LE2 PEDIA Flashcards
Which of the following vitamins is necessary for supplementation for an exclusively breastfed baby?
C. Vitamin D Deficiency
Which of the following is not a characteristic of underfeeding?
D. Delay of gastric emptying time
WHO recommends as a measure in the prevention of Vitamin A deficiency in a 2-year-old child:
C. 200,000 IU orally every 6 months
Breastfeeding by vegan mothers can place her infant at risk for what vitamin deficiency?
C. Vitamin B12
A 7-year-old girl presents dry and scaly skin, silver-gray plaques on the bulbar conjunctiva (Bitot’s spots), and anemia. What is your most likely diagnosis?
A. Vitamin A Deficiency
The best tool you can use to assess the nutritional status of a 1-year-old boy infant is:
D. Use of growth chart
An infant appears on a scale with peripheral neuropathy and flaccid paralysis. What type of vitamin deficiency does this infant have?
A. Thiamine (Vitamin B1)
A mother with 4 children came to your clinic because she is concerned that she may not be able to feed her children 3x a day. This condition is known as food insecurity. Which of the statements is true of food insecurity?
A. Appropriate dietary advice with nutritional counseling may be helpful
An 8-year-old boy was noted to have episodes of somnolence, cyanosis, hypoventilation, and sleep apnea. BMI is 32. What is the best advice you can give the mother?
D. Tell the mother that weight reduction is extremely important at this time
A severely malnourished 6-year-old boy was brought to the ER because of diarrhea and vomiting. On PE, you noticed that the boy is severely dehydrated. What is the initial plan of management?
A. Stabilize the patient and correct the dehydration appropriately
Prenatal factors associated with increased risk of later childhood obesity include all except:
A. Low birth weight
Toilet training occurs in toddler and preschool years and is usually completed at what age:
B. 4 y/o
Enuresis is repeated voiding of urine in clothes or beds at least 2 times/week for at least 3 consecutive months in a child who is at least:
A. 5 y/o
Children with secondary nocturnal enuresis may have:
D. Psychosocial stressor
Encopresis is the regular, voluntary or involuntary passage of feces into a place other than the toilet after the age of:
D. 5 yrs
If Baby Mary has biliary atresia, he should undergo a procedure called Kasai portoenterostomy to establish bile flow and this should be done before ____ weeks of life to have a higher success rate:
A. 6
A 17-year-old high school student presents with symptoms after being hit in the abdomen during a fraternity initiation rite. If you suspect pancreatitis, which of the following is the most appropriate diagnostic test?
C. Serum amylase
Which of the following is the most likely underlying cause that could have led to pancreatitis?
A. Traumatic injury
Crohn’s disease is differentiated from Ulcerative Colitis due to:
C. Extraintestinal manifestations
A term infant was brought to the ER with lethargy, vomiting, hepatomegaly, jaundice, and positive urine dipstick for reducing substance. The most helpful diagnostic test is:
A. Serum galactose-1-phosphate-uridyl transferase
The following causes of primary malnutrition in children include all except:
A. Starvation
Refeeding syndrome can complicate the acute nutritional rehabilitation of children. The hallmark for diagnosis of this syndrome includes all of the following except:
A. Hyperphosphatemia
A 4-year-old boy with edema of both lower extremities, mainly consuming corn, cassava, and rice porridge. The most likely diagnosis is:
A. Kwashiorkor
A 2-year-old girl severely malnourished and treated for pneumonia is ready for discharge. What will you tell the mother?
C. She should give her child a diet that provides up to 150 kcal/kilo/day and proteins of 4g/kilo/day
Breastfeeding by vegan mothers can place her infant at risk for what vitamin deficiency?
Vitamin B12
A 7-year-old girl presents with dry and scaly skin, silver-gray plaques on the bulbar conjunctivae (Bitot’s spots) and anemia. What is your most likely diagnosis?
D. Vitamin A deficiency
To assess the nutritional status of a 1-year-old boy:
Growth chart
An infant appears well but looks pale, cyanotic, with noticeable peripheral neuropathy and flaccid paralysis. What type of vitamin deficiency does the child have?
Thiamine (Vitamin B1)
One of the following statements about dimensions of food security is correct:
Sufficient food can be accessed by all people to maintain a healthy and active life
An 8-year-old boy was noted to have episodes of somnolence, cyanosis, hypoventilation, and sleep apnea. Physical examination revealed a BMI of 32 kg/m². What is the best advice that you can give the mother?
D. Tell the mother that weight reduction is extremely important at this time
Irritability, pruritus, painful extremities, body malaise, coarse hair, dry skin, seborrhea, and increased intracranial pressure are manifestations of which condition?
Hypervitaminosis A
The mother of a 2-year-old boy presents to the rural health center because she thinks her child looks pale. What is the best way to check for pallor in this setting?
C. Tongue
A 9-year-old obese boy was seen in your clinic for evaluation. His development has been appropriate and no major illnesses have been reported. Which of the following statements about obesity is most accurate?
B. Laboratory tests are usually not helpful in confirming the diagnosis
WHO recommends this as an additional primary treatment for diarrhea:
C. Zinc
A 6-month-old, exclusively breastfed, was brought to your clinic because the mother noted her child to be pale. Except for generalized pallor, physical examination was unremarkable. What type of malnutrition does this child have?
C. Specific deficiency
Prenatal factors associated with increased risk of later childhood obesity include all except:
A. Low birth weight
One of the following statements has NO sufficient evidence to control malnutrition at all levels and in all countries:
D. Vaccination against neonatal and childhood illness
A 2-year-old boy with mild pneumonia, body weight 8kg, height 52cm, MUAC <11.5 cm, and bilateral pitting edema. According to WHO, how would you classify the malnutrition of this boy?
B. Severe acute malnutrition
The MOST commonly used index for nutritional status of children is:
B. Weight-for-age
Which of the following statements about cobalamin deficiency is incorrect:
A. Dietary sources are almost exclusively from plants.
When a pediatric patient presents with scorbutic rosary and x-ray reveals Freckle’s lines, it indicates what vitamin deficiency?
C. Vitamin C
The investigations to be done as part of the initial evaluation of newly identified obesity in a 12-year-old girl include all of the following except:
C. Renal function tests
The MOST characteristic lesion of vitamin A deficiency is:
A. Xerophthalmia
Which of the following statements regarding thiamine deficiency is true?
A. Features develop within 2-3 weeks of deficient intake
Which of the following matching pair is TRUE about the trace elements deficiencies and their consequences?
A. Zinc and hypogonadism
Which of the following steps are not contributory to the control of the asthmatic attack?
C. Prophylactic antibiotic treatment
All of the following matching care between drugs and vitamins and nutrient deficiency states is correct, except:
D. Isoniazid - Vitamin B12 (Correct match: Isoniazid - Vitamin B6)
A 6-week-old preterm infant presents with progressive pallor and peripheral edema. Peripheral blood smear reveals anemia, elevated reticulocyte count, and thrombocytosis. The best management of this preterm is to:
C. Administer vitamin E
Lower GIT bleeding presenting as hematochezia occurs in which of the following conditions?
A. Diverticulitis
A 10-year-old boy with a history of bloody diarrhea, tenesmus, and abdominal pain presents with toxic megacolon. Which condition is associated with these findings?
B. Ulcerative colitis
In a pediatric patient with long-standing GERD who starts to complain of intermittent dysphagia for solids and weight loss, the most appropriate test would be:
B. Endoscopy
Which of the following statements regarding infantile hypertrophic pyloric stenosis is correct?
C. Pathologically shows hypertrophy of the longitudinal muscle layer of the pylorus
True statement regarding omphalocele and gastroschisis:
C. Both conditions may be diagnosed prenatally with ultrasound
Which of the following statements regarding inguinal hernias in children is not correct?
B. Are less common in preterm infants
A 2-month-old male infant presents with vomiting after each feeding, projectile whitish vomitus, and no diarrhea. The most likely diagnosis is:
C. Hypertrophic pyloric stenosis
If symptoms of vomiting persist and the patient is admitted, which of the following electrolyte abnormalities is expected based on the most likely diagnosis?
A. Hypochloremic, hypokalemic metabolic alkalosis
Abdomen positive for bowel sounds, soft, slightly tender with ill-defined sausage-like mass palpable in the RUQ. Rectal vault is empty. What is the most likely diagnosis?
Intussusception
Based on the most likely diagnosis in Question No. 9, which of the following is the most appropriate next step in this patient’s management?
Air contrast enema (Barium or Gastrographin)
A 5-year-old boy presents with periumbilical abdominal pain for the past 3 months. The most likely underlying cause is:
B. Functional abdominal pain
A 5-month-old infant with diarrhea and vomiting for one day, dry lips, and depressed anterior fontanelle. The most appropriate next step in management is:
B. Start oral rehydration solution
A 7-month-old female with frequent diarrhea after every intake of her usual milk formula. The most likely diagnosis is:
B. Lactose Intolerance
This is the single most reliable finding in the diagnosis of acute appendicitis:
D. Localized abdominal tenderness
For Baby Mary with suspected biliary atresia, the best gold standard tool to evaluate this disorder is:
C. Intraoperative Cholangiography
If Baby Mary has biliary atresia, the Kasai portoenterostomy should be done before how many weeks of life for a higher success rate?
A. 6
Which of the following statements about cow’s milk protein allergy is accurate?
C. Half of the patients present with skin symptoms
This represents pathology of ‘failure to differentiate’ during embryonic development:
C. Cleft lip and palate
A 17-year-old high school student with epigastric pain after being hit by a paddle during a fraternity initiation rite. The most appropriate diagnostic test for suspected pancreatitis is:
C. Serum amylase
Which of the following is the most likely underlying cause that could have led to pancreatitis?
A. Traumatic injury
Crohn’s disease is differentiated from Ulcerative Colitis due to:
C. Extraintestinal manifestation
An infant in severe respiratory distress immediately after birth with a barrel chest and scaphoid abdomen is suspected to have:
C. Congenital diaphragmatic hernia
Which of the following is the most common associated complication of the above diagnosis?
D. Pulmonary hypoplasia and pulmonary hypertension
Which of the following statements regarding abdominal wall defect noted in a 37-week newborn is correct?
A. Gastroschisis is commonly located to the right of the umbilicus
A 4-year-old boy with a history of constipation since age 2, with large hard stools every 3 to 4 days. The next step in management is:
B. Advise reassurance and dietary counseling
A 17-year-old boy with on and off epigastric pain relieved by milk or antacids, occasional vomiting, and occult blood in his stool. The most likely diagnosis is:
A. Peptic ulcer
Baby Alma had bilious vomiting on her first day of life. The initial diagnostic procedure you will request is:
C. Plain film of the abdomen
A 14-year-old boy with jaundice, abdominal pain, nausea, vomiting, and fever. The test most likely to reveal the cause of pain is:
B. Ultrasound of the right upper abdomen
The most common cause of lower intestinal obstruction in neonates, associated with male predilection and delayed stool passage, is:
B. Hirschsprung disease
In patients with a diagnosis of TE fistula, the most common type is:
C. Esophagus ends in blind pouch plus fistula from trachea to lower esophagus
A 1-month-old baby spits up milk after feeding, and the mother is concerned. What will you say to reassure this young first-time mom?
D. AOTA (This condition peaks between one to three months of age, usually resolves by 6 months, and small feeding with frequent burping helps decrease the symptoms)
After 1 year, the baby is brought back with vomiting, failure to thrive, and aspiration pneumonia. Which of the following is NOT part of your management?
C. Do endoscopy first to rule out strictures before managing the patient
A 7-year-old with progressive difficulty swallowing food, initially solids then liquids, suspected of having achalasia. Which of the following regarding achalasia is true?
B. It is a primary esophageal motor disorder characterized by loss of LES relaxation and loss of esophageal peristalsis
A 2-year-old boy with massive, painless blood in stools, hypotension, and anemia. The most likely diagnosis is:
D. Meckel’s diverticulum
Which of the following is the most appropriate diagnostic procedure at this time for Meckel’s diverticulum?
B. 99mTc-pertechnetate scan
John suffered esophagitis with perforation and stricture after ingesting a substance with coagulation necrosis and thick eschar formation. What was the likely substance?
A. Acid-based substance
A 2-year-old child with a palpable hard mass at the abdomen. Which of the following is NOT part of the management of abdominal masses?
B. Asymptomatic patients can be sent home for observation with advice of close follow-up in the clinic
A frequent sequelae of cleft lip and cleft palate is:
C. Recurrent otitis media
A 2-month-old female with acute onset of crying, bilious vomiting, tender, and distended abdomen. Suspected malrotation with midgut volvulus. Which of the following statements regarding malrotation is NOT correct?
D. Fluid resuscitation and nasogastric suctioning, wait for the intestine to untwist naturally by itself
A full-term infant with copious oral secretions requiring frequent suctioning and unsuccessful attempts to place a nasogastric tube with the tube curling in the esophagus. The most likely diagnosis is:
A. Esophageal Atresia
A 15-year-old girl with abdominal pain, non-bloody diarrhea, perianal disease, skin tags, fistulas, failure to thrive, and delayed sexual development. The condition explaining these findings is:
C. Crohn Disease
A 10-year-old girl with nausea, vomiting, epigastric pain, and icteric conjunctiva. Suspected Hepatitis A infection. Which statement is correct?
C. Serologic testing with IgG - anti HAV and IgM - anti HAV will confirm the diagnosis
Which marker is pathognomonic of active Hepatitis B infection?
A. HBV surface antigen (HBsAg)
The most common site of esophageal impaction is at the:
B. Thoracic inlet
A 12-year-old boy presents with crampy abdominal pain, bilious vomiting, and a history of laparotomy for Crohn’s disease. The clinical finding that most favors a diagnosis of postoperative small bowel obstruction rather than ileus is:
C. Hyperactive bowel sounds
A 2-year-old girl with a history of biliary atresia and a Kasai procedure presents with vomiting blood. The finding suggesting bleeding from esophageal varices is:
D. Splenomegaly
A 15-year-old girl with fatigue, fever, jaundice, and a history of IV drug use. The viral infection with the highest risk for chronic hepatitis and cirrhosis is:
C. Hepatitis C
A 10-year-old boy with periumbilical pain, green vomiting, and tenderness. The most likely diagnosis is:
B. Acute appendicitis
A 4-year-old boy and family with diarrhea after recent antibiotic use, and stool tests positive for Clostridium difficile toxin. The most appropriate management is to:
A. Treat all three patients with metronidazole
A 14-year-old boy with growth failure, intermittent abdominal pain, and diarrhea. The physical finding most associated with Crohn disease is:
C. Short stature
The Alvarado rule for diagnosing acute appendicitis gives 2 points for:
D. Tenderness in the right lower quadrant
Which of the following infections is a common cause of acute abdominal pain?
C. Pneumonia (lower lobes)
A healthy 3-year-old boy swallowed a small plastic toy. He is in no distress. The best next step in management is:
C. Chest and abdominal radiograph series
The common presentation of malrotation during the first month of life is:
D. Bilious vomiting
The classic triad of tremor, neuropsychiatric disturbance, and gingivostomatitis is seen in which heavy metal intoxication?
D. Mercury
Indications for hospitalization of burn patients does NOT include one of the following:
B. Burns that are 10% or less of the body surface area
The use of helmets, seatbelts, knee, and elbow pads are interventions that:
B. Will attempt to reduce the likelihood of injury by modifying the transfer of energy to the victim
Which of the following is NOT included in the management of burn patients?
C. Routine use of antibiotics
One of the following DOES NOT characterize Munchausen syndrome by proxy:
D. The symptoms occur when the mother is away from the child
The reason why pedestrian injuries occur commonly among children 5-9 years old is:
B. Children have poor ability to judge the distance and speed of traffic
One of the following is presumptive evidence of sexual abuse:
C. Presence of STD in a pubertal child
Which of the following is NOT a characteristic of acute mercury poisoning in children?
C. Anemia
Toxic reactions to acetaminophen poisoning in children:
B. Involve primarily the liver
A 3-year-old child drinks some kerosene and cries after the first swallow. She is most likely to develop:
B. Chemical pneumonitis
Accidental ingestion of corrosive agents should be managed initially by:
B. Administer large amounts of fluids such as water or milk
Shellfish poisoning caused by eating shellfish that have ingested toxic dinoflagellate (red tide) is characterized by:
D. Weakness and paralysis
All of the following investigations/laboratory measures are indicated as screening in toxicological diagnosis, except:
D. Stool screen
Which of the following is a clear protective factor against child abuse or neglect?
C. Good support for the mother or primary caregiver
Activated charcoal that is used for gastric decontamination in case of acute poisoning is effective against:
None of the listed options (Caustics, Corrosives, Hydrocarbons, Iron, Heavy metals)
A 2-year-old boy brought to the ER after taking many tablets of acetaminophen. The best advice regarding gastric decontamination is to use:
C. Activated charcoal
Which of the following is a clear risk factor for child abuse or neglect?
D. Maternal depression
You witnessed a 3-year-old boy collapse, and you’re concerned he may be in cardiac arrest. The correct order of steps in the initial management of a child in cardiopulmonary arrest is:
C. Check for breathing and pulse and start chest compressions
Which of the following is TRUE about caustic ingestion in children?
A. Ingestion of caustic materials may produce whitish plaques around the mouth secondary to burns.
Stable child with mid-sized VSD requiring dental cleaning for multiple caries. The appropriate management includes:
Amoxicillin (for dental prophylaxis in cases with cardiac defects)
A 6-year-old boy diagnosed with acute rheumatic fever with arthritis and carditis. The most appropriate statement regarding prognosis of heart disease is:
A. A chronic disease which may lead to valve stenosis
The criterion for acute rheumatic fever which does not need evidence of recent group A strep infection is:
A. Sydenham chorea
A 10-year-old boy with anorexia, abdominal discomfort, vomiting, marked cardiomegaly, jugular venous distention, and hepatomegaly. The clinical finding most suggestive of congestive heart failure from dilated cardiomyopathy is:
C. Prominent S3 gallop
The palliative surgical procedure indicated for a patient with pulmonary stenosis, cyanotic type lesion, hypoxic spells, frequent polycythemia, and small pulmonary arteries is:
B. Blalock-Taussig shunt (BTS)
A child with large VSD, poor feeding, apathetic, and tachypneic. The management is:
Furosemide
A 2-year-old child with minimal cyanosis, S3 and S4, systolic murmur in the pulmonic area, and mid-diastolic murmur. ECG shows right atrial hypertrophy and a bundle branch block pattern. The child most likely has:
Ebstein’s anomaly of the tricuspid valve
Permanent pacemaker insertion is best indicated in:
A. Patient with surgically induced complete heart block
False statement regarding tuberculous pericarditis:
D. It is best treated with continuous drainage of pericardial fluid
Most common cause of chest pain in pediatrics:
B. Musculoskeletal
VSD large enough to produce pulmonary overcirculation is usually indicated by which complex of symptoms:
Poor Breathing
Which of the following statements regarding treatment of patients with atrial septal defect (ASD) is accurate?
D. Surgical or catheter closure for moderate and large ASD’s
A 7-year-old boy with right ankle pain, previously sore left knee, fever, and a holosystolic murmur. The most likely laboratory finding associated with these findings is:
D. Elevated antistreptolysin O (ASO) titer
A 2-day-old term neonate with intermittent cyanosis that disappears when the baby cries or tries to suck breast milk. The most likely diagnosis is:
Choanal atresia
A 3-year-old with a history of URTI, low-grade fever, barking cough, and stridor. The expected x-ray finding is:
Steeple sign
During history taking in a child with chronic cough, which of the following is NOT a pertinent point to ask about?
C. Immunization especially BCG
The most common complication of recurrent acute pharyngitis if not given antibiotics is:
Rheumatic fever
A 1-year-old suddenly develops respiratory distress with unilateral wheezing sounds while playing. The expected lung findings are most likely due to:
C. Foreign body aspiration
A 2-month-old infant with stridor at birth and suspected vascular ring. The diagnostic procedure you should request is:
CT Scan
Common colds persisting for more than 10 days with runny nose, nasal discharge, and fever lead to this diagnosis:
D. Sinusitis
A 2-year-old diagnosed with CPAP-B and the mother requests home treatment. Aside from symptomatic treatment, what other forms of treatment should be given?
D. Antibiotics, Supportive care
The current treatment regimen for latent TB infection (LTBI) is:
Isoniazid daily for 6 months
Regimen 1 (2HRZE/4HR) is indicated in the treatment of TB patients EXCEPT for:
TB of bones and joints
A patient presents with a cough and suspected TB. What is the most appropriate next step?
C. Consider giving broad spectrum antibiotics
In which situation is Tuberculin Skin Test (PPD) or IGRA required prior to initiating preventive treatment for LTBI?
A. Children who are household contacts of clinically diagnosed PTB
A 14-year-old girl with a 2-week history of cough and family history of TB. The most appropriate workup is:
Sputum exam, Gene Xpert, Pleural fluid analysis
The following features identify presumptive extrapulmonary TB, EXCEPT:
Pulmonary cavitation
Which is considered the current treatment regimen for LTBI?
A. Isoniazid daily for 6 months
Regimen 1 (2HRZE/4HR) is indicated or eligible in the treatment of TB patients EXCEPT for:
C. TB of bones and joints
Which is NOT included in the presumptive symptoms of LTBI in children 5 years old and below?
A. Night sweats
Chronic cough in children is defined as a cough that persists for:
D. More than four weeks
What is the mainstay in the management of controlled bronchial asthma in children under 5 years old?
Inhaled corticosteroids
Which of the following is not suggestive of probable asthma in children?
Clinical improvement after giving SABA for 2-3 weeks
GINA guidelines recommendation for adolescents with acute asthma exacerbation:
C. Low dose ICS-Formoterol is a preferred controller and a reliever
Regular use of SABA for two weeks is associated with:
A. Rebound hyperresponsiveness
The use of ICS formoterol reliever combination therapy is not recommended in:
A 5-year-old wheezing for the past 3 years
A 7-year-old child with cough, high fever, and decreased breath sounds. The most likely diagnosis is:
Effusion
What chest X-ray finding is consistent with disseminated TB?
C. Miliary pattern
Which of the following features identifies presumptive extra pulmonary TB, EXCEPT:
B. Pulmonary cavitation
In which situation is Tuberculin Skin Test (PPD) or IGRA required prior to the initiation of preventive treatment for LTBI?
A. Children who are household contacts of clinically diagnosed PTB
A 10-month-old girl presents with non-labored tachypnea, low-grade fever, wheezing, and rales. The primary consideration is:
B. Acute Bronchiolitis
Which is NOT helpful about the primary prevention of asthma?
D. Primary cesarean delivery
In the GINA guidelines 2021, which of the following statements is NOT true in asthma and COVID-19?
A. People with well-controlled asthma are at increased risk of acquiring COVID-19
A 12-year-old boy with purpura, hypotension, acidosis, and low BP despite treatment. The most appropriate next step is to:
C. Begin dobutamine infusion at 15 mcg/kg/min
A 2-year-old child with fever, fussiness, dehydration, and weak pulses. The most appropriate initial management is to administer:
D. An IV bolus of 20 mL/kg of 0.9 Normal saline
WHO criteria for hypotension in healthcare systems without ICU include all EXCEPT:
D. Systolic blood pressure of less than 70 mmHg for a 1-year-old child
The best method to perform chest compressions among infants with 2 or more rescuers is:
B. Two thumb-encircling hands in the center of the chest
A 6-month-old infant with fever, hoarseness, barking cough, and stridor is suspected of having viral croup. The most likely cause is:
D. Parainfluenza virus
The best maneuver to expel foreign body airway obstruction in a conscious child is:
C. Back blows and chest thrust
For high-flow oxygen delivery in severe respiratory distress, make use of:
O2 with rebreathing bag
A sign of a displaced ET tube is:
Presence of breath sound in the stomach
An 18-year-old girl who swallowed 100 aspirin tabs 4 hours ago. The expected ABG result is:
D. Metabolic acidosis and respiratory alkalosis
The most likely type of shock in a 10-month-old infant with hypotension and ECG showing supraventricular tachycardia is:
A. Cardiogenic shock
The following statement is correct regarding cardiopulmonary (CP) arrest in children:
B. Often the end result of progressive deterioration of CP function
A 5-year-old boy with acute onset wheezing, urticaria, stridor, and hypotension presents with:
A 5-year-old boy with acute onset wheezing, urticaria, stridor, and hypotension presents with:
