Pediatrics II Second Long Exam 2014A

PEDIATRICS II SECOND LONG EXAM BAPS Note: only source was the recording.

1.

The main pathophysiologic mechanism that differentiates dengue fever from dengue hemorrhagic fever is B. evidence of capillary leakage

2.

A 5 year-old boy was brought in due to fever of 5 days duration. He has been complaining of severe epigastric pain with several episodes of vomiting. Gum bleeding was also noted by the mother. On PE, he appears weaklooking, febrile with a temperature of 38 deg C, BP = 90/50. Palpation of the abdomen reveals epigastric tenderness with a liver edge of 4 cm below right subcostal margin. CBC done at the ER reveals Hgb = 11, Hct = 44, WBC=3, segmented = 22, lymphocytes = 78, platelet = 90,000 or 19,000?? The necessary criteria to make a diagnosis of dengue hemorrhagic fever in this case is one of the ff except? C. Hepatomegaly

3.

A 10 yr-old boy suspected to have dengue is on his 7 th day of illness. The best serological test to be done at this point would be? B. Dengue IgM capture

4.

An 8 yr old male was brought to the ER due to fever of 5 days duration. This was associated with several episodes of vomiting of previously ingested food, and persistent epigastric pain. On PE, HR=100, RR=25, BP=100/60. Dengue is the likely diagnosis. As such, how would you classify this patient’s dengue? B. Dengue with warning signs - Because of several episodes of vomiting and epigastric pain

5.

Which is true regarding the Aedes aegypti mosquito? B. flight range is 50m

6.

An 8 month-old girl was brought to the OPD because of generalized maculopapular erythematous rashes extending from the face to the toes of the feet. The mother was worried because the patient remained highly febrile at 39 deg C with persistent coughing and consistent runny nose. You know that there was an associated conjunctivitis and suspect that the child has measles. The following is the best advice for the mother A. Admit to the pediatric unit and start antibiotic treatment. Remember: If the rashes extend down to the foot, you have to anticipate bacterial infection so you have to start antibiotic treatment.

7.

A 4 month-old girl was brought for consult because of a recent exposure to a neighbor with measles. Mother claims that the baby was brought to the neighbor’s house 4 days ago while she went to look for work. What is the best the best thing that can be done to the patient? A. Give measles immunoglobulin (You cannot give the vaccine because the patient is only 4 months old. Remember, the earliest time you can give the vaccine is at 6 months.)

8.

A 15 year-old leukemic girl was exposed to her sibling with Varicella 2 days ago. The Varicella zoster immunoglobulin is not available in the Philippines. At this point in time, what is the alternative post-exposure prophylaxis that can be given to a leukemic patient? B. IV Ig

9.

Which of the following viral exanthem diseases present with photophobia? B. Rubeola

10. A 10 yr-old girl was brought to the OPD because of generalized fine erythematous maculopapular rashes. The physician who saw the patient suspected the rashes to be Rubella. Which data in the history would be more specific to the rashes of Rubella? D. Rashes usually persist for 3 days 11. This viral exanthematous disease presents with vesicular lesions on the hands and feet with associated oral ulcers. The etiologic agent associated with pulmonary and CNS complications is? D. Enterovirus 71 12. Fetal hydrops may be a uterine complication of which virus? B. Parvovirus B19 13. One of the most dreaded complications of chickenpox is secondary bacterial infection of the lesion. The most common bacterial agent involved is? C. S. pyogenes

14. A 16 year-old girl was brought to the doctor because of fever and distinct pinpoint maculopapular rashes. She was diagnosed with a viral exanthem and was given supportive measures. The rashes resolved spontaneously. A few days later, she experienced joint pains on the knees and swelling of the small joints of the hands. The clinical course is usually seen in? C. Rubella 15. A 12 month-old boy was given his first dose of varicella vaccine. When is the earliest time to give the second dose? A. 15 months (you can give as early as 3 months after 1 st dose) 16. What is the congenital anomaly expected if the mother contracted Rubella during her 12 th week of gestation? D. Deafness 17. The most likely antibiotic regimen for patients with measles pneumonia are the ff except? D. ceftazidine and amikacin Organisms that can cause measles pneumonia are Staph, Strep and H. influenza. Other antibiotics that were included in the choices are oxacillin and chloramphenicol, cefuroxime and amoxicillin-clavulanic acid. Ceftazidine is for Pseudomonas infections.

18. The ff etiologic agents may be associated with a circular type of rashes. A. Coxsackie A16 19. A patient is diagnosed with Varicella. The most appropriate infection control is? A. Isolation in a room with negative air pressure 20. Which is true of measles infection and sequelae? C. Patients are contagious for 4 days before and after onset of the rash. (Nelson said it’s 3 days before and 4-6 days after onset of rashes.) 21. A 15 month-old boy has high-grade fever for 3 days, documented highest temperature is 40 deg C. After a day without fever, he developed generalized maculopapular rashes that lasted for 2 days. The most likely etiologic agent involved is? B. HHV6 (Roseola infantum) 22. Clinical diagnosis of measles may be made through recognition of the ff except? D. Characteristic vesicular rash 23. Which of the ff best describes mumps’ clinical course? C. May be asymptomatic in 20% of patients 24. The more common presentation of mumps in pre-school aged children is? B. cough and colds 25. Which characteristic of the rash is not a differentiating feature of measles from rubella? A. erythematous 26. Swimmer’s itch is seen in this parasitic infection? A. Schistosomiasis 27. The triad of abdominal pain, borborygmy, and diarrhea leading to protein-losing enteropathy is best treated with? A. Mebendazole (This is Capillaria philippinensis. This is a nematode so give mebendazole.) 28. Part of the management and prevention of Enterobiasis are the ff except? B. Proper disposal of feces (Enterobius is transmitted via autoinoculation. Scratch the anus and inhale/ingest the ova.) 29. A 15 year-old girl from Leyte was brought to Manila for consult. She has facial edema and abdominal distention. She has portal hypertension and hepatosplenomegaly. The most important diagnostic tool to rule out the patient’s condition would be? B. COPT 30. A 5 yo boy was brought for consult because of passing out of spaghetti-like worms during defecation. The mother also claimed that her son sometimes complained of vague abdominal pain. What is the diagnostic method of choice to establish the etiologic agent?

B. routine fecal exam (this is ascariasis) 31. What is the treatment of choice for a 7 year-old girl who complains of perianal pruritus especially noted at night? Stool exam reveal a D-shaped ova. C. pyrantel pamoate. (this is enterobiasis) 32. Which is true of Trichiuriasis? B. Diarrhea and dysentery may cause nutritional impairment 33. The protozoan most likely implicated as a cause of pneumonia in immunocompromised patients is? C. Pneumocystis jiroveci 34. A 16 yr old boy was admitted due to generalized tonic-clonic contractions of several episodes. A CT scan was done revealing a ring-like enhancement on the parietal area. He is fond of eating grilled pork. He also mentioned finding flat ribbon-like? material in his underwear. The primary impression for this patient’s condition is caused by? C. Taenia solium 35. A heavy infection of this nematode can cause an intestinal bolus of round worms leading to obstruction? D. Ascaris lumbricoides 36. A 5 year-old girl was rushed to the ER due to fever of 3 days duration. There were no significant signs and symptoms except occasional cough. PE revealed a highly febrile child with T=39C, HR=130, RR=35. CBC revealed anemia with leukocytosis and neutrophilia. Patient is awake but irritable, with skin that is firm to touch?? and with equal pulses. Which condition best describes the patient’s illness? A. SIRS (systemic inflammatory response syndrome) 37. A 2 month-old girl was admitted in the hospital for 7 days with pneumonia was transferred to the ICU and mechanically ventilated. The empiric antimicrobial treatment for mechanically-ventilated patients should always cover for? C. Gram negative bacteria 38. The management for septic shock include the following except? C. corticosteroid administration 39. The following etiologic agent is least likely to be considered in patient’s presenting with fever and petechiae? B. S. pyogenes 40. IL-1, together with this cytokine causes fever in patients who are septic. B. TNF 41. A 6 week-old infant has gained no weight since birth. Her skin appeared mottled and an indirect bilirubin level is measured at 24 mg/dl. Her extremities are cold and her temperature is 35 deg C. The most likely diagnosis is? B. hypothyroidism stunted physical growth, subnormal temp, presence of typical respiratory distress syndrome, cry a little and sleep a lot, poor appetite

42. Type I diabetes mellitus is most often associated with? C. Antibodies to glutamic acid dehydrogenase (other autoantibodies: islet cell cytoplasm, from Nelson) 43. Hyperglycemia during diabetic ketoacidosis maybe associated with? C. hyperkalemia 44. Ketoacidosis manifests with? A. acute abdominal pain, nausea, vomiting, and rapid breathing 45. A 6 year-old girl presents with breast enlargement and pubic hair development, otherwise, she is asymptomatic. The serum LH level is elevated. The most likely diagnosis is? D. central precocious puberty 46. The principal regulator of extracellular tonicity or osmolality is? B. vasopressin 47. Extravolume hemostasis is principally regulated by? C. renin-angiotensin system

48. Normal fasting blood glucose level is? C. ≤100 mg/dl 49. A 4 year-old with bacterial meningitis developed generalized convulsions on the 4 th day of illness. Investigation revealed SIADH is the most likely reason for the convulsions. The treatment of SIADH will include which of the following? C. restriction of fluid intake 50. The triad of polydipsia, polyuria, and hypernatremia is most likely due to? D. diabetes insipidus 51. the earliest sign of congenital hypothyroidism is: A. prolonged neonatal jaundice This is due to the delayed maturation of glucoronide conjugation

52. a 14-year old girl with polyuria, polydipsia, and hypernatremia was given oral vasopressin to which she responded well. Most likely diagnosis: B. central diabetes insipidus 53. Most common cause of congenital hypothyroidism is: C. thyroid dysgenesis 54. Most common cause of thyroid dysgenesis is: A. Ectopia 55. The renal threshhold for glucose is: B. 180mg/dl 56. Uncontrolled type 1 DM is due to severe insulin deficiency and may lead to ketonuria which is due to: C. Increased lipolysis 57. The monitoring of treatment compliance in patients with Type 1 DM is: A. Hgba1c levels 58. Most common cause of death in patients with diabetic ketoacidosis B. Cerebral edema 59. The first step in the treatment of PKA even before the administration of intravenous insulin is: A. Parenteral rehydration with 0.9 saline solution 60. A newborn with ambiguous genitalia is determined to be a genetic female. Virilization(?) is most commonly due to: A. 21-hydroxylase deficiency 61. Among the device-associated infections in the Pedia ICU, this is the most common health-care associated infection: B. Catheter-related bloodstream infection 62. For the surgical-site infections, which of the ff is the most commonly reported pathogen: B. Staph. aureus 63. Which of the following entities should be admitted in single-patient room with negative air pressure ventilation: A. (Couldn’t understand the recording but the explanation was: “because these can be transmitted through droplets like in varicella”) 64. Surveillance of health-care associated infections is necessary to understand thespecific infection problems in hospitals. Which of the following surveillance strategy is the best: D. active searching for cases by trained personnel 65. An 8-year old male was rushed to the hospital because of high-grade fever, headache, and sore throat of 12h and petechial rash of an hour duration. Vital signs at ER were the ff: Temp of 39.6 per axilla, BP of 80/60, HR of 140, RR of 20. He was ill-looking and drowsy. Which of the ff categories of transmission-based precautions warrants its application in this case on admission: B. Droplet

66. When is the lifting of the precautions in the patient in the above case permitted? A. 24 hours after initiation of effective antimicrobial therapy

67. A family is referred to you because a 35-year old father with 3 children was recently diagnosed to have TB with positive AFB smears. Children consisting of a 10-year old daughter and 2 sons, aged 4 and 1, had BCG at birth and were all asymptomatic. A 5.0 TU Mantoux test and a CXR revealed the following: 10-year old daughter: Tuberculin test 2mm, CXR normal. 4-year old son: Tuberculin test 5mm, CXR normal. 1-year old son: Tuberculin test 15mm, CXR with perihilar infiltrates with enlarged LN. Which of the ff would you do for the one-year old son: B. Start treatment with 2HRZ and 4HR 68. Which of the ff would you do for the 4-year old son, above: C. Start with INH for 3 months then repeat Mantoux test 69. Which of the ff would you do for the 10-year old daughter, above: B. No treatment but repeat Mantoux test in 3 months 70. Which of the following should be done in the follow-up care of the children, above: C. “Obtain AFB culture plus … from the mother” 71. In congenital TB, the Ghon’s complex is found in the: B. liver 72. Which of the ff is the recommended regimen for TB meningitis: D. 2HRZE/10HR 73. Which of the ff is considered to have latency infection: B. A 5-year old with positive BCG, positive exposure, tuberculin skin test of 10mm, with no signs and symptoms, and negative CXR 74. A 3-year old child has a positive tuberculin skin test. Which of the following would be the most suggestive of miliary TB? C. hepatosplenomegaly 75. which of the ff statements is NOT true of… (?) D. the annual risk of infection for TB is 2.5% will not increase will not change for the last 15 years (?) 76. A 15-year old male recently diagnosed with PTB. After a month of HRZE regimen, he remains symptomatic, still with actively rising temperature, cough, and back pain. Which of the ff actions would you do for this patient: A. Obtain AFB and … of the patient. 77. A 6-month old female infant was brought to the ER with fever without lethargy. Which of the following is associated with an increased risk for serious bacterial infection in this child? A. Fever of greater than 40 degrees Celsius 78. A 2-year old female with a 2-month history of cough was brought to the ER because of respiratory difficulties. She had a temp of 39 C, with intercostal retractions and crackles on both lung fields. CXR showed bilateral pulmonary infiltrates. Which of the ff is the culprit: A. Hemophilus influenzae B 79. Considering the preceding case, on admission, you will start the patient on which of the ff antibiotics: B. Ampicillin 80. A 7-year old female grade 1 student was brought to the OPD because of high-grade fever, sore throat, and difficulty swallowing. PE findings showed hyperemic oropharynx, enlarged tonsils with exudates, petechiae of soft palate, tender submandibular and anterior cervical LN. The most cost effective antibiotic of choice in this case would be: A. Phenoxymethylpenicillin 81. Which of the ff statements is/are true of exudative tonsillopharyngitis:

A.

Majority are still caused by viruses

82. A 10-year old male spends his summer vacation in the province. He will accompany his grandpa to the farm. About 2 weeks prior to the opening of classes, he developed high-grade fever, associated with headache, macular rashes along the trunk. A black eschar was noted on right inguinal area. He received measles vaccine at 9 months, MMR at 16 months and at 6 years of age. What is your impression of the case? B. … 83. Treatment of choice in the case above would be: B. Tetracycline 84. Which of the ff drug regimens is appropriate prophylaxis for close contacts, 5(?) years and below, of a child with meningococcal meningitis: C. Rifampicin for 2 days 85. A 16-year old sexually-active male comes to you because of low-grade fever, sore throat, headache, and appearance of a sore on his penis which does not hurt about 4 weeks prior to the appearance of symptoms. He has been sexually active for the past 2 years, and has had a steady girlfriend for the last 6 months, but admits to occasional sexual activity with other girls during that time. Which of the following is your diagnosis in this case: C. syphilis 86. Which of the ff is the best treatment option in the case above: C. Benzathine penicillin, 2.4 mu given IM single-dose 87. A one-month old male was rushed to the ER because of high-grade fever and irritability of one day. PE revealed bulging anterior fontanelle with neck rigidity. Considering CNS infection, the most likely pathogen would be: D. E. coli 88. A 4-year old female has been feverish for the past 3 days, and was rushed to the ER because of respiratory distress, as evidenced by stridor of 2 hours duration. The patient was toxic-looking with multiple enlarged cervical LN and had a grayish membrane on the tonsils. It bled when tried to be removed. The patient is suffering from: A. Diphtheria 89. A 10-year old female from San Mateo, Rizal, was rushed to the ER because of an axillary temperature of 40 C of 6 hours duration, associated with intense headache and drowsiness. PE findings showed a drowsy child with petechiae on all extremities, hyperemic oropharynx, supple neck, and a BP of 80/60. What is your diagnosis: B. meningococcemia 90. Which of the ff lab results may be a bad(?) prognosticator in the case above: C. ESR of 5mm per hour 91. Which of the ff would be a very common cause of prolonged fever “and malaise” (?): B. malaria 92. In TB meningitis, the exudate tends to be more severe: B. At the base of the brain 93. Which of the ff characterizes congenital syphilis: A. involvement of the long bones 94. Which of the ff characterizes staphylococcal food posioning? B. Extensive vomiting, abdominal cramps, and diarrhea 95. Which of the ff characterizes pertussis: B. ______ followed by a gradual worsening of cough and finally whooping 96. Which of the ff blood cell counts is most suggestive of pertussis: C. 20,000 with 75% leukocytes 97. The first clinical manifestation of tetanus neonatorum usually is: D. Difficulty in talking and swallowing 98. The 3 most common bacterial causes of meningitis in childhood, excluding the neonatal period, are: A. Hib, Strep. pneumoniae, N. meningitidis

99. The three most common causes of acute otitis media in children 3mos-5years are: B. Hib, Strep. pneumoniae, Moraxella catarrhalis 100. A.

Which of the ff is the drug of choice for the treatment of pertussis? Erythromycin