Barkley 3P Exam Questions and
Answers 2026 Update | Barkley
Pediatric Primary Care Certification
Review Q&A with Rationales
A soft, high pitched, blowing diastolic decrescendo murmur best heard at the 3rd left
interspace at base, initiated with S2 and heard when the patient sits up and leans forward. -
Answer- Aortic regurgitation
A low pitched diastolic rumble that does not radiate, best heard at the apex when in the left
lateral position. - Answer- Mitral stenosis
A loud, harsh murmur occurring midsystole, radiating down the side of the neck and down to
the apex. - Answer- Aortic stenosis
A loud blowing murmur heard at the apex that is pansystolic. - Answer- Mitral regurgitation
The most common metabolic bone disease characterized by chronic, progressive, systemic
low bone mass and deterioration of bone tissue, leading to increased skeletal fragility and
deformity. - Answer- Osteoporosis
The most common clinical manifestation of osteoporosis. - Answer- Bone deformity
A class of medications used to treat erectile dysfunction. - Answer- Phosphodiesterase
inhibitor
May be used at a dose of 2.5 mg daily if sexual activity will take place two or more times per
week. - Answer- Tadalafil (Cialis)
5 mg may be taken with a high-fat meal four hours before sexual activity. - Answer-
Vardenafil (Levitra)
50 mg may be taken one hour before sexual activity as long as the patient has a resting
blood pressure below 170/110 mm Hg. - Answer- Sildenafil (Viagra)
Recommended at 50 mg for all patients, and may be taken 30 minutes before sexual activity.
- Answer- Avanafil (Stendra)
A method of describing the three main factors that lead to thrombosis: hypercoagulability,
damage to endothelial cells, and turbulent blood flow. - Answer- Virchow's Triad
,A condition that leads to clotting, including malignancy, trauma, sepsis, and thrombophilia. -
Answer- Hypercoagulability
Part of Virchow's triad that causes blood to clot by promoting platelet adherence to the wall
of the vessels. - Answer- Endothelial cell damage
A component of circulatory stasis in Virchow's triad, which can be caused by atrial fibrillation,
venous obstruction, and ventricular dysfunction. - Answer- Turbulent blood flow
A condition that may present with hypercalcemia and mental confusion. - Answer- Kidney
stones
A condition that may be evaluated in patients with kidney stones, hypercalcemia, and mental
confusion. - Answer- Cushing Syndrome
A fracture that occurs due to weakened bone structure, commonly associated with
osteoporosis. - Answer- Pathologic fracture
A condition that is not common in osteoporosis, resulting from fat obstruction due to injury or
trauma. - Answer- Fat embolism
A potential symptom of osteoporosis, but not the most common clinical manifestation. -
Answer- Bone pain
Not part of Virchow's triad and does not affect blood clotting. - Answer- Sympathetic tone
The second aspect of Virchow's triad, which promotes blood clotting. - Answer- Vascular wall
injury
The third component of Virchow's triad, which can lead to thrombosis. - Answer- Circulatory
stasis
A symptom that may accompany hypercalcemia in patients with kidney stones. - Answer-
Mental confusion
An elevated level of calcium in the blood, often associated with kidney stones. - Answer-
Hypercalcemia
A condition characterized by excessive production of aldosterone, leading to hypertension
and electrolyte imbalances. - Answer- Conn's Syndrome
A condition where the parathyroid glands produce too much parathyroid hormone, resulting
in elevated calcium levels in the blood. - Answer- Hyperparathyroidism
A disorder in which the adrenal glands do not produce sufficient steroid hormones. - Answer-
Addison's disease
, Medications taken by mouth to prevent pregnancy, which may have various side effects and
risks. - Answer- Oral contraceptives
Drugs that are contraindicated in pregnancy due to evidence of fetal harm. - Answer-
Pregnancy category X drugs
A peptide hormone that causes blood vessels to constrict, leading to an increase in blood
pressure. - Answer- Angiotensin
A hormone produced by the adrenal glands that regulates sodium and potassium levels,
affecting blood pressure. - Answer- Aldosterone
An abnormal increase in resonance during percussion of the chest, often indicating the
presence of air, such as in pneumothorax. - Answer- Hyperresonance
A condition where air leaks into the space between the lung and chest wall, causing lung
collapse. - Answer- Pneumothorax
A clinical test used to detect hip dislocation in infants by flexing and abducting the legs. -
Answer- Ortolani maneuver
A disease characterized by the narrowing of coronary arteries, leading to reduced blood flow
to the heart. - Answer- Coronary heart disease
A type of fat found in the blood that is necessary for building cells, but high levels can
increase the risk of heart disease. - Answer- Cholesterol
Often referred to as 'bad' cholesterol, high levels can lead to plaque buildup in arteries. -
Answer- LDL (Low-Density Lipoprotein)
Known as 'good' cholesterol, it helps remove other forms of cholesterol from the
bloodstream. - Answer- HDL (High-Density Lipoprotein)
A type of fat found in the blood, high levels can increase the risk of heart disease. - Answer-
Triglycerides
A low-molecular-weight heparin used in combination with warfarin for the treatment of deep
vein thrombosis. - Answer- Tinzaparin
An anticoagulant medication used to prevent blood clots. - Answer- Warfarin
A hormonal contraceptive implant that releases etonogestrel to prevent pregnancy. -
Answer- Etonogestrel (Nexplanon)
A common reason for discontinuing hormonal contraceptive methods due to unpredictable
menstrual cycles. - Answer- Irregular bleeding
Answers 2026 Update | Barkley
Pediatric Primary Care Certification
Review Q&A with Rationales
A soft, high pitched, blowing diastolic decrescendo murmur best heard at the 3rd left
interspace at base, initiated with S2 and heard when the patient sits up and leans forward. -
Answer- Aortic regurgitation
A low pitched diastolic rumble that does not radiate, best heard at the apex when in the left
lateral position. - Answer- Mitral stenosis
A loud, harsh murmur occurring midsystole, radiating down the side of the neck and down to
the apex. - Answer- Aortic stenosis
A loud blowing murmur heard at the apex that is pansystolic. - Answer- Mitral regurgitation
The most common metabolic bone disease characterized by chronic, progressive, systemic
low bone mass and deterioration of bone tissue, leading to increased skeletal fragility and
deformity. - Answer- Osteoporosis
The most common clinical manifestation of osteoporosis. - Answer- Bone deformity
A class of medications used to treat erectile dysfunction. - Answer- Phosphodiesterase
inhibitor
May be used at a dose of 2.5 mg daily if sexual activity will take place two or more times per
week. - Answer- Tadalafil (Cialis)
5 mg may be taken with a high-fat meal four hours before sexual activity. - Answer-
Vardenafil (Levitra)
50 mg may be taken one hour before sexual activity as long as the patient has a resting
blood pressure below 170/110 mm Hg. - Answer- Sildenafil (Viagra)
Recommended at 50 mg for all patients, and may be taken 30 minutes before sexual activity.
- Answer- Avanafil (Stendra)
A method of describing the three main factors that lead to thrombosis: hypercoagulability,
damage to endothelial cells, and turbulent blood flow. - Answer- Virchow's Triad
,A condition that leads to clotting, including malignancy, trauma, sepsis, and thrombophilia. -
Answer- Hypercoagulability
Part of Virchow's triad that causes blood to clot by promoting platelet adherence to the wall
of the vessels. - Answer- Endothelial cell damage
A component of circulatory stasis in Virchow's triad, which can be caused by atrial fibrillation,
venous obstruction, and ventricular dysfunction. - Answer- Turbulent blood flow
A condition that may present with hypercalcemia and mental confusion. - Answer- Kidney
stones
A condition that may be evaluated in patients with kidney stones, hypercalcemia, and mental
confusion. - Answer- Cushing Syndrome
A fracture that occurs due to weakened bone structure, commonly associated with
osteoporosis. - Answer- Pathologic fracture
A condition that is not common in osteoporosis, resulting from fat obstruction due to injury or
trauma. - Answer- Fat embolism
A potential symptom of osteoporosis, but not the most common clinical manifestation. -
Answer- Bone pain
Not part of Virchow's triad and does not affect blood clotting. - Answer- Sympathetic tone
The second aspect of Virchow's triad, which promotes blood clotting. - Answer- Vascular wall
injury
The third component of Virchow's triad, which can lead to thrombosis. - Answer- Circulatory
stasis
A symptom that may accompany hypercalcemia in patients with kidney stones. - Answer-
Mental confusion
An elevated level of calcium in the blood, often associated with kidney stones. - Answer-
Hypercalcemia
A condition characterized by excessive production of aldosterone, leading to hypertension
and electrolyte imbalances. - Answer- Conn's Syndrome
A condition where the parathyroid glands produce too much parathyroid hormone, resulting
in elevated calcium levels in the blood. - Answer- Hyperparathyroidism
A disorder in which the adrenal glands do not produce sufficient steroid hormones. - Answer-
Addison's disease
, Medications taken by mouth to prevent pregnancy, which may have various side effects and
risks. - Answer- Oral contraceptives
Drugs that are contraindicated in pregnancy due to evidence of fetal harm. - Answer-
Pregnancy category X drugs
A peptide hormone that causes blood vessels to constrict, leading to an increase in blood
pressure. - Answer- Angiotensin
A hormone produced by the adrenal glands that regulates sodium and potassium levels,
affecting blood pressure. - Answer- Aldosterone
An abnormal increase in resonance during percussion of the chest, often indicating the
presence of air, such as in pneumothorax. - Answer- Hyperresonance
A condition where air leaks into the space between the lung and chest wall, causing lung
collapse. - Answer- Pneumothorax
A clinical test used to detect hip dislocation in infants by flexing and abducting the legs. -
Answer- Ortolani maneuver
A disease characterized by the narrowing of coronary arteries, leading to reduced blood flow
to the heart. - Answer- Coronary heart disease
A type of fat found in the blood that is necessary for building cells, but high levels can
increase the risk of heart disease. - Answer- Cholesterol
Often referred to as 'bad' cholesterol, high levels can lead to plaque buildup in arteries. -
Answer- LDL (Low-Density Lipoprotein)
Known as 'good' cholesterol, it helps remove other forms of cholesterol from the
bloodstream. - Answer- HDL (High-Density Lipoprotein)
A type of fat found in the blood, high levels can increase the risk of heart disease. - Answer-
Triglycerides
A low-molecular-weight heparin used in combination with warfarin for the treatment of deep
vein thrombosis. - Answer- Tinzaparin
An anticoagulant medication used to prevent blood clots. - Answer- Warfarin
A hormonal contraceptive implant that releases etonogestrel to prevent pregnancy. -
Answer- Etonogestrel (Nexplanon)
A common reason for discontinuing hormonal contraceptive methods due to unpredictable
menstrual cycles. - Answer- Irregular bleeding
