Science Medicine Pediatrics
Pediatric Primary Care PNCB 1
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2 year old with iron deficiency anemia
The child at highest risk for having an
elevated blood lead level is a:
3 month old exclusively breastfed infant
The amount of lead absorbed from the gut is increased in children with nutritional
6 month old who lives in a home built after deficiencies such as iron deficiency anemia (IDA). Iron deficiency anemia is often a
1970 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
2 year old with iron deficiency anemia 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
2 year old who is a picky eater supplemental iron are at increased risk of IDA. A child who is a picky eater may or
D. 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 25(OH)-D (cholecalciferol)
indicator of vitamin D deficiency?
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
1,25(OH)2-D (calcitriol) 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
PTH (parathyroid hormone) 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
25(OH)-D (cholecalciferol) of vitamin D deficiency.
, CT scan of the head
Posterior rib fractures associated with accidental trauma are rare. Posterior fractures
In a 2 month old with visible rib fractures
can be seen in infants who have been shaken as the perpetrator hands are typically
on radiograph, the NEXT most critical
wrapped around the infant's thorax during the shaking, with the vertebrae acting as a
evaluation to obtain is a:
fulcrum. These findings should alert the provider to consider shaken baby syndrome
(SBS). Subdural and subarachnoid hemorrhages are the most common acute
CT scan of the head
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
long bone series
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
coagulation profile
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
retinal ophthalmologic exam
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 finding an adult health care provider for transition.
transitioning health care for an adolescent
with special needs or chronic illness is
finding an adult health care provider for Finding an adult health care provider, one who is qualified to care for young adults
transition. 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
resistance of the family and adolescent to health care providers, and adult internists. Transitioning of care requires time and
transition of care. communication with the parents and adolescents involved. Many families may be
hesitant to leave the nurturing environment of pediatric care, and may perceive
lack of health care provider time to plan for differences in adult practices as a difficult adjustment. Internists may lack the training
transition of care. and qualifications to address many of the complicated health care needs of
adolescents with chronic illnesses. Because of the delicate nature of such
difficulty in talking with patients about conversations, some pediatric providers may not be comfortable in dealing with the
transitioning care. complexities of transitioning care.
elbow flexed with pronated forearm
A toddler is unable to use the right arm
normally after the caregiver pulled her arm
to prevent the child from falling. Which
finding would confirm the diagnosis of
Subluxation of the radial head, also called nursemaid's elbow, must be differentiated
subluxation of the radial head?
from a fracture prior to reducing the annular ligament of the elbow. Radiographic
examination is not necessary if the child's physical findings and history are consistent
severe swelling and bruising of the elbow
with subluxation. The typical presentation of this injury includes the following: age 2-
5 years; history of a longitudinal traction injury, possible "pop" and immediate pain,
elbow flexed with pronated forearm
inability to use the arm normally, and arm splinted against the side. On examination
the elbow appears normal, is flexed with a pronated forearm against the body, is
point tenderness at ulnar aspect of elbow
tender laterally over the radial head, and has limited flexion with no supination. If the
child fell on his/her elbow or there is no history of a traction injury, suspect a fracture
obvious deformity of the forearm
and order the appropriate radiograp
, Education for caregivers whose child has no identifying cause
sickle cell disease should include that the
majority of pain crises are triggered by
which of the following?
Sickle cell disease is a common genetic hematologic disorder. Pain is the most
no identifying cause common and disabling symptom of sickle cell disease. Environmental temperature
and second-hand smoke exposure have been studied as possible precipitating
temperature changes factors, but have not been supported by the research. Negative emotions can
facilitate the pain cycle. In general, pain episodes are erratic and unpredictable and
cigarette smoke exposure occur for various, unknown reasons.
stressful situations
frequent application of topical antibiotic.
Accidental abrasion of the corneal epithelium causes pain, tearing, and photophobia
A 5 year old complains of a painful left eye and is a common eye injury in children. An abrasion can be detected by examining
after being accidentally scratched by a the eye with a Wood's lamp after instillation of fluorescein dye. The one time use of a
sibling two hours ago. Fluorescein exam topical ophthalmic anesthetic may be useful in gaining cooperation for an adequate
shows a small central corneal abrasion. The eye exam. The goal of treatment is rapid healing of the abrasion. Until such healing
MOST appropriate management during the occurs, the eye should be protected from infection by the use of a topical
first 24 hours is ophthalmic antibiotic every 4-6 hours for a few days. The repeated use of a topical
anesthetic is not recommended, as these medications can cause corneal toxicity and
frequent application of topical antibiotic. inhibit the blinking reflex. Topical steroids are not recommended as they lower the
eye's resistance to infection. Oral acetaminophen or ibuprofen and intermittent cool
observation of the injured eye. compresses may manage discomfort. Narcotics are not recommended because of
frequent side effects.
frequent application of topical nonsteroidal
anti-inflammatory drops. The use of topical nonsteroidal anti-inflammatory drops is being studied in the
treatment of some sterile corneal abrasions, such as those acquired during laser
occlusive patching of the injured eye. treatment of refractive errors in adults, but are not recommended in management of
traumatic corneal abrasions in children. Patching is no longer recommended for
most corneal abrasions, as it does not reduce discomfort or speed healing and
makes instillation of antibiotic medication more difficult. Most corneal abrasions heal
steadily over the first 24-48 hours. Persistent or increasing pain or discomfort after
the first 24 hours indicates the need for further ophthalmologic evaluation.
Pediatric Primary Care PNCB 1
Save
Students also studied
Flashcard sets Study guides Practice tests
NICU Phase II Exam Neuro Exam 3 Nursing 4 Understanding Respiratory Syncytia... MVU N
Teacher 128 terms Teacher 228 terms Teacher 179 terms 43 terms
sinwar6 Preview xxxxxtencion Preview hush567 Preview felix
2 year old with iron deficiency anemia
The child at highest risk for having an
elevated blood lead level is a:
3 month old exclusively breastfed infant
The amount of lead absorbed from the gut is increased in children with nutritional
6 month old who lives in a home built after deficiencies such as iron deficiency anemia (IDA). Iron deficiency anemia is often a
1970 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
2 year old with iron deficiency anemia 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
2 year old who is a picky eater supplemental iron are at increased risk of IDA. A child who is a picky eater may or
D. 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 25(OH)-D (cholecalciferol)
indicator of vitamin D deficiency?
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
1,25(OH)2-D (calcitriol) 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
PTH (parathyroid hormone) 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
25(OH)-D (cholecalciferol) of vitamin D deficiency.
, CT scan of the head
Posterior rib fractures associated with accidental trauma are rare. Posterior fractures
In a 2 month old with visible rib fractures
can be seen in infants who have been shaken as the perpetrator hands are typically
on radiograph, the NEXT most critical
wrapped around the infant's thorax during the shaking, with the vertebrae acting as a
evaluation to obtain is a:
fulcrum. These findings should alert the provider to consider shaken baby syndrome
(SBS). Subdural and subarachnoid hemorrhages are the most common acute
CT scan of the head
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
long bone series
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
coagulation profile
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
retinal ophthalmologic exam
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 finding an adult health care provider for transition.
transitioning health care for an adolescent
with special needs or chronic illness is
finding an adult health care provider for Finding an adult health care provider, one who is qualified to care for young adults
transition. 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
resistance of the family and adolescent to health care providers, and adult internists. Transitioning of care requires time and
transition of care. communication with the parents and adolescents involved. Many families may be
hesitant to leave the nurturing environment of pediatric care, and may perceive
lack of health care provider time to plan for differences in adult practices as a difficult adjustment. Internists may lack the training
transition of care. and qualifications to address many of the complicated health care needs of
adolescents with chronic illnesses. Because of the delicate nature of such
difficulty in talking with patients about conversations, some pediatric providers may not be comfortable in dealing with the
transitioning care. complexities of transitioning care.
elbow flexed with pronated forearm
A toddler is unable to use the right arm
normally after the caregiver pulled her arm
to prevent the child from falling. Which
finding would confirm the diagnosis of
Subluxation of the radial head, also called nursemaid's elbow, must be differentiated
subluxation of the radial head?
from a fracture prior to reducing the annular ligament of the elbow. Radiographic
examination is not necessary if the child's physical findings and history are consistent
severe swelling and bruising of the elbow
with subluxation. The typical presentation of this injury includes the following: age 2-
5 years; history of a longitudinal traction injury, possible "pop" and immediate pain,
elbow flexed with pronated forearm
inability to use the arm normally, and arm splinted against the side. On examination
the elbow appears normal, is flexed with a pronated forearm against the body, is
point tenderness at ulnar aspect of elbow
tender laterally over the radial head, and has limited flexion with no supination. If the
child fell on his/her elbow or there is no history of a traction injury, suspect a fracture
obvious deformity of the forearm
and order the appropriate radiograp
, Education for caregivers whose child has no identifying cause
sickle cell disease should include that the
majority of pain crises are triggered by
which of the following?
Sickle cell disease is a common genetic hematologic disorder. Pain is the most
no identifying cause common and disabling symptom of sickle cell disease. Environmental temperature
and second-hand smoke exposure have been studied as possible precipitating
temperature changes factors, but have not been supported by the research. Negative emotions can
facilitate the pain cycle. In general, pain episodes are erratic and unpredictable and
cigarette smoke exposure occur for various, unknown reasons.
stressful situations
frequent application of topical antibiotic.
Accidental abrasion of the corneal epithelium causes pain, tearing, and photophobia
A 5 year old complains of a painful left eye and is a common eye injury in children. An abrasion can be detected by examining
after being accidentally scratched by a the eye with a Wood's lamp after instillation of fluorescein dye. The one time use of a
sibling two hours ago. Fluorescein exam topical ophthalmic anesthetic may be useful in gaining cooperation for an adequate
shows a small central corneal abrasion. The eye exam. The goal of treatment is rapid healing of the abrasion. Until such healing
MOST appropriate management during the occurs, the eye should be protected from infection by the use of a topical
first 24 hours is ophthalmic antibiotic every 4-6 hours for a few days. The repeated use of a topical
anesthetic is not recommended, as these medications can cause corneal toxicity and
frequent application of topical antibiotic. inhibit the blinking reflex. Topical steroids are not recommended as they lower the
eye's resistance to infection. Oral acetaminophen or ibuprofen and intermittent cool
observation of the injured eye. compresses may manage discomfort. Narcotics are not recommended because of
frequent side effects.
frequent application of topical nonsteroidal
anti-inflammatory drops. The use of topical nonsteroidal anti-inflammatory drops is being studied in the
treatment of some sterile corneal abrasions, such as those acquired during laser
occlusive patching of the injured eye. treatment of refractive errors in adults, but are not recommended in management of
traumatic corneal abrasions in children. Patching is no longer recommended for
most corneal abrasions, as it does not reduce discomfort or speed healing and
makes instillation of antibiotic medication more difficult. Most corneal abrasions heal
steadily over the first 24-48 hours. Persistent or increasing pain or discomfort after
the first 24 hours indicates the need for further ophthalmologic evaluation.
