2. Question: By what age should most children be able to sit well without support?

3. Question: All of the following are consistent with peritonsillar abscess except:

4. Question: You would be concerned about the language development of a child who:

5. Question: Which of the following is a true contraindication of vaccinating a child?

6. Question: Which of the following statements about "routine" screening tests is true?

7.  Question: You are performing an examination of a 3-year-old who is new to your office. Which finding requires immediate further evaluation?

8. Question: A mother of a 6-month-old asks you about normal sleep patterns for an infant this age. The best response is:

9. Question: You see a healthy 18-month-old for a well-child visit. At the 12-month visit he received the diphtheria, tetanus, and acellular pertussis (DTaP) third dose; hepatitis B second dose; measles, mumps, and rubella (MMR) first dose; injected poliovirus (IPV) second dose; pneumococcal conjugate (PCV13) fourth dose; and Haemophilus influenzae type B (Hib) fourth dose. Which of the following do you order today?

10. Question: Which of the following signs may indicate a baby is not receiving sufficient breastmilk?

11. Question: Sarah, age 15, presents with pain and pressure over her cheeks and discolored nasal discharge. You cannot transilluminate the sinuses. You suspect which common sinus to be affected?

 12. Question: An expected milestone of a 4-year-old is the ability to

13. Question: A child's head circumference is routinely measured on each well visit until what age?

14. Question: A healthy, well-developed 6-year-old child arrives as a new patient to your clinic. His immunization card reveals that he received an immunization at birth and some when he was 2 months old, but none sense. Which of the following statements about him is correct?

15. Question: A 4-year-old believes there is more juice in a tall, thin glass than a shorter, wider one. The child has not yet achieved which of the principles of Piaget?

16. Question: Conductive hearing loss can be caused by

17.Question: Miguel, age 14, was hit in the eye with a baseball and developed eye pain, decreased visual acuity, and injection of the globe. Upon exam you note blood in the anterior chamber and confirm diagnosis of hyphema. What treatment do you recommend while Miguel is waiting to see the ophthalmologist

18. Question: A child's central visual acuity is 20/30 by age

19. Question: A 9-year-old who weighs 70 pounds asks why she can't sit in the front passenger seat of the family car. Your best response is

20. Question: You receive a phone call from the mother of a 2-year-old. She states her child has sleep refusal. You suggest the child should be able to:

21. Question: An 8-year-old female is brought into the office by her mother. She has complaints of fever and sore throat for the past 2 days. She denies difficulty swallowing but has loss of appetite and mild diarrhea. A few classmates have similar symptoms. A review of systems reveals clear nasal drainage, dry cough, and hoarseness. On exam she has a 101.5 temperature, 3+ erythematous tonsils, and anterior cervical lymphadenopathy. What is the likely diagnosis?

22. Question: You see a 4-year-old for a well-child visit. He has received four diphtheria, tetanus, and acellular pertussis vaccines (DTaP); three injected polio vaccines (IPV); one measles, mumps, and rubella vaccine (MMR); one varicella vaccine; and two hepatitis B (Hep B) vaccines. What do you order today?

23. Question: A 13-month-old child is noted to be at the 25th percentile for weight, the 10th percentile for height, and less than the 5th percentile for head circumference. She was born at term. She was noted to have a small head at birth, to be developmentally delayed throughout her life, and to have required cataract surgery shortly after birth. She currently takes phenobarbital for seizures. Which of the following would most likely explain this child’s small size?

24. Question: At what age would a child be expected to remember a string of numbers and repeat them backwards?

25. Question: A 4-month-old child has poor weight gain. Her current weight is less than the 5th percentile, height about the 10th percentile, and head circumference at the 50th percentile. The planned pregnancy resulted in a normal, spontaneous, vaginal delivery; mother and child were discharged after a 48-hour hospitalization. Feeding is via breast and bottle; the quantity seems sufficient. The child has had no illness. The examination is unremarkable except for the child’s small size. Screening laboratory shows the hemoglobin and hematocrit are 11 mg/dL and 33% respectively, with a platelet count of 198,000/mm3. Serum electrolyte levels are sodium 140, chloride 105, potassium 3.5, bicarbonate 17, blood urea nitrogen 15, and creatinine 0.3. Liver function tests are normal. Urinalysis reveals a pH of 8 with occasional epithelial cells but no white blood cells, bacteria, protein, ketones, or reducing substances. Which of the following is the most appropriate therapy for this child?

26. Question: A 14-year-old female comes into the office for an urgent visit after taking 10 valium tablets.  Following the initial emergent care and stailization, the most important part of the management is:

27. Question: A mother brings her 4-week-old infant into the office because she noticed small yellow-white glistening bumps on her infant's gums. She says they look like teeth but is concerned that they may be cancer. You diagnose these bumps as

28. Question: Appropriate anticipatory guidance for the parents of an 8-year-old girl includes

29. Question: A differential diagnosis for child abuse would include all of the following except.

30. Question: An eye that deviates in when covered but that returns to midline when uncovered is an

31. Question: Sarah, 7 years old, is in the office today. All of the following are acceptable management options for allergic rhinitis, except

32. Question: Which of the following eye findings would be considered an ophthalmic emergency?

33. Question: Mark is in the exam room. You are concerned he may have epiglottitis. In what position do these patients prefer to sit?

34. Question: Which is the correct order for introduction of solid foods to an infant?

35. Question: Role-play with equipment during the course of the physical exam would be the most beneficial with which age group?

36. Question: A 2-year-old boy has been slightly less than the 50th percentile for weight, height and head circumference, but in the last 6 months he has fallen to slightly less than the 25th percentile for weight. The pregnancy was normal, his development is as expected, and the family reports no psychosocial problems. The mother says that he is now a finicky eater (wants only macaroni and cheese at all meals), but she insists that he eat a variety of foods. The meals are marked by much frustration for everyone. His examination is normal. Which of the following is the best next step in his care?

37. Question: A 3-year-old (37 months) refuses to have bowel movements on the toilet. He is bladder trained. He goes and hides and squats when having bowel movements. Positive encouragement and praise is not working. You advise:

38. Question: You see a 3-year-old for a well-child visit. His mother informs you that potty training has been very easy because he “has an amazing internal clock. He falls asleep, gets hungry, and has bowel movements at the same time every day.” This describes which aspect of temperament?

39. Question: Which adolescent would be at greatest risk for developing anorexia nervosa?

40. Question: Mark, a 10-year-old, has a lot of ear pain. He does not want anyone to touch it and is crying in pain. The ear canal is swollen and exudate is preswent. The TM is normal. What is the proper management for his patient?

41. Question: FIRST-LINE therapy for preschoolers (4-5 years of age) diagnosed with attention-deficit hyperactive disorder is:

42. Question: Which of the following screenings should adolescents have done annually?

43. Question: A 12-year-old male states he noticed an enlargement of his testes and scrotum. When counseling him about the next step in pubertal development, you state:

44. Question: A breastfed infant is expected to have a lower incidence of which of the following?

45. Question: Most children can independently get dressed by themselves by age:

46. Question: Which of the following statements is true regarding lying and stealing by the school-age child?

47. Question: The diagnostic criteria for autism spectrum disorder include all of the following except

48. Question: A 2-year-old child weighs 34 lb. What type of car seat should the child use?

49. Question: You see a young child who has tripled her birth weight and looks for hidden objects. When given blocks, she places one in each hand. She has a fine pincer grasp. On the floor, she walks around holding objects and is trying to take independent steps. This child is most likely how old?

50. Question: A 2-day-old newbornwith conjunctivitis is likely due t

51. Question: Which of the following strategies would not be appropriate to include as part of your treatment plan of an 8-year-old boy who is obese?

52. Question: Please interpret the following labs for an adolescent. The adolescent has a history of obesity and acanthosis nigricans.

53. Question: For adolescent girls, peak height velocity should occur by Tanner Stage (SMR):

54. Question: You see a 30-month-old who speaks in mixed Spanish and English. The child’s vocabulary is normal but at the low end of the normal language spectrum. The parent is worried the child’s development will not be normal because she mixes up the two languages. You respond:

55. Question: Which of the following characterizes middle adolescence (14 to 16 years old)?

56. Question: What method can be safely used to remove cerumen in a 15-month-old child's ear?

57. Question: Which of the following statements about bullying is true?

58. Question: Hannah, age 4, is brought into the office by her father. She complains of a sore throat, difficulty swallowing, copious oral secretions, stridor, and a temperature of 102F. She does not have pharyngeal erythema or cough. What do you suspect?

59. Question: A new mom calls the NP on postpartum day 5. She reports her newborn wants to nurse for 30 minutes every 1-1/2 to 2 hours. Which of these is the best response?

60. Question: Which of the following vaccines is routinely recommended at 4 months of age?

61. Question: What is the most common form of child abuse seen in pediatric primary care?

62. Question: Early reflexive responses that are not related to survival include all but:

63. Question: A 14-year old has ataxia. He is brought to the local emergency department, where he appears euphoric, emotionally labile, and a bit disoriented. He has nystagmus and hypersalivation. Many notice his abusive language. Which of the following agents is most likely responsible for his condition?

64. Question: A fifteen-year-old female makes a statement to you during a well visit. Which of the following statements should not be kept confidential?

65. Question: Upon eye examination of a newborn, you note inner canthal folds and Brushfield spots. What do you suspect?

66. Question: You see a 6-month-old for a well-child visit and the mother tells you the child’s grandmother recommends that she give the infant whole milk and eggs when he starts solids. What should you tell the mother?

67. Question: The parents of a 7-year-old are concerned their son does not want to attend school. Which of the historical findings are not usually associated with the diagnosis of school phobia?

68. Question: A common feature of 2-year-old behavior is:

69. Question: Which of the following is a priority nurse practitioner role to help children and adolescents to have healthy sexual development?

70. Question: The parent of a 2-year-old tells you her daughter recently started having breath-holding spells. She tells you the older sibling “did the same thing” and asks you for help. You advise her that after a breath-holding event:

71. Question: Appropriate advice for a mother of a 2-week-old child here for a “well child” visit includes which of the following?

72. Question: Luke, a 17-month-old, failed treatment with amoxicillin for otitis media. At the two-week recheck, his TM was still erythematous and you cannot see the landmarks. He has persistent nasal congestion, he is not sleeping at night, and he has a 101°F fever. What is the next best step for Luke?

73. Question: A teenage female who is overweight has moderate acne on the face and chest, and irregular menses. Elevation of which laboratory test provides the test evidence of polycystic ovarian syndrome?

74. Question: The appropriate lab tests in assessment of cervical adenitis include all of the following except:

75. Question: Which of the following are important considerations when screening child refugees for tuberculosis? SELECT TWO (2)

76. Question: The father of a 3-year-old is concerned because the child stutters. What should your approach be?

77. Question: A 19-month-old says “mama” and “dada,” points and gestures if he wants things, and follows simple one-step commands. Your best response is which of the following?

78. Question: During a domestic health assessment, the CDC recommends screening every refugee child for which of the following diseases?

79. Question: Which of the following children has abnormal language development?

80. Question: Initial screening tests for an 11-year-old with a family history of hyperlipidemia and weight at the 97th percentile include:

81. Question: Which of the following conditions requires urgent inpatient admission?

82. Question: Parents bring their 6-month-old son to see you. He is symmetrically less than the 5th percentile for height, weight and head circumference. He was born at 30 weeks’ gestation and weighed 1000g. He was a planned pregnancy, and his mother’s prenatal course was uneventful until an automobile accident initiated the labor. He was ventilated for 3 days in the intensive care unit but otherwise did well without ongoing problems. He was discharged at 8 weeks of life. Which of the following is the most likely explanation for his small size?

83. Question: Which of the following would not suggest an eating disorder with a purging component?

84. Question: Parents bring their 16-year-old daughter for a “well-child” checkup. She looks normal on examination. As part of your routine care you plan a urinalysis. The father pulls you aside and asks you to secretly run a UDS on his daughter. Which of the following is the most appropriate course of action?

85. Question: Which of the following complication of strep pharyngitis cannot be prevented with antibiotics?

86. Question: A Mantoux test in a child with no risk factors is considered positive with a reaction of:

87. Question: Mark, a 10-year-old, has a lot of ear pain. He does not want anyone to touch it and is crying in pain. The ear canal is swollen and exudate is present. The TM is normal. Mark should be instructed to do which of the following?

88. Question: A typically developing 8-year-old girl will have which of the following genital development?

89. Question: Which of the following substances is associated with pupillary constriction?

90. Question: Head and chest circumferences should be equal at:

91. Question: Acute otitis media can be diagnosed when there is

92. Question: I can walk well on tiptoes, my speech is 50% understandable, I know six body parts, but I cannot balance on one foot for 1 second. I am:

93. Question: You see a 7-year-old with complaints of "having accidents at night." Physical exam and history are unremarkable. Urinalysis, urine culture, and specific gravity are normal. His parents ask about the best treatment for this problem. The best response is

94. Question: You diagnose a 16-year-old with acute otitis media and need to prescribe an antibiotic with beta-lactamase coverage. What do you choose?

95. Question: While assessing the skin of an infant, you note cafe-au-lait spots. Which disease should be ruled out?

96. Question: You see a 5-month-old who is fussy, has interrupted sleep, and is drooling. You note large lower lateral incisor bulges. You recommend:

97. Question: A 6-month-old infant has been growing poorly. His parents have changed his formula three times without success. His examination is remarkable for a pale, emaciated child with little subcutaneous fat and anterior fontanelle fullness. His laboratory test results are notable for a hemolytic anemia and prolonged bleeding times. Which of the following is the most appropriate next step?

98. Question: Max, a 9-year-old boy, is a very active child with limited self-control. He is easily distracted and has difficulty staying on task. You determine that he should have a neurodevelopment evaluation because he is showing signs of

99. Question: Which of the following represents normal sequencing of development in a toddler?

100. Question: Sam has an otitis media. He also presents with conjunctivitis. This is due to which organism?

101. Question: Sally, age 4, presents to the office with her mother for a well-child visit. To assess for age-appropriate fine motor skills, what activity would you ask her to perform?