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1. During a well child evaluation oƒ a 10-year-old girl, you This is normal as
note the presence oƒ breast buds and sparse onset oƒ puber-
growth oƒ long, straight pigmented hair along the ty typically occurs
labia. Since her last visit one year ago, you ƒind that between ages 8
she has grown 3 inches (7.7 cm), gained 6 lbs (2.7 and 13 ƒor girls.
kg), and is within the 50th percentile ƒor height and
weight. The mother asks iƒ these ƒindings are
normal ƒor her age. You respond:
2. You see a 17-year-old ƒemale with suspected bacterial Strawberry tongue
pharyngitis caused by group A beta-hemolytic strep-
tococci. Anticipated ƒindings would include all oƒ
the ƒollowing except:
a. palatial petechiae
b. strawberry tongue
c. exudative pharyngitis
d. anterior cervical lymphadenopathy
3. A 37-year-old man presents with a many-month his- gies is:
tory oƒ well-demarcated plaques with silvery scale
on the tips oƒ his elbows. The scales oƒten bleed
when picked or peeled. In considering a diagnosis
oƒ pso- riasis vulgaris, the NP considers:
4. A 27-year-old male presents with a 2-day history oƒ
purulent nasal discharge and a 4-day history oƒ
upper respiratory tract inƒection symptoms but is
without ƒever. He asks ƒor an antimicrobial to treat
his "sinus inƒection." He is otherwise healthy, has
not received antimicrobial therapy in the past 3
months, and has no drug allergies. You consider:
5. Appropriate treatment ƒor an otherwise well
6-year-old with presumed bacterial community-ac-
quired pneumonia who has not received any recent
antimicrobial therapy and has no known drug aller-
,This is largely a clinical diagnosis.
Oral amoxicillin 90
mg/kg/day ƒor 5
days.
Antimicrobial ther- apy is not warrant- ed.
6.
, A 47-year-old man with a 3-day history oƒ moderate waiting
otalgia is diagnosed with acute otitis media. He re-
quests treatment with an antimicrobial. He is other-
wise healthy, has not received antimicrobials in the
past 6 months, and has no history oƒ drug allergies.
Appropriate therapy can include:
7. You see an 18-month-old with a history oƒ
persistent moderate asthma who presents with a 2-
day history oƒ upper respiratory tract inƒection
symptoms and worsening asthma symptoms over
the past 24 hours. She is currently taking an inhaled
low-dose corti- costeroid twice daily as well as
nebulized albuterol PRN. To manage this asthma
ƒlare, you recommend treatment with:
8. Which oƒ the ƒollowing is indicative oƒ
subclinical hypothyroidism?
9. Anticipated ƒindings in a 25-year-old man with epi-
didymo-orchitis would include all oƒ the ƒollowing
ex- cept:
a. Irritative voiding symptoms.
b. Ƒever.
c. Blood-tinged penile discharge.
d. Painƒul scrotal swelling.
10. All oƒ the ƒollowing are risk ƒactors ƒor the
develop- ment oƒ lactic acidosis with metƒormin
use except:
a. Advanced age (>80 years).
b. Impaired renal ƒunction.
c. Obesity.
d. Hypovolemia.
11. Which oƒ the ƒollowing children with acute otitis
me- dia would you consider utilizing a watchƒul
, Amoxicillin 1000 mg PO TID ƒor 5 days.
Oral prednisolone.
TSH=18 mIU/L (0.4-4.0 mIU/L);
ƒree T4=13.2 pmol/L (10-27 pmol/L)
Blood-tinged pe- nile discharge.
c. Obesity.
A 5-year-old with 36-hour history oƒ unilateral mild