2nd Sem Pediatrics Prelims

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2nd Sem PEDIATRICS Prelims (2014-2015) Nephrology - (20 items) 1. 2. 3.

9.

Anti-GBM nephritis

80% of minimal change nephrotic syndrome present at this age group: a. 1-6 yo b. 6-10 yo c. 10-15 yo d. 16-20 yo

Normal Fluid vascular component? 3 to 4 LITERS Interstial component? 2 to 3 LITERS Basic test used in screening patient with renal disease? URINALYSIS 4. Oliguria? 2000mL for 24rs a. Ace inhibitors 6. Telescope urine sediment signifies? RENAL FAILURE b. Corticosteroids 7. Hematuria seen in? BOTH FEVER AND EXERCISE c. Alkylating agents 8. Alkaline urine except? MEAT DIET d. Lavamsole? 9. AGN S/Sx? HEMATURIA< PROTEINURIA, PYURIA th 10. Below 90 percentile of age, height? NORMAL BP PRELIMS 2012 1. A 20 year old mother is about to deliver her baby and Nephrolotic Syndrome (10 Items) on biophysical profile, they found out that she had 1. Diagnosis of UTI includes: polyhydramnios? The following condition might be a. History expected the baby to have b. Physical examination a. Renal agenesis - oligohydrmnios c. Laboratory examination b. Duodenal atresia d. All of the above c. Lung hypoplasia – oligohydramnios d. Potter syndrome - oligohydramnios 2. Overall risk among symptomatic female patients with UTI 2.What would be the best way of assessing gestational a. 1-2% age of the baby if you have a 10 week old pregnant b. 3-5% mother. c. 5-7% a. crownrump length via ultrasound d. 7-9% b. femoral length via ultrasound c. biparietal diameter via ultrasound 3. Causative organism among 70-90% of UTI cases d. quickening a. E. Coli Crown-rump length obtained between 6 and 12 weeks’ b. S. Saprophyticus gestation biparietal diameter, after 12 weeks is accurate c. S. Hemolyticus within 10 days; beyond 26 weeks, accuracy diminishes to d. Klebsiella Oranea > 3 weeks. 4.

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Significant residual bladder volume that predisposes to 3. A mother experiences “quickening” of the baby. The recurrent UTI approximate age of gestation is said to be? a. 3% a. 10 weeks b. 5% b. 16 weeks c. 7% c. 20 weeks d. 9% d. 30 weeks >quickening at 16-18 weeks Defined as having BP of >/95th percentile for age, 4 The New Ballard Score is best examined up to 96 hour, if gender, height confirmed on 3 separate occasions > 26 weeks . It composed of the following a. Borderline HPN a. Neuromuscular maturity sign b. PreHPN b. Physical maturity sign c. Hypertension c. Both d. Severe Hypertension d. A only Children at risk for hypertension are those with: a. DM b. Obesity c. History of umbilical catheterization d. All of the above Drug classification of furosemide as BP lowering agent 5. APGAR SCORE are taken on the 1st and 5th minutes of a. Diuretic vasodilator life. A low APGAR score at 5 minutes of life connotes what b. Beta blocker probable condition? c. Loop diuretic a. poor resuscitation d. Ace inhibitor b. possible neurological deficit/sequelae c. no effect Primary acquired glomerulonephritis d. sepsis a. Post infectious glomerulonephritis b. Focal segmental glomerulonephritis 6. A 24 week , preterm baby was delivered in a taxi, you c. IgA nephropathy will have a quick assessment of the age of gestation. You

immediately look at the baby’s foot for creases and noted 14. Which of the following causes of shortness is the least that there is none. How would you asses the gestational stunting? age of this preterm? a. Growth hormone deficiency a. illuminate the foot b. Congenital hypothyroidism b. measure the foot from heel to toe c. Turner syndrome c. check for lanugo hair distribution d. Precocious puberty (di ko sure) d. heel to ear maneuver 15. Which of the following inhibit the secretion of growth 7. At Medical Center Manila, a newborn baby was delivered hormone? via normal spontaneous delivery. Please plot the following a. Cortisol data and classify. BW 4.2 kg BS 41 weeks (2 b. β-adrenergic blockers points) c. Insulin a. Term, Appropriate age of gestation d. Dopamine b. Post term, Small for gestational age c. Term, Large for gestational age 16. A 12 year old girl has a height of 120cm, an upper to d. Post term , Large for gestational age lower segment ratio of 2:1 and a bone age of 6 years. What is your most likely diagnosis? 8. A baby 30 weeks of gestation with a weight of 1.2 kg. a. Intrauterine growth retardation Plot and classify the baby according to age of gestation. b. Growth hormone deficiency (2 points) c. Constitutional delay in growth and development a. Preterm Appropriate age of gestation d. Congenital hypothyroidism ?(not sure) b. Term, Small for gestational age c. Term appropriate for gestational age 17. A 16 year old male with a height of 120cm, a very d. Preterm, small for gestational age positive upper to lower segment ratio, a large head and normal sexual development very likely has: 9. An 8-year old boy is found to have a height a. Congenital hypothyroidism measurement of 110 cm. What is his height age? b. Mucopolysaccharidosis a. 3 years c. Achondroplasia?(not sure) b. 6 years d. Vitamin D resistant rickets c. 10 years d. 8 years 18. A 10 year old female with a height of 130 cm whose mother is 5 ft 2 in and whose father is 5 ft 7 in has a bone 10. A bone-age of less than 4 years in a child who is 8 age which is normal for chronological age. What will be her years old is very likely due to: final height at 18 years? a. Nutritional deficiency a. 157.3 +/-5 cm b. An endocrine cause b. 150 +/- 5cm c. Normal variation in growth c. 145 +/- 5cm d. Genetic of familial causes d. 160 +/-5 cm 19. A 16 year old hypothyroid female on follow-up has a 11. A 14 year old female consults for shortness and lack of pulse rate of 72/min, increased TSH, decreased Free T4 and secondary sex characteristics. You suspect Turnerdecreased Free T3. Which of the following steps will you syndrome. Which of the following best supports your take? impression? a. Decrease her dose of thyroid a. History of edema of the hands and feet in the b. Increase her dose of thyroid c. Leave her dose of thyroid as is newborn period d. Repeat thyroid function test and tell her to b. A positive response to growth hormone return administration c. Very marked webbing of the neck on PE 20. A 12 year old hyperthyroid male returns for follow up d. An XO karyotype after 3 months and is found to have normal TSH, a normal 12. Which of the following is usually the earliest sign of Free T4 and a normal Free T3. The patient is asymptomatic, has no subjective complaints and gained 1 kg since his last sexual menstruation in a female? check-up. Which of the following are you going to do? a. Sudden growth spurt a. Increase his dose of methimazole b. Onset of menstrual periods b. Decrease his dose of methimazole c. Appearance of breast buds c. Prescribe an adrenergic β-blocker d. Appearance of pubic hair d. Leave his management as is 13. A 9 year old male gives a history of traumatic delivery and hypoglycemic seizures. On PE he is found to have a21. The most common cause of congenital hypothyroidism weight of 25 kg and a height of 110cm. This child should due to dishormonodysgenesis is a defect in which of the following steps in the production of thyroid hormones? be worked up for which of the following condition? a. Deiodination a. Congenital hypothyroidism b. Organification b. Growth hormone deficiency?(not sure) c. Coupling c. Cushing syndrome d. Iodine trapping d. Trisomy 21

urine specific 22. A 14-year old girl with a history of thyroid enlargement H 38. Congenital Adrenal Hyperplasia e. sNa 156 for the past 6 months is found to have a single nodule by gravity 1.003 f. HgbA1c 8.2% sNa 128 blood palpation. The nodule is very firm and non-tender. On g. sNa 124 K5.8 technetium scan, the nodule has no uptake and you glucose 41 blood glucose 54 suspect a malignancy. If you are right, the most probable h. sNa 127 K 5.9 17OH Progesterone histopathologic diagnosis would be: >300 a. Papillary cancer (cold) b. Poorly differentiated or anaplastic carcinoma 39. An 8 year old boy consults you for evaluation of his c. Follicular carcinoma (hot) short stature and is found to be just at the 5th % for height d. Medullary carcinoma on the NCHS growth curve. On follow-up visit 6 months *B or D?? ewan later, the interval growth is 2.6 cm. What advise should you give the parents? 23. The most commonly used marker or test in the post-a. The patient has to be further evaluated as he is still ablation follow-up of thyroid carcinoma is: about the 5th % a. FT3 and FT4 b. The patient can be reassured that he is growing at a b. Thyroid ultrasound constant rate c. Tc scan of the thyroid c. The patient should have thyroid studies done d. Serum thyroglobulin levels d. The patient needs to be evaluated for possible growth hormone deficiency 24. A 14-year old girl has a weight of 75 kg and height of 152cm has a BMI of: a. 32.6 40. A 9 year old boy is brought to you with complaint of b. 28 weight loss, polyuria, and polydipsia. You are suspecting c. 25.7 diabetes mellitus. Which of the following screening tests d. 35 will give you the most diagnostic information? a. Random blood sugar, HgbA1c 25. Which of the following is a required component of the b. Urinalysis, random blood sugar proposed definition of Metabolic syndrome in children? c. Venous blood gas, urine ketones a. Blood pressure of 140/90 (130/85) d. Random blood sugar, C-peptide level b. Fasting blood sugar >130 mg/dL (110) c. BMI >90th percentile (obese na to, dapat 41. Which of the following conditions will cause ambiguous overweight lang?) genitalia in a genetic male? d. HDL 12 b. CVAH secondary to 21-hydroxylase deficiency mg/dL and low levels of Mg and P. Which of the following c. CVAH secondary to 11-beta hydroxylase hormonal assays will you request for? deficiency a. Thyroid d. none of the above (LAHAT FOR FEMALE) b. Parathyroid c. Calcitonin 42. Which of the following are medical consequence of d. Insulin obesity? a. T2DM, pseudotumor cerebri, depression, 32. A 24 hour old premature infant with a history of hypothyroidism asphyxia is seen for generalized seizures. Serum Ca is 5 T2DM, obstructive sleep apnea, hypertension, mg/dL. One of the more common causes which should be b. Blount’s disease investigated is: T2DM, hepatitis, growth hormone deficiency, a. Hypoparathyroidism associated withc. depression mitochondrial disorders d. T1DM, obstructive sleep apnea, hepatitis, b. Idiopathic hypoparathyroidism c. Maternal hyperparathyroidism hypoparathyroidism d. Autoimmune hypoparathyroidism

33. A long term complication of hyperparathyroidism is: a. Calcification of the basal ganglia b. Intestinal obstruction c. Diabetes mellitus d. Nephrocalcinosis

43. How is BMI calculated? a. weight in pounds/height in cm2 b. height in m2/weight in kg c. height in cm2/weight in pounds d. weight in kg/height in m2

34-38. Match the conditions in Column A with the usual 44. At what BMI percentile is achild or adolescent laboratory findings associated that are in Column B considered to be overweight? a. BMI >50% Column A Column B b. BMI >75% F 34. Diabetes Mellitus a. sNa 124 K. 5.8 blood glucose 210 c. BMI >85% E 35. Diabetes Insipidus b. sNa 146 K 3.4 blood glucose 56 d. BMI>95% (obesity) G 36. Adrenal Insufficiencyc. HgbA1c 5.1 blood glucose 124 Na 146 D 37. Obesity 321

d. SGOT 63 HgbA1c 7.1%

Cholesterol45. Which of the following is a convincing observation that

a child’s growth is pathologic a. height is 2SD below the midparental height a. Growth hormone deficiency d. all of the above b. Iatrogenic Cushing’s syndrome c. Cushing’s Disease 46. A 15 year old undergoes a water deprivation test. The d. Growth failure from hypoxemia due to reactive starting serum sodium was 142 meq/L and closest urine thairway disease specific gravity to this determination was 1.005. Into the 5 hour of water deparivation, serum sodium was 158 meq/L and urine specific gravity was 1.005. A dose of 53. What conditions are tested for in the Newborn desmopressin (ADH) was given, and 2 hours later, serum Screening test? a. Congenital hypothyroidism, Congenital Adrenal sodium in 148 meq/L and urine specific gravity was 1.010. Hyperplasia, Galactosemia, Phenylketonuria, G6PD What is the correct diagnosis? deficiency a. Compulsive water drinking b. Congenital hypothyroidism, Congenital Adrenal b. Central diabetes insipidus Hyperplasia, Galactosemia, Maple syrup urine disease, c. Nephrogenic diabetes insipidus G6PD d. Diagnosis cannot yet be established c. Congenital hypothyroidism, Congenital Adrenal Hyperplasia, Maple syrup urine disease, Phenylketonuria, 47. A 7 year old girl from Ilocos Norte was incidentally found to have hyperglycemia. She has been asymptomatic: G6PD deficiency d. Congenital hypothyroidism, congenital lipid no polyuria, polydipsia, polyphagia, weakness or weight loss. The doctor in Ilocos started her in Lispro insulin 70/30 dystrophy, galactosemia, phenylketonuria, G6PD deficiency 12 units pre-breakfast and 6 units pre-dinner. The blood sugar readings have now been in the 70-110 range and 54. What is currently the most common cause of cirrhosis? a. Hepatitis B family wants to know if she truly has diabetes mellitus. b. Drug-induced hepatitis What test will you do to assess if she truly has diabetes c. Non-alcoholic steatohepatitis mellitus. What test will you do to assess is she has d. Alcoholic hepatitis remaining insulin secretory capacity? a. Oral glucose tolerance test 55. When should the hormonal evaluations of a newborn b. IV glucose tolerance test with ambiguous genitalia be undertaken? c. C-peptide level a. Before 2 months of age d. Serum insulin level b. Before 2 years of age c. Before 12 years of age 48. Which of the following genetic conditions has short d. the age of evaluation is not important status as one of its features: • Diagnostic evaluation should be performed in an a. Marfan’s syndrome organized and expeditious manner. Critical blood b. Klinefelter syndrome samples should be obtained PRIOR to c. Grave’s disease administration of gluccorticoids, gonadotropins, d. Prader Willi syndrome and androgens levels obtained before 2 mos of age. 49. What is the test that will allow you to assess remaining potential for bone growth? 56. What is the determinant of the differentiation along a. Serum IGF-1 level male line? b. Bone age a. Y chromosome c. Random growth hormone level b. H-Y antigen d. Osteocalcin c. Testes determining factor d. SRY gene 50. Which of the following associations will provide best potential for growth? 57. What is the clinical feature which distinguishes primary a. Height age>bone age>chronological age (adrenal) from secondary (pituitary): b. Height age>chronological age>bone age a. hyperpigmentation is observed in primary AI and c. Bone age>Chronological age>Height age not in secondary AI d. Chronological age>Bone age>Height age b. hyperpigmentation is observed in secondary AI 51. Which zone of the adrenal cortex is primarilyand not in primary AI c. obesity is often observed in primary AI and not in responsible for synthesis of adrenal androgens? secondary AI a. zona reticularis d. obesity is often observed in secondary AI and b. zona glomerulosa not in primary AI c. zona fasciculata d. zona tubularis 58. What is the desirable glycosylated Hgb level for patients with T1DM, which according to the DCCT trial will reduce the incidence of chronic complications by 50-75%? a. 6% b. 7% c. 8% 52. A 6 year old female has had asthma for 3 years and d. 9% has been taking oral prednisone 20 mg BID for 2 week periods almost every other week, Budesonide inhaler

Instructions: For items 59-63: from among the lettered choices below, choose the best answer. A. SGA B. IUGR C. Both of the above D. Neither of the above 59. 60. 61. 62. 63.

Statistical definition- C Suggests an intrauterine pathology- C Less than the 12th percentile weight for age- D Seen among premature infantsSeen among term infants

For items 64-68: from among the lettered choices below, choose the best answer. A. LGA B. Infant of a diabetic C. Both of the above D. Neither of the above 64. Statistical definition- A 65. Greater than the 95th percentile weight for age- C 66. Seen among premature infants 67. Seen among term infants 68. May be further classified into symmetric or asymmetric