NR511 | NR511 Differential Diagnosis & Primary
Care Exam 2 v3 | Questions with Correct Answers
and Expert Explanation for Each Question |
Chamberlain
1. A 6-year-old child presents with a ‘honey-colored’ crusted lesion around the mouth. What
is the most likely diagnosis?
A. Herpes Simplex Virus
B. Eczema
C. Contact Dermatitis
D. Impetigo
Correct Answer: D
Expert Explanation: The appearance of honey-colored crusts is the hallmark clinical sign
of non-bullous impetigo. This condition is typically caused by Staphylococcus aureus or
Streptococcus pyogenes. Treatment usually involves topical mupirocin for localized cases
or oral antibiotics for more extensive involvement.
2. Which of the following is the most appropriate first-line treatment for a child with mild
persistent asthma?
A. Long-acting beta-agonist (LABA) alone
B. Low-dose inhaled corticosteroid (ICS)
C. Oral corticosteroids
D. Short-acting beta-agonist (SABA) as needed only
Correct Answer: B
Expert Explanation: Mild persistent asthma requires daily controller medication to
manage underlying inflammation. Low-dose inhaled corticosteroids (ICS) are the preferred
first-line treatment for this classification. Using a SABA alone is only appropriate for
intermittent asthma and does not address the chronic inflammation present in persistent
types.
3. A mother brings her 4-month-old infant to the clinic due to concerns about a ‘flat head’ on
the right posterior side. What is the most likely diagnosis?
A. Craniosynostosis
B. Microcephaly
C. Hydrocephalus
,D. Positional Plagiocephaly
Correct Answer: D
Expert Explanation: Positional plagiocephaly results from repeated pressure on one side
of the skull, often seen since the ‘Back to Sleep’ campaign started. Physical therapy and
‘tummy time’ are recommended early interventions to encourage neck mobility.
Craniosynostosis would involve premature fusion of sutures, which is less likely if the
sutures feel open on palpation.
4. Which physical exam finding is most suggestive of Acute Otitis Media (AOM) rather than
Otitis Media with Effusion (OME)?
A. Bulging of the tympanic membrane with decreased mobility
B. A dull or opaque tympanic membrane
C. Presence of fluid behind the tympanic membrane
D. Air bubbles visible through the tympanic membrane
Correct Answer: A
Expert Explanation: Bulging of the tympanic membrane is the most specific indicator of
acute inflammation and pressure in the middle ear characteristic of AOM. OME is
characterized by fluid without signs of acute infection like bulging or intense erythema.
Accurate diagnosis is crucial to avoid the unnecessary prescription of antibiotics for OME
cases.
5. A 2-year-old boy presents with a barking cough and inspiratory stridor that worsens at
night. What is the most likely diagnosis?
A. Epiglottitis
B. Bronchiolitis
C. Foreign body aspiration
D. Croup (Laryngotracheobronchitis)
Correct Answer: D
Expert Explanation: Croup is typically caused by the parainfluenza virus and presents
with a characteristic seal-like barking cough. Symptoms are often worse at night and may
include inspiratory stridor due to upper airway narrowing. A single dose of dexamethasone
is frequently used to reduce airway edema in these patients.
6. What is the standard treatment for a 10-day-old infant diagnosed with Chlamydial
conjunctivitis?
A. Topical Erythromycin ointment
B. Topical Ciprofloxacin drops
, C. Oral Erythromycin or Azithromycin
D. Warm compresses and observation
Correct Answer: C
Expert Explanation: Chlamydial conjunctivitis in neonates must be treated systemically
because topical treatments do not eliminate the risk of developing chlamydial pneumonia.
Oral erythromycin or azithromycin is the standard treatment protocol for these cases.
Monitoring for hypertrophic pyloric stenosis is necessary when using macrolides in very
young infants.
7. A 14-year-old girl presents with a single large, oval, pink patch on her back, followed by a
‘Christmas tree’ distribution of smaller lesions. What is the diagnosis?
A. Tinea Corporis
B. Psoriasis
C. Secondary Syphilis
D. Pityriasis Rosea
Correct Answer: D
Expert Explanation: Pityriasis rosea typically begins with a ‘herald patch’ which is a single
larger lesion followed by a secondary eruption in a Christmas tree pattern. This condition is
self-limiting and usually resolves within 6 to 12 weeks. Management focuses on
symptomatic relief of pruritus if it is present.
8. In the Centor Criteria for Group A Beta-Hemolytic Strep (GABHS), which of the following is
NOT a point-earning clinical feature?
A. Cough
B. Tonsillar exudates
C. Fever
D. Tender anterior cervical adenopathy
Correct Answer: A
Expert Explanation: The Centor Criteria award points for fever, tonsillar exudates, tender
anterior cervical lymphadenopathy, and the absence of a cough. The presence of a cough
actually suggests a viral etiology rather than bacterial pharyngitis. A score of 0-1 usually
requires no testing, while higher scores may warrant a rapid strep test or culture.
9. Which of the following rashes is characterized by ‘slapped cheek’ appearance followed by a
lacy, reticular rash on the extremities?
A. Roseola
Care Exam 2 v3 | Questions with Correct Answers
and Expert Explanation for Each Question |
Chamberlain
1. A 6-year-old child presents with a ‘honey-colored’ crusted lesion around the mouth. What
is the most likely diagnosis?
A. Herpes Simplex Virus
B. Eczema
C. Contact Dermatitis
D. Impetigo
Correct Answer: D
Expert Explanation: The appearance of honey-colored crusts is the hallmark clinical sign
of non-bullous impetigo. This condition is typically caused by Staphylococcus aureus or
Streptococcus pyogenes. Treatment usually involves topical mupirocin for localized cases
or oral antibiotics for more extensive involvement.
2. Which of the following is the most appropriate first-line treatment for a child with mild
persistent asthma?
A. Long-acting beta-agonist (LABA) alone
B. Low-dose inhaled corticosteroid (ICS)
C. Oral corticosteroids
D. Short-acting beta-agonist (SABA) as needed only
Correct Answer: B
Expert Explanation: Mild persistent asthma requires daily controller medication to
manage underlying inflammation. Low-dose inhaled corticosteroids (ICS) are the preferred
first-line treatment for this classification. Using a SABA alone is only appropriate for
intermittent asthma and does not address the chronic inflammation present in persistent
types.
3. A mother brings her 4-month-old infant to the clinic due to concerns about a ‘flat head’ on
the right posterior side. What is the most likely diagnosis?
A. Craniosynostosis
B. Microcephaly
C. Hydrocephalus
,D. Positional Plagiocephaly
Correct Answer: D
Expert Explanation: Positional plagiocephaly results from repeated pressure on one side
of the skull, often seen since the ‘Back to Sleep’ campaign started. Physical therapy and
‘tummy time’ are recommended early interventions to encourage neck mobility.
Craniosynostosis would involve premature fusion of sutures, which is less likely if the
sutures feel open on palpation.
4. Which physical exam finding is most suggestive of Acute Otitis Media (AOM) rather than
Otitis Media with Effusion (OME)?
A. Bulging of the tympanic membrane with decreased mobility
B. A dull or opaque tympanic membrane
C. Presence of fluid behind the tympanic membrane
D. Air bubbles visible through the tympanic membrane
Correct Answer: A
Expert Explanation: Bulging of the tympanic membrane is the most specific indicator of
acute inflammation and pressure in the middle ear characteristic of AOM. OME is
characterized by fluid without signs of acute infection like bulging or intense erythema.
Accurate diagnosis is crucial to avoid the unnecessary prescription of antibiotics for OME
cases.
5. A 2-year-old boy presents with a barking cough and inspiratory stridor that worsens at
night. What is the most likely diagnosis?
A. Epiglottitis
B. Bronchiolitis
C. Foreign body aspiration
D. Croup (Laryngotracheobronchitis)
Correct Answer: D
Expert Explanation: Croup is typically caused by the parainfluenza virus and presents
with a characteristic seal-like barking cough. Symptoms are often worse at night and may
include inspiratory stridor due to upper airway narrowing. A single dose of dexamethasone
is frequently used to reduce airway edema in these patients.
6. What is the standard treatment for a 10-day-old infant diagnosed with Chlamydial
conjunctivitis?
A. Topical Erythromycin ointment
B. Topical Ciprofloxacin drops
, C. Oral Erythromycin or Azithromycin
D. Warm compresses and observation
Correct Answer: C
Expert Explanation: Chlamydial conjunctivitis in neonates must be treated systemically
because topical treatments do not eliminate the risk of developing chlamydial pneumonia.
Oral erythromycin or azithromycin is the standard treatment protocol for these cases.
Monitoring for hypertrophic pyloric stenosis is necessary when using macrolides in very
young infants.
7. A 14-year-old girl presents with a single large, oval, pink patch on her back, followed by a
‘Christmas tree’ distribution of smaller lesions. What is the diagnosis?
A. Tinea Corporis
B. Psoriasis
C. Secondary Syphilis
D. Pityriasis Rosea
Correct Answer: D
Expert Explanation: Pityriasis rosea typically begins with a ‘herald patch’ which is a single
larger lesion followed by a secondary eruption in a Christmas tree pattern. This condition is
self-limiting and usually resolves within 6 to 12 weeks. Management focuses on
symptomatic relief of pruritus if it is present.
8. In the Centor Criteria for Group A Beta-Hemolytic Strep (GABHS), which of the following is
NOT a point-earning clinical feature?
A. Cough
B. Tonsillar exudates
C. Fever
D. Tender anterior cervical adenopathy
Correct Answer: A
Expert Explanation: The Centor Criteria award points for fever, tonsillar exudates, tender
anterior cervical lymphadenopathy, and the absence of a cough. The presence of a cough
actually suggests a viral etiology rather than bacterial pharyngitis. A score of 0-1 usually
requires no testing, while higher scores may warrant a rapid strep test or culture.
9. Which of the following rashes is characterized by ‘slapped cheek’ appearance followed by a
lacy, reticular rash on the extremities?
A. Roseola
