PEDIA FINALS Flashcards
A 7-year-old child has elevated blood pressure on her initial physical examination before school entry. She is asymptomatic and has never been sick. On examination, no murmur is heard. Her heart rate is 90/min, and femoral pulses are delayed compared to radial pulses. You should suspect:
A. Ventricular septal defect
B. Atrial septal defect
C. Coarctation of the aorta
D. Patent ductus arteriosus
A 30-year-old woman delivered a healthy baby at 37 weeks of gestation. She is a known case of chronic hepatitis B infection and is positive for HBsAg but negative for HBeAg. Which of the following is the most appropriate treatment for the baby?
A. Both active and passive immunization soon after birth
B. Passive immunization soon after birth and active immunization at 1 year of age
C. Only passive immunization soon after birth
D. Only active immunization soon after birth
Characteristic laboratory findings in Henoch-Schönlein purpura (HSP) include all of the following EXCEPT:
A. Increased ESR
B. Mild leukocytosis
C. Thrombocytopenia
D. Increased serum IgA
The most feared complication of Kawasaki disease is:
A. Coronary artery aneurysm
B. Congestive heart failure
C. Aseptic meningitis
D. Pericarditis with effusion
All of the following statements are true about congenital rubella syndrome EXCEPT:
A. It is diagnosed when the infant has IgM antibodies at birth
B. It is diagnosed when IgG antibodies persist for more than 6 months
C. Congenital defects include deafness, cardiac malformations, and cataracts
D. Infection after 16 weeks of gestation results in major congenital defects
Kwashiorkor is diagnosed in growth-retarded children along with:
A. Hepatomegaly and anemia
B. Hypopigmentation and anemia
C. Mental retardation and anemia
D. Hypopigmentation and edema
A 2-week-old cyanotic baby had an echocardiogram showing Tetralogy of Fallot (TOF) with pulmonary valve atresia and a PDA. Which treatment will be helpful in keeping the ductus open to improve survival while waiting for definitive treatment?
A. Oxygen
B. NSAIDs
C. PGE1 infusion
D. Dopamine infusion
A 5-month-old infant on cow’s milk formula since birth has failure to thrive and marked arching of the head and neck when being fed, consistent with Sandifer syndrome. Symptoms persist despite prokinetic agents and PPIs. You should consider the following entity:
A. Eosinophilic enteropathy
B. Eosinophilic esophagitis
C. Achalasia
D. Esophageal hernia
A 2-year-old boy presents with three episodes of pneumonia, with one episode associated with blood culture growth of S. pneumoniae since 6 months old. He also has frequent otitis media and sinusitis. He most likely has a deficiency of this component of the immune system:
A. T cells
B. B cells
C. Phagocytes
D. Complement
An 18-year-old boy with mild persistent asthma presents to the ER with a 2-week history of coughing and wheezing that has not improved with twice-daily use of his SABA metered-dose inhaler. On examination, he is breathing comfortably but often coughs and has an audible expiratory wheeze. Oxygen saturation is 95%. Chest X-ray is normal. The most appropriate management step is:
A. Begin a course of outpatient oral steroids
B. Double his steroid MDI dose
C. Increase rescue β₂-agonist every 4 hours
D. Observe the patient
The most cost-effective diagnostic modality for screening choledochal cysts and detecting the triangular cord sign in biliary atresia is:
A. CT scan of the hepatobiliary tree
B. Scout film of the abdomen
C. MRI of the hepatobiliary tree
D. Ultrasound of the liver and gallbladder
A 6-year-old boy has been complaining of headaches and difficulty seeing objects on the sides for 4 months. On examination, he is not mentally retarded, his school grades are good, and visual acuity is diminished in both eyes. Visual field testing shows significant defects. A CT scan of the head shows a suprasellar mass with calcification. Which of the following is the most probable diagnosis?
A. Astrocytoma
B. Craniopharyngioma
C. Pituitary adenoma
D. Meningioma
An anemic child with high serum ferritin, low total iron-binding capacity, and low serum iron most likely has:
A. Iron deficiency anemia
B. Thalassemia syndromes
C. Anemia of chronic disease
D. Aplastic anemia
Which of the following primary immunodeficiencies is characterized by late-onset recurrent bacterial infections, chronic autoimmune hepatitis, lymphadenopathy, and low IgG, IgA, and IgM for age?
A. X-linked agammaglobulinemia
B. Common variable immunodeficiency
C. Chronic granulomatous disease
D. Selective IgA deficiency
The predominant sites of involvement of atopic dermatitis (AD) in older children with chronic-stage disease are:
A. Cheeks and extensor surfaces of extremities
B. Flexor surfaces of extremities
C. Chest and nipples
D. Digits and armpits
What is the most common cancer seen in children aged 0–9 years?
A. Acute leukemia
B. Lymphoma
C. Neuroblastoma
D. Brain tumor
A 2-year-old boy presents to the ER due to a painless abdominal mass. Physical examination reveals aniridia, cryptorchidism, hypospadias, horseshoe kidney, and hemihypertrophy. Urinalysis shows microscopic hematuria. The most likely diagnosis is:
A. Neuroblastoma
B. Hepatoblastoma
C. Rhabdomyosarcoma
D. Wilms tumor
A 5-month-old boy has had a persistent atopic dermatitis rash since birth, recurrent pneumonia despite multiple antibiotic changes, and frequent diarrhea despite changing formulas. His birth weight was 3 kg, and his current weight is 4 kg. Physical examination reveals bilateral crackles. Chest X-ray shows persistent bilateral infiltrates and an absent thymic shadow. CBC shows WBC 10,000/mm³, neutrophils 80%, lymphocytes 10%, monocytes 5%, basophils 2%, and eosinophils 3%. This infant should be worked up for:
A. DiGeorge syndrome
B. Severe combined immunodeficiency
C. Common variable immunodeficiency
D. X-linked agammaglobulinemia
A 15-month-old female presents with a mass noted on a chest X-ray in the superior mediastinal region, associated with left-sided miosis and ipsilateral ptosis. The most likely diagnosis is:
A. Wilms tumor
B. Neuroblastoma
C. Acute leukemia
D. Rhabdomyosarcoma
Which of the following bleeding disorders is diagnosed in older children and characterized by mucosal bleeding such as epistaxis, uterine bleeding, or bleeding with dental procedures?
A. von Willebrand disease
B. Factor XI deficiency
C. Hemophilia A
D. Hemophilia C
The following clinical manifestations of zinc deficiency are NOT reported in children:
A. Dwarfism and hypogonadism
B. Impaired cell-mediated immunity
C. Liver and spleen enlargement
D. Macrocytic anemia
A 3-year-old male was noted to have >30% microspherocytes in his peripheral blood smear. What laboratory test will you do to confirm your diagnosis?
A. Enzyme assay
B. Osmotic fragility test
C. Hemoglobin electrophoresis
D. Coombs test
You are evaluating a 16-year-old varsity volleyball player. The girl’s height is 6 feet, weight 60 kg, and BP 115/75. She has scoliosis and a Grade 3/6 holosystolic murmur heard at the cardiac apex with radiation to the left axilla. The most likely diagnosis for this patient is:
A. Marfan syndrome
B. Ehlers-Danlos syndrome
C. Rheumatic heart disease
D. Williams syndrome
A 3-month-old male child with normal genitalia presents to the ER with severe dehydration, hyperkalemia, and hyponatremia. Measuring blood levels of which of the following will be helpful?
A. 17-hydroxyprogesterone
B. Renin
C. Cortisol
D. Aldosterone
Which one of the following is the most common cause of congenital hydrocephalus?
A. Craniosynostosis
B. Intrauterine meningitis
C. Aqueductal stenosis
D. Malformation of the great vein of Galen
A mother delivers a 36-week neonate with meconium staining and an Apgar score of 3 at both 1 and 5 minutes of life. She had no prenatal care, and the delivery was by emergency C-section for severe bradycardia. Which of the following sequelae is most likely to happen in this baby?
A. Pneumonia
B. Respiratory distress syndrome
C. Pulmonary interstitial emphysema
D. Persistent pulmonary hypertension
The most appropriate treatment for adolescents with constitutional delay of growth and puberty is:
A. Growth hormone replacement
B. Thyroid hormone replacement
C. Testosterone injection
D. Reassurance
A 1-month-old boy is referred for failure to thrive. On examination, he shows features of congestive heart failure. The femoral pulses are diminished compared to the brachial pulses. The most likely clinical diagnosis is:
A. Congenital aortic stenosis
B. Coarctation of the aorta
C. Patent ductus arteriosus
D. Interrupted aortic arch
B. Coarctation of the aorta
Rationale: Diminished femoral pulses compared to brachial pulses suggest coarctation of the aorta, a congenital narrowing that obstructs systemic blood flow.
A disorder characterized by a deficiency of Galactose-1-phosphate uridyl transferase, associated with cataracts, is:
A. Glycogen storage disease
B. Galactosemia
C. Benign fructosuria
D. Phenylketonuria
The most practical and expeditious method for treating patients with severe hyperammonemia is:
A. Exchange transfusion
B. Hemodialysis
C. Peritoneal dialysis
D. Diet therapy
A small-for-gestational-age infant is born to a 36-year-old woman. At birth, the infant is noted to have low-set and malformed ears, microcephaly, rocker-bottom feet, inguinal hernias, cleft lip and palate, micrognathia, and a heart murmur. Chromosome analysis is likely to reveal which of the following?
A. Turner syndrome
B. Trisomy 18
C. Trisomy 13
D. Trisomy 21
A term newborn infant delivered vaginally has dysmorphic features, including microcephaly, slanted eyes, low-set ears, a flat nasal bridge, a large tongue, cryptorchidism, an umbilical hernia, and a heart murmur. This infant is most likely to have which of the following?
A. Holt-Oram syndrome
B. Trisomy 18
C. Trisomy 21
D. Down syndrome
Which of the following diseases follows an autosomal recessive inheritance pattern?
A. Marfan syndrome
B. Galactosemia
C. Ehlers-Danlos syndrome
D. Hereditary spherocytosis
A tall, thin 14-year-old boy has delayed signs of puberty, delayed speech development, and behavioral differences. Physical examination reveals breast development, long limbs, an infantile phallus and testes with low volume, and infertility. The most likely diagnosis is:
A. Klinefelter syndrome (47,XXY)
B. XYY syndrome
C. Turner syndrome (45,X0)
D. Fragile X syndrome
A 15-year-old girl with primary amenorrhea is noted to be well below the 5th percentile for height for her age. Her vital signs are significant for hypertension. On examination, she has a low posterior hairline, prominent and low-set ears, and excessive nuchal skin. The most likely diagnosis is:
A. Klinefelter syndrome
B. XYY syndrome
C. Turner syndrome
D. Fragile X syndrome
A 1-year-old infant was accidentally found to have a heart murmur. He has upslanted eyes with hypertelorism, low-set ears, and a Simian crease on the palms. The congenital heart defect most likely associated with this condition is:
A. Coarctation of the aorta
B. Atrioventricular septal defect
C. Patent ductus arteriosus
D. Pulmonary stenosis
The most common etiologic agent for early-onset sepsis in newborns in the local setting is:
A. Viral
B. Gram-negative bacilli
C. Gram-positive cocci
D. Fungal
A 5-year-old girl presents with a history of progressively increasing pallor since birth and hepatosplenomegaly. Which of the following is the most relevant test for achieving a diagnosis?
A. Hemoglobin electrophoresis
B. Peripheral blood smear examination
C. Osmotic fragility test
D. Bone marrow examination
A 2-year-old child was brought in due to ritualistic behavior. He was withdrawn and spent hours in solitary play. He had an impaired ability to sustain conversation and social interaction. He also exhibited nonsense rhyming and other idiosyncratic language forms. The most probable diagnosis is:
A. Habit disorder
B. Conduct disorder
C. Autism
D. Schizophrenia
A 3-year-old boy who is intubated for severe asthma is showing signs of acute respiratory and cardiac deterioration, evidenced by tachypnea, tachycardia, decreased BP, and an oxygen saturation of 75%. On examination, you note a marked shift of the trachea to the left and decreased aeration on the right side. The most likely cause of this boy’s sudden respiratory deterioration is:
A. Ventilator-associated pneumonia
B. Tension pneumothorax
C. Endotracheal tube obstruction
D. Exacerbation of underlying asthma
A 10-month-old infant is brought to the ER due to fussiness for one day. The mother reports that she was carrying him while answering the phone, and he fell from her arms to the floor. Examination shows a thin boy who is crying, resists weight-bearing on the left leg, and has bruises on the left temporal region, upper arm, and thighs. You suspect non-accidental trauma and order a skeletal survey. The skeletal survey finding that is most consistent with non-accidental trauma is:
A. Metaphyseal chip fracture
B. Spiral tibial fracture
C. Linear nondisplaced skull fracture
D. Long bone nondisplaced shaft fracture
The presence of pulmonary hypertension complicating congenital heart disease is manifested by which clinical finding?
A. Widely split S2
B. Loud P2
C. (+) Systolic thrill
D. Displaced apex beat to the 5th left intercostal space
A 3-month-old severely cyanotic baby presents with a systolic murmur (Grade 3/6) at the left mid-sternal border. S1 is normal, and S2 is single and accentuated. On chest X-ray, the cardiac silhouette shows an “egg on its side” appearance. You will most likely consider this congenital heart disease (CHD):
A. Total anomalous pulmonary venous return (TAPVR)
B. Truncus arteriosus
C. D-transposition of the great arteries (D-TGA)
D. Tetralogy of Fallot (TOF)
A 1-year-old infant has been diagnosed with pink Tetralogy of Fallot. He most likely has mild:
A. Pulmonary stenosis
B. Ventricular septal defect
C. Overriding aorta
D. Right ventricular hypertrophy
A patient develops gross hematuria three days after an attack of an upper respiratory tract infection (URTI). Which of the following is responsible?
A. Drug abuse
B. Acute glomerulonephritis
C. Minimal change disease
D. IgA nephropathy
An otherwise healthy 7-year-old child is brought to you for evaluation because he is the shortest child in his class. Careful measurement of his upper and lower body segments demonstrates normal body proportions for his age. Which of the following disorders of growth is likely?
A. Skeletal dysplasia
B. Morquio disease
C. Central hypothyroidism
D. Growth hormone deficiency
A 4-month-old male infant has generalized weakness, hypotonia, areflexia, and tongue fasciculations. The most likely diagnosis is:
A. Infant botulism
B. Dandy-Walker malformation
C. Werdnig-Hoffman disease
D. Juvenile myasthenia gravis
Which of the following statements about Simple Febrile Seizure is correct?
A. Seizures are focal, lasting for >15 minutes
B. Child has normal neurologic examination findings
C. It is caused by severe metabolic disturbances
D. Seizures recur twice within 24 hours of fever
B. Child has normal neurologic examination findings
Rationale: Simple febrile seizures are generalized, last <15 minutes, do not recur within 24 hours, and are associated with normal neurological examination findings.
A 12-year-old boy develops a severe headache, photophobia, and vomiting. He is febrile, with BP 140/90 mmHg. Cranial nerve and motor examinations are non-focal. He has nuchal rigidity and a positive extensor plantar response. The most appropriate study to obtain at this time is:
A. CSF analysis
B. EEG
C. CT scan
D. Skull X-ray
A 6-year-old boy complains of a 4-day history of low back pain and difficulty walking. On examination, you note weakness in the lower extremities and absent tendon reflexes. Sensory function is intact. MRI of the spine is normal. Which one of the following is the most likely diagnosis?
A. Duchenne muscular dystrophy
B. Guillain-Barré syndrome
C. Myasthenia gravis
D. Acute poliomyelitis
Patients with tuberculous (TB) meningitis have these characteristic CSF findings:
A. Decreased glucose, increased proteins, decreased lymphocytes
B. Increased glucose, decreased proteins, decreased lymphocytes
C. Increased glucose, increased proteins, increased lymphocytes
D. Decreased glucose, increased proteins, increased lymphocytes
A 12-week pregnant woman makes an appointment with her OB to discuss spina bifida, as her cousin had an affected infant. Which of the following statements is most likely?
A. The defect invariably leads to severe neurological impairment
B. Neural tube defects cannot affect the brain directly or indirectly
C. Neural tube defects arise due to a failure of the neural tube to close
D. Screening will show a low alpha-fetoprotein (AFP) if she has an affected infant
The most likely abnormality in patients with type 2 diabetes mellitus is:
A. Insulin resistance
B. Dyslipidemia
C. Autoimmune destruction of pancreatic β cells
D. Insulin underproduction
- One month PTA, a 5-year-old boy known asthmatic presents with puffy eyelids upon waking up in the morning, initially subsiding by midday, persisting throughout the day, with tightening waistline. Urinalysis shows 4+ proteinuria, serum albumin 2g/dL, and serum cholesterol elevated. C3 is normal. What should be your next step?
A. Give furosemide
B. Start prednisone
C. Request ANA titer
D. Perform kidney biopsy
One of the following statements regarding “breath-holding spells” is NOT true:
A. It is fairly common in the first 2 years of life
B. It does not contribute to an increased risk of seizure disorders
C. Parents are advised to ignore and not reinforce these attacks
D. It must be immediately attended to prevent hypoxia and onset of seizures
The appropriate approach to a neonate presenting with vaginal bleeding on day 4 of life is:
A. Administration of vitamin K
B. Investigation for a bleeding disorder
C. Administration of 10 mL/kg of fresh frozen plasma over 4 hours
D. No specific therapy
A 1-month-old infant was hospitalized for acute gastroenteritis caused by rotavirus. Her diarrhea improved with ORS, but when the mother resumed her usual cow’s milk formula, she had an increased number of watery stools. She appears well-hydrated, and abdominal examination is normal. The most appropriate approach to treat this infant’s diarrhea is:
A. Give her only ORS until the diarrhea resolves
B. Administer IV fluid therapy
C. Change to a lactose-free formula for the next few days
D. Dilute the cow’s milk formula with ORS for the next few days
A true statement regarding migraine headache in children is:
A. The headache is usually associated with aura
B. Headache is usually squeezing, tight-band-like in quality
C. The headache is usually associated with nausea, vomiting, and photophobia
D. Location of the pain is usually posterior and associated with neck muscle pain
Which of the following is an autoimmune disorder of the neuromuscular junction caused by autoantibodies binding to postsynaptic acetylcholine receptors?
A. Duchenne muscular dystrophy
B. Spinal muscular atrophy
C. Myasthenia gravis
D. Guillain-Barré syndrome
Secondary nephrotic syndrome should be suspected in patients with proteinuria and:
A. Age of 3 years old
B. Normal C3
C. Serum albumin of 1.5 g/dL
D. High blood pressure
Acute post-streptococcal glomerulonephritis (APSGN) in childhood:
A. Is most common between 6 months and 3 years of age
B. Heavy proteinuria is a common clinical feature
C. Typically develops 2-3 weeks after streptococcal infection of the skin or throat
D. Usually presents as severe renal failure
A 15-year-old patient was brought to the pediatrician due to decreased urine output for 1 week. Physical examination reveals stunted growth and pallor. Lab results show Hgb 6 g/dL, BUN 100 mg/dL, and creatinine 20 mg/dL. His anemia is primarily due to:
A. Fluid retention
B. Iron deficiency
C. Probable bleeding
D. Inadequate erythropoietin production
An 8-year-old girl presents with a distended abdomen and periorbital swelling. She is otherwise well and has no gastrointestinal symptoms. You suspect nephrotic syndrome. This condition is typically accompanied by:
A. Enlarged kidneys on ultrasound
B. Heavy proteinuria on urinalysis
C. Hypertension
D. Macroscopic hematuria
The presence of renal parenchymal scarring due to vesicoureteral reflux is best demonstrated by:
A. Renal DMSA scan
B. Renal ultrasonography
C. Voiding cystourethrogram (VCUG)
D. Intravenous pyelography (IVP)
A 2-year-old boy with chronic renal failure is brought to the ER for evaluation of nausea, fatigue, and muscle weakness. On examination, HR is 140/min, perfusion is decreased, and pulses are feeble. ECG shows peaked T waves, and lab results reveal serum potassium 7.5 mEq/L and glucose 72 mg/dL. The most appropriate initial treatment is administration of:
A. Calcium gluconate 10%
B. Plain NSS 20 cc/kg
C. Verapamil
D. Insulin
You are evaluating a 9-year-old girl who has had increasing constipation for the last 4 months, having previously had a normal bowel habit. The rest of her history and examination are normal. She is not on any medications. What is the next step in management?
A. Dietary advice will not be of help
B. A referral for a rectal suction biopsy should be made
C. The first step would be a manual evacuation
D. An osmotic laxative will be useful initially
A 2-hour-old neonate presents with cyanosis and tachypnea. To quickly differentiate pulmonary from cardiac causes of cyanosis, this screening procedure can be done:
A. Hyperoxia test
B. Hyperventilation test
C. 15-lead ECG
D. Chest X-ray
There is an increased risk for neonatal infection when rupture of membranes exceeds how many hours?
A. 8
B. 12
C. 18
D. 24
A 6-year-old boy presents with bright red blood and clots in the urine. There is no history of trauma, dysuria, frequency, urgency, or back pain. On examination, he is afebrile, HR 76, RR 14, BP 110/68. Urinalysis shows 3+ RBCs, pH 6.5, SG 1.025, no casts, and WBC 0-5/hpf. BUN/creatinine ratio is normal. The most appropriate next test is:
A. Renal scan
B. Intravenous pyelogram (IVP)
C. Renal ultrasound
D. Voiding cystourethrogram (VCUG)
The most definitive diagnostic procedure for persistent pulmonary hypertension of the newborn (PPHN) is:
A. Cardiac catheterization
B. Hyperoxia-hyperventilation test
C. Real-time fluoroscopy
D. 2D-Echocardiography
An 18-month-old girl has been having intermittent, non-productive cough for the past 8 weeks. Her parents state that the cough awakens her at night a few times a month. During a recent upper respiratory tract infection, her cough worsened and occurred daily for 3 weeks. On examination, there is no nasal discharge, and she appears healthy. The most likely diagnosis is:
A. Gastroesophageal reflux
B. Bronchial asthma
C. Atypical pneumonia
D. Infectious laryngitis
A large-for-gestational-age infant at birth, accompanied by macroglossia, umbilical hernia, and hyperinsulinemic hypoglycemia, is consistent with the diagnosis of:
A. Ketotic hypoglycemia
B. Hypopituitarism
C. Glycogen storage disease
D. Beckwith-Wiedemann syndrome
This is an acute complication of Type 1 diabetes, characterized by hyperglycemia (blood glucose >300 mg/dL), acidosis (pH <7.3, bicarbonate <14 mg/L), and ketonemia:
A. Diabetic ketoacidosis
B. Acute renal failure
C. Hyperosmolar coma
D. Neuropathy
The most sensitive and dynamic test for detecting thyroid hormone deficiency is:
A. Free T4 (FT4)
B. Free T3 (FT3)
C. Thyroid-stimulating hormone (TSH)
D. Thyroglobulin
A 15-year-old boy presents with acute asthma exacerbation. His peak flow rate (PFR) is 200 L/min, way below his previous best at 400 L/min. Based on his PFR reading, his asthma exacerbation is considered:
A. Mild
B. Moderate
C. Severe
D. Impending respiratory failure
A 6-year-old child presents with high fever, sore throat, and dyspnea with air hunger. His mouth is kept open, and he is leaning forward. These are characteristic features of:
A. Laryngotracheobronchitis
B. Epiglottitis
C. Peritonsillar abscess
D. Retropharyngeal abscess
A 5-year-old boy was brought by his father to the ER with a complaint of left shoulder pain and fever for 1 week. On examination, he is febrile (T 39.1°C), HR 95, RR 24, BP 96/55 mmHg. His left shoulder is warm and tender on palpation with a decreased range of motion. Lab results show WBC 17,000/cu mm, ESR 46, and CRP 18. The most likely diagnosis is:
A. Shoulder dislocation
B. Humerus fracture
C. Septic arthritis
D. Transient synovitis
A 2-year-old child is brought to a primary health center with complaints of fever and cough for the past 2 days. On examination, his weight is 10 kg, respiratory rate is 44, and chest indrawing is present. The most appropriate management is:
A. Classify as pneumonia, start antibiotics, and advise follow-up after 2 days
B. Classify as severe pneumonia and refer urgently
C. Classify as pneumonia and refer to a higher center
D. Classify as severe pneumonia, start antibiotics, and refer immediately to the hospital
A 2-year-old boy presents with intermittent abdominal pain and vomiting. He seems fine between pain episodes. Today, he has persistent bilious vomiting and bloody stools. Examination shows a child in distress, tachycardic, febrile, with a diffusely tender abdomen and a “sausage-shaped” mass in the right upper quadrant. The most likely diagnosis is:
A. Pyloric stenosis
B. Ileal atresia
C. Intussusception
D. Hirschsprung’s disease
The approved indications for growth hormone therapy include all of the following EXCEPT:
A. Prader-Willi syndrome
B. Small for gestational age (SGA) with no catch-up growth
C. Turner syndrome
D. Familial or genetic short stature
An infant born at 30 weeks gestation, now at a corrected age of 36 weeks, is found to have a Grade 3/6 murmur mostly in systole in the left subclavian area with bounding pulses. The most likely congenital heart disease is:
A. Atrial septal defect (ASD)
B. Ventricular septal defect (VSD)
C. Pulmonary stenosis
D. Patent ductus arteriosus (PDA)
An 8-year-old female child develops a maculopapular rash on the jaw, which spreads onto the trunk and clears on the third day without desquamation. She also has tender post-auricular and suboccipital lymphadenopathy. The most likely diagnosis is:
A. Kawasaki disease
B. Erythema infectiosum
C. Rubella
D. Measles
Which of the following conditions primarily affects the anterior horn cells of the spinal cord and has mostly been eradicated due to attenuated/killed virus vaccination?
A. Guillain-Barré syndrome
B. Poliomyelitis
C. Myasthenia gravis
D. Rabies
Which of the following infections is associated with Human Parvovirus B19?
A. Roseola infantum
B. Hand-foot-and-mouth disease
C. Erythema infectiosum
D. Croup
A 6-year-old male presents with recurrent otitis media, seborrheic dermatitis, intermittent fever, and polyuria. Skin biopsy and immunostaining are positive for CD1a, confirming the diagnosis of Langerhans cell histiocytosis. His polyuria is most likely due to:
A. Central diabetes insipidus (DI)
B. Nephrogenic diabetes insipidus (DI)
C. Psychogenic DI
D. Cerebral salt wasting
A 10-year-old boy suddenly develops brief, jerky, non-stereotyped movements that are difficult to describe and occur only while awake, affecting his daily activities. His penmanship deteriorated, and occasionally, his pens or utensils would fling out of his grasp. The primary consideration for this previously well boy should be:
A. Motor Tic
B. Sydenham’s chorea
C. Myoclonus
D. Tourette syndrome
Delayed speech in a 5-year-old child with normal motor and adaptive development is most likely due to:
A. Deafness
B. Kernicterus
C. Cerebral palsy
D. Mental retardation
A 2-year-old boy with a history of recurrent cervical adenitis and pneumonia presents with a perianal abscess, consistent with a diagnosis of:
A. Wiskott-Aldrich syndrome
B. DiGeorge syndrome
C. Ataxia-telangiectasia
D. Chronic granulomatous disease
A 9-month-old boy develops an evanescent, erythematous, maculopapular rash following the defervescence of a 3-day fever. The most likely associated organism is:
A. Rubella
B. Measles virus
C. Human herpesvirus-6
D. Coxsackie B virus
A 6-month-old male infant develops large hematomas after IM vaccinations. At 1 year old, he develops swelling of the right knee. Family history is negative for bleeding problems. He should be worked up for:
A. von Willebrand disease
B. Vitamin K deficiency
C. Idiopathic thrombocytopenic purpura
D. Hemophilia
A 1-year-old boy presents with a history of multiple episodes of otitis media, sinusitis, and pneumonia. He has not had any fungal, protozoal, or mycobacterial infections. You suspect a humoral immunity disorder. What laboratory test is helpful to make a diagnosis?
A. Peripheral blood smear
B. Total hemolytic complement (CH50)
C. Dihydrorhodamine flow cytometry test
D. Serum immunoglobulin determination
A 2-month-old male infant presents with jaundice since 6 weeks ago. He has persistently acholic stools and dark-colored urine. Laboratory findings show total bilirubin 15 mg/dL (B1: 2 mg/dL, B2: 13 mg/dL). Liver biopsy shows bile ductular hyperplasia. The most likely diagnosis is:
A. Idiopathic neonatal hepatitis
B. Extrahepatic biliary atresia
C. Alagille syndrome
D. Rotor syndrome
A 3-year-old girl presents with acute gum bleeding and cutaneous petechial lesions. She was previously well, except for a 3-day history of malaise, fever (38°C), colds, and cough 2 weeks ago. She is suspected to have acute immune thrombocytopenic purpura (ITP). Which of the following is expected in her laboratory findings?
A. Hemoglobin 5 g/dL
B. Few and small platelets on peripheral smear
C. Few large “sticky” platelets on blood smear
D. WBC of 100,000/mm³ with lymphocytic predominance
A 15-year-old boy presents with painless, non-tender, firm, rubbery cervical lymphadenopathy and unexplained fever >39°C, weight loss >10% of total body weight in a month, drenching night sweats, and pruritus. Chest X-ray shows a widened mediastinum. He most likely has:
A. Acute lymphoblastic leukemia
B. Acute myelogenous leukemia
C. Hodgkin lymphoma
D. Non-Hodgkin lymphoma
A 7-year-old girl has had 5 days of fever, conjunctivitis, erythema of the oropharynx, strawberry tongue, and a polymorphous truncal rash. She has enlarged cervical lymph nodes. Which of the following laboratory tests would NOT be used to establish the diagnosis?
A. Complete blood count (CBC)
B. C-reactive protein (CRP)
C. Erythrocyte sedimentation rate (ESR)
D. Antinuclear antibody (ANA)
At birth, a term newborn infant is noted to have hydrocephalus and intracranial calcifications on CT scan of the head. Eye examination shows bilateral chorioretinitis. He most likely has an intrauterine infection with:
A. Varicella
B. Syphilis
C. Toxoplasmosis
D. Cytomegalovirus
A 2-year-old female with microcytic hypochromic anemia was given adequate oral iron for more than 8 weeks, but there was no improvement in hemoglobin levels. What should be considered in the differential diagnosis?
A. G6PD deficiency
B. Hereditary spherocytosis
C. Thalassemia
D. Autoimmune hemolytic anemia
A 2-year-old child has a Mantoux test reading of >10 mm induration after 48 hours. In this case:
A. Anti-TB drugs should be started even if chest X-ray and CBC are normal
B. Treatment should be started only if chest X-ray and CBC are suggestive
C. One should wait until overt signs of TB appear
D. No treatment is required
In Hodgkin lymphoma, these are the three systemic symptoms considered as “B” symptoms, which are important in staging:
A. Lethargy, malaise, anorexia >4 weeks
B. Pruritus, pallor, intractable cough >2 weeks
C. Urticaria, bone pain, abdominal pain >4 weeks
D. Fever, night sweats, weight loss >10%
A 6-week-old female infant is brought by her mother for a well-baby check-up. The examination is normal except for a Grade 3/6 holosystolic murmur at the lower left sternal border without radiation. The most likely diagnosis is:
A. Ventricular septal defect (VSD)
B. Atrial septal defect (ASD)
C. Patent ductus arteriosus (PDA)
D. Atrioventricular septal defect (AVSD)
