PEDIATRICS II SECOND LONG EXAM

BAPS
Note: only source was the recording.

1.

The main pathophysiologic mechanism that differentiates dengue fever from dengue hemorrhagic fever is
B. evidence of capillary leakage

2.

A 5 year-old boy was brought in due to fever of 5 days duration. He has been complaining of severe epigastric
pain with several episodes of vomiting. Gum bleeding was also noted by the mother. On PE, he appears weaklooking, febrile with a temperature of 38 deg C, BP = 90/50. Palpation of the abdomen reveals epigastric
tenderness with a liver edge of 4 cm below right subcostal margin. CBC done at the ER reveals Hgb = 11, Hct
= 44, WBC=3, segmented = 22, lymphocytes = 78, platelet = 90,000 or 19,000?? The necessary criteria to
make a diagnosis of dengue hemorrhagic fever in this case is one of the ff except?
C. Hepatomegaly

3.

A 10 yr-old boy suspected to have dengue is on his 7 th day of illness. The best serological test to be done at
this point would be?
B. Dengue IgM capture

4.

An 8 yr old male was brought to the ER due to fever of 5 days duration. This was associated with several
episodes of vomiting of previously ingested food, and persistent epigastric pain. On PE, HR=100, RR=25,
BP=100/60. Dengue is the likely diagnosis. As such, how would you classify this patients dengue?
B. Dengue with warning signs - Because of several episodes of vomiting and epigastric pain

5.

Which is true regarding the Aedes aegypti mosquito?

B. flight range is 50m

6.

An 8 month-old girl was brought to the OPD because of generalized maculopapular erythematous rashes
extending from the face to the toes of the feet. The mother was worried because the patient remained highly
febrile at 39 deg C with persistent coughing and consistent runny nose. You know that there was an
associated conjunctivitis and suspect that the child has measles. The following is the best advice for the
mother
A. Admit to the pediatric unit and start antibiotic treatment.
Remember: If the rashes extend down to the foot, you have to anticipate bacterial infection so you have to start antibiotic
treatment.

7.

A 4 month-old girl was brought for consult because of a recent exposure to a neighbor with measles. Mother
claims that the baby was brought to the neighbors house 4 days ago while she went to look for work. What is
the best the best thing that can be done to the patient?
A. Give measles immunoglobulin (You cannot give the vaccine because the patient is only 4 months old.
Remember, the earliest time you can give the vaccine is at 6 months.)

8.

A 15 year-old leukemic girl was exposed to her sibling with Varicella 2 days ago. The Varicella zoster
immunoglobulin is not available in the Philippines. At this point in time, what is the alternative post-exposure
prophylaxis that can be given to a leukemic patient?
B. IV Ig

9.

Which of the following viral exanthem diseases present with photophobia?

B. Rubeola

10. A 10 yr-old girl was brought to the OPD because of generalized fine erythematous maculopapular rashes. The
physician who saw the patient suspected the rashes to be Rubella. Which data in the history would be more
specific to the rashes of Rubella?
D. Rashes usually persist for 3 days
11. This viral exanthematous disease presents with vesicular lesions on the hands and feet with associated oral
ulcers. The etiologic agent associated with pulmonary and CNS complications is?
D. Enterovirus 71
12. Fetal hydrops may be a uterine complication of which virus?
B. Parvovirus B19
13. One of the most dreaded complications of chickenpox is secondary bacterial infection of the lesion. The most
common bacterial agent involved is?
C. S. pyogenes

14. A 16 year-old girl was brought to the doctor because of fever and distinct pinpoint maculopapular rashes. She
was diagnosed with a viral exanthem and was given supportive measures. The rashes resolved spontaneously.
A few days later, she experienced joint pains on the knees and swelling of the small joints of the hands. The
clinical course is usually seen in?
C. Rubella
15. A 12 month-old boy was given his first dose of varicella vaccine. When is the earliest time to give the second
dose?
A. 15 months (you can give as early as 3 months after 1 st dose)
16. What is the congenital anomaly expected if the mother contracted Rubella during her 12 th week of gestation?
D. Deafness
17. The most likely antibiotic regimen for patients with measles pneumonia are the ff except?
D. ceftazidine and amikacin
Organisms that can cause measles pneumonia are Staph, Strep and H. influenza. Other antibiotics that were
included in the
choices are oxacillin and chloramphenicol, cefuroxime and amoxicillin-clavulanic acid. Ceftazidine is for Pseudomonas
infections.

18. The ff etiologic agents may be associated with a circular type of rashes.
A. Coxsackie A16
19. A patient is diagnosed with Varicella. The most appropriate infection control is?
A. Isolation in a room with negative air pressure
20. Which is true of measles infection and sequelae?
C. Patients are contagious for 4 days before and after onset of the rash. (Nelson said its 3 days before and
4-6 days after onset of rashes.)
21. A 15 month-old boy has high-grade fever for 3 days, documented highest temperature is 40 deg C. After a day
without fever, he developed generalized maculopapular rashes that lasted for 2 days. The most likely etiologic
agent involved is?
B. HHV6 (Roseola infantum)
22. Clinical diagnosis of measles may be made through recognition of the ff except?
D. Characteristic vesicular rash
23. Which of the ff best describes mumps clinical course?
C. May be asymptomatic in 20% of patients
24. The more common presentation of mumps in pre-school aged children is?
B. cough and colds
25. Which characteristic of the rash is not a differentiating feature of measles from rubella?
A. erythematous
26. Swimmers itch is seen in this parasitic infection?
A. Schistosomiasis
27. The triad of abdominal pain, borborygmy, and diarrhea leading to protein-losing enteropathy is best treated
with?
A. Mebendazole (This is Capillaria philippinensis. This is a nematode so give mebendazole.)
28. Part of the management and prevention of Enterobiasis are the ff except?
B. Proper disposal of feces (Enterobius is transmitted via autoinoculation. Scratch the anus and
inhale/ingest the ova.)
29. A 15 year-old girl from Leyte was brought to Manila for consult. She has facial edema and abdominal
distention. She has portal hypertension and hepatosplenomegaly. The most important diagnostic tool to rule
out the patients condition would be?
B. COPT
30. A 5 yo boy was brought for consult because of passing out of spaghetti-like worms during defecation. The
mother also claimed that her son sometimes complained of vague abdominal pain. What is the diagnostic
method of choice to establish the etiologic agent?

B. routine fecal exam (this is ascariasis)

31. What is the treatment of choice for a 7 year-old girl who complains of perianal pruritus especially noted at
night? Stool exam reveal a D-shaped ova.
C. pyrantel pamoate. (this is enterobiasis)
32. Which is true of Trichiuriasis?
B. Diarrhea and dysentery may cause nutritional impairment
33. The protozoan most likely implicated as a cause of pneumonia in immunocompromised patients is?
C. Pneumocystis jiroveci
34. A 16 yr old boy was admitted due to generalized tonic-clonic contractions of several episodes. A CT scan was
done revealing a ring-like enhancement on the parietal area. He is fond of eating grilled pork. He also
mentioned finding flat ribbon-like? material in his underwear. The primary impression for this patients
condition is caused by?
C. Taenia solium
35. A heavy infection of this nematode can cause an intestinal bolus of round worms leading to obstruction?
D. Ascaris lumbricoides
36. A 5 year-old girl was rushed to the ER due to fever of 3 days duration. There were no significant signs and
symptoms except occasional cough. PE revealed a highly febrile child with T=39C, HR=130, RR=35. CBC
revealed anemia with leukocytosis and neutrophilia. Patient is awake but irritable, with skin that is firm to
touch?? and with equal pulses. Which condition best describes the patients illness?
A. SIRS (systemic inflammatory response syndrome)
37. A 2 month-old girl was admitted in the hospital for 7 days with pneumonia was transferred to the ICU and
mechanically ventilated. The empiric antimicrobial treatment for mechanically-ventilated patients should
always cover for?
C. Gram negative bacteria
38. The management for septic shock include the following except?
C. corticosteroid administration
39. The following etiologic agent is least likely to be considered in patients presenting with fever and petechiae?
B. S. pyogenes
40. IL-1, together with this cytokine causes fever in patients who are septic.
B. TNF
41. A 6 week-old infant has gained no weight since birth. Her skin appeared mottled and an indirect bilirubin level
is measured at 24 mg/dl. Her extremities are cold and her temperature is 35 deg C. The most likely diagnosis
is?
B. hypothyroidism
stunted physical growth, subnormal temp, presence of typical respiratory distress syndrome, cry a little and sleep a lot, poor appetite

42. Type I diabetes mellitus is most often associated with?

C. Antibodies to glutamic acid dehydrogenase (other autoantibodies: islet cell cytoplasm, from Nelson)
43. Hyperglycemia during diabetic ketoacidosis maybe associated with?
C. hyperkalemia
44. Ketoacidosis manifests with?
A. acute abdominal pain, nausea, vomiting, and rapid breathing
45. A 6 year-old girl presents with breast enlargement and pubic hair development, otherwise, she is
asymptomatic. The serum LH level is elevated. The most likely diagnosis is?
D. central precocious puberty
46. The principal regulator of extracellular tonicity or osmolality is?
B. vasopressin
47. Extravolume hemostasis is principally regulated by?
C. renin-angiotensin system

48. Normal fasting blood glucose level is?

C. 100 mg/dl
49. A 4 year-old with bacterial meningitis developed generalized convulsions on the 4 th day of illness. Investigation
revealed SIADH is the most likely reason for the convulsions. The treatment of SIADH will include which of the
following?
C. restriction of fluid intake
50. The triad of polydipsia, polyuria, and hypernatremia is most likely due to?
D. diabetes insipidus
51. the earliest sign of congenital hypothyroidism is:
A. prolonged neonatal jaundice
This is due to the delayed maturation of glucoronide conjugation

52. a 14-year old girl with polyuria, polydipsia, and hypernatremia was given oral vasopressin to which she
responded well. Most likely diagnosis:
B. central diabetes insipidus
53. Most common cause of congenital hypothyroidism is:
C. thyroid dysgenesis
54. Most common cause of thyroid dysgenesis is:
A. Ectopia
55. The renal threshhold for glucose is:
B. 180mg/dl
56. Uncontrolled type 1 DM is due to severe insulin deficiency and may lead to ketonuria which is due to:
C. Increased lipolysis
57. The monitoring of treatment compliance in patients with Type 1 DM is:
A. Hgba1c levels
58. Most common cause of death in patients with diabetic ketoacidosis
B. Cerebral edema
59. The first step in the treatment of PKA even before the administration of intravenous insulin is:
A. Parenteral rehydration with 0.9 saline solution
60. A newborn with ambiguous genitalia is determined to be a genetic female. Virilization(?) is most commonly due
to:
A. 21-hydroxylase deficiency
61. Among the device-associated infections in the Pedia ICU, this is the most common health-care associated
infection:
B. Catheter-related bloodstream infection
62. For the surgical-site infections, which of the ff is the most commonly reported pathogen:
B. Staph. aureus
63. Which of the following entities should be admitted in single-patient room with negative air pressure ventilation:
A. (Couldnt understand the recording but the explanation was: because these can be transmitted
through droplets like in varicella)
64. Surveillance of health-care associated infections is necessary to understand thespecific infection problems in
hospitals. Which of the following surveillance strategy is the best:
D. active searching for cases by trained personnel
65. An 8-year old male was rushed to the hospital because of high-grade fever, headache, and sore throat of 12h
and petechial rash of an hour duration. Vital signs at ER were the ff: Temp of 39.6 per axilla, BP of 80/60, HR of
140, RR of 20. He was ill-looking and drowsy. Which of the ff categories of transmission-based precautions
warrants its application in this case on admission:
B. Droplet

66. When is the lifting of the precautions in the patient in the above case permitted?
A. 24 hours after initiation of effective antimicrobial therapy

67. A family is referred to you because a 35-year old father with 3 children was recently diagnosed to have TB with
positive AFB smears. Children consisting of a 10-year old daughter and 2 sons, aged 4 and 1, had BCG at birth
and were all asymptomatic. A 5.0 TU Mantoux test and a CXR revealed the following:
10-year old daughter: Tuberculin test 2mm, CXR normal.
4-year old son: Tuberculin test 5mm, CXR normal.
1-year old son: Tuberculin test 15mm, CXR with perihilar infiltrates with enlarged LN.
Which of the ff would you do for the one-year old son:
B. Start treatment with 2HRZ and 4HR
68. Which of the ff would you do for the 4-year old son, above:
C. Start with INH for 3 months then repeat Mantoux test
69. Which of the ff would you do for the 10-year old daughter, above:
B. No treatment but repeat Mantoux test in 3 months
70. Which of the following should be done in the follow-up care of the children, above:
C. Obtain AFB culture plus from the mother
71. In congenital TB, the Ghons complex is found in the:
B. liver
72. Which of the ff is the recommended regimen for TB meningitis:
D. 2HRZE/10HR
73. Which of the ff is considered to have latency infection:
B. A 5-year old with positive BCG, positive exposure, tuberculin skin test of 10mm, with no signs and
symptoms, and negative CXR
74. A 3-year old child has a positive tuberculin skin test. Which of the following would be the most suggestive of
miliary TB?
C. hepatosplenomegaly
75. which of the ff statements is NOT true of (?)
D. the annual risk of infection for TB is 2.5% will not increase will not change for the last 15 years (?)
76. A 15-year old male recently diagnosed with PTB. After a month of HRZE regimen, he remains symptomatic, still
with actively rising temperature, cough, and back pain. Which of the ff actions would you do for this patient:
A. Obtain AFB and of the patient.
77. A 6-month old female infant was brought to the ER with fever without lethargy. Which of the following is
associated with an increased risk for serious bacterial infection in this child?
A. Fever of greater than 40 degrees Celsius
78. A 2-year old female with a 2-month history of cough was brought to the ER because of respiratory difficulties.
She had a temp of 39 C, with intercostal retractions and crackles on both lung fields. CXR showed bilateral
pulmonary infiltrates. Which of the ff is the culprit:
A. Hemophilus influenzae B
79. Considering the preceding case, on admission, you will start the patient on which of the ff antibiotics:
B. Ampicillin
80. A 7-year old female grade 1 student was brought to the OPD because of high-grade fever, sore throat, and
difficulty swallowing. PE findings showed hyperemic oropharynx, enlarged tonsils with exudates, petechiae of
soft palate, tender submandibular and anterior cervical LN. The most cost effective antibiotic of choice in this
case would be:
A. Phenoxymethylpenicillin
81. Which of the ff statements is/are true of exudative tonsillopharyngitis:

A.

Majority are still caused by viruses

82. A 10-year old male spends his summer vacation in the province. He will accompany his grandpa to the farm.
About 2 weeks prior to the opening of classes, he developed high-grade fever, associated with headache,
macular rashes along the trunk. A black eschar was noted on right inguinal area. He received measles vaccine
at 9 months, MMR at 16 months and at 6 years of age. What is your impression of the case?
B.
83. Treatment of choice in the case above would be:
B. Tetracycline
84. Which of the ff drug regimens is appropriate prophylaxis for close contacts, 5(?) years and below, of a child
with meningococcal meningitis:
C. Rifampicin for 2 days
85. A 16-year old sexually-active male comes to you because of low-grade fever, sore throat, headache, and
appearance of a sore on his penis which does not hurt about 4 weeks prior to the appearance of symptoms. He
has been sexually active for the past 2 years, and has had a steady girlfriend for the last 6 months, but admits
to occasional sexual activity with other girls during that time. Which of the following is your diagnosis in this
case:
C. syphilis
86. Which of the ff is the best treatment option in the case above:
C. Benzathine penicillin, 2.4 mu given IM single-dose
87. A one-month old male was rushed to the ER because of high-grade fever and irritability of one day. PE revealed
bulging anterior fontanelle with neck rigidity. Considering CNS infection, the most likely pathogen would be:
D. E. coli
88. A 4-year old female has been feverish for the past 3 days, and was rushed to the ER because of respiratory
distress, as evidenced by stridor of 2 hours duration. The patient was toxic-looking with multiple enlarged
cervical LN and had a grayish membrane on the tonsils. It bled when tried to be removed. The patient is
suffering from:
A. Diphtheria
89. A 10-year old female from San Mateo, Rizal, was rushed to the ER because of an axillary temperature of 40 C
of 6 hours duration, associated with intense headache and drowsiness. PE findings showed a drowsy child with
petechiae on all extremities, hyperemic oropharynx, supple neck, and a BP of 80/60. What is your diagnosis:
B. meningococcemia
90. Which of the ff lab results may be a bad(?) prognosticator in the case above:
C. ESR of 5mm per hour
91. Which of the ff would be a very common cause of prolonged fever and malaise (?):
B. malaria
92. In TB meningitis, the exudate tends to be more severe:
B. At the base of the brain
93. Which of the ff characterizes congenital syphilis:
A. involvement of the long bones
94. Which of the ff characterizes staphylococcal food posioning?
B. Extensive vomiting, abdominal cramps, and diarrhea
95. Which of the ff characterizes pertussis:
B. ______ followed by a gradual worsening of cough and finally whooping
96. Which of the ff blood cell counts is most suggestive of pertussis:
C. 20,000 with 75% leukocytes
97. The first clinical manifestation of tetanus neonatorum usually is:
D. Difficulty in talking and swallowing
98. The 3 most common bacterial causes of meningitis in childhood, excluding the neonatal period, are:
A. Hib, Strep. pneumoniae, N. meningitidis

99. The three most common causes of acute otitis media in children 3mos-5years are:
B. Hib, Strep. pneumoniae, Moraxella catarrhalis
100.
A.

Which of the ff is the drug of choice for the treatment of pertussis?

Erythromycin