Lipincott PNCB-AC - Part 2 Exam 2026
Questions and Answers
In addition to irritability, sweating, and difficulty with feeding, the symptom that is
usually the first indication of congestive heart failure in a 3-week-old infant is:
a. Tachycardia
b. Cough
c. Jugular venous distention
d. Periorbital edema - Correct answer-A - Congestive heart failure (CHF) in an
infant is most commonly caused by unrepaired or partially repaired congenital
heart disease. Clinical findings of CHF can include hypotension cool extremities,
diaphoresis during feeding/activity, hepatomegaly, and jugular venous distention.
The first manifestation of CHF is usually tachycardia.
An 18-month-old child is noted to assume a squatting position frequently during
playtime with occasional episodes of perioral cyanosis during these episodes. The
most likely underlying etiology is:
a. Cardiomyopathy
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,b. Anomalous Left Coronary Artery
c. Tetralogy of Fallot
d. Ventricular Septal Defect - Correct answer-C - Tetralogy of Fallot (TOF) is a
combination of four characteristic findings which include a ventricular septal
defect, right ventricular outflow tract obstruction, overriding aorta and right
ventricular hypertrophy. A hypercyanotic episode (TET spell) can be triggered by
any event that decreases oxygen saturation (stooling, crying) or suddenly reduces
systemic vascular resistance, resulting in an increase in right to left shunting
through the VSD. When this happens, less blood flow is going to the lungs and
more desaturated blood is circulating to the body. Hypercyanotic episodes are
characterized by significant periods of decreased arterial saturation, and associated
cyanosis. Children with TOF may assume a squatting position during
hypercyanotic episodes resulting in increased peripheral vascular resistance, a
reduction in right to left shunting, and increased pulmonary blood flow. Medical
management of TET spells begins with placing the infant/child in the knee-chest
position to reduce systemic venous return and increase systemic vascular
resistance. Other therapies may be needed including oxygen, morphine, and
phenylephrine. Surgical repair or medical management will assist in resolving
these spells.
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,In children with the diagnosis of Transposition of the Great Arteries (d-TGA), the
hematocrit is high because of:
a. The associated anomaly of the coronary arteries
b. Frequently needed blood transfusions
c. Chronic hypoxia
d. Hemolysis - Correct answer-C - Children with d-TGA essentially have parallel
circulation circuits resulting in recirculation of deoxygenated blood. The amount of
deoxygenation will depend on the presence and size of an associated ventricular
septal defect or patent ductus arteriosus. In chronically cyanotic patients, the body
produces more hemoglobin to increase the oxygen-carrying capacity, resulting in
elevated hemoglobin and hematocrit or polycythemia.
A 2-year-old has a heart murmur noted during hospitalization for gastroenteritis
and dehydration. Admission laboratory results include a serum sodium 130 mEq/L,
Potassium 3.2 mEq/L, BUN 28 mg/dL, creatinine 0.8 mg/dL, hemoglobin is 7.6
g/dL and hematocrit of 25.3%. What is the most likely cause of murmur?
a. Anemia
b. Hyponatremia
c. Congenital heart disease
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, d. Innocent (still's) murmur - Correct answer-A - Tachycardia caused by anemia
can contribute to the temporary occurrence of a heart murmur. In anemia, the blood
is comprised of a lower viscosity. That coupled with tachycardia can increase the
velocity of the blood flow through the heart resulting in an extra heart sound or
murmur.
A 16-year-old presents with low grade fever, abdominal pain, nausea and vomiting
with anorexia which has been present for the past 5 days. He appears mildly
dehydrated and ill. Physical examination includes a mildly distended abdomen,
diminished bowel sounds, and mild pain on abdominal palpation. The most
appropriate initial laboratory studies to obtain include:
a. CMP, CBC with differential H. pylori antigen
b. Celiac panel, amylase, lipase, blood culture
c. CBC with differential, C-reactive protein, amylase, lipase, and CMP
d. Blood culture, celiac panel, CRP, H. pylori antigen - Correct answer-C - Acute
pancreatitis is associated with acute abdominal pain along with an elevation in
pancreatic enzymes; amylase and lipase. Symptoms include persistent fever,
abdominal pain, nausea, vomiting, and anorexia. Physical examination can include
abdominal distention, diminished bowel sounds, and pain on abdominal palpation.
Markers of pancreatitis are elevated amylase and lipase levels and may include
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Questions and Answers
In addition to irritability, sweating, and difficulty with feeding, the symptom that is
usually the first indication of congestive heart failure in a 3-week-old infant is:
a. Tachycardia
b. Cough
c. Jugular venous distention
d. Periorbital edema - Correct answer-A - Congestive heart failure (CHF) in an
infant is most commonly caused by unrepaired or partially repaired congenital
heart disease. Clinical findings of CHF can include hypotension cool extremities,
diaphoresis during feeding/activity, hepatomegaly, and jugular venous distention.
The first manifestation of CHF is usually tachycardia.
An 18-month-old child is noted to assume a squatting position frequently during
playtime with occasional episodes of perioral cyanosis during these episodes. The
most likely underlying etiology is:
a. Cardiomyopathy
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,b. Anomalous Left Coronary Artery
c. Tetralogy of Fallot
d. Ventricular Septal Defect - Correct answer-C - Tetralogy of Fallot (TOF) is a
combination of four characteristic findings which include a ventricular septal
defect, right ventricular outflow tract obstruction, overriding aorta and right
ventricular hypertrophy. A hypercyanotic episode (TET spell) can be triggered by
any event that decreases oxygen saturation (stooling, crying) or suddenly reduces
systemic vascular resistance, resulting in an increase in right to left shunting
through the VSD. When this happens, less blood flow is going to the lungs and
more desaturated blood is circulating to the body. Hypercyanotic episodes are
characterized by significant periods of decreased arterial saturation, and associated
cyanosis. Children with TOF may assume a squatting position during
hypercyanotic episodes resulting in increased peripheral vascular resistance, a
reduction in right to left shunting, and increased pulmonary blood flow. Medical
management of TET spells begins with placing the infant/child in the knee-chest
position to reduce systemic venous return and increase systemic vascular
resistance. Other therapies may be needed including oxygen, morphine, and
phenylephrine. Surgical repair or medical management will assist in resolving
these spells.
©C0PYRIGHT 2025, ALL RIGHTS RESERVED 2
,In children with the diagnosis of Transposition of the Great Arteries (d-TGA), the
hematocrit is high because of:
a. The associated anomaly of the coronary arteries
b. Frequently needed blood transfusions
c. Chronic hypoxia
d. Hemolysis - Correct answer-C - Children with d-TGA essentially have parallel
circulation circuits resulting in recirculation of deoxygenated blood. The amount of
deoxygenation will depend on the presence and size of an associated ventricular
septal defect or patent ductus arteriosus. In chronically cyanotic patients, the body
produces more hemoglobin to increase the oxygen-carrying capacity, resulting in
elevated hemoglobin and hematocrit or polycythemia.
A 2-year-old has a heart murmur noted during hospitalization for gastroenteritis
and dehydration. Admission laboratory results include a serum sodium 130 mEq/L,
Potassium 3.2 mEq/L, BUN 28 mg/dL, creatinine 0.8 mg/dL, hemoglobin is 7.6
g/dL and hematocrit of 25.3%. What is the most likely cause of murmur?
a. Anemia
b. Hyponatremia
c. Congenital heart disease
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, d. Innocent (still's) murmur - Correct answer-A - Tachycardia caused by anemia
can contribute to the temporary occurrence of a heart murmur. In anemia, the blood
is comprised of a lower viscosity. That coupled with tachycardia can increase the
velocity of the blood flow through the heart resulting in an extra heart sound or
murmur.
A 16-year-old presents with low grade fever, abdominal pain, nausea and vomiting
with anorexia which has been present for the past 5 days. He appears mildly
dehydrated and ill. Physical examination includes a mildly distended abdomen,
diminished bowel sounds, and mild pain on abdominal palpation. The most
appropriate initial laboratory studies to obtain include:
a. CMP, CBC with differential H. pylori antigen
b. Celiac panel, amylase, lipase, blood culture
c. CBC with differential, C-reactive protein, amylase, lipase, and CMP
d. Blood culture, celiac panel, CRP, H. pylori antigen - Correct answer-C - Acute
pancreatitis is associated with acute abdominal pain along with an elevation in
pancreatic enzymes; amylase and lipase. Symptoms include persistent fever,
abdominal pain, nausea, vomiting, and anorexia. Physical examination can include
abdominal distention, diminished bowel sounds, and pain on abdominal palpation.
Markers of pancreatitis are elevated amylase and lipase levels and may include
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