PNCB PRIMARY CARE COMPREHENSIVE
EXAM 2026 QUESTIONS AND SOLUTIONS
GRADED A+
◉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). Answer: 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. Answer: 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.. Answer:
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
EXAM 2026 QUESTIONS AND SOLUTIONS
GRADED A+
◉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). Answer: 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. Answer: 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.. Answer:
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
