PHILIPPINE PEDIATRIC SOCIETY – HOSPITAL ACCREDITATION BOARD

COMMITTEE ON EDUCATION
WRITTEN IN-SERVICE EXAMINATION
SECOND YEAR
OCTOBER 12, 2022

NAME______________________________ YEAR _______________________

DIRECTION: CHOOSE THE LETTER OF THE BEST ANSWER IN EACH OF THE

FOLLOWING QUESTIONS.

1. The most frequent complication of diphtheria is:

A. Septicemia
B. Endocarditis
C. Pyogenic arthritis
D. Myocarditis

2. A 15-year-old adolescent with multiple open wounds in both lower extremities

waded in floodwaters. What is the duration of doxycycline as postexposure
prophylaxis for Leptospirosis?
A. single dose within 24-72 hours from exposure
B. 3-5 days from exposure
C. daily for 7 days
D. once weekly for a month

3. A 16 year-old female was brought to the ER with high fever. 24 hours later, she
developed vomiting, diarrhea, a diffuse, erythematous, scarlatiniform rash with
pharyngeal, conjunctival hyperemia and strawberry tongue. She was then noted to
have altered level of sensorium and hypotension. History revealed that she used
tampons during her menstrual period. What is the most likely clinical diagnosis?
A. Staphylococcal Toxic Shock Syndrome
B. Streptococcal Toxic Shock Syndrome
C. Kawasaki Disease
D. Meningococcal Disease

4. A 2 ½ month old infant was brought to the ER after the grandmother noted the child
to have a sudden episode of gagging, gasping and choking associated with redness
of the face. The infant looks well when you examined him. History revealed that he
had runny nose 2 days ago but no fever and cough. According to the mother, a
similar episode of gagging and choking happened the day before which
spontaneously resolved. What is your initial clinical impression?
A. Respiratory Syncytial Virus infection
B. Adenovirus infection
C. Pertussis
D. Chlamydia trachomatis infection

5. What TETANUS prophylaxis should be given to a 2-year-old child with a punctured

wound in the right foot? The grandmother could not recall the previous
immunizations given.
A. DTaP and Tetanus Immunoglobulin
B. Tetanus toxoid only
C. Tdap and Tetanus Immunoglobulin
D. Tetanus Immunoglobulin only

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 PHILIPPINE PEDIATRIC SOCIETY – HOSPITAL ACCREDITATION BOARD
COMMITTEE ON EDUCATION
WRITTEN IN-SERVICE EXAMINATION
SECOND YEAR
OCTOBER 12, 2022

6. Toxic shock syndrome, necrotizing fasciitis and systemic infections like pneumonia,
osteomyelitis, surgical wound infections are clinical syndromes caused by this
organism:
A. Staphylococcus aureus
B. Group A Streptococcus
C. Pseudomonas aeruginosa
D. Klebsiella pneumoniae

7. A 3-year-old child presents with high fever, severe abdominal pain, vomiting and
frequent bloody mucoid stools with tenesmus. Physical examination shows
abdominal distension, tenderness and tender rectum on digital examination. Stool
examination shows fecal leukocytes and blood. What is the most likely pathogen
causing the diarrhea?
A. Entamoeba histolytica
B. Shigella
C. Cholera
D. Enterotoxigenic Escherichia coli

8. Which of the following conditions is a nonsuppurative complication of Group A

Streptococcal (GAS) infection?
A. Acute Rheumatic Fever
B. Peritonsillar Abscess
C. Mastoiditis
D. Sinusitis

9. Which of the following statements is TRUE regarding the clinical manifestations of

tetanus infection?
A. Seizures are the most common presenting symptom of generalized tetanus.
B. Neonatal tetanus presents as progressive difficulty of feeding followed by
spasms.
C. Cephalic tetanus is a common form of localized tetanus usually associated with
otitis media
D. Patients are unconscious during the tetanic seizures

10. Which of the following exposure history of a child signals the highest risk of TB
infection?
A. The grandfather whose sputum smear was (+) for TB but has already received
anti TB therapy for the past 3 months, He visits the child once a month.
B. Their neighbor was diagnosed to have PTB but has completed treatment
regimen.
C. The child’s 10-year-old sister was recently diagnosed with Primary TB Infection.
D. The family’s cook was recently diagnosed with PTB and is on anti-TB
medications for the past 2 weeks.

11. Based on the WHO current policies and guidance, this new rapid diagnostic tool
is used for children suspected at risk for drug – resistant TB or those who have
HIV-associated TB:
A. Nucleic Acid Amplification Test
B. Gene Xpert MTB/Rifampicin Test
C. DNA Fingerprinting
D. Interferon Gamma Release Assay (IGRA)

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 PHILIPPINE PEDIATRIC SOCIETY – HOSPITAL ACCREDITATION BOARD
COMMITTEE ON EDUCATION
WRITTEN IN-SERVICE EXAMINATION
SECOND YEAR
OCTOBER 12, 2022

12. In the absence of bacteriologic evidence for TB, a 15 year old adolescent may be
diagnosed to have presumptive extrapulmonary tuberculosis if he has:
A. Painful cervical lymphadenopathy
B. Subacute meningitis not responding to antibiotics
C. Enlarged painful joints of 1 month duration
D. Unexplained jaundice, ascites and weight loss

13. What is the rationale for the use of multiple drugs and for the prolonged duration of
therapy in tuberculosis?
A. Mycobacterium TB (MTB) replicates fast and can be eradicated only during its
replication.
B. MTB is more likely to develop secondary drug resistance in children.
C. Treatment produces more serious side effects in children.
D. MTB are of different population sizes, metabolic activities & replication rates

14. Which of the following conditions is considered as treatment failure for TB?
A. positive sputum smear or culture at 2 months during therapy.
B. positive sputum smear or culture at 5 months during therapy.
C. no improvement on Chest Xray at 2 months during therapy.
D. positive tuberculin test after 1 year of therapy.

15. What is the management for a 14-month-old infant with HIV infection who has
no TB disease and no contact with a TB case but currently resides in a setting with
high TB prevalence?
A. No need for TB prophylaxis
B. 6 months of INH preventive therapy
C. 6 months of INH/ Rifampicin preventive therapy
D. 2 months of INH/ Rifampicin/ Pyrazinamide

16. Who of the following patients is considered to have TB disease?

A. A child without signs and symptoms of TB, negative tuberculin test, is in close
contact with an adult with active TB.
B. A child without signs and symptoms of TB, with positive tuberculin test
C. A child with signs and symptoms of TB, positive Chest Xray findings and
exposure to an adult with active TB.
D. A child whose initial TB infection continues to progress over a period of 6
months.

17. Which of the following statements is true of TB meningitis?

A. Acute onset and rapid clinical course such as multiorgan failure, septic shock
B. Gradual onset with fever, irritability followed by neck stiffness, seizures and
cranial nerve palsies
C. Subacute onset with symptoms of space-occupying lesion such as headache,
seizures, focal deficits
D. Acute or subacute onset with progressive ascending paralysis

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 PHILIPPINE PEDIATRIC SOCIETY – HOSPITAL ACCREDITATION BOARD
COMMITTEE ON EDUCATION
WRITTEN IN-SERVICE EXAMINATION
SECOND YEAR
OCTOBER 12, 2022

18. A 7 year-old child with newly diagnosed TB meningitis (no previous intake
of anti-TB medications) should be given the following treatment regimen?
A. 2 months INH, Rifampicin, Pyrazinamide, Ethambutol
4 months INH, Rifampicin
B. 2 months INH, Rifampicin, Pyrazinamide, Ethambutol
10 months INH, Rifampicin
C. 2 months INH, Rifampicin, Pyrazinamide, Ethambutol, Streptomycin
1 month INH, Rifampicin, Pyrazinamide, Ethambutol
5 months INH, Rifampicin, Ethambutol
D. 2 months INH, Rifampicin, Pyrazinamide, Ethambutol, Streptomycin
1 month INH, Rifampicin, Pyrazinamide, Ethambutol
9 months INH, Rifampicin, Ethambutol

19. A 3-year-old child is the household contact of a bacteriologically confirmed TB

case. She has no signs and symptoms of TB. Her tuberculin skin test is negative.
What will you recommend?
A. Request for Chest Xray
B. Repeat tuberculin skin test after 3 months
C. Isolate the household contact for 3 months
D. Treat the child with a 6-month course of INH & Rifampicin

20. A 5-year-old male child with confirmed HIV infection has moderate malnutrition,
unexplained persistent diarrhea (14 days or more), persistent oral candidiasis,
severe recurrent bacterial pneumonia. What clinical stage does he belong using the
WHO Clinical Staging of HIV/AIDS?
A. 1 - Asymptomatic
B. 2- Mild symptoms
C. 3- Advanced symptoms
D. 4- Severe Symptoms

21. What is the WHO case definition for HIV infection in a child less than 18 months
old?
A. Positive HIV antibody test confirmed by a 2nd HIV antibody test
B. Positive virological test for HIV confirmed by a 2nd virological test
C. Recent HIV-related maternal death
D. CD4 value less than 20

22. What Clinical and laboratory features indicate severe illness in a child with
Plasmodium falciparum?
A. Impaired consciousness/ hyperglycemia
B. Multiple convulsions / metabolic acidosis
C. Respiratory distress/ pulmonary infiltrates on chest Xray
D. Clinical jaundice/ elevated liver enzymes

23. The clinical symptom /sign that differentiates Chikungunya from Dengue
infection is:
A. Fever pattern
B. Characteristics of the rash
C. Arthritis
D. Severe headache

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 PHILIPPINE PEDIATRIC SOCIETY – HOSPITAL ACCREDITATION BOARD
COMMITTEE ON EDUCATION
WRITTEN IN-SERVICE EXAMINATION
SECOND YEAR
OCTOBER 12, 2022

24. A 4-year-old male child developed influenza like symptoms which resolved
spontaneously after 3 days. 3 days later, he developed fever, severe muscle pain,
and paresthesia of the lower extremities. After 2 days, the child develops asymmetric
flaccid paralysis with intact sensation. What is the most likely clinical diagnosis?
A. Abortive poliomyelitis
B. Spinal paralytic poliomyelitis
C. Bulbar poliomyelitis
D. Polioencephalitis

25. A 2-year-old child was admitted with a diagnosis of Dengue Fever without warning
signs. On the 2nd hospital day (Day 5 of illness), the child was referred for epistaxis
and vomiting of previously ingested food around 2 tsp. On physical examination, he
is awake, oriented, capillary refill more than 2 seconds, cool peripheral extremities
with weak pulses. HR 120 / min, BP 90/70 , Temp 38.4 C. What is the hemodynamic
assessment of the child?
A. Stable
B. Compensated shock
C. Hypotensive shock
D. Hemorrhagic shock

26. A 2-year-old male child has high fever for 2 days accompanied by throat pain and
muffled voice. 4 hours later, he was noted to have drooling of saliva, dysphonia and
rapid respiration with preference for the tripod position. What is the most likely
diagnosis?
A. Laryngotracheobronchitis
B. Epiglottitis
C. Peritonsillar abscess
D. Diphtheria laryngitis

27. Which of the following statements best characterizes laryngomalacia?

A. It presents at birth with noisy breathing.
B. It manifests with inspiratory stridor by the 2nd to 4th week of life.
C. Prognosis depends on associated congenital anomalies.
D. Prompt placement of an oral airway is done to maintain patency of the airway.

28. Baby A, term, male, was delivered by normal spontaneous delivery with maturity
testing of 38 weeks, BW 3 kg. A few minutes after birth, he was noted to be in
respiratory distress. PE findings are as follows: baby is cyanotic, with barrel shaped
chest, decreased breath sounds on the right and scaphoid abdomen. What is your
initial clinical diagnosis?
A. Congenital cystic adenomatoid malformation
B. Congenital diaphragmatic hernia
C. Congenital lobar emphysema
D. Pulmonary agenesis

29. A 3-year-old child, known asthmatic has daily symptoms of cough, wheezing and
chest tightness with nocturnal coughing more than once a week. What is the
appropriate treatment regimen?
A. Short acting beta2 agonist (SABA) as needed for asthma attacks
B. SABA as needed and low dose inhaled corticosteroids
C. SABA as needed and medium dose inhaled corticosteroids
D. Medium dose inhaled corticosteroids and long acting beta2 agonist or
Montelukast

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 PHILIPPINE PEDIATRIC SOCIETY – HOSPITAL ACCREDITATION BOARD
COMMITTEE ON EDUCATION
WRITTEN IN-SERVICE EXAMINATION
SECOND YEAR
OCTOBER 12, 2022

30. The following is/ are the mechanisms for the chronic and intermittent clinical
manifestations of asthma:
A. Mucus plugging and edema of the mucosa and submucosa
B. Persistent airway inflammation & remodeling
C. Respiratory viral infection
D. Exposure to allergens

31. A 2 year old child presents with high fever, cough with purulent sputum, chest pain
and shortness of breath. Lung findings show intercostal retractions and decreased
breath sounds on the right. Chest Xray reveals a thick walled circular radiolucency
with air fluid level. What is your diagnosis?
A. Pneumothorax
B. Pneumonia with consolidation
C. Lung Abscess
D. Pneumonia with atelectasis

32. A 2-year-old infant develops colds, mild cough and low-grade fever. Three days
later, he was noted to have hoarse voice, barking cough and inspiratory stridor which
becomes worse at night. What is the most likely clinical diagnosis?
A. Acute epiglottitis
B. Acute laryngotracheobronchitis
C. Acute infectious laryngitis
D. Spasmodic cough

33. What is the purpose of time delayed cord clamping of the umbilical cord after a baby
is born?
A. Decrease the neonatal red blood cell (RBC) volume
B. Improve transitional circulation
C. Prevent maternal shock
D. Sustain integrity of umbilical cord vessels

34. Bianca was born full term to a primigravida mother in a lying-in clinic via forceps
delivery after 30 hours of difficult labor. She weighed 3.1 kg, with a length of 48 cm
and a head circumference of 35.5cm. On her 2nd day of life, a well-circumscribed
3x3 cm fluid-filled mass on her skull’s parietal area was noted which does not cross
the suture lines. It was slightly firm, non-movable and non-tender without any
discoloration. What is your diagnosis?
A. Subgaleal hemorrhage
B. Caput succedaneum
C. Craniotabes
D. Cephalhematoma

35. A G2P1 mother with preeclampsia and in preterm labor was given magnesium
sulfate IM x 3 doses, and eventually delivered via emergency caesarian section to a
live baby boy with APGAR score 5 becoming 6. He was lethargic, hypotonic, RR
40’s, HR 90’s, T= 36.3C, glucose 52 g/dl. Babygram, ECG and cranial ultrasound
findings were normal. He was given IV fluids and was noted to improve after 24
hours. What is your diagnosis?
A. Transient hypoglycemia
B. Hypermagnesemia
C. Hypocalcemia
D. Inborn error of metabolism

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 PHILIPPINE PEDIATRIC SOCIETY – HOSPITAL ACCREDITATION BOARD
COMMITTEE ON EDUCATION
WRITTEN IN-SERVICE EXAMINATION
SECOND YEAR
OCTOBER 12, 2022

36. A high risk preterm infant, with a birth weight of 1,300 g, born 29 weeks by PA,
intubated for 7 days due to pneumonia, is being assessed for discharge. She has
been breastfeeding most of the time with a stable temperature in a normal crib. She
now weighs 1,800 g. Which of the following factors will make you decide that this
baby is ready for discharge?
A. No recent episodes of apnea or bradycardia for the past 3 days
B. Postconceptional age (PCA) at present is 33 weeks
C. Growth occurring in steady increments with weight gain of 30g/day
D. Retinopathy of Prematurity (ROP) test is scheduled at 2 months post discharge

37. Simon is a full-term baby boy, delivered via spontaneous vaginal delivery to a 20-
year-old primigravid in a hospital, with an APGAR score of 7,8 with fair suck and
activity. On his 2nd day of life, he would vomit previously ingested milk and
eventually became lethargic, with poor suck and tachypnea. The mother had
preeclampsia and was given 1 dose of magnesium sulfate IM. Glucose 25g/dl, ABG
showed metabolic acidosis, ammonia 108 ug/dl. Which of the following differentials
will be the most likely diagnosis?
A. Neonatal sepsis
B. Inborn error of metabolism
C. Hypoxic-ischemic encephalopathy
D. Sedation from maternal anesthesia

38. Lily was born full term, 37 weeks PA, 3,500g, large for gestational age, delivered via
forceps extraction, to a 36 y/o G3P2 mother with uncontrolled gestational diabetes.
Upon delivery, she was limp, bradypneic, bradycardic, non-responsive, with an
APGAR score of 2 (0 minute) becoming 3 (5 minutes). Arterial blood gas at room air
showed pH 6.85, PCO2 48, PaO2 50, HCO3 12, O2 sat 82. She had 2 episodes of
tonic posturing. What is your diagnosis?
A. Inborn error of metabolism
B. Perinatal asphyxia
C. Sepsis neonatorum
D. Fetal hyperinsulinemia

39. Henoch Schonlein Purpura (HSP) is diagnosed (based on Pediatric Rheumatology

European Society) with the presence of palpable purpura (in the absence of
coagulopathy and thrombocytopenia), typically lasting for 3-10 days PLUS one of
the following:
A. Monoarticular arthritis of small joints
B. Recurrent dysuria
C. Eye redness and swelling
D. Acute, diffuse, colicky abdominal pain

40. In cyanotic heart conditions where obstruction to pulmonary blood flow is mild, what
is the clinical presentation in a child during conditions of stress?
A. Raynaud’s phenomenon
B. Hypercyanotic spell
C. Perioral cyanosis
D. Nasal flaring

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 PHILIPPINE PEDIATRIC SOCIETY – HOSPITAL ACCREDITATION BOARD
COMMITTEE ON EDUCATION
WRITTEN IN-SERVICE EXAMINATION
SECOND YEAR
OCTOBER 12, 2022

41. Based on the Modified Duke’s Criteria, one of the major clinical criteria is blood
culture. In which of the following circumstances is it considered positive for Infective
Endocarditis?
A. ≥2 positive culture findings of blood samples drawn >2 hours apart
B. 3 or most of ≥4 separate culture findings of blood (with first and last sample
drawn ≥1 hour apart)
C. Single positive blood culture for Coxiella burnetii or anti–phase I lgG titer ≥1:
200
D. 2 positive blood cultures drawn from 2 different sites and taken 30 minutes
apart

42. A 12 year old girl was brought to your clinic due to chronic arthritis. She experienced
persistent swelling, pain and limitation of motion in her elbow, knee and ankles joints
for the past 2 months for which she was given NSAIDs with minimal relief. She did
not have fever, rash, back pain, abdominal pain and enlargement. There was no
similar illness in the family. The local family physician ordered Rheumatoid factor
test which was negative. How will you classify the disease of this child based on the
International League of Associations for Rheumatology?
A. Systemic
B. Enthesitis-related
C. Oligoarthritis
D. Polyarthritis (RF negative)

43. Figure: ECG Lead II

A 9-month-old child born to a mother with Systemic Lupus Erythematous (SLE) was
noted to be bradycardic by her pediatrician. A 12 lead ECG was done with the lead
II showing a ventricular rate of 53 beats/ minute, regular. The atrial rate is variable
at 65-95 beats/minute and completely dissociated from the ventricle. The QRS
morphology is normal. What is your ECG interpretation?

A. Congenital complete atrioventricular (AV) block

B. First degree AV block
C. Wenckebach phenomenon
D. Premature ventricular contraction

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 PHILIPPINE PEDIATRIC SOCIETY – HOSPITAL ACCREDITATION BOARD
COMMITTEE ON EDUCATION
WRITTEN IN-SERVICE EXAMINATION
SECOND YEAR
OCTOBER 12, 2022

44. Diana was born full term in a lying in clinic with an APGAR 9,9 and a “blowing”
murmur on the left chest to which the midwife said “it will disappear in a month.” At
4 months old the mom noted feeding difficulties, poor growth and recurrent URTIs
which concerned her deeply. At the OPD, you noted duskiness while crying, a
prominent left chest, gr. 2-3/6 holosystolic murmur on the left parasternal border with
a mid-diastolic, low-pitch rumble at the apex. Her chest x-ray is shown in the figure
below. What is she at risk of developing if her condition is left untreated?

A. Pulmonic valve regurgitation

B. Acquired infundibular aortic stenosis
C. Pulmonary artery hypertension
D. Coronary artery disease

45. Kate,16 year old /F was brought to the OPD for recurrent fever and fatigue. Two
months ago, she experienced easy fatigability and headache after volleyball
practices, with on/off fever at least 3x/week and rashes on her cheeks that worsened
with sunlight exposure. She complained of bilateral painful swelling of her elbows,
wrists and knees and morning stiffness. On PE, BP=130/90, HR=100, RR= 24, with
a few oral ulcers and butterfly rash on her cheeks. CBC showed anemia and
leukopenia, urinalysis showed proteinuria. Anti-DS DNA is positive. What medication
will you start with this patient?
A. IV cyclophosphamide at 50 mg/kg/day
B. Oral prednisone at 0.5 mg/kg/day
C. Oral hydroxychloroquine at 8 mg/kg/day
D. IV methylprednisolone at 30 mg/kg/day

46. A 12 year old boy was brought to your clinic for medical clearance to join the varsity
basketball team. Apart from occasional leg pain after playing basketball, he seems
well. On PE, you noted bounding radial and carotid pulses. Upon checking his radial
and femoral pulses simultaneously, a radial-femoral delay was noted. His popliteal
and dorsalis pedis pulses were weak. Right arm BP= 140/95, left arm BP= 125/85,
BP on lower legs were both 100/70. A grade 2-3 short systolic murmur was heard on
the left parasternal border. Chest x-ray showed mild cardiomegaly with LV
prominence. What is your primary working impression?
A. Coarctation of the aorta
B. Interrupted aortic arch
C. Takayasu’s arteritis
D. Patent ductus arteriosus

47. Jenna, 6 year old /F, was referred by the health center due to a bluish-purple rash on
her eyelids associated with bilateral upper and lower limb weakness. You ordered for
creatinine kinase and lactate dehydrogenase which came back in elevated levels.
What findings will you expect in an electromyogram to confirm your diagnosis?
A. Negative sharp waves
B. Consistent low frequency repetitive charges
C. Short polyphasic motor unit potentials
D. insertional muscle paralysis

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 PHILIPPINE PEDIATRIC SOCIETY – HOSPITAL ACCREDITATION BOARD
COMMITTEE ON EDUCATION
WRITTEN IN-SERVICE EXAMINATION
SECOND YEAR
OCTOBER 12, 2022

48. What is the cornerstone of anti-inflammatory treatment for acute exacerbation in

atopic dermatitis?
A. Tar preparations
B. Topical corticosteroids
C. Nonsteroidal topical calcineurin inhibitors
D. Phosphodiesterase inhibitors

49. The result of the cranial ultrasound of a preterm with suspected intraventricular
hemorrhage (IVH) showed bleeding confined to the germinal matrix-subependymal
region (<10% of the ventricle). How will you grade the severity of the IVH?
A. IV
B. III
C. II
D. I

50. What is the most typical manifestation of immunodeficiency in children?

A. Recurrent sinopulmonary infections
B. Non-development of antibodies after vaccinations
C. Failure to thrive with frequent diarrhea episodes
D. Chronic oral candidiasis

51. A neonate diagnosed with Hypoxic Ischemic Encephalopathy (HIE) presents with
stupor, hypotonia, seizures, oculomotor and suck/ swallow abnormalities. In what
kind of injury (based on topography of brain injury) will you see this presentation?
A. Parasagittal injury
B. Periventricular injury
C. Selective neuronal necrosis
D. Focal ischemic necrosis

52. Diana is a 7 year old girl with recurrent bouts of watery nasal discharge, nasal
congestion and itchiness and sneezing. She would pick her nose due to the nasal
itchiness that she would sometimes have epistaxis. These symptoms would occur
for 2-3 days/ week which were noted to be troublesome when present, causing sleep
disruption and impairment of daily activities especially in school/ sports. Based on
the ARIA classification, how will you classify her allergic condition?
A. Mild intermittent
B. Moderate-severe intermittent
C. Mild persistent
D. Moderate-severe persistent

53. A 6 year old boy with a history of atopic dermatitis in infancy, allergic rhinitis and
food allergy was brought to the ER due to respiratory distress. He started wheezing
2 days ago, with the onset of his allergic rhinitis symptoms. At present he is
breathless at rest, speaks in single words and slightly agitated. On PE, HR=
125/min, RR= 38/min, with pulsus paradoxus, suprasternal and intercostal
retractions, and loud wheezing. In your functional assessment, what is the likely
peak expiratory flow value that you will achieve?
A. More than or equal to 70%
B. 40-69% or response lasts <2 hrs
C. Less than 40%
D. Cannot be determined anymore

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 PHILIPPINE PEDIATRIC SOCIETY – HOSPITAL ACCREDITATION BOARD
COMMITTEE ON EDUCATION
WRITTEN IN-SERVICE EXAMINATION
SECOND YEAR
OCTOBER 12, 2022

54. Dino is a 3,300 g full term baby born via vacuum-assisted delivery. A few hours after
birth, a 4x5 cm fluctuant mass developed along the left coronal suture of his skull,
covering the anterior fontanelle. Skull X-ray showed fragmentation of the superior
margin of the parietal bone with suture diastasis. A collection of fluid, probably blood,
was also noted beneath the aponeurosis covering the scalp. The mass continued to
increase in size for a week. Aside from anemia, what should you watch out for in the
succeeding 1-2 weeks?
A. Occasional hypertension
B. Subcutaneous bleed on the neck
C. Decreasing facial jaundice
D. Transient polycythemia

55. A 9 month old baby was brought to your clinic due to recurrent respiratory tract
infections and failure to thrive. From 2 months of age, the baby has been hospitalized
4x for pneumonia, with URTIs in between episodes. She would have recurrent oral
thrush and diarrhea, causing poor appetite and eventually weight loss. She had
chicken pox at age 7 months. On PE, she has severe wasting and stunting, oral
thrush, pox scars all over her body and pallor. What part of the immune system is
defective in this patient?
A. Granulocyte
B. Complement
C. B-cell predominant
D. T-cell predominant

56. An 18-month old boy was referred to the OPD due to failure to thrive. According to
the mother, he was diagnosed with primary Koch’s infection at the health center at
age 1 year. On further history he was doing well in early infancy but at 8 months old,
he started having recurrent otitis media, cough and colds, and was hospitalized 5
times due to pneumonia. He also had recurrent cutaneous and abscesses. CBC done
3 days ago showed neutropenia and serum IgA, IgM, IgG IgE are all <100 mg/dL.
What is your diagnosis?
A. Combined variable immunodeficiency (CVID)
B. IgG subclass deficiency
C. X-linked Agammaglobulinemia
D. Hyper IgM syndrome

57. A G5P4 mother delivered via emergency caesarean section to a 4,400 g baby boy.
Due to left shoulder dystocia, the obstetrician placed excessive traction over the
shoulder, causing an injury to the 5th and 6th cervical nerve of the baby. At birth,
there was adduction and internal rotation of the arm with pronation of the forearm.
Forearm extension was retained. Moro reflex was absent on the left side but the hand
can grasp your finger. What is your plan of management for this baby?
A. Partial immobilization and appropriate positioning with a splint
B. Microsurgical repair of damaged cervical nerves in 2 weeks
C. Botulinum toxin injection on the biceps and triceps muscles
D. No need for any intervention since it will heal spontaneously

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 PHILIPPINE PEDIATRIC SOCIETY – HOSPITAL ACCREDITATION BOARD
COMMITTEE ON EDUCATION
WRITTEN IN-SERVICE EXAMINATION
SECOND YEAR
OCTOBER 12, 2022

58. A 3-year-old boy who is exposed to his father with tuberculosis was given
prophylactic isoniazid (10mg/kg/day) to be taken once/day with Vit. B6
(12.5mg/day). The sweet tasting drug was placed on the dining table. On day 3 of
medication, the boy started having nausea, vomiting and fever with slurred speech
and prolonged sleeping time. The aunt noted that the INH bottle was empty since
last night. What antidote should you give?
A. Deferoxamine
B. Naloxone
C. Physostigmine
D. Pyridoxine

59. James, a 9-month-old toddler was brought to your clinic due to “cross eye”
(“nababanlag”) on the left, which the parents noted since he was 4 months old. The
left eye remained deviated inward compared to the right which goes back to midline.
What is the most rapid and easily performed diagnostic test you can perform to
assess his condition?
A. Cover-uncover
B. Alternate cover
C. Hirschberg corneal reflex
D. Red orange reflex

60. Which of the following indicators is associated with conductive hearing loss in
children?
A. Recurrence or persistence of otitis media with effusion
B. Anatomic deformities affecting the nasopharyngeal area
C. Family history of hereditary childhood hearing loss
D. In utero infection such as herpes, syphilis and rubella

61. While swimming in the river, John,10/M, and his friends were caught in a storm
making it difficult for them to get off the water. John got caught in the rapid flow of
the river, submerging him deeper until his head could not be seen anymore. Which
of the following would predict a poor outcome of survival?
A. Resuscitation duration <10 minutes
B. Submersion duration >10 minutes
C. Glasgow Coma Scale >6
D. Mild neurologic sequelae

62. Jenna, 4 year old /F was visiting your clinic for her yearly flu shots. She’s
developmentally at par with age and but her mom complains that she drinks
powdered fruit juices from the bottle or sippy cup. On PE, you noted multiple dental
caries with beginning gingivitis in the molar region. Jenna said she brushes her teeth
at night by herself without supervision. Her last dental visit was 2 years ago. After
doing risk assessment, how will you prevent further progress of her caries?
A. Apply fluoride varnish once a year on the molars
B. Use a smear or grain sized amount of fluoride toothpaste when brushing
C. Make an urgent referral to the dentist to extract her molars and dental pulp
D. Allow sweetened beverages but only at meal times at 6 oz/day

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 PHILIPPINE PEDIATRIC SOCIETY – HOSPITAL ACCREDITATION BOARD
COMMITTEE ON EDUCATION
WRITTEN IN-SERVICE EXAMINATION
SECOND YEAR
OCTOBER 12, 2022

63. Sam, 2 year old /M, was brought to your clinic due to foul smelling mucopurulent
nasal discharge on his left nostril for 4 weeks. This is accompanied by nasal
congestion, sneezing and itchiness, and 2 episodes of epistaxis. General PE findings
are normal; nasal exam with a speculum showed a single mass in the anterior part
of his left nose. What is your diagnosis?
A. Foreign body obstruction
B. Nasal polyp
C. Mucositis
D. Nasal septum deviation

64. Baby Sean was observed to have predominantly tonic neck reflex with arms held to
the sides. He is able to suck well and smile involuntarily and turns preferentially
towards his mother’s voice. How old would he most likely be (in months)?
A. 0-2
B. 4-6
C. 7-9
D. 10-12

65. A toy was hidden under a blanket while Baby Annika was watching. If she starts
searching for it, her age in months will be approximately:
A. 3
B. 5
C. 7
D. 9

66. Which of the activities is considered a negative indicator (activities that a child cannot
do) and thus will be needing developmental surveillance and screening?
A. Speech by 8 months
B. Walking alone by 12 months
C. Washing hands by 18 months
D. Run by 2.5 years

67. On developmental screening, you asked a child to copy a square (see figure). You
can say that his fine motor development is at par with which age in years?
A. 1
B. 2
C. 3
D. 4

68. Which of the following motor activities is arranged according to order of development
from earliest to latest:
1-Runs 2-Skips 3-Jumps on two feet
4-Pedals tricycle 5- Walks well

A. 1-3-4-2-5
B. 1-5-2-3-4
C. 5-2-1-4-3
D. 5-1-3-4-2

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 PHILIPPINE PEDIATRIC SOCIETY – HOSPITAL ACCREDITATION BOARD
COMMITTEE ON EDUCATION
WRITTEN IN-SERVICE EXAMINATION
SECOND YEAR
OCTOBER 12, 2022

69. Which radiographic findings is compatible with the most common type of
tracheoesophageal fistula?
A. Airless scaphoid abdomen on plain radiograph
B. Coiled NGT, gaseous dilatation of stomach on plain radiograph
C. Tracheal aspect of fistula superior to esophageal aspect on barium swallow
D. (+) outline of tracheobronchial tree on barium esophagogram

70. Witnessed or suspected ingestion of button battery requires immediate removal

within 2 hours regardless of the time of child’s last oral intake if lodged in which of
the following structures?
A. Oral cavity
B. Esophagus
C. Stomach
D. Intestines

71. Which of the following interventions may be acutely administered to a child with
accidental ingestion of acidic drain declogger prior to an upper endoscopic
procedure?
A. Dilution with water
B. Neutralization with base
C. Induced emesis
D. Gastric lavage

72. A 12-month old male infant underwent exploratory laparotomy due to malrotation
with volvulus. An ileal resection was performed. A central line was inserted for total
parenteral nutrition. Which of the following additional supplementation is necessary
based on the regional absorptive capacity of the resected intestinal segment?
A. Iron and folic acid
B. Calcium and phosphorus
C. Vitamin B12, bile acids
D. Water soluble vitamins and magnesium

73. A 3 year old girl was admitted due to 2 days history of abdominal pain and one day
history of vomiting. There was no fever. She is an active girl with a newly-born baby
brother aged 2 months. She would habitually put off urination when busy playing and
would have bowel movements every 3 days. Stools were noted to be large-sized.
PE: well-nourished, flat abdomen, normoactive bowel sounds, palpable mass LLQ.
Direct rectal exam revealed stool on examining finger. Neurologic examination –
normal. Which of the following workups and expected findings would be seen?
A. Anorectal manometry: relaxed internal anal sphincter with rectal distention
B. Barium enema: dilated proximal colon with abrupt narrowing distally
C. Rectal biopsy: ganglion cells with (-) staining for anticholinesterase
D. Spine MRI: tethered cord

74. What is the recommended initial triple therapy in Helicobacter pylori-related peptic
ulcer disease?
A. Omeprazole + Amoxicillin + Clarithromycin
B. Metronidazole + Clarithromycin + Amoxicillin
C. Amoxicillin + Ranitidine + Metronidazole
D. Sucralfate + Omeprazole + Amoxicillin

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 PHILIPPINE PEDIATRIC SOCIETY – HOSPITAL ACCREDITATION BOARD
COMMITTEE ON EDUCATION
WRITTEN IN-SERVICE EXAMINATION
SECOND YEAR
OCTOBER 12, 2022

75. A 12-month old male presents with diarrhea for 3 weeks duration. He was just
discharged one week ago due to Amoebiasis. At present stools were watery, non-
foul, non-bloodstreaked occurring twice a day. No episodes noted between feedings.
Stool anion gap was high. If you are considering postenteritis diarrhea syndrome,
which of the following stool test will turn out to be abnormal?
A. occult blood
B. reducing sugars
C. leukocytes
D. ova and parasites

76. Jerry, a 10 year old male was being evaluated due to abdominal pain of one day
duration. He pointed to the epigastric region as the location of the pain initially. Mother
observed that he would prefer to lie on his right side. PE revealed T 38.5 C, (+) RLQ
tenderness. CBC showed WBC 11,000 with neutrophilic predominance (75%). Since
the Pediatric Appendicitis Score was equivocal he underwent ultrasound. Which of
the following sonographic findings will point to an early diagnosis of Acute
Appendicitis?
A. Asymmetric wall thickening
B. Decreased local tenderness to compression
C. > 6mm wall thickness, non-compressible
D. Abscess formation

77. The respiratory pattern of an intubated 16-year old adolescent with alveolar interstitial
lung pathology does not match his ventilator settings. Which of the following
intervention is best in order to assume total control of his ventilation to avoid
ventilator-induced lung trauma?
A. institute sedation and pharmacologic paralysis
B. administer inhaled nitric oxide
C. potent analgesics and IV steroids
D. introduce Helium-oxygen mixture (Heliox)

78. An anxious14-year old girl lost consciousness after receiving an immunization shot
for the first time after several years. She was noted to be pale and diaphoretic. BP
was 80/50, CR 50/min. Which of the following complaints would she be expected to
mention?
A. “My head is spinning.”
B. “I feel faint.”
C. “My balance is off.”
D. “I feel disconnected, drugged.”

79. A child involved in a vehicular accident was noted to have midline trachea, muffled
heart sounds, jugular venous distention and hypotension with narrow pulse pressure.
He should undergo which of the following emergency procedures?
A. Pericardiocentesis
B. Needle thoracentesis
C. Chest tube insertion
D. Mechanical ventilation with PEEP

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 PHILIPPINE PEDIATRIC SOCIETY – HOSPITAL ACCREDITATION BOARD
COMMITTEE ON EDUCATION
WRITTEN IN-SERVICE EXAMINATION
SECOND YEAR
OCTOBER 12, 2022

80. A boy was diagnosed to have severe brain injury from abusive head trauma. He was
intubated with spine precaution and stabilized hemodynamically. Impending
increased intracranial pressure was anticipated. Which of the following is the next
best step to perform?
A. Elevation of the head of the bed
B. Lumbar CSF drainage
C. Decompressive craniotomy
D. Barbiturate infusion

81. Which type of shock is caused by pericardial tamponade?

A. Hypovolemic
B. Distributive
C. Cardiogenic
D. Obstructive

82. What type of disorder in body fluids is seen in a patient with hypernatremia?
A. It reflects derangement in water balance.
B. It is a disorder in Na balance.
C. There is normal plasma osmolality.
D. There is increased volume status.

83. A child with diabetes insipidus developed diarrhea and anorexia. His serum Na was
170 mEq/L. He was started on IV hydration. After 12 hours he was noted to develop
seizures and decreased level of consciousness. Repeat serum Na was 140 mEq/L.
Which of the following interventions should be administered?
A. IV bolus of furosemide at 2 mg/kg/dose
B. 3% NaCl infusion at 4 mL/kg
C. NSS infusion at 20 mL/kg over 20 minutes
D. D5W at 1.5 times maintenance

84. A 7 year old boy underwent exploratory laparotomy due to intestinal obstruction. A
JP drain was in place post-op. On the first post-op day, he was on D5NSS + 20 mEq
KCl at maintenance rate. His vital signs were stable but he looked slightly dehydrated.
JP drained 100 mL every shift. What modification in the IV hydration should be
instituted?
A. Same IV fluids and increase maintenance rate to thrice maintenance.
B. Start sips of oral rehydrating solution as tolerated.
C. Replace JP drainage with Plain LRS or NSS.
D. Switch to D5 ½ NS + 20 mEq/L with IV albumin infusion at 1 gm/kg.

85. Pseudohyponatremia is commonly associated with which of the following conditions?

A. Osmotic diuresis
B. Hyperglycemia
C. Third space losses
D. Hyperlipidemia

86. An adolescent male was brought to the ER due to tachypnea. He was noted to have
deep, rapid respiration. ABG revealed: pH 7.2 pCO2 26 HCO3 12 pAO2 99 ;
Laboratory tests: Na 142 K 4 Cl 110. Based on the anion gap, which of the
following conditions is the most likely cause?
A. Renal tubular acidosis
B. Diabetic ketoacidosis
C. Diarrheal disorder
D. Respiratory distress syndrome

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 PHILIPPINE PEDIATRIC SOCIETY – HOSPITAL ACCREDITATION BOARD
COMMITTEE ON EDUCATION
WRITTEN IN-SERVICE EXAMINATION
SECOND YEAR
OCTOBER 12, 2022

87. A 10 month old male infant was admitted due to high fever and chills. No obvious
focus of infection was seen on PE. A similar episode happened 2 months ago.
Urinalysis was significant for pyuria and bacteriuria. Urine culture grew E. coli
>100,00CFU/mL urine. Which sequence of imaging studies is best recommended for
this patient?
A. Kidney + Urinary bladder ultrasoundàDMSA renal scanàVCUG
B. Abdominal + Urinary bladder ultrasound àVCUG
C. Kidney + Urinary bladder ultrasound àIntravenous pyelographyà VCUG
D. Abdominal + Urinary bladder ultrasoundàUrodynamic studyàDMSA renal
scan

88. Which of the host factors is considered protective against urinary tract infection?
A. Constipation
B. Unidirectional urine flow
C. Intrarenal reflux of compound papillae of the kidney
D. Frequent bubble baths

89. Which of the following clinical features is compatible with a diagnosis of acute post-
infectious glomerulonephritis?
A. decreased serum C3, normal C4
B. Nephrotic-range proteinuria
C. Good response to oral steroids
D. Immediately follows a viral syndrome

90. A 12-year old female, a vehicular accident victim was noted to have hypotension due
to massive blood loss. On the 2nd hospital day, she was noted to have facial edema
and oliguria. BP was 140/90. Urine output was <0.5 mL/kg/hr for 12 hours PTA. If you
are suspecting acute kidney injury, which urinary indices will further support this?
A. Decreased fractional excretion of Na
B. Increased urine specific gravity
C. Presence of hyaline and red cell casts
D. Increased urine Na

91. Which of the following nutritional management is the ideal recommendation for a child
with chronic kidney disease?
A. 100% recommended protein requirement
B. RDA for trace elements like aluminum
C. Lesser unsaturated than saturated fats
D. Phosphate-rich diet

92. Which statement best explains the nature and context of newborn screening practice
in the Philippines?
A. It is a voluntary approach which entails an informed parental decision before
screening.
B. It is a routine approach with an opt-out option requiring an explicit refusal for
parents who object to this intervention.
C. It is a mandatory approach based on society’s obligation to promote child
welfare through early screening and intervention.
D. It is a research approach which clearly requires parental consent and
permission.

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 PHILIPPINE PEDIATRIC SOCIETY – HOSPITAL ACCREDITATION BOARD
COMMITTEE ON EDUCATION
WRITTEN IN-SERVICE EXAMINATION
SECOND YEAR
OCTOBER 12, 2022

93. In which of the following medical conditions is palliative care most appropriate?
A. Acute lymphocytic leukemia
B. Severe cerebral palsy with recurrent infections
C. Acute respiratory failure
D. Acute kidney injury

94. A 13-year old boy with metastatic rhabdomyosarcoma recently showed multiple
lymph node involvement in various anatomic sites after a PET scan. As part of the
multi-disciplinary team taking care of this boy how best will you respond to his
questions about death and dying?
A. Optimize comfort and consistency through familiar objects and routines using
soothing words and songs.
B. Reinforce self-esteem, self-respect and sense of worth allowing privacy,
independence and access to familiar people.
C. Provide assurance that the illness is not a personal fault while promoting
honest language.
D. Help and support personal need for control and allow participation in decision-
making.

95. Which of the following conditions strongly suggest physical abuse in a child?
A. cigarette-burn like lesions of varying sizes
B. bruising in bump areas
C. fractures in the posterior rib, scapula and sternum
D. contusion hematoma on the forehead

96. A term-newborn infant showed significant jaundice before the 1st 24 hours of life. TSB
(total serum bilirubin) was already 15 mg/dl with 90% indirect bilirubin fraction.
Maternal history revealed fever a day before delivery despite oral antibiotics
prescribed by the obstetrician. Which of the following antibiotics must be AVOIDED
to minimize progressive hyperbilirubinemia in this patient?
A. ampicillin
B. ceftriaxone
C. meropenem
D. vancomycin

97. Which type of pharmacodynamic drug interaction best explains the improved
bactericidal efficacy of ampicillin and gentamicin in the treatment of neonatal sepsis?
A. addition
B. antagonism
C. potentiation
D. synergy

98. Which of the following methods of gastrointestinal decontamination show potential

benefit in pediatric poisoning?
A. activated charcoal
B. syrup of ipecac
C. cathartics
D. gastric lavage

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 PHILIPPINE PEDIATRIC SOCIETY – HOSPITAL ACCREDITATION BOARD
COMMITTEE ON EDUCATION
WRITTEN IN-SERVICE EXAMINATION
SECOND YEAR
OCTOBER 12, 2022

99. A 10-year old male sustained severe head injuries after a vehicular accident. During
physical examination for signs of increased intracranial pressure, which of the
following is part of the Cushing triad?
A. altered breathing
B. altered sensorium
C. tachycardia
D. hypotension

100. A 12-year old boy sustained a whiplash injury causing altered sensorium. Upon
neurologic examination, the following findings were noted: (+) spontaneous eye
opening, oriented to 3 spheres and localizes pain upon stimulation. What is the
patient's Glasgow Coma Scale (GCS) score?
A. 15
B. 14
C. 12
D. 9

101. A 4-year old child with brain tumor is unable to maintain airway patency and is failing
to maintain adequate oxygenation. Endotracheal intubation contemplated. What size
(in mm) of uncuffed endotracheal tube is BEST suited for this patient?
A. 3
B. 4
C. 5
D. 6

102. Which of the following medical conditions best explains the type of shock associated
with anaphylaxis?
A. Presence of excessive fluid loss due to hemodilution.
B. Fluid loss due to third spacing of intravascular fluid into the extravascular
component.
C. Tissue hypoperfusion due to profound myocardial dysfunction.
D. Low cardiac output due to obstruction of blood flow in the peripheral circulation.

103. Which of the following is a component of high-quality CPR (cardiopulmonary

resuscitation?
A. chest compressions should push hard
B. chest compressions should push slowly
C. allow for several interruptions
D. avoid complete chest recoil

104. A 7-year old boy with suspected meningococcemia developed multiple ecchymoses
followed by hematemesis and hematochezia. Laboratory tests revealed
thrombocytopenia, prolonged PT and aPTT. Which possible therapeutic
intervention/s is most appropriate for these hematologic manifestations?
A. platelets, vitamin K and FFP
B. platelets, packed red cells and warfarin
C. FFP, corticosteroids, and oxygen
D. FFP, vitamin K and sodium bicarbonate

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 PHILIPPINE PEDIATRIC SOCIETY – HOSPITAL ACCREDITATION BOARD
COMMITTEE ON EDUCATION
WRITTEN IN-SERVICE EXAMINATION
SECOND YEAR
OCTOBER 12, 2022

105. Which clinical scenario is most likely due to cardiogenic shock?

A. 5-year-old boy with third degree burns
B. preterm infant with severe sepsis
C. 12-year-old boy with arrhythmia
D. 10-year-old boy with tension pneumothorax

106. Among trisomy 21 children, which organ is most commonly affected by congenital
defects?
A. Gastrointestinal tract
B. Heart
C. Thyroid gland
D. Lungs

107. What is the most common syndrome associated with hypogonadism and infertility in
males?
A. Klinefelter
B. Turner
C. Fragile X
D. XYY

108. Which of the following clinical features are true regarding Type 1 diabetes mellitus in
children?
A. Acanthosis nigricans
B. DKA at presentation
C. Very strong family history
D. Chronic, insidious onset of clinical manifestations

109. Which laboratory test is a reliable index of long-term glycemic control in children with
childhood diabetes?
A. Capillary blood glucose monitoring
B. random blood sugar
C. fasting blood sugar
D. glycosylated hemoglobin A1c

110. Which of the following mechanisms best explains the metabolic acidosis associated
with diabetic ketoacidosis (DKA)?
A. depleted insulin levels
B. excessive glucose production with decreased glucose utilization
C. increased release of free fatty acids from peripheral fat stores
D. increased catabolic processes leading to fluid and electrolyte imbalance

111. A 2-year old boy with suspected adrenal insufficiency was rushed to the ER due to
orthostatic hypotension preceded by vomiting, malaise and severe muscle weakness.
Which serum electrolyte/metabolic abnormality will you immediately address?
A. hypocalcemia
B. hypokalemia
C. hypoglycemia
D. hyponatremia

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 PHILIPPINE PEDIATRIC SOCIETY – HOSPITAL ACCREDITATION BOARD
COMMITTEE ON EDUCATION
WRITTEN IN-SERVICE EXAMINATION
SECOND YEAR
OCTOBER 12, 2022

112. A 4-year old girl with significant pyuria in urinalysis was prescribed with cotrimoxazole
by her pediatrician. After 1 ½ months patient developed fever, jaundice and a
morbilliform, pruritic rash on the head, upper trunk and arms prompting ER
consultation. Laboratory tests revealed eosinophilia and mild elevation of liver
enzymes. Based on these findings, what will be your most likely working diagnosis?
A. fixed drug eruption
B. drug rash with eosinophilia and systemic symptoms
C. serum-sickness like reaction
D. Stevens’ Johnson syndrome

113. A 3-year old boy developed tiny vesicles and pustules which rapidly developed into
honey-colored plaques on the angle of his left lower lip. What treatment will you most
likely prescribe to this patient?
A. topical antibiotics like mupirocin
B. systemic antibiotics like cephalexin
C. combination of topical and systemic antibiotics
D. cold compress with oral anti-histaminic drugs

114. A 6-year old boy has dry, elevated, slightly erythematous, elevated, scaly
papule/plaques spreading centrifugally but with central clearing giving the
appearance of annular lesion. KOH wet mount preparation was (+). What topical
treatment will you advise for this patient?
A. antibiotic
B. antibiotic + antifungal
C. antifungal
D. antifungal + steroid

115. A 6-year old boy developed fever accompanied by limping and pain which he
localizes in the lower extremities. On physical examination, you documented bone
tenderness, warmth and pain upon movement. Blood culture was positive in less than
24 hours from inoculation and plain radiographs of the affected extremities revealed
lytic lesions. What etiologic agent should you immediately address to help this
patient?
A. Group A beta hemolytic streptococcus (GAHBS)
B. Gram negative enteric bacilli (Escherichia coli)
C. Pseudomonas aeruginosa
D. Staphylococcus aureus

116. A 12-year old boy football player came home limping with painful movement of his
back and left leg after a half-day training for a forthcoming tournament. What
condition will you most likely consider?
A. transient synovitis
B. osteitis pubis
C. Legg Calve Perthes disease
D. femoral neck stress fracture

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 PHILIPPINE PEDIATRIC SOCIETY – HOSPITAL ACCREDITATION BOARD
COMMITTEE ON EDUCATION
WRITTEN IN-SERVICE EXAMINATION
SECOND YEAR
OCTOBER 12, 2022

117. A 2-year old girl was brought to you due to pallor. The child was previously well with
no previous hospitalizations nor laboratory tests done. Mother described the child’s
feeding habit as extremely picky and is fond of fad diets. Which of the following
laboratory test findings support your trial diagnosis of iron deficiency anemia (IDA)?
A. Low hemoglobin, low hematocrit, low red cells, microcytosis, low reticulocyte
count
B. Low hemoglobin, low hematocrit, low red cells, microcytosis, high reticulocyte
count
C. Low hemoglobin, low hematocrit, normal red cells, macrocytosis, high
reticulocyte count
D. Low hemoglobin, low hematocrit, normal red cells, macrocytosis, normal
reticulocyte count

118. Which statement is true regarding physiologic anemia of infancy?

A. Erythropoietin is downregulated causing suppression of red cell synthesis.
B. A hematologic problem should be ruled out so treatment can be started.
C. It is usually observed by 3-6 weeks of age.
D. Hemoglobin levels fall below 10 g/dL.

119. What is the recommended iron therapy supplementation in premature infants with
physiologic anemia of prematurity?
A. No iron supplementation is needed.
B. Iron supplementation at 1-2 mg/kg/day elemental iron starting at 1 month of
age up to age 1.
C. Iron supplementation at 1-2 mg/kg/day elemental iron starting at 4 months for
3 months.
D. Iron supplementation at 4-6 mg/kg/day elemental iron starting at birth up to
age 1.

120. A 5-year old patient with beta thalassemia major on chronic packed red cell
transfusion should be closely observed for which complication of diseases/
treatment?
A. splenomegaly
B. hemosiderosis
C. growth retardation
D. diabetes mellitus

121. A 6-year old boy with G6PD was diagnosed with exudative tonsillitis. Which of the
following antibiotics should be avoided?
A. Amoxicillin
B. Cefuroxime
C. Chloramphenicol
D. Erythromycin

122. A 10-year old boy has fever of more than a week’s duration, gum bleeding and pallor.
On physical examination T 39C, CR 125 beats/min RR 30 breaths/min BP 100/70,
swollen gums with bleeding, no lymphadenopathies, no hepatosplenomegaly,
multiple petechiae and purpura all over the body. This laboratory finding that will
make you suspect aplastic anemia if there is pancytopenia with:
A. blast cells in the bone marrow
B. an empty bone marrow
C. a normal bone marrow
D. spherocytes in the bone marrow

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 PHILIPPINE PEDIATRIC SOCIETY – HOSPITAL ACCREDITATION BOARD
COMMITTEE ON EDUCATION
WRITTEN IN-SERVICE EXAMINATION
SECOND YEAR
OCTOBER 12, 2022

123. A 3-year old thalassemic girl was admitted in the ambulatory care unit for her
scheduled blood transfusion. Which transfusion guideline will you use for this patient?
A. Packed red cells at 10-15 ml/kg IV to run for 2-4 hours
B. Fresh whole blood 10-20 ml/kg IV to run for 2-4 hours
C. Platelet concentrate 2 units IV as fast drip
D. Fresh frozen plasma 1 unit IV for 6 hours

124. Which of the following statements is true of idiopathic (autoimmune)

thrombocytopenic purpura in children?
A. There is a history of a preceding viral infection 1-4 weeks before onset of
bleeding signs and symptoms.
B. There is associated hepatosplenomegaly, lymphadenopathy and anemia in
most cases.
C. Spontaneous resolution is almost always not possible.
D. Severe bleeding is very common.

125. What is the single most important prognostic factor in the treatment of childhood
acute lymphoblastic leukemia (ALL)?
A. Age
B. Initial WBC count
C. Response to treatment
D. Gender

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