Philippine Pediatric Society – Hospital Accreditation Board

Committee on Education

Written In-Service Exam

Third Year
October 12, 2023

Name: ______________________________________________ Year: _________

Direction: Choose the letter of the BEST answer in each of the following questions.
Shade the corresponding letter of your choice in the answer sheet.

1. Which level of airway obstruction is associated with worse symptoms when

asleep than during the waking period?
A. Pharyngeal
B. Laryngeal
C. Tracheal
D. Bronchial

2. A 2-month-old male infant born premature was brought due to frequent noisy
breathing. The symptoms improve whenever the baby’s position is changed. On
PE: expiratory wheeze are heard loudest over the anterior neck area, no
subcostal and intercostal retractions. Salbutamol nebulization does not provide
relief. What condition should be considered?
A. Bronchiolitis
B. Tracheomalacia
C. Asthma
D. Cystic adenomatoid malformation

3. Which of the following congenital lung disease: etiologic factor pairing is correct?
A. Congenital pulmonary airway malformation: absence of supporting
cartilages
B. Lung hernia: pulmonary venous obstruction
C. Pulmonary hypoplasia: oligohydramnios
D. Congenital lobar emphysema: pulmonary artery sling

4. An ill-looking 4-year-old is seen in the ER due to fever of three days, cough and
respiratory distress. On PE: dullness on percussion right > left, decreased breath
sounds, right. PMI 5th left anterior axillary line. The diagnostic thoracentesis
revealed: pH 7.1 Neutrophils >100,000/mm3, Protein 4.0 g/L LDH 400 IU/L
Glucose 40 mg/dL. Aside from giving systemic antibiotics, what other treatment
options may be instituted?
A. Surgical decortication via VATS
B. Chest tube drainage
C. Open thoracotomy
D. Positive expiratory pressure (PEP)
5. Which of the following features are common in all infants with bronchopulmonary
dysplasia?
A. Requiring >30% supplemental O2 upon discharge if < 32 weeks gestation
at birth
B. Breathing room air at 36 weeks postmenstrual age (PMA)
C. Positive pressure ventilation at 36 weeks PMA
D. Requiring O2 for at least 28 days if < 32 weeks gestation at birth

6. A toddler who was with an older sibling was playing with Lego pieces suddenly
had choking episodes. In the ER, he had expiratory wheezing and asymmetric
breath sounds. Two chest radiographs PA view (A) and left lateral decubitus
(expiratory) films (B) are shown below. At which level of the airway is the foreign
body lodged?

A. Pharyngeal
B. Laryngeal
C. Tracheal
D. Bronchial

7. A 3-year-old male was admitted due to fever, irritability, sore throat, and drooling
of saliva. He had neck stiffness and refused to move his neck. If retropharyngeal
abscess is being considered, what other clinical data must be elicited?
A. Trauma to oropharynx or dental infection
B. Accompanying tea-colored urine or heart murmur
C. Hyponasal speech
D. Chronic nasal obstruction

8. Which of the following guidelines is recommended to decrease or eliminate

sudden infant death syndrome (SIDS)?
A. Side-sleeping
B. Sleeping on firm mattress
C. Bed sharing
D. Swaddling baby
 9. What is the most common complete vascular ring that encircles both the trachea
and esophagus?
A. Double aortic arch
B. Anomalous innominate artery
C. Aberrant right subclavian artery
D. Pulmonary artery sling

10. In what phase would warning signs of progression to severe dengue happen?
A. Early febrile
B. Late febrile
C. Critical
D. Convalescent

11. Usually, how many days after the onset of symptoms is a positive Dengue IgM
result expected?
A. 1-2
B. 3-5
C. 6-8
D. 9-10

12. An 11 year-old male was noted to be severely deteriorating in school

performance this past few months. He also seemed timid from a previously active
personality. In his past medical history, he had a viral infection when he was 8
months old characterized as high grade fever with rashes appearing on the 3rd
day of illness that started from the head progressing to the soles. He had no
vaccines at that time. With this information, what does he MOST probably have?
A. Acute encephalitis
B. Measles Inclusion Body Encephalitis
C. Subacute Sclerosing Panencephalitis
D. Poor intellectual and behavioral stimulation

13. A 9 month-old child develops high grade fever associated with febrile
convulsions. The fever ends abruptly after 3 days and is followed by a
maculopapular rash which lasted for only 48 hours. The child has good suck and
activity. This is most likely due to ________.
A. Parvovirus B19
B. Roseola
C. Rubella
D. Rubeola
14. An 18 year-old male adolescent, known as a nephrotic syndrome patient
currently maintained on corticosteroids, developed a belt of blister-like lesions
distributed in a band across his abdomen below the umbilical area with
associated severe pain for 2 days now. Which medication will he will most likely
benefit from?
A. Acyclovir
B. Aspirin
C. Ganciclovir
D. Ibuprofen

15. A preterm male, 28 weeks AOG, recently extubated 2 days ago, is currently on
the 12th hospital day and on Ampicillin-Sulbactam and Cefotaxime. He then had
poor suck and activity but not in distress. Urinalysis showed hyphal elements.
What is the next BEST pharmacotherapeutic management to give?
A. Amphotericin B
B. Cefepime
C. Fluconazole
D. Meropenem

16. Persistent or recurrent oral thrush with no obvious predisposing factors, such as
recent antibiotic intake, warrants investigation of _________.
A. child neglect or abuse
B. compliance to medications
C. hematologic disorders
D. immunodeficiency

17. A 2 year-old male, 8kg, was brought to the clinic due to perianal itching at night,
anemia and restless sleep for 6 months now. When is the best time to obtain
scotch-tape swab for laboratory examination?
A. Early morning
B. Lunch
C. Mid afternoon
D. Late at night

Topic: Bacterial Infections excluding TB (8 questions)

18. A 2 year-old male has generalized exfoliative dermatosis in which body surface
area becomes erythematous and necrotic superficial epidermis that strips off. On
PE, the vital signs and other regional exams are normal except for skin lesions
which has a combination of thick white and brown flaky desquamation of the
entire skin especially on the face and neck. There is separation of the stratum
granulosum layer of the skin. What does he most likely have?
A. Hidradenitis suppurativa
B. Necrotizing fasciitis
C. Staphylococcal Scalded Skin Syndrome
D. Staphylococcal Toxic Shock Syndrome
19. What is the most probable cause of consolidation of the right middle and lower
lobe then developing multiple lucent areas and pneumatocoele?
A. Staphylococcus aureus
B. Streptococcus pneumonia
C. Mycobacterium tuberculosis
D. Hemophilus influenza

20. What is the most probable cause of chronic active gastritis in children which can
cause gastric or duodenal ulcers?
A. Helicobacter pylori
B. Mycobacterium tuberculosis
C. Salmonella typhi
D. Treponema pallidum

21. A 12 month-old male with hydrocephalus who underwent VP shunting 6 months

ago, now has lethargy, vomiting, fever (39oC) and full fontanel. What is the best
management to do at this time?
A. Removal of shunt to decompress
B. Start appropriate sensitive antibiotic
C. Remove shunt & start appropriate antibiotic
D. Wait for quantitative CSF result and culture

22. Which among the following patients is at most risk for invasive pneumococcal
disease?
A. 2 month-old vaccine naive healthy male
B. 7 month-old male with Atrioventricular Septal Defect
C. 4 year-old female with Acute Glomerulonephritis
D. 5 year-old who recently had Dengue Fever with Warning Signs
23. Which of the following pertains to chronic otitis media needing antibiotic therapy?
A.

B.

C.

D.
24. Patient who develops a positive Nikolsky sign will usually benefit from which
drug?
A. Penicillin
B. Oxacillin
C. Amikacin
D. Metronidazole

25. Pneumococcal disease is frequently facilitated by viral respiratory tract infections

which may ______________
A. enhance epithelial cell ciliary activity
B. increase function of alveolar macrophage
C. produce mucosal injury
D. retain normal function of neutrophils

26. A 6-year-old girl who has no history of TB exposure developed symptoms of

cough, fever, and unexplained loss of appetite of 2 weeks duration. PE is normal.
TST is 5mm induration, chest x-ray showed collapse consolidation. What clinical
stage does the patient belong? TB ____
A. exposure
B. infection
C. disease
D. relapse

27. What is the recommended treatment for latent, INH-susceptible mycobacterium

tuberculosis infection?
A. 9 months of Rifampicin daily
B. 4 months DOT twice a week of Rifampicin
C. 9 months of INH daily
D. 12 months DOT twice a week of INH

28. What is the recommended treatment regimen for extrapulmonary tuberculosis

infection (except TB meningitis) if chest x-ray reveals hilar adenopathy only and
the risk of drug resistance is low?
A. 2 months INH, Rifampicin, PZA, Ethambutol daily followed by 4 months of
INH and Rifampicin
B. 2 months INH, Rifampicin, PZA, Ethambutol twice a week under DOT
followed by 4 months of INH and Rifampicin
C. 6 months INH and Rifampicin
D. 9-12 months of INH, Rifampicin

29. What is the most efficient primary, rapid diagnostic tool recommended by the
National Tuberculosis Program that detects Mycobacterium tuberculosis and
rifampicin resistance?
A. Line probe assay (LPA)
B. Smear microscopy
C. TB-LAMP
D. Xpert MTB/Rif

30. An 8-year-old girl was diagnosed with multi-drug resistant TB (MDR-TB). Their
family lives in a highly populated urban area with known TB cases. There is no
other family members diagnosed with tuberculosis. What is the evident risk factor
for her illness?
A. Delayed starting of anti-TB meds
B. Close family contact
C. Poor compliance with initial anti-TB meds
D. Residence in an area with possible high rate of resistance
31. Why do young children with TB disease rarely infect other children and adults?
A. Airborne mucus droplet nuclei is <1-5um
B. Copious production of thin sputum
C. Cough lacks tussive force to suspend particles
D. Extensive upper lobe infiltrate

32. A 6-year-old girl was brought to the OPD due to a 3-week history of a non-
healing wound at the left anterior neck associated with low grade intermittent
fever. It started as a discrete, non-tender, firm mass on the left neck which
gradually progressed to its present PE finding (see Figure 1). TST is at 5 cm
induration, CXR is normal. What is the most probable diagnosis?

Fig. 1. PE findings for #32

A. Branchial cleft cyst

B. Carbuncle
C. Cystic hygroma
D. Scrofuloderma

33. A 4-year-old boy was brought to the ER due to focal seizures. Ten days PTA, he
had a history of low grade fever associated with headache and irritability. This
progressed to lethargy, body malaise, vomiting until the present seizure episode.
Pertinent PE: (+) Brudzinski and Kernig sign, hypertonia, impaired CN III, VI, VII.
What is the most appropriate laboratory test to confirm the diagnosis?
A. Cranial CT Scan
B. Cranial MRI
C. CSF analysis Q&Q and culture
D. PCR testing of the CSF

34. The flexible, longitudinal, continuous and cumulative process whereby

pediatricians identify children who may have developmental problems is referred
to as Developmental ________.
A. monitoring
B. surveillance
C. screening
D. quotient

35. What is the earliest expected age of development (in years) of a child who begins
to dress independently and correctly?
A. 1-2
B. 3-4
C. 5-6
D. 7-8
36. A 2-year-old boy walked without support and spoke his first words at around 1
year old. Presently, he can walk up and down a few steps independently, copies
circular scribbles, speaks around 50 words and makes use of 2-word phrases.
What is his pattern of development?
A. Normal
B. Delayed
C. Dissociated
D. Deviant

37. A 12-month-old child who can pull to stand has a developmental quotient of
______:
A. 25
B. 50
C. 75
D. 100

38. A teacher examines a new student and observes that he hops on 1 foot, holds
scissors to cut out pictures, draws man with 2-4 parts plus head, with beginning
social interaction. What is the developmental age (in months) based on his
milestones?
A. 24
B. 30
C. 36
D. 48

39. An 18-month-old child would not call his parents ‘mama’ or ‘papa’. Instead, he
would pull his parents’ hands to call their attention. He does not answer ‘yes’ or
‘no’ or use gestures to communicate. But when requested, he readily names the
alphabet, colors, shapes and planets. He is fond of running around the house
and climbing chairs. What is the most probable diagnosis?
A. ADHD
B. Autism Spectrum Disorder
C. Intellectual disability
D. Learning disorder

40. Who among the following patients should alarm the pediatrician?
A. 12 months old who lacks interest in playing with other children
B. 18 months old who does not respond to pointing games
C. 24 months old who does not share toys but plays alongside other kids
D. 36 months old who fears imaginary things

41. A 6-year-old boy was observed at home and in school to be fidgety, often leaves
seat, always “on the go”, talks excessively, has difficulty awaiting turn, and butts
into conversations. What is the most probable diagnosis?
A. Attention-deficit/ hyperactivity disorder, combined
B. Attention-deficit/ hyperactivity disorder, predominantly inattentive
C. Attention-deficit/ hyperactivity disorder, predominantly hyperactive-impulsive
D. Attention-deficit disorder

42. A grade 2 student was observed by her teacher to have difficulties in

pronunciations, speech that lacks fluency with many pauses and struggles in
word recognition. Which of the following learning disabilities is the most likely
diagnosis?
A. Dyscalculia
B. Dysgraphia
C. Dysphasia
D. Dyslexia
43. A 5-year-old male child was observed to defecate twice a week with large stools
obstructing the toilet. Occasionally he would also defecate in inappropriate
places. Abdominal examination reveals palpable stool over the suprapubic area.
In this form of retentive encopresis, one should expect which of the following
complications?
A. Intestinal obstruction
B. Day and night urinary incontinence
C. Ulcerative colitis
D. Malabsorption syndrome

44. An adolescent female experienced chronic fatigue, malaise, behavioral changes,

anorexia and amenorrhea for the past six months and jaundice few days prior to
admission. If autoimmune hepatitis is present, which of the following blood levels
are increased?
A. Albumin
B. WBC and platelet
C. Immunoglobulin G
D. α1-antitrypsin

45. A 12-month-old male orphan was brought due to constipation. Fecal incontinence
was not noted. Neonatal history was not known. On PE: body weight 5 kg;
Abdomen is distended, tympanitic with palpable stool on left lower quadrant;
Rectal examination- empty vault with discharge of foul-smelling stool upon
removal of finger. What is the expected rectal biopsy finding?
A. (+) ganglion cells
B. (-) acetylcholinesterase stain
C. (+) NADPH-d stain
D. (-) endothelin type B receptor

46. A 2-year-old male infant, a known case of biliary atresia, was admitted due to
hematemesis and melena. PE: (+) splenomegaly. If esophageal varices are
being considered, which of the following is the most preferred intervention?
A. Upper endoscopy with band ligation
B. Sclerotherapy
C. Portosystemic shunt surgery
D. Ultrasound-guided octreotide infusion

47. A previously well 18-month-old male infant was seen in the ER due to severe,
paroxysmal colicky pain accompanied by straining efforts with knees and legs
flexed and loud cries. He passed red-colored stools admixed with mucus.
Abdominal PE: tender sausage-shaped mass. Which of the following
management should be instituted?
A. Stool culture, antibiotics, NGT decompression
B. Lateral or prone positioning
C. Endorectal pull-through
D. Fluoroscopic hydrostatic reduction

48. When is the most appropriate time of repair for inguinal hernia in a patient
<1y/o?
A. Upon diagnosis
B. If incarcerated
C. With ambiguous genitalia
D. Concomitant hypospadias
49. What is/are the first line drug/s recommended for the treatment of gastritis and
peptic ulcer disease in children?
A. Sucralfate
B. Amoxicillin-clarithromycin
C. H2 receptor antagonist
D. Magnesium-Aluminum hydroxide

50. Megalobastic anemia is a prominent clinical sign of which disorder of intestinal

absorption?
A. Cobalamin
B. Folate
C. Alpha-tocopherol
D. Dibasic amino acid (cystine)

51. A 5 year-old male with a history of seizure disorder was seen at the
Emergency Room after being given Diazepam in another hospital due to
prolonged seizure. His vital signs are: BP 60/40 mm Hg, HR 45/minute, RR
6/minute, O2 sat 70% at room air. What should be the next step in management?
A. Do endotracheal intubation
B. Provide bag mask ventilation
C. Give IV epinephrine
D. Do transcutaneous pacing

52. Which is a normal clinical finding in a 5 year old male?

A. O2 saturation of 92%
B. Heart rate of 200/ minute
C. Blood pressure 80/50 mm/hg
D. Respiratory rate of 55/minute

53. A 15 year-old female, known diabetic, was brought due to Kussmaul respiration.
The patient is awake, BP: 120/70 mmHg, and HR of 77bpm. Her blood glucose is
400mg/dL. What management should be done?
A. Normal Saline at 10ml/kg
B. D5.45 Saline at maintenance rate
C. Mannitol at 0.5 gm/kg
D. Subcutaneous insulin

54. What is the compression to ventilation ratio for 2-rescuer CPR in infants less than
1 year old ?
A. 15:2
B. 30:2
C. 15:1
D. 30:1

55. Which procedure should one do in order to ensure adequate ventilation during
resuscitation with bag valve mask?
A. Ensure that the size of the mask should extend over the chin
B. Perform adequate seal using a combination of CE grip
C. Position the child in sniffing position with the head hyperextended
D. Press the jaw downward and backward to stabilize the head
56. A 17 year-old male was brought to the ER after being hit by a baseball bat on his
right temple while walking from school. A depressed skull fracture was noted. He
was started on inotropes to support blood pressure. En route to ICU, his right
pupil suddenly became dilated. His BP is 180/70 mmHg with a HR of 45 bpm.
Which of the following intervention is the first priority?
A. Hyperventilate the patient
B. Position the head flat on bed
C. Administer Furosemide
D. Administer Atenolol

57. While on duty at the NICU, a patient diagnosed with pneumonia on chronic
mechanical ventilation for 2 weeks suddenly deteriorated with O2 saturation of
84%. What should be done next?
A. Check blood sugar
B. Check for equipment failure
C. Increase Tidal Volume
D. Increase IT (inspiratory time)

58. A 5 year-old female, known asthmatic, was brought due to difficulty of breathing.
After general assessment in triage, a primary assessment should be done. Which
of the following should be included?
A. Appearance
B. Circulation
C. Events
D. Signs and symptoms

59. A 3 month-old male with 3 days history of fever and diarrhea was brought to the
ER. His vital signs are: BP: 55/30 mmHg; HR: 185 bpm, RR- 60 cpm; Temp:
38.2oC; O2 sat 95%. His Capillary refill time is 5 seconds with cool extremities.
What type of shock does this infant have?
A. Distributive
B. Cardiogenic
C. Obstructive
D. Hypovolemic

60. A 5-year-old male child s/p exploratory laparotomy due to intestinal obstruction is
on the 2nd post-op day. A Jackson Pratt (JP) is draining 100 mL every 8 hours.
The main IV fluid is D5NSS at maintenance rate. Serum Na 130 mEq/L, K 4
mEq/L. He is afebrile and not in cardiorespiratory distress. Vital signs are stable.
How should hyponatremia be addressed?
A. Replace JP with isotonic saline
B. Institute fluid restriction
C. Check blood sugar level for hyperosmolality
D. Replace main IV to D5 0.3NaCl

61. Which of the following causes of hyperkalemia is due to transcellular K shift?

A. Hemolysis
B. Acidosis
C. ACE inhibitor
D. Renal failure
62. A 28 day-old premature male with sepsis, on ventilatory and circulatory support
has intractable metabolic acidosis despite correction. Latest laboratory results:
Serum Na 140 mEq/L, Cl 100 mEq/L, CBG 80 mg/dL. ABG: pH 7.25 CO2 30
HCO3 10 pO2 94. Based on computed anion gap, which of the following
conditions is the cause?
A. Lactic acidosis
B. Liver failure
C. Diabetic ketoacidosis
D. Pseudohypoaldosteronism

63. A 14-year-old adolescent girl with Chronic Kidney Disease due to chronic
glomerulonephritis was started on ACE inhibitor as an anti-hypertensive therapy.
In titrating her medication, what will be the ideal BP recording for age, gender
and height that should be targeted?
A. <p50
B. p50-75
C. p80-90
D. >p95

64. A 4 year-old female was admitted due to diarrheal dehydration. Her last urine
output was 8 hours prior to admission. Which one of the following AKI work-up is
compatible with the patient’s clinical course?
A. Elevated fractional excretion of Na
B. Decreased urine osmolality and specific gravity
C. Decreased urine Na
D. Presence of brownish granular casts

65. An 8 year-old male has tea-colored urine 2 days after a bout of nasopharyngitis.
Similar episodes have been seen in the past. His BP is in the 90th percentile. His
urinalysis reveals hematuria and proteinuria. His serum C3 is normal. What is the
most likely diagnosis?
A. IgA Nephropathy
B. Poststreptococcal Glomerulonephritis
C. Membranoproliferative Glomerulonephritis
D. Alport syndrome

66. Which of the urine test results is most diagnostic of UTI in a symptomatic infant?
A. Urine dipstick: nitrite (-), Leukocyte esterase 4+
B. Urine WBC: 20-30/hpf, protein 2+
C. Urine culture (catheterized): E.coli 60,000 CFU/mL
D. Urinary sediments: Nitrite 4+, amorphous urates 4+

67. Children with nephrotic syndrome are at risk for which type of infection due to
urinary losses of immunoglobulin leading to poor opsonization of
microorganisms?
A. Spontaneous bacterial peritonitis
B. Urinary tract infection
C. Disseminated varicella
D. Osteomyelitis
68. What is the correct sequence of essential intrapartum newborn care ?
A. Immediate and through drying, Skin to skin contact, Properly timed cord
clamping, Non separation of mother and baby
B. Properly timed cord clamping, Non separation of mother and baby, Skin to skin
contact, Monitoring of mother and baby dyad
C. Immediate and thorough drying, Skin to skin contact, Early cord clamping, Non
separation of mother and baby
D. Immediate and thorough drying of the baby, Skin to skin contact, Properly timed
cord clamping, Separation of mother and baby

69. A 5 day-old female was brought to the clinic with jaundice up to her thighs. She
was born to a G1P2 mother by NSD with a birth weight of 3kg. Her current weight
is 2.7 kg. Her mother’s blood type was A positive. The total bilirubin levels is
18mg/dL with indirect bilirubin at 17mg/dL and direct bilirubin at 1mg/dL. How
should this child be managed?
A. Phototherapy
B. Discontinue breastfeeding for 48 hours
C. Increase breastfeeding
D. Exchange transfusion

70. You were asked to resuscitate a newborn delivered term via NSD. At birth, the
patient was noted to be limp and gasping. After changing the linen, positioning
the airway and clearing secretions, what should be the next step?
A. Intubate patient
B. Give supplemental oxygen
C. Give PPV
D. Chest compression

71. A term infant born via Ceasarean Section presented with grunting on the 6th hour
of life with RR of 70 cpm. The Maternal history is negative for infection. After 20
hours of placing the patient on supplemental oxygen at 2 Liters/minute, the RR
now became 40 cpm. What will be the expected chest x-ray findings of this
patient?
A. Fluid in intralobal fissures
B. Patchy infiltrates
C. Air bronchogram
D. Diffuse reticulogranular pattern

72. What is the pathophysiology involved in an infant of diabetic mother?

A. High cortisol level on the mother’s circulation
B. High insulin level on the infant’s circulation
C. Use of insulin by the mother during pregnancy
D. Low level of fat deposit of the infants at birth

73. What is the treatment for newborns with Respiratory Distress syndrome?
A. Indomethacin
B. Corticosteroid
C. Surfactant
D. Bronchodilators

74. You are contemplating to enroll a premature patient for ambulatory kangaroo
mother care prior to discharge. Which of the following parameters should be
satisfied?
A. Discharge weight at 1,500 grams
B. Breastfeeding well
C. Weight gain of 10 grams per day
D. Health care facility near the home
75. A 28 year-old G1P1 mother with PROM for 21 hours gave birth to a 3-kg female
AS 6,9. What laboratory test should be requested?
A. ABG
B. CBG
C. Chest x-ray
D. Blood culture

76. Which of the following PE finding is normal in a newborn?

A. periodic respiration in a Preterm infant
B. hair tufts on sacrococcygeal area in a term infant
C. grunting in a term infant
D. Fluid filled mass on the scalp crossing sutures in a term infant

77. A 17-year-old male, diagnosed with Vesicoureteral reflux during infancy, was
seen again after 10 years. BP recording was >p95. Which of the following tests
should be recommended to detect target organ damage brought about by the
hypertension?
A. Echocardiography for left ventricular hypertrophy
B. Electromyography for neuropathy
C. Intraocular pressure monitoring for retinopathy
D. CT angiography for carotid intima-to-media thickness and vascular stiffness

78. A 2-year-old male infant has a large VSD and heart failure. He is on chronic
digoxin therapy. Which of the following electrolyte imbalances can alter the effect
of digoxin on his myocardium thereby exacerbating digitalis toxicity?
A. Hypocalcemia
B. Hypermagnesemia
C. Hypokalemia
D. Hyperchloremia

79. A 7-year-old male with a history of repeated attacks of rheumatic fever was
brought due to easy fatigability. Pertinent PE: thrill and heave apex, holosystolic
murmur, high pitched at the apex radiating to the axilla, (+) S3. Given this finding,
which of the cardiac valves is most likely involved?
A. Pulmonary
B. Tricuspid
C. Aortic
D. Mitral

80. A 1 year-old female infant with Tetralogy of Fallot has paroxysmal hypercyanotic
attacks especially after vigorous crying. Which of the following procedures should
be instituted in sequence during such attacks?
A. Knee-chest position – O2 inhalation – Morphine SC
B. O2 inhalation – prostaglandin E1 – NaHCO3
C. Intubation – anesthetic sedation – knee-chest position
D. Morphine – propranolol – diuretic

81. A newborn was born to a 30-year-old mother with SLE. The possibility of passive
transfer of maternal immunoglobulin G autoantibodies or neonatal lupus was raised.
Therefore, which clinical manifestations would be a most feared complication?
A. Hemolytic anemia, leukopenia and thrombocytopenia
B. Massive hematuria, proteinuria and decreased GFR
C. Generalized erythematous plaques with scaling over bony areas
D. Cardiac conduction abnormalities
82. Which of the following findings is a classic clinical criterion in the diagnosis of
Kawasaki disease?
A. Bilateral nonexudative bulbar conjunctival injection
B. Peribronchial infiltrates on chest radiograph
C. Aseptic meningitis (pleocytosis of CSF)
D. Anterior uveitis by slit-lamp examination
83. Henoch Schönlein Purpura is characterized by which type of deposits found
within the small vessels?
A. Plasma cells
B. Immunoglobulin A
C. Antinuclear antibodies
D. Antineutrophilic cytoplasmic antibodies (ANCA)

84. What is the most performed procedure in PDA closure?

A. Blaylock-Taussig
B. Transcatheter closure
C. Balloon valvuloplasty
D. Primary angioplasty

85. A 3 day-old baby girl was delivered to a 20 year-old G1P1 (1001) via NSD at
home assisted by a midwife. On the 2nd day of life, she started to have jaundice
on the face and eventually progressed all over her body. She was immediately
brought to ER where she developed generalized tonic-clonic seizure for about 5
minutes. Indirect bilirubin is 28 mg/dL and double exchange transfusion is to be
done. What possible cerebral palsy type would this neonate have?
A. Athetoid
B. Diplegia
C. Hemiplegia
D. Paraplegia

86. Which of the following fundoscopic findings would pertain to stage 5

papilledema?
A. C.

B. D.
87. In which of the following situations of unprovoked seizures is starting of long term
anticonvulsant therapy recommended?
A. 8 year-old male with sudden onset of Todd’s paralysis after the seizure event
with complaints of pins and needles sensation after the attack
B. 3 year-old female with generalized seizures lasting for 1 minute
C. 8 year-old male with normal EEG and cranial MRI findings but with a cousin
with history of seizures.
D. 13 year-old girl who suddenly lost consciousness after sleeping late the night
before her exam and missed eating her breakfast.

88. Which of the following sports is NOT recommended for adolescents with seizures
with impaired awareness?
A. Archery
B. Basketball
C. Diving
D. Football

89. A 9 year-old boy was rushed to the ER due to seizures. He has a 2-day history of
fever (39oC) with generalized severe headache and vomiting episodes. At the
ER, he had another seizure episode characterized by focal clonic movement of
left upper and lower extremities with upward rolling of eyeballs. He was then
drowsy to stuporous. He had a past medical history of acute otitis media. On
PE, he has neck rigidity with right eye mydriasis slowly reactive to light. What is
the most probable diagnosis?
A. Bacterial Meningitis
B. Cryptococcal Meningitis
C. Viral Meningoencephalitis
D. Brain Abscess

90. Which of the following circumstances of a child from 6 months to 5 years old
should primary immunodeficiency be investigated?
A. Cafe au lait spot
B. Pneumonia once a year
C. Recurrent abscess
D. Single episode bloody stool

91. Patients with atopic dermatitis have xerosis because of the reduction or
absence of which protein in the stratum corneum?
A. Filaggrin
B. Keratin
C. Melanin
D. Serine Protease

92. A 10 year-old female who just ate shrimp suddenly experienced

generalized flushing, swollen orbit, lips, and tongue associated with difficulty of
breathing, hypotonia, vomiting and BP 80/50 should be given _________.
A. Epinephrine IM
B. Epinephrine IV
C. Hydrocortisone
D. Racemic Epinephrine

93. Which of the following recommendations is a correct nutritional advise for

a 5 month-old infant brought for preventive care?
A. Continue exclusive breastfeeding from birth to 6 months old
B. May start complementary feeding anytime
C. Start with fruits and meat products as 1st solid foods
D. Start Vitamin A supplementation
94. A 3 year-old toddler with a weight-for-height z-score of -3 was brought for consult
by her mother. What should be the primary focus on this initial consult?
A. Growth monitoring
B. Injury prevention
C. Nutrition counseling
D. Prevention of child abuse

95. A 4 month-old infant who has no previous vaccination except for birth dose of
BCG and Hepatitis B vaccine was brought for consult for the 1st time. She was
given Pentavalent 1, OPV 1 and Pneumococcal vaccine 1 for the present
consult. At what age should be the next scheduled vaccination for dose 2 (in
months)?
A. 5
B. 6
C. 7
D. 8

96. The midwife assigned at the Rural Health Unit decided not to give Dose 1 of
Pentavalent vaccine, PCV 13 and OPV vaccine to a 5-week-old infant brought by
her mother for vaccination. What is the vaccine recommendation followed in this
case?
A. Simultaneous administration of vaccines
B. Minimum intervals and ages
C. Lapsed immunization
D. Missed opportunities

97. When 2 live vaccines are to be given one after the other, what is the minimum
recommended interval for full immunogenicity (in weeks)?
A. 2
B. 4
C. 6
D. 8

98. Unique in the injury prevention for infants compared to preschoolers is prevention
of _________.
A. burn
B. choking
C. drowning
D. fall

99. A 3 year-old male was brought to the OPD due to right ear pain associated with
low grade fever. Otoscopy revealed a hyperemic and bulging tympanic
membrane. What is the correct management plan for the patient?
A. Antibiotic treatment
B. Refer to an ENT specialist
C. Request for CBC
D. “Watchful waiting”

100. A 5 month-old infant was brought to the OPD due to episodes of strabismus. The
corneal light reflex test is normal. What is the management plan for the patient?
A. Advise the mother that it is normal for the patient’s age
B. Reassessment is not required
C. Refer to an ophthalmologist
D. Warn the mother of its implications
101. What is the most common malignant neoplasm in children?
A. Acute Leukemia
B. Astrocytoma
C. Lymphoma
D. Neuroblastoma

102. Interpret the CBC result of a 2-day old newborn who has good suck and activity.
Hematocrit: 48; Hemoglobin: 24; MCH: 35; MCV: 100;
WBC:28; Segmenter:55 Lymphocytes: 25 Platelet count: 400
A. Bacterial infection
B. Fungal infection
C. Normal
D. Viral infection

103. A 1 year-old female presented with 2 months history of inward gaze of the right
eye. On physical examination, she has strabismus and white pupillary reflex on
the right eye. What is the most likely diagnosis?
A. Congenital cataract
B. Endophthalmitis
C. Exudative Vitreoretinopathy
D. Retinoblastoma

104. A 3 year-old male was noted to have a left flank mass noticed when his mother
helped him put on his clothes. He was noted to have occasional abdominal pain.
On PE, BP is 120/90mmHg, 9x12 cm firm to hard, non-tender, non-movable
mass on the left flank. What is the most likely diagnosis?
A. Hepatoblastoma
B. Neuroblastoma
C. Rhabdomyosarcoma
D. Wilms tumor

105. In children with iron-deficiency anemia, pallor is evident when the hemoglobin
falls to (g/dL) _________
A. 5-6.
B. 7-8.
C. 9-10.
D. 11-12.

106. What is the major long-term disability/complication of children with Hemophilia A

and B?
A. Chronic arthropathy
B. Congestive Heart Failure
C. Development of an inhibitor to either factor VIII or factor IX
D. Transfusion-transmitted infectious diseases

107. In Acute Lymphoblastic Leukemia, which phase of treatment pertains to focusing

on intensive CNS therapy (repeated intrathecal chemotherapy) in combination
with continued systemic therapy in an effort to prevent CNS relapses?
A. Remission induction
B. Consolidation
C. Intensification
D. Maintenance
108. An 18 month-old male from a far flung area was noted to be pale for 6 months
now. He was also noted to have frontal bossing, flat nasal bridge, and maxillary
hyperplasia. What is the most likely diagnosis?
A. Leukemia
B. Hemophilia
C. Hydrocephalus
D. Thalassemia

109. You witnessed the sudden arrest of a child at the parking lot. What should be the
next step?
A. Place the patient in recovery position
B. Activate the emergency response system
C. Check for pulse
D. Provide 2 minutes of CPR

110. A 6 year-old female, known case of seizure disorder, was brought to the
emergency room for tonic clonic seizure which stopped a few minutes prior to
consult. The child was still noted to have slow and irregular respiration. What is
the assessment of this patient’s condition?
A. Upper airway obstruction
B. Lower airway obstruction
C. Disordered control of breathing
D. Lung Tissue Disease

111. As the senior resident on duty, a 5 year-old male was brought to the ER in
cardiac arrest. While high quality CPR is ongoing, rhythm check was done which
revealed (see image shown below):

What should be the next step?

A. Resume compressions
B. Give epinephrine at 0.01mg/kg
C. Check for a pulse
D. Deliver a shock dose of 2 joules/kg
112. A 1 year-old female was brought to emergency room because of irritability. She
was noted to be pale with cool extremities. Vital signs include BP of 50/35 mm
Hg, Heart rate of 220bpm and respiratory rate of 25cpm. O2 saturation is not
detectable. Capillary refill is 4 seconds. An intravenous access is already in
place. The cardiac rhythm showed (see image below):

If initial treatment is not available what would be your next step?

A. Defibrillation
B. Give amiodarone at 5mg/kg
C. Synchronized cardioversion
D. High quality CPR

113. A 5 year-old arrived at the emergency room with complaints of difficulty of

breathing. Which respiratory finding would make one suspect that this is most
likely a LATE SIGN of tissue hypoxia?
A. Tachypnea
B. Tachycardia
C. Increased inspiratory effort
D. Decreased level of consciousness

114. An infant remains apneic with heart rate of 55bpm. After 30 seconds of effective
positive pressure ventilation, what should be done next?
A. Transfer to warmer
B. Do immediate and thorough drying
C. Provide supplemental oxygen
D. Endotracheal intubation

115. What are the correct steps to follow when operating an AED?
A.Power on the AED, attach electrodes, shock the patient, analyze the rhythm
B.Attach electrode pads, check pulse, shock the patient, analyze the rhythm
C.Power on the AED, attach electrodes, analyze the rhythm, clear the patient,
deliver shock
D. Check pulse, attach electrodes, analyze rhythm, deliver shock

116. A 15 year-old male, known asthmatic, was noted to have decreased sensorium
with increase in respiratory effort. His RR is 35cpm and O2 saturation of 90%
with wheezes all over and wheals on the face and arms after eating crabs. Which
should be administered next?
A. Dexamethasone IM
B. Magnesium sulfate IV
C. Racemic epinephrine nebulized
D. Epinephrine IM

117. A 1 year-old female, known with autistic disorder, was brought to the emergency
room with fever and loose bowel movement of 10 episodes with 10 episodes of
vomiting. PE findings: BP=60/40mmHg, HR-150bpm, RR=70cpm, capillary refill
time more than 4 seconds, O2 sat 94%. How much fluid should be administered?
A. 10ml/kg of Lactated Ringer’s
B. 20ml/kg of Normal Saline
C. 15ml/kg of 5% dextrose in 45% normal saline
D. 20 ml/kg if 0.45% normal saline
118. A couple came for counseling. On history, they relayed that both their children,
one male and one female died at one week of life due to severe encephalopathy.
Both parents are healthy, asymptomatic and non-consanguineous. No other
relatives are affected. What is the most probable pattern of inheritance in this
case?
A. Autosomal recessive
B. Autosomal dominant
C. X-linked recessive
D. X-linked dominant

119. Which of the following is true of X-linked inheritance?

A. If daughters are affected, it will be more severe than sons
B. If mother is affected, all the sons will be affected
C. If present, sons will be more commonly affected than daughters
D. If the mother is affected, all the daughters will be carriers

120. A newborn is suspected of having Down Syndrome. Apart from the craniofacial
features, which of the following clinical features will further aid in making a clinical
diagnosis?
A. Seizures
B. Hypotonia
C. Rocker-bottom feet
D. Polydactyly

121. What is the most likely karyotype of an adolescent girl with short stature, webbed
neck, coarctation of the aorta, primary amenorrhea and lack of secondary sexual
characteristics?
A. 47, XX + 21
B. 47,XYY
C. 46, XX
D. 45, X

122. What is the recommended IV fluids given at 10-20mL/kg bolus for the 1st hour of
treatment for DKA?
A. 0.9% NaCl
B. 0.45% NaCl
C. D5NSS
D. D5LR

123. A 3 year-old male was brought to the clinic because of polyuria, polydipsia and
nocturia. He lost 2kg despite a good appetite. Capillary blood glucose revealed
235 mg/dl. What should be the initial diagnostic workup to confirm the noted
hyperglycemia?
A. RBS
B. FBS
C. HbA1c
D. OGTT

124. A 5 month-old infant was brought to the clinic due to irregular bowel movements
every after five days. PE - hypotonic, myxedematous with pale, dry skin and
prominent umbilical hernia. What is the most probable diagnosis?
A. Congenital adrenal hyperplasia
B. Congenital hypothyroidism
C. Hirschsprung’s disease
D. Infantile dyskesia
125. A 5 year-old female was brought to the clinic for short stature. After plotting her
previous height measurements, her growth consistently traverses the -2SD curve.
Predicted height falls within the mid-parental height potential. What can be
deduced from her bone age?
A. Older than her chronologic age
B. Younger than her chronologic age
C. The same as her chronologic age
D. No correlation with chronologic age

126. What is the prophylaxis for an adolescent rape victim to prevent sexually
transmitted infections?
A. Penicillin, Cloxacillin, Metronidazole
B. Penicillin, Doxycycline, Cloxacillin
C. Ceftriaxone, Erythromycin, Clindamycin
D. Ceftriaxone, Metronidazole, Doxycycline

127. A 14 year-old female who had consensual sexual contact with a 16 year-old
male. When the mother found out about this, the mother requested for
emergency postcoital prophylaxis to prevent pregnancy. How should the medical
provider respond to the mother’s request?
A. Oral post coital prophylaxis if the incident occurred within 72 hours
B. Insert IUD if the incident occurred within 120 hours
C. Oral post coital prophylaxis if the incident occurred in 7 days
D. No need for postcoital prophylaxis

128. As the attending pediatrician of a 17 year-old male who has a known Major
Depressive Disorder, which of the following findings is a major red flag for
suicide?
A. Change in sleeping patterns
B. Becoming suddenly cheerful after a period of depression
C. Loss of interest in things one cares about or activities previously enjoyed
D. Difficulty in concentrating and thinking clearly

129. A 14 year-old female was brought to the clinic for a well adolescent check-up.
Upon reviewing her vaccination status, she has the following vaccines as a child:
5 doses of DPT, 5 doses of IPV, 4 doses of HIB, 5 doses of Hepatitis B, 1 dose
of Varicella, 1 dose of MMR, 2 doses of Hepatitis A. The mother is asking for a
list of vaccines that the patient still needs. What vaccines will should be
recommended?
A. Varicella 2nd dose, MMR 2nd dose, Tdap, HPV
B. Tdap, HPV, Varicella 2nd dose, Hepatitis A 3rd dose, MMR 2nd dose
C. Hepatitis B 6th dose, Hepatitis A 3rd dose, Tdap, HPV
D. Tdap, HPV, IPV 6th dose, MMR 2nd dose

130. Which of the following features is a normal characteristic of adolescent growth

and development?
A. Females begin their growth acceleration before males
B. The first visible sign of puberty in males is the development of pubic hair
C. Females attain peak height velocity at SMR 2 to 3
D. Menarche occurs at least 6 months before growth spurt

131. Which of the following adolescents require evaluation? An adolescent ______

A. with no menstruation at 14 years old
B. with no menstruation for 1 year after the onset of puberty
C. with previous menarche but has no menstruation for 3 cycles
D. who had menarche at age 10 yrs old
132. While on duty at the emergency room, 8 patients ranging from 10 to 12 years old
presented with paroxysmal tonic clonic movements after watching a scary
movie. How should these patients be managed?
A. Reassurance
B. Diazepam 0.3mg/kg IV
C. Phenobarbital 10mg/kg IV
D. Referral to Neurology

133. A 17 year-old female was brought due to crampy pelvic pain radiating to the
lower back with nausea every first day of her menstrual cycle. Her SMR is
4. Which of the following diagnostics should be requested first?
A. T3, T4, TSH
B. Prolactin levels
C. Pelvic ultrasound
D. FSH

134. A 16 year-old female presents with 1 month history of feeling sad and empty with
decreased activity and inability to sleep and eat. What is the pharmacologic
medicine of choice for this patient?
A. Clomipramine
B. Clonidine
C. Selective serotonin reuptake inhibitor
D. Haloperidol

135. A 17 year-old male with multiple hematoma on the thigh was brought to the clinic
from a fraternity initiation with an increased creatinine kinase. This adolescent
most probably has _____.
A. Muscle injury
B. Rheumatoid Arthritis
C. Septic Arthritis
D. Systemic Lupus Erythematosus

136. At what age (in months) does head control occur?

A. 3 to 5
B. 6 to 8
C. 9 to 11
D. 12 to 15

137. A 16 year-old male was brought to the ER with painful and swollen knee. Pain
was noted when the patient incurred a blow to the knee. Clinical examination
revealed joint effusion, tenderness on the knee area with difficulty flexing the
knee. What is the most likely cause of these findings?
A. Quadriceps tendonitis
B. Meniscal tear
C. MCL tear
D. Patellar dislocation

138. A 14 year-old male complains of limping on the right with pain below the kneecap
every time he runs or jumps during basketball games. Xray of the knees revealed
new bone formation on the right tubercle. How should this patient be managed?
A. Rest from excessive activity
B. Casting of affected knee
C. Physical therapy
D. IV antibiotics
139. What condition does this child probably have?

A. Angioedema
B. Hypersensitivity Reaction
C. Fifth Disease
D. Systemic Lupus Erythematosus
140. This child with abdominal pain, joint pains and rashes on the lower extremities
(see image) would most probably have?

A. Dengue Fever
B. Kawasaki Disease
C. Henoch-Schönlein Purpura
D. Meningococcemia
141. A 9 year-old boy who was recently diagnosed with generalized seizure was given
phenobarbital for 2 weeks now. There was associated low grade fever, rashes
(see image below), lymphadenopathy and nephritis. What does he most likely
have?

A. Atopic dermatitis
B. Dengue Fever
C. DRESS Syndrome
D. Kawasaki Disease
142. A 6 month-old male has rashes for 2 weeks now with associated pruritus. There
are no other associated symptoms. He is not breastfed. Skin PE revealed this
(see image below). What does he most probably have?

A. Atopic dermatitis
B. Contact dermatitis
C. Hypersensitivity Reaction
D. Roseola infantum

143. Which of the following principles of bioethics states that all individuals should
have equal opportunity and access?
A. Autonomy
B. Beneficence
C. Non-maleficence
D. Justice

144. The parents of an infant born extremely premature at 27 weeks age of gestation
via emergency caesarian section decided to withdraw life-sustaining medical
treatment after the pediatrician explained the prognosis and recommended
treatment. What principle of bioethics are the parents trying to exercise?
A. Autonomy
B. Non-maleficence
C. Parental authority
D. Parental rights

145. A pediatrician who ensures that the treatment given to a patient not cause them
any harm is an example of which of following bioethics principle?
A. Autonomy
B. Beneficence
C. Non-maleficence
D. Justice
146. In which of the following cases is the withdrawal of life-sustaining treatment
considered ethical?
A. A patient diagnosed to have Hemolytic Disease of the Newborn who is
bleeding profusely
B. A patient diagnosed with hypoxic-ischemic encephalopathy who developed
intractable seizures and became irreversibly comatose
C. A newborn who had several episodes of seizures due to bacterial meningitis
and was noted to have reactive pupils
D. A premature baby, 33 weeks of gestation, who had several episodes of
bradycardia

147. A 4-year-old boy with a fractured forearm due to fall is brought to the ER by her
caregiver. Both the caregiver and the ER physician have attempted to reach her
parents to no avail. What is the best thing to do in this situation?
A. No interventions until parent consents
B. Caregiver’s consent is sufficient
C. ER physician should obtain a court order for the treatment
D. ER physician can proceed with the x-rays and initial treatment

148. Which among the following serves as a reliable gauge of a country’s health
system outcome?
A. Infant mortality rate
B. Neonatal mortality rate
C. Relative risk of disease
D. Under-five mortality rate

149. Which among the following Sustainability Development Goals (SDGs) focuses on
health-related sub-targets?
A. SDG 1 – No poverty
B. SDG 2 – Zero hunger
C. SDG 3 – Good health and well-being
D. SDG 6 – Clean water and sanitation

150. The Cruz family lives in a remote barrio without access to a health facility. The
child mortality rate in the community is high. What is the best strategy
recommended by UNICEF and WHO that could address this problem?
A. Conditional cash transfers
B. Doctors for the Barrio Program
C. Integrated Management of Childhood Illnesses
D. Integrated Community Case Management

***GOOD LUCK***