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Reference: Nelson, Textbook of Pediatrics, 17th edition

Case I. Nos. 1-2

A 3 year old normal child was admitted to a hospital because of simple febrile convulsions

  1. Routine management of the case includes:

A.careful search for cause of fever(0.5)

  1. short term anti-convulsant prophylaxis(0.5)
  2. Phenobarbital maintenance to prevent recurrence
  3. Lumbar puncture
  1. The anti-convulsant that may be effective in the acute management of prolonged febrile seizures is:

A.rectal Diazepam(0.33)

  1. rectal Phenobarbital(0.33)
  2. Intravenous Phenobarbital(0.33)
  3. Intravenous Phenytoin

Case II. Nos. 3-4

A two-week old baby was noted to have a rapidly increasing head circumference. At birth, head circumference was 40 cms, against a chest circumference of 34 cms. Present physical examination showed a head circumference of 45 cms, wide, bulging anterior fontanel, gaping sutures, dilated scalp veins and a (+) setting sun sign.

3. If the occiput is prominent, the primary consideration is: p 1489

  1. Aqueductal stenosis(0.33)
  2. Chiari malformation(0.33)

C.Dandy-Walker malformation(0.33)

  1. Hydranencephaly

4. This drug will reduce the rate of CSF production: p1490

  1. Dexamethasone

B.Acetazolamide(1.0)

  1. Prednisone
D.Mannitol

Case III. Nos. 5 – 9

A 9 year old child was brought to the OPD clinic because of deterioration in school preformance, frank dementia, myoclonic jerks and cerebellar ataxia. He had no immunization and contracted measles at 10 months of age, varicella at 2 years and mumps at 5 years

5. The most likely diagnosis is: p 844

  1. progressive rubella panencephalitits

B.subacute sclerosing panencephalitis (1.0)

C.post-varicella encephalitis
  1. adrenoleukodystrophy
  1. The seizures are best controlled by: p 1498
  1. Carbamazepine(0.5)

B.Valproate(0.5)

  1. Phenytoin
  2. Lamotrigine

Administration of this drug may prolong the child’s survival: p 844

  1. Methisoprinol

B.Inosiplex(0.5)

  1. Taurine
  2. Intravenous immunoglobulin(0.5)

The most important hormone regulating renal calcium excretion is: p 200

  1. Dihydroxy vitamin D(0.33)
  2. Calcitonin(0.33)

C.Parathyroid hormone(0.33)

D.Thyrotoxin

A 2 year old female was noted to be oliguric for 24 hours. She was brought to the ER with Creatinine levels of 350 mmol/l. Serum potassium level was 6.5 mmol/l. What possible maneuver can induce a negative potassium balance and decrease serum potassium levels? A.A sodium bicarbonate infusion (0.25)

insulin/glucose infusion(0.25)

calcium gluconate(0.25)

kayexalate(0.25)

10. A 1 year old baby boy was brought to the ER due to seizure. On PE, the baby was

seem to have flexed wrist, fingers extended, thumbs adducted over the palms and the feet extended and adducted. What is the possible cause of the seizures? P 224

A.grand mal seizure(0.25)
  1. meningitis(0.25)
  2. benign febrile seizures(0.25)

D.hypocalcemia(0.25)

11.A 3 year old boy has been having diarrhea for 5 days already with stooling of 3 – 5 x per day, voluminous, watery in character. On PE, he was noted to be in moderate dehydration, with serum sodium lever of 160 mmol/l. Patient was hydrated with D5water, however, after 2 hours of hydration. The patient went into a seizure. What is the possible cause of the seizure?

  1. Patient developed subdural effusion due to the hyperosmolality
  2. There is an excess movement of water into cerebral cells during rehydration causing cerebral edema
  3. The patient had late manifestation of hypernatremia (0.5)
D.Patient had meningitis (0.5)

12. A 2 year old male was seen in the ER due to fever of 5 days duration. This wasassociated with vomiting and anorexia. There were no cough, colds associated. CBCrevealed leukocytosis with predominance of Segmenters. Urinalysis revealed TNTC pus cells and 5-10/hpf RBC. Impression : UTI. The gold standard for the diagnosis of UTI is:

A. Urine Culture and sensitivity(1.0)

B. Leukocyte esterase test

C. Urinalysis

D. Nitrite test

13. A 6 year old male was seen in the ER due to Tea colored urine of 2 days duration. This was associated with periorbital edema, abdominal distention and grade 2 pitting edema of the lower extremities.

Impression : Acute Glomerulonephritis/PSGN

Post streptococcal glomerulonephritis is most common in children aged: P 1740

A. 5 - 10years old(0.5)

B. 2 - 4 years old(0.5)

C. 13-18 years old

D. 1-2 years old

14. The best single antibody titer to document cutaneous streptococcal infection in PSGN is: A. Deoxyribonuclease B antigen (DNase)

B. ASO titer(1.0)

C. Streptozyme test

D. Phadebact test

A term neonate with an uncomplicated birth history was noted to be cyanotic during the first few days of life. On examination, there was central cyanosis and absence of heart murmur. Chest x-ray showed normal heart size and diminished pulmonary vascular markings. Most likely diagnosis is

A.Pulmonary Valve Atresia(0.5)

  1. Tetralogy of Fallot
  2. Truncus Arteriosus, type I
  3. Transposition of Great Arteries with VSD(0.5)

A 3 month old boy was noted to be cyanotic on crying when he was 2 months old. This became persistent and more pronounced on exertion. On physical examination, the baby was cyanotic with a grade 2 – 3/6 systolic ejection murmur at the 3rd – 4th ICSLPSB. This baby is suffering from

  1. Pulmonary Valve Atresia

B.Tetralogy of Fallot

  1. Transposition of Great Arteries, no VSD(0.5)
  2. Tricuspid Valve Atresia(0.5)

A 4month old baby girl was brought for consultation because of frequent cough and colds accompanied by inability to consume her milk formula, fast breathing during feeding and chest retractions. A murmur was heard accompanied by bounding peripheral pulses and wide pulse pressure. The most likely diagnosis is

  1. Atrial Septal Defect
  2. Ventricular Septal Defect

C.Patent Ductus Arteriosus(1.0)

  1. Pulmonic Stenosis

A 2 year old boy presented with a history of 5 days fever accompanied by irritability, bilateral conjunctival injection, unilateral cervical lymphadenopathy, rashes in the diaper area and congested buccal mucosa. In order to prevent complication, this boy should be given high dose aspirin and

  1. Digoxin
  2. Penicillin(0.5)
  3. Diuretics

D.Intravenous immunoglobulin(0.5)

A 6 year old child was diagnosed as a case of acute rheumatic fever and received ten days course of aqueous penicillin. In order to prevent the recurrence of group A streptococcal infection, this child should receive p 876 - 879

  1. Benzathine benzylpenicillin 1.2 million units intramuscular once

B.Benzathine benzylpenicillin 1.2 million units intramuscular every 21-28 days (1.0)

  1. Oral penicillin 250 mg twice a day for 10 days
  2. Oral erythromycin 250 mg twice a day for 10 days

A 10 year old boy who presents with difficulty in breathing accompanied by a displaced PMI to the left, apical and systolic thrill and grade 4/6 holosystolic murmur at the apex, is most likely suffering from an insufficient p 1570

  1. Aortic valve

B.Mitral valve(1.0)

  1. Pulmonic valve
  2. Tricuspid valve

Children with small Ventricular Septal Defect are at risk for this complication

  1. Hypoxic spells(0.5)p 1509
  2. Heart failure
  3. Pulmonary Artery Hypertension(0.5)

D.Infective Endocarditis

Case 1 Nos. 22 – 24

Lito, a 5 year old child, was seeking enrollment in a nursery school. Both the teacher and the school physician evaluated him for growth and development. Birth history revealed that Lito was born prematurely at 34 weeks with a weight of 1924 grams and a length of 42 cms. Head circumference was 31 cms. The expected anthropometric measurements includes:

22. Weight that has increased at least ______from birth

  1. 4x
  2. 6x (0.5)
  3. 8x (0.5)
  4. 10x

23. An increased in length of

  1. 22 inches(0.25)
  2. 24 inches
  3. 26 inches
  4. 28 inches
  1. Ideal head circumference for age is
  1. 40 cms
  2. 42 cms
  3. 44 cms(1.0)
  4. 46 cms

Case 2. Nos. 25 - 29

Buboy is a 7 month old infant brought tot the clinic for a well baby visit. His grandmother recalled that his birthweight was 6 lbs but was not aware of the birth length and head circumference.

25. Buboy’s ideal length is

  1. 24 inches(0.25)
  2. 27 inches(0.25)
  3. 31 inches(0.25)
  4. 35 inches(0.25)

26.The expected increase in his head circumference is:

  1. 2 cms(1.0)
  2. 4 cms
  3. 6 cms
  4. 8 cms

27.Buboy’s ideal weight at 6 months is

A. 11 lbs

  1. 13 lbs(1.0)
  2. 15 lbs
  3. 17 lbs

28.When Buboy’s is offered an object he is expected to

  1. use his index finger to get it
  2. get the object and drop it(0.5)
  3. cast the object
  4. transfer the object form hand to hand(0.5)

29.The motor milestone expected for age is

A. sitting propped up on hands

  1. crawling(0.5)
  2. Pulling up to stand(0.5)

D. Cruising

  1. A 9 year old boy is suffering from greasy foul watery stool of 2 weeks duration accompanied with abdominal cramps and abdominal distention. You are entertaining the possibility of Giardiasis but the stool examinations done thrice were negative. The next best procedure to do is :

A. abdominal ultrasound

B. entero – test or string test (1.0)

C. duodenal biopsy

D. polymerase chain reaction

  1. A 2 year old girl was brought in for consultation because of watery stool and vomiting of 3 days duration. Modified acid fast staining of the stool revealed a 2-6 micrometer red oocysts . The most likely diagnosis in this case is : p 1128

A. giardiasis

B. balantidiasis (0.5)

C. cryptosporidiosis(0.5)

D. amebiasis

  1. A 4 year old girl with protuberant abdomen has recurrent colicky periumbilical pain. Fecalysis shows a broadly ovoidal ova with thick shell and outer

mammilated covering about 40-60 micrometer. Because of high rate of reinfection, chemotheraphy has to be repeated at :

A. 1 month interval (0.25)

B. 2 months interval (0.25)

C. 3-6 months interval(0.25)

D. 8-12 months interval(0.25)

33.An 18 year old male from Samar presented with abdominal distention, hepatomegaly nad some signs of portal hypertension. Fecalysis revealed small egg with short curved spine. The specific drug for this condition is : p 1167

A. diethylcarbamazine (0.33)

B. albendazole (0.33)

C. ivermectin(0.33)

D. praziquantel

34. A 6 month old infant with feeding problem was noted to have diffuse papular lesions , chorioretinitis on the right eye and enlarged head circumference . IGM-SAGA test was positive. This patient can best be treated with . p 1164 - 1166

  1. pyrimethamine + sulfadiazine + calcium leukoverin(0.25)
  2. Metronidazole(0.25)
  3. Iodoquinol(0.25)
  4. Chloroquine phosphate(0.25)
  1. 3 year old boy who owns a puppy has a history of pica. He develops fever, cough with wheezing and hepatomegaly. The test that that will most likely helps in making an accurate diagnosis is : p 1164 - 1166

A. stool examination

B. ELISA (0.5)

C. COPT(0.5)

D. PCR

  1. A 24 month old infant with a normal weight came in for diarrhea with severe dehydration. You opted to administer plain LRS. The total amount of fluid that should be administered in 3 hours is approximately
  2. 800 ml
  3. 1000 ml(0.5)
  4. 1200 ml(0.5)
  5. 1400 ml

37. A 12 month old infant came in for bloody stool, high fever, severe abdominal pain and toxicity for the past 32 hours. Stool exam revealed 60 fecal leukocytes, plenty of bacteria and amoebic cysts. Most likely the cause of the diarrhea is

A. Shigella(0.33)

B. Amoeba (Entamoeba histolytica)(0.33)

C. Salmonella

D. Enteroinvasive Escherichiae coli(0.33)

  1. A 3 week old infant came in for non-bilous vomiting occurring immediately after feeding. This was followed by progressive loss of fluids and electrolytes and dehydration. Feeding was alright. Most likely you are dealing with
  1. Duodenal atresia
  2. Esophageal atresia(0.5)
  3. Hypertrophic pyloric stenosis(0.5)
  4. Duodenal stenosis
  1. A fairly nourished one year old in some dehydration will be needing approximately this amount of rehydration fluid during the initial replacement therapy
  1. 200 – 400 ml(0.33)
  2. 400 – 600 ml(0.33)
  3. 600 – 800 ml(0.33)
  4. 800 – 1000 ml

Case 1. No. 40

A 2 year old child was brought to your clinic with a history of having fallen down the stairs from a height of 6 steps. You would suspect child abuse because of the presence of the following:

40. A. bruises on the back

B. 2 cm skull fracture – parietal area(0.5)

C. clavicular fracture – medial aspect(0.5)

D. contusion/abrasions on the upper arm and legs

REFERENCE: APMC Workbook on Child Protection

A 2 year old girl was brought to the ER with a history of paracetamol ingestion. Mother claimed that 3 hours PTC, the child ingested an almost full 30 ml bottle of Paracetamol with a concentration of 250 mg./kg. the child weighed 10 kg.

41. This statement is TRUE

  1. She has ingested a toxic dose of paracetamol(0.5)
  2. Children have a lower incidence of toxic plasma levels after ingestion than do adolescents(0.5)
  3. Ipecac should be given as an initial GI decontaminant
  4. Activated charcoal should not be given if NAC is to be administered
  1. Initial symptom include:P 2366 - 2367
  1. oliguria(0.25)
  2. jaundice(0.25)
  3. diaphoresis(0.25)
  4. abdominal pain(0.25)

A 10 year old child, diagnosed to have Juvenile Rheumatoid Arthritis and maintained on salicylate was brought to the ER with fever, headache and body malaise. You considered the possibility of salicylate toxicity

43. This statement is TRUE:P 2367 - 2368

A. Serum salicylate levels should be taken 6 hours after the last salicylate ingestion

B. Chronic toxicity usually presents with metabolic acidosis(1.0)

C. A salicylate level of 10 – 20 mg/dl will rule out chronic toxicity

D. Gastric decontamination should be performed immediately

44. The management of salicylate toxicity would include the administration of

A. Potassium(0.5)

  1. Calcium(0.5)
  2. Acetazolamide
  3. Mannitolp 2367 - 2368

Nos. 45 – 49: REFERENCE: Nelson, Textbook of Pediatrics, 16th edition

45. A major criteria in the diagnosis of atopic dermatitis isP 682

  1. chronic relapsing course(0.25)
  2. elevated serum IgE(0.25)
  3. early age of onset(0.25)
  4. white dermatographism(0.25)
  1. A 5 year old with asthma who have daytime symptoms of >2 times a week, nocturnal symptoms of > 2 times monthly. PEFR > or equal to 809. PEFR variability 20 – 30% is diagnosed to have P 673

A. intermittent asthma

B. mild persistent asthma(0.33)

C. moderate persistent asthma(0.33)

D. severe persistent asthma(0.33)

47. For controller/maintenance treatment, this patient may need EXCEPTP 675

A. inhaled corticosteroid(0.33)

B. cromolyn(0.33)

C. nedocromil

D. oral steroids(0.33)

48. A child who suddenly develops difficulty of breathing, urticarial rashes, abdominal pain 5 minutes after eating crabs need immediate administration of

A. intramuscular antihistamine(0.33)

B. intravenous antihistamine(0.33)

C. intramuscular corticosteroid

D. epinephrine 1:1000 intramuscular(0.33)P 687

49. The only effective treatment of B-cell disorder

A. Thymic cell transplant

B. Bone marrow transplant(0.5)

C. Regular administration of gammaglobulin (0.5)

D. Plasma transfusionP 598

REFERENCE: Nelson, Textbook of Pediatrics, 17th edition

Case 1. Nos. 50 - 51

Baby girl OA was born to a 24 year old primigravid at 39 weeks AOG, NSD after an uncomplicated pregnancy. She weighed 2850 grams, AS 9 & 10, On the 12 th hour of life, she was noted to be jittery. There was fair suck. Reflexes were good. Serum calcium was 4 mg/dl. HGT was 70 mg%

  1. The most likely diagnosis is
  2. Transient idiopathic neonatal hypocalcemia(0.5)
  3. Early neonatal hypocalcemia(0.5)
  4. Small for age
  5. Infant of diabetic mother, hypocalcemia secondary
  1. The most probable cause of her disorder is
  2. metabolic imbalance of hypoglycemia(0.25)
  3. presence of cytoplasmic antibodies(0.25)
  4. functional immaturity of PTG(0.25)
  5. prematurity

Case 2. Nos. 52 - 53

A 3 month old male was admitted due to frequent vomiting since 2 weeks of age. He had poor suck, weighed 3.5 kgs, dehydrated, hypotensive

  1. Differential diagnoses includes all of the following EXCEPT

A.septic shock(0.33)

B.adrenocortical insufficiency, etiology to be determined

C.failure to thrive(0.33)

D.Acute gastroenteritis(0.33)

  1. Management should include

A.DAT, Prednisone, NaCl supplementation

B.NPO, D5NSS, hydrocortisone succinate, fludrocortisone(0.33)

C.NPO, D5NSS, hydrocortisone succinate(0.33)

D.NPO, D5NSS, fludrocortisone and NaCl supplementation(0.33)

Case 3. No. 54

A 9 year old male had a weigh of 120 lbs, height of 4 feet complains of paroxysmal attacks of headache and nape pain. The dark pigmentation on the neck, axilla, nape and his acne bothers him a lot. On consultation, his BP was 120/80 mmHg, CR: 90/min

  1. The patient has

A.normal weight, height and BP

B.increased weight, normal height and increased BP(0.33)

C.normal weight, increased height and increased BP(0.33)

D.increased weight, increased height and increased BP(0.33)

Case 1. Nos. 55 – 56

A diabetic 33 year old Gravida 1 Para 1 type O+ mother delivered 5 weeks earlier than her expected date of confinement. The baby was delivered in a lying-in and was noted to be limp, cyanotic face and pale body, gasping, pulses weak and no response on suctioning

  1. If your are present on the delivery of this baby. The Apgar score at 1 minute is

A.0

B.1 (0.5)

C.2

D.3 (0.5)

56. If he was fed on expressed breast milk and no vitamin K given at birth, the anticipatory

condition that could probably set in

  1. Hemorrhage(0.33)
  2. Jaundice(0.33)
  3. Diarrhea(0.33)
  4. Necrotizing enterocolitis

REFERENCE: Routine newborn care

57. A 20 year old primigravid mother now on her 31st week age of gestation consulted for painless vaginal bleeding. Stat pelvic ultrasound showed placenta previa totalis and thus emergency caesarean section was done. What immediate problem do you expect in the baby?

  1. Meconium Aspiration Syndrome
  2. Respiratory Distress Type I(0.33)
  3. Apnea of Prematurity(0.33)
  4. Respiratory Distress Type II (0.33)
  1. The pulmonary problems brought about by Respiratory Distress Type I are due to
  2. low compliance(0.33)
  3. high resistance(0.33)
  4. high functional residual capacity
  5. low dead space(0.33)
  1. A post term was delivered thru caesarean section because of non-reassuring fetal heart rate status. Baby was born through thickly meconium stained amniotic fluid, weighed 2400 grams and had poor apgar score. He is at risk for the following problem:
  2. Respiratory Distress Type II(0.5)
  3. Persistent pulmonary hypertension(0.5)
  4. Meconium plug
  5. Meconium ileus
  1. One of the following is responsible for decrease pulmonary venous return at birth
  2. increase paO2(0.25)
  3. increase paCO2(0.25)
  4. decrease pH (0.25)
  5. all of the above(0.25)

REFERENCE: Nelson, Textbook of Pediatrics, 17th edition, p 584

  1. Unconjugated hyperbilirubinemia in an otherwise normal 8 day old infant can be attributed to
  2. breastmilk jaundice(0.33)
  3. breastfeeding jaundice(0.33)
  4. sepsis neonatorum
  5. galactosemia(0.33)
  1. A 3 year old child with malnutrition is being evaluated for admission at the ward. The anthropometric index that reflects recent nutritional experience of the child is p170
  2. weight for height(0.5)
  3. body mass index(0.5)
  4. mid-arm muscle circumference
  5. triceps skin fold
  1. A 1 ½ year old male consulted the OPD for persistent diarrhea of 2 ½ weeks. Physical examination showed he had dry, scaly eczematous dermatosis at the perioral, cheeks, perianal and acral areas with growth retardation, alopecia and reddish tint of hair. He is likely to have a deficiency of p 2248
  2. Iodine (0.25)
  3. Magnesium(0.25)
  4. zinc (0.25)
  5. fluoride
  1. A mother consulted the clinic to manage her 9 year old obese child. Her condition is most often associated with the following features EXCEPT
  2. hyperpigmentation in the neck and skin creases
  3. tall stature (0.5)
  4. slightly advanced bone age(0.5)
  5. delayed onset of puberty

65. A child with non-edematous protein energy malnutrition is now on the last phase of therapy. Iron therapy for this child is not given in the early phase of treatment because p 173

A. free iron in the early phase may exacerbate oxidant damage(0.25)

B. iron does not promote growth in the early phase of treatment(0.25)

C. iron has no significant effect on the host’s defense mechanism(0.25)