FITZ PRE-TEST Questions with Correct Solutions
Question:
1. During a well child evaluation of a 10-year-old girl, you note the presence of breast buds
and sparse growth of long, straight pigmented hair along the labia. Since her last visit one
year ago, you find that she has grown 3 inches (7.7 cm), gained 6 lbs (2.7 kg), and is within
the 50th percentile for height and weight. The mother asks if these findings are normal for
her age. You respond:
- This is normal as onset of puberty typically occurs between ages 8 and 13 for girls.
- A referral to endocrinology is likely warranted.
- A bone age determination is recommended.
- A follow-up visit in 6 months is needed to note any additional changes.
Answer:
This is normal as onset of puberty typically occurs between ages 8 and 13 for girls. The
presence of breast buds and sparse pubic hair signifies Tanner Stage 2 development, which is
normal for a 10-year-old girl. During pre-adolescence (6-10 years of age), children gain
approximately 2-3 kg (5-7 lbs) and 5-8 cm (2-3 inches) per year. Growth spurt in girls typically
begins around 9-10 years of age, with maximum growth at 12 years of age.
Question:
2. You see a 17-year-old female with suspected bacterial pharyngitis caused by group A
beta-hemolytic streptococci. Anticipated findings would include all of the following except:
Palatial petechiae. "Strawberry tongue." Exudative pharyngitis. Anterior cervical
lymphadenopathy.
Answer:
"Strawberry tongue." Physical examination of the patient with acute pharyngitis by S.
pyogenes will typically find exudative pharyngitis (C), palatial petechiae (A), and anterior
cervical lymphadenopathy (D).
Question:
3. A 37-year-old man presents with a many-month history of well-demarcated plaques with
silvery scale on the tips of his elbows. The scales often bleed when picked or peeled. In
considering a diagnosis of psoriasis vulgaris, the NP considers: This is largely a clinical
diagnosis. Testing for presence of rheumatoid factor and checking ESR. A biopsy of a
representative lesion is needed. Referral to dermatology.
Answer:
This is largely a clinical diagnosis. A diagnosis of psoriasis vulgaris can be made with a review
of patient history, patient risk factors including family history, and physical examination
(A). Additional testing can be considered to differentiate the condition from another possible
cause but is not usually required.
,Question:
4. A 27-year-old male presents with a 2-day history of purulent nasal discharge and a 4-day
history of upper respiratory tract infection symptoms but is without fever. He asks for an
antimicrobial to treat his "sinus infection." He is otherwise healthy, has not received
antimicrobial therapy in the past 3 months, and has no drug allergies. You consider: Oral
amoxicillin 1000 mg BID for 7 days. Oral amoxicillin-clavulanate 875/125 mg BID for 5 days.
Oral azithromycin 500 mg QD for 5 days. Antimicrobial therapy is not warranted.
Answer:
Antimicrobial therapy is not warranted. Given that this is likely a viral infection, antimicrobial
therapy is not warranted (A, B, C). If the illness progresses to suggest a bacterial infection
(e.g., "double sickening," where URI-like symptoms initially improve then worsen, or illness
persisting beyond 7?10 days), then an antimicrobial can be considered. Question:
Plan/Intervention
Question:
5. Appropriate treatment for an otherwise well 6-year-old with presumed bacterial
community-acquired pneumonia who has not received any recent antimicrobial therapy and
has no known drug allergies is: Oral amoxicillin 90 mg/kg/day for 5 days. Oral
amoxicillin-clavulanate 90/6.4 mg/kg/day for 14 days. Oral clarithromycin 15 mg/kg/day for
10 days. Oral levofloxacin 750 mg for 5 days.
Answer:
Oral amoxicillin 90 mg/kg/day for 5 days. Though viral pathogens also often implicated, the
primary treatment target for presumed bacterial community-acquired pneumonia in children
is Streptococcus pneumoniae. PIDS/IDSA guidelines recommend amoxicillin as a first-line
agent
(A). Cephalosporins can be considered in the presence of penicillin allergy.
Question:
6. A 47-year-old man with a 3-day history of moderate otalgia is diagnosed with acute otitis
media. He requests treatment with an antimicrobial. He is otherwise healthy, has not
received antimicrobials in the past 6 months, and has no history of drug allergies.
Appropriate therapy can include: Cephalexin 250 mg q6h BID for 10 days . Amoxicillin 1000
mg PO TID for 5 days. Trimethoprim-sulfamethoxazole 80 mg/400 mg PO BID for 14 days.
Levofloxacin 750 mg PO QD for 5 days.
Answer:
Amoxicillin 1000 mg PO TID for 5 days. For patients with risk factors for drug-resistant
infections, high-dose amoxicillin-clavulanate or certain cephalosporins are appropriate.
Cephalexin, a first-generation cephalosporin, has limited activity against Gram-negative
bacteria, including H. influenzae and M. catarrhalis, with or without beta-lactamase
production (A). Fluoroquinolones are not recommended as first-line therapy (D) and
TMP-SMX is not recommended for treatment of AOM (C).
,Question:
7. You see an 18-month-old with a history of persistent moderate asthma who presents with a
2-day history of upper respiratory tract infection symptoms and worsening asthma symptoms
over the past 24 hours. She is currently taking an inhaled low-dose corticosteroid twice daily
as well as nebulized albuterol PRN. To manage this asthma flare, you recommend treatment
with: Oral montelukast. Oral theophylline. Oral prednisolone. Oxygen therapy.
Answer:
Oral prednisolone. Leukotriene modifiers such as montelukast are used as controller therapy
and would not offer timely benefits during an asthma flare (A). Montelukast comes with a
FDA warning about serious neuropsychiatric events, including suicidal thoughts and actions.
Theophylline is used to prevent bronchospasm and not to treat an acute asthma flare (B).
Oxygen therapy is not typically needed except in severe asthma exacerbations where oxygen
saturation levels fall below a critical level (D).
Question:
8. Which of the following is indicative of subclinical hypothyroidism? Total T4=43 mcg/dL
(4.5-12.0 mcg/dL); free T3=6.5 pmol/L (3.5-7.7 pmol/L) Total T4=1.3 mcg/dL (4.5-12.0
mcg/dL); free T3=42 pmol/L (3.5-7.7 pmol/L) TSH <0.2 mIU/L (0.4-4.0 mIU/L); free T4=64
pmol/L (10-27 pmol/L) TSH=18 mIU/L (0.4-4.0 mIU/L); free T4=13.2 pmol/L (10-27 pmol/L)
Answer:
TSH=18 mIU/L (0.4-4.0 mIU/L); free T4=13.2 pmol/L (10-27 pmol/L) TSH levels below normal
is an indication of hyperthyroidism (C). Total T4 is rarely an indicated test for thyroid
conditions as the level can be increased or decreased in the absence of thyroid disease (A, B).
Free T3 is also a rarely indicated test for thyroid disorders.
Question:
9. Anticipated findings in a 25-year-old man with epididymo-orchitis would include all of the
following except: Irritative voiding symptoms. Fever. Blood-tinged penile discharge. Painful
scrotal swelling.
Answer:
Blood-tinged penile discharge. Clinical presentation typically includes irritative voiding
symptoms (A), fever (B), and painful swelling of epididymis and the scrotum (D).
Question:
10. All of the following are risk factors for the development of lactic acidosis with metformin
use except: Advanced age (>80 years). Impaired renal function. Obesity. Hypovolemia.
Answer:
Obesity. Risk factors for metformin-induced lactic acidosis include impaired renal function
(B), hypovolemia
(D), low perfusion state, and/or advanced age (>80 years) (A).
, Question:
11. Which of the following children with acute otitis media would you consider utilizing a
watchful waiting approach rather than prescribing antimicrobial therapy? An 8-year-old with
asthma and moderate bulging of left and right TM A 5-month-old with mild bulging of left TM
and fever of 38.7°C (101.7°F) A 5-year-old with 36-hour history of unilateral mild otalgia A
3-year-old with intense TM erythema with otalgia and fever of 39.1°C (102.4°F)
Answer:
A 5-year-old with 36-hour history of unilateral mild otalgia A watchful waiting approach for
AOM should not be considered in children younger than 6 months of age (B), AOM with
bilateral involvement (A), or severe illness (D).
Question:
12. Common signs of depression in a 10-year-old girl can include all of the following except:
Irritable mood. Physical complaints, such as stomach aches. Poor school performance.
Seeking out a new group of friends.
Answer:
Seeking out a new group of friends. Key findings in depression in children include ongoing
feeling of sadness, worthlessness, and guilt, irritable mood (A), loss of interest in social
activities, physical complaints (B), poor school performance (C), and thoughts of dying or
suicide.
Question:
13. A 22-year-old presents after being bitten by a brown recluse spider on the foot two days
earlier. Examination reveals a single lesion surrounded by an erythematous halo with edema
in the surrounding tissue. Treatment can include all of the following except: Local
debridement. Elevation and immobilization. Oral trimethoprim-sulfamethoxazole for 7 days.
Cool compresses to the affected area.
Answer:
Oral trimethoprim-sulfamethoxazole for 7 days. General wound management can include
local debridement (A), elevation, and loose immobilization of the affected area (B). Cool
compresses should be used until progression of the necrotic process has stopped (D).
Question:
14. The expected uterine size and developmental changes noted at 12-weeks' gestation is:
Uterine size of an orange and Chadwick sign is present. Uterine size of a grapefruit and fetal
heart tone detected by Doppler. Uterine fundus is at the level of the umbilicus and mother
reports quickening. Uterine fundus of approximately 34 cm above the symphysis pubis and
mother reports the fetus dropping.
Question:
1. During a well child evaluation of a 10-year-old girl, you note the presence of breast buds
and sparse growth of long, straight pigmented hair along the labia. Since her last visit one
year ago, you find that she has grown 3 inches (7.7 cm), gained 6 lbs (2.7 kg), and is within
the 50th percentile for height and weight. The mother asks if these findings are normal for
her age. You respond:
- This is normal as onset of puberty typically occurs between ages 8 and 13 for girls.
- A referral to endocrinology is likely warranted.
- A bone age determination is recommended.
- A follow-up visit in 6 months is needed to note any additional changes.
Answer:
This is normal as onset of puberty typically occurs between ages 8 and 13 for girls. The
presence of breast buds and sparse pubic hair signifies Tanner Stage 2 development, which is
normal for a 10-year-old girl. During pre-adolescence (6-10 years of age), children gain
approximately 2-3 kg (5-7 lbs) and 5-8 cm (2-3 inches) per year. Growth spurt in girls typically
begins around 9-10 years of age, with maximum growth at 12 years of age.
Question:
2. You see a 17-year-old female with suspected bacterial pharyngitis caused by group A
beta-hemolytic streptococci. Anticipated findings would include all of the following except:
Palatial petechiae. "Strawberry tongue." Exudative pharyngitis. Anterior cervical
lymphadenopathy.
Answer:
"Strawberry tongue." Physical examination of the patient with acute pharyngitis by S.
pyogenes will typically find exudative pharyngitis (C), palatial petechiae (A), and anterior
cervical lymphadenopathy (D).
Question:
3. A 37-year-old man presents with a many-month history of well-demarcated plaques with
silvery scale on the tips of his elbows. The scales often bleed when picked or peeled. In
considering a diagnosis of psoriasis vulgaris, the NP considers: This is largely a clinical
diagnosis. Testing for presence of rheumatoid factor and checking ESR. A biopsy of a
representative lesion is needed. Referral to dermatology.
Answer:
This is largely a clinical diagnosis. A diagnosis of psoriasis vulgaris can be made with a review
of patient history, patient risk factors including family history, and physical examination
(A). Additional testing can be considered to differentiate the condition from another possible
cause but is not usually required.
,Question:
4. A 27-year-old male presents with a 2-day history of purulent nasal discharge and a 4-day
history of upper respiratory tract infection symptoms but is without fever. He asks for an
antimicrobial to treat his "sinus infection." He is otherwise healthy, has not received
antimicrobial therapy in the past 3 months, and has no drug allergies. You consider: Oral
amoxicillin 1000 mg BID for 7 days. Oral amoxicillin-clavulanate 875/125 mg BID for 5 days.
Oral azithromycin 500 mg QD for 5 days. Antimicrobial therapy is not warranted.
Answer:
Antimicrobial therapy is not warranted. Given that this is likely a viral infection, antimicrobial
therapy is not warranted (A, B, C). If the illness progresses to suggest a bacterial infection
(e.g., "double sickening," where URI-like symptoms initially improve then worsen, or illness
persisting beyond 7?10 days), then an antimicrobial can be considered. Question:
Plan/Intervention
Question:
5. Appropriate treatment for an otherwise well 6-year-old with presumed bacterial
community-acquired pneumonia who has not received any recent antimicrobial therapy and
has no known drug allergies is: Oral amoxicillin 90 mg/kg/day for 5 days. Oral
amoxicillin-clavulanate 90/6.4 mg/kg/day for 14 days. Oral clarithromycin 15 mg/kg/day for
10 days. Oral levofloxacin 750 mg for 5 days.
Answer:
Oral amoxicillin 90 mg/kg/day for 5 days. Though viral pathogens also often implicated, the
primary treatment target for presumed bacterial community-acquired pneumonia in children
is Streptococcus pneumoniae. PIDS/IDSA guidelines recommend amoxicillin as a first-line
agent
(A). Cephalosporins can be considered in the presence of penicillin allergy.
Question:
6. A 47-year-old man with a 3-day history of moderate otalgia is diagnosed with acute otitis
media. He requests treatment with an antimicrobial. He is otherwise healthy, has not
received antimicrobials in the past 6 months, and has no history of drug allergies.
Appropriate therapy can include: Cephalexin 250 mg q6h BID for 10 days . Amoxicillin 1000
mg PO TID for 5 days. Trimethoprim-sulfamethoxazole 80 mg/400 mg PO BID for 14 days.
Levofloxacin 750 mg PO QD for 5 days.
Answer:
Amoxicillin 1000 mg PO TID for 5 days. For patients with risk factors for drug-resistant
infections, high-dose amoxicillin-clavulanate or certain cephalosporins are appropriate.
Cephalexin, a first-generation cephalosporin, has limited activity against Gram-negative
bacteria, including H. influenzae and M. catarrhalis, with or without beta-lactamase
production (A). Fluoroquinolones are not recommended as first-line therapy (D) and
TMP-SMX is not recommended for treatment of AOM (C).
,Question:
7. You see an 18-month-old with a history of persistent moderate asthma who presents with a
2-day history of upper respiratory tract infection symptoms and worsening asthma symptoms
over the past 24 hours. She is currently taking an inhaled low-dose corticosteroid twice daily
as well as nebulized albuterol PRN. To manage this asthma flare, you recommend treatment
with: Oral montelukast. Oral theophylline. Oral prednisolone. Oxygen therapy.
Answer:
Oral prednisolone. Leukotriene modifiers such as montelukast are used as controller therapy
and would not offer timely benefits during an asthma flare (A). Montelukast comes with a
FDA warning about serious neuropsychiatric events, including suicidal thoughts and actions.
Theophylline is used to prevent bronchospasm and not to treat an acute asthma flare (B).
Oxygen therapy is not typically needed except in severe asthma exacerbations where oxygen
saturation levels fall below a critical level (D).
Question:
8. Which of the following is indicative of subclinical hypothyroidism? Total T4=43 mcg/dL
(4.5-12.0 mcg/dL); free T3=6.5 pmol/L (3.5-7.7 pmol/L) Total T4=1.3 mcg/dL (4.5-12.0
mcg/dL); free T3=42 pmol/L (3.5-7.7 pmol/L) TSH <0.2 mIU/L (0.4-4.0 mIU/L); free T4=64
pmol/L (10-27 pmol/L) TSH=18 mIU/L (0.4-4.0 mIU/L); free T4=13.2 pmol/L (10-27 pmol/L)
Answer:
TSH=18 mIU/L (0.4-4.0 mIU/L); free T4=13.2 pmol/L (10-27 pmol/L) TSH levels below normal
is an indication of hyperthyroidism (C). Total T4 is rarely an indicated test for thyroid
conditions as the level can be increased or decreased in the absence of thyroid disease (A, B).
Free T3 is also a rarely indicated test for thyroid disorders.
Question:
9. Anticipated findings in a 25-year-old man with epididymo-orchitis would include all of the
following except: Irritative voiding symptoms. Fever. Blood-tinged penile discharge. Painful
scrotal swelling.
Answer:
Blood-tinged penile discharge. Clinical presentation typically includes irritative voiding
symptoms (A), fever (B), and painful swelling of epididymis and the scrotum (D).
Question:
10. All of the following are risk factors for the development of lactic acidosis with metformin
use except: Advanced age (>80 years). Impaired renal function. Obesity. Hypovolemia.
Answer:
Obesity. Risk factors for metformin-induced lactic acidosis include impaired renal function
(B), hypovolemia
(D), low perfusion state, and/or advanced age (>80 years) (A).
, Question:
11. Which of the following children with acute otitis media would you consider utilizing a
watchful waiting approach rather than prescribing antimicrobial therapy? An 8-year-old with
asthma and moderate bulging of left and right TM A 5-month-old with mild bulging of left TM
and fever of 38.7°C (101.7°F) A 5-year-old with 36-hour history of unilateral mild otalgia A
3-year-old with intense TM erythema with otalgia and fever of 39.1°C (102.4°F)
Answer:
A 5-year-old with 36-hour history of unilateral mild otalgia A watchful waiting approach for
AOM should not be considered in children younger than 6 months of age (B), AOM with
bilateral involvement (A), or severe illness (D).
Question:
12. Common signs of depression in a 10-year-old girl can include all of the following except:
Irritable mood. Physical complaints, such as stomach aches. Poor school performance.
Seeking out a new group of friends.
Answer:
Seeking out a new group of friends. Key findings in depression in children include ongoing
feeling of sadness, worthlessness, and guilt, irritable mood (A), loss of interest in social
activities, physical complaints (B), poor school performance (C), and thoughts of dying or
suicide.
Question:
13. A 22-year-old presents after being bitten by a brown recluse spider on the foot two days
earlier. Examination reveals a single lesion surrounded by an erythematous halo with edema
in the surrounding tissue. Treatment can include all of the following except: Local
debridement. Elevation and immobilization. Oral trimethoprim-sulfamethoxazole for 7 days.
Cool compresses to the affected area.
Answer:
Oral trimethoprim-sulfamethoxazole for 7 days. General wound management can include
local debridement (A), elevation, and loose immobilization of the affected area (B). Cool
compresses should be used until progression of the necrotic process has stopped (D).
Question:
14. The expected uterine size and developmental changes noted at 12-weeks' gestation is:
Uterine size of an orange and Chadwick sign is present. Uterine size of a grapefruit and fetal
heart tone detected by Doppler. Uterine fundus is at the level of the umbilicus and mother
reports quickening. Uterine fundus of approximately 34 cm above the symphysis pubis and
mother reports the fetus dropping.
