PEDIATRICS I - FINAL EXAM carepackage

May 11, 2021

Note: No synchronous feedback provided as this is the FINAL EXAM.

1. Which of the following statements is TRUE regarding harmless cyanosis in a B. Describes acrocyanosis which is normal in the newborn.
neonate? Acrocyanosis is the pallor of the hands and feet while the central
part of the newborn’s body is warm. This is a normal
A. Appears with red and pale halves compensatory mechanism of the newborn to conserve heat and
B. Hands and feet are cold prevent hypothermia.
C. Pallor is common
D. Associated with general circulatory instability Not A. Harlequin dyschromia or color change - division of body
from forehead to pubis into red and pale halves; transient and
harmless
B
Not C. Pallor may be caused by anemia, asphyxia, shock, or
edema; note that without being anemic, postmature infants
may tend to have paler and thicker skin that term or premature
infants

Not D. Mottling - may indicate general circulatory instability

associated with a serious illness or transient change in skin temp

Neonatal Assessment 2: PE of the Newborn [PED 1.02 p. 2-3]

2. While doing your examination on the skull, you identify a hard, A. Craniosynostosis is a birth defect in which the bones in a
non-movable ridge over the suture in an abnormally shaped head. You are baby’s skull fuse together too early before the brain is fully
quick to conclude that this is: formed. Persistent asymmetry may indicate craniosynostosis
(early closure of the sutures leading to an abnormal head shape).
A. Craniosynostosis
B. Craniotabes Not D. Temporary asymmetry from passage through the birth
C. Molding canal is normal (sutures overlap to allow passage through the
D. Overlapping sutures birth canal).
A
Not B. Craniotabes is the softening or thinning of the skull seen
mostly with the occipital and parietal bones. The bones are soft
and when pressure is applied they will collapse under it.

Not C. Molding occurs due to the pressure on the head by the

birth canal causing an abnormally shaped head.

Neonatal Assessment 2: PE of the Newborn [PED 1.02 p. 4]

3. Which of the following should be performed first in examining a quiet and

A. Examination of the infant should be performed from the least
relaxed infant to apply the principles of procedural, flexibility, patience and
invasive procedures to the most invasive. Among all of the
gentleness?
choices, inspection of the breathing patterns should be done
A first to ensure accuracy since the infant at that time is still quiet
A. Inspection of breathing patterns
and relaxed.
B. Palpation of the abdomen
C. Neurologic assessment
Neonatal Assessment 2: PE of the Newborn [PED 1.02]
D. Assessment from head to toe

4. On the examination of an infant at birth, you observed facial asymmetry

C. Face presentation is an obstetric event wherein there is a
when crying, The patient had the following history: (+) face presentation, AS
longitudinal line and full extension of the fetal head on the neck
5,6,8, (+) facial petechiae.
with the occiput against the upper back. (In simple words, it’s
The condition is secondary to _______.
the face-first exit on the birth canal instead of the cephalic
C
presentation.) Facial nerve palsy can happen due to traumatic
A. Nuchal cord coil
birth injury.
B. Muscle hyperplasia
C. Nerve palsy
Neonatal Assessment 2: PE of the Newborn [PED 1.02]
D. Congenital anomaly

5. Which of the following statements is true regarding thermoregulation? B. Immediate drying is important to prevent evaporative heat
loss that can lead to hypothermia. To prevent heat loss via
A. Neutral thermal environments are the same for all infants. evaporation, dry the wet baby immediately after birth and cover
B. Evaporative heat loss is vital at birth it with a warm, dry cloth.
B
C. Highest metabolic rate is achieved when the infant is warmed above
normal temperature Not A. NTE is the maintenance of the infant’s temperature with
D. Servocontrol devices are not for sick neonates a stable metabolic state along with minimal oxygen and energy
expenditure. This is best achieved when infants maintain a

PED Page 1 of 27
 temperature between 36.5C to 37.5C. NTE is a function of the
size and postnatal age of an infant; larger and older infants
require lower environmental temperatures than smaller,
younger infants.

Not D. The smaller and more immature the infant, the higher
the environmental temperature required. Infant warmth can be
maintained by heating the air to a desired temperature or by
servo-control.
[Nelson’s p. 903]
Neonatal Assessment 1: Normal Newborn [PED 1.02 p. 2]

6. You are attending to an infant who has remained in the hospital for longer
than 48 hours. You should perform a discharge examination within ____ hours A. Normal and stable vital signs for at least 12h prior to
prior to discharge. discharge; axillary temperature between 36.5 and 37.4°C,
respiratory rate below 60bpm and no other signs of respiratory
A
A. 12 distress and an awake heart rate of 100–160 bpm
B. 6
C. 48 Neonatal Assessment 2: PE of the Newborn [PED 1.02 p. 2]
D. 24

7. Which of the following statements is associated with the occurrence of D. Abusive head trauma (AHT) results in the most significant
retinal hemorrhages? morbidity and mortality. Abusive injury may be caused by direct
impact, asphyxia, or shaking.
A. APGAR score 3.5 at 1, 5 mins respectively Subdural hematomas, retinal hemorrhages, particularly when
B. Multiple gestation extensive and involving multiple layers, and diffuse axonal
C. Forceps extraction deliveries injury strongly suggest AHT, especially when they co-occur.
D. Vacuum-assisted deliveries D Retinal hemorrhages are an important marker of AHT.
Whenever AHT is being considered, a dilated indirect eye
examination by a pediatric ophthalmologist should be
performed. After normal spontaneous vaginal delivery, 25% of
term neonates may have retinal hemorrhages (lower with
caesarian section, higher with vacuum assisted delivery)
[Nelson’s]

8. Which of the following conditions is associated with poor adaptation at

birth? A. The Transitional period occurs from placenta-supported
intrauterine to self-maintained extrauterine life. Having poor
A. Poor extrauterine life changes A extrauterine life changes hinders the neonate to adapt at birth.
B. Adverse effects of delivery
C. Increasing annual death rates Neonatal Assessment 1: Normal Newborn [PED 1.02 p. 2]
D. Biological and physiologic changes

9. On routine examination of the eyes prior to discharge, you documented the

presence of bilateral red reflex on a patient 30 hours old, you tell the mother
C. Presence of bilateral red reflex on a patient is NORMAL.
that this would suggest the ABSENCE of;
Cataract and retinoblastoma are seen as ASYMMETRIC red
C reflexes, therefore it is ruled out for the patient. Other choices
A. Chorioretinitis
are not tested by ROR.
B. Tumors
C. Cataract
Neonatal Assessment 2: PE of the Newborn [PED 1.02 p. 2]
D. Retinopathy

10. Which statement refers to the physical examination finding characterized C. Congenital dermal melanocytosis (formerly known as
as well demarcated pigmentation noted over the buttocks of an infant? “Mongolian spot”): dark-blue pigmentation or slate-blue
well-demarcated areas of pigmentation, usually on the lower
A. Abnormality over lumbar spine back, buttocks; tend to disappear within 1st year
B. Vascular benign lesion C
C. Disappearance in the 1st year Not A because it describes spina bifida
D. Benign lesion containing eosinophil Not B/D because these describe erythema toxicum

Neonatal Assessment 2: PE of the Newborn [PED 1.02 p. 2]

11. Michael is 3 years old and was brought to the OPD for a well-child visit. On
PE, the anthropometric measurements were as follows: weight= 15 kg; C. See images for formulas
height= 96 cm. Using the Waterlow Classification, Michael’s nutritional status
can best be described as:
C
A. Not wasted, mildly stunted
B. Mildly wasted, not stunted
C. Not wasted, not stunted
D. Mildly wasted, mildly stunted

PED FINAL EXAM carepackage Page 2 of 27

 Solution:
Michael’s Age: 3 y/o
Wt in kgs= Age in years x 2 + 8
Wt in kgs= 3 x 2 + 8

Ideal weight= 14 kgs

Ht in cms= Age in years x 5 + 80

Ht in cms= 3 x 5 + 80
Ht in cms= 95 cm
From the formula, ideal weight= 14 kg; ideal height= 95 cm (vs
current anthropometrics 15 kg; 96 cm), Michael is not wasted
and not stunted.

Growth and Development I [PED 1.03a]

12. Risk factors with significant effects on in early child development includes A. Calcium deficiency in early child development may cause
the following, EXCEPT: Rickets but this does not satisfy the requirements for
satisfactory development provided below. It applies more to
A. Calcium deficiency growth spurt which applies more in the adolescence period.
B. Malnutrition that is chronic and severe enough to cause growth
stunting Not B. Applies to second bullet in the picture below: There
C. Iron deficiency anemia should be an environment that provides adequate nutrition
D. Inadequate stimulation or learning opportunities
Not C. Iron deficiency anemia in early child development may
lead to behavioral disturbances.
● Both iron deficiency and iron-deficiency anemia are
associated with impaired neurocognitive function in
infancy. Iron-deficiency anemia is also associated with
later, possibly irreversible, cognitive defects. Although
there is support for iron deficiency with or without anemia
causing these defects, it has not been established
unequivocally. Given the frequency of iron deficiency and
iron-deficiency anemia and the potential for adverse
neurodevelopmental outcomes, minimizing the incidence
of iron deficiency is an important goal. [Nelson’s}

Not D. Applies to third bullet in the picture below: There should

be stimulation that includes opportunities to learn
A

Growth and Development II [PED 1.03b]

PED FINAL EXAM carepackage Page 3 of 27

13. Anne is 4 years old. At present, she can follow two-step commands B. At 24 months: expressive language-two worded phrases;
without gesture and can speak in short phrases. The approximate expressive receptive language-able to follow 2-step commands
language age of Anne, in months, is:
Not A. 12 months: expressive language-second word (at least 3
A. 12 words with meaning), immature jargon; receptive language-able
B. 24 to follow 1-step commands without gesture
C. 36
B
D. 18 Not C. 36 months: expressive language-3-word sentence, gives
full name, age, sex; receptive language-identifies action in
figures

Not D. 18 months: receptive language-points to 2 body parts

Growth and Development II [PED 1.03b]

14. The following statement is TRUE of child development: C. The sequence of development is the same in all children

A. Development proceeds in a caudo-cephalic direction Not A. cephalocaudal

B. Development is static Not B. development is a continuous process from conception to
C
C. Development is sequential and orderly maturity
D. Rate of development at different age levels is the same Not D. rate of development varies from child to child

Growth and Development II [PED 1.03b]

15. It is the period of psychosexual development when children become C. Phallic Stage: sexual identity; resolving Oedipus/Electra
attracted toward the parents of the opposite sex complex

A. Anal Not A. Anal: toilet training

C
B. Latent Not B. Latent: learning/developing defense mechanisms
C. Phallic Not D. Oral: weaning off of breastfeeding or formula
D. Oral
Adolescence [PED 1.04]

16. Case: Marilou is 14 years old, seen at OPD Clinic because of skin rashes.
On physical examination of the breast and genitalia respectively, the following
were (+) breast budding and sparse, long, straight pubic hairs. Marilous’s
sexual maturity rating is at:

A. V
B. IV
C. II
D. I
E. III

Adolescence [PED 1.04]

17. Physical characteristics that heralds the onset of puberty in males: C. Recall. 2021 feedback.

A. Voice change First sign of puberty in girls: Breast budding (Thelarche)

C
B. Emergence of pubic hair First sign of puberty in boys: Testicular enlargement
C. Testicular enlargement
D. Penile elongation Adolescence [PED 1.04]

18. The following is TRUE of growth patterns in adolescents: B. First sign of puberty in girls: Breast budding (Thelarche)
First sign of puberty in boys: Testicular enlargement
A. Males experience a sudden increase in height earlier but ends this B
sooner than females Not A. Females experience a sudden increase in height earlier
B. The first sign of puberty in females is breast budding but end this sooner.

PED FINAL EXAM carepackage Page 4 of 27

 C. Increased production of body hairs and adipose deposition is Not C. Adipose deposition is common in females
common in males Not D. Muscle mass is greater in males
D. Muscle mass is greater in females Adolescence [PED 1.04]

19. The following statement/s is/are true regarding growth spurts during
adolescence:

A. PHV in females average 1cm per year less than males

B. PHV occurs few months later of the PWV in males
C. PWV occurs 6-9 months earlier of the PHV in females
D. PHV occurs 18-24 months earlier in females than in males

Not A. PHV in females average 2cm per year less than males
Not B. PHV occurs with PWV in males
Not C. PWV occurs 6-9 months after of the PHV in females

Adolescence [PED 1.04]

20. The statement regarding early adolescence is TRUE: A. Cognitive growth

● Early adolescence - concrete thought, egocentric
A. Concrete, black-and-white thinking is commonly observed ● Middle adolescence - abstract thought, formal
B. Friends play a very influential role at this time operations begin, insight
C. Heterogeneous peer relationship among peers is common ● Late adolescence - formal operations continue
D. Engagement with high risk taking behaviors is at its peak
Not B. Peer group is most important during middle adolescence
A
Not C. Homogeneous peer group - early adolescence;
heterogeneous peer group - middle adolescence

Not D. Risk taking behaviors often cause conflict with

authorities (middle adolescence)
Adolescence [PED 1.04]

21. The double burden of malnutrition includes the following: B. Recall.

A. Overweight & obesity

B. Undernutrition and overnutrition B
C. Macronutrient and micronutrient malnutrition
D. Type 1 and type 2 micronutrient deficiencies
Nutrition [PED 2.02]

PED FINAL EXAM carepackage Page 5 of 27

22. How many minutes after delivery should breastfeeding be initiated?

A. 30 B. Feeding cues
B. 60 ● Breastfeeding should be initiated within the first
C. 10 hour (20-60 minutes)
D. 15 B ● First, there is a 15-20 minute rest period for both
baby and mother

Nutrition [PED 2.01 p. 10]

23. The nutritional parameter weight for length/height signifies that nutrient Weight: Best index of growth and nutrition; used to measure
loss is: ACUTE nutritional status of children
Height: reliable criterion for growth; used to measure CHRONIC
A. Severe nutritional status of children
B. Mild
C. Acute Not A and B because classifying nutrition as mild or severe
D. Chronic depends on values and not just the parameter. It is primarily
used in GRADING malnutrition (See Waterlow Classification
below)

Not D. because HEIGHT is used to measure chronic nutritional

status.
Growth and Development [PED 1.03a]

24. The following is a feature of iron deficiency anemia: D. The specific sign for iron deficiency is pallor. Consequences of
iron deficiency anemia (IDA) include: tachycardia, dizziness and
A. Cheilosis pallor. Signs and symptoms of IDA include: pale conjunctiva,
B. Easy bruisability pale oral mucosa, palmar pallor, pale nail beds
C. Constipation
D. Spooning of nails D Not A. observed in vitamin B deficiency
Not B. observed in vitamin C deficiency
Not C. chronic functional constipation is linked to vitamin D
deficiency

Nutrition [PED 2.02]

25. Which of the following condition/s is/are absolute contraindication/s to B. Inborn errors of metabolism in the baby (e.g. Galactosemia) is
breastfeeding? an absolute contraindication to breastfeeding.

A. HIV positive mother Not A. relative contraindication

B
B. Baby with inborn error of metabolism Not C. baby concerns in lactation
C. Baby’s cleft lip Not D. relative contraindication
D. Covid positive mother
Breastfeeding and Nutrition [PED 2.01]

26. Vitamins A D E K are better absorbed when the diet is high in:

A. Water
B. Fats B. Vitamins A D E K are lipid soluble vitamins.
C. Carbohydrates B
D. Proteins Nutrition [PED 2.02]

PED FINAL EXAM carepackage Page 6 of 27

27. The most caloric dense macronutrient supplies: C. Fats yield the largest amount of calories of 9 cal/gram

A. 20 cal/30 ml 1g carbohydrate = 4 calories

C
B. 1 cal/ml 1g protein = 4 calories
C. 9 cal/gram
D. 4 cal/gram Nutrition [PED 2.02]

28. Water content in human milk comprises __ %: A. Human milk comprises 87% water.

A. 90
B. 50
C. 25
D. 75
A

Breastfeeding and Nutrition [PED 2.01]

29. Anthropometry, an important aspect in nutritional assessment, includes A. Growth parameters include weight for length and
this/these parameter/s: length/height for age, which determines wasting and stunting
status, respectively.
A. Wasting and stunting status
B. Biparental height Not B. Biparental height or midparental height is the child's
C. Skin fold test projected adult height based on the heights of the parents
D. Physical signs of micronutrient deficiencies A
Not C. It is just an assessment of body fat content

Not D. The physical sign of micronutrient deficiency is part of

the nutritional PE

Breastfeeding and Nutrition [PED 2.01]

30. You were asked to monitor the rooming in unit by checking the latch on D. A good latch on position includes: chin should be touching the
positions of the baby to the mother’s breast. The following correct position breast, mouth wide open and not pursed, lower lip turned
includes: outward, and areola showing above.

A. Lip should suck the nipple Not A. The baby needs to take more than the nipple into his
B. Lip should be pursed mouth. He needs to get far enough onto the breast so that his
C. Baby’s upper lip should be outward lower jaw and tongue can massage the pools of milk that lie in
D
D. Baby’s lower lip should be outward the lower part of the areola.

Not B. Lip should not be pursed

Not C. It should be the lower lip that is outward

Breastfeeding and Nutrition [PED 2.01]

31. What is the average head circumference of a healthy normal newborn full
term baby in cms? D. According to Doc. Battad, the average head circumference is
35 + 2 cm. However in Nelson and Navarro, the normal head
A. 32-33 D circumference is 32-37 cm at term.
B. 30-31
C. 36-37 Breastfeeding and Nutrition [PED 2.01]
D. 34-35

32. The family history is important in determining if there are relatives with C. In eliciting questions regarding family history, you may ask
similar illness that may be hereditary. Which one of the following items should about consanguinity, hereditary disorders, and developmental
be asked for in eliciting the family history? problems

A. At what age of the patient was the onset of illness? Not A. Question for Clinical History
B. Are there environmental factors affecting the illness? Not B. Question for Social History
C. Is there any degree of consanguinity between the parents? Not D. Question for identifying the child at risk
C
D. Is the illness progressive acute?
● Determining the nature of the problem
○ Acute vs Chronic
○ Static vs Progressive

Pediatric Neurologic Evaluation [PED 2.03]

PED FINAL EXAM carepackage Page 7 of 27

33. A tense, bulging anterior fontanelle in an infant may indicate increased D. The symptoms of bacterial infection (e.g. gastroenteritis)
intracranial pressure and may also be seen in one of the following conditions: include: fever, poor feeding, weak cry, vomiting, and somnolence.
PE findings consist of tense and bulging anterior fontanelle.
A. Thickened skull bones D
B. Hypothyroidism Not A. can be one of the rare causes of macrocephaly
C. During vigorous crying episodes
D. In acute dehydration due to gastroenteritis Pediatric Neurologic Evaluation [PED 2.03]

34. The presence of retinal hemorrhages on fundoscopic examination beyond B. Retinal hemorrhage from shaken infant syndrome is due to
the early neonatal period is suggestive of which one of the following? the acceleration and deceleration forces generated by the
shaking of the head.
A. Hemophilia A
B. Non-accidental trauma (Shaken Infant Syndrome) Not A. Chronic subdural/epidural hemorrhage : due to
C. Birth injury non-accidental trauma like in patients with Shaken Infant
D. Congenital CMV infection Syndrome or bleeding disorder (i.e. Hemophilia A)
B
Not C. This is not beyond early neonatal period

Not D. Congenital CMV infection manifests with retinitis and

not retinal hemorrhage

Pediatric Neurologic Evaluation [PED 2.03]

35. In the evaluation of the developmental milestones of a child, a history of a

progressive loss of skills (developmental regression) is strongly suggestive of A. Developmental milestones must always be recorded; to
which of the following? determine if development is par/normal, delayed or regressive.
- Regression suggests a neurodegenerative disease of
A
A. An inborn error of metabolism the CNS such as inborn errors of metabolism
B. A previous history of birth asphyxia
C. Acute brain injury Pediatric Neurological Evaluation [PED 2.03]
D. Social deprivation

36. Dr. Chacon met up with the barangay chairman and the school principal to C. Collaborates with partners and stakeholder
organize a school feeding program for the malnourished children in the
community. Not A. ensures that other healthcare workers practice good
rapport and provide good service to patients
What role is she taking on as a Community Pediatrician?
Not B. evaluate the progress of implementation of the activity
A. Supervisor C and assess the strengths or weakness that need to be adjusted in
B. Program Evaluator the program
C. Social Mobilizer
D. Resource Mobilizer Not D. works together with LDU and people in community to
source out funds for project/s

Community Pediatrics [PED 3.01]

37. Based on the 2018 DOH Data, what cause of mortality in the pediatric age
group is unique to the age group of 10-14 years?

A. Leukemia
B. Disease of the nervous system D. Intentional self-harm part of the 10 leading Cause of
C. Accidental drowning and submersion Adolescent Mortality (10-14 Years)
D. Intentional self-harm
Community Pediatrics [PED 3.01]

PED FINAL EXAM carepackage Page 8 of 27

38. Garantisadong Pambata (GP) reinforces availability and access to which A. Services Package under GP Health Care Services:
preventive health care service/s?

A. Deworming and catch-up immunization

B. Exclusive breastfeeding and proper nutrition
C. Smoking prevention and cessation
D. Oral health and hygiene

Not B. Under Nutrition Services

Not C. Under Environmental Services
Not D. Under Environmental Services

Community Pediatrics [PED 3.01]

39. Which statement/s is/are TRUE regarding Community Pediatrics?

A. This is both the practice of promoting and integrating the positive

social, cultural and environmental influences on children’s health and
a commitment to collaborate with partners to advocate for and
E. All choices are correct.
provide quality services for all children.
B. It is a commitment to collaborate with partners to advocate for and E
All the choices were statements given in the lecture ppt
provide quality services for all children.
regarding Community Pediatrics.
C. This is the practice of promoting and integrating the positive social,
cultural and environmental influences on children’s health.
Community Pediatrics [PED 3.01]
D. This would include synthesizing clinical practice and public health
principles to address the health of all pediatric patients.
E. All choices are correct.

40. Which of the Millennium Development Goals (MDG) directly addresses D. 4

the issues that pediatricians face in regard to child health?
MDG 4: Reduce child mortality. During the lecture and
A. 3 according to the slides, MDGs 4, 5, and 6 were the most
B. 8 emphasized.
C. 7 D
D. 4 Not A. MDG 3: Promote gender equality and empower women.
Not B. MDG 8: Global partnership for development.
Not C. MDG 7: Ensure environmental sustainability.

Community Pediatrics [PED 3.01]

41. Which among the choices show the correct sequence in performing the B. Immediate drying > Skin-to-skin contact > Delayed cord
Essential Intrapartum Newborn Care (EINC)? clamping and cutting > Non-separation of mother from infant

A. Non-separation of mother from infant > Skin-to-skin contact > Four Principles in EINC:
Delayed cord clamping and cutting > Administering vaccines Immediate drying (30-60 seconds) > Skin-to-Skin contact
B. Immediate drying > Skin-to-skin contact > Delayed cord clamping and (within the next 30 seconds) > Proper cord clamping and cutting
cutting > Non-separation of mother from infant B (1 to 3 minutes) > Non-separation of Baby from Mother and
C. Skin-to-skin contact > Non-separation of mother from infant > initiation of breastfeeding (60 - 90 minutes)
Initiating breastfeeding > Delayed cord clamping and cutting
D. Suctioning of secretions > Immediate drying > Skin-to-skin contact > Not D. Routine suctioning is avoided especially if the baby has
Non-separation of mother from infant exhibited crying and proper breathing.

Neonatal Assessment 1 [PED 1.01]

PED FINAL EXAM carepackage Page 9 of 27

42. The Integrated Management of Childhood Illness (IMCI) is a major B. Sick children under 5 years old. According to the trans:
strategy promoting the use of evidence-based algorithms to manage which 1) MCI aims to “deliver key preventive and treatment
group of children: interventions addressing the most common causes of deaths in
the under 5 year old population”.
A. Healthy newborn infants 2) To promote the use of a syndromic approach to manage a sick
B. Sick children under 5 years old child from age 0 to less than 5 years through evidence-based
C. School-aged children with learning disorders B algorithms
D. Adolescents with mental health concerns
Not A. Must be sick children aged 0 to less than 5
Not C. Not mentioned in the trans/lecture.
Not D. Not mentioned in the trans/lecture.

Community Pediatrics [PED 3.01]

43. Which among the age and recommendation pairs is INCORRECT based on B. From 6 months onwards, there would be an apparent “energy
the Infant and Young Children Feeding (IYCF) recommendations? gap” that needs to be filled in by the complementary feeding of
semi-solids (not solids)
A. 12-24 months: add variety of solid food
B. 6 months: introduce solids Not A. At 12-18 months, the baby gains the ability to try
C. 7-11 months: encourage finger feeding different tastes and flavors. Bite-sized solid foods are much
D. 0-6 months: breastfeeding only B more tolerated.
Not C. At 7 months onwards, the development of fine motor
skills such as pincer grasp occurs which enables baby to finger
food eventually
Not D. Infants should be exclusively breastfed for the next 6
months of life
Community Pediatrics [PED 3.01]

44. Which system of care pertains to the collaboration of the community A. Medical neighborhood: coordinated and efficient integration
pediatrician with the subspecialists and the healthcare providers to between primary care pediatricians and subspecialists,
streamline therapeutic goals and services? including integrated EHRs, efficient coordinated appointment
scheduling, and enhanced communication
A. Medical neighborhood
B. Population Health Approach Not B. Population Health Approach emphasizes on identifying
C. Patient neighborhood and addressing the needs of individuals and families who do not
D. Patient and family-centered medical home seek regular care, or whose care is episodic and suboptimal from
a prevention or management standpoint
A
Not C. Patient neighborhood was not discussed under systems
of care

Not D. Patient and family-centered medical home provides care

that is accessible, continuous, comprehensive, family-centered,
coordinated, compassionate, and culturally active.

Community Pediatrics [PED 3.01]

45. Dr. Salazar visited the barangay health center to oversee whether the D. Supervisor: checks guidelines for quality care and makes sure
process flow of essential newborn care being done by the midwife and health these are followed and ensures that the other healthcare
workers follows the current recommendations. workers practice good rapport and provide good service to the
patients.
What role is he taking on as a Community pediatrician?
Not A. Resource mobilizer works together with LGUs and people
A. Resource mobilizer in the community to source out funds for projects
B. Planner
D
C. Program evaluator Not B. The planner identifies and prioritizes most important
D. Supervisor issues and formulates goals to address the issues

Not C. Program evaluator evaluates progress of implementation

of an activity plan to assess the strengths and weaknesses that
need to be adjusted in the program

Community Pediatrics [PED 3.01]

46. What vaccine preventable disease/s have had reported outbreaks in

recent years?
C. Polio outbreak was declared in September 2019 while
measles outbreak was declared in 2018 due to vaccine
A. All choices are correct C
hesitancy
B. Polio
Community Pediatrics [PED 3.01]
C. Measles and polio only
D. Rubella

PED FINAL EXAM carepackage Page 10 of 27

 E. Measles

47. Which of the following statements best describes Primary Health Care
(PHC)?

A. Its scope focuses on interrelated but limited aspects of physical,

mental, and social health, and well-being
B. It provides whole-person care for health needs only for a set of
specific diseases
C. It invokes partial participation, self-reliance, and self-determination
of individuals, families, and communities
D. It is essential health care based on practical, scientifically sound, and
socially acceptable methods and technology that are universally
accessible and affordable to individuals, families, and communities D

Community Pediatrics [PED 3.01]

48. Which factor contributes to the high risk of further transmission of polio? A. Sub-optimal surveillance performance for acute flaccid
paralysis is a HIGH risk for further transmission at a NATIONAL
A. Poor surveillance for acute flaccid paralysis level.
B. Improved sanitation and hygiene conditions
C. Chronic optimal immunization coverage Not B. Poor sanitation and hygiene conditions
A
D. Decreasing detection of human cases and environmental samples Not C. Chronologically sub-optimal immunization coverage
Not D. Increasing number of human cases and (+)
environmental samples

Community Pediatrics [PED 3.01]

49. Which among the current issues in the Philippines has a direct detrimental
effect on child health and well-being?
C. Persistent poverty directly affects the overall health of the
A. Ethnic diversity C
child that can lead to severe and chronic stunting and wasting
B. Democratic republic
C. Persistent poverty
Community Pediatrics [PED 3.01]
D. Rapid industrialization

50. In monitoring nutritional status, which unfavorable outcome is most D. 33% of children under 5 years are stunted. Household wealth
prevalent and emphasizes chronic undernutrition? is a significant predictor of sunting.

A. Obesity Not A. 3.7% females and 4.4% males under 5 years old are
B. Wasting D overweight
C. Underweight Not B. 7% of children under 5 years old are wasted
D. Stunting Not C. 21.5% of children under 5 years are underweight

Community Pediatrics [PED 3.01]

51. Which factor greatly increased the scope and coverage of the Newborn
Screening (NBS) program?

A. Enactment of RA 9288 or Newborn Screening Act of 2004

B. Inclusion in PhilHealth Newborn Package in 2011
C. Availability of the service in 1996
D. Introduction of Expanded Newborn Screening in 2014

Community Pediatrics [PED 3.01]

PED FINAL EXAM carepackage Page 11 of 27

52. Based on the 2018 DOH Data, what is the most common cause of
mortality in children aged 1-4 years?
A. Pneumonia is the leading cause of Under-Five mortality
A. Pneumonia A
B. Sepsis Not B. Bacterial sepsis is the leading cause of Infant mortality
C. Diarrhea
D. Malnutrition Community Pediatrics [PED 3.01]

53. The target/s of Sustainable Development Goal-3 (Good health and

well-being) by 2030 include/s:

A. To end neonatal mortality and to reduce to ⅓ the incidence of AIDS,

tuberculosis, malaria and hepatitis
B. To reduce under-5 mortality to as low as 25 per 1,000 live births
C. To reduce ⅓ the incidence of AIDS, tuberculosis, malaria and
hepatitis
D. All choices are correct D
E. To end neonatal mortality

Community Pediatrics [PED 3.01]

54. Which current issue in the Philippines portrays the limited supply of basic C. Shortage of well-trained and qualified professionals cross all
services to children and their families? sectors portray issues in supply

A. Outdated sociocultural norms, practices and beliefs Not A. Portrays issue in enabling environment
C
B. Insufficient awareness and knowledge of their basic rights Not B. Portrays issue in demand
C. Shortage of qualified professionals across all sectors Not D. Portrays issue in enabling environment
D. Restricted amount of quality of data on children available for use
Community Pediatrics [3.01]

55. Which program on child health includes components of Family Planning,

Dangerous Drugs Abuse Prevention and Treatment, Mental Health, and
Women & Child Protection?

A. Adolescent Health and Development (AHD)

B. Garantisadong Pambata (GP)
C. Integrated Management of Childhood Illness (IMCI)
D. All choices are correct

Community Pediatrics [3.01]

PED FINAL EXAM carepackage Page 12 of 27

56. Elevated blood pressure for 1-13 years old is defined as having a blood
pressure of:

A. > 90th but < 95th percentile +12mmHg

B. 120/<80 - 129/<80 mmHg +12mmHg
C. > 90th but < 95th percentile
D. <120/<80 mmHg

Not A. 1-13 years old Stage 1 Hypertension

Not D. >13 years old Normotensive

Preventine Pediatrics [3.02]

57. In doing nutrition counselling, what food would you recommend? Preventine Pediatrics [3.02]

A. Sumptuous bowl of instant noodles enriched with vitamin A, iron and B. having a well-balanced diet will provide the adequate
iodine B nutrition needed by the child
B. Well-balanced meal with rice, meat, fruits and vegetables
C. Delightful mango-frosted cake topped with ice cream Not A,C,D because these are diets with too much calories and do
D. “Kiddie Meal” from a well-loved fast food chain not provide the best source of nutrients

58. You decide to discharge a newborn infant before the 48th hour of life
because_________?

A. There is significant jaundice noted at the 20th hour of life

B. Vital signs during the preceding 12 hours are as follows: Axillary
temp 36C, RR 75/min, HR 180/min
C. The infant has documented proper latch and absence of nipple C
discomfort
D. Upon physical examination, the patient is noted to have a unilateral
cleft palate

Preventine Pediatrics [3.02]

59. When is urinalysis recommended as a screening test?

A. For all children at least once a year

B. For a 5-year-old child with diarrhea
C. For all malnourished children
D. For a 3-year-old child with unexplained fever D

Preventine Pediatrics [3.02]

60. In which case would you request for a Complete Blood Count as screening
for anemia?

A. A healthy, term 3-month-old infant

B. A 7-year-old child with cough
C. A 4-year-old underweight child
D. A 13-year-old adolescent with dysuria C

Preventine Pediatrics [3.02]

PED FINAL EXAM carepackage Page 13 of 27

61. The best studied effect of lead exposure among children is? A. Exposure to lead can seriously harm a child’s health, including
damage to the brain and nervous system, slowed growth and
A. Cognitive impairment development, learning and behavior problems, and hearing and
B. Anemia speech problems (CDC)
C. Liver toxicity A
D. Hyperactivity Pregnant women exposed to lead may also pass it down to the
baby.

Preventine Pediatrics [3.02]

62. For patients with any signs of physical or sexual abuse, where should an
immediate referral be made?

A. Child Protection Unit

B. Kapwa Ko Mahal Ko
C. Bantay Bata 163
D. UNICEF C

Preventine Pediatrics [3.02]

63. Newborn screening samples may be taken before 24 hours from birth if A. For patients who are preterm (<37 weeks), low birth weight
blood transfusion will be done to patients born less than 37 weeks, with a (<2000 grams), and sick neonates (receiving intensive care),
birth weight of less than 2kg and those receiving intensive neonatal care. may have a blood sample taken before 24 hours from birth if
blood transfusion will be done but otherwise a sample should be
A
A. True taken immediately after 24 hours from birth and a repeat
B. False screening should be collected at the 28th day of life

Preventine Pediatrics [3.02]

64. For children with elevated blood pressure, you have to:

A. Encourage healthy diet, sleep and physical work

B. Counsel on physical activity and diet management, if obese, must be
done.
C. Refer to the subspecialist for further investigation and management
B
D. Do nothing, observe

Preventine Pediatrics [3.02]

65. What is the recommended once daily dose (in ml) and duration of iron
supplementation for low birth weight infants, using drops with 15mg
elemental iron/0.6ml:

A. 0.6 for 6 months

B. 0.6 for 3 months
C. 0.3 for 6 months
D. 0.3 for 3 months
C

Preventine Pediatrics [3.02]

66. A positive STTU PPD is an induration of: B. Using 5 TU PPD or 2TU-RT23

- Reading at 48 - 72 hours
A. > 1 mm B - (+) Tuberculin Skin Test
B. > 5 mm if immunocompromised
C. Any of the choices are correct Not A. >10 mm

PED FINAL EXAM carepackage Page 14 of 27

 D. > 0.5 cm if asymptomatic Not D. >5mm if symptomatic, (+) exposure, (+) CXR

Preventine Pediatrics [3.02]

67. Stage 1 Hypertension for 1-13 years old is defined as having a blood
pressure of:

A. 120/<80 - 129/<80 mmHg

B. > 90th but < 95th percentile +12mmHg
C. > 140/90 mmHg
D. > 90th but < 95th percentile B

Not A. >13 years old Elevated Blood Pressure

Not C. >13 years old Stage 2 Hypertension
Not D. 1-13 years old Elevated Blood Pressure

Preventine Pediatrics [3.02]

68. The Philippine Society of Developmental and Behavioral Pediatrics

B. Developmental screening should be done at specific ages: 9
recommends that developmental screening be done every:
months, 18 months, 30 months, and every year thereafter.
A. Month B
Not D. Surveillance should be done regularly every well-child
B. 9, 18, 30 months and every year thereafter
visit
C. Quarter
Preventine Pediatrics [3.02]
D. Well child clinic visit

69. The dose, in IU, and frequency of vitamin A supplementation at 12 months

old is:

A. 200,000 single dose D

B. 100,000 single dose
C. 100,000 every 6 months
D. 200,000 every 6 months Preventine Pediatrics [3.02]

70. The objectives of the Essential Intrapartum and Newborn Care (EINC)
include/s:

A. All choices are correct

B. To deliver time-bound core intervention as the immediate period Options B, C, and D are all included in the objectives of EINC.
before the delivery of the newborn A
C. To provide appropriate and timely emergency newborn care to Preventine Pediatrics [3.02]
newborns in need of resuscitation
D. To provide evidence-based practices to ensure survival of the
newborn from birth up to 2 years of life

71. For children with Stage 2 Hypertension, you have to: B. For Stage 1 and Stage 2 Hypertension, hypertensive patients
must be referred to subspecialist for further investigation and
A. Encourage healthy diet, sleep, and physical work management
B. Refer to the subspecialist for further investigation and management
C. Counsel on physical management and diet management, if obese, Not A. Indicated for normotensive patients
B
must be done Not C. Indicated for patients with elevated BP
D. Start statins Not D. Not specifically identified as an intervention

Preventine Pediatrics [3.02]

72. What is the recommended preparation, once daily dose and duration of Table 12: Iron Supplementation
iron supplementation for a 3 year old? Targets Preparation Dose/duration
A. Drops: 15mg elemental iron / 0.6ml, 0.6mL for 3 months Low birth weight Drops: 15mg 0.3mL once a day
B. Syrup: 30mg elemental iron / 5mL, 5mL for 3 months elemental iron / to start at 2 mos
C. Drops: 15mg elemental iron / 0.6mL, 0.6mL for 6 months 0.6mL until 6 mos
D. Syrup: 30mg elemental iron / 5mL, 5mL for 6 months B
Infants 6-11 mos Drops: 15mg 0.6mL once a day
elemental iron/ for 3 mos
0.6mL

Children 1-5 years Syrup: 30mg 1 tsp a day for 3

old elemental iron / mos, or 30 mg once

PED FINAL EXAM carepackage Page 15 of 27

 5mL a week for 6 mos
with supervised
administration

Adolescent girls Tablet containing One tablet once a

(10-19 years old) 60mg elemental day
iron with 400mcg
folic acid (coated)
Preventive Pediatrics [3.02]

73. The Expanded Newborn Screening increased the screening panel of C. Expanded Newborn Screening (December 2014) includes 28
disorders from 6 to ___ disorders. disorders that can be screened. Some of the additional disorders
that can be detected include:
A. 26 - Hemoglobinopathies
B. 27 - Disorders of amino acid and organic acid metabolism
C. 28 C - Disorders of fatty acid oxidation
D. 29 - Disorders of carbohydrate metabolism
- Disorders of biotin metabolism
- Cystic fibrosis

Preventive Pediatrics [3.02]

74. According to the Newborn Screening Reference Center Memorandum

2014-15 Protocol on Collecting Blood Sample for newborn screening should C. According to NSRCC, newborn screening for hereditary /
be: metabolic diseases should be done immediately after 24 hours
from birth, regardless of gestational age and clinical status. If
A. Performed after 24 hrs of life, but not later than 3 days from birth C done before the first 24 hours, we can get a false positive of
B. Anytime before 3 months of life congenital hypothyroidism, and a false negative of congenital
C. Ideally done immediately after 24 hrs of birth adrenal hyperplasia (CAH).
D. Tested by 7 days of life
Preventive Pediatrics [3.02]

75. What is the correct order of the 4 time-bound interventions of EINC?

A. Immediate & thorough drying of the newborn; early skin to skin

contact between mother & newborn; non-separation of newborn &
mother for early breastfeeding; properly-timed cord clamping &
cutting
B. Early skin to skin contact between mother & newborn; immediate &
thorough drying of the newborn; non-separation of newborn &
mother for early breastfeeding; properly-timed cord clamping &
cutting
C
C. Immediate & thorough drying of the newborn; early skin to skin
contact between mother & newborn; properly-timed cord clamping &
cutting; non-separation of newborn & mother for early breastfeeding
D. Early skin to skin contact between mother & newborn; immediate &
thorough drying of the newborn; properly-timed cord clamping &
cutting; non-separation of newborn & mother for early breastfeeding

Community Pediatrics [3.01]

PED FINAL EXAM carepackage Page 16 of 27

76. What are the parameters to monitor in giving intravenous fluids?

A. Vital signs
B. Urine output
C. All of the above
D. Weight gain/loss

Fluids & Electrolytes [PED 3.03]

77. What laboratory test would help in determining the cause of metabolic
alkalosis?

A. Urine chloride
B. Urine potassium A
C. Arterial blood gas
D. Serum sodium Not C. This is generally used to evaluate acid base disorders

Acid-Base Balance [PED 3.04]

78. This condition indicates true hyponatremia:

B. Hyponatremia is when serum sodium level: <135meq/L. Most
A. Normal serum sodium with low serum osmolality related to brain swelling.
B. Low serum sodium with low serum osmolality
C. Low serum sodium with normal serum osmolality
D. Low serum sodium with high serum osmolality

Fluids & Electrolytes [PED 3.03]

79. What is the most abundant extracellular cation? PISO = Potassium In, Sodium Out

A. Potassium
B. Phosphorus
C. Sodium C
D. Magnesium

Fluids & Electrolytes [PED 3.03]

PED FINAL EXAM carepackage Page 17 of 27

80. Which factor increases water loss?

A. Incubator
B. Oliguria
C. Humidified Ventilator
D. Radiant warmer D

Fluids & Electrolytes [PED 3.03]

81. Which of the following is TRUE about total body water?

D is the correct answer; recall
A. The fetus has the lowest percentage of total body water
B. In females, the total body water increases post puberty due to Upon birth: ↓ ECF: ↑ICF due to postnatal diuresis, extracellular
increased fat content fluid decreases and intracellular fluid increases (continual
C. By 3 years old, the ratio of ICF and ECF volume approaches the adult expansion). The continuous increase in the ICF volume is due to
level the rapid cellular growth in neonates and infants
D
D. Postnatally, the continuous increase in ICF is due to cellular growth
Not A, the fetus has the highest percentage of TBW
Not B, the TBW of females decreases post puberty due to
increasing fat content
Not C, by one year old, ECF:ICF volume approaches adult levels

Fluids & Electrolytes [PED 3.03]

82. Which are chronic manifestations of hypophosphatemia?

A. Cardiac and neurologic symptoms

B. Rickets and proximal muscle weakness
C. Systemic calcifications
D. Hemolysis and rhabdomyolysis

Fluids & Electrolytes [PED 3.03]

83. Which of the following intravenous fluids is a balanced IV solution? B. Recall

A. Albumin
B. Lactated Ringer’s Solution
C. Half normal saline
D. Normal Saline Solution
B

Fluids & Electrolytes [PED 3.03]

84. This is a necessary cofactor for enzymes, membrane stability and nerve
conduction?

A. Phosphorus C C. Recall
B. Sodium
C. Magnesium
D. Potassium

PED FINAL EXAM carepackage Page 18 of 27

 Not A. Phosphorus
Form and function:
● ATP: critical for cellular energy metabolism, cell
signaling and nucleic acid synthesis
● Phospholipid: component of cell membranes and
other structures
● Calcium phosphate: necessary for skeletal
mineralization
Not B. Sodium
● Principal determinant of extracellular osmolality
● Maintenance of intravascular volume
Not D. Potassium
● Necessary for maintaining cell volume
● Necessary for the electrical responsiveness of nerve
and muscle cells and for the contractility of cardiac,
skeletal, and smooth muscle

Fluids & Electrolytes [PED 3.03]

C. Recall
85. A 4 year old male came in with signs of moderate dehydration.
You will use ____ cc/kg to compute for his fluid deficit

A. 50
B. 30
C. 60
D. 100 C
Fluids & Electrolytes [PED 3.03]

86. What complication happens when sodium is rapidly decreased in the D. Recall
treatment of chronic hypernatremia?

A. Sodium shifts water into the interstitial space

B. Sodium shifts water into the extracellular space
C. Water moves from brain cells to the extracellular fluid
D. Water moves into the brain cells causing cerebral edema

Fluids & Electrolytes [PED 3.03]

PED FINAL EXAM carepackage Page 19 of 27

87. What is the preferred intravenous fluid in patients with metabolic Isotonic saline is recommended to reverse the alkalosis when
alkalosis? ECFV contraction is present. [Harrison’s]

A. LRS Metabolic Alkalosis[Amboss]

B. NSS ● Volume depletion: isotonic saline to increase urinary
C. Albumin bicarbonate excretion and correct extracellular
D. Half normal saline volume loss
● Bicarbonate excess: acetazolamide
● Electrolyte disturbances: correction

Table 69.8 Nelson’s

Replacement Fluid for Emesis* or Nasogastric losses

Average Composition of Gastric Fluid

Sodium: 60 mEq/L
Potassium: 10 mEq/L
Chloride: 90mEq/L

Approach to Replacement of Ongoing losses

Solution: normal saline + 10 mEq/L KCl
Replace output ml/ml every 1-6 hours
*Note that emesis a common cause of metabolic alkalosis in
children
B
More info on treatment according to lecture:

Not A. Using Lactated Ringer in patients with metabolic

alkalosis is not recommended because the lactic content would
worsen the alkalosis. However, LR is preferable to NS in shock
(volume depletion) because it is a balanced solution.

Fluids & Electrolytes [PED 3.03]

Acid-Base Balance [PED 3.04]

88. What is the normal anion gap?

B. The computation of anion gap: AG = Na+ - (Cl- + HCO3)
A. 0-4 divides the patient into two diagnostic groups narrowing down
B.
C.
D.
4-11
12-21
More than 21
B
○ Those with Normal anion gap: AG = 4-11 📌
the considerations. The following are the two diagnostic groups:

Acid-Base Balance [PED 3.04]

PED FINAL EXAM carepackage Page 20 of 27

89. An 8 month old infant came in due to vomiting and diarrhea. On P.E., the A. Recall
patient was lethargic, tachycardic, BP= 80/50, eyes are very sunken, with
patched mucous membrane. Extremities are cold and mottled with poor
peripheral pulses and capillary refill time >3 secs. What is the degree of
dehydration?

A. Severe
B. Moderate
C. No signs
D. Mild

Fluids & Electrolytes [PED 3.03]

90. Which of the following increases serum potassium?

A. Hyperosmolarity
B. Alkalosis
C. Beta-adrenergic agonist
D. Insulin

Not B. Alkalosis decrease serum K+

Not C. Beta-adrenergic agonists decrease serum K+
Not D. Insulin decrease serum K+

Fluids & Electrolytes [PED 3.03]

91. What ECG change is associated with hyperkalemia? Recall. ECG changes

A. Peaking of T waves A. Hyperkalemia

B. Torsades de pointes ● Peaking of T waves (first to appear)
C. Normal QRS interval ● ST segment depression
D. Appearance of U wave ● Increased PR interval
● Flattening of P wave
A ● Widening of QRS complex

Not B. Hypokalemia
● Flattening T waves (first to be seen)
● ST segment depression
● Appearance of U wave
● Ventricular fibrillation and torsades de pointes - only
in the context of underlying heart disease

PED FINAL EXAM carepackage Page 21 of 27

 Not D. Hypokalemia
● Flattening T waves(first to be seen)
● ST segment depression
● Appearance of U wave

Fluid & Electrolytes [PED 3.03]

92. What is the most devastating complication of untreated hypernatremia? B. Brain Hemorrhage is the most devastating consequence of an
untreated hypernatremia
A. Central Pontine Myelinolysis
B. Brain hemorrhage
C. Profound dehydration
D. Thrombotic complications

Not A. Treatment for HYPOnatremia is <12 meq/L/day or <18

meq/L/48 hours of correction to prevent Central Pontine
Myelinolysis (CPM)

Fluid & Electrolytes [PED 3.03]

93. Decreased intravascular volume stimulates? D. “When there is reduced ineffective intravascular volume,
RAAS regulates renal sodium excretion”
A. Atrial Natriuretic Peptide
B. Antidiuretic Hormone Not A. Synthesis of ANP is stimulated by volume expansion
C. Thirst inhibiting sodium absorption and facilitating excretion
D
D. Renin-Angiotensin System Not B. Secretion of ADH is stimulated by increase in osmolality
Not C. Thirst is stimulated when serum osmolality increases
together with volume depletion

Fluid & Electrolytes [PED 3.03]

94. What is the body’s response to increased osmolality?

D. Secretion of ADH is stimulated by increase in osmolality
A. Renin angiotensin system is stimulated
D Not A, B and C. Refer to rationale of #93
B. Secretion of atrial natriuretic peptide is stimulated
C. Thirst mechanism is stimulated
Fluid & Electrolytes [PED 3.03]
D. Secretion of antidiuretic hormone

95. What is the priority in the treatment of hyperkalemia? A. This is done to prevent life threatening arrhythmias, given
over a few minutes and its action is immediate
A. Stabilize the cardiac muscle using calcium gluconate
B. Infusion of sodium bicarbonate to correct concomitant acidosis A Not A,B and C. These are ways of reducing potassium but are
C. Give salbutamol nebulization to shift potassium intracellularly not the priority in stabilizing hyperkalemia.
D. Discontinue all sources of potassium
Fluid & Electrolytes [PED 3.03]

96. A child was noticed to have upward and slanted palpebral fissure and a B. The case presents the clinical features of Trisomy 21 which is
protruding large wrinkled tongue. She also has mild mental and growth caused by multiple non-disjunction. 1% of Trisomy 21 is mosaic
retardation. History revealed hypotonia at birth. This syndrome is mostly due while 4% is due to Robertsonian Translocation.
to
Not A. This applies to Non-Mendelian Inheritance particularly
A. DNA instability Triple Repeat Expansion Disorders such as Fragile X syndrome,
B. Multiple non-disjunction Myotonic dystrophy, Huntington disease, Spinocerebellar
B
C. Epigenetic modification ataxias.
D. Gene silencing
Not C. This applies to Non-Mendelian Inheritance particularly
Genomic Imprinting. Epigenetic Modification happens when
genetic change does not change the DNA nucleotide sequence.

PED FINAL EXAM carepackage Page 22 of 27

 Examples are:
● Microdeletion on chromosome 15q11-13
○ Prader-Willi syndrome - paternally derived
○ Angelman syndrome - maternal copy

Not D. Gene Silencing occurs when only 1 copy of gene is

transcribed while the other copy is silenced. This also applies to
Non-Mendelian Inheritance particularly Genomic Imprinting.

[3.05 Genetic Pediatrics]

97. On PE, a newborn was apparently healthy looking except for webbing of A. The observed clinical features are due to Turner Syndrome
the neck and swelling due to fluid accumulation over the dorsum of both 45X which is diagnosed by karyotyping. The laboratory
hands and feet. Which of the following procedures will help you diagnose this procedure is used for Trisomy cases.
newborn?
Not B. Turner syndrome is not detected through Newborn
A. Karyotyping Screening.
B. Newborn screening ● This procedure detect genetic and metabolic
C. DNA sequencing disorders in newborns that may lead to mental
D. Linkage analysis retardation and even death if left untreated
A
● Performed after 24 hours of life but not later than 3
days from complete delivery of the newborn

Not C. DNA Sequencing is usually performed in biopsies

Not D. Linkage analysis is used to determine the location of the

chromosomal disease

[3.05 Genetic Pediatrics]

98. A 6 month old infant was noted to be fussy and restless than normal. He B. Musty odor of urine, fussiness, restlessness, and seizures are
was also noted to have several episodes of vomiting and seizures. On PE you all manifestations of Classic Phenylketonuria (PKU). PKU is
noted the skin to be fair but dry and you smelled musty odor of his breath and caused by a deficiency in phenylalanine hydroxylase, the
urine. What would be the most appropriate therapy for this infant? enzyme that converts phenylalanine to tyrosine. Therefore there
is a buildup in phenylalanine that can damage the nervous
A. Pharmacologic treatment B system and cause learning disabilities, behavioral difficulties,
B. Dietary manipulation and epilepsy. Treatment is through dietary modification (low
C. Co-enzyme supplementation protein diet, Phe-free formula, avoidance of aspartame,
D. Replacement therapy breastfeeding, limited amino acid consumption, BH4
supplementation, etc)
[3.05 Genetic Pediatrics]

99. Hemoglobin S is a result of this type of mutation:

A. Missense
B. Nonsense
C. Silent A. Hemoglobin S is the type of hemoglobin in Sickle Cell Disease.
D. Frameshift A mutation causes GAG to become GTG, thereby replacing
glutamic acid with valine at the 6th position of the beta chain of
hemoglobin, producing Hemoglobin S. A missense mutation is
the substitution of an amino acid for another that affects
protein function or stability. This is what is seen in Sickle Cell
disease.

Not B. Nonsense mutations are substitutions that cause the

creation of a stop codon in the place of the original amino acid
A
codon. This would lead to a loss of function.

Not C. Silent/synonymous/wobbe mutations are substitutions

that do not affect the amino acid formed (as there are several
triplet codons that result in the same amino acid).

Not D. Frameshift mutations are the effect of deletions and

insertions in the coding sequence that alter the grouping of the
bases into triplets.
[3.05 Genetic Pediatrics]

PED FINAL EXAM carepackage Page 23 of 27

100. Which of the following is an example of replacement therapy in the D. Replacement therapy is defined as replacement of a missing
management and treatment of genetic disorders? metabolite, enzyme, organ or specific gene.

A. Gene therapy
B. Phototherapy
C. Dietary modification
D. Co-enzyme supplementation

Not A. Not classified under replacement therapies; use genes to

treat or prevent disease
Not B. effective for newborn jaundice
Not C. Phenylketonuria (PKU) is managed through dietary
modifications.
[3.05 Genetic Pediatrics]

101. The phenotypes associated with single gene disorders can vary from one B. Commonly seen in autosomal dominant disorders, variable
patient to another based on the severity of the change affecting the gene and expressivity causes phenotypes to be expressed in varying
additional modifications caused by genetic, environmental, and or stochastic degrees among family members or to have different
factors. This is termed as: manifestations in each generation

A. Founder effect Not A. Founder effect is the reduction in genetic variation that
B. Variable expressivity results when a small group from a population migrates and
C. Mosaicism settles in a new population. This may impact the population
D. Reduced penetrance causing more of a gene or less of a gene.
B
Not C. In Mosaicism, only a portion of cells making up a person’s
body are affected by the gene/chromosomal defect or genetic
disorder.

Not D. Reduced penetrance is where not all individuals have

phenotypic manifestations. This can appear as a skipped
generation in pedigree.
[3.05 Genetic Pediatrics; NIH ]

102. A 16 year old adolescent female was noted to have delayed growth and B. Sickle cell disease is described as Missense (Under
puberty. Her past history also showed several admissions due to unexplained Substitution) where glutamic acid is replaced by valine at the
pain and acute chest syndrome. Her condition is caused by a mutation due to: 6th position of the beta chain of hemoglobin. Signs and
symptoms include acute chest pain due to vaso-occlusive
A. Deletions properties, in addition to growth retardation, delayed sexual
B. Substitutions B maturation and being underweight.
C. Frameshift mutations
D. Insertions Not A, B and C
Missense is under Substitutions and not the other Genetic
Variations.
[3.05 Genetic Pediatrics]

103. Which of the following is NOT a characteristic of autosomal recessive D. D is a characteristic of an autosomal dominant inheritance
inheritance? Other characteristics
● Pattern is determined by presence of 1 abnormal gene on
A. Recurrence risk of 25% for carrier proteins who have had a previous any autosome (chromosome 1-22)
affected child ● Vertical transmission: Appears in multiple generations;
B. Males are equally affected as females
Parent to child
C. Observation of multiple affected members of a kindred in the same
generation, but none in other generations ● Any child of an affected parent has a 50% risk of inheriting
D. An affected individual has a 50% chance of passing deleterious gene D the disorder in each pregnancy (recurrence risk)
in each pregnancy ● Unaffected individuals do not pass the disorder to their
children
● No sexual predilection (males and females are equally
affected)
● Disorders (My HONey is dominant)
- Marfan Syndrome, Familial Hypercholesterolemia,
Osteogenesis imperfecta, Neurofibromatosis Type 1

PED FINAL EXAM carepackage Page 24 of 27

 Not A, B, C. All are characteristics of autosomal recessive
inheritance.

Other Characteristics:
● Mutations in both copies of a gene are required to
manifest the disease (Both parents are carriers)
● Horizontal transmission
● Increased probability of consanguinity (related parents);
First cousins (6-8%)
● Disorders (MarS, Patay Gutom CAH Lagi pag recess)
- Maple Syrup Urine Disease, Phenylketonuria,
Galactosemia, Congenital Adrenal Hyperplasia

[3.05 Genetic Pediatrics]

104. Possible reasons why many patients with an autosomal dominant

Genetic or Genomic imprinting is under Non-Mendelian
disorder have no history of an affected family member include the following
Inheritance
EXCEPT:
A Not B,C,D. Because these are possible reasons why autosomal
A. Genetic imprinting
dominant conditions present with no family history.
B. Variable expression
C. De novo mutation
[3.05 Genetic Pediatrics]
D. Incomplete penetrance

105. Linking of aminoacids to form proteins occurs in the A. After transcription in the nucleus, the mRNA gets translated
into proteins in the ribosome. The sequence of codons is read
A. Ribosomes and tRNA brings amino acids complementary to the sequence.
B. Nucleus Peptide bonds are formed between the amino acids, and
C. Cell wall proteins are eventually formed.
E. Golgi apparatus
Not B. Transcription takes place in the nucleus. DNA is used as a
A template to make mRNA.

Not C. The cell wall exists in plant cells

Not D. Post-translational modification occurs in the Golgi

apparatus.

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106. Ms. Reyes did not know that she married a distant cousin on her father’s D. Autosomal recessive disorders are more probable to occur
side. Of the following genetic disorders, which would be the most common with consanguinity (related parents), as in this case. Examples of
disease that her son would have if both of them carry the same defective autosomal recessive disorders are MSUD, PKU, Galactosemia,
gene? CAH, and lysosomal storage diseases.
D
A. Neurofibromatosis type 1 Not A. NF Type 1 is autosomal dominant.
B. Achondroplastic dwarfism Not B. Achondroplastic dwarfism is autosomal dominant.
C. Retinitis pigmentosa Not C. Retinitis pigmentosa is usually autosomal dominant.
D. Galactosemia
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107. Retinal detachment and subluxation of the lens are common among A. Aortic root aneurysm and ocular abnormalities (ectopia
patients with what condition? lentis, subluxation of lens, retinal detachment, cataracts) are
pathognomonic for Marfan Syndrome. Marfan Syndrome is
A. Marfan’s syndrome caused by a mutation in the fibrillin-1 gene of chromosome 15.
B. Turner’s syndrome
C. Crouzori’s syndrome Not B. Turner’s Syndrome (45XO) is a type of monosomy
D. Osteogenesis imperfecta wherein female patients usually present with short stature,
amenorrhea, webbed neck, lack of secondary sex
characteristics, congenital heart defects, lymphedema of hands
A
and feet, and widely spaced nipples.
Not C. Crouzon’s syndrome is a form of craniosynostosis, a
condition in which there is premature fusion of the fibrous joints
(sutures) between certain bones of the skull
Not D. Osteogenesis imperfecta (aka brittle bone disease) is an
autosomal dominant disease caused by a lack of Type 1
collagen. Patients present with blue sclerae, hearing loss, short
stature, and recurrent fractures.
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108. Cri-du-chat syndrome is a result of a deletion in: C. Recall. Cri-du-chat syndrome is a result of a deletion in the
short arm of chromosome 5
A. Short arm of chromosome 4
B. Long arm of chromosome 5 Not A. This causes Wolf-Hirschhorn syndrome
C. Short arm of chromosome 5 Not B. This causes 5q minus (5q-) syndrome
D. Long arm of chromosome 4 C Not D. Partial deletion of the long arm of chromosome 4 at q31
results in a clinical syndrome of mental retardation,
characteristic ears, facial bone hypoplasia, cleft palate very
prone to scarring on repair, and specific hand abnormalities.

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109. A prominent occiput, micrognathia, low set ears, short sternum, narrow A. Recall. Clinical manifestations of Edwards Syndrome (Trisomy
pelvis, prominent calcaneus, and flexion abnormalities of the fingers are 18) are rocker-bottom feet, flexed big toes with prominent heels,
features seen in Trisomy.. clenched hand with overlapping fingers, short for gestational
age (SGA), and characteristic facial features such as short
A. 18 palpebral fissures, short nose, low-set and small ears with
B. 21 dysplastic helices and micrognathia
C. 8
D. 13 Not B. Clinical features of Down Syndrome (Trisomy 21) are
facial and dysmorphic features such as upslanting of palpebral
fissures, flat nasal bridge, small ears with folded superior helices,
brushfield spots, flat facial profile, flattened occiput, and short
A neck with abundant skin folds in the nuchal area; simian crease;
and other associated signs and symptoms

Not C. Clinical Manifestations of mosaic trisomy are facial

dysmorphism, mild intellectual deficit and joint, urinary, cardiac
and skeletal anomalies.

Not D. Clinical manifestations of Patau Syndrome (Trisomy 13)

are holoprosencephaly, hypotelorism, cleft lip/palate, cardiac
defects, omphalocele, polydactyly, and cutis aplasia

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110. Atrioventricular septal defects are the most common congenital heart C. AVSDs are most common in infants with Down Syndrome or
defects seen in patient with this Trisomy: Trisomy 21.

A. 18 Not A. Trisomy 18 (Edwards Syndrome) presents with rocker

B. 8 bottom feet (pathognomonic), short palpebral fissures and nose,
C. 21 low set small ears, and micrognathia.
D. 13
Not B. Trisomy 8 is characterized by facial dysmorphism, mild
C
intellectual deficit and joint, urinary, cardiac and skeletal
anomalies.

Not D. Trisomy 13 (Patau Syndrome) presents with cleft

lip/palate, polydactyly, hypotelorism, holoprosencephaly,
omphalocele, and cardiac defects.

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111. The observation of multiple affected members of a kindred in the same

generation, but no affected family members in other generations is called: A. Recall. Horizontal transmission is the observation of multiple
affected members of a kindred in the same generation, but
A. Horizontal transmission no affected family members in other generations
B. Germline mosaicism
C. Multifactorial inheritance Not B. Germline mosaicism, also called gonadal mosaicism, is a
D. Vertical transmission type of genetic mosaicism where more than one set of genetic
information is found specifically within the gamete cells
A
Not C. Multifactorial inheritance is when traits are caused by
combination of inherited, environmental and stochastic factors

Not D. Appears in multiple generations

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112. Skipped generations in a pedigree can be seen in: D. Recall. Autosomal Dominant can appear as skipped
generation in pedigree; disorders under are: Familial
A. Focal dermal hypoplasia Hypercholesterolemia, Marfan Syndrome, Ehlers-Danlos
B. Huntington Disease Syndrome, Neurofibromatosis Type 1 or Von Recklinghausen
C. Duchenne Muscular Dystrophy Disease, Osteogenesis Imperfecta and Achondroplasia.
D. Ehlers-Danlos Syndrome
Not A. X-linked Dominant Inheritance
● Others included in this category:
Vitamin D resistant rickets,
Rett syndrome, and
Incontinentia pigmenti
D Not B. Non-mendelian inheritance: Triplet repeat expansion
disorders
● Others included in this category:
Fragile X syndrome,
Myotonic dystrophy,
Spinocerebellar ataxia
Not C. X-linked Recessive Inheritance
● Others included in this category:
Hemophilia A and B,
G6PD Deficiency

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113. In pedigree line definitions, what do double lines in a relationship line C. Recall. Double line in pedigree chart indicates consanguinity
indicate?
Not A. Marriage/Mating Line: horizontal line connecting 2
A. Multiple relationships symbols at the center of each symbol
B. Extramarital mating
C. Consanguinity Not B. Extramarital mating: represented by broken line between
D. Divorce or separation C 2 symbols at the center of each symbol

Not C. Separated, Divorce, Relationship no longer exists Line:

horizontal line connecting 2 symbols with 2 diagonal hash
marks.

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114. This syndrome characterized by microcephaly, large tongue and umbilical C. Microcephaly, Macroglossia, and Umbilical Hernia are the
hernia is governed by what type of inheritance: triad for Beckwith- Wiedmann syndrome. This syndrome is
under Non-Mendelian inheritance particularly Uniparental
A. Triplet repeat expansion Disomy, where both copies of a chromosome pair come from the
B. Mitochondrial disorders same parent.
C. Uniparental disomy
D. Genomic imprinting Not A. Triplet repeat expansion disorders, also under Non
mendelian inheritance, are described as having unstable DNA
and genetic anticipation. Examples under this are: Fragile X
syndrome, Myotonic dystrophy, Huntington disease and
C spinocerebellar ataxias

Not B. Mitochondrial disorders, also under Non mendelian

inheritance, are defects in oxidative phosphorylation. Example
under this is Kearns- Sayre syndrome

Not D. Genomic imprinting , also under Non mendelian

inheritance, is an example of gene silencing; examples are
Prader-Willi syndrome and Angelman syndrome

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115. The most common symptoms of galactosemia in children is: D. Recall. Jaundice is the most common symptom of
galactosemia. Physiologic jaundice is >24 hrs after birth while
A. Vomiting pathologic jaundice is within 24 hrs after birth.
B. Hepatomegaly
D
C. Hypoglycemia Not A,B or C. Also one of the clinical feature of galactosemia but
D. Jaundice not the most common

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