PNCB Acute Care Exam Questions and
Correct Answers| Latest Update
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
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.
,A child with a history of congenital heart disease fell while playing and presents
with a closed fracture of the humerus. Physical exam reveals mild bradycardia and
a moderate pain score.
Which of the following medications would MOST likely explain this child's
bradycardia?
A. Enalapril (Vasotec)
B. Furosemide (Lasix)
C. Levothyroxine (Synthroid)
D. Propranolol (Inderal)
D. Propranolol (Inderal)
(Decreases heart rate, myocardial contractility, blood pressure, and myocardial
oxygen demand. Adverse effects include bradycardia, hypotension, and
atrioventricular conduction disturbances)
Enteral nutrition is initiated in a child with severe malnutrition. Laboratory values
indicative of refeeding syndrome include a magnesium level of 1.5 mg/dL, and:
A. Phosphate 3.0 ml/dL & potassium 2.8 mEq/L
B. Phosphate 3.0 ml/dL & potassium 6 mEq/L
C. Phosphate 7.0 ml/dL & potassium 2.8 mEq/L
D. Phosphate 7.0 ml/dL & potassium 6 mEq/L
A. Phosphate 3.0 ml/dL & potassium 2.8 mEq/L
,(Refeeding syndrome occurs when malnourished patients are refed too
aggressively leading. It can occur within 1-3 days after reinstitution of nutrition.
The major manifestations include fluid overload, hypophosphatemia (phosphate
less than 3.5 mg/dL), hypokalemia (potassium less than 3.5 mEq/L),
hypomagnesemia (magnesium less than 1.8 mg/dL), and thiamine deficiency.
Complications include heart failure, dysrhythmias, respiratory muscle weakness,
seizures,
When informing a family that a report is being made to Child Protective Services
for suspected abuse, it is MOST important to
A. Focus on the child's well being
B. Identify the suspected perpetrator
C. Identify legal requirements for mandatory reporting
D. Share details with family to avoid misunderstanding
A. Focus on the child's well being
Manifestations of abdominal injuries secondary to a blast mechanism are typically:
A. Acute & immediately apparent
B. Observed less than 6 hours after exposure
C. Delayed 8-36 hours after exposure
D. Chronic & slow to develop
C. Delayed 8-36 hours after exposure
, (Blast attack, as seen in explosions, causes extensive compression and distortion
of the gastrointestinal (GI) tract & other air-filled organs. Manifestations generally
delayed, presenting 8-36 hours after exposure.)
A previously healthy preschooler who is fully immunized, presents with a history
of fever, URI symptoms, & joint pain over the past several days. Physical exam
reveals petechiae and hepatosplenomegaly. Vital signs include HR 156, RR 32,
temp 101.6 (38.7), BP 86/44 & O2 98% on RA. Lab results include Na+ 132, K+ 6,
Glucose 100, Ca+ 0.95, Phos 6.3, WBC 105,000, Hgb 6.1 & Plt 10,000. Which is the
BEST course of action?
A. Obtain LFTS & type & cross for blood products
B. Administer calcium gluconate & consult nephrology
C. Obtain blood cultures & administer IV Ceftriaxone
D. Administer a fluid bolus & consult oncology
D. Administer a fluid bolus & consult oncology
(The combination of leukocytosis, thrombocytopenia, and anemia should raise red
flags for an oncologic process, most likely leukemia. After initial laboratory values
are obtained, the child should receive aggressive hydration.)
An adolescent presents with bilateral knee pain that has occurred for several
months, exacerbated with activities such as climbing stairs and running. Pain is
also worsened by sitting with the knees flexed for an extended time and is
described as a grinding sensation under the kneecaps. No joint swelling is noted
on examination. The MOST likely diagnosis is:
Correct Answers| Latest Update
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
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.
,A child with a history of congenital heart disease fell while playing and presents
with a closed fracture of the humerus. Physical exam reveals mild bradycardia and
a moderate pain score.
Which of the following medications would MOST likely explain this child's
bradycardia?
A. Enalapril (Vasotec)
B. Furosemide (Lasix)
C. Levothyroxine (Synthroid)
D. Propranolol (Inderal)
D. Propranolol (Inderal)
(Decreases heart rate, myocardial contractility, blood pressure, and myocardial
oxygen demand. Adverse effects include bradycardia, hypotension, and
atrioventricular conduction disturbances)
Enteral nutrition is initiated in a child with severe malnutrition. Laboratory values
indicative of refeeding syndrome include a magnesium level of 1.5 mg/dL, and:
A. Phosphate 3.0 ml/dL & potassium 2.8 mEq/L
B. Phosphate 3.0 ml/dL & potassium 6 mEq/L
C. Phosphate 7.0 ml/dL & potassium 2.8 mEq/L
D. Phosphate 7.0 ml/dL & potassium 6 mEq/L
A. Phosphate 3.0 ml/dL & potassium 2.8 mEq/L
,(Refeeding syndrome occurs when malnourished patients are refed too
aggressively leading. It can occur within 1-3 days after reinstitution of nutrition.
The major manifestations include fluid overload, hypophosphatemia (phosphate
less than 3.5 mg/dL), hypokalemia (potassium less than 3.5 mEq/L),
hypomagnesemia (magnesium less than 1.8 mg/dL), and thiamine deficiency.
Complications include heart failure, dysrhythmias, respiratory muscle weakness,
seizures,
When informing a family that a report is being made to Child Protective Services
for suspected abuse, it is MOST important to
A. Focus on the child's well being
B. Identify the suspected perpetrator
C. Identify legal requirements for mandatory reporting
D. Share details with family to avoid misunderstanding
A. Focus on the child's well being
Manifestations of abdominal injuries secondary to a blast mechanism are typically:
A. Acute & immediately apparent
B. Observed less than 6 hours after exposure
C. Delayed 8-36 hours after exposure
D. Chronic & slow to develop
C. Delayed 8-36 hours after exposure
, (Blast attack, as seen in explosions, causes extensive compression and distortion
of the gastrointestinal (GI) tract & other air-filled organs. Manifestations generally
delayed, presenting 8-36 hours after exposure.)
A previously healthy preschooler who is fully immunized, presents with a history
of fever, URI symptoms, & joint pain over the past several days. Physical exam
reveals petechiae and hepatosplenomegaly. Vital signs include HR 156, RR 32,
temp 101.6 (38.7), BP 86/44 & O2 98% on RA. Lab results include Na+ 132, K+ 6,
Glucose 100, Ca+ 0.95, Phos 6.3, WBC 105,000, Hgb 6.1 & Plt 10,000. Which is the
BEST course of action?
A. Obtain LFTS & type & cross for blood products
B. Administer calcium gluconate & consult nephrology
C. Obtain blood cultures & administer IV Ceftriaxone
D. Administer a fluid bolus & consult oncology
D. Administer a fluid bolus & consult oncology
(The combination of leukocytosis, thrombocytopenia, and anemia should raise red
flags for an oncologic process, most likely leukemia. After initial laboratory values
are obtained, the child should receive aggressive hydration.)
An adolescent presents with bilateral knee pain that has occurred for several
months, exacerbated with activities such as climbing stairs and running. Pain is
also worsened by sitting with the knees flexed for an extended time and is
described as a grinding sensation under the kneecaps. No joint swelling is noted
on examination. The MOST likely diagnosis is:
