Module 1

Question 1

The Ishihara test is used to detect:

• Color blindness
• Streptococcal colonization
  - bone conduction of sound
  - the red reflex

Answer 1

Color blindness

Question 2

Any child with hemihypertrophy and any child with aniridia should also be routinely screened for what condition:
- Tuberous Sclerosis
- Wilm’s tumor
- Turner’s Syndrome
- Neurofibroamatosis

Answer 2

Wilm’s tumor
An important feature of Wilms tumor is the occurrence of associated congenital anomalies including renal abnormalities, such as cryptorchidism, hypospadias, duplication of the collecting system, ambiguous genitalia, hemihypertrophy, aniridia, cardiac abnormalities, and Beckwith-Wiedemann, Denys-Drash, and Perlman syndromes. Wilms tumor occurs with equal frequency in both sexes although males are diagnosed younger. There is a higher frequency in African Americans and a lower frequency in Asians.

Question 3

Please choose the correct definition for the condition sundowning:

• An acute or chronic irritation of the eyelid
• Acute inflammation of palpebral and bulbar surfaces of the eye
• Downward deviation of the eyes associated with hydrocephalus, intracranial hemorrhage, other pathologic brain conditions, or early sign of cerebral palsy.
• A cyst in the eyelid caused by inflation of the meibomian gland

Answer 3

Sundowning - Downward deviation of the eyes associated with hydrocephalus, intracranial hemorrhage, other pathologic brain conditions, or early sign of cerebral palsy; a sign of increased intracranial pressure when symptoms of lethargy, poor feeding, vomiting, bulging fontanel, or rapidly increasing head circumference are noted.

Question 4

A 5-year-old child is brought to the clinic with bilateral purulent discharge from both eyes. Physical findings include conjunctival redness, bilateral nasal discharge, and a bulging tympanic membrane in the left ear. Based on the history and physical examination the most common causative organism is:
- Streptococcus pneumoniae
- Nontypeable Haemophilus influenzae
- Adenovirus
- trachomatis

Answer 4

Non-typeable H. influenza remains a common cause of AOM and it is the most common cause of otitis-conjunctivitis syndrome. Treated with Augmentin or Omnicef due to beta-lactamase resistance.

Question 5

Please choose the correct definition for the condition chalazion:
- Exophthalmia
- Most often first indication of systemic jaundice and liver disease in children and adolescents
- Solid intraocular tumor
- A cyst in the eyelid caused by inflammation of the meibomian gland

Answer 5

A cyst in the eyelid caused by inflammation of the meibomian gland

Question 6

Please choose the correct definition for the condition congenital glaucoma:
- Solid intraocular tumor
- Inflammation of the episclera
- Causes ocular enlargement and visual impairment
- Downward deviation of the eyes associated with increased intracranial pressure

Answer 6

Causes ocular enlargement and visual impairment

Congenital glaucoma - Symptoms of photophobia (sensitivity to bright light), epiphora (excessive tearing), and blepharospasm (eyelid squeezing), conjunctival injection, causes ocular enlargement and visual impairment.

Question 7

Please choose the correct definition for the condition blepharitis:
- An acute or chronic irritation of the eyelid
- Inflammation of the layer beneath conjunctiva, causing acute irritation and redness
- An infection of the sebaceous glands of Zeis at base of eyelashes
- Inflammation of the nasolacrimal sac

Answer 7

Blepharitis - An acute or chronic irritation of the eyelid; may be caused by allergic conditions such as seborrhea, bacterial infections (staphylococcl), inflammation of meibomian glands, or parasities.

Question 8

Please choose the correct definition for the condition episcleritis:
- An infection of the sebacious glands of Zeis at base of eyelashes
- Inflammation of the layer beneath conjunctiva, causing acute irritation and redness of eyes
- Solid intraocular tumor
- Protrusion of the eye globe

Answer 8

Episcleritis - Inflammation of the episclera, layer beneath conjunctiva, causing acute irritation and redness of eyes, occurs in 2%-5% of children with inflammatory bowel disease (IBD), management with topical therapies and management of IBD.

Question 8

Please choose the correct definition for the condition hordeolum:

• An infection of the sebaceous glands of Zeis at base of eyelashes
• A cyst in the eyelid caused by inflammation of the meibomian gland
• Overgrowth of conjunctival tissues extending from the lateral canthus to cornea
• Symptoms of photophobia, epiphora, blepharospasm, conjunctival injection

Answer 8

Hordeolum - Stye; An infection of the sebaceous glands of Zeis at base of eyelashes; can be external or internal. Internal stye or hordeolum is an infection of the meibomian sebaceous glands lining the inside of the eyelid.

Question 8

Please choose the correct definition for the condition exophthalmos:
- Abnormal tearing pattern
- Inflammation of nasolacrimal sac
- Downward deviation of the eyes associated with hydrocephalus, intracranial hemorrhage, other pathologic brain conditions, or early sign of cerebral palsy.
- Proptosis

Answer 8

Exophthalmos - Protrusion of the blobe, also known as exophthalmia or proptosis, may be unilateral (e.g., orbital tumor, orbital cellulitis, or a tretrobulbar hemorrhage) or bilateral (Graves disease or hyperthyroidism)

Question 9

Please choose the correct definition for the condition pterygium:
- Downward deviation of the eyes associated with increased intracranial pressure
- Overgrowth of conjunctival tissue extending from the lateral canthus to cornea
- Inflammation of nasolacrimal sac
- Acute inflammation of palpebral and bulbar conjunctiva

Answer 9

Pterygium - Overgrowth of conjunctival tissue extending from the lateral canthus to cornea; begins in chidhood with overexposure to sun and constant dust/environmental irritants

Question 9

Please choose the correct definition for the condition lacrimal duct obstruction:
- Abnormal tearing pattern; upward pressure on lacrimal sac often yields mucoid discharge
- Causes ocular enlargement and visual impairment
- A cyst in the eyelid caused by inflammation of the meibomian gland
- An acute of chronic irritation of the eyelid

Answer 9

Lacrimal duct obstruction - Abnormal tearing pattern; upward pressure on lacrimal sac often yields mucoid discharge; massage of nasolacrimal duct with downward pressure on lacrimal sac may open duct to normal drainage by 6 months of age

Question 10

Please choose the correct definition for the condition retinoblastoma:
- Solid intraocular tumor
- A sign of increased intracranial pressure
- Symptoms of photophobia, epiphora, and blepharospasm, conjunctival injection
- Acute inflammation of palpebral and bulbar conjunctive

Answer 10

Retinoblastoma - Solid intraocular tumor; presents as abnormal retinal or retinal light reflex in newborn or as white pupillary reflex in infant; can be associated with proptosis, protruding eye bulb

Question 11

Please choose the correct definition for the condition dacryocystitis:
- Overgrowth of conjunctival tissue extending from the lateral canthus to cornea
- Inflammation of nasolacrimal sac
- Acute inflammation of palpebral and bulbar conjunctiva

Answer 11

Dacryocystitis - Inflammation of nasolacrimal sac; swelling and redness occur around lacrimal sac in are of inner canthus

Question 11

Please choose the correct definition for the condition scleral icterus:
- Early sign of cerebral palsy
- Overgrowth of conjunctival tissue extending for the lateral canthus to cornea
- Swelling and redness around the lacrimal sac in the the area of inner canthus
- Most often first indication of systemic jaundice and and liver dysfunction in neonate

Answer 11

Scleral icterus - yellowish coloration of sclera extending to the cornea; most often first indication of systemic jaundice and liver dysfunction in neonate; often first sign of liver disease in children and adolescents

Question 12

Definition of estropia

Answer 12

An inward deviation of the eye is referred to as esotropia”

Question 13

Lillie is a 6-month-old girly who develops a persistent cough with progressively worsening paroxysms and cyanosis. She has occasional posttusive emesis and is afebrile. Between coughing spells, her physical examination is normal. At this time, what is the most important question to ask the family regarding Lillie’s medical history?
- Early infant deaths in relatives
- Immunizations
- Family history of reactive airways disease
- Birth weight

Answer 13

Immunizations - This history is highly suggestive of pertussis. The clinical course is divided into three stages:
the catarrhal stage, 2-10 days in duration, characterized by rhinorrhea, lacrimation, and sometimes low-grade fever
the paroxysmal stage, lasting 1-6 weeks, during which there are intermittent episodes of coughing that may terminate with a forced inspiration against a partially closed glottis resulting in a “whoop” or may terminate with vomiting
the convalescent stage, lasting up to 6 months, during which the coughing episodes gradually resolve. Infants with pertussis often do not whoop because of their inability to generate sufficient inspiratory forces. Between episodes of cough, the examination is often normal. Of the choices given, the immunization status is of most importance.

Question 14

Lillie’s white blood cell count is 32,000/mm3, with 80% lymphocytes and 2% mononuclear cells. What is the most appropriate next step at this time?
- Order a CBC with peripheral smear
- Treat symptomatically with humidifier and honey for the cough
- Repeat the blood count in 24 hours
- Prescribe oral azithromycin

Answer 14

Prescribe oral azithromycin - A high white blood count with a marked lymphocytosis is characteristic of pertussis. Therefore, prescribing a macrolide, specifically azithromycin, is the most appropriate choice. A repeat CBC is not needed to follow the the treatment. Infact, antibiotics do not hasten the resolution of the illness but will decrease spread to other household members. Even so, all household contacts should also be treated prophylactically.

Question 15

Robin is a 6-year-old male known to have mild intermittent asthma. Hilar lymphadenopathy is noticed on the chest x-ray. Robin and his family live in rural Memphis on a farm with chickens. Tuberculin skin testing is negative and the family denies history of exposure to tuberculosis. You suspect histoplasmosis infection. What is the most likely mode of transmission of the spores?
- Droplet inhalation
- Oral ingestion
- Skin inoculation
- Inhalation

Answer 15

Inhalation
Histoplasma capsulatum is the most common primary systemic mycosis in the Unitied Stated and most often occurs in the Ohio and Mississippi river valleys. The organism grows in moist soil and is facilitated by bird droppings. As in adults, the respiratory tract is the portal of entry for histoplasmosis in essentially all cases in children. Inoculation other than by inhalation is exceedingly rare, and person to person transmission does not occur.

Question 16

What is the major source of immunity conferred in breast milk?
IgM
IgD
Complement mediated
IgA

Answer 16

IgA
Human milk provides optimal nutrition for the growing infant. It contains lactose and other carbohydrates that are substrates for protective microflora, such a Bifidobacterium and Lactobacillus spp. The major immunoglobulin present in breast milk is secretory IgA, and is available to act at the mucosal surface of the small intestine. Immunity is conferred against many specific enteropathogens and toxins. It also has been shown to inhibit binding of H influenzae and S pneumoniae to pharyngeal cells

Question 17

Camille is a 6-year-old-girl who is unimmunized and has a fever of 104 F (40 C) with crops of vesicles on the trunk along with scattered scabbed lesions. Which of the following infections is the likely diagnosis?
HHV-6
Scabies
Varicella
Measles

Answer 17

Varicella
Primary varicella infection (chickenpox) is most likely to present with a generalized, pruritic vesicular rash and fever. The typical exanthem appears first on the scalp, face, or trunk. New crops of lesions develop over a 1-7 day period. Progression from vesicle to pustule to crusted scab occurs quickly such that lesions of all stages are present after the first 48 hours#*)

Question 18

A 12-month-old child presents to your office for a well-child visit. The mother informs you that at the 6 month visit the child had fever of 101.6 and localized leg swelling after diphtheria-tetanus-acellular pertussis (DTaP) vaccine. She is worried if this vaccine should be withheld. Which of the following is a contraindication to receiving DTaP immunization?
- A prior dose associated with temperature > 103.1 F (39.5 C)
- Family history of seizures
- Encephalopathy within 7 days of previous dose
- A preterm infant who is 8 weeks of age

Answer 18

Encephalopathy within 7 days of previous dose
use of a combined diptheria-tetanus-acellular pertussis (DTaP) vaccine is routine and is the method of choice for the primary immunization of infants and young children. There are two contraindications to pertussis immunization: an immediate anaphylactic reaction or encephalopathy within 7 days of a prior dose manifested by major alteration in consciousness or protracted generalized or focal seizures without recovery within 24 hours.

Question 19

A malnourished 3-year-old refugee child from Honduras has a positive tuberculin skin test (TST>10 for this age). Which of the following would be most concerning for extra-pulmonary disease?
- Fever
- Hepatosplenomegaly
- Weight loss
- Hilar lymphadenopathy on roentography

Answer 19

Hepatosplenomegaly
Fever, cough, hilar lymphadenopathy, and elevated sedimentation rate are seen commonly in uncomplicated primary pulmonary tuberculosis. Hepatosplenomegaly is generally not seen in uncomplicated primary pulmonary tuberculosis, but does occur in more the 50% of children with disseminated disease.

Question 20

A 10-year-old child present to the clinic with a 2-day history of fever and newly noted altered mental status. His mother reports that he had been camping with his grandparents and sustained a “ton” of mosquito bites. Mosquitoes are recognized as vectors in the transmission of encephalitis of which of the following viruses?
Mumps Virus
Arbovirus
Coxsackievirus
Enterovirus

Answer 20

Arbovirus

Question 21

Junior is a 12-year-old boy who presents to urgent care with a 2 week history of cough and wheeze. He doesn’t have a history of asthma. Chest x-ray findings include bilateral patchy infiltrates. Oxygen saturation in normal range. What is the most likely etiology of his pneumonia?
- Streptococcus pneumoniae
- Pneumocystis jiroveci
- Chlamydophila psittaci
- Mycoplasma pneumoniae

Answer 21

Mycoplasma pneumoniae has long been known to cause pneumonia, bronchitis, otitis media, myringitis bullosa, and nonspecific upper respiratory infection. This organism also has been recognized as a cause of various non-respiratory manifestations such as polymorphous mucocutaneous eruptions including Stevens-Johnson syndrome, encephalitis, and meningitis. Other neurologic manifestations reported with M pneumoniae infection include transverse myelitis, psychosis, poliomyelitis-like syndrome, and Guillain-Barre syndrome.

Question 22

It is wintertime and you have been seeing children of different ages in the clinic with upper respiratory symptoms. Which of the following children is most likely to have group A streptococcal infection?
- Tonsillitis, rash, and fever in a 5-year-old
- Cough and pharyngitis in a 15-year-old
- Exudative pharyngitis in a 1-year-old
- Fever, congestion, cough, and pharyngitis in a 3-year-old

Answer 22

Tonsillitis, rash, and fever in a 5-year-old Pharyngotonsillitis is the typical clinical manifestation of group A streptococcal infection. Scarlet fever is a syndrome of tonsillitis, fever, and rash caused by an erthrogenic toxin-producing streptococcus in a patient lacking antitoxin immunity. Streptococcal respiratory tract infections generally peak in children aged 5-11 years and winter predominance is generally noted. Patients younger than 3 years of age with exudative pharyngitis are more likely to have viral disease, as are older children who present with sore throat, cough,, and/or rhinorrhea.

Question 23

You are a volunteer at a rural clinic in Haiti and examine a 6-year-old boy who has a temperature of 100F (38C), bilateral tender parotid swelling, and pain when you flex his neck. He has been complaining of a headache. His immunization history is unknown. What is the most likely cause of this child’s infection?
Cysticercosis
Epstein-Barr Virus
Leukemia
Mumps

Answer 23

Mumps causes subclinical infection in one-third of cases. The most common manifestation is unilateral parotid swelling that becomes bilateral with a prodrome of headache, fever, abdominal pain, and anorexia. EBV infection typically manifests as exudative pharyngitis and cervical chain adenopathy. Leukemia may vary in presentation, but often presents with fever, hematologic abnormality, petechial rash, and nonspecific complaints.The initial sign of cysticercosis in children is oftentimes a seizure in an otherwise healthy child.

Question 24

How often should people who have had their initial tetanus immunizations receive a booster?
10 years
1 year
5 years
It is life-long immunity

Answer 24

After the initial tetanus immunization, people should receive a tetanus immunization every 10 years. A tetanus immunization is necessary if it has been 5 years since the last tetanus immunization and the patient has a contaminated wound

Question 25

Emmie, a 3-year-old girl presents with 6 days of fever; conjunctivitis; red, cracked lips; polymorphous rash; and an isolated 2 cm cervical lymph node. You diagnose Kawasaki syndrome based on clinical findings. Which of the following sequelae of Kawasaki syndrome is most common?
Cerebral edema
Recurrent pericarditis
Fulminate hepatitis
Coronary artery aneurysm

Answer 25

Coronary artery aneurysm
Kawasaki syndrome is a multi-system vasculitis which typically manifests with high, spiking fever for 5 or more days along with conjunctival injection, mucositis, polymorphous rash, changes in peripheral extremities, and single cervical lymph nodes swelling. Treatment with aspirin and intravenous immune globulin is indicated; without treatment, 20% of children develop coronary artery aneurysms. Fulminant hepatitis, recurrent pericarditis, cerebral edema, are not features of Kawasaki syndrome.

Question 26

A 9-month-old presents to your clinic with a 2-day history of temperature of 101.6 F (38.7 C) and fussiness. The mother reports that the infant has been pulling at his ear. On physical examination, you note an erythematous, bulging, right tympanic membrane with purulent effusion. You diagnose otitis media. What organism of the following is the most likely cause of this infection?
Pseudomonas aeruginosa
Staphylococcus aureus
Streptococcus pyogenes
Streptococcus pneumoniae

Answer 26

Streptococcus pneumoniae is one of the most common causes of acute otitis media and of invasive bacterial infections in children. Nontypeable H influenzae is also a common cause, but since the advent of Hib vaccine H influenzae type B is rarely seen. Staphylococcus aureas and P aeruginosa cause complicated otitis media in patients with tympanostomy tubes. Pseudomonas aeruginosa is the most common cause of otitis externa. Streptococcus pyogenes can cause otitis media, however less frequently.

Question 26

Zamaria is a 3-year-old girl who returns to clinic with continued fever for 8 days, lymphadenopathy, splenomegaly, and numerous reactive or atypical lymphocytes on peripheral blood smear. The monospot test is negative. A likely cause of this clinical picture is infection with which of the following?
- Epstein-Barr virus
- Adenovirus
- Respiratory syncytial virus
- Rubella virus

Answer 26

Epstein-Barr virus
The monospot tests for heterophile antibodies, which are rarely produced by children younger than 4 years. A negative result does not exclude EBV infection. Patients present with a typical clinical picture of lymphadenopathy, splenomegaly, and atypical (reactive) lymphocytes on peripheral blood smear. RSV and rubella infection are unlikely to cause atypical lymphocytosis or splenomegaly. Although both herpes and noncongenitally acquired rubella may present with lymphadenopathy, adnovirus typically causes an upper respiratory tract infection and pharyngoconjunctival fever.

Question 26

Junie is a 15-month-old girl who presents to your office with a mild fever, and an intense, red flushed cheeks with circumoral pallor. What is the most likely etiology of this febrile exanthem?
Rubeola virus
Enterovirus 71
Parvovirus B19
Coxsackievirus A16

Answer 26

Parvovirus B19
The clinical manifestations of human parvovirus B-19 include erythema infectiosum (Fifth’s Disease), polyarthropathy syndrome (adults especially women), chronic anemia/pure red cell aplasia (immunocompromised hosts), transient aplastic crisis (sickle cell patients), and hydrops fetalis/congenital anemia (fetus). Erythema infectiosum is most commonly diagnosed and easily recognized. A distinctive rash featuring a “slapped cheek” appearance is noted that is often associated with circumoral pallor.

Question 26

Piers, a 14-year-old boy, presents to clinic with a 2 week history of cough and rhinorrhea. He now has 2-day history of fever and frontal headache. On examination he is tender to palpation over his maxillary sinuses. You make the clinical diagnosis of acute sinusitis. He has no allergies to medication. What is the first-line therapy for this child?
azithromycin
clindamycin
Amoxil or amoxicillin clavulanate.
ceftriaxone

Answer 26

Clinicians should prescribe amoxicillin with or without clavulanate as first-line treatment when a decision has been made to initiate antibiotic treatment of acute bacterial sinusitis.

Question 26

A child with a history of cancer who has received chemotherapy comes to you for an MMR vaccine. How much time must elapse after chemotherapy for the child to receive this vaccine?
4 months
3 months
5 months
12 months

Answer 26

3 months
Certain drugs may cause immunosuppression. For instance, persons receiving cancer treatment with alkylating agents or antimetabolites, or radiation therapy should not be given live vaccines. Live vaccines can be given after chemotherapy has been discontinued for at least 3 months.

Question 26

Maribel is in clinic 7/1/17 for a checkup after entering foster care. Maribel is 20 months old and her immunization record is as follows: DOB 11/4/15.
Hep B 11/4/15, 1/7/16, 9/5/16
DTaP 1/7/16, 4/1/16, 9/5/16
IPV 1/7/16, 4/1/16, 9/5/16
Hib 1/7/16, 4/1/16, 9/5/16
PCV 1/7/16, 4/1/16, 9/5/16
Rotavirus 1/7/16, 4/1/16What immunizations do you recommend today?
- Hep B, DTaP, IPV, Hib, PCV, MMR, Varicella, Hep A, Rotavirus
- Hep B, DTaP, IPV, Hib, PCV, MMR, Varicella, Hep A
- DTaP, Hib, PCV, MMR, Varicella, Hep A, Rotavirus
- DTaP, Hib, PCV, MMR, Varicella, Hep A

Answer 26

DTaP, Hib, PCV, MMR, Varicella, Hep A

Question 26

Please match the phase of disaster management to the action.

Provide patients and their families with information of the importance of family preparedness.

Preparedness
Response
Recovery
Prevention/Mitigation

Answer 26

Prevention/Mitigation

Question 27

Choose an action that demonstrates elements of good outpatient antibiotic stewardship.
- Avoid delayed prescribing or watchful waiting of antibiotic prescribing
-Do not waste time in self-evaluating antibiotic prescribing practices
- Do not display public commitments in support of antibiotic stewardship
- Use evidence-based diagnostic criteria and treatment recommendations

Answer 27

Use evidence-based diagnostic criteria and treatment recommendations

Question 28

Please match the phase of disaster management to the action.
Participate in a disaster drill within your facility/clinic/office for various scenario

Preparedness
Response
Recovery
Prevention/Mitigation

Answer 28

Preparedness

Question 28

Please match the phase of disaster management to the action.
Contact your community emergency headquarter to offer pediatric expertise

Preparedness
Response
Recovery
Prevention/Mitigation

Answer 28

Response

Question 29

Please match the phase of disaster management to the action.
Critique the disaster response and identify opportunities for improvement

Preparedness
Response
Recovery
Prevention/Mitigation

Answer 29

Recovery

Question 30

If it is likely that the power will be off to freezers and refrigerators storing vaccines longer than ___ hours, plan on moving vaccines to a safer location per AAP Preparedness Checklist for Pediatric Practices. Please fill in the blank with the correct answer.
4 hours
1 hour
24 hours
72 hours

Answer 30

4 hours

Question 31

Which of the following statements is correct concerning the unique physiological needs of children?
- Children breathe less air per pound of body weight than adults.
- Children are safer because they are closer to the ground.
- Children have thinner skin and higher body surface area to mass ratio
- Children are less prone to dehydration because they have less fluid in their bodies.

Answer 31

Children have thinner skin and higher body surface area to mass ratio

Question 31

A child is brought to the clinic with a fever, headache, malaise, and a red, annular macule surrounded by an area of clearing and a larger, erythematous annular ring. The child complains of itching at the site. What will the primary care pediatric nurse practitioner do to determine the diagnosis?
Order blood cultures
Perform serologic testing
Obtain a skin culture
Ask about recent tick bites

Answer 31

Ask about recent tick bites
The presence of an erythema migrans rash with a positive history is diagnostic for Lyme disease, and no further testing is necessary. Because Borrelia burgdorferi is transmitted to humans through ticks, asking about recent tick bites is paramount to making this diagnosis. Skin and blood cultures are not indicated. Serology testing for IgG and IgM antibodies may be performed if the child is symptomatic without the characteristic EM rash.

Question 32

A 3-year-old child whose immunizations are up-to-date has been exposed to measles because of a localized outbreak among unvaccinated children. The parent reports that contact with infected children occurred within the last 2 days at a birthday party. What is the best course of action?
- Administer the MMR vaccine to help prevent disease.
- Reassure the parent that most exposed children will not get measles.
- Give the child a dose of immune globulin to mitigate the response.
- Give antiviral medications at the first sign of symptoms.

Answer 32

Administer MMR
The measles vaccine can be given to those exposed if given within 72 hours of exposure. IG may be given in those without prior measles vaccine. Antiviral medications are not effective. Nine of 10 children who are unimmunized or under-immunized will contract the disease if exposed.

Question 33

A 10-month-old infant has an erythematous, fluctuant, non-draining abscess on the right buttock after 10 days of treatment with amoxicillin for impetigo. What is the next step in managing this infant’s care?
- Empiric treatment with clindamycin
- Incision and drainage of the abscess with culture
- Culture of any superficial open surface wounds
- Consultation with a pediatric infectious disease specialist

Answer 33

Incision and drainage of the abscess with culture

Non-draining, fluctuant abscesses should be incised, drained, and cultured to determine the causative organism. Consultation with an infectious disease specialist is necessary for seriously ill children, those who are immunocompromised, or those who have an increased risk for myocarditis. Superficial wounds should not be cultured because of the chance of sample contamination. Empiric treatment may be considered for severe infection, but many mild abscesses may not need antibiotic therapy after I&D.

Question 34

A child who has been diagnosed with asthma for several years has been using a short-acting B2-agonist (SABA) to control symptoms. The primary care pediatric nurse practitioner learns that the child has recently begun using the SABA two or three times each week to treat wheezing and shortness of breath. The child currently has clear breath sounds and an FEV1 of 75% of personal best. What will the nurse practitioner do next?
- Order a cough suppressant so he can sleep
- Administer 3 SABA treatments
- Continue the current treatment.
- Add a daily inhaled corticosteroid.

Answer 34

Add a daily inhaled corticosteroid.
The child is showing a need to step up treatment based on the frequency of symptoms, greater than twice each week. The PNP should order an inhaled corticosteroid maintenance medication to control symptoms and reduce the need for a SABA. The child is not having an acute exacerbation, so does not need 3 SABA treatments. Oral corticosteroids are given for acute exacerbation. Cough suppressant is not helpful.

Question 35

A 12-year-old who went camping 2 weeks ago in Oklahoma now presents with fever and headache. Laboratory studies demonstrate leukopenia, thrombocytopenia, elevated liver enzymes, and hyponatremia. Of the following, what is the most likely causative agent?
Borrelia burgdorferi
Rickettsia typhi
Ehrlichia chaffeensis
Coxiella burnetii

Answer 35

Ehrlichia chaffeensis monocytotropic
Human ehrlichiosis infection is an acute sytemic febrile illness seen most commonly in the south central, south eastern US with infection caused by Ehrlichia chaffeensis and transmitted via the bite of the Lone Star tick.
The clinical picture is similar to Rocky Mountain spotted fever (though more often without the rash) is reported with prominent CNS and gastrointestinal symptoms; hyponatremia, leukopenia, anemia, and elevated liver transaminases are common laboratory manifestations. Doxycycline is the drug of choice and should be used even in young patients as severe and fatal disease has been noted.

Question 35

Which of the following regimens would best constitute Step 3 in the stepwise management of a patient with asthma according to national recommendations?
- Preferred short-acting B2-agonist as required
- Preferred medium-dose ICS with considered oral systemic corticosteroid short course
- Preferred low-dose inhaled corticosteroid (ICS)
- Cromolyn or montelukast

Answer 35

Preferred medium-dose ICS with considered oral systemic corticosteroid short course
Step 3 in managing a patient with moderate to severe asthma would commonly involve administering a medium-dose inhaled corticosteroid (ICS) and considering a short course of oral systemic corticosteroids. A low-dose ICS is often the preferred course in Step 2 of asthma management, with cromolyn and montelukast suggested as alternatives. Lastly, short-acting B2-agonists are the common preferred course in Step 1 of managing a patient with asthma

Question 35

Trapezoid head shape and ear may be posteriorly displaced; palpable bony ridges

Answer 35

Craniosynostosis

Question 36

There is an outbreak of shigella infection is the community. You suspect that your three -year-old patient has a severe shigella infection. Because this organism is particularly drug-resistant, which of the following antibiotics is MOST appropriate to treat this infection?
- Treat according to the antibiogram in your area.
- TMP-SMX (Bactrim, Sulfatrim)
- Ampicillin (Omnipen, Principen)
- Amoxicillin (Amoxil, Moxatag)

Answer 36

Treat according to the antibiogram in your area.

Question 36

Parallelogram or brachycephalic head shape; ear may be anteriorly displaced; no palpable bony ridges

Answer 36

Nonsynostotic plagiocephaly

Question 36

Parainfluenza viruses are the most common cause of which of the following conditions?
retropharyngeal abscess
encephalitis
viral pneumonia
croup

Answer 36

croup

Question 37

A child is brought to the urgent care clinic complaining of fever, rash, and refusal to eat. During your examination, the patient is noted to have hand lesions. What is the most appropriate treatment for the child?
rest, antipyretics, and analgesics
topical 1% permethrin
doxycycline
referral to ER

Answer 37

rest, antipyretics, and analgesics
symptoms reported are consistent with Hand Foot and Mouth, caused by Coxsackie and sometimes Enterovirus. Treatment for this condition is supportive, ensuring adequate hydration, rest, and pain/fever control.

Question 38

Which TWO (2) of the following biologics are currently being evaluated for the treatment of food allergy?
- Dupilumab
- DNA vaccines
- Monophosphoryl lipid A (MPL) and CpG oligodeoxynucleotides
- Ligelizumab

Answer 38

Dupilumab is currently being investigated as monotherapy or as an adjunct therapy to oral immunotherapy; DNA vaccines are currently being evaluated for peanut allergy.

Monophosphoryl lipid A (MPL) and CpG oligodeoxynucleotides were investigated for allergic rhinitis but not food allergy
Ligelizumab was evaluated for asthma and spontaneous urticaria