[PEDIA1] LE3

Question 1

48. Considering Kurt’s age, how much is the approximate percent of water in his body?*
    A. 50-60%
    B. 60-70%
    C. 70-80%
    D. 80-90%

Answer 1

B. 60-70%
Rationale: Based on the provided information, infants and children typically have a total body water (TBW) percentage ranging from 60% to 70%. As Kurt is an 8-month-old infant, his TBW would fall within this range.

Question 2

49 Calculate the approximate total body water (in liters) for Kurt whose weight is 8.5 kgs
A. 4-5 liters
B. 5-6 liters
C. 6-7 liters
D. 7-8 liters

Answer 2

B. 5-6 liters

Given:
Kurt’s weight = 8.5 kg
TBW formula = Current weight (kg) × 60%
= 5.1 L

Question 3

50. To control water loss in Kurt’s body, which among these statements is accurate?
    A. Increased atrial natriuretic peptide hormone secretion
    B. Decreased ADH secretion
    C. Increased aldosterone secretion
    D. Decreased renin secretion

Answer 3

C. Increased aldosterone secretion

Rationale: In the presence of dehydration and sodium loss, the body typically responds by increasing aldosterone secretion, which promotes sodium and water reabsorption in the kidneys, helping to conserve body fluids and correct the fluid imbalance. Decreased ADH secretion and increased atrial natriuretic peptide would worsen dehydration by promoting diuresis, while decreased renin secretion would counteract the body’s efforts to conserve sodium and water.

Question 4

51. Based on the WHO classification of dehydration, how do you classify Kurt’s dehydration
    A. No dehydration
    B. Some dehydration
    C. Moderate dehydration
    D. Severe dehydration

Answer 4

C. Moderate dehydration
Rationale: Kurt’s signs such as sunken eyes and fontanels, along with irritability and increased heart rate, suggest moderate dehydration. These signs are more severe than those seen in mild dehydration (some dehydration), but not severe enough to indicate shock or severe dehydration, which would include extreme drowsiness or unconsciousness and very rapid and weak pulse.

Question 5

52. If Kurt has severe dehydration, which is the most appropriate fluid to give for resuscitation?
    A. D5 Water
    B. D5 0.3% Sodium chloride
    C. D5 IMB (Balanced Multiple Maintenance Solution)
    D. Plain Lactated Ringer Solution

Answer 5

D. Plain Lactated Ringer Solution
Rationale: For severe dehydration, particularly in cases where shock is present or suspected, the best initial resuscitation fluid is typically an isotonic solution like plain Lactated Ringer Solution or normal saline. These solutions are effective in quickly restoring circulatory volume and correcting electrolyte imbalances.

Question 6

53. You noticed that despite control of Kurt’s temperature, his RR remains to be high at 50’s, you decided to request for an arterial blood gas which showed the following: pH 7.25, pCO2 30, pO2 95, НСО3 18, BE -8. Interpret: *
    A. Compensated metabolic acidosis
    B. Uncompensated respiratory acidosis
    C. Compensated respiratory acidosis
    D. Uncompensated metabolic acidosis

Answer 6

D. Uncompensated metabolic acidosis

Rationale: The acidic pH and the low bicarbonate (HCO3) level indicate a metabolic acidosis. The pCO2 is also low, suggesting a respiratory compensation attempt, but since the pH is still significantly low and not near normal, it is considered uncompensated.

pH: 7.25 (acidic)
pCO2: 30 mmHg (low)
pO2: 95 mmHg (normal)
HCO3: 18 mEq/L (low)
Base Excess (BE): -8 (negative, indicating a deficit in base)

Question 7

54 The above acid/base deficit (answer in #51) is due to which of the following?
A. A primary decrease in plasma bicarbonate concentration
B. A primary decrease in pCO2
C. A compensatory increase in plasma bicarbonate concentrate
D.A compensatory increase in pCO2

Answer 7

A. A primary decrease in plasma bicarbonate concentration
Rationale: The primary problem in uncompensated metabolic acidosis is the decrease in bicarbonate levels, which is evident from Kurt’s arterial blood gas results showing a low HCO3.

Question 8

55 You decided to resume Kurt’s feeding however he had recurrence of vomiting episodes. You requested for an abdominal x-ray which showed ileus. Electrolytes showed some abnormalities.
Based on the above findings, what is the expected electrolyte problem or derangement?
A. Low calcium
B. Elevated sodium
C. Low potassium
D. Low chloride

Answer 8

C. Low potassium
Rationale: Vomiting and ileus can lead to significant losses of gastric contents and intestinal fluids, respectively, which are rich in potassium. This often results in hypokalemia (low potassium levels).

Question 9

56 Which is an early symptom seen in extracellular fluid deficit?
A. Thirst
B. Absence of tears
C. Sunken eyes
D. Prolonged capillary refill time

Answer 9

A. Thirst
Rationale: Thirst is an early and sensitive indicator of extracellular fluid deficit, as it reflects the body’s immediate response to fluid loss and the need to replenish water to maintain homeostasis.

Question 10

57 The following are the results of serum electrolytes of your patient. Na 135, K 3.1, CI 96.
Which is abnormal?
A. Sodium
B. Potassium
C. Chloride
D. All of the above

Answer 10

B. Potassium
Rationale: Normal serum potassium levels typically range from 3.5 to 5.0 mEq/L. Kurt’s potassium level of 3.1 mEq/L is below this range, indicating hypokalemia. Sodium and chloride levels are within normal limits for a child (Na 135-145 mEq/L, Cl 98-107 mEq/L).

Question 11

58. Kurt is on his 3rd hospital day, with no more vomiting and stools are soft to semi formed. His appetite is starting to come back. You noted that his serum potassium is low. What is the most appropriate fluid of choice for him at this point?
    A. D5 IMB
    B. D5 0.3% NaCl
    C. PLRS
    D. D5 LRS

Answer 11

A. D5 IMB (Balanced Multiple Maintenance Solution)
Rationale: Since Kurt’s appetite is improving and he is transitioning back to regular feeding, a balanced maintenance solution like D5 IMB, which includes electrolytes and a moderate amount of potassium, would be beneficial to address his low serum potassium levels in a controlled manner.

Question 12

59 How much potassium content is in D5IMB (Balanced Multiple Maintenance Solution)?
A. 4 mEq/L
B. 10 mEq/L
C. 25 mEq/L
D. 20 mEq/L

Answer 12

B. 10 mEq/L
Rationale: D5IMB typically contains a moderate amount of potassium, suitable for maintaining electrolyte balance in patients like Kurt who are recovering from episodes of hypokalemia.

Question 13

60.Using Holiday-Segar method to compute, how much fluid requirement does Kurt need in 24 hrs? Use his weight of 8.5 kgs.
A. 1000 ml
B. 850 ml
C. 800 ml
D. 650 ml

Answer 13

B. 850 ml
Rationale: According to the Holiday-Segar method:
First 10 kg of body weight requires 100 ml/kg.
Kurt weighs 8.5 kg, thus his fluid requirement = 8.5 kg × 100 ml/kg = 850 ml/24 hrs.

Question 14

61 Based on the above answers, what is the appropriate maintenance fluid and rate for Kurt that you will order in the chart? *
A. PLRS 500 ml to run at 27 ml/hr
B. D5 0.3% 500 ml to run at 33 ml/hr
C. D5NM 500 ml to run at 41 ml/hr
D. D5IMB 500 ml to run at 35 ml/hr

Answer 14

D. D5IMB 500 ml to run at 35 ml/hr
Rationale: Considering Kurt’s clinical improvement and his low potassium, D5IMB is appropriate to address both his hydration and electrolyte needs. The fluid rate of 35 ml/hr (totaling 840 ml over 24 hours) matches closely with his calculated fluid requirement.

Question 15

62 If the serum sodium of Kurt on admission showed an elevated result of 155 mEq/L, which is TRUE of his case? *
A. Among the symptoms to note include decreased skin turgor, cold clammy skin, coma due to cerebral edema
B. It does not tell us whether the ECF sodium is increased, normal or decreased. There is a thing called pseudohypernatremia
C. Fast correction of hypernatremia may result in central pontine myelinosis
D. In the treatment, decrease sodium initially by 0.5-1 mEq/L using D5 0.45% NaCl

Answer 15

D. In the treatment, decrease sodium initially by 0.5-1 mEq/L using D5 0.45% NaCl
Rationale: This choice directly reflects the correction strategy for hypernatremia as outlined. It specifies using 0.45% Saline Solution, which provides both water and sodium, suitable for cases where both need to be replenished. This method matches the recommended initial correction rate of sodium decrease by 0.5-1 mEq/L per hour, aligning with the goal of careful correction to avoid rapid shifts and subsequent complications like cerebral edema. The option is more specific and actionable regarding Kurt’s management compared to other options which are either overly broad or less directly related to the clinical strategy for managing a specific sodium level of 155 mEq/L.

Question 16

63. In rapid rehydration, a fluid infusion utilizing Normal saline (NS) or Lactated Ringer’s (LR) is a common starting point at a dose of: *
    A.30 cc / kg
    B.20 cc / kg
    C. 10 cc /kg
    D. 5 cc / kg

Answer 16

A. 30 cc / kg
Rationale: The standard initial bolus for rapid rehydration in cases of significant dehydration or shock typically involves administering isotonic fluids like Normal Saline or Lactated Ringer’s at a dose of 30 cc/kg. This rapid infusion helps to quickly restore circulating volume and improve hemodynamics.

Question 17

64. The best way to monitor initial improvement in children with 10% dehydration is by measuring:
    A. Central venous pressure
    B. Blood pressure
    C. Weight gain
    D. Urine output

Answer 17

D. Urine output
Rationale: Urine output is a practical and reliable indicator of renal perfusion and function. It’s particularly useful for assessing the effectiveness of rehydration therapy. In children with severe dehydration, improvements in urine output often reflect successful restoration of fluid balance and kidney function.

Question 18

65 This serves as a main buffer in the ECF compartment:
A. Bicarbonates
B. Chloride
C. Organic phosphates
D. Proteins

Answer 18

A. Bicarbonates
Rationale: Bicarbonate is the primary buffer in the extracellular fluid (ECF) compartment. It plays a crucial role in maintaining the pH balance by neutralizing excess acids in the bloodstream, thus stabilizing the body’s acid-base status.

Question 19

66 The normal plasma osmolality in children is approximately:
A. 265 -275 mOsm/kg H20
B. 280 -295 mOsm/kg H20
C. 305 - 315 mOsm/kg H20
D. 325 - 335 mOsm/kg H20

Answer 19

B. 280 -295 mOsm/kg H2O
Rationale: The normal range for plasma osmolality in children, as well as adults, typically falls between 280 to 295 mOsm/kg H2O. This range indicates a balanced concentration of solutes (like sodium, glucose, and urea) in the plasma.

Question 20

67. 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

Answer 20

A. Oral rehydration
Rationale: For a child who is alert and thirsty with signs of mild dehydration (such as dry oral mucosa), oral rehydration is typically the most appropriate management. Oral rehydration solutions (ORS) are effective, safe, and can be easily administered. The choice of oral rehydration is supported by the child’s ability to drink and retain fluids, and there’s no indication of severe dehydration or systemic infection that would necessitate IV fluids or antibiotics.

Question 21

68. Based on the Holliday-Segar method, the maintenance fluid requirement of a 15-kg infant is approximately:
    A. 1000 mL/day
    B. 1200 mL/day
    C. 1250 mL/day
    D. 1300 mL/day

Answer 21

B. 1200 mL/day

Question 22

69. The principal intravascular anion and the principal anion in the gastric juice is: *
    A. Chloride
    B. Bicarbonate
    C. Phosphates
    D. Organic acid

Answer 22

A. Chloride
Rationale: Chloride is the major extracellular anion and is a key component of gastric juice, making it highly abundant both in the bloodstream and in gastric secretions.

Question 23

70. A child presents with constipation after bouts of severe vomiting. The clinician noted weakness and abdominal distension and absent bowel sounds. ECG shows a depressed ST segment with biphasic T waves and prominent U waves. Which of the following is most likely? *
    A. Hyponatremia
    B.Hypernatremia
    C. Hyperkalemia
    D. Hypokalemia

Answer 23

D. Hypokalemia
Rationale: The ECG changes described, including depressed ST segments, biphasic T waves, and prominent U waves, are classic signs of hypokalemia. This condition is likely exacerbated by severe vomiting, which can lead to significant potassium loss.

Question 24

71. 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

Answer 24

B. Metabolic alkalosis
Rationale: Draining gastric contents through an NG tube can lead to loss of gastric acid, which is rich in hydrochloric acid (HCl). The loss of this acid can result in a metabolic alkalosis as the body loses H+ ions while retaining bicarbonate.

Question 25

72 A patient with hypoparathyroidism complains of weakness and tingling in his fingers and around the mouth. What electrolyte imbalance most likely this patient has? A. Hyponatremia B. Hypocalcemia C. Hyperkalemia D. Hypermagnesemia

Answer 25

B. Hypocalcemia Rationale: Hypoparathyroidism typically leads to hypocalcemia due to decreased production of parathyroid hormone (PTH), which is crucial for calcium regulation. Symptoms of hypocalcemia include tingling (paresthesia) and muscle weakness. Clinical Symptoms of Hypocalcemia Hyperreflexia, Tetany, laryngospasm/muscle spasms Seizures, paresthesia Cardiovascular Effects: Ventricular ectopy, arrhythmias, QT prolongation Hypotension Decreased cardiac output (Heart Failure)

Question 26

73. Which is incorrect with regards to the IV fluid and its content? * A. Normal Saline - 154 mmol Na+/L B. LRS - 134 mmol Na+/L C. D5 0.3% NaCl- 154 mmol/L D. D5 W- 50 gm glucose/L

Answer 26

C. D5 0.3% NaCl- 154 mmol/L Rationale: D5 0.3% NaCl (5% dextrose with 0.3% saline) contains approximately 51 mmol/L of sodium, not 154 mmol/L which is the sodium content of normal saline. This makes option C incorrect.

Question 27

74. A rise in the pH by 0.1 causes what decrease in serum K+? A. 0.1 mEq/L B. 0.25 mEg/L C. 0.5mEq/L D. 1.0mEq/L

Answer 27

B. C. 0.5mEq/L Rationale: As blood pH increases (becomes more alkaline), potassium ions move from the extracellular to the intracellular space to help balance the shift in hydrogen ions. This intracellular shift decreases extracellular (serum) potassium levels. The typical decrease in serum potassium for a 0.1 increase in pH is approximately 0.5 mEq/L, reflecting the significant impact that even small pH changes can have on potassium dynamics. This is consistent with medical guidelines and teaching regarding the relationship between acid-base balance and electrolyte distribution.

Question 28

75. All of the following will shift K+ into cell except A. Insulin B. Dextrose С. NaHCO3 D. NOTA

Answer 28

D. NOTA (None of the Above) Rationale: Insulin, dextrose, and sodium bicarbonate (NaHCO3) all facilitate the cellular uptake of potassium. Insulin and dextrose stimulate cells to take up glucose and potassium simultaneously, while bicarbonate correction of acidosis leads to a shift of potassium into cells.

Question 29

76. Which of the following statements with regards to Calcium 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

Answer 29

D. Calcium chloride has less elemental calcium than calcium gluconate Rationale: This statement is incorrect. Calcium chloride actually contains more elemental calcium compared to calcium gluconate. Calcium chloride contains about 27% elemental calcium, whereas calcium gluconate contains about 9% elemental calcium. Membrane Stabilization Calcium Administration: *Calcium Gluconate: Often preferred for its safer infusion profile, administered as a 10% IV infusion over 2-5 minutes. It is crucial for countering the myocardial depressant effects of hyperkalemia. Continuous monitoring is necessary during administration, and repeat treatments may be required. *Calcium Chloride: Contains a higher amount of elemental calcium compared to calcium gluconate, but it is more irritating to veins and thus typically reserved for more severe cases or when central venous access is available.

Question 30

77. Which does NOT cause a metabolic alkalosis? A. Vomiting B. Diarrhea C. Loop diuretics D. Thiazide diuretics

Answer 30

B. Diarrhea Rationale: Diarrhea typically causes metabolic acidosis due to the loss of bicarbonate-rich intestinal fluids, not metabolic alkalosis. Vomiting and both types of diuretics (loop and thiazide) can cause metabolic alkalosis due to the loss of stomach acid or altered kidney function leading to increased bicarbonate retention.

Question 31

78. The normal anion gap is: * A. <7 B. <12 C. <18 D. <22

Answer 31

B. <12 Rationale: The normal anion gap, which is calculated from the difference between measured cations (sodium) and the sum of the major measured anions (chloride and bicarbonate), is typically less than 12 mEq/L. Values higher than this can indicate the presence of unmeasured anions in the blood, often seen in various types of metabolic acidosis.

Question 32

79. Which statement is incorrect? * A. In acute respiratory alkalosis, for every drop of 10 mmg of pCO2, the HCO3- drops 2 mEq/L B. In chronic respiratory alkalosis, for every drop of 10 mmHg of pCO2, the HCO3- drops 5 mEq/L C. In acute respiratory acidosis, for every 10 mmHg rise in pCO2 ,the HCO3 rises 1 mEq/L D. In chronic respiratory acidosis, for every 10 mmHg rise in pCO2 ,the HCO3 rises 2 mEql/L

Answer 32

D. In chronic respiratory acidosis, for every 10 mmHg rise in pCO2, the HCO3 rises 2 mEq/L Rationale: This statement is incorrect. In chronic respiratory acidosis, for every 10 mmHg rise in pCO2, the HCO3 typically rises by approximately 3 to 4 mEq/L, not just 2 mEq/L. The kidneys compensate over time by retaining bicarbonate to buffer the increased acid load. Respiratory Acidosis 1. Acute Respiratory Acidosis: * Mechanism: Accumulation of CO2 due to hypoventilation or lung dysfunction. * Serum HCO3- Change: Increases by approximately 1 mEq/L for every 10 mmHg increase in pCO2. 2. Chronic Respiratory Acidosis: * Mechanism: Persistent hypoventilation. * Serum HCO3- Change: Increases by about 3.5 mEq/L for every 10 mmHg increase in pCO2, with renal compensation taking 24-48 hours to adjust bicarbonate levels. Respiratory Alkalosis 1. Acute Respiratory Alkalosis: * Mechanism: Loss of CO2 due to hyperventilation. * Serum HCO3- Change: Decreases by about 2 mEq/L for every 10 mmHg decrease in pCO2. 2. Chronic Respiratory Alkalosis: * Mechanism: Prolonged hyperventilation. * Serum HCO3- Change: Decreases by about 5 mEq/L for every 10 mmHg fall in pCO2, typically observed after 24-48 hours.

Question 33

80. A Plasma HCO3- concentration of 15 meq/L and plasma CO2 of 40 mm Hg with a pH of 7.35 represents * a. Simple metabolic acidosis b. Compensated metabolic acidosis c. Simple respiratory alkalosis d. Compensated respiratory alkalosis

Answer 33

b. Compensated metabolic acidosis Rationale: A low bicarbonate level with a normal pCO2 and a pH on the lower end of normal (but still within normal range, 7.35-7.45) indicates compensated metabolic acidosis. The body has adjusted the pCO2 to near normal levels to maintain a normal pH despite the bicarbonate deficit.

Question 34

81. Normal or physiological saline has the following characteristics, EXCEPT: * a. Physiologic ratio of Na+ to Cl - b. Na+ 154 mEq/L and CI- 154 mEq/L c. 9 gm Sodium Chloride in 1 liter of water d. Approximate isotonicity with blood

Answer 34

a. Physiologic ratio of Na+ to Cl - Rationale: Normal saline, which contains 0.9% sodium chloride, equates to approximately 154 mEq/L of sodium and 154 mEq/L of chloride. This results in a 1:1 ratio of sodium to chloride, which is not the physiological ratio found in blood plasma. Blood plasma typically has a higher concentration of sodium compared to chloride, thus normal saline is actually hyperchloremic compared to blood, potentially leading to acid-base imbalances when used in large volumes. The other options correctly describe characteristics of normal saline.

Question 35

82. All of the following clinical and laboratory parameters are utilized in fluid and electrolyte therapy, EXCEPT: a. Blood sugar b. Body weight c. Urine output d. Serum electrolytes

Answer 35

a. Blood sugar Rationale: Blood sugar, while important in many clinical settings, is not directly involved in routine fluid and electrolyte therapy unless specific conditions such as diabetes are involved. The other options (body weight, urine output, serum electrolytes) are directly relevant to assessing and managing fluid and electrolyte balance.

Question 36

83. What determines plasma osmolality ? a. Sodium b. Potassium c. Calcium d. Proteins

Answer 36

a. Sodium Rationale: Plasma osmolality is primarily determined by sodium (Na+), which is the major solute in the extracellular fluid. Changes in sodium concentration have a significant impact on plasma osmolality. While other solutes like potassium, calcium, and proteins also contribute to osmolality, sodium is the most impactful due to its concentration and osmotic activity.

Question 37

84. WHO recently recommended low osmolarity ORS should contain the following ingredients (in mmol/L of water) a. Na+90, K +20, CL- 80, HCO3 - 30 b. Na+80, K +20, CL- 90, CO3 - 30 c. Na+90, K +30, CL- 80, CO3 - 20 d. Na+75, K+20, Cl- 65, HCO3- 10

Answer 37

d. Na+75, K+20, Cl- 65, HCO3- 10 This matches the sodium, potassium, and chloride content of the ORS solution, although the bicarbonate is actually listed as citrate in the image, which upon metabolism would serve a similar function to bicarbonate in the body. The ORS formulation in the image indicates 75 mmol/L of sodium, 20 mmol/L of potassium, 65 mmol/L of chloride, and 10 mmol/L of trisodium citrate with an osmolarity of 245 mOsm/L.

Question 38

85 Determination of the anion gap entails measurement of the following except: a. Sodium b. Creatinine c. Bicarbonate d. Chloride

Answer 38

b. Creatinine Rationale: The anion gap is calculated as Na^+ - (Cl + HCO3). Creatinine is not used in the calculation of the anion gap. It is involved in assessing renal function but not directly in the anion gap calculation.

Question 39

86 The serum osmolality of child with Na of 125 meq/L, glucose of 108 mg/dL and BUN of 140 mg/dL would be a. 300 mOsm/kg b. 306 mOsm/kg c. 312 mOsm/kg d. 318mOsm/kg

Answer 39

d. 318 mOsm/kg

Question 40

87 What maintains the difference in cation concentration between the ICF and ECF? * a. Resting membrane potential b. Na-K pump c. Osmotic pressure d. Intracellular proteins

Answer 40

b. Na-K pump Rationale: The Na-K pump (sodium-potassium ATPase pump) actively transports sodium out of cells and potassium into cells, maintaining the essential electrochemical gradient and the difference in cation concentration between the intracellular and extracellular compartments.

Question 41

88. Which electrolyte is ideally withheld in a severely dehydrated patient with no urine output? a. Sodium b. Bicarbonate c. Potassium d. Calcium

Answer 41

c. Potassium Rationale: Potassium is typically withheld in patients who have no urine output (anuria) because the kidneys are responsible for excreting the majority of potassium from the body. If the kidneys are not producing urine, potassium can quickly accumulate to dangerous levels, leading to hyperkalemia, which can cause cardiac arrhythmias and cardiac arrest. This is especially a concern in patients with renal failure or any condition that severely compromises renal function. Sodium, bicarbonate, and calcium do not have the same immediate life-threatening implications with respect to anuria as potassium does.

Question 42

89 The concentration of sodium in Normal Saline (NS) solution is approximately a. 38 meq/L b. 50 meq/L c. 75 meq/L d. 154 meq/L

Answer 42

d. 154 meq/L Rationale: Normal Saline (0.9% sodium chloride solution) contains about 154 mEq/L of sodium, making it isotonic with respect to blood plasma.

Question 43

90. A specific sign of severe dehydration is: A. Dry mucous membrane B. Oliguria C. Reduced and mottled skin perfusion D. Thirsty

Answer 43

C. Reduced and mottled skin perfusion Rationale: Reduced and mottled skin perfusion is a specific and severe sign of dehydration indicating poor circulation and severe fluid loss. While other signs like dry mucous membranes and thirst are common in dehydration, reduced and mottled skin perfusion is a critical indicator of severe dehydration that requires immediate intervention.

Question 44

91. What electrolyte abnormality which showed an ECG finding of peaked "T" waves and the end result will be cardiac arrest in diastole if this abnormality is not reversed? a. Hypokalemia b. Hyperkalemia c. Hypocalcemia d. Hypercalcemia

Answer 44

b. Hyperkalemia Rationale: Peaked T waves are a classic ECG finding associated with hyperkalemia. Severe hyperkalemia can lead to cardiac dysrhythmias, including cardiac arrest in diastole, if not promptly treated.

Question 45

92. The most important hormone regulating calcium levels in the body is * a. 1, 25 dihydroxyvitamin D3 b. Parathyroid hormone (PTH) c. Thyrocalcitonin d. Growth hormone

Answer 45

b. Parathyroid hormone (PTH) Rationale: Parathyroid hormone (PTH) is the primary hormone responsible for the regulation of calcium levels in the blood. It increases blood calcium levels by stimulating the release of calcium from bone, increasing calcium absorption in the gut, and increasing calcium reabsorption in the kidneys.

Question 46

93. Which of the following findings indicates the serum calcium is low? a. Bone pain b. depressed DTR's c. Nausea d. (+) Chvostek sign

Answer 46

d. (+) Chvostek sign Rationale: A positive Chvostek sign (facial muscle spasm upon tapping the facial nerve) is an indicator of neuromuscular irritability due to hypocalcemia. It is a clinical sign suggestive of low serum calcium.

Question 47

94. Infants and children are more prone to develop fluid and electrolyte disturbances because they a. Are able to concentrate urine up to 500 mOsm/L b. Have greater body surface area c. Have lower metabolic rate d. Generally have poorer appetite

Answer 47

b. Have greater body surface area Rationale: Infants and children have a greater body surface area relative to their volume compared to adults. This higher surface area to volume ratio increases their fluid losses and makes them more susceptible to rapid changes in fluid and electrolyte balance.

Question 48

95 In treatment of hyperkalemia, which measure removes potassium from the body? a. Sodium bicarbonate administration (IV) b. Loop diuretic (IV or PO) c. Insulin and glucose (IV) d. IV calcium

Answer 48

b. Loop diuretic (IV or PO) Rationale: Loop diuretics are effective in treating hyperkalemia as they increase renal excretion of potassium. Insulin and glucose help shift potassium into cells but do not remove it from the body, sodium bicarbonate does the same, and IV calcium only stabilizes the cardiac membrane without removing potassium.

Question 49

96. Which of the following can cause high anion gap metabolic acidosis? * a. Diabetic ketoacidosis b. Milk alkali syndrome c. Proximal Renal tubular acidossis d. Distal Renal tubular acidosis

Answer 49

a. Diabetic ketoacidosis Rationale: Diabetic ketoacidosis (DKA) is a classic cause of high anion gap metabolic acidosis, due to the accumulation of ketones in the bloodstream. Milk-alkali syndrome, proximal, and distal renal tubular acidosis typically do not result in a high anion gap acidosis.

Question 50

97 All of the following kinds of IVF can be administered for isotonic dehydration except? a. 3% NaCl b. Plasma c. Lactated Ringers d. 0.9% NSS

Answer 50

a. 3% NaCl Rationale: 3% NaCl is a hypertonic saline solution, which would not be appropriate for treating isotonic dehydration. It is used in cases of severe hyponatremia. Plasma, Lactated Ringers, and 0.9% normal saline solution (NSS) are appropriate for treating isotonic dehydration.

Question 51

98 Which of the following is incorrect regarding Magnesium? a. Respiratory depression occurs before hyporefflexia in hypermagnesemia b. Manifestations of hypermagnesemia are rapidly reversed by intravenous calcium c. Hypomagnesemia and hypocalcemia often coexist d. Symptoms of hypomagnesemia are primarily those of increased neuromuscular irritability

Answer 51

a. Respiratory depression occurs before hyporeflexia in hypermagnesemia Rationale: In the setting of hypermagnesemia, hyporeflexia (decreased reflexes) is an early clinical sign, occurring at lower levels of magnesium excess before more serious symptoms like respiratory depression. The severity of symptoms tends to correlate with the serum magnesium level, and while hyporeflexia can be seen with modest increases, respiratory depression is typically associated with more significant hypermagnesemia. Thus, the sequence suggested in option a is incorrect. The other statements are correct: b. Intravenous calcium is used as an antagonist to magnesium and can help counteract the effects of hypermagnesemia. c. Hypomagnesemia can lead to secondary hypocalcemia because magnesium is required for the release of PTH. d. Symptoms of hypomagnesemia do indeed include increased neuromuscular irritability, such as tremors, tetany, and seizures.

Question 52

99. The combination of hypokalemia and metabolic acidosis is characteristic of A. Diarrhea B. Gastric losses C. Aldosterone excess D. Diuretics

Answer 52

A. Diarrhea Rationale: Diarrhea can lead to metabolic acidosis due to the loss of bicarbonate in the stool, which is a base. Additionally, significant potassium can be lost with chronic or severe diarrhea, leading to hypokalemia. While aldosterone excess can also cause hypokalemia, it typically leads to metabolic alkalosis rather than acidosis due to the excretion of hydrogen ions. Diuretics can lead to hypokalemia and in some cases to metabolic alkalosis or acidosis depending on the type of diuretic and the mechanism of action. Gastric losses, such as from vomiting, more commonly lead to hypokalemia and metabolic alkalosis due to the loss of gastric acid.

Question 53

100. Rapid correction of hyponatremia (>12 mEq/L/24 hr) should be avoided because of the remote risk of: * a. Central pontine myelinolysis b. Cerebral edema c. Brain herniation d. Acute tubular necrosis

Answer 53

b. Cerebral edema Rationale: Rapid correction of hyponatremia, particularly when it is corrected faster than recommended rates, can lead to cerebral edema. This occurs because a rapid increase in the extracellular osmolality can create an osmotic gradient that causes water to move into brain cells, leading to swelling and the potential for serious complications such as cerebral edema. While central pontine myelinolysis is a risk associated with the rapid correction of hyponatremia, the specifics provided in the scenario point more directly to the risks associated with cerebral edema in the context of managing hypernatremia.

Question 54

1. In pregnancy, which of the following statements is incorrect? a. Most drugs cross the placenta by passive diffusion. b. lonized drugs cross the placenta more easily than unionized drugs c. Drugs that reduce placental blood flow can reduce birth weight d. The fetal blood brain barriers not developed until the second half of pregnancy. e. The human placental possess multiple enzymes

Answer 54

b. Ionized drugs cross the placenta more easily than unionized drugs Rationale: Ionized drugs do not cross the placenta as easily as unionized drugs. Unionized and lipid-soluble drugs are more likely to cross the placenta by passive diffusion.

Question 55

2. Which of the following statements about placental drug transfer is accurate?* a. Placenta excludes drugs with low molecular weight b. Lipid soluble drugs cross the placenta readily c. lonized drugs cross the placenta easily d. Water soluble drugs cross the placenta by simple diffusion

Answer 55

b. Lipid-soluble drugs cross the placenta readily Rationale: Lipid-soluble drugs can easily cross cell membranes, including the placental barrier, due to their ability to dissolve in the lipid bilayer of cells.

Question 56

3. Which of the following drugs are believed unsafe in pregnancy? a. Aminoglycosides b. Penicillins c. Erythromycins d. Acetaminophen

Answer 56

a. Aminoglycosides Rationale: Aminoglycosides are known to be potentially ototoxic and nephrotoxic to the fetus and are usually avoided during pregnancy. Drugs that do not cross the placenta

Question 57

4. Which of the following drugs do not cross the placenta in significant amounts? a. Warfarin b. Heparin c. Corticosteroids d. Meperidine

Answer 57

b. Heparin Rationale: Heparin is a large molecule that does not cross the placenta to a significant extent, making it safer for use in pregnancy compared to other anticoagulants like warfarin.

Question 58

5. In neonates relative to adults, which of the following statements is NOT correct? a. Gastric acid is increased b. The glomerular filtration rate is reduced c. Plasma albumin is low d. The blood brain barrier is more permeable

Answer 58

a. Gastric acid is increased Rationale: Neonates have reduced gastric acid secretion compared to adults. The other options are correct; neonates do have a reduced glomerular filtration rate, lower plasma albumin, and a more permeable blood-brain barrier.

Question 59

6. The following properties of a drug encourage their presence in breast milk except: a. High lipid solubility b. Low molecular weight c. Unionized state d. Short half life e. Weak base

Answer 59

d. Short half-life Rationale: A short half-life would mean the drug is cleared more rapidly from the body, so it's less likely to be present in breast milk. The other properties listed would tend to increase a drug's concentration in breast milk.

Question 60

8. The following drugs should be avoided during breast feeding include all except: a. Carbamazepine b. Cyclophosphamide c. Ciprofloxacin d. Amiodarone

Answer 60

c. Ciprofloxacin Rationale: While caution is advised, ciprofloxacin is generally considered compatible with breastfeeding by the American Academy of Pediatrics. The other drugs listed are typically avoided due to potential risks to the breastfeeding infant.

Question 60

7. Which of the following drugs suppress lactation? a. Metronidazole b. Senna c. Salbutamol d. Bromocriptine

Answer 60

d. Bromocriptine Rationale: Bromocriptine is a dopamine agonist that inhibits prolactin secretion, which can suppress lactation.

Question 61

9 Permanent hearing loss or ototoxicity is most usually associated with administration of which drug? a. Furosemide b. Gentamicin and Furosemide c. Thiazides d. Ciprofloxacine

Answer 61

b. Gentamicin and Furosemide Rationale: Aminoglycosides like gentamicin are well known for their ototoxic potential, especially when used in high doses or for prolonged periods. Furosemide can also be ototoxic, particularly in high intravenous doses.

Question 62

10 What drug should be avoided in children under 16 years of age due to an association with Reye syndrome? a. Aspirin b. Warfarin c. Carbamazepine d. Paracetamol

Answer 62

a. Aspirin Rationale: Aspirin has been associated with Reye's syndrome, a rare but serious condition that can cause swelling in the liver and brain, most often following a viral illness when given to children and teenagers.

Question 63

11. Which of the following drugs is contraindicated for use by the breastfeeding mother? * a. Ergotamine b. Carbamazepine c. Phenytoin d. Valproic acid

Answer 63

a. Ergotamine Rationale: Ergotamine, used for treating migraines, is contraindicated during breastfeeding due to its potential to cause serious adverse effects in the breastfed infant, including vomiting, diarrhea, and convulsions.

Question 64

12. Which of the following agents that has an inhibitory effect on hepatic drug metabolism of indexed drug increasing the risk of toxicity? a. Cimetidine b. Rifampicin c. Phenobarbital d. Phenytoin

Answer 64

a. Cimetidine Rationale: Cimetidine is known to inhibit the activity of various cytochrome P450 enzymes, which can decrease the hepatic metabolism of many drugs, raising their levels and the risk of toxicity.

Question 65

13. This drug is most useful as an enzyme inducer of hepatic metabolism of drug in jaundiced infants and children. a. Cimetidine b. Phenobarbital c. Penicillin d. Rifampicin

Answer 65

b. Phenobarbital Rationale: Phenobarbital is an enzyme inducer and can stimulate the hepatic metabolism of drugs. It's used in neonatal jaundice to help reduce bilirubin levels.

Question 66

14. The bioavailability of this drug is increased in neonates compared with older children after oral administration. a. Ampicillin b. Diazepam c. Digoxin d. Phenytoin

Answer 66

c. Digoxin Rationale: The bioavailability of digoxin is higher in neonates due to their immature gastrointestinal and hepatic systems, which affects the metabolism and excretion of the drug.

Question 67

15. In patient on theophylline therapy for asthma, which of the following drugs can change its clearance and lower its levels? a. Azithromycin b. Rifampicin c. Carbamazepin d. Penicillin

Answer 67

b. Rifampicin Rationale: Rifampicin is a known potent inducer of cytochrome P450 enzymes and can enhance the metabolism of theophylline, reducing its serum concentration.

Question 68

16. The safest anticoagulant drug that can be given safely to pregnant mother because of its high molecular weight property is: a. Salicylates b. Coumadin c. Heparin d. Teclopidine

Answer 68

c. Heparin Rationale: Heparin does not cross the placenta due to its large molecular size, making it the anticoagulant of choice during pregnancy.

Question 69

17. Which of the following conditions increases drug absorption from the gastrointestinal tract of neonates and infants? * a. Delayed gastric emptying time b. Increased peristalsis c. Diarrhea d. Hyperacidity

Answer 69

b. Increased peristalsis Rationale: Increased peristalsis can enhance the absorption of drugs by moving contents through the gastrointestinal tract at a quicker rate, increasing the contact time with the absorptive surfaces. However, this could also have the opposite effect by decreasing the contact time; it often depends on the drug's characteristics and the extent of the increase in peristalsis. Conditions like delayed gastric emptying time and hyperacidity can actually decrease drug absorption, while diarrhea can both increase and decrease absorption depending on the drug and the severity of the diarrhea.

Question 70

18. Thiopental Sodium given intravenously as anesthesia to pregnant mother for CS readily cross the placenta to cause sedation and apnea of newborn infants because: a. it has low molecular weight b. it is water soluble and ionized c. it is lipid soluble d. it is highly protein bound

Answer 70

c. it is lipid soluble Rationale: Lipid solubility is a key factor in a drug's ability to cross the placental barrier. Thiopental is a barbiturate with high lipid solubility, allowing it to cross the placenta quickly and potentially affect the newborn.

Question 71

19. Drugs given to the mother readily passed the placenta and toxic to the fetus if: a. it is small molecule b. it is lipophilic c. it is nonpolar d. all of these

Answer 71

d. all of these Rationale: Small molecules, lipophilic substances, and nonpolar drugs can all readily cross the placenta due to their ability to diffuse through the lipid layers of cells, which can result in toxicity to the fetus.

Question 72

20. 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

Answer 72

a. Diazepam Rationale: Diazepam can be administered rectally and is absorbed rapidly, making it useful in the emergency treatment of status epilepticus.

Question 73

21. The major route of placental drug transfer is through this mechanism: * a. Active transport b. Facilitated diffusion c. Simple passive diffusion d. Solvent drag

Answer 73

c. Simple passive diffusion Rationale: The most common mechanism for drugs to cross the placenta is simple passive diffusion, which is driven by the concentration gradient across the placenta.

Question 74

22. Which of the following conditions in which Aminoglycosides dosage requirement can be reduced? a. asphyxiated newborn infants b. infants with pneumonia c. infants with gastroenteritis d. infants with UTI

Answer 74

a. asphyxiated newborn infants Rationale: In asphyxiated newborns, renal function may be compromised, which could increase the risk of drug accumulation and toxicity due to reduced drug clearance. Therefore, dosages of aminoglycosides, which are eliminated through the kidneys, may need to be reduced.

Question 75

23. Physical examinations of a newborn female infant reveals menngomyelocoele cleft lip and craniofacial anomalie. The most likely prenatal experience to explain these findings is a. alcohol b. lithium c. thiazide d. valproic acid

Answer 75

d. valproic acid Rationale: Exposure to valproic acid during pregnancy is associated with a higher risk of birth defects, including neural tube defects (like meningomyelocele) and craniofacial anomalies such as cleft lip.

Question 76

24. Teratogenic action of specific drugs on the fetus of pregnant mother depends on the stage of fetal development. The most crucial phase of development that increased the risk of congenital malformation is: a. Pre-embryonic phase b. Embryonic phase c. Fetal phase 2nd trimester d. Fetal phase 3rd trimester

Answer 76

b. Embryonic phase Rationale: The embryonic phase, particularly the first trimester, is the most sensitive period for teratogens because this is when organogenesis (the formation of organs) occurs. Exposure to teratogens during this time can lead to major congenital malformations.

Question 77

25 All of the following drugs requires therapeutic drug monitoring to maximize therapeutic efficacy while minimizing potential toxicity EXCEPT * a.Diazepam b. Aminoglycosides c. Chloramphenicol d. Theophylline

Answer 77

a. Diazepam Rationale: While therapeutic drug monitoring is commonly practiced for aminoglycosides, chloramphenicol, and theophylline due to their narrow therapeutic index, it is not routinely performed for diazepam, which has a wider therapeutic range.

Question 78

26. Most drugs are excreted into breast milk by this mechanism? a. Active transport b. facilitated diffusion c. Passive diffusion d. Pinocytosis

Answer 78

c. Passive diffusion Rationale: The primary mechanism by which drugs pass into breast milk is passive diffusion, which is driven by the concentration gradient of the drug between the plasma and the milk.

Question 79

27. You are evaluating a pregnant mother complaining of premature labor pain and you are concerned of this unexpected premature birth developing infantile respiratory distress syndrome. The best drug to prescribe to enhance fetal lung maturity is: * a. Indomethacin b. Corticosteroid c. Terbutaline d. Nefedipine

Answer 79

b. Corticosteroid Rationale: Corticosteroids, such as betamethasone, are administered to pregnant women at risk of preterm birth to accelerate fetal lung maturation and reduce the risk of infant respiratory distress syndrome.

Question 80

28. All of the following antiepileptic drugs (AED's) are well known to cause congenital malformations in the fetus when administered to an epileptic pregnant women EXCEPT: a. Carbamazepine b. Trimethadione c. Phenytoin d. Phenobarbital

Answer 80

b. Trimethadione Rationale: Trimethadione, a drug once used for epilepsy, is known for its high teratogenic risk. The correct answer should be a drug that is considered safer relative to the others, but all options listed have been associated with some level of teratogenic risk. Without a 'safer' alternative listed, this question may be incorrectly structured, as all the drugs provided are known to have teratogenic potential.

Question 81

29. The following drugs suppress lactation include all except: * a. Bromocriptine b. Oral contraceptive pills c. Thiazides d. Salbutamol

Answer 81

d. Salbutamol Rationale: Salbutamol (also known as albuterol) is a beta-2 agonist used primarily for the treatment of asthma and is not known to suppress lactation. Bromocriptine, oral contraceptive pills, and possibly thiazides (due to their diuretic effect) can suppress lactation.

Question 82

30. The disease condition that DOES NOT require modification of drug usage in infants and children is: * a. Edema b. Renal failure c. Septicemia d. Heart failure

Answer 82

c. Septicemia Rationale: While edema, renal failure, and heart failure often require careful consideration and possible modification of drug dosages due to altered drug pharmacokinetics and dynamics, septicemia does not inherently require a modification of drug usage due to the disease itself. However, the choice of drugs and dosages might be affected by associated conditions like organ dysfunctions that can accompany septicemia.

Question 83

31.The absorption of drugs from intramuscular routes enhances in one of the following conditions: a. Low cardiac output b. Shock c. Immobility d. Exercise

Answer 83

d. Exercise Rationale: Exercise increases blood flow to muscles, which can enhance the absorption of drugs administered via intramuscular injection.

Question 84

32. The most commonly prescribed medications in pregnant women is: a. Analgesic/antipyretic b. Antihistamines c. Antibiotics d. Prenatal vitamins

Answer 84

d. Prenatal vitamins Rationale: Prenatal vitamins are commonly prescribed during pregnancy to ensure adequate intake of necessary vitamins and minerals, which are important for the health of both the mother and the developing fetus.

Question 85

33. This drug if given concomitantly with prednisone or cyclosporine would result to graft rejection in kidney transplant pediatric patient: a. Rifampicin b. Ampicilin c. INH d. Tetracycline

Answer 85

a. Rifampicin Rationale: Rifampicin is a potent inducer of cytochrome P450 enzymes, which can enhance the metabolism of drugs like prednisone and cyclosporine, leading to lower blood levels and potential graft rejection due to inadequate immunosuppression.

Question 86

34. The major route of placental drug transfer is by: a. Active transport b. Simple passive diffusion c. Facilitated diffusion d. Pinocytosis

Answer 86

b. Simple passive diffusion Rationale: The most common mechanism by which drugs cross the placenta is simple passive diffusion, which is driven by the concentration gradient across the placenta and does not require energy.

Question 87

35. All of the following antiepileptic drugs (AED’s) are well known to cause congenital malformations in the fetus when administered to an epileptic pregnant woman EXCEPT: a. Carbamazepine b. Trimethadione c. phenytoin d. phenobarbital

Answer 87

b. Trimethadione Rationale: Trimethadione is actually highly teratogenic, so this seems like an error in the options given. The intent seems to be finding an AED that is relatively less teratogenic compared to others listed. Of the options provided, Carbamazepine is considered relatively less teratogenic compared to the others, but it still poses risks and must be used cautiously. Therefore, the question itself might need clarification as all these drugs are known to have some teratogenic risks.

Question 88

36. Sulfonamides is well known to increase CNS bilirubin and cause kernicterus by: a. its being water soluble b. its ionized state c. it displaces bilirubin at its albumin binding site d. its high molecular weight

Answer 88

c. it displaces bilirubin at its albumin binding site Rationale: Sulfonamides can displace bilirubin from albumin binding sites, leading to an increased free bilirubin in the plasma which can cross the blood-brain barrier and potentially cause kernicterus, especially in newborns.

Question 89

37 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 upturned nose, hypotonia, hypoplastic philtrum. The most likely prenatal agent that would explain these findings is: a. alcohol b. cocaine c. marijuana d. opiate

Answer 89

a. alcohol Rationale: The described features are characteristic of fetal alcohol syndrome, which includes facial abnormalities (such as a hypoplastic philtrum), growth deficiencies, and central nervous system dysfunction (e.g., hypotonia).

Question 90

38. The major route of placental drug transfer is by: A. Active transport B. Simple passive diffusion C. Facilitated diffusion D. Pinocytosis

Answer 90

B. Simple passive diffusion Rationale: Simple passive diffusion is the primary mechanism for drug transfer across the placenta, driven by concentration gradients without the need for energy.

Question 91

39. Important site of drug metabolism especially the aromatic oxidation reactions in the fetus is: a. fetal liver b. placenta c. fetal lungs d. fetal kidney

Answer 91

a. fetal liver Rationale: The fetal liver is an active site for drug metabolism, including processes such as aromatic oxidation, even though it is less active compared to postnatal liver.

Question 92

40. The target organ for the teratogenic effect of Tetracyclines: * a. ear b. teeth and bones c. kidney d. central nervous system

Answer 92

b. teeth and bones Rationale: Tetracyclines bind to calcium and are deposited in growing teeth and bones, leading to discoloration and defects in these structures.

Question 93

41. Type of adverse drug reaction when the dose of drug prescribed to the patient is excessive. a. Side effects b. Idiosyncratic reactions c. Toxic reactions d. Hypersensitivity reactions

Answer 93

c. Toxic reactions Rationale: Toxic reactions occur when the dose of a drug exceeds the therapeutic range and causes harm to the body. This is distinct from side effects, idiosyncratic reactions, and hypersensitivity reactions, which can occur at normal doses and due to other mechanisms.

Question 94

42. Advantages of cefotaxime over aminoglycoside include all of the following EXCEPT: a. greater activity in deep tissue infections b. less nephrotoxic c. No need to monitor renal function d. more frequent dosing

Answer 94

d. more frequent dosing Rationale: Cefotaxime generally does not require more frequent dosing compared to aminoglycosides; in fact, it often allows for less frequent dosing due to its extended half-life and broad spectrum of activity. Other options highlight cefotaxime's benefits, such as lower nephrotoxicity and less need for monitoring renal function compared to aminoglycosides.

Question 95

43. Important site of drug metabolism especially the aromatic oxidation reactions in the fetus is: * a. Fetal liver b. Fetal lungs c. Placenta d. Fetal kidney

Answer 95

a. Fetal liver Rationale: The fetal liver, though not as mature as the adult liver, plays a crucial role in drug metabolism, including aromatic oxidation reactions.

Question 96

44. The target organ for teratogenic effect of folic acid deficiency is * a. Spinal cord and bones b. Vestibular nerves c. kidney d. eyes

Answer 96

a. Spinal cord and bones Rationale: Folic acid deficiency during pregnancy is closely linked to neural tube defects, which primarily affect the spinal cord. Ensuring adequate folic acid intake before and during early pregnancy helps prevent these serious defects.

Question 97

45. Phase I reactions in hepatic drug metabolism include all of the following EXCEPT: a. Conjugation b. Hydroxylation c. Oxidation d. Reduction

Answer 97

a. Conjugation Rationale: Conjugation is a Phase II reaction, not Phase I. Phase I reactions, such as hydroxylation, oxidation, and reduction, typically involve modification of the drug molecule without conjugation to other substances.

Question 98

46. What adverse event that may occur during certain stages of development in premature neonates exposed to excess oxygen? a. Retrolental fibroplasia b.Hyaline membrane disease c.Periventricular leucomalacia d.None of the above

Answer 98

a. Retrolental fibroplasia Rationale: Retrolental fibroplasia, also known as retinopathy of prematurity, is a condition that can occur in premature infants exposed to high levels of oxygen. It involves abnormal growth of blood vessels in the retina and can lead to blindness.

Question 99

47. The plasma half life of gentamycin in premature infant <48 hours old is A. 4 hrs. B. 8 hrs. C. 12 hrs. D. 18 hrs.

Answer 99

c. 12 hrs. Rationale: The plasma half-life of gentamicin in premature infants, especially those less than 48 hours old, is generally longer due to their immature renal function. The half-life in this population can extend up to approximately 12 hours, compared to shorter periods in older children and adults.

Question 100

48. The following properties of a drug encourage their presence in breast milk include all except: * a. Weak base b. Unionized state c. High Lipid solubility d. Short half life e. Low molecular weight

Answer 100

d. Short half-life Rationale: Drugs with a short half-life are less likely to accumulate in the body and thus in breast milk, as they are cleared more rapidly from the mother's system.

Question 101

49. The breastfeeding infant should be monitored if the mother is prescribed by all of the following drugs except: a. Carbimazole b. Lithium c. Warfarin d. ß- blockers

Answer 101

c. Warfarin Rationale: Warfarin is generally considered safe in breastfeeding as it has a high molecular weight and binds extensively to plasma proteins, thus it does not pass into breast milk in significant amounts.

Question 102

50. Antimicrobials re commonly prescribed during pregnancy. The safest antibiotics in pregnancy is a. Penicillins b. Trimethoprim c. Cipofloxacin d.Metronidazole

Answer 102

a. Penicillins Rationale: Penicillins are generally considered safe for use during pregnancy as they have a low risk of teratogenic effects and are effective against a broad range of infections.

Question 103

51. Drugs taken by mother during pregnancy, which of the following statement is incorrect? a. Unionized drugs cross the placenta more easily than ionized drugs b. Most drugs cross the placenta by active transport c. The fetal blood brain barrier is not developed until the second half of pregnancy d. Drugs that reduce placental blood flow can reduce birth weight

Answer 103

b. Most drugs cross the placenta by active transport Rationale: Most drugs cross the placenta by passive diffusion, not active transport. Active transport is specific and typically involves substrates that the body needs to actively move against a concentration gradient.

Question 104

52. The following are confirmed teratogens in pregnant women except: a. Isotretinoin b. Warfarin c. Alcohol d. Amoxicillin

Answer 104

d. Amoxicillin Rationale: Amoxicillin is not known to be teratogenic and is commonly used during pregnancy due to its safety profile. Isotretinoin, warfarin, and alcohol are all well-documented teratogens.

Question 105

53. Incorrect statement about excretion of drugs during pregnancy: a. Renal plasma flow increases b. Glomerular filtration rate increases c. Digoxin excretion increases d. Gentamycin excretion increases

Answer 105

c. Digoxin excretion increases Rationale: During pregnancy, the excretion of drugs like digoxin does not necessarily increase. In fact, changes in renal function and blood volume can affect how drugs like digoxin are metabolized and excreted, sometimes necessitating adjustments in dosing.

Question 106

54. Which of the following drugs do not cross the placenta in significant amounts: a. Valproic acid b. Warfarin c. Heparin d. Demerol

Answer 106

c. Heparin Rationale: Heparin does not cross the placenta due to its large molecular size and strong negative charge, making it safe for use during pregnancy to manage or prevent thromboembolic disorders.

Question 107

55. The following is NOT appropriate treatment of dyspepsia in the second and trimesters of pregnancy: a. Cimetidine b. Misoprostol c. Metoclopramide d. Omeprazole

Answer 107

b. Misoprostol Rationale: Misoprostol is contraindicated during pregnancy because it can induce uterine contractions and potentially cause miscarriage or premature labor. It is used for labor induction and abortion but not for treating dyspepsia.

Question 108

56. The drug used to prevent premature birth includes all except: a. Ritodrine b.Terbutaline c. Ergometrine d. Magnesium sulfate

Answer 108

c. Ergometrine Rationale: Ergometrine is used postpartum to manage bleeding, not to prevent premature birth. It can cause strong uterine contractions, making it inappropriate for use during pregnancy as it could induce labor.

Question 109

57 A woman presents in the first trimester of pregnancy while having a mild LV dysfunction but feeling otherwise well. Which of the following drug is not contraindicated in the first trimester? a. Losartan b. Captopril c. Warfarin d. Metoprolol

Answer 109

d. Metoprolol Rationale: Metoprolol is generally considered safer during pregnancy compared to ACE inhibitors like Captopril and ARBs like Losartan, which are contraindicated due to their association with fetal renal dysfunction and other abnormalities. Warfarin is also contraindicated as it is a known teratogen.

Question 110

58 What is an example of psychological neglect to a child? a. Not giving support b. Comparing the child to another sibling c. Hurl insults to the child when he does something wrong d. Putting down the child In front of his friends

Answer 110

a. Not giving support Rationale: Psychological neglect involves the omission of emotional care or stimulation, which includes not giving support, affection, or attention, crucial for a child's emotional and psychological development.

Question 111

59. What is the social, emotional, and legal process that creates a family for children when their birth family is unable or willing to parent? * a. foster care b. childcare c. nursing care d. adoption

Answer 111

d. adoption Rationale: Adoption is the legal process that permanently gives parental rights to adoptive parents, unlike foster care which is usually temporary.

Question 112

60. The parents of an adopted child are usually anxious regarding the issue of telling the truth to their turmoil later in life adopted child. What can you assure the parents regarding such issues? a. Most adopted children and families adjust well and live productive life b. Most families with adopted children will be in c. Truancy and rebellion is common that they should be aware of it d. Most adopted children will have difficulty adjusting in school

Answer 112

a. Most adopted children and families adjust well and live productive life Rationale: Research shows that with supportive environments and honest communication, most adopted children and their families adjust well and lead fulfilling lives.

Question 113

61. What is a temporary measure to assist families in crisis that deals with children younger than 5 years old? a. adoption b. Foster care c. nursing care d. childcare

Answer 113

b. Foster care Rationale: Foster care is a temporary arrangement where children are placed with certified caregivers, often when the biological parents are unable to care for them due to various crises or challenges.

Question 114

62. A child was brought to you who suffered from physical and emotional abuse by his parents and no immediate relative to take care of him. What action will you coordinate with the social worker regarding this child? a. For adoption b. For Foster care c. For nursing care d. For childcare

Answer 114

b. For Foster care Rationale: Foster care is the appropriate temporary measure while a permanent solution such as adoption can be considered. It provides a safe and nurturing environment for the child during the interim.

Question 115

63. What kind of care will be provided by individuals outside the nuclear family or in a setting separate from the child's home? a. Adoption b. Foster care c. Nursing care d. Childcare

Answer 115

d. Childcare Rationale: Childcare typically refers to care provided by individuals outside of the nuclear family in settings separate from the child’s home, such as daycares or preschools.

Question 116

64. What 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

Answer 116

b. Young children Responses by Age Group Young Children (response to separation) * Initial reactions: Crying, tantrum-like protests or quieter, sadder demeanor * Later reactions: Subdued, withdrawn, irritable, moody, resistant to authority * Actions: Might look for parent in the neighborhood or even leave home School Children * Possible reactions: Depression, indifference, marked anger Older Children and Adolescents * Common reaction: More intense anger

Question 117

65. What age group will respond with depression, indifferent or be markedly angry to separation? * a. Infants b. Young children c. School children d. Adolescents

Answer 117

c. School children Responses by Age Group Young Children (response to separation) * Initial reactions: Crying, tantrum-like protests or quieter, sadder demeanor * Later reactions: Subdued, withdrawn, irritable, moody, resistant to authority * Actions: Might look for parent in the neighborhood or even leave home School Children * Possible reactions: Depression, indifference, marked anger Older Children and Adolescents * Common reaction: More intense anger

Question 118

66. How will children younger than 5 years old view death? * a. Reversible with belief in the dead coming back to life and in ghosts b. Personified like a grim reaper who punishes and avenges c. The destination with question who goes first d. A universal and final biologic process

Answer 118

a. Reversible with belief in the dead coming back to life and in ghosts Children and Their Views on Death (Table 1) Younger than 5 Years * Views death as reversible * Believes in the possibility of the dead returning to life and in ghosts 8-9 Years Old * Personifies death as a grim reaper who punishes and avenges Older Children * Understand death as a universal and final biological process

Question 119

67. How will children 8-9 years old view death * a. Reversible with belief in the dead coming back to life and in ghosts b. Personified like a grim reaper who punishes and avenges c. The final destination with question who goes first d. A universal and final biologic process

Answer 119

b. Personified like a grim reaper who punishes and avenges Children and Their Views on Death (Table 1) Younger than 5 Years * Views death as reversible * Believes in the possibility of the dead returning to life and in ghosts 8-9 Years Old * Personifies death as a grim reaper who punishes and avenges Older Children * Understand death as a universal and final biological process

Question 120

68. How will older children view death? a. Reversible with belief in the dead coming back to life and in ghosts b. Personified like a grim reaper who punishes and avenges c. The final destination with question who goes first d. A universal and final biologic process

Answer 120

d. A universal and final biologic process Children and Their Views on Death (Table 1) Younger than 5 Years * Views death as reversible * Believes in the possibility of the dead returning to life and in ghosts 8-9 Years Old * Personifies death as a grim reaper who punishes and avenges Older Children * Understand death as a universal and final biological process

Question 121

69. In domestic violence, how will children mostly get their injuries? * a. He does something wrong b. He s uncontrolled sibling rivalries c. He does action role play that went wrong d. When they intervened and protect their mother from her partner

Answer 121

d. When they intervened and protect their mother from her partner Rationale: As per the source of first exposure information provided, most injuries to children in domestic violence situations occur when they intervene to protect a parent, typically the mother, from her partner.

Question 122

70. A parent came in for consult regarding her child violent behavior at school, however you noted that the child watches TV a lot. What will you advice the mother regarding the risk of TV? a. TV enhances cognitive and social skills b. TV lowers the risk of suicidal behavior c. TV increases aggressive behaviors and obscures reality and fantasy d. TV can be a source of learning issues like martial arts and hunting skills

Answer 122

c. TV increases aggressive behaviors and obscures reality and fantasy Rationale: The effects of TV viewing, especially exposure to violent content, include an increase in aggressive behavior, acceptance of violence, obscuring the distinction between fantasy and reality, and possibly contributing to passivity and obesity. It is important to monitor and limit exposure to such content to mitigate these risks.

Question 123

71. You are requested to counsel a family regarding a student's violent behavior when he hit a classmate with a rock in the face. What is not true in these statements? a. violence affects children psychologically and behaviorally b. parents and children exposed to violence are resistant to counseling c. children who grow up in a violent homes are more likely to be aggressive with their peers d. the violence children experience and witness has profound impact on health and development

Answer 123

b. parents and children exposed to violence are resistant to counseling Rationale: The statement that parents and children exposed to violence are resistant to counseling is not necessarily true. Many affected by violence seek out and benefit from counseling. It can be an effective tool to address and mitigate the psychological and behavioral impacts of violence.

Question 124

72. Which IS NOT included in the following examples of Child neglect due to acts of Omission? a. Pregnant mother who didn't seek prenatal care b. Father who denies legitimacy of his child c. Pregnant mother who is a smoker d. Child abandoned by his father

Answer 124

c. Pregnant mother who is a smoker Rationale: While smoking during pregnancy is harmful and strongly discouraged due to its potential adverse effects on the fetus, it is typically not classified under legal frameworks as an act of neglect or omission in the same way that failing to seek prenatal care or abandoning a child would be. Smoking during pregnancy is a serious health risk, but it does not fit the legal definition of neglect as clearly as the other options listed.

Question 125

73. A 2 year old boy was brought due to multiple bruising and pain in the right arm, you are suspecting child abuse and reported the case to DSWD and CPU, which of the following statements is NOT true? * a. you should also look for cigarette burns b. bruising is the most common sign of abuse c. physical abuse is suspected when injury is unexplained d. spiral fracture will be seen in wrenching or pulling of extremities

Answer 125

d. spiral fracture will be seen in wrenching or pulling of extremities Rationale: Spiral fractures are typically associated with twisting injuries and are indeed suspicious for abuse; however, they are not exclusively seen in wrenching or pulling but rather more indicative of twisting forces applied to the limb. This can happen through abuse but also accidental injury, making it less definitive without further context.

Question 126

74. Which of the following statements is NOT true regarding sexual abuse? * a. the most common offender of sexual abuse is a stranger b. sexual abuse can be done by a family member or non-relatives known to the child c. It is any activity with a child before the age of legal consent that is for sexual gratification of an adult or significantly older child d. Intrafamilial sexual abuse is difficult to document and manage because the child must be protected from additional abuse

Answer 126

a. the most common offender of sexual abuse is a stranger Rationale: The most common offenders of sexual abuse are actually people known to the child, such as family members or acquaintances, not strangers. This fact makes cases of sexual abuse particularly complex and distressing.

Question 127

75. In the ideal observer theory, what is defined as the characteristic of a morally acceptable decision that has included all the readily available and relevant facts? a. Dispassion b. Disinterest c. Omniscience d. Omnipercipience

Answer 127

c. Omniscience Rationale: In philosophical terms, omniscience within the context of the ideal observer theory refers to having complete knowledge—knowing everything that is important to a decision. This includes all relevant facts needed to make a morally sound judgment.

Question 128

76. A child was brought in the ER due to seizure after being slapped by the drunk stepfather, what kind of maltreatment does this child experienced? * a. Physical abuse b. Psychological abuse c. Physical neglect d. Psychological neglect

Answer 128

a. Physical abuse Rationale: Being slapped hard enough by a caretaker to cause a seizure is a clear case of physical abuse. The immediate physical harm categorizes it as such.

Question 129

77. A boy was observed to be silent, shy and always stoops down. You learned that he was insulted by his stepmother. What kind of maltreatment does this child experienced? * a. Physical abuse b. Psychological abuse c. Physical neglect d.Psychological neglect

Answer 129

b. Psychological abuse Rationale: Insulting and demeaning a child, particularly on a regular basis, constitutes psychological abuse. This form of maltreatment affects the child's emotional and mental well-being and can manifest in behavioral changes such as becoming withdrawn or showing signs of low self-esteem.

Question 130

78. A child was intubated due to severe pneumonia, on history, the patient has been febrile coughing for almost 2 weeks and the parents only gave Lagundi decoction and refused to bring the child to the health center. What kind of maltreatment does this child experienced? * a. Physical abuse b. Psychological abuse c. Physical neglect d. Psychological neglect

Answer 130

c. Physical neglect Rationale: Physical neglect occurs when a caregiver fails to provide basic needs such as medical care. In this case, the parents’ refusal to seek appropriate medical care for a severe condition like pneumonia, relying instead on home remedies, constitutes neglect.

Question 131

79.A boy felt humiliated when he was teased by his classmate because his father did not recognize him by not giving him his family name. What kind of maltreatment does this child experienced? a. physical abuse b. psychological abuse c. physical neglect d. psychological neglect

Answer 131

b. Psychological abuse Rationale: This scenario reflects psychological abuse, where the child suffers emotional pain due to the actions or neglect of a parent, in this case, not being recognized by his father which led to humiliation and emotional distress.

Question 132

80. Children adopted from overseas usually suffer from: a. Poverty b. Obesity c. Social hardship d. Both A & C are correct

Answer 132

d. Both A & C are correct Rationale: Children adopted from overseas often face issues stemming from poverty (the conditions they may have lived in before adoption) and social hardship (adjusting to a new family and cultural environment).

Question 133

81. Young children react to separation by: a. Crying b. Intense anger c. Indifference d. Apathy

Answer 133

a. Crying Rationale: Young children often react to separation with crying, exhibiting a tantrum-like or sad response to the stress of being apart from their caregivers.

Question 134

82. Children who grow up in violent homes are more likely to show : a. Truancy b. Aggression towards peers c. Depressive behavior d. Obsessive compulsive behavior

Answer 134

b. Aggression towards peers Rationale: Children exposed to violence at home often emulate that behavior, showing aggression towards peers as they replicate the behaviors they observe in their domestic environment.

Question 135

83. The patient's ability to understand the possible consequences of his/her decisions and the available alternatives: * a. Autonomy b. Competence c. Paternalism d. Beneficence

Answer 135

b. Competence Rationale: Competence refers to the ability of a person to understand the potential consequences of decisions and to make informed choices about medical treatments or other significant decisions.

Question 136

84. The hallmark of ethical reasoning, meaning that similar cases are decided similarly: a. Omniscience b. Dispassion c. Consistency d. Omnipotence

Answer 136

c. Consistency Rationale: Consistency is crucial in ethical reasoning, ensuring that similar cases are treated in a similar manner, thus upholding the principle of fairness and justice in decision-making.

Question 137

85 The central principle in medical practice that allows a patient to make their own health decisions based on their values is: a. Competence b. Autonomy c. Beneficience d. Truth-telling

Answer 137

b. Autonomy Rationale: Autonomy is the ethical principle that emphasizes the patient's right to make decisions about their own health care based on their values, beliefs, and preferences.

Question 138

86. A patient who is terminally ill is alive because he is connected to a respirator. When you turn off the respirator you are: A. Allowing the patient to die B. Practicing active euthanasia C. Implementing passive euthanasia D. Exercising ethical/moral judgment

Answer 138

c. Implementing passive euthanasia Rationale: Turning off a respirator, which allows the patient to die naturally from their underlying condition, is considered passive euthanasia. This differs from active euthanasia, which involves taking specific steps to cause the patient's death.

Question 139

87. The role of the pediatrician in cases of adoption is to: a. Provide positive adjustments of the child and family b. Decide what gender to adopt c. Provide legal background d. Suggest which institution gives adoption

Answer 139

a. Provide positive adjustments of the child and family Rationale: The pediatrician’s role in adoption is to help ensure the health and well-being of the child and to facilitate positive adjustments within the adoptive family. This includes addressing medical, psychological, and developmental issues.

Question 140

88. The most important ethical dilemma that doctors face is: * a. Withholding and withdrawing life support b. Consenting patients for therapeutic research c. Practicing euthanasia d. Subjecting patients to clinical trials

Answer 140

a. Withholding and withdrawing life support Rationale: Decisions about withholding and withdrawing life support are among the most challenging ethical dilemmas faced by physicians because they directly involve judgments about the end of life and the quality of life.

Question 141

89. In response to separation and divorce of parents, older children and adolescent commonly show: a. Regressive behaviour b. Disturbance in appetite c. Resistance to authority d. More intense anger

Answer 141

d. More intense anger Rationale: Older children and adolescents often express more intense anger, frustration, and resistance to authority in response to their parents' separation or divorce, reflecting their higher cognitive and emotional processing capabilities.

Question 142

90. The physical abuse of children affects children of all ages. Serious injuries, such as head or abdominal trauma, are more likely to be inflicted by: a. mothers b. fathers c. old brothers d. grand mothers e. caregivers

Answer 142

b. fathers Rationale: According to the statistics you provided, both mothers and fathers are equally likely to be perpetrators of maltreatment (each at 21%). However, in cases involving severe injuries like head or abdominal trauma, it is often found that males (fathers or stepfathers) are more frequently associated with these more severe forms of physical abuse due to physical strength and the nature of the violence inflicted. This choice is made given the context of severe injury and the typical patterns observed in abuse dynamics, despite the equal percentage of overall maltreatment by mothers and fathers.

Question 143

91. Burns are commonly seen in child abuse. Approximately 10% of children hospitalized with burns are victims of abuse. Of the following, inflicted burn can be MOST commonly the result of a. contact with hot iron b. cigarette application c. contact with matchsticks d. scalding injuries

Answer 143

b. cigarette application

Question 144

92. Fractures are common presentation of physical abuse and those that should raise suspicion for abuse include fractures that are unexplained, occurring in young, non-ambulatory children, or involve multiple bones. The site of the fracture that is LESS specific for abuse is : * a. rib b. scapula c. skull d. radius e. vertebra

Answer 144

d. radius Rationale: Rib, scapula, skull, and vertebral fractures are highly suspicious for abuse due to the significant force required to cause these injuries in locations that are usually well-protected. Radius fractures, while they can occur from abuse, are also common in accidental injuries (such as falls), making them less specific for abuse compared to the other listed sites.

Question 145

93. You are meeting a couple who are going to adopt a 1-year-old girl; they are asking you about medical investigations that are needed for the child before adoption. The LEAST likely required investigation for the adoption of this girl is: a. neonatal screening tests b. immunization history c. screening tests for sexually transmitted diseases d. cognitive tests e. complete blood count

Answer 145

c. screening tests for sexually transmitted diseases Rationale: For a 1-year-old girl, screening for sexually transmitted diseases is generally not indicated unless there is a specific reason or history suggesting risk. Neonatal screening tests, immunization history, cognitive tests, and a complete blood count are more relevant to assessing the general health and developmental status of the child.

Question 146

94. The father of a 7-year-old child died in a car accident. The mother has been noted many reactions in her child after the father death. The child's reaction that would need immediate evaluation is: a. yearning to be with the dead father b. desire to commit suicide c. poor academic performance d. lack of enjoyment with activities

Answer 146

b. desire to commit suicide Rationale: Any expression of suicidal thoughts or behaviors in children, particularly following a traumatic event such as the loss of a parent, requires immediate evaluation and intervention. This is a critical sign of severe psychological distress.

Question 147

95.The child's reaction to the divorce is influenced by the child's age and developmental level. Of the following, the most likely feeling that school aged children may have when their parents are divorced is A. Fear of abandonment B. Fear of rejection C. Depression D. Irritability and listlessness

Answer 147

C. Depression

Question 148

96. Although understanding risk factors for violence is crucial for developing prevention strategies, the risk factors do not predict whether a particular individual will become violent. For children who begin their violence early in life, the strongest risk factor for violence is a. male gender b. early substance abuse c. poverty d. antisocial behavior e. hyperactivity

Answer 148

d. antisocial behavior Rationale: Antisocial behavior is a strong predictor of future violence among children who exhibit violent tendencies early in life. This behavior includes aggression towards people and animals, deceitfulness or theft, and serious violations of rules.

Question 149

97. Ethical issues that arise during critical illness include all except: a. Balancing benefits, burden and harms of therapy in the face of uncertainty b. Maintaining a helpful degree of transparency and communication about medical standard of care c. Defining the limits of therapy based on assessment of medical futility d. Deciding to forego or withdraw life sustaining medical treatments

Answer 149

b. Maintaining a helpful degree of transparency and communication about medical standard of care Rationale: While transparency and communication are crucial in all medical care, they are not typically categorized as ethical "issues" but rather as components of ethical practice. The options listed other than (b) directly refer to the ethical challenges or dilemmas in managing critical illness.

Question 150

98. The doctrine of double effect in Ethics in Pediatric care is commonly regarded as the combined effect of: a. Beneficence and Autonomy b. Autonomy and justice c. Non-malpractice and Autonomy d. Beneficence and non-malpractice

Answer 150

d. Beneficence and non-malpractice Rationale: The doctrine of double effect refers to the ethical principle allowing certain actions that have both good and bad effects. This doctrine is generally used to justify the administering of treatment intended for beneficence (doing good) that may have harmful side effects, underlining the importance of non-malpractice by ensuring the benefits outweigh the risks.

Question 151

99. Which of the following is a clear risk factor for child abuse or neglect? a. An "over concerned" grandmother b. Low socioeconomic status c. Children whose development is more advanced d. Maternal depression

Answer 151

d. Maternal depression Rationale: Maternal depression is a well-documented risk factor for child abuse and neglect. Depressed mothers may have diminished emotional, cognitive, and physical resources to care for their children, which can increase the risk of neglectful or abusive behaviors.

Question 152

100. Which of the following is a clear protective factor against child abuse or neglect? a. Good support for the mother or primary caregiver b. A comprehensive child abuse treatment center c. A child who is not in a child care setting d. Multiple agency involvement with the family

Answer 152

a. Good support for the mother or primary caregiver Rationale: Strong support networks for parents, particularly for the primary caregiver, significantly reduce the stress associated with parenting and can provide the necessary resources and emotional support to prevent situations that might lead to abuse or neglect.