PNCB Actual Exam
PNCB ACTUAL EXAM NEWEST 2025/2026 COMPLETE
QUESTIONS AND CORRECT DETAILED ANSWERS |ALREADY
GRADED A+||ALREADY GRADED A+
A 6-year-old in the office using Albuterol every week has nocturnal cough and has
just completed his second round of orapred from express care visit this month.
What would be the next step in the treatment plan per the NHLBI step-wise
guideline?
a) Begin low-dose ICS
b) increase albuterol to QID
c) refer to pulmonology
d) no change in treatment plan - ANSWER-a) Begin low-dose ICS
In addition to airway hyper-responsiveness and reversible airway obstruction,
asthma is a chronic lung disease characterized by:
a) bronchiectasis
b) inflammation
c) pleural effusion
d) retractions, stridor - ANSWER-b) inflammation
A child is being seen for wheezing. He has a history of asthma and is recovering
from a viral illness. The patient reports a "coughing fit" then started wheezing.
Four inhalations of albuterol were given with no improvement of symptoms. On
exam, the child is afebrile, responsive to questions, and + for unilateral wheezing.
What is the most likely cause?
a) croup
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, PNCB Actual Exam
b) asthma
c) foreign body aspiration
d) cystic fibrosis - ANSWER-c) foreign body aspiration
A toddler who was born prematurely refuses most solid foods and has poor
weight gain. A barium swallow study reveals a normal esophagus. What will the
PNP consider next to manage this child's nutritional needs?
a) consultation with a dietician
b) fibreoptic endoscopy evaluation
c) magnetic resonance imaging
d) videofluroscopy swallow study - ANSWER-a) consultation with a dietician
A school age child has recurrent diarrhea with foul-smelling stools, excessive
flatus, abdominal distension, and failure-to-thrive. A 2-week lactose-free trial
failed to reduce symptoms. What is the next step in diagnosing this condition?
a) lactose hydrogen breath test
b) serologic testing for celiac disease
c) stool for ova and parasites
d) sweat chloride test for cystic fibrosis - ANSWER-b) serologic testing for celiac
disease
A 12-month-old infant exhibits poor weight gain after previously normal growth
patterns. There is no history of vomiting, diarrhea, or irregular bowel movements,
and the physical exam is normal. What is the next step in evaluating these
findings?
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, PNCB Actual Exam
a) complete blood count and electrolytes
b) feeding and stooling history and 3-day diet history
c) stool cultures for ova and parasites
d) swallow study with videofluoroscopy - ANSWER-b) feeding and stooling history
and 3-day diet history
A toddler is seen in the clinic after a 2-day history of intermittent vomiting and
diarrhea. An assessment reveals an irritable child with dry mucous membranes, 3
second capillary refill, 2 second recoil of skin, mild tachycardia and tachypnea, and
cool hands and feet. The child has had two wet diapers in the past 24 hours. What
will the primary care PNP recommend?
a) anti-diarrheal medication and clear fluids for 24 hours
b) bolus of IV normal saline in the clinic until improvement
c) hospital admission for iV rehydration and oral fluids
d) oral rehydration solution with follow-up in 24 hours - ANSWER-d) oral
rehydration solution with follow-up in 24 hours
A 2-month-old infant cries up to 4 hours each day and according to the parents, is
inconsolable during crying episodes with fists and legs noted to be tense and stiff.
The infant is breastfeeding frequently but is often fussy during feedings. The
physical exam is normal and the infant is gaining weight normally. what will the
primary care PNP recommend?
a) a complete work-up, including laboratory and radiologic tests
b) eliminating certain foods from the mother's diet
c) empiric treatment with a proton pump inhibitor medications
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, PNCB Actual Exam
d) stopping breastfeeding and beginning a hydrolyzed formula - ANSWER-b)
eliminating certain foods from the mother's diet
The parents of a 3-month-old reports that the infant arches and gages while
feeding and spits up undigested formula frequently. The infant's weight gain has
dropped to the 5th percentile from the 12th percentile. What is the best course of
treatment for this infant?
a) begin a trial of extensively hydrolyzed protein formula for 2-4 weeks
b) initiative an empiric trial of acid suppression with a proton pump inhibitor
c) perform a esophageal pH monitoring to determine the degree of reflux
d) reassure the parent that these symptoms will likely resolve by 12-24 months -
ANSWER-a) begin a trial of extensively hydrolyzed protein formula for 2-4 weeks
An adolescent is diagnosed with functional abdominal pain (FAP). The child's
symptoms worsen during stressful events, especially with school anxiety. what will
be an important part of treatment for this child?
a) informing the parents that the pain is most likely not real
b) instituting a lactose-free diet along with lactobacillus supplements
c) teaching about the brain-gut interaction causing symptoms
d) using histamine2-blockers to help alleviate symptoms - ANSWER-c) teaching
about the brain-gut interaction causing symptoms
The most common congenital heart defect in children is:
a) tricuspid atresia
b) ventricular septal defect
4|Page
PNCB ACTUAL EXAM NEWEST 2025/2026 COMPLETE
QUESTIONS AND CORRECT DETAILED ANSWERS |ALREADY
GRADED A+||ALREADY GRADED A+
A 6-year-old in the office using Albuterol every week has nocturnal cough and has
just completed his second round of orapred from express care visit this month.
What would be the next step in the treatment plan per the NHLBI step-wise
guideline?
a) Begin low-dose ICS
b) increase albuterol to QID
c) refer to pulmonology
d) no change in treatment plan - ANSWER-a) Begin low-dose ICS
In addition to airway hyper-responsiveness and reversible airway obstruction,
asthma is a chronic lung disease characterized by:
a) bronchiectasis
b) inflammation
c) pleural effusion
d) retractions, stridor - ANSWER-b) inflammation
A child is being seen for wheezing. He has a history of asthma and is recovering
from a viral illness. The patient reports a "coughing fit" then started wheezing.
Four inhalations of albuterol were given with no improvement of symptoms. On
exam, the child is afebrile, responsive to questions, and + for unilateral wheezing.
What is the most likely cause?
a) croup
1|Page
, PNCB Actual Exam
b) asthma
c) foreign body aspiration
d) cystic fibrosis - ANSWER-c) foreign body aspiration
A toddler who was born prematurely refuses most solid foods and has poor
weight gain. A barium swallow study reveals a normal esophagus. What will the
PNP consider next to manage this child's nutritional needs?
a) consultation with a dietician
b) fibreoptic endoscopy evaluation
c) magnetic resonance imaging
d) videofluroscopy swallow study - ANSWER-a) consultation with a dietician
A school age child has recurrent diarrhea with foul-smelling stools, excessive
flatus, abdominal distension, and failure-to-thrive. A 2-week lactose-free trial
failed to reduce symptoms. What is the next step in diagnosing this condition?
a) lactose hydrogen breath test
b) serologic testing for celiac disease
c) stool for ova and parasites
d) sweat chloride test for cystic fibrosis - ANSWER-b) serologic testing for celiac
disease
A 12-month-old infant exhibits poor weight gain after previously normal growth
patterns. There is no history of vomiting, diarrhea, or irregular bowel movements,
and the physical exam is normal. What is the next step in evaluating these
findings?
2|Page
, PNCB Actual Exam
a) complete blood count and electrolytes
b) feeding and stooling history and 3-day diet history
c) stool cultures for ova and parasites
d) swallow study with videofluoroscopy - ANSWER-b) feeding and stooling history
and 3-day diet history
A toddler is seen in the clinic after a 2-day history of intermittent vomiting and
diarrhea. An assessment reveals an irritable child with dry mucous membranes, 3
second capillary refill, 2 second recoil of skin, mild tachycardia and tachypnea, and
cool hands and feet. The child has had two wet diapers in the past 24 hours. What
will the primary care PNP recommend?
a) anti-diarrheal medication and clear fluids for 24 hours
b) bolus of IV normal saline in the clinic until improvement
c) hospital admission for iV rehydration and oral fluids
d) oral rehydration solution with follow-up in 24 hours - ANSWER-d) oral
rehydration solution with follow-up in 24 hours
A 2-month-old infant cries up to 4 hours each day and according to the parents, is
inconsolable during crying episodes with fists and legs noted to be tense and stiff.
The infant is breastfeeding frequently but is often fussy during feedings. The
physical exam is normal and the infant is gaining weight normally. what will the
primary care PNP recommend?
a) a complete work-up, including laboratory and radiologic tests
b) eliminating certain foods from the mother's diet
c) empiric treatment with a proton pump inhibitor medications
3|Page
, PNCB Actual Exam
d) stopping breastfeeding and beginning a hydrolyzed formula - ANSWER-b)
eliminating certain foods from the mother's diet
The parents of a 3-month-old reports that the infant arches and gages while
feeding and spits up undigested formula frequently. The infant's weight gain has
dropped to the 5th percentile from the 12th percentile. What is the best course of
treatment for this infant?
a) begin a trial of extensively hydrolyzed protein formula for 2-4 weeks
b) initiative an empiric trial of acid suppression with a proton pump inhibitor
c) perform a esophageal pH monitoring to determine the degree of reflux
d) reassure the parent that these symptoms will likely resolve by 12-24 months -
ANSWER-a) begin a trial of extensively hydrolyzed protein formula for 2-4 weeks
An adolescent is diagnosed with functional abdominal pain (FAP). The child's
symptoms worsen during stressful events, especially with school anxiety. what will
be an important part of treatment for this child?
a) informing the parents that the pain is most likely not real
b) instituting a lactose-free diet along with lactobacillus supplements
c) teaching about the brain-gut interaction causing symptoms
d) using histamine2-blockers to help alleviate symptoms - ANSWER-c) teaching
about the brain-gut interaction causing symptoms
The most common congenital heart defect in children is:
a) tricuspid atresia
b) ventricular septal defect
4|Page
