2012

Pediatrics 250 Compiled 2012 At the pediatrics OPD, you were assigned a 14 day old baby boy who was brought by her mom for his first birthday checkup. 1. 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 c. Perinatal 2. 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 3. 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 4. 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.

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 11. 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 12. Which of the following vaccine is NOT part of the Expanded Program of Immunization? A. BCG B. Polio C. Varicella D. Pertussis 13. guarding principle of complimentary feeding based on: Global Strategy for Infant and Young Child feeding 14. Unfortunately, complementary foods that are predominant plant based have insufficient amounts of: Vit B 12 15. not considered a reason why complementary foods are started at 6mos of age decrease in breastmilk production 16. 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

5. 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 weight d. low financial savings for the family

17. 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"

6. 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

18. 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

7. the anticipatory guidance that should be given to the mother include: A. health B. Nutrition C. development/behavior D. AOTA

19. Which milestone is not significantly observed at 9 months A. pincer grasp B. object permanence C. parallel play D. creeps

8. 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

20. 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

9. At birth the baby was given Hep B. the regular vaccines that you can give at the time of consult is: a. Hep B 2nd dose b.BCG c.DPT 1st dose d.H. influenza B 10. Advice the mother to follow up 4 weeks after for growth monitoring

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21. 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

Pediatrics 250 Compiled 2012 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. 22. What is the classification of dehydration based on WHO guidelines? A. None B. Mild dehydration C. Some dehydration D. Severe dehydration 23. What should be the initial management done on this patient? A. Oxygen administration B. Fluid resuscitation C. Give inotropes D. Give antibiotics

38. 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 39. 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

24. What is the most probable diagnosis based on history and physical examination alone? A. Cholera B. Amoebiasis C. Shigellosis D. Salmonellosis

40. 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

25. If spirometry and PE flow are not available, what do you use? a.corticosteroids b.SABA c.LABA d.cont + LABA

41. non-edematous malnutrition

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 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 In a case of bacterial meningitis that happened 4 hours PTA: 28. what is your initial management? Diazepam 29. What is the drug of choice? Ampicillin IV 31.high dose penicillin 32.give IV fluids 33.viral gastroenteritis 36. 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 37. 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

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42. 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 43. 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 44. Which mineral, when given as a supplement for the severely malnourished child, enhances catch-up growth? A. Calcium B. Iron C. Zinc D. Selenium 45. 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 46. 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 47. What is the major mechanism that would explain the accumulation of nitrogenous waste products in patient with chronic renal failure? a. Impaired bicarbonate reabsorption b. Decrease in glomerular filtration rate a. Tubular damage

Pediatrics 250 Compiled 2012 b.

Impaired renal production of 1,25 dihydroxycholecalciferol

48. Children who are diagnosed to have chronic renal failure present with pallor and sallow appearance which can be attributed to a. Inadequate caloric intake b. Decreased net acid secretion c. Decrease erythropoietin production d. Excessive rennin production 49. What is the cornerstone of therapy for patients with chronic renal failure who exhibit renal osteodystrophy? a. Protein intake should be 2.5 g/kg/day b. Supplement diet with medium chain triglycerides. c. Vitamin D administration. d. Use phosphate binders such as calcium carbonate 50. Which of the following vaccines are advised to be administered before renal transplantation of a patient with chronic renal failure? a. H. influenza B vaccine b. Menigococcal vaccine c. Hepatitis A vaccine d. Varicella vaccine Case: 3 year old boy with delay in speech, very active, not used to pointing at things he wants, arranges toys in a linear fashion, has stereotype behaviors 1. What is the most important data in the history that would point at the most plausible diagnosis? a. Speech delay b. Impairment in social interaction c. Restricted, repetitive, stereotyped behavior d. A combination of each 2. Present working diagnosis? a. Hearing impairment b. Mental retardation c. Autism d. ADHD 3. Significance of weaning of grasp reflex in infants a. put objects in midline b. manipulate objects in both hands c. hold objects and voluntarily let them go 4. What can a 24 month old child do? a. runs swiftly b. runs well,walks down the stairs one step at a time c. stands at one feet momentarily 5. Not part of EPI? a. BCG b. Hepa B c. Pertussis d. Influenza 6.

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Important for food handlers a. typhoid b. Hepa B c. HiB d. BCG 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 Which of the following statements is false regarding injury? a) results from the transfer of energy to the body tissues

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b) c) d) 9.

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

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

10. 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 11. 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 12. 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: A. Past medical history B. Birth and maternal history C. Review of systems D. Family history 13-14 12 y.o. boy, fever 2 weeks duration with associated knee pains 1 week ago, malaise, palpitations and pallor PE: HR 128, RR 32, T 37.7, BP 90/60 Pale conjunctivae, AP, muffled heart, soft systolic murmur at apex, no hepatomegaly, good pluses and perfusion Swelling of joints 13. impression? a. ARF w/ carditis and arthralgia b. ARF w/ carditis and arthritis c. RHD w/ MR d. IE ans. A 14. Jones Criteria for RF? a. fever, arthritis, pallor b. fever, arthralgia, carditis c. fever, tachycardia, tachypnea d. fever, nodules, pallor ans. B 15. IM route is followed for the administration of the following vaccines a. Hepatitis B, BCG, Measles b. Hepatitis B, H. influenza type B, BCG c. Hepatitis B, DPT, H. influenza type B d. Hepatitis B, DPT, BCG ans. C 16. The most common complication of typhoid fever is a. meningitis b. myocarditis c. ileitis d. glomerulonephritis ans. c

Pediatrics 250 Compiled 2012 17. Not true about UTI: a. should be supported by (+) urine culture b. can lead to renal damage if left untreated c. associated with anatomical abnormalities in children d. presents with pathognomonic signs ans. D 18. 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 19. 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 20. 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 21-2 Alex is a 9-y.o. male, youngest of 6 children from Paco who presented at OPD with 3wks hx of cough positive for blood tinged phlegm. Associated symptoms include undocumented fever, weight loss and difficulty of breathing. There was a history of a similar condition in his grandmother. Ancillary tests showed CBC of leukocytosis, CXR showing pleural effusion, massive on the left, culture of the pleural fluid showing TB positive bacillus. He was started on triple anti-TB meds. 21. What would be your complete diagnosis for this case? a. PTB I b. PTB II c. PTB III d. PTB IV ans. D 22. On PE of this chest and lungs, what findings would you expect? a. symmetrical chest expansion b. chest lag on left c. chest lag on right d. intercostal retractions ans. B 23. Which physical finding would you expect from the patient? a. right chest lag b. left chest lag c. equal chest expansion d. none of the above 24. Upon auscultation, which finding would you expect from the affected lung? a. Vesicular breath sounds b. Normal breath sounds c. Decreased breath sounds d Loud breath sounds 25. Not considered a reason why complementary feeding is started at 6 moths of age a. energy and protein from breastmilk may be insufficient b. breast milk production decreases c. infants are ready developmentally d. infant digestive functions are mature ans. B Case: 3 year old boy with delay in speech, very active, not used to pointing at things he wants, arranges toys in a linear fashion, has stereotype behaviors 26. What is the most important data in the history that would point at the most plausible diagnosis?

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a. b. c. d.

Speech delay Impairment in social interaction Restricted, repetitive, stereotyped behavior A combination of each

27. Present working diagnosis? a. Hearing impairment b. Mental retardation c. Autism d. ADHD 28. Significance of weaning of grasp reflex in infants a. put objects in midline b. manipulate objects in both hands c. hold objects and voluntarily let them go 29. What can a 24 month old child do? d. runs swiftly e. runs well,walks down the stairs one step at a time f. stands at one feet momentarily 30. Not part of EPI? a. BCG b. Hepa B c. Pertussis d. Influenza 31. Important for food handlers a. typhoid b. Hepa B c. HiB d. BCG 32. 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 33. Which of the following statements is false regarding injury? e) results from the transfer of energy to the body tissues f) results from the impairment of function from lack of vital elements g) time between the exposure to the energy and appearance of an injury is short h) vast majority are unpredictable, hence unavoidable 34. 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 35. 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 36. 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

Pediatrics 250 Compiled 2012 37. 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: E. Past medical history F. Birth and maternal history G. Review of systems H. Family history 13-14 12 y.o. boy, fever 2 weeks duration with associated knee pains 1 week ago, malaise, palpitations and pallor PE: HR 128, RR 32, T 37.7, BP 90/60 Pale conjunctivae, AP, muffled heart, soft systolic murmur at apex, no hepatomegaly, good pluses and perfusion Swelling of joints 38. impression? a. ARF w/ carditis and arthralgia b. ARF w/ carditis and arthritis c. RHD w/ MR d. IE ans. A 39. Jones Criteria for RF? a. fever, arthritis, pallor b. fever, arthralgia, carditis c. fever, tachycardia, tachypnea d. fever, nodules, pallor ans. B 40. IM route is followed for the administration of the following vaccines a. Hepatitis B, BCG, Measles b. Hepatitis B, H. influenza type B, BCG c. Hepatitis B, DPT, H. influenza type B d. Hepatitis B, DPT, BCG ans. C 41. The most common complication of typhoid fever is a. meningitis b. myocarditis c. ileitis d. glomerulonephritis ans. c 42. Not true about UTI: a. should be supported by (+) urine culture b. can lead to renal damage if left untreated c. associated with anatomical abnormalities in children d. presents with pathognomonic signs ans. D 43. 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

at OPD with 3wks hx of cough positive for blood tinged phlegm. Associated symptoms include undocumented fever, weight loss and difficulty of breathing. There was a history of a similar condition in his grandmother. Ancillary tests showed CBC of leukocytosis, CXR showing pleural effusion, massive on the left, culture of the pleural fluid showing TB positive bacillus. He was started on triple anti-TB meds. 46. What would be your complete diagnosis for this case? a. PTB I b. PTB II c. PTB III d. PTB IV ans. D 47. On PE of this chest and lungs, what findings would you expect? a. symmetrical chest expansion b. chest lag on left c. chest lag on right d. intercostal retractions ans. B 48. Which physical finding would you expect from the patient? a. right chest lag b. left chest lag c. equal chest expansion d. none of the above 49. Upon auscultation, which finding would you expect from the affected lung? a. Vesicular breath sounds b. Normal breath sounds c. Decreased breath sounds d Loud breath sounds 50. Not considered a reason why complementary feeding is started at 6 moths of age a. energy and protein from breastmilk may be insufficient b. breast milk production decreases c. infants are ready developmentally d. infant digestive functions are mature ans. B 1.

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? a. Loss of consciousness b. Laterality of the jerking c. Watching television provokes his seizure d. All of the above Answer: D

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Which is an important info regarding the nature of the event? a. Presence of aura b. Time of the day c. Personality changes d. All of the above Answer: D

3.

In epilepsy, what factor is not of major concern? a. Duration of illness b. Age c. Seizure type and etiology d. NOTA Answer: A – Accdg to ma’am hindi daw ito masyadong important

4.

True of the guidelines of seizure treatment a. Seizure treatment is lifelong b. Single most important guideline is the recurrence of seizures c. Missing d. Missing Answer: B

44. 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 45. 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 21-2 Alex is a 9-y.o. male, youngest of 6 children from Paco who presented

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Pediatrics 250 Compiled 2012 5.

6.

7.

8.

9.

In the guidelines followed in epilepsy, diagnostic management of epilepsy? a. ECG b. MRI c. Activation EEG d. AOTA Answer: D Knee pain, malaise, tachycardia, pallor, febrile, muffled heart sounds, murmur at apex, no joint swelling a. Acute Rheumatic w/ carditis b. Acute Rheumatic w/ carditis + arthritis c. RHD d. Scarlet Fever Answer: AR w/ carditis Chest xray revealed Normal heart and pulmonary markings. What is the severity of carditis? a. No carditis b. Mild carditis c. Moderate carditis d. Severe carditis Answer: B Therapeutic Regimen for question #7? a. Penicillin and ASA b. Penicillin, furosemide, digoxin, prednisone c. Penicillin, ASA, digoxin, captopril d. Erythromycin, furosemide, prednisone Answer: A (note: mild carditis lang siya, yung sa past samplices, mas severe yung carditis) After 6 days, px was discharged. What is the preferred secondary RF prophylaxis? a. Oral pen 250 mg 2x/day b. Erythromycin 50mg 2x/day c. Benz pen 1.2m units deep IM every 21 days d. Benz pen 1.2m units deep IM every 28 days Answer: C (remember: 21 days!)

10. What is not a complication of RHD? Answer: Brain Abscess 11. The following statement is false about cerebral palsy: a. Not progressive b. Motor, cognitive, sensory are affected c. CP is commonly associated with epilepsy d. Temporary and reverts back Answer: D 12. The following factors are important in cerebral palsy patients, except? a. presence of spasticity b. Intellect of child c. Age of caregiver d. Age of child Answer: Feedback answer is B but we contested it and C yung dapat 13. 4-yr old child with developmental delay and unstable gait. What is the possible type of CP? a. Spastic b. Hemiplagia c. Ataxic d. Extrapyramidal Answer: C 14. Which is a sign that headache is benign? a. acute in onset b. recurrent c. symptoms are more chronic

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d. with concomitant vomiting Answer: C (Ang pagkaexplain ni ma’am, in comparison sa acute symptoms, mas benign ang chronic na headache) 15. Therapy for ICP Answer: Mannitol 16. 10 year old male drooling, assuming a tripod position, with a thumb sign on chest Xray. Answer: Epiglottitis (key word: drooling, tripod, thumb sign) 17. What is the cause of laryngotracheomalacia? A. Parainfluenza B. HibV C. RSV D. Rotavirus Answer: A 18. Increase probability of GERD of chronic cough a. symptomatic after activity b. vomiting after feeding c. wheezing Answer: B 19. The following pathogen of acute gastric require antibiotic use: a. Enterotoxicogenic E. coli b. Shigella c. Salmonella d. AOTA Answer: B (Yes, Shigella lang among the choices, others daw ay cholera, Amoeba, Giarda) 20. Non bloody diarrhea, thirsty, irritable, sunken eyeball. What is the degree of dehydration? a. No dehydration b. Some dehydration c. Severe dehydration Answer: B. 21. Treatment for #20 include: a. Antibiotic b. Zinc c. IV fluid Answer: B 22. Which factor is relied most in determining degree of dehydration? a. Mental status b. Thirst c. Eye sunken d. Skin turgor Answer: B 23. What is a complication of diarrhea? a. lactose malabsorption b. metabolic alkalosis c. hyperkalemia Answer: A 24. False regarding treatment with severe malnutrition and some dehydration. a. Replacement of fluid is done in hospital b. IV hydration preferred over oral rehydration c. Missing Answer: B 26. Not a treatment in non infectious diarrhea:

Pediatrics 250 Compiled 2012 a.

Instructing patient about indefinite duration of parenteral feeding b. Monitor volume of fluids c. IV nutrition Answer: A – dapat hindi indefinite yung duration 27. Which is a signs/symptom of typhoid fever a. biphasic fever b. Maculopapular rash on 1st 2 days c. relative bradycardia Answer: C

37. 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 weight d. low financial savings for the family Answer: D

28. Lab function of typhoid except: a. Leukopenia b. Thrombocytopenia c. Hemoconcentration Answer: C

38. 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 Answer: D

29. True regarding management of typhoid Answer: Patients are in isolation and standard contact tracing procedures are done

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31. Laboratory results not consistent with IDA Answer: low total Iron binding capacity 32. 6 year old girl, 2 mo history of cough, (+) family history of TB, (+) PPD result, (+) Xray for TB. How to treat? Answer: 2 mo HRZ, 4 mo HR 33. Clinical history of 14 day old, 1st well baby clinic. 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 Answer: B. 34. 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 Answer: D 35. 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 Answer: B 36. 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. Answer: C

The anticipatory guidance that should be given to the mother include: a. health b. Nutrition c. development/behavior d. AOTA Answer: D

40. 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 Answer: D 41. At birth the baby was given Hep B.The regular vaccines that you can give at the time of consult is: a. Hep B 2nd dose b. BCG c. DPT 1st dose d. H. influenza B Answer:B 42. 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 Answer: A 43. 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 Answer: C 44. Which of the following vaccine is NOT part of the Expanded Program of Immunization? a. BCG b. Polio c. Varicella d. Pertussis Answer: C 45. Guiding principle of complimentary feeding based on: Answer: Global Strategy for Infant and Young Child feeding

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Pediatrics 250 Compiled 2012 5. 46. Unfortunately, complementary foods that are predominant plant based have insufficient amounts of: a. Iron b. Vitamin B6 c. Vitamin B12 d. Folate Answer: C 47. Which is not considered a reason why complementary foods are started at 6mos of age? Answer: decrease in breastmilk production 48. 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 Answer: C 49. 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" Answer: D 50. 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 Answer: C

Developmental “Red Flags” that should be observed in this 3 year old boy include: a. Does not play with other children b. Cannot count sequentially c. Does not know birthday d. Can stand on one leg ANS: A 6. 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? a. DPT, polio, hep B, measles b. DPT, polio, measles c. Hep B, measles d. Measles only ANS: C 7. Theoretically, other special vaccines that can be given at his age include: a. Varicella, MMR, pneumococcal vaccine, hep A, H. Influenza type B, typhoid b. Varicella, MMR, pneumococcal vaccine, hep A, H. Influenza type B, typhoid, rotavirus c. Varicella, MMR, pneumococcal vaccine, hep A, H. Influenza type B, typhoid, rabies, AH1N1 vaccine d. Varicella, MMR, pneumococcal vaccine, hep A, H. Influenza type B, typhoid, rabies, yellow fever ANS: A 8.

Problems with feeding was noted and can be addressed by counselling the mother on the following helpful techniques, except: a. Practice forced feeding b. Vary type, appearance and texture of food c. Engage the child on preparing his own food d. Give 3 meals and 2 snacks ANS: A 9.

Clinical scenario (For questions 1-10): 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. 1. Your approach to assessing this 3 year old patient includes use of the following distraction techniques: a. Singing a favourite song b. Asking him to describe his favourite toy c. Reading a storybook d. All of the above ANS: D 2. Developmental physiology expected at his age includes: a. Ability to distinguish fantasy from reality b. Misconceptions about illness, injury and body functions c. Good sense of time & place d. Physical disability is a common fear ANS: B 3. To lessen his anxiety, one of the following techniques should not be employed a. Maintain him on his mother’s lap during assessment b. Allow him to handle equipment c. Ignore his feelings and proceed with history & PE d. Use simple terms to explain procedures ANS: C 4. Expected developmental milestones for this patient include: a. Kicks ball forcibly, throws ball overhand b. Asks what, where, who questions c. Names one to two colors d. AOTA ANS: D

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Advise on injury prevention for this age group should include: a. May leave child unsupervised b. Childproof house by keeping matches, knives, medicines out of reach c. Teach proper way of crossing streets d. Teach emergency numbers ANS: B

10. 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: a. Give whatever the boy wants b. Scold the child c. Ignore the act d. Reason with the child ANS: C 11. Which statement is false regarding health supervision visits? a. Inquiring about child’s developmental milestones is optional b. Complete physical exam is performed c. Appropriate screening tests are ordered d. A child’s current and chronic problems are discussed ANS: A 12. Which statement is false regarding anticipatory guidance? a. Child’s immunization status is reviewed b. Family relations and problems need not be discussed c. Child’s nutrition is an area of concern d. Safety issue is part of anticipatory guidance ANS: B 13. Which statement is true regarding injury prevention for adolescents? a. Guns may be kept in unlocked cabinets since teens are old enough to exercise caution.

Pediatrics 250 Compiled 2012 b.

Seat belts need not be used if the adolescent will drive carefully. c. Cellphones may be used when driving. d. A helmet should be worn when riding a bicycle at all times. ANS: D 14. Which statement is false regarding injuries? a. Injury can be defined as physical damage that results when a human body is suddenly or briefly subjected to intolerable levels of energy. b. Unintentional injuries are accidents. c. The vast majority of injury-causing events are predictable. d. Injury places economic burden on the survivor and his family. ANS: B 15. This is the most common skin disorder in infancy: a. Atopic dermatitis b. Contact dermatitis c. Diaper dermatitis d. Seborrheic dermatitis ANS: C 16. The following are symptoms associated with teething, except: a. Diarrhea b. Gingival swelling c. Increased salivation d. Irritability ANS: A 17. A method of extinction that aims to effect reduction or elimination of undesired behavior is: a. Punishment b. Reinforcement c. Rewards d. Time-out ANS: D 18. A sleeping child who appear agitated and frightened but not easily aroused and not able to recall it the next morning is said to experience: a. Nightmares b. Night terrors c. Night phobias d. Night panic attacks ANS: B Numbers 19 and 20 are BONUS questions. 21. Clinical manifestation of congenital hypothyroidism during the early weeks to the 2nd month of life does not include: a. Slightly increased head circumference b. Prolongation of physiologic jaundice c. Constipation that responds to treatment d. Feeding difficulties such as sluggishness & choking spells ANS: C 22. Respiratory difficulties of infants with congenital hypothyroidism before 3 months of age does not include: a. Apneic episodes b. Noisy respirations c. Nasal obstruction d. Tachypnea ANS: D 23. The most common associated congenital anomaly of infants with congenital hypothyroidism is: a. Cardiac b. Nervous system c. Eyes d. Gastrointestinal ANS: A 24. If congenital hypothyroidism goes undetected and untreated by 36 months of age, the following manifestations will develop:

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a. b. c. d.

Microcephaly Myxedema Hypotelorism Normal dentition

ANS: B 25. Development of infants with congenital hypothyroidism is retarded and manifested as: a. Late in learning to sit and stand b. Delay in expressive language c. Hyperactivity d. Inconsolable crying ANS: A 26. Laboratory findings in congenital hypothyroidism include: a. Low free T4 b. Normal T3 c. Elevated TSH d. AOTA ANS: D Case 2 (for questions 27-30): 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. 27. The most likely diagnosis of this patient is: a. Rett syndrome b. Autism c. Childhood Disintegrative Disorder d. Pervasive Developmental Disorder ANS: B 28. Key features of the case include: a. Qualitative impairment in social interaction b. Qualitative impairment in communication c. Stereotypic, repetitive patterns of behaviour d. AOTA ANS: D 29. Management of this patient would focus on: a. Intensive behavioural therapy b. Pharmacotherapy c. Psychotherapy d. Speech therapy ANS: A 30. A better prognosis for these patients is associated with: a. Higher intelligence b. Functional speech c. Less bizarre behaviour d. AOTA ANS: D Case 3 (for questions 31-35): 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. 31. The most likely diagnosis is a. Bronchial asthma b. PTB c. Pneumonia d. Bronchiolitis ANS: A 32. One of the following is the diagnostic exam that can least confirm the above diagnosis: a. Spirometry b. Peak flow by portable peak flow meter c. Airway challenge tests

Pediatrics 250 Compiled 2012 d.

Chest x-ray

ANS: D 33. The most common trigger for the above case: a. Viral infection b. Pollen c. House dust mite d. Food ANS: C 34. What should be the initial emergency management that should be given to the patient? a. Nebulisation with B2 agonist b. Administration of epinephrine intramuscularly c. Starting of antibiotics d. Request for a chest x-ray ANS: A 35. Which of the following description of the cough clinched your above diagnosis? a. Cough accompanied by voice changes b. Coughing at noon time c. Cough associated with feeding or swallowing d. Coughing after exercise or play in an otherwise asymptomatic child ANS: D 36. Simple partial seizures is characterized by: a. Asynchronous tonic, clonic movements of the trunk and extremities b. Conscious, verbalizing patient c. Automatism d. Post-ictal phenomenon follows ANS: B 37. Complex partial seizures is characterized by: a. Presence of aura in 1/3 of cases b. Impaired consciousness c. Automatism d. AOTA ANS: D 38. Automatism in older children may consist of: a. Semi-purposeful, uncoordinated gestural movements b. Lip smacking c. Excessive salivation d. Chewing ANS: A 39. 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: a. Complex partial b. Simple partial c. Absence seizure d. Myoclonic epilepsy of childhood ANS: C 40. 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: a. Generalized tonic-clonic b. Myoclonic epilepsies of childhood c. Absence d. Complex partial ANS: B 41. Which of the following supplies the greatest percentage of blood to the liver? a. Common hepatic artery b. Superior mesenteric artery c. Main hepatic vein d. Portal vein

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ANS: D 42. Which of the following blood chemistry results reflect the chronicity of the liver damage? a. Albumin b. Alkaline phosphatise c. ALT d. Bilirubin ANS: A 43. Which of the following is a post-sinusoidal cause of portal hypertension? a. Biliary cirrhosis b. Budd-Chiari syndrome c. Portal vein thrombosis d. Schistosomiasis ANS: B 44. Which of the following is the correct rationale for the pharmacologic treatment of portal hypertension? a. Furosemide is given to induce arteriolar vasodilatation. b. Metoclopromide is given to decrease lower esophageal sphincter tone. c. Propanolol is given to decrease cardiac output. d. Nitroglycerin is given to cause venous vasoconstriction. ANS: C 45. Treatment of hepatic encephalopathy includes which of the following? a. Gentamicin b. Lactulose c. Nadolol d. Somatostatin ANS: B 46. The following sign remain useful in the assessment of the severely malnourished child a. Irritability b. Poor skin turgor c. Thirst d. Sunken eyes ANS: C 47. The difference between the newly formulated oral rehydration salts (ORS) and the old ORS is in the content of glucose and a. Sodium chloride b. Citrate c. Potassium d. Bicarbonate ANS: A 48. Not recommended for the prevention and treatment of diarrheal disease in children a. Zinc supplementation b. Breastfeeding c. ORS d. Limitation of feeding ANS: D