1. Clinical findings are influenced by a child’s developmental stage.

Which of the
following features of the physical examination is most strongly influenced by
developmental stage?
A. Skin turgor
B. Respiratory rate
C. Lung aeration
D. Mitral valve closure
E. Muscle enlargement

2. The vulnerable child syndrome most influences which of the following

components of the well-child assessment?
A. Physical examination
B. Observation
C. Developmental assessment
D. History
E. Growth
3. Assessment of the state of well-being by observation relies mostly on the
child’s:
A. Nutritional status
B. Motor ability
C. Visual behavior
D. Interaction with parents
E. State variation

4. The mother of a 5-yr old near-drowning victim arrives at the PICU. She is
highly upset and emotional, and forcefully demands to see her child. The best
response to this situation is:
A. To sit with her and explain the procedures of the PICU, including times
permitted for visitation, the number of visitors permitted
B. To direct her to a social workser who would provide a description of the
rules for visitation in the PICU
C. To require that she speak with the child’s physician before being
permitted to visit the bedside
D. To direct her to the waiting area, and inform her that she will be
summoned when the time is right.
E. To take her as soon as possible to the bedsidem after having provided a
brief description of what the room might look like, what medical advices
will be present, and what level of response she might expect from the
child

5. A 2-yr-old child arrives in the PICU in respiratory distress and soon

requires intubation and mechanical support. Because of a heart murmur
detected 2 days later, a cardiology consultation is requested, and the
fellow performing the consultation speaks with the family, indicating the
need for immediate heart surgery. The family is distressed at this news,
and wonders why you have not mentioned the possibility of surgery. The
most appropriate next step in management is to:
A. Ask the family to discuss the matter further with the cardiology service
B. Contact the chief of cardiology and lodge a complaint about the actions
of the fellow
C. Convene a meeting with representatives from your service and the
cardiology service, develop a plan, and then meet with the family to
present recommendations
D. Advise the family not to give much credence to the fellow's opinions
E. Summon the fellow to your office and instruct him/her never to speak
to the family about treatment plans unless you are present

6. You inform the family of a gravely ill child in the PICU that she is very
likely to die soon. The family, consistent with their faith, wishes to apply
oils to her body and place various amulets on the bed. Your reaction
should be to:
A. Refer the matter to the hospital attorney
B. Refer the matter to the chaplain
C. Persuade them that the application of oils and the presence of amulets
cannot possibly influence the child's health status
D. Inform them that so long as what they wish to do does not pose
immediate threat to their child's health, you support their wishes
E. Inform them that hospital policies forbid applying the oil
because it is an unauthorized form of medical treatment

7. Regarding resuscitative efforts, the most important goal is:

A. Restoration of age-appropriate heart rate
B. Appropriate movement of the chest wall
C. Auscultation of equal breath sounds in both lung fields
D. Adequate oxygen delivery and utilization for the body
E. Palpation of equal pulses in all four extremities

8. A 5-yr-old boy presents with petechiae, fresh bruises, low-grade fever,

dizziness, and lethargy. He was brought to the ER and you were the
physician-in-charge. The most appropriate next step in management
would be:
A. Administration of 20 mL/kg of normal saline
B. CT scan of the head to rule out meningococcal meningitis
C. Collection of blood for a culture, CBC, and platelet count
D. Checking the vital signs of the patient accurately
E. Administration of 1-2 mg/kg of furosemide (Lasix)

9. A 4-yr-old girl sustains a head injury after pulling a television set onto
her. The paramedics intubate her at the scene because of inadequate
respiratory effort. On arrival in the ED, she is being ventilated at a rate of
20 breaths/min, and her chest wall rises adequately. Pulse is 100/min,
blood pressure is 100/70 mm Hg, and peripheral perfusion is good. What
is the most appropriate next step in patient management?
A. Immediate head CT
B. Hyperventilation to attain a PCO2 of 25 mm Hg
C. Gentle hyperventilation and an intravenous bolus of mannitol
D. Evaluation of level of alertness and pupil size and reactivity
E. Intravenous bolus of 3% saline

10. Risk factors for injury include all of the following except:
A. Toddler age
B. Female gender
C. Front-seating in an automobile
D. Chaotic family stress
E. Poverty

11. A 32 y/o G1P1 (1001) gave birth to her baby at 30 weeks AOG. On the
1st minute of delivery, the baby was noted to be inactive, HR <100, with
minimal response to stimulation, pink body with blue extremities, with
slow and irregular breathing. What is the APGAR score of the baby?
A. AS 3
B. AS 4
C. AS 5
D. AS 6
E. AS 7

12. A 32 y/o G1P1 had delivery of her baby at 30 weeks AOG. Upon
examining the baby, you take note of hair on the scapular area. How do
you classify it?
A. tufts of hair
B. thinning
C. Sparse
D. lanugo
E. curls of hair

13. The neonatal period is a highly vulnerable period. Periods of

development during the early birth to less than seven days may be
classified as:

A. Perinatal period
B. Very early neonatal period
C. Early neonatal period
D. Late neonatal period
E. Infancy
 14. All of the following in the gestational history is important to ask,
except:
A. alcohol, smoking
B. roentgen exposure
C. familial diseases
D. outcome of previous pregnancy
E. previous kidney transplant of the mother

15. Ideally, newborns should be examined at least 2 and preferably 3 times

between birth and discharge. Which of the following timing is true?
A. Delivery room immediately at birth
B. Nursery or rooming-in within 12 hours of birth
C. Upon discharge
D. All of the above
E. None of the above

16. The average head circumference of neonates is:

A. 30 cms
B. 31 cms
C. 32 cms
D. 33 cms
E. 35 cms

17. Which of the following statements is false?

A. Symmetric IUGR means the brain size corresponds with body size
B. Symmetric IUGR often has a later onset
C. Symmetric IUGR is associated with diseases that seriously affect fetal
cell number
D. Symmetric IUGR can be affected by conditions with chromosomal,
genetic, malformation, teratogenic, infectious, or severe maternal
hypertensive etiologies.
E. It is important to assess gestational age carefully in infants suspected to
have symmetric IUGR because incorrect overestimation of gestational age
may lead to the diagnosis of symmetric IUGR
18. Neonates born with weight above the 90th percentile can have the
following adversities after delivery, except:
A. perinatal asphyxia
B. hypoglycemia
C. clavicular fracture
D. Respiratory distress syndrome
E. sensorineural hearing loss

19. In Ballard scoring, this is defined as the angle between the hypothenar
eminence and the anterior aspect of the forearm:

A. Popliteal angle
B. Brachiocephalic angle
C. Square window
D. Arm Recoil
E. Scarf sign

20. Which of the following physical examination findings can be seen

among preterm neonates?
A. descending testes
B. scrotum is flat and smooth
C. rugae is visible on scrotum
D. labia majora is bigger than the clitoris
E. large genitalia

21. The posterior fontanel closes at:

A. 6-7 months
B. 2-4 months
C. 9-11 months
D. 1-3 months
E. at birth

22. Large fontanel can be associated with the following conditions,

except:

A. Hypothyroidism
B. Hyperthyroidism
C. Trisomy 13
D. Trisomy 18
E. Trisomy 21

23. Soft tissue swelling that crosses suture lines which may be secondary to
accumulation of blood or serum above the periosteum from prolonged labor
is defined as:
A. Cephalhematoma
B. Caput succudeneum
C. Macrocephaly
D. Craniosynostosis
E. Microcephaly

24. Temporary asymmetry of the skull resulting from the birth process is
called:
A. Cephalhematoma
B. Caput succudeneum
C. Molding
D. Craniosynostosis
E. Microcephaly
 25. The general appearance of the face should be noted with regard to
dysmorphic features which are the following, except:

A. hypertelorism
B. low-set ears
C. micrognathia
D. average philtrum
E. cleft palate

Matching type:
A. Caput succudeneum
B. Cephalhematoma

A. 26. Condition marked by localized soft tissue edema with poorly defined
outline
A. 27. present at birth, does not increase in size
B. 28. caused by subperiosteal hemorrhage
A. 29. caused by pressure of the fetal head against the cervix during labor
B. 30. disappears from several weeks to months after birth
B. 31. swelling does not cross suture lines
B. 32. complications: defective blood clotting, skull fracture, jaundice
B. 33. appears after birth, increases in size for 2-3 days
A. 34. complications are rare
B. 35. Condition marked by localized soft tissue edema with well- defined
outline

A. 36. tiny, sebaceous retention cyst, whitish with pin head-sized concretions

B. 37. numerous small areas of red skin with yellow-white papule in the
center

D. 38. pinpont clear vesicle that suddenly erupt in profusion over large areas
of the body surface

E. 39. Benign self limiting condition, polymorphic in nature with 3 stages:

Pustules, ruptured vesicopustules with scaling, hyperpigmented macules

C. 40. True vascular nevus usually seen in occipital area, eyelids and glabella

A. Milia
B. Erythema toxicum
C. Macular hemangioma
D. Milia crystallina
E. Neonatal pustular melanosis
41. Abdominal defect where the intestines are covered by peritoneum,
umbilicus is centrally located.
A. Gastroschisis
B. Omphalocoele
C. Diaphragmatic hernia
D. Hirschprung’s disease
E. Prune-belly syndrome

 42. Physical examination of the hips among neonates includes

abducting the hips with inward and upward pressure over the greater
tronchanter. This examination is known as:
A. Barlow maneuver
B. Ortolani maneuver
C. Heimlich maneuver
D. Ortolani’s sign
E. Barlow’s sign

42. Abnormal fusion of digits is known as:

A. Polydactyly
B. Syndactyly
C. Ectrodactyly
D. Arachnodactyly
E. Brachydactyly

43. A condition where the foot is turned downward and inward, sole is
directed medially
A. Talipes valgus
B. Talipes calcaneus
C. Talipes equinovarum
D. Talipes varus
E. Talipes equinus

44. A condition where the penile urethra is on the dorsal portion of the penile
shaft:
A. epispadias
B. hypospadias
C. ambiguous genitalia
D. undescended testes
E. hydrocele

45. A cystic swelling on the floor of the mouth is known as:

A. mucocele
B. ranula
C. deciduous teeth
D. epstein pearl
E. cleft palate