Pediatric Primary Care PNCB 1 Exam
Questions & Answers (Grade A+)
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 answer ✅2 year old with iron deficiency anemia
The amount of lead absorbed from the gut is increased in children
with 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
,Pediatric Primary Care PNCB 1 Exam
Questions & Answers (Grade A+)
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?
25(OH)-D (cholecalciferol)
1,25(OH)2-D (calcitriol)
PTH (parathyroid hormone)
25(OH)-D (cholecalciferol) -
correct 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
,Pediatric Primary Care PNCB 1 Exam
Questions & Answers (Grade A+)
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 -
correct answer ✅CT scan of the head
, Pediatric Primary Care PNCB 1 Exam
Questions & Answers (Grade A+)
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
Questions & Answers (Grade A+)
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 answer ✅2 year old with iron deficiency anemia
The amount of lead absorbed from the gut is increased in children
with 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
,Pediatric Primary Care PNCB 1 Exam
Questions & Answers (Grade A+)
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?
25(OH)-D (cholecalciferol)
1,25(OH)2-D (calcitriol)
PTH (parathyroid hormone)
25(OH)-D (cholecalciferol) -
correct 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
,Pediatric Primary Care PNCB 1 Exam
Questions & Answers (Grade A+)
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 -
correct answer ✅CT scan of the head
, Pediatric Primary Care PNCB 1 Exam
Questions & Answers (Grade A+)
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
