Meta Pedia Flashcards
1
Q
At the pediatrics OPD, you were assigned a 14 day old baby boy who was brought by her mom for his first birthday check-up.
A neonatal history is the proper format to follow in this case. The history starts from the general data, chief complaint, and should be followed by:
a. History of Present illness
b. Birth & Maternal history
c. Past Medical history
d. Perinatal
A
B. Birth & Maternal History
2
Q
At the pediatrics OPD, you were assigned a 14 day old baby boy who was brought by her mom for his first birthday check-up.
The pertinent symptoms that should be elicited from the mother at the time of consult to assess general well being of the newborn does not include:
a. good suck and activity
b. 6-8 bowel movements & micturation
c. cyanosis
d. weight gain
A
d.weight gain
3
Q
During the PE, the newborn was crying. What should be the age appropriate distraction technique that you should do to calm the patient:
a. use of rattle
b. sucking
c. offering of stuff toy
d. hugging
A
b.sucking
4
Q
You asked the mother to breastfeed her baby to observe if her breastfeeding techniques are correct. 1 of the ff is not recommended as a criterion.
a. baby’s head and entire body are supported
b. position of the baby is face to face, chest to chest, tummy to tummy with the mother
c. chin is away from the breast and lower lip is turned inward
d. baby grasps the entire nipple plus 1 inch of the surrounding areola.
A
c. chin is away from the breast and lower lip is turned inward
5
Q
Further advise the mother to continue breastfeeding due to its advantage which does not include 1 of the ff.
a. promotes emotional bonding between mother and baby
b. protects mother’s health against cancer (breast, uterine, ovary)
c. promotes early return to prepregnancy
d. low financial savings for the family
A
d. low financial savings for the family
6
Q
You should reiterate to the mother the benefits of breastmilk which include
a. adequate nutrients
b. safe, sterile, always available
c. easily digested and absorbed
d. AOTA
A
d. AOTA
7
Q
The anticipatory guidance that should be given to the mother include: A. health B. Nutrition C. development/behavior D. AOTA
A
D. AOTA
8
Q
Injury prevention and safety that should be advised to the mother:
A. smoke avoidance
B. right temperature of water during bathing
C. choking prevention
D. AOTA
A
D. AOTA
9
Q
At birth the baby was given Hep B. the regular vaccines that you can give ate the time of consult is:
a. Hep B 2nd dose
b. BCG
c. DPT 1st dose
d. H. influenza B
A
b. BCG
10
Q
Advice the mother to follow up 4 weeks after for growth monitoring as well as administering of the ff vaccine: a.Hep B 2nd dose, DPT first dose, OPV first dose
b. BCG
c. H. influenza type B
d. Measles
A
a.Hep B 2nd dose, DPT first dose, OPV first dose
11
Q
The intramuscular route is followed for the admission of: a. Hep B, BCG, measles
b. Hep B, H infuenza, BCG
c. Hep B, DPT, Infuenza type B
d. Hep B, DPT, BCG
A
c.Hep B, DPT, Infuenza type B
12
Q
Which of the following vaccine is NOT part of the Expanded Program of Immunization?
a. BCG
b. Polio
c. Varicella
d. Pertussis
A
c. Varicella
13
Q
Guarding principle of complimentary feeding based on:
A
Global Strategy for Infant and Young Child feeding
14
Q
Unfortunately, complementary foods that are predominant plant based have insufficient amounts of:
A
Vit B12
15
Q
Not considered a reason why complementary foods are started at 6mos of age
A
Decrease in breastmilk production
16
Q
Child with illness will require more food during:
a. illness
b. recovery
c. illness and recovery
d. depending on the nutritional status of child prior to illness
A
c. illness and recovery
17
Q
Which of the ff warrant further developmental assessment:
a. 3 month old who can’t roll over
b. 6 month old who can’t sit with support
c. 4 month old who can’t babble
d. 12 month old who can’t say “dada”
A
d. 12 month old who can’t say “dada”
18
Q
When (what age) is the best time to give a tricycle as a gift to a child?
a. 18 months
b. 24 months
c. 36 months
d. 48 months
A
c. 36 months
19
Q
Which milestone is not significantly observed at 9 months A. pincer grasp B. object permanence C. parallel play D. creeps
A
C. parallel play
20
Q
A developmentally normal child is able to run, build tower of 6 cubes, helps undress, 2-3word sentences A. 15 months B. 18 C. 24 D. 30
A
D. 30
21
Q
10 month old baby with 3 day history of fever cough vomiting and decreased feeding. PE shows PR 115 RR 56 Temp 38.8 subcostal retractions crackles. What is the most appropriate regiment?
A. prescribe amox and send him home
B. admit and start on ampicillin IV
C. nebulizer with budosenide at the ER and observe for next 4 hours
D. admit, request CBC and U/CS and start on ceftriaxone
A
B. admit and start on ampicillin IV
22
Q
Case of a 8 year old boy with 4 day history of bloody diarrhea and fever. Pt had decreased sensorium 1 day PTC. Pt had sunken eye balls, drinks eagerly and is irritable and restless.
What is the classification of dehydration based on WHO guidelines? None Mild dehydration Some dehydration Severe dehydration
A
Some dehydration
23
Q
Case of a 8 year old boy with 4 day history of bloody diarrhea and fever. Pt had decreased sensorium 1 day PTC. Pt had sunken eye balls, drinks eagerly and is irritable and restless.
What should be the initial management done on this patient? Oxygen administration Fluid resuscitation Give inotropes Give antibiotics
A
Fluid resuscitation
24
Q
Case of a 8 year old boy with 4 day history of bloody diarrhea and fever. Pt had decreased sensorium 1 day PTC. Pt had sunken eye balls, drinks eagerly and is irritable and restless.
What is the most probable diagnosis based on history and physical examination alone?
Cholera
Amoebiasis
Shigellosis
Salmonellosis
A
Shigellosis
25
If spirometry and PE flow are not available, what do you use?
a. corticosteroids
b. SABA
c. LABA
d. cont + LABA
b.SABA
26
Which of the ff descriptions of cough is a suggestion of asthma?
a. cough accompanied by somthing change b.cough in the morning with expectoration of significant volume of phlegm
c. cough while resting after exercise / play in an otherwise asymptomatic child
d. cough associated with feeding / swallowing
c.cough while resting after exercise / play in an otherwise asymptomatic child
27
Which of the ff doesn't define cerebral palsy:
a. caused by broad group of development, genetic, infectious, systemic, and other etiologies
b. often associated with epilepsy, abnormalities of speech, vision and intellect
c. has selection vulnerability of brain's motor system
d. considered a static encephalopathy
d. considered a static encephalopathy
28
In a case of bacterial meningitis that happened 4 hours PTA:
What is your initial management?
Diazepam
29
In a case of bacterial meningitis that happened 4 hours PTA:
What is the drug of choice?
Ampicillin IV
30
False regarding primary prevention
a. risk factors for health problems are reduced or eliminated
b. diagnosis is stopped before it starts
c. primary prevention includes vaccination and counselling
d. rehabilitation is a form of primary prevention
d. rehabilitation is a form of primary prevention
31
False regarding injury prevention in infants
a. infants may be placed in a forward facing car seat
b. infant walker use should be discouraged
c. choking hazards should be removed
d. caregivers should be taught CPR
a. infants may be placed in a forward facing car seat
32
```
What should not be done in the management of the patient: (patient is having a diarrhea)
a . give oral rehydration solution
b. give zinc supplement
c. continue breastfeeding
d. give diuretics
```
d. give diuretics
33
A 6 year old child arrived at the ER and presented with diarrhea for 2 days. She weighs 20 kg. She was hypotensive and her extremities are cold and clammy. How much fluid is needed for rapid replacement therapy? a. 400 mL
b. 600 mL
c. 800 mL
d. 1200 mL
d. 1200 mL
34
A 2 month old child was brought to the ER for watery stools for 3 days. She was eager to drink and irritable. How much ORS should be give? (weight = 8 kg)
a. 500 mL
b. 600 mL
c. 900 mL
d. 1000 mL
b. 600 mL
35
A 4 year old boy presented with recurrent respiratory tract infections for the past 6 months. On PE, you noted failure to thrive, emaciated look, tissue and muscle wasting . Your most likely impression is:
Marasmus
36
```
A 3 year old girl presented with recurrent respiratory tract infections for the past 6 months. On PE, you noted failure to thrive, flabby subcutaneous tissue, hepatomegaly, generalized eczematous rashes, and edema of the feet and legs. Your most likely impression is:
A. nephrotic syndrome
B. vitamin B deficiency
C. marasmus
D. kwashiorkor
```
D. kwashiorkor
37
Which mineral, when given as a supplement for the severely malnourished child, enhances catch-up growth? A. Calcium
B. Iron
C. Zinc
D. Selenium
C. Zinc
38
```
A 5-year-old male consulted at the OPD with a 30-hour history of high-grade fever with decreased appetite and occasional cough. There were no associated symptoms. PE was unremarkable except for a temperature of 38.8. Impression?
A. Occult bacteremia
B. Systemic viral infection
C. Fever of unknown origin
D. Acute bronchitis
```
B. Systemic viral infection
39
What would be the most appropriate advise to the patient's parent?
A. Blood culture, come back with results
B. Mucolytic, come back after 2 days
C. Antipyretic, advise to watch out for persistence of fever and appearance of other symptoms, come back for reassessment after 2 days
D. Amoxicillin, to cover for probable bacterial infection causing moderate-grade fever and send them home
C. Antipyretic, advise to watch out for persistence of fever and appearance of other symptoms, come back for reassessment after 2 days
40
What is the major mechanism that would explain the accumulation of nitrogenous waste products in patient with chronic renal failure?
Impaired bicarbonate reabsorption
Decrease in glomerular filtration rate
Tubular damage
Impaired renal production of 1,25 dihydroxycholecalciferol
Decrease in glomerular filtration rate
41
```
Children who are diagnosed to have chronic renal failure present with pallor and sallow appearance which can be attributed to:
Inadequate caloric intake
Decreased net acid secretion
Decrease erythropoietin production
Excessive rennin production
```
Decrease erythropoietin production
42
What is the cornerstone of therapy for patients with chronic renal failure who exhibit renal osteodystrophy?
Protein intake should be 2.5 g/kg/day
Supplement diet with medium chain triglycerides.
Vitamin D administration.
Use phosphate binders such as calcium carbonate
Use phosphate binders such as calcium carbonate
43
```
Which of the following vaccines are advised to be administered before renal transplantation of a patient with chronic renal failure?
H. influenza B vaccine
Menigococcal vaccine
Hepatitis A vaccine
Varicella Vaccine
```
Varicella Vaccine
44
At the Pediatric OPD, you were assigned an anxious 3 year old boy who was brought in by her mother for a well child check-up.
```
Your approach to assessing this 3 year old patient includes use of the following distraction techniques:
Singing a favourite song
Asking him to describe his favourite toy
Reading a storybook
All of the above
```
All of the above
45
At the Pediatric OPD, you were assigned an anxious 3 year old boy who was brought in by her mother for a well child check-up.
Developmental physiology expected at his age includes:
Ability to distinguish fantasy from reality
Misconceptions about illness, injury and body functions
Good sense of time & place
Physical disability is a common fear
Misconceptions about illness, injury and body functions
46
At the Pediatric OPD, you were assigned an anxious 3 year old boy who was brought in by her mother for a well child check-up.
To lessen his anxiety, one of the following techniques should not be employed
Maintain him on his mother’s lap during assessment
Allow him to handle equipment
Ignore his feelings and proceed with history & PE
Use simple terms to explain procedures
Ignore his feelings and proceed with history & PE
47
At the Pediatric OPD, you were assigned an anxious 3 year old boy who was brought in by her mother for a well child check-up.
Expected developmental milestones for this patient include:
Kicks ball forcibly, throws ball overhand
Asks what, where, who questions
Names one to two colors
AOTA
AOTA
48
At the Pediatric OPD, you were assigned an anxious 3 year old boy who was brought in by her mother for a well child check-up.
```
Developmental “Red Flags” that should be observed in this 3 year old boy include:
Does not play with other children
Cannot count sequentially
Does not know birthday
Can stand on one leg
```
Does not play with other children
49
At the Pediatric OPD, you were assigned an anxious 3 year old boy who was brought in by her mother for a well child check-up.
```
Review of immunization of this patient reveals that he only received BCG, 3 doses of DPT and polio, and 2 doses of Hep B vaccine before he reached 1 year old at the local health center. What are the required EPI vaccines that you can administer to the patient at the time of consult?
DPT, polio, hep B, measles
DPT, polio, measles
Hep B, measles
Measles only
```
Hep B, measles
50
At the Pediatric OPD, you were assigned an anxious 3 year old boy who was brought in by her mother for a well child check-up.
Theoretically, other special vaccines that can be given at his age include:
Varicella, MMR, pneumococcal vaccine, hep A, H. Influenza type B, typhoid
Varicella, MMR, pneumococcal vaccine, hep A, H. Influenza type B, typhoid, rotavirus
Varicella, MMR, pneumococcal vaccine, hep A, H. Influenza type B, typhoid, rabies, AH1N1 vaccine
Varicella, MMR, pneumococcal vaccine, hep A, H. Influenza type B, typhoid, rabies, yellow fever
Varicella, MMR, pneumococcal vaccine, hep A, H. Influenza type B, typhoid
51
Problems with feeding was noted and can be addressed by counselling the mother on the following helpful techniques, except:
Practice forced feeding
Vary type, appearance and texture of food
Engage the child on preparing his own food
Give 3 meals and 2 snacks
Practice forced feeding
52
Advice on injury prevention for this age group should include:
May leave child unsupervised
Childproof house by keeping matches, knives, medicines out of reach
Teach proper way of crossing streets
Teach emergency numbers
Childproof house by keeping matches, knives, medicines out of reach
53
```
Temper tantrums from the child was elicited which the mother said occurs when the patient is not able to get what he wants. The best advice to give the mother during these episodes is to:
Give whatever the boy wants
Scold the child
Ignore the act
Reason with the child
```
Ignore the act
54
Which statement is false regarding health supervision visits?
Inquiring about child’s developmental milestones is optional
Complete physical exam is performed
Appropriate screening tests are ordered
A child’s current and chronic problems are discussed
Inquiring about child’s developmental milestones is optional
55
Which statement is false regarding anticipatory guidance?
Child’s immunization status is reviewed
Family relations and problems need not be discussed
Child’s nutrition is an area of concern
Safety issue is part of anticipatory guidance
Family relations and problems need not be discussed
56
Which statement is true regarding injury prevention for adolescents?
Guns may be kept in unlocked cabinets since teens are old enough to exercise caution.
Seat belts need not be used if the adolescent will drive carefully.
Cellphones may be used when driving.
A helmet should be worn when riding a bicycle at all times.
A helmet should be worn when riding a bicycle at all times.
57
Which statement is false regarding injuries?
Injury can be defined as physical damage that results when a human body is suddenly or briefly subjected to intolerable levels of energy.
Unintentional injuries are accidents.
The vast majority of injury-causing events are predictable.
Injury places economic burden on the survivor and his family.
The vast majority of injury-causing events are predictable.
58
```
This is the most common skin disorder in infancy:
Atopic dermatitis
Contact dermatitis
Diaper dermatitis
Seborrheic dermatitis
```
Diaper dermatitis
59
```
The following are symptoms associated with teething, except:
Diarrhea
Gingival swelling
Increased salivation
Irritability
```
Diarrhea
60
```
A method of extinction that aims to effect reduction or elimination of undesired behavior is:
Punishment
Reinforcement
Rewards
Time-out
```
Time-out
61
```
A sleeping child who appears agitated and frightened but not easily aroused and not able to recall it the next morning is said to experience:
Nightmares
Night terrors
Night phobias
Night panic attacks
```
Night terrors
62
Clinical manifestation of congenital hypothyroidism during the early weeks to the 2nd month of life does not include:
Slightly increased head circumference
Prolongation of physiologic jaundice
Constipation that responds to treatment
Feeding difficulties such as sluggishness & choking spells
Constipation that responds to treatment
63
```
Respiratory difficulties of infants with congenital hypothyroidism before 3 months of age do not include:
Apneic episodes
Noisy respirations
Nasal obstruction
Tachypnea
```
Tachypnea
64
```
The most common associated congenital anomaly of infants with congenital hypothyroidism is:
Cardiac
Nervous system
Eyes
Gastrointestinal
```
Cardiac
65
```
If congenital hypothyroidism goes undetected and untreated by 3-6 months of age, the following manifestations will develop:
Microcephaly
Myxedema
Hypotelorism
Normal dentition
```
Myxedema
66
```
Development of infants with congenital hypothyroidism is retarded and manifested as:
Late in learning to sit and stand
Delay in expressive language
Hyperactivity
Inconsolable crying
```
Late in learning to sit and stand
67
```
Laboratory findings in congenital hypothyroidism include:
Low free T4
Normal T3
Elevated TSH
AOTA
```
AOTA
68
You were assigned at the Pediatric OPD a 3 year old boy who you observed to have repetitive hand flapping, poor eye contact and delayed language development. On history, mother noted absence of make believe play, emotional reciprocity, lack of interactive play with other children and severe tantrums.
```
The most likely diagnosis of this patient is:
Rett syndrome
Autism
Childhood Disintegrative Disorder
Pervasive Developmental Disorder
```
Autism
69
You were assigned at the Pediatric OPD a 3 year old boy who you observed to have repetitive hand flapping, poor eye contact and delayed language development. On history, mother noted absence of make believe play, emotional reciprocity, lack of interactive play with other children and severe tantrums.
Key features of the case include:
Qualitative impairment in social interaction
Qualitative impairment in communication
Stereotypic, repetitive patterns of behaviour
AOTA
AOTA
70
You were assigned at the Pediatric OPD a 3 year old boy who you observed to have repetitive hand flapping, poor eye contact and delayed language development. On history, mother noted absence of make believe play, emotional reciprocity, lack of interactive play with other children and severe tantrums.
```
Management of this patient would focus on:
Intensive behavioural therapy
Pharmacotherapy
Psychotherapy
Speech therapy
```
Intensive behavioural therapy
71
You were assigned at the Pediatric OPD a 3 year old boy who you observed to have repetitive hand flapping, poor eye contact and delayed language development. On history, mother noted absence of make believe play, emotional reciprocity, lack of interactive play with other children and severe tantrums.
```
A better prognosis for these patients is associated with:
Higher intelligence
Functional speech
Less bizarre behaviour
AOTA
```
AOTA
72
Melchor is a 6 year old boy who has a history of recurrent cough with occasional wheeze since 3 years old. Associated symptoms include breathlessness and chest tightness. Precipitating factors include exposure to dust, sudden changes in weather, strenuous exercise/play. Diurnal pattern of coughing was observed. The mother had similar symptoms when she was still in grade school.
```
The most likely diagnosis is:
Bronchial asthma
PTB
Pneumonia
Bronchiolitis
```
Bronchial asthma
73
Melchor is a 6 year old boy who has a history of recurrent cough with occasional wheeze since 3 years old. Associated symptoms include breathlessness and chest tightness. Precipitating factors include exposure to dust, sudden changes in weather, strenuous exercise/play. Diurnal pattern of coughing was observed. The mother had similar symptoms when she was still in grade school.
```
One of the following is the diagnostic exam that can least confirm the above diagnosis:
Spirometry
Peak flow by portable peak flow meter
Airway challenge tests
Chest x-ray
```
Chest x-ray
74
Melchor is a 6 year old boy who has a history of recurrent cough with occasional wheeze since 3 years old. Associated symptoms include breathlessness and chest tightness. Precipitating factors include exposure to dust, sudden changes in weather, strenuous exercise/play. Diurnal pattern of coughing was observed. The mother had similar symptoms when she was still in grade school.
```
The most common trigger for the above case:
Viral infection
Pollen
House dust mite
Food
```
House dust mite
75
Melchor is a 6 year old boy who has a history of recurrent cough with occasional wheeze since 3 years old. Associated symptoms include breathlessness and chest tightness. Precipitating factors include exposure to dust, sudden changes in weather, strenuous exercise/play. Diurnal pattern of coughing was observed. The mother had similar symptoms when she was still in grade school.
What should be the initial emergency management that should be given to the patient?
Nebulisation with B2 agonist
Administration of epinephrine intramuscularly
Starting of antibiotics
Request for a chest x-ray
Nebulisation with B2 agonist
76
Melchor is a 6 year old boy who has a history of recurrent cough with occasional wheeze since 3 years old. Associated symptoms include breathlessness and chest tightness. Precipitating factors include exposure to dust, sudden changes in weather, strenuous exercise/play. Diurnal pattern of coughing was observed. The mother had similar symptoms when she was still in grade school.
Which of the following description of the cough clinched your above diagnosis?
Cough accompanied by voice changes
Coughing at noon time
Cough associated with feeding or swallowing
Coughing after exercise or play in an otherwise asymptomatic child
Coughing after exercise or play in an otherwise asymptomatic child
77
Simple partial seizures is characterized by:
Asynchronous tonic, clonic movements of the trunk and extremities
Conscious, verbalizing patient
Automatism
Post-ictal phenomenon follows
Conscious, verbalizing patient
78
```
Complex partial seizures is characterized by:
Presence of aura in 1/3 of cases
Impaired consciousness
Automatism
AOTA
```
AOTA
79
Automatism in older children may consist of:
Semi-purposeful, uncoordinated gestural movements
Lip smacking
Excessive salivation
Chewing
Semi-purposeful, uncoordinated gestural movements
80
```
This type of generalized seizure is characterized by a sudden cessation of motor activity or speech with a blank facial expression and flickering of the eyelids, not associated with aura nor post-ictal state:
Complex partial
Simple partial
Absence seizure
Myoclonic epilepsy of childhood
```
Absence seizure
81
```
This type of generalized seizure is characterized by repetitive seizures consisting of brief, often symmetric muscular contractions with loss of body tone and falling or slumping forward:
Generalized tonic-clonic
Myoclonic epilepsies of childhood
Absence
Complex partial
```
Myoclonic epilepsies of childhood
82
```
Which of the following supplies the greatest percentage of blood to the liver?
Common hepatic artery
Superior mesenteric artery
Main hepatic vein
Portal vein
```
Portal vein
83
```
Which of the following blood chemistry results reflect the chronicity of the liver damage?
Albumin
Alkaline phosphatise
ALT
Bilirubin
```
Albumin
84
```
Which of the following is a post-sinusoidal cause of portal hypertension?
Biliary cirrhosis
Budd-Chiari syndrome
Portal vein thrombosis
Schistosomiasis
```
Budd-Chiari syndrome
85
Which of the following is the correct rationale for the pharmacologic treatment of portal hypertension?
Furosemide is given to induce arteriolar vasodilatation.
Metoclopromide is given to decrease lower esophageal sphincter tone.
Propanolol is given to decrease cardiac output.
Nitroglycerin is given to cause venous vasoconstriction.
Propanolol is given to decrease cardiac output.
86
```
Treatment of hepatic encephalopathy includes which of the following?
Gentamicin
Lactulose
Nadolol
Somatostatin
```
Lactulose
87
```
The following sign remain useful in the assessment of the severely malnourished child
Irritability
Poor skin turgor
Thirst
Sunken eyes
```
Thirst
88
```
The difference between the newly formulated oral rehydration salts (ORS) and the old ORS is in the content of glucose and ___
Sodium chloride
Citrate
Potassium
Bicarbonate
```
Sodium chloride
89
```
Not recommended for the prevention and treatment of diarrheal disease in children
Zinc supplementation
Breastfeeding
ORS
Limitation of feeding
```
Limitation of feeding
90
7-year old male, with 2 year history of jerking of the left arm and leg, without loss of consciousness, especially during TV watching. Which is important to note?
Loss of consciousness
Laterality of the jerking
Watching television provokes his seizure
All of the above
All of the above
91
```
Which is an important info regarding the nature of the event?
Presence of aura
Time of the day
Personality changes
All of the above
```
All of the above
92
```
In epilepsy, what factor is not of major concern?
Duration of illness
Age
Seizure type and etiology
NOTA
```
NOTA
93
True of the guidelines of seizure treatment
Seizure treatment is lifelong
Single most important guideline is the recurrence of seizures
Single most important guideline is the recurrence of seizures
94
```
In the guidelines followed in epilepsy, diagnostic management of epilepsy?
ECG
MRI
Activation EEG
AOTA
```
AOTA
95
```
Knee pain, malaise, tachycardia, pallor, febrile, muffled heart sounds, murmur at apex, no joint swelling
Acute Rheumatic w/ carditis
Acute Rheumatic w/ carditis + arthritis
RHD
Scarlet Fever
```
Acute Rheumatic w/ carditis
96
```
Chest xray revealed Normal heart and pulmonary markings. What is the severity of carditis?
No carditis
Mild carditis
Moderate carditis
Severe carditis
```
Mild carditis
97
```
Therapeutic Regimen?
Penicillin and ASA
Penicillin, furosemide, digoxin, prednisone
Penicillin, ASA, digoxin, captopril
Erythromycin, furosemide, prednisone
```
Penicillin and ASA
98
After 6 days, px was discharged. What is the preferred secondary RF prophylaxis?
Oral pen 250 mg 2x/day
Erythromycin 50mg 2x/day
Benz pen G 1.2m units deep IM every 21 days
Benz pen G 1.2m units deep IM every 28 days
Benz pen G 1.2m units deep IM every 28 days
99
What is not a complication of RHD?
Brain Abscess
100
```
The following statement is false about cerebral palsy:
Not progressive
Motor, cognitive, sensory are affected
CP is commonly associated with epilepsy
Temporary and reverts back
```
Temporary and reverts back
101
```
The following factors are important in cerebral palsy patients, except?
presence of spasticity
Intellect of child
Age of caregiver
Age of child
```
Age of caregiver
102
```
4-yr old child with developmental delay and unstable gait. What is the possible type of CP?
Spastic
Hemiplagia
Ataxic
Extrapyramidal
```
Ataxic
103
Which is a sign that headache is benign?
a. acute in onset
b. recurrent
c. symptoms are more chronic
d. with concomitant vomiting
c. symptoms are more chronic
104
Therapy for increased ICP
Mannitol
105
10 year old male drooling, assuming a tripod position, with a thumb sign on chest Xray.
Epiglottitis
106
What is the cause of laryngotracheomalacia? Parainfluenza 1 & 2
HibV
RSV
Rotavirus
Parainfluenza 1 & 2
107
Increase probability of GERD of chronic cough
symptomatic after activity
vomiting after feeding
wheezing
vomiting after feeding
108
```
The following pathogen of acute gastric require antibiotic use:
Enterotoxicogenic E. coli
Shigella
Salmonella
AOTA
```
Shigella
109
What is a complication of diarrhea?
lactose malabsorption
metabolic alkalosis
hyperkalemia
lactose malabsorption
110
False regarding treatment with severe malnutrition and some dehydration:
Replacement of fluid is done in hospital
IV hydration preferred over oral rehydration*
IV hydration preferred over oral rehydration*
111
Not a treatment in non infectious diarrhea:
Instructing patient about indefinite duration of parenteral feeding
Monitor volume of fluids
IV nutrition
Instructing patient about indefinite duration of parenteral feeding
112
Which is a signs/symptom of typhoid fever
biphasic fever
Maculopapular rash on 1st 2 days
relative bradycardia
relative bradycardia
113
Lab function of typhoid except:
Leukopenia
Thrombocytopenia
Hemoconcentration
Hemoconcentration
114
True regarding management of typhoid
Patients are in isolation and standard contact tracing procedures are done
115
Laboratory results not consistent with IDA
Low total Iron binding capacity
116
6 year old girl, 2 mo history of cough, (+) family history of TB, (+) PPD result, (+) Xray for TB. How to treat?
2 mo HRZ, 4 mo HR
117
10/M with ssx of cough, DOB, chest tightness. 1-2x/year esp. during the cold months. lately, he's been having ssx 5-6x/day, esp after play/activity, and has been roused from sleep daily during the past week because of cough.
```
Classification of BA:
A. Intermittent
B. Mild persistent
C. Moderate persistent
D. Severe persistent
```
D. Severe persistent
118
10/M with ssx of cough, DOB, chest tightness. 1-2x/year esp. during the cold months. lately, he's been having ssx 5-6x/day, esp after play/activity, and has been roused from sleep daily during the past week because of cough.
```
What is the initial ER management for this patient?
A. give oxygen using face mask
B. give nebulized B2 agonist
C. Montelukast
D. request for CXR
```
A. give oxygen using face mask
119
```
Which of the following is not a controller medication?
A. salbutamol
B. montelukast
C. budesonide
D. omalizumab (anti-IgE)
```
A. salbutamol
120
3/F with severe dyspnea, productive cough, fever on the day of consult, difficulty of breathing, dysphagia, drooling. Immunization history is incomplete.
```
What is the most likely diagnosis?
A. acute bronchiolitis
B. acute laryngotracheobronchitis
C. pneumonia
D. acute epiglottitis
```
D. acute epiglottitis
121
```
Etiology of Epiglottitis
A. Parainfluenza
B. RSV
C. Hib
D. Staph
```
C. Hib
122
```
NOT done for epiglottitis
A. O2
B. Racemic
C. antibiotics
D. tracheostomy
```
B. Racemic
123
12/F persistent knee swelling and pain. 3 weeks PTC moderate fever, left knee pain, followed by Right knee. Paracetamol relived fever and swelling. Sx recurred, persists now. Allergic to Beta lactam drugs. + CLAD, murmur, joint swelling.
Based on the revised Jones criteria, ff sx that the pt fulfilled:
A. Fever, ___, carditis
B. Fever, arthritis, pallor
C. Fever, arthritis, carditis
C. Fever, arthritis, carditis
124
```
5/F 1 month history of on/off headache
What diseases to consider?
A. primary headache
B. CNS infection
C. brain tumor
D. AOTA
```
D. AOTA
125
```
Headache accompanied by vomiting but not fever, rule out:
A. primary headache
B. CNS infection
C. brain tumor
D. NOTA
```
D. NOTA
126
Neuro exam revealed bilateral papilledema and babinski sign. What to do next:
A. give paracetamol, send home.
B. request for neuroimaging, manage as OPD
C. admit to hospital
D. any
C. admit to hospital
127
Headache, no fever, + vomiting
| Diagnostics?
CT scan
128
Congenital hypothyroidism symptoms
poor feeding, lethargy, open fontanelles
129
```
10 day old neonate screened positive for congenital hypothyroidism by Newborn screening. However, because of Ondoy, patient’s family was unable to follow up. The child was brought to clinic after 6 months. Which of the following will support dx of Congenital Hypothyroidism?
A. sits without support
B. length of 67 cm
C. wide anterior fontanelle
D. consumes 7-8oz of milk/day
```
C. wide anterior fontanelle
130
```
4-week old female with large tongue and lethargy, constipated and feeding poorly. Thyroid function test results would show:
A. increased T4, decreased TSH
B. normal T4, increased TSH
C. decreased T4, increased TSH
D. decreased T4, normal TSH
```
C. decreased T4, increased TSH
131
```
9month old female, good diet and a good drinker, height and weight 50th percentile. Noted pallor, hemoglobin of 72 g/dl. PBS showed microscopic, hypochromic RBCs. Probable etiology of disease:
A. thalassemia
B. transient viral ____ of bone marrow
C. anemia of chronic disease
D. Iron deficiency
```
D. Iron deficiency
132
12/M, decreased urine output. BP 170/100, periorbital edema. Tachypnea. Which serologic titer is the best single antibody determination done?
A. ASO
B. antinicotinamide adenine dinucleotidase (anti-NAD)
C. Streptokinase
D. anti–DNAse B
D. anti–DNAse B
133
```
Prognosis of APSGN in children:
A. 3% still have renal lesions after 12 years.
B. 0% recurrence rate
C. A&B
D. NOTA
```
A. 3% still have renal lesions after 12 years.
134
Which of the following strep antibodies is _____ for preventing recurrence of APSGN?
A. anti-IM protein
B. anti-streptokinase
C. anti-NAPlr?? (nephritis-associated plasmin receptor)
D. anti-neura___
C. anti-NAPlr?? (nephritis-associated plasmin receptor)
135
WHO child growth standard states the following growth indicator suggests normal growth: (weight for height, height for age)
A. w – h 2+2
D. h – a 2>+2
D. h – a 2>+2
136
```
5/M w-h >-2 , h for age >-2
A. wasting and stunting
B. severe wasting and stunting
C. wasting and severe stunting
D. severe wasting and severe stunting
```
D. severe wasting and severe stunting
137
```
True contraindication for DPT:
A. inconsolable crying for 3 hours
B. HHR within 48 hours
C. encephalopathy 7 days after
D. seizures within 3 days
```
A. inconsolable crying for 3 hours
138
To encourage complimentary feeding:
A. Offer small, frequent meals
139
To ensure safe complimentary foods, mothers must:
A. wash own hands
B. wash hands with soap
C. wash hands before preparing and feeding the child
D. refrigerate left over foods
C. wash hands before preparing and feeding the child
140
```
Complimentary foods are properly fed if given in:
A. infant feeding bottles
B. dropper
C. cup and spoon
D. AOTA
```
D. AOTA
141
```
Expected language dev at a 14-day old neonate
A. crying
B. Cooing
C. babble
D. jargon
```
A. crying
142
If spirometry and peak flow meter are not available or feasible, a diagnosis of asthma may be made if the patient demonstrates good clinical effect after therapeutics trial with which of the following inhaled agents?
a. SABA
b. Corticosteroids
c. LABA
d. LABA + corticosteroids
a. SABA
143
This applies to all children in the diagnosis of asthma
a. thorough Hx and PE
b. Spirometry
c. peak flow monitoring by portable peak flow meter
d. airway challenge tests
a. thorough Hx and PE
144
Carmen, 12yo/F from Malabon, brought to the clinic because of developmental delay. Birth history revealed prolonged jaundice. Mother volunteered info that she seldom cries and has difficulty feeding her. Her developmental milestones were that of a 4 yo girl. She weighed 30 kg and her height 115 cm. She has globular abdomen with umbilical and inguinal hernia.
Based on her anthropometrics. She has:
a. Normal wt, Normal ht
b. wasted, Normal ht
c. Normal wt, stunted
d. Wasted, stunted
d. Wasted, stunted
145
In a hypothyroid patient, what would you expect to find in TSH/T4 levels?
High TSH, Low T4
146
```
Manifestations of hypothyroid EXCEPT:
A. Big tongue
B. Constipation
C. Cold and mottled skin
D. Pulses are rapid or plethoric
```
D. Pulses are rapid or plethoric
147
```
Tx for patient?
A. Sodium-L-thyroxine
B. Potassium Iodide
C. Radioiodide
D. Amiodarone
```
A. Sodium-L-thyroxine
148
Prognosis has improved for patients with congenital hypothyroidism due to:
Neonatal screening
149
8 mo old, mixed feeding, diarrhea & vomiting, with sunken eyeballs, skin pinch slow, drinks eagerly
Category?
Some dehydration
150
```
Most probable cardiac pathology
a. ASD
b. VSD
c. PDA
D. TGA
```
b. VSD
151
2D echo. Least expected
a. RVH
b. RAH
c. LVH
d. LAH
b. RAH
152
Left Atrial Enlargement in xray except
a. apex displaced laterally and downward
b. Flat bronchus
c. double shadow
d. increased pulmonary vascular markings
a. apex displaced laterally and downward
153
All of the following are physiologic compensation of the body to augment oxygen delivery EXCEPT
a. Salt and water retention
b. myocardial hypertrophy
c. decreased circulating catecholamines
d. activation of RAAS
c. decreased circulating catecholamines
154
Drug of choice for standard general prophylaxis to prevent infective endocarditis.
a. amoxicilin
b. azithromycin
c. cephalexin
d. clindamycin
a. amoxicilin
155
Bendita; 9/f
Cc: blank staring for 15-30 seconds
-on and off vague left temporal headaches, occuring anytime of the day for 2-3 hours
-vomiting last 2 days
-5 day PTC – jerking of right arm noted during sleep for 2-5 minute duiration
PE: pimple like lesion on face, whitish patches on trunk and back; cooperative but aphasic
Fundoscopy - abnormal
CN – normal
Motor power normal except for mild right pronator drift. Sens int. Plantar response going right
Based on the characteristics of seizures, which parts of the brain are involved?
a. frontal and occipital lobe
b. temporal and occipital lobe
c. parietal and temporal lobe
d. frontal and temporal lobe
d. frontal and temporal lobe
156
Bendita; 9/f
Cc: blank staring for 15-30 seconds
-on and off vague left temporal headaches, occuring anytime of the day for 2-3 hours
-vomiting last 2 days
-5 day PTC – jerking of right arm noted during sleep for 2-5 minute duiration
PE: pimple like lesion on face, whitish patches on trunk and back; cooperative but aphasic
Fundoscopy - abnormal
CN – normal
Motor power normal except for mild right pronator drift. Sens int. Plantar response going right
Best ancillary procedure for possible tumor.
a. CT scan
b. MR angiogram
c. MRI
d. UTZ
c. MRI
157
Bendita; 9/f
Cc: blank staring for 15-30 seconds
-on and off vague left temporal headaches, occuring anytime of the day for 2-3 hours
-vomiting last 2 days
-5 day PTC – jerking of right arm noted during sleep for 2-5 minute duiration
PE: pimple like lesion on face, whitish patches on trunk and back; cooperative but aphasic
Fundoscopy - abnormal
CN – normal
Motor power normal except for mild right pronator drift. Sens int. Plantar response going right
Characteristic of seizure
a. Simple partial
b. complex partial
c. A>B
d. B>A
d. B>A
158
True of seizures with brain tumors except
a. irritation of cortex secondary to mass effect
b. irritation of cortex secondary to vasogenic edema
c. result to normal firing of neurons
d. usually with supratentorial tumors
c. result to normal firing of neurons
159
(No case provided)
Based on physical exam findings, what is the diagnosis?
a. systemic viral illness
b. typhoid fever
c. dengue hemorrhagic fever
d. acute tonsillopharyngitis
c. dengue hemorrhagic fever
160
(No case provided)
What is/are the most cost effective lab test/s?
a. salmonella IgG/IgM
b. CBC with platelet
c. throat swab
d. blood culture
b. CBC with platelet
161
(No case provided)
What is your initial treatment?
a. oxygen ventilation
b. fluid resuscitation
c. antibacterial
d. antipyretic
b. fluid resuscitation
162
```
1st thing to do on 1st well baby check-up
A. Establish rapport
B. Introduce self
C. Get general data
D. Ask birth and maternal hx
```
B. Introduce self
163
```
After general data, ask for?
A. Birth & maternal hx
B. HPI
C. Nutritional
D. PMH
```
B. HPI
164
```
Best method to put babies in relaxed state to promote auscultation of the heart:
A. sleep
B. breastfeeding
C. Cuddling
D. AOTA
```
D. AOTA
165
```
Anticipatory guidance for parents regarding this child (40 wk/F)
A. Behavior pattern
B. Nutrition
C. Safety and Injury prevention
D. AOTA
```
D. AOTA
166
```
What dev'l milestone is expected of a 1 mo old?
A. Regards
B. Smiles
C. Turns head
D. Holds head
```
A. Regards
167
```
What can be given at current visit, assuming pt had Hep B at birth:
A. BCG and 2nd dose of Hep B
B. BCG
C. 2nd dose of Hep B
D. DPT & OPV
```
A. BCG and 2nd dose of Hep B
168
The next following schedule of the patient should be?
a. 2 weeks
b. 1 month
c. 1 ½ month
d. 2 months
b. 1 month
169
How should you conclue the encounter with the patient
a. thank them
b. counsel on the danger signs for the patient
c. advise on the importance of continuty of care
d. all of the above
d. all of the above
170
On a population basis, recommended meal frequencies - assuming a diet w/ energy density of 0.8 kcal/g or above and low breastmilk intake - are:
a. 2-3 meals/day for infants aged 6-8 mos
b. 3-4 meals/day for infants aged 9-11 mos and children 12-24 mos
c. add'l nutritious snacks may be added 1-2 x a day, as desired
d. AOTA
d. AOTA
171
Feeding during and after illnesses
A. Indreased fluid intake during illness, including more frequent breastfeeding
B. Encourage child to eat soft, varied, appetizing, favorite foods
C. After illness, give food more often than usual and encourage the child to eat more
D. AOTA
D. AOTA
172
Based on neurodevelopment of infants, you should check all of the ff EXCEPT:
By 5 mos most children can eat finger foods
173
Not true in Proper Food Hygiene and Food Handling?
A. Handwashing of food handlers only before food preparation
B. Using clean utensils, cups and bowls
C. Not using feeding bottle bec. those are difficult to clean
A. Handwashing of food handlers only before food preparation
174
The application of the principle of psycho-social care to responsive feeding inclue
a. feeding infants directly and asesesing older children when they feed themselves
b. experiments with different food combinations, tastes, textures, and methods of encouragement
d. AOTA
d. AOTA
175
Meeting energy and nutrient requirement to complementary feeding includes the following except
a. increasing complementary feeding frequency impairs breastmilk intake with the potential risk of reducing energy and nutrient intake
b. as infants grow, complementary food should range from semisolid to solid food and variety o tastes should increase
c. complementary feeding is part of continuing linked intervention which include maternal breastfeeding, micronutrient supplementation, psychosocial interaction, feeding during and after illness, and illness prevention and control
d. NOTA
d. NOTA
176
Which of the following patients has epilepsy?
A 10-year old girl who has episodes of loss of consciousness associated with too much stress in school
An 8-month old baby who developed cyanosis and mild jerking of the arms during vaccination
A 7-year old boy with clonic movements associated with fever
A 10-year old boy with left facial twitching during sleep
A 10-year old boy with left facial twitching during sleep
177
```
A 6-year old girl with Down syndrome has episodes of loss of body tone. At times, she is able to control her falls but last week, she hit her head on the wooden floor. Her EEG showed epileptiform activity. This girl’s events are consistent with:
Tonic seizures
Atonic seizures
Petit mal
Syncope
```
Atonic seizures
178
Which of the following children has complex febrile seizures?
One-month old baby boy with myoclonic seizures at the height of the fever
Two-year old girl with fever, increased sleeping time
A 4-year old girl who had generalized tonic-clonic seizures at the height of fever for 16 minutes
A newborn with lip-smacking movements
A 4-year old girl who had generalized tonic-clonic seizures at the height of fever for 16 minutes
179
```
The following are intracranial pain-sensitive structures except
Venous sinuses
Basal arteries
Dura
Scalp vessels
```
Venous sinuses
180
```
What type of headache is usually diffuse, dull, aching or “band-like?”
Migraine
Tension headache
Cluster
Occipital neuralgia
```
Cluster
181
Responsive feeding involves all except
Feed infants directly and assist older children
Feed slowly and patiently
Experiment with different food combinations
Experiment with different caregivers
Experiment with different caregivers
182
Research in complementary feeding should be aimed at all of the following except
Determining the impact of improved responsive feeding on child growth and developmental outcomes
Developing strategies for sustaining breastfeeding Exploring easy food preparation, e.g. “just add water” foods
Developing and testing appropriate and effective strategies to ensure safe food storage
Exploring easy food preparation, e.g. “just add water” foods
183
BCG vaccine should be discarded how many hours after reconstitution?
a. 2
b. 4
c. 6
d. 8
b. 4
184
Varicella vaccine is potent up to how many hours after reconstitution?
a. 0.5
b. 1
c. 1.5
d. 2
a. 0.5
185
A child incurred a large wound and was given tetanus vaccine and immunoglobulin. How many months after can he have his measles vaccine?
a. 3
b. 4
c. 5
d. 6
a. 3
186
A 5-month old baby diagnosed with leukemia. He was transfused with several units of packed RBC at that time. At what age (in months) can he be given his measles vaccine?
a. 8
b. 11
c. 12
d. 16
b. 11
187
```
When doing an intramuscular injection for an emancipated patient, which of the following should you do to the site of administration?
Spread out the skin
Bunch up the muscle
Pinch the skin
Nothing
```
Bunch up the muscle
188
When doing a subcutaneous injection, the needle must be angled at what degree?
a. 0
b. 15
c. 30
d. 45
d. 45
189
A mother asks you if her 1-year old needs a fourth dose of HepB vaccine. Which of the following is an indication for a fourth dose?
If her child is a term baby
If she completed the series using the schedule 6-10-14 weeks
If she completed the series by age 6 months
If she completed the series by age 8 months
If she completed the series by age 6 months
190
```
A child was given oral polio vaccine. When will you have the mother bring back the baby for rotavirus vaccination?
1 week
2 weeks
3 weeks
4 weeks
```
4 weeks
191
In the hepatitis A vaccination series, how many months apart should the doses be given?
a. 3
b. 6
c. 9
d. 12
b. 6
192
```
A child with rheumatic fever has been on prolonged aspirin therapy. Which of the following vaccines should he be given in order to avoid Reye syndrome?
DPT
Typhoid
MMR
Influenza or Varicella
```
Influenza or Varicella
193
```
BCG is administered by which route?
Intradermal
Subcutaneous
Intramuscular
Oral
```
Intradermal
194
```
Influenza vaccine is given yearly, preferably during which months?
February to June
July to September
October to November
December to January
```
October to November
| But sa US ata to
195
```
Your patient developed urticaria and angioedema after immunization. What emergency drug will you give him?
Diphenhydramine
Epinephrine
Dopamine
Dobutamine
```
Epinephrine
196
```
How many doses of influenza vaccine should a child initially have?
1
2
3
4
```
1
197
```
Human papilloma virus vaccine is recommended for females beginning what age?
4
6
8
10
```
10
198
On taking initial blood pressure in children, measurements from all four extremities must be taken
The child must be upright when taking the brachial arterial pressure
The child must be upright when taking the popliteal arterial pressure
The child must be reclining while taking the brachial arterial pressure
The child must be reclining while taking the popliteal arterial pressure
The child must be reclining while taking the popliteal arterial pressure
199
On taking initial blood pressure in children, measurement from all four extremities must be taken
The child may be seated when taking the brachial arterial pressure
The child may be seated when taking the popliteal arterial pressure
The child may be standing upright when taking the brachial arterial pressure
The child may be standing upright when taking the popliteal arterial pressure
The child may be seated when taking the brachial arterial pressure
200
In prescribing the amount of Amoxicillin (at 20-40 mg/kg/dose divided every 8 hours, preparation 12.5 mg/teaspoon) to be consumed by the child per dose
The dose is multiplied by the weight of the child, then divided by the frequency, then divided by preparation
The dose is multiplied by the weight, then multiplied by the frequency, then divided by the preparation
The dose is multiplied by the weight of the child, then divided by preparation
The dose is multiplied by the frequency, then multiplied by the weight of the child, then divided by the preparation
The dose is multiplied by the weight of the child, then divided by preparation
201
```
The WHO Child Growth Standards states that the following growth indicator suggests normal growth
A weight-for-height z-score below -2
A height-for-age z-score below -2
A weight-for-height z-score above +2
A height-for-age z-score below +2
```
A height-for-age z-score below +2
202
```
A 5-year old boy has a weight-for-height z-score below -2 and a height-for-age z-score below 2. He has
Wasting and stunting
Severe wasting, and stunting
Wasting and severe stunting
Severe wasting and severe stunting
```
Wasting and stunting
203
An 8-year old girl has a BMI z-score above +2 and a height-for-age z-score above +2. She has
Possible risk for overweight and no stunting
No wasting and no stunting
Overweight and no stunting
Obesity and no stunting
Overweight and no stunting
204
```
A 6-month old boy, after a 1-week diarrhea was noted to have a weight-for-length z-score below -2 and a length-for-age z-score below -1. He has
No wasting and no stunting
Wasting and stunting
Wasting and no stunting
No wasting, and stunting
```
Wasting and no stunting
205
```
A 12-year old boy weighs 65 kg. His height is 144 cm. His BMI computed at
25
28
31
35
```
31
206
An 18-month old boy was brought to the clinic for poor growth. Although he has not been sick, his current weight-for-length z-score is below -1 and his length-for-age z-score is below -1. On review of his previous weight and length measurements, you noted that his weight-for-length z-score six months ago was above +2 and his length-for-age z-score then was below -1. You conclude that:
The child has no growth problem and the mother needs reassurance.
The child is stunted and must be referred to an endocrinologist.
The child has been crossing z-score lines for weight-for-length and must undergo nutritional rehabilitation.
The child needs urgent attention to correct wasting and stunting.
The child has no growth problem and the mother needs reassurance.
207
A 10-year old girl was brought to the clinic for weight loss. Her current BMI-for-age z-score is below -2 and her height-for-age z-score is at the median. On review of her previous measurements, you noted that 3 months ago, her BMI-for-age z-score was above +1 and her height-for-age z-scorer was at the median. You conclude that:
The child has acute undernutrition.
The child has chronic undernutrition.
The child was previously obese and is now “growing into her height.”
The child has no growth problem and the mother needs reassurance.
The child has acute undernutrition.
208
An 8-year old boy was brought to the clinic for poor growth. Although he has not been sick, his current BMI-for-age z-score is below -1 and his height-for-age z-score is below -2. On review of his previous weight and height measurements, you noted that his BMI-for-age z-score for the past 3 years was consistently below -1 and his height-for-age z-score was consistently below -2. You conclude that
The child has no growth problem and the mother needs reassurance.
The child is stunted and must be referred to an endocrinologist.
The child has been crossing z-score lines and must undergo nutritional rehabilitation.
The child needs urgent attention to correct wasting and stunting.
The child is stunted and must be referred to an endocrinologist.
209
One of the following patients has failure to thrive:
A 6-year old boy whose weight-for-height fell from the 75th to the 25th percentile in the past 6 months.
A 2-year old girl whose weight-for-length has been consistently at the 5th percentile in the past 6 months.
A 6-year old girl whose weight-for-height has been consistently at the 5th percentile in the past 6 months.
A 2-year old boy whose weight-for-length fell from the 75th to the 25th percentile in the past 6 months.
A 2-year old boy whose weight-for-length fell from the 75th to the 25th percentile in the past 6 months.
210
```
The hormone that is responsible for breast milk ejection or letdown.
FSH
LH
Oxytocin
Estrogen
```
Oxytocin
211
“Early latching on” should be done
After first urination and bowel movement
Within 30 minutes to 1 hour of baby’s birth
When the mother is fully conscious and can hold the baby
Within the first 24 hours when the baby has thermoregulated
Within 30 minutes to 1 hour of baby’s birth
212
```
Which is not indicative of a good latch?
Asymmetric latch
More areola seen above than below
Mouth wide open
Loud, smacking noise when baby sucks
```
Loud, smacking noise when baby sucks
213
The “wetness test,” one of the ways to assess adequacy of breast milk intake, means
Baby has moist buccal mucosa
Has copious tears during crying
Urinates adequately using about 5-6 diapers/24 hours
Has soft, watery yellow stools
Urinates adequately using about 5-6 diapers/24 hours
214
What is the best advice to a mother who says she isn’t producing enough milk?
Supplement with sugared water to prevent dehydration Increase frequency of breastfeeding on a per demand basis
Offer a pacifier to quiet down the baby
Take malunggay tablets and plenty of water
Increase frequency of breastfeeding on a per demand basis
215
(TB Case)
What is the most important data in the history that would point to the most plausible diagnosis?
a. ) chronic cough
b. ) intermittent fever
c. ) loss of appetite
d. ) exposure to and adult with cough
a.) chronic cough
216
(TB Case)
What is the most important PE finding given that would point to the most plausible diagnosis?
a. ) matted CLAD
b. ) poor weight gain
c. ) temperature of 38.5 degrees
d. ) normal chest and lung findings
a.) matted CLAD
217
(TB Case)
Present working impression?
a. ) pneumonia
b. ) URTI
c. ) PTB
d. ) bronchiolitis
c.) PTB
218
(Dengue Case)
what is the most important PE finding in the case that would lead you to the diagnosis?
Fever pattern
219
(Dengue Case)
```
What is the most important PE finding given that would point at the most probable diagnosis?
A. temperature of 38.8
B. equivocal tourniquet test
C. hyperemic tonsillar walls
D. hypotension
```
D. hypotension
220
(Dengue Case)
```
What is your present working impression?
A. Typhoid fever
B. Dengue Hemorrhagic Fever
C. Systemic Viral Illness
D. Acute Tonsillopharyngitis
```
B. Dengue Hemorrhagic Fever
221
(Dengue Case)
```
What is the most important cost-effective diagnostic test that should be done to confirm your diagnosis?
A. Salmonella IgG/IgM
B. Blood culture
C. Throat swab
D. CBC with platelet count
```
D. CBC with platelet count
222
(Diarrhea Case)
What is the classification of the dehydration based on WHO?
a. ) none
b. ) mild dehydration
c. ) moderate
d. ) severe
d.) severe
223
(Diarrhea Case)
grading in the growth chart
a. ) not stunted not wasted
b. ) severely stunted, severely wasted
c. ) stunted, wasted
d. ) stunted, severely wasted
a.) not stunted not wasted
224
Gold standard for diagnosing diarrhea
Stool culture
225
Management of diarrhea
Fluid resuscitation
226
Diagnosis
Shigellosis
227
(Jaundice Case)
most important data to establish diagnosis?
a. ) female gender
b. ) early breastfeeding
c. ) jaundice from 48th to 72nd hour of life
d. ) early discharge
c.) jaundice from 48th to 72nd hour of life
228
(Jaundice Case)
impression?
a. ) breastmilk jaundice
b. ) physiologic jaundice
c. ) pathologic jaundice
d. ) neonatal jaundice
b.) physiologic jaundice
229
(Jaundice Case)
most important PE finding to support diagnosis?
a. ) jaundice from face to lower extremities
b. ) good suck and activity
c. ) no pallor and no bruises
d. ) AOTA
d.) AOTA
230
Management for physiologic jaundice
Phototherapy
231
(Meningitis Case)
initial management for the patient
a. ) o2 administration
b. ) IV insertion
c. ) diazepam
d. ) paracetamol
a.) o2 administration
232
(Meningitis Case)
diagnostic to confirm diagnosis
a. ) Ct scan
b. ) EEG
c. ) lumbar tap
d. ) cranial UTZ
c.) lumbar tap
233
(Meningitis Case)
initial drug of choice
a. ) high dose pen G
b. ) Phenobarbital
c. ) tetanus ig
d. ) ceftriaxone
a.) high dose pen G
234
(Meningitis Case)
what vaccine could have prevented this illness if administered early on?
a. DPT
b. HiB
c. BCG
d. OPV
b. HiB
235
31. ) difference of pediatric history based on content
a. ) HPI
b. ) personal social
c. ) birth and maternal
d. ) chief complaint
c.) birth and maternal
236
distraction technique for toddlers
a. ) visual distraction
b. ) humor
c. ) imagery
d. ) dim lighting
c.) imagery
237
Calm child then started crying when she saw you. What will you do?
Allow the child to remain cuddled by parent
238
A 3 yo girl who was crying and very anxious was brought in by her mother
a. come back once she stopped
b. proceed with history
c. PE then history after child calms
d. distraction technique to make child comfortable
d. distraction technique to make child comfortable
239
A 5 yo was brought to the clinic for cough. During developmental history, mother reports the following, which is most alarming
a. stand on 1 foot for 3-5 seconds
b. draw a person with 6 parts
c. recall parts if a story
d. wants to please and be with friends
a. stand on 1 foot for 3-5 seconds
240
an infant who sits with minimal support, attempts to attain a toy beyond reach and rolls over from supine to prone but does not have a pincer grasp is what month old?
a. ) 9
b. ) 4
c. ) 6
d. ) 2
c.) 6
241
a 12 month old infant would differ from a 6 month old in his or her ability to
a. ) turn to sounds
b. ) walk alone
c. ) dress self completely
d. ) point to all body parts
b.) walk alone
242
this is the age when toilet training is expected
a. ) 1.5
b. ) 2
c. ) 3
d. ) 4
c.) 3
243
red flag sign for the corresponding age:
a. 5 month old who hasn’t babbled
b. 9 month old who says “mama” and “dada”
c. 2 years old who speaks 10-12 specific words
d. 12 month old who follows simple commands
c. 2 years old who speaks 10-12 specific words
244
a benefit of breastfeeding over bottle feeding is that, breastfeeding,
a. provides more calcium and phosphorus
b. promotes shorter, rhythmic sucking bursts
c. allow for more time between feeding sessions
d. encourages a unique interaction between mother and infant
d. encourages a unique interaction between mother and infant
245
when performing an assessment of a woman who is breastfeeding, the health worker should consider that regardless of the condition, most breastfeeding mothers complain of:
a. fatigue
b. sore nipples
c. inadequate milk supply
d. engorgement of breasts
b. sore nipples
246
To sustain exclusive breastfeeding in a mother who will soon report to an office (8 to 5 job), the best advice would be
a. learn how to express milk
b. get info on formula feeding
c. buy a good breast pump
d. get somebody to breast feed the infant while she is at work
a. learn how to express milk
247
The most satisfactory stimulus to the secretion of human milk
a. intake of “galactogenic” food
b. complete emptying of the breast
c. breast engorgement
d. increase fluid intake of the mother
b. complete emptying of the breast
248
To prevent contamination of breastmilk, which of the following can be done?
a. Keep expressed milk warm until delivered to the infant. b. Wash hands with soap and water prior to collecting milk.
c. Boil milk in glass bottles for 20 minutes before refrigeration.
d. Clean breast with a circular motion from areola to nipple.
b. Wash hands with soap and water prior to collecting milk.
249
False regarding health supervision visits:
a. Developmental milestones reviewed
b. Complete PE
c. Screening tests
d. Only the child’s current problems are discussed.
d. Only the child’s current problems are discussed.
250
false regarding anticipatory guidance
a. ) child’s immunization is received
b. ) family relation and problems are discussed
c. ) child’s nutrition is an area of concern
d. ) safety issue is not part of anticipatory guidance
d.) safety issue is not part of anticipatory guidance
251
which is false regarding injury and prevention
a. ) injury results from an interplay of several factors
b. ) there are several levels of prevention
c. ) injury prevention measures include education and enforcement of safety laws
d. ) injury prevention counselling is discussed only during sick child visits
d.) injury prevention counselling is discussed only during sick child visits
252
```
Questions on the pertinent positives and negatives that help in arriving at the diagnosis of a case are included in what part of the pediatric history?
A. History of present illness
B. Review of systems
C. Family history
D. Past medical history
```
B or D
253
```
Included in this part of the pediatric history are symptoms not mentioned in the history of present illness but which are still important in arriving at a diagnosis:
Past medical history
Birth and maternal history
Review of systems
Family history
```
Review of systems
254
```
History of drug reactions or allergies should be included in this part of the pediatric history:
History of present illness
Past medical history
Family history
Review of systems
```
Past medical history
255
```
Not a part of the distraction techniques that should be used in neonates:
Positioning
Cuddling
Sucking
Distraction devices (toys/music)
```
Distraction devices (toys/music)
256
```
Distraction technique unique to pre-schoolers:
Play therapy
Humor
Heat/cold application
Imagery
```
Play therapy
257
Not a true statement regarding the growth and development of a child:
It is a continuous proves
Developmental sequence is orderly and predictable.
Rate is the same for every child
Progresses in a cephalo-caudal and proximo-distal pattern
Rate is the same for every child
258
Developmental red flag sign for 1-3 month old babies:
Doesn’t seem to respond to loud noises*
Doesn’t follow object with both eyes
Does not laugh or squeal
Head still flops back when body is pulled to a sitting position
Head still flops back when body is pulled to a sitting position
259
Developmental red flag sign for 2-3 year old toddlers:
Understands simple instructions
Frequent falling and difficulty with stairs
Cannot jump in place
Cannot ride a bike
Frequent falling and difficulty with stairs
260
In prescribing the amount of Amoxicillin (at 20-40 mg/kg/day divided every 8 hours; preparation 125 mg/teaspoon) to be consumed by the child per dose:
The dose is multiplied by the weight of the child, then divided by the frequency, then divided by preparation
The dose is multiplied by the weight, then multiplied by the frequency, then divided by preparation
The dose is multiplied by the weight of the child, then divided by the preparation
The dose is multiplied by the frequency, then multiplied by the weight of the child, then divided by preparation
700-1400 mg/day – 28-56 mL/day
The dose is multiplied by the weight of the child, then divided by the frequency, then divided by preparation
261
A 4-year old child, who weighed 14kg, was given 10mL of Cloxacillin 125mg/5mL syrup 4 times a day. Based on the formulary Cloxacillin must be given at 50-100mg/kg/day divided every 6 hours. You conclude that:
The dose was correct but the frequency was incorrect
The frequency was correct but the dose was incorrect Both the frequency and dose were correct
Both the frequency and dose were incorrect
Both the frequency and dose were correct
262
On administering intradermal injections, the ideal sites are:
The deltoid, the buttocks and the thighs
The thighs, the deltoids and the forearms
The buttocks, the deltoids and the forearms
The forearms, the buttocks and the thighs
The deltoid, the buttocks and the thighs
263
On administering subcutaneous injections, it is ideal to: Use the abdomen, thighs and arms
Use a 2-cm gauge 23 needle
Use the z-track technique in obese children
Insert the needle parallel to the skin
Use the abdomen, thighs and arms
264
```
Which of the following vaccine is NOT part of the Expanded Program of Immunization?
BCG
Polio
Varicella
Pertussis
```
Varicella
265
```
Polio vaccine can be administered as early as what age?
2 weeks old
4 weeks old
6 weeks old
8 weeks old
```
6 weeks old
266
```
A mother brings in her 8-month-old baby for immunization. Which of the following can you give the baby?
Measles vaccine
Measles, mumps, rubella (MMR) vaccine
Varicella vaccine
Hepatitis B booster
```
Hepatitis B booster
267
```
After vaccine administration, how long must the patient be observed?
20 minutes
1 hour
1 ½ hours
2 hours
```
20 minutes
268
```
Your patient developed urticaria and angioedema after immunization. What emergency drug will you give him?
Diphenhydramine
Epinephrine
Dopamine
Dobutamine
```
Epinephrine
269
```
Commonly used vaccines that can be administered simultaneously must be given how many cms apart?
0.5
1
1.5
2
```
2
270
What is the most common approach used in the diagnosis of rheumatic diseases in children requiring a thorough clinical history and physical examination, using laboratory parameters only as supportive evidence? hypothetic-deductive reasoning
algorithm
pattern recognition
exhaustive approach
hypothetic-deductive reasoning
271
```
Which of the following sign differentiate arthritis from arthralgia?
erythema
swelling
warmth
all of the above
```
all of the above
272
Which of the following findings in a child with joint pains suggest a more serious condition?
pain is located between joints
pain usually occurs at night
pain is persistent and prolonged
pain is not associated with abnormal physical findings
pain is persistent and prolonged
273
Which of the following is NOT true about growing pains?
Diagnosis is based on the typical characteristic symptoms and unremarkable physical findings
Analgesics are necessary to alleviate the pain
Growing pains in children is usually benign and does not portend serious illness
Clinical monitoring is important to evaluate the persistence or progression of symptoms
Clinical monitoring is important to evaluate the persistence or progression of symptoms
274
```
A 6-year old child comes to your clinic with a history of fever, rash, arthritis. Which of the following will NOT be part of your INITIAL laboratory examination?
complete blood count
erythrocyte sedimentation rate
streptococcal antibody titers
rheumatoid factor
```
rheumatoid factor
275
```
Which of the following supplies the greatest percentage of blood to the liver?
common hepatic artery
superior mesenteric artery
main hepatic vein
portal vein
```
portal vein
276
Which of the following is the correct rationale for the pharmacologic treatment of portal hypertension?
furosemide is given to induce arteriolar vasodilation
metoclopramide is given to decrease lower esophageal sphincter tone
propranolol is given to decrease cardiac output
nitroglycerin is given to cause vasoconstriction
propranolol is given to decrease cardiac output
277
A 5-year old male developed high grade fever and sore throat. A few hours later, the patient appeared toxic with difficulty swallowing and labored breathing. On PE, he was tachypneic and preferred to sit upright and lean forward. He also had stridor and drooling of saliva.
```
The most likely diagnosis for the above case would be:
laryngomalacia
acute laryngotracheobronchitis
acute epiglottitis
brachial tracheitis
snowstorm sign
```
acute epiglottitis
278
A 5-year old male developed high grade fever and sore throat. A few hours later, the patient appeared toxic with difficulty swallowing and labored breathing. On PE, he was tachypneic and preferred to sit upright and lean forward. He also had stridor and drooling of saliva.
```
You requested for a radiograph of the cervical area and soft tissues. What radiographic finding should you look for?
steeple sign
thumb sign
sail sign
snowstorm sign
```
thumb sign
279
A 5-year old male developed high grade fever and sore throat. A few hours later, the patient appeared toxic with difficulty swallowing and labored breathing. On PE, he was tachypneic and preferred to sit upright and lean forward. He also had stridor and drooling of saliva.
Immediate management for the above case at the ER include the following EXCEPT:
Perform a complete throat exam
Give supplemental oxygen if hypoxemic
Administer intravenous anti-bacterial agent
Keep patient in position of comfort
Perform a complete throat exam
280
```
Feature of allergic facies:
periorbital swelling
round face
small ears
anterior nasal crease
```
anterior nasal crease
281
```
Cell important in the allergic response:
mast cell
natural killer cell
neutrophil
macrophage
```
mast cell
282
```
Hallmarks of allergic rhinitis EXCEPT:
recurrent nasal infection
sneezing
rhinorrhea
nasal pruritus
```
recurrent nasal infection
283
The major advantage of second-generation antihistamines include:
they cross the blood brain barrier and help the patient relax
they are long-acting
they decrease appetite
they help decrease rhinorrhea
they are long-acting
284
```
Immunoglobulin responsible for the immediate type hypersensitivity reaction:
IgG
IgA
IgM
IgE
```
IgE
285
One of the following statements is not true regarding cerebral palsy:
It is a progressive disorder of movement and posture
It occurs in 1 in 2500
There are spastic, hypotonic and athetoid types
50% may have epilepsy
It is a progressive disorder of movement and posture
286
```
The following is TRUE of the spastic type of cerebral palsy:
static nervous system disorder
manifests in adolescence
has an acute course
has the least functional limitation
```
has the least functional limitation
287
The following are goals in the management of children with cerebral palsy EXCEPT:
use of orthotics to prevent impairment
oral medications like diazepam and baclofen to improve muscle strength
proper positioning to promote skeletal alignment
physical therapy to promote optimal function
oral medications like diazepam and baclofen to improve muscle strength
288
Cerebral palsy has several co-morbidities like:
mental retardation in 60% of cases
visual impairment in 10% of cases
behavior and emotional disorders in 90% of cases
feeding and growth abnormalities in 2% of cases
mental retardation in 60% of cases
289
According to Global IYCF exclusive breastfeeding should be done at
1st 6 months of life
290
According to Global IYCF, once complementary feeding has been started, breastfeeding should
be continued until 2 years and beyond
291
Complementary feeding should be started with
nutritionally adequate and safe food
292
Under the Global IYCF strategy after starting complementary feeding.. breastfeeding should be..
continued up to 1 year
continued up to 2 years
continued up to 2 years
293
```
Which of the ff is an indication for separating the new bornbaby to mother
maternal hepatitis b
maternal rubella titer antibody +
mother with … infection
none of the above
```
none of the above
294
In low income countries, nutritional programs needed to prioritize by the government
fortifying commercial foods
295
Best person to encourage the infant to feed
Someone the child is comfortable with
296
Significance of weaning of grasp reflex in infants
put objects in midline
manipulate objects in both hands
hold objects and voluntarily let them go
hold objects and voluntarily let them go
297
What can a 24 month old child do?
runs swiftly
runs well,walks down the stairs one step at a time
stands at one feet momentarily
runs well,walks down the stairs one step at a time
298
The limited ability to cognitively consider other’s point of view in the preschool year
egocentrism
centration
magical thinking
egocentrism
299
```
In what stage of adolescence are issues about consolidation of sexuality happens?
early adolescence
middle adolescence
late adolescence
any stage of adolescence
```
late adolescence
300
Which is true regarding vaccines?
you can change route without diminishing activity
you can use it 1 month post expiration
you can reconstitute in any way that you like
you may opt not to change needle after reconstitution
you may opt not to change needle after reconstitution
301
Which is the most important source of passive immunity in infancy?
Transplacental transfer
302
```
the temperature needed to maintain the cold chain
-2 to -4
-4 to -8
0
+2 to +8
```
+2 to +8
303
```
which of the ff is heat sensitive
MMR
OPV
Hep B
HiB
```
OPV
304
BCG should be discarded how many hrs after reconstitution?
4 hours
305
One of the ff is correct.. in athropometric measurement abdominal circumference at level of umbilicus
head at the level of nosebridge
chest circumference at level of nipple
abdominal circumference at level of umbilicus
306
On taking the blood pressure in children
cuff must cover
half of cuff 2/3 of arm length
applied at cubital fossa
half of cuff 2/3 of arm length
307
On taking the blood pressure of children
appearance of korottkoff coincides with the diastolic pressure
the disappearance of the korotkoff sound coincides with the diastolic pressure
muffling sounds
the disappearance of the korotkoff sound coincides with the diastolic pressure
308
```
Proper procedure to follow in prescribing the amount in mg of paracetamol at 10 mg per dose per hour to be consumed by the child in 1 day is
Dose x height/frequency
Dose x weight
Dose x weight x frequency
Dose x frequency/weight
```
Dose x weight x frequency
309
```
Proper procedure to follow in prescribing amoxicillin for a child at 20-40 mg/kg/day.. Q8 in one day
Dose x height/frequency
Dose x weight
Dose x weight x frequency
Dose x frequency/weight
```
Dose x weight
310
Which of the following revised waterlow scores is normal?
Weight for age 92 percentile : no wasting
Height for age 93 percentile: no stunting
Weight for length for .. 84 percentile: mod wasting
Weight for height 89 percentile: mild wasting
Weight for height 89 percentile: mild wasting
311
```
Which WHO Z score implies a growth problem?
Length for age z score -1
Weight for height z score – 1
Length for age z score + 1
Weight for height z score +1
```
Weight for height z score +1
312
A 2 year old, breast fed, watery diarrhea 6x/day, associated with fever and vomiting. Etiology?
Viral
313
No sunken eyeballs, good skin turgor, drinks water completely
Management?
oresol 60-100/ml after every episode of diarrhea
314
3 month.old boy, brought in for diarrhea and vomiting, not breastfed, 2kg, Bonna 1:2 dilution -> diluted to 1:3. On P.E. irritable, sunken eyeballs, did not drink offered water Acute viral with some dehydration
Acute bacteria with some dehydration
Acute viral with severe dehydration
Acute bacteria with severe dehydration
Acute bacteria with some dehydration
315
```
You noted that the patient described has distended abdomen with hypoactive bowel sounds, able to take in oresol. What would you do?
Continue with oresol
Iv hydration
Refer to nearest ER
Add a mineral
```
Continue with oresol
316
At 12 mos, a child can
walk alone
spontaneous scribbling
jargon words and gestures
walk alone
317
```
Factors that contributed to global developmental delay
congenital infection
perinatal-prenatal assault
epilepsy
all of the above
```
all of the above
318
```
Most important in the history that could be the major basis for diagnosis of a globally developmental delay in this case is
chief complaint
birth and maternal history
family history
development history
```
birth and maternal history
| development history
319
Kim 13/F consulted for joint pains – migratory in nature. Started in elbows, then knees, then ankles. Associated with moderately high fever, poor apetite, body malaise. No cough nor easy fatigability. PE: HR-110, RR-16, T-38, BP-100/60. Clear breath sounds, adynamic precordium,distinct heart sounds, tachycardic, no murmurs, no hepatomegaly, extremities warm to touch, good pulses, no cyanosis,(+) dubor, calor,dolor of joints
Impression?
RF
Myocarditis
JRA
Septic arthritis
RF
320
```
If you are considering RF, what diagnostic tests will confirm?
Blood culture
Rheumatoid factor
ESR, ASO, CXR, ECG, CRP
B and C
```
ESR, ASO, CXR, ECG, CRP
321
```
The management appropriate for this patient
prednisone
aspirin
determination of ..levels after weeks
a and b
```
a and b
322
The following statements are true regarding the pathogenesis of RF and RHD
cytotoxicity and ??
initial attack peaks at children (adolescent)
patient with one attack of RF.. more severe recurrent, than initial
attack a and b
attack a and b
323
RF not characterized by any of the features
Involves large joints particularly the knee, elbows and shoulders
Rheumatic joints are generally are red, swollen, tender, even clothes friction are unbearable
Dramatic response to even small doses of -----
Dramatic response to even small doses of -----
324
```
Mainstay of the management of persistent type of asthma
Oral short acting bronchodilators
Inhaled glucocorticosteroids
Inhaled long acting bronchodilators
Avoidance of triggers
```
Inhaled glucocorticosteroids
325
Among children aged 6 months and older, complementary feeding bridges__________
energy gap, vitamin A, iron gap in breastfed infants at 6 months
energy gap, vitamin A, iron gap in non- breastfed infants at 6 months
vit A + iron gap among breastfed infants
multivtiamins and mineral gap
energy gap, vitamin A, iron gap in breastfed infants at 6 months
326
```
What is true when measuring height using a stadiometer?
spine should be flat on the wall
height should be measured chin up
buttocks should be flattened on the wall
feet should be in a 45 degree angle
```
buttocks should be flattened on the wall
327
What is true about subcutaneous injection?
the usual site is abdomen, anterior thigh, arm
use a gauge 23 2 cm needle
it should be inserted parallel to the skin
the usual site is abdomen, anterior thigh, arm
328
What is true about intramuscular injection?
it should be inserted perpendicular to the skin
329
Why is a dropper use for infants?
less concentration is needed for infants
it contains greater amount
less volume of medicine is needed for infants
less volume of medicine is needed for infants
330
16. Not part of EPI?
a. BCG
b. Hepa B
c. Pertussis
d. Influenza
d. Influenza
331
As early as ____ can measles be given.
a. 2 mos
b. 3 mos
c. 6 mos
d. 8 mos
c. 6 mos
332
Important for food handlers
a. typhoid
b. Hepa B
c. HiB
d. BCG
a. typhoid
333
A 2 year old child had Kawasaki disease. He was given IVig on Feb 1, 2008. He had not had his measles vaccine. You tell the mom that he can't have his immunization yet. When is the earliest time he can have his immunization? a. January 2009
b. February 2009
c. November 2008
d. December 2008
a. January 2009 – 11 months apart
334
Which can't be given simultaneously?
a. Cholera and Yellow fever
b. OPV and Hep B
c. DPT and Hep B
d. BCG and Measles
a. Cholera and Yellow fever
335
The following is not accepted as a measure to prevent or deal with poisoning in pre-school children
A. Medicines should be kept out of sight and reach of children
B. Items should be kept in original childproof containers
C. Ipecac should be available in case poisoning does occur
D. Keep poison control number handy
C. Ipecac should be available in case poisoning does occur
336
Which of the following statements is false regarding injury?
results from the transfer of energy to the body tissues
results from the impairment of function from lack of vital elements
time between the exposure to the energy and appearance of an injury is short
vast majority are unpredictable, hence unavoidable
vast majority are unpredictable, hence unavoidable
337
Where in the pediatric history would you ask about prenatal, perinatal and antenatal care
a) CC
b) HPI
c) birth and maternal
d) developmental
c)birth and maternal
338
Where in the pediatric history would you ask about domestic violence
a) family history
b) HPI
c) past medical
d) personal/social
d)personal/social
339
where in the pediatric history would you ask about the chronological events of the illness
a) CC
b) HPI
c) past medical
d) personal/social
b)HPI
340
Which of the following is not a complicated migraine?
a. basilar
b. hemiplegic
c. ophthalmoplegic
d. migrainous neuralgia
d. migrainous neuralgia
341
RG, a 10 month old male, with a history of 5 days high grade fever. He was brought at the ER because of generalized seizures at the height of the fever a few minutes PTC. Upon physical examination, he was drowsy and irritable.
Which of the following exams should be taken?
a. EEG
b. CT Scan
c. Lumbar Tap
d. Cranial UTZ
c. Lumbar Tap
342
A 6 year old female with global developmental delay, episodes of abrupt loss of consciousness and loud cry, subsequent jerking of extremities. This girl has..
a. Myoclonal seizures
b. Generalized tonic-clonic seizures
c. Motor seizures with secondary generalization
d. Tonic seizures
b. Generalized tonic-clonic seizures
343
A 16 y.o. comes in for pallor since 1 wk PTC. PE grades bipedal edema, pale conjunctivae, dyspnea, HR:120 bpm, RR: 25 bpm, BP: 140/90 .
CBC: Hgb: 80; Hct: 241; RBC: 5.0x 1012 L.; WBC: 10 x 10 9 L, 60% segmenters, 40 % lymphocytes
Urine: yellow, clear, pH: 5.0, (-) gluc, +4 albumin, 1.010 specific gravity, 8 -10 pus cells/HPF, TNTC
Important parameters in history that should be asked to arrive at a diagnosis:
Symptoms of decompensation
bleeding symptoms
change in urine color
AOTA
AOTA
344
A 16 y.o. comes in for pallor since 1 wk PTC. PE grades bipedal edema, pale conjunctivae, dyspnea, HR:120 bpm, RR: 25 bpm, BP: 140/90 .
CBC: Hgb: 80; Hct: 241; RBC: 5.0x 1012 L.; WBC: 10 x 10 9 L, 60% segmenters, 40 % lymphocytes
Urine: yellow, clear, pH: 5.0, (-) gluc, +4 albumin, 1.010 specific gravity, 8 -10 pus cells/HPF, TNTC
```
PE finding that would point at the most probable diagnosis:
pallor
grade 3 edema
hypertension
dyspnea
```
hypertension
345
A 16 y.o. comes in for pallor since 1 wk PTC. PE grades bipedal edema, pale conjunctivae, dyspnea, HR:120 bpm, RR: 25 bpm, BP: 140/90 .
CBC: Hgb: 80; Hct: 241; RBC: 5.0x 1012 L.; WBC: 10 x 10 9 L, 60% segmenters, 40 % lymphocytes
Urine: yellow, clear, pH: 5.0, (-) gluc, +4 albumin, 1.010 specific gravity, 8 -10 pus cells/HPF, TNTC
```
Least likely diagnosis for this case:
ESRD
Acute glomerulonephritis
HUS
blood dyscrasia
```
blood dyscrasia
346
A 16 y.o. comes in for pallor since 1 wk PTC. PE grades bipedal edema, pale conjunctivae, dyspnea, HR:120 bpm, RR: 25 bpm, BP: 140/90 .
CBC: Hgb: 80; Hct: 241; RBC: 5.0x 1012 L.; WBC: 10 x 10 9 L, 60% segmenters, 40 % lymphocytes
Urine: yellow, clear, pH: 5.0, (-) gluc, +4 albumin, 1.010 specific gravity, 8 -10 pus cells/HPF, TNTC
```
Other Laboratories:
Renal fxn test
PBS
KUB-UTZ
AOTA
```
AOTA
347
Diagnosis of asthma is confirmed when:
FEV1 increases by at least 12% or more after administration of bronchodilator
FEV1 increases by 20% or more after administration of bronchodilator
Peak flow variability ≤ 20%
Wheezing disappears after giving short acting bronchodilator
FEV1 increases by at least 12% or more after administration of bronchodilator
348
```
Which of the following are reliever drugs from asthma:
Formoterol
Salmeterol
Terbutaline
Budesonide
```
Terbutaline
349
```
J. G., 9 yo, male. Known asthmatic since 2 yo, on inhaled fluticasone past 2 weeks. Claims he coughs every after PE class which is 2x a week, uses his salbutamol inhaler around 3x a week, woke up in the middle of the night 2x last week, his level of asthma control is:
Controlled
Partly controlled
Uncontrolled
Intermittent
```
Partly controlled
350
```
Differential diagnosis of nocturnal cough include the following except:
Nasal congestion with postnasal drip
Asthma
Pneumonia
GERD
```
Pneumonia
351
```
Complications of allergic rhinitis except:
Serous otitis media
Eustachian tube dysfunction
Pneumonia
Anosmia
```
Anosmia
352
What is the most common cause of cough in children?
Asthma
Gastroesophageal reflux disease
Bronchiolitis
Acute viral upper respiratory tract infection
Acute viral upper respiratory tract infection
353
```
A patient with mild, intermittent allergic rhinitis can the following drugs EXCEPT:
Oral antihistamine
Topical nasal antihistamine spray
Short course oral steroids
Leukotriene receptor antagonists
```
Short course oral steroids
354
```
A 15 year female has been complaining of constant nasal blockage and ocular pruritus noted in the past year and which has been interfering with her sleep and and school work. Initial medical management will be:
Daily oral antihistamines
Daily antileukotrienes
Decongestants
Topical nasal corticosteroids
```
Daily oral antihistamines
355
A 2-year old fairly nourished boy was brought to your …. for right extremity weakness. On review of history, patient had an unremarkable birth and maternal history. He was apparently well until 6 months of age when mother noted patient to have preferential movement of left-sided extremities. Currently, patient drags his right leg and has decreased arm swing when walking. He can speak 2-word sentences with 60% intelligibility.
```
What is the likely diagnosis?
Todd’s paralysis
Cerebral palsy
Polio
Guillain-Barre syndrome
```
Cerebral palsy
356
A 2-year old fairly nourished boy was brought to your …. for right extremity weakness. On review of history, patient had an unremarkable birth and maternal history. He was apparently well until 6 months of age when mother noted patient to have preferential movement of left-sided extremities. Currently, patient drags his right leg and has decreased arm swing when walking. He can speak 2-word sentences with 60% intelligibility.
```
Which component of the developmental milestones is more severely affected?
Gross motor
Fine motor
language
personal and social
```
Gross motor
357
Which statement regarding cerebral palsy is true?
Cerebral palsy is purely a disorder of movement and posture.
Risk factors are varied
Cerebral palsy is a progressive brain disorder
None of the above
Risk factors are varied
358
```
What are possible risk factors which may result in cerebral palsy?
All below
CNS malformations
Cerebrovascular disorders
Birth asphyxia
```
All below
359
```
What pattern of weakness does patient have?
Quadriplegia
Hemiplegia
Paraplegia
Diplegia
```
Hemiplegia
360
Diarrhea is defined as:
Passage of semi-formed or soft stools at least 6 times in 48 hours
Passage of semi-formed or soft stools at least 3 times in 24 hours
Passage of loose or watery stools at least 6 times in 48 hours
Passage of loose or watery stools at least 3 times in 24 hours
Passage of loose or watery stools at least 3 times in 24 hours
361
```
What is the most common cause of severe diarrhea in infants and children?
Rotavirus and E. coli
Vibrio cholerae
Entamoeba histolytica
Shigella spp
```
Rotavirus and E. coli
362
```
2 year old with diarrhea for 3x over the past 10 hours. (+) lethargy, (+) sunken eyeballs, (+) poor skin turgor but still able to drink from cup. What is the type of dehydration?
Mild dehydration
Moderate dehydration
Some dehydration
Severe dehydration
```
Severe dehydration
363
```
A 4 year old child with a 2-day history of passage of loose stools 6x/day has been given hypertonic drinks such as softdrinks, sweetened fruit juices, salted rice water. A few hours after arrival at the ER, she developed seizure. The most probable electrolyte imbalance is:
Hypernatremia
Hyponatremia
Hyperkalemia
Hypokalemia
```
Hyponatremia
364
True of simple febrile seizures
Axillary temperature of 38oC or greater
Characterized by generalized tonic-clonic seizures
Lasts less than 5 minutes
Can recur within the same febrile illness
Can recur within the same febrile illness
365
```
Gold standard for diagnosis of meningitis
CSF analysis
Cranial UTZ
Cranial CT Scan
Electrocephalogram
```
CSF analysis
366
Lumbar puncture not needed in the ff:
9-month-old with seizure, without meningeal signs
15-month-old with seizure, without meningeal signs
4-year-old with nuchal rigidity
2-year-old with seizure, without meningeal signs
9-month-old with seizure, without meningeal signs
367
```
Most common cause of acute CNS infection?
Bacterial
Viral
Parasitic
Fungal
```
Viral
368
```
Contraindications for doing a Lumbar Puncture:
Recent seizure episode
Hypertension
Stupor
Fever
```
Hypertension
369
```
Infants should be examined by a qualified health care professional in the first few days after discharge to assess infant well-being and the presence or absence of jaundice. A healthy term newborn discharged at 36 hours … should be seen by what age?
72 hours
96 hours
120 hours
7 days
```
7 days
370
Jaundice is observed during the 1st week of life in approximately 60% of term infants and 80% of preterm infants. Which is true regarding physiologic jaundice of the newborn?
Indirect bilirubin cord levels is 1-3 mg/dl and rises at a rate of > 5 mg/dl in 24 hours
Jaundice becomes visible on 1st -3rd day and peaks between the 2nd – 4th days at 5-6 mg/dl
Bilirubin levels decrease to below 2 mg/dl between the 5th – 7th days of life
All of the above
Indirect bilirubin cord levels is 1-3 mg/dl and rises at a rate of > 5 mg/dl in 24 hours
371
Breast feeding jaundice may be due to the following:
Decreased breast milk intake with dehydration
Reduced caloric intake
A and B
None of the above
A and B
372
An exclusively breastfed term newborn developed jaundice on the 3rd day of life. The best advice for the mother is:
Stop breastfeeding temporarily and give formula milk for 3 days then resume breastfeeding
Assure her that it’s just physiologic jaundice
Do early morning sunlight exposure fully unclothed daily
Continue to nurse her infant at least 8-12 times a day
Do early morning sunlight exposure fully unclothed daily
| Continue to nurse her infant at least 8-12 times a day
373
Which of the following interventions does not reduce the incidence of early breastfeeding jaundice?
Frequent breastfeeding
Rooming-in with night feeding
Giving glucose water or water supplementation
Continuous skin-to-skin contact with mother
Giving glucose water or water supplementation
374
```
A 12-year old girl presents with a 6-month history of episodic incapacitating bifrontal, throbbing headaches occurring 3-4x/month associated with nausea and photophobia. The attacks are usually precipitated by skipping meals and eating hotdogs. Her PE and neuro exam were normal. This girl most probably has:
Cluster headaches
Tension-type headaches
Migraine with aura
Migraine without aura
```
Migraine without aura
375
```
A 7-year old boy complains of bifrontal throbbing pain for the past 2 months usually after school occurring almost everyday lasting for 15-30 minutes. These events are usually relieved by rest. Neurological exam is normal. This boy most probably has:
Cluster headache
Tension-type headaches
Migraine with aura
Migraine without aura
```
Migraine with aura
376
```
The following are pain-sensitive structures in the head EXCEPT:
Skin
Muscle
Brain
Arteries
```
Brain
377
```
The most likely diagnosis in garbage inspector presenting with fever, calf tenderness, and jaundice:
Dengue
Leptospirosis
Malaria
Typhoid fever
```
Leptospirosis
378
```
In addition to fever, what is the most frequent manifestation reported among patients with typhoid fever?
Diarrhea
Headache
Rose spots
Vomiting
```
Headache
379
```
Primary pathologic mechanism which increases susceptibility to Salmonella infection in humans:
Asplenia
Complement deficiency
Decreased stomach acidity
Prior cholecystectomy
```
Decreased stomach acidity
380
```
What is the recommended laboratory examination to confirm typhoid fever during the 1st week?
Blood culture
ELISA
Typhidot
Widal test
```
Typhidot
381
```
S. typhi is likely to persist in the following specimen despite adequate antibiotic therapy:
Blood
Bone
Gallbladder
Meninges
```
Gallbladder
382
What is the main pathology for the late intestinal manifestations of typhoid fever?
Necrosis of the site of Salmonella infiltration at Peyer’s patches
Pseudo-obstruction at the ileocecal area
Vasculitis in the rectosigmoid area
Volvulus involving the ileum and cecum
Necrosis of the site of Salmonella infiltration at Peyer’s patches
383
Most likely outcome of a child with typhoid fever wherein the S. typhi is susceptible to all the usual antibiotics and the patient completed a course of an appropriate antibiotic?
Complete cure
Chronic carrier state
High risk of ileal bleeding
Life-long immunity against Salmonella infection
Complete cure
384
```
The positivity of blood culture of S. typhi maybe decrease (sic: may be decreased by)
Impaired host immune response
Profound toxemia
Severity of the disease
Prior antibiotic therapy
```
Prior antibiotic therapy
385
```
The best laboratory test to diagnose patient in carrier state of Typhoid fever is culture of the
Blood
Bile
Urine
Stool
```
Stool
386
```
The most important data to be considered in suspecting Malaria in a patient
Triad of fever, chills, and sweating
Jaundice, tender hepatosplenomegaly
History of travel to Palawan
Fond of eating fishballs
```
History of travel to Palawan
387
The sequence of examination is different in pediatric patients compared to adults. In examining children:
Head to foot examination is recommended
Distressing procedures should be done at once to relieve anxiety
Potentially painful maneuvers should be performed near the end of the examination
Entire PE may be deferred if patient is uncooperative
Potentially painful maneuvers should be performed near the end of the examination
388
```
The stage where the world is experienced through their bodies and are comforted by being cuddled or by familiar touches:
Neonate
Infant
Toodler
Preschooler
```
Infant
389
```
This stage is filled with fantasies and ideologies thus having difficulty distinguishing fantasy from reality:
Toddler
Preschooler
School-aged child
Adolescent
```
Preschooler
390
Which of the following is a true fact about breastmilk:
Increase incidence of atopic dermatitis from diet of mother
Contains less fat in the form of DHA
A good source of nutrients even when given exclusively from 0-12 months
Efficiently used by the baby’s immature system
Efficiently used by the baby’s immature system
391
Advice on breastfeeding should start at the antenatal period and should include the following facts:
Breastmilk alone is the best possible food in the first 6 months of life
The baby does not need milk supplements or glucose water
Let the baby suck as often as he wants
Let the baby finish the first breast before offering him the second
AOTA
AOTA
392
```
Known as the Rooming-in and Breastfeeding Act of 2004:
R.A. 7610
R.A. 7600
R.A. 7620
R.A. 7604
```
R.A. 7600
393
Complementary food should be introduced to an infant 6 months of age using the following method:
Start with “finger foods”
May force feed to attain required weight
Feed with 3 meals and 2 snacks
Do not add salt
Feed with 3 meals and 2 snacks
| Do not add salt
394
Complementary food when given to infants should be:
Hygienically prepared and stored
Suitable for age in terms of frequency and method
Adequate and timely
AOTA
AOTA
395
Normal for Age or Red Flag?
Unable to hold objects by 7 months
Red Flag
396
Normal for Age or Red Flag?
Does not sit independently by 10 months
Red Flag
397
Normal for Age or Red Flag?
Cannot stand on one leg by 3 months
Red Flag
398
Normal for Age or Red Flag?
Does not turn to sound by 3 months
Normal for Age
399
Normal for Age or Red Flag?
Does not babble by 8 months
Normal for Age
400
Normal for Age or Red Flag?
No 2 word phrases by 15 months
Normal for Age
401
Normal for Age or Red Flag?
No social smile by 3 months
Red Flag
402
Normal for Age or Red Flag?
Does not play with other children at 3 years old
Red Flag
403
Normal for Age or Red Flag?
Not searching for dropped objects at 4 months
Normal for Age
404
Normal for Age or Red Flag?
Does not know full name at 2 years old
Normal for Age
