Pediatric Primary Care PNCB 1, Exam Questions & Answers

Pediatric Primary Care PNCB 1, Exam Questions & Answers
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. - 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) - 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 - 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 needed
as part of a thorough work-up of non-accidental trauma, but the skull would 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 transitioning health care for an adolescent with special
needs or chronic illness is
finding an adult health care provider for transition.
resistance of the family and adolescent to transition of care.
lack of health care provider time to plan for transition of care.
difficulty in talking with patients about transitioning care. - finding an adult health care provider
for transition.
Finding an adult health care provider, one who is qualified to care for young adults 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 health care providers, and adult
internists. Transitioning of care requires time and communication with the parents and
adolescents involved. Many families may be hesitant to leave the nurturing environment of
pediatric care, and may perceive differences in adult practices as a difficult adjustment. Internists
may lack the training and qualifications to address many of the complicated health care needs of
adolescents with chronic illnesses. Because of the delicate nature of such conversations, some
pediatric providers may not be comfortable in dealing with the complexities of transitioning care.

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