NATIONAL KNOWLEDGE BASED EVALUATION

OF INDONESIAN PEDIATRIC RESIDENT

October, 27, 2016
MN1016krm

For each of the following multiple choice questions,

select the one, most appropriate answer

1. The results of using the Denver II screening test on a child aged 9 months was concluded
suspect, the child fails to perform two task forces of the language that is already past age
lines. What's the next step ?
A. making a diagnosis of delayed speech
B. conduct further tests with CAPUT SCALE
C. consult a psychologist
D. referring to a speech therapist
E. follow up with an examination of the M-CHAT R / F

2. The results of the examination of anthropometry plotting a boy age 9 months on the WHO
2006 chart Length for Age <-2 SD, the interpretation is
A. malnutrition.
B. wasted
C. severely stunted
D. stunted
E. severely wasted

3. An eleven years old boy is afraid of his parent. He is not allowed to play outside his house
and restricted to share his opinion. The possible parenting style that the parents used to
their son is:
A. Otoriter style
B. Democracy style
C. Permissive style
D. Over protection style
E. Autoritative style

4. A 19 –month old baby was admitted to an emergency room with febrile seizures. Fever
appeared since last night, accompanied by cough and cold. Seizure lasted 1 minute. After
seizure he was crying, conscious, and there had history of febrile seizures when she was
13 month old. Physical examination revealed no abnormalities Laboratory results showed
leukopenia. The day before the fever, he received measles vaccine. Based on that case,
what is the classification of the “adverse events following immunization”?
A. vaccine product-related reaction
 B. vac cine quality defect-related reaction
C. immunization error-related reaction 5
D. immunization anxiety-related reaction
E. coincidental event

5. If a child can hop and stand on one leg , his age is about :
A. 12 months
B. 18 months
C. 2 years
D. 3 years
E. 4 years

6. Which of the following pairs shows the CORRECT stage of normal development ?
A. 6 months – pulls to stand
B. 12 months – pincer grasp
C. 18 months – put on T-shirt
D. 2 years – draws a cross
E. 3 years – tells a story

7. Which of the following characteristics best describes this screening test of the Parents’
Evaluations of Developmental Status (PEDS) questionnaire?
A. Used to evaluate development of children 10–14 years
B. Screens for development in children less than 8 years
C. Utilizes a 100-question format
D. Used to evaluate teen adjustment
E. Less than 50% sensitivity, but high specificity for diagnosing emotional disorders
in children

8. Which of the following best describes the usual sequence for attainment of gross motor
milestones in a young infant?
A. head control, rolling over, hands together in midline, sits without support
B. head control, hands together in midline, rolling over, pulls to stand
C. rolls over, sits without support, hands together in midline, pulls to stand
D. sits without support, hands together in midline, pulls to stand, walks along
E. pulls to stand, walks along table, sits without support, hands together at midline

9. One of your asthmatic patients arrives for a check-up. The mother reports that the 9-year-
old child seems to need salbutamol daily, especially when exercising, and she has
coughing fits that awaken her from sleep about twice a week. Which of the following is
the most appropriate management?
A. Short-acting, inhaled β-agonists, as needed
B. Daily leukotriene modifier with short-acting β-agonist
C. Inhaled nedocromil with short-acting β-agonists
D. Medium-dose, inhaled corticosteroids with short-acting β-agonists
E. High-dose, inhaled corticosteroids with theophylline and short-acting β-agonists

10. A 15-month-old boy presents with barking cough, stridor inspiratory, fever, and hoarse.
Physical examination reveals fever (39.80C), stridor inspiratory, and chest retraction.
There is no history of choking.
What is the appropriate treatment for the child?
 A. Ampicillin intra venous
B. Third generation of Cephalosporin
C. Nebulization with β-2 agonist
D. Nebulization with 5 ml epinephrine
E. Tracheostomy

11. A 4-year-old boy was brought to the OPD with “whooping cough” for the last 14 days.
Physical examination reveals normal vital sign, tonsillar enlagment, exudates (-), and
subconjuctival bleeding, and normal lung sound. There is no history of immunization.
What is the antibiotic choice for the patient?
A. Amoxicillin 50-80 mg/BW/day tid for 7 days
B. Eritromisin 40-50 mg/BW/day qid for 14 days
C. Azitromisin 10 mg/BW/day qd for 7 days
D. Claritromisin 15 mg/BW/day bid for 14 days
E. Cefixime 5 mg/BW/day bid for 14 days

12. Primary complex in TB consisted of :

A. primary focus, lymphadenitis and lung cavity
B. cell Datia Langhans, lymphocyte T-cell and primary focus
C. primary focus, lymphadenitis and cellular mediated immunity
D. primary focus, lymphangitis and lymphadenitis
E. Lymphocyte T-cell, primary focus and Gohn complex

13. A 8 year old girl presents with well controlled asthma. Her theraphies consist of
occasional use of short acting inhaled β agonists, daily inhaled steroid and a leukotriene
inhibitor. She presents with white patches on her buccal mucosa. You recommended
which of the following?
A. HIV testing
B. Tuberculin skin tes
C. Measurement of serum immunoglobulin
D. Discontinuation of all her asthma medications
E. Rinse her mouth after use of her inhaled medications

14. We can confirmation obstructive degree of respiratory track according to asthma

symptom with below indicators :
A. Spirometry test showed low FEV1 (<80% prediction value) and FEV1 / FVC ≤
90%
B. Reversibility test showed decrease of FEV1 >12%
C. Variability test showed difference of daily PEFR < 13%
D. Provocation test showed increase of FEV1 >20%, atau PEFR >15%
E. Total vital capacity is lower than 60%

15. A baby boy born from mother with active TB who have already taken anti TB drugs for 3
months. The baby is well doing, Apgar Score 9/10, BW 3000 gram and has no complaints.
What will you do to the baby:
A. Treat the baby with anti TB drugs 2RHZE 7RH
B. Treat the baby with anti TB drugs 2RHZE 10RH
C. Give INH prophylactic therapy for 3 months and perform TST
D. Give INH prophylactic therapy for 6 months
E. Observed the baby and perform TST in 1 month
16.The indication for giving corticosteroid in TB cases is :
A. Spondilytis TB
B. Congenital TB
C. Lymphadenitis TB
D. Pericarditis TB
E. Scrofuloderma

17. A 2-years old girl admitted to pediatric outpatient clinic with complaint of pain on
micturition, increased frequency of micturition. On physical examination: alert, blood
pressure 100/60 mmHg, temperature 38.60C. On laboratory examination Hb 9.6 g/dL,
WBC 9600/mm3, serum ureum 52 mg/dL, serum creatinine 1.1 mg/dL. Urinalysis:
brown, protein (-), WBC: 10/field, RBC 6-8/field.
For this case we suggest to collect urinary sample by:
A. Folley cathether
B. Midstream
C. Urinary collector
D. Suprapubic aspiration
E. Condom cathether

18. A 2 years old boy admitted to outpatient clinic with swelling in his whole body. Diuresis
0,9 mL/kgBW/hour. On physical examination alert, Vital sign within normal limit. On
laboratory examination: Urinalysis: protein ++++, Serum ureum: 33 mg/dL, Serum
creatinine: 0,6 mg/dL, Serum albumin: 2.0 g/dL, We diagnosed the patient as nephrotic
syndrome
Predictor of poor prognosis on this patient is:
A. Onset of disease < 1 years old
B. Male gender
C. Blood albumin < 1.2 g/dL
D. Encephalopathy
E. Heart failure

19. A 9-years old boy admitted to pediatric emergency unit with chief complaint of cola
coloured urine. There was history of skin infection about three weeks ago. On physical
examination: alert, blood pressure 180/120 mmHg, swelling on eyelids, on urine
examination: RBC 20/field, WBC 0-1/field, protein (-)Laboratory examination we will
suggest:
A. Anti ds-DNA
B. ASTO
C. DNAse B
D. CRP
E. ANA

20. A 13-years old girl admitted to pediatric emergency with complaint of pale. The
complaint accompanied by history of involuntary on micturition since she was 3 years
old. On physical examination he was compos mentis with blood pressure 130/80 mmHg,
pulse 110x/minutes, respiratory rate 24x /minutes, temperature 36.90C. Laboratory
examination: Hb: 8,0 g/dL, PCV: 24%, WBC: 6600/mm3, Platelete: 168.000/mm3. Serum
ureum 100 mg/dL, Serum creatinine 1.5 mg/dL, Sodium: 140 mEq/L, Potassium 5
mEq/L, Phosphor 7 mEq/L, Calcium 1,5 mg/dL. Our working diagnosis is:
 A. Postrenal Acute kidney injury
B. Prerenal Acute kidney injury
C. Renal Acute kidney injury
D. Chronic kidney disease
E. Acidosis renal tubules

21. What is kidney biopsy indication in acute post streptococcal glomerulonephritis

(APSGN)?
A. Gross hematuria more than 1 week
B. Microscopic hematuria more than 3 months
C. Persistent hypertension for more than 6 weeks
D. APSGN accompanied with risk phase acute kidney injury
E. Swelling on whole body with oliguria

22. A 10 years old boy admitted to your hospital with hypertension crisis. Glomerular
filtration rate was less than 15 mL/min/1.73 m2
What is your suggest treatment?
A. Ca channel blocker
B. ACE inhibitor
C. Angiotensin receptor blocker
D. Beta blocker
E. Osmotic diuretic

23. A 11 years old girl admitted to your hospital with chief complaint of no micturition since
2 days. Before the complaint she had bloody diarrhea. On physical examination the
children was alert, no breathless, mild hypertension, no swelling, no dehydration. On
laboratory examination there was high ureum (150 mg/dL). What is your suggest
examination?
A. Urine osmolality
B. Na urine
C. Na serum
D. Coombs test
E. Hematocrit

24. Which of the following findings suggests an organic cause for chronic abdominal pain?
A. Prolonged sleep phases.
B. Spasmodic periumbilical pain.
C. Persistent nausea.
D. Persistent discomfort in the left upper quadrant.
E. Height deceleration.

25. What feature differentiates abdominal migraine from cyclic vomiting syndrome?
A. Vomiting.
B. Abdominal pain.
C. Headache.
D. Chief complaint.
E. Sleep disorder

26. A 3-year-old boy with no prior history presents with a 3-day history of vomiting.
Abdominal X- ray demonstrates dilated loops of bowel and a paucity of gas in the colon.
 He is afebrile, and his white blood cell (WBC) count and C-reactive protein (CRP) level
are normal. His abdomen is distended and tender. Which of the following is the most
appropriate first diagnostic test?
A. Meckel's scan.
B. Abdominal ultrasound.
C. CT scan without contrast
D. CT scan with contrast
E. Laparotomy.

27. A thin, 10-year-old boy presents to the emergency department with a 48-hour history of
fever, nausea, and right lower quadrant pain. He has a leukocytosis and an elevated C-
reactive protein level. His abdominal ultrasound demonstrates a compressible, normal-
appearing appendix, and a 2-cm noncompressible structure in the pelvis with surrounding
inflammatory changes. What is the most plausible Meckel's diverticulum–related
explanation for these clinical and ultrasound findings?
A. Meckel's diverticulum with pancreatic tissue.
B. Meckel's diverticulum with gastric tissue.
C. Meckel's diverticulitis.
D. Meckel's diverticulum as a pathologic lead point.
E. Meckel's diverticulum with ulceration causing bleeding

28. Which of the following statements is incorrect regarding biliary atresia?

A. Most infants with biliary atresia look healthy and thrive satisfactorily.
B. Age at surgical correction of biliary atresia by Kasai portoenterostomy is the most
important predictor of successful outcome.
C. Biliary atresia is much more common in girls than in boys.
D. Biliary atresia after failed Kasai portoenterostomy is the most common indication for
liver transplantation in pediatric age.
E. Kasai portoenterostomy is the treatment of choice, except in those infants with
decompensated cirrhosis at diagnosis.

29.A 6-week-old infant presents with jaundice, conjugated hyperbilirubinemia, and elevated
liver enzymes. γ-Glutamyl transferase level is 562 U/L. Which of the following diagnoses
is least likely in this neonate?
A. Biliary atresia.
B. Alagille syndrome.
C. Bile acid synthetic disorder.
D. MDR3 deficiency.
E. Neonatal sclerosing cholangitis.

30. What is the current reference standard investigation for diagnosing H. pylori ?
A. Urea breath test.
B. Serologic tests.
C. Upper gastrointestinal endoscopy.
D. Upper gastrointestinal endoscopy and biopsy.
E. Stool antigen test.

31. An 7-day-old male infant is brought to clinic for a routine post delivery evaluation. On
examination, the child weight 5 kg. The neonate is excessively jittery. Pregnancy history,
 labor, and vaginal delivery were unremarkable. The mother states the baby is feeding
well.
Evaluation of which of the following would be most beneficial in an infant with these
physical findings and history?
A. Calcium
B. Glucose
C. Magnesium
D. Thyroid
E. Sodium

32. A pediatric endocrinologist has diagnosed familial short stature in 14-year-old boy
Which of the following are consistent with this diagnosis?
A. bone age is low compared to chronologic age
B. prognosis for normal adult height is good
C. Family history for chilhood short stature
D. Undernourished for the first year of life
E. Infant was small for size at birth

33. An otherwise healthy 8-year-old child is brought to you to be evaluated because he is the
shortest child in his class. Careful measurement of his upper and lower body segments
demonstrate abnormal body proportions for his age and lower body his shortes and bone
ages as 8 cronological ages.
Which of the following disorders of growth is likely?
A. Achondroplasia
B. Morquio disease
C. Hypothyroidism
D. Growth hormone deficiency
E. Marfan syndrome

34. A 13 month-old female presents with motoric delay development. You note that her TSH
is high and FT4 is still normal .
What is the most likely diagnosis?
A. Primary Hipothyroidism
B. Secondary Hipothyroidism
C. Tersiary Hipothyroidism
D. Hipothyroid compensated
E. Transient Hipothyroidism

35. A 14 year old girl with short stature has webbing of the neck, low posterior hairline, a
broad chest, and cubitus valgus.
Which hormone is affected most frequently in patients with this syndrome?
A. parathyroid
B. Estrogen
C. GH
D. Thyroid
E. IGF-1

36. The parent of a 14-year-old boys are concerned about his short stature and obesity, The
physical examnation his body height was 135 cm, his body weight was 70 kg, testicle not
papable in scrotum or inguinal, hypotonic, delayed development.
 Which of the following is the most likely diagnosis?
A. Seckle syndrome
B. Kallman syndrome
C. Prader willy syndrome
D. Musquito syndrome
E. Crnelia Delange syndrome

37. A 4 years old boys come to your clinic brought by his mother, the mother show the
refferal medical data from the Pediatric in distric hospital: Pallor, Hb low, MCV low and
no bleeding history, suspect of thalassemia.
Which of the following haemoglobin (Hb) estimation will be diagnostically helpful in a
case of beta thalassemia trait?
A. HbF
B. HbA1c
C. HbA2
D. HbH
E. HbA1b

38. A 10 year old female, asymptomatic, not requiring blood transfusion, presents with Hb 12
g/dl. MCV 67. HbF Level are 95%, HbA2 1.5%.
Which of the following is the most likely diagnosis?
A. Hereditary persistentce of fetal hemoglobin
B. Beta homozygous thalassemia
C. Thalassemia intermedia
D. Beta thalassemia mayor
E. Hereditary Spherocytosis

39. A 11-month old boy, on screening laboratory testing of hemoglobin 7.8 g/dl, Hct of 24%,
leucocyte count 12.200/uL with 39% neutrophils, 6% bands, 55% lymphocyte;
hypochromic on smear. Reeticulocyte count 0.2%; platelet count normally; MCV 64fl.
Stool normal, no lead contact.
Which of the following is the most appropriate recommendation?
A. FWB transfusion
B. Oral ferrous sulfate
C. Intramusculaar iron dextran
D. An iron – fortified porridge
E. PRC transfussion

40. Iron deficiency (ID) is systemic condition impairing physical endurance, work capacity,
infant growth and development and depressing function.
What long-term problems can IDA cause?
A. Decrease brain iron stores may impair the activity of iron dependent enzymes
synthesis.
B. The impact of ID for the infant growth and development is irreversible
C. Growth and development in children ID depend on level education of the parent
D. IDA is one of emergency condition in hematology services
E. IDA can induce chronic cardiac dsease, espescially pulmonary hypertension

41. An Infant 4th day of life come to your clinic with bleeding vaginal. Pregnancy history is
clear, vaginal delivery, well doing baby.
 Appropriate therapy for neonate with vaginal bleeding:
A. Vitamin K injection intramuscular
B. Investigate the case for bleeding disorder
C. Factor coagulation therapy
D. No spesific therapy
E. Thrombyte transfussion

42. The strain of virus that often causes death in HFMD is :

A. Coxsackievirus A6
B. Coxsackievirus A10
C. Enterovirus 71
D. Coxsackievirus A16
E. Human enterovirus A

43. A 5-year-old boy has been febrile for 2 days. He does not want to drink and vomited this
morning. There have been no cough, rhinorhea nor diarrhea. On examination, he is
sleepy and has temperature of 39,60C. His posterior oropharynx is markedly
erythematous with enlarged, simmetrical and cryptic tonsils that are laden with exudate.
Shoddy cervical lymphadenopathy is noted. He moves his neck vigorously in an effort to
thwart your examination. What is the most likely diagnosis?
A. Coxsackie pharyngitis
B. Streptococcal tonsillitis
C. Parapharyngeal abces
D. Lymphadenitis
E. Retropharyngeal abces

44. A 10-year-old girl came with the main complaint of gum bleeding, fever for 5 days,
headache, retro-orbital and muscle pain. On the admission revealed restlessness, blood
pressure 90/65 mmHg, pulse rate 96 ×/min/weak, respiratory rate 30 ×/minute, and
temperature 36.5°C. The liver was 2,5 cm below the costal arc. The extremities were
cold with capillary refill time less than two seconds. Tourniquet test was positive.
hemoglobin 15,5 g/dL, hematocrite 48%, leukocyte 2,700/mm3, and platelet 45,000/mm3.
The most likely diagnosis in this patient would be
A. Dengue fever
B. Dengue Hemorrhagic Fever grade I
C. Dengue Hemorrhagic Fever grade II
D. Dengue Hemorrhagic Fever grade III
E. Dengue Hemorrhagic Fever grade IV

45. An infant presents with abrupt onset of diffuse erythema, marked skin tenderness, and
fever. Flaccid bullae develop and rupture, leading beefy red, weeping surfaces. Physical
exam reveals separation of the epidermis on light rubbing (Nikolsky sign). Labs show S.
aureus as the causative agent. Which of the following is most likely?
A. Bullous impetigo
B. Nonbullous impetigo
C. Scalded skin syndrome
D. Folliculitis
E. Cellulitis
46. Amir, a two year old boy came with his mother with the main complaint of high grade
fever for 4 days. Mother also complaint of some red rashes appear in his face since
yesterday that spread to his neck and chest. The mother said that his neighbour was
suffered with the same complaint, and now hospitalized due to dyspnea. What is the most
likely diagnosis of Amir?
A. Rubella
B. Scarlet fever
C. Measles
D. Varicella
E. Exanthema subitum

47. The advantage of delay cord clamping.

A. Prevent jaundice
B. Prevent early onset neonatal sepsis
C. Prevent anemia
D. Reduce policytemia
E. Prevent hypoxia

48. What should be given when heart rate is <60 x/minute after chest compression and
positive pressure ventilation.
A. Epinephrine
B. NaCl bolus 10 mL/kgBW
C. Naloxone
D. Sodium bicarbonate
E. Blood

49. An 3-hours-old baby with birth weight 4200 grams was brought to Emergency
Department, referred by midwife with paralysis, in the right upper extremity . If the
paralysis were related to birth trauma, the most likely finding would be:
A. Erb’s paralysis
B. Klumpke paralysis
C. Fracture of clavicula
D. Fracture of humerus
E. Horner syndrome

50. What is true on laboratory finding of neonatal sepsis?

A. Decrease leucocyte
B. Increase absolute neutrophil count
C. Decrease immature leucocyte
D. Increase hematocrit
E. Decrease acute phase reactant

51. Target of rewarming of severely hypothermic newborn (32,5o C).

A. 0.1-0,5 o C/hour
B. 0.5-1 o C/hour
C. >1-1.5 o C/hour
D. >1.5-2 o C/hour
E. >2 o C/hour
52. Blood glucose of very low birth weight infant is 20 mg/dL. What should you do?
A. Bolus glucose 40% 1 mL/kgBW
B. Bolus glucose 40% 2 mL/kgBW
C. Bolus glucose 10% 1 mL/kgBW
D. Bolus glucose 10% 2 mL/kgBW
E. Bolus glucose 5% 1 mL/kgBW

53. What is the radiologic finding of respiratory distress syndrome?

A. Lung patchy appearance
B. Opacity of both lung
C. Lung Infiltration
D. Reduce of lung vascular appearance
E. Lung reticulogranular

54. A 13-months-old boy was brought to the ER by paramedics. His mother found him
chocking and gagging in the kitchen next to a container of spilled nuts. She immediately
called 118. Paramedics note that the child is alert, his works of breathing was increased
with wheezing on auscultation and he did not look cyanotic. The chest radiograph reveals
hyperinflation of the right lung.
What is your initial management priority?
A. Airway positioning
B. Bag-mask ventilation
C. Heimlich Manuvers
D. Back blow procedure
E. Bronchoscopy

55. A 6-months-old boy had constant vomitting for the last 24 hours. He was irritable, weak
and grunting. Lung was normal. He was looks pale and mottled. Respiratory rate 30
breaths/minute, heart rate 180 beats/minute, and blood pressure 50 mmHg/palpation. The
skin was cold and capillary refilling time was 4 seconds. The brachial pulse was weak.
His abdomen was distended. Laboratory: Natrium 118 mEq/L, Potassium 2,4 mEq/L,
Chloride 85 mEq/L, Glucose 89 mg/dL, Calsium 7 mEq/L.
Which treatment could be the best decision in this situation?
A. Give sodium bicarbonate infusion
B. Give isotonic fluid boluses
C. Give colloid fluid boluses
D. Give sodium chloride 3%
E. Give vasoactive agent

56. A 5-years-old girl was hit by a car. She had throwed 10 feet and had a brief loss of
counsciousness. In the ER, she is lying motionless on the gurney, but still could open her
eyes with a loud verbal stimulus. She can not speak or interact. The lung was normal.
Respiratory rate was 20 breaths/minute, heart rate was 95 beats/minute, and blood
pressure was 100 mmHg/palpation. The chest radiograph was normal. Warm skin with
capillary refill time was less than 2 seconds, and her brachial pulse was strong. She had a
large frontal haematoma. No others bruises are found.
What is her physiologic status?
A. Stable head injury patient
B. Suggest a possible intracranial injury
C. Respiratory distress
 D. Cardiopulmonary failure
E. Decompensated shock

57. A 4-year-old boy was brought to the ER who had had constant vomitting for the last 24
hours. His family reports that he had just eaten cassava while he had outbond vacation of
the school holiday trip. He was in the deep sleep, and look flashed. Blood pressure was
low (70/25 mmHg). His capillary refill was quite brisk.
What is the working diagnosis in this boy?
A. Hypovolemik shock
B. Cardiogenic shock
C. Obstructive shock
D. Distributive shock
E. Septic shock

58. A 5-year-old girl presents with the heart rate was 180 beats/minute, appearance was
mottled and the systolic blood pressure was 70 mmHg, hypothermia, wheez and
respiratory distress for several days after being diagnosed as an influenza. She had
received low flow oxygen via face mask, and the fluid resuscitation had begun with
isotonic saline. The patient will intubate.
Which is best the medication should be use in this case?
A. Morphine
B. Ketamine
C. Benzodiazepine
D. Propofol
E. Fentanyl

59.To established definitive diagnosis of CHD, can be determine by:

A. ECG
B. Chest X ray
C. Blood examination
D. Echocardiography
E. Blood gas analysis

60. In cyanotic CHD patient with hemoglobin level of 6 g/dL, cyanosis will appear if arterial
oxygen saturation decreases to:
A. 30%
B. 40%
C. 50%
D. 60%
E. 70%

61.To close PDA non-invasively, can be treated with

A. Digoxin
B. Frusemid
C. Spironolakton
D. Prostaglandin
E. Ibuprofen

62. Palliative treatment of congenital heart disease is:

A. Transcatheter closure of ASD using Amplatzer devise
 B. Hybrid intervention of VSDtreatment in newborn
C. Total correction of tetralogy of Fallot
D. Blallock-Tausig shunt operation of pulmonary atresia
E. Mitral valve repaired in rheumatic heart diseases

63. Optimal age to undergo operation of complete atrioventricular septal defect (CAVSD) is
A. At age 2 week
B. Age 3-6 month
C. Age less than 6-12 month
D. Age between 1-2 year
E. Age above 2 year

64. A 9 months-old baby brought to out patient department (OPD) for his eczema. Parent
complaints of itchy rashes formerly on cheeks and later spread onto elbows. The rashes
come and go which seems to be even worsen despite treatment given by doctor,
consisting of lotion and anti pruritic.
What is your consideration to get favorable outcome for the patient above.
A. The strength or potency of topical steroid used based on location and severity of the
eczema
B. Topical steroid given together with moisturizer enhance efficacy and efficiency
A. Antiseptic during bathing increase the efficacy of eczema management
B. Avoid long and detail education as this will add burden to parent.
C. Either steroid or emolient should be avoided in longterm use.

65. A 2 months-old baby suffering from itchy wet-redness rashes over his cheeks since 2
weeks before. Mother insisted she only give exclusive breast milk. Mother however has
asthma when she was young. Father suffers from allergic rhinitis. You presume that
mother’s diet will be in fact a source of the allergen she has not aware of. For this case,
the major food offender that you consider, will be:
A. Sea food
B. Tree Nuts
C. Peanut
D. Cow’s milk
E. Soy

66. In the case of generalized urticarial a few minutes after ingesting cow’s milk in the 2
months-old baby, where mother can not continue breastfed, what do you consider as an
alternative for the cow’s milk formula ?
A. Soy milk
B. Rice milk
C. Partially hydrolyzed milk formula
D. Amino acid formula
E. Extensively hydrolyzed milk formula

67. During the primary allergy prevention session, a mother ask that even when she give
exclusive breastfed, her son still having eczema. She is questioning what is the benefit of
exclusive breastfeeding when her son can still possibly get allergy?
What will you say when the question is addressed to you?
A. Breastmilk is not fully protective
B. Mother may not exclusively breastfed the baby
 C. Breastmilk can be allergenic in some way
D. Breastmilk can give rashes when in contact to baby skin
E. Some allergen can pass through breastmilk .

68. A 2 years-old girl get bee sting on her arm and chest, followed by urticarial and severe
lips angioedema in ten minutes so she can’t drink and swallow her drink and her family
can not recognize her face. She otherwise calm. Respiratory rate and pulse are normal.
What do you do for this management
A. Remove the stung, continue observation, giving epinephrine i.v
B. Remove the stung, evaluate ABC simultaneously give epinephrine i.m
C. Remove the stung, simultaneously give epinefrin i.m, evaluate ABC
D. Giving epinephrine i.m, diphenhydramine and steroid, evaluate ABC
E. Giving steroid i.v, diphenhydramine Iv, observe the need of epinephrine

69. A 4 month old baby taking formula milk for two days as mother start back to work. The
baby has been reported to be redden all over the body, having shortness of breath ten
minutes after starting to drink the milk . Mother start to panic as she wants to give breast
milk but she has not enough. What your best suggestion in this situation?
A. Start soy formula
B. Start Partially hydrolyzed formula
C. Start extensively hydrolyzed formula
D. Start cow’s formula with different brand
E. Start amino acid formula

70. A 3 month old baby having atopic dermatitis since 1 months that come and go. Doctors
has prescribed 3 creams: lotion, emollient, steroid that has been applied by mother,
Mother put all over the drug at once.
What is the inappropriate practice in the care of atopic dermatitis skin?
A. Giving steroid is always the best practice
B. Emolient especially after bath should always be given in all cases.
C. The strongest steroid potency will give best outcome
D. The modest strength of steroid potency is the safest choice
E. Skin care only needed for the worst case of atopic dermatitis

71. A 2 years child with cerebral palsy, came to the with complaints suffered of recurrent
seizures since six months ago. Seizures always preceded by high fever, and repeated each
month. Each episode of seizure lasts for 15-20 minutes, 2-3 times / day. The last seizures
was 1 week ago. What are your actions to prevent recurrent seizures later in his life?
A. giving intermittent prophylaxis with oral diazepam if high fever
B. giving intermittent prophylaxis with oral phenobarbital if high fever
C. giving long-term prophylaxis with valproic acid during the first year.
D. giving of long-term prophylaxis with valproic acid for 2 years.
E. Educational parents without giving any medicine

72. A 6-year old girl came with a complaint often looked blank since last 6 months. When
stunned, the child does not respond to any calls / questions. After the attack the child
return to normal activities. Physical and neurological examination sere normal. On EEG
shows a picture of generalized slow spike-wave 2-3 spd.
What is the diagnosis of this patient?
 A. Juvenile absence epilepsy
B. Idiopathic generalized epilepsy
C. Day-dreaming
D. Temporal lobe epilepsy
E. Childhood absence epilepsy

73.A 6 months child came to the emergency department with generalized seizures,
tonic-clonic, for 20 minutes, post-ictal child looks whimpering and lethargy. There was
fever, cough, runny nose for 5 days, and the history of immunization was not clear.
Physical examinations showed bulding of fontanella, strabismus, hemiparesis dexstra,
meningeal stimuli sign (-).
What examination is needed to make a diagnosis:
A CT-scan of the head
B. ultrasound of head
C. lumbar puncture
D. procalcitonin
E. complete blood

74.A 10-year-old girl suddenly not be able to stand and walk, the child was not able to control
the micturition and defecation. One week before there was a paralysis of the child and
she has a high fever for 3 days with cough and colds that are cured without treatment.
What is the diagnosis in this child?
A. Guillain-Barre Syndrome
B. Poliomyelitis
C. Transverse myelitis
D. Meningitis
E. Multiple sclerosis

75.A 12 years boy came with complaints of difficulty breathing since 2 hours before
admission, accompanied by paralysis of the limbs. Two days before admission there was
lower limb weakness, in the next day the child could not lift his both hands.
What is the management to the patient?
A. Methyl-prednisolone IV 30 mg / kg / day for 3 days
B. Immunoglobulin 0.4 g / kg / day, for 3 days
C. Plasmapheresis for 2 cycles
D. Immunoglobulins 0.4 g / kg / day, for 5 days
E. Methyl prednisolone IV 1-2 mg / kg / day for 5 days

76. An 18 months old girl was brought to hospital with edema on her both extremities.
Physical examination shows apathetic general appearance, no sign of breathing
difficulties, increase heart rate, organ enlargement or intra peritoneal fluid collection.
Severe muscular wasting existed following 1 month of moderate febrile illness. No
protein was found in the urine.
Which one of the listed below is likely to explain the child condition?
A. Pellagra
B. Marasmus
C. Kwashiorkor
D. Marasmus- kwashiorkor
E. Nephrotic syndrome
77. Two years of age boy was admitted to the hospital with respiratory problems. His
respiratory rate was 70 times per minute. Based on physical examination, chests x ray
and blood gas analysis, physician in charge consider him as having pneumonia infection
with severe metabolic acidosis. Besides administration of proper antibiotic, which of the
following is best route for nutritional support?
A. Oral route
B. Orogastric tube
C. Nasogastric tube
D. Parenteral route
E. Both enteral and parenteral route

78.Mother of a 5 years old boy visit your clinic and seek for consultation regarding her son
nutritional status. The child seems healthy, however he is looking a little bit bigger for his
age. If the body mass index measurement of the child is between 85 th and 95th percentiles
of CDC 2000 curve, what would you inform the parents regarding their child nutritional
status?
A. Well-nourished
B. Risk of overweight
C. Overweight
D. Risk of obesity
E. Obesity

79.A one year old boy was admitted to your hospital, the body weight was 7.0 kg, the length
was 74.5 cm, WHZ was below -3 z score on WHO growth chart. He suffered from
recurrent diarrhoea since one month ago. What kind of nutritional management should be
given?
A. Rice and vegetables
B. Rice porridge
C. Formula 75
D. Soy formula
E. Modisco

80.A 14-months old boy is brought to your outpatient clinic. The body weight is 20.0 kg and
the body length is 79.5 cm. The mother concerns about his body weight. What should
should you recommend for the feeding?
A. Feed with low fat
B. Feed with low carbohydrate
C. Feed only day time
D. Feed using feeding rule
E. Feed main course only (no snack)

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