BIT 1106 PNP Final Exam Questions and Answers.

BIT 1106 PNP Final Exam Questions and Answers. H.O. is a 5 yo Vietnamese child who has fallen off of his growth curve. The best intervention would be to: a. Suggest high-calorie breakfast drinks as supplements b. incorporate traditional foods into a management plan that will provide increased calories and nutrients c. educate the family on the need for increased calories and nutrients d. refer the family to growth clinic for evaluation B While taking the history of 6-month old E.M. you learn that she is not sleeping through the night and will not fall back to sleep without the parents rocking or feeding her. This is an example of: a. somnambulism b. pavor nocturnus c. learned behavior d. delayed sleep phase C Which of the following scenarios is suggestive of a child who may not be ready to enter first grade? An inability to: a. recognize six colors and remember one's phone number b. accurately use pronouns c. empathize with others d. count to five and draw a person with three parts d T.T. is a 9 week old preterm infant whose birth wt was 2.3 kg. Mom was HBs Ag Neg. He is seen today for the first time since discharge from the nursery. He has received no prior immunizations. The appropriate immunizations to give at this time would be: a. Dtap, Hib, IPV, rotavirus, HepB 1, pneumo b. Dtap, Hib, OPV, rotavirus, HepB 1 c. Dtap, Hib, rotavirus, IPV, pneumo d. Dtap, Hib, IPV, pneumo a While examining 10 yo RMs teeth you note that the upper incisors slightly overlap the lower incisors. The second and lower first molars are absent. Your assessment is: a. malocclusion b. delayed mandibular dentition c. normal dentition d. hyperdontia b The mother of 5yo DW is concerned that her son often cheats when playing board games with his older sister. What is the most appropriate response to DWs behavior? a. encourage the parent to use 5 minute time-outs when cheating occurs b. explain that DW is developmentally unable to comprehend rigid rules c. make sure that DW understands the rules before starting to play the game d. explain to DW that cheating is like lying and is not acceptable behavior b Which of the following is not a sign of readiness to toilet train? a. can sit for extended periods b. can follow directions c. occasional waking from naps with dry diapers d. regularity of bowel movements d Which of the following physical findings in a 2 month old child warrants an immediate referral to a neurologist/neurosurgeon? a. head circumference growing faster than height and weight b. unresolved cephalhematoma c. rigid and immobile sagittal suture d. snapping sensation when pressure is applied to parietal bone c While listening to 2.5 yo KL talk, you note that she frequently omits final consonants and her sentences are two and three words in length. The appropriate plan of care would be. a. routine follow up at next well child visit b. referring for hearing screening c. assessing for developmental delays d. referring to a speech pathologist a The mother of 3 yo GW reports that he has begun to stutter. Further probing reveals that the stuttering occurs frequently and lasts 1 to 2 seconds. GW does not seem bothered by the stuttering. The appropirate management would be: a. referral to a speech pathologist b. referral for an evaluation for an anxiety disorder c. reassuring the mother that this is a mild problem d. demonstrating to GW slow, deep breathing before talking c You would expect a school age child to: a. grow 1.5 inches per year b. grow 0.5 inch per year c. gain about 6 lbs per year d. gain about 3 lbs per year c During 8 mon old LBs physical exam, the father boasts that LB is going to be a left-handed batter since he prefers doing everything with his left hand. The appropriate response would be to: a. ask if others in the family are left handed b. suggest play activities that require using both hands c. present toys more often to the right hand d. perform a careful neurological exam d At 12 yo, Peter has been dx with constitutional growth delay. Appropriate management would include: a. starting low-dose testosterone therapy now b. counseling regarding delayed onset of puberty c. thyroxine replacement d. nutritional counseling b Which of the following best describes behavior associated with Piaget's concrete operations? a. learning primarily by trial and error b. interpreting events in relationship to themselves c. categorizing information into lower to higher classes d. drawing logical conclusions from observations c Jeffrey, at 8 years of age, has been diagnosed with ADHD and is receiving stimulant medication. Which of the following interventions would be least helpful? a. monthly ht and wt checks b. small frequent meals and snack c. high-calorie supplemental drinks d. elimination of refined sugar from diet d The principle that growth and development becomes increasingly integrated is best demonstrated by: a. gaining head control before raising the chest b. bringing the cup to mouth, tipping and swallowing c. rolling over before sitting d. grasping with fist before using fingers b In males, Tanner stage III can be distinguished from tanner stage II by: a. fine downy pubic hair at the base of penis b. adultlike pubic hair not extending to thighs c. penile growth in width d. penile growth in length d TJ, 13 yo, reluctantly shares with you that his "chest hurts." On physical exam, you note unilateral breast enlargement, which is tender to palpation. You suspect physiolgic gynecomastia. Which tanner stage would support that diagnosis? a. tanner stage I b. tanner stage III c. tanner stage IV d. tanner stage V b During a physical exam of 10.5 yo Melissa, you note the appearance of breast buds. You tell her that she can expect which of the following in approximately 2 years? a. growth of pubic hair b. peak height velocity c. onset of menses d. axillary hair c Adolescents who engage in risky behavior, such as driving without a seat belt, are displaying: a. a type of egocentrism b. a need for independence c. role experimentation d. low self-esteem a An increase in which of the following behaviors is seen more frequently in late, rather than in early, adolescence? a. value conflict with parents b. focus on physical apperance c. peer group involvement d. understanding inner motivations of others d You detect a hear murmur while examining a 3 yo child. In determining whether of not a referral is necessary, you determine it is an "innocent" heart murmur for which of the following reasons? a. It is best heard during diastole b. it radiates to the axilla c. the intensity is no greater than I or II/VI d. there is no variation with change in child's position c When providing anticipatory guidance about infant development, you might teach parents that a normal infant could first transfer an object from hand to hand at which age? a. 2 mos b. 4 mos c. 7 mos d. 9 mos c A 2 mos old infant at your clinic received a combined Dtap/HepB/IPV vaccine and the parents are in need of teaching about possible side effects. Which of the following is not an adverse effect following administrations of the Dtap vaccination? a. local reaction b. fever c. increased fussiness d. transient morbilliform rash d When reviewing immunization protocols at your clinic, you are aware that the varicella vaccine can be administered to susceptible children beginning at what age a. 4 mos b. 6 mos c. 12 mos d. 15 mos c A 2 wk old infant is in the clinic for a scheduled weight check. The best indication that a 2 wk old infant is receiving adequate breastmilk is that the baby: a. passes a least 4 stools a day b. feeds every 3 hrs c. voids 4 times a day d. has regained birth wt d A mother of an 8 month old infant asks you for advice about continued introduction of solids. Which of the following food groups do you recommend be introduce to the baby last? a. egg yolk b. egg white c. fruits d. vegetables b The mother of a 15 mos old child informs you that she feeds the baby skim milk. You advise the mother to change to whole milk primarily because skim milk: a. is not as easily digested as whole milk b. contains an insufficient amount of calcium c. contains too little protein d. provides an inadequate amount of essential fatty acids d An adolescent is being evaluated for childhood depression. Which behavior or sign is least likely to be evident? a. evidence of hallucinations and delusions b. a history of recurrent "accidents" c. a sense of guilt d. the presence of eating disorders a A 12 yo boy is brought into the clinic for an urgent visit after having ingested 10 diazepam tablets. Following the initial emergent care and stabilization of the child, the most important aspect of your management is: a. referring the case to social services b. assessing the family support available to the child c. obtaining a psychiatric consultation d. reviewing the history for signs of depression c You are seeing a 15 mos old boy with leukemia for a check up. If indicated, this child may receive all of the following vaccines except: a. inactivated polio vaccine (IPV) b. H. influenzae type B (Hib) c. DTap d. Varicella (VAR) d While conducting the Denver II developmental screening test, the mother of an 18 mos old child reports to you that the toddler doesn't imitate activities. You decide to assess the child's development further by giving him tasks from which sector? a. personal-social b. fine motor-adaptive c. language d. gross motor a You have ordered routine blood screening for a 2yo girl who because of dietary habits, is at risk for iron deficiency anemia. Which of the following findings is not associated with iron deficiency anemia? a. hypochromic RBC b. microcytic RBC c. low reticulocyte count d. low free erythrocyte protoporphyrin (FEP) level d During a prenatal visit, you review the mother's record for routine prenatal screening results. While education the mother, you explain that the screening of maternal serum for alpha-fetoprotein (MSAFP) between the 15th - 21st weeks of pregnancy is done primarily to screen for: a. phenylketonuria b. galactosemia c. cystic fibrosis d. neural tube defects d A tenderness is detected over the tibial tuberosity of a 10 year old boy during a routine exam at a school based clinic. The PNP knows this may be a sign of: a. osgood-schlatter dz b. blount's dz c. plantar fasciitis d. effusion in the joint space a The parents of a 1 wk old infant are concerned about the unusual shape of their child's head. In the physical exam of the infant, which of the following signs would not support a diagnosis of craniosynostosis? a. palpation of a ridge along a given suture line b. unusual skull configuration c. a palpable lesion at the occipital region d. abnormal head cirumference c In the emergency room, you encounter a toddler whose injuries are not consistent with the history that is given. Which of the following would be the best step a provider could take in order to foster communication with abusive parents? a. realize that abusive parents have essentially different goals for their children than other caregivers do b. understand that parental hostility and resistance are potent symptoms of fear and inadequacy c. consider referring the parents to substance abuse program d. be cautious when sharing the results of medical findings b You are preparing a drug prevention program for middle school students. Your educational approach is based on the knowledge that the most common substance abuse in adolescence is: a. marijuana b. cocaine c. heroin d. alcohol d During a check up of a 15 mos old girl, you note that the child has dropped significantly in percentile for weight over the past few months. In evaluating a child with failure to thrive, the most important part of you assessment involves: a. the history b. the physical exam c. laboratory studies d. observation of family interactions a A 7yo child in your caseload has recently been placed on methylphenidate for behavioral concerns associated with ADHD. Which of the following side effects are not associated with this drugs? a. decreased appetite b. weight loss c. irritability d. decreased heart rate d The parents of an 8yo child are concerned that their son does not want to attend school. Which of the following historical findings aren't usually associated with the diagnosis of school phobia? a. sporadic school absence b. chronic medical illness c. vague physical symptoms d. depression and anxiety b A 17yo girl is referred to your clinic by the school nurse to be assessed for an eating disorder. Which of the following dynamics is not characteristic of anorexia nervosa? a. excessive eating followed by purging b. a pervasive sense of helplessness and ineffectiveness c. wt loss that gives the patient a sense of mastery and control d. low body temp, pulse, and bp a Following an episode of meningitis, it is most important to assess the child for: a: hearing loss b. changes in taste c. cervical lymphadenopathy d. tinnitus a An 8 yo boy has been brought to the clinic with a chief c/o ear pain. When you grasp the pinna of he ear, he says "that hurts real bad." These findings are consistent with a diagnosis of: a. serous otitis media b. mastoiditis c. otitis externa d. cholesteatoma c Steven, at 10 years of age, as been diagnosed with otitis externa twice this year. Health teaching for Steven and his mother should include: a. emphasis on consistent use of low-dose prophylactic antibiotics b. sleeping with affected ear in the dependent position c. info on the use of decongestants to open the eustachian tube d. info on the use of acetic acid after ear canal contact with water d Following tympanostomy tube insertion, it is important that the tubes remain patent. Which of the following methods may by used to determine patency? a. visual inspection b. impedance tympanometry c. valsalva maneuver d. instillation of an ototopical suspension a The diagnois of AOM in a 1 yo child is based on: a. abnormal findings when pneumatic otoscopy and hearing test are performed b. changes in the tympanic membranes contour, color, and mobility c. presence of fever and color of the tympanic membrane d. presence of fever, ear pain, and tenderness of the pinna b Connor, 12 mos of age, has been treated 5 times for AOM. When planning Connor's f/u care, it is most important to evaluate for which of the following? a. otitis externa b. hearing loss c. enlarged tonsils d. shotty lymph nodes b Brian, 13 yo, presents to the clinic with a sore throat. Hx reveals that he had a sore throat a couple of weeks ago and thought he had gotten well. He now has severe pharyngeal pain of 2 days duration and says he has been sweating and thinks he has fever. Physical exam reveals a temp of 102 and erythematous and edematous pharynx and soft palate. The right tonsil is swollen and inflammed without exudate and the uvula is displaced to the left. Right cervical nodes are tender. Lungs are clear to auscultation. Brian's signs and symptoms are suggestive of: a. acute uvulitis b. viral pharyngitis c. epiglottitis d. peritonsillar abscess d Which of the following is an expected finding after treatement of acute suppurative otitis media? a. otitis externa b. central auditory dysfunction c. functional hearing loss d. middle ear effusion d The mother of 2yo Shanda has brought her to the clinic bc she thinks the child is having trouble hearing. Your evaluation of the compliant should start with: a. asking detailed questions related to Shanda's medical history b. examination of the ear c. tympanometry and hearing tests d. assuring the mother that transient hearing loss in childhood is common a Assessment of the red reflex may be used to rule out which of the following: a. opacities b. myopia or hyperopia c. decreased visual acuity d. blindness a The mother of 2yo Bridget has brought her to the clinic because "she got bathroom cleaner in her eye." Hx reveals that about 30 min ago, Bridget was sitting on the floor playing with a squeeze bottle of bathroom cleaner, when the bottle accidentally opened and the liquid splashed into her right eye. Physical exam reveals a reddened right eye with an edematous lid. Initial treatment should include: a. allowing the natural tearing process to cleanse the eye b. performing a retinal fundoscopic exam to assess for burns c. irrigating the eye with copious amount of normal saline d. referring Bridget to an opthalmologist c The mother of a 5yo boy has brought him to the clinic bc she thinks he has pinkeye. Which of the following would lead you to consider a dx other than bacterial conjunctivitis? a. hyperemic conjunctiva b. scratchy sensation in the eye c. decreased corneal clarity d. copious tearing c Julie, at 18 mos of age, has been brought to the clinic by her mother who tells you that Julie has had a cold for the past 4 days. There is no hx of cough and the mother is unsure whether Julie has had fever. Physical exam reveals greenish, blood-tinges mucus with a strong, foul odor, draining from the right nostril. The clinical picture is most consistent with a diagnois of: a. allergic rhinitis b. viral rhinits c. acute sinusitis d. nasal foreign body d In a child with chronic sinusitis, the most accurate method of identifying sinus abnormalities is: a. dark room transillumination of the sinuses b. percussion of the paranasal sinuses c. AP, lateral, and occipitomental sinus radiograhps d. CT scan of the sinuses d The mother of 12yo Nathan has brought him to the clinic bc he has had a runny nose for 2 wks. Hx reveals that Nathan has visited the clinic 3 other times this year for upper respiratory complaints. Examination reveals slightly edematous and erythematous eyes, pale nasal mucosa with clear mucus, and pharynx with thin secretions posteriorly. There is no tonsillar swelling or exudate. Lips and nail beds are pink. Lymph node exam is significant for multiple shotty nodes. Lungs are clear to auscultation. Which actions is appropriate at this time? a. discuss symptomatic relief of the common cold with Nathan and his mother b. culture nasal drainage and delay treatment until result are known c. order an antibitotic d. order an antihistamine d A 1 wk old infant has been diagnosed with nasolacrimal duct obstruction. A typical initial therapy includes: a. use of prophylactic oral antibiotics b. nasolacrimal sac massage c. surgical opening of obstructed ducts d. referral to an ophthalmologist b Marie, at 4 years old, has been brought to the clinic bc she " has something wrong with her eye." Marie and her mother report that there has been no injury to the eye and that it has been red since yesterday. Exam reveals conjuntival hyperemia and a copious amount of purulent discharge bilaterally. Vision, pupilary reflexes, and corneal clarity are normal. Which treatment should be ordered? a. sodium sulfacetamide ophthalmic solution b. gentamycin ophth sol c. tobramycin ophth sol d. cromolyn sodium ophth sol a During the routine exam of a 12 yo boy, you detect a group of hard fixed nontender lymph nodes, each of which measure about 1 cm, in the posterior cervical chain. You are unable to detect any signs of infection. Your management should include: a. recording the finding and reassessing the nodes in 1 month b. ordering a 10d course of a broad spectrum abx and reevaluating the nodes in 2wks c. ordering a CBC, ESR, and chest radiograh d. referring the child to and allergist c Which method might be used to assess the vision of a 1 mos old child? a. check the vessel pattern of the fundus of the eye b. watch to see if the infant turns his or her head toward you when you speak c. observe the pattern of interaction with the mother d. perform the titmus test on the infant C The most common congenital heart defect in children is: a. tricuspid atresia b. ventricular septal defect c. coarctation of the aorta d. pulmonary atresia with intact ventricular septum b The mother of a 4 mos old infant reports that he turned "blue" and seemed to have fast, labored breathing after vigorous crying soon after awakening. He settled down and his color and breathing seemed to improve. On physical exam, the mucous membranes of the lips and mouth appear mildly cyanotic. A systolic murmur is heard best at the left sternal border. Vital signs are normal with normal peripheral pulses. There is no hepatomegaly. A likely diagnosis is: a. congestive heart failure b. acute life-threatening event related to reflux c. coarctation of the aorta d. cyanotic spell related to tetraology of Fallot d Management of the infant with suspected heart dz and a reported cyanotic spell should include: a. prompt referral to a cardiolgist b. an apnea monitor for 30 days to document further events c. instructing the parent to keep a diary of these episodes d. continuous administation of oxygen a Chest pain in young children is usually: a. a symptom of congenital heart disease b. noncardiac in origin c. an early sign of hypercholesterolemia d. a symptom of CHF b A common cause of CHF in the first year of life is: a. mild pulmonary stenosis b. inflammatory heart disease c. rheumatic fever d. complete heart block d The least likely physical finding in a 2 mos old infant with CHF is: a. tachypnea b. tachycardia c. hepatomegaly d. pedal edema d Which of the following may cause vol. overload leading to CHF if not appropriately followed and managed? a. coarctation of the aorta b. pulmonary stenosis c. ventricular septal defect d. supraventricular tachycardia c A vibratory systolic murmur is heard between the lower left sternal border and the apex in a healthy 4yo girl at her preschool physical. There are no concerns from the parent. The cardiovascular exam is otherwise normal. A likely diagnosis: a. venous hum b. still's murmur c. transposition of the great arteries d. rheumatic heart disease b Characteristics of a venous hum include: a. a systolic murmur b. radiation over precordium c. marked decrease or disappearance of murmur when child is supine d. heard best at lower left sternal border c Which of the following is true regarding innocent murmurs? a. the murmur is often holosystolic b. prompt referral to a cardiologist is indicated c. a precordial thrill is present d. the murmur is low in intensity, grade 1 through 3 d SBE prophylaxis is recommended for: a. all children with congenital heart disease on a daily basis b. all children with cong. heart dz before dental, GI, and GU procedures c. children with repaired cong. heart dz with a residual defect at the repair site d. children who have undergone surgical repair of a cong. heart condition for 5 yrs after the procedure c A 12 yo girl seen at a routine visit has a bp of 145/90. She denies any symptoms. The initial management would include: a. intravenous pyelogram b. return for two repeat blood pressure measurements c. no f/u needed--blood pressure probably related to anxiety d. diuretic therapy b A 4yo caucasian female presents for a well-child check. Her bp by auscultation is 135/80. There is no significant family hx of HTN or heart dz. Besides wanting to repeat the bp for accuracy, what are potential differential diagnoses for this child? a. severe coronary artery dz b. renal artery stenosis and coarctation of the aorta c. rheumatic fever and ventricular septal defect d. tetralogy of fallot and coarctation of the aorta b A 9 yo boy presents with a fever of 102 and complains of leg pains. His mother reports that he had an URI with a sore throat approximately 2 wks ago which subsided without therapy. On physical exam, he has tender swollen knees bilaterally. His heart rate is 120/min and a blowing systolic murmur is heard at the apex that was not noted on previous visits. The most likely diagnosis is: a. kawasaki dz b. rheumatic fever c. sickle cell anemia d. viral infection b The most useful test for evaluation of suspected acute rheumatic fever is: a. antistreptolysin-O (ASO) titer b. electrocardiogram c. hemoglobin electophoresis d. urinalysis a The initial attack of acute rheumatic fever is preceded by: a. a viral illness b. a group A streptococcal infxn c. an exposure to mites d. an exposure o chicken pox b A 3 wk old infant has a 1 day hx of irritability pallor and poor feeding. He is afebrile. On physical exam, his HR is 240 bpm while asleep. The most likely dx is: a. supraventricular tachycardia b. premature ventricular contractions c. sinus tachycardia d. cyanotic heart defect a A 10 mos old infant presents with a 3 day hx of fever, runny nose and coughing. Per the parent, has not been eating well, and only drinking a few cups of milk and juice over the last 2 days. On exam, he feels very warm, his RR is 45 and his HR is 210. He has no rashes. His abd is soft and round. Your initial dx includes: a. SVT based on HR; needs immediate transfer b. CHF based on HR and RR, need immediate transfer c. Sinus tachycardia based on clinical hx and HR; needs antipyretics and possibly fluids d. kawasaki dz based on clinical hx and fever; needs transfer for IV IgG c The most common cause of myocarditis is: a. bacterial b. viral c. drug reaction d. radiation therapy b Which of the following is not an expected finding in a child with myocarditis? a. persistent tachycardia b. hx of antecedent flulike illness c. a gallop rhythm d. a significant heart murmur d Which of the following is not a component of Metabolic syndrome, a clustering of factors in children shown to be associated with increased risk of coronary artery disease later in life? a. obesity b. elevated lipid levels c. heart murmur d. elevated fasting glucose levels c Initial management of a 4 yo, overweight boy with a repeat total cholesterol level of 185 md/dl includes all of the following excepts: a. educate the family about decreasing saturated fat intake to less than 7% of calories and cholesterol intake to less that 200mg per day b. blood sent for lipoprotien analysis c. educate the family about decreasing/eliminating daily intake of fruit juices, sugar-sweetened food and beverages, and salt intake d. educate the family about increasing aerobic activities a Kawasaki dz is most common in: a. neonates b. children younger than 5 years of age c. children older than 6 years of age d. females b A principal clinical feature that aids in the diagnosis of Kawasaki dz includes: a. low-grade fever for 24 hrs and a pruritic rash b. conjunctivitis with exudate and facial rash c. arthritis and chorea d. High (39C/102F) fever persisting at least 5 days and acute erythema and/or edema of hands and feet d An essential test in the evaluation of a 2yo child being managed for Kawasaki dx is : a. an echocardiogram b. electrolytes c. cholesterol d. streptoccoccal antibody titer a The PNP is teaching a group of expectant parents about infant care and illness prevention. It is most important for the PNP to stress: a. keeping all animals out of the house b. keeping the infant away form cigarette smoke c. keeping the infant well covered at night d. keeping the infant away from crowds b Which of the following does not place an infant at increased risk for sudden infant death syndrome? a. documented episodes of periodic breathing b. prematurity c. severe bronchopulmonary dysplasia d. apnea of prematurity a In the management of a child with bronchiolitis, the early use of which of the following is likely to be the most benficial? a. antihistamines b. broad spectrum antibiotics. c. fluids and nutritional support d. bronchodilators c A NICU graduate with bronchopulmonary dysplasia (BPD) has been discharged to home. A potential problem area that requires close monitoring is: a. insufficient caloric intake b. atrophy of abdominal muscles due to abdominal breathing patterns c. lack of tactile stimuli due to restrictions on parental handling d. the predisposition to development of nasal polyps a A 4 yo child with cystic fibrosis (CF) comes to the primary care office with c/o runny nose, cough, congestion, and fever. You know that children with CF: a. are more likely to have normal CXR and LFTs findings b. usually are poor eaters with accompanying poor growth c. routinely take an oral mucolytic agent d. warrant more liberal use of antibiotics for respiratory infections d To promote normal growth in the child with cystic fibrosis, dietary management should include: a. limited fats and 50% more calories than usual daily allowances b. liberal fats and 50% more calories than usual daily allowances c. the usual # of calories as indicated by ht and wt d. limited fat and sodium in moderation b Mrs. S has brought 10 day old Jacob to the clinic bc she is concerned about his breathing. She says that while she is feeding the baby, he often stops breathing for periods of about 10 secs. History reveals that Jacob eats well, has never appeared pale or cyanotic, and has never become limp during any of the apnea episodes. Your management plan is based on which of the following? a. this is a normal breathing pattern for an infant b. these episodes likely indicate aspiration of formula and should be evaluated c. a variety of pathologic processes are associated with the episodes described d. neurologic deficits in infants are often manifested by such episodes a Matthew, at 5 mos old, is brought to the clinic bc he has been coughing and has had clear rhinorrhea for the last 2 days. His mother tells you that he has never been sick before. Family hx is positive for allergies and you hear generalized wheezing. You may conclude that: a. Matthew has familial asthma b. Matthew has asthma exacerbated by a viral infection c. Matthew should be referred for allergy testing d. Asthma should not be diagnosed at this stage d When educating parents regarding transmission of RSV, it is important to stress which of the following? a. children with RSV should be totally isolated from other children b. RSV can be spread by airborne droplets or from contact with a hard surface that has been contaminated c. children who attend day care centers should take prophylactic antibiotics early each fall d. wiping hard surfaces with soap and water or disinfectant will not help in the prevention of RSV transmission b In mild to moderate attacks of acute asthma, albuterol should be given every 3 to 4 hrs and routine medications should be: a. continued as usual b. discontinued until albuterol treatments are deemed unnecessary c. given only if the albuterol is ineffective d. be decreased to the minimum recommended dose a Josh, age 5, presents to the clinic with inspiratory stridor, drooling, and a temp of 105. He insists on sitting up during the clinical examination. This clinical picture is most consistent with a dx of: a. aspirated foreign body b. reactive airway dz c. viral croup d. epiglottitis d Josh, age 5, presents to the clinic with inspiratory stridor, drooling, and a temp of 105. He insists on sitting up during the clinical examination. Appropriate initial management of Josh includes: a. high dose of an oral broad spectrum antibiotic and antipyretics b. teaching the mother to administer racemic epi by nebulization c. teaching the mother how to administer loading and decreasing doses of prednisione d. immediate hospitalization with intravenous antibiotics d A dx of croup is substantiated by which radiographic finding? a. ground glass appearance in the upper airway b. sparse areas of atelectasis c. "thumb sign" on lateral view d. "hourglass" narrowing in the subglottic region d A lethargic appearing 18 mos old child presents to the clinic with s/s of croup. Physical exam reveals a RR of 20 bpm and mild dehydration. Appropriate management includes: a. instructing the mother to force fluids and use a cool mist humidifier in the child's room b. instructing the mother to liberally give fluids and to encourage intake of solid food c. prescribing an oral broad spectrum antibiotic and prednisone d. referring the child for hospitalization and IV fluids d A 6 mos old boy is brought to the clinic bc he has been coughing since yesterday. His mother states that he has never been sick before. She thinks he has been afebrile but is not sure. Physical exam reveals a well-developed baby with a RR of 50 bpm, mild retraction, wheezes, and a dry cough. Chest radiograph reveals diffuse hyperinflation and patchy areas of infiltration. These findings are most consistent with a dx of: a. laryngotracheobronchitis b. cystic fibrosis c. bronchiolitis d. respiratory distress syndrome c Brent, a 22 mos old, has been brought to the clinic by his mother who says he has been coughing for 2 days and is now making a funny noise when he breathes. Examination reveals a fussy child with a brassy cough and inspiratory stridor. Lips and nail beds are pink. Axillary temp is 103F and RR is 50 bpm. The most likely diagnosis of Brent's condition is: a. laryngotracheobronchitis b. brochiolitis c. respiratory distress syndrome d. reactive airway disease a Brent, a 22 mos old, has been brought to the clinic by his mother who says he has been coughing for 2 days and is now making a funny noise when he breathes. Examination reveals a fussy child with a brassy cough and inspiratory stridor. Lips and nail beds are pink. Axillary temp is 103F and RR is 50 bpm. Which diagnostic test should be ordered first for Brent? a. pulmonary function tests b. throat culture c. radiograph of the upper airway d. laryngoscopic exam c Emily, a 4 yo, stays with her great aunt during the day while her mother is at work. Emily's mother has brought her to the clinic bc the great aunt has just been dx with TB. Emily's Mantoux skin test is positive but there is not clinical or radiographic evidence of dz. Appropriate managment includes: a. reassuring Emily's mother that no treatment is needed b. Administering another skin test in 3 mos c. oral penicillin therapy d. oral preventative isoniazid therapy d The mother of 2yo Heather has brought her to the clinic with a "bad cough". Hx reveals onset of illness 4 days ago with clear rhinorrhea and coughing. Her mother says that Heather's fever has been as high 103 axillary. Physical exam reveals a temp of 101F and RR of 56 bpm, w/ slight nasal flaring and intercostal, subcostal, and suprasternal retractions. The pharynx is red without tonsillar exudate. Chest auscultation reveals widespread rales and wheezing. The lips and nail beds are slightly pale but pink, skin turgor is good and mucous membranes are moist. The most likely diagnosis of Heather's condition is: a. viral pneumonia b. pneumococcal pneumo c. strep pneumo d. Hib pneumo a The mother of 2yo Heather has brought her to the clinic with a "bad cough". Hx reveals onset of illness 4 days ago with clear rhinorrhea and coughing. Her mother says that Heather's fever has been as high 103 axillary. Physical exam reveals a temp of 101F and RR of 56 bpm, w/ slight nasal flaring and intercostal, subcostal, and suprasternal retractions. The pharynx is red without tonsillar exudate. Chest auscultation reveals widespread rales and wheezing. The lips and nail beds are slightly pale but pink, skin turgor is good and mucous membranes are moist. Initially, Heather should receive which diagnostic test? a. sputum culture b. sputum gram stain c. chest radiograph d. erythrocyte sedimentation rate c The mother of 2yo Heather has brought her to the clinic with a "bad cough". Hx reveals onset of illness 4 days ago with clear rhinorrhea and coughing. Her mother says that Heather's fever has been as high 103 axillary. Physical exam reveals a temp of 101F and RR of 56 bpm, w/ slight nasal flaring and intercostal, subcostal, and suprasternal retractions. The pharynx is red without tonsillar exudate. Chest auscultation reveals widespread rales and wheezing. The lips and nail beds are slightly pale but pink, skin turgor is good and mucous membranes are moist. When deciding whether Heather should be treated at home or in the hospital, it is most important to consider Heather's: a. max temp b. frequency of coughing episodes c. hydration status d. total length of illness c Which of the following secondary skin changes is not associate with atopic dermatitis? a. lichenification (thick, leathery patches of skin) b. striae c. pigment changes d. excoriations b In infants, the lesions associated with atopic dermatitis are most likely to be distributed on the: a. cheeks and forehead b. wrists and ankles c. antecubital and popliteal fossae d. flexural surfaces a A 7 yo AA female presents with several hyperkeratotic raised, periungal lesions on the two middle fingers of her left hand. She has a history of nail biting. The most likely dx is: a. impetigo b. molloscum contagiosum c. verruca vulgaris d. herpetic whitlow c During the newborn exam of KL, you note a generalized lacy reticulated blue discoloration. This clinical presentation describes: a. harlequin color change b. mongolian spots c. blue nevus d. cutis marmorata d DM, 7 yo, presents with a beefy red macular-papular rash on the diaper area with satellite lesions on the abdomen. the appropriate treatment would be: a. clotrimazole b. A & D ointment c. gentian violet 1 to 2 % d. cornstarch a The mother of 4 yo TW states that the infant has been irritable and has not been sleeping well. During the physical exam, you note papular lesions on his feet and erythematous papules over his back. To confirm your suspicion of scabies you would order a: a. wood's lamp examination b. microscopic skin scraping c. KOH prep of skin scraping d. skin culture b During 3 yo JTs physical exam, you observe eight, light brown macules, ranging in size from 0.5 to 0.75 cm on his trunk, arms, and legs. Your management plan would be to: a. educate the family to apply sunscreen frequently b. explain that the lesions will fade with time c. refer to dematologist d. document the findings an reevaluate in 6 mos c Mrs. Franklin is concerned about a light pink lesion on the back of 2 mos old Aaron's neck that darkens with crying. The description is consistent wtih: a. sturge-weber dz b. salmon patch c. port-wine stain d. hemangioma b The mother of 4 yo TW states that the infant has been irritable and has not been sleeping well. During the physical exam, you note papular lesions on his feet and erythematous papules over his back. Having confirmed the dx of scabies in TW, the treatment of choice would be: a. permethrin 5% b. lindane 1% c. sulfur oitment 6% d. crotamiton 10% a Mrs. J brings her 6 yo son in bc of "hives" that she describes as a red raised rash. Which finding below would support a dx of erythema multiforme rather than uriticaria? a. lesions that blanch with pressure b. eyelid edema c. lesions that are present for more than 24 hrs d. intense pruritus c When examining 7 mos old RV, you note red scaly plaques in his diaper area, particularly in the inguinal folds, with satellite lesions on his abdomen. The appropriate treatment would be: a. petrolatum/lanolin ointment b. petroleum jelly c. zinc oxide d. nystatitn d Which of the following statements regarding treatment of pediculosis capitis is true? a. carpeting and furniture must be shampooed and sprayed with a pediculicide b. nonwashable items that have come into contact with an infected person should be sealed in plastic bags for 2 - 4 wks c. hair must be trimmed close to the scalp to insure elimination of nits d. frequent shampooing with permethrin 1 % will prevent reinfestation b You not a single, large, oval, pink, patch with central clearing on 16 yo MPs back. Lesions are not present elsewhere. Results of the KOH prep of the lesion are negative. This would confirm a dx of: a. seborrheic dermatitis b. secondary syphilis c. tinea corporis d. pityriasis rosea d LR, at 6 years of age, presents at clinic with a solitary nonprruritic lesion around his upper lip. Closer inspection reveals some vesicles and honey colored crusts. The most likely dx is: a. herpes simplex b. varicella c. nummular eczema d. impetigo d LR, at 6 years of age, presents at clinic with a solitary nonprruritic lesion around his upper lip. Closer inspection reveals some vesicles and honey colored crusts. The treatment of choice for LR would be: a. acyclovir b. topical steroids c. topical antibiotics d. petrolatum/lanolin ointment c During 15 yo NMs routine physical exam, she c/o getting pimples all the time. You note open and closed comedones over her forehead and chin. There are more than 15 papules and pustules, but no cysts. NMs clinical presentation is consistent with: a. comedonal acne b. mild acne c. moderate acne d. severe acne c During 15 yo NMs routine physical exam, she c/o getting pimples all the time. You note open and closed comedones over her forehead and chin. There are more than 15 papules and pustules, but no cysts. Which of the following medications below is the appropriate choice? a. antiandrgens b. isotretinoin c. minocycline d. corticosteroids c During 15 yo NMs routine physical exam, she c/o getting pimples all the time. You note open and closed comedones over her forehead and chin. There are more than 15 papules and pustules, but no cysts. Which of the following statements is not consistent with an appropriate management plan for acne? a. improvement with use of keratolytic agents should occur within 4-6 wks b. facial scrubs are recommended before applying topical antibiotics c. noncomedogenic moisturizers and cosmetics may be used d. sunscreens should always be used in conjunction with retinoic acid b HB is 2 days old. Her mother calls and reports a rash consisting of redness with yellow-white "bumps" all over her body except for the palms and soles. The infant most likely has: a. erythema toxicum b. transient neonatal pustular melanosis c. molluscum contagiosum d. milia a DJ is a 4 yo AA child with a depigmented macular lesion on his forehead. The lesion has sharp borders. No scales are present. The most appropriate treatment would be: a. 1% hydrocortisone b. alpha hydroxy acid c. ketoconazole d. silver sulfadiazine a While examining 7yo SRs scalp you note three small patches of hair loss. Broken hair is present, as is erythema and scaling. Based on this information, which of the following dx is most likely? a. tinea capitis b. traction alopecia c. trichotillomania d. alopecia areata a The mother of 4 mos old ND reports episodes of vomiting and diarrhea beginning 2 days ago. He has also had several episodes of screaming and drawing up his legs. Prior to this he has been healthy with a normal wt gain. The likely dx is. a. incarcerated hernia b. gastroenteritis c. intussusception d. pyloric stenosis d The mother of 4 mos old ND reports episodes of vomiting and diarrhea beginning 2 days ago. He has also had several episodes of screaming and drawing up his legs. Prior to this he has been healthy with a normal wt gain. Physical exam of ND reveals a sausage-shaped mass and guaiac-positive stool. This would confirm a dx of: a. incarcerated hernia b. gastroenteritis c. intussusception d. pyloric stenosis c RD, at 14 years of age, presents with a c/o abd pain that has occurred several times over the past 3 mos. She describes the pain as an intermittent sharp pain, occasionally relieved with a heating pad. Her physical exam is WNLs. You suspect recurrent abd pain (RAP). Which clinical finding is most consistent with RAP? a. periumbilical pain b. constipation c. pain worsens with defecation d. wt loss a Education and counseling of the parents of a 4 mos old child with gastroesophageal reflux should include all of the following except: a. thicken formula with rice cereal b. change to a hypoallergenic formula c. place infant in a car seat after feeding d. avoid exposure of the infant to tobacco smoke c (sitting the infant in a car seat or similar device compresses the stomach, making the infant more likely to reflux) BW, at 6 years of age, c/o sharp epigastric pain radiating to his back. Which labatory data would be consistent with these physical signs? a. decreased albumin b. elevated serum amylase c. elevated serum gastrin d. decreased serum protein b An umbilical hernia: a. occurs more frequently in full-term infants b. resolves spontaneously in 3 to 6 months c. is frequently associated with diastasis recti d. responds well to taping c SL, at 9 years of age, is brought to the clinic for eval of abd pain that wakes her at night. Her parents have recently divorced an she is attending a new school. She has missed 8 days of school in the past 6 wks. She reports occasional emesis. An appropriate management plan would be: a. a band diet with small frequent feedings b. a referral to a gastroenterologist c. to stress importance of school attendance d. to consult with the school psychologist b JD, at 7 mos of age, is seen with a 2 day hx of diarrhea. He has had 3 to 4 wet diapers in the past 24 hrs. The anterior fontanel is slightly depressed. Capillary refill is normal. Which degree of dehydration is most consistent with these findings? a. 1 to 2% b. 3 to 5% c. 6-10% d. greater than 10% c ( depressed fontanel & decreased UOP are indicators of moderate 8% dehydration) JD, at 7 mos of age, is seen with a 2 day hx of diarrhea. He has had 3 to 4 wet diapers in the past 24 hrs. The anterior fontanel is slightly depressed. Capillary refill is normal. Based on your assessment of JD, the appropriate management plan for his dehydration would be to: a. begin BRAT diet b. withhold formula for 24 hrs and give electrolyte solution c. begin rehydration in the office and observe for 3 to 4 hrs d. refer immediately for parenteral fluids c AW, at 3 days old, presents with vomiting, abd distention, and constipation. Which of the following should be included in the diff dx? a. hirschsprung dz b. pyloric stenosis c. celiac dz d. meckel diverticulum a CR, 4 yo, was dx with celiac dz a 18 mos. In addition to closely monitioring her growth, you also monitor for anemia. At this visit her lab results confirm an elevated MCV. An appropriate f/u lab test would be serum: a. protein b. ferritin c. folate d. transferrin c Justin, 11 yo, presents with c/o chronic diarrhea and abd pain. You note a 5 kg wt loss from last year's annual exam. Today, his exam reveals RLQ pain and perianal skin tags. The most likely dx is: a. encopresis b. crohn's dz c. irritable bowel dz d. ulcerative coliits b EG, at 9 years of age, presents with diffuse abd pain and acute onset of diarrhea described as a frequent urge to defecate. She is passing large amounts of flatus, small amounts of stool, and c/o tenderness during rectal examination. This clinical picture is highly suggestive of: a. gastoenteritis b. ulcerative colitis c. giardiasis d. appendicitis d EG, at 9 years of age, presents with diffuse abd pain and acute onset of diarrhea described as a frequent urge to defecate. She is passing large amounts of flatus, small amounts of stool, and c/o tenderness during rectal examination. Which of the following lab test would confirm your dx for EG? a. serum albumin b. abd ultrasound c. stool for ova and parasites d. bone age b Sam, at 8 years of age, presents to your clinic with his third episode of diarrhea in 3 mos. He also c/o frequent flatulence and a decreased appetite. After going over the hx, you recall that he went on a camping trip with his Cub scout troop several months ago. What is the most likely dx? a. celiac dz b. giardiasis c. rotovirus d. crohn's dz b JV, 7 yo, presents with a 1 wk hx of fever, nausea, and anorexia. His mother reports that his skin "looks funny" as well. Further lab studies confirm a dx of viral hepatitis. which type of hepatitis is the most likely? a. A b. b c. C d. D a CA, 2 wks old, is being seen for the first time since discharge from the newborn nursery. She currently weighs 3.6kg, which is 0.3 kg below her birth wt. While interviewing her mother you learn she has been using too little water when preparing the formula. Which of the following is least likely related to the error? a. vomiting b. diarrhea c. dehydration d. flatus d ( too little H20 will increase GI and renal solute load, may result in vomiting, diarrhea and dehydration) Vomitus that is bilious suggests: a. GI obstruction proximal to the pylorus b. GI obstruction below the ampulla of vater c. pyloric stenosis d. peptic ulcer dz b JP, 5 yo, presents with a hx of stool staining his underwear, evidence of bright red blood after wiping, and abd discomfort. The physical exam reveals moderate abd distention with midline abd mass. Rectal exam is positive for an impacted rectum and two small anal fissures. The priority in your management plan would be: a. increasing H2O and fiber in the diet, and limiting milk intake b. regular toilet sitting for 10 mins, 3 x a day c. 2 fleets enemas d. mineral oil after breakfast and before bed c Which of the following would not be included in the management of pinworms? a. nutritional support and iron supplementation b. simultaneous treatment of all family members c. washing bed linen in hot water d. keeping fingernails short and clean a Mrs. D reports starting her 6 mos old infant on rice cereal sweetened with one tablespoon of honey. In addition, the infant is consuming 42 oz of forumla. His ht and wt are at 50% on the growth curve. You would recommend: a. adding pureed vegetables b. substituting 4oz juice for a formula feeding c. adding scrambled egg whits d. discontinuing honey d Sam's mother has telephoned the clinic because chicken pox has been "going around" at Sam's school and she has just noticed a few red spots along the hairline on his face. She asks if there is anything that can be given to shorten the duration or severity of the illness. Which of the following is most accurate? a. diphenhydramine elixir has been shown to shorten the duration and severity of the rash b. acyclovir has been shown to shorten the duration and severity of the illness c. aspirin taken 4x a day has been shown to shorten the duration and severity of the illness d. there is no medication known to alter the course of the illness b A 14 yo adolescent has been dx with mononucleosis. The PNP should teach the adolescent and the parents that which of the following should be avoided? a. strenuous exercise if the spleen is palpable b. wt-bearing activities until lab test show resolution of the dz c. unnecessary activity until lymph nodes return to normal size d. stretching and reaching activities during the acute stage of illness a A well-nourished 10 yo girl presents to the clinic with low-grade fever, sore throat, fatigue and malaise, and left upper abd pain. Based on clinical presentation and lab results, a dx of infectious mononuclesis is made. Which of the presenting signs and symptoms requires further investigation immediately? a. low-grade fever b. sore throat with lymphadenopathy c. fatigue and malaise d. left upper abd pain d Initial treatment for a child with uncomplicated infectious mono should include: a. home care with bed rest progressing to activity as tolerated b. home care with complete bed rest until afebrile c. hospitalization with complete bed rest until lab values return to normal d. hospitalization with daily, planned physical therapy a You are performing a physical exam on a 12 yo boy who is planning to go to summer camp in a primitive wooded area. What teaching is appropriate for the prevention of Rocky Mountain spotted fever? a. inspect the body several times a day and remove ticks immediately b. inspect the skin while taking a shower and apply soap to ticks before removing c. ticks should be removed only after they have been killed with alcohol d. tick removal should be performed by a healthcare professional a The mother of 8 yo John telephones to tell you that he developed chicken pox 3 days ago. She wants to know if there is anything she can do to make him more comfortable. You should tell his mother to: a. apply topical calamine lotion b. apply a topical antibiotic to the new vesicles c. give aspirin for fever and discomfort d. keep John our of bright light a The mother of 8 yo John telephones to tell you that he developed chicken pox 3 days ago. She wants to know if there is anything she can do to make him more comfortable. You should also tell his mother to: a. avoid getting the lesions wet b. encourage him to take a bath every day c. have John take a bath only if he develops a fever and sweats d. encourage John to take only sponge baths until all lesions are healed b The mother of 8 yo John telephones to tell you that he developed chicken pox 3 days ago. She wants to know if there is anything she can do to make him more comfortable. John's mother calls you again 10 days after onset of the initial rash to report that John has had a severe headache since yesterday and that he is very irritable. Which of the following would be advised? a. ask the mother if John has had a bowel mvmt since he has been ill b. tell John's mother that these symptoms are common when chicken pox is resolving c. ask the mother if there is a family hx of severe headaches d. ask John's mother to bring him to the office today for evaluation d A 16 yo boy has been dx with measles (rubeola). He is also c/o ear pain. His tympanic membranes are red and bulging. Appropriate mgmt of the ear problem is to treat the ears with: a. pain medication until the virus has run its course b. the same med used to treat any case of otitis media c. liquid topical antibiotics and topical steroids d. acyclovir given by mouth b The mother of 7 yo Bob has brought him to the clinic bc he has a rash. Physcial exam reveals vesicles on the hands, feet and in the mouth. Hand, foot and mouth dz is diagnosed. Treatment is based on: a. alleviating symptoms b. eradication of causative bacteria c. prevention of febrile convulsions d. prevention of secondary infections a The mother of 6 yo Cali brings her to the clinic bc the family is planning a trip to a tropical area, and she wants to know how to avoid illness. Knowing that cases of malaria have been reported in the area, you should teach: a. avoidance of contact with infected people b. hand washing after touching contaminated fomites c. avoidance of mosquito bites d. cooking of all vegetables c Steven, at 6 years of age, has been dx with erythema infectiosum (fifth dz). His mother asks you how to prevent the spread of the dz to her other children. Your answer should be: a. the dz is not thought to be contagious b. stephen should eat and drink from disposable containers c. other children should not be allowed to touch the erythematous areas d. the patient is no longer contagious by the time the rash appears d Considering the patho associated with erythema infectiosum (fifth dz), a child with hx of which of the following diseases must be monitored closely? a. frequent respiratory infections b. multiple skin allergies c. malabsorption syndrome d. hemolytic anemia d (bc of reticulocytopenia associated with EI may result in dangerous decrease of hemoglobin concentration in the child with hemolytic anemia) The mother of 4 day old Susan has brought her to the clinic bc she has not seemed interested in her bottle since yesterday. Physical exam reveals a lethargic infant with an axillary temp of 96F and a pulse rate of 100. Extremities are slightly cool. Appropriate mngmt includes: a. reassuring the mother that infants tend to regulate their own feeding habits b. instructing the mother on proper nipple placement and feeding techniques c. changing the infant to a soy-based formula and reevaluating her in 24 hrs d. considering the possibility of sepsis with appropriate referral d The mother of a toddler with a typical roseola-type rash and a hx of high fever asks if there is any treatment available for the condition. The PNP tells the mother that: a. topical corticosteroids are helpful to relieve itching b. oral diphenhydramine is helpful to decrease desquamation c. aspirin should be used to treat the typical high fver d. there is not medical treatment for roseola d Mrs. Chancellor contracted rubella while pregnant with 2 mos old Andrew. Andrew should be considered contagious for what time perioud? a. between 5 and 7 days b. until he is afebrils c. at least the first year of life d. he is not contagious c (infants with congenital rubella may excrete the virus from the nasopharynx and in the urine for a year) James, at 4 years old, has been dx with cat scratch dz. His mother asks what should be done about the cat. What should your response be? a. the cat should be isolated until it can be treated with antibiotics b. the cat should be isolated until it can be treated with anthelmintics c. the cat should be evaluated by a medical lab and destroyed d. there are no recommendations for treating and destroying the cat d Which of the following vaccines is contraindicated for routine use in a 3 yo child for maintenance treatment of acute lymphocytic leukemia? a. DPT b. injectable influenza c. MMR d. hepatitis b c Stephanie, at 1 year old, is infected with HIV, but is asymptomatic at this time. When should her MMr immunization be given? a. according to the usual schedule b. after she has been asymptomatic for 1 year c. only if she attends day care d. MMR should not be given to her b Premature infants should receive routine immunizations based on: a. chronological age b. gestational age c. birth wt d. current wt a Which of the following is recommended as the standard immunizing agent for healthy preschool children? a. DTP b. DTaP c. DT d. Td b An injury at which of the following sites will most likely result in a bone length discrepancy? a. diaphysis b. epiphysis c. medullary cavity d. metaphysis b Growth in muscle length is related to growth in length of: a. underlying bone b. underlying ligament c. underlying tendon d. opposing muscle group a (growth in muscles is d/t the ROM muscle has to perform as underlying bone lengthens) Varus between the tibia and femur of up to 15 degrees followed by a progression to a neutral angle, which then progresses to valgus between 7 to 9 degrees, is associated with which of the following? a. blount dz b. internal tibial torsion c. normal developmental growth d. abnormal tibiofermoral growth pattern c Tracy, who is 9 yo, complains that she does not like to wear shorts bc her knees look funny. Upon exam you note a genu valgum angle of than 15 degees. You should: a. reevaluate in one year if still presnt b. consult with an orthopedic specialist c. instruct her to avoid the "W" sitting position d. encourage exercise to strengthen quadriceps a What is the appropriate treatment for genu varum in a 15 mos old child? a. passive exercise w/ each diaper change b. Denis Browne splint at night c. Blount brace at night d. no treatment is warrented d During exam of a 2 wk old JP you note irritability when lifted, asymmetrical Moro reflex, and spasm along the right sternocleidmastoid. What does this suggest? a. torticollis b. sprengel deformity c. fractured clavicle d. klippel-feil syndrome c A child with growing pains is most likely to experience: a. mild limp b. bilateral lower extremity pain c. lower extremity pain primarily during the day d. lower extremity pain associated with decreased ROM b CW, a 20 mos old, presents in the ER with a greenstick fracture of his left femur. Physical exam also reveals and enlarged anterior fontanel and enlarged costochondral junction. What do these clinical findings suggest. a. child abuse b. osteogenesis imperfecta c. osteoporosis d. rickets d Which of the following represents appropriate anticipatory guidance for a child diagnosed with slipped capital femoral epiphysis? a. avoid contact sports until pain resolves b. crutches to facilitate mobility during acute phase c. apply ice to affected area d. ROM and strengthening exercises b Which of the following factors most affects outcomes of patients with LCPD (legg claves perthe dz)? a. age b. severity of pain and antalgic gait c. family hx of LCPD d. bilateral involvment a (younger children have more time to remodel) During 2.5 yo Jason's physical exam you note large muscular calves and observe his difficulty rising from a sitting position. The Denver screening exam reveals delays in the gross motor area. Which of the following lab test would be most beneficial? a. serum calcium b. serum magnesium c. serum phosphurus d. seurm creatine kinase d The appropriate mngmt of Osgood-shlatters dz includes: a. local injection of soluble corticosteroids b. decreasing activity applying ice and taking NSAIDs c. program strengthening and stretching for quadriceps d. casting in adduction for 6 weeks b You have been treating 14-month-old JV for torticollis since birth. The condition has not resolved. The appropriate management plan would be to: A: referral for surgical consultation B: Continue with passive range of motion C: provide environmental stimulation opposite the contracture D: apply cervical collar at night a While completing the hip examination on newborn infant you were able to dislocate the infants right hip. The appropriate management plan will be to: A: triple diaper and reevaluate in two weeks B: recommend positioning prone while awake C: Referred to orthopedic specialist D: Order tight swaddling of the infant c TC who is three years of age presents with a history of fever for the past several days pain in his left leg and refusal to bear weight on the left leg. 10 days ago he fell from a slide and bruised his leg his WBC count is slightly elevated. You suspect either toxic synovitis or osteomyelitis. Which finding supports a diagnosis of osteomyelitis more so than toxic synovitis? A: Recent injury B: leg pain C: Non-weight bearing D: elevated white blood count A (Osteomyelitis is associated with local trauma wild toxic synovitis is associated with recebt upper respiratory illness) Which of the following would not be an appropriate indicator for developmental dysplasia of the hip in a six month old child? A: Allis sign B: skinfold symmetry C: galeazzi sign D: ortolani maneuver D Which of the following suggests internal tibial torsion rather than internal femoral torsion in a two-year- old child presenting with an in -toeing gate? A: sitting in "w" position B: knees face forward when walking C: Generalized ligament laxity D: Limited external rotation of hip B (The patella will rotate in word if the problem is above the knee) You examine CJ in the newborn nursery and know what a deformity in her left foot consisting of a convex lateral border and a forefoot, which can be abducted past and imaginary line extending from the middle of the heel through the second toe. Which of the following management strategies is most appropriate? A: reverse last shoes B: Out flare shoes C: Stretching exercises D: Orthopedic referral C (metatarsus adductus Is a Flexural deformity of the foot related most commonly to intrauterine positioning; Flexural deformities, that is, movement past the midline, can be managed with stretching exercises) A macular, salmon to red colored rash with irregular borders and central clearing is typical of which of the following? A: Systemic juvenile arthritis B: Lyme disease C: Systemic lupus erythematosus D: rheumatic fever A Coach Jones asks for advice on how to prevent little league elbow (epicondylitis) in his eight and nine- year-old players. Which of the following would be an incorrect advice? A: have each child pitch only three innings B: limit or eliminate curveballs C: Use ice massage before and after pitching D: Conduct slow warm-ups C (LLE results from reptitive Forearm supination and pronation. Therefore the goal is to prevent injury by reducing the repetitive motion. Ice falsely reassures parents or coaches that the injury can be prevented by applying the before and after pitching) A five month old boy, a former 28 week Premature infant, is being evaluated in your practice because of a concern about delayed development. In formulating the differential diagnosis, you keep in mind that spastic cerebral palsy is characterized by: A: Increased deep tendon reflexes and sustained clonus B: Dystonic posturing C: Abnormal involuntary movements D: nystagmus A A four-year-o