Fitzgerald Nurse Practitioner Pre-Test 2026
Review Materials
1. During a well child evaluation of a This is normal as onset of puberty typically occurs
10- year-old girl, you note the presence between ages 8 and 13 for girls.
of breast buds and sparse growth of
long, straight pigmented hair along
the labia. Since her last visit one year
The presence of breast buds and sparse pubic
ago, you find that she has grown 3
hair signifies Tanner Stage 2 development, which
inches (7.7 cm), gained 6 lbs (2.7 kg),
is normal for a 10-year-old girl. During pre-ado-
and is within the 50th percentile for
lescence (6-10 years of age), children gain ap-
height and weight. The mother asks if
proximately 2-3 kg (5-7 lbs) and 5-8 cm (2-3
these findings are normal for her age.
inches) per year. Growth spurt in girls typically
You respond:
begins around 9-10 years of age, with maximum
growth at 12 years of age.
- This is normal as onset of puberty
typically occurs between ages 8 and 13
for girls.
- A referral to endocrinology is likely
warranted.
- A bone age determination is recom-
mended.
- A follow-up visit in 6 months is need-
ed to note any additional changes.
2. You see a 17-year-old female with sus- "Strawberry tongue."
pected bacterial pharyngitis caused by
group A beta-hemolytic streptococci. Physical examination of the patient with acute
Anticipated findings would include all pharyngitis by S. pyogenes will typically find ex-
of the following except: udative pharyngitis (C), palatial petechiae (A), and
anterior cervical lymphadenopathy (D).
Palatial petechiae.
"Strawberry tongue."
Exudative pharyngitis.
Anterior cervical lymphadenopathy.
, Fitzgerald Nurse Practitioner Pre-Test 2026
Review Materials
3. A 37-year-old man presents with a This is largely a clinical diagnosis.
many-month history of well-demarcat-
ed plaques with silvery scale on the
A diagnosis of psoriasis vulgaris can be made
tips of his elbows. The scales often
with a review of patient history, patient risk factors
bleed when picked or peeled. In con-
including family history, and physical examination
sidering a diagnosis of psoriasis vul-
(A). Additional testing can be considered to ditter-
garis, the NP considers:
entiate the condition from another possible cause
but is not usually required.
This is largely a clinical diagnosis.
Testing for presence of rheumatoid
factor and checking ESR.
A biopsy of a representative lesion is
needed.
Referral to dermatology.
4. A 27-year-old male presents with a Antimicrobial therapy is not warranted.
2-day history of purulent nasal dis-
charge and a 4-day history of upper Given that this is likely a viral infection, antimicro-
respiratory tract infection symptoms bial therapy is not warranted (A, B, C). If the illness
but is without fever. He asks for an progresses to suggest a bacterial infection (e.g.,
antimicrobial to treat his "sinus infec- "double sickening," where URI-like symptoms ini-
tion." He is otherwise healthy, has not tially improve then worsen, or illness persisting
received antimicrobial therapy in the beyond 7?10 days), then an antimicrobial can be
past 3 months, and has no drug aller- considered. Question: Plan/Intervention
gies. You consider:
Oral amoxicillin 1000 mg BID for 7
days.
Oral amoxicillin-clavulanate 875/125
mg BID for 5 days.
, Oral azithromycin 500 mg QD for 5
days.
Antimicrobial therapy is not warrant-
ed.
5. Appropriate treatment for an other- Oral amoxicillin 90 mg/kg/day for 5 days.
wise well 6-year-old with presumed Though viral pathogens also often implicated, the
bacterial community-acquired pneu- primary treatment target for presumed bacter-
monia who has not received any re- ial community-acquired pneumonia in children
cent antimicrobial therapy and has no is Streptococcus pneumoniae. PIDS/IDSA guide-
known drug allergies is: lines recommend amoxicillin as a first-line agent
(A). Cephalosporins can be considered in the
presence of penicillin allergy.
Oral amoxicillin 90 mg/kg/day for 5
days.
Oral amoxicillin-clavulanate 90/6.4
mg/kg/day for 14 days.
Oral clarithromycin 15 mg/kg/day for
10 days.
Oral levofloxacin 750 mg for 5 days.
6. A 47-year-old man with a 3-day history Amoxicillin 1000 mg PO TID for 5 days.
of moderate otalgia is diagnosed with
acute otitis media. He requests treat- For patients with risk factors for drug-re-
ment with an antimicrobial. He is oth- sistant infections, high-dose amoxicillin-clavu-
erwise healthy, has not received an- lanate or certain cephalosporins are appropriate.
timicrobials in the past 6 months, and Cephalexin, a first-generation cephalosporin, has
has no history of drug allergies. Appro- limited activity against Gram-negative bacteria,
priate therapy can include: including H. influenzae and M. catarrhalis, with
or without beta-lactamase production (A). Fluo-
roquinolones are not recommended as first-line
Cephalexin 250 mg q6h BID for 10 therapy (D) and TMP-SMX is not recommended
days . for treatment of AOM (C).
, Amoxicillin 1000 mg PO TID for 5 days.
Trimethoprim-sulfamethoxazole 80
mg/400 mg PO BID for 14 days.
Levofloxacin 750 mg PO QD for 5 days.
7. You see an 18-month-old with a histo- Oral prednisolone.
ry of persistent moderate asthma who
presents with a 2-day history of up- Leukotriene modifiers such as montelukast are
per respiratory tract infection symp- used as controller therapy and would not otter
toms and worsening asthma symp- timely benefits during an asthma flare (A). Mon-
toms over the past 24 hours. She is cur- telukast comes with a FDA warning about se-
rently taking an inhaled low-dose cor- rious neuropsychiatric events, including suicidal
ticosteroid twice daily as well as neb- thoughts and actions. Theophylline is used to
ulized albuterol PRN. To manage this prevent bronchospasm and not to treat an acute
asthma flare, you recommend treat- asthma flare (B). Oxygen therapy is not typically
ment with: needed except in severe asthma exacerbations
where oxygen saturation levels fall below a critical
level (D).
Oral montelukast.
Oral theophylline.
Oral prednisolone.
Oxygen therapy.
8. Which of the following is indicative of TSH=18 mIU/L (0.4-4.0 mIU/L); free T4=13.2
subclinical hypothyroidism? pmol/L (10-27 pmol/L)
TSH levels below normal is an indication of hy-
Total T4=43 mcg/dL (4.5-12.0 mcg/dL); perthyroidism (C). Total T4 is rarely an indicated
free T3=6.5 pmol/L (3.5-7.7 pmol/L) test for thyroid conditions as the level can be
Total T4=1.3 mcg/dL (4.5-12.0 mcg/dL); increased or decreased in the absence of thyroid
free T3=42 pmol/L (3.5-7.7 pmol/L) disease (A, B). Free T3 is also a rarely indicated
TSH <0.2 mIU/L (0.4-4.0 mIU/L); free test for thyroid disorders.
T4=64 pmol/L (10-27 pmol/L)
Review Materials
1. During a well child evaluation of a This is normal as onset of puberty typically occurs
10- year-old girl, you note the presence between ages 8 and 13 for girls.
of breast buds and sparse growth of
long, straight pigmented hair along
the labia. Since her last visit one year
The presence of breast buds and sparse pubic
ago, you find that she has grown 3
hair signifies Tanner Stage 2 development, which
inches (7.7 cm), gained 6 lbs (2.7 kg),
is normal for a 10-year-old girl. During pre-ado-
and is within the 50th percentile for
lescence (6-10 years of age), children gain ap-
height and weight. The mother asks if
proximately 2-3 kg (5-7 lbs) and 5-8 cm (2-3
these findings are normal for her age.
inches) per year. Growth spurt in girls typically
You respond:
begins around 9-10 years of age, with maximum
growth at 12 years of age.
- This is normal as onset of puberty
typically occurs between ages 8 and 13
for girls.
- A referral to endocrinology is likely
warranted.
- A bone age determination is recom-
mended.
- A follow-up visit in 6 months is need-
ed to note any additional changes.
2. You see a 17-year-old female with sus- "Strawberry tongue."
pected bacterial pharyngitis caused by
group A beta-hemolytic streptococci. Physical examination of the patient with acute
Anticipated findings would include all pharyngitis by S. pyogenes will typically find ex-
of the following except: udative pharyngitis (C), palatial petechiae (A), and
anterior cervical lymphadenopathy (D).
Palatial petechiae.
"Strawberry tongue."
Exudative pharyngitis.
Anterior cervical lymphadenopathy.
, Fitzgerald Nurse Practitioner Pre-Test 2026
Review Materials
3. A 37-year-old man presents with a This is largely a clinical diagnosis.
many-month history of well-demarcat-
ed plaques with silvery scale on the
A diagnosis of psoriasis vulgaris can be made
tips of his elbows. The scales often
with a review of patient history, patient risk factors
bleed when picked or peeled. In con-
including family history, and physical examination
sidering a diagnosis of psoriasis vul-
(A). Additional testing can be considered to ditter-
garis, the NP considers:
entiate the condition from another possible cause
but is not usually required.
This is largely a clinical diagnosis.
Testing for presence of rheumatoid
factor and checking ESR.
A biopsy of a representative lesion is
needed.
Referral to dermatology.
4. A 27-year-old male presents with a Antimicrobial therapy is not warranted.
2-day history of purulent nasal dis-
charge and a 4-day history of upper Given that this is likely a viral infection, antimicro-
respiratory tract infection symptoms bial therapy is not warranted (A, B, C). If the illness
but is without fever. He asks for an progresses to suggest a bacterial infection (e.g.,
antimicrobial to treat his "sinus infec- "double sickening," where URI-like symptoms ini-
tion." He is otherwise healthy, has not tially improve then worsen, or illness persisting
received antimicrobial therapy in the beyond 7?10 days), then an antimicrobial can be
past 3 months, and has no drug aller- considered. Question: Plan/Intervention
gies. You consider:
Oral amoxicillin 1000 mg BID for 7
days.
Oral amoxicillin-clavulanate 875/125
mg BID for 5 days.
, Oral azithromycin 500 mg QD for 5
days.
Antimicrobial therapy is not warrant-
ed.
5. Appropriate treatment for an other- Oral amoxicillin 90 mg/kg/day for 5 days.
wise well 6-year-old with presumed Though viral pathogens also often implicated, the
bacterial community-acquired pneu- primary treatment target for presumed bacter-
monia who has not received any re- ial community-acquired pneumonia in children
cent antimicrobial therapy and has no is Streptococcus pneumoniae. PIDS/IDSA guide-
known drug allergies is: lines recommend amoxicillin as a first-line agent
(A). Cephalosporins can be considered in the
presence of penicillin allergy.
Oral amoxicillin 90 mg/kg/day for 5
days.
Oral amoxicillin-clavulanate 90/6.4
mg/kg/day for 14 days.
Oral clarithromycin 15 mg/kg/day for
10 days.
Oral levofloxacin 750 mg for 5 days.
6. A 47-year-old man with a 3-day history Amoxicillin 1000 mg PO TID for 5 days.
of moderate otalgia is diagnosed with
acute otitis media. He requests treat- For patients with risk factors for drug-re-
ment with an antimicrobial. He is oth- sistant infections, high-dose amoxicillin-clavu-
erwise healthy, has not received an- lanate or certain cephalosporins are appropriate.
timicrobials in the past 6 months, and Cephalexin, a first-generation cephalosporin, has
has no history of drug allergies. Appro- limited activity against Gram-negative bacteria,
priate therapy can include: including H. influenzae and M. catarrhalis, with
or without beta-lactamase production (A). Fluo-
roquinolones are not recommended as first-line
Cephalexin 250 mg q6h BID for 10 therapy (D) and TMP-SMX is not recommended
days . for treatment of AOM (C).
, Amoxicillin 1000 mg PO TID for 5 days.
Trimethoprim-sulfamethoxazole 80
mg/400 mg PO BID for 14 days.
Levofloxacin 750 mg PO QD for 5 days.
7. You see an 18-month-old with a histo- Oral prednisolone.
ry of persistent moderate asthma who
presents with a 2-day history of up- Leukotriene modifiers such as montelukast are
per respiratory tract infection symp- used as controller therapy and would not otter
toms and worsening asthma symp- timely benefits during an asthma flare (A). Mon-
toms over the past 24 hours. She is cur- telukast comes with a FDA warning about se-
rently taking an inhaled low-dose cor- rious neuropsychiatric events, including suicidal
ticosteroid twice daily as well as neb- thoughts and actions. Theophylline is used to
ulized albuterol PRN. To manage this prevent bronchospasm and not to treat an acute
asthma flare, you recommend treat- asthma flare (B). Oxygen therapy is not typically
ment with: needed except in severe asthma exacerbations
where oxygen saturation levels fall below a critical
level (D).
Oral montelukast.
Oral theophylline.
Oral prednisolone.
Oxygen therapy.
8. Which of the following is indicative of TSH=18 mIU/L (0.4-4.0 mIU/L); free T4=13.2
subclinical hypothyroidism? pmol/L (10-27 pmol/L)
TSH levels below normal is an indication of hy-
Total T4=43 mcg/dL (4.5-12.0 mcg/dL); perthyroidism (C). Total T4 is rarely an indicated
free T3=6.5 pmol/L (3.5-7.7 pmol/L) test for thyroid conditions as the level can be
Total T4=1.3 mcg/dL (4.5-12.0 mcg/dL); increased or decreased in the absence of thyroid
free T3=42 pmol/L (3.5-7.7 pmol/L) disease (A, B). Free T3 is also a rarely indicated
TSH <0.2 mIU/L (0.4-4.0 mIU/L); free test for thyroid disorders.
T4=64 pmol/L (10-27 pmol/L)
