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Pediatrics A Mock exam

A 4 y/o male with nephrotic syndrome had proteinuria of +3 one day PTA. He now complains of dizziness and decreased urine output. BP was 60 palpatory. What is the best thing to do immediately?

Give epinephrine 0.3 cc IV

Start IV fluid at maintenance rate

Start oral prednisone and observe

Give albumin transfusion at 1-2 gm/kg

NEPHROTIC SYNDROME MANAGEMENT

Triad of clinical findings associated with nephrotic syndrome:

1. Hypoalbuminemia (≤2.5 g/dL)

2. Edema

3. Hyperlipidemia (cholesterol >200 mg/dL)

Nephrotic Management

Based sa platinum the first line of treatment for proteinuria is corticosteroids which is letter C. however, this is not for the acute management as you are required to correct the fluid imbalance first by giving IV albumin which is letter D. YOU
DON’T GIVE IV FLUIDS because bale wala lang yun if there is persistent protein loss as there will be a continuous shift in the starling forces. Which rules out Letter B. Letter A. Is for mema lang go ka na for letter D

NEPHROTIC SYNDROME MANAGEMENT

Triad of clinical findings associated with nephrotic syndrome:

1. Hypoalbuminemia (≤2.5 g/dL)

2. Edema

3. Hyperlipidemia (cholesterol >200 mg/dL)

Nephrotic Management

Massive protein losses in nephrotic syndrome is due to injury of the:

Endothelial cells

Epithelial cells

Juxtaglomerular cells

Podocytes

Nephrotic syndrome- increased permeability of glomerular

capillary wall leading to massive proteinuria and hypoalbuminemia

Podocyte injury- underlying mechanism of proteinuria

Function:

- Structural support of capillary loop

- Major component of glomerular filtration barrier to proteins

- Synthesis and repair of glomerular basement membrane

Nephrotic syndrome- increased permeability of glomerular

capillary wall leading to massive proteinuria and hypoalbuminemia

Podocyte injury- underlying mechanism of proteinuria

Function:

- Structural support of capillary loop

- Major component of glomerular filtration barrier to proteins

- Synthesis and repair of glomerular basement membrane

. The drug of choice for newly diagnosed idiopathic nephrotic syndrome is:

Prednisone

High protein diet

Diuretics

Penicillin

For children with idiopathic nephrotic syndrome, corticosteroids are the mainstay of treatment

NS= Nephrotic Syndrome

In prelims ratio recording: Idiopathic nephrotic Syndrome encompasses the different types of histologic types of NS= Nephrotic Syndrome

In prelims ratio recording: Idiopathic nephrotic Syndrome encompasses the different types of histologic types of Nephrotic Syndrome. However,initial management would
usually involve the use of your steroid so Prednisone is the correct answer.

For children with idiopathic nephrotic syndrome, corticosteroids are the mainstay of treatment

NS= Nephrotic Syndrome

In prelims ratio recording: Idiopathic nephrotic Syndrome encompasses the different types of histologic types of NS= Nephrotic Syndrome

A 9-month-old baby was brought due to red colored urine with some red particles on the diaper. He also had URTI for 4 days ago. What is the probable diagnosis?

Acute kidney injury

Hemorrhagic cystitis

Glomerulonephritis

Pyelonephritis

100. A 5-year-old female presented with fever of 40C, vomiting and poor intake with no other symptoms. Urinalysis showed hematuria, pyuria, leucocyte esterase +, nitrite +. Urine culture showed E. Coli at 100,000 cfu/mL. What is the diagnosis?

Acute pyelonephritis

Acute kidney parenchymal injury

Acute cystitis

Covert bacteriuria

This statement is TRUE of chronic kidney disease:

Proteinuria of 30 mg/m2/ hr of 12 weeks duration.

Anemia is usually secondary to a dilutional type

GFR of less than 60ml/1.73m2/ hr of 3 months duration.

Growth is normal.

Criteria for Definition of Chronic Kidney Disease (NKF KDOQI Guidelines)

Patient has chronic kidney disease (CKD) if either of the

following criteria are present:

1. Kidney damage for ≥ 3 mo, as defined by structural or functional abnormalities of the kidney, with or without decreased GFR, manifested by one or more of the following features:

• Abnormalities in the composition of the blood or urine

• Abnormalities in imaging tests

• Abnormalities on kidney biopsy

2. GFR < 60 mL/min/1.73 m2 for ≥ 3 mo, with or without the other signs of kidney damage described above

Criteria for Definition of Chronic Kidney Disease (NKF KDOQI Guidelines)

Patient has chronic kidney disease (CKD) if either of the

following criteria are present:

1. Kidney damage for ≥ 3 mo, as defined by structural or functional abnormalities of the kidney, with or without decreased GFR, manifested by one or more of the following features:

• Abnormalities in the composition of the blood or urine

• Abnormalities in imaging tests

• Abnormalities on kidney biopsy

2. GFR < 60 mL/min/1.73 m2 for ≥ 3 mo, with or without the other signs of kidney damage described above

. An 8-year-old was brought to the ER for oliguria and hypertension. Patient had tea-colored urine, edema for 3 days. Mother reported that 4 weeks prior, he also had multiple crusting lesions over his nose and legs that spontaneously resolved. What antihypertensive is ideal for this patient?

Loop diuretic

Alpha-1 blocker

Beta 2 antagonist

Calcium channel blocker

● Thiazide (hydrochlorothiazide, chlorothiazide) or loop diuretics (furosemide) can be helpful in controlling hypertension related to salt and fluid retention.

Source: page 10899, Chapter 550.2 Chronic Kidney Disease,Nelson Textbook

of Pediatrics,21st edition

● Since oliguric si px,Diuresis may be augmented by the administration of loop diuretics (furosemide), orally or intravenously

Source: page 10822,Nelson Textbook of Pediatrics,21st edition

● Thiazide (hydrochlorothiazide, chlorothiazide) or loop diuretics (furosemide) can be helpful in controlling hypertension related to salt and fluid retention.

Source: page 10899, Chapter 550.2 Chronic Kidney Disease,Nelson Textbook

of Pediatrics,21st edition

● Since oliguric si px,Diuresis may be augmented by the administration of loop diuretics (furosemide), orally or intravenously

Source: page 10822,Nelson Textbook of Pediatrics,21st edition

A 5 y/o male, 18 kg was seen because of vomiting and diarrhea of 2 days. At the ER he was hypotensive with severe signs of dehydration, urine output of 125 cc in the past 16 hours. He was hooked to IVF at 20 cc/kg x 2 doses; after 1 hour, VS improved with appearance of urine output. He is classified as PRIFLE category:

Failure

Injury

Risk

Loss

Criteria of RIFLE (MEMORIZE)

Criteria of RIFLE (MEMORIZE)

SD is a 5-year-old girl who complained of tea colored urine a day prior to consult. She has a history of sore throat 3 weeks pta. Which of the following laboratory result would support your diagnosis?

Low serum C3

Enlarged kidneys on ultrasound

Elevated BUN and Creatinine

Hyponatremia

A patient with acute Post Strep glomerulonephritis is recovering from the acute phase of the disease. After 3 months, repeat the serum C3 was still low. What would be the proper advice for this patient?

Observe the patient further as the C3 remains at low levels up to 6 months

Start another course of antibiotics

Advise the patient to undergo a renal biopsy

Start steroids

A 5y/o child, 18 kg was seen at the ER due to| vomiting and diarrhea of 1 day. He was hypotensive with severe signs of dehydration UO was 100 cc for the past 16 hours. He was given IF at 20 cc/kg × 2 doses as fast drip. After 1 hour, VS improved and with urine output. Creatinine level was increased at 9 mg/dL Under KDIGO staging of AKI, the staging of our patient is:

Stage I

Stage III

Stage II

Stage IV

A 3 year ols was seen at the ER due to weakness of 3 days. BP 90/60, CR=89/min, RR=23/min. Urinalysis: alkaline urine, hematuria. Serum Na= 143, K= 2, Cl= 126, ABG: pH 7.25, HCO3 11, CO2 30, O2 99. What is the blood anion gap?

A 3-year-old had weakness of 5 days. Weight: 10 kgs, Length: 75 cms, BP: 90/60, CR: 89/min, RR: 23/min. UA pH: 8, RBC and WBC: 0-1/hpf. CBG: 100 mg/dl, Serum Na: 140 mmol/l, K: 2 mmol/l, Cl: 120 mmol/l, ABG showed pH: 7.25, HCO3: 10, CO2: 30, O2: 99. KUB UTZ: nephrocalcinosis. Interpret the blood anion gap:

Decreased

Normal

Not significant

Increased

Computation:

[140] - [120 + 10] = 10

Interpretation:

NORMAL

Computation:

[140] - [120 + 10] = 10

Interpretation:

NORMAL

A 5 y/o male was seen due to weakness and diarrhea. PE: severely stunted, moderately wasted, with moderate dehydration. Labs: alkaline urine, hypokalemia and metabolic acidosis which persisted despite adequate hydration and potassium correction for 3 days. Urine anion gap is + 3. The type of RTA is most likely:

RTA type IV

RTA type I

RTA type III

RTA type II

RATIO

a. RTA type IV  hyperkalemic RTA due to a defect in aldosterone-sensitive acid secretion

c. RTA type III  combined proximal and distal RTA as a result of inherited carbonic anhydrase II

deficiency

d. RTA type II  proximal RTA: negative urine anion gap, urinary pH <5.5 acidic urine pH (under mildmoderate metabolic acidosis urinary pH may be >5.5)

RATIO

a. RTA type IV  hyperkalemic RTA due to a defect in aldosterone-sensitive acid secretion

c. RTA type III  combined proximal and distal RTA as a result of inherited carbonic anhydrase II

deficiency

d. RTA type II  proximal RTA: negative urine anion gap, urinary pH <5.5 acidic urine pH (under mildmoderate metabolic acidosis urinary pH may be >5.5)

The following are crieria for the diagnosis of recurrent UTI, EXCEPT

2 or more episodes of acute cystitis

2 or more episodes of acute pyelonephritis

3 episodes of acute cystitis

1 episodes of acute pyelonephritis and 2 episode of cystitis

A 5 y/o male was seen due to weakness and diarrhea. PE: severely stunted, moderately wasted child with moderate dehydration. There was persistent of hypokalemia, alkaline urine, and presence of metabolic acidosis despite adequate hydration and potassium correction. The anion gap is 10. What work up would differentiate RTA type I to RTA type II?

Blood anion gap

Fractional excretion of sodium

TTKG

Urine anion gap

Urine anion gap- calculated to confirm diagnosis of distal RTA

Fractional Excretion of Sodium (FENa)

Most discriminating test to differentiate prerenal from intrinsic

Urine pH- distinguish distal from proximal RTA

Urine pH <5.5 in the presence of acidosis suggests pRTA dRTA typically have a urine pH >6.0

Urine anion gap- calculated to confirm diagnosis of distal RTA

Fractional Excretion of Sodium (FENa)

Most discriminating test to differentiate prerenal from intrinsic

Urine pH- distinguish distal from proximal RTA

Urine pH <5.5 in the presence of acidosis suggests pRTA dRTA typically have a urine pH >6.0

The following test/tests for specific IgE:

Patch test

Skin prick test

Test dosing

A & B

The classification of allergic rhinitis of 4 days duration with no troublesome symptoms is?

Intermittent mild

Intermittent severe

Persistent mild

Persistent severe

The drug of choice for anaphylaxis is:

Epinephrine 1:1,000 at 0.1 ml/kg IM

Epinephrine 1:10,000 at 0.1 ml/kg IM

Epinephrine 1:10,000 at 0.01 ml/kg IM

Epinephrine 1:1,000 at 0.01 ml/kg IM

● Anaphylaxis is a medical emergency requiring aggressive management with

intramuscular (first line) or intravenous epinephrine, intramus- cular or

intravenous H1 and H2 antihistamine antagonists, oxygen, intravenous

fluids, inhaled β-agonists, and corticosteroids

● Epinephrine should be given by the intramuscular route to the lateral thigh

(1:1,000 dilution, 0.01 mg/kg; max 0.5 mg).

● Anaphylaxis is a medical emergency requiring aggressive management with

intramuscular (first line) or intravenous epinephrine, intramus- cular or

intravenous H1 and H2 antihistamine antagonists, oxygen, intravenous

fluids, inhaled β-agonists, and corticosteroids

● Epinephrine should be given by the intramuscular route to the lateral thigh

(1:1,000 dilution, 0.01 mg/kg; max 0.5 mg).

The following statement characterizes atopic dermatitis:

Majority appears after 5 years of age

Commonly involves the diaper area

Chronic relapsing course

ATOPIC DERMATITIS (ATOPIC ECZEMA)

● Most common chronic relapsing skin disease seen in infancy and childhood

● Affects 10-30% of children worldwide and frequently occurs in families with other atopic diseases, such as asthma, allergic rhinitis, and food allergy

● Typically begins in infancy. Approximately 50% of patients experience symptoms in the 1st year of life, and an additional 30% are diagnosed between 1 and 5 yr of age.

● Generally more acute in infancy and involves the face, scalp, and extensor surfaces of the extremities. The diaper area is usually spared.

ATOPIC DERMATITIS (ATOPIC ECZEMA)

● Most common chronic relapsing skin disease seen in infancy and childhood

● Affects 10-30% of children worldwide and frequently occurs in families with other atopic diseases, such as asthma, allergic rhinitis, and food allergy

● Typically begins in infancy. Approximately 50% of patients experience symptoms in the 1st year of life, and an additional 30% are diagnosed between 1 and 5 yr of age.

● Generally more acute in infancy and involves the face, scalp, and extensor surfaces of the extremities. The diaper area is usually spared.

A 16-year-old was brought in due to colds of 4 weeks. This is not associated with fever nor difficulty in breathing. However, mother would note that patient would frequently rub his nose and eyes until they are swollen. What is your complete diagnosis?

Allergic rhinitis, mild intermittent

Allergic rhinitis, moderate-severe intermittent

Allergic rhinitis, mild persistent

Allergic rhinitis, moderate-severe persistent

The most common cause of chronic urticarial rash is:

Food preservative

Autoimmune disorder

Idiopathic

Inhalants

A 13-year-old was brought to your clinic due to pruritic erythematous excoriated plaques on flexural areas, wrists and ankles.

Dennie-Morgan folds

Ichthyosis

Xerosis

Pruritus

The following are used in the pharmacotherapy of this condition EXCEPT:

Topical calcineurin inhibitors

Systemic corticosteroids

Dupilumab

Allergen immunotherapy

A 3 yo child has sudden onset of fever, cough and rhinorrhea. On PE you noted watery nasal discharge and with expiratory wheeze. No family history of asthma or allergy. Your plan of management:

Diphenhydramine, salbutamol nebulization, prednisone

Saline nasal spray, Anti-leukotriene

Diphenhydramine, Ipratropium nebulization, paracetamol

Saline spray, Salbutamol, Amoxicillin

A child with rhinorrhea and congestion and facial pain of 3 weeks duration. After a thorough PE and sinus plain films your diagnosis is acute Pansinusitis. What is the possible age of this child?

6 years old

4 years old

2 years old

8 years old

A 7 yo child has a symptoms most days or waking with asthma once a week with low lung function from the last 4 weeks:

Med dose ICS-LABA and Reliever needed for symptoms

Medium dose ICS and reliever needed for symptoms

Low dose ICS and Reliever needed for symptoms

Low dose ICS-LABA, and Reliever needed for symptoms

7 yo Josh had 2 episode of wheeze and needs to be worked up to diagnose asthma. But clinically he still experiences interval exacerbations. Your approach for Josh:

Do allergy test and desensitization

Do Diagnostic spirometry testing within 6 months

Check for Peak flow average daily diurnal PEF variability more than 20%

Give empiric treatment with ICS and prn SABA. Review response

A 6 yo child brought to ER Talks in words, sits hunched forwards, agitated RR 55 breaths/min Accessory muscles in use, Pulse rate125 bpm and known asthmatic. Your initial management:

SABA 4 puffs by pMDI and Prednisolone 1 mg/kg

SABA and ipratropium bromide, 6lpm oxygen via face mask

SABA and ipratropium bromide, O2, IV corticosteroid

SABA 4 puffs by pMDI, repeat every 20 min. for 1 hour and O2

In common colds, rhinorrhea is treated with one of the listed drugs to counter act the stimulation of the cholinergic receptor in the airway by the virus:

Chlorpheniramine

Cetirizine

Loratadine

Phenylephrine

A 7yo child with scratchy throat and fever followed by runny nose. On the 4th day of illness the nonproductive cough occurs mostly during daytime and more prominent when the child reclines to bed. The rest of the chest PE is unremarkable. What are the medications needed to prescribe for this child:

Paracetamol, loratadine, and salbutamol

Paracetamol,oxymetazoline, and saline nasal spray

Paracetamol, chlorpheniramine and saline nasal spray

Paracetamol, diphenhramine and oseltamivir

A 13 year old was seen in the emergency room because of difficulty in ambulation. He had diarrhea 2 weeks prior to consult. On examination motor strength 3/5 on both lower extremeties sensory is intact with areflexia. What is your diagnosis?

Myasthenia Gravis

Transverse myelitis

Botulinism

Guillan Barre

Which of the following is the sign of Chiari crisis?

Increasing head size

Stridor

Seizures

Increase urine output

A 7-year-old fell from a 5 feet high tree about 5 hours prior to consult. He then compiled of headache and had a vomiting episode. In time for mealtime the mother noted he was difficult to arouse. On PE he did not have spontaneous eye opening in deep sternal pain, no verbal and motor response. What is the GCS of the patient?

A 14 year old male was brought to the OPD due to overweight. On examination you noted he was obese with bitemporal hemianopsia. Where is the most likely location of the pathology?

Brainstem

Sella-supra sellar

Cerebrum

Cerebellum

What is the percentage of patients with port wine stain are truly Sturge Weber cases?

50-70%

5-20%

8-33%

80-100%

Survival rate is poorest for patients with

Astrocytoma

Atypical rhabdoid

Ependymoma

Medulloblastoma

A 17-year old was brought to the emergency room due to a vehicular accident, on examination the left pupils measure 7 mm non-reactive to light with apnea and absence of the corneal reflex. What is the kind of herniation did the patient have?

Transcalvarial herniation

Tonsillar herniation

Subfalcine herniation

Uncal herniation

Which of the following is a characteristic of a neuromuscular junction weakness?

Muscle biopsy is important for confirmatory diagnosis

Creatinine kinase is elevated

Proximal and distal muscles are equally affected

Deep tendon reflex is decreased

This type of drug hypersensitivity involves IgM or IgG antibodies that recognize drug antigen on cell surface:

Type I

Type IV

Type III

Type II

The following is an associated feature of atopic dermatitis?

Facial erythema or pallor

Chronic or relapsing dermatitis

Facial and extensor edema in infant

Pruritus

In Wiskott-Aldrich Syndrome, there is presence of atopic dermatitis, thrombocytopenic purpura with small defective platelets and:

Decreased IgE

Increased IgG

Decreased IgA

Decreased IgM

A 32 kg 10 year old developed pruritic maculopapular lesions, difficulty in breathing and abdominal pain 5 minutes after the 2nd dose of Covid 19 vaccination. What should you do?

Give epi at 0.1ml/kg

Give diphenhydramine at 1mg/kg

Give diphenhydramine at 0.3ml/kg

Give epi at 0.3ml/kg

The following is a risk factor for hypersensitivity reaction except:

Genetic predisposition

Route of administration

Prior exposure

Atopy

What is the responsible to the clinical manifestation of Erysipelas?

Exfoliative toxin

Erythrogenic toxin

Exotoxin A

M protein

Rifampicin is given as prophylaxis in which of the following bacterial infections?

Pneumococcal penumonia

Meningococcemia

Pneumococcal meningitis

Pertussis

Treatment options of Streptococcal pharyngitis include the following EXCEPT?

Benzathin Penicillin IM single dose

Penicillin x 10 days

Azithromycin x 10 days

Amoxicillin x 10 days

The drug of choice for treatment of pneumococcal meningitis is?

Clindamycin

Ceftriaxone

Cefuroxime

Ampicillin

The most common cause of pyogenic infections is children is:

S. pyogenes

S. aureus

H. influenza

Strep.pneumonia

A 3 year old child was brought in because of high grade fever of 2 days and difficulty of breathing. The patient did not receive any vaccination. PPE: in respiratory distress, leaning forward and very ill looking. The ER resident warned you not to examine the throat. Your impression is:

Croup

Epiglottitis

Exudative Tonsillopharyngitis

Diptheria

The following are suggestive of streptococcal pharyngitis EXCEPT?

Tender cervical lymph adenopathy

Petechiae at the soft palate

Conjunctivitis

Diffuse beefy red tonsillar pillars

Most common cause o osteomyelitis in children

Streptococcus pyogenes

Strep. pneumoniae

Staphylococcus aureus

H. influenzae

An 11-year-old child was brought in due to easy fatigability and knee pain with swelling relieved by aspirin. He had recurrent pharyngitis few years ago. Your impression is:

Post streptococcal reactive arthritis

Septic arthritis

Gouty arthritis

Rheumatic fever

The following statements are TRUE about typhoid fever EXCEPT:

Intestinat hemorrhage and/ or perforation commonly occur within the first week of fever

Hepatomegaly, splenomegaly and/or distended abdomen with sustained fever are common on the 2nd week of illness

Diarrhea may occur several days after the onset of fever in younger children while constipation occurs more often in older children.

The symptoms and PE findings may gradually resolve within 2-4 weeks if uncomplicated

Which organism is associated with a diarrheal disease where some patients go on to develop acute kidney failure, thrombocytopenia and microangiopathic hemolytic anemia?

Enteroinvasive E.coli

Shiga toxin-producing E.coli

Enterotoxigenic E.coli

Enteroaggregative E. coli

A 15y/o had fever and cough, headache, sore throat for 12 days. His mother self-medicated with amoxicillin 500mg 3x/day starting on day 7 of illness but without relief. He was not in distress, but with occasional crackles and wheezes. CBC was normal. Tuberculin test: non-reactive. CXR showed interstitial pneumonia. What is an appropriate antibiotic to give?

Cephalexin

Cefuroxime

Amoxicillin with clavulanate

Azithromycin

Which of these statements about Chlamydophila pneumonia infections is NOT TRUE?

Mild illness can be pertussis like

CXR findings are more significant than the clinical status

Pneumonia is more commonly associated with severe constitutional symptoms like fever, headache, cough and pharyngitis

Can trigger hyperactivity among asthmatics

Children infected with this organism can present as watery or bloody diarrhea with crampy periumbilical pain that may persist even after the diarrhea resolves. The abdominal pain cann mimic appendicitis, colitis or intussusception

Enterogenic E. coli

Enteropathogenic E.coli

Salmonella

Campylobacter

The nontreponemal tests like VDL or RPR are not used for?

Detecting re-infection

Establishing the diagnosis of syphilis

Monitoring response of treatment

Rapid and easy screening

A 7y/o girl had cough and colds for 7 days. Past medical history was unremarkable. Mother denied any exposure to TB but they live in a crowded neighborhood. PE was normal. CXR showed interstitial pneumonitis with prominent hilar nodes. WHat is your assessment?

Clinically diagnosed Pullmonary TB

Bacteriologically confirmed PTB

Presumptive TB

Latent TB

Most cases of congenital syphilis are asymptomatic and identified only by prenatal screening. But, this can be an early clinical sign:

Saber shin

Olympian brow

Osteochodritis

Rhagades

A 5-year-old girl was seen because of vaginal discharge. She is allegedly being sexually molested by her stepfather. Urinalysis was normal. Gram stain of the vaginal discharge showed gram negative intracellular diploccoci. What empirical treatment will you consider?

Single dose of ceftriaxone

7 days of ceftriaxone + 7 days of azithromycin

Single dose of ceftriaxone + 7 days of oral erythromycin

Single dose of ceftriaxone + 7 days of oral doxycycline

Which of the following provides an accepted and convenient method for reporting the status pf the newborn infant immediately after birth and the response to resuscitation if it is needed?

Dubowitz scoring

Apgar scoring

Crib scoring

Ballard's scoring

A 40 week AOG neonate would need the following in order to have a normal transition from intrauterine life to birth, EXCEPT which of the ff:

Surfactant secretion

Increase in pulmonary vascular resistance

Clearance of fetal lung fluid

Thermogenesis

In fetal circulation, which of the following blood vessel acts as a shunt to bypass the pulmonary circulation.

Ductus arteriosus

Umbilical vein

Umbilical artery

Ductus venosus

Which of the ff. Antimicrobial agents maybe used for eye prophylaxis in the immediate care of the newborn?

ALL OF THE CHOICES ARE CORRECT

1% silver nitrate drops

2.5% povidine iodine eye drops

Erythromycin ophthalmic ointment

What are the primary mediators that prepare the fetus for birth and support the multi-organ transition?

Cortisol and cathecolamine

Cathecolamine and thyroid hormone

Prostaglandins and cortisol

Catecholamine and prostaglandin

What is responsible for the decrease in the resistance to blood flow in the arterial bed of lung of a fetus after birth so that all blood coming from the right side of the heart would go to the lungs for oxygenation?

Decreasing both O2 and CO2 in pulmonary bed

Increasing both O2 and CO2 in pulmonary bed

Increasing O2 and Decreasing CO2 in pulmonary blood

Increasing CO2 and decreasing O2 in pulmonary blood

Infants of diabetic mothers are at increased risk for becoming hypoglycemic because they have

Glucagon insufficiency

Increased utilization of glucose

Increased levels of insulin

Decrease glycogen stores

Which of the following is the treatment of choice for symptomatic polycythemia with a central hematocrit of 70..

Phlebotomy

Prbc transfusion

Double volume exchange transfusion with saline

Partial exchange with saline solution

Which of the following is a risk factor for late onset neonatal sepsis? a.

Indwelling venous or arterial catheters

Chorioamnionitis

Premature rupture of membranes of more than 18 hours

Maternal UTI

A 2-month-old female was brought to the emergency room due to exaggerated startle reflex. On examination you noted whitish macules seen in the trunk and extremities. The birth, maternal, family history are unremarkable. What is the most likely diagnosis of your patient?

Sturge Weber

Incontinentia pigmenti

Tuberous sclerosis

Hypomelanosis of Ito

A 15-year-old boy was seen in the OPD due to cyanosis and clubbing of the lower extremities. What is the most possible diagnosis if this is due to a congenital heart disease?

PDA with pulmonary hypertension

AVSD

ASD with pulmonary hypertension

VSD with pulmonary hypertension

RATIO: NATURAL HISORY OF PDA - EISENMENGER SYNDROME

Small PDA usually remains asymptomatic HOWEVER persistence of LV volume overload and LV failure may Pulmonary Hypertension (Eisenmenger Syndrome)

RATIO: NATURAL HISORY OF PDA - EISENMENGER SYNDROME

Small PDA usually remains asymptomatic HOWEVER persistence of LV volume overload and LV failure may Pulmonary Hypertension (Eisenmenger Syndrome)

At birth, a 39 weeks AOG neonate was acrocyanotic with slight grimace on suctioning, some flexion, heart rate 80/min and crying. The following resuscitative measures are needed in the above situation EXCEPT:

Tactile stimulation

Keep baby warm

Delivery of oxygen thru intubation

Clear oropharyngeal area with secretions

A 5-year-old boy had large stools with occasional blood streaks and noted to be withholding his stools when he feels the urge to defecate. His history would reveal intoxication of which of the following vitamins?

Vitamin D

Vitamin C

Vitamin B

Vitamin A

A 24-month-old baby was brought due decreased intake for more than 2 weeks. He was also noted to be less playful. His mother is on 2nd month of HRZE. Tuberculin test of the baby showed 5 mm induration. CXR result is pending. What is your impression?

Clinically diagnosed PTB

Latent TB

Presumptive TB

Bacteriologically diagnosed PTB

3 y/o boy in severe respiratory distress was referred to you. PPE: awake, highly febrile, with drooling of saliva, mouth open, head slightly tilted up, both hands on thighs with arms extended supporting the body. Which is the best treatment option?

Start IV dexamethasone

Nebulize with epinephrine

Do tracheotomy

Start high dose antibiotics

A 3 y/o girl has poor appetite, fever, and sore throat. PE: small vesicles and multiple punched out ulcers in the posterior pharynx. The etiology of this infection is most likely

Grp A 􀈕-hemolytic Streptococcus

Epstein-Barr virus

Coxsackie virus

Adenovirus

Which of the following best describes GI duplication?

Lining of the duplication is extraintestinal with tendency to malignancy

Most common location is in the duodenum

Located on the mesenteric border of the duplicated portion

Blood supply of the duplication comes from a separate vascular system A

A 3 y/o boy was seen with fever of 38.5C, colds and ear pain. He has good suck, tolerates milk feeding and sits on his mother’s lap. The following will be your initial management on the child:

Start Amoxicillin at 80mg/kg /day

Paracetamol + observe + follow up at 72 hours 􀀀

Start Amoxicillin Clavulanate 90mg/kg/day

Paracetamol + Chlorpheniramine + phenylephrine

A 12-year-old boy with history of recurrent tonsillitis presents with fever, migrating polyarthritis and a new murmur. The most common cardiac valve pathology in this case is:

Mitral valve regurgitation

Tricuspid valve regurgitation

Aortic valve regurgitation

Mitral valve stenosis

This is true about Non-typhoidal salmonella gastroenteritis:

It presents solely as watery, non-bloody diarrhea

Symptoms usually subside within 2-7 days in healthy children

There is no risk for bacteremia

It is usually afebrile

Unconjugated hyperbilirubinemia which is noted on the tenth day of life in a well, purely breastfeeding infant is probably due to:

Biliary atresia

Breastfeeding jaundice

Neonatal hepatitis

Breastmilk jaundice

A 􀃆 biliary atresia causes direct hyperbilirubinemia

C 􀃆 the first biochemical evidence of HBV infection is elevation of serum ALT levels. The illness ispreceded by a serum sickness-like prodrome marked by arthralgia or skin lesions, including urticarial,purpuric, macular, or maculopapular rashes. Jaundice is present in approximately 25% of acutely infected patients and usually begins approximately 8 weeks after exposure and lasts for 4 weeks.

A 􀃆 biliary atresia causes direct hyperbilirubinemia

Balloon atrial septostomy is indicated in this congenital heart disease.

Tricuspid atresia

TGA with large VSD

Truncus arteriosus

TOF

Atrial septostomy is indicated for TGA with intact septum, TVA, and TAPVR

B 􀃆 PGE1 infusion, balloon atrial septostomy, aortopulmonary shunt, Rastelli, Mustard operation. These are the treatment options for TGA with VSD and pulmonary stenosis according to Nelson. I’m not sure which ones are indicated for large VSD and I’m not sure if atrial septostomy is only indicated for TGA with intact septum or even small VSD. Read chapter 457.6 page 2405 Nelson 21st edition.

C 􀃆 treatment is Rastelli procedure

D 􀃆 treatment is aortopulmonary (MBTS, Central) shunt

Atrial septostomy is indicated for TGA with intact septum, TVA, and TAPVR

C 􀃆 treatment is Rastelli procedure

D 􀃆 treatment is aortopulmonary (MBTS, Central) shunt

Early laboratory findings in Salicylate poisoning include

Respiratory acidosis

Hypoglycemia

Abnormal coagulation studies

Hyperglycemia

Following a planned home birth, a term female infant is brought to the ER at two hours of life due to respiratory distress. The right hand O2 saturation reading is 70%. Her saturation quickly increases to 96% during crying and drops again to 70% when she stops crying. This pattern of saturation change is typical of which condition?

Choanal atresia

Cyanotic congenital heart disease 􀀀 d.

Pneumonia

Persistent pulmonary hypertension b.

A 4-year old female was admitted because of urticaria after eating lobsters. The rash subsided after 48 hours but her mother was hesitant to go home. On the 4TH hospital day, she became febrile & had productive cough. On examination, her RR was 46 CPM. She had crackles on both lung fields. Which of the following pathogens should be suspected?

Staphylococcus aureus

Hemophilus influenzae

Mycobacterium tuberculosis

Streptococcus pneumoniae

Which of the following structures in the fetus has the highest oxygen saturation?

Descending aortic arch

Ductus venosus

Right ventricle

Superior vena cava

The placenta is not as efficient an oxygen-exchange organ as the lungs, so that umbilical venous partial pressure of oxygen (PO2), the highest O2 level provided to the fetus, is only 30-35 mmHg. Approximately 50% of the umbilical venous blood enters the hepatic circulation, whereas the rest bypasses the liver and joins the
inferior vena cava via the ductus venosus, where it partially mixes with poorly oxygenated IVC blood derived from the lower part of the body.

A 1-year-old child has cough, fever and mild dehydration. PPE: RR: 65 cpm, symmetrical chest expansion, no retractions, equal breath sounds with crackles on both lung fields. Your most likely impression is

PCAP C

PCAP D

PCAP A

PCAP B

Ingestion of this foreign body needs to be removed within 2 hours because it can induce mucosal injury in as little as 1 hour:

Button batteries

Coin

Sharp objects

Magnets

A 16-year-old was noted to have generalized seizure. History revealed that he was noted to have jerky movements in the morning and disappears about mid-morning. The drug of choice for this patient is:

Vigabatrin

Valproic Acid

Topiramate

Carbamazepine

You saw a patient at the ER with muffled heart sounds, hypotension and distended neck veins. What are the expected ECG findings in this patient?

Tall QRS complexes on left chest leads

QRS complexes within normal limits but with isolated ventricular arrhythmias

Normal ECG for age

Low voltage QRS complexes

This may be a case of acute pericarditis with pericardial effusion and signs of cardiac tamponade. The findings make up the Beck’s triad which is characteristic of cardiac tamponade.

The damaging pneumonitis caused by proximal blind esophageal atresia and distal TEF is best prevented by:

Surgical ligation

Aspiration of gastric content via distal fistula

Antibiotic therapy

Endotracheal intubation

The cornerstone in the management of purulent skin and soft tissue infections is

Culture of abscess

Drainage of Abscess

Topical Mupirocin

Antibiotics

The best management in a patient who has deepening jaundice and progressively elevated bilirubin levels despite phototherapy is:

Exchange transfusion

Continue phototherapy

Blood transfusion

Antibiotic treatment

RATIO:

Jaundice / Hyperbilirubinemia: Treatment

􀁸 Phototherapy

o Works by structural and configurational photo-isomerization; photo-oxidation

o Maximum intensive phototherapy – uses blue lamps (420-470 nm), distance of 15-20 cm from infant, phototherapy blanket;

o Complications: Loose stools, rash, overheating, dehydration, Bronze Baby Syndrome (BBS)

􀁸 Exchange transfusion (ET)

o Done if phototherapy fails; critical level for a particular infant may be an indication for ET during the 1st 2 days of life when further rise is expected, but not typically on D4 in term or D7 in the PT as hepatic conjugation matures

RATIO:

Jaundice / Hyperbilirubinemia: Treatment

􀁸 Phototherapy

o Works by structural and configurational photo-isomerization; photo-oxidation

o Maximum intensive phototherapy – uses blue lamps (420-470 nm), distance of 15-20 cm from infant, phototherapy blanket;

o Complications: Loose stools, rash, overheating, dehydration, Bronze Baby Syndrome (BBS)

􀁸 Exchange transfusion (ET)

This medication will promote closure of PDA in a preterm infant

Prostaglandin

Dopamine

Adenosine

Paracetamol

Ratio

Indomethacin, Ibuprofen and Paracetamol - These 3 drugs are used for medical closure of the PDA.

Indomethacin is less commonly used because of complications

Ratio

Indomethacin, Ibuprofen and Paracetamol - These 3 drugs are used for medical closure of the PDA.

Indomethacin is less commonly used because of complications

Which of the following describes the pathophysiology of Respiratory Distress Syndrome (RDS)?

Air leak

Granular membranes in bronchioles

Ball-valve effect

Microatelectasis

This condition should be highly suspected in patients with bronchopulmonary dysplasia not responding to therapy or with frequent exacerbation without clear triggers

Asthma

GERD

Cystic fibrosis

Chronic aspiration

Which is a consistent manifestation of intestinal obstruction in the newborn?

Abdominal distention

Constipation

Vomiting

Double bubble sign

Ratio:

􀀐 Vomiting – Vomiting caused by obstruction of the GI tract is probably mediated by intestinal visceral afferent nerves stimulating the vomiting center. If obstruction occurs below the second part of the duodenum, vomitus is usually bile stained. Emesis can also become bile stained with repeated vomiting in the absence of obstruction when duodenal contents are refluxed into the stomach.

Nonobstructive lesions of the digestive tract can also cause vomiting; this includes diseases of the upper bowel, pancreas, liver, or biliary tree. CNS or metabolic derangements and cyclic vomiting syndrome can lead to severe, persistent emesis.

􀀐 Double bubble sign- duodenal atresia

􀀐 Constipation - Any definition of constipation is relative and depends on stool consistency,

􀀐 stool frequency, and difficulty in passing the stool

􀀐 Abdominal distention – enlargement of the abdomen which can result from diminished tone of the wall musculature or from increase content of fluid, gas, or solid

Ratio:

􀀐 Double bubble sign- duodenal atresia

􀀐 Constipation - Any definition of constipation is relative and depends on stool consistency,

􀀐 stool frequency, and difficulty in passing the stool

􀀐 Abdominal distention – enlargement of the abdomen which can result from diminished tone of the wall musculature or from increase content of fluid, gas, or solid

What is the auscultatory finding of a patient with Rheumatic Heart Disease with Mitral Stenosis?

Systolic ejection murmur at the left upper sternal border

Diastolic rumbling murmur at the apex

Holosystolic murmur at the apex radiating to the back

Holosystolic murmur at the left lower sternal border accentuated by inspiration

Some babies are born small even if they are not premature due to complications of pregnancy such as hypertension or malnutrition. What will differentiate premature infants from those who are just small for gestational age?

Ballard’s scoring

Crib scoring

Apgar scoring

Last Menstrual Period (LMP)

RATIO:

􀀐 Apgar score is useful for conveying information about the newborn’s overall status and response to resuscitation.
􀀐 Crib scoring - predict initial risk of mortality amongst low birth weight babies
􀀐 LMP – to determine AOG in pregnancy

RATIO:

The initial therapy of the toxic ingestion of this substance focuses on aggressive rehydration and correction of electrolyte abnormalities. Which substance is this?

Acetaminophen

Iron

Salicylate

Isoniazid

Which of the following correctly describes the principal characteristics of Kawasaki disease?

Polymorphic rash including maculopapular, erythema multiforme, bullous and vesicular

Bilateral conjunctival injection with limbal sparing and suppurative discharge

Nonsuppurative cervical lymphadenopathy, usually unilateral with node size more than 1.5 cm

Discrete lesions of the oral and buccal mucosa Ratio:

Ratio:

5 Principal Criteria of Kawasaki disease:

Fever for at least 5 days + at least 4 of the 5 principal features:

1. Conjunctival Injection - Bilateral, non-exudative, with limbal sparing

2. Erythema of the oral and pharyngeal mucosa - With strawberry tongue and red, cracked lips

3. Edema and erythema of the hands and feet - Acute – erythema and edema of hands and feet and

Subacute – periungual peeling of fingers, toes

4. Rash of various forms - Maculopapular, erythema multiforme, scarlatiniform, Polymorphic

except for the vesicular form

5. Cervical lymphadenopathy - Non-suppurative, usually unilateral, >1.5 cm in size

Ratio:

5 Principal Criteria of Kawasaki disease:

Fever for at least 5 days + at least 4 of the 5 principal features:

1. Conjunctival Injection - Bilateral, non-exudative, with limbal sparing

2. Erythema of the oral and pharyngeal mucosa - With strawberry tongue and red, cracked lips

3. Edema and erythema of the hands and feet - Acute – erythema and edema of hands and feet and

Subacute – periungual peeling of fingers, toes

4. Rash of various forms - Maculopapular, erythema multiforme, scarlatiniform, Polymorphic

except for the vesicular form

5. Cervical lymphadenopathy - Non-suppurative, usually unilateral, >1.5 cm in size

The following are characteristics of Streptococcal Pharyngitis EXCEPT:

Tender cervical lymphadenopathy

Beefy red throat

Hoarseness

Petechiae at the soft palate

Ratio:

Streptococcal Pharyngitis – Clinical manifestations

􀀐 Rapid onset: prominent sore throat and fever

􀀐 Headache and GIT symptoms are frequent

􀀐 Pharynx is red (beefy red)

􀀐 Enlarged Tonsils - Classically covered with a yellow, blood-tinged exudate

􀀐 Petechiae or “doughnut” lesions on the soft palate and posterior pharynx

􀀐 Uvula may be (beefy) red, stippled, and swollen

􀀐 Anterior cervical lymph nodes are enlarged and tender

Ratio:

Streptococcal Pharyngitis – Clinical manifestations

􀀐 Rapid onset: prominent sore throat and fever

􀀐 Headache and GIT symptoms are frequent

􀀐 Pharynx is red (beefy red)

􀀐 Enlarged Tonsils - Classically covered with a yellow, blood-tinged exudate

􀀐 Petechiae or “doughnut” lesions on the soft palate and posterior pharynx

􀀐 Uvula may be (beefy) red, stippled, and swollen

􀀐 Anterior cervical lymph nodes are enlarged and tender

Which of the following carbohydrates will not produce glucose during enzymatic hydrolysis at the brush borders of enterocytes?

Sucrose

Maltose

Lactose

Trehalose

The only primitive reflex that gets modified in adulthood is

Parachute reflex

Asymmetric neck tonic reflex

Landau reflex

Hoffman’s reflex

Which of the following is the chest x-ray picture found in a patient with Transient Tachypnea of the Newborn?

Fine reticulogranularity, hyper aeration

Hyper aeration, flattened diaphragm

Low volume lungs, air bronchogram

Air bronchogram, pleural effusion

At birth, this term neonate should receive the following:

Hepatitis B vaccine 0.5 ml IM

Vit K 0.1 cc by IM

All choices are correct

Erythromycin ophthalmic ointment

The following are associated to both cleft lip and palate, EXCEPT:

Hearing loss

Misarticulation

Ethnicity

Genetics

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