Pediatric FNP Fitzgerald Exam
Questions With All Solved Solutions
2025\2026 Updated.
110. Which of the following is the most prudent first-line treatment choice for an otherwise well
toddler without known allergies who now has AOM and requires antimicrobial therapy?
A. oral cefdinir
B. oral amoxicillin
C. oral cefuroxime
D. oral azithromycin - Answer 110. Correct: B. oral amoxicillin
When antimicrobial therapy is deemed necessary for AOM, an agent with activity against S
pneumoniae is needed. According to guidelines, first-line therapy would include oral amoxicillin
(B) or oral amoxicillin-clavulanate. Incorrect: The macrolides such as azithromycin are not
recommended for AOM due to elevated rates of resistance by S pneumoniae (D).
Cephalosporins such as cefuroxime (C) or cefdinir (A) can be considered in children with a
penicillin allergy and who would not be able to take amoxicillin.
111. Most AOM is caused by:
A. certain gram-positive and gram-negative bacteria and select respiratory viruses.
B. atypical bacteria and pathogenic fungi.
C. rhinovirus and methicillin-resistant Staphylococcus aureus (MRSA).
D. predominately beta-lactamase-producing organisms. - Answer 111. Correct: A. certain
gram-positive and gram-negative bacteria and select respiratory viruses.
The most common pathogens that cause AOM include the gram-positive S pneumoniae as well
as gramnegative pathogens H influenzae and M catarrhalis (A). Certain respiratory viruses, such
as RSV, human rhinovirus, and coronavirus, can also be involved. Incorrect: Atypical pathogens,
such as M pneumoniae and C pneumoniae, and fungi are rarely implicated in AOM and are
more likely to be found in lower respiratory tract infections such as pneumonia (B). Though
rhinovirus has been implicated in AOM, the presence of MRSA is not a common finding (C).
Though H influenza and M catarrhalis commonly produce beta-lactamase, the predominant
pathogen is S pneumoniae (D).
112. The incidence of AOM in children has decreased in the past decade in part because of:
,D. lower rates of viral infections. - Answer 112. Correct: C. an increase in select vaccination
use.
As a greater number of children are receiving the pneumococcal and Hib vaccines, this has
brought down the incidence of AOM over the years (C). Incorrect: Earlier detection and
treatment of AOM will not affect the incidence of the disease (A) and neither will the availability
of more effective treatment options (B). There has been no indication of lower rates of viral
infections associated with AOM (D).
113. Which of the following represents the best choice of clinical agents for a child with AOM
who has had a history of penicillin allergy, with parental report of a flat, pink, slightly itchy rash
without difficulty breathing during the reaction, who requires antimicrobial therapy?
A. oral azithromycin
B. oral cefdinir
C. oral amoxicillin
D. oral trimethoprim-sulfamethoxazole (TMP-SMX) - Answer 113. Correct: B. oral cefdinir
When antimicrobial therapy is deemed necessary for the treatment of AOM in a child with
penicillin allergy,
114. Which of the following does not represent a risk factor for recurrent AOM in younger
children?
A. pacifier use after age 10 months
B. history of first episode of AOM before age 3 months
C. exposure to secondhand smoke
D. beta-lactam allergy - Answer 114. Correct: D. beta-lactam allergy
AOM is one of the most common diagnoses in young children, and about one-third will have
three or more episodes by the age of 2 years. Certain risk factors for recurrent AOM have been
identified, though betalactam allergy, where a systemic allergic reaction is noted with the use of
cephalosporins and/or penicillins, is not among them (D). Incorrect: Risk factors for recurrent
AOM in young children include exposure to secondhand smoke (C), feeding in a supine position,
pacifier use beyond 10 months of age (A), and history of a first AOM episode before 3 months of
age (B).
115. The main risk factor for AOM in infants is:
, Knowledge of the pathophysiology of disease is critical in ensuring proper management of the
disease and recognition of risk factors. Conditions that cause eustachian tube dysfunction or
eustachian tube obstruction will block secretions and allow aspiration of pathogens into the
middle ear, causing AOM (B). Incorrect: Cigarette smoke exposure is a risk factor for AOM but is
not as strong a risk factor as eustachian tube dysfunction (C). A dairy allergy (A) or the use of
soybased infant formula (D) are not risk factors for AOM. However, bottle-fed babies tend to be
at higher risk compared to breastfed babies.
116. In the treatment of AOM in the child, which of the following antimicrobial agents affords
the most effective activity against S pneumoniae?
A. oral nitrofurantoin
B. oral clarithromycin
C. oral TMP-SMX
D. oral cefuroxime - Answer 116. Correct: D. oral cefuroxime
Cefuroxime is a second-generation cephalosporin that has activity against S pneumoniae and is
recommended for the treatment of AOM in children with a penicillin allergy (D). Incorrect:
Nitrofurantoin (A) and TMP-SMX (C) exhibit activity against gram-negative pathogens and are
generally used in the treatment of UTIs, as they are effective against E coli. Though the
macrolides do have activity against gram-positive bacteria, they are not recommended
treatment options for AOM due to elevated rates of resistance by S pneumoniae against these
agents (B).
117. A 3-year-old boy with AOM continues to have otalgia and fever (39°C and greater [102.2°F
and greater]) after 3 days of amoxicillin 80 mg/kg/day. Which of the following is recommended?
A. switch to high-dose oral ampicillin
B. start antimicrobial therapy with oral azithromycin
C. initiate therapy with oral clindamycin
D. administer intramuscular (IM) ceftriaxone - Answer 117. Correct: D. administer
intramuscular (IM) ceftriaxone
In cases when there is an inadequate response to oral amoxicillin treatment after 48 to 72
hours, treatment should be switched to either oral amoxicillin-clavulanate or IM ceftriaxone for
3 days (D). Incorrect: For an infection that is resistant to amoxicillin, it will be very likely that
cross-resistance to ampicillin will occur, and so ampicillin would not be useful for this infection
(A). Azithromycin (B) and clindamycin (C) are not recommended agents for the treatment of
AOM, either as first-line or with treatment failure.
Questions With All Solved Solutions
2025\2026 Updated.
110. Which of the following is the most prudent first-line treatment choice for an otherwise well
toddler without known allergies who now has AOM and requires antimicrobial therapy?
A. oral cefdinir
B. oral amoxicillin
C. oral cefuroxime
D. oral azithromycin - Answer 110. Correct: B. oral amoxicillin
When antimicrobial therapy is deemed necessary for AOM, an agent with activity against S
pneumoniae is needed. According to guidelines, first-line therapy would include oral amoxicillin
(B) or oral amoxicillin-clavulanate. Incorrect: The macrolides such as azithromycin are not
recommended for AOM due to elevated rates of resistance by S pneumoniae (D).
Cephalosporins such as cefuroxime (C) or cefdinir (A) can be considered in children with a
penicillin allergy and who would not be able to take amoxicillin.
111. Most AOM is caused by:
A. certain gram-positive and gram-negative bacteria and select respiratory viruses.
B. atypical bacteria and pathogenic fungi.
C. rhinovirus and methicillin-resistant Staphylococcus aureus (MRSA).
D. predominately beta-lactamase-producing organisms. - Answer 111. Correct: A. certain
gram-positive and gram-negative bacteria and select respiratory viruses.
The most common pathogens that cause AOM include the gram-positive S pneumoniae as well
as gramnegative pathogens H influenzae and M catarrhalis (A). Certain respiratory viruses, such
as RSV, human rhinovirus, and coronavirus, can also be involved. Incorrect: Atypical pathogens,
such as M pneumoniae and C pneumoniae, and fungi are rarely implicated in AOM and are
more likely to be found in lower respiratory tract infections such as pneumonia (B). Though
rhinovirus has been implicated in AOM, the presence of MRSA is not a common finding (C).
Though H influenza and M catarrhalis commonly produce beta-lactamase, the predominant
pathogen is S pneumoniae (D).
112. The incidence of AOM in children has decreased in the past decade in part because of:
,D. lower rates of viral infections. - Answer 112. Correct: C. an increase in select vaccination
use.
As a greater number of children are receiving the pneumococcal and Hib vaccines, this has
brought down the incidence of AOM over the years (C). Incorrect: Earlier detection and
treatment of AOM will not affect the incidence of the disease (A) and neither will the availability
of more effective treatment options (B). There has been no indication of lower rates of viral
infections associated with AOM (D).
113. Which of the following represents the best choice of clinical agents for a child with AOM
who has had a history of penicillin allergy, with parental report of a flat, pink, slightly itchy rash
without difficulty breathing during the reaction, who requires antimicrobial therapy?
A. oral azithromycin
B. oral cefdinir
C. oral amoxicillin
D. oral trimethoprim-sulfamethoxazole (TMP-SMX) - Answer 113. Correct: B. oral cefdinir
When antimicrobial therapy is deemed necessary for the treatment of AOM in a child with
penicillin allergy,
114. Which of the following does not represent a risk factor for recurrent AOM in younger
children?
A. pacifier use after age 10 months
B. history of first episode of AOM before age 3 months
C. exposure to secondhand smoke
D. beta-lactam allergy - Answer 114. Correct: D. beta-lactam allergy
AOM is one of the most common diagnoses in young children, and about one-third will have
three or more episodes by the age of 2 years. Certain risk factors for recurrent AOM have been
identified, though betalactam allergy, where a systemic allergic reaction is noted with the use of
cephalosporins and/or penicillins, is not among them (D). Incorrect: Risk factors for recurrent
AOM in young children include exposure to secondhand smoke (C), feeding in a supine position,
pacifier use beyond 10 months of age (A), and history of a first AOM episode before 3 months of
age (B).
115. The main risk factor for AOM in infants is:
, Knowledge of the pathophysiology of disease is critical in ensuring proper management of the
disease and recognition of risk factors. Conditions that cause eustachian tube dysfunction or
eustachian tube obstruction will block secretions and allow aspiration of pathogens into the
middle ear, causing AOM (B). Incorrect: Cigarette smoke exposure is a risk factor for AOM but is
not as strong a risk factor as eustachian tube dysfunction (C). A dairy allergy (A) or the use of
soybased infant formula (D) are not risk factors for AOM. However, bottle-fed babies tend to be
at higher risk compared to breastfed babies.
116. In the treatment of AOM in the child, which of the following antimicrobial agents affords
the most effective activity against S pneumoniae?
A. oral nitrofurantoin
B. oral clarithromycin
C. oral TMP-SMX
D. oral cefuroxime - Answer 116. Correct: D. oral cefuroxime
Cefuroxime is a second-generation cephalosporin that has activity against S pneumoniae and is
recommended for the treatment of AOM in children with a penicillin allergy (D). Incorrect:
Nitrofurantoin (A) and TMP-SMX (C) exhibit activity against gram-negative pathogens and are
generally used in the treatment of UTIs, as they are effective against E coli. Though the
macrolides do have activity against gram-positive bacteria, they are not recommended
treatment options for AOM due to elevated rates of resistance by S pneumoniae against these
agents (B).
117. A 3-year-old boy with AOM continues to have otalgia and fever (39°C and greater [102.2°F
and greater]) after 3 days of amoxicillin 80 mg/kg/day. Which of the following is recommended?
A. switch to high-dose oral ampicillin
B. start antimicrobial therapy with oral azithromycin
C. initiate therapy with oral clindamycin
D. administer intramuscular (IM) ceftriaxone - Answer 117. Correct: D. administer
intramuscular (IM) ceftriaxone
In cases when there is an inadequate response to oral amoxicillin treatment after 48 to 72
hours, treatment should be switched to either oral amoxicillin-clavulanate or IM ceftriaxone for
3 days (D). Incorrect: For an infection that is resistant to amoxicillin, it will be very likely that
cross-resistance to ampicillin will occur, and so ampicillin would not be useful for this infection
(A). Azithromycin (B) and clindamycin (C) are not recommended agents for the treatment of
AOM, either as first-line or with treatment failure.
