NSG5140 Week 5 Midterm Exam Advanced
Pathophysiology and Primary Care Pediatrics
Complete Actual Exam – Questions and Correct
Answers (Verified Answers) Plus Rationales 2026
Q&A | Comprehensive Practice Examination
Instructions
This comprehensive examination consists of multiple-choice
questions covering all core domains of advanced pathophysiology and
primary care pediatrics. The assessment evaluates advanced knowledge of
pathophysiology principles, pediatric primary care, acute and chronic disease
management, pharmacology, diagnostic reasoning, immunization schedules,
genetic disorders, infectious diseases, and system-based pathophysiology.
Select the single best answer for each question.
Question 1
A 6-month-old infant presents with failure to thrive, recurrent infections, and
a characteristic "pigeon chest" deformity. Laboratory findings reveal
hypocalcemia and decreased parathyroid hormone levels. Which of the
following is the most likely diagnosis?
• A) Cystic fibrosis
• B) DiGeorge syndrome (22q11.2 deletion syndrome)
• C) Severe combined immunodeficiency (SCID)
• D) Wiskott-Aldrich syndrome
• E) Ataxia-telangiectasia
Answer: B) DiGeorge syndrome (22q11.2 deletion syndrome)
Rationale: DiGeorge syndrome (22q11.2 deletion syndrome) is characterized
by thymic aplasia/hypoplasia (leading to T-cell deficiency),
hypoparathyroidism (leading to hypocalcemia), and cardiac defects. The
,"pigeon chest" and failure to thrive are consistent with this presentation. SCID
presents with severe infections early in life without the characteristic facial
features and hypocalcemia.
Question 2
A 2-year-old child presents with recurrent episodes of wheezing, cough, and
shortness of breath triggered by viral infections. The child has a history of
atopic dermatitis. Which of the following pathophysiological mechanisms best
explains this presentation?
• A) Airway hyperresponsiveness and chronic inflammation with
eosinophilic infiltration
• B) Impaired mucociliary clearance leading to bacterial colonization
• C) Deficiency of alpha-1 antitrypsin causing elastase-mediated lung
destruction
• D) Autoimmune destruction of bronchial epithelium
• E) Pulmonary vascular remodeling secondary to hypoxia
Answer: A) Airway hyperresponsiveness and chronic inflammation with
eosinophilic infiltration
Rationale: This presentation is consistent with asthma, which is
characterized by airway hyperresponsiveness and chronic inflammation with
eosinophilic infiltration. The history of atopic dermatitis supports an atopic
predisposition. Asthma in young children is commonly triggered by viral
infections.
Question 3
A newborn presents with bilious vomiting, abdominal distension, and failure
to pass meconium within the first 48 hours of life. A contrast enema reveals a
microcolon. Which of the following is the most likely diagnosis?
• A) Hirschsprung disease
• B) Meconium ileus
, • C) Intestinal malrotation with volvulus
• D) Necrotizing enterocolitis
• E) Imperforate anus
Answer: B) Meconium ileus
Rationale: Meconium ileus is a common presentation of cystic fibrosis in
newborns. It presents with bilious vomiting, abdominal distension, and failure
to pass meconium. A contrast enema reveals a microcolon due to the inability
of meconium to pass through the terminal ileum. Hirschsprung disease
typically presents with delayed passage of meconium but without a
microcolon.
Question 4
A 4-year-old child presents with a 3-day history of fever, headache, and
vomiting. On examination, the child is lethargic and has nuchal rigidity. A
lumbar puncture reveals cloudy cerebrospinal fluid with elevated protein, low
glucose, and gram-positive diplococci. Which of the following is the most
likely causative organism?
• A) Neisseria meningitidis
• B) Streptococcus pneumoniae
• C) Haemophilus influenzae type b
• D) Listeria monocytogenes
• E) Group B Streptococcus
Answer: B) Streptococcus pneumoniae
Rationale: Streptococcus pneumoniae is a gram-positive diplococcus that
causes bacterial meningitis. In children over 3 months of age, S. pneumoniae is
a common cause, along with N. meningitidis. The gram-positive diplococci in
the CSF point to S. pneumoniae. N. meningitidis is a gram-negative
diplococcus.
, Question 5
A 10-year-old child with a history of recurrent pharyngitis presents with acute
onset of edema, hypertension, and hematuria. Urinalysis reveals red blood cell
casts and proteinuria. Which of the following is the most likely diagnosis?
• A) Post-streptococcal glomerulonephritis
• B) IgA nephropathy
• C) Minimal change disease
• D) Alport syndrome
• E) Hemolytic uremic syndrome
Answer: A) Post-streptococcal glomerulonephritis
Rationale: Post-streptococcal glomerulonephritis typically occurs 1-2 weeks
after a group A streptococcal infection (pharyngitis or impetigo). It presents
with acute onset of edema, hypertension, hematuria, and red blood cell casts.
IgA nephropathy can present similarly but is not typically preceded by a
streptococcal infection.
Question 6
A 3-month-old infant presents with progressive hypotonia, feeding difficulties,
and a "cat-like" cry. On examination, the infant has microcephaly and
epicanthal folds. Which of the following genetic abnormalities is most likely?
• A) Trisomy 21
• B) Deletion of chromosome 5p (Cri-du-chat syndrome)
• C) Trisomy 18
• D) Deletion of 22q11.2
• E) Fragile X syndrome
Answer: B) Deletion of chromosome 5p (Cri-du-chat syndrome)
Rationale: Cri-du-chat syndrome is caused by a deletion on the short arm of
chromosome 5 (5p-). It is characterized by a high-pitched, "cat-like" cry,
Pathophysiology and Primary Care Pediatrics
Complete Actual Exam – Questions and Correct
Answers (Verified Answers) Plus Rationales 2026
Q&A | Comprehensive Practice Examination
Instructions
This comprehensive examination consists of multiple-choice
questions covering all core domains of advanced pathophysiology and
primary care pediatrics. The assessment evaluates advanced knowledge of
pathophysiology principles, pediatric primary care, acute and chronic disease
management, pharmacology, diagnostic reasoning, immunization schedules,
genetic disorders, infectious diseases, and system-based pathophysiology.
Select the single best answer for each question.
Question 1
A 6-month-old infant presents with failure to thrive, recurrent infections, and
a characteristic "pigeon chest" deformity. Laboratory findings reveal
hypocalcemia and decreased parathyroid hormone levels. Which of the
following is the most likely diagnosis?
• A) Cystic fibrosis
• B) DiGeorge syndrome (22q11.2 deletion syndrome)
• C) Severe combined immunodeficiency (SCID)
• D) Wiskott-Aldrich syndrome
• E) Ataxia-telangiectasia
Answer: B) DiGeorge syndrome (22q11.2 deletion syndrome)
Rationale: DiGeorge syndrome (22q11.2 deletion syndrome) is characterized
by thymic aplasia/hypoplasia (leading to T-cell deficiency),
hypoparathyroidism (leading to hypocalcemia), and cardiac defects. The
,"pigeon chest" and failure to thrive are consistent with this presentation. SCID
presents with severe infections early in life without the characteristic facial
features and hypocalcemia.
Question 2
A 2-year-old child presents with recurrent episodes of wheezing, cough, and
shortness of breath triggered by viral infections. The child has a history of
atopic dermatitis. Which of the following pathophysiological mechanisms best
explains this presentation?
• A) Airway hyperresponsiveness and chronic inflammation with
eosinophilic infiltration
• B) Impaired mucociliary clearance leading to bacterial colonization
• C) Deficiency of alpha-1 antitrypsin causing elastase-mediated lung
destruction
• D) Autoimmune destruction of bronchial epithelium
• E) Pulmonary vascular remodeling secondary to hypoxia
Answer: A) Airway hyperresponsiveness and chronic inflammation with
eosinophilic infiltration
Rationale: This presentation is consistent with asthma, which is
characterized by airway hyperresponsiveness and chronic inflammation with
eosinophilic infiltration. The history of atopic dermatitis supports an atopic
predisposition. Asthma in young children is commonly triggered by viral
infections.
Question 3
A newborn presents with bilious vomiting, abdominal distension, and failure
to pass meconium within the first 48 hours of life. A contrast enema reveals a
microcolon. Which of the following is the most likely diagnosis?
• A) Hirschsprung disease
• B) Meconium ileus
, • C) Intestinal malrotation with volvulus
• D) Necrotizing enterocolitis
• E) Imperforate anus
Answer: B) Meconium ileus
Rationale: Meconium ileus is a common presentation of cystic fibrosis in
newborns. It presents with bilious vomiting, abdominal distension, and failure
to pass meconium. A contrast enema reveals a microcolon due to the inability
of meconium to pass through the terminal ileum. Hirschsprung disease
typically presents with delayed passage of meconium but without a
microcolon.
Question 4
A 4-year-old child presents with a 3-day history of fever, headache, and
vomiting. On examination, the child is lethargic and has nuchal rigidity. A
lumbar puncture reveals cloudy cerebrospinal fluid with elevated protein, low
glucose, and gram-positive diplococci. Which of the following is the most
likely causative organism?
• A) Neisseria meningitidis
• B) Streptococcus pneumoniae
• C) Haemophilus influenzae type b
• D) Listeria monocytogenes
• E) Group B Streptococcus
Answer: B) Streptococcus pneumoniae
Rationale: Streptococcus pneumoniae is a gram-positive diplococcus that
causes bacterial meningitis. In children over 3 months of age, S. pneumoniae is
a common cause, along with N. meningitidis. The gram-positive diplococci in
the CSF point to S. pneumoniae. N. meningitidis is a gram-negative
diplococcus.
, Question 5
A 10-year-old child with a history of recurrent pharyngitis presents with acute
onset of edema, hypertension, and hematuria. Urinalysis reveals red blood cell
casts and proteinuria. Which of the following is the most likely diagnosis?
• A) Post-streptococcal glomerulonephritis
• B) IgA nephropathy
• C) Minimal change disease
• D) Alport syndrome
• E) Hemolytic uremic syndrome
Answer: A) Post-streptococcal glomerulonephritis
Rationale: Post-streptococcal glomerulonephritis typically occurs 1-2 weeks
after a group A streptococcal infection (pharyngitis or impetigo). It presents
with acute onset of edema, hypertension, hematuria, and red blood cell casts.
IgA nephropathy can present similarly but is not typically preceded by a
streptococcal infection.
Question 6
A 3-month-old infant presents with progressive hypotonia, feeding difficulties,
and a "cat-like" cry. On examination, the infant has microcephaly and
epicanthal folds. Which of the following genetic abnormalities is most likely?
• A) Trisomy 21
• B) Deletion of chromosome 5p (Cri-du-chat syndrome)
• C) Trisomy 18
• D) Deletion of 22q11.2
• E) Fragile X syndrome
Answer: B) Deletion of chromosome 5p (Cri-du-chat syndrome)
Rationale: Cri-du-chat syndrome is caused by a deletion on the short arm of
chromosome 5 (5p-). It is characterized by a high-pitched, "cat-like" cry,
