PEDIATRIC PRIMARY CARE PNCB 1
NEWEST 2025 – 2026 QUESTIONS AND
DETAILED CORRECT ANSWERS | A+
GRADE
A 4 month old with congenital nasolacrimal duct
obstruction had several episodes of dacryocystitis and is
currently hospitalized for cellulitis. Which is the appropriate
follow up?
continued frequent massage over the lacrimal duct
daily use of an ophthalmic antibiotic ointment
surgical referral for potential tear duct probing
oral antibiotic prophylaxis Correct Answer surgical referral
for potential tear duct probing
Congenital nasolacrimal duct obstruction (CNLDO)
occurs in about 6% of newborn infants, and resolves
spontaneously in most children by 12 months of age.
Symptoms include excessive pooling of tears in the
eye, overflow of tears onto the lid or cheek, and reflux
of mucoid material from the lacrimal sac. Appropriate
conservative management of CNLDO includes
frequent massage and cleansing of the lids and lashes
,with warm water. Application of an ophthalmic
antibiotic ointment or drops is useful when
mucopurulent discharge is present, rather than on a
continuous basis, which may be irritating to the
cornea. Gentle downward massage over the
nasolacrimal duct is helpful in clearing the
accumulation of mucoid material, though it is not
established as a curative measure. If tearing persists
after 12 months of age, or if the younger infant has
repeated episodes of dacryocystitis, earlier referral to
an ophthalmologist for tear duct probing or other
surgical management is recommended.
The benefit of fluoride is achieved through which of the
following mechanisms?
bacteriocidal effect on Streptococcus mutans
destruction of milk sugars
prevention of plaque adherence
remineralization of carious lesions Correct Answer
remineralization of carious lesions
It is important for health care providers to screen for
dental caries and to identify risk factors for
development of decay. Caries occur from the
overgrowth of the bacteria Streptococcus mutans,
,streptococcus sobrinus, and lactobacillus species,
which are part of normal human flora. These bacteria
adhere well to the tooth surface. Topical fluoride is
effective in assisting in the prevention of caries by
inhibiting demineralization and aiding in the
remineralization of carious lesions. While fluoride
does not prevent plaque adherence, it can alter the
enamel of teeth making it more resistant to the
destructive effects of the bacteria found in the mouth.
Milk sugars are a common cause of caries providing a
medium for the bacteria to flourish.
A school-age child with 4 days of viral respiratory
symptoms now has a fever of 103° F (39.4° C), tachypnea,
decreased breath sounds to auscultation and a white
blood cell count of 17,000/microliter. The MOST likely
organism is:
Streptococcus pneumoniae
Group B streptococci
Mycoplasma pneumoniae
Pneumocystis carinii Correct Answer Streptococcus
pneumoniae
Ninety percent of childhood bacterial pneumonia is
caused by Strep pneumoniae. While Mycoplasma
, pneumoniae is also a common cause of pneumonia in
school- age children, this scenario is suggestive of
secondary bacterial infection following a viral
infection. With bacterial pneumonia, a chest
radiograph usually demonstrates lobar consolidation.
Group B streptococci and Chlamydial pneumoniae are
organisms more often associated with pneumonia
affecting infants. Pneumocystis carinii occurs most
often in immunocompromised individuals, not healthy
school-age children.
Nutrition assessment of the child on a strict vegan diet
should include regular growth monitoring, diet analysis,
and laboratory assessment of
vitamin B12, zinc and iron status.
vitamin B12, calcium, and electrolytes.
electrolytes, iron and vitamin B6.
vitamin B6, zinc and calcium Correct Answer vitamin B12,
zinc and iron status.
Slower growth rates have been reported in infants and
children who follow vegan and macrobiotic diets
during the first five years of life. However, catch-up
growth usually occurs in these children by age 10
years. Strict restriction of dietary fats is not part of a
NEWEST 2025 – 2026 QUESTIONS AND
DETAILED CORRECT ANSWERS | A+
GRADE
A 4 month old with congenital nasolacrimal duct
obstruction had several episodes of dacryocystitis and is
currently hospitalized for cellulitis. Which is the appropriate
follow up?
continued frequent massage over the lacrimal duct
daily use of an ophthalmic antibiotic ointment
surgical referral for potential tear duct probing
oral antibiotic prophylaxis Correct Answer surgical referral
for potential tear duct probing
Congenital nasolacrimal duct obstruction (CNLDO)
occurs in about 6% of newborn infants, and resolves
spontaneously in most children by 12 months of age.
Symptoms include excessive pooling of tears in the
eye, overflow of tears onto the lid or cheek, and reflux
of mucoid material from the lacrimal sac. Appropriate
conservative management of CNLDO includes
frequent massage and cleansing of the lids and lashes
,with warm water. Application of an ophthalmic
antibiotic ointment or drops is useful when
mucopurulent discharge is present, rather than on a
continuous basis, which may be irritating to the
cornea. Gentle downward massage over the
nasolacrimal duct is helpful in clearing the
accumulation of mucoid material, though it is not
established as a curative measure. If tearing persists
after 12 months of age, or if the younger infant has
repeated episodes of dacryocystitis, earlier referral to
an ophthalmologist for tear duct probing or other
surgical management is recommended.
The benefit of fluoride is achieved through which of the
following mechanisms?
bacteriocidal effect on Streptococcus mutans
destruction of milk sugars
prevention of plaque adherence
remineralization of carious lesions Correct Answer
remineralization of carious lesions
It is important for health care providers to screen for
dental caries and to identify risk factors for
development of decay. Caries occur from the
overgrowth of the bacteria Streptococcus mutans,
,streptococcus sobrinus, and lactobacillus species,
which are part of normal human flora. These bacteria
adhere well to the tooth surface. Topical fluoride is
effective in assisting in the prevention of caries by
inhibiting demineralization and aiding in the
remineralization of carious lesions. While fluoride
does not prevent plaque adherence, it can alter the
enamel of teeth making it more resistant to the
destructive effects of the bacteria found in the mouth.
Milk sugars are a common cause of caries providing a
medium for the bacteria to flourish.
A school-age child with 4 days of viral respiratory
symptoms now has a fever of 103° F (39.4° C), tachypnea,
decreased breath sounds to auscultation and a white
blood cell count of 17,000/microliter. The MOST likely
organism is:
Streptococcus pneumoniae
Group B streptococci
Mycoplasma pneumoniae
Pneumocystis carinii Correct Answer Streptococcus
pneumoniae
Ninety percent of childhood bacterial pneumonia is
caused by Strep pneumoniae. While Mycoplasma
, pneumoniae is also a common cause of pneumonia in
school- age children, this scenario is suggestive of
secondary bacterial infection following a viral
infection. With bacterial pneumonia, a chest
radiograph usually demonstrates lobar consolidation.
Group B streptococci and Chlamydial pneumoniae are
organisms more often associated with pneumonia
affecting infants. Pneumocystis carinii occurs most
often in immunocompromised individuals, not healthy
school-age children.
Nutrition assessment of the child on a strict vegan diet
should include regular growth monitoring, diet analysis,
and laboratory assessment of
vitamin B12, zinc and iron status.
vitamin B12, calcium, and electrolytes.
electrolytes, iron and vitamin B6.
vitamin B6, zinc and calcium Correct Answer vitamin B12,
zinc and iron status.
Slower growth rates have been reported in infants and
children who follow vegan and macrobiotic diets
during the first five years of life. However, catch-up
growth usually occurs in these children by age 10
years. Strict restriction of dietary fats is not part of a
