AC PNP PEDIATRIC NURSE 2024
PRACTITIONER - ACUTE CARE
MELNIC
ANSWER ALL QUESTIONS IN THIS SECTION
QUESTION 1
A 10 year old male presents with a 1 month history of fever, weight loss, fatigue
and pain in his right thigh. On exam you note painful localized swelling in the area
of his right midproximal femur. What is the most likely diagnosis?
A. Osteosarcoma
B. Legg-Calve Perthes Disease
C. Osgood-Schlater syndrome
D. Ewings Sarcoma - ANSWERS-Explanation: Answer C. Ewing's sarcoma tends
to involve systemic symptoms such as fever, weight loss and fatigue. It is
associated with an increased ESR. It usually involves the diaphyseal portion of the
long bones. The most common sites are in the lower body including the
midproximal femur and the bones of the pelvis.
Answer A. Legg-Calve-Perthes patients are usually younger (4-8 years)
Answer B. Osgood-Schlatter present with pain and swelling over the tibial
tuberosity
Answer D. Osteosarcoma involves tumors in long bones (humerus, femur and
tibia). Common in adolescents and young adults.
END OF
PAGE 1
, AC PNP PEDIATRIC NURSE 2024
PRACTITIONER - ACUTE CARE
MELNIC
QUESTION 2
Gastroenteritis associated with Escherichia coli is associated with which of the
following complications?
A. Hemolytic Uremic Syndrome
B. Cholera
C. Failure to thrive
D.. Appendicitis - ANSWERS-Explanation: Answer C. Both Shigella dysenteriae
and Escherichia coli (0157:H7) produce an enterotoxin associated with hemolytic
uremic syndrome. This syndrome causes: hemolytic anemia, nephropathy and
thrombocytopenia.
Answer A. Failure to thrive occurs with giardiasis.
Answer B. Cholera does not cause HUS
Answer D. Appendicitis does not cause HUS
END OF
PAGE 2
, AC PNP PEDIATRIC NURSE 2024
PRACTITIONER - ACUTE CARE
MELNIC
QUESTION 3
A 15 year old male presents with mid abdominal pain radiating to back and fever.
There is no history of recent trauma and he has been well until today. As the PNP
you know to order the following labwork:
A. Trypsinogen, lipase and amylase
B. Renal ultrasound
C. Drug screen
D. CT scan of the head - ANSWERS-Explanation: Answer C. Symptoms of
pancreatitis are epigastric pain radiating to the back and fever. The lab tests to
order include trypsinogen, lipase and amylase. Pancreatic enzymes can be elevated
up to 4-6 times higher than normal althoug Amylase is least specific for
pancreatitis as it's also produced in other areas of the body.
Answer A. Drug Screen is not pertinent in this scenario
Answer B. CT scan of the head will not reveal the cause of fever and pain
Answer D. Renal Ultrasound is not pertinent unless the patient had signs or
symptoms of UTI
END OF
PAGE 3
, AC PNP PEDIATRIC NURSE 2024
PRACTITIONER - ACUTE CARE
MELNIC
QUESTION 4
A 3 week old male infant present to the ED with a chief complaint of vomiting x 3-
4 days. His mother describes the vomiting as "shooting out of his mouth." The
emesis is non-bilious and non-bloody. His vital signs are stable, his abdomen is
slightly distended and he has a firm, small, movable mass below his xiphoid
process. His lab work shows: Na 135, K3.5, Cl 86, Bicarb 37, glucose 69. As the
PNP you interpret these labs as:
A. Hypochloremic alkalosis
B. Hyperchloremic acidosis
C. Moderate dehydration
D. Nephrotic syndrome - ANSWERS-Explanation: Answer A. Hypertrophic
pyloric stenosis (HPS)
Males>females
+ family history
END OF
PAGE 4
PRACTITIONER - ACUTE CARE
MELNIC
ANSWER ALL QUESTIONS IN THIS SECTION
QUESTION 1
A 10 year old male presents with a 1 month history of fever, weight loss, fatigue
and pain in his right thigh. On exam you note painful localized swelling in the area
of his right midproximal femur. What is the most likely diagnosis?
A. Osteosarcoma
B. Legg-Calve Perthes Disease
C. Osgood-Schlater syndrome
D. Ewings Sarcoma - ANSWERS-Explanation: Answer C. Ewing's sarcoma tends
to involve systemic symptoms such as fever, weight loss and fatigue. It is
associated with an increased ESR. It usually involves the diaphyseal portion of the
long bones. The most common sites are in the lower body including the
midproximal femur and the bones of the pelvis.
Answer A. Legg-Calve-Perthes patients are usually younger (4-8 years)
Answer B. Osgood-Schlatter present with pain and swelling over the tibial
tuberosity
Answer D. Osteosarcoma involves tumors in long bones (humerus, femur and
tibia). Common in adolescents and young adults.
END OF
PAGE 1
, AC PNP PEDIATRIC NURSE 2024
PRACTITIONER - ACUTE CARE
MELNIC
QUESTION 2
Gastroenteritis associated with Escherichia coli is associated with which of the
following complications?
A. Hemolytic Uremic Syndrome
B. Cholera
C. Failure to thrive
D.. Appendicitis - ANSWERS-Explanation: Answer C. Both Shigella dysenteriae
and Escherichia coli (0157:H7) produce an enterotoxin associated with hemolytic
uremic syndrome. This syndrome causes: hemolytic anemia, nephropathy and
thrombocytopenia.
Answer A. Failure to thrive occurs with giardiasis.
Answer B. Cholera does not cause HUS
Answer D. Appendicitis does not cause HUS
END OF
PAGE 2
, AC PNP PEDIATRIC NURSE 2024
PRACTITIONER - ACUTE CARE
MELNIC
QUESTION 3
A 15 year old male presents with mid abdominal pain radiating to back and fever.
There is no history of recent trauma and he has been well until today. As the PNP
you know to order the following labwork:
A. Trypsinogen, lipase and amylase
B. Renal ultrasound
C. Drug screen
D. CT scan of the head - ANSWERS-Explanation: Answer C. Symptoms of
pancreatitis are epigastric pain radiating to the back and fever. The lab tests to
order include trypsinogen, lipase and amylase. Pancreatic enzymes can be elevated
up to 4-6 times higher than normal althoug Amylase is least specific for
pancreatitis as it's also produced in other areas of the body.
Answer A. Drug Screen is not pertinent in this scenario
Answer B. CT scan of the head will not reveal the cause of fever and pain
Answer D. Renal Ultrasound is not pertinent unless the patient had signs or
symptoms of UTI
END OF
PAGE 3
, AC PNP PEDIATRIC NURSE 2024
PRACTITIONER - ACUTE CARE
MELNIC
QUESTION 4
A 3 week old male infant present to the ED with a chief complaint of vomiting x 3-
4 days. His mother describes the vomiting as "shooting out of his mouth." The
emesis is non-bilious and non-bloody. His vital signs are stable, his abdomen is
slightly distended and he has a firm, small, movable mass below his xiphoid
process. His lab work shows: Na 135, K3.5, Cl 86, Bicarb 37, glucose 69. As the
PNP you interpret these labs as:
A. Hypochloremic alkalosis
B. Hyperchloremic acidosis
C. Moderate dehydration
D. Nephrotic syndrome - ANSWERS-Explanation: Answer A. Hypertrophic
pyloric stenosis (HPS)
Males>females
+ family history
END OF
PAGE 4
