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Exam (elaborations)

FITZ Pre-Test: –Questions With Fully Explained Solutions

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FITZ Pre-Test: –Questions With Fully Explained Solutions

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FITZ Pre-Test: –Questions With Fully Explained
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,During a well child evaluation of a 10- This is normal as onset of puberty typically occurs
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
ago, you find that she has grown 3 The presence of breast buds and sparse pubic hair
inches (7.7 cm), gained 6 lbs (2.7 kg), signifies Tanner Stage 2 development, which is
and is within the 50th percentile for normal for a 10-year-old girl. During pre-
height and weight. The mother asks if adolescence (6-10 years of age), children gain
these findings are normal for her age. approximately 2-3 kg (5-7 lbs) and 5-8 cm (2-3
You respond: inches) per year. Growth spurt in girls typically
begins around 9-10 years of age, with maximum
- This is normal as onset of puberty growth at 12 years of age.
typically occurs between ages 8 and
13 for girls.
- A referral to endocrinology is likely
warranted.
- A bone age determination is
recommended.
- A follow-up visit in 6 months is
needed to note any additional
changes.


You see a 17-year-old female with "Strawberry tongue."
suspected bacterial pharyngitis
caused by group A beta-hemolytic Physical examination of the patient with acute
streptococci. Anticipated findings pharyngitis by S. pyogenes will typically find
would include all of the following exudative pharyngitis (C), palatial petechiae (A), and
except: anterior cervical lymphadenopathy (D).


Palatial petechiae.
"Strawberry tongue."
Exudative pharyngitis.
Anterior cervical lymphadenopathy.

,A 37-year-old man presents with a This is largely a clinical diagnosis.
many-month history of well-
demarcated plaques with silvery
scale on the tips of his elbows. The A diagnosis of psoriasis vulgaris can be made with a
scales often bleed when picked or review of patient history, patient risk factors
peeled. In considering a diagnosis of including family history, and physical examination
psoriasis vulgaris, the NP considers: (A). Additional testing can be considered to
differentiate 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.


A 27-year-old male presents with a 2- Antimicrobial therapy is not warranted.
day history of purulent nasal
discharge and a 4-day history of Given that this is likely a viral infection, antimicrobial
upper respiratory tract infection therapy is not warranted (A, B, C). If the illness
symptoms but is without fever. He progresses to suggest a bacterial infection (e.g.,
asks for an antimicrobial to treat his "double sickening," where URI-like symptoms initially
"sinus infection." He is otherwise improve then worsen, or illness persisting beyond
healthy, has not received 7?10 days), then an antimicrobial can be considered.
antimicrobial therapy in the past 3 Question: Plan/Intervention
months, and has no drug allergies.
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
warranted.

, Appropriate treatment for an Oral amoxicillin 90 mg/kg/day for 5 days.
otherwise well 6-year-old with Though viral pathogens also often implicated, the
presumed bacterial community- primary treatment target for presumed bacterial
acquired pneumonia who has not community-acquired pneumonia in children is
received any recent antimicrobial Streptococcus pneumoniae. PIDS/IDSA guidelines
therapy and has no known drug recommend amoxicillin as a first-line agent (A).
allergies is: 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.


A 47-year-old man with a 3-day Amoxicillin 1000 mg PO TID for 5 days.
history of moderate otalgia is
diagnosed with acute otitis media. He For patients with risk factors for drug-resistant
requests treatment with an infections, high-dose amoxicillin-clavulanate or
antimicrobial. He is otherwise healthy, certain cephalosporins are appropriate. Cephalexin,
has not received antimicrobials in the a first-generation cephalosporin, has limited activity
past 6 months, and has no history of against Gram-negative bacteria, including H.
drug allergies. Appropriate therapy influenzae and M. catarrhalis, with or without beta-
can include: lactamase production (A). Fluoroquinolones are not
recommended as first-line therapy (D) and TMP-
SMX is not recommended for treatment of AOM (C).
Cephalexin 250 mg q6h BID for 10
days .
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.

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