FNP 2 EXAM 3 2026 ACTUAL TEST PAPER
QUESTIONS SOLUTIONS VERIFIED COMPLETE
STUDY PACKAGE
◉ What is the most likely diagnosis for a 3-week-old infant
presenting with hypotonia, lethargy, and hepatomegaly?
Answer: Inborn error of metabolism
◉ What diagnosis is most likely for a child with short stature,
delayed bone age, but growth consistent with bone age?
Answer: Constitutional growth delay
◉ What is the likely diagnosis for a female infant with mild breast
development but no pubic or axillary hair?
Answer: Premature thelarche
◉ What is the next step for a 6-year-old female with a recent growth
spurt and breast and pubic hair development?
Answer: polycystic ovary syndrome and metabolic syndrome
◉ What is the next step for a 6-year-old female with a recent growth
spurt and breast and pubic hair development?
,Answer: Start with bone radiographs and labs for LH, FSH, estradiol
or testosterone
If LH and FSH are high, consider CNS involvement—imaging
required to r/o CNS tumor. Boys have a 40-50% chance of
intracranial pathology with central CPP
IF LH and FSH are low, consider peripheral involvement—do a GnRH
stimulating study to distinguish central from peripheral puberty
Peripheral puberty: ultrasound of pelvis (girls) and testicles (boys)
to r/o tumors, serum 17-OHP to r/o congenital adrenal hyperplasia
◉ What is the appropriate action for an infant with congenital
adrenal hyperplasia presenting with vomiting, poor feeding, and
lethargy?
Answer: TSH (Thyroid-Stimulating Hormone): To assess the
adequacy of current treatment.
Free T4 (Thyroxine): To ensure that thyroid hormone levels are
within the target range.
Anti-thyroid peroxidase (anti-TPO) antibodies: To check for the
presence of autoimmune thyroiditis, which could indicate a
secondary cause for poor growth.
Growth velocity measurement: To evaluate the rate of growth over
time compared to age and sex norms.
Dietary evaluation: To rule out any nutritional deficiencies that
could be impacting growth
,X-ray of the left hand and wrist: To assess bone age, which can help
evaluate growth potential.
Consider Genetic Testing (if indicated): To rule out any underlying
genetic syndromes that could affect growth.
◉ What tests should be ordered for a 9-month-old with congenital
hypothyroidism showing slowed growth despite treatment?
Answer: Blood spot test 24 hours after birth (assesses for congenital
hypothyroidism)
Serum free T4/TSH
TBG deficiency
Diagnostic criteria Low free T4, high TSH = congenital
hypothyroidism High TSH alone = subclinical or overt
hypothyroidism Low free T4, normal TSH = central hypothyroidism
Low total T4, normal free T4, normal TSH = TBG deficiency
◉ Which test is ordered to determine the type of diabetes in a 12-
year-old with hyperglycemia and obesity?
Answer: Presence of autoantibodies indicates T1DM, not T2DM
Prediabetes FBG > 100-125 mg/dL (on two occasions) HbA1c >
5.7%-6.4% OGTT 2-hour level > 140-199 mg/dL
T2DM FBG > 126 mg/dL (on two occasions) HbA1c > 6.5% OGTT 2-
hour level > 200 mg/dL
, ◉ What is the correct course of action for an 8-year-old newly
diagnosed with type 1 diabetes and mild symptoms?
Answer: Insulin Management
Lifestyle changes: Dietary changes, sick-day plans, exercise plans,
hypoglycemia, multidisciplinary teams, wearable medical
identification
◉ What is the most appropriate initial management for an
adolescent with tremors, palpitations, and weight loss?
Answer: Hyperthyroidism
Labs: T4 (elevated), TSH low
Referral to endocrinologists
Lifestyle Changes Encourage proper rest, nutrition Frequent f/u
visits
Methimazole Oral once daily AE: rashes, urticaria, GI distress, joint
pain
Propylthiouracil Oral once daily AE: hepatotoxicity, agranulocytosis,
rashes PTU is advised only for patients not responding well to
methimazole d/t the increased risks associated with PTU (per
Pediatric Endocrine Society)
◉ What is recommended for a 12-year-old with type 1 diabetes
diagnosed at age 9, focusing on ongoing management?
Answer: 1. Continuous glucose monitoring
QUESTIONS SOLUTIONS VERIFIED COMPLETE
STUDY PACKAGE
◉ What is the most likely diagnosis for a 3-week-old infant
presenting with hypotonia, lethargy, and hepatomegaly?
Answer: Inborn error of metabolism
◉ What diagnosis is most likely for a child with short stature,
delayed bone age, but growth consistent with bone age?
Answer: Constitutional growth delay
◉ What is the likely diagnosis for a female infant with mild breast
development but no pubic or axillary hair?
Answer: Premature thelarche
◉ What is the next step for a 6-year-old female with a recent growth
spurt and breast and pubic hair development?
Answer: polycystic ovary syndrome and metabolic syndrome
◉ What is the next step for a 6-year-old female with a recent growth
spurt and breast and pubic hair development?
,Answer: Start with bone radiographs and labs for LH, FSH, estradiol
or testosterone
If LH and FSH are high, consider CNS involvement—imaging
required to r/o CNS tumor. Boys have a 40-50% chance of
intracranial pathology with central CPP
IF LH and FSH are low, consider peripheral involvement—do a GnRH
stimulating study to distinguish central from peripheral puberty
Peripheral puberty: ultrasound of pelvis (girls) and testicles (boys)
to r/o tumors, serum 17-OHP to r/o congenital adrenal hyperplasia
◉ What is the appropriate action for an infant with congenital
adrenal hyperplasia presenting with vomiting, poor feeding, and
lethargy?
Answer: TSH (Thyroid-Stimulating Hormone): To assess the
adequacy of current treatment.
Free T4 (Thyroxine): To ensure that thyroid hormone levels are
within the target range.
Anti-thyroid peroxidase (anti-TPO) antibodies: To check for the
presence of autoimmune thyroiditis, which could indicate a
secondary cause for poor growth.
Growth velocity measurement: To evaluate the rate of growth over
time compared to age and sex norms.
Dietary evaluation: To rule out any nutritional deficiencies that
could be impacting growth
,X-ray of the left hand and wrist: To assess bone age, which can help
evaluate growth potential.
Consider Genetic Testing (if indicated): To rule out any underlying
genetic syndromes that could affect growth.
◉ What tests should be ordered for a 9-month-old with congenital
hypothyroidism showing slowed growth despite treatment?
Answer: Blood spot test 24 hours after birth (assesses for congenital
hypothyroidism)
Serum free T4/TSH
TBG deficiency
Diagnostic criteria Low free T4, high TSH = congenital
hypothyroidism High TSH alone = subclinical or overt
hypothyroidism Low free T4, normal TSH = central hypothyroidism
Low total T4, normal free T4, normal TSH = TBG deficiency
◉ Which test is ordered to determine the type of diabetes in a 12-
year-old with hyperglycemia and obesity?
Answer: Presence of autoantibodies indicates T1DM, not T2DM
Prediabetes FBG > 100-125 mg/dL (on two occasions) HbA1c >
5.7%-6.4% OGTT 2-hour level > 140-199 mg/dL
T2DM FBG > 126 mg/dL (on two occasions) HbA1c > 6.5% OGTT 2-
hour level > 200 mg/dL
, ◉ What is the correct course of action for an 8-year-old newly
diagnosed with type 1 diabetes and mild symptoms?
Answer: Insulin Management
Lifestyle changes: Dietary changes, sick-day plans, exercise plans,
hypoglycemia, multidisciplinary teams, wearable medical
identification
◉ What is the most appropriate initial management for an
adolescent with tremors, palpitations, and weight loss?
Answer: Hyperthyroidism
Labs: T4 (elevated), TSH low
Referral to endocrinologists
Lifestyle Changes Encourage proper rest, nutrition Frequent f/u
visits
Methimazole Oral once daily AE: rashes, urticaria, GI distress, joint
pain
Propylthiouracil Oral once daily AE: hepatotoxicity, agranulocytosis,
rashes PTU is advised only for patients not responding well to
methimazole d/t the increased risks associated with PTU (per
Pediatric Endocrine Society)
◉ What is recommended for a 12-year-old with type 1 diabetes
diagnosed at age 9, focusing on ongoing management?
Answer: 1. Continuous glucose monitoring
