,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.
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.
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.
"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).
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.
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.
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.
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
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.
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.
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.
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.
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.
"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).
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.
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.
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.
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
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.
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.
