Pediatric Primary Care PNCB 1
Pediatric Primary Care PNCB 1 Exam
Questions and Answers
Question 1
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 risk for IDA, depending on foods actually eaten.Which
laboratory assessment is the BEST indicator of vitamin D deficiency?
Page 1 of 75
, Pediatric Primary Care PNCB 1
Question 2
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 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.
Page 2 of 75
, Pediatric Primary Care PNCB 1
Question 3
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
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.
Page 3 of 75
, Pediatric Primary Care PNCB 1
Question 4
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.
Correct 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.
Page 4 of 75
Pediatric Primary Care PNCB 1 Exam
Questions and Answers
Question 1
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 risk for IDA, depending on foods actually eaten.Which
laboratory assessment is the BEST indicator of vitamin D deficiency?
Page 1 of 75
, Pediatric Primary Care PNCB 1
Question 2
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 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.
Page 2 of 75
, Pediatric Primary Care PNCB 1
Question 3
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
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.
Page 3 of 75
, Pediatric Primary Care PNCB 1
Question 4
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.
Correct 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.
Page 4 of 75
