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Flashcards in Pediatric Final Exam Deck (180):
1

    The cardiac silhouette of patients with Tetralogy of Fallot is best described as:

a.     boot shaped

2

    The most common cause of neonatal seizures is

b.    hypoxic ischemic encephalopathy

3

    Immunization with polio vaccine may be started as early as

b.    6 weeks of age

4

    Measles immune globulin may prevent or modify infection if given within

b.    6 days after exposure

5

    What congenital anomaly is associated with growth and mental retardation, abnormal facial features like low set ears, hypotonia and an endocardial cushion defect?

b.    Down’s syndrome

6

    A scaphoid abdomen at birth usually suggests a:

a.     diaphragmatic hernia

7

    One of the following drugs is ABSOLUTELY contraindicated to Breastfeeding:

c.     tetracycline

8

    The presence of subperiosteal hemorrhage in the newborn which is located to the surface of one cranial bone is called:

d.    cephalhematoma

9

    Congenital Rubella Syndrome is characterized by the following conglomeration of symptoms:

a.     cataracts, cardiac abnormality, hearing defects, microcephaly and mental retardation

10

   The mature levels of surfactant is seen by:

d.    35 weeks

11

   The most frequently fractured bone of the newborn during labor and delivery is the:

c.     clavicle

12

   A 5 year old child suddenly developed edema . It was more prominent in the morning. No meds and consult done. However, she complained of headache and noted dark colored urine. On day of consult, she also noted decrease frequency of urination:

c.     Acute Glomerulonephritis

13

   A 16 year old female developed nephritis. Her C3 is noted to be low. She is also complaining of joint pains and photosensitivity. The probable diagnosis of this patient is:

c.     Systemic Lupus Erythematosus

14

   The most common pathogen associated with HEMOLYTIC UREMIC SYNDROME is :

c.     E. Coli

15

   The SMR stage of a female adolescent who presents with coarse abundant curly pubic hair and an areola and papilla with a secondary mound is a:

d.    SMR 4

16

   Delayed eruption is considered when there is no teeth at approximately:

d.    13 months

17

   The principal vector of DENGUE FEVER is:

b.    Aedes Aegypti

18

   A 5 year old male was noted to have fever of five days duration which is rapidly increasing to 39 to 40 C . It is accompanied by frontal headache and was noted to have back pain. After 2 days of defervecence of fever rashes appear at the lower and

d.    Dengue Fever

19

   The WHO criteria for dengue hemorrahagic fever are the following:

a.     fever, minor or major hemorrhagic manifestation and thrombocytopenia

20

   A 6 year old child developed high grade fever and cough. Chest x- ray was done and reveled pnuematocoeles . What is the most common pathogenic organism responsible for pneumatocoeles?

d.    Staphylococcal

21

   An important indicator of pneumonia among infants is:

b.    increased respiratory rate

22

   The drug of choice for atypical pneumonia is:

c.     Erythromycin

23

   One of the following is a pathologic finding in the newborn:

d.    Jaundice during the first 24 hours

24

   The duration of treatment for uncomplicated H. Influenzae meningitis is

b.    7-10 days

25

   Acute bronchiolitis, a common disease of infants has a peak incidence at

c.     6 months of age

26

   Stridor is most commonly seen in infants with

a.     croup

27

   Subacute sclerosing panencephalitis (SSPE) is associated with

b.    rubeola

28

   The absolute contraindication to giving immunization is:

d.    previous anaphylactic reaction

29

   A 10-month old male comes in for a well-baby visit. He had BCG, 3 doses of DPT & OPV and 2 doses of hepatitis B vaccine. What can you give him for this particular visit?

a.     measles & 3rd dose of Hepatitis B vaccine

30

The WHO recommends that breast feeding can be the infant’s sole source of food up to about:

b.    6 months of age

31

Which vaccine should be given intradermally?

b.    BCG

32

A fully immunized child is one who has completed the following before 12 months of age:

d.    3 hepatitis B; BCG; 3 DPT; 3 OPV, measles vaccine

33

A 12-year old male with repeated episodes of streptococcal pharyngitis comes to the clinic with another episode of sore throat. Oral amoxicillin was started. One hour later, he had tingling sensation around his mouth, difficulty of swallowing and dev

a.     epinephrine

34

A 12-year old presents with sneezing, clear rhinorrhea and nasal itching. Physical examination reveals boggy, pale nasal edema with a clear discharge. The most likely diagnosis is:

d.    allergic rhinitis

35

The most common manifestation of rheumatic fever in children is:

c.     carditis

36

An 18-month old is noted to assume a squatting position frequently during playtime at the daycare center. The mother also notices occasional episodes of perioral cyanosis during some of these squatting periods. The day of admission, the child becomes

c.     tetralogy of Fallot

37

A 14-year old male presents with Grade 4/6 regurgitant systolic murmur at the apex with history of swollen and painful joints. The murmur is most likely:

b.    mitral regurgitation

38

A 14-year old female was brought to you because of mother’s worry that she has no menarche yet as compared to her classmates. Medical history and complete PE are normal. Breast development and pubic hair have been present for 18 months and are normal

a.     reassurance that she likely will begin menstruating within the year

39

The hallmarks of diabetes insipidus are:

c.     polyuria and polydypsia

40

A 2-year old male presents with a history of chronic constipation. Upon review of history, you were told that he had delayed passage of black stools. He had unremarkable PE findings. The parents were giving him laxatives for the past 2 weeks. Your mo

d.    Hirschprung disease

41

A prominent clinical presentation of duodenal atresia is:

a.     bilious vomiting without abdominal distention

42

The radiologic finding of “double tract sign” is typically seen in:

b.    pyloric stenosis

43

Classic hemophilia is best treated by giving:

b.    Factor VIII

44

A 5-year old female has multiple bruises on her lower extremities and oral mucosal bleeding for 3 days’ duration. Two weeks before these signs she had a mild respiratory tract infection. Physical examination reveals multiple ecchymoses and petechiae;

d.    idiopathic thrombocytopenic purpura

45

Which of the following suggests a bacterial etiology in a child with tonsillopharyngitis?

b.    beefy tonsils with petechiae

46

A 1-year old infant had cough 2 weeks PTC which started as mild and becoming paroxysmal. This was accompanied by low-grade fever but was relieved by antipyretics. She had a poor history of immunizations. PPE showed explosive outburst of cough accompa

c.     pertussis

47

The period of communicability of mumps in a child is:

c.     from several days before the onset of swelling until the swelling has subsided

48

A 12-year old girl had a mild sore throat, low-grade fever and a diffuse maculopapular rash. During the next 24 hours, she developed redness of her eyes. PE showed mild tenderness and marked swelling of her posterior cervical and occipital lymph node

a.     Rubella

49

Which is the most common cause of osteomyelitis in children?

a.     Staphylococcus aureus

50

A full term newborn with Apgar score of 8 & 9, is having episodes of cyanosis and apnea which are worse when attempting to feed, but seems better when crying. At this point, it is important to establish:

b.    choanal atresia

51

The initial treatment for neonates with sepsis consists of:

c.     ampicillin + aminoglycoside

52

A 10-day old infant who was born by NSD by a “hilot” was brought in because of difficulty of sucking and excessive crying noted 2 days PTC. PPE: wt= 3,000 gms; T= 37.5˚C, with hoarse cry and spasms. Lungs were clear. The most appropriate treatment wo

b.    penicillin by IV

53

A 3-year old child awakens at night with high-grade fever, a severe sore throat and a barking cough. P.E. shows a child who is drooling and with respiratory stridor. Lungs are clear. The child may have:

c.     acute epiglottitis

54

A 10-month old infant has fever, cough, dyspnea and leucocytosis. Chest x-ray shows patchy distribution of consolidation. Treatment of choice without bacterial culture is:

a.     Ampicillin

55

Tracheo-esophageal fistula is usually suspected in one of the following conditions:

a.     excessive oral secretions

56

A syndrome that starts as diarrhea and progresses to fever, oliguria, acute renal failure, thrombocytopenia and microangiopathic anemia in children is due to:

b.    hemolytic-uremic syndrome

57

A 2-year old female was hospitalized because of afternoon fever and anorexia for 3 weeks and seizures few hours prior to consultation. No previous medications; no history of seizures in the past. PE findings: T=39.5˚C, stuporous, (+) nuchal rigidity,

c.     INH/Rifampicin/Streptomycin/corticosteroids

58

Sparse and thin hair with dyspigmentation as a sign of undernutrition is commonly observed in:

b.    kwashiorkor

59

Milk feedings must be supplemented with iron preparations to prevent iron deficiency anemia starting:

a.     6-8 weeks of age

60

The present age recommendation to start solid food for supplementation for infants is at:

b.    6 months of age

61

Normally, a newborn infant’s weight may decrease 10% below the birth-weight in the first week of life as a result of:

a.     excretion of excess extravascular fluid

62

The 1-minute APGAR Score may indicate which of the following?

a.     the need for immediate resuscitation

63

In general, jaundice is considered pathologic and therefore, a search to determine its cause should be made if:

d.    direct-reacting bilirubin is greater than 2 mg/dL at any time

64

An infant is observed to follow objects 18 degrees, laughs out loud and grasp objects and bring them to mouth. He must be:

d.    4 months old

65

This is a major milestone at about 9 months old age, which is the understanding that objects continue to exist even when not seen:

b.    object constancy

66

The first visible sign of puberty in girls is:

a.     thelarche

67

This vaccine is contraindicated in household contacts of immunocompromised persons:

a.     OPV

68

Baby Girl Cruz was delivered spontaneously at term to a 28 y/o G3P2 mother. Following delivery, she was noted to be limp, had irregular respiration, CR 80/min, extremities and body cyanotic with no response to suctioning of oronasal passages. What i

a.     2

69

The second dose of MMR should be routinely given at the age of:

c.     4-6 years old

70

If the first dose of Hepatitis B vaccine was given at birth, the last dose should not be given before the age of:

a.     6 months

71

For infants born to mothers whose HBsAG status is unknown, the first dose of Hepatitis B should be given at what age?

a.     within 12 hours at birth

72

A 4 year old child is expected to have an approximate weight of:

c.     16 kg

73

A newborn was noted to have increased oral bubbly secretion accompanied by cough and choking on feeding. The most likely diagnosis is:

a.     TEF

74

A 3 year old boy was brought to the ER because of barking cough and stridor. He was afebrile, non-toxic and well when seen by his physician. Symptoms were similar for the past 3 nights. This clinical condition is typical of:

a.     spasmodic croup

75

A 5 y/o has frequent cough and colds of more than a month accompanied by marked weight loss. Her mother also has chronic cough. If Mantoux test shows an induration of 10 mm., the most likely diagnosis is:

b.    TB disease

76

. Which of the following is a major criteria of atopic dermatitis?

d.    (+) FH of atopy

77

A 15 month old boy developed generalized pruritus, hives and dyspnea 30 minutes after intake of egg. The initial treatment should be administration of:

b.    Epinephrine IM

78

A 7 year old girl came because of polyuria (about 8 L./day) noted for 4 weeks. She was also noted to have marked weight loss (60%). If urinalysis shows specific gravity 1.032, urine glucose 3+, urine osmolality of 500 mOsm/L, the most likely cause

c.     Type I DM

79

Randy, a 5 y/o was brought to your clinic for polyuria. On pitressin test, there was a decrease in urine volume, increase in specific gravity and urine osmolality. The next diagnostic test you will request is:

b.    cranial MRI

80

The most common malignant neoplasm in children:

d.    Leukemia

81

A 1 year-old baby was brought to the OPD for a well baby check up. He was exclusively breastfed from birth until 6 months, and was given complementary feeding from then on. Physical examination was unremarkable except for pallor. CBC showed anemia,

b.    Iron deficiency anemia

82

A 4 y/o male patient consulted because of joint pains, he was also noted to have intermittent low grade fever for 2 weeks. PE: pale palpebral conjunctivae, (+) petechiae on soft palate, Grade 1-2 systolic ejection murmur at the LLSB, clear breath so

c.     Acute lymphocytic leukemia

83

A 4 month infant was brought to the hospital because of diarrhea. He passed out watery yellow stools with low grade fever. The most likely cause of the acute diarrhea is

b.    Rotavirus

84

If this baby presents with lethargy with CR 140/min, weak pulses, sunken fontanels and eyeballs, dry lips, + skin fold test of > 3 sec. What is the degree of dehydration?

d.    severe

85

GIT condition that manifest symptoms early in the neonatal period, but has high incidence of spontaneous remission as the infant grows older:

c.     GE reflux

86

Features strongly suggest cholestatic jaundice:

d.    Acholic stools

87

Drug of choice used to rapidly terminating severe cyanotic spells in babies with Tetralogy of Fallot:

c.     Morphine

88

Palpating the peripheral pulses is important in infants and children. This particular congenital cardiovascular disease may be suspected if the femoral pulses are diminished or absent:

b.    coarctation of the aorta

89

In which of the following situations can a diagnosis of acute rheumatic fever be made?

b.    (-) ASO titer (+) chorea’s syndenham

90

Baby Twinkle was delivered term to a mother with poorly-controlled gestational diabetes. At birth, her Apgar Score were 5 and 6 at 1 and 5 minutes, respectively. Maternal blood type is O+, baby’s blood type is A+ .If she developed jaundice at the

b.    Hemolytic disease of the newborn

91

   A 6 year old boy complained of nape pains and headache, with a BP of 160/100. He had a history of “sorethroat” a week PTA, with passage of tea-colored urine 3 days PTA and facial and leg edema. The most likely consideration is:

b.    Post-infectious glomerulonephritis

92

   The most important risk factor for infants with febrile UTI due to its potential for causing renal injury is:

b.    vesicoureteral reflux

93

   A 3 year old boy had a history of profuse watery diarrhea and vomiting. On consultation, there was no urine output for the last 12 hours. Minimal urine was obtained by catheterization. Urine was dark yellow, highly concentrated with a low urine

a.     pre-renal

94

   A 2 ½ month old unimmunized baby was brought to the ER following a mild two-week upper respiratory infection. She then developed severe paroxysmal cough. A presumptive diagnosis of Pertussis can be made by a:

b.    White blood cell count

95

   The WHO criteria added for Dengue Shock Syndrome include the criteria for DHF plus:

c.     narrow pulse pressure (< 20 mmHg) or hypotension

96

   A 9 year old girl has been having on and off fever for the past 10 days. On examination there was conjunctivitis, strawberry tongue, and periungual desquamation. The most likely diagnosis is:

b.    Kawasaki disease

97

   A 10 year old girl complained of fever, sore throat. PE revealed exudative pharyngitis accompanied by generalized lymphadenopathy, splenomegaly and atypical lymphocytosis on peripheral smear. The most likely etiologic agent is:

c.     Epstein Barr Virus

98

   A 17 year old girl had a mild prodrome of nasal catarrh and low fever followed by retroauricular, posterior cervical and postoccipital lymphadenopathy and the appearance of discrete reddish maculopapules. This fits the diagnosis of:

b.    Rubella

99

        A 6 year old presented by a mild respiratory prodrome. The initial stage wascharacterized by erythematous facial flushing likened to a “slapped cheek”. The disease is most likely:

d.    erythema infectiosum

100

  The management of benign febrile seizures includes:

d.    maternal education and antipyretic measures

101

  Cyanosis and seizures on prolonged crying in an infant suggests:

c.     breatholding spells

102

        A 12 year old female with malar rash palatal ulcers, polyarthritis and photosensitivity. The most likely diagnosis is:

c.     systemic lupus

103

  This drug is used as prophylaxis against Pneumocystis carinii pneumonia in renal transplant patients:

b.    Trimethoprim-sulfamethoxazole

104

        Hand-foot and mouth disease is caused by:

a.     Coxsackie A virus

105

        Iron chelation will be most useful in:

b.    beta thalassemia major

106

  The principal organ affected after most hydrocarbon ingestion is the:

d.    lungs

107

  The most common viral agent causing bronchiolitis is:

a.     respiratory syncitial virus

108

  The treatment of choice for uncomplicated N. meningitides meningitis is:

a. Ceftriaxone b. Cefotaxime c. Penicillin d. ceftazidime

109

        The clinical symptoms of Hirschprung’s disease usually begins at birth and ushered in by:

b.    delayed passage of meconium

110

  The most sensitive study in the diagnosis of Meckel’s diverticulum is:

d.    radionuclide scan

111

        A 3300 gram, 39 weeker, male, was delivered via stat cesarean section due to placenta previa. Baby was pink, with good cry and muscle tone but had early onset of tachypnea and grunting. The most likely diagnosis is:

b.    RDS type II

112

        The diagnosis of tetanus is established by:

c.     presence of lockjaw followed by progressive stiffness of the voluntary muscles

113

        The earliest sign of puberty in girls:

b.    breast enlargement

114

        The most common primary cause of nephrotic syndrome in children is:

c.     minimal change nephrotic syndrome

115

        Physiologic bowing of the legs completely resolves by:

b.    2 years

116

        Hydrocoele is often physiologic up to:

d.    12 months

117

        A 7-year-old boy has crampy abdominal pain and purpuric rashes on the back of his legs and buttocks as well as on the extensor surfaces of his forearm. Urinalysis reveals proteinuria and microhematuria. Your most probable diagnosis is which

b.    Henoch-Schonlein Purpura

118

        Which of the following is NOT associated with Acute Renal Failure:

a.     Hyponatremia

119

        A 2-month-old infant was rushed to the emergency room with generalized seizure. The infant was born term, AGA at home attended by a hilot. He was purely breastfed. At the ER, he was pale, drowsy with bulging anterior fontanel. He had clea

d.    acquired prothrombin complex deficiency

120

        Tuberculin reactivity is a Type ____ hypersensitivity:

d.    Type IV cell mediated

121

        An apparently healthy neonate was brought to a well baby clinic. PE showed palpable liver 2 cm below the right subcostal margin. The most probable diagnosis is:

d.    normal

122

        A 12-month-old male suddenly draws up his leg and scream in pain. This was repeated periodically throughout the night interspersed with periods of quiet sleep. He was seen after 12 hours and looked pale, has just vomited and passed out bloo

c.     Intussusception

123

        Which of the following is the first sign of puberty in girls:

a.     thelarche

124

        Which of the following is true of cephalhematoma:

a.     may not be visible until several hours after birth

125

        A 35-week AOG newborn was delivered with an Apgar Score of 8 and 9 at 1 and 5 minutes, respectively. Mother had no prenatal check up. Within a few minutes of birth, the baby was noted to develop respiratory distress. Which of the following

c.     Meconium Aspiration Syndrome

126

        A newborn was exposed to the infectious diseases mentioned below. History revealed that the mother had received the recommended immunizations during pregnancy and had these diseases years prior to pregnancy. Which of the following diseases

c.     pertussis

127

        Which of the following are not routinely recommended:

c.     Rabies

128

        Which of the following is the most frequent cause of Common Cold:

d.    Rhinovirus

129

        A 10-year-old child was admitted because of abdominal pain and nausea. This was followed perioral numbness. At the ER, the patient had respiratory arrest and was thus intubated. History revealed that the patient had eaten shellfish about 2

a.     saxitoxin

130

        A 15-year-old male sought consult because of fever, malaise and headache. He also complains of pain over the area from the back of his mandible toward the mastoid space. He also describes that his earlobe on the affected side appears to be s

b.    mumps

131

        An 18-month-old infant presents at the ER because of convulsions. He also has high grade fever. During the lumbar puncture (where CSF exam was normal), he passed large volume of watery stools with blood and mucus. The most likely diagnosi

b.    Shigellosis

132

        In a 6-month-old infant, which of the following would be a contraindication to doing a lumbar tap:

d.    uncorrected bleeding diathesis

133

        The single most sensitive method of diagnosis of Typhoid Fever is which of the following:

d.    Blood or bone marrow culture

134

        Which of the following conditions is a contraindication to breastfeeding:

c.     substance abuse

135

        A 3 year-old boy has fever and seizure. He was drowsy, with nuchal rigidity and bilateral upgoing of toes. CSf examination shows turbid, cell count of 10,000, 75% polyss, protein 500 mg/dl, sugar 40 mg/dl with 100 mg/dl random blood sugar.

b.    bacterial

136

        In basic life support, what is the ratio of chest compression to ventilation for children less than 8 years old:

c.     5:1

137

        A 24 year old susceptible medical student is exposed during wardwork to a patient with chickenpox. He is advised to have varicella vaccine at:

b.    two monthly injections

138

        A 5 year old girl presents with severe protein energy malnutrition. The anthropometric indicator which is an index of acute nutritional status and which is the simplest to measure is:

b.    weight

139

        A 4 year old boy looks malnourished. The height for age measurement is 75% therefore the waterlow classification is _______ stunting:

d.    Severe

140

        A 2 year old child was rushed to the ER because of seizure. He initially developed fever with associated petechial rashes on both extremities. While at the ER, the resident noted petechial rash and several slate gray satellite shape descent.

a.     bacterial meningitis

141

        While the parents were transporting their four year old child to the Emergency Department for difficulty of breathing, the child stopped breathing. On arrival in the ER the child is pulseless and apneic. The monitor shows a bradyarrhythmia at

a.     ventilation

142

        A 3 month old presents to the ER with a one day history of poor feeding and rapid breathing. The infant’s pulse is 260/min. The color is gray and perfusion is poor. ECG is consistent with SVT. Treatment in this child consists of:

d.    synchronized cardioversion

143

        A 3 year old female has a grade 3/6 systolic ejection murmur at the RUSB with weak pulses at the lower extremities and a lower extremity BP of 90/60 and an upper extremity BP of 110/70. The most likely diagnosis is:

b.    coarctation of the aorta

144

        A term infant was noted to have PDA. The pharmacogenic agent that is given to this baby to promote closure of the PDA is:

c.     indomethacin

145

        A 3 day old newborn has blotchy erythematous macules with tiny central vesicles or pustules noted on the trunk and the face. The most likely diagnosis is:

a.     erythema toxicum

146

        A 2 year old male child consulted for speech delay. Mother reports that he can only babble at present and would not respond when called. He flaps his hands when he hears his favorite song but cannot establish eye contact. He perseverates on s

b.    autism

147

        A term female infant at one week old was noted to have weak movements macroglossia, and wide anterior fontanel. This baby most probably has:

d.    Congenital hypothyroidism

148

        A 16 year old male with a height age of 13 years, a bone age of 13 years, a history of the same complaints in an uncle when he was of the same age, no other abnormalities very likely has:

a.     Constitutional delay

149

        A six-month-old baby boy was seen at the Outpatient Clinic because of jaundice which was noted since two weeks of age. The jaundice was deepening associated with pruritus and irritability and abdominal distention. Stools were acholic

a.     billiary atresia

150

        Ana, a 15 year old teenager came in due to recurrent heavy menstruation. Her regular menstrual cycle lasts for 10 days with large blood clots. She also frequently develops gum bleeding after brushing. What is the most likely diagnosis?

c.     Von Willebrand disease

151

        A 6 month old presented with 3 days of high grade fever. He was cheerful and feeding well when afebrile and had no respiratory symptoms. After the 3 day fever, maculopapular rashes appeared on the face progressing downwards.The most likely di

b.   Roseola infantum

152

        A child suspected to have TB infection will have

a.     10 mm induration on Mantoux test

153

        A 4 year old child was complaining of difficulty in walking .On PE there was palpable, tender left inguinal lymphadenitis and pus coming out from the wound located at the dorsum of the left foot. The appropriate antibiotic to give is:

b.    Oxacillin

154

        A test to verify to presence of maternal blood in the swallowed blood syndrome:

a.     Apts test

155

        Jo-anne, an 8 year old female known asthmatic was seen at the ER because of difficulty of breathing which started one hour PTC: Initial treatment consists of:

a.     inhaled short acting B2 agonist

156

        An 8 year old male presents with tea-colored urine oliguria, periobital edema most prominent in early morning and hypertension. The most likely diagnosis is:

c.     acute glomerulonephritis

157

        Most reliable method of collection of urine for urine culture:

d.    suprapubic aspiration

158

        The laboratory test that confirms the presence of UTI:

c.     >100,000 CFU/ml of urine

159

        A 10 year old male was admitted for fever and seizures. History revealed he had 3 days fever with productive cough, headache and yellowish nasal discharge. Few hours PTA he developed generalized tonic seizures for 15 minutes followed by loss

b.    Meningococcemia

160

        A 7 year old child present with cheilosis, glossitis and atrophic lingual papillae. The most likely diagnosis is a deficiency of:

b.    riboflavin

161

        Which of the following is the most important procedure with diagnosis of the infective endocarditis?

    Blood culture Answer: D – The critical information for appropriate treatment of infective endocarditis is obtained from blood cultures.

162

        At 5 minutes of life, an infant has the following findings : Pulse rate 135 per minute, good muscle tone, cyanotic hands and feet, strong cry and a grimace after a catheter was inserted thru the nostril. The infant’s Apgar score is :

c.     9 Pulse rate 2, Body Pink 1, Extremities, Cyanotic, Muscle Tone good 2, Strong cry 2, Grimace 2

163

        Which one is most often fractured in difficult deliveries?

a.     Clavicle Answer: A – The clavicle is fractured during labor and delivery

164

        Hemorrhagic disease of the newborn is effectively prevented by which one of the following?

d.    Injection of 1 mg vitamin K at birth Answer: D – Intramuscular injection of 1 mg of vitamin K at the time of birth prevents the decrease of vitamin – K dependent factors in full-term infants.

165

        A 2-year-old child living in Baguio City is bitten by a dog. After cleaning and washing the wound, which of the following should be done next?

b.    Begin rabies hyper immune globulin. Answer: B – Local wound care is designed to remove or kill the virus by mechanical and virucidal action. Passive immunization with human rabies immunoglobulin (HRIG) then provides intermediate blockage of attachment of virus to the nerve endings

166

        The most common caused of blood-stained stool in an otherwise normal infant is:

a.     Anal fissure Answer: A- Anal fissure is a small laceration of the mucocutaneous junction of the arms. It is an acquired lesion secondary to the forceful passage of a hard start, mainly seen in infancy.

167

        The clinical manifestation that differentiates marasmus from kwashiorkor is :

c.     Edema Answer: C – Marasmus is a nonedematous protein energy malnutrition while kwashiorkor is edematous protein energy malnutrition. Both present with irritability, failure to gain weight and loose subcutaneous tissue.

168

        The average time at which the anterior fontanel closes is at :

c.     18 months of age Answer: C – The average time of closure of the anterior fontanel is 18 months.

169

        Which are the first permanent teeth to erupt?

d.    First molars Answer: D – The first molar erupt between 6 – 7 years of age. A – Central incisor erupt between 7 – 8 years of age. B – Lateral incisor erupt between 8 – 9 years of age C. Canine (maxillary) erupt between 11 – 12 years of age.

170

        Bronchiolitis in infants is most often caused by which one of the following?

a.     Respiratory syncytial virus Answer: A – Acute Bronchiolitis is predominantly a viral disease. Respiratory syncytial virus (RSV) is responsible for more than 50% of cases.

171

        Which of the following is the most likely diagnosis in an otherwise normal adolescent with the sudden onset of respiratory distress, cyanosis, retraction and markedly decreased breath sounds over his left lung?

c.     Pneumothorax Answer: C – The onset of pneumothorax is usually abrupt, and the severity of symptoms depend on the extent of the lung collapse and in the amount of pre-existing lung disease. Pneumothorax may cause pain, dyspepsia and cyanosis.Usually, there is respiratory distress, retractions, and markedly decreased breath sounds on the involve lung. Empyema and chylothrax are not sudden in onset, and staphylococcal pneumonia is not likely in adolescents.

172

        A 3 –year –old presents with strider and a barking cough. There is mild respiratory distress, tachypnea, respiratory strider, and a temperature of 39 ˚C. The most likely diagnosis is:

a.     Laryngotracheobronchitis Answer: A – Most patients have an upper respiratory tract infection with some combination of rhinorhea, pharyngitis, mild cough, and low-grade fever ( 39 – 40 ˚C) for 1 to 3 days before the signs and symptoms of upper airway obstruction become apparent. The child then develops the characteristic “ barking” cough , hoarseness, and inspiratory stridor.

173

        A child has low grade fever, abdominal pain, arthritis, microscopic hematuria and rash only in the lower extremity. The most likely has:

c.     Henoch-Schonlein purpura (HSP) Answer: C – HSP, also known as Anaphylactoid purpura, is a varculitis of the small vwssels. Low-grade fever and fatigue occur in more than half of the affected children. The hallmark of the disease is the rash, beginning as pinkish maculopapules that initially blanch or pressure and progress to petechiae or purpura. Renal involvement is manifested by red blood cells, white blood cells, casts or albumin in the urine

174

        A 7 year old had a sore throat 10 days ago. Today she manifest periorbital edema and tea-colored urine. Her blood pressure is 155/95. the serum complement level is low. The most likely diagnosis is:

c.     Postreptococcal glomerulonephritis Answer: C – Postreptococcal glomerulonephritis is the most common cause of hypocomplementeremic nephritis. Depending on the severity of renal involvement, patients may develop various degrees of edema, hypertension and oliguria.

175

        The triad of microangiopathic hemolytic anemia, renal failure and thrombocytopenia is characteristic of which of the following?

c.     hemolytic – uremic syndrome Answer: C – the hemolytic uremic syndrome (HUS) is the most common cause of acute renal failure in young children and is characterized by microangiopathic hemolytic anemia, thrombocytopenia and uremia.

176

        Which of the following is NOT true of nephrotic syndrome?

c.     reduced sodium reabsorption by the kidney

177

        The most common abdominal mass in a neonate is:

a.     Renal dysplasia – hydroneprhosis Answer: A – Renal masses are the most common lesions in neonates with an abdominal mass. Hydronephrosis and multi – cystic – dysplastic lesions are the most common renal masses.

178

        Partial complex seizures is typically characterized as :

c.     Automatism like chewing, facial grimace or repetition speech Answer: C – Automatisms are common feature of complex partial seizures in infants and children characterized by alimentary automatisms including lip smacking, chewing, swallowing and excessive salivation. CPS may begin with a simple partial seizure with or without an aura, followed by impaired conciousness. The seizure are tonic-clonic and the average duration is 1 – 2 min.

179

        A 5- year-old female has multiple bruises on her lower extremities and oral – mucosal bleeding of 3 days duration. Two weeks before these signs, she had a mild respiratory tract infection. Physical examination reveals multiple ecchymoses and

a.     a complete blood count Answer: A – A complete blood count (CBC) reveals a hemoglobin value of 12 g/dl, a white blood cell (WBC) count of 11,000 and a platelet count of 5000

180

        Which is not a frequent presenting symptoms or sign of childhood leukemia?

d.    abdominal pain Answer: D – Most children with leukemia present with less than 4 weeks of symptoms. Most children with ALL have pallor, 50% have petechiae, 60% have lymphadenopahty, 25% have fever, and about 25% have bone pain and arthralgias caused by leukemia infiltration of the perichondral bone or joint or by leukemic expansion of the marrow cavity.