A father brings his 3-year-old son to the clinic with complaints of high fever, sore throat, and seems to have pain with swallowing because child doesn’t want to eat. His symptoms started in the last 24 hours.

Question 1A father brings his 3-year-old son to the clinic with complaints of high fever, sore throat, and seems to have pain with swallowing because child doesn’t want to eat. His symptoms started in the last 24 hours. On exam you note the child seems anxious, is drooling, sitting in a tripod position, and has mild inspiratory stridor. The best diagnosis for this child is:

 

Retropharyngeal abscess

 

Foreign body aspiration

 

Croup

 

Epiglottitis

 

Question 2All of the following are true of Still’s murmurs EXCEPT:

 

They are usually Grade I-II/IV

 

Heard best in the lower left sternal border

 

Intensity increased when standing up or sitting

 

Intensity increases with laying supine

 

Question 3Etiologic agents responsible for 95% of the cases of meningitis in children >2 months of age have been Streptococcus pneumoniae, Neisseria meningitis and

 

Haemophilus influenzae type b

 

Escherichia coli

 

Mycococcus meningitides

 

Fluvoricoccus type c

 

Question 4Hand, foot, and mouth disease is a viral disease characterized by fever and vesicular lesions of the mouth, palms, and soles. It is caused by

 

Kawasaki’s

 

Coxsackie virus

 

Herpes virus

 

Candida albicans

 

Question 5A 10-year-old child manifests symptoms of fever, sore throat, and swollen lymph nodes. Spleen tip is palpable. Throat culture and rapid strep test results are negative. The next logical diagnostic test would involve

 

Repeat throat culture

 

Chest x-ray

 

Bone marrow aspiration

 

Epstein-Barr antibody test

 

Question 6Which of the following is TRUE regarding innocent murmurs?

 

 

 

The murmur is often holosystolic

 

Prompt referral to a cardiologist is indicated

 

A precordial thrill is present

 

Tends to disappear during later childhood

 

Question 7A 12-year-old boy seen at a routine visit has a BP of 150/96. He denies symptoms. The initial management would include

 

IV pyelogram

 

Return in 2 weeks for repeat BP measurements and keep a BP diary at home

 

No follow up needed – BP related to anxiety

 

Diuretic therapy

 

Question 8Which of the following is a common cause of acquired heart disease during childhood?

 

Lyme disease

 

Down syndrome

 

Systemic lupus

 

Kawasaki disease

 

Question 9A 5-year-old child who had a repair for transposition of the great arteries shortly after birth is growing normally and has been asymptomatic since the surgery. The primary care nurse practitioner (PNP)notes mild shortness of breath with exertion and, upon questioning, learns that the child has recently reported dizziness. What will the nurse practitioner do?

 

Order an echocardiogram and chest radiograph.

 

Perform pulmonary function testing.

 

Reassure the parent that these symptoms are common.

 

Refer the child to the cardiologist immediately.

 

Question 10A school-age child has fever of 104°F, sore throat, vomiting and malaise. The primary care pediatric nurse practitioner observes that the tonsils, oropharynx, and palate are erythematous and covered with exudate; the tongue is coated and red; and there is a red, sandpaper-like rash on the child’s neck, trunk, and extremities. A rapid strep test is positive. What will the nurse practitioner do to manage this child’s illness?

 

Administer intramuscular ceftriaxone.

 

Hospitalize for further diagnostic tests.

 

Prescribe oral amoxicillin.

 

Refer to a pediatric infectious disease specialist.

 

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