PEDS FINAL EXAM Practice Q's with 100% correct answers

-----------WEEK 9------ A client presents to clinic for the first time. The provider discovers that the client was diagnosed with prader-willi syndrome. What symptoms does the provider expect to find during this encounter? >>Hyperphagia, obesity, and strabismus Lethargy and stridor and irritability Low-set ears, short stature, webbed neck Flat nasal bridge, epicanthal folds and heart murmur Prader-Willi Syndrome 1) Caused by a lack of genetic material in the 15 pair of chromosomes. 2) Usually inherited from the father. The leading genetic cause of obesity. 3) Children with Prader-Willi syndrome can be rigid and oppositional. They do not respond well to sudden changes in their routine. 4) Mild MR, low muscle tone, short stature, incomplete sexual development, cognitive disabilities, problem behaviors, and a chronic feeling of hunger that can lead to excessive eating and life-threatening obesity. Turner Syndrome A chromosomal disorder in females in which either an X chromosome is missing, making the person XO instead of XX, or part of one X chromosome is deleted. Affects females, short stature, infertility, short neck with a webbed appearance, a low hairline at the back of the head, low-set ears, and narrow fingernails and toenails that are turned upward. Down syndrome features prominent tongue flat occiput slanting eyes (palpebral fissures) short hands ASD- epicanthal folds redundant nuchal skin fifth finger clinodactyly and brachydactyly single transverse palmar crease Brush field's spots on iris periphery low muscle tone s, respiratory problems, and digestive tract obstruction. A client with prader willi syndrome, well known to clinic, presents today for a well exam. The client is at higher risk and should be screened for what medical condition? Depression Pyloric stenosis Celiac disease >>Type 2 diabetes A new client presents to the clinic to establish care on exam, the provider notes the following: a long narrow face, high-arched palate and dental crowding, prominent ears, strabismus, macroorchidism, short stature, cognitive impairments and stereopathies. What would be the most likely diagnosis? >>Fragile X Prader-Willi Angelman Beckwith-Weidemann If a client is positive for any of the following categorical clinical findings and developmental deficiencies: failuare to thrive, central obesity, enamel hypoplasia, scoliosis, motor delays, mild intellectual disability and compulsive hyperphagia; what would be the most likely diagnosis? Fragile X >>Prader-Willi Angelman Beckwith-Weidemann If a client is positive for any of the following categorical clinical findings and developmental deficiencies: Seizures, Global developmental delays, Abnormal gait, arms held high/flexed elbows, Hypotonic trunk with hypertonic limbs (commando crawl), Feeding/growth problems, Acquired microcephaly, Speech delay, Spontaneous (persistent) social smile/fits of laughter, and Loves water. What would be the most likely diagnosis? Fragile X Prader-Willi >>Angelman Beckwith-Weidemann If a client is positive for any of the following categorical clinical findings and developmental deficiencies: Omphalocele or umbilical hernia, macroglossia, facial features: Nevus flammeus, helical pits, prominent eyes, anterior ear lobe creases, Large placenta/long umbilical cord, Hypoglycemia, Cardiomegaly, Dental malocclusion with maxillary underdevelopment, and Articulation issues. What would be the most likely diagnosis? Fragile X Prader-Willi Angelman >>Beckwith-Weidemann If a client is positive for any of the following categorical clinical findings and developmental deficiencies: tall, long limbs, aortic root dilatation, mitral valve prolapse/regurgitation, ectopia lentis, myopia, retinal detachment, exotropia/strabismus, spontaneous pneumothorax, connective tissue problems, pectus deformities, joint hyperextensibility. What would be the most likely diagnosis?What would be the most likely diagnosis? Turner DiGeorge >>Marfan Huntington What is true about diploid cells? (select all that apply) >>Each contains 23 paired chromosomes. Each one contains 23 chromosomes. >>Replication produces two identical cells. >>They replicate via the process of mitosis. Cystic fibrosis is a genetic disorder that affects the cells that produce mucus, sweat, and digestive juices. It is considered a recessive disease caused by a gene mutation on both alleles inherited from the parents. Which type of genetic disorder is this? Chromosome Mitochondrial >>Monogenetic Multifactorial Which diagnostic test is most appropriate when a provider wishes to identify and evaluate the size, shape, and number of chromosomes of a client? Chromosomal microarray Fluorescence in-situ hybridization >>Karyotype Molecular testing The signs and symptoms of bacterial sepsis in children beyond the neonatal period has a common presentation. Which of the following would be the most typical? Question 1 options: a) Cough, fever, abdominal pain b) Abdominal pain, diarrhea, vomiting >>c) Irritability, fever, lethargy d) Vesicular rash, pruritus, fever A 11-year-old child presents with fever, sore throat, and swollen lymph nodes. The abdominal exam reveals a spleen tip that is palpable. A throat culture and monospot test results are negative. What would be the next step in the plan of care? Question 2 options: a) Repeat throat culture b) Bone marrow biopsy c) Chest radiograph >>d) Epstein-Barr titer The nurse practitioner has a differential diagnosis of Lyme disease. Which of the following skin lesion would confirm the diagnosis? >>a) Erythema migrans b) Koplik spots c) Pustules d) Scales Which of the following would best reflect the physical presentation in a newborn with Down's syndrome? a) Pigeon-breasted chest, Brushfield spots, arachnodactyly >>b) Hypotonia, large-appearing tongue, small mouth, upward eye slant c) Microcephaly, flattened philtrum, downward eye slant d) Lymphadenopathy, coarctation of the aorta, webbed neck What is an expected finding in young infants with cerebral palsy (CP)? Question 5 options: a) Weight gain and increased appetite b) Reactions to initial vaccines >>c) Hypotonia in the first weeks of life d) Hepatosplenomegaly ----------WEEK 8------ The Parents of an established patient call the pediatric clinic to ask what they should do for their child who tripped, fell, and hit head their head on the sidewalk Which of the following symptoms would require that the child goes to the emergency room? a) History of febrile seizure b) Scalp laceration c) Uncontrollable crying >>d) Loss of consciousness Which of the following is the best measure of childhood intelligence? >>a) Wechsler scale---It generates an IQ score, which represents a child's cognitive ability. b) Vineland scales-- measures the personal and social skills of individuals from birth through adulthood c) Bayley scales-- assess developmental functioning of infants and toddlers. d) Denver II-- widely used assessment for examining children 0-6 years of age as to their developmental progress. A nurse practitioner has a follow-up visit with a child who experienced a febrile seizure. Which of the following statements would be the most accurate when educating the parents on febrile seizures? a) The child will be at an increased risk for epilepsy b) The child would benefit from phenytoin c) The child would benefit from phenobarbital >>d) The child may experience repeated seizures A child with Tourette syndrome presents to the pediatric clinic. Which of the following should the nurse practitioner be aware of? >>a) Symptoms become more unpredictable during adolescence b) Sleep disturbance from tics increases with age c) Boys have an increased incidence of behavioral problems d) Medications are now available to control tics without a change in functioning A child who is enrolled in Head Start is suspected of having developmental delays based on Denver II results at two separate clinic visits. What would be the next step in the plan of care? a) Request Head Start complete an independent evaluation b) Discuss interventions to foster development with the parents c) Repeat the Denver II again in 6 months >>d) Refer the child for a more definitive evaluation The physical exam of an established 7-month-old client - diagnosed with spastic cerebral palsy - will mostly likely be positive for which signs? >>Increased deep tendon reflexes and sustained clonus Dystonic posturing and sustained clonus Abnormal involuntary movements and increased deep tendon reflexes Nystagmus and absent reflexes A 4-year-old client, who is new to the clinic, presents for a sick visit. However, upon exam the provider discovers that the client has flaccid paralysis over the lower extremities, absent deep tendon reflexes, lack of response to touch and pain, and has a saclike cyst on the lower back. What is the most probable diagnosis? Viral gastroenteritis >>Myelomeningocele Meningitis Shunt infection BACTERIAL Meningitis in the newborn is caused by what bacteria? group B streptococcus listeria monocytogenes e-coli BACTERIAL Meningitis in infants >1 month old is caused by what bacteria? streptococcus pneumonias neisseria meningitides haemophilus influenzae VIRAL meningitis is caused by: Herpes simplex Enteroviruses (coxsackie/echoviruses) Herpes Simplex Poliovirus A 7-month old female client presents to the clinic to establish care. During the visit, the parents report that their daughter was developing as expected during the first 5 months of life but they fear that her development has plateaued. Over the last two months she has become withdrawn and has lost skills previously performed like partial hand skills and acquired spoken language. The provider notes on exam excessive bruxism, periods of apnea followed by hyperpnea, hand wringing, and spastic para¬paresis. What is the most likely diagnosis? >>Rett Syndrome Autism Spectrum Disorder Cerebral Palsy Brain Damage An apparently healthy 7-year-old client, presents to the clinic complaining of left-sided facial paralysis that occurred suddenly. The client denies any sensory loss but reports difficulty closing the left eyelid. The provider suspects the client has Bell's Palsy. Which cranial nerve is most likely affected in this condition? IV V VI >>VII A 2-year-old client, who is unknown to the clinic, is presented as a walk-in after experiencing two seizures last night when the temperature spiked to 102°F. During the visit, the provider learns that the client is currently being treated for a viral illness. In the clinic, the client's temperature is 100°F. The provider informs the parent that febrile seizures may reoccur. Although rarely required, what prophylactic medication can the provider prescribe? (select all that apply) >>Diazepam 0.33 mg/kg by mouth every 8 hours for 2 to 3 days >>Diazepam 0.5mg/kg by suppositories once per day Phenytoin 0.33mg/kg by mouth every 8 hours for 2 to 3 days Phenytoin 0.5mg/kg by suppositories once per day A 16-year-old client presents to the clinic complaining of frequent headaches with bouts of nausea, vomiting, abdominal pain, photophobia and throbbing unilateral pain that is only relieved with sleep. What is the most likely diagnosis? Cluster headache Vascular headache Tension headache >>Migraine headache A 15-year-old client presents to the clinic complaining of tension headaches. The provider understands that the client will experience pain to what region of the head? At the back of the head >>On both sides of the head At the top of the head On one side of the head The parents of a 4-year-old client hysterically calls the office to seek assistance after their child hit his head on the brick walkway and lost consciousness for 10 minutes. What possible complications/conditions is the client at risk for? (select all that apply) >>Concussions >>Intracranial lesions >>Cerebral contusions Febrile seizures Seventy-two hours after an emergency delivery, a newborn develops respiratory insufficiency, dysphagia, hypotonia, ptosis, weakness, weak cry, poor sucking, choking, expressionless face, and absent Moro reflex. Based on the symptomology the provider suspects that the newborn may be showing signs of Myasthenia Gravis. Which clinical test, when performed, may confirm this diagnosis? >>Administering the short-acting cholinesterase inhibitor, edrophonium. Administering the long-acting cholinesterase inhibitor, neostigmine. Administering the short-acting cholinesterase inhibitor, pyridostigmine. Administering the long-acting cholinesterase inhibitor, Rivastigmate. A 16-year-old client, new to the clinic, presents with complaints of weakness and Landry ascending paralysis progressing over the last few weeks. The provider suspects Guillain-Barré syndrome based on the reported symptoms. However, as the collection of the client's health history continues, a past infection with which virus supports the providers suspicions? Enterovirus >>Epstein-Barr virus Haemophilus influenzae Hantavirus Attention deficit hyper activity disorder maybe >>Familiar Learned Acquired Triggered by a virus Symptoms of ADHD are present prior to ....years of age. Ten >>Seven Nine Six .....are the first line choice for treatment of ADHD disordrs. SSRIs >>Long acting stimulants Tricyclics Dopamine agonist inhibitors .....children are less likely to be diagnosed with attention deficit disorder than others >>AA Non-hispanic white Asian Hispanic -----WEEK 7--------- A 5-year-old boy presents to the clinic with his mother who states the chief complaint of: "painful limping on the right leg for 2 days." Today he has a low-grade fever. Which of the following would be the most likely diagnosis? Question 1 options: a) Osgood-Schlatter b) Slipped capital femoral epiphysis >>c) Transient synovitis of the hip d) Osteomyelitis Which of the following is a typical presentation of a dislocated hip of a child 6-months or older? Question 2 options: a) Symmetry of skin folds b) Negative Trendelenburg sign >>c) Positive Galeazzi sign d) Atrophied leg muscle During the examination of a 3-week-old it is noted that the infant is irritable when lifted, has asymmetrical Moro reflex, and spasms along the right sternocleidomastoid. What does this suggest? Question 3 options: a) Klippel-Feil syndrome b) Torticollits c) Sprengel deformity >>d) Fractured clavicle