Chamberlain NR 602 Final Exam Prep
Primary Care of the Childbearing &
Childrearing Family (2026) 100 Practice
Questions with Answers and Detailed
Rationales
EXAM SET 1: Questions 1-50
Question 1:
A 15-year-old male presents with complaints of feeling fullness in one ear,
dizziness, fluid discharge with foul smell, and decreased hearing. Upon
assessment, you notice a tumor-like mass on the tympanic membrane.
What is the most likely diagnosis and appropriate management?
A) Chronic otitis media with effusion; place tympanostomy tubes
B) Cholesteatoma; refer to ENT for surgical excision
C) Acoustic neuroma; urgent MRI with contrast
D) Cerumen impaction; irrigation and manual removal
Correct Answer: B) Cholesteatoma; refer to ENT for surgical excision
Rationale: A pearly white mass behind the tympanic membrane with
foul-smelling discharge and conductive hearing loss is pathognomonic for
cholesteatoma, a keratinizing epithelial growth that erodes ossicles and can
extend intracranially. Medical management is ineffective; surgical
tympanomastoidectomy is required to prevent complications such as
hearing loss, facial nerve paralysis, and intracranial extension. Acoustic
neuroma presents with unilateral hearing loss and tinnitus but not the
characteristic pearly mass or foul discharge. Cerumen impaction would not
present with a pearly mass or foul odor. Chronic otitis media with effusion
,presents with fluid behind the tympanic membrane without the
characteristic mass.
Question 2:
A mother brings her 6-year-old male with complaints of fever for one week
and rash. Upon exam, you find conjunctival injection, red/tender/edematous
hands and feet, cracked red dry lips, cervical lymphadenitis, and a red
strawberry tongue. What is the diagnosis and treatment?
A) Scarlet fever; oral penicillin and antipyretics
B) Kawasaki disease; IVIG and high-dose aspirin
C) Stevens-Johnson syndrome; immediate hospitalization
D) Measles; vitamin A and supportive care
Correct Answer: B) Kawasaki disease; IVIG and high-dose aspirin
Rationale: Fever ≥5 days with bilateral conjunctivitis, mucosal changes
(strawberry tongue, cracked lips), extremity edema/erythema, and cervical
lymphadenopathy meets the criteria for Kawasaki disease. This is a
vasculitis that can lead to coronary artery aneurysms if untreated.
Treatment is IV immunoglobulin (IVIG) and high-dose aspirin, followed by
low-dose aspirin for antiplatelet effect. Scarlet fever typically presents with
a sandpaper-like rash and fever but lacks the extremity findings and
conjunctival injection. Stevens-Johnson syndrome presents with
widespread blistering and mucosal involvement. Measles presents with
cough, coryza, conjunctivitis, and Koplik spots.
Question 3:
A mother presents with her 3-month-old child and complains of a "goopy"
eye that is sometimes matted shut after naps. Upon exam, the conjunctiva
is clear with some mild crusting to the eyelashes. What is the diagnosis and
management?
,A) Bacterial conjunctivitis; prescribe erythromycin ointment TID
B) Probable lacrimal duct obstruction; daily massage and warm
compresses
C) Viral conjunctivitis; cold compresses and artificial tears
D) Blepharitis; lid scrubs with baby shampoo
Correct Answer: B) Probable lacrimal duct obstruction; daily massage and
warm compresses
Rationale: Clear conjunctiva with crusting in an infant indicates
nasolacrimal duct obstruction rather than infection. Parents should be
taught lacrimal duct massage and warm compresses while monitoring for
signs of bacterial superinfection or periorbital cellulitis. Most cases resolve
spontaneously by 6-12 months. Bacterial conjunctivitis would present with
purulent discharge and conjunctival injection. Viral conjunctivitis typically
presents with watery discharge and conjunctival injection. Blepharitis
presents with crusting at the eyelid margins, not just the lashes.
Question 4:
A 13-year-old female presents with complaint of nasal congestion, yellow
nasal discharge, fever, and hyposmia (decreased smell) for 10 days. Upon
exam, patient has maxillary and facial tenderness. What is the diagnosis
and treatment?
A) Viral URI; supportive care with saline nasal spray
B) Acute bacterial rhinosinusitis; amoxicillin for low-risk patients
C) Allergic rhinitis; intranasal corticosteroids and antihistamines
D) Migraine with autonomic features; sumatriptan and NSAIDs
Correct Answer: B) Acute bacterial rhinosinusitis; amoxicillin for low-risk
patients
Rationale: Persistent symptoms >10 days without improvement, purulent
discharge, and facial pain meet criteria for acute bacterial rhinosinusitis.
Amoxicillin remains first-line for children without recent antibiotic use,
, daycare attendance, or moderate-severe illness; Augmentin is reserved for
high-risk patients. Viral URI typically resolves within 7-10 days. Allergic
rhinitis presents with clear nasal discharge and itching, not purulent
discharge. Migraine with autonomic features would not present with
purulent nasal discharge.
Question 5:
A mother brings her 9-year-old overweight son to the clinic with complaints
of pain to the groin, knee, and right hip. She reports the patient has been
walking with a limp for the last couple days but is unable to ambulate today.
Mother denies any recent trauma. Upon inspection, there is external
rotation of the right foot. What is the diagnosis and management?
A) Toxic transient synovitis; NSAIDs and non-weight bearing status
B) Legg-Calvé-Perthes disease; refer to orthopedics for casting
C) Slipped capital femoral epiphysis; immediate referral to ER for surgery
D) Septic arthritis; emergency joint aspiration and IV antibiotics
Correct Answer: C) Slipped capital femoral epiphysis; immediate referral to
ER for surgery
Rationale: Hip pathology presenting as knee pain with external rotation of
the foot in an obese adolescent is pathognomonic for SCFE, a surgical
emergency requiring immediate fixation to prevent avascular necrosis of
the femoral head. Legg-Calvé-Perthes disease typically presents in
younger children (4-8 years) and does not present with the acute inability to
ambulate and external rotation. Toxic transient synovitis is a diagnosis of
exclusion with mild symptoms and no external rotation. Septic arthritis
presents with fever, severe pain, and refusal to bear weight, but external
rotation is more characteristic of SCFE.
Question 6:
A four-month-old infant's mother calls and states the patient has a fever of
Primary Care of the Childbearing &
Childrearing Family (2026) 100 Practice
Questions with Answers and Detailed
Rationales
EXAM SET 1: Questions 1-50
Question 1:
A 15-year-old male presents with complaints of feeling fullness in one ear,
dizziness, fluid discharge with foul smell, and decreased hearing. Upon
assessment, you notice a tumor-like mass on the tympanic membrane.
What is the most likely diagnosis and appropriate management?
A) Chronic otitis media with effusion; place tympanostomy tubes
B) Cholesteatoma; refer to ENT for surgical excision
C) Acoustic neuroma; urgent MRI with contrast
D) Cerumen impaction; irrigation and manual removal
Correct Answer: B) Cholesteatoma; refer to ENT for surgical excision
Rationale: A pearly white mass behind the tympanic membrane with
foul-smelling discharge and conductive hearing loss is pathognomonic for
cholesteatoma, a keratinizing epithelial growth that erodes ossicles and can
extend intracranially. Medical management is ineffective; surgical
tympanomastoidectomy is required to prevent complications such as
hearing loss, facial nerve paralysis, and intracranial extension. Acoustic
neuroma presents with unilateral hearing loss and tinnitus but not the
characteristic pearly mass or foul discharge. Cerumen impaction would not
present with a pearly mass or foul odor. Chronic otitis media with effusion
,presents with fluid behind the tympanic membrane without the
characteristic mass.
Question 2:
A mother brings her 6-year-old male with complaints of fever for one week
and rash. Upon exam, you find conjunctival injection, red/tender/edematous
hands and feet, cracked red dry lips, cervical lymphadenitis, and a red
strawberry tongue. What is the diagnosis and treatment?
A) Scarlet fever; oral penicillin and antipyretics
B) Kawasaki disease; IVIG and high-dose aspirin
C) Stevens-Johnson syndrome; immediate hospitalization
D) Measles; vitamin A and supportive care
Correct Answer: B) Kawasaki disease; IVIG and high-dose aspirin
Rationale: Fever ≥5 days with bilateral conjunctivitis, mucosal changes
(strawberry tongue, cracked lips), extremity edema/erythema, and cervical
lymphadenopathy meets the criteria for Kawasaki disease. This is a
vasculitis that can lead to coronary artery aneurysms if untreated.
Treatment is IV immunoglobulin (IVIG) and high-dose aspirin, followed by
low-dose aspirin for antiplatelet effect. Scarlet fever typically presents with
a sandpaper-like rash and fever but lacks the extremity findings and
conjunctival injection. Stevens-Johnson syndrome presents with
widespread blistering and mucosal involvement. Measles presents with
cough, coryza, conjunctivitis, and Koplik spots.
Question 3:
A mother presents with her 3-month-old child and complains of a "goopy"
eye that is sometimes matted shut after naps. Upon exam, the conjunctiva
is clear with some mild crusting to the eyelashes. What is the diagnosis and
management?
,A) Bacterial conjunctivitis; prescribe erythromycin ointment TID
B) Probable lacrimal duct obstruction; daily massage and warm
compresses
C) Viral conjunctivitis; cold compresses and artificial tears
D) Blepharitis; lid scrubs with baby shampoo
Correct Answer: B) Probable lacrimal duct obstruction; daily massage and
warm compresses
Rationale: Clear conjunctiva with crusting in an infant indicates
nasolacrimal duct obstruction rather than infection. Parents should be
taught lacrimal duct massage and warm compresses while monitoring for
signs of bacterial superinfection or periorbital cellulitis. Most cases resolve
spontaneously by 6-12 months. Bacterial conjunctivitis would present with
purulent discharge and conjunctival injection. Viral conjunctivitis typically
presents with watery discharge and conjunctival injection. Blepharitis
presents with crusting at the eyelid margins, not just the lashes.
Question 4:
A 13-year-old female presents with complaint of nasal congestion, yellow
nasal discharge, fever, and hyposmia (decreased smell) for 10 days. Upon
exam, patient has maxillary and facial tenderness. What is the diagnosis
and treatment?
A) Viral URI; supportive care with saline nasal spray
B) Acute bacterial rhinosinusitis; amoxicillin for low-risk patients
C) Allergic rhinitis; intranasal corticosteroids and antihistamines
D) Migraine with autonomic features; sumatriptan and NSAIDs
Correct Answer: B) Acute bacterial rhinosinusitis; amoxicillin for low-risk
patients
Rationale: Persistent symptoms >10 days without improvement, purulent
discharge, and facial pain meet criteria for acute bacterial rhinosinusitis.
Amoxicillin remains first-line for children without recent antibiotic use,
, daycare attendance, or moderate-severe illness; Augmentin is reserved for
high-risk patients. Viral URI typically resolves within 7-10 days. Allergic
rhinitis presents with clear nasal discharge and itching, not purulent
discharge. Migraine with autonomic features would not present with
purulent nasal discharge.
Question 5:
A mother brings her 9-year-old overweight son to the clinic with complaints
of pain to the groin, knee, and right hip. She reports the patient has been
walking with a limp for the last couple days but is unable to ambulate today.
Mother denies any recent trauma. Upon inspection, there is external
rotation of the right foot. What is the diagnosis and management?
A) Toxic transient synovitis; NSAIDs and non-weight bearing status
B) Legg-Calvé-Perthes disease; refer to orthopedics for casting
C) Slipped capital femoral epiphysis; immediate referral to ER for surgery
D) Septic arthritis; emergency joint aspiration and IV antibiotics
Correct Answer: C) Slipped capital femoral epiphysis; immediate referral to
ER for surgery
Rationale: Hip pathology presenting as knee pain with external rotation of
the foot in an obese adolescent is pathognomonic for SCFE, a surgical
emergency requiring immediate fixation to prevent avascular necrosis of
the femoral head. Legg-Calvé-Perthes disease typically presents in
younger children (4-8 years) and does not present with the acute inability to
ambulate and external rotation. Toxic transient synovitis is a diagnosis of
exclusion with mild symptoms and no external rotation. Septic arthritis
presents with fever, severe pain, and refusal to bear weight, but external
rotation is more characteristic of SCFE.
Question 6:
A four-month-old infant's mother calls and states the patient has a fever of
