NRNP 6541
Primary Care of Adolescents &
Children
Complete Midterms Review
(Questions & Solutions)
2025
1
,1. A 14-year-old girl presents with absence of menarche, normal
breast development, and sparse pubic hair. Which evaluation is
MOST appropriate first?
A. Serum follicle‐stimulating hormone (FSH) level
B. Pelvic ultrasound to assess Müllerian structures
C. Serum thyroid‐stimulating hormone (TSH) level
D. Karyotype analysis
ANS: B
Rationale: Pelvic ultrasound distinguishes outflow tract anomalies
(Müllerian agenesis) from endocrine causes before hormonal assays.
2. A 10-year-old boy with sustained BMI at the 97th percentile has
elevated blood pressure and acanthosis nigricans. Which
intervention is PRIORITY?
A. Referral for bariatric surgery evaluation
B. Structured family‐based lifestyle modification program
C. Start metformin therapy for insulin resistance
D. Prescribe a low‐dose antihypertensive agent
ANS: B
Rationale: Family‐centered lifestyle change addressing diet and
activity is first‐line management for pediatric obesity and related
metabolic markers.
3. A 6-year-old with a history of recurrent otitis media now shows
developmental delay in speech. Which screening tool is MOST
appropriate?
A. Pediatric Symptom Checklist
B. Modified Checklist for Autism in Toddlers (M‐CHAT)
C. Denver Developmental Screening Test II
2
, D. Vanderbilt ADHD Diagnostic Rating Scale
ANS: C
Rationale: The Denver II assesses gross motor, fine motor,
language, and social skills in preschool‐aged children.
4. A 15-year-old male athlete coming for a sports physical is tall, has
long limbs, joint hypermobility, and a systolic murmur. Which finding
would confirm Marfan syndrome?
A. Positive wrist sign (thumb and fifth finger overlap)
B. Pectus carinatum on chest inspection
C. Displaced apical impulse on cardiac exam
D. Wrist circumference greater than index finger length
ANS: A
Rationale: The wrist (Steinberg) sign indicates arachnodactyly and
supports Marfan diagnostic criteria.
5. A 13-year-old presents with intermittent knee pain and an antalgic
gait. Imaging shows a slipped capital femoral epiphysis. What is the
next step?
A. Nonweight‐bearing and immediate orthopedic referral
B. Start nonsteroidal anti‐inflammatory drugs and observe
C. Refer for physiotherapy to strengthen hip abductors
D. Prescribe crutches and weight‐bearing as tolerated
ANS: A
Rationale: SCFE is an orthopedic emergency; prompt nonweight‐
bearing status and surgical consultation prevent further slippage.
6. A 12-year-old girl reports acne unresponsive to over‐the‐counter
benzoyl peroxide and has complaints of mood swings. What
3
Primary Care of Adolescents &
Children
Complete Midterms Review
(Questions & Solutions)
2025
1
,1. A 14-year-old girl presents with absence of menarche, normal
breast development, and sparse pubic hair. Which evaluation is
MOST appropriate first?
A. Serum follicle‐stimulating hormone (FSH) level
B. Pelvic ultrasound to assess Müllerian structures
C. Serum thyroid‐stimulating hormone (TSH) level
D. Karyotype analysis
ANS: B
Rationale: Pelvic ultrasound distinguishes outflow tract anomalies
(Müllerian agenesis) from endocrine causes before hormonal assays.
2. A 10-year-old boy with sustained BMI at the 97th percentile has
elevated blood pressure and acanthosis nigricans. Which
intervention is PRIORITY?
A. Referral for bariatric surgery evaluation
B. Structured family‐based lifestyle modification program
C. Start metformin therapy for insulin resistance
D. Prescribe a low‐dose antihypertensive agent
ANS: B
Rationale: Family‐centered lifestyle change addressing diet and
activity is first‐line management for pediatric obesity and related
metabolic markers.
3. A 6-year-old with a history of recurrent otitis media now shows
developmental delay in speech. Which screening tool is MOST
appropriate?
A. Pediatric Symptom Checklist
B. Modified Checklist for Autism in Toddlers (M‐CHAT)
C. Denver Developmental Screening Test II
2
, D. Vanderbilt ADHD Diagnostic Rating Scale
ANS: C
Rationale: The Denver II assesses gross motor, fine motor,
language, and social skills in preschool‐aged children.
4. A 15-year-old male athlete coming for a sports physical is tall, has
long limbs, joint hypermobility, and a systolic murmur. Which finding
would confirm Marfan syndrome?
A. Positive wrist sign (thumb and fifth finger overlap)
B. Pectus carinatum on chest inspection
C. Displaced apical impulse on cardiac exam
D. Wrist circumference greater than index finger length
ANS: A
Rationale: The wrist (Steinberg) sign indicates arachnodactyly and
supports Marfan diagnostic criteria.
5. A 13-year-old presents with intermittent knee pain and an antalgic
gait. Imaging shows a slipped capital femoral epiphysis. What is the
next step?
A. Nonweight‐bearing and immediate orthopedic referral
B. Start nonsteroidal anti‐inflammatory drugs and observe
C. Refer for physiotherapy to strengthen hip abductors
D. Prescribe crutches and weight‐bearing as tolerated
ANS: A
Rationale: SCFE is an orthopedic emergency; prompt nonweight‐
bearing status and surgical consultation prevent further slippage.
6. A 12-year-old girl reports acne unresponsive to over‐the‐counter
benzoyl peroxide and has complaints of mood swings. What
3
