PHILIPPINE PEDIATRIC SOCIETY – HOSPITAL ACCREDITATION BOARD

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

NAME__________________________________ YEAR _______________________

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

FOLLOWING QUESTIONS.

1. A bedridden 5 year-old boy, malnourished, has recurrent episodes of pneumonia.

Wheezing was observed in several episodes but there is no family history of
asthma. What is the most likely cause of his chronic lung disease?
A. Gastroesophageal reflux
B. Immotile cilia syndrome
C. Interstitial pneumonitis
D. Reactive airway disease

2. Which of the following is one of the common causes of neonatal pneumonia?

A. Chlamydia
B. Haemophilus influenza
C. Mycoplasma pneumoniae
D. Streptococcus pneumoniae

3. A 7 year-old boy is brought to the emergency room because of status

asthmaticus. His respiratory rate is 50 breaths per minute with diffuse wheezing.
Capillary blood gas revealed respiratory alkalosis and the pulse oximetry reading
was 94%. What is the best treatment management for this child? Give B2 agonist
and_______.
A. inhaled corticosteroid
B. leukotriene modifiers
C. magnesium sulfate
D. systemic corticosteroid

4. Which virus is known for its genetic reassortment and lead four global pandemics
since the 1900?
A. Adenovirus
B. Human immunodeficiency virus (HIV)
C. Influenza virus
D. Poliovirus

5. An 18 year-old student reports sore throat and extreme fatigue. He has had fever
for several weeks. His girlfriend also appears to be sick. On physical
examination, the tonsils are inflamed with a white exudate, cervical
lymphadenopathy and splenomegaly. What is the most likely causative agent?
A. Adenovirus
B. Epstein-Barr Virus
C. Influenza virus
D. Retrovirus

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

6. What is the most common diagnostic modality used in Infectious Mononucleosis?

A. Assay for Epstein-Barr nuclear antigen
B. Isolate EBV from saliva, blood or lymphoid tissue
C. Monospot test for heterophile antibody
D. Presence of atypical lymphocytes in the blood

7. A 18 year-old sexually active female developed purulent vaginal discharge and

dysuria without urgency nor frequency. What bacteriologic characteristics would
you expect from the vaginal discharge?
A. Gram-negative diplococcus, which is oxidase positive
B. Gram-positive coccus, which is catalase positive and coagulase negative
C. Gram-positive bacillus grown on low oxidation-reduction medium
D. Gram-negative bacterium capable of reducing nitrates to nitrites

8. A 2 year-old AIDS patient with septicemia develops a target-shaped necrotic

lesion on the buttock with a black center and an erythematous margin. Which is
the most likely causative agent?
A. Enterococcus faecalis
B. Pseudomonas aeruginosa
C. Staphylococcus aureus
D. Streptococcus pyogenes

9. What is the most common organism isolated in catheter-related UTI?

A. Candida species
B. Coagulase negative Staphylococci
C. Gram negative Bacilli
D. Streptococci

10. What is the most common form of extrapulmonary tuberculosis?

A. Pleural Effusion
B. Central Nervous System Tuberculosis
C. Miliary Tuberculosis
D. Tuberculous Lymphadenitis

11. After the primary infection, when does disseminated and meningeal tuberculosis
occur in children?
A. 1 month
B. 2 to 6 months
C. 3 to 9 months
D. 1 to 3 years

12. A 3-year old boy was brought for consult due to exposure to his nanny who was
diagnosed to have pulmonary tuberculosis. His Chest X-ray and Mantoux test
were negative. There are no symptoms of fever or weight loss. How should this
child be managed?
A. 2HRZE/4HR
B. 2HRZE/10HR
C. INH for 3 months and repeat Mantoux test after 3 months
D. No medication and repeat Mantoux test after 3 months

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

13. Which of the following parenting attributes is consistent with a progressive type of
parenting?
A. Consistency with routines and expectations.
B. Labelling emotions and behaviors to help children understand their feelings.
C. Providing a safe environment.
D. Noticing and praising new skills and desirable behaviors.

14. A 12 month-old boy was brought to the out-patient clinic because of concerns on
language delay. His speech consists of short babbles, vocalizations, and
communicates his needs mostly through gestures. What would be the first step in
the management of this patient?
A. Request for an EEG
B. Administer standardized screening tool
C. Request for an OAE
D. Request for Brain MRI

15. Which of the following statements is TRUE about toddler’s diarrhea?

A. Presents with failure to thrive
B. Daily recurrent passage of painless stools
C. Presents with nighttime defecation
D. Duration of diarrhea is at least 3 weeks

16. A 5 month-old infant was brought due to recurrent regurgitation of gastric

contents. He was observed to have repetitive contractions of the abdominal
muscles and diaphragm with no signs of distress. Which of the following
statements would confirm your diagnosis?
A. Age of onset is at 2 months
B. History of fever or illness
C. Duration of symptoms for at least 1 month
D. Does not occur during sleep or during social interaction

17. A 1 year old, 10 kg child presented to the emergency room with fever and
vomiting. The grandmother has been giving Paracetamol 100 mg/ml at 2.5 ml
every 4 hours for the fever with a total of 6 doses. The liver transaminase is
elevated and the acetaminophen blood level is pending. What is the definitive
management for the patient?
A. Administer activated charcoal
B. Do Gastric Lavage
C. Give N acetyl cysteine
D. None since this is not a toxic dose

18. Which of the following is characteristic of moderate dehydration?

A. 10 percent loss of body weight in an infant
B. 9 percent loss of body weight in a child
C. Skin recoil less than 2 seconds
D. No urine output

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

19. Which of the following vitamins is most likely deficient in a malnourished 9-year-old
child with peripheral neuritis and tenderness and cramping of the leg muscles?
A. A
B. B1
C. B2
D. B6

20. A 6 year old female came to the clinic with dysuria. Urinalysis revealed pH 1.020,
yellow, slightly turbid, WBC 10-12, (-) glucose, (-) ketones, RBC:0-1. Pending
urine culture results, what should be the initial treatment?
A. TMP- SMX at 6 to 12 mg/kg/day
B. Metronidazole at 20 to 30 mg/kg/day
C. Ciprofloxacin at 15 to 30 mg/kg/day
D. Ceftriaxone at 50 mg/kg/day

21. A 5 year old male was brought to the clinic due to tea colored urine and oliguria.
Interval history revealed recurrent skin infections. Which will be the possible
complication in this child?
A. Hypophosphatemia
B. Heart failure
C. Hypokalemia
D. Respiratory distress secondary to pneumonia

22. A 4-day-old male, 2.6kg, was brought for consult due to jaundice down to the legs.
His birth weight was 3.2 kg. The mother exclusively breastfeeds him but seems to
be vigorously crying and active. The results of the CBC and CRP were normal.
The mother’s and the baby’s blood types are A+. What is the neonate’s clinical
condition?
A. Physiologic jaundice
B. Blood incompatibility
C. Breastfeeding Jaundice
D. Clinical Sepsis

23. Which of the following is true about cephalhematoma?

A. It resolves in 48 to 72 hours
B. It occurs in the subperiosteum
C. It is usually associated with vacuum assisted delivery
D. Its mechanism of injury is usually secondary to rupture of the emissary veins

24. A newborn male born to a mother with polyhydramnios presents with frothing and
bubbling at the mouth with respiratory distress. What is the clinical diagnosis?
A. Choanal atresia
B. Hirschprung disease
C. Neonatal pneumonia
D. Tracheoesophageal fistula

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

25. What is the appropriate placement of probes when using pulse oximeter in
neonates suspected of having Congenital Heart Disease?
A. Left foot, Left hand
B. Left foot, Right foot
C. Left foot. Right hand
D. Right foot, Left hand

26. A newborn male was born to a 38 year old G1P1 mother. On physical exam, the
baby had upward slanted palpebral fissures, epicanthal folds, protruding tongue,
flat face, short neck and hypotonia. Which of the following should be watched out
for in the immediate newborn period?
A. Anemia
B. Hyperthyroidism
C. Pulmonary hypertension
D. Seizures

27. A 5-year-old male was brought for consult due to fever of 5 days duration
associated with bilateral conjunctival injections, strawberry tongue, cervical
lymphadenopathy on left measuring 2x2 cm, and erythema of the palms and
soles. What should be the treatment for this child?
A. Ceftriaxone at 50 mg/kg IV as single dose
B. Clindamycin 20 mg/kg/24 hours
C. IVIG at 2gm/kg as single infusion
D. Penicillin 50,000 units/kg/24 hours

28. A 3 year old with seizure disorder was rushed to the emergency room because of
generalized tonic clonic seizures lasting for 3 hours. What is the most appropriate
INITIAL management for this patient?
A. Diazepam 0.1 mg/kg IV
B. Diazepam 0.5 mg/kg per rectum
C. Phenobarbital 20 mg/kg IV
D. Sodium Valproate 20mg/kg IV

29. A 5-year-old male was brought to the emergency room due to fever and
headache. Upon examination, he has purpuric rashes, nuchal rigidity and
weakness. After a few hours the patient developed tachycardia, tachypnea,
hypotension and subsequently died. The close contact of the child should take
___________.
A. Amoxicillin
B. Azithromycin
C. Ciprofloxacin
D. Clindamycin

30. What is the duration (in weeks) of symptoms for a patient to have chronic
urticaria?
A. 1
B. 2
C. 4
D. 6

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

31. A 12 year old male was brought to your clinic with no MMR vaccine since birth.
What should be done?
A. Do not give any MMR vaccine since time has elapsed for giving the vaccine
B. Give 1 MMR vaccine once
C. Give MMR vaccine for 2 doses at 1 month apart
D. Give MMR vaccine for 2 doses at 1 year apart

32. You receive a phone call from a mother whose child has unilateral purulent nasal
discharge. What should be the proper advice?
A. Amoxicillin at 80 mg/kg/day
B. Intranasal corticosteroids
C. Refer to an ENT specialist
D. Saline spray

33. A 1 ½ year old female was brought to the clinic. The mother requested her child’s
immunization to be updated on the background of this immunization history: 3
doses of Hepatitis B, 3 doses of DPT, IPV and HIB, one dose of Measles, one
dose of Varicella, one dose of MMR and 3 doses of PCV 13. Which of the
following vaccines should be given?
A. DPT4IPV4HIB4
B. Hepatitis B 4th dose
C. MMR 2nd dose
D. Typhoid 1st dose

34. According to the American Society of Hematology, what is the initial approach to a
patient with Immune Thrombocytopenic Purpura (ITP) who has mild bleeding
symptoms?
A. Education and Counseling
B. Corticosteroid therapy
C. Intravenous Immunoglobulin
D. Rituximab therapy

35. A previously healthy 3-year old male was brought to the outpatient department
due to generalized petechiae and purpura. He was fine yesterday and now
covered with bruises, purple dots and gum bleeding. He had a viral infection 3
weeks before the onset of symptoms. Laboratory showed platelet count of 9,000.
What is the BEST approach for this child?
A. Education and Counseling
B. Corticosteroid therapy
C. Intravenous Immunoglubulin
D. Rituximab therapy

36. Which management should be given for a child with anemia secondary to a
chronic disease besides treating the underlying disease?
A. erythropoietin
B. ferrous sulfate
C. folic acid
D. zinc sulfate

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

37. Which of the following is Trisomy 21?

A. Down Syndrome
B. Edward Syndrome
C. Patau Syndrome
D. Turner Syndrome

38. A 10 year-old female, known DM Type 1 was rushed to the emergency room due
to difficulty of breathing. She has low grade fever and cough for 3 days. At the ER,
patient has Kussmaul breathing, with sunken eyeballs, dry lips, dry buccal mucosa
and is non-conversant. Her capillary blood glucose is 450 mg/dl. What should be
the initial management for this child?
A. Give antibiotics
B. Give subcutaneous insulin
C. Infuse intravenous fluids
D. Provide oxygen support

39. A 7-year old female was brought to the outpatient department due to central
obesity, hirsutism, moon face and hypertension. She has been taking prednisone
for 1 month now causing her to eat plenty. What is the most probable disease of
this child?
A. Constitutional Overweight
B. Cushing Syndrome
C. Exogenous obesity
D. Hypothyroidism

40. A 4-year old male was bitten by a dog, which he accidentally stepped on. The
puncture wounds oozed with blood. He is a completely immunized child including
DTaP-IPV booster 2 given a week ago. What is the best management for this
child?
A. Antibiotics + Rabies immunoglobulin and vaccine
B. Antibiotics + Tetanus immunoglunulin and toxoid + Rabies immunoglobulin
and vaccine
C. Rabies immunoglobulin and vaccine
D. Rabies immunoglobulin and vaccine + Tetanus immunoglobulin and toxoid

41. A 9-year old male admitted patient developed difficulty of breathing after giving
the first dose of intravenous penicillin for acute tonsillopharyngitis. It was
accompanied by hypotension, chest retractions and wheezing. What is the best
therapeutic management for this patient?
A. Cetirizine
B. Diphenhydramine
C. Epinephrine
D. Levocetirizine

42. A 16-year-old female has abnormal uterine bleeding causing mild anemia. What is
the most appropriate treatment for this patient?
A. Blood transfusion
B. Hormonal replacement
C. Iron supplementation
D. Tranexamic acid

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

43. What is the most appropriate management for this 8 year-old child who developed
a solitary rash on the chin described with a yellowish crusting on top?

A. Amoxicillin
B. Clindamycin
C. Cotrimoxazole
D. Mupirocin

44. A 16-year-old male was brought to the hospital due to red purple rash which forms
like blisters. History revealed that he was recently diagnosed 2 months ago with
epilepsy and has been taking phenobarbital. What does he most probably have?

A. Bullous impetigo
B. Staphylococcal scalded skin syndrome
C. Stevens-Johnson Syndrome
D. Urticaria

45. What is the most common injury for both male and female adolescents who
frequently engage in basketball that usually has jumping and running activities?
A. ACL tear
B. Ankle sprain
C. Osgood-Schlatter Disease
D. Sinding-Larsen-Johannson Syndrome

46. A 9-year old boy is being forced to have circumcision. He objects and wants to
have it done next year. What should be done in this situation?
A. Obey the decision of the parents
B. Punish the child
C. Push through with the circumcision
D. Respect the child’s decision

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

47. A mother was hesitant to give vaccines to her 6-week-old child. She believes that
diseases can be reduced by herd immunity because other children were already
immunized. What is the most appropriate advice to be given to the mother?
A. Assess the child and follow-up monthly
B. Educate the mother of the benefits of the vaccine
C. Immunize the child despite mother’s hesitancy
D. Scold the mother, discharge the patient with no follow-up

48. Which among the images of hymen should reporting to a child protection
specialist be done?

A. Annular hymen

B. Crescentic hymen

C. Lacerated hymen

D. Septated hymen

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

49. According to Basic Life Support, what is the compression:ventilation ratio in a 3-

year old child by a single rescuer?
A. 3:1
B. 15:2
C. 30:1
D. 30: 2

50. You are a witness to an 18-year-old male who had sudden loss of consciousness
while jogging. What steps should be followed according to the Basic Life Support
of AHA?
A. Check responsiveness, check pulses and breathing, if no pulses and no
breathing start CPR, call for help and ask for AED
B. Check scene safety, call for help, check responsiveness, check pulses and
breathing, if no pulses and no breathing, ask for AED, start CPR
C. Check scene safety, check pulses and breathing, call for help, check
responsiveness, if no pulses and no breathing, ask for AED, start CPR
D. Check scene safety, check responsiveness, call for help, check pulses and
breathing, if no pulses and no breathing, ask for AED, start CPR

51. What is the most frequent complication of Diphtheria?

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

52. A 15 year-old adolescent with multiple open wounds in both lower extremities
waded in floodwaters. How long should you give Doxycycline as postexposure
prophylaxis for Leptospirosis?
A. single dose within 24-72 hours from exposure
B. for 3-5 days from exposure
C. daily for 7 days
D. once weekly for a month

53. A 16 year-old female was brought to the ER with sudden onset of high fever.
Twenty-four 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 is fond of using 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

54. 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

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

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

56. 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.

57. What is the management of a 14 month- old infant with HIV infection, living in a
setting with high TB prevalence who has no TB disease based on screening and
has no contact with a TB case?
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

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

A. cute 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

59. 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

60. What is the clinical symptom /sign that differentiates Chikungunya from Dengue
infection?
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
FIRST YEAR
OCTOBER 12, 2022

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

62. Baby A, term, male, was delivered by normal spontaneous delivery with maturity
testing of 38 weeks, BW 3kg. A few minutes after birth, he was noted to be in
respiratory distress. PE findings: 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

63. Which of the following statements describes the patterns of wheezing in asthma of
infancy?
A. A Transient wheezing involves infants with an acute episode of wheezing
associated with bacterial infection.
B. Persistent wheezing is associated with history of atopy and asthma
symptoms later in infancy.
C. The onset of wheeze at less than 2 years old predicts the persistence of
asthma in later childhood.
D. May present with frequent episodes of nocturnal and exercise induced
coughing.

64. 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

65. Which of the following statements is TRUE of Congenital Cystic Adenomatoid

Malformation (CCAM)?
A. Type 1 is the most common, affecting only a part of a lobe and has a good
prognosis.
B. Type 2 is characterized by overexpansion of a pulmonary lobe
C. Type 3 has the worst prognosis because the insult occurs during the
embryonic stage.
D. Type 1 is commonly associated with other congenital anomalies

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

66. 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. He is most likely in this age range in months:
A. 0-2
B. 4-6
C. 7-9
D. 10-12

67. 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
68. 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

69. 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
70. 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. Additional supplementation of which of the following 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

71. A 12-month old male presents with diarrhea of 3 weeks duration. He was just
discharged one week ago due to Amoebiasis. At present stools are watery, non-
foul, non-blood streaked occurring twice a day. No episodes noted between
feedings. Stool anion gap was high. If you are considering post-enteritis 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

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

72. A 15 year old adolescent male, victim of blast injury was observed to open his eyes
to voice, but was confused and disoriented and withdraws from a painful stimuli.
What is his Glasgow Coma Scale?
A. 14
B. 11
C. 8
D. 5

73. 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

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

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

75. 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.

76. 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 showed significant 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 ultrasound→DMSA renal scan →VCUG
B. Abdominal + Urinary bladder ultrasound →VCUG
C. Kidney + Urinary bladder ultrasound →Intravenous pyelography → VCUG
D. Abdominal + Urinary bladder ultrasound →Urodynamic study →DMSA renal
scan

77. Which of the following clinical features is compatible with a diagnosis of acute post-
infectious glomerulonephritis?
A. Decreased serum C3
B. Nephrotic-range proteinuria
C. Low hemoglobin
D. Decreased creatinine

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

78. 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

79. 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 the most probable diagnosis?
A. Subgaleal hemorrhage
B. Caput succedaneum
C. Craniotabes
D. Cephalhematoma

80. A high risk preterm infant, with a birth weight of 1,300g, 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 1,800g. 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

81. 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 the diagnosis?
A. Inborn error of metabolism
B. Perinatal asphyxia
C. Sepsis neonatorum
D. Fetal hyperinsulinemia

82. 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

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

83. Kate,16/F was brought to the OPD for recurrent fever and fatigue. Two months ago,
she experienced easy fatiguability 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 hydrochloroquine at 8 mg/kg/day
D. IV methylprednisolone at 30 mg/kg/day

84. 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

85. 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 succeeding1-2 weeks?
A. Occasional hypertension
B. Subcutaneous bleed on the neck
C. Decreasing facial jaundice
D. Transient polycythemia

86. A 40 year old G5P4 mother delivered via mercy 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

87. 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 (12.5
mg/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
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 PHILIPPINE PEDIATRIC SOCIETY – HOSPITAL ACCREDITATION BOARD
COMMITTEE ON EDUCATION
WRITTEN IN-SERVICE EXAMINATION
FIRST YEAR
OCTOBER 12, 2022

88. 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

89. 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

90. A 16-year old girl with metastatic brain tumor has been on mechanical ventilation
and cardio-respiratory support for a week with no obvious signs of clinical
improvement. The attending physician requested that her case be presented to the
Pediatric Ethics Committee for review and recommendations. Which of the
following conditions is NOT an element of a helpful approach in this case
consultation?
A. Review of medical indications
B. Costing of care
C. Quality of life
D. Patient preferences

91. 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

92. 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
FIRST YEAR
OCTOBER 12, 2022

93. 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.

94. A 15-year old male with end stage hepatic failure suddenly developed tachycardia
and after a few minutes was noted to have hypotension. Which mechanism best
explains the patient’s shock-like state?
A. abnormalities of vasomotor tone due to loss of venous and arterial
capacitance.
B. cardiac pump failure secondary to poor myocardial function
C. low plasma oncotic pressure due to hypoproteinemia
D. decreased preload due to internal and external losses

95. 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

96. 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

97. A 2-month old male infant was noted to have a bright red protuberant, compressible,
sharply demarcated lesion on the anterior chest. Suspecting infantile hemangioma,
what advice will you give to this child’s parents?
A. Expectant observation is prudent as complete resolution is possible.
B. Oral corticosteroids may be started to halt rapid progression.
C. A trial of propranolol may help provide immediate involution.
D. Laser surgery may be considered as soon as possible.

98. A 3-year old boy suspected of being subjected to child abuse was brought to the
ER due to multiple fractures. Which statement should guide you in the diagnostic
assessment?
A. Transverse fractures of the long bones are the least prevalent.
B. Corner fractures in the metaphyses are the most classic.
C. There are pathognomonic fracture patterns in child abuse.
D. Non-accidental injury includes femur fractures in ambulatory children

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

99. Which of the following laboratory test findings is common in the anemia of chronic
disease (ACD)?
A. severe anemia
B. microcytic hypochromic red cells
C. low serum iron
D. high transferrin saturation

100. 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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