PNCB PNP-PC EXAM 2025/2026 | Primary & Acute
Care Master Questions — 250 MCQs | version 2
1. What is the most common cause of bacterial meningitis in children aged 1 month to 18 years?
A) Listeria monocytogenes
B) Neisseria meningitidis and Streptococcus pneumoniae (correct answer)
C) Group B Streptococcus
D) Haemophilus influenzae type b
Rationale: Neisseria meningitidis and Streptococcus pneumoniae are the leading causes of
bacterial meningitis in children beyond the neonatal period; H. influenzae type b has
dramatically declined since widespread vaccination; Group B Strep predominates in
neonates.
2. A 6-week-old infant presents with a rectal temperature of 38.1°C. What is the most
appropriate next step?
A) Reassure the parents and follow up in 24 hours
B) Full sepsis workup (CBC, blood culture, UA/urine culture, LP), hospitalization, and
empiric antibiotics (correct answer)
C) Administer acetaminophen and discharge with close follow-up
D) Obtain CBC only and treat if WBC is elevated
Rationale: Infants ≤60 days with fever ≥38°C (100.4°F) are at significant risk for serious
bacterial infection (SBI); current guidelines support a full sepsis evaluation (blood, urine,
CSF cultures) and empiric antibiotics pending results regardless of clinical appearance.
3. Which vaccine is recommended for all healthy children at 11–12 years of age as part of the
routine immunization schedule?
A) Hepatitis A booster
B) Tdap, MenACWY, and HPV series initiation (correct answer)
C) MMR booster only
D) Varicella booster only
,Rationale: At 11–12 years, ACIP recommends: Tdap (one dose), MenACWY (with booster
at 16), HPV series (2-dose if started before age 15), and annual influenza; this "pre-teen"
platform is critical for adolescent immunization.
4. A 4-year-old presents with a 3-day history of fever, strawberry tongue, erythematous palms
and soles, bilateral non-purulent conjunctivitis, and a desquamating rash. What is the priority
treatment?
A) Oral amoxicillin for Group A Streptococcus
B) IVIG 2 g/kg and high-dose aspirin for Kawasaki disease (correct answer)
C) Corticosteroids for serum sickness
D) Acyclovir for viral infection
Rationale: This presentation meets criteria for Kawasaki disease (KD): fever ≥5 days plus
≥4 of 5 principal features (conjunctivitis, lymphadenopathy, rash, oral changes, extremity
changes); IVIG + aspirin within 10 days of fever onset dramatically reduces coronary
artery aneurysm risk.
5. What are the diagnostic criteria for Kawasaki disease?
A) Fever >5 days plus 3 of 5 features
B) Fever ≥5 days plus ≥4 of 5 features: bilateral non-purulent conjunctivitis,
oropharyngeal changes, rash, extremity changes, cervical lymphadenopathy (correct
answer)
C) Fever >3 days plus any 2 features
D) Fever ≥5 days plus ≥5 of 5 features
Rationale: Classic KD criteria: fever ≥5 days AND ≥4 of 5: (1) bilateral non-exudative
conjunctivitis, (2) erythema of lips/tongue/oral mucosa, (3) polymorphous rash, (4)
extremity changes (erythema, edema, desquamation), (5) cervical lymphadenopathy ≥1.5
cm; incomplete KD may be diagnosed with fewer features plus echocardiographic findings.
6. A 9-year-old with a known peanut allergy develops generalized urticaria, throat tightening,
and hypotension after eating at a restaurant. What is the first-line treatment?
A) Diphenhydramine 1 mg/kg IV
B) Epinephrine 0.01 mg/kg IM into the anterolateral thigh (correct answer)
C) Hydrocortisone 2 mg/kg IV
D) Nebulized albuterol only
,Rationale: Epinephrine IM (anterolateral thigh) is the first-line, life-saving treatment for
anaphylaxis — the only drug that reverses all components (bronchospasm, vasodilation,
edema, urticaria); antihistamines and steroids are adjuncts only and should never replace
or delay epinephrine.
7. Which of the following is the most appropriate antibiotic for outpatient treatment of
community-acquired pneumonia (CAP) in a 5-year-old with no comorbidities?
A) Azithromycin
B) Amoxicillin 90 mg/kg/day divided TID (correct answer)
C) Trimethoprim-sulfamethoxazole
D) Doxycycline
Rationale: IDSA/PIDS guidelines recommend high-dose amoxicillin (90 mg/kg/day in 2–3
divided doses) as first-line for presumed bacterial CAP in fully immunized preschool and
school-age children without complications; macrolides are added if atypical organisms are
suspected (>5 years of age).
8. What is the recommended treatment for an otherwise healthy 8-year-old with a positive rapid
strep test and pharyngitis?
A) Azithromycin 5-day course
B) Penicillin V or amoxicillin for 10 days (correct answer)
C) Clindamycin for 7 days
D) Watchful waiting without antibiotics
Rationale: Penicillin (amoxicillin preferred for palatability) for 10 days remains the
treatment of choice for Group A Streptococcal (GAS) pharyngitis; 10-day course is
necessary to eradicate pharyngeal carriage and prevent acute rheumatic fever.
9. A 2-year-old presents with inspiratory stridor, a barking cough, and hoarse voice for 2 days.
Vital signs are stable with SpO₂ 98%. What is the most appropriate treatment?
A) IV racemic epinephrine and hospitalization
B) A single oral dose of dexamethasone 0.6 mg/kg (correct answer)
C) Nebulized albuterol every 4 hours
D) Amoxicillin for bacterial tracheitis
Rationale: Croup (viral laryngotracheobronchitis — most commonly parainfluenza) is
treated with a single dose of oral dexamethasone 0.6 mg/kg (max 16 mg) for mild-moderate
, cases; dexamethasone reduces edema through anti-inflammatory effects and significantly
reduces return visits and hospitalizations.
10. Which organism most commonly causes croup?
A) Respiratory syncytial virus (RSV)
B) Parainfluenza virus type 1 (correct answer)
C) Influenza A
D) Adenovirus
Rationale: Parainfluenza virus type 1 is the most common cause of croup (viral
laryngotracheobronchitis), typically presenting in fall/early winter; other causes include
parainfluenza 2 and 3, RSV, adenovirus, and rhinovirus.
11. A 3-month-old presents with tachypnea, subcostal retractions, and wheezing during peak
RSV season. Pulse oximetry shows 91%. What is the most evidence-based treatment?
A) Nebulized albuterol and racemic epinephrine
B) Supportive care — supplemental oxygen, suctioning of secretions, and hydration
(correct answer)
C) Oral corticosteroids for 5 days
D) Ribavirin antiviral therapy
Rationale: Bronchiolitis (most commonly RSV) management is supportive; AAP guidelines
do NOT recommend albuterol, epinephrine, steroids, or antibiotics for routine
bronchiolitis; supplemental O₂ for SpO₂ <90–92% (per institution), nasal suctioning, and
adequate hydration are evidence-based.
12. What are the current criteria for hospitalization of a child with bronchiolitis?
A) Age <12 months, any wheezing, or fever >38°C
B) SpO₂ persistently <90–92%, significant respiratory distress, poor feeding, apnea, or
high-risk features (age <2 months, prematurity, cardiac/pulmonary disease) (correct
answer)
C) RSV-positive test result always requires admission
D) WBC >15,000 with respiratory symptoms
Rationale: Bronchiolitis hospitalization criteria: SpO₂ <90–92% on room air, moderate-
severe respiratory distress (RR >70, retractions, grunting), inability to maintain adequate
Care Master Questions — 250 MCQs | version 2
1. What is the most common cause of bacterial meningitis in children aged 1 month to 18 years?
A) Listeria monocytogenes
B) Neisseria meningitidis and Streptococcus pneumoniae (correct answer)
C) Group B Streptococcus
D) Haemophilus influenzae type b
Rationale: Neisseria meningitidis and Streptococcus pneumoniae are the leading causes of
bacterial meningitis in children beyond the neonatal period; H. influenzae type b has
dramatically declined since widespread vaccination; Group B Strep predominates in
neonates.
2. A 6-week-old infant presents with a rectal temperature of 38.1°C. What is the most
appropriate next step?
A) Reassure the parents and follow up in 24 hours
B) Full sepsis workup (CBC, blood culture, UA/urine culture, LP), hospitalization, and
empiric antibiotics (correct answer)
C) Administer acetaminophen and discharge with close follow-up
D) Obtain CBC only and treat if WBC is elevated
Rationale: Infants ≤60 days with fever ≥38°C (100.4°F) are at significant risk for serious
bacterial infection (SBI); current guidelines support a full sepsis evaluation (blood, urine,
CSF cultures) and empiric antibiotics pending results regardless of clinical appearance.
3. Which vaccine is recommended for all healthy children at 11–12 years of age as part of the
routine immunization schedule?
A) Hepatitis A booster
B) Tdap, MenACWY, and HPV series initiation (correct answer)
C) MMR booster only
D) Varicella booster only
,Rationale: At 11–12 years, ACIP recommends: Tdap (one dose), MenACWY (with booster
at 16), HPV series (2-dose if started before age 15), and annual influenza; this "pre-teen"
platform is critical for adolescent immunization.
4. A 4-year-old presents with a 3-day history of fever, strawberry tongue, erythematous palms
and soles, bilateral non-purulent conjunctivitis, and a desquamating rash. What is the priority
treatment?
A) Oral amoxicillin for Group A Streptococcus
B) IVIG 2 g/kg and high-dose aspirin for Kawasaki disease (correct answer)
C) Corticosteroids for serum sickness
D) Acyclovir for viral infection
Rationale: This presentation meets criteria for Kawasaki disease (KD): fever ≥5 days plus
≥4 of 5 principal features (conjunctivitis, lymphadenopathy, rash, oral changes, extremity
changes); IVIG + aspirin within 10 days of fever onset dramatically reduces coronary
artery aneurysm risk.
5. What are the diagnostic criteria for Kawasaki disease?
A) Fever >5 days plus 3 of 5 features
B) Fever ≥5 days plus ≥4 of 5 features: bilateral non-purulent conjunctivitis,
oropharyngeal changes, rash, extremity changes, cervical lymphadenopathy (correct
answer)
C) Fever >3 days plus any 2 features
D) Fever ≥5 days plus ≥5 of 5 features
Rationale: Classic KD criteria: fever ≥5 days AND ≥4 of 5: (1) bilateral non-exudative
conjunctivitis, (2) erythema of lips/tongue/oral mucosa, (3) polymorphous rash, (4)
extremity changes (erythema, edema, desquamation), (5) cervical lymphadenopathy ≥1.5
cm; incomplete KD may be diagnosed with fewer features plus echocardiographic findings.
6. A 9-year-old with a known peanut allergy develops generalized urticaria, throat tightening,
and hypotension after eating at a restaurant. What is the first-line treatment?
A) Diphenhydramine 1 mg/kg IV
B) Epinephrine 0.01 mg/kg IM into the anterolateral thigh (correct answer)
C) Hydrocortisone 2 mg/kg IV
D) Nebulized albuterol only
,Rationale: Epinephrine IM (anterolateral thigh) is the first-line, life-saving treatment for
anaphylaxis — the only drug that reverses all components (bronchospasm, vasodilation,
edema, urticaria); antihistamines and steroids are adjuncts only and should never replace
or delay epinephrine.
7. Which of the following is the most appropriate antibiotic for outpatient treatment of
community-acquired pneumonia (CAP) in a 5-year-old with no comorbidities?
A) Azithromycin
B) Amoxicillin 90 mg/kg/day divided TID (correct answer)
C) Trimethoprim-sulfamethoxazole
D) Doxycycline
Rationale: IDSA/PIDS guidelines recommend high-dose amoxicillin (90 mg/kg/day in 2–3
divided doses) as first-line for presumed bacterial CAP in fully immunized preschool and
school-age children without complications; macrolides are added if atypical organisms are
suspected (>5 years of age).
8. What is the recommended treatment for an otherwise healthy 8-year-old with a positive rapid
strep test and pharyngitis?
A) Azithromycin 5-day course
B) Penicillin V or amoxicillin for 10 days (correct answer)
C) Clindamycin for 7 days
D) Watchful waiting without antibiotics
Rationale: Penicillin (amoxicillin preferred for palatability) for 10 days remains the
treatment of choice for Group A Streptococcal (GAS) pharyngitis; 10-day course is
necessary to eradicate pharyngeal carriage and prevent acute rheumatic fever.
9. A 2-year-old presents with inspiratory stridor, a barking cough, and hoarse voice for 2 days.
Vital signs are stable with SpO₂ 98%. What is the most appropriate treatment?
A) IV racemic epinephrine and hospitalization
B) A single oral dose of dexamethasone 0.6 mg/kg (correct answer)
C) Nebulized albuterol every 4 hours
D) Amoxicillin for bacterial tracheitis
Rationale: Croup (viral laryngotracheobronchitis — most commonly parainfluenza) is
treated with a single dose of oral dexamethasone 0.6 mg/kg (max 16 mg) for mild-moderate
, cases; dexamethasone reduces edema through anti-inflammatory effects and significantly
reduces return visits and hospitalizations.
10. Which organism most commonly causes croup?
A) Respiratory syncytial virus (RSV)
B) Parainfluenza virus type 1 (correct answer)
C) Influenza A
D) Adenovirus
Rationale: Parainfluenza virus type 1 is the most common cause of croup (viral
laryngotracheobronchitis), typically presenting in fall/early winter; other causes include
parainfluenza 2 and 3, RSV, adenovirus, and rhinovirus.
11. A 3-month-old presents with tachypnea, subcostal retractions, and wheezing during peak
RSV season. Pulse oximetry shows 91%. What is the most evidence-based treatment?
A) Nebulized albuterol and racemic epinephrine
B) Supportive care — supplemental oxygen, suctioning of secretions, and hydration
(correct answer)
C) Oral corticosteroids for 5 days
D) Ribavirin antiviral therapy
Rationale: Bronchiolitis (most commonly RSV) management is supportive; AAP guidelines
do NOT recommend albuterol, epinephrine, steroids, or antibiotics for routine
bronchiolitis; supplemental O₂ for SpO₂ <90–92% (per institution), nasal suctioning, and
adequate hydration are evidence-based.
12. What are the current criteria for hospitalization of a child with bronchiolitis?
A) Age <12 months, any wheezing, or fever >38°C
B) SpO₂ persistently <90–92%, significant respiratory distress, poor feeding, apnea, or
high-risk features (age <2 months, prematurity, cardiac/pulmonary disease) (correct
answer)
C) RSV-positive test result always requires admission
D) WBC >15,000 with respiratory symptoms
Rationale: Bronchiolitis hospitalization criteria: SpO₂ <90–92% on room air, moderate-
severe respiratory distress (RR >70, retractions, grunting), inability to maintain adequate
