Pediatrics Finals Samplex 1

One of these is NOT a leading cause of neonatal mortality
a. prematurity
b. intrapartum factors
c. neonatal infections
d. congenital anomalies

d. congenital anomalies

This shunt allows blood to flow to the aorta from the pulmonary artery
a. ductus venosus
b. umbilical artery
c. ductus arteriosus
d. foramen ovale

c. ductus arteriosus

The INCREASE in this factor contributes to successful initiation of the first breath?
a. blood in the amniotic fluid
b. lung compliance
c. lung fluid viscosity
d. alveolar surface tension

b. lung compliance

Which is NOT a maternal risk factor?
a. Smokes 3-5 sticks per day and drinks beer occasionally only
b. Mother is 16 y/o studying in a public high school
c. Had previous delivery to a premature baby with cleft palate
d. She only had 4 prenatal check-ups in a health center

Had previous delivery to a premature baby with cleft palate

Overlapping of scalp bones of newborns to get accommodated in the vaginal canal is referred to as
a. caput succedaneum
b. molding
c. cephalhematoma
d. craniotabes

b. molding

Amniotic bands result in
a. amputations
b. ring constrictions
c. syndactyly
d. all of the above

d. all of the above

What instrument is used to check for the red orange reflex in the newborn?
a. neurologic hammer
b. penlight
c. otoscope
d. ophthalmoscope

d. ophthalmoscope

This primitive reflex is expected to persist and NOT disappear
a. Rooting
b. Moro
c. Palmar grasp
d. Parachute

d. Parachute

What will you consider if the abdomen is noted to be globular in the newborn at birth?
a. Meconium is probably impacted in the colon
b. A globularly shaped abdomen at birth is normal
c. Ileus is observed in the first few days of life
d. Consider an enlarged stomach and duodenum

b. A globularly shaped abdomen at birth is normal

This is used to assess fetal aging
a. Lubchenco chart
b. Biophysical scoring
c. Apgar score
d. Ballard’s score

d. Ballard’s score

Which of the following will suggest a neurologic disorder in the newborn?
a. slight flexion of both upper and lower extremities
b. an observed withdrawal when flicking the sole
c. a progressive increase in deep tendon reflex
d. irritability when hungry and uncomfortably warm

c. a progressive increase in deep tendon reflex

These techniques will allow the examiner to successfully examine newborn's eyes EXCEPT?
a. Warm your hands and slowly rock the baby back and forth for a few times
b. Gently open their eyes using the examiners thumb and index finger
c. Dim the lights and adjust the temperature in the examining room
d. Swaddle and wrap the baby's arms, legs and body with clean cloth

d. Swaddle and wrap the baby's arms, legs and body with clean cloth

In determination of blood pressure, which of the following statements is TRUE:
a. Using too small cuff can lead to falsely low BP readings
b. A more accurate cuff size is one whose inflatable bladder width is 60% of the arm circumference midway between the olecranon and the acromion
c. BP monitoring in a routine well child visits usually starts at 3 years old
d. Using too large cuff can lead to falsely high BP readings

c. BP monitoring in a routine well child visits usually starts at 3 years old

A 16-year-old female came in for routine check up. You noted the patient was obese. On inspection of the skin, you noted velvety hyperpigmented grayish coarsened skin at the neck and the axilla. This is consistent with:
a. Acanthosis nigricans
b. Hypersensitivity reaction
c. Normal for age
d. Café au lait macules

a. Acanthosis nigricans

The following statement/s is/are TRUE about cardiac auscultation
a. The diaphragm of the stethoscope is placed firmly on the chest wall to auscultate for high-pitched sounds, while the bell is placed lightly to detect low-pitched sounds
b. The 1st heart sound (S1) is caused by closure of AV valves & is best heard at the apex
c. The 2nd heart sound (S2) is caused by closure of the semilunar valves & is best heard at the upper left & right sternal borders
d. All of the above

d. All of the above

Liza, a 13-year-old girl, came to the pediatric emergency room due to a seizure. What relevant information/s may you ask:
a. Recent history of head trauma
b. Family history of epilepsy
c. Menstrual history
d. All of the above

d. All of the above

This is an abnormal breath sound usually heard over large airways such as the trachea. It is usually associated with pulmonary disorders when air flows through the passages that have been narrowed by secretions, a tumor or foreign body, bronchospasm, or mucosal thickening
a. Wheeze
b. Rhonchi
c. Crackles
d. Tracheal

Rhonchi

The rigid diaphragm screens out low-pitch sound, and best transmits high-pitch sound
a. True
b. False

a. True

This is the first part of the neurologic examination in older children and adolescents:
a. Mental status
b. Cranial nerves
c. Cerebellar
d. Motor

a. Mental status

What postural reflex is the last one to be acquired and persists in life?
a. Lateral propping
b. Landau
c. Positive support reflex
d. Parachute

d. Parachute

What is the average time of closure of the posterior fontanel (in months)?
a. 4
b. 6
c. 3
d. 5

c. 3

In what age (in months) can a child skip, draws a triangle, names 4 colors and helps in dressing/undressing?
a. 30
b. 60
c. 48
d. 36

b. 60

Which of the following statements is CORRECT regarding pediatric neurologic evaluation:
a. The usual sequencing of evaluation is followed
b. The age of the child and the stage of brain development are important factors to consider during neurologic evaluation
c. A major part of the neurologic exam is usually not performed due to difficulty getting the child's cooperation
d. It is important to not undress the child in doing inspection to look for neurocutaneous stigmata

b. The age of the child and the stage of brain development are important factors to consider during neurologic evaluation

What is the predicted head growth of a 12-month-old boy if his birth head circumference is 35 cm.?
a. 45 cm
b. 43 cm
c. 42 cm
d. 44 cm

a. 45 cm

Hands in midline, reaches and grasps objects and brings them to mouth is usually seen at this age (in months):
a. 3
b. 4
c. 2
d. 5

5

TRUE about the Babinski sign:
a. It is elicited by stroking the medial border of the sole toward the base of the great toe.
b. Seen normally in majority of 1-year old children and as many up to 2 1/2 years old and should always be asymmetric.
c. It is a sign of upper motor neuron disease if asymmetric
d. Positive response is immediate plantarflexion of the big toe and fanning of the other toes

Seen normally in majority of 1-year old children and as many up to 2 1/2 years old and should

A Grade of 4/5 in the manual muscle strength test means:
a. Full range of motion (ROM), gravity eliminated
b. Full ROM against moderate resistance
c. Full ROM against high resistance, Normal strength
d. Full ROM, against gravity, no resistance

b. Full ROM against moderate resistance

A 13 year old male came in the ER due to 10-day history of intermittent headache associated with fever and behavioral changes. The mother noted him to have difficulty moving his neck. What neurologic exam would you perform to verify meningismus:
a. Weber
b. Oppenheim
c. Pupillary light reflex testing
d. Kernig

d. Kernig

This whitish cheesy material which covers fetus as protective layer intrauterinely is called:
a. vernix caseosa
b. amniotic fluid
c. meconium
d. lanugo

a. vernix caseosa

Passively transferred antibody from the mother to the baby usually protects newborn from what viral infection/s?
a. pertussis
b. hepatitis A
c. Measles
d. typhoid

c. Measles

An 8 month old female was brought to the ER because of seizure, diazepam needs to be given to control the seizure, based on her age what is her approximate weight in kg?
a. 9
b. 7
c. 6
d. 10

b. 7

Temporary teeth usually starts to erupt at 6 months of age, a 10 month old child is expected to have how many teeth?
a. 4
b. 6
c. 2
d. 3

4

One of the following is not affected by genetics in a child's development?
a. food preference
b. height
c. temperament and intelligence
d. general physique

a. food preference

An expectant mother developed high grade fever with cough five days prior to her expected delivery. How could this affect the outcome of the baby?
a. small for gestational age
b. large for gestational age
c. might have congenital anomaly
d. might develop clinical sepsis

d. might develop clinical sepsis

Myelination of cerebrum is completed up to this age, hence head circumference should be measured up to what age in months
a. 36
b. 24
c. 18
d. 12

24

This is/are the earliest physical sign of puberty in girls?
a. menarche
b. adrenarche
c. thelarche
d. all of the above

c. thelarche

Neurological exam of the 10 month old patient with seizure is within normal, what is his expected head circumference if HC at birth is 35 cm?
a. 37
b. 44
c. 40
d. 38

b. 44

Best fine motor ability a 4 year old child can do:
a. ride a tricycle
b. draw a square
c. complete a sentence
d. all of the above

b. draw a square

Developmental screening test that can be done to 5 year old to evaluate his milestone:
a. Denver developmental screening test
b. Newborn screening test
c. Hearing test
d. A and C

a. Denver developmental screening test

A 20 year old primigravida mother was diagnosed with Rubella on her 9th week of pregnancy, what is the expected effect on the baby:
a. Congenital anomalies
b. Neonatal infection
c. Fetal death
d. Growth retardation

a. Congenital anomalies

An increase in the physical size and mass of an individual or a single organ pertains to:
a. Development
b. Growth
c. Myelination
d. All of the above

b. Growth

Which of the following is affected by genetics in a child's development?
a. Height
b. Temperament and intelligence
c. General physique
d. All of the above

d. All of the above

What micronutrient is responsible for improvement of linear growth?
a. Zinc
b. Cadmium
c. Selenium
d. Iron

a. Zinc

All of the following are needed for strong bones EXCEPT:
a. Calcium
b. Vitamin D
c. Thiamine
d. Magnesium

c. Thiamine

The need for vitamin E in the diet will increase with an increase in the amount of what other nutrients in the diet?
a. Protein
b. Saturated fatty acids
c. Polyunsaturated fatty acids
d. Carbohydrates

c. Polyunsaturated fatty acids

All except one are true about the significance of dietary fibers:
It promotes peristalsis
Increases glycemic index
Reduces cholesterol absorption
Acts as an anti-oxidant

Increases glycemic index

Nipple pain can be caused by the following conditions EXCEPT:
Improper latching
Poor positioning
Breast engorgement
All of the above

All of the above

What advice can you give to lactating mothers with mastitis?
Continue breastfeeding on the affected breast
Continue breastfeeding on the unaffected breast
Stop breastfeeding on both breast
Express the milk then throw it away

Continue breastfeeding on the affected breast

Deficiency of Zinc is usually associated with the following conditions:
Increased risk of respiratory and diarrheal diseases
Increased in linear growth
Increased immune function
All of the above

Increased risk of respiratory and diarrheal diseases

Green frothy stool in a breastfed baby is most likely an indicator of?
Fore-milk/hind-milk imbalance
Too many green vegetables in mom's diet
Milk protein intolerance
Lactose intolerance

Fore-milk/hind-milk imbalance

The average breastfed baby takes in about how many ounces of breastmilk per day?
35 oz.
24 oz.
50 oz.
40 oz.

35oz

Screening for anemia in the following age groups, EXCEPT:
2-6 year old
10-19 years old
6-24 months
2-6 months

2-6 months

A 9 month old infant was brought to the clinic for immunization update. Which of the following vaccines should NOT be given to this patient?
Measles
Tetanus
Diphtheria
Rotavirus

Rotavirus

A 15 year old adolescent female was brought for varicella vaccine. No previous immunization. Should receive:
Two doses, second dose at least 6 months from first
Two doses at least 3 months apart
One dose only
Two doses at least one month apart

Two doses at least one month apart

A 6 year old child on chemotherapy for ALL, exposed to PTB, PPD = 5mm. Appropriate management:
No treatment
Repeat PPD after 6 months
Anti-Koch therapy should be given
No treatment since PPD is negative

Anti-Koch therapy should be given

A full-term neonate born to Hep B Ag (+) mother, proper prophylaxis given. At 9 months Hep B Ag and anti-HBs are negative. Next step:
No further vaccination
Give Hep B immunoglobulin + Hep B vaccine
Give 3-dose series of Hep B vaccine
Refer to GI

Give 3-dose series of Hep B vaccine

Mother requests discharge the next day. Which condition needs deferral?
Has passed urine and meconium
Delivered by C-section
Normal PE and VS
Mother has no comorbidity

Delivered by C-section

A 2-year-old with Kawasaki disease received IVIG. Brought for MMR after 3 months:
Give MMR at least 7 months after IVIG
Return after 1 month
Check immunoglobulin level
May give MMR

Give MMR at least 7 months after IVIG

4-year-old received washed RBC. Scheduled for Varicella in 2 weeks. Management:
Defer 3 months
Give at 7 months
Give anytime
Give at 11 months

Give anytime

Thalassemia patient for splenectomy. Vaccines needed EXCEPT:
Hib
Pneumococcal
Influenza
Meningococcal

Influenza

Prednisone for 5 days. Now for Measles vaccine. Best action:
Give after 3 months
Wait 1 month
Give now
Return after 2 weeks

Give now

Primary preventive measure:
Safe drinking water
Expanded newborn screening
Support group
Pap smear

Safe drinking water

Patients requiring ophthalmologic exam EXCEPT:
Newborn with sibling w/ retinoblastoma
Infant born to mother with syphilis
Premature neonate BW 2kg
Neonate MI 30 weeks intubated

Premature neonate BW 2kg

False regarding active immunization:
Offers partial protection
Complete protection for some vaccines
Induces transient protection
Whole/part organism administered

Induces transient protection

Child with acute ITP received IVIG. Came for Pneumococcal polysaccharide vaccine:
Give DPT at 11 months
Defer DPT 3 months
Give DPT anytime
Give DPT 7 months

Give DPT 7 months

Routine BP monitoring begins at:
6 years
10 years
3 years
1 year

3 years

7 Steps – majority of offenders are trusted persons:
Act on suspicion
Learn how to react
Minimize opportunity
Learn the facts

Learn the facts

7 Steps – more than 80% occur in one-adult/one-child situations:
Learn the facts
Act on suspicion
Minimize opportunity
Learn how to react

Minimize opportunity

7 Steps – includes teaching children about body parts, abuser can be family:
Minimize opportunity
Act on suspicion
Learn the facts
Talk about it

Talk about it

7 Steps – emotional/behavioral signs (“too perfect”, withdrawal, etc.):
Stay alert
Learn how to react
Act on suspicion
Get involved

Stay alert

7 Steps – future well-being at stake; abuse will continue if not helped:
Act on suspicion
Talk about it
Learn the facts
Minimize opportunity

Act on suspicion

7 Steps – offering support and encouraging child to talk:
Get involved
Act on suspicion
Stay alert
Learn how to react

Learn how to react

7 Steps – using voice/vote for safer community:
Act on suspicion
Get involved
Stay alert
Learn how to react

Get involved

Anticipatory guidance: domestic violence, infant crying, shaking →
School age
Preschool
Toddler
Infancy

Infancy

Anticipatory guidance: bullying, peers, internet safety, alcohol, dating violence →
Preschool
Toddler
School age
Adolescence

Adolescence

Process of standardized tool to identify at-risk kids:
Developmental surveillance
Developmental screening
Both
Neither

Developmental screening

Main indication of intubation:
Endotracheal meds
Mechanical ventilation support
Aspirate for culture
Alleviate stenosis

Mechanical ventilation support

Standard nasal cannula flow for older children:
0.5–1 L

5 L
2–5 L
1–2 L

2–5 L

Ideal site for NBS blood sample:
Sole of foot
Femoral artery
Popliteal artery
Radial artery

Sole of foot

Most common complication of lumbar tap:
Seizure
Decreased consciousness
Headache
Bloody tap

Headache

Double exchange transfusion best via:
Radial artery
Femoral cannulation
Double line insertion
Umbilical catheter

Umbilical catheter

Not an indication for thoracostomy:
Small spontaneous pneumothorax
Hemothorax
Chylothorax
Empyema

Small spontaneous pneumothorax

Ideal thoracostomy site in children:
None
2nd–3rd ICS MCL
3rd–4th ICS MAL
4th–5th ICS AAL

4th–5th ICS AAL

Not an indication for umbilical catheterization:
Blood sampling
BP monitoring
Exchange transfusion
Phlebotomy

Phlebotomy

Pediatric BLS 1-rescuer ratio:
None
30:2
15:2
Both

30:2

Best sites for pulse ox screening for CCHD:
Left foot + left hand
Right hand + any foot
Left hand
Right hand

Right hand + any foot

Micronutrient for linear growth:
Zinc
Cadmium
Selenium
Iron

Zinc

Needed for strong bones EXCEPT:
Calcium
Vitamin D
Thiamine
Magnesium

Thiamine

Vit E need increases with ↑ of:
Protein
Saturated fats
Polyunsaturated fats
Carbs

Polyunsaturated fats

Dietary fiber significance EXCEPT:
Promotes peristalsis
Increases glycemic index
Reduces cholesterol absorption
Antioxidant

Promotes peristalsis

Nipple pain EXCEPT:
Improper latching
Poor positioning
Breast engorgement
All of the above

All of the above

Fat-soluble vitamins – NOT true:
Accumulate to toxic amounts
Protein-bound in blood
Consumed less frequently
Excreted readily

Excreted readily

Rich sources of Vit B:
Liver
Green leafy vegetables
Fresh liver oils
Egg yolk

Liver

Advice for mastitis:
Continue breastfeeding affected breast
Continue breastfeeding unaffected breast
Stop breastfeeding
Express and throw

Continue breastfeeding on the affected breast

A 9 month old infant was brought to the clinic for an immunization update. Which of the following vaccines should NOT be given to this patient?
Measles
Tetanus
Diphtheria
Rotavirus

Rotavirus

A 15 year old adolescent female was brought to Jonelta Clinic for varicella vaccine. He has no previous immunization with the said vaccine and therefore should receive:
Two doses, the second dose should at least 6 months from the first dose
Two doses at least 3 months apart
One dose only since passive exposure to varicella could have occurred.
Two doses at least one month apart

Two doses at least one month apart

A 6 year old child on chemo for ALL, exposed to PTB, PPD = 5 mm. Management:
No treatment
Repeat PPD after 6 months
Anti-Koch therapy should be given
No treatment since PPD negative

Anti-Koch therapy should be given

A full term neonate exposed to Hep B Ag (+) mother, prophylaxis given; at 9 months both tests negative. Next step:
No further vaccination
Give Hep B IG + vaccine
Give 3-dose Hep B vaccine
Refer to GI

Give 3-dose Hep B vaccine

Full-term neonate; mother requests discharge next day. Condition needing deferral:
Passed urine/meconium
Delivered by CS
Normal PE/VS
Mother no comorbidity

Delivered by CS

2-year-old Kawasaki, received IVIG, now for MMR after 3 months:
Give MMR 7 months after IVIG
Return after 1 month
Check Ig levels
May give MMR

Give MMR 7 months after IVIG