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PNCB PEDIATRIC PRIMARY CARE FINAL EXAM REVIEW 2024/ ACTUAL EXAM WITH 70 QUESTIONS AND CORRECT VERIFIED ANSWERS WITH RATIONALES/ NEWEST EXAM $19.99
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PNCB PEDIATRIC PRIMARY CARE FINAL EXAM
REVIEW 2024/ ACTUAL EXAM WITH 70 QUESTIONS
AND CORRECT VERIFIED ANSWERS WITH
RATIONALES/ NEWEST EXAM 2024-2025
The 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.
- CORRECT ANS:->>2 year old with iron deficiency anemia
Reasoning:->>.The amount of lead absorbed from the gut is
increased in childrenwith 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?
Reasoning:->>.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 hormonereleases 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 - CORRECT ANS:->>CT scan of the
head
Reasoning:->>.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 hospital clients about transitioning care. -
CORRECT ANS:->>finding an adult health care provider for
transition.
Reasoning:->>.Finding an adult health care provider, one who is
qualified to carefor 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 - CORRECT ANS:->>elbow
flexed withpronated forearm
Reasoning:->>.Subluxation of the radial head, also called
nursemaid's elbow, must be differentiated from a fracture prior to
reducing the annularligament of the elbow. Radiographic
examination is not necessaryif 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,
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