Pedia-Board-Post-Test-2017-1.ppsx

Pediatric Board Review 2017:
Post Test
By:
Remedios C. Ong, MD
UST, Faculty of Medicine & Surgery
Department of Pediatrics

1. Social smile is usually first
observed at how many months of
age:
A. 1
B. 2
C. 3
D. 4
P

2. Repetitive consonant sounds like
“mama” or “dada” is usually first
observed at how many months?
A. 6
B. 9
C. 12
D. 15
P

3. Which is NOT a developmental
milestone in a 15-month old child?
A. Jargon language
B. Walking alone
C. Average of 10 words
D. Indicates need by pointing
P

4. At what age (in years) can a child
most likely be able to identify his
age and sex?
A. 1.5
B. 2
C. 2.5
D. 3 P

5. The 1st visible sign or
manifestation of puberty in females
(SMR2) is the appearance of:
A. Axillary hair
B. Pubic hair
C. Menarche
D. Breast budding
P

6. Peak height velocity in
adolescence begins:
A. distally
B. proximally
C. both
P

7. Growth of facial and chest hair is
an important physical and biologic
development during:
A. Early adolescence
B. Middle adolescence
C. Late adolescence
D. Young adulthood
P

8. The following skin finding in a
neonate warrants further
investigation or intervention:
A. Pustular melanosis
B. Harlequin color change
C. Mottling
D. Erythema toxicum
P
Common in black infants, pustular
lesions
Red & pale halves of the body from forehead to
pubis
Small white papules on erythematous base
containing EOs
May signify circulatory instability or temperature
fluctuation

9. Which of the ff vaccines is
contraindicated in a child who has
an immunocompromised relative at
home?
A. BCG
B. OPV
C. Pneumococcal conjugate vaccine
D. Tdap
P

10. Giving 2 live vaccines
separately should be done at least
how many weeks apart?
A. 2
B. 4
C. 6
D. 8
P
2 live vaccines can be given
simultaneously at different sites

11. Induration at the site of BCG
injection is usually expected at how
many days after administration?
A. 2 days
B. 2 weeks
C. 4 weeks
D. 8-12 weeks
P
Accelerated reaction
Pustulation
Scar formation

12. The ff vaccines can be given to
a one year old child EXCEPT:
A. Flu
B. Varicella
C. MMR
D. Rotavirus
P

13. High fever, encephalopathy & a
shock like state are potential severe
adverse reactions to which
component of DTP-OPV vaccine
A. Diptheria
B. Tetanus
C. Pertussis
D. OPV
P

14. Visual acuity is 20/20 by age (in
years):
A. 1
B. 2
C. 3
D. 4
P

15. BP should be checked at least
yearly starting from what age (in
years)?
A. 1
B. 2
C. 3
D. 4
P

16. The drug of choice for
deworming children beginning at
age 2 years old is:
A. Praziquantel
B. Irvemectin
C. Diethylcarbamazine
D. mebendazole
P

17. The expected systolic BP
(mmHg) of a 3 year old child is:
A. 70
B. 76
C. 80
D. 86
P

18. Giving Benzathine penicillin IM
every 3 wks to patients with acute
rheumatic fever is considered what
level of prevention?
A. primary
B. secondary
C. tertiary
P

19. A 6 mo old male infant had 3 episodes
of febrile UTI since 2 months old. He was
found to have pelvocaliectasia of the right
kidney by ultrasound. The next imaging
modality to be requested should be:
 A. IV pyelogram
 B. DTPA renal scan
 C. VCUG
 D. CT scan
P
Diethylenetriaminepenta
acetate: for GFR determination
DMSA : to detect renal scarring (photopenic
areas)
To detect reflux

20. A renal biopsy is NOT needed to
determine the cause of microscopic
hematuria in this condition:
 A. Acute PSGN
 B. Membranoproliferative GN
 C. IgA nephropathy (Berger’s disease)
 D. Thin basement membrane disease
P
PSGN Dx: hematuria + evidence of recent recent
streptococcal infection + i C3
Biopsy indicated in the presence of:
1. Renal failure
2. Nephrotic syndrome
3. NL C3
4. Absence of evidence of recent streptococcal

21. A 10 y/o male with generalized edema,
normal complement levels, high-grade
proteinuria, no hematuria & slightly elevated
serum Cr did not respond to an 8 wk course
of steroids. The most likely diagnosis is:
 A. Minimal change nephrotic syndrome
 B. Diffuse mesangial sclerosis
 C. Focal segmental glomerulosclerosis
 D. Membranoproliferative GN
P
95% response
rate
50% response
rate
20% response
rate, often
progressive
disease
MPGN: with persistent low C3,; idiopathic or secondary to chronic
infection or SLE, also with guarded prognosis if primary

22. A 15 y/o male has a serum creatinine of
7 mg/dL and estimated CrCl of 20 mL/min.
He still has urine output of 0.8 mL/Kg/hr. An
indication for dialysis should be
 A. Serum K+ = 6 mg/dL
 B. BUN = 90 mg/dL
 C. Blood pH = 7.18 on bicarbonate
 D. Serum Ca++ = 7 mg/dL,
phospate = 7 mg/dL
P
Only slight h, Salbutamol,
Ca++, Insulin, Kayexalate can
be used
Not uremic range yet
Ca x phospate not > 55
yet
AKI category Failure based on estimated GFR < 35
mL/min
Severe acidosis = pH <
7.15

Indications for dialysis in AKI:
 Anuria / Oliguria
 Volume overload with evidence of HPN &/or
pulmonary edema refractory to diuretic tx
 Persistent hyperkalemia
 Severe metabolic acidosis unresponsive to
medical mx
 Uremia (encephalopathy, pericarditis,
neuropathy)
 BUN > 100-150 mg/dL ( or lower if rapidly
rising)
 Ca:P imbalance, with hypocalcemic tetany
cannot be controlled by other measures

23. The anti-hypertensive of choice in all
children with proteinuric renal disease at risk
for chronic kidney disease is:
 A. Thiazides
 B. Clonidine
 C. Amlodipine
 D. Enalapril
P

24. This radiologic finding is diagnostic of
necrotizing enterocolitis
 A. Pneumoperitoneum
 B. Double bubble sign
 C. Pneumatosis intestinalis
 D. Coiled spring sign
P
Duodenal atresia,
Malrotation
Intussusception

25. The current recommended range of O2
saturation to relieve hypoxemia in the
preterm infant is:
 A. 85 – 90%
 B. 91 – 95%
 C. 96 – 98%
 D. 99 – 100%
P

26. Among the ff, the most important risk
factor for neonatal sepsis is:
 A. Maternal UTI in the last trimester
 B. Maternal fever during labor
 C. Meconium staining of amniotic fluid
 D. Inadequate prenatal care
P Chorioamnionitis

27. The antenatal steroid of choice for a
mother with premature labor at age of
gestation of less than 34 wks to prevent
RDS in the preterm offspring:
 A. Hydrocortisone
 B. Methylprednisolone
 C. Betamethasone
 D. Dexamethasone
P

28. A 5 day old infant with a diagnosis of
PPHN remains to have hypoxemia despite
100% O2 & assisted ventilation. This drug
will be most helpful in improving
oxygenation.
 A. Morphine
 B. Sildenafil
 C. Indomethacin
 D. Dexamethasone
P Other agents: Surfactant, Nitric
Oxide

29. Which of the ff is true of hemolytic
disease of the newborn due to ABO
incompatibility?
A. Anemia is usually seen in the 1st 24
hrs of life
B. Severity is directly related to birth
order
C. Microspherocytosis is a hallmark of
the disorder
D. Not seen in the first born infants
P

30. A preterm developed respiratory distress
on her 2nd day of life. On her 7th day, a gr
2-3/6 systolic murmur was noted at the
LUSB, CR = 160-170/min. Rales were noted
on her lungs but baby was not cyanotic.
Which of the following drugs should be
given if baby has PDA?
 A. Digitalis
 B. Indomethacin
 C. PGE1
 D. Furosemide
P Paracetamol is now the 1st
line drug given per orem or
IV

31. A child with this CHD undergoing dental
extraction will not require antibiotic
prophylaxis because endocarditis is seldom
seen in such CHD?
 A. ASD
 B. VSD
 C. PDA
 D. AVSD
P

32. A 6-month old baby with VSD presents
with feeding interruptions, tachypnea,
tachycardia, rales on both lungs and
hepatomegaly. This baby most likely has
developed this complication.
 A. Infective endocarditis
 B. CHF
 C. Pulmonary HPN
 D. Eisenmenger syndrome
P

33. A 1-yr old girl presents with 3 days
cough & fever. PE reveals a grade 3/6
continuous machinery murmur at the LUSB.
What other PE finding will be consistent with
her condition?
 A. Presence of thrill
 B. Loud P2
 C. BP 100/60
 D. Bounding peripheral pulses
P

34. A 6 mo old baby with ToF turned limp &
cyanotic after prolonged crying. On PE,
murmur was not appreciated but baby was
tachypneic. This is a manifestation of:
 A. Hyperventilation
 B. Hypoxic spell
 C. Cerebral infarct
 D. Seizure disorder
P “Tet” spell

35. Which of the ff anatomic pathologies is
TRUE of TAPVR?
 A. Aorta arises from the right ventricle
 B. Pulmonary artery comes off from
the
left ventricle
 C. 4 pulmonary veins drain to the right
atrium
 D. 4 pulmonary veins drain to the left
atrium
P

36. The auscultatory finding that will
differentiate a TAPVR from ToF is the
presence of
 A. Single S2
 B. Loud S2
 C. Split S2
 D. Soft S2
P
Pulmonary or aortic atresia, severe
stenosis, TA, TGA, ToF
ToF
Usually widely split: also seen in
ASD, pulmonic stenosis,
Accentuated pulmonic component of 2nd heart sound with
narrow splitting is a sign of pulmonary HPN

37. The etiologic agent in Rheumatic fever
is:
 A. Streptococcus viridans
 B. Streptococcus pyogenes
 C. Streptococcus agalactiae
 D. Streptococcus pneumoniae
P GABHS

38. In children with RHD, the valve most
commonly affected is:
 A. tricuspid
 B. pulmonic
 C. aortic
 D. mitral
P

39. For the primary prevention of acute
rheumatic fever, Phenoxymethylpenicillin or
amoxicillin should be given for how many
days?
 A. 5
 B. 7
 C. 10
 D. 14
P
Also true for alternative drugs like Erythromycin,
Clarithromycin & Cephalexin.
EXCEPT Azithromycin which is given for 5 days

40. All of the ff findings can be seen in
patients with severe bronchial asthma
exacerbation EXCEPT this: *
A. Pulsus paradoxus
B. Paradoxical thoracic & abdominal
movement
C. Clubbing
D. Harrison’s sulcus
P
Secondary to chronic hypoxemic states
as in cyanotic heart disease or
bronchiectasis

41. A 8 y/o known asthmatic was given
Ibuprofen for toothache. Within 15 minutes,
he developed angioedema of the lids, lips &
face. At the ER, he feels a lump in the throat
& has dyspnea & wheezing. The initial drug
of choice is:
 A. Salbutamol nebulization
 B. IV Diphenhydramine
 C. IV hydrocortisone
 D. IM Epinephrine
P
NSAIDs induced anaphylactoid reaction is NOT IgE
mediated but involves alteration in cell membrane
phospholipid metabolism but tx is sama as in

42. Anne, a 5 month old girl has atopic
dermatitis (AD) rash since 2 months old.
Over the last 2-3 wks, rash intensified
becoming more erythematous with
exfoliations & crusting & oozing. Her AD
rash most likely exacerbated due to
secondary infection with:
 A. Streptococcus pyogenes
 B. Staphylococcus epidermidis
 C. Staphylococcus aureus
 D. Pseudomonas aeruginosa
P
Drug of choice: Clindamycin or cotrimoxazole
especially if MRSA
By enterotoxins that
act as superantigens

43. If Anne who is being breastfed and has
pets & carpets at home, has an allergic
trigger that exacerbates her AD, the most
likely cause will be:
 A. Dust mites
 B. Animal dander
 C. Molds
 D. Food allergens
P
Foods like egg, cow milk being taken by Mom.
Roughly 30 - 40% of infants with moderate to
severe AD have associated food allergens that
exacerbate AD. In a breastfeeding mother, the
allergen can be from maternal diet

44. Omalizumab in the treatment of severe
allergies acts by binding to:
 A. TNF-a
 B. IL-5
 C. IgE
 D. IgG4
P

45. A 2 month old male infant developed coryza
followed by cough, tachypnea & wheezing. Family
history is (-) for atopy. There is no exposure to
cigarette smoking. What is the most likely course
this baby will have regarding the subsequent
development of wheezing episodes / atopic
diseases / asthma ?
A. He will develop (+) skin tests to common food allergens in
the subsequent months and develop atopic dermatitis
before he reaches one yr old.
B. He will develop (+) skin tests to common inhalant allergen
by school age and develop allergic rhinitis after 2 year old
C. He will most likely developed progressive airflow limitation
leading to persistent asthma
D. He may have recurrent wheeze with viral infections but
eventually he will outgrow these wheezing episodes
P
Transient wheezers
Persistent wheezers

46. The most practical approach to
confirming asthma diagnosis in a school
aged child with recurrent cough, colds and
wheezing:
A. chest x-ray finding of hyperinflation
B. FEV1/FVC < 80% at baseline on
spirometry
C. physical findings of tachypnea, chest
retractions & wheezing
D. improved peak flow rate by at least 12%
from baseline after ß2 agonist challenge
P

47. Topical steroid cream of choice for
atopic dermatitis (AD) on face:
A. Clobetasol proprionate 0.05%
B. Mometasone furoate 0.1%
C. Hydrocortisone 1 %
D. Betamethasone valerate
P

48. The most common cause of drug induced
angioedema:
A. ß-lactams
B. ß-blockers
C. ACE inhibitors
D. Cotrimoxazole
P
Most common cause of drug
allergy
Exacerbates hypersensitivity
reactions
Notorious for SJS, TEN

Identify the most likely arm of the immune system
that is deficient given the ff susceptibility pattern &
clinical manifestations
Susceptibility patterns or clinical
manifestations
Component
affected
Encapsulated gram (+) organisms,
sinopulmonary infections
Neisserial infections
Gram (-) intracellular organisms, viruses,
yeast, protozoa, Mycobacterium; FTT,
Dermatitis, malabsorption
Gram + & - organisms, fungi, protozoal;
mucositis, periodontitis, cold abscesses
B cells
Complements
T cells
Granulocyte

49. Patients with CGD (chronic
granulomatous disease) are at high risk for
infections with:
 A. Encapsulated gram (+) organisms
 B. Viruses, mycobacteria, gm (-) intra-
cellular organisms
 C. Neisseria meinigitides
 D. Catalase (+) orgnisms like S.
aureus,
Serratia marcescens
P

50. Doing intradermal skin test to Candida
Ag screens for defect in:
 A. B cells
 B. T cells
 C. Phagocytes
 D. Complement
P

51. This immunodeficiency condition is
considered a medical emergency right
after birth as the infant will need immediate
immune reconstitution to survive:
 A. CGD
 B. DiGeorge syndrome
 C. XLA (X-linked
agammaglobulinemia)
 D. SCID (severe combined ID)
P

52. A 15 y/o male presents with recurrent
painful mouth sores almost monthly for the
last 6 months. Immune defect of this arm
of the immune system should be
suspected
 A. B cell
 B. T cell
 C. Phagocytes
 D. Complement
P

53. Painful stimuli from the distal small
bowel, cecum, appendix & proximal colon
are usually & initially felt at the:
 A. epigastric area
 B. periumbilical
 C. right lower quadrant
 D. suprapubic
P

54. A newborn with bilious vomiting
without abdominal distention and with (+)
history of polyhydramnios during
pregnancy should be worked up for:
 A. Duodenal atresia
 B. Malrotation
 C. TE fistula
 D. intussusception
P

55. A 3-year old overweight male presents
with recurrent crampy abdominal pain,
nausea & vomiting over the last 6 months.
Stools are usually Bristol type 1 to 2. PE
reveals soft slightly distended abdomen.
Rectal exam reveals some stools in the
ampulla. Patient consumes 6-8 bottles of
milk daily and eats very little table foods.
He most likely has:
 A. Malrotation
 B. Short segment Hirschsprung’s
disease
 C. Cow milk allergy
 D. Functional constipation
P

56. A 2 month old male baby developed
recurrent nonbilious projectile vomiting for
the last 1 week. An olive sized mass was
palpated at the epigastric area with visible
peristaltic waves. This baby most likely
has:
 A. Intussusception
 B. Malrotation
 C. Hypertrophic pyloric stenosis
 D. volvulus
P
Intake of Macrolide in the neonatal period is a risk
factor

57. A 2 y/o infant had just recovered from 2
days of watery diarrhea when he returned
because of recurrence of watery stools
associated with abdominal distention &
pain especially after feeding. There was
perianal excoriation & reddening. The most
likely cause for the recurrence of diarrhea
is:
 A. Cow milk protein intolerance
 B. Lactose intolerance
 C. Ulcerative colitis
 D. Persistence of infection
P

58. An 8 week old female infant has
cholestasis since 2-3 wks old. On
admission, which of the ff lab findings
warrants immediate intervention?
A. Hgb = 9 gm/Dl
B. SGPT = 100 u/dL
C. TB = 20 mg/dL, B1 = 5 mg/dL, B2 = 15
mg/dL
D. PT = 25 sec
P Requires immediate Vit K

59. This hepatotropic virus usually causes
mild anicteric flu like illness in young
children:
 A.
 B.
 C.
 D.
P

60. A 6 wk old has cholestatic jaundice
since 2 wks old. Newborn screen is (-).
She was born 35 wks premature & SGA.
Her urine is tea colored. Which clinical or
lab finding will be more consistent with
idiopathic neonatal hepatitis?
 A. Unusual facies
 B. Absent gall bladder
 C. Stools are pigmented most of the
time
 D. + for cataract
P

The 2nd dose of Hepa A vaccine is given at
least how many months after the 1st dose?
 A. 1
 B. 2
 C. 4
 D. 6
P

A 9 month old infant may receive which IU
of Vit A?
 A. 50,000
 B. 75,000
 C. 100,000
 D. 200,000
P For infants 6 mo – 1 y/o
For infants < 6 mo
For children ≥ 1 y/o

Rehabilitation is what type of prevention?
 A. Primary
 B. Secondary
 C. Tertiary
P

Giving antibiotic therapy to children with
GABHS pharyngitis constitutes what level
of prevention against RF?
 A. Primary
 B. Secondary
 C. Tertiary
P
Giving Benzathine penicillin q 3-
4 wks for patients with RF

A breastfed 4 day old baby born to an 18 y/o
primi with birth wt of 3 Kg has fever of 38.5/axilla
& is noted to be jaundiced from face down to
thighs. PE: dry skin & lips. Infant appears eager
to suck. Current wt = 2.6 Kg. CBC:
unremarkable, urinalysis: sp gr = 1.025 but is
otherwise normal. What is the most likely
diagnosis?
 A. early onset sepsis
 B. UTI
 C. dehydration fever
 D. Fever is due to environmental heat
P
Wt loss is > 10% of birth
wt.
Breastfeeding jaundice

61. The most serious cardiac complication
of Kawasaki disease is:
 A. Acute myocarditis
 B. Pericardiac tamponade
 C. Heart block
 D. Coronary aneurysm
P

62. Autoantibody that has been implicated
in neonatal lupus:
 A. Anti-cardiolipin
 B. Anti-Ro
 C. Anti-Smith
 D. Anti-dsDNA
P
Diagnostic for SLE
Anti-phospholipid
syndrome

63. Quotidian fever pattern is characteristic
of:
 A. SLE
 B. Takayasu’s arteritis
 C. Systemic JIA
 D. Kawasaki disease
P
Quotidian fever is defined as a fever that rises to 39°C
once a day and returns to 37°C between fever peaks.

64. Violaceous periorbital swelling is a
characteristic cutaneous manifestation of:
 A. SLE
 B. Juvenile scleroderma
 C. Juvenile dermatomyositis
 D. Polyarteritis nodosa
P Heliotrope rash

65. A 3 y/o male developed palpable non-
blanching purpura on the lower extremities
associated with intermittent abdominal
pain. If he has HSP, skin biopsy will show
deposition of this Ig class:
 A. IgG
 B. IgA
 C. IgM
 D. IgE
P

66. A 14 y/o sexually active girl had fever,
splenomegaly, generalized
lymphadenopathy and a maculopapular
rash. Blood smear showed Downey cells.
She most likely has:
 A. Parvovirus B19 infection
 B. Typhoid fever
 C. Exanthem subitum
 D. Infectious mononucleosis
P

67. A 12 month old male infant developed
high grade fever for 3 days. On
defervescence, erythematous
maculopapular to morbilliform rash
appeared on the trunk spreading to the
face and extremities. The most likely
cause of the exanthem is:
 A. Rubeola
 B. Parvovirus B19
 C. Rubella
 D. Human herpes virus 6
P

68. A 5 y/o unvaccinated boy had fever,
cough, coryza of 4 days duration. On PE,
both palpebral conjunctivae were markedly
erythematous and white pinpoint lesions
on erythematous mucosa were noted in
the area opposite the lower molars. He
probably has:
 A. Rubeola
 B. Rubella
 C. Roseola infantum
 D. Kawasaki disease
P Koplik’s spots
Forchheimer spots on soft
palate
Nagamaya spots (ulcers)
on uvulopalatoglossal
junctions
_ __
_ __ _ _

69. Which of the ff is NOT a necessary
criterion to diagnose Dengue Hemorrhagic
fever?
A. Fever
B. Leukopenia
C. Thrombocytopenia
D. Hemoconcentration or evidence of
capillary leak
P

70. A newborn will develop varicella
after birth if the mother has varicella
at this time:
 A. 1st trimester
 B. 2nd till 3 wks before delivery
 C. 20 days until 6 days before delivery
 D. 5 days before to 2 days after
delivery
P

71. Tissue hypersensitivity in
tuberculosis causing reaction in the
lung parenchyma and lymph node
infiltrates occurs within what period of
time?
 A. 2-12 wks
 B. 15-30 wks
 C. 31-40 wks
 D. > 40 weeks
P

72. A 3 y/o child exposed to an
grandmother recently diagnosed with
cavitary lesion is asymptomactic, with
normal chest x-ray & (-) TST. You
should give:
A. H for 3 months then repeat PPD B.
B. H for 9 months
C. HR for 6 months
D. HRZ for 2 mo, then HR for 4 more mo
P

73. A 3-year old, exposed to his dad with
cavitary tuberculosis, has history of 1
month on and off cough, afternoon rises of
temperature and progressive weight loss.
If tuberculin skin test is 5 mm and chest x-
ray shows paratracheal
lymphadenopathies, what is the most likely
diagnosis?
A. TB Exposure
B. Latent TB Infection (LTBI)
C. PTB disease
D. Disseminated tuberculosis
P

74. A 3-year old in PICU & intubated for
severe pneumonia developed multiple
violaceous, ulcerative plaques on the
trunk. You should suspect infection with:
 A. Pseudomonas
 B. Streptococcal
 C. Staphylococcal
 D. Anaerobic
P Ecthyma gangrenosa

75. A 6-month-old infant with a 5-days of
URTI was noted to have fast breathing. On
chest auscultation, crackles and wheezing
were appreciated. Salbutamol challenge
provided no relief. His respiratory problem
is most likely due to:
 A. H. influenzae
 B. S. pneumoniae
 C. RSV
 D. Mycoplasma pneumoniae
P

76. The most common cause of secondary
bacterial pneumonia following measles:
 A. S. pneumoniae
 B. S. pyogenes
 C. H. influenza
 D. P. aeruginosa
P S. aureus

77. This is the expected PE findings in
pneumothorax:
A. Dull, bronchial breath sounds &
increased tactile fremitus
B. Tympanitic, increased breath sounds
C. Hyperresonant, decreased breath
sounds & mediastinal shift to the
unaffected side
D. Dull, absent breath sounds &
mediastinal shift to affected side
P

78. A 4- year old child known asthmatic
presents with halitosis & persistent
mucopurulent nasal discharge on the left
nostril for the past 2 weeks. What is the
most likely diagnosis?
 A. polyps
 B. AR
 C. Foreign body
 D. sinusitis
P

79. A 4-year old child has 2 days of
conjunctivitis, coryza, hoarseness and
cough. PE shows diffuse tonsillar and
pharyngeal erythema. The most likely
cause of the pharyngitis is:
 A. Adenovirus
 B. Coxsackie
 C. EBV
 D. Influenza
P

80. The drug of choice for reducing
laryngeal swelling in a toddler with
croup is:
:A. Salbutamol nebulization
B. Ipratropium bromide nebulization
C. Budesonide nebulization
D. epinephrine IM
P

81. Which of the ff upper airway
respiratory infections/conditions will
require intubation because of high risk
of airway obstruction?
:
A. croup
B. epiglottits
C. Spasmodic
D. epinephrine IM
P

82. An infant presents with developmental
delay and recurrent generalized and focal
seizure. PE: microcephaly with midline
facial defects, hypotelorism, cleft lip &
palate. Which of the ff congenital CNS
disorder should be your primary
consideration
 A. Agenesis of corpus callosum
 B. Holoprosencephaly
 C. Lissencephaly
 D. Schizencephaly
P Defective formation of procencephaly & induction of
forebrain structures, affecting median facial structures
Agyria, absence of convolutions from arrest
of neuroblast migration
Presence of unilateral or bilateral clefts with
the cerebral hemisphers

83. A2-year old boy presents with focal
clonic movements of the right upper
extremity & preferential gaze to the right
lasting for 7 minutes. PE shows a bulging
tympanic membrane on the right but
neurological examination is normal.
Family history is (+) for febrile seizures
(FS). Which feature will label this child as
having complex febrile seizure?
 A. Focal seizure
 B. 7 minutes duration
 C. + FH
 D. Focus of infection
P
Other features of
complex febrile
seizures:
• > 15 min
• recurs within 24 hrs

84. A 6 y/o presents with episodic staring
occurring at any time interrupting his
activities with fluttering of the eyelids &
motion arrest lasting ~ 10-15 seconds.
Seizure semiology here is consistent with
which type of seizure?
 A. Atonic
 B. Complex partial
 C. Absence
 D. Myoclonic
P No aura, may have simple automatisms,
No postictal state
+ aura, with impaired conscious-
ness, automatisms, + postictal sta
Rapid shocklike contraction, not rhythmic
Or astatic; momentary loss of tone with a
sudden fall, usually ff myoclonic seizures

85. A 6 y/o boy is seen toe walking starting 1½
yr ago. When getting up from the ground, he
needs to push off his thighs to stand. PE: +
lumbar lordosis, hypertrophied gastrocnemius
with weakness over the lower extremities,
normal sensory exam, no Babinski. The most
likely Dx is:
 A. Duchene muscular dystrophy
 B. Hereditary motor-sensory neuropathy
 C. Poliomyelitis
 D. Transverse myelitis
P
Muscle weakness, no babinski
Anterior horn disease, pure motor defect, with
asymmetric pattern, distal more affected, atrophy of
involved extremity
Segmental, with UMN involvement, hyperreflexia,
Babinski, sensory deficit
Degenerative

86. A 1 y/o girl presents with recurrent seizures.
Developmental arrest was noted since seizures
commenced. PE: + numerous hypopigmented
macules over the trunk. Imaging studies: +
calcified subependymal nodules in the
periventricular areas. The most likely diagnosis
is:
 A. NF1
 B. NF2
 C. Tuberous sclerosis
 D. Sturge Weber disease
P Triad of skin lesions
+ MR + seizure
Subcutaneous neurofibromas, h risk for
intracranial tumor
Bilateral acoustic neuroma, deafness;
also known as von Recklinghausen’s
disease
Portwine stain, leptomingeal angioma & abnormal
vessel in the eye leading to glaucoma

87. A 5-year old boy is discovered to have
pubic hair during his physical examination
prior to school entry. Bone age showed
advanced bone age. Which of the
following should be considered?
 A. Idiopathic premature adrenarche
 B. CNS tumor
 C. Growth hormone excess
 D. Normal variant
P

88. A 1 y/o boy presents with global
developmental delay. PE: coarse facies,
protruding tongue, cool dry skin &
hypotonia. PMH: + prolonged jaundice. He
was allegedly normal at birth though no
new born screen was done. What is the
most likely diagnosis?
 A. Congenital hypothyroidism
 B. Hashimoto’s thyroiditis
 C. Cerebral palsy
 D. Grave’s disease
P

89. Which of the ff statements about
congenital adrenal hyperplasia is TRUE?
 A. Most common casue is 11-
hydroxylase
deficiency
 B. Diagnosed earlier among boy in the
neonatal period
 C. Salt wasting form is primarily due to
glucocorticoid deficiency
 D. May present as ambiguous genitalia
in
female infants
P
Most common is C 21 hydroxylase
deficinecy
Diagnosed late in
boys
Mineralocorticoid

90. A 3 y/o girl with craniopharyngioma
presents with high urine output at the ward
post-surgery. Which of the ff will NOT be
compatible with central diabetes insipidus?
 A. Urine output 6 mL/Kg/hr
 B. Urine sp. gr. 1.020
 C. Elevated serum osmolality
 D. Low urine osmolality
P Expect i sp gr in DI
> NL of 1 mL/Kg
> 300 mOsm/KG
< 300 mOsm/KG

91. Type 1 DM manifestation will occur
when how % of pancreatic ß cells are lost?
 A. 30
 B. 50
 C. 75
 D. 90
P

92. In treating iron deficiency anemia
(IDA), iron therapy should be completed till
how many weeks after initial normalization
of CBC?
 A. 4
 B. 6
 C. 8
 D. 10
P

93. TRUE of G6PD?
A. It affects both sexes equally
B. Most affected individuals have
chronic hemolysis
C. Heinz bodies precipitate & destroy
RBCs
D. Significant splenomegaly is
frequent
P

94. This (these) CBC finding(s) strongly
favor(s) the diagnosis of thalassemia trait
rather than IDA:
A. low Hgb & Hct
B. low reticulocyte production index
C. relatively normal or high RBC count
D. low MCV & MCH
P

95. Which of the ff anemias involves an
autoimmune pathogenesis?
A. Anemia of chronic disease
B. Diamond Blackfan anemia
C. Familial spherocytosis
D. Aplastic anemia
P

96. A 14 y/o female has recurrent severe
metromenorrhagia. Her mother has the
same history. You should strongly
consider:
A. Chronic ITP
B. Hemophilia
C. Von Willebrand disease
D. Vit K deficiency
P

97. A hemophilia patient usually presents
with:
A. Petechiae
B. DIC
C. hemarthrosis
D. Urticarial vasculitis
P

98. A child with chronic hemolytic anemia
will be at high risk for developing aplastic
crisis after acquiring this viral infection
A. EBV
B. Parvovirus B19
C. Measles
D. HHV 6 & 7
P

99. A 16-year old female presents with 3
week-history of intermittent low grade
fever, anorexia, fatigue, and irritability. PE
showed pallor, discrete non-tender mass
on the right temporal area, splenomegaly
and petechial lesions on extremities. CBC
revealed pancytopenia. She most likely
has:
 A. ALL
 B. AML
 C. Non-Hodgkin lymphoma
 D. Hodgkin lymphoma

P

100. TRUE of childhood leukemia:
A. ALL peaks at 15-19 y/o
B. Most children with ALL has 5 yr
survival of > 80%
C. AML commonly presents with
mediastinal mass
D. Hematopoietic stem cell transplant is
the treatment of choice for ALL
P

A 16 y/o female presents with pallor for
several months associated with recurrent
febrile illnesses, & lately gum bleeding &
epistaxis. PE confirms presence of pallor,
bleeding gums & epistaxis but no
lymphadenopathy & hepatosplenomegaly.
She most likely has:
 A. ALL
 B. AML
 C. Aplastic anemia
 D. ITP
P

A 3 y/o healthy male presents with
generalized petechiae & gum bleeding. 2
wks PTC, he developed coryza with mild
to moderate fever which resolved after 3-4
days. PE is unremarkable except for the
petechiae & gum bleeding. He most likely
has:
 A. ALL
 B. Aplastic anemia
 C. HSP
 D. ITP
P

A 3 y/o boy with severe hemophilia A is
being treated with factor VIII concentrate
once a day for a right iliopsoas bleed for 3
days now. There is persistent pain when
he extends his thigh. An aPTT mixing
studies showed a value of 44 seconds
from baseline of 102 sec (n.v. 25 -44 sec).
The boy:
A. has developed an inhibitor vs Factor
VIII
B. has antiphospholipid antibody
C. is given inadequate amount of Factor
VIII
D. has acute appendicitis
P

A 12 month old male is noted by his
caretaker to have a palpable abdominal
mass during bath. If he has a malignant
tumor, the most likely cause is
 A. Wilm’s tumor
 B. Lymphoma
 C. Rhabdomyosarcoma
 D. Neuroblastoma
P

A 2 y/o child with persistent microcytic
hypochromic anemia despite adequate
iron therapy, reticulocytosis but low RPI
and normal RDW should be worked up for:
 A. IDA
 B. Thalassemia
 C. G6PD deficiency
 D. Diamond-Blackfan anemia
P

Consolidation of sexual identity is
achieved by what stage of adolescence?
 A. Early
 B. Middle
 C. Late
P

A 6 y/o girl diagnosed with T1DM missed
her insulin shots. She presents with rapid
deep breathing and is lethargic &
dehydrated with harsh breath sounds. She
most likely has:
 A. pneumonia
 B. DKA
 C. encephalitis
 D. sepsis
P Kussmaul breathing, lethargy &
dehydration from glycosuria

A 2 y/o child with URI for the past 2 days
develops barking cough, low grade fever,
hoarseness & inspiratory stridor, which
resolved after 3 days. This describes the
course of:
 A. Acute LTB
 B. Acute epiglottitis
 C. Bacterial tracheitis
 D. Foreign body aspiration
P
High fever & toxicity
Rapidly progressive upper airwa
obstruction

Age range in months considered as the
critical learning period for introduction of
complimentary feeding:
 A. 0 - < 6
 B. 6 - < 12
 C. 12 - < 24
 D. 24 - < 36
P

A 34 wk preterm male born by CS due to
respiratory distress developed grunting,
tachypnea, crackles & retractions few hrs
after birth. Mother is 40 y/o with diabetes
mellitus. He was meconium stained with
good APGAR scores. Chest X-ray reveals
reticulogranular pattern with air
bronchogram. He most likely has:
 A. Meconium aspiration syndrome
 B. Transient tachypnea
 C. RDS
 D. Persistent pulmonary HPN
P
__________________________

A 5 y/o male had received only 3 doses of
DTaP-IPV in his first 6 months of life. He
should be given:
 A. One dose of DTaP-IPV now
 B. 2 doses of DTaP-IPV 1 year apart
 C. One dose of Tdap
 D. 2 doses of Tdap 6 months apart
P

An underweight 5 y/o male had low to moderate grade
fever from late afternoon through the night for 1
month, with poor appetite & low energy drive. 2 wks,
PTA, he had moderate to severe headache, lately with
vomiting of previously ingested food becaming
lethargic in the last few days. PE: + nuchal rigidity.
Chest X-ray: + perihilar lymph nodes. CSF: turbid, with
pellicle formation on standing. WBC = 500/mm3,
lymphocytic predominance. CSF glucos =10 mg/dL,
protein = 1000 mg/dL. Gram stain, inidia ink & AFB
stain are (-). He most likely has:
 A. Bacterial meningitis
 B. TB meningitis
 C. Viral meningoencephalitis
 D. Fungal meningitis
P

Comparison of different
meningitides
Acute
purulent
viral TB Fungal
Appearanc
e
Turbid clear Turbid,
pellicle
formation
Turbid
WBC hhh h hh hh
predomina
ntly
neutrophils lymphoc
ytes
lymphocytes lymphocyte
s
Protein hh Normal
or h
hhh hhh
Sugar i Normal ii ii
stain Gram stain (-) AFB India Ink

A 1 y/o infant is brought to you because a
sibling who just had varicella this morning.
What is the most cost effective post-
exposure measure that should be given to
the infant?
 A. Immunoglobulin IM
 B. Herpes zoster Ig IM
 C. Varicella vaccine
 D. acyclovir
P

The mode of transmission of this
exanthematous disease can be through
oral secretions (deep kissing) & exchange
of saliva from person to person
 A. Erythema infectiosum
 B. Eneroviral exanthemata
 C. Infectious mononucleosis
 D. Typhoid fever
P

A 6 y/o girl presents with enlarged breasts.
PE: Tanner SMR 2 for breasts, SMR 1 for
genitalia, otherwise normal. History is
unremarkable. The enlarged breasts are
due to:
 A. Premature thelarche
 B. CNS tumor
 C. Growth hormone excess
 D. Ovarian tumor
P
No other abnormal
findings

A 12 month old male is noted to be pale
soon after developing fever, cough &
colds. His diaper was noted to be darkly
stained with passage of tea colored urine.
If his anemia is due to G6PD deficiency,
this lab finding will be strongly consistent:
 A. Presence of Heinz bodies on
peripheral smear
 B. Presence of dysmorphic RBCs in
the
urine
 C. h haptoglobin level
P
Represents
denatured Hgb after
oxidation
i hapatoglobin
h RPI
Dark urine from dipyrrulia; dysmorphic
urine seen in GN

Which of the ff agents is usually transmitted
vertically from the mother to the infant?
 A. CMV
 B. Treponema pallidum
 C. Rubella
 D. HIV
P Hepa B, HSV
Transplacental

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