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In a child with myasthenia gravis, which of the following symptoms would be MOST indicative
of a myasthenic crisis?
A. Eye drooling
B. Respiratory distress
C. Excessive salivation
D. Muscle fasciculation - (ANSWERS)B. Respiratory distress
(Characterized by weakness and fatigue of skeletal muscle tissue that results from
autoimmune destruction of acetylcholine receptors (achr). A crisis event, or myasthenic crisis,
is an acute exacerbation of the disease process that results in severe weakness from
dysfunction of the neuromuscular junctions. It is characterized by respiratory failure due to
weakness of the airway or respiratory muscles.
A cholinergic crisis, is a severe weakness caused by overtreatment with cholinergic
medications used to treat MG & crisis present with excessive salivation, excessive lacrimation,
diarrhea, sweating, pupillary constriction, and muscle fasciculation.
A child with a history of congenital heart disease fell while playing and presents with a closed
fracture of the humerus. Physical exam reveals mild bradycardia and a moderate pain score.
Which of the following medications would MOST likely explain this child's bradycardia?
A. Enalapril (Vasotec)
B. Furosemide (Lasix)
C. Levothyroxine (Synthroid)
D. Propranolol (Inderal) - (ANSWERS)D. Propranolol (Inderal)
(Decreases heart rate, myocardial contractility, blood pressure, and myocardial oxygen
demand. Adverse effects include bradycardia, hypotension, and atrioventricular conduction
disturbances)
Enteral nutrition is initiated in a child with severe malnutrition. Laboratory values indicative of
refeeding syndrome include a magnesium level of 1.5 mg/dl, and:
A. Phosphate 3.0 ml/dl & potassium 2.8 meq/L
B. Phosphate 3.0 ml/dl & potassium 6 meq/L
C. Phosphate 7.0 ml/dl & potassium 2.8 meq/L
D. Phosphate 7.0 ml/dl & potassium 6 meq/L - (ANSWERS)A. Phosphate 3.0 ml/dl & potassium
2.8 meq/L
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(Refeeding syndrome occurs when malnourished patients are refed too aggressively leading. It
can occur within 1-3 days after reinstitution of nutrition.
The major manifestations include fluid overload, hypophosphatemia (phosphate less than 3.5
mg/dl), hypokalemia (potassium less than 3.5 meq/L), hypomagnesemia (magnesium less than
1.8 mg/dl), and thiamine deficiency. Complications include heart failure, dysrhythmias,
respiratory muscle weakness, seizures,
When informing a family that a report is being made to Child Protective Services for suspected
abuse, it is MOST important to
A. Focus on the child's well being
B. Identify the suspected perpetrator
C. Identify legal requirements for mandatory reporting
D. Share details with family to avoid misunderstanding - (ANSWERS)A. Focus on the child's well
being
Manifestations of abdominal injuries secondary to a blast mechanism are typically:
A. Acute & immediately apparent
B. Observed less than 6 hours after exposure
C. Delayed 8-36 hours after exposure
D. Chronic & slow to develop - (ANSWERS)C. Delayed 8-36 hours after exposure
(Blast attack, as seen in explosions, causes extensive compression and distortion of the
gastrointestinal (GI) tract & other air-filled organs. Manifestations generally delayed, presenting
8-36 hours after exposure.)
A previously healthy preschooler who is fully immunized, presents with a history of fever, URI
symptoms, & joint pain over the past several days. Physical exam reveals petechiae and
hepatosplenomegaly. Vital signs include HR 156, RR 32, temp 101.6 (38.7), BP 86/44 & O2 98%
on RA. Lab results include Na+ 132, K+ 6, Glucose 100, Ca+ 0.95, Phos 6.3, WBC 105,000, Hgb
6.1 & Plt 10,000. Which is the BEST course of action?
A. Obtain LFTS & type & cross for blood products
B. Administer calcium gluconate & consult nephrology
C. Obtain blood cultures & administer IV Ceftriaxone
D. Administer a fluid bolus & consult oncology - (ANSWERS)D. Administer a fluid bolus &
consult oncology
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(The combination of leukocytosis, thrombocytopenia, and anemia should raise red flags for an
oncologic process, most likely leukemia. After initial laboratory values are obtained, the child
should receive aggressive hydration.)
An adolescent presents with bilateral knee pain that has occurred for several months,
exacerbated with activities such as climbing stairs and running. Pain is also worsened by sitting
with the knees flexed for an extended time and is described as a grinding sensation under the
kneecaps. No joint swelling is noted on examination. The MOST likely diagnosis is:
A. Osgood-Schlatter disease
B. Osteochondritis dissecans
C. Patellofemoral pain syndrome
D. Popliteal cyst (Baker's cyst) - (ANSWERS)C. Patellofemoral pain syndrome
(Type of idiopathic anterior knee pain, common in adolescents. This type of knee pain worsens
with activity, especially going up and down stairs, and when sitting in one position for a
prolonged period of time. Treatment involves an exercise program focusing on hip girdle and
vastus medialis strengthening with lower extremity flexibility)
A toddler presents with vomiting and altered mental status after an ingestion of a large amount
of aspirin about 45 minutes ago. Prior to the administration of activated charcoal, the PRIORITY
is to:
A. Obtain a urine drug screen
B. Ensure IV access
C. Obtain and EKG
D. Ensure adequate airway protection - (ANSWERS)D. Ensure adequate airway protection
Which of the following children is MOST at risk for opiate withdrawal?
A. Infant intubated for respiratory failure receiving Dexmedetomidine (Precedex) infusion for 5
days
B. Infant intubated for respiratory failure receiving a morphine infusion for 6 days
C. Adolescent post-posterior spinal fusion receiving hydromorphone via PCA for 3 days
D. Adolescent post-cardiac surgery receiving PO oxycodone PRN for 2 days - (ANSWERS)B.
Infant intubated for respiratory failure receiving a morphine infusion for 6 days
(Opiate withdrawal should be suspected in any child who has received opioids for a minimum
of 3 days. After 5 days, approximately 50% of children are expected to experience some
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withdrawal symptoms. When opiates are administered for >10 days, withdrawal should be
expected in 100% of patients)
Following an episode of gastroenteritis, a child is diagnosed with reactive inflammatory arthritis
that is affecting joints in the lower extremities. To maximize return to the previous level of
mobility, the treatment plan should include:
A. Weight-bearing exercise plan
B. Administration of corticosteroids
C. PT & OT
D. Calcium & vitamin D supplementation - (ANSWERS)C. PT & OT
(Maintain joint range of motion and strength of associated muscle groups, to decrease pain,
and to prevent contractures and deformities, all of which maximize the potential to return to
the previous level of activity).
Which of the following is the MOST likely presentation of behavioral and psychiatric disorders
in a preschooler?
A. Fear of the dark
B. Issues with identity formation
C. Learning disabilities
D. Frequent temper tantrums - (ANSWERS)D. Frequent temper tantrums
Routine preventive healthcare for an infant with sickle cell disease includes
A. The MMR vaccine at 6 months of age
B. Penicillin prophylaxis until 5 years of age
C. Pneumococcal polysaccharide vaccine at 6 months of age
D. Sulfamethoxazole-trimethoprim prophylaxis until 5 years of age - (ANSWERS)B. Penicillin
prophylaxis until 5 years of age
Which of the following exam findings in a child are MOST consistent with a diagnosis of Stage
III hepatic encephalopathy?
A. Periodic lethargy, mood swings, incontinence & hyperreflexia
B. Drowsiness, confusion, agitation, & incontinence
C. Asterixis, agitation, response limited to noxious stimuli, areflexia
D. Confusion, arousable from stupor, asterixis, hyperreflexia - (ANSWERS)D. Confusion,
arousable from stupor, asterixis, hyperreflexia
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In a child with myasthenia gravis, which of the following symptoms would be MOST indicative
of a myasthenic crisis?
A. Eye drooling
B. Respiratory distress
C. Excessive salivation
D. Muscle fasciculation - (ANSWERS)B. Respiratory distress
(Characterized by weakness and fatigue of skeletal muscle tissue that results from
autoimmune destruction of acetylcholine receptors (achr). A crisis event, or myasthenic crisis,
is an acute exacerbation of the disease process that results in severe weakness from
dysfunction of the neuromuscular junctions. It is characterized by respiratory failure due to
weakness of the airway or respiratory muscles.
A cholinergic crisis, is a severe weakness caused by overtreatment with cholinergic
medications used to treat MG & crisis present with excessive salivation, excessive lacrimation,
diarrhea, sweating, pupillary constriction, and muscle fasciculation.
A child with a history of congenital heart disease fell while playing and presents with a closed
fracture of the humerus. Physical exam reveals mild bradycardia and a moderate pain score.
Which of the following medications would MOST likely explain this child's bradycardia?
A. Enalapril (Vasotec)
B. Furosemide (Lasix)
C. Levothyroxine (Synthroid)
D. Propranolol (Inderal) - (ANSWERS)D. Propranolol (Inderal)
(Decreases heart rate, myocardial contractility, blood pressure, and myocardial oxygen
demand. Adverse effects include bradycardia, hypotension, and atrioventricular conduction
disturbances)
Enteral nutrition is initiated in a child with severe malnutrition. Laboratory values indicative of
refeeding syndrome include a magnesium level of 1.5 mg/dl, and:
A. Phosphate 3.0 ml/dl & potassium 2.8 meq/L
B. Phosphate 3.0 ml/dl & potassium 6 meq/L
C. Phosphate 7.0 ml/dl & potassium 2.8 meq/L
D. Phosphate 7.0 ml/dl & potassium 6 meq/L - (ANSWERS)A. Phosphate 3.0 ml/dl & potassium
2.8 meq/L
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(Refeeding syndrome occurs when malnourished patients are refed too aggressively leading. It
can occur within 1-3 days after reinstitution of nutrition.
The major manifestations include fluid overload, hypophosphatemia (phosphate less than 3.5
mg/dl), hypokalemia (potassium less than 3.5 meq/L), hypomagnesemia (magnesium less than
1.8 mg/dl), and thiamine deficiency. Complications include heart failure, dysrhythmias,
respiratory muscle weakness, seizures,
When informing a family that a report is being made to Child Protective Services for suspected
abuse, it is MOST important to
A. Focus on the child's well being
B. Identify the suspected perpetrator
C. Identify legal requirements for mandatory reporting
D. Share details with family to avoid misunderstanding - (ANSWERS)A. Focus on the child's well
being
Manifestations of abdominal injuries secondary to a blast mechanism are typically:
A. Acute & immediately apparent
B. Observed less than 6 hours after exposure
C. Delayed 8-36 hours after exposure
D. Chronic & slow to develop - (ANSWERS)C. Delayed 8-36 hours after exposure
(Blast attack, as seen in explosions, causes extensive compression and distortion of the
gastrointestinal (GI) tract & other air-filled organs. Manifestations generally delayed, presenting
8-36 hours after exposure.)
A previously healthy preschooler who is fully immunized, presents with a history of fever, URI
symptoms, & joint pain over the past several days. Physical exam reveals petechiae and
hepatosplenomegaly. Vital signs include HR 156, RR 32, temp 101.6 (38.7), BP 86/44 & O2 98%
on RA. Lab results include Na+ 132, K+ 6, Glucose 100, Ca+ 0.95, Phos 6.3, WBC 105,000, Hgb
6.1 & Plt 10,000. Which is the BEST course of action?
A. Obtain LFTS & type & cross for blood products
B. Administer calcium gluconate & consult nephrology
C. Obtain blood cultures & administer IV Ceftriaxone
D. Administer a fluid bolus & consult oncology - (ANSWERS)D. Administer a fluid bolus &
consult oncology
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(The combination of leukocytosis, thrombocytopenia, and anemia should raise red flags for an
oncologic process, most likely leukemia. After initial laboratory values are obtained, the child
should receive aggressive hydration.)
An adolescent presents with bilateral knee pain that has occurred for several months,
exacerbated with activities such as climbing stairs and running. Pain is also worsened by sitting
with the knees flexed for an extended time and is described as a grinding sensation under the
kneecaps. No joint swelling is noted on examination. The MOST likely diagnosis is:
A. Osgood-Schlatter disease
B. Osteochondritis dissecans
C. Patellofemoral pain syndrome
D. Popliteal cyst (Baker's cyst) - (ANSWERS)C. Patellofemoral pain syndrome
(Type of idiopathic anterior knee pain, common in adolescents. This type of knee pain worsens
with activity, especially going up and down stairs, and when sitting in one position for a
prolonged period of time. Treatment involves an exercise program focusing on hip girdle and
vastus medialis strengthening with lower extremity flexibility)
A toddler presents with vomiting and altered mental status after an ingestion of a large amount
of aspirin about 45 minutes ago. Prior to the administration of activated charcoal, the PRIORITY
is to:
A. Obtain a urine drug screen
B. Ensure IV access
C. Obtain and EKG
D. Ensure adequate airway protection - (ANSWERS)D. Ensure adequate airway protection
Which of the following children is MOST at risk for opiate withdrawal?
A. Infant intubated for respiratory failure receiving Dexmedetomidine (Precedex) infusion for 5
days
B. Infant intubated for respiratory failure receiving a morphine infusion for 6 days
C. Adolescent post-posterior spinal fusion receiving hydromorphone via PCA for 3 days
D. Adolescent post-cardiac surgery receiving PO oxycodone PRN for 2 days - (ANSWERS)B.
Infant intubated for respiratory failure receiving a morphine infusion for 6 days
(Opiate withdrawal should be suspected in any child who has received opioids for a minimum
of 3 days. After 5 days, approximately 50% of children are expected to experience some
, PNCB Acute Care | Questions and Answers (100%
CORRECT ANSWERS) ALREADY GRADED A+ |
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solutions | Latest Update,
withdrawal symptoms. When opiates are administered for >10 days, withdrawal should be
expected in 100% of patients)
Following an episode of gastroenteritis, a child is diagnosed with reactive inflammatory arthritis
that is affecting joints in the lower extremities. To maximize return to the previous level of
mobility, the treatment plan should include:
A. Weight-bearing exercise plan
B. Administration of corticosteroids
C. PT & OT
D. Calcium & vitamin D supplementation - (ANSWERS)C. PT & OT
(Maintain joint range of motion and strength of associated muscle groups, to decrease pain,
and to prevent contractures and deformities, all of which maximize the potential to return to
the previous level of activity).
Which of the following is the MOST likely presentation of behavioral and psychiatric disorders
in a preschooler?
A. Fear of the dark
B. Issues with identity formation
C. Learning disabilities
D. Frequent temper tantrums - (ANSWERS)D. Frequent temper tantrums
Routine preventive healthcare for an infant with sickle cell disease includes
A. The MMR vaccine at 6 months of age
B. Penicillin prophylaxis until 5 years of age
C. Pneumococcal polysaccharide vaccine at 6 months of age
D. Sulfamethoxazole-trimethoprim prophylaxis until 5 years of age - (ANSWERS)B. Penicillin
prophylaxis until 5 years of age
Which of the following exam findings in a child are MOST consistent with a diagnosis of Stage
III hepatic encephalopathy?
A. Periodic lethargy, mood swings, incontinence & hyperreflexia
B. Drowsiness, confusion, agitation, & incontinence
C. Asterixis, agitation, response limited to noxious stimuli, areflexia
D. Confusion, arousable from stupor, asterixis, hyperreflexia - (ANSWERS)D. Confusion,
arousable from stupor, asterixis, hyperreflexia
