PEDIA 3B AY21-22 FIRST BIMON EXAM 9/28/21

PULMO, NEPHRO, NEONAT

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1.A 2-day old term neonate has an abrupt onset of excessive purulent yellow
discharge observed from both eyes with bilateral lid edema and erythematous
conjunctivae. Gram-stain and culture of the discharges were done. Which of the
following is the most appropriate initial management while waiting for test
results?
(1 Point)
Select your answer

2.The presence of WBC and RBC casts in the urine points to hematuria of ________
origin.

(1 Point)
Select your answer

3.A 4-year old male child was brought for consult due to generalised muscle
weakness. Lab result showed hypokalemia. A renal problem is highly considered
specifically involving the_______

(1 Point)
Select your answer

4.The gold standard in the diagnosis of UTI is _____________

(1 Point)
Select your answer

5.You attended a normal spontaneous vaginal delivery of a term infant. Based on

the Early intrapartum newborn care (EINC), what properly time-sequenced
interventions should you do?

(1 Point)
Select your answer
6.Which one of the following conditions WILL NOT cause transient proteinuria?

(1 Point)
Select your answer

7.A 5-year old girl was diagnosed with acute renal injury. Among these clinical
findings and laboratory results, which one is NOT an indication for dialysis?

(1 Point)
Select your answer

8.In children, Covid 19 is usually mild, however in rare cases, children can be
severely affected with clinical manifestations of persistent fever, systemic
hyperinflammation and multiorgan involvement which differ in adults. This
condition is called ____________

(1 Point)
Select your answer

9.A 6-year old child has cough, fever and tachypnea.  Onset is abrupt and fever is
high grade.  On auscultation, fine crepitations are noted.  Chest radiograph
reveals lobar pneumonia.  The most likely diagnosis is:

(1 Point)
Select your answer

10.A 3-month-old develops respiratory distress with fever, tachypnea, stridor, and
retractions during an URTI. The parents report that the child is noisy breather
with sounds becoming worse when the child is positioned supine. The most likely
diagnosis is

(1 Point)
Select your answer

11.A 32-week newborn who had RDS with sepsis was on mechanical ventilation
for 10 days. This patient should be referred to Ophthalmologist for screening for
____________

(1 Point)
Select your answer

12.A 6-year-old girl is brought to the physician because of increasing swelling

around her eyes for the past 3 days. Her vital signs are within normal limits.
Physical examination shows periorbital edema and abdominal distention with
shifting dullness. Laboratory studies show a serum albumin of 2 g/dL and a serum
cholesterol concentration of 290 mg/dL. Urinalysis shows 4+ proteinuria and fatty
casts. Which of the following is the most likely diagnosis?

(1 Point)
Select your answer

13.A 4-year-old boy brought to ER with a fever and a sore throat. On examination
he was drooling, sitting still and upright with an open mouth, with a soft
inspiratory stridor. The Patient has incomplete immunization. What is the most
likely diagnosis?

(1 Point)
Select your answer

14.Which of the following the maternal pregnancy-related conditions IS LEAST

likely associated with accelerated lung maturation and surfactant production?

(1 Point)
Select your answer

15.A 4-day-old newborn is brought to the OPD because of a generalized rash of

1 day. He was born term to a mother who had a history of gonorrhea, which was
treated 4 years agoAnthropometric measurements and vital signs were within
limits. Pertinent PE: erythematous maculopapular rash and pustules with an
erythematous base over the face, trunk and extremities, sparing the palms and
soles and no other abnormalities. Which of the following is the most likely
diagnosis?

(1 Point)
Select your answer

16.Which of the following statements is TRUE of Hemolytic-uremic Syndrome?

(1 Point)
Select your answer

17.Prevention of hypothermia in the community should focus on:

            a. Kangaroo mother care 
            b. Keeping the room warm (25-28 degree C) 
            c. Ensure adequate breastfeeding 

(1 Point)
Select your answer

18.A 6-year-old boy is brought to the physician because of increasing swelling

around his eyes for the past 3 days. During this period, he had frothy light-yellow
urine. On PE he appears tired, temperature is 37°C , PR 90/min, and BP is 105/65
mm Hg. He has periorbital and pitting edema of the lower extremities.
Cardiopulmonary examination shows no abnormalities. Urinalysis showed
hematuria, 3+ protein with fatty cast. What is the mainstay treatment of this
condition?

(1 Point)
Select your answer

19.A full term infant who weighs 4.5kg (LGA) was born to a diabetic mother by
caesarian section. This neonate should be screened for ___________ within the first
24 hours of life.

(1 Point)
Select your answer

20.A previously healthy 8-yr-old girl presents with upper respiratory symptoms of
one week duration, with worsening cough and fever. PE reveals a temperature of
39°C, RR of 30/min and inspiratory crackles in both lung fields. Oxygen saturation
is 91-92%. Chest film shows scattered infiltrates in both lung fields. What is the
mechanism  of hypoxia here?

(1 Point)
Select your answer
21.Bilateral flank masses, hypertension and a history of oligohydramnios in an
infant are strongly suggestive of:

(1 Point)
Select your answer

22.What is the recommended empiric antibiotics for early onset sepsis in a

neonate?

(1 Point)
Select your answer

23.A newborn male delivered vaginally at 41 weeks’ gestation was noted to have
persistent central cyanosis with increased work of breathing and coarse breath
sounds after birth.The baby requires a high oxygen concentration to maintain
appropriate saturations. There was a background of non-reassuring fetal heart
rate and meconium-stained amniotic fluid but no sepsis risk factors. Based on the
history and PE findings, which of the following chest radiograph findings is
consistent with the condition?

(1 Point)
Select your answer

24.Which chronic glomerulonephritis has a slowly progressive course?

(1 Point)
Select your answer

25.UTI is present if the specimen taken via suprapubic aspiration has:

(1 Point)
Select your answer

26.A 2-year-old boy comes to the ER with sudden onset of cough and respiratory
distress. His father was watching football on television and eating popcorn when
he noted his son coughing on the floor. On PE, wheezing was heard over the left
lung. What is the most appropriate study to order? 

(1 Point)
Select your answer

27.Which of the following is not a part of the medical management of acute

kidney injury(AKI)?

(1 Point)
Select your answer

28.A 14-year-old boy is brought to the emergency department because of acute

left-sided chest pain and dyspnea following a motor vehicle accident. His pulse is
122/min and blood pressure is 85/45 mm Hg. Physical examination shows
distended neck veins and tracheal displacement to the right side. The left chest is
hyperresonant to percussion and there are decreased breath sounds. What is
your diagnosis?

(1 Point)
Select your answer

29.Which of the following physical finding is considered abnormal in a  neonate

less than 24 hours of age?

(1 Point)
Select your answer

30.A 1-year old infant was brought to the OPD for immunization. On history,
mother revealed that the patient was exposed to a relative who was diagnosed to
have active Tuberculosis more than a month ago. Which of the following would
you advise to rule out TB infection? 

(1 Point)
Select your answer

31.Which of the following patients who is awake and alert is tachypneic? 

(1 Point)
Select your answer

32.An 18-month old girl had a 2-day history of rhinorrhea, pharyngitis and low-
grade fever.During the night, she wakes up with a barking cough, inspiratory
stridor and a hoarse cry. Which of the following is the most likely etiologic agent
causing the condition?

(1 Point)
Select your answer

33.A 3.5 kg full-term infant is born after an uncomplicated delivery with Apgar
score of 9 and 9 at 1 and 5 minutes. The infant cries vigorously after birth but
then goes into a quiet state. Within 10 minutes, the infant develops cyanosis and
respiratory arrest. During resuscitation, the nasogastric tube cannot pass through.
The most likely diagnosis is

(1 Point)
Select your answer

34.A fullterm neonate who was delivered by caesarian section developed

tachypnea with intercostal retractions few minutes after delivery. On auscultation,
occasional crackles were heard. Chest Xray done showed prominent pulmonary
vascular markings and fluid in the interloper fissures. Prenatal course was
unremarkable. Which of the following showed be the primary consideration?

(1 Point)
Select your answer

35.An infant has the following findings at 5 minutes of life: pulse:130/min,

cyanotic hands and feet, good muscle tone, strong cry and grimace. The APGAR
score is:

(1 Point)
Select your answer

36.During drying and stimulating the newly delivered baby, your rapid
assessment shows that the baby has good muscle tone and is crying. What would
be your next action/step? 

(1 Point)
Select your answer
37.Grunting is produced by expiration against a partially closed glottis in an
attempt to maintain positive airway pressure during expiration for as long as
possible. It is MOST commonly prominent in which of the folowing conditions?

(1 Point)
Select your answer

38.A 5-year old male child was brought to the ER unconscious after he was
thrown off from a motorbike without a helmet. It was noted that there was
a cyclic pattern of waxing and waning of breathing interposed by central
apneas/hypopneas. What do you call this kind of breathing?

(1 Point)
Select your answer

39.Which of the following IS NOT part of management of apnea of prematurity?

(1 Point)
Aminophylline

Caffeine

Continuous nasogastric feedings

Continuous positive airway pressure (CPAP)

40.A neonate develops purulent eye discharge at 7 days of life. The mother
recalled that the infant initially had a watery eye discharges and infant’s
conjunctivae appear red and swollen. What is the most common ethology in this
situation?
(1 Point)
Select your answer

41.A 12-year old adolescent is having on and off cough for three weeks.  He also
complained of body malaise with occasional nausea.  He was treated with one-
week course of 2nd generation cephalosporin orally but afforded no relief.  Chest
x-ray revealed interstitial pattern with hyperinflation.  What is the most
appropriate treatment at this time?

(1 Point)
Select your answer

42.Steroid resistant Nephrotic Syndrome is defined as failure to achieve

remission 
after _______ wk of corticosteroid therapy?

(1 Point)
Select your answer

43.In a 3-week-old term neonate with fever, the most specific sign suggestive of
meningitis is  

(1 Point)
Select your answer

44.A 17-year-old man came in for consult because of a 2-week history of cough

and decreased urination. The cough was initially nonproductive, but in the last
few days he has coughed up small amounts of blood-tinged sputum with clots.
He has not had any fevers, chills, or weight loss. PR is 115/min and BP is 125/66
mm Hg. PE revealed dried blood around the lips. Lab tests showed creatinine of
2.9 mg/dL. Results of a serum antineutrophil cytoplasm antibody test is negative.
A biopsy specimen of the kidney is shows fibrin crescents in Bowman
space. Which of the following is the most likely diagnosis?

(1 Point)
Select your answer

45.A 800-g male infant was born at 24 1/7 weeks' gestation. His hospital course
was complicated by cholestatic jaundice, feeding intolerance, and chronic
respiratory failure requiring intubation from birth until his death from E.
coli pneumonia and bacteremia at 105 days of age. Which of the following
features would you expect to see on pathologic examination (autopsy) of this
infant's lungs? 

(1 Point)
Select your answer

46.Which one of the following is the most important cause of jaundice presenting
in the first 24 hours of life?
(1 Point)
Select your answer

47.Conventional criteria for the diagnosis of Sinusitis based on the presence of at

least __

(1 Point)
Select your answer

48.A neonate born to a HBS Ag (+) and HBS Ab (-) mother should receive
________ 

(1 Point)
Select your answer

49.A 6-yr old boy was brought to the ER due to difficulty of breathing which
started 3 hours prior to consultation. On PE RR is 48 and there were intercostal
and subcostal retractions. On auscultation, it was noted that there was high-
pitched musical sound, heard during expiration. Which of the following is most
likely diagnosis? 

(1 Point)
Select your answer

50.Which of the following awake, alert patients is tachypneic? 

(1 Point)
Select your answer

51.The appropriate BP apparatus for an accurate blood pressure

measurement should have which characteristic?

(1 Point)
Select your answer

52.Nephrotic syndrome is a hypercoagulable state that results from 

(1 Point)
Select your answer
53.The mechanism of edema in Nephrotic Syndrome is: 

(1 Point)
Select your answer

54.An eight-month old infant is diagnosed with Staphylococcal

pneumonia.  Blood culture and sensitivity grew Methicillin Sensitive Staph. aureus
and chest x-ray revealed multiple cystic lucencies on the right lung.  He suddenly
deteriorated.  What is the most likely problem/complication that caused the
demise of the patient?

(1 Point)
Select your answer

55.The most common causes of lower respiratory tract infections in infants and
children older than 1 mo but younger than 5 yr of age.

(1 Point)
Select your answer

56.If the chest radiograph of a patient showed pneumatocoeles, the initial

antibiotic therapy should include

(1 Point)
Select your answer

57.Dimercaptosuccinic acid (DMSA) renal scan is a procedure that can

(1 Point)
Select your answer

58.The initial empiric treatment of UTI should cover for ___________ because it is
the common etiologic agent.

(1 Point)
Select your answer

59.A 3 day old male neonate was brought in for cyanosis, feeding interruption,
tachypnea. Pertinent PE revealed a scaphoid abdomen with bowel sounds heard
on the lower left lobe. Chest radiography shows bowel loops on the left
hemithorax. What is the likely diagnosis of this newborn?

(1 Point)
Select your answer

60.A 5-year-old girl is brought to the clinic with complaints of dysuria and vague
suprapubic  pain. She has a history of constipation, but reports no other
complaints. Urinalysis is obtained which demonstrated presence of nitrites,
leukocyte esterase, and many bacteria. A urine culture is pending. Which
antibiotic is most appropriate as initial treatment?

(1 Point)
Select your answer

61.Which of the following is the most frequent manifestation of UTI in infants?

(1 Point)
Select your answer

62.An asymptomatic neonate is born to a mother with a positive RT-PCR for SARS
COV2 (COVID 19) with absence of clinical disease and has normal chest
radiograph . Which of the following is a correct management?

(1 Point)
Select your answer

63.Which one of the following is the most useful tool in the prediction of
neurodevelopmental outcome for a baby with moderate encephalopathy
secondary to hypoxic–ischemic encephalopathy (HIE)?

(1 Point)
Select your answer

64.Which of the following  is the standardized internationally accepted guideline

for Vitamin K administration in the neonate?

(1 Point)
Select your answer
65.Alport Syndrome AS, is a genetically heterogeneous disease caused by
mutations in the genes coding for type IV collagen, it is characterized by

(1 Point)
Select your answer

66.A one-year old child is admitted for cough of 5 days, fever and tachypnea
noted the day prior to admission.  The chest–ray reveals interstitial
pneumonia.  CBC is unremarkable.  He completed all the routine vaccinations for
age.  What is the most appropriate therapy?

(1 Point)
Select your answer

67.A 5-yr-old girl has had symptoms of an upper respiratory infection for 1 week.
Over the past 24 hours, fever and tachypnea developed, with worsening cough
and increased work of breathing. Her temperature is 39.1 C, RR of 55/min, and
O2 saturation is 94-95%. PE revealed diffuse wheezing, inspiratory rhonchi, and
crackles in the right anterolateral chest. Chest film shows a shaggy right heart
border, generalized hyperinflation, and peribronchial cuffing. WBC count is
18,000/mm3 with 70% granulocytes. What is the most likely diagnosis and
diagnostic work-up to be done?

(1 Point)
Select your answer

68.Physiologic icterus usually appears on the _____and disappear by the ____day of

life in a term newborn.

(1 Point)
Select your answer

69.Good response to antibiotic treatment in pneumonia is initially seen as:

(1 Point)
Select your answer

70.A term male infant on the second day was noted to have a well-demarcated
midline color difference throughout his body; half of his body is bright red and
the other half is pale. After observing the infant for 30 minutes, his color becomes
homogenously pink.
Which of the following is the most likely explanation for this infant’s color
change?

(1 Point)
Select your answer

71.An 11-year-old girl comes to the physician with her mother because of a 2-day
history of passing “cola-colored “urine. During the past week, her mother noticed
episodes of facial swelling. The patient had skin lesions in the lower extremities 4
weeks ago. Which of the following is the most likely diagnosis?

(1 Point)
Select your answer

72.A 10 year old child is found to have a positive PPD test result on routine
screening. There are no symptoms. Laboratory test, include chest films, are
normal. Which of the following is the best interpretation of this finding?

(1 Point)
Select your answer

73.Kernicterus is a neurologic condition that result from 

(1 Point)
Select your answer

74.A 40 weeks' gestation infant is born by forceps-assisted vaginal delivery to a

diabetic mother following a prolonged course of active labor. The baby
developed diffuse bruising and petechiae on the scalp and lateral face and large
midline area mass on his scalp with edema that completely obscures the
posterior fontanelle. This is compatible with _______

(1 Point)
Select your answer

75.A. is a 4 yo female child was brought to the ER due to cough and high grade
fever. Vital signs showed HR of 120, RR of 55, Temp of 39C and O2 sat of 91 % at
room air. The patient was seen awake but in mild respiratory distress. Chest and
lung findings showed equal chest expansion, subcostal and intercostal retraction
with fine crackles on both lung fields. What is your Risk Classification based on
the PAPP update on PCAP?

(1 Point)
Select your answer

76.Which of the following findings are consistent with acute nephritic syndrome
in Acute Glomerulonephritis? 

(1 Point)
Select your answer

77.A 5-year-old male presented with dark color urine 1 to 2 days after an
upper  respiratory tract infection, GUE: RBC +++, albumin +; blood urea: 25
mg/dl; serum  creatine: 0.6 mg/dl; with normal serum complement. Which of the
following IS NOT a poor prognostic indicator?

(1 Point)
Select your answer

78.A 9-month-old infant presents with a 2-day history of fever, cough and
breathlessness following an upper respiratory infection. She is febrile with RR of
80/min., intercostal and subcostal retractions, and prominent rhonchi on
auscultation. A chest X-ray reveals a hyperinflated lungs. The most likely
diagnosis is __________  

(1 Point)
Select your answer

79.Non-cardiogenic pulmonary edema, in its most severe state, is also known as

acute respiratory distress syndrome (ARDS).  Which of the following radiographic
features is usually present in non-cardiogenic pulmonary edema?

(1 Point)
Select your answer
80.A 3 years old male with weight of 14 kg, height of 95 cm has several
admissions due to kidney disease. Labs: serum Creatinine = 1.2 mg/ dL, BUN =20
mg/dL, Potassium=3.5 mg/dL, Sodium=140 mg/dL: Urinalysis showed hematuria
and proteinuria. What stage of chronic renal disease the patient?

(1 Point)
Select your answer

81.A child was diagnosed clinically with Acute PSGN. Previous cutaneous
Streptococcal infection is suspected. Which of the following is the best test to
prove this?

(1 Point)
Select your answer

82.Which of the following IS NOT a recommended treatment of COVID 19 in

children at present?

(1 Point)
Select your answer

83.Blood pressure measurement and  monitoring in a patient with predisposing

factors such as a family history of renal problem should start at _______

(1 Point)
Select your answer

84.After delivery, which part of the neonate should you wipe first?

(1 Point)
Select your answer

85.A 2- year old toddler who was playing on the floor suddenly developed noisy
breathing with shortness of breath. A loot bag with candies inside was found
beside the child. He was brought to the ER and it was noted that RR was 68/min
with subcostal retractions, O2 saturation of 90%. What is the most appropriate
action regarding this matter?

(1 Point)
Select your answer

86.Which of the following urine examination findings is diagnostic of UTI?

(1 Point)
Select your answer

87.A 3-month-old develops respiratory distress with fever, tachypnea, stridor, and
retractions during an URTI. The parents report that the child is noisy breather;
these sounds become worse when the child is positioned supine. What is the
treatment of choice for this condition?

(1 Point)
Select your answer

88.Which of the following pathophysiologic mechanisms is associated with

neonatal hypoxic-ischemic brain injury? 

(1 Point)
Select your answer

89.Which of the following findings IS NOT consistent with Nephrotic Syndrome?

(1 Point)
Select your answer

90.Which of the following supplements IS NOT indicated for patients with

chronic renal failure?

(1 Point)
Select your answer

91.Which of the following is considered as significant hematuria?

(1 Point)
Select your answer

92.Jaundice is most likely to be physiologic in a term infant in which of the

following situations?

(1 Point)
Select your answer

93.Foreign bodies are often placed in the nose by small children and those with
developmental delay. Of the following, the MOST common presenting clinical
symptom is _________

(1 Point)
Select your answer

94.When attending to a delivery of a newborn, the ideal temperature of the

delivery room should be set at ____ degrees Celsius .

(1 Point)
Select your answer

95.A previously healthy 12-yr-old boy presents with upper respiratory symptoms
of 8 days' duration, with worsening cough and fever. PE reveals a temperature of
39°C, RR of 24/minand inspiratory crackles in both lung fields. Oxygen saturation
is 93-94%. Chest film shows scattered infiltrates in both lung fields, focal
consolidation in the right lower lobe and blunting of the right cost-phrenic
angle. CBC: WBC 11,000/mm3 with 70% neutrophils. What is the most possible
diagnosis?

(1 Point)
Select your answer

96.A newborn 40 weeks AOG with birthweight of 2.5 kg (below 10th percentile),

length of 50 cm (between 10-90thpercentile) and head circumference of 35 cm
(between 10-90th percentile) is classified as __________

(1 Point)
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97.The MOST consistent clinical manifestation of pneumonia is

(1 Point)
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98.A full term male neonate weighing 2.8 kg develops seizures at 20 hours of age.
Which of the following is the LESS LIKELY to be considered?
(1 Point)
Select your answer

99.A patient with APGAR score of 1 and 2 at 1 and 5 minutes respectively appears
hyperalert and has hyperactive deep tendon reflexes with mydriasis. The most
likely diagnosis is:

(1 Point)
Select your answer

100.In a child with recurrent UTI and vesico-ureteral reflux is highly entertained,
the best diagnostic work-up to document the condition and its stage is ______

(1 Point)
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