PRAC 6541 – PRIMARY CARE OF ADOLESCENTS AND
CHILDREN PRACTICUM (QUARTER 6 /11-WEEK)
COMPREHENSIVE EXAM
The exam contains multiple-choice questions with answers and rationales in italics.
PRAC 6541 – Final Practicum Exam
Quarter 6 (11 weeks)
Total Questions: 180
Topics: Adolescent & Child Primary Care – Clinical Application
Section 1: Growth and Development (Questions 1–20)
1. A 12-year-old male has grown 4 inches in the past 6 months. He reports occasional
knee pain, worse at night, with no swelling or redness. What is the most likely diagnosis?
A) Juvenile idiopathic arthritis
B) Osgood-Schlatter disease
C) Benign nocturnal limb pain of childhood
D) Patellofemoral syndrome
Answer: C
Rationale: Benign nocturnal limb pain (growing pains) is common in school-aged children
and young adolescents. Pain is bilateral, nonarticular, occurs at night, and resolves by
morning. Osgood-Schlatter presents with anterior knee pain and tibial tubercle swelling.
2. A 14-year-old girl has not yet reached menarche. She has breast development
(Tanner stage 3) and pubic hair (Tanner stage 3). Her height and weight are appropriate
,for age. What is the appropriate next step?
A) Obtain a karyotype
B) Reassure and follow up in 6 months
C) Start estrogen therapy
D) Order pelvic ultrasound
Answer: B
Rationale: Menarche typically occurs 2–2.5 years after thelarche (breast development),
usually around Tanner stage 4. This patient is still within normal limits; reassurance and
observation are appropriate.
3. A 6-year-old boy cannot hop on one foot, ride a bicycle, or tie his shoes. His parents
are concerned. What is the most appropriate response?
A) Refer for occupational therapy
B) Reassure that these skills develop by age 7–8
C) Order a brain MRI
D) Diagnose developmental coordination disorder
Answer: A
Rationale: By age 6, most children can hop, skip, ride a bike, and tie shoes. Inability
suggests possible developmental coordination disorder; referral to occupational therapy is
appropriate for evaluation and intervention.
4. Which Tanner stage in females describes breast development with elevation of papilla
only (areola not yet elevated)?
A) Tanner stage 1
B) Tanner stage 2
C) Tanner stage 3
D) Tanner stage 4
Answer: B
Rationale: Tanner stage 2 (thelarche) shows breast buds with elevation of breast and
papilla; areola is small and not elevated above the breast contour.
,5. A 16-year-old male on the sports physical exam has a testicular volume of 20 mL and
pubic hair spread to the medial thighs. What Tanner stage is this?
A) Tanner stage 3
B) Tanner stage 4
C) Tanner stage 5
D) Tanner stage 2
Answer: C
Rationale: Tanner stage 5 (adult) — testicular volume >20 mL, pubic hair extends to
medial thighs. Stage 4 has penile enlargement and darker pubic hair but not yet adult
distribution.
6. A 2-month-old infant is brought in for a well-child visit. The parent asks when the
baby will begin to smile socially. What is your best response?
A) 4–6 weeks
B) 2–3 months
C) 4–5 months
D) 6–7 months
Answer: B
Rationale: Social smiling typically emerges at 6–12 weeks, with reliable social smiling by
2–3 months. Absence by 3 months warrants further evaluation.
7. Which fine motor milestone is expected in a 9-month-old infant?
A) Pincer grasp
B) Builds a tower of 2 cubes
C) Scribbles spontaneously
D) Holds crayon with fingers
Answer: A
Rationale: Pincer grasp (using thumb and forefinger) develops around 8–10 months. Tower
building comes at 12–15 months, scribbling at 12–18 months.
, 8. A 4-year-old girl is afraid of the dark and insists on a nightlight. What should you
advise?
A) This is abnormal and requires psych referral
B) Reassure parents this is normal at this age
C) Use behavioral extinction by keeping lights off
D) Prescribe low-dose melatonin
Answer: B
Rationale: Fear of the dark is common in preschoolers (ages 3–5), representing normal
fantasy thinking. Parents should be reassured; nightlights are appropriate.
9. Which immunization is recommended at the 4-month well-child visit?
A) MMR
B) Varicella
C) DTaP
D) Tdap
Answer: C
Rationale: DTaP is given at 2, 4, 6, and 15–18 months, then at 4–6 years. MMR and
varicella are given at 12–15 months. Tdap is for adolescents.
10. A 7-year-old boy has difficulty sitting still, interrupts others, and talks excessively.
Symptoms have been present since age 5 and occur at home and school. What is the
first-line treatment?
A) Clonidine
B) Parent management training and classroom behavioral interventions
C) Fluoxetine
D) Risperidone
Answer: B
*Rationale: For ADHD in children 4–5 years, first line is behavioral therapy. For 6+ years,
first line is FDA-approved medications plus behavioral therapy. Howeve
CHILDREN PRACTICUM (QUARTER 6 /11-WEEK)
COMPREHENSIVE EXAM
The exam contains multiple-choice questions with answers and rationales in italics.
PRAC 6541 – Final Practicum Exam
Quarter 6 (11 weeks)
Total Questions: 180
Topics: Adolescent & Child Primary Care – Clinical Application
Section 1: Growth and Development (Questions 1–20)
1. A 12-year-old male has grown 4 inches in the past 6 months. He reports occasional
knee pain, worse at night, with no swelling or redness. What is the most likely diagnosis?
A) Juvenile idiopathic arthritis
B) Osgood-Schlatter disease
C) Benign nocturnal limb pain of childhood
D) Patellofemoral syndrome
Answer: C
Rationale: Benign nocturnal limb pain (growing pains) is common in school-aged children
and young adolescents. Pain is bilateral, nonarticular, occurs at night, and resolves by
morning. Osgood-Schlatter presents with anterior knee pain and tibial tubercle swelling.
2. A 14-year-old girl has not yet reached menarche. She has breast development
(Tanner stage 3) and pubic hair (Tanner stage 3). Her height and weight are appropriate
,for age. What is the appropriate next step?
A) Obtain a karyotype
B) Reassure and follow up in 6 months
C) Start estrogen therapy
D) Order pelvic ultrasound
Answer: B
Rationale: Menarche typically occurs 2–2.5 years after thelarche (breast development),
usually around Tanner stage 4. This patient is still within normal limits; reassurance and
observation are appropriate.
3. A 6-year-old boy cannot hop on one foot, ride a bicycle, or tie his shoes. His parents
are concerned. What is the most appropriate response?
A) Refer for occupational therapy
B) Reassure that these skills develop by age 7–8
C) Order a brain MRI
D) Diagnose developmental coordination disorder
Answer: A
Rationale: By age 6, most children can hop, skip, ride a bike, and tie shoes. Inability
suggests possible developmental coordination disorder; referral to occupational therapy is
appropriate for evaluation and intervention.
4. Which Tanner stage in females describes breast development with elevation of papilla
only (areola not yet elevated)?
A) Tanner stage 1
B) Tanner stage 2
C) Tanner stage 3
D) Tanner stage 4
Answer: B
Rationale: Tanner stage 2 (thelarche) shows breast buds with elevation of breast and
papilla; areola is small and not elevated above the breast contour.
,5. A 16-year-old male on the sports physical exam has a testicular volume of 20 mL and
pubic hair spread to the medial thighs. What Tanner stage is this?
A) Tanner stage 3
B) Tanner stage 4
C) Tanner stage 5
D) Tanner stage 2
Answer: C
Rationale: Tanner stage 5 (adult) — testicular volume >20 mL, pubic hair extends to
medial thighs. Stage 4 has penile enlargement and darker pubic hair but not yet adult
distribution.
6. A 2-month-old infant is brought in for a well-child visit. The parent asks when the
baby will begin to smile socially. What is your best response?
A) 4–6 weeks
B) 2–3 months
C) 4–5 months
D) 6–7 months
Answer: B
Rationale: Social smiling typically emerges at 6–12 weeks, with reliable social smiling by
2–3 months. Absence by 3 months warrants further evaluation.
7. Which fine motor milestone is expected in a 9-month-old infant?
A) Pincer grasp
B) Builds a tower of 2 cubes
C) Scribbles spontaneously
D) Holds crayon with fingers
Answer: A
Rationale: Pincer grasp (using thumb and forefinger) develops around 8–10 months. Tower
building comes at 12–15 months, scribbling at 12–18 months.
, 8. A 4-year-old girl is afraid of the dark and insists on a nightlight. What should you
advise?
A) This is abnormal and requires psych referral
B) Reassure parents this is normal at this age
C) Use behavioral extinction by keeping lights off
D) Prescribe low-dose melatonin
Answer: B
Rationale: Fear of the dark is common in preschoolers (ages 3–5), representing normal
fantasy thinking. Parents should be reassured; nightlights are appropriate.
9. Which immunization is recommended at the 4-month well-child visit?
A) MMR
B) Varicella
C) DTaP
D) Tdap
Answer: C
Rationale: DTaP is given at 2, 4, 6, and 15–18 months, then at 4–6 years. MMR and
varicella are given at 12–15 months. Tdap is for adolescents.
10. A 7-year-old boy has difficulty sitting still, interrupts others, and talks excessively.
Symptoms have been present since age 5 and occur at home and school. What is the
first-line treatment?
A) Clonidine
B) Parent management training and classroom behavioral interventions
C) Fluoxetine
D) Risperidone
Answer: B
*Rationale: For ADHD in children 4–5 years, first line is behavioral therapy. For 6+ years,
first line is FDA-approved medications plus behavioral therapy. Howeve
