the child for a more definitive evaluation D. Discussed ways in which parents can foster the child's development

Carol is a 16-year-old adolescent who has been sexually active with a male partner for six months. They have use condoms consistently. Cara is interested in a hormonal method as well. Your advice includes all of the following except: A. Combined oral contraceptives prevent ovulation B. Trans dermal contraceptive patches must be correctly applied and the site rotated C. The vaginal contraceptive ring must be changed weekly D. Long-acting progestins might cause weight gain

During the first well baby visit of Joshua, two weeks old, his mother says that she is concerned because his penis looks different from his three-year-old brothers penis. During the physical exam, you notice that the baby scrotum is hyperpigmented. The PNP knows that the most common cause of ambiguous genitalia is: A. Idiopathic B. A chromosomal defect C. Congenital adrenal hyperplasia D. An embryologic disorder

For children with diabetes, in addition to home monitoring of blood glucose and urine ketone levels, glycosylated hemoglobin (Hgb A1c) should be measured every: A. 1 wk B. 1 mos C. 3 mos D. 6 mos

In documenting quality care, patient satisfaction is considered to be what type of measure? A. Structural B. Process C. Outcome D. Cost containment

Michael is a 15-year-old high school student who presents for a school sports physical. He appears to be in good health, but is concerned about a bad headache he had a few weeks ago. He is concerned because his mother's friend died of a brain tumor. You tell Michael that the most common type of headache with onset in adolescence is: A. Sinus headache B. Vascular headache C. Tension headache D. Migraine headache

One month after prescribing iron therapy to treat iron deficiency in a child who has no other known health problems, the PNP should: A. Teach the parent or guardian about iron rich foods B. Check the child's stool for occult blood C. Order a hemoglobin measurements D. Order a complete blood count

Political activism through lobbying is an example of what type of change strategy? A. Normative reeducative B. Empirical rational C. Power-coercive D. Confrontational

Prescriptive writing privileges: A. Require a formal collaborative relationship with a physician B. Are regulated by both boards of nursing and medicine C. Very according to state statutes D. Are granted upon certification

The early and periodic screening, diagnostic, and treatment (EPSDT) program describes a comprehensive set of healthcare services as provided by: A. Private insurance B. State child protection teams C. Medicaid D. Most managed care organizations

The granting of authority to practice is known as: A. Credentialing B. Accreditation C. Licensure D. Regulation

The most common bacterial cause of a sexually transmitted infection is: A. Neisseria gonorrhoeae B. Trichinomas vaginalis C. Chlamydia trachomatis D. Herpes simplex

The most important lab test to be performed when a UTI is suspected in a school-age child is a: A. CBC with differential B. Urine dipstick C. Clean catch urine for U/A and C/S D. Voiding cystourethrogram

The mother of a 14-year-old girl indicates to you that she is concerned because the girl has not yet started to menstruate. The history is noncontributory and the physical exam is normal. Breast development and pubic hair have been present for 12 months the most appropriate initial step would be to: A. Do a pregnancy test B. Obtain a Buccal smear for chromosomal analysis C. Reassure, educate the family, and follow up D. Draw LH and FSH levels

Tonya, at five years of age, has sickle cell disease. Tonya's mother has brought her to the clinic because she has had fever of 101 for the past two days and her appetite has been poor. Physical exam reveals no apparent cause for the fever. Appropriate treatment includes: A. Acetaminophen for fever and reevaluating Tonya in 24 hours B. Ibuprofen for fever and reevaluating Tonya and 24 hours C. Inpatient or outpatient antibiotic therapy D. No treatment unless the fever is above 102

Which anticipatory guidance would be helpful in decreasing the risk of toxoplasmosis? A. When camping, treat water from streams with iodine B. Do not go barefoot in high-risk areas C. Wash hands after changing cat litter D. Avoid handling contaminated diapers

Which method might be used to assess the vision of a 1 mos old child? a. check the vessel pattern of the fundus of the eye b. watch to see if the infant turns his or her head toward you when you speak c. observe the pattern of interaction with the mother d. perform the titmus test on the infant

Which of the following physical exam findings is a major criterion for identifying a patient with Marfan syndrome? A. Freshfield spots B. Shield test with widely spaced nipples C. Pectus excavatum requiring surgery D. Large testicles

Coach Jones asks for advice on how to prevent little league elbow (epicondylitis) in his eight and nine-year-old players. Which of the following would be an incorrect advice? A: have each child pitch only three innings B: limit or eliminate curveballs C: Use ice massage before and after pitching D: Conduct slow warm-ups

C (LLE results from reptitive Forearm supination and pronation. Therefore the goal is to prevent injury by reducing the repetitive motion. Ice falsely reassures parents or coaches that the injury can be prevented by applying the before and after pitching)

Which of the following is not true about the use of Imipramine for the treatment of enuresis? A. It is not generally recommended for this nonfatal disorder due to the potentially lethal side effects B. The lasting cure rate is approximately 17% C. Imipramine should only be given to children who have had a baseline EEG D. The most appropriate imipramine treatment group is adolescent boys with both ADHD and persistent nocturnal enuresis

C (Use is controversial due to dangerous side effects and it's relative ineffectiveness, and EEG is not recommended prior to initiating treatment)

You examine CJ in the newborn nursery and know what a deformity in her left foot consisting of a convex lateral border and a forefoot, which can be abducted past and imaginary line extending from the middle of the heel through the second toe. Which of the following management strategies is most appropriate? A: reverse last shoes B: Out flare shoes C: Stretching exercises D: Orthopedic referral

C (metatarsus adductus Is a Flexural deformity of the foot related most commonly to intrauterine positioning; Flexural deformities, that is, movement past the midline, can be managed with stretching exercises)

You receive the results of newborn screening and find that the TSH, done at day two, is 82. What is your best option? A. Have the child come to the clinic next week for a reevaluation B. Rescreen the child in one month C. Begin thyroid supplementation immediately D. Reassure the family that these are normal results

C (tsh >20)

You are following a four-year-old girl and your practice with a history of breast development that appeared 12 months ago and appears to be progressing. She is growing rapidly. The PNP considers ordering a bone age because she knows that most cases of premature thelarche in girls are: A. A result of enzymatic defects B. Due to systemic CNS disease C. Idiopathic D. A result of hypothyroidism

C. (Sexual precocity is idiopathic in 80% of girls however the PNP should refer the child to pediatric endocrine to evaluate for advancing bone age and progressive clinical signs since some children require treatment)

An 11 month old African-American boy has just started walking and is found to have severely bowed legs. In the history, you learn that he is exclusively breast-fed with very little other food intake. You must consider: A. Trauma B. Developmental variation C. Chromosomal abnormality D. Rickets

An adolescent boy presents to the clinic with a painless mass in the left side of his scrotum. The most likely diagnosis is: A. Epididymitis B. Testicular torsion C. Incarcerated hernia D. Hydrocele

A two year old child evaluated in the emergency department for a closed head injury following a 10 foot fall from an open window. When interpreting diagnostic imaging results, you are aware that the most common and generally the least serious type of skull fracture is: A. Basilar fracture B. compound fx C. Depressed fx D. Linear fx

A 10-year-old boy comes to your clinic for evaluation of a suspected urinary tract infection (UTI). The culture indicates sensitivity to trimethoprim/sulfa. The boys treated with this antibiotic for 10 days. The most appropriate follow-up in this case would include: A. Obtaining a urinalysis in two weeks B. Instructing the parents that the child should return to the clinic if symptoms persist C. Teaching parents home monitoring with nitrate sticks D. Referring the child for renal ultrasound

A 12-year-old girl presents to your clinic with symptoms of vaginitis, including odor, dysuria, frequency, and discomfort. Upon further history, physical examination, and laboratory screening, the girl is diagnosed with Candida albicans vaginitis. Appropriate treatment would include: A. Avoiding bubble baths B. Topical acyclovir C. Ceftriaxone D. Clotrimazole

A labial adhesion extending from the posterior fourchette to the clitoris is noted during the routine assessment of a four-year-old girl. There is no history of difficulty voiding, dysuria, or discomfort. The most appropriate initial management is to: A. Recommend mechanical lysis using petrolatum appointment B. Prescribe a topical application of estrogen cream C. Refer to a GU specialist D. Reassure parents that no specific treatment is needed at this time

Jackson was born at 34 weeks gestation. He is now 10 weeks old and his mother has brought him to your office for a routine exam. He appears alert and will develop. His mother tells you that he takes 2 to 4 ounces of formula every 2 to 4 hours around the clock. The plan for Jackson should include which of the following? A. Initiation of rice cereal at bedtime B. Addition of two bottles of water each day next line C. Encouraging Jackson's mother to limit his feedings to every four to 6 D. Prescribing Ferrous sulfate to be administered three times a day

Main goal of continuous quality improvement is to: A. Incorporate norms, criteria, and standards as evaluative measures B. Emphasize outcome measures in addition to structure and process C. Promote evaluation based on peer review, audits, and chart reviews D. Inform that quality assurance is more than a periodic evaluation of performance

Managed-care plans may be certified by which of the following? A. Centers for Medicare and Medicaid services B. Department of health and human services C. National Institutes of Health D. National committee for quality assurance

Mrs. B has brought 5 yo Julio to the clinic. She reports that he has been lethargic and has been running a low-grade fever for about two weeks. Physical exam reveals no significant findings other than pallor and lymphadenopathy. A CBC reveals a decreased hematocrit, neutropenia, and thrombocytopenia. The practitioners next action should be to: A. Prescribe a broad spectrum antibiotic and ferrous sulfate B. Instruct Mrs. B on the appropriate use of Acetaminophen to treat Julio's fever C. Reassure Mrs. B that Julio's signs and symptoms are indicative of a viral infection D. Refer Julio to a pediatric hematologist/oncologist for further evaluation

Mrs. S has brought her toddler to the clinic for an immunization update. While talking to her, you learn that they live in an old building that has been under renovation for the past two months. Based on this information, you should first assess the child for: A. Asbestosis B. Coccidioidomycosis C. Mold allergy D. Lead poisoning

Mrs. W has brought her one-year-old baby to the clinic for well baby exam. She is pregnant with her second child and is concerned about possible risks to the fetus because she has gestational class a diabetes. Which of the following conditions is the fetus not at risk for? A. Congenital anomalies B. Hypoglycemia C. Birth trauma D. Congenital hearing loss

Patients with acute nephrotic syndrome may present with all but which of the following signs. A. Edema B. HTN C. Dark amber colored urine D. History of weight loss

Scope of practice statements: A. Are prepared by national professional organizations B. Provide the basis for reimbursement policies C. Are written by employers D. May vary from state to state

The most common type of brain tumor in children is: A. Ependymoma B. Brain stem tumor C. Craniopharyngioma D. Medulloblastoma

The mother of an 11-year-old boy is concerned that her son is developing secondary sexual characteristics too early. Your counseling for the family is based on the knowledge that puberty is considered precocious in boys if secondary sexual characteristics appear prior to age: A. 12 B. 11 C. 10 D. 9

There are several skin features seen with the tuberous sclerosis. Which of the following is more characteristic? A. Café au lait spots B. Blue or purple striae C. Papules in a "Christmas tree" pattern D. Hypopigmented macules in an "ash leaf" shape

To establish a diagnosis of sickle cell disease, which lab test is appropriate? A. CBC with RBC indices B. Sickle cell prep C. Sickledex D. Hemoglobin electrophoresis

To prevent complications of sickle cell disease during the ages three months to five years, daily doses of which medication should be prescribed prophylactically? A. Baby aspirin B. Acetaminophen C. Diphenhydramine D. Penicillin

Tonya, at five years of age, has sickle cell disease. Tonya's mother tells you that she is upset because Tonya sometimes wets the bed. A urinalysis reveals no significant findings. After review of the pathophysiology of sickle cell and vaso-occlusive crisis with her, which of the following should you tell the mother? A. To limit Tonya's fluids after dinner and especially before bedtime B. To keep reminding Tonya than most girls her age to not with the bed C. To wait Tonya in the middle of the night and take her to the bathroom D. To encourage Tonya to drink fluids and put a waterproof covering on her bed

Upon physical examination of a 4 yo boy, you note seven café Au last spots > than 5 mm in diameter. This finding maybe indicative of: A. Tuberous sclerosis B. Sturge-Weber dz C. Duchenne's dystrophy D. Neurofibromatosis

What congenital infection can present with snuffles, lymphadenopathy, pseudoparalysis of Parrot , CNS abnormalities, and low birth weight? A. Cytomegalovirus B. Rubella C. Toxoplasmosis D. Syphillis

What hormone needs replacement in adolescents with Klinefelter's syndrome? A. Thyroid hormone B. Growth hormone C. Estrogen D. Testosterone

What physical exam finding distinguishes a new born with congenital toxoplasmosis from a new born with congenital cytomegalovirus? A. Jaundice B microcephaly C. Cerebral calcification D. Petechial rash

When planning screening protocols, it is important for the practitioner to know that iron deficiency anemia is most common in which life period(s)? A. The first month of life B. The period when the child is most sedentary C. The preschool years D. Periods of rapid growth

Which of the following historic points would not alert the practitioner to the possibility of a brain tumor? A. Headache in the morning with associated w/ vomiting B. Failure to thrive and developmental delay in young children C. School failure and personality changes in older children D. Sleep apnea

Which of the following is a risk factor for adolescent pregnancy? A. Good grades in school B. Asks for contraceptive at the school health clinic C. Plans to study nursing in college D. Unsure if monogamous partner uses condoms

Which of the following statements is not true with regard to primary nocturnal enuresis? A. There is often a positive family history of enuresis B. It appears to be related to maturation delay C. Some nighttime wetters stop wetting without any form of treatment D. The incidence is higher in girls than in boys

Which of the following would not be an appropriate indicator for developmental dysplasia of the hip in a six month old child? A: Allis sign B: skinfold symmetry C: galeazzi sign D: ortolani maneuver

You are evaluating a 13-year-old girl for graves disease. Which of the following signs would not support this diagnosis? A. An enlarged thyroid B. Exophthalmos C. A positive family history D. An elevated TSH level

You have ordered red blood cell indices for a 10-year-old girl. Results reveal a decrease in both the mean corpuscular hemoglobin MCH and the mean corpuscular volume MCV. Differential diagnosis should include: A. Sickle cell anemia B. Vitamin B 12 deficiency anemia C. Pernicious anemia D. Iron deficiency anemia

After treating a two-year-old for iron deficiency anemia, lab test show that his hemoglobin level has returned to normal. Which of the following actions is appropriate? A. Discontinue iron therapy and recheck his hemoglobin level in one month B. Discontinue iron therapy and tell the child's mother to reinitiate therapy if she notices any pallor C. Continue iron therapy and to all the medicine at home is gone D. Continue iron therapy for 2 to 3 months

D ( to replenish the body's iron stores)

Which of the following screenings is done annually on a four-year-old child with down syndrome? A. Cervical spine B. Urinalysis C. Celiac screening D. Thyroid screening

D (Children with down syndrome or at great risk for thyroid disease and leukemia)

A three year old boy with known G6PD deficiency has acute purulent otitis media. Which of the following drugs should not be used for his treatment? A. Amoxicillin B. Amoxicillin - clavulanate C. Erythromycin D. Trimethoprim/sulfa

D (sulfa drugs precipitate hemolysis) patients with G6PD)

A 14 yo adolescent has been dx with mononucleosis. The PNP should teach the adolescent and the parents that which of the following should be avoided? a. strenuous exercise if the spleen is palpable b. wt-bearing activities until lab test show resolution of the dz c. unnecessary activity until lymph nodes return to normal size d. stretching and reaching activities during the acute stage of illness

A 17yo girl is referred to your clinic by the school nurse to be assessed for an eating disorder. Which of the following dynamics is not characteristic of anorexia nervosa? a. excessive eating followed by purging b. a pervasive sense of helplessness and ineffectiveness c. wt loss that gives the patient a sense of mastery and control d. low body temp, pulse, and bp

A 3 wk old infant has a 1 day hx of irritability pallor and poor feeding. He is afebrile. On physical exam, his HR is 240 bpm while asleep. The most likely dx is: a. supraventricular tachycardia b. premature ventricular contractions c. sinus tachycardia d. cyanotic heart defect

A NICU graduate with bronchopulmonary dysplasia (BPD) has been discharged to home. A potential problem area that requires close monitoring is: a. insufficient caloric intake b. atrophy of abdominal muscles due to abdominal breathing patterns c. lack of tactile stimuli due to restrictions on parental handling d. the predisposition to development of nasal polyps

A tenderness is detected over the tibial tuberosity of a 10 year old boy during a routine exam at a school based clinic. The PNP knows this may be a sign of: a. osgood-schlatter dz b. blount's dz c. plantar fasciitis d. effusion in the joint space

AW, at 3 days old, presents with vomiting, abd distention, and constipation. Which of the following should be included in the diff dx? a. hirschsprung dz b. pyloric stenosis c. celiac dz d. meckel diverticulum

Adolescents who engage in risky behavior, such as driving without a seat belt, are displaying: a. a type of egocentrism b. a need for independence c. role experimentation d. low self-esteem

An adolescent is being evaluated for childhood depression. Which behavior or sign is least likely to be evident? a. evidence of hallucinations and delusions b. a history of recurrent "accidents" c. a sense of guilt d. the presence of eating disorders

An essential test in the evaluation of a 2yo child being managed for Kawasaki dx is : a. an echocardiogram b. electrolytes c. cholesterol d. streptoccoccal antibody titer

Assessment of the red reflex may be used to rule out which of the following: a. opacities b. myopia or hyperopia c. decreased visual acuity d. blindness

Brent, a 22 mos old, has been brought to the clinic by his mother who says he has been coughing for 2 days and is now making a funny noise when he breathes. Examination reveals a fussy child with a brassy cough and inspiratory stridor. Lips and nail beds are pink. Axillary temp is 103F and RR is 50 bpm. The most likely diagnosis of Brent's condition is: a. laryngotracheobronchitis b. brochiolitis c. respiratory distress syndrome d. reactive airway disease

DJ is a 4 yo AA child with a depigmented macular lesion on his forehead. The lesion has sharp borders. No scales are present. The most appropriate treatment would be: a. 1% hydrocortisone b. alpha hydroxy acid c. ketoconazole d. silver sulfadiazine

DM, 7 yo, presents with a beefy red macular-papular rash on the diaper area with satellite lesions on the abdomen. the appropriate treatment would be: a. clotrimazole b. A & D ointment c. gentian violet 1 to 2 % d. cornstarch

During a check up of a 15 mos old girl, you note that the child has dropped significantly in percentile for weight over the past few months. In evaluating a child with failure to thrive, the most important part of you assessment involves: a. the history b. the physical exam c. laboratory studies d. observation of family interactions

Following an episode of meningitis, it is most important to assess the child for: a: hearing loss b. changes in taste c. cervical lymphadenopathy d. tinnitus

Following tympanostomy tube insertion, it is important that the tubes remain patent. Which of the following methods may by used to determine patency? a. visual inspection b. impedance tympanometry c. valsalva maneuver d. instillation of an ototopical suspension

HB is 2 days old. Her mother calls and reports a rash consisting of redness with yellow-white "bumps" all over her body except for the palms and soles. The infant most likely has: a. erythema toxicum b. transient neonatal pustular melanosis c. molluscum contagiosum d. milia

In infants, the lesions associated with atopic dermatitis are most likely to be distributed on the: a. cheeks and forehead b. wrists and ankles c. antecubital and popliteal fossae d. flexural surfaces

In mild to moderate attacks of acute asthma, albuterol should be given every 3 to 4 hrs and routine medications should be: a. continued as usual b. discontinued until albuterol treatments are deemed unnecessary c. given only if the albuterol is ineffective d. be decreased to the minimum recommended dose

Initial management of a 4 yo, overweight boy with a repeat total cholesterol level of 185 md/dl includes all of the following excepts: a. educate the family about decreasing saturated fat intake to less than 7% of calories and cholesterol intake to less that 200mg per day b. blood sent for lipoprotien analysis c. educate the family about decreasing/eliminating daily intake of fruit juices, sugar-sweetened food and beverages, and salt intake d. educate the family about increasing aerobic activities

Initial treatment for a child with uncomplicated infectious mono should include: a. home care with bed rest progressing to activity as tolerated b. home care with complete bed rest until afebrile c. hospitalization with complete bed rest until lab values return to normal d. hospitalization with daily, planned physical therapy

JV, 7 yo, presents with a 1 wk hx of fever, nausea, and anorexia. His mother reports that his skin "looks funny" as well. Further lab studies confirm a dx of viral hepatitis. which type of hepatitis is the most likely? a. A b. b c. C d. D

Management of the infant with suspected heart dz and a reported cyanotic spell should include: a. prompt referral to a cardiolgist b. an apnea monitor for 30 days to document further events c. instructing the parent to keep a diary of these episodes d. continuous administation of oxygen

Marie, at 4 years old, has been brought to the clinic bc she " has something wrong with her eye." Marie and her mother report that there has been no injury to the eye and that it has been red since yesterday. Exam reveals conjuntival hyperemia and a copious amount of purulent discharge bilaterally. Vision, pupilary reflexes, and corneal clarity are normal. Which treatment should be ordered? a. sodium sulfacetamide ophthalmic solution b. gentamycin ophth sol c. tobramycin ophth sol d. cromolyn sodium ophth sol

Mrs. S has brought 10 day old Jacob to the clinic bc she is concerned about his breathing. She says that while she is feeding the baby, he often stops breathing for periods of about 10 secs. History reveals that Jacob eats well, has never appeared pale or cyanotic, and has never become limp during any of the apnea episodes. Your management plan is based on which of the following? a. this is a normal breathing pattern for an infant b. these episodes likely indicate aspiration of formula and should be evaluated c. a variety of pathologic processes are associated with the episodes described d. neurologic deficits in infants are often manifested by such episodes

Premature infants should receive routine immunizations based on: a. chronological age b. gestational age c. birth wt d. current wt

RD, at 14 years of age, presents with a c/o abd pain that has occurred several times over the past 3 mos. She describes the pain as an intermittent sharp pain, occasionally relieved with a heating pad. Her physical exam is WNLs. You suspect recurrent abd pain (RAP). Which clinical finding is most consistent with RAP? a. periumbilical pain b. constipation c. pain worsens with defecation d. wt loss

T.T. is a 9 week old preterm infant whose birth wt was 2.3 kg. Mom was HBs Ag Neg. He is seen today for the first time since discharge from the nursery. He has received no prior immunizations. The appropriate immunizations to give at this time would be: a. Dtap, Hib, IPV, rotavirus, HepB 1, pneumo b. Dtap, Hib, OPV, rotavirus, HepB 1 c. Dtap, Hib, rotavirus, IPV, pneumo d. Dtap, Hib, IPV, pneumo

The most useful test for evaluation of suspected acute rheumatic fever is: a. antistreptolysin-O (ASO) titer b. electrocardiogram c. hemoglobin electophoresis d. urinalysis

The mother of 2yo Heather has brought her to the clinic with a "bad cough". Hx reveals onset of illness 4 days ago with clear rhinorrhea and coughing. Her mother says that Heather's fever has been as high 103 axillary. Physical exam reveals a temp of 101F and RR of 56 bpm, w/ slight nasal flaring and intercostal, subcostal, and suprasternal retractions. The pharynx is red without tonsillar exudate. Chest auscultation reveals widespread rales and wheezing. The lips and nail beds are slightly pale but pink, skin turgor is good and mucous membranes are moist. The most likely diagnosis of Heather's condition is: a. viral pneumonia b. pneumococcal pneumo c. strep pneumo d. Hib pneumo

The mother of 2yo Shanda has brought her to the clinic bc she thinks the child is having trouble hearing. Your evaluation of the compliant should start with: a. asking detailed questions related to Shanda's medical history b. examination of the ear c. tympanometry and hearing tests d. assuring the mother that transient hearing loss in childhood is common

The mother of 4 yo TW states that the infant has been irritable and has not been sleeping well. During the physical exam, you note papular lesions on his feet and erythematous papules over his back. Having confirmed the dx of scabies in TW, the treatment of choice would be: a. permethrin 5% b. lindane 1% c. sulfur oitment 6% d. crotamiton 10%

The mother of 7 yo Bob has brought him to the clinic bc he has a rash. Physcial exam reveals vesicles on the hands, feet and in the mouth. Hand, foot and mouth dz is diagnosed. Treatment is based on: a. alleviating symptoms b. eradication of causative bacteria c. prevention of febrile convulsions d. prevention of secondary infections

The mother of 8 yo John telephones to tell you that he developed chicken pox 3 days ago. She wants to know if there is anything she can do to make him more comfortable. You should tell his mother to: a. apply topical calamine lotion b. apply a topical antibiotic to the new vesicles c. give aspirin for fever and discomfort d. keep John our of bright light

Tracy, who is 9 yo, complains that she does not like to wear shorts bc her knees look funny. Upon exam you note a genu valgum angle of > than 15 degees. You should: a. reevaluate in one year if still presnt b. consult with an orthopedic specialist c. instruct her to avoid the "W" sitting position d. encourage exercise to strengthen quadriceps

Which of the following does not place an infant at increased risk for sudden infant death syndrome? a. documented episodes of periodic breathing b. prematurity c. severe bronchopulmonary dysplasia d. apnea of prematurity

Which of the following would not be included in the management of pinworms? a. nutritional support and iron supplementation b. simultaneous treatment of all family members c. washing bed linen in hot water d. keeping fingernails short and clean

While conducting the Denver II developmental screening test, the mother of an 18 mos old child reports to you that the toddler doesn't imitate activities. You decide to assess the child's development further by giving him tasks from which sector? a. personal-social b. fine motor-adaptive c. language d. gross motor

While examining 7yo SRs scalp you note three small patches of hair loss. Broken hair is present, as is erythema and scaling. Based on this information, which of the following dx is most likely? a. tinea capitis b. traction alopecia c. trichotillomania d. alopecia areata

While listening to 2.5 yo KL talk, you note that she frequently omits final consonants and her sentences are two and three words in length. The appropriate plan of care would be. a. routine follow up at next well child visit b. referring for hearing screening c. assessing for developmental delays d. referring to a speech pathologist

You are performing a physical exam on a 12 yo boy who is planning to go to summer camp in a primitive wooded area. What teaching is appropriate for the prevention of Rocky Mountain spotted fever? a. inspect the body several times a day and remove ticks immediately b. inspect the skin while taking a shower and apply soap to ticks before removing c. ticks should be removed only after they have been killed with alcohol d. tick removal should be performed by a healthcare professional

You have been treating 14-month-old JV for torticollis since birth. The condition has not resolved. The appropriate management plan would be to: A: referral for surgical consultation B: Continue with passive range of motion C: provide environmental stimulation opposite the contracture D: apply cervical collar at night

Growth in muscle length is related to growth in length of: a. underlying bone b. underlying ligament c. underlying tendon d. opposing muscle group

a (growth in muscles is d/t the ROM muscle has to perform as underlying bone lengthens)

Which of the following factors most affects outcomes of patients with LCPD (legg claves perthe dz)? a. age b. severity of pain and antalgic gait c. family hx of LCPD d. bilateral involvment

a (younger children have more time to remodel)

A 1 wk old infant has been diagnosed with nasolacrimal duct obstruction. A typical initial therapy includes: a. use of prophylactic oral antibiotics b. nasolacrimal sac massage c. surgical opening of obstructed ducts d. referral to an ophthalmologist

A 12 yo girl seen at a routine visit has a bp of 145/90. She denies any symptoms. The initial management would include: a. intravenous pyelogram b. return for two repeat blood pressure measurements c. no f/u needed--blood pressure probably related to anxiety d. diuretic therapy

A 16 yo boy has been dx with measles (rubeola). He is also c/o ear pain. His tympanic membranes are red and bulging. Appropriate mgmt of the ear problem is to treat the ears with: a. pain medication until the virus has run its course b. the same med used to treat any case of otitis media c. liquid topical antibiotics and topical steroids d. acyclovir given by mouth

A 4yo caucasian female presents for a well-child check. Her bp by auscultation is 135/80. There is no significant family hx of HTN or heart dz. Besides wanting to repeat the bp for accuracy, what are potential differential diagnoses for this child? a. severe coronary artery dz b. renal artery stenosis and coarctation of the aorta c. rheumatic fever and ventricular septal defect d. tetralogy of fallot and coarctation of the aorta

A 9 yo boy presents with a fever of 102 and complains of leg pains. His mother reports that he had an URI with a sore throat approximately 2 wks ago which subsided without therapy. On physical exam, he has tender swollen knees bilaterally. His heart rate is 120/min and a blowing systolic murmur is heard at the apex that was not noted on previous visits. The most likely diagnosis is: a. kawasaki dz b. rheumatic fever c. sickle cell anemia d. viral infection

A child with growing pains is most likely to experience: a. mild limp b. bilateral lower extremity pain c. lower extremity pain primarily during the day d. lower extremity pain associated with decreased ROM

A mother of an 8 month old infant asks you for advice about continued introduction of solids. Which of the following food groups do you recommend be introduce to the baby last? a. egg yolk b. egg white c. fruits d. vegetables

A vibratory systolic murmur is heard between the lower left sternal border and the apex in a healthy 4yo girl at her preschool physical. There are no concerns from the parent. The cardiovascular exam is otherwise normal. A likely diagnosis: a. venous hum b. still's murmur c. transposition of the great arteries d. rheumatic heart disease

An injury at which of the following sites will most likely result in a bone length discrepancy? a. diaphysis b. epiphysis c. medullary cavity d. metaphysis

At 12 yo, Peter has been dx with constitutional growth delay. Appropriate management would include: a. starting low-dose testosterone therapy now b. counseling regarding delayed onset of puberty c. thyroxine replacement d. nutritional counseling

BW, at 6 years of age, c/o sharp epigastric pain radiating to his back. Which labatory data would be consistent with these physical signs? a. decreased albumin b. elevated serum amylase c. elevated serum gastrin d. decreased serum protein

Chest pain in young children is usually: a. a symptom of congenital heart disease b. noncardiac in origin c. an early sign of hypercholesterolemia d. a symptom of CHF

Connor, 12 mos of age, has been treated 5 times for AOM. When planning Connor's f/u care, it is most important to evaluate for which of the following? a. otitis externa b. hearing loss c. enlarged tonsils d. shotty lymph nodes

During 15 yo NMs routine physical exam, she c/o getting pimples all the time. You note open and closed comedones over her forehead and chin. There are more than 15 papules and pustules, but no cysts. Which of the following statements is not consistent with an appropriate management plan for acne? a. improvement with use of keratolytic agents should occur within 4-6 wks b. facial scrubs are recommended before applying topical antibiotics c. noncomedogenic moisturizers and cosmetics may be used d. sunscreens should always be used in conjunction with retinoic acid

EG, at 9 years of age, presents with diffuse abd pain and acute onset of diarrhea described as a frequent urge to defecate. She is passing large amounts of flatus, small amounts of stool, and c/o tenderness during rectal examination. Which of the following lab test would confirm your dx for EG? a. serum albumin b. abd ultrasound c. stool for ova and parasites d. bone age

In the emergency room, you encounter a toddler whose injuries are not consistent with the history that is given. Which of the following would be the best step a provider could take in order to foster communication with abusive parents? a. realize that abusive parents have essentially different goals for their children than other caregivers do b. understand that parental hostility and resistance are potent symptoms of fear and inadequacy c. consider referring the parents to substance abuse program d. be cautious when sharing the results of medical findings

Justin, 11 yo, presents with c/o chronic diarrhea and abd pain. You note a 5 kg wt loss from last year's annual exam. Today, his exam reveals RLQ pain and perianal skin tags. The most likely dx is: a. encopresis b. crohn's dz c. irritable bowel dz d. ulcerative coliits

Kawasaki dz is most common in: a. neonates b. children younger than 5 years of age c. children older than 6 years of age d. females

Mrs. Franklin is concerned about a light pink lesion on the back of 2 mos old Aaron's neck that darkens with crying. The description is consistent wtih: a. sturge-weber dz b. salmon patch c. port-wine stain d. hemangioma

SL, at 9 years of age, is brought to the clinic for eval of abd pain that wakes her at night. Her parents have recently divorced an she is attending a new school. She has missed 8 days of school in the past 6 wks. She reports occasional emesis. An appropriate management plan would be: a. a band diet with small frequent feedings b. a referral to a gastroenterologist c. to stress importance of school attendance d. to consult with the school psychologist

Sam's mother has telephoned the clinic because chicken pox has been "going around" at Sam's school and she has just noticed a few red spots along the hairline on his face. She asks if there is anything that can be given to shorten the duration or severity of the illness. Which of the following is most accurate? a. diphenhydramine elixir has been shown to shorten the duration and severity of the rash b. acyclovir has been shown to shorten the duration and severity of the illness c. aspirin taken 4x a day has been shown to shorten the duration and severity of the illness d. there is no medication known to alter the course of the illness

Sam, at 8 years of age, presents to your clinic with his third episode of diarrhea in 3 mos. He also c/o frequent flatulence and a decreased appetite. After going over the hx, you recall that he went on a camping trip with his Cub scout troop several months ago. What is the most likely dx? a. celiac dz b. giardiasis c. rotovirus d. crohn's dz

Stephanie, at 1 year old, is infected with HIV, but is asymptomatic at this time. When should her MMr immunization be given? a. according to the usual schedule b. after she has been asymptomatic for 1 year c. only if she attends day care d. MMR should not be given to her

TJ, 13 yo, reluctantly shares with you that his "chest hurts." On physical exam, you note unilateral breast enlargement, which is tender to palpation. You suspect physiolgic gynecomastia. Which tanner stage would support that diagnosis? a. tanner stage I b. tanner stage III c. tanner stage IV d. tanner stage V

The appropriate mngmt of Osgood-shlatters dz includes: a. local injection of soluble corticosteroids b. decreasing activity applying ice and taking NSAIDs c. program strengthening and stretching for quadriceps d. casting in adduction for 6 weeks

The PNP is teaching a group of expectant parents about infant care and illness prevention. It is most important for the PNP to stress: a. keeping all animals out of the house b. keeping the infant away form cigarette smoke c. keeping the infant well covered at night d. keeping the infant away from crowds

The diagnois of AOM in a 1 yo child is based on: a. abnormal findings when pneumatic otoscopy and hearing test are performed b. changes in the tympanic membranes contour, color, and mobility c. presence of fever and color of the tympanic membrane d. presence of fever, ear pain, and tenderness of the pinna

The initial attack of acute rheumatic fever is preceded by: a. a viral illness b. a group A streptococcal infxn c. an exposure to mites d. an exposure o chicken pox

The most common cause of myocarditis is: a. bacterial b. viral c. drug reaction d. radiation therapy

The most common congenital heart defect in children is: a. tricuspid atresia b. ventricular septal defect c. coarctation of the aorta d. pulmonary atresia with intact ventricular septum

The mother of 4 yo TW states that the infant has been irritable and has not been sleeping well. During the physical exam, you note papular lesions on his feet and erythematous papules over his back. To confirm your suspicion of scabies you would order a: a. wood's lamp examination b. microscopic skin scraping c. KOH prep of skin scraping d. skin culture

The mother of 5yo DW is concerned that her son often cheats when playing board games with his older sister. What is the most appropriate response to DWs behavior? a. encourage the parent to use 5 minute time-outs when cheating occurs b. explain that DW is developmentally unable to comprehend rigid rules c. make sure that DW understands the rules before starting to play the game d. explain to DW that cheating is like lying and is not acceptable behavior

The mother of 8 yo John telephones to tell you that he developed chicken pox 3 days ago. She wants to know if there is anything she can do to make him more comfortable. You should also tell his mother to: a. avoid getting the lesions wet b. encourage him to take a bath every day c. have John take a bath only if he develops a fever and sweats d. encourage John to take only sponge baths until all lesions are healed

The parents of an 8yo child are concerned that their son does not want to attend school. Which of the following historical findings aren't usually associated with the diagnosis of school phobia? a. sporadic school absence b. chronic medical illness c. vague physical symptoms d. depression and anxiety

The principle that growth and development becomes increasingly integrated is best demonstrated by: a. gaining head control before raising the chest b. bringing the cup to mouth, tipping and swallowing c. rolling over before sitting d. grasping with fist before using fingers

To promote normal growth in the child with cystic fibrosis, dietary management should include: a. limited fats and 50% more calories than usual daily allowances b. liberal fats and 50% more calories than usual daily allowances c. the usual # of calories as indicated by ht and wt d. limited fat and sodium in moderation

Vomitus that is bilious suggests: a. GI obstruction proximal to the pylorus b. GI obstruction below the ampulla of vater c. pyloric stenosis d. peptic ulcer dz

When educating parents regarding transmission of RSV, it is important to stress which of the following? a. children with RSV should be totally isolated from other children b. RSV can be spread by airborne droplets or from contact with a hard surface that has been contaminated c. children who attend day care centers should take prophylactic antibiotics early each fall d. wiping hard surfaces with soap and water or disinfectant will not help in the prevention of RSV transmission

Which of the following is recommended as the standard immunizing agent for healthy preschool children? a. DTP b. DTaP c. DT d. Td

Which of the following represents appropriate anticipatory guidance for a child diagnosed with slipped capital femoral epiphysis? a. avoid contact sports until pain resolves b. crutches to facilitate mobility during acute phase c. apply ice to affected area d. ROM and strengthening exercises

Which of the following secondary skin changes is not associate with atopic dermatitis? a. lichenification (thick, leathery patches of skin) b. striae c. pigment changes d. excoriations

Which of the following statements regarding treatment of pediculosis capitis is true? a. carpeting and furniture must be shampooed and sprayed with a pediculicide b. nonwashable items that have come into contact with an infected person should be sealed in plastic bags for 2 - 4 wks c. hair must be trimmed close to the scalp to insure elimination of nits d. frequent shampooing with permethrin 1 % will prevent reinfestation

While examining 10 yo RMs teeth you note that the upper incisors slightly overlap the lower incisors. The second and lower first molars are absent. Your assessment is: a. malocclusion b. delayed mandibular dentition c. normal dentition d. hyperdontia

A 10 mos old infant presents with a 3 day hx of fever, runny nose and coughing. Per the parent, has not been eating well, and only drinking a few cups of milk and juice over the last 2 days. On exam, he feels very warm, his RR is 45 and his HR is 210. He has no rashes. His abd is soft and round. Your initial dx includes: a. SVT based on HR; needs immediate transfer b. CHF based on HR and RR, need immediate transfer c. Sinus tachycardia based on clinical hx and HR; needs antipyretics and possibly fluids d. kawasaki dz based on clinical hx and fever; needs transfer for IV IgG

A 12 yo boy is brought into the clinic for an urgent visit after having ingested 10 diazepam tablets. Following the initial emergent care and stabilization of the child, the most important aspect of your management is: a. referring the case to social services b. assessing the family support available to the child c. obtaining a psychiatric consultation d. reviewing the history for signs of depression

A 6 mos old boy is brought to the clinic bc he has been coughing since yesterday. His mother states that he has never been sick before. She thinks he has been afebrile but is not sure. Physical exam reveals a well-developed baby with a RR of 50 bpm, mild retraction, wheezes, and a dry cough. Chest radiograph reveals diffuse hyperinflation and patchy areas of infiltration. These findings are most consistent with a dx of: a. laryngotracheobronchitis b. cystic fibrosis c. bronchiolitis d. respiratory distress syndrome

A 7 yo AA female presents with several hyperkeratotic raised, periungal lesions on the two middle fingers of her left hand. She has a history of nail biting. The most likely dx is: a. impetigo b. molloscum contagiosum c. verruca vulgaris d. herpetic whitlow

During 15 yo NMs routine physical exam, she c/o getting pimples all the time. You note open and closed comedones over her forehead and chin. There are more than 15 papules and pustules, but no cysts. Which of the following medications below is the appropriate choice? a. antiandrgens b. isotretinoin c. minocycline d. corticosteroids

An 8 yo boy has been brought to the clinic with a chief c/o ear pain. When you grasp the pinna of he ear, he says "that hurts real bad." These findings are consistent with a diagnosis of: a. serous otitis media b. mastoiditis c. otitis externa d. cholesteatoma

An umbilical hernia: a. occurs more frequently in full-term infants b. resolves spontaneously in 3 to 6 months c. is frequently associated with diastasis recti d. responds well to taping

Brent, a 22 mos old, has been brought to the clinic by his mother who says he has been coughing for 2 days and is now making a funny noise when he breathes. Examination reveals a fussy child with a brassy cough and inspiratory stridor. Lips and nail beds are pink. Axillary temp is 103F and RR is 50 bpm. Which diagnostic test should be ordered first for Brent? a. pulmonary function tests b. throat culture c. radiograph of the upper airway d. laryngoscopic exam

CR, 4 yo, was dx with celiac dz a 18 mos. In addition to closely monitioring her growth, you also monitor for anemia. At this visit her lab results confirm an elevated MCV. An appropriate f/u lab test would be serum: a. protein b. ferritin c. folate d. transferrin

Characteristics of a venous hum include: a. a systolic murmur b. radiation over precordium c. marked decrease or disappearance of murmur when child is supine d. heard best at lower left sternal border

During 3 yo JTs physical exam, you observe eight, light brown macules, ranging in size from 0.5 to 0.75 cm on his trunk, arms, and legs. Your management plan would be to: a. educate the family to apply sunscreen frequently b. explain that the lesions will fade with time c. refer to dematologist d. document the findings an reevaluate in 6 mos

During a physical exam of 10.5 yo Melissa, you note the appearance of breast buds. You tell her that she can expect which of the following in approximately 2 years? a. growth of pubic hair b. peak height velocity c. onset of menses d. axillary hair

During exam of a 2 wk old JP you note irritability when lifted, asymmetrical Moro reflex, and spasm along the right sternocleidmastoid. What does this suggest? a. torticollis b. sprengel deformity c. fractured clavicle d. klippel-feil syndrome

During the routine exam of a 12 yo boy, you detect a group of hard fixed nontender lymph nodes, each of which measure about 1 cm, in the posterior cervical chain. You are unable to detect any signs of infection. Your management should include: a. recording the finding and reassessing the nodes in 1 month b. ordering a 10d course of a broad spectrum abx and reevaluating the nodes in 2wks c. ordering a CBC, ESR, and chest radiograh d. referring the child to and allergist

In the management of a child with bronchiolitis, the early use of which of the following is likely to be the most benficial? a. antihistamines b. broad spectrum antibiotics. c. fluids and nutritional support d. bronchodilators

JD, at 7 mos of age, is seen with a 2 day hx of diarrhea. He has had 3 to 4 wet diapers in the past 24 hrs. The anterior fontanel is slightly depressed. Capillary refill is normal. Based on your assessment of JD, the appropriate management plan for his dehydration would be to: a. begin BRAT diet b. withhold formula for 24 hrs and give electrolyte solution c. begin rehydration in the office and observe for 3 to 4 hrs d. refer immediately for parenteral fluids

JP, 5 yo, presents with a hx of stool staining his underwear, evidence of bright red blood after wiping, and abd discomfort. The physical exam reveals moderate abd distention with midline abd mass. Rectal exam is positive for an impacted rectum and two small anal fissures. The priority in your management plan would be: a. increasing H2O and fiber in the diet, and limiting milk intake b. regular toilet sitting for 10 mins, 3 x a day c. 2 fleets enemas d. mineral oil after breakfast and before bed

LR, at 6 years of age, presents at clinic with a solitary nonprruritic lesion around his upper lip. Closer inspection reveals some vesicles and honey colored crusts. The treatment of choice for LR would be: a. acyclovir b. topical steroids c. topical antibiotics d. petrolatum/lanolin ointment

Mrs. J brings her 6 yo son in bc of "hives" that she describes as a red raised rash. Which finding below would support a dx of erythema multiforme rather than uriticaria? a. lesions that blanch with pressure b. eyelid edema c. lesions that are present for more than 24 hrs d. intense pruritus

SBE prophylaxis is recommended for: a. all children with congenital heart disease on a daily basis b. all children with cong. heart dz before dental, GI, and GU procedures c. children with repaired cong. heart dz with a residual defect at the repair site d. children who have undergone surgical repair of a cong. heart condition for 5 yrs after the procedure

The mother of 2yo Bridget has brought her to the clinic because "she got bathroom cleaner in her eye." Hx reveals that about 30 min ago, Bridget was sitting on the floor playing with a squeeze bottle of bathroom cleaner, when the bottle accidentally opened and the liquid splashed into her right eye. Physical exam reveals a reddened right eye with an edematous lid. Initial treatment should include: a. allowing the natural tearing process to cleanse the eye b. performing a retinal fundoscopic exam to assess for burns c. irrigating the eye with copious amount of normal saline d. referring Bridget to an opthalmologist

The mother of 2yo Heather has brought her to the clinic with a "bad cough". Hx reveals onset of illness 4 days ago with clear rhinorrhea and coughing. Her mother says that Heather's fever has been as high 103 axillary. Physical exam reveals a temp of 101F and RR of 56 bpm, w/ slight nasal flaring and intercostal, subcostal, and suprasternal retractions. The pharynx is red without tonsillar exudate. Chest auscultation reveals widespread rales and wheezing. The lips and nail beds are slightly pale but pink, skin turgor is good and mucous membranes are moist. Initially, Heather should receive which diagnostic test? a. sputum culture b. sputum gram stain c. chest radiograph d. erythrocyte sedimentation rate

The mother of 2yo Heather has brought her to the clinic with a "bad cough". Hx reveals onset of illness 4 days ago with clear rhinorrhea and coughing. Her mother says that Heather's fever has been as high 103 axillary. Physical exam reveals a temp of 101F and RR of 56 bpm, w/ slight nasal flaring and intercostal, subcostal, and suprasternal retractions. The pharynx is red without tonsillar exudate. Chest auscultation reveals widespread rales and wheezing. The lips and nail beds are slightly pale but pink, skin turgor is good and mucous membranes are moist. When deciding whether Heather should be treated at home or in the hospital, it is most important to consider Heather's: a. max temp b. frequency of coughing episodes c. hydration status d. total length of illness

The mother of 3 yo GW reports that he has begun to stutter. Further probing reveals that the stuttering occurs frequently and lasts 1 to 2 seconds. GW does not seem bothered by the stuttering. The appropirate management would be: a. referral to a speech pathologist b. referral for an evaluation for an anxiety disorder c. reassuring the mother that this is a mild problem d. demonstrating to GW slow, deep breathing before talking

The mother of 4 mos old ND reports episodes of vomiting and diarrhea beginning 2 days ago. He has also had several episodes of screaming and drawing up his legs. Prior to this he has been healthy with a normal wt gain. Physical exam of ND reveals a sausage-shaped mass and guaiac-positive stool. This would confirm a dx of: a. incarcerated hernia b. gastroenteritis c. intussusception d. pyloric stenosis

The mother of 6 yo Cali brings her to the clinic bc the family is planning a trip to a tropical area, and she wants to know how to avoid illness. Knowing that cases of malaria have been reported in the area, you should teach: a. avoidance of contact with infected people b. hand washing after touching contaminated fomites c. avoidance of mosquito bites d. cooking of all vegetables

The mother of a 5yo boy has brought him to the clinic bc she thinks he has pinkeye. Which of the following would lead you to consider a dx other than bacterial conjunctivitis? a. hyperemic conjunctiva b. scratchy sensation in the eye c. decreased corneal clarity d. copious tearing

The parents of a 1 wk old infant are concerned about the unusual shape of their child's head. In the physical exam of the infant, which of the following signs would not support a diagnosis of craniosynostosis? a. palpation of a ridge along a given suture line b. unusual skull configuration c. a palpable lesion at the occipital region d. abnormal head cirumference

Varus between the tibia and femur of up to 15 degrees followed by a progression to a neutral angle, which then progresses to valgus between 7 to 9 degrees, is associated with which of the following? a. blount dz b. internal tibial torsion c. normal developmental growth d. abnormal tibiofermoral growth pattern

When providing anticipatory guidance about infant development, you might teach parents that a normal infant could first transfer an object from hand to hand at which age? a. 2 mos b. 4 mos c. 7 mos d. 9 mos

When reviewing immunization protocols at your clinic, you are aware that the varicella vaccine can be administered to susceptible children beginning at what age a. 4 mos b. 6 mos c. 12 mos d. 15 mos

Which of the following best describes behavior associated with Piaget's concrete operations? a. learning primarily by trial and error b. interpreting events in relationship to themselves c. categorizing information into lower to higher classes d. drawing logical conclusions from observations

Which of the following is not a component of Metabolic syndrome, a clustering of factors in children shown to be associated with increased risk of coronary artery disease later in life? a. obesity b. elevated lipid levels c. heart murmur d. elevated fasting glucose levels

Which of the following may cause vol. overload leading to CHF if not appropriately followed and managed? a. coarctation of the aorta b. pulmonary stenosis c. ventricular septal defect d. supraventricular tachycardia

Which of the following physical findings in a 2 month old child warrants an immediate referral to a neurologist/neurosurgeon? a. head circumference growing faster than height and weight b. unresolved cephalhematoma c. rigid and immobile sagittal suture d. snapping sensation when pressure is applied to parietal bone

Which of the following vaccines is contraindicated for routine use in a 3 yo child for maintenance treatment of acute lymphocytic leukemia? a. DPT b. injectable influenza c. MMR d. hepatitis b

While completing the hip examination on newborn infant you were able to dislocate the infants right hip. The appropriate management plan will be to: A: triple diaper and reevaluate in two weeks B: recommend positioning prone while awake C: Referred to orthopedic specialist D: Order tight swaddling of the infant

You detect a hear murmur while examining a 3 yo child. In determining whether of not a referral is necessary, you determine it is an "innocent" heart murmur for which of the following reasons? a. It is best heard during diastole b. it radiates to the axilla c. the intensity is no greater than I or II/VI d. there is no variation with change in child's position

You would expect a school age child to: a. grow 1.5 inches per year b. grow 0.5 inch per year c. gain about 6 lbs per year d. gain about 3 lbs per year

JD, at 7 mos of age, is seen with a 2 day hx of diarrhea. He has had 3 to 4 wet diapers in the past 24 hrs. The anterior fontanel is slightly depressed. Capillary refill is normal. Which degree of dehydration is most consistent with these findings? a. 1 to 2% b. 3 to 5% c. 6-10% d. greater than 10%

c ( depressed fontanel & decreased UOP are indicators of moderate 8% dehydration)

Mrs. Chancellor contracted rubella while pregnant with 2 mos old Andrew. Andrew should be considered contagious for what time perioud? a. between 5 and 7 days b. until he is afebrils c. at least the first year of life d. he is not contagious

c (infants with congenital rubella may excrete the virus from the nasopharynx and in the urine for a year)

Education and counseling of the parents of a 4 mos old child with gastroesophageal reflux should include all of the following except: a. thicken formula with rice cereal b. change to a hypoallergenic formula c. place infant in a car seat after feeding d. avoid exposure of the infant to tobacco smoke

c (sitting the infant in a car seat or similar device compresses the stomach, making the infant more likely to reflux)

A 2 mos old infant at your clinic received a combined Dtap/HepB/IPV vaccine and the parents are in need of teaching about possible side effects. Which of the following is not an adverse effect following administrations of the Dtap vaccination? a. local reaction b. fever c. increased fussiness d. transient morbilliform rash

A 2 wk old infant is in the clinic for a scheduled weight check. The best indication that a 2 wk old infant is receiving adequate breastmilk is that the baby: a. passes a least 4 stools a day b. feeds every 3 hrs c. voids 4 times a day d. has regained birth wt

A 4 yo child with cystic fibrosis (CF) comes to the primary care office with c/o runny nose, cough, congestion, and fever. You know that children with CF: a. are more likely to have normal CXR and LFTs findings b. usually are poor eaters with accompanying poor growth c. routinely take an oral mucolytic agent d. warrant more liberal use of antibiotics for respiratory infections

A 7yo child in your caseload has recently been placed on methylphenidate for behavioral concerns associated with ADHD. Which of the following side effects are not associated with this drugs? a. decreased appetite b. weight loss c. irritability d. decreased heart rate

A common cause of CHF in the first year of life is: a. mild pulmonary stenosis b. inflammatory heart disease c. rheumatic fever d. complete heart block

A dx of croup is substantiated by which radiographic finding? a. ground glass appearance in the upper airway b. sparse areas of atelectasis c. "thumb sign" on lateral view d. "hourglass" narrowing in the subglottic region

A lethargic appearing 18 mos old child presents to the clinic with s/s of croup. Physical exam reveals a RR of 20 bpm and mild dehydration. Appropriate management includes: a. instructing the mother to force fluids and use a cool mist humidifier in the child's room b. instructing the mother to liberally give fluids and to encourage intake of solid food c. prescribing an oral broad spectrum antibiotic and prednisone d. referring the child for hospitalization and IV fluids

A principal clinical feature that aids in the diagnosis of Kawasaki dz includes: a. low-grade fever for 24 hrs and a pruritic rash b. conjunctivitis with exudate and facial rash c. arthritis and chorea d. High (>39C/102F) fever persisting at least 5 days and acute erythema and/or edema of hands and feet

A well-nourished 10 yo girl presents to the clinic with low-grade fever, sore throat, fatigue and malaise, and left upper abd pain. Based on clinical presentation and lab results, a dx of infectious mononuclesis is made. Which of the presenting signs and symptoms requires further investigation immediately? a. low-grade fever b. sore throat with lymphadenopathy c. fatigue and malaise d. left upper abd pain

An increase in which of the following behaviors is seen more frequently in late, rather than in early, adolescence? a. value conflict with parents b. focus on physical apperance c. peer group involvement d. understanding inner motivations of others

Brian, 13 yo, presents to the clinic with a sore throat. Hx reveals that he had a sore throat a couple of weeks ago and thought he had gotten well. He now has severe pharyngeal pain of 2 days duration and says he has been sweating and thinks he has fever. Physical exam reveals a temp of 102 and erythematous and edematous pharynx and soft palate. The right tonsil is swollen and inflammed without exudate and the uvula is displaced to the left. Right cervical nodes are tender. Lungs are clear to auscultation. Brian's signs and symptoms are suggestive of: a. acute uvulitis b. viral pharyngitis c. epiglottitis d. peritonsillar abscess

CW, a 20 mos old, presents in the ER with a greenstick fracture of his left femur. Physical exam also reveals and enlarged anterior fontanel and enlarged costochondral junction. What do these clinical findings suggest. a. child abuse b. osteogenesis imperfecta c. osteoporosis d. rickets

During 2.5 yo Jason's physical exam you note large muscular calves and observe his difficulty rising from a sitting position. The Denver screening exam reveals delays in the gross motor area. Which of the following lab test would be most beneficial? a. serum calcium b. serum magnesium c. serum phosphurus d. seurm creatine kinase

During 8 mon old LBs physical exam, the father boasts that LB is going to be a left-handed batter since he prefers doing everything with his left hand. The appropriate response would be to: a. ask if others in the family are left handed b. suggest play activities that require using both hands c. present toys more often to the right hand d. perform a careful neurological exam

During a prenatal visit, you review the mother's record for routine prenatal screening results. While education the mother, you explain that the screening of maternal serum for alpha-fetoprotein (MSAFP) between the 15th - 21st weeks of pregnancy is done primarily to screen for: a. phenylketonuria b. galactosemia c. cystic fibrosis d. neural tube defects

During the newborn exam of KL, you note a generalized lacy reticulated blue discoloration. This clinical presentation describes: a. harlequin color change b. mongolian spots c. blue nevus d. cutis marmorata

EG, at 9 years of age, presents with diffuse abd pain and acute onset of diarrhea described as a frequent urge to defecate. She is passing large amounts of flatus, small amounts of stool, and c/o tenderness during rectal examination. This clinical picture is highly suggestive of: a. gastoenteritis b. ulcerative colitis c. giardiasis d. appendicitis

Emily, a 4 yo, stays with her great aunt during the day while her mother is at work. Emily's mother has brought her to the clinic bc the great aunt has just been dx with TB. Emily's Mantoux skin test is positive but there is not clinical or radiographic evidence of dz. Appropriate managment includes: a. reassuring Emily's mother that no treatment is needed b. Administering another skin test in 3 mos c. oral penicillin therapy d. oral preventative isoniazid therapy

In a child with chronic sinusitis, the most accurate method of identifying sinus abnormalities is: a. dark room transillumination of the sinuses b. percussion of the paranasal sinuses c. AP, lateral, and occipitomental sinus radiograhps d. CT scan of the sinuses

In males, Tanner stage III can be distinguished from tanner stage II by: a. fine downy pubic hair at the base of penis b. adultlike pubic hair not extending to thighs c. penile growth in width d. penile growth in length

James, at 4 years old, has been dx with cat scratch dz. His mother asks what should be done about the cat. What should your response be? a. the cat should be isolated until it can be treated with antibiotics b. the cat should be isolated until it can be treated with anthelmintics c. the cat should be evaluated by a medical lab and destroyed d. there are no recommendations for treating and destroying the cat

Jeffrey, at 8 years of age, has been diagnosed with ADHD and is receiving stimulant medication. Which of the following interventions would be least helpful? a. monthly ht and wt checks b. small frequent meals and snack c. high-calorie supplemental drinks d. elimination of refined sugar from diet

Josh, age 5, presents to the clinic with inspiratory stridor, drooling, and a temp of 105. He insists on sitting up during the clinical examination. Appropriate initial management of Josh includes: a. high dose of an oral broad spectrum antibiotic and antipyretics b. teaching the mother to administer racemic epi by nebulization c. teaching the mother how to administer loading and decreasing doses of prednisione d. immediate hospitalization with intravenous antibiotics

Josh, age 5, presents to the clinic with inspiratory stridor, drooling, and a temp of 105. He insists on sitting up during the clinical examination. This clinical picture is most consistent with a dx of: a. aspirated foreign body b. reactive airway dz c. viral croup d. epiglottitis

Julie, at 18 mos of age, has been brought to the clinic by her mother who tells you that Julie has had a cold for the past 4 days. There is no hx of cough and the mother is unsure whether Julie has had fever. Physical exam reveals greenish, blood-tinges mucus with a strong, foul odor, draining from the right nostril. The clinical picture is most consistent with a diagnois of: a. allergic rhinitis b. viral rhinits c. acute sinusitis d. nasal foreign body

LR, at 6 years of age, presents at clinic with a solitary nonprruritic lesion around his upper lip. Closer inspection reveals some vesicles and honey colored crusts. The most likely dx is: a. herpes simplex b. varicella c. nummular eczema d. impetigo

Matthew, at 5 mos old, is brought to the clinic bc he has been coughing and has had clear rhinorrhea for the last 2 days. His mother tells you that he has never been sick before. Family hx is positive for allergies and you hear generalized wheezing. You may conclude that: a. Matthew has familial asthma b. Matthew has asthma exacerbated by a viral infection c. Matthew should be referred for allergy testing d. Asthma should not be diagnosed at this stage

Mrs. D reports starting her 6 mos old infant on rice cereal sweetened with one tablespoon of honey. In addition, the infant is consuming 42 oz of forumla. His ht and wt are at 50% on the growth curve. You would recommend: a. adding pureed vegetables b. substituting 4oz juice for a formula feeding c. adding scrambled egg whits d. discontinuing honey

Steven, at 10 years of age, as been diagnosed with otitis externa twice this year. Health teaching for Steven and his mother should include: a. emphasis on consistent use of low-dose prophylactic antibiotics b. sleeping with affected ear in the dependent position c. info on the use of decongestants to open the eustachian tube d. info on the use of acetic acid after ear canal contact with water

Steven, at 6 years of age, has been dx with erythema infectiosum (fifth dz). His mother asks you how to prevent the spread of the dz to her other children. Your answer should be: a. the dz is not thought to be contagious b. stephen should eat and drink from disposable containers c. other children should not be allowed to touch the erythematous areas d. the patient is no longer contagious by the time the rash appears

Which of the following scenarios is suggestive of a child who may not be ready to enter first grade? An inability to: a. recognize six colors and remember one's phone number b. accurately use pronouns c. empathize with others d. count to five and draw a person with three parts

The least likely physical finding in a 2 mos old infant with CHF is: a. tachypnea b. tachycardia c. hepatomegaly d. pedal edema

The mother of 12yo Nathan has brought him to the clinic bc he has had a runny nose for 2 wks. Hx reveals that Nathan has visited the clinic 3 other times this year for upper respiratory complaints. Examination reveals slightly edematous and erythematous eyes, pale nasal mucosa with clear mucus, and pharynx with thin secretions posteriorly. There is no tonsillar swelling or exudate. Lips and nail beds are pink. Lymph node exam is significant for multiple shotty nodes. Lungs are clear to auscultation. Which actions is appropriate at this time? a. discuss symptomatic relief of the common cold with Nathan and his mother b. culture nasal drainage and delay treatment until result are known c. order an antibitotic d. order an antihistamine

The mother of 4 day old Susan has brought her to the clinic bc she has not seemed interested in her bottle since yesterday. Physical exam reveals a lethargic infant with an axillary temp of 96F and a pulse rate of 100. Extremities are slightly cool. Appropriate mngmt includes: a. reassuring the mother that infants tend to regulate their own feeding habits b. instructing the mother on proper nipple placement and feeding techniques c. changing the infant to a soy-based formula and reevaluating her in 24 hrs d. considering the possibility of sepsis with appropriate referral

The mother of 4 mos old ND reports episodes of vomiting and diarrhea beginning 2 days ago. He has also had several episodes of screaming and drawing up his legs. Prior to this he has been healthy with a normal wt gain. The likely dx is. a. incarcerated hernia b. gastroenteritis c. intussusception d. pyloric stenosis

The mother of 8 yo John telephones to tell you that he developed chicken pox 3 days ago. She wants to know if there is anything she can do to make him more comfortable. John's mother calls you again 10 days after onset of the initial rash to report that John has had a severe headache since yesterday and that he is very irritable. Which of the following would be advised? a. ask the mother if John has had a bowel mvmt since he has been ill b. tell John's mother that these symptoms are common when chicken pox is resolving c. ask the mother if there is a family hx of severe headaches d. ask John's mother to bring him to the office today for evaluation

The mother of a 15 mos old child informs you that she feeds the baby skim milk. You advise the mother to change to whole milk primarily because skim milk: a. is not as easily digested as whole milk b. contains an insufficient amount of calcium c. contains too little protein d. provides an inadequate amount of essential fatty acids

The mother of a 4 mos old infant reports that he turned "blue" and seemed to have fast, labored breathing after vigorous crying soon after awakening. He settled down and his color and breathing seemed to improve. On physical exam, the mucous membranes of the lips and mouth appear mildly cyanotic. A systolic murmur is heard best at the left sternal border. Vital signs are normal with normal peripheral pulses. There is no hepatomegaly. A likely diagnosis is: a. congestive heart failure b. acute life-threatening event related to reflux c. coarctation of the aorta d. cyanotic spell related to tetraology of Fallot

The mother of a toddler with a typical roseola-type rash and a hx of high fever asks if there is any treatment available for the condition. The PNP tells the mother that: a. topical corticosteroids are helpful to relieve itching b. oral diphenhydramine is helpful to decrease desquamation c. aspirin should be used to treat the typical high fver d. there is not medical treatment for roseola

What is the appropriate treatment for genu varum in a 15 mos old child? a. passive exercise w/ each diaper change b. Denis Browne splint at night c. Blount brace at night d. no treatment is warrented

When examining 7 mos old RV, you note red scaly plaques in his diaper area, particularly in the inguinal folds, with satellite lesions on his abdomen. The appropriate treatment would be: a. petrolatum/lanolin ointment b. petroleum jelly c. zinc oxide d. nystatitn

Which of the following is an expected finding after treatement of acute suppurative otitis media? a. otitis externa b. central auditory dysfunction c. functional hearing loss d. middle ear effusion

Which of the following is not a sign of readiness to toilet train? a. can sit for extended periods b. can follow directions c. occasional waking from naps with dry diapers d. regularity of bowel movements

Which of the following is not an expected finding in a child with myocarditis? a. persistent tachycardia b. hx of antecedent flulike illness c. a gallop rhythm d. a significant heart murmur

Which of the following is true regarding innocent murmurs? a. the murmur is often holosystolic b. prompt referral to a cardiologist is indicated c. a precordial thrill is present d. the murmur is low in intensity, grade 1 through 3

You are preparing a drug prevention program for middle school students. Your educational approach is based on the knowledge that the most common substance abuse in adolescence is: a. marijuana b. cocaine c. heroin d. alcohol

You are seeing a 15 mos old boy with leukemia for a check up. If indicated, this child may receive all of the following vaccines except: a. inactivated polio vaccine (IPV) b. H. influenzae type B (Hib) c. DTap d. Varicella (VAR)

You have ordered routine blood screening for a 2yo girl who because of dietary habits, is at risk for iron deficiency anemia. Which of the following findings is not associated with iron deficiency anemia? a. hypochromic RBC b. microcytic RBC c. low reticulocyte count d. low free erythrocyte protoporphyrin (FEP) level

You not a single, large, oval, pink, patch with central clearing on 16 yo MPs back. Lesions are not present elsewhere. Results of the KOH prep of the lesion are negative. This would confirm a dx of: a. seborrheic dermatitis b. secondary syphilis c. tinea corporis d. pityriasis rosea

CA, 2 wks old, is being seen for the first time since discharge from the newborn nursery. She currently weighs 3.6kg, which is 0.3 kg below her birth wt. While interviewing her mother you learn she has been using too little water when preparing the formula. Which of the following is least likely related to the error? a. vomiting b. diarrhea c. dehydration d. flatus

d ( too little H20 will increase GI and renal solute load, may result in vomiting, diarrhea and dehydration)

Considering the patho associated with erythema infectiosum (fifth dz), a child with hx of which of the following diseases must be monitored closely? a. frequent respiratory infections b. multiple skin allergies c. malabsorption syndrome d. hemolytic anemia

d (bc of reticulocytopenia associated with EI may result in dangerous decrease of hemoglobin concentration in the child with hemolytic anemia)

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