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Pediatrics CMS form 3

1- prevention of nosocomial rota virus gastoenteritis first choice rota virus

vaccine 2nd hand washing
2-C Failure to thrive : <5% wt on chart in infant plus failure to have milestone
like roll over,sitting,standing. due to undernutrition<8-12 feeds uptill 6
months of age, <4-6 feeds in 7-12 months , other week sucking , low
weaning, improper formula feed preparation, celiac, milk protein allergy, in
this case failure to gain wt been present since birth also 5% on chart and no
of feeds are adequate looks like milk protein allergy so replace it with plant
based soy protein based formula feed. also continue weaning!
3- D pseudo-hyponatremia seizure, na level
4- B Salt depletion type heat exhaustion because he kept on replacing it with
free water. salt depleted type gives nausea,vomiting . why not A! because he
had breakfast (milk products) but its due to preformed toxin which only gives
you svere vomiting(staph.aureus) no fever
5- A
6- A Breast feeding jaundice(increase EHR)
Epidural=Lense shaped
10- F
suck at this storage thingie!!

7- A

11- B

8- D

13- E pubertile increase in glandular tissue due to estrogen from adrenal

androgens aromatization by adipose tissues
14- E type 1 DM with DKA
15- F look from immigrant from Mexico plus glucose is <2/3 of serum level in
TBM than to bacterial cause. also LOOK at SED rate= high(chronic) its TBM
16- B microcytic anemia with high>20% RDW iron def , <20% RDW -->
THALASEMIA smear shows Target cells (again a clue) because asymptomatic
its most probably a minor one
17- D spirochete (borrela burgdoferi) lyme disease= erythema migran
18- D HX recurrent pulmonary infections+clubbing+mucous
plugging(scattered atelactasis)bronchiectasis+ end exp wheeze
19- C .. a tricky one !! Pulmonic stenosis with VSD?? Left steernal border
heave ,also the murmur of MR + decreased lung vascular markings!!! CXR
RV-megaly age above 1yr. if same scenario with age<1yr then it would have
been TOF (Persistent pulm.HTN)

20- A systolic 2/6 benign flow murmur

21- C (synpharyngitic,repeated hematuria with URTI=IGA nephropathy)
22- C
23- C
24- B [HCO3=36 Secondary hyperaldosteronism? due to low cardiac
output/kidney perfusion]
25- E

26- A bruton's x-linked

27- E +ve R/F + Bilirubin >20=Exchange transfusion how would it cause

chronic bilirubin encephalopathy/subtle bilirubin encaphalopathy
28- B
29- A even if benzodiazepine was given along atypical/typical
antipsychotics you will still chose benzo=calm him first then give definitive
30- D
31- A
34- C not sure


B (RA/JRA can cause but OA don't)

35- C 36- A ? 37- C same scenario in infant =dandy

40- D
41- C/D?
42- B

43- B
45- E

33- C

38- D 39- C

44- H cong.hypothroidism .Macrocephaly(wide

46- A
SVT(Vagal menever failed)
(residual fluid in lung)

47- E

48- C

49- B intermittent for 2 months high ESR ,

50- C Sepsis-->DIC vasodilation with increased permeability,
chemical pneumonitis secondary to aspiration/ingestion causes respiratory
epithelial damage!!
End of the world!! BOOM