1 4th NATIONAL MCQ EXAMINATION NATIONAL BOARD OF EVALUATION, INDONESIAN COLLEGE OF PAEDIATRICS NOVEMBER 19, 2008 SELECT THE ONE

BEST ANSWER, put your answers in the answer sheet Time allocation: 100 minutes GROWTH AND DEVELOPMENT A newborn girl named Sitti presents to the evening nurse in the general care nursery with floppy tone and dysmorphic features. She is born full term to a 28 – year – old G2 P1 whose first pregnancy resulted in a healthy daughter. She has delivered a full – term 3 – kg girl. Pregnancy, labor, and delivery were all uncomplicated. The obstetrician has told the parents that all went well. A. What are the medical examination findings that occur in 50% but not in 90% of individuals with Down syndrome ? A. Mid – face hypoplasia B. Excess nuchal skin C. Small ears D. Central hypotonia E. Wide space between first and second toes B. Your examination reveals a clustering of craniofacial dysmorphism, central hypotonia, and a strong Moro. When you come in to discuss your concerns with the family, you should : A. Talk to the father alone B. Tell the nurse what to say to mother C. Talk to both parents and describe what the process will involve D. Talk to both parents and say that you do not know what to do for children with Down syndrome E. Describe in detail all that children with Down syndrome cannot do C. What medical concern listed below is not associated with GI malformations ? A. Oligohydramnions B. Vomiting after first feed C. Delayed passage of meconium D. Choking during feedings E. Double bubble on abdominal radiograph D. Which of the following cardiac malformations does not commonly occur in infants with Down syndrome ? A. Atrioventricular canal B. Tetralogy of Fallot C. Hypoplastic left heart syndrome D. Atrial septal defects E. Ventricular septal defects IMMUNIZATION A. An outbreak of measles is occurring in a large urban city. Measles vaccine can be administered to children as young as : A. 4 weeks B. 4 months C. 6 months D. 9 months E. 12 months B. Compared with natural infection with varicella-zoster-virus, varicella vaccine is more likely to result in: A. Herpes zoster B. Transmission of virus to contacts C. Mild varicella disease if breakthrough varicella occurs D. The serious adverse event of encephalitis E. Fever

2 ENDOCRINOLOGY A 10 – year – old boy comes into your office for a routine physical examination. His only complaint is that he is shorter than all of his friends, and that he can‟t ride the mega roller coaster at the local amusement park because he is shorter than the requirement. You have followed this child for many years, but most visits have been for illness, and his height has not been measured for the last few years. He is on no medications. He reports occasional fatigue and occasional constipation. On physical examination, his height is less than the 3 rd percentile and he is prepubertal 5. Of the following, which is the least likely to help with his diagnosis ? A. Parental heights B. Growth velocity C. Actual height D. Bone age E. BMI 6. What is the most likely diagnosis if his growth rate is 5 cm/year, height age is 8 years, and bone age is 10 years ? A. Constitutional delay of growth and puberty B. Intrinsic short stature C. Hypothyroidism D. Growth hormone deficiency E. Cushing‟s syndrome C. What is the most likely diagnosis if he has abnormal body proportions and a narrow interpedicular distance in the lower lumbosacral area ? A. Noonan‟s syndrome B. Achondroplasia C. Hypochondroplasia D. Klinefelter‟s syndrome E. Exogenous obesity D. Which of the following is one of the most common causes of short stature in children ? A. Familial intrinsic short stature B. Growth hormone deficiency C. Poor nutrition D. Chronic illness E. Hypothyroidism

INFECTIOUS DISEASE E. An 18-month-old child presents to the emergency center having had a brief, generalized tonic clonic seizure. He is now postictal and has a temperature of 40C. During the lumbar puncture (which proves to be normal), he has a large, watery stool, that has both blood and mucus in it. The most likely diagnosis in this patient is: A. Salmonella B. Enterovirus C. Rotavirus D. Campylobacter E. Shigella F. The 3-year-old sister of a newborn baby develops a cough diagnosed as pertussis by nasopharyngeal culture. The mother gives a history of having been immunized as a child. A correct statement regarding this clinical situation is: A. The mother has no risk of acquiring the disease because she was immunized B. Hyperimmune globulin is effective in protecting the infant C. The risk to the infant depends on the immune status of the mother D. Erythromycin should be administered to the infant E. The 3-year-old sister should be immediately immunized with an additional dose of pertussis vaccine

3 G. A 14-month-old infant suddenly develops a fever of 40.2C. Physical examination shows an alert, active infant who drinks milk eagerly. No physical abnormalities are noted. The white blood cell count is 22.000/mm3 with 78% polymorphonuclear leucocytes, 18% of which are band forms. The most likely diagnosis is: A. Pneumococcal bacteremia B. Roseola C. Streptococcosis D. Typhoid fever E. Diphteria H. A 4-year-old child presents in the clinic with mumps. Correct statements about this condition include which of the following? A. Arthritis is a common presenting complaint in children B. The disease could have been prevented by prior immunization with killed whole cell vaccine C. Involvement of the CNS may occur 10 days after the resolution of parotitis D. Orchitis occur almost exclusively in prepubertal males E. Subendocardial fibrolastosis is a common complication in this age child

GASTROENTEROLOGY I. An awake, alert infant with a 2 day-history of diarrhea presents with a depressed fontanel, tachycardia, sunken eyes, and the loss of skin elasticity. The appropriate percent of dehydration is: A. Less than 1 percent B. 1 percent to 5 percent C. 5 percent to 9 percent D. 10 percent to 15 percent E. More than 20 percent J. An 11-year-old child has been diagnosed with hepatitis C infection. Which of the following may be considered in the treatment of chronic hepatitis C infection? A. Active vaccination B. Interferon C. Gamma globulin D. Zidovudine E. Low protein diet K. An 8-month-old child regularly regurgitates a large portion of her feeds. In the diagnostic evaluation of gastroeosophageal reflux for this infant, the least helpful procedure is A. Barium swallow and upper GI series B. Urea breath test C. Esophageal manometry D. Esophageal pH probe E. Technetium 99m scintiscan L. A 55-day-old former 27-week premature infant is noted by the neonatal nurse to have a swelling in the left groin extending into the scrotum but not involving the testicle. The swelling is not tender, firm, hot or red, and it does not transilluminate. It seems to resolve with pressure, but returns when the infants begin to perform the Valsalva maneuver. The most appropriate course of action at this point is to: A. Obtain a surgical consultation B. Perform a needle aspiration C. Order a barium enema D. Order a KUB E. Do nothing, spontaneous resolution will occur

MCT has a medium length of carbonic chain. As he is concerned about driving next year. An explanation for MCT recommendation in those situations is: A. Phenobarbital and lorazepam E. Medium chain triglyceride or MCT is beneficial for certain conditions like cholestasis and premature baby. D. A 15 year. focal. :Children with complex partial seizures need to be seizure – free for at least 5 years before a decision can be made”. MCT stimulates the production of bile salt that promotes the absorption of dietary fats NEUROLOGY 21. MCT does not need any lipase for its digestion in guts B. E. Which of the following option is most likely a part of the syndrome. MCT may directly enter the enterocytes without any support of bile salt C. Febrile seizures 23. Conjunctivitis B. Infantile spasms D. Retinal ablation 20. MCT is a polyunsaturated fatty acid which is more accessible in binding bile salt E. Which of the following antiepileptic drugs are generally considered the first – and second – line therapies for neonatal seizures ? A.4 NUTRITION 19. Benign rolandic epilepsy E. hyperkeratosis. Carbamazepine and phenytoin are equally effective in the treatment of febrile seizures should one consider treatment . During the visit. Diazepam and phenobarbital B. “Let‟s obtain an EEG. Syndrome of vitamin A deficiency is as follows: xerophthalmia. there is an approximately 70% chance you will be seizure – free”. keratomalacia. Which of the following is the most common form of childhood seizures ? A. he asks you when he can go off his medication. Phenytoin and midazolam D. or occurs multiple times per febrile illness B. Bitot spots D. B. growth failure and death.old male with a history of complex partial seizures recently moves into your practice area. Subconjunctival bleeding E. but occasionally they would progress to generalized tonic – clonic seizures. Up to 10 % of patients with febrile seizures develop epilepsy E. The most appropriate response would be which of the following ? A. C. Hordeolum C. “Never. Phenobarbital and valproic acid 22. Absence seizures C. therefore gastric juice easily break down it into small fractions D. He is currently treated with carbamazepine. He comes into your office for a general physical examination. “If a child is seizure-free for two years it may be possible to stop their medication straight away” 22. “It all depends on the epilepsy syndrome or type and complex partial seizures seldom go into remission”. Developmental delay is a risk factor for the development of a first febrile seizure D. Which of the following statements is not true about febrile seizures ? A. A febrile seizure is considered “complex” if it is prolonged. Epilepsy is a lifelong condition”. A. he states that he has been seizure – free for approximately 2 ½ years. A family history of febrile seizures in a first – or second – degree relative is a risk factor for the development of febrile seizures C. His spells consisted of staring with automatisms. Complex partial seizures B. Phenobarbital and phenytoin C. If that test is normal.

5 RESPIROLOGY 25. Bronchodilator nebulizer 28. He describes his symptoms as daily and also experiencing nocturnal symptoms approximately 2x per week. Mild persistent D. A 2 year old female child developed fever. She improved with antibiotics but on follow up at 8 weeks was again found to have increasing consolidation in right lower lobe and fever. Albuterol jet nebulizer B. CT scan of the chest D. A 15 year. Bronchoscopy B. Nosebleeds with low thrombocyte on screening E. Begin iv antibiotics B. The new mother of a 3 week-old infant is concerned that her child is having breathing difficulty. last 2 minutes. Nosebleeds associated with fever and anemia D. it would be prudent to: A. These results classify his severity of asthma as: A. Patient has one kidney E. A 5 year-old boy is brought for evaluation during winter by his mother because of recurrent nosebleeds. Myalgia HEMATOLOGY 29. Asthma C. All of the following would prompt you to explore the etiology of this boy‟s nosebleeds except : A. They happen between one and three times a week. Anemia D. Ice cream PO C. Bacterial culture of the nasopharynx C. Family history of bleeding disorder C. and are difficult to stop.old comes to you for a football physical. Along with securing an airway what are other treatment options? A. She states he is a noisy breather but has remained afebrile and sleeps/feeds well. Spirometry performed in your office reveal that his FEV1/ PEFR is 75% of his predicted value. Mild intermittent E. A patient comes into your office in severe respiratory distress with a deep barky cough and stridor. Which finding below in this child‟s history would preclude him from a contact sport? A. Prescribe a decongestant C. After a history/physical exam. This has been going on for about 6 weeks. Severe persistent B. You diagnose the child with croup and decide to admit the child. cough and respiratory distress. A 15 year old boy comes to your office for follow up of his reactive airway disease. Racemic epinephrine and steroids D. Mantoux test 26. Moderate persistent C. Begin albuterol nebulizer E. Moderate intermittent GENERAL PAEDIATRICS 49. Nosebleeds that don‟t stop within 2 minutes or more as a cut-off B. Allergen sensitivity test E. No treatment options are available E. Evidence of gum bleeding . Begin a bronchodilator 27. Sickle cell disease B. Reassure mom and send home with saline nasal spray D. On chest x-ray consolidation is seen in right lower lobe. Your next investigation would be ? A.

The family history is noncontributory. Thickened basement membrane E. Acute tubular necrosis C. and no significant Past Medical History / Family History (PMH/FH). stomach. A complete blood count done in the emergency room is within normal except for a platelet count of 8. Thrombocytopenia B. Rectourethral fistula C. He had a “cold” approximately 2 weeks previously. A child has a history of repaired high imperforate anus.old girl presents after referral to you for proteinuria. He has no palpable lymphadenopathy or hepatosplenomegaly. On physical exam.6 30 A 5 year-old boy awoke this morning covered in “red dots”. Neuroblastoma B. Benign orthostatic proteinuria D. He has diffuse petechiae covering his face. A 15 year. Hepatoblastoma 32. Vesicoureteral reflux B. Posterior urethral valves. arms and legs. Polycystic kidney E. no edema. What is your initial diagnosis ? A. Urine analysis shows proteinurea + and hematuria +++. Minimal change B. Hydronephrosis D. Membranous GN E. Deposition of IgG and complement 33. Post streptococcal GN C.148 and quantitative protein is 25 (normal 2-10). On kidney biopsy which finding will be most commonly seen ? A. back. Clotting time NEFROLOGY 31. Prolonged prothrombin time C. chest. Deposition of IgA D. Vesicorectal fistula 34. What is the most likely cause? A. Low factor VIII level E. Which of the following laboratory abnormalities is most commonly associated with the development of petechiae? A. A mother of a 4 yr-old child noticed that there is a solid mass in the right area of her child which she noticed for the first time with occasional blood in urine. Lupus nephritis .000/L. A 71/2 year old child presents with non-blanching rash over the extensor aspect of arm with swelling over knee. but otherwise has been well. the child is well-appearing and afebrile. neck. He now has a urinary tract infection. Fusion of podocytes B. What is the most likely diagnosis? A. Elevated fibrin degradation products D. Neurogenic bladder D. Urine protein/creatinine ratio is 0. Urinalysis (U/A) shows 1+ proteinuria (no other abnormalities). normal cholesterol. E. Wilms tumour C.

The peak incidence for coronary artery aneurysms is 6 to 12 months following the onset of fever C. Order a renal ultrasound E. Group A beta hemolytic streptococcal pharyngitis E. Cervical adenopathy greater than 1. swollen and erythematous lips and strawberry tongue with erythematous and edematous hands and feet and a polymorphous rash on the face. Patients with giant coronary artery aneurysms greater than 8 mm in diameter are at highest risk for late stenosis and myocardial infarction D. Aspirin and IVIG B. Order an ECG CARDIOLOGY 35. Begin medical therapy with antihypertensive medications D. Recheck the blood pressure on at least two other separate occasions before beginning further evaluation C. A 10 year-old boy presents for a pre-participation sports physical examination. Coronary artery rupture is the most common cause of mortality within the first 7 days of the onset of fever E. He has previously been well with no significant past medical history. The most likely diagnosis in this patient is: A. His vital signs demonstrate a heart rate of 101 bpm and a blood pressure of 130/85 mm Hg (greater than the 95th percentile for age). Penicillin and IVIG C. Which of the following statements is true regarding coronary artery involvement with this 2 year -old‟s disease ? A. A 2 year-old child presents with a 10 day-history of fever. a heart murmur. Measles C. Hydrops of the gallbladder C. Name the two drugs most commonly used for acute management of this disease. bilateral nonexudative conjunctivitis. Thrombocytosis is associated with myocardial infarction. and extremities.7 GENERAL PAEDIATRICS 50. Anterior uveitis in 70% cases 37. Kawasaki disease B. trunks.5 cm D. Smaller aneurysms mostly do not resolve on their own 38. A. Infective endocarditis diagnosis ? 36. Steroids and penicillin E. Steroids and IVIG . Viral upper respiratory tract infection D. What is the most appropriate next step? A. E. Steroids and aspirin D. The remainder of his exam is normal. What acute finding would not be expected to be associated with this 2 year-old‟s A. Sterile pyuria B. Recheck the blood pressure with a smaller blood pressure cuff B. There is a 50% incidence of coronary artery aneurysms if untreated B.

Midgut volvulus D. Herpes B. In utero infection D. Maternal fibroids E. A transfer to the ICU with administration of nebulized salbutamol D. Coagulase – negative staphylococcus B. The patient has a normal barium enema (specifically.5oC and he appears toxic. He was well previously. Maternal size and parity. the heart rate is 120 bpm. Lower bowel contrast enema D. The differential diagnosis of a newborn who is SGA with a normal physical examination includes : ? A. Fetal chromosomal disorder C. A term infant has not passed meconium for 48 hours.old neonate presents with bilious vomiting. there is no evidence of microcolon. Syphilis EMERGENCY A 5 year – old boy presents to the emergency room with a 12 – hour history of fever and drooling. Manometry C. 42. Pyloric stenosis 40. He has received immunizations. In this case. An endotracheal intubation before transfer to the ICU E. Preduodenal portal vein C. 43. Haemophilus influenzae D. Respiratory syncitial virus 44. Oesophagoscopy E. Rubella C. small for gestational age. If the diagnosis of epiglottitis is confirmed in the operating room by direct visualization by an otolaryngologist. and the room air blood oxygen saturation is 92%. His temperature is 39. He presents with distension of abdomen and emesis since one day. leaning forward slightly and refuses to lie down for the examination.000/mm3 with significant left shift. Genetic testing for cystic fibrosis B. The prenatal course was notable for suspected intrauterine growth retardation. A tracheotomy before transfer to the ICU .) Which of the following would be the least likely diagnoses? A. Duodenal web E. Toxoplasmosis D. The child has marked inspiratory stridor and refuses to swallow. A transfer to the ICU with supplemental humidified oxygen B. On physical exam. Varicella E. Abdomen X ray 41. Streptococcus pneumoniae C. A full-term baby is born to a 16 year-old mother. if the diagnosis is epiglottitis. There have been no other symptoms and no sick contacs. He is sitting. Parainfluenza virus E. An abdominal film demonstrates air within the distended stomach and duodenum with a small amount of air in the distal small bowel. Next most appropriate investigation would be: A. A transfer to the ICU with administration of corticosteroids C. the best next step would be : A. what is the likely pathogen ? A. term. small for gestational age (SGA) newborn. A chest radiograph is normal. In the evaluation of a low-birthweight. A one day. Duodenal atresia B. The leukocyte count is 28. Maternal vascular disease B. the respiratory rate is 26.8 PERINATOLOGY 39. The birth weight is 2325 g. which of the following should not be considered in the management of this newborn baby? A.

Your examination reveals a non – toxic child who is afebrile. GI symptoms can present before the rash C. the purpuric rash is secondary to thrombocytopenia D. All the following are true about GI involvement in HSP except : A. The child with viral croup always has a more abrupt onset of stridor than the patient with epiglottitis C. You suspect that she has Henoch – Schonlein purpura (HSP). It usually presents shortly after HSP diagnosis with nephritic syndrome and hypertension D. Complications include intussusception. often increasing after physical activity B. No emesis or diarrhea was reported. coalescing by the ankles. E. Then her mother noted a red rash on her legs. hands and feet is common in children younger than 4 years old E. In a small percentage of children. The child with viral croup is often older than the patient with epiglottitis B. Rash frequently recurs over the first 6 weeks after presentation. She has palpable purpuric lesions. and may be occult or gross B.9 45. It is associated with a membranous lesion on renal biopsy C. The child with viral croup clinically looks identical to the child with epiglottitis. Skin biopsy will show a leukocytoclastic vascultis with IgA deposition. is common C. The child with viral croup never presents with high fever ALLERGY IMMUNOLOGY 46. and brought her to your office. It may persist in 1% to 5% of children and may progress to end – stage disease in approximately 1% E. Arthritis. Which statement is true for renal involvement secondary to HSP ? A. A normal barium enema rules out intussusception in HSP D. All of the following are true about HSP except : A. For the past few days a 5 – year – old child has been complaining of intermittent abdominal pain. Her abdominal exam reveals mild diffuse tenderness. especially of ankles and knees. Edema of the scalp. but no rebound. The majority of children who have hematuria during the acute phase of HSP illness have progression of renal disease B. GI hemorrhage is common. and ascending up to the buttocks. Ultrasonography may show edema of bowel wall and may identify an intussusception 48. 47. The child with viral croup is more likely to present in the middle of an upper respiratory infection than the patient with epiglottitis D. bowel infarction and perforation E. Differences between viral croup and epiglottitis include : A. It occurs more commonly in patients < 8 years old at the time of HSP diagnosis .

He was uneventfully born at term with a birth-weight of 3 kg. the BW was 2. 2009 SELECT THE ONE BEST ANSWER. Cow‟s milk allergy D. Barium enema E. Which of the following statements is FALSE : A. The pain is not associated with the onset of a change in stool frequency or stool form. bilious emesis. She feels also early satiety. CT Scan D. The most probable diagnosis in this case is: A. A baby. 4 months of age has 5 bowel movements a day for the last 3 days. Ultrasonography C. but her total and direct bilirubin are only slightly above normal.10 NATIONAL MCQ EXAMINATION NATIONAL BOARD OF EVALUATION INDONESIAN COLLEGE OF PEDIATRICS JUNE 1. Hirschprung Disease D. and guarding. A girl aged 6 years old has experienced recurrent abdominal pain since the last 6 months. In any infant or toddler who present with acute abdominal pain. Salmonellosis C. What is the most likely diagnosis? A. No abnormalities are evident on physical examination. Shigellosis B. Her serum transaminases are elevated. Hypertrophic Pyloric Stenosis E. The most likely diagnosis is: A. Abdominal migraine D. which is soft and contains blood and mucus. A 3 week-old baby came to the emergency department with the main complaint of profuse non-bilious vomiting after feeds. Pancreas Annulare 5. bloating and nausea. Functional dyspepsia B. Atresia Duodenum C. on physical examination. Magnetic resonance imaging B. Most patients with this illness do not develop fulminant or chronic disease B. Gastroesophageal Reflux B. A 3-year old girl present to the Emergency Department with fever. Several other children in her day care are sick with similar symptoms. She complains of persistent or recurrent pain or discomfort centered in the upper abdomen (cranial to the umbilicus). vomiting and abdominal pain. Intussusceptions E. This disease more commonly occur in a crowded community (urban) 4. which of the following imaging studies is the initial study of choice most likely to confirm your suspicions? A. Upper GI series . Gastroesophageal reflux disease E. Amebic colitis 3. Functional abdominal pain 2. has a good appetite and no signs of dehydration. Highly effective vaccines exist against this disease D. put your answer in The Answer Sheet TIME ALLOCATION : 100 MINUTES GASTRO-HEPATOLOGY 1. She looks healthy. Jaundice is common in young children with this illness C.5 kg along with moderate dehydration and hypokalemia. Irritable bowel syndrome C. She has right upper quadrant tenderness and hepatomegaly. Most commonly transmitted by fecal-oral contact E.

Chronic systemic illness E. hematocrit 14 %. Drug Allergy 9. Angloedema C. tachycardia. Lead poisoning 7. The drug of choice for this patient is: A. red blood cell count 2. and breathing difficulty. Iron deficiency B. β thalasemia trait C. Hemostatic function also reveals normal. Followup hemoglobin electrophoresis demonstates an increased concentration of hemoglobin A2. white blood cell count 11. The child is most likely to have A. The most likely diagnosis of the patient is : A. Stop the transfusion and change with another Packed Red Cell bag E.00/ . Laboratory finding shows hemogloblin level 3g/dl. There was no other complaint.000/ . Physical examination was unremarkable. Secondary Thrombocytopenic Purpura C. What is the most possible diagnosis in this child ? A. A 3 year-old develops pallor and recurrent epistaxis. Stop the transfusion and change into washed erythrocyte transfusion D. Systemic Lupus Erithematous D.11 HEMATOLOGY 6. Ephedrine . In emergency situation like this. A 5 year old boy came with rashes like purpura in the lower extremities. and then continue transfusion C. Iron deficiency anemia 8. Henoch-Schonlein Purpura E. Asthma E. Urticaria B. Give paracetamol and continue transfusion B. raised. On a routine-screening of complete blood count. Corticosteroid D. Sickle cell anemia D. Immune Thrombocytopenic Purpura B. Give paracetamol and antihistamin.000/ . A 3 month old boy was admitted because he had red. Hemolytic anemia B. Aplastic anemia C. along with cyanosis. a 1 year-old is noted to have a microcytic anemia.500. There is no hepatosplenomegaly or lymphnode enlargement. Digitalis E. what should you do? A. Anaphylaxis D. He had been breastfed and his mother recently gave him cow‟s milk formula 5 days before admission. There was no history of transfusion before. Leukimia E. keep the intravenous line open with Psychological Saline until the symptom resolved ALLERGY-IMMUNOLOGY 10. Complete blood count reveals slight leukocytosis and normal platelet count. What is the baby‟s diagnosis? A. Post-hemorrhagic anemia D. Heart Problems 11. There was a history of low grade fever for few days. Antihistamine B. Stop the transfusion. A Patient suffered from fever and chills 30 minutes during Packed Red Cell transfusion. palpable wheals all over his body. Epinephrine C. lower trunk and buttocks. and platelet count 180.

ear. Thrombocyte count exceeding the normal limit TROPICAL/INFECTIOUS DISEASE 14. She has some inspiratory stridor and thick white-gray material covering her tonsils and faucial pillars. E. Roseola D. Prolonged PTT D. His oral exam is significant for thrush. Polymerase chain reaction C. He is noted to have oral thrush. Ceftriaxon injection D. Viral culture 17. Which is the following vaccines is contra-indicated in HIV-infected children? A. What you expected to find is: A. Pneumococcal E. Assuming this case to be Henoch Schonlein Purpura. IPV B. HIB D.12 12. heart and lung exams are normal. Prolonged APTT C. B2 agonist nebulization B. You noticed that the purpura was palpable. low-grade fever. and appears moderately ill. B. you asked for laboratory investigation. Immunzation with DT E. A 5 years old girl presented to you with purpura that spread over her buttock and lower extremities. Western-blot D. The most likely diagnosis of this girl‟s condition is A. Your immediate management step to the case . Erythema infectiosum E. In addition. Corticosteroid C. Which one of the following is used as a screening test in HIV infection diagnosis? A. He has liver. During the next 24 hours. He was hospitalized 3 times with the same complaint. she develops tender swelling of her wrists and redness of her eyes. Prolonged clotting time B. along with breathing difficulty of 1 day‟s duration. spleen enlargement along with anterior/posterior cervical and occipital lymphadenopathies. A 20 month-old baby has a three week history of diarrhea and recurrent fever. MMR C. ADS 40. A 10 years old girl present with a history of sore throat for 4 days. and she has swelling of her neck. Enzyme immunoassay B. You are a doctor on duty when a pregnant woman visit you and ask if you can do something to avoid her baby from getting allergy after the baby is born. Thrombocyte count below the normal limit E. C. At the moment he has a body weight of 7 kg.000 IU 15. Four days after the onset of illness the rash has vanished. D. her physician notes mild tenderness and marked swelling of her posterior cervical and occipital lymph nodes. BCG . Erythema multiforme 16. Rubella B. Rubeola C. and a diffuse maculopapular rash. Immune fluorescence assay E. is : A. On examination she is very ill-appearing. What kind of treatment will you give for the patient at the time? A. His head. A 14 year old girl awakens with a mild sore throat. To do allergy screening by taking both parent and siblings history of allergy Suggest parent to give hypoallergenic formula anytime when manifestasion of allergy appear Consider long term antihistamine for the baby soon after delivery Treat allergy symptom when it appears Improving quality of life of the allergic baby 13.

Serum electrolyte E. What is the most possible diagnosis of this baby? A. A 2 month-old baby came to the Emergency Department with seizures and unconsciousness. Polymyositis B. Chikungunya E. A previously healthy 10 year old girl has developed progressive weakness. along with pallor and bulging fontanella. Poliomyelitis C. On examination he has weakness of all muscle groups in his right lower limb.3”). cough or other illness. toxic appearance. flank pain. Which of the following is an appropriate treatment option? A. The limb is hypotonic. Sensory examination is normal. a urine specimen was obtained that grew Escherichia coli with a colony count of 2000/µL. Physical examination showed a very weak baby. There was no history of fever. CK-MB examination D. haematuria and leucocyturia. Hemophilia B. but there has been no preceding trauma. A 6 year old boy is being evaluated for high fever of unknown etiology. Nephritis 23. Oral antibiotics for 7 days E. Von Willebrand Disease C. Stool culture C.13 NEUROLOGY 18. Guillain Barre Syndrome B. paresis of extraocular muscles and respiratory insufficiency over a 2 week period. . Eneuresis E. Acute spinal muscular atrophy D. What kind of examination would you suggest for the patient? A. ITP 21. Lumbal puncture 20. The MOST likely diagnosis is A. CBC revealed Hb 7. Intravenous antibiotics for 7 days C. As part of the laboratory evaluation. Acquired Prothrombin Complex Deficiency D.1” (control 26. These findings will be definite evidence of a urinary tract infection if the sampled urine. Volding cystoureterography reveals findings as a shown below. What would be the most likely diagnosis? A. and deep tendon reflexes cannot be elicited. A 6 week old child is being evaluated for a fever of unknown etiology. Cystitis C. The baby was uneventfully born spontaneously with good condition and had only been breastfed. This was preceded by a febrile illness. There is no pain on movement of the joints nor is there tenderness. Intravenous antibiotics for 3 days B. Which of the following is a working diagnosis option? A. Myasthenia gravis C. DIC E. Spinal tumour 19. Urethritis B. Head CT scan B.2 g/dL normal white blood count and platelet count. A 5-year-old boy present with a limp. Oral antibiotics for 10 days 24. Oral antibiotics for 3 days D. Haemostatic function revealed PPT 45” (control 11.3”) and APTT 53. Pyelonephritis D. vomiting. Diphtheritic Polyneuropathy D. Botulism NEPHROLOGY 22. areflexia. Guillain-Barre syndrome E.

and respirations of 48 breaths/min. and his descended testes are both 2 mL in volume. Sign of decreased perfusion to the respiratory center D. thin hair. Sign of impending respiratory failure C. Order a growth hormone level D. Reassure the mother that the child has normal prepubertal development E. E. Stridor B. sleeps more than normal. his phallus is normal in size and appearance. Normal finding for a toddler B. a pulse of 128 beats/min. XX B. A 2 year old girl who having difficulty breathing and a barky cough has had a fever and runny nose for the past 3 days. XX/XY C. On examination today. flushed skin. XXY D. Cyanosis 29. Measure thyroid function B. Of the following. has an immature facies. Assessment reveals that she has warm. Determine bone age C. The ability to tolerate oral feedings E. is using her abdominal muscles to breathe. hyperkalemia. and hypoglycemia. Weak pulses D. She is alert and sitting on her mother‟s lap. He has begun to gain quite a bit of weight over the last year. and slow reflexes. A normal-apperaring 9 month old boy is discovered on routine herniorrhaphy to have bilateral Fallopian tubes and a rudimentary uterus. A pregnant woman has a low urinary estriol level. What diagnosis should you consider? A. he is obese. Congenital adrenal hypoplasia C. B. D. and has increase work of breathing. His growth demonstrates that he has fallen from to the percentile for height. XY PEDIATRIC EMERGENCY 28. Abdominal breathing in the patient above should be viewed as a : A. but his weight has increased to percentile. her male infant develops hyponatermia. Which is the following is the most appropriate course of action for this child? A. Inappropriate antidiuretic hormone B.14 A. Chromosomal analysis 27. Juvenille diabetes mellitus D.008 ENDOCRINOLOGY 25. Biopsy of the gonads performed during this procedure revealed normal testicular tissue. Is the first morning sample Is from an ileal loop bag Is from a suprapubic tap Is from a bag attached to the perineum of uncircumcised boy Has a specific gravity of 1. Phenylketonuria E. Compensatory mechanism to increase the volume of air inhaled E. An 8 year old boy has short stature. XO/XY E. Hyperthyroid 26. On examination. You should immediately determine whether the patient has: A. and complains of feeling cold. has little or no energy. Delayed capillary refill time C. the MOST likely sex chromosome complement for this child is: A. C. Compensatory mechanism to increase the respiratory rate . She has a blood pressure of 88/66 mm Hg. At delivery.

The appropriate initial treatment in patient above is to A. This child most probably had a deficiency of A. Marasmus C. A 3 month old infant who is extremely lethargic has had a cough. Proper management would be: A. Vitamin E . A 3 year old boy came with a history of nausea. fatigue and headache. anorexia. Administer 100% oxygen by mask B. vomiting. the ribs pronounce. The boy‟s face resembled „old man face‟. He has a blood preasure of 74/60 mm Hg. a pulse of 190 beats/min. respirations without increased work of breathing at 60 breaths/min. (using gold standard CDC -2000). Pneumothorax D. Marasmic-Kwashiorkor D. and rapid. The hemoglobin level was 6 g/dL. On admission the body weight was 6 kg. Oral iron supplementation is allowed starting at second week of hospitalization D. Immediate transfer to intensive or high care ward C. Administer fluid infusion NUTRITION 32. Thiamin C. He had measles two months before. High protein along with a low fat diet 34. Blood transfusion given as soon as possible B. hyper-pigmented skin and edema on the feet. The boy‟s weight is 9 kg and his height 90 cm.15 30. Immediately starting a high calorie diet of 200 KKal/kg E. The boy was slimy. A 3 year old boy who suffer from diarrhea more than 6 times a day was brought to the clinic. Vitamin C D. Failure to thrive E. along with „flag sign hair‟. No bloody stool was found. diarrhea. Vitamin A B. Stunting 33. she did not show any sign of respiratory distress or cardiac emergencies. has mottled skin color. Swelling of the brain E. What the diagnosis of the child? A. and a capillary refill time of 4 seconds. Laboratory examination revealed hypercalcuria. Perform endotracheal intubation E. Kwashiorkor B. A 2 year old girl came with obvious pallor. Administer epinephrine via an intraosseous needle D. vomiting. and diarrhea for the past 3 days. The tachycardia in this infant is most likely due to: A. Vitamin D E. Administer dopamine intravenous C. Pain 31. Hypovolemia C. Assessment reveals that he respond to pain. Anxiety B. He showed confusion and appeared psychotic. the skin wasting.

thereby decreasing the risk of infections C.5 kg infant is delivered at 37 weeks of gestation. D. He uses gestures to communicate. can lift his head from a prone position 45º off the examining table. Pillows in the crib should be soft to provide a comfortable sleeping environment B. When should enteral feeding be given or this patient? A. A 3. Manipulative behaviour D. including tympanography. 10 months 37. C. and these are poorly articulated. Administer 10 ml/kg 50% dextrose intravenously D. The most likely age of the infant is A. cough and cold. An infant is brought by his mother to your well-baby clinic.16 35. 8 months E. E. Intellectual disability B. The infant is lethargic in the nursery and the blood Dextrostix test is found to be undetectable. the respiratory rate was 54x/minute and Capillary Refill Time 10 seconds. you tell her that A. Deafness C. He cannot maintain seated position. and the ideal body weight 11. There was no history of vomiting and diarrhea. Administer 2ml/kg 10% dextrose intravenously . As soon as possible after stable condition After 72 hours 48 – 72 hours After the patient was conscious As soon as possible after 24 hours GROWTH AND DEVELOPMENT 36. Her baby should be placed on his back to sleep. Seven days before admission. The body weight was 10 kg. she look weak. she got high fever. Dysarthria E. The mother has concerns about maintaining a safe environment for her child. B. The Apgar scores are 4 and 7 at 1 and 5 minutes respectively. 6 months D. There were fine moist rales on both lungs. The next appropriate step is: A. the percent ideal body weight was 84%. body length 85 cm. 1 month B. The heart and bowel sounds were within normal limits. Administer glucagon intravenously E. Obtain serum for blood sugar analysis to confirm the Dextrostix value B. A 4. is normal.5 year old boy says only three single words.9 kg. She can start to give solid food like pieces of apple or banana D. to increase his fine motor development 38. The mother is a 29 year old juvenile diabetic. gross and fine motor skills are normal for age and physical examination. He can move his head from side to side while following a moving object. Which of the following is the MOST LIKELY explanation? A. 3 months C. as this decreases the risk of Sudden Infant Death Syndrome E. On clinical findings. Maternal blood glucose prior to delivery was 320 mg/dl. Administer glucose water by mouth C. She should set her water heater to 70ºC to ensure the sterility. In providing age-appropriate anticipatory guidance. There are no other reported problems. A cesarean section is performed when fetal distress is noted. She should give him small objects such as round pliable toys. Autism PERINATOLOGY 39. smiles when encourage and make cooing sounds. A 24 month old girl was admitted to the emergency department the main complaint of high fever.

Low birth weight B. night sweats. PCO2 50 mm Hg. Administer endotracheal surfactant immediately B. The ECG demonstrates right axis deviation and right ventricular hypertrophy. Premature infant C. A chest radiograph reveals a fine granular appearance of the lung fields. PO2 55 mm Hg. What is the most likely diagnosis for this patient? A. How would you classify this infant by weight for gestational age? A. Small for Gestational Age (SGA) E. The baby is hypotensive and poor is noted. By her date and abdominal palpation she is 32 weeks pregnant. Arterial blood gas shows a normal pH. Administer 10 ml/kg 0. Initial arterial blood gas reveals pH 7. Ventricular septal defect . Increase the ventilator settings to keep PaCO2 below 40 mm Hg C. Juvenile rheumatoid arthritis C. The chest x-ray film reveals a large heart with a reduced main pulmonary artery segment. Subarachnoid hemorrhage B. Appropriate for Gestational Age (AGA) D. and PaO2 at rest. Focal brain contusion E. PaCO2. Administer a dopamine infusion at 10 mgm/kg/min E. and intercostal retractions and is intubated. a 30 week gestational infant is delivered. weight loss. The New Ballard Score confirm the gestational age. A patient presents in labour at a level 1 clinic. Acute rheumatic fever D. Kawasaki disease B. A one month old is seen after turning blue when feeding. The baby demonstrates nasal flaring. A five year old girl presents with fever for 8 days. splenomegaly. Epidural hematoma C. A 27 year old gravida 1 para 0 female presents with a history of prolonged rupture of membranes and is presently in active labor. Positive pressure ventilation is initiated. Concussion 41.16. Coarctation of the aorta C. and base excess -14. Atrial septal defect B. After a short labour she delivers a male infant weighing 1400 grams. Auscultation of the heart reveals a harsh grade ill systolic ejection murmur over the pulmonary area that radiates to the back. Large for Gestational Age (LGA) CARDIOLOGY 43. Which of the following congenital heart disorder is consistent with these findings? A. Which of the following is the most appropriate intervention at this time? A.9% sodium chloride IV D. a new heart murmur. the most likely finding would be: A. Tocolytics are started. grunting. Administer broad-spectrum antibiotics immediately 42. joint pains and a history of having her teeth cleaned by a dentist 1 month prior to this visit. A 2 day old is brought to ED after a generalized seizure lasting 3 minutes.17 40. If the seizure were related to birth trauma. Patent ductus arterious E. Infective endocarditis E. and despite medical intervention. Systemic Lupus Erythematosus 44. Tetralogy of Fallot D. Subdural hematoma D.

A 4 year old boy was referred for dyspnea on exertion. Septic shock 46. with no evidence of cyanosis. A 13 year old girl was admitted to the hospital due to chronic cough and difficulty of breathing since 2 days ago. Heart rate was 112 times per minute. and Blood Gas Analysis. Peripheral Blood Smear. Cardiomyopathy RESPIROLOGY 47. Congestive heart failure C. while the father was a heavy smoker. severe pain and redness of ankles. Bronchopneumonia C. The precordium is normal except for a mild thrill in the apex. Physical examination revealed that the baby was alert. Cardiogenic shock E. Respiratory acodosis on BGA 49. Infective endocarditis E. rhinorrhea and fever 2 days before. but a harsh holosystolic murmur is heard in the apex. Emphysematous lung. All other vital signs were normal. Juvenile rematoid arthritis B. especially at night. no rhales or crackels was evident. cold sweat on the forehead. Pneumonia B. Antitussive to depress coughing . Metabolic acodosis on BGA B. The patient then underwent Chest X Ray. Administration of broad spectrum antibiotics B.18 45. only metabolic acodosis on BGA E. There is distended neck veins and tachycardia. Hyperaeration on CXR and Hypercapnia. The CXR showed cardiomegaly with increased pulomnary vascular marking. He started to have cough. The ECG showed LVH. Diffuse wheeze was heard over both lungs. Acute rheumatic fever C. She complained that this condition recurs almost every month. Infective endocarditis B. Myocarditis D. Proper initial prompt treatment of this case : A. Respiratory acodosis on BGA C. Poor weight gain. What is the diagnose? A. respiration rate 60 times per minute. Acute asthma attack 48. S1 and S2 are normal. Alveolar infiltrate on CXR and no hypoxemia.5 C. She was able to communicate to the physician. Bronchiolitis E. with increased expiration time. appeared distressed. Cardiomyopathy D. Lung auscultation appeared wheezing. The result of CXR or BGA is predicted as: A. Oral mucolitic to dissolve mucus E. On physical examinantion the child looked slightly dyspneic. with each attack typically lasting for 1 or 2 days. alveolar infiltrate on CXR and Metabolic acodosis on BGA D. Working diagnosis of the cas is: A. What is the diagnosis? A. The mother had a history of having allergic rhinitis. Pleural effusion on CXR and Hypoxemia. with clear and uninterrupted sentences. Diffuse infiltrate on CXR and Hypoxemia. Inhalation therapy with B2 Agonist C. Simultaneous steroid and aminophyllin intravenously D. The abdomen is soft and there is no organomegaly. A 6 year old boy was referred for prolonged fever and welling. A 7 month old boy was brought to the hospital with the chief complaint of difficulty in breathing since 3 hours prior to admission. the body temperature was 38. Acute Bronchitis D.

His father suffered from haemopthysis and has been treated with antituberculous drugs since a week ago. Refer the patient for evaluation of neonatal cholestatis D.2 mg/dl.6 mg/dl.200/µL respectively. Inform the family that it must be a lab error since conjugated bilirubin suggests breast milk jaundice. Explore the possibility of ABO incompatibility. Platelet count is 20. The child was symptomless with normal body weight. Prolonged clotting time . Tuberculin skin test result was 12 mm. Elevated fibrin degradation products D. Presence of a mediastinal mass B. The best course of action is to: A. Secondary chemoprophylaxis with isoniazid for 6 months D. A 4 year old child presents a petechial rash but is otherwise well and without physical findings. Malrotation with midgut volvulus D. Secondary chemoprophylaxis with isoniazid + rifampin for 6 months E. What is the most likely diagnosis? A. Age between 1and 10 years E. 2009 SELECT THE ONE BEST ANSWER. The family of a child just diagnosed with acute lymphoblastic leukemia asks for information about the child‟s a prognosis. Hemoglobin and WBC are 12. B. Pyloric stenosis C. Prolonged bleeding time B. Repeat blood work in two months since presence of unconjugated bilirubin suggest to breast milk jaundice. E.000/µL. White blood cell count at diagnosis of less than 100. Total bilirubin was 4. Inform the family that liver biopsy and cholanglogram are associated with high risk of bleeding and shoud be avoided at all cost. Hyperdiploidy with more than 50 chromosomes C. Appendicitis B. rifampin. and pyrazinamide for 2 months. Which of the following laboratory abnormalities is most commonly found in this case? A. C. conjugated bilirubin was 3. A 3 year old boy was brought to pediatric clinic for consultation. PUT YOUR ANSWER IN THE ANSWER SHEET TIME ALLOCATION IS 100 MINUTES GASTRO-HEPATOLOGY 1. Give isoniazid. Prolonged prothrombin time (PT) C.1 mg/dl. Included as a poor prognostic sign is which of the following? A. 2. Which of the following answers is the most appropriate management in this child? A. Early pre-B-cell variety of the disease 4. Primary chemoprophylaxis with isoniazid for 3 months B. and the chest x-ray doesn‟t show any suggestion for tuberculosis. A pediatrician received result of fractionated bilirubin on a 1 month old infant. follow with isoniazid and rifampin for 4 months NATIONAL MCQ EXAMINATION NATIONAL BOARD OF EVALUATION INDONESIAN COLLEGE OF PEDIATRICS DECEMBER . Functional intestinal obstruction HEMATOLOGY 3.4 g/dl and 7. Primary chemoprophylaxis with isoniazid + rifampin for 3 months C. unconjugated bilirubin was 1.000/µL D. A 10 day old mate presents with bilious emesis.19 50. Prolonged APTT E. Feeding intolerance E.

Secondary Thrombocytopenic Purpura C. Systemic Lupus Erithematous D. Hemostatic function also reveals normal. lower trunk and buttocks. What is the most likely allergen responsible for the symptoms? A. Immune Thrombocytopenic Purpura B. Iron deficiency B. The body temperature was 40ºC and blood culture positive for a pathogenic microorganism. a teenage boy breaks out in an evolving rash that is remarkable for target lesions. A 15 year old has had persistent year round nasal itching and stuffiness. The family usually eats a regular diet including meats and vegetables. Breast feeding at least 4 months C. The most likely diagnosis in this child is: A.000/µL. DIC J. Juvenile pernicious anemia E. CBC reveals slightly leukocytosis with normal platelet count. Weed C. What would you recommend? A. gum bleeding. Transcobalamin deficiency D. There was history of low grade fever for few days. What is the primary treatment? A. The parent also report that she has not been eating well. Grass E. Two weeks following a viral illness. ALL 6. Using HEPA air filter and vacuum E. A 3 year and 5 month old child presented to the clinic with fever. Folate deficiency ALLERGY-IMMUNOLOGY 8. Henoch-Schonlein Purpura E. Nutritional deficiency C. A 5 year old boy came with rashes like purpura in the lower extremities. There was no other complaint. A mother of a children with multiple allergic disease asks you for allergy prevention advice for her next child. ITP H. Tree D. Diet control during pregnancy D. red. Physical examination was unremarkable. The blood pressure was 90/70 mmHg and peripheral blood count revealed Hemoglobin 7 g/dl. Corticosteroids D. Glucagon C. APTT and PTT were prolonged. Antihistamines E. Mold 9. Immunotherapy during pregnancy 10.20 5. Germ free environment B. and tender. The most likely diagnosis of this case is: F. Drug Allergy 7. The parents of a previously healthy 3 year old girl bring the children to your office because she is complaining that ther tongue hurts. Epinephrine B.000/µL and platelet count 30. Her complete blood count reveals a macrocytic anemia. Henoch-Schonlein purpura G. Symptomatic or supportive therapy depending on severity . melena and purpura. She is pale and has tachycardia. WBC 22. On physical examination her tounge is smooth. Hemophilia I. Which is the most possible diagnosis in this child ? A. Dust mite B.

Failure to thrive B. Drug allergy B. urticaria. Coxsacklevirus E. along with.21 11. The etiology of this infection is likely: A. Oral candidiasis E. and when she has eaten them in the past. Antitoxin alone E. A 5 years old boy presents to the clinic with a history of low grade fever for 3 days. chronic cough. Viral urticaria TROPICAL / INFECTIOUS DISEASE 12. Food allergy C. Mononucleosis infection C. bleeding area of tissue. Popular pruritic eruption 13. oral candidiasis. the most likely that indicate cellular immunodeficiency is A. Exam shows an adherent grayish white membrane over both tonsils and the soft palate that. Lunch included foods she normally eats. She had just finished lunch today and taken her medication when she experienced respiratory difficulties. After calling your state health department. prolonged fever. Intravenous erythromycin or penicillin G B. Mumps D. An 8 month old boy born from a HIV infected mother had failure to thrive. From all the above mentioned symptoms. Prolonged fever C. A 6 year old child complains of sore throat and is noted by the parens to have a lot of “grayish junk” in his mouth and nose. The most likely diagnosis of the boy‟s condition is : A. IVIG . febrile and has profuse rhinorrhea. and general discomfort. the MOST likely cause of her reaction is: A. Coronavirus D. Arcanobacterium haemolyticum C. you initiate therapy with: A. She does not like eggs. when removed. There was no evidence of cough or coryza. Drug allergy E. The above antibiotics plus antitoxin C. The above antibiotics plus antitoxin plus active immunization D. leaves an edematous. except for a new brand of chicken noodle soup and shrimp salad for dessert. Diphteria B. Corynebacterium diphtheria 15. Serum sickness E. shallow ulcers are noted on the soft palate and vesicles are noted on one plam and both soles of the feet. and popular eruption. On exam. She is currently taking amoxicillin for treatment of otitis media. Chronic cough D. Group A streptococci B. A 3 year old is very fussy. Lymphadenopathy tuberculosis 14. she spat them out. Mother says that there were 2 other children in her neighborhood presenting similar symptoms. You are seeing a 4 year old girl in the emergency department for treatment of an episode of anaphylaxis. Food poisoning D. Of the following. tender swelling of both of his mandibula.

and her performance in school begins to deteriorate. After a urinary tract infection. What is MOST likely to be the position/location of the transtentorial herniation? A. Chickenpox B. Low doses antibiotic B. She is eventually quadriparetic. A 7 year old girl develops behavioral changes. Death occurs within a year. She should be put in a bath of cold water C. A previously healthy 3 year old child has a single generalized convulsion lasting 5 min. and hepatomegaly. German measles C. This patient may have had which of the following viral disease at 1 year of age? A. 600 mg aspirin should be administered D. ataxia. Several months later she develops a seizure disorder. Most such children will not have a further seizure 18. Which of the following is CORRECT? A. Idiopathic hypercalciuria 21. He present with hypertension. Postsreptococcal glomerulonephritis B. Hydrocephalus D. An antibiotic should be administered promptly E. periorbital edema. a 1 year old boy is diagnosed with grade 2 vesicourethral reflux. Diencephalon C. Diet low in protein E. medulla 17. and focal neurologic symptoms.7ºC. Immediate surgical reimplantation of the ureters C. Hypothyroidism C. Mid-brain-upper pons D. Reticular formation B. Mumps E. Weekly urinalyses and culture D. Parvovirus B19 19. Low pons-upper medulla E. Which of the following is an appropriate treatment option? A. Three months later she again becomes febrile with an upper respiratory tract infection. There is central hyperventilation. from which she recovers uneventfully in 5 days. A condition unlikely to cause this problem is : A. Early toilet training . A 6 year old boy has brown urine and healing impetigo lesions. Pupils are mid-position and irregular 3-5 mm and fixed.22 NEUROLOGY 16. Measles D. On physical examination you found that he still has a palpable anterior fontanel. dyspnea. Hypophosphatemia NEPHROLOGY 20. she is found to have a reddened throat and a rectal temperature of 39. Nephritic syndrome D. She should be started on oral phenobarbitone B. He shows bilateral decerebration posturing to noxious stimuli. lgA nephropathy C. The vestibule-ocular reflex is intact. Rickets B. and unresponsive. Undernutrition E. The most likely cause of this problem is: A. A 20 month old child was seen at a well baby visit for routine examination. spastic. Pyelonephritis E. A child presents in a coma.

Which of the following conditions is the most likely cause of primary ovarian failure? A. a small penis. Wait for improvement of her diabetes over the next 1-2 days. Congenital adrenal hyperplasia C. At age 6 years. Henoch Schenloin Purpura C. although the thyroid gland cannot be palpated. Laboratory studies show how low estradiol and elevated follicle-stimulating hormone (FSH) levels. Androgen insensitivity syndrome 24. Ask her to recheck her urine ketones again every day D. it was the 40th percentile. Non-Robertsonian translocation E. and blood glucose is 360 mg/dl. Her parents are of average height. as determined by plotting her height on a standard growth curve. A 2 year old boy developed bloody diarrhea shortly after eating a fast food restaurant. Hemolytic uremic syndrome ENDOCRINOLOGY 23. Her urine test have become positive for ketones. Which of the following approaches is appropriate? A. Free T4 and T3 B. Growth hormone and blood urea nitrogen C.23 22. A short 16 year old girl presents with primary amenorrhea. The boy has had some difficulties in school. Deletion B. it was at the 10th percentile. and the parents say that according to the school psychometrist he had an IQ of 90. The pair of laboratory test that would best help explain the cause of this patient‟s recent growth retardation is: A. Intussusceptions D. he develops pailor and lethargy. followed by the introduction of antibiotics B. her height was at the 60th percentile. lg A nephropathy B. and gynecomastia. An 8 year old girl has a 2 year decline in growth velocity. TSH amd free T4 26. Thyroid ultrasonography and technetium pertechnetate scan D. and ate age 8 years. T4 and free T3 E. Laboratory evaluation reveals low hematocrit and platelet count and positive blood and protein in the urine. Advise her to drink clear non-caloric fluids only and stop all solid food E. Nondisjunction of an autosomal chromosome C. Autoimmune ovarian failure D. at age 7 years. Physical examination reveals small testes. Her history is otherwise unremarkable. Admit her to hospital for stabilization 25. A 15 year old boy is evaluated by a clinician for failure to develop normal male secondary sexual characteristics. A girl aged 10 years with diabetes type 1 developes polyuria and polydipsia in the course of an eposide of bronchopneumonia. Which of the following diagnoses is likely to explain this symptoms? A. This patient‟s condition is most likely to be related to which of the following? A. A few days later. his face looks swollen and his mother reports that he has been urinating very little. Nondisjunction of a sex chromosome D. Poststreptococcal glomerulonephritis E. and physical examination reveals no abnormalities. Increase her insulin doses the next day by 30% C. Robertsonian translocation . Hypogonadotropic hypogonadism E. Turner syndrome B.

Trisomy 21 D. no symptoms after gavage feeding. Tow dimensional echocardiography reveals congenital heart defects. Which of the following signs suggest significant obstruction of the tracheostomy tube? A. immunological and physiological benefits to breastfeeding. XYY PEDIATRIC EMERGENCY 28. His mother states that his breathing is getting much worse. Tracheo-esophageal fistula without esophageal atresia C. Irregular respiration and wheezing C. Pyloric stenosis E. practical. Which of the following genetic conditions is most likely to be the cause of this child‟s presentation? A. A 3 year old boy who has a tracheostomy has had difficulty in breathing and coughing for 2 days because of increased secretions. The baby has tachycardia but otherwise the vital signs are stable. Crackles and fever D. Opioid E. Recommended food for infants both term and preterm B.24 27. Cholinergic D. Perform an upper gastrointestinal contrast study E. coarse rhonchi and rales after swallowing. Isolated esophageal atresia D. Tracheo-esophageal fistula with esophageal atresia B. Trisomy 13 B. A slow heart rate and poor air movement B. gastric distension after crying. small eyes and 6 fingers on each hand. What would be the next step in this case? A. Consider the possibility of gastro-esophageal reflux B. You are called to ask for new feeding orders. Trisomy 18 C. On physical examination the abdomen was “full” without marked abnormalities. Start a proton pump inhibitor C. Sympathomimetic C. no difficulty in swallowing. There are nutritional. He is on continuous oxygen. Decreases incidence of allergic disorders PERINATOLOGY 31. Anticholinergic B. A newborn infant presents with the following clinical picture: coughing and cyanosis immediately after ingesting fluids. A child with a suspected ingestion presents to the emergency department with delirium. This child exhibits signs and symptoms of which toxidrome? A. mydriasis. Breast milk is the natural food for full term and premature infants during the first months of life. Fifty percent of energy are from proteins C. A one week old newborn is irritable and has several episodes of bilious emesis after the most recent feeding. XXY E. has cool. mottled skin. tachycardia. Achalasia .e. The most likely diagnosis is: A. Contains immunological benefits (i. No breathing 29. active lymphocytes) D. Sedative hypnotic NUTRITION 30. Unequal chest rise and wheezing E. Assessment reveals that he is lethargic. Perform ultrasound examination of the pylorus D. and has copious secretions in the tracheostomy tube. psychological. Which is the following is NOT true about breast feeding? A. Promotes growth of lactobacillus in GI E. lgA. A baby is born with small head. dry mucus membranes and warm/dry skin. Change oral feeding to a soy-based formula 32.

Likely diagnoses is: A. circulation D. Congenital heart disease C. What is the most likely diagnosis? A. She was born uneventfully at 37 weeks gestation with a body weight of 2900 grams. the first thing to assess is: A. A child is brought to your clinic for routine examination. and there were no neonatal problems. develops persistent regurgitation and vomiting in the second and third weeks of life. Gastric resection D. A baby who was apparently normal at birth. A 12 year old girl presents with poor feeding. There is no organomegaly. and HR 150/min. He smiled at 6 weeks and could pick up a small object with his finger and thumb at 10 months. no rash or dysmorphic features. She has lost weight <3%.25 33. Presence or absence of a suck reflex E. Spina bifida occulta E. phenylketonuria 38. A baby boy was born at 32 weeks gestation. E. Presence or absence of symptoms C. Mental subnormality B. He is not yet walking at the age of 16 months. and can speak in short sentences. RR 40/min. Congenital adrenal hyperplasia B. the chest is clear with no evidence of murmur. Oral antibiotics E. She can dress with help. vomiting nd lethargy. When evaluating a hypoglycemic infant. Inborn errors of metabolism D. 4 years E. Transient tachypnea of the newborn E. can ride a tricycle. She had difficulty in copying a square. Which of the following therapies is most likely to be effective in this case? A. Gross motor delay C. Neonatal hypoglycemia D. Coli meningitis B. Congenital hypothyroid 35. No drugs or other medications were given. Which of the following conditions is LEAST likely to be associated with neonatal seizures? A. Ballard exam B. No fever is present and hematologic studies and blood chemistries are normal. The age of this child is most likely A. Sepsis E. 5 years . 2 years C. 3 years D. Antacids B. Airway. the temperature is 36. kows her own age. 1 year B. Apgar score 36. Syndrome of inappropriate diuretic hormone C. His speech is normal. breathing. Muscular dystrophy D. Umbilical cord prolapse GROWTH AND DEVELOPMENT 37. Barium enema C. Pyloromyotomy 34.5 5ºC. On examination she is thin and wasted.

S1 and S2 are normal. what is the lesion? A. The precordium is normal except for a mild thrill in the apex. PDA (Patent Ductus Arteriosus) D. AVSD (Atrio-Ventricular Septal Defect) E. Turn pages one at a time B. She should be able to do all of the following except: A. including tympanigraphy. A 7 years old girl is referred for chronic recurrent cough. gross and fine motor skills are normal for age and physical examination. severe pain and redness of his ankles. and thes are poorly articulated. Ventricular septal defect . PS (Pulmonal Stenosis) 42. Walk unsupported CARDIOLOGY 41. She shows normal vital signs. Cardiomyopathy 43. A rough murmur is heard at the left upper sternal border. Juvenile rematoid arthritis B. There are no other reported problems. A 2 year old girl comes in for a well baby check up. but harsh holosystolic murmur is heard at the apex. Dysarthria E. Infective endocarditis E. is normal. pulses. Use 2-3 word phrases C. A 3. A patient presents with cyanosis and clubbing of the toes with sparing of the fingers. Atrial septal defect B. VSD (Ventricular Septal Defect) B. An eight year old boy with known diagnosis of unrepaired tetralogy of Fallot becomes severely cyanotic while crying. What is the diagnosis? A. S2 is fixed and widely split. The RV impulse is accentuated. Manipulative behavior D. and abdomen. He uses gestures to communicate. Participate in group play E. Propranolol E. Morphine sulfate D. Insert rectal tube 44. Autism 40. Oxygen C. Intellectual disability B. A 6 year old boy was referred for prolonged fever and swelling. What is the most likely diagnosis? A. Acute rheumatic fever C.5 year old boy says only three single words. Which of the following is NOT indicated for acute management of this situation? A.26 39. and there is also a 2/6 middiastolic murmur at the lowest left sterna border. Which of the following is the MOST LIKELY explanation? A. A nonspecific 2/6 almost vibratory systolic ejection murmur is best heard at the left sterna border. The abdomen is soft and there is no organomegaly. Myocarditis D. Patent ductus arterious E. Sinus of valsava fistula C. Deafness C. Common atrioventricular canal defect D. ASD (Atrium Septal Defect) C. Follow two step commands D. Placing in knee chest position B.

Acute epiglottitis D. Pneumococcal pneumonia. fever. Chest radiograph E. macrolide C. Viral croup . A 3 month old girl has suffered from dyspnea since 2 days befor admission. Give isoniazid. Primary chemoprophylaxis with isoniazid for + rifampin for 3 months C. supraclavicular. no dyspnea and no TB contact. Complete blood count and differential C. and the chest x-ray didn‟t show any suggestion for tuberculosis. Severe asthma exacerbation B. A 2 year old boy suffer of inspiratory stridor. No hepatosplenomegaly. especially at night. Primary chemoprophylaxis with isoniazid for 3 months B. cephalosporin D. cough. aminoglycoside B. A healthy 15 year old complains of swollen glands in his neck and groin for the last 6 months along with an increasing cough over the previous 2 weeks. no abnormalities were found except for a slight decrease of her right field breath sound. Foreign body aspiration B. Biopsy of a node B. What is the most likely diagnosis for this patient? A. Asthma. Pneumonia with GER E. and pyrazinamide for 2 months. Bronchiolitis 48. He has ha a mild upper respiratory tract infection for 3 days. Her laboratory result are WBC: 4000/ with a preponderance of polymorphonuclear. and wheezing were evident. He also reports some fevers. and vomiting. There is no family history of atopy.27 RESPIROLOGY 45. Acute laryngitis C. and inguinal nodes. Severe pneumonia C. His father suffered from haemopthysis and had been treated with antituberculous drugs since the week before. Pertussis. On examination. A 10 year old girl came to the outpatient clinic with the chief complaint of cough for 3 weeks. Tuberculosis. and possibly some weight loss. The child was symptomless and had a normal body weight. The most likely diagnosis in the patient is: A. The most appropriate assessment and management of choice would be: A. Which of the following would be the appropriate next step? A. crackles. On physical examination she had good nutritional status. She also complains of rhinorrhea. Secondary chemoprophylaxis with isoniazid for 6 months D. follow with isoniazid and rifampin for 4 months 47. Which of the following answers is the most appropriate management in this child? A. Cat-scratch titers 46. chest indrawing. salbutamol nebulizer 49. nasal flaring. On the physical examination revealed suprasternal and intercostals retractions. On physical examination fever. Secondary chemoprophylaxis with isoniazid + rifampin for 6 months E. axillary. and barking cough. Papilloma of larynx E. Atypical pneumonia. nasal flaring. Tuberculin skin test result was 12 mm. you notice that he has nontender cervical. Pneumonia with asthma exacerbation D. rifampicin E. tachypnea. rifampin. Trial of antituberculos drugs D. She had no fever. The Tuberculin SkinTest resulted in a 5 mm induration and the Chest X-Ray was as attached below. A 3 year old boy was brought to a pediatric clinic for consultation. and otherwise looks to be fairly healthy.

Inspection of the anus reveals no fissures. Cholecystitis C. She denies fever or diarrhea but has nausea and intermittent vomitting. Her direct bilirubin is 9. but blood is present on the examiner‟s finger following digital examination of the rectum. 2010 SELECT THE ONE BEST ANSWER. On her examination. Streptomycin 7th NATIONAL MCQ EXAMINATION NATIONAL BOARD OF EVALUATION INDONESIAN COLLEGE OF PEDIATRICS JULY 14. A patient with tuberculosis develops bright orange-red urine. Hepatitis B e antigen 3. Juvenile polyp C. PUT YOUR ANSWERS IN THE ANSWER SHEET TIME ALLOCATION : 100 MINUTE GASTRO-HEPATOLOGY 1. Intussusception B. Billiary atresia B. Meckel‟s diverticulum D. Rifampin E. His mother was in a panic because she is afraid he is bleeding into the urine. Hepatitis B surface antigen D. A 5-year-old girl has had intermittent. Ulcerative colitis . The most likely cause of her direct hyperbilirubinemia is which of the following : A. Pyridoxine D. Which of the following medications is most likely to procedure this side effect? A. Of the following. An 8-year-old girl presents to your office with a 3 day-history of decreased appetite and abdominal pain. Acetaminophen toxicity E. Your initial evaluation includes A. Sepsis D.full-term girl has worsening jaundice that the parents first noticed 10 days ago. Chollytiasis F. Physical examination reveals a jaundiced girl with a height and weight at the 50 percentile for age.28 50. she is well appearing and is noted to have a liver edge 4 cm below her costal margin. Hepatitis B antibody E. The patient has no other urinary tract symptoms. but the patient has diffuse right upper quadrant pain and enlargement of the liver without splenomegaly. Isoniazid C. painless. the most likely cause of this patient‟s rectal bleeding is : A. Peptic ulcer disease E. Ethambutol B. bright red colored bleeding from the rectum in association with bowel movements for the past 3 months. The abdomen is soft and nondistended with positive bowel sounds. Hepatitis A antibody B. Monospot C. A 7-week-old.

Replace the volume B. Cephalohematoma D. Evaluation with ultrasound of this lesion may demonstrate : A. Laboratory studies at 18 hours of age revealed a hematocrit of 79 %.7 mg/dl. His 8 years old sister was well nourished and had no complaints. A premature infant had been fed 10 ml for orogastric tube. magnesium 2.5 mEg/l. and calcium 8.000/micro. Choledochal cyst C. Volvulus 5. A newborn male spits up his first feeding and subsequently develops bilious emesis following further feddings. His Birth Weight was 3100 gram and his placenta didn‟t show any tubercle. Tracheoesophageal fistula E. Polycythemia B. Increase the interval of feeding E. she delivered a 2100 grams -infant with an Apgar score of 1 at 1 minute and 5 at 5 minutes. His mother was on antituberculosis treatment since 1 month before the baby was born. Discard the aspirate and continue the feedings C. Hirschsprung disease D. Omphalocele E. The examination of a newborn‟s back reveals a quarter-size “lump” of the soft tissue overlying the lower spine. the most likely cause for this infant‟s vomiting and clinical findings is : A. the infant had a generalized convulsion. Hypermagnesemia E. when the clinical condition is good and tuberculin test negative D.29 PERINATOLOGY 4. There is no need for giving BCG immunization 6. Soon after. when the clinical condition is good and tuberculin test negative E. On physical examination. Fasting B. At the age of 3 months. The physical examination and vital signs are normal. A 19 year-old primiparous woman developed toxemia in her trimester of pregnancy and during the course of her labor was treated with magnesium sulfate. Immediately after Birth B. Thrombocytopenia 7. At the age of 1 months. The most appropriate time for BCG immunization would be : A. he appears ill. glucose 41 mg/dl. What should you do to the infant? A. Of the following the infant‟s seizure was most likely caused by A. Of the following. and has absent bowel sounds. A baby boy was born from a mother who had positive AFB from her sputum. Hypoglycemia C. The baby was doing well with 9/10 Apgar Score. has a scaphoid abdomen. His 3 years old brother was also in a good condition. Occult spina bifida . The gastric residual before feeding is 2 ml which contained digested formula. Take an abdominal radiograph D. Antral web B. At the age of 2 months as a routine immunization schedule C. platetet count of 100. He also had two siblings. Hypocalcemia D. Ebstein pearl B. Mongolian spot C. At 38 weeks‟ gestation. A plain radiograph reveals air in the proximal small bowel but a paucity of air in the distal digestive tract.

Septic shock B. A 5-year-old boy came to the emmergency departement because of clammy hands. Kawasaki‟s disease C. erythematous rash which blanches on pressure. Hematocrit 47 % and platelet count 90. Dengue Hemorrhagic Fever grade II D.000/cmm. Stevens-Johnson syndrome E. Dengue Hemorrhagic Fever grade IV 11 A 9-year-old boy presents with fever >39°C for 4 days. conjunctival injection. Based only on that story. Kawasaki disease C. A thick white exuadate develops on the tongue which peels off leaving a “stawberry tongue” with prominent papillae.30 TROPICAL/INFECTION DISEASE 9. Which of the following would be the most important priority in the prehospital setting? A. Cardiogenic shock C. Staphylococcal scalded skin syndrome E. beginning in the axilar along with some perioral pallor and relative facial sparing. was hospitalized because of dengue virus infection. A 7 year and 6 months-old girl with a body weight and length of 24 kg and 125 cm respectively. A 6 year-old boy has a bright. There were no history of bleeding. Caough and cold were not noted. Petechia and echymosis was found on her skin. Staphylococcal scalded skin syndrome B. Infectious mononucleosis D. His appetite was decreased. punctate. blood pressure of 80/40 mm Hg. Dengue Hemorrhagic Fever grade III E. Toxic shock syndrome D. abdominal pain. Scarlet fever B. Blood pressure was 100/70 mmHg. The rash fades and desquamates on the hands and feet. watery diarrhea. Dengue Fever B. The mother told the doctor that her son had had fever for 4 days. This description is typical of : A. The temperature bacame normal the night before. The skin feels like “sandpaper”. pulse 100/min. Defecation was nornal. Dengue shock syndrome D. the most likely diagnosis is : A. and vomiting. You are informed that a 6 year-old girl is being transported to your ED following a drowning incident at a nearby pool. Wrap the patient in warm blankets D. The most likely diagnosis is : A. Do nothing and continur rapid transport E. The patient is unconscious and total submersion time is unknown. noticed by his parents since the afternoon. Initiate cardiopulmonary resuscitation if the patient is pulseless . she felt that her son‟s hand got clammy. diffuse erythroderma. Cervical spine immobilization C. body temperature 39°C. There were some small red dots on the face and feet. The patient presented with fever for 5 days. red. The most likely diagnosis would be A. Attempts to evacuate aspirated fluid by performing Heimlich maneuver B. Hypoglicemia shock E. Toxic epidermal necrolysis PEDIATRIC EMERGENCY 14. and moderately elevated hepatic transaminases. vomiting and diarrhea. however a few hours later. Measles 10. Dengue Hemorrhagic Fever grade I C. Anaphylactic shock 15. strawberry tongue.

which was of a general type. A 4 year-old boy was admitted to the hospital with alteration of consciousness since 2 days prior of hospitalization. There is marked edema. Quickly push the needle in all the way until a pop is left B. Twirl the needle repeatedly E. A 5 month-old girl came to Emergency Room with difficulty in breathing. the child is not able to cough and is unconscious. Advance the needle by small increments and remove the stylet after each advance to see if cerebrospinal fluid (CSF) comes out 20. and never got severe disease since birth. Haemophylus influenzae D. begin agressive fluid administration. Platelet count 540. and some blistering present. When performing the lumbar puncture in this child.000/cmm. Nebulize respiratory treatments to prevent bronchospasm 17. B.00 cell/ul and chest X-ray showed multiple blebs in right hemithorax. Her physical examination showed increased respiratotory rate along with a chest indrawing. On examination yo note that the burns to the hands and face seem qiute extensive. Blood culture E. Hemoglobin 12. Which of the following is a management priority in this child? A. fever. The most reasonable examination which should be perfomed is : A. Her CBC showed a leucocyte count of 27. Spinal tap . and stiff neck. His bowelmovement and urination were normal. Assess the child‟s airway and oxygenation status C. Auscultation revealed crackles without any evidence of whezzing. Staphylococcus epidermidis E. Push the needle in until resistance is left and then withdraw the stylet C. Estimate the percentage surface area involved in the burn. Streptococcus pneumoniae B. along with headache and projectile vomiting. Three days prior to admission she suffered from fever and cough. Use a needle without a stylet D. The possible causative agent of pneumoniae in this baby girl would be : A. Chlamydia trachomatis NEUROLOGY 19. neck stiffness and spasm. EEG D. perform the Heimlich manouver E. A 5 year-old boy is brought to your emergency departement (ED) for evaluation of scalding burns to face. You are at a restaurant when you observe a child apparently choking. Seizures developed 2 days before admission. which resolved by itself. Administer a combination of back blows and chest thrust D. Physical examinations revealed GCS 8 (E2M4V2). He has had fever for 3 days. Begin humidified oxygen and prepare for intubation D. lasting for 5 minutes and recurred.500/mm³. If the cough becomes ineffective. If the burn involved more than 15 % body surface area (BSA). Active emergency medical service (EMS) B. and torso from hot water. you should A.31 A. Laboratory examinations revealed WBC 5. His physiological reflexes were increased ang pathological reflexes were present. Staphylococcus aureus C. erythema. Which of the following describes the most appropriate intervention? A. Head CT-scan B. He never received basic immunization. hyperthermia. Attempt to remove the foreign body if visualized in oropharynx C.1 g/dl. Place the child on the floor and administer five abdominal thrust RESPIROLOGY 18. An 11-month-old presents to your emergency departement with irritability. MRI C. except for swollen cheek about 2 weeks before. Determine the circulation status E. arms.

gait : unable to walk unassisted.baby by a difficult forceps delivery. The history and physical examination was unremarkable. Hypoplastic anemia 25. Give Iron orally C. Give high calorie diet . upper extremities is 5/5. complex febrile seizure + hyperpyrexia 23. A12 year-old boy. Fracture of the left clavicle B. Continue TB treatment E. Spinal injury with left hemiparesis HEMATOLOGY 24. A 13-year-old boy admitted for complaints of lower extremity weakness niticed that his legs were weak when getting out of bed.32 21.ith lung TB was consulted to you because of pallor. which she kept internally rotated by her side with the forearm extended and pronated. The patient suffered from lung TB since 4 months ago and now was in 2nd month of TB treatment. Give PRC transfusion until Hb 10 g/Dl to increase blood oxygenation B. Fracture of the left humerus C. Malnutrition D. The rest of her physical examination was normal. Poliomyelitis C. status epilepticus + hyperpyrexia + obesity C. Hemoglobinopathy E. Platelet 176000/cmm. bacterial meningitis E. This clinical picture most likely indicates A.2 %. respiration rate 40/m deep. Encephalitis + obesity + bronchopneumonia B. The baby was alert and active. Sensory normal. He contracted an upper respiratory tract infection about 2 weeks ago but did not experience any fever. Myastenia gravis 22. Chronic disease C. His symptoms seem to be getting worse because now he is having difficulty in walking. cranial nerves normal.9 g/Dl. Hb 13 g %. no pronator drift and lower extermity strength is 3/5. Laboratory findings revealed Hb 8. His body weight was 33 kg. Serum Iron 35 (N 60-90) Total Iron Binding Capacity 275 (N 250-400). BP 130/90. Relfexes are absent in the lower extremities. The best management in this patient is A. body temperature was 41. tuberculosis meningitis D. however. Physical examination revealed an unconcious boy. He plays football but denies any recent trauma. Myositis E. leucocyte 18000. pulse rate 144 m. she also did not move it during a Moro reflex. Iron deficiency B. Guillain Barre Syndrome D. 20 kg. differential count 1/-/8/16/54/21. A mother in the predecing question delivered a 4000 g. Left-sided Erb-Duchenne paralysis D. PCV 40 %. Give the most likely diagnosis : A. Physical examination : afebrile. She did not more her left arm. A six year-old boy was brought to the emergency departement because of seizure since one hour before admission. The working diagnosis of this boy is : A. A. WBC 7400/cmm. Transverse myelitis B.5 ° C. Give erythropoietin injection D. Reticulocyte 1. Left-sided Klumpke paralysis E.

There is no evidence of hepatosplenomegaly or lymphnode enlargement. body height of 104 cm. Laboratory findings reveals a hemoglobin level of 3 g/dl. Disturbance of synthesis in Von Wiillebrand factor C. There is no hepatosplenomegaly or lymphnode enlargement. platelet count is 200. red blood cell count 1. Laboratoryfindings revealed Hb 9 g/dl. A 6 year-old child came to the hospital with the chief complaint of nose-bleed a long with red dot spots on his extremities. Leukimia E. leucocyte : 0-1/HPF. Syndrome of Inappropriate Anti Diuretic Hormone (SIADH) E. There aws no history of bleeding beforehand.000/mm³. ITP NEPHROLOGY 30.500. The patient was diagnosed as ALL (L type) since 2 weeks before and started induction phase of chemotherapy since 8 days before.000/µL. Disturbance of thrombocyte function B. white blood cell count 1. Iron deficiency anemia 27. Hemolytic anemia B. A 3 year-old boy develops pallor. Post-hemorrhagic anemia D. Aplastic anemia C. Not adequate hydration D. Disturbance of fibrinolytic system E. The most likely diagnosis of this patient is : A. which of the following is most likely to explain this child‟s condition? A. Vitamin K deficiency E. Tumor Lysis Syndrome C. The total urine output was 0. Disturbance of vascular D. Nephrotic syndrome D. Hyperleukocytosis 29. The most possible reason for this condition is : A.3%. Von Willebrand‟s Disease C. Acute pyelonephritis C.6 mg/dl.33 26. looked ill with a body weight of 18 kg. pallor and difficulty to gain weight for one year. Hemophilia D. Blood pressure was 140/100 mmHg. hematocrit 9. purpura on the skin and recurrent epistaxis. ureum 150 mg/dl. Primary Trombocytosis B. erythrocyte : 20-40/HPF. Acute Kidney Injury B. A 3 year-old boy with ALL (L3 type) suddenly experienced low urine output.500//µL respectively. Hb and WBC are 11. plasma creatinine 3. Acute post-streptococcal glomerulonephritis B.000/mm³. Chronic pyelonephritis . There was no history of the same symptoms in his family The physical examination revealed no evidence of hepatosplenomegaly. A thorough physical examination revealed that he was alert. and bleeding ime is 2 minutes. A 7 year-old Indonesian boy has complaints. He had been circumcized without any problem. The most likely diagnosis of the patient is : A.1 g/dl and 5.3 ml/kg BW/h.500/mm³ and platelet count 55. There was no fever. Erythroctre cast. A 5 year-old has had recurrent hematoma on both his arms and legs since the age of one year. Chronic glomerulonephritis E. The most likely cause of these symptoms would be A. Disturbance of coagulation system 28.

Which of the following laboratory finding is expected to be present in the child? A. Start growth hormone tratment. The most lukely diagnosis is A. Start short trial of growth hormone and see the response 35. Height was much below 3rd percentile and weight was on 75th percentile. Haemorrhagic cystitis D. Immunizations are up to date. What would be the best therapy for this case? A. Intravenous antibiotics for Gram-positive bacteria E. Glomerulonephritis C. Physical examinations were normal. abundant leucocytes. bacteria +. Hyperkalemia C. Urine dipstix testing shows 4+ haematuria.8ºC. erythrocyte 20-30/hpf. calculate mid-parental height B. hirsutism and short stature. Oral antibiotics for Gram-negative bacteria C. Henoch-Schonlein Disease E. Ureteropelvic junction obstruction B. Benign familial haematuria B. if clinically suggestive of GH deficiency E. Urinany tract infection 33. Posterior urethal valve C. Intravenous followed by oral antibiotics for Gram-negative bacteria ENDOCRINOLOGY 34. On examination her blood pressure was hidh and her obesity was truncal. and receives spesial schooling. Oral antibiotics for Gram-positive bacteria B. Intravenous antibiotics for Gram-negative bacteria D. along with visible pink urine and clots. A ten year-old girl presented with obesity. Measure parent‟s height. On examination she has a temperature of 37. respiratory rate of 18/min and heart rate of 90/min. She has suprapubic tenderness. A 6 year-old girl with global developmental delay presents with fever and gross haematuria. 3+ proteinuria and 3+ nitrites. Which of the following is important in your initial evaluation? A. Immediately do growth hormone stimulation test D.34 31. Nephrotic syndrome E. A 1 year-old male child was brought with fever for 2 days along with decreased appetite. Assure him that his short statute is not pathological C. Prune belly syndrome D. Metabolic acidosis B. There is no family or social history of note. Birth history revealed full term normal delivery with no neonatal complications. Hypoglycemia D. She has been diagnosed as developmental delay at 9 months. Vesico-uretheral reflux 32. An eleven year-old boy presented to the clinic because of short stature. Hypokalemia and metabolic alkalosis E. round plethoric face. Urinalysis showed protein +1. Increased cortisol level . Which of the following that is NOT the indication for long-term prophylaxis against urinary tract infection : A.

The child is entirely prepubertal. Boottled water B. of the skin C. Dysmorphic face D. What is the most likely diagnosis if this a boy with a bone age of 11 years. Hypogonadotropic hypogonadism D. as it has a long-acting profile and provides good control of basal hyperglycemic E. Infant formula is not a sterile product and may be contamined with pathogens that can cause serious illness. but did remember being shorter than all his friends in high school. Delayed development C. Short stature B. but the child has been complaining that all of his/her friends seem to be getting much taller than him/her. Water directly from water dispenser D. He has experiended some mild abdominal discomfort but there was no evidence of nausea or vomiting. The mother is 165 cm and had menarche at age 14 years. There are only 2 ways of starting insulin D. Klinefelter‟s syndrome E. Mixture of hot boiling water and cool water to achieve temperature of 70°C Nutritional obesity has to be differentiated with obesity as a part of a syndrome. Hypogonadotropic hypogonadism B. the statements below are true expect A.oral cavity and nail 39 40 . in the sclera and oral cavity B. Boiled water that has been allowed to cool to no less than 70°C E. and weight is at the 30 th percentile. in the oral cavity E. An 8 year-old male has a 3 week-history of weight loss. He has been urinating approximately two or three times per hour for the last few weeks. Lantus is very helpful. polyuria and polydipsia. The child‟s father is 180 cm and could not recall when he went through puberty. Taking into consideration that the child has Diabetes. On the physical examination. A 14 year-old is brought into your office because concerns of lack of pubertal development. According to the WHO guidelines it has to be reconstituted with A. Kallmann syndrome NUTRITION 38. Selection and rotation of insulin sites are important 37. Familial occurrence E. and his father grew 10 cm after high school? A. Mentally retarded A two year-old boy was diagnosed as hypercarotenemia. Hot boiling water (100°C) C. in the sclera. The following feature that is hard to diferentiate between nutritional obesity and syndromic obesity is: A. The parents report that the child has otherwise been healthy. in the sclera and nail D. Patient undergoing minor surgial procedures may be brought in on the morning of surgery C. Constitutional delay of puberty C. Of the following the most important examination is featuring yellow pigmentation A.35 36. A patient with poorly controlled diabetes should not undergo elective surgery until glucose is reasonably B. Proper handling and correct preparations will reduce the risk. the child‟s heigh t is less than the 5th percentile.

C. Hepatitis 4. Severe malnutrition marasmic. Pharmacologic action of lowering triglyceride blood level E. He has the following anthropometric measures: weight-for-age zscore <-3 SD. Arachidonic acid is thebiological active form D. The eatablishment of handedness and footedness. D. which are appropriate immunization for him now: A. Polio 5 B.kwarshiorcor type D. He recently understands simple instruktion. DPT 4. The most probable development problem for this child is: A. A significant increase in fine-motor control. The diagnosis of this patient is A. Essential for the nervous system and retina development C. Global delayed development C. DPT 4. and can eat using a spoon. Normal development In his previuos basic immunization.36 41.he has got BCG1x.5 kg. Delayed speech D. DPT 4. DPT3x. A latency period of minimal physical growth and development. Delayed motoric development B. Body Length 80 cm. Polio 5 E.dramatic improvment in gross-motor control. Hepatitis 4 44. A 2 years-old boy. weight for height = 59%. Main source: Deep-sea fist body oil B. complains of weight loss for the last 6 months. The following statements are appropriate for Essential Fatty Acid W-6: A. Between the ages of six and eight. A sudden. height for age= 93%. Not essential for the healing of skin lesion 42. B.can say dada-tata. measles D. children typically become able to participate in a much greater of activities primarily as a result of: A. He was bom at 32 weeks of gestation. Short stature A premature baby is presented with apparent Essential Fatty Acid W-6 defyciency due to prolonged parenteral nutrition without proper supplementation. Measles C. along with loss of appetite. Severe malnutrition marasmic type B. Body Weight 6. E. . Polio 5. Delayed fine motor development E. Hepatitis B 3x. Polio 4x. GROWTH AND DEVELOPMENT 42 A mother brings her 7 month-old child for a routine check-up. Severe malnutrition kwarshiorcor type C. Failure to thrive E. Change of intelligence 43 An 18 month-old boy comes to clinic with the chief complaint of not being able to walk yet.

Echocardiography reveals a large patent ductus arteriosus. A 3-month old boy comes to you with fast breathing occurring mainly during feeding. Relative mitral sttenosis D. What is the murmur at the upper left sternal border most likely caused by? A. Relative tricuspid stenosis C. The lungs are clear. Complement-mediated lysis of worm attached to host tissues D. CAPVD D. Administration of digoxin C. you find mild respiratory distress. Administer indomethacin intravenously C. IgE-mediated type I hypersensitivity disrupting worm attachment E. A 14-year old girl is exposed to roundworm Ascaris but does not develop clinical signs of infection. electrolytes and creatinine are normal. PDA E. A 7 year-old child returns for follow up. Concentrations of hemoglobin. D. Relative aortic stenosis E. pulses. and precordial activity. Precordial palpation is hyperdynamic. it also heard well in the lung fields. Relative pulmonary stenosis B. ASD C. Pulses are bounding. Relative mitral insufficiency ALLERGY-IMMUNOLOGY 1. Administer furosemide intravenously B. On physical examination. The parents estimate that the tachycardia lasted 20 minutes. but S2 is fixed and widely split. Observation without drug therapy 48 49 50. VSD B. Of the following the MOST appropriate management of this child is. Obtain a surgical consultation of ligation of the ductus. The most likely diagnosis is: A. Administration of a beta blocker B. He has a grade 2 holosystolic murmur that extends past the second heart sound. almost descrescendo at the lower left sternal border. The mother tells you that her baby often stops every 5 minutes during breast feeding. A. CTL-induced apoptosis of worm-infected cells C. Administer indomethacin via nasogastric tube. Administration of verapamil E. EKG reveal a HR of 300/min that spontaneously converts to asinus rate of 100/min. First and second heart sound are normal. S1 is normal. He is pink and healthy looking with normal vital signs. Phagocytosis of worms followed by necrosis of phagocytes . Antibody-mediated destruction of worm-infected cells B.37 CARDIOLOGY 47 A 5 day old infant bom at 31 weeks gestation is on ventilatory support. Administration of procainamide D. A2/6 medium frequency systolic ejection murmur is heard at the upper left sternal border and all along the left ssternal border. There is also an early 2/6 diastolic murmur. the child was asymtomatic throughout. but a lound machinery murmur is heard on the upper left sternal border. Defer intervention because spontaneous closure is likely E. Of the following the most appropriate INITIAL management is to: A. The liver is 1 cm below the right costal margin. Tetralogy of Fallot A 1 year-old child is brought to the ER because his parent thought his heart was pounding as they were putting him to bed. However the anteroposterior diameter of her chest is somewhat increased. Which of the following mechanisms is likely to be responsible for his resistance to infection? A.

Genetic shift D. His temperature is normal between spikes. When febrile. measles. Genetic drift C. Rheumatic fever B. Periodic fever syndrome D. Hard immunity B. previously healthy boy has had a daily spiking fever up to 40°C in the evening for 4 weeks. Kawasaki disease E. Tolerance 3. Systemic Lupus Erythematosus . His mother is concernet that his finger and knee joints appear swollen. A 15-month old body who has not received any recommended vaccines remains healthy despite his daily assosiation with several other children for the past years in his otherwise well-tended inner city housing area‟ Which of the following merchanisms best explains why he has not contracted diphttheria.38 2. He is often active and playful when afebrile. This child‟s diagnosis is most likely A. or polio? A. the child is irritable. A 5-year old. Immune evasion E. Systemic arthritis C. pertussis. He appears stiff in the morning. has malaise and does not want to play or move.

.............................................................39 KOLEGIUM ILMU KESEHATAN ANAK INDONESIA 8th MCQ Progress Test Nasional................ : . : .................... Bayi berusia 2 hari diperiksakan ke ruang gawat darurat karena pendarahan dari dubur dan hidung.............................................................................................. ... (Yunior / Madya / Senior) : .......................... Petunjuk : Berilah tanda X pada huruf jawaban yang benar pada lembar jawaban 1.... 11 Mei 2011 Nama IPDSA Tahapan Semster :.......................................................