Indonesian Child Health Collegium

NATIONAL KNOWLEDGE BASED EVALUATION

OF INDONESIAN PEDIATRIC RESIDENT
REMED OCTOBER 2014
FOR EACH OF THE FOLLOWING MULTIPLE CHOICE QUESTIONS, SELECT THE
ONE-MOST APPROPRIATE ANSWER
1. For each patient below, choose the most probable diagnosis from the
list of options : A 1 year old baby boy is wheezy, coughing, cyanosed
and breathless with intercostals recession :
A. Bronchiolitis
B. Croup
C. Diptheria
D. Epiglotitis
E. Pneumonia
Jawaban :
2. Which of the above drugs, when prescribed to the mother, is
associated with the following abnormalities in the breast-fed infant :
May result in platelet dysfunction
A. Amiodarone
B. Chloramphenicol
C. Aspirin
D. Sulfasalazine
E. Warfarin
Jawaban :
3. Rash and mucous membrane lesions develop in an infant being 5 days
in the course of an upper respiratory infection with otitis media and
being treated with amoxillin. The most likely diagnosis of this disease is
A. Urticaria
B. Measles
C. Steven Johnson syndrome
D. Kawasaki disease
E. Scarlet Fever
Jawaban :
4. Select one option from the list that is most suitable for the following.
Patients : can follow ingestion dust containing dried faecal material
A. Adenovirus
B. E.Coli
C. Hepatitis A
D. Norwalk virus
E. Rotavirus
Jawaban :

5. Select the most appropriate chemotherapeutic agent from the above

list that corresponds with the following actions and side effect : an
anthracycline with a serious risk of cardiotoxicity
A. Actomyosin D
B. Asparginase
C. Doxorubicin
D. Methotrexate
E. Vincristine
Jawaban :
6. Which is the most likely diagnosis in the following case : an infant is
seen for his 6 week check and found to have a loud ejection systolic
murmur in the third left intercostal space and a single second heart
sound on examination. There is no obvious cyanosis but a suggestion
of mild desaturation. On the chest X ray there is a concavity on the left
heart border and decreased pulmonary vascular markings
A. Ventricular septal defect
B. Atriventricular septal defect
C. Pulmonary valve stenosis
D. Coarctation of the aorta
E. Tetralogy of fallot
Jawaban :
7. A 2900 g black baby boy is born at home at term. On arrival at the
hospital, he appears pale, but the psychical examination is otherwise
normal. Laboratory studies reveal the following:mothers blood type A,
RH positive; babys blood type 0, Rh positive; hematocrit 38%;
reticulocyte count 5%. Which of following is most likely cause of the
anemia?
A. Fetomaternal Transfusion
B. ABO incompatibility
C. Physiologic anemia of the newborn
D. Sickle Cell Anemia
E. Iron Deficiency Anemia
Jawaban :
8. Select the most appropriate oncological diagnosis from the list of
options to explain the following scenario : a young child presents with
fevers and a mass in the femur is noted and a diagnosis malignancy is
made. This malignancy is 30 times more common in white children
compared to black children
A. Ewing Sarcoma
B. Hepatoblastoma
C. Neuroblastoma
D. Teratoma
E. Wilms Tumor

Jawaban :
9. Which one of the following contains least fat content in the milk
A. Human milk
B. Goat milk
C. Buffalo milk
D. Cow milk
E. Horse milk
Jawaban :
10. The infant was born after a difficult forceps delivery and the head
appeared to be swollen in the right parieto-occipital area. Jaundice
developed after 24 hours. The haemoglobin is 12 g/dl; there is indirect
hyperbilirubinemia. What is the working diagnosis of this case?
A. Breast milk jaundice
B. Cephalhaetomas
C. Galactosaemia
D. Preterm birth
E. Sepsis
Jawaban :
11. Select the most appropriate option from the list that would account
for this presentations : by day 4 the abdomen appears erythematous
and the baby becomes apnoeic
A. Tracheo-oesophageal fistula with atresia
B. Gastro-oesophageal reflux
C. Meconium plug syndrome
D. Meckels Diverticulum
E. Necrotizing Enterocolitis
Jawaban :
12. A 14 year-old girl awakens with a mild sore throat, low-grade fever,
and a diffuse maculopapular rash. During the next 24 h, she develops
tender swelling of her wrist and redness of her eyes. In addition, her
physician notes mild tenderness and marked swelling of her posterior
cervical and occipital lymph nodes. Four days after the onset of her
illness, the rash has vanished. The most likely diagnosis of this girls
condition is
A. Rubella
B. Rubeola
C. Roseola
D. Erythema infectiosum
E. Erythema multiforme
Jawaban :

1
3.

A 12 years-old boy presents with a 5-days history of sore

throat, fever, and progressive rightsided neck pain and
swelling. On physical examination, his temperature is 40.0oC,
he has trismus, the right side of his neck is swollen and tender
to palpation, and his chest is clear to auscultation. His white
blood cell count is 30.0x103/mcL (30.0x109), with 80% PMN
leukocytes, 15% lymphocytes, and 5% monocytes. Computed
tomography scan of the neck reveals a deep parapharyngeal
abscess.
Of the following, the MOST appropriate antimicrobial to include
in his therapy is

1
4.

1
5.

1
6.

1
7.

1
8.

A. Ampicillin-sulbactam
D. gentamicin
B. Azithromycin
E. trimethoprimC. Clarithromycin
sulfamethoxazole
For each description below choose the single most likely viral
infection from the list of options:
Caused by a gram negative pleomorphic bacillus
A. Measles
D. Pertussis
B. Rubella
E. Hepatitis A
C. Mumps
A 3-month-old male infant developed otitis media for which he
was given a course of cotrimoxazole. A few days later, he
developed extensive peeling of the skin; there were no
mucosal lesions and the baby was not toxic. The most likely
diagnosis is
A. Toxic epidermal
D. Infantile pemphigus
E. Herpes zoster
necrolysis
B. Staphylococcal
scalded skin syndrome
C. Steven Johnson
syndrome
Examination of the CSF of an 8-year-old mildly febrile child
with nuchal rigidity and intermittent stupor shows the
following: white blood cells all lymphocytes, negative Gram
stain, protein 150 mg/dl, and glucose 15 mg/dl. The most
likely diagnosis is
A. Tuberous sclerosis
D. Acute bacterial meningitis
B. Tuberculous meningitis
E. Cerebral pseudotumor
C. Stroke
Select the most appropriate diagnosis from the list of options
of rash with the illness for which they are the most typical
exanthema. A 3 year old child presents with high fever for 7
days, conjungtival injection, fissuring of the lips and
strawberry tongue, erythema followed by desquamation of the
hands and feet, and a macular rash over the trunk with
cervical lymphadenopathy.
A. Staphylococcal
D. Infectious mononucleosis
E. Henoch-Schonlein
scalded skin syndrome
B. Rubella
purpura
C. Kawasakis Disease
A neonate born to infected hepatitis-B mother, should be
treated with
A. Isolation
D. Immunoglobulins and
B. Immunoglobulins
hepatitis-B vaccine
C. Hepatitis-B vaccine
E. Active immunization soon
after birth and passive
immunization at year 1 of

1
9.

2
0.

2
1.

2
2.

2
3.

2
4.

age
A 10-month old baby previously normal, suddenly becomes
distressed in his crib. The external appearance of genitalia
was normal, except hyperpigmentation. Blood glucose showed
a level of 30mg%. What is the most probable diagnosis?
A. 21 hydroxylase
D. Cushings syndrome
E. Growth hormone
deficiency
B. Hiperinsulinism
deficiency
C. Familial glucocorticoid
deficiency
A poverty-stricken mother suffering from active tuberculosis
delivers a baby. Which one of the following advices would be
the most appropriate in her case:
A. Breast feeding and
D. Stop feeds and isoniazid
BCG immunization
administration
B. Breast feeding and
E. Breast feeding and
isoniazid
rifampycine
administration
administration
C. Expressed breast milk
and BCG immunization
Increased fetal Hb is seen in
A. Juvenile CML
D. Lymphoma
B. Congenital red cell
E. Hepatoblastoma
aplasia
C. Hereditary
spherocytosis
Select the most appropriate pathogen that would account for
the following presentation. A .. old boy presents with painful
red swellings of his shins. Examination of his throat reveals .
exudative tonsillitis
A. Group B streptococcus
D. Respiratory syncytial
B. Haemopilus influenza
virus
C. Mycoplasma
E. Staphylococcus aureus
pneumonia
Select the most appropriate emergency treatment for the
following children: A term baby is born in poor condition.
Apgar scores 3 at 1 minute and 5 at 5 minutes. CPR is
commenced. At 10 minutes he remain bradycardic
A. Adenosine
D. DC shock
B. Adrenaline
E. Dobutamine
C. Atropine
The baby has a temperature of 38oC and tends to bring up its
feed. The circulating white cell count is 18x109/L. Microscopy
of urine from a suprapubic aspirate shows large numbers of
neutrophil polymorphs

A. Breast milk jaundice

B. Cephalhaematoma
C. Galactosaemia

D. Preterm birth
E. Sepsis

25. Select the most appoproiate option from the list that would account
for this presentations : A baby on the post natal ward is seen to have a
cianotyc episode during feeding.
A. Tracheo-oesophageal fistula with atresia
B. Gastro oesophageal reflux
C. Meconium plug syndrome
D. Meckels Diverticulum
E. Necrotising Enterocolitis
Jawaban :
26. Which of the vaccines listed would be contra-indicated in HIV
possitive patients
A. BCG
B. Diphtheria Tetanus Pertussis
C. Haemophilus Influenzae B
D. Measles Mumps Rubella
E. Tetanus
Jawaban :
27. Which diagnosis is most appopriate for this patients?. A 4 month
baby boy is admitted because of inconsolable crying. He had been
trhiving otherwise and was well previously, He seem settled during
assesment, feeds well and is afebrile, Urinalysis reveals white cells
45/HPF, Red cells 10/Hpf, organisms 100,000/ml
A. Acute Nephritis
B. Nephrotic Syndrome
C. Diabetes Insipidus
D. Urinary Tract Infection
E. Chronis Renal Failure
Jawaban :
28. Which of the vaccines listed would be contra-indicatedin subjects
with progressive neurological conditions.
A. BCG
B. Diphtheria Tetanus Pertussis
C. Haemophilus Influenzae B
D. Measles Mumps Rubella
E. Tetanus
Jawaban :
29. Most common tumor in children is
A. Leukemia
B. Lymphoma
C. Wilms Tumor
D. Neuroblastoma
E. Retinoblastoma
Jawaban :

30. Which is the most likely diagnosis in the following case?: A 3-weekold premature infant born at 27 weeks gestation remains ventilated
following surfactant deficient respiratory distress syndrome. On
auscultation of his chest a systolic mumur is heard at the left sternal
edge and pulses are very easy to feel. There is pulmonary plethora on
chest X-Ray.
A. Atrioventricular Septal Defect
B. Coarctation of the aorta
C. Hypoplastic left heart syndrome
D. Patent Ductud Arteriosus
E. Pulmonary Valve Stenosis
Jawaban :
31.

A child can walk up and down the stairs alternating his feet by
A. 12 months
B. 24 months
C. 36 months
D. 48 months
E. 56 months
Jawaban :

32. For this patients with breathlessness, select the most likely
diagnosis: A-three-years-old boys who presents with worsening cough
and breathlessness of 3 weeks duration. His mother was an
intravenous drug abuser. He has always been prone to infections.
When he was 2 years old he had chicken pox for 4 weeks. On
examination, he has an emaciated appearance, his weight is below the
0,4th centile, he has a temprature of 37,6oC and he has generalized
crepitations on auscultation of his chest. A blood count shows severe
lymphopenia.
A. Asthma
B. Hyperventilation
C. Cystic Fibrosis
D. Pneumocystis Cranii
E. Ventricular Septal Defect
Jawaban :
33.

IQ (Intelligence quotient) of child means

A. The creative efficiency of the child
B. The capability of the child to perform intellectual task in relation to
other children of same age
C. The efficiency of memory of child
D. Qualification of the learning ability of child
Jawaban :

34. Which of the following diseases have a very close relationship with
protein energy malnutrition?
A. Tuberculosis
B. Measles
C. Diarrhea
D. Pertusis (whooping cough)
E. Common cold
Jawaban :
35. Choose the most probable diagnosis from the list of option : A 1 year
old baby boy is wheezy, coughing, cyanosed, and breathless with
intercostal recession
A. Asthma
B. Bronchiolitis
C. Croup
D. Epiglottis
E. Pneumonia
Jawaban :
36. For each description below choose the single most likely viral
infection from the list of options : is caused by a paramyxovirus
A. Measles
B. Rubella
C. Mumps
D. Pertussis
E. Hepatitis A
Jawaban :
37. Kwashiorkor is diagnosed in growth retarded children along with
A. Edema and mental retardation
B. Hypopigmentation and anemia
C. Edema and hypopigmentation
D. Hepatomegaly and anemia
E. Global development delay
JAWABAN :
38. The new additives to infant formulas that are supposed to support a
childs development are :
A. Calcium and iron
B. DHA and ARA
C. Comfort protein
D. Whey and casein
E. Vitamin D
JAWABAN :

39. Which the most likely diagnose in this case : A 13-year-old girl is
referred for evaluation of her short stature. She is prepubertal. On
auscultation she has an ejection systolic murmur in the second and
third left intercostals spaces radiating to the back, but is a
symptomatic.
A. Ventricular septal defect
B. Atrioventricular septal defect
C. Pulmonary valve stenosis
D. Coarctation of the aorta
E. Tetralogy of fallot
JAWABAN :
40. An infants sits with minimal support, attempts to attain a toy beyon
reach, rolls over from supine to prone position and does not have
pincer graps is at a development of
A. 3 months
B. 4 months
C. 6 months
D. 8 months
E. 12 months
JAWABAN :
41. The most important factor to overcome protein energy malnutrition
in children less than 3 years is
A. Supply of subsidized food from ration shop
B. Early suplementation of solids in infants
C. Imunization to the child
D. Treatment of anemia and pneumonia in infant and toddlers
E. Treatment of dehydration and electrolyte imbalance
JAWABAN :
42. A routine physical examination of a newborn reveals a grade 2/6,
short, hars systolic murmur at the apex. The newborn is completely
asymptomatic. The most likely diagnosis is :
A. Atrial septal defect
B. Ventricular septal defect
C. Mitral stenosis
D. Mitral regurgitation
E. Patent ductus arteriosus
JAWABAN :
43. A child has short stature and is noted to have a large head with a
prominent forehead. Select the most appropiate diagnosis :
A. Achondroplasia
B. Anorexia nervosa
C. Constitutional delay

D. Familial short stature

E. Growth hormone deficiency
JAWABAN :
44. In a child with a suspected genetic disorder and the clinical
abnormalities of Simian creases choose the single most likely
diagnosis from the lists of options
A. Blooms syndrome
B. Cockaynes syndrome
C. Downs syndrome
D. Hunters syndrome
E. Prader-willi syndrome
JAWABAN :
45. For the following children presenting with diarrhoea which is the
most likely Diagnnosis? : A 8 month old infant has recurrent diarrhoea.
Mother dates the start of symptoms from the an episode of
gastroenteritis. The diarrhoea is explosive in nature
A. Coeliac disease
B. Crohns disease
C. Ulcerative colitis
D. Toddlers diarrhoea
E. Lactose intolerance
JAWABAN :
46. Perioral rash, pigmentation of skin creases and neuritis is seen in
deficiency of
A. Zinc
B. Copper
C. Magnesium
D. Biotin
E. Cuprum
JAWABAN :
47. Select the most appropiate diagnosis from the list of option of the
following descriptions of rash with the illness for which they are the
most typical exanthem : a 12 years old boy develops petechiae and
papules, some of which become purpuric over his buttocks and legs,
associated with painful swollen knees. There is microscopic
haematuria on testing. The platelet count is normal.
A. Staphylococcal scalded skin syndrome
B. Infectious mononucleosis
C. Henoch-schonlein purpura
D. Meningococcal infection
E. Systemic onset juvenile chronic arthritis
JAWABAN :

48.

Select one one option from the list tht is most suitable for the
following Patients. Accepted as the most common cause of infections
diarrhea in children in the developed society.
A. Adenovirus
B. E.Coli
C. Hepatitis A
D.Norwalk virus
E. Rotavirus
Jawaban:

49. Syndrome of vitamin A deficiency is as follows: xeropthalmia,

keratomalacia, hyperkeratosis, growth failure and death. Which of the
following option is most likely a part of the syndrome
A. Conjunctivitis
B. Hordeolum
C. Botot spots
D.Subconjunctival bleeding
E. Retinal ablation
Jawaban:
50. Select the most appropriate diagnosis from the list of option that
would best explain the following case : A 5 year old girl presents with
puffiness around the eyes. Urinalysis confirms proteinuria with a trace
of blood.
A. Henoch Schonlein Purpura
B. Nephrotic syndrome
C. Polycystic kidneys
D.Pyelonephritis
E. Renal tubular acidosis
Jawaban:
51. the preferred intravenous therapy for an infection in animal bite
wounds is :
A. Cefotaxime
B. Ceftriaxone
C. Ciprofloxacin
D.Penicillin
E. Ampicillin and sulbactam
Jawaban:
52. Two weeks after a viral syndrome, a 2-year-old child develops bruising
and generalized petechiae, more prominent over the legs. No

hepatosplenomegaly or lymph node enlargement is noted. The

examination is otherwise unremarkable. Laboratory testing shows the
patient have normal hemoglobin, hematocrit, white blood count and
differential. The platelet count is 15,000/. The most likely diagnosis is
:
A. Von Willebrand disease
B. Acute leukemia
C. Idiopathic thrombocytopenic purpura
D.Aplastic anemia
E. Trombotic thrombocytopenia purpura
Jawaban:
53. The preferred therapy for patients with chronic cholestasis without
biliary obstruction is :
A. Kasai operation
B. Phenytoin
C. Discontinue fatty foods
D.Ursodeoxycholic acid
E. Gentamicin
Jawaban:
54. Select one option from the list that is most suitable for the following
patient: A 2 day old breast fed baby is vomiting after each feed.
Abdominal X-Ray demonstrates a double bubble.
A. Cyclical vomiting
B. Duodenal atresia
C. Meckels diverticulum
D.Gastro-oesophageal reflux
E. Urinary tract infection
Jawaban:
55. Select the most appropriate diagnosis from the list of option that
would best explain the following case: A 2 year old boy is admitted
with a history of bloody diarrhea, abdominal pin and puffiness around
his eyes. He is found to slightly jaundiced. His urea I 2,6 and creatinine
163 mmol/liter
A. Haemolytic uraemic syndrome
B. Henoch Schonlein purpura
C. Renal tubular acidosis
D.Renal vein thrombosis
E. Systemic Lupus Erythematosus
Jawaban:

56. A 17 year old female presents with acute breathlessness. She has had
asthma for approximately 3 years and recently commenced new
therapy. Which agent may be responsible for this exacerbation?
A. Salmeterol
B. Theophylline
C. Beclomethasone
D.Ipratropium Bromide
E. Monteleukast
Jawaban:
57. A 2 year old boy appears with intermittent loose stools for the past 1
month. Stools typically occure during the day and not overnight. The
boy is otherwise healthy. The growth and development are normal. The
most likely diagnosis is :
A. Chronic enteritis
B. Rotavirus enteritis
C. Salmonella enteritis
D.Food allergy
E. Toddlers diarrhea
Jawaban:
58. For the following children presenting with diarrhoea which is the most
likely diagnosis. A 4 month baby girl has severe atopic eczema and is
regularly reviewed in the paediatric clinic. She had now develop
diarrhoea and her weight has been static in recent weeks. A full blood
count shows a slight eosinophilia.
A. Cows milk protein allergy
B. Toddlers diarrhea
C. Lactose intolerance
D.Irritable bowel syndrome
E. Haemolytic uraemic syndrome
Jawaban:
70.

Select one option from the list that is most suitable for the following
patient: A 4 month old baby who is thriving has persistent vomiting
which is occassionally blood stain.
a. Cyclical vomiting
b. Duodenal Atresia
c. Meckels diverticulum
d. Gastro-oesophageal reflux
e. Urinary tract infection
jawaban:

71.

72.

73.

74.

75.

Select the most appropiate option from the list: A child can scribble
and draw a straight line but not yet a circle.
a. 18 month
b. 2 years
c. 3 years
d. 4 years
e. 5 years
jawaban:
Select the most appropriate diagnosis from the list of option that
would best explain the following case: An 11 year old with a
previous history of chronic glomerulonephritis presents with
bruishing and epistaxis. A full blood count confirms a pancytopenia.
a. Haemolytic uraemic syndrome
b. Henoch schonlein purpura
c. Renal Tubular Acidosis
d. Renal vein thrombosis
e. Systemic Lupus Erithematous
jawaban:
A 14 years old girl presents with a history of cough and
breathlessness on exercise. She has seasonal rhinitis, and admits to
have started smoking. Clinical examination is unremarkable. What is
the most likely diagnosis?
a. Gastroesophageal reflux
b. Allergic rhinitis
c. sinusitis
d. asthma
e. croup
jawaban:
which diagnosis is most appropriate for this patient? A 4 years old
girl was admitted to hospital with a 10 day history of progressive
shortness of breath and puffiness of the face. Clinical examination
revealed a raised JVP, pulse rate of 160/min, normal heart sound,
hepatomegaly 2 cm and bilateral basal lung crepitations. She was
seen by her family doctor for a sore throat 2 weeks previously.
a. acute nephritis
b. nephrotic syndrome
c. diabetes insipidus
d. urinary tract infection
e. chronic renal failure
jawaban:
the coagulation in 13-years ld girl with menorrhagia having von
Willebrands disease is:
a. Prolongation of PTT with a normal PT

76.

77.

78.

79.

80.
is:

b. Prolongation of PT with normal PTT

c. Prolongation of both PT and PTT
d. Prolongation of Thrombine Time
e. Decrease of Thrombocyte count
jawaban:
IQ between 50-70 indicates:
a. Mild mental retardation
b. Moderate retardation
c. Severe Retardation
d. Profound retardation
e. No retardation
jawaban:
Rash and mucous membrane lesions develop in an infant being 5
days in the course of an upper respiratory infection with otitis
media, and being treated with amoxillin. The most likely diagnosis of
this disease is:
a. Urticaria
b. Measles
c. Steven- Johnson syndrome
d. Kawasaki Disease
e. Scarlet fever
jawaban:
SSPE (Subacute Sclerosing Panencephalitis) is associated with:
a. Mumps
b. Chickenpox
c. Herpes
d. Measles
e. Varicella
Jawaban:
Select the most appropriate diagnosis from the list of options of the
following descriptions of with the illness fo witch they are the most
typical exanthem: A salmon-coloured, reticulate macular rash
develops mainly over the extensor surfaces of the limbs in a 5 years
old with swing temperature, hot, swollen, painful kness and left
elbow and palpable spleen. The ESR in 95...blood count. C- reactive
protein and chest X-ray are normal.
a. Staphylococcal scalded skin syndrome
b. Infectious mononucleosis
c. Henoch-Schonlein purpura
d. Meningococcal Infection
e. Systemic onset juvenile Chronic Arthritis
jawaban:
Complication of using a hydrogen pump inhibitor (e.g., Omeprazole)

a. Acquired pyloric stenosis

b. Diarrhea
c. Vomiting
d. Gastroesophageal Narrowing
e. Bacterial overgrowth
jawaban: