PNCB Acute Care FINAL EXAM STUDY
GUIDE 2026/2027 COMPLETE QUESTIONS
WITH VERIFIED CORRECT ANSWERS ||
100% GUARANTEED PASS
<NEWEST VERSION>
1. In a child with myasthenia gravis, which of the following symptoms would
be MOST indicative of a myasthenic crisis?
A. Eye drooling
B. Respiratory distress
C. Excessive salivation
D. Muscle fasciculation - ANSWER ✔ B. Respiratory distress
(Characterized by weakness and fatigue of skeletal muscle tissue that results
from autoimmune destruction of acetylcholine receptors (AchR). A crisis
event, or myasthenic crisis, is an acute exacerbation of the disease process
that results in severe weakness from dysfunction of the neuromuscular
junctions. It is characterized by respiratory failure due to weakness of the
airway or respiratory muscles.
A cholinergic crisis, is a severe weakness caused by overtreatment with
cholinergic medications used to treat MG & crisis present with excessive
salivation, excessive lacrimation, diarrhea, sweating, pupillary constriction,
and muscle fasciculation.
2. For the past 4 days a previously healthy infant has had a fever and upper
respiratory symptoms. Vital signs and laboratory values include T-38.7, HR
156, RR 32, BP 86/44, O2 92%, Na+ 132, K+ 4.5, glucose 100, ionized Ca+
0.95, Phos 6.3, WBC 130,000, Hgb 6.1 & Plt 10,000.
Which of the following is the PRIORITY intervention?
A. administer a fluid bolus and consult oncology
, B. administer calcium gluconate and consult nephrology
C. obtain blood cultures and administer IV ceftriaxone (Rocephin)
D. assess BUN and creatinine levels and obtain type and cross for blood
products - ANSWER ✔ A. administer a fluid bolus and consult
oncology
The combination of hyperleukocytosis, thrombocytopenia, and anemia
should raise red flags for leukemia. It is imperative to involve the oncology
service for treatment.
3. An adolescent presents after a recent viral illness with numbness and a
feeling of heaviness and weakness in bilateral lower extremities. The MOST
likely diagnosis is:
A. acute flaccid myelitis
B. Guillain-Barré syndrome
C. myasthenia gravis
D. tick paralysis - ANSWER ✔ B. Guillain-Barré syndrome
GBS is an acute inflammatory demyelinating polyradiculoneuropathy. It
typically presents post infectious illness with the typical timing of
presentation about 10 days following the infection. The classic symptoms
are areflexia, flaccidity, and symmetrical ascending weakness. Progression
can vary in nature from rapid onset with progression to slower development
over weeks. Typical symptoms start with numbness or paresthesia in the
hands and feet, with a sensation of heaviness in the legs. The weakness is
ascending and involves the arms, trunk, and bulbar muscles, and is often
symmetric.
The manifestation of AFM typically occurs within 7 days of a respiratory or
febrile illness, and the resultant limb weakness may be to one or all four
limbs. While AFM can be challenging to differentiate from GBS, weakness
is more commonly asymmetrical and is most often seen in young children.
Myasthenia gravis is an autoimmune condition where antibodies block the
acetylcholine receptors at the neuromuscular junction.
, Tick paralysis produces an acute lower motor pattern of weakness, clinically
similar to Guillain-Barré syndrome, but without the prodrome of an
infectious illness.
4. A child is resuscitated on location after a presumed submersion injury. Upon
arrival the child is alert and fully conscious, and airway, perfusion, and
respiratory effort are normal. Management includes supplemental oxygen,
blood gas measurements, along with
A. chest radiograph and IV antibiotics.
B. IV diuretics and admission to general pediatric floor.
C. IV steroids and admission to PICU.
D. observation for at least 6 hours and discharge home if stable. -
ANSWER ✔ D. observation for at least 6 hours and discharge home if
stable.
Even those who have spontaneous ventilation and minimal or no neurologic
dysfunction after resuscitation should be given supplemental oxygen to
minimize the risk of progressive hypoxemia and acidosis with subsequent
myocardial and cerebral damage.Physical examination has limited
sensitivity for detecting hypoxemia. If oxygenation is confirmed as normal
by pulse oximetry or blood gas determination while breathing room air, the
likelihood of aspiration is minimal.
Observation for a minimum of 6 hours with continued or repeat pulse
oximetry or repeat blood gas determination should be sufficient to assess the
possibility of late deterioration in gas exchange. When significant problems
occur in gas exchange they typically present within 4 to 6 hours of
submersion. Children who are observed for at least 6 hours and remain alert
and fully conscious, may be discharged from the emergency department.
The risk of pulmonary infection is always present, but retrospective studies
have demonstrated no benefit from prophylactic antibiotics. Antibiotics
should thus be reserved for strongly-suspected or proven bacterial infection.
There is no demonstrated value in the use of steroids in this scenario.
, 5. A previously healthy adolescent presents with a sudden onset of severe right
hip and knee pain. Physical examination findings include limited internal
rotation of the right hip and inability to bear weight. What is the MOST
appropriate diagnostic study?
A. nuclear medicine bone scan of pelvis, right femur, and knee
B. magnetic resonance imaging (MRI) of right hip, femur, and knee
C. radiographs of pelvis in anterior-posterior and lateral views
D. ultrasound of right hip - ANSWER ✔ C. radiographs of pelvis in
anterior-posterior and lateral views
The differential diagnosis of hip pain in children and adolescents includes
fractures, Legg-Calvé-Perthes disease, slipped capital femoral epiphysis
(SCFE), septic arthritis, and toxic synovitis. In the adolescent age group,
sudden onset of pain without history of trauma or fever is most
representative of slipped capital femoral epiphysis.
6. An adolescent female with a body-mass index of 30 has complaints of
severe headaches that have occurred when going to the bathroom followed
by brief loss of vision and hearing own heartbeat. The MOST likely
diagnosis is:
A. cluster headache
B. neuroblastoma
C. pseudotumor cerebri
D. tension headache - ANSWER ✔ C. pseudotumor cerebri
Pseudotumor cerebri is a disorder characterized by increased intracranial
pressure. It is associated with certain medical conditions and typically
affects adolescent females, with a higher frequency in adolescents who are
overweight. The symptoms of pseudotumor cerebri include nonspecific
headaches, pulsatile tinnitus, malaise, photophobia and phonophobia.
Immediate referral and work-up with a lumbar puncture are important for
management.
Cluster headaches are vascular headaches and occur in clusters over a period
of weeks or months. Pain is severe and comes on suddenly.
GUIDE 2026/2027 COMPLETE QUESTIONS
WITH VERIFIED CORRECT ANSWERS ||
100% GUARANTEED PASS
<NEWEST VERSION>
1. In a child with myasthenia gravis, which of the following symptoms would
be MOST indicative of a myasthenic crisis?
A. Eye drooling
B. Respiratory distress
C. Excessive salivation
D. Muscle fasciculation - ANSWER ✔ B. Respiratory distress
(Characterized by weakness and fatigue of skeletal muscle tissue that results
from autoimmune destruction of acetylcholine receptors (AchR). A crisis
event, or myasthenic crisis, is an acute exacerbation of the disease process
that results in severe weakness from dysfunction of the neuromuscular
junctions. It is characterized by respiratory failure due to weakness of the
airway or respiratory muscles.
A cholinergic crisis, is a severe weakness caused by overtreatment with
cholinergic medications used to treat MG & crisis present with excessive
salivation, excessive lacrimation, diarrhea, sweating, pupillary constriction,
and muscle fasciculation.
2. For the past 4 days a previously healthy infant has had a fever and upper
respiratory symptoms. Vital signs and laboratory values include T-38.7, HR
156, RR 32, BP 86/44, O2 92%, Na+ 132, K+ 4.5, glucose 100, ionized Ca+
0.95, Phos 6.3, WBC 130,000, Hgb 6.1 & Plt 10,000.
Which of the following is the PRIORITY intervention?
A. administer a fluid bolus and consult oncology
, B. administer calcium gluconate and consult nephrology
C. obtain blood cultures and administer IV ceftriaxone (Rocephin)
D. assess BUN and creatinine levels and obtain type and cross for blood
products - ANSWER ✔ A. administer a fluid bolus and consult
oncology
The combination of hyperleukocytosis, thrombocytopenia, and anemia
should raise red flags for leukemia. It is imperative to involve the oncology
service for treatment.
3. An adolescent presents after a recent viral illness with numbness and a
feeling of heaviness and weakness in bilateral lower extremities. The MOST
likely diagnosis is:
A. acute flaccid myelitis
B. Guillain-Barré syndrome
C. myasthenia gravis
D. tick paralysis - ANSWER ✔ B. Guillain-Barré syndrome
GBS is an acute inflammatory demyelinating polyradiculoneuropathy. It
typically presents post infectious illness with the typical timing of
presentation about 10 days following the infection. The classic symptoms
are areflexia, flaccidity, and symmetrical ascending weakness. Progression
can vary in nature from rapid onset with progression to slower development
over weeks. Typical symptoms start with numbness or paresthesia in the
hands and feet, with a sensation of heaviness in the legs. The weakness is
ascending and involves the arms, trunk, and bulbar muscles, and is often
symmetric.
The manifestation of AFM typically occurs within 7 days of a respiratory or
febrile illness, and the resultant limb weakness may be to one or all four
limbs. While AFM can be challenging to differentiate from GBS, weakness
is more commonly asymmetrical and is most often seen in young children.
Myasthenia gravis is an autoimmune condition where antibodies block the
acetylcholine receptors at the neuromuscular junction.
, Tick paralysis produces an acute lower motor pattern of weakness, clinically
similar to Guillain-Barré syndrome, but without the prodrome of an
infectious illness.
4. A child is resuscitated on location after a presumed submersion injury. Upon
arrival the child is alert and fully conscious, and airway, perfusion, and
respiratory effort are normal. Management includes supplemental oxygen,
blood gas measurements, along with
A. chest radiograph and IV antibiotics.
B. IV diuretics and admission to general pediatric floor.
C. IV steroids and admission to PICU.
D. observation for at least 6 hours and discharge home if stable. -
ANSWER ✔ D. observation for at least 6 hours and discharge home if
stable.
Even those who have spontaneous ventilation and minimal or no neurologic
dysfunction after resuscitation should be given supplemental oxygen to
minimize the risk of progressive hypoxemia and acidosis with subsequent
myocardial and cerebral damage.Physical examination has limited
sensitivity for detecting hypoxemia. If oxygenation is confirmed as normal
by pulse oximetry or blood gas determination while breathing room air, the
likelihood of aspiration is minimal.
Observation for a minimum of 6 hours with continued or repeat pulse
oximetry or repeat blood gas determination should be sufficient to assess the
possibility of late deterioration in gas exchange. When significant problems
occur in gas exchange they typically present within 4 to 6 hours of
submersion. Children who are observed for at least 6 hours and remain alert
and fully conscious, may be discharged from the emergency department.
The risk of pulmonary infection is always present, but retrospective studies
have demonstrated no benefit from prophylactic antibiotics. Antibiotics
should thus be reserved for strongly-suspected or proven bacterial infection.
There is no demonstrated value in the use of steroids in this scenario.
, 5. A previously healthy adolescent presents with a sudden onset of severe right
hip and knee pain. Physical examination findings include limited internal
rotation of the right hip and inability to bear weight. What is the MOST
appropriate diagnostic study?
A. nuclear medicine bone scan of pelvis, right femur, and knee
B. magnetic resonance imaging (MRI) of right hip, femur, and knee
C. radiographs of pelvis in anterior-posterior and lateral views
D. ultrasound of right hip - ANSWER ✔ C. radiographs of pelvis in
anterior-posterior and lateral views
The differential diagnosis of hip pain in children and adolescents includes
fractures, Legg-Calvé-Perthes disease, slipped capital femoral epiphysis
(SCFE), septic arthritis, and toxic synovitis. In the adolescent age group,
sudden onset of pain without history of trauma or fever is most
representative of slipped capital femoral epiphysis.
6. An adolescent female with a body-mass index of 30 has complaints of
severe headaches that have occurred when going to the bathroom followed
by brief loss of vision and hearing own heartbeat. The MOST likely
diagnosis is:
A. cluster headache
B. neuroblastoma
C. pseudotumor cerebri
D. tension headache - ANSWER ✔ C. pseudotumor cerebri
Pseudotumor cerebri is a disorder characterized by increased intracranial
pressure. It is associated with certain medical conditions and typically
affects adolescent females, with a higher frequency in adolescents who are
overweight. The symptoms of pseudotumor cerebri include nonspecific
headaches, pulsatile tinnitus, malaise, photophobia and phonophobia.
Immediate referral and work-up with a lumbar puncture are important for
management.
Cluster headaches are vascular headaches and occur in clusters over a period
of weeks or months. Pain is severe and comes on suddenly.
