NURS 6541 FINAL EXAM Complete Solution Package

NURS 6541 FINAL EXAM • Question 1 0 out of 0 points When completing this quiz, did you comply with Walden University’s Code of Conduct including the expectations for academic integrity? Selected Answer: Yes • Question 2 1 out of 1 points Antibiotic therapy is one of the mainstays of treatment for which of the following causes of wheezing? Selected Answer: c. Epiglottitis • Question 3 1 out of 1 points Dave, age 17, has gynecomastia. You should also assess him for Selected Answer: c. Testicular cancer • Question 4 1 out of 1 points A small-for-gestational-age infant is born to a 35-year-old woman. He has low-set and malformed ears, microcephaly, rocker-bottom feet, inguinal hernias, cleft lip/palate, and micrognathia. Chromosomal analysis is likely to reveal which of the following? Selected Answer: e. Edwards syndrome (trisomy 18) • Question 5 1 out of 1 points Primary dysmenorrhea is due to Selected Answer: a. Elevated prostaglandin level • Question 6 1 out of 1 points A 3-week-old male infant with 2 days of projectile, nonbilious vomiting and constant feeding. Which of the following is the most likely etiology? Selected Answer: f. Pyloric stenosis • Question 7 1 out of 1 points Which fo the following foods would be most appropriate for a child with celiac disease? Selected Answer: a. Rice with butter • Question 8 0 out of 1 points Which of the following is a measure of childhood intelligence? Selected Answer: a. Bayley scales • Question 9 1 out of 1 points An 8-month-old baby arrives to the office with his mother with a complaint of decreased left arm movement. He is a product of a normal term pregnancy, has had no medical problems, and was in good health when his mother dropped him off at the daycare center. Upper arm radiographs show a left humerus spiral fracture. Which of the following is the most appropriate next step in management? Selected b. Answer: Send the child to the hospital for admission and call child protective services. • Question 10 1 out of 1 points A 4-year-old female with profuse vomiting, sweating, lacrimation, and diarrhea, who seizes in the emergency room. Which of the following is the most likely etiology? Selected Answer: f. Insecticide ingestion • Question 11 1 out of 1 points A 9-year-old is diagnosed with dyspepsia without hematemesis, melena, or occult blood. The most appropriate next step is Selected Answer: d. Trial of ranitidine (Zantac) • Question 12 1 out of 1 points Which of the following therapeutic options is common for the treatment of both bee stings and bite wounds? Selected Answer: d. Tetanus vaccination • Question 13 1 out of 1 points You are examining Beth, age 9 months, and note a palpable right supraclavicular node. You know that this finding is suspicious for Selected Answer: d. Lymphoma of the mediastinum • Question 14 1 out of 1 points When examining a child with abdominal pain, what symptom would lead to a likely organic etiology? Selected Answer: c. Night waking • Question 15 1 out of 1 points Which of the following objective data are associated with significantly better long-term outcomes in children born with open spina bifida? Selected Answer: b. Perineal sensation • Question 16 1 out of 1 points A 14-year-old has a 3-week history of fever, anorexia, and abdominal pain. What additional symptom would cause the NP to suspect Crohn's disease? Selected Answer: b. Blood, mucous diarrhea • Question 17 1 out of 1 points A 3-year-old presents with macrocephaly, developmental delay, coarse facial features, large tounge, kyphosis, hip dislocation, tonsillar and adenoidal hypertrophy, and hepatomegaly. She is receiving early intervention services without improvement. What is the best next step? Selected Answer: a. Refer to genetics for further evaluations • Question 18 1 out of 1 points Ben has been diagnosed with folliculitis, an inflammatory condition involving the pilosebaceous follicle. What is the most common cause of this condition? Selected Answer: d. Staphylococcus aureus • Question 19 1 out of 1 points Which of the following is not true of insect stings from bees, wasps, and fire ants? Selected b. Answer: Greater reaction of hypersensitivity occurs most often with the initial exposure than with subsequent exposures. • Question 20 1 out of 1 points Unilateral wheezing is a finding suggestive of Selected Answer: c. Foreign body aspiration • Question 21 1 out of 1 points A 16-year-old is brought in as a walk-in by his parents. His parents state that he acutely developed a fever, chills and rash. He has been confused and not answering their questions. On examination he is toxically ill appearing, and is febrile, tachycardia and hypotensive. He is noted to have a diffuse petechial rash. What is the most likely diagnosis? Selected Answer: d. Meningococcemia • Question 22 1 out of 1 points A 12-year-old girl was brought to the emergency department because of severe sore throat, muffled voice, drooling, and fatigue. She had been sick for the past 3 days and is unable to eat because of painful swallowing. The parents deny any history of recurrent pharyngitis. The patient still managed to open her mouth and you were able to see an abscess at the upper pole of the right tonsil with deviation of the uvula toward the midline. Examination of the neck reveals enlarged and tender lymph nodes. Which of the following is the most appropriate management? Selected Answer: c. Incision and drainage of the abscess • Question 23 1 out of 1 points A 15-day-old infant has respiratory distress. A quick observation suggests she has slight cyanosis, hepatosplenomegaly, and features consistent with Down Syndrome. The cardiac examination demonstrates a loud first heart sound, a low-pitched, middiastolic murmur at the lower left sternal border, and a harsh apical holosystolic murmur in the mitral area. Which of the following cardiac conditions most likely explains her heart findings? Selected Answer: c. Complete atrioventricular canal (endocardial cushion defect) • Question 24 1 out of 1 points The organism that causes hand, foot, mouth syndrome is what virus? Selected Answer: d. Coxsackie • Question 25 1 out of 1 points Your patient has inflammatory bowel disease. Which of the following finding is most consistent with ulcerative colitis? Selected Answer: a. Left-sided abdominal pain • Question 26 1 out of 1 points Jesse, age 5, has a diagnosis of encopresis. After the diagnosis, what would be your next action? Selected Answer: b. Rule out a neurologic disorder. • Question 27 1 out of 1 points The parents of an 8-year-old Down Syndrome boy arrive for his annual well-child visit. He wants to participate in sports, including the Special Olympics. Until further examination can be completed, which of the following sports would you suggest as being safe? Selected Answer: e. Tennis • Question 28 1 out of 1 points Six months after being diagnosed with what appears to be insulin-dependent diabetes, the 5year-old in the case presentation has a significant decrease in his insulin requirement. Which of the following is the most likely explanation? Selected Answer: a. He has entered the "honeymoon phase" of his diabetes. • Question 29 1 out of 1 points The classic radiographic finding of croup is Selected Answer: d. Steeple sign • Question 30 1 out of 1 points A common cause of in-toeing in childhood is Selected Answer: a. Internal tibial torsion • Question 31 1 out of 1 points Mrs. Bay is upset. She is convinced something is seriously wrong with her son. He is a 2month-old and frequently vomits after feeding. Which of the following is most suggestive of GERD (gastroesophageal reflux disease)? Selected Answer: d. He drinks 7 to 8 ounces every 3 hours. • Question 32 0 out of 1 points Which of the following is true regarding the diagnosis of epiglottitis? Selected a. Answer: Every effort should be made to visualize the epiglottitis in the office and confirm the diagnosis • Question 33 1 out of 1 points Of the following patients, which child should not receive a tuberculin skin test? Selected d. Answer: A 2-year-old who was infected with RSV 2 months ago and is currently asymptomatic. • Question 34 1 out of 1 points Hope is a 7-month-old who presents in January with a 1-day history of cough, yellow nasal discharge, and low-grade temp (T max 100°F). She was previously healthy. She does have 2+ edema of the nasal turbinates and cloudy rhinorrhea. She is afebrile in the office. Her chest, mouth, and ears are clear. You prescribe: Selected Answer: b. Saline drops, bulb suction, humidified air, and increased PO fluids • Question 35 1 out of 1 points An ex-preemie with bronchopulmonary dysplasia has been discharged to home from the NICU. One potential problem area that requires close monitoring is Selected Answer: d. Insufficient caloric intake. • Question 36 1 out of 1 points Which of the following symptoms are most suggestive of pneumonia in a young child? Selected Answer: a. Fever, tachypnea, coryza, cough, scattered rales • Question 37 1 out of 1 points A 14-month-old child has lower extremity bowing, a waddling gait, genu varum, and is at the 5th percentile for height. Laboratory data include low-normal serum calcium, moderately low serum phosphate, and elevated serum alkaline phosphatase levels, hyperphosphaturia, and normal parathyroid levels. Which of the following is the most likely diagnosis? Selected Answer: c. Genetic primary hypophosphatemia • Question 38 0 out of 1 points Lisa has Cushing's syndrome. You would suspect her to have or to develop Selected Answer: b. Generalized increased pigmentations of the skin • Question 39 1 out of 1 points You have a patient that you think may have intussusception. Which of the following finding may you see? Selected Answer: b. Inconsolable screaming • Question 40 1 out of 1 points An 11-month-old male with intermittent bouts of crying and nonbilious vomiting, has a history of Meckel diverticulum. A small elongated mass is felt on the right side of his abdomen. Which of the following is the most likely etiology? Selected Answer: e. Intussusception • Question 41 1 out of 1 points Tracy, the mother of a 2-year-old, is concerned because her daughter walks on her toes all the time. What do you tell her? Selected Answer: d. Toe walking is considered normal until age 3. • Question 42 1 out of 1 points Mark, age 15, is 5 feet tall andn weighs 85 pounds. You suspect anorexia and know that the best initial approach is to Selected Answer: b. Confront Mark with the fact that you suspect an eating disorder. • Question 43 1 out of 1 points The following clinical description best matches which genetic disorder? A tall, thin 14year-old boy has no signs of puberty. He was delayed in his speech development and always has done less well in school than his siblings. He is shy, and teachers report his activity is immature. Physical examination reveals breast development, and long limbs with a decreased upper segment/lower segment ration. He has small testes and phallus. Selected Answer: c. Klinefelter syndrome (XXY) • Question 44 1 out of 1 points Which test is routinely recommended for a preparticipation sports physical? Selected Answer: d. A Snellen test • Question 45 1 out of 1 points Prophylactic penicillin should be started in children with sickle cell anemia by Selected Answer: d. 2 to 3 months of age • Question 46 1 out of 1 points Which of the following statements is not true with slipped capital femoral epiphysis? Selected b. Answer: It is thought to be caused by repetitive stresses in young athletes prior to growth spurts. • Question 47 1 out of 1 points Fifth disease is usually Selected Answer: d. Seen in children ages 5 to 14 years of age • Question 48 1 out of 1 points A head injury in which bruising or tearing of the cerebral structures occurs is a Selected Answer: b. Contusion • Question 49 1 out of 1 points Sam is a healthy 17-year-old student. He is thinking about having sex and asks for more information about condoms. You give him all of the following information except Selected Answer: b. Latex condoms are the most recommended and are heat tolerant. • Question 50 1 out of 1 points A 15-year-old girl has experienced abdominal pain, vomiting, and lethargy for 3 days. Her chest and throat examinations are clear, but her abdominal examination is significant for right lower quadrant pain. Rectal examination is equivocal for pain, and her pelvic examination is remarkable for pain upon movement of her cervix. Laboratory data include elevated white blood cell count, serum glucose level of 145 mg/dL, and serum bicarbonate level of 21mEq/dL. Her urinalysis is remarkable for 1+ white blood cells, 1+ glucose, and 1+ ketones. Which of the following is the most likely diagnosis? Selected Answer: b. Pelvic inflammatory disease (PID) • Question 51 1 out of 1 points A common presenting symptom of inflammatory bowel disease is Selected Answer: c. Unexplained fever • Question 52 1 out of 1 points Tommy has bloody diarrhea. His family eats fast-food four to five times each week. Which organism may have caused the diarrhea? Selected Answer: b. E. Coli • Question 53 1 out of 1 points While doing a 5-year-old well child exam, you notice two small patches of hair loss. Broken hair is present, as is erythema and scaling. On the basis of this information, which of these is the likely diagnosis? Selected Answer: b. Tinea corporis • Question 54 1 out of 1 points A 14-year-old girl from another state was followed for 7 years for a history of insulindependent diabetes mellitus. Her hemoglobin A1C is 14.9%. This laboratory test indicates which of the following? Selected Answer: a. Her glucose control is poor. • Question 55 1 out of 1 points A 6-year-old boy is left alone for 10 hours, now with hematemesis and pneumomediastinum on chest x-ray. Which of the following is the most likely etiology? Selected Answer: e. Esophageal foreign body • Question 56 1 out of 1 points The following clinical description best matches which genetic disorder? An institutionalized male juvenile delinquent upon close examination has severe nodulocystic acne, mild pectus excavatum, large teeth, prominent glabella, and relatively long face and fingers. His family says he has poor fine motor skills (such as penmanship), an explosive temper, and a low-normal IQ. Selected Answer: a. XYY male • Question 57 1 out of 1 points Riley, a 12-year-old girl, has scaly, hyperpigmented lesions in a "Christmas tree" distribution. It is predominantly on her trunk. One lesion is on her buttock that is larger than the other, at about 4 cm in diameter. What is your diagnosis? Selected Answer: b. Pityriasis rosea • Question 58 1 out of 1 points A healthy, thriving 4-year-old male has had sudden episodes of drawing his knees to his chest and crying like he is in acute pain for the last 5 hours. These episodes are separated by quiet times when he appears normal and comfortable. He is not vomiting and has not had a bowel movement today. What is the most likely diagnosis. Selected Answer: d. Intussusception • Question 59 0 out of 1 points In children who have not received antibiotics in the past month, which antibiotic is recommended by the Centers for Disease Control and Prevention for the management of acute bacterial respiratory infection? Selected Answer: c. Amoxicillin plus clavulanic acid (Augmentin) • Question 60 1 out of 1 points Which of the following is not a feature of DiGeorge syndrome? Selected Answer: b. Frontal bossing • Question 61 1 out of 1 points What is the appropriate management of a child with asthma who presents with acute wheezing and/or coughing? Selected Answer: b. Administer a short-acting beta agonist • Question 62 1 out of 1 points Jennifer, age 16, is an active cheerleader who just developed type 1 diabetes. She is worried that she will not fit in with her friends anymore because she does not think she can have all the same snacks they have. How do you respond? Selected d. Answer: Any snacks that are sufficient in calories to maintain your normal weight are okay. • Question 63 1 out of 1 points Shelby is a healthy 4-week-old who presents to your office in mid-January with a 3day history of nasal congestion with occasional cough. She started running a lowgrade fever last night (T max 101.5°F). Now she is refusing to nurse and has paroxysmal coughing and noisy/labored breathing. Physical exam reveals an illappearing infant with lethargy and tachypnea, intercostal retractions, expiratory wheezes, and occasional rales. She does not attend day care but has a 3-year-old sibling who does and who recently had a “cold.” What is the MOST LIKELY cause of Shelby’s illness? Selected Answer: b. RSV bronchiolitis • Question 64 1 out of 1 points The diet of a 3-year-old with cystic fibrosis should be supplemented with which of the following? Selected Answer: d. Vitamin D • Question 65 1 out of 1 points Which of the following vaccines provides protection against a common type of sepsis/meningitis? Selected Answer: b. Haemophius influenzae vaccine • Question 66 1 out of 1 points You are seeing a patient you think may have IBD. Which of the following tests would not be helpful? Selected Answer: b. Amylase and lipase • Question 67 1 out of 1 points Sarah, age 13, is markedly obese and has a poor self-image. How do you differentiate between compulsive eating and bulemia? Selected Answer: a. A compulsive eater does not induce vomiting. • Question 68 1 out of 1 points Which of the following is not associated with congenital adrenal hyperplasia? Selected Answer: c. Hypernatremia • Question 69 1 out of 1 points Which of the following is not a sign or symptom of congenital hypothyroidism? Selected Answer: a. Frequent stooling • Question 70 1 out of 1 points A 2-year-old girl has increased work of breathing. Her father notes she had cough and subjective fever over the past 3 days. She has been complaining that her “belly hurts” and has experienced one episode of post-tussive emesis but no diarrhea. Her immunizations are current, and she is otherwise healthy. Her temperature is 102°F. She is somnolent but easily aroused. Respirations are 28 breaths/min, and her examination is remarkable for decreased breath sounds at the left base posteriorly with prominent crackles. Which of the following acute interventions is the LEAST likely to assist in the diagnosis? Selected Answer: a. Sputum culture • Question 71 1 out of 1 points During a track and field meet, a 16-year-old male pole-vaulter falls to the ground screaming in pain. He complains of intense pain in his right scrotum. He vomits twice while waiting for the ambulance. He most likely has Selected Answer: b. Testicular torsion • Question 72 0 out of 1 points A 5-year-old girl is somewhat short and has mild leg bowing. Her medical history is significant only for well-controlled seizure disorder. Serum calcium, phosphorus, and alkaline phosphatase levels and urinary amino acid concentration are normal. A bone age is notable for abnormal distal radius and ulna mineralization. Which of the following is the most likely diagnosis? Selected Answer: b. Genetic primary hypophosphatemia • Question 73 1 out of 1 points Screening infants for anemia should occur at what age? Selected Answer: a. 9 months • Question 74 1 out of 1 points When Jason, age 12, slid into homeplate while playing baseball, he injured his ankle. You are trying to differentiate between a strain and a sprain. You know that a sprain Selected Answer: c. Is an injury to the ligaments that attach to the bones in a joint. • Question 75 1 out of 1 points Which of the following is not found in an adolescent with untreated Graves' disease? Selected Answer: c. Tendency to gain weight easily • Question 76 1 out of 1 points A 10-year-old male presents with a fever of 102ºF and complaints of leg pains. His mother reports that he had an upper respiratory infecion with a sore throat about 2 weeks ago. No treatment was needed. On examination, he has tender and swollen knees bilaterally. His heart rate is 125 bpm and a blowing systolic murmur is heard at the apex. No murmur was noted at in the chart. The mostly diagnosis is: Selected Answer: a. Rheumatic fever • Question 77 1 out of 1 points The most common congenital heart defect in children as Selected Answer: c. Ventricular septal defect • Question 78 1 out of 1 points You are on call and receive a phone call from the parents of a 13-year-old known asthmatic. She has been having chest tightness and a worsening cough for 48 hours. She has significant nasal discharge that began 14 days ago and intermittent complaint of headache. She is now running a low-grade fever. Her peak flow the last 48 hours is 70–80% of personal best. Her temperature right now is 101.7°F. She is on salmeterol with corticosteroid (Advair) and PRN albuterol. Which of the following is most appropriate? Selected c. Answer: See her in the office in the morning and prescribe a 14-day course of amoxicillin plus the addition of a short course of oral steroids. • Question 79 1 out of 1 points You see a 7-year-old with a positive stool culture for Salmonella enteriditis. The appropriate therapy for a non-dehydrated child is Selected Answer: d. Bland diet with focus on maintaining hydration • Question 80 1 out of 1 points Chest pain in young children is usually Selected Answer: b. Noncardiac in origin • Question 81 1 out of 1 points During the 2-year-old well-child visit, the child's mother shows you a picture from the birthday party. You notice only one eye has a red reflex on the picture. When you do the exam, in the right eye, you notice leukocoria. What is your diagnosis? Selected Answer: c. Retinoblastoma • Question 82 1 out of 1 points A 6-week-old boy, born by vaginal delivery after an uncomplicated term gestation, has experienced cough and “fast breathing” for 2 days. His mother relates that he has a 1-week history of nasal congestion and watery eye discharge, but no fever or change in appetite. He has a temperature of 99.4°F and a respiratory rate of 44 breaths/min. He has nasal congestion, clear rhinorrhea, erythematous conjunctivae bilaterally, and watery, right eye discharge. His lungs demonstrate scattered crackles without wheezes. Which of the following is the most likely pathogen? Selected Answer: e. Chlamydia trachomatis • Question 83 1 out of 1 points The most common central nervous system side effect of mumps in children is Selected Answer: a. Ataxia • Question 84 1 out of 1 points Which malignancy is associated with genitourinary anomalies? Selected Answer: a. Wilms' tumor • Question 85 0 out of 1 points In evaluating Tommy, a child with bloody diarrhea, which of the following would not be an appropriate first action? Selected Answer: d. Check growth chart • Question 86 1 out of 1 points When a neonate is initially protected against measles, mumps, and rubella because the mother is immune, this is an example of which type of immunity? Selected Answer: d. Natural passive Question 87 1 out of 1 points An 11-year-old has been diagnosed with mild intermittent asthma. Which of the following is not a routine part of the clinical management? Selected c. Answer: School excuse to not participate in recess and/or physical education activities • Question 88 1 out of 1 points Anthony is a known asthmatic. He has symptoms three times a week but never more than once a day. Exacerbations affect his normal activities occasionally. He awakens with cough three to four times a month. You classify his asthma as Selected Answer: c. Mild persistent • Question 89 1 out of 1 points Hypercholesterolemia in children older than 2 is defined as a total cholesterol at or above Selected Answer: d. 200 mg/dL Question 90 0 out of 1 points A 2-year-old presents with a history of wheezing and persistent cough. The father reports the child had a coughing/choking episode about a week ago that was spontaneously resolved. A few days later she began to cough and wheeze. This scenario is most consistent with Selected Answer: b. Bronchiolitis • Question 91 1 out of 1 points Robert, your 15-year-old male patient, is here today for a well visit. He is tall in stature and has increased arm span, laxity of joints, pectus excavatum, and an abnormal echocardiogram. Which of the following diagnosis would you suspect Robert as having? Selected Answer: c. Marfan syndrome • Question 92 1 out of 1 points The most common trigger for an acute asthma episode in the very young child is Selected Answer: c. Respiratory infections Question 93 1 out of 1 points All of the following is treatment for a child with phimosis except Selected Answer: a. Ice packs • Question 94 1 out of 1 points An adolescent who has tall stature, increased arm span, laxity of joints, pectus excavatum, and abnormal echocardiogram woudl be expected to have Selected Answer: a. Marfan syndrome • Question 95 1 out of 1 points Seborrhea dermatitis is common for both infants and adolescents. Which is not correct for this condition? Selected b. Answer: The condition in adolescents is known as acne with comedones and popular and pustular lesions. • Question 96 1 out of 1 points Vomiting in infancy has a long list of differential diagnoses. Which of the following other symptoms would mostly likely point to pyloric stenosis? Selected Answer: b. Sausage-shaped mass in abdomen • Question 97 1 out of 1 points A previously healthy male has a 3-month history of increasing headaches, blurred vision, and personality changes. Previously he admitted to marijuana experimentation more than 1 year ago. On examination he is a healthy, athleticappearing 17-year-old with decreased extraocular range of motion and left eye visual acuity. Which of the following is the best next step in his management? Selected Answer: a. Neuroimaging • Question 98 1 out of 1 points Which of the following conditions is most responsible for developmental delays in children? Selected Answer: a. Fetal Alcohol Syndrome • Question 99 1 out of 1 points The following clinical description best matches which genetic disorder? A 15-year-old girl with primary amenorrhea is noted to be well below the 5th percentile for height. She has hypertension, a low posterior hairline, prominent and low-set ears, and excessive nuchal skin. Selected Answer: d. Turner syndrome (XO) • Question 100 1 out of 1 points An adolescent female presents with a 2-day history of increasing lower abdominal pain. She has mild vomiting and anorexia and fevers to 101F. She is unable to defecate but has an urge to do so. CBC reveals a slightly elevated WBC of 14,000, but is otherwise normal. Serum electrolytes are normal. The next step is Selected Answer: b. Refer to surgery for evaluation for appendicitis. • Question 101 1 out of 1 points A 7-year-old presents with abrupt fever, stridor, drooling, and hyperextension of the neck. You examine the nose and throat and notice one tonsil is enlarged and there is marked erythema of the pharynx with uvular deviation. Which is most appropriate? Selected a. Answer: Refer to otolaryngology for management of a peritonsillar abscess and possible hospital admission Friday, May 8, 2020 3:48:09 AM EDT Question 1 1 out of 1 points A small-for-gestational-age, dysmorphic newborn infant has microcephaly and sloping forehead, cutis aplasia (missing portion of the skin and hair) of the scalp, polydactyly, microphthalmia, and omphalocele. Which of these is the most likely diagnosis? Selected Answer: a. Patau syndrome (trisomy 13) • Question 2 • 1 out of 1 points A 16-year-old girl has enuresis, frequent urination, a white vaginal discharge, and a dark rash around her neck. Her serum glucose level is 250 mg/dL, and her urinalysis is positive for 2+ glucose but is otherwise negative. Which of the following is the most likely diagnosis? Selected Answer: c. Type II diabetes • Question 3 • 1 out of 1 points Mark, age 15, is 5 feet tall andn weighs 85 pounds. You suspect anorexia and know that the best initial approach is to Selected Answer: d. Confront Mark with the fact that you suspect an eating disorder. • Question 4 • 1 out of 1 points Which of the following is not a sign or symptom of congenital hypothyroidism? Selected Answer: d. Frequent stooling • Question 5 • 0 out of 1 points While doing a 5-year-old well child exam, you notice two small patches of hair loss. Broken hair is present, as is erythema and scaling. On the basis of this information, which of these is the likely diagnosis? Selected Answer: c. Alopecia areata • Question 6 • 1 out of 1 points Hope is a 7-month-old who presents in January with a 1-day history of cough, yellow nasal discharge, and low-grade temp (T max 100°F). She was previously healthy. She does have 2+ edema of the nasal turbinates and cloudy rhinorrhea. She is afebrile in the office. Her chest, mouth, and ears are clear. You prescribe: Selected Answer: d. Saline drops, bulb suction, humidified air, and increased PO fluids • Question 7 • 1 out of 1 points The parents of an 8-year-old Down Syndrome boy arrive for his annual well-child visit. He wants to participate in sports, including the Special Olympics. Until further examination can be completed, which of the following sports would you suggest as being safe? Selected Answer: a. Tennis • Question 8 • 1 out of 1 points Jason, age 14, appears with tender discoid breast tissue enlargement (2-3 cm in diameter) beneath the areola. Your next action would be to Selected Answer: a. Perform watchful waiting for 1 year. • Question 9 • 1 out of 1 points You see a 7-year-old boy a day after he was bitten by his pet dog. According to the mother, the dog bit the child after he snuck up on the dog and grabbed his tail. The dog has had all its vaccinations, including rabies. The child has had no fever, has full movement of the injured limb, and has no sign of neurologic or vascular injury. The wound is on the child’s forearm, is not deep, and is not bleeding, but has developed about 2 cm of erythema surrounding the site. Which of the following is the most appropriate treatment? Selected Answer: c. Oral amoxicillin-clavulanate for 7-14 days • Question 10 • 1 out of 1 points A head injury in which bruising or tearing of the cerebral structures occurs is a Selected Answer: d. Contusion • Question 11 • 1 out of 1 points A 14-year-old has a 3-week history of fever, anorexia, and abdominal pain. What additional symptom would cause the NP to suspect Crohn's disease? Selected Answer: b. Blood, mucous diarrhea • Question 12 • 1 out of 1 points Which of the following should be done annually after 1 year of age in a child with Down syndrome? Selected Answer: a. Thyroid screenings • Question 13 • 1 out of 1 points A previously healthy male has a 3-month history of increasing headaches, blurred vision, and personality changes. Previously he admitted to marijuana experimentation more than 1 year ago. On examination he is a healthy, athletic-appearing 17-year-old with decreased extraocular range of motion and left eye visual acuity. Which of the following is the best next step in his management? Selected Answer: c. Neuroimaging • Question 14 • 1 out of 1 points Kelly, your 11-year-old well visit patient, presents to the office with weight loss, polyuria, and polydipsia. Which of the following do you need to rule out? Selected Answer: d. Diabetes mellitus • Question 15 • 1 out of 1 points A 3-week old presents to the office in January with a 1-week history of nasal congestion and occastional cough. On the night prior to the visit in infant developed a fever 102ºF rectally, was difficult to breastfeed, and had paroxysmal coughing and noisy, labored breathing. On exam, you note an ill-appearing infant who is lethergic with wheezing, tachypnea, and intercostal retractions. The infant is home with the mom at this time; however, has a sibling who is 4-years-old and is in daycare and recently had cold symptoms. If the patient has been diagnosed with RSV bronchiolitis, which of the following would be the treatment of choice? Selected Answer: a. Fluids and nutritional support and close monitoring • Question 16 • 1 out of 1 points Chest pain in young children is usually Selected Answer: a. Noncardiac in origin • Question 17 • 1 out of 1 points Maddie, age 2, had a complete blood count (CBC) drawn at her last visit. It indicates that she has a microcytic hypochromic anemia. What should you do now at this visit? Selected Answer: a. Obtain a lead level. • Question 18 • 1 out of 1 points Most children with Duchenne muscular dystrophy become wheelchair dependent by what age? Selected Answer: b. 4 to 6 years of age • Question 19 • 1 out of 1 points The following clinical description best matches which genetic disorder? A tall, thin 14-yearold boy has no signs of puberty. He was delayed in his speech development and always has done less well in school than his siblings. He is shy, and teachers report his activity is immature. Physical examination reveals breast development, and long limbs with a decreased upper segment/lower segment ration. He has small testes and phallus. Selected Answer: e. Klinefelter syndrome (XXY) • Question 20 • 1 out of 1 points Of the following patients, which child should not receive a tuberculin skin test? Selected d. Answer: A 2-year-old who was infected with RSV 2 months ago and is currently asymptomatic. • Question 21 • 1 out of 1 points A 10-year-old male presents with a fever of 102ºF and complaints of leg pains. His mother reports that he had an upper respiratory infecion with a sore throat about 2 weeks ago. No treatment was needed. On examination, he has tender and swollen knees bilaterally. His heart rate is 125 bpm and a blowing systolic murmur is heard at the apex. No murmur was noted at in the chart. The mostly diagnosis is: Selected Answer: a. Rheumatic fever • Question 22 • 1 out of 1 points When a neonate is initially protected against measles, mumps, and rubella because the mother is immune, this is an example of which type of immunity? Selected Answer: b. Natural passive • Question 23 • 1 out of 1 points Sarah, age 13, is markedly obese and has a poor self-image. How do you differentiate between compulsive eating and bulemia? Selected Answer: a. A compulsive eater does not induce vomiting. • Question 24 • 1 out of 1 points Seborrhea dermatitis is common for both infants and adolescents. Which is not correct for this condition? Selected b. Answer: The condition in adolescents is known as acne with comedones and popular and pustular lesions. • Question 25 • 1 out of 1 points Which chromosomal abnormality is associated with short stature in girls? Selected Answer: b. Turner syndrome • Question 26 • 1 out of 1 points You see a patient you believe has folliculitis. What medication would be the best to treat this patient? The patient has no allergies. Selected Answer: c. Dicloxacillin • Question 27 • 1 out of 1 points Antibiotic therapy is one of the mainstays of treatment for which of the following causes of wheezing? Selected Answer: b. Epiglottitis • Question 28 • 1 out of 1 points Which of the following symptoms are most suggestive of pneumonia in a young child? Selected Answer: a. Fever, tachypnea, coryza, cough, scattered rales • Question 29 • 1 out of 1 points An 11-year-old has been diagnosed with mild intermittent asthma. Which of the following is not a routine part of the clinical management? Selected a. Answer: School excuse to not participate in recess and/or physical education activities • Question 30 • 0 out of 1 points Generalized absence seizures usually occur in which age group? Selected Answer: a. Middle-aged adults • Question 31 • 1 out of 1 points Which test is routinely recommended for a preparticipation sports physical? Selected Answer: c. A Snellen test • Question 32 • 0 out of 1 points A healthy, thriving 4-year-old male has had sudden episodes of drawing his knees to his chest and crying like he is in acute pain for the last 5 hours. These episodes are separated by quiet times when he appears normal and comfortable. He is not vomiting and has not had a bowel movement today. What is the most likely diagnosis. Selected Answer: d. Hirschprung disease • Question 33 • 1 out of 1 points A 15-day-old infant has respiratory distress. A quick observation suggests she has slight cyanosis, hepatosplenomegaly, and features consistent with Down Syndrome. The cardiac examination demonstrates a loud first heart sound, a low-pitched, mid-diastolic murmur at the lower left sternal border, and a harsh apical holosystolic murmur in the mitral area. Which of the following cardiac conditions most likely explains her heart findings? Selected Answer: b. Complete atrioventricular canal (endocardial cushion defect) • Question 34 • 0 out of 1 points An ex-preemie with bronchopulmonary dysplasia has been discharged to home from the NICU. One potential problem area that requires close monitoring is Selected Answer: a. Temperature control. • Question 35 • 1 out of 1 points A 16-year-old presents with pharyngitis, cough, and high fever. Her chest x-ray reveals bilateral pulmonary infiltrates. Her white blood cell count is normal and the neutrophil count is normal. The most likely etiology is Selected Answer: b. Chlamydia pneumonia • Question 36 • 1 out of 1 points Which of the following vaccines provides protection against a common type of sepsis/meningitis? Selected Answer: b. Haemophius influenzae vaccine • Question 37 • 1 out of 1 points A mother brings a 2-year-old to your office with the complaint that she passes 5 to 10 watery stools per day that often contain undigested food. The child appears healthy and has no other GI symptoms. She is acting, eating, and voiding normally. Weight gain is normal and the mother states she often drinks (her favorite drink is Kool-Aid) instead of eating. The best management for Selected Answer: c. Counsel to decrease fluid intake, increase dietary fiber, and increase fats to 40% of calories. this condition is: • Question 38 • 1 out of 1 points Six months after being diagnosed with what appears to be insulin-dependent diabetes, the 5-yearold in the case presentation has a significant decrease in his insulin requirement. Which of the following is the most likely explanation? Selected Answer: b. He has entered the "honeymoon phase" of his diabetes. • Question 39 • 1 out of 1 points Grace, age 15, has been diagnosed with acne. Which of the following is not true with this condition? Selected Answer: a. Poor hygiene is the primary cause of acne. • Question 40 • 1 out of 1 points All of the following is treatment for a child with phimosis except Selected Answer: a. Ice packs • Question 41 • 1 out of 1 points Primary dysmenorrhea is due to Selected Answer: b. Elevated prostaglandin level • Question 42 • 1 out of 1 points Children in child care facilities are at greater risk of being exposed to which of the following infections? Selected Answer: d. HAV • Question 43 • 1 out of 1 points A 14-month-old child has lower extremity bowing, a waddling gait, genu varum, and is at the 5th percentile for height. Laboratory data include low-normal serum calcium, moderately low serum phosphate, and elevated serum alkaline phosphatase levels, hyperphosphaturia, and normal parathyroid levels. Which of the following is the most likely diagnosis? Selected Answer: a. Genetic primary hypophosphatemia • Question 44 • 1 out of 1 points A child has developed her second perirectal abscess in 6 months. She should be evaluated for which of the following conditions? Selected Answer: d. Crohn's disease • Question 45 • 1 out of 1 points The classic radiographic finding of croup is Selected Answer: b. Steeple sign • Question 46 • 1 out of 1 points What is the primary treatment for testicular torsion? Selected Answer: a. Immediate surgical referral • Question 47 • 1 out of 1 points You see a 7-year-old with a positive stool culture for Salmonella enteriditis. The appropriate therapy for a non-dehydrated child is Selected Answer: d. Bland diet with focus on maintaining hydration • Question 48 • 1 out of 1 points Riley, a 12-year-old girl, has scaly, hyperpigmented lesions in a "Christmas tree" distribution. It is predominantly on her trunk. One lesion is on her buttock that is larger than the other, at about 4 cm in diameter. What is your diagnosis? Selected Answer: a. Pityriasis rosea • Question 49 • 1 out of 1 points You are on call and receive a phone call from the parents of a 13-year-old known asthmatic. She has been having chest tightness and a worsening cough for 48 hours. She has significant nasal discharge that began 14 days ago and intermittent complaint of headache. She is now running a low-grade fever. Her peak flow the last 48 hours is 70–80% of personal best. Her temperature right now is 101.7°F. She is on salmeterol with corticosteroid (Advair) and PRN albuterol. Which of the following is most appropriate? Selected d. Answer: See her in the office in the morning and prescribe a 14-day course of amoxicillin plus the addition of a short course of oral steroids. • Question 50 • 1 out of 1 points Which of the following therapeutic options is common for the treatment of both bee stings and bite wounds? Selected Answer: b. Tetanus vaccination • Question 51 • 1 out of 1 points A common presenting symptom of inflammatory bowel disease is Selected Answer: d. Unexplained fever • Question 52 • 1 out of 1 points Newborn R.T. has a vascular lesion that will not fade as she gets older. What is your diagnosis? Selected Answer: a. Port-wine stain (nervus flammeus) • Question 53 • 0 out of 1 points Ana is a 14-year-old female and has not yet started her menstrual cycle. The history is noncontributory and the physical is normal. Mom started her menstrual cycle at 14-years of age. Ana's breast development and pubic hair began about a year ago. Mom is very concerned. The most appropriate initial step would be to Selected Answer: a. Do a pregnancy test • Question 54 • 1 out of 1 points The diet of a 3-year-old with cystic fibrosis should be supplemented with which of the following? Selected Answer: e. Vitamin D • Question 55 • 1 out of 1 points Which of the following objective data are associated with significantly better long-term outcomes in children born with open spina bifida? Selected Answer: c. Perineal sensation • Question 56 • 1 out of 1 points Individuals with chronic adrenal insufficiency often have Selected Answer: b. A craving for salt • Question 57 • 1 out of 1 points A healthy 8-month-old infant presents with diarrhea but no dehydration. What is the best advice to give to the parents? Selected Answer: b. Give bananas, cereal, vegetables, and full-strength formula as tolerated. • Question 58 • 1 out of 1 points An essential test in the evaluation of a 2-year-old being managed for Kawasaki disease is Selected Answer: b. an echocardiogram • Question 59 • 1 out of 1 points In mild to moderate attacks of acute asthma, Albuterol should be given every 4-6 hours prn and routine medication should be Selected Answer: c. Continued as usual • Question 60 • 1 out of 1 points Which fo the following foods would be most appropriate for a child with celiac disease? Selected Answer: a. Rice with butter • Question 61 • 1 out of 1 points John is 4 years old and in today for a well child visit. He is due for his 4-year-old immunizations. He was recently diagnosed with ALL and is being treated with chemotherapy and radiation. Which statement is true about immunizations during treatments during childhood cancer? Selected Answer: d. Immunizations are not given during active chemotherapy. • Question 62 • 1 out of 1 points The most useful test for evaluation of suspected acute rheumatic fever is Selected Answer: c. Antistreptolysin-O (ASO) titer • Question 63 • 1 out of 1 points A 15-year-old girl has a 1-month history of urinary frequency without dysuria and recent onset of an itchy rash beneath both breasts. She has been gaining weight over the past year and regularly complains of fatigue. She is afebrile, with a weight greater than the 99th percentile and has an erythematous, macular rash beneath both breasts characterized by satellite lesions. Urinalysis is significant for 2+ glucosuria but no pyuria. Which of the following is the most likely diagnosis? Selected Answer: a. Diabetes mellitus • Question 64 • 1 out of 1 points Tommy has bloody diarrhea. His family eats fast-food four to five times each week. Which organism may have caused the diarrhea? Selected Answer: a. E. Coli • Question 65 • 1 out of 1 points A 6-year-old male is brought in for evaluation of a painful hip. He has been limping and not wanting to walk for the past 2 days. He has no obvious injury. He feels a little better if he is given ibuprofen. He has not had a fever and does not have any other current symptoms, although he had "the flu" last week. On examination, his vital signs are normal. His right hip has some pain with internal rotation. He walks with a pronounced limp. Which of the following statements is most accurate? Selected Answer: a. He should have a complete blood count (CBC) and ESR. • Question 66 • 1 out of 1 points Which of the following conditions is most responsible for developmental delays in children? Selected Answer: c. Fetal Alcohol Syndrome • Question 67 • 1 out of 1 points Which of the following is not a feature of DiGeorge syndrome? Selected Answer: c. Frontal bossing • Question 68 • 1 out of 1 points The peak incidence for adolescent gynecomastia occurs at age Selected Answer: a. 13 to 14 years of age • Question 69 • 1 out of 1 points The most common trigger for an acute asthma episode in the very young child is Selected Answer: d. Respiratory infections • Question 70 • 1 out of 1 points The following clinical description best matches which genetic disorder? A 15-year-old girl with primary amenorrhea is noted to be well below the 5th percentile for height. She has hypertension, a low posterior hairline, prominent and low-set ears, and excessive nuchal skin. Selected Answer: e. Turner syndrome (XO) • Question 71 • 1 out of 1 points Kawasaki disease is most common in Selected Answer: c. Children younger than 5 years of age • Question 72 • 1 out of 1 points What does a low level of thyroid stimulating hormone (TSH) indicate? Selected Answer: a. Hyperthyroidism • Question 73 • 1 out of 1 points John, age 12, injured his spinal cord by diving into a shallow lake. He is in a wheelchair but can selftransfer. He can use his shoulder and extend his wrist, but has no finger control. At what level of the spinal cord was the damage? Selected Answer: a. C6 • Question 74 • 1 out of 1 points Drew is a 6-month-old with newly diagnosed sickle cell disease. His mother brings him to the office for a well-baby visit. Which of the following should you do on this visit? Selected a. Answer: Immunize Drew with diphtheria, tetanus, and pertussis: Haemophilus influenzae type B (HIB), hepatitis B (HBV), and polio vaccines. • Question 75 • 1 out of 1 points The most common central nervous system side effect of mumps in children is Selected Answer: c. Ataxia • Question 76 • 1 out of 1 points Whitney is a 2-year-old female with dysuria. She has a fever of 102.4 and is nontoxic. She has no prior history of UTI. Urine dipstick reveals 1+ leukocyte esterase, 2+ nitrates, 1+ non-hemolyzed blood, pH of 6.0, and specific gravity 1.025. Her vulvovaginal area is slightly red with no discharge. Which of the following treatments is recommended. Selected a. Answer: Start sulfamethoxazole/trimethoprim (Bactrim) for 10 days and send culture and sensitivity • Question 77 • 1 out of 1 points One of the most appropriate agents used to treat influenza A is Selected Answer: d. Oseltamivir • Question 78 • 1 out of 1 points Robert, your 15-year-old male patient, is here today for a well visit. He is tall in stature and has increased arm span, laxity of joints, pectus excavatum, and an abnormal echocardiogram. Which of the following diagnosis would you suspect Robert as having? Selected Answer: b. Marfan syndrome • Question 79 • 0 out of 1 points A 7-week-old male with three episodes of severe abdominal pain and vomiting in the last month, previously diagnosed with failure to thrive. Which of the following is the most likely etiology? Selected Answer: b. Volvulus • Question 80 • 1 out of 1 points Which of the following is a characteristic physical sign of fragile X syndrome in adolescent males? Selected Answer: c. Macro-orchidism • Question 81 • 0 out of 1 points A small-for-gestational-age infant is born to a 35-year-old woman. He has low-set and malformed ears, microcephaly, rocker-bottom feet, inguinal hernias, cleft lip/palate, and micrognathia. Chromosomal analysis is likely to reveal which of the following? Selected Answer: d. Patau syndrome (trisomy 13) • Question 82 • 0 out of 1 points Sam is a healthy 17-year-old student. He is thinking about having sex and asks for more information about condoms. You give him all of the following information except Selected Answer: a. It is only safe to use water-based lubricant with latex condoms. • Question 83 • 1 out of 1 points During the 2-year-old well-child visit, the child's mother shows you a picture from the birthday party. You notice only one eye has a red reflex on the picture. When you do the exam, in the right eye, you notice leukocoria. What is your diagnosis? Selected Answer: c. Retinoblastoma • Question 84 • 0 out of 1 points Which of the following is true regarding the diagnosis of epiglottitis? Selected Answer: d. Diagnosis is decreasing in incidence. • Question 85 • 1 out of 1 points Dave, age 17, has gynecomastia. You should also assess him for Selected Answer: b. Testicular cancer • Question 86 • 0 out of 1 points In children who have not received antibiotics in the past month, which antibiotic is recommended by the Centers for Disease Control and Prevention for the management of acute bacterial respiratory infection? Selected Answer: d. Amoxicillin plus clavulanic acid (Augmentin) • Question 87 • 1 out of 1 points A 6-week-old boy, born by vaginal delivery after an uncomplicated term gestation, has experienced cough and “fast breathing” for 2 days. His mother relates that he has a 1-week history of nasal congestion and watery eye discharge, but no fever or change in appetite. He has a temperature of 99.4°F and a respiratory rate of 44 breaths/min. He has nasal congestion, clear rhinorrhea, erythematous conjunctivae bilaterally, and watery, right eye discharge. His lungs demonstrate scattered crackles without wheezes. Which of the following is the most likely pathogen? Selected Answer: a. Chlamydia trachomatis • Question 88 • 1 out of 1 points Screening infants for anemia should occur at what age? Selected Answer: a. 9 months • Question 89 • 0 out of 1 points Tracy, the mother of a 2-year-old, is concerned because her daughter walks on her toes all the time. What do you tell her? Selected Answer: a. Don't worry, she will outgrow it. • Question 90 • 1 out of 1 points Pinworms can cause which of the following? Selected Answer: b. Anal itching • Question 91 • 1 out of 1 points Which of the following is important to determine in the recent history of a child with suspected Clostridium difficile infection? Selected Answer: d. Antibiotic use • Question 92 • 1 out of 1 points The following clinical description best matches which genetic disorder? An institutionalized male juvenile delinquent upon close examination has severe nodulocystic acne, mild pectus excavatum, large teeth, prominent glabella, and relatively long face and fingers. His family says he has poor fine motor skills (such as penmanship), an explosive temper, and a lownormal IQ. Selected Answer: d. XYY male • Question 93 • 0 out of 1 points You are seeing a patient you think may have IBD. Which of the following tests would not be helpful? Selected Answer: c. Serum total protein and albumin • Question 94 • 1 out of 1 points What does shift to the left mean in a white blood count? Selected Answer: c. A rise in neutrophils • Question 95 • 1 out of 1 points A 6-year-old boy is left alone for 10 hours, now with hematemesis and pneumomediastinum on chest x-ray. Which of the following is the most likely etiology? Selected Answer: a. Esophageal foreign body • Question 96 • 1 out of 1 points During a track and field meet, a 16-year-old male pole-vaulter falls to the ground screaming in pain. He complains of intense pain in his right scrotum. He vomits twice while waiting for the ambulance. He most likely has Selected Answer: d. Testicular torsion • Question 97 • 1 out of 1 points A 12-year-old girl was brought to the emergency department because of severe sore throat, muffled voice, drooling, and fatigue. She had been sick for the past 3 days and is unable to eat because of painful swallowing. The parents deny any history of recurrent pharyngitis. The patient still managed to open her mouth and you were able to see an abscess at the upper pole of the right tonsil with deviation of the uvula toward the midline. Examination of the neck reveals enlarged and tender lymph nodes. Which of the following is the most appropriate management? Selected Answer: d. Incision and drainage of the abscess • Question 98 • 1 out of 1 points Prophylactic penicillin should be started in children with sickle cell anemia by Selected Answer: d. 2 to 3 months of age • Question 99 • 1 out of 1 points An 18-month-old African American girl is brought to your office because she has been crying and stopped walking today. She will crawl, however. Her mom denies any injury to the child. On examination, she is crying but consolable in her mother’s arms. She has bruising and swelling just proximal to the left ankle. An x-ray reveals a spiral fracture of the tibia. At this time, you advise the mother that: Selected Answer: c. This is a common fracture resulting from twisting on a planted foot. • Question 100 • 1 out of 1 points Mrs. Bay is upset. She is convinced something is seriously wrong with her son. He is a 2-month-old and frequently vomits after feeding. Which of the following is most suggestive of GERD (gastroesophageal reflux disease)? Selected Answer: a. He drinks 7 to 8 ounces every 3 hours. • Question 101 • 0 out of 0 points When completing this quiz, did you comply with Walden University’s Code of Conduct including the expectations for academic integrity? Selected Answer: Yes Friday, May 8, 2020 12:41:41 AM EDT Question 1 1 out of 1 points An 11-year-old has been diagnosed with mild intermittent asthma. Which of the following is not a routine part of the clinical management? Selected Answer: c. School excuse to not participate in recess and/or physical education activities Question 2 1 out of 1 points A 14-year-old has a 3-week history of fever, anorexia, and abdominal pain. What additional symptom would cause the NP to suspect Crohn's disease? Selected Answer: b. Blood, mucous diarrhea Question 3 1 out of 1 points A 9-year-old is diagnosed with dyspepsia without hematemesis, melena, or occult blood. The most appropriate next step is Selected Answer: a. Trial of ranitidine (Zantac) Question 4 1 out of 1 points Jesse, age 5, has a diagnosis of encopresis. After the diagnosis, what would be your next action? Selected Answer: a. Rule out a neurologic disorder. Question 5 0 out of 1 points A 15-year-old girl has experienced abdominal pain, vomiting, and lethargy for 3 days. Her chest and throat examinations are clear, but her abdominal examination is significant for right lower quadrant pain. Rectal examination is equivocal for pain, and her pelvic examination is remarkable for pain upon movement of her cervix. Laboratory data include elevated white blood cell count, serum glucose level of 145 mg/dL, and serum bicarbonate level of 21mEq/dL. Her urinalysis is remarkable for 1+ white blood cells, 1+ glucose, and 1+ ketones. Which of the following is the most likely diagnosis? Selected Answer: a. Appendicitis Question 6 0 out of 1 points A previously healthy male has a 3-month history of increasing headaches, blurred vision, and personality changes. Previously he admitted to marijuana experimentation more than 1 year ago. On examination he is a healthy, athletic-appearing 17-year-old with decreased extraocular range of motion and left eye visual acuity. Which of the following is the best next step in his management? Selected Answer: e. Urine drug screen Question 7 1 out of 1 points Kelly, your 11-year-old well visit patient, presents to the office with weight loss, polyuria, and polydipsia. Which of the following do you need to rule out? Selected Answer: c. Diabetes mellitus Question 8 0 out of 1 points Lisa has Cushing's syndrome. You would suspect her to have or to develop Selected Answer: d. Generalized increased pigmentations of the skin Question 9 1 out of 1 points Tracy, the mother of a 2-year-old, is concerned because her daughter walks on her toes all the time. What do you tell her? Selected Answer: b. Toe walking is considered normal until age 3. Question 10 1 out of 1 points The peak incidence for adolescent gynecomastia occurs at age Selected Answer: d. 13 to 14 years of age Question 11 0 out of 1 points A 12-year-old girl was brought to the emergency department because of severe sore throat, muffled voice, drooling, and fatigue. She had been sick for the past 3 days and is unable to eat because of painful swallowing. The parents deny any history of recurrent pharyngitis. The patient still managed to open her mouth and you were able to see an abscess at the upper pole of the right tonsil with deviation of the uvula toward the midline. Examination of the neck reveals enlarged and tender lymph nodes. Which of the following is the most appropriate management? Selected Answer: d. Nebulized racemic epinephrine Question 12 1 out of 1 points Newborn R.T. has a vascular lesion that will not fade as she gets older. What is your diagnosis? Selected Answer: a. Port-wine stain (nervus flammeus) Question 13 0 out of 1 points A 16-year-old presents with pharyngitis, cough, and high fever. Her chest x-ray reveals bilateral pulmonary infiltrates. Her white blood cell count is normal and the neutrophil count is normal. The most likely etiology is Selected Answer: a. Streptococcus pneumonia Question 14 1 out of 1 points A common cause of in-toeing in childhood is Selected Answer: c. Internal tibial torsion Question 15 1 out of 1 points A 2-year-old presents to your office with the following symptoms: nasal congestion and rhinorrhea for 48 hours, low-grade fever, and a harsh/barky cough that is significantly worse at night. Inspiratory stridor is present and she has clear but slightly decreased breath sounds. Which of the following treatments is best? Selected Answer: b. One dose of oral dexamethasone Question 16 1 out of 1 points All of the following is treatment for a child with phimosis except Selected Answer: a. Ice packs Question 17 1 out of 1 points Which of the following is not a feature of DiGeorge syndrome? Selected Answer: b. Frontal bossing Question 18 1 out of 1 points A small-for-gestational-age, dysmorphic newborn infant has microcephaly and sloping forehead, cutis aplasia (missing portion of the skin and hair) of the scalp, polydactyly, microphthalmia, and omphalocele. Which of these is the most likely diagnosis? Selected Answer: e. Patau syndrome (trisomy 13) Question 19 1 out of 1 points Which of the following physical stigmata are common in newborns with Down syndrome? Selected Answer: b. Hypotonia, large-appearing tongue and small mouth, upward slant to eyes Question 20 1 out of 1 points Which of the following is not associated with congenital adrenal hyperplasia? Selected Answer: d. Hypernatremia Question 21 0 out of 1 points Ana is a 14-year-old female and has not yet started her menstrual cycle. The history is noncontributory and the physical is normal. Mom started her menstrual cycle at 14-years of age. Ana's breast development and pubic hair began about a year ago. Mom is very concerned. The most appropriate initial step would be to Selected Answer: b. Do a pregnancy test Question 22 1 out of 1 points An 8-month-old baby arrives to the office with his mother with a complaint of decreased left arm movement. He is a product of a normal term pregnancy, has had no medical problems, and was in good health when his mother dropped him off at the daycare center. Upper arm radiographs show a left humerus spiral fracture. Which of the following is the most appropriate next step in management? Selected Answer: e. Send the child to the hospital for admission and call child protective services. Question 23 0 out of 1 points An ex-preemie with bronchopulmonary dysplasia has been discharged to home from the NICU. One potential problem area that requires close monitoring is Selected Answer: d. Temperature control. Question 24 0 out of 1 points The most common central nervous system side effect of mumps in children is Selected Answer: b. Decreased hearing Question 25 1 out of 1 points A 3-year-old presents with macrocephaly, developmental delay, coarse facial features, large tounge, kyphosis, hip dislocation, tonsillar and adenoidal hypertrophy, and hepatomegaly. She is receiving early intervention services without improvement. What is the best next step? Selected Answer: b. Refer to genetics for further evaluations Question 26 0 out of 1 points Which test is routinely recommended for a preparticipation sports physical? Selected Answer: c. An electrocardiogram Question 27 1 out of 1 points A 6-year-old male is brought in for evaluation of a painful hip. He has been limping and not wanting to walk for the past 2 days. He has no obvious injury. He feels a little better if he is given ibuprofen. He has not had a fever and does not have any other current symptoms, although he had "the flu" last week. On examination, his vital signs are normal. His right hip has some pain with internal rotation. He walks with a pronounced limp. Which of the following statements is most accurate? Selected Answer: a. He should have a complete blood count (CBC) and ESR. Question 28 0 out of 1 points Which of the following is true regarding the diagnosis of epiglottitis? Selected Answer: d. Radiologic finding of "steeple sign" Question 29 1 out of 1 points Which of the following is not characteristic of an apparent life-threatening event (ALTE)? Selected Answer: b. Fever Question 30 1 out of 1 points Lyme disease is most closely associated with which of the following skin lesions? Selected Answer: d. Erythema migrans Question 31 1 out of 1 points A head injury in which bruising or tearing of the cerebral structures occurs is a Selected Answer: a. Contusion Question 32 1 out of 1 points Which of the following vaccines provides protection against a common type of sepsis/meningitis? Selected Answer: a. Haemophius influe