PEDIATRICS

CRS 2
Apiril 20, 2017

5. This same patient is also assessed as __.

a. 100% appropriate
b. 50% wasted below the ideal
EXAM COVERAGE: c. Belonging to the 50th percentile
1. Basic Pediatric Nutrition I – Dr. Battad d. A and C
2. Basic Pediatric Nutrtion II – Dr. Battad
3. Fluids and Electrolyes – Dr. Thiam-Tuazon 6. A 2 y/o girl has a Z score of below -2 in her nutritional indices height
4. Pediatric Neurological Exam – Dr. Rivera for age and height. These signify nutrient loss as __.
a. Acute
b. Moderate
1. At what age does growth deceleration start? c. Chronic
a. 3-5 months old d. A and C
b. 6-12 months old
c. 12-24 months old
d. 12-16 months old
2. Brain growth spurt occurs during the prenatal age of __ up to the
postnatal age of __.
Prenatal age (months) Postnatal age (months)
a. 2-3 12
b. 4-6 36
c. 8-10 48
d. 10-12 36

3. Anthropometry is an important subject aspect in nutritional

assessment. This includes this/these parameter/s:
a. Biparenteral height
b. Physical signs of micronutrient deficiencies
c. Skin fold test
d. Wasting and stunting status

7. The period of adiposity rebound commences by this age in years.

a. 6
b. 8
c. 10
Cases for #4,5. A 1 y/o was brought in for nutritional assessment. His d. 12
weight fell on the zero line of the Z score weight for height chart.
8. A 5kg baby is able to consume 5 ounces of milk every 3 hours with
4. This signifies the patient has __ wasting. a caloric density equivalent to human milk. In 24 hours he is getting
a. No approximately a total of __ calories.
b. Mild a. 100
c. Moderate b. 400
d. Severe c. 800
d. 1000
5 oz x 20 cal/oz = 100 cal/feed
100 cal x 8 feedinds/day = 800

9. In a child whose Z score is below -3 for weight and height, mortality

risk is increased by:
a. Threefold
b. Sixfold
c. Ninefold
d. Tenfold

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 a. 18% in relation to whey
b. 40% in relation to whey
c. 60% in relation to casein
d. 82% in relation to casein

15. At what average postnatal day can a mother start to experience

breast fullness with testing?
a. 2-4
b. 5-6
c. 7-9
d. 10-12

16. The colostrum contains very high levels of the following

component/s:
10. In lactation management, the mother may clean her breast with: a. Carbohydrates and proteins
a. 30% isopropyl alcohol b. Fats and carotenoids
b. Baby lotion c. Proteins and immunoglobulin
c. Soap and water d. Water
d. Water
Nipple care: Benefits of colostrum:
 Keep breasts dry  Higher level of protein, minerals and fat soluble vitamins (A,E,& K)
 No lotions, ointment, soap and alcohol  Low fat, low carbohydrates
 Just water  95% immunoglobulins (IgA)
 80-90% macrophages
11. This reflex helps initiate the baby to crawl towards the mother’s  Important in maturation of GALT
breast:
a. Landau 17. A 10 kg baby was supplied 200 calories of proteins. His caloric
b. Let down intake derived from this diet is equivalent in gram per day as:
c. Moro a. 0.5
d. Stepping b. 5
 Landau reflex - response of infants when held in a horizontal prone c. 50
position to maintain a convex arc with the head raised and the legs d. 500
slightly flexed *1 g protein = 4 calories
 Let-down reflex - milk leakage; when the mother is breastfeeding 200 cal / (4 cal/g) = 50 g
on one side, the other side is also dripping with milk; indicates good
production/levels of oxytocin 18. A 5 kg baby needs 500 calories for his diet for the day. Of the total
 Moro reflex - response when you startle a baby by clapping your caloric requirement 30% would be coming from fats. This would be
hands or banging the door equivalent in grams to:
 Stepping reflex – “Breast Crawl”; while on prone position on the a. 8.5
mother’s abdomen, the baby will crawl to the breast. b. 16.6
c. 75
12. You were asked to monitor in the rooming unit by checking on d. 150
babies’ latch on positions. The following position is correct: *1 g fat = 9 calories
a. Baby’s lower lip should be inward 500 cal X .30 = 150 cal
b. Baby’s mouth should be wide open 150 cal / (9 cal/g) = 16.66 g
c. Lips should be pursed
d. Lips should suck the nipple 19. The most caloric-dense macronutrient serves as a vehicle to better
absorb the following:
Signs of good attachment: a. A,B,C
 Chin should touch the breast b. A,D,K
 Lower lip turned outward/outturned c. B,E,K
 Mouth is wide open d. A,B,K
 More areola showing above
Fats
13. Water comprises __ percent in human milk.  most caloric-dense macronutrient
a. 25  functions: -Integral part of cellular membrane
b. 50 -Vehicle for fat soluble vitamins (A,D,E,K)
c. 75 -Spares proteins for energy
d. 90 -Provides satiety value to diet

14. The main protein in human milk is characterized as:

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20. A balanced diet includes the following proportion of macronutrients
in relation to the total caloric requirement”
a. 50% carbohydrates, 50% fats, 50% proteins
b. 50% carbohydrates, 35% fats, 15% proteins
c. 50% carbohydrates, 15% fats, 35% proteins
d. 35% carbohydrates, 50% fats, 15% proteins

21. In lactation, the hormone responsible for the let-down reflex is:
a. Estrogen
b. Oxytocin
c. Progesterone
d. Prolactin

Prolactin
 Stimulates growth and development of breast tissue during
pregnancy
 Stimulates milk production
 Triggers lactocytes to secrete milk
Oxytocin
 Let down reflex
 Triggers contraction of myoepithelial cells
 Induces state of calm and reduces stress

22. National policies on infant feeding stress that breast feeding must
be initiated postnataly after birth and continued thereafter as:
a. within 24 minutes and continued exclusively up to 6 months
b. within 60 minutes and exclusive up to 6 months 26. In complementary feeding, finger foods can be started once the
c. within 4 hours and exclusive up to 2 years baby has exhibited the following skill:
d. within 6 hours and exclusive up to 2 years a. Grasp reflex
b. Intentional grasp
23. By 6 months, breastfeeding must be augmented by: c. Hand to mouth
a. complementary feeding d. Pincer grasp
b. shifting to infant formula
c. vitamin supplements 27. Optimum growth requires the following essential nutrients:
d. wearing a. Amino Acids
b. Fatty Acids
Complementary Feeding (WHO) c. Sugars
 Exclusive breastfeeding for 6 months d. Vitamins and Minerals
 Thereafter, infants should receive complementary foods with
continued breastfeeding up to 2 years of age and beyond 28. In fat metabolism, long chain triglycerides are characterized by the
following:
 Exclusive breastfeeding is not adequate to meet the infant’s
nutritional needs beyond 6 months a. They are transported by the chylomicrons.
b. Absorption is direct to the portal circulation
c. Emulsification by the bile is needed prior to absorption
24. The following may ensue if there is failure to augment by this age
d. A and C
in months:
a. growth faltering
B is referring to medium chain triglycerides (MCTs).
b. mental delay
c. iron gap
29. The dissacharidase enzyme that yields one glucose unit and one
d. A and C
galactose unit is:
a. Galatase
25. Babies must start consuming adult food by this age in months.
b. Lactase
a. 6
c. Maltase
b. 12
d. Sucrase
c. 36
d. 48

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30. The hemodynamic status of a severely malnourished person is  Endochondral formation: loss of osteoids, subperiosteal
characterized by the following: bleeding and brittle bones leading to random spontaneous
a. Decreased cardiac output pathologic fractures
b. Hypotension
c. Increased stroke volume 35. The management for the patient in #34 is:
d. Poor cardiac perfusion a. Ascorbic acid
b. Calcium-fortified milk intake
31. A malnourished child has increased risk for severe infections c. Cholecalciferol
because the immune pathology is characterized by: d. Daily exposure to UV rays of the sun for 10 minutes from
a. Absence of Interferon 10am to 2pm
b. Absence of white blood cells
c. Decreased T and B cell function 36. Early onset mental retardation may be manifested by this nutrient
d. Poor bone marrow function deficiency:
a. Iron
b. Iodine
c. Vitamin C
d. Zinc

37. A patient was noted to have generalized muscle wasting with old
man facies. The deficient nutrient/s include/s:
a. Carbohydrates
b. Fats
c. Proteins
d. All of the above
32. Nutritional edema in Kwashiorkor can be explained by the Kwashiorkor: unbalanced diet (High Carb/Low Protein)
following:
a. Decreased plasma oncotic pressure due to low proteins Marasmus: ALL nutrients are inadequate, overall deficiency
b. Erratic blood sugar levels due to low carbohydrates
c. Increased fat deposits in the vascular wall
d. Laxity of skin

33. The following is/are considered essential amino acids:

a. Histamine
b. Lysine
c. Tyrosine
d. All of the above

For numbers 38 to 41: The following statements best describe the

micronutrtients, answer:
34. A 4-year-old was noted to have scurvy. The following are hallmarks a. If the description is correct
of the disease: b. If the description is incorrect
a. Bowleggedness and knock knees (Vit. D Deficiency) c. If the description is not relevant
b. Brittle bones and spongy gums (to be deliberated by
examiner) 38. Lactobacilli, vitamins and trace elements make up the
c. Harrison’s groove and rachitic chest (Vit. D Deficiency) micronutrients. (B) (Should only be vitamins and trace elements)
d. Pathologic fractures and pseudo-paralysis (from answer
key) 39. Growth failure and anorexia are the dominant features in children
who lack the Type 2 micronutrients. (A)
Scurvy:
 Spongy gums 40. Type 1 micronutrients show specific deficiency signs when they are
 hemorrhagic tendencies inadequate in the body. (A)

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41. Vitamins are organic compounds synthesized by the body. (B) Retinol/Vit. A Deficiency:
(Vitamins are organic compounds NOT synthesized by the body.)  Night blindness
 Xerophthalmia
42. This parameter has a high sensitivity for picking up moderate acute  Keratomalacia
malnutrition (MAM) and severe acute malnutrition (SAM):  Bitot’s spots
a. Abdominal circumference
b. Mid-upper arm circumference
c. Triceps skin fold 48. The following is a feature of pellagra:
d. Waist to hip ration a. Acanthosis nigricans
b. Casal’s necklace
Measuring the MUAC is part of the recommendation of the WHO to c. Constipation
assess severe wasting. d. Dehydration
 In MUAC, if <115mm or <11.5cm = Severe Wasting
Niacin/Vitamin B3 Deficiency = 3Ds of Pellagra
43. The following is/are key nutritional strategy/ies in reducing child  Dermatitis
mortality:  Dementia
a. Non-exclusive breastfeeding  Diarrhea
b. Timely complementary feeding
c. Vitamin preparation supplementation Casal’s necklace is also seen in Vitamin B3 deficiency.
d. All of the above
49. Nutritional programming in the first 2 years of life or the first 1000
After 6 months of exclusive breastfeeding, you now initiate days decreases the risk for non-communicable disease/s such as:
complementary feeding. Complementary feeding aims to: a. Diabetes Insipidus
 Fill nutrient gaps b. Obesity
 Train feeding skills of the baby to achieve full oral motor c. Renal hypertension
abilities by 2 years of age d. All of the above

44. A 6-month old failed to receive the micronutrient needed to supplied
by this time. He will have the risk of this micronutrient malnutrition
characterized by the following deficiency signs:
a. Beri-beri (Thiamine/Vit. B1 deficiency)
b. Night-blindness and keratomalacia (Vit. A deficiency)
c. Pallor and koilonychia (Iron Deficiency)
d. Ricketts (Vit. D deficiency)
Barker’s Hypothesis:
adult susceptibility to Obesity, HPN, DM, and Metabolic syndromes
originate from fetal adaptation to the intrauterine environment.
The first 1000 days of life (3 years of age) already has an impact on
adult disease. Environment play a very important role in the
development of non-communicable diseases (NCDs).

Your iron stores are depleted by 6 months that is why you need iron 50. The double burden of malnutrition includes the following nutritional
supplementation to prevent iron deficiency anemia (IDA). disorders:
a. Marasmus and Kwashiorkor
45. What nutritional parameter screens for overweight and obesity? b. Ricketts and Scurvy
a. Abdominal circumference c. Pellagra and Protein Energy Malnutrition
b. Body Mass Index d. Overnutrition and Undernutrition
c. Mid-upper arm circumference
d. Triceps skin fold 51. What are the two factors in the regulation of osmotic equilibrium
a. Fluid loss and blood volume
Body Mass Index (BMI): Overweight and Obesity b. Fluid loss and intravenous fluid
c. Serum osmolality and blood volume
Mid-upper arm circumference (MUAC): Moderate Acute Malnutrition d. Serum sodium and potassium
(MAM) and Severe Acute Malnutrition (SAM)
Osmotic Equilibrium Is regulated by two different factors: (1)
Triceps Skin Fold: measures fats osmolality & (2) volume.

46. The dietary fats that contribute to the risk of obesity is/are:  Both have independent factors which affect their regulation
a. Long polyunsaturated fatty acids  Proper cell functioning requires close regulation of plasma
b. Medium chain triglycerides osmolality and intravascular volume; these are controlled by
c. Saturated fatty acids independent systems for water balance, which determines
d. Short chain fatty acids osmolality, and sodium balance, which determines volume
status. Maintenance of a normal osmolality depends on
Polyunsaturated fatty acids: control of water balance. Control of volume status depends
 Gives rise to HDL, which is healthy on regulation of sodium balance
 Examples: olive oil, peanut
52. What is the normal value of serum osmolality in mOsm/kg
Saturated fatty acids: a. 275-285
 Gives rise to your LDL, which is lethal b. 275-295
 High risk for cardiovascular disease c. 285-295
 Examples: Beef, cheese d. 285-305

47. The clinical profile of retinol deficiency includes: 53. Which of the following occurs in response to decreased blood
a. Blind spots volume?
b. Cataracts a. Decreased glomerular filtration rate
c. Sore eyes b. Decrease in anti-diuretic hormone release
d. Xerophthalmia c. Increased sodium excretion

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d. Increased water excretion

In an increased intravascular volume, there is increased excretion of

fluids out of the body. GFR increases which also increases sodium
urinary excretion. The opposite happens if there is a decrease in blood
volume.

54. What is the first step in the approach in fluid therapy? 57. A 10 year old with <3% body weight dehydrated is classified as
a. Assess the degree of dehydration having what degree of dehydration
b. Compute the fluid deficit a. None
c. Determine etiology of dehydration b. Mild
d. Give ORS c. Moderate
d. Severe
Approach in Deficit Therapy: Refer to the table in no. 55.
1. Assess the degree of dehydration – this tells the urgency of fluids
and the amount of volume that should be given Case for number 58 to 59: A child was brought to the emergency
2. Etiology of dehydration – based on type of fluid losses room with diarrhea. On PE, he was lethargic, with decreased
3. Calculation of fluid therapy peripheral pulses and cold extremities

Case for numbers 55 and 56: A year old child was brought to the 58. What is the degree of dehydration in this patient?
emergency room due to diarrhea and vomiting of 4 days duration. On a. None
PE, the patient is irritable, tachycardic, with capillary refill time equal b. Mild
to 2 seconds. c. Moderate
d. Severe
55. What is the patient’s degree of dehydration Refer to the table in no. 55.
a. None
b. Mild 59. What intravenous fluid would you give?
c. Moderate a. Normal saline solution
d. Severe b. Colloids
c. D5 0.45% NaCl
d. D5 0.3% NaCl

60. What replacement fluid/s is/are recommended for patients with

diarrhea?
a. D5 0.45% + 30meqs/L HCO3 + 20meqs/L KCl
b. NSS + 20 meqs KCl
c. NSS + 10 meqs Kcl
d. All of the above

Diarrhea
 Patient losses 55meq/L Na, 25 meq/L K, and 15 meq/L HCO3
 Out of all the available replacement fluids (see table 6), ORS’
electrolyte contents has nearest values to the value of
electrolytes lost in diarrhea
 D5 0.45% may be used as an alternative and ideally is
added with 30 meq/L HCO3 & 20 meq/L KCL.

61. What is the main goal of the resuscitation phase of fluid therapy?
a. Maintain fluid balance
b. To prevent starvation ketoacidosis
c. To restore intravascular volume
d. To stop ongoing losses

Phases of Fluid Therapy

1. Resuscitation/Deficit therapy
 Used if dehydration is present
 To restore intravascular volume
2. Replacement
 For patients with continued excessive losses
3. Maintenance
56. How will you compute for the replacement therapy for this patient  Used in children who cannot be fed enterally
in cc/kg
a. 30 62. What parameters is/are used in the monitoring of adequate fluid
b. 50 therapy?
c. 60 a. Blood pressure
d. 100 b. Urine output
c. Weight
d. All of the above

Monitoring
 Intake and output

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 o Urine output – indicates success of therapy  Goal: <12 mEqs/L/day or <18 mEqs/L/48 hrs to prevent
 Physical examination Central Pontine Myelinolysis
o Vital signs: pulse, blood pressure Do not correct it rapidly because this is irreversible
o Weight  Restore intravascular volume using isotonic saline for
o Signs of depletion or overload (assess every 6 hypovolemic patients
hours)  Hypervolemic hyponatremia – use of diuretics, vasopressin
 Electrolytes (at least daily) antagonists, albumin infusion
o Serum Na+, K+  Isovolemic hyponatremia – eliminate excess water, hormone
replacement for hypothyroidism and cortisol deficiency
63. It is the dominant extracellular fluid cation and is the principal
determinant of serum osmolality? 67. It is the main intracellular cation found mostly in the muscles
a. Bicarbonate a. Bicarbonate
b. Calcium b. Calcium
c. Potassium c. Potassium
d. Sodium d. Sodium

SODIUM POTASSIUM
 Dominant ECF cation 
 Principal determinant of osmolality 
 Intracellular concentration = <3% 

64. Which of the following will NOT cause hypernatremia? 68. Which of the following may cause hypokalemia?
a. Diabetes Insipidus a. Acidosis
b. Hyperaldosteronism b. Alkalemia
c. IV hypertonic saline c. Renal failure
d. Syndrome of Inappropriate ADH secretion d. Tumor lysis syndrome

65. A 6-month-old infant with history of vomiting came in due to 69. What is the first change seen in ECG of patients with
irritability, doughy skin and high-pitched cry. What electrolyte hyperkalemia?
abnormality does this patient have? a. Appearance of U wave
a. Hyperkalemia b. Flattening of T waves
b. Hypernatremia c. Peaking of T waves
c. Hypokalemia d. St segment depression
d. Hyponatremia
Hyperkalemia
Characteristics of Hypernatremia  Characteristics
 Na level > 145 mEq/L o ECG changes
 Clinical manifestations  Peaking of T waves
o Irritable, restless, weak, lethargic  ST segment depression
o Doughy skin  Increased PR interval
o High-pitched cry and hyperpnea  Flattening of T wave
o Brain hemorrhage, pulmonary edema  Widening of QRS complex
o Ventricular fibrillation
66. What intravenous fluid should be used in treating severe o Asystole
symptomatic hyponatremia?
a. 3% NaCl 4-6ml/kg 70. In oliguric patients, what volume of maintenance fluid should be
b. 3% NaCl 12 meqs/hr given?
c. D5 0.3% NaCl 4-6 ml/kg a. 15-25%
d. D5 0.3% NaCl 12 meqs/hr b. 25-40%
c. 50%
Treatment of Hyponatremia d. Full
 3% NaCl 4-6 ml/kg
Increase Na by 1 mEq/L Oliguria/Anuria
 25-40% of maintenance fluid is sufficient

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  Amount given is decreased because the kidneys might not
be able to handle the normal amount of maintenance fluids
given
 It is important to add a urine replacement solution to prevent
dehydration

71. Which of the following regulates plasma osmolality?

a. Aldosterone
b. Anti-diuretic hormone
c. Atrial natriuretic peptide
d. Renin

Osmolality
 increase in the plasma osmolality stimulates thirst through the
osmoreceptors in the hypothalamus and secretion of antidiuretic
hormone (ADH) in the supraoptic & paraventricular nuclei of the
hypothalamus

which increases the permeability of water leading to water resorption
(fluid is retained), thereby decreasing urinary water loss/excretion &
increasing urine concentration 75. What laboratory test would be helpful in determining the cause of
 decreases, the osmoreceptors metabolic alkalosis?
sense the decrease and stops the secretion of ADH a. Anion Gap
b. Creatinine
72. These physical examination findings are seen in patients with c. Urine bicarbonate
moderate signs of dehydration EXCEPT: d. Urine chloride
a. Capillary refill time >3 secs
b. Increased pulse rate Diagnosis of Metabolic Alkalosis
c. Irritability History: diuretic use
d. Sunken fontanel Signs of volume depletion: thirst and lethargy
Refer to the table in no. 55 Hypertension due to aldosterone secretion
Symptoms of hypokalemia
73. This is a condition in which a pathologic disorder causes a
Decreased calcium – due to binding to albumin
decrease in serum bicarbonate concentration.
Patients may present with tetany or spasms
a. Metabolic acidosis
b. Metabolic alkalosis Arrhythmias
c. Respiratory acidosis Laboratories:
d. Respiratory alkalosis o Urine chloride, plasma renin, and aldosterone

Metabolic Acidosis 76. In alkalemia, patients may present with carpopedal spasms
 Characteristics or tetany due to:
o Low serum bicarbonate concentration a. Associated hypokalemia
o Commonly seen in patients with diarrhea (due to b. Gastronintestinal losses of sodium
bicarbonate loss in the stool)  c. Increased binding of calcium to albumin
o If the pCO2 > predicted = with respiratory acidosis d. Increased chloride secretion in the urine
o If the pCO2 < predicted = with respiratory alkalosis
o Respiratory response: compensatory 77. A 9 year old boy has progressively increasing difficulty
hyperventilation to lower pCO2 (H+ also walking and climbing stairs. From a squatting position, he
decreases, increasing pH)  compensates by pushing himself up by his thighs to get
himself upright. Part of history taking should include inquiries
74.. Which of the following diseases have a high anion gap metabolic about one of the following:
acidosis? a. Family history of males with similar pattern of
a. Central diabetic insipidus weakness
b. Cushing syndrome b. History of intake of unpasteurized honey
c. Gitelman syndrome c. Past history of episodic weakness
d. Inborn error of metabolism d. Past history of traumatic injury to the back

78. A newborn weighing 8 lbs 8oz via NSD with shoulder

dystocia… Apgars 7 and 9 at 1 and 5 minutes is noted to
have a limp right upper extremity. On further examination,
there is no movement elicited from the shoulder and elbow,
but is able to move the fingers and slight flex the wrist. The
right upper extremity assumes a “waiter’s tip” posture. The
most likely diagnosis is:
a. Bell’s palsy
b. Cervical spinal cord injury
c. Erb-Duchenne’s palsy
d. Klumpke’s palsy

79. A previously healthy 4 year-old develops progressively

worsening difficulty in walking over the past 4 weeks and on

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 examination is noted to have a wide-based gait and is unable d. Previous history of CNS infection such as
to walk straight. He is complaining of headache. He most encephalitis
likely has one of the following conditions:
a. Basal ganglia lesion 89. Normal infants begin to orient to sound at this age in months:
b. Cerebellar tumor a. Birth
c. Frontal lobe mass b. 1-2
d. Otitis media c. 3-4
d. 5-6
80. Palpable raised cranial sutures in a 4 month-old with unusual
asymmetrically shaped head is most likely due to: 90. Diplopia on lateral gaze is often seen in patients with
a. Craniosynostosis increased intra cranial pressure and is most frequently due to
b. Hydrocephalus partial _________
c. Increased intracranial pressure a. CN 3 palsy
d. Skull fracture b. CN 4 palsy
c. CN 6 palsy
81. One of the signs of increased intracranial pressure in an d. Optic nerve compression
infant is:
a. Distended and prominent superficial scalp 91. A large for gestation newborn baby delivered vaginally but
veins complicated by shoulder dystocia is noted a “waiters tip”
b. Overlapping cranial sutures posture/ This is consistent with:
c. Seizures a. Brachial plexus palsy involving right c5-c6
d. Sunken anterior fontanelles nerve roots
b. “ involving right c8-T1 nerve roots
82. An infant with generalized hypotonia will exhibit one of the c. “ involving right distal median nerve
following d. Right clavicular fracture
a. Head lag on pull-to-sit maneuver
b. Increased deep-tendon reflexes 92. A newborn has asymmetric grimace of the mouth when
c. Persistent fisting crying but with normal nasolabial folds and symmetric eye
d. Sustained ankle clonus closure. This condition is most likely due to:
a. Bell’s palsy
83. Preferential use or handedness is usually established by this b. Hypoplastic depressor anguli
age: c. Trigeminal nerve palsy
a. 1 d. Neonatal stroke
b. 2
c. 3 93. Multiple café-au-lait birth marks are suggestive of:
d. 4 a. McCune Albright syndrome
b. Neurofibromatosis
84. Skin birthmark/s that may be suggestive of an underlying c. Sturge-Weber syndrome
neurological syndrome is/are d. Tuberous sclerosis
a. Café-au-lait spots
b. Hypopigmented macuels 94. A 9 year-old with waddling gait, pseudohypertrophy of the calf
c. “Port0wine” stains on the face muscles and with difficulty getting up from a sitting position
d. AOTA most likely has:
a. Congenital (Duchenne’s) muscular dystrophy
85. A 4 we-old infant with an abnormal rapidly enlarging head b. Guillain-Barre syndrome
due to suspected hydrocephalus will most likely have: c. Poliomyelitis
a. Bell’s Palsy d. Transverse myelitis
b. Palpable ridge-lie cranial sutures
c. Sunken anterior fontanelles 95. The predominant pattern of motor tone of a normal newborn
d. Widened cranial sutures is:
a. Extensor tone in both extremities and trunk/neck
86. A 9 month-old infant with flattened occiput and g eneralized muscles
hypotonia will most likely exhibit the following: b. Extensor tone in the extremities, flexor tone in the
a. Generalized spasticity trunk and neck
b. Head lag on pull-to-sit maneuver c. Flexor tone in both extremities and trunk/neck
c. Signs of increased intracranial pressure muscles
d. Widened biparietal diameter d. Flexor tone in the extremities, extensor tone in
the trunk and neck
87. One of the following exhibits normal developmental
milestones: 96. Aside from glutaric aciduria, the presence of acute retinal
a. Able to speak in 3-word sentences at 4 yo hemorrhages in an infant should be strongly suspected to
b. Pincer grasp at 15 months old have:
c. Spontaneously rolling over at 4 months old a. Bleeding disorders
d. Walks unassisted beginning 20 months old b. Hydrocephalus
c. Meningitis
88. Loss of skills over time in a toddler is very strongly suggestive d. Shaken infant syndrome
of:
a. Chilld abuse
b. Lack of parental supervision/care
c. Inborn error of metabolism

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 97. A newborn infant was delivered vaginally via forceps
extraction wherein one of the blades of the forceps was
accidentally applied on the baby’s face. On delivery, the right
side of the face is asymmetric when crying. The most likely
finding is:
a. Flattened right naso-labial fold, intact forehead
wrinkles and equal eyelid closure
b. Flattened right naso-labial folds, partial closure
of the right eye and absent wrinkling of the right
forhead
c. Flattened naso-labial folds bilaterally, absent
forehead wrinkling of the right side
d. Intact naso-labial folds bilaterally, impaired
depressor menti on the right

98. The normal gap in mm between unfused cranial sutures in a

newborn infant is:
a. 1-2
b. 5-10
c. 15-20
d. 50-100

99. Abnormal odors such as “burnt sugar” in an infant with sepsis

like manifestations may indicated this condition:
a. Antibiotic induced kidney dysfunction
b. Inborn errors of metabolism
c. Fecal and urine contamination
d. Munchausen’s syndrome

100. Children who are excessively clumsy or who have poor

coordination often experience one of the following conditions
a. Bullying by their siblings or peers
b. Frequent injuries from accidental falls
c. Mistakenly diagnosed as child abuse victims
d. Withdrawal and depression

CRS 2 10 of
10