Topnotch Medical Board Prep Pediatrics Super Exam

TOPNOTCH MEDICAL BOARD PREP PEDIATRICS SUPEREXAM For inquiries visit www.topnotchboardprep.com.ph or email us at [email protected] TOPNOTCH MEDICAL BOARD PREP PEDIATRICS SUPEREXAM Page 1 of 97 For inquiries visit www.topnotchboardprep.com.ph or email us at [email protected] For inquiries visit www.topnotchboardprep.com.ph or email us at [email protected] DEARTOPNOTCHFRIENDS:PLEASEFOLLOWTHESEINSTRUCTIONS:1. Thesequestionsarepreviousdiagnostic,midterm,andfinalsexamsofTopnotch,almostallofthemmadebyTopnotchBoardExamTopnotchers.2. AnswerthisTopnotchSuperexamseriously100-itemsatatime.CovertheExplanationsColumn.Donotimmediatelylookattheanswersfromtheanswerkey.Thatsnotthecorrectwayofansweringsampleexams.YouneedtotreattheseMCQsasexercisesandnotashandouts.3. Timeyourself.1.5hoursper100-itemblock.4. Afteransweringeach100-itemblock,refertotheTopnotchAnswerKeyforthecorrectanswers.Pleasebecarefulofframeshiftmutationswhencheckingyouranswers-checkevery10items.(theformatoftheanswerkeywasdesignedforyoutopracticeagainstframeshiftmutations)5. TheTopnotchSuperexamsareEXERCISESfortheactualmedboards.Theywillnotappearverbatiminyourfutureexams.Morethanknowingwhatsthecorrectanswer,itsmoreimportantforyouto:a. Knowwhytheotherchoicesarewrongb. Knowwhytheotherchoiceswereincludedinthefirstplacec. Knowtheexplanationtothecorrectanswer6. SharpenyourmindbyansweringtheTopnotchSuperexams.Mostofthesequestionsbasedonpastfeedbackaremoredifficultthantheactualquestionsinthemedboards.IntheseexamsmadebyBoardExamTopnotchers,ifyouregettingascoreof60/100,thatsalreadyagoodscore.Morethan80/100isoutstanding.Item#QUESTIONEXPLANATIONAUTHORTOPNOTCHEXAM1WhichphaseofKawasakidiseaseisassociatedwithcoronaryaneurysms?A.AcutefebrilephaseB.SubacutephaseC.ConvalescentphaseD.PhaseofcomplicationsE.AlloftheaboveKawasakidiseasepresentswithcharacteristicallyhigh,unremittingfeverand4outofthe5principalfeatures:Bilateralnonexudativebulbarconjunctivalinjectionwithlimbalsparing;erythemaoftheoralandpharyngealmucosawithstrawberrytongueanddry,crackedlips;edemaanderythemaofthehandsandfeet;rashofvariousforms(scarlatiniform,maculopapular,erythemamultiforme);nonsuppurativecervicallymphadenopathy(usuallyunilateral,withnodesize>1.5cm).Acutefebrilephase-feverandtheacutesignsofillnessandusuallylasts1-2wksSubacutefebrilephase-desquamation,thrombocytosis,coronaryaneurysmsandhighestriskofsuddendeathusuallylasts2wksConvalescentphase-AllclinicalsignshavedisappeareduntilESRnormalizestypically6-8wksafteronsetonillnessSource:NelsonsTextbookofPediatrics19theditionp864KRISTELTANHUI(TOP3-AUG2015MEDBOARDS;TOPNOTCHMDFROMLASALLE)DIAGNOSTICEXAM-MARCH20162Afouryearoldpresentswithlow-gradefever,intermittentcrampyabdominalpainwithemesisandswollenkneesof3daysduration.Apurpuricrashdistributedbelowthekneesofbothlowerextremitiesisnotedonphysicalexamination.Thispatientmostlikelyhas:A.MeningococcemiaB.IdiopathicthrombocytopenicpurpuraC.Henoch-ScholeinpurpuraD.SLEE.JuvenileRheumatoidarthritisHSPisacommonvasculitisamongchildrenandpresentswiththeclassicfindingsofabdominalpainwithorwithoutrectalbleeding,vasculitisrash,arthritisandnephritis.Theplateletcountisnormal.Gastrointestinalinvolvementmayprogresstointussusception.Source:NelsonsTextbookofPediatrics19theditionp868KRISTELTANHUI(TOP3-AUG2015MEDBOARDS;TOPNOTCHMDFROMLASALLE)DIAGNOSTICEXAM-MARCH20163A3yearoldfemalepresentswith1weekhistoryofdaily(quotidian)feverassociatedwitharthritisofbothanklesandherrightknee.Hermothernotesthatshehasdecreasedactivityandalsonotesrashesthatcomeandgoindifferentpartsofherbodybutnotontheface.Onphysicalexamination,salmoncoloredpatcheswerenotedonthetrunkandextremities.Palpationrevealedsplenomegaly.Whatisthediagnosis?A.HenochSchoenleinPurpuraB.SystemicLupusErythematosusC.JuvenileRheumatoidarthritisD.JuvenileDermatomyositisE.DenguefeverDontforgettostudyrheumaticdiseasesofchildhoodevenifitsnotyourfavoritetopic.FamiliarizeyourselfwiththerelativelycommononeslikeJRA,SLEanddermatomyositosis,HSPandscleroderma.Payattentiontothecharacteristicsoftherashandotherfeatures.(Dontfallforthetrapofrash+arthritis=SLE..ItsnotalwaysSLE!!)JRA-Salmoncoloredpatch,evanescent,sparesthefaceSLE-Malarrash,photosensitivieDermatomyositis-heliotrope(periorbitalrash),gottronpapules(rashontheknuckles)HSP-purpuraindependentportionsForJRA,knowthedifferencesbetweensubtypes(oligoarticularvspolyarticularvssystemiconset)ThiscaseinparticularisacaseofsystemiconsetJuvenileRheumatoidarthritis(alsocalledStillsDisease)Source:NelsonsTextbookofPediatrics19theditionp830KRISTELTANHUI(TOP3-AUG2015MEDBOARDS;TOPNOTCHMDFROMLASALLE)DIAGNOSTICEXAM-MARCH2016TOPNOTCH 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Item#QUESTIONEXPLANATIONAUTHORTOPNOTCHEXAM4A4yroldboypresentswithhisthirdepisodeofpainfulcervicallymphadenitis.EachwastreatedwithincisionanddrainageandgrewS.aureus.Healsoexperiencesrecurrentskininfections.Ayearago,hewashospitalizedforosteomyelitis.Themostimportantlaboratorytestis:A.PCRforADAdeficiencyB.NitrobluetetrazoliumtestC.MAC-IassayD.NeutrophilcountE.GeneticchromosomalanalysisThisisacaseofChronicgranulomatousdiseasewhereinpatientsaresusceptibletocatalasepositiveorganismslikeS.aureus.Thenitrobluetetrazoliumteststheneutrophilsabilitytogeneratesuperoxideanionandthuskillingestedbacteria.Source:NelsonsTextbookofPediatrics19theditionp746KRISTELTANHUI(TOP3-AUG2015MEDBOARDS;TOPNOTCHMDFROMLASALLE)DIAGNOSTICEXAM-MARCH20165WhichamongthefollowingisnotaprominentfeatureofWiskott-Aldrichsyndrome?A.X-linkedrecessiveinheritanceB.AtopicdermatitisC.ThrombocytopeniaD.RecurrentinfectionswithencapsulatedbacteriaE.LeukopeniaNote:TheprominentimmunologicimpairmentinWiskottAldrichSyndromeisagainstpolysaccharidesofencapsulatedorganismsSource:NelsonsTextbookofPediatrics19theditionp734KRISTELTANHUI(TOP3-AUG2015MEDBOARDS;TOPNOTCHMDFROMLASALLE)DIAGNOSTICEXAM-MARCH20166A12yearoldseeksconsultfor1dayhistoryofsneezing,clearrhinorrheaandnasalitchingnotassociatedwithfeveroranyothersystemicsymptoms.PErevealsboggy,palenasaledemawithacleardischarge.Themostlikelydiagnosisis?A.ForeignbodyB.VasomotorrhinitisC.AllergicrhinitisD.NeutrophilicrhinitisE.RhinitismedicamentosaAllergicrhinitisisoftenseasonalandassociatedwithallergicconjunctivitis.Eosinophilspredominateinthenasalsecretions.Itisclassifiedas-Seasonal(cyclical)orperinneal(allyear)-Intermittent(symptomsoccur4consecutiveweeks)-Mild-moderate(noimpairment)orsevere(withimpairmentofdailyliving/sleep)Source:NelsonsTextbookofPediatrics19theditionp775KRISTELTANHUI(TOP3-AUG2015MEDBOARDS;TOPNOTCHMDFROMLASALLE)DIAGNOSTICEXAM-MARCH20167TheKasaiprocedureisindicatedforwhichofthefollowing?A.NeonatalhepatitisB.BiliaryatresiaC.MetabolicliverdiseaseD.FulminanthepaticfailureE.NoneoftheaboveDespiteinitialsuccessoftheKasaioperation,patientswithbiliaryatresiaeventuallygetlivertransplantation.Source:NelsonsTextbookofPediatrics19thedition1387KRISTELTANHUI(TOP3-AUG2015MEDBOARDS;TOPNOTCHMDFROMLASALLE)DIAGNOSTICEXAM-MARCH20168An8montholdmanifestswithfussinessandemesisandrefusestoeat.1weekago,hewasbroughtforconsultandwasdiagnosedwithURTI.Onthemorningofconsult,hismothernotedcurrantjellylikematerialonhisdiaper.OnPE,asausageshapedmasswaspalpableintheabdomen.Thereislikewiseabdominaldistentionandrectalexamrevealsbloodinthestool.Themostlikelydiagnosisis:A.ViraldiarrheaB.DuodenalatresiaC.IntussusceptionD.HypertrophicpyloricstenosisE.IntestinaladenomaAsidefromthat,intussusceptionmaypresentwithlethargyoutofproportiontotheintestinalsignsandsymptoms.Intussusceptioninchildrenisusuallyduetolymphoidhyperplasiaintheintestines.Thisbecomestheleadpoint.Themostcommonlocationisileocolic.Source:NelsonsTextbookofPediatrics19theditionp1288KRISTELTANHUI(TOP3-AUG2015MEDBOARDS;TOPNOTCHMDFROMLASALLE)DIAGNOSTICEXAM-MARCH20169A3yearoldfemalepresentstoyourofficewithunilateralnasaldischarge.Thedischargeisdescribedbythecaretakertobemalodorousandlatelyhasbeenbloodtinged.Themostlikelydiagnosisis:A.TertiarysyphilisB.UnilateralchoanalatresiaC.NasopharyngealcarcinomaD.ForeignbodyE.AngiosarcomaofthenoseSource:NelsonsTextbookofPediatrics19theditionp1431KRISTELTANHUI(TOP3-AUG2015MEDBOARDS;TOPNOTCHMDFROMLASALLE)DIAGNOSTICEXAM-MARCH201610A3yearoldisbroughttotheER.OnPE,inspiratorystridorandabarkingcoughwerenoted.Thereismildrespiratorydistress,tachypnea,andfever.Thesignsandsymptomsareaggravatedbyagitationandcrying.ThemostlikelydiagnosisisA.TrachiomalaciaB.LaryngotracheobronchitisC.EpiglotittisD.BacterialtracheitisE.PeritonsillarabscessThisisacaseofcroupandiscommoninthisagegroup.Barkingcough=croupEpiglotitisandbacterialtracheitispatientsaremoretoxicappearingandnotinmerelymildrespidistressSource:NelsonsTextbookofPediatrics19theditionp1446KRISTELTANHUI(TOP3-AUG2015MEDBOARDS;TOPNOTCHMDFROMLASALLE)DIAGNOSTICEXAM-MARCH2016TOPNOTCH 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Item#QUESTIONEXPLANATIONAUTHORTOPNOTCHEXAM11Anewbornwasnotedtobecyanotic.Unfortunatelytheimagingfacilitiesareunavailablefortheday.AhyperoxiatestwasthusdonewhichshowednoimprovementofPaO2afteradministrationof100%O2.Thenextstepinthemanagementofthisneonateis:A.LowtidalvolumemechanicalventilationB.PositivepressureventilationC.DigoxinD.EmergencylaparotomyE.ProstaglandinEThehyperoxiatestisusedtodifferentiatewhethertheetiologyofcyanosisiscardiacornot.PaO2doesnotimproveincardiacetiologies.Intheabsenceofimagingfordefinitivediagnosisofthecongenitalheartdisease,theclinicianshouldnothesistatetoadministerprostaglandinincasethepatienthasaductusdependentcongenitalheartdisease.Prostaglandinpreventstheductusfromclosing.Source:NelsonsTextbookofPediatrics19theditionp1572KRISTELTANHUI(TOP3-AUG2015MEDBOARDS;TOPNOTCHMDFROMLASALLE)DIAGNOSTICEXAM-MARCH201612Apatientwasdiagnosedwithtetralogyoffallot.HischestxrayrevealstheclassicLeCouerenSabot.WhichofthefollowingcomponentsofTOFisresponsibleforthisshape?A.PulmonarystenosisB.VSDC.RVHD.OverridingoftheaortaE.RightsidedaortaThetypicalconfigurationonAPviewconsistsofanarrowbase,concavityoftheleftheartborderintheareausuallyoccupiedbythepulmonaryarteryandnormaloverallheartsize.Thehypertrophiedrightventriclecausestheroundedapicalshadowtobeuptiltedsothatitissituatedhigherabovethediaphragmthannormalandpointinghorizontallytotheleftofthechestwall.Thecardiacshadowhasbeenlikenedtothatofabootorawoodenshoe.Source:NelsonsTextbookofPediatrics19theditionp1575KRISTELTANHUI(TOP3-AUG2015MEDBOARDS;TOPNOTCHMDFROMLASALLE)DIAGNOSTICEXAM-MARCH201613A5yearoldpresentswithmultiplepetichiaeonherlowerextremitiesandoral-mucosalbleedingof3daysduration.2weeksprior,shehadamildrespiratorytractinfectionbutotherthanthat,hercaretakersdescribehertobeactiveandgenerallyfine.OnPE,sheisafebrile.Nolymphadenopathynorhepatosplenomegalyisnoted.Whichisthebestnextdiagnosticsteptoconfirmthediagnosis?A.CBCwithplateletcountB.PTC.PTTD.BleedingtimeE.ClottingtimeCBCwithPCwouldrevealdecreasedplateletsandnormalotherparameterssuggestingthatthisisacaseofITP.Source:NelsonsTextbookofPediatrics19theditionp1715KRISTELTANHUI(TOP3-AUG2015MEDBOARDS;TOPNOTCHMDFROMLASALLE)DIAGNOSTICEXAM-MARCH201614Aninfanthasahemangiomathatgrowsrapidlyinsize,leadingtothrombocytopeniaandmicroangiopathichemolyticanemia.Whichtermdescribesthiscondition?A.KaposilikeformofinfantilehemangiomaB.McCuneAlbrightsyndromeC.Kasabach-MerrittsyndromeD.MaffuccisyndromeE.EvanssyndromeMcCuneAlbrightsyndrome-polyostoticfibrousdysplasia,caf-au-laitskinpigmentation,autonomousendocrinehyperfunctionMafuccisyndrome-MultipleenchondromasandhemangiomasEvanssyndrome-autoimmuneanemia+thrombocytopeniaSource:NelsonsTextbookofPediatrics19theditionp1719KRISTELTANHUI(TOP3-AUG2015MEDBOARDS;TOPNOTCHMDFROMLASALLE)DIAGNOSTICEXAM-MARCH201615Apreviouslyhealthy8yearoldmalepresentswithprogressivepainlessproptosisanddecreasedvisualacuityofthelefteyeduringthepast10weeks.Themostlikelydiagnosisis:A.OrbitalcellulitisB.TrichinosisC.RetinoblastomaD.RhabdomyosarcomaE.NoneoftheaboveRhabdomyosarcomaisthemostcommonsarcomaofchildhood.Orbitalrhabdomyosarcomaisacommonsiteforrhadomyosarcomawhichproduceslocalsignsasitgrowsanddisplacesnormaltissues.Retinoblastomamaybeendophyticorexophyticfromtheretina.Theypresentwithleukocoriaorstrabismus.Source:NelsonsTextbookofPediatrics19theditionp1761,1768KRISTELTANHUI(TOP3-AUG2015MEDBOARDS;TOPNOTCHMDFROMLASALLE)DIAGNOSTICEXAM-MARCH201616A4yearoldmaleexperiencedanupperrespiratorytractinfectionthatwasfollowedin2weeksbygeneralizededema.Hisbloodpressureisnormal.Urinalysisreveals2-5rbc/hpfand4+protein.HisBUNis19mg/dl.Serumalbumin0.9g/dlandC3was93mg/dl.Themostlikeydiagnosisis:A.PoststreptococcalglomerulonephritisB.MembranousglomerulonephritisC.MinimalchangediseaseD.FocalsclerosisE.IgAnephropathyPatientispresentingwithnephroticsyndrome.Themostcommonofwhichisminimalchangediseaseinchildren.Hypoalbuminemia,proteinuria,edemaandhyperlipidemiaconstitutethenephroticsyndrome.Source:NelsonsTextbookofPediatrics19theditionp1804KRISTELTANHUI(TOP3-AUG2015MEDBOARDS;TOPNOTCHMDFROMLASALLE)DIAGNOSTICEXAM-MARCH201617ThefollowinglistedphrasesarecharacteristicsofsimplepartialseizuresEXCEPT:A.LossofconsciousnessB.Durationof10-20secC.VersiveseizuresD.MayhavesecondarygeneralizationE.AbnormalEEGThereisneveralossofconsciousnessinsimplepartialseizures.Somepatientsmayactuallybeconversantandtalktoyouduringtheevent.Source:NelsonsTextbookofPediatrics19theditionp2021KRISTELTANHUI(TOP3-AUG2015MEDBOARDS;TOPNOTCHMDFROMLASALLE)DIAGNOSTICEXAM-MARCH2016TOPNOTCH 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Item#QUESTIONEXPLANATIONAUTHORTOPNOTCHEXAM18Pincergraspisusuallynotedatwhatage?A.2mosB.4mosC.6mosD.8mosE.10mosPincergrasp/thumbfingergraspSource:NelsonsTextbookofPediatrics19theditionp27KRISTELTANHUI(TOP3-AUG2015MEDBOARDS;TOPNOTCHMDFROMLASALLE)DIAGNOSTICEXAM-MARCH201619A12yearoldmalepresentswithcomplaintsofpolyarthritisandanevanescentrashwhichsparestheface.OnPE,patientappearstobeinrespiratorydistressandauscultationrevealedtachycardiaandagalloprhythm,andsomehardpainlessfreelymovableswellingsovertheextensorsurfacesliketheelbows.ChestxrayrevealscardiomegalyandASOTis350Toddunits.Thefollowingareappropriateinthemanagementofthispatientexcept:A.PenicillinV200-500mgQIDx1weekB.CompletebedrestC.MorphineD.DigoxinE.02supplementationTheantibiotictreatmentforeradicationofstreptococcuscanbeeither:PenicillinVKx10days(notjustoneweek)BenzathinePCN0.6-1.2MUIMErythromycin250mgTIDx10daysSource:TopnotchhandoutinpediatricsKRISTELTANHUI(TOP3-AUG2015MEDBOARDS;TOPNOTCHMDFROMLASALLE)DIAGNOSTICEXAM-MARCH201620A5yearoldpresentswithcomplaintofchroniccoughof1monthdurationwithassociatedweightlossandrecurrentfever.PPDwasdone.Whichofthefollowingistrue.A.Equaltoor>5ispositive.Anythingbelowthisvalueisnegative.B.Equaltoor>10ispositive.Anythingbelowthisvalueisnegative.C.Equaltoor>15ispositive.Anythingbelowthisvalueisnegative.D.Equaltoor>20ispositive.Anythingbelowthisvalueisnegative.E.Equaltoor>25ispositive.Anythingbelowthisvalueisnegative.Equaltoor>5-positiveifwithhistoryofclosecontact,withsuggestiveclinicalfindings,suggestiveCXR,immunocompromisedEqualtoor>10=positiveSource:TopnotchhandoutsinpediatricsKRISTELTANHUI(TOP3-AUG2015MEDBOARDS;TOPNOTCHMDFROMLASALLE)DIAGNOSTICEXAM-MARCH201621Whichoneofthefollowingformsofjuvenileidiopathicarthritisismostlikelytobeassociatedwithseriouseyecomplications?A.PolyarticulararthritisthatisseropositiveforrheumatoidfactorB.PolyarticulararthritisthatisseronegativeforrheumatoidfactorC.OligoarticulararthritiswithoutaxialspineinvolvementD.OligoarticulararthritiswithaxialspineinvolvementE.Systemic-onsetjuvenilerheumatoidarthritisPatientswitholigoarticulararthritiswithoutaxialspineinvolvementaremostlikelytodevelopchronicandpotentiallysevereanterioruveitis,whichcanbeclinicallyquitesubtleevenasitleadstoprogressivevisualloss.Upto25%ofpatientsinthissubsetmaydevelopanterioruveitis,andthegroupthatisANApositiveappearstobeathighestrisk.Patientswithaxialspineinvolvementcanalsodevelopanterioruveitis,butthistendstobeacute,self-limited,andeasilytreatable.LESTERBRYANCO(TOP10-AUG2015MEDBOARDS;TOPNOTCHMDFROMUST)MIDTERM1EXAM-MARCH201622A7-year-oldboypresentswithpalpablepurpuraonthebuttocksandlegs,fever,abdominalpainandvomiting,arthritisinhiskneesandankles,melena,andhematuria.Hismotherstatesthathehadanupperrespiratoryillnessapproximately1weekago,buthasotherwisebeenwell.Bloodtestsrevealmildrenalinsufficiency.ThemostlikelycauseofthebleedingintotheskinobservedinthispatientisA.coagulationfactordeficiencyB.qualitativeplateletdysfunctionC.quantitativeplateletdysfunctionD.vasculitisE.vitamindeficiencySIMILARTOPREVIOUSBOARDEXAMCONCEPT/PRINCIPLE.TheclinicaldescriptionisthatofHenoch-Schnleinpurpura,aformofleukocytoclasticangiitis(hypersensitivityvasculitis)resultingfromanimmunereactionthatdamagesthevascularendothelium.Henoch-SchnleinpurpuraiscloselyrelatedtoIgAnephropathy,aglomerulopathyresultinginnephriticsyndrome,andmayrepresentasystemicversionofthisdisease.LESTERBRYANCO(TOP10-AUG2015MEDBOARDS;TOPNOTCHMDFROMUST)MIDTERM1EXAM-MARCH201623Amothercallsyoufranticbecauseshehasjustbeendiagnosedwithvaricella(chickenpox).Shedeliveredaterminfant7daysagothatappearstobeeating,stooling,andurinatingwithoutdifficulty.Thechildhasbeenafebrileandseemstobedoingwell.Whichofthefollowingisthemostappropriatestepinmanagement?a.Isolatetheinfantfromthemother.b.Hospitalizetheinfantintheisolationward.c.Administeracyclovirtotheinfant.d.Administervaricella-zosterimmunoglobulintotheinfant.e.Advisethemothertocontinueregularwell-babycarefortheinfant.SIMILARTOPREVIOUSBOARDEXAMCONCEPT/PRINCIPLE.PerCDCrecommendations,varicella-zosterimmunoglobulin(VZIG)shouldbeadministeredtotheinfantimmediatelyafterdeliveryiftheotherhadtheonsetofvaricellawithin5dayspriortodelivery,andimmediatelyupondiagnosisifherchickenpoxstartedwithin2daysafterdelivery.Ifuntreated,abouthalfoftheseinfantswilldevelopseriousvaricellaasearlyas1dayofage.Ifanormalfull-termnewbornisexposedtochickenpox2ormoredayspostnatally,VZIGandisolationarenotnecessarybecausethesebabiesappeartobeatnogreaterriskforcomplicationsthanolderchildren.Acyclovirmaybeusedininfantsatriskforseverevaricella,suchasthoseinfantsexposedperinatally.LESTERBRYANCO(TOP10-AUG2015MEDBOARDS;TOPNOTCHMDFROMUST)MIDTERM1EXAM-MARCH2016TOPNOTCH MEDICAL BOARD PREP PEDIATRICS SUPEREXAM For inquiries visit www.topnotchboardprep.com.ph or email us at [email protected] TOPNOTCH MEDICAL BOARD PREP