2024 – 2025 LATEST UPDATED APEA FNP EXAM |
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4 year old female is brought into the clinic by her mother who reports that she is constantly
scratching "her private part". The patient states that it itches on exam. The vagina is red and
irritated. How should the NP proceed?
A- call child protection for suspected sexual abuse.
B- Prescribe a cortisone cream.
C- Collective vaginal swab of the external vagina for microscopic evaluation
D- Prescribe a topical antifungal.
C- Collective vaginal swab of the external vagina for microscopic evaluation
The child has vaginitis. There are many diagnosis in the differential including pinworms, yeast
contact, irritants from soap or bubble bath, etc. Since the diagnosis is not clear, some
evaluation must occur in order to determine the diagnosis so proper treatment can be initiated
since the description of the problem does not indicate what the diagnosis is. It is inappropriate
to treat with a cortisone cream or topical antifungal.
A positive Trendelenburg test could be used to identify a child with:
A-scoliosis
B-Osgood-Schlatter disease
C-nursemaid's elbow
D-slipped capital femoral epiphysis (SCFE).
,slipped capital femoral epiphysis (SCFE)
Asking a child with a complaint of hip pain to stand on the affected side is how the
Trendelenburg test is assessed. A positive Trendelenburg test occurs when standing on the
affected leg causes a pelvic tilt such that the unaffected hip is lower. This can be assessed and
observed in children with slipped capital femoral epiphysis. Legg-Calve-Perthes disease, or
developmental dysplasia of the hip. Nursemaid's elbow is a common ligamentous injury in
young children. The radial head becomes subluxed. Displacement is usually easy to reduce. The
Adam's Forward bend test is used to assess for scoliosis. Osgood-Schlatter disease is assessed
by assessing for pain with palpitation of the tibial tubercle.
6 year old patient with sore throat has coryza, hoarseness and diarrhea. What is the likely
etiology?
Group A streptococcus
H. parainfluenzae
viral etiology
or Mycoplasma?
VIRAL ETIOLOGY
This constellation of symptoms is typical of a viral infection. Group A Streptococcus is usually
not accompanied by cariza. H pair influenza is not common cause of pharyngitis. Mycoplasma is
usually associated with lower respiratory tract infections.
A 6-week-old is suspected of having developmental dysplasia of the hip (DDH). What test would
be best assessed for this?
A) Barlow and Ortolani
B) Galeazzi and Klisic
C) Trendelenburg pelvic tilt test
,D) Romberg balance test?
A) Barlow and Ortolani
Barlow and Ortolani maneuvers are physical exam techniques used to assess hip stability in
newborns and infants 3 months of age and younger. It should be examined at every visit until
the child is walking normally, usually two years of age. The combination of these maneuvers has
approximately 98 to 99%. Specificity for detection of hip instability.
Barlow Maneuver: This test involves adducting the hip while applying gentle pressure on the
knee, directing the force posteriorly. A positive test occurs if the hip dislocates.
Ortolani Maneuver: This test involves abducting the hip while lifting the thigh anteriorly. A
positive test occurs if a "clunk" is felt as the hip relocates.
Galeazzi Test: The Galeazzi test, also known as the Allis sign, is used to assess for hip dislocation
or developmental dysplasia of the hip (DDH) in infants.
Procedure: The infant is placed in a supine position with hips and knees flexed.
The examiner compares the height of the knees. A positive Galeazzi sign is indicated by one
knee being lower than the other, suggesting a hip dislocation or femoral shortening.
Klisic Test: The Klisic test is another method to screen for developmental dysplasia of the hip
(DDH). Procedure: The examiner places the index finger on the anterior superior iliac spine
(ASIS) and the middle finger on the greater trochanter.
An imaginary line between these points should pass through or above the umbilicus in a child
without DDH. If the line falls below the umbilicus, it suggests a dislocated hip.
A mother of a four week old infant visits your office. She states that her baby is vomiting after
feeding and then cries as if he is hungry again. What should the nurse practitioner assess
a -his abdomen for an olive shaped mass
, B- his rectum for patency,
C- his swallowing ability, or
D- the position his mother uses when she feeds him.
a -his abdomen for an olive shaped mass
The symptoms likely reflect pyloric stenosis. The most common time for this to occur is three to
six weeks. It rarely occurs after 12 weeks of age. Babies who have episodes of projectile
vomiting and who demand to be referred are called "hungry vomiters". Add A diagnosis of
peloric stenosis should be considered. The olive shaped mass, if found, probably represents
hypertrophy of the lateral edge of the rectus abdominis muscle. It is most easily felt
immediately after vomiting. This diagnosis is made much earlier now than it used to be so. With
dehydration are not as common as decades ago.
A six week old male infant is brought to the nurse practitioner because of vomiting. The mother
describes vomiting after feeding and feeling a knot in his abdomen, especially after he vomits.
The child appears adequately nourished. What is the likely etiology?
A- gastroesophageal reflux.
B- pyloric stenosis
C- constipation
D- Munchausen syndrome by proxy.
B- pyloric stenosis
This scenario is typical of an infant with pyloric stenosis. It is more common in males 88%, and
usually is diagnosed before the child is 12 weeks old. The classic presentation is an infant who
vomits immediately after eating. The "knot" in the abdomen is the typical olive shaped mass
palpable at the lateral edge of the rectus abdominis muscle in the right upper quadrant of the
abdomen. The mass is best palpated immediately after vomiting. The differentials should
include gastroesophageal reflux, but no mass is palpable. Munchausen syndrome by proxy is
the fabrication or induction of an illness in a child in order for the caregiver to receive attention.
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