PNCB PRIMARY CARE QUESTIONS AND ANSWERS
2026 WITH COMPLETE SOLUTION.
Correct
Incorrect
1 of 165
Term
An otherwise healthy adolescent male presents with bilateral breast
enlargement for the past 6 months and small masses palpable below
the nipples. The BEST next step is to
A. obtain thyroid, testosterone, and estradiol levels.
B. discuss expected resolution within 2 years.
C. order a bilateral breast ultrasound.
D. refer to an endocrinologist.
Give this one a try later!
B. discuss expected resolution A. symptom of a problem in the
within 2 years. organization's processes
C. a 14-year-old male who is at
C. prescribe an oral antibiotic.
genital stage I
, Don't know?
2 of 165
Term
A 12 month old has a normal white blood cell count and normal
platelet count, with the following additional results (Hbg 9.7, Hct
32%, MCV low & RDW increased. After the infant is started on iron
supplementation, the MOST appropriate laboratory follow-up plan is
to obtain a:
A. serum ferritin in 2 weeks
B. serum iron levels in 2 weeks
C. complete blood count in 1 month
D. total iron binding capacity in 1 month
Give this one a try later!
C. discontinue analgesics
Ibuprofen is an effective analgesic in the treatment of migraines, but analgesic
use should be limited to no more than 3 uses per week.
Medication-overuse headaches are caused by using analgesics too frequently.
Use of analgesics more than 3 times per week for headaches can actually cause
headaches. Treatment of medication-overuse headaches requires
discontinuation of the analgesics.
If there are neurological abnormalities on examination or a history of headaches
that awaken the individual from sleep, an MRI is the most appropriate imaging
strategy.
Triptan medications can be an effective abortive therapy for migraines and
feedback therapy can be effective in acute and preventative management to
provide the individual with some self-control.
,C. systemic juvenile idiopathic arthritis
Systemic JIA causes inflammation in one or more joints for 6 weeks’ duration in
a child younger than 16 years of age and is often accompanied by fatigue,
inflammation of joints, skin rash, and a high fever (103° F [39.4° C] or higher)
that lasts at least 2 weeks. Pericarditis, pleuritis, anemia, or enlargement of
lymph nodes, liver or the spleen may also occur.
Systemic lupus erythematosus (SLE) is a chronic systemic rheumatic disease.
Symptoms include fatigue, skin rashes, fever, and joint involvement with non-
deforming arthritis but with effusion and tenderness. SLE can involve many
organ systems (kidney, skin, blood cells, and nervous system). A malar rash
across the cheeks and bridge of the nose in the shape of a butterfly is seen in
95% of SLE cases.
The most common manifestation of acute rheumatic fever is polyarthritis of
large joints. The latency period from infection with group A streptococcal
infection until the onset of arthritis is about 2-6 weeks.
Dermatomyositis is an autoimmune myopathic illness affecting the pediatric
population. Proximal muscle weakness in addition to thick scaling on extensor
surfaces, known as Gottron papules, are characteristic of dermatomyositis.
C. inquire about inhaler usage
While assessment of environmental factors can help identify new triggers, a
different inhaled corticosteroid may be beneficial, and a chest radiograph may
identify pulmonary issues needing other treatment, the first step is to always
assess if the prescribed plan is being used. Evaluation of when and how each
inhaler is used is helpful in differentiating whether the current treatment plan is
not being followed versus being ineffective in controlling the asthma, leading to
the recent exacerbations.
C. complete blood count in 1 month
The low hemoglobin and hematocrit and reduced mean corpuscular
volume (MCV) indicate that the child in this scenario has iron deficiency
anemia likely related to an insufficient dietary intake of iron.
The first laboratory indication of iron deficiency anemia is reduced iron
stores, which is reflected in the ferritin value, a protein that estimates the
stores of iron. As the stores of iron decrease, the capacity to absorb more
increases, which is evaluated through total iron binding capacity. With
reduced availability of hemoglobin, the size of red blood cells (RDW)
increases and the MCV decreases.
, Administration of iron supplementation will increase the hemoglobin by 1-
2 g/dL within a month. Supplemental iron is continued for 2-3 months after
normalization of the hemoglobin to develop adequate iron reserves. With
severe anemia, a reticulocyte count can be obtained shortly after iron
therapy has begun to confirm the diagnosis of iron deficiency anemia.
Serum iron, ferritin, and total iron binding capacity are not required to
make the diagnosis of iron deficiency anemia and are usually obtained
when the hemoglobin and hematocrit are not improving as expected with
iron supplementation. Serum ferritin levels may be tested 6 months after
iron supplements are stopped to assure adequate iron stores.
Don't know?
3 of 165
Term
A mother is concerned about a lump identified under the nipple of
her 10-year-old daughter’s breast. The child recently completed
treatment for leukemia. On examination the right nipple is elevated
with soft tissue that is non-tender to palpation. The MOST
appropriate next step is to
A. reassure that this is normal breast development for the child’s age.
B. obtain bloodwork to assess hormone levels and blood counts.
C. arrange an ultrasound to assess the swelling.
D. consult with the child’s oncologist.
Give this one a try later!
A. reassure that this is normal breast development for the child's age.
A. refer to a pediatric speech pathologist with access to translators
At two years of age a child should be speaking short phrases of two to three
words with a vocabulary of about 50 words, of which 25% are intelligible to
2026 WITH COMPLETE SOLUTION.
Correct
Incorrect
1 of 165
Term
An otherwise healthy adolescent male presents with bilateral breast
enlargement for the past 6 months and small masses palpable below
the nipples. The BEST next step is to
A. obtain thyroid, testosterone, and estradiol levels.
B. discuss expected resolution within 2 years.
C. order a bilateral breast ultrasound.
D. refer to an endocrinologist.
Give this one a try later!
B. discuss expected resolution A. symptom of a problem in the
within 2 years. organization's processes
C. a 14-year-old male who is at
C. prescribe an oral antibiotic.
genital stage I
, Don't know?
2 of 165
Term
A 12 month old has a normal white blood cell count and normal
platelet count, with the following additional results (Hbg 9.7, Hct
32%, MCV low & RDW increased. After the infant is started on iron
supplementation, the MOST appropriate laboratory follow-up plan is
to obtain a:
A. serum ferritin in 2 weeks
B. serum iron levels in 2 weeks
C. complete blood count in 1 month
D. total iron binding capacity in 1 month
Give this one a try later!
C. discontinue analgesics
Ibuprofen is an effective analgesic in the treatment of migraines, but analgesic
use should be limited to no more than 3 uses per week.
Medication-overuse headaches are caused by using analgesics too frequently.
Use of analgesics more than 3 times per week for headaches can actually cause
headaches. Treatment of medication-overuse headaches requires
discontinuation of the analgesics.
If there are neurological abnormalities on examination or a history of headaches
that awaken the individual from sleep, an MRI is the most appropriate imaging
strategy.
Triptan medications can be an effective abortive therapy for migraines and
feedback therapy can be effective in acute and preventative management to
provide the individual with some self-control.
,C. systemic juvenile idiopathic arthritis
Systemic JIA causes inflammation in one or more joints for 6 weeks’ duration in
a child younger than 16 years of age and is often accompanied by fatigue,
inflammation of joints, skin rash, and a high fever (103° F [39.4° C] or higher)
that lasts at least 2 weeks. Pericarditis, pleuritis, anemia, or enlargement of
lymph nodes, liver or the spleen may also occur.
Systemic lupus erythematosus (SLE) is a chronic systemic rheumatic disease.
Symptoms include fatigue, skin rashes, fever, and joint involvement with non-
deforming arthritis but with effusion and tenderness. SLE can involve many
organ systems (kidney, skin, blood cells, and nervous system). A malar rash
across the cheeks and bridge of the nose in the shape of a butterfly is seen in
95% of SLE cases.
The most common manifestation of acute rheumatic fever is polyarthritis of
large joints. The latency period from infection with group A streptococcal
infection until the onset of arthritis is about 2-6 weeks.
Dermatomyositis is an autoimmune myopathic illness affecting the pediatric
population. Proximal muscle weakness in addition to thick scaling on extensor
surfaces, known as Gottron papules, are characteristic of dermatomyositis.
C. inquire about inhaler usage
While assessment of environmental factors can help identify new triggers, a
different inhaled corticosteroid may be beneficial, and a chest radiograph may
identify pulmonary issues needing other treatment, the first step is to always
assess if the prescribed plan is being used. Evaluation of when and how each
inhaler is used is helpful in differentiating whether the current treatment plan is
not being followed versus being ineffective in controlling the asthma, leading to
the recent exacerbations.
C. complete blood count in 1 month
The low hemoglobin and hematocrit and reduced mean corpuscular
volume (MCV) indicate that the child in this scenario has iron deficiency
anemia likely related to an insufficient dietary intake of iron.
The first laboratory indication of iron deficiency anemia is reduced iron
stores, which is reflected in the ferritin value, a protein that estimates the
stores of iron. As the stores of iron decrease, the capacity to absorb more
increases, which is evaluated through total iron binding capacity. With
reduced availability of hemoglobin, the size of red blood cells (RDW)
increases and the MCV decreases.
, Administration of iron supplementation will increase the hemoglobin by 1-
2 g/dL within a month. Supplemental iron is continued for 2-3 months after
normalization of the hemoglobin to develop adequate iron reserves. With
severe anemia, a reticulocyte count can be obtained shortly after iron
therapy has begun to confirm the diagnosis of iron deficiency anemia.
Serum iron, ferritin, and total iron binding capacity are not required to
make the diagnosis of iron deficiency anemia and are usually obtained
when the hemoglobin and hematocrit are not improving as expected with
iron supplementation. Serum ferritin levels may be tested 6 months after
iron supplements are stopped to assure adequate iron stores.
Don't know?
3 of 165
Term
A mother is concerned about a lump identified under the nipple of
her 10-year-old daughter’s breast. The child recently completed
treatment for leukemia. On examination the right nipple is elevated
with soft tissue that is non-tender to palpation. The MOST
appropriate next step is to
A. reassure that this is normal breast development for the child’s age.
B. obtain bloodwork to assess hormone levels and blood counts.
C. arrange an ultrasound to assess the swelling.
D. consult with the child’s oncologist.
Give this one a try later!
A. reassure that this is normal breast development for the child's age.
A. refer to a pediatric speech pathologist with access to translators
At two years of age a child should be speaking short phrases of two to three
words with a vocabulary of about 50 words, of which 25% are intelligible to
