PNCB Acute Care questions Latest Update -

PNCB Acute Care questions Latest Update -

150 Questions and Verified Correct Answers Golden Ticket to Guaranteed A+ Verified by Professor

A 10 month old is evaluated for a cough, conjunctivitis, and a rash. Physical examination reveals coryza, greyish-white spots on the posterior buccal mucosa, a generalized, macular, erythematous rash, and no cervical lymphadenopathy or changes

to the peripheral extremities are noted. The MOST LIKELY etiology is:

• Kawasaki disease
• Measles
• Parvovirus B19

D. Roseola - CORRECT ANSWER: B. Measles

Measles is a highly contagious viral illness which presents with cough, coryza, conjunctivitis, and greyish-white spots on the posterior buccal mucosa, known as Koplik spots.Kawasaki diseasepresents with 4-5 days of fever and at least 4 of the following 5 signs

or symptoms: nonsuppurative conjunctivitis, mucous membrane changes, peripheral

extremity changes, polymorphous rash, or cervical lymphadenopathy.The human parvovirus B19 frequently manifests with a distinct facial rash that appears as a "slapped cheek", contrasted by a paler area around the mouth. Also known as erythema infectiosum (EI) or fifth disease, it typically includes a pruritic rash that extends from the trunk, buttocks, and extremities with a lace-like appearance, which can fluctuate in intensity responding to environmental changes such as temperature.Roseola, caused by human herpesvirus-6 (HHV-6), includes clinical manifestations of an erythematous maculopapular rash that typically appears once the fever resolves.Occipital and cervical lymphadenopathy is characteristic with acute infection, which may also include high fevers, and respiratory and gastrointestinal symptoms. Due to decreasing maternal antibodies, infections with HHV-6 are prevalent in children between

• and 24 months of age.
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A 13-month-old female with a history of developmental delay and hypotonia presents with new onset seizures, with the following measurements obtained during assessment: weight 18.7 lb (8.5 kg), length 28.3 inches (72 cm) - both in 25 %ile for age , head circumference 14.75 inches (40 cm). Her head circumference is below the 2 %ile After achieving control of seizures, which diagnostic testing should be performed

FIRST?

• Brain MRI
• Head CT
• Skeletal survey

D. Skull series - CORRECT ANSWER: A. Brain MRI

Imaging by MRI for microcephaly provides more structural information than CT without the radiation exposure, and identifies abnormalities including lissencephaly, pachygyria, and polymicrogyria. CT is most useful in evaluating for presence of calcifications, which are associated with congenital viral infections, Sturge-Weber syndrome, tuberous sclerosis, and intracranial lipoma in newborns, and with some vascular and neoplastic conditions in older children.

A 16 month old with Trisomy 21 presents with a 4 day history of low grade fever, pallor and decreased activity. Laboratory values reveal hgb 5.2, hct 14%, plt 43,000, reticulocyte count 2.2%, pt 13 sec, ptt 33 sec & wbc 1,700 Which is the MOST likely diagnosis?

• Bacterial sepsis
• Fanconi anemia
• Hemolytic uremic syndrome (HUS)

D. Leukemia - CORRECT ANSWER: D. Leukemia

Children with Trisomy 21 have a higher incidence of developing leukemia, most often occurring in the early years of life. This predisposition for developing leukemia is thought to be related to the abnormal genetic karyotype. Clinical findings of leukemia include persistent fevers, anemia, thrombocytopenia and either hyperleukocytosis or leukopenia.

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A 16 year old presents with a 6-hour history of migraine headache unresponsive to ibuprofen. With a normal initial physical exam, which of the following is the MOST appropriate next step?

• obtain EEG
• obtain neuroimaging
• administer sumatriptan

D. administer topiramate - CORRECT ANSWER: C. administer sumatriptan

Goals of migraine treatment are to abort the migraine pain with as minimal side effects as possible. Multiple medications are used in treatment of pediatric and adolescent migraine; few have significant data and fewer have FDA approval.First-line treatment is typically NSAIDs and acetaminophen; if these are ineffective, triptans are commonly employed. Triptans with FDA-approval in pediatric patients include: almotriptan (ages 12 years and older), rizatriptan (Maxalt) (in children and adolescents 6-17 years of age), sumatriptan (ages 12 years and older), and zolmitriptan (ages 12 years and older). With sumatriptan demonstrating the best pain relief in the studies. Rizatriptan is the only medication approved for children under 12 years of age.Topiramate (Topamax) is used off-label as a prophylactic agent and would not be effective for acute treatment. Neither neuroimaging nor EEG is indicated in this child with a normal physical exam.

A 2 day old with dysmorphic features is diagnosed with an interrupted aortic arch.Evaluation for which of the following is indicated?

• Coagulation defects
• Immune dysfunction
• Intestinal atresia

D. Pulmonary sequestration - CORRECT ANSWER: B. Immune dysfunction

DiGeorge syndrome is associated with deletions in the 22Q11.2 chromosome. The phenotype typically includes cardiac outflow tract abnormalities, dysmorphic features, cleft palate, and aplasia or hypoplasia of the thymus and parathyroid. The cardiac abnormality most strongly associated with DiGeorge syndrome is an interrupted aortic arch. Thymic aplasia or hypoplasia may produce immune dysfunction that requires the aggressive management of infections. 3 / 4

Administration of live vaccines is contraindicated. Seizures secondary to hypocalcemia may occur in the newborn period and typically resolve in the first year.Dysmorphic features associated with intestinal atresia occur most commonly in trisomy 21.Dysmorphic features occur in conjunction with coagulopathy in genetic disorders of the metabolic process of glycosylation. Pulmonary sequestrations are most often intrapulmonary lesions, but may also be extrapulmonary.

A 2 month old with an infantile hemangioma around the left eye is being evaluated for propranolol therapy. Which of the following findings would be considered a potential

CONTRAINDICATION?

• prematurity
• hypertension
• sinus bradycardia

D. family history of diabetes - CORRECT ANSWER: C. sinus bradycardia

Propranolol is a beta-adrenergic blocker currently being used for the treatment of infantile hemangioma (IH). The exact mechanism of action for propranolol on IH is not well understood, but hypothesized mechanisms include vasoconstriction, decreased renin production, inhibition of angiogenesis, and stimulation of apoptosis.Propranolol has both the negative chronotropic and inotropic cardiac effects resulting in decreased heart rate and blood pressure. Due to the negative chronotropic effects, children with documented bradycardia are not candidates for treatment with propranolol.

A 2 year old with previously undiagnosed, uncomplicated coarctation of the aorta has normal growth and development. The stenosis is located just distal to the left subclavian artery. Medical management includes

• diuretics to control pulmonary venous congestion.
• serial cardiac catheterizations for anatomic assessment.
• monitoring upper extremity blood pressures for hypertension.
• activity restriction based on echocardiograph assessment of left ventricular

hypertrophy. - CORRECT ANSWER: C. monitoring upper extremity blood pressures for hypertension.

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