Newborn - 1 y/o
A newborn infant is derived from a mother who is HBsAg (+) and HBeAg (+). What should be given to the infant?
a. Hepatitis B vaccine
b. No hepatitis B vaccine and immunoglobulin
c. Hepatitis B immunoglobulin
d. Hepatitis B vaccine and hepatitis B immunoglobulin
D. Hepatitis B vaccine and hepatitis B immunoglobulin
The ability to manipulate small objects with the pincer grasp is usually noted at what age?
A. 0 to 2 months
B. 3 to 5 months
C. 6 to 7 months
D. 8 to 9 months
D - The pincer grasp, which is noted at age 8 to 9 months, along with increasing mobility, enables an infant to explore the environment. (Nelson Textbook of Pediatrics, 17th ed, 2004)
A 3-year old boy was admitted to the ER because of difficulty of breathing. History revealed that he developed high grade fever and sore throat 24 hours prior to consult with associated difficulty of swallowing. Physical examination showed a very toxic looking boy, highly febrile, with labored breathing and hyper extended neck and drooling of the saliva. The most plausible diagnosis of the above case is:
A. Acute infectious laryngitis
B. Acute epiglottitis
C. Acute laryngotracheobronchitis
D. Acute bacterial tracheitis
B - Acute epiglotittis This is a potentially lethal condition characteristically presenting with acute fulminating course of high grade fever, sore throat, dyspnea and rapidly progressing respiratory obstruction. Drooling of the saliva is frequently present and is due to difficulty of swallowing. Hyperextension of the neck is due to his attempt to maintain the patency of the airway. This fatal disease is frequently caused by H. influenzae.
An 11 year old Tanner stage 2 female developed epigastric pain / 8 hours later there was fever nausea and vomiting. She passed 2 soft bowel movements. In the clinic, she limps and abdominal palpation, there was generalized guarding. Most likely, she has:
A. Pelvic inflammatory disease
B. Ruptured ectopic pregnancy
C. Appendicitis
D. Mesenteric adenitis
C. Appendicitis
All choices are differentials of appendicitis
(A) PID presents with vaginal discharge
(B) Pregnancy is unlikely for Tanner 2
(D) Mesenteric adenitis follows a week of respiratory infection
When will the increase of hemoglobin level be expected as a response to iron therapy
a. 2 days
b. 1 day
c. 3 days
d. 4 days
C. 3 Days
In the immunization history, if the patient is 4 months old and is up to date with the immunization you would expect that the patient should have received which of the following vaccines?
a. 1 dose each of BCG, measles and 3 doses each of DTP, OPV, Hepa B
b. 3 doses each of BCG, DTP, OPV and hepa B
c. 1 dose of BCG ad 3 doses each of DTP, OPV, Hepa B, measles
d. 1 dose of BCG, 3 doses each of DTP, OPV, Hib, Hepa B
D. 1 dose of BCG, 3 doses of DTP, OPV, HiB and Hep B
An 8 yeaar old girl is brought to the ER with a fever of 38.5C, stiff neck, photophobia, and headache. Lumbar puncture was performed revealing the ff results: WBC 38 cells/mm3 with 40% PMN and 60% lymphocyte, normal protein and glucose, and negative gram stain. which of the ff is the most likely cause of her meningitis?
A. N. meningitidis
B. S. pneumoniae
C. Enterovirus
D. Cryptococcus neoformans
E. M. tuberculosis
C. Enterovirus because the CSF is most consistent with aseptic meningitis, specifically viral meningitis. Enterovirus are the MC cause of viral meningitis there is lymphocytic predominance and normal protein and sugar.
The common infectious cause/s of bronchiectasis is/are:
A. Pertussis
B. Klebsiella pneumoniae
C. Streptotoccus pneumoniae
D. H. influenzae
A - Pertussis Infections due to Bordatella pertussis, measles, rubella, togavirus, respiratory syncytial virus and Mycobacterium tuberculosis induce chronic inflammation, progressive bronchial wall damage and dilatation of the bronchial tree. The common thread in the pathogenesis of bronchiectasis is difficulty clearing secretions and recurrent infections.
Which of the micronutrients does not have recognized anti-infective properties?
A. Vitamin A
B. Vitamin D
C. Iron
D. Zinc
B - Deficiency of any essential nutrient may result in failure to thrive and accompanying lack of immune protection. However, infections are more common in children with Vitamin. A, Iron, Zinc deficiencies. These 3 have roles in the immune system. (Nelson’s Textbook of Pediatrics, 17th ed, 2004, Chapter 44)
Recurrent gum bleeding was noted in a 7-year old female. CBC and platelet count are normal, Prothrombin time is normal but bleeding time and partial thromboplastin time are prolonged. The most likely diagnosis is:
A. ITP
B. Hypoprothrombinemia
C. TTP
D. Von Willebrand Disease
D - Von Willebrand disease is a disorder associated with mucocutaneous hemorrhages. The disorder is due to deficiency of Von Willebrand factor, a glycoprotein that is synthesized in megakaryocytes and endothelial cells. During normal hemostasis VWF adheres to the endothelial matrix after vascular damage. Changes in the conformation of VWF cause platelets to be an adhere to VWF resulting to platelet activation and recruitment of additional platelets. VWF also serves as the carrier protein for plasma factor VIII. Severe deficiency of VWF can cause prolongation of bleeding time and PTT. ITP (Choice A) results only to prolonged BT because the coagulation phase is not affected. Hypoprothrombinemia (Choice B) results to decreased synthesis of Vitamin K – dependent factor causing prolonged PT. ITP (Choice C) is a form of microangiopathic hemolytic anemia with thrombocytopenia.
A 28 year old primigravida mother, who had a past history of adequately treated PTB, gave birth to a healthy 3 kg baby. Which of the following preventive measures against TB would you take?
A. Separate the baby from the mother for another month
B. Separate the baby from the mother and give INH for 3 months
C. Give BCG only
D. Give BCG now but separate the baby from the mother for a month
C. Give BCG only
Which histologic lesion associated with idiopathic nephrotic syndrome is known to respond best to prednisone?
a. Mesangial proliferative
b. Focal sclerosis
c. Membranous
d. Minimal change
d. Minimal change - note that MCD's treatment method is steroids and cyclosporine
An 8-year old presents with sneezing, clear rhinorrhea, and nasal itching. P.E. findings show 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
D - Allergic rhinitis is often seasonal and associated with allergic conjunctivitis. Eosinophils predominate in the nasal secretions.
Painless small erythematous or hemorrhagic lesion on the palms and soles are classic lesion in:
A. Osler nodes
B. Janeway lesions
C. Roth spots
D. Splinter Hemorrhages
B - Janeway lesion are painless small erythematous or hemorrhagic lesions on the palms and soles. (A) Osler nodes are tender pea-sized intradermal nodule in the pads of the fingers and toes. These lesions may represent vasculitis produced by circulating antigen antibody complexes (C ) Sphincter hemorrhages are linear lesions beneath the nodes (D) Roth spots – immune complex phenomena and seen in the eyes (Nelson’s Textbook of Pediatrics, 17th ed, 2004)
A 10-kg child with iron deficiency anemia should receive:
A. 20 mg elemental iron
B. 30 mg elemental iron
C. 60 mg elemental iron
D. 70 mg elemental iron
C - The therapeutic dose of elemental iron is 6 mkd
Treatment of iron deficiency anemia:
- Preterm infants: 2-4 mg elemental iron/kg/day PO divided BID or may be given once a day
- Children: 3-6 mg elemental iron/kg/day PO divided BID - TID
The breastfed baby of a pure vegetarian mother may develop:
A. Xerophthalmia
B. Diarrhea & Dementia
C. Osteomalacia
D. Anemia
D - Strict Vegan diets contain no eggs, meat or milk products making this deficient in Vitamin B 12. (Chap. 446 p. 1612) Nursing Vegan mothers must be given B12 to prevent. Methylmalonic academia and anemia in their infants. (166) (A) Xerophthalmia is Vitamin A deficiency and for which Vitamin A rich sources are the vegetables. (B) Diarrhea and dementia are signs of niacin deficiency (Pellagra) B vitamins come from grains and vegetables. (C) Osteomalacia is Vitamin D deficiency (Rickets)
An 18 month old child was brought to your clinic because of developmental delay, you noted a sweet smelling urine similar to maple syrup, you know that the enzyme deficient in this case metabolizes which amino acids?
A. Leucine, lysine, valine
B. Isoleucine, phenylalanine, tryptophan
C. Leucine, isoleucine, aspartate
D. Valine, leucine, isoleucine
E. Phenylalanine, tryptophan, glycine
D. Leucine, isoleucine, valine This is a case of MSUD in which there is a deficiency of the enzyme branched chain alpha-keto acid dehydrogenase complex causing accumulation of the above AA causing the sweet maple odor urine
What is the typical chest x-ray findings of meconium aspiration pneumonia?
a. Reticulogranular pattern
b. Patchy infiltrates, coarse streaking of both lung fields
c. Ground glass appearance
d. Prominent pulmonary vascular markings
b. Patchy infiltrates, coarse streaking of both lung fields
Which of the following cardiac anomaly is NOT present in Tetralogy of Fallot?
A. Pulmonary stenosis
B. ASD
C. Overriding of the aorta
D. Right ventricular hypertrophy
B. ASD
Atrial septal defect is NOT seen in patients with TOF. It is ventricular septal defect (VSD) is the defect
that is part of the defect and the VSD is frequently non restrictive and large frequently located
just below the aortic valve
A 3y/o female presents with 1 week history of daily ("Quotidian") fever associated with arthritis of both ankles and her right knee. Her mother notes that she has decreased activity and also notes rashes that come and go in different parts of her body but NOT on the face. On PE, salmon colored patches were noted on the trunk and extremities. Palpation revealed splenomegaly.
A. Henoch Schoenlein Purpura
B. Systemic Lupus Erythematosus
C. Juvenile Rheumatoid Arthritis
D. Dengue Fever
C. JRA - salmon colored patches all over body EXCEPT on the face
A one day old had bilious vomiting. He was noted to be slightly jaundiced. The abdomen was not distended but there was occasional visible peristaltic nerves on the abdominal wall. Plain abdomen x-ray showed double-bubble sign. The obstruction is on what level?
A. Distal esophagus
B. Gastric
C. Duodenal
D. Colonic
C. Duodenal
A newborn baby girl was born with a head circumference of 33cm. At 4 months of age what is her expected head circumference?
a. 35.5cm
b. 40.0 cm
c. 45 cm
d. 42.5cm
A. 35.5cm (note that at 36 months HC is no longer measured) https://www.cdc.gov/growthcharts/html_charts/hcageinf.htm
The pathologic findings of bronchopulmonary dysplasia (BPD) consist of the following:
A. Decreased alveolarization
B. Decreased alveolar septation
C. Minimal airway disease
D. All of the above
BPD is a result of lung injury in infants requiring mechanical ventilation and supplemental oxygenation. It is apparent that patients with BPD have decreased alveolarization, alveolar septation and minimal airway disease all of which suggest arrest in lung development. The lung injury occurring in children is due to an interaction of multiple factors. Since RDS is a disease of progressive alveolar collapse, Atelectasis which is affected by insufficient PEEP together with ventilator-induced increased lung volume and regional overdistention promotes injury. Oxygen promotes injury by producing free radical that cannot be metabolized by immature antioxidant systems. Therefore, mechanical ventilation and /or oxygen injure the preterm lung by affecting alveolar and vascular development. Moreover, inflammation as measured by circulating neutrophils and macrophage in the alveolar fluid and pro-inflammatory cytokines contribute to the progression of the lung injury. (Nelson’s Textbook of Pediatrics, 17th ed, 2004)
Systolic murmurs are a clinical manifestation of large VSD in neonatal patients: True or False?
FALSE; systolic murmur may not be audible this occurs only in small VSD this is due to the fact that the left to right shunt may be minimal because of the higher right sided pressure
Which of the following statements best define physiologic anemia?
a. The hemoglobin in preterm infants is 7-10g/ dL
b. It is a physiologic decrease in hemoglobin content in term infants that occurs at 2-4 weeks of life
c. The hemoglobin in term infants is 11g/dL
d. It is a physiologic decrease in hemoglobin content in preterm infants that occurs at 3-4 weeks of life
b. It is a physiologic decrease in hemoglobin content in term infants that occurs at 2-4 weeks of life