UNIVERSITY OF PERPETUAL HELP RIZAL JONELT JONELTA FOUNDATION FOUNDATION SCHOOL OF MEDICINE TEST BLUE PRINT 2005 DEPARTMENT OF PEDIATRICS I. TEST BLUE PRINT Object!e" T)e N%(&#$ Ne/b%(* 1. To descri describe be the phys physiol iologi ogic c changes occurring at birth as the newly born infant adjust for extra-uterine existence. 2. Descri Describe be a nor normal mal newb newbor orn, n, physically and give its normal physiologic status. . Discus Discuss s the para paramet meters ers involved in the !"#!$ score and develop the s%ills in scoring. H) R"1 F#ct%(" #* Ne%*#t#$ M%(bt+3Ne%*#t#$ Re"-"ct#t%* 1. To To identify high ris% newborns newborns based on maternal maternal conditions, fetal conditions, conditions of labor and delivery and immediate neonatal period. He&#t%$%c D"%(e(" #* H+'e(b$(-b*e&# * t)e Ne/b%(* 1. To dene the etiology of neonatal jaundice and cholestasis. 2. To dierentiate dierentiate physiologic from pathologic jaundice as well as jaundice associated with breastfeeding. 4#"t(%*te"t*#$ D"%(e(" % t)e Ne/b%(* 1. To enumerate the dierent dierent disorders disorders of the digestive system, their clinical presentation, diagnostic procedures, management and prevention. 4(%/t) #* De!e$%'&e*t 1. /tate the the pattern pattern of physical physical growth, developmental maturation by milestones, emotional needs and ac0uisition of competence during the 1 st, 2nd years of age and pre-school age. A%$e"ce*ce 1. To describe the growth growth and development of the adolescents in the biological, social and psychological psychological aspects. 4#"t(%*te"t*#$ D"%(e(" 1. To discuss the mechanism of occurrence of abdominal pain. 2. To enumerate the causes of recurrent abdominal pain.
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N-t(t%* Re6-(e&e*t" #* M#$*-t(t%* 1. numerate the $ecommended $ecommended daily allowances of the major nutrients, carbohydrates, carbohydrates, proteins, fats, vitamins, minerals and trace elements. 2. Dene Dene the importanc importance e of infant nutrition for optimum growth and development. C)$)%% I*j-(e" #* C)$ P(%tect%* 1. To discuss the dierent forms of childhood injuries Pe#t(c E*%c(*%$%+ 1. To To enumerate the dierent dierent ndocrine Disorders as to clinical manifestations, manifestations, laboratory diagnosis, treatment and complications. I*b%(* E((%(" % Met#b%$"& 1. To discuss the common inborn errors of metabolism for prompt diagnosis and management. De!e$%'&e*t#$ #* Be)#!%(#$ D"%(e(" 1. To Discuss the the common developmental and behavioral problems in children, their causes, clinical presentation, diagnosis, management and treatment 2. To discuss the most common health haard in children their clinical manifestation, manifestation, diagnosis and treatment 4e*etc" 1. To discuss the clinical condition of common genetic condition Pe#t(c I*ect%-" D"e#"e 1. To describe the epidemiology, epidemiology, pathophysiology, clinical manifestations, manifestations, disease presentations presentations and complications of certain bacterial, viral and fungal infections. C#(%!#"c-$#( "%(e(" 1. To To describe the general general aspects of cardiovascular disease in children A$$e(%$%+ #* I&&-*%$%+ 1. To To identify the dierent dierent manifestations manifestations of allergic allergic reactions, their management and prevention. Re"'(#t%(+ D"%(e(" 1. To To enumerate the dierent dierent respiratory diseases as to pathophysiology, clinical manifestation, manifestation, diagnostic approach, treatment and complications He&#t%$%+ #* O*c%$%+
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1. To describe the hematopoetic responses of children to dierent systemic diseases.
2. #ive the neoplasms commonly found at dierent age groups. Pe#t(c Ne-(%$%+ 1. To discuss diagnosis, treatment and preventive measures of neurologic diseases including se0uelae from other system illnesses and to develop the s%ill in performing neurologic examinations at dierent age level. Pe#t(c Ne')(%$%+ 1. To identify patients suering from renal disorders. 2. To identify the common renal problems in children3 a4 5T6 b4 !cute glomerulonephritis c4 7ephrotic syndrome D"e#"e" % B%*e" #* J%*t" 1. To identify clinically common presenting problems of bones and joints diseases in children C%**ect!e T""-e D"e#"e" 1. To dene and explain the mechanism of autoimmune disease in general and to %now and recognie clinically the common collagen vascular and other multisystem disorders in children Pe#t(c P)#(&#c%$%+ 1. To explain therapeutic use of drugs in pregnant women aecting the fetus and in lactating mother 2. To describe the uni0ue pharmaco%inetic and pharmacodynamic principles of drug therapy in children particularly the neonates and infants F$-" #* E$ect(%$+te" 1. To explain the basic physiology of 8uids and lectrolytes and discuss the factors that in8uence the re0uirements.
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III. E?#& ,-e"t%*" S-bject Pe#t(c" I*"t(-ct%*" C)%%"e t)e BEST #*"/e( 1. The parameters used to estimate the gestational age based on physical maturity are description of the following ECEPT3 !. lanugo <. plantar surface =. genitalia D. pupillary dilatation !ns3 D $ef3 7elson>s Textboo% of "ediatrics !63 1 Recall 2. !n infant weighing 1& gm is born at 2 wee%s gestation in a delivery room that has an ambient temperature of 2& degrees centigrade. ?ithin a few minutes of birth, this infant is li%ely to exhibit all the following ECEPT3 !. "allor <. /hivering =. a fall in body temperature D. metabolic acidosis !ns3 < $ef3 7elson>s Textboo% of "ediatrics !63 .' Comprehension . The immediate postnatal changes in a term newborn includes the following ECEPT !. decrease in pulmonary vascular resistance <. decrease in right to left shunting via ductus arteriosus =. increase in venous return to the left atrium D. increase right to left shunting via foramen ovale !ns3 D $ef3 7elson>s Textboo% of "ediatrics !63 .' Comprehension &. !n infant has the following ndings at ' minutes of life@ pulse 1 per minute, cyanotic hands and feet, good muscle tone, and a strong cry. This infant>s !pgar score is !. ) <. * =. + D. 1
4
!ns3 = $ef3 7elson>s Textboo% of "ediatrics !63 .' Analysis '. ! newborn infant was noted to have the following physical features at birth3 ?eight . %g, absent lanugo, white parchment-li%e des0uamating s%in and long nails. The infant>s gestational age is most li%ely 3 !. A&2 w%s <. ) B + w%s =. C) w%s D. &-&2 w%s !ns3 ! $ef3 7elson>s Textboo% of "ediatrics !63 .' Analysis (. ?hich of the following patterns noted on continuous monitoring of fetal heart rate is most indicative of fetal distress !.
s Textboo% of "ediatrics !63 .' Recall ). Faternal condition that would post for high ris% pregnancy !. "regnancy interval of 2- years <. Faternal age 2-2' year old =. "rimigravid status D. 6nade0uate pre-natal care !ns3 D $ef3 7elson>s Textboo% of "ediatrics !63 .' Comprehension *. !nticipated neonatal morbidities associated with maternal ris% factors include !. 7eonatal macrosomia with Faternal Diabetes <. 7eonatal euthyroid state with Faternal #raves disease =. 7eonatal thrombocytosis with Faternal thrombocytopenia D. 7eonatal polycythemia with Faternal placenta previa !ns3 ! $ef3 7elson>s Textboo% of "ediatrics !63 .' Comprehension +. ! mother delivers a neonate with meconium staining and low !pgar scores of at 1 and ' mins. :f life. The goals of resuscitation are the following ECEPT !. Finimie heat loss <. stablish normal respiration and lung expansion =. /upport cardiac output D. !nticipate neonatal demise !ns3 D $ef3 7elson>s Textboo% of "ediatrics !63 .' Analysis
5
1. ! newborn was noted to have recurrent episode of aspiration with excessive salivation, most li%ely the mother had !. "olyhydramnios <. :ligohydramnios =. 7ormohydramnios D. !nhydramnios !ns3 ! $ef3 7elson>s Textboo% of "ediatrics !63 . Analysis 11. ?hich of the following blood factors are decreased in the newborn !. G66, 6H, and H <. 66, G, G66, and 6H =. G, G66, 6H, and H D. G66, G66, 6H, and H6 !ns3 < $ef3 7elson Textboo% of "ediatrics 1(th d, p'2( !63 1 Recall 12. ?hich situation is Iaundice most li%ely physiologic in a term infant !. Iaundice at 12 hours of age <. /erum bilirubin increasing by ' mgJdlJ2& hours or less in the rst 2 to & days =. Direct Kconjugated4 serum bilirubin greater than 1 mgJdl D. Iaundice at 12 days of age !ns3 < $ef3 7elson Textboo% of "ediatrics 1( th d, p'1'-'1( !63 .' Comprehension 1. The most appropriate treatment for hyperbilirubinemia K11.2 mgJdl4 in a -wee%-old breast-fed infant with normal growth and development !. "hototherapy <. xchange transfusion =. "henobarbital D. 7one of the above !ns3 D $ef3 7elson Textboo% of "ediatrics 1( th d, p'1) !63 1 Comprehension 1&. ! primiparous woman whose blood type is :-positive gives birth at term to an infant who has an !-positive blood and a hematocrit of ''L. ! serum bilirubin level obtained at ( hours of age is 12 mgJ1 ml. ?hich of the following laboratory ndings would be most characteristic of this infant>s disease !. !n elevated reticulocyte count <. ! wea%ly positive direct =oombs test =. 7ucleated red blood cells in the blood smear D. Mematocrit less than ''L !ns3 D $ef3 7elson Textboo% of "ediatrics 1( th d, p'2' !63 .' Analysis
6
1'. ! full term infant was born by normal spontaneous delivery. 7ursery stay was unremar%able and baby was breastfed. :n the 2 nd wee% of life, baby was noted to be jaundiced. This baby is most li%ely having3 !. "hysiologic jaundice <. "athologic jaundice =.
about necrotiing enterocolitis3 6t is primarily a disease of infants (-12 months old.
!ns3 D $ef3 7elson Textboo% of "ediatrics 1( th d, p'12-'1 !63 .' Comprehension 1+. ! two-wee%-old premature infant is found to have several milliliters of formula still present is the stomach two hours after being fed. !lso noted are gastric distention and the passage of blood-strea%ed stools. ?hich historical factor would best support a tentative diagnosis of necrotiing enterocolitis !. "assage of a thic% tenacious meconium plug at 2& hours of age <. /evere hyaline membrane disease with anoxic episodes in the rst wee% of life =. ! maternal history of severe ulcerative colitis D. ! history of mil%-protein allergy in family members !ns3 < $ef3 7elson Textboo% of "ediatrics 1( th d, pp'12-'1 !63 .' Analysis
2. ! woman was noted to have a large volume of amniotic 8uid at the time of her delivery of her child. !t ( hours of age, her baby begins regurgitating small amounts of mucus
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and bile-stained 8uid. ".. is normal. !bdominal x-ray obtained showed a OdoublebubbleP sign. The most li%ely diagnosis of this infant>s disorder3 !. sophageal atresia <. "yloric stenosis =. Fidgut volvulus D. Duodenal atresia !ns3 D $ef3 7elson Textboo% of "ediatrics 1( th d, p11-11& !63 .' Analysis 21. ! 1 month old infant forces at near object attains its visual activity of 2J2 at age !. 2 <. =. & D. ' !ns3 = $ef3 7elson>s "ediatric Textboo% 1)th d. " && !63 1 Recall 22. ! ( month old child who weighed . %g at birth would have a weight of !. ' %g <. ) %g =. + %g D. 11 %g Formula used: !ge in months Q + -----------------------2 (Q+ 1' -------- 9 ---------- 9 9.5 1 2 2
!ns3 < $ef3 7elson>s "ediatric Textboo% 1)th d. " 1 !63 1 Comprehension 2. !t age 1' months, which motor activity can be performed normally !. ?al%s upstairs with alternating steps <. =limbs the stairs one step at a time =. ?al%s alone by herself D. $uns and seldom falls !ns3 = $ef3 7elson>s "ediatric Textboo% 1)th d. " + !63 .' Analysis 2&. !t 12 months, a child can already !. /ay bye-bye <. /ay his full name =. =omprehend words as OhelloP D. 5tter 2 words li%e the ODadaP and OFamaP !ns3 D $ef3 7elson>s "ediatric Textboo% 1)th d. " & !63 .' Analysis 2'. The rst visible sign of puberty in boys. !. growth of pubic hair <. enlargement of the penis =. testicular enlargement
8
D. axillary perspiration !ns3 = $ef3 7elson textboo% 1'th ed., Topic@ !dolescence pp '+-( !63 1 Recall 2(. The sexual maturity of a girl whose breast buds appeared when she was 1 years old and had menarche at 1( years old. !. normal <. precocious =. delayed D. undetermined !ns3 = 6f a girl has no breast buds by the age of 1 years, or if more than ' years separate the onset of pubertal change from menarche, her puberty is delayed. $ef3 7elson Textboo%. Topic !dolescence pp '*-( !63 1 Comprehension 2). The most common stimulus in the gut provo%ing abdominal pain3 !. edema <. ischemia =. tension or stretching D. accumulation of tissue metabolites !ns = $ef3 7elson Textboo% 1'th ed. Topic !bdominal pain p.1' !63 .' Recall 2*. ! ( month-old male infant previously well, suddenly developed paroxysmal colic%y abdominal pain at fre0uent intervals accompanied by straining eorts is most li%ely having this condition. !. !cute !ppendicitis <. !bdominal pilepsy =. 5rinary Tract 6nfection D. 6ntussusception !ns3
D "aroxysmal colic%y abdominal pain at fre0uent intervals in a previously well infant is characteristic of 6ntussusception. $ef3 7elson Textboo%.Topic3 6ntussuseption.pp1)2-1)& !63 .' Comprehension 2+. The most li%ely diagnosis of a + year old male with severe epigastric pain and muscle rigidity on the epigastrium, unrelieved by ordinary antispasmodic. !. 5rolithiasis <. !bdominal pilepsy =. !cute "ancreatitis D. !cute Mepatitis !ns = The pain in 5rolithiasis may also be severe but is usually located at the lumbar and lower bac% areas. The pain in abdominal epilepsy is usually in the periumbilical area. !bdominal pain in !cute Mepatitis is usually not severe. !cute "ancreatitis is characteried by severe epigastric pain and muscle rigidity. $ef3 7elson Textboo% 1'th ed. Topic3 "ancreatitis, acute pp 1122-112& !63 . Comprehension . The recommended daily allowance of "rotein during the 1 st ( months of life is about3 !. 1. gJ%gJ2& hr <. 2. gJ%gJ2& hr =. . gJ%gJ2& hr D. &. gJ%gJ2& hr
9
!ns3
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< The current $D! for protein during the rst ( months of life in a healthy term infant is 2.-2.2 gJ%gJ2& hour. 7elsons Textboo% of "ediatrics 1) th d. pp1'' chap& 1
1.
< !lthough human mil% contains less iron than most formulas iron is absorbed 2-x more eRciently from human mil% than from cow>s mil%. 6ron deciency secondary to inade0uate dietary inta%e is not common before ( months of life. $ef3 7elsons Textboo% of "ediatrics 1) th d. pp1(1& !63 .' Analysis . !n otherwise healthy ( month old infant was brought to your clinic because of restlessness, crying and failure to gain weight. ?hat is the possible cause of the child>s problem3 !. This infant is suering from septicemia <. Eate introduction of complementary feeding =. "ossibility of an abnormal mother-infant bonding D. !ll of the above !ns
D 5nderfeeding is suggested by restlessness, crying, slow weight gain or actual weight l oss. !ll of the above can cause infant>s failure to ta%e suRcient 0uantity of food. $ef3 7elsons Textboo% of "ediatrics 1) th d. pp1(& chap&1 !63 . Analysis
&. The most common cause of death from physical abuse is3 !. 6ntra-abdominal injuries <.
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= Fore than +'L of serious intracranial injuries during the 1 st year of life are the result of 6MT. 6ntra-abdominal injuries from impacts are the second most common cause of death in battered children. $ef3 7elson>s Textboo% of "ediatrics 1) th d. "12, chap' !63 1 Recall '. s Textboo% of "ediatrics 1) th d. "12, chap' !63 1 Comprehension (. ! 2 year old male child was seen at the $ due to 2 nd degree burns of both hands. ?hat would you do !. !dmit the patient since you cannot clearly tell if the burns are intentional or not <. Treat the burns and send home the patient =. $efer to the surgeon on duty for management of the burns D. !s% for the immuniation status of the patient !ns3
! 6n cases where the diagnosis is unclear, always admit the patient. The parents should be told why an in8icted injury is suspected. $ef3 7elson>s Textboo% of "ediatrics 1) th d. "12' chap' !63 .' Analysis ). The use of helmets, seat belts, %nee and elbow pads are interventions that3 !. prevent the occurrence of the injury-producing agent <. will attempt to reduce the li%elihood of injury by modifying the transfer of energy to the victim =. will limit the impact of injuries on the victims D. all of the above !ns3 < The use of seat belts and other safety devices will modify the rate of release of the haard from its source. $ef3 Textboo% of "ediatrics and =hildhealth, by Del Fundo & th ed p1&*-1&+ !63 .' Analysis *. ! reliable index of long-term glycemic control is provided by measurement of 3 !. Ss Textboo% of "ediatrics 1)th d. p. 1+(2 !63 1 Recall +. The rst and rate B limiting step in steroid synthesis is the conversion of cholesterol to3 !ldosterone !. =ortisol <. "regnenolone =. sex steroids !ns3 = $ef3 7elson>s Textboo% of "ediatrics 1) th d. p. 1*++
11
!63 .' Comprehension &. !t what age is onset of puberty considered precocious in girls !. C ) years of age <. C * years of age =. C + years of age D. C 1 years of age !ns3 < $ef3 7elson>s Textboo% of "ediatrics 1) th d. p. 1*( !63 .' Comprehension &1. ! newborn with congenital Mypothyroidism is diagnosed and treated ade0uately by two wee%s of age. 6t can be anticipated that with continued treatment he will have3 !. /hort stature but normal intelligence <. /hort stature and slight mental retardation =. 7ormal growth and development D. 7ormal stature but a mild degree of mental retardation !ns3 = $ef3 7elson>s Textboo% of "ediatrics 1) th d. p. 1*)) !63 .' Analysis &2. ! 1 year and ( months old child has congenital adrenal hyperplasia. Me carries a boy>s name, and had been raised as a boy. ". shows a moderately enlarged phallus but empty scrotal sacs. =hromosome analysis shows an HH pattern. 6f you were the doctor, you would3 !. continue to raise him as a boy <. as% parents how they feel and follow their wishes =. advise the parents that it would be best to raise the child as a girl after surgical correction of the external genitalia D. wait until the child is old enough to decide which sex to assume !ns3 = $ef3 7elson>s Textboo% of "ediatrics 1) th d. !63 .' Analysis
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&. The most severe form of mucopolysaccharidoses due to the deciency of alpha-Eiduronidase is3 !. Murler>s syndrome <. Munter>s syndrome =. For0uio>s syndrome D. /anllippo syndrome !ns3 ! $ef3 7elson>s Textboo% of "ediatrics 1) th d. p&*& !63 .' Recall &&. 6nborn error of amino acid metabolism associated with mousy or musty odor of the urine is3 !. Tyrosinemia <. Maw%insinuria =. "henyl%etonuria D. :ast house urine disease !ns3 = $ef3 7elson>s Textboo% of "ediatrics 1) th d. p+) !63 .' Comprehension &'. ! 2 wee% old baby boy, delivered 7/D, T$F, !#!, was admitted due to poor suc% and vomiting, upon admission patient was stuporous, dehydrated with sweet smelling urine. The most li%ely diagnosis3 !. "enyl%etenuria <. :ast house urine disease
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=. Faple syrup urine disease D. Hanthunuria !ns3 = $ef3 7elson>s Textboo% of "ediatrics 1) th d. p&+ !63 .' Analysis &(. Eipid /torage disease associated with the deciency of the lysosomal enyme s Textboo% of "ediatrics 1) th d. p&(& !63 .' Comprehension &). Iesus, a ) year old 2nd grader was brought by her mother to their physician because he was always in trouble at school and impossible at home. Me cannot sit still at the dinner table or anywhere else, except perhaps in front of the television. "hysical examination revealed nothing more than a slight diRculty in performing s%illful motor acts and some clumsiness. The most li%ely diagnosis is3 !. Temporal lobe epilepsy <. =onduct disorder =. !ttention decit hyperactivity disease D. !ttention decit hyperactivity disorder !ns3 D $ef3 7elsons Textboo% of "ediatrics, 1( th d, pp 1-11 !63 .' Comprehension &*. !n 1* year old farm wor%er was brought to the $ with symptoms of abdominal cramps, excessive salivation, vomiting diarrhea and muscle fasciculation. Mistory revealed that he has been applying pesticides on a large area of the banana plantation where he wor%ed. The most common cause of his problem3 !. Dioxin poisoning <. :rganophosphate poisoning =. Mydrocarbon poisoning D. Meavy metal poisoning !ns3 < $ef3 7elsons Textboo% of "ediatrics, 1( th d, p 21' !63 .' Analysis &+. ! 2 year old #1" woman gave birth to a baby boy with Down /yndrome. Mer rst pregnancy resulted in abortion. /uch chromosomal abnormality is usually due to3 !. Translocation <. 7ondisjunction =. Fosaicism D. "oint mutation !ns3 ! $ef3 7elsons Textboo% of "ediatrics, 1( th d, p 2) !63 1 Recall
'. ! 12 year old female was brought in for consultation because of poor performance in school especially in mathematics. :n physical examination she was found to have short stature, low posterior hairline, webbed nec%, widely spaced nipples and sexual infantilism. The most li%ely diagnosis3 !. Nlinefelter /yndrome <. Turner /yndrome
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=. dward /yndrome D. !drenogenital /yndrome !ns3 < $ef3 7elsons Textboo% of "ediatrics, 1( th d, p !63 1 Analysis '1. ?hich of the following organisms is the major cause of severe systemic and focal infections in newborns !. /taphylococcus aureus <. /treptococcus viridans =. #roup < streptococcus D. "seudomonas species !ns3 = $ef3 7elson>s Textboo% of "ediatrics 1(th d, p. *1 !63 1 Recall '2. ! four year old boy was brought to your clinic because he was exposed to his grandmother who was coughing out blood for two months already. Me has good weight gain and appetite, and has no chronic cough nor fever. ou administer a Fantoux tuberculin test and the reading after )2 hours is 1'mm. ?hat category does this child belong to !. T< xposure <. T< 6nfection =. T< Disease D. T< 6nactive !ns3 < $ef3 Tuberculosis in 6nfancy U =hildhood by ""/, p. 2-2 !63 .' Comprehension '. ! ' year old girl developed fever, corya and conjunctivitis. !fter ' days, still with fever, she was noted to have maculo-papular rashes and cervical lymphadenopathy. ?hat is your diagnosis !. $ubella <. $oseola =. Sifth>s Disease D. $ubeola !ns3 D $ef3 7elson>s 1(th ed, p. +&(-&* !63 .' Analysis '&. ! mother with a %nown herpes simplex type 2 infection gave birth vaginally to a full term healthy loo%ing baby boy with the assistance of a hilot. ?hat is the next immediate step to do after resuscitation !. #ive herpes simplex vaccine intramuscularly within rst 12 hours of life <. /end baby to the hospital for admission and intravenous acyclovir treatment =. !dvise mother to closely observe baby for appearance of oral lesions D. /tart rst dose of oral acyclovir and refer to a pediatrician for further management !ns3 < $ef3 7elson>s 1(th d, p. +(+-)1 !63 .' Analysis
''. "eople of all ages can develop acute rheumatic fever, but it usually occurs in children !. B 1 year old <. 2 B & years old =. ' B 1' years old D. 1( B 1+ years old
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!ns3 = $ef3 7elsons Textboo% of "ediatrics 1) th d. p *)' !63 1 Recall '(. The diagnosis of acute rheumatic fever is mainly determined by !. blood culture <. clinical signs =. electrocardiogram D. acute phase reactants !ns3 < $ef3 7elsons Textboo% of "ediatrics 1) th d. p *)( !63 .' Comprehension '). 7:T T$5 regarding mitral stenosis3 !. 6t is usually rheumatic in origin seen in older children and adolescents <. 6t may cause concentric hypertrophy of the EG =. The heart murmur is diastolic in timing D. 6t can be managed with balloon valvuloplasty !ns3 < $ef3 7elsons Textboo% of "ediatrics 1)th d. p 1')-1')1 !63 .' Comprehension '*. ! ) year old girl presents with a tender and swollen right %nee as well as a more recently appearing swollen left an%le. /he also has fever. ?hich of the following modied Iones criteria does the patient fulll !. 1 Fajor 1 minor <. <.1 Fajor 2 minors =. =.2 Fajors D. D. 2 Finors !ns3 ! $ef3 7elsons Textboo% of "ediatrics 1)th d. p *)'-*)( !63 .' Analysis '+. The patient is 1 year old who had fre0uent tonsillitis and he had complained of migratory joint swelling, intermittent high grade fever, palpitations and easy fatigue. " includes <" 1*J2 =$ 11Jmin. Meart dynamic precordium, !< at ( th E6=/, !!E, /1 normal, /2 split "2 accentuated, #rade J( diastolic blowing murmur E5/< radiating to apex, "eripheral pulses bounding. The diagnosis is that he has $MD. ?hat is the most li%ely cardiac pathology !. mitral insuRciency <. mitral stenosis =. aortic insuRciency D. aortic stenosis !ns3 = $ef3 7elsons Textboo% of "ediatrics 1) th d. p 1')1 !63 .' Analysis
(. ?hat is the most common cause of asthma attac%s in the infancy period !. Giral infection <. /tressful activity =. xposure to allergen D. Sood hypersensitivity
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!ns3 ! $ef3 7elson>s 1(th d, p. ((&-(( !63 1 Recall (1. During the rst year of life, the most common scenario in a child with adverse reaction to foods is3 !. $ashes after inta%e of soy-based foods <. Drowsiness after inta%e of cured meat =. "ruritic erythematous patches after inta%e of cheese D. ?atery, blood-strea%ed stools after cow>s mil% inta%e !ns3 D $ef3 7elson>s 1(th d, p. (+'-+) !63 .' Comprehension (2. ! preschooler was brought to the $ for diRculty of breathing. /he was noted to be breathless while tal%ing in phrases and prefers to sit when examined. :n ", her $$ is A&Jminute, wheeing was heard throughout expiration, was tachycardic and "S$ was ''L. ?hat is the classication of severity of this child>s acute asthma attac% !. Fild intermittent <. Fild persistent =. Foderate persistent D. /evere persistent !ns3 = $ef3 7elson>s 1(th ed, p. (() !63 .' Analysis (. ! )-year-old boy was brought to the $ due to tightness in the chest. arlier, he mentioned that he was stung by a bee. !round minutes after the sting, he felt warm and had diRculty swallowing his saliva. Me started feel diy and was noted to have diRculty of breathing. :n " he was noted to have a <" of ' palpatory, M$ of 'Jmin regular in rhythm, $$ of 'Jmin, with wheeing all over his lung elds. ?hat is the immediate treatment of choice for this patient !. :ral corticosteroid <. 6nhaled beta-2 agonist =. 6ntramuscular epinephrine D. :ral antihistamine !ns3 = $ef3 7elson>s 1(th d, p. (*(-*) !63 .' Analysis (&. s Textboo% of "ediatrics !63 1 Recall
('. ! 2 year old boy has recurrent breathing pauses and snoring during sleep, consulted at the $ due to diRculty of breathing. :n " his tonsils are swollen and enlarged. our most commonly diagnosis is !. !cute epiglottitis <. !cute tracheitis =. :bstructive sleep apnea D. Diptheria
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!ns3 = $ef3 7elson>s Textboo% of "ediatrics !63 .' Comprehension ((. ! ( month old male infant has mild upper respiratory tract infection and low grade fever gradually develops into respiratory distress characteried by wheeing and dyspnea. The most li%ely diagnosis is !. s Textboo% of "ediatrics !63 .' Comprehension (). 7:T included in the management of !cute Earyngotracheobronchitis3 !. #ive :2 and supportive care <. /tart racemic epinephrine by aerosol =. !dd inhaled steroids D. !dmit and start cephalosporins !ns3 D $ef3 7elson>s Textboo% of "ediatrics !63 .' Analysis (*. ! 2 year old with class 666 childhood T< would have the following characteristics ECEPT3 !. KQ4 history of exposure to an adult with active T< <. KQ4 mantoux tuberculin test =. abnormal chest radiographs suggestive of "T< D. /tarted on 67M, $ifampicin, "V! and thembutol !ns3 D $ef3 7elson>s Textboo% of "ediatrics !63 .' Analysis (+. ?hat is the main stimulus for red blood cell production !. !noxia <. 6nfection =. Memorrhage D. 6mmunodeciency !ns3 ! $ef3 Del Fundo p.12*,4 !63 1 Recall ). ! & year old child with brain tumor underwent radiotherapy and chemotherapy. !fter 2 years, the child was noted to be stunted Kheight at p'4. ?hat is the li%ely reason for such a nding !. Decrease in brain sie due to radiotherapy lessened capacity of growth hormones to induce growth <. Damage to hypothalamic axis has decreased amount of growth hormones causing stunting =. =hemotherapy caused hypoperfusion and ischemia of the brain D. $adiation induced hypoplasia of the s%ull which limited brain development !ns3 < $ef3 Del Fundo, p. 1'-'& !6 3 .' Comprehension )1. Eaboratory test to conrm the diagnosis of neuroblastoma3 !. 5rine vanillylmandelic acid KGF!4 <. 5rine catecholamins =. /erum alpha-fetoproteins K!S"4 D. /erum beta- human chorionic gonadotrophin K<-M=#4 !ns3
!
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$ef3 Del Fundo, p. 1( !63 .' Comprehension )2. ! 2 year old child was brought to the emergency room for on and o fever and easy bruisability for & wee%s already. :n ", you noted palmar pallor, generalied lympadenopathy and hepatomegaly. ?hat is the most li%ely cause for his signs U symptoms !. =onnective tissue disease <. =hronic infection =. s disease =. 6mpacted feces D. ?ilms> tumor !ns3 D $ef 3 Del Fundo, p.1'' !6 3 .' Analysis )&. The most common cause of bacterial meningitis at 2 months of age is3 !. #roup < /treptococcus <. Fycoplasma pneumoniae =. "suedomonas aeruginosa D. Eisteria monocytogenes !ns3 ! $ef3 7elson Textboo% of "ediatrics 1( th d, p)'1 !63 1 Recall )'. Eumbar puncture is indicated in the following conditions3 !. =hild with encephalitis with signs of increased intracranial pressure <. =hild who present with headache, associated with left-sided hemiparesis, facial asymmetry and ptosis =. =hild who presents with fever, generalied seiures and nuchal rigidity D. =hild with fever, seiures, purpuric rash and hematoma at all puncture sites !ns = $ef3 7elson Textboo% of "ediatrics 1( th d, p1* !63 .' Comprehension
)(. ! 1-year-old boy developed severe headache, photophobia and vomiting. Me is febrile. "91*J1 mm Mg. $esults of cranial nerve and motor examinations are normal. Me has nuchal rigidity and extensor plantar response, KQ4
=
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$ef3 7elson Textboo% of "ediatrics 1) th d, p 1*1' !63 .' Analysis )). ou are evaluating a '-year-old girl who has fever, vomiting, and nuchal rigidity. =/S examination reveals ?<=91(', *'L segmenters, 1'L lymphocytes, glucose92 mgJdl and protein92' mgJdl. #ram stain showed 7eisseria meningitides. The best choice of parenteral antibiotic for this patient is3 !. "enicillin <. =eftriaxone =. 7afcillin D. Gancomycin !ns3 < $ef3 7elson Textboo% of "ediatrics 1) th d, p )'& !63 .' Analysis )*. ! ) year old child was admitted for !cute "ost /trep #lomerulonephritis. ?hat is the usual presenting symptom of the patient !. Meadache <. Dysuria =. "eriorbital edema D. !bdominal "ain !ns3 = $ef3 7elson>s Textboo% on "ediatrics 1)th d. pp 1)& !63 .' Comprehension )+. !nemia in "ost /trep #lomerulonephritis is due to3 !. Migh grade hemoglobin <. Mematuria =. Memodilution D. decrease production of $<= !ns3 = $ef3 7elson>s Textboo% on "ediatrics 1)th d. pp 1)& !63 .' Comprehension *. ?hich of the following indicate that the patient is experiencing a severe complication of acute glomerulonephritis !. Temperature of *.* W= <. s Textboo% on "ediatrics 1) th d. pp 1)&-1)&1 !63 .' Analysis
*1. ! year old boy come in the $ with abdominal pain generalied edema, <" +J( mmMg T(.*= M$*'Jmin <57 21)mgJdl =r4.' mgJdl, 5rine "rotein is1*mgJ2&h. 6mpression is3 !. =ongestive Meart Sailure <. 6diopathic 7ephrotic /yndrome =. /ystemic Eupus rythematosus D. "ost-streptococcal #lomerulonephritis !ns3 $ef3 !63
< 7elson>s Textboo% on "ediatrics 1) th d. .'
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Analysis *2. The most common etiologic agent involved in acute hematogenous osteomyelitits in children is !. #roup < streptococcus <. #roup ! streptococcus =. /taphylococcus aureus D. Memophilus in8uena type < !ns3 = $ef3 7elsons Textboo% of "ediatrics 1( th d. p ))( !63 1 Recall *. ?hich !. <. =.
of the following statements is T$5 /eptic arthritis is a disease most commonly found in adolescent males 6n septic arthritis, the hips and %nees are the most commonly aected joints 6n a child with septic arthritis of the hip, redness swelling and warmth are often detectable on " D. =hildren with transient synovitis never present with fever !ns3 < $ef3 7elsons Textboo% of "ediatrics 1( th d. p ))) !63 .' Comprehesion *&. =ardinal features of hlers-Danlos syndrome include all of the following ECEPT3 !. hyperextensible doughy s%in <. palpable purpura =. joint hypermobility D. vascular fragility and brusing !ns3 < $ef3 7elsons Textboo% of "ediatrics 1( th d. pp 22)-22* !63 .' Analysis *'. These are group of bone diseases in which the ossication centers undergo avascular necrosis followed by resorption, fragmentation of dead bones and nally regeneration and replacement of reparative bone tissues. !. :steochondroma <. :steochondroses =. :steopetrosis D. :steochondritis !ns3 < $ef3 7elsons Textboo% of "ediatrics 1( th d. p 2(2 !63 1 Recall *(. The most feared complication of Nawasa%i Disease3 !. "ericarditis <. =oronary !neurysm =. !septic Feningitis D. Fyocarditis !ns3 < $ef3 7elsons Textboo% of "ediatrics 1( th d. p )2) !63 1 Recall *). ! child who has low grade fever, abdominal pain, arthritis, microscopic hematuria and purpuric rash only in the lower extremity. Me most li%ely has !. Feningococcemia <. "oststreptococcal #lomerulonephritis =. Menoch-/choenlein purpura D. ?egener>s granulomatosis !ns3 = $ef3 7elsons Textboo% of "ediatrics 1( th d. pp )2*-)2+ !63 .' Comprehension
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**. 6n the diagnosis of Farfan syndrome, the most useful information is !. Mistory of consanguinity <. =hromosomal mapping to detect deletions of =hromosome 1' =. ?idth of aortic root exceeding more than +'th percentile D. Feasurement of brillin precursors in peripheral leucocytes !ns3 = $ef3 7elsons Textboo% of "ediatrics 1( th d. p 211 !63 . Comprehension *+. ! 1 year old girl is seen because of & wee%s history of body malaise, anorexia, intermittent fever and arthritis of an%les, wrist and %nees. /he developed shortness of breath and dyspnea on exertion. " revealed <" +2J'*, $$ of 2&, "ulse 12', crac%leson both lung bases, muXed heart sounds accompanied by friction rub. 2 D chocardiography documents pericardial eusion. The most useful screening laboratory test for this patient is !. /erum 6g levels <. !ntinuclear antibody =. /erum complement levels D. Muman lymphocyte antigen KME!4 !ns3 = $ef3 7elsons Textboo% of "ediatrics 1( th d. pp (+*-(++ !63 .2' Analysis +. ! 1& year old male is referred for evaluation of heart murmur noted on sports preparticipation physicals. " reveals a very tall thin boy who has pectus deformity of the chest, hyperextensible joints, and apical holosystolic murmur with mid diastolic rumble. The most helpful diagnostic evaluation to determine the cause of these ndings is !. /%eletal survey <. /lit lamp eye examination =. Feasurement of plasma amino acids D. F$6 of the spine and sternum !ns3 < $ef3 7elsons Textboo% of "ediatrics 1(th d. p 211 !63 .2' Analysis +1. ?hich of the following drugs is contraindicated for use by the breastfeeding mother !. rgotamine <. =arbamaepine =. "henytoin D. Galproic acid !ns3 ! $ef3 7elsons Textboo% of "ediatrics 1) th d. p ' !63 .' Recall
+2. ! 2' gram infant who is born at ( wee%s !:# has a head circumference of 2) cm and crown-heel length of & cm. :ther ndings include upturned nose, hypotonia, hypoplastic philtrum. The most li%ely prenatal agent that would explain these ndings is !. !lcohol <. =ocaine =. Farijuana D. :piates !ns3 ! $ef3 7elsons Textboo% of "ediatrics 1) th d. p '&1 !63 .' Comprehension
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+. "hysical examination of a newborn female infant reveals meningomyelocoele, cleft lip and craniofacial anomalies. The most li%ely prenatal experience to explain these ndings is !. alcohol <. Eithium =. Thiaides D. Galproic acid !ns3 < $ef3 7elsons Textboo% of "ediatrics 1) th d. p '&1 !63 .' Comprehension +&. ! ' year old boy who is ta%ing =arbamaepine for control of generalied seiure presents with signs and symptoms of pneumonia. ?hich of the following antibiotics most li%ely cause toxicity if prescribed concomitantly with =arbamaepine !. !mpicillin <. rythromycin =. Gancomycin D. Trimethoprim-/ulfamethoxaole !ns3 < $ef3 7elsons Textboo% of "ediatrics 1) th d. p 2&2+ !63 .' Analysis +'. ! 1' year old patient has asthma and is ta%ing salbutamol or albuterol via metered dose inhaler. ou are as%ed the %nown side eects of this drug by this patient. The most common side eect to tell is !. /eiure <. muscle cramps =. somnolence D. tachycardia !ns3 D $ef3 7elsons Textboo% of "ediatrics 1( th d. p 2& !63 .' Analysis +(. 7ormal plasma osmolality is approximately !. 2('-2)' m:smJ%g M2 <. 2*'-2+' m:smJ%g M2 =. '-1' m:smJ%g M2 D. 2'-' m:smJ%g M2 !ns3 < $ef3 7elson Textboo% of "ediatrics 1(th d, p 1+ !63 .' Recall
+). Myponatremia dened as C1 m0JE of sodium may be caused by the following ECEPT !. Fineralocorticoid deciency <. :smotic diuresis =. /ymptom of inappropriate !DM secretion K/6!DM4 D. Diabetes insipidus !ns3 D $ef3 7elson Textboo% of "ediatrics 1(th d, p 1+'-1+( !63 .' Comprehension +*. The following are conse0uences of hypo%alemia ECEPT
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!. <. =. D.
"aralytic ileus "rolonged YT interval 6ncreased neuromuscular excitability ?ea%ness
!ns3 = $ef3 7elson Textboo% of "ediatrics 1( th d, p 1+* !63 .' Comprehension ++. ! year old child with diarrhea who presented with lethargy, rapid feeble pulses and very sun%en eyeballs has an estimated 8uid decit of3 !. -' mlJ%g <. (-+ mJ%g =. Z1 mlJ%g D. Z1' mlJ%g !ns3 = $ef3 7elson Textboo% of "ediatrics 1(th d, p 21 !63 .' Analysis 1. !n arterial blood gas determination ta%en on room air showing the following values pM9 )., p=:29 ' mmMg, M=:9 1( mmolJE, ":29 ( mmMg is indicative of3 !. Fetabolic acidosis and normal oxygenation <. Fetabolic acidosis and hypoxemia =. $espiratory acidosis and hypoxemia D. 7ormal acid-base balance with hypoxemia !ns3 < $ef3 7elson Textboo% of "ediatrics 1(th d, p 2+ !63 .' Analysis
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