END - Pedia1 Flashcards

Question

Regarding breath-holding spells in children, one of the following statements is NOT true: a. It is fairly common in the first 2 years of life b. It does not contribute to an increased risk of seizure disorders c. Parents are advised to ignore and not to reinforce these attacks d. It must be immediately attended to prevent hypoxia and onset of seizures

Answer 1

d. It must be immediately attended to prevent hypoxia and onset of seizures 💡 Rationale: 🛑 Breath-holding spells are benign, often triggered by crying or frustration 👶 Common in ages 6 months–2 years 🧘‍♂️ Parents are advised to stay calm and avoid reinforcing the behavior 🙅‍♂️ Why not: a. 👶 True — common under age 2 b. ✅ True — not linked to seizure disorders c. 👪 True — ignoring the episode helps prevent behavioral reinforcement

Answer 2

c. 3 💡 Rationale: 👶 By 3 months, infants typically: 🧠 Develop neck strength 💪 Can lift and control their head when upright or during tummy time 🙅‍♂️ Why not: a. 1️⃣ Not enough muscle tone yet b. 2️⃣ Some head lifting may occur, but not full control d. 6️⃣ By this age, head control is already well established

Answer 3

d. Listen to voices, coos 💡 Rationale: 👶 At 1 month, infants: 🧍‍♂️ Show tonic neck posture 👁️ May begin to track moving objects 👋 Exhibit head lag when pulled to sit ❌ Cooing and listening/responding starts around 2 months 🙅‍♂️ Why not: a. ✅ Tonic neck is normal at 1 month b. ✅ Following objects is emerging at this stage c. ✅ Head lag is expected

Answer 4

b. Speaks one or two words with meaning 💡 Rationale: 👶 At 12 months, children often: 🗣️ Say “mama” or “dada” with meaning 📈 Communicate basic needs verbally 🙅‍♂️ Why not: a. 🥤 Drinking from a cup begins at ~15 months c. 🔔 Ringing a bell purposely is typical at ~15–18 months d. 🪑 Sitting down from standing is more 12–15 months but not exclusive to 1 year milestone

Answer 5

a. 6 months of age 💡 Rationale: ⚖️ Weight milestones: 📍 Doubles by 6 months 📍 Triples by 12 months 📍 Quadruples by 2 years 🙅‍♂️ Why not: b. ❌ 1 year = triples, not doubles c/d. ❌ 2 and 3 years = quadruples or stabilizes, not relevant to "doubling"

Answer 6

a. Social smile 💡 Rationale: 👶 Milestone timeline: 😊 Social smile: ~6 weeks 😟 Stranger anxiety: ~6–9 months 🪑 Sitting without support: ~6 months 👌 Pincer grasp: ~9 months 🙅‍♂️ Why not: b. 😨 Stranger anxiety is later c. 🪑 Sitting = occurs at 6 months d. 👌 Pincer grasp = fine motor milestone around 9 months

Answer 7

b. 7 months 💡 Rationale: 🪑 Sits briefly, leaning on hands 🧱 Reaches for and transfers a cube (radial-palmar grasp) 🗣️ Babbles ❌ Cannot wave or use pincer grasp (comes ~9–10 months) 🙅‍♂️ Why not: a. 4️⃣ months: Cannot sit or transfer objects c. 🔟 months: Would likely wave bye-bye and use pincer d. 14️⃣ months: Would definitely have both skills

Answer 8

d. 10 months 💡 Rationale: 🪑 Sits unsupported 🧍‍♂️ Pulls to stand 👋 Waves bye-bye, plays peek-a-boo – classic social 10-month milestone 🙅‍♂️ Why not: a. 4️⃣ months: No unsupported sitting b. 6️⃣ months: Not yet pulling to stand or waving c. 8️⃣ months: Some babies pull to stand but not consistent for all three skills

Answer 9

c. 12 months 💡 Rationale: 🗣️ Uses "Mama/Dada" meaningfully 🧍‍♀️ Stands alone 🧠 Imitates actions (like clapping, waving) 🙅‍♂️ Why not: a. 36️⃣ months: Already forming sentences b. 24️⃣ months: Vocabulary is much larger d. 6️⃣ months: No standing or word discrimination yet

Answer 10

a. Standing unaided at 13 months 💡 Rationale: 🧍‍♂️ Normal to stand unaided around 12–14 months 🙅‍♂️ Why not: b. 🦷 First molars erupt ~12–18 months, not 6 months c. 👣 Extensor plantar after 12–18 months may suggest upper motor neuron pathology d. 💩 Bowel control is typically gained around 2–3 years, not 13 months

Answer 11

a. Optic nerve 💡 Rationale: 👁️ Papilledema = swelling of the optic disc 📈 Suggests raised ICP → affects CN II (Optic nerve) 🙅‍♂️ Why not: b. CN III: Controls eye movement, pupil c. CN V: Facial sensation, chewing d. CN VI: Lateral eye movement, not vision or disc margin

Answer 12

b. CN XII, left 💡 Rationale: 👅 The hypoglossal nerve (CN XII) controls tongue movement. 🧠 Lower motor neuron lesion causes ipsilateral tongue deviation (toward the affected side). 📍 So, deviation to the left = left CN XII lesion 🙅‍♂️ Why not: a/c. CN XI is for sternocleidomastoid/trapezius, not tongue d. Right CN XII lesion → tongue would deviate right

Answer 13

b. 2 years 💡 Rationale: 🦴 Ossification of the capitate and hamate typically occurs by 12–18 months, so by 2 years, two carpal bones are usually visible on X-ray. 🙅‍♂️ Why not: a. 1 year: Often only 1 ossified bone c/d. 3–4 years: More carpal bones ossify, not just 2

Answer 14

d. Hop 5 steps 💡 Rationale: 🧠 Age 3 skills: ✏️ Draw a circle 🗣️ Talk in sentences 🪜 Climb down stairs (alternating feet with help) 🐸 Hopping on one foot typically develops by age 4 🙅‍♂️ Why not: a. Drawing a circle = ✅ 3 years b. Sentences = ✅ 3 years c. Climbing down stairs = ✅ 3 years

Answer 15

d. 12 months of age 💡 Rationale: 📏 Head circumference growth pattern: 🎯 Birth: ~35 cm ➕ 1 cm/month in first year 📈 So by 12 months, ~+8 cm = 43 cm 🙅‍♂️ Why not: a. 4 months: ~39 cm b. 6 months: ~41 cm c. 8 months: ~42–42.5 cm

Answer 16

c. 1,500 kcal/day 💡 Rationale: 🍽️ General caloric needs: 👶 1 y/o = ~900–1,000 kcal/day 👧 3–5 y/o = ~1,200–1,600 kcal/day 🧒 5 y/o average = 1,500 kcal/day, adjusted by activity 🙅‍♂️ Why not: a. 800 kcal/day = too low, fits infants b. 1,000 kcal/day = more for toddlers d. 2,000 kcal/day = school-age to pre-teen

Answer 17

c. Its supplementation effectively decreases the incidence of scurvy 💡 Rationale: 🍊 Ascorbic acid (Vitamin C) is crucial for collagen synthesis, iron absorption, and antioxidant protection. ✅ Supplementation prevents scurvy, which presents with bleeding gums, petechiae, and poor wound healing. 🙅‍♂️ Why not the others: ❌ a. Unstable in light, alkaline conditions, and heat. ❌ b. Enhances, not decreases, iron absorption. ❌ d. While needs may increase during stress/febrile states, this is not the key distinguishing feature in exams.

Answer 18

b. Fewer episodes of allergic manifestations 💡 Rationale: 🍼 Breastfeeding provides immune protection and lowers the risk of developing atopic diseases like eczema or allergies. 🤱 Exclusive breastfeeding also improves gut microbiota and decreases systemic inflammatory responses. 🙅‍♂️ Why not the others: ❌ a. Breastfed infants have fewer, not more, episodes of diarrhea and URTI. ❌ c. Weight gain may be slightly slower, but still within normal range. ❌ d. Colic occurs in both breastfed and formula-fed infants—not more common in breastfed ones.

Answer 19

d. Secretory IgA 💡 Rationale: 🛡️ Secretory IgA binds to pathogens and prevents them from adhering to and invading the mucosal surfaces—especially in the gut and respiratory tract. 🙅‍♂️ Why not the others: ❌ a. Lactoferrin binds iron, limiting bacterial growth (non-specific immunity). ❌ b. Macrophages offer immune support but are not the main source of specific immunity. ❌ c. Oligosaccharides promote healthy gut flora, not specific immunity.

Answer 20

c. Height 💡 Rationale: 📏 Height is a measure of linear growth and is not influenced by temporary changes in fluid retention or fat stores, unlike weight or MUAC. 🙅‍♂️ Why not the others: ❌ a. Head circumference can be affected in hydrocephalus or edema. ❌ b. Weight fluctuates with hydration, fat stores, and illness. ❌ d. MUAC reflects both fat and muscle mass—thus influenced by fluid and nutrition status.

Answer 21

d. Infrequent or ineffective feedings 💡 Rationale: 🍼 Poor latch, short nursing duration, or infrequent feeding sessions lead to inadequate milk intake, which is the most common cause of poor weight gain. 🙅‍♂️ Why not the others: ❌ a. Metabolic disorders are rare and not the usual cause. ❌ b. Breast milk fat content is generally adequate. ❌ c. Maternal diet has minimal effect on milk quality and weight gain unless severely deficient.

Answer 22

d. Human milk 💡 Rationale: 🍼 Human milk contains about 3.5-4% fat, which is lower than the fat content in carabao (~7-8%), goat (~4.5%), and cow milk (~3.7%). 🧠 It is optimized for slow, steady growth and high brain development, not for rapid weight gain. 🙅 Why not the others: ❌ a. Carabao milk – highest fat content among common milks (~7-8%). ❌ b. Cow milk – higher than human (~3.7%). ❌ c. Goat milk – ~4.5%, also higher than human milk.

Answer 23

c. 2 fingers technique positioned 1 finger breadth below the intermammary line 💡 Rationale: 👶 For neonatal resuscitation, use 2-finger technique for lone rescuers. ✋ Place fingers just below the intermammary line, targeting the lower third of the sternum. Depth: ~1.5 inches (1/3 anterior-posterior diameter). 🙅 Why not the others: ❌ a. 10:1 ratio is used when there's an advanced airway, not typically for solo neonatal CPR. ❌ b. Heel of one hand – used for older children, not neonates. ❌ d. 2 inches depth – appropriate for children, not neonates.

Answer 24

c. Pinna is pulled posteriorly and downward 💡 Rationale: 🧒 In children under 3 years, the external auditory canal is more horizontal, so to straighten it: 👉 Pull pinna backward and downward. 🧑 In adults, the pinna is pulled upward and backward. 🙅 Why not the others: ❌ a. While true, this doesn't answer the technique. ❌ b. The same hand is used as the ear examined (e.g., right hand → right ear). ❌ d. 4 mm speculum may be too large for infants/toddlers.

Answer 25

d. Presence of condensation in the ET during exhalation 💡 Rationale: 🌫️ Condensation during exhalation inside the ET tube = airflow through lungs = proper placement. It's one of the quickest bedside confirmations before capnography or X-ray. 🙅 Why not the others: ❌ a. Wheezing in both lungs doesn't confirm tracheal placement. ❌ b. Asymmetric chest movement → possible right mainstem bronchus intubation. ❌ c. Breath sounds in the stomach = possible esophageal intubation.

Answer 26

d. Volar aspect of the forearm 💡 Rationale: 💉 The PPD is administered intradermally at the volar (inner) forearm, allowing easy visibility of the induration at 48–72 hrs. 🙅 Why not the others: ❌ a. Deltoid is for IM vaccines, not for PPD. ❌ b. Dorsal hand – too thin, uncomfortable, poor visualization. ❌ c. Gluteal – not used for skin tests.

Answer 27

a. Proximal tibia 📘 Rationale: 🦴 Proximal tibia is the most commonly used IO site in children because it's easily accessible and has a broad, flat surface with a large marrow cavity. 🙅 Why not the others: ❌ b. Distal femur – less preferred due to increased risk of growth plate injury. ❌ c. Sternum – used more in adults, not routinely in children. ❌ d. Iliac crest – not standard for emergent IO access.

Answer 28

c. Giving tetanus toxoid 📘 Rationale: 💉 Tetanus toxoid stimulates active immunity, prompting the body to make its own antibodies. 🙅 Why not the others: ❌ a. Diphtheria antitoxin – passive immunity (pre-formed antibodies). ❌ b. Gamma globulin – passive (IgG antibodies). ❌ d. Tetanus immune globulin – passive protection with antibodies.

Answer 29

c. Umbilicus 📘 Rationale: 👶 In neonates, the umbilical vein is the preferred site for exchange transfusion, especially in the first week of life, as it provides reliable central access. 🙅 Why not the others: ❌ a. External jugular – technically difficult in neonates. ❌ b. Cut-down site – more invasive, less ideal. ❌ d. Intraosseous – emergency fluid access, not used for exchange transfusion.

Answer 30

b. Gentamicin 📘 Rationale: 👂 Gentamicin (aminoglycoside) is classically ototoxic, especially with prolonged or high-dose use. 🙅 Why not the others: ❌ a. Ethacrynic acid – also ototoxic, but less commonly used. ❌ c. Thiazides – not associated with ototoxicity. ❌ d. Mannitol – not ototoxic; it’s an osmotic diuretic.

Answer 31

a. Diazepam 📘 Rationale: 💊 Rectal diazepam is effective and rapidly absorbed for status epilepticus—commonly used in pediatrics when IV access is not available. 🙅 Why not the others: ❌ b. Phenobarbital – used IV or IM; slower onset. ❌ c. Phenytoin – requires IV; not for rectal use. ❌ d. Valproic acid – available orally or IV; not rectally.

Answer 32

b. Metronidazole 📘 Rationale: ⚠️ Metronidazole is hepatically metabolized and can worsen hepatic dysfunction, especially in jaundiced children with impaired liver function. 🙅 Why not the others: ❌ a. Hydrochlorothiazide – cleared renally; not directly hepatotoxic. ❌ c. Indomethacin – NSAID; use cautiously but not contraindicated solely due to jaundice. ❌ d. Salbutamol – beta-agonist; minimal hepatic metabolism.

Answer 33

b. Short half-life 📘 Rationale: 🕒 A short half-life means the drug is cleared quickly, so it doesn't stay in the plasma long enough to accumulate in breast milk. 🙅 Why not the others: ❌ a. High lipid solubility – 💧 lipid-soluble drugs cross membranes easily → higher breast milk levels. ❌ c. Low molecular weight – ⚖️ smaller molecules pass more readily into milk. ❌ d. Unionized state – 💊 unionized drugs cross membranes more easily.

Answer 34

d. Valproic acid 📘 Rationale: 💥 Valproic acid is teratogenic, associated with neural tube defects (e.g., meningomyelocele) and craniofacial anomalies. 🙅 Why not the others: ❌ a. Alcohol – causes fetal alcohol syndrome (not meningomyelocele). ❌ b. Lithium – associated with Ebstein anomaly (cardiac defect). ❌ c. Thiazides – not strongly linked to major congenital malformations.

Answer 35

d. The blood-brain barrier is less permeable 📘 Rationale: 🧠 In neonates, the blood-brain barrier is MORE permeable, making the CNS more vulnerable to drugs and toxins. 🙅 Why not the others: ✅ a. Gastric acid is reduced – true; affects drug absorption. ✅ b. Fat content is low – true; influences drug distribution. ✅ c. Plasma albumin is low – true; affects protein binding and free drug availability.

Answer 36

a. Alcohol 📘 Rationale: 🍷 Fetal alcohol syndrome presents with facial dysmorphisms, growth retardation, and neurologic impairment (e.g., hypotonia). 🙅 Why not the others: ❌ b. Cocaine – more associated with placental abruption and growth restriction, not facial anomalies. ❌ c. Marijuana – weak association with birth defects. ❌ d. Opiate – associated with neonatal abstinence syndrome, not craniofacial anomalies.

Answer 37

b. Teeth and bones 📘 Rationale: 🦷 Tetracyclines bind to calcium and get deposited in developing teeth and bones, leading to permanent discoloration of teeth and impaired bone growth in the fetus. 🙅 Why not the others: ❌ a. Ear – Ototoxicity is linked more with aminoglycosides, not tetracyclines. ❌ c. Kidney – Not a primary teratogenic target for tetracyclines. ❌ d. CNS – Neural defects are typically linked to folate deficiency or anticonvulsants.

Answer 38

a. Spinal cord and bones 📘 Rationale: 🧠 Folic acid is essential for neural tube closure. Deficiency can lead to spina bifida, anencephaly, and other neural tube defects involving the spinal cord. 🙅 Why not the others: ❌ b. Vestibular nerves – Not directly related to folate. ❌ c. Kidney – Not the primary target in folate-related teratogenesis. ❌ d. Eyes – No strong link to folic acid deficiency.

Answer 39

b. Erythromycin 📘 Rationale: 💊 Erythromycin is considered one of the safer antibiotics during pregnancy (except estolate form, which may cause hepatotoxicity). 🙅 Why not the others: ❌ a. Fluoroquinolones – Can damage developing cartilage. ❌ c. Aminoglycosides – Risk of ototoxicity in fetus. ❌ d. Ribavirin – Highly teratogenic and contraindicated.

Answer 40

c. Gastric emptying time and small intestinal motility are increased 📘 Rationale: 🤰 Progesterone slows GI motility and gastric emptying, which actually decrease, not increase. 🙅 Why not the others: ✅ a. Plasma volume increases – True. ✅ b. Blood volume increases – True (~50% increase). ✅ d. Water-soluble drugs have larger Vd – True, due to increased total body water.

Answer 41

a. Mid arm circumference 📘 Rationale: 📏 MUAC (mid-upper arm circumference) is relatively stable from ages 1 to 5 years and is useful for nutritional screening. 🙅 Why not the others: ❌ b. Skinfold thickness – Can vary with nutritional status. ❌ c. Height – Increases steadily with age. ❌ d. Chest:head circumference ratio – Changes as head growth slows and chest grows after infancy.

Answer 42

a. Erythromycin 📘 Rationale: 🧬 Erythromycin is a CYP450 enzyme inhibitor, especially CYP3A4. It slows down hepatic metabolism of other drugs, potentially increasing their plasma levels and risk of toxicity. 🙅 Why not the others? ❌ b. Rifampicin – 🚀 Induces CYP enzymes, increasing metabolism of other drugs. ❌ c. Phenobarbital – 🚀 Enzyme inducer. ❌ d. Phenytoin – 🚀 Strong CYP450 inducer, like phenobarbital.

Answer 43

c. 6 months 📘 Rationale: 🔄 Rolls in both directions ✋ Reaches with one hand 🧍‍♂️ Sits momentarily or with support 🗣️ Babbles — These are classic 6-month milestones. 🙅 Why not the others? ❌ a. 2 months – Only raises head, smiles, coos ❌ b. 4 months – May roll front to back, not both ways ❌ d. 8 months – More advanced: sits unsupported, begins crawling

Answer 44

b. SMR2 📘 Rationale: 👙 Thelarche (breast bud development) is the first visible sign of puberty in girls, marking the beginning of Tanner Stage 2 (SMR2). 🙅 Why not the others? ❌ a. SMR1 – Prepubertal stage ❌ c. SMR3 – Breast enlargement without contour separation ❌ d. SMR4 – Areola and papilla form secondary mound

Answer 45

d. 3 years 📘 Rationale: 🦷 By 3 years old, a child usually has all 20 primary teeth (milk teeth) erupted. 🙅 Why not the others? ❌ a. 1.5 years – Only ~8–10 teeth ❌ b. 2 years – About 16 teeth ❌ c. 2.5 years – Almost all, but not yet guaranteed full eruption

Answer 46

c. Bids for autonomy 📘 Rationale: 🧍‍♂️ At this stage, teens strive for independence, seek peer approval, and challenge parental boundaries — classic bids for autonomy. 🙅 Why not the others? ❌ a. Developing identity and self-image – Yes, but more internal; the described behavior is more social ❌ b. Stereotypical behavior – Too vague, doesn’t define autonomy ❌ d. Intimate procedure takes precedence – Not related to the adolescent's general social development

Answer 47

b. 4–6 y/o 📘 Rationale: ✨ Children begin identifying their gender around age 2–3, but by ages 4–6, most children have a stable and consistent gender identity. 🙅 Why not the others? ❌ a. 2–3 y/o – Gender awareness starts here but is not yet stable. ❌ c. 7–9 y/o – Gender identity is usually already established by this time. ❌ d. 10–12 y/o – This age may involve role exploration, but not identity formation.

Answer 48

c. Tanner Stage III 📘 Rationale: ✨ By Tanner Stage III, adolescents are often more aware of gender identity issues and may begin the coming out process. Providers should intervene with support, mental health care, and stigma reduction at this stage.

Answer 49

d. SMR 4 📘 Rationale: ✨ Tanner Stage IV (SMR 4) is the stage when menarche typically occurs in most girls (~90%). ✨ It follows the peak height velocity seen in Stage III. 🙅 Why not the others? ❌ a. SMR 1 – Prepubertal. ❌ b. SMR 2 – Breast budding begins. ❌ c. SMR 3 – Ongoing development; menarche uncommon here.

Answer 50

d. Must be treated vigorously in the first year 📘 Rationale: ✨ Thumb sucking is a normal self-soothing behavior in infants and toddlers. ✨ Intervention is not needed in the first year unless it persists beyond 4–5 years, where it may affect dentition. 🙅 Why not the others? ✅ a. Can lead to malocclusion – True with prolonged sucking. ✅ b. Is a source of pleasure – Common for self-soothing. ✅ c. Is a sign of insecurity – May emerge during stress.

Answer 51

b. Career decision becomes pressing 📘 Rationale: ✨ During late adolescence (ages 17–21), individuals focus on career planning, intimacy, and personal identity formation. ✨ Making future-oriented decisions becomes a central developmental task. 🙅 Why not the others? ❌ a. Selection of adults outside family – Occurs more in middle adolescence. ❌ c. Focus on physical attractiveness – Prominent in early to mid adolescence. ❌ d. Role model presence – Important throughout adolescence, not specific to late stage.

Answer 52

d. Increase in body fat 📘 Rationale: ✨ Testosterone promotes: 💪 Muscular growth 🎤 Deepening of the voice ⚫ Enlargement & pigmentation of the scrotum 🚫 It does not increase body fat—this is typically due to estrogen or caloric imbalance. 🙅 Why not the others? ✅ a. Muscular growth – Classic anabolic effect of testosterone. ✅ b. Scrotum pigmentation – Driven by androgens. ✅ c. Deepening of the voice – Due to laryngeal growth stimulated by testosterone.

Answer 53

c. 20 mEq/L 📘 Rationale: ✨ D5IMB contains: 💧 Sodium: ~ 133 mEq/L ⚡ Potassium: 20 mEq/L 📦 Chloride: ~ 98 mEq/L 🍬 Glucose: 5% Used for maintenance hydration in pediatric patients.

Answer 54

a. Thirst 📘 Rationale: ✨ Thirst is the body's first compensatory response to volume depletion. 😓 Absence of tears 👁️ Sunken eyes 🕒 Prolonged cap refill …are signs of moderate to severe dehydration.

Answer 55

a. Oral rehydration 📘 Rationale: ✨ Signs indicate mild dehydration. Best managed with: 🧃 Oral Rehydration Solution (ORS) ✅ Conscious & able to drink → no need for IV 💊 No infection = no need for antibiotics

Answer 56

a. 1000 mL/day 📘 Rationale (Holliday-Segar Rule): ✨ 100 mL/kg for the first 10 kg 📦 For a 10-kg infant: 🧮 100 × 10 = 1000 mL/day

Answer 57

a. Chloride 📘 Rationale: ✨ Chloride (Cl⁻) is: 🩸 The main anion in extracellular fluid (plasma) 🧪 The principal anion in gastric juice, as part of HCl 🙅‍♂️ Why not the others? 🧂 b. Bicarbonate – Major buffer but not the primary anion in plasma or gastric juice 🧬 c. Phosphates – More relevant intracellularly 🧫 d. Organic acid – Not a principal plasma or gastric anion

Answer 58

d. D5 0.3 NaCl - 77 mmol Na⁺/L 📘 Rationale: ✨ Sodium content per type: 💧 0.9% NaCl (NSS) = 154 mmol/L 💧 0.45% NaCl = 77 mmol/L 💧 0.3% NaCl = 51 mmol/L ❌ Not 77 💧 D5W = 50 g glucose/L 🙅‍♂️ Why not the others? ✅ a. Normal saline – 154 mmol/L – correct ✅ b. LRS – 134 mmol/L – correct ✅ c. D5W – 50 g/L – correct

Answer 59

b. Peaked T wave 📘 Rationale: ✨ ECG progression in hyperkalemia: 🔺 Peaked T waves – early finding 📉 Flattened P wave – later 🔄 QRS widening – dangerous later phase 🧿 Sine wave – pre-terminal ECG pattern 🙅‍♂️ Why not the others? ❌ a. Sine wave – late, pre-arrest ❌ c. Flattened P wave – after peaked T ❌ d. QRS widening – later

Answer 60

c. 0.5 mEq/L 📘 Rationale: ✨ Alkalosis drives potassium into cells: ⬆️ pH by 0.1 = ⬇️ serum K⁺ by ~0.5 mEq/L 🧪 This is due to H⁺/K⁺ exchange across cell membranes 🙅‍♂️ Why not the others? ❌ a. 0.1 – too small ❌ b. 0.25 – underestimates effect ❌ d. 1.0 – too large

Answer 61

b. Metabolic alkalosis 📘 Rationale: ✨ Loss of gastric HCl through NG suction causes: 🚫 ↓ H⁺ → relative ↑ HCO₃⁻ → metabolic alkalosis 🙅‍♂️ Why not the others? ❌ a. Respiratory alkalosis – not related to GI fluid loss ❌ c. Metabolic acidosis – seen with diarrhea, not vomiting/NG suction ❌ d. Respiratory acidosis – from hypoventilation, unrelated here

Answer 62

d. Calcium chloride has less elemental calcium than calcium gluconate 📘 Rationale: ⚠️ Incorrect because Calcium chloride contains more elemental calcium (13.6 mEq per 10 mL of 10% solution) than calcium gluconate (4.65 mEq per 10 mL of 10% solution). 💡 Therefore, calcium chloride is more potent and is used in emergencies like cardiac arrest. 🙅‍♂️ Why not the others? ✅ a. 8–10.5 mg/dL – Normal total calcium range. ✅ b. 1.14–1.3 mmol/L – Correct range for ionized calcium, the biologically active form. ✅ c. Hypomagnesemia can impair calcium response → magnesium correction is essential.

Answer 63

c. Is the procedure of choice for immunization of normal children 📘 Rationale: 💉 The DTP (Diphtheria-Tetanus-Pertussis) combination vaccine is recommended in all countries for routine primary immunization in children. ✅ It simplifies administration and enhances compliance. 🙅‍♂️ Why not the others? ❌ a. Only for catch-up – False, it’s for routine primary immunization. ❌ b. Inferior to separate vaccines – False, combined vaccines are standard and effective. ❌ d. Only for underdeveloped countries – False, used globally.

Answer 64

a. Birth 📘 Rationale: 👶 Universal newborn hearing screening is standard at birth, allowing early detection and intervention for hearing loss. 🙅‍♂️ Why not the others? ❌ b. 1 month – Too late for initial screen. ❌ c. 6 months / d. 12 months – Reserved for re-screening, not primary detection.

Answer 65

b. Young children 📘 Rationale: 🧸 Young children (toddlers to preschoolers) react to separation with: 😢 Crying or tantrums 🚪 Trying to find or follow parent 🙁 Mood swings, irritability 🙅‍♂️ Why not the others? ❌ a. Infants – React with crying, but not seeking behavior ❌ c. School children – Show more coping or internalized stress ❌ d. Adolescents – More withdrawn or rebellious but not tantrum-prone

Answer 66

d. Anovulatory and irregular 📘 Rationale: 🌸 Menarche typically begins as anovulatory (no ovulation) and irregular due to an immature hypothalamic-pituitary-ovarian axis. ⏳ Ovulation and regular cycles establish over 1–2 years. 🙅‍♂️ Why not the others? ❌ a/b. Ovulatory and irregular/regular – Too early for consistent ovulation ❌ c. Anovulatory and regular – Irregularity is expected in the beginning

Answer 67

c. Single umbilical artery 📘 Rationale: 🔍 A single umbilical artery (instead of the usual two arteries and one vein) is a red flag. 🫀 It is associated with congenital anomalies, especially in the cardiovascular, renal, and GI systems. 🙅‍♂️ Why not the others? ❌ a. Umbilical hernia – Common and benign in neonates; usually resolves spontaneously. ❌ b. Nevus flammeus – A birthmark (port-wine stain); only concerning if associated with syndromes like Sturge-Weber. ❌ d. Hypospadias – A congenital anomaly, yes, but not usually associated with syndromic defects unless severe or part of a pattern.

Answer 68

b. 2.5–4 g/kg/day 📘 Rationale: 🍼 This range supports rapid postnatal growth and tissue development in full-term neonates. 🧠 Protein is crucial for brain and organ development in early life. 🙅‍♂️ Why not the others? ❌ a. 2–2.5 g/kg/day – Too low for a term neonate's needs. ❌ c. 3–4.5 g/kg/day / d. 4–5 g/kg/day – Closer to preterm infant requirements due to higher growth demands.

Answer 69

a. Coarse, tremulous movements with ankle or jaw myoclonus 📘 Rationale: ⚠️ These movements may indicate neurological immaturity or pathology (e.g., seizures, hypoglycemia, or withdrawal). 🚫 They are not typical in normal neonatal behavior. 🙅‍♂️ Why not the others? ✅ b. Absent activity during relaxed sleep – Normal quiet sleep phase. ✅ c. Asymmetric upper extremity movement – May be normal briefly post-birth due to position but needs monitoring. ✅ d. Vigorous crying with limb movement – A healthy, normal response.

Answer 70

b. Crackling, dry, desquamating 📘 Rationale: ❌ Premature infants have thin, gelatinous, red skin with visible vessels – not dry or peeling. 🧴 Crackling, dry, and desquamating skin is more typical in post-term babies. 🙅‍♂️ Why not the others? ✅ a. Lanugo – Common in preterm infants for thermoregulation. ✅ c. Deep red, visible veins – Due to immature skin. ✅ d. Gelatinous and bruises easily – A hallmark of skin fragility in preemies.

Answer 71

a. Erythema toxicum 📘 Rationale: 🌼 A common benign rash in neonates, usually appears on day 2–3, resolves in a few days. 🧪 No treatment needed; diagnostic with clinical appearance. 🙅‍♂️ Why not the others? ❌ b. Harlequin change – Transient color change due to vascular immaturity, not pustular. ❌ c. Pustular melanosis – Present at birth, ruptures easily, leaves pigmented spots. ❌ d. Scalded skin – Suggests staphylococcal scalded skin syndrome, not a benign condition.

Answer 72

b. It represents edema of the scalp 📘 Rationale: ✅ Cephalhematoma is a subperiosteal hemorrhage — it is not edema. 🧠 It is bounded by suture lines, discrete, and often self-limited. 🙅‍♂️ Why not the others? ✅ a. Rounded and discrete, bounded by sutures – ✅ True ✅ c. May take weeks to resorb – ✅ True ✅ d. No treatment unless neurologic signs appear – ✅ True

Answer 73

a. Abnormal vital signs within 30 - 60 minutes of life are always pathologic and indicate an unhealthy newborn 📘 Rationale: 🍼 Vital signs in the first hour can fluctuate due to normal transitional physiology as the newborn adapts to life outside the womb. 🙅‍♂️ Why not the others? ✅ b. Breastmilk reduces disease incidence – 🌿 True; it’s protective. ✅ c. Circumcision not routinely recommended solely for medical advantage – 🩺 Correct, current guidelines favor parental choice, not routine recommendation. ✅ d. Breastfed stools: loose, yellow, seedy – 💩 True and normal.

Answer 74

d. Increase right-to-left shunting via foramen ovale 📘 Rationale: ❤️ After birth, the foramen ovale begins to close, due to increased left atrial pressure, reducing right-to-left shunting. 🙅‍♂️ Why not the others? ✅ a. ↓ Pulmonary vascular resistance – 🫁 Due to lung expansion. ✅ b. ↓ Right-to-left shunting via ductus arteriosus – ✔ True, it's functional closure. ✅ c. ↑ Venous return to LA – ✅ From increased pulmonary flow.

Answer 75

b. Full flexion of arms and legs 📘 Rationale: 🧸 Normal full-term neonates assume a flexed posture due to their intrauterine positioning in the womb. 🙅‍♂️ Why not the others? ❌ a. Arms/legs extended – More typical of premature infants. ❌ c. Slight flexion with extended arms – Not typical of full-term neonates. ❌ d. Frog-leg posture – Seen in hypotonia or prematurity.

Answer 76

a. 24 hr of birth 📘 Rationale: 🕰 Delayed meconium passage beyond 24 hours may indicate Hirschsprung disease, meconium ileus, or intestinal atresia. 🙅‍♂️ Why not the others? ❌ b. 48 hr / c. 72 hr / d. 96 hr – These are too delayed for most healthy newborns and warrant investigation if stool hasn't passed by 24 hrs.

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