PEDIATRICS I - LONG TEST 2 carepackage

March 17, 2021

COVERAGE:

2.01 - Breastfeeding & Nutrition I (Battad)

2.02 - Nutrition (Battad)
2.03 - Neurological PE of A Child (Rivera)

1. Breast engorgement must be managed with the following measure/s: Breast engorgement is due to the incomplete removal of milk
due to improper positioning of the mouth of the baby and is
A. Continued breastfeeding addressed by emptying the breast before the next feeding
B. Oral antibiotics A [PED] 2.01
C. All choices are correct
D. Topical analgesics Oral antibiotics are given to mothers with mastitis due to S.
aureus infection

2. The nutrient deficiency in the pregnant mother may result in a baby with
congenital disorder reflected in the newborn screen. When left uncorrected ,
the baby may have
Cretinism is a congenital disorder observed in infants with
A
A. Cretinism mothers who are iodine deficient [PED] 2.02
B. Goiter
C. Sepsis
D. Neonatal anemia

3. The following nutritional gap occurs by age 6 months :

From birth to 6 months, infants have a lot of iron stores
A. Iron coming from maternal blood. By 6 months, when the
A
B. Fat maternal blood has already been used up and the baby is now
C. Micronutrients on its own, iron gap has to be filled up [PED] 2.02
D. Iodine

4. How many months postnatal should breastfeeding be exclusive

Breastfeeding as defined by WHO and recommended by
A. 12 UNICEF is the exclusive feeding of breastmilk, not allowing
C
B. 3 infants to receive any other food or drink, even water, for the
C. 6 first 6 months of life [PED] 2.01
D. 24

5. For prevention of overweight and obesity, play activity is encouraged daily

for a duration of ___ minutes
Children should have at least 30 mins to 1 hour 3x a week of
A. 180 B physical activity to prevent overweight and obesity
B. 30-60 [PED] 2.02
C. 10-15
D. 5-10

6. What are the measures to be observed in assessing the length of a 1 year

old? For children below 2 years old, recumbent length
(infantometer) is the prescribed way of measurements.
A. Need 3 persons to assist for assisting in the procedure Guidelines:
B. The child’s head should be tilted at 15 degrees with eye downward Use a length board with fixed headboard and movable foot
C. Two persons are needed to steadily fix both head and feet plate, straighten knees,
D. Two persons are needed to steadily fix both head and feet and the Requires a partner,
child’s head should be tilted at 15 degrees with eyes downward No socks or shoes,
Remove lower garments and hari ornaments,
C
Frankfort Horizontal Plane (head should follow a
horizontal plane created by the tragon of the ear and lower
margin of the orbit of the eye),
Line of sight perpendicular to the base of the board (chin
should not be against the chest),
Feet flat, heels against the board

[PED] 2.01

PED Page 1 of 12
7. In lactogenesis, the hormone responsible for milf formation is secreted in Prolactin is the hormone that stimulates milk production and
the : is secreted by the anterior pituitary gland [PED] 2.01

A. Posterior pituitary C Posterior pituitary gland secretes ADH and Oxytocin.

B. Hypothalamus Hypothalamic hormones include CRH, GhRH, GnRH,
C. Anterior Pituitary Somatostatin, TRH, Dopamine.
D. Lactiferous sinuses Lactiferous sinuses do not secrete hormones rather store milk.

8. The following condition/s is/are absolute contraindications to breastfeeding

Galactosemia is an absolute contraindication to
A. HIV positive mother
breastfeeding [PED] 2.01
B. COVID positive mother C
C. Baby with galactosemia
HIV positive mother is a relative contraindication
D. Baby with congenital cleft lip
E. All choices are correct

9. This/These is/are/ consideration/s regarding the giving of fruit juice in

children:

A. It is appropriate since it is a good source of added sugar Not fruit juice before 12 months. Better to give the fruit
C
B. It must be given by 4 months to ensure vit C supplementation and it is rather than the juice [PED] 2.01
appropriate since ti is a good source of added sugar
C. It must not be given before 12 months of age
D. It must be given by 4 months to ensure vit C supplementation

10. A patient was noted to have moon facies, flag sign, bipedal edema, Moon facies, flag sign, bipedal edema: signs of protein energy
Harrison’s groove and prominent rib cage with rachitic changes. You will deficiency, specifically kwashiorkor
consider the following conditions:
Harrison’s groove, prominent rib cage with rachitic changes:
A. Protein and Vitamin C deficiency signs of Vit D deficiency.
D
B. Carbohydrate and vitamin D deficiency
C. Carbohydrate with Vit C deficiency Not Option A: Rachitic rosary can be a sign of Vit C deficiency,
D. Protein and Vitamin D deficiency but in Vit C deficiency, sternum is depressed

[PED] 2.02

11. This/These statement/s describe/s human foremilk: Option A describes foremilk: first few drops, thin fluid, MORE
WATER CONTENT
A. It is predominantly water keeping the baby well hydrated Option B describes hindmilk: more fat which contributes to
B. It is predominantly fat leading to its high satiety value satiety of baby
A
C. It is the fluid passed during the first four days Option C describes colostrum. Both foremilk and hindmilk are
D. All the choices are correct mature human milk which is passed beyond 14 days.

[PED] 2.01

12. For a 12 year old undergoing nutritional assessment prior to school entry,
Head circumference assesses brain growth spurt which starts
which parameter is least needed?
at mid-gestation up to 3 years old. This is measured until 3
years old only, unless there is obvious micro/macrocephaly. In
A. Body Mass Index C
the scenario, the patient is 12 years old already.
B. Weight
C. Head Circumference
[PED] 2.01
D. Height

13. The dietary Fats that increase the risk for obesity are
Obesogenic diet: diet high in SATURATED FATS, added sugar
A. Long Chain Triglycerides and sodium.
C
B. Unsaturated Fatty Acids
C. Saturated Fatty Acids [PED] 2.02
D. Medium Chain Triglycerides

14. This food item is rich in saturated fatty acids:

Food high in saturated fats: beef, cheese, ice cream, pizza,
sausage, BACON, hamburger, mexican fast food, cookies
A. Beans
B. Eggs
Beans: good source of Vit B1
C. Salmon D
eggs: source of Vit B2, Vit B12, Vit D
D. Bacon
Salmon: good source of Vit D

[PED] 2.02

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15. The Head circumference signifies that
Head circumference is a proxy measure for brain growth.
A. Cerebrospinal fluid is rapidly accumulating Brain growth spurt begins at mid-gestation up until 3 years
B. Developmental milestones are at par old.
C. Brain growth is appropriate
C
D. Myelination is increased It is not option B since head circumference assesses brain
growth and not brain development.

[PED] 2.01

16. How would you approach and advise a mother of an 8 month old baby
Anthropometry is the single most universal, applicable,
whose child’s weight-for-length is plotted on the 50th percentile?
inexpensive and non-invasive method of measuring
proportion, size and composition of the human body.
A. Congratulate the mother for a job well done
In the WHO standard population, the standard is 50th
B. Go back to exclusive breastfeeding because he is faltering A
percentile and a Z score of 0. This indicates 100%
C. Go back to exclusive breastfeeding because he is faltering and give
appropriateness.
foods needed for complementary feeding for catch up growth
D. Give foods needed for complementary feeding for catch up growth
[PED] 2.01

17. The following parameter/s indicate/s severe acute malnutrition: Presence of edema classifies the patient with severe
malnutrition
A. Triceps skin fold positive
B. MUAC more than 115 mm It is not Option A: a positive triceps skin fold reflects that
C. Weight for height z score is zero there is enough fat stores
D. Bipedal edema It is not Option B: MUAC or mid-upper arm circumference
D
E. Bipedal edema, MUAC more than 115mm and weight for height measures somatic protein. This must be LESS THAN 115 mm
z-score is zero for patient to be classified as severe wasting
It is not option C: a weight for height z score of 0 is normal
and does not indicate severe acute malnutrition

[PED] 2.01

18. This/These statement/s is/are TRUE of the appetite test?

Both options A and C are correct statements.
A. Three mouthful intake of the RUTF means the patient can be managed
Passed appetite test means that there is good intake of 3
as an outpatient
mouthful Ready to Use Therapeutic Food or RUTF → patient
B. Failed appetite test indicates the need for admission and three
will be managed as an outpatient and monitored weekly
mouthful intake of the RUTF means the patient can be managed as an B
outpatient
Failed appetite test means the patient has no appetite → has
C. Failed appetite test indicates the need for admission
to be admitted and referred as an inpatient.
D. One teaspoon intake of the ready to use therapeutic food (RUTF)
signifies that the patient can be managed in the designated outpatient
[PED] 2.02
facility

19. What is the gold standard for infant feeding?

Breast milk is Indisputably the unsurpassed standard of
infant feeding and is the best food for optimal growth and
A. Human and cow colostrum
development of infants It has an energy density of 0.67
B. Colostrum C
calories /ml.
C. Human milk
D. Modified cow colostrum
[PED] 2.02
E. Infant formula

20. Nutritional programming for decreasing the risk of NCDs or non

communicable adult diseases must cover the period of first ___:
Critical exposure in complementary feeding involves nutrition
in the first 1000 days of life which is important in terms of
A. 1000 days of life
A nutritional programming
B. 10 years of life
C. 365 days of life
[PED] 2.01
D. 270 days post natal
E. 10000 days

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21. KC, an 8 month old baby was brought for her regular check up. Her
weight-for-length data was plotted on the 50th percentile. This means her z
score is:

A. Below minus 3
B. Below minus 1
C. zero
D. Below minus 2

Weight-for-length percentile chart. X-axis denotes the length

(in cm) of the patient while the Y-axis denotes the weight of
the patient.
The ideal weight is located at the 50th percentile (green line).
[PED] 2.01

22. The double burden of malnutrition includes the following: Recall. Currently, Philippines has a double burden of
malnutrition:
A. Type 1 and type 2 micronutrient deficiencies ○ Undernutrition
D
B. Wasting and stunting ○ Overnutrition
C. Overweight and obesity
D. Undernutrition and overnutrition [PED] 2.02

23. The clinical profile of Retinol Deficiency includes: Signs of vitamin A deficiency are decreased immune status
and eye signs which includes corneal ulcer (keratomalacia)
A. Kreyser Fiescher rings wherein the whole eye is liquified, the eyeball is removed,
B
B. Keratomalacia leading to blindness.
C. Cafe au lait spots
D. Blind spots [PED] 2.02

24. One of the periods of rapid growth spurts occurs during the stage of:
Recall. The periods of rapid growth or growth spurts are in the
infancy stage and adolescent stage. These stages require
A. Adiposity rebound
D adequate calories and have high risk for malnutrition.
B. Adulthood
C. Preschool age
[PED] 2.01
D. Infancy

25. The marasmic child exhibits this PE findings: Manifestations of marasmus:

■ Quiet
A. Generalized edema ■ Hungry
B. Flag sign C ■ Old man facies
C. Old man facies ■ Gross wasting
D. Moon facies ■ Deficiency in all macronutrients
[PED] 2.02

26. After initial intake of high triglycerides and elevated LDL, it has been Saturated FA don’t have double bonds and are considered
estimated that the number of years for atheromatous plaque to build up and “bad'' fats. It is carried by LDL which is responsible for
deposit in the vascular wall is within: building up artherosclerotic plaque in 15 to 20 years
D
A. 6-10 Food sources: Fast food, beef, ice cream, sausage, hamburger,
B. 1-5 cheese, pizza, bacon, cookies
C. 11-15
D. 15-20 [PED] 2.02

27. For prevention of obesity, one must limit the intake of the following

A. Plant based oil PED Nutrition (Battad) 2.02

B. HDL
C. Polyunsaturated fatty acids Environmental factors:
D
D. Added salt and sugar Obesogenic Diet - high in saturated fats, added sugar and
sodium; less fiber and minerals, little to no vitamins
Limit sugar, salt, and saturated fats

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28. For prevention of overweight and obesity, the duration, in hours, of screen PED Nutrition (Battad) 2.02
time with gadgets, tv, and computer must be limited to: Preventive Strategies:
5-2-1-0
A. 3
B
B. 2 5- servings of fruits and vegetables
C. 1 2 - hours of less of screen time (5 years old and above)
D. 4 1 - hour of physical activity
0 - sweetened beverages

29. The modifiable risk factor/s for obesity include/s the following:
PED Nutrition (Battad) 2.02
A. Genetic and diet
C Environmental factors:
B. Genetic, endocrine, diet, and activity
Modifiable risk factors - poor diet and sedentary activity
C. Diet and activity
D. Genetic and endocrine

30. The whey in human milk has the following property/ies: PED Nutrition (Battad) 2.01

A. All choices are correct Whey

B. It has 40% ratio compared to casein - 60% of the total protein in human milk
C. Its main protein is Beta-Lactoglobulin -Main whey in human milk is Alpha-lactoglobulin
D. It has complete set of essential amino acids D -Better amino acid profile
-Complete in essential amino acid
-Better for growing babies
-HIgher efficacy value for muscle synthesis
-Capacity to increase immune response
-Contains, lactoferrin, Secretory IgA, and albumin

31. The anti-infective property/ies of human milk include/s: PED Nutrition (Battad) 2.01 / page 322, Nelson

A. IgE
B. Nucleotides
C. Cytokines
D. Both cytokines and nucleotides
E. Cytokines, nucleotides, and IgE

32. A malnourished child had tingling sensation and numbness. If you were
considering a particular micronutrient deficiency, what other associated signs PED Nutrition (Battad) 2.02
are compatible with the condition?
Signs of B6 deficiency: Skin dermatitis/intertrigo, glossitis,
A. Angular stomatitis, fissured tongue, and cheilitis stomatitis
B. NIght blindness and corneal ulceration cheilosis, neuropathy (tingling and numbness)
C. Frontal bossing and bowleggedness Patient is experiencing B-complex micronutrient deficiency.
D. Fractures and pseudoparalysis, bleeding Signs of B2 deficiency: Skin dermatitis/intertrigo, glossitis,
stomatitis, cheilosis, neuropathy (tingling and numbness)

A B - Signs of Vit A deficiency: eye signs and decreased immune

status
C - Signs of Vit D deficiency: Rickets in children, Frontal
bossing, Pectus carinatum: pigeon breast, Harrison’s Groove
in the subcostal level, Rachitic rosary: costochondral junction
swelling
D - Vit C def deficiency Clinical manifestations: Defective
dentin, Hemorrhagic tendencies, Defective endochondral
formation, Chest - rib cage scorbutic beads, Pseudoparalysis,
lethargy, weakness, irritability, weight loss, and bruising

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33. In lactation management, the proper latch on the position is described by PED Nutrition (Battad) 2.01
this/these statement/s:
The nipple should reach the baby’s soft palate and his tongue
A. The baby’s mouth must press the nipple should reach well underneath the breast tissue
B. The nipple must reach the baby’s palate ○ Triggering the sucking swallowing reflexes
C. Baby’s mouth must be pursed ○ Make sure the lactiferous sinus is compressed so that the
D. Baby’s mouth must compress the lactiferous sinus within the areola baby is able to squeeze out the milk from the storage
E. Baby’s mouth must compress the lactiferous sinus within the areola
and the nipple must reach the baby’s palate E SIGNS OF GOOD ATTACHMENT

34. How many minutes after delivery should breastfeeding be initiated? PED Nutrition (Battad) 2.01

A. 180 FEEDING CUES

D
B. 80 ● Within the first hour (20-60min after birth)
C. 120 ● First, there’s a 15-20min rest period for both the baby and
D. 60 the mother

35. The earliest onset of developed coordinated sucking swallowing

mechanism is evident between ____ weeks of gestation
Coordinated sucking swallowing is present at 32-35 weeks
A. 24-27 C
○ Not expected in premature infants <32 weeks of age
B. 28-31
C. 32-35
D. 36-38

36. The length, weight, and height data is compared to a reference standard PED Nutrition (Battad) 2.01
and this may be expressed as:
● Patient’s anthropometric measurements must be compared
A. Computed based on mnemonics to the standard population
B. Standard deviation from the mean reference population ○ Reference population is composed of breastfed babies from
C. Belonging to a percentile curve of 100 subjects reference population developing and developed countries (growth charts by WHO)
and standard deviation from the mean reference population ● Expressed as:
D. Belonging to a percentile curve of 100 subjects reference population C ○ Standard deviation (z-score)
■ A z-score of 0 indicates 100% appropriateness
■ Currently most utilized; used clinically
○ Percentile
■ Ranking of a child out of 100 from the average 50th
centile
■ 50th percentile indicates appropriateness

37. A 2-year old child has a z-score of below negative 3 for his weight and PED Nutrition (Battad) 2.01
height parameter. What does this mean?
WEIGHT FOR HEIGHT:
A. He is both wasted and stunted, acutely and chronically malnourished ● Assess body proportion; wasting
B. He is wasted and acutely malnourished ○ a wasted patient means the patient has ACUTE
C. He is stunted and chronically malnourished malnutrition
D. He is poorly malnourished and poorly developed LENGTH/HEIGHT FOR AGE:
● Expressed in stunting
○ Stunting denotes CHRONIC malnutrition

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38. A baby is taking in one ounce of human milk per feeding. How many
calories per feeding has he received?
PED Breastfeeding & Nutrition I (Battad) 2.01
A. 24 C
B. 27 Energy density of breast milk: 20 cal/oz
C. 20
D. 30

39. The micronutrient supplementation to be started at 6 months of age aims PED Nutrition (Battad) 2.02
to prevent this condition:
Prevention of Iron Deficiency Anemia
A. Pathologic fractures
B. Anemia Premature: supplement at 2 weeks
C. Bleeding gums Full term: Supplement at 6 months (must fill up Iron Gap)
D. Bowleggedness
B
“If a patient is below 6 months, you cannot use the term IDA
because the baby has stored iron up to 6 months of age in
which they get from the breast milk. Beyond 6 months, that’s
the time we include IDA in the differentials” (Battad, 2021)

A, C - Vitamin C deficiency
D - Vitamin D deficiency

40. In the anatomy of the human breast, the structure that maintains the PED Breastfeeding & Nutrition I (Battad) 2.01
breast tone is the:
Cooper’s ligament - attaches from the underside of the skin to
A. Subcutaneous fat the chest wall and holds breast shape up and maintains its
D
B. Pectoralis muscle firm tight tone. It is responsible for when breasts sag with age
C. Glands of Morgagni
D. Cooper’s ligament Glands of Morgagni - Glands found in the areola that secrete
oily fluids to lubricate and protect the skin

41. The following data base gives a description of the quantity and quality of 24 hr food recall: It is the recording of the food intake during
total specific food items offered to the patient for a given period of time. the last 24 hours
● Must include: Time, food intake, portion size, quantity,
A. Food diary for the last 6 hours D
manner of preparation, variety, and quality
B. Food record for the last 7 days
C. 24 day food recall
D. 24 hour food recall PED Nutrition (Battad) 2.01

42. A balanced diet includes the following caloric distribution: PED Nutrition (Battad) 2.02

A. 50% each for carbohydrates, proteins, and fats

B. 60-70% carbohydrates, 10-15% proteins, 30-40% fats
C. 40-50% carbohydrates, 30-40% proteins, 10-15% fats B
D. 50-60% carbohydrates, 25-30% proteins, 25-30% fats

43. The following essential amino acid/s is/are needed for growth: PED Nutrition (Battad) 2.02

A. Riboflavin Essential Amino Acids (PVT TIM HALL):

B. Tryptophan B Phenylalanine, Valine, Threonine, Tryptophan, Isoleucine,
C. Thiamine, Niacin, Riboflavin Methionine, Histidine, Leucine, Lysine
D. Thiamine
E. Niacin A, C, D, E - Vitamin B Complex

44. Compared with unmodified cow milk, the human milk has low levels of: PED Breastfeeding & Nutrition I (Battad) 2.01

A. Iron
B. Vitamin K
C. Vitamin A
D. Sodium
B

The human milk has very poor levels of Vitamin K, that is why
at birth the baby is given 1 mg Vitamin K

● To reduce the risk of hemorrhagic disease of the newborn

● Vitamin K for the prothrombin complex supply

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45. A child has koilonychia if you were considering a particular micronutrient
deficiency, what other associated sign will you look for?
Koilonychia is a sign of iron deficiency anemia. Other signs to
A. Bitot’s spot B
look for are palmar and conjunctival pallor.
B. Palmar pallor
C. Purpura and hematomas
D. Icteric sclerae

46. This/These metabolic problem/s has/have to be addressed initially in PED Nutrition (Battad) 2.02
severe malnutrition:
Phases of management of severe malnutrition
A. Hypoglycemia Phase 1: Stabilization Phase (1st week)
B. Anorexia ● Addresses the medical and metabolic problems
C. Hyperthermia A ● Goal: Homeostasis
D. All choices are correct Must recognize:
● Hypoglycemia, Hypothermia, Dehydration and
Infection
Phase 2: Rehabilitation Phase (2nd week onwards) - catch up
growth by feeding child both intravenously and orally

47. Based on the organ growth curve, what organ system shows most rapid
growth from mid-gestation up to 3 years postnatal?

A. Musculoskeletal
B. Pulmonary system
C. Central Nervous System
D. Hematopoietic system

48. The growth parameter that measures the spurt in the previous question is
__________.
(Previous Q: Based on the organ growth curve, what organ system shows most A: Pulmonary system
rapid growth from mid-gestation up to 3 years postnatal) B: Variable and unreliable
D
A. Chest circumference C: Gauge for nutrition
B. Abdominal circumference D: Rate of brain growth
C. Mid Upper Arm circumference
D. Head circumference

49. Baby Zia shows the following oral and motor skills and reflexes: intact Moro Reflex: Present at 28-32weeks of gestation; fades
moro reflex, grasp reflex and extrusion reflex. between 3-5 months
Her age in months is approximately: Grasp Reflex: Present at 28-32weeks of gestation; fades
between 5-6 months
A. 1-2 Extrusion Reflex: Present at 32-36weeks of gestation; fades
B. 3-4 between 4-6 months
A
C. 5-6
D. 7-8 Analysis: Choices B-D are wrong because...
● Moro reflex fades 3-5 months
● Grasp reflex fades 5-6 months
● Extrusion reflex fades 4-6 months

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50. What type of food is appropriate for Baby Zia?
(Previous Q: Baby Zia exhibits intact moro reflex, grasp reflex and extrusion
reflex.)
A. Fluids
B. Mashed foods
C. Finger foods
D. All choices may be given to Baby Zia

51. A severely hypotonic infant suspected to have Spinal Muscular Atrophy

type1 is noted to have limp upper and lower extremities and weak deep
tendon reflexes(DTRs). Which on of the following is most likely to be seen in Recall.
Infants with this disorder? Hypotonia and weak DTRs = LMN lesion;
B
A. Persistent palmar grasp
B. Fasciculations of the lateral aspect of the tongue at rest Choices ACD = UMN lesion
C. Hyperactive DTRs
D. Opisthotonus

52. At what corrected gestational age, in weeks can a newborn baby blink to Recall.
bright light?

A. 40. Only at term

B. 32 D
C. 36
D. 28

53. A month-old baby is noted with motor tone abnormalities. Which of the A: hypotonia
following is a sign of hypertonia? B: hypotonia
C: hypertonia
A. Frog-legged posture C D: hypotonia
B. Head lag on pull to sit maneuver
C. Persistent fisting of both hands
D. Poor sucking

54. What is the normal gap between the cranial sutures in an unfused skull of
an infant?
PED Neurological PE (Rivera) 2.03
A. 0.5 to 1 cm C
B. 1 to 2 cm Recall. Normal gap is 1-2 mm apart in the unfused skull.
C. 1 to 2 mm
D. 3 to 4 cm

55. At what age of gestation in weeks, is the sucking and rooting reflex
observed in premature infants?
PED Neurological PE (Rivera) 2.03
A. 28 A
Recall. Sucking and Rooting reflexes start at 28 weeks AOG
B. 26
and persists till 3 months
C. 30
D. 24

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56. Which one of the developmental milestones is abnormal and requires PED Neurological PE (Rivera) 2.03
further evaluation?
A..Pincer grasp: Expected age at 9 months, Referral, >12
A. Pincer grasp at 9 months months
B. Walking alone at 20 months of age
C. Head control at 2 months of age PED Growth and Development II (Eusebio) 1.03b
D. Babbling at 12 months
A. Pincer grasp (9-12 mos., would range from an inferior one
to a mature one at 11-12 mos.)
D
B. Walk alone (9-17 mos, most critical period is at 18 months;
mean age 13 mos)

C. Head control starts at 3 months (doc Eusebios’s PPT) / 2

months (Nelson’s)

D. By the age of 12 mos the infant can form Immature jargon,

second word (There should be at least 3 words with meaning;
when he says mama at 1 yr it should refer to mommy)

57. Which one of the following is most likely compatible in toddler with
PED Neurological PE (Rivera) 2.03
Multiple cafe-au-lait birthmarks?
A. Hypomelanosis of Ito: Streaked, whirled, or mottled
A. Hypomelanosis of Ito B
patches of light-colored skin
B. Neurofibromatosis
C. Sturge Weber syndrome: port-wine stain
C. Sturge weber syndrome
D. Tuberous sclerosis: hypomelanotic macules
D. Tuberous sclerosis

58. A 5 year old complaining of headaches is noted to medial deviation of the

PED Neurological PE (Rivera) 2.03
right eye primary gaze. Palsy of this muscle is most likely the cause of the
medial deviation of the eye on the right eye?
Recall: 6th nerve palsy/Abducens Nerve Palsy
D Right eye is medially deviated due to the weakening of the
A. Right Medial Rectus
Right lateral rectus which is an indicative sign of this disorder.
B. Left Lateral Rectus
C. Left Medial Rectus
CN VI innervates the lateral rectus (LR6SO4)
D. Right Lateral Rectus

59. A large-for-gestation newborn baby was delivered vaginally but

complicated by shoulder dystocia. On physical examination there is a limp
upper extremity, asymmetric Moro reflex but with intact wrist flexion in a
“waiter’s tip” posture. PED Neurological PE (Rivera) 2.03

The most likely diagnosis is right _____? C Patients with Erb-Duchenne’s palsy usually present with the
“waiter’s tip” posture (arm abducted, internally rotated, elbow
A. Klumpke’s palsy extended, forearm pronated and wrist flexed).
B. Radial nerve injury
C. Erb-Duchenne palsy
D. Clavicular fracture

60. An 8 year old boy is noted to have slowly progressive climbing up stairs. On
physical examination, bilateral calve muscles are enlarged. He has waddling
PED Neurological PE (Rivera) 2.03
gait.
Waddling gait, pseudohypertrophy of the calf muscles and
What abnormality is most likely expected on physical examination?
B with difficulty getting up from a sitting position is a
characteristic of Gowers sign. A classic physical examination
A. Hyper-active deep tendon reflexes
finding in Duchenne muscular
B. Gowers sign
dystrophy.
C. Muscle tenderness on deep palpation
D. Sustained ankle clonus

61. Preferential handedness is normally established most often at what age, in

years?
PED Neurological PE (Rivera) 2.03
A. 4
B. 2 Recall. Handedness develops at 2 year old, if present before 1
B
C. 1 year old may be indicative or may suggest a subtle sign of
D. 3 hemiparesis

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62. What is the average time of closure, in months, of the anterior fontanel in a
normally developing full-term infant?
A. 18 months. The normal closure time is from 13 months to
A. 18 A
24 months, with average closure time of 18 months.
B. 9
C. 24
D. 15

63. An 8 month-old boy with a past history of prematurity and birth asphyxia is
noted to have persistent fisting of the right hand which is a pyramidal sign. D. Hypertonia. This would elicit persistent fisting where the
Which one of the following findings is consistently associated in these types of thumb is opposed towards the palm and is closed over by the
patients: other fingers (thumb-in-fist posture).
D
A. Hyporeflexia Not Hypotonia (option C). Hypotonia elicits scarf sign,
B. Tremors U-shape on horizontal suspension, slipping through armpit on
C. Hypotonia vertical suspension, and head lag on pull-to-sit.
D. Hypertonia

64. Which maneuver would be appropriate for evaluating a full term newborn
with suspected brachial plexus injury? B. Moro reflex. Arms spread out and go back to midline. This
reflex is a good way to determine if one arm is weaker than
A. Tonic neck reflex B the other. Doctor supports the head and abruptly releases it
B. Moro reflex (like making the baby fall) and the baby would open his/her
C. Parachute response arms like reaching out and sometimes cry.
D. Plantar reflex

65. A previously healthy 4 year-old with no history of trauma or fever develops

a wobbly gait over a period of 2 weeks. Where is the lesion most likely in
D. Cerebellum. Wobbly gait or broad-based ataxia is
children with ataxic gait?
indicative of cerebellar lesion.
D
A. Frontal lobe
Not Peripheral nerves (option B) since peripheral neuropathy
B. Peripheral nerves
would elicit high steppage gait (foot drops).
C. Spinal cord
D. Cerebellum

66. A 6-year-old boy is noted to have tremors of the hand when reaching out
for a toy, but no tremors noted at rest. Where is the most likely lesion?
A. Cerebellum. Accentuation of tremor is a characteristic of
A. Cerebellum A
cerebellar dysfunction.
B. Cervical spinal cord
C. Basal ganglia
D. Neocortex

67. A 2 month-old baby girl with 3 days of fever with poor feeding, weak cry,
vomiting and somnolence is admitted. On physical examination, head
circumference is 35 cm and the anterior fontanelle is tense and bulging. Which
one is the most likely cause of this patient’s bulging anterior fontanelle? C. Bacterial meningitis symptoms include: fever, poor feeding,
C weak cry, vomiting, somnolence. PE finding: anterior
A. Acute subdural hematoma fontanelle is tense and bulging.
B. Thickened skull
C. Bacterial meningitis
D. Obstructive hydrocephalus

68. A newborn was born without complications but is noted to have facial
weakness noted only when crying, described as facial deviation of the mouth
to the right when crying with intact crease (nasolabial fold) on the left and
flattening of the right. At rest, no asymmetry is seen and the baby has good
suck. The most likely cause of this asymmetry of the face in this newborn when
D. Depressor menti or angular oris dysgenesis. With crying,
crying is a left ________.
only one part of the mouth curls downward with intact
nasolabial folds. At rest, no asymmetry is seen.
A. Middle cerebral artery thrombosis
B. Frontal brain tumor D
Not Left—sided Bell’s palsy (option C), since this condition
C. - sided Bell’s palsy
would elicit widened palpebral fissure, flattened nasolabial
D. Depressor menti or angularis oris dysgenesis
fold, and depressed corner of the mouth in the affected side of
the face AT REST.

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69. A 7-year old boy with congenital muscular dystrophy complains of
PED Neurological PE (Rivera) 2.03
progressive muscle weakness. Which finding on physical examination is most
likely to be seen?
Gowers’ sign is a classic physical examination finding in
B Duchenne muscular dystrophy. Pseudohypertrophy of the calf
A. Sustained ankle clonus
muscles, waddling gait, and difficulty getting up from a sitting
B. “Pseudohypertrophy” of both gastrocnemius muscles
position are physical examination findings of Duchenne
C. Spasticity of the lower extremities
muscular dystrophy.
D. Hyperreflexia of the deep tendon reflexes

70. A 12-month old baby is being evaluated for global developmental delay and
has an unremarkable birth history with no report of prenatal complications.
Which one of the following is a strong predictor of intellectual disability based PED Neurological PE (Rivera) 2.03
on a Norweigan study?
C If head circumference at birth is <3 standard deviations from
A. Patent anterior fontanelle the normal, mental retardation is a strong possibility in the
B. Closed posterior fontanelle future.
C. Microcephaly
D. Plagiocephaly

71. The scarf sign is abnormally seen in newborn full term babies in which one
PED Neurological PE (Rivera) 2.03
of the following conditions?
Scarf sign is when the elbow crosses the midline when the
A. Cervical spinal cord injury D
upper extremity of a normal infant is pulled gently across the
B. Brachial plexus injury
chest. Scarf sign is characterized as hypotonia or abnormally
C. Hypertonia
diminished tone.
D. Hypotonia

72. A 7 month old infant is evaluated for possible seizures (infantile spasms).
On physical examination, infant has multiple hypopigmented macules on the
skin since birth according to the mother. What are the skin lesions most PED Neurological PE (Rivera) 2.03
suggestive of?
D Hypopigmented macules are the pathognomonic of Tuberous
A. Hypomelanosis of Ito Sclerosis (TS) one of the most common causes of infantile
B. Vitiligo spasms.
C. Neurofibromatosis
D. Tuberous sclerosis

73. An infant with severe obstructive hydrocephalus is often accompanied by

prominent distended scalp veins, and which one of the following findings? PED Neurological PE (Rivera) 2.03

A. ‘Setting sun’ eyes A “Sun setting” eyes are usually seen in hydrocephalus due to
B. Prematurely closed anterior fontanelle loss of upward conjugate gaze caused by a raised intracranial
C. Sunken fontanelles pressure (ICP) at the tectum.
D. Anisocoria

74. An infant is suspected to have craniosynostosis. Which one is the most

likely finding on physical examination? PED Neurological PE (Rivera) 2.03

A. Sunken fontanelles B Craniosynostosis is when the skull cannot expand

B. Elevated ridge along a cranial suture perpendicular to the fused suture therefore it compensates by
C. Bulging fontanelle growing more in the direction parallel to the closed sutures.
D. Widely split cranial suture

75. Retinal hemorrhages were seen in a 4 month old infant with a normal birth
history in a private hospital with no fever and with a tense bulging anterior
fontanelle. Aside from glutaric aciduria type 2, in which of the following PED Neurological PE (Rivera) 2.03
conditions are retinal hemorrhages seen?
A Retinal hemorrhage is due to shaken infant syndrome which is
A. Non-accidental traumatic brain injury caused by head trauma, whiplash, or forcefully shaking an
B. Blood dyscrasia infant.
C. Meningococcal meningitis
D. Hemorrhagic stroke due to AVM

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