CPNP-PCClinical categories 3 and 4 of 21, by item volume
Pediatric ENT and allergy
Facts read from pncb.org and 1 more · last checked Nov 7, 2026
Allergy and immunology and otolaryngology rank third and fourth among PNCB's categories. Together they cover the most common sick visit in pediatrics, the ear, along with the throat, the nose, and allergic disease from rhinitis to anaphylaxis.
Practice questions
60 questions written to the CPNP-PC outline; each choice is explained once you pick.
Throat and mouth: strep pharyngitis and viral look-alikes, tonsils and sleep-disordered breathing.
Nose and sinuses: allergic rhinitis, sinusitis, epistaxis, foreign bodies.
Allergy and immunology: food allergy, anaphylaxis, drug allergy labels, recurrent infections.
Eyes: red eye, alignment and vision screening, which PNCB lists as its own small category.
2
15 ENT and allergy questions
0 / 15 answered15 questions
Tap an option: why each one is right or wrong appears under it.
Pediatric ENT and allergy
A 3-year-old has a 3-cm tender, warm, fluctuant anterior cervical node despite 4 days of oral cephalexin. Neck movement is full, and there is no drooling or stridor. Which imaging study is MOST appropriate?
MRI usually needs sedation in a 3-year-old and adds nothing over ultrasound for a superficial node.
Contrast CT is for suspected deep neck infection, such as a retropharyngeal abscess with neck stiffness, drooling, or stridor, none of which is present.
A tender, warm, fluctuant node that has not improved on oral cephalexin suggests suppurative lymphadenitis with abscess; ultrasound confirms a drainable collection without radiation or sedation.
A lateral film can show prevertebral widening in retropharyngeal infection but cannot show a fluid collection in a superficial node.
A 20-month-old has had mild right ear pain for 24 hours and a temperature of 38.3 °C. The right tympanic membrane is bulging with an effusion; the left is normal. After discussion, the parents prefer to avoid antibiotics and can return. Which is MOST appropriate?
Unilateral AOM at 6 to 23 months with mild pain for under 48 hours and a temperature below 39 °C is non-severe, so the AAP allows shared-decision observation with pain control and a plan to start antibiotics if there is no improvement in 48 to 72 hours.
If an antibiotic is chosen for a child under 2, it is high-dose amoxicillin, 80 to 90 mg/kg/day, for 10 days; 45 mg/kg/day for 5 days is underdosed and too short.
Topical quinolone drops treat otorrhea through tubes or a perforation; they do not reach the middle ear behind an intact drum.
Amoxicillin-clavulanate is first line only after amoxicillin in the past 30 days, with conjunctivitis-otitis, or a history of amoxicillin failure, none of which applies.
A 9-year-old has anterior nosebleeds 2–3 times a week this winter that stop with pressure. Exam shows prominent vessels and crusting on the anterior septum. There is no other bleeding history. Which is the MOST appropriate management?
A topical decongestant can stop an active bleed, but daily use for weeks causes rebound congestion.
Cautery is for bleeds that recur despite local care, and treating both sides of the septum at once risks septal perforation.
Bleeding tests are for nosebleeds with bleeding elsewhere, a family history, or bleeds that do not stop with pressure; none is present.
Recurrent anterior nosebleeds from dry, crusted vessels on the front of the septum in winter respond first to humidifying the mucosa with saline and a bland ointment.
A 4-year-old has a wad of tissue paper visible in the right ear canal. The tympanic membrane cannot be seen, and the child is cooperative. Which removal method is MOST appropriate?
A swab pushes the object deeper and can injure the canal or eardrum.
A soft, graspable object such as tissue paper in a cooperative child is removed with alligator forceps under direct vision; paper soaks up water and swells, so irrigation is avoided.
Irrigation suits small hard objects when the eardrum is known to be intact; here paper would swell and the drum cannot be seen.
Mineral oil is used to kill a live insect before removal; it does nothing for paper and the irrigation step has the same swelling problem.
A healthy term newborn has an isolated skin tag in front of the right ear. The rest of the exam is normal, the newborn hearing screen was passed, and there is no family history of deafness or renal disease. Which is the MOST appropriate plan?
An isolated minor ear anomaly does not raise the risk of heart disease enough to justify an echocardiogram.
An isolated preauricular tag in an otherwise normal term newborn who passed the hearing screen, with no family history of deafness or kidney anomalies, needs no further testing.
Genetic testing is for multiple anomalies or dysmorphic features, not a single skin tag in a well infant.
Kidney imaging is for an ear tag that comes with other malformations, dysmorphic features, a family history of deafness or ear anomalies, or maternal diabetes, none of which applies.
Before prescribing carbamide peroxide drops for cerumen impaction in a 3-year-old, which history is a contraindication?
Regular swimming raises the risk of otitis externa but is not a contraindication to cerumenolytics.
A past ear infection that has resolved leaves an intact drum and does not limit softening drops.
Cerumenolytic drops are contraindicated when the eardrum is not intact, including a perforation or tympanostomy tubes, because they can enter the middle ear.
Facial eczema does not involve the ear canal and is not a reason to avoid drops.
A 7-year-old has year-round nasal congestion. Skin testing is positive only to dust mite. Which environmental measure is MOST appropriate?
Closing windows helps pollen allergy, and this child's testing shows no pollen sensitization and year-round symptoms.
Rehoming a pet only helps a child sensitized to that animal, and skin testing was negative except for mite.
For a child sensitized only to dust mite, impermeable mattress and pillow covers with hot-water washing of bedding target the allergen that drives the symptoms.
Higher humidity helps dust mites thrive, so a humidifier worsens exposure.
A 4-year-old has had bilateral otitis media with effusion for 4 months. Audiometry shows a 30-dB conductive hearing loss, and the parents report unclear speech. Which is MOST appropriate?
Antibiotics do not resolve effusion without acute infection and add adverse effects and resistance.
Further watchful waiting fits effusion without hearing loss or developmental risk; with a 30-dB loss and unclear speech it delays treatment.
Intranasal steroids do not clear middle ear effusion and are not recommended for it.
Bilateral effusion for 3 months or longer with documented hearing loss and speech concerns meets the indication to offer tympanostomy tubes.
Which objective hearing screen can be performed in primary care for an uncooperative 18-month-old?
Tympanometry measures eardrum and middle ear mobility; it detects effusion but does not test hearing.
Pure-tone screening needs a child who can raise a hand to tones, usually from about 4 years.
OAE testing needs no behavioral response from the child, so it is the objective screen that works in a toddler who will not cooperate.
Play audiometry needs a child of roughly 2 to 4 years who can learn a listening game, so it is behavioral, not objective, and too advanced for this toddler.
A 3-year-old boy has had pneumonia twice and recurrent otitis since age 8 months. Tonsils are barely visible. IgG, IgA, and IgM are all markedly low, and CD19 B cells are absent. The MOST LIKELY diagnosis is:
Transient hypogammaglobulinemia of infancy has normal B-cell numbers and improves by preschool age.
Selective IgA deficiency leaves IgG and IgM normal and B cells present; many children have few infections.
CVID usually appears later in childhood or adulthood and B cells are present, though they fail to make antibody.
Bacterial infections beginning after maternal antibody wanes, tiny tonsils, very low IgG, IgA, and IgM, and absent B cells in a boy point to X-linked agammaglobulinemia.
A 6-year-old has had nasal congestion, cloudy nasal discharge, and daytime cough for 12 days with no improvement. The child is afebrile and well-appearing. The MOST LIKELY diagnosis is:
Nasal discharge or daytime cough lasting more than 10 days without improvement meets the AAP persistent-symptoms criterion for acute bacterial sinusitis; imaging is not needed.
Viral colds usually start to improve by days 7 to 10; no improvement after 10 days is the threshold that separates bacterial sinusitis, regardless of discharge color.
A nasal foreign body causes one-sided, foul-smelling discharge, not bilateral congestion with cough.
Allergic rhinitis brings clear discharge with sneezing and itching, often seasonal, rather than a cloudy discharge and cough after a cold.
Parents report that their 6-month-old looks cross-eyed. The infant has a wide, flat nasal bridge. Corneal light reflexes are symmetric, and the cover-uncover test shows no refixation movement. The MOST LIKELY diagnosis is:
A broad, flat nasal bridge and epicanthal folds hide the inner whites of the eyes; symmetric light reflexes and no refixation on cover testing confirm pseudostrabismus.
Accommodative esotropia usually appears at 2 to 3 years with farsightedness and is a true deviation on cover testing.
True infantile esotropia shows displaced corneal reflexes and a refixation movement when the fixing eye is covered.
Sixth nerve palsy limits abduction and gives an esotropia that worsens looking to the affected side, with an abnormal cover test.
A 7-year-old had hives 20 minutes after eating shrimp, with no respiratory, gastrointestinal, or circulatory symptoms; it resolved with cetirizine. Which plan is MOST appropriate?
Avoidance is part of the plan, but without epinephrine, an action plan, and confirmation by an allergist the child is unprotected at the next exposure.
Hives within minutes of eating shrimp suggest an IgE-mediated food allergy, and the next reaction can be more severe; the child needs an epinephrine auto-injector, an emergency plan, and allergist referral.
Broad IgE panels give many positives without true allergy and lead to needless avoidance; testing is targeted to the food in the history.
Steroids add nothing once hives have resolved and do not prevent the next reaction.
A 2-year-old in child care has fever, drooling, and poor intake. Small vesicles and ulcers are seen on the soft palate, uvula, and tonsillar pillars, and the gums and lips are normal. The MOST LIKELY diagnosis is:
Strep throat causes exudate or palatal petechiae rather than vesicles, and it is uncommon under 3 years.
Fever with small vesicles and ulcers confined to the soft palate, uvula, and tonsillar pillars in a toddler is enteroviral herpangina.
Aphthous ulcers occur on the lips, cheeks, and tongue without fever or vesicles.
Primary herpes affects the front of the mouth, with swollen, bleeding gums and lip lesions; normal gums and lips argue against it.
A 5-year-old snores loudly most nights with witnessed pauses in breathing, and the teacher reports hyperactivity. The tonsils are 3+. Which is the MOST appropriate next step?
Snoring alone can be benign, but witnessed pauses and daytime symptoms move it out of the reassurance category.
Waiting a year prolongs the cognitive, behavioral, and cardiovascular effects of untreated sleep apnea.
Starting a stimulant treats the behavior while untreated sleep apnea, a reversible cause of the hyperactivity, goes unaddressed.
Loud habitual snoring with witnessed apneas, enlarged tonsils, and daytime behavior problems suggests obstructive sleep apnea, which needs polysomnography or ENT evaluation for adenotonsillectomy.
A running total sits here; it fills in after your last pick.
3
Throat, ear and allergy traps
Testing a sore throat with a cough. The IDSA 2012 guideline advises no strep test when viral features such as cough, runny nose, hoarseness or oral ulcers are present, and no routine testing under age 3.
Trusting a negative rapid test in a child. In children and teens, a negative rapid antigen test is backed up with a throat culture (IDSA 2012).
Plain amoxicillin after a recent course. The AAP 2013 otitis guideline moves to amoxicillin-clavulanate when amoxicillin was taken in the past 30 days or there is purulent conjunctivitis.
Delaying peanut in a high-risk infant. NIAID 2017 guidance introduces peanut at 4 to 6 months in infants with severe eczema or egg allergy, after evaluation, and around 6 months with mild to moderate eczema.
Accepting every penicillin allergy label. Most children labeled allergic tolerate amoxicillin; a low-risk history such as a remote, benign rash can be delabeled with a supervised oral challenge.
An oral antihistamine as the main rhinitis drug. For persistent allergic rhinitis, a nasal steroid spray outperforms any other single medicine.
4
Eyes, a small category kept here
Ophthalmology is 17th of PNCB's 21 categories, too small for its own page, so its questions sit on this page and in the 60-question set. Expect red eye, alignment, the red reflex and age-matched vision screening. AAP policy allows instrument-based screening from 12 months to 3 years, with chart testing once a child can cooperate.
5
Where these topics continue
Hives and drug eruptions in the skin are on dermatology.
Croup, wheeze and pneumonia are airway, on respiratory.
Adult ear, nose and throat problems are family NP content and have no page here yet.