Professional Documents
Culture Documents
DEPARTMENT OF PEDIATRICS
1 A newborn FT was noted to be pale at 4th month of life. Iron is unlikely in this condition because
infants have sufficient stores to meet their iron requirement for:
A. 2-3 months
B. 4-6 months
C. 7-8 months
D. 10-12 months
(Problem Solving) - GIT
B – It is by 6 months that iron should be supplemented among healthy full terms.
(Nelson’s Textbook of Pediatrics, 17th ed, 2004, p. 156)
3 By 6th month of age micronutrients must be started. Foremost among these is that nutrient that
prevents:
A. Xerophthalmia
B. Scurvy
C. Anemia
D. Goiter
(Problem Solving) - GIT
C - All nutrient needs of infants must be met by 6 months. But during this time breast milk volume
and iron stores may not be adequate to accommodate the demands of growth – Iron
deficiency anemia may ensue.
(Nelson’s Textbook of Pediatrics, 17th ed, 2004, p. 164)
7. A 1-1/2 year old is discovered to have a bottle of alkali solution in his mouth. The bottle was noted to
be half empty. No external signs on the child's face were seen. Your advice is to bring the child to the
ER. There must be prior administration of:
A. Emetic
B. Antiemetic
C. Milk
D. Laxative
(Problem Solving) - GIT
C - Milk calms the child and dilutes the alkali
(A) don’t induce emesis
(Nelson’s Textbook of Pediatrics, 17th ed, 2004, (Chapter 308.2)
8. A 3 year old accidentally ingested a coin. A chest x-ray was taken. In contrast to foreign body
trachea, the coin in the esophagus as seen on radiograph will show:
A. Edge of the coin in AP view
B. Edge of coin on lateral view
C. Flat surface in AP view
D. A and C
(Problem Solving) - GIT
D - (Nelson’s Textbook of Pediatrics, 17th ed, 2004, Chapter 308.1)
9. The WHO recommends the use of ORS in developing countries to have a sodium concentration of
_____ mmol/L:
A. 90
B. 100
C. 110
D. 120
(Recall) - GIT
A - 90 mmol/l
Above 90 is hyperosmolar
(Nelson’s Textbook of Pediatrics, 17th ed, 2004, p. 250)
10. A 3-week old with essentially normal birth history had episodes of intermittent vomiting after feeding.
If pyloric stenosis is being considered, you expect the following EXCEPT:
A. Hypochloremic alkalosis
B. Bilous vomiting
C. Gastric peristaltic wave
D. Olive-shaped RUQ mass in abdominal palpation
(Problem Solving) - GIT
C - The hallmark of gastric obstruction is non-bilious vomiting.
(Nelson’s Textbook of Pediatrics, 17th ed, 2004, Chapter 310)
11. A one day old had bilous vomiting. He was noted to be slightly jaundiced. The abdomen was not
distended but there was occasional visible peristaltic nerves on the abdominal wall. Plain abdomen x-ray
showed double-bubble sign. The obstruction is on what level?
A. Distal esophagus
B. Gastric
C. Duodenal
D. Colonic
(Problem Solving) - GIT
C - (Nelson’s Textbook of Pediatrics, 17th ed, 2004, p. 1233)
When the obstruction is in the duodenum beyond the Ampula of Vater – vomitus is bilous. The
Ampulla of Vater is the site where bile exits.
12. A 2-year old with head trauma underwent a neurosurgical procedure. At the PICU he had massive
13. An 11 year old Tanner stage 2 female developed epigastric pain / 8 hours later there was fever nausea
and vomiting. She passed 2 soft bowel movements. In the clinic, she limps and abdominal palpation,
there was generalized guarding. Most likely, she has:
A. Pelvic inflammatory disease
B. Ruptured ectopic pregnancy
C. Appendicitis
D. Mesenteric adenitis
(Problem Solving) - GIT
C - All choices are differentials of appendicitis
(A) PID presents with vaginal discharge
(B) Pregnancy is unlikely for Tanner 2
(D) Mesenteric adenitis follows a week of respiratory infection
(Nelson’s Textbook of Pediatrics, 17th ed, 2004, Chapter 324)
14. A 2 year old previously well child had intermittent crying episodes and projectile vomiting 12 hours
ago. There was gassy abdominal distention and passage of maroon-colored stools. You would:
A. Give antiamebics and antiemetics
B. Do abdominal x-ray and refer to surgery
C. Give antibiotics
D. All of the above
(Problem Solving) - GIT
B - The diagnosis is intussusception
(A) and (C) are not employed in intussusception
(Nelson Textbook of Pediatrics, 17th ed, 2004)
16. Prolonged antibiotic therapy can result to bleeding with the following laboratory results:
A. Normal PT, normal PTT
B. Prolonged PT, prolonged PTT
C. Prolonged PT, normal PTT
D. Normal PT, prolonged PTT
(Problem Solving) – Hema/Onco
C - Prolonged antibiotic therapy can lead to gut sterilization leading to reduced synthesis of Vitamin
K – dependent clotting factors (Factors II, VII, IX & X, protein C and protein S). This
reduction of clotting factors of the extrinsic limb of coagulation will lead to prolongation of
Prothrombin Time with normal PTT.
(Nelson’s Textbook of Pediatrics, 17th ed, 2004)
17. The CBC of a 7-yer old male with epistaxis and ecchymoses revealed Hgb 67 g/dl, Hct 18%, WBC
50,000, Neutrophils 5%, Lymphoblast 95%, Platelet Count 20,000. What is you primary consideration?
A. Aplastic anemia
B. Acute lymphocytic leukemia
C. Disseminated intravascular coagulation
D. Idiopathic thrombocytopenic purpura
(Problem Solving) – Hema/Onco
B - The anemia and thrombocytopenia are due to decreased production of erythroid and megakaryocytic
precursors resulting from blastic proliferation in the bone marrow. Aplastic anemia (Choice a) is
associated with pancytopenia. DIC (Choice C) doesn’t produce leukocytosis and blasts
in the peripheral smear. It is associated with the coagulation mechanism, not the
hematopoietic cells. ITP (Choice D) is only associated with thrombocytopenia. No
leukocytosis and blasts are seen in the peripheral smear.
(Nelson’s Textbook of Pediatrics, 17th ed, 2004)
18. Recurrent gum bleeding was noted in a 7-year old female. CBC and platelet count are normal,
Prothrombin time is normal but bleeding time and partial thromboplastin time are prolonged. The most
likely diagnosis is:
A. ITP
B. Hypoprothrombinemia
C. TTP
D. Von Willebrand Disease
(Problem Solving) – Hema/Onco
D - Von Willebrand disease is a disorder associated with mucocutaneous hemorrhages. The disorder is
due to deficiency of Von Willebrand factor, a glycoprotein that is synthesized in
megakaryocytes and endothelial cells. During normal hemostasis VWF adheres to the
endothelial matrix after vascular damage. Changes in the conformation of VWF cause platelets
to be an adhere to VWF resulting to platelet activation and recruitment of additional
platelets. VWF also serves as the carrier protein for plasma factor VIII. Severe deficiency
of VWF can cause prolongation of bleeding time and PTT. ITP (Choice A) results only to
prolonged BT because the coagulation phase is not affected. Hypoprothrombinemia
(Choice B) results to decreased synthesis of Vitamin K – dependent factor
causing prolonged PT. ITP (Choice C) is a form of microangiopathic hemolytic anemia with
thrombocytopenia.
(Nelson’s Textbook of Pediatrics, 17th ed, 2004, Chap. 469)
23. Which of the following patterns noted on continuous monitoring of fetal heart rate is most indicative
of fetal distress?
A. Baseline variability with periodic acceleration
B. Increasing baseline variability
C. Early deceleration without baseline variability
D. Late deceleration without baseline variability
(Problem Solving) - Neonatology
D - Baseline variability with or without periodic acceleration of the heart rate is a sign of fetal well-
being. Increasing baseline variability may represent early compromise of fetal
oxygenation. The early deceleration pattern is due to pressure of the anterior fontanelle on
the cervix and is not a sign of fetal distress. The variable deceleration pattern indicates
umbilical cord compression. The late deceleration pattern signifies fetal hypoxemia.
(Behrman, ed. 13, p. 368)
24. A healthy premature infant who weighs 950 g (2 lb, 1 1/2 oz) is fed undiluted breast milk to provide
120 cal/kg per day. Over ensuing weeks the baby is most apt to develop:
A. Hypernatremia
B. Hypocalcemia
C. Blood in the stool
D. Metabolic acidosis
(Problem Solving) - Neonatology
B - Breast milk has much less calcium and phosphorus than do commercial formulas.
(Behrman, ed. 113, pp. 162-163)
25. An infant weighing 1400 g (3 lb) is born at 32 weeks gestation in a delivery room that has an
ambient temperature of 24'C. Within a few minutes of birth, this infant is likely to exhibit all the following
EXCEPT:
A. Pallor
B. Shivering
C. A fall in body temperature
D. Increased respiratory rate
(Problem Solving) - Neonatology
B - A room temperature of 24’C provides a cold environment for preterm infants weighing less than
1500 g. Aside from the fact that these infants emerge from a warm intrauterine
environment. In order to bring body temperature back to normal they must increase their
metabolic rate; ventilation in turn, must increase proportionally to ensure adequate
oxygen supply. Infants rarely shiver in response to a need to increase heat production.
(Behrman, ed. 113, p. 363)
26. Initial examination of a full tem infant weighing less than 2500 g (5 lb, 8 oz) shows edema over
the dorsum of her hands and feet. Which of the following findings would support a diagnosis of Turner's
syndrome?
A. A liver palpable to 2 cm below the costal margin
B. Tremulous movements and ankle clonus
C. Redundant skin folds at the nape of the neck
D. A transient, longitudinal division of the body into a red half and a pale half
(Problem Solving) - Neonatology
C - Turner’s syndrome is a genetic disorder with the 45XO karyotype being most common. At birth
affected infants have low weights, short stature, edema over the dorsum of hands and
feet and loose skin folds at the nape of the neck.
(Behrman, ed. 13, pp. 264-266. 1236-1237)
27. Object permanence is not present in a 2 months old, whose response to dropping a ball is:
A. Staring descending as the ball descends
B. Eyes descending as the ball hits the ground
C. Crying when the ball hits the ground
D. Smiling at the game of the hide-and-seek
28. The ability to manipulate small objects with the pincer grasp is usually noted at what age?
A. 0 to 2 months
B. 3 to 5 months
C. 6 to 7 months
D. 8 to 9 months
(Recall) - Neonatology
D - The pincer grasp, which is noted at age 8 to 9 months, along with increasing mobility, enables an
infant to explore the environment.
(Nelson Textbook of Pediatrics, 17th ed, 2004)
29. A developmentally normal child who is able to run, build a tower of two cubes, pretend play with a
doll and speak in two-word sentences is what age?
A. 19 months
B. 15 months
C. 14 months
D. 24 months
(Problem Solving) - Neonatology
A - (See Table 11-3, Chapter 11, Nelson Textbook of Pediatrics, 15th ed)
30. A developmentally normal child who is just able to sit without support, transferobjects from
hand to hand, and speak in a monosyllabic babble is probably what age?
A. 2 months
B. 4 months
C. 9 months
D. 6 months
(Problem Solving) - Neonatology
D - (Nelson Textbook of Pediatrics, 15th ed, See Table 11-3, Chap 11)
32. Which of the following case scenarios merit an EEG as an initial test as part of the
neurodiagnostic evaluation?
A. Febrile seizure
B. First non-febrile seizure
C. Meningitis
D. Intracranial SOL
(Problem Solving) - Neurology
B - While the first febrile seizure is generally a benign one, an EEG is requested if it recurs. The EEG
provides characterization of seizure types which allows for the specific medical or
surgical management. A lumbar puncture with CSF analysis would have confirmed
meningitis. A brain CT scan would have demonstrated the intracranial SOL.
(Nelson’s Textbook of Pediatrics, 17th ed. ; Behrman, Kliegman & Jenson, 2004, p. 1978)
33. A 2-year old boy was admitted because of low to moderate grade fever of 3 weeks, on and off frontal
headache of 1 week, squinting of 1 day, one episode of generalized seizure of 2 minute
duration 6 hours prior to admission. No medical consult done. No medications given except
paracetamol. Which of the following clinical consideration is NOT COMPATIBLE with this
history?
A. Acute meningococcal meningitis
B. TB meningitis
C. Cryptococcal meningitis
D. Brain abscess of otogenic origin
(Problem Solving) - Neurology
A - Except for A, all the rest are compatible of the history, presenting with the clinical manifestations
of at least 2 weeks.
(Nelson’s Textbook of Pediatrics, 17th ed., 2004, pp. 965 ; 2040-44)
34. A mother calls to inform you that her previously well 4-year old child has been complaining of
headaches for about a month. For the past two weeks he has been keeping his hand in a tilted position,
and for the past few days he has been vomiting in the morning. The most likely diagnosis is:
A. Meningitis
B. Degeneration brain disease
C. Brain abscess
D. Brain tumor
(Problem Solving) - Neurology
D - Frequently, meningitis or CNS infections will present with fever, headache, and signs of irritability.
Brain abscess, because it behaves like an intracranial SOL, will present as low grade
fever, headache, and localizing signs. The hallmark of neurodegenerative disease is
progressive deterioration of neurologic functions with loss of speech, vision, hearing, or
locomotion, often associated with seizures, feeding difficulties, and impairment of intellect.
Generally, brain tumors present with signs and symptoms relating to increased intracranial
pressure (vomiting, lethargy, irritability) and focal neurologic deficits. Within the 1st year of life,
supratentorial tumors predominate and include, most commonly, choroids plexus
complex tumors and teratomas. From 1-10 years of age, infratentorial tumors predominate, owing to
the high incidence of juvenile pilocytic astrocytoma and medulloblastoma. After 10 years of
age, supratentorial tumors again predominate, with the diffuse astrocytomas, most
common.
(Nelson’s Textbook of Pediatrics, 17th ed, 2004, pp. 1703, 2029, 2038, 2047)
35. Clinical evidence backs up the use of IV dexamethasone as an adjunctive therapy in acute
meningitis caused by _____:
A. Neisseria meningitidis
B. Streptococcus pneumoniae
C. Hemophilia influenza
D. Listeria monocytogenes
(Recall) - Neurology
C - Data support the use of IV dexamethasone, 0.15 mg/kg/dose given every 6 hours x 2 days with
bacterial meningitis caused by Hemophilus influenzae type b, but not with other
bacterial causes, in terms of less fever, lower CSF protein and lactate levels, and a
reduction in permanent auditory nerve damage, as manifested by sensoneural loss.
(Nelson’s Textbook of Pediatrics, 17th ed, 2004, p. 2043)
36. A 12-year old child is admitted because of the sudden onset of coma. The child had been well until
about 6 hours prior to admission, when he began to complain of a headache. The headache became
more severe, and the child lapsed into coma. Physical examination: T = 38.2'C, flaccid and comatose.
CSF: bloody: after centrifugation, the fluid appears xanthochromic, RBC = 3,000, WBC 7/mm3 , protein
400 mg/dl, glucose is 62 mg/dl. The most likely etiology of the coma is:
A. Intraventricular hemorrhage
B. Subarachnoid hemorrhage
C. Viral encephalitis
D. Subdural effusion
(Problem Solving) - Neurology
B - The event is something acute, dramatic, catastrophic so the choices would only be between A and B.
Intracranial bleeding may occur in the subarachnoid space or the bleeding may be
primarily located in the parenchyma of the brain. Subarachnoid bleeding characterized by
severe headache, nuchal rigidity, and progressive low of consciousness, and
intracerebral bleeding is a common event in premature infant (intraventricular hemorrhage).
Rupture of an arteriovenous malformation (AV mal) may occur at any age, and causes
severe headache, vomiting, nuchal rigidity caused by subarachnoid bleeding, progressive
hemiparesis and a focal or generalized seizure.
(Nelson’s Textbook of Pediatrics, 17th ed, 2004, pp. 2036, 562)
37. The metaphyseal ends of long bones are common sites of osteomyelitis. This condition occurs
because:
A. Relative anoxia promotes bacterial growth
B. There is blood pooling and reduced phagocytic activity
C. They are closer to the skin surface
D. They are common sites of trauma
(Problem Solving) – Musculoskeletal Disorders
B -The unique anatomy and circulation of the ends of long bones results in the predilection for localization
of blood borne bacteria. In the metaphysic, nutrient arteries branch into non-anastomosing
capillaries under the physics, which make a sharp loop before entering venous sinusoids
draining into the marrow. Blood flow in this area is sluggish and provides an ideal environment for
bacterial seeding.
(Nelson’s Textbook of Pediatrics, 17th ed., 2004, pp. 2297-2298)
38. It is the most common primary malignant bone tumor in children and adolescents, which shows a
"sunburst" pattern on radiographs:
A. Ewing sarcoma
B. Osteosarcoma
C. Osteochondroma
D. Osterblastoma
(Recall) – Musculoskeletal Disorders
B - Osteosarcoma is the most common primary malignant bone tumor in children and adolescents,
followed by Ewing sarcoma. In children younger than 10 years of age, Ewing sarcoma is
more common than osteosarcoma. Both tumor types occur most frequently in the 2nd decade
of life.
(Ref. Nelson’s Textbook of Pediatrics, 17th ed., 2004, pp. 1717)
39. An adolescent male basketball enthusiast consults you with a painful bump below his right
knee. He denies fever or trauma. Which of the following is the most likely diagnosis?
A. Legg-Calve Perthes Disease
B. Osteoid osteoma
C. Osgood-Schlatter disease
D. Osteomyelitis
(Problem Solving) – Musculoskeletal Disorders
C – Osgood-Schlatter disease occurs in active children, particularly during late childhood or
adolescence, especially in athletes, and consists of the tearing of cartilage from the tibial
tuberosity by the ligamentum patellae. The child presents with pain and swelling
at the site of one or both tibial tubercles. Rest, restriction of activities, and occasionally, a
knee immobilizer may be necessary combined with isometric exercise program. Complete
resolution of symptoms through physiologic healing (physeal closure) of the tibia tubercle usually
requires 12-24 months.
(Nelson’s Textbook of Pediatrics, 17th ed., 2004, pp. 2272).
40. An overweight adolescent male complains of pain in the medial aspect of his knee. He denies
trauma, and he has not had a fever. The most likely diagnosis is:
A. Toxic synovitis
B. Legg-Calve-Perthes disease
C. Medial collateral ligament strain
D. Slipped capital femoral epiphysis
(Problem Solving) – Musculoskeletal Disorders
D - Slipped capital femoral epiphysis (SCFE) is the most common adolescent hip disorder with an
unknown cause, in which there is a displacement of the femoral head from the femoral
neck prior to epiphyseal closure. Common in obese adolescent boys, it presents with pain, limp,
or refusal to walk. The pain may be referred to the knee or thigh. Legg-Calve-Perthes Disease,
avascular necrosis of the femoral head presents with joint stiffness, hip and pain in the hip,
thigh, knee, or groin of several weeks to months. Boys between 1-12 years (average 7 years)
are most commonly affected. Toxic synovitis is a transient inflammatory arthritis
of the hip associated with fever.
(Nelson’s Textbook of Pediatrics, 17th ed., 2004, pp. 2276-2279)
42. Painless small erythematous or hemorrhagic lesion on the palms and soles are classic lesion in:
A. Osler nodic
B. Janeway lesions
C. Roth spots
D. Spincter Hemorrhages
(Recall) - Cardiovascular
B - Janeway lesion are painless small erythematous or hemorrhagic lesions on the palms and soles.
(A) Osler nodes are tender pea-sized intradermal nodule in the pads of the fingers and toes. These
lesions may represent vasculitis produced by circulating antigen antibody complexes
(C ) Sphincter hemorrhages are linear lesions beneath the nodes
(D) Roth spots – immune complex phenomena and seen in the eyes
(Nelson’s Textbook of Pediatrics, 17th ed, 2004)
44. The clinical manifestation of large VSD in neonatal patients does not include:
A. Systolic murmur may not be audible
B. Dyspnea
C. Profuse perspiration
D. Recurrent pulmonary infection
(Problem Solving) - Cardiovascular
A - systolic murmur may not be audible this occurs only in small VSD this is due to the fact that the left to
right shunt may be minimal because of the higher right sided pressure
(B) Dyspnea happens because of excessive blood flow and pulmonary hypertension
(C ) profuse perspiration is a sign of heart failure secondary to high level of left ventricular output heart
rate and stroke volume are increased mediated by an increased level of sympathetic nervous
system stimulation and activity thus increasing the circulation of catecholamines
combined with increased work of breathing resulting in the elevation of in total body oxygen
consumption often beyond the oxygen transport ability of the circulation
(D recurrent respiratory infection secondary to the presence of “wet” lung syndrome that serves as a
niduos infection coupled with the disruption of the mucociliary clearance these will be
responsible for the recurrence of URTI
(Nelson’s Textbook of Pediatrics, 17th ed, 2004)
45. Which of the following cardiac anomaly is NOT present in Tetralogy of Fallot?
A. Pulmonary stenosis
B. ASD
C. Overriding of the aorta
D. Right ventricular hypertrophy
(Recall) - Cardiovascular
B - Atrial septal defect is NOT seen in patients with TOF. It is ventricular septal defect (VSD) is the defect
that is part of the defect and the VSD is frequently non restrictive and large frequently
located just below the aortic valve.
(A) Pulmonary stenosis leads to the obstruction of the Right ventricular outflow. The pulmonary valve
annulus may be of nearly normal size or may be quite small in size. The valve itself is
bicuspid and occasionally is the only site of the stenosis. In cases where the right
ventricular outflow tract is completely obstructed, pulmonary blood flow may be supplied by
a patent ductus arteriosus (PDA) and by major aortopulmonary collateral arteries arising
from the aorta
(C ) Over riding of the aorta is part of the congenital defect
(D) Right ventricular hypertrophy is due to the degree of right ventricular outflow obstruction
(Nelson’s Textbook of Pediatrics, 17th ed, 2004)
46. A 3-year old boy was admitted to the ER because of difficulty of breathing. History revealed that he
developed high grade fever and sore throat 24 hours prior to consult with associated difficulty of
swallowing. Physical examination showed a very toxic looking boy, highly febrile, with labored breathing
and hyper extended neck and drooling of the saliva. The most plausible diagnosis of the above case is:
A. Acute infectious laryngitis
B. Acute epiglottitis
C. Acute laryngotracheobronchitis
D. Acute bacterial tracheitis
49. The pathologic findings of bronchopulmonary dysplasia (BPD) consist of the following:
A. Decreased alveolarization
B. Decreased alveolar septation
C. Minimal airway disease
D. All of the above
(Recall ) - Respiratory
D - all of the above
BPD is a result of lung injury in infants requiring mechanical ventilation and supplemental
oxygenation. It is apparent that patients with BPD have decreased alveolarization,
alveolar septation and minimal airway disease all of which suggest arrest in lung
development. The lung injury occurring in children is due to an interaction of multiple factors.
Since RDS is a disease of progressive alveolar collapse, Atelectasis which is affected by
insufficient PEEP together with ventilator-induced increased lung volume and regional
overdistention promotes injury. Oxygen promotes injury by producing free radical that
cannot be metabolized by immature antioxidant systems. Therefore, mechanical ventilation
and /or oxygen injure the preterm lung by affecting alveolar and vascular development.
Moreover, inflammation as measured by circulating neutrophils and macrophage
in the alveolar fluid and pro-inflammatory cytokines contribute to the progression of the lung
injury.
(Nelson’s Textbook of Pediatrics, 17th ed, 2004)
50. A patient is considered to have intermittent asthma when the following is/are present:
A. PEFR variability = <20%
B. PEFR 60-79% of predicted
C. FEVI <60%
D. PEFR variability = 20-30%
(Problem Solving) - Respiratory
A - PEFR variability =<20%
Peak expiratory flow rate variability is a measure of the stability of the airways and it is
considered as a diagnostic tool to predict the success of one’s treatment PEFR variability
=<20% is still within normal limits. Intermittent asthma has normal PEFR and PEFR variability
values. Symptoms of these patients are very infrequent
(B) Once PEFR is 60-79% of the predicted, it only means that airway obstruction is present [(N)
PEFR = ≥ 80% of the predicted] and signals that the patient belongs to the
moderate persistent category
(C ) FEV1 (forced expiratory volume in one second) is a measure of airflow obstruction. And the
value of <60% indicates that the patient belongs to the category of severe
persistent asthma.
(D) PEFR variability =20-30% means that airways are still unstable and asthma is not well
controlled and the patient belongs to the mild persistent asthma category
(Nelson’s Textbook of Pediatrics, 17th ed, 2004)
51. An 8-year old presents with sneezing, clear rhinorrhea, and nasal itching. P.E. findings show boggy,
pale nasal edema with a clear discharge. The most likely diagnosis is:
A. Foreign body
B. Vasomotor rhinitis
C. Neutrophilic rhinitis
D. Allergic rhinitis
(Problem Solving) – Immunology/Allergology
D - Allergic rhinitis is often seasonal and associated with allergic conjunctivitis. Eosinophils
predominate in the nasal secretions.
(Nelson’s Textbook of Pediatrics, 17thed, 2004, pp. 759-760)
52. The mother of 7-year old girl with acute strep throat calls to report that within 15 minutes after the
first dose of oral penicillin you prescribed, she is complaining of itching and has developed hives. Which
of the following should you recommend?
A. Give her oral antihistamines and call again if not improved within 30 minutes
B. Bring her to your office or the nearest emergency room
C. Substitute erythromycin for penicillin
D. Bring her to the nearest emergency room once difficulty of breathing is experienced
(Problem Solving) – Immunology/Allergology
B - The urticarial reaction described in the question may develop into anaphylaxis which requires
emergency treatment. Aside from this, penicillin should be stopped and a substitute non-
penicillin appropriate antibiotic chosen.
(Nelson’s Textbook of Pediatrics, 17th ed, 2004,Chap 137, pp. 781-782)
53. A child has abdominal pain, arthritis, microscopic hematuria, and a purpuric rash only on the lower
extremities. Which of the following is the most likely diagnosis?
A. Meningococcemia
B. Varicella
C. Henoch-Schonlein vasculitis
D. Post streptococcal glomerulonephritis
(Problem Solving) – Immunology/Allergology
C -The purpura on the lower extremities suggests Henoch-Schonlein Vasculitis. Meningococcemia is
generalized. Varicella gives papulo-vesicular lesions which are likewise generalized.
Erythema nodosum is the cutaneous lesion usually found on the lower extremities in post-
strep infection.
(Nelson’s Textbook of Pediatrics, 17th ed, 2004,pp. 794, 826-828)
54. A 2-day old neonate with vomiting of bilous material since birth was brought to your hospital. X-rays
taken showed “double-bubble”.
A. Metabolic problems must be addressed initially
B. Schedule for emergency laparotomy
C. Do upper GI series
D. Intubate once seen
(Problem Solving) - Neonatology
A - (Nelson’s Textbook of Pediatrics,, 17th ed, 2004, pp. 1233-1234)
55. A 24-hour old neonate is brought to the ER because of inability to pass meconium in 24 hours. He
does not have vomiting or distention. Your recommendation would be to:
A. Do suction rectal biopsy
B. Request for barium enema
C. Request for abdominal x-ray
D. Observe the patient
(Problem Solving) - Neonatology
D - (Nelson’s Textbook of Pediatrics, 17th ed, 2004, pp. 1232-1241)
56. A 7-day old 900 gram pre-term has been noted to have abdominal distention with gastric retention.
OGT drainage is 10 cc in 24 hours and stool occult blood is positive. Abdominal x-ray showed
pneumatosis intestinalis. This patient should:
A. Undergo immediate surgery
B. Have intensive medical therapy
C. Peritoneal drainage
D. Have a blood culture.
(Problem Solving) - Neonatology
B - (Nelson’s Textbook of Pediatrics, 17th ed, 2004, pp. 590-591)
57. A live 30 weeks of gestation baby boy was born via cesarean section to a diabetic mother. Grunting
and tachypnea was noted on the 6th hour of life. After receiving therapeutic measures, the patient
improved. However on the 4th day of life, lethargy, apnea and poor muscle tone was noted. Transfontanel
cranial ultrasonography was done and showed increased echogenecity at the thalamocapsular region
with ventricular dilatation. What is the grade of this patient’s germinal matrix hemorrhage?
A. Grade 1
B. Grade 2
C. Grade 3
D. Grade 4
(Problem Solving) - Neonatology
D - (Nelson’s Textbook of Pediatrics, 17th ed, 2004, pp. 563)
58. Which of the following chest radiographic findings can be found in mild ventricular septal defect?
A. Small heart
B. Increased pulmonary vascularity
C. Increased size of the aorta
D. Left atrial enlargement
(Problem Solving) - Neonatology
B - (Nelson’s Textbook of Pediatrics, 17th ed, 2004, pp. 1509)
61. In a newborn suspected of having choanal atresia, respiratory distress may be relieved by:
A. Opening the mouth
B. Intubation
C. Bag and mask ventilation
D. Administering O2
(Problem Solving) - Neonatology
A - (Nelson’s Textbook of Pediatrics, 17th ed, 2004, pp. 1387)
62. The most common clinical manifestation of Persistent Pulmonary Hypertension is:
A. Respiratory distress
B. Pallor
C. Cyanosis
D. Apnea
(Recall) - Neonatology
C - (Nelson’s Textbook of Pediatrics, 17th ed, 2004, pp. 585)
63. Which of the following statements regarding the diagnosis of intrauterine infection is/are accurate?
A. IgM in neonatal serum may be used as a screening tool
B. Total IgM has a low rate of both false positive and false negative results
C. IgM titers may have low specificity and low sensitivity
D. IgG rising titers in infancy are not helpful
(Problem Solving) - Neonatology
A- (Nelson Textbook of Pediatrics, 17th ed, 2004)
64. Thyrotoxicosis in the first day of life is most likely to occur in an infant born to a mother
A. With untreated hypothyroidism
B. With untreated Grave’s disease
C. With Grave’s disease being treated with antithyroid medications
D. Receiving iodides as therapy for chronic Thyrotoxicosis
(Problem Solving) - Neonatology
B - (Nelson’s Textbook of Pediatrics, 17th ed, 2004, pp. 1886)
65. A 6-year old male was brought to the OPD because of jaundice of 5 days associated with anorexia of
one week. A hepatitis profile done on him revealed the following:
Anti-HAV (IgM) - Reactive
HBsAg - Non-reactive
Anti-HBc - Non-reactive
Anti-HBe - Non-reactive
Anti-HBs - Non-reactive
The patient Had a recent:
A. HAV and HBV infection
B. HAV infection with a post infection of HBV
C. HAV infection with HBV immunity
D. HAV infection and post infection of HAV
(Problem Solving) – Infectious Diseases
C – (Nelson’s Textbook of Pediatrics, 17th ed., 2004, pp. 1324-1329)
66. A 9-month old female was brought to the OPD because of watery diarrhea, yellowish, non-bloody,
non-mucoid stools, with no pus nor RBC’s. Her anterior fontanel is slightly sunken. The most likely
organism to cause this type of diarrhea is:
A. ETEC
B. Vibrio cholera
C. Rotavirus
D. Norwalk virus
(Problem Solving) – Infectious Diseases
C – (Nelson’s Textbook of Pediatrics, 17th ed., 2004, pp. 1324-1329)
69. Which of the following diseases has the greatest capacity to be a “pandemic?”
A. HIV
B. Influenza
C. Measles
D. Hepatitis B
70. A newborn was found to have the following anomalies: hydrocephalus, cicatricial scarring over the
6th-7th left intercostals, malformed feet (fusion and maldevelopment of both feet). Which congenital
infection shows these findings at birth?
A. HIV
B. CMV
C. Parovovirus B19
D. Varicella-Zoster virus
(Recall) – Infectious Diseases
D - (Nelson’s Textbook of Pediatrics, 17th ed., 2004, p. 1059)
71. Which of the following features is TRUE of all infants born to HIV-infected women?
A. They will have low CD4 cell counts
B. They will eventually develop AIDS
C. They will have antibodies to HIV
D. They will be infected with HIV
(Problem Solving) – Infectious Diseases
C - (Nelson’s Textbook of Pediatrics, 17th ed., 2004, p. 1161)
72. One of the following is LEAST associated with ascaris infection in humans:
A. Intestinal obstruction
B. Loeffler’s syndrome
C. Iron deficiency anemia
D. Pancreatitis
(Recall) – Infectious Diseases
C - (Nelson’s Textbook of Pediatrics, 17th ed., 2004, pp. 1156)
73. Which of the following does NOT RESULT from a vesicoureteral reflux?
A. Hypertension
B. Chronic failure
C. Proteinuria
D. Dilatation of the ureters
(Problem Solving) – Nephro/GU
C - Vesicoureteral reflux results from valvular incompetence at the uretero vesicular junction as a
result of a shortened segment of ureter within the bladder wall. It is often associated with
other genitourinary anomalies. Vesicoureteral reflux can result in chronic renal failure,
dilatation of the ureters, hypertension and urinary tract infections. Proteinuria results from
glomerular injury.
(Nelson’s Textbook of Pediatrics, 17th ed, 2004,pp. 1790-1794)
74. The triad of microangiopathic hemolytic anemia, renal failure, and thrombocytopenia is characteristic
of which one of the following?
A. Membranous lupus nephritis
B. Focal glomerulonephritis secondary to sepsis
C. Acute post-streptococcal glomerulonephritis
D. Hemolytic-uremic syndrome
(Recall) – Nephro/GU
D -The name gives the answer away.
(Nelson’s Textbook of Pediatrics, 17th ed, 2004,pp. 1746-1747)
75. A 2-year old male developed an upper respiratory tract infection that was followed in 2 weeks by
general edema. His blood pressure is normal. Urinalysis reveals 2-5/hpf and +4 protein. His BUN is 19
mg/dl, creatinine 0.6 mg/dl, cholesterol 402 mg/dl, serum albumin 0.9 g/dl, ASO=200, and C3=92 mg/dl.
The most likely diagnosis would be:
A. Poststreptococcal glomerulonephritis
B. Membranous glomerulonephritis
C. Minimal lesion nephrotic syndrome
D. Focal sclerosis
(Problem Solving) – Nephro/GU
C - Hypoalbuminemia, proteinuria, edema and hyperlipidemia constitute the nephrotic syndrome.
Hypertension, azotemia, edema or hematuria would suggest nephritis but may also be
encountered in minimal lesion nephrotic syndrome. This patient has nephrotic
syndrome, not nephritis.
(Nelson’s Textbook of Pediatrics, 17thed, 2004,pp. 1740-1746 ; 1753-1757)
76. The recommended age to perform corrective surgery in a child with a unilateral undescended testes
is:
A. The first 6 months of life
B. Between 21 and 18 months of age
C. Between 5 and 7 years of age
D. Before puberty
(Recall) – Nephro/GU
B - Corrective surgery performed between 12 and 18 months of age represents a safe balance between
anesthetic risk, allowance of time for the testes to descend, and the risks of leaving a
testis in the abdomen.
(Nelson’s Textbook of Pediatrics, 17thed, 2004,pp. 1817-1820)
77. Maternal varicella results in severe neonatal varicella when maternal infection takes place during:
A. The 1st trimester
B. The 2nd trimester
C. The 3rd trimester
D. The week before and after delivery
(Problem Solving) – Infectious Diseases
D - Birth within 1 week before or after the onset of maternal varicella frequently results in the newborn
developing varicella, which may be severe. The risk to the newborn is dependent on the
amount of maternal anti-VZV antibody that the fetus acquired transplacentally before
birth. If the internal between maternal chickenpox and parturition is less than 1 week, the
newborn will be unlikely to have protective VZV antibody and neonatal chickenpox may
be exceptionally severe.
(Nelson’s Textbook of Pediatrics, 17th ed., 2004, p. 1058)
78. A 2-year old has a positive tuberculin test (15 mm induration). Which of the following would be
suggestive of “military tuberculosis?”
A. Fever
B. Hepatosplenomegaly
C. Hilar adenopathy on chest x-ray
D. Cough
(Problem Solving) – Infectious Diseases
B - “Miliary tuberculosis” suggests lymphohematogenous spread or disseminated form of TB, occurring is
distant sites, including liver, spleen, skin and other organs aside from the lungs. Fever
and cough are non-specific manifestations of TB which may be found in other diseases,
while hilar adenopathy on chest x-ray, may be found in primary pulmonary TB.
(Nelson’s Textbook of Pediatrics, pp. 962-964)
79. A 3-year old nonimmunized child is seen at the OPD and diagnosed as having measles. There is an 8-
month old nonimmunized sibling at home. Appropriate management of this sibling would include:
A. A modifying dose of gammaglobulin
B. A preventive dose of gammaglobulin
C. Immediate immunization with live attenuated measles vaccine
D. Immediate immunization with killed measles vaccine
(Problem Solving) – Infectious Diseases
A - Passive immunization with immune globulin is effective for prevention and attenuation of measles
within 6 days of exposure. Susceptible household and hospital contacts who are <12
months of age or who are pregnant should receive immune globulin (modifying dose, 0.25
ml/kg; maximum 15 ml) IM as soon as possible after exposure, but within 5 days.
Immunocompromised persons should receive immune globulin (preventive dose, 0.5 ml/kg ;
maximum 15 ml) IM regardless of immunization status.
80. An 8-year old male consulted the OPD because of high grade fever and sore throat. The pertinent
P.E. findings were: hyperemic oropharynx, enlarged tonsils with exudates, petecchiae on the soft palate
and painful, enlarged cervical lymphadenopathies. This patient is most likely suffering from:
A. Streptococcus pyogenes
B. Epstein Barr Virus
C. Adenovirus
D. Corynebacterium diphtheria
(Recall) – Infectious Diseases
C - (Nelson’s Textbook of Pediatrics, 17th ed., 2004, pp. 870-879)
81. An 8-month old boy presents with failure to thrive, thrush, lymphadenopathy, and pneumocystis
carinii pneumonia. He most likely has:
A. Severe malnutrition
B. Acute leukemia
C. HIV infection
D. X-linked hypogammaglobulinemia
(Recall) - Infectious Diseases
C - These constellation of manifestation are associated with HIV infection. The clinical manifestations
of HIV infection vary widely among infants, children, and adolescents. In most infants,
PE findings at birth are normal. Initial symptoms are subtle, such as lymphadenopathy and
hepatosplenomegaly, or non-specific such as failure to thrive, chronic or
recurrent diarrhea, interstitial pneumonia, or oral thrush, and may be distinguishable only by
their persistence. Whereas systemic and pulmonary findings are common in the United
States and Europe, chronic diarrhea, wasting, and severe malnutrition predominate in Africa.
Symptoms found more commonly in children than adults with HIV infection include
recurrent bacterial infections, chronic parotid swelling, lymphocytic interstitial pneumonitis
(LIP), and early onset of progressive neurologic deterioration. The HIV classification
system is used to categorize the stage of pediatric disease by using 2
parameters: clinical status, and degree of immunologic impairment (absolute CD4
lymphocyte count or the percentage of CD4 cells).
Category A (Mild Symptoms):
Children with at least 2 mild symptoms such as:
- lymphadenopathy
- parotitis
- hepatomegaly
- splenomegaly
- dermatitis
- recurrent or persistent sinusitis or otitis media
Category B (Moderate Symptoms):
- lymphocytic interstitial pneumonitis (LIP)
- oropharyngeal thrush persisting for <2 months
- recurrent or chronic diarrhea
- persistent fever >1 month
- hepatitis
- recurrent herpes simplex stomatitis or HSV esophagitis or pneumonitis
- disseminated varicella (i.e., with visceral involvement)
- cardiomegaly
- nephropathy
Category C (Severe Symptoms):
Children with 2 serious infections (i.e., sepsis, meningitis, pneumonia) in a 2 year period
- esophageal or lower respiratory tract candidiasis
- cryptococcosis
- cryptosporidiosis (>1 mo)
- encephalopathy
- malignancies
- disseminated myocobacterial infection
- pneumocystis carinii pneumonia (PCP)
- cerebral toxoplasmosis (onset after 1 month of age)
- severe weight loss
The Pneumocystis carinii pneumonia (PCP) is the most common opportunistic infection in the
pediatric population. The peak incidence of PCP occurs at age 3-6 months with
the highest mortality rate in children <1 year of age.
(Nelson’s Textbook of Pediatrics, 17th ed., 2004, pp. 1112-1113)
82. In our country, the first dose of live attenuated measles vaccine should be administered:
A. at 4 months of age
B. at 6-9 months of age
C. at 12-15 months of age
D at 18-24 months of age
(Recall) - Infectious Diseases
B - The attack rate of measles among the susceptibles in <1 year is 80% (DOH Philippines 2000),
such that even if vaccine efficacy at 6 months is just 50% and at 9 months it is 85%, we
give it as early as 6 months, during which time transplacentally acquired maternal
antibodies for measles would already be at its nadir.
(DOH Philippines 2000)
83. Neonatal bacterial sepsis is most commonly caused by which one of the following organisms (in the
Philippines):
A. Group B streptococci
B. Pseudomonas aerugenosa
C. Streptococcus pneumoniae
D. E. coli
(Recall) - Infectious Diseases
D - In our country, gram (-) organisms are the most common causes of neonatal bacterial sepsis (2:1)
compared with the gram positive organisms. The gram negative enteric bacilli like E. coli
are the more common causative agents. Pseudomonas aerugenosa, a gram
negative bacilli, is a common nosocomial pathogen.
(Textbook of Pediatrics and Child Health, Del Mundo, Fe et. al (eds.) 4th ed, 2000, p. 265)
86. The findings of sudden onset of fever, petecchial rash, and BP = 70/50 in a 5 year old child is most
suggestive of infection with:
A. Neisseria meningitidis
B. Hemophilus influenzae
C. Staphylococcus aureus
D. Streptococcus pneumoniae
(Problem Solving) - Infectious Diseasess
A - These findings are compatible with meningococcemia caused by Neisseria meningitides which can
progress rapidly over hours to septic shock. The other etiologic agents, while they may
cause a similar picture these are usually in relation to DIC which would manifest over a
longer period of time, not in a matter of hours.
(Nelson’s Textbook of Pediatrics, 17th ed, 2004, p. 897)
87. Of the following parasitic infections, which is most likely to present with intestinal obstruction?
A. Trichuris trichura
B. Necator americanus
C. Ascaris lumbricoides
D. Enterobius vermicularis
(Recall) - Infectious Diseases
C - A large mass of Ascaris lumbricoides leads to intestinal obstruction. Rectal prolapse is associated
with Trichuris trichura. Heavily infected children with Necator americanus suffer from
intestinal blood loss resulting in iron deficiency, which can lead to anemia as well as
protein malnutrition. Pruritus ani is associated with enterobiasis.
(Nelson’s Textbook of Pediatrics, 17th ed., 2004, pp. 1156-1159)
88. A 10-month old child has a temperature of 39-40’C for 4 days without other signs. On the 4th day, a
maculopapular rash appears, and the temperature returns to normal. The most likely diagnosis is:
A. scrub typhus
B. roseola
C. rubeola
D. echoviral infection
(Recall ) - Infectious Diseases
B - (Nelson’s Textbook of Pediatrics, 17th ed., 2004, pp. 1069-1072)
89. Which of the following is the chemoprophylactic antimicrobial given to intimate contacts of a 7-year
old with meningococcal meningitis?
A. Rifampin
B. aqueous Pen G
C. Isoniazid
D. Erythromycin
(Problem Solving) - Infectious Diseases
A - (Nelson’s Textbook of Pediatrics, 17th ed., 2004, pp. 898-899)
90. The clinical manifestations in DHF are secondary to the pathogenetic mechanism of:
A. direct invasion of the virus to the different organ system
B. hypersensitivity reaction
C. immune enhancement
D. adherence of the viruses to the endothelial cells
(Recall) - Infectious Diseases
C - (Textbook of Pediatrics & Child Health, Del Mundo, et al (eds.), 4th ed, 2000, p. 561)
91. In a case of DHF (Grade 3) who is bleeding profusely, which of the following fluids (all available)
would you give?
A. properly typed & X-matched fresh whole blood
B. properly typed & X-matched fresh plasma
C. D5LRS
D. D5NSS
(Problem Solving) - Infectious Diseases
A - (Textbook of Pediatrics & Child Health, Del Mundo, et al (eds.), 4th ed, 2000, p. 569 - 571)
92. The following CSF analysis results are compatible with which of the following clinical entities?
CSF Results: Opening pressure = 300 mm H2O
WBC = 296 (segs: 10% ; lymphos : 90%)
Protein = 2 g/L
CSF sugar / RBS = 20%
A. Acute meningococcal meningitis
B. TB meningitis
C. Japanese B encephalitis
D. Febrile seizures
(Problem Solving) – Infectious Diseases
B - (Nelson’s Textbook of Pediatrics, 17th ed., 2004, pp. 965, 2040-2044)
93. On the 3rd day of treatment for Hemophilus influenzae meningitis, an eight month old child who had
been alert is noted to be lethargic. Serum electrolytes reveal the following:
Na = 120 mEq/L
Cl = 83 mEq/L
K = 3.1 mEq/L
BUN = 2 mg/dl
The most likely cause of the lethargy and hyponatremia in this patient:
A. Acute renal failure
B. Congestive heart failure
C. Syndrome of inappropriate ADH secretion
D. Subdural effusions
(Problem Solving) – Infectious Diseases
C - (Nelson’s Textbook of Pediatrics, 17th Ed, 2004, p. 200)
94. A 28 year old primigravida mother, who had a past history of adequately treated PTB, gave birth to a
healthy 3 kg baby. Which of the following preventive measures against TB would you take?
A. Separate the baby from the mother for another month
B. Separate the baby from the mother and give INH for 3 months
C. Give BCG only
D. Give BCG now but separate the baby from the mother for a month
(Problem Solving) – Infectious Diseases
C - (Textbook of Pediatrics & Child Health, Del Mundo, et al (eds.), 2000 pp. 516-525)
95. A 2-year old boy was admitted because of low to moderate grade fever of 3 weeks, on and off frontal
headache of 1 week, squinting of 1 day, one episode of generalized seizure of 2 minute duration 6 hours
prior to admission. No medical consult done. No medications given except paracetamol. Which of the
following clinical consideration is NOT COMPATIBLE with this history?
A. Acute meningococcal meningitis
B. TB meningitis
C. Cryptococcal meningitis
D. Brain abscess of otogenic origin
(Problem Solving) – Infectious Diseases
A - (Nelson’s Textbook of Pediatrics, 17th ed., 2004, pp. 965, 2040-2044)
100. At 2 years of age, Mario had a height of 85 cms. How tall would he be when he becomes an adult?
A. 4 feet 6 inches
B. 5 feet
C. 5 feet 6 inches
D. 6 feet
(Recall) - Neurodev
C - (Textbook of Pediatrics & Child Health, Del Mundo, et al (eds.), 4th ed, 2000, pp 78-80)
University of the East
RAMON MAGSAYSAY MEMORIAL MEDICAL CENTER
Aurora Boulevard, Quezon City
DEPARTMENT OF PEDIATRICS