PEDIATRICS

1. The cardiac silhouette of patients with Tetralogy of Fallot is best described

as:
a. boot shaped
b. egg on the side
c. markedly enlarged
d. mild cardiomegaly
p.1312
2. The most common cause of neonatal seizures is
a. meningitis
b. hypoxic ischemic encephalopathy
c. congenital CNS anomalies
d. metabolic causes
p. 1696
3. Immunization with polio vaccine may be started as early as
a.
b.
c.
d.

newborn period
6 weeks of age
8 weeks of age
3 months

p. 1023
4. Measles immune globulin may prevent or modify infection if given within
a.
b.
c.
d.

3 days after exposure

6 days after exposure
10 days after exposure
2 weeks after exposure

p. 1017
5. What congenital anomaly is associated with growth and mental retardation,
abnormal facial features like low set ears, hypotonia and an endocardial
cushion defect?
a. velocardiofacial syndrome
b. Downs syndrome
c. Turner Syndrome
d. Cornelia de Lange syndrome
Answer B

p 619 Nelson

6. A scaphoid abdomen at birth usually suggests a:

a.
b.
c.
d.

diaphragmatic hernia
omphalocoele
gastroschisis
omphalitis
ans. A

p527

7. One of the following drugs is ABSOLUTELY contraindicated to

Breastfeeding:
a.
b.
c.
d.

diuretics
prednisone
tetracycline
hydralazine
ans C

p. 530

8. The presence of subperiosteal hemorrhage in the newborn which is located

to the surface of one cranial bone is called:
a.
b.
c.
d.

caput succedaneum
molding
fracture of the skull
cephalhematoma
ans: D

p 562

9. Congenital Rubella Syndrome is characterized by the following

conglomeration of symptoms:
a. cataracts, cardiac abnormality, hearing defects, microcephaly and
mental retardation
b. hepatomegaly, splenomegaly, jaundice, petecchiae, chorioretinitis
c. IUGR,intracranial calcifications, hepatosplenomegaly
d. Hydranancephaly, chorioretinitis, spasticity,mental retardation
Ans A

p.569

10. The mature levels of surfactant is seen by:

a.
b.
c.
d.

20 weeks
28 weeks
32 weeks
35 weeks
ans: D

p.575

11. The most frequently fractured bone of the newborn during labor and delivery
is the:
a.
b.
c.
d.

femur
humerus
clavicle
hip bone
ans C

p. 572

12. A 5 year old child suddenly developed edema . It was more prominent in the
morning. No meds and consult done. However, she complained of
headache and noted dark colored urine. On day of consult, she also noted
decrease frequency of urination: What is the probable illness of this patient?

a.
b.
c.
d.

Ig A nephropathy
Alport Syndrome
Acute Glomerulonephritis
MPGN
answer C

p.1740

13. A 16 year old female developed nephritis. Her C3 is noted to be low. She is
also complaining of joint pains and photosensitivity. The probable diagnosis
of this patient is:
a.
b.
c.
d.

Acute Glomerulonephritis
Henoch Schoelein Purpura
Systemic Lupus Erythematosus
Membranoproliferative GN
Ans C

p1743

14. The most common pathogen associated with HEMOLYTIC UREMIC

SYNDROME is :
a.
b.
c.
d.

shigella
salmonella
E. Coli
Rotavirus
Ans C

p. 1274

15. The SMR stage of a female adolescent who presents with coarse abundant
curly pubic hair and an areola and papilla with a secondary mound is a:
a.
b.
c.
d.

SMR 1
SMR 2
SMR 3
SMR 4

Ans: D p. 54
16. Delayed eruption is considered when there is no teeth at approximately:
a.
b.
c.
d.

6 months
9 months
10 months
13 months
answer is: D

p. 61

17. The principal vector of DENGUE FEVER is:

a.
b.
c.
d.

Plasmodium Falciparum
Aedes Aegypti
Perumycus Perinomata
Culex pipiens
Answer B

p.1092

18. A 5 year old male was noted to have fever of five days duration which is
rapidly increasing to 39 to 40 C . It is accompanied by frontal headache and
was noted to have back pain. After 2 days of defervecence of fever rashes
appear at the lower and upper extremities that is glove and stockings in
distribution. The most plausible diagnosis is:
a.
b.
c.
d.

Measles
Typhoid Fever
Yellow Fever
Dengue Fever
Ans D

p 1093

19. The WHO criteria for dengue hemorrahagic fever are the following:
a. fever, minor or major hemorrhagic manifestation and
thrombocytopenia
b. fever, elevated ESR and thrombocytopenia
c. fever, (+) dengue blot and thrombocytopenia
d. fever, biphasic fever and thrombocytopenia
ans A

p. 1093

20. A 6 year old child developed high grade fever and cough. Chest x- ray was
done and reveled pnuematocoeles . What is the most common pathogenic
organism responsible for pneumatocoeles?
a.
b.
c.
d.

Influenza
Streptoccocal
Pnuemococcal
Staphylococcal

Ans: D
21. An important indicator of pneumonia among infants is:
a.
b.
c.
d.

fever
increased respiratory rate
cyanosis
cough
ans B

p.1435

22. The drug of choice for atypical pneumonia is:

a.
b.
c.
d.

Ampicillin
Chloramphenicol
Erythromycin
Ceftriaxone
ans C

p 934

23. One of the following is a pathologic finding in the newborn:

a.
b.
c.
d.

milia
Mongolian spots
Erythema toxicum
Jaundice during the first 24 hours
Ans D 561

24. The duration of treatment for uncomplicated H. Influenzae meningitis is

a.
b.
c.
d.

3-5 days
7-10 days
2 weeks
4 weeks
ans. B

p. 711

25. Acute bronchiolitis, a common disease of infants has a peak incidence at

a.
b.
c.
d.

2 months of age
4 months of age
6 months of age
10 months of age
ans. C

p. 1211

26. Stridor is most commonly seen in infants with

a.
b.
c.
d.

croup
bronchiolitis
bronchitis
pneumonia
ans. A

p. 1215

27. Subacute sclerosing panencephalitis (SSPE) is associated with

a.
b.
c.
d.

rubella
rubeola
varicella
roseola infantum
ans. B
p. 934

28. The absolute contraindication to giving immunization is:

a.
b.
c.
d.

immunodeficiency state of the patient

high grade fever at the time of administration
malignancy in a child
previous anaphylactic reaction
p. 1085

29. A 10-month old male comes in for a well-baby visit. He had BCG, 3 doses of
DPT & OPV and 2 doses of hepatitis B vaccine. What can you give him for
this particular visit?
a.
b.
c.
d.

measles & 3rd dose of Hepatitis B vaccine

measles vaccine
3rd dose of hepatitis B
varicella vaccine

31. The WHO recommends that breast feeding can be the infants sole source of
food up to about:
a.
b.
c.
d.

2 months of age
6 months of age
12 months of age
2 years of age

32. Which vaccine should be given intradermally?

a.
b.
c.
d.

measles
BCG
hepatitis B
MMR
p. 896

33. A fully immunized child is one who has completed the following before 12
months of age:
a.
b.
c.
d.

BCG; 3 doses each of hepatitis B, DPT and OPV

BCG, 3 DPT; 3 OPV; measles vaccine
3 hepatitis B; 3 DPT; 3 OPV; measles vaccine
3 hepatitis B; BCG; 3 DPT; 3 OPV, measles vaccine

34. A 12-year old male with repeated episodes of streptococcal pharyngitis

comes to the clinic with another episode of sore throat. Oral amoxicillin was
started. One hour later, he had tingling sensation around his mouth, difficulty
of swallowing and developed hoarse voice. At the ER, he had urticaria,
PR=130/min, RR=32/min, BP=70/30 and t= 37.2C. The most appropriate
therapy is:
a. epinephrine
b. prednisone
c. diphenhydramine
d. lactated Ringers solution
p. 687
35. A 12-year old presents with sneezing, clear rhinorrhea and nasal itching.
Physical examination reveals boggy, pale nasal edema with a clear
discharge. The most likely diagnosis is:
a. foreign body
b. vasomotor rhinitis
c. neutrophilic rhinitis
d. allergic rhinitis
p. 662

36. The most common manifestation of rheumatic fever in children is:

a.
b.
c.
d.

erythema marginatum
subcutaneous nodules
carditis
arthritis
p. 807

37. An 18-month old is noted to assume a squatting position frequently during

playtime at the daycare center. The mother also notices occasional episodes
of perioral cyanosis during some of these squatting periods. The day of
admission, the child becomes restless, hyperpneic and deeply cyanotic.
Within 10 minutes, the child becomes unresponsive. The most likely
condition is:
a.
b.
c.
d.

cardiomyopathy
anomalous coronary artery
tetralogy of Fallot
breath-holding spell
p 1385

38. A 14-year old male presents with Grade 4/6 regurgitant systolic murmur at
the apex with history of swollen and painful joints. The murmur is most likely:
a.
b.
c.
d.

mitral stenosis
mitral regurgitation
aortic regurgitation
mitral valve prolapse
p. 1428

39. A 14-year old female was brought to you because of mothers worry that she
has no menarche yet as compared to her classmates. Medical history and
complete PE are normal. Breast development and pubic hair have been
present for 18 months and are normal. Which would be the most
appropriate?
a. reassurance that she likely will begin menstruating within the
year
b. laboratory evaluation for systemic disease
c. urinary estriol determination
d. referral for psychological counseling
p.1687
40. The hallmarks of diabetes insipidus are:
a.
b.
c.
d.

polyuria and polyphagia

hyperthermia and vomiting
polyuria and polydypsia
hyperthermia and weight loss
p. 1682

41. A 2-year old male presents with a history of chronic constipation. Upon
review of history, you were told that he had delayed passage of black stools.
He had unremarkable PE findings. The parents were giving him laxatives for
the past 2 weeks. Your most likely initial impression is:
a.
b.
c.
d.

functional constipation
constipation due to laxative abuse
intestinal pseudo-obstruction
Hirschprung disease
p. 1139

42. A prominent clinical presentation of duodenal atresia is:

a.
b.
c.
d.

bilious vomiting without abdominal distention

non-bilious vomiting
polyhydramnios
colicky abdominal pain

p. 1133
43. The radiologic finding of double tract sign is typically seen in:
a.
b.
c.
d.

Intussusception
pyloric stenosis
duodenal atresia
midgut volvulus

p. 1130
44. Classic hemophilia is best treated by giving:
a.
b.
c.
d.

whole blood
Factor VIII
packed rbc
Factor X
p. 1510

45. A 5-year old female has multiple bruises on her lower extremities and oral
mucosal bleeding for 3 days duration. Two weeks before these signs she
had a mild respiratory tract infection. Physical examination reveals multiple
ecchymoses and petechiae; no lymphadenopathy nor splenomegaly was
noted. The most likely diagnosis is:
a.
b.
c.
d.

Leukemia
Neuroblastoma
aplastic anemia
idiopathic thrombocytopenic purpura
p. 1521

46. Which of the following suggests a bacterial etiology in a child with

tonsillopharyngitis?
a.
b.
c.
d.

pale tonsils with mild pharyngeal congestion

beefy tonsils with petechiae
mild pharyngeal exudates
enlarged tonsils with moderate congestion
p. 1265

47. A 1-year old infant had cough 2 weeks PTC which started as mild and
becoming paroxysmal. This was accompanied by low-grade fever but was
relieved by antipyretics. She had a poor history of immunizations. PPE
showed explosive outburst of cough accompanied by reddish face. The child
looks well when not coughing. Lungs were clear. There were few petechiae
in the neck. T=37C. The most likely diagnosis is:
a.
b.
c.
d.

viral pneumonia
epiglottitis
pertussis
laryngotracheobronchitis
p. 839

48. The period of communicability of mumps in a child is:

a. for 5 days starting with the first day of visible parotid swelling
b. from 3 days of onset of swelling to the day of visible swelling
c. from several days before the onset of swelling until the
swelling has subsided
d. only while fever persists
p. 954
49. A 12-year old girl had a mild sore throat, low-grade fever and a diffuse
maculopapular rash. During the next 24 hours, she developed redness of her
eyes. PE showed mild tenderness and marked swelling of her posterior
cervical and occipital lymph nodes. Four days after the onset of illness, the
rash vanished. The most likely diagnosis is:
a.
b.
c.
d.

Rubella
Rubeola
erythema infectiosum
acute infectious lymphocytosis
p. 951

50. Which is the most common cause of osteomyelitis in children?

a.
b.
c.
d.

Staphylococcus aureus
Group A streptococcus
Group B streptococcus
Pseudomonas aeruginosa
p. 776

51. A full term newborn with Apgar score of 8 & 9, is having episodes of cyanosis
and apnea which are worse when attempting to feed, but seems better when
crying. At this point, it is important to establish:
a.
b.
c.
d.

patent ductus arteriosus

choanal atresia
ventricular septal defect
respiratory distress syndrome
p. 1259

52. The initial treatment for neonates with sepsis consists of:
a.
b.
c.
d.

erythromycin + cloxacillin
ampicillin + sulfa
ampicillin + aminoglycoside
cloxacillin + aminoglycoside
p. 549

53. A 10-day old infant who was born by NSD by a hilot was brought in
because of difficulty of sucking and excessive crying noted 2 days PTC.
PPE: wt= 3,000 gms; T= 37.5C, with hoarse cry and spasms. Lungs were
clear. The most appropriate treatment would be:
a.
b.
c.
d.

feeding by NGT
penicillin by IV
muscle relaxant IM
sedative IM
p. 879

54. A 3-year old child awakens at night with high-grade fever, a severe sore
throat and a barking cough. P.E. shows a child who is drooling and with
respiratory stridor. Lungs are clear. The child may have:
a.
b.
c.
d.

bronchitis
tonsillopharyngitis
acute epiglottitis
bronchiolitis
p. 1275

55. A 10-month old infant has fever, cough, dyspnea and leucocytosis. Chest xray shows patchy distribution of consolidation. Treatment of choice without
bacterial culture is:
a.
b.
c.
d.

Ampicillin
Erythromycin
Oxacillin
Amikacin

56. Tracheo-esophageal fistula is usually suspected in one of the following

conditions:
a.
b.
c.
d.

excessive oral secretions

maternal hypertension
presence of stridor
vomiting
p. 1122

57. A syndrome that starts as diarrhea and progresses to fever, oliguria, acute
renal failure, thrombocytopenia and microangiopathic anemia in children is
due to:
a.
b.
c.
d.

systemic lupus erythematosus

hemolytic-uremic syndrome
Good-Pasteur disease
Henoch-Schonlein nephritis
p. 1586

58. A 2-year old female was hospitalized because of afternoon fever and
anorexia for 3 weeks and seizures few hours prior to consultation. No
previous medications; no history of seizures in the past. PE findings:
T=39.5C, stuporous, (+) nuchal rigidity, right eye deviated medially, spastic
extremities. CSF was cloudy with WBC 204/cc and lymphocytes of 90%,
sugar=0.8 mmol/L. Your treatment would include:
a.
b.
c.
d.

aqueous penicillin
ampicillin and chloramphenicol
INH/Rifampicin/Streptomycin/corticosteroids
anti-viral drugs
p. 891

59. Sparse and thin hair with dyspigmentation as a sign of undernutrition is

commonly observed in:
a.
b.
c.
d.

marasmus
kwashiorkor
intrinsic factor deficiency
vitamin A deficiency
p. 170

60. Milk feedings must be supplemented with iron preparations to prevent iron
deficiency anemia starting:
a.
b.
c.
d.

6-8 weeks of age

6 months of age
9 months of age
12 months of age
p. 165

61. The present age recommendation to start solid food for supplementation for
infants is at:
a.
b.
c.
d.

3 months of age
6 months of age
9 months of age
upon eruption of 2nd incisors
p. 165

62. Normally, a newborn infants weight may decrease 10% below the birthweight in the first week of life as a result of:
a.
b.
c.
d.

excretion of excess extravascular fluid

high environmental temperature
hypoglycemia
intake of high-fat breast milk
Answer: A

p. 32-33

63. The 1-minute APGAR Score may indicate which of the following?
a.
b.
c.
d.

the need for immediate resuscitation

the probability of successful resuscitation
predict neonatal death
predict neurologic outcome
Answer: A p.592

64. In general, jaundice is considered pathologic and therefore, a search to

determine its cause should be made if:
a.
b.
c.
d.

it appears on the 36-48 hr. of life

serum bilirubin is rising at a rate faster than 1 mg/dl/24 hr.
jaundice persists after 5-7days of life
direct-reacting bilirubin is greater than 2 mg/dL at any time
Answer: D p. 595

65. An infant is observed to follow objects 18 degrees, laughs out loud and grasp
objects and bring them to mouth. He must be:
a. 2 weeks old
b. 1 month old
c. 2 months old
d. 4 months old
Answer: D p. 34
66. This is a major milestone at about 9 months old age, which is the
understanding that objects continue to exist even when not seen:
a. rapproachment
b. object constancy
c. object permanence
d. magical thinking
Answer: B p. 36

67. The first visible sign of puberty in girls is:

a.
b.
c.
d.

thelarche
pubarche
menarche
peak height velocity
Answer: A p. 54

68. This vaccine is contraindicated in household contacts of

immunocompromised persons:
a.
b.
c.
d.

OPV
Measles
Varicella
BCG
Answer: A p. 1182

69. Baby Girl Cruz was delivered spontaneously at term to a 28 y/o G3P2
mother. Following delivery, she was noted to be limp, had irregular
respiration, CR 80/min, extremities and body cyanotic with no response to
suctioning of oronasal passages. What is the APGAr Score of Baby Girl
Cruz?
a.
b.
c.
d.

2
3
4
5
Answer A

p. 528

70. The second dose of MMR should be routinely given at the age of:
a.
b.
c.
d.

1 years old
2-3 years old
4-6 years old
7-10 years old

Answer: C

p. 1178

71. If the first dose of Hepatitis B vaccine was given at birth, the last dose should
not be given before the age of:
a.
b.
c.
d.

6 months
9 months
12 months
15 months
Answer: A

p. 1177

72. For infants born to mothers whose HBsAG status is unknown, the first dose
of Hepatitis B should be given at what age?
a.
b.
c.
d.

within 12 hours at birth

4 weeks old
6 weeks old
8 weeks old
Answer: A p. 1177

73. A 4 year old child is expected to have an approximate weight of:

a.
b.
c.
d.

12 kg
14 kg
16 kg
20 kg
Answer

C p. 31

74. A newborn was noted to have increased oral bubbly secretion accompanied
by cough and choking on feeding. The most likely diagnosis is:
a. TEF
b. pulmonary sequestration
c. pulmonary hypoplasia
d. CCAM
Answer: A

page: 1219

75. A 3 year old boy was brought to the ER because of barking cough and
stridor. He
was afebrile, non-toxic and well when seen by his physician.
Symptoms were
similar for the past 3 nights. This clinical condition is
typical of:
a. spasmodic croup
b. acute laryngotracheobronchitis
c. congenital subglottic stenosis
d. angioneurotic edema
Answer: A page 1407
76. A 5 y/o has frequent cough and colds of more than a month accompanied
by marked weight loss. Her mother also has chronic cough. If Mantoux test
shows an induration of 10 mm., the most likely diagnosis is:
a.
b.
c.
d.

TB infection
TB disease
TB exposure
Miliary TB
Answer B

page 962

77. . Which of the following is a major criteria of atopic dermatitis?

a. Xerosis
b. postauricular fissure
c. elevated IgE
d. (+) FH of atopy
Answer: D page: 775

78. A 15 month old boy developed generalized pruritus, hives and dyspnea 30
minutes after intake of egg. The initial treatment should be administration of:
a.
b.
c.
d.

diphenhydramine IM
Epinephrine IM
Epinephrine SC
Prednisone IV
Answer: B page: 781

79. A 7 year old girl came because of polyuria (about 8 L./day) noted for 4
weeks. She was also noted to have marked weight loss (60%). If urinalysis
shows specific gravity 1.032, urine glucose 3+, urine osmolality of 500
mOsm/L, the most likely cause of polyuria of this patient is:
a.
b.
c.
d.

Neurogenic DI
Nephrogenic DI
Type I DM
Type II DM
Answer: C page 1954

80. Randy, a 5 y/o was brought to your clinic for polyuria. On pitressin test, there
was a decrease in urine volume, increase in specific gravity and urine
osmolality.
The next diagnostic test you will request is:
a.
b.
c.
d.

ultrasound of KUB
cranial MRI
glycosylated hemoglobin
serum Na, K and calcium
Answer: B page: 1854

81. The most common malignant neoplasm in children:

a.
b.
c.
d.

Retinoblastoma
Neuroblastoma
Wilms Tumor
Leukemia
Answer: D page: 1694

82. A 1 year-old baby was brought to the OPD for a well baby check up. He was
exclusively breastfed from birth until 6 months, and was given
complementary feeding from then on. Physical examination was
unremarkable except for pallor. CBC showed anemia, low red cell indices,
normal reticulocyte count. What is the most likely diagnosis?
a.
b.
c.
d.

Thalassemia trait
Iron deficiency anemia
Aplastic Anemia
Diamond Blackfan anemia
Answer: B

page: 1614

83. A 4 y/o male patient consulted because of joint pains, he was also noted to
have intermittent low grade fever for 2 weeks. PE: pale palpebral
conjunctivae, (+) petechiae on soft palate, Grade 1-2 systolic ejection
murmur at the LLSB, clear breath sounds, liver edge 5 cm below RCM,
spleen 3 cm below LCM, (+) 3 cm bluish discoloration on the thigh. CBC
showed Hgb = 6.0/dL, Hct 20 vol % RBC = 2.0 x 109/L, MCV = 85 fl, MCH =
30 pg, MCHC = 31, RDW = 13, WBC = 10 x 109/L, segmenters = 1%,
lymphocytes = 90%, Platelet count = 100 x 109/L. What is the most likely
diagnosis?
a. Aplastic anemia
b. Infectious mononucleosis
c. Acute lymphocytic leukemia
d. Rheumatoid arthritis
Answer: C

p. 1645

84. A 4 month infant was brought to the hospital because of diarrhea. He passed
out watery yellow stools with low grade fever. The most likely cause of the
acute diarrhea is
a. Enterotoxiginic E. coli
b. Rotavirus
c. Cholera
d. Shigella
Answer: B

page: 1082

85. If this baby presents with lethargy with CR 140/min, weak pulses, sunken
fontanels and eyeballs, dry lips, + skin fold test of > 3 sec. What is the
degree of dehydration?
a. none
b. mild
c. moderate
d. severe
Answer: D

page: 245

86. GIT condition that manifest symptoms early in the neonatal period, but has
high incidence of spontaneous remission as the infant grows older:
a.
b.
c.
d.

Hypertonic pyloric stenosis

Hirschprungss disease
GE reflux
Intussusception
Answer: C

page: 1222

87. Features strongly suggest cholestatic jaundice:

a.
b.
c.
d.

yellowish skin and sclerae

straw yellow urine
TB 12 mg/dL B1 10.8mg/dL B2 = 1.2 mg/dL
Acholic stools
Answer: D

pages: 1314-1315

88. Drug of choice used to rapidly terminating severe cyanotic spells in babies
with Tetralogy of Fallot:
a.
b.
c.
d.

Clonidine
Paracetamol
Morphine
Diazepam
Answer: C

page: 1525

89. Palpating the peripheral pulses is important in infants and children. This
particular congenital cardiovascular disease may be suspected if the femoral
pulses are diminished or absent:
a.
b.
c.
d.

patent ductus arteriosus (PDA)

coarctation of the aorta
transposition of the great arteries (TGA)
atrial septal defect
Answer: B page: 1482 & 1518

90. In which of the following situations can a diagnosis of acute rheumatic fever
be made?
a.
b.
c.
d.

(+) ASO titer (+) joint pains, (+) fever

(-) ASO titer (+) choreas syndenham
(+) ASO titer, (+) erythema marginatum ESR
(+) ASO titer, (+) polyarthritis, CRP
Answer: B

p. 876

91. Baby Twinkle was delivered term to a mother with poorly-controlled

gestational diabetes. At birth, her Apgar Score were 5 and 6 at 1 and 5
minutes, respectively. Maternal blood type is O+, babys blood type is A+
If she developed jaundice at the 20th hours of life, the most likely cause is:
a.
b.
c.
d.

Perinatal asphyxia
Hemolytic disease of the newborn
Maternal diabetes
Hemorrhagic disease of the newborn
Answer: B

page: 601

92. A 6 year old boy complained of nape pains and headache, with a BP of
160/100. He had a history of sorethroat a week PTA, with passage of teacolored urine 3 days PTA and facial and leg edema. The most likely
consideration is:
a.
b.
c.
d.

UTI
Post-infectious glomerulonephritis
Idiopathic nephritic syndrome
Urolithiasis
Answer: B

page: 1740

93. The most important risk factor for infants with febrile UTI due to its potential
for causing renal injury is:
a.
b.
c.
d.

being uncircumcised
vesicoureteral reflux
voiding dysfunction
male sex
Answer: B

page: 1790

94. A 3 year old boy had a history of profuse watery diarrhea and vomiting. On
consultation, there was no urine output for the last 12 hours. Minimal urine
was obtained by catheterization. Urine was dark yellow, highly concentrated
with a low urine sodium content. The cause of renal failure is:
a.
b.
c.
d.

pre-renal
intrinsic renal
bladder outlet obstruction
neurogenic bladder
Answer: A page: 1768, 1769

95. A 2 month old unimmunized baby was brought to the ER following a mild
two-week upper respiratory infection. She then developed severe
paroxysmal cough. A presumptive diagnosis of Pertussis can be made by a:
a.
b.
c.
d.

throat culture
White blood cell count
Chest-x-ray
Grams stain of nasal discharge
Answer: B

page: 910

96. The WHO criteria added for Dengue Shock Syndrome include the criteria for
DHF plus:
a.
b.
c.
d.

minor or major hemorrhagic manifestations

thrombocytopenic (< 100,000/mm3)
narrow pulse pressure (< 20 mmHg) or hypotension
pleural effusion by chest radiograph or hypoalbuminemia
Answer C

page 1093

97. A 9 year old girl has been having on and off fever for the past 10 days. On
examination there was conjunctivitis, strawberry tongue, and periungual
desquamation. The most likely diagnosis is:
a.
b.
c.
d.

atypical measles
Kawasaki disease
Typhoid fever
Streptococcal septicemia
Answer: B

page: 824

98. A 10 year old girl complained of fever, sore throat. PE revealed exudative
pharyngitis accompanied by generalized lymphadenopathy, splenomegaly
and atypical lymphocytosis on peripheral smear. The most likely etiologic
agent is:
a.
b.
c.
d.

Group A b-hemolytic Streptococcus

Corynebacterium diphtheriae
Epstein Barr Virus
Coxsackie Virus
Answer: C

page: 1067

99. A 17 year old girl had a mild prodrome of nasal catarrh and low fever
followed by retroauricular, posterior cervical and postoccipital
lymphadenopathy
and the appearance of discrete reddish
maculopapules. This fits the diagnosis of:
a.
b.
c.
d.

Varicella
Rubella
Meningococcemia
Parvovirus B19
Answer: B

100.

A 6 year old presented by a mild respiratory prodrome. The initial stage

wascharacterized by erythematous facial flushing likened to a slapped
cheek. The disease is most likely:
a. scarlet fever
b. CMV infection
c. Roseola
d. erythema infectiosum
Answer: D

101.

page: 1049

The management of benign febrile seizures includes:

a.
b.
c.
d.

Phenobarbital therapy if the patient is one year or older

baseline neuroimaging
electroencephalogram a week after the attack
maternal education and antipyretic measures
Answer: D

102.

page: 1032

page: 1994

Cyanosis and seizures on prolonged crying in an infant suggests:

a.
b.
c.
d.

benign rolandic seizures

ceongenital heart disease
breatholding spells
infantile spasm
Answer: C

page 2010

103.

A 12 year old female with malar rash palatal ulcers, polyarthritis and
photosensitivity. The most likely diagnosis is:
a. polyarteritis nodosa erythematosus
b. systemic scleroderma
c. systemic lupus
d. Kawasaki disease
Answer: C

104.

This drug is used as prophylaxis against Pneumocystis carinii pneumonia

in renal transplant patients:
a.
b.
c.
d.

Azithromycin
Trimethoprim-sulfamethoxazole
Permethrin
Albendazole
MPL: 1.00

105.

Coxsackie A virus
Epstein barr virus
Cytomegalovirus
Parvovirus B19
MPL: 1.0

Idiopathic Thrombocytopenic Purpura

beta thalassemia major
chronic myelogenous leukemia
iron deficiency anemia
MPL: 1.0

p: 1632

The principal organ affected after most hydrocarbon ingestion is the:

a.
b.
c.
d.

liver
GIT
bone marrow
lungs
MPL: 1.0

108.

p: 1044

Iron chelation will be most useful in:

a.
b.
c.
d.

107.

p: 1155

Hand-foot and mouth disease is caused by:

a.
b.
c.
d.

106.

page: 810

p: 2372-2373

The most common viral agent causing bronchiolitis is:

a.
b.
c.
d.

respiratory syncitial virus

influenzae
rhinovirus
parainfluenzae
MPL: 0.25

p: 1415-1416

109.

The treatment of choice for uncomplicated N. meningitides meningitis is:

a.
b.
c.
d.

Ceftriaxone
Cefotaxime
Penicillin
ceftazidime
MPL: 1.0

110.

The clinical symptoms of Hirschprungs disease usually begins at birth and

ushered in by:
a. failure to thrive
b. delayed passage of meconium
c. vomiting
d. abdominal distention
MPL: 1.0

111.

plain abdominal radiograph

superior mesenteric radiography
barium study
radionuclide scan
MPL: 1.0

p: 1237

A 3300 gram, 39 weeker, male, was delivered via stat cesarean section
due to placenta previa. Baby was pink, with good cry and muscle tone but
had early onset of tachypnea and grunting. The most likely diagnosis is:
a.
b.
c.
d.

RDS type I
RDS type II
meconium aspiration pneumonia
bronchopulmonary dysplasia
MPL: 1.0

113.

p: 1239

The most sensitive study in the diagnosis of Meckels diverticulum is:

a.
b.
c.
d.

112.

p: 2042-2043

p: 583

The diagnosis of tetanus is established by:

a. blood culture
b. lumbar tap
c. presence of lockjaw followed by progressive stiffness of the
voluntary muscles
d. complete blood count
MPL: 1.0

114.

p: 952

The earliest sign of puberty in girls:

a.
b.
c.
d.

menstruation
breast enlargement
broadening of the hips
appearance of pimples
MPL: 1.0

p: 54

115.

The most common primary cause of nephrotic syndrome in children is:

a.
b.
c.
d.

membranous GN
membrano-proliferative GN
minimal change nephrotic syndrome
focal segmental GN
MPL: 1.00

116.

p:1755

Physiologic bowing of the legs completely resolves by:

a.
b.
c.
d.

1 year
2 years
3 years
4 years
p: 2265

117.

Hydrocoele is often physiologic up to:

a.
b.
c.
d.

3 months
6 months
9 months
12 months
p: 1820

118.

A 7-year-old boy has crampy abdominal pain and purpuric rashes on the
back of his legs and buttocks as well as on the extensor surfaces of his
forearm. Urinalysis reveals proteinuria and microhematuria. Your most
probable diagnosis is which of the following:
a.
b.
c.
d.

poststreptococcal glomerulonephritis
Henoch-Schonlein Purpura
IgA nephrophathy
Hemolytic Uremic Syndrome
p: 1744

119.

Which of the following is NOT associated with Acute Renal Failure:

a.
b.
c.
d.

Hyponatremia
hypokalemia
hypocalcemia
metabolic acidosis
p: 1769

120.

A 2-month-old infant was rushed to the emergency room with generalized

seizure. The infant was born term, AGA at home attended by a hilot. He
was purely breastfed. At the ER, he was pale, drowsy with bulging
anterior fontanel. He had clear breath sounds, liver edge was 4 cm below
the right subcostal margin and right hemiparesis. Your most probable
diagnosis is:
a.
b.
c.
d.

hemophilia
neonatal sepsis
bacterial meningitis
acquired prothrombin complex deficiency
p: 606

121.

Tuberculin reactivity is a Type ____ hypersensitivity:

a.
b.
c.
d.

Type I IgE mediated

Type II cytotoxic
Type III immune complex
Type IV cell mediated
p: 783, 961

122.

An apparently healthy neonate was brought to a well baby clinic. PE

showed palpable liver 2 cm below the right subcostal margin. The most
probable diagnosis is:
a.
b.
c.
d.

neonatal hepatitis
choleduchal cysts
biliary atresia
normal
p: 526

123.

A 12-month-old male suddenly draws up his leg and scream in pain. This
was repeated periodically throughout the night interspersed with periods of
quiet sleep. He was seen after 12 hours and looked pale, has just
vomited and passed out blood streaked stools. There is a palpable mass
around the umbilicus. The most likely diagnosis is:
a.
b.
c.
d.

Acute appendicitis
Acute gastroenteritis
Intussusception
Mesenteric adenitis
p: 279

124.

Which of the following is the first sign of puberty in girls:

a.
b.
c.
d.

thelarche
pubic hair
axillary hair
enlargement of clitoris
p: 59

125.

Which of the following is true of cephalhematoma:

a.
b.
c.
d.

may not be visible until several hours after birth

it is a subcutaneous edema of the scalp
usually resolves in 24 hours
not associated with complications
p: 562

126.

A 35-week AOG newborn was delivered with an Apgar Score of 8 and 9 at

1 and 5 minutes, respectively. Mother had no prenatal check up. Within a
few minutes of birth, the baby was noted to develop respiratory distress.
Which of the following causes of respiratory distress is least likely in this
patient:
a. Transient Tachypnea of the Newborn
b. Neonatal Pneumonia
c. Meconium Aspiration Syndrome
d. Hyaline Membrane Disease
p: 575-583

127.

A newborn was exposed to the infectious diseases mentioned below.

History revealed that the mother had received the recommended
immunizations during pregnancy and had these diseases years prior to
pregnancy. Which of the following diseases would probably affect this
newborn:
a. tetanus
b. rubeola
c. pertussis
d. varicella
p: 909

128.

Which of the following are not routinely recommended:

a. Hep B vaccine
b. DPT
c. Rabies
d. Polio vaccine
p: 1177

129.

Which of the following is the most frequent cause of Common Cold:

a. S. aureus
b. S. pneumoniae
c. Pseudomonas sp.
d. Rhinovirus
p: 1389

130.

A 10-year-old child was admitted because of abdominal pain and nausea.

This was followed perioral numbness. At the ER, the patient had
respiratory arrest and was thus intubated. History revealed that the
patient had eaten shellfish about 2 hours before the onset of symptoms.
Which of the following is the most probable toxin involved:
a.
b.
c.
d.

saxitoxin
ciguatoxin
scambrotoxin
solanine
p: 2377

131.

A 15-year-old male sought consult because of fever, malaise and

headache. He also complains of pain over the area from the back of his
mandible toward the mastoid space. He also describes that his earlobe
on the affected side appears to be sticking upward and outward. Drinking
sour liquids causes much pain in the affected area. The most probable
condition affecting the child is:
a.
b.
c.
d.

measles
mumps
varicella
rubella
p: 1035

132.

An 18-month-old infant presents at the ER because of convulsions. He

also has high grade fever. During the lumbar puncture (where CSF exam
was normal), he passed large volume of watery stools with blood and
mucus. The most likely diagnosis is:
a.
b.
c.
d.

Salmonellosis
Shigellosis
Rotavirus diarrhea
Cholera
p: 919

133.

In a 6-month-old infant, which of the following would be a contraindication

to doing a lumbar tap:
a. bulging fontanel
b. history of seizure
c. significantly elevated WBC
d. uncorrected bleeding diathesis
p: 1980

134.

The single most sensitive method of diagnosis of Typhoid Fever is which

of the following:
a. clinical picture
b. Typhidot
c. Widals test
d. Blood or bone marrow culture
p: 917

135.

Which of the following conditions is a contraindication to breastfeeding:

a.
b.
c.
d.

mastitis
common cold
substance abuse
intake of amoxicillin
p: 161

136.

A 3 year-old boy has fever and seizure. He was drowsy, with nuchal
rigidity and bilateral upgoing of toes. CSf examination shows turbid, cell
count of 10,000, 75% polyss, protein 500 mg/dl, sugar 40 mg/dl with 100
mg/dl random blood sugar. Based on the CSF exam, what is the most
probable etiologic agent:
a.
b.
c.
d.

Tuberculous
bacterial
viral
fungal
p: 2043

137.

In basic life support, what is the ratio of chest compression to ventilation

for children less than 8 years old:
a.
b.
c.
d.

2:1
3:1
5:1
10:1
p: 281

138.

A 24 year old susceptible medical student is exposed during wardwork to

a patient with chickenpox. He is advised to have varicella vaccine at:
a.
b.
c.
d.

one injection
two monthly injections
one injection followed by a booster after 6 months
one injection followed by a booster after 1 year

Reference: Nelson textbook of pediatrics, 17th ed. P 1061-1062

139.

A 5 year old girl presents with severe protein energy malnutrition. The
anthropometric indicator which is an index of acute nutritional status and
which is the simplest to measure is:
a.
b.
c.
d.

height
weight
mid-arm circumference
head circumference

Reference: Nelson textbook of pediatrics, 17 th ed. P 170-172

140.

A 4 year old boy looks malnourished. The height for age measurement is
75% therefore the waterlow classification is _______ stunting:
a.
b.
c.
d.

Normal
Mild
Moderate
Severe

Reference: Nelson textbook of pediatrics, 17 th ed. P 59 (Table 15-1)

141.

A 2 year old child was rushed to the ER because of seizure. He initially

developed fever with associated petechial rashes on both extremities.
While at the ER, the resident noted petechial rash and several slate gray
satellite shape descent. The most likely diagnosis is:
a.
b.
c.
d.

bacterial meningitis
viral encephalitis
intracranial hemorrhage
seizure disorder

Reference: Nelson textbook of pediatrics, 17 th ed. P 2041

142.

While the parents were transporting their four year old child to the
Emergency Department for difficulty of breathing, the child stopped
breathing. On arrival in the ER the child is pulseless and apneic. The
monitor shows a bradyarrhythmia at 20 beats per minute. The initial and
immediate treatment consists of:
a.
b.
c.
d.

ventilation
chest compressions
vascular access
parental medications

Reference: Nelson textbook of pediatrics, 17 th ed. P 279, P2

143.

A 3 month old presents to the ER with a one day history of poor feeding
and rapid breathing. The infants pulse is 260/min. The color is gray and
perfusion is poor. ECG is consistent with SVT. Treatment in this child
consists of:
a. Rapid IV digitalization
b. IV verapamil
c. oral digitalization
d. synchronized cardioversion
Reference: Nelson textbook of pediatrics, 17th ed. P 282

144.

A 3 year old female has a grade 3/6 systolic ejection murmur at the RUSB
with weak pulses at the lower extremities and a lower extremity BP of
90/60 and an upper extremity BP of 110/70. The most likely diagnosis is:
a.
b.
c.
d.

pulmonary stenosis
coarctation of the aorta
patent ductus arteriosus
Ebstein anomaly

Reference: Nelson textbook of pediatrics, 17 th ed. p. 1518

145.

A term infant was noted to have PDA. The pharmacogenic agent that is
given to this baby to promote closure of the PDA is:
a.
b.
c.
d.

prostaglandin E1
ibuprofen
indomethocin
prednisone

Reference: Nelson textbook of pediatrics, 17 th ed. p. 580

146.

A 3 day old newborn has blotchy erythematous macules with tiny central
vesicles or pustules noted on the trunk and the face. The most likely
diagnosis is:
a.
b.
c.
d.

erythema toxicum
sebaceous gland hyperplasia
hemangioma
epidermal nevus

Reference: Nelson textbook of pediatrics, 17 th ed. p. 525

147.

A 2 year old male child consulted for speech delay. Mother reports that
he can only babble at present and would not respond when called. He
flaps his hands when he hears his favorite song but cannot establish eye
contact. He perseverates on spinning objects. The most probable
consideration for this is:
a.
b.
c.
d.

developmental language disorder

autism
hearing impairment
cerebral palsy

Reference: Nelson textbook of pediatrics, 17 th ed. p. 93-94

148.

A term female infant at one week old was noted to have weak movements
macroglossia, and wide anterior fontanel. This baby most probably has:
a.
b.
c.
d.

149.

galactosemia
G6PD
Phenylketonuria
Congenital hypothyroidism

Reference: Nelson textbook of pediatrics, 17 th ed. p. 1875

A 16 year old male with a height age of 13 years, a bone age of 13 years,
a history of the same complaints in an uncle when he was of the same
age, no other abnormalities very likely has:
a.
b.
c.
d.

Constitutional delay
Hypopituitarism
Turner syndrome in the male
Isolated LH-FSH deficiency

Reference: Nelson textbook pediatrics

150.

A six-month-old baby boy was seen at the Outpatient Clinic because of

jaundice which was noted since two weeks of age. The jaundice was
deepening associated with pruritus and irritability and abdominal
distention. Stools were acholic and urine was deep yellow. On PE, the
child was wasted and stunted, with generalized jaundice; distended
abdomen with(+) fluid wave; liver edge was not palpable, (+)
splenomegaly 4 cm below the left costal margin; (+) visible superficial
veins on the abdomen; (+) palmar erythema and clubbing. The most likely
diagnosis is:
a.
b.
c.
d.

billiary atresia
viral hepatitis
pyloric stenosis
choledochal cyst

Reference: Nelson Textbook of Pediatrics, 17 ed. Ch. XVII p. 1317,

Biliary atresia
151.

Ana, a 15 year old teenager came in due to recurrent heavy menstruation.

Her regular menstrual cycle lasts for 10 days with large blood clots. She
also frequently develops gum bleeding after brushing. What is the most
likely diagnosis?
a.
b.
c.
d.

hemophilia A
protein C deficiency
Von Willebrand disease
TFPI deficiency

Reference: Nelson Textbook of Pediatrics, 17 ed. P 1662

152.

A 6 month old presented with 3 days of high grade fever. He was cheerful
and feeding well when afebrile and had no respiratory symptoms. After the
3 day fever, maculopapular rashes appeared on the face progressing
downwards.The most likely diagnosis is:
a.
b.
c.
d.

Measles
Roseola infantum
Rubella
erythema infectiosum

Reference: Nelson textbook of pediatrics, 17 th ed. Part XVI, p. 10691070

153.

A child suspected to have TB infection will have

a.
b.
c.
d.

10 mm induration on Mantoux test

(+) Ghons complex on Chest X-ray
(+) Blood culture
(+) AFB smear

Reference: PPS TB concensus for children

154.

A 4 year old child was complaining of difficulty in walking .On PE there

was palpable, tender left inguinal lymphadenitis and pus coming out from
the wound located at the dorsum of the left foot. The appropriate antibiotic
to give is:
a.
b.
c.
d.

Penicillin
Oxacillin
Chloramphenicol
Cotrimoxazole

Reference: Nelson textbook of pediatrics, Part. XXXI, p.2300

155.

A test to verify to presence of maternal blood in the swallowed blood

syndrome:
a.
b.
c.
d.

Apts test
Kelihaeur-Bethk test
Mantoux test
Coombs test

Reference: Nelson textbook of pediatrics, 17 th part XVIII, p. 599-607

156.

Jo-anne, an 8 year old female known asthmatic was seen at the ER

because of difficulty of breathing which started one hour PTC: Initial
treatment consists of:
a.
b.
c.
d.

inhaled short acting B2 agonist

oral steroid
inhaled steroid
leukotrienes

Reference: GINA Guidelines

157.

An 8 year old male presents with tea-colored urine oliguria, periobital

edema most prominent in early morning and hypertension. The most likely
diagnosis is:
a.
b.
c.
d.

UTI
Nephrotic syndrome
acute glomerulonephritis
hemorrhagic cystitis

Reference: Nelson Textbook of Pediatrics, 17ed. p.1735-1737

158.

Most reliable method of collection of urine for urine culture:

a.
b.
c.
d.

Catheterization
wee bag collection
midstream clean catch
suprapubic aspiration

Reference: PPS clinical practice guidelines for Urinary Tract

Infection

159.

The laboratory test that confirms the presence of UTI:

a.
b.
c.
d.

Bacteruiria
Pyuria
>100,000 CFU/ml of urine
hematuria

Reference: PPS clinical practice guidelines for urinary tract infection

160.

A 10 year old male was admitted for fever and seizures. History revealed
he had 3 days fever with productive cough, headache and yellowish
nasal discharge. Few hours PTA he developed generalized tonic
seizures for 15 minutes followed by loss of consciousness. On
admission he was febrile with violaceous, purpuric rashes on the trunk,
positive kernigs, hyperactive reflexes and glascow coma scale of 6. The
most probable diagnosis is
a.
b.
c.
d.

Fungal meningitis
Meningococcemia
dengue encephalitis
Tuberculous meningitis

Reference: Nelson Textbook of Pediatrics, 17ed. Part XVI, p. 896-897

161.

A 7 year old child present with cheilosis, glossitis and atrophic lingual
papillae. The most likely diagnosis is a deficiency of:
a. thiamine
b. riboflacin
c. pyridoxine
d. niacin
Reference: Nelson textbook of pediatrics, 17 th ed. p. 182

162.

Which of the following is the most important procedure with diagnosis of

the infective endocarditis?
a.
b.
c.
d.

Complete blood count

Urinalysis
Erythrocyte sedimentation rate
Blood culture

(Comprehension)
Answer: D The critical information for appropriate treatment of
infective endocarditis is obtained from blood cultures.
p.1566 Nelson 17th ed.
163.

At 5 minutes of life, an infant has the following findings :

Pulse rate 135 per minute, good muscle tone, cyanotic hands and feet,
strong cry and a grimace after a catheter was inserted thru the nostril. The
infants Apgar score is :
a.
b.
c.
d.

7
8
9
10

(Comprehension)
Answer: C -

Pulse rate
2
Body pink
1
Extremities
Cyanotic
Muscle tone, good 2
Strong cry
2
Grimace
2
9
p. 628 Nelson 17th ed.

164.

Which one is most often fractured in difficult deliveries?

a.
b.
c.
d.

Clavicle
Radius
Humerus
Femur
(Recall)
Answer: A The clavicle is fractured during labor and delivery
more frequently than any other bone. p. 572 Nelson 17th ed

165.

Hemorrhagic disease of the newborn is effectively prevented by which one

of the following?
a.
b.
c.
d.

Platelet transfusion
Heparin administration
Injection of anti-D globulin (RhoGAM) in the mother
Injection of 1 mg vitamin K at birth
(Comprehension)
Answer: D Intramuscular injection of 1 mg of vitamin K at the
time of birth prevents the decrease of vitamin K dependent
factors in full-term infants.
p. 606 Nelson 17th ed

166.

A 2-year-old child living in Baguio City is bitten by a dog. After cleaning

and washing the wound, which of the following should be done next?
a.
b.
c.
d.

Find the dog and observe it.

Begin rabies hyper immune globulin.
Vaccinate the child with duck embryo vaccine.
Give both immune globulin and vaccine.
(Analysis)
Answer: B Local wound care is designed to remove or kill
the virus by mechanical and virucidal action. Passive
immunization with human rabies immunoglobulin (HRIG) then
provides intermediate blockage of attachment of virus to the
nerve endings.
p. 1104 Nelson 17th ed.

167.

The most common caused of blood-stained stool in an otherwise normal

infant is:
a.
b.
c.
d.

Anal fissure
Ulceritis colitis
Intussusception
Meckels diverticulum

(Comprehension)
Answer: A- Anal fissure is a small laceration of the
mucocutaneous junction of the arms. It is an acquired lesion
secondary to the forceful passage of a hard start, mainly seen
in infancy.
p.1288 Nelson 17th ed
168.

The clinical manifestation that differentiates marasmus from kwashiorkor

is :
a.
b.
c.
d.

irriitability
loose subcutaneous tissue
edema
failure to gain weight

(Comprehension)
Answer: C Marasmus is a nonedematous protein energy
malnutrition while kwashiorkor is edematous protein energy
malnutrition. Both present with irritability, failure to gain
weight and loose subcutaneous tissue. p. 172 Nelson 17 th ed.
169.

The average time at which the anterior fontanel closes is at :

a.
b.
c.
d.

6 months of age
12 months of age
18 months of age
24 months of age

(Recall)
Answer: C The average time of closure of the anterior
fontanel is 18 months. p. 1974 Nelson 17th ed.

170.

Which are the first permanent teeth to erupt?

a.
b.
c.
d.

Central incisors
Lateral incisors
Canine ( maxillary)
First molars

(Recall)
Answer: D The first molar erupt between 6 7 years of age.
A Central incisor erupt between 7 8 years of age.
B Lateral incisor erupt between 8 9 years of age
C. Canine (maxillary) erupt between 11 12 years of age.
p. 1205 Table 288-1 Nelson 17th ed.

171.

Bronchiolitis in infants is most often caused by which one of the following?

a.
b.
c.
d.

Respiratory syncytial virus

Influenza virus
Streptococcus pneumonia
Hemophilus influenza B

(Recall)
Answer: A Acute Bronchiolitis is predominantly a viral
disease. Respiratory syncytial virus (RSV) is responsible for
more than 50% of cases.
p. 1415 Nelson 17th ed
172.

Which of the following is the most likely diagnosis in an otherwise normal

adolescent with the sudden onset of respiratory distress, cyanosis,
retraction and markedly decreased breath sounds over his left lung?
a.
b.
c.
d.

Empyema
Chylothorax
Pneumothorax
Staphylococcal pneumonia

(Analysis)
Answer: C The onset of pneumothorax is usually abrupt, and
the severity of symptoms depend on the extent of the lung
collapse and in the amount of pre-existing lung disease.
Pneumothorax may cause pain, dyspepsia and cyanosis.
Usually, there is respiratory distress, retractions, and
markedly decreased breath sounds on the involve lung.
p.1464 Nelson 17th ed
Empyema and chylothrax are not sudden in onset, and
staphylococcal pneumonia is not likely in adolescents.
173.

A 3 year old presents with strider and a barking cough. There is mild
respiratory distress, tachypnea, respiratory strider, and a temperature of
39 C. The most likely diagnosis is:
a. laryngotracheobronchitis
b. epiglottitis
c. bacterial tracheitis
d. retropharyngeal abscess
(Analysis)
Answer: A Most patients have an upper respiratory tract
infection with some combination of rhinorhea, pharyngitis,
mild cough, and low-grade fever ( 39 40 C) for 1 to 3 days
before the signs and symptoms of upper airway obstruction
become apparent. The child then develops the characteristic
barking cough , hoarseness, and inspiratory stridor.
p.1405 Nelson 17th ed

174.

A child has low grade fever, abdominal pain, arthritis, microscopic

hematuria and rash only in the lower extremity. The most likely has:
a. Meningococcemia
b. Postotreptococcal glumerulonephritis
c. Henoch-Schonlein purpura (HSP)
d. Wegners granulomatosis

( Analysis)
Answer: C HSP, also known as Anaphylactoid purpura, is a
varculitis of the small vwssels. Low-grade fever and fatigue
occur in more than half of the affected children. The hallmark
of the disease is the rash, beginning as pinkish
maculopapules that initially blanch or pressure and progress
to petechiae or purpura. Renal involvement is manifested by
red blood cells, white blood cells, casts or albumin in the urine
pp. 826 827 Nelson 17th ed.
175.

A 7 year old had a sore throat 10 days ago. Today she manifest periorbital
edema and tea-colored urine. Her blood pressure is 155/95. the serum
complement level is low. The most likely diagnosis is:
a.
b.
c.
d.

lupus nephritis
nephritic syndrome
Postreptococcal glomerulonephritis
Berger disease

(Analysis)
Answer: C Postreptococcal glomerulonephritis is the most
common cause of hypocomplementeremic nephritis.
Depending on the severity of renal involvement, patients may
develop various degrees of edema, hypertension and oliguria.
p. 1740 Nelson 17th ed.
176.

The triad of microangiopathic hemolytic anemia, renal failure and

thrombocytopenia is characteristic of which of the following?
a.
b.
c.
d.

Membranous lupus nephritis.

Focal glomerulonephritis secondary to septicemia
hemolytic uremic syndrome
Acute poststeptococcal glomenulonghitis

(Comprehension)
Answer: C the hemolytic uremic syndrome (HUS) is the most
common cause of acute renal failure in young children and is
characterized by microangiopathic hemolytic anemia,
thrombocytopenia and uremia.
p. 1746 Nelson 17th ed.
177.

Which of the following is NOT true of nephrotic syndrome?

a.
b.
c.
d.

elevated serum cholesterol

85% experience minimal change in disease
reduced sodium reabsorption by the kidney
elevated triglycerides

(Comprehension)
Answer: C Because of renal protein loss and
hypoalbuminemia, there is reduced intravascular volume. This
stimulates the rennin angiotensisn system, resulting in
enhanced renal sodium reabsorption. Eventually, the sodium
partially contributes to the edema. The incidence of nephritic
syndrome is 2 3 / 100, 000 children per year, and the most

majority affected children will have a steroid sensitive

minimal change diseases..
In the nephritic state, serum lipid levels ( Cholesterol,
triglycerides) are elevated.
p. 1753 1755 Nelson 17th ed.
178.

The most common abdominal mass in a neonate is:

a.
b.
c.
d.

Renal dysplasia hydroneprhosis

Wilms tumor
neuroblastoma
Meckless diverticulum

(Recall)
Answer: A Renal masses are the most common lesions in
neonates with an abdominal mass. Hydronephrosis and multi
cystic dysplastic lesions are the most common renal
masses.
p. 1784 Nelson 17th ed.
179.

Partial complex seizures is typically characterized as :

a. Simple staring that last for 30 mins. or more
b. Absence of impaired consciousness
c. Automatism like chewing, facial grimace or repetition
speech
d. Seizures describe as generalized clinic movements.
(Comprehension)
Answer: C Automatisms are common feature of complex
partial seizures in infants and children characterized by
alimentary automatisms including lip smacking, chewing,
swallowing and excessive salivation. CPS may begin with a
simple partial seizure with or without an aura, followed by
impaired conciousness. The seizure are tonic-clonic and the
average duration is 1 2 min.
pp. 1995 1996 Nelson 17th ed.

180.

A 5- year-old female has multiple bruises on her lower extremities and oral
mucosal bleeding of 3 days duration. Two weeks before these signs,
she had a mild respiratory tract infection. Physical examination reveals
multiple ecchymoses and petichaie: no lymphadenopathy or
hepatosplenomegaly is noted. The next diagnostic step is:
a.
b.
c.
d.

a complete blood count

a prothrombin time
a bleeding time
a partial thromboplastin time

(Analysis)
Answer: A A complete blood count (CBC) reveals a
hemoglobin value of 12 g/dl, a white blood cell (WBC) count of
11,000 and a platelet count of 5,000
p. 1654 Nelson 17th ed.

181.

Which is not a frequent presenting symptoms or sign of childhood

leukemia?
a.
b.
c.
d.

pallor
petechiae
lymphadenopathy
abdominal pain

(Comprehension)
Answer: D Most children with leukemia present with less
than 4 weeks of symptoms. Most children with ALL have
pallor, 50% have petechiae, 60% have lymphadenopahty, 25%
have fever, and about 25% have bone pain and arthralgias
caused by leukemia infiltration of the perichondral bone or
joint or by leukemic expansion of the marrow cavity.
pp. 1694 1698 Nelson 17th ed.