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Pediatric Primary Care PNCB 2: Questions/Answers
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Pediatric Primary Care PNCB 2: Questions/Answers
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Pediatric Primary Care PNCB 2: Questions/AnswersA female athlete experiences anaphylaxis during a soccer game. The only
significant history is that she had lunch about 1 hour before the incident.
Food-dependent exercise-induced anaphylaxis is diagnosed. Of the following,
the MOST likely cause is:
chocolate milkshake
pineapple
tomatoes
whole wheat bread Right Ans - whole wheat bread
Exercise is a known co-factor in some children who experience anaphylaxis.
Food-dependent exercise-induced anaphylaxis (FDEIA) is defined as a food
induced allergic reaction that occurs during or soon after exercise. Children
should not exercise within 2-3 hours of ingesting the triggering food. Nuts,
wheat, apples, bananas, kiwi, peaches and eggs frequently are the cause for
anaphylaxis.
A healthy 24 month old can be expected to have achieved which of the
following language milestones?
counts three objects correctly
speaks using 30 - 50 words
states full name
tells a story Right Ans - speaks using 30 - 50 words
Utilizing the Early Language Milestone Scale, beginning at the age of 11
months and continuing to 24 months of age, the child should have a
vocabulary of 50 words. This child should be able to put words together in
short, 2 - 3 word sentences and name at least one object in a picture. The child
at age 3 - 4 years will be able to tell a short story and begin to count. A 2 year
,old may know his first name, but usually cannot state full name until he/she is
older.
Which is the MOST important safety question to ask a 17 year old?
"Are you aware of ways to avoid accidents?"
"Do you play violent video games more than 2 hours a day?"
"Do you always wear a seat belt when driving or riding in a car?"
"Is there a gun anywhere in your house?" Right Ans - "Do you always wear
a seat belt when driving or riding in a car?"
Motor vehicle accidents are the leading cause of death among children in the
United States, with 78% of all unintentional injury deaths related to MVA
among adolescents. When correctly used, restraint systems can prevent
fatalities and reduce the number and severity of injuries to children and
adolescents. As adolescents begin to drive and carry peer passengers, it is
especially important to remind them of basic safety issues, including the use
of seat belts, emphasizing the danger of driving, drinking and drug use as well
as appropriate behavior while in the car. Reinforcing pedestrian safety is
another important issue with adolescents. Firearm injuries have decreased
over recent years, especially among older children, and there is no link
between violent video games and increased accidents.
The parent of an 8 month old, reports switching the baby's formula to cow's
milk due to the continued expense of formula. Which is the BEST response?
Cow's milk does not contain adequate nutrition, and poses a higher risk for
allergy.
Cow's milk has a lower protein and fat content, which will impede growth of
the baby.
Switching to cow's milk sooner than 1 year will not cause any harm.
,There is no need to continue formula as long as the child is receiving other
baby foods. Right Ans - Cow's milk does not contain adequate nutrition,
and poses a higher risk for allergy.
During the first year of life, infants should receive only formula or breast milk.
The use of cow's milk is contraindicated because of its high protein content,
inappropriate nutrition composition, especially lack of iron sources, and the
risk of gastrointestinal bleeding and allergic reactions. If an infant is switched
sooner than one year, the practitioner should encourage the family to resume
use of formula or breast milk until the one year birthday. Despite the addition
of table foods or baby solid foods, formula and breast milk are still the dietary
mainstay.
A 10 month old has had apparent abdominal pain for the past 4 hours. During
episodes of pain, the infant screams inconsolably and draws his legs towards
the abdomen, has vomited twice, but has had no diarrhea. Between episodes
the infant is calm and quiet. The MOST likely diagnosis is:
Meckel's diverticulum
intussusception
acute appendicitis
acute gastroenteritis Right Ans - intussusception
Acute onset of abdominal pain requires immediate investigation. The nurse
practitioner must be able to distinguish between conditions that can safely be
managed at home and those requiring immediate referral. Meckel's
diverticulum usually involves painless rectal bleeding. Acute appendicitis can
occur in infants and must be considered in the differential diagnosis. The pain
history of acute appendicitis is usually more continuous, and there is no
palpable mass. Acute gastroenteritis may involve intermittent pain and
cramping, but more typically the child appears ill, and vomiting and diarrhea
play a more prominent role. The pain of intussusception is very severe, with
periods of well-being in between. There is frequently vomiting, however
stools initially are normal. Later stools can be like red jelly in appearance. A
sausage shaped mass is frequently palpable in the right upper quadrant and
aids in diagnosis.
, For the parents of an 8 month old, the MOST appropriate age-related
anticipatory guidance regarding safety includes which of the following?
cover electrical outlets, keep small objects out of reach, turn car seat to
forward-facing position
keep medications out of reach, continue to use car seat in rear-facing position,
cover electrical outlets
avoid finger foods that can be easily aspirated, teach stranger safety, place Mr.
Yuk stickers on toxic materials
keep matches out of reach, place Mr. Yuk stickers on toxic materials, teach
stranger safety Right Ans - keep medications out of reach, continue to use
car seat in rear-facing position, cover electrical outlets
An 8 month old is beginning to cruise, crawl and develop a fine pincer grasp.
Keeping medications and small objects out of reach in this age group assists in
avoiding choking or toxic ingestions. Covering electrical outlets helps to
prevent accidental electrocution while the infant is exploring his
surroundings. An infant should maintain the rear-facing position of the car
seat until the age of one year. An 8 month old is not at a developmental level
to understand stranger caution nor Mr. Yuk stickers. Keeping matches out of
reach is important, although it is not as likely that an 8 month old would have
the dexterity to strike a match.
The INITIAL treatment for a school-age female with well-demarcated
erythema and mucoid discharge in the vulva area includes:
discontinuation of bubble baths.
instruction on front to back cleansing.
oral penicillin.
topical Premarin. Right Ans - instruction on front to back cleansing.
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