Pediatric Primary Care PNCB 2 Actual Exam
PEDIATRIC PRIMARY CARE PNCB 2 ACTUAL EXAM NEWEST
2025/2026 COMPLETE QUESTIONS AND CORRECT DETAILED
ANSWERS |ALREADY GRADED A+||ALREADY GRADED A+
A two year old presents with a history of fever and intermittent bone pain and
now has an apparent abdominal mass. Which is the MOST likely diagnosis?
neuroblastoma
non-Hodgkin's lymphoma
osteogenic sarcoma
Wilms tumor - ANSWER-neuroblastoma
Neuroblastoma is the most common extracranial solid tumor in children and the
most commonly diagnosed malignancy in infants. The median age at diagnosis is
22 months, and approximately 90% of cases have been diagnosed by 5 years of
age. Neuroblastoma may develop at any site of sympathetic nervous system
tissue. Symptoms may mimic many other disorders and can be hard to diagnose.
Signs and symptoms reflect the tumor site and extent of disease, but may include
fever, failure to thrive, bone pain, cytopenias, orbital proptosis, masses, bowel
obstruction or spinal cord compression. Wilms tumor is an embryonal malignancy
of the kidney that can also present with an abdominal mass. Sarcomas of the
extremities are more likely to occur in older children.
1|Page
, Pediatric Primary Care PNCB 2 Actual Exam
Which factor is MOST suggestive of an organic cause of recurrent abdominal pain?
pain localized to the periumbilical area
pain accompanied by diaphoresis
pain associated with a change in bowel habits
pain described as sharp in nature - ANSWER-pain associated with a change in
bowel habits
Recurrent abdominal pain is a very common complaint in children. Pain associated
with a change in bowel habits, constipation or diarrhea, is a red flag for a potential
organic cause of abdominal pain. Location and quality of pain are of limited value
in children, as they are often unclear as to the meaning of these terms. Almost all
children will point to the umbilicus when asked to locate the site of pain!
Complaints of recurrent abdominal pain are most common in school-age children
greater than 5 years. Associated autonomic symptoms such as nausea,
diaphoresis, vertigo, and pallor may occur in non-organic causes of recurrent
abdominal pain.
Which of the following is the MOST appropriate information in providing
anticipatory guidance for parents whose infant has colic?
infants with colic are hypersensitive to stimuli
2|Page
, Pediatric Primary Care PNCB 2 Actual Exam
teething can stimulate a colicky response
symptoms increase at 3 - 4 months of age
fever is often an accompanying symptom of colic - ANSWER-infants with colic are
hypersensitive to stimuli
The crying infant elicits a stressful response from both parents and providers. It is
imperative to rule out significant pathology in an infant in distress who has no way
to communicate feelings but through crying. The differential diagnosis list is long
and must be considered in an organized way. First, determine if there is fever
indicative of infection. Fever is not a usual symptom of colic. Teething usually does
not occur until close to six months of age, after the typical period of colic which is
between 1 week and 2 - 3 months of age. Physical examination of the infant
should reveal normal growth and development, and helps to differentiate
neurological, metabolic, allergic or traumatic causes for the crying. Once
pathological causes for the crying have been ruled out, parents need reassurance
that the crying is the only way the infant can communicate not feeling well.
Infants with colic are frequently hypersensitive to their new extrauterine
environment. Review findings with parents; educate them on the colicky baby
syndrome and what to look for when crying is not associated with infantile colic.
Which should always be included in the evaluation of a child with a suspected
learning disorder?
full history and physical exam
3|Page
, Pediatric Primary Care PNCB 2 Actual Exam
Denver II developmental assessment
genetic and chromosomal testing
intelligence quotient measurement - ANSWER-full history and physical exam
In 2006, the American Academy of Pediatrics recommended developmental
surveillance at every well child visit and developmental screening at defined ages.
Historically, only about 30% of children with developmental and behavioral
problems are identified by their primary care providers. Along with the emphasis
on completing this testing, it is most important to initially rule out physiological
problems related to vision and hearing that may contribute to learning or
developmental disorders. A full history and physical exam is foundational to and
should be included with any evaluation of learning, developmental or behavioral
problems.
Which BEST represents the description of Tanner stage 3 in an adolescent female?
areola and breast enlarges with no separation of contours, presence of pubic hair
over the middle of the pubic bone
distinctive projection of the areola, presence of pubic hair over the middle of the
pubic bone
areola and breast enlarges with no separation of contours, appearance of fine,
downy pubic hair along the labia
4|Page
PEDIATRIC PRIMARY CARE PNCB 2 ACTUAL EXAM NEWEST
2025/2026 COMPLETE QUESTIONS AND CORRECT DETAILED
ANSWERS |ALREADY GRADED A+||ALREADY GRADED A+
A two year old presents with a history of fever and intermittent bone pain and
now has an apparent abdominal mass. Which is the MOST likely diagnosis?
neuroblastoma
non-Hodgkin's lymphoma
osteogenic sarcoma
Wilms tumor - ANSWER-neuroblastoma
Neuroblastoma is the most common extracranial solid tumor in children and the
most commonly diagnosed malignancy in infants. The median age at diagnosis is
22 months, and approximately 90% of cases have been diagnosed by 5 years of
age. Neuroblastoma may develop at any site of sympathetic nervous system
tissue. Symptoms may mimic many other disorders and can be hard to diagnose.
Signs and symptoms reflect the tumor site and extent of disease, but may include
fever, failure to thrive, bone pain, cytopenias, orbital proptosis, masses, bowel
obstruction or spinal cord compression. Wilms tumor is an embryonal malignancy
of the kidney that can also present with an abdominal mass. Sarcomas of the
extremities are more likely to occur in older children.
1|Page
, Pediatric Primary Care PNCB 2 Actual Exam
Which factor is MOST suggestive of an organic cause of recurrent abdominal pain?
pain localized to the periumbilical area
pain accompanied by diaphoresis
pain associated with a change in bowel habits
pain described as sharp in nature - ANSWER-pain associated with a change in
bowel habits
Recurrent abdominal pain is a very common complaint in children. Pain associated
with a change in bowel habits, constipation or diarrhea, is a red flag for a potential
organic cause of abdominal pain. Location and quality of pain are of limited value
in children, as they are often unclear as to the meaning of these terms. Almost all
children will point to the umbilicus when asked to locate the site of pain!
Complaints of recurrent abdominal pain are most common in school-age children
greater than 5 years. Associated autonomic symptoms such as nausea,
diaphoresis, vertigo, and pallor may occur in non-organic causes of recurrent
abdominal pain.
Which of the following is the MOST appropriate information in providing
anticipatory guidance for parents whose infant has colic?
infants with colic are hypersensitive to stimuli
2|Page
, Pediatric Primary Care PNCB 2 Actual Exam
teething can stimulate a colicky response
symptoms increase at 3 - 4 months of age
fever is often an accompanying symptom of colic - ANSWER-infants with colic are
hypersensitive to stimuli
The crying infant elicits a stressful response from both parents and providers. It is
imperative to rule out significant pathology in an infant in distress who has no way
to communicate feelings but through crying. The differential diagnosis list is long
and must be considered in an organized way. First, determine if there is fever
indicative of infection. Fever is not a usual symptom of colic. Teething usually does
not occur until close to six months of age, after the typical period of colic which is
between 1 week and 2 - 3 months of age. Physical examination of the infant
should reveal normal growth and development, and helps to differentiate
neurological, metabolic, allergic or traumatic causes for the crying. Once
pathological causes for the crying have been ruled out, parents need reassurance
that the crying is the only way the infant can communicate not feeling well.
Infants with colic are frequently hypersensitive to their new extrauterine
environment. Review findings with parents; educate them on the colicky baby
syndrome and what to look for when crying is not associated with infantile colic.
Which should always be included in the evaluation of a child with a suspected
learning disorder?
full history and physical exam
3|Page
, Pediatric Primary Care PNCB 2 Actual Exam
Denver II developmental assessment
genetic and chromosomal testing
intelligence quotient measurement - ANSWER-full history and physical exam
In 2006, the American Academy of Pediatrics recommended developmental
surveillance at every well child visit and developmental screening at defined ages.
Historically, only about 30% of children with developmental and behavioral
problems are identified by their primary care providers. Along with the emphasis
on completing this testing, it is most important to initially rule out physiological
problems related to vision and hearing that may contribute to learning or
developmental disorders. A full history and physical exam is foundational to and
should be included with any evaluation of learning, developmental or behavioral
problems.
Which BEST represents the description of Tanner stage 3 in an adolescent female?
areola and breast enlarges with no separation of contours, presence of pubic hair
over the middle of the pubic bone
distinctive projection of the areola, presence of pubic hair over the middle of the
pubic bone
areola and breast enlarges with no separation of contours, appearance of fine,
downy pubic hair along the labia
4|Page
