NATIONAL KNOWLEDGE BASED EVALUATION

OF INDONESIAN PEDIATRIC RESIDENT

April, 19, 2019
MN0419

For each of the following multiple choice questions,

select the one, most appropriate answer

1. A 34 week newborn was performed initial step of resuscitation because of not breath at
birth. What is the indication of positive pressure ventilation?
A. Weak muscle tone or heart rate <100 beat/minute
B. Weak muscle tone or no breathing effort
C. Heart rate <100 beat/minute or respiratory distress
D. Heart rate <100 beat/minute or apnea
E. Has respiratory effort with chest retraction

2. After positive pressure ventilation, the baby breath spontaneously with chest retraction
and other signs of respiratory distress, and heart rate 120 beat/minute. What should
doctors do next?
A. Continue positive pressure ventilation (PPV)
B. Continuous positive airway pressure (CPAP)
C. PPV and chest compression
D. Send to neonatal ward
E. Free flow oxygen

3. A 31 week infant was admitted to neonatal ward. Previously, the infant was performed
initial step and positive pressure ventilation for 30 second, and continued by continuous
positive airway pressure. During stabilization after resuscitation, doctor plan to check
blood glucose. What is the minimal target of blood glucose for this preterm infant?
A. 35 mg/dL
B. 40 mg/dL
C. 45 mg/dL  Preterm
D. 50 mg/dL  50-60 Aterm
E. 55 mg/dL

4. A preterm infant was born at 31 week gestational of age. What is the appropriate term for
the infant?
A. Extremely preterm (<25 week)
B. Very preterm (<31 week)
C. Moderate preterm
D. Late preterm
E. Mild Preterm

5. A preterm infant was born at 30 week and 5 day. Today the baby’s age is 41 week and 5
day. What is the chronological age of this baby?  usia dihitung mulai dilahirkan
A. 41 week
B. 30 week
 C. 11 week
D. 4 week
E. 1 week

6. A 30 week infant was born in tertiary hospital. Now the baby’s age is 12 hour. Doctor
decides to start parenteral feeding. What is the contain of parenteral nutrition?
A. Protein 1 g/kg/day, lipid 0,5 g/kg/day, calcium
B. Protein 1 g/kg/day, lipid 0,5 g/kg/day, phosphate
C. Protein 1,5 g/kg/day, lipid 0,5 g/kg/day, magnesium
D. Protein 1,5 g/kg/day, lipid 1 g/kg/day, potassium
E. Protein 1,5 g/kg/day, lipid 1 g/kg/day, iron

7. A 33 week infant, now the infant’s age is 20 day. To monitor the growth of the baby,
what chart should doctor use that to be continued by WHO 2006 chart.  22 weeks until
50 weeks gestation ( 10 weeks corrected ages)
A. Fenton 2013 chart until 12 months after birth.
B. Fenton 2013 chart until 6 months after birth.
C. Fenton 2013 chart until 1 month after birth.
D. Fenton 2013 chart until 37 week gestational age.
E. Fenton 2013 chart until 40 week gestational age.

8. A 28 week infant was hospitalized for 20 days. Full enteral feeding was achieved with in
2 week. What is the target of calories for this infant?
A. 115-120 kcal/kg/day  preterm infant
B. 110-<115 kcal/kg/day
C. 105-<110 kcal/kg/day
D. 100-<105 kcal/kg/day
E. 95-<100 kcal/kg/day

9. You are evaluating a 10-month-old infant for recurrent fracture following relatively
minor trauma. You note deep blue sclera and bowing of the lower extremities. X-ray
examination reveals generalized osteopenia.
Which of the following is the most likely diagnosis?
A. Achondroplasia
B. Spondyloepiphysial Dysplasia
C. Osteogenesis imperfecta
D. Osteopetrosis
E. Rickets

10. A 4-week-old male infant was admitted because of vomiting, weight loss, and poor
feeding. The infant weighed 3 kg at birth. On examination, the child was mildly
dehydrated. Hyperpigmentation was noted on external genitalia. Weight was 2.5 kg.
Other physical examinations were unremarkable. Serum electrolytes revealed Na + 108
meq/L, K+ 7,2 meq/L, BUN 31 mg/dL, Glucose 40 mg/dL.  Hiperplasia adrenal
kongenital
Which of the following should be included in the treatment of this infant?
A. Sex steroid replacement
B. High protein diet
C. ADH replacement
D. High sodium fluid replacement
E. Glucocorticoid replacement

11. An 8-year-old boy was brought for his preschool checkup by his grandmother, who
concerned about his growth. According to his grandmother he was not growing
appropriately in this last 2 years.
 Which of the following best approximates the annual height increment of this boy?
A.1-2 cm
B.3-4 cm
C.5-7 cm
D.8-10 cm
E.12-14 cm
 PB 1 thn: 25 cm,
1-2 thn:13 cm,
2-3 thn: 9 cm,
4-pubertas 5cm/tahun

12. You have a 2 weeks-old term infant in your clinic for a well child visit. The baby grew
accordingly without significant clinical findings. The mother brought laboratory results,
which showed TSH is 90 mU/ml (normal: < 20 mU/ml) and the T4 is 0.3 mU/ml (>7
mU/ml).
Which of the following is the most appropriate action at this point?  Dx Hipotiroid
A. Start sodium L-thyroxine 10-15 mg/kg/day
B. Repeat TSH and order for free T4
C. Order for thyroid gland Ultrasound
D. Order for 123I-sodium iodine uptake scan
E. Start methimazole 0.1 - 0.4 mg/kg/day

13. An adolescent with type 1 diabetes presents in your clinic for follow-up visit. You note
that his serum glucose is elevated and his glycosylated hemoglobin (Hemoglobin A1c)
level is 15.7 % (Normal < 7%).
This finding suggests poor metabolic control of his diabetes over at least which of the
following time periods?
A. 1 week
B. 1 month
C. 3 months
D. 5 months
E. 6 months

14.A 12-year-old girl is at the 3th percentile for height. She is an otherwise healthy child.
The bone age is greater than two standard deviations below the chronologic age, but in
concordance with her height age. Of the following, the MOST likely cause of this
patient's short stature is:
A.   Constitutional growth delay
B.   Familial short stature
C.   Growth hormone deficiency
D.   Hypothyroidism
E. Emotional deprivation

1. A 7-year-old child presents after a car accident. He was not wearing a seatbelt and he was
sitting at the point of impact in the left passenger seat. He complains of left upper
quadrant abdominal pain and left shoulder pain. Physical examination shows diffuse
abdominal tenderness but no obvious tenderness or trauma to the shoulder. Blood
pressure is 120/80 mmhg and heart rate is 120 beats/min. You have sent blood for a
complete blood count. Of the following, the most approriate next diagnostic study is:
A. Abdominal CT
B. Abdominal ultrasound
C. Barium contrast enema
 D. Diagnostic peritoneal lavage
E. Upright plain abdominal x-ray

16. An 8 year old is accidentally hit in the abdomen by a baseball bat. After several minutes
of discomfort, he seems to be fine. Over the ensueing 24 hours, however, he develops a
fever, abdominal pain radiating to the back and persistent vomiting. On examination, the
child appears quite uncomfortable. The abdomen is tender, with decreased bowel sounds
throughout, but especialy painfull in the midepigastric region with guarding. What is the
diagnosis?
A. Appendicitis
B. Pancreatitis
C. Chron disease  chronic case
D. Gallstones / cholelitiasis
E. Choledocal cyst  congenital conditions

17. A 10 year old boy comes with complaint of altered conciousness. About 2 weeks earlier
he appeared to be jaundice which preceded with other signs such as fever and abdominal
pain. After few days of hospitalization patient becomes more toxic, on examination the
liver size is small, hepatic enzymes levels decrease with elevated direct and indirect
serum bilirubin levels. What is the correct diagnosis?
A. Autoimmune Hepatitis
B. Fulminant Hepatic Failure  hepatic encepalopaty
C. Hepatitis A
D. Hepatitis B
E. Hepatitis C

18. Fulminant hepatic failure may lead to encephalopathy, cerebral edema and brain death
within several days. Which mode of support might best prevent the progression from
grade II to grade III + hepatic encephalopathy ?
A. Fluid restriction
B. Furosemide transfusion
C. Porcine hepatocyte column filtration
D. Continuous hemofiltration and plasma exchange
E. Hemodialysis

19. A previously healthy 6 months old child develops paroxysmal colicky abdominal pain.
The infant has occasional vomiting. Over the next 12 hours the infant passes stool
containing blood and mucus and becomes progressively lethargic. After fluid
resuscitation, the most appropriate next step in management is. Dx:Meckel diverticulum?
A. Colonoscopy
B. Stool culture
C. Meckel scan
D. Air- contras enema
E. Empiric antibiotic therapy

20. An 18-hour-old infant has bilious stained emesis following 3 initial feedings. The
prenatal and delivery history are unremarkable. On physical exam, the infant is quiet.
The occasional peristaltic waves are noted and the abdomen is not distended. Which of
the following findings is MOST likely on further radiologic evaluation of this infant?
A. GE reflux
B. Pyloric hypertrophy stenosis  single bubble
C. A “double bubble” sign  atresia duodenum
D. Malrotation
E. A choledochal duct cyst
 Pdx : babygram, screening VACTERL, proses embriologi
21. 11 – month old boy, on screening laboratory testing of Hemoglobin 7.8g/dL, HCt 24%,
Leucocyte count 10.000 /mm3. Thrombocyte 276.000/mm3. MCV 62 fl, normaly
differential count, blood smear microcytic hypochromic, Ferritin 1700.
Which of the following is the most appropiate recommendation:
A. blood transfusion
B. oral ferrous sulfate
C. Intramusculair iron dextran
D. Intravasculair iron dextran
E. An iron- fortified porridge

22. 7 years old boy presented to Emergency room with history of fever, pallor and nose
bleeding, 4 weeks duration. On examination: febrile, pale, petechie, subconjuctival
bleeding, hepatosplenomegaly. Laboratory finding : Complate Blood Count: Hb 5 gr/dl :
WBC 50,000/uL. Platelet 15,000/uL; Lymphocyte count 78%; The most likely clinical
diagnosis is:
A. Acute Lymphoblastic leukemia
B. Limphoma Malignan Non Hodgkins
C. Anemia aplastic
D. Nasopharyngeal tumor
E. Neuroblastoma stage IV

3. Five years following successful treatment for acute lymphoblastic leukemia (ALL), the
parents report that the patient, who is now 8 year old, is experiencing serious difficulties
with school performance. Areas of particular concern relate to reading, language and
mathematics. What component of ALL therapy would a possible cause of cognitive
dysfunction?
A. IT Methotrexate
B. IT Cytarabin
C. Cranial radiation
D. High dose Cyclophosphamide
E. High dose IV Methotrexate

24. A full-term newborn infant is covered with petechiae. Platelet count is 5,000 per mm3.
The remainder of the CBC is normal. The pregnancy, labor and delivery were
uncomplicated, and the mother’s platelet is 370,000 per mm3.
What is the correct management?
A. Intravenous immunoglobulin
B. Platelet transfusion from a random donor
C. Platelet transfusion from the father
D. Cortocosteroids
E. Observation; no drug therapy necessary

25. Four year old boy known case of hemophilia A coming to Emergency Room with first
time right side knee joint swelling in order to control bleeding at the joint, , it is
necessary to raise the serum level of factor VIII to about:
A. 1-2% of normal
B. 5-10% of normal
C. 10-25% of normal
D. 25-50% of normal
E. 75-100% of normal

26. The most urgent complication in a patient with Non – Hodgkin’s Lymphoma that needs
to evaluated at diagnosis and followed closely is :
 A. An Elevated WBC > 50.000
B. Elevated urine production
C. A uric Acid level of 6.0
D. A large of mediastinal mass
E. Complaints of left flank pain

27. Prognostic indicators at diagnosis in Patient with Acute Lymphoblastic Leukemia (ALL)
in childhood include age, biologicproperties of the leukemic blasts bone marrow and
pheripheral blood.
A. Gender
B. Down Syndrom
C. Prolonged fever
D. Initial White blood count
E. Hepatosplenomegli

28. 15 years-old boy presented with 4 days ago history of bleeding gums, subconjuctival
bleeding and petechie. Complate Blood Count: Hb 6.5 g/dL, Leucocyte count 86.000
/mm3; Platelet 24.000/mm3; blast 30%. Uric Acid 7.2 mg/L, hyperphospatemia.
Which of the following is the most likely:
A. Leukostasis
B. Tumor Lysis Syndrome
C. Septicemia
D. Superior vena cava syndrome
E. Disseminated Intravasculair Coagulation

29. 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

30. A boy 1 year old came with his mother to Primary Health Care . His complain were
fever, poor apetite, runny nose and sore throat within five days after exposure with his
brother who suffered from Hand Foot and Mouth Disease ( HFMD) .The typical rash of
Hand Foot and Mouth Disease is :
A. Papulo vesicles throughout the body
B. Macular erythema arising centripetal
C. Petichie arising on the test Rumple Leed
D. Macular papules around the mouth, hands and feet
E. Macular papules accompanied by strawberry tongue

31. You are evaluating a 10-month-old girl who has had a temperature to 38.9°C for 2 days.
Her parents deny other symptoms except a slight increase in fussiness. Her
immunizations are up to date. Findings on physical examination are normal, and she
appears well. Which of the following tests is most helpful in establishing a diagnosis in
this child?
A. Blood culture
B. Chest radiograph
C. Complete blood count
D. C-reactive protein
E. Urine culture
32. A 10-year-old girl came to the hospital with the main complaint of gum bleeding 1 day
before admission. She had suffered high grade fever for 6 days, and headache, retro-
orbital and muscle pain. T: 90/65 mmHg, pulse rate 96 x/min, respiratory rate 24
x/minute, temp 36.5.0C. The liver was not palpable,. The extremities were warm,
Tourniquet test was Positive. Laboratory examination revealed: hemoglobin 11.5 g/dl,
hematocrite 34.6%, 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 IV
D. Dengue Hemorrhagic Fever grade III
E. Dengue Hemorrhagic Fever grade II

33. 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 but arousable and has temperature of 39,6 0C. 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

34. A 14-years-old boy presents with extreme fatigue. Testing shows fever, generalized
lymphadenopathy, atypical lymphocytes, and a positive heterophile antibody test.
Epstein-Barr virus is suspected. Which of the following diagnosis is most likely?
A. Croup
B. Epiglottitis
C. Mononucleosis
D. Bronchiolitis
E. Pertussis

35. Amir, 2 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

36. A 5 years old boy came to health center with day 3 of fever, acute onset, high fever and
not doing wellHe also complain of pain on retro orbital, leg and also head ache. This boy
looked ill, with temperature 38.6, BP 100/65, pulse 125/min and petechiae on his right
hand. What is the probable diagnosis of this case?
A. Dengue viral infection
B. Dengue fever
C. Typhoid fever
D. Undiferentiated fever
E. Dengue haemorrhagic fever
37. The results of the examination of anthropometry plotting a boy age 10 months on the
WHO 2006 chart Weight for Lenght  <-2 SD, the interpretation is
A. a malnutrition. 
B. Wasted
C. severely stunted
D. stunted
E. severely wasted

38. 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. A week 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. vaccine quality defect-related reaction
C. immunization error-related reaction
D. immunization anxiety-related reaction
E. coincidental event

39. What is the purpose of screening for developmental milestones ?

A. Plan for treatment of developmental delays
B. Assess the incidence of developmental delays in a clinic population
C. Diagnose developmental delays
D. Determined the prognosis
E. Identify children who should for referral for further evaluation

40.A 2- year-old boys is developing normally, which of the following receptive language
milestones is consistent with her developmental age ?
A. Point to part of picture
B. Name body part with function
C. Knows right and left on self
D. Follow two step command
E. Knows function of certain objects

41. How long should you correct for gestational age when evaluating preterm infants?
A. 6 months.
B. 12 months.
C. 24 months.
D. Until kindergarten.
E. Until entry to high school.

42. A three year old child growing consistently between the 1 SD and the 2 SD on the WHO
BMI-for- Age growth chart would be categorized as:
A. Within normal range.
B. Underweight
C. Risk of overweight
D. Overweight
E Risk of Obese

43. A mother wants to start giving complementary food to her baby. She is confused what
solid food should be given to her baby for the first moment. What the appropriate
suggestion should be given?
A. Fortified cereal
 B. Fortified rice
C. Pure banana
D. Fortified wheat-base-cereal
E. Fortified-rice-base-cereal

44. A child with idiopathic obesity is diagnosed to have a pathological cause for the obesity.
Which of the following clinical feature is likely to be present?
A. Height velocity of 4 cm/year or more
B. Shorter than age matched peers
C. Increased linier growth
D. Advanced bone age
E. Early growth spurt

45. A obese boy, 11 year old, brought to the clinic. His mother worried about his health.
Which one of the statement bellow is correct as the most frequent obesity comorbidity?
A. Obstructive sleep apnea syndrome
B. Non Alcoholic steatohepatitis
C. Hypertension
D. Hyperlipidemia
E. Cardiomyopaty

46. A baby girl was born with 39 weeks gestational age, her birth weight was 2300 g, with 50
cm in birth length. Apgar score was 8 in the first minute and 10 in the 5 minute. The
baby is looking healthy with appropriate suckling reflex.
What is the best nutrition for this baby:
A. Mature Mother Breast Milk
B. Mature Mother Breast Milk added with human milk fortifier  premature
C. Premature Mother Breast Milk
D. Premature Mother Breast Milk added with human milk fortifier
E. Mature Mother Breast Milk mix with Premature Mother Breast Milk

47. A 3-year-old girl came up with palpebra edema, glazed eyes and a round face. Physical
examination showed hepatomegaly and thin reddish hair that easily removed. There are
pinkish patches on her skin that widespread all over her body.
What is the diagnosis?
A. Marasmus
B. Kwashiorkor
C. Marasmus-Kwashiorkor
D. Mild Protein-Energy Malnutrition
E. Moderate Protein-Energy Malnutrition

1. Two years old boy brought to outpatient clinic because skin problem. From physical
examination she has generalized edema, irritable, reddish hair and easily removed, and
prominent pinkish patches on his skin. What is the name of skin lesion?
A. Baggy pants
B. Hypopigmentation
C. Ulcerated exudative lesions
D. Crazy pavement dermatosis
E. Acute dermatitis
2. A 7-year-old male is admitted to the hospital with his fourth episode of wheezing and
dyspnea. His symptoms are exacerbated by mold and pollen. Which of the following is
most likely to be observed in this patient?
A. Abnormal chest radiograph
B. Normal FEV1
C. Sputum eosinophils
D. Normal FEV1/FVC
E. Ground glass opacities on chest CT

50. A 12 years old male present to ED with wheezing and increased work of breathing for
the fifth time in the past year. On examination, his respiratory rate 30 breaths/minute and
oxygen saturation is 98% in room air. He is talking in complete sentences and there is
expiratory wheezing with prolonged expiratory phase. What is the first treatment he
should receive?
A. Nebulized β-agonists

B. Nebulized β-agonists+ anticholinergic

C. Subcutanes epinephrine

D. Intravenous steroid

E. Intravenous aminophylline

51. A 10 years old girl present to ED with wheezing and increased work of breathing for the
fifth time on the last six months. She has been using inhaled fenoterol inhaler per week to
control wheezing. In addition to fenoterol inhaler, what is the best additional medicine
she should receive?
A. Fluticasone inhaler
B. Salmeterol inhaler
C. Procaterol inhaler
D. Theophyllin slow released
E. Formoterol inhaler

52. You are seeing a 14 old girl in the Emergency room with an acute asthma attack. She
looks very uncomfortable, she has diffuse wheezing throughout all lung fields and is
requiring 50% oxygen by face mask to maintain oxygen saturations above 90%. A nurse
reports that when the patient blows in her peak flow meter it reads in the normal range.
What should you do next?
A. send the patient home
B. repeat the peak flow several more times
C. ignore the results and treat for severe asthma
D. get another peak flow
E. E. Get the Lung function test

53. A 2 months old girl came to Emergency Room with chief complain worsening
respiratory distress since 2 days ago. 3 days prior to admission she had fever, cough and
decreased appetite. Her physical examination showed febrile infants, tachypnea with
chest indrawing and rales in both lung.
What is the diagnosis of this case?
A. Bronchiolitis
B. Bronchopneumonia
C. Bronchitis
D. Asthma
 E. Tuberculosis

54. A 2 months old girl came to Emergency Room with chief complain worsening
respiratory distress since 2 days ago. 3 days prior to admission she had fever, cough and
decreased appetite. Her physical examination showed febrile infants, tachypnea with
chest indrawing and rales in both lung. Chest X ray showed infiltrates with
pneumatocele. What is the possible etiology of the disease?
A. Streptococcus pneumoniae
B. Haemophilus Influenzae
C. Staphylococcus aureus
D. Klebsiella pneumoniae
E. Chlamidya pneumoniae

55. A 15 year-old girl came to the ER with main complaints of loss of consciousness
experienced since 3 hours ago after an motorcycle accident. On physical examination
found GCS 10 (E3V3M4), asymmetric chest movement and breath sounds weaken.
Blood pressure was low 80/40 mmHg, heart rate 128 beats/minute and respiratory rate
46 times/minute and his capillary refill time is more than 2 second. What is the working
diagnosis of this patient ?
A. Hypovolemic shock
B. Cardiogenic shock
C. Obstructive shock
D. Distributive shock
E. Septic shock

56. A 2 year old boy presents to the ER with 4 day history of vomiting, diarrhea and fever.
The patient is lethargic and has cracked lips, sunken fontanelle and skin turgor back
slowly. Laboratory result : Na : 120 mEq/L, K : 4 mEq/L, Cl : 100 mEq/L, KGD : 45
mg/dL.
What are the priorities of management for this patient?
A. Bolus D 10 % 5 cc/kgBW
B. Bolus D 10% 2 cc/KgBW  infant
C. Give RL 10 cc/KgBW
D. Give HES 10 % 10 cc/KgBW
E. Give HES 6 % 20 cc/KgBW

57. An 8 year-old girl with Steven Johnsons syndrome is being treated for septic shock in the
ED. She has already received 80 ml/kg isotonic saline, has been intubated and dopamine
was intiated when her shock failed to improve at 60 ml/kg. Her cardiopulmonary
assement at this juncture reveals that her HR = 160 x/min, her peripheries are warm,
flushed, pulses are bounding and Capillary refil time is flash < 1 sec, BP = 80/50. Urine
output is less than 1 ml/kg/hr.
What vasoactive medication should be intiated first ?
A. Epinephrine
B. Dopamine
C. Dobutamine
D. Norepinephrine
E. Milrinone

58. A group of toxic compounds that effect muscarinic is bronchoconstriction and increased
bronchial secretions while nicotine effects which cause irregular movement, muscle
contraction, and weakness in the muscles of the volunteers are:
A. Organophosphate
B. Organochlorines
C. Strichnine
 D. Paraquat
E. Cyanide

59. A 12 year old child comes to the ED pulseless. ECG reveals a wide complex tachycardia.
Initial management should be: 
A. Immediate defibrillation
B. Immediate synchronized cardioversion
C. Give Adenosine 
D. Bolus Epinephrine
E. Bolus Atropine

60. A 12-years old girl admitted to your clinic to have general check up in order to continue
her study. On physical examination: alert, blood pressure 100/60 mmHg, body
temperature 36.60C. On laboratory examination Hb 11.6 g/dL, WBC 9600/mm 3, serum
ureum 24 mg/dL, serum creatinine 0.7 mg/dL. Urinalysis: brown, protein (-), WBC: 2-
4/hpf, RBC 0-1/hpf. Urinary culture: Staphylococcus epidermidis 105 /cfu.
What is our management?
A. No antibiotics
B. Oral antibiotics
C. Intravenous antibiotics
D. Probiotics
E. Antiinflammatory drugs

61. A 9-years old boy admitted to pediatric emergency with complaint of disability of
urinary voiding. Before the complaint, he ate jengkol bean. There was no swelling
history. His breath was well. On physical examination he was alert with blood pressure
of 110/70 mmHg, pulse 110x/minutes, temperature 36.9 0C. On suprapubic area there
was a palpable mass. On laboratory examination: Serum ureum 80 mg/dL, Serum
creatinine 1.1 mg/dL, Sodium: 140 mEq/L, Potassium 5 mEq/L, Cl 105 mEq/L Blood
gas analysis: pH 7,31, HCO3 16, Our working diagnosis is:
A. Prerenal Acute kidney injury
B. Renal Acute kidney injury
C. Postrenal Acute kidney injury
D. Chronic kidney disease stage I
E. Renal tubular acidosis

62. A 10-years old boy admitted to outpatient clinic because of pale and fatigue. On
physical examination he was alert, blood pressure 140/90 mmHg, his nutritional state
was weight for age < -3 SD, height for age < -3 SD. Urinalysis revealed: Protein (+2),
RBC: 2-4/hpf, WBC: 2-4/hpf. Serum ureum 400 mg/dL, serum creatinine 15mg/dL,
Hb: 8.0 g/dL, Platelete count: 300,000/mm 3 Renal ultrasound: hyperechoic small size
on bilateral kidney. What is the mostly possible diagnostic for this patient?
A. Acute kidney injury
B. Acute on chronic kidney disease
C. Chronic kidney disease
D. Hemolytic uremic syndrome
E. Interstitial nephritis

63. A 7 years old boy admitted to outpatient clinic with swelling for the first time on
whole his body. Diuresis 1.2 mL/kgBW/hour. On physical examination he was alert
with vital signs were within normal limit. Urinalysis revealed protein (4+). Serum
ureum: 20 mg/dL. Serum creatinine: 0.6 mg/dL. The most common etiology for this
disease is:
A.Genetic mutation
B.Congenital origin
 C.Systemic Lupus Erithematosus
D.Henoch-Schonlein Nephritis
E.Idiopathic

64. A 7-years old boy admitted to pediatric emergency unit with chief complaint of dark
cola coloured urine. There was history of impetigo about three weeks ago. On
physical examination: alert, blood pressure 170/110 mmHg, swelling on eyelids, on
urine examination: RBC 20/hpf, WBC 0-1/hpf, protein (+1)
Laboratory examination we will suggest:
A. C-reactive protein (CRP)
B. Antistreptolysin O titer (ASOT)
C. Deoxyribonuclease B (DNAse B)
D. Anticardiolipin antibody (ACA)
E. Antinuclear antibody (ANA)

65. A 7 years girl admitted to your clinic because of vomitus. Her mother said that she often
vomit and her body weight and height smaller than her friends. On physical examination
vital sign within normal limit. Nutritional state: body weight for age: < -2 SD, height for
age: < -3 SD. Urinalysis revealed: specific gravity 1.030. Protein (-), RBC: 0-1/hpf,
WBC: 0-1/hpf. Blood gas analysis: pH: 7.46, HCO3 14, Na: 130 mEq/L, K: 2.4 mEq/L,
Cl: 102 mEq/L Mg: 2.2 mEq/L.
What is the most probable diagnosis for this patient?
A. Hypokalemic periodic paralysis
B. Bartter syndrome  asidosis metabolik, hipokalemi, plasma renin meningkat, TD N
C. Gietelman syndrome  autosomal resesif, hipokalemi, alkalosis metabolik,
hipomagnesi, hipokalsiuri
D. Renal tubular acidosis
E. Juvenile nephronophtisis

66. Drugs that be used in management congenital heart disease for definitive treatment is:
A. Digoxin in ventricular septal defect
B. Furosemide in atrial septal defect
C. Spironolactone in rheumatic heart disease
D. Ibuprofen in patent duct arteriosus
E. Captopril in pulmonary hypertension

67. Male, 15 years old was brought with chief complain of shortness of breath since 3 days
ago. On auscultation found pansystolic murmur grade 3/6 at 5th intercostal space
midclavicular line radiate to left lateral and louder when patient lying to the left. VSD
The most probable diagnosis is:
A. Acute rheumatic fever
B. Chronic rheumatic heart disease
C. Congenital heart disease
D. Dilated cardiomiopathy
E. Restrictive cardiomiopathy

68. A baby, 8 months come with chief complaint of fever 7 days ago. On physical
examination found she is irritable, eye hyperemia, rash on the skin, enlargement of limph
node on the neck size 1.5 mm, erythema on hand and foot.
The most probable diagnosis is:
A. Measles
B. Scarlet fever
C. Rubella
D. Kawasaki disease
E. Acute rheumatic fever
69. A female, 12 years old come with chief complaint of palpitation. On auscultation found
wide and fixed split 2nd heart sound, and ejection systolic murmur heard on the 2nd
intercostal space left parasternal line. ECG shows right ventricular hypertrophic. Chest
X-rays show CTR 0.8, and apex upward.
The most probable diagnosis is:
A. Pulmonary stenosis
B. Tetralogy of Fallot
C. Atrial septal defect
D. Aortic stenosis
E. Persistent foramen oval

70. A baby, 8 months old, body weight 6 kg, come with chief complaint irritable, there is
feeding problem. She is alert, heart rate 250 times per minute, murmur not clear. ECG
showed heart rate 250 times per minute, narrowed QRS complex, no P wave.
The management is:
A. Cardioversion
B. Adenosine
C. Digoxin
D. Verapamil
E. Amiodarone

71. A male, 6 years old come with chief complain of palpitation. He is alert, heart rate 220
times per minute. ECG showed 220 times per minute, and broad QRS complex.
Laboratory showed potassium level 9.5 mEq/L:
Immediate management should be given is:
A. Cardioversion 1-2 joule /kg
B. Cardioversion 2-4 Joule/kg
C. Adenosine 0.1 mg/kg
D. Digoxin 0.01 mg/kg
E. Insulin 1 unit/kg

72. A 3 month-old boy was admitted because he had red, raised, palpable wheals all over his
body, along with cyanosis, tachycardia, and breathing difficulty. He had been breastfed
and his mother recently gave him cow’s milk formula 5 days before admission. What is
the baby’s diagnosis?
A. Urticaria
B. Angioedema
C. Anaphylaxis
D. Asthma
E. Heart problems

73. A girl, 8 month old, she has colic and bloody diarrhea since 2 weeks ago. From skin
prick test showed positive result of cow’s milk allergen. She still had breastmilk and she
also had cow’s milk. She got complimentary food since 6 month old.
What information that could be given to patient?
A. Consumed goat’s milk
B. Consumed partial hydrolized milk
C. Cow’s milk changed with extensive hydrolized
D. Elimination diet for mother is not recommended
E. Food should be eliminated from egg and seafood

74. A 7 year-old boy was sent to the hospital because he complained of recurrent cold. Now,
he is still taking allergy and cold medications from a doctor before. His father suffered
from asthma and her mother often got itchy skin. They want to know whether their child
 has an allergy. To support the diagnosis of allergy and to determine the type of allergen,
what is the most appropriate examination?
A. Atopy Patch Test
B. Intra Dermal Test
C. Specific IgE
D. Skin Prick Test
E. Total IgE

75. A 4 month old, boys with chief complain pruritus in the body since 2 weeks ago. From
family history, his mother suffer from asthma, and father suffer from asthma. He still got
exclusive breastfeeding until now. From family history, the baby could classified as high
risk of atopic with risk factor to get allergy disease for :
A.0-5%
B. 5-15%
C.20-40%
D.40-60%
E. 60-80%

76. Select the most appropriate diagnosis from the list of options of the following descriptions
of rash with the illness for which they are the most typical exanthem: A 12 year old boy
develops petechiae and papules, some of which become purpuric over his buttocks and
legs, associated with painful swollen knees. There is microscopic haematuria on testing.
The platelet count is normal.
A. Staphylococcal scalded skin syndrome
B. Infectious mononucleosis
C. Henoch – Schonlein purpura
D. Meningococcal infection
E. Systemic onset juvenile chronic arthritis

77. Select the most appropriate diagnosis from the list of options that would best explain the
following case: An 11 year old with a previous history of chronic glomerulonephritis
presents with bruising and epistaxis. A full blood count confirms a pancytopenia.
A. Haemolytic uraemic syndrome
B. Henoch Schonlein purpura
C. Renal tubular acidosis
D. Renal vein thrombosis
E. Systemic lupus erythematosus

78. Select the most appropriate diagnosis from the list of options of the following
descriptions of rash with the illness for which they are the most typical exanthem: A
salmon-coloured, reticulate macular rash develops mainly over the extensor surfaces of
the limbs in a 5 year old boy with swinging temperature; hot, swollen, painful knees and
left elbow and palpable spleen. The ESR is 95. The blood count, C-reactive protein and
chest X-ray are normal.
A. Staphylococcal scalded skin syndrome
B. Infectious mononucleosis
C. Henoch – Schonlein purpura
D. Meningococcal infection
E. Systemic onset juvenile chronic arthritis

79.A 15 years old boy came to you with nose congestion and watery runny nose all year
round since he was 11 years-old. You also found dark circle surrounding his eyes .
Based on what you know, how would you presume the cause of all year round
rhinitis ?
A. Reptil pet
 B. House dust mite
C. Grass pollen
D. Tree Pollen
E. Flower Pollen

80.A premature baby girl was born 28 weeks of gestation and hospitalized in NICU.
Currently she cannot coordinate sucking and swallowing well. When the preterm infant have
normal coordination of sucking and swallowing?
A. 28 weeks
B. 30 weeks
C. 32 weeks
D. 34 weeks
E. 36 weeks

--------------- Selamat mengerjakan semoga sukses -------------