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CPNP Primary Care > Review Questions > Flashcards

Review Questions Flashcards

Infectious Disease Gastrointestinal Disorders

1
Q

Septicemia in the newborn period is most likely caused by which organism?

a. Listeria monocytogenes
b. Haemophilus influenzae
c. Neisseria meningitis
d. Streptococcus pneumonia

A

A. Listeria monocytogenes

Listeria monocytogenes is the most likely cause of sepsis in the newborn period

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2
Q

Signs and symptoms of bacterial sepsis in children beyond the neonatal period include:

a. cough, fever, abdominal pain
b. vesicular rash, pruritus, fever
c. irritability, fever, lethargy
d. abdominal pain, diarrhea, vomiting

A

C. irritability, fever, lethargy

Irritability, fever, lethargy are s/s of sepsis in children beyond the neonatal period

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3
Q

Which of the following vaccines provides protection against a common type of sepsis/meningitis?

a. smallpox vaccination
b. Hepatitis B vaccine
c. Haemophilus influenzae vaccine
d. Inactivated polio vaccine

A

C. Haemophilus influenzae vaccine

Haemophilus influenzae vaccine provides protection against sepsis/meningitis

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4
Q

Although relatively rare in the United States, diphtheria can occur among underimmunized children. Which of the following clusters of s/s and physical findings would suggest diphtheria ina child presenting with upper respiratory complaints?

a. Low-grade fever, sore throat, nasal discharge, and grayish-white pseudomembrane in his/her throat
b. abrupt onset of high fever, severe sore throat, nasal discharge, and grayish-white pseudomembrane in his/her throat space
c. low-grade fever, abrupt onset of severe sore throat, with difficult swallowing and drooling
d. abrupt onset of high fever, severe sore throat, with difficulty swallowing and drooling

A

A. Low-grade fever, sore throat, nasal discharge, and grayish-white pseudomembrane in his/her throat

These findings suggests diptheria

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5
Q

Infants younger than 6 months of age with pertussis frequently require hospitalization to manage:

a. fever, cough and dehydration
b. coughing paroxysms, apnea, cyanosis, feeding difficulties
c. coughing paraoxysms, dehydration, renal failure
d. seizures, fever, pneumonia

A

B. coughing paroxysms, apnea, cyanosis, feeding difficulties

Infants younger than 6 months of age require hospitalization to manage the respiratory symptoms of pertussis and maintain adequate nutrition

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6
Q

One of the most appropriate agents used to treat influenza A is:

a. acyclovir
b. oseltamivir
c. erythromycin
d. tetracycline

A

B. Oseltamivir

Oseltamivir is recommended to treat influenza A within 2 days of symptoms onset

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7
Q

Which of the following symptoms are characteristic of rubella?

a. vesicular, crusted lesions and high fever
b. postauricular lymphadenopathy and low-grade fever
c. intense pruritus, usually in finger webs, buttocks, thighs, and ankles
d. rough-textured maculopapular rash that blanches with pressure

A

B. postauricular lymphadenopathy and low-grade fever

The rash in rubella starts on the forehead and face and spreads over trunk and extremities during the 1st day and disappears by 3rd day

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8
Q

Although uncommon, potential sequelae of rubella may include:

a. pneumonia and chronic otitis media
b. arthritis, thrombocytopenia, and encephalitis
c. oophoritis and infertility
d. arthritis, carditis and neurologic involvement

A

B. Arthritis, thrombocytopenia and encephalitis

Complications of rubella include arthritis and, rarely, thrrombytopenia and encephalitis

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9
Q

Rubeola is:

a. preventable by active immunization
b. caused by human herpesvirus 6
c. treated with IV acyclovir
d. not associated with severe complication (e.g., encephalitis, pneumonia)

A

A. preventable by active immunization

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10
Q

You are examining a child who has fever, coryza, cough, conjunctivitis, malaise, and aorexia. During the oral examination, you observe red eruptions with white centers on the buccal mucosa. What are these eruptions called?

a. pastia spots
b. rubeola spots
c. Koplik spots
d. Strawberry spots

A

C. Koplik spots

Koplik spots are red eruptions with white centers on buccal mucosa; they occur prior to appearance of rash

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11
Q

Which of the following best describes the treatment for roseola?

a. acetaminophen or iburopfen for fever, parental reassurance
b. warm compresses for salivary gland swelling
c. oral acyclovir, 20mg/kg/dose, four times a day
d. bed rest, saline gargles for sore throat

A

A. acetaminophen or iburopfen for fever, parental reassurance

Roseola is best managed by controlling fever and reassuring caregivers that appearance of rash is sign of recovery

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12
Q

Fifth disease is usually:

a. seen in children ages 5 to 14 year
b. transmitted via the deer tick
c. treated with oral erythromycin
d. characterized by prolonged coughing episodes

A

A. seen in children ages 5 to 14 year

Fifth disease, or erythema infectiosum (EI), is typically seen in older children, caregivers need reassurance of the benign nature of the disease

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13
Q

Which of the following statements is not true regarding the transmission of chickenpox?

a. susceptible individuals can contract chichkepox from patients with varicella zoster (shingles)
b. children with chicenpox are infectious only during the period of time when skin lesions are present
c. Children with chickenpox are no longer infectious once crusting of skin lesions has occured
d. varicella-zoster immune globulin (VZIG) should be administered to susceptible immunocompromised individuals who are exposed to a patient with varicella-zoster infection

A

B. children with chickenpox are infectious only during the period of time when skin lesions are present

VZV incubation period is between 10 and 21 days, and infected individuals are contagious for 24-48 hours prior to outbreak of lesions until all lesions have crusted over.

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14
Q

A child with chickenpox and temperature of 102F should recieve which medication for fever?

a. aspirin
b. amoxicillin
c. acetaminophen
d. acyclovir

A

C. acetaminophen

Aspirin should be avoided in children due to potential for Reye syndrome. Amoxicillin and acyclovir are not indicated for treatment of fever

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15
Q

The most appropriate agent for use in traeting varicella-zoster infection in an immunocompromised host is:

a. ganciclovir
b. acyclovir
c. ceftriaxone
d. chloramphenicol

A

B. acyclovir

Acyclovir is an antiviral agent that inhibits DNA polymerase; it incorporates into viral DNA. Ganciclovir is indicated for CMV; ceftriaxone is a cephalosporin abx, and chloramphenicol is an antibacterial

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16
Q

Varicella-zoster inefction is most commonly assocaited with which of the following skin lesions?

a. Vesicle
b. comedone
c. Nodule
d. Macule

A

A. Vesicle

Vesicles are characteristic lesions of viral infections. Comedones are skin lesions seen in acne. A nodule is a raised lesion, and a macule is a flat lesion; neither are characteristic of varicella-zoster infection

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17
Q

Which of the following is not a complication of mumps?

a. meningitis
b. pneuomnia
c. oophoritis
d. pancreaitis

A

B. Pneumonia

Complications of mumps include pancreatitis, oophoritis, meningitis, and orchitis

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18
Q

What recommendationw ould you make to a parent whose sone has been diagnosed with mumps and who wants to know when the child can return to child care?

a. He can return once he becomes afebrile and can tolerate eating
b. he can return 9 days after onset of symptoms
c. he can return when he is well enough to participate in activities
d. he can return after a minimum of 5 days of abx therapy

A

B. he can return 9 days after onset of symptoms

Child may return when all symptoms have resolved or 9 days after onset of symptoms

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19
Q

Which of the following are symptoms of cat scratch disease?

a. joint pain, conjunctivitis, mild neck stiffness
b. irritability, fever, hypotension
c. fever, malaise, lymphadenopathy
d. severe coughing, vomiting, anorexia

A

C. Low-grade fever, general malaise, HA, nausea, chills, general aching, and swollen lymph nodes are symptoms of CSD.

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20
Q

The following describes a characteristic rash assocaited with which disease? Initially erythematous and macular, becoming macupapular and petechial. The rash first appears on the wrists and ankles and then spreads proximally to the trunk. The palms and soles are often involved.

a. lyme disease
b. roseola
c. rubeola (measles)
d. rocky mountain spotted fever

A

D. Rocky Mountain Spotted Fever

RMSF has a characteristic petechial or purpuric rash, Lyme disease rash (EM) has central clearing. Roseola rash is erythematous and macupapular, starting on the trunk and spreading to the arms and neck. Rubeola rash is maculopapular and occurs 3-4 days after initial symptoms.

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21
Q

A 10-year-old child manifests symptoms of fever, sore throat, and swollen lymph nodes. Spleen tip is palpable. Throat culture and monospot test results are negative. The next logical diagnostic test would involve:

a. repeat throat culture
b. chest radiograph
c. bone marrow examination
d. Epstein-Barr virus titer

A

D. Epstein-Barr virus titer

AN EBV IgM titer may appear in the first 2 weeks of infectious mononuclesosis (IM) and may need 7-10 days to show a positive test. A chest x-ray or bone marrow aspiration is not a diagnostic test for IM.

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22
Q

Which of the following factors is not associated with increased risk for infantile botulism?

a. rural environments
b. use of honey
c. use of corn syrup
d. farm families

A

C. Use of corn syrup

Rural environments, use of honey, and farm families are risk factors for infantile botulism

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23
Q

Which of the following interventions would not be appropriate for a 6 month old infant with a suspected diagnosis of infantile botulism?

a. stool and blood cultures
b. immedaite administrationn of equine antitoxin
c. stool softeners
d. supportive care

A

B. immedaite administrationn of equine antitoxin

Equine antitoxin is not usually recommended for onfant botulism

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24
Q

Which of the following are associated with paralytic poliomyelitis?

a. lacy, erythematous, pruritic rash
b. respiratory compromise, speech disturbances, urinary incontinence
c. abdominal swelling, lymphadenopathy, and jaundice
d. nonspecific abdominal pain, nausea and vomiting

A

b. respiratory compromise, speech disturbances, urinary incontinence

Phsycial findings of paralytic poliomyelitis are meningeal signs, respiraotry compromise, inability to speak without frequent pauses, and muscle weakness

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25
Q

Muscle spasms associated with tetanus are aggravated by which of the following?

a. fever
b. tetanus immunoglobulin
c. external stimuli
d. NSAIDs

A

C. external stimuli

Minimize external stimuli to prevent aggravating muscle spasms

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26
Q

Classic symptoms associated with malaria include:

a. low-grade fever, upper respiratory congestion, cough
b. annular rash, conjunctivitis, headache, arthralgia
c. high fever, chills, rigors, sweats, headache
d. high fever, jaundice, lethargy, vomiting

A

C. high fever, chills, rigors, sweats, headache

27
Q

Lyme disease is most closely associated with which of the following skin lesions?

a. erythema migrans
b. nodule
c. scale
d. pustule

A

A. erythema migrans

Erythema migrans is the characterisitic rash of lyme disease. About 70% of patients get the rash of erythema with central clearing

28
Q

Many infectious diseases present with rashes along with general complaints of fever, malaise, and headaches. Which of the following clusters of symptoms would make you consider Lyme disease as a likely diagnosis?

a. fever, malaise, headache, arthralgia, and well-circumscribed, erythematous, annular rash with central clearing
b. fever, malaise, headache, transient bone pain, and generalized erythematous, maculopapular rash that began on the face and spread to trunk and extremities
c. fever, malaise, anorexia, and confluent, erythematous, brownish maculopapular rash
d. fever, malaise, anorexia, and erythematous rash beginning on wrists and ankles and then spreading to the trunk

A

A. fever, malaise, headache, arthralgia, and well-circumscribed, erythematous, annular rash with central clearing

29
Q

Which of the following would be included in patient education regarding lyme disease?

a. educate caretakers regarding complications, incuding hypertension and renal calculi due to immobility
b. educate caretakers to avoid use of aspirin-containing products for fever control due to association with increased risk for eye syndrome
c. educate caretakers regarding use of protective clothing and tick repellent in heavily wooded areas
d. educate caretakers regarding natural history of the illness and need for specific follow-up after infection with Rickettsia rickettsii

A

C. educate caretakers regarding use of protective clothing and tick repellent in heavily wooded areas.

Tickborne infection is caused by Borrelia

30
Q 
A 10-month-old child has been diagnosed with gastroenteritis. He attends a child care facility. What is the most likely cause of his illness?
a. Clostridium difficile
b. Rotavirus
C. Salmonella
D. Crytosporidium
A

B. Rotavirus is the most common pathogen that causes gastroenteritis. It affects the small intestine, resulting in the passage of large amounts of watery stool. In the United States, it affects mainly infants between3 and 15 months of age. It is transmitted by the fecal-oral route and can survive for days on hands and hard surfaces.

31
Q

In a healthy, 8-month-old with diarrhea but no dehydration, what would be the most appropriate advice to give parents?

a. Encourage strength formula for 12 hours
b. Give oral rehydration solution (ORT) for 12 hours
c. Give only fluids until stool return to normal
d. Give bananas and cereal as tolerated

A

D. Give bananas and cereal as tolerated

Starvation depresses digestive function and prolongs diarrhea. ORT is only given is dehydration is present

32
Q

When evaluating a child with abdominal pain, what symptom would lead to a likely organic etiology?

a. Night waking
b. Pallor
c. Suprapubic pain
d. Sweating

A

A. Night waking

This usually does not occur with functional disorders

33
Q

Vomiting in infancy has a long list of differential diagnoses. Which accompanying symptom would most likely point to pyloric stenosis?

a. Diarrhea
b. Appropriate growth
c. Acts hungry after vomiting
d. Sausage-shaped mass in abdomen

A

C. Acts hungry after vomiting

In pyloric stenosis, projectile vomiting usually starts between 1 and 2 months of age, and the infant will be very hungry after vomiting. Other symptoms of pyloric stenosis include constipation, fussiness, and weight loss

34
Q

Which of the following is the appropriate regimen for pinworm medication?

a. Daily times 7 days, repeat as needed
b. Three times a day for 10 days, repeat as needed
c. Twice daily for 3 days, repeat in 2 weeks
d. 1 dose/1 time, repeat in 2 weeks if needed

A

D. Albendazole 4oomg orally as a single dose repeated in 2 weeks is used to treat pinworms

35
Q

Mrs. Doyle is upset. Two-month-old John’s frequent vomiting has her convinced that “something is seriously wrong.” Which if the following is most suggestive of GER (gastroesophageal reflux)?

a. He’s gained 5 ounces this month
b. He has a slight wheeze today
c. He eats hungrily after vomiting
d. He drinks 7 to 8 ounces every 3 to 4 hours

A

D. He drinks 7 to 8 ounces every 3 to 4 hours

John is being overfed, which predisposes infants to GER. A more appropriate intake for a 2-month-old is 4-5 oz every 3-4 hours

36
Q 
You see Jack, a 20-month-old toddler with normal growth and development, in your office for diarrhea. His mother tells you that he is passing up to three loose stools a day and that he drinks 20 ounces of apple juice a day. What is the most likely diagnosis?
a. Crohn's Disease
B. Giardia lamblia
C. Celiac Disease
D. Nonspecific "toddler" diarrhea
A

D. Toddler diarrhea is caused by carbohydrate malabsorption and will resolve if juice is removed from the diet.

Crohn’s disease is rare in children <2 years
Celiac disease may cause failure to thrive
Giardia causes interittent diarrhea

37
Q

Baby Sally was in your office last week for her 6-month check up. Her weight was 7kg. Today she presents with diarrhea and vomiting for 4 days. Today her weight is 6.5kg. What is her percentage of dehydration?

a. 5%
b. 7%
c. 10%
d. <1%

A

B. 7%

% dehydration = pre-illness weight- illness weight/ preillness weight x100

7kg-6.5kg = 500g
0.5/7 = 0.07x100 =7% dehydration
38
Q

What clinical signs would you expect to see in Sally on your examination?

a. Normal capillary refill
b. Normal fontanel
c. Cool, mottled skin
d. Dry mucous membranes

A

D. dry mucous membranes

Dehydration of 7% causes dry mucous membranes, normal or sunken fontanel, and increased heart. Capillary refill is prolonged

39
Q

Sally’s vomiting and diarrhea have stopped. If she needs oral replacement therapy (ORT) today, what would be an appropriate amount to recommend?

a. 325-350cc over 4 hours
b. 600-700cc over 4 hours
c. 600-700cc over 12 hours
d. 325-350cc over 8 hours

A

B. 600-700cc over 4 hours

100ml/kg of ORT is given over 4 hours for moderate dehydration

40
Q

Pinworms can cause which of the following?

a. Constipation
b. Anal itching
c. Abdominal pain
d. Diarrhea

A

B. Anal itching

Anal itching is the most common symptom of pinworm infestation. The female lays eggs in the child’s perianal area. Scratching and then putting the hands in the mouth leads to the eggs being swallowed. They hatch in the duodenum and then make their way to the colon, and the cycle begins again. Symptoms such as grinding of teeth at night, weight loss and enuresis have been attributed to pinworm infections, but proof of a causal relationship has not been established.

41
Q

In evaluating Billy, a child with bloody diarrhea, which of the following would not be an appropriate first action?

a. Check growth chart
b. Stool culture
c. Upper GI
d. Hemoccult test stools

A

C. Upper GI

An upper GI study is useful for assessing for any anatomic abnormalities. In a child with bloody diarrhea, stool cultures should be obtained to look for an infectious agent. Hemoccult can be done to prove the presence of blood. Suboptimal growth may point to inflammatory bowel disease.

42
Q

Billy’s family eats at fast-food restaurants four to five times each week. If you suspect the diarrhea is infectious in nature, what is a likley causative organism?

a. Adenovirus
b. E. coli
c. Giardia lamlia
d. S. aureus

A

b. E. Coli

Undercooked ground beef and leafy greens contaminated with E. coli 0157: H7 cause bloody diarrhea.

  • S. aureus causes vomiting and diarrhea, but there is no bleeding.
  • Giardia is generally contracted from contaminated water, for example, lakes and streams.
  • Adenovirus is found on hard surfaces and usually affects children <3 years old in daycare settings
43
Q

Which of the following conditions would be most likley to occur ina 4-year-old boy?

a. Pyloric stenosis
b. Recurrent abdominal pain
c. Intussusception
d. Giardia infection

A

D. Giardia infection

The highest incidence of Giardia is in children 1 to 9 years of life.

  • pyloric stenosis occurs in the first few months of life
  • intussusception: first 2 years of life
  • functional abdominal pain is uncommon in children younger than 4 years of age and mostly occurs btw 8 -15 years of age
44
Q

Which of the following findings could be expected to occur in a baby with intussusception?

a. Inconsolable screaming
b. Olive-shaped mass
c. Left-right-peristaltic waves
d. Weight loss

A

A. Inconsolable screaming

Intussusception cause abdominal pain.

Olive-shaped mass, left-to-right peristaltic waves, and weight loss are all symptoms of pyloric stenosis

45
Q

Which of the following may occur with suspected appendicitis?

a. Pain not relieved with ambulation
b. Young children appear very ill in the early phase
c. Fever is 102 F to 103 F
d. Leukopenia with left shift

A

A. Pain not relieved with ambulation

Children with appendicitis have difficulty ambulating and will not jump. Young children may not appear very ill in the early phases. Fever is absent or low grade. There may be a leukocytosis with a left shift.

46
Q

In the United States, parasitic gastroenteritis is most commonly caused by whih organisms?

a. Enterbius vermicularis
b. Entamoeba histolytica
c. Crypotsporidium parvum
d. Giardia lambia

A

D. Giardia lambia
Giardia is the most common intestinal parasitic infection of humans in the United States.
- Enterobius vermicularis (pinworms) do not cause gastroenteritis

47
Q

Which if the following serological findings indicates chronic HBV infection?

a. HBsAG negative for 6 months
b. Anti-HBc positive and HBsAg positive
c. IgM anti-HBc positive
d. Anti-HBs positive

A

B. Anti-HBc positive and HBsAG positive

48
Q

Children in child care facilties are at greater risk of ceing exposed to whichc of the following infections?

a. HAV
b. HBV
c. HCV
d. HDV

A

A.

49
Q

Infant immunization for hepatitis B often raises many parental questions about the disease. Which of the following is not rue about hepatitis B virus?

a. It can survive for more than 1 week on fomites
b. It is the most common form of hepatitis in the world
c. contaminated water and shellfish are hte major sources
d. perinatally infected infants are likely to become carriers

A

A

50
Q

Two-day-old baby Jamie is in the hospital nursery and still has not passed meconium. This is a red flag for which condition?

a. Intussusception
b. Hemolytic uremic syndrome
c. Pyloric stenosis
d. Hirschsprung disease

A

D. Hirschsprung disease

51
Q

Consistent with the condition in question 21, Jamie’s findings on rectal examination would be which of the following?

a. tight anal canal with no stool in vault
b. impacted stool with fissure
c. large, dilated rectum
d. soft stool, normal tone

A

C

52
Q

What treatment would be appropriate for Jamie’s condition?

a. emulsified mineral oil, a tablespoon per day
c. referral to gastroenterologist/surgeon
c. malt soup extract, 2 teaspoons for 3 days
d. rectal dilatation with the thermometer

A

B

53
Q

When evaluating a child with suspected IBD, which of the following diagnostic tests would not be helpful?

a. Amylase and lipase
b. ESR
c. Serum total protein an albumin
d. CBC with differential

A

D

54
Q

Your patient has inflammatory bowel disease. Which is most consistent with ulcerative colitis?

a. occult blood
b. perirectal abscess
c. aphthous ulcers
d. left sided abdominal pain

A

B

55
Q

Antimicrobials will improve the condition of a 4-year-old child with diarrhea caused by which of the following organisms?

a. Salmonella
b. Rotavirus
c. Shigella
d. E. coli (0157:H7)

A

D

56
Q

Katie has functional abdominal pain. When counseling her family on the management of painful episodes, you would recommend which of the following?

a. take ibuprofen 200 mg for pain
b. stay home from school during episode
c. decrease milk products
d. go to school during episodes

A

c

57
Q

Which of the following would not be consistent with a diagnosis of functional constipation in an infant?

a. vomiting
b. anal fissure
c. straining
d. starting solids

A

a

58
Q

A child has developed her second perirectal abscess in 6 months. She should be evaluated for which condition?

a. Giardia lamblia
b. Crohn’s disease
c. Ulcerative colitis
d. Enterobiasis

A

B

59
Q

Which of the following symptoms are most common in the early phase of appendicitis in children?

a. Abdominal pain after eating
b. Fever and diarrhea
c. Severe localized RLQ pain with pallor and sweating
d. Anorexia and vague, diffuse pain

A

D

60
Q 
Steatorrhea is not consistent with which of the following conditions?
a. C. difficile infection
b. Giardia lamblia infection
c. Celiac disease
D. Cystic fibrosis
A

A

61
Q

Jamil has had diarrhea for 3 days. His mother calls concerned. Which of the following would not be helpful advice?
a. Monitor stool for blood or mucus
b. Encourage solid food
C. Avoid milk products
d. Monitor for urination at least every 6 hours

A

d

62
Q

Of the following advice, which would be most helpful for the parents of a baby with gastroesophageal reflux?

a. Most babies continue to vomit until they are walking, at around 1 year of age
b. Lying prone after eating will decrease the amount of vomiting
c. Increase the interval between feedings to a minimum of 4 hours
d. Medications are generally necessary to prevent further problems

A

B

63
Q

Which of the following foods would be appropriate for a child with celiac disease?

a. Aatmeal for breakfast
b. Boiled rice breakfast
c. Commercially baked bread
d. Cream of wheat

A

A

64
Q

A parent requests that her 6-month-old child receive immunoglobulin (IG) as protection against hepatitis A prior to international travel. Which of the following does this parent need to know?

a. After IG administration, a 3-month interval is needed prior to the administration of measles vaccine
b. There is no impact on future immunizations
c. No immunizations can be given for 1-year
d. Since children do not have symptoms with hepatitis A, IG is not necessary

A

A

CPNP Primary Care (5 decks)

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