NR-604 PRIMARY CARE ACROSS THE LIFESPAN EXAM 2
EXAM with Questions and Answers/Plus a Rationale Updated
2026 A+/Instant Download PDF
EXAM COVERAGE
1. Advanced Pediatric Health Assessment and Common Childhood Disorders
2. Adolescent Medicine, Mental Health, and Developmental Transitions
3. Comprehensive Geriatric Assessment and Chronic Disease Management
4. Women's Health Across the Lifespan and Prenatal Care
5. Men's Health and Urological Disorders in Primary Care
6. Dermatological, Musculoskeletal, and Neurological Conditions
7. Pharmacotherapeutics and Evidence-Based Guidelines Across Populations
1. A 4-month-old infant is brought to the pediatric primary care clinic by her mother, who reports
that the baby has had a low-grade fever, rhinorrhea, and a worsening "barking" cough for the
past two days, which is notably worse at night. Physical examination reveals inspiratory stridor
at rest and mild retractions. What is the most likely diagnosis and first-line treatment?
A. Acute epiglottitis; immediate endotracheal intubation in the operating room
B. Croup (laryngotracheobronchitis); single dose of oral dexamethasone and cool mist or
nebulized epinephrine if stridor is severe
C. Bacterial tracheitis; intravenous vancomycin and ceftriaxone
D. Bronchiolitis; palivizumab prophylaxis and supplemental oxygen
CORRECT ANSWER : B
Rationale: Croup is classically characterized by a barking cough, inspiratory stridor, and
hoarseness, most commonly caused by parainfluenza virus. A single dose of oral corticosteroid
, (dexamethasone) reduces laryngeal edema and clinical symptoms, while nebulized epinephrine
is reserved for moderate-to-severe cases with stridor at rest.
2. A 2-year-old toddler is evaluated for recurrent lower respiratory tract infections. The mother
notes foul-smelling, bulky, greasy stools and poor weight gain despite a robust appetite. Which
diagnostic test is the gold standard for confirming the suspected genetic condition?
A. Serum Immunoglobulin E (IgE) and RAST testing
B. Sweat chloride test via pilocarpine iontophoresis measuring chloride concentration
C. High-resolution chest computed tomography (CT) scan
D. Barium swallow radiographic study
CORRECT ANSWER : B
Rationale: The clinical triad of failure to thrive, recurrent pulmonary infections, and steatorrhea
strongly suggests cystic fibrosis. The diagnostic gold standard is the sweat chloride test, where
elevated sweat chloride levels reflect dysfunctional CFTR chloride channels.
3. A 6-week-old male infant is brought in by his first-time parents due to non-bilious, projectile
vomiting that occurs immediately after feeding. The infant appears hungry immediately after
vomiting. Palpation of the abdomen is most likely to reveal which of the following findings?
A. A sausage-shaped abdominal mass in the right upper quadrant
B. An olive-shaped, mobile, hard mass in the epigastric region
C. Generalized abdominal tympany with diffuse tenderness
D. A reducible umbilical hernia with a wide fascial ring
CORRECT ANSWER : B
Rationale: Pyloric stenosis typically presents in infants aged 3 to 6 weeks with progressive
projectile non-bilious vomiting and metabolic alkalosis. Physical examination classic finding is a
palpable, firm, olive-sized mass in the epigastrium.
4. A 9-month-old infant is brought to the clinic with a 3-day history of high-grade fever (103°F)
that resolved abruptly this morning, followed immediately by the appearance of a faint, pink
maculopapular rash spreading from the trunk to the neck and extremities. What is the causative
agent of this condition?
A. Parvovirus B19
, B. Human Herpesvirus 6 (HHV-6) or HHV-7
C. Measles (Rubeola) virus
D. Varicella-zoster virus
CORRECT ANSWER : B
Rationale: Roseola infantum (exanthem subitum), caused primarily by human herpesvirus 6,
classically presents with high fever for 3 to 5 days followed by abrupt defervescence and the
sudden onset of a blanching maculopapular rash.
5. A 5-year-old child presents with facial edema, generalized body swelling, fatigue, and foamy
urine. Laboratory evaluation reveals heavy proteinuria (3+ to 4+), hypoalbuminemia (< 2.5
g/dL), and hyperlipidemia, with normal renal function and complement levels. What is the initial
drug of choice for this condition?
A. Furosemide combined with spironolactone
B. Oral corticosteroid therapy (prednisone) daily followed by a taper
C. Intravenous cyclophosphamide pulse therapy
D. Broad-spectrum empiric oral antibiotics
CORRECT ANSWER : B
Rationale: Minimal change disease is the most frequent cause of nephrotic syndrome in children,
presenting with heavy proteinuria, edema, and hypoalbuminemia. Corticosteroids are the
cornerstone of initial treatment, to which most children achieve complete remission.
6. An 8-year-old boy is brought by his mother due to recurrent episodes of staring spells lasting 5 to
10 seconds, during which he stops talking, drops objects, and immediately resumes his activity
without post-ictal confusion. Electroencephalography (EEG) during an episode is most likely to
reveal which pattern?
A. Generalized slow spike-and-wave discharges at 1.5 to 2.5 Hz
B. Generalized symmetric 3-Hz spike-and-wave discharges
C. Focal temporal sharp waves with intermittent phase reversal
D. Hypsarrhythmia with chaotic background activity
CORRECT ANSWER : B
, Rationale: Childhood absence epilepsy is characterized by brief lapses in awareness without loss
of postural tone. The hallmark diagnostic EEG finding is generalized, symmetric 3-Hz spike-and-
wave discharges provoked by hyperventilation.
7. A 14-year-old adolescent female presents with lower abdominal pain and primary amenorrhea.
She has normal secondary sexual characteristics (breast and pubic hair development). Physical
examination reveals a bulging, bluish-tinted vaginal membrane without a visible vaginal
opening. What is the diagnosis?
A. Turner syndrome (45,X)
B. Imperforate hymen
C. Androgen insensitivity syndrome
D. Mayer-Rokitansky-Küster-Hauser syndrome
CORRECT ANSWER : B
Rationale: An imperforate hymen is a congenital anomaly where the hymenal tissue fails to
perforate, resulting in hematocolpos (menstrual blood accumulation) behind the bulging hymen,
causing cyclic pelvic pain with normal secondary sexual maturation.
8. A 16-year-old male athlete presents with gradual onset of pain and localized tenderness at the
tibial tubercle, which is exacerbated by running, jumping, and kneeling. Physical examination
reveals swelling and tenderness directly over the tibial tuberosity. What is the primary
management strategy?
A. Immediate surgical fixation and bone grafting
B. Activity modification, relative rest, ice, stretching, and strengthening exercises
(conservative management)
C. Strict non-weight-bearing immobilization in a long-leg cast for 8 weeks
D. High-dose oral systemic corticosteroid therapy
CORRECT ANSWER : B
Rationale: Osgood-Schlatter disease is an overuse traction apophysitis of the tibial tubercle
common in growing adolescents. It is a self-limiting condition managed conservatively with
activity modification, NSAIDs, and physical therapy.
9. A 3-year-old child is brought to the clinic with acute onset of high fever, drooling, dysphagia,
and severe respiratory distress. The child is sitting in a "tripod" position with the neck
EXAM with Questions and Answers/Plus a Rationale Updated
2026 A+/Instant Download PDF
EXAM COVERAGE
1. Advanced Pediatric Health Assessment and Common Childhood Disorders
2. Adolescent Medicine, Mental Health, and Developmental Transitions
3. Comprehensive Geriatric Assessment and Chronic Disease Management
4. Women's Health Across the Lifespan and Prenatal Care
5. Men's Health and Urological Disorders in Primary Care
6. Dermatological, Musculoskeletal, and Neurological Conditions
7. Pharmacotherapeutics and Evidence-Based Guidelines Across Populations
1. A 4-month-old infant is brought to the pediatric primary care clinic by her mother, who reports
that the baby has had a low-grade fever, rhinorrhea, and a worsening "barking" cough for the
past two days, which is notably worse at night. Physical examination reveals inspiratory stridor
at rest and mild retractions. What is the most likely diagnosis and first-line treatment?
A. Acute epiglottitis; immediate endotracheal intubation in the operating room
B. Croup (laryngotracheobronchitis); single dose of oral dexamethasone and cool mist or
nebulized epinephrine if stridor is severe
C. Bacterial tracheitis; intravenous vancomycin and ceftriaxone
D. Bronchiolitis; palivizumab prophylaxis and supplemental oxygen
CORRECT ANSWER : B
Rationale: Croup is classically characterized by a barking cough, inspiratory stridor, and
hoarseness, most commonly caused by parainfluenza virus. A single dose of oral corticosteroid
, (dexamethasone) reduces laryngeal edema and clinical symptoms, while nebulized epinephrine
is reserved for moderate-to-severe cases with stridor at rest.
2. A 2-year-old toddler is evaluated for recurrent lower respiratory tract infections. The mother
notes foul-smelling, bulky, greasy stools and poor weight gain despite a robust appetite. Which
diagnostic test is the gold standard for confirming the suspected genetic condition?
A. Serum Immunoglobulin E (IgE) and RAST testing
B. Sweat chloride test via pilocarpine iontophoresis measuring chloride concentration
C. High-resolution chest computed tomography (CT) scan
D. Barium swallow radiographic study
CORRECT ANSWER : B
Rationale: The clinical triad of failure to thrive, recurrent pulmonary infections, and steatorrhea
strongly suggests cystic fibrosis. The diagnostic gold standard is the sweat chloride test, where
elevated sweat chloride levels reflect dysfunctional CFTR chloride channels.
3. A 6-week-old male infant is brought in by his first-time parents due to non-bilious, projectile
vomiting that occurs immediately after feeding. The infant appears hungry immediately after
vomiting. Palpation of the abdomen is most likely to reveal which of the following findings?
A. A sausage-shaped abdominal mass in the right upper quadrant
B. An olive-shaped, mobile, hard mass in the epigastric region
C. Generalized abdominal tympany with diffuse tenderness
D. A reducible umbilical hernia with a wide fascial ring
CORRECT ANSWER : B
Rationale: Pyloric stenosis typically presents in infants aged 3 to 6 weeks with progressive
projectile non-bilious vomiting and metabolic alkalosis. Physical examination classic finding is a
palpable, firm, olive-sized mass in the epigastrium.
4. A 9-month-old infant is brought to the clinic with a 3-day history of high-grade fever (103°F)
that resolved abruptly this morning, followed immediately by the appearance of a faint, pink
maculopapular rash spreading from the trunk to the neck and extremities. What is the causative
agent of this condition?
A. Parvovirus B19
, B. Human Herpesvirus 6 (HHV-6) or HHV-7
C. Measles (Rubeola) virus
D. Varicella-zoster virus
CORRECT ANSWER : B
Rationale: Roseola infantum (exanthem subitum), caused primarily by human herpesvirus 6,
classically presents with high fever for 3 to 5 days followed by abrupt defervescence and the
sudden onset of a blanching maculopapular rash.
5. A 5-year-old child presents with facial edema, generalized body swelling, fatigue, and foamy
urine. Laboratory evaluation reveals heavy proteinuria (3+ to 4+), hypoalbuminemia (< 2.5
g/dL), and hyperlipidemia, with normal renal function and complement levels. What is the initial
drug of choice for this condition?
A. Furosemide combined with spironolactone
B. Oral corticosteroid therapy (prednisone) daily followed by a taper
C. Intravenous cyclophosphamide pulse therapy
D. Broad-spectrum empiric oral antibiotics
CORRECT ANSWER : B
Rationale: Minimal change disease is the most frequent cause of nephrotic syndrome in children,
presenting with heavy proteinuria, edema, and hypoalbuminemia. Corticosteroids are the
cornerstone of initial treatment, to which most children achieve complete remission.
6. An 8-year-old boy is brought by his mother due to recurrent episodes of staring spells lasting 5 to
10 seconds, during which he stops talking, drops objects, and immediately resumes his activity
without post-ictal confusion. Electroencephalography (EEG) during an episode is most likely to
reveal which pattern?
A. Generalized slow spike-and-wave discharges at 1.5 to 2.5 Hz
B. Generalized symmetric 3-Hz spike-and-wave discharges
C. Focal temporal sharp waves with intermittent phase reversal
D. Hypsarrhythmia with chaotic background activity
CORRECT ANSWER : B
, Rationale: Childhood absence epilepsy is characterized by brief lapses in awareness without loss
of postural tone. The hallmark diagnostic EEG finding is generalized, symmetric 3-Hz spike-and-
wave discharges provoked by hyperventilation.
7. A 14-year-old adolescent female presents with lower abdominal pain and primary amenorrhea.
She has normal secondary sexual characteristics (breast and pubic hair development). Physical
examination reveals a bulging, bluish-tinted vaginal membrane without a visible vaginal
opening. What is the diagnosis?
A. Turner syndrome (45,X)
B. Imperforate hymen
C. Androgen insensitivity syndrome
D. Mayer-Rokitansky-Küster-Hauser syndrome
CORRECT ANSWER : B
Rationale: An imperforate hymen is a congenital anomaly where the hymenal tissue fails to
perforate, resulting in hematocolpos (menstrual blood accumulation) behind the bulging hymen,
causing cyclic pelvic pain with normal secondary sexual maturation.
8. A 16-year-old male athlete presents with gradual onset of pain and localized tenderness at the
tibial tubercle, which is exacerbated by running, jumping, and kneeling. Physical examination
reveals swelling and tenderness directly over the tibial tuberosity. What is the primary
management strategy?
A. Immediate surgical fixation and bone grafting
B. Activity modification, relative rest, ice, stretching, and strengthening exercises
(conservative management)
C. Strict non-weight-bearing immobilization in a long-leg cast for 8 weeks
D. High-dose oral systemic corticosteroid therapy
CORRECT ANSWER : B
Rationale: Osgood-Schlatter disease is an overuse traction apophysitis of the tibial tubercle
common in growing adolescents. It is a self-limiting condition managed conservatively with
activity modification, NSAIDs, and physical therapy.
9. A 3-year-old child is brought to the clinic with acute onset of high fever, drooling, dysphagia,
and severe respiratory distress. The child is sitting in a "tripod" position with the neck
