PNCB Acute Care Questions With Complete Solutions

PNCB Acute Care Questions and
Answers
InAaAchildAwithAmyastheniaAgravis,AwhichAofAtheAfollowingAsymptomsAwouldAbeAMOSTAindi
cativeAofAaAmyasthenicAcrisis?
A.AEyeAdrooling
B.ARespiratoryAdistress
C.AExcessiveAsalivationA
D.AMuscleAfasciculationA-AcorrectAanswers-B.ARespiratoryAdistress

(CharacterizedAbyAweaknessAandAfatigueAofAskeletalAmuscleAtissueAthatAresultsAfromAautoi
mmuneAdestructionAofAacetylcholineAreceptorsA(AchR).AAAcrisisAevent,AorAmyasthenicAcrisi
s,AisAanAacuteAexacerbationAofAtheAdiseaseAprocessAthatAresultsAinAsevereAweaknessAfromA
dysfunctionAofAtheAneuromuscularAjunctions.AItAisAcharacterizedAbyArespiratoryAfailureAdueA
toAweaknessAofAtheAairwayAorArespiratoryAmuscles.A
AAcholinergicAcrisis,AisAaAsevereAweaknessAcausedAbyAovertreatmentAwithAcholinergicAme
dicationsAusedAtoAtreatAMGA&AcrisisApresentAwithAexcessiveAsalivation,AexcessiveAlacrimati
on,Adiarrhea,Asweating,ApupillaryAconstriction,AandAmuscleAfasciculation.
AAchildAwithAaAhistoryAofAcongenitalAheartAdiseaseAfellAwhileAplayingAandApresentsAwithAaAcl
osedAfractureAofAtheAhumerus.APhysicalAexamArevealsAmildAbradycardiaAandAaAmoderateA
painAscore.A
WhichAofAtheAfollowingAmedicationsAwouldAMOSTAlikelyAexplainAthisAchild'sAbradycardia?
A.AEnalaprilA(Vasotec)
B.AFurosemideA(Lasix)
C.ALevothyroxineA(Synthroid)
D.APropranololA(Inderal)A-AcorrectAanswers-D.APropranololA(Inderal)A

(DecreasesAheartArate,AmyocardialAcontractility,AbloodApressure,AandAmyocardialAoxygenA
demand.AAdverseAeffectsAincludeAbradycardia,Ahypotension,AandAatrioventricularAconduct
ionAdisturbances)
EnteralAnutritionAisAinitiatedAinAaAchildAwithAsevereAmalnutrition.ALaboratoryAvaluesAindicati
veAofArefeedingAsyndromeAincludeAaAmagnesiumAlevelAofA1.5Amg/dL,Aand:
A.APhosphateA3.0Aml/dLA&ApotassiumA2.8AmEq/L
B.APhosphateA3.0Aml/dLA&ApotassiumA6AmEq/L
C.APhosphateA7.0Aml/dLA&ApotassiumA2.8AmEq/L
D.APhosphateA7.0Aml/dLA&ApotassiumA6AmEq/LA-AcorrectAanswers-
A.APhosphateA3.0Aml/dLA&ApotassiumA2.8AmEq/L

(RefeedingAsyndromeAoccursAwhenAmalnourishedApatientsAareArefedAtooAaggressivelyAlea
ding.AItAcanAoccurAwithinA1-3AdaysAafterAreinstitutionAofAnutrition.A
TheAmajorAmanifestationsAincludeAfluidAoverload,AhypophosphatemiaA(phosphateAlessAtha
nA3.5Amg/dL),AhypokalemiaA(potassiumAlessAthanA3.5AmEq/L),AhypomagnesemiaA(magne

,siumAlessAthanA1.8Amg/dL),AandAthiamineAdeficiency.AComplicationsAincludeAheartAfailure,A
dysrhythmias,ArespiratoryAmuscleAweakness,Aseizures,
WhenAinformingAaAfamilyAthatAaAreportAisAbeingAmadeAtoAChildAProtectiveAServicesAforAsus
pectedAabuse,AitAisAMOSTAimportantAto
A.AFocusAonAtheAchild'sAwellAbeingA
B.AIdentifyAtheAsuspectedAperpetrator
C.AIdentifyAlegalArequirementsAforAmandatoryAreporting
D.AShareAdetailsAwithAfamilyAtoAavoidAmisunderstandingA-AcorrectAanswers-
A.AFocusAonAtheAchild'sAwellAbeing
ManifestationsAofAabdominalAinjuriesAsecondaryAtoAaAblastAmechanismAareAtypically:
A.AAcuteA&AimmediatelyAapparentA
B.AObservedAlessAthanA6AhoursAafterAexposureA
C.ADelayedA8-36AhoursAafterAexposure
D.AChronicA&AslowAtoAdevelopA-AcorrectAanswers-C.ADelayedA8-36AhoursAafterAexposure

(BlastAattack,AasAseenAinAexplosions,AcausesAextensiveAcompressionAandAdistortionAofAthe
AgastrointestinalA(GI)AtractA&AotherAair-

filledAorgans.AManifestationsAgenerallyAdelayed,ApresentingA8-36AhoursAafterAexposure.)
AApreviouslyAhealthyApreschoolerAwhoAisAfullyAimmunized,ApresentsAwithAaAhistoryAofAfever
,AURIAsymptoms,A&AjointApainAoverAtheApastAseveralAdays.APhysicalAexamArevealsApetechi
aeAandAhepatosplenomegaly.AVitalAsignsAincludeAHRA156,ARRA32,AtempA101.6A(38.7),ABPA
86/44A&AO2A98%AonARA.ALabAresultsAincludeANa+A132,AK+A6,AGlucoseA100,ACa+A0.95,APh
osA6.3,AWBCA105,000,AHgbA6.1A&APltA10,000.AWhichAisAtheABESTAcourseAofAaction?
A.AObtainALFTSA&AtypeA&AcrossAforAbloodAproductsA
B.AAdministerAcalciumAgluconateA&AconsultAnephrology
C.AObtainAbloodAculturesA&AadministerAIVACeftriaxone
D.AAdministerAaAfluidAbolusA&AconsultAoncologyA-AcorrectAanswers-
D.AAdministerAaAfluidAbolusA&AconsultAoncologyA

(TheAcombinationAofAleukocytosis,Athrombocytopenia,AandAanemiaAshouldAraiseAredAflagsA
forAanAoncologicAprocess,AmostAlikelyAleukemia.AAfterAinitialAlaboratoryAvaluesAareAobtaine
d,AtheAchildAshouldAreceiveAaggressiveAhydration.)
AnAadolescentApresentsAwithAbilateralAkneeApainAthatAhasAoccurredAforAseveralAmonths,Ae
xacerbatedAwithAactivitiesAsuchAasAclimbingAstairsAandArunning.APainAisAalsoAworsenedAbyA
sittingAwithAtheAkneesAflexedAforAanAextendedAtimeAandAisAdescribedAasAaAgrindingAsensati
onAunderAtheAkneecaps.ANoAjointAswellingAisAnotedAonAexamination.ATheAMOSTAlikelyAdiag
nosisAis:
A.AOsgood-SchlatterAdisease
B.AOsteochondritisAdissecansA
C.APatellofemoralApainAsyndrome
D.APoplitealAcystA(Baker'sAcyst)A-AcorrectAanswers-C.APatellofemoralApainAsyndrome

(TypeAofAidiopathicAanteriorAkneeApain,AcommonAinAadolescents.AThisAtypeAofAkneeApainAw
orsensAwithAactivity,AespeciallyAgoingAupAandAdownAstairs,AandAwhenAsittingAinAoneApositio
nAforAaAprolongedAperiodAofAtime.ATreatmentAinvolvesAanAexerciseAprogramAfocusingAonAhi
pAgirdleAandAvastusAmedialisAstrengtheningAwithAlowerAextremityAflexibility)

,AAtoddlerApresentsAwithAvomitingAandAalteredAmentalAstatusAafterAanAingestionAofAaAlargeAa
mountAofAaspirinAaboutA45AminutesAago.APriorAtoAtheAadministrationAofAactivatedAcharcoal,A
theAPRIORITYAisAto:
A.AObtainAaAurineAdrugAscreen
B.AEnsureAIVAaccess
C.AObtainAandAEKG
D.AEnsureAadequateAairwayAprotectionA-AcorrectAanswers-
D.AEnsureAadequateAairwayAprotection
WhichAofAtheAfollowingAchildrenAisAMOSTAatAriskAforAopiateAwithdrawal?
A.AInfantAintubatedAforArespiratoryAfailureAreceivingADexmedetomidineA(Precedex)Ainfusio
nAforA5Adays
B.AInfantAintubatedAforArespiratoryAfailureAreceivingAaAmorphineAinfusionAforA6Adays
C.AAdolescentApost-posteriorAspinalAfusionAreceivingAhydromorphoneAviaAPCAAforA3Adays
D.AAdolescentApost-cardiacAsurgeryAreceivingAPOAoxycodoneAPRNAforA2AdaysA-
AcorrectAanswers-

B.AInfantAintubatedAforArespiratoryAfailureAreceivingAaAmorphineAinfusionAforA6Adays

(OpiateAwithdrawalAshouldAbeAsuspectedAinAanyAchildAwhoAhasAreceivedAopioidsAforAaAmini
mumAofA3Adays.AAfterA5Adays,AapproximatelyA50%AofAchildrenAareAexpectedAtoAexperience
AsomeAwithdrawalAsymptoms.AWhenAopiatesAareAadministeredAforA>10Adays,AwithdrawalAs

houldAbeAexpectedAinA100%AofApatients)
FollowingAanAepisodeAofAgastroenteritis,AaAchildAisAdiagnosedAwithAreactiveAinflammatoryA
arthritisAthatAisAaffectingAjointsAinAtheAlowerAextremities.AToAmaximizeAreturnAtoAtheApreviou
sAlevelAofAmobility,AtheAtreatmentAplanAshouldAinclude:
A.AWeight-bearingAexerciseAplan
B.AAdministrationAofAcorticosteroidsA
C.APTA&AOT
D.ACalciumA&AvitaminADAsupplementationA-AcorrectAanswers-C.APTA&AOT

(MaintainAjointArangeAofAmotionAandAstrengthAofAassociatedAmuscleAgroups,AtoAdecreaseAp
ain,AandAtoApreventAcontracturesAandAdeformities,AallAofAwhichAmaximizeAtheApotentialAtoAr
eturnAtoAtheApreviousAlevelAofAactivity).
WhichAofAtheAfollowingAisAtheAMOSTAlikelyApresentationAofAbehavioralAandApsychiatricAdiso
rdersAinAaApreschooler?
A.AFearAofAtheAdark
B.AIssuesAwithAidentityAformation
C.ALearningAdisabilities
D.AFrequentAtemperAtantrumsA-AcorrectAanswers-D.AFrequentAtemperAtantrums
RoutineApreventiveAhealthcareAforAanAinfantAwithAsickleAcellAdiseaseAincludes
A.ATheAMMRAvaccineAatA6AmonthsAofAage
B.APenicillinAprophylaxisAuntilA5AyearsAofAage
C.APneumococcalApolysaccharideAvaccineAatA6AmonthsAofAageA
D.ASulfamethoxazole-trimethoprimAprophylaxisAuntilA5AyearsAofAageA-AcorrectAanswers-
B.APenicillinAprophylaxisAuntilA5AyearsAofAage
WhichAofAtheAfollowingAexamAfindingsAinAaAchildAareAMOSTAconsistentAwithAaAdiagnosisAofA
StageAIIIAhepaticAencephalopathy?

, A.APeriodicAlethargy,AmoodAswings,AincontinenceA&Ahyperreflexia
B.ADrowsiness,Aconfusion,Aagitation,A&Aincontinence
C.AAsterixis,Aagitation,AresponseAlimitedAtoAnoxiousAstimuli,Aareflexia
D.AConfusion,AarousableAfromAstupor,Aasterixis,AhyperreflexiaA-AcorrectAanswers-
D.AConfusion,AarousableAfromAstupor,Aasterixis,AhyperreflexiaA

STAGEAI:Aalertness,Aagitation,AbutAdistractible;AinfantsAandAyoungAchildrenAareAirritableAan
dAfussy.AReflexesAareAnormalAbutAtremorAwithApoorAhandwritingAisAnoted.AChildrenAareAabl
eAtoAobeyAage-appropriateAcommands.
STAGEAII:AconfusionAandAlethargy,AcombativenessAorAinappropriateAeuphoria.AReflexesAa
reAhyperactiveAwithAasterixisApresent,AandAwhileAmovementsAareApurposeful,AtheAchildAma
yAnotAbeAableAtoAobeyAcommands.
STAGEAIII:AstuporousAbutAarousable,AmotorAresponseAtoApain,AincoherentAspeech,Ahyperr
eflexia,Ahyperventilation,AandAasterixisAisApresent.
STAGEAIV:AunconsciousnessAandAeitherAunresponsiveAorArespondsAnon-
purposefullyAtoAnoxiousAstimuli,Ahyperreflexia,AirregularArespirations,AandAsluggishApupillar
yAresponse.
WhichAofAtheAfollowingAfindingsAwouldAbeAMOSTAconcerningAforAaAchildAwithAFactorAVALeid
enAdeficiency?
A.AFemurAfracture
B.AHematochezia
C.APeriorbitalApetechiae
D.APersistentAepistaxisA-AcorrectAanswers-A.AFemurAfracture

(AnAinheritedAdisorderAthatAresultsAfromAanAalterationAinAtheAaminoAacidAsequenceAofAtheAf
actorAVAmolecule,AwhichAmakesAitAresistantAtoAproteinACAandAproteinAS,AresultingAinAaAprot
hromboticAstate.A
WhileAaAfemurAfractureAcanAcauseAmajorAbloodAloss,AtheAmostAconcerningAissueAisAtheArel
atedAtraumaAtoAtheAlimbAandAvascularAinjuryAwithAtheAfracture.ATheAcombinationAofAtraumaA
andAFactorAVALeidenAdeficiencyAplacesAtheAchildAatAhighAriskAforAthrombosisAandApossibleA
embolus)
InAwhichAofAtheAfollowingAscenariosAisAtheAriskAofAabuseAMOSTAconcerningAforAanAinfantAw
hoApresentsAwithAlethargy,ApoorAweightAgain,AandApossibleAseizureAactivity?
A.AMotherAisAaAsingleAparentAofA4AchildrenAwhoAareAeachAaAyearAapartAinAage
B.AInfantAwithAcleftAlipA&ApalateA&AhasAdifficultyAfeedingAwithAaAspecialAdevice
C.AMotherA&AinfantAareAlivingAwithAtheAmaternalAgrandmotherAwhoAprovidesAchildcare
D.AInfantAwithAlowAbirthAweightAwhoArequiresAfortificationAofAformulaAforAcatch-upAgrowthA-
AcorrectAanswers-

B.AInfantAwithAcleftAlipA&ApalateA&AhasAdifficultyAfeedingAwithAaAspecialAdevice
TheApalliativeAcareAteamAisAbeingAconsultedAforAaA6AmonthAoldAwithAcomplexAmedicalAcond
itionsAwhoAhasAbeenAhospitalizedAsinceAbirth.AItAisAMOSTAimportantAforAtheAfamilyAtoAunder
standAthatAtheAprimaryAfocusAofApalliativeAcareAisAto:
A.AAssessAtheAinfant,AmodifyAcareAgoalsA&AfocusAonAdischargeApreparationA
B.AAssistAwithAanticipatingAbereavementAneedsA&AtransitionAtoAhospiceAcare
C.APreventAreadmissionsAtoAtheAhospitalAforAacuteAillnessesAafterAtheAinfantAisAdischargedA
toAhome