Pedia 251 [Block 7: Mejia to Opea]

PHILIPPINE GENERAL HOSPITAL

University of the Philippines Manila
Department of Pediatrics
Year Level VI
End of Rotation Exam
July 5, 2008
Choose the BEST answer.

*disclaimer: we didnt have any feedback after the exam, the answers here were from an informal discussion with our resident monitor.

1.

The most rapid increase in height in boys is found in which Tanner SMR stage?
a. 1
b. 2
c. 3
d. 4
e. 5

2.

The posterior fontanel usually closes by

a. 6-8 weeks
b. 15-18 weeks
c. 6-8 months
d. 15-18 months
e. 2-4 months

3.

The total average gain in length during the first year of life reaches 25cm. From birth to 3 months, what is the approximate
gain in length?
a. 3cm
b. 4cm
c. 5cm
d. 8cm
e. 9cm

4.

An infant has the following findings at 5 minutes of life: cyanotic, limp, with slow, irregular respirations, heart rate of 70bpm,
and no grimace. The APGAR score of the patient is:
a. 5
b. 4
c. 3
d. 2
e. 1

5.

An infant born with gestational age of 32 weeks develops progressive cyanosis, grunting, flaring and retractions 1 hour
after delivery. The chest radiograph reveals a ground glass-air bronchogram pattern. What is the most likely diagnosis for
this patient?
a. Transient tachypnea of the newborn
b. Persistent pulmonary hypertension in the newborn
c. Hyaline membrane disease
d. Neonatal pneumonia
e. Meconium aspiration syndrome

6.

The infant now requires intubation and mechanical ventilation with 40% oxygen. Antibiotics are administered after drawing
blood for culture but the infant continues to require 40-50% oxygen to maintain adequate oxygenation. The most
appropriate therapeutic intervention would be to administer:
a. Oral indomethacin
b. Intravenous dexamethasone
c. Intramuscular vitamin E
d. Endotracheal surfactant
e. Intravenous sodium bicarbonate

7.

Jaundice is most likely to be physiologic in a term infant in which one of the following situations?
a. Jaundice at 12 hrs of age
b. Serum bilirubin level increasing <5mg/dl/24 hrs in the first 2 to 4 days
c. Direct (conjugated) bilirubin greater than 1mg/dl
d. Jaundice at 12 days of age

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8.

A 2-week old infant is brought to the ER in coma with retinal hemorrhages and severe pallor. He was born at home and
was first seen by a physician at 10 days of age and place on Amoxicillin for otitis media. His diet is breastmilk. He oozes
blood from all venipuncture sites. Diagnostic tests should include the following EXCEPT:
a. Coagulation studies
b. Skeletal survey
c. Cranial CT scan
d. CBC
e. Lumbar puncture

9.

An A+ infant was born to an O+ mother and developed hyperbilirubinemia requiring 2 days of phototherapy in the NICU
after birth. The infant was brought to your clinic 4 weeks later appearing apathetic and pale with Grade 2/6 systolic ejection
murmur and heart rate of 172/min. The most likely diagnosis is
a. Anemia of chronic disease
b. Cholestatis secondary to neonatal hepatitis
c. Hereditary spherocytosis
d. Sickle cell anemia
e. ABO incompatibility with continued hemolysis

10. A 12 yo with repeated episodes of sore throat was given oral ampicillin. One hour later, she develops a funny feeling and a
tingling sensation around her mouth. Next she becomes apprehensive, has difficulty swallowing and develops hoarse
voice. On arrival at the ER, she has urticaria, HR 130, RR 32, BP 70/30, and temperature 37.2 C. The most appropriate
therapy is
a. Epinephrine
b. Prednisone
c. Diphenhydramine
d. Ranitidine
e. Lactated ringers solution
11. A 12 yo presents with sneezing, clear rhinorrhea, and nasal itching. PE reveals boggy, pale nasal edema with a clear
discharge. The most likely diagnosis is
a. Foreign body
b. Vasomotor rhinitis
c. Neutrophilic rhinitis
d. Nasal mastocytosis
e. Allergic rhinitis
12. A 6mo old infant was brought to PER due to a 3day history of loose watery stools, non-bloody, approximately 4 episodes
per day, with no history of fever. On admission, the patient was irritable with note of absent tears and sunken eyeballs.
There was fair skin turgor and CRT 2 seconds. This patient has
a. No dehydration
b. Mild dehydration
c. Moderate dehydration
d. Severe dehydration
13. Oral rehydration therapy is the treatment of choice for all children with gastroenteritis EXCEPT those with
a. Vomiting, high fever
b. Ileus, coma or shock
c. Cholera
d. Shigellosis
e. Poor skin turgor, sunken fontanel, dry mouth and decreased urine output
14. A 2-week illness characterized by gradually increasing fever that eventually reaches 40 C and is associated with
headache, malaise and abdominal pain
a. Cholera
b. Diphtheria
c. Shigellosis
d. Typhoid fever
e. Tetanus
15. Which is the most useful parameter to assess the degree of dehydration in a malnourished child?
a. Skin turgor
b. Thirst
c. Irritability
d. Sunken eyeballs
e. AOTA

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16. A 6-month old infant presents with tonic-clonic seizures lasting 30minutes. The child id found to be hypothermic and
remains lethargic. The diet history reveals that due to financial difficulties his mother has begun to dilute the remaining milk
formula with water at a ratio of 1:4. The most likely reason for his seizure is
a. Hypocalcemia
b. Hyponatremia
c. Hypoglycemia
d. Hypernatremia
e. Hypokalemia
17. Which of the following is the most likely diagnosis in an otherwise normal adolescent with sudden onset of respiratory
distress, cyanosis and retractions?
a. Empyema
b. Chylothorax
c. Pneumothorax
d. Staphylococcal pneumonia
e. AOTA
18. A 3 yo male was brought to the PER for difficulty of breathing. He had fever, cough with yellowish to greenish phlegm since
5days ago. One day PTA, he was noted to be tachypneic. Before transferring to PGH, he had 1 episode of cyanosis. At
the PER, he was awake, HR 120, RR 48, T 39.5C with chest indrawing and alar flaring. This patient should be classified as
having:
a. No pneumonia
b. Pneumonia
c. Severe pneumonia
d. Very severe pneumonia
19. The first line antibiotic for this child consist of
a. Amoxicillin PO
b. Cotrimoxazole PO
c. Penicillin G IV
d. Cefuroxime IV
e. Chloramphenicol IV (?)
20. What is the most common etiologic agent of pneumonia for this age group?
a. Streptococcus pneumoniae
b. Group B Streptococcus
c. Mycoplasma pneumoniae
d. Staphylococcus species
e. Haemophilus influenzae
21. An 18 month old is noted to assume a squatting position frequently during playtime at a daycare center. The mother also
notices occasional episodes of perioral cyanosis during some of these squatting periods. On the day of admission, the
child becomes restless, hyperapneic and deeply cyanotic. Within 10 minutes, the child becomes unresponsive. The most
likely underlying lesion is
a. Cardiomyopathy
b. Anomalous coronary artery
c. Tetralogy of fallot
d. VSD
e. Transposition of the great arteries
22. Therapy of a tet spell could include all of the following, EXCEPT
a. Epinephrine
b. Knee-chest position
c. Oxygen
d. Morphine
e. Sodium bicarbonate
f. Phenylephrine
23. What is the recommended secondary prophylaxis for rheumatic fever?
a. Erythromycin 250mg 2x a day
b. Oral penicillin 250mg 2x a day
c. Oral penicillin 500mg 2x a day
d. Benzathine penicillin 1.2 M units deep IM every 21 days
e. Benzathine penicillin 1.2 M units deep IM every 28 days
24. A 15 yo male consulted for 1 month history of moderate to high grade fever more prominent in the afternoon associated
with progressive easy fatigability, orthopnea, and bipedal edema. On PE, there was note of pale conjunctivae, rales on

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bilateral lung fields, diastolic murmur at the right upper sternal border radiating to the apex, and bounding pulses, with no
neck vein engorgement. Hepatosplenomegaly was likewise noted. The most likely diagnosis is
a. Pericarditis
b. Infective endocarditis
c. Myocarditis
d. Dilated cardiomyopathy
e. AOTA
25. A 3month old presents with a T of 39.5 C and a generalized seizure that lasts 35 minutes. After the seizure, the infant
remains lethargic. The family history is unremarkable. After 5 hours of observation, the patient develops another
generalized seizure. A consultant suggests that the patient has had febrile seizures. This diagnosis is questioned. All of the
following suggests another diagnosis EXCEPT
a. Patients age
b. Duration of seizures
c. Recurrence of seizure
d. Family history
e. Persistence of lethargy
26. You strongly suspect bacterial meningitis. Common etiologic agents causing bacterial meningitis in this age group include
the following EXCEPT
a. Group B Streptococcus
b. Neisseria meningitides
c. Haemophilus influenzae
d. Streptococcus pneumoniae
e. NOTA
27. If the CSF culture revealed growth of N. meningitides, how long should IV antibiotics be given?
a. 5-7 days
b. 7-10 days
c. 10-14 days
d. 14-21 days
e. 21-28 days
28. True of status epilepticus EXCEPT
a. A single epileptic seizure of >30minute duration
b. A series of epileptic seizures during which time function and consciousness are not regained between ictal events
c. The goal of management is to prevent irreversible brain damage
d. Status epilepticus is always an emergency
e. The first priority in the management of status epilepticus is to secure an IV access and hook D 50.9 NaCl
29. A positive tourniquet test performed in suspected dengue cases is done by inflating a blood pressure cuff on the upper arm
to a point midway between the systolic and diastolic pressures for 5 minutes. A test is considered positive when the
following is observed:
a. 20 petechiae per 1 square inch
b. 10 petechiae per 1 square inch
c. 50 petechiae per 1 square inch
d. 30 petechiae per 1 square inch
e. 40 petechiae per 1 square inch
30. A woman delivers a 3800 g infant at term. The mothers medical record reveals that she is HBsAg-positive. She denies
drug use or having any sexually transmitted diseases. Of the following, the MOST appropriate treatment of the infant at this
time would be to administer
a. Hepatitis B immune globulin
b. Hepatitis B immune globulin and Hepatitis B vaccine
c. Hepatitis B vaccine
d. IVIg and Hepatitis B vaccine
e. Interferon-alpha
31. Which statement applies to a 2yo female whose father has been diagnosed with pulmonary tuberculosis the past 2 weeks?
a. A PPD reaction <15mm indicates that she is at no risk for tuberculosis disease
b. Contact with her father should be stopped immediately
c. She should receive a PPD test and chest radiograph and begin treatment only if results of one or both is
positive
d. She should be started on INH even after her skin test results is nonreactive and her findings on CXR are normal
e. NOTA

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32. A child aged 18mos had a convulsion at the onset of a feverish illness; the child was active, playful with good appetite and
PE was essentially normal except for a mild nasal catarrh. After 3 days, the fever settled and an erythematous macular
rash appeared. What is the most probable diagnosis?
a. Measles
b. Rubella
c. Roseola infantum
d. Dengue fever
e. Varicella
33. A 4 year old male sought consult for a 2 week history of generalized edema. Blood pressure is normal. Urinalysis showed
2-5 rbc/hpf and +4 protein. BUN and creatinine are within normal range, cholesterol 402mg/dl, serum albumin 0.9g/dl and
C3 92mg/dl. What is the most likely diagnosis?
a. Acute glomerulonephritis, post-infectious
b. Nephrotic syndrome
c. Rapidly progressing glomerulonephritis
d. Membranous glomerulonephritis
e. Focal segmental glomerulosclerosis
34. The patient was sent home on oral corticosteroids. After 4 weeks, he came back with abdominal pain, fever, and lethargy.
PE reveals normal vital signs except for temperature of 39C and diffuse abdominal tenderness. Neither nuchal rigidity nor
rash is noted. What is the most likely diagnosis?
a. Cholecystitis
b. Meningitis
c. Acute appendicitis
d. Spontaneous bacterial peritonitis
e. Pseudomembranous colitis
35. The triad of microangiopathic hemolytic anemia, renal failure and thrombocytopenia is characteristic of which of the
following:
a. Membranous lupus nephritis
b. Focal glomerulonephritis secondary to sepsis
c. Hemolytic uremic syndrome
d. Acute post-infectious glomerulonephritis
e. Berger disease
36. The following are risk factors for urinary tract infection EXCEPT:
a. Female
b. Uncircumcised male
c. Toilet training
d. Pinworm infestation
e. Wiping front to back
37. Which condition DOES NOT present with microcytic anemia?
a. INH toxicity
b. Hemoglobin E disease
c. Vitamin B12 deficiency
d. Beta thalassemia
e. AOTA
38. A 12 year old male was brought to the PER due to difficulty in extending the right hip. He is a diagnosed case of
Hemophilia A. The blood component of choice for this patient is:
a. Fresh frozen plasma
b. Cryoprecipitate
c. Platelet concentrate
d. Stored plasma
e. Cryosupernate
39. Assessment of the degree of control of blood sugar in a patient with Type 1 DM is best done by:
a. Oral glucose tolerance test
b. 24 hour urine for microalbuminuria
c. 24 hour urine for glucose determination
d. Glycosylated hemoglobin
e. CBG pre-meals and at bedtime
40. Which combination of manifestations best describes untreated congenital hypothyroidism?
a. Short stature, coarse facies, dry skin, cataracts, macroglossia
b. Feeding difficulties, hoarse cry, umbilical hernia, hypotonia

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c.
d.
e.

Global developmental delay, corneal clouding, stiff joints, umbilical hernia

Obesity, edema, dry brittle hair, high arched palate
NOTA

41. When performing a puncture for arterial blood gas collection, the following are true EXCEPT:
a. The radial artery is the preferred site
b. Existence of collateral circulation should always be checked
c. The ulnar artery is also a preferred site
d. The puncture site should be monitored after the procedure
e. NOTA
42. A 9 month old boy with a purpuric rash is unresponsive when brought to the ER. The pulse is barely palpable. After several
attempts, you are unable to establish peripheral venous access. Of the following, the BEST site for the next attempt to
provide fluid resuscitation for this patient is the
a. Femoral artery
b. Internal jugular vein
c. Intraosseous space
d. Saphenous vein
e. Subclavian vein
43. True of lumbar puncture EXCEPT
a. The ideal interspace for lumbar puncture is L3-L4 or L4-L5
b. A gauge 22 needle, 1-2 in, sharp, beveled spinal needle with a properly fitting stylet is introduced into the
midsagittal plane directed slightly in the cephalic direction
c. A manometer and a three-way stopcock may be attached to obtain an opening pressure
d. The most common cause of an elevated opening pressure is a crying, uncooperative and struggling patient
e. The pressure is recorded most reliably with a child positioned comfortably with the head and the legs flexed
44. The expected head circumference of a 6month old is: (BONUS, choices should be in inches???)
a. 36 cm
b. 36.5 cm
c. 37 cm
d. 37.5 cm
e. 38 cm
45. A 3 year old male was brought to PER for difficulty of breathing. He had fever, cough with yellowish to greenish phlegm
since 5days ago. One day PTA, he was noted to be tachypneic. Before transferring to PGH, he had 1 episode of cyanosis.
At the PER, he was awake, HR 120, RR 48, R 39.5 with chest indrawing and alar flaring. You placed this patient on NPO. If
you want to start with a total fluid intake of full maintenance + 30% to account for the tachypnea and fever, how much IVF
should you give? (CLUE: calculate the expected weight for age first).
a. 1200 ml
b. 1350 ml
c. 1400 ml
d. 1560 ml
e. NOTA
46. A 10month old female was brought to the PER for pallor. Her diet consists of table food which was started at around 6
months of age and whole milk and she is a good drinker. She was born prematurely and was on exclusive breastfeeding
until 6 months of age. Her weight and length are at the 50th percentile and no changes are noted in her growth curves. Her
physical examination is notable for pallor and tachycardia; otherwise there are no abnormalities. Her hemoglobin is 7.5 g/dl
and the peripheral blood smear reveals microcytic hypochromic cells. Which of the following is the MOST likely etiology of
this anemia?
a. Thalessemia
b. Transient viral suppression of her bone marrow
c. Anemia of chronic disease
d. Iron deficiency anemia
47. What could have contributed mainly to the childs condition?
a. Exclusive breastfeeding since breastmilk has low iron
b. Premature birth since iron stores are expected to be low
c. Giving of whole milk which is deficient in iron
d. Early introduction of complementary feeding
48. What management option/s should be done?
a. Transfusion of packed RBCs
b. Giving of iron drops
c. Changing whole milk to iron-fortified formula

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d.

AOTA

49. A 6 month old child comes to the clinic with a weight of 5kg and a length of 63cm. On looking at his growth chart, plotting
the weight against the length, the following were noted: 5th percentile = 5.5kg, 25th percentile = 6kg, 50th percentile = 6.5kg,
75th percentile = 7kg. What is his current nutritional status?
a. Mild wasting
b. Moderate wasting
c. Second degree malnourished
d. Severe wasting
50. A.R., a 2 y/o girl, was brought to the ER because of edema, which was noted two weeks after an episode of diarrhea. The
mother discontinued milk feeding and gave the child only porridge (lugaw) and rice water for fear that the diarrhea would
recur. His weight was noted to be 14kg and length was 80cm. The median weight-for-length on the growth table was 12kg
and the median length-for-age was 86cm. She was noted to have puffy eyelids and with ascites and pedal edema. There
was also note of hepatomegaly. What is A.R.s nutritional status?
a. No wasting, no stunting
b. Overweight, no stunting
c. No wasting, mild stunting
d. Severe malnutrition, kwashiorkor type
51. In which of the following scenarios can the diagnosis of nosocomial infection be made?
a. A 2 y/o girl who was discharged 2 days ago for pneumonia and then develops fever at home
b. A 3/yo boy admitted in the wards for pneumonia and develops diarrhea after 1 day of confinement
c. A 9month old infant who has a history of 4 day duration of intermittent fever at home who develops maculopapular
rashes starting on the face becoming generalized after 1 day of confinement
d. A 12 y/o male admitted for elective surgery for indirect inguinal hernia who develops cough and colds after 1 day
of staying in the hospital
52. In the management of diabetic ketoacidosis in children the following are instituted EXCEPT
a. Fluid of choice for initial therapy is 0.9% NaCl
b. After the initial bolus hydration, continue rehydration and maintenance with 0.45% NaCl
c. Provide potassium at 20-40 mmol/L
d. Bicarbonate is usually indicated at 1-2mmol/kg