CHAMBERLAIN NR 602 PRIMARY CARE FINAL EXAM
ACTUAL QUESTIONS WITH EXPERT CLINICAL
RATIONALES AND 100% VERIFIED ANSWERS
Question 1
Multiple Choice:
A mother presents with her 3-month-old child and complains of a "goopy" eye
that is sometimes matted shut after naps. Upon exam the conjunctiva is clear with
some mild crusting to eyelashes. What is the diagnosis and patient teaching?
• A. Bacterial conjunctivitis; prescribe erythromycin ointment TID
• B. Probable lacrimal duct obstruction; daily massage and warm compresses
• C. Viral conjunctivitis; cold compresses and artificial tears
• D. Blepharitis; lid scrubs with baby shampoo
Answer: B. Probable lacrimal duct obstruction; daily massage and warm
compresses
Expert Rationale: Clear conjunctiva with crusting in an infant indicates
nasolacrimal duct obstruction rather than infection. Parents should be taught
lacrimal duct massage and warm compresses while monitoring for signs of
bacterial superinfection or periorbital cellulitis; most resolve spontaneously by 6–
12 months.
Question 2
Multiple Choice:
,A nine-year-old patient presents with a tender, swollen, erythemic bump to the
eyelid. What is the diagnosis and patient education?
• A. Hordeolum; warm 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
Answer: A. Hordeolum; warm 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 with warm compresses
promotes drainage, while lid hygiene prevents recurrence; oral antibiotics are
reserved for associated cellulitis or resistant cases.
Question 3
Multiple Choice:
A 9-year-old patient presents with acute swelling and erythema to the eyelid with
flaky, scaly debris to eyelid margins. Patient reports gritty, burning feeling to eyes.
She has already attempted warm compresses and washing eyelids with baby soap
with minimal relief. What 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
Answer: B. Anterior blepharitis; erythromycin ophthalmic ointment
Expert Rationale: Chronic lid margin inflammation with scaly debris refractory to
hygiene measures indicates anterior blepharitis. Erythromycin ointment is
preferred for its prolonged contact time with the lid margin; oral azithromycin
,may be used for long-term control in children <8 years to avoid dental staining
from tetracyclines.
Question 4
Multiple Choice:
A mother brings her nine-year-old overweight son to the clinic with complaints of
pain to the groin, knee, and right hip. She reports the patient has been walking
with 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. What is the diagnosis and treatment?
• A. Toxic transient synovitis; NSAIDs and non-weight 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
Answer: C. Slipped capital femoral epiphysis; immediate referral to ER for surgery
Expert Rationale: Hip pathology presenting as knee pain with 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.
Question 5
Multiple Choice:
Father presents with his four-year-old son and states that the patient has been
limping since this morning and was 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. What is the probable diagnosis, and what is the
appropriate diagnostic workup?
, • A. Legg-Calvé-Perthes disease; order hip X-ray and refer to orthopedics
• B. Toxic transient synovitis; obtain hip X-ray, CBC, ESR, and CRP to rule out
septic arthritis
• C. Septic arthritis; immediate emergency department referral for aspiration
• D. Juvenile idiopathic arthritis; refer to rheumatology for further evaluation
Answer: B. Toxic transient synovitis; obtain hip X-ray, CBC, ESR, and CRP to rule out
septic arthritis
Expert Rationale: Acute onset hip pain with decreased range of motion in a young
child following a viral illness is highly suggestive of toxic transient synovitis.
Diagnostic workup should include hip X-ray and inflammatory markers to
differentiate from septic arthritis, which would present with higher fever, toxicity,
and significantly elevated ESR/CRP.
Question 6
Multiple Choice:
A 16-year-old female presents with 3 days of sore throat, fever, and fatigue. On
exam, she has diffuse pharyngeal erythema, swollen tonsils with white exudates,
palatal petechiae, and tender anterior cervical lymphadenopathy. She denies
cough. Rapid strep test is negative. What is the most appropriate next step?
• A. Prescribe amoxicillin empirically
• B. Order a monospot test
• C. Send a throat culture
• D. Prescribe symptomatic care and reassure
Answer: B. Order a monospot test
Expert Rationale: The presence of exudative pharyngitis, palatal petechiae, and
lymphadenopathy with a negative rapid strep test in an adolescent is highly
ACTUAL QUESTIONS WITH EXPERT CLINICAL
RATIONALES AND 100% VERIFIED ANSWERS
Question 1
Multiple Choice:
A mother presents with her 3-month-old child and complains of a "goopy" eye
that is sometimes matted shut after naps. Upon exam the conjunctiva is clear with
some mild crusting to eyelashes. What is the diagnosis and patient teaching?
• A. Bacterial conjunctivitis; prescribe erythromycin ointment TID
• B. Probable lacrimal duct obstruction; daily massage and warm compresses
• C. Viral conjunctivitis; cold compresses and artificial tears
• D. Blepharitis; lid scrubs with baby shampoo
Answer: B. Probable lacrimal duct obstruction; daily massage and warm
compresses
Expert Rationale: Clear conjunctiva with crusting in an infant indicates
nasolacrimal duct obstruction rather than infection. Parents should be taught
lacrimal duct massage and warm compresses while monitoring for signs of
bacterial superinfection or periorbital cellulitis; most resolve spontaneously by 6–
12 months.
Question 2
Multiple Choice:
,A nine-year-old patient presents with a tender, swollen, erythemic bump to the
eyelid. What is the diagnosis and patient education?
• A. Hordeolum; warm 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
Answer: A. Hordeolum; warm 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 with warm compresses
promotes drainage, while lid hygiene prevents recurrence; oral antibiotics are
reserved for associated cellulitis or resistant cases.
Question 3
Multiple Choice:
A 9-year-old patient presents with acute swelling and erythema to the eyelid with
flaky, scaly debris to eyelid margins. Patient reports gritty, burning feeling to eyes.
She has already attempted warm compresses and washing eyelids with baby soap
with minimal relief. What 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
Answer: B. Anterior blepharitis; erythromycin ophthalmic ointment
Expert Rationale: Chronic lid margin inflammation with scaly debris refractory to
hygiene measures indicates anterior blepharitis. Erythromycin ointment is
preferred for its prolonged contact time with the lid margin; oral azithromycin
,may be used for long-term control in children <8 years to avoid dental staining
from tetracyclines.
Question 4
Multiple Choice:
A mother brings her nine-year-old overweight son to the clinic with complaints of
pain to the groin, knee, and right hip. She reports the patient has been walking
with 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. What is the diagnosis and treatment?
• A. Toxic transient synovitis; NSAIDs and non-weight 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
Answer: C. Slipped capital femoral epiphysis; immediate referral to ER for surgery
Expert Rationale: Hip pathology presenting as knee pain with 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.
Question 5
Multiple Choice:
Father presents with his four-year-old son and states that the patient has been
limping since this morning and was 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. What is the probable diagnosis, and what is the
appropriate diagnostic workup?
, • A. Legg-Calvé-Perthes disease; order hip X-ray and refer to orthopedics
• B. Toxic transient synovitis; obtain hip X-ray, CBC, ESR, and CRP to rule out
septic arthritis
• C. Septic arthritis; immediate emergency department referral for aspiration
• D. Juvenile idiopathic arthritis; refer to rheumatology for further evaluation
Answer: B. Toxic transient synovitis; obtain hip X-ray, CBC, ESR, and CRP to rule out
septic arthritis
Expert Rationale: Acute onset hip pain with decreased range of motion in a young
child following a viral illness is highly suggestive of toxic transient synovitis.
Diagnostic workup should include hip X-ray and inflammatory markers to
differentiate from septic arthritis, which would present with higher fever, toxicity,
and significantly elevated ESR/CRP.
Question 6
Multiple Choice:
A 16-year-old female presents with 3 days of sore throat, fever, and fatigue. On
exam, she has diffuse pharyngeal erythema, swollen tonsils with white exudates,
palatal petechiae, and tender anterior cervical lymphadenopathy. She denies
cough. Rapid strep test is negative. What is the most appropriate next step?
• A. Prescribe amoxicillin empirically
• B. Order a monospot test
• C. Send a throat culture
• D. Prescribe symptomatic care and reassure
Answer: B. Order a monospot test
Expert Rationale: The presence of exudative pharyngitis, palatal petechiae, and
lymphadenopathy with a negative rapid strep test in an adolescent is highly
