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EXAM VERSION OF (2026-2027) With
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During a well child evaluation of a 10-year-old girl, you note the presence of breast buds and sparse
growth of long, straight pigmented hair along the labia. Since her last visit one year ago, you find that
,she has grown 3 inches (7.7 cm), gained 6 lbs (2.7 kg), and is within the 50th percentile for height and
weight. The mother asks if these findings are normal for her age. You respond:
- This is normal as onset of puberty typically occurs between ages 8 and 13 for girls.
- A referral to endocrinology is likely warranted.
- A bone age determination is recommended.
- A follow-up visit in 6 months is needed to note any additional changes. - correct ans:This is normal as
onset of puberty typically occurs between ages 8 and 13 for girls.
The presence of breast buds and sparse pubic hair signifies Tanner Stage 2 development, which is
normal for a 10-year-old girl. During pre-adolescence (6-10 years of age), children gain approximately 2-
3 kg (5-7 lbs) and 5-8 cm (2-3 inches) per year. Growth spurt in girls typically begins around 9-10 years of
age, with maximum growth at 12 years of age.
You see a 17-year-old female with suspected bacterial pharyngitis caused by group A beta-hemolytic
streptococci. Anticipated findings would include all of the following except:
Palatial petechiae.
"Strawberry tongue."
Exudative pharyngitis.
Anterior cervical lymphadenopathy. - correct ans:"Strawberry tongue."
Physical examination of the patient with acute pharyngitis by S. pyogenes will typically find exudative
pharyngitis (C), palatial petechiae (A), and anterior cervical lymphadenopathy (D).
A 37-year-old man presents with a many-month history of well-demarcated plaques with silvery scale on
the tips of his elbows. The scales often bleed when picked or peeled. In considering a diagnosis of
psoriasis vulgaris, the NP considers:
,This is largely a clinical diagnosis.
Testing for presence of rheumatoid factor and checking ESR.
A biopsy of a representative lesion is needed.
Referral to dermatology. - correct ans:This is largely a clinical diagnosis.
A diagnosis of psoriasis vulgaris can be made with a review of patient history, patient risk factors
including family history, and physical examination (A). Additional testing can be considered to
differentiate the condition from another possible cause but is not usually required.
A 27-year-old male presents with a 2-day history of purulent nasal discharge and a 4-day history of
upper respiratory tract infection symptoms but is without fever. He asks for an antimicrobial to treat his
"sinus infection." He is otherwise healthy, has not received antimicrobial therapy in the past 3 months,
and has no drug allergies. You consider:
Oral amoxicillin 1000 mg BID for 7 days.
Oral amoxicillin-clavulanate 875/125 mg BID for 5 days.
Oral azithromycin 500 mg QD for 5 days.
Antimicrobial therapy is not warranted. - correct ans:Antimicrobial therapy is not warranted.
Given that this is likely a viral infection, antimicrobial therapy is not warranted (A, B, C). If the illness
progresses to suggest a bacterial infection (e.g., "double sickening," where URI-like symptoms initially
improve then worsen, or illness persisting beyond 7?10 days), then an antimicrobial can be considered.
Question: Plan/Intervention
Appropriate treatment for an otherwise well 6-year-old with presumed bacterial community-acquired
pneumonia who has not received any recent antimicrobial therapy and has no known drug allergies is:
Oral amoxicillin 90 mg/kg/day for 5 days.
Oral amoxicillin-clavulanate 90/6.4 mg/kg/day for 14 days.
, Oral clarithromycin 15 mg/kg/day for 10 days.
Oral levofloxacin 750 mg for 5 days. - correct ans:Oral amoxicillin 90 mg/kg/day for 5 days.
Though viral pathogens also often implicated, the primary treatment target for presumed bacterial
community-acquired pneumonia in children is Streptococcus pneumoniae. PIDS/IDSA guidelines
recommend amoxicillin as a first-line agent (A). Cephalosporins can be considered in the presence of
penicillin allergy.
A 47-year-old man with a 3-day history of moderate otalgia is diagnosed with acute otitis media. He
requests treatment with an antimicrobial. He is otherwise healthy, has not received antimicrobials in the
past 6 months, and has no history of drug allergies. Appropriate therapy can include:
Cephalexin 250 mg q6h BID for 10 days .
Amoxicillin 1000 mg PO TID for 5 days.
Trimethoprim-sulfamethoxazole 80 mg/400 mg PO BID for 14 days.
Levofloxacin 750 mg PO QD for 5 days. - correct ans:Amoxicillin 1000 mg PO TID for 5 days.
For patients with risk factors for drug-resistant infections, high-dose amoxicillin-clavulanate or certain
cephalosporins are appropriate. Cephalexin, a first-generation cephalosporin, has limited activity against
Gram-negative bacteria, including H. influenzae and M. catarrhalis, with or without beta-lactamase
production (A). Fluoroquinolones are not recommended as first-line therapy (D) and TMP-SMX is not
recommended for treatment of AOM (C).
You see an 18-month-old with a history of persistent moderate asthma who presents with a 2-day
history of upper respiratory tract infection symptoms and worsening asthma symptoms over the past 24
hours. She is currently taking an inhaled low-dose corticosteroid twice daily as well as nebulized
albuterol PRN. To manage this asthma flare, you recommend treatment with:
Oral montelukast.
Oral theophylline.
Oral prednisolone.
Oxygen therapy. - correct ans:Oral prednisolone.
EXAM VERSION OF (2026-2027) With
Expected real and comprehensive
Questions and Revised Correct
Answers Guarantee Pass A+
Professional Academic Assistance Services
Services Offered
Proctored Exam Assistance
Online Class Management (Full Course Support)
Exam Preparation & Study Materials
Assignments and Coursework Support
Essays and Research Papers
Discussion Posts and Replies
During a well child evaluation of a 10-year-old girl, you note the presence of breast buds and sparse
growth of long, straight pigmented hair along the labia. Since her last visit one year ago, you find that
,she has grown 3 inches (7.7 cm), gained 6 lbs (2.7 kg), and is within the 50th percentile for height and
weight. The mother asks if these findings are normal for her age. You respond:
- This is normal as onset of puberty typically occurs between ages 8 and 13 for girls.
- A referral to endocrinology is likely warranted.
- A bone age determination is recommended.
- A follow-up visit in 6 months is needed to note any additional changes. - correct ans:This is normal as
onset of puberty typically occurs between ages 8 and 13 for girls.
The presence of breast buds and sparse pubic hair signifies Tanner Stage 2 development, which is
normal for a 10-year-old girl. During pre-adolescence (6-10 years of age), children gain approximately 2-
3 kg (5-7 lbs) and 5-8 cm (2-3 inches) per year. Growth spurt in girls typically begins around 9-10 years of
age, with maximum growth at 12 years of age.
You see a 17-year-old female with suspected bacterial pharyngitis caused by group A beta-hemolytic
streptococci. Anticipated findings would include all of the following except:
Palatial petechiae.
"Strawberry tongue."
Exudative pharyngitis.
Anterior cervical lymphadenopathy. - correct ans:"Strawberry tongue."
Physical examination of the patient with acute pharyngitis by S. pyogenes will typically find exudative
pharyngitis (C), palatial petechiae (A), and anterior cervical lymphadenopathy (D).
A 37-year-old man presents with a many-month history of well-demarcated plaques with silvery scale on
the tips of his elbows. The scales often bleed when picked or peeled. In considering a diagnosis of
psoriasis vulgaris, the NP considers:
,This is largely a clinical diagnosis.
Testing for presence of rheumatoid factor and checking ESR.
A biopsy of a representative lesion is needed.
Referral to dermatology. - correct ans:This is largely a clinical diagnosis.
A diagnosis of psoriasis vulgaris can be made with a review of patient history, patient risk factors
including family history, and physical examination (A). Additional testing can be considered to
differentiate the condition from another possible cause but is not usually required.
A 27-year-old male presents with a 2-day history of purulent nasal discharge and a 4-day history of
upper respiratory tract infection symptoms but is without fever. He asks for an antimicrobial to treat his
"sinus infection." He is otherwise healthy, has not received antimicrobial therapy in the past 3 months,
and has no drug allergies. You consider:
Oral amoxicillin 1000 mg BID for 7 days.
Oral amoxicillin-clavulanate 875/125 mg BID for 5 days.
Oral azithromycin 500 mg QD for 5 days.
Antimicrobial therapy is not warranted. - correct ans:Antimicrobial therapy is not warranted.
Given that this is likely a viral infection, antimicrobial therapy is not warranted (A, B, C). If the illness
progresses to suggest a bacterial infection (e.g., "double sickening," where URI-like symptoms initially
improve then worsen, or illness persisting beyond 7?10 days), then an antimicrobial can be considered.
Question: Plan/Intervention
Appropriate treatment for an otherwise well 6-year-old with presumed bacterial community-acquired
pneumonia who has not received any recent antimicrobial therapy and has no known drug allergies is:
Oral amoxicillin 90 mg/kg/day for 5 days.
Oral amoxicillin-clavulanate 90/6.4 mg/kg/day for 14 days.
, Oral clarithromycin 15 mg/kg/day for 10 days.
Oral levofloxacin 750 mg for 5 days. - correct ans:Oral amoxicillin 90 mg/kg/day for 5 days.
Though viral pathogens also often implicated, the primary treatment target for presumed bacterial
community-acquired pneumonia in children is Streptococcus pneumoniae. PIDS/IDSA guidelines
recommend amoxicillin as a first-line agent (A). Cephalosporins can be considered in the presence of
penicillin allergy.
A 47-year-old man with a 3-day history of moderate otalgia is diagnosed with acute otitis media. He
requests treatment with an antimicrobial. He is otherwise healthy, has not received antimicrobials in the
past 6 months, and has no history of drug allergies. Appropriate therapy can include:
Cephalexin 250 mg q6h BID for 10 days .
Amoxicillin 1000 mg PO TID for 5 days.
Trimethoprim-sulfamethoxazole 80 mg/400 mg PO BID for 14 days.
Levofloxacin 750 mg PO QD for 5 days. - correct ans:Amoxicillin 1000 mg PO TID for 5 days.
For patients with risk factors for drug-resistant infections, high-dose amoxicillin-clavulanate or certain
cephalosporins are appropriate. Cephalexin, a first-generation cephalosporin, has limited activity against
Gram-negative bacteria, including H. influenzae and M. catarrhalis, with or without beta-lactamase
production (A). Fluoroquinolones are not recommended as first-line therapy (D) and TMP-SMX is not
recommended for treatment of AOM (C).
You see an 18-month-old with a history of persistent moderate asthma who presents with a 2-day
history of upper respiratory tract infection symptoms and worsening asthma symptoms over the past 24
hours. She is currently taking an inhaled low-dose corticosteroid twice daily as well as nebulized
albuterol PRN. To manage this asthma flare, you recommend treatment with:
Oral montelukast.
Oral theophylline.
Oral prednisolone.
Oxygen therapy. - correct ans:Oral prednisolone.
