SOAL

1. A three years old girl was brought to ER with a sudden onset of dyspneic for 6
hours10 hours. She had suffered from a low-grade fever with a barking cough for
two days. You noticed respiratory distress, suprasternal retraction, and
inspiratory stridor, an X ray revealed “a steeple sign” with narrowed of air column
in the subglottic area. What is the most common etiology for the condition ?
a. Corynebacterium diphteria
b. Influenza virus
c. Staphylococcus aureus
d. Haemophilus influenzae
e. Parainfluenza virus
PDT unpad ada

2. A 5 years old boy was presented as a referral case due to Dengue Shock
Syndrome. Shock was resolved in ER following fluid administration. On the third
day of hospitalization, he was conscious, BP 84/45 mmHg, HR 62x/min, RR
48x/min, temperature 36,6°C., while eyelids were swollen, crackles was heard on
both lungs, liver was palpable ¼ - ¼ with blunt edge. Which of the management
below is most appropriate for the case?
a. Diuretics
b. Fluid loading 10ml/kgBW
c. Fluid restriction
d. Packed red cell transfusion
e. Vasoactive agent

3. A term infant weighing 4530 g born to a mother with pregestational diabetes

(non-insulin requiring). Initial glucose level was 30 mg/dL, which increased to 50
mg/dL after feeding 30 cc of infant formula, and another 30 minutes later was 55
mg/dL. Physical findings was unremarkable. He turned mildly jaundiced after 48
hours, but generally well. Which laboratory tests would you most likely need to
evaluate the jaundice?
a. Total protein, serum albumin, and liver transaminases
b. Total bilirubin and complete blood count
c. Total bilirubin and hematocrit
d. Total and direct bilirubin with complete blood count, diff count and platelet
e. Total and direct bilirubin, liver transaminases, and hepatitis panel.
4. A 12-years-old girl was admitted to your outpatient clinic on a lupus nephritis
routine check-up. The upper extremities BP 130/90 mmHg. BMI/U 1-2 SD.
Urinalysis revealed protein +2, erythrocyte 20-30 /hpf, serum ureum, and
creatinine were also within normal limit. What do you choose as first
antihypertensive treatment?
a. Bisoprolol
b. Captopril
c. Thiazid
d. Irbesartan
e. Amlodipine
5. A 7 years old boy was presented to your clinic as he could not stay calm, always
moving and difficult to follow your order. Patient remained able to communicate
but easily to get distracted. What was your management of choice for this
patient?
a. IQ Test
b. Referred to psychology
c. Observation and stimulation at home
d. Give Methylphenidate
e. Occupation therapy

6. A-15-year-old boy is referred to you by a general physician in the emergency

department with diagnosis chronic kidney disease stage 3A. What is the most
common complication of CKD in children?
a. Growth failure
b. Hypertension
c. Mineral and bone disorder
d. Fluid and electrolyte abnormalities
e. Anemia

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6341007/pdf/main.pdf

7. A 7-year-old girl was brought to the ER due to all day and night repetitive cough.
Mother reported the girl choked on a safety pin 3 days before. She shown an X-
 ray from the previous hospital revealing a pin in the left bronchus. Laboratory test
were within normal limits. What was your next plan for the patient?
a. Perform Jaw thrusts
b. Perform backblow
c. Perform bronchoscopy
d. Perform Heimlick maneuver
e. Perform abdominal thrusts

8. A 15 months old girls could play pat a cake, had not been able to express desire
without crying, could not wave bye - bye, could thumb finger grasp, bang 2 cubes
held in hands, could not put block in a cup, could babble, could not say
dada/mama specific, could get to sitting and stand for 2 seconds. The girl was
born prematurity at 33 weeks gestation. What was the categories of the child
development now?
a. Global delayed
b. Appopriate for age
c. Speech delayed
d. Fine motor delayed
e. gross motoric delay
hitung usia koreksi, denver

9. You are in a discussion with a new mother about immediated breastfeed

initiation. She knows from the internet that newborn infant has benefit from a
healthy breastfeeding as breastmilk contain non-digestable oligosaccharide. She
 excitedly asked you the name of most dominant beneficial microbe in the gut of
breastfeed infant with the capacity of digesting the oligosaccharide. Your answer
was
a. Proteus
b. Lactobacillus
c. Bifidobacteria
d. Propionibacterium
e. E. coli

https://www.nature.com/articles/s41598-020-72635-x

10. A 4 year old boy, BW 20 kg, unconscious with fast breathing but no retractions,
cyanosis, soft pulse 180x/minute, cold extremities, capillary refill times (CRT) 4
seconds, BP 50/30 mmHg. The patient was on high fever for 5 days. What was
the emergency assessment of this patient?
a. Circulation failure
b. Breathing failure
c. Respiratory distress
d. Cardiopulmonary failure
e. CNS disorders

assemsmen saga
pasien tidak sadar, nafas cepat tetapi tidak ada retraksi, tidak sianosis,
ektremitas dingin, CRT 4 detik
11. A 1-year-old boy presents with neck stiffness and a purpuric rash. What is the single
best treatment option for this patient?
a. Flucloxacillin
b. Ampicillin plus gentamycin
c. Benzylpenicillin
d. Ciprofloxacin
e. Acyclovir plus cefotaxime
meningococcemia
12. A 4 year-old boy had come in vomiting a large amount of bright red blood and
tachycardia, the first step would be to:
a. Admit the child to the hospital for intravenous H2 blocker therapy and a GI
consult
b. Send the boy home to start H2 blocker therapy
c. Refer the boy to gastroenterologist
d. Refer to the emergency department for stabilization and evaluation
e. Order CBC for the patient

13. An HIV positive-mother who was a single mom wanted to have explanation about
choosing between breast milk and bottle milk. She preferred to give bottle milk to her
baby, but afraid that she could not serve it right as no one assist her in preparing the
milk for the baby. Which one of the AFASS requirement might be interfered in the
situation?
a. Sustainable
b. Feasible
c. Safe
d. Affordable
 e. Acceptable

14. A 12-hours baby girl was referred due to dyspnoeic and vomiting. She was born
spontaneously, immediately cried at 40 weeks-gestation, APGAR scores 7-8 at 1
and 5 minutes, BW 3200 gr, vomited after being breastfed and turned dyspnoeic, RR
70 x/min; HR 140 x/min. The abdomen was scaphoid. Which clinical manifestation
do you seek to support the diagnosis?
a. Abdominal distention
b. The breath sounds on the affected side is very difficult to hear
c. Stridor
d. Rolling ball appearance
e. Bowel sound on abdominal auscultation

15. You were seeing a 14 old girl in the ER with an acute asthma attack. She looked
very uncomfortable, she experienced diffuse wheezing throughout all lung fields and
was requiring 50% oxygen by face mask to maintain oxygen saturations above 90%.
 A nurse reported that when the patient blows in her peak flow meter, it showed a
normal range. What was your management decision?
a. Get the lung function test
b. Send the patient home
c. Get the another peak flow
d. Repeat the peak flow several more times
e. Ignore the results and treat for severe asthma

16. A 5 year-old boy, weight 18 kg, admitted to the ER due to a sudden painful swelling
on left knee. He was not pale, has no organ enlargement, and has stabile
hemodynamics. He had repeated spontaneous bruising before. Older brother died
due to profuse bleeding after circumcision. Advanced diagnostic examination
showed Factor VIII 0,5%. What is your diagnosis conclusion?
a. Moderate Hemophilia B
b. Non Hemophilia
c. Severe Hemophilia A
d. Moderate Hemophilia A
e. Severe Hemophilia B
17. A 4-year old male child was admitted to ED 30 min after sudden onset of tremor on
right leg as well as right hemiparesis. No pre-existing fever or other symptoms was
noticeable. The non-contrast brain computed tomography (CT) showed no evidence
of acute ischemia. CT angiogram demonstrated a thrombus in the M1 segment of
the left middle cerebral artery. What was your diagnosis?
a. Moyamoya disease
b. Vasculitis
c. Infarction arterial
d. Acute ischemic stroke
e. Hemorrhagic stroke
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6739694/

18. A mother brought her three-year old girl who was growing consistently between the
1 SD and the 2 SD on the WHO BMI for age growth chart. She needed your
assessment about her child status. You would categorized the girl as..
a. Risk of overweight
b. Underweight
 c. Overweight
d. Within normal range
e. Risk of obese
Pasien ini 3 tahun

19. A 4-year-old-boy, BW 20 kg who had high fever for 5 days, presented to the ED
unconscious with fast breathing but no retractions. He was cyanotic with soft pulse
palpable at 180x/minute, cold extremities, CRT 4 seconds, BP 50/30 mmHg.
Administration of RL 400 mL resulted in stronger pulse, but extremities remain cold.
CRT 3 seconds, urine 20 cc, BP 70/50 mmHg, no crackles heard on lung
auscultation. What is your next step?
a. Stop giving crystalloid fluids
b. Give D10%
c. Continue giving crystalloid fluids
d. Do intubation
e. Give milrinone
20. The figure shown a 15 years-old-boy with hyperpigmentation of neck and axillary,
height 157 cm, body weight (BW) 66 kg, body mass index 26,8 kg/m2 (P > 95).
Blood pressure (BP) 120/80 mmHg, fasting plasma glucose was 290 mg/. Which
laboratory test do you order for the boy?

a. HOMA IR
b. HbA1C
c. Urine glucose
d. Random blood glucose
e. Lipid profile

21. A 3-year-old girl complaining of difficulty opening mouth for the last 2 days. The right
eye cannot close completely for 1 day. She had head injury 7 days prior, which
nerve is the most possibly affected in this case?
a. Nerve V
b. Nerve II
c. Nerve IV
d. Nerve IX
e. Nerve VII
Nervus Trigeminus (N. V)
 Fungsi: saraf motorik, gerakan mengunya, sensai wajah, lidah dan gigi, refleks korenea dan
refleks kedip
 Cara Pemeriksaan: menggerakan rahang kesemua sisi, pasien memejamkan mata, sentuh
dengan kapas pada dahi atau pipi. menyentuh permukaan kornea dengan kapas.
Nervus Fasialis (N. VII)
 Fungsi: saraf motorik, untuk ekspresi wajah
  Cara pemeriksaan: senyum, bersiul, mengngkat alis mata, menutup kelopak mata dengan
tahanan, menjulurkan lida untuk membedakan gula dan garam

22. A 5 years old child has been diagnosed with severe ARDS with oxygenation index
12 what is the best ventilator setting for this patient?
a. High oxygen fraction, 12 ml/kg tidal volume and high PEEP
b. Low oxygen fraction, with low tidal volume and 5 cmH2O, low PEEP
c. High oxygen fraction with driving pressure
d. Low oxygen fraction, with tidal volume of 6 ml/kb BW and high PEEP
e. High oxygen fraction with tidal volume 5ml/KgBW and PEEP 5 cmH2O

Adequate PEEP is necessary to prevent atelectrauma in patients with

ARDS and the PALICC recommend the titration of oxygenation and
hemodynamic response with moderately elevated levels of PEEP (10–15
cm H2O) and a PEEP level of greater than 15 cm H2O might be required
for severe PARDS.
In patients with good lung compliance, a physiological range tidal
volume of 5–8 mL/kg of ideal body weight should be applied to preserve
the respiratory system compliance. On the other hand, in those with poor
lung compliance, a tidal volume of 3–6 mL/kg of ideal body weight
should be applied.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8177958/

23. A 6 year old-by admitted to ER due to severe recurrent abdominal pain for 2 weeks.
Urine was tea coloured for 5 days. He was alert, BP 90/60 mmHg, edema on
eyelids, pupura was palpable on buttocks and legs. Urinalysis revealed protein (+2),
WBC 2-3/hpf, RBC 30-40 hpf. Which of the following is the most likely kidney
problem in this patient?
a. Lupus nefritis
b. Immunoglonulin A nephropathy
c. Urolithiasis
d. Henoch-Schonlein Purpura Nephropathy
e. Post Streptoccoccal glomerulonephritis

https://www.healthychildren.org/English/health-issues/conditions/skin/Pages/
Henoch-Schonlein-Purpura.aspx

24. A 13 months old boy was brought to your clinic for immunization. Immunization card
revealed the patient already got pentabio twice and polio 4 times. What are the
vaccine you decide to give at this time?
a. BCG, pentabio 3 and MMR
b. BCG, pentabio 3 and MR
c. Mantoux text then BCG, pentabio 3 and MMR
 d. Mantoux test then BCG, pentabio 3 and MR
e. Pentabio 3 and MR

25. A 2 years old was brought to the ER with difficulty of breathing for the last 10 hours.
He had suffered from a low grade fever with a barking cough for two days. He
showed respiratory distress, suprasternal retraction, and inspiratory stridor. The soft
tissue X-ray of the neck showed “a stepple sign” with narrowed of air column in the
subglottic area, what is the most likely diagnosis?
a. Peritonsilar abscess
b. Viral laryngotracheobronchitis
c. Tonsyllopharyingitis
d. Epiglotitis
e. Bacterial Tracheitis
PDT unpad
26. A 6 months old girl was brought to the ER as she passage of large amount of dark
red blood from rectum some brick colored, jelly like stool also present. She has been
otherwise well prior to the event. During-prior and after the stool passage the girl
was quiet. Peristaltic was normal. The baby girl weigh 7.8 kg What is the possible
diagnosis?
a. Infective colitis
b. Intussuseption
c. Anal Fissure
d. Malrotation with volvulus
e. Meckel’s diverticulum

https://www.ncbi.nlm.nih.gov/books/NBK431078/
27. A 2 years old boy was brought to the ER due to sudden onset of inspiratory stridor,
tachypnea and chest retraction. He had veeb playing with his 5 years old brother
before episode. He was afebrile. Lung sounds were clear other physical examination
was otherwise normal. Chest radiograph revealed no abnormalities. What is the best
next step management for this patient?
a. Perform endotracheal intubation
b. Administer aerosoled racemic epinephrine
c. Administer oral dexamethasone
d. Evaluate the airway on bronchoscopy
e. Administer parenteral antibiotics

Stridor, takipnue, chest retraction, afebrile, lung sound clear chest xray
normal  Foreign Body Aspiration

28. A 2 years old boy brought with skin problem. He experienced generalized edema
and irritable.His hair was reddish and easily removed. Almost all of the skin shown
prominent pinkish patches with desquamation which has started on the face then
spread all over the body. No fever preceding the lesion. What do you consider as the
skin lesion?
a. Fungal dermatitis
b. Acute dermatitis
c. Crazy pavement dermatitis
d. Ulcerated exudative lesion
e. Hypopigmentation

29. A 5 years old boy, come due to appearance of rash. Patient had high fever for 4
days, also cough, runny nose and red eyes. The mother said the rash appeared just
in the morning when the body temperature reach 40C. Maculopapular rash was
found all over the face, trunk and extremities. What is the possible diagnosis?
a. Rubella
b. Hand Foot and Mouth disases
c. Enterovirus
d. Measles
e. Varicella
Conjungtivitis, coryza (runny nose), koplik spots

30. A 20 hours old infant has billous emesis following 3 initial feeding, The prenatal and
delivery history was unremarkable. On physical examination, the infant is quiet. The
occasional peristaltic waves are noted and the abdomen was not distended. Which
of the following is the MOST likely on further radiologic evaluation of this patient?
a. Pyloric hypertrophy
b. GE reflux
c. Malrotation
d. Double buble sign
e. Cholleodochal duct cyst
31. A boy was brought to you on November 23, 2021 for vaccination. He was born on
March 18, 2020. Physical examination of the child revealed no abnormalities. He has
received complete vaccination of Hepatitis B-0, BCG, DPT, HiB OPV, IPV, PCV, MR,
rotavirus, influenza vaccine and no adverse events following immunization occurred.
What was the live booster vaccine indicated to be administered for the child on this
visit?
a. DPT
b. PCV
c. Rotavirus
d. Influenza
e. MR

32. A 14 years girl was presented as she looked much shorter than her peers. Height
for age was below -2 standard deviation implied below genetic potential height. Other
physical examination revealed webbed-neck, cubitus valgus, and Tanner pubertal stage
of M1P1. What is the most likely diagnosis?
a. Turner syndrome
b. Hypothyroidism
c. Constitutional delay of growth and puberty
d. Familial short stature
e. Growth hormone deficiency
Clinical features of classic Turner syndrome with 45,X include short
stature in the majority, delayed puberty and infertility in 60-90%, left-
sided cardiac anomalies in 50% and renal defects in one-third of cases. 3-
5
 Other clinical features seen in these patients are short webbed neck,
low-set ears, multiple pigmented naevi, oedema of hands and feet, short
metacarpals or metatarsals and cubitus valgus deformity. Studies have
shown that cardiovascular malformations are more common in classic
Turner with 45,X karyotype compared to non-classic Turner with
chromosome mosaicism or structural X abnormalities.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7784167/

33. A 3 years old boy was sent due to 3+ proteinuria. Father noticed swollen eyes on
previous week, which remained noticeable on your physical evaluation, in addition to
mild pitting edema on lower legs. Laboratory tests shown normal serum creatinine,
albumin was 1,2 g/day. What is your prediction for kidney histopathology based on the
clinical presentation?
a. Membranous nephropathy
b. Mesangial proliferative glomerulonephritis
c. Minimal change nephrotic syndrome
d. Membranoproliferative glomerulonephritis
e. Focal segmental glomerulosclerosis

34. A 15 years old boy complained with a bilateral tender breast enlargement. He
otherwise in good condition. You noticed no palpable mass, no redness or warmth on
the breast. Pubic area shown dark curled hair, scrotum skin was red-dark and wrinkle.
Which one of the following is your first option for the management?
a. Surgery
b. Treatment with an aromatase inhibitor
c. Reassurance
d. Pain killer
e. Treatment with an anti-estrogen (Tamoxifen)

Tamoxifen, an estrogen antagonist, is effective for recent-onset and tender

gynecomastia when used in doses of 10-20 mg twice daily.  [32] Up to 80% of
patients report partial to complete resolution. Tamoxifen is typically used for 3
months before referral to a surgeon. Nausea and epigastric discomfort are the
main adverse effects.

35. You were on duty and presented to a patient with urticaria which was the third time
occurred in the past 1 month. It always occurred after the boy having meals with
chicken. You decided to give antihistamine, which you believe will resolve the urticaria.
What make you so sure about the antihistamine efficacy in the case?
a. It competes with the histamine in the mast cell
b. It blocks the histamine receptor
c. It blocks the histamine production
d. It prevents mast cell from degranulation
e. It competes with the histamine release

36. You are attending duty in ED, when a 2 year old girl was brought with tachycardia.
She was mottled with weak pulse and hypotension. The 12-leads ECG shows HR of
242/min, narrow QRS and variable P wave morphology and position. The most likely
diagnosis is:
 a. Wandering atrial pacemaker
b. Supraventricular tachycardia
c. Ventricular fibrillation
d. Sinus tachycardia
e. Atrial flutter

37. A 2 years old boy, presented with seizures on left hand, 2-3 times per weeks. You
noticed a port-wine stain of the face. The child also experienced right hemiplegia. Brain
MRI shown intracranial angioma. What do you consider as the patient’s diagnosis?
a. Myasthenia gravis
b. Angioma
c. Tuberosclerosis
d. Multiple sclerosis
e. Sturge-weber syndrome

https://radiopaedia.org/articles/sturge-weber-syndrome-1

38. A 5 year old girls is going to receive her scheduled measles vaccine. She has been
diagnosed with immune thrombocytopenia 3 weeks ago and has been treated with
prednisolone 2 mg/kg/day, since that time. What is your recommendation regarding
vaccine administration?
a. Stop corticosteroids for at least 1 month before resuming her vaccination
b. She can receive her vaccine immediately once corticosteroids are discontinued
c. She can receive her vaccine immediately
d. She should not receive vaccine any more
e. Stop corticosteroids for 2 weeks before resuming her vaccination
39. A 8 year old girl came with gum bleeding and pale for 3 days. She also had fever for
2 weeks. BP 100/70 mmHg, pulse 90x/min, respiratory 24x/min, temp 38,5 0C. the liver
was unpalpable, Hgb 6,5 g/dL, leukocyte 1500/mm 3 and platelet 27.000/mm3. Neutrophil
26%, lymphocyte 70%, monocyte 2%. Which diagnostic test will you order at this stage?
a. Hb Electrophoresis
b. Transferrin saturation
c. Ferritin
d. ANA profile
e. Bone marrow aspiration

40. A male neonate born from a 28 weeks gestation, was not spontaneously crying at
birth, weak tones, APGAR scores 5-7 at 1 and 5 minutes, BW 1100 g, Downe score 5,
SpO2 was 82% on room air. Chest X-ray revealed HHD grad 3. You managed with
CPAP, FiO2 40%, PEEP 7. How do you prevent ROP in this baby?
a. Decrease PEEP
b. Specify the SpO2 target to 88-92%
c. Specify the PaO2 target to 100%
d. Lower FiO2 level
e. Decrease flow oxygen

41. An outbreak of sepsis caused by Stapylococus aureus has occurred in the newborn
nursery. You are asked to investigate. What is the most likely source of the organism ?
a. Scalp
b. Axilla
c. Oropharynx
d. Vagina
e. Nose
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6186810/

42. a three days old neonate was found having asymmetrical mass on neck.
Ultrasound confirming a moderate enlarged thyroid gland. Thyroid function test revealed
high TSH and low FT3. Mother revealed she needed to take amiodarone pills during her
pregnancy due to an arrythmia. Which of the following is the most appropriate
explanation for the goiter and hypothyroidism in the case ?
a. congenital thyroid dysgenesis
b. endemic goiter
c. iodine excess
d. mother’s anti thyroid treatment
e. iodine deficiency goiter

43. a 2 years old girl was consulted to your clinic for a routine control as mother worry of
the possible developmental delay. What were the milestone that you expect as normal
finding of this age ?
a. jump, tell one picture, draw circle, and wash hand
b. stand in one feet, tell one colour, make tower of 4 cube and wear clothes.
c. run, tell one colour, make tower of 4 cube and wash hand
d. walking in stair, say six words, abstract drawing, and wash hand
e. walking in stair, say six words, draw circle and wear clothes

44. a 10 months boy with down syndrome is brought to the growth and development
outpatient clinic. What do you expect as the milestone at this age ?
a. plays with mirror, says dada, bangs toys together
b. look a picture in books, begin to respond to their names, hold bottles, getting ready to
crawls on hand and knees
c. reaches for toys, begin imitating sound, moves toys from hand to hand
d. enjoys listening to songs, understand no-no, fedds self finger food, crawls on hands
and knees
e. looks from toy to toy, respond to your voice, brings hands to mouth

45. an 8 years old boy was presented due to altered mental status since 3 months.
Patient had slow response, sluggish and mildly confused in the morning. He was able to
attend school, but teachers noticed patient’s speech only partly comprehensible; he
failed to follow instruction and was forgetful. EEG showed 3-4 Hz spike and slow wave
discharges and polyspike and slow wave discharges. The diagnosis was
A. focal secondary generalized epilepsy
b. absence epilepsy
c. generalized epilepsy
d. myoclonic juvenile epilepsy

46. A 5-year old boy had fever for two weeks. He has been diagnosed with PDA since
he was two years old. Dental caries with swollen gum was found on the left lower molar.
Echocardiography revealed vegetation near the pulmonary valve. What is your
conclusion?
a. PDA with infective endocarditis.
b. PDA with pulmonary hypertension
c. PDA with pericardial effusion
d. PDA with cardiac tamponade
e. PDA with cerebral abscess.

47. A two-year-old boy had a history of frequent swelling in the past year. He presented
with stage II hypertension and whole bodies swelling, but no hematuria, while C3
complement was normal. You realized that you need to refer the boy as you cannot
expect a minimal change nephrotic syndrome, based on the presence of:
a. Stage 2 hypertension
b. A 2 years of age
c. Normal C3 complement
d. No hematuria
e. Edema anasarca

48. A 28 weeks – gestation infant was born weighing 1,1 kg. He started parenteral
nutrition upon delivery at 80 ml/kg/day. On day 2, customized nutrition was ordered;
10% dextrose was continued, amino acids were includes to 4 g/kg/day and intravenous
lipids were started at 2 g/kg/day. How many calories were needed to achieve growth
rate of 15 to 20 g/kg/day in this infant on parenteral nutrition ?
a. 30 to 60 kcal/kg/day
b. 60 to 80 kcal/kg/day
c. 90 to 110 kcal/kg/day
d. 140 to 160 kcal/kg/day
e. 110 to 130 kcal/kg/day

49. A boy with leukimia had to stay in hospital for a prolonged period of time. He
developed a serious infection during that time which possibly related to a central line
associated bloodstream infection (CLABSI). Which of the following pathogens would
you suspect as a cause of CLABSI in this boy ?
a. Coagulase negative staphylococcus
b. Pseudomonas aeruginosa
c. Clostridium pefringens
d. Mycoplasma pneumonia
e. Streptococcus pyogens

Gram-positive organisms (coagulase-negative staphylococci, 34.1%; enterococci, 16%;

and Staphylococcus aureus, 9.9%) are the most common, followed by gram negatives
(Klebsiella, 5.8%; Enterobacter, 3.9%; Pseudomonas, 3.1%; E.coli, 2.7%; Acinetobacter, 2.2%),
Candida species (11.8%), and others (10.5%).
https://www.ncbi.nlm.nih.gov/books/NBK430891/
50. a boy was brought to ED as he presented with urticaria after having dinner with fish.
This was the second time experience urticaria after having meals with fish. both of the
events occurred around 15 minutes after meal. What is the explanation of the urticaria ?
a. Histamin bound to mast cell
b. Histamin produced by Macrophage
c. Histamin bound to its receptor on skin
d. Histamin produced by B lymphocyte
e. Histamin produced by T lymphocyte

51. 51. A 16-month-old girl was admitted to ED for fever and seizure at home lasting
20 minutes. The seizure resolved spontaneously after which the girl cried.
Temperature was 40oC, but other physical evaluation was normal. What was
your diagnosis?
a. Complex febrile seizure
b. Bacterial meningitis
c. Meningoensefalitis
d. Simple febrile seizure
e. Ensefalitis
52. A two years old boy was brought to ER with difficulty of breathing since 10 hours.
He had suffered from a low grade-fever with a barking cough for two days. He
showed a respiratory distress, suprasternal retraction, and inspiratory stridor. The
soft tissue x-ray of the neck showed “A steeple sign” with narrowed of air column
in the subglottic area. What was you decision management with regards to
nebulization?
a. Albuterol nebulization
b. Epinephrine 1:1000 nebulization
c. Nacl 0,9% nebulization
d. Salbutamol nebulization
e. Corticosteroid nebulization
PDT unpad
53. A 5 days old girl, weight 3000 gr, just experienced seizure which ceased
spontaneously but consciousness was decreased. She looked pale, had bulging
fontanella, and anisocor pupils. She was delivered spontaneously attended by
midwife, AS 7-9, no vitamin K injection was written on pink health book. she was
exclusively breastfed, and was all well previously. Head trauma was denied by
parents. What do you choose as an immediate management after stabilization at
the ER
a. Head ct-scan
b. Complete blood count
c. Consult neurosurgery
d. Oxygenation
e. Vitamin k injection
Kasus APCD
54. A 10 years old girl came to outpatient clinic with the main complaint of rash
appears on the trunk and face. She never get the MMRV vaccine. On the
physical examination the doctor found no abnormalities other than rash on the
body and face, and temperature 37,7 oC. doctor said the complication for her
disease is rash called herpes zoster. Which one of the following appearance
show the clinical characteristic lesion for the case?
a. Bullae rash
b. Papular rash
c. Vesicular rash
d. Nodular rash
e. Erythematous macular rash

55. A 5-day baby, weight 1500 g, born from a 28 weeks of gestation often stops
breastfeeding. First and second heart sound revealed normal, but systolic
murmur heard on the 2nd intercostal space in the upper left sternal border, and
98% oxygen saturation. The chest x-ray revealed cardiomegaly and stage II-
hyaline membrane disease. That is the most possible heart defect in this baby?
a. Persistent ductus arteriosus
b. Transposition of the great arteries
c. Ventricular septal defect
d. Tetralogy of fallot
e. Atrial septal defect

56. A term infant was born to a known HIV-positive mother. Mother has been taking
antiretroviral medications for 15 weeks prior to delivery. which among the
following will you apply for the infant management?
a. Admit infant to the NICU for close cardiovascular monitoring
b. Administration of IVIG to the baby to reduce risk of perinatal HIV infection
c. Begin immediate course of zidovudine for the infant
d. Determine if congenital infection has occurred with HIV ELISA
e. Chest radiographs to evaluate for congenital pneumocystis carinii

57. A 2-years old girl with shortness of breath, hoarseness, accompanied by stridor
and fever, was brought to the ER. She had no previous history of chocking. The
peripheral blood tests were within normal limits, and the chest x-ray showed
normal heart and lung. What do you choose as therapy for this patient?
a. Nacl 0,9% nebulization
b. Ipratropium bromide nebulization
c. Long-acting nebulization beta-2 agonis
d. Epinephrine nebulization
e. Short-acting nebulization beta-2 agonis
 58. A 4 months-old baby experienced redness on cheeks for 2 weeks. He scratched
sometimes, and the whole body skin was dry. He was calm and grew well. Body weight
was accordance to his age. What do you consider as the most fundamental management
of the skin problem?
a. Anti fungal
b. Emollient
c. Corticosteroid
d. Antibiotics
e. Tacrolimus

59. A term female infant was born vaginally after an uncomplicated pregnancy. She
appeared normal but has respiratory distress when stop crying. During crying,
skin was pink, when not crying the infant made vigorous respiratory effects but
becomes dusky. What was the most likely explanation for the symptoms?
a. Pneumothorax
b. Diaphragmatic hernia
c. Meconium aspiration
d. Neonatal narcosis
e. Choanal atresia

60. A 5-years old boy was brought due to persistent high fever for 8 days despite
antibiotic and antipyretic. Eyes were red with no exudate, tongue was swollen
and redden with whitish papillae, lymph nodes were palpable 3x4cm in size on
left neck, lips were cracked, heart sounds were muffled. Maculo-papular red
rashes notable on skin, palms, and feet, legs were swollen. What is the most
likely diagnosis for this case?
a. Henoch-schoenlein purpura
b. Acute rheumatic fever
c. Pericardial effusion
d. Infected endocarditis
e. Kawasaki disease

61. A 5-year-old boy, weight 18 kg, admitted to the ER due to a sudden painful
swelling on left knee. He was not pale, has no organ enlargement and had
stabile hemodynamics. He had repeated spontaneous bruising before. Older
brother died due to perfuse bleeding after circumcision. Which of the following
test will you order for this patient?
a. Complete blood count, ESR, Reticulocyte count, PT/aPTT
b. Complete blood count, Ureum/Creatinine, abdominal USG
c. Complete blood count, PT/aPTT, Factor VIII and or IX level
d. Complete blood count, bone marrow aspiration, reticulocyte count
e. Complete blood count, SGPT/SGOT, abdominal USG
kasus hemofilia
62. A 2000 grams neonate, on day 6 of life is taking 100ml.kg/day of feeds out of
daily requirement od 150ml/kg/day od daily fluids required. What is your next
step?
a. Maintain iv fluid until full feeding
b. Stop iv fluids
c. Decrease the IV dextrose concentration day
d. Taper iv fluids and then stop
e. Maintain iv fluid with minimal rate

63. A 3-year-old boy was rushed in to the ED in comatous state, hypersalivation,

bradycardia and miotic pupils. Father revealed the boy might be poisoned as he
was found played in their storage where father stored insecticide in a used plastic
bottle. What do you suggest as the most possible cause of the child condition?
a. Intoxication of Hydrocarbons
b. Intoxication of cyanoacrylates
c. Intoxication of Phenobarbital
d. Intoxication of Organophosphate
e. Intoxication of Atropine

64. A two years old boy was bought to ER with difficulty of breathing since 10 hours.
He had suffered from a low-grade fever with a barking cough for two days. He
showed a respiratory distress, suprasternal retraction, and inspiratory stridor. The
soft tissue X-Ray of the neck showed “a steeple sign” with narrowed of air
column in the subglottic area. What do you choose for the systemic corticosteroid
in this case?
a. Dexamethasone at a dose 0.5ml/kg body weight
b. Dexamethasone at a dose 0.15ml/kg body weight
 c. Dexamethasone at a dose 1ml/kg body weight
d. Dexamethasone at a dose 0.5ml/kg body weight
e. Dexamethasone at a dose 0.5ml/kg body weight
PDT unpad
65. A month old was presented with yellowish skin first noticed when she was 5 days
old. She was born full-term, 3200 grams at birth, has three days of phototherapy
and daily sun bathing at home. Parents noticed pale stool when she was 14 days
old. Upon admission, hemoglobin was 7.8 g/dl, platelet 155 u/L, total bilirubin
8.29 mg/dl, direct bilirubin 7.22 mg/dl, other liver chemistries were normal. Which
test do you choose to confirm diagnosis?
a. Alkali phosphatase
b. Abdominal ultrasound
c. Abdominal CT scan
d. Cholangiography
e. Viral hepatitis panel test

66. 9-month-old with weight for age < -2 SD, length for age <-3 SD, presented with
conjunctival xerosis. How do you manage the conjunctival xerosis?
a. Vitamin A 50.000 IU days 1,2 and 14
b. Vitamin A 100.000 IU days 1,2 and 14
c. Vitamin A 200.000 IU days 1,2, and 14
d. Vitamin A 1,667 IU/day
e. Vitamin A 500 micrograms/day

67. A mother of 6-month-old boy come as she was afraid her son didn’t get enough
food for growth. She started complimentary food with breast milk, gave the baby
3 tablespoons banana puree once day. What do you suggest of the daily calorie
amount needed by the baby at his age?
a. 300 kcal
b. 200 kcal
c. 150 kcal
 d. 250 kcal
e. 100 kcal

68. A girl was brought by her mother to the growth and development outpatient clinic
on December 24, 2021. She was born on December 6, 2019 (35 weeks,
premature). On the examination of the child, she denoted a speech delay. What
was the development of expressive speech that appropriate for this time?
a. Can combine word
b. Papa and Mama specifically
c. Can speak 2 words
d. Can speaks 6-10 words
e. Can make sentence
Usia 2 tahun 18 hari
69. A baby girl was born to a 39-weeks gestational age, BW 2300 gr, length 50 cm at
birth. Apgar score was 8-10 in 1 and 5 minutes. The baby was healthy with
appropriate suckling reflex. What do you choose as the best nutrition for this
baby?
a. Premature mother breast milk added with human milk fortifier
b. Mature mother breast milk added with human milk Fortifier
c. Mature mother breast milk
d. Mature mother breast milk mix with premature mother breast milk
e. Premature mother breast milk
Aterm tetapi berat badan 2300gram
70. A boy was bought to ED as he presented with urticaria after eating grilled fish.
Mother revealed the fish might not fresh when being grilled as there was some
awful odor but the boy insisted to eat. This is the first time the boy experienced
urticaria and none of the family ever had allergy. What is the more likely
explanation to the urticaria?
a. Histamine produced by basophil
b. Hypersensitivity to the fish
c. Histamine produced by the contaminated fish
d. Allergy to fish
e. Psychological event