NRNP 6541 WALDEN UNIVERSITY WEEK
11 FINAL EXAM(UPDATED 2026) SPRING
COMPLETE QUESTION AND WELL
DETAILED ANSWERS|| GRADED A+
(4) A 15-year-old female 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
febrile with a weight greater than the 99th percentile and has an erythematous,
macular rash beneath both breasts characterized by satellite lesions. UA is
significant for 2+ glucosuria, but no pyuria. Which of the following is the most
likely diagnosis?
A. Diabetes mellitus
B. Fanconi syndrome
C. Human immunodeficiency virus
D. Occult malignancy
E. Severe combined immunodeficiency (SCID)
A. The obese adolescent in this case has findings of diabetes mellitus. Her cutaneous
candidiasis is likely an indication of secondary immunosuppression related to
hyperglycemia. In diabetes, hyperglycemia promotes neutrophil dysfunction, and
circulatory insufficiency contributes to ineffective neutrophil chemotaxis during infection.
HIV infection is possible and antibody testing might be reasonable, but this scenario is
most consistent with hyperglycemia.
,(4) A mother notes her 6-week-old son's umbilical cord is still attached. His
activity and intake are normal; there has been no illness or fever. Delivery was at
term without problems. His examination is notable for a cord without evidence of
separation and a shallow, 0.5cm ulceration at the occiput without discharge or
surrounding erythema. Mother declares that the "sore," caused by a scalp probe,
has been slowly healing since birth and was deemed unremarkable at his 2-week
checkup. Which of the following is consistent with this child's likely diagnosis?
A. Defective humoral response
B. Functional leukocyte adherence glycoproteins
C. Marked neutrophilia
D. Normal wound healing
E. Purulent abscess formation
C. You suspect leukocyte adhesion deficiency (LAD) as the etiology of this child's
problem. LAD is an inheritable disorder of leukocyte chemotaxis and adherence
characterized by recurring sinopulmonary, oropharyngeal, and cutaneous infections with
delayed wound healing. Neutrophila is common with WBC counts of typically more than
50,000 cells/mm. Severe, life-threatening infection is possible with Staphylococcus
species, Enterobacteriaceae, and Candida species. Good skin and oral hygiene are
important; broad-spectrum antimicrobials and surgical debridement are early
consideration with infection.
(4) A 6-month-old girl is seen after an emergency room visit for decreased intake,
emesis, and watery diarrhea for the past 3 days. She was diagnosed yesterday
with "stomach flu" and given IV fluids. She is doing better today with improved
, intake and resolution of her emesis and diarrhea. The father is concerned about
her thrush since birth (despite multiple courses of an oral antifungal) and that she
has been hospitalized twice for pneumonia over the past 4 months. Her weight
has dropped from the 50th percentile on her 4-month visit to the 5th percentile
today. She has no findings consistent with dehydration, but she does appear to
have some extremity muscle wasting. Her examination is remarkable for buccal
mucosal exudates and hyperactive bowel sounds. Vital signs and the remainder
of her examination are normal. You suspect severe combined immunodeficiency
(SCID). Which of the following is consistent with the diagn
C. SCID is an autosomal recessive or X-linked disorder of both humoral and cellular
immunity. Serum immunoglobulins and T cells are often markedly diminished or absent.
Thymic dysgenesis is also seen. Recurring cutaneous, gastrointestinal, or pulmonary
infections occur with opportunistic organisms such as cytomegalovirus (CMV) and PCP.
Death typically occurs in the first 12 to 24 months of life unless bone marrow
transplantation is performed.
(4) You are called urgently to examine a term, 2-hour-old newborn who has had
temperature instability, difficulty with feeding, and a suspected seizure. He has
atypical facies (wide-set eyes, a prominent nose, and a small mandible), a cleft
palate, and a holosystolic murmur. Stat laboratory tests and chest radiograph
reveal marked hypocalcemia, a boot-shaped heart, and no apparent thymus.
Which of the following is the most likely diagnosis?
A. Ataxia-telangiectasia
B. DiGeorge syndrome
11 FINAL EXAM(UPDATED 2026) SPRING
COMPLETE QUESTION AND WELL
DETAILED ANSWERS|| GRADED A+
(4) A 15-year-old female 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
febrile with a weight greater than the 99th percentile and has an erythematous,
macular rash beneath both breasts characterized by satellite lesions. UA is
significant for 2+ glucosuria, but no pyuria. Which of the following is the most
likely diagnosis?
A. Diabetes mellitus
B. Fanconi syndrome
C. Human immunodeficiency virus
D. Occult malignancy
E. Severe combined immunodeficiency (SCID)
A. The obese adolescent in this case has findings of diabetes mellitus. Her cutaneous
candidiasis is likely an indication of secondary immunosuppression related to
hyperglycemia. In diabetes, hyperglycemia promotes neutrophil dysfunction, and
circulatory insufficiency contributes to ineffective neutrophil chemotaxis during infection.
HIV infection is possible and antibody testing might be reasonable, but this scenario is
most consistent with hyperglycemia.
,(4) A mother notes her 6-week-old son's umbilical cord is still attached. His
activity and intake are normal; there has been no illness or fever. Delivery was at
term without problems. His examination is notable for a cord without evidence of
separation and a shallow, 0.5cm ulceration at the occiput without discharge or
surrounding erythema. Mother declares that the "sore," caused by a scalp probe,
has been slowly healing since birth and was deemed unremarkable at his 2-week
checkup. Which of the following is consistent with this child's likely diagnosis?
A. Defective humoral response
B. Functional leukocyte adherence glycoproteins
C. Marked neutrophilia
D. Normal wound healing
E. Purulent abscess formation
C. You suspect leukocyte adhesion deficiency (LAD) as the etiology of this child's
problem. LAD is an inheritable disorder of leukocyte chemotaxis and adherence
characterized by recurring sinopulmonary, oropharyngeal, and cutaneous infections with
delayed wound healing. Neutrophila is common with WBC counts of typically more than
50,000 cells/mm. Severe, life-threatening infection is possible with Staphylococcus
species, Enterobacteriaceae, and Candida species. Good skin and oral hygiene are
important; broad-spectrum antimicrobials and surgical debridement are early
consideration with infection.
(4) A 6-month-old girl is seen after an emergency room visit for decreased intake,
emesis, and watery diarrhea for the past 3 days. She was diagnosed yesterday
with "stomach flu" and given IV fluids. She is doing better today with improved
, intake and resolution of her emesis and diarrhea. The father is concerned about
her thrush since birth (despite multiple courses of an oral antifungal) and that she
has been hospitalized twice for pneumonia over the past 4 months. Her weight
has dropped from the 50th percentile on her 4-month visit to the 5th percentile
today. She has no findings consistent with dehydration, but she does appear to
have some extremity muscle wasting. Her examination is remarkable for buccal
mucosal exudates and hyperactive bowel sounds. Vital signs and the remainder
of her examination are normal. You suspect severe combined immunodeficiency
(SCID). Which of the following is consistent with the diagn
C. SCID is an autosomal recessive or X-linked disorder of both humoral and cellular
immunity. Serum immunoglobulins and T cells are often markedly diminished or absent.
Thymic dysgenesis is also seen. Recurring cutaneous, gastrointestinal, or pulmonary
infections occur with opportunistic organisms such as cytomegalovirus (CMV) and PCP.
Death typically occurs in the first 12 to 24 months of life unless bone marrow
transplantation is performed.
(4) You are called urgently to examine a term, 2-hour-old newborn who has had
temperature instability, difficulty with feeding, and a suspected seizure. He has
atypical facies (wide-set eyes, a prominent nose, and a small mandible), a cleft
palate, and a holosystolic murmur. Stat laboratory tests and chest radiograph
reveal marked hypocalcemia, a boot-shaped heart, and no apparent thymus.
Which of the following is the most likely diagnosis?
A. Ataxia-telangiectasia
B. DiGeorge syndrome
