NP Pediatric Nurse Practitioner 3 — Questions and Answers
Question 1: A 15-year-old athlete reports anterior knee pain worsened by stair climbing and kneeling, with tenderness over the tibial tuberosity. What is the most likely diagnosis?
- Patellar tendonitis
- Osgood-Schlatter disease (Correct answer)
- Slipped capital femoral epiphysis
- Patellofemoral syndrome
Correct answer: Osgood-Schlatter disease
Osgood-Schlatter disease is traction apophysitis at the tibial tuberosity, common in active adolescents during growth spurts, causing localized tenderness and swelling.
Question 2: Which developmental milestone is expected at 9 months of age?
- Walking independently
- Saying 2-word phrases
- Pincer grasp (Correct answer)
- Copying a circle
Correct answer: Pincer grasp
Pincer grasp (using thumb and index finger to pick up objects) typically develops between 9-12 months as fine motor skills mature.
Question 3: A breastfed 6-week-old has 8-10 yellow seedy stools per day. The mother is concerned. What is the appropriate response?
- Order stool culture for infectious diarrhea
- Recommend switching to formula
- Reassure that this is normal for breastfed infants (Correct answer)
- Prescribe probiotics
Correct answer: Reassure that this is normal for breastfed infants
Frequent loose yellow seedy stools are normal in breastfed newborns due to the laxative effect of human milk and immature stool regulation.
Question 4: A 5-year-old with a history of eczema develops a cluster of vesicles on an erythematous base around the mouth. Which pathogen is most likely?
- Staphylococcus aureus
- Herpes simplex virus (Correct answer)
- Streptococcus pyogenes
- Molluscum contagiosum
Correct answer: Herpes simplex virus
Herpes simplex virus (HSV-1) causes clusters of vesicles on an erythematous base; eczema herpeticum is a serious superinfection in children with atopic dermatitis.
Question 5: Which screening tool is recommended by the AAP for autism spectrum disorder at the 18-month and 24-month well-child visits?
- Ages and Stages Questionnaire (ASQ)
- Modified Checklist for Autism in Toddlers (M-CHAT) (Correct answer)
- Denver Developmental Screening Test
- Child Behavior Checklist (CBCL)
Correct answer: Modified Checklist for Autism in Toddlers (M-CHAT)
The M-CHAT (Modified Checklist for Autism in Toddlers) is the AAP-recommended autism-specific screening tool used at 18 and 24 months.
Question 6: A 13-year-old with type 1 diabetes has an HbA1c of 9.5%. Which insulin regimen is most appropriate?
- Once-daily NPH insulin
- Twice-daily premixed 70/30 insulin
- Basal-bolus regimen with insulin glargine and rapid-acting insulin (Correct answer)
- Sliding scale regular insulin only
Correct answer: Basal-bolus regimen with insulin glargine and rapid-acting insulin
Basal-bolus therapy with a long-acting basal insulin (glargine) and mealtime rapid-acting insulin provides the physiologic flexibility needed for optimal glycemic control in type 1 diabetes.
Question 7: A 2-month-old has a head circumference crossing from the 50th to the 95th percentile over 4 weeks. What is the priority next step?
- Reassure and remeasure at 4-month visit
- Order head ultrasound or CT to evaluate for hydrocephalus (Correct answer)
- Refer to genetics for macrocephaly workup
- Check parental head circumferences
Correct answer: Order head ultrasound or CT to evaluate for hydrocephalus
Rapid increase in head circumference crossing percentile lines warrants urgent neuroimaging to rule out hydrocephalus or other intracranial pathology.
NP Pediatric Nurse Practitioner 3
A 15-year-old athlete reports anterior knee pain worsened by stair climbing and kneeling, with tenderness over the tibial tuberosity.
What is the most likely diagnosis?