b.

Integrated Management of Childhood

Illnesses
November 2015 LOCAL MIDWIFERY
LICENSURE EXAM

Salbutamol

d. Erythromycin

12. In the ARI program, a child who has only one of the danger
signs is classified as having:
a. Severe pneumonia
c. Very severe pneumonia
b. No pneumonia
d. Pneumonia

Prepared by: Jonas Marvin M. Anaque RM, RN

SITUATION: Cristina brought her one month old baby Chris to the
RHU because of cough and colds . On examination, the child is noted
to have fast breathing. There is no stridor or convulsion noted upon
the assessment but there is a presence of intercostals retraction or
chest indrawing when the baby is calm.
1.

As a prudent midwife utilizing the IMCI process; Fast breathing

in this particular child has a respiratory rate of:
a. 60 and above
c. 40 and above
b. 50 and above
d. 30 and above

2.

Under the ARI Management Chart, Midwife Debbie will

classify this child is as a case of:
a. Very Severe disease
c. Pneumonia
b. Severe Pneumonia
d. No Pneumonia

13. An appropriate source of information about the family is/are the

following:
a. Interview results with the members of the family
b. Family folder
c. Actual observation of family situation
d. All of these are sources of information
14. An important factor which should serve as basis in preparing the
family health care plan is:
a. Data gathered from the health center
b. Needs and problem as seen and accepted by the family
c. Needs and problems gathered and recognized by the midwife
herself
d. Needs are expressed by the midwife assigned in the area where
the family resides.

3.

After certain assessment and examination following the IMCI

protocol the management for this child would be:
a. Urgent referral to the hospital
b. Antibiotics to be taken at home
c. Close observation at the health center
d. Home care

SITUATION: As frontline health worker, the midwife must be

knowledgeable about the first aid measures
15. External chest compression is done as an emergency measures
when:
a. There is a respiratory arrest
b. There is a heartbeat but not breathing
c. There is no pulse
d. A and C only

4.

Counting the respiratory rate of the child, the midwife should

remember the following except for which?
a. Count the RR for one full minute
b. Count the RR when the child is restless or crying
c. Count the RR when the child is calm
d. None of the above

16. If a patient to commit suicide by taking an overdose of sleeping

pills, the first aid measure that the midwife can do is:
a. Dont induce vomiting
b. Give stimulant like coffee if still awake
c. Do gastric lavage
d. Inject a stimulant

5.

Under the ARI Program, chest indrawing would mean:

a. Noisy inspiration
c intercostal retraction
b. Noisy expiration
d. subcostal retraction

17. There is bleeding in the forearm of your patient. Your first aid
measure would be:
a. Elevate the part higher than the heart level
b. Apply direct pressure on the bleeding site
c. Apply pressure at the site of the brachial pulse
d. Any of the above

SITUATION: A three year old child came to the Health Center

because of Diarrhea. At present, the child is unwell and irritable. His
eyes are sunken although his mouth and tongue are moist.
6.

Using the CDD Assessment Chart, this child is having diarrhea

with:
a. No signs of dehydration
c. Severe dehydration
b. Some dehydration
d. Very Severe Dehydration

7. Management to this child would be:

a. Close observation at home
b. Oresol to be taken for the first 4 hrs
c. Referral to the hospital
d. IV Fluid therapy
8.
a.
b.
c.
d.
9.
a.
b.
c.
d.

Oral Rehydration therapy is important in the management of this

child. How much Oresol should be given to the child?
100-200 after BM
800-1200 ml for the first 4hrs
as much as he desires
1200-2200
Diarrhea is one of the leading causes of morbidity in the
Philippines. The most common cause of diarrhea among the
older children is:
Unsanitary source of water
Improper human waste disposal
Unhygienic feeding practice
Uncollected refuse

10. Prevention is the best care for diarrheal disease. Which of the
following does not match this principle?
a. Measles immunization
c. Hand washing
b. Breastfeeding
d. Oral rehydration
11. This is the drug of choice in the treatment of early pneumonia:
a. Co-trimoxazole
c. Penicillin

18. First aid measures are done:

a. With medical attendance
b. Before the doctor arrives
c. When there is an emergency
d. B and C
SITUATION: During one of the morbid clinics, Rose admitted a 4
month old child who has having diarrhea.
19. Chronic diarrhea is defined as:
a. 2 liquid stools per day for 10 days
b. 3 or more liquid stools per day for less than 2 weeks
c. 3 or more liquid stools per day for less than one month
d. 3 LBM per day for 2 weeks or more in duration
20. In her assessment of the child, Rose found out the following: the
child is unwell and irritable. He is thirsty and on pinching the
skin, it went back slowly. The child is having diarrhea with:
a. No sign of dehydration
c. Severe dehydration
b. Some dehydration
d. Moderate dehydration
21. With the above status of the child, Rose can manage him by
using:
a. Plan A
c. Plan C
b. Plan B
d. Plan D
22. The above treatment plan includes:
a. Home care
b. Oresol for hours given at the health center
c. Intravenous fluid therapy
d. Urgent referral to the hospital
23. What is the fast breathing of Jana who is 3 weeks old?
a. 60 breaths per minute
b. 40 breaths per minute
c.
10 breaths per minute

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d.

20 breaths per minute

24. Which of the following signs and symptoms indicate some

dehydration?
a. Drinks eagerly
b. Restless and irritable
c. Unconscious
d. A and B
25. What is the first line for dysentery?
a. Amoxicillin
b. Tetracycline
c. Cefalexin
d. Cotrimoxazole
26. In home made oresol, what is the ratio of salt and sugar if you
want to prepare with 1 liter of water?
a. 1 tbsp. salt and 8 tbsp. sugar
b. 1 tbsp. salt and 8 tsp. sugar
c. 1 tsp. salt and 8 tsp. sugar
d. 8 tsp. salt and 8 tsp. sugar
27. Gentian Violet is used for:
a. Wound
b. Umbilical infections
c. Ear infections
d. Burn
28. Which of the following is not a part of IMCI case management
process
a. Counsel the mother
b. Identify the illness
c. Assess the child
d. Treat the child
29. If a young child has pneumonia when should the mother bring
him back for follow up?
a. After 2 days
b. In the afternoon
c. After 4 days
d. After 5 days
30. In Integrated Management of Childhood Illness, severe conditions
generally require urgent referral to a hospital. Which of the following
severe conditions DOES NOT always require urgent referral to a
hospital?
A. Mastoiditis
B. Severe dehydration
C. Severe pneumonia
D. Severe febrile disease
31. A mother brought her daughter, 4 years old, to the RHU because
of cough and colds. Following the IMCI assessment guide, which of
the following is a danger sign that indicates the need for urgent
referral to a hospital?
A. Inability to drink
B. High grade fever
C. Signs of severe dehydration
D. Cough for more than 30 days
32. The major sign of iron deficiency anemia is pallor. What part is
best examined for pallor?
A. Palms
B. Nailbeds
C. Around the lips
D. Lower conjunctival sac
33. A 3-year old child was brought by his mother to the health center
because of fever of 4-day duration. The child had a positive
tourniquet test result. In the absence of other signs, which is the most
appropriate measure that the PHN may carry out to prevent Dengue
shock syndrome?
[Link] an NGT and give fluids per NGT.
[Link] the mother to give the child Oresol.
[Link] the patient on intravenous fluids STAT.
[Link] the client to the physician for appropriate management.
34. Which of the following signs will indicate that Baby Rev is
suffering from severe pneumonia?
[Link]
[Link]
[Link] Breathing
[Link] Indrawing

SITUATION: Two children were brought to you. One with

chest indrawing andthe other had diarrhea.
[Link] the integrated Management of Childhood illness approach,
howwould you classify the 1st
child?
[Link]
[Link] pneumonia cough or colds
[Link] pneumonia
[Link]
[Link] 1stchild who is 13 months has fast breathing. Using IMCI
parametershe has:
a.40 breaths per minute or more
b.50 breaths per minute or more
c.30 breaths per minute or more
d.60 breaths per minute or more
[Link] the second child has diarrhea for 5 days. There is no blood
in thestool. She is irritable and her eyes are sunken. The nurse offered
fluidsand the child drinks eagerly. How would you classify
Nenes illness?
[Link] dehydration
[Link]
[Link] dehydration
[Link] dehydration
[Link] treatment should include the following EXCEPT:
[Link] the child and classify him for dehydration
[Link] infants under 6 months old who are not breastfed, give 100-200
ml of clean water as well during this period
[Link] in the health center the recommended amount of ORS for 4
hours.
[Link] not give any other foods to the child for home treatment
[Link] on treatment, Nene 18 months old weighed 18 kg and her te
mperature registered at 370C. Her mother says she developed
cough 3days ago. Nene has no general danger signs. She has 45
breaths per minute, no chest indrawing, no stridor. How would you
classify Nenesmanifestations?
[Link] pneumonia
[Link] pneumonia
[Link]
[Link]
SITUATION: Baby Gem, 3 months old, is brought
to the health center for consultation because of fever and cough. You
suspect that Baby Gem has a respiratory infection.
40. If you assess Baby Gem which of the following is/are important
questionsthat you would ask her mother?
[Link] Baby Gem feeding well?
[Link] Baby Gem able to drink?
[Link] Baby Gem had convulsions during the present illness?
d.A and C only
[Link] is important to assess Baby Gem breathing. You would know
that shehas fast breathing if her RR is:
a.40 breaths/min
b.60 breaths/min
c.65 breaths/min
d.50 breaths/min
42. Baby Gem has fast breathing. The nurse knows that this is a
sign of
[Link] pneumonia
[Link]
[Link] Pneumonia
[Link] Severe Disease
[Link] on the IMCI protocol, Baby Gem belongs to what row?
[Link]
[Link]
[Link]
d.Red10.
44. If baby Gem has stridor, what is the classification?
[Link] Pneumonia: Cough and Cold
[Link]

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[Link] Severe Disease

[Link] Pneumonia
45. What is the dose and schedule of amoxicillin (250 mg
tablet) for a 5-week-old infant who weighs 3.5 kilograms
and has local bacterial infection:
a) tablet 2 times a day for 5 days
b) tablet 3 times a day for 5 days
c) 1 teaspoon of syrup 5 times a day for 2 days
d) 5 ml of syrup 3 times a day for 3 days 2)
46. What is a childs classification if he is 10 months old, has
had a cough that lasted two days, has a breathing rate of 46
breaths per minute and chest indrawing?
a. no pneumonia: cough or cold
b. pneumonia
c. severe pneumonia or very severe disease
d. very severe febrile disease
47. What are the four main symptoms for which every sick
child should be checked?:
a. Malnutrition
b. anaemia
c. Cough, diarrhoea, malnutrition, ear problem
d. cough, diarrhoea, fever, ear problem
48. Approximately 70% of all childhood deaths are associated
with one or more of 5 conditions. Three of these conditions
are diarrhoea, measles and malnutrition. The other two are:
a. Acute respiratory infections, primarily
pneumonia
b. malaria
c. Tuberculosis
d. HIV&AIDS
e. diabetes
A.
B.
C.
D.

A,B
ABC
ACE
ACD

49. A 3-year-old child has fever and diarrhoea. He has no

danger signs and he does not have a cough or difficult
breathing. The child has had diarrhoea for 2 weeks and
there is no blood in stool. The child is restless and irritable,
but is not drinking eagerly. His eyes are not sunken. A skin
pinch goes back slowly. He does not have an ear problem.
The childs diarrhoea should be classified as:
a. no dehydration
b. some dehydration
c. severe dehydration
d. severe persistent diarrhoea
e. persistent diarrhea
f. dysentery
A. ALL EXCEPT A
B. A,B,C,E
C. B &D
D. F ONLY
50. The IMCI clinical guidelines are designed for use with
certain age groups. One group is 2 months up to 5 yeas.
What is the other age group?
a. birth up to 5 years
b. birth up to 2 months
c. 2 months up to 1 year
d. 2 months up to 9 years
e. 6 months up to 10 years
51. A 2-year-old child has had diarrhoea for several days. He is
not dehydrated, but the mother is alarmed because she saw
blood in his stool this morning. Your treatment includes:
a. start antibiotic for dysentery and ORS in the
clinic, re-assess in 4 hours, give the mother ORS
to continue at home, advise on feeding and fluids,
zinc supplement and tell her to return in 5 days
b. start antibiotic for cholera , advise on feeding and
fluids and send home
c. start antibiotic for dysentery, give antibiotic to
take home, advise on feeding and fluids, zinc
supplement, and tell her to return in 2 days
d. start antibiotic for cholera, give vitamin A, give
antibiotic to take home, advise on feeding and
fluids and tell her to return in 3 days

52. Feeding should be assessed in a child who:

a. need urgent referral
b. is less than 2 years old
c. is classified as having anaemia, very low weight
and or growth faltering
d. is classified as having persistent diarrhoea
A. A,B &C
B. B & C ONLY
C. A & D ONLY
D. A & B
53. When a mother is advised to return to a health worker for
her child, it is necessary to tell her when to return for a
follow-up visit and when to return immediately. When to
return for a follow-up visit depends on the childs
classification; for example, in case of acute ear infection
child needs to return in 5 days. The mother needs to return
to the clinic immediately if her child:
a. is drinking eagerly
b. is not able to drink or breastfeed
c. develops fever
d. is coughing often
e. has blood in stool
f. becomes sicker
A.
B.
C.
D.

A & B ONLY
B, C & F
ALL OF THE CHOICES
A ONLY

54.

If a child has had ear pain and pus draining from the ear
for 10 days, and no tender swelling behind the ear, you will
classify this child as having:
a. acute ear infection
b. chronic ear infection
c. mastoiditis
d. not enough signs to classify this child
55. If a child has any of the five general danger signs, you
should urgently refer him to hospital for treatment, These
signs are:
a. not able to drink or breastfeed
b. severe cough
c. convulsions during this illness
d. vomiting everything
e. lethargic or unconsciousness
f. convulsing now
A. A, B, C, E
B. ALL EXCEPT C
C. ALL EXCEPT B
D. ALL OF THE ABOVE
56.

If a child less than 5 years of age and did not receive

immunization for DPT-HB as recommended, it is necessary
to:
a. increase the dose of the vaccine prescribed for
that age
b. not immunize at all because it is too late
c. immunize the child any time, and give the
remaining doses 4 weeks apart

57. A follow-up visit in 5 days should take place if a child is

classified as having which of the following condition(s):
a. pneumonia
b. measles
c. persistent diarrhoea
d. pallor
e. very low weight-for-age and or growth faltering
f. feeding problem
g. acute ear infection
A. A, B, D, F, G
B. C, F, G
C. ALL EXCEPT D &E
D. NONE OF THE CHOICES
58. To be classified as having MASTOIDITIS a child must
have the following signs:
a. severe ear pain
b. redness behind the ear
c. pus draining from one of the ears
d. tender swelling behind the ear

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e.

pus draining from both ears

59. To be classified as having JAUNDICE a young infant must

have the following signs:
a. yellow palms and soles if age is more than 24
hours
b. only yellow eyes and skin if age is more than 24
hours
c. Any jaundice if age less than 24 hours 17)
d. pus draining from the eyes
e. no signs suggesting jaundice
60. What is the cut-off rate for fast breathing in a child who is
11 months old?
a. 60 breaths per minute or more
b. 50 breaths per minute or more
c. 40 breaths per minute or more
d. 30 breaths per minute or more
61. A 14-month-old child with cough is brought to an
outpatient clinic. You will assess this child for:
a. general danger signs
b. common main symptoms such as cough or
difficult breathing, diarrhoea, fever and ear
problems
c. trauma
d. malnutrition and anaemia
e. immunization status
f. developmental milestones
A. A, B, D
B. F ONLY
C. ALL EXCEPT C
D. EITHER B OR D
62. Choose the three best questions for checking the mothers
understanding about how to give an antibiotic:
a. How will you give the antibiotic?
b. Will you give the antibiotic three times per day?
c. For how many days will you give antibiotic?
d. Do you understand how to give the antibiotic?
A. A& C
B. A, B, D,
C. A&D
D. ALL OF THE CHOICES
63. According to IMCI, a mother of a sick child should be
counselled about what topics:
a. importance of the fluids and feeding
b. why she needs to come to clinic
c. when to immediately return to clinic
d. food and feeding problems
e. her own health
f. immunization
g. when to return for a follow-up visit
A. A,C,E
B. A,C,E,G
C. B,D,F
D. ALL EXCEPT A
64. Complimentary foods should be started if the child:
a. shows interest in semisolid foods
b. does not show interest in semisolid foods
c. appears hungry after breastfeeding
d. does not appear hungry after breastfeeding
e. is not gaining weight adequately
f. is six months old
65. If a child has measles now or has had it within the last three
months, and has fever and any general danger sign, he or
she will be classified as having:
a. Uncomplicated malaria
b. severe complicated measles
c. very severe febrile disease or severe malaria
d. measles with eye or mouth complication
A. A&B
B. B&C
C. C&D
D. A ONLY
66. What are two signs that are used to classify severe
malnutrition?

a.
b.
c.
d.
e.

small arm circumference

visible severe wasting
oedema of both feet
severe dehydration
growth faltering
A. A&B
B. B&C
C. C&D
D. A ONLY

67. To classify the dehydration status of young infant with

diarrhoea you will look:
a. at the general condition of the child (does the
infant move when stimulated or does not move
even when stimulated, restless and irritable)
b. for sunken eyes
c. for oedema of both feet
d. if the young infant is drinking eagerly or poorly
e. for visible severe wasting
f. for a swollen abdomen
A. A,C ,D
B. A, B, D
C. C,E,F
D. F ONLY
68. A boy is 13 months old. He weighs 8 kg. His temperature is
37C. His mother says he has had a dry cough for the last 3
weeks. He does not have any general danger signs. The
breathing rate is 41 breaths per minute. There is no chest
indrawing. You can hear wheezing noise when the child
breathes out. There is no stridor when he is calm. The
breathing per minute remained 41 after 3 cycles trial of an
inhaled bronchodilator. There is no diarrhoea, fever or ear
problem. He does not have visible severe wasting, there is
no oedema of both feet and no growth faltering. His palms
are very pale and appear almost white. The child should be
classified as having:
a. pneumonia with wheezing
b. severe anaemia
c. no pneumonia: cough or cold and wheezing
d. severe pneumonia with wheezing or very severe
disease
e. anaemia, very low weight and or growth faltering
A. A, B
B. B ,C
C. C,D
D. NOTA
69. Where can the IMCI case management guidelines be used?
a. in the inpatient ward of a hospital
b. in a neonatal ward
c. in the outpatient ward of a hospital
d. at first-level health facilities
e. at the house hold level
A. A, E
B. A,D,E
C. C, D
D. A,B,D
70. Which should be checked for malnutrition and anaemia?
a. only children with feeding problems
b. only children who are younger than 12 months
old
c. all children brought to the clinic
d. only children who are not breastfed
e. only children with diarrhoea
f. only children with malaria
71. What is the dose and schedule of cotrimoxazole for a 2year-old child who weighs 12 kilograms and is classified as
having pneumonia?
a. 1 adult tablet 2 times a day for 5 days
b. 1 paediatric tablet 3 times a day for 5 days
c. 4 paediatric tablets 2 times a day for 3 days
d. 1 teaspoon of syrup 5 times a day for 2 days
72. A child with fever plus any general danger sign should be
classified as:
a. uncomplicated malaria
b. acute ear infection
c. measles

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d.
e.

very severe febrile disease or severe malaria

mastoiditis

73. If a caretaker brings an 18-month-old child with a cough to

a health facility, what do you need to do?
a. ask the duration of the cough
b. count the number of breaths in one minute
c. look for chest indrawing
d. check for sore throat
e. look and listen for stridor and wheeze
f. take the childs pulse rate
g. check for other main symptoms (e.g. fever,
diarrhoea, ear problem)
h. check for malnutrition and anaemia
i. check the childs immunization status
j. check for other problems
A. ALL ECEPT D& F
B. All except A & E
C. All except H,I &J
74. A boy is 20 months old. He has had fever for 5 days, cough
for 3 days; he is able to drink, does not have convulsions,
and is not lethargic or unconscious. His breathing rate is 51
per minute, there is no chest indrawing or stridor or
wheeze. The boy does not have diarrhoea, but has
generalized rash and a runny nose. There is no clouding of
the cornea or mouth ulcers. The boy should be classified as
having:
a. no pneumonia: cough or cold
b. pneumonia
c. severe pneumonia or very severe disease
d. very severe febrile disease
e. uncomplicated malaria
f. measles
g. measles with eye or mouth complications
A. A& b
B. B &F
C. G ONLY

D.

B ONLY

75. A mother brought her 16-month-old child back to clinic

after 2 days of ORS treatment for diarrhoea with no
dehydration. The mother says that the child still has
diarrhoea and now is coughing and has fever. What is the
proper course of action?
a. immediately refer the child to hospital
b. reassess the child for diarrhea
c. continue current treatment and ask mother to
return later
d. disregard diarrhoea, treat cough
e. assess and classify childs cough and fever as in
initial visit
f. treat diarrhoea, its more important than cough
g. assess and classify diarrhoea as if it is initial visit
A. A, C, D, E
B. A& E ONLY
C. F & G ONLY
D. ALL EXCEPT D
76. Which of the following statements are true?
a. a 3-month-old child should be exclusively
breastfed
b. a 5-month-old child should be breastfed as often
as s/he wants, day and night, at least 10 times in
24 hours
c. children should be given fewer feedings during
illness
A. A ONLY
B. B, C
C. A, B
D. B ONLY

Failure defeats losers, failure inspires winners.

- Robert T. Kiyosaki

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