University of the East RAMON MAGSAYSAY MAGSAYSAY MEMORIAL MEDICAL ME DICAL CENTER Aurora Boulevar! "ue#on City DE$ARTMENT DE$ARTMENT O% $EDIATRICS $EDIATRICS "UESTIONS AND ANS&ERS %OR MEDICAL BOARD RE'IE& %EBRUARY ())*
C+OOSE T+E BEST ANS&ER, - A ne./orn %T .as note to /e 0ale at 1th 2onth of life3 Iron is unli4ely in this 5onition /e5ause /e5ause infants have suffi5ient stores to 2eet their iron re6uire2ent for, A3 (78 2onths B3 19 2onths C3 :7; 2onths D3 -)7-( 2onths (Problem Solving) - GIT B – It is by 6 months that iron should be supplemented among healthy full terms (!elson"s Te#tboo$ of Pediatri%s& ' th ed& **+& p ',6) ( The /reastfe /a/y /a/y of a 0ure ve
De2entia C3 Osteo2ala5ia D3 Ane2ia (Problem Solving) - GIT - Stri%t .egan diets %ontain no eggs& meat or mil$ produ%ts ma$ing this defi%ient in .itamin B ' (/hap ++6 p '6') !ursing !ursing .egan .egan mothers mothers must be given B' to prevent prevent 0ethylmal 0ethylmaloni% oni% a%ademia a%ademia and anemia anemia in in their infants ('66) (1) 2erophthalmia 2erophthalmia is .itamin .itamin 1 defi%ien%y and for 3hi%h .itamin .itamin 1 ri%h sour%es are the vegetables vegetables (B) iarrhea iarrhea and dement dementia ia are are signs signs of nia%in nia%in defi%ie defi%ien%y n%y (Pell (Pellagra) agra) B vitam vitamins ins %ome %ome from from grains grains and vegetables (/) 4steomala%ia is .itamin .itamin defi%ien%y (5i%$ets) (!elson"s Te#tboo$ of Pediatri%s& ' th ed& **+& /hap ++6 Table ++-I) 8 By 9th 2onth of a
*3 A 87hour ol ne./orn .ith a 0renatal history of 2aternal hyra2nios .as note to have frothin< of 2outh an nose .ith 5ir5u2oral 5yanosis3 You You anti5i0ate that, A3 There is ina/ility to 0ass the naso**) 93 &hi5h of the 2i5ronutrients oes not have re5o have roles in the immune immune system (!elson"s Te#tboo$ of Pediatri%s& ' th ed& **+& /hapter ++) :3 A -7-( year ol is is5overe to have a /ottle of al4ali solution in his 2outh3 The /ottle .as note to /e half e20ty3 No eternal si*;) ;3 A 8 year ol a55ientally a55ientally in*;') 3 The &+O re5o22ens the use of ORS in evelo0in< 5ountries to have a soiu2 5on5entration of 22olL, A3 ) B3 -)) C3 --) D3 -() (5e%all) - GIT 1 - A* mmol:l 1bove A* is hyperosmolar (!elson"s Te#tboo$ Te#tboo$ of Pediatri%s& Pediatri%s & ' th ed& **+& p ,*) -)3 A 87.ee4 ol .ith essentially nor2al /irth history ha e0isoes of inter2ittent vo2itin< after feein<3 If 0ylori5 stenosis is /ein< 5onsiere! 5onsiere ! you e0e5t the follo.in< E=CE$T, A3 +y0o5hlore2i5 al4alosis B3 Bilous vo2itin< C3 Gastri5 0eristalti5 .ave D3 Olive7sha0e Oli ve7sha0e RU" 2ass in a/o2inal 0al0ation (Problem Solving) - GIT / - The hallmar$ of gastri% obstru%tion is non-bilious vomiting (!elson"s Te#tboo$ Te#tboo$ of Pediatri%s& ' th ed& **+& /hapter >'*)
--3 A one ay ol ha /ilous vo2itin<3 +e .as note to /e sli>) hen the obstru%tion is in the duodenum beyond the 1mpula of .ater – vomitus is bilous The 1mpulla of .ater is the site 3here bile e#its -(3 A (7year ol .ith hea trau2a uner.ent a neurosur'6') Gastri% hyperse%retion is asso%iated 3ith head trauma and severe /!S disorders (1) /urling"s ul%ers are asso%iated 3ith severe burns (B) The %ourse is too a%ute for ? pylori infe%tion -83 An -- year ol Tanner sta+) -13 A ( year ol 0reviously .ell 5hil ha inter2ittent 5ryin< e0isoes an 0roFe5tile vo2itin< -( hours a;) -93 $rolon
(!elson"s Te#tboo$ of Pediatri%s& ' th ed& **+) -:3 The CBC of a :7yer ol 2ale .ith e0istais an e55hy2oses reveale +AF of neonatal malignan%ies 0i#ed
embryonal neoplasm %omposing of three elements (/hoi%e B) pertains to ilm"s tumor eu$oria (/hoi%e /) is the %hara%teristi% %lini%al presentation of retinoblastoma iagnosis does not reuire a biopsy (/hoi%e ) in retinoblastoma sin%e %hara%teristi% ophthalmologi% findings are suffi%ient (!elson"s Te#tboo$ of Pediatri%s& ' th ed& **+& /hap +A*) ((3 A2on< the follo.in< tu2ors! the one .ith the /est over7all survival rate is, A3 &il2s tu2or B3 Non7+o<4ins ly20ho2a C3 +e0ato/lasto2a D3 Neuro/lasto2a (Problem Solving) – ?ema:4n%o 1 - Prognosis of neuroblastoma is generally good Survival in lo3 ris$ group is A'-'**F7 average group ,-A;F Stage +S %arries '**F survival 3ith supportive %are only be%ause the tumor regresses spontaneously ilm"s tumor (/hoi%e 1) prognosti% fa%tors are tumor siCe& stage and histology 0ore than 6*F of patients 3ith all stages generally survive !on?odg$in"s lymphoma (/hoi%e B) is %onsidered disseminated disease from the time of diagnosis ?epatoblastoma (/hoi%e /) if unrese%ted %arries survival rate of 6*F (!elson"s Te#tboo$ of Pediatri%s& ' th ed& **+& /hap +A') (83 &hi5h of the follo.in< 0atterns note on 5ontinuous 2onitorin< of fetal heart rate is 2ost ini5ative of fetal istress? A3 Baseline varia/ility .ith 0erioi5 a55eleration B3 In5reasin< /aseline varia/ility C3 Early e5eleration .ithout /aseline varia/ility D3 Late e5eleration .ithout /aseline varia/ility (Problem Solving) - !eonatology - Baseline variability 3ith or 3ithout periodi% a%%eleration of the heart rate is a sign of fetal 3ellbeing In%reasing baseline variability may represent early %ompromise of fetal o#ygenation The early de%eleration pattern is due to pressure of the anterior fontanelle on the %ervi# and is not a sign of fetal distress The variable de%eleration pattern indi%ates umbili%al %ord %ompression The late de%eleration pattern signifies fetal hypo#emia (Behrman& ed '>& p >6;) (13 A healthy 0re2ature infant .ho .ei& pp '6-'6>) (*3 An infant .ei& p >6>) (93 Initial ea2ination of a full te2 infant .ei& pp 6+-66 '>6-'>)
(:3 O/Fe5t 0er2anen5e is not 0resent in a ( 2onths ol! .hose res0onse to ro00in< a /all is, A3 Starin< es5enin< as the /all es5ens B3 Eyes es5enin< as the /all hits the & /hapter ''& !elson Te#tboo$ of Pediatri%s& ', th ed) 8)3 A evelo02entally nor2al 5hil .ho is Fust a/le to sit .ithout su00ort! transfero/Fe5ts fro2 han to han! an s0ea4 in a 2onosylla/i5 /a//le is 0ro/a/ly .hat a& /hap '') 8-3 This 0ri2itive refle is o/serve in a nor2al one year ol, A3 Toni5 ne54 refle B3 $ara5hute refle C3 $al2ar
1 - <#%ept for 1& all the rest are %ompatible of the history& presenting 3ith the %lini%al manifestations of at least 3ee$s (!elson"s Te#tboo$ of Pediatri%s& ' th ed& **+& pp A6, 7 *+*-++)
813 A 2other 5alls to infor2 you that her 0reviously .ell 17year ol 5hil has /een 5o20lainin< of heaa5hes for a/out a 2onth3 %or the 0ast t.o .ee4s he has /een 4ee0in< his han in a tilte 0osition! an for the 0ast fe. ays he has /een vo2itin< in the 2ornin<3 The 2ost li4ely ia& *A& *>;& *+) 8*3 Clini5al evien5e /a54s u0 the use of I' ea2ethasone as an aFun5tive thera0y in a5ute 2enin) 893 A -(7year ol 5hil is a2itte /e5ause of the suen onset of 5o2a3 The 5hil ha /een .ell until a/out 9 hours 0rior to a2ission! .hen he /e6& ,6) 8:3 The 2eta0hyseal ens of lon< /ones are 5o22on sites of osteo2yelitis3 This 5onition o55urs /e5ause, A3 Relative anoia 0ro2otes /a5terial
draining
into the marro3 Blood flo3 in this area is sluggish and provides an ideal environment for ba%terial seeding (!elson"s Te#tboo$ of Pediatri%s& ' th ed& **+& pp A-A;)
8;3 It is the 2ost 5o22on 0ri2ary 2ali
1(3 $ainless s2all erythe2atous or he2orrha
(5e%all) - /ardiovas%ular B - Hane3ay lesion are painless small erythematous or hemorrhagi% lesions on the palms and soles (1) 4sler nodes are tender pea-siCed intradermal nodule in the pads of the fingers and toes These lesions may represent vas%ulitis produ%ed by %ir%ulating antigen antibody %omple#es (/ ) Sphin%ter hemorrhages are linear lesions beneath the nodes () 5oth spots – immune %omple# phenomena and seen in the eyes (!elson"s Te#tboo$ of Pediatri%s& ' th ed& **+) 183 Neonatal 5ir5ulation is NOT 5hara5teri#e /y, A3 In the 0resen5e of 5ario0ul2onary isease $DA 2ay re2ain 0atent B3 %ora2en ovale 2ay 0ersistently /e fun5tional C3 The .all thi54ens an 2us5le 2ass of the neonatal LJ an R J ventri5les are al2ost e6ual D3 The 0ul2onary vas5ulature is insensitive to 5hanrd months of life (/ ) the 3all thi%$ness and mus%le mass of the ventri%les right and left are almost eual ithout the pla%enta& and the %losure of the du%tus venosus& the left ventri%le is no3 %oupled to the high resistan%e systemi% %ir%ulation 3hereas the right ventri%le is no3 %oupled 3ith the lo3 resistan%e pulmonary %ir%ulation and the 3all is slightly thi%$ened as 3ell (!elson"s Te#tboo$ of Pediatri%s& ' th ed& **+) 113 The 5lini5al 2anifestation of lar
193 A 87year ol /oy .as a2itte to the ER /e5ause of iffi5ulty of /reathin<3 +istory reveale that he evelo0e hi days before the appearan%e of the signs and symptoms of upper air3ay obstru%tion It starts 3ith bar$ingJ %ough &hoarseness and inspiratory stridor 3hi%h %hara%teristi%ally be%oming 3orse at night and often re%urring 3ith de%reasing intensity for several days and %ompletely resolves 3ith in a 3ee$ () 1%ute ba%terial tra%hietis this entity is a form of ba%terial infe%tion of the upper air3ay and does not involve the epiglottis It is %apable of %ausing life threatening air3ay obstru%tion It is freuently %aused by staphylo%o%%us aureus and other organisms li$e 0ora#ella %atarrhalis& nontypable ? InfluenCae and anaerobi% organisms have been impli%ated It freuently o%%urs in %hildren younger than > years of age 1 patient seen at the pediatri% 4P %lini% be%ause of prolonged harsh bar$yJ %ough that lingered behind after a bout of viral infe%tion not responsive to treatment ie bron%hodilators and mu%olyti%s and disappears 3hen the patient is asleep (!elson"s Te#tboo$ of Pediatri%s& ' th ed& **+) 1:3 The 2e5hanis2 of hy0oia in 0ul2onary ee2a is, A3 '" 2is2at5h B3 +y0oventilation C3 Diffusion i20air2ent D3 R7L shunt (Problem Solving) - 5espiratory / - diffusion impairment In pulmonary edema there is fluid that a%ts as a barrier bet3een the alveolo-%apillary membrane 3hi%h in%reases the travel time of the 4 from the alveoli to the %apillary thus hindering the diffusion of the gas through the membrane and subseuently lo3ers the4 levels in the %ir%ulation .:L mismat%h as a %ause of hypo#emia o%%urs in t3o stagesM . ventilation 3hen there 3ill be less 4 delivered to the alveoli due to airflo3 obstru%tion as it happens in pneumonia L (perfusion) hypo#emia o%%urs despite adeuate o#ygenation if the %ir%ulation is blo%$ed as in pulmonary embolism ?ypoventilation – %ould %ause lo3 4 level due to de%reased amount of 4 delivered in to the alveoli due to %entral %auses – (/!S depression or infe%tion) or due to lo3 levels of 4 in the atmosphere due to high altitude 5- shunt this happens parti%ularly in patient 3ith %ardia% shunts 3here a high per%entage of the %ardia% output returns to the general %ir%ulation 3ithout passing through the lungs 4r this %an o%%ur in %ases of intrapulmonary shunts as 3ell (!elson"s Te#tboo$ of Pediatri%s& ' th ed& **+) 1;3 The 5o22on infe5tious 5auses of /ron5hie5tasis isare, A3 $ertussis B3 le/siella 0neu2oniae C3 Stre0toto55us 0neu2oniae D3 +3 influen#ae (5e%all) - 5espiratory 1 - Pertussis Infe%tions due to Bordatella pertussis& measles& rubella& togavirus& respiratory syn%ytial virus and 0y%oba%terium tuber%ulosis indu%e %hroni% inflammation& progressive bron%hial 3all damage and dilatation of the bron%hial tree The %ommon thread in the pathogenesis of bron%hie%tasis is diffi%ulty %learing se%retions and re%urrent infe%tions
(!elson"s Te#tboo$ of Pediatri%s& ' th ed& **+) 13 The 0atholo*F means that air3ays are still unstable and asthma is not 3ell %ontrolled and the patient belongs to the mild persistent asthma %ategory (!elson"s Te#tboo$ of Pediatri%s& ' th ed& **+) *-3 An ;7year ol 0resents .ith snee#in& pp ;'-;) *83 A 5hil has a/o2inal 0ain! arthritis! 2i5ros5o0i5 he2a turia! an a 0ur0uri5 rash only on the lo.er etre2ities3 &hi5h of the follo.in< is the 2ost li4ely ia
B3 'ari5ella C3 +eno5h7S5honlein vas5ulitis D3 $ost stre0to5o55al
*13 A (7ay ol neonate .ith vo2itin< of /ilous 2aterial sin5e /irth .as /rou>-'>+) **3 A (17hour ol neonate is /rou-'+') *93 A :7ay ol )) ) *;3 &hi5h of the follo.in< 5hest raio-,;+) 9)3 A 4ey 0rei5tor for eath or /rain a2a
(5e%all) - !eonatology B - (!elson"s Te#tboo$ of Pediatri%s& ' th ed& **+& pp ,6) 9-3 In a ne./orn sus0e5te of havin< 5hoanal atresia! res0iratory istress 2ay /e relieve /y, A3 O0enin< the 2outh B3 Intu/ation C3 Ba< an 2as4 ventilation D3 A2inisterin< O( (Problem Solving) - !eonatology 1 - (!elson"s Te#tboo$ of Pediatri%s& ' th ed& **+& pp '>;) 9(3 The 2ost 5o22on 5lini5al 2anifestation of $ersistent $ul2onary +y0ertension is, A3 Res0iratory istress B3 $allor C3 Cyanosis D3 A0nea (5e%all) - !eonatology / - (!elson"s Te#tboo$ of Pediatri%s& ' th ed& **+& pp ,;,) 983 &hi5h of the follo.in< state2ents re+-'>A) 993 A 72onth ol fe2ale .as /rou+-'>A) 9:3 &hi5h of the follo.in< is TRUE of 5anial infe5tion? A3 Dia0er er2atitis is the 2ost 5o22on infe5tion 5ause /y 5ania B3 &ith i20rove survival of very LB& infants! 5anie2ia has /e5o2e less fre6uent n NICUs C3 %lu5ona#ole is the ru< of 5hoi5e for the treat2ent of syste2i5 5ani5iasis D3 Most 5ases of 5anie2ia is I22uno5o20ro2ise 0atients are ue to non75ania al/i5ans s003 (Problem Solving) – Infe%tious iseases 1 - (!elson"s Te#tboo$ of Pediatri%s& ' th ed& **+& pp '*'-'*'>) 9;3 &hi5h of the follo.in< state2ents is NOT TRUE of A2e/iasis? A3 The infe5tive sta
C3 A 5arrier of E3 histolyti5a 5ysts shoul /e treate D3 It is the 2ost 5o22on 5ause of /looy stools (5e%all) – Infe%tious iseases - (5ef !elson"s Te#tboo$ of Pediatri%s& ' th ed& **+& pp ''>-'',) 93 &hi5h of the follo.in< iseases has the
/ - ?ypoalbuminemia& proteinuria& edema and hyperlipidemia %onstitute the nephroti% syndrome ?ypertension& aCotemia& edema or hematuria 3ould suggest nephritis but may also be en%ountered in minimal lesion nephroti% syndrome This patient has nephroti% syndrome& not nephritis (!elson"s Te#tboo$ of Pediatri%s& 'thed& **+&pp '+*-'+6 7 ',>-',) :93 The re5o22ene a
B3 A5ute leu4e2ia C3 +I' infe5tion D3 =7lin4e hy0o-6 months 3ith the highest mortality rate in %hildren O' year of age (!elson"s Te#tboo$ of Pediatri%s& ' th ed& **+& pp '''-'''>) ;(3 In our 5ountry! the first ose of live attenuate 2easles va55ine shoul /e a2inistere, A3 at 1 2onths of a
- In our %ountry& gram (-) organisms are the most %ommon %auses of neonatal ba%terial sepsis (M') %ompared 3ith the gram positive organisms The gram negative enteri% ba%illi li$e < %oli are the more %ommon %ausative agents Pseudomonas aerugenosa& a gram negative ba%illi& is a %ommon noso%omial pathogen (Te#tboo$ of Pediatri%s and /hild ?ealth& el 0undo& =e et al (eds) +th ed& ***& p 6,) ;13 The first 5lini5al 2anifestation of tetanus neonatoru2 usually is, A3 %ever B3 'o2itin< C3 S0as2s D3 Diffi5ulty su54in< an s.allo.in< (5e%all) - Infe%tious iseases - !eonatal tetanus is generaliCed in type and starts a s progressive diffi%ulty in su%$ing and irritability (Te#tboo$ of Pediatri%s and /hild ?ealth& el 0undo& =e& et al (eds)& +th ed& ***& p +6A) ;*3 The usual 5ourse of 0ertussis in an infant is 5hara5teri#e /y, A3 1 * ays of hi
B3 hy0ersensitivity rea5tion C3 i22une enhan5e2ent D3 aheren5e of the viruses to the enothelial 5ells (5e%all) - Infe%tious iseases / - (Te#tboo$ of Pediatri%s E /hild ?ealth& el 0undo& et al (eds)& + th ed& ***& p ,6') -3 In a 5ase of D+% Grae 8J .ho is /leein< 0rofusely! .hi5h of the follo.in< fluis all availa/leJ .oul you =72at5he fresh .hole /loo B3 0ro0erly ty0e > =72at5he fresh 0las2a C3 D*LRS D3 D*NSS (Problem Solving) - Infe%tious iseases 1 - (Te#tboo$ of Pediatri%s E /hild ?ealth& el 0undo& et al (eds)& + th ed& ***& p ,6A - ,')
(3 The follo.in< CS% analysis results are 5o20ati/le .ith .hi5h of the follo.in< 5lini5al entities? CS% Results, O0enin< 0ressure K 8)) 22 +(O &BC K (9 se
C3 not stunte! 2illy .aste D3 Milly stunte! 2illy .aste (Problem Solving) - !eurodev 1 - (Te#tboo$ of Pediatri%s E /hild ?ealth& el 0undo& et al (eds)& + th ed& ***& pp ;-;*) :3 The hea 5ir5u2feren5e of Mario is, A3 nor2al B3 /elo. nor2al C3 a/ove nor2al D3 variation of nor2al (Problem Solving) – !eurodev 1 - (Te#tboo$ of Pediatri%s E /hild ?ealth& el 0undo& et al (eds)& + th ed& ***& p ;*)
;3 Base on evelo02ental s5reenin-'') 3 The a00roi2ate evelo02ental a-'') -))3 At ( years of a
University of the East RAMON MAGSAYSAY MEMORIAL MEDICAL CENTER Aurora Boulevar! "ue#on City DE$ARTMENT O% $EDIATRICS "UESTIONS AND ANS&ERS %OR MEDICAL BOARD RE'IE& %EBRUARY ())*
To0i5s
GIT Hema/Onco Neonatology Neurology Muculo!eletal "ar#$o%acular &e'$ratory Immuno/llergo In*ect$ou Ne'+ro Neuro#e% TOTAL
No3 of "uestions 15 7 19 6 4 5 5 3 27 4 5 -))
$ro/le2 Solvin< 11 5 16 5 3 3 3 3 13 2 4 9;
Re5all
4 2 3 1 1 2 2 ) 14 2 1 8(
