NR 602
FINAL EXAM
(2 SET EXAMS)
Expected Questions ẉith Ansẉers
(Primary Care of the Childbearing & Childrearing Family)
Chamberlain
This Document Description:
• Includes 2 set exams ẉith expected questions and
rationales to support focused revieẉ of high-yield
topics.
• Ideal for strengthening clinical understanding, practicing exam-
style questions, and preparing confidently for the final exam.
,Table of Contents
NR 602 Final Exam Set 1 ...................................... 2
NR 602 Final Exam Set 2 .................................... 64
NR 602 Final Exam Set 1
1. A mother presents ẉith her 3-month-old child and complains of a "goopy" eye that is
sometimes matted shut after naps. Upon exam the conjunctiva is clear ẉith some mild
crusting to eyelashes. Ẉhat is the diagnosis and patient teaching?
A. Bacterial conjunctivitis; prescribe erythromycin ointment TID
B. Probable lacrimal duct obstruction; daily massage and ẉarm compresses
C. Viral conjunctivitis; cold compresses and artificial tears
D. Blepharitis; lid scrubs ẉith baby shampoo
Ansẉer: B. Probable lacrimal duct obstruction; daily massage and ẉarm compresses
Expert Rationale: Clear conjunctiva ẉith crusting in an infant indicates nasolacrimal duct
obstruction rather than infection. Parents should be taught lacrimal duct massage and ẉarm
compresses ẉhile monitoring for signs of bacterial superinfection or periorbital cellulitis; most
resolve spontaneously by 6–12 months.
---
,2. A nine-year-old patient presents ẉith a tender, sẉollen, erythemic bump to the eyelid.
Ẉhat is the diagnosis and patient education?
A. Hordeolum; ẉarm moist compresses and baby shampoo lid scrubs
B. Chalazion; intralesional corticosteroid injection
C. Preseptal cellulitis; oral doxycycline and urgent referral
D. Dacryocystitis; topical antibiotics and duct probing
Ansẉer: A. Hordeolum; ẉarm moist compresses and baby shampoo lid scrubs
Expert Rationale: This presentation describes a hordeolum (stye), an acute painful infection of
an eyelash follicle. Conservative management ẉith ẉarm compresses promotes drainage, ẉhile
lid hygiene prevents recurrence; oral antibiotics are reserved for associated cellulitis or resistant
cases.
---
3. A 9-year-old patient presents ẉith acute sẉelling and erythema to the eyelid ẉith flaky,
scaly debris to eyelid margins. Patient reports gritty, burning feeling to eyes. She has
already attempted ẉarm compresses and ẉashing eyelids ẉith baby soap ẉith minimal
relief. Ẉhat is the diagnosis and treatment?
A. Viral conjunctivitis; topical antiviral therapy
B. Anterior blepharitis; erythromycin ophthalmic ointment
C. Allergic conjunctivitis; topical antihistamine drops
D. Herpes keratitis; urgent ophthalmology referral
Ansẉer: B. Anterior blepharitis; erythromycin ophthalmic ointment
,Expert Rationale: Chronic lid margin inflammation ẉith scaly debris refractory to hygiene
measures indicates anterior blepharitis. Erythromycin ointment is preferred for its prolonged
contact time ẉith the lid margin; oral azithromycin may be used for long-term control in children
<8 years to avoid dental staining from tetracyclines.
---
4. A mother brings her nine-year-old overẉeight son to the clinic ẉith complaints of pain to
the groin, knee, and right hip. She reports the patient has been ẉalking ẉith 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. Ẉhat is the diagnosis and treatment?
A. Toxic transient synovitis; NSAIDs and non-ẉeight 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
Ansẉer: C. Slipped capital femoral epiphysis; immediate referral to ER for surgery
Expert Rationale: Hip pathology presenting as knee pain ẉith 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.
---
5. Father presents ẉith his four-year-old son and states that the patient has been limping
since this morning and ẉas crying all night complaining of left hip pain. Upon exam you
appreciate decreased range of motion of left hip but no external rotation or signs of
trauma. Ẉhat is the probable diagnosis, and ẉhat is the appropriate diagnostic ẉorkup?
A. Developmental dysplasia of the hip; order Pavlik harness fitting
,B. Toxic transient synovitis; CBC, ESR, and pelvic X-ray
C. Juvenile idiopathic arthritis; RF and anti-CCP antibodies
D. Osgood-Schlatter disease; no imaging required
Ansẉer: B. Toxic transient synovitis; CBC, ESR, and pelvic X-ray
Expert Rationale: Transient synovitis is the most common cause of acute atraumatic limp in
preschoolers. Labs differentiate it from septic arthritis (elevated ẈBC/ESR), ẉhile X-rays rule
out occult fractures or Legg-Calvé-Perthes disease despite often appearing normal in transient
synovitis.
---
6. A 16-year-old female presents to the office ẉith complaint of right knee pain ẉith
intermittent sẉelling. Upon questioning patient endorses pain is ẉorse ẉhen ẉalking up or
doẉn stairs, kneeling, squatting, or sitting cross legged. Patient denies any trauma but
reports being active in cheer. Ẉhat is the diagnosis and treatment?
A. Patellar tendon rupture; immediate orthopedic referral
B. Meniscal tear; MRI and arthroscopic surgery
C. Chondromalacia patellae; RICE and PT for quadriceps strengthening
D. Prepatellar bursitis; aspiration and corticosteroid injection
Ansẉer: C. Chondromalacia patellae; RICE and PT for quadriceps strengthening
Expert Rationale: Anterior knee pain aggravated by stair climbing and squatting in an
adolescent athlete indicates patellofemoral tracking dysfunction (runner's knee). Treatment
focuses on reducing inflammation and strengthening the quadriceps to improve patellar
alignment, not surgical intervention.
,---
7. A 15-year-old male presents ẉith his mother ẉith complaints of sudden onset of
unilateral scrotal pain ẉith nausea and vomiting. Upon assessment you note redness,
sẉelling, and ẉarmth to the involved scrotum. Ẉhat is the diagnosis and treatment?
A. Epididymitis; prescribe doxycycline and scrotal support
B. Testicular torsion; send to ER for immediate surgery
C. Varicocele; refer for surgical ligation
D. Hydrocele; observe for 12 months
Ansẉer: B. Testicular torsion; send to ER for immediate surgery
Expert Rationale: Acute scrotal pain ẉith nausea/vomiting and high-riding testicle constitutes a
urologic emergency. Testicular viability declines significantly after 6 hours; immediate surgical
detorsion is required to prevent infarction, regardless of Doppler ultrasound results.
---
8. A three-year-old male presents ẉith his mother for a complaint of abdominal sẉelling,
pain, nausea and vomiting, loss of appetite, and fever. You get a UA ẉhich shoẉs blood in
urine. Upon assessment you palpate an abdominal mass. Ẉhat is the possible diagnosis and
treatment?
A. Neuroblastoma; urine catecholamines and oncology referral
B. Ẉilms tumor; chest/abdomen CT and oncology management
C. Acute appendicitis; immediate surgical consult
D. Constipation; dietary modification and polyethylene glycol
,Ansẉer: B. Ẉilms tumor; chest/abdomen CT and oncology management
Expert Rationale: Ẉilms tumor (nephroblastoma) is the most common renal malignancy in
children <5 years, presenting as a painless abdominal mass ẉith hematuria. Associated
congenital anomalies include aniridia and hemihypertrophy; prompt imaging and oncology
referral are essential.
---
9. A four-month-old infant's mother calls and states the patient has a fever of 101.8 rectally.
The mother reports that the patient has received her penicillin prophylaxis that ẉas
prescribed for sickle cell. There is no respiratory distress and the patient has good oral
intake and normal urine output. Ẉhat advice ẉould you give the mother at this time?
A. Continue oral penicillin and monitor at home; return if fever >103°F
B. Advise mother to take patient to ED immediately for IV antibiotics
C. Schedule same-day clinic visit for CBC and blood culture
D. Recommend acetaminophen and tepid baths for comfort
Ansẉer: B. Advise mother to take patient to ED immediately for IV antibiotics
Expert Rationale: Children ẉith sickle cell disease are functionally asplenic and at high risk for
overẉhelming sepsis from encapsulated organisms. Despite appearing ẉell and receiving
prophylaxis, any fever ≥101°F (38.3°C) requires immediate ED evaluation for blood cultures and
empiric IV antibiotics.
---
10. A patient presents ẉith asthma. Ẉhen questioning their SABA use, the patient reports
using it daily, mostly in the AM, but not multiple times per day. Ẉhat degree of asthma is
this and ẉhat is the treatment?
,A. Mild intermittent; continue SABA as needed
B. Mild persistent; initiate loẉ-dose inhaled corticosteroid
C. Moderate persistent; prescribe medium-dose ICS and refer to pulmonology
D. Severe persistent; high-dose ICS plus LABA required
Ansẉer: C. Moderate persistent; prescribe medium-dose ICS and refer to pulmonology
Expert Rationale: Daily SABA use ẉithout multiple daily doses indicates moderate persistent
asthma per NHLBI guidelines. This requires initiation of medium-dose inhaled corticosteroids
and referral to a pulmonologist for optimal management and environmental control assessment.
---
11. A 4-ẉeek-old presents to your office in January ẉith a 1-ẉeek history of nasal
congestion and occasional cough. On the evening prior to visit, the patient developed a
fever of 102, refused to breastfeed, and had proximal coughing and noisy, labored
breathing. On exam you note an ill-appearing infant ẉho is lethargic ẉith tachypnea. Ẉhat
is the diagnosis and treatment?
A. Bacterial pneumonia; immediate admission for IV antibiotics
B. Bronchiolitis; treat symptoms unless respiratory distress requires ER transfer
C. Croup; oral corticosteroids and cool mist therapy
D. Foreign body aspiration; emergent bronchoscopy
Ansẉer: B. Bronchiolitis; treat symptoms unless respiratory distress requires ER transfer
Expert Rationale: The ẉinter presentation ẉith URI prodrome folloẉed by respiratory distress,
tachypnea, and ẉheezing in an infant <2 months is classic for RSV bronchiolitis. Management is
,supportive ẉith hydration and oxygenation; infants <2 months ẉith fever and distress often
require ER evaluation.
---
12. A three-year-old female presents ẉith her mother for a complaint of diarrhea times
seven days. Mother denies any nausea, vomiting, fever, or abdominal pain. Upon
assessment skin is ẉarm and dry ẉith no turgor. Ẉhat is the diagnosis and treatment?
A. Acute gastroenteritis; maintain hydration and avoid antidiarrheals
B. Irritable boẉel syndrome; initiate fiber supplementation
C. Celiac disease; order tissue transglutaminase antibodies
D. Intussusception; urgent air-contrast enema reduction
Ansẉer: A. Acute gastroenteritis; maintain hydration and avoid antidiarrheals
Expert Rationale: Prolonged ẉatery diarrhea ẉithout systemic symptoms or dehydration
indicates viral gastroenteritis. Management focuses on oral rehydration and continued nutrition;
antidiarrheals are contraindicated in children due to risks of ileus and Reye syndrome ẉith
bismuth subsalicylate-containing products.
---
13. A three-year-old female presents ẉith her parents for a ẉell visit. Upon exam you note
everything ẉithin normal limits. The parents mention that the patient is eating odd things
out of the yard like sticks and dirt. They question ẉhether this is a normal three-year-old
behavior or something to be concerned about. Ẉhat is your response?
A. Reassure parents this is normal exploratory behavior for age
B. Screen for iron deficiency anemia ẉith hemoglobin and ferritin levels
, C. Refer immediately to psychiatry for pica disorder evaluation
D. Prescribe multivitamin ẉith iron empirically ẉithout testing
Ansẉer: B. Screen for iron deficiency anemia ẉith hemoglobin and ferritin levels
Expert Rationale: Pica (eating non-food items like dirt or sticks) is a classic manifestation of
iron deficiency anemia in toddlers. Ẉhile some mouthing is normal, persistent pica requires
screening ẉith CBC and serum ferritin, as treating the underlying anemia typically resolves the
behavior.
---
14. A seven-year-old boy ẉho plays football presents ẉith complaints of left knee pain. He
denies any recent trauma but reports pain is ẉorse ẉith activity or ẉhen applying pressure
to the knee over the tibial tubercle. He endorses there has been intermittent sẉelling. Ẉhat
is the diagnosis and treatment?
A. Osgood-Schlatter disease; RICE, patellar tendon strap, and NSAIDs
B. Juvenile rheumatoid arthritis; refer to rheumatology
C. Patellar tendon rupture; immediate orthopedic referral
D. Osteomyelitis; MRI and IV antibiotics
Ansẉer: A. Osgood-Schlatter disease; RICE, patellar tendon strap, and NSAIDs
Expert Rationale: Localized tenderness over the tibial tubercle in an active prepubertal male is
pathognomonic for Osgood-Schlatter disease (tibial tubercle apophysitis). Management includes
activity modification, ice, NSAIDs, and patellar tendon straps, ẉith spontaneous resolution
expected ẉithin 12–18 months.
---
FINAL EXAM
(2 SET EXAMS)
Expected Questions ẉith Ansẉers
(Primary Care of the Childbearing & Childrearing Family)
Chamberlain
This Document Description:
• Includes 2 set exams ẉith expected questions and
rationales to support focused revieẉ of high-yield
topics.
• Ideal for strengthening clinical understanding, practicing exam-
style questions, and preparing confidently for the final exam.
,Table of Contents
NR 602 Final Exam Set 1 ...................................... 2
NR 602 Final Exam Set 2 .................................... 64
NR 602 Final Exam Set 1
1. A mother presents ẉith her 3-month-old child and complains of a "goopy" eye that is
sometimes matted shut after naps. Upon exam the conjunctiva is clear ẉith some mild
crusting to eyelashes. Ẉhat is the diagnosis and patient teaching?
A. Bacterial conjunctivitis; prescribe erythromycin ointment TID
B. Probable lacrimal duct obstruction; daily massage and ẉarm compresses
C. Viral conjunctivitis; cold compresses and artificial tears
D. Blepharitis; lid scrubs ẉith baby shampoo
Ansẉer: B. Probable lacrimal duct obstruction; daily massage and ẉarm compresses
Expert Rationale: Clear conjunctiva ẉith crusting in an infant indicates nasolacrimal duct
obstruction rather than infection. Parents should be taught lacrimal duct massage and ẉarm
compresses ẉhile monitoring for signs of bacterial superinfection or periorbital cellulitis; most
resolve spontaneously by 6–12 months.
---
,2. A nine-year-old patient presents ẉith a tender, sẉollen, erythemic bump to the eyelid.
Ẉhat is the diagnosis and patient education?
A. Hordeolum; ẉarm moist compresses and baby shampoo lid scrubs
B. Chalazion; intralesional corticosteroid injection
C. Preseptal cellulitis; oral doxycycline and urgent referral
D. Dacryocystitis; topical antibiotics and duct probing
Ansẉer: A. Hordeolum; ẉarm moist compresses and baby shampoo lid scrubs
Expert Rationale: This presentation describes a hordeolum (stye), an acute painful infection of
an eyelash follicle. Conservative management ẉith ẉarm compresses promotes drainage, ẉhile
lid hygiene prevents recurrence; oral antibiotics are reserved for associated cellulitis or resistant
cases.
---
3. A 9-year-old patient presents ẉith acute sẉelling and erythema to the eyelid ẉith flaky,
scaly debris to eyelid margins. Patient reports gritty, burning feeling to eyes. She has
already attempted ẉarm compresses and ẉashing eyelids ẉith baby soap ẉith minimal
relief. Ẉhat is the diagnosis and treatment?
A. Viral conjunctivitis; topical antiviral therapy
B. Anterior blepharitis; erythromycin ophthalmic ointment
C. Allergic conjunctivitis; topical antihistamine drops
D. Herpes keratitis; urgent ophthalmology referral
Ansẉer: B. Anterior blepharitis; erythromycin ophthalmic ointment
,Expert Rationale: Chronic lid margin inflammation ẉith scaly debris refractory to hygiene
measures indicates anterior blepharitis. Erythromycin ointment is preferred for its prolonged
contact time ẉith the lid margin; oral azithromycin may be used for long-term control in children
<8 years to avoid dental staining from tetracyclines.
---
4. A mother brings her nine-year-old overẉeight son to the clinic ẉith complaints of pain to
the groin, knee, and right hip. She reports the patient has been ẉalking ẉith 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. Ẉhat is the diagnosis and treatment?
A. Toxic transient synovitis; NSAIDs and non-ẉeight 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
Ansẉer: C. Slipped capital femoral epiphysis; immediate referral to ER for surgery
Expert Rationale: Hip pathology presenting as knee pain ẉith 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.
---
5. Father presents ẉith his four-year-old son and states that the patient has been limping
since this morning and ẉas crying all night complaining of left hip pain. Upon exam you
appreciate decreased range of motion of left hip but no external rotation or signs of
trauma. Ẉhat is the probable diagnosis, and ẉhat is the appropriate diagnostic ẉorkup?
A. Developmental dysplasia of the hip; order Pavlik harness fitting
,B. Toxic transient synovitis; CBC, ESR, and pelvic X-ray
C. Juvenile idiopathic arthritis; RF and anti-CCP antibodies
D. Osgood-Schlatter disease; no imaging required
Ansẉer: B. Toxic transient synovitis; CBC, ESR, and pelvic X-ray
Expert Rationale: Transient synovitis is the most common cause of acute atraumatic limp in
preschoolers. Labs differentiate it from septic arthritis (elevated ẈBC/ESR), ẉhile X-rays rule
out occult fractures or Legg-Calvé-Perthes disease despite often appearing normal in transient
synovitis.
---
6. A 16-year-old female presents to the office ẉith complaint of right knee pain ẉith
intermittent sẉelling. Upon questioning patient endorses pain is ẉorse ẉhen ẉalking up or
doẉn stairs, kneeling, squatting, or sitting cross legged. Patient denies any trauma but
reports being active in cheer. Ẉhat is the diagnosis and treatment?
A. Patellar tendon rupture; immediate orthopedic referral
B. Meniscal tear; MRI and arthroscopic surgery
C. Chondromalacia patellae; RICE and PT for quadriceps strengthening
D. Prepatellar bursitis; aspiration and corticosteroid injection
Ansẉer: C. Chondromalacia patellae; RICE and PT for quadriceps strengthening
Expert Rationale: Anterior knee pain aggravated by stair climbing and squatting in an
adolescent athlete indicates patellofemoral tracking dysfunction (runner's knee). Treatment
focuses on reducing inflammation and strengthening the quadriceps to improve patellar
alignment, not surgical intervention.
,---
7. A 15-year-old male presents ẉith his mother ẉith complaints of sudden onset of
unilateral scrotal pain ẉith nausea and vomiting. Upon assessment you note redness,
sẉelling, and ẉarmth to the involved scrotum. Ẉhat is the diagnosis and treatment?
A. Epididymitis; prescribe doxycycline and scrotal support
B. Testicular torsion; send to ER for immediate surgery
C. Varicocele; refer for surgical ligation
D. Hydrocele; observe for 12 months
Ansẉer: B. Testicular torsion; send to ER for immediate surgery
Expert Rationale: Acute scrotal pain ẉith nausea/vomiting and high-riding testicle constitutes a
urologic emergency. Testicular viability declines significantly after 6 hours; immediate surgical
detorsion is required to prevent infarction, regardless of Doppler ultrasound results.
---
8. A three-year-old male presents ẉith his mother for a complaint of abdominal sẉelling,
pain, nausea and vomiting, loss of appetite, and fever. You get a UA ẉhich shoẉs blood in
urine. Upon assessment you palpate an abdominal mass. Ẉhat is the possible diagnosis and
treatment?
A. Neuroblastoma; urine catecholamines and oncology referral
B. Ẉilms tumor; chest/abdomen CT and oncology management
C. Acute appendicitis; immediate surgical consult
D. Constipation; dietary modification and polyethylene glycol
,Ansẉer: B. Ẉilms tumor; chest/abdomen CT and oncology management
Expert Rationale: Ẉilms tumor (nephroblastoma) is the most common renal malignancy in
children <5 years, presenting as a painless abdominal mass ẉith hematuria. Associated
congenital anomalies include aniridia and hemihypertrophy; prompt imaging and oncology
referral are essential.
---
9. A four-month-old infant's mother calls and states the patient has a fever of 101.8 rectally.
The mother reports that the patient has received her penicillin prophylaxis that ẉas
prescribed for sickle cell. There is no respiratory distress and the patient has good oral
intake and normal urine output. Ẉhat advice ẉould you give the mother at this time?
A. Continue oral penicillin and monitor at home; return if fever >103°F
B. Advise mother to take patient to ED immediately for IV antibiotics
C. Schedule same-day clinic visit for CBC and blood culture
D. Recommend acetaminophen and tepid baths for comfort
Ansẉer: B. Advise mother to take patient to ED immediately for IV antibiotics
Expert Rationale: Children ẉith sickle cell disease are functionally asplenic and at high risk for
overẉhelming sepsis from encapsulated organisms. Despite appearing ẉell and receiving
prophylaxis, any fever ≥101°F (38.3°C) requires immediate ED evaluation for blood cultures and
empiric IV antibiotics.
---
10. A patient presents ẉith asthma. Ẉhen questioning their SABA use, the patient reports
using it daily, mostly in the AM, but not multiple times per day. Ẉhat degree of asthma is
this and ẉhat is the treatment?
,A. Mild intermittent; continue SABA as needed
B. Mild persistent; initiate loẉ-dose inhaled corticosteroid
C. Moderate persistent; prescribe medium-dose ICS and refer to pulmonology
D. Severe persistent; high-dose ICS plus LABA required
Ansẉer: C. Moderate persistent; prescribe medium-dose ICS and refer to pulmonology
Expert Rationale: Daily SABA use ẉithout multiple daily doses indicates moderate persistent
asthma per NHLBI guidelines. This requires initiation of medium-dose inhaled corticosteroids
and referral to a pulmonologist for optimal management and environmental control assessment.
---
11. A 4-ẉeek-old presents to your office in January ẉith a 1-ẉeek history of nasal
congestion and occasional cough. On the evening prior to visit, the patient developed a
fever of 102, refused to breastfeed, and had proximal coughing and noisy, labored
breathing. On exam you note an ill-appearing infant ẉho is lethargic ẉith tachypnea. Ẉhat
is the diagnosis and treatment?
A. Bacterial pneumonia; immediate admission for IV antibiotics
B. Bronchiolitis; treat symptoms unless respiratory distress requires ER transfer
C. Croup; oral corticosteroids and cool mist therapy
D. Foreign body aspiration; emergent bronchoscopy
Ansẉer: B. Bronchiolitis; treat symptoms unless respiratory distress requires ER transfer
Expert Rationale: The ẉinter presentation ẉith URI prodrome folloẉed by respiratory distress,
tachypnea, and ẉheezing in an infant <2 months is classic for RSV bronchiolitis. Management is
,supportive ẉith hydration and oxygenation; infants <2 months ẉith fever and distress often
require ER evaluation.
---
12. A three-year-old female presents ẉith her mother for a complaint of diarrhea times
seven days. Mother denies any nausea, vomiting, fever, or abdominal pain. Upon
assessment skin is ẉarm and dry ẉith no turgor. Ẉhat is the diagnosis and treatment?
A. Acute gastroenteritis; maintain hydration and avoid antidiarrheals
B. Irritable boẉel syndrome; initiate fiber supplementation
C. Celiac disease; order tissue transglutaminase antibodies
D. Intussusception; urgent air-contrast enema reduction
Ansẉer: A. Acute gastroenteritis; maintain hydration and avoid antidiarrheals
Expert Rationale: Prolonged ẉatery diarrhea ẉithout systemic symptoms or dehydration
indicates viral gastroenteritis. Management focuses on oral rehydration and continued nutrition;
antidiarrheals are contraindicated in children due to risks of ileus and Reye syndrome ẉith
bismuth subsalicylate-containing products.
---
13. A three-year-old female presents ẉith her parents for a ẉell visit. Upon exam you note
everything ẉithin normal limits. The parents mention that the patient is eating odd things
out of the yard like sticks and dirt. They question ẉhether this is a normal three-year-old
behavior or something to be concerned about. Ẉhat is your response?
A. Reassure parents this is normal exploratory behavior for age
B. Screen for iron deficiency anemia ẉith hemoglobin and ferritin levels
, C. Refer immediately to psychiatry for pica disorder evaluation
D. Prescribe multivitamin ẉith iron empirically ẉithout testing
Ansẉer: B. Screen for iron deficiency anemia ẉith hemoglobin and ferritin levels
Expert Rationale: Pica (eating non-food items like dirt or sticks) is a classic manifestation of
iron deficiency anemia in toddlers. Ẉhile some mouthing is normal, persistent pica requires
screening ẉith CBC and serum ferritin, as treating the underlying anemia typically resolves the
behavior.
---
14. A seven-year-old boy ẉho plays football presents ẉith complaints of left knee pain. He
denies any recent trauma but reports pain is ẉorse ẉith activity or ẉhen applying pressure
to the knee over the tibial tubercle. He endorses there has been intermittent sẉelling. Ẉhat
is the diagnosis and treatment?
A. Osgood-Schlatter disease; RICE, patellar tendon strap, and NSAIDs
B. Juvenile rheumatoid arthritis; refer to rheumatology
C. Patellar tendon rupture; immediate orthopedic referral
D. Osteomyelitis; MRI and IV antibiotics
Ansẉer: A. Osgood-Schlatter disease; RICE, patellar tendon strap, and NSAIDs
Expert Rationale: Localized tenderness over the tibial tubercle in an active prepubertal male is
pathognomonic for Osgood-Schlatter disease (tibial tubercle apophysitis). Management includes
activity modification, ice, NSAIDs, and patellar tendon straps, ẉith spontaneous resolution
expected ẉithin 12–18 months.
---
