Pediatric Primary Care PNCB 2, Exam Questions & Answers

Pediatric Primary Care PNCB 2, Exam Questions & Answers-A female athlete experiences anaphylaxis during a soccer game. The only significant history is that she had lunch about 1 hour before the incident. Food-dependent exercise-induced anaphylaxis is diagnosed. Of the following, the MOST likely cause is: chocolate milkshake pineapple tomatoes whole wheat bread - whole wheat bread Exercise is a known co-factor in some children who experience anaphylaxis. Food-dependent exercise-induced anaphylaxis (FDEIA) is defined as a food induced allergic reaction that occurs during or soon after exercise. Children should not exercise within 2-3 hours of ingesting the triggering food. Nuts, wheat, apples, bananas, kiwi, peaches and eggs frequently are the cause for anaphylaxis. A healthy 24 month old can be expected to have achieved which of the following language milestones? counts three objects correctly speaks using 30 - 50 words states full name tells a story - speaks using 30 - 50 words Utilizing the Early Language Milestone Scale, beginning at the age of 11 months and continuing to 24 months of age, the child should have a vocabulary of 50 words. This child should be able to put words together in short, 2 - 3 word sentences and name at least one object in a picture. The child at age 3 - 4 years will be able to tell a short story and begin to count. A 2 year old may know his first name, but usually cannot state full name until he/she is older. Which is the MOST important safety question to ask a 17 year old? "Are you aware of ways to avoid accidents?" "Do you play violent video games more than 2 hours a day?" "Do you always wear a seat belt when driving or riding in a car?" "Is there a gun anywhere in your house?" - "Do you always wear a seat belt when driving or riding in a car?" Motor vehicle accidents are the leading cause of death among children in the United States, with 78% of all unintentional injury deaths related to MVA among adolescents. When correctly used, restraint systems can prevent fatalities and reduce the number and severity of injuries to children and adolescents. As adolescents begin to drive and carry peer passengers, it is especially important to remind them of basic safety issues, including the use of seat belts, emphasizing the danger of driving, drinking and drug use as well as appropriate behavior while in the car. Reinforcing pedestrian safety is another important issue with adolescents. Firearm injuries have decreased over recent years, especially among older children, and there is no link between violent video games and increased accidents. The parent of an 8 month old, reports switching the baby's formula to cow's milk due to the continued expense of formula. Which is the BEST response? Cow's milk does not contain adequate nutrition, and poses a higher risk for allergy. Cow's milk has a lower protein and fat content, which will impede growth of the baby. Switching to cow's milk sooner than 1 year will not cause any harm. There is no need to continue formula as long as the child is receiving other baby foods. - Cow's milk does not contain adequate nutrition, and poses a higher risk for allergy. During the first year of life, infants should receive only formula or breast milk. The use of cow's milk is contraindicated because of its high protein content, inappropriate nutrition composition, especially lack of iron sources, and the risk of gastrointestinal bleeding and allergic reactions. If an infant is switched sooner than one year, the practitioner should encourage the family to resume use of formula or breast milk until the one year birthday. Despite the addition of table foods or baby solid foods, formula and breast milk are still the dietary mainstay. A 10 month old has had apparent abdominal pain for the past 4 hours. During episodes of pain, the infant screams inconsolably and draws his legs towards the abdomen, has vomited twice, but has had no diarrhea. Between episodes the infant is calm and quiet. The MOST likely diagnosis is: Meckel's diverticulum intussusception acute appendicitis acute gastroenteritis - intussusception Acute onset of abdominal pain requires immediate investigation. The nurse practitioner must be able to distinguish between conditions that can safely be managed at home and those requiring immediate referral. Meckel's diverticulum usually involves painless rectal bleeding. Acute appendicitis can occur in infants and must be considered in the differential diagnosis. The pain history of acute appendicitis is usually more continuous, and there is no palpable mass. Acute gastroenteritis may involve intermittent pain and cramping, but more typically the child appears ill, and vomiting and diarrhea play a more prominent role. The pain of intussusception is very severe, with periods of well-being in between. There is frequently vomiting, however stools initially are normal. Later stools can be like red jelly in appearance. A sausage shaped mass is frequently palpable in the right upper quadrant and aids in diagnosis. For the parents of an 8 month old, the MOST appropriate age-related anticipatory guidance regarding safety includes which of the following? cover electrical outlets, keep small objects out of reach, turn car seat to forward-facing position keep medications out of reach, continue to use car seat in rear-facing position, cover electrical outlets avoid finger foods that can be easily aspirated, teach stranger safety, place Mr. Yuk stickers on toxic materials keep matches out of reach, place Mr. Yuk stickers on toxic materials, teach stranger safety - keep medications out of reach, continue to use car seat in rear-facing position, cover electrical outlets An 8 month old is beginning to cruise, crawl and develop a fine pincer grasp. Keeping medications and small objects out of reach in this age group assists in avoiding choking or toxic ingestions. Covering electrical outlets helps to prevent accidental electrocution while the infant is exploring his surroundings. An infant should maintain the rear-facing position of the car seat until the age of one year. An 8 month old is not at a developmental level to understand stranger caution nor Mr. Yuk stickers. Keeping matches out of reach is important, although it is not as likely that an 8 month old would have the dexterity to strike a match. The INITIAL treatment for a school-age female with well-demarcated erythema and mucoid discharge in the vulva area includes: discontinuation of bubble baths. instruction on front to back cleansing. oral penicillin. topical Premarin. - instruction on front to back cleansing. Vulvovaginitis is the most common genital complaint among prepubertal girls due to the thin hypo estrogenized mucosal tissue with an alkaline pH, small labia minora, and location proximal to the anus. Vulvovaginitis, caused by streptococcal bacterial infections, is identified by well-demarcated areas of erythema with a mucoid discharge. A 10-day regimen of oral penicillin or amoxicillin is the treatment for a streptococcal infection which is the most common organism. Vulvovaginitis can be caused by poor hygiene in girls who may be wiping inadequately or inappropriately (e.g. from back to front), leading to local irritation. Prepubertal females should be instructed in proper hygiene and wiping of perianal area. Soaps, shampoos, and bubble baths are the most common cause of dysuria due to chemical urethritis. Topical Premarin is used in the initial treatment of labial adhesions. Emphasis on promoting healthy behavioral changes for the overweight child should include which of the following? establishing family goals maintaining family holiday meal rituals weighing child daily using weight loss as a sign of success - establishing family goals Effective weight loss planning and implementation need to involve the entire family. Emphasis should be placed on family change and family goals as children will copy their parents' behaviors. In addition, parents have control over some aspects of the change process that can occur in relation to goals and meals in the home. Daily weights are not recommended, and weight loss should not be used as the measure of success. Changing behaviors is a success by itself and should be celebrated. New family and holiday rituals should be established for a focus on non-food related events. A 7 year old fell, injuring the right wrist. Radiographs of the wrist were negative, and the child was treated for a moderate sprain and sent home with a sling. Ten days later the child is still complaining of wrist pain with point tenderness. Which should be the NEXT step in management? discontinue use of the sling order a bone scan repeat wrist radiographs refer to orthopedic surgeon - repeat wrist radiographs Early fractures and Salter I fractures can be missed initially; repeat films 10 to 14 days after an injury may be necessary to confirm the diagnosis of a fracture. Because this child is still symptomatic with complaints of pain and point tenderness after the fall, follow up radiographic studies are indicated. Bone scanning is useful in diagnosing stress fractures, but not appropriate in this situation with a history of a known injury. It is likely that this is a simple fracture that will heal quickly with immobilization, with no disruption to bone growth. If the follow-up radiograph showed evidence of trauma to growth plates, a referral to an orthopedic surgeon would then be appropriate. The MOST common sign/symptom of hepatitis A in a 14 month old is: ascites dark urine fever jaundice - fever Hepatitis A is a viral infection acquired through contaminated food and water, the fecal oral route, and person to person contact. Hepatitis A is a significant public health concern. Young children with hepatitis A tend to be asymptomatic or have only mild flu-like symptoms including fever, nausea, and anorexia. Few children younger than 6 years have jaundice. Older children usually are symptomatic, with symptoms typically lasting less than 2 months. A symptom of jaundice is dark urine. The elderly have more disease complications with hepatitis A including ascites, prolonged cholestasis, pancreatitis, and death from liver failure. The factor with the STRONGEST link to malignant melanoma is Special Note: It has been determined as of November 2016 that there are two (2) correct answers to this question, supported by separate references. Credit will be given for choosing EITHER of the correct options. family history of malignant melanoma. fair skin coloring. living near the equator. sun exposure early in life. - family history of malignant melanoma. sun exposure early in life. Skin cancers are the most frequent cancers seen in this country, accounting for nearly 50% of all new cancers. The most serious of the skin cancers is malignant melanoma and its incidence is increasing at a rate of about 4% per year. There are several risk factors for developing skin cancers including family history, fair skin color, and living at high altitudes or near the equator. At the time this module was published, the supporting reference cited the most significant factor in developing malignant melanoma as sun exposure early in life. Good pediatric anticipatory guidance should include avoiding sun exposure in any child less than 6 months of age, limiting sun exposure to children over 6 months of age, and using a sun screen with an SPF of 15 or greater when sun exposure does occur. An additional, newer reference indicates that family history is the more important factor.