CPNP-PC Questions

Which of these dermatological disorders is most commonly associated w/elevated serum IgE levels? A. Atopic dermatitis B. Acne C. Pityriasis rosea D. Varicella zoster virus

A. Atopic dermatitis

Of the following, which viral infection most commonly present w/Koplik spots? A. Rubeola B. Roseola infantum C. Rubella D. Lyme Dz

A. Rubeola

The most common findings of impetigo include all of the following choices except: A. Pain B. Pruritic rash C. Honey-crusting lesions D. Regional lymphadenopathy

B. Pruritic rash

Which of the following is not a physical manifestation of asthma? A. Hypertrophy of mucus glands B. Purulent sputum C. Hypertrophy of smooth muscle D. Mucosal edema & hyperemia

B. Purulent sputum (p. 111)

Which f these clinical tests would be most useful in evaluating the degree of a pt's scoliosis? A. Genetic testing B. Radiograph C. Ultrasound D. Joint fluid aspiration

B. Radiograph

A 6 mo appears to have a shorter left leg, which turns outward slightly further than her right leg. Given this finding, which of the least expect to present during the diagnostic assessment? A. Galeazzi sign B. Barlow sign C. Gower's sign D. Allis' sign

C. Gower's sign

In July, Marian brings in her 5-year-old son Jensen, who has just started presenting w/the varicella zoster virus. His contraction of the virus was on purpose. Marian brought Jensen to a "chickenpox party" where a child w/the virus can spread it to the other kids so that all the children can get the virus now & not when school is in session. Marion asks you for a treatment that specifically reduces the duration of his signs & symptoms. What is the best treatment recommendation for her? A. Acyclovir B. Antihistamine C. Acetaminophen D. Calamine

A Acyclovir (p. 87)

In male infants, cryptorchidism occurs in 20-30% of which specific population? A. Infants 6 months of age B. Brothers of males who experienced cryptorchidism C. Premature infants D. Sons of males who experienced cryptorchidism

C. Premature infants

When diagnosing depression in an adolescent, which of the following is the most important question to ask? A. "Have you ever thought about or attempted to hurt yourself?" B. "Have you ever been treated for depression?" C. "Have you ever experienced delusions or hallucinations?" D. "Do you regularly take prescription medication for depression?"

A. "Have you ever thought about or attempted to hurt yourself?"

A premature infant should typically be given palivizumab (Synagis) for the prevention of RSV bronchiolitis if gestation is less than: A. 29 weeks B. 33 weeks C. 35 weeks D. 40 weeks

A. 29 weeks

According to the psychosocial development model, at which age would an infant be least likely to cry when she is handed to her new babysitter? A. 4 months B. 6 months C. 8 months D. 10 months

A. 4 months

Of the following cases, which of the following would you recognize as a child whose development is not that of a typical healthy child? A. A 2 ½ year old who usually speaks in 1-word sentences B. A 15-month-old who scribbles with a large crayon C. A 2-year-old jumps with both feet D. The 3 month old who lifts his head & chest when on his stomach

A. A 2 ½ year old who usually speaks in 1-word sentences (p. 11)

Which of your patients would you most expect to present with Burtonian lines? A. A 3yo who frequently spends her afternoons @ her grandfathers stained glass studio B. A 4yo who is living in a 1980's house while it is being renovated C. A 7yo who receives acupuncture to help treat his anxiety D. A 9yo who spends most of his free time playing video games

A. A 3yo who frequently spends her afternoons @ her grandfathers stained glass studio (p. 137)

You are assessing for egophony in a young pt w/suspected pneumonia. You ask the pt to produce a long "E" sound. What sound should you anticipate to auscultation when the pt has lung consolidation? A. A long "A", or "ay" sound B. A short "A", or "ah" sound C. A long "E", or "ee" sound D. A short "E", or "eh" sound

A. A long "A", or "ay" sound

Which of the following patients, all of whom have a known history of congenital heart disease, is least likely to require prophylactic antibiotics prior to a dental procedure? A. A patient w/a heart transplant B. A patient w/a ventricular septal defect w/a patch repair C. A patient w/a previous history of endocarditis D. A patient w/a partially repaired cyanotic heart defect

A. A patient w/a heart transplant

In the correct method for assessing an infant for developmental hip dysplasia, the NP would have the baby on his back with knees flexed &: A. Abduct knees, listening for click as femoral head slips into acetabulum B. Adduct knees, listening for click as femoral head slips into acetabulum C. Abduct knees, feeling femoral head enter acetabulum D. Adduct knees, feeling femoral head slip into acetabulum

A. Abduct knees, listening for click as femoral head slips into acetabulum (Ortolani' s click, commonly used to assess for developmental dysplasia of the hip (DDH), is performed by abducting the knees, then listening & feeling for the femoral head to re-enter the acetabulum. Barlow's maneuver, which also assesses for DDH is done by abducting the knees & feeling the femoral head pop out of , not into, the acetabulum.)

A 16-year-old male presents to your office with a 2 day history of fatigue, cough, & chills. His temp today is 99F. His lung sounds are coarse. The patient has a history of good health but "feels awful" today. Which of the following would be the most appropriate treatment recommendation? A. Acetaminophen B. Levofloxacin C. Ceftriaxone D. Azithromycin

A. Acetaminophen (In healthy patients with viral infections, supportive measures such as hydration & acetaminophen are the most appropriate treatment option. The patient's chills, low fever, and coarse wet lung sounds point to a viral cause rather than bacterial pneumonia. A bacterial infection typically presents with a much higher fever. Azithromycin, levofloxacin, and ceftriaxone are all antibiotics that do not treat this patient's viral infection.)

A mother brings her son to your facility, who has never had serious disease before. The 3yo boy is in preschool & has contracted the Coxsackievirus. At this time, which of the following would be most appropriate to give the child to treat his signs & symptoms? A. Acetaminophen B. Acyclovir C. Amoxicillin D. Penicillin

A. Acetaminophen (p. 97)

You are examining Ryan, a 17 yo male, & note inflamed papules on his face & upper trunk. He admits to using steroids in order to keep up w/his teammates in baseball; these steroids appear to have exacerbated the symptoms. Of the following, which dermatological disorder is the most likely diagnosis? A. Acne B. Psoriasis C. Atopic dermatitis D. Pityriasis rosea

A. Acne

Which of these factors is most likely to increase the risk of Down syndrome in infants? A. Advanced maternal age B. Intrauterine infection during the 2nd trimester C. Alcoholism during pregnancy D. Smoking during pregnancy

A. Advanced maternal age

You are counseling one of your pregnant patients on the prevalence of genetic disorders. If the baby has no predisposition for a specific genetic disorder, his chance of being born w/a major malformation is most likely: A. Approximately 2% B. Approximately 5% C. Approximately 8% D. Approximately 10%

A. Approximately 2%

You are assessing a 1-year old infant w/gastroenteritis for dehydration. What are some signs that would cause you to judge that the infant is moderately dehydrated? A. BP is normal; cap refill is 2 seconds; pulse is thready; skin turgor is decreased; fontanelle is slightly soft; & UOP < 1 mL/kg/hr B. BP 94/56; HR 120; cap refill is 3 seconds; skin rapidly snaps back to position; fontanelle is firm & slightly curves inward; & UOP is slightly decreased C. BP 70/55; HR 75; cap refill is 4 seconds; skin does not rapidly snap back to position; fontanelle is soft; & UOP < 1 mL/kg/hr D. Her BP, HR, cap refill, skin turgor, & fontanelle, are all normal but UOP is slightly decreased

A. BP is normal; cap refill is 2 seconds; pulse is thready; skin turgor is decreased; fontanelle is slightly soft; & UOP < 1 mL/kg/hr (p. 72)

Which test can be used to diagnose either Hirschsprung's Dz or intussusception? A. Barium enema B. Rectal biopsy C. Ultrasound D. Colon biopsy

A. Barium enema

Robert, a good friend of yours, has called you for advice on obtaining a medical certification. He wants to know his various options. Which statement is true regarding the difference between licensure & certification? A. Certification signifies mastery of specialized knowledge & is granted by a non-governmental agency B. Licensure signifies that a person is qualified to perform a particular role & is granted by a non-governmental agency C. Licensure signifies mastery of specialized knowledge & is granted by a governmental agency D. Certification signifies that a person is qualified to perform a particular role & is granted by a governmental agency

A. Certification signifies mastery of specialized knowledge & is granted by a non-governmental agency (p. 167)

Jackie, an 8-year-old girl, comes to your clinic complaining of a throbbing headache on the left side of her head. Her parents state their daughter seems to be having episodes of headaches since last week. They say that Jackie has seemed disoriented several times in the past, vomited & fallen into deep sleep. Of the known migraine syndromes, which of the following does Jackie most likely have? A. Confusional migraine B. Classic migraine C. Abdominal migraine D. Common migraine

A. Confusional migraine (Confusional migraines are characterized by periods of confusion & disorientation followed by vomiting & deep sleep. Furthermore, this type of migraine is more common in younger children, such as Jackie. Abdominal migraines are also among the variant migraine syndromes but are characterized by abdominal pain & nausea along with headache, none of which are present in this scenario. "Classic" & "common" migraines are categories of migraine headaches, but, as the question calls for a type of migraine syndrome & not a generalized category, this would not be applicable.)

You are providing nutritional education to the parents of a 12 yo male who has been newly diagnosed w/DM1. All of the following statements regarding proper nutrition would be appropriate except: A. Consume no less than 2,000 calories per day B. Carbohydrates should make up the majority of the diet C. Protein should account for roughly 20% of caloric intake D. The diet s/be high in fiber

A. Consume no less than 2,000 calories per day (The caloric intake of a child w/DM1 is commonly determined by the child's weight & growth patterns. A 2,000 calorie diet may be appropriate for one child, but not for another. Carbohydrates are the main energy source & should make up the majority of daily calories. Protein, which delays the absorption of carbohydrates, should account for about 20% of daily calories. Individuals w/DM1 should generally consume about 25 grams of fiber per 1,000 calories, which equates to a high-fiber diet. High fiber diets may help to control blood sugar levels & A1C.)

Your patient has allergic conjunctivitis. Which of the following treatments would you be least likely to prescribe due to the risk of increased intraocular pressure? A. Corticosteroid eye drops B. Antihistamine eye drops C. A mast cell stabilizer D. Non-steroidal anti-inflammatory eyedrops

A. Corticosteroid eye drops (p. 100)

Claire, 6yo, comes to your clinic w/a low-grade fever & bark-like cough. Her gym teacher sent her home the day before because she seemed as if she was having difficulty catching her breath on the least exertional of activities. Her lungs, however, are clear on auscultation. Which of the following would most account for all of the patient's signs & symptoms? A. Croup B. Group A ß-hemolytic streptococcal infection C. Common cold D. Epiglottitis

A. Croup (p. 108)

A concerned mother brings her 4yo son, Kevin, to your office. The mother is worried about Kevin's weakness & clumsiness compared to other children his age as well as his abnormal posture. Further, she notes unusual movements from her son, such as moving his hands up his legs when rising stand. As you begin laboratory testing to confirm your suspected diagnosis, which of the following diagnostics would you not expect to see? A. Decreased creatine kinase B. Necrotic degenerating fibers C. Abnormal electrocardiogram D. Myopathy

A. Decreased creatine kinase (p. 121)

The NP knows that which of the following prophylactic drugs is not used in pediatric migraine mgmt? A. Doxepin B. Bisoprolol C. Ibuprofen D. Amitriptyline

A. Doxepin

Using the Dubowitz/Ballard exam to estimate the gestational age of a Caucasian newborn, you determine him to be a post-term. Which of the following is not related to the criterion included in the Dubowitz/Ballard exam? A. Elasticity of cartilage in nose B. Thickness & size of breast tissue C Hypertonic flexion of knees D. Plantar creases over sole of feet

A. Elasticity of cartilage in nose

You are taking the medical history of 11-year-old Jake, who complains of regularly been tired. His father states that he has had trouble getting through soccer practice because of muscle fatigue. You note that Jake has gained an abnormal amount of weight but hasn't grown as much as you would have expected for his age. Upon examination, you detect thick tongue. Which of the following should be tested for to verify the most likely diagnosis? A. Elevated TSH & decreased T4 B. Glucose C. Decreased TSH & elevated T3 D. Ketonemia

A. Elevated TSH & decreased T4

All of the following conditions may be present in afebrile patients except: A. Encephalitis B. Acute glaucoma C. Subarachnoid hemorrhage D. Cerebral ischemia

A. Encephalitis (p. 125)

Which of the following is one of the therapeutic treatments used in the symptomatic relief of sickle cell anemia? A. Ensure adequate oxygenation B. Neurodevelopmental monitoring C. Environmental investigation D. Referral to an oncologist

A. Ensure adequate oxygenation

You are examining a newborn who has arrived for her 1st check-up. Her trunk is covered in blotchy red spots of varying sizes, & some spots present w/white pustules over them. Which of the following is the most probable diagnosis? A. Erythema toxicum B. Milia C. Telangiectasia D. Mongolian spots

A. Erythema toxicum

Of the following, which is not the purpose of the Patient Safety and Quality Improvement Act? A. Establish a database to which healthcare providers must report errors B. Resolve patient safety and health care quality issues C. Analyze medical errors D. Establish a voluntary reporting system

A. Establish a database to which healthcare providers must report errors (The purpose of the Patient Safety and Quality Improvement Act is to establish a confidential, liability-free, voluntary database of medical errors so that patient safety organizations can examine the data to help resolve patient safety and health care quality issues.)

You consider screening Sylvester, a 9-year-old African-American boy, for DMII Sylvester presents w/a # of risk factors for DMII; he is obese & has a FHx of the condition. Based on these risk factors, you decide to begin screening the following year, when Sylvester is 10 years old. How often do you subsequently continue screening? A. Every 2 years B. No further screening is necessary C. Every 6 months D. Every year

A. Every 2 years (p. 141)

Which of the following is thought to be a predisposing psychosocial factor for ADHD? A. Family history of alcoholism B. Near-death experience from perinatal asphyxia C. Depression D. Current lack of friends

A. Family history of alcoholism

A couple brings their 4 month old child, Elena, for a regular check up. During the exam, the parents remark about Elena's calm temperament. The mother tells you that Elena "will let anybody hold her". The parents express concern that Elena may even be "too easy-going" & open to strangers. Of the following, what should you tell the parents to allay their fears? A. Fear of strangers usually develops @ about 6 months of age B. Refer to neurologist C. Elena's behavior is abnormal, as she should be afraid of strangers at her age D. Children do not usually develop separation anxiety until 2 years of age

A. Fear of strangers usually develops @ about 6 months of age

A concerned father brings his very ill child to your office. Upon evaluating the child, your assess the child is having pneumonia. Which of the following signs & symptoms would lead you to reach this conclusion? A. Fever, chills, & purulent sputum B. Moderate fever, nonproductive cough, & wheezing C. Belching, hiccoughs, and dysphasia D. Diaphoresis, hyperresonance, chest tightness, & difficulty speaking

A. Fever, chills, & purulent sputum

According to the psychosocial development model, at which age would an infant be least likely to cry when she is handed to her new babysitter? A. Four months B. Six months C. Eight months D. Ten months

A. Four months (An infant would be least likely to cry when introduced to a stranger at around 4 months, as stranger anxiety typically develops at around 6 months. Thus, the 6-month-old, the 8-month-old, & 10-month-old are more likely that the 4-month-old to have developed a fear of strangers, & would be more likely to cry when introduced to a new babysitter)

You have just administered the human papillomavirus vaccine to a 12yo pt. Regarding post vaccination mgmt, which of the following is recommended? A. Have the pt sit for @ least 15 min after vaccination B. Test for antibodies to the human papilloma virus C. Massage the injection site D. Follow up with a 2nd vaccine 2 months after the 1st dose

A. Have the pt sit for @ least 15 min after vaccination

Which of the following is dedicated to identifying disparities that prevent people from obtaining healthcare? A. Healthy People 2020 B. Collaborative practice C. Patient safety and quality improvement act D. Health insurance portability and accountability act

A. Healthy People 2020

Which of the following findings in a newborn would be least likely to indicate an abnormality? A. Heart murmurs B. White forelocks C. Wide fontanelles D. 4 junctional nevi clustered on trunk

A. Heart murmurs (Heart murmurs may present in 85-90% of all newborns; despite this high percentage, structural heart dz typically only presents in 8-10 live births out of 1000. White forelocks may indicate Waardenburg syndrome, whereas wide fontanelles may indicate hydrocephalus, Down syndrome, or hypothyroidism. Although junctional nevi may be present in newborns, groupings of the spots may signal a precursor tuberous sclerosis or generalized neurofibromatosis.)

A mother brings her adopted 6 yo to see you after he bruised his elbow bumping it on the kitchen counter. She became concerned the day after the injury b/c he said his elbow was tingling. After finding a normal CBC, you order a coagulation panel b/c you are most concerned about which disorder? A. Hemophilia B. Platelet disorder C. Anemia D. Leukemia

A. Hemophilia

A father brings his 10-year-old son in for an examination. He states that for the past 3 months, his son has been coughing all night and unable to sleep. The child is very fatigued at school & lacks the stamina to participate in sports. The father is concerned about the child's declining health. In your auscultation of the patient, you note wheezing in both lungs. Which of the following findings best directs you to asthma as the most likely cause? A. History of frequent upper respiratory infections B. Elevated temperature C. Palpable liver and spleen D. Elevated white blood count

A. History of frequent upper respiratory infections

Of the following, which eye disorder is characterized by an abrupt or sudden onset w/painful swelling on the lid margin? A. Hordeolum B. Strabismus C. Conjunctivitis D. Chalazion

A. Hordeolum

An infant present to the clinic w/angry red diaper rash w/satellite lesions. A KOH prep used to examine the lesion is negative. Your tx would consist of which of these methods? A. Hydrocortisone 1% cream B. Zinc oxide ointment C. Acyclovir 5% cream D. Nystatin 100,000 units/gram

A. Hydrocortisone 1% cream

A 15-year-old female comes to your office because she is worried that she may be pregnant. She says that she has been having menstrual irregularities & muscle cramps. She also reports that she is restless & that her hair has become fine. Regardless of her feeling "hungry all the time," you note that she has lost weight since her last checkup. Her tests indicate an elevated T3 level. What is the most likely diagnosis? A. Hyperthyroidism B. Hypothyroidism C. Type II diabetes D. Type I diabetes

A. Hyperthyroidism (p. 143)

Which of the following does not commonly impact temperature stability & regulation in a child? A. Increased subcutaneous tissue w/increased evaporative heat loss B. Decreased body surface area to mass ratio C. Thinner skin D. Increased energy expenditure

A. Increased subcutaneous tissue w/increased evaporative heat loss (Temp stability in children is commonly impacted by their limited, no increased, SQ tissue w/evaporative heat loss, as well as a smaller BSA to mass ratio, thinner skin, & increased energy expenditure. D/t the fact that more energy is needed to facilitate proper growth, less energy is available for thermoregulation. These factors are important b/c they put children @ an increased risk of hypothermia.)

In what area of the brain do childhood tumors predominately occur? A. Infratentorial region B. Supratentorial region C. Tentorium cerebelli D. Occipital lobes

A. Infratentorial region

Joey, an 11 mo infant, is brought in by his mother b/c he's been sleeping more than usual. A PE indicates pallor, palpitations, & tachycardia. In discussing recent events w/the mother, she says that she has been alternating between breast milk & formula for Joey; when pressed for time & lacking formula, she gives him whole milk instead. After he responded well to the taste, she replaced breast milk whole cow's milk. Joey most likely has which of these dietary insufficiencies? A. Insufficient iron B. Insufficient folic acid C. Insufficient fiber D. Insufficient Vitamin D

A. Insufficient iron

A 5-year-old male has recently been diagnosed w/splenomegaly. Of the following, which is not usually associated with the signs & symptoms? A. Iron deficiency anemia B. Glucose-6-phosphate dehydrogenase deficiency C. Leukemia D. Sickle cell disease

A. Iron deficiency anemia (p. 133)

You are examining a 24 mo old African-American patient whose parents complain that she is "unusually tired". She has no history of chronic illness. The patient's history reveals that she was switched to whole milk @ 12 mo of age & she is currently drinking approximately 32 oz/day. Upon physical examination, you noticed pale conjunctiva but no hepatosplenomegaly. Laboratory results indicate the following: mean corpuscular volume = 76 fL; & mean corpuscular hemoglobin concentration = 31%. What is the most likely diagnosis given this information? A. Iron deficiency anemia B. Thalassemia C. Vitamin B 12 deficiency D. Sickle cell anemia

A. Iron deficiency anemia (p. 133)

Of the following options, which is not a differential diagnosis for a child with obesity? A. Juvenile idiopathic scoliosis B. Prader Willi syndrome C. Endocrine disease D. Medication-induced obesity (antipsychotics)

A. Juvenile idiopathic scoliosis

A toddler who presents w/iron deficiency anemia is also @ increased risk for lead poisoning d/t pica. After moving to a house built in 1965, the mother brings the child in for venous blood level testing. While going over the results, you explain that chelation therapy is not recommended b/c the toddler's venous blood level concentrations do not reach the threshold to treat with chelation therapy. What is the toddler's lead level? A. Level 35 mcg/dl B. Level 45 mcg/dl C. Level 65 mcg/dl D. Level 75 mcg/dl

A. Level 35 mcg/dl (Chelation therapy is recommended for venous blood level concentrations that meet or exceed 45 mcg/dL. At levels below 45 mcg/dL, removing led sources from the child's environment is considered to be more effective than chelation therapy. At levels above 70 mcg/dL, hospitalization for chelation, hydration & close observation is recommended.)

Your 13-year-old patient, Teresa, complains of cold intolerance & of having recently gained weight. You note that she has thinning hair &, upon further interview, you discover that she has impaired motor coordination. She also experiences hyperactive bowel sounds & constipation. Which drug should you use to treat her condition? A. Levothyroxine B. Metformin C. Thiourea D. Propranolol

A. Levothyroxine

You were treating an infant w/a painful, protuberant abdomen as well as a severe, chronic diarrhea that results in bulky & foul stool. Additionally, her appearance suggests fatigue, pallor, & failure to thrive. Which of the following could most likely cause all of the patient's signs & symptoms? A. Malabsorption B. Hirschsprung's disease C. Appendicitis D. Intussusception

A. Malabsorption (p. 76)

A patient of yours has a tall stature. His arm span is greater than his height. He also has thin extremities with a long narrow face. When you look into his mouth, you notice that he has a high arched, narrow palate. The patient wants to know if he has some sort of growth problem. According to the findings above, you know that the patient most likely has: A. Marfan syndrome B. DiGeorge syndrome C. Turner's syndrome D. Tay-Sachs disease

A. Marfan syndrome

Alex, an 11-year-old male, comes to your clinic for a physical examination. During the exam, you notes that his spine is severely curved in the lumbar & thoracic areas. Although the diagnosis is concurrent, you also know that this finding is most consistent with which of the following genetic conditions? A. Marfan syndrome B. Down syndrome C. Turner's syndrome D. DiGeorge syndrome

A. Marfan syndrome (Kyphoscoliosis, a combination of both kyphosis & scoliosis is a common phenotypic presentation of Marfan syndrome.)

All of the following are viral causes of pharyngitis & tonsillitis except: A. Mumps virus B. Respiratory syncytial virus C. Influenza A & B D. Epstein-Barr virus

A. Mumps virus (Although the mumps virus belongs to the same family as parainfluenza, which can produce pharyngitis & tonsillitis, it produces neither condition; the virus affects the salivary glands, genitals, & nervous system, rather than the throat & pharynx. RSV, EBV, & Influenza A & B are all viral causes of pharyngitis & tonsillitis.)

You are examining an infant w/red-brown vesiculopapular lesions & curved burrows on the head, neck, palms, & soles. The infant appears to have sensations of intense itching. Which of the following dermatologic conditions is the most likely cause of the infant's findings? A. Scabies B. Molluscum contagiosum C. Varicella zoster D. Atopic dermatitis

A. Scabies (p. 92)

Which of the following categories of burns often present as being moist? A. Second B. First & second C. First D. Second & third

A. Second (p. 80)

The term "pervasive developmental disorders" refers to a group of conditions that involve delays in the development of many basic skills. Children with these conditions often are confused in their thinking & generally have problems understanding the world around them. Which of the following is a factor leading to this condition? A. No known factor B. Failure of a parent to respond to their infant's cues C. Lack of maternal infant bonding D. An X-chromosome break

A. No known factor (Until more is known about the causes of pervasive developmental disorders, it is not possible to predict or prevent them. However, this is a child symptoms begin treatment, the better he or she will do it in the long run as early diagnosis & treatment improves outcomes.)

Following a routine, natural birth, you utilize the common appearance, pulse, grimace, activity, & respiration (APGAR) scoring method to determine the overall health of Mabel, a newborn African-American baby. You notice overall normal skin color, but there is a bluish tint on her hands & feet. With regards to her appearance, what is the appropriate Apgar score for Mabel? A. One B. Three C. Zero D. Two

A. One (p. 26)

A 5 yo is brought to your clinic by his mother b/c she is concerned about the multiple bruises on his extremities & back. The boy's mother also states that he looks pale. During your PE, you detect scattered, enlarged lymph nodes. Which of the following actions are you most likely to do? A. Order a peripheral smear B. Refer the patient to a hematologist-oncologist C. Do a bone marrow aspiration & biopsy D. Consult a child protective agency

A. Order a peripheral smear (A peripheral smear s/be ordered to detect malignant cells. If malignant cells are detected, the next step would be a referral to a hematologist-oncologist who would likely perform a bone marrow aspiration & biopsy. Although abuse must be considered, especially w/bruises on the back, enlarge lymph nodes would not be expected in suspected cases of child abuse.)

A 17 yo obese female undergoes a diabetes screening every 2 years. Which set of risk factors r/t the patient's heritage & MHx would best justify this screening? A. Pacific Islander w/polycystic ovarian dz B. Caucasian w/HTN C. Hispanic w/dysmenorrhea D. Native American w/hypotension

A. Pacific Islander w/polycystic ovarian dz (For individuals w/obesity & @ least 2 risk factors, screening for DM should typically be done q2y, beginning around the onset of puberty. 1 risk factor is being Asian/Pacific Islander, AA, Native American, or Hispanic. Signs of insulin resistance, evidenced by polycystic ovarian dz, acanthosis nigricans, HTN, or dyslipidemia, are also risk factors. Caucasians are not generally @ an increased risk of developing DM. Hypotension & dysmenorrhea are also not considered to be risk factors for DM.)

A 7 yo boy, Clark, presents w/a fever of 103. You have seen Clark for WCEs, as well as acute conditions, since he was 2 years old. You know that he has a history of multiple strep infections. Upon your PE, you note the presence of a red skin rash, & lab tests reveal an elevated erythrocyte sedimentation rate. Which of the following is the best treatment plan for the suspected condition? A. Penicillin B. Corticosteroids C. Intravenous gamma globulin D. Acyclovir

A. Penicillin

Which of the following is most likely to be c/by Chlamydia trachomatis? A. Pharyngitis B. Croup C. Infections mononucleosis D. Epiglottitis

A. Pharyngitis

Which of the following WCE screening test is usually performed between 4-6 years of age? A. Purified protein derivative B. Lead screening questionnaires C. Hematocrit D. Cholesterol

A. Purified protein derivative (p. 39)

While assessing a newborn, which of the following should cause you to consider coarctation of the aorta? A. Radio-femoral pulses delay B. Expiratory grunting C. Subcostal and intercostal retractions D. Delayed capillary refill

A. Radio-femoral pulses delay

A 6 yo male presents to your office w/a limp & complaints of pain in his groin. Upon further examination, you notice stiffness in the hip area on the affected side, as well as significant muscle tone loss in the upper thigh d/t limited motion. Which of the following diagnostics would be most helpful in confirming Legg-Calve-Perthes Dz? A. Radiograph B. Ultrasound C. Muscle biopsy D. Electromyography

A. Radiograph

For pts w/inadequate iron intake, most of what composes a pt's blood will be lower than normal in lab findings. What aspect of blood, however, may actually be found to increase? A. Red cell distribution width (RDW) B. Mean corpuscular volume (MCV) C. Mean corpuscular hemoglobin concentration (MCHC) D. Serum iron

A. Red cell distribution width (RDW) (Red cell distribution width (RDW) is increased as RBC may change in shape & size. Serum iron, mean corpuscular volume (MCV), mean corpuscular hemoglobin concentration (MCHC) will all be lower than normal in their lab results d/t lack of iron in the blood.)

Margaret, an 11 yo female diagnosed w/DM1 is experiencing hypoglycemia @ 3AM, & elevated blood sugar @ 7AM. What is the proper treatment for her? A. Reduce of eliminate the dose of insulin before bed B. Increase the dose of metformin before bed C. Add or increase the dose of insulin before bed D. Advise a snack before bed

A. Reduce of eliminate the dose of insulin before bed

Your pt has significant edema & ecchymoses around the elbow. After ordering a radiograph, you notice a fat pad sign on the x-ray but no visible fracture. What would be the best course of action to take regarding treatment? A. Refer the pt to ortho B. Administer NSAIDs C. Employ the RICE method D. Supinate the arm to correct subluxation

A. Refer the pt to ortho

During a physical examination, a newborn is found to have length, weight, & head circumference all at < 10th percentile for her age. All of the following factors should likely be considered as potential sources for her condition except: A. Residing at high altitudes B. Bacterial intrauterine infection C. Inborn errors of metabolism D. Congenital or chromosomal abnormalities

A. Residing at high altitudes (Symmetric intrauterine growth retardation (IUGR) presents w/length, weight, & head circumference < 10th percentile, whereas asymmetric IUGR presents w/weight < 10th percentile but length & head circumference w/in normal range; residing at high altitudes is more likely to produce asymmetric IUGR, d/t decreased O2 available to the fetus, than symmetric IUGR. Bacterial intrauterine infection, inborn errors of metabolism, & congenital or chromosomal abnormalities are known factors that may contribute to symmetric IUGR.)

Which of the following conditions is caused by an RNA virus? A. Rubella B. Erythema infectiosum C. Roseola infantum D. Red measles

A. Rubella (p. 95)

Which of the following are 2 psychosocial developments that are associated primarily w/adolescents? A. Sense of identity & narcissism B. Narcissism & desire to please adult figures C. Sense of identity & development of self-esteem D. Development of self-esteem & desire to please adult figures

A. Sense of identity & narcissism

When implementing the Guidelines for Adolescent Preventive Services in a WCE with a 16 yr old female, which piece of information would you be most likely to share with her parent? A. She mentions that she is depressed & wonders if life is worth living B. She had unprotected sex w/her boyfriend last month & is late for her period C. She has 3 best girlfriends & they have all started experimenting with marijuana D. She thinks her mother's new boyfriend is creepy

A. She mentions that she is depressed & wonders if life is worth living (Confidentiality s/be assured when implementing GAPS but the NP is expected to disclose information if there is a concern about a patient hurting herself or someone else.)

A 16yo male, w/no abnormalities in his medical records, presents w/ unusual body proportions & underdeveloped sexual characteristics. A blood test indicates Klinefelter syndrome. Which of the following is not a typical feature of Klinefelter syndrome? A. Short stature B. Learning disability C. Gynecomastia D. Hypogonadism

A. Short stature (Klinefelter syndrome is a genetic disorder involving only males w/an extra X-chromosome. This disorder is known to cause tall rather than short stature. S/S include hypogonadism, learning disabilities, & gynecomastia. Other manifestations include a simian crease & personality impairment. short stature is not a finding of Klinefelter syndrome; rather it is usually present in those w/Turner syndrome.)

You are examining a 2 1/2 mo infant named Jessica. Which of the following reflexes would not expect Jessica to display? A. Stepping reflex B. Fanning of the toes when bottom of foot is stroked C. Flinging arms to the sides when startled D. Tonic neck reflex

A. Stepping reflex

What is the most common etiology of pneumonia in children 1-3 yo? A. Streptococcus pneumoniae B. Mycoplasma C. Group B Streptococcus D. Haemophilus influenzae

A. Streptococcus pneumoniae

Kasey, age 7 months, is bought to the clinic by her concerned parents. They have been talking to other parents in their parenting group & need reassurance that Kasey is keeping up developmentally. As you observe Kasey, you notice that she responds to her name, consistently babbles, crawls around on the floor, & is able to pick up objects. Which of the following additional milestones would also be expected in a child her age? A. Supports weight on feet B. Holds head steady C. Equal coordination of hands D. Plays independently

A. Supports weight on feet (A child exhibiting the milestones of a 6-9 month old, as evidenced by crawling, babbling, picking up objects, & responding to her name, is likely to be able to support her weight on her feet. The ability to hold her head steady by 2-5 months; play independently & exhibit equal coordination in her hands by 10-12 months.)

Which of the following genetic disorders is most found in the Ashkenazic Jewish population? A. Tay-Sachs disease B. Marfan's syndrome C. XXY syndrome D. Trisomy 21

A. Tay-Sachs disease (p.23)

An Ashkenazic Jewish couple comes to your office with their 8 month old boy. Their child, Ezra, was healthy at birth, but, in the last few weeks, he appeared to be losing his eyesight and hearing. He does not seem to recognize his parents, & he reaches out wildly & without purpose. The baby also does not turn his head when called or respond to sounds. You note that the baby has low muscle tone & seems listless. Which of the following should be a part of your ddx? A. Tay-Sachs dz B. DiGeorge syndrome C. Turner syndrome D. Marfan syndrom

A. Tay-Sachs dz

You were reading a peer-reviewed journal article about predictors of birth length. In 95% of identical experiments, neonates measure 49.2 cm @ birth, plus/minus .05 cm. The value 49.2 plus/minus .05 is known by what statistical term? A. The confidence interval B. The correlation C. The level of significance D. The standard deviation

A. The confidence interval (p. 169)

Which of the following findings would most strongly indicate that a febrile infant is moderately ill? A. The infant has a temperature of 101.8 but smiles often. B. The infant is fussy but calms quickly when offered support. C. The infant appears listless & doesn't feed well. D. The infant has a temperature of 103 but appears alert & active.

A. The infant has a temperature of 101.8 but smiles often. (Moderately ill infants typically display irritable or fussy behavior & have a fever below 102, yet are easy to console, may smile, & continue to feed normally. Infants that present w/ fever above 100.4 but smile, feed normally, & appear alert & active are typically classified as mildly ill. Severely ill infants normally present w/fever > 104, these infants often appear listless, may not feed at all or feed poorly, & are typically recommended for hospital admission.)

Which of the following findings would most strongly indicate that a febrile infant is moderately ill? A. The infant has temp of 101.8 F but smiles often B. The infant is fussy but calms quickly when offered support C. The infant appears listless & does not feed well D. The infant has temp of 103 F but appears alert & active

A. The infant has temp of 101.8 F but smiles often (Moderately ill infants typically display irritable or fussy behavior & have a fever < 102 F, yet are easy to console, may smile, & continue to feed normally. Infants that present w/temp > 100.4 but smiles, feed normally, & appear alert & active are typically classified as mildly ill. Severely ill infants normally present w/ temp > 104, these infants often appear listless, may not feed at all or feed poorly, & are typically recommended for hospital admission)

A NP friend of yours comes to you worried because her office has been receiving a total reimbursement of the Physician Fee Schedule for her services rendered even though she assigned her billing rights to the office. she thinks there may be fraudulent billing & asks for your advice. You tell her that there is nothing to worry about because: A. The office most likely billed under the physician's Medicare provider code. B. Medicare recently changed the rules to allow for total reimbursement of the Physician Fee Schedule for NPs C. Assigned billing rights allows for total reimbursement of the Physician Fee Schedule. D. Legislators have finally recognized the invaluable services provided by NPs & added provisions to reimburse NPs 100% of the Physician Fee Schedule

A. The office most likely billed under the physician's Medicare provider code. (Medicare payments reimburse 85% of the Physician Fee Schedule if the NP directly bills Medicare w/his/her Medicare provider number; however, 100% of the Physician Fee Schedule rate may be reimbursed for services rendered, including those provided by an NP, if the supervising physician provides his/her Medicare provider number for billing purposes. Assigning billing rights to the office does not satisfy the necessary conditions for 100% reimbursement. Currently, legislators & Medicare still allow for only 85% reimbursement of the Physician Fee Schedule to NPs.)

You are treating a overweight 7 yo Hispanic female diagnosed w/HTN. She has a FHx of DM2. Which of the following is true regarding risk factors & screening for DM2 for this patient? A. The patient should not be screened until age 10 or onset of puberty B. The patient s/b screened ASAP d/t her HTN C. The patient should have been screening before the age of 7 D. The patient s/b screened ASAP d/t risk factors r/t her ethnicity

A. The patient should not be screened until age 10 or onset of puberty

Management of symptoms in infants w/GERD is more likely to include which of these in non-severe cases? A. Thickening of feedings B. Histamine 2-receptor antagonist C. A diet that either reduces or eliminates protein D. Switching to hydrolyzed or amino acid-based formula

A. Thickening of feedings

Which asthma pt would you be most likely to treat w/a short course of oral systemic steroids? A. Tinh, 6yo female, whose ratio of FEV1/FVC is 79% B. Nathan, 7yo male, who uses his short-acting beta agonist 3 times/week for symptom control C. Mateo, 3yo male, whose nighttime symptoms wake him up an average of 2 times/month D. Brigid, 10yo female, whose predicted FEV1 is 82%

A. Tinh, 6yo female, whose ration of FEV1/FVC is 79% *A short course of oral systemic corticosteroids should be considered for pediatric pts w/moderate persistent or severe persistent asthma; therefore, a 6yo child whose ratio of FEV1/FVC capacity is 79%, which is an indicator of moderate persistent asthma in this age range, is likely to be prescribed oral systemic corticosteroids. Children w/mild persistent asthma are likely to be prescribed a low-dose ICS. A 7yo who uses a SABA for symptom control > 2 d/wk but not daily has mild persistent asthma. A 3yo who experiences nighttime awakenings 1-2 times/mo also has mild persistent asthma. A 10yo whose predicted FEV1 is 82% would be classified as having mild persistent asthma as well.)

What is the purpose of case management (CM)? A. To mobilize, monitor, & control resources used by patients during illness B. To establish the qualification & mastery of skills of NPs C. To review health care cases so as to improve patient safety D. A management process of monitoring, evaluating, continuous review, & improving quality in health care

A. To mobilize, monitor, & control resources used by patients during illness (CM is a comprehensive & systematic approach to providing quality health care that balances the quality & cost of resources used by the pt during the course of his/her illness. A management process of monitoring, evaluating, continuous review, & improving quality in health care is quality improvement, while establishing the qualification & mastery of skills of NPs is the purpose of certification. Reviewing health care cases so as to improve patient safety is one of the objectives of the The Patient Safety & Quality Improvement Act (PSQIA).)

Which of the following is not true regarding breast-feeding? A. Transfers the daily requirement of vitamin D to the infant B. Decreased illnesses in the infant C. Positively affects the baby's immune system D. Unique nutritional source

A. Transfers the daily requirement of vitamin D to the infant (p. 6 - 400IU/day @ 2 months thru the lifespan)

If a baby has a heart murmur similar to those heard in a patient w/a ventricular septal defect & his echocardiogram indicates right ventricular hypertrophy, what would be the most likely diagnosis? A. Transposition of the great arteries B. Tetralogy of Fallot C. Atrial septal defect D. Patent ductus arteriosus

A. Transposition of the great arteries (p. 65)

Angela brings in her son, Jonathan, a 5 mo old infant. He has been scratching himself constantly, especially now that it is winter. A physical examination indicates very small, firm, pink to flesh-colored discrete papules on his trunk & face. Which of the following is the best treatment specifically for the patient's lesions? A. Tretinoin B. Hydrocortisone C. Triamcinolone D. Desonide

A. Tretinoin (p. 87 Mulluscum Contagiosum)

Which of the following is most likely if you have a patient w/a webbed neck, lymphedema, & low hairline, w/hypertension & learning disabilities? A. Turner's B. Marfan C. Klinefelter's D. DiGeorge

A. Turner's (p. 23)

Which type of diet practiced by adolescents warrants the closest monitoring by parents? A. Vegetarian B. High-protein C. Lactose-free D. Pescetarian

A. Vegetarian (This diet may not provide all nutritional requirements. Alternative sources of protein, fatty acids, calcium, zinc, iron, & vitamins B12 & D may need to be incorporated into the diet.)

If a newborn's mother is HBsAg-positive, when should the NP order the hepatitis B vaccine for the newborn? A. Within 12 hours after birth B. Prior to home discharge C. One week after birth D. Not until 1 year of age

A. Within 12 hours after birth (If mom is HBsAg-positive —give Hep B vax w/in 12 hours of birth. If the mom is a hepatitis B carrier the new born would still need the vax shortly after birth. If mom tests positive and her status was previously unknown — give hepatitis B immune globulin no later than 1 week of age.)

What would be the correct dose of influenza vaccine for children 6 - 35 months of age? A. 0.15 ML B. 0.25 ML C. 0.10 ML D. 0.20 ML

B. 0.25 ML (p. 18)

What is the maximum APGAR score that can be given to a newborn baby upon assessment? A. 5 B. 10 C. 20 D. 12

B. 10 (p. 25)

By what age would a lack of awareness of cars & animals be 1st considered a developmental delay? A. 1 year B. 2 years C. 3 years D. 4 years

B. 2 years

What is the average age by which toddlers achieve daytime control of bowel & bladder movements? A. 18 months B. 2 years C. 2.5 years D. 3 years

B. 2 years (The age when they are physiologically & psychologically ready for toilet training is 18 months, they are able to control it by 2 years but often are not completely trained. Nighttime control is about 3 years or approx 1 year after daytime control is achieved.)

At what age does taking a blood pressure reading usually become a part of the WCE? A. 2 years B. 3 years C. 4 years D. 5 years

B. 3 years

A parent wants to know when the best time is to give the medicine being prescribed for ADHD. Your instructions are based on your knowledge that the earliest onset of action after the infection of methylphenidate in children is usually: A. 15 minutes B. 30 minutes C. 45 minutes D. 90 minutes

B. 30 minutes

Sam, a toddler, arrives at the clinic to see the NP for a regular check up. The NP asks his name, to which the boy replies, "My name is Sam!". Next, the NP asks Sam whether he is a boy or a girl, and Sam says, "I'm a boy!" The NP then asks Sam what he had for breakfast, & Sam says, "I had Fruit Loops with lots of milk, eggs, & juice, my favorite!" Finally, when the NP asks the boy to sing a nursery rhyme with her, he cannot. Assuming that Sam is on track in his language & communication development, what would you estimate Sam's age to be? A. 4yo B. 3yo C. 5yo D. 1yo

B. 3yo (If Sam is developing at an average pace, then he is most likely 3yo. At this age, one would be able to follow instructions w/2 or 3 steps & say one's name, age, & sex. Additionally a 3yo child should be able to hold a conversation using 2-3 sentences. At 4yo, a child would command greater communication skills & know basic rules of grammar, such as correctly using "he" & "she". A 4yo child should also be able to sing a song or say a poem such as "Itsy-Bitsy Spider". A 5yo child should have a greater grasp of language. He/she should be able to speak clearly and tell a simple story using full sentences. A 5yo child should be able to use future tense & repeat their name & address as well. A 1yo child, however, would have a much smaller grasp of language than a 3yo child. He/she would respond only to simple spoken requests & use simple gestures like shaking the head, waving goodbye, or saying "mama".)

Between what ages should typical pediatric patients 1st receive a purified protein derivative test for tuberculosis? A. 2-4 years B. 4-6 years C. 6-8 years D. 8-10 years

B. 4-6 years

The Bayley-III test is the standard test for the diagnosis of developmental delays in children until what age? A. 48 months B. 42 months C. 36 months D. 24 months

B. 42 months (p. 42)

You are examining a smiling & cooing baby who grabs the stethoscope from around your neck w/1 hand & transfers it to her other hand. Which of the following age ranges is typically when babies develop or begin to develop disability? A. 4 - 5 months B. 5 - 6 months C. 3 - 4 months D. 2 - 3 months

B. 5 - 6 months (p. 11)

Holly, age 4, is at a WCE. During the visit, her weight is recorded as being 40 lb. Assuming expected growth parameters, how much will Holly most likely weigh in 2 years? A. 60 lb B. 52 lb C. 45 lb D. 42 lb

B. 52 lb (School age children typically gain around 5-7 lbs annually. Therefore 40 + 10 = 50 & 40 + 12 = 52 so closest answer is B - 52 lbs.)

You are examining a post-pubertal child w/café au lait macules & are determining if he has neurofibromatosis type 1. Which of the following physical findings would lead you to suspect that he has this disease? A. 6 café au lait macules measuring at least 6 mm & a father w/the condition B. 6 café au lait macules measuring at least 16 mm & 3 iris Lisch nodules C. 7 café au lait macules measuring at least 6 mm & 3 cutaneous neurofibromas D. 4 café au lait macules measuring at least 15 mm & distinct osseous lesions

B. 6 café au lait macules measuring at least 16 mm & 3 iris Lisch nodules (p. 28)

The most likely weight of a 1-year-old child whose weight @ birth was 6 pounds would be: a. 19-20 pounds b. 13-14 pounds c. 25-26 pounds d. Impossible to estimate

a. 19-20 pounds (An infant's weight should approximately triple by the age of 1 year.)

A concerned father says that his daughter recently turned 5 years old, & he has noticed she is beginning to stutter. The NP tells the father that his daughter's condition is probably normal, but you will be watching w/him to see if it persists or if she avoids speaking. As the NP, you know that it is usually acceptable to wait before referring the child for her stuttering until how long? A. 3 months B. 6 months C. 9 months D. 12 months

B. 6 months (It should be evaluated if the child continues stuttering for 6 months or avoids speaking.)

The mother of a 2 month old pt says that their family is relocating to Japan to pursue a long-term business opportunity. You know that the majority of Japan does not practice water fluoridation. You recommend that the mother incorporate fluoride supplementation of 0.25 mg/day into her child's diet, starting at what age? A. 3 months B. 6 months C. 1 year D. 3 years

B. 6 months (The AAP recommends that in areas w/little to no water fluoridation, children s/be started on fluoride supplementation @ 6 months, w/a daily dose of 0.25 mg. Supplementation is not required for the 1st 6 months of life, meaning 3 months of age is too early to introduce fluoride. By 1 year of age, the patient should already be receiving 0.25 mg/day. From 3-6 years of age, children should receive 0.50 mg/day of fluoride.)

What feature best distinguishes the characteristic murmur of patent ductus arteriosus? A. A holosystolic thrill @ the LLSB B. A "machinery" noise @ the LUSB C. An ejection murmur w/radiation to the left interscapular area D. A click @ the LUSB that decreases w/inspiration & increases w/expiration

B. A "machinery" noise @ the LUSB

Marge & Homer have brought their 3-day old son, Bartholomew, in for a WCE. Which of the following would you be least likely to conduct at this visit? A. Measure head circumference B. A tuberculosis screening C. Examine mouth & throat D. A jaundice examination

B. A tuberculosis screening (p.34)

You ask Samuel, a toddler, to point to one body part & he points directly to his elbow. Samuel's mother states that he just started correctly pointing to body parts last week. If Samuel is properly reaching expected developmental milestones, he would most likely be: A. About 13 months old B. About 18 months old C. About 20 months old D. About 2 years old

B. About 18 months old (A properly developing toddler would be expected to point to his body parts @ 15-18 months old. A 13 month old can typically walk & understand a few words, but would not be expected to point to body parts. A 20 month old & a 2 year old would already be expected to be able to properly indicate parts of their body.)

A mother has just given birth to her infant daughter. The mother's chart indicates that she is positive for HBsAg. Regarding hepatitis B vaccination, which of the following is the correct action to take initially? A. Arrange an appointment for the mother to bring her daughter in for hepatitis B vaccine when her child is 1 - 2 months of age B. Administer the hepatitis B vaccine & 0.5 ML hepatitis B immune globulin within 12 hours C. Test for HBsAg & antibody to HBsAg in the infant D. Administer the hepatitis B vaccine before the child discharges & follow up with another 2 vaccinations given 2 & 6 months of age

B. Administer the hepatitis B vaccine & 0.5 ML hepatitis B immune globulin within 12 hours (Infants born to HBsAg positive mother should receive the hepatitis B vaccine (HepB) & 0.5mL hepatitis B immune globulin w/in 12 hours of birth. All newborn children should receive the 1st dose of HepB before hospital discharge. The 2nd dose, not initial dose, should be given at 1-2 months of age. Administering the hepatitis B vaccine before the child discharges, & then following up w/another 2 vaccinations given at 2 & 6 months of age is that correct dosing series for a child born to HBsAg negative mothers, but incorrect for those born to HBsAg positive mothers. Testing for HBsAg & antibody to HBsAg in the infant is a necessary action only after the child has received 3 or more doses HepB vaccine.)

Which of the following standardized test may be performed by parents w/no formal training? A. Denver Developmental Screening Test II B. Ages & Stages Questionnaire C. Bayley Scales of Infant Development D. Newborn Behavioral Assessment Scale

B. Ages & Stages Questionnaire

Which of the following standardized tests may be performed by parents w/no formal training? A. Denver Developmental Screening Test II B. Ages & Stages Questionnaire C. Bayley Scales of Infant Development D. Newborn Behavioral Assessment Scale

B. Ages & Stages Questionnaire (The Ages & Stages Questionnaire is a standardized test that may be utilized by parents or care takers & does not require a professional. The Denver Developmental Screening Test II & the Bayley Scales Of Infant Development test typically require the employment of professionals. The Newborn Behavioral Assessment Scale may be performed by Brazelton-certified individuals.)

Which of the following diagnostics is least likely to indicate a diagnosis of rheumatic fever? A. EKG B. Aldosterone level C. Echocardiogram D. Throat culture

B. Aldosterone level

Which of these couples in the early stages of their pregnancy would least require a genetic screening for mutations in the HEXA gene? A. An Inuit mother & Louisiana Cajun father B. An African-American mother & a Druze father C. An Ashkenazi Jewish mother & a Scots-Irish father D. A Pinoy mother & a French Canadian father

B. An African-American mother & a Druze father (The mutations at the HEXA gene can result in Tay-Sachs dz, most commonly found in Ashkenazi Jewish, French Canadians, Louisiana Cajuns.)

A child with a h/o rheumatic fever presents with syncope. A grade II, systolic thrill is heard at the right upper sternal border. The NP also hears a consistent systolic ejection click. The child's x-ray indicate left ventricular hypertrophy. Which of the following is the most likely diagnosis? A. Ventricular septal defect B. Aortic stenosis C. Pulmonic stenosis D. Group A Beta-hemolytic streptococcus infection

B. Aortic stenosis

You are examining a 10yo boy who is presenting w/epigastric pain & low grade fever. The pt's mother indicated that the pt has been feeling ill all week & vomited just today before the visit. The pain worsens w/coughing & localizes to the RLQ. Suspicious, you extend the pt's right thigh, which causes him to cry out in pain. Which of the following is the most likely diagnosis? A. Acute gastroenteritis B. Appendicitis C. Testicular torsion D. Gastroesophageal reflux dz

B. Appendicitis

You are weighing the benefits of performing invention on a patient & conclude that the quality of benefit the intervention will produce would be extremely poor. Which of the following is the correct definition of this type of intervention? A. Sentinel event B. Qualitative futility C. Quantitative futility D. Patient medical abandonment

B. Qualitative futility

A 5 yo patient is brought to your clinic w/extensive 2nd deg burns. The burns cover the entirety of the back of his head but do not extend any further than that. Approximately how much of his body has been burned? A. ~ 6% B. ~ 7% C. ~ 9% D. ~ 10%

B. Approximately 7% (For a 5 yo child, the back of the head is commonly considered 7% of the surface area of the skin. The surface area of a child's head, thighs, & legs changes during early development, & thus has varying values based on age. The back of the head would typically be considered 10% of total skin surface area in a newborn, 9% in a 1 yo, & 6% in a 10 yo.)

The mother brings her 5yo child, who is coughing out yellow-tinged mucus, to your clinic. Yesterday, both vomiting & diarrhea occurred. During a physical exam, you discover a high fever. The patient appears ill & lethargic, & crackles are heard over the right lower lobe by auscultation. An x-ray reveals infiltrates. Which of the following conditions most accounts for all the patient's signs & symptoms? A. Epiglottitis B. Bacterial pneumonia C. Pulmonary edema D. Sinusitis

B. Bacterial pneumonia (p. 114)

A 9 mo boy is brought to your office by his parents. The infant has a history of irritability, crying, & flexing his legs upwards while kicking his feet in the air. These episodes have become more frequent in the last few hours. A sausage-shaped mass is palpable over the infant's abdomen; you note streaks of blood & mucus in his diaper. Which of the following diagnostics is most likely to be used to confirm the most likely diagnosis? A. Complete blood count B. Barium enema C. Urine catecholamines D. Rectal biopsy

B. Barium enema (p. 74)

The parents of 8-year-old Morris are worried about his adjustment to school. He has not exhibited dysfunctional behavior yet, but his older brother, who is now 20, did. Which of the following is not a developmental warning sign for younger school children? A. Frequent need to stay home from school B. Being a picky eater C. Not working too ability D. Poor adjustment to school

B. Being a picky eater (p.49)

Which test or exam should be performed @ every female adolescent WCE regardless of personal or family medical history? A. Scoliosis assessment B. Blood pressure C. Liver function tests D. A pelvic exam

B. Blood pressure

A worried mother brings her 2yo daughter whose slight symptoms of a cold have progressed into a prominent cough, quick breathing, & wheezing. Which of the following would be your best diagnosis? A. Reflux B. Bronchiolitis C. Strep throat D. Seasonal allergy

B. Bronchiolitis

You have a 2yo patient who has an upper respiratory infection. Findings include a fever of 102 & signs of respiratory distress, including nasal flaring, grunting, & prolonged expiration a physical exam indicates a palpable liver & spleen. You would most expect to see which of the following is the patient's signs & symptoms are the result of a condition that could've caused all of these? A. Productive cough B. Chest x-ray with hyperinflated lungs C. Slight white blood cell á w/eosinophilia D. Peak flow < 60 L/min

B. Chest x-ray with hyperinflated lungs (p. 110-11)

A 6 yo pt arrives at your clinic w/a painful limp that seemed to develop out of nowhere. While examining the pt, you discover that the internal rotation of the hip causes spasms. Suspecting toxic synovitis, you order a series of lab panels & imaging studies for confirmation. Which of these procedures would not typically be ordered? A. US B. Creatine kinase test C. MRI D. ESR

B. Creatine kinase test (Creatine kinase determination is used to detect inflammation of muscles, not joints, & would serve little use in confirming a dx of toxic synovitis. The presence of inflammation stemming from toxic synovitis is usually detected through a CBC, an ESR, or a C-RP. US is used to detect intracapsular effusion, whereas MRI is used to r/o other potential causes of pain.)

An 8-year-old patient with asthma presents with coughing & shortness of breath. The child was playing tag but immediately left the group of children due to the severity of his symptoms. Which of the following should a NP expect regarding this child's forced expiratory volume in one second? A. Decreased volume of gas remaining in lungs after maximal expiration B. Decreased volume of gas expelled in the first second of the forced vital capacity maneuver C. Increased volume of gas expelled in the first second of the forced vital capacity maneuver D. Maximal air flow rate achieved in forced vital capacity maneuver

B. Decreased volume of gas expelled in the first second of the forced vital capacity maneuver

Which of the following is the first component of quality assurance? A. Collecting & organizing data B. Delineating the scope of care C. Assessing the effectiveness of an action D. Establishing thresholds for evaluations related to the indicators

B. Delineating the scope of care (Once a quality management plan is developed, the next step in quality assurance is to delineate the scope of care, making collecting & organizing data the correct answer. The remaining steps are, in the following order, establishing thresholds for evaluations r/t the indicators, delineating the scope of care, and assessing the effectiveness of an action.)

The mother of a toddler complains that her child is a picky eater, &, despite evidence of a healthy growth pattern, she is concerned about her child's nutrition & diet. Which of the following is most accurate regarding toddler nutrition? A. Parents of toddlers should insist their children clean their plate & consume 90 kcal/kg/day B. Despite being picky eaters, toddlers should consume 100 kcal/kg/day C. Toddlers should consume more protein & a total of 115 kcal/kg/day D. Toddlers are very active & require more calories than infants

B. Despite being picky eaters, toddlers should consume 100 kcal/kg/day (p. 5, 70-100 kcal/kg/day)

Melanie, an 8-month-old baby, comes to the clinic with bluish skin & a cleft palate. The pediatric NP notes that the baby has twitching around her mouth with spasms on her hands and arms. Melanie's parents also report seizures. Upon further observation & interview, the NP learns that the baby is also developmentally delayed in many areas. Which of the following should be a part of your differential diagnosis? A. Tay-Sachs dz B. DiGeorge syndrome C. Marfan syndrome D. Turner syndrome

B. DiGeorge syndrome

During routine screening, a 22 mo old patient shows signs of short stature. The MHx, which reveals poor weight game & recurrent GI symptoms that include vomiting & chronic diarrhea, lead you to suspect celiac dz. Which of the following findings would enable you to establish the dx & determine the etiology of the patient's short stature? A. Human leukocyte antibodies B. Endomysial antibodies C. Serum antinuclear antibodies D. Growth hormone antibodies

B. Endomysial antibodies

A mother brings her 1 yr old to your practice, claiming that the child has had a fever for 6 days. She thought it was a simple illness at first, but she has noticed recent swelling in the hands & feet. An examination shows that the child has inflammation in the lips & oral cavity, as well as redness in both eyes w/out exudate. To rule out Kawasaki dz, which test would best help to isolate the child's most likely condition? A. Hemoglobin & hematocrit level B. Erythrocyte sedimentation rate C. WBC D. Blood urea nitrogen

B. Erythrocyte sedimentation rate

Of the following, which is a necessary guideline for interviewing adolescents in a clinical setting? A. Having the adolescent fill out a questionnaire at the same time. B. Excluding the parents from the interview with the adolescent C. Advising the adolescent that his/her parents are privy to what was discussed in the interview D. Having the parents & the adolescent in your office for a meeting

B. Excluding the parents from the interview with the adolescent

A 1 mo patient presents w/chronic cough, nasal passages filled w/mucus, & a respiratory infection. You find an obstructive pattern in the pulmonary functions test. A chest x-ray indicates atelectasis in the right lung. You try to look for more signs to confirm your suspected diagnosis. Of the following findings, which would not help you confirm the most likely diagnosis? A. Large, liquid, bulky, foul stool B. Fever C. Hepatosplenomegaly D. Salt-tasting skin

B. Fever (p. 115)

A 9yo male & his mother present to your office. The boy explains that he has been having trouble breathing & keeping up with the other children on his soccer team. His mother noticed him wheezing & states, " I'm afraid he might have asthma." Which pulmonary function test results would confirm these suspicions? A. Forced expiratory volume (FEV) in 1 second of 1.4 liters & a forced vital capacity (FVC) of 1.7 liters B. Forced expiratory volume (FEV) in 1 second of 1.8 liters & a forced vital capacity (FVC) of 2.9 liters C. Forced expiratory volume (FEV) in 1 second of 2.8 liters & a forced vital capacity (FVC) of 3.5 liters D. Forced expiratory volume (FEV) in 1 second of 1.0 liters & a forced vital capacity (FVC) of 1.2 liters

B. Forced expiratory volume (FEV) in 1 second of 1.8 liters & a forced vital capacity (FVC) of 2.9 liters (A FEV1 of 1.8 liters & a FVC of 2.9 liters indicates a FEV1/FVC of 62%, well below the threshold of 75-80% ratio of healthy individuals. Low FEV1/FVC ratios usually indicate an obstructive pulmonary dz. In the case of this pt, the low ratio, which indicates moderate obstruction, along with the other symptoms, most likely indicates asthma. The FEV1/FVC ratio of 1.0 liter & 1.2 liters, respectively, is 83%. The FEV1/FVC ratio of 2.8 liters & 3.5 liters, respectively, is 80%. Lastly, the FEV1/FVC ratio of 1.8 liters & 2.9 liters, respectively, is 82%.

Which of the following characteristics is not typically associated w/febrile seizures? A. Fever w/rectal temp of 102 or greater B. Generally manifests in early infancy by 3 months of age C. There is usually a FHx of febrile seizures D. There is typically a loss of consciousness w/this type of seizure

B. Generally manifests in early infancy by 3 months of age

An 18 mo old child's feet have an inward-turned appearance. Which of the following would most likely not be associated w/the patient's condition? A. Metatarsus adductus B. Genu valgum C. Adducted great toe D. Tibial torsion

B. Genu valgum (p. 40)

When diagnosing a heart defect with an x-ray, increased pulmonary vascular markings are oft-noted finding. Which of the following is most associated with the acyanotic atrial septal defect? A. Left ventricular hypertrophy B. Grade II systolic ejection murmur heard at left upper sternal border C. Holosystolic thrill felt at the left lower sternal border D. "Egg on a string" with cardiomegaly

B. Grade II systolic ejection murmur heard at left upper sternal border

Robin & Mindy bring in their 8-week old son, Jonathan, because he is irritable & his skin is warm to the touch. Taking his temperature, you discover it is 102.0. Which of the following is the most likely cause of the patient's signs and symptoms? A. Influenza A B. Group A Beta-hemolytic streptococci C. Respiratory syncytial virus D. Epstein-Barr

B. Group A Beta-hemolytic streptococci (p. 387)

A toddler recently diagnosed as anemic is found to have reticulocyte count of 0.3%. All of the following may explain these findings except: A. Iron deficiency anemia B. Hemolytic anemia C. Folic acid deficiency D. Bone marrow failure

B. Hemolytic anemia (In hemolytic anemia, the destruction of RBCs causes the bone marrow to produce an elevated reticulocyte count. A reticulocyte count of 0.3% is below the normal range of 1-2%. Allow reticulocyte count may indicate IDA, folic acid deficiency, or bone marrow failure.)

You are treating a 24-month-old infant who has completed her PCV13 series. All of the following are possible preexisting conditions that would require administration of one dose of the 23PS formulation except: A. Chronic cardiac dz B. Hepatitis B C. Renal failure D. Asplenia

B. Hepatitis B (Other conditions that may require the 23PS would be, splenic dysfunction, HIV, nephrotic syndrome, pulmonary dz, & DM.)

Donovan has Down's syndrome. Which of the following is a genotypic presentation of Down's syndrome in Donovan? A. Protruding tongue B. Homozygous for a single transverse palmar crease C. Upward slanting eyes D. Inner epicanthal folds

B. Homozygous for a single transverse palmar crease (p. 22)

Your nephew, Ben, is 8 years old & just joined the Cub Scouts. He is proud of his uniform & eager to earn his badges. Ben's latest assignment is to make a birdhouse, & he has been working hard at it all afternoon. Which of Erik Erickson's psychosocial stages would best describe Ben? A. The latency stage B. Industry versus inferiority C. Concrete thinking D. Initiative versus guilt

B. Industry versus inferiority

Which of the following conditions does not have a bacterial etiology? A. Epiglottitis B. Infectious mononucleosis C. Acute otitis media D. Conjunctivitis

B. Infectious mononucleosis

Which of the following is true regarding Turner's syndrome? A. It presents as a result of the mutations in the HEXA gene B. It is the most common sex-chromosome anomaly found in females C. It typically presents with tall stature & kyphoscoliosis D. It typically presents w/increased risk of infection d/t thymus aplasia

B. It is the most common sex-chromosome anomaly found in females (HEXA gene - Tay-Sachs; Tall stature, kyphoscoliosis - Marfan; increased risk of infection d/t thymus aplasia - DiGeorge)

In the middle of a busy morning schedule, a mother brings in her 6-year-old son and says that he has trouble breathing. While examining him, you notice the child frequently opens his mouth & sticks out his tongue as if he were choking. According to the mother, he also has had a high fever that appeared just yesterday. The pulse oximetry placed on his finger reads 90. Which of the following is the best course of action at this time? A. Administer oxygen and an injection of ceftriaxone B. Keep the child in a sitting position & arrange for STAT transport to the hospital C. Administer oxygen & examine the throat for foreign objects D. Lay the child in a comfortable position & give a breathing treatment

B. Keep the child in a sitting position & arrange for STAT transport to the hospital

When treating a child prone to seizures an NP should primarily keep which childhood anatomical feature in mind? A. Smaller circulating blood volume B. Large tongue compared to the oropharynx C. A thin cranium D. Large head in comparison to body proportion

B. Large tongue compared to the oropharynx (Developmentally, the tongue of a child is often comparatively > than the oropharynx, which can protectively cause obstruction during a SZ & may lead to severe repercussions attributed to O2 loss. Children have a smaller circulating blood volume in absolute terms, but this is primarily a concern in cases of blood loss or bacterial infection no SZ. Children have thinner craniums, which would place them @ > risk of head injury if the skill is penetrated' this may present a concern during convulsions, but is < of a concern that the risk of obstruction. Lastly, a child's large head, in comparison to the child's body, accounts for a smaller body surface area when compared w/an adult, but this doesn't greatly influence potential complications from SZ)

You are treating a 14yo soccer player for transient knee pain. His father tells you that the boy's ability to kick has declined recently because of tightness in his hamstrings. He adds that the boy is upset about falling behind his peers on the team & would like to be able to participate again ASAP. Looking @ the boy's chart, you see that he has grown 2 1/2 inches in the last 6 mo. Based on the most likely diagnosis, which of the following treatments is most appropriate for this pt? A. Complete restriction of activity until the end of growth spurt. B. Limit physical activity C. No treatment is necessary D. Surgical excision of bursa & referral to orthopedic surgeon

B. Limit physical activity (The most likely dx is Osgood-Schlatter dz. However, the tightness in the hamstrings warrants a recommendation of limiting activity. In children, Osgood-Schlatter dz is self-limiting, so surgical intervention is almost never recommended. Likewise, complete activity restriction is not recommended until after the child's growth spurt.)

Your pt, a 2yo boy, presents w/ fever of 102F & a noticeable, non-productive cough. You suspect bronchiolitis. Upon exam, you hear unusual crackling in the lungs & note that the liver & spleen are readily palpable. Which of the following findings would you most likely observe in in the diagnostic testing results? A. Elevated WBCs w/eosinophilia B. Lung hyperinflation on the chest x-ray C. Patchy infiltrates on the x-ray D. Minimum of 60mEq/L chloride in 100 mg of sweat

B. Lung hyperinflation on the chest x-ray (The child's presentation is most consistent w/acute bronchiolitis. Hyperinflated lungs on the chest x-ray are an expected finding in bronchiolitis. Patchy infiltrates on the x-ray & a minimum of 60 mEq/L chloride in 100 mg sweat are expected findings in bacterial cystic fibrosis rather than bronchiolitis. Elevated WBC w/eosinophilia is an expected finding in asthma.)

A 6 yo female who is new to this country presents w/a racing heart, rapid breathing, & pale-colored skin. During the PE, you notice splenomegaly & a very bony facial structure, Based on the patient's findings, which of the following would be most likely to present? A. MCV 82 fl; MCHC 32%; reticulocyte count 2% B. MCV 72 fl; MCHC 30%; reticulocyte count 3% C. MCV 70 fl; MCHC 34%; reticulocyte count 1% D. MCV 88 fl; MCHC 35%; reticulocyte count 1%

B. MCV 72 fl; MCHC 30%; reticulocyte count 3% (Values of MCV 72 fl, MCHC 30%, & reticulocyte count 3%, respectively, are suggestive of thalassemia, which may present w/tachypnea, tachycardia, pale skin, splenomegaly, & frontal bossing. Thalassemia is a microcytic, hypochromic anemia w/a high reticulocyte count. Patients w/MCVs of 82 fl & 88 fl fall w/in the normocytic range. The normal range for MCHC is 32-36%, so patients w/a MCHC of either 32% or 36% would be normochromic, not hypochromic. A reticulocyte count of 1-2% is considered normal, not elevated.)

A tall 15yo male comes to your office w/complaints of recent onset of double vision in his right eye, which he says worsens his already poor, nearsighted vision. Upon physical examination, you note that the patient has a hollow chest & an arm span exceeding his tall height. While taking the patient's history, you learn the family history includes unexplained heart related deaths on his father's side. Which of the following choices is the most likely diagnosis? A. Gigantism B. Marfan's syndrome C. Klinefelter syndrome D. Precocious puberty

B. Marfan's syndrome (p. 23)

Key immunizations to offer during adolescence include all the following except: A. Meningococcal B. Measles, mumps, & rubella C. Tetanus, ditheria, & attenuated pertussis D. Human papillomavirus

B. Measles, mumps, & rubella

Which of the following vaccines should not be given to patients who are pregnant? A. Inactivated polio vaccine B. Measles, mumps, rubella vaccine (MMR) C. Influenza vaccine D. Tetanus, diphtheria, & acellular pertussis vaccine (Tdap)

B. Measles, mumps, rubella vaccine (MMR) (The MMR should not be given to the pregnant or immunosuppressed patient as it is a live virus. And women should avoid getting pregnant until after 4 weeks after getting the MMR. The ideal time to vaccinate a pregnant woman is 27-36 weeks gestation.)

Which of the following is least likely to result in lead poisoning? A. A red wagon from the 1970s B. Mexican soft drinks C. Inner-city playgrounds near major highways D. Indian herbal remedies

B. Mexican soft drinks

Which of the following best defines a simple partial seizure? A. Staring for 25 seconds prior to onset of minor autonomic symptoms B. Minor motor symptoms w/no loss of consciousness C. Staring for 10 seconds w/brief onset & termination D. Partial LOC w/increased muscle tone

B. Minor motor symptoms w/no loss of consciousness

What are the last permanent teeth to fully erupt during development? A. Bicuspids B. Molars C. Incisors D. Canines

B. Molars

Which of the following types of heart murmurs is not typically considered an innocent heart murmur? A. Continuous humming murmur B. Radiating murmur C. Murmur that may vary w/position changes D. Musical systolic murmur

B. Radiating murmur

Which of the following best describes the state of the pancreatic islet cells @ symptom presentation in pediatric patients w/DM1? A. Pancreatic islet cells have shrunken in #s but grown in size B. Most pancreatic islet cells have been destroyed C. The # of pancreatic islet cells is near normal levels but shrinking rapidly D. Pancreatic cells produce insulin @ a lower rate but their # doesn't change

B. Most pancreatic islet cells have been destroyed

You're discussing treatment options with the family of a boy who has just been diagnosed with like Legg-Calvé-Perthes disease. Given that the boy has just turned 5, which of the following would you expect to be part of the treatment plan for this condition? A. Orthosis worn until early ossification is noted B. Observation only C. Referral for pin fixation with open epiphysiodesis using bone graft D. Referral for femoral osteotomy

B. Observation only (Since the child is < 6 years of age, observation without intervention is permissible depending on the extent of epiphyseal involvement, while aggressive treatment such as orthosis & femoral osteotomy are not recommended. The age of the child, whether full range of motion is preserved, & the involvement of the femoral head should all be considered in the management plan for this patient's condition. Pin fixation with open at epiphysiodesis using a bone graft is a treatment for slipped capital femoral epiphysis, rather than Legg-Calvé-Perthes disease.)

As a NP, you know that the eating disorder mortality rate is about 10% but that a complication from the eating disorder, & not the eating disorder itself, is frequently listed as the cause of death. Which cause of death is most likely to be listed as the cause of death of an individual who dies from an eating disorder? A. Asphyxia B. Organ failure C. Anemia D. Dehydration

B. Organ failure (Organ failure is the most common cause of death in eating disorders d/t severe malnutrition; cardiac complications, such as arrhythmias & loss of muscle are common, but they may also result in liver damage & multi-organ failure.)

You are conducting an assessment for a 12 yo whose feet point slightly inward, though he walks normally w/o a limp. His chief complaint is pain in the "front, bottom part" of his knee, pointing to the tibial tubercle. He indicates that he began playing soccer year-round 7 months prior w/o any significant incident or injury. The pain began 3 weeks ago & has been constant since. Which of the following conditions is the pt most likely experiencing? A. Genu valgum B. Osgood-Schlatter dz C. Grade I knee sprain D. Legg-Calve-Perthes Dz

B. Osgood-Schlatter dz

Which of these signs would indicate meningitis in a pt? A. Pain upon external rotation of the knee B. Pain upon extension of the leg when the hip is flexed 90 deg C. Sciatic pain when both legs are elevated off the exam table D. Pain w/internal rotation of the flexed right thigh

B. Pain upon extension of the leg when the hip is flexed 90 deg

How & where does the obturator sign present in pediatric patients w/appendicitis? A. Sharp pain in RLQ of abdomen B. Pain w/internal rotation of the right hip C. Pain w/extension of the right hip D. Tenderness 1/3 distance from the anterior superior iliac spine to the umbilicus

B. Pain w/internal rotation of the right hip

Mia brings her 4-year-old son, Mason, to the clinic because he has been having problems speaking. He had been speaking normally, but, as he tries to speak in longer sentences, he begins stuttering. Mia is concerned that her son will be made fun of by other children & asks the NP whether he should begin speech therapy. Which of the following is the NP's best advice? A. Begin speech therapy as quickly as possible B. Patiently observe for about 6 months then consider referral C. Begin speech therapy if the stuttering last > 3 months D. Postpone speech therapy until the child stop speaking altogether

B. Patiently observe for about 6 months then consider referral

Which of the following it's not true about Turner's syndrome? A. Most common sex chromosome anomaly of females B. Patients have tall stature w/irregular arm span C. Occurs in 1:2,000 live births D. 95% of embryos do not survive to term

B. Patients have tall stature w/irregular arm span (p. 23)

You are assessing a newborn who presents w/a reddish-purple vascular malformation of the skin consisting of dilated capillaries. You recognize this as which of the following? A. Café au lait spots B. Port-wine stain C. Strawberry mark D. Mongolian spots

B. Port-wine stain (p. 28)

A worried mother brings her 6yo son in for a check up. He presents with a 103F fever, subcutaneous nodules, & cries out frequently because of pain in his arms & legs. Which of the following labs would you most expect in this child? A. Right ventricular hypertrophy on the electrocardiogram B. Positive rapid strep assay C. Positive C-reactive protein D. Left ventricular hypertrophy on the electrocardiogram

B. Positive rapid strep assay (The child presents with 1 major finding, subcutaneous nodules, & 2 minor findings, 103F fever & arthralgia, included in the Jones' criteria for the diagnosis of rheumatic fever; therefore, a positive rapid strep essay is most expected, as this condition usually follows a group A strep infection of the upper respiratory tract. Furthermore, the patient is within the age group that has the highest incidence of this condition. The other findings are not expected with rheumatic fever.)

David is a 14-year-old with attention deficit hyperactivity disorder. He has been unresponsive to treatment with central nervous system stimulants. David has also been diagnosed with depression. Which of the following treatments is most appropriate for David's conditions? A. Referring the patient will behavior therapy B. Prescribing second-line medications C. Ceasing all medications D. Prescribing homeopathic treatment

B. Prescribing second-line medications

Which 2 lab findings best characterizes the findings of restrictive dz in pulmonary function test results? A. Reduced airflow rates & lung volumes w/in normal range or larger B. Primarily reduced volumes &, to some extent, reduced expiratory flow rates C. Normal volumes & reduced expiratory flow rates D. Primarily reduced airflow rates &, to some extent, increased lung volumes

B. Primarily reduced volumes &, to some extent, reduced expiratory flow rates (Restrictive dz in PFT results is primarily characterized by reduced volumes &, to some extent, expiratory flow rates. Primarily, reduced airflow rates & expiratory flow rates accompanied by lung volumes w/in the normal range or larger are, to some extent, more indicative of obstructive dz, not restrictive dz.)

You are treating Cynthia, age 9, who has recently been diagnosed w/hyperthyroidism, What 2 drugs should you recognize as typical 1st line treatment? A. Tapazole & synthroid B. Propranolol & Tapazole C. Levothyroxine & propranolol D. Insulin & propylthiouracil

B. Propranolol & Tapazole

You are examining a newborn in the nursery. As part of your examination, you stimulate the Moro reflex. How would you do this, & what reaction would you look for in the patient? A. Turn his head to one side & watch for contralateral upper extremity to extend. B. Release your support of the newborn's head to observe nervous system response. C. Stroke the infant's lower foot to observe an upward curling of his big toe. D. Hold the baby aloft to see if he extends his arms towards the ground.

B. Release your support of the newborn's head to observe nervous system response. (The Moro reflex is best tested by releasing the newborn's head in order to observe the nervous system's response to surprise; most infants will respond by abducting or addicting their arms in an attempt to regain balance. an impaired or absent response may indicate motor or neurologic disorders. Turning the head to one side w/ipsilateral arm extension is the fencing reflex. Stroking the infant's lower foot tests the Babinski reflex, which, barring pathology, commonly vanishes by 2 years of age. Holding the infant aloft & rotating him or her forward to test the response to a simulated fall is part of the parachute test & should not typically stimulate the startle reflex.)

During a physical exam on a 17 yr old female, you note a sore throat, parotid gland enlargement, & dental erosion. You begin to suspect a possible eating disorder, Which of the following findings would most strongly indicate bulimia nervosa in this patient? A. Amenorrhea B. Russell's sign C. Lanugo D. Thinning hair

B. Russell's sign (Characterized by bruises on knuckles that result from self-induced vomiting, is often an indicator of bulimia. Amenorrhea can be an indicator for either bulimia or anorexia nervosa. Thinning hair is commonly a sign of anorexia nervosa. Lanugo is more typical of anorexia than bulimia.)

You are treating a 5-year-old boy who has been diagnosed w/celiac disease. You discuss w/his mother how to adjust the child's diet accordingly. Which of the following should be included in an appropriate diet for this child? A. Whole grain cereal B. Skim milk & fresh vegetables C. Rice & vegetables, w/soy substitute for protein D. Oatmeal w/soy milk instead of lactose milk

B. Skim milk & fresh vegetables (p. 77)

Danny, a 13yo African-American male, is 5'6" & has a BMI of 34. His temperature & BP are within the normal range. He has grown 2.5 inches in the last 12 months. He normally spends several hours each afternoon & evening in his room playing video games, but, in an effort to lose weight, he walks for an hour every evening. Today, he began to feel pain in his left thigh & knee, & now he has groin pain as well as pain in the right thigh & knee. He denies any recent bodily trauma. In your physical examination, you note that he is unable to properly flex either hip when the femur abducts. Which of the following is the most likely diagnosis? A. Osgood-Schlatter dz B. Slipped capital femoral epiphysis (SCFE) C. Legg-Calve-Perthes dz D. Septic arthritis

B. Slipped capital femoral epiphysis (SCFE)

A 14 yo patient presents to your clinic w/complaints of stiff joints & pain that starts in her shoulders before traveling down her arms. She reports that, following a recent nature hike, she found a tick on her leg. W/in a few days, a lesion that "looks like a bull's eye" had developed at the tick site. She also tells you that she has been experiencing severe HA, & that her heart occasionally "races like a drum". Which stage of the most likely dx is the patient experiencing? A. Stage 1 B. Stage 2 C. Stage 3 D. Stage 4

B. Stage 2 (HA, stiff joints, migratory pains, & cardiac irregularities all typically characterize Stage 2 of Lyme Dz, as would ascetic meningitis, Bell's palsy, & peripheral neuropathy. Although muscle & joint pain may present in Stage 1, this stage is more commonly characterized by flu-like symptoms, fatigue, & erythema migrants. Stage 3 is also often characterized by pain, stiffness, & swelling in the joints, but these symptoms would typically evolve into clear manifestations of arthritis, usually presenting in the knees. Furthermore, other symptoms such as acrodermatitis chronicum atrophicans, characterized by bluish-red discoloring of the distal extremity w/edema, or subacute encephalopathy may produce in Stage 3. There is not Stage 4 in Lyme Dz.)

Bulimia is harmful to overall health & destructive to teeth. Which of the following factors is most damaging to the teeth? A. Germs introduced into the mouth from the fingers B. Strong acids that erode tooth enamel C. Failure to brush twice a day D. Change to the oral pH from vomiting

B. Strong acids that erode tooth enamel

A 4-year-old boy comes to your office accompanied by his mother, who states that she has been concerned about frequent pauses & repetition in her son's speech. After conducting differential diagnosis for hearing & visual impairment, you diagnose the child w/stuttering. You will assure his mother that no immediate treatment is needed, & that stuttering frequently resolves on its own; however, her son may require a future referral. Which of the following would typically not require a referral? A. Stuttering lasting more than 7 months B. Stuttering lasting for 4 months C. Child totally avoids speaking D. 7-year-old child w/a stutter

B. Stuttering lasting for 4 months (p. 44)

You were taking the history of a 15yo patient who complains of being "tired all the time". She presents with dry, flaky skin, puffiness around the eyes, & reports being very depressed. Included with your examination & lab work should be which of the following tests? A. CBC, electrolytes, and BUN B. TSH and T4 C. Urine for T4 & T3 D. T4 & serum T3 test

B. TSH and T4

Seizures & dementia can manifest in infants & young pediatric patients as a typical result of which of the following disorders? A. Klinefelter's syndrom B. Tay-Sachs disease C. Turner's syndrome D. Marfan syndrome

B. Tay-Sachs disease (Progressive disorder that destroys nerve cells in the brain & spinal cord, manifesting as seizures, dementia and eventually leading to death.)

David & Sally want to make their home as safe as possible for their toddler. They come to your office asking for advice. When discussing safety issues with them, which of the following is the best advice to give? A. It is crucial to nail into place window guards. B. Test the temperature of hot water before giving a bath. C. Train the toddler to stay off the stairs. D. Talk to the toddler about staying away from poisons.

B. Test the temperature of hot water before giving a bath.

Tanner stages help providers understand the stage of sexual development in adolescents. Which of the following best describes the Tanner stage II in boys? A. Rugae appear B. Testes grow larger C. Penis elongates D. Glans develops

B. Testes grow larger (p. 58)

A 4-month-old baby presents with mild distress diagnosed as bronchiolitis. Immunofluorescence analysis is positive for respiratory syncytial virus, also known as bronchiolitis. Oral intake is adequate & urine output is good. Which statement is true regarding treatment options for this patient? A. A one time dose of palivizumab at 15 mg/kg should be given B. Infant may be treated at home w/hydration & saline nose drops C. The infant should be hospitalized for respiratory distress and receive respiratory treatments D. The NP should order home nebulizer treatment of albuterol PRN

B. The infant may be treated at home with hydration & saline nose drops

Two 2 year olds are playing in a sandbox. They are both scooping & pouring sand, occasionally glancing over at each other but not interacting. How would the NP best characterize this type of play? A. This behavior is abnormal, as by now they should want to play together B. This behavior demonstrates parallel play, which is common in this age group C. These children are participating in associative play, which is not expected in this age group D. This is active play & is typical in this age group

B. This behavior demonstrates parallel play, which is common in this age group

An infant presents w/a grade II systolic murmur. His chest x-ray reveals an "egg on a string" image, cardiomegaly, & increased pulmonary vascular markings. Which of the following is the most likely condition? A. Coarctation of the aorta B. Transposition of the great arteries C. Pulmonic stenosis D. Tetralogy of Fallot

B. Transposition of the great arteries. *Transposition of the great arteries presents w/a grade II systolic murmur & a chest x-ray findings of an "egg on a string, " cardiomegaly, & increased pulmonary vascular markings. Tetralogy of Fallot x-ray findings exhibit a boot-shaped heart & no cardiomegaly or increased pulmonary vascular findings. Coarctation of the aorta presents w/cardiomegaly & pulmonary vascular markings, but rib notching due to collateral circulation would also be noted. Pulmonic stenosis presents with normal x-ray findings.)

The mother of a 3yo boy inquires about her son's immunization schedule. The mother mentions that her son has had initial measles, mumps, and rubella (MMR) vaccination shortly after his 1st birthday, & she wants to know how many additional doses he should receive. How many doses of MMR are recommended for any child following the normal vaccine schedule? A. Four B. Two C. One D. Three

B. Two (p. 19)

Concerned parents bring their 2 yo son w/hypospadias to the clinic. They say they wish to learn more about the likelihood of other genitourinary anomalies that may occur alongside hypospadias. The NP should explain that all of the following disorders may potentially present in conjunction w/hypospadias except: A. Undescended testicles B. UTI C. Inguinal hernia D. Hydrocele

B. UTI (A UTI is not known to accompany hypospadias, although pts which have undergone hypospadias corrective sx are at an increased risk for UTIs, especially if hair-bearing skin was used int he operation. Undescended testicles, inguinal hernia, & hydrocele are GU anomalies that may potentially occur alongside hypospadias.)

Of the following, which form of conjunctivitis most often presents w/watery discharge? A. Bacterial B. Viral C. Gonococcal D. Allergic

B. Viral

A 3-year-old male patient presents for a WCE. While interviewing his parents, you learn that the patients family comes from a working-class neighborhood in downtown Los Angeles. All of the following laboratory exams are especially indicated at this age except: A. Hemoglobin & hematocrit B. Vitamin D level C. Cholesterol D. Lead level

B. Vitamin D level (Cholesterol only if warranted by weight > 95%, but there are not requirements for the vitamin D testing.)

Infants w/o any drastic health ailment would typically require supplementation of all of the following except: A. Vitamin D B. Vitamin K C. Iron D. Fluoride

B. Vitamin K (p. 36)

Jerome, an 11 year old, wakes up every morning @ 6 AM. At what time should he go to bed in order to get the minimum recommended amount of sleep for his age? A. 8 PM B. 9 PM C. 10 PM D. 11 PM

C. 10 PM (School age children should get 8 hours of sleep w/max of 11 hours.)

Which of the following values most likely indicates the normal visual acuity of a 5 year old? A. 20/80 B. 20/50 C. 20/30 D. 20/20

C. 20/30 (3 — 20/50; 4 — 20/40; 5 — 20/30)

You note that an infant waves "bye-bye" when leaving the clinic. This is an unexpected finding by at least what age? A. 2 to 4 months B. 4 to 6 months C. 8 to 9 months D. One year

C. 8 to 9 months (p. 10)

You are consulting a mother who is worried about her 8 mom old male infant. She states that he has a fever, & wants to give him ibuprofen. You recommend giving him 90 mg of ibuprofen q6h. Based on the above repayment guidelines, what is the most likely weight of this infant? A. 7.5 kg B. 8.18 kg C. 9 kg D. 10 kg

C. 9 kg

You are consulting a mother who is worried about her 8-month-old male infant. She states that he has a fever, & she wants to give him ibuprofen. You recommend giving him 90 mg of ibuprofen every 6 hours. Based on the above treatment guidelines, what is the most likely weight of this infant? A. 7.5 kg B. 8.18 kg C. 9 kg D. 10 kg

C. 9 kg (The suggested ibuprofen regimen for managing fever in infants > 6 months is 10 mg/kg every 6 hours; thus, a 90 mg dose of ibuprofen would be recommended for an infant weighing 9 kg. The dosing regimens for acetaminophen is 10-15 mg/kg every 4 hours.)

Which of the following BP percentiles on the "BP levels for boys & girls by age & height percentile table" published by the National Institutes for Health serves as the hypertension threshold in pediatric patients? A. 50th B. 90th C. 95th D. 99th

C. 95th (p. 68)

In general, how frequently would a typical pediatric pt w/mild persistent asthma use a rescue inhaler? A. < 2 days/week B. Several times per day C. > 2 days/week D. Once per day

C. > 2 days/week

At least how many months apart should hepatitis A doses of vaccines be administered? A. @ least 1 month apart B. @ least 3 months apart C. @ least 6 months apart D. @ least 12 months apart

C. @ least 6 months apart (The 2 doses should be given between the ages of 1 & 2 & they should be 6 months apart. The 1st dose protects the body against hepatitis A for 1 year & allows the body to make antibodies against the virus. The 2nd dose acts to protect against hepatitis A for 20 years.)

For which of the following patients is a lumbar puncture most indicated? A. A patient w/a known seizure disorder B. A patient w/streptococcal pneumonia C. A feverish patient w/seizures D. A nauseous patient w/an erythematous tympanic membrane

C. A feverish patient w/seizures (p. 130)

Of the following patients, which does not need to be reported to state or local authorities? A. A low risk patient whose tuberculin test results is < 15mm B. Accident gunshot wound C. A patient whose serology results are anti-HAV & IgG D. Non-rabid dog bite

C. A patient whose serology results are anti-HAV & IgG

A 4 yo presents w/an awkward walk & run, w/o any pain & w/full ROM. The PE revels that the distance between his ankles exceeds 3 inches. Which of these conditions would be the most likely dx? A. Genu valrum B. Muscular dystrophy C. Genu valgum D. Slipped capital femoral epiphysis

C. Genu valgum

A mother brings her 18 mo old daughter to your practice w/complaints of watery diarrhea. The mother says that she has noticed her child "has not looked too well". She also says that her daughter has been refusing to eat & has been unable to keep her food down. The mother also reports hearing loud rumbling noises coming from the child's stomach. Based on these findings, which finding would you most expect to see in this patient during your exam? A. Enlarged abdominal mass B. Visible peristaltic waves C. Abdominal distention D. Positive psoas sign

C. Abdominal distention (Abdominal distention is an expected finding of AGE, which often produces watery diarrhea, hyperactive bowel sounds, non-bilious vomiting, & anorexia in infants. An enlarged abd mass, on the other hand, may be a sign of neuroblastoma, but this condition is accompanied by profuse sweating & tachycardia. Although AGE may present w/peristaltic rushes, peristaltic waves are more likely a sign of pyloric stenosis. A positive psoas sign indicates appendicitis, no AGE.)

Mrs. Jones often catches her 13yo student, George, staring into space, daydreaming, & not paying attention in class. When she calls out to him to get his attention, he ignores her. He usually stares off for about 10-20 seconds, coming back to attention w/o any memory of the episode. George's behavior is most indicative of which of the following seizures? A. Tonic seizure B. Atonic seizure C. Absence D. Tonic-clonic seizure

C. Absence

Which form of leukemia accounts for about 20% of all childhood leukemia's & occurs primarily in infants & adolescents? A. Chronic myelogenous leukemia (CML) B. Chronic lymphocytic leukemia (CLL) C. Acute myelogenous leukemia (AML) D. Acute lymphocytic leukemia (ALL)

C. Acute myelogenous leukemia (AML) (AML is a form of leukemia that accounts for about 20% of all leukemia's & occurs primarily in infants & adolescents. ALL accounts for about 75% of pediatric leukemia cases, rather than 20%, & peak incidence occurs in children < 5yo. CML & CLL rarely occur in children.)

A couple brings their 3yo boy to you for evaluation because he has been irritable & feverish. 3 days prior, they brought him in & were sent home w/instructions to given the child acetaminophen. However, his temp has remained @ or slightly above 102F. The parents are also worried about skin rashes found on the child's trunk & his reddened palms & soles, they point out how red the child's eyes are "from all the crying". Your exam reveals a whitish coat on the child's tongue & very chapped lips. You also see that the skin of the palms & soles is starting to peel. What of the following is the most appropriate treatment plan for this child's likely condition? A. Acyclovir; acetaminophen B. Corticosteroids; ibuprofen C. Admit to hospital for intravenous gamma globulin & high dose aspirin D. Oral penicillin; aspirin

C. Admit to hospital for intravenous gamma globulin & high dose aspirin

A Tanner sexual maturity rating of 3 in a male indicates which of the following? A. A penis that is adult in shape & appearance w/adult pattern pubic hair B. A rough, red scrotum with sparse, fine pubic hair C. An elongated penis with darker, curlier pubic hair D. Development of glans & rugae on the penis & curly, sparse pubic hair

C. An elongated penis with darker, curlier pubic hair

Which of the following best distinguishes epiglottitis from croup? A. Epiglottitis presents w/fever, whereas croup does not B. Epiglottitis targets children between 3 mo - 6 yo, whereas croup usually presents in children 6-10 yo C. An x-ray for epiglottitis will show a thumb sign, whereas an x-ray for croup will show a steeple sign D. Epiglottitis Is entirely bacterial in nature, whereas croup is entirely viral

C. An x-ray for epiglottitis will show a thumb sign, whereas an x-ray for croup will show a steeple sign

Which of the following serological test results indicate an active hepatitis A infection? A. Anti-HBc, Anti-HBsAg B. HBsAg, HBeAg, Anti-HBc, elevated IgM C. Anti-HAV, elevated IgM D. Anti-HAV, elevated IgG

C. Anti-HAV, elevated IgM (Anti-HAV, elevated IgM, serology indicates active hepatitis A. Anti-HAV, elevated IgG indicates recovered hepatitis A. HBsAg, HBeAg, Anti-HBc, elevated IgM indicates active hepatitis B. Lastly, serology results that show Anti-HBc, Anti-HBsAg indicate recovered hepatitis B.)

Autism in children is generally identified by 3 years of age. Alice is 30 months of age, & her mother mentions that she is not playing w/others at preschool, is unable to pretend play, & has a very limited vocabulary. Her only interest is stacking blocks, at which she is very good. When considering the disorders in the spectrum of pervasive development disorders, which of the following should be your initial consideration in your ddx? A. Down's Syndrome B. Fragile X C. Autism D. Asperger's Syndrome

C. Autism (Children w/autism have problems with social interaction, pretend play, & communication. They also have a limited range of activities & interests. Nearly 75% of children w/autism also have some degree of mental retardation. Children w/Asperger's syndrome display a relatively good grasp of language, unlike children w/suspected autism. Fragile X syndrome is not as prominent in female patients as male patients, as this condition severely affects those w/a single X chromosome. Thus, although this disorder causes similar symptoms, it is not an initial consideration for female patients. Children with Down syndrome present with a whole array of physical findings not seen in this patient; their findings usually include microcephaly, a flat nose, protruding tongue, among others.)

A pt has been referred to your practice by an optometrist, who found Lisch nodules in the pt's irises. Which finding would best help to confirm the suspected diagnosis? A. Photophobia B. FTT C. Axillary freckling D. Aphasia

C. Axillary freckling

Your patient, a 3yo male, hit his head after falling off his bike & now is having trouble w/his sense of smell. Which cranial nerve was most likely affected? A. CN IX B. CN III C. CNI D. CN II

C. CNI (p. 123)

A 2 yo is brought to your clinic presenting w/red, irritated eyes. The mother says the symptoms manifested after they had visited a public swimming pool the day prior. Upon exam, you see no discharge. The child does not indicate any pain, only an itching sensation. You tell the mother that the condition is sel-limiting, & you proceed w/a normal saline flush on the patient's eyes. Which is the most likely diagnosis? A. Bacterial conjunctivitis B. Hordeolum C. Chemical conjunctivitis D. Viral conjunctivitis

C. Chemical conjunctivitis

You have diagnosed an infant w/hypospadias. Knowing that hypospadias is correctable, you advise the infant's parents of their available options. Which of the following must be true for the management & eradication of hypospadias to be successful? A. The infant must not have had any sort of flu vaccinations B. The newborn must still be breast-feeding C. Circumcision must not be performed D. The infant must not be toilet trained

C. Circumcision must not be performed (p. 149)

A mother brings her child, Ted, to your clinic. Ted has developmental delays, & the mother is concerned that he may not be able to be toilet trained. You know, however, that some children with developmental delays can be trained to use the toilet. Using the guidelines of the American Academy of Pediatrics, which of the following is the best advice to give her? A. Praise the child for using the toilet successfully, but scold, withhold affection from child if he was unsuccessful B. Schedule regular toilet times, rituals & make the child sit on the potty until the achieved action is done C. Confirm developmental readiness by ensuring that the child can stay dry for more than an hour, appears to be aware of when he needs to have a bowel movement, & has the motor skills to undress D. Make sure the child wears diapers in the first stage of training & later wears clothing that makes it easy for the child to manage on their own. Wait until child is chronologically 5 years of age to begin toilet training.

C. Confirm developmental readiness by ensuring that the child can stay dry for more than an hour, appears to be aware of when he needs to have a bowel movement, & has the motor skills to undress (According to the AAP, toilet training readiness can be determined in some children with developmental disorders or delays in the same manner as all children. If a child with delayed development can stay dry for more than an hour, appears to be aware of when he/she needs to have a BM, has the motor skills to undress self, & appears to be motivated, the process can begin. Most children begin to understand this concept by the cognitive ages of 1.5-2.5 yo. Depending on the individual child with delays, this process may not begin until the age of 5 or later. The chronological age of a child with developmental delays has no bearing on his/her toilet training readiness. After it is determined that the child is ready to be potty trained, then regular toilet times maybe scheduled. It is important to make it easy for the child to manage training on his/her own & to praise the child for good effort, rather than punish for failure.)

Which of the following is the most specific test for muscular dystrophy? A. Transaminase level B. Prolactin level C. Creatine kinase determination D. Polymerase chain reaction result

C. Creatine kinase determination

Sally is 16 years old & does not want to finish high school. Her mother brings her in for an exam to find out if there may be a condition causing Sally's "unusual" behavior. Sally was in excellent health, had an active social life, & received good grades. However, in recent few months, her behavior has become defiant, her grades have dropped, and she is uninterested in school or her friends. Her parents tell you that Sally's long time friend has moved out of state. Which of the following is the most likely reason for her behavior? A. Stress B. Overbearing parents C. Depression D. Puberty

C. Depression

A patient reports to your clinic w/intense fatigue & a fever. Suspecting infectious mononucleosis, you begin a PE. Which of the following signs is not consistent w/the common presentation of this condition? A. White exudate on tonsils B. Generalized lymphadenopathy C. Discolored nasal discharge D. Petechial rash

C. Discolored nasal discharge

You see 12yo Erin, who started menstruating earlier this year. Now she complains of pain & cramping, stating that she feels the pain both in her back & in her stomach. You prescribed ibuprofen. Based on Erin's presentation & your treatment, what is the most likely diagnosis? A. Gonorrhea B. Urinary tract infection C. Dysmenorrhea D. Chlamydia

C. Dysmenorrhea (p. 150-1)

A mother brings in her 15yo son because she is concerned about the effects of a concussion he had 10 days ago. She tells you that he passed out suddenly while playing video games this afternoon, and his body began "jerking around" for several minutes. Reviewing the child's medical history, you learned that he was referred for an immediate follow up at the hospital for a similar occurrence but was never seen. Which test is the most important in classifying this patient's seizure? A. Magnetic resonance imaging B. Echocardiogram C. Electroencephalogram D. Computed tomography scan

C. Electroencephalogram

You are teaching the parents of an 8 mo old infant w/GERD. Which of the following actions should you advise the parents to perform immediately after meals specifically to decrease reflux activity? A. Position the infant in a semi-supine position B. Assist the newborn to burp after meals C. Elevate the newborn's head D. Administer a histamine 2-receptor antagonist

C. Elevate the newborn's head

Which of these diagnostics is not routinely recommended for pts presenting w/classic symptoms of slipped capital femoral epiphysis? A. Radiography B. Bone scanes C. Endocrine studies D. CT

C. Endocrine studies

Which of the following is not associated w/some forms of anorexia nervosa? A. Lanugo B. Eating disturbances C. Episodic binging D. Amenorrhea

C. Episodic binging (p. 60)

Vitamin deficiency resulting from malabsorption is most likely to present with: A. Vomiting B. Chronic diarrhea C. Fatigue D. Thin stools

C. Fatigue (Fatigue is most likely to be associated w/vitamin deficiency d/t malabsorption b/c it may be a sign of anemia resulting from malabsorption of vitamin B12, folate, & iron. Vomiting & chronic diarrhea are also symptoms of malabsorption, but are not directly c/b vitamin deficiency. Thin stools usually are not indication on abnormal condition, but may result from IBS.)

The measles, mumps, and rubella (MMR) vaccine must be administered in two doses. When should the MMR vaccines typically be given? A. Both doses given between the ages of 13 - 18 years old B. First dose: 1 - 2 yo; Second dose: 15 yo C. First dose: 12 - 15 mo; second dose: 6yo D. First dose: 1 - 4 yo; second dose: 10 yo

C. First dose: 12 - 15 mo; second dose: 6yo

Which of these abdominal findings would be of most concern in newborns? A. Umbilical hernia B. Diastasis recti C. Flat abdomen D. Abdomen rising w/inspiration, falling w/expiration

C. Flat abdomen (A flat contour to the abdomen is abnormal in infants & may indicate malnutrition or IUGR. Reduction in nutrients to the fetus can cause a decrease in intra-abdominal fat. This can be caused by poor blood flow, decreased trans placental concentration of amino acids, or impairment of the ability of the placenta to transfer nutrients. Slight dissension is normal & the NP should see a slight protuberance in a health infant. A rounded, symmetrical contour to the abdomen that rises w/inspiration is normal in infants; an asymmetrical abdomen may indicate an abdominal mass. An umbilical hernia may present in the infant, but this condition is fairly harmless & often resolves itself by 1 year of age. Likewise, diastasis recti may present in newborns, bit this condition typically resolves on it is own accord.)

How would you best auscultate to confirm a venous hum? A. Have the patient lay supine; auscultate the LUSB B. Have the patient stand; auscultate the between the LLSB & the apex C. Have the patient sit up; auscultate the RUSB D. Have the patient turn his or her head; auscultate the apex

C. Have the patient sit up; auscultate the RUSB

Leonard, a 4 year old toddler, is brought to your office by this parents who have some concerns regarding his development. Which of the following factors should Leonard's parents be most concerned about? A. He has only eaten mashed potatoes for the previous 4 weeks B. He has had a stutter the previous 4 months C. He struggles w/nighttime bowel & bladder control D. He has never acquired the motor skill of skipping

C. He struggles w/nighttime bowel & bladder control (This should be acquired by the age of 3.)

You are conducting a WCE on a 5 month old boy, as per the Bright Futures guidelines. At this point in time, which of following would least qualify as a concerning finding? A. Undescended testes B. Galactorrhea C. Head lag when pulled to sitting position D. Failure to hold head up when lying on stomach

C. Head lag when pulled to sitting position

You are conducting a Well Child Check on a 5-month-old boy, as per the Bright Futures guidelines. At this point in time, which of the following would least qualify as a concerning finding? A. Undesended testes B. Galactorrhea C. Head lag when pulled to sitting position D. Failure to hold head up when lying on stomach

C. Head lag when pulled to sitting position (Although infants should mostly maintain head control by 4 months of age, it is still normal for an infant to reach this developmental milestone anywhere between 4 & 6 months of age. The inability to raise the head when lying on the stomach, galactorrhea, and undescended testes are all considered to be developmental warning signs starting at 3 on this of age.)

A 14 yo pt comes to your office showing signs of fever, painful tender joints, & strep throat. Laboratory findings show positive throat culture & a positive rapid strep assay. Based on the findings of this patient, which of the following is not typically included in the treatment regimen of the patients most likely condition? A. Bedrest acute carditis present B. Aggressive management of the strep infection C. High dose acetyl salicylic acid therapy D. Prophylactic antibiotics for invasive procedures

C. High dose acetyl salicylic acid therapy (p. 69)

A mother brings her 5 month old son in for a check up. She is concerned that her son's right leg appear shorter than his left. Furthermore, she states that his right leg looks as if it were turned out. She adds that it does not seem as if her child is in any pain though. Suspicious, the NP examined the child by adducting his right hip while applying pressure on the knee. For which the following conditions is the NP examining? A. Genu varum B. Slipped capital femoral epiphysis C. Hip dysplasia D. Genu valgum

C. Hip dysplasia

Christopher, 10 months old, is brought to your office by his parents, who state that he experiences bilious vomiting as well as infrequent BMs. Christopher's appearance is jaundiced, & his low weight & slight stature indicates failure to thrive. Upon examination you note progressive abdominal distention & a tight anal sphincter w/an empty rectum. Which of the following would most likely account for all of the patient's signs & symptoms? A. Neuroblastoma B. Intussusception C. Hirschsprung's disease D. Malabsorption

C. Hirschsprung's disease (p. 75)

When examining heart defects, what is a sign that would indicate his ventricular septal defect? A. Ejection click on the right upper sternal border B. Murmur at the left upper sternal border C. Holosystolic thrill felt at the lower left sternal border D. Ejection click on the left upper sternal border

C. Holosystolic thrill felt at the lower left sternal border (A holosystolic thrill felt at lower left sternal border is a finding of ventricular septal defect. Atrial septal defect is heard as a grade II - II/VI systolic ejection murmur at the left upper sternal border. An ejection click on the right upper sternal border is a finding of coarctation of the aorta. There is no heart defect that presents with an ejection click on the left upper sternal border.)

Max, the infant son of Mel & Anne, has a red rash on his pelvis due to the type of diaper he wears. A physical exam reveals raised bumps w/no discoloration. Which of the following would best treat the patient's bumps? A. Emollients B. Domeboro C. Hydrocortisone D. Topical antifungal

C. Hydrocortisone (p. 88 - eczema)

A 10yo female w/a loud aortic 2nd heart sound & an early systolic ejection click has a HR = 85, RR = 22, BP = 129/88. She skipped breakfast & is now c/o dizziness w/o fatigue or dyspnea. What is the most likely cause of her dizziness? A. Pulmonic stenosis B. Hypoglycemia C. Hypertension D. Congestive Heart Failure

C. Hypertension (The pts BP is elevated & the heart sounds are consistent w/HTN, which may cause dizziness. HTN in a 10yo pt is defined as 2 consecutive readings on 3 separate occasions of BP > 126/82 (note that hypertensive BP benchmarks differ by age, height, & sex for children). Hypoglycemia may make her feel light headed & unsteady but would not have associated heart murmur. Pulmonic stenosis is associated w/a systolic ejection murmur but also features cyanosis, fatigue, & dizziness, the cardiac exam was normal & did not indicate CHF.)

What is the preferred OTC analgesic for the tx of dysmenorrhea? A. Aspirin B. Acetaminophen C. Ibuprofen D. Indomethacin

C. Ibuprofen

A mother brings her 3-month-old male child to your office w/complaints of sudden difficulty feeding the child, as well as an inability to console his screaming. Although the child shows a response to her efforts, his crying & agitation have not decreased. The mother also notes that she noticed a bump on his head, which she assumed was from him hitting his head during one of his screaming fits. Which of the following would be the best initial course of action? A. Lumbar puncture B. Administration of ceftriaxone C. Immediate admission to hospital D. Blood count & culture

C. Immediate admission to hospital

During an annual physical exam, you notice that 12yo Lisa's areola & nipple project as a secondary mound. You tell her she can expect which of the following in 2 years: A. Sparse, pale, fine pubic hair B. Breast buds w/areolar enlargement C. Onset of menses D. Receding areolas & retracting nipples

C. Onset of menses

You were seeing an infant who presents with strabismus. In which situation would you be least likely to refer the patient to an ophthalmologist? A. The findings first presented at seven months of age B. The child presents with persistent hypertropia C. The child is four months of age D. The child presents with persistent hypotropia

C. The child is four months of age

A mother brings her 3-month-old male child to your office with complaints of sudden difficulty feeding the child, as well as an inability to console his screaming. Although the child shows a response to her efforts, his crying and agitation have not decreased. The mother also notes that she noticed a bump on his head, which she assumed was from him hitting his head during one of his screaming fits. Which of the following would be the best initial course of action? A. Lumbar puncture B. Administration of ceftriaxone C. Immediate admission to the hospital D. Blood count & culture

C. Immediate admission to the hospital (The signs that the child is displaying — persistent screaming w/no evidence of fever & a soft, bulging fontanelle — are indicative of intracranial pressure in the infant, which warrants immediate hospital admission. A bulging fontanelle typically occurs when fluid builds up in the brain, causing increased intracranial pressure. A lumbar puncture would be appropriate if the aim was to measure the intracranial pressure. Administering ceftriaxone would be warranted in cases of bacterial infection, which is often indicated by a temperature change in the infant. Performing a blood count test & obtaining cultures are often used to detect bacteremia in infants.)

An otherwise healthy 4 yo presents w/bruises that the parents can't explain, The parents 1st noticed the bruises a few days ago. The CBC results show the platelet count is low, hemoglobin is 12 g/dL, hematocrit is 36%, & her WBC is 7,000/mm3. Which of the following is the most likely diagnosis? A. Suspected child abuse B. Iron deficiency anemia C. Immune thrombocytopenic purpura D. Leukemia

C. Immune thrombocytopenic purpura

To ensure that your research methods are providing the intended data, you choose three parameters that you wish to test for & construct three questions for each one. After collecting the results, you look for a variance within each group of the three answers. Which of the following research principles have you appealed to him verifying your research? A. Sensitivity B. Reliability C. Internal consistency D. Validity

C. Internal consistency (Internal consistency measures the reliability of inquiries (or instruments) by grouping together various instruments that are aimed at achieving the same response. By asking the same three questions and three different ways, you have tested whether each instrument is providing the appropriate information. An instruments validity is tested by ensuring that the variable itself is tested accurately and yields the intended information. Sensitivity measures the proportion of actual positives to false positives (e.g. a pregnancy test that is 99% sensitive or accurate after a trial of 1000 uses indicates that about 990/1000 tests were accurate). Reliability gauges if an instrument will measure results the same way over time; test questions repeated over multiple administrations indicate high reliability when they elicit the same response from the same test takers.)

All of the following are school age fears the NP should expect when interviewing a child except: A. Pain B. Death C. Isolation D. Loss of control

C. Isolation

Which of these conditions is least likely to be inherited through genetics or other parental factors? A. Down syndrome B. Marfan syndrome C. Klinefelter's syndrome D. Tay-Sachs disease

C. Klinefelter's syndrome (Klinefelter's is not inherited a key clinical feature is infertility, it is a failure of chromosomal separation during meiosis.)

In which of the following age groups is primary dysmenorrhea most commonly seen? A. Early adolescence in individuals w/precocious puberty B. Women over the age of 30 C. Late adolescence D. Pre-menopausal women

C. Late adolescence

Which of the following is not a typical minor adverse reaction to a vaccine? A. Low-grade fever B. Local tenderness C. Local pallor D. Local muscle soreness

C. Local pallor

Michelle, a 6yo girl, arrives at your office presenting with a high fever. Immediately upon entering the waiting room, you see that the child has suddenly lost consciousness, has uncontrolled jerky movements, & urinary incontinence. How should the child symptoms be initially managed? A. Lumbar puncture B. Cardiopulmonary resuscitation C. Maintain airway & administer oxygen D. Lorazepam and diazepam

C. Maintain airway & administer oxygen

You are examining a toddler who is visiting from Mexico. The mother is very concerned about her child & is hoping you can treat him. You learn that the mother has been taking her son to a healer in Mexico, but his condition has not improved. The child appears fatigued & irritable. He's frequently constipated & does not have much of an appetite. The child's hemoglobin is 12.0 g/dl & the lead level is 18 mcg/dl. What is your next action? A. Order a blood transfusion B. Refer the child for possible chelation therapy. C. Measure blood levels in 1 month D. Hospitalize the child

C. Measure blood levels in 1 month (The child's lead level indicates that he has lead poisoning with a Class IIB lead level (level 15-19 mcg/dl), which should be treated completing the environmental assessment to identify potential sources of lead exposure & monitoring blood lead levels at recommended intervals. The hemoglobin level is normal for the child's age, so blood transfusion is not indicated. Chelation therapy is recommended for children with Class IV lead levels & greater (> 45 mcg/dl), & hospitalization is recommended for children w/Class V lead levels (> 70 mcg/dl).)

Tension & psychogenic HAs are commonly associated w/what mechanism of HA pain? A. Vascular dilation B. Traction C. Muscular contraction D. Inflammation

C. Muscular contraction

A newborn is born weighing 9lb. After 2 weeks, what would be the expected weight of the newborn? A. Eight lb B. Eight lb 5 oz C. Nine lb D. Nine lb 10 oz

C. Nine lb (The normal weight game progression of an infant indicates that, @ 1-2 weeks mark, the weight will be approx the same as birth. The infant will typically lose 10% of the BW in the days after birth, weighing a little over 8 lb, & then gain that weight back w/in 7-14 days. By 5 months, will double, & by 1 year triple, by 2 years quadruple.)

While examining a newborn infant, which of the following would be most indicative of a neuromuscular problem? A. Arms & legs flexed over abdomen B. Inability to track w/eyes C. No response to clapping of hands D. 3 cafe au lait spots on back

C. No response to clapping of hands (A newborn should respond to a startle w/a loud sound; failure to elicit this response could indicate hearing damage or other neuromuscular challenges. The normal posture of a newborn is flexion of extremities over trunk. Newborns may look at an object or face, but are not commonly expected to track. Cafe au lait spots are often counted & measured, & could be indicative of a problem if > 5-6 mm in size.)

A 7-year-old patient presents w/a pruritic rash that is macular & has a crinkled appearance. 1 week later, at his follow-up exam, the appearance of the patient's rash has developed into a Christmas tree pattern, appearing on his trunk & proximal extremities. Which medication would be most likely to prescribe to treat the most likely condition? A. Calcipotriene B. Vancomycin C. Oral erythromycin D. Permethrin 5% rinse

C. Oral erythromycin (p. 91)

During the exam of a 3 mo old patient, you place the infant in the supine position w/the hips flexed 90 deg & abducted. You then grab the patient's leg while applying downward, lateral pressure. What is the name of the supplementary exam that is commonly performed in conjunction w/the exam you are performing on your patient? A. Klisic B. Barlow C. Ortolani's D. Gaeazzi

C. Ortolani's

During the examination of a 3-month-old patient, you place the infant in the supine position w/the hips flexed 90 & abducted. You then grab the patient's legs by the thigh & gently adduct the leg while applying downward, lateral pressure. What is the name of the supplementary exam that is commonly performed in conjunction w/the exam you are performing on your patient? A. Klisic B. Barlow C. Ortolani's D. Galeazzi

C. Ortolani's (The scenario describes the Barlow test, which is used to assess for developmental dysplasia of the hip (DDH); the Ortolani test is typically performed w/the Barlow test & is also used to assess for DDH. These 2 tests evaluate the hip stability & are the favored diagnostic exams for patients 3 months of age & younger. The Klisic & Galeazzi signs are often performed on patients > 3 months to assess for decreased hip abduction & unequal thigh length.)

The NP is reading an interesting article that outlines a new protocol for the mgmt of COPD. She notices that the article was published in a well-known, peer-reviewed journal. Concerning the efficacy of the new protocol, which of the following is most important to consider before the NP adapts this new protocol to her practice? A. R-value B. T-test C. P-value D. Standard deviation

C. P-value (In this case, the NP should pay attention to the P-value. A high value such as 0.1, for example, would indicate the proposed protocol did not produce the desired results in 1/10 tests, whereas a p-value of 0.001 would indicate that the desired results did not occur in 1/1000 tests. The t-test compares the means of 2 groups, e.g., whether DBP differs between a control & treated group, between men & women, or any other 2 groups. While standard deviation can help determine if the results are indeed valid, this does not help in deciding whether a new protocol will produce significant results in practice. Lastly, R-value is not a measurement in statistical analysis.)

The first nurse practitioner program, in the early 1960s, was meant to address a shortage in which area of healthcare practice? A. Outpatient care B. Obstetrics C. Pediatrics D. Intensive care

C. Pediatrics

A 5 mo old infant's parent describes him as being recently irritable & constantly rubbing at his skin. Your exam reveals red-brown vesiculopapular lesions on his soles. Which drug would be the best choice to manage the most likely condition? A. Lindane lotion (Kwell) B. Calamine w/topical diphenhydramine (Ivarest or Caladryl) C. Permethrin (Nix) 5% rinse D. Griseofulvin (Grifulvin V)

C. Permethrin (Nix) 5% rinse (Permethrin 5% rinse is a common primary tx for scabies, which is indicated by the infant's irritability, itching, & red-brown vesiculopapular lesions on his soles. While Lindane is also a treatment for scabies it is not approved for < 6 months old d/t its neurotoxic side effects.)

Which of the following is an element essential for the diagnosis of attention deficit hyperactivity disorder? A. Symptoms occurring at age ≥ 7 B. Symptoms affect behavior at home C. Persistence of symptoms for at least 6 months D. Symptoms interfere w/school work

C. Persistence of symptoms for at least 6 months (p. 52)

A 7 yo presents w/symptoms indicative of asthma. His mother states that he typically experiences symptoms once per day. His mother adds that the symptoms also keep him out of some of the more active past times of his peers & cause him to wake 2-3 nights per week. How should you classify the pts asthma? A. Intermittent B. Persistent mild C. Persistent moderate D. Persistent severe

C. Persistent moderate (A pt between the ages of 5-11 yo who presents w/daily asthma symptoms, some limitation of activity, & nighttime awakening more than once per week s/be classified as experiencing persistent moderate asthma. Intermittent asthma typically presents w/no limitation of activity, symptoms < 2 d/wk, & nighttime awakenings < 2 nights/month. Mild persistent asthma commonly presents w/monitor activity limitation, as well as symptoms > 2 d/week, but not daily & nighttime awakenings > 3-4 times per month. Severe persistent asthma presents w/nighttime awakenings > once per week, but also presents w/asthma symptoms throughout the day & extreme activity limitation.)

Isaac age 6 months, has been brought to your practice by his parents for a routine check-up. As you enter the interview phase, you would know all of these methods would be well-suited for the interview except: A. Carefully phrasing potential health & safety concerns to respect the cultural practices of Isaac's parents B. Breaking from the assessment regularly to ensure the parents have accurately expressed their concerns C. Phrasing your questions in an open-ended fashion to ensure a nonjudgemental approach D. Using play to keep the patient engaged, regularly putting the assessment on hold to ensure a proper response

C. Phrasing your questions in an open-ended fashion to ensure a nonjudgemental approach (Although a non-judgmental approach s/be utilized @ all times, questions s/be directed & purposeful, not open-ended, to ensure key details of the patient's hx are not missed. Other proper techniques to utilize during an interview include ensuring cultural sensitivity, ensuring accurate perception of the parents' concerns, using lay to enhance the patient's comfort, & pausing to allow adequate time for a response.)

Which of the following pathogens responsible for pneumonia does not typically demonstrate lobar consolidation as a radiographic characteristic? A. Streptococcus pneumoniae B. Haemophilus influenzae C. Pneumocystis jiroveci D. Klebsiella pneumoniae

C. Pneumocystis jiroveci

Which of the following is typically used to screen for fungal infections? A. Erythrocyte sedimentation rate B. Serologic C. Potassium hydroxide D. Western blot

C. Potassium hydroxide (p. 85-6, 154)

Which of the following regimens would best constitute Step 3 in the stepwise mgmt of a pt w/asthma, according to national recommendations? A. Preferred low-dose inhaled corticosteroid (ICS) B. Cromolyn or Montelukast as required C. Preferred medium dose ICS w/considered oral systematic corticosteroid short course D. Preferred short-acting B2-agonist as required

C. Preferred medium dose ICS w/considered oral systematic corticosteroid short course

A 5yo patient comes to your office w/a fever, shaking chills, and purulent sputum w/cough. Upon auscultation, you note that he also has lung consolidation. After a laboratory examination, you discover that the patient has a respiratory syncytial virus, Haemophilus Influenzae. Which of the following would be the best way to manage the patient's condition? A. Refer to a specialist B. Prescribe penicillin C. Prescribe amoxicillin D. Prescribe azithromycin

C. Prescribe amoxicillin (p. 114)

A parent has brought in her 14-month-old for a checkup. Which of the following should have already occurred in the development of the toddler? A. Eats with a fork B. Has started toilet training C. Pulls to stand D. Speaks in 2-3 word sentences

C. Pulls to stand (p. 11)

You are evaluating a 4 mo old, whose mother says, "She's been vomiting & doesn't seem to be taking any milk or fluids. She's also been sleeping a lot more than usual." You note that the patient's fontanel is slightly sunken, & that her skin is cool to the touch & has poor turgor. These findings are least likely to be an initial indication of which condition? A. Intussusception B. Gastroenteritis C. Pyloric stenosis D. Hirschsprung's Dz

C. Pyloric stenosis

A mother brings her child in for a checkup. She is worried that the child is exhibiting mental development delays because she repeatedly has to keep saying things to him. You conduct a physical exam, including a Weber & Rinne test. The Weber test indicates sound lateralizes to the child's right ear, & the Rinne test indicates air conduction < bone conduction in the same ear. You also note â tympanic membrane mobility. Which of the following treatment options is most appropriate for this child at this time? A. Decongestants B. Oral antibiotics C. Reevaluation in 3 months D. Antihistamines

C. Reevaluation in 3 months (pts conductive hearing loss - evidenced by R/W test & decreased tympanic membrane mobility are suggestive of serous OM @ this time monitoring & re-eval in 3 mo is appropriate treatment)

A mother brings her 7 mo old infant daughter to your office b/c, over the past week, she's felt the daughter's lymph nodes in the neck "getting harder". Upon PE, you notice that the lymph nodes feel, small, round, & slightly hardened. Which of the following is the most likely cause? A. Pyelonephritis B. Lymphoma C. Respiratory infection D. Leukemia

C. Respiratory infection

A mother brings her 7-month-old infant daughter to your office b/c, over the past week, she's felt the daughter's lymph nodes in the neck "getting harder". Upon physical examination, you notice that the lymph noses feel small, round, & slightly hardened. Which of the following is the most likely cause? A. Pyelonephritis B. Lymphoma C. Respiratory infection D. Leukemia

C. Respiratory infection (The most likely cause is a respiratory infection b/c the infant is presenting w/shoddy lymph nodes, which often indicate a past infection. Although pyelonephritis is an infection, it is less likely than a respiratory infection to cause shoddy lymph nodes in the neck. Lymphoma would be more strongly indicated by enlarged lymph nodes, as opposed to shoddy lymph nodes. Leukemia would be characterized by generalized lymphadenopathy, not localized to one area.)

Tanya is 10 years old, 4'8" tall, & weighs 110 pounds. Tanya's mother is concerned about her weight & eating habits, as she has found junk food wrappers hidden around the house. She adds that Tanya it is very defiant when it comes to food restrictions. Which of the following is the most appropriate way of approaching the topic of diet with Tanya? A. Explain to Tanya that being overweight can cause type 2 diabetes, which can lead to major complications including amputations & early death B. Explain to Tanya that being overweight puts her at an increased risk for developing many types of cancer & heart disease C. Review the MyPlate standards with Tanya & help her understand why a balanced diet & maintaining a healthy weight are important D. Explain to Tanya that junk food, especially sweets, can lead to tooth decay

C. Review the MyPlate standards with Tanya & help her understand why a balanced diet & maintaining a healthy weight are important

You are conducting a WCE on a 9 mo old & discover that he has low hematocrit. His mother informs you that he drinks only goat's milk because he has trouble tolerating formula. A physical examination reveals tachycardia & pale skin. Based on your suspected diagnosis, which of the following laboratory test do you order initially? A. Peripheral smear B. Hemoglobin electrophoresis C. Serum iron tests D. ß-globin gene mapping

C. Serum iron tests (p. 133-4)

After which Tanner stage do males usually begin spermarche or nocturnal emissions? A. Stage 1 B. Stage 2 C. Stage 3 D. Stage 4

C. Stage 3

As a part of Priscilla's WCE, the NP is gathering information from Priscilla, age 13. The NP asks whether Priscilla has tried marijuana or engaged in sexual activity. The NP also asks whether or not Priscilla has any worries or stressors. Of the following types of data, which is the NP gathering? A. Objective data B. Management data C. Subjective data D. Clinical data

C. Subjective data

Which of these lab values would most likely be decreased in a patient w/hyperthyroidism? A. Free thyroxine index B. Serum antinuclear antibodies C. TSH D. Triiodothyronine

C. TSH

Of the following, which condition most often occurs in children between 10-20 years of age? A. Hypospadias B. Enuresis C. Testicular torsion D. Cryptorchidism

C. Testicular torsion (p. 150)

Which of the following types of congenital heart defects is most likely to be present w/right to left shunting? A. Transposition of the great arteries B. Coarctation of the aorta C. Tetralogy of Fallot D. Pulmonary stenosis

C. Tetralogy of Fallot

If a mother's HbsAg is unknown, the following steps would be taken w/her baby except: A. Administer hepatitis B vaccine within 12 hours of birth B. If a mother tests positive, hepatitis B immune globulin should be given no later than 1 week of age C. The 1st dose of the hepatitis B vaccine should be given at 6 months of age D. Check status immediately after birth

C. The 1st dose of the hepatitis B vaccine should be given at 6 months of age (p. 17)

The parents of a 6 mo old male infant come into your office. As of late, the baby has been fussy & drooling more than usual. The mother suspects that the child is teething & has questions regarding tooth eruption. Which of the following is most accurate regarding tooth eruption in children? A. Tooth eruption occurs in random order B. The lateral incisor is usually the 1st tooth to erupt C. The 1st tooth usually erupts @ 6 mo of age D. The primary teeth are usually in by 18 mo of age

C. The 1st tooth usually erupts @ 6 mo of age (p.7)

Which of these factors is not a typical indication to recommend a prenatal evaluation for genetic disorders? A. The mother has experienced 2 stillbirths B. The father has a brother w/Down syndrome C. The father worked w/pesticides 3 years ago D. The mother is of African descent

C. The father worked w/pesticides 3 years ago (Exposure to toxic chemicals is a common indicator for genetic evaluation if the fetus was exposed but it was the father.)

Why must circumcision not be performed on pts w/hypospadias? A. It makes the pt susceptible to infection B. There is not foreskin to remove C. The foreskin is used in repair D. Complications often cause death

C. The foreskin is used in repair

You recently diagnosed a 2yo female w/iron deficiency anemia. She has a Hgb level of 9.8 g/dL & the serum ferritin of 20 mcg/L. She presents w/increased labor of breathing, SOB & lethargy. Which of the following should be your next step in treating this patient? A. Treat w/2-3 mg/kg/d of elemental iron B. Order iron to be administered IV C. Treat w/3-6 mg/kg/d of elemental iron D. Order 1 unit packed red blood cells

C. Treat w/3-6 mg/kg/d of elemental iron (p. 134)

You are examining the newborn child of a recovering alcoholic. During the interview, she mentions she was still drinking early into her pregnancy & didn't know she was pregnant for some time. You examine the newborn's mouth. Which of the following findings would most strongly indicate fetal alcohol syndrome? A. Shrunken, contracted mouth B. Enlarged tongue C. Triangular upper lip D. Whitish-yellow cysts on gums

C. Triangular upper lip (A triangular upper lip with fish-like mouth, or the fish mouth deformity, is commonly observed in neonates & pediatric patients born w/fetal alcohol syndrome. Microstomia, on the other hand, presents as a shrunken, contracted mouth & is usually observed in trisomy 18 & 21. Macroglossia, or enlarged tongue, may be d/t hypothyroidism or mucopolysaccharidoses. Epstein pearls present as whitish-yellow cysts on the gums & roof of the mouth; these reals are common in newborns & are not considered an abnormal sign b/c they typically disappear w/in 1-2 weeks of birth.)

Jack, a school-aged child, has a 4-year-old brother who has just been diagnosed with acute lymphocytic leukemia (ALL). Jack should receive which of the following flu vaccine preparations? A. Inhaled influenza B. Quadrivalent inactivated influenza C. Trivalent inactivated influenza D. The child should not receive any influenza vaccine at risk of shedding the virus to the sibling

C. Trivalent inactivated influenza (The inhaled version is a live virus & should be avoided in families w/immunocompromised members. The trivalent inactivated influenza is a dead virus & can't shed the virus, this is the recommended version for patients under 18.)

According to Erik Erickson, the industry vs. inferiority stage occurs during school age. Which of the following would Piaget expect for appropriate cognitive development during this stage? A. Being active, energetic, & curious B. Magical thinking C. Understanding the concept of space D. Seeking rewards & approval

C. Understanding the concept of space (Concrete operational thinking - concepts of space, marked cognitive development in the school age years.)

Which of the following is a developmental warning sign in older school-age children? A. Height gain of only 2 inches a year B. Sleeps 10 hours a night C. Uses excuse of illness to get out of chores D. Weight gain of only 5 pounds a year

C. Uses excuse of illness to get out of chores (p. 49)

Regarding congenital heart defects, what would the NP recognize as not true? A. Left to right shunting occurs w/acyanotic defects B. Transposition of the great arteries, Tetralogy of Fallot, & tricuspid atresia are cyanotic defects C. Ventricular septal defect, pulmonary atresia, & patent ductus arteriosus are examples of acyanotic defects D. Right to left shunting occurs w/cyanotic defects

C. Ventricular septal defect, pulmonary atresia, & patent ductus arteriosus are examples of acyanotic defects (p. 64-5)

The NP would expect which of the following lab tests to be least useful in a work up for cystic fibrosis? A. Pilocarpine lontophoresis sweat test B. Pulmonary function tests C. WBC D. Sputum culture

C. WBC

All of the following accurately reflect the typical WCE except: A. After age 4 years, a child should have a WCE yearly B. Children on ADHD medication should see a physician or NP q6m C. WCE are arranged around immunizations schedules, which are the key purpose of the visit D. If the parents are experienced, their newborn does not commonly need to have a check-up until 1-2 weeks after birth

C. WCE are arranged around immunizations schedules, which are the key purpose of the visit (WCE commonly include PE to assess the physical well-being of a child; preventive care (immunizations).. communication w/the parents, developmental tracking, & personal family issues are all equally important aspects of the WCE. If no complications they should have a WCE yearly after age 4, if taking ADHD meds then they s/be seen q6m, after birth, it is recommended that the newborn be seen in 2-4 days unless the parents are experienced.)

Which of the following is not a developmental warning sign in younger school age children? A. Lack of social interaction B. Not paying attention in class C. Worrying about the opinions of peers D. Dropping in test score performance

C. Worrying about the opinions of peers

A 7 year old child arrives at your practice w/a radial fracture & bruising around the lower arm. When asked how he received the fracture, the child says he fell while riding his bike earlier that day, Suspecting abuse, you decide to undertake a more thorough examination. All of the following signs would increase your concern of child abuse except: A. The child appears shy w/a limited vocabulary B. Closer examination of the lower arm reveals thin, finger-like bruises C. You learn that the child exhibits poor academic performance D. You not that the child has "fallen off his bike" before & presented w/a slight concussion

C. You learn that the child exhibits poor academic performance

What is the name of the condition in which the foreskin is not retractable over the tip of the penis? A. Epispadias B. Chordee C. Hypospadias D. Phimosis

D Phimosis (Phimosis presents w/foreskin that is not retractable over the tip of the penis. This condition is considered common in infant patients & is often resolved by 3 years of age. Hypospadias results in the opening of the urethra manifesting on the underside, rather than the tip of the penis; epispadias similarly affects the urethra, causing it to open on the top or side of the penis. Chordee refers to curvature of the penis at the junction of head & shaft.)

In considering the need to refer a child to a specialist for cystic fibrosis, all of the following statements from the mother would typically support the decision except: A. "My child's stool is often bulky & foul smelling w/an oily residue" B. "My child doesn't seem to be growing. Am I not breastfeeding her enough?" C. "My child always seems to coughing & has a runny nose that won't quit." D. "My child wets his diaper 6 times a day & nearly soaks it through each time."

D. "My child wets his diaper 6 times a day & nearly soaks it through each time."

Hector, an infant born to a working-class couple, has been diagnosed with phenylketonuria (PKU), a known inborn error of metabolism. While PKU is treatable, the diagnosis of this condition has nonetheless caused his parents to believe that they are cursed. They ask you what the occurrence of PKU in the general population is. Which of these most clearly elucidates the designated occurrence of PKU? A. 1:500-1,000 B. 1:1,000-3,000 C. 1:5,000-9,000 D. 1:10,000-25,000

D. 1:10,000-25,000 (p. 32)

Dan & Kara bring their toddler son, Ian, to your office b/c they are worried about his feeding habits They explain that they still have to feed him b/c he is unable to use utensils — even a spoon — on his own. As the NP, you know that at what earliest age would Ian have to be for this issue to be a developmental concern? A. 12 months B. 15 months C. 17 months D. 20 months

D. 20 months (This control s/be gained by 18 months)

When should the rotavirus not be administered to an infant? A. 24 weeks of age B. 16 weeks of age C. 8 weeks of age D. 32 weeks of age

D. 32 weeks of age

You are examining a prepubescent child w/cafe au lait macules. You suspect that she may have neurofibromatosis-1. Which of the following physical findings would lead you to suspect this? A. 4 cafe au lait macules measuring 5 mm, & 2 cutaneous neurofibromas B. 6 cafe au lait macules measuring 4 mm, & 2 cutaneous neurofibromas C. 3 cafe au lait macules measuring 6 mm, & 3 cutaneous neurofibromas D. 6 cafe au lait macules measuring 6 mm, & 2 cutaneous neurofibromas

D. 6 cafe au lait macules measuring 6 mm, & 2 cutaneous neurofibromas

Which of the following physical findings would you least expect in individual w/trisomy 21? A. Hypotonia B. A single palmar crease C. The appearance of hypertelorism D. A "shield" shaped chest

D. A "shield" shaped chest (p. 22)

There are several reflexes that initiate in the newborn period. Which of the following is most indicative of a baby is exhibiting normal development? A. A 24 mo old whose big toe points up, w/other toe fanning out B. A 6 mo old who has just been able to watch a person's face intently C. An 8 mo old who started holding his head steady when pulled to sit last month D. A 4 mo old infant who lifts his head & chest when on his stomach

D. A 4 mo old infant who lifts his head & chest when on his stomach (p. 11)

When examining the vision of an infant, which finding would be most indicative of Tay-Sachs disease? A. Brushfield spots B. Ectopia lentis C. Iridodonesis D. A cherry red macula

D. A cherry red macula (p. 23)

You are performing an eye exam on a newborn child. When you perform the red reflex test, a black spot presents instead, Which of these conditions would this finding typically indicate? A. Optic nerve hypoplasia B. Retinoblastoma C. Heterochromia D. Absence of a clear retinal pathway

D. Absence of a clear retinal pathway (The red reflex replaced by a black spot commonly indicates that there is no clear pathway from the lens to the retina & is a crucial finding for congenital contra acts, corneal scar, or ocular hemorrhage. Optic nerve hypoplasia, on the other hand, is a midline defect of the CNS & may present s/colobomas. Heterochromia simply refers to a difference in coloration of the iris & usually does not indicate an underlying condition. Further, retinoblastoma & congenital cataracts may ne indicated by the red reflex being replaced by a whitish color, not a black spot.)

The parents of a 16yo patient are concerned that their child may be depressed. The parents state that their child has increasingly isolated himself & has an overall sad demeanor. While interviewing the child, which of the following guidelines for effective communication is necessary? A. Asking the parent to repeat to you what the school counselor has told them B. Taking a lead in the conversation & stay on topic C. Telling the parent the exact details goal resolution D. Active listening skills & therapeutic response

D. Active listening skills & therapeutic response

Which of the following is not an indication for genetic evaluation? A. Fetal exposures to medication B. History of miscarriages & stillbirths C. Family history of birth defects D. Advanced paternal age 30

D. Advanced paternal age 30 (p. 21)

You are taking over the case of a 2yo girl w/a 5 day history of fever; erythema on her palms & soles; & erythematous, cracked lips. In addition, a physical examination indicates a strawberry tongue & cervical lymph nodes that are palpable & 2 cm in diameter. Based on the most likely diagnosis, which of the following findings would you most expect? A. A shortened PR interval B. A decreased erythrocyte sedimentation rate C. Bradycardia D. An increased C-reactive protein

D. An increased C-reactive protein (p. 69-70)

Pyloric stenosis is characterized by which type of abdominal mass? A. A lump in the lower abdomen B. Multiple sausage shaped masses around the abdomen C. A sausage shaped mass in the RUQ D. An olive shaped mass in the RUQ

D. An olive shaped mass in the RUQ (p. 74)

Your 9yo patient is brought to the clinic with a 3 day history of sneezing, runny nose, & coughing. His temperature is 103F & his cough produces yellow-tinged mucous. His father reports that the child has been very tired & has been shaking because of overwhelming chills. You hear crackles during auscultation & order an x-ray. The x-ray indicates patchy infiltrates & pleural effusion. Which of the following would be the most likely diagnosis & pathogenic cause? A. Bronchiolitis; respiratory syncytial virus B. Bacterial pneumonia; Streptococcus pneumoniae C. Bronchiolitis; mycoplasma D. Bacterial pneumonia; Escherichia coli

D. Bacterial pneumonia; Escherichia coli (The patient's findings & chest x-ray indicate bacterial pneumonia caused by Escherichia coli. Coughing in bronchiolitis is generally non-productive, & patients typically have a mild fever. Additionally, an x-ray showing bronchiolitis will have areas of scattered consolidation rather than patchy infiltrates in this case. Infections with S. pneumonia presents with lobar consolidation, not patchy infiltrates, on an x-ray.)

Jeanette, age 14, comes to your office for her annual checkup accompanied by her mother. You observe that Jeanette has stained teeth, calloused knuckles, & hoarseness in her voice. Upon physical examination, you also note that she has lost weight & presents w/decreased vital signs & anemia. Which of the following is the most likely diagnosis? A. Substance abuse B. Personality disorder C. Anorexia nervosa D. Bulimia nervosa

D. Bulimia nervosa (p. 60-1)

Which cranial nerve controls hearing & equilibrium? A. CN II B. CN IV C. CN VI D. CN VIII

D. CN VIII

During auscultation of a newborn, a grade IV murmur is heard w/a holosystolic thrill @ the LLSB. You suspect a congenital heart defect & order an x-ray. What findings would be most consistent w/a suspected diagnosis of ventricular septal defect? A. Normal chest x-ray B. Cardiomegaly w/rib notching C. Boot-shaped heart D. Cardiomegaly w/increased pulmonary vascular markings

D. Cardiomegaly w/increased pulmonary vascular markings

A 10 yo male w/a recent history of group A Beta-hemolytic streptococcus infection currently has a fever of 103. Which of the following findings is most consistent w/a diagnosis of rheumatic fever? A. Elevated acute phase reactants B. Arthralgia without objective inflammation C. Prolonged interval between the P-wave to the beginning of the QRS complex D. Carditis

D. Carditis

A 4-year-old girl c/o localized, painful swelling of her left eyelid. Her parents say that an abscess on her eyelid seems to be causing the swelling & redness. Your examination confirms the parents' suspicions concerning the abscess. Which of the following would be the most likely cause? A. Chalazion B. Blepharitis C. Conjunctivitis D. Hordeolum

D. Hordeolum

You are examining a newborn's head after a full term vaginal delivery, without complications, from a mother who does not have a significant medical history. The newborn is alert and crying, the anterior fontanelle is full, and the scalp feels loose & slightly edematous. The blood does not seem to increase with crying & does not cross the midline, which is palpable. What is the most probable diagnosis? A. Microcephaly B. Macrocephaly C. Caput succedaneum D. Cephalohematoma

D. Cephalohematoma (A diagnosis of cephalohematoma, the collection of blood between the surface of the cranial bones & the periosteal membrane, is most appropriate because the blood does not cross the patient's midline. Caput succedaneum is often the result of a long & difficult labor or vacuum extraction, &, in this case, blood would be seen crossing the suture lines. Microcephaly & macrocephaly refer to cranial circumference, of less or greater than two standard deviation's, respectively. These are not reported in this patient.)

Kevin, 3yo male, is brought to your clinic. Upon evaluation, you determine that he has poor motor, language, & social skills. His parents state, however, that until very recently, Kevin's communication skills & social relationships were much better & age-appropriate. Which of the following disorders does he most likely have? A. Asperger's syndrome B. Rett syndrome C. Down syndrome D. Childhood disintegrative disorder

D. Childhood disintegrative disorder

Johnny, age 3, is brought into the clinic by his parents, who state that he has been unable to perform certain skills that he used to be able to perform. They also say that his ability to use language has started to deteriorate, & he doesn't want to play w/the other childrean @ school. Which of the following conditions would be the most likely diagnosis? A. Autistic disorder B. Asperger's syndrome C. Rett's disorder D. Childhood disintegrative disorder

D. Childhood disintegrative disorder (Based on the age of the patient & the recent decline in multiple areas of functioning.)

A 7 yo patient is brought to you complaining of difficulty swallowing & drooling. During the examination you note that the epiglottis is inflamed. Which of the following pathogens is usually not associated with this type of inflammation? A. Streptococci B. Haemophilus influenzae C. Pneumococci D. Chlamydia trachomatis

D. Chlamydia trachomatis (Chlamydia trachomatis may cause pharyngitis, not epiglottitis. Pneumococci, streptococci, and Haemophilus influenzae are all common causes of epiglottitis.)

An infant presents with cyanosis in the lower extremities. Upon for the exam, you know that the patient has a higher pulse rate and blood pressure in the upper extremities in comparison to his lower extremities. What is the most probable cause of these findings? A. Cutis marmorata B. The patent ductus arteriosus did not close properly C. Harlequin color change D. Coarctation of the aorta

D. Coarctation of the aorta

Jamie, a 4 yo male, presents to the clinic in a sleepy, afebrile state. His mother mentions that, after his afternoon nap, he started screaming in their brightly-lit den & began vomiting. When she tried to talk to him, he spoke nonsense. When you talk to Jamie, he rouses, exhibits normal speech, & says he feels find. What is the most likely source of Jamie's symptoms? A. Viral meningitis B. Brain tumor C. Neurofibromatosis D. Confusional migraine

D. Confusional migraine

Which of the following is not a finding of DiGeorge syndrome? A. Short palpebral fissures B. Lateral displacement of the inner canthi C. Hypoparathyroidism with hypocalcemia D. Decreased muscle tone

D. Decreased muscle tone (p. 24)

There is concern at your clinic that some children with developmental delays are not being identified soon enough. You are examining a 6yo male. Of the following, which is the best tool to identify risk for developmental delay in this child? A. Cognitive adaptive test B. M-CHAT C. Ages and stages questionnaire D. Denver II

D. Denver II

Michael, a 5 yo pt, is experiencing involuntary urination during waking hours. His parents point out that Michael historically exhibited bladder control until 2 weeks ago. As he does not demonstrate any signs of psychological distress, you suspect Michael's condition may be neurogenic in origin. How would you best classify Michael's enuresis? A. Primary enuresis B. Nocturnal enuresis C. Functional enuresis D. Diurnal enuresis

D. Diurnal enuresis

A 1 month old baby girl presents with a swollen eyelid with purulent discharge. The NP notes red inflammation on the eyelid. Of the following, which is the best treatment for this patient? A. Oral antihistamines B. Allergist referral C. Ophthalmologist referral D. Erythromycin ointment

D. Erythromycin ointment

What finding is not a classic characteristic of a 3 month old w/congenital heart disease & signs of heart failure? A. Failure to thrive B. Irritability C. Rales upon lung auscultation D. Frequent vomiting w/feeding

D. Frequent vomiting w/feeding

Whic of these treatments is primarily recommended for mgmt of tinea capitis? A. Oral acyclovir B. Aluminum subacetate solution C. Need shampoo D. Griseofulvin

D. Griseofulvin

Which of the following pathogens is most commonly responsible for epiglottitis? A. Neisseria gonorrhoeae B. Streptococcus pneumniae C. Moraxella catarrhalis D. Haemophilus influenzae

D. Haemophilus influenzae

A 15yo male presents w/ c/o general malaise & fatigue for the past few wks w/o resolution. He has also had a fever & sore throat. All of the following exam findings would support the diagnosis of infectious mononucleosis except: A. Diffuse cervical lymphadenopathy B. White exudate on tonsils C. Maculopapular rash D. Hepatomegaly

D. Hepatomegaly (Splenomegaly, not hepatomegaly, is found in infectious mononucleosis. All the other listed exam findings are indicative of infectious mononucleosis, along w/an early rise in immunoglobulin M, & a permanent rise in immunoglobulin G.)

A mother brings in her 2-year-old child for a routine follow-up as well as immunizations. The child weighed 3.45 kg @ birth & was 20" long. Which of the following is the most accurate statement regarding her physical development? A. Her current height should be about 1/3 her adult height B. Her birth weight was appropriate for her gestational age C. Her birth weight would be categorized as below average D. Her current weight should be about 14 kg today

D. Her current weight should be about 14 kg today (p. 6)

A 1 mo male is brought to the clinic or a regular check-up. He exhibits irritability & fever of 100.2, & shows signs of dehydration & documented weight loss. A urinalysis is positive for leukocytes & nitrites. Given the most likely diagnosis, what is the 1st step that s/b taken in treating his underlying condition? A. Home course of oral cephalosporins B. Surgical intervention C. Oral desmopressin D. Hospitalization

D. Hospitalization

When using the Weber & Rinne tests to screen for hearing loss, which of the following statements is true? A. In sensorineural hearing loss, sound lateralizes to the unaffected ear with the Rinne test B. Normal findings w/the Weber test include an air conduction rate > the bone conduction rate C. In conductive hearing loss, air conduction > bone conduction is expected w/the Rinne test D. In conductive hearing loss, sound lateralizes to the affected ear during the Weber test

D. In conductive hearing loss, sound lateralizes to the affected ear during the Weber test (p. 105)

A 5 yo male presents w/weakness, muscle fatigue, & arthralgias. A PE reveals dry skin, diminished heart sounds, & diminished DTRs. Suspecting hypothyroidism, you order a series of lab studies. Which of following findings would confirm a dx of hypothyroidism? A. Low liver enzymes B. Low serum cholesterol C. Elevated T3 D. Increased TSH

D. Increased TSH

The Denver II assessment test commonly measures a child for all of the following except: A. Personal-social development B. Language C. Fine motor development D. Intelligence

D. Intelligence (Although the Denver II assessment test measures several aspects of child development, it is NOT an intelligence test. It measures language, personal-social dev, fine motor, & gross motor dev.)

A child's serology results come back showing Anti-HCV & HCV RNA. Which of the following may be included in his treatment plan? A. Oxycodone B. Trimethoprim-sulfamethoxazole C. Erythromycin D. Interferon & ribavirin

D. Interferon & ribavirin

A 6 mo old male is brought to your clinic w/complaints of vomiting. His mother says that her some was fine, but then "he just got really irritable & started crying, & then just started throwing up green barf". The mother says that she noticed her son has not been as energetic as usual, & that there was "jelly-like poop" when changing his diaper. Based on these findings, which GI disorder would you most likely suspect? A. Gastroenteritis B. Hirschsprung's Dz C. Pyloric stenosis D. Intussusception

D. Intussusception

The parents of 9mo Kent comes to your office, hurried & during the middle of the night. The parents state that their child is lethargic & constantly cries out despite all attempts to comfort him. Upon exam, the NP notes palpable sausage-shaped mass in the RUQ & abdominal distention. When asked about the child's stool, the parents stated that his diapers were jelly like. Of the following, which is the most likely diagnosis? A. Appendicitis B. Pyloric stenosis C. Malabsorption D. Intussusception

D. Intussusception

The acronym SAFETEENS provides a checklist of preventive care topics for NPs. Going by this checklist, which of the following is not a significant concern in preventive care? A. Sexual abstinence B. Suicide C. School performance D. Involvement in hobbies

D. Involvement in hobbies (SAFETEENS - S - sexuality, A - accidents, F - firearms/violence, E - emotions (suicide), T - toxins, E - environment (school perfo, E - exercise, N - nutrition, S - shots

A 24 month old Caucasian baby brought in by her mother so says the child is "unusually tired". She has no history of chronic illness. After interviewing the mother, the pediatric NP learns that she was switched to whole milk at 12 months of age. Currently she is drinking 60 ounces per day & is not interested in solid foods. Upon physical exam, you notice a pale conjunctiva, and lab results reveal microcytic hypochromic anemia with normal blood white blood cell, platelet, & reticulocyte counts. What is the most likely diagnosis? A. Vitamin B12 deficiency B. Alpha-thalassemia minor C. Pernicious anemia D. Iron deficiency anemia

D. Iron deficiency anemia

Shortly after a routine, healthy delivery of a male newborn, you are determining the necessary tests & exams to be administered. Mandatory screening for this child would include all of the following except: A. Galactosemia B. Hypothyroidism C. Phenylketonuria screening D. Iron deficiency anemia

D. Iron deficiency anemia (p. 31)

All of the following are findings of pre-icteric hepatitis except: A. Fatigue B. Anorexia C. Malaise D. Jaundice

D. Jaundice (p. 78)

A concerned mother brings her 18 month old child to you with his feet conspicuously turned inward. Which of the following is not included among the differential diagnoses? A. Metatarsus adductus B. Adducted great toe C. Femoral anteversion D. Legg-Calve-Perthes disease

D. Legg-Calve-Perthes disease (Legg-Calve-Perthes disease (LCPD) is an aseptic or avascular necrosis of the femoral head. Physical findings include limited passive internal rotation & abduction of the hip joint & do not include inward pointing feet. Inward turned feet may be attributed to femoral anteversion, metatarsus adductus, and an adducted great toe but not LCPD.)

Which of these genetic disorders is most likely to lead to blindness in later life? A. Turner's syndrome B. DiGeorge syndrome C. Kleinfelter's syndrome D. Marfan syndrome

D. Marfan syndrome (This is b/c of ectopia lentis & the increased chance of retinal detachment & glaucoma which can lead to blindness.)

Which of the following physical features is not characteristic of a newborn with Down's syndrome? A. Unruly hair B. Brushfield spots C. Wide fontanelle D. Micrognathia

D. Micrognathia (p. 29)

What physical exam findings would lead you to diagnose a toddler w/allergic rhinitis? A. Nasal quality voice B. Orbital edema C. Fissures @ lip corners D. Mouth breathing

D. Mouth breathing (p. 40)

Which of the following medications is least recommended for the tx of enuresis? A. Desmopressin B. Oxbutynin C. Flavoxate D. Nitofurantoin

D. Nitofurantoin

While assessing a patient during a physical, you find a small elevated area on her lower back. The area is a firm lesion of approx 1.5 cm; it feels smooth to the touch, is not filled w/fluid, & does not appear to extend below the epidermis. This morphology best describes which type of lesion? A. Wheal B. Tumor C. Cyst D. Nodule

D. Nodule

You are assessing a toddler's fractured right radius. There is minimal swelling @ the fracture site & no bruising. Other than the fracture, a physical exam did not reveal anything other than the obvious pain the child felt @ the site of the fracture. The mother is perplexed as to how the fracture happened. You suspect abuse but also consider a differential diagnosis that could account for this toddler's symptoms. Which of the following could most explain the child's fracture? A. Avascular necrosis B. Osteoporosis C. Sickle cell anemia D. Osteogenesis imperfecta

D. Osteogenesis imperfecta

The 1st NP programs were initiated, primarily, because of what issues in healthcare at that time? A. Hospital restructuring B. Managed-care C. Indigent patient needs D. Pediatric physician shortages

D. Pediatric physician shortages (p. 186)

Which of the following newborn screening tests are required by law in all 50 states? A. Galactosemia, HIV, and phenylketonuria B. Galactosemia, hemoglobin disorders, & hepatitis C. Sickle cell disorders, phenylketonuria & vision scan D. Phenylketonuria, hypothyroidism, sickle cell, & galactosemia

D. Phenylketonuria, hypothyroidism, sickle cell, & galactosemia

What is the name of the condition in which the foreskin is not retractible over the tip of the penis? A. Epispadias B. Chordee C. Hypospadias D. Phimosis

D. Phimosis

Which of the following skin variations that occurs in newborns would be of most concern? A. Milia B. Hemangioma C. Erythema toxicum D. Port wine stain

D. Port wine stains (Port wine stains are vascular birthmarks consisting of superficial & deep dilated capillaries that cause permanent reddish to purplish discoloration of the skin & may signify neurologic concerns. Milia are Pinpoint white papule on the face that spontaneously disappear w/in 3-4 weeks of like. A hemangioma is characterized by raised, soft, red lumps on the skin & is not usually a concern, Erythema toxicum is a benign newborn rash.)

You determine that a 12 yo male presents w/testicular torsion. Your tx priorities should include: A. Recommend cilostazol to improve blood flow B. Write release from physical education for the next 5 days C. Advise to make appt w/urology D. Refer to the ED for immediate surgical evaluation

D. Refer to the ED for immediate surgical evaluation

Metformin is not recommended as a 1st line therapy for DM2 patients presenting w/which of the following? A. Children < 10 yo B. Hypoglycemia C. Polydipsia D. Renal failure

D. Renal failure (Patients w/hepatic or renal failure s/not be prescribed metformin, which is commonly used to control high blood glucose & reduce gluconeogenesis in pts w/DM2. Metformin is known to upset the GI tract & exacerbate lactic acidosis. Metformin doesn't generally produce or exacerbate hypoglycemia in DM pts. Polydipsia may present as a symptoms in DM1 or DM1 pts, but is not a contraindication for metformin.)

In a pt w/tic disorders, all of the following presentations would typically be recognized as a simple tic except: A. Blinking for 30 seconds w/o interruption B. Extensive clearing of the throat C. Jerking the head back & forth D. Repeating a word another person said

D. Repeating a word another person said

What the following heart sounds is known as the "Kentucky" gallop? A. S2 B. S4 C. S1 D. S3

D. S3 (p. 62)

Which of these heart sounds would most strongly indicate a cardiac disorder in a pediatric patient? A. S1 B. S2 C. S3 D. S4

D. S4

The process of developmental surveillance includes eliciting & attending to parental concerns, obtaining a relevant developmental history, & making accurate & informative observations of children. Of the following, which best accomplishes this task? A. Using standardized growth charts B. Using standardized questionnaires C. Using clinical impressions primarily D. Screening process instruments

D. Screening process instruments (The screening process is best done by using developmental screening instruments; these are brief, standardized tests used to identify children who require further in-depth examination. When physicians use on my clinical impressions, such as an interview, estimates of children's developmental status are often inaccurate. Standardized questions & growth charts are part of developmental screening instruments that are utilized, but these should be used along with other screening instruments for a more comprehensive gathering of information.)

A child presents with symptoms of nausea, vomiting, & diarrhea which you determine to be the result of an acute inflammation of the gastric mucosa. After a diagnostic culture, you determine that the cause is not viral, so you decide to test for bacterial agents. Of the possible bacterial pathogens, you most respect to find which of the following bacteria? A. Salmonella, E. coli, & beta Streptococci B. Clostridium, Giardia, & E. coli C. Shigella, botulism, & H. pylori D. Shigella, Clostridium, & E. coli

D. Shigella, Clostridium, & E. coli

A febrile 5 yo patient w/sickle cell anemia has continued bed wetting. You order a urinalysis. Which of the following findings would you expect? A. Proteinuria B. Red blood cells C. Leukocyte esterase D. Specific gravity of 1.008

D. Specific gravity of 1.008 ( The urinalysis for a child w/ sickle cell anemia is usually hypoconcentrated, as indicated by a urine specific gravity of 1.008. Presence of WBCs, leukocyte esterase, or RBCs would not be expected w/sickle cell anemia. Proteinuria may be found in adult patients w/sickle cell anemia b/c of sickle cell neuropathy, but in pediatric sickle cell dz patients typically have normal renal function.)

Which of the following authorizes the Board of Nursing of the respective state to establish statutory authority? A. Standards of Advanced Practice B. Drug Enforcement Agency C. Department of Health and Human Services D. State practice acts

D. State practice acts

During a routine pediatric physical exam, you hear a murmur in a 12-year-old boy. You hear it best between the left lower sternal border & the apex of the heart. The murmur is "musical" or "vibratory" as opposed to harsh. Which of the following is the most likely cause of this murmur? A. Pulmonic stenosis B. Venous hum C. Aortic stenosis D. Still's murmur

D. Still's murmur

Which of the following components of Continuous Quality Improvement monitors the numbers of qualified staff, equipment, & resources? A. Establishments B. Appropriateness C. Processes D. Structures

D. Structures

Which test would provide the most definitive diagnosis of neuroblastoma? A. Physical exam B. Low levels of urine catecholamines C. Abdominal CT scan D. Surgical biopsy

D. Surgical biopsy (A sx biopsy is the most definitive dx for neuroblastoma. Elevated urinary catecholamine levels, rather than low levels, may be used to dx neuroblastoma. Imaging studies, such as CT & physical exams, may strongly suggest the presence of this condition, but are unable to confirm a dx.)

Which of these genetic disorders is not associated w/cardiac defects? A. DiGeorge syndrome B. Marfan syndrome C. Turner's syndrome D. Tay-Sachs disease

D. Tay-Sachs disease (DiGeorge: aortic arch anomalies; Marfan: mitral valve prolapse, aortic regurgitation, & aortic dissection; Turner's: coarctation of the aorta.)

Which of the following conditions is least likely to present as asymptomatic in males? A. Gonorrhea B. Cryptorchidism C. Chlamydia D. Testicular torsion

D. Testicular torsion (Testicular torsion is not likely to present as asymptomatic, & is often heralded by sudden, severe pain in one testicle. Gonorrhea, cryptorchidism, & chlamydia are all often asymptomatic in males.)

Jason, age 8 years, is going to South America on vacation w/his parents. His parents want to know which vaccinations he needs to keep from getting sick. Assuming he is caught up on all of his other vaccinations, which of the following vaccines would be least necessary for Jason? A. Hepatitis A vaccine B. Typhoid vaccine C. Malaria vaccine D. Tetanus, diphtheria, acellular pertussis vaccine

D. Tetanus, diphtheria, acellular pertussis vaccine (Since this vaccine will normally protect the patient for 10 years, since they are up to date, this vaccine would not be needed.)

Regarding cardiac assessment, which of the following is true? A. The S1 heart sound is c/b opening of the mitral & tricuspid valves B. The S2 heart sound is c/b closure of the mitral & tricuspid valves C. The S1 heart sound is c/b opening of the aortic & pulmonic valves D. The S2 heart sound is c/b closure of the aortic & pulmonic valves

D. The S2 heart sound is c/b closure of the aortic & pulmonic valves (p. 62)

Mary brings her 2m old son, Parker, for A WCE. Mary has been breastfeeding Parker since birth, & Parker has been growing @ a rate of about 31 g/day. Mary wonders whether she is producing enough milk for her baby & would like info about switching to formula. Which of the following is the most appropriate advice to give Mary? A. If Mary feels that she is not producing enough milk, she should include vitamin D & B12 supplements for the baby, but she does not need to switch to formula. B. Mary should follow the AAP guidelines & continue breastfeeding. C. Parker could be suffering from malnutrition, but further tests are necessary to confirm this. D. The best way to confirm that Parker is receiving adequate nutrition is by his weight gain. According to his growth chart, he is in an appropriate rage for his age.

D. The best way to confirm that Parker is receiving adequate nutrition is by his weight gain. According to his growth chart, he is in an appropriate rage for his age.

All of these statements are true of slipped capital femoral epiphysis except: A. The condition typically occurs in girls prior to menarche B. The condition usually occurs w/o sudden severe force or trauma C. There is an increased incidence of the condition amongst obese adolescents D. The condition is more common in males & Caucasian adolescents

D. The condition is more common in males & Caucasian adolescents (SCFE is most common in male & AA, not Caucasian, adolescents. Female adolescents are also likely to experience the condition during growth spurts & prior to menarche. SCFE also shows a higher incidence amongst children who are obese or who have sedentary lifestyles & often presents w/o sudden force or trauma.)

Which of the following statements is most true regarding sinusitis in young children? A. Sinusitis occurs in children beginning @ 6 years of age or older B. Sinusitis is distinguished from acute otitis media by its typical pathogens C. Radiological studies are the most common method of confirming a diagnosis D. The paranasal sinuses are the most commonly affected sinuses

D. The paranasal sinuses are the most commonly affected sinuses (In young children, the 2 sinuses most commonly affected by sinusitis are 2 of the paranasal sinuses: the maxillary & ethmoid sinuses. Sinusitis can occur in children < 6 yo b/c the ethmoid & maxillary sinuses are present @ birth. Sinusitis can't be distinguished from AOM by its typical pathogens, as sinusitis shares the same typical pathogens w/AOM, such as Streptococcus pneumoniae, Haemophilus influenzae, & Moraxella catarrhalis.

Sharon, age 16, has just received her 1st meningococcal conjugate vaccine. How long should she ideally wait before receiving the booster dose? A. 8 weeks B. 6 months C. 1 year D. The patient does not require a booster dose.

D. The patient does not require a booster dose. (If given prior to the age of 16, as recommended from 11-12 yr, then a booster would be needed at the age of 16 or at least 8 weeks after the 1st dose. Since the dose was given @ 16, she does not require a 2nd dose.)

Which of the following statements is not true about the varicella vaccine? A. It is preferable to separate administration by 1 month from the administration of the MMR vaccine B. The vaccine is administered in a series of 2 shots C. The vaccine must be administered between 12 months & 12 years of age D. The series of shots must be administered a minimum of 4 months apart

D. The series of shots must be administered a minimum of 4 months apart (p. 19)

Jack, age 12, is diagnosed with ADHD. Which of the following is most strongly recommended regarding Jack's medication regimen? A. There should be a drug holiday @ nighttime during the week B. There should be a drug holiday on the weekends C. There should be a drug holiday during holiday breaks from school D. There should be no drug holiday in the course of treatment.

D. There should be no drug holiday in the course of treatment.

A 12 yo boy comes to the clinic w/a small, circular, erythematous rash w/a central clearing. His mother reports that his sister has the same rash. A physical exam indicates normal vitals. Which of the following is the most likely diagnosis? A. Tinea versicolor B. Lyme disease C. Molluscum contagiosum D. Tinea corporis

D. Tinea corporis (p. 86)

The measles, mumps, & rubella vaccine (MMR) may be given simultaneously w/tuberculosis testing & the purified protein derivative (PPD) skin test, but it is commonly recommended to postpone the PPD for 4-6 weeks for which reason? A. To avoid unwanted protein binding to the MMR vaccine B To avoid adverts effects C. To allow the MMR to form antibodies D. To avoid possible false negative on the PPD test

D. To avoid possible false negative on the PPD test (The combination of the MMR, PPD can yield an unwanted false negative response.)

According to the normal stage of primitive reflex development, which of the following reflexes is expected to not disappear by about 12 months of age? A. The head turning towards anything that strokes the cheek or mouth B. The arms spreading or contracting in response to loss of balance C. Sucking in response to objects touching the roof of the mouth D. Toes fanning out in response to stroking of the sole

D. Toes fanning out in response to stroking of the sole (The Babinski reflex, or fanning of the toes upon stroking of the sole, is expected to disappear after 12 months or when the infant starts walking, but may last for up to 2 years; if it persists past this point, it may indicate a nervous system disorder. The turning of the head towards anything that strokes the cheek is a sign of the rooting reflex, whereas sucking on anything that touches the roof of the mouth demonstrates the sucking reflex; both these reflexes are expected to disappear at 3-4 months of age. The Moro reflex, indicated by stretching or contracting the arms upon perceiving a loss of balance, is also expected to disappear during this window.)

A 7yo male presents to the clinic w/a limp from pain on his right side. You ask how long he has been limping but the boy's mother is not sure. She tells you that she noticed him limping a few days ago, but the boy did not c/o pain until very recently. He is unable to walk long distances. His temperature is 99F, which the mother explains is d/t a recent cold. Upon physical exam, you see no obvious signs, but an internal rotation of the hip causes spasm. The x-ray appears normal. Which of the following conditions do you suspect is the most likely cause? A. Septic arthritis B. Legg-Calve-Perthes dz C. Slipped capital femoral epiphysis D. Toxic synovitis

D. Toxic synovitis

Karen & Alan bring their 9-year old son, Pascal, because they are worried that he has gained an excessive amount of weight in the past 6 months. You are about to interview them and Pascal himself about his nutritional history. As you talk to them, you keep in mind the likely causes of obesity. Which of the following is not because of obesity? A. Hypothyroidism B. Antipsychotic C. Prader-Willi syndrome D. Type I diabetes

D. Type I diabetes (p. 50, 139, 144)

A 9 mo old infant presents to the clinic fussy, w/decreased appetite & fever of 102.3 F. Upon examining the patient, you find it difficult to find a localized site of infection. Which of the following is the most likely condition? A. Otitis media B. Group B streptococcal infection C. Occult bacteremia D. Urinary tract infection

D. Urinary tract infection

A 9-month-old infant presents to the clinic fussy, w/decreased appetite & a fever of 102.3. Upon examining the patient, you find it difficult to find a localized site of infection. Which of the following is the most likely condition? A. Otitis media B. Group B streptococcal infection C. Occult bacteremia D. Urinary tract infection

D. Urinary tract infection (A dx of UTI s/be considered if a local site of infection can't be found in a febrile infant. Typically, an unexplained fever is the most characteristic symptoms in an infant w/a UTI. Pneumonia & OM are also associated w/causing fever in infants, but both conditions would likely present w/other findings as well, such as tachypnea or respiratory distress in pneumonia & irritability & vertigo in OM. Gastroenteritis in infants would also cause other symptoms & wouldn't be the most likely dx.)

Maude, the 8-year old daughter of Judd, complains of an increased frequency in urination, having to go to the bathroom 3-4 times a night. This has already caused difficulty in school due to tiredness & now she is missing school due to a fever. Which of the following diagnoses do you suspect the most? A. Enuresis B. Hypospadias C. Type I DM D. Urinary tract infection

D. Urinary tract infection (p.148)

By the age of 3, a child should have received the 3rd dose of all of the following immunizations except: A. Hepatitis B B. Diphtheria, tetanus, & acellular pertussis (DTaP) C. Haemophilus influenzae D. Varicella

D. Varicella (Only 1 dose of varicella by age 3, they will have the 2nd and final dose between 4-6 years of age.)

When performing a physical exam on a 14-year-old patient, which of the following me be subject to change because of puberty? A. Teeth corruption B. Basic fine motor skills C. Hearing D. Visual acuity

D. Visual acuity (p. 58)

Incidence of viral gastroenteritis in pediatric patients usually peaks during which season? A. Spring B. Summer C. Fall D. Winter

D. Winter

A patient w/heart disease has headaches & dizziness. He also states that he has visual & breathing problems. Based on these findings, what would be the most likely diagnosis for this patient? A. Rheumatic fever B. Hypertension C. Kawasaki disease D. Pulmonic stenosis

Hypertension (p. 68)

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

a. A type of egocentrism (The belief that one is immune to poor or bad outcomes (e.g., death, disease) is a form of egocentrism known as personal fable in which adolescents believe that the laws of nature do not apply to them.)

One of the major psychosocial tasks of infancy is: a. Development of secure attachment b. Separation-individuation c. Symbiosis d. Regulation

a. Development of secure attachment (The development of an infant-caregiver bond is key to the prevention of long-term psychological effects associated w/deprivation and/or failure to develop secure, stable bonds.)

The most common temperament profile is: a. Easy b. Difficult c. Slow-to-warm-up d. Intermediate

a. Easy (p. 36 Approximately 40% of children are described as having an easy (rhythmic, approachable, adaptive) temperament.)

A risk factor that is common to many psychosocial pediatric problems, including failure to thrive, conduct or oppositional disorders, and childhood depression, is: a. Maternal depression or other psychiatric disorder b. Substance abuse c. Prematurity d. History of sexual abuse

a. Maternal depression or other psychiatric disorder (All of these problems have multifactorial etiologies; maternal psychiatric disorders that could affect parenting or development of a secure and stable bond are important factors to consider.)

A preschool boy whose parents have separated & are beginning divorce procedures: a. May think that he caused the divorce by misbehaving b. Should not be told of the impending divorce until the parents are sure of their decision c. Is likely to experience gender identity confusion d. Should be able to make a decision about which parent he prefers living with

a. May think that he caused the divorce by misbehaving (Preschoolers are characterized by egocentrism; they think the world revolves around them & that everything that happens is because they did or did not do something.)

The common practice of using "time-outs" w/young children is a direct application of: a. Operant conditioning b. Classical conditioning c. Separation-individuation d. Maturational reinforcement

a. Operant conditioning (Time-out is a practice of behavioral modification as promulgated by B. F. Skinner's model of operant conditioning w/a negative consequence for an unacceptable behavior.)

The stage of cognitive development that Piaget described as characteristic of the way preschoolers think is the: a. Preoperational stage b. Mental combinations stage c. Tertiary circular function stage d. Sensorimotor stage

a. Preoperational stage (Piaget characterizes preschoolers as preoperational thinkers.)

Which of the following strategies would not be appropriate to include as part of your management of a 9-year-old boy who is obese? a. Referral to nutritionist for weight reduction plan b. Increase physical exercise c. Behavior modification strategies to deal w/stress &/or reinforce treatment plan d. Involve family in management program

a. Referral to nutritionist for weight reduction plan (Treatment of obesity in a 9-year-old requires a multifactorial approach, including "eating healthy", exercise, & needs; not necessarily focus on weight reduction. The goal is to prevent weight gain & maintain weight until linear growth catches up.)

While listening to 2 1⁄2-year-old KL talk, you note that she frequently omits final consonants & her sentences are 2-3 words in length. The appropriate plan of care would be: a. Routine follow-up at the next WCE b. Referring for hearing screen c. Assessing for developmental delays d. Referring to a speech pathologist

a. Routine follow-up at the next WCE (Children aged 2-3 years have several articulation disfluencies, among them is the dropping of final consonants. 2-3 word sentences are normal for the 24-30-month-old child.)

Which adolescent would be at greatest risk for developing anorexia nervosa? a. 12 yo female who just had her first period b. 14 yo female gymnast c. 16 yo male runner d. 18 yo female college student

b. 14 yo female gymnast (There is a very high incidence of anorexia nervosa in ballet dancers and gymnasts.)

Most healthy infants are able to reach, grasp, & hold on to a rattle or other small toy by about: a. 2 months b. 6 months c. 8 months d. 10 months

b. 6 months (These are gross developmental norms associated w/the 6 mo child.)

Which of the following situations does not necessarily warrant immediate mental health assessment and/or referral? a. 13 yo girl who has been "down" for the last month w/varied somatic complaints b. 9 yo boy whose parents recently separated & filed for a divorce, who seems to be doing well c. 16 yo girl who has a history of longstanding depression & has started to have "slipping grades" at school d. 15 yo boy who expresses suicidal thoughts

b. 9 boy whose parents recently separated & filed for a divorce, who seems to be doing well (This child may be at risk for a mental health issue, but he appears to be coping well & immediate referral is not indicated.)

The first physical sign indicating the onset of female puberty is: a. Sparsely distributed, fine, pale pubic hairs b. Breast buds c. Menarche d. Peak height velocity

b. Breast buds (The first sign of female puberty is the development of breast buds, closely followed by the development of pubic hair. Peak height velocity & menarche generally occur at age 12 1⁄2 years.)

The principle that growth & development become increasingly integrated is best demonstrated by: a. Gaining head control before raising the chest b. Bringing cup to mouth, tipping, & swallowing c. Rolling over before sitting d. Grasping with fist before using fingers

b. Bringing cup to mouth, tipping, & swallowing (Infants must first develop hand-mouth coordination before incorporating tipping & swallowing, which is a more integrated function. Head control before raising the chest demonstrates the principle of cephalocaudal progression. Options C and D suggest proximal-distal progression.)

While examining 10-year-old RM's teeth, you note that the upper incisors slightly overlap the lower incisors. The second & lower first molars are absent. Your assessment is: a. Malocclusion b. Delayed mandibular dentition c. Normal dentition d. Hyperdontia

b. Delayed mandibular dentition (The mandibular (lower) molars usually erupt between ages 6 & 7. Even allowing for individual variation, this is a considerable delay. Hyperdontia refers to supernumerary teeth.)

A preschool child who says that the sky is blue b/c it is his favorite color is illustrating the concept of: a. Symbolic thinking b. Egocentrism c. Centration d. Imaginary audience

b. Egocentrism (Egocentrism is the hallmark of preschoolers; there is little they think they do not control, from the weather to the color of the sky.)

The mother of 5-year-old DW is concerned that her son often cheats when playing board games with his older sister. What is the most appropriate response to DW's 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.

b. Explain that DW is developmentally unable to comprehend rigid rules. (Developmentally, the concept of cheating is not well understood until 7 years of age. The idea of playing fairly to ensure everyone an equal chance occurs with maturity & the ability to differentiate among moral choices.)

HO is a 5-year-old 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 & nutrients c. Educate the family on the need for increased calories & nutrients d. Refer family to a growth clinic for evaluation

b. Incorporate traditional foods into a management plan that will provide increased calories & nutrients (It is important for healthcare professionals to understand the cultural norms & perspectives of others. This often helps in compliance with suggestions for improved health. Asian families, out of respect, often do not ask questions or challenge advice. By understanding their food patterns & incorporating that into a diet plan, the healthcare professional may increase compliance.)

Which behavior would you expect to decrease during the preschool years? a. Rough-and-tumble play b. Instrumental aggression c. Hostile aggression d. Cooperative play

b. Instrumental aggression (Preschoolers strongly defend what is "theirs," be it a toy or a space or a special privilege; this aggression wanes as they begin to understand sharing & appropriate impulse control).

Good communication among families, schools, & primary care providers is an example of which ecological concept? a. Microsystem b. Mesosystem c. Exosystem d. Macrosystem

b. Mesosystem (A mesosystem is the link or relationship between the various settings (microsystems) w/in which a child exists (i.e., home, school, day care, etc.).)

In addition to specific academic skill deficits, learning disabilities are commonly associated with which of the following characteristics? a. Perceptual-motor impairments, normal motor function b. Perceptual-motor impairments, impulsiveness c. Perceptual-motor impairments, Down syndrome d. Lack of impulsiveness, perceptual-motor impairment

b. Perceptual-motor impairments, impulsiveness (Children with LD may demonstrate impulsive behaviors as attention-getting behaviors.)

You would be concerned about the language development of a child who: a. Repeats simple phrases at 32 months b. Stutters when excited or tired at the age of 7 years c. Has a vocabulary of 10 words at 12 months d. Pronounces words that are not understandable at 24 months

b. Stutters when excited or tired at the age of 7 years (Stuttering associated w/fatigue or excitement is not unusual in a preschooler but may indicate a more pervasive problem in a 7-year-old.)

TJ, 13 years old, reluctantly shares w/you that his "chest hurts." On physical examination, you note unilateral breast enlargement, which is tender to palpation. You suspect physiologic gynecomastia. Which Tanner stage would support that diagnosis? a. Tanner stage I b. Tanner stage III c. Tanner stage IV d. Tanner stage V

b. Tanner stage III (Physiologic gynecomastia is a common clinical finding in young adolescent males. It is usually present during Tanner stage III.)

Most stage-based theories of development focus primarily on: a. The continuity of development b. The discontinuity of development c. Persistence of inherent personality characteristics d. The influence of context on development

b. The discontinuity of development (These theories address deviations from developmental progress norms.)

The diagnostic criteria for autism spectrum disorder include: a. A noted lack of back-and-forth conversation b. Tolerance of flexibility with routines c. Fascination with light or movement d. Abnormal eye movements or body language

b. Tolerance of flexibility with routines (Children with ASD do not tolerate alterations to prescribed routines and may benefit from predictable schedules.)

The pincer grasp is a fine motor skill that involves the ability to pick up a small object such as a raisin or piece of cereal w/the thumb & forefinger & that usually is mastered around: a. 4 months b. 6 months c. 9 months d. 16 months

c. 9 months (This is a developmental norm for a child of 9 months.)

The underlying emotion of an insecurely attached (avoidant) relationship is: a. Ambivalence b. Deprivation c. Anger d. Conditional love

c. Anger (Attachment is the bond that develops throughout the first year of life; underlying anger characterizes avoidance or an insecure bond.)

Which of the following findings would be helpful in distinguishing obesity from large body frame in an adolescent who is concerned w/her weight? a. Tricep skin fold measurement b. Weight-for-height ratio c. Body mass index d. Percent of ideal body weight

c. Body mass index (Body mass index is generally considered the best index for evaluation of weight; it correlates weight w/height. BMI = weight (kg) / [height (m)]2)

Which of the following best describes behavior associated with Piaget's concrete operational phase? a. Learning primarily by trial and error b. Interpreting events in relationship to themselves c. Categorizing information into lower or higher classes d. Drawing logical conclusions from observations

c. Categorizing information into lower or higher classes (Concrete operations occur during the school-age years as children begin to understand the characteristics of things & objects. Classification is a thought process that develops during this time.)

Which of the following issues or concepts is relevant to the school-aged child? a. Operational thinking b. Initiative c. Concrete operations d. Separation-individuation

c. Concrete operations (Concrete operational thinking is key to successful adaptation to school. It involves the concepts of reversibility, conservation, classification, & seriation.)

Which of the following clinical findings would not suggest an eating disorder w/a purging component? a. Sore throat b. Brittle nails c. Diarrhea d. Finger calluses

c. Diarrhea (Eating disorders w/a purging component are characterized by constipation, rather than diarrhea, resulting from chronic laxative use.)

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 pounds per year d. Gain about 3 pounds per year

c. Gain about 6 pounds per year (The recognized standard of physical growth of school-age children is to gain 5-7 pounds per year & grow about 2.5 inches per year.)

Which of the following substances is associated with pupillary constriction? a. Amphetamines b. LSD c. Heroin d. Nicotine

c. Heroin (Opiates cause constricted pupils. Amphetamines and LSD cause dilated pupils, and nicotine generally does not have any effect on the pupils.)

While taking the history of 6-month-old EM, you learn that she is not sleeping through the night & will not fall back to sleep w/o the parents rocking or feeding her. This is an example of: a. Somnambulism b. Pavor nocturnus c. Learned behavior d. Delayed sleep phase

c. Learned behavior (Sleepwalking (somnambulism) and pavor nocturnus (night terrors) are sleep disturbances that occur in school-age & preschool-age children, respectively. Learned behavior is a result of parents interfering with the child's attempts to return to sleep without stimulation from the parents.)

During a physical examination of 10 1⁄2-year-old 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

c. Onset of menses (Understanding the sequencing of pubertal development is important, but it must be remembered that individual timing may differ. In the female patient, pubic hair, axillary hair, & the peak height velocity generally occur before menarche.)

The mother of 3-year-old GW reports that he has begun to stutter. Further probing reveals that the stuttering occurs frequently & lasts 1-2 seconds. GW does not seem bothered by the stuttering. The appropriate 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

c. Reassuring the mother that this is a mild problem (This represents a mild stuttering problem but does not warrant immediate referral unless the child or parent is increasingly concerned or if it continues indefinitely.)

Which of the following physical findings in a 2 mo child warrants an immediate referral to a neurologist/neurosurgeon? a. Head circumference growing faster than height & weight b. Unresolved cephalhematoma c. Rigid & immobile sagittal suture d. Snapping sensation when pressure is applied to parietal bone

c. Rigid & immobile sagittal suture (Rigid & immobile sutures indicate premature fusing resulting in craniosynostosis. For proper brain growth, sutures need to approximate each other yet remain mobile.)

The most common form of child abuse seen in pediatric primary care is: a. Burns b. Fractures c. Soft tissue injuries d. Shaken baby syndrome

c. Soft tissue injuries (Soft tissue injuries, such as bruises, abrasions, & lacerations, are the most common form of abuse, occurring in all age groups.)

Which developmental theory best explains the multifactorial etiology of failure to thrive? a. Organismic-maturational theory b. Social learning theory c. Transactional theory d. Psychoanalytic theory

c. Transactional theory (Transactional theory explains risks and protective factors associated w/resilience & vulnerability. It may explain some of the environmental factors associated w/FTT.)

Which of the following findings would most likely be associated w/asymmetric intrauterine growth retardation? a. Weight, length, & head circumference ranging from 3rd - 5th percentile b. Heavy maternal smoking throughout pregnancy c. Weight at 3rd percentile & length at 25th d. Gestational diabetes

c. Weight at 3rd percentile & length at 25th (The weight & length are at significantly different percentiles; if the IUGR were symmetrical, these would be at the same percentile.)

Which of the following scenarios is suggestive of a child who may not be ready to enter first grade? An inability to: a. Recognize 6 colors & remember one's phone number b. Accurately use pronouns c. Empathize with others d. Count to 5 & draw a person with 3 parts

d. Count to 5 & draw a person with 3 parts (Children entering first grade should have the requisite skills to master the tasks they will encounter. This includes language, fine & gross motor skills, & personal and social skills. At this age the child should be able to draw a person with at least 6 parts & count to 10 or more.)

Jeffrey, at 8 years of age, has been diagnosed with ADHD & is receiving stimulant medication. Which of the following interventions would be least helpful? a. Monthly height & weight checks b. Small frequent meals & snacks c. High-calorie supplemental drinks d. Elimination of refined sugar from diet

d. Elimination of refined sugar from diet (Stimulant medication may decrease the appetite, so careful monitoring of growth & a nutritional plan that encourages adequate calories are important. There is no sound evidence that sugar or artificial additives play a role in ADHD.)

Which of the following diagnoses is not more common among males? a. ADHD b. Conduct disorders c. Suicide d. FTT

d. FTT (The incidence of failure to thrive has no predominance in males or females.)

Which of the following symptoms is not typical of a child w/ADHD? a. Easily distracted b. Difficulty playing quietly c. Doesn't follow directions d. Frequently angry & resentful

d. Frequently angry & resentful (Anger is not usually a manifestation of ADHD, whereas high distractibility & inability to sit quietly or follow directions are red flags that a child may have ADHD.)

In males, Tanner stage III can be distinguished from Tanner stage II by: a. Fine, downy pubic hair at the base of penis b. Adult-like pubic hair not extending to thighs c. Penile growth in width d. Penile growth in length

d. Penile growth in length (Most penile growth in Tanner stage III is in length rather than width because of underdevelopment of the corpora cavernosa. Fine, downy pubic hair appears in stage II, & adult-like appearance occurs in stage IV.)

During 8 mo LB's physical examination, 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 neurologic examination

d. Perform a careful neurologic examination (Handedness before a 1 yr is cause for concern & may indicate cerebral palsy. A neurologic examination is indicated. The examiner should carefully assess for increase in deep tendon reflexes & tone.)

A differential diagnosis for child abuse would include all of the following except: a. Birth marks b. Unintentional injury c. Inadequate parenting d. Prader-Willi syndrome

d. Prader-Willi syndrome (Prader-Willi is associated w/uncontrolled appetite & obesity; it has no outward sign that could be confused with signs of child abuse.)

Early reflexive responses that are not r/t survival include all but: a. Babinski b. Moro c. Swimming d. Rooting

d. Rooting (Rooting (i.e., moving the head to locate the nipple) is a key survival reflex.)

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 appearance c. Peer group involvement d. Understanding inner motivations of others

d. Understanding inner motivations of others (Late adolescence is characterized by increased autonomy & beginning to appreciate the complexities & motivations of other people's behaviors.)