Primary Care of Adolescents and Children

· Question 2

Miguel, age 14, was hit in   the eye with a baseball and developed eye pain, decreased visual acuity, and   injection of the globe. Upon exam you note blood in the anterior chamber and   confirm diagnosis of hyphema. What treatment do you recommend while Miguel is   waiting to see the ophthalmologist

· Question 3

The father of a   3-year-old is concerned because the child stutters. What should your approach   be?

· Question 4

A 2-day-old   newbornwith conjunctivitis is likely due to

· Question 5

You see a 13-year-old who   reports she is learning some basic geometry (areas, volume etc.). The ability   to successfully master these concepts occurs during which Piaget   developmental stage? 

· Question 6

For adolescent   girls, peak height velocity should occur by Tanner Stage (SMR):

· Question 7

Which is the correct   order for introduction of solid foods to an infant?

· Question 8

I can walk well on tiptoes,   my speech is 50% understandable, I know six body parts, but I cannot balance   on one foot for 1 second. I am:

· Question 9

You receive a phone call from   the mother of a 2-year-old. She states her child has sleep refusal. You   suggest the child should be able to: 

· Question 10

A   15-month-old  boy says “mama” and “dada,” points and gestures if he   wants things, and follows simple one-step commands. Your best response is   which of the following?

· Question 11

At what age would a child   be expected to remember a string of numbers and repeat them backwards?

· Question 12

A 13-month-old child is noted   to be at the 25th percentile for weight, the 10th percentile for height, and   less than the 5th percentile for head circumference. She was   born at term. She was noted to have a small head at birth, to be   developmentally delayed throughout her life, and to have required cataract   surgery shortly after birth. She currently takes phenobarbital for seizures.   Which of the following would most likely explain this child’s small size?

· Question 13

A child’s head   circumference is routinely measured on each well visit until what age?

· Question 14

A 14-year-old female comes   into the office for an urgent visit after taking 10 valium tablets.    Following the initial emergent care and stailization, the most important part   of the management is:

· Question 15

All of the   following are consistent with peritonsillar abscess except:



· Question 16

Which of the   following complication of strep pharyngitis cannot be prevented with   antibiotics?



· Question 17

A 4-year-old   believes there is more juice in a tall, thin glass than a shorter, wider one.   The child has not yet achieved which of the principles of Piaget?



· Question 18

Josh, age 13, has   some enlargement of the scrotum and testes, a reddened scrotal sac, and some   hair texture alteration. His penis is not enlarged. He is in Tanner stage



· Question 19

A breastfed infant   is expected to have a lower incidence of which of the following?



· Question 20

A 12-year-old male   states he noticed an enlargement of his testes and scrotum. When counseling   him about the next step in pubertal development, you state:


The penis will grow in length and width.

· Question 21

You see a 7-year-old   with complaints of “having accidents at night.” Physical exam and   history are unremarkable. Urinalysis, urine culture, and specific gravity are   normal. His parents ask about the best treatment for this problem. The best   response is


Fluid restriction and voiding prior to the night may be effective.

· Question 22

Chelsea, age 8,   complains that she feels as if something is stuck in her ear. What action is   contraindicated?


Flushing the ear with water.

· Question 23

By what age should most   children be able to sit well without support?


9 months

· Question 24

A typically   developing 8-year-old girl will have which of the following genital   development?


No pubic hair at all

· Question 25

John is diagnosed   with allergic conjunctivitis. What type of discharge do you expect to see   upon exam?


Serous and clear

· Question 26

Which of the following   vaccines is routinely recommended at 4 months of age?


Diphtheria, tetanus, acellular pertussis (DTaP)

· Question 27

An 8-year-old female   has an edematous, mildly erythematous right upper eyelid for 2 days with a   fever of 102.9 (F). Which important eye assessment do you need to consider?


Ocular mobility

· Question 28

Role-play with equipment during the course of the physical exam   would be the most beneficial with which age group?



· Question 29

Conductive hearing   loss can be caused by


Serous otitis

· Question 30

You see a 30-month-old who   speaks in mixed Spanish and English. The child’s vocabulary is normal but at   the low end of the normal language spectrum. The parent is worried the   child’s development will not be normal because she mixes up the two   languages. You respond:


“Your child’s speech is normal and bilingual children commonly     intermix the words from both languages until about 3 years of age.”

· Question 31

Mark is in the exam   room. You are concerned he may have epiglottitis. In what position do these   patients prefer to sit?


Sitting up and leaning forward

· Question 32

The mother of a   4-year-old tells you he likes to “play with himself” while playing   and watching television. You advise the mother to


Explain to the child that masturbation is something that should be     done in private.

· Question 33

Parents bring their   6-month-old son to see you. He is symmetrically less than the 5th   percentile for height, weight and head circumference. He was born at 30   weeks’ gestation and weighed 1000g. He was a planned pregnancy, and his   mother’s prenatal course was uneventful until an automobile accident   initiated the labor. He was ventilated for 3 days in the intensive care unit   but otherwise did well without ongoing problems. He was discharged at 8 weeks   of life. Which of the following is the most likely explanation for his small   size?


Normal ex-preemie infant growth

· Question 34

You assess a   15-year-old’s visual acuity and note her vision to be 20/50 in the right eye.   She asks you what that means and you respond


“You can see at 20 feet with your right eye what most people can     see at 50 feet.”

· Question 35

During a “well-child” visit,   the parents of a healthy 5-month-old offer a great amount of information.   Which of the following bits of information is of most concern?


Limited eye contact with parents.

· Question 36

You are performing   an examination of a 3-year-old who is new to your office. Which finding   requires immediate further evaluation?


Heart rate     increases during inspiration and decreases during expiration

· Question 37

A 9-year-old who   weighs 70 pounds asks why she can’t sit in the front passenger seat of the   family car. Your best response is


The safest place for children under 12 years old and 100 pounds is in     the backseat of the car.

· Question 38

Which of the   following would not suggest an eating disorder with a   purging component?


Finger calluses

· Question 39

A fifteen-year-old   female makes a statement to you during a well visit. Which of the following   statements should not be kept confidential?


“Sometimes I feel like ending my life.”

· Question 40

Sarah, age 15,   presents with pain and pressure over her cheeks and discolored nasal   discharge. You cannot transilluminate the sinuses. You suspect which common   sinus to be affected?


Maxillary sinus

· Question 41

A 6-month-old infant has been   growing poorly. His parents have changed his formula three times without   success. His examination is remarkable for a pale, emaciated child with   little subcutaneous fat and anterior fontanelle fullness. His laboratory test   results are notable for a hemolytic anemia and prolonged bleeding times.   Which of the following is the most appropriate next step?


Obtain a sweat chloride concentration

· Question 42

Medicaid provides   health insurance coverage to


Certain categories of people whose personal income falls below a     certain percentage of the federal poverty level.

· Question 43

The mother of a   5-year-old informs you that her daughter cheats when playing board games.   What is the best response?


Tell the mother to spend time clarifying board game rules before     starting games.

· Question 44

Which of the   following substances is associated with pupillary constriction?



· Question 45

A 7-year-old has just been   diagnosed with attention deficit hyperactivity disorder (ADHD). Her parents   report that she is doing poorly in school and is disruptive in the classroom.   They ask you what they can do. Your best response is:


“Use a consistent approach with behavioral cues both at home and     at school.”

· Question 46

Flourescein staining   of the eye is used to detect a


Corneal abrasion

· Question 47

0 out of 1 points

Luke, a 17-month-old, failed   treatment with amoxicillin for otitis media. At the two-week recheck, his TM   was still erythematous and you cannot see the landmarks. He has persistent   nasal congestion, he is not sleeping at night, and he has a 101°F fever. What   is the next best step for Luke?


Ceftriaxone and an antihistamine

· Question 48

All of the   following may predispose a patient to thrush except:


Poor oral hygiene

· Question 49

Head and chest   circumferences should be equal at:


1 year of age

· Question 50

The diagnostic   criteria for autism spectrum disorder include all of the following except


Tolerance of flexibility with routines

· Question 51

Which of the   following statements about bullying is true?


It occurs most commonly during unstructured times (lunch, recess,     etc.).

· Question 52

The most likely   weight of a 1-year-old whose birth weight was 6-1/2 pounds would be:


19 to 20 pounds

· Question 53

An eye that deviates   in when covered but that returns to midline when uncovered is an



· Question 54

A 7-year-old boy with mental   retardation was born at home at 26 weeks gestation to a 28-year-old mother   who had received no prenatal care. An evaluation is likely to suggest his MR   is related to which of the following?


Complications of prematurity

· Question 55

The most common   substance used in middle school is



· Question 56

A 2-day-old infant has   significant nasal and rectal bleeding. He was delivered by a midwife at home;   the pregnancy was without complications. His Apgar scores were 9 at 1 minute   and 9 at 5 minutes. He has breastfed well and has not required a health care   professional visit since birth. Which of the following vitamin deficiencies   might explain his condition?


Vitamin K

· Question 57

Tammy, age 3, is at   the office for her well-child visit. She has trouble removing her own shirt   as requested. Her mother yanks off her shirt after smacking her wrist and   saying, “you must do as you’re told quickly.” Which action is   indicated?


Observe Tammy for signs of child abuse.

· Question 58

A 4-month-old child has poor   weight gain. Her current weight is less than the 5th percentile, height about   the 10th percentile, and head circumference at the 50th percentile. The   planned pregnancy resulted in a normal, spontaneous, vaginal delivery; mother   and child were discharged after a 48-hour hospitalization. Feeding is via   breast and bottle; the quantity seems sufficient. The child has had no   illness. The examination is unremarkable except for the child’s small size.   Screening laboratory shows the hemoglobin and hematocrit are 11 mg/dL and 33%   respectively, with a platelet count of 198,000/mm3. Serum electrolyte levels   are sodium 140, chloride 105, potassium 3.5, bicarbonate 17, blood urea   nitrogen 15, and creatinine 0.3. Liver function tests are normal. Urinalysis   reveals a pH of 8 with occasional epithelial cells but no white blood cells,   bacteria, protein, ketones, or reducing substances. Which of the following is   the most appropriate therapy for this child?


Oral supplementation with bicarbonate

· Question 59

A teenage female who   is overweight has moderate acne on the face and chest, and irregular menses.   Elevation of which laboratory test provides the test evidence of polycystic   ovarian syndrome?


free testosterone

· Question 60

A 2-year-old boy has been   slightly less than the 50th percentile for weight, height and head   circumference, but in the last 6 months he has fallen to slightly less than   the 25th percentile for weight. The pregnancy was normal, his development is   as expected, and the family reports no psychosocial problems. The mother says   that he is now a finicky eater (wants only macaroni and cheese at all meals),   but she insists that he eat a variety of foods. The meals are marked by much   frustration for everyone. His examination is normal. Which of the following   is the best next step in his care?


Reassurance and counseling for family about childhood normal     developmental stage

· Question 61

I like to use my pincer grasp that involves the ablitily to pick   up a small object such as a raisin or piece of cereal with the thumb and   forefinger, and that is mastered around what age?


9 months

· Question 62

An 11-year-old girl   has dizziness, pupillary dilation, nausea, fever, techycardia, and facial   flushing. She says she can “see” sound and “hear” colors.   The agent likely to be responsible is which of the following?


Lysergic acid diethylamide (LSD)

· Question 63

An 8-year-old female is   brought into the office by her mother. She has complaints of fever and sore   throat for the past 2 days. She denies difficulty swallowing but has loss of   appetite and mild diarrhea. A few classmates have similar symptoms. A review of   systems reveals clear nasal drainage, dry cough, and hoarseness. On exam she   has a 101.5 temperature, 3+ erythematous tonsils, and anterior cervical   lymphadenopathy. What is the likely diagnosis?


Viral pharyngitis

· Question 64

Appropriate advice for a   mother of a 2-week-old child here for a “well child” visit includes which of   the following?


Sleep in the supine position is recommended

· Question 65

0 out of 1 points

What is the most   traumatic, yet common form and of child abuse seen in pediatric primary care?


Soft tissue injuries

· Question 66

Which of the   following is a priority nurse practitioner role to help children and   adolescents to have healthy sexual development?


Begin anticipatory guidance related to sexuality and normal pubertal     development in the early school-age visits.

· Question 67

Appropriate   anticipatory guidance for the parents of an 8-year-old girl includes


Information that the child will start to value personal idols and role     models.

· Question 68

Max, a 9-year-old   boy, is a very active child with limited self-control. He is easily   distracted and has difficulty staying on task. You determine that he should   have a neurodevelopmental evaluation because he is showing signs of



· Question 69

Which of the   following injuries is most likely to be caused by abuse of a toddler?


A displaced posterior rib fracture.

· Question 70

Which of the   following issues or concepts is relevant to the school-age child?


Erikson’s initiative versus guilt

· Question 71

While assessing the   skin of an infant, you note cafe-au-lait spots. Which disease should be ruled   out?



· Question 72

The first sign of   the onset of female puberty is usually:


Breast buds

· Question 73

A mother states that   her 4-year-old son constantly grinds his teeth at night. You document this   as:



· Question 74

Which of the   following characterizes middle adolescence (14 to 16 years old)?


Intense peer     group involvement, feelings of immortality, sexual experimentation

· Question 75

I can roll over, grasp a   rattle, and reach for things and have begun feeding myself finger foods, but   I can’t wave bye-bye yet. How old am I?


6 months

· Question 76

You would be   concerned about the language development of a child who:


Stutters when excited or tired at the age of 7

· Question 77

Most children can   independently get dressed by themselves by age:


5 years

· Question 78

A differential   diagnosis for child abuse would include all of the   following except.


Prader-Wlli syndrome

· Question 79

Which of the   following eye findings would be considered an ophthalmic emergency?


Unilateral vesicular lesions on the upper eyelid in a 3-week old.

· Question 80

A 2-year-old child weighs 34   lb. What type of car seat should the child use?


A forward-facing car seat in the back of the vehicle.

· Question 81

An expected   milestone of a 4-year-old is the ability to


Copy a cross

· Question 82

Sam has an otitis   media. He also presents with conjunctivitis. This is due to which organism?


Haemophilus influenza

· Question 83

A 14-year   old has ataxia. He is brought to the local emergency department, where he   appears euphoric, emotionally labile, and disoriented. Many notice his   abusive language. Which of the following agents is most likely responsible   for his condition?



· Question 84

What method can be   safely used to remove cerumen in a 15-month-old child’s ear?


Irrigation using warm water from a soft bulb syringe

· Question 85

The appropriate lab   tests in assessment of cervical adenitis include all of the   following except:


Blood culture

· Question 86

Which of the   following represents normal sequencing of development in a toddler?


Feeds self, can undress self with help, washes hands, imitates     housework.

· Question 87

You see a young child who has   tripled her birth weight and looks for hidden objects. When given blocks, she   places one in each hand. She has a fine pincer grasp. On the floor, she   walks around holding objects and is trying to take independent steps. This   child is most likely how old?


12 months

· Question 88

During a domestic health   assessment, the CDC recommends screening every refugee child for which of the   following diseases?



· Question 89

A 4-month-old   presents with both eyes turning inward. What is this called?



· Question 90

A mother brings her   4-week-old infant into the office because she noticed small yellow-white   glistening bumps on her infant’s gums. She says they look like teeth but is   concerned that they may be cancer. You diagnose these bumps as


Epstein’s pearls

· Question 91

The parents of a   7-year-old are concerned their son does not want to attend school. Which of   the historical findings are not usually associated with the   diagnosis of school phobia?


Chronic medical illness

· Question 92

You are doing a   kindergarten physical on a 5-year-old girl. Which of the following scenarios   would suggest the child is not ready to start kindergarten in the fall?


Counts to 4 and draws a person with three parts.

· Question 93

Which of the   following children should be referred for a comprehensive developmental   evaluation?


A 3-year-old who consistently tracks at the 5th percentile for height     and weight since birth.

· Question 94

Sarah, 7 years old,   is in the office today. All of the following are acceptable management   options for allergic rhinitis, except


Nasal neosynephrine

· Question 95

You see a 3-year-old for a   well-child visit. His mother informs you that potty training has been very   easy because he “has an amazing internal clock. He falls asleep, gets hungry,   and has bowel movements at the same time every day.” This describes which   aspect of temperament?



· Question 96

You see a healthy   18-month-old for a well-child visit. At the 12-month visit he received the   diphtheria, tetanus, and acellular pertussis (DTaP) third dose; hepatitis B   second dose; measles, mumps, and rubella (MMR) first dose; injected   poliovirus (IPV) second dose; pneumococcal conjugate (PCV13) fourth dose; and   Haemophilus influenzae type B (Hib) fourth dose. Which of the following do   you order today?


DTaP, varicella, hepatitis A, and hepatitis B

· Question 97

The results of the hemoglobin   A1c test are LESS reliable in children with which of the following   conditions? (Hint: select two)

Selected     Answers:


Cystic Fibrosis


Sickle Cell Disease

· Question 98

You see a 5-month-old who is   fussy, has interrupted sleep, and is drooling. You note large lower lateral   incisor bulges. You recommend:

· Question 99

A 7-month-old male is found   to have a spiral fracture of the femur that his father says he got by   climbing onto a chair and then jumping off. Which of the following statements   is true regarding this situation?

· Question 100

The nurse   practitioner role was initially established to

· Question 101

Which of the following is a   true contraindication of vaccinating a child?

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