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PEDIATRICS 1. The cardiac silhouette of patients with Tetralogy of Fallot is best described as: a. boot shaped b.

egg on the side c. markedly enlarged d. mild cardiomegaly p.1312 2. The most common cause of neonatal seizures is a. meningitis b. hypoxic ischemic encephalopathy c. congenital CNS anomalies d. metabolic causes p. 1696 3. Immunization with polio vaccine may be started as early as a. b. c. d. newborn period 6 weeks of age 8 weeks of age 3 months

p. 1023 4. Measles immune globulin may prevent or modify infection if given within a. b. c. d. 3 days after exposure 6 days after exposure 10 days after exposure 2 weeks after exposure

p. 1017 5. What congenital anomaly is associated with growth and mental retardation, abnormal facial features like low set ears, hypotonia and an endocardial cushion defect? a. velocardiofacial syndrome b. Downs syndrome c. Turner Syndrome d. Cornelia de Lange syndrome Answer B p 619 Nelson

6. A scaphoid abdomen at birth usually suggests a: a. b. c. d. diaphragmatic hernia omphalocoele gastroschisis omphalitis p527

ans. A

7. One of the following drugs is ABSOLUTELY contraindicated to Breastfeeding: a. b. c. d. diuretics prednisone tetracycline hydralazine p. 530

ans C

8. The presence of subperiosteal hemorrhage in the newborn which is located to the surface of one cranial bone is called: a. b. c. d. caput succedaneum molding fracture of the skull cephalhematoma p 562

ans: D

9. Congenital Rubella Syndrome is characterized by the following conglomeration of symptoms: a. cataracts, cardiac abnormality, hearing defects, microcephaly and mental retardation b. hepatomegaly, splenomegaly, jaundice, petecchiae, chorioretinitis c. IUGR,intracranial calcifications, hepatosplenomegaly d. Hydranancephaly, chorioretinitis, spasticity,mental retardation Ans A p.569

10. The mature levels of surfactant is seen by: a. b. c. d. 20 weeks 28 weeks 32 weeks 35 weeks p.575

ans: D

11. The most frequently fractured bone of the newborn during labor and delivery is the: a. b. c. d. femur humerus clavicle hip bone p. 572

ans C

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

a. b. c. d.

Ig A nephropathy Alport Syndrome Acute Glomerulonephritis MPGN answer C p.1740

13. A 16 year old female developed nephritis. Her C3 is noted to be low. She is also complaining of joint pains and photosensitivity. The probable diagnosis of this patient is: a. b. c. d. Acute Glomerulonephritis Henoch Schoelein Purpura Systemic Lupus Erythematosus Membranoproliferative GN p1743

Ans C

14. The most common pathogen associated with HEMOLYTIC UREMIC SYNDROME is : a. b. c. d. shigella salmonella E. Coli Rotavirus Ans C p. 1274

15. The SMR stage of a female adolescent who presents with coarse abundant curly pubic hair and an areola and papilla with a secondary mound is a: a. b. c. d. SMR 1 SMR 2 SMR 3 SMR 4

Ans: D p. 54 16. Delayed eruption is considered when there is no teeth at approximately: a. b. c. d. 6 months 9 months 10 months 13 months p. 61

answer is: D

17. The principal vector of DENGUE FEVER is: a. b. c. d. Plasmodium Falciparum Aedes Aegypti Perumycus Perinomata Culex pipiens p.1092

Answer B

18. A 5 year old male was noted to have fever of five days duration which is rapidly increasing to 39 to 40 C . It is accompanied by frontal headache and was noted to have back pain. After 2 days of defervecence of fever rashes appear at the lower and upper extremities that is glove and stockings in distribution. The most plausible diagnosis is: a. b. c. d. Measles Typhoid Fever Yellow Fever Dengue Fever Ans D p 1093

19. The WHO criteria for dengue hemorrahagic fever are the following: a. fever, minor or major hemorrhagic manifestation and thrombocytopenia b. fever, elevated ESR and thrombocytopenia c. fever, (+) dengue blot and thrombocytopenia d. fever, biphasic fever and thrombocytopenia ans A p. 1093

20. A 6 year old child developed high grade fever and cough. Chest x- ray was done and reveled pnuematocoeles . What is the most common pathogenic organism responsible for pneumatocoeles? a. b. c. d. Influenza Streptoccocal Pnuemococcal Staphylococcal

Ans: D 21. An important indicator of pneumonia among infants is: a. b. c. d. ans B fever increased respiratory rate cyanosis cough p.1435

22. The drug of choice for atypical pneumonia is: a. b. c. d. Ampicillin Chloramphenicol Erythromycin Ceftriaxone p 934

ans C

23. One of the following is a pathologic finding in the newborn: a. b. c. d. Ans D 561 24. The duration of treatment for uncomplicated H. Influenzae meningitis is a. b. c. d. 3-5 days 7-10 days 2 weeks 4 weeks ans. B p. 711 milia Mongolian spots Erythema toxicum Jaundice during the first 24 hours

25. Acute bronchiolitis, a common disease of infants has a peak incidence at a. b. c. d. ans. C 2 months of age 4 months of age 6 months of age 10 months of age p. 1211

26. Stridor is most commonly seen in infants with a. b. c. d. ans. A croup bronchiolitis bronchitis pneumonia p. 1215

27. Subacute sclerosing panencephalitis (SSPE) is associated with a. b. c. d. rubella rubeola varicella roseola infantum ans. B p. 934 28. The absolute contraindication to giving immunization is: a. b. c. d. immunodeficiency state of the patient high grade fever at the time of administration malignancy in a child previous anaphylactic reaction p. 1085

29. A 10-month old male comes in for a well-baby visit. He had BCG, 3 doses of DPT & OPV and 2 doses of hepatitis B vaccine. What can you give him for this particular visit? a. b. c. d. measles & 3rd dose of Hepatitis B vaccine measles vaccine 3rd dose of hepatitis B varicella vaccine

31. The WHO recommends that breast feeding can be the infants sole source of food up to about: a. b. c. d. 2 months of age 6 months of age 12 months of age 2 years of age

32. Which vaccine should be given intradermally? a. b. c. d. measles BCG hepatitis B MMR p. 896 33. A fully immunized child is one who has completed the following before 12 months of age: a. b. c. d. BCG; 3 doses each of hepatitis B, DPT and OPV BCG, 3 DPT; 3 OPV; measles vaccine 3 hepatitis B; 3 DPT; 3 OPV; measles vaccine 3 hepatitis B; BCG; 3 DPT; 3 OPV, measles vaccine

34. A 12-year old male with repeated episodes of streptococcal pharyngitis comes to the clinic with another episode of sore throat. Oral amoxicillin was started. One hour later, he had tingling sensation around his mouth, difficulty of swallowing and developed hoarse voice. At the ER, he had urticaria, PR=130/min, RR=32/min, BP=70/30 and t= 37.2C. The most appropriate therapy is: a. epinephrine b. prednisone c. diphenhydramine d. lactated Ringers solution p. 687 35. A 12-year old presents with sneezing, clear rhinorrhea and nasal itching. Physical examination reveals boggy, pale nasal edema with a clear discharge. The most likely diagnosis is: a. foreign body b. vasomotor rhinitis c. neutrophilic rhinitis d. allergic rhinitis p. 662

36. The most common manifestation of rheumatic fever in children is: a. b. c. d. erythema marginatum subcutaneous nodules carditis arthritis p. 807 37. An 18-month old is noted to assume a squatting position frequently during playtime at the daycare center. The mother also notices occasional episodes of perioral cyanosis during some of these squatting periods. The day of admission, the child becomes restless, hyperpneic and deeply cyanotic. Within 10 minutes, the child becomes unresponsive. The most likely condition is: a. b. c. d. cardiomyopathy anomalous coronary artery tetralogy of Fallot breath-holding spell p 1385 38. A 14-year old male presents with Grade 4/6 regurgitant systolic murmur at the apex with history of swollen and painful joints. The murmur is most likely: a. b. c. d. mitral stenosis mitral regurgitation aortic regurgitation mitral valve prolapse p. 1428 39. A 14-year old female was brought to you because of mothers worry that she has no menarche yet as compared to her classmates. Medical history and complete PE are normal. Breast development and pubic hair have been present for 18 months and are normal. Which would be the most appropriate? a. reassurance that she likely will begin menstruating within the year b. laboratory evaluation for systemic disease c. urinary estriol determination d. referral for psychological counseling p.1687 40. The hallmarks of diabetes insipidus are: a. b. c. d. polyuria and polyphagia hyperthermia and vomiting polyuria and polydypsia hyperthermia and weight loss p. 1682

41. A 2-year old male presents with a history of chronic constipation. Upon review of history, you were told that he had delayed passage of black stools. He had unremarkable PE findings. The parents were giving him laxatives for the past 2 weeks. Your most likely initial impression is: a. b. c. d. functional constipation constipation due to laxative abuse intestinal pseudo-obstruction Hirschprung disease p. 1139 42. A prominent clinical presentation of duodenal atresia is: a. b. c. d. bilious vomiting without abdominal distention non-bilious vomiting polyhydramnios colicky abdominal pain

p. 1133 43. The radiologic finding of double tract sign is typically seen in: a.Intussusception b. pyloric stenosis c. duodenal atresia d. midgut volvulus p. 1130 44. Classic hemophilia is best treated by giving: a. b. c. d. whole blood Factor VIII packed rbc Factor X p. 1510 45. A 5-year old female has multiple bruises on her lower extremities and oral mucosal bleeding for 3 days duration. Two weeks before these signs she had a mild respiratory tract infection. Physical examination reveals multiple ecchymoses and petechiae; no lymphadenopathy nor splenomegaly was noted. The most likely diagnosis is: a. b. c. d. Leukemia Neuroblastoma aplastic anemia idiopathic thrombocytopenic purpura p. 1521

46. Which of the following suggests a bacterial etiology in a child with tonsillopharyngitis? a. b. c. d. pale tonsils with mild pharyngeal congestion beefy tonsils with petechiae mild pharyngeal exudates enlarged tonsils with moderate congestion p. 1265 47. A 1-year old infant had cough 2 weeks PTC which started as mild and becoming paroxysmal. This was accompanied by low-grade fever but was relieved by antipyretics. She had a poor history of immunizations. PPE showed explosive outburst of cough accompanied by reddish face. The child looks well when not coughing. Lungs were clear. There were few petechiae in the neck. T=37C. The most likely diagnosis is: a. b. c. d. viral pneumonia epiglottitis pertussis laryngotracheobronchitis p. 839 48. The period of communicability of mumps in a child is: a. for 5 days starting with the first day of visible parotid swelling b. from 3 days of onset of swelling to the day of visible swelling c. from several days before the onset of swelling until the swelling has subsided d. only while fever persists p. 954 49. A 12-year old girl had a mild sore throat, low-grade fever and a diffuse maculopapular rash. During the next 24 hours, she developed redness of her eyes. PE showed mild tenderness and marked swelling of her posterior cervical and occipital lymph nodes. Four days after the onset of illness, the rash vanished. The most likely diagnosis is: a. b. c. d. Rubella Rubeola erythema infectiosum acute infectious lymphocytosis p. 951 50. Which is the most common cause of osteomyelitis in children? a. b. c. d. Staphylococcus aureus Group A streptococcus Group B streptococcus Pseudomonas aeruginosa p. 776

51. A full term newborn with Apgar score of 8 & 9, is having episodes of cyanosis and apnea which are worse when attempting to feed, but seems better when crying. At this point, it is important to establish: a. b. c. d. patent ductus arteriosus choanal atresia ventricular septal defect respiratory distress syndrome p. 1259 52. The initial treatment for neonates with sepsis consists of: a. b. c. d. erythromycin + cloxacillin ampicillin + sulfa ampicillin + aminoglycoside cloxacillin + aminoglycoside p. 549 53. A 10-day old infant who was born by NSD by a hilot was brought in because of difficulty of sucking and excessive crying noted 2 days PTC. PPE: wt= 3,000 gms; T= 37.5C, with hoarse cry and spasms. Lungs were clear. The most appropriate treatment would be: a. b. c. d. feeding by NGT penicillin by IV muscle relaxant IM sedative IM p. 879 54. A 3-year old child awakens at night with high-grade fever, a severe sore throat and a barking cough. P.E. shows a child who is drooling and with respiratory stridor. Lungs are clear. The child may have: a. b. c. d. bronchitis tonsillopharyngitis acute epiglottitis bronchiolitis p. 1275 55. A 10-month old infant has fever, cough, dyspnea and leucocytosis. Chest xray shows patchy distribution of consolidation. Treatment of choice without bacterial culture is: a. b. c. d. Ampicillin Erythromycin Oxacillin Amikacin

56. Tracheo-esophageal fistula is usually suspected in one of the following conditions: a. b. c. d. excessive oral secretions maternal hypertension presence of stridor vomiting p. 1122 57. A syndrome that starts as diarrhea and progresses to fever, oliguria, acute renal failure, thrombocytopenia and microangiopathic anemia in children is due to: a. b. c. d. systemic lupus erythematosus hemolytic-uremic syndrome Good-Pasteur disease Henoch-Schonlein nephritis p. 1586 58. A 2-year old female was hospitalized because of afternoon fever and anorexia for 3 weeks and seizures few hours prior to consultation. No previous medications; no history of seizures in the past. PE findings: T=39.5C, stuporous, (+) nuchal rigidity, right eye deviated medially, spastic extremities. CSF was cloudy with WBC 204/cc and lymphocytes of 90%, sugar=0.8 mmol/L. Your treatment would include: a. b. c. d. aqueous penicillin ampicillin and chloramphenicol INH/Rifampicin/Streptomycin/corticosteroids anti-viral drugs p. 891 59. Sparse and thin hair with dyspigmentation as a sign of undernutrition is commonly observed in: a. b. c. d. marasmus kwashiorkor intrinsic factor deficiency vitamin A deficiency p. 170 60. Milk feedings must be supplemented with iron preparations to prevent iron deficiency anemia starting: a. b. c. d. 6-8 weeks of age 6 months of age 9 months of age 12 months of age p. 165

61. The present age recommendation to start solid food for supplementation for infants is at: a. b. c. d. 3 months of age 6 months of age 9 months of age upon eruption of 2nd incisors p. 165 62. Normally, a newborn infants weight may decrease 10% below the birthweight in the first week of life as a result of: a. b. c. d. excretion of excess extravascular fluid high environmental temperature hypoglycemia intake of high-fat breast milk Answer: A p. 32-33

63. The 1-minute APGAR Score may indicate which of the following? a. b. c. d. the need for immediate resuscitation the probability of successful resuscitation predict neonatal death predict neurologic outcome Answer: A p.592 64. In general, jaundice is considered pathologic and therefore, a search to determine its cause should be made if: a. b. c. d. it appears on the 36-48 hr. of life serum bilirubin is rising at a rate faster than 1 mg/dl/24 hr. jaundice persists after 5-7days of life direct-reacting bilirubin is greater than 2 mg/dL at any time Answer: D p. 595 65. An infant is observed to follow objects 18 degrees, laughs out loud and grasp objects and bring them to mouth. He must be: a. 2 weeks old b. 1 month old c. 2 months old d. 4 months old Answer: D p. 34 66. This is a major milestone at about 9 months old age, which is the understanding that objects continue to exist even when not seen: a. rapproachment b. object constancy c. object permanence d. magical thinking Answer: B p. 36

67. The first visible sign of puberty in girls is: a. b. c. d. thelarche pubarche menarche peak height velocity Answer: A p. 54 68. This vaccine is contraindicated in household contacts of immunocompromised persons: a. b. c. d. OPV Measles Varicella BCG Answer: A p. 1182 69. Baby Girl Cruz was delivered spontaneously at term to a 28 y/o G3P2 mother. Following delivery, she was noted to be limp, had irregular respiration, CR 80/min, extremities and body cyanotic with no response to suctioning of oronasal passages. What is the APGAr Score of Baby Girl Cruz? a. b. c. d. 2 3 4 5 Answer A p. 528

70. The second dose of MMR should be routinely given at the age of: a. b. c. d. 1 years old 2-3 years old 4-6 years old 7-10 years old p. 1178

Answer: C

71. If the first dose of Hepatitis B vaccine was given at birth, the last dose should not be given before the age of: a. b. c. d. 6 months 9 months 12 months 15 months Answer: A p. 1177

72. For infants born to mothers whose HBsAG status is unknown, the first dose of Hepatitis B should be given at what age? a. b. c. d. within 12 hours at birth 4 weeks old 6 weeks old 8 weeks old Answer: A p. 1177 73. A 4 year old child is expected to have an approximate weight of: a. b. c. d. 12 kg 14 kg 16 kg 20 kg Answer C p. 31

74. A newborn was noted to have increased oral bubbly secretion accompanied by cough and choking on feeding. The most likely diagnosis is: a. TEF b. pulmonary sequestration c. pulmonary hypoplasia d. CCAM Answer: A page: 1219

75. A 3 year old boy was brought to the ER because of barking cough and stridor. He was afebrile, non-toxic and well when seen by his physician. Symptoms were similar for the past 3 nights. This clinical condition is typical of: a. spasmodic croup b. acute laryngotracheobronchitis c. congenital subglottic stenosis d. angioneurotic edema Answer: A page 1407 76. A 5 y/o has frequent cough and colds of more than a month accompanied by marked weight loss. Her mother also has chronic cough. If Mantoux test shows an induration of 10 mm., the most likely diagnosis is: a. b. c. d. TB infection TB disease TB exposure Miliary TB Answer B page 962

77. . Which of the following is a major criteria of atopic dermatitis? a. Xerosis b. postauricular fissure c. elevated IgE d. (+) FH of atopy Answer: D page: 775

78. A 15 month old boy developed generalized pruritus, hives and dyspnea 30 minutes after intake of egg. The initial treatment should be administration of: a. b. c. d. diphenhydramine IM Epinephrine IM Epinephrine SC Prednisone IV

Answer: B page: 781 79. A 7 year old girl came because of polyuria (about 8 L./day) noted for 4 weeks. She was also noted to have marked weight loss (60%). If urinalysis shows specific gravity 1.032, urine glucose 3+, urine osmolality of 500 mOsm/L, the most likely cause of polyuria of this patient is: a. b. c. d. Neurogenic DI Nephrogenic DI Type I DM Type II DM Answer: C page 1954 80. Randy, a 5 y/o was brought to your clinic for polyuria. On pitressin test, there was a decrease in urine volume, increase in specific gravity and urine osmolality. The next diagnostic test you will request is: a. b. c. d. ultrasound of KUB cranial MRI glycosylated hemoglobin serum Na, K and calcium Answer: B page: 1854 81. The most common malignant neoplasm in children: a. b. c. d. Retinoblastoma Neuroblastoma Wilms Tumor Leukemia Answer: D page: 1694 82. A 1 year-old baby was brought to the OPD for a well baby check up. He was exclusively breastfed from birth until 6 months, and was given complementary feeding from then on. Physical examination was unremarkable except for pallor. CBC showed anemia, low red cell indices, normal reticulocyte count. What is the most likely diagnosis? a. b. c. d. Thalassemia trait Iron deficiency anemia Aplastic Anemia Diamond Blackfan anemia Answer: B page: 1614

83. A 4 y/o male patient consulted because of joint pains, he was also noted to have intermittent low grade fever for 2 weeks. PE: pale palpebral conjunctivae, (+) petechiae on soft palate, Grade 1-2 systolic ejection murmur at the LLSB, clear breath sounds, liver edge 5 cm below RCM, spleen 3 cm below LCM, (+) 3 cm bluish discoloration on the thigh. CBC showed Hgb = 6.0/dL, Hct 20 vol % RBC = 2.0 x 109/L, MCV = 85 fl, MCH = 30 pg, MCHC = 31, RDW = 13, WBC = 10 x 109/L, segmenters = 1%, lymphocytes = 90%, Platelet count = 100 x 109/L. What is the most likely diagnosis? a. Aplastic anemia b. Infectious mononucleosis c. Acute lymphocytic leukemia d. Rheumatoid arthritis Answer: C p. 1645

84. A 4 month infant was brought to the hospital because of diarrhea. He passed out watery yellow stools with low grade fever. The most likely cause of the acute diarrhea is a. Enterotoxiginic E. coli b. Rotavirus c. Cholera d. Shigella Answer: B page: 1082

85. If this baby presents with lethargy with CR 140/min, weak pulses, sunken fontanels and eyeballs, dry lips, + skin fold test of > 3 sec. What is the degree of dehydration? a. none b. mild c. moderate d. severe Answer: D page: 245

86. GIT condition that manifest symptoms early in the neonatal period, but has high incidence of spontaneous remission as the infant grows older: a. b. c. d. Hypertonic pyloric stenosis Hirschprungss disease GE reflux Intussusception Answer: C page: 1222

87. Features strongly suggest cholestatic jaundice: a. b. c. d. yellowish skin and sclerae straw yellow urine TB 12 mg/dL B1 10.8mg/dL B2 = 1.2 mg/dL Acholic stools Answer: D pages: 1314-1315

88. Drug of choice used to rapidly terminating severe cyanotic spells in babies with Tetralogy of Fallot: a. b. c. d. Clonidine Paracetamol Morphine Diazepam Answer: C page: 1525

89. Palpating the peripheral pulses is important in infants and children. This particular congenital cardiovascular disease may be suspected if the femoral pulses are diminished or absent: a. b. c. d. patent ductus arteriosus (PDA) coarctation of the aorta transposition of the great arteries (TGA) atrial septal defect Answer: B page: 1482 & 1518 90. In which of the following situations can a diagnosis of acute rheumatic fever be made? a. b. c. d. (+) ASO titer (+) joint pains, (+) fever (-) ASO titer (+) choreas syndenham (+) ASO titer, (+) erythema marginatum ESR (+) ASO titer, (+) polyarthritis, CRP Answer: B p. 876

91. Baby Twinkle was delivered term to a mother with poorly-controlled gestational diabetes. At birth, her Apgar Score were 5 and 6 at 1 and 5 minutes, respectively. Maternal blood type is O+, babys blood type is A+ If she developed jaundice at the 20th hours of life, the most likely cause is: a. b. c. d. Perinatal asphyxia Hemolytic disease of the newborn Maternal diabetes Hemorrhagic disease of the newborn Answer: B page: 601

92. A 6 year old boy complained of nape pains and headache, with a BP of 160/100. He had a history of sorethroat a week PTA, with passage of teacolored urine 3 days PTA and facial and leg edema. The most likely consideration is: a. b. c. d. UTI Post-infectious glomerulonephritis Idiopathic nephritic syndrome Urolithiasis Answer: B page: 1740

93. The most important risk factor for infants with febrile UTI due to its potential for causing renal injury is: a. b. c. d. being uncircumcised vesicoureteral reflux voiding dysfunction male sex Answer: B page: 1790

94. A 3 year old boy had a history of profuse watery diarrhea and vomiting. On consultation, there was no urine output for the last 12 hours. Minimal urine was obtained by catheterization. Urine was dark yellow, highly concentrated with a low urine sodium content. The cause of renal failure is: a. b. c. d. pre-renal intrinsic renal bladder outlet obstruction neurogenic bladder Answer: A page: 1768, 1769 95. A 2 month old unimmunized baby was brought to the ER following a mild two-week upper respiratory infection. She then developed severe paroxysmal cough. A presumptive diagnosis of Pertussis can be made by a: a. b. c. d. throat culture White blood cell count Chest-x-ray Grams stain of nasal discharge page: 910

Answer: B

96. The WHO criteria added for Dengue Shock Syndrome include the criteria for DHF plus: a. b. c. d. minor or major hemorrhagic manifestations thrombocytopenic (< 100,000/mm3) narrow pulse pressure (< 20 mmHg) or hypotension pleural effusion by chest radiograph or hypoalbuminemia Answer C page 1093

97. A 9 year old girl has been having on and off fever for the past 10 days. On examination there was conjunctivitis, strawberry tongue, and periungual desquamation. The most likely diagnosis is: a. b. c. d. atypical measles Kawasaki disease Typhoid fever Streptococcal septicemia Answer: B page: 824

98. A 10 year old girl complained of fever, sore throat. PE revealed exudative pharyngitis accompanied by generalized lymphadenopathy, splenomegaly and atypical lymphocytosis on peripheral smear. The most likely etiologic agent is: a. b. c. d. Group A b-hemolytic Streptococcus Corynebacterium diphtheriae Epstein Barr Virus Coxsackie Virus Answer: C page: 1067

99. A 17 year old girl had a mild prodrome of nasal catarrh and low fever followed by retroauricular, posterior cervical and postoccipital lymphadenopathy and the appearance of discrete reddish maculopapules. This fits the diagnosis of: a. b. c. d. Varicella Rubella Meningococcemia Parvovirus B19 Answer: B page: 1032

100.A 6 year old presented by a mild respiratory prodrome. The initial stage wascharacterized by erythematous facial flushing likened to a slapped cheek. The disease is most likely: a. scarlet fever b. CMV infection c. Roseola d. erythema infectiosum Answer: D 101. page: 1049

The management of benign febrile seizures includes: a. b. c. d. Phenobarbital therapy if the patient is one year or older baseline neuroimaging electroencephalogram a week after the attack maternal education and antipyretic measures Answer: D page: 1994

102.

Cyanosis and seizures on prolonged crying in an infant suggests: a. b. c. d. benign rolandic seizures ceongenital heart disease breatholding spells infantile spasm Answer: C page 2010

103.

A 12 year old female with malar rash palatal ulcers, polyarthritis and photosensitivity. The most likely diagnosis is: a. polyarteritis nodosa erythematosus b. systemic scleroderma c. systemic lupus d. Kawasaki disease Answer: C page: 810

104.

This drug is used as prophylaxis against Pneumocystis carinii pneumonia in renal transplant patients: a. b. c. d. Azithromycin Trimethoprim-sulfamethoxazole Permethrin Albendazole MPL: 1.00 p: 1155

105.

Hand-foot and mouth disease is caused by: a. b. c. d. Coxsackie A virus Epstein barr virus Cytomegalovirus Parvovirus B19 MPL: 1.0 p: 1044

106.

Iron chelation will be most useful in: a. b. c. d. Idiopathic Thrombocytopenic Purpura beta thalassemia major chronic myelogenous leukemia iron deficiency anemia MPL: 1.0 p: 1632

107.

The principal organ affected after most hydrocarbon ingestion is the: a. b. c. d. liver GIT bone marrow lungs MPL: 1.0 p: 2372-2373

108.

The most common viral agent causing bronchiolitis is: a. b. c. d. respiratory syncitial virus influenzae rhinovirus parainfluenzae MPL: 0.25 p: 1415-1416

109.

The treatment of choice for uncomplicated N. meningitides meningitis is: a. b. c. d. Ceftriaxone Cefotaxime Penicillin ceftazidime MPL: 1.0 p: 2042-2043

110.

The clinical symptoms of Hirschprungs disease usually begins at birth and ushered in by: a. failure to thrive b. delayed passage of meconium c. vomiting d. abdominal distention MPL: 1.0 p: 1239

111.

The most sensitive study in the diagnosis of Meckels diverticulum is: a. b. c. d. plain abdominal radiograph superior mesenteric radiography barium study radionuclide scan MPL: 1.0 p: 1237

112.

A 3300 gram, 39 weeker, male, was delivered via stat cesarean section due to placenta previa. Baby was pink, with good cry and muscle tone but had early onset of tachypnea and grunting. The most likely diagnosis is: a. b. c. d. RDS type I RDS type II meconium aspiration pneumonia bronchopulmonary dysplasia MPL: 1.0 p: 583

113.

The diagnosis of tetanus is established by: a. blood culture b. lumbar tap c. presence of lockjaw followed by progressive stiffness of the voluntary muscles d. complete blood count MPL: 1.0 p: 952

114.

The earliest sign of puberty in girls: a. b. c. d. menstruation breast enlargement broadening of the hips appearance of pimples MPL: 1.0 p: 54

115.

The most common primary cause of nephrotic syndrome in children is: a. b. c. d. membranous GN membrano-proliferative GN minimal change nephrotic syndrome focal segmental GN MPL: 1.00 p:1755

116.

Physiologic bowing of the legs completely resolves by: a. b. c. d. 1 year 2 years 3 years 4 years p: 2265

117.

Hydrocoele is often physiologic up to: a. b. c. d. 3 months 6 months 9 months 12 months p: 1820

118.

A 7-year-old boy has crampy abdominal pain and purpuric rashes on the back of his legs and buttocks as well as on the extensor surfaces of his forearm. Urinalysis reveals proteinuria and microhematuria. Your most probable diagnosis is which of the following: a. b. c. d. poststreptococcal glomerulonephritis Henoch-Schonlein Purpura IgA nephrophathy Hemolytic Uremic Syndrome p: 1744

119.

Which of the following is NOT associated with Acute Renal Failure: a. b. c. d. Hyponatremia hypokalemia hypocalcemia metabolic acidosis p: 1769

120.

A 2-month-old infant was rushed to the emergency room with generalized seizure. The infant was born term, AGA at home attended by a hilot. He was purely breastfed. At the ER, he was pale, drowsy with bulging anterior fontanel. He had clear breath sounds, liver edge was 4 cm below the right subcostal margin and right hemiparesis. Your most probable diagnosis is: a. b. c. d. hemophilia neonatal sepsis bacterial meningitis acquired prothrombin complex deficiency p: 606

121.

Tuberculin reactivity is a Type ____ hypersensitivity: a. b. c. d. Type I IgE mediated Type II cytotoxic Type III immune complex Type IV cell mediated p: 783, 961

122.

An apparently healthy neonate was brought to a well baby clinic. PE showed palpable liver 2 cm below the right subcostal margin. The most probable diagnosis is: a. b. c. d. neonatal hepatitis choleduchal cysts biliary atresia normal p: 526

123.

A 12-month-old male suddenly draws up his leg and scream in pain. This was repeated periodically throughout the night interspersed with periods of quiet sleep. He was seen after 12 hours and looked pale, has just vomited and passed out blood streaked stools. There is a palpable mass around the umbilicus. The most likely diagnosis is: a. b. c. d. Acute appendicitis Acute gastroenteritis Intussusception Mesenteric adenitis p: 279

124.

Which of the following is the first sign of puberty in girls: a. b. c. d. thelarche pubic hair axillary hair enlargement of clitoris p: 59

125.

Which of the following is true of cephalhematoma: a. b. c. d. may not be visible until several hours after birth it is a subcutaneous edema of the scalp usually resolves in 24 hours not associated with complications p: 562

126.

A 35-week AOG newborn was delivered with an Apgar Score of 8 and 9 at 1 and 5 minutes, respectively. Mother had no prenatal check up. Within a few minutes of birth, the baby was noted to develop respiratory distress. Which of the following causes of respiratory distress is least likely in this patient: a. Transient Tachypnea of the Newborn b. Neonatal Pneumonia c. Meconium Aspiration Syndrome d. Hyaline Membrane Disease p: 575-583

127.

A newborn was exposed to the infectious diseases mentioned below. History revealed that the mother had received the recommended immunizations during pregnancy and had these diseases years prior to pregnancy. Which of the following diseases would probably affect this newborn: a. tetanus b. rubeola c. pertussis d. varicella p: 909

128.

Which of the following are not routinely recommended: a. Hep B vaccine b. DPT c. Rabies d. Polio vaccine p: 1177

129.

Which of the following is the most frequent cause of Common Cold: a. S. aureus b. S. pneumoniae c. Pseudomonas sp. d. Rhinovirus p: 1389

130.

A 10-year-old child was admitted because of abdominal pain and nausea. This was followed perioral numbness. At the ER, the patient had respiratory arrest and was thus intubated. History revealed that the patient had eaten shellfish about 2 hours before the onset of symptoms. Which of the following is the most probable toxin involved: a. b. c. d. saxitoxin ciguatoxin scambrotoxin solanine p: 2377

131.

A 15-year-old male sought consult because of fever, malaise and headache. He also complains of pain over the area from the back of his mandible toward the mastoid space. He also describes that his earlobe on the affected side appears to be sticking upward and outward. Drinking sour liquids causes much pain in the affected area. The most probable condition affecting the child is: a. b. c. d. measles mumps varicella rubella p: 1035

132.

An 18-month-old infant presents at the ER because of convulsions. He also has high grade fever. During the lumbar puncture (where CSF exam was normal), he passed large volume of watery stools with blood and mucus. The most likely diagnosis is: a. b. c. d. p: 919 Salmonellosis Shigellosis Rotavirus diarrhea Cholera

133.

In a 6-month-old infant, which of the following would be a contraindication to doing a lumbar tap: a. bulging fontanel b. history of seizure c. significantly elevated WBC d. uncorrected bleeding diathesis p: 1980

134.

The single most sensitive method of diagnosis of Typhoid Fever is which of the following: a. clinical picture b. Typhidot c. Widals test d. Blood or bone marrow culture p: 917

135.

Which of the following conditions is a contraindication to breastfeeding: a. b. c. d. mastitis common cold substance abuse intake of amoxicillin p: 161

136.

A 3 year-old boy has fever and seizure. He was drowsy, with nuchal rigidity and bilateral upgoing of toes. CSf examination shows turbid, cell count of 10,000, 75% polyss, protein 500 mg/dl, sugar 40 mg/dl with 100 mg/dl random blood sugar. Based on the CSF exam, what is the most probable etiologic agent: a. b. c. d. Tuberculous bacterial viral fungal p: 2043

137.

In basic life support, what is the ratio of chest compression to ventilation for children less than 8 years old: a. b. c. d. 2:1 3:1 5:1 10:1 p: 281

138.

A 24 year old susceptible medical student is exposed during wardwork to a patient with chickenpox. He is advised to have varicella vaccine at: a. b. c. d. one injection two monthly injections one injection followed by a booster after 6 months one injection followed by a booster after 1 year

Reference: Nelson textbook of pediatrics, 17th ed. P 1061-1062 139. A 5 year old girl presents with severe protein energy malnutrition. The anthropometric indicator which is an index of acute nutritional status and which is the simplest to measure is: a. b. c. d. height weight mid-arm circumference head circumference

Reference: Nelson textbook of pediatrics, 17th ed. P 170-172

140.

A 4 year old boy looks malnourished. The height for age measurement is 75% therefore the waterlow classification is _______ stunting: a. b. c. d. Normal Mild Moderate Severe

Reference: Nelson textbook of pediatrics, 17th ed. P 59 (Table 15-1) 141. A 2 year old child was rushed to the ER because of seizure. He initially developed fever with associated petechial rashes on both extremities. While at the ER, the resident noted petechial rash and several slate gray satellite shape descent. The most likely diagnosis is: a. b. c. d. bacterial meningitis viral encephalitis intracranial hemorrhage seizure disorder

Reference: Nelson textbook of pediatrics, 17th ed. P 2041 142. While the parents were transporting their four year old child to the Emergency Department for difficulty of breathing, the child stopped breathing. On arrival in the ER the child is pulseless and apneic. The monitor shows a bradyarrhythmia at 20 beats per minute. The initial and immediate treatment consists of: a. b. c. d. ventilation chest compressions vascular access parental medications

Reference: Nelson textbook of pediatrics, 17th ed. P 279, P2 143. A 3 month old presents to the ER with a one day history of poor feeding and rapid breathing. The infants pulse is 260/min. The color is gray and perfusion is poor. ECG is consistent with SVT. Treatment in this child consists of: a. Rapid IV digitalization b. IV verapamil c. oral digitalization d. synchronized cardioversion Reference: Nelson textbook of pediatrics, 17th ed. P 282 144. A 3 year old female has a grade 3/6 systolic ejection murmur at the RUSB with weak pulses at the lower extremities and a lower extremity BP of 90/60 and an upper extremity BP of 110/70. The most likely diagnosis is: a. b. c. d. pulmonary stenosis coarctation of the aorta patent ductus arteriosus Ebstein anomaly

Reference: Nelson textbook of pediatrics, 17th ed. p. 1518

145.

A term infant was noted to have PDA. The pharmacogenic agent that is given to this baby to promote closure of the PDA is: a. b. c. d. prostaglandin E1 ibuprofen indomethocin prednisone

Reference: Nelson textbook of pediatrics, 17th ed. p. 580 146. A 3 day old newborn has blotchy erythematous macules with tiny central vesicles or pustules noted on the trunk and the face. The most likely diagnosis is: a. b. c. d. erythema toxicum sebaceous gland hyperplasia hemangioma epidermal nevus

Reference: Nelson textbook of pediatrics, 17th ed. p. 525 147. A 2 year old male child consulted for speech delay. Mother reports that he can only babble at present and would not respond when called. He flaps his hands when he hears his favorite song but cannot establish eye contact. He perseverates on spinning objects. The most probable consideration for this is: a. b. c. d. developmental language disorder autism hearing impairment cerebral palsy Reference: Nelson textbook of pediatrics, 17th ed. p. 93-94 148. A term female infant at one week old was noted to have weak movements macroglossia, and wide anterior fontanel. This baby most probably has: a. b. c. d. 149. galactosemia G6PD Phenylketonuria Congenital hypothyroidism

Reference: Nelson textbook of pediatrics, 17th ed. p. 1875 A 16 year old male with a height age of 13 years, a bone age of 13 years, a history of the same complaints in an uncle when he was of the same age, no other abnormalities very likely has: a. b. c. d. Constitutional delay Hypopituitarism Turner syndrome in the male Isolated LH-FSH deficiency

Reference: Nelson textbook pediatrics

150.

A six-month-old baby boy was seen at the Outpatient Clinic because of jaundice which was noted since two weeks of age. The jaundice was deepening associated with pruritus and irritability and abdominal distention. Stools were acholic and urine was deep yellow. On PE, the child was wasted and stunted, with generalized jaundice; distended abdomen with(+) fluid wave; liver edge was not palpable, (+) splenomegaly 4 cm below the left costal margin; (+) visible superficial veins on the abdomen; (+) palmar erythema and clubbing. The most likely diagnosis is: billiary atresia viral hepatitis pyloric stenosis choledochal cyst Reference: Nelson Textbook of Pediatrics, 17 ed. Ch. XVII p. 1317, Biliary atresia

a. b. c. d.

151.

Ana, a 15 year old teenager came in due to recurrent heavy menstruation. Her regular menstrual cycle lasts for 10 days with large blood clots. She also frequently develops gum bleeding after brushing. What is the most likely diagnosis? a. b. c. d. hemophilia A protein C deficiency Von Willebrand disease TFPI deficiency

Reference: Nelson Textbook of Pediatrics, 17 ed. P 1662 152. A 6 month old presented with 3 days of high grade fever. He was cheerful and feeding well when afebrile and had no respiratory symptoms. After the 3 day fever, maculopapular rashes appeared on the face progressing downwards.The most likely diagnosis is: a. b. c. d. Measles Roseola infantum Rubella erythema infectiosum

Reference: Nelson textbook of pediatrics, 17th ed. Part XVI, p. 10691070 153. A child suspected to have TB infection will have a. b. c. d. 10 mm induration on Mantoux test (+) Ghons complex on Chest X-ray (+) Blood culture (+) AFB smear

Reference: PPS TB concensus for children

154.

A 4 year old child was complaining of difficulty in walking .On PE there was palpable, tender left inguinal lymphadenitis and pus coming out from the wound located at the dorsum of the left foot. The appropriate antibiotic to give is: a. b. c. d. Penicillin Oxacillin Chloramphenicol Cotrimoxazole

Reference: Nelson textbook of pediatrics, Part. XXXI, p.2300 155. A test to verify to presence of maternal blood in the swallowed blood syndrome: a. b. c. d. Apts test Kelihaeur-Bethk test Mantoux test Coombs test

Reference: Nelson textbook of pediatrics, 17th part XVIII, p. 599-607 156. Jo-anne, an 8 year old female known asthmatic was seen at the ER because of difficulty of breathing which started one hour PTC: Initial treatment consists of: a. b. c. d. inhaled short acting B2 agonist oral steroid inhaled steroid leukotrienes

Reference: GINA Guidelines 157. An 8 year old male presents with tea-colored urine oliguria, periobital edema most prominent in early morning and hypertension. The most likely diagnosis is: a. b. c. d. UTI Nephrotic syndrome acute glomerulonephritis hemorrhagic cystitis

Reference: Nelson Textbook of Pediatrics, 17ed. p.1735-1737 158. Most reliable method of collection of urine for urine culture: a. b. c. d. Catheterization wee bag collection midstream clean catch suprapubic aspiration

Reference: PPS clinical practice guidelines for Urinary Tract Infection

159.

The laboratory test that confirms the presence of UTI: a. b. c. d. Bacteruiria Pyuria >100,000 CFU/ml of urine hematuria

Reference: PPS clinical practice guidelines for urinary tract infection 160. A 10 year old male was admitted for fever and seizures. History revealed he had 3 days fever with productive cough, headache and yellowish nasal discharge. Few hours PTA he developed generalized tonic seizures for 15 minutes followed by loss of consciousness. On admission he was febrile with violaceous, purpuric rashes on the trunk, positive kernigs, hyperactive reflexes and glascow coma scale of 6. The most probable diagnosis is a. Fungal meningitis b. Meningococcemia c. dengue encephalitis d. Tuberculous meningitis Reference: Nelson Textbook of Pediatrics, 17ed. Part XVI, p. 896-897 161. A 7 year old child present with cheilosis, glossitis and atrophic lingual papillae. The most likely diagnosis is a deficiency of: a. thiamine b. riboflacin c. pyridoxine d. niacin Reference: Nelson textbook of pediatrics, 17th ed. p. 182 162. Which of the following is the most important procedure with diagnosis of the infective endocarditis? a. b. c. d. Complete blood count Urinalysis Erythrocyte sedimentation rate Blood culture

(Comprehension) Answer: D The critical information for appropriate treatment of infective endocarditis is obtained from blood cultures. p.1566 Nelson 17th ed. 163. At 5 minutes of life, an infant has the following findings : Pulse rate 135 per minute, good muscle tone, cyanotic hands and feet, strong cry and a grimace after a catheter was inserted thru the nostril. The infants Apgar score is : a. b. c. d. 7 8 9 10

(Comprehension)

Answer: C

Pulse rate 2 Body pink 1 Extremities Cyanotic Muscle tone, good 2 Strong cry 2 Grimace 2 9 p. 628 Nelson 17th ed.

164.

Which one is most often fractured in difficult deliveries? a. b. c. d. Clavicle Radius Humerus Femur (Recall) Answer: A The clavicle is fractured during labor and more frequently than any other bone. p. 572 Nelson

delivery 17th ed 165.

Hemorrhagic disease of the newborn is effectively prevented by which one of the following? a. b. c. d. Platelet transfusion Heparin administration Injection of anti-D globulin (RhoGAM) in the mother Injection of 1 mg vitamin K at birth (Comprehension) Answer: D Intramuscular injection of 1 mg of vitamin K at the time of birth prevents the decrease of vitamin K dependent factors in full-term infants. p. 606 Nelson 17th ed

166.

A 2-year-old child living in Baguio City is bitten by a dog. After cleaning and washing the wound, which of the following should be done next? a. b. c. d. Find the dog and observe it. Begin rabies hyper immune globulin. Vaccinate the child with duck embryo vaccine. Give both immune globulin and vaccine.

(Analysis) Answer: B Local wound care is designed to remove or kill the virus by mechanical and virucidal action. Passive immunization with human rabies immunoglobulin (HRIG) then provides intermediate blockage of attachment of virus to the nerve endings. th p. 1104 Nelson 17 ed.

167.

The most common caused of blood-stained stool in an otherwise normal infant is: a. b. c. d. Anal fissure Ulceritis colitis Intussusception Meckels diverticulum

lesion seen 168.

(Comprehension) Answer: A- Anal fissure is a small laceration of the mucocutaneous junction of the arms. It is an acquired secondary to the forceful passage of a hard start, mainly in infancy. p.1288 Nelson 17th ed The clinical manifestation that differentiates marasmus from kwashiorkor is : a. b. c. d. irriitability loose subcutaneous tissue edema failure to gain weight

(Comprehension) Answer: C Marasmus is a nonedematous protein energy malnutrition while kwashiorkor is edematous protein energy malnutrition. Both present with irritability, failure to gain weight and loose subcutaneous tissue. p. 172 th Nelson 17 ed. 169. The average time at which the anterior fontanel closes is at : a. b. c. d. 6 months of age 12 months of age 18 months of age 24 months of age

(Recall) Answer: C The average time of closure of the anterior fontanel is 18 months. p. 1974 Nelson 17th ed. 170. Which are the first permanent teeth to erupt? a. b. c. d. Central incisors Lateral incisors Canine ( maxillary) First molars

(Recall) Answer: D The first molar erupt between 6 7 years of age. A Central incisor erupt between 7 8 years of age. B Lateral incisor erupt between 8 9 years of age C. Canine (maxillary) erupt between 11 12 years of age. p. 1205 Table 288-1 Nelson 17th ed.

171.

Bronchiolitis in infants is most often caused by which one of the following? a. b. c. d. Respiratory syncytial virus Influenza virus Streptococcus pneumonia Hemophilus influenza B

(Recall) Answer: A Acute Bronchiolitis is predominantly a viral disease. Respiratory syncytial virus (RSV) is responsible for more than 50% of cases. p. 1415 Nelson 17th ed 172. Which of the following is the most likely diagnosis in an otherwise normal adolescent with the sudden onset of respiratory distress, cyanosis, retraction and markedly decreased breath sounds over his left lung? a. b. c. d. Empyema Chylothorax Pneumothorax Staphylococcal pneumonia

cyanosis. and lung.

(Analysis) Answer: C The onset of pneumothorax is usually abrupt, and the severity of symptoms depend on the extent of the lung collapse and in the amount of pre-existing lung disease. Pneumothorax may cause pain, dyspepsia and Usually, there is respiratory distress, retractions, markedly decreased breath sounds on the involve p.1464 Nelson 17th ed Empyema and chylothrax are not sudden in onset, and staphylococcal pneumonia is not likely in adolescents.

173.

A 3 year old presents with strider and a barking cough. There is mild respiratory distress, tachypnea, respiratory strider, and a temperature of 39 C. The most likely diagnosis is: a. laryngotracheobronchitis b. epiglottitis c. bacterial tracheitis d. retropharyngeal abscess

(Analysis) Answer: A Most patients have an upper respiratory tract infection with some combination of rhinorhea, pharyngitis, mild cough, and low-grade fever ( 39 40 C) for 1 to 3 days before the signs and symptoms of upper airway obstruction become apparent. The child then develops the characteristic barking cough , hoarseness, and inspiratory stridor. p.1405 Nelson 17th ed 174. A child has low grade fever, abdominal pain, arthritis, microscopic hematuria and rash only in the lower extremity. The most likely has: a. Meningococcemia b. Postotreptococcal glumerulonephritis

c. Henoch-Schonlein purpura (HSP) d. Wegners granulomatosis ( Analysis) Answer: C HSP, also known as Anaphylactoid purpura, is a varculitis of the small vwssels. Low-grade fever and fatigue occur in more than half of the affected children. The hallmark of the disease is the rash, beginning as pinkish maculopapules that initially blanch or pressure and progress to petechiae or purpura. Renal involvement is manifested by red blood cells, white blood cells, casts or albumin in the urine pp. 826 827 Nelson 17th ed. 175. A 7 year old had a sore throat 10 days ago. Today she manifest periorbital edema and tea-colored urine. Her blood pressure is 155/95. the serum complement level is low. The most likely diagnosis is: a. b. c. d. lupus nephritis nephritic syndrome Postreptococcal glomerulonephritis Berger disease

(Analysis) Answer: C Postreptococcal glomerulonephritis is the most common cause of hypocomplementeremic nephritis. Depending on the severity of renal involvement, patients may develop various degrees of edema, hypertension and oliguria. p. 1740 Nelson 17th ed. 176. The triad of microangiopathic hemolytic anemia, renal failure and thrombocytopenia is characteristic of which of the following? a. b. c. d. Membranous lupus nephritis. Focal glomerulonephritis secondary to septicemia hemolytic uremic syndrome Acute poststeptococcal glomenulonghitis

(Comprehension) Answer: C the hemolytic uremic syndrome (HUS) is the most common cause of acute renal failure in young children and is characterized by microangiopathic hemolytic anemia, thrombocytopenia and uremia. p. 1746 Nelson 17th ed. 177. Which of the following is NOT true of nephrotic syndrome? a. b. c. d. elevated serum cholesterol 85% experience minimal change in disease reduced sodium reabsorption by the kidney elevated triglycerides

(Comprehension) Answer: C Because of renal protein loss and hypoalbuminemia, there is reduced intravascular volume. This stimulates the rennin angiotensisn system, resulting in enhanced renal sodium reabsorption. Eventually,

the sodium of nephritic the most sensitive

partially contributes to the edema. The incidence syndrome is 2 3 / 100, 000 children per year, and majority affected children will have a steroid minimal change diseases.. In the nephritic state, serum lipid levels ( Cholesterol, triglycerides) are elevated. p. 1753 1755 Nelson 17th ed.

178.

The most common abdominal mass in a neonate is: a. b. c. d. Renal dysplasia hydroneprhosis Wilms tumor neuroblastoma Meckless diverticulum

multi

(Recall) Answer: A Renal masses are the most common lesions in neonates with an abdominal mass. Hydronephrosis and cystic dysplastic lesions are the most common renal masses. p. 1784 Nelson 17th ed. Partial complex seizures is typically characterized as : a. Simple staring that last for 30 mins. or more b. Absence of impaired consciousness c. Automatism like chewing, facial grimace or repetition speech d. Seizures describe as generalized clinic movements.

179.

(Comprehension) Answer: C Automatisms are common feature of complex partial seizures in infants and children characterized by alimentary automatisms including lip smacking, chewing, swallowing and excessive salivation. CPS may begin with a simple partial seizure with or without an aura, followed by impaired conciousness. The seizure are tonic-clonic and the average duration is 1 2 min. pp. 1995 1996 Nelson 17th ed. 180. A 5- year-old female has multiple bruises on her lower extremities and oral mucosal bleeding of 3 days duration. Two weeks before these signs, she had a mild respiratory tract infection. Physical examination reveals multiple ecchymoses and petichaie: no lymphadenopathy or hepatosplenomegaly is noted. The next diagnostic step is: a. b. c. d. a complete blood count a prothrombin time a bleeding time a partial thromboplastin time

count of

(Analysis) Answer: A A complete blood count (CBC) reveals a hemoglobin value of 12 g/dl, a white blood cell (WBC) 11,000 and a platelet count of 5,000 p. 1654 Nelson 17th ed.

181.

Which is not a frequent presenting symptoms or sign of childhood leukemia? a. b. c. d. pallor petechiae lymphadenopathy abdominal pain

(Comprehension) Answer: D Most children with leukemia present with less than 4 weeks of symptoms. Most children with ALL have pallor, 50% have petechiae, 60% have lymphadenopahty, 25% have fever, and about 25% have bone pain and arthralgias caused by leukemia infiltration of the perichondral bone or joint or by leukemic expansion of the marrow cavity. pp. 1694 1698 Nelson 17th ed.