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The initial attack of acute rheumatic fever is preceded by:

The mother of a 7-year-old girl brings her child to clinic. She tells the provider she has noticed her daughter has pubic hair growth and breast buds over the last month. Physical exam reveals genitalia and breasts at Tanner stage 3. Which diagnostic findings would be congruent with these history and physical findings?

A 5-year-old child is brought to the clinic. The caregiver reports the child has been lethargic and has had a low-grade fever for about 2 weeks. Physical examination reveals no significant findings other than pallor and lymphadenopathy. A complete blood count reveals decreased hematocrit, neutropenia, and thrombocytopenia. What action should the nurse practitioner take next? 

The nurse practitioner is seeing a 10-month-old female for her first urinary tract infection. She presented with a fever and foul-smelling urine. Her urine culture results reveal E. coli. What should be included in the plan of care for the child at this visit?

An 8-year-old male presents to clinic for a routine health exam. His growth chart is attached for review. His father is 5 ft. 4 in. and his mother is 5 ft. 1 in.. His health history and physical exam are unremarkable. He had a radiograph of the left wrist which shows a bone age equal to his chronological age. Which of the following is the most appropriate next step in his care?

A 13-year-old client presents to clinic for a follow-up on a head injury, occurring 3 days ago The child initially had a headache when the injury occurred, but it resolved. The child reports a her energy level is back to normal but is experiencing headaches, which are relieved by acetaminophen, about 20 minutes after her first class of the day. The headaches recur in the afternoon when she tries to do her homework. Her mother is concerned she is falling behind in school.  Which of the following is the next best step in this client’s management?

A 7-year-old child presents to clinic with a chief complaint of “rash” in the child’s left axilla. The caregiver states the lesions have been present for several weeks and are non-pruritic. She has tried over the counter steroid creams with no improvement. What is the most likely etiology and treatment of these lesions?

A 13-year-old girl presents for assessment of her short stature. On exam, the child has height and weight below the 5th percentile, webbed neck, lack of breast bud development, high-arched palate and low-set posterior hair line. What is the most likely diagnosis in this child?

A 12-year-old female presents to the clinic with a history of heavy menses, episodes of epistaxis twice a month, and reports to bruise easily. What is the most likely diagnosis for this patient?

A 16-year-old client presents to clinic for evaluation of recurrent headaches, which are described as a tight band around the client’s head. The client is an ambitious, high-achieving student who voices anxiety about upcoming final examinations. The client denies nausea, vomiting, visual disturbances, muscle weakness, or aura with the headache episodes. The vital signs are all within normal limits for age and gender. What is the most likely diagnosis?