1.

The parameters used to estimate the gestational age based on physical maturity are description of the following EXCEPT:
A. lanugo
B. plantar surface
C. genitalia
D. pupillary dilatation

Ans: D
Ref: Nelson’s Textbook of Pediatrics
AI: 1
Recall

2. An infant weighing 1400 gm is born at 32 weeks gestation in a delivery room that has an ambient temperature of 24 degrees
centigrade. Within a few minutes of birth, this infant is likely to exhibit all the following EXCEPT:
A. Pallor
B. Shivering
C. a fall in body temperature
D. metabolic acidosis

Ans: B
Ref: Nelson’s Textbook of Pediatrics
AI: 0.5
Comprehension

3. The immediate postnatal changes in a term newborn includes the following EXCEPT
A. decrease in pulmonary vascular resistance
B. decrease in right to left shunting via ductus arteriosus
C. increase in venous return to the left atrium
D. increase right to left shunting via foramen ovale

Ans: D
Ref: Nelson’s Textbook of Pediatrics
AI: 0.5
Comprehension

4. An infant has the following findings at 5 minutes of life; pulse 130 per minute, cyanotic hands and feet, good muscle tone, and a
strong cry. This infant’s Apgar score is
A. 7
B. 8
C. 9
D. 10

Ans: C
Ref: Nelson’s Textbook of Pediatrics
AI: 0.5
Analysis
5. A newborn infant was noted to have the following physical features at birth: Weight 3.0 kg, absent lanugo, white parchment-like
desquamating skin and long nails. The infant’s gestational age is most likely :
A. >42 wks
B. 37 – 39 wks
C. <37 wks
D. 40-42 wks

Ans: A
Ref: Nelson’s Textbook of Pediatrics
AI: 0.5
Analysis

6. Which of the following patterns noted on continuous monitoring of fetal heart rate is most indicative of fetal distress?
A. Baseline variability with periodic acceleration
B. Increasing baseline variability
C. Early deceleration pattern
D. Late deceleration without baseline variability

1
Ans: D
Ref: Nelson’s Textbook of Pediatrics
AI: 0.5
Recall

7. Maternal condition that would post for high risk pregnancy

A. Pregnancy interval of 2-3 years
B. Maternal age 20-25 year old
C. Primigravid status
D. Inadequate pre-natal care

Ans: D
Ref: Nelson’s Textbook of Pediatrics
AI: 0.5
Comprehension

8. Anticipated neonatal morbidities associated with maternal risk factors include

A. Neonatal macrosomia with Maternal Diabetes
B. Neonatal euthyroid state with Maternal Graves disease
C. Neonatal thrombocytosis with Maternal thrombocytopenia
D. Neonatal polycythemia with Maternal placenta previa

Ans: A
Ref: Nelson’s Textbook of Pediatrics
AI: 0.5
Comprehension

9. A mother delivers a neonate with meconium staining and low Apgar scores of 3 at 1 and 5 mins. Of life. The goals of
resuscitation are the following EXCEPT
A. Minimize heat loss
B. Establish normal respiration and lung expansion
C. Support cardiac output
D. Anticipate neonatal demise

Ans: D
Ref: Nelson’s Textbook of Pediatrics
AI: 0.5
Analysis

10. A newborn was noted to have recurrent episode of aspiration with excessive salivation, most likely the mother had
A. Polyhydramnios
B. Oligohydramnios
C. Normohydramnios
D. Anhydramnios

Ans: A
Ref: Nelson’s Textbook of Pediatrics
AI: 0.33
Analysis

11. Which of the following blood factors are decreased in the newborn?
A. VII, IX, and X
B. II, V, VII, and IX
C. V, VII, IX, and X
D. VII, VII, IX, and XI

Ans: B
2
Ref: Nelson Textbook of Pediatrics 16th Ed, p526
AI: 1
Recall

12. Which situation is Jaundice most likely physiologic in a term infant?

A. Jaundice at 12 hours of age
B. Serum bilirubin increasing by 5 mg/dl/24 hours or less in the first 2 to 4 days
C. Direct (conjugated) serum bilirubin greater than 1 mg/dl
D. Jaundice at 12 days of age
Ans: B
Ref: Nelson Textbook of Pediatrics 16th Ed, p515-516
AI: 0.5
Comprehension

13. The most appropriate treatment for hyperbilirubinemia (11.2 mg/dl) in a 3-week-old breast-fed infant with normal growth and
development?
A. Phototherapy
B. Exchange transfusion
C. Phenobarbital
D. None of the above

Ans: D
Ref: Nelson Textbook of Pediatrics 16th Ed, p517
AI: 1
Comprehension

14. A primiparous woman whose blood type is O-positive gives birth at term to an infant who has an A-positive blood and a
hematocrit of 55%. A serum bilirubin level obtained at 36 hours of age is 12 mg/100 ml. Which of the following laboratory
findings would be most characteristic of this infant’s disease?
A. An elevated reticulocyte count
B. A weakly positive direct Coombs test
C. Nucleated red blood cells in the blood smear
D. Hematocrit less than 55%
Ans: D
Ref: Nelson Textbook of Pediatrics 16th Ed, p525
AI: 0.5
Analysis

15. A full term infant was born by normal spontaneous delivery. Nursery stay was unremarkable and baby was breastfed. On the 2 nd
week of life, baby was noted to be jaundiced. This baby is most likely having:
A. Physiologic jaundice
B. Pathologic jaundice
C. Breast-milk jaundice
D. Kernicterus
Ans: C
Ref: Nelson Textbook of Pediatrics 16th Ed, p517
AI: 0.5
Analysis

16. Typical abdominal x-ray in necrotizing enterocolitis:

A. “double-bubble” sign
B. “string” sign
C. Pneumatosis intestinalis
D. “apple peel” sign

Ans: C
Ref: Nelson Textbook of Pediatrics 16th Ed, p512-513
AI: 1
3
Recall

17. A fecaloid vomitus indicates

A. Obstruction to the stomach
B. Obstruction in the duodenum proximal to the ampulla of Vater
C. Narrowing or closure of the intestinal lumen distal to the ampulla of Vater
D. Obstruction low in the intestinal tract

Ans: D
Ref: Nelson Textbook of Pediatrics 16th Ed, p1103
AI: 0.5
Comprehension

18. TRUE about necrotizing enterocolitis:

A. It is primarily a disease of infants 6-12 months old.
B. Breast milk feedings are not protective.
C. Bloody stools are seen in most patients.
D. It usually presents with abdominal distention with gastric retention.

Ans: D
Ref: Nelson Textbook of Pediatrics 16th Ed, p512-513
AI: 0.5
Comprehension

19. A two-week-old premature infant is found to have several milliliters of formula still present is the stomach two hours after being
fed. Also noted are gastric distention and the passage of blood-streaked stools. Which historical factor would best support a
tentative diagnosis of necrotizing enterocolitis?
A. Passage of a thick tenacious meconium plug at 24 hours of age
B. Severe hyaline membrane disease with anoxic episodes in the first week of life
C. A maternal history of severe ulcerative colitis
D. A history of milk-protein allergy in family members

Ans: B
Ref: Nelson Textbook of Pediatrics 16th Ed, pp512-513
AI: 0.5
Analysis

20. A woman was noted to have a large volume of amniotic fluid at the time of her delivery of her child. At 6 hours of age, her baby
begins regurgitating small amounts of mucus and bile-stained fluid. P.E. is normal. Abdominal x-ray obtained showed a “double-
bubble” sign. The most likely diagnosis of this infant’s disorder:
A. Esophageal atresia
B. Pyloric stenosis
C. Midgut volvulus
D. Duodenal atresia

Ans: D
Ref: Nelson Textbook of Pediatrics 16th Ed, p1133-1134
AI: 0.5
Analysis

21. A 1 month old infant forces at near object attains its visual activity of 20/20 at age
A. 2
B. 3
C. 4
D. 5

Ans: C
Ref: Nelson’s Pediatric Textbook 17th Ed. P 44
4
AI: 1
Recall

22. A 6 month old child who weighed 3.0 kg at birth would have a weight of
A. 5 kg
B. 7 kg
C. 9 kg
D. 11 kg

Formula used:

Age in months + 9
------------------------
2

6+9 15
-------- = ---------- = 7.5 kg
2 2

Ans: B
Ref: Nelson’s Pediatric Textbook 17th Ed. P 31
AI: 1
Comprehension

23. At age 15 months, which motor activity can be performed normally?

A. Walks upstairs with alternating steps
B. Climbs the stairs one step at a time
C. Walks alone by herself
D. Runs and seldom falls

Ans: C
Ref: Nelson’s Pediatric Textbook 17th Ed. P 39
AI: 0.5
Analysis

24. At 12 months, a child can already

A. Say bye-bye
B. Say his full name
C. Comprehend words as “hello”
D. Utter 2 words like the “Dada” and “Mama”
Ans: D
Ref: Nelson’s Pediatric Textbook 17th Ed. P 34
AI: 0.5
Analysis
25. The first visible sign of puberty in boys.
A. growth of pubic hair
B. enlargement of the penis
C. testicular enlargement
D. axillary perspiration

Ans: C
Ref: Nelson textbook 15th ed., Topic; Adolescence pp 59-60
AI: 1
Recall

26. The sexual maturity of a girl whose breast buds appeared when she was 10 years old and had menarche at 16 years old.
A. normal
B. precocious
C. delayed
D. undetermined
Ans: C
If a girl has no breast buds by the age of 13 years, or if more than 5 years separate the onset of pubertal change from
menarche, her puberty is delayed.
5
Ref: Nelson Textbook. Topic Adolescence pp 58-63
AI: 1
Comprehension

27. The most common stimulus in the gut provoking abdominal pain:
A. edema
B. ischemia
C. tension or stretching
D. accumulation of tissue metabolites

Ans: C
Ref: Nelson Textbook 15th ed. Topic Abdominal pain p.1035
AI: 0.5
Recall

28. A 6 month-old male infant previously well, suddenly developed paroxysmal colicky abdominal pain at frequent intervals
accompanied by straining efforts is most likely having this condition.
A. Acute Appendicitis
B. Abdominal Epilepsy
C. Urinary Tract Infection
D. Intussusception

Ans: D
Paroxysmal colicky abdominal pain at frequent intervals in a previously well infant is characteristic of Intussusception.
Ref: Nelson Textbook.Topic: Intussuseption.pp1072-1074
AI: 0.5
Comprehension

29. The most likely diagnosis of a 9 year old male with severe epigastric pain and muscle rigidity on the epigastrium, unrelieved by
ordinary antispasmodic.
A. Urolithiasis
B. Abdominal Epilepsy
C. Acute Pancreatitis
D. Acute Hepatitis
Ans: C
The pain in Urolithiasis may also be severe but is usually located at the lumbar and lower back areas. The pain in abdominal
epilepsy is usually in the periumbilical area. Abdominal pain in Acute Hepatitis is usually not severe. Acute Pancreatitis is
characterized by severe epigastric pain and muscle rigidity.
Ref: Nelson Textbook 15th ed. Topic: Pancreatitis, acute pp 1122-1124
AI: 0.33
Comprehension

30. The recommended daily allowance of Protein during the 1 st 6 months of life is about:
A. 1.0 g/kg/24 hr
B. 2.0 g/kg/24 hr
C. 3.0 g/kg/24 hr
D. 4.0 g/kg/24 hr
Ans: B
The current RDA for protein during the first 6 months of life in a healthy term infant is 2.0-2.2 g/kg/24 hour.
Ref: Nelsons Textbook of Pediatrics 17th Ed. pp155 chap40
AI: 1
Recall

31. Breastmilk from mothers whose diet is sufficient and balanced supply all the necessary nutrients needed by the infant. One of
the following is found to be insufficient at birth:
A. Vitamin A
B. Vitamin D
C. Fluoride
D. Iron

Ans: C

6
 Amount of iron and Vitamin D are sufficient during the 1st 4-6 months of life. Supplement is needed beyond this period. If
the water supply is not adequately fluoridated (< 0.3ppm), the breastfed infant should receive at least 10 ug of fluoride daily
for the 1st 6 months of life.
Ref: Nelsons Textbook of Pediatrics 17th Ed. pp158 chap 41
AI: 0.5
Comprehension

32. Most normal newborns are thought to have sufficient stores of iron. However, iron deficiency is still a common problem during
infancy. One of the following statement is true regarding iron deficiency in infants:
A. Human milk contains less iron than most formulas, thus breastfed infants are prone to develop anemia than formula fed
infants.
B. Amount of iron stores at birth and its absorption are variable, thus onset of iron deficiency may also vary.
C. Inadequate dietary intake of iron is the most common cause of this problem.
D. Rapid destruction of RBC during infancy

Ans: B
Although human milk contains less iron than most formulas iron is absorbed 2-3x more efficiently from human milk than
from cow’s milk. Iron deficiency secondary to inadequate dietary intake is not common before 6 months of life.
Ref: Nelsons Textbook of Pediatrics 17th Ed. pp1614
AI: 0.5
Analysis

33. An otherwise healthy 6 month old infant was brought to your clinic because of restlessness, crying and failure to gain weight.
What is the possible cause of the child’s problem:
A. This infant is suffering from septicemia
B. Late introduction of complementary feeding
C. Possibility of an abnormal mother-infant bonding
D. All of the above

Ans: D
Underfeeding is suggested by restlessness, crying, slow weight gain or actual weight l oss. All of the above can cause
infant’s failure to take sufficient quantity of food.
Ref: Nelsons Textbook of Pediatrics 17th Ed. pp164 chap41
AI: 0.33
Analysis

34. The most common cause of death from physical abuse is:
A. Intra-abdominal injuries
B. Burns
C. Intentional Head Trauma (IHT)
D. Poisoning

Ans: C
More than 95% of serious intracranial injuries during the 1 st year of life are the result of IHT. Intra-abdominal injuries from
impacts are the second most common cause of death in battered children.
Ref: Nelson’s Textbook of Pediatrics 17th Ed. P123, chap35
AI: 1
Recall

35. Bruises are the most common manifestations of child abuse. Appropriate age of bruises allows physicians to correlate history
with actual age of injury. A bruise that is characterized as purple or bluish is approximately:
A. 0-48 hours
B. 48-72 hours
C. 4-7 days
D. > 7 days

Ans: B
7
 Bruise that is fresh (0-48 hours) is red; purple-blue is 48-72 hours; yellow-green 4-7 days; brown > 7 days.
Ref: Nelson’s Textbook of Pediatrics 17th Ed. P123, chap35
AI: 1
Comprehension

36. A 2 year old male child was seen at the ER due to 2 nd degree burns of both hands. What would you do?
A. Admit the patient since you cannot clearly tell if the burns are intentional or not
B. Treat the burns and send home the patient
C. Refer to the surgeon on duty for management of the burns
D. Ask for the immunization status of the patient

Ans: A
In cases where the diagnosis is unclear, always admit the patient. The parents should be told why an inflicted injury is
suspected.
Ref: Nelson’s Textbook of Pediatrics 17th Ed. P125 chap35
AI: 0.5
Analysis

37. The use of helmets, seat belts, knee and elbow pads are interventions that:
A. prevent the occurrence of the injury-producing agent
B. will attempt to reduce the likelihood of injury by modifying the transfer of energy to the victim
C. will limit the impact of injuries on the victims
D. all of the above
Ans: B
The use of seat belts and other safety devices will modify the rate of release of the hazard from its source.
Ref: Textbook of Pediatrics and Childhealth, by Del Mundo 4 th ed p1408-1409
AI: 0.5
Analysis

38. A reliable index of long-term glycemic control is provided by measurement of :

A. FBS
B. Urine sugar
C. Glycosylated hemoglobin
D. Oral glucose tolerance test
Ans: C
Ref: Nelson’s Textbook of Pediatrics 17th Ed. p. 1962
AI: 1
Recall
39. The first and rate – limiting step in steroid synthesis is the conversion of cholesterol to: Aldosterone
A. Cortisol
B. Pregnenolone
C. sex steroids
Ans: C
Ref: Nelson’s Textbook of Pediatrics 17th Ed. p. 1899
AI: 0.5
Comprehension

40. At what age is onset of puberty considered precocious in girls?

A. < 7 years of age
B. < 8 years of age
C. < 9 years of age
D. < 10 years of age

Ans: B
Ref: Nelson’s Textbook of Pediatrics 17th Ed. p. 1863
AI: 0.5
Comprehension

41. A newborn with congenital Hypothyroidism is diagnosed and treated adequately by two weeks of age. It can be anticipated that
with continued treatment he will have:
A. Short stature but normal intelligence
B. Short stature and slight mental retardation
C. Normal growth and development
8
 D. Normal stature but a mild degree of mental retardation

Ans: C
Ref: Nelson’s Textbook of Pediatrics 17th Ed. p. 1877
AI: 0.5
Analysis

42. A 1 year and 6 months old child has congenital adrenal hyperplasia. He carries a boy’s name, and had been raised as a boy. P.E
shows a moderately enlarged phallus but empty scrotal sacs. Chromosome analysis shows an XX pattern. If you were the
doctor, you would:
A. continue to raise him as a boy
B. ask parents how they feel and follow their wishes
C. 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

Ans: C
Ref: Nelson’s Textbook of Pediatrics 17th Ed. p. 1912
AI: 0.5
Analysis

43. The most severe form of mucopolysaccharidoses due to the deficiency of alpha-L- iduronidase is:
A. Hurler’s syndrome
B. Hunter’s syndrome
C. Morquio’s syndrome
D. Sanfillippo syndrome
Ans: A
Ref: Nelson’s Textbook of Pediatrics 17th Ed. p484
AI: 0.5
Recall

44. Inborn error of amino acid metabolism associated with mousy or musty odor of the urine is:
A. Tyrosinemia
B. Hawkinsinuria
C. Phenylketonuria
D. Oast house urine disease
Ans: C
Ref: Nelson’s Textbook of Pediatrics 17th Ed. p397
AI: 0.5
Comprehension
45. A 2 week old baby boy, delivered NSD, TERM, AGA, was admitted due to poor suck and vomiting, upon admission patient was
stuporous, dehydrated with sweet smelling urine. The most likely diagnosis:
A. Penylketenuria
B. Oast house urine disease
C. Maple syrup urine disease
D. Xanthunuria

Ans: C
Ref: Nelson’s Textbook of Pediatrics 17th Ed. p409
AI: 0.5
Analysis

46. Lipid Storage disease associated with the deficiency of the lysosomal enzyme B- hexosaminidase A is:
A. Gaucher Disease
B. Lesch-Nyhan Disease
C. Niemann-Pick Disease
D. Tay-Sachs Disease

Ans: D
Ref: Nelson’s Textbook of Pediatrics 17th Ed. p464
AI: 0.5
Comprehension

9
47. Jesus, a 7 year old 2nd grader was brought by her mother to their physician because he was always in trouble at school and
impossible at home. He cannot sit still at the dinner table or anywhere else, except perhaps in front of the television. Physical
examination revealed nothing more than a slight difficulty in performing skillful motor acts and some clumsiness. The most likely
diagnosis is:
A. Temporal lobe epilepsy
B. Conduct disorder
C. Attention deficit hyperactivity disease
D. Attention deficit hyperactivity disorder

Ans: D
Ref: Nelsons Textbook of Pediatrics, 16th Ed, pp 100-101
AI: 0.5
Comprehension

48. An 18 year old farm worker was brought to the ER with symptoms of abdominal cramps, excessive salivation, vomiting diarrhea
and muscle fasciculation. History revealed that he has been applying pesticides on a large area of the banana plantation where
he worked. The most common cause of his problem:
A. Dioxin poisoning
B. Organophosphate poisoning
C. Hydrocarbon poisoning
D. Heavy metal poisoning

Ans: B
Ref: Nelsons Textbook of Pediatrics, 16th Ed, p 2153
AI: 0.5
Analysis
49. A 20 year old G1P0 woman gave birth to a baby boy with Down Syndrome. Her first pregnancy resulted in abortion. Such
chromosomal abnormality is usually due to:
A. Translocation
B. Nondisjunction
C. Mosaicism
D. Point mutation

Ans: A
Ref: Nelsons Textbook of Pediatrics, 16th Ed, p 327
AI: 1
Recall

50. A 12 year old female was brought in for consultation because of poor performance in school especially in mathematics. On
physical examination she was found to have short stature, low posterior hairline, webbed neck, widely spaced nipples and sexual
infantilism. The most likely diagnosis:
A. Klinefelter Syndrome
B. Turner Syndrome
C. Edward Syndrome
D. Adrenogenital Syndrome

Ans: B
Ref: Nelsons Textbook of Pediatrics, 16th Ed, p 330
AI: 1
Analysis

51. Which of the following organisms is the major cause of severe systemic and focal infections in newborns?
A. Staphylococcus aureus
B. Streptococcus viridans
C. Group B streptococcus
D. Pseudomonas species

Ans: C
Ref: Nelson’s Textbook of Pediatrics 16th Ed, p. 810
AI: 1
Recall

10
52. A 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. He has good weight gain and appetite, and has no chronic cough nor fever. You administer a Mantoux
tuberculin test and the reading after 72 hours is 15mm. What category does this child belong to?
A. TB Exposure
B. TB Infection
C. TB Disease
D. TB Inactive

Ans: B
Ref: Tuberculosis in Infancy & Childhood by PPS, p. 20-23
AI: 0.5
Comprehension

53. A 5 year old girl developed fever, coryza and conjunctivitis. After 5 days, still with fever, she was noted to have maculo-papular
rashes and cervical lymphadenopathy. What is your diagnosis?
A. Rubella
B. Roseola
C. Fifth’s Disease
D. Rubeola

Ans: D
Ref: Nelson’s 16th ed, p. 946-48
AI: 0.5
Analysis
54. A mother with a known herpes simplex type 2 infection gave birth vaginally to a full term healthy looking baby boy with the
assistance of a hilot. What is the next immediate step to do after resuscitation?
A. Give herpes simplex vaccine intramuscularly within first 12 hours of life
B. Send baby to the hospital for admission and intravenous acyclovir treatment
C. Advise mother to closely observe baby for appearance of oral lesions
D. Start first dose of oral acyclovir and refer to a pediatrician for further management

Ans: B
Ref: Nelson’s 16th Ed, p. 969-71
AI: 0.5
Analysis

55. People of all ages can develop acute rheumatic fever, but it usually occurs in children
A. 0 – 1 year old
B. 2 – 4 years old
C. 5 – 15 years old
D. 16 – 19 years old

Ans: C
Ref: Nelsons Textbook of Pediatrics 17th Ed. p 875
AI: 1
Recall

56. The diagnosis of acute rheumatic fever is mainly determined by

A. blood culture
B. clinical signs
C. electrocardiogram
D. acute phase reactants

Ans: B
Ref: Nelsons Textbook of Pediatrics 17th Ed. p 876
AI: 0.5
Comprehension

57. NOT TRUE regarding mitral stenosis:

A. It is usually rheumatic in origin seen in older children and adolescents
B. It may cause concentric hypertrophy of the LV
C. The heart murmur is diastolic in timing
11
 D. It can be managed with balloon valvuloplasty

Ans: B
Ref: Nelsons Textbook of Pediatrics 17th Ed. p 1570-1571
AI: 0.5
Comprehension

58. A 7 year old girl presents with a tender and swollen right knee as well as a more recently appearing swollen left ankle. She also
has fever. Which of the following modified Jones criteria does the patient fulfill?
A. 1 Major 1 minor
B. B.1 Major 2 minors
C. C.2 Majors
D. D. 2 Minors

Ans: A
Ref: Nelsons Textbook of Pediatrics 17th Ed. p 875-876
AI: 0.5
Analysis

59. The patient is 10 year old who had frequent tonsillitis and he had complained of migratory joint swelling, intermittent high grade
fever, palpitations and easy fatigue. PE includes BP 180/20 CR 110/min. Heart dynamic precordium, AB at 6 th LICS, AAL, S1
normal, S2 split P2 accentuated, Grade 3/6 diastolic blowing murmur LUSB radiating to apex, Peripheral pulses bounding. The
diagnosis is that he has RHD. What is the most likely cardiac pathology?
A. mitral insufficiency
B. mitral stenosis
C. aortic insufficiency
D. aortic stenosis

Ans: C
Ref: Nelsons Textbook of Pediatrics 17th Ed. p 1571
AI: 0.5
Analysis

60. What is the most common cause of asthma attacks in the infancy period?
A. Viral infection
B. Stressful activity
C. Exposure to allergen
D. Food hypersensitivity

Ans: A
Ref: Nelson’s 16th Ed, p. 664-66
AI: 1
Recall

61. During the first year of life, the most common scenario in a child with adverse reaction to foods is:
A. Rashes after intake of soy-based foods
B. Drowsiness after intake of cured meat
C. Pruritic erythematous patches after intake of cheese
D. Watery, blood-streaked stools after cow’s milk intake

Ans: D
Ref: Nelson’s 16th Ed, p. 695-97
AI: 0.5
Comprehension

62. A preschooler was brought to the ER for difficulty of breathing. She was noted to be breathless while talking in phrases and
prefers to sit when examined. On PE, her RR is >40/minute, wheezing was heard throughout expiration, was tachycardic and
PEFR was 55%. What is the classification of severity of this child’s acute asthma attack?
A. Mild intermittent
12
 B. Mild persistent
C. Moderate persistent
D. Severe persistent

Ans: C
Ref: Nelson’s 16th ed, p. 667
AI: 0.5
Analysis

63. A 7-year-old boy was brought to the ER due to tightness in the chest. Earlier, he mentioned that he was stung by a bee. Around
30 minutes after the sting, he felt warm and had difficulty swallowing his saliva. He started feel dizzy and was noted to have
difficulty of breathing. On PE he was noted to have a BP of 50 palpatory, HR of 50/min regular in rhythm, RR of 50/min, with
wheezing all over his lung fields. What is the immediate treatment of choice for this patient?
A. Oral corticosteroid
B. Inhaled beta-2 agonist
C. Intramuscular epinephrine
D. Oral antihistamine

Ans: C
Ref: Nelson’s 16th Ed, p. 686-87
AI: 0.5
Analysis

64. Based on the National Prevalence Survey, how many mm induration response to PPD 5 TU test, differentiate the TB infected
from the non infected Filipino?
A. 5
B. 8
C. 10
D. 15
Ans: C
Ref: Nelson’s Textbook of Pediatrics
AI: 1
Recall

65. A 2 year old boy has recurrent breathing pauses and snoring during sleep, consulted at the ER due to difficulty of breathing. On
PE his tonsils are swollen and enlarged. Your most commonly diagnosis is?
A. Acute epiglottitis
B. Acute tracheitis
C. Obstructive sleep apnea
D. Diptheria
Ans: C
Ref: Nelson’s Textbook of Pediatrics
AI: 0.5
Comprehension

66. A 6 month old male infant has mild upper respiratory tract infection and low grade fever gradually develops into respiratory
distress characterized by wheezing and dyspnea. The most likely diagnosis is?
A. Bronchial asthma
B. Acute bronchiolitis
C. Acute bronchitis
D. Laryngotracheobronchitis (LTB)
Ans: B
Ref: Nelson’s Textbook of Pediatrics
AI: 0.5
Comprehension

67. NOT included in the management of Acute Laryngotracheobronchitis:

A. Give O2 and supportive care
B. Start racemic epinephrine by aerosol
C. Add inhaled steroids
D. Admit and start cephalosporins
13
Ans: D
Ref: Nelson’s Textbook of Pediatrics
AI: 0.5
Analysis

68. A 2 year old with class III childhood TB would have the following characteristics EXCEPT:
A. (+) history of exposure to an adult with active TB
B. (+) mantoux tuberculin test
C. abnormal chest radiographs suggestive of PTB
D. Started on INH, Rifampicin, PZA and Ethembutol
Ans: D
Ref: Nelson’s Textbook of Pediatrics
AI: 0.5
Analysis

69. What is the main stimulus for red blood cell production?
A. Anoxia
B. Infection
C. Hemorrhage
D. Immunodeficiency
Ans: A
Ref: Del Mundo p.1280,)
AI: 1
Recall

70. A 4 year old child with brain tumor underwent radiotherapy and chemotherapy. After 2 years, the child was noted to be stunted
(height at p35). What is the likely reason for such a finding?
A. Decrease in brain size due to radiotherapy lessened capacity of growth hormones to induce growth
B. Damage to hypothalamic axis has decreased amount of growth hormones causing stunting
C. Chemotherapy caused hypoperfusion and ischemia of the brain
D. Radiation induced hypoplasia of the skull which limited brain development
Ans: B
Ref: Del Mundo, p. 1353-54
AI : 0.5
Comprehension
71. Laboratory test to confirm the diagnosis of neuroblastoma:
A. Urine vanillylmandelic acid (VMA)
B. Urine catecholamins
C. Serum alpha-fetoproteins (AFP)
D. Serum beta- human chorionic gonadotrophin (B-HCG)

Ans: A
Ref: Del Mundo, p. 1360
AI: 0.5
Comprehension

72. A 2 year old child was brought to the emergency room for on and off fever and easy bruisability for 4 weeks already. On PE, you
noted palmar pallor, generalized lympadenopathy and hepatomegaly. What is the most likely cause for his signs & symptoms?
A. Connective tissue disease
B. Chronic infection
C. Blood malignancy
D. Nutritional anemia

Ans: C
Ref: Del Mundo, p. 1305 topic on acute leukemia
AI: 0.5
Analysis

73. A 5-year-old boy was brought to the OPD for frequent vomiting and abdominal distention. He has had poor appetite for almost
one month and would complain of constipation and reddish urine. On PE, BP= 130/90, T= 38.2C. You palpated a mass on the
right side of the abdomen which was firm, not movable and non-tender. What is your diagnosis?
A. Rhabdomyosarcoma
B. Hirschsprung’s disease
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 C. Impacted feces
D. Wilms’ tumor

Ans: D
Ref : Del Mundo, p.1355
AI : 0.5
Analysis

74. The most common cause of bacterial meningitis at 2 months of age is:
A. Group B Streptococcus
B. Mycoplasma pneumoniae
C. Psuedomonas aeruginosa
D. Listeria monocytogenes

Ans: A
Ref: Nelson Textbook of Pediatrics 16th Ed, p751
AI: 1
Recall

75. Lumbar puncture is indicated in the following conditions:

A. Child with encephalitis with signs of increased intracranial pressure
B. Child who present with headache, associated with left-sided hemiparesis, facial asymmetry and ptosis
C. Child who presents with fever, generalized seizures and nuchal rigidity
D. Child with fever, seizures, purpuric rash and hematoma at all puncture sites

Ans: C
Ref: Nelson Textbook of Pediatrics 16th Ed, p1800
AI: 0.5
Comprehension

76. A 10-year-old boy developed severe headache, photophobia and vomiting. He is febrile. P=180/100 mm Hg. Results of cranial
nerve and motor examinations are normal. He has nuchal rigidity and extensor plantar response, (+) Babinski. The most
appropriate to obtain this time is:
A. CSF analysis
B. Electroencephalogram
C. CT scan
D. Skull x-ray

Ans: C
Ref: Nelson Textbook of Pediatrics 17th Ed, p 1815
AI: 0.5
Analysis

77. You are evaluating a 5-year-old girl who has fever, vomiting, and nuchal rigidity. CSF examination reveals WBC=1650, 85%
segmenters, 15% lymphocytes, glucose=20 mg/dl and protein=250 mg/dl. Gram stain showed Neisseria meningitides. The best
choice of parenteral antibiotic for this patient is:
A. Penicillin
B. Ceftriaxone
C. Nafcillin
D. Vancomycin

Ans: B
Ref: Nelson Textbook of Pediatrics 17th Ed, p 754
AI: 0.5
Analysis

78. A 7 year old child was admitted for Acute Post Strep Glomerulonephritis. What is the usual presenting symptom of the patient
A. Headache
B. Dysuria
C. Periorbital edema
D. Abdominal Pain
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Ans: C
Ref: Nelson’s Textbook on Pediatrics 17th Ed. pp 1740
AI: 0.5
Comprehension

79. Anemia in Post Strep Glomerulonephritis is due to:

A. High grade hemoglobin
B. Hematuria
C. Hemodilution
D. decrease production of RBC

Ans: C
Ref: Nelson’s Textbook on Pediatrics 17th Ed. pp 1740
AI: 0.5
Comprehension

80. Which of the following indicate that the patient is experiencing a severe complication of acute glomerulonephritis?
A. Temperature of 38.8 °C
B. Blood Pressure of 140/92 /mm Hg
C. Severe Sodium of 140 mg/ L
D. Weight loss of 2 lbs

Ans: B
Ref: Nelson’s Textbook on Pediatrics 17th Ed. pp 1740-1741
AI: 0.5
Analysis

81. A 3 year old boy come in the ER with abdominal pain generalized edema, BP 90/60 mmHg T36.8C HR85/min BUN 217mg/dl
Cr).5 mg/dl, Urine Protein is1800mg/24h. Impression is:
A. Congestive Heart Failure
B. Idiopathic Nephrotic Syndrome
C. Systemic Lupus Erythematosus
D. Post-streptococcal Glomerulonephritis

Ans: B
Ref: Nelson’s Textbook on Pediatrics 17th Ed.
AI: 0.5
Analysis

82. The most common etiologic agent involved in acute hematogenous osteomyelitits in children is
A. Group B streptococcus
B. Group A streptococcus
C. Staphylococcus aureus
D. Hemophilus influenza type B

Ans: C
Ref: Nelsons Textbook of Pediatrics 16th Ed. p 776
AI: 1
Recall

83. Which of the following statements is TRUE?

A. Septic arthritis is a disease most commonly found in adolescent males
B. In septic arthritis, the hips and knees are the most commonly affected joints
C. In a child with septic arthritis of the hip, redness swelling and warmth are often detectable on PE
D. Children with transient synovitis never present with fever
Ans: B
Ref: Nelsons Textbook of Pediatrics 16th Ed. p 777
AI: 0.5
Comprehesion
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84. Cardinal features of Ehlers-Danlos syndrome include all of the following EXCEPT:
A. hyperextensible doughy skin
B. palpable purpura
C. joint hypermobility
D. vascular fragility and brusing
Ans: B
Ref: Nelsons Textbook of Pediatrics 16th Ed. pp 2207-2208
AI: 0.5
Analysis

85. These are group of bone diseases in which the ossification centers undergo avascular necrosis followed by resorption,
fragmentation of dead bones and finally regeneration and replacement of reparative bone tissues.
A. Osteochondroma
B. Osteochondroses
C. Osteopetrosis
D. Osteochondritis
Ans: B
Ref: Nelsons Textbook of Pediatrics 16th Ed. p 2062
AI: 1
Recall

86. The most feared complication of Kawasaki Disease:

A. Pericarditis
B. Coronary Aneurysm
C. Aseptic Meningitis
D. Myocarditis
Ans: B
Ref: Nelsons Textbook of Pediatrics 16th Ed. p 727
AI: 1
Recall
87. A child who has low grade fever, abdominal pain, arthritis, microscopic hematuria and purpuric rash only in the lower extremity.
He most likely has
A. Meningococcemia
B. Poststreptococcal Glomerulonephritis
C. Henoch-Schoenlein purpura
D. Wegener’s granulomatosis

Ans: C
Ref: Nelsons Textbook of Pediatrics 16th Ed. pp 728-729
AI: 0.5
Comprehension

88. In the diagnosis of Marfan syndrome, the most useful information is

A. History of consanguinity
B. Chromosomal mapping to detect deletions of Chromosome 15
C. Width of aortic root exceeding more than 95th percentile
D. Measurement of fibrillin precursors in peripheral leucocytes
Ans: C
Ref: Nelsons Textbook of Pediatrics 16th Ed. p 2131
AI: 0.33
Comprehension

89. A 13 year old girl is seen because of 4 weeks history of body malaise, anorexia, intermittent fever and arthritis of ankles, wrist
and knees. She developed shortness of breath and dyspnea on exertion. PE revealed BP 92/58, RR of 24, Pulse 125, crackleson
both lung bases, muffled heart sounds accompanied by friction rub. 2 D Echocardiography documents pericardial effusion. The
most useful screening laboratory test for this patient is
A. Serum Ig levels
B. Antinuclear antibody
C. Serum complement levels
D. Human lymphocyte antigen (HLA)

Ans: C
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Ref: Nelsons Textbook of Pediatrics 16th Ed. pp 698-699
AI: 0.25
Analysis

90. A 14 year old male is referred for evaluation of heart murmur noted on sports pre-participation physicals. PE 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 findings is
A. Skeletal survey
B. Slit lamp eye examination
C. Measurement of plasma amino acids
D. MRI of the spine and sternum

Ans: B
Ref: Nelsons Textbook of Pediatrics 16th Ed. p 2131
AI: 0.25
Analysis

91. Which of the following drugs is contraindicated for use by the breastfeeding mother?
A. Ergotamine
B. Carbamazepine
C. Phenytoin
D. Valproic acid

Ans: A
Ref: Nelsons Textbook of Pediatrics 17th Ed. p 530
AI: 0.5
Recall

92. A 2500 gram infant who is born at 36 weeks AOG has a head circumference of 27 cm and crown-heel length of 40 cm. Other
findings include upturned nose, hypotonia, hypoplastic philtrum. The most likely prenatal agent that would explain these
findings is
A. Alcohol
B. Cocaine
C. Marijuana
D. Opiates

Ans: A
Ref: Nelsons Textbook of Pediatrics 17th Ed. p 541
AI: 0.5
Comprehension

93. Physical examination of a newborn female infant reveals meningomyelocoele, cleft lip and craniofacial anomalies. The most likely
prenatal experience to explain these findings is
A. alcohol
B. Lithium
C. Thiazides
D. Valproic acid

Ans: B
Ref: Nelsons Textbook of Pediatrics 17th Ed. p 541
AI: 0.5
Comprehension

94. A 5 year old boy who is taking Carbamazepine for control of generalized seizure presents with signs and symptoms of
pneumonia. Which of the following antibiotics most likely cause toxicity if prescribed concomitantly with Carbamazepine?
A. Ampicillin
B. Erythromycin
C. Vancomycin
D. Trimethoprim-Sulfamethoxazole

18
Ans: B
Ref: Nelsons Textbook of Pediatrics 17th Ed. p 2429
AI: 0.5
Analysis

95. A 15 year old patient has asthma and is taking salbutamol or albuterol via metered dose inhaler. You are asked the known side
effects of this drug by this patient. The most common side effect to tell is
A. Seizure
B. muscle cramps
C. somnolence
D. tachycardia

Ans: D
Ref: Nelsons Textbook of Pediatrics 16th Ed. p 2433
AI: 0.5
Analysis

96. Normal plasma osmolality is approximately

A. 265-275 mOsm/kg H20
B. 285-295 mOsm/kg H20
C. 305-315 mOsm/kg H20
D. 325-335 mOsm/kg H20

Ans: B
Ref: Nelson Textbook of Pediatrics 16th Ed, p 190
AI: 0.5
Recall

97. Hyponatremia defined as <130 mEq/L of sodium may be caused by the following EXCEPT:
A. Mineralocorticoid deficiency
B. Osmotic diuresis
C. Symptom of inappropriate ADH secretion (SIADH)
D. Diabetes insipidus

Ans: D
Ref: Nelson Textbook of Pediatrics 16th Ed, p 195-196
AI: 0.5
Comprehension

98. The following are consequences of hypokalemia EXCEPT:

A. Paralytic ileus
B. Prolonged QT interval
C. Increased neuromuscular excitability
D. Weakness

Ans: C
Ref: Nelson Textbook of Pediatrics 16th Ed, p 198
AI: 0.5
Comprehension

99. A 3 year old child with diarrhea who presented with lethargy, rapid feeble pulses and very sunken eyeballs has an estimated fluid
deficit of:
A. 30-50 ml/kg
B. 60-90 m/kg
C. ≥100 ml/kg
D. ≥150 ml/kg

Ans: C
Ref: Nelson Textbook of Pediatrics 16th Ed, p 213
19
AI: 0.5
Analysis

100.An arterial blood gas determination taken on room air showing the following values pH= 7.3, pCO2= 35 mmHg, HCO3= 16
mmol/L, PO2= 60 mmHg is indicative of:
A. Metabolic acidosis and normal oxygenation
B. Metabolic acidosis and hypoxemia
C. Respiratory acidosis and hypoxemia
D. Normal acid-base balance with hypoxemia

Ans: B
Ref: Nelson Textbook of Pediatrics 16th Ed, p 209
AI: 0.5
Analysis

20