PNCB 1 Pediatric Primary Care Exam
Questions and Answers59
Which is the MOST APPROPRIATE management for a 14-year-old sexually active adolescent who
tests positive for Neisseria gonorrhea and Chlamydia trachomatis?
azithromycin, 1 g orally, single dose
ceftriaxone 250 mg IM, + azithromycin 1 g orally, single dose
ofloxacin 400 mg orally, single dose, to both the adolescent and partner
metronidazole 2 g, single dose and doxycycline 100 mg BID x 7 days - ANSWERS -ceftriaxone 250
mg IM, + azithromycin 1 g orally, single dose
Infection with N. gonorrhoeae is a major cause of pelvic inflammatory disease, ectopic
pregnancy and infertility, and can facilitate HIV transmission. To treat uncomplicated genital
gonorrheal infections, the most recent Centers for Disease Control and Prevention (CDC) update
recommends a single IM injection of ceftriaxone plus azithromycin or doxycycline in specific
doses. Because of a progressive rise in resistance to penicillin, tetracycline, and quinolones, the
CDC advises against using these antibiotic classes to treat gonorrhea. To treat trichomoniasis,
administer metronidazole (Flagyl) to both partners. Use a seven-day course of Flagyl to treat
bacterial vaginosis (BV).
,Parents complain that their child awakens crying and agitated during the last half of night sleep.
The child is awake and can be comforted. The parent denies other behaviors. This child is
experiencing:
sleep terrors
nightmares
somniloquy
sleep starts - ANSWERS -nightmares
Nightmares typically occur during rapid eye movement (REM) sleep in the latter half to one
third of the nighttime sleep cycle. In the event of a nightmare, the child is fully awake and
responds to parental or caregiver comforting measures. Night terrors or sleep terrors occur in
the first portion of sleep and are manifested by abrupt partial awakenings accompanied by a
blood curdling scream, characterized by intense autonomic symptoms such as pupillary dilation,
diaphoresis, and tachypnea. With sleep terrors the child cannot be fully aroused or comforted
by parental presence. Sleep starts and somniloquy are sleep-wake transition disorders typically
occurring during the time of transition from wakefulness to sleeping and vice versa. Sleeps
starts are characteristically sudden, muscular jerking of the arms and legs. Somniloquy or sleep
talking is common during childhood and associated with sleep terrors. Vocalizations and bodily
movements are rare with nightmares.
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. - ANSWERS -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?
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) - ANSWERS -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 - ANSWERS -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
Questions and Answers59
Which is the MOST APPROPRIATE management for a 14-year-old sexually active adolescent who
tests positive for Neisseria gonorrhea and Chlamydia trachomatis?
azithromycin, 1 g orally, single dose
ceftriaxone 250 mg IM, + azithromycin 1 g orally, single dose
ofloxacin 400 mg orally, single dose, to both the adolescent and partner
metronidazole 2 g, single dose and doxycycline 100 mg BID x 7 days - ANSWERS -ceftriaxone 250
mg IM, + azithromycin 1 g orally, single dose
Infection with N. gonorrhoeae is a major cause of pelvic inflammatory disease, ectopic
pregnancy and infertility, and can facilitate HIV transmission. To treat uncomplicated genital
gonorrheal infections, the most recent Centers for Disease Control and Prevention (CDC) update
recommends a single IM injection of ceftriaxone plus azithromycin or doxycycline in specific
doses. Because of a progressive rise in resistance to penicillin, tetracycline, and quinolones, the
CDC advises against using these antibiotic classes to treat gonorrhea. To treat trichomoniasis,
administer metronidazole (Flagyl) to both partners. Use a seven-day course of Flagyl to treat
bacterial vaginosis (BV).
,Parents complain that their child awakens crying and agitated during the last half of night sleep.
The child is awake and can be comforted. The parent denies other behaviors. This child is
experiencing:
sleep terrors
nightmares
somniloquy
sleep starts - ANSWERS -nightmares
Nightmares typically occur during rapid eye movement (REM) sleep in the latter half to one
third of the nighttime sleep cycle. In the event of a nightmare, the child is fully awake and
responds to parental or caregiver comforting measures. Night terrors or sleep terrors occur in
the first portion of sleep and are manifested by abrupt partial awakenings accompanied by a
blood curdling scream, characterized by intense autonomic symptoms such as pupillary dilation,
diaphoresis, and tachypnea. With sleep terrors the child cannot be fully aroused or comforted
by parental presence. Sleep starts and somniloquy are sleep-wake transition disorders typically
occurring during the time of transition from wakefulness to sleeping and vice versa. Sleeps
starts are characteristically sudden, muscular jerking of the arms and legs. Somniloquy or sleep
talking is common during childhood and associated with sleep terrors. Vocalizations and bodily
movements are rare with nightmares.
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. - ANSWERS -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?
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) - ANSWERS -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 - ANSWERS -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
