1pediatrics-compilation-of-feedbacks.pdf

Department of Pediatrics - 2nd Semester (AY 2008-2009) PRELIM EXAM A 5 year old child was seen in the clinic because of fever and sore throat. Physical examination revealed exudates on the tonsils. Your differential diagnosis should include. A. Streptococcal Pharyngitis C. Diphtheria B. Infectious Mononucleosis D. All of the above A leukemoid reaction in the complete blood count may be seen in this disease A. Tetanus C. Chlamydial infections B. Pertussis D. All of the above

Penicillin is the drug of choice for the following diseases EXCEPT A. Leptospirosis C. Chlamydial infection B. Syphilis D. Meningococcal infection The following staphylococcal infection require antibiotics for treatment A. Scalded skin syndrome C. Toxic shock syndrome B. Staph enterocolitis D. All of the above Which staphylococci is one of the most common causes of primary UTI in boys and girls A. Staph aureus C. Staph saprophyticus B. Staph Epidermidis D. None of the above

The skin infection is NOT a manifestation Staphylococcus aureus A. Impetigo C. Carbuncle B. Erysipelas D. Furuncle

One of the following antibiotics is not recommended for staphylococcal infection A. Oxacillin C. Clindamycin B. Ceftriaxone D. Cephalexin

To prevent ophthalmia neonatorum, the newborn should receive A. Credes prophylaxis C. Penicillin C. Ceftriaxone IV D. All of the above

Most common manifestation of gonorrhea in prepubertal females is A. Anal discharge C. Endocervicitis B. Vulvovaginitis D. None of the above

The giving of antitoxin is part of the management of A. Diphtheria and Pertussis B. Tetanus and Pertussis C. Diphtheria and Tetanus D. Staphylococcal toxic shock syndrome and Streptococcal toxic shock syndrome

A 1-year old girl was brought to the emergency room because of one day high grade fever and rapid progression of petechiae to purpuric rash. Her blood pressure is 60 palpatory. She is most likely to have A. Enteroviral infection C. Streptococcal infection B. Menigococcal infection D. Toxic shock syndrome

The toxin responsible for scalded skin syndrome is A. Hemolysin C. Tetanolysin B. Epidermolytic lysin D. Endotoxin Which of the following drugs is not use for chemoprophylaxis against meningococcal infections? A. Rifampicin C. Ceftriaxone B. Penicillin D. Ciprofloxacin Which of the following infections is transmitted by droplet inhalation? A. Impetigo C. Syphilis B. Menigococcemia D. Gonorrhea Which is an early congenital syphilis manifestation? A. Snuffles C. Interstitial keratitis B. 8th nerve deafness D. All of the above The following are poor prognostic factors of meningococcal infections A. BP 70/50 mmHg C. Thrombocytopenia B. Leukopenia D. All of the above Scarlet fever, erysipelas, toxic shock syndrome, and necrotizing fasciitis are infections caused by A. Staphylococcus aureus C. Group B beta-hemolytic strep B. Streptococcus pyogenes D. None of the above Chemoprophylaxis is not indicated in the following situation to prevent meningococcal infections A. Household contact B. Medical personnel who did intubation C. Menigococcal patients treated with penicillin D. Household contact of medical personnel exposed to the index case

The presumptive diagnosis of the above case is established by the presence of A. Gm (+) diplococci from the petechial scraping B. Gm (-) bacilli from the blood culture C. Gm (-) diplococci from the petechial scraping D. Leucopenia and Thrombocytopenia The primary stage of acquired syphilis is characterized by A. Café au lait C. Gumma B. Chancre D. Condylomata lata Which of the following serologic tests is used as a screening tests for syphilis A. FIA-ABS C. RPR B. TPI D. All of the above An asymptomatic newborn delivered by a mother who had syphilis must be considered from treatment if A. The mother was treated with erythromycin B. Maternal treatment was <30 days before delivery C. Maternal non-treponemal titers decreased three-folds D. All of the above (+) Nikolsky sign is seen in A. Scarlet fever B. Scalded skin syndrome

C. Erysipelas D. Toxic shock syndrome

This is manifested as circulatory collapse secondary to overwhelming meningococcal infection attributed to adrenal insufficiency A. Fitz-hugh–curtis syndrome B. Higoumenakis sign C. Waterhouse-Friedrichsen syndrome D. Toxic shock syndrome

The presence of pneumatocoeles is suggestive of A. Strep Pneumonia C. Chlamydial pneumonia B. Staph Pneumonia D. All of the above Dark field examination is used to diagnose A. Gonorrhea C. Chlamydial infection B. Syphilis D. Menigococcemia The presence of antibodies against this toxin is evidence of streptococcal infections retrospectively A Exotoxin A C. Erythrogenic toxin B. Streptolysin-O D. Exotoxin B Vaginal discharge is a manifestation of the following infections, EXCEPT A. Streptococcal infections C. Chlamydial infections B. Gonorrhea D. Syphilis These are linear scars that extend in a spoke-like pattern from previous mucocutaneous fissures of the mouth, anus and genitalia of congenital syphilis A. Snuffles C. Juvenile tabes B. Rhagades D. Hutchinson’s triad The drug of choice for methicillin resistant staphylococcal infections is A. Clindamycin C. Cephalexin B. Vancomycin D. All of the above The differential diagnosis of enteric fever during the 2 nd week of the disease are the following EXCEPT A. Dengue C. Tuberculosis B. Malaria D. Infectious mononucleosis One of the following is NOT a differential diagnosis of tetanus A. Hypokalemia C. Narcotic withdrawal B. Rabies D. Hypocalcemia These clinical specimens are used in isolating the infecting organism of leptospirosis EXCEPT A. Urine C. CSF B. Stool D. Blood

Preventive measures of tetanus neonatorum include/s the following A. Immunization of women with tetanus antitoxin B. Active immunization should begin at birth C. Aseptic technique during delivery D. All of the above The diagnosis of tetanus may be established by A. Clinical assessment C. CSF analysis B. Blood culture D. EEG In typhoid fever, clinical specimen will give the highest yield during the first week of the disease A. Bone marrow C. Stool B. Urine D. Blood Prolonged fever, conjunctival suffusion, calf muscle tenderness and meningitis are manifestations of A. Typhoid fever C. Influenzae B. Leptospirosis D. Dengue Hemorrhagic Fever Stridor and croupy cough is suggestive of A. Nasal diphtheria C. Laryngeal diphtheria B. Faucial diphtheria D. All of the above One of the following manifestations is not correctly correlated with the disease A. Rose-spot in typhoid fever B. Bull-neck appearance in Pertussis C. Weil syndrome in Leptospirosis D. Pseudomembrane in diphtheria One of the following statements is not true with regards to the immunity against pertussis A. Natural diseases provides lifelong immunity B. Vaccination doesn’t provide complete immunity C. Mothers provide little if any passive protection to young infants D. Protection begins to wave 3-5 years after vaccination The principal complications of pertussis is/are A. Apnea C. Pneumonia B. Otitis media D. All of the above

Method in establishing the diagnosis of leptospirosis is A. ELISA B. Microscopic agglutination test C. …….. microscopy D. Immunoflourescent method

These are the recommended antimicrobials for C. trachomatis genital infection among 18-year old and above A. Azithromycin C. Ofloxacin B. Erythromycin D. All of the above

The principal source of human leptospirosis A. (Fish) RAT C. Dog B. Pig D. All of the above

The prognosis for patients with diphtheria depends on A. The virulence of organism C. Site of infection B. Immunization status D. All of the above

The immune phase of icteric leptospirosis is distinctive from anicteric leptospirosis by the presence of the following A. Arotemia C. Hyperbilirubinemia B. Cardiovascular prolapse D. All of the above

The presence of board like abdominal rigidity in untreated patient with typhoid fever is suggestive of A. Cholecystitis C. Hepatitis B. Peritonitis D. None of the above

Tetanus neonatorum is manifested in the form of A. Generalized spasm C. Localized spasm B. Cephalic spasm D. Carpopedal spasm

Children exposed to this heavy metal may grow up to be hypertensive adults A. Lead C. Cadmium B. Mercury D. Arsenic

Management of tetanus neonatorum includes the following EXCEPT A. Immediate administration of tetanus toxoids B. Diazepam C. Tetanus immunoglobulin D. Antimicrobial therapy

Which of the following drug can cause extrapyramidal toxic syndrome A. Heroin C. Alcohol B. Amphetamines D. Metoclopromide

Which of the following is an oral chelating agent used for arsenic and mercury poisoning A. Dimercaprol B. 2,3 dimercaptosuccinic acid (DMSA) C. Edatate D. Penicillamine Which of the following form of mercury is 90% absorbed in gastrointestinal tract, then distributed rapidly across the blood brain barrier and placenta A. Elemental mercury C. Methyl mercury B. Inorganic mercury D. All of the above 57. Gastric decontamination during activated charcoal is most effective in what type of poisoning A. Salycilate C. Kerosene B. Iron D. Cyanide Which of the following toxicants chloracne A. PCB C. Arsenic B. Dioxin D. All of the above Which of the following is the recommended treatment for kerosene poisoning A. Syrup of ipecac C. Activated charcoal B. Prophylactic antibiotics D. Supportive treatment Which of the following are the effects of endocrine disrupting chemicals A. Altered sex ratio B. Impaired immune function C. Increase incidence of hormone related cancers D. All of the above Which toxicant interferes with oxygen in the cytochrome oxidase system resulting in cellular hypoxia A. Carbon monoxide C. Cyanide B. Kerosene D. Organophosphate In paralytic selfish poisoning what neurotoxin inhibits the sodium and potassium pump A. Succumbotoxin C. Maltotoxin B. ……… D. Saxitoxin Which of the following is the antidote for iron poisoning A. Deferroxamine C. Atropine B. DMSA D. Sodium nitrite Why are young children more susceptible to toxic effects of salicylate A. …….. to acidify the urine B. …….. to inhibit prostaglandin syntheis C. ……… ability to buffer the acid produced by the toxin D. All of the above The mercury poisoning is characterized by pain in the extremities, pinkish skin discoloration and desquamation A. Minamata disease C. Tremor mercurialis B. Acrodynia D. All of the above Which organ system is primarily affected by organic mercury poisoning A. Cardiovascular C. Hematologic B. GIT D. CNS

What is the gold standard for the evaluation of lead poisoning A. Blood lead level C. Urine lead level B. X-ray fluorescence D. Peripheral blood What mineral deficiency exacerbates lead poisoning A. Zinc C. Iodine B. Copper D. Calcium One of the following toxic syndrome is characterized by exocrine hyposecretion, thirst, flushed skin, mydriasis, delirium and tachycardia A. Cholinergic C. Anticholinergic B. Narcotic D. Etrapyramidal Which heavy metal poses a minimal risk of poisoning via breastfeeding A. Lead C. Arsenic B. Mercury D. Cobalt The transverse striae in the nails that is usually seen in arsenic poisoning is A. Hyperkeratosis C. Mee’s lines B. Gingival line D. Lead line sign A definitive work up for arsenic poisoning is A. Blood arsenic level C. 24 hour urine arsenic level B. Hair arsenic level D. Nail arsenic level One of the following toxicants are combustion products of fossil fuel A. Ozone C. Carbon monoxide B. Sulfur dioxide D. All of the above This chemical from tobacco smoke is considered developmental neurotoxin A. Tar C. Nicotine B. Polycystic aromatic hydrocarbon D. Ozone This by product of plastic and bleach paper combustion is considered class A carcinogen A. DDT C. Dioxin B. Polyvinyl chloride D. Hydrocarbon One of the following pollutants accumulate in the breast milk A. PCB C. Dioxin B. Mercury D. All of the above Which of the following is considered internal contamination type of radiation injury? A. Exposure to a patient or sibling who received a therapeutic dose of Iodine 131 B. Whole body irradiation C. Exposure to MRI D. Cobalt irradiation Which of the following is/are very sensitive to ionizing radiation A. Thyroid C. Lungs B. Female breasts D. All of the above Hematopoietic syndrome occurs at what radiation dose A. > 800 rads C. > 1000 rads B. > 200 rads D. > 3000 rads

Why children are equally vulnerable to chemical pollutants A. Due to hand to mouth behavior B. They have shorter life expectancy C. They have efficient detoxification and elimination body processes D. They have the ability to understand danger END OF EXAM What is the basic for the ultimate diagnosis of meningococcemia? a. HIstologic features of skin biopsy b. Characteristic clinical manifestations c. Isolation of the Meningococcus from the nasopharynx d. Positive culture, gram stain, immunoassay of body fluids What is the cornerstone in the management of dengue hemorrhagic fever a. Antibiotics c. Fluids b. Corticosteroids d. Platelet transfusion AIDS results from an infection caused by: a. Arbovirus c. Coronavirus b. Hepadnavirus d. Retrovirus What is the characteristic radiologic finding in inhalational anthrax a. Cavity with air fluid level c. Wedge shape density b. Symmetric mediastinal widening d. Bilateral multilobular infiltrates There is no evidence that the spores of bacillus anthracis can be introduced into the human body via the: a. Airways c. Genitourinary tract b. Alimentary tract d. Integument

What form of the malarial parasite invades red blood cells a. Sporozoites c. Hypnozoites b. Merozoites d. Gametocytes What plasmodium species has the longest duration of erythrocytes cycle? a. Falciparum c. Ovale b. Malariae d. Vivax What is the characteristic and ominous feature of falciparum malaria? a. Coma c. Ability to cause relapse b. Classic malaria paroxysm d. Mild Jaundice Compared to mosquito bite acquired malaria, blood transfusion transmitted malaria has the following feature: a. Shorter incubation period b. More severe clinical manifestations c. Longer duration of treatment d. Radical chemothterapy is necessary The hypoglycemia of severe malaria is primarily due to: a. Decreased pancreatic insulin secretion b. Failure of hepatic Gluconeogenesis c. Decreased consumption of glucose by the host d. Decreased consumption of glucose by the malarial parasite Emergency Pediatrics Exams Choose the BEST answer:

What form of antrax in humans has the best prognosis? a. Cutaneous c. Gastrointestinal b. Inhalational d. Meninges

Aspiration of hydrocarbons is most likely to present with which of the following clinical pictures? A. Cough, sputum, fever, and infiltrates B. Dyspnea, cough, pulmonary edema, hypoxemia C. Dyspnea, wheezing, cyanosis, pulmonary edema D. Fever, wheezing, and cough with sputum

Which of the following statements is NOT descriptive of clostridium tetani? a. It is aerophilic c. It has a terminal spore b. It produces a neurotoxin d. It is a gram positive bacillus

Which statement best describes how activated charcoal works? A. Prevents absorption and enhances elimination of toxin B. Inactivates toxins within the gastrointestinal tract C. Promotes emesis to eliminate toxins from the gut D. Neutralizes gastric acid to reduce hazard of aspiration

Which of the following wound condition would make the germination of tetanus spores unlikely ,except: a. Active infection c. Foreign bodies b. Devitalized tissue d. Superficial abrasive

Which of the following IS NOT an accurate method for determining the extent of a thermal injury in children, especially those under 4 years of age? A. Lund and Browdwer method B. Palmar method C. Rule of Nines D. Calculation of BSA affected

What is the effect of tetanospasmin on the inhibitory neurotransmitter glycine and gamma aminobutyric acid? a. Augments the production c. Hasten the degradation b. Blocks the release d. Potentiate the action Cases of cephalic tetanus ensue as a result of a. Abortion c. Puncture wound of the foot b. Childbirth d. Otitis media What condition would result from tetanic spasm of the facial muscles a. Dystonia c. Risus sardonicus b.Opisthotonus d. Trismus

Which of the following is a LATE sign of inadequate intravascular volume resuscitation in a burn injured patient? A. Diminished pulses B. Tachycardia C. Hypotension D. Oliguria For a child in hypovolemic shock from gastrointestinal fluid losses, which is the preferred intravenous fluid to maximally increase the intravascular volume? A. Dextrose 5% in water B. 0.45% normal saline solution C. 0.9% normal saline solution D. 7 % normal saline solution

5.

The following is the most sensitive test to identify specific igE in a child suspected to have allergy? a. In vitro igE determination b. Eosinophil determination c. Allergy skin test d. Serum igE

6.

The following are proven management for atopic dermatitis EXCEPT a. Avoidance of allergens and irritants that trigger symptoms b. Systemic antihistamines c. Moisturizers d. Desensitization

7.

Which of the following is a common factor leading to poor control of asthma? a. Uncontrolled allergic rhinitis b. Age of ther patient (beyond 2yrs old) c. Lack of vitamin C d. Presence of Impetigo

8.

Which of the following medications may lead to significant sedation? a. Corticosteroids b. 1st gen antihistamines c. Multivitamins d. Antileukotrienes

9.

Which of the following is a minor clinical feature in the diagnosis of atopic dermatitis a. Xerosis b. Chronic relapsing course c. Personal or family history of atopic disease d. Pruritus

For hypovolemic shock, which fluid therapy is usually most effective? A. Crystalloids alone B. Colloids alone C. Crystalloids and colloids D. Crystalloids and whole blood What do all forms of shock have in common? A. Decreased cardiac output B. Insufficient tissue perfusion C. Massive vasodilation D. Decreased renal perfusion Which electrolyte imbalance is most likely to develop following multiple transfusions to treat hemorrhagic shock? A. Hypernatremia B. Hypokalemia C. Hypophosphatemia D. Hypocalcemia The most common site of abdominal trauma in children is the: A. Liver B. Spleen C. Kidney D. Bladder Which of the following signs and symptoms related to hypokalemia would you expect to find during your assessment of a 4-year old girl who was admitted to the PICU with hypovolemic shock and a serum K of 2.8 mEq/L related to diarrhea. A. Weakness, bradycardia, prolonged PR interval B. Nausea, tented T waves, fatigue C. Fatigue, weakness, flattened T wave D. Muscle pain, nausea, wide QRS

10. The most common secondary skin infection in patients with

PEDIATRICS 2nd SEMESTER MIDTERM 1. Atopic individuals respond to potential allergens with expansion of a. T Helper type 1 cells b. T helper type 2 cells c. T helper type 3 cells d. T helper type 4 cells 2.

The following features are common among patients with allergic rhinitis EXCEPT a. Rhinorrhea b. Nasal congestion c. Purulent nasal discharge d. Allergic salute

3.

The risk for allergic disease in a child when none of his parents has a history of allergy a. 0-20% b. > 20-40% c. > 40-80% d. > 80%

4.

The following features would make one suspect an allergic child EXCEPT a. Allergic shiners b. Eye pruritus with watery discharge c. Localized angioedema with overlying tenderness d. Rashes in the antecubital areas

atopic dermatitis is due to a. Staphylococcus aureus b. Streptococcus viridans c. Moraxella catarrhalis d. Tinea versicolor 11. The following features should alert you to the presence of an

anaohylactic reaction a. Pruritus, flushing, conjunctivitis b. Nasal congestion, sneezing dizziness c. Tightness in the throat, urticarial, angioedema d. Wheezing, dyspnea, dry cough 12. Which of the following options is a preventive measures for

food allergies? a. Delaying introduction of major food allergens to infants b. Manipulation of mother’s diet during pregnancy c. Allergen immunotherapy within the first 2 years d. Maintaining pregnant high risk mother on antihistamine until birth 13. What should you give a patient who develops flushed skin and

difficulty of breathing 15 minutes after eating shrimps? a. IV fluids b. Nebulized salbutamol c. Epinephrine IM d. Corticosteroids IV

14. A 1 year old female developed a pruritic wheal 2 days after a

23. MARIO, a 6 month old boy, was admitted for evaluation due to

PPD test. This is most likely due to this type of hypersensitivity reaction a. Type I b. Type II c. Type III d. Type IV

recurrent infections. Which of the following diagnostic parameter is the initial non-specific screening test for him? a. CBC b. T-cell enumeration c. Serum immunoglobulin levels d. CH50 test

15. In an IgE mediated reaction which of the following is the most

24. Which of the following information is vital if T cell defect is

important inflammatory cell? a. Antigen presenting cell b. Langerhans cell c. Mast cell d. Eosinophils 16. A 9 year old girl developed cough with difficulty of breathing

after engaging in a pillow fight with her older brother. She usually gets similar attacks of difficulty of breathing when she helps her mother sweep the floow during weekends. What could be the trigger for her asthma attacks? a. Infection b. Strong detergent odor c. Exercise d. House dustmites 17. To confirm your suspicion for the above trigger what test would

you suggest? a. Allergy skin test b. Patch test c. Serum IgE determination d. Exercise-challenge test 18. Immunotherapy is NOT indicated in this type of igE mediated

allergy a. b. c. d.

Allergic rhinitis Bronchial asthma Urticarial Insect sting hypersensitivity

19. The best method to manage drug allergy is a. Give small amounts orally b. Give antihistamines prior to intake of suspected food c. Avoid drug d. Double the dose 20. One differentiating feature of urticarial and angioedema is a. Depth of skin involvement b. Duration of lesions in the skin c. IgE involvement d. Response to antihistamine 21. Which of lymphocyte undergoes development, maturation and

differentiation in the thymus? a. B cells b. T cells c. NK cells d. Dendritic cells 22. B lymphocytes specifically bear these protein surface molecules

(CD) a. b. c. d.

CD19 and CD20 CD4 and CD8 CD56 and CD16 CD26

highly considered? a. Onset of infection is at 2 months old b. Abnormal absolute neutrophil count c. Frequent skin abscesses d. Delayed separation of umbilical cord 25. If MARIO will be worked up for B cell immunodeficiency, the ff

test will be necessary EXCEPT a. Level of immunoglobulins b. Antibody test for diphtheria if immunized c. Candida skin test d. Isohemaglglutinins 26. Primary immunologic deficiency is suspected if a child presents

with the following conditions EXCEPT a. Two ear infections within 1 year b. One or more systemic bacterial infections (sepsis, meningitis) c. Two or more serious respiratory or documented bacterial infections like pneumonia/1 yr d. Serious infections occurring at unusual sites (liver, brain abscess) 27. A patient presenting with recurrent infections involving

Neisseria organisms is due to defect of this component of the immune system a. T cells b. B cells c. Complement d. Phagocytic 28. Lymphocytes migrate to the lymph nodes at this fetal age of

gestation a. b. c. d.

2-3 weeks 5 weeks 8 weeks 11 weeks

29. Which T cell phenotyoe isassociated with allergic sensitization

involving interleukin 4, IL-5 and IL-13? a. Th0 b. Th1 c. Th2 d. T mg cells 30. What is the most frequent cause of primary immunodeficiency? a. Antibody defect b. T-cell defect c. Complement defect d. Combined B and T cell defect

31. JON JON is a 7 month old boy presented with on and off

diarrhea, diaper rashes, since 3 months old. At present he is confined to a hospital due to severe pneumonia. CBC showed decreased absolute lymphocyte cound, marked decreased serum immunoglobulins, normalabsolute neutrophil count. Jon Jon is probably suffering from which defect? a. Antibody defect b. T cell defect c. Combined defect d. Combined B and T cell defect 32. What is the most frequent cause of primary defect of antibody

production? a. IgG deficiency b. IgM deficiency c. IgA deficiency d. IgE deficiency 33. This type of immunodeficiency requires emergency recognition

because if left untreated, it causes death before 1 year of age a. Selective igA deficiency b. X-linked agammaglobulinemia c. HyperIgM syndrome d. Severe combined B and T cell defect 34. Baby Jessica is a normal newborn baby delivered vaginally in

MCU hospital. She had unremarkable stay at the Nursery. Which of the following immunoglobulins are most abundant in her umbilical cord serum? a. IgA b. IgE c. IgM d. IgG 35. Di George syndrome is associated with the following signs and

symptoms, EXCEPT a. Hypercalcemia b. Thymic hypoplasia c. Cardiac anomalies d. Abnormal facies like hypertelorism 36. TRUE statement regarding Wiskott Aldrich Syndrome a. Symptoms include atopic dermatitis, b. c. d.

thrombocytopenia and recurrent infections Defect is primarily antibody deficiency Presents with marked elevated IgM Associated with autoimmunity

37. What immunodeficiency is associated with defect in embryonic

development of 3rd and 4th pharyngeal pouch? a. Cartilage Hair hypoplasia b. Chronic mucocutaneous disorder c. DiGeorge syndrome d. Hyper IgM syndrome 38. X-linked Hyper IgM syndrome id due to a. Mutation of the WASP gene b. Gene defect on common gamma chain encoding for c. d.

IL-2 Gene defect on adhesion molecules CD18 Gene defect on CD40 Ligand expression

39. Deficiency associated with defects on the gene encoding for

Bruton tyrosine kinase is called a. Transient hypogammaglobulinemia b. X linked agammaglobulinemia c. Common variable ID d. Selective IgA deficiency 40. Which of the following complement proteins is most deficient

in patient presenting with meningococcal infections a. C1qn b. C2-C4 c. C3 d. C5-C8 41. One of the following situations in children would warrant

evaluation of the immune function a. Severe pneumonia in infants b. Acute diarrhea in 6 yr old child c. Infection occurring at aunusual sites such as liver or brain abscess d. Infections with common childhood pathogens 42. The most effective screening test for complement defect is a. Serum complement component level b. CH50 assay c. Properdin level d. Complete blood 43. The most common primary immunodeficiency disease is a. X-linked agammaglobulinemia (XLA) b. Common variable immunodeficiency c. Selective IgA deficiency d. Hyperimmunoglobulin syndrome 44. This statement of XL Agammaglobulinemia a. Symptoms begins to manifest by the first 6-9 months b. They present with multiple Staphylococcal abscesses c. Girls are affected more than boys d. Treatment consist of supportive therapy in the form

of proper nutrition 45. Fetal anaphylaxis with IVIg administration has been observed

among patients with a. Hyper IgM syndrome b. X-linked Lymphoproliferative Disease c. XLA d. Selective IgA deficiency 46. One of the following conditions will initially suggest the

diagnosis of thymic hypoplasia a. Neonatal sepsis b. Hypocalcemic seizures c. Failure to thrive d. Mental retardation 47. The treatment of choice of patients with fatal T-cell or

combined T and B cell defects is a. Bone marrow transplant b. IVIg c. Judicious antibiotics d. Surgery when appropriate

48. The following disease are associated with an increase in serum

IgE EXCEPT a. Graft vs Host reaction b. Intestinal parasitism c. Allergic disorder d. SCID 49. A 2 yr old F whose family live in streets was brought to ER for a

3rd episode of BOB. Both parents are unemployed. PE showed a 9 kg girl with intercostal retraction and crackles all over what could this be? a. Primary immunodeficiency b. Non-immunologic causes c. Secondary immunodeficiency d. Allergy

55. A 4 month old patients workup showed low CD3, CD4, CD8 and

CD19 and was advised to undergo bone marrow transplantation and while awaiting for a doctor, you will also advise a. Completing the patient’s immunization b. Do not give blood transfusions c. Give only irradiated blood if blood transfusions is warranted d. Start prophylactic penicillin every 4 weeks 56. Louie was brought to the OPD because of diarrhea. This would

mean that Louie has a. 3-4 episodes of pasty stool for the past 24 hours b. 3-4 passing out of watery stools in 24 hours c. Bowel movement every after each feeding d. Vomiting every after each feeding

50. A 4 month old male was brought to ER for a second episode of

DOB. He also has diarrhea for 2 wks. PE showed a weight of 4.5 kg, whitish plaques on the tongue, intercostal retraction and crackles all over. What arm of the immune system is likely to be affected? a. Cell mediated immunity b. Humoral immunity c. Phagocytosis d. Complement 51. Which patient has a likely immunodeficiency? a. A cerebral palsy patient with two episodes of b. c. d.

pneumonia A 6 month old infant with oral trush since 5 months old A 1 yr old boy with one episode of pneumonia and 3 episoefs os sinusitis requiring IV antibiotics A 4 yr old female with 6 episodes of otitis media

52. A 9 month old infant had two episodes of pneumonia since 4

months old. What test for immunodeficiency will you do initially? a. CXRay b. Serum Immunoglobulin levels c. CH50 d. Nitroblue tetrazolium dye reduction test 53. A patient was brought to you for fever and tenderness at RUQ.

PE showed abscesses at the chest and liver US showed a liver abscess. What test will you request? a. Delayed-type hypersensitivity skin testing b. Serum immunoglobulin levels c. CH50 d. Nitroblue tetrazolium dye reduction test 54. A patient with recurrent pneumonia and diarrhea had normal

CD3, CD4 and CD8 levels but has low CD19 and immunoglobulin levels. Management with this patient will be a. Bone marrow transplantation b. IVIg at 500 mg/kg every 3 wks c. IMIg at 400 mg every 4 weeks d. Enzyme replacement therapy

57. Enteropathogens elicit noninflammatory diarrhea through a. Enterotoxin production by some bacteria b. Destruction of villus (surface) cells by viruses c. Adherence by parasites d. All of the above

58. Corazon, 2 months old was brought to the ER because of bloody diarrhea. On PE she was asleep with slight fever. The degree of dehydration of Corazon: a. No dehydration b. Some dehydration c. Severe dehydration d. cannot be assessed 59. Jojo, 6 months old was brought to the ER because of diarrhea. The mother described Jojo to be crying every time he will defecate. Stool noted to be containing blood. The mother likewise felt Jojo is suffering from: a. Acute diarrhea with some dehydration b. Bacterial dysentery c. Chronic diarrhea d. Cannot be evaluated 60. Cita, 8 months old was seen at the OPD because of watery diarrhea for 3 days. Cita was irritable with eyes sunken. Grabs her bottle eagerly when offered. Skin pinch goes back slowly. Cita has this degree of dehydration. a. No dehydration b. Some dehydration c. Severe dehydration d. Cannot be assessed 61. Angelo, 8 months old was brought to the ER because of diarrhea and vomiting. The following manifestation that would indicate that Angelo is severely dehydrated: a. Sunken eyes b. Dry lips c. Irritable d. Unable to drink 63. The WHO recommendation of the electrolyte compensation of ORS: a. Na = 90 mmol/L, K=25 mmol/L, Cl= 65mmol/L b. Na= 75 mmol/L, K= 20 mmol/L, Cl= 65mmol/L c. Na= 45mmol/L, K=20 mmol/L, Cl= 65mmol/L d. Na= 90 mmol/L, K= 20 mmol/L, Cl= 85mmol/L

64. Bubut, 10 months old was seen at the OPD because of acute diarrhea wth some dehydration. He is best treated with: a. ORS at 75 cc/kg in 4 hours b. Plain LRS at 50 cc/kg in 4 horus c. Fluid based food every 2-3 hours d. None of the above

73. Prior to a diagnostic procedure for MECKEL’S, the patient has to be prepared via the administration of: a. H2 receptor antagonist b. corticosteroid c. antibiotics d. atropine

65. Bubut, 10 months old was seen at the OPD because of acute diarrhea with some dehydration. The dose of zinc sulfate supplementation in Bubut is: a. 10 mg/day b. 15 mg/day c. 20 mg/day d. 25 mg/day

74. Inhibition of prostaglandin production causes peptic ulcer via: a. increased mucosal fragility b. increased acid production c. decreased local immunity to H. Pylori d. Decreased bicarbonate secretion

66. Luisa was admitted because of acute diarrhea due to shigella. The DOC is: a. Ampicillin b. Ciprofloxacin c. Chloramphenicol d. Co-amoxiclav 67. Diarrhea may be prevented with: a. Exclusive breastfeeding throughout his life b. Rotavirus immunization after first birthday c. Proper handwashing d. Improve management of diarrhea 68. Indication of antimicrobial therapy for salmonella related diarrhea: a. in the presence of malignancy b. infants less than 3 months c. in patient with chronic malignancy d. all of the above 69. Trimetoprim sulfamethoxazole is indicated for diarrhea caused by the ff organism EXCEPT: a. EPEC b. Shigella c. Giardia Lamblia d. Aeromonas 70. Management of diarrhea that would greatly reduce number of death among children include: a. Low osmolality ORS b. Zinc supplementation c. Rational use of antimicrocials d. All of the above 71. A 2 ylo child with vomiting, irritability and incessant crying passed mucoid bloody stools in between episodes, the child looks normal. He has abdominal distension with palpable mass near the epigastrium. What is your impression? a. Meckel’s diverticulum b. Acute appendixitis c. Pancreatitis d. Intussusception 72. Meckel’s diverticulum is a developmental anomaly caused by the ectopic location of a. Gastric mucosa b. Appendix c. Mesentery d. Pancreatic tissue

75. HBsAg (-), Anti HBs (-), HBsAG (+), Anti HBc (-) profile. The ff statements are correct except: a. There is active Hep B infection b. The patient is infectious c. The patient is going into chronicity d. This maybe of recent onset 76. HBsAg (-), HBeAg (-), Anti HBc (+), Anti HBs (+) means: a. The patient is highly infectious b. The patient is either going to have the infection or not so a repeat profile is necessary several months from now c. The patient needs immediate immunization with Hep B vaccine d. The patient is on his way to recovery 77. The pain of PUD in children is classically located on the: a. Epigastrium b. Periumbilical c. LUQ d. RUQ 78. H. Pylori gastritis and duodenitis are best diagnosed via: a. Serology b. Stool exam for antigen c. Endoscopy d. Urea breath test 79. The anti reflux barrier consist of the ff EXCEPT: a. Cardia of the stomach b. Crura of the diaphragm c. LES d. Valve- like mechanism in the gastroesophageal junction 80. Which of the following procedures can detect gastric emptying time in children with GERD? a. Endoscopy b. 24 hour monitoring c. Scintigraphy d. Intaluminal impedance testing 81. In an older child with GERD the position he is advised to always assume is: a. Upright b. Prone c. Left lateral decubitus d. Right lateral decubitus 82. Which of the ff prokinetic agent has the worst side effects of extra pyramidal manifestation? a. Metoclopromide b. Erythromycin c. Betanechol d. Domperidone

83. Long-term complication of surgery for tracheoesophageal fistula and esophageal atersia is: a. constipation b. GERD c. Recurrent abdominal distension d. Chronic abdominal pain

93. Bloating, contributing to abdominal pain is found in patients with these dses EXCEPT: a. fructose intolerance b. Meckel’s diverticulum c. Lactose intolerance d. Parasitism

84. Among patients with pyloric stenosis who underwent barium studies, the bulge of the pyloric muscle into the atrium is called: a. Rat tail sign b. Double bubble sign c. Double tract sign d. Shoulder sign

94. In lead poisoning abdominal pain is associated with this GI symptom: a. Diarrhea b. Vomiting c. Constipation d. Bleeding

85. The first line management for infants with pyloric stenosis is: a. Pyloromyotomy b. Atropine administration c. Fluid and electrolyte stabilization d. Endoscopic balloon dilatation

95: Melena may be a manifestation of: a. Hemorrhoids b. Intussusception c. PUD d. Meckel’s Diverticulum

86. Swallowing of solids os more problematic than swallowing of liquids in patients with? a. Botulism b. Strictures c. Obstructed nasal passages d. Salivary glands abnormalities

96. Hematemesis may be a symptom of the ff EXCEPT: a. Esophageal varices b. Duodenitis c. Mallory Weis tears d. Parasitism

87. Regurgitation is characterized by the ff EXCEPT: a. caused by immature LES b. effortless movement of stomach contents into the oral cavity c. most cases develop apnea and tachypnea d. infants are hungry after every episode 88. Bile-stained vomitus in infants is the hallmark of: a. Jejunal atresia b. Milk allergy c. PUD d. Pancreatitis 89. The definition of constipation on following parameters, EXCEPT: a. frequency of bowel movement b. blood in the stools c. perceived difficulty during bowel movement d. consistency of stools 90. Defective rectal filling causing constipation occurs in the ff conditions EXCEPT: a. Lesions in the pelvic floor b. Hypothyroidism c. Aganglionic megacolon d. Opiate use 91. Periumbilical pain without later localization is experienced by patients with ff conditions EXCEPT: a. Lactose intolerance b. Parasitism c. Cholelithiasis d. Intussusception 92. Abdominal pain associated with blood in the stolls may be found in patients with these conditions EXCEPT: a. intussusceptions b. functional constipation c. fructose intolerance d. parasitism

97. Transudate causing ascites may be due to the ff EXCEPT: a. severe malnutrition b. cirrhosis of the liver c. nephrotic syndrome d. malignancy 98. The most common cause of infantile cholestasis: a. biliary atresia b. neonatal hepatitis c. choledochal cyst d. paucity of the bile ducts 99. The MC route of transmission of HEP A is: a. Blood transfusion b. Sexual contact c. Perinatal transmission d. Saliva or fecal contaminated 100. W/c of the ff heap viruses is primarly transmitted enterally: a. HEP D b. HEP E c. HEP C d. HEP B

1. True of gonoccocal – house hold contact 2. TSS except: a. Rash b. Fever >38C c. Shock d. Renal failure 3. Differential diagnosis of laryngeal diphtheria - Croup 4.Best specimen for thyphoid fever during the first week = Blood 5.Worst complication of leptosperosis= acute renal failure 6.Prophylaxis for close contact (brother ,sister) of a 2 year old with diphtheria=erythromycin 7. Pertussis blood exam – (Extremely high WBC with Lymphocytosis…) 8. 4 y/o girl with fever, palpatory BP, rash – Meningitis 9. Streptococcus pyogenes – causes scarlet fever 10. In anaerobic infection , this is the medication that should be given: a. Erythromycin b. Ofloxacin c. Metronidazole d. Cefalexin 11. In the IgE mediated allergy, Immunotherapy is the therapy indicated in… a. Allergic Rhinitis b. Anaphylaxis c. Cholinergic urticaria d. None of the above 12. Collin came to you for the 2nd opinion. According to 1st physician she consulted with, she has allergy. This diagnosis is based on: a. Allergic skin testing b. Determination of IgE levels c. Ruling out non-allergic causes first d. history and PE 13. Immunodeficiency can be seen in…(oral thrush in 2 y/o child, pneumonia, brain, liver abscess in a 2 month old…) 14. Autoreactive T-cell undergoes… a. Irradiation b. Fixation c. Apoptosis d. Phagocytosis 15. Treatment of severe Combined Immunodeficiency – BM transplant 16. Most severe form of lead intoxication: a. Peripheral neuropathy b. Mental retardation c. Cerebral edema d. Anemia 17. Fe deficiency – best managed by a. Administer IV Na bicarbonate b. Oral deferoxamine c. activated charcoal d. None of the above 18. Only clear effect of dioxin in children – chloracne 19. Action of cyanide toxicity – Cytochrome oxidase system 20. Scabicides contain –Permethrin 21. Hand tremor & gingivitis – (Iron, Mercury, Lead) 22. Most common Clinical manifestation of Hirschprung dse: constipation 23. Most effective H2 antagonist – Famotidine 24. Initial therapeutic approach for treatment of intussuseption: a. barium enema b. air enema c. fluid correction and resuscitation 25. Painless rectal bleeding is a hallmark of – Meckel’s diverticulitis

26. Blood transfusion hepa? Hepa C 27. Given to a NB w/ Hepa B (+) mother? Hepa B vaccine w/ Hepa B Immuneoglobulin at birth 28. Non-bilous vomiting – feature of pyloric stenosis 29. Techniques in order to elicit a complete history – Use open ended questions 30. Before doing the interview… a. Know the goals of the interview b. groom properly c. d. All of the Above 31. True when greeting the patient… a. Use first name even w/o permission b. Use title as tatay, ma’am… c. You don’t have to greet the patient… 32. Undivided attention – Active listening 33. Emer 16 y/o with abdominal pain… she’s with her mom. What do you exclude in the interview? a. vices b. Food preference c. Boyfriend d. peer relationship 34. 10 y/o consul for UTI, General data include: Religion 35. HPI – presence of fever 36. milestone at 9 months – (sit with support…) 37. at 9 months… a. 1 dose BCG, measles; 2 doses DPT, OPV, Hepa B b. 1 dose BCG, measles; 3 doses DPT, OPV, Hepa B 38. 2 years old cannot – hop in 1 foot (can run around, can go up and down the stairs by himself) 39. 2 word sentence – can do…??? 40. chief complaint… -upward rolling eyeballs Case: 3/F cold and cough for 5 days 41. What will not be part of HPI? a. Personal b. Medical c. Social d. Interval Case: 2 week old/ Male… DOB 42. Not part of medical history: a. Type of delivery b. BW c. Course of Pregnancy d. NOTA 43. Given at birth to a baby with a hepa B (+) mom? 44. full set of genes – Genotype 45. Position of a given Chromosome - Locus 46. True about recessive traits? –homozygous traits 47.Which of the ff is not an Autosomal Dominant?= Galactosemia 48. Sex-linked recessive – Hunter’s dse 49. Bloom Syndrome – Autosomal recessive 50. Male with Hemophilia A – All of her daughters are carriers 51. Cleft lip and Palate – probability cannot be ascertained 52. True when Male has De Toni Fanconi, Female normal: All the female offspring will have the disease 53. Antenatal manifestation???a. most are inherited by Autosomal recessive 54. Y-linked – Hairy pinna 55. All are cause of Chromosomal aberration, except: a. Autosomal DO b. Late Paternal age c. Viral infection d. Radiation

56. Most common cause of inherited mental retardation – Fragile X syndrome PEDIATRICS Remedial 1. Gauge of nutrition for under six yr old child : upper arm mid circumference 2. HR : 120-160/min 3. RR : 30-60 4. Boys will lead again : 14yrs old 5. Features of autism except : respond when called 6. included in newborn screening : ? 7. 1 ½ yrs old : spoon 8. apnea : 15 secs 9. indicators of nutritional status : anthropometric measures (ht. and wt.) 10. 1 month old : 4 teeth 11. most common immunodeficiency syndrome : selective IgA def. 12. Rett DO except : Female 13. Apgar Score : 9 14. Before 1 yr old : 1BCG, 3DPT, 3Polio, 3HepaB, 1Measles 15. Both parents have allergy : 50%-80% 16. Hep B vaccine for pts in dialysis : Plasma derived 17. Ultimate goal for Primary health care : Health for All 18. inc. CHO, inc. CHON, Dec. Fat (Caloric excess) : over nutrition 19. Hemorrhagic Dse. Of the newborn : Vit K 20. For neonates, ophthalmia neonatorum : Erythromycin 21. Cultural Challenge (Oral phase) : Weaning 22. Preterm infant formula : 24 kcal/oz (if termed infant-20 kcal/oz) 23. Lead : Mee's Line (0.1 Normal ) 24. Fluoride :1.5 mg/L / ppm 25. Paint chips : Lead 26. Congenital anomaly : rubella 27. Arsenic : urine level 28. Newborn screening : done after 24hrs but not later than 72hrs 29. Pathologic Jaundice : <24hrs, Physiologic Jaundice : >72hrs 30. Sunken eyes, unable to drink : severe dehydration 31. ORS : CHO, Na, K, Cl 32. Zinc : <6mos (10mg/day), >6mos (20mg/day) 33. Food Allergy : eliminate identified culprit foods 34. 45XO : Turner Syndrome 35. Craniostenosis with Trigonocephaly : 9P Syndrome 36. Prominent anti-helix : 18q Syndorme (if auricle : 18p) 37. Positioning approp. For GERD : infant : if asleep : non-prone If awake : upright Older children: left side and head elevated During sleep 38. Cullen's sign: bluish discoloration around umbilicus 39. Grey Turner's Sign : bluish discoloration of flanks 40. Acute taste discrimination: 3mos 41. Flecks of Mucus : dysentery 42. inc. in ht of a 9mos old child : 22cm 43. normal ht. at birth : 50cm 44. Normal wt at birth : 3000gm / 6 ½ / 3kgs 45. deciduous teeth, 1st teeth to erupt : Central Incisors 46. permanent teeth, 1st teeth to erupt : First Molar Last teeth : Third Molar 47. difficulty in initiating sleep – Limit Setting Sleep DO 48. most effective Tx for Enuresis : Bell and Pad 49. maturity of the prod'n of surfactant : 37wks 50. Central cyanosis : more serious abnormalities CNS/Cardiovascular 51. Erythema Toxicum : Papular Lesions 52. Hepatitis : Hepa B

53. Herd Immunity : Polio 54. ?????? except : genotypically normal but phentoypically abnormal