NURS6541 ADVANCED PEDIATRIC
PRIMARY CARE EXAM 3 PRACTICE
1. A 4-year-old child presents with a sudden onset of high fever, drooling, and inspiratory
stridor. The child is sitting in a tripod position. What is the most appropriate immediate
action?
A. Perform a thorough throat examination using a tongue depressor.
B. Maintain a calm environment and prepare for emergency airway management.
C. Obtain a lateral neck radiograph to confirm the ‘steeple sign’.
D. Administer nebulized epinephrine and oral dexamethasone.
Answer: B
Conceptual Explanation: These symptoms are classic for epiglottitis. Any attempt to
visualize the throat with a tongue depressor can trigger complete airway obstruction. The
priority is maintaining the airway and avoiding agitation until experts are ready for
intubation.
2. Which of the following findings is most characteristic of a ventricular septal defect (VSD)?
A. A continuous ‘machinery’ murmur heard at the left upper sternal border.
,B. A harsh, holosystolic murmur heard best at the left lower sternal border.
C. An ejection click followed by a mid-systolic crescendo-decrescendo murmur.
D. A fixed split S2 heart sound.
Answer: B
Conceptual Explanation: A VSD typically presents as a harsh, holosystolic murmur at the
left lower sternal border. Machinary murmurs are for PDA, fixed split S2 is for ASD, and
ejection clicks are for stenotic valves.
3. An 8-year-old boy presents with a limp and hip pain that radiates to the knee. On
examination, he has limited internal rotation and abduction of the hip. He is at the 95th
percentile for BMI. What is the most likely diagnosis?
A. Legg-Calvé-Perthes disease
B. Transient synovitis
C. Slipped Capital Femoral Epiphysis (SCFE)
D. Osgood-Schlatter disease
Answer: C
Conceptual Explanation: SCFE typically occurs in obese adolescent males and presents
with hip or knee pain and a limp. Physical exam shows limited internal rotation. Legg-
Calvé-Perthes usually occurs in younger children (4-8) and is often associated with a
smaller stature.
, 4. In the treatment of Acute Otitis Media (AOM), when is ‘watchful waiting’ appropriate
according to AAP guidelines?
A. In a 6-month-old with bilateral AOM and high fever.
B. In a 12-month-old with severe unilateral symptoms.
C. In any child with otorrhea regardless of age.
D. In a 3-year-old with mild ear pain and temperature under 102.2°F (39°C).
Answer: D
Conceptual Explanation: Watchful waiting (observation) is appropriate for children 6
months to 2 years with unilateral AOM without severe symptoms, or children >2 years with
mild symptoms (unilateral or bilateral). Severe symptoms or age <6 months require
immediate antibiotics.
5. A 10-year-old child has asthma symptoms occurring 3-4 days per week and awakens 3
times a month due to cough. Their FEV1 is >80% predicted. How should this asthma be
classified?
A. Mild Persistent
B. Intermittent
C. Moderate Persistent
D. Severe Persistent
Answer: A
PRIMARY CARE EXAM 3 PRACTICE
1. A 4-year-old child presents with a sudden onset of high fever, drooling, and inspiratory
stridor. The child is sitting in a tripod position. What is the most appropriate immediate
action?
A. Perform a thorough throat examination using a tongue depressor.
B. Maintain a calm environment and prepare for emergency airway management.
C. Obtain a lateral neck radiograph to confirm the ‘steeple sign’.
D. Administer nebulized epinephrine and oral dexamethasone.
Answer: B
Conceptual Explanation: These symptoms are classic for epiglottitis. Any attempt to
visualize the throat with a tongue depressor can trigger complete airway obstruction. The
priority is maintaining the airway and avoiding agitation until experts are ready for
intubation.
2. Which of the following findings is most characteristic of a ventricular septal defect (VSD)?
A. A continuous ‘machinery’ murmur heard at the left upper sternal border.
,B. A harsh, holosystolic murmur heard best at the left lower sternal border.
C. An ejection click followed by a mid-systolic crescendo-decrescendo murmur.
D. A fixed split S2 heart sound.
Answer: B
Conceptual Explanation: A VSD typically presents as a harsh, holosystolic murmur at the
left lower sternal border. Machinary murmurs are for PDA, fixed split S2 is for ASD, and
ejection clicks are for stenotic valves.
3. An 8-year-old boy presents with a limp and hip pain that radiates to the knee. On
examination, he has limited internal rotation and abduction of the hip. He is at the 95th
percentile for BMI. What is the most likely diagnosis?
A. Legg-Calvé-Perthes disease
B. Transient synovitis
C. Slipped Capital Femoral Epiphysis (SCFE)
D. Osgood-Schlatter disease
Answer: C
Conceptual Explanation: SCFE typically occurs in obese adolescent males and presents
with hip or knee pain and a limp. Physical exam shows limited internal rotation. Legg-
Calvé-Perthes usually occurs in younger children (4-8) and is often associated with a
smaller stature.
, 4. In the treatment of Acute Otitis Media (AOM), when is ‘watchful waiting’ appropriate
according to AAP guidelines?
A. In a 6-month-old with bilateral AOM and high fever.
B. In a 12-month-old with severe unilateral symptoms.
C. In any child with otorrhea regardless of age.
D. In a 3-year-old with mild ear pain and temperature under 102.2°F (39°C).
Answer: D
Conceptual Explanation: Watchful waiting (observation) is appropriate for children 6
months to 2 years with unilateral AOM without severe symptoms, or children >2 years with
mild symptoms (unilateral or bilateral). Severe symptoms or age <6 months require
immediate antibiotics.
5. A 10-year-old child has asthma symptoms occurring 3-4 days per week and awakens 3
times a month due to cough. Their FEV1 is >80% predicted. How should this asthma be
classified?
A. Mild Persistent
B. Intermittent
C. Moderate Persistent
D. Severe Persistent
Answer: A
