3. .....

46, xx

a.
b.
c.
d.
e.

..-alpha reductase deficiency

Congenital adrenal hyperplasia
Maternal androgen exposure
Gonadal dysgenesis
Ovotesticular disorder of sex development (DSO)

4. Allagyle Criteria is a tool to differ among

a. Intra and extra Hepatic Abnormalities
b. Diagnosis of Allagyle Syndrome
c. Neonatal Hepatitis and Neonatal Septicemia
d. Hemolytic and Hemoconcentration
e. Liver failure and Fatty liver
5. A boy, 1 month old 3200 grams was taken to the outpatient clinic (IRJ) of Dr.
Soetomo Hospital with jaundice since the age of 1 week. Stool color increasingly pale
and urine also to be more dark yellow like tea water. Laboratory tests showed direct
bilirubin 6.2 mg/dL and total bilirubin 8.4 mg/dL. Appropiate working diagnosis for
these patient is :
a. Neonatal jaundice
b. Liver cirrhosis
c. Cholestasis
d. Acute Hepatitis
e. Cholangitis
6. Baby boy, 3500 g born with spontaneous delivery with shoulder distocia. Physical
examination of extremities of baby B showed that right upper extremity was weak,
adduction and pronation and the grasp reflex was positive. The diagnosis was :
a. Erb paralyse
b. Klumpke paralyse
c. Total brachial paralyse
d. Cerebral palsy
e. Fracture antebrachii
7. Baby boy, 7 days, 1500 gram, with main complain seizure. From physical
examination showed bulging fontanella, anemia. The etiology of seizure in this
patient was :
a. hydrocephalus
b. epilepsy
c. tumor intracranial
d. intraventricular hemorrhage
e. deficiency pyridoxine
8. The most non-specific early sign of neonatal early onset sepsis is :
a. Apnea
b. Temperature instability
c. Respiratory distress

d. Seizure
e. Abdominal distention
9. Target organ of late onset of neonatal septicemia is :
a. Heart
b. Kidney
c. Lung
d. Brain
e. Gastrointestinal
10. Baby B, 5 day old, gestational age 34 weeks, apnea and bradycardia, no bulging
fontanelle, no pain, temperature 36.30C, from the blood glucose revealed 55 mg/dl.
What is the cause of apnea ?
a. anemia of prematurity
b. apnea of prematurity
c. respiratory distress syndrome
d. hypoglicemia
e. hypothermia
11. Baby F, male, 1400 gram, with spontaneous delivery. On Balard score revealed 34
weeks and Lubchencko score 25 50 percentile. Whait is your diagnosis ?
a. Preterm neonate, Very Low Birth Weight, Appropiate for Gestational Age
b. Preterm neonate, Low Birth Weight, Appropiate for Gestational Age
c. Preterm neonate, Very Low Birth Weight, Small for Gestational Age
d. Preterm neonate, Very Low Birth Weight, Large for Gestational Age
e. Preterm neonate, Low Birth Weight, Appropiate for Gestational Age
12. Baby born caesarean section with indication preeclampsia mother. Estimation
gestational age using Ballard score 31-33 weeks with Lubchencko score P25-50. Birth
weight 1400 gram. Soon after delivery the baby was dispnea respiratory rate 60-70
bpm, cyanotic in mouth, mild retraction, good air entry, and grunting can be heard by
stethoscope. Team was control the environment and give plastic wrap and CPAP. What
is the Downe score ?
a. 3
b. 4
c. 5
d. 6
e. 7
13. A Father brings her daughter 5-year-old to you because of concerns about the
girls significant overweight. The mothers pregnancy was complicated by gestational
diabetes and hypertension. Several family members are obese, including the mother,
maternal grandmother and many family members on the fathers side of family.
There is also a family history of type 2 diabetes. Her weight is 36.2 kg (>97th
percentile); height 111.2 cm (75th percentile); and BMI 29.3 kg/m2 (>95th percentile
for age). Her waist circumference is 80 cm. Apart from obesity, there are no abnormal
findings on examination. Her blood pressure is 100/60 mmHg. The correct screening
for obesity in this patient is ...
a. BMI of 22 at 28 years.
b. Calculated BMI every 10 years
c. Approach of prevention unnecessary

d. No once true
e. Waist or Waist/Hip Ratio
14. The basic principle of normal growth in children :
a. Growth process since birth until 6 years old
b. Rates and patterns of groeth are not specific to certain parts of the body
c. Wide individual differences exist in growth rates
d. Growth is influence by genetic factor only
e. The brain growth rates is equal with the body height
15. The scientific evidence during critical and sensitive periods in child brain
development :
a. Requires instruction from experience in order to develop properly
b. Critical aspects of brain architecture begin to be shaped by experience after 6
years old
c. Critical periods are not a subset of sensitive periods
d. The effects of experience on performance during critical periods are reversible
e. Boya are always develop better than girls during sensitive periode
16. A 7-year-old boy came with main complain of [ale for 1 months. He also suffered
from fever for more than a month. There was also abdominal enlargement with liver
3x3x4 cm below costae arc and spleen SII. Complete Blood Count were performed,
revealed Hb 7.8 g/dl, WBC 3200/cmm and platelet 76000/cmm. In this case, what is
the cause of liver and spleen enlargement ?
a. Bone marrow depression
b. Blast cell proliferation
c. Blast cell infiltration
d. Hypercatabolic reaction
e. Increase of hematopoesis activity
17. A 8-year-old boy came to perform circumsision but he has history easy to bleed.
Complete Blood Count investigation showed normal result. What is the next screening
investigation to know the cause of bleeding ?
a. Hemostatic function test
b. Factor VIII level
c. Factor IX level
d. Von Willebrand Factor level
e. Platelet aggregation Test
18. A 4 month-old girl came with ptechiae all over body since 2 days. There were no
fever, cough, and rainy nose during this illness period. She got Hepatitis B
immunization 2 weeks ago. Complete Blood Count revealed Hb 11.4 g/dl, leukocyte
7600/mm3 and platelet 58000/mm3. What is the most likely diagnosis of this patient ?
a. Acute leukemia
b. Aplastic anemia
c. Hemophilia
d. Platelet function disorder
e. Immune Thrombocytopenic Purpura

19. A 3 year-old came pallor and Complete Blood Count investigation showed Hb 7
g/dL. A week ago there were worms came out from his anus. There was no history of
pallor in the family. What is the most common cause of anemia in this child?
a. Worms infection
b. Iron deficiency Anemia
c. Thalasemia
d. Aplastic Anemia
e. Anemia hemolytic
20. A father brings Hie 6-year-old daughter to you because her teacher has observed
multiple, daily episodes in which the child stares and is unresponsive to verbal cues.
The teacher also has noted facial twitching with some of these several-second
events. Results of physical examination of the girl are normal. What medication to
start?
a. Carbamazepine
b. Topiramate
c. Valproic acid
d. Ocarbazepine
e. Felbamate
21. A mother brings her 8-year-old daughter to emergency unit with the chief
complaint f seizure. The seizure is tonic clonic lasted for 15 minutes and end abruptly.
After seizure, she is in post ictal coma. While the patient in the 30 minutes
observation period, she is having another seizure with the same semiology and the
seizure does not diminish after two times intravenous diazepam intervention. The
patient was previously having recurrent seizures since the age of 6 years. How do you
manage the patient?
a. Phenytoin loading 20 mg/kg (1 mg/kg/minute)
b. Midazolam syringe pump 0,2 mg/kg/hour
c. Diazepam loading 3 mg/kg (1mg/kg/minute)
d. Pentotal loading 10 mg/kg (2 mg/kg/minute)
e. Phenobarbital loading 20 mg/kg (1 mg/kg/minute)
22. A father brings his 3-year-old son to emergency departement with the chief
complaint of seizure. He notes generalized seizure and the eyeball goes up when the
temperature 39oC. After the seizure stops, she is conscious. He observed 2 days of
cough and fever. The history of growth and development, the patient still can not
walk by himself. Neurology examination within normal limit. What is the treatment of
this patient?
a. Phenytoin
b. Valproic acid
c. Topiramate
d. Midazolam
e. Carbamazepine
23. What hormone that acts as appetite and body weight regulator?
a. Thyroxin
b. Angiotensin
c. Glucagon
d. Leptin
e. Adipocyte

24. Argha, 2 weeks baby boy. Her mother gives infant formula feeding as soon after
birth. The baby has stooling more than 6-8 times per day since 2 weeks ago. Body
weight still persist as birth weight. Which are the following statement are true?
a. This is normal for baby in early weeks of birth
b. Body weight decrease in early weks of life
c. Possibly diarrhea caused by viral, lactose intelorance, etc
d. Normal because milk formula contain more lactose than human milk
e. Normal because body weight still persist as birth
25. Which are the following statement are true for physiology of lactation
a. After delivery. The prolactin concentration drops, leading to increased milk
synthesis
b. Lactation doesnt occur if pregnancy does not progress beyond 20 weeks
c. Obesity does not interfere with lactogenesis
d. Oxitocyn causes the milk ejection-reflex or letdown
e. The tax rate of milk synthesis is not related to the degree of emptiness or
fullnes of the breast
26. A 6 years old boy brought by his mother to emergency room because of fever
and convulsion. A minutes after arrived, he was apneu. What should you do?
a. Start chest compression
b. The SAFE approach and CPR
a. c start rescue breathing
c. giving anti convulsion and oxygen
d. Open the airway and chest compression
27. Your neighbour ask you to come to their house to see their 7 years old child
whose uncoscious ... minute ago. When you arrived, you ask the parents to call the
emergency medical service and you evaluate the ABC. You found a gasping child and
the pulsonly 50 times per minute. What ... compression to ventilation ratio for lone
rescuer giving CPR to this patient?
a. 10:1
b. 30:1
c. 30:2
d. 15:2
e. 3:1
28. Ga keliatan, maaf ya
29. A 6 month old baby came to emergency room with her mother. His mother said
that he suffered from difficulty of breathing since 2 days ago. ___ days ago the patient
suffered from cough and runny nose. From physical examination at the moment, the
baby was having fever, looked dyspnea, with chest indrawing and ___ was heard from
auscultation. His baby said that the baby couldnt drink well since 2 days ago.
Common etiology from empirical data of 6 month old baby with disease was:
a. Chlamydia trachomatis
b. Streptococcal pneumonia
c. Mycoplasma pneumonia
d. Escherichia coli

e. Streptococcus pyogenes
30. In emergency room, a 22 month-old boy came with shortness of breath.
According to his mother, the baby looked ill with symptom of cough and fever since 2
days ago. Doctor in primary care said that was suffered from common cold and gave
antipyretic medicine. After 2 days the baby looked distress and difficult to drink,
wheezings were heard from both lung, with prolonged expiration. No history of
aspiration. What is the possible diagnosis for the patient?
a. Severe attack of asthma
b. Laryngitis
c. Bronchiolitis
d. Epiglositis
e. Heart failure
31. Mr. Ahmad brought his 5 year old son Tono because of pain when he swallowed
something. He also suffered from mild fever for 3 days. Mr. Ahmad saw a clean, white
membrane in thethroat. The suspicion that Tono suffered from unspesific infection
made the doctor decide:
a. He should be hospitalized
b. No treatment is needed
c. Injection ceftriaxone 3 times an then go home
d. Erythromicin 2x 24 hours and then return for follow up
e. Cefixim for 3 days, during those period the child should be seen by the doctor
Daily
32. Amir, a two year old boy came with his mother with the main complaint of high
grade fever for 4 days. Mother also complaint of some red rashes appear in his face
since yesterday that spread to his neck and chest. The mother said that his
neighbour was suffered with the same complaint, and now hospitalized due to
dyspnea. What other symptom that is not usually accompany fever in this disease?
a. Cough
b. Strawberry tongue
c. Diarrhea
d. Coryza
e. Conjungtivitis
33. A nine year old girl was brought by her mother with the main complaint of fever
since 6 days. The fever was high, especially in the last 3 days. Chill was present,
along with nausea, meteorismus, and headache. There were no cough, and coryza.
She didnt defecate for the last 4 days. What kind of laboratory examination that you
order from the diagnosis?
a. Complete blood count
b. IgM anti measles
c. Urine analysis
d. IgM anti dengue
e. IgM anti salmonela
34. a six year old girl living in Sepanjang was brought by her mother to a general
practitioner with the main complaint of difficulty to gain weight. She didnt suffered
for chronic fever, nor cough. From physical examination, her weight was 15 kg,
looked pale, and chacexic. Other physical examination reveal normal limit. Complete

blood countshowed hypochromic micrositic anemia, the Hb level was 6 mg/dL. What
was the most likely etiologic cause of disease in this child?
a. Tuberculosis of the lung
b. Hookworm infection
c. Leukimia
d. Thalassemia
e. Ascariasis
35. Santi, a 1 year old girl, was brought by her father, Mr. Anang because he got HIV
infection. Santi did not have any abnormality in her body, based on the history taking
and physical diagnosis. Mr Anang asked what would we do if he wanted to know
whether his daughter got the infection or not?
a. we can make the conclusion by examining her physically
b. we need a lab test from her urine
c. we need to do some tests from her blood
d. there is no diagnostic methods for 1 year old girl
e. diagnostic is not important. Just treat her.
36. Mr. Tono brought his son, Kaka 6 years old, because of unstable high fever for 1
week. He also get cough, rainy nose, and nausea. No bleeding was found. He said
about normal urination and defecation. He loss his appetite but he drank normally.
From physical examination we found some red spots on the right legs, probably
because of insect bites. Beside Mr. Tono, another member of the family, Mr. Ahmad,
the grandfather joined them to the hospital. This old man just returned to Surabaya 1
week ago after spent many days in Manokwari, where they had one core family
business. If the whole story lead you to Malaria, which point is the most supportive ?
a. unstable high fever
b. cough and rainy nose
c. insect bites
d. Manokwari
e. red spots
37. A mother complained that her 1,5 year old daughter suffered from an abrupt on
fever, was listless and irritable, refused to eat or drink her milk due to plain or
swallowing and drooling. On admission markedly swollen, erythematous, and
occasionally bleeding gums along with excessive drooling were evident. Vesicular
lesion were obvious on the tongue, buccal mucosa and palate, with extension to the
lips and face. Tender submandibular and cervical adenopathy were palpable. The
diagnose would be
a. Varicella zoster virus infection
b. Cytomagalovirus infection
c. acute herpetic ginggivostomatitis
d. Stevens Johnson syndrome
e. HHV-6 infection
38. A 2 year old year child weas admitted for evaluation of fever and swelling. He had
no history of drug or food allergy, nor was there a history of trauma. On physical
examination the child was alert, his temperature was 38,8 C, there was periorbital
swelling and mild injected throat, along with excessive a few pea sized lymphnode
enlargement on both his necks. The heart and lungs were normal, the liver was

enlarged 2 cm below the costal margin, the spleen was palpable. In this case blood
examination most likely reveal:
a. anemia, leucocytosis, and thrombocytosis
b. anemia, hyperleucocytosis, and thrombocytopenia
c. anemia and absolute lymphocytosis
d. anemia, leucopenia, thrombocytopenia
e. Lymphocytosis with evidence of atypical lymphocytes
39. An 11 year old boy with a body weight of 30 kgs came on the fifith day of fever.
The child also complained of nausea and vomiting, headache, myalgia, joint pain,
cough, and abdominal discomfort. At admission the child was weak and alert, blood
pressure 90/70, pulse rate 144x/minute, temperature 36,2 C, respiratory rate
28x/minute. The abdomen was tender, liver was palpable 2 cm below the costal
margin. The extremities were cold and clammy. Blood examination revealed
hemoglobin : 14,6 g/dl, leucocyte 3500/cmm, Hct 45%, platelet count 78000/cmm.
IgG anti dengue +. Recommended daily fluid management of this child should not
exceed
a. 1500 ml
b. 1700 ml
c. 2000 ml
d. 2700 ml
e. 3200 ml
40. an 8 year old girl came in the hospital presented with fever less than 2 weeks
prior to admission. She was known to have cyanotic congenital heart disease (ToF)
since the age of 6 months old. Complete blood count showed Hb 10,6 , leucocyte
18.000 , thrombocyte 210.000 and Hct 31%. Vegetation on the pulmonal valve was
discovered upon echo. Based on the short illustration, what is the most possible
diagnosis
a. miocarditis
b. pericarditis
c. endocarditis
d. pleurtitis
e. decompensation cordis
41. a 7-month old child had diarrhea 3 days prior to admission, watery without blood
or mucous, with volume around 50 ml for each episode. The frequent exceed to 5-6
times/day. Four days ago, the child also vomited which had stopped yesterday. The
child was subfebrile with no cough nor runny nose. On physical examination the child
had mild moderate dehydration. The most possible cause of diarrhea in this case
would be
a. Rotavirus
b. Adenovirus
c. Norovirus
d. Hantavirus
e. Rhinovirus
42. an 8 year old child, BW 25 kg, was rushed to the ER with watery diarrhea 10
times.day, flashy odour and white in colour. No fever nor vomiting. Physical
examination showed: BP 80 on palpation, pulse 11 times/minute, CRT >2 seconds,
aphatic condition. The most correct rehydration formula given:

a.
b.
c.
d.
e.

PZ 500 cc in 1 hour
HSD 750 cc in 1 hour
RL 750 cc in 1 hour
D5 1/2S 500 cc in 1 hour
D5 500 cc in 1 hour

43. year old child. BW 18 kg had diarrhea with blood and mucous for a week. A
little amount of volume diarrhea, exceeded 4-5 times/day. No fever and the kid was
active. No vomiting nor seizure. Based on physical examination, the child was alert
without any sign of dehydration. Which therapy should be given
a. Cotrimoxazole
b. Amoxycillin
c. Metronidazol
d. Ciprofloxacin
e. Eritromycin
44. An 11 month-old boy admitted to our hospital with diagnosis of
bronchopneumonia. Before he admitted to our hospital, he was already treated in
other hospital about 5 days. Chest x-ray show broncho-infiltrate in both lung. He was
looked distress and rales was heard in both lung. What is the empirical antibiotic can
be administered before knowing the exact etiology?
a. Ampicillin
b. Macrolide
c. Aminoglycoside
d. Ceftriaxone
e. Oral Amoxycillin
45. An infant can regard his parents face, follow to the midline, lift his head from
examining table, smile, spontaneously, and respond to a bell. He does not yet regard
his own hand, follow past the midline, nor lift his head to a 45o angle off the
examining table. Which of the following is most likely age of the infant?
a. 1 month
b. 3 month
c. 6 month
d. 8 month
e. 10 month
46. A young boy (13 year-old) went for consultation with physician because of
recurrent cough. He suffered from recurrent cough since 1 year old. Almost every
night he couldnt sleep well. The symptoms become worst in cold air or if he was
exhausted. He could not do some sports because of his disease. According of the
history. What is the possible diagnosis of the boy?
a. Infrequent asthma
b. Frequent asthma
c. Persistent asthma
d. First asthma attack
e. Allergic bronchitis
47. A 3 tear-old boy has a 5-day history of runny nose. He also had history 2 day of
sore throat and already resolved. Subjective cough and slight fever also were noted
today. On examination, he is febrile to 37,6oC, with respiratory rate 24 breaths/min.

his examination is purulent rhinorrhea, swollen nasal cavity and erythematous nasal
turbinates. What is the most likely diagnosis?
a. Common cold
b. Faringitis
c. Rhinitis bacterial
d. Allergic rhinitis
e. Sinusitis
48. A 4 year-old boy has been febrile for 2 days. He also has sore throat and
vomiting. There have been no cough nor rhinorhea. On examination, he is febrile to
39,8oC. There are petechiae or doughnut lessionon the soft palate and the
posterior pharynx. The uvula is read, strippled and swollen. The anterior lymphnodes
are enlarged and tender. Which of the following is the first choice of treatment?
a. Amocycillin
b. Cefixim
c. Clindamycin
d. Cefadroxil
e. Cephalexin
49. A 3 year-old boy has history of a rough cough for 1 day. He has been suffer from
mild rhinorrhea and cough but last night he had an episode of increased effort of
breathing and stridor. He has done twice previously in the last 2 months and are well
before each episodeon physical examination, he is afebrile, there is no stridor nor
dyspnea, only he looks rhinorrhea. What is the likely diagnosis?
a. Spasmodic croup
b. Thacheomalacia
c. Extraluminal compression of the trachea by a tumor
d. Organic foreign body aspiration
e. Laryngitis
50. A 7 year-old boy presents with fever for 3 weeks. He has been suffer from weight
loss and cough. There was no history of contact tuberculosis in his family. The
induration of TST is 12 mm. The chest x-ray looks like this. What is the appropriate
therapy for this patient?
a. Primary prophylaxis with isoniazid for 6 months
b. Secondary prophylaxis with isoniazid for 6 months
c. Oral anti tuberculosis drug with regimen 2HRZ 4HR
d. Oral anti tuberculosis drug with regimen 2HRZE 4HR
e. Oral anti tuberculosis drug with regimen 2HRZ 10HR