END - Pedia1 Flashcards
Hemorrhagic disease of the newborn (HDN) is prevented by administration of a single dose of vitamin K (1 mg).
a. Oral
b. Intravenous
c. Subcutaneous
d. Intramuscular
d. Intramuscular
💡 Rationale:
💉 Vitamin K 1 mg IM at birth is the standard prophylaxis to prevent Hemorrhagic Disease of the Newborn (HDN).
🚫 Oral vitamin K is less effective, and IV/subcutaneous routes are not preferred due to erratic absorption or risk of toxicity.
🙅♂️ Why not:
a. Oral – Less effective, especially in exclusive breastfeeding.
b. IV – Risk of anaphylaxis; not routine.
c. Subcutaneous – Less reliable absorption.
Very low birth weight (VLBW) infants, defined as infants having birth weights of less than:
a. 750 gm
b. 1000 gm
c. 1500 gm
d. 2000 gm
e. 2500 gm
c. 1500 gm
All the following are problems of small for gestational age infants except:
a. Anemia
b. Hypothermia
c. Hypoglycemia
d. Perinatal asphyxia
d. Perinatal asphyxia
💡 Rationale:
🧊 Hypothermia, 🍬 hypoglycemia, and 🔴 anemia are common in SGA infants due to decreased glycogen and fat stores, and ineffective erythropoiesis.
⚠️ While perinatal asphyxia can occur in any neonate, it is not a universal consequence of SGA.
🙅♂️ Why not:
a. Anemia – Decreased iron stores.
b. Hypothermia – Reduced fat and surface area-to-volume ratio.
c. Hypoglycemia – Low glycogen stores and poor feeding.
Which of the following statements best describes milia?
a. These are numerous small areas of red skin with a yellow papule in the center.
b. These are erythematous plaques with sharply demarcated edges.
c. These are whitish pin-head size concretions usually seen on the chin, nose, forehead, and cheeks.
d. These are comedones and papules usually seen over the cheeks, chin, and forehead.
c. Whitish pin-head size concretions on chin, nose, forehead, cheeks
💡 Rationale:
❄️ Milia = small keratin-filled epidermal cysts, commonly on the face of newborns.
👶 Harmless, resolve spontaneously within weeks.
🙅♂️ Why not:
a. Red skin with yellow papules = Erythema toxicum neonatorum
b. Erythematous plaques = Candida diaper rash
d. Comedones and papules = Neonatal acne
The findings used to estimate the gestational age based on physical maturity by the New Ballard scoring system are a description of the following except:
a. Lanugo
b. Skin texture
c. Genitalia
d. Palmar creases
e. Ear cartilage
d. Palmar creases
💡 Rationale:
The main physical maturity criteria in the Ballard Score are:
1. Skin
2. Lanugo
3. Plantar Surface (Sole Creases)
4. Breast Tissue
5. Eye and Ear Formation
6. Genitalia (Male and Female)
🙅♂️ Why not:
a. Lanugo – Assesses fetal hair development.
b. Skin texture – Evaluates maturity.
c. Genitalia – Checks sex-based maturity indicators.
e. Ear cartilage – Degree of firmness = gestational maturity.
Characteristic respiratory patterns in normal newborns include all of the following except:
a. Breath sounds are bronchovesicular
b. Periodic breathing predominates
c. Occasional apneic episodes in moderately premature infants
d. Grunting and nasal flaring
d. Grunting and nasal flaring
💡 Rationale:
🫁 Normal in newborns: bronchovesicular breath sounds, periodic breathing, and occasional short apneic spells (especially in preterm).
🚨 Grunting & nasal flaring = signs of respiratory distress, not normal.
🙅♂️ Why not:
a. 🟢 Bronchovesicular breath sounds are normal.
b. 🟢 Periodic breathing is common, especially during sleep.
c. 🟢 Brief apneas (<15 sec) in preterms can be benign.
True statements about postmaturity include each of the following, except:
a. The infants are usually 42-44 weeks
b. The fingernails and umbilical cord may be yellow-stained
c. There is an increased incidence of fetal distress, meconium aspiration
d. Birth weight is usually greater than the 95th percentile
d. Birth weight is usually greater than the 95th percentile
💡 Rationale:
🍼 Postmature infants (>42 weeks) may have placental insufficiency, leading to weight loss, meconium aspiration, and signs like long nails and dry peeling skin.
⚖️ They are not necessarily LGA (>95th percentile); in fact, some are SGA due to uteroplacental insufficiency.
🙅♂️ Why not:
a. 🟢 >42 weeks = postmature.
b. 🟢 Yellow-stained nails and cord = meconium exposure.
c. 🟢 ↑ Risk of distress and meconium aspiration.
Rooming in refers to the procedure of nursing babies with their mother rather than keeping them in a separate nursery. The advantages include all of the following except:
a. Promotes bonding
b. Makes exclusive breastfeeding easy
c. Increases the risk of infection
d. Mother is able to keep a close watch on her infant
c. Increases the risk of infection
💡 Rationale:
🤱 Rooming-in helps with:
🤝 Bonding
🍼 Breastfeeding
👁️ Mother monitoring infant
🦠 It does not increase infection risk; actually may reduce nosocomial infections by limiting nursery exposure.
🙅♂️ Why not:
a. 🟢 Promotes bonding through closeness.
b. 🟢 Encourages exclusive breastfeeding.
d. 🟢 Allows mother to detect early issues.
Good cord care includes all of the following except:
a. Cutting the cord with sterile equipment or a new razor blade depending on the setting
b. Ligation with a sterile plastic clamp or clear thread
c. Binding, use of powder on the cord
d. Keeping the cord stump exposed, cleaning with 70% alcohol or simple soap and water
c. Binding, use of powder on the cord
💡 Rationale:
🧼 Cord care:
Keep stump dry & clean
Use sterile tools
Avoid powders/binding (can cause infection)
💥 Powders trap moisture → ↑ infection risk
🙅♂️ Why not:
a. 🟢 Sterile cutting is essential.
b. 🟢 Sterile clamp/thread prevents bleeding.
d. 🟢 Air-drying the stump is beneficial.
Premature babies are prone to hypothermia because of:
a. Subcutaneous fat is thinner
b. Small body surface area
c. Adequate brown fat
d. Capable of shivering thermogenesis
a. Subcutaneous fat is thinner
💡 Rationale:
❄️ Preemies lack:
❌ Insulating subcutaneous fat
❌ Adequate brown fat for non-shivering thermogenesis
❌ Ability to shiver
✅ They have a larger surface area to weight ratio
🙅♂️ Why not:
b. ❌ They have larger surface area relative to body mass → more heat loss.
c. ❌ Inadequate brown fat in preemies.
d. ❌ No shivering thermogenesis in neonates.
Jaundice is most likely to be physiologic in a term infant in which one of the following situations?
a. Jaundice within 24 hours of life
b. Bilirubin increasing < 1mg/dL/24 hours in the first 2 days
c. Direct serum bilirubin level > 15% of the total bilirubin level
d. Jaundice after the second week of life
b. Bilirubin increasing < 1 mg/dL/24 hours in the first 2 days
💡 Rationale:
🟡 Physiologic jaundice appears after 24 hrs, with:
⬆️ Slow rise in indirect bilirubin (<5 mg/dL/day)
⏰ Peaks at 3–5 days
📉 Resolves by day 7–10 in term infants
🙅♂️ Why not:
a. ❌ Within 24 hrs → always pathologic
c. ❌ Direct bilirubin >15% → suggests conjugated hyperbilirubinemia (rule out cholestasis, infections)
d. ❌ After 2 weeks → consider prolonged jaundice (e.g., breast milk jaundice, biliary atresia)
In asymmetric IUGR, which organ is not affected?
a. Subcutaneous fat
b. Muscle
c. Liver
d. Brain
d. Brain
💡 Rationale:
🧠 In asymmetric IUGR, there’s “brain-sparing” due to redistribution of blood flow.
🫀 Vital organs (brain, heart, adrenals) get prioritized.
📉 Other tissues like liver, muscle, fat are sacrificed.
🙅♂️ Why not:
a. ❌ Subcutaneous fat = ↓ in IUGR
b. ❌ Muscle = ↓ due to protein catabolism
c. ❌ Liver = ↓ glycogen stores and perfusion
Whitish shiny cysts that are found in the palate and gum margins of newborns are:
a. Epstein pearls
b. Herpes simplex
c. Milia
d. Erythema toxicum
a. Epstein pearls
💡 Rationale:
⚪ Epstein pearls = benign keratin-filled cysts on gums/palate
🍼 Common in neonates, disappear in weeks
🙅♂️ Why not:
b. ❌ Herpes = vesicular, painful, not white cysts
c. ❌ Milia = on face, not in the mouth
d. ❌ Erythema toxicum = red blotches + pustules, not cysts
Normal caloric requirement (kg/day) of a term newborn infant in the first 7-10 days:
a. 110-120 kcal
b. 120-150 kcal
c. 90-100 kcal
d. 150-200 kcal
a. 110–120 kcal
💡 Rationale:
🍼 Term newborns: 110–120 kcal/kg/day
⚠️ Preterms: up to 120–150 kcal/kg/day
📈 Supports rapid growth and high metabolic demand
A child can roll in both directions, sits still, reaches one hand, and babbles. Developmental age of this child:
a. 2 months
b. 4 months
c. 6 months
d. 9 months
c. 6 months
💡 Rationale:
🧸 6-month milestones:
🤸♂️ Rolls both ways
🪑 Sits with or briefly without support
🤲 Reaches unilaterally
🗣️ Babbles consonant-vowel sounds (“ba”, “da”)
🙅♂️ Why not:
a. ❌ 2 months = lifts head, coos
b. ❌ 4 months = rolls front to back only
d. ❌ 9 months = sits well, cruises, says “mama/dada” nonspecifically
A central issue during the early school years:
a. Acceptance
b. Independence
c. Rapprochement
d. Self-esteem
d. Self-esteem
💡 Rationale:
🧠 Early school years (ages 6–11) = Erikson’s “Industry vs. Inferiority” stage
🏆 Children seek achievement, competence, and recognition, building self-esteem through academic and social success.
🙅♂️ Why not:
a. Acceptance = More relevant during adolescence
b. Independence = Key during toddlerhood
c. Rapprochement = Toddler milestone (18-24 months, back-and-forth autonomy/closeness)
Difficulty in following directions, wandering attention during lessons, and difficulty with reading comprehension are associated problems of this process:
a. Expressive language
b. Receptive language
c. Short-term memory
d. Selective attention
b. Receptive language
💡 Rationale:
🧏♂️ Receptive language = understanding spoken or written language
❗ Delays → misinterpreting instructions, low focus, poor reading comprehension
🙅♂️ Why not:
a. Expressive language = deals with speaking or forming thoughts into words
c. Short-term memory = might affect following multi-step commands, but not comprehensive reading
d. Selective attention = attention-based, but not primarily language processing
The earliest sign of puberty among boys:
a. Enlargement of the penis
b. Change in the texture of the scrotum
c. Enlargement of the testicles
d. Appearance of pubic hair
c. Enlargement of the testicles
💡 Rationale:
👦 First pubertal change = testicular enlargement (>4 mL)
Then → scrotal thinning, pubic hair, penis enlargement
🙅♂️ Why not:
a. Penis enlarges later
b. Scrotal texture changes second
d. Pubic hair comes after testicular growth
The first visible sign of puberty among girls:
a. Appearance of fine straight pubic hair
b. Widening of the hips
c. Enlargement of the labia majora
d. Appearance of breast bud
d. Appearance of breast bud (thelarche)
💡 Rationale:
👧 Thelarche = first sign of estrogen effect and pubertal onset
🌱 Followed by pubic hair (pubarche), then growth spurt and menarche
🙅♂️ Why not:
a. Pubic hair appears later
b. Widening of hips follows estrogen-driven changes
c. Labial changes are not the first sign
The sequence of development of secondary sexual characteristics in girls includes:
a. Thelarche, pubarche, peak height velocity, menarche
b. Pubarche, thelarche, menarche, peak height velocity
c. Menarche, pubarche, peak height velocity, thelarche
d. Peak height velocity, thelarche, menarche, pubarche
a. Thelarche → pubarche → peak height velocity → menarche
💡 Rationale:
📈 Estrogen triggers thelarche first
✨ Pubarche due to adrenal androgens
⏫ Growth spurt (peak height velocity) follows
🩸 Menarche is typically late (Tanner stage 4)
🙅♂️ Why not:
b/c/d = incorrect sequences not aligned with Tanner staging and physiologic development
If Sonia’s SMR is stage IV, what is her expected breast finding should be?
a. Areola is part of the general breast contour.
b. Areola and papilla form a secondary mound.
c. Breast and papilla are elevated as a small mound with an increased areola diameter.
d. Breast and areola are enlarged but with no contour separation.
b. Areola and papilla form a secondary mound.
💡 Rationale:
👩⚕️ SMR (Tanner) Stage IV breast = areola and papilla form a secondary mound above the breast contour.
🌀 This stage shows clear distinction between the mound of the breast and the projection of the nipple-areola complex.
🙅♂️ Why not:
a. 🟩 Describes SMR Stage V (mature breast, contour smooth again).
c. 🟨 Describes SMR Stage II (breast bud).
d. 🟧 Describes SMR Stage III (enlargement without contour separation).
The Tanner Stage of Ralph, who has pubic hair that is thicker, curlier, spread to the mons pubis, penis lengthens, and larger testes:
a. SMR 2
b. SMR 3
c. SMR 4
d. SMR 5
b. SMR 3
💡 Rationale:
👦 SMR 3 in males includes:
🍥 Pubic hair: darker, coarser, curlier, spreading over pubis
🍆 Penis begins to lengthen
🥜 Testes continue to enlarge
🙅♂️ Why not:
a. 🍼 SMR 2 = sparse straight pubic hair, testicular enlargement begins
c. 🧔 SMR 4 = hair resembles adult type but limited in area
d. 🧑🦱 SMR 5 = adult genitalia, hair spread to thighs
Spermache, appearance of acne, and axillary perspiration among boys usually occur during this period:
a. SMR 2
b. SMR 3
c. SMR 4
d. SMR 5
c. SMR 4
💡 Rationale:
💦 SMR 4 = when spermarche typically begins, along with:
😓 Axillary sweat
😬 Facial acne
🔺 Continued growth of penis and scrotum
🙅♂️ Why not:
a. 🍼 SMR 2 = testicular enlargement begins, fine hair
b. 🧒 SMR 3 = penile length increases, pubic hair curls
d. 🧔 SMR 5 = full adult development
Characteristics of cognitive development during early adolescence:
a. Transition from concrete operational thinking to formal logical operation
b. Extensive questioning and analysis
c. Increasing thoughts about concepts of justice, patriotism, and history
d. Cognition tends to be less self-centered
a. Transition from concrete operational thinking to formal logical operation
💡 Rationale:
🧠 Early adolescence (~10–13 years):
🚧 Transition from concrete (real objects) → abstract reasoning
💭 Beginning to think hypothetically
🙅♂️ Why not:
b. ❓ Extensive questioning = more common in middle adolescence
c. 📚 Thinking about justice/patriotism = late adolescence
d. 🤳 Less self-centered cognition = late adolescence
Regarding breath-holding spells in children, one of the following statements is NOT true:
a. It is fairly common in the first 2 years of life
b. It does not contribute to an increased risk of seizure disorders
c. Parents are advised to ignore and not to reinforce these attacks
d. It must be immediately attended to prevent hypoxia and onset of seizures
d. It must be immediately attended to prevent hypoxia and onset of seizures
💡 Rationale:
🛑 Breath-holding spells are benign, often triggered by crying or frustration
👶 Common in ages 6 months–2 years
🧘♂️ Parents are advised to stay calm and avoid reinforcing the behavior
🙅♂️ Why not:
a. 👶 True — common under age 2
b. ✅ True — not linked to seizure disorders
c. 👪 True — ignoring the episode helps prevent behavioral reinforcement
Head control is possible in an infant by ____ months of age.
a. 1
b. 2
c. 3
d. 6
c. 3
💡 Rationale:
👶 By 3 months, infants typically:
🧠 Develop neck strength
💪 Can lift and control their head when upright or during tummy time
🙅♂️ Why not:
a. 1️⃣ Not enough muscle tone yet
b. 2️⃣ Some head lifting may occur, but not full control
d. 6️⃣ By this age, head control is already well established
A one-month-old infant can do all of the following, EXCEPT:
a. Tonic neck posture predominates in supine
b. Follows a moving object
c. Head lag on pull to a sitting position
d. Listen to voices, coos
d. Listen to voices, coos
💡 Rationale:
👶 At 1 month, infants:
🧍♂️ Show tonic neck posture
👁️ May begin to track moving objects
👋 Exhibit head lag when pulled to sit
❌ Cooing and listening/responding starts around 2 months
🙅♂️ Why not:
a. ✅ Tonic neck is normal at 1 month
b. ✅ Following objects is emerging at this stage
c. ✅ Head lag is expected
Which of the following acts can a one-year-old perform?
a. Drinks from a cup
b. Speaks one or two words with meaning
c. Rings a bell purposely
d. Sits down from a standing position
b. Speaks one or two words with meaning
💡 Rationale:
👶 At 12 months, children often:
🗣️ Say “mama” or “dada” with meaning
📈 Communicate basic needs verbally
🙅♂️ Why not:
a. 🥤 Drinking from a cup begins at ~15 months
c. 🔔 Ringing a bell purposely is typical at ~15–18 months
d. 🪑 Sitting down from standing is more 12–15 months but not exclusive to 1 year milestone
Birth weight of an infant usually doubles at:
a. 6 months of age
b. 1 year of age
c. 2 years of age
d. 3 years of age
a. 6 months of age
💡 Rationale:
⚖️ Weight milestones:
📍 Doubles by 6 months
📍 Triples by 12 months
📍 Quadruples by 2 years
🙅♂️ Why not:
b. ❌ 1 year = triples, not doubles
c/d. ❌ 2 and 3 years = quadruples or stabilizes, not relevant to “doubling”
Which comes first in an infant?
a. Social smile
b. Stranger anxiety
c. Sitting without support
d. Pincer grasp
a. Social smile
💡 Rationale:
👶 Milestone timeline:
😊 Social smile: ~6 weeks
😟 Stranger anxiety: ~6–9 months
🪑 Sitting without support: ~6 months
👌 Pincer grasp: ~9 months
🙅♂️ Why not:
b. 😨 Stranger anxiety is later
c. 🪑 Sitting = occurs at 6 months
d. 👌 Pincer grasp = fine motor milestone around 9 months
A normal infant sits briefly leaning forward on her hands, reaches for and grasps a cube, and transfers it from hand to hand. She babbles but cannot wave bye-bye nor can she grasp objects with the thumb and finger:
a. 4 months
b. 7 months
c. 10 months
d. 14 months
b. 7 months
💡 Rationale:
🪑 Sits briefly, leaning on hands
🧱 Reaches for and transfers a cube (radial-palmar grasp)
🗣️ Babbles
❌ Cannot wave or use pincer grasp (comes ~9–10 months)
🙅♂️ Why not:
a. 4️⃣ months: Cannot sit or transfer objects
c. 🔟 months: Would likely wave bye-bye and use pincer
d. 14️⃣ months: Would definitely have both skills
A child who sits unsupported by own hands and who pulls to standing position, waves bye-bye, or plays peek-a-boo:
a. 4 months
b. 6 months
c. 8 months
d. 10 months
d. 10 months
💡 Rationale:
🪑 Sits unsupported
🧍♂️ Pulls to stand
👋 Waves bye-bye, plays peek-a-boo – classic social 10-month milestone
🙅♂️ Why not:
a. 4️⃣ months: No unsupported sitting
b. 6️⃣ months: Not yet pulling to stand or waving
c. 8️⃣ months: Some babies pull to stand but not consistent for all three skills
A child who is able to discriminate the use of “Mama” or “Dada”, stands alone, imitates action has reached a developmental age at:
a. 36 months
b. 24 months
c. 12 months
d. 6 months
c. 12 months
💡 Rationale:
🗣️ Uses “Mama/Dada” meaningfully
🧍♀️ Stands alone
🧠 Imitates actions (like clapping, waving)
🙅♂️ Why not:
a. 36️⃣ months: Already forming sentences
b. 24️⃣ months: Vocabulary is much larger
d. 6️⃣ months: No standing or word discrimination yet
The following are normal findings in children:
a. Standing unaided at 13 months
b. The first molar erupting at 6 months
c. Extensor plantar response at age 26 months
d. Controls bowels by age 13 months
a. Standing unaided at 13 months
💡 Rationale:
🧍♂️ Normal to stand unaided around 12–14 months
🙅♂️ Why not:
b. 🦷 First molars erupt ~12–18 months, not 6 months
c. 👣 Extensor plantar after 12–18 months may suggest upper motor neuron pathology
d. 💩 Bowel control is typically gained around 2–3 years, not 13 months
A 16-year-old female who is pregnant complains of headaches and has blurring of the disc margin on fundoscopy. Which of the following cranial nerves is affected?
a. Optic nerve
b. Oculomotor nerve
c. Trigeminal nerve
d. Abducens nerve
a. Optic nerve
💡 Rationale:
👁️ Papilledema = swelling of the optic disc
📈 Suggests raised ICP → affects CN II (Optic nerve)
🙅♂️ Why not:
b. CN III: Controls eye movement, pupil
c. CN V: Facial sensation, chewing
d. CN VI: Lateral eye movement, not vision or disc margin
If a patient comes in and you ask him to stick out his tongue and it deviates to the left, which cranial nerve could be involved and what side?
a. CN XI, left
b. CN XII, left
c. CN XI, right
d. CN XII, right
b. CN XII, left
💡 Rationale:
👅 The hypoglossal nerve (CN XII) controls tongue movement.
🧠 Lower motor neuron lesion causes ipsilateral tongue deviation (toward the affected side).
📍 So, deviation to the left = left CN XII lesion
🙅♂️ Why not:
a/c. CN XI is for sternocleidomastoid/trapezius, not tongue
d. Right CN XII lesion → tongue would deviate right
Two carpal bones are radiologically seen in the X-ray of most children by the end of:
a. 1 year
b. 2 years
c. 3 years
d. 4 years
b. 2 years
💡 Rationale:
🦴 Ossification of the capitate and hamate typically occurs by 12–18 months, so by 2 years, two carpal bones are usually visible on X-ray.
🙅♂️ Why not:
a. 1 year: Often only 1 ossified bone
c/d. 3–4 years: More carpal bones ossify, not just 2
Which among the following is NOT expected in a 3-year-old?
a. Draw a circle
b. Talk in sentences
c. Climb down the stairs
d. Hop 5 steps
d. Hop 5 steps
💡 Rationale:
🧠 Age 3 skills:
✏️ Draw a circle
🗣️ Talk in sentences
🪜 Climb down stairs (alternating feet with help)
🐸 Hopping on one foot typically develops by age 4
🙅♂️ Why not:
a. Drawing a circle = ✅ 3 years
b. Sentences = ✅ 3 years
c. Climbing down stairs = ✅ 3 years
A newborn baby has a head circumference of 35 cm at birth. His optimal head circumference will be 43 cm at:
a. 4 months of age
b. 6 months of age
c. 8 months of age
d. 12 months of age
d. 12 months of age
💡 Rationale:
📏 Head circumference growth pattern:
🎯 Birth: ~35 cm
➕ 1 cm/month in first year
📈 So by 12 months, ~+8 cm = 43 cm
🙅♂️ Why not:
a. 4 months: ~39 cm
b. 6 months: ~41 cm
c. 8 months: ~42–42.5 cm
The normal caloric requirement for a 5-year-old child is:
a. 800 kcal/day
b. 1,000 kcal/day
c. 1,500 kcal/day
d. 2,000 kcal/day
c. 1,500 kcal/day
💡 Rationale:
🍽️ General caloric needs:
👶 1 y/o = ~900–1,000 kcal/day
👧 3–5 y/o = ~1,200–1,600 kcal/day
🧒 5 y/o average = 1,500 kcal/day, adjusted by activity
🙅♂️ Why not:
a. 800 kcal/day = too low, fits infants
b. 1,000 kcal/day = more for toddlers
d. 2,000 kcal/day = school-age to pre-teen
One of the following statements is TRUE of Ascorbic Acid?
a. It is stable in the presence of light, alkaline medium, and heat
b. It decreases the absorption of iron
c. Its supplementation effectively decreases the incidence of scurvy
d. Its requirement is increased during febrile episodes
c. Its supplementation effectively decreases the incidence of scurvy
💡 Rationale:
🍊 Ascorbic acid (Vitamin C) is crucial for collagen synthesis, iron absorption, and antioxidant protection.
✅ Supplementation prevents scurvy, which presents with bleeding gums, petechiae, and poor wound healing.
🙅♂️ Why not the others:
❌ a. Unstable in light, alkaline conditions, and heat.
❌ b. Enhances, not decreases, iron absorption.
❌ d. While needs may increase during stress/febrile states, this is not the key distinguishing feature in exams.
Infants exclusively breastfed for six months will have:
a. More episodes of diarrhea and URTI
b. Fewer episodes of allergic manifestations
c. The same weight gain as formula-fed infants
d. More episodes of colic
b. Fewer episodes of allergic manifestations
💡 Rationale:
🍼 Breastfeeding provides immune protection and lowers the risk of developing atopic diseases like eczema or allergies.
🤱 Exclusive breastfeeding also improves gut microbiota and decreases systemic inflammatory responses.
🙅♂️ Why not the others:
❌ a. Breastfed infants have fewer, not more, episodes of diarrhea and URTI.
❌ c. Weight gain may be slightly slower, but still within normal range.
❌ d. Colic occurs in both breastfed and formula-fed infants—not more common in breastfed ones.
What component in human milk provides specific immunity against many organisms?
a. Lactoferrin
b. Macrophages
c. Oligosaccharides
d. Secretory IgA
d. Secretory IgA
💡 Rationale:
🛡️ Secretory IgA binds to pathogens and prevents them from adhering to and invading the mucosal surfaces—especially in the gut and respiratory tract.
🙅♂️ Why not the others:
❌ a. Lactoferrin binds iron, limiting bacterial growth (non-specific immunity).
❌ b. Macrophages offer immune support but are not the main source of specific immunity.
❌ c. Oligosaccharides promote healthy gut flora, not specific immunity.
One of the anthropometric indications that is unaffected by excess fat or fluid is:
a. Head circumference
b. Weight
c. Height
d. Mid-upper arm circumference
c. Height
💡 Rationale:
📏 Height is a measure of linear growth and is not influenced by temporary changes in fluid retention or fat stores, unlike weight or MUAC.
🙅♂️ Why not the others:
❌ a. Head circumference can be affected in hydrocephalus or edema.
❌ b. Weight fluctuates with hydration, fat stores, and illness.
❌ d. MUAC reflects both fat and muscle mass—thus influenced by fluid and nutrition status.
The most common cause of poor weight gain among breastfed infants during the first 4 weeks after birth is:
a. Infant metabolic disorders
b. Low-fat content of breast milk
c. Maternal nutritional deficiencies
d. Infrequent or ineffective feedings
d. Infrequent or ineffective feedings
💡 Rationale:
🍼 Poor latch, short nursing duration, or infrequent feeding sessions lead to inadequate milk intake, which is the most common cause of poor weight gain.
🙅♂️ Why not the others:
❌ a. Metabolic disorders are rare and not the usual cause.
❌ b. Breast milk fat content is generally adequate.
❌ c. Maternal diet has minimal effect on milk quality and weight gain unless severely deficient.
Which one of the following contains the least fat content in the milk?
a. Carabao milk
b. Cow milk
c. Goat milk
d. Human milk
d. Human milk
💡 Rationale:
🍼 Human milk contains about 3.5-4% fat, which is lower than the fat content in carabao (~7-8%), goat (~4.5%), and cow milk (~3.7%).
🧠 It is optimized for slow, steady growth and high brain development, not for rapid weight gain.
🙅 Why not the others:
❌ a. Carabao milk – highest fat content among common milks (~7-8%).
❌ b. Cow milk – higher than human (~3.7%).
❌ c. Goat milk – ~4.5%, also higher than human milk.
A 4-day-old newborn while being managed for neonatal sepsis suddenly went into cardiopulmonary arrest. Chest compression technique applied:
a. Compression to ventilation ratio 10:1
b. Heel of one hand is used
c. 2 fingers technique positioned 1 finger breadth below the intermammary line
d. Depth of compression is 2 inches
c. 2 fingers technique positioned 1 finger breadth below the intermammary line
💡 Rationale:
👶 For neonatal resuscitation, use 2-finger technique for lone rescuers.
✋ Place fingers just below the intermammary line, targeting the lower third of the sternum.
Depth: ~1.5 inches (1/3 anterior-posterior diameter).
🙅 Why not the others:
❌ a. 10:1 ratio is used when there’s an advanced airway, not typically for solo neonatal CPR.
❌ b. Heel of one hand – used for older children, not neonates.
❌ d. 2 inches depth – appropriate for children, not neonates.
John, a 2-year-old boy, cried the whole night pulling his ear. Otoscopy done:
a. To evaluate the auditory canal
b. Right hand holds otoscope to examine the left ear
c. Pinna is pulled posteriorly and downward
d. 4mm speculum is used
c. Pinna is pulled posteriorly and downward
💡 Rationale:
🧒 In children under 3 years, the external auditory canal is more horizontal, so to straighten it:
👉 Pull pinna backward and downward.
🧑 In adults, the pinna is pulled upward and backward.
🙅 Why not the others:
❌ a. While true, this doesn’t answer the technique.
❌ b. The same hand is used as the ear examined (e.g., right hand → right ear).
❌ d. 4 mm speculum may be too large for infants/toddlers.
A 2-year-old girl came in at the ER with PR-10/min., CR-55/min., and is limp. ET intubation done and it is in place if:
a. Equal wheezing in each lateral chest
b. Asymmetrical chest movement
c. Presence of breath sounds in the stomach
d. Presence of condensation in the ET during exhalation
d. Presence of condensation in the ET during exhalation
💡 Rationale:
🌫️ Condensation during exhalation inside the ET tube = airflow through lungs = proper placement.
It’s one of the quickest bedside confirmations before capnography or X-ray.
🙅 Why not the others:
❌ a. Wheezing in both lungs doesn’t confirm tracheal placement.
❌ b. Asymmetric chest movement → possible right mainstem bronchus intubation.
❌ c. Breath sounds in the stomach = possible esophageal intubation.
Tuberculin Skin Test (PPD) done to determine if the patient is TB infected is performed at:
a. Deltoid area
b. Dorsal aspect of the hand
c. Gluteal area
d. Volar aspect of the forearm
d. Volar aspect of the forearm
💡 Rationale:
💉 The PPD is administered intradermally at the volar (inner) forearm, allowing easy visibility of the induration at 48–72 hrs.
🙅 Why not the others:
❌ a. Deltoid is for IM vaccines, not for PPD.
❌ b. Dorsal hand – too thin, uncomfortable, poor visualization.
❌ c. Gluteal – not used for skin tests.
The best site of intraosseous infusion for a 5-year-old boy is:
a. Proximal tibia
b. Distal femur
c. Sternum
d. Iliac crest
a. Proximal tibia
📘 Rationale:
🦴 Proximal tibia is the most commonly used IO site in children because it’s easily accessible and has a broad, flat surface with a large marrow cavity.
🙅 Why not the others:
❌ b. Distal femur – less preferred due to increased risk of growth plate injury.
❌ c. Sternum – used more in adults, not routinely in children.
❌ d. Iliac crest – not standard for emergent IO access.
All of the following are vaccines that provide passive immunity to infants and children, except:
a. Diphtheria antitoxin
b. Gamma globulin
c. Giving tetanus toxoid
d. Giving tetanus immune globulin
c. Giving tetanus toxoid
📘 Rationale:
💉 Tetanus toxoid stimulates active immunity, prompting the body to make its own antibodies.
🙅 Why not the others:
❌ a. Diphtheria antitoxin – passive immunity (pre-formed antibodies).
❌ b. Gamma globulin – passive (IgG antibodies).
❌ d. Tetanus immune globulin – passive protection with antibodies.
A 4-day-old baby has 26 mg/dl of B1 with ABO incompatibility. The appropriate site for exchange transfusion is at:
a. External jugular vein
b. Cut-down site
c. Umbilicus
d. Intraosseous
c. Umbilicus
📘 Rationale:
👶 In neonates, the umbilical vein is the preferred site for exchange transfusion, especially in the first week of life, as it provides reliable central access.
🙅 Why not the others:
❌ a. External jugular – technically difficult in neonates.
❌ b. Cut-down site – more invasive, less ideal.
❌ d. Intraosseous – emergency fluid access, not used for exchange transfusion.
Permanent hearing loss or ototoxicity is most usually associated with administration of:
a. Ethacrynic acid
b. Gentamicin
c. Thiazides
d. Mannitol
b. Gentamicin
📘 Rationale:
👂 Gentamicin (aminoglycoside) is classically ototoxic, especially with prolonged or high-dose use.
🙅 Why not the others:
❌ a. Ethacrynic acid – also ototoxic, but less commonly used.
❌ c. Thiazides – not associated with ototoxicity.
❌ d. Mannitol – not ototoxic; it’s an osmotic diuretic.
Which of the following drugs can be administered through the rectum because of its rapid absorption and can be used to treat status epilepticus?
a. Diazepam
b. Phenobarbital
c. Phenytoin
d. Valproic acid
a. Diazepam
📘 Rationale:
💊 Rectal diazepam is effective and rapidly absorbed for status epilepticus—commonly used in pediatrics when IV access is not available.
🙅 Why not the others:
❌ b. Phenobarbital – used IV or IM; slower onset.
❌ c. Phenytoin – requires IV; not for rectal use.
❌ d. Valproic acid – available orally or IV; not rectally.
The following drug should be avoided in children with liver disease who are jaundiced.
a. Hydrochlorothiazide
b. Metronidazole
c. Indomethacin
d. Salbutamol
b. Metronidazole
📘 Rationale:
⚠️ Metronidazole is hepatically metabolized and can worsen hepatic dysfunction, especially in jaundiced children with impaired liver function.
🙅 Why not the others:
❌ a. Hydrochlorothiazide – cleared renally; not directly hepatotoxic.
❌ c. Indomethacin – NSAID; use cautiously but not contraindicated solely due to jaundice.
❌ d. Salbutamol – beta-agonist; minimal hepatic metabolism.
The following properties of a drug encourage their presence in breast milk EXCEPT:
a. High lipid solubility
b. Short half-life
c. Low molecular weight
d. Unionized state
b. Short half-life
📘 Rationale:
🕒 A short half-life means the drug is cleared quickly, so it doesn’t stay in the plasma long enough to accumulate in breast milk.
🙅 Why not the others:
❌ a. High lipid solubility – 💧 lipid-soluble drugs cross membranes easily → higher breast milk levels.
❌ c. Low molecular weight – ⚖️ smaller molecules pass more readily into milk.
❌ d. Unionized state – 💊 unionized drugs cross membranes more easily.
Physical examination of a newborn female infant reveals meningomyelocoele, cleft lip, and craniofacial anomalies. The most likely prenatal experience to explain these findings is:
a. Alcohol
b. Lithium
c. Thiazides
d. Valproic acid
d. Valproic acid
📘 Rationale:
💥 Valproic acid is teratogenic, associated with neural tube defects (e.g., meningomyelocele) and craniofacial anomalies.
🙅 Why not the others:
❌ a. Alcohol – causes fetal alcohol syndrome (not meningomyelocele).
❌ b. Lithium – associated with Ebstein anomaly (cardiac defect).
❌ c. Thiazides – not strongly linked to major congenital malformations.
In neonates relative to adults with regards to handling of drugs which of the following is NOT true?:
a. Gastric acid is reduced
b. Fat content is low
c. Plasma albumin is low
d. The blood-brain barrier is less permeable
d. The blood-brain barrier is less permeable
📘 Rationale:
🧠 In neonates, the blood-brain barrier is MORE permeable, making the CNS more vulnerable to drugs and toxins.
🙅 Why not the others:
✅ a. Gastric acid is reduced – true; affects drug absorption.
✅ b. Fat content is low – true; influences drug distribution.
✅ c. Plasma albumin is low – true; affects protein binding and free drug availability.
A 2500-gram infant who is born at 36 weeks AOG has a head circumference of 27 cm and crown-heel length of 40 cm. Other findings include an upturned nose, hypotonia, hypoplastic philtrum. The most likely prenatal agent that would explain these findings is:
a. Alcohol
b. Cocaine
c. Marijuana
d. Opiate
a. Alcohol
📘 Rationale:
🍷 Fetal alcohol syndrome presents with facial dysmorphisms, growth retardation, and neurologic impairment (e.g., hypotonia).
🙅 Why not the others:
❌ b. Cocaine – more associated with placental abruption and growth restriction, not facial anomalies.
❌ c. Marijuana – weak association with birth defects.
❌ d. Opiate – associated with neonatal abstinence syndrome, not craniofacial anomalies.
The target organ for the teratogenic effect of Tetracyclines:
a. Ear
b. Teeth and bones
c. Kidney
d. Central nervous system
b. Teeth and bones
📘 Rationale:
🦷 Tetracyclines bind to calcium and get deposited in developing teeth and bones, leading to permanent discoloration of teeth and impaired bone growth in the fetus.
🙅 Why not the others:
❌ a. Ear – Ototoxicity is linked more with aminoglycosides, not tetracyclines.
❌ c. Kidney – Not a primary teratogenic target for tetracyclines.
❌ d. CNS – Neural defects are typically linked to folate deficiency or anticonvulsants.
The target organ for the teratogenic effect of folic acid deficiency is:
a. Spinal cord and bones
b. Vestibular nerves
c. Kidney
d. Eyes
a. Spinal cord and bones
📘 Rationale:
🧠 Folic acid is essential for neural tube closure. Deficiency can lead to spina bifida, anencephaly, and other neural tube defects involving the spinal cord.
🙅 Why not the others:
❌ b. Vestibular nerves – Not directly related to folate.
❌ c. Kidney – Not the primary target in folate-related teratogenesis.
❌ d. Eyes – No strong link to folic acid deficiency.
The following are believed safe in pregnancy:
a. Fluoroquinolones
b. Erythromycin
c. Aminoglycosides
d. Ribavirin
b. Erythromycin
📘 Rationale:
💊 Erythromycin is considered one of the safer antibiotics during pregnancy (except estolate form, which may cause hepatotoxicity).
🙅 Why not the others:
❌ a. Fluoroquinolones – Can damage developing cartilage.
❌ c. Aminoglycosides – Risk of ototoxicity in fetus.
❌ d. Ribavirin – Highly teratogenic and contraindicated.
During pregnancy which of the following statements is incorrect?:
a. Plasma volume increases
b. Blood volume increases
c. Gastric emptying time and small intestinal motility are increased
d. Predominantly water-soluble drugs will have a larger apparent volume of distribution
c. Gastric emptying time and small intestinal motility are increased
📘 Rationale:
🤰 Progesterone slows GI motility and gastric emptying, which actually decrease, not increase.
🙅 Why not the others:
✅ a. Plasma volume increases – True.
✅ b. Blood volume increases – True (~50% increase).
✅ d. Water-soluble drugs have larger Vd – True, due to increased total body water.
Anthropometric measurement which does not show much change in 1-4 years.
a. Mid arm circumference
b. Skinfold thickness
c. Height
d. Chest circumference: Head circumference ratio
a. Mid arm circumference
📘 Rationale:
📏 MUAC (mid-upper arm circumference) is relatively stable from ages 1 to 5 years and is useful for nutritional screening.
🙅 Why not the others:
❌ b. Skinfold thickness – Can vary with nutritional status.
❌ c. Height – Increases steadily with age.
❌ d. Chest:head circumference ratio – Changes as head growth slows and chest grows after infancy.
Which of the following agents has an inhibitory effect on hepatic drug metabolism?
a. Erythromycin
b. Rifampicin
c. Phenobarbital
d. Phenytoin
a. Erythromycin
📘 Rationale:
🧬 Erythromycin is a CYP450 enzyme inhibitor, especially CYP3A4. It slows down hepatic metabolism of other drugs, potentially increasing their plasma levels and risk of toxicity.
🙅 Why not the others?
❌ b. Rifampicin – 🚀 Induces CYP enzymes, increasing metabolism of other drugs.
❌ c. Phenobarbital – 🚀 Enzyme inducer.
❌ d. Phenytoin – 🚀 Strong CYP450 inducer, like phenobarbital.
A child can roll in both directions, sits still, reaches one hand, and babbles. Developmental age of this child:
a. 2 months
b. 4 months
c. 6 months
d. 8 months
c. 6 months
📘 Rationale:
🔄 Rolls in both directions
✋ Reaches with one hand
🧍♂️ Sits momentarily or with support
🗣️ Babbles — These are classic 6-month milestones.
🙅 Why not the others?
❌ a. 2 months – Only raises head, smiles, coos
❌ b. 4 months – May roll front to back, not both ways
❌ d. 8 months – More advanced: sits unsupported, begins crawling
The first visible sign of puberty in girls is the hallmark of:
a. SMR1
b. SMR2
c. SMR3
d. SMR4
b. SMR2
📘 Rationale:
👙 Thelarche (breast bud development) is the first visible sign of puberty in girls, marking the beginning of Tanner Stage 2 (SMR2).
🙅 Why not the others?
❌ a. SMR1 – Prepubertal stage
❌ c. SMR3 – Breast enlargement without contour separation
❌ d. SMR4 – Areola and papilla form secondary mound
By years all milk teeth are erupted:
a. 1.5 years
b. 2 years
c. 2.5 years
d. 3 years
d. 3 years
📘 Rationale:
🦷 By 3 years old, a child usually has all 20 primary teeth (milk teeth) erupted.
🙅 Why not the others?
❌ a. 1.5 years – Only ~8–10 teeth
❌ b. 2 years – About 16 teeth
❌ c. 2.5 years – Almost all, but not yet guaranteed full eruption
Robert is a 16-year-old middle adolescent who was observed to be always out with his friends, experiencing storm, stress, and relationship with parents becomes strained and distant:
a. Developing identity and self-image
b. Stereotypical behavior
c. Bids for autonomy
d. Intimate procedure takes precedence
c. Bids for autonomy
📘 Rationale:
🧍♂️ At this stage, teens strive for independence, seek peer approval, and challenge parental boundaries — classic bids for autonomy.
🙅 Why not the others?
❌ a. Developing identity and self-image – Yes, but more internal; the described behavior is more social
❌ b. Stereotypical behavior – Too vague, doesn’t define autonomy
❌ d. Intimate procedure takes precedence – Not related to the adolescent’s general social development
Gender identity refers to a person’s basic sense of being boy/man, girl/woman, or other gender which is typically fixed by:
a. 2-3 y/o
b. 4-6 y/o
c. 7-9 y/o
d. 10-12 y/o
b. 4–6 y/o
📘 Rationale:
✨ Children begin identifying their gender around age 2–3, but by ages 4–6, most children have a stable and consistent gender identity.
🙅 Why not the others?
❌ a. 2–3 y/o – Gender awareness starts here but is not yet stable.
❌ c. 7–9 y/o – Gender identity is usually already established by this time.
❌ d. 10–12 y/o – This age may involve role exploration, but not identity formation.
Jose had undergone the “coming out” stage of his transgender identity. Health providers can’t assist him and his family in alleviating distress and stigma reduction as early as Tanner stage:
a. I
b. II
c. III
d. IV
c. Tanner Stage III
📘 Rationale:
✨ By Tanner Stage III, adolescents are often more aware of gender identity issues and may begin the coming out process. Providers should intervene with support, mental health care, and stigma reduction at this stage.
Menarche is achieved by 90% of girls by:
a. SMR 1
b. SMR 2
c. SMR 3
d. SMR 4
d. SMR 4
📘 Rationale:
✨ Tanner Stage IV (SMR 4) is the stage when menarche typically occurs in most girls (~90%).
✨ It follows the peak height velocity seen in Stage III.
🙅 Why not the others?
❌ a. SMR 1 – Prepubertal.
❌ b. SMR 2 – Breast budding begins.
❌ c. SMR 3 – Ongoing development; menarche uncommon here.
Which is incorrect about thumb sucking?
a. Can lead to malocclusion
b. Is a source of pleasure
c. Is a sign of insecurity
d. Must be treated vigorously in the first year
d. Must be treated vigorously in the first year
📘 Rationale:
✨ Thumb sucking is a normal self-soothing behavior in infants and toddlers.
✨ Intervention is not needed in the first year unless it persists beyond 4–5 years, where it may affect dentition.
🙅 Why not the others?
✅ a. Can lead to malocclusion – True with prolonged sucking.
✅ b. Is a source of pleasure – Common for self-soothing.
✅ c. Is a sign of insecurity – May emerge during stress.
Psychological development during the late adolescence period:
a. Selection of adults outside the family as role models.
b. Career decision becomes pressing.
c. Physical attractiveness and popularity remain critical in peer relationships and self-esteem.
d. The presence or absence of a realistic role model can be crucial.
b. Career decision becomes pressing
📘 Rationale:
✨ During late adolescence (ages 17–21), individuals focus on career planning, intimacy, and personal identity formation.
✨ Making future-oriented decisions becomes a central developmental task.
🙅 Why not the others?
❌ a. Selection of adults outside family – Occurs more in middle adolescence.
❌ c. Focus on physical attractiveness – Prominent in early to mid adolescence.
❌ d. Role model presence – Important throughout adolescence, not specific to late stage.
The somatic changes in a male adolescent’s male secondary sex characteristics are all due to testosterone, which include all of the following except:
a. Muscular growth
b. Enlargement and pigmentation of scrotum
c. Deepening of the voice
d. Increase in body fat
d. Increase in body fat
📘 Rationale:
✨ Testosterone promotes:
💪 Muscular growth
🎤 Deepening of the voice
⚫ Enlargement & pigmentation of the scrotum
🚫 It does not increase body fat—this is typically due to estrogen or caloric imbalance.
🙅 Why not the others?
✅ a. Muscular growth – Classic anabolic effect of testosterone.
✅ b. Scrotum pigmentation – Driven by androgens.
✅ c. Deepening of the voice – Due to laryngeal growth stimulated by testosterone.
How much potassium content is in D5IMB (Balanced Multiple Maintenance Solution)?
a. 4 mEq/L
b. 10 mEq/L
c. 20 mEq/L
d. 30 mEq/L
c. 20 mEq/L
📘 Rationale:
✨ D5IMB contains:
💧 Sodium: ~ 133 mEq/L
⚡ Potassium: 20 mEq/L
📦 Chloride: ~ 98 mEq/L
🍬 Glucose: 5%
Used for maintenance hydration in pediatric patients.
Which is an early symptom seen in extracellular fluid deficit?
a. Thirst
b. Absence of tears
c. Sunken eyes
d. Prolonged capillary refill time
a. Thirst
📘 Rationale:
✨ Thirst is the body’s first compensatory response to volume depletion.
😓 Absence of tears
👁️ Sunken eyes
🕒 Prolonged cap refill
…are signs of moderate to severe dehydration.
A 2-year-old boy was found to be alert, thirsty, with dry oral mucosa. The appropriate management is?
a. Oral rehydration
b. Intravenous fluid therapy
c. Oral rehydration and antibiotics
d. Intravenous fluid therapy and antibiotics
a. Oral rehydration
📘 Rationale:
✨ Signs indicate mild dehydration. Best managed with:
🧃 Oral Rehydration Solution (ORS)
✅ Conscious & able to drink → no need for IV
💊 No infection = no need for antibiotics
Based on the Holliday-Segar method, the maintenance fluid requirement of a 10-kg infant is approximately:
a. 1000 mL/day
b. 1200 mL/day
c. 1250 mL/day
d. 1300 mL/day
a. 1000 mL/day
📘 Rationale (Holliday-Segar Rule):
✨ 100 mL/kg for the first 10 kg
📦 For a 10-kg infant:
🧮 100 × 10 = 1000 mL/day
The principal intravascular anion and the principal anion in the gastric juice is:
a. Chloride
b. Bicarbonate
c. Phosphates
d. Organic acid
a. Chloride
📘 Rationale:
✨ Chloride (Cl⁻) is:
🩸 The main anion in extracellular fluid (plasma)
🧪 The principal anion in gastric juice, as part of HCl
🙅♂️ Why not the others?
🧂 b. Bicarbonate – Major buffer but not the primary anion in plasma or gastric juice
🧬 c. Phosphates – More relevant intracellularly
🧫 d. Organic acid – Not a principal plasma or gastric anion
Which is incorrect with regard to the IVF and its content?
a. Normal saline - 154 mmol Na+/L
b. LRS - 134 mmol Na+/L
c. D5W - 50 grams glucose/L
d. D5 0.3 NaCl - 77 mmol Na+/L
d. D5 0.3 NaCl - 77 mmol Na⁺/L
📘 Rationale:
✨ Sodium content per type:
💧 0.9% NaCl (NSS) = 154 mmol/L
💧 0.45% NaCl = 77 mmol/L
💧 0.3% NaCl = 51 mmol/L ❌ Not 77
💧 D5W = 50 g glucose/L
🙅♂️ Why not the others?
✅ a. Normal saline – 154 mmol/L – correct
✅ b. LRS – 134 mmol/L – correct
✅ c. D5W – 50 g/L – correct
What is the earliest sign of hyperkalemia?
a. Sine wave
b. Peaked T wave
c. Flattened P wave
d. QRS widening
b. Peaked T wave
📘 Rationale:
✨ ECG progression in hyperkalemia:
🔺 Peaked T waves – early finding
📉 Flattened P wave – later
🔄 QRS widening – dangerous later phase
🧿 Sine wave – pre-terminal ECG pattern
🙅♂️ Why not the others?
❌ a. Sine wave – late, pre-arrest
❌ c. Flattened P wave – after peaked T
❌ d. QRS widening – later
A rise in the pH by 0.1 causes a decrease in serum K+.
a. 0.1 mEq/L
b. 0.25 mEq/L
c. 0.5 mEq/L
d. 1.0 mEq/L
c. 0.5 mEq/L
📘 Rationale:
✨ Alkalosis drives potassium into cells:
⬆️ pH by 0.1 = ⬇️ serum K⁺ by ~0.5 mEq/L
🧪 This is due to H⁺/K⁺ exchange across cell membranes
🙅♂️ Why not the others?
❌ a. 0.1 – too small
❌ b. 0.25 – underestimates effect
❌ d. 1.0 – too large
A 5-year-old child with small bowel obstruction has had an NG tube placed draining yellowish gastric fluid. What acid-base disorder should be monitored in this child’s condition?
a. Respiratory alkalosis
b. Metabolic alkalosis
c. Metabolic acidosis
d. Respiratory acidosis
b. Metabolic alkalosis
📘 Rationale:
✨ Loss of gastric HCl through NG suction causes:
🚫 ↓ H⁺ → relative ↑ HCO₃⁻ → metabolic alkalosis
🙅♂️ Why not the others?
❌ a. Respiratory alkalosis – not related to GI fluid loss
❌ c. Metabolic acidosis – seen with diarrhea, not vomiting/NG suction
❌ d. Respiratory acidosis – from hypoventilation, unrelated here
With regards to Calcium which statement is incorrect?
a. The normal serum concentration range is 8-10.5 mg/dL
b. The ionized calcium correct range is 1.14 - 1.3 mmol/L
c. Treatment with calcium may not work if magnesium is not given as well
d. Calcium chloride has less elemental calcium than calcium gluconate
d. Calcium chloride has less elemental calcium than calcium gluconate
📘 Rationale:
⚠️ Incorrect because Calcium chloride contains more elemental calcium (13.6 mEq per 10 mL of 10% solution) than calcium gluconate (4.65 mEq per 10 mL of 10% solution).
💡 Therefore, calcium chloride is more potent and is used in emergencies like cardiac arrest.
🙅♂️ Why not the others?
✅ a. 8–10.5 mg/dL – Normal total calcium range.
✅ b. 1.14–1.3 mmol/L – Correct range for ionized calcium, the biologically active form.
✅ c. Hypomagnesemia can impair calcium response → magnesium correction is essential.
Which is the best statement regarding the use of combined diphtheria-tetanus-pertussis (DPT) vaccine for primary immunization of young children?
a. Is advisable only for catch-up immunization of children behind the recommended schedule
b. Is acceptable practice, although clearly inferior to the use of separate vaccines
c. Is the procedure of choice for immunization of normal children
d. Should be restricted to underdeveloped countries
c. Is the procedure of choice for immunization of normal children
📘 Rationale:
💉 The DTP (Diphtheria-Tetanus-Pertussis) combination vaccine is recommended in all countries for routine primary immunization in children.
✅ It simplifies administration and enhances compliance.
🙅♂️ Why not the others?
❌ a. Only for catch-up – False, it’s for routine primary immunization.
❌ b. Inferior to separate vaccines – False, combined vaccines are standard and effective.
❌ d. Only for underdeveloped countries – False, used globally.
Sensory screening like hearing should be performed at what age?
a. Birth
b. 1 month
c. 6 months
d. 12 months
a. Birth
📘 Rationale:
👶 Universal newborn hearing screening is standard at birth, allowing early detection and intervention for hearing loss.
🙅♂️ Why not the others?
❌ b. 1 month – Too late for initial screen.
❌ c. 6 months / d. 12 months – Reserved for re-screening, not primary detection.
This age group will show initially crying, either of a tantrum-like, protesting type or a quieter sadder type then subdued withdrawn, irritable, fussy, moody resistant to authority, go out to neighborhood looking for parent, or even leave home as a reaction to separation:
a. Infants
b. Young children
c. School children
d. Adolescents
b. Young children
📘 Rationale:
🧸 Young children (toddlers to preschoolers) react to separation with:
😢 Crying or tantrums
🚪 Trying to find or follow parent
🙁 Mood swings, irritability
🙅♂️ Why not the others?
❌ a. Infants – React with crying, but not seeking behavior
❌ c. School children – Show more coping or internalized stress
❌ d. Adolescents – More withdrawn or rebellious but not tantrum-prone
The first menstrual period in females is usually:
a. Ovulatory and irregular
b. Ovulatory and irregular
c. Anovulatory and regular
d. Anovulatory and irregular
d. Anovulatory and irregular
📘 Rationale:
🌸 Menarche typically begins as anovulatory (no ovulation) and irregular due to an immature hypothalamic-pituitary-ovarian axis.
⏳ Ovulation and regular cycles establish over 1–2 years.
🙅♂️ Why not the others?
❌ a/b. Ovulatory and irregular/regular – Too early for consistent ovulation
❌ c. Anovulatory and regular – Irregularity is expected in the beginning
You are performing an initial physical examination on a term newborn in the delivery room. The presence of which of the following leads you to suspect an underlying congenital anomaly?*
a. Umbilical hernia
b. Nevus flammeus
c. Single umbilical artery
d. Hypospadias
c. Single umbilical artery
📘 Rationale:
🔍 A single umbilical artery (instead of the usual two arteries and one vein) is a red flag.
🫀 It is associated with congenital anomalies, especially in the cardiovascular, renal, and GI systems.
🙅♂️ Why not the others?
❌ a. Umbilical hernia – Common and benign in neonates; usually resolves spontaneously.
❌ b. Nevus flammeus – A birthmark (port-wine stain); only concerning if associated with syndromes like Sturge-Weber.
❌ d. Hypospadias – A congenital anomaly, yes, but not usually associated with syndromic defects unless severe or part of a pattern.
The protein requirements for a full-term infant at birth are:*
a. 2-2.5 g/kg/day
b. 2.5-4 g/kg/day
c. 3-4.5 g/kg/day
d. 4-5 g/kg/day
b. 2.5–4 g/kg/day
📘 Rationale:
🍼 This range supports rapid postnatal growth and tissue development in full-term neonates.
🧠 Protein is crucial for brain and organ development in early life.
🙅♂️ Why not the others?
❌ a. 2–2.5 g/kg/day – Too low for a term neonate’s needs.
❌ c. 3–4.5 g/kg/day / d. 4–5 g/kg/day – Closer to preterm infant requirements due to higher growth demands.
The physical activity of a term normal newborn during examination varies. It is therefore not normal to see:*
a. Coarse, tremulous movements with ankle or jaw myoclonus
b. Absent physical activity during relaxation of normal sleep
c. Asymmetric movement of upper extremities
d. Vigorous crying with accompanying activity of arms and legs
a. Coarse, tremulous movements with ankle or jaw myoclonus
📘 Rationale:
⚠️ These movements may indicate neurological immaturity or pathology (e.g., seizures, hypoglycemia, or withdrawal).
🚫 They are not typical in normal neonatal behavior.
🙅♂️ Why not the others?
✅ b. Absent activity during relaxed sleep – Normal quiet sleep phase.
✅ c. Asymmetric upper extremity movement – May be normal briefly post-birth due to position but needs monitoring.
✅ d. Vigorous crying with limb movement – A healthy, normal response.
The skin of the premature infant is characterized by the following except:*
a. Abundant lanugo over back
b. Crackling, dry, desquamating
c. Deep red, delicate, with visible veins
d. Gelatinous and bruises easily
b. Crackling, dry, desquamating
📘 Rationale:
❌ Premature infants have thin, gelatinous, red skin with visible vessels – not dry or peeling.
🧴 Crackling, dry, and desquamating skin is more typical in post-term babies.
🙅♂️ Why not the others?
✅ a. Lanugo – Common in preterm infants for thermoregulation.
✅ c. Deep red, visible veins – Due to immature skin.
✅ d. Gelatinous and bruises easily – A hallmark of skin fragility in preemies.
On day 3 of a newborn baby, you observe that the skin has small, white, vesiculopustular papules with an erythematous base. Your main consideration would be:*
a. Erythema toxicum
b. Harlequin change
c. Pustular melanosis
d. Scalded skin
a. Erythema toxicum
📘 Rationale:
🌼 A common benign rash in neonates, usually appears on day 2–3, resolves in a few days.
🧪 No treatment needed; diagnostic with clinical appearance.
🙅♂️ Why not the others?
❌ b. Harlequin change – Transient color change due to vascular immaturity, not pustular.
❌ c. Pustular melanosis – Present at birth, ruptures easily, leaves pigmented spots.
❌ d. Scalded skin – Suggests staphylococcal scalded skin syndrome, not a benign condition.
A 1-day-old infant who was born by a difficult forceps delivery is alert and active. On physical examination, a cephalhematoma on the right temporoparietal area was noted. The following characterizes cephalhematoma except:*
a. It is rounded and discrete, with boundaries limited by suture lines
b. It represents edema of the scalp
c. It may take several weeks to resorb
d. Treatment is not necessary unless there are neurologic indicators
b. It represents edema of the scalp
📘 Rationale:
✅ Cephalhematoma is a subperiosteal hemorrhage — it is not edema.
🧠 It is bounded by suture lines, discrete, and often self-limited.
🙅♂️ Why not the others?
✅ a. Rounded and discrete, bounded by sutures – ✅ True
✅ c. May take weeks to resorb – ✅ True
✅ d. No treatment unless neurologic signs appear – ✅ True
Which of the following statements is incorrect?*
a. Abnormal vital signs within 30 - 60 minutes of life are always pathologic and indicate an unhealthy newborn
b. Breastmilk is associated with a decreased incidence of several common diseases
c. Circumcision should be routinely recommended based on medical advantage
d. Normal stools from breastfed infants appear to be loose, yellow, and seedy
a. Abnormal vital signs within 30 - 60 minutes of life are always pathologic and indicate an unhealthy newborn
📘 Rationale:
🍼 Vital signs in the first hour can fluctuate due to normal transitional physiology as the newborn adapts to life outside the womb.
🙅♂️ Why not the others?
✅ b. Breastmilk reduces disease incidence – 🌿 True; it’s protective.
✅ c. Circumcision not routinely recommended solely for medical advantage – 🩺 Correct, current guidelines favor parental choice, not routine recommendation.
✅ d. Breastfed stools: loose, yellow, seedy – 💩 True and normal.
The immediate postnatal changes in a term newborn include the following except:*
a. Decrease in pulmonary vascular resistance
b. Decrease in right-to-left shunting via ductus arteriosus
c. Increase in venous return to the left atrium
d. Increase right-to-left shunting via foramen ovale
d. Increase right-to-left shunting via foramen ovale
📘 Rationale:
❤️ After birth, the foramen ovale begins to close, due to increased left atrial pressure, reducing right-to-left shunting.
🙅♂️ Why not the others?
✅ a. ↓ Pulmonary vascular resistance – 🫁 Due to lung expansion.
✅ b. ↓ Right-to-left shunting via ductus arteriosus – ✔ True, it’s functional closure.
✅ c. ↑ Venous return to LA – ✅ From increased pulmonary flow.
A normal full-term baby has this posture:*
a. Arms and legs extended
b. Full flexion of arms and legs
c. Slight flexion of hips knees with arms extended
d. Frog-like position of legs
b. Full flexion of arms and legs
📘 Rationale:
🧸 Normal full-term neonates assume a flexed posture due to their intrauterine positioning in the womb.
🙅♂️ Why not the others?
❌ a. Arms/legs extended – More typical of premature infants.
❌ c. Slight flexion with extended arms – Not typical of full-term neonates.
❌ d. Frog-leg posture – Seen in hypotonia or prematurity.
Passage of meconium usually occurs within 12 hr after birth. It is expected that 98% of term babies and 95% of preterm infants have their first stool within:*
a. 24 hr of birth
b. 48 hr of birth
c. 72 hr of birth
d. 96 hr of birth
a. 24 hr of birth
📘 Rationale:
🕰 Delayed meconium passage beyond 24 hours may indicate Hirschsprung disease, meconium ileus, or intestinal atresia.
🙅♂️ Why not the others?
❌ b. 48 hr / c. 72 hr / d. 96 hr – These are too delayed for most healthy newborns and warrant investigation if stool hasn’t passed by 24 hrs.
