NP Pediatric Nurse Practitioner 4 — Questions and Answers
Question 1: A 4-year-old with recurrent ear infections has persistent middle ear effusion for 4 months bilaterally with a 25 dB hearing loss. What is the recommended management?
- Oral amoxicillin for 10 days
- Observation for another 3 months
- Tympanostomy tube insertion (Correct answer)
- Oral decongestants and antihistamines
Correct answer: Tympanostomy tube insertion
Persistent bilateral otitis media with effusion causing ≥20 dB hearing loss for ≥3 months meets AAP criteria for tympanostomy tube referral.
Question 2: Which electrolyte abnormality is most characteristic of pyloric stenosis?
- Hyperkalemic metabolic acidosis
- Hyponatremic metabolic acidosis
- Hypochloremic hypokalemic metabolic alkalosis (Correct answer)
- Hyperchloremic metabolic acidosis
Correct answer: Hypochloremic hypokalemic metabolic alkalosis
Pyloric stenosis causes loss of hydrochloric acid and potassium through vomiting, resulting in hypochloremic, hypokalemic metabolic alkalosis.
Question 3: A 6-year-old is brought in for bedwetting 3-4 nights per week. He has never had a dry night. What is this condition called?
- Secondary enuresis
- Primary nocturnal enuresis (Correct answer)
- Overactive bladder
- Neurogenic bladder
Correct answer: Primary nocturnal enuresis
Primary nocturnal enuresis refers to bedwetting in a child who has never achieved a consistent dry period, distinguishing it from secondary enuresis which follows a dry period.
Question 4: Which finding is most consistent with Kawasaki disease in a 3-year-old with 6 days of fever?
- Bilateral exudative conjunctivitis
- Diffuse maculopapular rash with vesicles
- Strawberry tongue with peeling fingertips (Correct answer)
- Petechial rash on trunk and extremities
Correct answer: Strawberry tongue with peeling fingertips
Kawasaki disease is characterized by strawberry tongue (oral mucosal changes), non-exudative conjunctivitis, rash, lymphadenopathy, and desquamation of fingertips/toes.
Question 5: A 16-year-old female reports not having her first menstrual period. Physical exam shows breast development at Tanner stage 4 and sparse pubic hair. What is the most likely diagnosis?
- Turner syndrome
- Polycystic ovary syndrome
- Androgen insensitivity syndrome (Correct answer)
- Constitutional delayed puberty
Correct answer: Androgen insensitivity syndrome
Complete androgen insensitivity syndrome (CAIS) presents in 46,XY individuals with female phenotype, normal breast development, absent/sparse pubic hair, and primary amenorrhea.
Question 6: A 9-month-old is noted to have a fixed, non-reactive right pupil with no history of trauma. Which condition must be ruled out first?
- Physiologic anisocoria
- Retinoblastoma (Correct answer)
- Congenital cataract
- Horner syndrome
Correct answer: Retinoblastoma
Retinoblastoma can present with leukocoria (white pupillary reflex) and a fixed pupil; it is a life-threatening malignancy requiring urgent ophthalmologic evaluation.
Question 7: A 14-month-old is not yet walking and has hypertonia in the lower extremities with brisk deep tendon reflexes. Which diagnosis is most likely?
- Benign hypotonia of infancy
- Spastic diplegic cerebral palsy (Correct answer)
- Duchenne muscular dystrophy
- Spinal muscular atrophy
Correct answer: Spastic diplegic cerebral palsy
Spastic diplegia is the most common form of cerebral palsy, presenting with hypertonia, hyperreflexia, and delayed walking predominantly affecting the lower limbs.
NP Pediatric Nurse Practitioner 4
A 4-year-old with recurrent ear infections has persistent middle ear effusion for 4 months bilaterally with a 25 dB hearing loss.
What is the recommended management?