MSN 629 WEEK 3 QUIZ – COMPREHENSIVE EXAM QUESTIONS
COMPLETE WITH 100% VERIFIED ANSWERS
Question 1
A 2-week-old newborn presents with jaundice that began on day 3 of
life. The total bilirubin is 18 mg/dL, and the direct bilirubin is 1.2 mg/dL.
The infant is breastfeeding well and has adequate urine output. Which
of the following is the most appropriate next step?
A. Perform a sepsis workup and initiate antibiotics
B. Discontinue breastfeeding for 24 hours
C. Initiate phototherapy
D. Obtain a liver ultrasound
C. Initiate phototherapy
RATIONALE: This infant has unconjugated hyperbilirubinemia (direct
bilirubin <2 mg/dL) with a total bilirubin level above the phototherapy
threshold for a 2-week-old. Phototherapy is indicated to prevent
kernicterus. Breastfeeding should continue with increased frequency.
Sepsis workup is not indicated without signs of illness.
Question 2
A 5-year-old child presents with a 3-day history of cough, coryza, and
conjunctivitis. On examination, the child has Koplik spots on the buccal
,mucosa and a maculopapular rash that began on the face and is
spreading downward. Which of the following is the most appropriate
management?
A. Supportive care and vitamin A supplementation
B. Oral acyclovir and supportive care
C. Amoxicillin for secondary bacterial infection
D. Corticosteroids to reduce inflammation
A. Supportive care and vitamin A supplementation
RATIONALE: This presentation is classic for measles (rubeola).
Management is supportive care with vitamin A supplementation (two
doses given 24 hours apart) to reduce morbidity and mortality.
Antibiotics are only indicated if secondary bacterial infection develops.
Corticosteroids are not routinely recommended.
Question 3
A 12-year-old adolescent reports chronic fatigue, cold intolerance, and
constipation. Physical examination reveals bradycardia and a palpable
goiter. Thyroid function tests show elevated TSH and low free T4. Which
of the following is the most appropriate initial treatment?
A. Levothyroxine 50 mcg daily
B. Methimazole 5 mg daily
C. Radioactive iodine ablation
D. Levothyroxine 12.5 mcg daily
A. Levothyroxine 50 mcg daily
,RATIONALE: This presentation is consistent with hypothyroidism. The
starting dose of levothyroxine for adolescents is approximately 1-2
mcg/kg/day. A dose of 50 mcg daily is appropriate for a 12-year-old.
Methimazole and radioactive iodine are used for hyperthyroidism.
Question 4
A 9-month-old infant is brought to the clinic for a well-child visit. The
infant cannot sit without support and does not bear weight on the legs.
Which of the following is the most appropriate next step?
A. Reassure the parents that this is within normal limits
B. Refer for early intervention evaluation
C. Schedule a follow-up visit in 3 months
D. Recommend physical therapy immediately
B. Refer for early intervention evaluation
RATIONALE: At 9 months, infants should be able to sit without support
and bear weight on legs with support. Failure to achieve these
milestones warrants referral for developmental evaluation through
early intervention services.
Question 5
A 7-year-old child with a history of recurrent otitis media presents with
hearing loss in the right ear. Audiometry reveals a conductive hearing
loss. The tympanic membrane is retracted with an air-fluid level. Which
of the following is the most appropriate management?
, A. Insertion of tympanostomy tubes
B. Oral amoxicillin for 10 days
C. Observation with follow-up in 3 months
D. Referral for hearing aids
A. Insertion of tympanostomy tubes
RATIONALE: This child has chronic otitis media with effusion (OME) with
associated hearing loss. Tympanostomy tube insertion is indicated for
OME lasting >3 months with hearing loss >20 dB. Antibiotics are not
effective for OME without acute infection.
Question 6
A 14-year-old adolescent reports abdominal pain, bloating, and
alternating diarrhea and constipation. Symptoms have been present for
6 months. Physical examination is normal. Stool studies are negative for
pathogens. Which of the following is the most appropriate initial
management?
A. Low FODMAP diet trial
B. Oral loperamide for diarrhea
C. Referral for colonoscopy
D. Fiber supplementation and stress reduction
D. Fiber supplementation and stress reduction
RATIONALE: This presentation is consistent with irritable bowel
syndrome (IBS). Initial management includes soluble fiber
supplementation, stress reduction, and reassurance. The low FODMAP
COMPLETE WITH 100% VERIFIED ANSWERS
Question 1
A 2-week-old newborn presents with jaundice that began on day 3 of
life. The total bilirubin is 18 mg/dL, and the direct bilirubin is 1.2 mg/dL.
The infant is breastfeeding well and has adequate urine output. Which
of the following is the most appropriate next step?
A. Perform a sepsis workup and initiate antibiotics
B. Discontinue breastfeeding for 24 hours
C. Initiate phototherapy
D. Obtain a liver ultrasound
C. Initiate phototherapy
RATIONALE: This infant has unconjugated hyperbilirubinemia (direct
bilirubin <2 mg/dL) with a total bilirubin level above the phototherapy
threshold for a 2-week-old. Phototherapy is indicated to prevent
kernicterus. Breastfeeding should continue with increased frequency.
Sepsis workup is not indicated without signs of illness.
Question 2
A 5-year-old child presents with a 3-day history of cough, coryza, and
conjunctivitis. On examination, the child has Koplik spots on the buccal
,mucosa and a maculopapular rash that began on the face and is
spreading downward. Which of the following is the most appropriate
management?
A. Supportive care and vitamin A supplementation
B. Oral acyclovir and supportive care
C. Amoxicillin for secondary bacterial infection
D. Corticosteroids to reduce inflammation
A. Supportive care and vitamin A supplementation
RATIONALE: This presentation is classic for measles (rubeola).
Management is supportive care with vitamin A supplementation (two
doses given 24 hours apart) to reduce morbidity and mortality.
Antibiotics are only indicated if secondary bacterial infection develops.
Corticosteroids are not routinely recommended.
Question 3
A 12-year-old adolescent reports chronic fatigue, cold intolerance, and
constipation. Physical examination reveals bradycardia and a palpable
goiter. Thyroid function tests show elevated TSH and low free T4. Which
of the following is the most appropriate initial treatment?
A. Levothyroxine 50 mcg daily
B. Methimazole 5 mg daily
C. Radioactive iodine ablation
D. Levothyroxine 12.5 mcg daily
A. Levothyroxine 50 mcg daily
,RATIONALE: This presentation is consistent with hypothyroidism. The
starting dose of levothyroxine for adolescents is approximately 1-2
mcg/kg/day. A dose of 50 mcg daily is appropriate for a 12-year-old.
Methimazole and radioactive iodine are used for hyperthyroidism.
Question 4
A 9-month-old infant is brought to the clinic for a well-child visit. The
infant cannot sit without support and does not bear weight on the legs.
Which of the following is the most appropriate next step?
A. Reassure the parents that this is within normal limits
B. Refer for early intervention evaluation
C. Schedule a follow-up visit in 3 months
D. Recommend physical therapy immediately
B. Refer for early intervention evaluation
RATIONALE: At 9 months, infants should be able to sit without support
and bear weight on legs with support. Failure to achieve these
milestones warrants referral for developmental evaluation through
early intervention services.
Question 5
A 7-year-old child with a history of recurrent otitis media presents with
hearing loss in the right ear. Audiometry reveals a conductive hearing
loss. The tympanic membrane is retracted with an air-fluid level. Which
of the following is the most appropriate management?
, A. Insertion of tympanostomy tubes
B. Oral amoxicillin for 10 days
C. Observation with follow-up in 3 months
D. Referral for hearing aids
A. Insertion of tympanostomy tubes
RATIONALE: This child has chronic otitis media with effusion (OME) with
associated hearing loss. Tympanostomy tube insertion is indicated for
OME lasting >3 months with hearing loss >20 dB. Antibiotics are not
effective for OME without acute infection.
Question 6
A 14-year-old adolescent reports abdominal pain, bloating, and
alternating diarrhea and constipation. Symptoms have been present for
6 months. Physical examination is normal. Stool studies are negative for
pathogens. Which of the following is the most appropriate initial
management?
A. Low FODMAP diet trial
B. Oral loperamide for diarrhea
C. Referral for colonoscopy
D. Fiber supplementation and stress reduction
D. Fiber supplementation and stress reduction
RATIONALE: This presentation is consistent with irritable bowel
syndrome (IBS). Initial management includes soluble fiber
supplementation, stress reduction, and reassurance. The low FODMAP
