PEDIATRIC PRIMARY CARE PNCB 1
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The child at highest risk for having an elevated blood lead level is a:
3 month old exclusively breastfed infant
6 month old who lives in a home built after 1970
2 year old with iron deficiency anemia
2 year old who is a picky eater
D. - ANSWER 2 year old with iron deficiency anemia
The amount of lead absorbed from the gut is increased in children with nutritional
deficiencies such as iron deficiency anemia (IDA). Iron deficiency anemia is often
a comorbidity of lead poisoning. The hand-to-mouth behavior of infants and
young children increases their lead exposure. However, living in a home built after
1970 reduces the risk since residential paint used in that era should not have been
lead based. Infants more than 4 months of age exclusively breast fed without
supplemental iron are at increased risk of IDA. A child who is a picky eater may or
may not be at high risk for IDA, depending on foods actually eaten.Which
laboratory assessment is the BEST indicator of vitamin D deficiency?
Which laboratory assessment is the BEST indicator of vitamin D deficiency?
25(OH)-D (cholecalciferol)
1,25(OH)2-D (calcitriol)
PTH (parathyroid hormone)
25(OH)-D (cholecalciferol) - ANSWER 25(OH)-D (cholecalciferol)
The best diagnostic study of vitamin D deficiency is the level of 25(OH)-D
(cholecalciferol). 1,25(OH)2-D (calcitriol) is the active metabolite of 25(OH)-D, but
,due to its short half-life it is not a good indicator of vitamin D sufficiency. The
parathyroid hormone releases calcium from bone. Rachitic changes can be seen at
growth plates and decreased calcification leads to thickening of the growth plate.
Serum calcium and phosphorous are initial screening tests but not the best
indicator of vitamin D deficiency.
In a 2 month old with visible rib fractures on radiograph, the NEXT most critical
evaluation to obtain is a:
CT scan of the head
long bone series
coagulation profile
retinal ophthalmologic exam - ANSWER CT scan of the head
Posterior rib fractures associated with accidental trauma are rare. Posterior
fractures can be seen in infants who have been shaken as the perpetrator hands
are typically wrapped around the infant's thorax during the shaking, with the
vertebrae acting as a fulcrum. These findings should alert the provider to consider
shaken baby syndrome (SBS). Subdural and subarachnoid hemorrhages are the
most common acute intracranial injuries seen in SBS and are associated with high
rates of morbidity and mortality. Thus, the most important study to do next is a CT
scan. Studies have shown that nearly one third of confirmed abusive head trauma
cases were missed on initial presentation, and many infants then sustain
additional brain injury along with poorer neurologic outcomes because of the
delay in diagnosis. Long bone studies will be needed as part of a thorough work-up
of non-accidental trauma, but the skull would be the most critical area to image
first. Coagulation studies are done to rule out any coagulation problem associated
with injury to the brain and are important for medico-legal reasons, but again,
brain studies take precedence. A thorough ophthalmologic exam is needed in
suspected cases of SBS—preferably done by a pediatric ophthalmologist.
The MOST common barrier related to transitioning health care for an adolescent
with special needs or chronic illness is
finding an adult health care provider for transition.
resistance of the family and adolescent to transition of care.
,lack of health care provider time to plan for transition of care.
difficulty in talking with patients about transitioning care. - ANSWER finding an
adult health care provider for transition.
Finding an adult health care provider, one who is qualified to care for young
adults with special health care needs, is the most commonly perceived barrier to
the successful transition of health care as identified by family and young adults,
pediatric health care providers, and adult internists. Transitioning of care requires
time and communication with the parents and adolescents involved. Many
families may be hesitant to leave the nurturing environment of pediatric care, and
may perceive differences in adult practices as a difficult adjustment. Internists
may lack the training and qualifications to address many of the complicated
health care needs of adolescents with chronic illnesses. Because of the delicate
nature of such conversations, some pediatric providers may not be comfortable in
dealing with the complexities of transitioning care.
A toddler is unable to use the right arm normally after the caregiver pulled her
arm to prevent the child from falling. Which finding would confirm the diagnosis
of subluxation of the radial head?
severe swelling and bruising of the elbow
elbow flexed with pronated forearm
point tenderness at ulnar aspect of elbow
obvious deformity of the forearm - ANSWER elbow flexed with pronated forearm
Subluxation of the radial head, also called nursemaid's elbow, must be
differentiated from a fracture prior to reducing the annular ligament of the elbow.
Radiographic examination is not necessary if the child's physical findings and
history are consistent with subluxation. The typical presentation of this injury
includes the following: age 2-5 years; history of a longitudinal traction injury,
possible "pop" and immediate pain, inability to use the arm normally, and arm
splinted against the side. On examination the elbow appears normal, is flexed
with a pronated forearm against the body, is tender laterally over the radial head,
, and has limited flexion with no supination. If the child fell on his/her elbow or
there is no history of a traction injury, suspect a fracture and order the
appropriate radiograp
Education for caregivers whose child has sickle cell disease should include that the
majority of pain crises are triggered by which of the following?
no identifying cause
temperature changes
cigarette smoke exposure
situations - ANSWER no identifying cause
Sickle cell disease is a common genetic hematologic disorder. Pain is the most
common and disabling symptom of sickle cell disease. Environmental
temperature and second-hand smoke exposure have been studied as possible
precipitating factors, but have not been supported by the research. Negative
emotions can facilitate the pain cycle. In general, pain episodes are erratic and
unpredictable and occur for various, unknown reasons.
A 5 year old complains of a painful left eye after being accidentally scratched by a
sibling two hours ago. Fluorescein exam shows a small central corneal abrasion.
The MOST appropriate management during the first 24 hours is
frequent application of topical antibiotic.
observation of the injured eye.
frequent application of topical nonsteroidal anti-inflammatory drops.
occlusive patching of the injured eye. - ANSWER frequent application of topical
antibiotic.
Accidental abrasion of the corneal epithelium causes pain, tearing, and
photophobia and is a common eye injury in children. An abrasion can be detected
by examining the eye with a Wood's lamp after instillation of fluorescein dye. The
one time use of a topical ophthalmic anesthetic may be useful in gaining
cooperation for an adequate eye exam. The goal of treatment is rapid healing of
the abrasion. Until such healing occurs, the eye should be protected from
infection by the use of a topical ophthalmic antibiotic every 4-6 hours for a few
Exam Questions and Answers Latest
Versions Graded A+
The child at highest risk for having an elevated blood lead level is a:
3 month old exclusively breastfed infant
6 month old who lives in a home built after 1970
2 year old with iron deficiency anemia
2 year old who is a picky eater
D. - ANSWER 2 year old with iron deficiency anemia
The amount of lead absorbed from the gut is increased in children with nutritional
deficiencies such as iron deficiency anemia (IDA). Iron deficiency anemia is often
a comorbidity of lead poisoning. The hand-to-mouth behavior of infants and
young children increases their lead exposure. However, living in a home built after
1970 reduces the risk since residential paint used in that era should not have been
lead based. Infants more than 4 months of age exclusively breast fed without
supplemental iron are at increased risk of IDA. A child who is a picky eater may or
may not be at high risk for IDA, depending on foods actually eaten.Which
laboratory assessment is the BEST indicator of vitamin D deficiency?
Which laboratory assessment is the BEST indicator of vitamin D deficiency?
25(OH)-D (cholecalciferol)
1,25(OH)2-D (calcitriol)
PTH (parathyroid hormone)
25(OH)-D (cholecalciferol) - ANSWER 25(OH)-D (cholecalciferol)
The best diagnostic study of vitamin D deficiency is the level of 25(OH)-D
(cholecalciferol). 1,25(OH)2-D (calcitriol) is the active metabolite of 25(OH)-D, but
,due to its short half-life it is not a good indicator of vitamin D sufficiency. The
parathyroid hormone releases calcium from bone. Rachitic changes can be seen at
growth plates and decreased calcification leads to thickening of the growth plate.
Serum calcium and phosphorous are initial screening tests but not the best
indicator of vitamin D deficiency.
In a 2 month old with visible rib fractures on radiograph, the NEXT most critical
evaluation to obtain is a:
CT scan of the head
long bone series
coagulation profile
retinal ophthalmologic exam - ANSWER CT scan of the head
Posterior rib fractures associated with accidental trauma are rare. Posterior
fractures can be seen in infants who have been shaken as the perpetrator hands
are typically wrapped around the infant's thorax during the shaking, with the
vertebrae acting as a fulcrum. These findings should alert the provider to consider
shaken baby syndrome (SBS). Subdural and subarachnoid hemorrhages are the
most common acute intracranial injuries seen in SBS and are associated with high
rates of morbidity and mortality. Thus, the most important study to do next is a CT
scan. Studies have shown that nearly one third of confirmed abusive head trauma
cases were missed on initial presentation, and many infants then sustain
additional brain injury along with poorer neurologic outcomes because of the
delay in diagnosis. Long bone studies will be needed as part of a thorough work-up
of non-accidental trauma, but the skull would be the most critical area to image
first. Coagulation studies are done to rule out any coagulation problem associated
with injury to the brain and are important for medico-legal reasons, but again,
brain studies take precedence. A thorough ophthalmologic exam is needed in
suspected cases of SBS—preferably done by a pediatric ophthalmologist.
The MOST common barrier related to transitioning health care for an adolescent
with special needs or chronic illness is
finding an adult health care provider for transition.
resistance of the family and adolescent to transition of care.
,lack of health care provider time to plan for transition of care.
difficulty in talking with patients about transitioning care. - ANSWER finding an
adult health care provider for transition.
Finding an adult health care provider, one who is qualified to care for young
adults with special health care needs, is the most commonly perceived barrier to
the successful transition of health care as identified by family and young adults,
pediatric health care providers, and adult internists. Transitioning of care requires
time and communication with the parents and adolescents involved. Many
families may be hesitant to leave the nurturing environment of pediatric care, and
may perceive differences in adult practices as a difficult adjustment. Internists
may lack the training and qualifications to address many of the complicated
health care needs of adolescents with chronic illnesses. Because of the delicate
nature of such conversations, some pediatric providers may not be comfortable in
dealing with the complexities of transitioning care.
A toddler is unable to use the right arm normally after the caregiver pulled her
arm to prevent the child from falling. Which finding would confirm the diagnosis
of subluxation of the radial head?
severe swelling and bruising of the elbow
elbow flexed with pronated forearm
point tenderness at ulnar aspect of elbow
obvious deformity of the forearm - ANSWER elbow flexed with pronated forearm
Subluxation of the radial head, also called nursemaid's elbow, must be
differentiated from a fracture prior to reducing the annular ligament of the elbow.
Radiographic examination is not necessary if the child's physical findings and
history are consistent with subluxation. The typical presentation of this injury
includes the following: age 2-5 years; history of a longitudinal traction injury,
possible "pop" and immediate pain, inability to use the arm normally, and arm
splinted against the side. On examination the elbow appears normal, is flexed
with a pronated forearm against the body, is tender laterally over the radial head,
, and has limited flexion with no supination. If the child fell on his/her elbow or
there is no history of a traction injury, suspect a fracture and order the
appropriate radiograp
Education for caregivers whose child has sickle cell disease should include that the
majority of pain crises are triggered by which of the following?
no identifying cause
temperature changes
cigarette smoke exposure
situations - ANSWER no identifying cause
Sickle cell disease is a common genetic hematologic disorder. Pain is the most
common and disabling symptom of sickle cell disease. Environmental
temperature and second-hand smoke exposure have been studied as possible
precipitating factors, but have not been supported by the research. Negative
emotions can facilitate the pain cycle. In general, pain episodes are erratic and
unpredictable and occur for various, unknown reasons.
A 5 year old complains of a painful left eye after being accidentally scratched by a
sibling two hours ago. Fluorescein exam shows a small central corneal abrasion.
The MOST appropriate management during the first 24 hours is
frequent application of topical antibiotic.
observation of the injured eye.
frequent application of topical nonsteroidal anti-inflammatory drops.
occlusive patching of the injured eye. - ANSWER frequent application of topical
antibiotic.
Accidental abrasion of the corneal epithelium causes pain, tearing, and
photophobia and is a common eye injury in children. An abrasion can be detected
by examining the eye with a Wood's lamp after instillation of fluorescein dye. The
one time use of a topical ophthalmic anesthetic may be useful in gaining
cooperation for an adequate eye exam. The goal of treatment is rapid healing of
the abrasion. Until such healing occurs, the eye should be protected from
infection by the use of a topical ophthalmic antibiotic every 4-6 hours for a few
