Pedia FinalA

7/25/2019 Pedia FinalA

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PEDIATRICS

1. The cardiac silhouette of patients with Tetralogy of Fallot is best describedas:

a. boot shapedb. egg on the sidec. markedly enlargedd. mild cardiomegaly

p.1312

2. The most common cause of neonatal seizures isa. meningitisb. hypoxic ischemic encephalopathy

c. congenital CNS anomalies

d. metabolic causes

p. 1696

3. Immunization with polio vaccine may be started as early as

a. newborn periodb. 6 weeks of age

c. 8 weeks of aged. 3 months

p. 1023

4. Measles immune globulin may prevent or modify infection if given within

a. 3 days after exposureb. 6 days after exposure

c. 10 days after exposured. 2 weeks after exposure

p. 1017

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

a. velocardiofacial syndromeb. Downs syndrome

c. Turner Syndromed. Cornelia de Lange syndrome

Answer B p 619 Nelson

6. A scaphoid abdomen at birth usually suggests a:

a. diaphragmatic hernia

b. omphalocoelec. gastroschisisd. omphalitis

ans. A p527


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7. One of the following drugs is ABSOLUTELY contraindicated to

Breastfeeding:

a. diuretics

b. prednisonec. tetracyclined. hydralazine

ans C p. 530

8. The presence of subperiosteal hemorrhage in the newborn which is locatedto the surface of one cranial bone is called:

a. caput succedaneumb. molding

c. fracture of the skulld. cephalhematoma

ans: D p 562

9. Congenital Rubella Syndrome is characterized by the followingconglomeration of symptoms:

a. cataracts, cardiac abnormality, hearing defects, microcephaly andmental retardation

b. hepatomegaly, splenomegaly, jaundice, petecchiae, chorioretinitisc. IUGR,intracranial calcifications, hepatosplenomegalyd. Hydranancephaly, chorioretinitis, spasticity,mental retardation

Ans A p.569

10. The mature levels of surfactant is seen by:

a. 20 weeksb. 28 weeksc. 32 weeksd. 35 weeks

ans: D p.575

11. The most frequently fractured bone of the newborn during labor and deliveryis the:

a. femurb. humerusc. clavicle

d. hip bone

ans C p. 572

12. A 5 year old child suddenly developed edema . It was more prominent in themorning. No meds and consult done. However, she complained ofheadache and noted dark colored urine. On day of consult, she also noteddecrease frequency of urination: What is the probable illness of this patient?


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a. Ig A nephropathyb. Alport Syndromec. Acute Glomerulonephritisd. MPGN

answer C p.1740

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

a. Acute Glomerulonephritisb. Henoch Schoelein Purpurac. Systemic Lupus Erythematosus

d. Membranoproliferative GN

Ans C p1743

14. The most common pathogen associated with HEMOLYTIC UREMICSYNDROME is :

a. shigellab. salmonellac. E. Coli

d. Rotavirus

Ans C p. 1274

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

a. SMR 1b. SMR 2c. SMR 3d. SMR 4

Ans: D p. 5416. Delayed eruption is considered when there is no teeth at approximately:

a. 6 monthsb. 9 monthsc. 10 monthsd. 13 months

answer is: D p. 61

17. The principal vector of DENGUE FEVER is:

a. Plasmodium Falciparumb. Aedes Aegypti

c. Perumycus Perinomatad. Culex pipiens

Answer B p.1092


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18. A 5 year old male was noted to have fever of five days duration which israpidly increasing to 39 to 40 C . It is accompanied by frontal headache andwas noted to have back pain. After 2 days of defervecence of fever rashesappear at the lower and upper extremities that is glove and stockings indistribution. The most plausible diagnosis is:

a. Measlesb. Typhoid Feverc. Yellow Feverd. Dengue Fever

Ans D p 1093

19. The WHO criteria for dengue hemorrahagic fever are the following:

a. fever, minor or major hemorrhagic manifestation and

thrombocytopeniab. fever, elevated ESR and thrombocytopeniac. fever, (+) dengue blot and thrombocytopeniad. fever, biphasic fever and thrombocytopenia

ans A p. 1093

20. A 6 year old child developed high grade fever and cough. Chest x- ray wasdone and reveled pnuematocoeles . What is the most common pathogenicorganism responsible for pneumatocoeles?

a. Influenzab. Streptoccocalc. Pnuemococcald. Staphylococcal

Ans: D

21. An important indicator of pneumonia among infants is:

a. feverb. increased respiratory rate

c. cyanosisd. cough

ans B p.1435

22. The drug of choice for atypical pneumonia is:

a. Ampicillinb. Chloramphenicolc. Erythromycin

d. Ceftriaxone

ans C p 934


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

a. miliab. Mongolian spotsc. Erythema toxicum

d. Jaundice during the first 24 hours

Ans D 561

24. The duration of treatment for uncomplicated H. Influenzae meningitis is

a. 3-5 daysb. 7-10 days

c. 2 weeksd. 4 weeks

ans. B p. 711

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

a. 2 months of ageb. 4 months of agec. 6 months of age

d. 10 months of age

ans. C p. 1211

26. Stridor is most commonly seen in infants with

a. croup

b. bronchiolitisc. bronchitisd. pneumonia

ans. A p. 1215

27. Subacute sclerosing panencephalitis (SSPE) is associated with

a. rubellab. rubeola

c. varicellad. roseola infantum

ans. Bp. 934

28. The absolute contraindication to giving immunization is:

a. immunodeficiency state of the patientb. high grade fever at the time of administrationc. malignancy in a childd. previous anaphylactic reaction

p. 1085


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

a. measles & 3rddose of Hepatitis B vaccine

b. measles vaccinec. 3rddose of hepatitis Bd. varicella vaccine

31. The WHO recommends that breast feeding can be the infants sole source offood up to about:

a. 2 months of ageb. 6 months of age

c. 12 months of aged. 2 years of age

32. Which vaccine should be given intradermally?

a. measlesb. BCG

c. hepatitis Bd. MMR

p. 896

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

a. BCG; 3 doses each of hepatitis B, DPT and OPVb. BCG, 3 DPT; 3 OPV; measles vaccinec. 3 hepatitis B; 3 DPT; 3 OPV; measles vaccined. 3 hepatitis B; BCG; 3 DPT; 3 OPV, measles vaccine

34. A 12-year old male with repeated episodes of streptococcal pharyngitiscomes to the clinic with another episode of sore throat. Oral amoxicillin wasstarted. One hour later, he had tingling sensation around his mouth, difficultyof swallowing and developed hoarse voice. At the ER, he had urticaria,PR=130/min, RR=32/min, BP=70/30 and t= 37.2C. The most appropriatetherapy is:

a. epinephrine

b. prednisonec. diphenhydramined. lactated Ringers solution

p. 687

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

a. foreign bodyb. vasomotor rhinitisc. neutrophilic rhinitisd. allergic rhinitis

p. 662


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36. The most common manifestation of rheumatic fever in children is:

a. erythema marginatumb. subcutaneous nodules

c. carditisd. arthritis

p. 807

37. An 18-month old is noted to assume a squatting position frequently duringplaytime at the daycare center. The mother also notices occasional episodesof perioral cyanosis during some of these squatting periods. The day ofadmission, the child becomes restless, hyperpneic and deeply cyanotic.Within 10 minutes, the child becomes unresponsive. The most likelycondition is:

a. cardiomyopathyb. anomalous coronary arteryc. tetralogy of Fallot

d. breath-holding spell

p 1385

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

a. mitral stenosisb. mitral regurgitation

c. aortic regurgitationd. mitral valve prolapse

p. 1428

39. A 14-year old female was brought to you because of mothers worry that shehas no menarche yet as compared to her classmates. Medical history andcomplete PE are normal. Breast development and pubic hair have beenpresent for 18 months and are normal. Which would be the mostappropriate?

a. reassurance that she likely will begin menstruating within theyear

b. laboratory evaluation for systemic diseasec. urinary estriol determinationd. referral for psychological counseling

p.1687

40. The hallmarks of diabetes insipidus are:

a. polyuria and polyphagiab. hyperthermia and vomitingc. polyuria and polydypsia

d. hyperthermia and weight loss

p. 1682


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41. A 2-year old male presents with a history of chronic constipation. Uponreview of history, you were told that he had delayed passage of black stools.He had unremarkable PE findings. The parents were giving him laxatives forthe past 2 weeks. Your most likely initial impression is:

a. functional constipationb. constipation due to laxative abusec. intestinal pseudo-obstructiond. Hirschprung disease

p. 1139

42. A prominent clinical presentation of duodenal atresia is:

a. bilious vomiting without abdominal distention

b. non-bilious vomiting

c. polyhydramniosd. colicky abdominal pain

p. 1133

43. The radiologic finding of double tract sign is typically seen in:

a. Intussusceptionb. pyloric stenosis

c. duodenal atresiad. midgut volvulus

p. 1130

44. Classic hemophilia is best treated by giving:

a. whole bloodb. Factor VIII

c. packed rbcd. Factor X

p. 1510

45. A 5-year old female has multiple bruises on her lower extremities and oralmucosal bleeding for 3 days duration. Two weeks before these signs shehad a mild respiratory tract infection. Physical examination reveals multipleecchymoses and petechiae; no lymphadenopathy nor splenomegaly wasnoted. The most likely diagnosis is:

a. Leukemiab. Neuroblastomac. aplastic anemiad. idiopathic thrombocytopenic purpura

p. 1521


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46. Which of the following suggests a bacterial etiology in a child withtonsillopharyngitis?

a. pale tonsils with mild pharyngeal congestionb. beefy tonsils with petechiae

c. mild pharyngeal exudatesd. enlarged tonsils with moderate congestion

p. 1265

47. A 1-year old infant had cough 2 weeks PTC which started as mild andbecoming paroxysmal. This was accompanied by low-grade fever but wasrelieved by antipyretics. She had a poor history of immunizations. PPEshowed explosive outburst of cough accompanied by reddish face. The childlooks well when not coughing. Lungs were clear. There were few petechiaein the neck. T=37C. The most likely diagnosis is:

a. viral pneumoniab. epiglottitisc. pertussis

d. laryngotracheobronchitis

p. 839

48. The period of communicability of mumps in a child is:

a. for 5 days starting with the first day of visible parotid swellingb. from 3 days of onset of swelling to the day of visible swellingc. from several days before the onset of swelling until the

swelling hassubsidedd. only while fever persists

p. 954

49. A 12-year old girl had a mild sore throat, low-grade fever and a diffusemaculopapular rash. During the next 24 hours, she developed redness of hereyes. PE showed mild tenderness and marked swelling of her posteriorcervical and occipital lymph nodes. Four days after the onset of illness, therash vanished. The most likely diagnosis is:

a. Rubella

b. Rubeolac. erythema infectiosumd. acute infectious lymphocytosis

p. 951

50. Which is the most common cause of osteomyelitis in children?

a. Staphylococcus aureus

b. Group A streptococcusc. Group B streptococcusd. Pseudomonas aeruginosa

p. 776


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

a. patent ductus arteriosus

b. choanal atresiac. ventricular septal defectd. respiratory distress syndrome

p. 1259

52. The initial treatment for neonates with sepsis consists of:

a. erythromycin + cloxacillinb. ampicillin + sulfac. ampicillin + aminoglycoside

d. cloxacillin + aminoglycoside

p. 549

53. A 10-day old infant who was born by NSD by a hilot was brought inbecause of difficulty of sucking and excessive crying noted 2 days PTC.PPE: wt= 3,000 gms; T= 37.5C, with hoarse cry and spasms. Lungs wereclear. The most appropriate treatment would be:

a. feeding by NGTb. penicillin by IV

c. muscle relaxant IMd. sedative IM

p. 879

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

a. bronchitisb. tonsillopharyngitisc. acute epiglottitis

d. bronchiolitis

p. 1275

55. A 10-month old infant has fever, cough, dyspnea and leucocytosis. Chest x-ray shows patchy distribution of consolidation. Treatment of choice withoutbacterial culture is:

a. Ampicillin

b. Erythromycinc. Oxacillind. Amikacin


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56. Tracheo-esophageal fistula is usually suspected in one of the followingconditions:

a. excessive oral secretions

b. maternal hypertension

c. presence of stridord. vomiting

p. 1122

57. A syndrome that starts as diarrhea and progresses to fever, oliguria, acuterenal failure, thrombocytopenia and microangiopathic anemia in children isdue to:

a. systemic lupus erythematosusb. hemolytic-uremic syndrome

c. Good-Pasteur diseased. Henoch-Schonlein nephritis

p. 1586

58. A 2-year old female was hospitalized because of afternoon fever andanorexia for 3 weeks and seizures few hours prior to consultation. Noprevious medications; no history of seizures in the past. PE findings:T=39.5C, stuporous, (+) nuchal rigidity, right eye deviated medially, spasticextremities. CSF was cloudy with WBC 204/cc and lymphocytes of 90%,sugar=0.8 mmol/L. Your treatment would include:

a. aqueous penicillinb. ampicillin and chloramphenicolc. INH/Rifampicin/Streptomycin/corticosteroids

d. anti-viral drugs

p. 891

59. Sparse and thin hair with dyspigmentation as a sign of undernutrition iscommonly observed in:

a. marasmusb. kwashiorkor

c. intrinsic factor deficiencyd. vitamin A deficiency

p. 170

60. Milk feedings must be supplemented with iron preparations to prevent irondeficiency anemia starting:

a. 6-8 weeks of age

b. 6 months of agec. 9 months of aged. 12 months of age

p. 165


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61. The present age recommendation to start solid food for supplementation forinfants is at:

a. 3 months of ageb. 6 months of age

c. 9 months of aged. upon eruption of 2ndincisors

p. 165

62. Normally, a newborn infants weight may decrease 10% below the birth-weight in the first week of life as a result of:

a. excretion of excess extravascular fluid

b. high environmental temperaturec. hypoglycemia

d. intake of high-fat breast milk

Answer: A p. 32-33

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

a. the need for immediate resuscitation

b. the probability of successful resuscitationc. predict neonatal deathd. predict neurologic outcome

Answer: A p.592

64. In general, jaundice is considered pathologic and therefore, a search todetermine its cause should be made if:

a. it appears on the 36-48hr. of lifeb. serum bilirubin is rising at a rate faster than 1 mg/dl/24 hr.c. jaundice persists after 5-7days of lifed. direct-reacting bilirubin is greater than 2 mg/dL at any time

Answer: D p. 595

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

a. 2 weeks oldb. 1 month oldc. 2 months oldd. 4 months old

Answer: D p. 34

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

a. rapproachmentb. object constancy

c. object permanenced. magical thinking

Answer: B p. 36


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67. The first visible sign of puberty in girls is:

a. thelarche

b. pubarche

c. menarched. peak height velocity

Answer: A p. 54

68. This vaccine is contraindicated in household contacts ofimmunocompromised persons:

a. OPV

b. Measlesc. Varicella

d. BCG

Answer: A p. 1182

69. Baby Girl Cruz was delivered spontaneously at term to a 28 y/o G3P2mother. Following delivery, she was noted to be limp, had irregularrespiration, CR 80/min, extremities and body cyanotic with no response tosuctioning of oronasal passages. What is the APGAr Score of Baby GirlCruz?

a. 2

b. 3c. 4d. 5

Answer A p. 528

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

a. 1 years oldb. 2-3 years oldc. 4-6 years oldd. 7-10 years old

Answer: C p. 1178

71. If the first dose of Hepatitis B vaccine was given at birth, the last dose shouldnot be given before the age of:

a. 6 months

b. 9 monthsc. 12 monthsd. 15 months

Answer: A p. 1177


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

a. within 12 hours at birth

b. 4 weeks old

c. 6 weeks oldd. 8 weeks old

Answer: A p. 1177

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

a. 12 kgb. 14 kgc. 16 kg

d. 20 kg

Answer C p. 31

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

a. TEF

b. pulmonary sequestrationc. pulmonary hypoplasiad. CCAM

Answer: A page: 1219

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

a. spasmodic croup

b. acute laryngotracheobronchitisc. congenital subglottic stenosisd. angioneurotic edema

Answer: A page 1407

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

a. TB infectionb. TB disease

c. TB exposured. Miliary TB

Answer B page 962

77. . Which of the following is a major criteria of atopic dermatitis?a. Xerosisb. postauricular fissurec. elevated IgEd. (+) FH of atopy

Answer: D page: 775


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78. A 15 month old boy developed generalized pruritus, hives and dyspnea 30

minutes after intake of egg. The initial treatment should be administration of:

a. diphenhydramine IM

b. Epinephrine IMc. Epinephrine SCd. Prednisone IV

Answer: B page: 781

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

a. Neurogenic DIb. Nephrogenic DIc. Type I DM

d. Type II DM

Answer: C page 1954

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

a. ultrasound of KUBb. cranial MRI

c. glycosylated hemoglobind. serum Na, K and calcium

Answer: B page: 1854

81. The most common malignant neoplasm in children:

a. Retinoblastomab. Neuroblastomac. Wilms Tumord. Leukemia

Answer: D page: 1694

82. A 1 year-old baby was brought to the OPD for a well baby check up. He wasexclusively breastfed from birth until 6 months, and was givencomplementary feeding from then on. Physical examination wasunremarkable except for pallor. CBC showed anemia, low red cell indices,normal reticulocyte count. What is the most likely diagnosis?

a. Thalassemia traitb. Iron deficiency anemia

c. Aplastic Anemiad. Diamond Blackfan anemia



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83. A 4 y/o male patient consulted because of joint pains, he was also noted tohave intermittent low grade fever for 2 weeks. PE: pale palpebralconjunctivae, (+) petechiae on soft palate, Grade 1-2 systolic ejectionmurmur at the LLSB, clear breath sounds, liver edge 5 cm below RCM,spleen 3 cm below LCM, (+) 3 cm bluish discoloration on the thigh. CBC

showed Hgb = 6.0/dL, Hct 20 vol % RBC = 2.0 x 109

/L, MCV = 85 fl, MCH =30 pg, MCHC = 31, RDW = 13, WBC = 10 x 10 9/L, segmenters = 1%,lymphocytes = 90%, Platelet count = 100 x 109/L. What is the most likelydiagnosis?

a. Aplastic anemiab. Infectious mononucleosisc. Acute lymphocytic leukemia

d. Rheumatoid arthritis

Answer: C p. 1645

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

a. Enterotoxiginic E. colib. Rotavirus

c. Cholerad. Shigella


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

a. noneb. mildc. moderated. severe

Answer: D page: 245

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

a. Hypertonic pyloric stenosisb. Hirschprungss diseasec. GE reflux

d. Intussusception

Answer: C page: 1222

87. Features strongly suggest cholestatic jaundice:

a. yellowish skin and scleraeb. straw yellow urinec. TB 12 mg/dL B1 10.8mg/dL B2 = 1.2 mg/dLd. Acholic stools

Answer: D pages: 1314-1315


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88. Drug of choice used to rapidly terminating severe cyanotic spells in babieswith Tetralogy of Fallot:

a. Clonidineb. Paracetamol

c. Morphined. Diazepam


89. Palpating the peripheral pulses is important in infants and children. Thisparticular congenital cardiovascular disease may be suspected if the femoralpulses are diminished or absent:

a. patent ductus arteriosus (PDA)b. coarctation of the aorta

c. transposition of the great arteries (TGA)d. atrial septal defect

Answer: B page: 1482 & 1518

90. In which of the following situations can a diagnosis of acute rheumatic feverbe made?

a. (+) ASO titer (+) joint pains, (+) feverb. (-) ASO titer (+) choreas syndenham

c. (+) ASO titer, (+) erythema marginatum ESRd. (+) ASO titer, (+) polyarthritis, CRP

Answer: B p. 876

91. Baby Twinkle was delivered term to a mother with poorly-controlledgestational diabetes. At birth, her Apgar Score were 5 and 6 at 1 and 5minutes, respectively. Maternal blood type is O+, babys blood type is A+

If she developed jaundice at the 20thhours of life, the most likely cause is:

a. Perinatal asphyxiab. Hemolytic disease of the newborn

c. Maternal diabetesd. Hemorrhagic disease of the newborn

Answer: B page: 601

92. A 6 year old boy complained of nape pains and headache, with a BP of160/100. 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 likelyconsideration is:

a. UTIb. Post-infectious glomerulonephritis

c. Idiopathic nephritic syndromed. Urolithiasis



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

a. being uncircumcisedb. vesicoureteral reflux

c. voiding dysfunctiond. male sex


94. A 3 year old boy had a history of profuse watery diarrhea and vomiting. Onconsultation, there was no urine output for the last 12 hours. Minimal urinewas obtained by catheterization. Urine was dark yellow, highly concentratedwith a low urine sodium content. The cause of renal failure is:

a. pre-renal

b. intrinsic renalc. bladder outlet obstructiond. neurogenic bladder

Answer: A page: 1768, 1769

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

a. throat cultureb. White blood cell count

c. Chest-x-rayd. Grams stain of nasal discharge

Answer: B page: 910

96. The WHO criteria added for Dengue Shock Syndrome include the criteria forDHF plus:

a. minor or major hemorrhagic manifestationsb. thrombocytopenic (< 100,000/mm3)c. narrow pulse pressure (< 20 mmHg) or hypotension

d. pleural effusion by chest radiograph or hypoalbuminemia

Answer C page 1093

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

a. atypical measlesb. Kawasaki disease

c. Typhoid feverd. Streptococcal septicemia

Answer: B page: 824


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98. A 10 year old girl complained of fever, sore throat. PE revealed exudativepharyngitis accompanied by generalized lymphadenopathy, splenomegalyand atypical lymphocytosis on peripheral smear. The most likely etiologicagent is:

a. Group A b-hemolytic Streptococcusb. Corynebacterium diphtheriaec. Epstein Barr Virus

d. Coxsackie Virus


99. A 17 year old girl had a mild prodrome of nasal catarrh and low feverfollowed by retroauricular, posterior cervical and postoccipitallymphadenopathy and the appearance of discrete reddishmaculopapules. This fits the diagnosis of:

a. Varicellab. Rubella

c. Meningococcemiad. Parvovirus B19


100. A 6 year old presented by a mild respiratory prodrome. The initial stagewascharacterized by erythematous facial flushing likened to a slappedcheek. The disease is most likely:

a. scarlet feverb. CMV infectionc. Roseolad. erythema infectiosum


101. The management of benign febrile seizures includes:

a. Phenobarbital therapy if the patient is one year or olderb. baseline neuroimagingc. electroencephalogram a week after the attackd. maternal education and antipyretic measures


102. Cyanosis and seizures on prolonged crying in an infant suggests:

a. benign rolandic seizuresb. ceongenital heart diseasec. breatholding spells

d. infantile spasm

Answer: C page 2010


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

a. polyarteritis nodosa erythematosusb. systemic sclerodermac. systemic lupus

d. Kawasaki disease

Answer: C page: 810

104. This drug is used as prophylaxis against Pneumocystis carinii pneumoniain renal transplant patients:

a. Azithromycinb. Trimethoprim-sulfamethoxazole

c. Permethrind. Albendazole

MPL: 1.00 p: 1155

105. Hand-foot and mouth disease is caused by:

a. Coxsackie A virus

b. Epstein barr virusc. Cytomegalovirusd. Parvovirus B19

MPL: 1.0 p: 1044

106. Iron chelation will be most useful in:

a. Idiopathic Thrombocytopenic Purpurab. beta thalassemia major

c. chronic myelogenous leukemiad. iron deficiency anemia

MPL: 1.0 p: 1632

107. The principal organ affected after most hydrocarbon ingestion is the:

a. liverb. GITc. bone marrowd. lungs

MPL: 1.0 p: 2372-2373

108. The most common viral agent causing bronchiolitis is:

a. respiratory syncitial virus

b. influenzaec. rhinovirusd. parainfluenzae

MPL: 0.25 p: 1415-1416


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

a. Ceftriaxoneb. Cefotaximec. Penicillin

d. ceftazidime

MPL: 1.0 p: 2042-2043

110. The clinical symptoms of Hirschprungs disease usually begins at birth andushered in by:

a. failure to thriveb. delayed passage of meconium

c. vomitingd. abdominal distention

MPL: 1.0 p: 1239

111. The most sensitive study in the diagnosis of Meckels diverticulum is:

a. plain abdominal radiographb. superior mesenteric radiographyc. barium studyd. radionuclide scan

MPL: 1.0 p: 1237

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

a. RDS type Ib. RDS type II

c. meconium aspiration pneumoniad. bronchopulmonary dysplasia

MPL: 1.0 p: 583

113. The diagnosis of tetanus is established by:

a. blood cultureb. lumbar tapc. presence of lockjaw followed by progressive stiffness of the

voluntary muscles

d. complete blood count

MPL: 1.0 p: 952

114. The earliest sign of puberty in girls:

a. menstruationb. breast enlargement

c. broadening of the hipsd. appearance of pimples

MPL: 1.0 p: 54


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

a. membranous GNb. membrano-proliferative GN

c. minimal change nephrotic syndromed. focal segmental GN

MPL: 1.00 p:1755

116. Physiologic bowing of the legs completely resolves by:

a. 1 yearb. 2 years

c. 3 yearsd. 4 years

p: 2265

117. Hydrocoele is often physiologic up to:

a. 3 monthsb. 6 monthsc. 9 monthsd. 12 months

p: 1820

118. A 7-year-old boy has crampy abdominal pain and purpuric rashes on theback of his legs and buttocks as well as on the extensor surfaces of hisforearm. Urinalysis reveals proteinuria and microhematuria. Your mostprobable diagnosis is which of the following:

a. poststreptococcal glomerulonephritisb. Henoch-Schonlein Purpura

c. IgA nephrophathyd. Hemolytic Uremic Syndrome

p: 1744

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

a. Hyponatremia

b. hypokalemiac. hypocalcemiad. metabolic acidosis

p: 1769


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120. A 2-month-old infant was rushed to the emergency room with generalizedseizure. The infant was born term, AGA at home attended by a hilot. Hewas purely breastfed. At the ER, he was pale, drowsy with bulginganterior fontanel. He had clear breath sounds, liver edge was 4 cm belowthe right subcostal margin and right hemiparesis. Your most probable

diagnosis is:

a. hemophiliab. neonatal sepsisc. bacterial meningitisd. acquired prothrombin complex deficiency

p: 606

121. Tuberculin reactivity is a Type ____ hypersensitivity:

a. Type I IgE mediatedb. Type II cytotoxicc. Type III immune complexd. Type IV cell mediated

p: 783, 961

122. An apparently healthy neonate was brought to a well baby clinic. PEshowed palpable liver 2 cm below the right subcostal margin. The mostprobable diagnosis is:

a. neonatal hepatitisb. choleduchal cystsc. biliary atresiad. normal

p: 526

123. A 12-month-old male suddenly draws up his leg and scream in pain. Thiswas repeated periodically throughout the night interspersed with periods ofquiet sleep. He was seen after 12 hours and looked pale, has justvomited and passed out blood streaked stools. There is a palpable massaround the umbilicus. The most likely diagnosis is:

a. Acute appendicitisb. Acute gastroenteritisc. Intussusception

d. Mesenteric adenitis

p: 279

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

a. thelarche

b. pubic hairc. axillary haird. enlargement of clitoris

p: 59


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125. Which of the following is true of cephalhematoma:

a. may not be visible until several hours after birth

b. it is a subcutaneous edema of the scalpc. usually resolves in 24 hours

d. not associated with complications

p: 562

126. A 35-week AOG newborn was delivered with an Apgar Score of 8 and 9 at1 and 5 minutes, respectively. Mother had no prenatal check up. Within afew minutes of birth, the baby was noted to develop respiratory distress.Which of the following causes of respiratory distress is least likely in thispatient:

a. Transient Tachypnea of the Newbornb. Neonatal Pneumonia

c. Meconium Aspiration Syndromed. Hyaline Membrane Disease

p: 575-583

127. A newborn was exposed to the infectious diseases mentioned below.History revealed that the mother had received the recommendedimmunizations during pregnancy and had these diseases years prior topregnancy. Which of the following diseases would probably affect thisnewborn:

a. tetanusb. rubeolac. pertussis

d. varicella

p: 909

128. Which of the following are not routinely recommended:a. Hep B vaccineb. DPTc. Rabies

d. Polio vaccine

p: 1177

129. Which of the following is the most frequent cause of Common Cold:a. S. aureusb. S. pneumoniaec. Pseudomonas sp.d. Rhinovirus

p: 1389


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130. A 10-year-old child was admitted because of abdominal pain and nausea.This was followed perioral numbness. At the ER, the patient hadrespiratory arrest and was thus intubated. History revealed that thepatient had eaten shellfish about 2 hours before the onset of symptoms.Which of the following is the most probable toxin involved:

a. saxitoxin

b. ciguatoxinc. scambrotoxind. solanine

p: 2377

131. A 15-year-old male sought consult because of fever, malaise andheadache. He also complains of pain over the area from the back of hismandible toward the mastoid space. He also describes that his earlobe

on the affected side appears to be sticking upward and outward. Drinkingsour liquids causes much pain in the affected area. The most probablecondition affecting the child is:

a. measlesb. mumps

c. varicellad. rubella

p: 1035

132. An 18-month-old infant presents at the ER because of convulsions. Healso has high grade fever. During the lumbar puncture (where CSF examwas normal), he passed large volume of watery stools with blood andmucus. The most likely diagnosis is:

a. Salmonellosisb. Shigellosis

c. Rotavirus diarrhead. Cholera

p: 919

133. In a 6-month-old infant, which of the following would be a contraindicationto doing a lumbar tap:

a. bulging fontanelb. history of seizurec. significantly elevated WBCd. uncorrected bleeding diathesis

p: 1980

134. The single most sensitive method of diagnosis of Typhoid Fever is whichof the following:

a. clinical pictureb. Typhidotc. Widals testd. Blood or bone marrow culture

p: 917


26/37

135. Which of the following conditions is a contraindication to breastfeeding:

a. mastitisb. common cold

c. substance abused. intake of amoxicillin

p: 161

136. A 3 year-old boy has fever and seizure. He was drowsy, with nuchalrigidity and bilateral upgoing of toes. CSf examination shows turbid, cellcount of 10,000, 75% polyss, protein 500 mg/dl, sugar 40 mg/dl with 100mg/dl random blood sugar. Based on the CSF exam, what is the mostprobable etiologic agent:

a. Tuberculousb. bacterialc. virald. fungal

p: 2043

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

a. 2:1b. 3:1c. 5:1

d. 10:1

p: 281

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

a. one injectionb. two monthly injections

c. one injection followed by a booster after 6 monthsd. one injection followed by a booster after 1 year

Referenc e: Nelson textb oo k of pediatr ics, 17thed. P 1061-1062

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

a. heightb. weight

c. mid-arm circumferenced. head circumference

Referenc e: Nelson textb oo k of pediatr ics, 17thed. P 170-172


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140. A 4 year old boy looks malnourished. The height for age measurement is75% therefore the waterlow classification is _______ stunting:

a. Normalb. Mild

c. Moderated. Severe

Referenc e: Nelson textb oo k of pediatr ics, 17thed. P 59 (Tab le 15-1)

141. A 2 year old child was rushed to the ER because of seizure. He initiallydeveloped fever with associated petechial rashes on both extremities.While at the ER, the resident noted petechial rash and several slate graysatellite shape descent. The most likely diagnosis is:

a. bacterial meningitis

b. viral encephalitisc. intracranial hemorrhaged. seizure disorder

Referenc e: Nelson textb oo k of pediatr ics, 17thed. P 2041

142. While the parents were transporting their four year old child to theEmergency Department for difficulty of breathing, the child stoppedbreathing. On arrival in the ER the child is pulseless and apneic. Themonitor shows a bradyarrhythmia at 20 beats per minute. The initial andimmediate treatment consists of:

a. ventilation

b. chest compressionsc. vascular accessd. parental medications

Referenc e: Nelson textb oo k of pediatr ics, 17thed. P 279, P2

143. A 3 month old presents to the ER with a one day history of poor feedingand rapid breathing. The infants pulse is 260/min. The color is gray andperfusion is poor. ECG is consistent with SVT. Treatment in this childconsists of:

a. Rapid IV digitalizationb. IV verapamilc. oral digitalizationd. synchronized cardioversion

Reference: Nelson textb oo k of pediatr ics, 17thed. P 282

144. A 3 year old female has a grade 3/6 systolic ejection murmur at the RUSBwith weak pulses at the lower extremities and a lower extremity BP of90/60 and an upper extremity BP of 110/70. The most likely diagnosis is:

a. pulmonary stenosisb. coarctation of the aorta

c. patent ductus arteriosusd. Ebstein anomaly

Referenc e: Nelson textb oo k of pediatr ics, 17thed. p . 1518


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

a. prostaglandin E1b. ibuprofenc. indomethocind. prednisone

Referenc e: Nelson textb oo k of pediatr ics, 17thed. p. 580

146. A 3 day old newborn has blotchy erythematous macules with tiny centralvesicles or pustules noted on the trunk and the face. The most likelydiagnosis is:

a. erythema toxicumb. sebaceous gland hyperplasiac. hemangiomad. epidermal nevus


147. A 2 year old male child consulted for speech delay. Mother reports thathe can only babble at present and would not respond when called. Heflaps his hands when he hears his favorite song but cannot establish eyecontact. He perseverates on spinning objects. The most probableconsideration for this is:

a. developmental language disorderb. autism

c. hearing impairmentd. cerebral palsy

Referenc e: Nelson textb oo k of pediatr ics, 17thed. p . 93-94

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

a. galactosemiab. G6PDc. Phenylketonuriad. Congenital hypothyroidism


149. 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 sameage, no other abnormalities very likely has:

a. Constitutional delay

b. Hypopituitarismc. Turner syndrome in the maled. Isolated LH-FSH deficiency

Reference: Nelson textbook pediatrics


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150. A six-month-old baby boy was seen at the Outpatient Clinic because ofjaundice which was noted since two weeks of age. The jaundice wasdeepening associated with pruritus and irritability and abdominaldistention. Stools were acholic and urine was deep yellow. On PE, the

child was wasted and stunted, with generalized jaundice; distendedabdomen with(+) fluid wave; liver edge was not palpable, (+)splenomegaly 4 cm below the left costal margin; (+) visible superficialveins on the abdomen; (+) palmar erythema and clubbing. The most likelydiagnosis is:

a. billiary atresia

b. viral hepatitisc. pyloric stenosisd. choledochal cyst

Referenc e: Nelson Textbook of Pediatr ics, 17 ed. Ch. XVII p. 1317,Bi l iary atresia

151. 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. Shealso frequently develops gum bleeding after brushing. What is the mostlikely diagnosis?

a. hemophilia Ab. protein C deficiencyc. Von Willebrand disease

d. TFPI deficiency

Referenc e: Nelson Textb oo k o f Pediatr ics, 17 ed. P 1662

152. A 6 month old presented with 3 days of high grade fever. He was cheerfuland feeding well when afebrile and had no respiratory symptoms. After the3 day fever, maculopapular rashes appeared on the face progressingdownwards.The most likely diagnosis is:

a. Measlesb. Roseola infantum

c. Rubellad. erythema infectiosum

Referenc e: Nelson textb oo k of pediatr ics, 17thed. Part XVI, p. 1069-

1070

153. A child suspected to have TB infection will have

a. 10 mm induration on Mantoux test

b. (+) Ghons complex on Chest X-rayc. (+) Blood cultured. (+) AFB smear

Reference: PPS TB conc ensus fo r chi ldren


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

a. Penicillinb. Oxacillinc. Chloramphenicold. Cotrimoxazole

Referenc e: Nelson textbo ok of p ediatr ics, Part. XXXI, p.2300

155. A test to verify to presence of maternal blood in the swallowed bloodsyndrome:

a. Apts test

b. Kelihaeur-Bethk testc. Mantoux testd. Coombs test

Referenc e: Nelson textb oo k of pediatr ics, 17thpar t XVIII, p. 599-607

156. Jo-anne, an 8 year old female known asthmatic was seen at the ERbecause of difficulty of breathing which started one hour PTC: Initialtreatment consists of:

a. inhaled short acting B2 agonist

b. oral steroidc. inhaled steroidd. leukotrienes

Referenc e: GINA Gu idel ines

157. An 8 year old male presents with tea-colored urine oliguria, periobitaledema most prominent in early morning and hypertension. The most likelydiagnosis is:

a. UTIb. Nephrotic syndromec. acute glomerulonephritis

d. hemorrhagic cystitis

Reference: Nelson Textboo k o f Pediatr ics, 17ed. p .1735-1737

158. Most reliable method of collection of urine for urine culture:

a. Catheterizationb. wee bag collectionc. midstream clean catchd. suprapubic aspiration

Referenc e: PPS clinical practice gu idel ines for Urinary Tract

Infect ion


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159. The laboratory test that confirms the presence of UTI:

a. Bacteruiriab. Pyuriac. >100,000 CFU/ml of urine

d. hematuria

Reference: PPS cl inical pract ice guidel ines for ur inary tract infect ion

160. A 10 year old male was admitted for fever and seizures. History revealedhe had 3 days fever with productive cough, headache and yellowishnasal discharge. Few hours PTA he developed generalized tonicseizures for 15 minutes followed by loss of consciousness. Onadmission he was febrile with violaceous, purpuric rashes on the trunk,positive kernigs, hyperactive reflexes and glascow coma scale of 6. Themost probable diagnosis is

a. Fungal meningitisb. Meningococcemia

c. dengue encephalitisd. Tuberculous meningitis

Referenc e: Nelson Textbo ok o f Pediatr ics, 17ed. Part XVI, p. 896-897

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

a. thiamineb. riboflacin

c. pyridoxined. niacin

Referenc e: Nelson textb oo k of pediatr ics, 17thed. p. 182

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

a. Complete blood countb. Urinalysisc. Erythrocyte sedimentation rated. Blood culture

(Comprehension)Answer: DThe cr i t ical informat ion for appropr iate treatment ofinfect ive endo cardi t is is obtained from bloo d cul tu res.

p.1566 Nelson 17thed.

163. 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. Theinfants Apgar score is :

a. 7b. 8c. 9

d. 10


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(Comprehension)An swer: C - Pulse rate 2

Body pink 1

Extremities

Cyanot ic

Muscle tone, goo d 2Strong cry 2

Grimace 2

9

p. 628 Nelson 17thed.

164. Which one is most often fractured in difficult deliveries?

a. Clavicle

b. Radius

c. Humerusd. Femur

(Recall)Answer : A The clavic le is fractured dur ing labor and del iverymo re frequen tly than any oth er bon e. p. 572 Nelson 17thed

165. Hemorrhagic disease of the newborn is effectively prevented by which oneof the following?

a. Platelet transfusionb. Heparin administrationc. Injection of anti-D globulin (RhoGAM) in the motherd. Injection of 1 mg vitamin K at birth

(Comprehension)Answ er: DIntramu scular inject ion of 1 mg of vi tamin K at thet ime of b ir th prevents the decrease of vi tamin K dependentfactors in ful l- term infant s. p. 606 Nelson 17thed

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

a. Find the dog and observe it.b. Begin rabies hyper immune globulin.

c. Vaccinate the child with duck embryo vaccine.d. Give both immune globulin and vaccine.

(Analysis)Answer : B Loc al wound care is designed to remove or ki l lthe virus by mechanical and virucidal act ion. Passive

immu nization w ith hum an rabies immu nog lobul in (HRIG) then

provid es intermediate blockage of attachment of vi rus to the

nerve endin gs. p. 1104 Nelson 17thed.


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167. The most common caused of blood-stained stool in an otherwise normalinfant is:

a. Anal fissure

b. Ulceritis colitis

c. Intussusceptiond. Meckels diverticulum

(Comprehension)Answ er: A- Anal f issure is a smal l lacerat ion of the

muc ocutaneou s junct ion o f the arms. It is an acquired lesion

secondary to the forceful passage of a hard star t , mainly seen

in infancy . p.1288 Nelson 17thed

168. The clinical manifestation that differentiates marasmus from kwashiorkoris :

a. irriitabilityb. loose subcutaneous tissuec. edema

d. failure to gain weight

(Comprehension)Answ er: CMarasmus is a non edematous protein energymalnutr i t ion w hi le kwashiorkor is edematous p rotein energy

malnutr i t ion. Bot h p resent w i th ir r i tabi l i ty , fai lure to gain

weight and loose subc utaneous tissue. p. 172 Nelson 17thed.

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

a. 6 months of ageb. 12 months of agec. 18 months of age

d. 24 months of age

(Recall)Answ er: CThe average t ime o f closu re of th e anter iorfon tanel is 18 month s. p. 1974 Nelson 17thed.

170. Which are the first permanent teeth to erupt?

a. Central incisorsb. Lateral incisorsc. Canine ( maxillary)d. First molars

(Recall)Answ er: DThe f i rst 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 ageC. Canine (maxillary) erupt between 11 12 years of age.

p. 1205 Table 288-1 Nelson 17thed .


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

a. Respiratory syncytial virus

b. Influenza virusc. Streptococcus pneumonia

d. Hemophilus influenza B

(Recall)Answer : A Acute Bron chiol i t is is predominant ly a viraldisease. Respiratory sy nc ytial virus (RSV) is respon sible for

mo re than 50% of cases. p. 1415 Nelson 17thed

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

a. Empyemab. Chylothoraxc. Pneumothorax

d. Staphylococcal pneumonia

(Analysis)Answ er: CThe onset of pneumothorax is usu al ly abrup t, andthe sever i ty of symptoms depend o n the extent of the lung

col lapse and in th e amoun t of p re-exist ing lung disease.

Pneumoth orax may cause pain, dyspepsia and cyanosis.

Usual ly, there is respiratory d istress, retractions, and

markedly decreased breath sou nds o n the involve lung .

p.1464 Nelson 17thed

Empyema and chylothrax are not sudden in onset, andstaphylococcal pneumonia is not likely in adolescents.

173. A 3yearold presents with strider and a barking cough. There is mildrespiratory distress, tachypnea, respiratory strider, and a temperature of39 C. The most likely diagnosis is:

a. laryngotracheobronchitis

b. epiglottitisc. bacterial tracheitisd. retropharyngeal abscess

(Analysis)Answer : A Most p at ients h ave an u pper respiratory tractinfect ion with som e combin at ion of rhino rhea, pharyngi t is ,

mild c oug h, and low -grade fever ( 3940 C) for 1 to 3 daysbefore the signs and symp toms of upp er airway obstru ct ion

become apparent. The child then develops the characteristic barking cou gh , ho arseness, and inspiratory str idor .p.1405 Nelson 17thed

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

a. Meningococcemiab. Postotreptococcal glumerulonephritisc. Henoch-Schonlein purpura (HSP)

d. Wegners granulomatosis


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( Analysis)Answ er: CHSP, also kn ow n as Anaph ylactoid purp ura, is avarcul i t is of th e smal l vwss els. Low -grade fever and fat igue

occu r in m ore than hal f of th e affected ch i ldren. The hal lmark

of the disease is the rash, beginning as pink ish

maculop apules that ini t ial ly blanch or p ressure and prog ressto p etechiae or pu rpura. Renal involvement is m ani fested by

red blood cel ls, wh i te blood cel ls, casts or albumin in the ur ine

pp . 826827 Nelson 17thed.

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

a. lupus nephritisb. nephritic syndrome

c. Postreptococcal glomerulonephritisd. Berger disease

(Analysis)Answ er: CPostreptococc al glomerulon ephr i t is is the mo stcommon cause of hypocomplementeremic nephr i t is .

Depending on the sever i ty of renal involvement, pat ients m ay

develop var ious d egrees of edema, hyp ertension and ol igu r ia.


176. The triad of microangiopathic hemolytic anemia, renal failure andthrombocytopenia is characteristic of which of the following?

a. Membranous lupusnephritis.b. Focal glomerulonephritis secondary to septicemiac. hemolyticuremic syndrome

d. Acute poststeptococcal glomenulonghitis

(Comprehension)Answ er: Cthe hemolyt ic u remic synd rome (HUS) is the mo stcommon cause of acute renal fai lure in youn g chi ldren and is

character ized by microang iopathic h emolyt ic anemia,

thromboc ytopenia and uremia.


177. Which of the following is NOT true of nephrotic syndrome?

a. elevated serum cholesterolb. 85% experience minimal change in diseasec. reduced sodium reabsorption by the kidney

d. elevated triglycerides

(Comprehension)Answ er: CBecause of renal protein loss andhypo albuminemia, there is reduc ed intravascular volume. This

st imulates the rennin angiotensisn system, resul t ing inenhanced renal sodium reabsorp t ion. Eventual ly, the sodium

part ial ly con tr ibutes to the edema. The incidence of nephr i t ic

synd rome is 23 / 100, 000 chi ld ren p er year, and the most


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major i ty affected chi ldren wi l l have a steroid sensit ivemin imal change diseases..

In th e nephrit ic s tate, serum lip id levels ( Cho lesterol,

tr iglyc erides) are elevated.


178. The most common abdominal mass in a neonate is:

a. Renal dysplasiahydroneprhosis

b. Wilms tumorc. neuroblastomad. Meckless diverticulum

(Recall)Answer : A Renal masses are the most common lesions inneonates with an abdominal mass. Hydroneph rosis and mu lt i

cyst ic dysp last ic lesions are the most common renalmasses.p. 1784 Nelson 17thed.

179. Partial complex seizures is typically characterized as :

a. Simple staring that last for 30 mins. or moreb. Absence of impaired consciousnessc. Automatism like chewing, facial grimace or repetition

speech

d. Seizures describe as generalized clinic movements.

(Comprehension)Answ er: CAutom atisms are commo n feature of complexpartial seizures in infants and c hi ldren ch aracterized by

al imentary automatisms includin g l ip smacking, chewing,

swal lowing and excessive salivat ion. CPS may begin w ith a

simple part ial seizure with or w ithout an aura, fol lowed by

impaired con ciousn ess. The seizure are tonic-c lonic and the

average du ration is 12 min.pp . 19951996 Nelson 17thed.

180. A 5- year-old female has multiple bruises on her lower extremities and oralmucosal bleeding of 3 days duration. Two weeks before these signs,she had a mild respiratory tract infection. Physical examination revealsmultiple ecchymoses and petichaie: no lymphadenopathy orhepatosplenomegaly is noted. The next diagnostic step is:

a. a complete blood count

b. a prothrombin timec. a bleeding timed. a partial thromboplastin time

(Analysis)Answer : A A complete blood coun t (CBC) reveals ahemog lobin value of 12 g/dl , a wh i te blood cel l (WBC) cou nt of

11,000 and a platelet coun t of 5,000



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181. Which is not a frequent presenting symptoms or sign of childhoodleukemia?

a. pallorb. petechiae

c. lymphadenopathyd. abdominal pain

(Comprehension)Answ er: DMost chi ldren w ith leukemia present w i th lessthan 4 weeks of symp toms. Most chi ldren with ALL h ave

pallor, 50% have petech iae, 60% have lymphadenop ahty, 25%

have fever, and about 25% have bon e pain and arthralgias

caused by leukemia inf i l t rat ion of the per ichondral bon e or

jo in t o r by leu kem ic ex pan s ion of the mar row cav ity .

pp . 16941698 Nelson 17thed.

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