RESPI

Question 1

What ABG result can you expect if the cause is an imbalance between respiratory muscle and strength load?

a. Respiratory acidosis
b. Respiratory alkalosis
c. Metabolic acidosis
d. Metabolic alkalosis

Answer 1

a. Respiratory acidosis

Question 2

form of disseminated tuberculosis is of insidous onset, presenting with dyspnea, cough, rales with associated weight loss, low grade fever. Diagnosis is via high index of suspicion, with chest xray findings of millet seed densities. This form of TB is:

a. Pott’s disease
b. Reactivation tuberculosis
c. Miliary tuberculosis
d. Chronic pulmonary tuberculosis

Answer 2

c. Miliary tuberculosis

Question 3

4.What is the drug of choice for patients classified under PCAP C with incomplete or unknown status of HiB vaccination?

a. Penicillin G 100,000 units/kg/day every 6 hours
b. Ampicillin 100 mg/kg/day every 6 hours
c. Clarithromycin 10 mg/kg/day BID for 7 days
d. Oral amoxicillin 40 - 50 mg/kg/day TID, for 7 days

Answer 3

b. Ampicillin 100 mg/kg/day every 6 hours

Question 4

What is the ideal management for bronchiolitis?

a. Supportive management, Hospitalization for those with respiratory distress, supplemental oxygen for hypoxemic children, supplemental hydration
b. Supportive management, supplemental oxygen for hypoxemic children
c. Supportive management, hydration, frequent suctioning of nasal and oral secretions, use of
corticosteroids
d. Supplemental oxygen, hydration and use of albuterol and corticosteroids

Answer 4

a. Supportive management, Hospitalization for those with respiratory distress, supplemental oxygen for hypoxemic children, supplemental hydration

Question 5

Sandra, 4 years old female, came in for shortness of breath, accompanied by fever and cough noted 3 days prior to admission. She was brought to the emergency room, quick physical examination findings of the patient: Temp 38C RR 40cpm, HR 110 bpm, O2sat 90% (room air). Chest and lung findings of equal chest expansion, (+) subcostal and intercostal retractions, dullness in percussion, crackles on auscultation. Based on PE is the case considered a restrictive or obstructive disease, probably manifesting as what condition?

a. Obstructive disease, Asthma
b. Restrictive disease, Pneumonia
c. Obstructive disease, Pneumothorax
d. Restrictive disease, Atelectasis

Answer 5

b. Restrictive disease, Pneumonia

Question 6

Adventitious sound of crackles is an indication of involvement in the central and lower airways, presence of such respiratory sound could mean?
a. Airway obstruction and flow limitation
b. Airway closure and secretions
c. Secretions, abnormal airway collapsibility
d. Rupture of fluid films and airway wall vibration

Answer 6

b. Airway closure and secretions

Question 7

What could be the cause of Pulmonary sequestration?
a. Result from abnormalities in the aortic arch complex
b. Due to a non functioning pulmonary tissue that has no connection with the tracheobronchial tree
c. Insult occurs during the embryonic stage, resulting in the absence of bronchi, airways, pulmonary
vasculature and lungs
d. Overexpansion of a pulmonary lobe caused by bronchial mucosa redundancy

Answer 7

B. Due to a non functioning pulmonary tissue that has no connection with the tracheobronchial tree

Question 8

What causative agent would have a pleural fluid appearance that is “Anchovy” brown?
a. Chylothorax
b. Staphylococcus aureus
c. Entamoeba histolyticum
d. Group A Streptococcus

Answer 8

c. Entamoeba histolyticum

Question 9

Congenital Cystic Adenomatoid Malformation (CCAM) has three types. Which of the following best describes type II?
a. It is a precursor of pleuropulmonary blastoma or mucinous bronchoalveolar carcinoma
b. Grossly consists of a single large cyst or several large cysts that are >2cm in diameter
c. Rarely associated with other congenital anomalies and affects only a part of a lobe
d. Consists of multiple small cysts that are <2cm in diameter

Answer 9

d. Consists of multiple small cysts that are <2cm in diameter

Question 10

What is the pathogenesis for Acute otitis media?
a. Eustachian tube in children is shorter and more horizontal thus interferes with the gravitational drainage of nasopharyngeal secretions.
b. Increased mucus secretion due to inflammation and impaired mucociliary function causing pooling of nasopharyngeal secretions.
c. Obstruction of the sinus ostium due to inflammatory changes in the nasal epithelium provides favorable milieu for bacterial colonization.
d. Viruses trigger the inflammatory response by direct mucosal invasion and disruption of the eustachian tube.

Answer 10

a. Eustachian tube in children is shorter and more horizontal thus interferes with the gravitational drainage of nasopharyngeal secretions.

Question 11

This specific pleural fluid level confirms presence of Chylothorax:
a. Pleural fluid triglyceride of >110 mg/dL
b. Pleural fluid with >5,000 leukocytes
c. Pleural fluid comprising >50% lymphocytes
d. Pleural fluid amylase >100 mg/dL

Answer 11

a. Pleural fluid triglyceride of >110 mg/dL

Question 12

Tiffany, 5 years old female, came in for cough, with colds associated with fever (Temp range: 38 - 38.6C), with sensation of lump when swallowing and hyposmia noted 4 days prior to consult. Physical examination revealed swollen nasal turbinates, hypertrophic tonsils without exudates, with clear breath sounds on auscultation. Other examination findings were unremarkable. What would be your working diagnosis for this patient?
a. Allergic rhinitis
b. Acute pharyngitis
c. Acute rhinitis
d. Sinusitis

Answer 12

c. Acute rhinitis

Question 13

This specific Pediatric interstitial lung disease (ILD) occurs due to involvement of lateral viral infections causing
injury to the alveolar epithelium:
a. Exposure related ILD
b. ILD specific to infancy
c. Systemic disease associated
d. Alveolar structure disorder associated

Answer 13

d. Alveolar structure disorder associated

Question 14

One diagnostic method in assessing patients presenting with respiratory distress is to do an Arterial Blood Gas (ABG). If you are given this ABG result: pH 7.33, PCO2 30 mmHg, PO2 90 mmHg, HCO3 18 mmol/L, BE -5, O2 sat 97%. What will your interpretation be?
a. Metabolic acidosis
b. Respiratory acidosis
c. Respiratory alkalosis
d. Metabolic alkalosis

Answer 14

a. Metabolic acidosis

Question 15

What condition will present with weakness, lethargy, productive cough, hemoptysis accompanied by abdominal discomfort and pneumonia?
a. Legionella pneumonia
b. Mycoplasma pneumonia
c. Chlamydophila pneumonia
d. Atypical pneumonia

Answer 15

a. Legionella pneumonia

Question 16

Mark, 5 years old was admitted because of difficulty in breathing after having colds for 2 days which was
later accompanied by cough. According to his mother he talks in words in order to communicate and is noted to be agitated. Further examination revealed the following vital signs: RR 40 cpm O2sat 88% (room air) HR 123 bpm Temp 36.5C with auscultatory findings of wheezing with intercostal, subcostal and suprasternal retractions. You diagnosed this patient for Bronchial asthma in severe exacerbation. Management was given accordingly, however on the 2nd hospital stay, he suddenly complained of acute chest pain and shortness of breath with desaturations despite adequate oxygen supplementation. Chest PE findings of chest lagging on the right with diminished breath sound on the same side. Repeat chest xray revealed findings for Pneumothorax. What initial management must you perform for this patient?

a. Closed tube thoracotomy
b. Open thoracotomy
c. Emergency needle thoracentesis
d. Supplemental O2 at high concentrations

Answer 16

c. Emergency needle thoracentesis

Question 17

What is the most severe complication of acute sinusitis?
a. Osteomyelitis of the facial bones
b. Periobital cellulitis
c. Meningitis
d. Mastoiditis

Answer 17

c. Meningitis

Question 18

Congenital lobar emphysema can result to overexpansion of a pulmonary lobe caused by either intraluminal obstruction or extraluminal compression. Extrinsic compression is caused by:

a. Endobronchial granuloma
b. Abnormal vessels or mass lesions
c. Inspissated mucus
d. Bronchial cartilage deficiency

Answer 18

b. Abnormal vessels or mass lesions

Question 19

In interpreting the Tuberculin skin test, an induration of 5mm is considered as the positive cut off size in this group if:
a. Children ≥4years old without any risk factors
b. Children exposed to adults with HIV infection, users of illicit drugs, residents of nursing homes
c. Children with other medical conditions (Hodgkin disease, lymphoma, malnutrition, chronic renal failure)
d. Children receiving immunosuppressive therapy or with immunosuppressive conditions such as HIV
infection

Answer 19

d. Children receiving immunosuppressive therapy or with immunosuppressive conditions such as HIV
infection

Question 20

What preventive measure can you advice for patients diagnosed for Bronchiectasis?
a. Annual influenza vaccination and pneumococcal vaccination every 5 years
b. No preventive measures needed
c. Deep breathing exercises
d. Chest physiotherapy

Answer 20

a. Annual influenza vaccination and pneumococcal vaccination every 5 years

Question 21

You received a baby with and apgar score of 4,6,7, in respiratory distress with episodes of cyanosis and apnea, which you eventually intubated. Further digging in the patient’s history, mother was noted to have oligohydramnios prior delivery with decreased fetal movements. Physical examination revealed: breath sounds diminished on both sides, dull to percussion, with desaturation despite being hooked to a mechanical ventilator. Chest xray revealed small lung with mediastinal ipsilateral shift and compensatory hyperinflation. With these findings what could be your working impression?

a. Pulmonary sequestration
b. Tracheoesphageal fistula
c. Congenital lobar emphysema
d. Pulmonary aplasia

Answer 21

d. Pulmonary aplasia

Question 22

What preoperative management must be done for cases with confirmed tracheoesophageal fistula and esophageal atresia?
a. Chest tube placement to evacuate any leakage from esophageal anastomosis
b. Gastrostomy tube should be placed for feeding access
c. Do end to end esophageal anastomosis
d. Evaluate for associated VACTERL anomalies

Answer 22

d. Evaluate for associated VACTERL anomalies

Question 23

The Pathogenesis of Progressive Primary TB occurs in this setting:
a. There is reinfection with M. tuberculosis and the apices of the lungs are most often affected
b. When the immune system is weakened and fails to control the multiplication of TB
c. There is reactivation of dormant bacilli in the Ghon focus or complexes
d. When inhalation of organism is not destroyed by the macrophages thus undergoing unrestrained
replication.

Answer 23

b. When the immune system is weakened and fails to control the multiplication of TB

Question 24

Corticosteroid is a useful adjunct as treatment for this TB complication particularly when the host inflammatory response is contributing to tissue damage or is impairing function. What TB complication is this?
a. TB meningitis
b. HIV negative patients
c. TB pericarditis
d. TB pleural effusion

Answer 24

b. HIV negative patients

Question 25

John, 6 year old child, came in to the emergency room for fever, sore throat and cough for 2 days accompanied by difficulty of breathing. Further examination revealed hoarseness and stridor, membranous pharynx, with marked swelling of the soft tissues. What could be the possible etiologic agent for this condition?

a. Group A beta hemolytic streptococcus
b. Corynebacterium diphtheriae
c. Adenoviral infection
d. Mononucleosis

Answer 25

b. Corynebacterium diphtheriae

Question 26

. Apart
contraindications, what other recommendations should you advise for your patient if a child or adolescent is overweight or obese?
from Adenotonsillectomy as first line of treatment for Childhood OSAS given that he/she has no

a. Weight loss
b. CPAP management
c. Nocturnal video recording
d. Bariatric surgery

Answer 26

a. Weight loss

Question 27

. What tuberculosis?
is the treatment regimen that will be utilized for patients who had Treatment after failure pulmonary
a. 2HRZES/1HRZE/9HRE
b. 2HRZES/1HRZE/5HRE
c. 2HRZE/10HR
d. 2HRZE/4HR

Answer 27

b. 2HRZES/1HRZE/5HRE

Question 28

Belle, 6 years old female was worked up after having been exposed to her grandmother who was recently diagnosed for Pulmonary tuberculosis. She on the other hand showed no manifestations but came out positive for tuberculin skin test, showed normal chest findings, TB Gene Xpert showed no findings for M. tuberculosis. What spectrum of the disease does she belong?

a. TB infection
b. TB new
c. TB expsoure
d. TB disease

Answer 28

a. TB infection

Question 29

This common complication of Respiratory diseases is usually seen as a complication of pneumonia:

a. Bronchiectasis
b. Atelectasis
c. Pneumothorax
d. Lung abscess

Answer 29

d. Lung abscess

Question 30

30. For chronic or recurrent tonsillopharyngitis, Tonsillectomy is usually warranted. Based on the Paradise criteria for Tonsillectomy, how many minimum frequency of sore throat episodes a child must have to qualify for the said procedure?

a. At least 7 episodes in the previous year, at least 3 episodes in each of the previous 2 years or at least 3 episodes in each of the previous year
b. At least 7 episodes in the previous year, at least 5 episodes in each of the previous 2 years or at least 3 episodes in each of the previous year
c. At least 5 episodes in the previous year, at least 3 episodes in each of the previous 2 years or at least 2 episodes in each of the previous year
d. At least 5 episodes in the previous year, at least 5 episodes in each of the previous 2 years or at least 3 episodes in each of the previous year

Answer 30

b. At least 7 episodes in the previous year, at least 5 episodes in each of the previous 2 years or at least 3 episodes in each of the previous year

Question 31

What is the most common etiologic agent causing Epiglottitis?

a. Staphylococcus aureus
b. Streptococcus pneumoniae
c. Moraxella catarrhalis
d. Haemophilus influenza B

Answer 31

d. Haemophilus influenza B

Question 32

A patient who was previously treated for TB but was lost to follow up for ≥2 months in their most recent course of treatment and has is currently diagnosed with either bacteriologically confirmed or clinically diagnosed TB. This patient belongs to which registration group?

a. Treatment after failure
b. Previous treatment outcome unknown (PTOU) c. TB relapse
d. Treatment after lost to follow up

Answer 32

d. Treatment after lost to follow up

Question 33

Prenatally what could be a significant finding that could lead to a diagnosis of Congenital Cystic Adenomatoid Malformation (CCAM)?

a. Findings of decreased fetal breathing due to CNS lesions
b. Fetal ultrasonography shows multiloculated cysts within the lung parenchyma
c. Polyhydramnios and an abnormally small stomach
d. Presence of oligohydramnios and and decreased fetal movement

Answer 33

b. Fetal ultrasonography shows multiloculated cysts within the lung parenchyma

Question 34

What is the expected PEFR for a 6yo male patient with a 130cm height?
a. 320 L/minutes
b. 181 L/minute
c. 325 L/minute
d. 285 L/minute

Answer 34

c. 325 L/minute

Question 35

When performing thoracentesis, where will your point of entry be?

a. 7th ICS and anterior axillary line
b. 5th ICS and anterior axillary line
c. 7th ICS and posterior axillary line
d. 5th ICS and posterior axillary line

Answer 35

a. 7th ICS and anterior axillary line

Question 36

What are the different tests requested for PCAP A or B?

a. Chest radiograph, pulse oximetry, chest ultrasound
b. CBC, Blood culture an sensitivity, chest xray
c. Chest radiograph, pulse oximetry, ABG. Chest ultrasound
d. CBC, CRP, Chest xray, ABG, Chest ultrasound

Answer 36

a. Chest radiograph, pulse oximetry, chest ultrasound

Question 37

What has the highest incidence among different types of tracheoesophageal fistula and esophageal atresia?

a. True esophageal atresia without fistula
b. Proximal and distal fistula
c. Proximal esophageal fistula with distal tracheoesophageal fistula
d. Proximal tracheoesophageal fistula

Answer 37

c. Proximal esophageal fistula with distal tracheoesophageal fistula

Question 38

Jacob, 2 year old male, had acute onset of high grade fever with sore throat, dyspnea. 3 hours after the mother noted difficulty of swallowing, muffled voice, hyperextended neck as if grasping for air, muffled voice and drooling. You were entertaining Epiglottis for this patient and one of the diagnostic tests you requested for this patient includes radiographic imaging which should reveal what sign?

a. Thumb sign
b. Ace of spades sign
c. Accordion sign
d. Steeple sign

Answer 38

a. Thumb sign

Question 39

This ILD specific to infancy variant has reported a variety of underlying conditions including connective tissue diseases and surfactant disorders. What variant is this?

a. Desquamative interstitial pneumonia
b. Systemic disease associated
c. Pulmonary interstitial glycogenosis (PIG)
d. Nonspecific interstitial pneumonia

Answer 39

d. Nonspecific interstitial pneumonia

Question 40

Joseph a 5 year old child was brought to the emergency room manifesting the following signs and symptoms: Vital signs: Temp 38.5C HR 102 bpm RR 55 cpm O2sat 95% (room air). By history he had fever and cough for 4 days, with decreased appetite, no post tussive vomiting or loose bowel movement. PE findings of alar flaring, crackles with intercostal and subcostal retractions. Based on the WHO organization classification for Pneumonia, which classification does the patient belong?

a. Moderate pneumonia
b. Very severe pneumonia
c. Severe pneumonia
d. Nonsevere pneumonia

Answer 40

c. Severe pneumonia

Question 41

.What is gold standard method in the diagnosis of Interstitial lung disease?

a. High resolution Computed Tomography (HRCT)
b. Bronchoalveolar lavage
c. Pulmonary function test
d. Lung biopsy

Answer 41

d. Lung biopsy

Question 42

Acute pharyngitis’ most common complaint is sore throat. It may be viral or bacterial in nature. If by PE findings you will appreciate small vesicles on the soft palate, uvula and anterior tonsillar pillar. What could be the most likely cause?

a. Influenza infection
b. HSV infection
c. Herpangina caused Coxsackie virus
d. Mononucleosis caused by EBV

Answer 42

c. Herpangina caused Coxsackie virus

Question 43

JJ, 10 months old infant was admitted for paroxysmal cough, high grade fever, decreased activity and appetite, irritable. Upon examination, he was tachypneic with desaturations at room air, (O2sat 89%), with alar flaring, on auscultation he has wheezing and crackles, with intercostal and subcostal retractions. Your initial impression was Bronchiolitis. What diagnostic measures are needed for you to support your initial impression for JJ?

a. CBC, chest xray, Viral testing, blood culture and sensitivity
b. Clinical diagnosis, CBC, chest xray, blood culture and sensitivity, CRP
c. Clinical diagnosis, CBC, chest xray
d. CBC, chest xray, blood culture and sensitivity, CRP

Answer 43

b. Clinical diagnosis, CBC, chest xray, blood culture and sensitivity, CRP

Question 44

One of the most serious complication of tuberculosis in children is TB meningitis. At what stage of TB meningitis
has this presentation of lethargy, nuchal rigidity, seizures, hypertonia, presence of cranial nerve palsies?

a. 1st stage
b. 2nd stage
c. 3rd stage
d. 4th stage

Answer 44

b. 2nd stage

Question 45

In cases for Drug resistant TB, when there is resistance to Isoniazid and Rifampicin, duration of therapy must be extended for how long?

a. 12 to 24 months
b. 12 to 18 months
c. 12 to 36 months
d. 18 to 24 months

Answer 45

a. 12 to 24 months

Question 46

Andres, 4 year old male, sought consult for fever with associated cough, odynophagia. Upon physical examination, findings of hypertrophic, hyperemic tonsils with exudates and enlarged lymph nodes were noted. Based on these findings what score using the Modified Centor’s Criteria will you have? *

a. 2
b. 3
c. 1
d. 4

Answer 46

d. 4

Question 47

CHARGE syndrome stands for:

a. Congenital cataract, Heart defects, Atresia of the choanae, Renal anomalies, Growth retardation, Ear
anomalies
b. Coloboma, Heart defects, Atresia of the choanae, Retarded growth and development, Genital hypoplasia, Ear deafness
c. Congenital cataract, Heart defects, Atresia of the choanae, Retarded growth and development, Genital hypoplasia, Ear deafness
d. Coloboma, Heart defects, Atresia of the choanae, Renal anomalies, Growth and development, Ear anomalies

Answer 47

b. Coloboma, Heart defects, Atresia of the choanae, Retarded growth and development, Genital hypoplasia, Ear deafness

Question 48

In the Diagnosis and Management of Childhood Obstructive Sleep Apnea Syndrome, this is considered as an Absolute contraindication in performing Adenotonsillectomy:

a. No adenotonsillar tissue
b. Morbid obesity and small tonsils or adenoid
c. Submucus cleft palate
d. Bleeding disorder refractory to treatment

Answer 48

a. No adenotonsillar tissue

Question 49

What presentation signifies that the patient has chronic infection of the tonsils?

a. Dry tongue with erythematous enlarged tonsils
b. Tonsils with copious debris within crypts
c. Apaltine petechiae
d. Tonsillar or pharyngeal exudate

Answer 49

b. Tonsils with copious debris within crypts

Question 50

What component of the pulmonary function test is assessed if we determine the amount of air that moves in and
out of the lungs through maximum inspiration and expiration?

a. Residual volume
b. Total lung capacity
c. Tidal volume
d. Vital capacity

Answer 50

d. Vital capacity