PEDIA2 FINALS Rationale Complete

PEDIATRICS 2
FINALS
All Exams Compilation | SY: 2021-2022
PEDIATRICS 2 EXAM BANK
Exam- Subject Date of Exam

FIRST SEMESTER| AY: 2021-2022
Long Exam 1 Pedia-2 All Sections
Sept. 1, 2021
(Viral Infections)
Long Exam 2.1 Pedia-2 All Sections
Sept. 24, 2021
(Neonatology Part 1)
Long Exam 2.2 Pedia-2 All Sections
Sept. 24, 2021
(Neonatology Part 2)
Oct. 19, 2021
(Bacterial Infections)
Nov. 10, 2021
(Connective Tissue Disorders)
Long Exam 5 (FtoF Exam)
Pedia-2 All Sections Nov. 22, 2021
(Allergy/ Immuno- Dr. Nery)
Pedia-2 All Sections Dec. 1, 2021
(Burns & Accidents- Dr. Gallo)
Pedia-2 All Sections Dec. 1, 2021
(Pulmonology- Dr. Angos)
1st Semestral Exam Pedia
Feb. 2, 2022
(All first semester topics)
SECOND SEMESTER| AY: 2021-2022

Feb. 9, 2022
(Fluid & Electrolytes- Dr. Angos)
Feb. 9, 2022
Growth Dev’t- Dr. Cabahug)
Long Exam 10 (FtoF Exam) Pedia-2 All Sections
Feb. 16, 2022
(Adol. Pediatrics- Dr. Manguilimotan)
Feb. 23, 2022
(Endocrine- Dr. Uy)
March 23, 2022
(Pedia Emerg-Dr. Manguilimotan)
March 30, 2022
(Resp. Disorders-Dr. Yu)
April 11, 2022
(GIT- Dr. Lopez)
April 27, 2022
(Hema Onco-Dr. Lucero)
Long Exam 16.1 (FtoF Exam) Pedia-2 Sec ACE
May 11, 2022
(Neuro- Dr. Bael)
Long Exam 16.2 (FtoF Exam) Pedia-2 Sec BDF
May 11, 2022
(Neuro- Dr. De La Calzada)
May 19, 2022
(Nephro)
May 19, 2022
(Cardio/ Child Abuse)
2nd Semestral Exam (FtoF Exam) Pedia-2 All Sections
May 18, 2022
(Ped Emerg, Respi, GIT, Hema, Neuro, Nephro, Genetics)
PEDIATRICS-2
1ST SEMESTER
SHIFTING EXAM 1
VIRAL INFECTIONS
1. Which of the following best describes appropriate

administration of beta 2 agonists in pediatric patients in this
time of CORONA virus 19 pandemic:
A. The use of beta 2 agonists like salbutamol is not
advised at all
B. Nebulization should be avoided because the risk of
infection transmission via droplet nuclei or aerosols
may increase during nebulizer treatments, so MDI is
used
C. Use of nebulizer is allowed if used by adolescents 5. A 6 month old /male had preceding symptoms of common
since they can be left alone in a room cold and developed respiratory distress. You observed harsh,
D. Use of a metered dose inhaler (MDI) is not brassy cough & inspiratory stridor. Neck AP radiograph
appropriate for children so beta 2 agonists are still revealed subglottic narrowing. Your primary diagnosis is:
given via nebulizer A. Epiglottitis
B. Laryngotracheobronchitis
ANSWER: B. Nebulization should be avoided because the risk C. Bacterial tracheitis
of infection transmission via droplet nuclei or aerosols may D. Foreign body aspiration
increase during nebulizer treatments, so MDI is used
ANSWER: B. Laryngotracheobronchitis
2. In RSV infection among preterm infants, which of the

following signs is frequently noted? 6.Which of the following finding is seen during critical phase of
A. Apnea dengue?
B. Audible wheeze A. Hemoconcentration
C. Fever B. Leukocytosis
D. Chest indrawing C. Thrombocytosis
D. Lymphopenia
ANSWER: A. Apnea
ANSWER: A. Hemoconcentration
7.A child with sickle cell anemia presents with fever, malaise,
palpitations & dyspnea with a mild transient erythematous
rash. CBC showed very low RBC count, severe anemia and
low hemoglobin. Which viral agent can cause this?
A. CMV
B. HHV-8
3. Variation in antigenic composition of influenza virus surface C. HHV-6
proteins occurs almost yearly, for this reason, the formulation D. B19V
of the influenza vaccine is reviewed each year and updated as
needed. Minor changes within a subtype continually occur ANSWER: D
through point mutations during viral replication, particularly in Source: Excelsus Trans: Herpes Virus by Dr. Fajardo - p.1;
the HA gene, and result in new influenza strains of the same Nelson Chap 278
HA type. This phenomenon is termed as:
A. Antigenic shift 8.What is the best treatment for Oliver’s case?
B. Gene reassortment A. Rabies vaccination + Rabies Immunoglobulin
C. Antigenic drift B. Rabies vaccination only
D. Antigen skipped mutation C. Rabies Immunoglobulin
D. None of the above since this is a cat bite
ANSWER: C. Antigenic drift
ANSWER: B. Rabies vaccination only
Ratio:
Source: Viral Infections: Influenza Viruses (Vanessa M.

Fajardo) Excelsus trans page 1
4. On PE Dawn had confluent erythematous maculopapular

rash on the face & trunk. There was no conjunctival erythema
nor oral ulcers at the time of examination. After a week she
came back to you for follow up & you noted resolution of rash
on the face & trunk but w/ branny desquamation over the
extremities. The final diagnosis is/are:
A. Staphylococcal scalded skin syndrome
B. Rubella infection 9. A 4 yo/F developed distinct erythematous macules that
C. Stevens Johnson Syndrome started on the face and spreads down to the trunk, arms, and
D. Rubeola infection legs. After 3 to 4 days, the rash began to clear, leaving a
brownish discoloration and desquamation. Which of the
ANSWER: D. Rubeola Infection following vaccies did this patient probably miss?
|pg. 1
PEDIATRICS-2
1ST SEMESTER
SHIFTING EXAM 1
VIRAL INFECTIONS
A. Measles of for compassionate use. Informed consent must be obtained

B. Rubella prior to prescribed Remdesivir for pediatric COVID-19 patients.
C. varicella Source: COVID-19 in Children TRANS
D. Mumps
ANSWER: A. MEASLES 13. A 5 yo/F was brought to the ER for 5 days fever, abdominal
pain, vomiting & headache, diagnosed as having dengue. PE:
Wt = 35kg, BP 90/70, HR=110, conscious & coherent w/
positive tourniquet test & brisk CRT. What is your
hemodynamic assessment of this patient?
A. Stable circulation
B. Ongoing shock
C. Hypotensive shock
D. Compensated shock
ANSWER: A. Stable circulation

Ratio:
10. Pathognomonic sign of measles described as discrete red

lesions with bluish white spots in the center on the inner
aspects of the cheeks at the level of the premolars.
A. Koplik spots
B. Warthin-Finkeldey cells
C. Forchheimer spots
D. Nagayama spots
ANSWER: A. Koplik spots

Source: Measles, Rubella, Mumps, Varicella (MMRV) TRANS ,
(Vanessa Fajardo-Nery)
Source: Dengue trans page 8
14. A patient consults on his 5th day of fever. You suspect

dengue infection & took a dengue screening test. Results
showed negative NS1 antigen & positive to both dengue IgG &
IgM antibodies. Which of the following is the best interpretation
of the test result?
A. Dengue is ruled out since negative to NS1 Antigen.
B. A primary dengue infection is considered
C. This is a secondary dengue infection
D. Result suggest a past infection which is not relevant.
wrong because IgM is also positive
ANSWER:
11. The following are the laboratory findings seen in MIS-C Source: Due to positive IgG antibody
(multi inflammatory syndrome in children), EXCEPT:
A. Lymphopenia T 15. A 3 yo child exposed to his COVID positive father
B. elevated albumin developed acute diarrhea & abdominal pain. On PE has non
C. elevated C-reactive protein (CRP), erythrocyte purulent conjunctivitis, strawberry tongue, desquamation of tips
sedimentation rate (ESR) of fingers, morbilliform rash. Lab findings showed elevated
D. Neutrophilia ESR. What is the most likely diagnosis?
A. Kawasaki disease
ANSWER: B. Elevated Albumin B. Critical COVID
Ratio: Including but not limited to, one or more of the ff: an C. Multisytemic inflammatory syndrome in children
elevated C-reactive protein (CRP), erythrocyte sedimentation (MISC)
rate (ESR), fibrinogen, procalcitonin, d-dimer, ferritin, lactic D. Sepsis
acid dehydrogenase (LDH), or interleukin 6 (IL-6), elevated
neutrophils, reduced lymphocytes and low albumin. ANSWER: A. Kawasaki disease
Source: Covid-19 in children Trans
12. Which of the following best describes remdesivir use in

children:
A. Remdesivir has been available through

compassionate use to children with severe COVID-19
B. Informed consent is not needed prior to prescribing
Remdesivir for pediatric COVID-19 patients
C. It is recommended for mild, moderate, and critical
COVID-19
D. Remdesiviris given in the treatment of all pediatric
hospitalized patients regardless of supplemental
oxygen requirement
ANSWER: A.
Ratio: Recommendation: It may be used to treated pediatric
patients with severe COVID-19 disease in a clinical trial setting
|pg. 2
PEDIATRICS-2
1ST SEMESTER
SHIFTING EXAM 1
VIRAL INFECTIONS
Source: Nelson’s (Kawasaki Dse) page 1312

20. A 2 yo/M was brought in for anorexia and drooling. On PE
(+) vesicular oral lesions were noted & ulcers on the anterior
16. A newborn was seen at 1 wk old for follow up. Mom asked tonsillar pillars were seen. What is the most likely diagnosis?
you when is the earliest time the child can be administered with A. Herpangina
rotavirus vaccine. You will advise her to bring the child for B. Varicella
vaccination at what age? C. Measles
A. 10 weeks D. Mumps
B. 6 weekS
ANSWER: A
C. 4 weeks
Source: Nelson’s 20E Ch250, page 1565
D. 8 weeks
ANSWER: pedia plat pg 143. 21.Home treatment for mild symptomatic COVID 19 infected
children are as follows, EXCEPT:
17. An 8 mo old child presents with 3 days fever, erythematous A. Antipyretics such as paracetamol may be given to
pharynx, mild cervical lymphadenopathy, and diarrhea. She make the febrile child more comfortable
was given paracetamol for fever. On the 4th day of the illness, B. Provide balanced diet& proper nutrition
upon defervescence, and a generalized morbilliform rash C. steam inhalation
appears. The child appears normal on PE. The most likely D. Give adequate hydration
diagnosis is:
A. Drug reaction to paracetamol ANSWER: C
B. Rubella
C. HHV-6 infection
D. Measles
ANSWER: C. HHV-6 infection

Source: Nelson Textbook of Pediatrics - 20th Edition: chapter
256, page 1595
18. Which of the following features can differentiate viral

myositis from paralytic poliomyelitis?
A. Presence of residual paralysis in viral myositis
B. no history of recent URTI in v myositis
C. Hyperreflexia is seen in v myositis
D. Pseudoparalysis w/c progresses from hours to days
ANSWER: D. Pseudoparalysis w/c progresses from hours to Source: Viral Infections: Coronavirus Trans (Dr. Nery) page 6
days
19. A 14 yo male was seen at the ED due to scrotal pain. He 22. A 5 yo male child presented with fever, rhinorrhea & sore
was highly febrile & had findings of scrotal swelling. You throat with progression of symptoms within the week eventually
noticed that he has a bit of a facial asymmetry, w/ slight brought to ER for central cyanosis and dyspnea. O2 saturation
swelling of his left parotid area. Your patient most likely has: was noted to be at 90% at room air. What is his classification of
A. acute abdomen COVID illness according to severity?
B. Testicular torsion A. Severe infection
C. epididymo-orchitis B. Critical condition
D. incarcerated inguinal Hernia C. Moderate infection
D. Mild infection
ANSWER: C
Source : Pedia viral infections ppt of dr nerry page 6 ANSWER: A. Severe infection
Ratio: Severe Infection
- child with early respiratory symptoms (fever & cough)
may be accompanied by GIT symptoms (diarrhea)
- disease progresses after around 1 week, and
dyspnea occurs, with central cyanosis
- oxygen saturation is less than 92%, accompanied by
other manifestations of hypoxia
Source: Covid 19 in children - Insignis Notes
23.Which of the following is the standard treatment for MISC?

A. Broad spectrum antibiotic
B. Oral steroid
C. intravenous immunoglobulin (IVIg
|pg. 3
PEDIATRICS-2
1ST SEMESTER
SHIFTING EXAM 1
VIRAL INFECTIONS
D. Aspirin
ANSWER: B. Oral steroid
24.Which of the following is at present a vaccine preventable

disease?
A. Exanthem subitum
B. Rubella
C. Hand-Foot-Mouth Disease
D. Erythema infectiosum
ANSWER: B. Rubella
27.In your clinic, you noticed a 4 month old whose head

circumference is less than the 20th percentile, with absence of
visual threat on PE. She had history of seizures. The following
will be your differentials EXCEPT:
A. Congenital varicella syndrome
B. Congenital rubella syndrome
C. Congenital Hydrocephalus
D. Congenital CMV infection
ANSWER: C. Congenital Hydrocephalus
28.A mild illness, with or without low-grade fever w/ inflamed

oropharynx and contains scattered vesicles on the tongue,
buccal mucosa, w/ maculopapular, vesicular, and/or pustular
lesions may also occur on the hands and fingers, feet, and
25. The peak incidence of roseola is seen in which of the buttocks and groin:
following age groups? A. Hand-Foot-Mouth disease
A. Children 5-10 yr B. Herpangina
B. Newborns, in whom it is a congenital infection C. Varicella
C. Children 10-15 yr D. Rubella
D. Children 0-5 yr
ANSWER: A
ANSWER: D
Source: Nelson Textbook of Pediatrics 20th Ed (Ch.250

p.1564)
Source: Pediatrics 2 Herpes Virus Trans- Dr. Nery, pg 1

29. A measles epidemic was reported, a 6 month old child was
brought to the local health center for immunization. What is the
26. All of the following are characteristic manifestations of best advice that you can give?
congenital rubella syndrome EXCEPT: A. Give the measles vaccine as soon as possible
A. Snuffles B. No need to give measles vaccine, wait until the child
B. Cataracts is 9 months of age
C. Intrauterine growth retardation C. No need to give vaccine, a 6 month old still has
D. Structural cardiac defects maternal antibodies
D. Give 1st dose of measles vaccine now, then 2nd dose
ANSWER: C. Intrauterine growth retardation at 3-4 yo
Source: Nelson’s 21st Ed. Chapter 274. (Rubella). Page 1679
ANSWER: A. Give the measles vaccine as soon as possible
30. The following are the most common hematologic

abnormalities during dengue hemorrhagic fever and dengue
shock syndrome, EXCEPT:
A. hemoconcentration with an increase of < 20% in the
hematocrit
B. prolonged bleeding time
C. Thrombocytopenia
|pg. 4
PEDIATRICS-2
1ST SEMESTER
SHIFTING EXAM 1
VIRAL INFECTIONS
D. a moderately decreased prothrombin level (seldom < 36. The most common symptoms seen in COVID-19 infection
40% of control) in children:
A. dyspnea & tachypnea
ANSWER: D B. abdominal pain & vomiting
C. fever & cough
D. rhinorrhea & sore throat
ANSWER: C. Fever and cough
Source:
https://www.cdc.gov/coronavirus/2019-ncov/hcp/pediatric-hcp.h
31. The mom revealed that Kita had onset of runny nose & tml
cough a week ago. At present he still have occasional cough.
Which is/are the pathophysiologic mechanism(s) of her illness:
A. All of the above 37. A neurodegenerative disease caused by a slow rubeola
B. This is a secondary bacterial infection ? knsa mana si infection in the CNS w/ delayed onset several years after
Kita primary infection & has fatal outcome.
C. Foreign body obstructing the ear canal A. SSPE
D. Primary infection due to Eustachian tube obstruction B. PRP
C. GBS
ANSWER: A. All of the above
D. Bulbar paralysis
32.The following are CORRECT regarding Zinc
supplementation in children, EXCEPT: ANSWER: A
A. Zinc supplements given to zinc-deficient children Source: Trans- excelsus( Dr. Nery- MMRV) pg. 3
could reduce measles-related morbidity and mortality
caused by lower respiratory tract infections.
B. Zinc supplementation has a role in the early cure of 38. A global pandemic can result if an animal influenza A virus
pneumonia with a novel HA or NA enters a nonimmune human population
C. Zinc supplement may affect not only COVID-19- and acquires the capacity for sustained and efficient
related symptoms like diarrhea and lower respiratory transmission between people. This is possible due to which of
tract infection but also the SARS-CoV-2 virus itself. the following processes:
D. Zinc sufficiency results in dysfunction of both humoral A. Gene reassortment
and cell-mediated immunity and increases B. Antigenic drift
susceptibility to infectious diseases C. Antigen skipped mutation
D. Antigenic shift
ANSWER: D. Zinc sufficiency results in dysfunction of both
humoral and cell-mediated immunity and increases
ANSWER: Nelson - influenza viruses page 1727
susceptibility to infectious diseases
“Zinc sufficiency (insufficiency) results in dysfunction of both
humoral and cell-mediated immunity and increases
susceptibility to infectious diseases”
33. A 9-month-old/ F is brought to the clinic due to

maculopapular rash. Three days ago he had onset of high
grade fever w/ fussiness as the fever broke, rash erupted.
Which of the following is the most likely diagnosis for this
patient?
A. Roseola
B. Rubella
C. Erythema infectiosum
39. Contact” is defined by WHO as a person who has
D. Rubeola
experienced any one of the following exposures during the 2
days before and the 14 days after the onset of symptoms of a
probable or confirmed case:
A. Indirect physical contact with a confirmed case for
less than 5 minutes with mask &faceshield
B. Direct physical contact with a probable or confirmed
case
C. Indirect care for a patient with probable or confirmed
Source: Nelsons Page 1724 COVID-19 disease usingusing recommended
personal protective equipment
D. Face-to-face contact with a probable or confirmed
34. Dawn, a 6yo/F came in for consult due to 4 days fever & case beyond2 meters and for at least 5 minutes
rash. History revealed that she was seen at the local health
center & was given cotrimoxazole. On day 2 of medication she ANSWER: B
developed conjunctivitis & would not eat due to oral sores.
Morning PTC she developed a rash. What are your differential
diagnoses?
A. Rubeola infection
B. All of the above
C. Stevens Johnson Syndrome
D. Staphylococcal scalded skin syndrome
ANSWER: A
|pg. 5
PEDIATRICS-2
1ST SEMESTER
SHIFTING EXAM 1
VIRAL INFECTIONS
C. Category I
D. Category II
ANSWER: D. Category II
40. Which of the following statements concerning measles and

vitamin A is true?
A. Treatment with vitamin A reduces measles severity for
children in developing countries
B. Measles causes vitamin A deficiency
C. There is not a confirmed relationship of vitamin A to
the prognosis of measles
D. Vitamin A supplementation should be given to all
children with measles
ANSWER: C.
Ratio:
44. Kita is an 8 month old female who was brought to the OPD
due to high grade fever & incessant crying. On PE you noted
yellowish ear discharge on the right & erythematous tympanic
membrane on the left. What will be your diagnosis?
A. Eustachian tube dysfunction

B. Suppurative otitis media
C. mastoiditis
* D. foreign body in the ears
* All children diagnosed with measles should receive two
doses of vitamin A supplements, given 24 hours apart. - WHO ANSWER: B. Suppurative otitis media
2019
45. A neonate is born at 36 weeks. Pregnancy was
Source: Nelson Textbook of Pediatrics 19th Ed (Ch.238 complicated by intrauterine growth restriction. When examined
p.1073) you note that the infant has microcephaly, cataracts,
hepatomegaly, and petechiae. Possible etiologic agents may
41.Which of the following is TRUE with regards to Varicella include the following, EXCEPT:
vaccination schedule? A. Herpes simplex virus (HSV)
A. Can be given anytime to an unvaccinated woman who B. Cytomegalovirus (CMV)
plants to get pregnant in a month C. HHV-6
B. Dose # 1 at 12 -15 months D. Rubella
C. Dose # 2 at 6 years old
D. Dose #1 at 9 months ANSWER: C. HHV-6
Source: Nelson’s 21st Ed. Page 1724. Part XVI. Infectious
ANSWER: B Diseases.
Additional symptoms and signs include irritability, inflamed
tympanic membranes, rhinorrhea, and congestion,
gastrointestinal complaints, and encephalopathy
46. A 12 yo/F had prodrome of fever, anorexia, headache, sore

throat, mild abdominal pain followed 24-48 hrs after by a rash
described as “dewdrop on a rose petal”, with simultaneous
presence of lesions in various stages of evolution. Which of the
following vaccine might have been missed by this patient?
A. H. zoster vaccine
Source: Pedia Platinum Page 114
B. Measles
C. Rubella
D. varicella
42. A 20yo/F veterinary medicine student was bitten by a dog.
She already completed pre exposure rabies prophylaxis. ANSWER: D. varicella
Which of the following is the best advice that you can give? Nelsons, page 1709
She will need:
A. two doses of rabies immunoglobulin
B. two doses of the rabies vaccine
C. both RIG & 2 doses of the vaccine
D. one dose of the rabies vaccine + rabies
immunoglobulin
ANSWER: B
Source: Pedia Platinum, Chapter 7, page 147
43. Oliver, a 5 yo child sustained superficial scratch w/c did not

bleed over the left cheek while playing with a stray cat. What is
the category of rabies exposure?
A. Category III
B. None of the above, only dogs have rabies
|pg. 6
PEDIATRICS-2
1ST SEMESTER
SHIFTING EXAM 1
VIRAL INFECTIONS
A. central unilateral or bilateral ground glass opacities

and/or consolidation
B. discrete small nodules, lung cavitation, pleural
effusion, or lymphadenopathy
C. Bilateralground glass opacities / consolidation in lower
lobe predominant pattern
D. Unilateral segmental or lobar consolidation
ANSWER: Coronavirus Trans, Dr. Fajardo-Nery, p.4
50. A 17yo/M had acute onset of fever and nasal congestion

living in an area with high incidence of SARS CoV2 infection
developed anosmia. How will you classify according to WHO
case definition of COVID 19?
A. Clinical Suspect case
B. Confirmed case
C. Probable case
D. Epidemiological Suspect case
47. Infectious diarrhea is responsible for a fraction of pediatric ANSWER: D. Epidemiological suspect case
deaths. Which of the following pathogens causes the largest Source: Coronavirus trans page 4
percentage of deaths due to gastroenteritis?
A. Shigella
B. Norwalk virus
C. Astrovirus
D. Rotavirus
ANSWER: D. Nelson’s 21st Ed. p2020
51. A 2 yo/M presented with rhinorrhea, mild cough & low

grade fever. He then developed barking cough & inspiratory
stridor. What is the most likely diagnosis?
A. Supraglotittis
B. Acute bronchitis
C. Acute Infectious Laryngitis
D. Croup
ANSWER: D. Laryngotracheobronchitis aka Viral Croup

manifests with barking cough and inspiratory stridor. subglottic
narrowing or “steeple sign” 8=D
52. Polio vaccine (IPV) should be administered to healthy

children at which ages?
A. 2 and 4 mo and 4-6 yr
48. Which of the following best characterizes dengue infection? B. 2, 4, 6, and 15-18 mo, and every 10 yr thereafter
A. very young infants who have dengue infection almost C. 2, 4, and 6-18 mo and 4-6 yr
always have very mild diseasex D. 2, 4, 6, and 15-18 mo and 10-12 yr
B. severe dengue occurs most commonly in individuals
experiencing primary infectionx ANSWER: C. 2, 4, and 6-18 mo and 4-6 yr
C. in heterotypic infections, host anamnestic immune Source: Nelson’s 21st Ed. Chapter 197 (Immunization
response is postulated to mechanistically contribute to Practices). Page 1355
severe manifestations
D. viral entry in secondary dengue infection is facilitated
by cross reacting neutralizing antibodies
ANSWER: word for word from a study
53. Cytokine storm is central in the pathophysiology of severe

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3294426/ covid. Which of the following best matches the function of each
cytokine?
A. Interferons - Growth and differentiation of leukocytes;
49. Which of the following are the typical chest CT scan many are proinflammatory
findings in children with COVID 19? B. Colony-stimulating factors - Proinflammatory,
|pg. 7
PEDIATRICS-2
1ST SEMESTER
SHIFTING EXAM 1
VIRAL INFECTIONS
activates cytotoxic T lymphocytes

C. Chemokines - Control of chemotaxis, leukocyte
recruitment; many are proinflammatory 57. Dora was brought to the ER due to 5 days fever, poor
D. Interleukins - Regulation of innate immunity, activation intake and abdominal pain pain. She is in hypotensive shock
of antiviral properties, antiproliferative effects upon assessment. What is the appropriate fluid management
for Dora if her weight is 20kg?
ANSWER: C. A. PNSS 200 cc to run for 1 hour
Inflammatory chemokines function mainly as chemoattractants B. PNSS 400 cc to run for 15 minutes
for leukocytes, recruiting monocytes, neutrophils and other C. Fresh whole blood 200cc to run for 4 hours
effector cells from the blood to sites of infection or tissue D. D5 LR 400 to run for 30 minutes
damage. Certain inflammatory chemokines activate cells to
initiate an immune response or promote wound healing. ANSWER: B. PNSS 400 cc to run for 15 minutes
Source:https://www.sinobiological.com/resource/cytokines/che Source: :
mokine-inflammation - Give isotonic crystalloid or colloid (PNSS /D5 NSS) 20
mL/kg over 15 minutes via “push-pull” method
- 20 mL/kg (crystalloid) x 20 kg (weight of Dora) = 400
54. Which CBC result will be indicative of an acute viral mL or 400 cc
illness? * Source: Pedia Platinum page 220
A. thrombocytosis
B. Lymphopenia 58. You diagnose measles in a patient. Exposed patients in the
C. Leukopenia clinic waiting room: a well 6 mon old infant, a 12mon old
D. hemoconcentration unimmunized child, and a 3 year old who received MMR at 1
year old. Which post exposure prophylaxis strategy is NOT
ANSWER: B & C appropriate?
A. Give the 6 mo old infant measles vaccine
B. Immunize the 12 mo old child with MMR within 48 hr
C. No need to give postexposure prophylaxis since index
patient is not a household member
D. You may give the 3 yr old patient 2nd dose of MMR
ANSWER: A. Give the 6 mo old infant with measles vaccine

Source: Nelson's 21ed. Chap-273
Source: Trans - Viral Infections - MMRV (Dr. Nery) page 2 59. Which of the following best describes the mechanism of
action of nebulized racemic epinephrine for the treatment of
moderate to severe croup?
55. Which of the following features distinguishes paralytic polio A. it effects mostly as a bronchodilator
from Guillain-Barré syndrome? B. laryngeal mucosal edema decreased by its beta
A. The paralysis of polio is usually spastic adrenergic action
B. Paralysis is usually asymmetric in paralytic polio C. through alpha adrenergic receptors the precapillary
C. Pleocytosis is uncommon in paralytic polio arterioles constrict
D. Paralytic polio only occurs in unimmunized persons D. dilatation of the precapillary arterioles causes
resorption of interstitial space fluid
ANSWER: B. Viral Infection: Poliovirus trans page 4 table
249-1 ANSWER: B
Source: Nelson Textbook of Pediatrics - 21st Edition: chapter
412, page 2205
56.A 6 yo/F was brought to you by her teacher for red marks
on both cheeks, as a case of possible child abuse. Which of 60. 4 yo child with fever, lymphadenopathy, arthralgia with
the following development will tell you that this is not a child macular erythematous rash over the ears & face, progressing
abuse? downwards. This can be
A. The child denies being physically abused A. Erythema Infectiosum
B. Facial redness will soon turn to bluish violet color in a B. Rubella
day or two C. Roseola infantum
C. The parents/caregiver denies any form of violence D. Rubeola
towards the child
D. A diffuse macular erythema which soon becomes lacy ANSWER: B
is seen
ANSWER: D. One of the clinical manifestation of Fifth Disease

is a “SLAPPED-CHEEK APPEARANCE”
SOURCE: Trans of Viral Infections - Herpes Viruses (Dr. Nery)
page 1
61. A 6 yo /M with 5 day history of fever came in with persistent

vomiting & dyspnea. Pertinent PE findings showed liver edge
palpable 4cm below R subcostal margin, with decreased
breath sounds on both lower lung fields. Dengue screen
revealed (+) NS1 Antigen, (+) for both Dengue IgG, IgM
Antibodies. How will you classify his illness according to
severity?
A. Probable Dengue
B. Severe dengue
C. Dengue with warning signs
|pg. 8
PEDIATRICS-2
1ST SEMESTER
SHIFTING EXAM 1
VIRAL INFECTIONS
D. Dengue without warning signs
ANSWER:
C. Dengue w/ warning signs
----- END OF EXAM ---
|pg. 9
PEDIATRICS-2
1ST SEMESTER
SHIFTING EXAM 2.1
NEONATOLOGY PART 1
1. An ominous signs requiring immediate intervention in C. Miliaria Rubra

respiratory distress syndrome 1. * D. Sebaceous hyperplasia
A. Tachypnea and expiratory grunting
B. Cyanosis and dyspnea 10. The hamstring muscles is being tested, unreliable if
C. Apnea and irregular respirations frank breech. *
D. Subcostal retraction and alar flaring A. Popliteal sign
B. Ortolani test
2. Major risk factors for developing NEC? * C. Heel to ear
A. Formula feeding D. Barlow test
B. Prematurity
C. None 11. RhoGAM is more effective than a single dose if given
D. Bacterial colonization of the GUT at what gestation and at birth. *
E. All A. 26–30week gestation
B. 28-32week gestation
3. MK a 42 week by BS, male, neonate was delivered C. 24-30week gestation
with an AS 1,4,5 at 1, 5 and 10 mins respectively. D. 30-34week gestation
Developed seizure at 5 hours old and hypoglycemia.
What is the most sensitive test for this disease? * 12. Most frequently involved in necrotizing enterocolitis. *
A. CT scans A. Distal part of the colon and Distal part of the
B. MRI ileum
C. Cranial ultrasound B. Distal part of the ileum
D. EEG C. Distal part of the colon and Proximal part of
the ileum
4. 5 days old Bb. Girl Day had sudden onset of D. Proximal part of the ileum
blood-streaked vomitus. She is exclusively breastfed. E. Distal part of the colon
Bb. Girl Day has? *
A. Hemorrhagic disease of the newborn 13. Which statement/s is/are correct? *
B. Erythroblastosis fetalis A. Exchange transfusion should be over 60-75
C. Kernicterus min and involves removal of 15-20ml
D. Hemolytic disease of the Fetus and Newborn aliquots of blood
B. NEC is a common complication of exchange
5. An intubated 5 day old preterm, developed sudden transfusion
onset of apnea, with nasal flaring and noted chest C. Exchange transfusion goal is an isovolemic
retraction. Mechanical ventilator set-up was then exchange of 2 blood volumes of the infant to
increased. Umbilical catheter was in place. Chest achieve 90% replacement of fetal RBCs and
X-ray revealed bilateral infiltrates with a CBC: Hct 45, 50% removal of bilirubin
WBC 3,100 and platelet count 150K. Which D. All
statement/s is/are correct? * E. Packed RBCs should be reconstituted with
A. Caregiver education is one measure to fresh-frozen plasma to a hematocrit of about
decrease infection 45% before the procedure
B. Most common cause of this disease is
CONS and The most common HAIs in the 14. It is a cardinal sign in babies with CDH. *
NICU A. Increase chest wall diameter
C. Most common cause of this disease is B. Decrease bowel sounds heard in the chest
CONS C. Scaphoid abdomen
D. The most common HAIs in the NICU D. Respiratory distress
E. Most common cause of this disease is
CONS and Caregiver education is one 15. The measurements that are used and graph upon
measure to decrease infection delivery. *
A. Weight and Head Circumference
6. Most birth defects seen in the neonate is/are. * B. Weight and Chest circumference
A. Dysplasia C. Weight
B. Disruption D. Chest circumference
C. Deformation E. Head Circumference
D. Malformation
16. Healthcare-associated infections in the NICU is
7. A subperiosteal hemorrhage that is always limited to predominantly caused by? *
the surface of one cranial bone. * A. Gram (+) organisms
A. Caput succedaneum B. Candida
B. Subarachnoid hemorrhage C. CONS
C. Subgaleal hemorrhage D. Gram (-) bacilli
D. Cephalhematoma
17. What are the landmarks included in heel to ear for the
8. Bb. TB was delivered via NSD and had shoulder neuromuscular maturity? *
dystocia, AS 5,8 at 1 and 5 min respectively with a A. Ear
BW =3,969 grams and 38 wk BS. At 2 hours old or 30 B. Femoral crease
min before feeding, CBS was taken with a result of C. Nose
35mg/dl, TB was then fed, a repeat CBS was taken D. Nipple line
after 30 mins which showed 30mg/dl and noted lip E. All
smacking and twitching movement on arms. Which
is/are correct? * 18. This congenital disease is a cause of a 1st trimester
A. Give 200mg/kg of dextrose as IV bolus and infection that alters embryogenesis and results in the
Give 2 ml/kg of 10% dextrose as IV bolus malformation of heart and eyes. Patients with this
B. Give 2 ml/kg of 10% dextrose as IV bolus disease manifest with blueberry muffin syndrome. *
C. Give 200mg/kg of dextrose as IV bolus A. Congenital syphilis
D. Give continuous IV infusion at 4-8mg/kg/min B. Congenital cytomegalovirus
E. All C. Congenital rubella syndrome
D. Congenital toxoplasmosis
9. It is a small white or yellow papule or vesicle, benign
lesion that appears on the 1st 1 to 2 days of life and 19. The most common congenital diaphragmatic hernia. *
may persist for 1 weeks. * A. Paraesophageal hernia
A. Erythema toxicum B. Foramen of Morgagni hernia
B. Miliaww C. Bochdalek hernia
|pg. 1
PEDIATRICS-2
1ST SEMESTER
SHIFTING EXAM 2.1
NEONATOLOGY PART 1
D. Hiatal hernia B. None

C. All
20. A second and more detailed physical examination of D. Weight loss
the neonate should be performed within how many E. Polycythemia
hours of birth? *
A. 36 hours 30. This is correct of invasive candidiasis that decreases
B. 12 hours its risk in the neonate. *
C. 24 hours A. Enteral feeding that is given after the patient
D. 48 hours is stable or later
B. Use of cephalosporins as empiric therapy
21. Bb. Boy DG was born LGA, and the resident noted C. Limited use of broad-spectrum antimicrobials
that there was a herniation of abdominal content with D. Use of postnatal corticosteroids in VLBW
a sac. CBS taken at 3 hours old and was 25 mg/dl. infants
Bb. Boy has? *
A. Infant of a diabetic mother 31. The severity of hemorrhage in IVH with ventricular
B. Pierre-Robin syndrome dilatation?
C. Beckwith-Wiedemann syndrome A. Grade IV
D. Down syndrome B. Grade III
C. Grade I
22. This is true of PDA EXCEPT? * D. Grade II
A. Ductal closure occurs by 72 hr after birth in
almost all term infants 32. Which statement/s is/are correct? *
B. Radiographic evidence of cardiomegaly and A. Criteria for the detection of live birth are
increased pulmonary vascular markings detection of cardiac activity, definite
C. Dose of ibuprofen for closure is 10mg/kg for movement generated by involuntary muscle
2 doses every 24 hr then followed by 1 dose contraction
of 5 mg/kg B. Infant death is the mortality taking place from
D. Prophylactic indomethacin given for the 1st the time after delivery at any gestational age
72 hr to preterm infants reduces the need for up to the 1st birthday
surgical ligation C. Perinatal period is the time from 20th wk of
pregnancy through the 7th postpartum day
23. It results from the asymmetry in the cranial suture and D. Infant morbidity rate is a gauge of the overall
the head shape is asymmetric in the sagittal or quality of pediatric and population health
coronal plane. * among a given population residing within a
A. Craniosynostosis geographically defined border
B. Brachycephaly
C. Plagiocephaly 33. Poor predictive variables for hypoxic-ischemic
D. Scaphocephaly encephalopathy. *
A. Seizure onset > 12 hr
24. Therapeutic hypothermia in the treatment of HIE is B. Abnormal neurologic exam > 7 days
done whether head cooling or systemic with C. Low (0-3) 1 min APGAR
temperature within 1st 6 hr after birth and maintained D. Delayed onset of spontaneous breathing >20
for 72 hr. * min
A. 33.5 degrees C
B. 33 degrees C 34. Lanugo is a fine, downy hair that begins to appear at
C. 34 degrees C 24 to 25 week gestation. It is abundant across the
D. 34.5 degrees C shoulders and upper back by 28 weeks. It is part of
the physical maturity for Ballard scoring. *
25. Predisposing factors for development of persistent A. False
pulmonary hypertension? * B. True
A. Anemia
B. Late-onset sepsis 35. A developmental reflex that appears at 30 week
C. Birth asphyxia gestation and disappears at 3-4 months. *
D. Late-onset sepsis and Anemia A. Rooting reflex
E. Late-onset sepsis and Birth asphyxia B. Plantar grasp
C. Sucking reflex
26. Preventive strategies like avoidance of cesarean D. Palmar grasp
delivery, appropriate management of high-risk
pregnancy and labor including administration of 36. Hydrops fetalis is an excessive abnormal fluid in 2 or
antenatal corticosteroids are seen in what disease? * more fetal compartments EXCEPT. *
A. Transient tachypnea of the newborn A. Amniotic fluid, placenta, skin
B. Persistent pulmonary hypertension B. Skin, pleura, peritoneum
C. Respiratory distress syndrome I C. Peritoneum, skin, meninges
D. Necrotizing enterocolitis D. Pleura, pericardium, placenta
27. Included in the physical maturity for Ballard scoring. * 37. A brachial palsy that is injured in the 7th and 8th
A. Skin, eye/ears, heel to ear cervical nerves and the 1st thoracic nerve which
B. Female/male genitals, lanugo, plantar produces a paralyzed hand and ipsilateral ptosis and
surface miosis. *
C. Posture, lanugo, plantar surface A. None
D. Breast, scarf sign, skin B. Klumpke paralysis
C. Erb-Duchenne paralysis
28. Hemorrhagic disease of the newborn result from a D. Phrenic nerve paralysis
deficiency in the vitamin K-dependent factors? *
A. All 38. Neonatal abstinence syndrome (NAS) Except. *
B. Factor II and Factor VII A. Signs begin after heroin exposure within 48
C. Factor VII hours after birth
D. Factor XI B. Withdrawal signs develop in opioid-exposed
E. Factor II infants
C. Patients manifest with CNS hyperexcitability
29. Risk factors which increase indirect bilirubin levels and autonomic instability
includes EXCEPT? * D. First line of treatment is nonpharmacologic
A. Maternal diabetes support
|pg. 2
PEDIATRICS-2
1ST SEMESTER
SHIFTING EXAM 2.1
NEONATOLOGY PART 1
48. Suppress surfactant therapy. *

39. A case of Bb. Girl EL 20 days old, preterm 30 week A. Pulmonary ischemia and Hyperemia
by BS, BW: 1,020 grams with tolerated feedings and B. Hyperemia
weaned from CPAP, developed sudden onset of C. Pulmonary ischemia and Asphyxia
abdominal distention with feeding intolerance. CBC D. Asphyxia
showed WBC of 4,100, Hgb: 7 and platelet count of E. Pulmonary ischemia
90,000. Abdominal Xray showed dilated bowel loops.
* 49. Which of the ff is/are correct? *
A. Late-onset sepsis A. PRBC volume is 10-20 ml/kg and PRBC
B. Meconium ileus transfusion should be completed within 6
C. Healthcare associated infections hours
D. Necrotizing enterocolitis B. PRBC transfusion should be completed
within 6 hours
40. EJ is a 1 month and 20 days old infant who was C. PRBC volume is 10-20 ml/kg
delivered at 34 week gestation. His mother was D. PRBC transfusion is delivered at a rate of
worried because she noted that EJ is pale thus 3-5 ml/kg/hr
check-up was done. CBC showed hemoglobin of E. PRBC volume is 10-20 ml/kg and PRBC
8.3g/dl. EJ is having what disease? * transfusion is delivered at a rate of 3-5
A. Hemolysis ml/kg/hr
B. G6PD deficiency
C. Congenital leukemia 50. This/These statement/s is/are correct regarding levels
D. Physiologic nadir of unconjugated hyperbilirubinemia? *
A. Increased by hypoproteinemia ?
41. It assesses the wrist flexibility or resistance to B. Increased in polycythemia
extensor stretching at the wrist. Angle decreases as C. Increased by hypoproteinemia and
gestational age increases. * Increased in polycythemia
A. Scarf sign D. Decreased by breastfeeding
B. Heel to ear
C. Square window
D. Arm recoil
42. A transient, benign phenomenon that affects the

cutaneous vessels and it is commonly observed in the
LBW infants. *
A. Cutis marmorata
B. Vitiligo
C. Harlequin sign
D. Acrocyanosis
43. A disease that is caused by the presence of maternal

antibodies against RBC antigens within the circulation
of the infant. *
A. Hereditary spherocytosis
B. Hemolytic disease of the fetus and newborn
C. Hemorrhagic disease of the newborn
D. Neonatal Anemia
44. It is a self-limited tachypnea associated with a

delayed clearance of the fetal lung fluid. *
A. Aspiration pneumonia
B. Respiratory distress syndrome I
C. Persistent pulmonary hypertension
D. Transient tachypnea of the newborn
45. Complications of induced hypothermia. *

A. Thrombocytopenia
B. Cold injury syndrome
C. Subcutaneous fat necrosis
D. All
46. OP a fullterm infant treated as a case of meconium

aspiration pneumonia. Intubated and hooked to
mechanical ventilator for 3 days suddenly developed
cyanosis and dyspnea. O2 saturation was between
70-80% and going down. Peripheral pulses were not
appreciated, and he developed hypotension. The
physician noted decrease breath sounds on the right
lung area. OP has? *
A. Pneumothorax
B. Pneumopericardium
C. Subcutaneous emphysema
D. Meconium aspiration syndrome
47. 7 days old, 32week GA preterm had increasing

oxygen dependence from a 0.5LPM nasal cannula to
2LPM. PE showed a bounding peripheral pulses,
hepatomegaly and chest retraction with alar flaring.
Diagnosis? *
A. Respiratory distress syndrome
B. Patent ductus arteriosus
C. Bronchopulmonary dysplasia
D. Aspiration pneumonia
|pg. 3
PEDIATRICS-2
1ST SEMESTER
SHIFTING EXAM 2.2
NEONATOLOGY PART 2
1. Which of the following is seen in patients with hemolytic A. Thyroid hormone treatment is aimed to maintain total
disease of the newborn: * thyroxine or free thyroxine in the upper half of the
A. The presence of sickle cells on peripheral smear normal range during the first 3 years after birth.
B. Direct hyperbilirubinemia B. Congenital screening followed by thyroid hormone
C. Increased number of nucleated red cells replacement therapy started within two weeks after
D. The presence of IgM antibodies to A or B antigen birth can normalize cognitive development. — It
should within 30 days
2. The following are late manifestations of congenital syphilis, C. Most infants with congenital hypothyroidism are
except: * symptomatic at birth and presents with jaundice,
A. Small biting surfaces and excessive number of cusps goiter and persistently mottled skin. — It should be
of the first lower molars asymptomatic
B. Anterior bowing of the midportion of the fibula D. Congenital hypothyroidism is one of the most
C. Depression of the nasal root common preventable causes of mental retardation. —
D. Peg shaped upper incisors It should be developmental disability
Source: Nelsons Page 982
3. Vernix caseosa provides protection against infection
because: * 11. Which of the following is seen in chronic form of
A. A. IgA antibodies are present in the vernix kernicterus:
B. It increases hypothermia and offers protection from E. A. Sensorineural hearing loss
coli and Group B strep. B. Fever
C. It prevents the crawling reflex and prevent more C. Opisthotonos
exposure to maternal it pathogenic flora. D. Poor suck
D. Antimicrobial protein embedded in organized granules
inhibits the growth of L.monocytogenes and C. 12. Jaundice in eryuthroblastosis fetalis may be absent at birth
albicans. because: *
A. D antigen sensitization does not cause an increase in
4. What is the greatest risk associated with Ratio: Kernicterus, bilirubin levels.
or bilirubin indirect hyperbilirubinemia? * B. The biliruibin produced is the direct type
A. Anemia C. Extramedullary hamatopoeisis compensates for the
B. Bilirubin induced neurologic dysfunction anemia.
C. Transient porphyrinemia D. The placenta clears bilirubin in utero.
D. Cardiac decompensation secondary to severe anemia
13. Drug of choice for perinatal HSV infection *
5. A 5 day old neonate was brought to your clinic for frequent A. Valacyclovir
“spit ups”. He was born full term, with negative maternal, B. Penicillin
perinatal and early neonatal history. Baby has been breastfed C. Gancyclovir
since birth. Mother claims that he has good suck and good D. Acyclovir
latch but has been noted to have an increasing frequency of
spit ups since the third day of life/ 1 day post discharge. He is 14. This results from the persistence of all part of the
active with no note of abdominal distention. Stools are yellow omphalomesenteric duct or the urachus
and soft. Spit ups are noted to be whitish yellow initially but has A. Persistent urachus
been noted to become green in color, thus the consultation. B. Omphalitis
Your consideration at this time is: C. Umbilical hernia
A. Cow’s milk protein allergy D. Umbilical polyp
B. Sepsis
C. GERD 15. Bronze baby syndrome refers to:
D. Upper GI obstruction A. A complication of double volume exchange
transfusion
6. Which of the following is true for persistent pulmonary B. The transient erythema in patients undergoing
hypertension of the newborn? Persistent pulmonary phototherapy when given metalloporphyrins
hypertension of the newborn occurs mostly in term and C. Photochemical reaction of lumirubin
preterm infants. D. Discoloration produced from photoinduced
A. Persistence of the fetal circulatory pattern of left to modification of porphyrin
right shunting through the PDA and foramen ovale
after birth is the result of excessively high pulmonary 16. This is the result of a failure of closure of the allantoic duct
vascular resistance. and is associated with bladder outlet obstruction.
B. The hypoxemia is often labile and is corroborated by A. Umbilical polyp
the findings on chest radiograph. B. Umbilical hernia
C. A PaO2 or oxygen saturation gradient between a pre C. Persistent urachus
ductal and a postductal site of blood sampling D. Omphalocoele
suggests a right to left shunting through the ductus
arteriosus 17. One of the following is an important and effective means of
reducing health care associated infection among neonate.
7. Breastmilk jaundice is attributed to: A. UV sterilization
A. Sensitization to breastmilk B. Hand hygiene
B. Glucoronidase in breastmilk C. Personal Protective Equipment
C. Passage of maternal bilirubin in breastmilk D. Use of HEPA filters
8. All of the following lumbar puncture result would indicate the 18. A 16 day old neonate presents with poor suck and
presence of bacterial meningitis, EXCEPT: seizures. Maternal history shows the presence of vesicular
A. CSF protein 200mg/dL lesions in the perineal area. Primary working diagnosis would
B. CSF leukocyte count: 35mm3 be: *
C. CSF Sugar = 80% of A. Congenital rubella syndrome
D. Predominance of polymorphonuclears on gram stain B. Herpes virus encephalitis
C. Syphilis
9. The most common congenital abnormalities in infants of D. Congenital toxoplasma infection
diabetic mothers:
A. Neural tube defects and cardiac malformations 19. Which of the following is a drug of choice for a neonate
B. Cardiac malformations and lumbosacral agenesis suspected with Congenital syphylis *
C. Lumbosacral agenesis and anorectal atresia A. Acyclovir
D. Hydronephrosis and renal agenesis B. Penicillin
C. Galancyclovir
10. The following are true for congenital hypothyroidism: D. Valacyclovir
|pg. 1
PEDIATRICS-2
1ST SEMESTER
SHIFTING EXAM 2.2
NEONATOLOGY PART 2
C. Frequent use of broad spectrum antibiotics

20. Which of the following is the most frequent pathogen for D. Enteral nutrition
neonatal health care associated infections. *
A. S. aureus 31. These are tiny, sebaceous retention cysts usually seen on
B. Group B strep the chin, forehead, nose and cheeks. *
C. P. aeruginosa A. Erythema toxicum
D. E. coli B. Milia
C. Neonatal acne
21. The most important neonatal factor predisposing to D. Epstein pearls
infection
A. Prematurity 32.The following are symptoms of chronic bilirubin
B. Chorioamniotis toxicity/kernicterus, except:
C. Maternal leukocytosis > 18,000 hours A. Dental dysplasia
D. Premature rupture of membranes > 18 hours B. Hypotonia
C. Athetoid palsy
22. A term newborn was delivered by scheduled cesarian D. Hearing loss
section with low risk maternal history, presented with
tachypnea after birth. Chest radiograph showed fluid in the 33. Which of the following is a preventable disease:
intralobar fissures and hyperaeration. Most likely diagnosis A. Cytomegalovirus infection
would be. B. Rubella infection
A. Meconium aspiration pneumonia C. Syphilis
B. Transient tachypnea of the newborn D. Toxoplasmosis
C. Air leak syndrome
D. Bronchopulmonary dysplasia 34. Hemolytic disease of the newborn rarely occurs in the first
pregnancy for Rh incompatibility because:
23. Which of the following will present with direct A. Primigravida is protective of incompatibility
hyperbilirubinemia B. Fetal red cells are resistant to hemolysis
A. Twin to twin transfusion C. Transfusion of Rh positive fetal blood into an Rh
B. Rh Incompatibility negative mom occurs near the time of delivery
C. G6PD deficiency D. IgG passes through the placenta
D. Galactosemia
35. A pregnant mother was referred to you for antenatal
24. Administration of antenatal steroids to women before 34 counselling due to the following findings on ultrasound:
weeks of gestation reduces the following, except: * polyhydramnios, presence of a chest mass, mediastinal shift
A. Postnatal growth and the gastric bubble in the thoracic cavity. Which will be your
B. Duration of ventilatory support most likely diagnosis? *
C. Incidence of Necrotizing Enterocolitis A. Congenital cystic adenomatoid malformation
D. Overall mortality B. Isolated Esophageal atresia
C. Esophageal atresia with a distal fistula
25. This presents with paralysis of the hand and ipsilateral D. Congenital diaphragmatic hernia
ptosis and miosis and is secondary to injury of the 7th and 8th
cervical nerves and the first thoracic root. * 36.The following are major risk factors for developing severe
A. Erb-Duchenne paralysis hyperbilirubinemia in infants >35 weeks AOG, except: *
B. Facial nerve paralysis A. Cephalhematoma
C. Klumpke”s paralysis B. exclusive breastfeeding
D. Phrenic nerve paralysis C. previous sibling received phototherapy
26. Which is a risk factor for hyperbilirubinemia: * 37. The Hyperbilirubinemia in the neonates can be due to
A. Cutaneous bruising except:
B. Female sex A. Increased hemolysis of fetal red cells who survive for
C. Caucasian race 120 days
D. Anemia B. Sterility of the newborn gastrointestinal tract
C. Bile duct obstruction
27. Hypothermia in the neonate may result in the following D. Hepatic immaturity
except:
A. Meconium Aspiration 38. In patients with an intraventricular haemorrhage, the
B. Cardiac arrhythmias following are markers for a good prognosis, EXCEPT:
C. Respiratory distress syndrome A. Short hospital stay
D. Persistent Pulmonary Hypertension B. Normal sonogram on discharge
C. Presence of white matter injury
28. Which is true for fetal alcohol syndrome * D. Grade 1 IVH
A. Advanced maternal age is an additional risk factor.
B. The risk of abnormality for infants born to moderate 39. Patients treated with pyrimethamine for congenital
drinkers is twice that for infants born to heavy toxoplasmosis will have inhibition of the enzyme dihydrofolate
drinkers. reductase and may have this reversible side effect
C. Facial abnormalities would include, short palpebral A. Bone marrow depression
fissures, epicanthal folds, smooth philtrum, cleft B. chorioretinitis
palate and micrognathia. C. hyperbilirubinemia
D. It may be a consequence of impairment of the D. jarisch-Hexheimer reaction
placental transfer of amino acids and magnesium,
which are necessary for protein synthesis. 40. The following major changes take place within seconds
after birth, except: (NRP) *
29. A child with congenital infection is considered contagious A. Pulmonary arteries constrict
until one year of age. * B. Umbilical arteries and vein constrict
A. CMV infection C. Pulmonary arteries dilate
B. Congenital toxoplasmosis D. Fluid in alveoli absorbed
C. Congenital rubella
D. Congenital syphilis 41. A 4 day old male, neonate was admitted for jaundice up to
the abdomen:Your initial evaluation should the include the
30.The following are risk factors for Healthcare associated following, except: *
Infections. * A. Extract feeding history
A. Prolonged hospitalization B. Ultrasound of the liver
B. Indwelling catheters C. Ask about the patient’s bowel movement
|pg. 2
PEDIATRICS-2
1ST SEMESTER
SHIFTING EXAM 2.2
NEONATOLOGY PART 2
D. Ballard’s score
42. Which statement is true regarding surfactants: *

A. Synthesis of surfactant depends in part on normal pH,
temperature and glucose concentration.
B. Surfactant is present in highest concentrations in fetal
lung homogenates by 20 weeks AOG.
C. Deficient synthesis or release of surfactant results in
well ventilated but not perfused alveoli.
D. It appears in amniotic fluid at 25 weeks AOG.
43. The following are causes of abnormal stool patterns among

neonates except :
A. prematurity
B. IDM
C. Electrolyte abnormalities
D. Hypothyroidism
44. A two week old newborn was referred for consult. He was
born preterm and was noted to be IUGR at birth with
hepatosplenomegaly. Present complaint was coryza and white
mucous patches on the palate and perineum. Your primary
consideration would be:
A. Congenital Herpes Infection
B. Congenital rubella
C. Congenital syphilis
D. Congenital CMV infection
45. The following predisposes a patient to have hemorrhagic

disease of the newborn, except:
A. Gut sterility
B. Breastfeeding
C. Mother on anticonvulsants
D. Placental transfer of Vit K in utero
46. A single umbilical artery is associated with an increased

risk for an occult ___ anomaly.
A. Gastrointestinal
B. Adrenogenital
C. Cardiac
D. Renal
47. A 16 day old neonate presents with poor suck and

seizures. Maternal history shows the presence of vesicular
lesions in the perineal area. Primary working diagnosis would
be:
A. Congenital rubella syndrome
B. Herpes virus encephalitis
C. Syphilis
D. Congenital toxoplasma infection
|pg. 3
PEDIATRICS-2
1ST SEMESTER
LONG EXAM 3
BACTERIAL INFECTIONS
A 5-year-old male child was brought in to the Emergency d. Immune reconstitution

Room with complaints of high grade fever, cough and difficulty SOURCE: Nelson’s Pediatrics 21st ed page 1434
breathing, since 5 days prior. Physical examination showed
tachypnea and nasal flaring. There was decreased breath 7.What is the primary virulence factor associated with
sounds on the right hemithorax. A stat Chest Xray was this condition? *
requested and preliminary result showed multiple radioluscent a. TSST-1
areas over the right lung field. b. Slime Layer
CASE DIAGNOSIS: Staphylococcus aureus infection (Nelson c. STST-1
21st ed page 1430) d. Teichoic acid
SOURCE: Nelson’s Pediatrics 21st ed page 1434
1.What were these multiple radioluscent areas noted? *
a. Consolidation An 11-month-old female child with no history of immunization
b. Abscess was brought in to the Emergency Room with complaints of high
c. Pleural effusion grade fever, cough and difficulty breathing, for 2 days. Physical
d. Pneumatocoeles examination showed tachypnea, nasal flaring and diffuse rales
SOURCE: Nelson’s Pediatrics 21st ed page 1432 over the right lung field. A stat Chest Xray was requested and
preliminary result showed a round, nodular area of
2. What is the characteristic culture appearance of this consolidation on the right mid-lung. Lateral view showed a
organism? * triangular diffuse density.
a. Pink solitary colonies with varying degrees of
hemolysis on chocolate and blood agar 8.The recommended dosing schedule for the primary
b. Yellow to orange mucoid colonies producing doses of the vaccine for the prevention of this
B-hemolysis on blood agar disease: *
c. White to gray clumping colonies producing a. 3 dose series, starting at 6 weeks of age, 4
B-hemolysis on blood agar weeks apart
d. Colorless mucoid colonies with yellowish b. 2 dose series, starting at 6 weeks of age, 4
surrounding pigmentation with B hemolysis weeks apart
on blood agar c. 2 dose series, starting at 4 weeks of age, 4
SOURCE: Growth and Laboratory Maintenance of weeks apart
Staphylococcus aureus d. 3 dose series, starting at 4 weeks of age, 6
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6211185/ weeks apart
SOURCE: Nelson’s Pediatrics 21st ed page
A 7-year old male child was brought in to the ER for abrupt and
acute onset of high grade fever, vomiting, diarrhea and a 9.What do we give as prophylaxis for high-risk children
diffuse erythematous macular rash, described by the parents exposed to this patient? *
as “sunburn-like”. Upon arrival, the patient was hypotensive a. Ciprofloxacin
and oliguric. b. Clarithromycin
CASE DIAGNOSIS: Toxic Shock Syndrome (Nelson 21st ed c. Penicillin
page 1434) d. Erythromycin
SOURCE: Nelson’s Pediatrics 21st ed page
3.What is the diagnostic modality of choice for this
condition? * 10. On isolation, what is the characteristic appearance of
a. Stool culture Streptococcus pneumonia colonies on solid media? *
b. Blood culture a. Colorless, pinpoint colonies surrounded by
c. Radio-immunfluorescence studies an area of varying hemolysis
d. None b. Scarlatiniform colonies with yellow pigments
SOURCE: Nelson’s Pediatrics 21st ed page 1435 surrounded by B hemolysis
c. Grayish to Yellowish mucoid colonies with B
4.Upon arrival, the patient was hypotensive and oliguric. hemolysis
What is the most probable etiologic agent of this d. Unpigmented, umbilicated colonies
patients condition? * surrounded by an area of incomplete
a. Streptococcus pneumoniae hemolysis
b. Staphylococcus aureus SOURCE: Nelson’s Pediatrics 21st ed page 1436
c. Streptococcus pyogenes
d. Staphylococcus epidermidis 11. One of the following patients is NOT a
SOURCE: Nelson’s Pediatrics 21st ed page 1434 moderate-to-severe risk factor for this disease
immunization. *
5. What should be your initial antibiotic coverage of a. 4 year old child
choice? * b. HIV
a. Vancomycin monotherapy c. Asthma on high dose oral corticosteroid
b. Oxacillin monotherapy therapy
c. Vancomycin + Gentamycin d. 2 year old child
d. Oxaciliin + Amikacin SOURCE: Nelson’s pediatrics 21st ed
12. A very important pathogenicity factor seen in this

organism. *
a. Polysaccharide capsule
b. Fimbriae
c. Terminal spore
d. Slime layer
SOURCE: Nelson’s Pediatrics 21st ed page 1436
13. What is the probable etiologic agent of this patient

pneumonia? *
a. Mycoplasma pneumonia
b. Streptococcus pneumonia
It should be MSSA Drugs + Clindamycin as initial therapy c. Haemophilus influenza
SOURCE: Nelson’s Pediatrics 21st ed page 1435 d. Moraxella catarrhalis
Source: Trans Pneumonia - Dahlia L. Yu, page 2
6. What is the basic pathophysiologic process
underlying this condition? * 14. What antibiotic should you start this patient on?
a. Immunocompromisity a. Penicillin + Cefotaxime
b. Toxin mediation b. Cefotaxime + Ceftiraxone
c. Bacterial invasion
|pg. 1
PEDIATRICS-2
1ST SEMESTER
LONG EXAM 3
c. Penicillin monotherapy
d. Vancomycin monotherapy
A 7-year-old male child was brought in to the Emergency

Room with complaints of high grade fever of 3 days duration
and acute appearance of a punctuate, erythematous rash a
few hours prior.The rash was described as diffuse, finely
papular, erythematous eruptions, producing a bright red
discoloration of the skin. There was facial sparing.
SOURCE: Insignis Trans - Gram (+) By Dr. Chin
15. What should be your initial antibiotic coverage of
24. One of the following is NOT a minor manifestation in
choice? *
JONES CRITERIA: *
a. Erythromycin monotherapy
a. Elevated ASO titer
b. Penicillin + Amikacin
b. Fever
c. Penicillin monotherapy
c. Prolonged PR interval
d. Vancomycin monotherapy
d. Elevated ESR
16. What does this patient have? *
25. One of the following is NOT a major manifestation in
a. Erysipelas
JONES CRITERIA: *
b. Kawasaki Disease
a. Carditis
c. Scarlet fever
b. Erythema multiforme
d. Staphylococcal Scalded Skin Sydrome
c. Chorea
d. Polyarthritis
17. What is the most probable etiologic agent of this
patients condition? *
A 7-year-old child was brought into your clinic with chief
a. Streptococcus pneumoniae
complaints of fever, throat pain and hoarseness for the past 3
b. Staphylococcus epidermidis
days. Physical examination findings showed neck soft tissue
c. Staphylococcus aureus
edema, enlarged submandibular lymph nodes and a grayish
d. Streptococcus pyogenes
black membrane covering the tonsillar area.
18. The virulence of the organisms that cause scarlet
26. What is the most probable etiologic agent? *
fever depends primarily on what virulence factor? *
a. Parvovirus B19
a. Erythrogenic Toxin
b. RSV
b. M Protein
c. Corynebacterium
c. Polysaccharide capsule
d. Listeria monocytogenes
d. Coagulase
27. The role of Antibiotic coverage for this condition are
19. This major manifestation of Jones criteria
the following, EXCEPT: *
CORRELATES well with peak antibody levels and has
a. Treat systemic infection, decreasing antitoxin
an inverse relationship with possible cardiac
release in circulation
involvement. *
b. Prevents transmission to contacts
a. Carditis
c. Halt toxin production
b. Polyarthritis
d. Treat localized infection
c. Subcutabeous nodules
Source: insignis trans bacterial infection by doc chin, page 6
d. Chorea
Source: Dr. James Chin lecture excelsus trans gram positive
28. Which of the following is not true in the complications
bacteria p. 5/9
of pharyngeal diphtheria? *
a. Complication are toxin-mediated
20. What is the Drug of choice for secondary prevention
b. Severity is associated with the extent of the
of acute rheumatic fever? *
local disease
a. Amoxicillin PO
c. Death occurs in 5-10% of patients.
b. Penicillin G PO
d. Most frequent complications: myocarditis
c. Penicillin V IM
and myositis
d. Penicillin G IM
Source: insignis trans bacterial infection by doc chin. Page 6
SOURCE: Nelson’s Pediatrics 21st ed page 1449, chapter 210,
table 210.4
29. The antibiotic of choice for pharyngeal diphtheria? *
a. Penicillin
21. Jones criteria: *
b. Vancomycin
a. Both
c. Erythromycin
b. None of the above
d. Nafcillim
c. 2 major manifestation
Source: insignis trans bacterial infection by doc chin. Page 6
d. 1 major PLUS 1 minor
SOURCE: Trans- Bacterial Infections : Gram Positive Bacteria
30. What is your admitting diagnosis? *
(9/21/2021), page 5 of 9
a. Pharyngeal diphtheria
b. Laryngotracheobronchitis
22. The diagnosis of rheumatic fever can be made
c. Acute tonsillopharyngitis
without fulfilling the Jones criteria, EXCEPT: *
d. Infectious mononucleosis
a. Recurrent disease
Source: Insignis trans Pedia Bacterial Infection Pg. 6- Dr. Chin
b. Chorea
c. Indolent carditis
A 6-month-old infant was rushed to the ER for complaints of
d. Polyarthritis
high-grade, spiking fever of one day duration, associated with
SOURCE: Trans- Bacterial Infections : Gram Positive Bacteria
increased sleeping time, bulging anterior fontanelle and
(9/21/2021), page 5 of 9
hypotension. A generalized reddish to purple purpuric rash was
noted after an hour of the fever.
23. How long should the prophylaxis be given? *
a. None of the above
31. All of the following are the reasons why this child, a
b. Both
6-month-old, is at an increased risk for the disease,
c. For 3 years or until age 21
EXCEPT: *
d. For 1o years or until age 21
a. Routine nasopharyngeal carriage by majority
of the population
b. Absent to low acquired serum antibodies
c. Increased exposure to the organism
|pg. 2
PEDIATRICS-2
1ST SEMESTER
LONG EXAM 3
d. Immature alternative and pectin complement Source: Insignis Pedia Bacterial Infections - Dr. Chin pg. 11
pathways
An 11-year-old male child was brought in to the OPD for
32. Based on the routine surveillance for this disease anorexia, weight loss and persistent cough with nocturnal
entity, what factor is lacking to complete its clinical paroxysms violent enough to awaken him, for about 4 weeks.
case definition? * He also reported occasional wheezing and chest tightness.
a. Neck stiffness Chest and Lung findings were positive for diffuse crackles and
b. Turbid CSF findings expiratory wheezes.
c. CSF cell count and differential count
d. Typical CSF gram staining findings 41. What is the major virulence factor present in the
organism causing the disease? *
33. All of the following serogroups of this disease most a. M antigen
commonly cause invasive disease worldwide, b. Pertussis toxin
EXCEPT: * c. Tracheal cytotoxin
a. D d. Capsular polysaccharide
b. A Source: Insignis Pedia Bacterial Infections - Dr. Chin pg. 12
c. W-135
d. Y 42. One of the following statements regarding the
different stages of this disease is TRUE: *
34. Which of the following pertains a POOR PROGNOSIS a. The paroxysmal stage lasts for about 4-7
for this disease entity? * days and is characterized by the paroxysms
a. Elevated WBC and platelet counts of cough, followed by the inspiratory effort or
b. Elevated ESR “whoop”
c. Onset of rashes at 24-48 hours b. The convalescent stage lasting for about 2-3
d. Absence of meningitis weeks is a high risk stage for infection, and
coughing may still persist.
35. Which of the following is the most frequent c. The afebrile stage is a short 2-3 days,
complication and neurologic sequelae of meningitis * occurring right after the paroxysmal stage
a. Non-suppurative arthritis and is characterized by resolution of fever
b. Deafness and fluid resorption.
c. Erythema nodosum d. The incubation period or the catarrhal stage
d. Facial nerve palsy lasts for about 1-2 weeks and may present
with non-specific signs and symptoms
36. What do you call that specific rash? * Source: Insignis: Bacterial Infecton
a. Purpura fulminans
b. Henoch-Schonlein purpura 43. What is the recommended drug of choice for a
c. Erythema multiforme 2-month-old infant noted to have persistent nocturnal
d. Erythema marginatum paroxysms of cough ? On Pe, positive wheeze,
positive intercostal and subcostal retraction..? *
37. A 7-month-old infant was rushed to the ER of vcmc a. Ampicillin
for complaints of high-grade fever of 2 days duration b. Penicillin
which was associated with a generalized reddish to c. Azithromycin
purple purpuric rash . An hour prior to admission, the d. Erythromycin
infant was noted to be sleeping at all times. Upon Source: Nelson’s Textbook of Pediatrics, 21ed. pg 1494
physical examination noted to have bulging anterior
fontanelle and hypotension. Your immediate suspicion 44. all of the following are an important factor for the
would be? * WHO CLINICAL CASE DEFINITION of pertussis
a. Pseudomonas sepsis except *
b. Scarlet fever a. Post-tussive inspiratory whoop
c. Meningococcemia b. Cough > 2 weeks, non-continuous
d. Haemophilus influenza sepsis with c. Fever > 14 days
meningitis d. Cough > 14 days, intermittent
Source: Insignis Pedia Bacterial Infections - Dr. Chin pg. 8 Source: Insignis Pedia Bacterial Infections - Dr. Chin - page 12
A 2-year old child was rushed to the ER by his parents due to 45. A non-progressive infection characterized by a
fever, sore throat and “noisy breathing”. On physical superficial, ecthymic, non-healing ulcer with gray-
examination, patient was noted to be highly febrile at 41C, brown membrane: *
irritable, flushed with nasal flaring, and preferred a sitting a. Bullous impetigo
position. Chest and Lung findings include an inspiratory stridor b. Cutaneous diphtheria
and occasional wheezing. No immunizations were given to this c. Ecthyma gangrenosum
child d. Syphilitic chancre
Source: Nelson pediatrics 21e, chapter 214, page 1460
38. What disease entity should be your primary (Corynebacterium Diphtheriae)
consideration? *
a. Pneumonia 46. One of the following is NOT included in the
b. Bronchial Asthma management of patients with tetanus: *
c. Croup a. Ciprofloxacin
d. Epiglottitis b. 500 U TIG
Source: Insignis Pedia Bacterial Infections - Dr. Chin pg. 11 c. Diazepam
d. Penicillin G
39. What is the antibiotic of choice? * Source: Insignis Pedia Bacterial Infections - Dr. Chin
a. Ampicillin pg. 33
b. Penicillin 47. The optimal drug regimen for newly diagnosed TB of
c. Vancomycin Peripheral lymph node in children suspected to have
d. Cefuroxime drug resistance: *
Source: Insignis Pedia Bacterial Infections - Dr. Chin pg. 12 a. HRZE for 2 months, HR for 7 months
b. HRZE for 4 months, HR for 2 months
40. What microorganism should be suspecting in this c. HRZE for 4 months, HR for 3 months
case? * d. HRZE for 2 months, HR for 4 months
a. Haemophilus influenza Source: Insignis Pedia Bacterial Infections - Dr.
b. Streptococcus pyogenes Veloso pg. 2
c. Bordetella pertussis 48. An important pathogen in burn patients causing
d. Streptococcus pneumonia sepsis: *
|pg. 3
PEDIATRICS-2
1ST SEMESTER
LONG EXAM 3
a. V. cholera
b. H. influenza
c. C. perfringens
d. P. aeruginosa
Source: Insignis Gram-negative bacteria - Dr. Chin
pg. 12
49. Which of the following statements is TRUE regarding
C. diphtheria infection? *
a. Only the toxigenic strains can cause the
infection
b. Paralysis of the palate and hypopharynx is
an early local effect of the toxin
c. The causative agent is an exclusive
inhabitant of the GIT
d. Primary focus of infection is the larynx
Source: Insignis Gram-positive bacteria - Dr. Chin pg. 7
50. The most common sexually transmitted infection in

sexually abused children: *
a. Hepatitis B infection
b. HIV
c. Gonorrhea
d. Syphilis
Source:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1758110/pdf/v0
74p00167.pdf
Gonorrhoea is the most frequent STD found in abused
children, reported to occur in 1–30% of abused children.
|pg. 4
PEDIATRICS-2
1ST SEMESTER
SHIFTING EXAM 4
CONNECTIVE TISSUE DISORDERS
1. Which phase of Kawasaki is associated with coronary b) JRA

aneurism? * c) Scleroderma
a) Convalescent phase d) Juvenile Dermatomyositis
b) Acute febrile phase
c) All of the above 12. Which of the following vaccines is CONTRAINDICATED in
d) Subacute phase patients taking immunosuppressant drugs? *
a) Hepatitis B
2. Karen a 3yo female child was brought to the ER of b) DPT (diphtheria, pertussis and tetanus)
VCMC for low grade fever ,joint pains with intermittent crampy c) Intramuscular influenza
abdominal pain and purpuric rashes noted in the buttocks d) Pneumococcal
down to lower extremities.A week PTA was noted to have e) Rubella-live vaccine
URTI.The patient most likely has : *
a) Menigococemia
b) JRA 13. Which of the following is NOT a feature of benign nocturnal
c) ITP pains of childhood? *
d) HSP a) Occurs between 4-12 yrs old
b) Found in boys
3. All of the following are symptoms suggestive of c) Leg pains are associated occasionally with upper
Rheumatic disease except : * extremity pain
a) Rash d) Involves the shin, calf, and thigh bilaterally
b) Fever 14. The following are small vessel vasculitis EXCEPT: *
c) Oral rash a) Eosinophilic granulomatosis with polyangitis
d) Joint Pain b) Polyarteritis nodosa -
c) Microscopic polyangitis
4. Arthritis is a sign commonly seen among the following d) IgA vasculitis
Rhematic disease except; *
a) Juvenile Idiopathic Arthritis 15. Which of the following age at onset of arthritis in the
b) Kawasaki disease classification criteria of chronic arthritis in childhood is: *
c) HSP a) 16 years old
d) RA b) 15 years old <16 years old
c) 17 years old
5. All of The following features are suggestive of a vasculitic d) 18 years old
syndrome except: *
a) Fever of unknown origin 16. This subtype of JIA is characterised by arthritis, fever and
b) oliguria prominent visceral involvement: *
c) HPN a) RF-positive polyarthritis
d) Arthralgia b) Systemic onset JIA
c) Oligoarthritis
6. Joint pains with polyarticular involvement are commonly d) Enthesitis related arthritis
seen in the following except: *
a) Septic arthritis 17. Which of the following conditions is NSAID not indicated? *
b) SLE a) Lupus nephritis class III
c) Dermatomyositis b) Pericarditis
d) HSP c) JIA with uveitis
d) Pleuritis
7. A 14 yo male child was noted to have morning stiffness and
joint pains of the lower extremities associated with on and off 18. This condition produces the saddle nose deformity
moderate grade fever for more than 6 months.Mother claimed because of the inflammation causing damage to the nasal
consultation was done 2 weeks PTA and was given unrecalled cartilage *
meds. The patient most likely haski : * a) Eosinophilic granulomatosis with polyangitis
a) Juvenile Idiopathic arthritis b) Microscopic polyangiitis
b) Septic Arthritis c) Granulomatosis with polyangitis
c) Reactive Arthritis d) Polyarteritis nodosa
d. Growing pains
8. A diagnostic test which is positive in 40-85% with pauci and 19. An erythematous raised patches with adherent keratotic
polyarticular JRA * scaling and follicular plugging: *
a) ANA a) Heliotrope rash
b) Antiphospholipid b) Gowttrons papule
c) Direct Coombs c) Malar rash
d) Rheumatoid factor d) Discoid rash
9. Which of the following organism is /are associated with 20. Juvenile idiopathic arthritis is disease associated with
Reactive arthritis? * alterations in *
a) Shigella a) Neither
b) Salmonella b) Cell-mediated immunity
c) All of the above c) Both
d) E coli d) Humoral immunity
e) Chlamydia trachomatis
21. Which of the following statements DOES NOT describe
10. The following is/are Diagnostic criteria for A child Wegener’s granulomatosis? *
suspected to have Juvenile Dermatomyositis : * a) It is associated with a history of refractory asthma
a) Gottron papules b) Circulating ANCA is specific to PR3 antigen
b) Elevated creatine kinase c) It is a necrotising granulomatous small vessel
c) Symmetrical muscle weakness vasculitis
d) All of the above d) It targets the respiratory tract and kidneys
e) Heliotrope rash
22. A 2 yo male child complaints of acute onset of joint pain
11. A 14 yo female child has a month history of progressive of and swelling noted in less than 2 weeks duration.The following
walking down the stairs. Phyical Examination reveals positive is/are your consideration : *
Gowers sign,noted also an erythematous rash crossing the a) Infection
nasolabial fold and a violaceous discoloration with swelling b) All of the above
over the periorbital areas.Most likely patients has : * c) Trauma
a) SLE d) Reactive arthritis
|pg. 1
PEDIATRICS-2
1ST SEMESTER
SHIFTING EXAM 4
32. Which of the following is a non biologic agent engineered

23. A 10 yr old female child was seen at the OPD for consult to target and modulate specific components of the immune
with musculoskeletal pain.The following approach must be system to decrease inflammatory response? *
done except ; * a) Azathioprine
b) Anakinra
a) Ask patient to extend and flex knee c) Etanercept
b) Ask patient to touch tips of fingers d) Rituximab
c) Observe patient walking on her heels and on tip toe
d) Ask her to inhale and exhale 33. What do you call the reaction caused by Naproxen which is
e) Observe her from front to back and sides characterized by the presence of small hypopigmented
depressed scars seen in areas of minor skin
24. What is the z score based classification of aneurysm in KD trauma? *
that warrants anticoagulation? * a) Steven-Johnsons syndrome
a) <5 b) Red man syndrome
b) at least 9 c) Hypersensitivity vasculitis
c) 5-8 d) Pseudoporphyria
d) At least 10
34. The following are radiographic features of Juvenile
25. Systemic lupus erythematosus is an auto-antibody disease Ankylosing Spondylitis (JAS) EXCEPT: *
that affects: * a) Syndesmophyte formation in the spine
a) Cell mediated immunity b) Indistinct margins and erosions in the sacroiliac joints
b) Both c) Osteophyte formation
c) None d) Joint space widening
d) Humoral mediated immunity
35. Axials spondyloarthritis criteria must have a mandatory
26. Median age of onset of SLE in children is: * criteria of: *
a) 13-16 years old a) Definite radiographic sacroilitis, Low back pain at least 3
b) 11-12 years old months and Family history of spondyloarthropathies
c) 8-10 years old b) Definite radiographic sacroilitis and Low back pain at least 3
d) 5-7 years old months
c) Low back pain at least 3 months
27. This subtype of JIA have a strong association with d) Family history of spondyloarthropathies
polymorphisms at the histocompatibility locusthan autoantibody e) Definite radiographic sacroiliitis
formation as the central factor to its pathogenesis *
a) Oligoarthritis 36.Which of the following statements is NOT TRUE about
b) Systemic onset JIA reactive arthritis?
c) RF-positive polyarthritis a) Arthritis is oligoarticular mostly on the lower extremities
d) Enthesitis related arthritis b) It may progress to chronic spondyloarthritis
c) 75% are HLA B27+
28. These antibodies are specific for SLE: * d) Common classic triad in children is arthritis, conjunctivitis
a) Anti-dsDNA and urethritis
b) Anti-SSA e) Patients present with systemic symptoms
c) ANA
d) Anti-Sm 37. Spondyloarthropathies include the following: *
e) Anti-Sm and Anti-dsDNA only a) Reactive arthritis, Psoriatic arthritis and Inflammatory bowel
disease
29. This antibody is associated with neonatal lupus syndrome * b) Inflammatory bowel disease
a) Anti-Sm c) Psoriatic arthritis
b) Anti-Ro d) Psoriatic arthritis and Inflammatory bowel disease only
c) Anti-Smooth muscle e) Reactive arthritis
d) Anti-dsDNA
39. Which of the following drugs has a definite association with 41. Which of the following is a non biologic agent engineered
drug induced lupus? * to target and modulate specific components of the immune
a) Penicillin system to decrease inflammatory response? *
b) Carbamazepine a) Azathioprine
c) Phenytoin b) Anakinra
d) Rifampin c) Etanercept
e) Isoniazid d) Rituximab
40. Which of the following is NOT a feature of drug induced 42. What do you call the reaction caused by Naproxen which is
lupus? * characterized by the presence of small hypopigmented
a) Hepatitis depressed scars seen in areas of minor skin trauma? *
b) Malar rash a) Steven-Johnsons syndrome
c) (+) ANA b) Red man syndrome
d) (+) Anti-dsDNA c) Hypersensitivity vasculitis
d) Pseudoporphyria
30. . Which of the following drugs has a
definite association with drug induced 43. The following are radiographic features of Juvenile
lupus? * Ankylosing Spondylitis (JAS) EXCEPT: *
a) Penicillin a) Syndesmophyte formation in the spine
b) Carbamazepine b) Indistinct margins and erosions in the sacroiliac joints
c) Phenytoin c) Osteophyte formation
d) Rifampin d) Joint space widening
e) Isoniazid
44. Axials spondyloarthritis criteria must have a mandatory
31. . Which of the following is NOT a feature of criteria of: *
drug induced lupus? * a) Definite radiographic sacroilitis, Low back pain at
a) Hepatitis least 3 months and Family history of spondyloarthropathies
b) Malar rash b) Definite radiographic sacroilitis and Low back pain at
c) (+) ANA least 3 months
d) (+) Anti-dsDNA c) Low back pain at least 3 months
d) Family history of spondyloarthropathies
|pg. 2
PEDIATRICS-2
1ST SEMESTER
SHIFTING EXAM 4
e) Definite radiographic sacroiliitis

55. A 3 year old male child was admitted due to 6 days onset
45. Which of the following statements is NOT TRUE about of fever unresponsive to antibiotics, associated with non
reactive arthritis? * purulent discharges, right cervical lymphadenopathy. Other
a) Arthritis is oligoarticular mostly on the lower physical examination findings are normal. Laboratories were
extremities requested and showed WBC count of 15,000/cumm, normal
b) It may progress to chronic spondyloarthritis haemoglobin and hematocrit for age, platelet count
c) 75% are HLA B27+ 450,000/cumm. ESR and CRP are elevated. 2D echo done
d) Common classic triad in children is arthritis, showed coronary ectasia in the left anterior descending. What
conjunctivitis and urethritis would be the best measure to do? *
e) Patients present with systemic symptoms a) Treat with IVIG and aspirin
b) Request for supplemental laboratories
46. Spondyloarthropathies include the following: * c) Wait for other signs to occur
a) Reactive arthritis, Psoriatic arthritis and Inflammatory d) Consult an expert
bowel disease
b) Inflammatory bowel disease 56. Coronary artery aneurysm will develop in how many
c) Psoriatic arthritis percent of Kawasaki patients if left untreated? *
d) Psoriatic arthritis and Inflammatory bowel disease a) 20-25%
only b) 5%
e) Reactive arthritis c) 10-20%
d) 95%
47. Which of the following drug is commonly used as a steroid
sparing agent? 57. Which of the following is NOT an ANCA-associated
a) Colchicine vasculitis? *
b) Prednisone a) Wegener’s granulomatosisi
c) Hydrochloroquin b) Churg Strauss Syndrome
d) Methotraxate c) Microscopic polyangiitis
d) PAN
48. Which of the following medication is given to a child
suspected to have HSP and with significant gastrointestinal 58. All of the following are common vasculitis syndromes
involvement: * encountered except: *
a) Prednisone 1 mg/k/day for 1-2 weeks a) Behcet disease
b) Methotrexate 1 tab /day for 2 weeks b) Polyarteritis Nodosa
c) Interferon 1 tab/day for 1 month c) Takayasu arteritis
d) NSAID for 1 week d) HSP
49. The following describes a skin pathergy test * 59. Confirms the diagnosis of oligoarthritis JIA
a) Test is done to confirm Behcet's disease and a) Increased risk to develop SLE in the future
scleroderma b) Increased risk for uveitis
b) Positive result will shows 5-10 petechial rashes per c) Resemblance of the characteristic symmetric
square inch presentation of adult rheumatoid arthritis
c) saline solution is injected intradermally and read 72
hours after
d) Positive result will show an erythematous pustule that
develops 24-48 hrs after a needle prick
50. True of Sjogren’s syndrome: *

a) None of the above
b) 75% of the patients are boys
c) Most common manifestation in children is polyarthritis
d) Classic symptoms include keratoconjunctivitis sicca &
xerostomia
51. Sjogren syndrome is associated with the development of

this type of malignancy *
a) MALT lymphoma
b) ALL
c) Hemophagocytic lymphohistiocyotisis
d) JMML
e) Non-Hodgkins lymphoma
52. This test is used to detect damaged ocular epithelial

conjunctival and corneal cells *
a) Schirmer test
b) Sialography
c) Anti-𝛽 fording autoantibodies
d) Rose Bengal
53. Which of the following statements is NOT TRUE about

Kawasaki disease? *
a) It is a self limited disease
b) Lowest incidence among girls in Japan is between 3
and 8 months old
c) It occurs after a direct cell mediated attack on the
endothelial cells
d) Mitral regurgitation is present in the acute phase
54.Which of the following is NOT part of the classification

criteria of Kawasaki disease? *
a) Edema of hands and feet
b) Cervical lymphadenopathy >1.5cm
c) Fever ≥ 5 days
d) Truncal vesicular rash
|pg. 3
PEDIATRICS-2
1ST SEMESTER
SHIFTING EXAM 5
ALLERGY / IMMUNOLOGY (Dr. Nery)
1. A 12 yo /F has bothersome, daily nasal symptoms (pruritus,

sneezing, rhinorrhea) for 3 months now which affect her
studies, which is the drug of choice for her allergic rhinitis
severity?
A. leukotriene receptor antagonist
B. Non-sedating antihistamine
C. Intranasal steroid
D. Intranasal decongestant
ANSWER: C. Intranasal steroids
Source: Nelson’s 21st Ed. Page 1182. Part XIV (Allergic
Disorders)
2. Which of the following best describes the time course of

serum histamine elevation in association with an anaphylactic
episode? *
A. Begins to rise in 5-10 minutes, peaks in 60-90
minutes
B. Begins to rise in 30-60 minutes, remains elevated for
60-90 minutes
C. Begins to rise in 5-10 minutes, remains elevated for
30-60 minutes
D. Begins to rise in 5-10 minutes, remains elevated for
as long as 5 hours
ANSWER:C. Begins to rise in 5-10 minutes, remains elevated
for 30-60 minutes
4. The following are part of the Jeffrey Modell Foundation
criteria for suspected primary immunodeficiency EXCEPT?
A. 2 or more episodes of urinary tract infections in a year
(for a male)
B. Failure to thrive
C. 8 or more upper respiratory tract infections in one
year
D. 2 or more deep-seated abscesses in one year
ANSWER: A. 2 or more episodes of urinary tract infections in a
year (for a male)
5. Allergens are recognized specifically by which of the

following cells:
A. B-cell
B. T-cell
C. Neutrophils
D. Dendritic cells
ANSWER: B. T-cell
Source: Nelson’s 21st Ed. Chapter 166 (Allergic disorders).
Page 1169.
3. Paul is a 3 month old male who was brought to you for
diarrhea for two weeks now. The following are the PE findings:
weight below 2 SD from P50, white plaques on the tongue,
perforated tympanic membrane AS, purulent discharge AD. He
was also treated with antibiotic a week ago for pneumonia. The
patient most likely has
A. Wiskott – Aldrich syndrome (WAS)
B. Common Variable Immunodeficiency Syndrome
(CVID)
C. Severe Combined Immunodeficiency Syndrome
(SCID) 6. In a Wiskott-Aldrich syndrome patient, which of the following
D. X-Linked Agammaglobulinemia (XLA) clinical symptoms will NOT be present?
A. gum bleeding
ANSWER: C. B. maculopapular rashes
Source: Immunology Trans, page 3. C. recurrent pneumonia
D. Hypertelorism
ANSWER: D
|pg. 1
PEDIATRICS-2
1ST SEMESTER
SHIFTING EXAM 5
10. A 4yo patient was underwent immunodeficiency work up

due to recurrent sinopulmonary infections. He showed positive
on intradermal tests to PPD, candida & tetanus toxoid. These
CMI tests rules out a defect in what arm of the immune
system?
A. T cell
B. Complement
C. B cell
D. Phagocytic
ANSWER: C. B cell
11. Which of the following drugs binds to circulating IgE, thus

preventing its attachment to high affinity receptors on mast
cells / basophils?
A. Dexamethasone
B. Epinephrine
C. Omalizumab
D. Diphenhydramine
Source:Nelsons Textbook of Pediatrics, Chapter 152, ANSWER: C. Omalizumab
Immunodeficiencies Affecting Multiple Cell Types p. 1117 Source: Nelson Textbook of Pediatrics - 20th Edition: page
1086
7. An 8 yo /M presented w/ recurrent infections by
encapsulated organisms. He is currently being seen for otitis
media. On PE you noted absence of tonsils and no palpable
lymph nodes. He had an older male sibling who died at 7
months due to severe pneumonia. Which of the following is the
most likely diagnosis?
A. Common Variable Immunodeficiency (CVID)
B. Bruton’s Agammaglobulinemia
C. SCID
D. Leukocyte adhesion defect
ANSWER: B.
Ratio:
12. Atopic individuals respond to allergen exposure with rapid

expansion which specific T cells?
A. T- helper type 2 (Th2) cells
B. T- helper type 17 (Th17) cells
Source: Nelson’s 21st Ed. Chapter 150 (Allergic disorders). C. T- regulatory cells (TRegs) cells
Page 1107 D. T- helper type 1 (Th1) cells
ANSWER: A. T- helper type 2 (Th2) cells
Source: Nelson Textbook of Pediatrics - 20th Edition: chapter
8. The best treatment for Paul is: 140, page 1074
A. IVIG infusion
B. Prophylactic antibiotic
C. Bone marrow transplant
D. Administration of live vaccines
ANSWER: A
9. Which of the following is the most common cause of acute

urticaria in the pediatric population? 13. Cytokine that is a potent eosinophil activator and is
A. Food allergies responsible for eosinophil
B. Viral infections maturation: *
C. Autoantibodies A. IL 12
D. Contact allergens B. IL 4
ANSWER:A C. IL 5
D. IL 21
ANSWER: C
Source: Nelson Textbook of Pediatrics 20th ed page 1076
|pg. 2
PEDIATRICS-2
1ST SEMESTER
SHIFTING EXAM 5
14. Complement defect often presents with recurrent infections

of which of the
following pathogens?
A. Pneumocystis jiroveci
B. Enterovirus
C. Staphylococci
D. Neisseria
ANSWER: D
Source: Nelson Textbook of Pediatrics 21e Chapter 169, pg

1203
18. Blistering mucocutaneous disorder induced by

carbamazepine characterized by
hemorrhagic crusting of the lips, eye erythema with purulent
15. The following are examples of IgE mediated diseases, discharge & 40% total body surface area of skin detachment:
EXCEPT: A. Toxic Epidermal Necrolysis
A. Allergic Rhinitis B. SJS-TEN overlap
B. Stevens Johnson Syndrome C. DRESS (Drug rash, eosinophilia & systemic
C. Acute Urticaria symptoms) syndrome
D. Anaphylaxis D. Stevens Johnson Syndrome
ANSWER: B ANSWER: A. Toxic Epidermal Necroysis
Source: Nelson’s 20E Ch645 p.3142
16. A 7 month old presented with recurrent sinopulmonary

infections. You suspect
this patient to have primary immunodeficiency disorder of the B
cell arm. Which of the following tests should be prioritized?
A. DTH testing
B. HIV testing
C. Respiratory burst assays
D. Specific antibody responses
ANSWER: B. HIV Testing
Source: Nelson’s 21st Ed. p1245
19. A 20-year old, male has sneezing and stuffy nose 5 days in
a week for 2 months now. His nasal congestion wakes him up
at night but he has no limitation of activity. Classify his allergic
rhinitis.
A. Mild intermittent
B. Moderate-severe intermittent
C. Moderate-severe persistent
D. Mild persistent
ANSWER: C
17. Which of the following classes of drugs possess mild
antiinflammatory properties and exhibit bronchodilator effects?
A. Leukotriene-Modifying Agents
B. Second generation Antihistamine
C. Steroid
D. First generationAntihistamine
ANSWER: A
|pg. 3
PEDIATRICS-2
1ST SEMESTER
SHIFTING EXAM 5
25. Which of the following PIDs is considered a true pediatric

emergency, since death usually occurs on the 1st year of life
unless immunologic reconstitution is achieved?
A. Selective IgA deficiency
B. X linked agammaglobulinemia
C. SCID
D. Hyper Ig E syndrome
ANSWER: C. SCID
26. Sophia was given Cotrimoxazole for pneumonia. After 3

days she had confluent purpuricmacules on face and trunk
which turned to blisters. Severe, oral mucosal erosions,
20. True statements regarding FCєRI receptors: conjunctivitis, and fever were noted. The most likely diagnosis
A. All of the above is:
B. they are present on surfaces of mast cells & basophils A. Staphylococcal scalded skin syndrome
C. they bind IgE B. Stevens Johnson Syndrome
D. their crosslinking is mediated by re-exposure to an C. Measles infection
allergen during elicitation phase D. Meningococcemia
ANSWER: A ANSWER: B. Stevens Johnson Syndrome
Source: Nelson Textbook of Pediatrics 20th Ed (Ch 140 p1076) Ratio:
21.The central component of all allergic diseases:

A. interleukin activation
B. Mast cell degranulation
C. Histamine production
D. Mast cell inhibition
ANSWER: B
22.The central component of allergic diseases:

A. Histamine production
B. interleukin activation
C. Mast cell degranulation
D. Mast cell inhibition
ANSWER: C
23. Which of the following drugs for allergy has

anti-inflammatory action and directly inhibit cytokines &
mediators?
A. Cetirizine
B. Prednisone
C. Ranitidine
D. Montelukast
ANSWER: B. Prednisone
Ratio:
- Act by their broad anti-inflammatory efficacy. Source: Nelson Textbook of Pediatrics Chap 152 page 1144
- Inhibits the infioltration of airways by lymphocytes,
eosinophils, and mast cells
- inhibition of production of inflammatory cytokines 27. Which type of immunoglobulin or antibody will be expected
Source: Pharmacology Dr. Bacquilod PPT to rise after first dose of Hepa B vaccine?
A. IgE
B. IgM
24. MCH Class 1 molecules present antigens to which cell? C. IgG
A. Regulatory T Cells D. IgA
B. Helper T Cells
C. Cytotoxic T Cells ANSWER: B. IgM
D. Th 17 cells
ANSWER: C. Cytotoxic T cells
Ratio:
Source: Dr. Fajardo PPT
|pg. 4
PEDIATRICS-2
1ST SEMESTER
SHIFTING EXAM 5
28.Which of the following immune function should be ANSWER:C. fever and chills during blood transfusion
considered defective in a patient with autoimmune disease
(SLE) / chronic nephritis, with recurrent pyogenic infections,
disseminated meningococcal or gonococcal infection? * 34. Which of the following is the most important risk factor in
A. T cell the development of allergic diseases?
B. Complement A. Early introduction of allergenic food
C. B cell B. Family history of atopy
D. Phagocytic C. Prematurity
ANSWER: B. Complement D. Exposure to dust mites & pollens
ANSWER: C. Family of atopy
Source: Nelson’s 21st. Ed. Part XIV ( Allergic Disorder). Page
1174.
29. A rare disease characterized by neutrophils and monocytes

capable of normal chemotaxis, ingestion, and degranulation,
but unable to kill catalase positive microorganisms because of
a defect in the generation of microbicidal oxygen metabolites:
A. Leukocyte adhesion defect 1
B. Leukocyte adhesion defect 2
C. Chediak Higashi syndrome
D. Chronic granulomatous disease
ANSWER: D. Chronic granulomatous disease
Ratio: CGD is characterized by neutrophils and monocytes
capable of normal chemotaxis, ingestion, and degranulation, 35. Which of the following best describes allergens?
but unable to kill catalase positive microorganisms because of A. They are almost always carbohydrates
a defect in the generation of microbicidal oxygen metabolites. B. frequently contain elastases
Source: Nelson’s 20th ed., Chap 130 page 1045 C. induce IgM antibody production
D. Most allergens are 10-70 kDa molecular weight
ANSWER: D. Most allergens are 10-70 kDa molecular weight
30. The best thing to do in Sophia’s case is to: Source: Nelson’s 21st Ed Chapter 166 (Allergy and the
A. Start antibiotic with staphylococcal coverage Immunologic Basis of Atopic Disease). Page 1170.e1
B. Do oral challenge to cotrimoxazole to confirm drug
allergy
C. Discontinue cotrimoxazole
D. Get titers for serum Measles IgG
ANSWER:C. Discontinue cotrimoxazole
Source: Trans Adverse Drug Reaction page 5
31. The delayed type of allergic reaction (DTH) is

characterized by:
A. A positive skin prick test to dust mite allergen
B. Responsiveness to antihistamines
C. Unresponsiveness to steroids
D. induration to an intradermal skin test after 48 hours
ANSWER: D. induration to an intradermal skin test after 48
hours
.
32. Drug of choice for anaphylaxis:

A. Ranitidine 4mg/kg/day 36. After a booster dose of pneumococcal vaccine which
B. Diphenhydramine 1mg/kg/dose antibody type is elevated?
C. Epinephrine 0.01mg/kg/dose A. IgA
D. Prednisone 1mg/kg/day B. IgE
ANSWER: C. Epinephrine 0.01mg/kg/dose C. IgG
Source: Nelson's 21st Ed. Chapter 174 (Anaphylaxis) Page D. IgM
1231 ANSWER: C. IgG
37. Which of the following best describes an atopic individual’s

response to allergen exposure? *
A. increased IL-4, IL-5, and IL-13
B. IgE synthesis and eosinophilia as Th1 responses
C. clonal expansion of TH1 cells
D. rapid expansion of Th2 cells that secrete IFN-γ,
TNF-α
ANSWER: C. increased IL-4, IL-5, and IL-13

33. The following are considered Type I (IgE mediated
hypersensitivity) reactions EXCEPT:
38. The diagnostic modality that would best detect
A. urticaria 20 minutes after intake of paracetamol
allergen-specific IgE is:
B. pruritus after intake of isoniazid
A. Skin Prick Test to allergens
C. fever and chills during blood transfusion
B. CBC to check for eosinophilia
D. wheezing after administration of Penicillin G
C. Serum immunoassays for IgE to allergens
|pg. 5
PEDIATRICS-2
1ST SEMESTER
SHIFTING EXAM 5
D. Total serum IgE determination Ratio:

ANSWER: A. Skin prick test to allergens
Ratio: Skin prick test (SPT) is the most frequently used method
for the detection of IgE antibodies, due to its rapidity, simplicity
and low cost.
Source: Nelson’s 21st Ed Chapter 166 (Allergy and the

Immunologic Basis of Atopic Disease). Page 1170
39. The following constitutes the sensitization phase of the 44. A 4 month old who is a diagnosed case of PID was brought
sequence of events in hypersensitivity reactions, EXCEPT: * to the ER for intractable seizure. Which of the following primary
A. TH2 cell activation by the allergen immunodeficiency disorders will present with hypocalcemic
B. IgE production by plasma cells seizures?
C. Antigen recognition by dendritic cells A. ChediakHegashi Syndrome
D. Mast cell activation B. Di George syndrome
ANSWER:C. Antigen recognition by dendritic cells C. Wiskott Aldrich Syndrome
D. Chronic granulomatous disorder
ANSWER: B. Di George Syndrome
40. Which of the following arm of the immune system is
defective in DiGeorge syndrome?
A. Complement
B. Phagocytic
C. B cell
D. T cell
ANSWER: D. T cell
41. Which of following is NOT considered as Type I (immediate

hypersensitivity) reaction?
A. fever and chills during blood transfusion
B. flushing and hypotension after intake of peanuts
C. wheals/hives 20 minutes after intake of paracetamol
D. bronchospasm/wheezing after administration of
Penicillin G
ANSWER: A
Geha, R., Notarangelo, L. Janeway’s Immunobiology, 8th ed.
2012
45. The resident on duty decides to insert an IV line, to infuse
42. The most common type of primary immunodeficiency fluids rapidly. The most appropriate intervention afterwards
disorders involves: would be:
A. Combined Ab& cellular immunodeficiency A. Intubate the patient
B. Phagocytic defects B. Give IV epinephrine
C. Disorders of the complement system C. Give IV anticonvulsant
D. Defects in Antibody production D. Give IM epinephrine
E. Defects in Cellular Immunity ANSWER: B. Give epinephrine
ANSWER: D
Ratio: 46. A patient with rhinorrhea and throat clearing has been
having problems at school due to his bothersome nasal
symptoms for a month. What is the best medication for him?
A. Oral Antihistamines
B. Oral Antihistamine + Decongestant
C. Intranasal corticosteroid
D. Intranasal antihistamine
ANSWER: A
Source: Insignis Trans: Respiratory Allergies by Dr. Fajardo, p.
2
47. A 15yo/ F was brought to the ER for loss of consciousness

a few minutes after taking clarithromycin for cough. On PE her
BP was 60/40 & was tachycardic, with generalized flushed
skin. What is your diagnosis? *
A. Vasovagal reaction
B. Adverse food reaction
C. Seizure episode
D. Anaphylaxis
ANSWER: D
48. True statements regarding FCєRI receptors:

A. they are present on surfaces of mast cells & basophils
Source: Nelsons Textbook of Pediatrics 21e Chapter 150 B. their crosslinking is mediated by re-exposure to an
Primary defects of antibody production page 1107 allergen during elicitation phase
C. they bind IgE
D. All of the above
43. Which of the following cytokines play a key role in ANSWER: D. AOTA
immunoglobulin type switching to IgE?
A. IL-5 and IL-9 49. A 16 yo/ F was brought to the ER for loss of consciousness
B. IL-3 and IL-9 a few minutes after COVID 19 Pfizer vaccination. On PE her
C. interferon-γ (IFN-γ) BP was 60/40 & was tachycardic, no cutaneous manifestations
D. IL-4 and IL-13 was noted. What is your diagnosis?
ANSWER: D A. Seizure episode
|pg. 6
PEDIATRICS-2
1ST SEMESTER
SHIFTING EXAM 5
B. Anaphylaxis 56. A rare autosomal recessive disorder characterized by

C. Vasovagal reaction increased susceptibility to infection caused by defective
D. Adverse food reaction degranulation of neutrophils, a mild bleeding diathesis, partial
ANSWER: B. Anaphylaxis oculocutaneous albinism, progressive peripheral neuropathy,
Source: Nelson p. 1231 and a tendency to develop a life-threatening form of
hemophagocyticlymphohistiocytosis:
50. The intern on duty inserted an IV line, to infuse fluids A. Chédiak-Higashi syndrome
rapidly. The most appropriate intervention would be: B. Wiscott Aldrich syndrome
A. Give IM epinephrine C. DiGeorge syndrome
B. Intubate the patient D. Bruton’sagamaglobulinemia
C. Give anticonvulsanT
D. Give IV corticosteroid ANSWER: A. Chédiak-Higashi syndrome
ANSWER: Nelson’s p. 1231 Source: Nelson Textbook of Pediatrics - 20th Edition: chapter
130, page 1045
51. What is the most common immunodeficiency disorder of
the B cell arm?
A. CVID
B. XLA
C. Selective Ig A deficiency
D. Hyperimmunoglobin E syndrome
ANSWER: C. Selective Ig A deficiency
52. A 2 month old /M was seen for follow up, you notices that
the umbilical cord / stump has still not detached. Soon after the
patient has recurrent skin abscesses. What arm of the immune
system is affected in this case?
A. Complement
B. T Cell
C. Phagocytic
D. B Cell --- end of exam ---
ANSWER: C. Phagocytic
Source: Nelsons 1403- 1404
53. A previously well adolescent or young adult with

meningococcal meningitis caused by an uncommon serotype
(not A, B, or C) might have a defect in which arm of the
immune system?
A. Complement
B. Phagocytic
C. B cell
D. T cell
ANSWER: A
Source: Nelson, p. 1152
54. The following event immediately precedes the

degranulation of mast cells:
A. Production of IgE antibodies by plasma cells
B. Cross-linking of receptor-bound IgE molecules by
allergen
C. Release of various mediators of allergic inflammation
D. Processing of antigen by dendritic cells
ANSWER: C
55. Which of the following is a transcription factor is expressed

by T regulatory cells to mitigate the allergic immune response?
A. Nuclear Factor KB
B. GATA 3
C. STAT 6
D. FOXP3
ANSWER: D
|pg. 7
PEDIATRICS-2
1ST SEMESTER
SHIFTING EXAM 6
BURNS & ACCIDENTS (Dr. Gallo)
1. Which of the following is/are Signs of a. Carbon dioxide contributes significantly to early
overhydration /over-resuscitation in burn mortality
fluid resuscitation? * b. Carbon monoxide poisoning contributes to early
a) Oliguria mortality
b) Poor peripheral pulses c. Neither
c) Increased BP d. Both are correct
d) Confusion
12. Which of the following is a
2. Which of the following is a sign of bronchoscopic finding of inhalational injury?
positive response to resuscitation in a. Erythema
pediatric trauma? * b. All of the above
a) Mottling of skin c. Edema
b) Hypotension d. Carbon deposits
c) Persistent tachycardia
d) Return of peripheral pulses 13. Which of the following topical antibiotics penetrates the
eschar well but painful on application? *
3. In Jackson’s theory of thermal burns, a) Bacitracin
what describes accurately the zone of b) Mupirocin
coagulation? * c) Mafenide
a) The most painful portion d) Silver sulfadiazine
b) Heal without scarring
c) Most severely burned portion 14. Which of the following is a
d) Found the periphery of the wound recommended Treatment for smoke
inhalational injury? *
4. A 10 year old boy patient sustained a a) Nebulization with acetylcysteine
40 % TBSA full thickness thermal burns b) All of the Above
injury due to an explosion of a gas tank c) Aggressive pulmonary toilet and bronchodilators
at home. Resuscitation was done at the d) inhalation of nitrous oxide
ER. Which of the following is/are Signs
of under hydration/ Under-resuscitation 15. Which of the following is part of the
in burn during fluid resuscitation? secondary survey in trauma?
a) increased BP ( blood pressure) a. Circulation
b) Polyuria b. Head to Toe evaluation
c) urine output is less than 1 ml/kg/hour c. Breathing
d) pulmonary edema d. Airway
5. A 8 year old boy accidentally stepped on 16. Which of the following accurately
a campfire while having a scouting activity describes the Parkland formula for burn
.Which of the following burn injury is injury fluid resuscitation?
expected to happen? a. 4 ml/kg/hr x % TBSA burns x Wt (kg)/24hrs
a) Chemical burn injury b. 2 ml/kg/hr x % TBSA burns x Wt (kg)/24hrs
b) Scald burn injury c. 6 ml/kg/hr x % TBSA burns x Wt (kg)/ 24hrs
c) Electrical burn injury d. 8 ml/kg/hr x %TBSA burnsx Wt (kg) / 24hrs
d) Flame burn injury
17. Which of the following correctly
6. Which of the following is/are signs of describes the Jackson’s Zones of Thermal
shock? Injury? *
a. Decreased urine output a) Outer zone of necrosis
b. Strong peripheral pulses b) Outer zone of stasis
c. All of the above c) Outer zone of hyperemia
d. Tachycardia d) Outer zone of coagulation
7. Which of the following is not appropriate 18. During the primary survey, which of the
for out patient management of burn patient? following life-threatening condition should
a. Abused patients be identified? *
b. Special child a) Unstable pelvic fractures
c. All of the above b) All of the above
d. With co morbid conditions c) Cardiac tamponade
d) Massive hemothorax
8. Which of the following is/are true
regarding smoke inhalation injury? 19. Which of the following is not included in
a. Causes direct heat injury to the upper the Guidelines for referral to a burn center?
airways a) Partial thickness burns more than 10% TBSA in
b. Injury to pulmonary alveolar macrophages releases children
prostaglandins b) None of the above
c. all of the above c) Burns involving the face, hands, feet, genitalia
d. Due to inhalation of combustion products d) Inhalational injury
9. A 12 yo boy was diagnosed with deep 20. A 2 year old boy accidentally spilled a
partial thickness burn at ER. Which of the cup of hot chocolate in his hand. Which of
following is/are characteristic of deep the following Burn Injury is most likely
partial thickness burn injury? * expected? *
a) Dry, blotchy and cherry red a) Electrical burn
b) Fast capillary refill time b) Chemical burn
c) Blister formation c) Scald burn
d) Epidermis and dermis is intact d) Contact burn
11. Smoke inhalation injury is a serious 21. Which of the following statement is
matter thus examination and careful true regarding cause of hypothermia in
evaluation of the patient is paramount. pediatric patients? *
Which of the following contributes in the a. Children lose heat easily
early mortality of these patients? * b. All of the above
|pg. 1
PEDIATRICS-2
1ST SEMESTER
SHIFTING EXAM 6
c. Over exposure of the child in a cold

environment 32. Which of the following statements is
d. Children has higher body surface area to true regarding pediatric burns? *
mass ratio a) Always Be Aware Of Child Abuse
b) They have small surface area
22. Which of the following condition is c) Scald Burns areMost Common over 3
possible complication of prolonged Years old
mechanical ventilation? * d) Flame Burns More Commonly under 3
a. Barotrauma Years old
b. Difficulty respiration
c. NOA 33. 1. All of the following statements
d. Urine Output of 1-1.5 ml/kglhr concerning early tangential excision of burn
wound are true except: *
23. In Thermal Burn injury, which of the a) It will entail significant blood loss
following functions of the skin will be b) By expediting healing in burns around
compromised? * joints, the procedure preserves joint
a. Regulates body fat functions
b. None of the above c) In patients with severe inhalational injury,
c. Synthesizes vitamin C with UV procedure should be done under local
d. Temperature regulation anesthesia
d) Procedure is carried out sequentially until
24. 1. Which of the following statement good capillary bleeding indicates viable
regarding cause of mortality in pediatric tissues
trauma is correct? *
a. 30 % died within days/weeks due to 34. 1. Which of the following statement is
complications the reason why pediatric trauma tends to
b. 30% died within first few hours have a multiple organ involvement? *
c. All of the above a) more widely spaced organs
d. 80% died at the scene due to airway b) smaller body mass
compromise c) more connective tissue
d) more body fat
25. Which of the following is a sign of
impending respiratory compromise? * 35. Which of the following statement
a) Stridor regarding blunt trauma in children is/are
b) Hoarse voice true? *
c) Wheezing a) Most often results from vehicular
d) All of the above accidents
b) due to accelerating and decelerating
26. Which of the following is used to forces
estimate the size of an endotracheal tube to c) may occur in assaults
be used in cases of pediatric airway d) falls from heights
compromise? *
a) Diameter of the big toe 36. Which of the following is the most
b) Diameter of the child’s 5th digit common cause of death in children *
c) Size of the child’s mouth a) Burns
d) None of the above b) Blunt trauma
c) Motor Vehicular associated injuries
27. The following are signs of Cardiac d) Fall
tamponade, except?
a. Decreased Blood Pressure 37. A 9 year old boy came in at ER due
b. Distended Neck Veins Burn injury to his abdomen and lower
C. Muffled Heart Sounds extremity. Which of the following sequence
D. Elevated Blood Pressure of tissue layers arrangement is correct?
a) Epidermis, Subcutaneous, Dermis, Fascia
28. Fluid crystalloid used in the initial b) Epidermis, Subcutaneous, Dermis, muscle
resuscitation of burn patient c) Epidermis, Dermis, Subcutaneous, Fascia
a. Lactated Ringers d) Epidermis, Dermis, Fascia, Subcutaneous
b. Fresh frozen plasma
C. Dextran 40 in 0.9% NaCl 38. A 6 year old male boy was seen in the emergency room
D. D5 Lactated Ringers with scalding burn injury 4 hours after the incident. Vital sign:
HR: 100bpm, RR: 34 cpm, BP: 100/70 mmhg, Wt: 20 kg. On
29. Which of the following strategy is/are PE: Scalding burn, anterior trunk, both feet and leg,
used in the Management of Electrical Burn circumferential, pinkish with blister in appearance and painful.
Injury? * What is burn depth of this patient? *
a) Urine output should be 2ml/kg/hour in children a) Superficial burn
b) Alkalinization of the urine b) Full thickness burn
c) All of the above c) None of the above
d) Giving of IV fluids d) Superficial partial thickness burn
30. In the pathophysiology of burns, which

of the following is least likely to happen? *
a) Decreased cardiac output
b) Fluid shift
c) Decreased metabolic rate
d) Decreased GI motility
31. Airway management can be more

challenging in children, due to which of the
following reason? *
a) Smaller diameter with larger tongue
b) Shorter trachea
c) All of the above
d) More anteriorly placed
|pg. 2
PEDIATRICS-2
1ST SEMESTER
SHIFTING EXAM 6
c) Focus resuscitation on airway

39. . What is the extent of the injury? management
a) 35 % TBSA d) Bring patient to the closest hospital
b) 25% TBSA
c) 31 % TBSA 48. What is the Glassgow comma scale of
d) 27% TBSA the patient? *
a. E2M4V2= 8
40. 38. What is the severity grading system b. E3M6V5= 14
of this patient? * c. E1M1V1= 3
a) Major d. E2M5V3=10
b) Moderate
c) Minor 49. In the emergency room, you are ask by
d) None of the above your intern to manage the airway of the
patient. Which of the following is the
41. Using the Parkland formula, What is appropriate thing to do to maintain and
the fluid requirement of this patient for the secure the airway? *
first 24 hours? a. All of the above
a) 2000 mL/day b. Avoid passive flexion
b) 2480mL/day c. Maintain neutral alignment
c) 2160 mL/day d. Immobilize the cervical spine
d) 2800 mL/day
50. Which of the following are signs and
42. How do you give your fluids? * symptoms of increased intracranial
a) 1000mL in the first 8 hours the 1000mL pressure? *
on the remaining 16 hrs a. Vomiting
b) 1400 mL in the first 8 hours the 1400 mL b. All of the above
on the remaining 16 hrs c. Increase blood pressure
c) 1080mL in the first 8 hours the 1080mL d. Papilledema
on the remaining 16 hrs
d) 1240mL in the first 8 hours the 1240mL
on the remaining 16 hrs
43. After a day of fluid resuscitation. Patient

is presenting signs of over fluid
resuscitation. Which of the following
condition is expected to happen? *
a) Poor peripheral color
b) Pulmonary edema
c) Oliguria
d) Restlessness
CASE: A 10 year old girl was accidentally hit by

a car on the parking area outside their
school. The child was able to open his
eyes to pain, and able to localize to pain,
the child was consolable. You
responded at the scene and noted
the following VS: HR: 110 bpm, BP:
80/60 mmhg, RR:40 cpm, WT: 30 kg.
44. After several minutes at the ER, patient

became cyanotic. What are the possible
problems of the patient? *
a) Hypoxia
b) Hemothorax
c) Inadequate ventilation
d) All of the above
45. What is the appropriate thing to do

for this patient at this point? *
a) Blood transfusion
b) Insert large bore IV catheters
c) All of the above
d) Volume replacement using 20-40 ml
kg warm isotonic solution
46. On further evaluation at the ER. BP:

80/50 mmhg, HR: 136bpm, PR: absent,
skin- cyanotic. Left chest: diminished breath
sounds. On chest xray: hemothorax on the
left.Urine output : minimal What is the
extent of blood loss? *
a) None of the above
b) Mild
c) Not significant blood loss
d) Severe
e) Moderate
47. What is the appropriate step to do as a

medical student? *
a) All of the above
b) Give Intavenous fluids if available if
available
|pg. 3
PEDIATRICS-2
1ST SEMESTER
SHIFTING EXAM 7
PULMONOLOGY (Dr. Angos)
1. Diagnostic of choice for obstructive lung disease that D. CAP High risk patient still febrile and
can also test for reversibility hypotensive.
A. Chest xray
B. Chest CT scan 13. This occurs when systemic factors influence the
C. Spirometry formation and absorption of pleural fluid
D. Chest ultrasound A. Bacterial pneumonia
B. Malignancy
2. What is the effect of cigarette smoke on the airway, C. Cirrhosis
which predisposes COPD patients to bacterial D. Tuberculosis
infection with neutrophilia?
A. Proliferation of lymphoid follicles 14. Presence of ferruginous bodies on Bronchoalveolar
B. Inhibition of mammalian target of rapamycin lavage is diagnostic of which ILD?
C. Impaired macrophage phagocytosis A. Idiopathic pulmonary fibrosis
D. Decreased B cells B. Hypersensitivity pneumonitis
C. Asbestosis
3. Most common reason for poor asthma control: D. Diffuse alveolar damage
A. Poor compliance with medication
B. Allergen exposure 15. Which of the following ILDs that does NOT present
C. Severe rhinosinusitis with granulomatous lesions?
D. GERD A. Sarcoidosis
B. Wegener’s disease
4. A patient with pancreatitis developed ARDS. The C. Asbestosis
PaO2 on blood gas was 30 on FiO2 of 21 percent. D. Hypersensitivity pneumonitis
What type of ARDS does he have?
A. Mild 16. Which of the following is a central histopathologic
B. Moderate finding in Interstisial lung disease(ILD) ?
C. Severe A. Inflammation and fibrosis
D. Need more information B. Interstitial edema
C. Interstitial necrosis
5. Which of the following is an indirect cause of lung D. Granulation tissue formation
injury associated with ARDS?
A. Near drowning 17. Most valuable imaging technique for evaluating
B. Toxic inhalation mediastinal masses
C. Pancreatitis A. Chest xray
D. Pulmonary contusion B. CT scan
C. MRI
6. Most common extrapulmonary TB (EPTB): D. Ultrasound
A. Pott’s disease
B. Pleural TB 18. Which of the following OTC cough preparations help
C. Laryngeal TB in clearing secretions in patients with bronchiectasis:
D. TB lymphadenitis A. Carbocisteine
B. Dextromethorphan
7. Which of the following is NOT part of the basic C. Butamirate
principle of mechanical ventilator support? D. Salbutamol
A. Avoiding ventilator induced lung injury (VILI)
B. Permissive hypercapnia 19. Which of the following can cause both focal and
C. Adequate volume not to cause overstretch diffuse bronchiectasis:
D. Permissive hypoxemia A. Endobronchial tumor
B. Aspiration pneumonia
8. Which of the following ILDs does NOT respond to C. Pulmonary tuberculosis
steroids? D. Rheumatoid arthritis
A. Nonspecific interstitial pneumonia
B. Usual interstitial pneumonia 20. Bronchi undergo changes resulting in COPD. Which
C. Cryptogenic organizing pneumonia of these changes lead to airflow limitation?
D. Desquamative interstitial pneumonia A. Smooth muscle hypertrophy
B. Mucus gland enlargement
9. This antibiotic is recommended if CA-MRSA is C. Goblet cell hyperplasia
considered as the cause of pneumonia: D. Squamous metaplasia
A. Gentamicin
B. Meropenem 21. Which COPD patient will need home oxygen
C. Linezolid supplementation?
D. Levofloxacin A. Room air PaO2 of 58mmhg without other
accompanying signs and symptoms
10. Recommended antibiotic for pneumonia in the B. Room air O2 saturation of 89%
out-patient setting in a previously healthy patient: C. PaO2 in room air of 59mm hg with
A. Levofloxacin hematocrit of 64 vol%
B. Cefuroxime D. Patient recently discharged after being on
C. Azithromycin mechanical ventilator for 2 weeks for
D. Co-amoxiclav E. respiratory failure.
11. Based on chronicity, which of the following is NOT an 22. Which of the following conditions when non-invasive
example of subacute ILD? ventilation for acute respiratory failure seems
A. Hypersensitivity pneumonitis beneficial?
B. Cryptogenic organizing pneumonia A. Respiratory arrest
C. Drug-induced pneumonitis B. Unresponsiveness
D. SLE pneumonitis C. Inability to clear up secretions
D. Stable myocardial infarction
12. Which of the following situations warrants extubation?
A. Frequent suctioning of ET since patient 23. Eye examination may reveal choroidal tubercles and
cannot cough well. is pathognomonic in up to 30% of:
B. Patient now follows commands after 3 weeks A. TB meningitis
of being unconscious. B. TB uveitis
C. Stroke patient that is GCS 3. C. Miliary TB
|pg. 1
PEDIATRICS-2
1ST SEMESTER
SHIFTING EXAM 7
D. Tuberculous otitis
24. Which of the following is NOT true about

granulomatous lung disease?
A. Sarcoidosis is an example
B. May progress into fibrosis
C. Started as inflammation into the epithelial
lining
D. Started with epitheloid cells organized into
discrete structures
25. A 30 year-old female presented at the clinic for

recurrent cough since 3 months ago. She reports 33. Likely pathogen in patients with severe structural lung
worsening of cough at early morning. She claims her disease:
mother also had unrecalled lung problems. What is A. MRSA
the most likely diagnosis? B. Pseudomonas
A. Heart failure C. Legionella
B. Chronic obstructive pulmonary disease D. Enterobacteriaceae
C. Bronchial asthma
D. Bacterial pneumonia 34. Complete recovery is assured in these patients if
removed from exposure within 6 months of symptoms
26. To be adequate for culture, a sputum sample must A. Exercise-induced asthma
have: B. Corticosteroid-resistant asthma
A. >25 neutrophils and >10 squamous epithelial C. Occupational asthma
cells per low-power field D. Intrinsic asthma
B. <25 neutrophils and <10 squamous epithelial
cells per low-power field. 35. More accurate term for post-primary PTB:
C. >25 neutrophils and <10 squamous epithelial A. Adult-type TB
cells per low-power field B. Reactivation TB
D. <25 neutrophils and >10 squamous epithelial C. Latent TB
cells per low-power field D. Secondary TB
27. This mode of ventilation does NOT use an 36. Major site of increased resistance in most individuals
endotracheal tube thus decreases the risk of with COPD
ventilator associated pneumonia? A. Alveoli
A. PSV B. Large airways
B. AC mode C. Small airways
C. NIV D. Acini
D. SIMV
37. Cardiac complication of pneumonia except:
28. One of the following is not a risk factor for early A. Left ventricular hypertrophy
deterioration in Community-acquired pneumonia: B. Myocardial infarction
A. Hyponatremia C. Arrythmias
B. Hypoglycemia D. Congestive heart failure
C. Hypoalbuminemia
D. Hypovolemia 38. A 30 year-old male was rushed to the ER for multiple
physical injuries secondary to a vehicular accident.
29. Which of the following is NOT an example of Type I He underwent chest tube insertion after there was
respiratory failure? note of a pleural effusion on the right hemithorax.
A. ARDS Fluid was noted to be bloody. When will you consider
B. Pulmonary congestion angiographic coil embolization in this patient
C. COPD A. Pleural hemorrhage exceeding 200ml/hr
D. Sepsis B. Initial drain of 100ml
C. Bloody effusion
30. A 28 year-old asthmatic patient comes in to the clinic D. Hematocrit level >1/2 of peripheral blood
because of her concerns about taking her inhalers
during pregnancy. Which of the following is true about 39. Which tumor is most commonly associated with
asthma in pregnancy? malignant pleural effusion?
A. Inhaler medications are contraindicated in A. Lung carcinoma
pregnancy B. Brain tumor
B. Shift her inhaler corticosteroid to oral C. Prostate cancer
steroids D. Hepatocellular carcinoma
C. Advise her that 1/3 of pregnant asthmatics
improve, 1/3 deteriorate and 1/3 remain 40. Most common manifestation of pleural TB seen on
D. unchanged chest xray:
E. Terminate her pregnancy A. Cavitary formation
B. Pulmonary nodule
31. Upper respiratory tract virus infections are the most C. Unilateral pleural effusion
common triggers of acute severe exacerbations and D. Peripheral reticulo-nodular infiltrates
may invade epithelial cells of the lower as well as the
upper airways. Which among the following is not 41. The importance of dust exposure as a risk factor for
among them? COPD, independent of cigarette smoking, is not
A. Rotavirus certain for most occupational exposures. However, in
B. Respiratoy syncytial virus this certain work population, such occupation is a
C. Coronavirus significant risk factor for the development of
D. Rhinovirus emphysema in both smokers and nonsmokers:
A. Cotton textile dust
32. Which of the following is NOT smoking-related ILD? B. Gold mining
A. Hypersensitivity pneumonitis C. Shellcraft dust
B. Desquamative interstitial pneumonia D. Coal mining
C. Respiratory bronchiolitis-associated lung
disease(RB-ILD) 42. One of the following is not a factor in the development
D. Langerhans cell granulomatosis of tuberculosis (TB):
A. Innate immunologic response
|pg. 2
PEDIATRICS-2
1ST SEMESTER
SHIFTING EXAM 7
B. Non-immunologic defenses 50. Chest CT scan finding/s of bronchiectasis except:

C. Level of function of cell-mediated immunity A. Airway dilatation
D. Degree of infectiousness of the case B. Bronchial wall cysts
C. Ground glass opacities
43. Drug of choice for acute exacerbation of asthma D. Absent bronchial tapering
A. Theophylline
B. Antileukotrienes
C. Inhaled corticosteroid
D. Short-acting B2 agonists
44. This antibiotic can be inhaled and is used for the

treatment of bronchiectasis:
A. Azithromycin 51. Which condition is most commonly associated with
B. Tobramycin secondary pneumothorax?
C. Gentamicin A. Asthma
D. Clarithromycin B. COPD
C. Heart failure
45. The most common symptom of PTB: D. Lung cancer
A. Hemoptysis
B. Unexplained weight loss
C. Chronic cough
D. Low grade afternoon fever
46. This senses the ventilator to initiate an inspiratory

cycle: 52. Which of the following statements is CORRECT
A. Cycle regarding chest xrays in ILDs?
B. Limiting factors A. Chest xray has no value in diagnosing ILDs
C. Mode B. Chest xrays appearance identifies a
D. Trigger particular ILD
C. Chest xray identify patterns that may relate
to a particular ILD
D. Early in the history of ILDs there is diffuse
involvement of the lung parenchyma
53. The most infectious form of EPTB:

47. Upon long-term exposure to cigarette smoke, A. Upper airway TB
inflammatory cells are recruited to the lung; they B. TB meningitis
release proteinases in excess of inhibitors, and if C. Pleural TB
repair is abnormal, this leads to air space destruction D. TB lymphadenitis
and enlargement or emphysema. Matrix
metalloproteinase are secreted by: 54. Common risk factor for Pseudomonas infection:
A. Neutrophils A. Structural lung disease
B. Eosinophils B. HIV infection
C. Macrophages C. Alcoholism
D. A and C D. Recent hospitalization
Matrix metalloproteinase (MMP)-9 exists in neutrophils and is
released on neutrophil activation. Also, MMPs are produced by 55. The bacteria most frequently implicated in COPD
many cell types, including lymphocytes and granulocytes, but exacerbations:
in particular by activated macrophages. A. Haemophilus influenzae
SOURCE: B. Mycoplasma pneumoniae
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC98682/ C. Klebsiella pneumonia
D. Pseudomonas aeruginosa
48. Likely pathogen in a patient who stayed in hotel or on
cruise ship in previous 2 weeks:
A. Legionella spp.
B. H. capsulatum
C. Coxielle burnetii
D. S. aureus
49. Which of the following is the recommended definitive 56. Increased respiratory drive in the systemic
diagnosis for PTB: inflammatory response syndrome (SIRS) can lead to:
A. Sputum microscopy A. Metabolic acidosis
B. Sputum culture B. Metabolic alkalosis
C. Sputum nucleic acid amplification C. Respiratory alkalosis
D. Chest xray D. Respiratory acidosis
57. Diagnostic thoracentesis is indicated in the patients

with heart failure when the following is present
A. Symmetrical pleural effusion — It should be
asymmetrical
SOURCE: Pedia Platinum 1st ed page 315
B. Fever
|pg. 3
PEDIATRICS-2
1ST SEMESTER
SHIFTING EXAM 7
C. Bipedal edema — not mentioned

D. Ascites — not mentioned 62. In the management of ARDS, the following has a
grade A recommendation:
A. Early neuromuscular blockade
B. Minimized left atrial filling pressure
C. High PEEP
D. Low tidal volume
63. Hypoxemia in COPD is largely due to which

mechanism?
A. Shunting
B. Low FIO2
C. V/Q mismatching
D. Elevated pCO2
64. True for the prescription of supplemental oxygen

therapy in stable COPD patients
58. Pyridoxine (10–25 mg/d) should be added to the A. PaO2 of 58mmHg with cor pulmonale
regimen to prevent neuropathy secondary to this B. Titrate to keep sO2 >94%
drug: C. SO2 <90% with hypercapnia over a 3-week
A. Isoniazid period
B. Rifampicin D. Reevaluate after 1 month if oxygen is still
C. Ethambutol needed
D. Pyrazinamide
65. The risk factor for bronchial asthma:

A. Environmental pollution
B. Smoking
C. Genetics
D. Atopy
59. Recommended empiric cephalosporin for VAP if no All in the choices are seemingly the risk factors for bronchial
resistant gramnegative pathogen is considered: asthma (according to Dr. Yu’s lecture). But smoking is
A. Ceftriaxone seemingly the odd one out since smoking is an action word.
B. Ceftazidime Risk factor for asthma indicates inhalation of tobacco smoke
C. Cefepime only.
D. Cefuroxime
60. Which of the following diagnostic work-ups in ILDs is

CORRECT?
A. Diffusing capacity of carbon monoxide
(DLCO) is increased in ILDs — Should be
low DLCO
B. Open lung or transbronchial lung biopsy is
gold standard in the diagnosis
C. High resolution CT scan is comparable to
lung biopsy in the diagnosis of ILDs
D. Chest xray reveals patterns and location that
may help identify specific ILDs — Should be
CT scan, not chest x-ray
SOURCE: Insignis Trans - Bronchial Asthma (Dr. Yu)
66. Wheezing in bronchiectasis is due to:

A. Cystic outpouching
B. Secretions in the alveoli
C. Abnormal bronchodilation
D. Sputum in the airway
61. An 18 year-old male complained of sudden onset of
right-sided chest pain after playing basketball. PE 67. Among the three most common symptoms of COPD,
showed decrease breath sounds on the right. What is which is the principal feature in advanced cases?
the most likely diagnosis? A. Exertional dyspnea
A. Primary spontaneous pneumothorax B. Persistent cough
B. Secondary pneumothorax C. Chronic sputum production
C. Traumatic pneumothorax D. All of the above
D. Tension pneumothorax
Pneumothorax can affect any side of the chest (right or left). 68. COPD patients may develop cor pulmonale when the
The case does not indicate any lung disease or chest injury. FEV1 is decreased to which level?
Therefore, this is a primary spontaneous pneumothorax). A. <60%
B. <25%
C. <50%
D. <15%
69. In this phase of Acute Respiratory Distress Syndrome

(ARDS), condensed plasma proteins aggregate in the
air spaces with cellular debris and dysfunctional
pulmonary surfactant to form hyaline membrane
whorls.
A. Exudative phase
B. Proliferation phase
C. Fibrotic phase
D. Resolution phase
|pg. 4
PEDIATRICS-2
1ST SEMESTER
SHIFTING EXAM 7
D. Note of minimal secretions upon suctioning

70. One of the following is not an “atypical” cause of via ET tube
pneumonia:
A. Klebsiella pneumoniae 80. Most obvious risk factor for ventilator-associated
B. Mycoplasma pneumoniae pneumonia (VAP):
C. Chlamydophila pneumoniae A. Frequent suctioning
D. Legionella spp B. Mechanical ventilator
C. Endotracheal tube
71. One of the following is an unlikely mechanism of how D. Overwhelming infection
micro-organism gain
A. access to the lower respiratory tract: 81. A 53 year-old female presented with episodic cough
B. Aspiration from the oropharynx and dyspnea. PE showed diffuse wheezing.
C. Hematogenous spread Laboratory tests showed negative skin tests for
D. Contiguous extension common allergens with normal serum IgE. What is the
E. Direct contact most likely diagnosis?
A. Occupational asthma
72. Which among the following factors does not favor the B. Exercise-induced asthma
development of asthma C. Intrinsic asthma
A. Widespread use of antibiotics
B. Urban environment 82. Frequent use of this drug appears to be the major risk
C. Sensitization to house dust mites factor for infection with MRSA and extended spectrum
D. TB or measles infection beta-lactamase–positive strains:
A. Macrolides
73. Most common cause of pleural effusion: B. Carbapenems
A. Heart failure C. Fluoroquinolones
B. Liver Cirrhosis D. Cephalosporins
C. Bacterial pneumonia
D. Kidney failure 83. Chemokines, such as IL-8 and granulocyte
colony-stimulating factor are responsible for:
74. Which pulmonary function test results are the most A. Purulent secretions
likely findings in Chronic obstructive pulmonary B. Hyperventilation
disease? C. Hemoptysis
A. Normal TLC, normal RV, increased FEV1, D. Fever
decreased FVC, normal MIP
B. Increased total lung capacity (TLC), 84. The occurrence of optic neuritis is an indication for
decreased vital capacity (VC), decreased permanent discontinuation of this drug:
C. FEV₁/FVC ratio A. Isoniazid
D. Decreased TLC, increased RV, normal B. Rifampicin
FEV₁/FVC ratio, decreased MIP C. Ethambutol
E. Decreased TLC, decreased VC, decreased D. Pyrazinamide
residual volume (RV), decreased FEV₁/FVC
F. ratio, decreased maximum inspiratory 85. A 60-year old asthmatic male patient was treated for
pressure (MIP) an asthma exacerbation. He complains of urinary
retention. Which drug is the most likely offending
75. Which of the following is the recommended screening agent?
test for PTB: A. Short-acting B2 agonists
A. Chest xray B. Anticholinergics
B. Sputum culture C. Theophyllines
C. Sputum nucleic acid amplification D. Systemic glucocorticosteroids
D. Sputum microscopy
86. Which of the following is part of adjunctive
76. Which is of the following is NOT a goal of starting management in intubated patients?
mechanical ventilation? A. Turning to sides on schedule
A. Decrease work of breathing B. Daily bed bath
B. Avoid respiratory muscle fatigue C. Flat on bed to prevent aspiration
C. Reverse life threatening hypoxemia D. Chest physiotherapy
D. Normalize pH to 7.4
87. Which among the following is not a characteristic
77. A 22-year old male, had sudden onset of dyspnea feature of asthma?
after a burn injury. Chest radiograph showed bilateral A. Recurring symptoms
infiltrates, no cardiomegaly. PF ratio is 125. Patient B. Smoking history
has which of the following? C. Airflow obstruction
A. Mild ARDS D. Bronchial hyperresponsivenes
B. Severe ARDS
C. Congestive heart failure 88. In COPD, the major mechanism/s responsible for
D. Moderate ARDS essentially all of the reduction in PaO2 is/are:
A. Ventilation-perfusion mismatch
78. Which of the following will increase the risk for an B. Right to left shunt
asthma exacerbation? C. Diffusion impairment
A. Weight-lifting in a temperature-regulated gym D. Mucus plugs and bronchospasm
B. Swimming in Mactan
C. Playing golf during summer 89. Clinical Conditions Associated likely with MRSA in
D. Running during winter Health Care–Associated Pneumonia are the following
except:
79. Which of the following situations is NOT appropriate A. Hospitalization for ≥ 2 days in prior 3 month
for extubation? B. Chronic dialysis
A. Patient has regained orientation after C. Antibiotic therapy in preceding 3 month
treatment of sepsis in a patient with septic D. Hospitalization for ≥ 48 h
encephalopathy
B. An intubated patient but with note of 90. Which among the following is not part of the aims of
coughing episodes upon suctioning asthma therapy?
C. Hypoxic ischemic encephalopathy patient A. Peak expiratory flow circadian variation
with very poor coughing reflex <20%
|pg. 5
PEDIATRICS-2
1ST SEMESTER
SHIFTING EXAM 7
B. Minimal use of B1-agonist 101.One of the following mechanisms is unlikely to be the

C. No emergency visits cause of GIT TB:
D. Minimal nocturnal symptoms A. Direct extension from adjacent hilar lymph
nodes
91. Erythrocytocytosis in a patient with COPD suggests B. Hematogenous spread
the presence of which of the following? C. Ingestion of milk affected by TB
A. Chronic hypoxemia D. Swallowing of sputum with direct seeding
B. Acute hypercarbia
C. Chronic hypercarbia
D. Compensated metabolic alkalosis
92. A 20 year-old male came in for chronic cough and

dyspnea. Chest xray revealed a left pleural effusion.
To help establish the diagnosis of tuberculous
pleuritis, we should order the following laboratory test
A. Pleural fluid glucose
B. Pleural fluid ADA level
C. Pleural fluid pH
D. Pleural fluid AFB
93. Factors responsible for pneumonia in the out-patient

infected with the multidrug-resistant (MDR) pathogens
previously associated with HAP include the following:
A. Widespread use of potent IV antibiotics
B. Delayed transfer of patients out of
acute-care hospitals to their homes
C. Increased use of in-patient IV antibiotic
therapy
D. General aging of the population
94. This is what the ventilator senses to end an

inspiration:
A. Mode
B. Trigger
C. Cycle
D. Limiting factors
95. Which of the following is not a physical examination

finding of a patient with COPD?
A. Barrel chest
B. Nicotine stained fingers
C. Clubbing
D. Prolonged Expiratory phase
96. Likely percussion finding in a patient with pleural TB:

A. Dull
B. Normal
C. Resonant
D. Tympanytic
97. This is the most common symptom of patients with

ILD?
A. Fever
B. Cough
C. Chest pain
D. Dyspnea
98. AL underwent thoracentesis for a massive pleural

effusion. Pleural fluid analysis showed pleural
fluid/serum protein of 0.6 and pleural fluid/serum LDH
of 0.4. What is the most likely diagnosis?
A. Kidney failure
B. Cirrhosis
C. Left ventricular heart failure
D. Bacterial pneumonia
99. Which of the following is considered a direct cause of

lung injury?
A. Postcardiopulmonary bypass
B. Pulmonary contusion
C. Burns
D. Flail chest
100.The main purpose of the sputum Gram's stain is:

A. Rapid identification of certain bacteria
through their characteristic appearance
B. To differentiate between bacterial and fungal
etiologies
C. To ensure that a sample is suitable for
culture
D. To correlate the growth in the culture with the
predominant microorganism in the GS
|pg. 6
PEDIATRICS-2
1ST SEMESTER
SEMESTRAL EXAM 1
1. A newborn placed under a phototherapy needs a other complaints. No available pre-loss weight. P.E.
maintenance fluid that is: Child is irritable; drinks eagerly when offered water
A. increased by 1.7 times but vomits thereafter, sunken eyes, skin pinch goes
B. increased by 0.7 times back immediately. Vital signs are normal except for
C. Increased by 1.5 times slight tachycardia, wt= 13.8 kg. T=37C. Other P.E.
D. increased by 2 times findings are within normal.
E. increased by 1.2 times Total deficit fluid and deficit sodium for this child are:
A. 828 ml, 25 meq/L
2. A 2 yr old child is consulted for diarrhea of 3 days, B. 1380 ml, 66 meq/L
and severe vomiting few hours prior to consult. No C. 1242 ml, 66 meq/L
other complaints. No available pre-loss weight. P.E. D. 828 ml, 66 meq/ L
Child is irritable; drinks eagerly when offered water E. 1380 ml, 25 meq/L
but vomits thereafter, sunken eyes, skin pinch goes
back immediately. Vital signs are normal except for 11. A fecal loss of 500 ml water in 24 hours is:
slight tachycardia, wt= 13.8 kg. T=37C. Other P.E. A. normal water loss
findings are within normal. B. obligatory loss
A. The pre-loss weight of child based on the C. abnormal water loss
degree of dehydration. D. insensible loss
B. 14. 3 kg E. A, B, and D are correct
C. 14 kg
D. 15.6 kg 12. The part of the gastro intestinal tract that processes
E. 14.6 kg the majority of water absorbed and secreted normally
F. none of the above everyday is the:
A. jejunum
3. The most ideal guide to determine degree of B. duodenum
dehydration is: C. stomach
A. acute weight loss D. all of the above
B. at least 2 signs of dehydration E. colon
C. weight loss
D. urine output 13. The most common cause of death due to diarrhea in
E. thirst children is:
A. acid-base imbalance
4. Children are prone to fluid and electrolytes problem B. dehydration
because they have high metabolic rate C. electrolyte imbalance
A. false D. sepsis
B. true E. malnutrition
5. Skin pinch is performed on the abdomen with pinch 14. The ideal intravenous fluid for hydration of a severely
done along the direction of the: dehydrated child with diarrhea is:
A. horizontal axis A. D5 Water
B. none of the above B. Normosol M
C. any direction on the abdomen C. 0.9% NACL
D. skin pinch is performed in any part of body D. Ringers Lactate
E. vertical axis E. 0.3 % NACL
6. A 2 yr old child is consulted for diarrhea of 3 days, 15. Jerry is an 11-month old baby, who has diarrhea for 3
and severe vomiting few hours prior to consult. No days. He is breastfed and mother continued to
other complaints. No available pre-loss weight. P.E. breastfeed during the diarrhea. Normal fluids given
Child is irritable; drinks eagerly when offered water include water, fresh fruit juice, fresh vegetable soups
but vomits thereafter, sunken eyes, skin pinch goes and occasional bottle of milk. No other complaints.
back immediately. Vital signs are normal except for P.E. findings were normal except that Jerry is
slight tachycardia, wt= 13.8 kg. T=37C. Other P.E. examined irritable, with sunken eyes, the skin pinch
findings are within normal. goes back immediately. He drinks normally from the
What is/are the appropriate initial fluid/s to administer water offered.
to the child. A. Assessment of Jerry’s dehydration using
A. Dextrose free Lactated Ringers WHO table of dehydration:
B. ORS B. B and C correct
C. Dextrose containing Lactated Ringers C. mild to moderate dehydration
D. A and B are correct D. no dehydration
E. A and C are correct E. some dehydration
F. severe dehydration
7. The rate of IV fluid administration may be calculated
as such: 16. Abnormal thirst is generated if the plasma osmolality
A. microdrips per minute is at least increased by:
B. all of the above A. any of the above
C. 4 microdrips in one drop B. 2-3%
D. 60 microdrips in 1 ml C. 3-4%
E. drops per minute D. 4-5%
E. 1-2%
8. Deficit fluid therapy replaces:
A. Previous fluid loss 17. The most common type of dehydration in children with
B. Obligatory loss + ongoing abnormal loss diarrhea according to osmolality disturbance:
C. Obligatory loss + previous fluid loss A. Hypotonic
D. A and C correct B. A, B are correct
E. A, B, C correct C. none of the above
D. hypertonic
9. The normal blood pH is: E. isotonic
A. 7.50-7.55
B. none of the above 18. A 15 kg 3yr-old child who is moderately dehydrated
C. 7.15-7.35 has a deficit fluid of at least:
D. 7.35-7.45 A. 1000 ml
E. 7.45-7.50 B. none of the above
C. 900 ml
10. A 2 yr old child is consulted for diarrhea of 3 days, D. 1350 ml
and severe vomiting few hours prior to consult. No E. 1500 ml
|pg. 1
PEDIATRICS-2
1ST SEMESTER
SEMESTRAL EXAM 1
28. A skin pinch going back slowly within two seconds in

19. A 12 kg child needs a normal maintenance fluid a child with diarrhea is a sign under (WHO table):
volume (Holliday-Segar) of: A. severe dehydration
A. 1200 ml/24 hrs B. some dehydration
B. 1060 ml/24 hrs C. none of the above
C. 1100 ml/24 hrs D. no dehydration
D. 1400 ml/24 hrs E. all kinds of dehydration
E. 855 ml/24 hrs
29. A 2 yr old child is consulted for diarrhea of 3 days,
20. Jerry is an 11-month old baby, who has diarrhea for 3 and severe vomiting few hours prior to consult. No
days. He is breastfed and mother continued to other complaints. No available pre-loss weight. P.E.
breastfeed during the diarrhea. Normal fluids given Child is irritable; drinks eagerly when offered water
include water, fresh fruit juice, fresh vegetable soups but vomits thereafter, sunken eyes, skin pinch goes
and occasional bottle of milk. No other complaints. back immediately. Vital signs are normal except for
P.E. findings were normal except that Jerry is slight tachycardia, wt= 13.8 kg. T=37C. Other P.E.
examined irritable, with sunken eyes, the skin pinch findings are within normal.
goes back immediately. He drinks normally from the What is/are the appropriate treatment plan/s for the
water offered. child.
A. Deficit Therapy WHO
After treatment, Jerry is already alert, no longer B. Treatment Plan B
irritable but eyes are still slightly sunken. One episode C. 24-hr Rehydration Method B
of diarrhea and one episode of vomiting. Assessment D. B and C are correct
of Jerry’s dehydration is: E. A, B, C are correct
A. severe dehydration
B. B and C correct 30. Jerry is an 11-month old baby, who has diarrhea for 3
C. mild to moderate dehydration days. He is breastfed and mother continued to
D. some dehydration breastfeed during the diarrhea. Normal fluids given
E. no dehydration include water, fresh fruit juice, fresh vegetable soups
and occasional bottle of milk. No other complaints.
21. The two most common pathogenic mechanisms of P.E. findings were normal except that Jerry is
infectious diarrhea in children are toxin mediated examined irritable, with sunken eyes, the skin pinch
AND: goes back immediately. He drinks normally from the
A. invasive water offered. For the first 4 hours, what fluid/s is/are
B. oral-fecal given to Jerry.
C. increased peristalsis A. IVF+ORS
D. malabsorption B. ORS + breast milk
E. A and B correct C. ORS+ home fluids
D. ORS
22. Salt sugar solution can be used as home fluid for E. IVF
diarrhea at the following ratio mixed in one liter water:
A. 1 tsp salt: 7 tsp sugar 31. Jerry is an 11-month old baby, who has diarrhea for 3
B. none of the above days. He is breastfed and mother continued to
C. 2 tsp salt: 8 tsp sugar breastfeed during the diarrhea. Normal fluids given
D. 1 tsp salt: 8 tsp sugar include water, fresh fruit juice, fresh vegetable soups
E. 1.5 tsp salt: 8 tsp sugar and occasional bottle of milk. No other complaints.
P.E. findings were normal except that Jerry is
23. Repletion phase of fluid deficit Method B is to repair examined irritable, with sunken eyes, the skin pinch
the: goes back immediately. He drinks normally from the
A. plasma volume water offered. Fluid treatment plan for Jerry:
B. insterstitial fluid volume A. Treatment Plan A
C. intracellular fluid volume B. Treatment Plan B
D. all of the above C. Treatment Plan C
E. remaining ECF volume after plasma D. IVF treatment
E. A and B are correct
24. Reliable indicators that fluid maintenance is adequate
are no loss of weight, abnormal thirst is not generated 32. An infant with 8% percent weight loss has/is:
AND: A. moderate dehydration
A. urine output at 1.5 ml/k/hr B. dehydrated
B. urine output at 0.5 ml/k/hr C. severe dehydration
C. urine output at 1.0 ml/k/hr D. no dehydration
D. A, B, C are correct E. mild dehydration
E. B and C are correct
33. Infant’s total body water and extracellular fluid
25. A child with diarrhea undergoing Treatment Plan B compartment are almost 70% of the body weight.
who vomited once should: A. true
A. gives ORS and IVF B. false
B. B and C are correct
C. stops taking ORS for few minutes then 34. An 8 kg dehydrated, infantin shock needs an initial
resume ORS slowly after fluid volume (Method B) of:
D. gives IVF A. 180 ml in 1 hr
E. stops taking ORS B. 160 ml in 20 minutes
C. 800 ml in 6 hrs
26. Rotavirus is the most common cause of diarrhea in D. 266 ml in one hour
infants. E. 720 ml in 3 hrs
A. true Solution: 8 kg x 100mL = 800 mL
B. false
35. Normal maintenance is fluid needed to replace:
27. To estimate active maintenance to replace on going A. all of the above
fluid losses: B. obligatory loss + mild fever
A. 50-100 ml per watery stool (below 2 yrs old) C. obligatory loss+ mild abnormal loss
B. 10 ml/kg per episode of watery stool D. obligatory loss
C. 2 ml/kg per episode of vomiting E. obligatory loss + urinary loss
D. A and B are correct
E. A, B, C are correct
|pg. 2
PEDIATRICS-2
1ST SEMESTER
SEMESTRAL EXAM 1
D. glucose, sodium chloride potassium chloride,

sodium bicarbonate
E. glucose, sodium chloride, potassium chloride
40. An 8 kg moderately dehydrated infant needs a total

meqs of sodium to replace the deficit:
A. 48 meqs
B. 58 meqs
C. 38 meqs
D. 68 meqs
E. 28 meqs
RATIO:
Calculate Sodium Deficit and Sodium Requirement Formula:
36. A 2 yr old child is consulted for diarrhea of 3 days,

and severe vomiting few hours prior to consult. No
where, desired Na is 145 meq/L.
other complaints. No available pre-loss weight. P.E.
8kg baby is isotonic (see question #38) and that’s 135meq/L.
Child is irritable; drinks eagerly when offered water
but vomits thereafter, sunken eyes, skin pinch goes
Calculation:
back immediately. Vital signs are normal except for
= 0.6 x 8kg x (145 - 135)
slight tachycardia, wt= 13.8 kg. T=37C. Other P.E.
= 48 meqs
findings are within normal.
Describe the degree of dehydration (Severity of
41. Normal plasma osmolality is:
Dehydration Table)
A. none of the above
A. moderate dehydration
B. 290-300 mOSM / kg water
B. no dehydration
C. 265-275 mOSM / kg water
C. mild to moderate dehydration
D. 285-295 mOSM / kg water
D. severe dehydration
E. 300-310 mOSM / kg water
E. mild dehydration
42. The normal respiratory response to metabolic
acidosis is:
A. all of the above
B. hypoventilation
C. hyperventilation
D. alternate hypo and hyperventilation
E. irregular respiration
43. Glucose in oral rehydration solution facilitates the

entry of sodium across the GI mucosa at:
A. any ratio
B. 1:1:5 ratio
C. 2: 1 ratio
D. 1: 1 ratio
E. 1: 2ratio
44. The most important pathologic step in a

toxin-mediated diarrhea is the production of:
A. cytotoxin
B. necrosis
37. Seizure is a common clinical symptom of: C. adenylate cyclase
A. hypomagnesemia D. leukotrienes
B. hypernatremia E. cyclic AMP
C. hypocalcemia
D. A, B, C are correct 45. Jerry is an 11-month old baby, who has diarrhea for 3
E. A and B correct days. He is breastfed and mother continued to
breastfeed during the diarrhea. Normal fluids given
38. A 2 yr old child is consulted for diarrhea of 3 days, include water, fresh fruit juice, fresh vegetable soups
and severe vomiting few hours prior to consult. No and occasional bottle of milk. No other complaints.
other complaints. No available pre-loss weight. P.E. P.E. findings were normal except that Jerry is
Child is irritable; drinks eagerly when offered water examined irritable, with sunken eyes, the skin pinch
but vomits thereafter, sunken eyes, skin pinch goes goes back immediately. He drinks normally from the
back immediately. Vital signs are normal except for water offered.
slight tachycardia, wt= 13.8 kg. T=37C. Other P.E. What is the name of Jerry’s treatment plan now?
findings are within normal. A. Treatment Plan B
Dehydration osmolality if child’s serum sodium done B. Treatment Plan C
was 135 meq/L. C. A and B are correct
A. hypertonic dehydration D. IVF treatment
B. hypotonic dehydration E. Treatment Plan A
C. isotonic dehydration. no osmolality
disturbance 46. An obese child calculated to need 3500 ml/24 hrs of
D. not enough information normal maintenance fluid should instead receive:
RATIO: A. 3500 ml/24 hrs
Isotonic = 135-145 mEq/L B. 2000 ml/24 hrs
Hyponatremic (hypotonic) dehydration = <135 mEq/L C. 2400 ml/24 hrs
Hypernatremic (hypertonic) dehydration >145 mEq/L D. none of the above
SOURCE: E. 3400 ml/24 hrs
https://www.utmb.edu/Pedi_Ed/CoreV2/Fluids/Fluids_print.html
47. A good maintenance fluid should at the minimum
39. The ORS recommended by WHO contains: contain water AND:
A. glucose, sodium chloride, potassium A. glucose
chloride, zinc sulfate B. potassium
B. glucose, sodium chloride, potassium C. sodium
chloride, trisodium citrate D. A B. C are correct
C. glucose, sodium chloride, trisodium citrate E. A and B are correct
|pg. 3
PEDIATRICS-2
1ST SEMESTER
SEMESTRAL EXAM 1
48. Glucose in maintenance fluid is: 58. Ideal body weight for 12 years old
A. provide nutrition A. 39 kg
B. at least 5% B. 38 kg
C. prevent ketone degradation C. 37.5 kg
D. A and C are correct D. 38.5 kg
E. A, B, C are correct E. 39.5 kg
49. Potassium ion loss is comparatively higher if body 59. Ig responsible for hemolysis
fluid lost is through: A. Ig G
A. burns B. Ig M
B. sweat C. Ig A
C. gastric fluid D. Ig D
D. diarrhea E. Ig E
E. ileostomy
60. Baby Andrew was born full term cephalic with birth
weight of 3,500 grams and birth length of 51 cms.The
major task of psychosocial theory’s 1 st stage is:
A. I am what I can achieve
B. I am what I can do
C. I am what I imagine
D. I am what I am given
50. The most immediate correction needed for a fluid and 61. Major differentiation of organs happen
electrolyte problem: A. fertilization
A. correct acid-base imbalance B. preterm
B. correct osmolality C. fetal
C. correct extracellular fluid loss D. ovular
D. restores the plasma volume E. embryonic
E. correct electrolyte imbalance
62. Autism Specific Screening Test is done usually at
51. Matthew can sit alone and creeps. He pulls himself up what age?
and trying to take a few steps. Matthew is in what A. 12 months
stage of development? B. 36 months
A. Toddler C. 18 months
B. Newborn D. 26 months
C. Infancy
D. Pre School 63. Baby Andrew was born full term cephalic with birth
weight of 3,500 grams and birth length of 51 cms. The
52. Ideal length for 10 months baby peak of crying is about what age?
A. 65 cm A. 4 weeks
B. 80 cm B. 2 weeks
C. 75 cm C. 1 week
D. 70 cm D. 6 weeks
E. 85 cm
64. Carl likes to read books and plays soccer. He knows
53. Upper segment and lower segment ratio is for the 4 basic operations of the Arithmetic. He enjoys his
A. identification of obesity achievements as he learns to win recognition.What is
B. for identification of short stature the major fine motor development of Carl at this
C. for identification of complications stage?
D. identification of malnutrition A. points capital letter
E. identification of complications B. pencil control
C. colors beyond borders
54. Baby Andrew was born full term cephalic with birth D. works well with tools
weight of 3,500 grams and birth length of 51 cms.His
birth weight is expected to double at what age? 65. The following are social development of school age
A. 4 mos except:
B. 3 mos A. Forms Groups with Common Social Interest
C. 2 mos B. Plays with Same Sex
D. 5 mos C. Group Play
D. Play in Group of Opposite Sex
55. Rose likes to scribble & draw lines (vertical &
horizontal) since 2 years old. Rose is expected to 66. Milk teeth are completed at _______________
know her age & sex at: A. 2 years old
A. 4 years old B. 6 years old
B. 3 years old C. 5 years old
C. 5 years old D. 3 years old
D. 2 years old E. 4 years old
56. Bea’s mother is worried because she has a slow 67. Bb Ralph was delivered term, by NSD from an 18 yo
growth. She has a poor appetite and likes to explore mother. He had congenital cataract and microcephaly.
the environment a lot. Physically moving around.As BW=2kg BL=46cm CC=30cm were the
Bea grows, she likes to scribble and copies a cross so anthropometric measurements.At 6 mon old, the
her age now is? expected weight of Ralph will be:
A. 4 years old A. 5,600 grams
B. 5 years old B. 3,000 grams
C. 6 years old C. 4.5kg
D. 3 years old D. 6,000 grams
57. Anthropometric measurements easily affected by fats 68. Expected number of teeth at 10 months old
A. head circumference A. 1 teeth
B. height B. no teeth
C. weight for length C. 3 teeth
D. chest circumference D. 2 teeth
E. weight E. 4 teeth
|pg. 4
PEDIATRICS-2
1ST SEMESTER
SEMESTRAL EXAM 1
69. Ideal body weight of 3 years old 79. Ig responsible for respiratory infections
A. 14 kg A. Ig D
B. 13 kg B. Ig G
C. 16 kg C. IgA
D. 15 kg D. IgM
E. 15.5 kg E. Ig E
70. Mid arm circumference with measurement of 12 cm 80. Matthew can sit alone and creeps. He pulls himself up
seen up to the yellow strap color and trying to take a few steps. The following are the
A. moderately malnourished development expectation of his age except
B. severely malnourished A. Ambulation
C. moderately to severe malnourished B. Awareness of Surroundings
D. well – nourished C. Feeding
E. mildly malnourished D. Language Skills
71. Carl likes to read books and plays soccer. He knows 81. Rose likes to scribble & draw lines (vertical &
the 4 basic operations of the Arithmetic. He enjoys his horizontal) since 2 years old. Rose is noted to have a
achievements as he learns to win recognition.Carl’s slow growth since she does not eat much, however
BMI is 30, he is then she is so mobile that her father is anxious she might
A. obese be at risk for injury. What period of growth best
B. normal describes this?
C. overweight A. Toddler
D. lean B. Infancy
C. Pre school age
72. BMI of 27 is D. School age
A. overweight
B. obese 82. Derivatives of endoderm are the following except:
C. normal A. liver
D. small B. pancreas
E. medium C. subcutaneous glands
D. tympanic membrane
73. Head circumference is bigger than chest E. part of urethra
circumference noted at
A. birth 83. Derivatives od mesoderm except
B. adolescent A. dermis
C. toddler B. heart
D. childhood C. muscle
E. adult D. gonads
E. thymus
74. Bb Ralph was delivered term, by NSD from an 18 yo
mother. He had congenital cataract and microcephaly. 84. Ideal height of 8 years old
BW=2kg BL=46cm CC=30cm were the A. 127 cm
anthropometric measurements. Expected length at 10 B. 130 cm
months old, Ralph will be: C. 125 cm
A. 73cm D. 132 cm
B. 71cm E. 135 cm
C. 69.5cm
D. 68cm 85. Matthew can sit alone and creeps. He pulls himself up
and trying to take a few steps. If Birth weight of
75. Neural type of growth follows a sequence except: Matthew is 3 kilograms, what is his weight at 10
A. proximo-distal months?
B. rate of development is the same in all stages A. 8 kilograms
C. gross to precise responses B. 8.6 kilograms
D. cephalo – caudal C. 7,500 grams
E. brain develops with myelination completed D. 8,300 grams
76. Girlie squirms and rolls over trying to reach and grasp 86. Z score of -2 for weight for length
a teddy bear using her palm. She smiles to her A. wasted
mother and babbles. What developmental expectation B. obese
can we expect of Girlie? C. normal
A. language skills D. severely wasted
B. toileting E. overweight
C. school readiness
D. feeding 87. Matthew can sit alone and creeps. He pulls himself up
and trying to take a few steps. What is the expected
77. Rose likes to scribble & draw lines (vertical & fine motor development of Matthew?
horizontal) since 2 years old. When is she expected to A. Object Permanence
draw square? B. Reaching Objects
A. 2 years old C. Crawling
B. 3 years old D. Pincer Grasp
C. 4 years old
D. 5 years old
78. Bb Ralph was delivered term, by NSD from an 18 yo

mother. He had congenital cataract and microcephaly.
BW=2kg BL=46cm CC=30cm were the
anthropometric measurements. At 9 months, Ralph
becomes attached to his yaya & cries when she
leaves. What’s the challenge of this phase in Bowlby’s
88. At 50 cm birth length what’s the expected height at 13
theory of attachment?
years old
A. Attachment in making phase
A. 149 cm
B. Object permanence
B. 160 cm
C. Temperament
C. 180 cm
D. Separation anxiety
|pg. 5
PEDIATRICS-2
1ST SEMESTER
SEMESTRAL EXAM 1
D. 150 cm B. Inductive reasoning

E. 130 cm C. Logical operations
D. Concrete Thoughts
89. Theory that recognizes infant’s emotional tie to the
caregiver. 100.Teratogens are the following except
A. Bowlby’s Attachment Theory A. diabetes
B. Moral Development Theory B. hypertension
C. Intelligence Quotient C. asthma
D. Psychosexual Theory D. X-ray
E. rubella
90. The 1st set of teeth to erupt
A. first molar
B. mandibular central incisor
C. permanent teeth
D. deciduous teeth
E. maxillary central incisor
91. Weight quadruples at

A. 3 years old
B. 6 years old
C. 2 years old
D. 4 years old
E. 5 years old
92. Girlie squirms and rolls over trying to reach and grasp
a teddy bear using her palm. She smiles to her
mother and babbles.How old is Girlie?
A. 1 year old
B. 9 months old
C. 7 months old
D. 3 months old
93. Bea’s mother is worried because she has a slow

growth. She has a poor appetite and likes to explore
the environment a lot. Physically moving
around.Because of Bea’s poor appetite, her Z score
for weight for height is -3 this means
A. she is stunted
B. she is wasted
C. she is severely stunted
D. she is severely wasted
94. Bea’s mother is worried because she has a slow

growth. She has a poor appetite and likes to explore
the environment a lot. Physically moving around.If
Bea runs well and jumps, how old is she?
A. 1 ½ years old
B. 3 years old
C. 2 ½ years old
D. 2 years old
95. Preschool Social Development includes bedtime

stories starting at
A. 36 months
B. 24 months
C. 12 months
D. 48 months
96. Used to correlate risk for cardiovascular disease and

morbidity
A. waist hip ration
B. skin fold thickness
C. BMI
D. US/LS
E. mid arm circumference
97. Ideal body height for 4 years old

A. 110 cm
B. 102 cm
C. 105 cm
D. 100 cm
E. 101 cm
98. Can assess body build more accurately

A. weight for height
B. weight
C. height
D. length
E. head circumference

horizontal) since 2 years old. In cognitive
development at 5-6 years old, what is the
expectation?
A. Abstract reasoning
|pg. 6
PEDIATRICS
2ND SEMESTER
SHIFTING EXAM 8
FLUIDS & ELECTROLYTES (Dr. Angos)
1. Bb Ralph was delivered term, by NSD from an d. adolescent

18 yo mother, He had congenital cataract and e. toddler
microcephaly BW=2kg BL=46cm CC=30cm were
the anthropometrie measurements.At 6 mon old, 12. Used to correlate risk for cardiovascular disease
the expected weight of Ralph will be: and morbidity
a. 1.5kg a. BMI
b. 5,600 gramp b. US/LS
c. 3.000 grams c. skin fold thickness
d. 6,000 grams d. waist hip ration
e. mid arm circumference
horizontal) since 2 years old. When is she 13. Matthew can sit alone and creeps. He pulls
expected to draw square? himself up and trying to take a few steps. The
a. 4 years old following are the development expectation of his
b. 2 years old age except:
c. 5 years old a. Ambulation
d. 3 years old b. Language Skills
c. Feeding
3. Expected number of teeth at 10 months old d. Awareness of Surroundings
a. 4 teeth
b. 3 teeth 14. Bb Ralph was delivered term, by NSD from an 18
c. 1 tooth yo mother. He had congenital cataract and
d. 2 teeth microcephaly BW-2kg BL=46cm CC-30cm were
e. no teeth the anthropometric m measurements. Expected
length at 10 months old, Ralph will be:
4. Mid arm circumference with measurement of 12 a. 73cm
cm seen up to the yellow strap color b. 68cm
a. moderately to devere malnourished c. 69.5cm
b. seretely malinowished d. 71cm
c. moderately me nourished
d. well - nourished 15. Beas mother is worried because she has a slow
e. mildly malnourished growth, She has a poor appetite and likes to
explore the environment a lot. Physically moving
5. Can assess body build more accurately around. If Bea runs well and jumps, how old is
a. head circumference she?
b. length a. 1 ½ years old
c. height b. 3 years old
d. weight for height c. 2 years old
e. weight d. 2 ½ years old
6. Girlie squirms and rolls over trying to reach and 16. lg responsible for hemolysis
grasp a teddy bear using her palm. She smiles to a. Ig A
her mother and babbles How old is Girlie? b. Ig M
a. 7 months old c. Ig D
b. 9 months o d. Ig G
c. 1 year old e. Ig E
d. 3 months old
17. Milk teeth are completed at ________
7. lg responsible for respiratory infections a. 4 years old
a. Ig A b. 3 years old
b. Ig G c. 5 years old
c. Ig E d. 6 years old
d. Ig D e. 2 years old
e. IgM
18. Matthew can sit alone and creeps. He pulls
8. Ideal height of 8 years old himself up and trying to take a few steps. If Birth
a. 132 cm weight of Matthew is 3 kilograms, what is his
b. 125 cm weight at 10 months?
c. 130 cm a. 8,300 grams
d. 135 cm b. 8.6 kilograms
e. 127 cm c. 7,500 grams
d. 8 kilograms
9. Z score of-2 for weight for length
a. obese 19. Bea's mother is worried because she has a slow
b. severely wasted growth. She has a poor appetite and likes to
c. normal explore the environment a lot. Physically moving
d. wasted around. Because of Bea's poor appetite, her Z
e. overweight score for welght for height is -3 this means
a. she is severely wasted
10. Neural type of growth follows a sequence except: b. she is severely stunted
a. gross to precise responses c. she is wasted
b. proximo-distal d. she is stunted
c. brain develops with myelination
completed 20. Girlie squirms and rolls over trying to reach and
d. rare of development is the same in all grasp a teddy bear using her palm. She smiles to
stages her mother and babbles. What developmental
e. cephalo – cauda expectation can we expect of Girlie?
a. language skilla
11. Head circumference is bigger than chest b. school readiness
circumference noted at c. feeding
a. childhood d. toileting
b. birth
c. adult
|pg. 1
PEDIATRICS
2ND SEMESTER
SHIFTING EXAM 8
21. Bb Ralph was delivered term, by NSD from an 18 30. Jerry is an 11-month old baby who has diarrhea
yo mother. He had congenital cataract and for 3 days. He is breastfed and mother continued
microcephaly. BW=2kg BL=46cm CC=30cm were to breastfeed during the diarrhea. Normal fluids
the anthropometric measurements. At 9 months, given include water, fresh fruit juice, fresh
Ralph becomes attached to his yaya & cries vegetable soups and occasional bottle of milk. No
when she leaves. What's the challenge of this other complaints. PE findings were normal except
phase in Bowlby's theory of attachment? that Jerry is examined irritable with sunken eyes,
a. Attachment in making phase the skin pinch goes back Immediately. He drinks
b. Separation anxiety normally from the water offered Fluid treatment
c. Temperament plan for Jerry:
d. Object permanence a. A and B are correct
b. Treatment Plan C
22. Major differentiation of organs happen c. Treatment Plan A
a. embryonic d. IVF treatment
b. fertilization e. Treatment Plan B
c. fetal
d. preterm 31. A 2 yr old child is consulted for diarrhea of 3
e. ovular days, and severe vomiting few hours prior to
consult. No other complaints. No avallable
23. Ideal body height for 4 years old pre-loss weight. RE. Child is irritabie, drinks
a. 101 cm eagerly when offered water but vomits thereafter,
b. 110 cm sunken eyes, skin pinch goes back immediately
c. 105 cm Vital signs are normal except for slight
d. 102 cm tachycardia, wt= 13.8 kg. T=37C Other PE
e. 100 cm findings are within normal.
24. Rose likes to scribble & draw lines (vertical & What is/are the appropriate initial fluids to administer
horizontal) since 2 years old. In cognitive to the child.
development at 5-6 years old, what is the a. Dextrose containing Lactated Ringers
expectation? b. ORS
a. Concrete Thoughts c. A and C are correct
b. Logical operations d. Dextrose free Lactated Ringers
c. Abstractreasoning e. A and B are correct
d. Inductive reasoning
32. Normal plasma osmolality is:
25. The 1st set of teeth to erupt a. none of the above
a. fist molar b. 265-275 mOSM/kg water
b. maxillary central incisor - 6-8 months ni c. 285-295 mOSM/kg water
c. permanent teeth d. 290-300 mOSM/kg water
d. deciduous teeth e. 300-310 mOSM/kg water
e. mandibular central incisor -6-7 months
ni 33. Abnormal thirst is generated if the plasma
osmolality is at least increased by:
26. Weight quadruples at a. 4-5%
a. 2 years old b. any of the above
b. 3 years old c. 1-2%
c. 5 yesrs old d. 2-3%
d. 6 years old e. 3-4%
e. 4 years old
34. An obese child calculated to need 3500 ml/24 hrs
27. A child with diarrhea undergoing Treatment Plan of normal maintenance fluid should instead
B who vomited once should: receive:
a. B and C are correct a. 3400 ml/24hrs
b. stops taking ORS b. 2400 ml/24hrs
c. stops taking ORS for few minutes then c. 2000 ml/24hrs
resume OR slowly after d. 3500 ml/24hrs
d. gives IVF e. none of the above
e. gives ORS and IVF
35. Potassium Ion loss is comparatively higher if
28. A 2 yr old child is consulted for diarrhea of 3 body fluid lost is through:
days, and severe vomiting few hours prior to a. Ileostomy
consult. No other complaints. No available b. sweat
pre-loss weight. PE. Child is irritable, drinks c. burns
eagerly when offered water but vomits thereafter, d. gastric fluid
sunken eyes skin pinch goes back immediately. e. diarrhea
Vital signs are normal except for slight
tachycardia, wt= 13.8 kg. T=37C. Other PE 36. Repletion phase of fuld deficit Method B is to
findings are within normal. repair the:
a. plasma volume
What is/are the appropriate treatment plan/s for the b. insterstitial Rurd volume
child. c. all of the above
a. Deficit Therapy WHO d. intracelluler fluid volume
b. Treatment Plan B e. remaining ECF volume
c. 24-hr Rehydration Method B
d. A, B, C are correct 37. Glucose in maintenance fluid is:
e. B and C are correct a. at least 5%
b. provide nutrition
29. Children are prone to fluid and electrolytes c. A, B, C are correct
problem because they have high metabolic rate d. A and C are correct
a. true e. prevent ketone degradation
b. false
38. A newborn placed under a phototherapy needs a
maintenance fluid that is:
|pg. 2
PEDIATRICS
2ND SEMESTER
SHIFTING EXAM 8
a. increased by 1.2 times a. 14.6 kg

b. increased by 1.7 times b. 14 kg
c. increased by 0.7 times c. none of the above
d. increased by 2 times d. 15.6 kg
e. increased by 1.5 times e. 14.3 kg
39. Deficit fluid therapy replaces: 47. The most ideal guide to determine degree of
a. Obligatory loss + ongoing abnormal dehydration is:
loss a. urine output
b. A and C cottect b. at least 2 signs of dehydration
c. A, B, C correct c. weight loss
d. Obligatory logs + previous fluid loss d. acute weight loss
e. Previous fuld loss e. thirst
40. A 2 yr old child is consulted for diarrhea of 3 48. A 2 yr old child is consulted for diarrhea of 3
days, and severe vomiting few hours prior to days, and severe vomiting few hours prior to
consult. No other complaints. No available consult. No other complaints No available
pre-loss weight. RE Child is irritable drinks pre-loss weight RE. Child is irritable, drinks
eagerly when offered water but vomits thereafter, eagerly when offered water but vomits thereafter,
sunken eyes, skin pinch goes back immediately sunken eyes; skin pinch goes back Immediately
Vital signs are normal except for slight Vital signs are normal except for slight
tachycardia, wit= 13.8 kg. T=37C. Other PE tachycardia, wt= 13.8 kg. T=37C. Other PE
findings are within normal. findings are within normal.
Total deficit fluid and deficit sodium for this child are Describe the degree of dehydration (Severity of
a. 1242 mL 66 meq/L Déhydration Table)
b. 828 mL 25 meq/L a. moderate dehydration
c. 828 mL 66 meq/L b. no dehydration
d. 1380 mL 25 meq/L c. mild to moderate dehydration
e. 1380 mL 66 meq/L d. mild dehydration
e. severe dehydration
41. An 8 kg moderately dehydrated infant needs a
total meds of sodium to replace the deficit: 49. An infant with 8% percent weight loss has/is:
a. 68 meqs a. severe dehydration
b. 58 meqs b. no denydrarion
c. 28 meqs c. dehydration
d. 38 meqs d. mild dehydration
e. 48 meqs e. moderate dehydration
42. A good maintenance fluid should at the minimum 50. A 15 kg 3yr-old child who is moderately
contain water AND dehydrated has a deficit fluid of at least:
a. A and B are correct a. none of the above
b. sodium b. 900 ml
c. potassium c. 1000 ml
d. glucose d. 1500 ml
e. A, B, C are correct e. 1350 ml
43. The most common type of dehydration in children 51. The most important pathologie step in a
with diarrhea according to osmolality disturbance: toxin-mediated diarrhea is the production of:
a. Hypertonic a. adenylate cyclase
b. Hypotonic b. cyclic AMP - enterotoxin stimulates the
c. A, B are correct production of cAMP from ATP in the
d. none of the above presence of adenyl cyclase
e. isotonic c. leukotrienes
d. cytotoxin
44. The most immediate correction needed for a fluid e. necrosis
and electrolyte problem:
a. correct osmolality
b. correct extracellular fluid loss
c. correct acid-base imbalance
d. restores the plasma volume
e. correct electrolyte imbalance
45. An 8 kg dehydrated, Infantin shock needs an

initial fluid volume (Method B) of:
a. 180 ml in 1 hr
b. 720 ml in 3 hrs
c. 800 ml in 6 hrs
d. 160 ml in 20 minutes
e. 266 ml in one hour
46. A 2 yr old child is consulted for diarrhea of 3

days, and severe vomiting few hours prior to
consult. No other complaints. No available
pre-loss weight. RE. Child is irritable, drinks
eagerly when offered water but vomits thereafter,
sunken eyes, skin pinch goes back immediately
Vital signs are normal except for slight
tachycardia, wt= 13.8 kg. T=370. Other PE
findings are within normal.
The pre-loss weight of child based on the degree of

dehydration:
|pg. 3
PEDIATRICS
2ND SEMESTER
SHIFTING EXAM 9
GROWTH DEVELOPMENT (Dr. Cabahug)
1. Autism Specific Screening Test is done usually at what age? B. 7800

A. 18 months C. 4500
B. 36 months D. 5800
C. 12 months Source: Trans (Dr. Cabahug) -Growth and Development, pg 3
D. 26 months
12. Baby Cheska is 11 month old. She now begins to
2. The following are the development expectation of his age cuirse furniture. What age do expect her to walk alone?
except: A. 13 Months
A. Awareness of Surroundings B. 11 Months
B. Ambulation C. 12 Months
C. Feeding D. 10 Months
D. Language Skills Source:Trans (Dr Celeste Cabahug) Growth and
Development pg 8 (Insignis): Its 15mos (Toddler/Gross
3. What is the expected fine motor development of Matthew? Motor)Nearest?
A. Pincer Grasp
B. Object Permanence 13. What istheaverage length duringthefirstyearof life?
C. Crawling A. 20cm
D. Reaching Objects B. 30cm
SOURCE: Trans (Dr. Cabahug) -Growth and Development, pg C. 25cm
8 D. 35cm
Source: Trans(Dr. Cabahug) -Growthand
CASE: Rose likes to scribble & draw lines (vertical & horizontal) Development, pg4
since 2 y.o.
14. One of the following is not used to measure for
4. Rose is noted to have a slow growth since she does not growth assessment in infants and toddlers<2y.o.
eat much, however she is so mobile that her father is anxious A. Weight
she might be at risk for injury. What period of growth best B. Length
describes this? C. Chest Circumference
A. School age D. HeadCircumference
B. Toddler Source: Trans(Dr. Cabahug) -Growthand
C. Infancy Development, pg4
D. Pre school age
Source: Trans (Dr. Cabahug) -Growth and Development, pg 8 15. Expectednumberofteethat10 monthsold:
A. 1 teeth
5. Rose is expected to know her age & sex at: B. 3 teeth
A. 4 years old C. 2 teeth
B. 5 years old D. no teeth
C. 2 years old E. 4 teeth
D. 3 years old Source:Trans(Dr CelesteCabahug)Growth andDevelontpg6(Insi
Source: Trans (Dr. Cabahug) -Growth and Development, pg 9 gnis): Central incisor, Lateral incisor and 1st molar
6. In cognitive development of school age and adolescence, 16. Ideal bodywtof3yearsold

what is the expectation? A. 16kg
A. Abstract reasoning B. 14kg
B. Concrete Thoughts C. 13kg
C. Logical operations D. 15kg
D. Inductive reasoning Source:Trans (Dr Celeste Cabahug) Growth and Develont pg 4
Trans (Dr. Cabahug) -Growth and Development, pg 9 (Insignis)
7. When is she expected to draw square? 17. Ideal body ht for 4 yrs. old.
A. 2 years old A. 102 cm
B. 3 years old B. 105 cm
C. 5 years old C. 101 cm
D. 4 years old D. 110 cm
Source: Trans (Dr. Cabahug) -Growth and Development, pg 8 E. 100 cm
Source:Trans (Dr Celeste Cabahug) Growth and Develont pg 3
8. Expected length at 10 months old, Ralph will be: BL= 46cm (Insignis); Age in yrs x 6 + 77cm
A. 73 cm
B. 69.5 cm 18. Can assess body build more accurately:
C. 68 cm A. weight for height
D. 71 cm B. length
Source: Trans (Dr. Cabahug) -Growth and C. weight
Development, pg 3 D. height
E. head circumference
9. At 9months, Ralph becomes attached to his yaya cries when
she leaves. What's The challenge of this phase in Bowlby's 19. Ig responsible for hemolysis:
Theory? A. Ig E
A. Temperament B. Ig A
B. Attachment in making phase B. Ig G
C. Separationanxiety C. Ig M
D. Object Permanence D. Ig D
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4503931/
10. At 6mos old, the expected weight of Ralphwill be: *
A. 6,000grams 20. At 50 cm birth length what’s the expected height at 13 years
B. 5,600grams old: 130 cm
C. 4.5kg A. 180 cm
D: 7.5kgs B. 140 cm
C. 160 cm
11. Gia 5 months old baby was brought for a well baby checkup D. 150 cm
in your clinic. She was born full term, birth history was Source: Trans (Dr. Cabahug) -Growth and Development, pg 4
unremarkable. Her birthweight is 2900 grams. What is her
expected weight now? 21. Teratogens are the following except:
A. 6800 A. Hypertension
|pg. 1
PEDIATRICS
2ND SEMESTER
SHIFTING EXAM 9
B. Rubella 32. Igresponsibleforrespiratory infections:

C. diabetes A. IgA
D. asthma B. Ig D
C. Ig G
22. Ideal length for 10 months baby: A. 80 cm D. Ig E
B. 85 cm 33. Major differentiation organs happen:
C. 70 cm A. ovular
D. 65 cm B. fetal
E. 75 cm C. preterm
D. embryonic
23. The major task of psychosocial theory’s 1st stage is: E. fertilization
A. I am what I am given Trans (Dr. Cabahug) -Growth and Development, pg 1
B. I am what I can do
C. I am what I imagine 34. The peak of crying is about what age?
D. I am what I can achieve A. 6 weeks
B. 1 week
24. Preschool Social Development includes bedtime stories C. 4 weeks
starting at: D. 2 weeks
A. 12 months
B. 36 months CASE: Girlie squirms and rolls over trying to reach and grasp a
C. 24 months teddy bear using her palm. She smiles to her mother and say
D. 48 months “aah” “ngah” vowel sounds.
Source:Trans (Dr Celeste Cabahug) Growth and
Develont pg 9 (Insignis) Social table 35. What development expectation can we expected of Girlie?
A. Language Skills
25. If Birth weight of Matthew is 3 kilograms, what is his weight B. Feeding
at 10 mo? C. Toileting
A. 7,500 grams D. School readiness
B. 8 kilograms Source: Trans (Dr. Cabahug) -Growth and
C. 8,300 grams Development, pg 8
D. 8.6 kilograms
Source:Trans (Dr Celeste Cabahug) Growth and 36. How old is Girlie?
Develontpg3(Insignis) Parameterstable A. 3 months old
B. 7 months old
26. The following are social development of school age except: C. 1 year old
A. Group Play D. 9 months old
B. Play in Group of Opposite Sex Source: Trans (Dr. Cabahug) -Growth and
C. Plays with Same Sex Development, pg 8
D. Forms Groups with Common Social Interest
Source:Trans(Dr Celeste Cabahug) Growth and Develont
pg9(Insignis) CASE: Carl likes to read books and plays soccer. He knows the
4 basic operations of the Arithmetic. He enjoys his
27. Matthew is in what stage of development? achievements as he learns to win recognition.
A. PreSchool
B. Infancy 37. Carl’s BMI is 30, he is then:
C. Toddler A. Overweight
D. Newborn B. Normal
Source:Trans(DrCeleste Cabahug)Growthand C. Obese
Develont pg8 (Insignis) Trans (Dr. Cabahug) -Growth and
Development, pg 5
28. The 1st set of teeth to erupt:
A. permanent teeth 38. What is the major fine motor development of Carl at
B. deciduous teeth this stage?
C. maxillary central incisor A. Works well with tools
D. mandibularcentral incisor B. Points capital letter
E. firstmolar C. Color beyond borders
Source:Trans(DrCeleste Cabahug)Growthand Develontpg6(Insi D. Pencil control
gnis) Source: Trans (Dr. Cabahug) -Growth and
Development, pg 9
29. BMI of27 is:
A. small
B. medium CASE: Bea’s mother is worried because she has a slow growth.
C. overweight She has a poor appetite and likes to explore the environment a
D. normal lot. Physically moving around.
E. obese
Trans(Dr. Cabahug) -Growth and Development, pg5 39. If Bea runs well and jumps, how old is she?
A. 2 ½ years old
30. Mid arm circumference with measurement of 12cm seen up B. 3 years old
to the yellow strap color: C. 2 years old
A. mildly malnourished D. 1 ½ years old
B. severely malnourished Trans (Dr. Cabahug) -Growth and Development, pg 8
C. moderately malnourished
D. moderately to severe malnourished 40. Bea likes to scribble and copies a cross so her age is:
E. well–nourished A. 4 years old
Source; Trans(dr. Angos 2ndyearNotes)Nutrition B. 5 years old
LecturePart1Pg2 C. 3 years old
Trans (Dr. Cabahug) -Growth and Development, pg 8
31. Neural typeofgrowthfollowsa sequenceexcept:
A. cephalo – caudal 41. Because of Bea’s poor appetite, her Z score for weight for
B. rate of development isthesame in all stages gross to height is -3, this means:
precise responses A. She is severely stunted
C. proximo-distal B. She is severely wasted
D. brain developswithmyelination completed C. She is wasted
|pg. 2
PEDIATRICS
2ND SEMESTER
SHIFTING EXAM 9
D. She is stunted A. Thymus

Trans (Dr. Cabahug) -Growth and Development, pg 5 B. Dermis
C. Muscle
D. Heart
CASE: Baby Andrew was born full term cephalic with birth E. Gonads
weight of 3500 grams and birth length of 51cm.
53. Ideal body weight for 12 years old
42. His birth weight is expected to double at what age? A. 37.5 kg
A. 2 months B. 39.5 kg
B. 4 months C. 38.5 kg
C. 5 months D. 39 kg
D. 3 months Trans (Dr. Cabahug) -Growth and Development, pg 3
43. Anthropometric measurements easily affected by fats:

A. Head circumference
B. Height
C. Weight for length
D. Chest circumference
E. Weight
44. Ideal height of 8 years old:

A. 127 cm
B. 132 cm
C. 135 cm
D. 125 cm
E. 130 cm
45. Head circumference is bigger than chest circumference

noted at:
A. Toddler
B. Adult
C. Childhood
D. Birth
E. Infancy
46. Weight quadruples at:

A. 4 years old
B. 2 years old
C. 6 years old
D. 3 years old
E. 5 years old
47. Milk teeth are completed at ______.

A. 3 years old
B. 5 years old
C. 2 years old
D. 6 years old
E. 4 years old
48. Derivatives of endoderm are the following except:

A. Subcutaneous gland
B. Tympanic membrane
C. Liver
D. Kidney
E. Pancreas
49. Upper segment and lower segment ratio is for:

A. Identification of complications
B. Identification of malnutrition
C. For identification of short stature
D. Identification of Obesity
50. Z score of -2 for wt for length:

A. Wasted
B. Normal
C. Severely wasted
D. Overweight
E. Obese
51. Used to correlate risk for cardiovascular disease and

morbidity:
A. Mid arm circumference
B. US/LS
C. Skin fold thickness
D. Waist hip ratio
E. BMI
52. Derivatives of mesoderm except:
|pg. 3
PEDIATRICS
2ND SEMESTER
SHIFTING EXAM 10
ADOLESCENT (Dr. Manguilimotan)
1. Contraindication to estrogen-containing methods: current breast cancer, severe cirrhosis, acute deep venous
a) Endometrial myoma thrombosis/pulmonary embolism or history of DVT/PE with higher
b) Current breast CA risk for recurrence, major surgery with prolonged immobilization,
c) Chronic kidney disease diabetes with nephropathy, retinopathy or neuropathy, migraines
d) Recent pregnancy with aura, stage II hypertension, vascular disease, ischemic heart
disease, hepatocellular adenoma or malignant liver tumors, multiple
risk factors for cardiovascular disease, peripartum cardiomyopathy,
postpartum <21 days, complicated solid-organ transplantation,
history of cerebrovascular accident, systemic lupus erythematosus
with positive antiphospholipid antibodies, thrombogenic mutations,
and complicated valvular heart disease.
SOURCE: Nelsons 21ed p.1070
2. Step/s in youth-friendly consultation and interview of The HEADS/SF/FIRST mnemonic, basic or expanded, can be
an adolescent: useful in guiding the interview if encounter forms are not available
(Table 137.4). Based on the assessments, appropriate counseling or
a) Let the accompanying of adolescent referrals are recommended for more thorough probing or for
introduce him/herself in-depth interviewing.
b) Introduce yourself to adolescent
c) State the concern of consultation
d) HEADDSS Nelsons 21ed p.1034
3. This situation is considered as Very Serious see Table 140.1 in Nelsons 21ed. P.1040
assessment of drug use in adolescent:
a) Improving school performance Px has history of accidents falls under +2
b) More than 18 years old
c) History of accidents
d) Use of marijuana and beer
4. Breast asymmetry in females is considered as/with: Breast Asymmetry and Hypomastia

a) Delayed secondary characteristic Some degree of asymmetry is normal in women
b) Hormonal imbalance
c) Hypothyroidism
d) Normal in women Nelsons 21ed. p.2854
5. Psychosocial development of Adolescent period: PSYCHOSOCIAL DEVELOPMENT

a) Cognitive development often follows In contrast to cognitive development, psychosocial development
physical maturation correlates more strongly with pubertal status and physical
b) Correlates more with pubertal and maturation than with chronologic age
physical maturation
c) Is linear to growth processing
d) Affiliations to church and other
environmental factors does not always Nelsons 21ed. p.1018
defines him/herself as individual
6. A 16 year old boy has been managed and followed nelsons 21.ed chapter 19
up at the pediatric outpatient department because of
chronic heart problem. He had a good follow-up
without his parents at the non-urgent care clinic and
his condition is stable over the past years since his
diagnosis. What is the next step in the management
plan of this boy?
a) Refer to a local health care unit and
doesn’t need to be followed up in the tertiary
care center
b) Transitioning to an adult care clinic in
preparation for adult service
c) Referral to a psychiatrist for psychiatric
evaluation for school attendance
d) Monthly follow-up with the pediatric care
for maintenance
7. Myrna is an 17 year old child on peritoneal dialysis

for systemic lupus nephropathy. She recently have a
boyfriend and was planning to have sexual activity.
She consulted to you on the best contraception that
does not affect her present condition. What is the
best contraception for Myrna?
a) Depo-provera injections
b) Intrauterine device
c) Combined oral contraception
d) Fertility awareness
8. This stage of substance abuse involves

cross-addiction, physical and mental retardation:
a) Regular use
b) Burn-out
c) Potential for abuse
d) Experimentation
|pg. 1
PEDIATRICS
2ND SEMESTER
SHIFTING EXAM 10
9. Rocky has been into several fight for the last 6

months. How are you going to assess the behavior
of Rocky?
a) FISTS
b) AUDIT
c) HEADSSS
d) CRAFFT
10. The type of disorder which loses age-appropriate

behavior due to long term use of cannabis:
a) Amotivational syndrome
b) Cannabis overdose syndrome
c) Short term memory syndrome
d) Early dementia syndrome
11. Gender dysphoria in children is:

a) Is part of a normal development
process in the adolescent period
b) Usually the conforming and maturing
adolescent has more prone to the
condition
c) They identify themselves as girl/boy
and create group of individuals that
are like them
d) Marked incongruence between one’s
experienced gender and
12. A 14 year old boy considers himself as gay came to

clinic for URTI. He claimed he had intimate
relationship with his boy-bestfriend in school. How
are you going to provide care for this boy?
a) Evaluate physical health, emotional
and social well-being
b) Give enough condoms in your clinic
for his protection Ask the boy to
separate himself from his best friend
c) Call the parents and discuss with them
the problem
13. This type of drug can result to suppression of Marijuana affects a variety of hormones that are regulated by
testosterone levels and spermatogenesis after hypothalamic function and it appears that the psychoactive
smoking 4days/ week for 6 months: ingredient, THC, is the major compound responsible for this action.
a) Amphitamines It is probable that THC affects these hormones through its ability to
b) Opiods alter various neural transmitters in the hypothalamus or neural
c) Alcohol transmitters in the CNS which impinge on the hypothalamus. The
d) Marijuana THC-induced block of GnRH release results in lowered LH and
FSH which is responsible for reduced testosterone production
by the Leydig cells of the testi
Source: https://pubmed.ncbi.nlm.nih.gov/6090909/
14. Physical examination finding/s of pregnancy: The Goodell sign refers to a probable sign of pregnancy,
a) Uterine epithelial hypertrophy characterized by softening of the cervix. A positive Goodell sign
b) Cervical softening and cyanosis occurs due to increased blood flow noticed in the cervix during the
c) Abdominal enlargement first 4 to 8 weeks of pregnancy, which can also give the vaginal part
d) Vaginal mucosal bleeding of the cervix a bluish appearance (Chadwick sign
|pg. 2
PEDIATRICS
2ND SEMESTER
SHIFTING EXAM 10
Source:
https://www.osmosis.org/answers/goodell-sign#:~:text=The%20Goo
dell%20sign%20refers%20to,bluish%20appearance%20(Chadwick
%20sign).
15. A normal looking adolescent female came for One cause or anovulation may be an immature
consultation due to irregular menstrual cycle. On hypothalamic-pituitary-ovarian axis. The fact that initial menstrual
PE, secondary characteristics are fully developed. cycles are usually irregular and often anovulatory implies that a
You performed laboratory examination showed maturation process is taking place in the HPO axis and that cyclic
within normal limits. What could be the reason of an ovulatory menstruation begins only when adequate maturation
abnormal menstruation? occurs. Moreover, the external appearance of the ovary of a
a) The presence of endometriosis can severely oligomenorrheic or amenorrheic female frequently is similar
affect the blood flow to that of a prepubertal female--this is, the ovary appears normal in
b) Abnormal uterine bleeding can be size of slightly smaller, has a smooth, glistening surface without
due to uterine cancer convolutions, and its capsule-like outer surface reveals few, if any,
c) Abnormal secretion of menstrual underlying follicles.
hormones from the ovaries
d) Immaturity of the hypothalamic Source:
pituitary ovarian axis https://pubmed.ncbi.nlm.nih.gov/1089157/#:~:text=One%20cause%
20or%20anovulation%20may,only%20when%20adequate%20matur
ation%20occurs.
16. One of the situation below is considered as a Protective Factors associated with family
protective factors at HOME: 1. Relationship based on family bond
a) Transferring to dormitories 2. Positive support within the family
b) Separation of parents 3. Adequate parental supervision
c) Adolescent’s closeness to family 4. Respect for friends by parents
members 5. Closeness between parents and children (affection)
d) Engaging in church activities 6. Consistent disciplinary methods
7. Adequate parental behaviour and practices
Source:
https://www.publicsafety.gc.ca/cnt/rsrcs/pblctns/wht-knw/index-en.as
px
17. Extensive investigation is warranted in: Girls without breast development by 13 years of age should be
a) Lack of pubertal signs for female evaluated for delayed puberty, and girls without menarche by 15
age 13 years- pubertal delay years of age should be evaluated for primary amenorrhea.
b) Irregular menstrual flow at 16 years
old female
c) Fad dieters and extreme exercise
among female athletes
d) Dysmenorrhea in a 15 year old Source: https://www.aafp.org/afp/2017/1101/p590.html
female adolescent
18. One of the reasons of heightened emotional Frontal lobe disorder, also frontal lobe syndrome, is an impairment
vulnerability and risk taking behavior among of the frontal lobe that occurs due to disease or frontal lobe injury.[
adolescent is because of: The frontal lobe of the brain plays a key role in executive functions
a) Inconsistent parenting such as motivation, planning, social behaviour, and speech
b) Ineffective discipline production. Frontal lobe syndrome can be caused by a range of
c) Incomplete frontal lobe maturation conditions including head trauma, tumours, neurodegenerative
d) Mental health problems diseases, Neurodevelopmental disorders, neurosurgery and
cerebrovascular disease. Frontal lobe impairment can be detected
by recognition of typical signs and symptoms, use of simple
screening tests, and specialist neurological testing.
Source: https://en.wikipedia.org/wiki/Frontal_lobe_disorder
19. This type of rape is not always reported and less Most rapes are perpetrated by a person known to the victim.
likely to proceed with criminal prosecution: However, acquaintance rape is less likely to be reported than
a) Drug-facilitated rape stranger rape
b) Date rape
c) Statutory rape https://en.wikipedia.org/wiki/Acquaintance_rape
d) Acquaintance rape
20. Transgender identity development: During the exploration stage, people develop new relationships,
a) Coming out stage is changes in practice gender expression, manage navigating the binary view of
gender role are considered others, and enact stereotypes of the opposite sex
b) Intimacy stage when transgender
identity is no longer the most https://files.eric.ed.gov/fulltext/EJ1258650.pdf
important signifier of identity
c) Pre-coming out involves

acknowledging one’s self to others
d) Exploration stage is experimenting
various options of being a transgender
21. Primary consideration of nipple discharge in men Discharge from a man's breast is not normal and should always be
and women: checked by a doctor. Nipple discharge may be a symptom of an
a) Hormonal imbalance infection, a side effect of a medicine, or maybe a symptom of breast
b) Malignancy cancer.
c) Increase estrogen stimulation
|pg. 3
PEDIATRICS
2ND SEMESTER
SHIFTING EXAM 10
d) Pregnancy https://myhealth.alberta.ca/Health/aftercareinformation/pages/conditi
ons.aspx?hwid=abq7374
22. Emotional distress and functional impairment, with Premenstrual syndrome (PMS) has a wide variety of signs and
dysmenorrhea: symptoms, including mood swings, tender breasts, food cravings,
a) PMDD fatigue, irritability and depression.
b) PMS
c) PTSD
d) ADMS
23. Roel is considered as rebellious adolescent and he These youths offend only in their teenage years. So their
is involve in vandalism and running away from involvement in crime is only temporary. And once they get older,
home. What is the type of antisocial youth that Roel they stop offending.
has?
a) Persistent offenders https://criminologyweb.com/juvenile-delinquency-two-types-of-crimin
b) Juvenile delinquent al-careers/#:~:text=well%20into%20adulthood.-,Adolescence%2DLi
c) Oppositional defiant disorders mited%20Offenders,get%20older%2C%20they%20stop%20offendin
d) Adolescent limited offenders g.
- Case does not apply to the other choices
24. The condition/syndrome of female breast Poland syndrome includes the features of ipsilateral breast and
abnormality associated with pectoralis muscle nipple hypoplasia and/or aplasia, deficiency of subcutaneous fat and
aplasia and rib deformities: axillary hair, absence of the sternal head of the pectoralis major
a) Holland syndrome muscle, hypoplasia of the rib cage, and hypoplasia of the upper
b) Moebius syndrome extremity.
c) Poland syndrome https://emedicine.medscape.com/article/1273664-overview#a1
d) Stockholm syndrome
25. One of the sentences below is TRUE about

adolescent drug use: High risk taking behavior is
always the reason why adolescent are more prone
to become addicted to drugs
a) Psychiatrist are always needed in

order to diagnose substance abuse
among the adolescent population
b) Among the adolescent who uses
drugs the parents are either terrorizing
them or giving them difficult tasks to
overcome the addictions
c) This stage of transgender identity will
proceed with other human
development tasks including dating
and relationships:
d) Intimacy Exploration Coming out
Integration
26. If initial laboratory examination for amenorrhea RATIO:

showed low or normal FSH, diagnosis of ______ is
considered:
a) Ovarian insufficiency
b) Anatomic abnormality
c) Constitutional delay
d) Pregnancy
SOURCE: BOOK: Part XII; P. 1060; Nelson's Textbook of Pediatrics

21e
27. Approach to youth violence prevention:

a) Tertiary prevention: handgun ban
b) Primary prevention: increase police
|pg. 4
PEDIATRICS
2ND SEMESTER
SHIFTING EXAM 10
presence
c) Secondary prevention: substance
abuse treatment for perpetrators
d) Primary prevention: violence
anticipatory guidelines
28. Tony is a 16 years old with history of multiple RATIO:

injuries due to driving under the influence of drug.
He has been in and out of the institution for a year
now, When you review his history, he is already
using it daily because his family is already
neglecting him. What stage of substance abuse
does Tony have?
a) Regular use
b) Potential use
c) Burnout
d) Experimentation

21e
29. Levi is a homosexual adolescent in the stage where RATIO:

he wants to explore his sexuality by having a
relationship to someone. You discuss about sexual
education and contraception. Among the
contraceptions below which is the best to protect
Levi from acquiring STI?
a) Spermicide
b) Condom
c) Sponge
d) Withdrawal

21e
30. Gender non-conformity behavior is: RATIO:

a) Common in boys than in girls
b) Always a precedent to transgender
identity
c) Is a part of normal sexual
development
d) Is always associated with gender
dysphoria
|pg. 5
PEDIATRICS
2ND SEMESTER
SHIFTING EXAM 10
SOURCE: TRANS: page 3; 2. Insignis Pedia Adolescent Gender _

Sexual Identity, GLB, Transgender Care (1)
31. Example of combined hormonal contraception:

a) Transdermal hormonal patch
b) Long-acting reversible contraception
c) Etonogestrel oral pill
d) Intrauterine device
32. Ramil is a 14 year old boy with family history of drug

abuse. He recently goes into this activity because of
influence of an older brother at home and they use it
together after school around 3 times in a week.
Everytime he use the drug his grades has improved.
How do you classify the seriousness of Ramil’s drug
use?
a) Needs referral
b) Very serious
c) Less worrisome
d) Serious
33. Lola is an 18 years old diagnosed case of RHD in

failure for a month now. She recently has a partner.
Which is considered as the most effective and
safest contraception for Lola?
a) Abstinence
b) IUDs
c) Vasectomy
d) Implants
34. This type of contraception is very effective and

considered as having typical failure rate of <1%:
a) Vasectomy
b) Diaphragm
c) Condom Ring
35. Which among the situation/scenario below that

needs further investigation?
a) Absence of menstruation at the age
of >15 years old
b) An individual of any age that requires
NSAIDS during menstruation
c) Menstrual flow that is observed at
around 11 years old
d) An adolescent with regular
menstruation but sexually active
36. One of the following phrases below is a protective

factors for substance abuse prevention:
a) Individual aggressiveness
b) Strong neighborhood attachment
c) Drug availability in the community
d) Consistent attachment to religious
group
|pg. 6
PEDIATRICS
2ND SEMESTER
SHIFTING EXAM 10
37. Laboratory evaluation of sexual assault within 8-12

hours:
a) Blood for comprehensive toxicology
b) Pregnancy test kit
c) Forensic evidence kit
d) Urine and blood for date rape drugs
38. Characterized by severe non-cyclic pain at time of During a woman's regular menstrual cycle, this tissue builds up and
menses which showed abnormal implants of is shed if she does not become pregnant. Women with
endometrial tissues outside the uterus on imaging endometriosis develop tissue that looks and acts like endometrial
technique: tissue outside of the uterus, usually on other reproductive organs
a) Pelvic inflammatory disease inside the pelvis or in the abdominal cavity. Each month, this
b) Endometriosis misplaced tissue responds to the hormonal changes of the
c) Mittelsmirsch menstrual cycle by building up and breaking down just as the
d) Tube pregnancy endometrium does, resulting in small bleeding inside of the pelvis.
This leads to inflammation, swelling and scarring of the normal
tissue surrounding the endometriosis implants.
39. Emergency contraception:

a) Prevent fertilization
b) Causes malignancy disorders
c) Indicated for rape victims
d) Effective only after 120 hours from
intercourse
40. A TRUE GYNECOMASTIA is characterized by:

a) Diffuse bilateral adiposity of the anterior
chest walls
b) Regression of mass overtime up to 90% in
adolescent period
c) Painful palpable mass that may involve
the chest muscles
d) Discrete disk of palpable glandular tissue
under the nipple areolar complex
41. Most common STI among sexually experience

adolescents:
a) Syphilis
b) HIV
c) Hepatitis
d) Gonorrhea
42. An adolescent cancer was brought to the ER for

morphine intoxication. What will be the antidote?
a) Naloxone
b) Acetylcysteine
c) fomepizole
d) Haloperidol
|pg. 7
PEDIATRICS
2ND SEMESTER
SHIFTING EXAM 10
43. Considered as a risk factor in psychosocial Ratio:

interview of adolescent:
a) Dieting or skipping meals

b) Authoritative parents
c) Engaging in church activities
d) Enrolled or employed
Source: Nelson’s Textbook 20e - p 126
44. Condoms, diaphragm and fertility awareness

method belongs to tier 3. It means
a) It has the least side effect

b) The most effective contraception
c) It has pregnancy failure of 13%
d) It is most safe method of contraception
45. According to many studies, mortality and morbidity Ratio:

among adolescents are due to behavioural rather
than infections. Which among the reasons below is
a cause of inability of adolescent to access to health
care?
a) Limited health care coverage compared to
other age group
b) Adolescents rarely get sick because
immune system are already mature
c) Prolong health seeking behavior that runs
in the family
d) The family doesn’t have any budget for
the adolescent health care
46. Mechanism of action for combined hormonal Ratio:

contraception:
a) Prevents fertilization
b) Prevents implantation
c) Inhibits ovulation
d) Inhibits sperm penetration
Source:Nelson’s Textbook 20e - p 974
47. Rowena is a 13 years old female came in because Ratio:

of amenorrhea for 5 months already. She had her
menarche at 11.5 years old and claimed to have
regular menstruation after few months. Recently
she was involved with ballet dancing and she has
an upcoming performance. What will be the best
management of Rowena?
a) Investigate ovarian insufficiency like an
idiopathic or autoimmune disorder
b) Get CBC and urinalysis for possible
underlying pathologic condition
c) Check anthropometric measurements for
possible functional hypothalamic causes
d) Perform PE and look for signs of
hyperandrogenism
|pg. 8
PEDIATRICS
2ND SEMESTER
SHIFTING EXAM 10
48. Primary dysmenorrhea is: Ratio:

a) An initial manifestation of pelvic
inflammatory disease
b) Common in adolescent without specific
pathology
c) Uterine cramps usually happen in
between menses
d) Always associated with pelvic
abnormalities
Source: Comprehensive Gyne 7e - p 815
49. Example for management associated with Ratio:

dysmenorrhea syndrome:
a) Advance antipsychotic medication
b) Diet modification
c) Combined OCPs
d) Avoidance of alcohol and drugs
Source: Comprehensive Gyne 7e - p 817
|pg. 9
PEDIATRICS
2ND SEMESTER
SHIFTING EXAM 11
ENDOCRINE (Dr. Uy)
1. During the first year of life , an infant who weighs 7.5 C. Both the osmotic diuresis and the kaliuretic
lbs at birth ordinarily would gain about: effect of the
A. 15 lb D. hyperaldosteronism excrete the potassium
B. 20 lb via the urine
C. 5 lb E. Ketonuria inhibit renal losses of potassium
D. 10 lb and phosphate
2. Gender of the external genitalia becomes clearly 11. Which of the following statements is true regarding
distinguishable by gestational age: the nutritional management of a child with T1DM?
A. 12 Wks A. Approximately 70% of the carbohydrate
B. 8 Wks content should be derived from complex
C. 20 Wks carbohydrates such as starch
D. 16 Wks B. The caloric mixture should comprise
approximately 35% carbohydrates, 30% fats
3. Common side effects of insulin includes: and 35% protein
A. Cellulitis or abscess commonly occur at the C. The prevalence of overweight children and
injection site. adolescents with T1DM has decreased over
B. Rebound hyperglycemia the past 20 years
C. Lipohypertrophy D. Special nutritional requirements are needed
D. Weight loss for the diabetic child to have optimal growth
and development
4. Prepubertal annual increase in height in children is
closest to: 12. During the first month of life, head circumference
A. 5-7 cm grows about:
B. 8-10 cm A. 5 cm
C. 1-2 cm B. 7.5 cm
D. 3-4 cm C. 2.5 cm
D. 1.25 cm
5. A 15-year-old girl presents to her primary care
physician because her mother is concerned that she 13. Ovulation usually:
has not yet begun menstruating. Maternal menarche A. follows menarche by 12-24months
was at age 13 years. She is in the 9th grade and does B. precedes menarche by 1-2 months
well in school. She does not participate in sports but C. follows menarche by 1-2 months
does play in the school band. She denies sexual D. precedes menarche by 12-24 months
activity. On physical examination, her height is 54 in
(< 5th percentile for age), she weighs 102 lb (25th 14. During the second year of life, the average child
percentile for age), and her BMI is 24.6 kg/m2 (85th grows about:
percentile for age). She has Tanner stage 1 breasts A. 5-7 cm
with widely spaced nipples and Tanner 3 stage pubic B. 12-15 cm
hair. Which of the following is this patient’s most likely C. 20-25 cm
diagnosis? D. 7-9 cm
A. Craniopharyngioma
B. Hypothyroidism 15. Which of the following statement is true regarding
C. Turner’s Syndrome constitutional delay in growth and puberty?
D. Polycystic ovarian Disease A. It is one of the variants of normal growth
B. Growth is decrease at 4-6 years of life
6. A child attains 50% of adult height by about age: C. Bone age is consistent with the chronological
A. 48 months age
B. 36 months D. It is a pathological proportionate short
C. 24 months stature
D. 60 months
16. Which of the following statements is true in regards to
7. Menarche in the adolescent girl: the pathogenesis and natural history of T1DM?
A. generally occurs when Tanner stage III A. Environmental factors do not appear to act
breast and pubic hair as accelerators of T1DM
B. development have been achieved B. Breast-feeding does not lower the risk of
C. occurs simultaneously with Tanner stage II T1DM
breast development C. All patients with T1DM with the appearance
D. Precedes the spurt in linear growth of autoimmunity is followed by progressive
destruction of pancreatic B cells
8. Weight gain in infant is a good parameter of overall D. Genetic susceptibility to T1DM is determined
well being. After 2 weeks of age, a term neonate will by several genes with the largest
gain an average of: contribution coming from variants in the HLA
A. 45 grams per day system
B. 15 grams per day
C. 30 grams per day 17. The anterior fontanel usually feels closed on physical
D. 60 grams per day examination:
A. Between 24and 36 months
9. A 15 year old girl with short stature, overweight, neck B. Between 9 and 18 months
webbing, and sexual infantilism is found to have C. Between 3 and 9 months
coarctation of the aorta. A chromosomal analysis D. Between 18 and 24 monthsear-old boy
would demonstrate: presents to his primary care(prepubertal).
A. defect at chromosome 4p16 18. Which of the following is this patient’s most likely
B. mutation at chromosome 15q21.1 diagnosis if testing shows that bone age is consistent
C. normal chromosomal analysis with chronologic age?
D. XO karyotype A. Growth hormone deficiency
B. Hypothyroidism
10. Which of the following statements is true in regards to C. Malnutrition
body potassium loss in a child with DKA? D. Normal growth
A. Total body potassium loss can approach
15-18 meq/ kg 19. Which of the following is the most appropriate next
B. The acidosis move potassium from the step in the management of this patient?
serum to the cell A. Bone age determination
|pg. 1
PEDIATRICS
2ND SEMESTER
SHIFTING EXAM 11
ENDOCRINE (Dr. Uy)
B. Karyotype determination D. than 7.3 Blood pH more than 7.3

C. Thyroid function testing
D. Computed tomography scan of the head 28. Androgen insensitivity syndrome:
A. It is an autosomal recessive condition
20. The first visible sign of puberty in girls is: resulting in a failure of normal
A. appearance of axillary hair masculinization of the external genitalia in
B. development of breast buds chromosomally male individual.
C. menarche B. Affected individuals have normal testes with
D. appearance of pubic hair normal production of testosterone
C. All of the choices are correct
21. The upper segment/ lower segment body ratio which D. There is an abnormal conversion of
is 1.7:1 at birth reaches 1:1 at about age: testosterone to dihydrotestosterone as a
A. 1 year cause
B. 5 years
C. 7 years 29. Which of the following condition/s manifest as
D. 3 years hypogonadotropic hypogonadism?
A. Klinefelter syndrome
22. Overweight and obese children and adolescents are B. Gonadal dysgenesis
at increased risk of developing: C. Turner syndrome
A. Type 2 diabetes D. Kallmann syndrome
B. Growth hormone deficiency
C. Thalassemia
D. Psoriasis
23. Females with severe forms of adrenal hyperplasia

due to deficiencies of the following enzyme/s
has/have ambiguous genitalia at birth due to excess
adrenal androgen production in utero:
A. 21-hdroxylase
B. All of the choices are correct
C. 3 B- hydroxy steroid dehydrogenase
D. 11-B-hydroxylase
24. A 13-year-old girl presents to her primary care

physician because her mother is concerned that she
has not yet begun menstruating. Maternal menarche
was at age 11 years. The patient is on no medications
and has never been hospitalized or had any
surgeries. She is in the 7th grade, does well in school,
and is active in sports. She denies sexual activity. On
physical examination, her height is 60 in (25th
percentile for age), she weighs 94 lb (35th percentile
for age), and her BMI is 18.4 kg/ m2 (45th percentile
for age). She has Tanner stage 3 breasts and pubic
hair. Which of the following is the most appropriate
next step in this patient’s management?
A. Estrogen therapy
B. Follicle-stimulating hormone and luteinizing
hormone determination
C. Reassurance
D. Bone age determination
25. Clinical presentation in males with congenital adrenal

hyperplasia due to 21-hydoxylase deficiency:
A. All of the choices are correct
B. Hypernatremia (hyponatremia) and
hyperglycemia suggest the possibility of
adrenal insufficiency
C. Affected males maybe misdiagnosed as
gastroenteritis or pyloric stenosis, with
potentially disastrous consequences due to
delayed treatment with glucocorticoids.
D. Affected males are generally identified in the
neonatal period because the genitalia are
ambiguous
26. After your intervention, the whole blood glucose is

485 mg/dl. Intravenous fluids and insulin are given,
and the patient is admitted for further care. Which of
the following metabolic abnormalities is most likely to
occur during insulin therapy?
A. hyperphosphatemia
B. hypokalemia
C. hypermagnesemia
D. hyperkalemia
27. In patient with DKA, the determining factors that can

transitioned to oral intake and subcutaneous insulin
from insulin drip would include:
A. Serum CO2 level more than 15 mmol/L No
emesis
B. All of the choices are correct
C. No emesis and Blood pH more
|pg. 2
PEDIATRICS
2ND SEMESTER
SHIFTING EXAM 12
PEDIA EMERGENCY (Dr. Manguilimotan)
1.In the topic, pediatric emergencies and resuscitation, the

indication to begin chest compression would include which of
the following:
a. Less than 100 beats per minute with good perfusion
b. Less than 60 beats per minute with good perfusion
c. Less than 60 beats per minute with poor perfusion O
d. Less than 100 beats per minute with poor perfusion
● A heart rate <60 bpm with poor perfusion is an
indication to begin chest compressions (Insignis
trans)
2.A 12 year old child was brought to the ER because of loss of

consciousness, tachycardia with pulse and poor perfusion.
Initial management will be:
a. Maintain patent airway and assist breathing
b.Complete neurologic examination as soon as possible
c.Call for a code in the hospital and insert advance ventilation
O
d. Provide immediate CPR starting with compression ANSWER: B
● The most common precipitating event for cardiac https://quizlet.com/581918878/150-neo-exam-2-flash-cards/
instability in infants and children is respiratory
insufficiency. Therefore, rapid assessment of 6.High quality CPR is the key to successful pediatric
respiratory failure and immediate restoration of resuscitation for cardiac arrest. The elements of High Quality
adequate ventilation and oxygenation remain the first CPR include the following:
priority in the resuscitation of a child. (Nelson’s 20th a. Compression rate of 100-120 compressions per minute
ed., Chapter 67 p.491) b. Avoid complete chest recoil after each compression
c. Compression rate to 1⁄4 of the anterior-posterior diameter
3.This condition found in patient with shock is considered an d. Allow minimum interruption every compression
ominous sign that the patient has already in late stage of
decrease peripheral perfusion in the major organ of the body.
O
a. Azotemia
b. Hypertension
c. Hyperoxia
d. Acidosis
7.Billy is a medical clerk at the ER called for a code for an

infant because of lethargy and poor perfusion. The patient was
attached to cardiac monitor:
What is the next best thing to do?
4.A 2-year old patient with cough and fever came in with
increase work of breathing and chest retractions. In giving high
flow oxygen you will provide.
a.Non-invasive bilevel positive pressure ventilation
b. 02 cannula at 10-15 liters per minute a. Epinephrine IV
c.Advance ventilation by securing airway using ET tube O b.Vagal maneuver - indicated if: SVT with good perfusion
d. 02 supplementation via non-rebreathing mask c. CPR
d. Insert advance airway
5.Which of the following pictures below is the correct position
to open up the airway of a newborn during resuscitation? 60% Rationale: SVT with poor perfusion
a. None of the above picture is a correct position
|pg. 1
PEDIATRICS
2ND SEMESTER
SHIFTING EXAM 12
b. Insert IV line and give vasopressor O

c.Provide surfactant via ET tube
d. Maintain positive pressure ventilation
11.In the event where the adult chest pads are the only
available in the emergency kits, what will be the best thing to
do as provider to check the cardiac rhythm of a child or infant?
A. Use the chest pads in the usual location in the anterior chest
wall
B.Put the chest pads in the anterior chest and the other at the
back
C.Never use adult chest paddles in the pediatric population O
D.Maybe altered by using the adult hands- on paddles
12.This type of pediatric assessment is the first, quick from the

doorway observation appearance and cardiopulmonary
function:
a. Primary assessment
b. General assessment
c.Tertiary assessment
d. Secondary assessment
Rationale: Nelson’s 20th Edition p. 489
13.An adolescent male of unknown medical history was seen

at the accident area with multiple injuries. As a trained
bystander, what is the first step in the algorithm BLS?
Nelson’s 20th Edition pp. 497-500
a. Check if the scene is safe
b.Look for emergency kits
8. An 8-months old infant with diagnosis of high risk
C.Contact nearest hospital O
pneumonia from a referring hospital came in at the emergency
d. Call for help
room because of severe respiratory symptoms. How do you
describe an infant in impending respiratory failure that requires
ANSWER: A
an immediate respiratory resuscitation?
a. Increase respiratory rate with chest indrawings
RATIONALE:
b. Seesaw breathing with decrease level of sensorium O
c.Increase respiratory effort but able drink water
d. Awake but irritable infant when approach
● BREATHING (Insignis Pediatric Emergencies Trans p.
5)
○ Assessment of breathing includes:
■ Evaluation of the child’s respiratory
rate
■ Respiratory effort
■ Abnormal sounds
■ Pulse oximetry
○ Normal breathing = comfortable, quiet;
occurs at an age-appropriate rate
○ Abnormal breathing: bradypnea, tachypnea,
apnea
○ Bradypnea and irregular respiratory patterns
require urgent attention because they are
often signs of impending respiratory failure
and/or apnea
○ Signs of increased respiratory effort include:
■ Nasal flaring
■ Grunting
■ Chest or neck muscle retraction
■ Head bobbing
■ Seesaw respirations
9. MISSING QUESTION SOURCE: Nelson’s 21st Edition Chapter 81, Page 532
10. A severe dengue patient came in the ER due to severe 14. A newborn baby with good APGAR score showed cyanosis
respiratory distress and in need of advanced ventilation. Upon of the extremities. How will you manage this baby?
intubation noted with bloody secretions in the airway. What is
the next step in the management of this patient?
a.Secure blood products for possible transfusion
|pg. 2
PEDIATRICS
2ND SEMESTER
SHIFTING EXAM 12
c.Activate EMS
d. Call for help
18.A 3 year of Boy admitted for severe asthma exacerbation

was wheeled to the radiology department for chest -ray when
suddenly developed decreased level of sensorium and gasping
breath but there is a definite pulse. How will you initially
manage this patient?
a.Call ambulance
b.Provide rescue breath
C.Perform CPR
d. Compressed chest
a. Prepare for suctioning of the airways
b. Keep the baby warm as this is a normal finding O 19.The definition of sepsis according to International
c. Attach to cardiac monitor with pulse oximeter O Consensus for Pediatric Sepsis:
d.Provide oxygen supplementation a. SIRS plus a suspected or proven infection. (Insignis Trans)
● Vasomotor instability and peripheral circulatory b. The presence of fever plus leukopenia.
sluggishness are revealed by deep redness or purple c.An elevated inflammatory biomarker.
lividity in a crying infant, whose color may darken d. The presence of multi-organ dysfunction.
profoundly with closure of the glottis preceding a
vigorous cry, and by harmless cyanosis 20.In the secondary assessment of a pediatric patient, these
(acrocyanosis) of the hands and feet, especially when components are included to provide adequate information of
they are cool. (Nelson’s 20th Ed. Chapter 94.2 p. 794) cardiorespiratory and neurologic dysfunction:
a. General appearance, consciousness and color – Primary
15.After emergency management for choking/foreign body Assessment
aspiration and the patient becomes unconscious, what is the b. Focused history and physical examination
best thing to do next? c.Laboratory screening of oxygen level in the blood – Tertiary
a. Cardio-pulmonary resuscitation starting from compression Assessment
b. Attempt several mouth to mouth resuscitation d. Patency of the airway and circulatory assessment
c.Open the airway and finger-sweep foreign body O
d. Place on the ground and open the airway
16.A 1-year old girl with a history of vomiting and diarrhea is at

the ER. Upon primary assessment, the infant responding only
to pain. The upper airway is patent, RR-40/min with good
breath sounds, 100% oxygen is administered. The infant has
cool extremities, weak pulses and CRT >3 secs. HR 180/min
BP palpatory 60mmHg, glucose-30mg/dL.
What is the pathophysiologic state of this patient?
a.Uncompensated warm shock
b.Compensated warm shock
c.Uncompensated cold shock
d. Compensated cold shock
21.This type of mechanism of injury is usually found in

drowning or near-drowning accident:
a.Vascular hemorrhage
b.Increase intracranial pressure
c.Interstitial lung edema
d. Hypoxia and ischemia
● The injury following a drowning event is
hypoxia. (source: Nelson’s Pedia 21st Chap
91)
● In drowning, the primary mechanisms of
injury to the central nervous system are
tissue hypoxia and ischemia
(source:https://www.reliasmedia.com/articles
/135278-submersion-and-drowning-injuries)
22.An irritable 6-month old male has a history of vomiting and

diarrhea. He appears pale and has an R of 65 breaths per
minute, HR of 200 beats per minute, and a systolic blood
pressure of 50 mmHg. His extremities are cool and mottled
with a capillary refill time of >2 seconds. After providing 100%
oxygen, what is the best next thing to do?
a. Attach to the monitor to check for the cardiac rhythm
b. Start IV line and give epinephrine at 0.1 mg/kg thru IV
c. Insert IV line and give bolus of isotonic solution 20cc/kg
d. Insert advance ET as eventually this will lead to respiratory
failure
How do you treat decompensated shocks?

Group C patients with hypotensive (decompensated) shock
should be managed more vigorously. Initiate IVF resuscitation
with isotonic crystalloid or a colloid solution at 20 mL/kg as a
bolus given over 15 minutes to bring patient out of shock as
quickly as possible.
https://www.cdc.gov/dengue/training/cme/ccm/page53534.html
17.After 2 minutes of CPR of an 18-year old from the victim of
vehicular accident, the AED analyzed non-shockable. What is 23.A female adolescent patient developed high grade fever for
the best thing to do next? 5 days now. PE showed abscess formation in the perineal
a. Give shock area. Her mother told the doctor that she's been shaving her
b. Resume CPR immediately
|pg. 3
PEDIATRICS
2ND SEMESTER
SHIFTING EXAM 12
pubic hair occasionally. Upon admission, you noted she was d. Provide rescue breathing
confused to questions, lethargic, HR 150, RR 40/min and
pulses are poor in the dorsalis pedis artery with cold, clammy
extremities. What is the pathophysiologic mechanism of
symptoms does this patient had?
a. Extracorporeal fluid loss
b. Low plasma oncotic pressure
C.High hydrostatic pressure
d. Increased vascular permeability
27.Drowning that is common in < 1 year old children are

24.Baby Boy G, a newborn infant was noted to have poor usually in the_
APGAR score because of maternal bleeding. The physician a. Ocean
decided to perform advance ventilation. Which of the following b. Lakes - school-age children
indication below is appropriate in this situation? c. Bath tubs
a.The infant is unable to control the level of oxygen because of d. Swimming pool - children 1-4 years old
severe infection Source: Chap 91, Nelson’s Pedia 21st,
b.The infant is unable to maintain patent airway because of
severe hypoxia 28.Which of the following pictures below is the correct size and
C.The infant needs to be sedated for a procedure/surgery after anatomic position of the mask during positive-pressure
the delivery ventilation of a pediatric patient?
d. The infant is unable to protect airway because secretions
from the upper airway
25.Roman is 3-year old boy in a car accident. You were on 29. This type of maneuver is recommended in infants and
duty in the ER, and you noticed that he is lethargic and has small children in order to provide 100 percent oxygen and
poor peripheral pulses. After a few hours, Romans' condition avoiding obstruction the airways during positive pressure
deteriorated. You decide to perform advance intubation
because of respiratory failure and started on fluid resuscitation
because of circulatory failure. What are the things that you
need to successfully reverse Romans' condition?
a. Emergency anesthesiologist, critical care specialists,
residents
b. Emergency carts, stretchers, paramedic experts in
resuscitations
c.Nurses, medical clerks, PGIs, emergency department
managers
d. Monitors, suction machine, oxygen source, medications,
people
26.You were a passenger in an airplane when a 17-year old

female on peritoneal dialysis due to chronic kidney disease
was found lying on the floor was brought to you because of
unresponsiveness. The crew member recognized you as
medical practitioner hence they called you for help. What is the ventilation:
next step in pediatric BLS algorithm? a. C-E technique
a.Call for help b. Head-tilt chin lift
b. Verify the scene c. Jaw thrust
c. Attach AED d. Sellick's
|pg. 4
PEDIATRICS
2ND SEMESTER
SHIFTING EXAM 12
30.A 4-year old with history of allergy to peanuts accidentally

collapsed while inside the classroom. When you perform initial
BLS, you noticed he had poor perfusion. What type of shock
does this patient have?
a. Anaphylaxis
b. Hypovolemic
c. Septic
d. Cardiogenic
31.A newborn male infant with respiratory distress syndrome

type 1 was intubated immediately upon delivery. After few
hours the patient went into cardiac arrest. What could be the
possible cause cardiorespiratory failure in this situation?
a. Hypoglycemia
b.Hypoxia
c.Hemorrhage
d. Trauma
● Type 1 Respiratory Failure (hypoxemic): is 34.An 18-month old infant with history of cough and fever for 5
associated with damage to lung tissue which prevents days came in due to increase respiratory effort. Which of the
adequate oxygenation of the blood. situations below that requires advance ventilatory
(https://www.medtronic.com/covidien/en-gb/respirator support?
y-and-monitoring-solutions/patient-monitoring-respirat a.Awake but irritable when approach
ory-interventions-blog/operating-room-post-anaesthes b.Sleeping but arousable
ia-care-unit/type-1-and-type-2-respiratory-failure-prev C.Awake with respiratory rate of 66/min
ent-detect-intervene.html#) d. Restless with seesaw breathing
35.Children are particularly susceptible to foreign-body

aspiration and choking. Liquids are the most common cause of
choking in infants, whereas small objects and food (e.g.
grapes, nuts, hot dogs, candies) are the most common source
of foreign bodies in the airways of toddlers and older children.
What age poses the highest risk of airway obstruction?
a. 5-10 years old
b. &It;3 years old
c. &It:5 years old
● d. 10-15 years old
● Children <5 yr old are particularly susceptible to
32. Bedside observation that is present in a patient with warm foreign body aspiration and choking. (source: Chap
shock is_ 81 Nelson’s Pedia)
a. Hypoglycemia
b.Weak peripheral pulses 36.When doing the advance ventilation for a patient in
c.Wide pulse pressure impending respiratory failure, maneuver is use to minimize or
d. Tachycardia prevent aspiration of gastric contents.
a. Sellick's maneuver - or Cricoid pressure is a technique that
Rationale: has become part of rapid sequence intubation to prevent
aspiration of gastric contents.
b. C-E technique - applies the mask by forming a 'C' shape
with each thumb and index finger over each side of the mask
while the third, fourth, and fifth fingers of both hands lift the
mandible toward the mask in a three fingered 'E' shape.
C.Head-tilt chin-lift - procedure used to prevent the tongue
obstructing the upper airways.
d. Jaw thrust - used relieve upper airway obstruction by moving
the tongue anteriorly with the mandible, minimizing the
tongue's ability to obstruct the airway
37.A 2-year old boy playing with his toys suddenly was found
by her mother holding his neck and looks like he was choking.
What is the best immediate management for this boy?
a. Head-tilt chin-lift
33. A child with congenital heart disease found by the b. Heimlich's maneuver
laboratory technician lying in the floor. Emergency response C.Sellick's maneuver
unit was activated and the patient was attach to cardiac d. Jaw thrust
monitor and showed. The patient BP is undetectable and the ● For conscious child >1 yr old (Source: Chap 81
patient has no pulse. What is the best management of this Nelson’s Pedia)
child?
38.Ben is a 10-year old with complaints of high grade fever for
8 days now. He had bicycle accident and acquired a deep
wound in his leg. The mother only concoct some herbs and
place it in the wound area. Few hours prior to admission, Ben
was noted to be lethargic, vomiting his previously ingested
Monomorphic Ventricular Tachycardia– without pulse food and looks very sick. He was brought to nearest hospital
a. Defibrillation where the vital signs shows: BP 70/40mmHg, HR 150/min, RR
b. Synchronize cardioversion 35/min clear lungs, T40C, bounding pulses in the extremities.
c.Cardiorespiratory resuscitation What type of shock does the Ben have?
d. IV epinephrine infusion a.Cardiogenic shock
b. Hypovolemic shock
C.Anaphylactic shock
d. Septic shock
Source: International Consensus Definitions of Pediatric

Sepsis. Pedia EMED Trans page 11
|pg. 5
PEDIATRICS
2ND SEMESTER
SHIFTING EXAM 12
4. Leukocyte count elevated or depressed for age

39.After providing rescue breathing for a 5-year old with (not secondary to chemotherapy) or >10%
gasping breath you check for the pulse. You will perform CPR if immature neutrophils
the patient has.
a.Decreased sensorium 42.Rowe is a 5-year old boy with history of voluminous
b. Gasping breath diarrhea. He was immediately brought to the hospital because
c. HR &/t;100/bpm of decrease level of sensorium and hypotension. What will be
d. Poor perfusion the management of Rowe the emergency department?
a. Cardiac resuscitation
Source: Pediatric BLS Algorithm b.Advance ventilation
c.Oxygen supplementation
d. Fluid resuscitation
● The cornerstone of pediatric diarrhea management is
to ensure proper hydration.
(https://www.sciencedirect.com/science/article/pii/S22
11419X12000717)
● Without adequate volume replacement, hypotension
develops (Insignis Trans)
43.The most common case of cardiopulmonary arrest in infants

and children is:
a. Hemorrhagic shock
b.Myocardial dysfunction
C.Ventricular fibrillation
d. Respiratory insufficiency
44.An infant in the emergency department was brought by a

paramedic but showed lethargic, cyanotic, mottling of the skin.
ECG tracing in a cardiac monitor showed:
What is the best management for this infant?

a. Insert IV and start CPR
b.Give 20cc isotonic solution
c.Start amiodarone IV
d.Defibrillate right away
Source: (not entirely sure)
40.This advance upper airway device is use to maintain airway

patency if the child is unconscious after attempts of
unsuccessful foreign body aspiration:
a. Endotracheal tube
b.Naso/oropharyngeal tube
c.High flow nasal cannula
d. Tracheostomy tube
41.In the international consensus of pediatric sepsis, this is

considered as having SIRS (systemic inflammatory response
syndrome) if the a pediatric patient has_
a.Persistent bradycardia in the absence of vagal stimuli
b. Core temperature of 36.5C in previously-well child
c.Tachycardia in an active child with temperature of 37.5C
d. Elevated leukocvte count in patient with chronic steroid use
RATIO:
TWO of 4 criteria, 1 of which must be abnormal temperature
or abnormal leukocyte count:
1. Core temperature >38.5 C (101.3 F) or < 36.5 C
(96.8 F) (rectal, bladder, oral. Or central catheter
2. Tachycardia:
a. Mean heart rate >2 SD above normal for
age in absence of external stimuli, chronic
drugs or painful stimuli. OR
b. Unexplained persistent elevation over
0.5-4 hr. OR
c. In children <1 yr old, persistent
bradycardia over 0.5 hr (mean heart rate
<10th percentile for age in absence of
45.In an emergency situation where endotracheal intubation is
vagal stimuli, B-blocker drugs, or CHD)
place, how are you going the confirm the proper placement of
3. Respiratory rate >2 SD above normal for age or
ET tube in the airway?
acute need for mechanical ventilation not related to
a. Arterial blood gas determination
neuromuscular disease or general anesthesia
b. Auscultation of the abdomen
|pg. 6
PEDIATRICS
2ND SEMESTER
SHIFTING EXAM 12
C.Analysis of exhaled CO2 using a device

d. Ultrasound of the hemithorax
Source:
https://www.acls.net/confirming-placement-of-endotracheal-tub
e#:~:text=Waveform%20capnography%3A&text=Capnography
%20provides%20the%20most%20reliable,(ETT)%20promptly
%20after%20intubation.
46.This finding in the primary assessment is considered as

with LIFE THREATENING CONDITION and further delay on
the next procedure should be warranted:
a.breathing: RR 35/min
b. airway: alar flaring
c.circulation: hypotension
d. disability: irritable
47.If an individual is not trained for advance airway

management, this maneuver will provide 100 percent 02
saturation to an unconscious patient:
a.Oropharyngeal airway
b. High flow oxygen mask
c. Nasopharyngeal airway
d. Positive pressure ventilation
Source:
https://ahainstructornetwork.americanheart.org/idc/groups/aha
ecc-public/@wcm/@ecc/documents/downloadable/ucm_48140
2.pdf. Page 5
48.A 5 year old boy with history of cough and high grade fever
for >1 week came in because of increase work of breathing.
Among the respiratory problems below which could be the
cause of respiratory distress of this boy?
a.Upper airway foreign body aspiration
b. Acute asthmatic attack
c. Pulmonary parenchymal infection
d. Viral upper airway infection (croup)
Source: Nelson Textbook of Pediatrics, 21st Edition p. 2574
49.Advance ventilation using endotracheal tube insertion is

indicated in this situation:
a. awake adolescent with trismus because of tetanus infection
b. traumatic brain injury with decrease level of sensorium (GCS
≤8)
c. a child with cough with moderate risk pneumonia
d. burn injury in the face with 15% surface area 50.
Source: Nelson Textbook of Pediatrics, 21st Edition p. 2621
|pg. 7
PEDIATRICS
2ND SEMESTER
SHIFTING EXAM 13
RESPIRATORY DISORDERS (Dr. Yu)
1. In a child having watery nasal discharge, cough, body source: 12.01 Disorders of the Upper Respiratory Tract (Dr.
malaise who is positive for Influenza virus, the antiviral drug Dahlia Yu)
to give is:
A. Acyclovir 4. A child with PCAP and severe malnutrition is already
B. Rivabirin classified as
C. Oseltamivir A. Very severe
D. Molnupiravir B. Moderate risk PCAP
C. Non severe
ANSWER: D. High Risk PCAP
ANSWER: A
Source: Pedia Platinum, 1st Edition (2020), Ch12, Section 4,

Page 312, Classification based on WHO Guidelines
5. Treatment for acute uncomplicated sinusitis is:

A. Cefuroxime
B. Amoxycillin
C. Clarithromycin
D. Clindamycin
ANSWER:
Source: Doc Yu’s Trans of “Disorders of the Upper Respiratory 6. Which of the following is not a manifestation of acute
Tract” page 2. epiglottitis?
A. Muffied voice
2. True of common colds: B. Cough
A. Incidence increases with increasing age C. Edematous epiglottis
B. Common cause is bacterial D. Subglottic edema
C. Young children can have 6-8 colds per year
D. Antibiotics is the mainstay treatment ANSWER: B. Cough
Ratio:
ANSWER: C
source: Pediatrics Platinum 1Ed 2020 (Page 301) Section 3
Disorders of the Upper Respiratory Tract
3. The most frequent organism causing common colds or

Rhinitis in children is:
A. Respiratory Synctial Virus
B. CoronaVirus
C. Human metapneumo virus
D. Influenza virus
(source: Pedia Plat. 1Ed. 2020, Chap.12. Sec.3. Page 307)
ANSWER: B
Ratio: The most common cause of common colds in adults and 7. One of the following is part of the supportive management
children is Rhinoviruses but since it isnt included in the in ALTS given to cause vasoconstriction of edematous
choices, Coronavirus is next to it. subglottic mucosa
A. Nebulized Racemic epinephrine
B. Steroids
C. Antibiotic Anti
D. Antiviral drug
ANSWER: A
8. A 2 yo old male child was seen at the ER of VSMC for

hoarseness, dysphagia with barking cough and noisy
breathing. Patient is dyspneic, in respiratory distress, enlarge
cervical lymph nodes on the neck with marked swelling and
characteristic bull neck appearance. Mother claimed poor
compliance to immunization. Examination of the throat
revealed small yellowish white spots on the reddened tonsils
that form adherent pseudo membrane. Most likely diagnosis:
A. ALTB
B. Diphteritic laryngitis
C. Epiglotitis
D. Streptocoocal Pharyngitis
ANSWER:
9. The preferred controlled medication in asthma is:

|pg. 1
PEDIATRICS
2ND SEMESTER
SHIFTING EXAM 13
A. Inhaled corticosteroids ,tongue sticking out is commonly seen in which of the following
B. Short acting beta 2 agonist conditions
C. Montelukast A. Epiglottis
D. Ipatropium bromide B. Acute Laryngotracheobronchitis
C. Retropharnygeal Abscess
ANSWER: A. ICS D. Bacterial Tracheitis
10. A person with TB infection has:

A. No exposure to TB but with chest X-ray findings
presumptive of TB
B. Has signs and symptoms of TB with (+) AFB smear ANSWER:
microscopy
C. (+) Tuberculin Skin test symptoms of TB 14. One of the following is not a risk factor for Bronchiolitis:
D. May or may not have history of exposure to TB with A. Living in crowded condition
(+) tuberculin skin test B. Infants who have not been breastfeed
C. Male gender
D. Infant of a mother who smoked during pregnancy
ANSWER:
11. To determine the etiology of the pathogen in PCAP. a

diagnostic test to request is:
A. CBC source:
B. C-reactive protein Inflammatory Disorders of the Small Airways
C. Gram stain and differential count Dr. Dahlia L. Yu, FPPS, FPAPP 2/22/22
D. Culture and sensitivity
15. Supportive management in acute bronchitis is:
ANSWER:D. Culture and Sensitivity A. Oxygen
B. Antihistamines
C. Adequate Hydration
D. Use of cough suppressants
ANSWER:
12. Ben is a 3 yr old male child complaining of fever and sore

throat for 3 days. On physical examination, he has enlarged
tonsils with exudates and palatal petechiae noted. What is the
most common organism causing this disease in Ben?
A. Streptococccus pneumonia
B. Mycoplasma pneumonia
C. Group A beta hemolytic Strep
D. Arcanobacteriumhemolyticum
ANSWER: C. Group A Beta Hemolytic Strep
16. The pathology seen in bronchiolitis is:

A. Hyperplasia of smooth muscle
B. Hyper secretion of mucus cells
C. Airway edema
D. Destruction of ciliated epithelial cells
ANSWER: D
13. A characteristic tripod position considered as an indication

of respiratory distress,where in child sits and leans forward
|pg. 2
PEDIATRICS
2ND SEMESTER
SHIFTING EXAM 13
ANSWER: C
Source: Nelson Textbook of Pediatrics 20th Ed (Ch.259 p.
1603)
21. One of the following is a most common infectious cause of

stridor in children:
A. Acute epiglottitis
B. ALTB
C. Retropharyngeal Abscess
D. Peritonsillar Abscess
ANSWER: B
Source: Nelson Textbook of Pediatrics 20th ed. (Ch. 65 p. 475)
Source: Nelson’s book, chapter 418 pg.2218 22. One of the following is / are confirms diagnosis of
Epiglottitis on direct laryngoscopy
A. swollen arytenoid aryepiglottic folds
17. The antibiotic prophylaxis given to close contact with B. All of the above
epiglottitis: C. Narrowing of Glottic Orifice
A. Rifampicin D. Cherry Red Epiglottis
B. Cefuroxime
C. Amoxicillin ANSWER: B
D. Cefuroxime
ANSWER: A. Rifampicin
Source: Bacterial Infections Trans; Dr. Yu, page 2
18. One of the following medication is beneficial to ALTS:

A. Antiviral
B. Corticosteroid
C. Antifungal
D. Antibiotics
ANSWER:
19. Peak expiratory flow rate is highly suggestive of asthma

when:
A. diurnal variation of 5 % in patient not on
bronchodilator
B. 12 % increase after giving a corticosteroids
C. More than 15 percent decrease after an exercise Source: Bacterial Infections, page 1, Dr. Dahlia Yu
D. More than 20 percent increase after giving a
bronchodilator 23. A Laboratory study that can be helpful in common colds:
A. PCR
ANSWER: D B. Xray of the paranasal sinuses
C. Gram staining of secretions
D. Chest Xray
ANSWER: A
Page 2187 Nelson’s textbook of pedia
24. True of bacteriologically confirmed pulmonary tuberculosis

A. a person who fulfilled the clinical criteria for TB
B. A person with (+) Tuberculin skin test
C. A person with (+) Gene Expert MTB/RIF
D. A person with history of treatment for TB
ANSWER: C
Source: Tuberculosis trans, page 1, Dr. Dahlia Yu

25. Which of the following is A characteristic finding on lateral
soft tissue radiograph of the neck of Acute infectious
Epiglottitis: e
A. Silhoutte sign
B. Thumb sign
Source Nelson textbook of pedia (chapter 169 page 1191. C. Steeple sign
Table 169.6) D. Halo sign
ANSWER: B
Source: Trans Bacterial Infections, pg 1, Dr. Dahlia Yu
20. One of the ff is the most frequent cause of ALTB (acute
laryngotracheobronchitis):
A. Adenovirus
B. Influenza A
C. Para-Influenza Virus
D. RSV
|pg. 3
PEDIATRICS
2ND SEMESTER
SHIFTING EXAM 13
B. 12 months
C. 4 months
D. 9 months
ANSWER: A- 6 Months Total.
26. A Surrogate marker for possible presence of pathogens

requiring empiric initial antibiotic therapy is:
A. Gram staining
B. Gene Xpert source: Insignis Pedia TB Trans (Dr. Veloso)
C. Culture and sensitivity
D. Procalcitonin 32. Which of the following organism accounts for 30% of
pathogens in acute sinusitis?
ANSWER: A. H. influenza
27. One of the following is a hallmark of Croup among infants B. Staph. Aureus
and children: C. E. coli
A. Barking cough D. Streptococcus Pneumoniae
B. Dry cough
C. Wet cough ANSWER: D
D. Whooping cough SOURCE: Nelson’s Chapter 209
ANSWER: A. Barking Cough
33. Signs and symptoms of Acute Sinusitis usually last for:
A. 3 months
B. 14 day
C. 1 month
D. 30 days
ANSWER: D
Source: Nelson Chapter 408 - page 2,189
34. The recommended dose of Azithromycin for PCAP is:

A. 15 mg/kg/day for 5 days
B. 10 mg/kg for Day 1, followed by 5 mg/kg/day for 2
days (Days 2-5 dapat)
SOURCE: Trans (Dr. Yu) Bacterial Infections page 1 C. 5 mg/kg day for 7 days
28. A diagnostic aid to assess gas exchange is : D. 10 mg/kg/day for 3 days
A. CBC
B. Chest Xray ANSWER: D
C. Oxygen Saturation by Pulse Oximetry Source: Pedia Platinum Page 313
D. Venous blood gas
35. Tachypnea for a 6 month old infant is:
ANSWER: C A. RR of 30 and above
SOURCE: Nelson textbook of Pediatrics 20th ed page 2069 B. RR of 40 and above
C. RR of 60 cycle/min
29. Most common complication of acute rhinitis is : D. RR of 50 cycle/min
A. Brain abscess
B. Sinusitis ANSWER: D
C. Otitis Media SOURCE: Pedia Platinum Chapter 1 - page 6
D. Acute tonsillitis 36. The characteristic sign on lateral neck radiography of
Epiglotitis:
ANSWER: A. Steeple sign
B. Silhoutte Sign
30. Which of the following conditions require urgent C. Halo sign
endotracheal intubation? D. Thumb sign
A. Epiglottitis
B. Bacterial Tracheitis ANSWER: D
C. Acute laryngotracheobronchitis
D. Retropharyngeal Abscess
ANSWER: A
SOURCE:Trans Bacterial Infections, pg 1, Dr. Dahlia Yu
31. Current recommendation for the duration of treatment for

Pulmonary Tuberculosis:
A. 6 months
|pg. 4
PEDIATRICS
2ND SEMESTER
SHIFTING EXAM 13
ANSWER: A
Source: Pedia Platinum Chapter 12, Page 308
43. Which of the following pathogens is a common cause of

Epiglotitis?
A. H. Influenzae type B.
B. Parainfluenza virus
C. Staph. Aureus
D. RSV
ANSWER: A. H. Influenza type B
Source: Doc Yu Trans on bacterial infections page 1
Source: Chapter 421 Page 2204 Nelson 21st Edition

37. The gold standard in the diagnosis of tuberculosis is:
A. Gene Expert MTB
B. Sputum smear microscopy 44. Before starting controller medication in asthma, the
C. TST physician should:
D. TB culture A. Do skin test to all possible trigger factors
B. Ensure that the patient can use the inhaler correctly
ANSWER: D C. Refer to a pediatric pulmonologist
Source: Trans (Dr. Yu)- Tuberculosis., Page 4 D. Spirometry should be performed
38. Non pharmacologic strategy in Bronchial Asthma: ANSWER: B

A. Cessation of smoking Source: Trans (Dr. Yu) - Asthma page 5
B. Weight control
C. Limit physical activity 45. Chest Xray findings seen in patient with Acute Bronchitis:
D. Use of herbal medication A. Pneumothorax
B. Pleural effusion
ANSWER: Trans (Dr. Yu) - Asthma, page 6 C. Consolidation
D. Peribronchial cuffing
39. One of the ff is A life saving maneuver in sudden upper
airway obstruction: ANSWER: D
A. Heimlich Manuever Source: Trans (Dr. Yu) - Inflammatory Disorders of the Small
B. Endotracheal Intubation Airways page 1
C. Giving of Steroids
D. Direct Laryngoscopy 46. What is the characteristic radiologic finding of LTB?
A. Thumb sign
ANSWER: A B. Silhouette sign
SOURCE: Trans (Dr. Yu)Foreign Body Aspiration Page 4 C. Halo sign
40. For a patient with PCAP A or B without history of antibiotic D. Steeple sign
treatment, the empiric drug to use is
A. Cefuroxime ANSWER:
B. Amoxycillin Steeple sign = Laryngotracheobronchitis / Croup (LTB)
C. Ampcillin Thumb Sign = Epiglottitis (Nelson’s p2203)
D. Erythromycin Silhouette sign = loss of normal borders/loss of contour
Halo sign = hemorrhage/huge infection
ANSWER: B.
SOURCE: Pedia Platinum Chapter 12 - page 313 47. Which of the following confims the diagnosis of patient
suspect to have Diptheritic Laryngitis :
41. The prophylactic medication given to family members A. Bacterial smear and culture from the membrane
exposed to a child with Acute epiglottitis is: B. Xray of the neck
A. Amoxycillin C. All of the above
B. Erythromycin D. Direct Laryngoscopy
C. Penicllin G
D. Rifampicin ANSWER: A
ANSWER: D
Source: Harrisons Principles of Internal Medicine 19th Edition,
Ch. 45, Page 235
42. Which of the following pathogen is a cause of Bacterial

Tracheitis?
A. Staph. Aureus
B. H. Influenza
C. Streptococcus pneumonia
D. Staph epidermidis
|pg. 5
PEDIATRICS
2ND SEMESTER
SHIFTING EXAM 13
48. A case of a 4 yo male child with sudden onset of high fever,

severe throat pain, muffled voice that suddenly becomes ill
looking. He had difficulty in swallowing with drooling of saliva
.On admission, noted to have difficulty in breathing with tongue
noted to thrust forward .He assumes an upright sitting posture
with chin up and mouth open. C/1: soft inspiratory strider. What
is your most likely diagnosis?
A. Epiglottitis
B. Oiptheric laryngitis
C. Bacterial Tracheitis
D. ALTB
ANSWER: A. Epiglottitis
SOURCE:Trans Dr. Yu Bacterial Infections page 1
49. True of bacteriologically confirmed pulmonary tuberculosis:

A. a person who fulfilled the clinical criteria for TB
B. a person with (+) tuberculin skin test
C. a person with (+) Gene Expert MTB/ RIF
D. a person with history of treatment for TB
ANSWER: C
Source: Trans Dr. Yu, p.1, Tuberculosis
|pg. 6
PEDIATRICS
2ND SEMESTER
SHIFTING EXAM 14
GIT (Dr. Lopez)
1. Neonatal cholestasis mechanism exemplified by B. HBsAG (-), anti HBc (+), anti HBs (-)
infectious hepatitis in which of the following etiology? C. HBsAG (+), AntiHBs (-), Anti HBc (+)
A. Inflammation of the liver cells or cells within D. HBsAg (-), AntiHBs (+), Anti HBc (-), HBeAg
the biliary tract (-)
B. Obliteration of the bile flow
C. Accumulation of toxic bile acids 11. Which of the following trauma injury to teeth that
D. Autoimmunity results to minor damage to periodontal ligament?
A. Concussion
2. The incubation period for Hepatitis B is? B. Subluxation
A. 14-160 days C. Extrusion
B. 21-63 days D. Intrusion
C. 60-180 days
D. 15-19 days 12. A 6-month-old female infant is brought to her physician
for vomiting, which began after her first morning
3. Which of the following is the first marker to appear and feeding and has continued to further unrelated
its rise coincides with onset of symptoms: feedings.The vomitus has initially looked like
A. HBeAg undigested food but now appears to be mostly mucus,
B. Anti HBc with the last episode having a green tinge. On PE,
C. HBsAg the abdomen has positive bowel sounds and is soft
D. Anti HBs and a mildly tender, ill-defined mass is palpable in the
right upper quadrant, extending inferiorly. Rectal exam
4. A 10-year-old boy presents for evaluation of a food revealed an empty rectal vault except for a small
bolus impaction. The patient has had 2 similar amount of mucus, which is guaiac negative. What is
episodes over the past year. His past medical history is the most likely diagnosis of this patient?
significant for asthma, but he is not taking medication. A. Malrotation
In the past, large meat boluses were extracted B. Pyloric Stenosis
endoscopically, but no overt esophageal abnormalities C. Intussusception
were noted. The patient is unable to control his D. Duodenal Atresia
secretions and undergoes repeat endoscopy. No overt
obstruction is seen, but some white exudates are seen 13. A 20 yo G1P1 mother with polyhydramnios delivered a
in the esophagus. The food bolus is successfully healthy termed male neonate noted to have abdominal
removed. What is the most likely underlying diagnosis distention and bilious vomiting at 24 hrs old.Radiologic
in this patient? finding of abdomen showed double bubble sign that
A. GERD results from a distended stomach and duodenal bulb
B. Achalasia that are separated by a hypoechoic gastric antrum
C. Eosinophilic esophagitis .Most likely diagnosis:
D. Schatzi ring A. Pyloric stenosis
B. Intussusception
5. Which of the following can cause oropharyngeal C. Ileal atresia
dysphagia? D. Duodenal atresia
A. Cervical osteochondritis (cause pharyngeal
dysphagia) 14. Which of the following can cause blue to black
B. Esophagitis (cause esophageal dysphagia) discoloration of the primary teeth?
C. Lyme disease A. Neonatal hyperbilirubinemia
D. Chagas disease (cause esophageal B. Acute porphyria
dysphagia) C. Lead poisoning
D. Dentinogenesis imperfecta
6. Which of the following is the next most appropriate
patient's management? 15. Which among the following bacteria can cause acute
A. CT scan of the abdomen dysentery?
B. Exploratory laparotomy A. Campylobacter spp.
C. Air-contrast enema B. Helicobacter pylori
D. Endoscopy C. Vibrio cholerae
D. Clostridium difficile
7. Which of the following histologic findings is not
suggestive of hepatocyte injury? 16. Which of the following can cause conjugated
A. Fibrosis hyperbilirubinemia?
B. Cirrhosis A. Reduced hepatic removal
C. Apoptosis B. Metabolic disease
D. Necrosis C. Increased production
D. Hemolysis
8. A newborn was noted to have micrognathia,
accompanied by high arched and cleft palate. On 17. A 7-year-old boy presents to the emergency
further physical examination, you noted that the infant's department with clinical evidence of a small bowel
tongue is normal in size but the floor of the mouth is obstruction. This is his third such presentation in the
foreshortened. What is the possible diagnosis? past year. Previously, his symptoms had resolved with
A. Edward Syndrome nasogastric suction and bowel rest, but the child is
B. Down Syndrome now unresponsive to these measures. On examination,
C. Pierre Robin Syndrome the patient has some pigmented spots on his lips and
D. Gilbert Syndrome gums, a normal cardiopulmonary examination, and
grossly distended abdomen with high-pitched bowel
9. A 6-year-old boy was given Lactulose syrup for his sounds. The patient is taken to laparotomy and found
constipation complain. However, he develops diarrhea to have a 5-cm obstructing polyp, which is found to be
after 3 days of treatment. What is the mechanism of hamartomatous on pathologic analysis.What is the
this loose bowel movement? underlying diagnosis?
A. Mucosal invasion A. Familial adenomatous polyposis syndrome
B. Osmotic B. Irritable bowel movement
C. Secretory C. Celiac sprue
D. Increased motility D. Peutz-Jeghers syndrome
10. Which of the following is an expected result for an HBV 18. Which of the following stigna of hepatic disease which
vaccinated person ? results from altered estrogen metabolism?
A. HBsAG (-),anti HBc (-),anti HBS (+) A. Palmar erythema
|pg. 1
PEDIATRICS
2ND SEMESTER
SHIFTING EXAM 14
GIT (Dr. Lopez)
B. Spider angioma A. Congenital adrenal hyperplasia

C. Pruritus B. Trisomy 18
D. Xanthoma C. Hyperthyroidism
D. Incontinentia pigmenti
19. A mother who delivered a Fullterm female neonate is
HBsAb (+).HBeAg(+) .How many percent is her baby 30. The following are true of a Resolving Acute infection of
at risk for HBV: Hepatitis B except:
A. 40-50% A. anti-HBs (-)
B. 70-90% B. anti HBs (+)
C. 50-60% C. anti-HBc (+).
D. 70-80% D. HBsAg (-),
20. The above surgical case is best managed by which of 31. A 1-month-old infant is brought to your clinic due to
the following surgical procedure? jaundice. The infant was born in term without
A. Hepatoportoenterostomy complications. The jaundice was noted on the second
B. Cholecystostomy day of life and subsided on the second week. However,
C. Duodenopylorostomy the jaundice recurred on the third week of life and has
D. Gastroenterostomy been increasing progressively. The mother also noted
the infant with pale stool. On PE, the infant is active
21. A congenital anomaly commonly associated with with good suck. Jaundice and icteric sclerae were
Pyloric stenosis is evident. The liver is firm and palpable 2cm below the
A. Malrotation right subcostal margin. What could be the primary
B. Tracheoesophageal fistula impression of this patient?
C. Asplenia-polysplenia congenital heart A. Neonatal hepatitis
disease B. Biliary atresia
D. Tracheoesophageal atresia C. ABO incompatibility
D. Ascending cholangitis
22. Which of the following metabolic disorder can cause
constipation? 32. A combination of achalasia, alacrima and adrenal
A. Hypercalcemia insufficiency is suggestive of what condition?
B. Hypochloremia A. Allgrove syndrome
C. Hyperthyroidism B. Wilkie syndrome
D. Hyperkalemia C. Sandifer syndrome
D. Boerhaave syndrome
23. 9 month old male infant noted to have abdominal pain,
with currant jelly stool and a palpable sausage mass 33. One of the following serves as marker of active viral
noted in RUQ of the abdomen.You suspect him to replication:
have Intussusception. What is the of classic sign seen A. Anti HBs
in barium enema of the patient: B. HBsAg
A. Shoulder sign C. Anti HBe
B. Double tract sign D. HBeAg
C. String sign
D. Coiled spring sign 34. An adolescent female was noted with gingival
hyperplasia. Which of the following may less likely
24. A viral hepatitis that can cause acute and benign cause this finding?
infection : A. Beta blockers
A. Hepatitis A B. Cyclosporin
B. Hepatitis C C. Phenytoin
C. Hepatitis D D. Calcium channel blockers
D. Hepatitis B
25. Hydrops gallbladder is less likely associated in which

of the following condition?
A. Henoch Schoenlein Purpura
B. Leptospirosis
C. Kawasaki Disease
D. Chagas Disease
26. Which among the following antibiotic can predispose to

pyloric stenosis if chronically used?
A. Ciprofloxacin
B. Erythromycin
C. Tetracycline
D. Chloramphenicol
27. An eight-year-old girl presented with recurrent crampy

abdominal pain, associated with occult blood in the
stool, arthritis and characteristic rash. What is your
impression on this case? 35. It is considered as a normal digestive phenomenon.
A. Gilbert Syndrome A. Meconium is expected to pass out in the first
B. Sickle Cell Crisis 48 hours of life.
C. Henoch-Schonlein Purpura B. Regurgitation is physiologic in the first 2 years
D. Idiopathic Thrombocytopenic Purpura of life
C. Blood loss is never abnormal among
28. What is the most serious life-threatening complication children.
of oropharyngeal dysphagia? D. 80% of regurgitation will spontaneously
A. Asphyxia resolve at 12 months of age
B. Hypothyroidism
C. Hypoglycemia 36. The above condition is associated with what neonatal
D. Aspiration cholestasis mechanism?
A. Inflammation of the liver cells or cells within
29. What condition is associated with delayed eruption of the biliary tract
20 deciduous teeth? B. Autoimmunity
C. Obliteration of the bile flow
|pg. 2
PEDIATRICS
2ND SEMESTER
SHIFTING EXAM 14
GIT (Dr. Lopez)
D. Accumulation of toxic bile acids C. Fundoplication

D. Inhaled or systemic corticosteroids
37. A 2-month old infant is brought to his physician due to
vomiting, which began after his first morning feeding 2 47. The above diagnosis is usually associated with what
days ago and has followed each subsequent congenital anomaly?
feeding. The vomitus is described by his mother as [Above diagnosis: Pyloric stenosis]
white with the appearance of undigested formula; the A. Asplenia-polysplenia congenital heart
vomiting has been increasing in amount and has disease
become more forceful. The infant's bowel movement B. Tracheoesophageal fistula
yesterday was normal. PE is remarkable for dry lips C. Tracheoesophageal atresia
with sticky mucus membrane. The patient's abdomen D. Malrotation
has bowel sounds and is soft and non-tender. A firm
mobile 1 x 1 cm mass is palpable in the right epigastric 48. A 1-day-old, full-term neonate experiences coughing,
area. Which of the following is the most likely frothing of the mouth and cyanosis during attempts of
diagnosis? breastfeeding. Because of concerns on aspiration, an
A. Intussusception attempt to insert orogastric tube is tried. But the tube
B. Malrotation meets resistance during the procedure. What is the
C. Pyloric stenosis most likely diagnosis of this patient?
D. Gastroesophageal Reflux Disease A. Achalasia
B. Zener's Diverticulum
38. Which of the following can cause secretory type of C. Esophageal Atresia
diarrhea? D. Gastroesophageal Reflux Disease
A. Laxative abuse
B. Celiac disease 49. A viral hepatitis that can be transmitted through
C. Carcinoid tumor blood,oralfecal with associated cirrhosis and portal
D. Thyrotoxicosis hypertension that is rapidly progressive:
A. Hepatitis A
39. One of the following is a the classic electrolyte and B. Hepatitis D
acid-base imbalance seen in a neonate with pyloric C. Hepatitis C
stenosis. D. Hepatitis B
A. Hypochloremic, metabolic alkalosis
B. Hyperkalemic metabolic acidocis
C. Hyperchloremic metabolic acidocis
D. Hypernatermic metabolic alkalosis
40. The risk for acute liver failure is low but risk for chronic
hepatitis is high.
A. Hepatitis B
B. Hepatitis D
C. Hepatitis A
D. Hepatitis C
41. The infection of the biliary tract is usually associated in

which of the following causative agent?
A. Hemophilus
B. Klebsiella
C. Campylobacter
D. Helicobacter pylori
42. What is the most effective preventive measure against

dental caries?
A. Fluoridated toothpaste
B. Water fluoridation
C. Oral prophylaxis
D. Fluoride varnish
43. How should this patient be treated?

A. Placement of an endobronchial stent to
prevent aspiration
B. Insertion of a percutaneous endoscopic
gastrostomy tube for feeding and hydration
C. Endoscopic reattachment of the proximal and
distal esophagus
D. Surgery to correct the anatomic defects
44. The following are true of Hepatitis B except:

A. Incubation period is 14-160 days
B. Mortality rate is 1%
C. It can predispose to develop membranous
glomerulonephritis.
D. Transmission can be vertical/perinatal
45. Which of the following conditions is less likely

predispose cyclic vomiting?
A. Autonomic dysfunction
B. Mitochondrial disorder
C. Migraine
D. Thyroid dysfunction
46. What is the most appropriate management of this

patient?
A. Pyloromyotomy
B. Proton pump inhibitors
|pg. 3
PEDIATRICS
2ND SEMESTER
SHIFTING EXAM 15
HEMATOLOGY-ONCOLOGY (Dr. Lucero)
1. A rare condition characterized by the presence of

simultaneous or sequential direct Coombs -Positive ANSWER: D. Congenital dyserythropoietic Anemia
autoimmune hemolytic anemia (AIHA) in conjunction with Source: Nelson’s 21st Edition, Chapter 124 (Blood Disorders),
immunemediated thrombocytopenia, with no known underlying Page 965.
etiology
A. Evan’s syndrome
B. Immune thrombocytopenic purpura
C. hemolytic-uremic syndrome
D. thrombotic thrombocytopenic purpura
8. A naturally occurring anticoagulant which is activated by
ANSWER: A. Insignis Trans - Evan’s syndrom = AIHA + ITP thrombin-thrombomodulin complex and degrades factor Va and
VIIIa:
2. A 5-week old male infant was brought to the Emergency A. Heparin
room for consult regarding a recurrent minimal bleeding and B. Tissue Factor Pathway Inhibitor
delayed separation of the umbilical stump. Bleeding C. . Antithrombin -lll
parameters showed a normal bleeding time, normal PT, normal D. Protein C
aPTT and normal platelet count. The most likely diagnosis is:
A. Vitamin k deficiency ANSWER: C
B. von willebrand disease
C. factor VII deficiency 9. A 5-year boy sought consult for prolonged bleeding at the
D. factor XIII deficiency site of tooth extraction. His bleeding parameters showed a
normal platelet count, normalPT but a prolonged bleeding time
ANSWER: D. Factor XIII deficiency and aPTT. The most likely diagnosis :
FACTOR XIII parameters: normal bleeding time, normal PT, A. Vitamin K deficiency
normal aPTT and normal platelet count. B. Hemophilia B
C. Hemophilia A
3. A cellular membrane defect due to abnormal horizontal D. Von Willebrand Disease
protein interactions of spectrin, protein 4.1 and rarely
glycophorin c deficiency: ANSWER: vWD : Normal PT, Prolonged PTT, Prolonged
A. Hereditary stomatocytosis Bleeding Time, Normal/Decr Platelet Count - Source Pedia Plat
B. hereditary elliptocytosis 1st edi page 279
C. hereditary pyropoikilocytosis
D. hereditary spherocytosis
10. A Repletion of Iron stores is expected response after iron
ANSWER: B. hereditary elliptocytosis therapy at:
A. 12-24 hrs
B. 4-30 days
C. 1-3 months
D. 36-38 hrs
ANSWER: C
Source: Nelson’s 21st Edition, Chapter 486 (Hereditary
Elliptocytosis, Hereditary Pyropoikilocytosis, and Related
Disorders), Page 2535.
4. All of the following are common risk factors of Iron deficiency

anemia among infants and toddlers except:
A. Perinatal blood loss
B. chronic blood loss
C. prematurity
D. excessive consumption of cow's milk
Source: Nelson’s 21st Edition, Chapter 482, Page 2524.
ANSWER: Nelsons Chapter 482, page 4408
11. The laboratory findings in Diamond Blackfan Anemia,
5. Characterized by an excess in and chains:
except:
A. Sickle cell disease
A. normocytic anemia
B. hemoglobin e
B. reticulopenia
C. beta-thalassemia
C. increased HbF
D. alpha thalassemia
D. increased rbc Adenosine Deaminase activity
ANSWER:
ANSWER: A. DBA has elevated HbF and reticulopenia
(Nelson) , Macrocytic anemia / Inc MCV, Increased Adenosine
6. A life threatening complication occurring primarily in infants
Deaminase ADA, (rarediseases.org)
and children with sickle cell anemia
A. Dactylitis
B. Avascular Necrosis
12. Iron Chelation Therapy should start as soon as the patient
C. Aplastic Crisis
becomes significantly iron overloaded. Chelation therapy aims
D. Acute Splenic Sequestration
to balance the rate of iron accumulation from blood transfusion
by increasing iron excretion in urine and or faces with
ANSWER: D. Acute Splenic Sequestration
chelators. The following are guidelines in the initiation of
Source: Nelson’s 21st Edition, Chapter 489
Chelation therapy, except:
(Hemoglobinopathies), Page 2543.
A. serum ferritin > 1000ng/ml
B. generally, after one year of transfusion therapy
C. not currently labeled for use in children < 2 yr.
D. liver iron concentration > 2500 ug/g dry weight
ANSWER:
7. Multinuclearity, inter-chromatin bridges and a positive
acidified serum test are hallmarks of what type of anemia? 13. A 15-monthold male infant was admitted due to recurrent
A. Fanconi Anemia fever of 2 weeks’ duration b and productive cough. Pertinent
B. Pearson Syndrome PE: presence of facial rashes, gum bleeding, cervical
C. Sideroblastic Anemia lymphadenopathies, chest ausculation revealed presence of
D. Congenital dyserythropoietic Anemia rales in both lung fields and hepatosplenomegaly. Peripheral
| pg. 1
PEDIATRICS
2ND SEMESTER
SHIFTING EXAM 15
blood revealed moderate anemia, leucocytosis with increased

monocytes, and thrombocytopenia. Bone marrow examination
showed myelodysplastic pattern with 15 % blasts.Which is the
most likely diagnosis:
A. Aplastic Anemia
B. Infantile Leukemia
C. Juvenile Myelomonocytic Leukemia
D. Chronic Myelogenous Leukemia
ANSWER: C.
17. A 3 yo female child was brought to the OPD of VSMC for
easy fatiguability, pallor and poor appetite and recurrent
abdominal pain. Mother claimed his child is fond of walking
barefoot. CBC taken HB 8g/dl, eosinophilia, Low rbc, MCV,
retic ct, Peripheral smear microcytic, hypochromic rbc. Most
likely he has:
A. Aplastic Anemia
B. Iron def Anemia
C. Megaloblastic Anemia
D. Thalasemia
ANSWER: B
Source: Nelson 21st Ed Chapter 482; Pedia Platinum p. 274
SOURCE: Nelson’s Textbook of Pediatrics (21ed) Chapter 522

p. 2655
14. A 2-month old male infant born was brought for regular
follow up, on examination the baby was found to have pallor,
icterus and splenomegaly. Baby had severe anemia with Hb
4gm% which required prbc transfusion. Reticulocyte count
10.2% Coombs' Tests were negative. Red cell indices were
MCV 84fl, MCHC 36%, MCH 32pg andRed cell Distribution 18.Disseminated Intravascular Coagulopathy is characterized
Width 15. Peripheral blood smear showed the presence of by:
significant amount of erythrocytes noted to be smaller, more A. fibrin deposition
dense and round with loss of central pallor rather than normal B. active fibrinolysis
biconcave disc shaped red cells. What is the morphologic C. all of the above
classification of the anemia in this case? D. microvascular thrombosis
A. macrocytic, hyperchromic
B. microcytic, hypochromic
C. macrocytic, hypochromic ANSWER: C
D. normocytic, normochromic Source: Nelson’s textbook of pediatrics, 21st edition, Disease
of the blood, Chapter 510, Page 2608
ANSWER:
15. A 9-year-old adolescent female was brought to the clinic for

evaluation and management of her hyperplastic gum with
bleeding associated with intermittent fever, anorexia, weight
loss and body malaise. Pertinent PE: (++) cervical
lymphadenopathies and hepatosplenomegaly.CBC showed 19. The blood product of choice in the treatment of Hemophilia
mild anemia, leukocytosis with presence of blasts and A:
thrombocytopenia. Bone marrow findings are consistent with A. Cryosupernate
acute leukemia.Cytogenetic study revealed the presence of inv B. Fresh Frozen Plasma
(16). This confirms the diagnosis of: C. Packed RBC
A. Erythroleukemia D. Cryoprecipitate
B. Acute Monoblastic Leukemia
C. Acute Myelomonocytic Leukemia
D. Acute Promyelocytic Leukemia ANSWER: D
ANSWER:
16. A second generation tyrosine kinase inhibitor used in the

treatment for Chronic Myelogenous Leukemia that prolong
morphologic & cytogenetic response resulting to improved
remission rate: (Source: Dr lucero trans pedia hemorrhagic and thromboplastic
A. Doxorubicin disorder page 5.)
B. Imatinib mesylate
C. Nilotinib 20 A 3-month old male infant was brought to E.R. for
D. L- asparaginase hematoma on the left thigh following a DPT vaccination.
History revealed a strong family history for Hemophilia.
Bleeding screening tests would reveal:
ANSWER: C .
Source: Childhood and Adolescent Cancer ( Dr. Wilma A A. Normal PT, bleeding time & platelet
Lucero) count, prolonged aPTT
B. Normal aPTT, bleeding time & platelet
count, prolonged PT
| pg. 2
PEDIATRICS
2ND SEMESTER
SHIFTING EXAM 15
C. Normal aPTT, PT & platelet count, 26. Hemoglobinopathy which is a result of Glu→Lys mutation
prolonged bleeding time at position 6th of β globin chain
D. Normal PT& platelet count, prolonged (β6 of Glu→Lys):
aPTT& bleeding time A. Hb Constant Spring
b. Hemoglobinopathy E
ANSWER: A. Hemophilia parameters are : Normal PT, c. Hemoglobinopathy C
Bleeding TIme, Platelet Count, Prolonged aPTT ( Pedia Plat d. Hemoglobin S
1st edi pg 279)
ANSWER: C
21. Risk directed therapy has become the standard of current Source: Pedia-Hema-Onco Excelsus Trans (Dr. Lucero) p.11
ALL treatment and takes into account the following, except :
27. Tumor Lysis Syndrome is an oncologic emergency that can
a. initial white blood cell count occur before therapy in patients with large tumor burden,
b. immunophenotypic & cytogenetic except:
characteristics of blast population a. Lymphoblastic Lymphoma
c. rapidity of early treatment response b. Hodgkin Lymphoma
d. sex/gender c. T cell, ALL
d. Burkitt Lymphoma
ANSWER: D ANSWER: B
Source: Nelson's Textbook of Pediatrics 20th ed (Ch 495 p.
2439)
22. A 2-year old well child suddenly developed hematoma on

trunk and extremities, petechiae on buccal mucosa and palate
with gum bleeding. No organomegaly. Hgb 12 gm/dl, Hct 0.37,
WBC 5,000/L, Seg 40%, Lympho 60%, Platelet 10,000/L. BMA
was normal. Treatment of choice:
a. Fresh Frozen Plasma transfusion

b. Splenectomy
c. Platelet transfusion
d. Intravenous Immunoglobulin
23. A 5-year-old boy presented to the clinic with left elbow

swelling after hitting it against the wall while playing a day after.
The swelling increased in size and became more painful. CBC
showed mild anemia, normal WBC and Differential count, and
normal platelet count. Bleeding parameters revealed a normal
bleeding time, normal PT and prolonged aPTT, Factor assay
showed a Factor lX activity of 3%. He is classified as :
a. Severe Hemophilia B
b. Moderate Hemophilia B
c. Moderate Hemophilia A
d. Severe Hemophilia A
24. The chromosomal abnormalities in Acute Myelogenous

Leukemia with unfavorable prognosis:
a. t (15;17)
b. inv (16)
c. t (8;21)
d. del(7q)-7
25. A 15-month old female infant developed diarrhea and

failure to thrive. PE revealed a mass in the lower abdominal
quadrant and ascites. CBC showed mild anemia, normal WBC
count with neutrophilic predominance and thrombocytosis.
LDH 2170 IU. CT scan showed an extensive intra abdominal
disease and right pleural effusion. An exploratory laparatomy
was performed and revealed diffuse abdominal involvement
including omentum and ovaries, which were biopsied.
Immunohistochemistry showed strong positivity for CD20.
Pleural effusion phenotypic analysis by flow cytometry was
positive for HLA Dr, CD19, CD20, IgM, and CD45 and negative
for CD34, CD3, CD4, and CD8. The cerebrospinal fluid and
bone marrow were negative for the disease. What is the most
likely diagnosis?
A. Lymphoblastic Lymphoma
b. Burkitt Lymphoma
c. Anaplastic Large Cell Lymphoma
d. Diffuse Large B cell Lymphoma
ANSWER: D
*Did not mention tumor lysis syndrome in Hodgkin Lymphoma;

Source: Childhood and Adolescent Cancer trans, page 9, Dr. it was only mentioned in ALL and Non-Hodgkin Lymphoma
Lucero (Lymphoblastic Lymphoma & Burkitt Lymphoma are types of
Non-Hodgkin Lymphoma)*
| pg. 3
PEDIATRICS
2ND SEMESTER
SHIFTING EXAM 15
Source: Childhood and Adolescent Cancer, page 8, Dr. Lucero ANSWER: A. I don't know what symbol was used but B-D are
all in Insignis Pedia Cancer and Benign Diseases Trans.
28. The most common genetic lesion in Hemophilia: Assuming the symbol was “greater than”, Hepatoblastoma
a. translocation affects children under 3, with the median age of diagnosis at
b. missense mutation 1yr.
c. deletional mutation
d. gene inversion 32. Therapeutic dose for oral anticoagulation is best monitored
by:
ANSWER: C a, Anti Xa activity
b. PT/INR.
29. The following are pediatric tumors that metastasize to the c. Bleeding time
CNS, except: d. aPTT
a. Neuroblastoma ANSWER: B
b. Osteosarcoma Source: Nelson Chapter 506.1 - page 2,606
c. Hepatoblastoma
d. Retinoblastoma 33. An acquired hemolytic anemia associated with RBCs
unusually sensitive to complement mediated cell
ANSWER: C lysis,associated with decreased Decay Accelerating Factor:
Source: Trans Childhood and Adolescent Cancer, pg 13, Dr. a. Congenital dyserythropoietic anemia
Wilma A. Lucero b. Autoimmune Hemolytic Anemia
c. Sickle Cell Disease
d. Paroxysmal Nocturnal Hemoglobinuria
ANSWER: D
34. Pallor an important clinical sign of Iron Deficiency Anemia

in children is manifested if hemoglobin is:
a.a. 6-8 g/dl
b. 5-6 g/dl
c. 7-8 g/dl
d. < 5 g/dl
ANSWER: D
30. One of the following statements is not true for Iron 35. A 12-year-old female adolescent presents to the
Deficiency Anemia: emergency department with an episode of syncope. She has
a. Breastfed infants absorb iron 2-3 times more been feeling progressively more tired and her mother noticed
efficiently than infants fed with cow's milk. that she was pale since a week ago. The girl has had
b. Delayed clamping of the umbilical cord puts the intermittent headaches but no complaints of palpitations,
infant at risk for irondeficiency. weight loss, abdominal pain, or rectal bleeding. Her diet
c. Most iron in neonates is in circulating hemoglobin. consists of vegetables and meat. Physical examination findings
d. Blood loss must be considered as a possible cause include: heart rate of 116 beats/min, respiratory rate of 28
in every case of iron deficiency anemia. breaths/min, blood pressure of 102/52 mm. The only finding of
note on physical examination is conjunctival pallor. CBC
ANSWER: B showed Hemoglobin 4.9 g/dL (20 g/L) Hematocrit 15% (0.9)
Source: Trans Dr. Lucer on Pediatric Hematology-ocology p. 7 MCV 67.5 fL MCHC 24%, MCH 22pg. White blood cell count
4,200/μL (4.2 × 109/L) Platelet count 363 × 103/μL (363 ×
109/L) Reticulocytecount 6.8%. Additional laboratory tests
needed?
a. Iron studies
b. all of the above
c. Hemoglobin electrophoresis
d. Coombs Tests (Direct & Indirect)
31.Characteristics of Hepatoblastoma, except: ANSWER: B

a, predominantly in children < 3years of age???
b. Bilirubin and liver enzymes are usually normal 36. The peripheral blood findings of thrombocytopenia,
c. often associated with Hepatitis B or C infection fragments and spherocytes is most indicative of which kind of
d. associated with familial adenomatous polyposis anemia?
a. Megaloblastic
ANSWER: C b. Autoimmune
Source: Trans Childhood and Adolescent Cancer, pg 11, Dr. c. Sideroblastic
Wilma A. Lucero d. Microangiopathic
37. In the diagnosis of Acute Lymphoblastic Leukemia, bone

marrow evaluation demonstrate the presence of homogenous
population of lymphoblasts:
a. >10%
b. >25 %
c. 5-10%
d. >50%
ANSWER: B
Source: Nelson Chapter 522.1 - page 2,650
38. Fanconi Anemia is characterized by this finding:

a. Hypocellular monocytopenia
b. Selective loss of RBC progenitors
c. Erythroblastic multinuclearity
| pg. 4
PEDIATRICS
2ND SEMESTER
SHIFTING EXAM 15
d. Defects in chromosomal stability and repair b. Stage lV

c. Stage lll
ANSWER: D d. Stage ll
Nelson’s Textbook of Pediatrics 21st Ed Page 2568
ANSWER: What case? Questions are jumbled.
39. A 5-year-old male child was admitted to the Emergency

Department with complaints of pallor associated with
abdominal and back pains, with dyspnea and cough noted for
2-3 weeks prior to admission. History revealed that at the age
of 10 months, he had severe anemia requiring regular prbc
transfusion every 4-6 weeks up to the present. Initial CBC at
diagnosis showed a severe anemia of 4gm%, white cells and
platelets within normal, Reticulocyte count 3.5% MCV 63fl,
MCHC 22%, MCH 20pg. Coombs tests were negative.
Hemoglobin Electrophoresis showed hemoglobin (Hgb) A 43. The most commonly employed imaging study for the
87.5%, Hgb A2 2.2%, Hgb F 10.3%. What was the most likely diagnosis of Pulmonary embolism:
diagnosis? a. CT with venography
a. Hemoglobin H Disease b. Spiral CT
b. Beta Thalassemia Major c. Ultrasound with Doppler Flow
c. Alpha Thalassemia Intermedia d. MR venography
d. Sickle cell Anemia
ANSWER:C. Ultrasound with Doppler Flow
ANSWER: B Source: Nelson’s 21st Ed, Chapter 436, page 2311.
The normal hemoglobin pattern is ≥95% HbA, ≤3.5 HbA2, and
<2.5% HbF. Based on he following table, best answer would
have been Beta Thalassemia Intermedia 44. Medications precipitating hemolysis in Glucose 6 Phophate
Dehydrogenase Deficiency are the following, except:
a. Aspirin
b. Nalidixic Acid
c. Primaquine
d. Sulfonamides
ANSWER: A. Aspirin
Source: Nelson’s 21st Ed, Chapter 490, (Enzymatic Defects),
page 2561.
40. Hypercoagulable states are the following, except;

a. Acute Leukemia
b. Nephrotic Syndorme
c. Antiphospholipid Antibody Syndrome
d. Immune Thrombocytopenic Purpura
ANSWER: A
41. A 12-year-old male adolescent sought consult in the clinic

for abdominal discomfort and that he was experiencing pain on
his shoulder and wrist. Physical examination revealed marked
splenomegaly. CBC revealed a mild anemia, hyperleukocytosis
with myeloid cells at all stages of differentiation and 45. A secondary cause of Warm AutoImmune Hemolytic
throbocytosis. Bone marrow examination revealed both Anemia:
granulocytic and megakaryocytic overproliferation with a. Infectious Mononucleosis
blastcells <5%. What is the most likely diagnosis? b. Systemic Lupus Erythematosus
a. Acute Myelogenous Leukemia c. Paroxysmal Cold Hemoglobinuria
b. Chronic Myelogenous Leukemia d. Congenital or Tertiary Syphilis
c. ALL , T cell ANSWER: B. Systemic Lupus Erythematosus
d. ALL, B cell Source: Nelson’s 21st Ed, Chapter 491, (Hemolytic Anemias
Resulting from Extracellular Factors—Immune Hemolytic
ANSWER: B. CML Page 7 trans Anemias), page 2563.
46. The most common malignant cerebellar tumor located in

42. Based on the site of involvement in the case #44, what is
the posterior fossa. Its anaplastic variant is often aggressive
the clinical stage of the disease based on the current revised
associated with worse prgnosis. It can present as signs &
staging system used for HNL, the International Pediatric Non
symptoms of increased intracranial pressure and cerebellar
Hodgkin Lymphoma Staging System:
dysfunctions such as ataxia, poor balance and dysmetria:
a. Stage l
a. Craniopharyngioma
| pg. 5
PEDIATRICS
2ND SEMESTER
SHIFTING EXAM 15
b. Choroid Plexus Carcinoma

c. Glioblastoma Multiforme
d. Medulloblastoma
ANSWER: D. Medulloblastoma
Source: Nelson’s 21st Ed, Chapter 524 (Brain tumors in

childhood), page 2673.
47. A 2year & 6 months old old female child was brought to
clinic for evaluation & management. History revealed a
one-month duration of recurrent fever associated with
abdominal distension and proptosis of left eye. On
examination, she was found to have proptosis and periorbital
ecchymosis of left eye, swelling of left parietal bone and a hard
non tender fixed nodular mass in the left hypochondirum
crossing the midline. CT scan confirmed a mass in the
paravertebral region below the left kidney, extending
downwards to left iliac fossa. Laparotomy showed a large
unresectable left paravertebral tumor which was biopsied and
the histopathological report revealed the presence of small
round blue tumor cells. The following pediatric tumors are
considered except:
a. Rhabdomyosarcoma
b. Non Hodgkin Lymphoma
c. Neuroblastoma
d. Langerhan Cell Histiocytosis
48. Additional laboratory tests done on the patient on #12 were

Total Bilirubin 6.5 mg/dl, Direct bilirubin 1 mg/dl. LDH was also
elevated. Baby’s electrolyte levels were normal. Iron Profile,
Folate, HB electrophoresis were done which were found
normal. OsmoticFragility started at 0.96% of NaCl and ended
at 0.28% of NaCl. (Markedly increased) What is the most likely
diagnosis?
a. Diamond Blackfan Anemia
b. Autoimmune Hemolytic Anemia
c. Fanconi Anemia
d. Hereditary Spherocytosis
49. An autosomal recessive congenital disorder associated

with severe platelet dysfunction characterized by
thrombocytopenia, with giant platelets, markedly prolonged
bleeding time and absence of ristocetin-induced platelet
aggregation:
a. Von Willebrand Disease
b. Bernard-Soulier Syndrome
c. Gray Platelet Syndrome
d. Glanzmann Thrombasthenia
ANSWER: b. Bernard-Soulier Syndrome

Source: Nelson’s textbook of pediatrics, 21st edition, chapter
511, page 2617.
| pg. 6
PEDIATRICS
2ND SEMESTER
SHIFTING EXAM 16.1
NEURO (Dr. Bael)
1. Conventional antiseizure medications are not enough to b. E. coli

control the seizures in this condition: c. H. in§uenzae
a. Rasmussen’s encephalitis d. N. meningitides
b. Febrile Induced related epilepsy syndrome
c. Herpes simplex encephalitis ANSWER: C
d. Anti NMDAR Encephalitis
ANSWER: A
o
Source: Pediatric Neurology (Dr. Victoria Bael)
6.The inheritance pattern of the severe form of Myotubular

Myopathy
a. Autosomal recessive
Source: Adams and Victor’s Principles of Neurology, page 345 b. Any of the above
c. X- linked
2. This is associated with focal status epilepticus d. Autusomal dominant
a. Febrile Induced related epilepsy syndrome
b. Herpes simplex encephalitis ANSWER: C
c. Anti NMDAR Encephalitis
d. Rasmussen’s encephalitis
Nelson’s textbook of pediatrics, 21st edition, chapter 616,

page 3181-3182
Source: Nelson’s textbook of pediatrics, 21st edition,

Neuromuscular disorder, Chapter 626, Page 3262
7.A 10-month-old child had cough and colds for 2 days. On the
day of consult, he had a fever of 40 and subsequently
developed stiffening of all extremities with upward rolling of
eyeballs, for about 5 minutes. What is your first management?
a. Check sugar
b. Establish airway
c. Give Phenobarbital per orem because no line yet
has been inserted
d. Insert an IV line
.
ANSWER: B
3. Cannabidiol has been approved for use in
a. Rasmussen’s Encephalitis 8.The CSF analysis showing an opening pressure of 300 mm
b. Dravet Syndrome H2O, WBC 899/cu mm (lymphocytes 85%, neutrophils 15%),
c. Panayiotopoluos Syndrome protein 324mg/dl, CSF sugar/RBS 30% is suggestive of
d. Epileptic Myoclonic Encephalopathy a. Acute meningococcal meningitis
b. Viral Meningitis
https://www.fda.gov/news-events/press-announcements/fda-ap c. Simple Febrile Seizure
proves-first-drug-comprised-active-ingredient-derived-marijuan d. Tuberculous Meningitis
a-treat-rare-severe-forms
ANSWER: A
4. The first drug of choice in status epilepticus in a 15 year old 9.The highest prevalence of Moya moya disease is found in
is a. Indonesia
b. Korea
a. Diazepam c. China
b. Phenytoin d. The Philippines
c. Valproic Acid
d. Phenobarbital ANSWER: B
ANSWER: A Source:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4747069/#:~:tex
t=Recent%20epidemiological%20studies%20have%20confirm
ed,such%20as%20Korea%20and%20Japan.
10.Complete 3rd nerve palsy will show a

a. Upward and outward eyeball
b. Downward and inward eyeball
c. Upward and inward eyeball
d. Downward and outward eyeball
ANSWER: D
Source: Nelson’s textbook of pediatrics, 21st edition A complete third nerve palsy causes a completely closed
eyelid and deviation of the eye outward and downward.
5. Dexamethasone can be used as an adjuvant therapy in The eye cannot move inward or up, and the pupil is typically
bacterial meningitis in cases where the causative organism can enlarged and does not react normally to light.
be reliably diagnosed, particularly those with
a. S pneumoniae
|pg. 1
PEDIATRICS
2ND SEMESTER
SHIFTING EXAM 16.1
NEURO (Dr. Bael)
Source: Nelson’s textbook of pediatrics, 21st edition, Chapter

Spinal Muscular Atrophies
15.In multiple sclerosis, demyelination in the brain occurs

commonly in
a. Posterior fossa
b. Thalamih
Source: Nelson’s textbook of pediatrics, 21st edition, Chapter c. Gray cortex
641 Disorders of Eye Movement and Alignment d. Periventricular area
11.Most common etiologic agent of bacterial meningitis in a ANSWER:

3-year old child
a. Pseudomonas
b. H. in§uenzae
c. S. pneumoniae
d. E. coli 16.The most common presentation of Moya Moya disease in
children is
ANSWER: C a. Seizure
b. Syncope
c. Stroke
d. Generalized weakness
ANSWER:
Source: Nelson’s textbook of pediatrics, 21st edition

17. One of the following ¦ndings is not a characteristic of TB
12. The severity of SMA is based on meningitis
a. The number of respiratory muscles involved a. arteritis
b. The number of SMN2 protein b. obstructive hydrocephalus
c. Degeneration of the anterior horn cell c. basal exudates
d. The number of SMN1 protein d. multiple cranial nerve de¦cits
ANSWER: B ANSWER:
The number of copies of the SMN2 gene modifies the
severity of the condition and helps determine which type 18.A seizure documented on EEG without a clinical event is
develops. The SMN1 and SMN2 genes both provide called
instructions for making a protein called the survival motor a. Any of the above
neuron (SMN) protein. b. Electroclinical seizure
c. Nonconvulsive seizure
13.Oral-buccal-lingual movements are a common form of d. Electrographic seizure
seizures in the neonates because of
a. Inadequate axonal and dendritic ramifications ANSWER: D
b. Rudimentary synaptic connections
c. Well developed connections between limbic 19.Which is the true statement
structures and diencephalon and brainstem a. All of the statements are true
d. Undeveloped lamination of cortical neurons b. The premature infant will grow 0.75 cm on the head
circumference on the 3rd week of life
ANSWER: C c. At birth the head circumference/chest
circumference is =1
RATIONALE: d. A term infant will have a normal head
The relatively advanced cortical development apparent in circumference of 32 cms
limbic structures in the human newborn infant and the
connections of these structures to the diencephalon and brain ANSWER: B
stem may underlie the frequency and dominance of
oral-buccal-lingual movements (e.g., sucking, chewing, or
drooling), oculomotor movements, and apnea as clinical
manifestations of neonatal seizures.
SOURCE: Volpe’s Neurology of the Newborn 6th Edition

Chapter 12, Page 276
14.The most common mutation in SMN1

a. Duplication of exon 21
b. Duplication of exon 7
c. Deletion of exon 12
d. Deletion of exon 7
ANSWER: D
|pg. 2
PEDIATRICS
2ND SEMESTER
SHIFTING EXAM 16.1
NEURO (Dr. Bael)
ANSWER: Page 3066 Nelson’s Textbook of Pedia
24.The T1 for focal status epilepticus with impaired awareness

is
a. 10 minutes
b. 15 minutes
c. 5 minutes
d. 3 minutes
ANSWER: A
Source:
https://www.sciencedirect.com/topics/medicine-and-dentistry/st
atus-epilepticus
25. One of the following findings is not characteristic of TB

meningitis:
a. arteritis
b. obstructive hydrocephalus
c. multiple cranial nerve deficits
d. basal exudates
(Source: pediatric neurology trans of Dr bael page 1) ANSWER:
● Diagnostic triad of TB meningitis:
20. In scaphocephaly, there is premature closure of ○ Presence of basal exudates
a. Lambdoid sutures ○ Infarcts
b. Sagittal sutures ○ hydrocephalus
c. Metopic stures
d. Coronal sutures 26.A burst suppression pattern on EEG is seen in this
syndrome
ANSWER: B a. Juvenile Myolconic Epilepsy
b. Ohtahara syndrome
c. LennnoxGestaut Syndrome
d. Childhood Absence Epilepsy
ANSWER: B
Source: Nelson’s textbook of pediatrics, 21st edition, Chapter

on Craniosynostosis
21.Commonly associated with ovarian tumors in adult females

a. Rasmussen’s encephalitis
b. Herpes simplex encephalitis Source:
c. Febrile Induced related epilepsy syndrome https://www.epilepsy.com/what-is-epilepsy/syndromes/ohtahara
d. Anti NMDAR Encephalitis -syndrome
ANSWER: D
27.Risk factors for pediatric multiple sclerosis
Source: Nelson's Textbook of Pediatrics 20th ed. (Ch 598 p. a. Male gender
2907) b. Asian race
c. Second hand smoke exposure
22.Benign Familial Neonatal Epilepsy is associated with a d. Previous Japanese encephalitis
mutation in
a. Chromosome 7 ANSWER: C
b. Chromosome 20
c. Chromosome 16 28.Childhood Absence Epilepsy will show this EEG pattern
d. Chromosome 5 a. Generalized 3 Hz spike and slow waves
b. Hypsarrhythmia
ANSWER: In Nelson’s: Benign familial neonatal seizures, an c. Burst suppression pattern
autosomal dominant condition, begins on the 2nd to 3rd day of d. Generalized spike and polyspike wav discharges
life, with a seizure frequency of 10-20/ day. Patients are normal
between seizures, which stop in 1-6 mo. These are caused by ANSWER: A
mutations in the voltage-sensitive potassium channel genes
Kv7.2 and Kv7.3 (KCNQ2 and KCNQ3). * No chromosome
number
In the Internet: KCNQ2 gene is located on Chromosome 20
23.A 2-month old infant was brought for consult for a

lumbosacral mass. It was cystic, illuminated well with a
§ashlight. Neurologic exam revealed normal tone of both lower
extremities with active movements. The rectal examination was Source: Adams and Victor’s Principles of Neurology
normal. Patient most probably has a
29.A 9 month old infant was brought to your clinic because of
a. lipomeningocoele cystic mass abnormal movements. She had an unremarkable birth and
b. myelomeningocoele no paralysis of extermities maternal history. The mother informed you that she has
c. sacral teratoma observed her daughter to would always get startled, even if
d. Meningocoele there were no sudden loud sounds. The episodes would occur
in groups observed to be more frequent when the child was
|pg. 3
PEDIATRICS
2ND SEMESTER
SHIFTING EXAM 16.1
NEURO (Dr. Bael)
drowsy and about to sleep. On examination, you observed

hypomelanotic macules on the skin. The infant can only roll 35.The lesion in internuclear ophthalmoplegia is in
over but not turn over yet, she did not reach out for objects and a. The medial longitudinal fasciculus
only grasped them . Your most likely diagnosis is b. The ipsilateral (to the lesion) optic nerve
a. Benign Sleep Myoclonus of infancy c. The contralateral sixth nerve
b. Ohtahara Syndrome d. The contralateral oculomotor nerve
c. West Syndrome
d. Dravet Syndrome ANSWER: A
This results from damage to the medial longitudinal fasciculus
ANSWER: C ascending from the abducens nucleus in the pons to the
oculomotor nucleus in the midbrain (hence, internuclear)
30.The posterior fontanelle closes by Source: Harrison’s Neurology in Clinical Medicine, 4th Ed
a. 18 months old
b. 6 months old 36.The minimum number of spinal segments in length, to
c. 3 months old diagnose Neuromyelitis optica
d. 20 months old a. 1
b. 4
ANSWER: C c. 3
SOURCE: Nelson textbook of Pediatrics 20th ed page 2792 d. 2
31.The usually age Benign Rolandic Epilepsy is outgrown is ANSWER: C

a. 15 years old
b. 10 years old 37.The first drug of choice for neonatal siezures is
c. 5 years old a. Phenobarbital
d. 20 years old b. Diazepam
c. Phenytoin
ANSWER: Outgrown by adolescence. d. Levetiracetam
ANSWER: B
Source: Trans-Dr. bael-pediatric neurology., Page 9
38.he inverted champagne bottle appearance is commonly

seen in
a. Charcot Marie Tooth Disease
b. Spinal Muscular Atrophy type 4
source: c. Centronuclear Myopathy
https://practicalneurology.com/articles/2018-oct/self-limited-foc d. Duchenne Muscular dystrophy
al-epilepsies-in-childhood
ANSWER: A
32. Lhermitte’s sign may be seen in Source: Trans- Insignis Pedia Neurology, pg 17
a. Balo’s encephalitis
b. Transverse Myelitis 39.Muscle weakness with Normal deep tendon refexes is
c. Acute Disseminated Encephalomyelitis elicited in
d. Optic Neuritis a. Charcot Marie Tooth Disease
b. Myasthenia gravis
ANSWER: B c. Congenital Myopathies
Source: Trans- Insignis Pedia Neurology, pg 9 d. Cerebral palsy
33.Seizure can be generated by ANSWER: B
a. Influx of Calcium
b. Decreased activation of NMDA receptors 40.The first drug of choice for West Syndrome isIVIG
c. Increased GABA concentration a. Phenobarbital
d. Blockage of sodium channels b. ACTH
c. Cannabidiol
ANSWER: A d. Carbamazepine
ANSWER: B
Source: Trans- Insignis Pedia Neurology, pg 5
41.A muscle biopsy showing a denervation pattern is present

in
a. Dermatomyositis
b. Nemaline myopathy
c. Myasthenia gravis
d. Spinal muscular atrophy
ANSWER: A
SOURCE: Trans (Dr. Eribal) - Inflammatory Myopathies., page
4
42. 30% of patients had a previous herpes simplex encephalitis

b. Anti NMDAR Encephalitis
c. Rasmussen’s encephalitis
d. Acute Disseminated Encephalomyelitis
34.The Moro refex appears as early as

a. 28 weeks
b. 32 weeks
c. 20 weeks
d. 36 weeks
ANSWER: A (Start at birth 28- 32 weeks)
|pg. 4
PEDIATRICS
2ND SEMESTER
SHIFTING EXAM 16.1
NEURO (Dr. Bael)
ANSWER: B
43.t Is a subset of New Onset Refractory Status Epilepticus

b. Herpes simplex encephalitis
c. Rasmussen’s encephalitis
d. Anti NMDAR Encephalitis
ANSWER: A
Source: https://www.ncbi.nlm.nih.gov/books/NBK567765/
44.Grade 3 Muscle strength is

a. Active movement of joint without gravity and
presence of fasciculations
b. Active movement of joint without gravity
c. Active movement of joint against gravity
d. Active movement against resistance
ANSWER: C
45.Which statement is TRUE?

a. Epilepsy is considered resolved if the patient is
seizure free for 2 years
b.A 60 year old patient who had a stroke 3 years ago
and developed right hemiparesis, develops an
episode of right focal clonic movement of his right
arm. He has Epilepsy
c. A 2 year old had vomiting of previously ingested
food and developed 2 episodes generalized tonic
clonic seizures a few hours later. He was brought to
the emergency room. Your ¦rst impression is Epilepsy.
d. In neonates, GABA is initially inhibitory
ANSWER: B
Source: ILAE 2017 Report (as cited in doc Bael’s lectures)
Not A Not C
By this definition as well, Letter B can be identified as an

epilepsy even with just one unprovoked seizure, because the
recurrence rate of post-stroke seizure can be up to 90%.
Not D - GABA is the principal fast-acting excitatory transmitter
in the neonatal brain.
46.KugelbergWelander disease is the eponym for

a. Spinal Muscular Atrophy type 3
b. Spinal Muscular Atrophy type 2
c. Spinal Muscular Atrophy type 0
d. Spinal Muscular Atrophy type 1
|pg. 5
PEDIATRICS
2ND SEMESTER
SHIFTING EXAM 16.2
NEURO (Dr. Dela Calzada)
1. A seizure documented on EEG without a clinical event is elicited in

called: A.Charcot Marie Tooth Disease
A. Electroclinical seizure B. Cerebral palsy
B. Any of the above C. Congenital Myopathies
C. Electrographic seizure D.Myasthenia gravis
D.Nonconvulsive seizure
15. The inverted champagne bottle appearance is commonly
2. The Moro reflex appears as early as : seen in
A.36 weeks A.Spinal Muscular Atrophy type 4
B. 32 weeks B. Charcot Marie Tooth Disease
C. 28 weeks C. Centronuclear Myopathy
D. 20 weeks D.Duchenne Muscular dystrophy
3. Tracking a red ball allows evaluation of which cranial nerves 16.The first drug of choice for neonatal siezures is
A. III, IV, VI A.Phenytoin
B. II,III,IV,V,VI B. Levetiracetam
C. II C. Diazepam
D. II,III,IV,VI D. Phenobarbital
4. The severity of SMA is based on: 17.Complete 3rd nerve palsy will show a
A.Degeneration of the anterior horn cell A.Downward and inward eyeball
B. The number of SMN2 protein B. Downward and outward eyeball
C. The number of SMN1 protein C.Upward and inward eyeball
D. The number of respiratory muscles involved D.Upward and outward eyeball
5. KugelbergWelander disease is the eponym for 18.Most common etiologic agent of bacterial meningitis in a
A.Spinal Muscular Atrophy type 3 3-year old child
B. Spinal Muscular Atrophy type O A. S. pneumoniae
C.Spinal Muscular Atrophy type 1 B. H. influenzae
D. Spinal Muscular Atrophy type 2 C. Pseudomonas
D. E. coli
6. The T1 for focal status epileptics with impaired awareness is
A.10 minutes 19. Conventional antiseizure medications are not enough to
B. 15 minutes control the seizures in this condition
C. 3 minutes A. Anti NMDAR Encephalitis
D. 5 minutes B. Febrile Induced related epilepsy syndrome
C. Herpes simplex encephalitis
7. The first drug of choice for West Syndrome isIVIG D. Rasmussen's encephalitis
A.Cannabidiol
B. Carbamazepine 20. A 9 month old infant was brought to your clinic because of
C. Phenobarbital abnormal movements. She had an unremarkable birth and
D.ACTH maternal history. The mother informed you that she has
observed her daughter to would always get startled, even if
8. The most common mutation in SMN1 there were no sudden loud sounds. The episodes would occur
A. Duplication of exon 7 in groups observed to be more frequent when the child was
B. Duplication of exon 21 drowsy and about to sleep. On examination, you observed
C. Deletion of exon 7 hypomelanotic macules on the skin. The infant can only roll
D. Deletion of exon 12 over but not turn over yet, she did not reach out for objects and
only grasped them. Your most likely diagnosis is
9. The posterior fontanelle closes by A.West Syndrome
A.18 months old B.Ohtahara Syndrome
B. 6 months old C. Benign Sleep Myoclonus of infancy
A.20 months old D.Dravet Syndrome
D.3 months old
21. The minimum number of spinal segments in length, to
10. In scaphocephaly, there is premature closure of diagnose Neuromyelitis optica
A.Sagittal sutures A.2
B. Coronal sutures B.4
C. Metopic stures C.1
D.Lambdoid sutures D.3
11. The usually age Benign Rolandic Epilepsy is outgrown is 22.The first drug of choice in status epilepticus in a 15 year old
A.20 years old is:
B.10 years old A.Phenytoin
C. 5 years old B. Diazepam
D.15 years old C. Valproic Acid
D. Phenobarbital
12. Dexamethasone can be used as an adjuvant therapy in
bacterial meningitis in cases where the causative organism 23. Which statement is TRUE?
can be reliably diagnosed, particularly those with A. A 60 year old patient who had a stroke 3 years ago and
A. N. meningitides developed right hemiparesis, develops an episode of right
B. E. coli focalclonic movement of his right arm. He has Epilepsy
C. S pneumoniae B. In neonates, GABA is initially inhibitory
D.H. influenzae C. Epilepsy is considered resolved if the patient is seizure free
for 2 vears
13. One of the following findings is not characteristic of TB D.A 2 year old had vomiting of previously ingested food and
meningitis: developed 2 episodes generalized tonic conic seizures a few
A. obstructive hydrocephalus hours later. He was brought to the emergency room. Your first
B. multiple cranial nerve deficits impression is Epilepsy.
C. basal exudates
D.arteritis 24. Benign Familial Neonatal Epilepsy is associated with a
mutation in
14. Muscle weakness with Normal deep tendon reflexes is
|pg. 1
PEDIATRICS
2ND SEMESTER
SHIFTING EXAM 16.2
A.Chromosome 16 diencephalon and brainstem

B. Chromosome 5 C. Undeveloped lamination of cortical neurons
C. Chromosome 20 D.Inadequate axonal and dendritic ramifications
D.Chromosome 7
37. In multiple sclerosis, demyelination in the brain occurs
25. 30% of patients had a previous herpes simplex commonly in
encephalitis A.Thalami
A.Rasmussen's encephalitis B. Gray cortex
B. Febrile Induced related epilepsy syndrome C. Posterior fossa
C.Acute Disseminated Encephalomyelitis D. Periventricular area
D.Anti NMDAR Encephalitis
38. Childhood Absence Epilepsy will show this EEG pattern
26. A 2-month old infant was brought for consult for a A.Generalized spike and polyspike wav discharges
lumbosacral mass. It was cystic, illuminated well with a B. Hypsarrhythmia
flashlight. Neurologic exam revealed normal tone of both lower C. Burst suppression pattern
extremities with active movements. The rectal examination was D.Generalized 3 Hz spike and slow waves
normal. Patient most probably has a
A.myelomeningocoele 39. Risk factors for pediatric multiple sclerosis
B.sacral teratoma A.Male gender
C.meningocoele B. Previous Japanese encephalitis
D.lipomeningocoele C. Second hand smoke exposure
D.Asian race
27. Lhermitte's sign may be seen in
A.Acute Disseminated Encephalomyelitis 40. The highest prevalence of Moya moya disease is found in
B. Optic Neuritis A.Korea
C. Balo's encephalitis B. Indonesia
D.Transverse Myelitis C. China
D.The Philippines
28. Grade 3 Muscle strength is
A.Active movement of joint without gravity 41. A muscle biopsy showing a enervation pattern is present in
B. Active movement of joint without gravity and presence of A.Nemaline myopathy
fasciculations B. Myasthenia gravis
C. Active movement of joint against gravity C. Dermatomyositis
D. Active movement against resistance D. Spinal muscular atrophy
29. Cannabidiol has been approved for use in 42. The inheritance pattern of the severe form of Myotubular
A.Rasmussen's Encephalitis Myopathy
B. Panayiotopoluos Syndrome A. X-linked
C. Epileptic Myoclonic Encephalopathy B. Autosomal recessive
D. Dravet Syndrome C. Any of the above
D. Autusomal dominant
30. Commonly associated with ovarian tumors in adult females
A.Herpes simplex encephalitis 43. An EEG finding of extreme delta brush may be seen in this
B. Febrile Induced related epilepsy syndrome condition
C.Rasmussen's encephalitis A.Anti- NMDAR Encephalitis
D.Anti NMDAR Encephalitis B. Febrile induced related epilepsy syndrome
C. Rasmussen's encephalitis
31. The most common presentation of Moya Moya disease in D. Herpes simplex encephalitis
children is
A.Stroke 44. Which is the true statement?
B. Seizure A.All of the statements are true
C. Generalized weakness B. A term infant will have a normal head circumference of 32
D.Syncope cms
C. At birth the head circumference/chest circumference is =1
32. Seizure can be generated by D.The premature infant will grow 0.75 cm on the head
A.Influx of Calcium circumference on the 3rd week of life
B. Decreased activation of NMDA receptors
C. Blockage of sodium channels 45. Interferon is a treatment option for
D.Increased GABA concentration A.Multiple Sclerosis
B. Acute Disseminated Encephalomyelitis
33. This is associated with focal status epilepticus C. Anti NMDAR Encephalitis
A.Rasmussen's encephalitis D. Optic Neuritis
B. Herpes simplex encephalitis
C. Anti NMDAR Encephalitis 46. One of the following findings is not a characteristic of TB
D. Febrile Induced related epilepsy syndrome meningitis
A. arteritis
34. This primitive reflex is persistent throughout life B. obstructive hydrocephalus
A.Grasp reflex C. basal exudates
B. Sucking reflex D.multiple cranial nerve deficits
C. Parachute reflex
D. Tonic neck reflex 47. The lesion in internuclear ophthalmoplegia is in
A.The medial longitudinal fasciculus
35. A burst suppression pattern on EEG is seen in this B. The contralateral sixth nerve
syndrome C.The contralateral oculomotor nerve
A.Juvenile Myolconic Epilepsy D.The ipsilateral (to the lesion) optic nerve
B. Lennnox Gestaut Syndrome
C.Childhood Absence Epilepsy 48. It Is a subset of New Onset Refractory Status Epilepticus
D.Ohtahara syndrome A.Rasmussen's encephalitis
B. Febrile Induced related epilepsy syndrome
36. Oral-buccal-lingual movements are a common form of C.Anti NMDAR Encephalitis
seizures in the neonates because of D.Herpes simplex encephalitis
A. Rudimentary synaptic connections
B. Well developed connections between limbic structures and 49. A 10-month-old child had cough and colds for 2 days. On
|pg. 2
PEDIATRICS
2ND SEMESTER
SHIFTING EXAM 16.2
the day of consult, he had a fever of 40 and subsequently

developed stiffening of all extremities with upward rolling of
eyeballs, for about 5 minutes. What is your first management?
A.Check sugar
B. Insert an IV line
C. Establish airway
D.Give Phenobarbital per orem because no line yet has been
inserted
|pg. 3
PEDIATRICS
2ND SEMESTER
SHIFTING EXAM 17
NEPHROLOGY
1. Glomerular bleeding is characterized by the following C. Familial juvenile nephronophthisis

EXCEPT D. Alport syndrome
A. Painless
B. Presence of blood clots
C. Presence of acanthocytes in the urine
D. Associated with proteinuria eceeding 100
mg/dl on dipstick
2. Low serum C3 is seen in the following EXCEPT: 13. The following are considered pre-renal causes of acute
A. Focal Segmental Glomerulosclerosis kidney injury EXCEPT:
B. Lupus Nephritis A. Massive bleeding
C. Acute Poststrep GN B. Septic shock
D. MembranoproliferativeGN C. Use of nephrotoxic drugs
D. Cardiac failure
3. The following urinary indices support pre renal cause
of AKI EXCEPT: 14. The simplest accurate method to measure urine
A. FeNa is > 2% protein excretion in a child israndom urine protein
B. Urine specific gravity is > 1.020 measurement
C. Urinary sodium content is < 20 meg/L A. 24-hour urinarv protein excretion
D. Urinary osmolality is >500 mosm/L B. random urine protein/creatinine ratio
C. 24-hour urinary protein/creatinine ratio
4. The following are indications of doing renal biopsy
among patients with Acute PSGN EXCEPT 15. Hyperkalemia is one of the complications of AKI that
A. Microscopic hematuria lasting for one year can lead to cardiac arrythmia and death. Serum
B. Synpharyngitic hematuria potassium can be lowered by all of the following
C. Persistently low C3 beyond 3 months EXCEPT:
D. Persistent azotemia A. Regular Insulin and glucose
B. Sodium polystyrene sulfonate resin
5. Pathogenesis of chronic kidney disease (CKD) include C. Salbutamol nebulization
all of the following EXCEPT D. Calcium gluconate
A. Hyperfiltration injury
B. Proteinuria
C. Hypertension
D. Hyperkalemia
6. The following clinical manifestations will differentiate

lower UTI from upper UTI EXCEPT
A. Gross hematuria with blood clots
B. Suprapubic pain
C. Fever
D. Voiding dysfunction
7. The most common cause of ESRD among pediatric

patients > 5 y.o is
A. Acquired glomerulonephritides 16. Which one of the following is the first line of treatment
B. Metabolic diseases for children with nephrotic syndrome?
C. Nephrotoxic drugs A. Cyclosporin A
D. Obstructive uropathy B. Prednisone
C. Chlorambucil
8. The most reliable method of urine collection among D. Cyclophosphamide
neonates and infants
A. Catheterization 17. If a child with Idiopathic nephrotic syndrome (INS) is
B. Midstream clean catch collection started on steroids and his urine became protein-free
C. Suprapubic aspiration after 6-8 weeks, he most likely has this histologic type:
D. Wee bag collection A. Minimal change disease
B. Focal segmental glomerulosclerosis
9. The most frequent organism associated with C. Membranous nephropathy
spontaneous peritonitis among nephrotic syndrome D. Mesangial proliferative glomerulonephritis
patients is
A. Salmonella 18. A 10 v.o. male child is assessed to have elevated BP if
B. Strep pneumoniae his BP is
C. E coli A. 140/90 mmHg
D. Shigella B. 150/100 mmHg
C. 120/80 mmHg
10. The following can cause intermittent/transient D. 130/80 mmHg
proteinuria EXCEPT
A. Exercise 19. Cystitis is associated with all of the following EXCEPT
B. Fever A. Adenovirus infection
C. Reflux nephropathy B. Hypogastric pain
D. Dehydration C. Presence of renal scarring
D. Urgency/ dysuria
11. The following are present in nephrotic syndrome
EXCEPT: 20. The following are stone-promoting factors EXCEPT:
A. Edema A. Decrease potassium intake
B. Increased serum cholesterol B. Less urine volume
C. Decreased tubular reabsorption of sodium C. Urinary stasis
and water D. Presence of urinary citrate
D. Hypoalbuminemia
21. The following statements are true of VUR EXCEPT
12. Chronic kidney disease in children < 5 v.o. is MOST A. Incidence of renal scarring decreases with
commonly a result of decreasing grade of reflux
A. Lupus nephritis — >5 years old B. Reflux is usually congenital
B. Renal hypoplasia C. Reflux is unlikely to cause renal injury in the
|pg. 1
PEDIATRICS
2ND SEMESTER
SHIFTING EXAM 17
NEPHROLOGY
absence of infection hypertension

D. Continuous antibiotic prophylaxis is the C. Associated with strong family history of
cornerstone in the initial management of low hypertension
grades VUR D. Age < 6 y.0.
22. The predominant pathogenic mechanism following 31. The most common cause of Chronic GN in older
injury leading to GN is children is
A. Traumatic A. Membranous GN
B. Immunologic B. ESGS
C. Coagulopathy C. MPGN
D. Infectious D. Mesangial Proliferative GN
23. A 3 y.o, girl had a 3 day history of profuse watery 32. The following are the indications for antihypertensive
diarrhea and vomiting. On consultation, there was no drug therapy in children EXCEPT
urine output for the last 12 hours. Three fluid boluses A. Symptomatic HPN
were given but very minimal urine was obtained by B. Primary HPN due to obesity
catheterization. Urine was dark yellow, highly C. Presence of LVH
concentrated with low urine sodium content. The D. Coexisting diabetes mellitus
classification of the acute kidney injury in this patient is
A. LosS 33. The following statements are true of Acute Poststrep
B. Failure GN EXCEPT:
C. Risk A. Recurrences are extremely rare
D. ESRD B. Antibiotic therapy will affect the clinical course
of glomerulonephritis
24. The most common metabolic abnormality causing C. Epidemic of nephritis have been associated
nephrolithiasis in children with skin infections due to serotype 49 of
A. Hypercalciuria Group A B-hemolytic Strep
B. Hyperoxaluria D. Rare before the age of 3y.0
C. Hyperparathyroidism
D. Renal tubular acidosis 34. Minimal change nephrotic syndrome is characterized
by the following EXCEPT:
25. The following statements are true of UTI EXCEPT: A. Does not progress to renal failure
A. Infants and young children are at a higher B. Commonly seen between 2-6v.o
risk than older children for renal scarring due C. Hypertension is seen in 35% of cases
to UTI D. Electron microscopic findings show fusion of
B. The presence of fever has been accepted as podocyte foot processes
a clinical marker of renal parenchymal
involvement 35. Acute glomerulonephritis results in hematuria when:
C. UTI can occur in the absence of ovuria A. Organism from the throat attacks the
D. The risk of renal damage decreases as the glomeruli
number of UTI recurrence increases B. Immune complexes are deposited in the
basement membrane
26. If you want to know if UTI has caused renal injury C. Bacteria from skin infection attacks glomeruli
(scarring) in infants and children, the best imaging D. ASO antibodies are deposited in the
modality is glomeruli
A. Renal scintigraphy (DMSA)
B. Intravenous pyelography 36. Complete recovery occurs in how many percent of
C. Abdominal CT scan patients with PSGN?
D. KUB ultrasound A. 85%
B. 95%
27. True statements regarding the edematous child with C. 75%
Nephrotic Syndrome EXCEPT: D. 65%
A. The child is immunocompromised
B. The degree of edema generally correlates 37. The following factors are associated with the
directly with serum albumin levels occurrence of hypertension in children EXCEPT
C. The child should be cautiously given diuretics A. Hyperuricemia
D. The child may have decreased intravascular B. LBW/Prematurity
volume despite increase in total body water C. Increased physical activity
D. Obstructive sleep apnea
28. The catheterized urine specimen is considered
diagnostic if culture vields 38. Indications for dialysis in AKI include the following
A. Single urinary pathogen count of EXCEPT
>10,000CFU/mL A. Pulmonary edema intractable to diuretic
B. 50.000 CFU/ml of a single urinary pathogen therapy
C. 2 or more pathogens of 100,000 CFU/MI B. Uremic encephalopathy
D. Growth of any number C. BUN level >100mg/dl
D. Persistent hypokalemia
29. A 2 y.0. boy has had a 5-day history of frequent watery
stools and vomiting. On the day of admission he was 39. The following are usually present in chronic kidney
noted to have poor urine output and lethargy. In the disease Stage 5 EXCEPT:
ER, he was found to have dry mucous membranes and A. Hyperkalemia
a heart rate of 150/min. Weight was 11 kg and height B. Metabolic Acidosis
was 88 cms. His serum creatinine is 1 mg/dI. What is C. Hypercalcemia
the estimated creatinine clearance of this patient? D. Anemia
A. 44 ml/min
B. 60 m|/min 40. The best imaging modality to document vesicoureteral
C. 35 ml/min reflux is
D. 50 ml/min A. Micturating Urography
B. Renal Scan
30. Primary hypertension in the pediatric age group is C. Doppler Ultrasound
characterized by the following EXCEPT D. IVP
A. Children are frequently overweight
B. Characterized by mild or Stage 1 41. A 5 y. o., boy was diagnosed with Acute Postinfectious
|pg. 2
PEDIATRICS
2ND SEMESTER
SHIFTING EXAM 17
NEPHROLOGY
Glomerulonephritis. CBC revealed Hb: 8.5 g/dI, Hct: D. Risk

29%. The management of anemia for this patient is
A. Erythropoeitin injection
B. No treatment
C. pRBC transfusion
D. Iron supplementation
42. Medical management of Acute kidney injury include all

of the following EXCEPT
A. Fluid restriction is essential if there is no
response to a diuretic
B. Mannitol is not effective in the prevention of
pigment induced renal failure
C. Furosemide may be administered as a single
IV dose
D. Intravenous administration of boluses of
isotonic saline
43. Which of the following statements is not true of VUR

A. It is due to a congenital anomaly of the
insertion of the ureter into the kidney
B. The higher the grade of reflux the higher the
incidence of renal scarring
C. High grade refluxes warrant the use of long
term low dose antimicrobial therapy
D. It is likely to resolve spontaneously if it is low
grade
44. Which of the following statements is not true among

patients with Rapidly Progressive Glomerulonephritis
(RPGN)?
A. Children with crescentic post infectious GN
can lead to permanent damage
B. Combination of high dose IV steroids and IV
cyclophosphamide is effective
C. The histopathologic hallmark is the presence
of crescents in glomeruli
D. Most children present with acute nephritis
and nephrotic syndrome
45. The following are part of the management of children

with nephrolithiasis EXCEPT
A. Limit calcium intake
B. Increase oral fluid intake to one and a half or
twice the maintenance fluid
C. Avoid excessive intake of animal protein
D. Potassium citrate
46. Acute Kidney Injury is characterized by the following

EXCEPT:
A. Reversibility
B. Azotemia
C. Maybe associated with normal urine output or
polyuria
D. Small contracted kidneys
47. Complement C3 level in glomerulonephritis normalizes

A. 8-10 weeks
B. 10-12 weeks
C. 4-6 weeks
D. 6-8 weeks
48. The generalized edema of nephrotic syndrome is best

treated with:
A. Antibiotics
B. Albumin infusion
C. Prednisone
D. Diuretics
49. Accurate BP measurement should be part of the

routine physical examination by the age of:
A. 10
B. 7
C. 3
D. 5
50. A 2 day old female neonate, with an APGAR score of

3, 4 and thickly meconium stained had a urine output
of < 1 ml/kg/hr for the past 24 hours. What is the AKI
classification of this patient?
A. Loss of kidney function
B. Injury
C. Failure
|pg. 3
PEDIATRICS
2ND SEMESTER
SHIFTING EXAM 18
CARDIOLOGY & CHILD ABUSE
1. Pediatric Cardiology, Child Maltreatment Shifting Exam

Anti Child Abuse Law
A. RA 9858
B. RA 9502
C. RA 5610
D. RA 7610
2. Diagnostic findings of left ventricular hypertrophy,

prominent main pulmonary artery, and increased
pulmonary vascular markings, are seen in:
A. Atrial septal defect
B. Coarctation of the aorta
C. Ventricular septal defect
D. Patent ductus arteriosus
3. Tony, 4 years old, was born blue. He loves to run around

and play. He has recently been observed to squat after
running a few feet associated with an increase in his
"blueness". Tony's squatting condition most likely describes
9. Nico fullterm newborn was noted to be cyanotic,
A. Hypoxic spell
tachypneic and tachycardic a few hours after birth. No
B. Dyspnea on exertion
murmur was appreciateD. Chest x-ray was requesteD. This
C.Orthopnea
showed increased pulmonary vascular markings with the
D. Easy fatigability
heart described to look an egg on its sides. Most likely
diagnosis:
4. 3 yr old boy with frequent dyspnea on exertion and
A.Truncus arteriosus
squatting. Cardiac exam revealed systolic ejection murmur
B.Tricuspic valve atresia
over the left upper- and mid-sternal border with single S2.
C.Transposition of the great arteries
Chest x-ray showed an uplifted apex with decreased
D. Tetralogy of Fallot
pulmonary vascular markings. ECG showed right axis
deviation.
10. The most common abdominal organ
A.TAPVR
affected due to abusive abdominal trauma :
B.Truncus arteriosus
A. Kidney
C.Transposition of the great arteries
B.Spleen
D. Tetralogy of Fallot
C.Liver
D. Stomach
5. Carla, a 9-year old girl presents with low-grade fever of
one-month duration. This was associated with swelling,
11. Adult bite marks are found on the torso of a 6 year-old
tenderness and limited motion of her ankles, knees and wrists
boy. The boy claimed that his father was mad on him a dav
which manifested at different times during the last month. In
ago. You will:
the last 5 days, she had been complaining of dyspnea, easy
A. Suspect abuse, treat the bite
fatigability and has been noted to need 3 pillows to sleep. On
marks and report to the mandated
P.E., the child looks ill with tachypnea, tachycardia, normal BP.
agencies
She has pale, cool skin; harsh breath sounds; gallop rhythm,
B. treat the bite marks
grade 3/6 pansystolic murmur at the 5th ICS LMCL: normal
C.Advise the child to behave all times
liver size and a swollen, tender left knee. The child is
D. Interview his father
presenting with signs and symptoms of which of the following:
A. Carditis
12. Predictor for spontaneous closure of VSD
B. Polyarthralgia
A. Size of defect
C. Erythema marginatum
B. Intensity of murmur
D. A & B
C. Age at diagnosis
D. Gender
6. Carla is diagnosed to have rheumatic fever when which
of the following of the Jones criteria is fulfilled?
13. The Frank-Starling principle states
A.Two maior manifestations + four-fold increase in ASO titer
A. As ventricular end-diastolic volume increases, a healthy
B.One maior manifestation + two minor manifestations
heart increases cardiac output until a maximum is reached
C.One maior manifestation + one minor
and cardiac output can no longer be increased
manifestation + four-fold increase in ASO titer
B. As ventricular end-diastolic volume decreases, a healthy
D.One major manifestation + one minor
heart decreases cardiac output until a maximum is reached
manifestation + two-fold increase in ASO titer
C. As ventricular end-diastolic pressure decreases, a healthy
7. Carla's 2D-echo revealed carditis with residual heart
heart increases cardiac output until a maximum is reached
disease. How long should she receive antibiotic
prophylaxis?
D. None of the above
A. Until she is 21 yrs old
B.Until she is 40 yrs old
14. A major compensatory mechanism for increasing
C. Single dose only
cardiac output is an increase in sympathetic tone from
D. Until she is 19 yrs old
increased secretion of epinephrine and norepinephrine.
The initial beneficial effects include
8. Primary prophylaxis means treating Carla with:
A. Activation of the renin-angiotensin-aldosterone system
A. Seven-day course of penicillin
B. An increase in heart rate and myocardial contractilitv
B. Single IM dose of long-acting penicillin
C. Local vasodilation resulting in redistribution of blood
C. Ten-day course of penicillin
from the cutaneous, visceral and renal beds to the heart
D. B or C
and brain, thereby increasing preload
D. All of the above
15. Prolonged increases in sympathetic stimulation due to

untreated heart failure will result in which of the following
effects:
A. Increased mvocardial requirements
B.Hypermetabolism
C. Increased afterload
D. All of the above
|pg. 1
PEDIATRICS
2ND SEMESTER
SHIFTING EXAM 18
26. Streptococcal tonsillopharyngitis, the antecedent

16. A full term newborn developed respiratory distress soon infection that leads to rheumatic fever is caused by:
after birth and was transferred to the neonatal ICU. A.Group A -hemolytic Streptococcus
Physical examination was normal except for nasal flaring, B.Streptococcal species
rapid respiration and tachycardia of 262 beats/min. 02 C. Streptococcal viridans
saturation was 90% in room air, which responded quickly to D. Streptococcal pneumoniae
35% of ambient oxygen. Core temperature was 37.6C.
Infant has 27. The primary determinant/s of stroke volume is/ are
A. Ventricular fibrillation A. Preload
B. Neonatal lupus B.Afterload
C. Benign tachycardia C. Contractility
D. Symptomatic supraventricular tachycardia D. A,B,C
17. Ana a 7yr old child was brought to ER due to foul 28. Which of the following diagnostic tests may be most
smelling vaginal discharge. Mother suspects her child to be helpful in confirming the diagnosis of Acute Rheumatic Fever?
molested by a drug addict uncle. The most important aspect A. ASO titer
in child sexual abuse evaluation B. Rheumatoid factor
A. laboratory finding C. ANA
B. Ana's disclosure D. Blood culture
C. mother's disclosure
D. medical examination 29. The most common cause of heart failure in infants is
A. Kawasaki disease
18. Serious morbidity occurs in 50-60% of children with B.Supraventricular tachycardia
documented infective endocarditis. Of the following, the C. Left-to-right shunts
MOST common morbidity is D.Viral myocarditis
A. Heart failure
B. Mycotic aneurysms 30. The leading causative agents for endocarditis in pediatric
C. Pulmonary emboli patients are:
D. Heart block A. Fungal organisms
B. Pseudomonas aeruginosa
19. The following is a major Duke criterion for the diagnosis of C. Serratia marcescens
endocarditis: D. Viridans-type Streptococci
A. High erythrocyte sedimentation rate
B.Osler nodes 31. Radiofemoral pulse delay is a characteristic finding seen
C. New valve regurgitant flow by echocardiography in:
D. Serologic evidence of infection A.Atrial septal defect
B.Patent ductus arteriosus
20. Most common intentional C.Coarctation of the aorta
intracranial injury among physically D.Ventricular septal defect
abuse infants
A. Subarachnoid hemorrhage 32. Which of the following is/are true about domestic violence?
B. Subdural hematoma A. It happens only between married couples
C. Anoxic changes B. It happens because the dominant partner usually finds it
D. Epidural hematoma difficult to control his/her temper
C. It refers to an behavior within an intimate relationship
21. Child abuse cases must be reported to the following, that causes physical, psychological or sexual harm to those
EXCEPT: in the relationship
A. DSWD D.It happens because the dominant partner is usually
B. NGOs handling abused children mentally-ill.
C. NBI
D.PNP 33. Characteristic of AD murmur:
A. Narrow S2 split with loud A2
22. Erythema marginatum Best heard over the 5th ICS, left midclavicular line
A. Consists of pruritic, pink, evanescent skin rash C.Diastolic ejection murmur
B. Primarily found on the trunk buttocks and D. Fixed splitting of S2
proximal parts of extremities
C. Consists of non- pruritic, erythematous, 34. To keep the ductus arteriosus open, which drug
serpiginous macular lesions should be given to patients with cyanotic congenital
with pale centers heart disease?
D. B & C are correct A. Paracetamol
B. Prostaglandin E
23. A newborn developed severe cyanosis and congestive C. Propanolol
heart failure at birth. Chest x-ray showed a large egg shaped D. Digoxin
heart with increase in pulmonary vascular markings. ECG
showed right ventricular hypertrophy 35. Diagnostic findings of right atrial dilatation and sR
A. Truncus arteriosus pattern in the right precordial leads on ECG are seen in:
B.Tetralogy of Fallot A. Ventricular septal defect
C.Tricuspid valve atresia B.Coarctation of the aorta
D. Transposition of the great arteries C. Patent ductus arteriosus
D. Atrial septal defect
24. Initial treatment for #15 involves:
A. Benzathine penicillin IM single dose every 21 days 36. Women are at a greater risk for injury from domestic
B. IVIG 2g/kg violence when
C. Methylprednisolone 30 mg/kg A. They have ended a relationship either temporarily or
D.Aspirin 3-5 mg/kg permanently
B.Their male partners are unemployed
25. The diagnostic finding of rib notching on chest radiograph C.Their male partners abuse alcohol or use drugs
is seen in: D.All of the above are true
A.Coarctation of the aorta
B. Atrial septal defect 37. The most practical cardiac tool as initial diagnostic work
C. Ventricular septal defect up in pediatric patients with cyanosis, respiratory difficulty
D. Patent ductus arteriosus and also assess rhythm and conduction disturbances:
A. 2D Echocardiography
|pg. 2
PEDIATRICS
2ND SEMESTER
SHIFTING EXAM 18
B.MRI this infant are, EXCEPT:

C ECG A. Intercostal retractions
D.Chest x-ray B. Alar flaring
C.Tachypnea
38. The goals of congestive heart failure therapy is/are: D.Harrison's groove
A. To decrease afterload work
B. To decrease preload work 46. One of the following is a sign of right-sided heart failure:
C. All of the above A.edema
D. To increase myocardial contractility B. pulmonary edema
C.wheezing
39. Mark is a 5-month old infant who was noted to be D. orthopnea
tachypneic since birth with feeding difficulties, excessive
perspiration and weak cry. A day prior to consultation labored 47. A preterm neonate develops difficulty breathing and
breathing was noted and the baby was irritable. Pertinent a murmur is hearD. You suspect PDA. Which finding is
physical examination findings include: RR=82/min, expected?
HR=178/min, BP (upper extremities) =80/50 mmHg, BP (lower A.Weak pulses
extremities) =90/50 mmHg wt=3.7kg, pale and warm skin, B. Right axis deviation and right ventricular hypertrophy
beads of perspiration on the forehead, alar flaring, intercostal C. Absent pulmonary vascular markings
and subcostal retractions, Harrison's groove, harsh breath D. Machinery murmur
sounds, precordial bulge, LV heave, apex beat at the 6th ICS
left anterior axillary line, normal S1 & S2, grade 3/6 48. Subcutaneous nodules are found on:
continuous murmur at the 2nd left ICS, gallop rhythm, liver A.Soles and palms
edge 2 cm below right subcostal margin and bounding pulses B.Extensor surfaces of tendons near bony prominences
on all four extremities.The sign/s of heart failure in this infant C. Flexor surfaces, upper extremities
is/are: D. Scalp
A. Feeding difficulties
B. Excessive perspiration 49. Martin was brought to a doctor due to frequent cough. On
C. Poor weight gain auscultation a continuous machinery type of murmur was
D. All of the above heard at the L infraclavicular areA. Chest xray was taken. The
latter showed cardiomegaly with increase pulmonary vascular
40. A 4 yr old child was brought to the emergency room of markings. Martin's most likely heart condition is
VSMC by her stepmother for fever, cough, and rashes A.Tricuspic valve atresia
however on PE a well circumscribed second degree burn is B.Truncus arteriosus
seen on the dorsum of his left hand, symmetrical bruises were C.Transposition of the great arteries
also seen in his lower extremities. Most likely diagnosis: D. Patent Ductus Arteriosus
A.Physically abuse
B.PCAP 50. Nino a Fullterm male newborn asymptomatic with good
C. Viral exanthema suck. On auscultation noted to have mid systolic murmur,
D. URTI Grade 2/6, high pitch, prominent pulmonic area with radiation
to upper back and sides of the chest.ECG CXR and 2D echo
41. Which of the following is included among the were normal. Nino's condition is most likely:
major manifestations of JONES criteria? A. ASD
A. Prolonged P-R interval B. Innocent Murmur
B. Chorea C.PDA
C. Fever D. VSD
D. Arthralgia
42. Is an acute febrile illness that causes inflammation in the

walls of medium size arteries, especially coronary arteries
commonly occurring in children less than 5 years old caused
by an infectious agent?
A. Rheumatic heart Disease
B. Infective Endocarditis
C. Primary Pulmonarv HPN
D. Kawasaki disease
43. Secondary prophylaxis means

A. Prevention of recurrence of rheumatic fever
B.Prevention of a relapse of rheumatic fever
C.Deep IM injection of long-acting penicillin every 21 days
D. A & C
44. A laboratory parameter which is a must in children

less than 2 yr old suspected of physical abuse:
A.clotting parameter
B.abdominal ultrasound
C.skeletal survey
D.Ct scan
45. Mark is a 5-month old infant who was noted to be

tachypneic since birth with feeding difficulties, excessive
perspiration and weak cry. A day prior to consultation labored
breathing was noted and the baby was irritable. Pertinent
physical examination findings include: RR=82/min,
HR=178/min, BP (upper extremities) =80/50 mmHg, BP
(lower extremities) =90/50 mmHg wt=3.7kg, pale and warm
skin, beads of perspiration on the forehead, alar flaring,
intercostal and subcostal retractions, Harrison's groove, harsh
breath sounds, precordial bulge, LV heave, apex beat at the
6th ICS left anterior axillary line, normal S1 & S2, grade 3/6
continuous murmur at the 2nd left ICS, gallop rhythm, liver
edge 2 cm below right subcostal margin and bounding pulses
on all four extremities.The signs of pulmonary congestion in
|pg. 3
PEDIATRICS
2ND SEMESTER
SEMESTRAL EXAM 2
1. Which of the following modifies the somatic genotype

of the patient? 6. A 5year old boy presented to the clinic with left elbow
A. Low protein diet for Phenylketonuria swelling after hitting it against the wall while playing
B. Pamidronate therapy for Osteogenesis .The following day the swelling increased in size and
imperfecta became more painful. CBC showed mild anemia,
C. Liver transplantation in Tyrosinemia type 1 normal WBC and Differential count, and normal
D. Sodium benzoate therapy for UCD platelet count. Bleeding parameters revealed a
Somatic gene therapy can be defined as the ability to introduce normal bleeding time, normal PT and prolonged
genetic material (RNA) into an appropriate cell type or tissue in aPTT, Factor assay showed a Factor IX activity of 3%.
vivo in such a way that it alters the cell's pattern of gene Most likely He is classified as :
expression to produce a therapeutic effect. A. Severe Hemophilia B
B. Severe Hemophilia A
C. Moderate Hemophilia A
D. Moderate Hemophilia B
SOURCE: Severity Based on patient’s Hemophilia A
https://aasldpubs.onlinelibrary.wiley.com/doi/10.1002/hep.3244 circulating FVIII/FIX
1
Severe <1% factor VIII deficiency
2. A12-year old male child with complaints of on and off
high grade fever for 2 days now. A day PTA he had Moderate 1-5% Hemophilia B
watery diarrhea, fouls smelling, about 1⁄2 c per
episode. Mother cannot recall how many episodes in Mild 6- <50% Factor IX deficiency
a day. The mother only concoct some herbs and let
his son drinks the concoction. Few hours prior to Source:Trans Hematology Lecture Doc Lucero
admission, Ben was noted to be lethargic, vomiting
his previously ingested food and looks very sick. He 7.Steroid resistance nephrotic syndrome is defined as
was brought to nearest hospital where the vital sign failure to achieve complete remission after:
shows: BP 70/40mmHg, HR 150/min, RR 35/min a. 10th week of corticosteroid therapy
clear lungs, T 40C, faint pulses in the extremities cool b. 8th week of corticosteroid therapy
and mottled with a capillary refill time of >2 seconds. c. 4th week of corticosteroid therapy
What type of shock does the child have? d. 6th week of corticosteroid therapy
A. Anaphylactic shock SOURCE: Nelson’s Textbook of Pediatrics 21e, Page 2758
B. Septic shock
C. Cardiogenic shock
D. Hypovolemic shock
8.The most common case of cardiopulmonary arrest in

infants and children is:
A. Hemorrhagic shock
SOURCE: B. Ventricular fibrillation
https://my.clevelandclinic.org/health/diseases/22795-hypovole C. Respiratory insufficiency
mic-shock D. Myocardial dysfunction
SOURCE: Insignis Pediatric EMED Page 4
3. All of the following are true on Simple febrile seizure
except:
A. brief less than 10 minute duration
B. focal in character
C. generalized tonic clonic
D. occurs at the height of fever 9. Which of the following is a well known complication of
membranous nephropathy?
A. Acute renal failure
B. HPN
C. Nephritic syndrome
D. Renal vein thrombosis
10. All of the following are true of Hirschsprungs Disease

except:
A. Failure to pass meconium /
B. Pellet like or ribbon like stool with fluid
consistency /
C. Common cause of non billous vomiting in
infants
D. Large fecal mass palpable in the left lower
quadrant /
4. You were the physician receiving a term baby born via SOURCE: Nelson’s Textbook of Pediatrics 21e, Page 2726
normal vaginal delivery. He was noted to have a head
circumference of 29 cm and a midline cleft lip and
palate. The anterior fontanel was noted to be small
while the posterior fontanel was noted to be closed.
There was an underdeveloped nasal bridge and
nares. What would be the most important initial
diagnostic test to order for this case?
A. Skull x-rays 11. A test of meningeal irritation wherein the patient
B. Karyotyping flexes the knees with forced flexion of the neck is:
C. Brain imaging studies (CT Scan or MRI) A. Kernig sign
D. EEG B. Lhermittes sign
C. Babinski
5. General work up for proteinuria in urine includes the D. Brudzinski sign
following except:
A. Urine culture 12. What is the classic example of codominance type of
B. 24 hr urine protein and creatinine excretion inheritance?
C. Urine dipstick test A. Skin color
D. Microalbuminimia B. Head circumference
E. Spot urine/creatinine ratio C. Eve color
|pg. 1
PEDIATRICS
2ND SEMESTER
SEMESTRAL EXAM 2
D. Blood type B. Tachypnea

C. Cough
D. Expiratory wheezing
13. A 2-month old infant is brought to his physician due to ANSWER:
vomiting which began after his first morning feeding 2
days ago and has followed each subsequent feeding.
The vomitus is described by his mother as white with
the appearance of undigested formula; the vomiting
has been increasing in amount and has become more
forceful. The infant's bowel movement yesterday was
normal. PE is remarkable for dry lips with sticky
mucus membrane. The patient's abdomen has bowel
sounds and is soft and non-tender. A firm mobile 1x 1
cm mass is palpable in the right epigastric area.
Which of the following is the most likely diagnosis?
A. Malrotation
B. Gastroesophageal Reflux Disease
C. Intussusception
D. Pyloric stenosis
14. A one day old, full term neonate experiences

coughing, frothing of the mouth and cyanosis during
attempts of breastfeeding. Because of concerns on 19. Triad of Hemolytic uremic Syndrome includes the
aspiration, an attempt to insert orogastric tube is tried. following except:
But the tube meets resistance during the procedure. A. Microangiopathic hemolytic anemia
What is the most likely diagnosis of this patient? B. Renal insufficiency
A. Esophageal Atresia C. arthritis
B. Gastroesophageal Reflux Disease D. Thrombocytopenia
C. Zener's Diverticulum ANSWER: TRIAD: microangiopathic hemolytic anemia,
D. Achalasia thrombocytopenia, and acute kidney injury
SOURCE:
https://emedicine.medscape.com/article/779218-overview#:~:te
xt=Hemolytic%20uremic%20syndrome%20(HUS)%20is,throm
bocytopenia%2C%20and%20acute%20kidney%20injury.
20. A fluid balance in the management of Nephrotic

syndrome includes the following except:
A. Diuretics: furosemide
B. Monitoring of serum electrolytes
C. Intravenous 25% HUMAN ALBUMIN
D. Fluid restriction e. high sodium diet
21. A common congenital Gl tract anomaly that presents

as intermittent painless rectal bleeding and brick
colored or currant jelly stool:
A. Intussuseption
15. is the most common inherited abnormality of the red B. malrotation
blood cell membrane: C. Meckel Diverticulum
A. Pure Red Cell Aplasia D. Volvulus
B. G6PD
C. Thalassemia
D. Hereditary spherocytosis
16. A 10-year old female child with history of allergy to

shrimp accidentally collapsed while dining inside the
restaurant. When you perform initial BLS, you noticed
she had poor perfusion. What type of shock does this
patient have?
A. Hypovolemic
B. Anaphylaxis
C. Cardiogenic
D. Septic
22. All of the following are common cause of Pneumonia
17. All of the following are true of Viral hepatitis B spread in 4 months to 4 yrs of age except:
except: A. RSV
A. Blood/blood product B. H infuenza
B. Fecal oral C. GBS
C. Sexual D. S pneumoniae
D. Vertical ANSWER: 4 months to 4 years : RDV and other viruses, S.
SOURCE: Liver and Biliary Tract Disorders Insignis Page 3 pneumoniae, H. influenzae type b, Mycoplasma pneumoniae
SOURCE: Pedia Platinum, page 310
18. All of the following are manifestations of lower airway
obstruction except: 23. which of the following types of Nephrotic Syndrome is
A. Inspiratory stridor commonly seen among 5-15 yr of age associated with
|pg. 2
PEDIATRICS
2ND SEMESTER
SEMESTRAL EXAM 2
hematuria in 80% of cases, has low complement

levels C1,C4,C3,C9 and with mesangial and
subendothelial deposits on electron microscopy?
A. Membranous Nephropathy
B. Membranoproliferative Glomerulonephritis
C. Focal Segmental Glomerulosclerosis
D. Minimal Change disease 29. Which of the following is an important determinant of
outcome of TB meningitis?
A. Stage of illness
B. Age
C. Cranial nerve deficit
D. Seizure on admission
30. All of the following are contraindications for doing an

LP except:
A. Platelet ct less than 150.000
B. Suspected space occupying lesion
C. Signs of increase ICP
D. Infection at the sacral area
31. Phenylalanine gets converted to which amino acid,

making this amino acid essential in PKU?
A. Tyrosine
B. Valine
24. Which of the following indicates resolved HBV
C. Arginine
infection and determines immunity after vaccination?
D. Leucine
A. IgM anti HBC
SOURCE: Management of Metabolic Disorders Insignis Dr.
B. Anti HBC
Cavan Page2
C. HBsAg
D. Anti HBs
SOURCE: Liver and Biliary Tract Disorders Insignis
25. Which of the following is not a parasitic cause of

acute gastroenteritis?
A. Strongyloides
B. C.jejuni
C. G.lamblia
D. E.histolytica
32. A 5 week old male infant was brought to the
Emergency room for consult regarding a recurrent
minimal bleeding and delayed separation of the
umbilical stump.Bleeding parameters showed a
normal bleeding time, normal PT, normal aPTT and
normal platelet count. The most likely diagnosis is:
A. Vitamin K deficiency
B. Factor VIl deficiency
C. Factor XIll deficiency
D. Von Willebrand Disease (BT↑ , aPTT↑, PT N,
Plt N)
SOURCE: Hemorrhagic and Thrombotic Disorders in Children
Dr. Lucero Page 7
26. Which of the following Cranial nerves are commonly

affected in TB meningitis?
A. CN VI 33. Marfan syndrome is diagnosed by:
B. A and c only A. 2D echocardiography
C. CN VII B. Fibrillin gene studies
D. CN III C. Karyotyping
E. All of the above D. Diagnostic criteria
ANSWER: E. Brainstem is the site of the greatest involvement,
commonly affecting cranial nerves III, VI, and VII
SOURCE: PEDIA PLATINUM page 452
27. All of the following is/are true of glomerular hematuria

except
A. tea colored urine
B. urinary microscopic finding of re cast
C. presence of leucocyte cast
D. proteinuria on dipstick <100mg/dl
28. A continuous seizure without neurologic recovery

lasting for 30 minutes or longer
A. Complex Febrile seizure – >15 mins
B. Status epilepticus
C. Febrile Myclonus
D. Febrile Seizure Plus
|pg. 3
PEDIATRICS
2ND SEMESTER
SEMESTRAL EXAM 2
39. Regurgitation is common manifestation among patient

with:
A. Malabsorption
B. Lactose Intolerance
C. GERD
D. Nasal obstruction
40. When doing the advance ventilation for a patient in

impending respiratory failure, which of the following
maneuver can lower aspiration risk us minimize or
prevent aspiration of gastric contents
A. Sellick's maneuver
B. Head-tilt chin-lift
C. C-E technique
D. Jaw thrust
SOURCE: Chapter 81 Nelson’s Pedia
41. One of the following is a hallmark of Croup among

infants and children
A. Barking cough
B. Wet cough
C. Whooping cough
34. The amino acid that causes the sweet smell in the D. Dry cough
urine of MSUD patients is: SOURCE:
A. Valine
B. Leucine
C. Isoleucine
D. Allo-isoleucine
SOURCE: Management of Metabolic Disorders
35. Vaccines required prior to splenectomy are the

following except:
A. Influenza 42. A 1 yo male child has a history of 3 days watery
B. H. influenza type b diarrhea. He appears pale and has an RR of 65
C. Meningococcus breaths per minute, HR of 200 beats per minute, and
D. Pneumococcus a systolic blood pressure of 50 mmHg. His extremities
are cool and mottled with a capillary refill time of >2
36. The following are the expected laboratory results of seconds. After providing 100% oxygen, what is the
iron deficiency anemia: best next thing to do?
A. L VMCV, L RBC, L TIBC A. Insert advance ET as eventually this will lead
B. L MCV. L RBC. I TIBC to respiratory failure
C. L MCV. normal RBC, I TIBC B. Start IV line and give epinephrine at
D. L MCV. L RBC. normal TIBC 0.1mg/kg thru IV
C. Insert IV line and give bolus of isotonic
solution 20cc/kg
D. Attach to the monitor to check for the cardiac
rhythm
37. Which of the following condition does NOT require a

low protein diet?
A. PKU
B. Citrullinemia Recognizing the patient has decreased perfusion, at 0 min, the
C. MSUD patient must be provided with high flow O2 wherein the child
D. Galactosemia was provided with 100% O2. Next best thing is to establish
IV/IO access and push 20cc/kg isotonic solution.
38. One of the ff is the most frequent cause of ALTB: SOURCE: Shock Chapter in Nelsons Pediatrics
A. RSV
B. Adenovirus 43. Which of the following is not a component of cushings
C. Para influenza virus response?
D. Influenza A A. Bradycardia
B. Hypertension
C. Irregular respiration
D. tachycardia
44. Baby M was born full-term via normal spontaneous

delivery with good APGAR score. He was sent home
on day 3 of life. At home, mother noticed that the
baby was not sucking so well and started to become
irritable. In the days that followed, the baby started to
be lethargic. Which of the following is the most likely
diagnosis?
A. Duchenne muscular dystrophy
B. Di George syndrome
C. G6PD deficiency
|pg. 4
PEDIATRICS
2ND SEMESTER
SEMESTRAL EXAM 2
D. Phenylketonuria C. Provide surfactant via ET tube

D. Secure blood products for possible
45. A common inherited enzymatic disorder often transfusion
affecting males that causes hemolyticanemia:
A. Sickle cell Disease 52. The following are classic triad of Intussuception
B. Thalassemia except:
C. Hereditary spherocytosis A. Pain
D. G6PD B. vomiting
C. Currant jelly stool
D. Palpable shaped abdominal mass RUQ
46. A drug that can cause exon skipping is considered an SOURCE: Nelson’s Textbook of Pediatrics 21e, Page 1966
example of:
A. Pharmacologic modulation of gene 53. All of the following is/are hallmark of Nephrotic
expression syndrome except
B. Pharmacologic treatment A. edema
C. Physiologic treatment B. hyperlipidemia
D. Protein replacement or modification C. hypoalbuminemia
D. Heavy proteinuria
47. Which of the following confirms the diagnosis of E. HPN
patient suspected to have Diptheritic Laryngitis SOURCE: Pedia Platinum, Page 399
A. Bacterial smear and culture from the
membrane
B. Direct laryngoscopy
C. All of the above
D. Xray of the neck
48. The incubation period for Hepatitis B is

A. 15-19 days
B. 60-180 days
C. 14-160 days
D. 21-63 days
54. Which of the following is/are common cause of

persistent proteinuria among school age children?
A. All of the above
B. Orthostatic proteinuria
C. Fixed proteinuria
D. Transient proteinuria
SOURCE: Pedia Platinum, Page 519 and 398
49. Which of the following stage of Chronic Kidney

Disease has moderate decrease in GFR?
A. Stage 5
B. Stage 1
C. Stage 4
D. Stage 2
E. Stage 3
SOURCE: ResearchGate
50. A 6 months old male infant was seen at your clinic for 55. A 10 yo male child with fever and cough was brought
watery stools a day PTC. A stool culture is considered to your clinic. History revealed he was exposed to his
in the following cases: grandmother with TB.Work up done :Tuberculin test
A. during outbreaks (+), chest xray (-), Direct sputum smear
B. all of the above microscopy(-).Most likely he has
C. Bloody diarrhea A. TB Disease
D. stool with fecal leucocytes B. TB Infection
C. PCAP
51. A severe dengue patient came in the ER due to D. TB Exposure
severe respiratory distress and in need of advanced SOURCE: Pedia TB Dr. Yu
ventilation. Upon intubation noted with bloody
secretions in the airway. What is the next step in the
management of this patient?
A. Insert IV line and give vasopressor
B. Maintain positive pressure ventilation
|pg. 5
PEDIATRICS
2ND SEMESTER
SEMESTRAL EXAM 2
56. In the following human pedigrees, the filled symbols

represent the affected individuals. You may assume
that the disease allele is rare and therefore individuals
marrying into the family are unlikely to have defective
allele.What is the most likely mode of inheritance for
this pedigree?
A. X-linked dominant
B. Autosomal dominant
C. Autosomal recessive
D. X-linked recessive
A. X-linked dominant
C. Autosomal recessive
D. X-linked recessive
In an autosomal dominant disorder, the altered gene is a
dominant gene located on one of the nonsex chromosomes
(autosomes). You need only one altered gene to be affected by
this type of disorder.
SOURCE:
https://ocw.mit.edu/courses/7-01sc-fundamentals-of-biology-fall
-2011/fc9adae0d860c52cde83e97909f3951a_MIT7_01SCF11_
3.3sol1.pdf
59. A 15 yo female adolescent with low grade fever and

cough with nasal congestion and purulent nasal
discharge for more than a week. Most likely she has:
A. Common Colds
B. Acute Sinusitis
C. Sub acute Sinusitis
D. Chronic Sinusitis
SOURCE: pedia platinum
SOURCE:
https://www.genome.gov/genetics-glossary/Autosomal-Domina
nt-Disorder
57. Some carriers of an X-linked recessive condition can

manifest the condition because:
A. They have a dominant mutation
B. Of random X-inactivation 60. An 8-months old infant with diagnosis of high risk
C. They are homozygous for the mutation pneumonia from a referring hospital came in at the
D. Of skewed X-inactivation emergency room because of severe respiratory
symptoms How do you describe an infant in
impending respiratory failure that requires an
immediate respiratory resuscitation?
A. Increase respiratory effort but able drink
water
B. Seesaw breathing with decrease level of
sensorium
C. Increase respiratory rate with chest
indrawings
D. Awake but irritable infant when approach
58. The following human pedigree shows a family

affected by a specific disease. Assume that the
individuals marked with an asterisk (*) do not carry
any allele associated with the affected phenotype and
that no other mutation spontaneously occurs. Also
assume complete penetrance.What is the most likely
mode of inheritance for this disease?
|pg. 6
PEDIATRICS
2ND SEMESTER
SEMESTRAL EXAM 2
63. A 3 yo male child has edema, gross hematuria and

HPN that follows after a throat infection: Most likely he
has:
A. Good pasture Syndrome
B. Idiopathic RPGN
C. PSGN
D. IgA Nephropathy
64. Which of the following conditions have cure?

A. Isolated non-syndromic cleft lip
B. Diabetes mellitus
C. Neural tube defects
D. MSUD
ANSWER: A. The cleft lip usually is corrected early in a child's
life, between 3 to 6 months of age, but sometimes later. Cleft
lip surgery will correct the cleft and usually will leave minimal
scarring.
Theres no diabetes cure, diabetes can be treated and
controlled, and some people may go into remission.
SOURCE: TRANS - Pediatric Emergencies
There is no cure for neural tube defects. The nerve damage
and loss of function that are present at birth are usually
61. The following human pedigree shows a family
permanent.
affected by a specific disease. Assume that the
The main treatment for MSUD is a low-protein diet with low
individuals marked with an asterisk (*) do not carry
levels of the three amino acids. Babies with MSUD must be on
any allele associated with the affected phenotype and
a special formula as soon as possible. Then, they'll follow the
that no other mutation spontaneously occurs. Also
special diet for the rest of their lives.
assume complete penetrance.What is the probability
SOURCE: Medscape
that individual 5 will be a carrier? [Pedigree in the
case: Autosomal recessive]
65. Height is inherited in which manner?
A. Autosomal recessive
C. Mosaicism
D. Multifactorial
SOURCE: Because height is determined by multiple gene
variants (an inheritance pattern called polygenic inheritance), it
is difficult to accurately predict how tall a child will be.
A. 1/4 66. Which of the following conditions would most likely

B. 1/3 present with hypoketotic hypoglycemia?
C. 3/4 A. Fatty Acid Oxidation Defects
D. 1⁄2 50% B. Aminoacidopathies
C. Urea Cycle Defects
D. Organic Acidurias
ANSWER: A
● Presenting hypoketotic hypoglycemic coma during
catabolic states
- Prolonged fasting, operations, infections
SOURCE: 3. Insignis Pedia Management of Metabolic

Disorders, page 3
SOURCE: PedigreeKEY.pdf
https://www.claytonschools.net/cms/lib/MO01000419/Centricity 67. TB meningitis has subacute and non specific clinical
/Domain/990/PedigreeKEY.pdf?fbclid=IwAR0tMudPAez7_d1A course, which of the following key factors aids in the
XQ3pGj-Yz68feq21qKhl24jebNjPuuQU-9RmHpUeC1o diagnosis
A. Only b is correct
62. A 12 year old male adolescent sought consult in the B. Detection of pulmonary and other forms of
clinic for abdominal discomfort and that he was TB
experiencing pain on his shoulder and wrist. Physical C. Identification of recent close contact with
examination revealed marked splenomegaly. CBC infectious TB within the past 12 months
revealed a mild anemia, hyperleukocytosis with D. All of the above
myeloid cells at all stages of differentiation and E. High index of suspicion
throbocytosis.Bone marrow examination revealed The clinician should have a high index of clinical suspicion if a
both granulocytic and megakaryocytic patient presents with a clinical picture of
overproliferation with blast cells <5%. What is the meningoencephalitides, especially in high-risk groups or in
most likely diagnosis? endemic areas. There is frequently diagnostic uncertainty
A. Chronic Myelogenous Leukemia when differentiating TBM from other meningoencephalitides, in
B. ALL, B cell particular partially treated meningitis. TBM must be
C. ALL,Tcell differentiated not only from other forms of acute and subacute
D. Acute Myelogenous Leukemia meningitis, but also from conditions such as viral infections and
SOURCE: Pedia Platinum page 284 cerebral abscesses (See Diagnosis).
The diagnosis of TBM cannot be made or excluded solely on
the basis of clinical findings. Tuberculin testing is of limited
|pg. 7
PEDIATRICS
2ND SEMESTER
SEMESTRAL EXAM 2
value. Variable natural history and accompanying clinical SOURCE: Pedia Platinum: Chapter 11, Page 287
features of TBM may confuse the clinician. A lumbar puncture
is necessary if meningitis is suspected, with the caveat that
there is some risk of herniation of the medulla if intracranial
hypertension is suspected. A small-volume lumbar puncture
may be considered in such cases. CNS imaging modalities
lack specificity but may aid in suggesting the diagnosis and
monitoring for complications that require neurosurgical
intervention (See Workup).
SOURCE:
https://emedicine.medscape.com/article/1166190-overview
68. A 6-month old female infant is brought to her

physician for vomiting, which began after her first
morning feeding and has continued to further
unrelated feedings. The vomitus has initially looked
like undigested food but now appears to be mostly
mucus, with the last episode having a green tinge. On
PE, the abdomen has positive bowel sounds and is
soft and a mildly tender, ill-defined mass is palpable in
the right upper quadrant, extending inferiorly. Rectal
exam revealed an empty rectal vault except for a
small amount of mucus, which is guaiac negative.
What is the most likely diagnosis of this patient?
A. Malrotation
B. Pyloric stenosis
C. Intussusception 73. The following are risk factors of iron deficiency
D. Duodenal atresia anemia among children and adolescents except:
Most describe the symptoms of intussusception as a triad of A. Menstrual blood loss YES
colicky abdominal pain, bilious vomiting, and "currant jelly" B. Chronic blood loss YES
stool. The primary symptom of intussusception is described as C. Hookworm infestation YES
intermittent crampy abdominal pain. In addition to the D. Excessive consumption of cow's milk
abdominal pain, most children will also have episodes of SOURCE:Pediatric Hematology-Oncology page 7
vomiting associated with the pain. This vomiting is usually not
associated with eating and may be bilious (yellow-green 74. Drowning that is common in < 1 year old children is
colored). Some affected individuals who do not seek early usually in the
medical attention may pass "currant jelly stool". This is stool A. Ocean
that is bloody and mucousy and may be a sign that the affected B. Lakes
bowel has lost its blood supply and that the bowel may be C. Swimming pool
necrotic (non-viable). D. Bath tubs
SOURCE: SOURCE: Nelsons 21st Ed page 607
https://www.medicinenet.com/intussusception/article.htm
69. Baby M was born full-term via normal spontaneous

delivery with good APGAR score. He was sent home
on day 3 of life. At home, mother noticed that the
baby was not sucking so well and started to become
irritable. In the days that followed, the baby started to 75. Therapeutic dose for oral anticoagulation is best
be lethargic. Which of the following diagnostic tests is monitored by:
BEST to confirm your diagnosis? A. PT/INR.
A. Urine metabolic screen B. aPTT
B. Fluorescence in situ hybridization (FISH) C. Anti Xa activity
C. Benedict's test D. Bleeding time
D. Urinalysis SOURCE: Hemorrhagic and Thrombotic Disorders in Children
Page 9
70. A whooping, paroxysmal cough is common among
patients with:
A. Croup
B. GER
C. Pertussis
D. Bronchial asthma
SOURCE: Disorders of the Upper Respiratory Tract page 2
76. The following is/are general principles in the care of a
71. What age is Supplemental iron to be started to child with seizures during an attack:
prevent Iron Deficiency Anemia:? A. All of the above
A. 2 months old B. Provide adequate airway
B. 1 year old C. Prevent injury during an attack
C. 4 months old D. Prevent aspiration
D. at birth SOURCE: https://www.cdc.gov/epilepsy/about/first-aid.htm
SOURCE: Nelson’s Textbook of Pediatrics 21Ed. Page 2524
77. Which of the following test is used to measure the
final step in the clotting cascade in which fibrinogen is
converted to fibrin?
A. Prothrombin time
B. Partial Thromboplastin time
C. Thrombin time
72. Most common extracranial solid tumor in children that D. Bleeding time
presents with periorbital ecchymoses, abdominal pain SOURCE:Nelson’s Textbook of Pediatrics 21e, Page 2593
and abdominal mass that crosses the midline
A. Wilms tumor
B. Neuroblastoma
C. Craniopharyngioma
D. Hepatoblastoma
|pg. 8
PEDIATRICS
2ND SEMESTER
SEMESTRAL EXAM 2
78. The following are True for G6PD deficiency except: B. Lansoprazole
A. Degree of hemolysis varies with the inciting C. Esomeprazole
agent and the amount ingested D. Sucralfate
B. Heterozygous females have normal SOURCE: Nelson’s Pediatrics 21st ed. Chapter 361 Table
enzymatic activity and normal BC 361.3
morphology
C. Most patients are asymptomatic 84. One of the following is a striking feature of Henoch
D. Hemolysis ensues 24-48 hours from Schonlein purpura:
ingestion A. bloody diarrhea
B. vasculitis typically on the lower legs and
79. Which of the following conditions presents with burtocks
leucine encephalopathy? C. gross hematuria
A. PKU D. anemia
B. Urea Cycle Defect SOURCE: Trans - Hemorrhagic and Thrombotic Disorders in
C. MCAD deficiency Children page 8
D. MSUD
SOURCE: Nelson’s Textbook of Pediatrics 21e, Page 708 85. All of the following are common etiologic agent of
Bacterial meningitisin the first 2 months of life except:
A. L monocytogenes
B. GBS
C. H influenza
D. Gm (-) enteric bacilli
80. A 2-year old boy playing with his toys suddenly was
found by her mother holding his neck and looks like
he was choking. What is the best immediate
management for this boy?
A. Head-tilt chin-lift
B. Heimlich's maneuver
C. Sellick's maneuver
D. Jaw thrust
SOURCE: Insignis Trans Pedia Emergency pg. 7 ANSWER: C
SOURCE: pedia plat pg 453
81. Which of the following is not a primary treatment of
IgA nephropathy? 86. A 1- month old infant is brought to your clinic due to
A. Appropriate Bp control jaundice. The infant was born in term without
B. Renal transplant complications. The jaundice was noted on the second
C. Management of significant proteinuria day of life and subsided on the second week.
D. Giving of corticosteroids medication However, the jaundice recurred on the third week of
SOURCE: Nelson’s Textbook of Pediatrics 21e, Page 2721 life and has been increasing progressively. The
mother also noted the infant with pale stool. On PE,
the infant is active with good suck. Jaundice and
icteric sclerae were evident. The liver is firm and
palpable 2cm below the right subcostal margin. What
could be the primary impression of this patient?
A. Biliary atresia
B. Ascending cholangitis
C. ABO incompatibility
D. Neonatal hepatitis
82. Which of the following is an antibiotic of choice for

meningitis with PCN resistant isolate?
A. Vancomycin
B. Ampicillin
C. Ceftriaxone
D. Ceftazidime
ANSWER: A
SOURCE: Nelson’s Pediatrics 20th ed. chapter 603.1pg 2941
SOURCE:
https://liverfoundation.org/biliary-atresia-symptoms-and-treatm
ent/
87. The following diagnostic test is/are done in a 2 month

old infant with 5 days fever, irritability, poor suck,
generalized seizure for 5 minutes and nuchal rigidity
A. procalcitonin
B. Blood culture
C. LP
D. Crp
E. all of the above
Nelson textbook of pediatrics 21th edition PG 2830
● Meningitis should be considered in the differential
diagnosis, and lumbar puncture should be performed
for all infants younger than 6 mo of age who present
with fever and seizure, or if the child is ill-appearing or
at any age if there are clinical signs or symptoms of
concern.
83. All of the following are proton pump inhibitors use as Nelson textbook of pediatrics 21th edition PG 2940
first line of treatment of PUD in children except: ● Blood cultures should be performed in all patients with
A. Omeprazole suspected meningitis. Blood cultures reveal the
|pg. 9
PEDIATRICS
2ND SEMESTER
SEMESTRAL EXAM 2
responsible bacteria in up to 80-90% of cases of

meningitis.
● Elevations of the C-reactive protein, erythrocyte
sedimentation rate, and procalcitonin have been used
to differentiate bacterial (usually elevated) from viral
causes of meningitis.
88. The antibiotic prophylaxis given to close contact with

epiglottitis:
A. Cefuroxime
B. Rifampicin (rifampin)
C. Cefuroxime
D. Amoxycillin
SOURCE: Nelson textbook of pediatrics 21th edition (pdf) pg.
8711-8712
89. A common cause of meningoencephlitis in children:

A. Coxsachie
B. Enterovirus
C. HSV
D. Influenza 92. All of the following are major risk factors for
recurrence of febrile seizures except:
ETIOLOGY: Among the most common causes of viral A. Age less than 12 months of age
meningoencephalitis are viruses of the family Picornaviridae, B. Fever 38-39C
including the enteroviruses (poliovirus, coxsackievirus, C. Duration of fever <24 hours
enterovirus, and echovirus) and parechoviruses. D. Age less than 6 months of age
SOURCE: Nelson’s Pediatrics 21th ed. pg 3232 SOURCE: Nelson’s Textbook of Pediatrics 21ed. pg. 3093
90. A 7 month old febrile infant had seizures 5 minute

duration, generalized tonic clonic, an LP is considered
in the following conditions:
A. Immunization status for H infuenza is
deficient
B. A and c only
C. Immunization of Streptococcus pnemoniae is
undetermined
D. All of the above
E. Patient has been given prior antibiotics
93. A 5 yo male child had admitted for anuria, edema and

hypertension with elevated creatine level more than
2x, eGFR decrease by 50%,urine output less than
0.5ml/k/hr for 16 hr based on Pediatric Modified Rifle
(pRIFLE) Criteria he has
A. Failure
B. End Stage
C. Injury
SOURCE: Pedia Platinum 1st ed D. Risk
SOURCE: Insignis Pedia Acute Kidney Injury, page 1
91. In the following human pedigrees, the filled symbols Rationale:
represent the affected individuals. You may assume
that the disease allele is rare and therefore individuals
marrying into the family are unlikely to have defective
allele.What is the genotype of individual #5? (Use "A"
to represent the dominant allele and "a" to represent
the recessive allele)
A. AA
B. aa
C. AAa
D. Aa
ANSWER:
SOURCE: Chapter 97 Part IX: Human Genetics p.640;
Solutions to Practice Problems - 94. The following are indications for dialysis in Acute
Kidney Injury Except:
A. Volume overload
B. Persistent hypercalciuria
C. Oliguria
D. Severe metabolic acidosis
SOURCE: Nelson’s 21e, cha 550 - Renal Failure page 2773
Rationale:
|pg. 10
PEDIATRICS
2ND SEMESTER
SEMESTRAL EXAM 2
95. The following are indications for biopsy of a lymph

node except:
A. Size remains the same after 1 wk of
antibiotics
B. Presence of mediastinal mass
C. Supraclavicular lymph node /
D. Hard and fixed node /
96. An antibiotic of choice for Shigellosis:

A. Ampicillin
B. Metronidazole
C. Co trimoxazole
D. Ciprofloxacin
SOURCE: Nelson’s 21e, cha 226 - shigella, page 1510
Rationale:
97. Systemic symptoms classified as B Symptoms in

Hodgkin Lymphoma are associated with worse
prognosis include the following, except:
A. anorexia
B. drenching night sweats
C. weight loss &qt; 10% total bod weight over 6
months
D. unexplained fever > 38 degrees
SOURCE: Nelson’s 21e, cha 523 (Lymphoma), pages

2657-2658
Rationale:
Systemic symptoms, classified as B symptoms, that are
considered important in staging are unexplained
fever >38°C (100.4°F), weight loss >10% total body weight
over 6 mo, and drenching night sweats. Less common and not
considered of prognostic significance are symptoms of pruritus,
lethargy, anorexia, or pain.
98. Which of the following tests evaluates the phenotype?

A. Karyotyping — test for abnormal
chromosomes
B. Plasma amino acid analysis — test for amino
acid content
C. DNA panel — DNA test / DNA sequencing
D. Gene panel
|pg. 11

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PEDIATRICS 2

Exam- Subject Date of Exam

SECOND SEMESTER| AY: 2021-2022

1. Which of the following best describes appropriate

2. In RSV infection among preterm infants, which of the

Source: Viral Infections: Influenza Viruses (Vanessa M.

4. On PE Dawn had confluent erythematous maculopapular

A. Measles of for compassionate use. Informed consent must be obtained

ANSWER: A. Stable circulation

10. Pathognomonic sign of measles described as discrete red

ANSWER: A. Koplik spots

Source: Dengue trans page 8

14. A patient consults on his 5th day of fever. You suspect

12. Which of the following best describes remdesivir use in

A. Remdesivir has been available through

Source: Nelson’s (Kawasaki Dse) page 1312

ANSWER: C. HHV-6 infection

18. Which of the following features can differentiate viral

23.Which of the following is the standard treatment for MISC?

ANSWER: B. Oral steroid

24.Which of the following is at present a vaccine preventable

27.In your clinic, you noticed a 4 month old whose head

ANSWER: C. Congenital Hydrocephalus

28.A mild illness, with or without low-grade fever w/ inflamed

Source: Nelson Textbook of Pediatrics 20th Ed (Ch.250

Source: Pediatrics 2 Herpes Virus Trans- Dr. Nery, pg 1

30. The following are the most common hematologic

ANSWER: C. Fever and cough

33. A 9-month-old/ F is brought to the clinic due to

40. Which of the following statements concerning measles and

A. Eustachian tube dysfunction

46. A 12 yo/F had prodrome of fever, anorexia, headache, sore

43. Oliver, a 5 yo child sustained superficial scratch w/c did not

A. central unilateral or bilateral ground glass opacities

ANSWER: Coronavirus Trans, Dr. Fajardo-Nery, p.4

50. A 17yo/M had acute onset of fever and nasal congestion

ANSWER: D. Nelson’s 21st Ed. p2020

51. A 2 yo/M presented with rhinorrhea, mild cough & low

ANSWER: D. Laryngotracheobronchitis aka Viral Croup

52. Polio vaccine (IPV) should be administered to healthy

ANSWER: word for word from a study

53. Cytokine storm is central in the pathophysiology of severe

activates cytotoxic T lymphocytes

ANSWER: A. Give the 6 mo old infant with measles vaccine

ANSWER: D. One of the clinical manifestation of Fifth Disease

61. A 6 yo /M with 5 day history of fever came in with persistent

D. Dengue without warning signs

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1. An ominous signs requiring immediate intervention in C. Miliaria Rubra

D. Hiatal hernia B. None

48. Suppress surfactant therapy. *

42. A transient, benign phenomenon that affects the

43. A disease that is caused by the presence of maternal

44. It is a self-limited tachypnea associated with a

45. Complications of induced hypothermia. *

46. OP a fullterm infant treated as a case of meconium

47. 7 days old, 32week GA preterm had increasing

C. Frequent use of broad spectrum antibiotics

42. Which statement is true regarding surfactants: *