PEDIATRICS SHIFTING EXAM

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COVERAGE: PEDIA- NEUROLOGY Faculty: Doc Remedio

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1. Which among the following questions is not a. “What time of day is it, morning or night?” -
approximately paired with its corresponding orientation
component of the MSE being tested? b. “Spell WORLD then spell it backwards” - speech
c. “Raise your left hand and touch your right ear” -
following complex tasks
d. “Why do you think you are here at the hospital” -
insight and judgment

2. Which among the following is correct a. A 6-month -old patient can play peek-a-boo
regarding the domains of b. Gross motor development is cephalocaudal in
neurodevelopment? progression
c. A 2- year old patient can pretend to play, such as
drinking from a cup but is unable to roleplay yet
with other children. She is not developmental
delayed
d. Ability to transfer objects between different hands
is achieved at 3 months

3. An 18-month-old female patient cae into the a. 7 months

OPD. Upon examination, she can sit with b. 8 months
support and is only able to say Mama and c. 9 months
Papa. She reaches for bright objects and is d. 10 months
able to play peek-a-boo.What is her
developmental age?

4. Which among the following seizure a. Breath Holding Spells

mimickers should not be considered beyond b. Restless Leg Syndrome
infancy? c. Sleep Myoclonus
d. Malingering

(5-6) a 5 year old patient is rushed to the ER with an ongoing tonic-clonic movement of all
extremities. First aid was given to the patient, with noted seizure lysis. Upon interviewing the
mother claims that the patient has been having the “seizure” for 30 mins.

5. Which among the following cannot be used a. Seizures long enough to finish a whole song
to verify the duration of the seizure? lasts approximately 3-5 mins
b. Seizures long enough to finish a commercial last
approximately 30 seconds
c. If the seizure started at home and continued until
arrival at the ER, ask the parent how long said
travel time normally occurs
d. Seizures long enough to finish a whole song

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lasts approximately 15 mins

6. Upon assessment, the previously a. Did the GTC last more than 15 mins?
mentioned generalized tonic-clonic b. Did the patient’s level of sensorium return to
movement was confirmed to be a seizure. baseline in between episodes of seizures?
As per ILAE 2015, which among the c. Did the patient lose consciousness postictally?
following should be considered when trying d. Did the patient have other seizure semiologist?
to rule in or rule out a status epilepticus?

7. A patient comes in at the ER in an active a. When was the patient diagnosed with Epilepsy
seizure. He is a known case of Epilepsy. and what was the trigger?
The following are useful when interviewing b. What are the medications being given and when
the mother except? was the last dose given?
c. When were the medications last adjusted?
d. None of the above

8. Which of the following are pertinent when a. HPI, neonatal, perinatal, past medical history,
assessing a patient with seizure? head circumference, presence of malformations
or deformations, size and fullness of fontanelles,
neurologic PE
b. HPI, neonatal, perinatal, developmental
milestones, past medical history, head
circumference, presence of malformations or
deformations, size and fullness of fontanels,
neurologic PE
c. HPI, ROS, neonatal, perinatal, HEAADSS, past
medical history, presence of malformations or
deformations, size and fullness of fontanels,
neurologic PE
d. HPI, ROS, neonatal, perinatal, developmental,
personal social, HEADDSS, past medical history,
head circumference, presence of malformations
or deformations, size and fullness of fontanels,
neurologic PE

9. When trying to determine the presence of a. Ask the patient to identify 3 objects at the start of
good recent memory, which among the the examination and asking the patient to name
following is the appropriate question to ask? all 3 objects at the end.
b. Asking the patient his/her birthday
c. Asking the patient to identify his mother among
the people standing at his bedside
d. Asking the patient what he ate for dinner

10. Which among the following abnormal PE a. Frontal lobe - acalculia, Wernicke’s aphasia
findings is correctly paired with its involved b. Parietal lobe - astereognosis, right-left
cerebral lobe? disorientation
c. Temporal lobe - unable to hear spoken voice,
Broca’s aphasia

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d. Occipital lobe - bilateral temporal hemianopsia,

visual acuity 20/200 OU

11. A patient comes in at the ER for facial a. Central Facial Palsy, Right - frontal lobe
asymmetry. When examining her, you noted involvement
the following: patient can raise her eyebrow b. Central Facial Palsy, Left - frontal lobe
on the left side only; no ptosis noted; patient
involvement
is unable to close her eyelids against
resistance on the right. There is also noted c. Peripheral Facial Palsy, Right - cranial nerve VII
flattening of the right nasolabial fold and she involvement
is unable to fully puff the right side of her d. Peripheral Facial Palsy, Left - cranial nerve VII
cheek. Which among the following explains involvement
fully your physical examination findings?

12. A 15- year old patient comes in at the ER, a a. 13

victim of a motor vehicular accident. Upon b. 12
examination, the patient is drowsy, opening c. 11
his eyes when his name is called. He is d. 10
confused but answers appropriately. When
asked, he does not raise his hand but
localizes to pain. What is his GCS score?

13. Which among the following is the a. Conduct it in order:

appropriate way to conduct a PE on an b. Conduct it in order:
infant? c. Observe the child how he/she interacts with
mother first prior to any maneuvers that require
manipulation
d. Observe the child how he/she interacts with
mother, then get anthropometric measurements,
then check cranial nerves in order, then check for
motor strength and the way the patient
ambulates

(14-15) a 14-year old male patient comes in with acute onset weakness, progressing from inability to
walk to inability to hold a glass of water. Upon physical examination, you note the following: patient
is noted lying down on the bed, muscle strength 0/5 on all muscle groups of the lower extremities,
and ⅖ on the upper extremities. Biceps, triceps, ankle and patellar reflex +. Babinski reflex
negative, bilaterally.

14. Which among the following best describes a. Asymmetric ascending paralysis - lower motor
your physical examination findings? neuron lesion involvement
b. Asymmetric ascending paralysis - upper motor
neuron lesion involvement
c. Symmetric ascending paralysis - lower motor
neuron lesion involvement
d. Symmetric ascending paralysis - upper motor
neuron lesion involvement

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15. What is the physical examination finding of a. Patient can raise his arms against resistance
the patient when he was noted to have a b. Patient’s muscle twitches
muscle strength of ⅖? c. Patient can move his arms but is unable to
elevate them
d. Patient can raise arms against gravity.

16. A 15 month old patient comes in for a a. Patient is able walk with wide based gait with
well-baby check-up. Which physical arms outstretched
examination finding should prompt the b. Patient reaches out for and holds toys with her
resident-in-charge to do further neurologic right hand
PE? c. Patient turns when her name is called
d. Patient is seen sitting in the playpen and was
stacking 3 blocks on top of each other

(17-18) A 10 year old patient comes in at the ER in active seizure. Upon examination, Bacterial
meningitis is considered and the resident on duty decides to check for presence of meningeal
irritation

17. Which among the following is the correct a. Kernig sign: involuntary flexion of the knees and
maneuver to assess for the presence of hips after passive flexion of the neck while supine
nuchal rigidity? b. Kernig sign: extension of the hip, with
subsequent pain with 90-degree flexion of the leg
c. Brudzinski sign: involuntary flexion of the knees
and hips after passive flexion of the neck while
supine
d. Brudzinski sign: flexion of the hip 90 degrees with
subsequent pain with extension of the leg

18. What is the physiology behind nuchal a. This is caused by spasms of the neck muscles
rigidity? due to recurrent episodes of seizures
b. This is caused by stretching of the already
inflamed meninges when the maneuvers are
conducted
c. This is caused by compression of spinal nerves
when the maneuvers are conducted
d. This is caused by compression of the already
inflamed meninges when the maneuvers are
conducted.

(19-20) a term newborn infant was delivered via NSD, with good cry and activity. Anthropometric
measurements were as follows: BW 3500g, BL 50cm, HC 35cm, CC 33cm. Patient’s clinically
course was unremarkable and the patient was discharged after 2 days. Upon follow-up at the OPD
after 1 year, mother verbalized that she is worried because the head of her baby looks big.
Anthropometric measurements were taken by the RIC and were said to be normal.

19. What should be the measured head a. 47 to 48

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circumference in cm during said b. 48 to 49

examination? c. 49 to 50
d. 50 to 51

20. Which among the following does not a. Having a HC of less than 25th percentile for age
correctly describe the presence of b. Having a HC of less than 2 SD below the mean
microcephaly? for age
c. Having a HC of less than 5th percentile for age
d. Having a HC of less than 3 SD below the mean
for age

(21-22) A patient at the PICU is referred for assessment regarding brain death. He is intubated and has
a GCS of 2T (E1VTM1). The following findings were noted upon examination: pupils were fixed,
dilated, there was no blinking when a cotton wisp was touched on the patient’s limbus. No gag was
noted upon manipulation. When the head was turned to sides, the eyes were noted to be left
behind. When pain was applied on the patient’s toes, there was dorsiflexion of the foot and flexion
of the hip and thigh.

21. Which among the following best describes a. Corneal reflex was positive indicating problems in
the physical examination done? cranial nerve 5 and 7
b. Doll’s eye was positive indicating intact brain
stem only
c. Withdrawal from pain was noted precluding brain
death
d. Pupils were fixed dilated indicating impaired
cranial nerve 2

22. What is the physical examination of the a. Patient is intubated, opens eyes and moves
patient to be able to fulfill a GCS 2T affected limb in response to pain
(E1VTM1) ? b. Patient is intubated, opens eyes and withdraws
from pain stimulus
c. Patient is intubated, does not open eyes nor
moves despite the pain stimulus.
d. Patient is intubated, opens eyes spontaneously
and moves the affected limb in response to pain.

23. A 3 month old patient was referred to a. Head lags behind his body when patient is pulled
VSMMC for further neurologic assessment. to sitting from lying supine
Assessment at the primary institution was a b. Head lags behind his body when the patient is
floppy baby. Which among the following pulled to sitting from lying supine. Body remains
supports the presence of this condition? suspended with the lower extremities in partial
flexion when the patient is held at the armpits.
c. Head lags behind his body when the patient is
pulled to sitting from lying supine. Body remains
suspended with partial flexion when patient is
horizontally suspended
d. Head lags behind his body when the patient is
pulled to sitting from lying supine. Extremities
extend and the body forms an inverted U during
horizontal suspension.

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24. Which among the following physical a. Negative corneal reflex - cranial nerve 5
examination findings is correctly partnered b. Able to fixate and follow bright objects - cranial
with the cranial nerve being tested? nerve 2,3,4,6
c. Gag reflex intact - cranial nerve 10
d. Turns head to sound - cranial nerve 9
e. Turns head against resistance - cranial nerve 12

25. Which among the following is a positive a. Present bilateral extensor toe reflex in a 1-year
physical examination finding? old female
b. A 10-month old male patient who is able to sit
with support
c. A 12 month old female patient who calls out to
her mother saying “mama”
d. A newborn with a head circumference of 35 cm

26. A 12 month old infant is rushed into the ER a. Patient should be admitted. Work-ups include
for tonic-clonic movement of all her CBC, serum electrolytes, lumbar puncture, MRI
extremities. First aid was given for said and EEG. if all are unremarkable and patient has
episode of seizure and the patient was no seizure recurrence, he can be discharged
examined once out of the postictal state. after being seizure-free for 24 hours
She was febrile at 39C and was otherwise b. Patient should be admitted for work-up and
unremarkable. After interviewing her monitoring. Since the patient is still 12 months
mother, the ER doctor was able to elicit that old, a lumbar puncture should be done despite
this was her 1st seizure episode but the the strong family history of Febrile seizures. If
mother was not worried since they have a laboratory results are normal and there are no
strong family history of Febrile seizures. seizure recurrence. The patient can be
Developmental milestones are at par with discharged after being seizure free for 24 hours.
age. Which is the best course of action for c. Since the patient has a strong family history of
the patient? Febrile Seizures, the patient should be admitted
for seizure recurrence monitoring. No work up is
needed. If there are no seizure recurrence,
patient can be discharged after 24 hours
d. Since the patient has a strong family history of
Febrile seizure, there is no need to admit the
patient. Patient is sent home after parents are
educated on what to do if there is a seizure
recurrence.

27. Which test examples are the first aid to be a. Call for help. Put the patient in a side lying
given to a patient undergoing seizures? position. Hold down the patient to prevent
him/her from acquiring injuries. While waiting for
help to arrive take a video of the seizure episode
and take note of the duration. Continue to do so
until the seizure abates and the help arrives.
b. Put the patient on a side lying position. Do not
restrict the patient, instead apply a pillow or other
forms of cushion around the patient. Call for help
await until seizure abates.
c. Put the patient on side lying position. Do not
restrict the patient, instead apply a pillow or other

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forms of cushion around the patient. Call for help

and record the duration of the seizure episode
while the mother waits for the seizure to lie down
d. Put the patient on side lying position. Do not
restrict the patient, instead apply a pillow or other
forms of cushion around the patient. Call for help
while waiting for help to arrive, take a video of the
seizure episode and take note of the duration.
Continue to do so until the seizure abates and for
help arrives

28. Seizure semiology noted in infants are a. Use a penlight to determine the pupillary light
unlike the general population. They can reaction.
stimulate normal movement. Examples of b. Shake the patient to see if the patient stops said
which are lip smacking and bicycling movement.
movements. How does one best determine c. Press against or hold the moving part of the body
whether these are true seizures? and check if there is continued movement.
d. Pinch the patient to see if the patient cries.

29. A 5-year-old child comes into the ER for 2 a. Complex febrile seizures
episodes of seizures, occurring 4 hours b. Seizures starting within 1 hour from fever onset
apart, with the patient fully awake in c. Family history of epilepsy
between episodes. Associated symptoms d. Neurodevelopmental abnormalities
include fever of 39C starting a few minutes
before seizure onset. On examination, the
patient was noted to be developmentally
delayed but was otherwise unremarkable.
On further investigation, the mother reports
that the patient has a family history of
Epilepsy. Also, she is a known case of
Global Developmental Delay and was
undergoing therapy prior to seizure onset.
work -up showed unremarkable results and
the patient was treated as a case of
Complex Febrile Seizure. Among all the,
which puts the patient at highest risk for
developing Epilepsy after her episode of
Febrile seizure?

30. Which among the following is a seizure a. Infantile spasms

mimicker in infancy? b. Bicycling movement of all extremities
c. Jitteriness
d. Lip smacking

31. A 7-year-old female is rushed to the ER for a. Absence seizure persisted for 20 minutes
seizures. History taken by the ___ is as

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follows: 2 hours prior to consult, while b. Patient had recurrent episodes of seizures, with
playing with her mother, the patient is noted less than 1 hour interval
to suddenly stop and start to blink her eyes. c. Patient was asleep postically after the last
This lasted for only a few seconds and the seizure episode.
patient proceeded to play thereafter, d. Patient had recurrent episodes of seizures, with
apparently well. Thus, mother did not seen less than 1 hour interval awake in between
consult. 1 hour prior to consult, while on the
ride home the patient was again noted to be
silent, doing nothing but blinking her eyes.
This lasted for 20 minutes. Thereafter,
condition reoccurred thus, patient was
rushed to the ER, asleep and in a postictal
state. Given this, the patient was diagnosed
as a case of Status Epilepticus. Which
among the following supports his
diagnosis?

32. A 7-month old arrives at your clinic for a a. Ohtahara syndrome

regular check-up. Mother voices out her b. West syndrome
concern that her child has multiple episodes c. Jitteriness
of “jitteriness”. This was noted since the d. Dravet syndrome
patient was 3 months old, recurring without e. Benign rolandic seizures
provocation. As per the mother, patient —-
—- electrocuted jerking then suddenly going
back to normal. Mother also complained
that the patient is no longer able to say
mama papa and does not turn to sound.
EEG showed tachy?arrhythmia. What is the
patient’s diagnosis?

33. Which among the following should not be a. CSF protein

tested routinely on a CSF sample? b. CSF glucose
c. CSF Gram stain
d. CSF cell count
e. CSF KOH smear

34. A patient comes in at the ER in an active a. Check and maintain airway, breathing, circulation
seizure. Which among the following should and vitals.
not be routinely done during the first few b. Check fingerstick glucose
minutes at arrival? c. Assess oxygenation, give oxygen via nasal
cannula/mask
d. Time seizure from its onset
e. Give Thiamine 100 mg IV immediately

35. A 10-year-old male patient comes in at the a. Paralytic poliomyelitis - positive stool findings
ER with lower extremity weakness. It taken 24 hours apart

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started 3 weeks prior when the patient was b. Ischemic stroke, anterior communicating artery -
noted to have difficulty going up the stairs hypodensity on the medial aspect of the bilateral
until the patient was no longer able to sit up frontal lobes as seen on cranial CT scan
from lying down thus, this consult. Upon c. Guillain -Barre Syndrome - CSF showing
further history taking, there was a history of cytoalbuminologic dissociation
an episode of cough and coryza 1 week d. Transverse Myelitis - positive starch test from L2
prior to symptom onset. PE findings showed downwards
a fully awake patient, conversant and
oriented to 3 spheres. Motor strength was
0/5 on both lower extremities, 5/5 on both
upper extremities. Sensation was intact and
100% on all dermatomes, DTR +, with a
negative bilateral Babinski Reflex. The rest
of the physical examination findings were
unremarkable. Which among the following
diagnoses and their corresponding
laboratory results should be expected of this
case?

36. A 15-year-old patient comes in for ptosis a. Patient had sudden onset of ptosis and
and generalized muscle weakness. Upon generalized weakness while walking to her 1st
examination by the ER physician, he class in the morning
determines that the patient has Myasthenia b. Ptosis and weakness are absent upon waking
Gravis. Which among fits the diagnosis? but was noted to gradually progress throughout
the day. This renews daily or when patients take
a nap or rests in the middle of the day.
c. The patient had a sudden severe headache,
followed by sudden ptosis and generalized
weakness.
d. Patient had a history of cough and coryza 1 week
prior which was then followed by ptosis and
weakness on 1 side of the face.

37. Which among the following should not be a. Vitamin K Deficiency

considered as part of the differential b. Protein C and S Coagulopathy
diagnosis for Pediatric Ischemic Stroke? c. Homocystinuria
d. Cardioembolic Stroke

38. A patient comes in at the ER and is a. Get a cranial MRI to determine extent of bleed
suspected as having a Hemorrhagic Stroke. b. Put the patient on NPO and start IVF immediately
Which among the following should not be c. Thermoregulate patient and elevate the patients
done immediately? head 30 degrees
d. Get CBC, patient’s blood type and work-up for
coagulopathy to prepare for possible operative
management.

39. Which among the following should be done a. Start antibiotic coverage immediately
for a patient with symmetric ascending b. Give IVIg 0.4g/kg/Day for 5 days
paralysis, cytoalbuminologic dissociation c. Start Mannitol 0.5g/kg/dose q4H
and oligoclonal bands seen on the CSF? d. Get a cranial CT scan immediately

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40. When assessing a patient for lower a. Presence of a severe headache, symmetry of
extremity weakness, which among the weakness, sensory changes, deep tendon
following PE findings should be considered? reflexes, Babinski reflex
b. History of urinary and bowel incontinence,
symmetry of weakness, sensory changes, deep
tendon reflexes, presence of ocular or bulbar
involvement.
c. Symmetry of weakness, sensory changes, deep
tendon reflexes, presence of ocular or bulbar
involvement, digital rectal exam.
d. Symmetry of weakness, sensory changes,
deep tendon reflexes, presence of ocular or
bulbar involvement, digital rectal exam,
Babinski reflex

41. A Babinski reflex can normally be found a. Using a reflex hammer, gentle pressure should
until 3 years of age. It is elicited by doing be applied on the sole of the patient, moving
the following maneuver: from the heel to the big toe, passing through the
lateral aspect of the aforementioned sole. A
positive result is the flexion of the big toe.
b. Using a reflex hammer, gentle pressure should
be applied on the sole of the patient, moving
from the heel to the big toe, passing through the
lateral aspect of the aforementioned sole. A
positive result is the extension of the big toe and
fanning of the other toes.
c. Using a reflex hammer, gentle pressure should
be applied on the sole of the patient, moving
from the heel to the big toe, passing through the
medial aspect of the aforementioned sole. A
positive result is the extension of the big toe and
fanning of the other toes.
d. Using a reflex hammer, gentle pressure should
be applied on the sole of the patient, moving
from the big toe to the heel, passing through the
lateral aspect of the aforementioned sole. A
positive result is the extension of the big toe

42. A patient is noted to have ascending flaccid a. T8

paralysis with sensory loss starting at the b. T9
level of the umbilicus. On digital rectal c. T10
examination, the patient is noted to have d. T11
weak sphincter tone. What spinal level of

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involvement does the patient have?

43. Which among the following cases should an a. A patient complains of the worse headache of his
intracranial bleed not be considered? life which was then followed by facial asymmetry
and loss of consciousness.
b. An adolescent comes in with flattening of her
nasolabial fold and inability to raise her left
eyebrow.
c. A newborn baby is brought to the ER due to a
decrease in sensorium. Upon examination, the
patient is drowsy with red splotches noted on her
conjunctiva.
d. A child is brought to the ER along with his father
after a motor vehicular accident, both of which
are drowsy with multiple abrasions and
lacerations on their extremities.

(44-45) A 15- year-old patient comes in for consult at the clinic due to recurring headache, a total of 10
episodes in the past year since the patient started 9th grade. This was described as pulsating in
quality, with a pain scale of 5-6/10, nonprogressive. Associated symptoms include nausea and
photophobia prior to onset of headache.

44. What is the diagnosis of this patient? a. Tension Headache

b. Migraine with Aura
c. Migraine without Aura
d. Cluster Headache

45. You prescribe the patient Ibuprofen to be a. The patient should not take simple analgesics
taken as needed for headache recurrence. like ibuprofen more than 15 days/month.
Which among the following does not b. The patient should not take prescription
contribute to the prevention of medication of medications more than 10 days/month.
Medication Overuse Headaches? c. If medications are already maximized, use
hydrating fluids for the rest of the week.
d. The patient should not take simple analgesics
like ibuprofen for more than 10 days/month.

46. Which among the following is a red flag for a. Headache that is preceded by vomiting.
Secondary Headaches, prompting need for b. Headache that does not worsen with activity.
Neuroimaging? c. Headache that is chronic and nonprogressive
d. Headache that worsens when the patient exerts
effort during bowel movement.

47. This best describes Post Traumatic a. It is considered Acute if it is of less than 4 months

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Headaches? duration.
b. It is considered chronic if it's of more than 4
months duration.
c. It can occur anytime within 7 days of trauma.
d. It occurs immediately after the traumatic injury.

48. Which correctly differentiates a Tension a. It is not relieved by sleep.

Headache from other types of Headaches? b. It is usually severe in intensity.
c. It is aggravated by routine physical activity.
d. It is associated with nausea and vomiting.

49. A patient comes in at the ER with a. Vancomycin and Ceftriaxone

progressive headache, fever and left sided b. Vancomycin, Metronidazole and Ceftriaxone
weakness. Upon examination, she is __ as c. Vancomycin, Metronidazole and Cefatizidime
a cause of Brain Abscess, Right Frontal d. Clindamycin, Metronidazole and Ceftriaxone
Lobe. What empiric antibiotics should be
given to this patient while pending work-up?

50. A 3-year old patient was rushed to the ER a. No loss of consciousness.

at dawn after falling from the top of the b. A fall of more than 3 feet distance
stairs of the home. Which of the following c. Patient was asleep but easily arousable.
supports the need for emergency brain CT d. Presence of scalp hematoma
scan?

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