Answers 2026 update
The most likely cause of bilateral purulent conjunctivitis in a 1-day old infant is a.
Gonorrheal opthalmia
b. Chlamydia infection
c. Symphilitic opthalmia
d. Adenovirus infection - a. Gonorrheal ophthalmia
Rationale: Gonorrehea usually appears in the first 3-5 days of life. Chlamydia is between
days 5-14. The other 2 are less common in neonates. Most common causes of
conjunctivitis in newborn includes, Chlamydia, Gonorrhea, HSV, and chemical induced
conjunctivitis. (Burns)
Which of the following circumstances is most suggestive of excessive stress in a family
with a chronically ill child?
a. The father takes a second job to meet financial responsibilities
b. The mother provides the majority of the care for the child
c. The parents stop participation in a support group
d. A sibling exhibits decline in school performance - c. The parents stop participation in a
support group
Rationale: Chronic illness takes a significant stress on the family. It can result in changes
in roles as well as the sibling feeling unloved or left out in some way. Can also result in
depression/anxiety of parents and other family members. Positive social networks are a
positive influence on parents and the PNP should be concerned if the family is
withdrawing from supportive social networks. This could indicate depression or extreme
stress on the family unit. (Burns)
An otherwise healthy 2-year old boy is brought to the emergency room with a four-week
history of wheezing and persistent cough. Prior to the start of these symptoms, the parent
recalls a coughing event which resolved spontaneously. Of the following the most likely
diagnosis is:
, a. Viral pneumonia
b. Acute laryngotracheobronchitis
c. Bronchiolitis
d. Foreign body aspiration - d. Foreign body aspiration
Rationale: An initial choking, gagging, or coughing episode following by spontaneous
resolution is often present in history finding of a child with foreign body aspiration. The
episode is typically followed by respiratory symptoms such as stridor, wheezing, and
prolonged cough in the absence of illness. Acute layngotracheobronchitis, bronchitis, and
viral pneumonia are also associated with coughing and wheezing but also involve other
symptoms such as fever, rhinorrhea, fatigue and usually resolve within 10-14 days.
(Nelson Textbook of Pediatrics 20th edition, Chapter 327)
The sexual development of a 14-year old girl is notably delayed. She is very short,
slightly obese, and complains of constipation and fatigue. Her skin is sallow and coarse in
texture, and her hair is brittle. Which of the following tests should be obtained?
a. Serum leutinizing hormone and chromosome analysis
b. Serum thyroxine and thryroid-stimulating hormone
c. Chromosome analysis and serum thyroxine
d. Serum leutinizing hormone and thyroid stimulating hormone - b. Serum thyroxine and
thryroid-stimulating hormone
Rationale: Classic symptoms of growth failure, goiter, delayed or arrested puberty,
delayed dentition, weight gain, fatigue, dry skin, hyperlipidemia, decline in school
performance, menorrhagia, and fatigue. It would be most appropriate to test for
hypothyroidism first in this patient. If these are normal then you may want to consider the
other tests for reasons for her growth delay etc. (Burns)
Which of the following children requires a language referral for further evaluation?
a. 1-year-old with a 5-word vocabulary
b. 2-year-old who cannot put two words together
c. 2-year-old with a 30-word vocabulary
d. 3-year-old who is understandable to parents - b. 2-year-old who cannot put two words
together