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Peds final review
| Question | Answer |
|---|---|
| Related to the Global Health Status of Children, what are the largest percentage of mortality and morbidity from what infectious causes? | Pneumonia and diarrhea |
| Regarding the Health Status of Children in the US, which statement is true | US youths have the highest rate of obesity at 17% with a BMI > 95th% |
| Which statement is true in regards of the Goals for Healthy People 2020? | Improve access to quality healthcare; increase autism and developmental screening in the children at 18 and 24 months old, and increase children <2 years to receive early intervention and school readiness for children entering into kindergarten |
| What is CHIPRA? | Children's Health Insurance Program Reauthorization Act of 2009 |
| What would the ideal pediatric healthcare/medical home look like? | A pediatric healthcare office promoting holistic care through a collaborative approach with pediatric healthcare providers for children and their families |
| What is the NP's role as healthcare reform continues? | Provide continuity of care and high quality primary care services within the NP's scope of practice. |
| A classic Health History would include what components? | Patient demographics, CC, HPI, PMH, ROS, FH, and Socioeconomic information |
| A family assessment would include what components? | the assessment of the family's structure and roles of those members, the family life cycle such as the stage of the family and the functioning level of the family, and the social support or network of that family. |
| What would be an essential element of communication? | Communication should provide information to both pt and provider, should be sensitive interpersonally in order to indicate attention and interest, and should help build a partnership among the parties involved. |
| The NP is aware of the need for educational support in school for a child with developmental disabilities. Which example demonstrates PL 94-142? | A 6 year old with hearing impairment having access to a sign language interpreter at school. |
| A mother comes to discuss her child's needs at school not being met. He needs to sit closer at the front of the class because he refuses to wear his hearing aids. What is the best response by the NP? | Your child is eligible to have special seating accommodation under Section 504 of the Rehabilitation Act of 1973. |
| The NP is aware that prescribing a pharmacological agent requires knowledge of the pharmacodynamics and pharmacokinetics of the drug. Which example of proper prescribing is seen below? | The NP prescribes an antibiotic for a child with an ear infection. |
| The NP knows it is important to document patient telephone calls. Which example below demonstrates appropriate documentation for management of illnesses? | Mrs. Jones called on 1/2/16 at 4pm about Josh, her son, who has a low grade temperature for 2 days. Based upon his s/s, the call was categorized as non-urgent and instructions given re: when to call back or come for a visit. |
| When the NP is asking about the concerns for that visit or the presenting problem, the NP would elaborate on the description of the problem. The NP would do this by: | Obtaining a symptom analysis |
| The NP knows specific genetic conditions or distinctive traits may be more prominent in certain groups of people. The NP obtains the history by asking the family about | Ethnicity |
| The NP knows healthcare providers must be culturally competent. One way the NP can achieve this is by | Reading about health and illnesses specific to certain culture |
| The NP knows shared decision making (SDM) is important to many parents. A good example of SDM would be: | The provider educating about obesity and the parent requesting a nutrition referral. |
| The NP knows pt education about preventative diseases and management of common acute problems is essential in caring for a pediatric patient. Which would be an example of a pt-parent education plan? | The provider discussing proper medication and dosing for this sickness |
| The NP is aware of the importance of providing care to children with special health care needs (CSHCN). Which example of the children below would be classified as CSHCN? | A full term baby born with spina bifida |
| The goal of the Bright Futures initiative is to focus on child immunization practices only. | False |
| An infant weighs 6lbs and 14 oz at birth. The infant presents to the office for his 2 week check up. Which is a correct statement regarding weight to tell the mother at today's visit. | Today, your baby weighs 7lbs even. This is an adequate amt of wt gain after birth. |
| A kindergarten child has not received any vaccines in his school record. The NP knows this is only acceptable in NC if? | Either the medical waiver (#A) or the parent written statement (#B) can be acceptable |
| A mother brings her 3 year old child in for a physical. The mother is concerned about the child's speech because her older daughter was an early talker. What is a concern regarding speech for this child that needs further evaluation? | The child is able to answer a question in a two-word combination. |
| A term 2 month old baby comes in for a well visit. The NP measures the head circumference and notes it to be below the 5th percentile. The mother questions the NP regarding what this means. The NP's best response re: this concern is? | The baby's head growth is smaller than expected at this time and should be evaluated. |
| A toddler comes to the office for a 2 yr check up. The mom is concerned about her height (which is 32 inches) and thinks she is too short. The mother explains she has women in the family under 5ft. What is the best response by the NP to the mom? | Your daughter is growing fine at this time and should be close to 5ft 4 inches as an adult. |
| Anna, age 6m, comes for her 6m physical. The NP has concerns about Anna's developmental milestones. Which statement below would cause concern in re: to Anna's development? | Anna has head lag present |
| At a 6 year old check up, the parent has several questions in general. The NP provides anticipatory guidance about several subjects. Which of the following is a true statement for this age group? | The child of this age should have 3 nutritious meals and 2 nutritious snacks daily. |
| DTaP is an immunization given to children starting at 2m of age. The parent questions you as to the purpose of the vaccine. The NP states DTaP is used to protect against? | Diptheria, Tetanus, and Pertussis |
| In preparation to examine a child, the NP knows the approach may be different for different ages. Which scenario is the best choice for an exam approach for that age group? | Four and five year olds can sit on the exam table. The NP should use simple explanations and allow the child to help with the equipment during the exam. |
| In regards to infant wt, the NP knows an infant at birth weighing 7lbs should weigh around? | 14 lbs at his 4 month visit, and 21 lbs at his 12 month visit |
| Jane, age 13, is brought to the clinic for a physical due to recent foster care placement. The NP knows there is a chance Jane will be reunited w/her biological family. Which statement below best describes the situation for children in foster care? | About half of children living in foster care will return to their biological families |
| John, age 17, comes in for his yearly checkup. The NP knows John has used recreational drugs in the past. The NP performs a risk behavior assessment. Which of the following method is best to use for John? | HEEADSSS |
| Josh's mother asks the NP about the best ways to handle temper tantrums. Josh is 20m old. Which statement below would be most appropriate response by the NP? | It is important to ensure your child is safe and will not injure himself during the tantrum |
| The Advisory Committee on Immunization Practices had provided some guidelines for practitioners when administering vaccinations. In applying the knowledge base of these guidelines, which statement responds to correctly administering vaccines? | The NP accidently administers a vaccine to a child who has already received that vaccine but discusses with the parent there is no harm in reimmunization. |
| A parent defers all immunizations because she states she does not want her child to receive live vaccines. What is the best response by the NP? | Each immunization is different and is considered live or inactivated depending upon the vaccine. |
| The NP works in a primary care pediatric setting. Which child is considered at risk for RSV and prophylaxis should be considered? | A premature infant born 30 weeks gestation in the month of August. |
| There are 6 key dimensions that affect family functioning, communication in the family, and the family's ability to adapt. Which is not a true statement re: these common themes r/t dimensions in family functioning? | Spiritual beliefs and values affect only religious decisions in the family. |
| The NP knows it is important to obtain a neonatal birth health history when establishing care for a newborn in a primary care clinic. What items below are important for the NP to include in the child's medical history? | Apgar scores, gestational age, birth weight, length of hospitalization, birth weight and length, maternal depression, maternal substance use or abuse, maternal health during pregnancy |
| When interviewing the teenager, the NP knows trust is an important concern. Which example is the best scenario for approaching the flow of the exam during the interview process? | Greet the teenager, greet the parent, discuss confidentiality with both parent and teenager, conduct the interview with the adolescent separately from the parent |
| Which statement regarding Tanner stages is true for females? | The appearance of pubic hair, Tanner II usually starts at age 11-12 years old |
| The NP sees a 3 y/o child who chronically withholds stools, in spite of the parents' attempts to stop the behavior, requiring frequent treatments with laxative medications. What is the most likely diagnosis? | Encopresis |
| The primary care ped NP is performing a well child check on a 20m old. The child was 4 weeks premature and, according to a parent-completed developmental questionnaire, has achieved milestones for a 15 m infant. Which action is correct? | Perform an in-depth developmental assessment screen at this visit to evaluate this child. |
| The NP performs a developmental assessment on a 3 y/o and notes normal cognitive, fine-motor, and gross-motor abilities. The kid respond OK to verbal commands but refuses to speak. Parents report kid talks at home and most adults understand. The NP will | continue to evaluate the child's speech at subsequent visits. |
| The parent of a toddler is concerned that the child may have autism. The primary care ped NP completes the M-CHAT tool, which indicates several areas of concern. What will the NP do? | Consult a specialist to determine appropriate early intervention strategies |
| The NP is performing a well child assessment on an adolescent and is concerned about possible alcohol and tobacco use. Which assessment tool will the NP use? | CRAFFT |
| The NP evaluates a school-age child whose BMI is greater than the 97th %. The NP is concerned about possible metabolic syndrome and orders lab tests to evaluate this. Which diagnosis will the NP document for this visit? | Obesity |
| The NP understands that a major child health outcome associated with worldwide climate change is | Nutrition |
| The NP cares for kids from a Native American family and learns that they used many herbs to treat and prevent illness. What initial approach will the NP use to promote optimum health in the kids? | Ask about the types of practices used and when they are applied |
| The NP in a community health center meets a family who has recently immigrated to the US who speak only Karon. They arrive in the clinic with a church sponsor, who translates. The NP notices that the sponsor answers b4 they speak. What to do? | Use the telephone interpreter service to communicate with the family |
| The NP conducts a well baby exam on an infant and notes mild gross motor delays but no delays in other areas. Which initial course of action will the NP recommend? | Teach the parents to provide exercises to encourage motor development |
| The NP performs a CPE on a 9m infant and notes 2 central incisors on lower gums. The parent states that the infant nurses, takes solid foods 3xdaily, and occasionally takes water from a cup. What will NP counsel parent to promote dental health | to make an appointment for an initial dental exam |
| The NP enters an exam room and finds a 2m infant in a car seat on the exam table. The mother is playing a game on her smart phone. The NP interprets this behavior as | Of moderate concern for parenting problems |
| The NP performs a WCC on a 4 day infant who is nursing well, according to the mother. The NP notes that the infant weighted 7lbs at birth and 7lbs 2ozs when d/c on 2nd day of life. Infant weighs 7lbs, 6ozs at this visit. Which action is correct? | Schedule a weight check in one week |
| During an assessment of a 4w infant, the NP learns that a breastfed infant nurses q 2 hours during the day but is able to sleep for 4h periods at night. Infant has gained 0.5-1oz/day in the interval since last seen. NP recommends? | Continuing to nurse the infant using the current pattern |
| The NP is evaluating a 2 y/o with a documented speech delay. Screenings to assess motor skills and cognition are normal, and the child passed a recent hearing test. What will the ped NP do initially? | Ask the child's parents whether they read to the child |
| The NP is counseling the parents of a toddler about appropriate discipline. The parents report that the child is very active and curious, and they are worried about the potential for injury. The NP recommends? | Allow the child to explore and experiment while providing safe, appropriate limits |
| The parents of a 3 y/o child are concerned that he is refusing usual foods and wants same foods at each meal and snack. Weight gain has slowed but still in same percentile. What will the NP tell the parents to do? | Place a variety of nutritious foods on the child's plat at each meal as the child wishes |
| During a WCC of a school-age child, the NP learns the child has been having angry episodes at school. The NP observes the child to appear withdrawn and sad. The NP initially should? | Ask the child and the parent about stressors at home |
| The NP is preparing to conduct a WCC of an 8 y/o child. How will the NP begin the exam? | Ask the patient about school, friends, home activities, and sports |
| The parent of a 6 y/o child expresses concern that the child may have ADHD. Which screening tool with the NP use to evaluate this possibility? | Conner's 3 Parent and Teacher Rating Scale |
| The NP is performing an exam on an adolescent male who asks about sexual identity b/c of a concern that a friend is worried about being gay. Which response will the NP make in this situation? | Tell the adolescent that, unless he is at risk, what he says will be confidential |
| A 2m infant presents to the clinic b/c a family member was diagnosed w/pertussis. What aspect of the history is most important in determining the diagnosis? | Immunization history |
| Which of the following statements about vaccine admin is correct? | Routine vaccine doses may be given 4 days or fewer prior to the minimum intervals or ages to provide some schedule flexibility |
| A 2m infant will receive initial immunizations, and the parent asks about giving meds to increase the infant's comfort and minimize fever. What will the NP recommend? | Admin acetaminophen as needed |
| The NP reviews the immunization record of an 18m child and notes that the child received the MMR immunization 2 days prior to the 1st birthday. What will the NP do? | Recommend the next dose of MMR vaccine at 4-5 years of age. |
| A 5 year child who has a history of pertussis infection as an infant is in the clinic for immunizations prior to kindergarten. Which vaccine will be given? | DTaP |
| An adolescent female who is sexually active and who has not had the HPV vaccine asks if she may have it. What will the NP tell her? | The vaccine will not protect her from any HPV oncogenic types acquired previously |
| Which of the following statements regarding the influenza vaccine is false? | Immunity wanes up to 50% within 1-2 months after vaccination |
| An adolescent who is overweight expresses a desire to lose wt in order to participate in sports but tels the NP that he doesn't want to give up sweets and soft drinks b/c he enjoys them too much. Which stage of change does this represent? | Contemplation |
| The parent of a 12m infant asks the NP why 2% cow's milk is recommended instead of whole milk. What will the NP tell this parent? | Younger children need a limited amount of fats and sugars |
| The NP is counseling the mother of a newborn about breastfeeding her infant. Which supplements will the NP recommend? | Vitamin D |
| The NP is examining a newborn who is breastfeeding and notes the presence of ankyloglossia. What will the NP do initially? | Ask the mother if the infant has any feeding difficulties. |
| The NP is performing an assessment on a 1w newborn with slightly elevated bilirubin who is breastfeeding well and who has gained 30g in 24h. Stooling and voiding well. NP suspects breast milk jaundice. What next? | Recheck the serum bilirubin and infant's weight in 24 hours |
| The NP is performing a WCC on a 4m infant who is nursing exclusively. The mom reports that the infant has had a marked decrease in the # of stools/day, from 3-5 to only 1 qod. The NP responds? | Ask the mother to describe the color and consistency of the stools |
| The NP is performing a WCC on a 12m infant. Parent tells NP that infant has predictable b&b habits and asks about toilet training. The NP says? | place chid on a "potty" chair helps child to associate elimination cues with the toilet |
| Which of the following are contraindications for receiving Hep B and IPV | allergy to yeast |
| The parent of a kid who has asthma asks the NP about whether the child may engage in strenuous exercise. What will the NP say? | Kids with asthma show improved aerobic and anaerobic fitness with moderate to vigorous physical activity |
| The NP is offering anticipatory guidance to parents of 6 y/o with Down Syndrome. What will NP tell the parents about physical activity and sports in school? | Their child should have a cervical spine evaluation before participation in sports |
| The NP is evaluating a heart murmur during a pre-participation exam of a high school athlete. Which finding would be a concern requiring referral to a cardologist? | A murmur that is quieter when squatting and louder with a Valsalva maneuver |
| A 15 y/o femal basketball player who has secondary amenorrhea is evaluated by the NP who notes a BMI in the 3rd %. What will NP say? | To work with a dietician to improve healthy wt gain. |
| The NP is counseling a new parent about ways to reduce the risk of SIDS. What will the NP include in the discussion? | Bed-sharing with infants greatly increases the risk of SIDS |
| While the NP is discussing anticipatory guidance with the mother of a 11m infant, the child repeatedly pulls objects out of the mother's purse. Each time, mom slaps child's hands as she takes the objects away. What will the NP recommend? | Keep her purse out of the child's reach |
| The NP is performing an exam on a 4 y/o placed in emergency foster care w/aunt after the child's mom has been arrested for child abuse. The kid has hx of asthma w/freq exacerbations b/c of parental smoking. NP 's priority this visit? | evaluation of financial resources, medical insurance, and access to health care and medications |
| The American Academy of Pediatrics (AAP) recommends screening for autism using an MCHAT at what ages? | 18 and 24 months |
| Which of the following vaccines are recommended during pregnancy to provide immunity for the newborn? | Tdap and influenza |
| You are performing a WCC on Anna. Anna's BMI is in the 98th%. You discuss Anna's medical and FH and consider her risk factors for type 2 DM. All off the follow is pertinent except: | Family history of type 1 DM |
| The NP understands that, to achieve the greatest world-wide reduction in child mortality from PNA and diarrhea, which of the following interventions is most effective? | Vaccines |
| When meeting with a newly relocated family of a 2 y/o, the NP develops a database that ID family members and others living in the household, relationships with others outside the household, and sign behavior/emotion issues | Ecomap |
| The mother of a 2w newborn tells the NP that she is worried that her child will develop allergies and asthma. Which tool will the NP use to evaluate this risk? | Third-generation pedigree |
| The primary care ped NP is examining a 5 year old who has cerebral palsy. Which part of the family history raises concerns about potential child maltreatment? | limited family support and financial resources |
| Comedone | Plugged, dilated port: open (blackhead); closed (whitehead) |
| Wheal | Fleeting, irregularly shaped, elevated, itchy lesion of varied size, pale at center, slightly red at borders |
| Lichenification | Thickening of skin with deep visible furrows |
| Striae | Fine pink or silver lines in areas where skin has been stretched |
| Vesicle | Blister filled with clear fluid |
| Papule | Solid, raised lesion of varied color with distinct borders, 1cm or less |
| Ecchymosis | Bruise, purple to brown, macular or papular, varied in size |
| Fissure | Linear, wedge-shaped cracks extending into dermis |
| Pustule | Raised lesion filled with pus, often in hair follicle or sweat pore |
| Keloid | Healed lesion of hypertrophied connective tissue |
| Nodule | Raised, firm, movable lesion with indistinct borders and deep palpable portion, 2cm or smaller |
| Macule | Flat, nonpalpable, discolored lesion, 1cm or smaller |
| Tumor | Large nodule, may be firm or soft |
| Erosion | Oozing or moist, depressed area with loss of superficial epidermis |
| Crusts | Dried exudate or scab of varied color |
| 6th grader with fever 103-104 x 2 days, sore throat 2 days, refuses food/drink. Marked posterior lymphadenopathy. 3+ tonsils w gray exudate,mild to mod splenomegaly. rapid strep neg, cbc- lymphocytosis; Next step? | Monospot, may take 2 weeks to show positive, OTC pain relievers, push fluids, increase rest; return within the week for evaluation of splenomegaly or if s/s become severe |
| 9m female with high fever, mild URI s/s and injected conjunctivae for several days. resolution of fever with diffuse, rose-colored maculopapular rash that blanches when pressure applied | Exanthem subitum (Roseola infantum) |
| What is the most appropriate situation for the FNP to prescribe antivirals for a 10 y/o with confirmed influenza? | The child is in a group home that serves youths with behavioral health diagnoses |
| Which of the following best describes Erythema infectiosum | Fifth disease; Lacy maculopapular rash on the trun and extremities that is typically preceded by red eruptions on cheeks bilaterally. Child experiences malaise and fatigue |
| Education for parents of children with atopic dermatitis should include which of the following? | Hydroxyzine, nails short and clean, lukewarm bath not greater than 10 min, apply emollient immediately after bath, use only steroid creams prescribed |
| 12 y/p spend weekend camping, now has red, vesicular rash on forearms, hands, neck and face. Right eye swollen shut, face puffy. Scratched rash all night even though he had benadryl | Contact dermatitis due to exposure to plant oils, such as poison ivy |
| Fifth disease | Mild fever, myalgias, URI symptoms followed by slapped cheeks and a red, maculopapular lacy appearance to trunk and extremities |
| Hand-Foot-Mouth syndrome | Vesicular eruption on buccal mucosa, fever, maculopapular rash of hands and feet; may last 1-2 weeks |
| tinea corporis | Superficial annular, oval, or circinate with flat, scaling, slightly red patches and raised borders; fungal |
| urticaria | Hypersensitivity reaction; often called hives; transient or acute; annular, raised, and may be either scattered or coalesced |
| scabies | Presents as pruritic rash; lesions are burrows that appear most often in areas of the body with creases (fingers, armpits, belt line, etc) |
| pityriasis rosea | Often with a herald spot; red, finely scaled, elevated border that enlarges quickly; Christmas tree |
| erythema multiforme | Acute and self-limiting; red target papules of various sizes; often follows a virus; most predominant on fact, arms and legs, hands and feet |
| tinea versicolor | Multiple annular, scaling macules or patches; fungal; on trunk and extremities; more apparent in the summertime |
| molluscum contagiosum | Very small, firm, pink or flesh-colored papules with “belly buttons”; viral; last from a few |
| impetigo | Contagious bacterial infection of the superficial skin; erythemateous papules or pustules that lead to vesicles that rupture producing honey-colored crusty lesions |
| candidiasis (diaper) | Deep-red macules and papules that is moist and has sharply marked borders and satellite lesions; could be erosive; looks painful |
| acne vulgaris | Inflammatory and noninflammatory lesions; combination of excess sebum, keratinous debris and bacterial accumulation to produce microcomedones |
| contact dermatitis | Acute of chronic inflammation caused by a hypersensitivity reaction (irritant or allergen); localized with sharp borders; may have a chafed appearance |
| seborrhea dermatitis | Chronic inflammatory dermatitis; flaking crusts that look greasy; appear yellow or white; may be an overgrowth of saprophytic yeast |
| keratosis pilaris | Rough skin on the extremities, buttocks, and sometimes the face; more common in children with atopic disorders; ‘chicken skin’ |
| 6 y/o pt with c/o coughing and wheezing at least 1x/week after PE. S/s brief and do not interfere with daily activities. What is the most consistent classification of asthma severity? | Intermittent |
| Which of the following statements is incorrect when discussing moderate persistent asthma with a parent | symptoms less than 2 times per week |
| Pt presents with a brown raised purpura rash on the legs and buttocks that started 2 days ago. The mother reports the pts feet look more swollen than usual. What is the most likely diagnosis? | Henoch-Schonlein Purpura |
| Pt presents with a brown raised purpura rash on the legs and buttocks that started 2 days ago. The mother reports the pts feet look more swollen than usual. What diagnostic study would you consider completing on the pt? | Urinalysis |
| 3m infant previously healthy now has persistent cough, bilateral lung crackles, and poor appetite that indicate CHF; grade 3 low-pitched, holosystolic murmur LLSB, liver 1cm below ribs | Ventricular septal defect |
| 4 y/o WCC, nurse recorded 20/50 for kid's vision but child had difficulty cooperating with exam. NP recommends? | Re-test in one month |
| 24m old has acute diarrheal illness. Afebrile and has remained well hydrated. Parents ask what can help shorten the course of the illness. NP recommends? | Lactobacillus |
| What will the primary care NP teach the parents of a kid who has new pressure-equalizing tubes in both ears? | Parents should notice improved hearing in their child. |
| When prescribing topical glucocorticoids to treat inflammatory skin conditions, primary care NP will | prescribe brand-name preparations for consistent effects |
| Parent of a 3m old reports that the infant arches and gags while feeding and spits up undigested formula frequently. Wt has dropped to 5th % from 12th. Best course of treatment? | Begin a trial of extensively hydrolyzed protein formula for 2 to 4 weeks |
| A child is diagnosed with tinea versicolor. What is the correct management? | Application of selenium sulfide 2.5% lotion twice weekly for 2-4 weeks |
| 5 y/o child with URI has cloudy nasal d/c and mod nasal congestion interfering w/sleep. Parent asks what product to use to help w/symptoms. NP recommends? | Saline rinses |
| Pre-school child has honey-crusted lesions on erythematous, eroded skin around the nose and mouth, with satellite lesions on arms/legs. Child's parent has several similar lesions and reports other kids at daycare have similar rash. Treat with? | Amoxicillin-clavulanate 90mg/kg/day for 10 days |
| NP performs a 9m WCC w/history of prematurity at 28w gestation. Treated for retinopathy of prematurity and all s/s have resolved. When is next ophthalmologic exam? | Annually |
| Parent of school-age kid says kid has allergic rhinitis s/s beginning each fall and non-sedating antihistamines are barely effect, esp for nasal obstruction s/s. NP recommends | Order an intranasal corticosteroid to begin 1-2 weeks prior to pollen season |
| 5m infant has a hx of reddened, dry, itchy skin. NP notes fine papules on extensor aspect of infant's arms, anterior thighs, and lateral aspects of cheeks. Initial treatment? | Moisturizers and skin hydration |
| 6m WCC, NP notes harsh blowing grade 4 murmur. NP does? | Refer to a peds cardiologist for further evaluation |
| What will primary care NP recommend to the parent of an infant who is teething who asks about comfort measures? | Given the infant a cold teething ring or wet washcloth to chew |
| Child has an acute infection causing lower airway obstruction. What initial symptom to expect? | Wheezing |
| School-age child has herpes stomatitis for a week and continues to c/o pain. NP recommends | topical application of diphenhydramine and maalox |
| NP diagnoses acute otitis media in a 2yo who has a history of recurrent otitis media. TM intact, fever 101.5. NP prescribes? | Amoxicillin BID for 10 days at 80-90mg/kg |
| NP notes a small, round object in external auditory canal, near the TM. Parent thinks it is probably a dried pea. NP does? | Refer to otolaryngologist for removal |
| 5 year WCC, NP hears grade 2 harsh, late systolic ejection murmur at the upper LSB that transmits to both lung fields. Normal growth and development. NP suspects | pulmonic stenosis |
| Child has small, firm, flesh-colored papules in both axillae which are mildly pruritic. What is acceptable initial approach? | Reassuring parents that these are benign and may disappear spontaneously |
| 4 y/o is hit in the face with a baseball bat and is brought to the clinic by paren. Exam reveals 3 avulsed front teeth. Xrays negative for facial fractures. Recommended treatment? | Refer to dentist immediately for further examination |
| Child in clinic b/c purulent, foul-smelling d/c from the right nostril. Nasal visualization reveals something shiny near opening in the nasal cavity. NP does? | Attempt to remove the mass gently using alligator forceps |
| An adolescent who has asthma and severe perennial allergies has poor asthma control in spite of appropriate use of SABA and daily high-dose steroid. NP will? | Refer to a pulmonologist for omalizumab therapy |
| 7 y/o child has nasal d/c and daytime cough w/o fever for 12 d and no improvement in s/s. No recent abx and no significant abx resistance in the community. Treat with: | Amoxicillin 45mg/kg/day |
| Adolescent female reports poor sleep, fatigue, muscle and joint pain, and anxiety lasting several months. Point tenderness at several sites. NP will: | Refer the adolescent to a rheumatologist for further evaluation |
| Child swallowed metal bead. Xray of GI tract shows 6mm cylindrical object in kids stomach. Able to swallow w/o difficulty and no pain. Treatment: | Have parents watch for the object in the child's stool |
| 12m infant has poor wt gain after previous normal growth patterns. No vomiting, diarrhea, or irregular BMs. Normal physical exam. Next step? | Feeding and stooling history and 3-day diet history |
| 8 y/o child with pediculosis capitis infestation at school. If child is positive, what will NP find on physical exam, along with live lice near scalp? | itching of the scalp with skin excoriation on the back of the head |
| 7 y/o child has itching in both ears and trouble hearing. NP notes periauricular edema and marked swelling of the external auditory canal and severe pain when manipulating external ear. NP will | order ototopical antibiotic/corticosteroid drops |
| School-age child had abrupt sore throat, nausea, HA, fever of 102.3. Petechiae on soft, palate, beefy-red tonsils w/yellow exudate, and scarlatiniform rash. Rapid antigen detection test negative. What next? | Perform a follow-up throat culture |
| Adolescent has acne w/lesions on the cheeks and under the chin. Which distribution is this? | Hormonal |
| NP examines a school-age kid who has had several hospitalizations for bronchitis/wheezing. several coughing episodes w/chest tightness per week relieved w/albuterol MDI. NP orders? | Spirometry testing |
| Parent asks ways to promote dental health in school-age kids while on family vacation camping. NP recommends? | Offering gum containing xylitol after meals |
| Toddler in clinic after 2d history of intermittent vomiting/diarrhea. Child irritable w/dry mucous membranes, 3s cap refill, 2s recoil of skin, mild tachycardia and tachypnea, cool hands/feet. 2 wet diapers/24 h. NP recommends? | Oral rehydration solution w/follow-up in 24 hrs |
| NP performing a sports physical on adolescent whose history reveals mild aortic stenosis. NP recommends? | Evaluation by a cardiologist prior to participation |
| School-age kid seen in clinic after fragment from a glass bottle flew into the eye. NP will: | refer immediately to an ophthalmologist |
| Np performs a well baby assessment of 6d infant and notes mild conjunctivitis, corneal opacity, and serosanguinous d/c in the right eye. NP will: | Admit infant to the hospital immediately |
| 3 y/o child has head lice. Initial treatment: | Permethrin |
| NP will teach parent of infant about cleaning the child's teeth? | Use a smear of toothpaste and not to rinse the mouth |
| 3 y/o has clusters of small, clear, tense vesicles w/erythematous base on one side of mouth along vermillion border, causing discomfort and difficulty eating. NP recommends: | Topical diphenhydramine and magnesium hydroxide |
| 2 y/o has exotropia of R eye during a cover-uncover test; NP will refer to peds ophthalmologist for: | Patching of unaffected eye for 2 hours each day |
| 8 y/o child has enlarged tonsils and history fo 4 throat infections in the previous year with fever/cervical lymphadenopathy/+ GAS. Child snores at night, parent concerned about quality of sleep. What next? | refer to a pulmonologist for sleep study evaluation |
| Adolescent with exercise-induced asthma on track team and recently begun practice. Uses 2 puffs albuterol MDI 20 min before exercise but decreased effectiveness. NP will: | order a daily inhaled corticosteroid medication |
| 10 y/o with abd pain x 2d that began in periumbilical area then localized to RLQ. Vomited once today then experienced relief from pain followed by increased fever. Likely diagnosis? | Appendicitis with perforation |
| Preschool-age child who goes to daycare has 2d history of matted eyelids in AM and burning and itching of the eyes. NP notes yellow-green purulent d/c from both eyes, conjunctival erythema, mild URI s/s. What next? | Prescribe topical antibiotic drops |
| 5m infant with 3d history of cough and rhinorrhea has resp distress with audible exp wheezes and increased cough. Vaccines utd. Resp rate 50, prolonged expiration. POX 96%. NP will: | recommend increased fluids and close follow-up |
| Several circular, scaly lesions on arms and abdomen, some have central clearing. smaller scaly lesion on scalp. NP will | prescribe oral griseofulvin for 2-4w |
| 14 y/o has 2w history of severe itching and tearing of both eyes. NP notes redness and swelling of eyelids with stringy, mucoid d/c. NP will: | topical mast cell stabilizer |
| NP observes tender, swollen red furuncle on upper lid margin of kid's eye. NP will recommend: | warm, moist conpresses 3-4 times daily |
| 9m infant has vesiculopustular lesions on palms and soles, face and neck, and skin folds on extremities. NP notes linear and S-shaped burrow lesions on parent's hands/wrists. What is treatment? | Permethrin 5% cream to face, neck, body, and rinsed off in 8 to 14 hours |
| 12 y/o boy with right knee pain x 3w. Athletic, plays basketball, runs track, no recent trauma. Increased pain when run/jump. Normal PE except for mild edema and tenderness over right tibial tubercule. Diagnosis? | Osgood-Schaltter disease |
| First-line treatment for Osgood-Schaltter disease | Advise rest and apply ice to the knees after activity |
| If pt complained of limp when walking on right leg with thigh and groin pain in addition to knee pain. He is overwt with dimished ability to flex and internally rotate right femur. Likely diagnosis? | Slipped capital femoral epiphysis |
| Best step in management of slipped capital femoral epiphysis | arrange for an orthopedic surgery consultation |
| 15 y/o with right knee pain, unable to bear wt on affected joint; knee is tender, edematous, warm, erythematous, and has diminished ROM. Next step: | Obtain more history, including sexual history |
| 2w male presents with twisted neck. Term difficulty vaginal delivery r/t large size. Head tilted to right side with chin rotated to left, palpable firm right sternocleidomastoid muscle mass. Likely diagnosis? | Muscular torticollis |
| Best treatment for muscular torticollis | Teach mother PT techniques to passively stretch the sternocleidomastoid muscle |
| 3m infant has intermittent torticollis. Term birth, uneventful course/delivery. Frequently spits up after feeding and has had once episode of PNA. Next step? | Evaluate the child for GERD |
| Assessment of preadolescent girls for scoliosis | Examine the pt minimally clad so that one can assess the symmetry of scapular height, waist angles, and Adams test |
| In PE of newborn, NP notes hip click. What other findings are associated with this condition? | Limited abduction |
| Adolescent twisted knee while skateboarding c/o knee pain and that knee has locked up a few times in the last few weeks. Positive McMurray's test elicited. Diagnosis? | Medial meniscus tear |
| Young children with c/o hip pain w/o history of trauma suggests several diff dxs. Which diagnosis is true orthopedic emergency | Avascular necrosis of the femoral head |
| Differentiation btw structural and functional scoliosis can be done by placing child in Adam's position. What occurs in this position? | Functional scoliosis disappears and structural scoliosis is enhanced |
| Male child w/pectus excavatum and associated scoliosis should be evaluated for | Marfan's syndrome |
| 7 y/o boy stopped riding his bike b/c of pain in left hip. Next 4 weeks, limps with any activity and continued to c/o pain. No history of trauma or lesions. Likely diagnosis: | Legg-Calve-Perthes' disease |
| 16 y/o refuses to eat meals w/family and eats only protein drinks, on swim team and spends much time training or working out. Wt dropped from 21% to 3% in past year. Child has problem with? | Body image |
| Parent who encourages competitiveness in an adolescent who excels at a single sport but not in others may also encourage a sense of ? | Insecurity |
| 11 y/o child is "class clown", denies problems at school, but acknowledges poor grades by saying "I'm not smart, I guess." NP recommends? | help the child identify skills and activities that he is good at |
| 17 y/o football player w/weight fluctuations of 7-8lbs before games. Eager to talk about championships won and feels he will get scholarships for college. Dad says grades not good enough, kid blames teachers. Potential problem? | self-esteem |
| Parent concerned that child is going to be short like both parents and will have difficulty in school if he isn't successful in a variety of sports. NP counsels parent? | Encourage the child to engage in regular physical activity |
| Parent concerned because child has started to express anger about grandparent's death even though this occurred when child was 3y. NP says? | The significance of this loss must be reworked at each developmental level |
| Parent of preschool age child reports child appears anxious and nervous with rapid heart rate, sweating, and tremors. Best type of referral? | Play therapy |
| Middle school age child skipping school frequently and getting poor grades 3m ago since child's father was killed while deployed in the military. NP manages the situation by? | Refer the child to a mental health specialist for evaluation and treatment |
| Newly divorced mom of 4yo reports child has difficulty sleeping and nightmares with angry outbursts and tantrums for 3m. Child refuses to play and spends time sitting quietly. What is NOT appropriate? | Consult with a child psychiatrist to prescribe medications |
| NP attempts to learn more about the emotional health of a 20m old thru which assessment strategy? | Observation of the child with caretakers in structured and unstructured situations |
| 15 y/o female to clinic w/amenorrhea for 4m. Pregnancy test -. Body weight at 55% of expected for height and age. Refuses to eat most foods. NP suspects? | Anorexia nervosa |
| Parent of school age child reports child becomes frustrated when unable to perform tasks well and often has temper tantrums and difficulty sleeping. What disorder? | Generalized anxiety disorder |
| Parent of a child w/ADHD tells NP that the child gets overwhelmed by homework assignments and doesn't know which to do first, then doesn't do any. There is impairment in what function? | Activation |
| NP is considering medication options for a school age child recently diagnosed w/ADHD who has primarily hyperactive presentation. What will NP choose initially? | Moderate dose stimulant |
| Child with ADHD has difficulty stopping activities to begin other activities at school. NP understands this is due to difficulty with the self-regulation component of? | Flexibility |
| NP examines a 4yo child who speaks loudly in monotone and does not make eye contact. Also prefers to sit on the exam room floor moving a toy truck back and forth repetitively. NP suspects? | Autism spectrum disorder |
| Parent of preschool age child who is diagnosed w/sensory processing disorder asks NP how to help the child manage symptoms. NP recommends? | Maintaining predictable routines as much as possible |
| NP is evaluating school age child who has ADHD. Which plan will NP recommend asking the child's school about to help w/ academic performance? | 504 or IEP |
| NP is conducting a 1m follow-up exam on a child who recently started low-dose stimulants for ADHD. School and home behaviors have improved. Parent noticed a few tics but child is unaware of them and isn't bothered. NP recommends? | Continue the medication as prescribed |
| Female infant developed normal but stops meeting milestones at 15m then begins losing previous acquired skills. NP expects to tell parents the prognosis is? | Intellectual development will not progress further; Rett syndrome |
| 5yo pt with single non-febrile seizure. Has normal neuro exam. Which diagnostic test would NP order? | EEG |
| Parents of 22m old bring pt to the clinic after observing a brief seizure of less than 2 min. In clinic, she has fever 103.1 and NP notes bilateral otitis media. Child alert, responding normal. NP will? | Prescribe an antibiotic for the ear infection and reassure the parents |
| NP performing a neuro exam to assess for meningeal signs in an infant. How will NP elicit Kernig sign? | extending the leg at the knee with infant supine |
| 8yo child with head injury after fall on playground. Child cried immediately and able to walk after fall. NP notes slight slurring of speech and vomiting x 2 in exam room. NP recommends? | Admit the child to the hospital for a neurology consult |
| Adolescent female with moderate dysmenorrhea w/periods tells NP that 400mg Ibuprofen q 6-8h doesn't completely control pain. NP recommends? | Naproxen 500mg initially then 250mg q 6-8h |
| NP evaluates 9yo who describes shooting pain in both legs associated w/aching, tingling, and burning. Child is unable to pinpoint specific locations for this pain. NP suspects? | Neuropathic pain |
| 3yo child recovering from injuries sustained in MVA. NP will evaluate pain by? | Have child describe any pain as "no pain, a little pain, or a lot of pain" |
| 3d infant has total serum bilirubin level of 15.7mg/dL after having 10.8mg/dL 24 hours prior. Infant nursed 8 times, had 7 wet diapers, and passed 4 stools in past 24h. Indicated treatment? | Recommend nursing every 2 hours, order a biliblanket, and recheck TSB in 24h |
| 2w infant w/forceful vomiting 1w prior and worse w/time. Infant nurses well but losing weight. 90g weight loss over 2w, dry mucous membranes, sunken fontanel and a "olive mass" in epigastrium. NP will? | Obtain serum electrolytes and admit to hospital for a surgical consult. Pyloric stenosis suspected |
| 4d infant has abdominal distention and poor feeding. Mother worried that infant is constipated b/c 1st stool was yesterday and only a small amt of meconium. NP will? | Order an abd xray and refer to ped surgeon. Hirschprung suspected. |
| 2m infant has increased head circumference from 9th% at 2w to 35th% today. NP will? | Refer infant immediately to a pediatric neurosurgeon |
| NP is discussing newborn care w/parents prior to the delivery of their first son. NP will tell them what about circumcision? | The benefits of the procedure outweigh the risks of the procedure |
| NP perofrms a well baby exam on a 3d old infant and notes clusters of firm, yellow-white papules w/surrounding erythematous flare. NP will? | Reassure the parents that no treatment is necessary |
| NP performing a well baby exam on a 8d infant born to Chlamydia+ mother. Infants eyes are clear w/o exudate. Infant free from cough and lungs clear. What will NP do to prevent illness? | Schedule a follow-up in 1 week |
| NP evaluating a child with short stature. Bone age studies reveal a delay in bone age, growth is consistent with bone age. Most likely diagnosis? | Constitutional growth delay |
| 6 y/o female with recent growth spurt and exam revealing breast and pubic hair development. Bone age determined to be 8y. NP will? | Refer the child to a pediatric endocrinologist for management |
| NP prescribes metformin for a 16y adolescent newly diagnosed w/ T2DM. What will NP include when teaching about the drug? | Consume diet with foods that are high in vitamin B12 |
| 15yo child with recent history of increased thirst and freq urination. Child's weight 98th% for several years. UA positive for glucose, and random plasma glucose 375. Positive acanthosis nigricans. What test will NP do to determine type of DM? | Fasting plasma glucose |
| Iron-deficiency anemic child at WCC who had initial hgb of 8.8 and hct of 32 that has been taking ferrous sulfate 3mg/kg/day for 4 weeks. Now hgb 105. and hct 36. Next step? | Continue current dose of ferrous sulfate and recheck labs in 1-2 months |
| 6m WCC who is exclusively breastfed and whose mother plans to introduce only small amts of fruits and veggies in addition to breastfeeding. To ensure infant gets enough iron, NP will recommend? | Elemental iron supplementation of 1mg/kg/day until cereals are added |
| NP evaluated 6yo with pallor and obtains labs revealing a hgb of 8.5 and hct of 31. NP will? | Prescribe elemental iron and recheck labs in 1 month |
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jessupj17