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Pediatric Primary Care PNCB 1: Questions & Answers
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Pediatric Primary Care PNCB 1: Questions & Answers
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Pediatric Primary Care PNCB 1: Questions & AnswersThe 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. Right Ans - 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) Right Ans - 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 Right Ans - 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. Right Ans -
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 Right Ans - 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
stressful situations Right Ans - 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
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