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PNCB 3 Exam – Questions And Solutions By Expert
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PNCB 3 Exam – Questions And Solutions By Expert
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PNCB 3 Exam – Questions And Solutions By ExpertAn adolescent presents after a recent viral illness with numbness and a feeling
of heaviness and weakness in bilateral lower extremities. The MOST likely
diagnosis is:
A) acute flaccid myelitis
B) Guillain-Barre syndrome
C) myasthenia gravis
D) tick paralysis Right Ans - B) Guillain-Barre
A child with bacterial meningitis has a urine output that increases to 8
mL/kg/hour. Lab results are provided in the table (see image below by
expanding the related images tab). The MOST appropriate intervention is:
serum sodium 150 mEq/L
serum osmolarity 310 mOsm/L
urine specific gravity 1.001
A) fluid restriction
B) hydrocortisone replacement
C) intranasal desmopressin
D) intravenous vasopressin Right Ans - D) intravenous vasopressin
Appropriate preventive care following splenectomy includes
A) fluconazole (Diflucan) prophylaxis daily
B) hepatitis A, hepatitis B, and varicella vaccines
C) pneumococcal, Haemophilus influenzae, and meningococcal vaccines
D) sulfamethoxazole-trimethoprim (Bactrim) prophylaxis daily Right Ans -
C) pneumococcal, Haemophilus influenzae, and meningococcal vaccines
Vaccination with pneumococcal, Haemophilus influenzae, and meningococcal
vaccines should be administered or planned around 14 days following
splenectomy. Additionally, children with functional asplenia should receive
daily penicillin prophylaxis.
,For the past 4 days a previously healthy infant has had a fever and upper
respiratory symptoms. Vital signs and laboratory values are provided in tables
(see image below by expanding the related images tab). Which of the
following is the PRIORITY intervention?
Temp 38.7C
HR 156 bpm
RR 32/min
BP 86/44
SpO2 92%
Sodium 132
Potassium 4.5
Glucose 100
Ionized calcium 0.95
Phosphorus 6.3
WBC 130,000
Hemoglobin 6.1
Platelet count 10,000
A) administer a fluid bolus and consult oncology
B) administer calcium gluconate and consult nephrology
C) obtain blood cultures and administer IV ceftriaxone (Rocephin)
D) assess BUN and creatinine levels and obtain type and cross for blood
products Right Ans - A) administer a fluid bolus and consult oncology
The combination of hyperleukocytosis, thrombocytopenia, and anemia should
raise red flags for leukemia.
Lysis of tumor cells results in hyperphosphatemia, hypocalcemia,
hyperuricemia, and hyperkalemia due to the release of intracellular contents
into the serum. In order to protect the kidneys from the sudden release of
cellular components of TLS, it is important to provide aggressive hydration.
A child newly diagnosed with an intracranial mass is intubated and sedated
and acutely develops hypertension, bradycardia, and anisocoria with a fixed,
dilated left pupil. The MOST appropriate intervention is administration of:
A) epinephrine
,B) hydralazine
C) hypertonic sodium chloride
D) sodium bicarbonate Right Ans - C) hypertonic sodium chloride
Anisocoria is a condition characterized by unequal pupil sizes
An adolescent with no significant past medical history who could not be
wakened by caregivers is being evaluated. There is no history or physical
findings of trauma, and pupils are pinpoint bilaterally. Vital signs and Glasgow
Coma Scale score are provided in the table. The MOST likely diagnosis is:
HR 60bpm
RR 8/minute
BP 80/54 (62)
Temp 36.2 C
SpO2 86% on RA
GCS:
Eye opening 2
Verbal 3
Motor 4
Total: 9
A) anticholinergic ingesti0on
B) meningitis
C) opiate intoxication
D) space occupying lesion Right Ans - C) opiate intoxication
The classic presentation of opioid toxicity includes respiratory and central
nervous system depression accompanied by miosis. Thus, in the case
presented, bradypnea, oxygen desaturation, pinpoint pupils, and depressed
level of consciousness in an adolescent with no previous health concerns or
evidence of trauma is highly concerning for opiate intoxication
Anticholinergic toxicity can also present with coma; however, other cardinal
findings in the anticholinergic toxidrome include mydriasis, fever,
tachycardia, and hypertension. These signs are described in the classic
mnemonic "hot as a hare, blind as a bat, dry as a bone, red as a beet, and mad
as a hatter".
, A school-aged child with a history of an anaphylactic reaction to vancomycin
presents with pneumonia and severe respiratory distress. Which of the
following antibiotics is the BEST treatment option to provide empiric
coverage for community-acquired, methicillin-resistant Staphylococcus
aureus?
A) cefepime
B) clindamycin
C) levofloxacin
D) nafcillin Right Ans - B) clindamycin
This organism most commonly causes respiratory and skin and soft-tissue
infections and is susceptible to non-beta lactam classes of antibiotics including
clindamycin and trimethoprim-sulfamethoxazole. Vancomycin has been the
standard therapy for MRSA in inpatient settings. Additional choices include
clindamycin and linezolid, which are available in enteral formulations.
A child presents with lethargy and generalized malaise. Physical exam is
significant for jugular venous distention and a liver edge palpable at 5 cm
below the right costal margin. A chest radiograph demonstrates cardiomegaly,
pulmonary edema, blunting of the right costophrenic angle, but with no
mediastinal shift. Which diagnostic study should be obtained NEXT?
A) chest CT without contrast
B) lateral decubitus chest radiograph
C) oblique chest radiograph
D) spiral CT Right Ans - B) lateral decubitus chest radiograph
Simple effusion is best evaluated by a lateral decubitus radiograph on which
the fluid will layer out along the chest wall and can be graded as small,
moderate, or large depending on the width of the rim measured from the
inner margin of the ribs to the outer margin of the lung.
A child with leukemia requires intrathecal chemotherapy. The desired
intervertebral space for instillation of the medication(s) is:
A) T1-T2
B) T8-T9
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