1. A 10-year old boy has a 4-day history of purulent nasal discharge.

He also had high fever, nasal

congestion and cough. On examination, he is febrile to 39 oC with respiratory rate 24 breaths/min.
His examination is purulent rhinorrhea, swollen and erythematous nasal mucosa. What is the
common etiology of the disease?
a. Respiratory syncytial virus
b. Rhinovirus
c. Staphyloccocus aureus
d. Streptococcus pneumonia
e. Haemophyllus influenza

2. Baby D, 1 day old, 2500 gram, was vomiting since birth. There was greenish vomit and from
physical examination no abdominal distended. From baby gram found double bubble sign. What
should you do?
a. TPN
b. NaCl
c. PPN
d. D5%
e. D10%
Dx: atresia duodenum

3. A girl, 1 year 1 month 8 days old brought by her mother to the growth and developmental
outpatient clinic for progression monitoring. She was born premature (35 weeks). Apgar score
was 6/9. Physical examination revealed there was no facial dysmorphic, other examination was in
the normal limit and she had normal nutritional status. Developmental examination showed the
child can stand on its own for two minutes, can’t walk, can say mama and papa but no specific,
grab objects, and prefer to hold small objects as corn. How does the interpretation of the child’s
development?
a. Fine motor delay
b. Gross motor delay
c. Personal social delay
d. Speech delay
e. Appropriate to age
Usia koreksi: 12 bulan
4. A 14-year old girl was admitted to the hospital with history of consumption of some amount of
wild cassava while she was camping near the forrest. She was folloes by vomiting, cephalgia, and
seizure. Her skin was reddish appearance like cheery. She was brought to ER with respiratory
distress and comatous after the seizure attack. The blood pressure was 85/50 mmHg and heart
rate was irregulary 110 beat/minute. The antidotum for this patient is:
a. Sodium thiosulphate 25% 1,6 ml/kg BW (singkong  sianida)
b. There is no antidotum for this situation, just doing the symptomatic treatment
c. Sodium nitroprussid 3% 0,33 ml/kgBW harusnya sodium nitrat
d. Natrium bicarbonate 84% 2ml/kg BW  Keracunan Jengkol

5. A 5-year-old boy, admitted to our hospital with chief complain of bloody urine. This complain
accompanied with common cold from 2 days before admission. These complaints also occurred
about 2 years ago. From physical examination: normal blood pressure, no fever, no swelling.
Urinalysis: RBC full, WBC 2-3/lpb, nitrit (-), leucocyte esterase (-). The most probable diagnosis is:
a. IgA Nephropathy
b. Focal segmental glomerulonephritis
c. Pyelonephritis
d. Acute nephritic syndrome
e. Cystitis

6. A child who were hospitalized in the pediatric ward obtained echymoses, purpura and
gastrointestinal bleeding. Blood examination showed thrombocytopenia, prolongation of
coagulation studies (PT/PTT), and fibrinogen levels decreased. What is the examination you need
to make a diagnosis: DIC
a. D-dimer
b. C reactive protein
c. Bone marrow aspiration
d. Blood smear
e. Urea and creatinine

7. An 8 months old baby was brought to the ER with information falling out of bed. On physical
examination the child conscious, vital signs good, hematoma in the right eye, and left parieto-
occipital cephal hematoma. The right hand is not active child. Based on the findings of suspected
child abuse. To help make a diagnosis for acts of violence against children, the first imaging
examination to be carried out is: child abuse
a. Scintigraphy head and hands
b. CT scan of the head
c. Ultrasound head
d. MRI of the head
e. X-rays of long bones
`
 8. An 8 year old is accidentally hit in the abdomen by a baseball bat. After several minutes of
discomfort, he seems to be fine. Over the ensueing 24 hours, however, he develops a fever,
abdominal pain radiating to the back and persistent vomiting. On examination, the child
appears quite uncomfortable. The abdomen is tender, with decreased bowel sounds throughout,
but especially painfull in the midepigastric region with guarding. What is the diagnosis?
a. Chron disease
b. Appendicitis
c. Gallstones
d. Choledocal cyst
e. Pancreatitis

9. Babies born from G2P0A0 mother, aterm, crying loudly, by midwife. At age 1 month came to the
ER with seizures, physical examination found normal growth and development, there was no
neurological deficit. Norma routine blood tests. There was a blood clotting disorder. The most
likely diagnosis in this patient is.
a. Alpha thalassemia
b. Beta thalassemia major
c. Vitamin K deficiency
d. Hemophilia A
e. Hemophilia B

10. A 10 year old boy comes with complaint of altered consciousness. About 2 weeks earlier he
appeared to be jaundice which preceded with other signs such as fever and abdominal pain.
After few days of hospitalization patient becomes more toxic, on examination the liver size is
small, hepatic enzymes levels decrease with elevated direct and indirect serum bilirubin levels.
What is the correct diagnosis?
a. Autoimmune hepatitis
b. Hepatitis A
c. Hepatitis B
d. Hepatitis C
e. Fulminant hepatic failure

??????????????
11. A 6-week-old boy comes to your office with several days of vomiting and irritability. He vomits
“everything he eats”. The vomiting does not have any blood in it and is not associated with
diarrhea or fever. The vomitus is described as being light in color but not green. The baby is the
product of a full term gestation with no complications. His birth weight was 3.2 kg. On physical
examination this is a well-nourished child: the weight is 4.4kg, the HR is 180, and the RR is 38. His
anterior fontanel is slightly sunken and there are dry mucous membranes. The abdomen is non
distended with normal bowel sounds. The reminder of examination is unremarkable. The most
likely diagnosis is:
a. Gastroesophageal reflux
b. Pyloric stenosis
c. Intususseption
d. Malrotation
e. Viral gastroenteritis

12. A 6-months child came to the emergency department with generalized seizures, tonic clonic, for
20 minutes, post ictal child looks whimpering and lethargy. There was fever, cough, runny nose
for 5 days, and the history of immunization was not clear. Physical examinations showed bulding
of fontanella, strabismus, hemiparesis dextra, meningeal stimuli sign (-). What examination is
needed to make a diagnosis:
a. CT scan of the head
b. Complete blood
c. Ultrasound of head
d. Procalcitonin
e. Lumbal puncture
??????????????

13. Your patient experienced wheeze everytime “pulang kampong”, which is situated in cold region.
Parent suspected the boy is allergic to aeroallergen and plan skin prick test. However, they asked
what do the need to prepare before the test?
a. Bronchodilator need to be stop, 3 days before the test day
b. Continue antihistamin as there is no deals with test result
c. Stop antihistamin at least 3 days before the test
d. All medication need to be stop before the test day
e. There is no such a preparation. SPT is frankly safety
14. A 3-days boy baby, was weakness, weight 4000 grams, his blood sugar was always below than 60
mg/dl despite being on a drip with dextrose 10% and had persistent hypoglycemia despite
already given dexamethasone and dextrose infusion already increase. The priority treatment
immediately, that must be done to overcome hypoglycemia is it? Dx PHHI
a. Provide acid-base correction
b. Provide correction of electrolyte
c. Increasing the dextrose infusion
d. Provide diaxocid medicine (potassium channel activator)
e. Increasing dose of corticosteroid dose

15. A 5-year old girl weight of 20 kg came to the emergency room complaining of a reddish rash
accompanied by fever and cough and cold for 5 days. On examination found temperature of
40oC, blood pressure of 100/60mmHg, pulse rate 110x/min, GCS 456, there was a confluence
maculopapular rash on the face and neck and part of the thorax. The differential diagnosis in this
case is
a. Rubella  panas tidak tinggi
b. Scarlet fever  strawberry tongue, tonsillitis bilateral
c. Dengue fever
d. Exanthema subitem  demam turun baru muncul rash
e. Morbili = measles = campak = rubeola

16. A boy was brought to hospital by his mother on Januari 21, 2021 to continue the vaccination. He
was born on November 20, 2020. Examination of the child revealed no abnormalities. He has get
vaccination of hepatitis B 0, BCG, oral polio vaccine, and no adverse events following
immunization occurred. Which of the live attenuated vaccines that will be obtained on this age?
a. Oral polio vaccine (KRS dr RS, 2bl, 3bl, 4bl boleh)
b. IPV (bukan live attenuated)
c. BCG x (live attenuated)
d. Measles X (live attenuated)
e. DPT (bukan live attenuated)

17. The most optimal for the operation of complete atrioventricular septal defect (CAVSD) is in the
age:
a. In the age of 2 weeks
b. Age between 3-6 months
c. Age between 7-12 months
d. Age between 3-5 years
e. Age between 1-2 years
 18. Arsa with complaints of pain when swallowing for 4 days, followed by hoarseness for 3 days,
and barking cough. Since the last 2 days do not want to drink and when the fed, sound sleep
snoring. He had slight fever since the last 4 days. On physical examination found temperature
37,8oC, pulse and breath rate appear normal. There were sound of snoring and palpable
enlarged lymph nodes in the neck in the left site. Showed white membrane dirty on the right
half of the tonsils and uvula. What the diagnosis in this patient?
a. Moniliasis
b. Acute laryngitis
c. Infectious mononukleosus
d. Diphtheria in tonsil
e. Laryng and tonsil diphtheria

19. In cyanotic congenital heart disease with a hemoglobin concentration of 6 g/dL, cyanosis will
appear if the oxygen saturation drops to
a. 50%
b. 40%
c. 60%
d. 30%
e. 70%

Contoh soal: Hb polisitemia 20 3/20x100=15% 100-15=85

Rumus: 3/hbx100%=…

20. Baby A, 3800gram, was delivered spontaneously. On physical examination found respiratory
distress (C3,C4,C5 nervus phrenicus pada brachial plexus injury yang lebih proximal), and
weakness of right upper extremities. From radiology examination found that dome of right
diaphragm was increased (hemidiafragma paralisis). The diagnosis of anomaly is:
a. Eventration of diaphragm  kongenital (rubella, CMV), hemidiafragma kiri terangkat
b. Diaphragmatic hernia  kongenital (rubella, CMV)
c. Paralysis of plexus brachialis  mostly karena birth trauma
d. Cerebral edema  kejang, penurunan kesadaran
e. Paralysis of phrenicus nerve  paralisis diafragma ipsilateral, sianosis, asimetris refleks
moro, CXR: elevasi diafragma, shift to contralateral side
21. A 4-year old girl has a 3-days history of sore throat and difficulty swallowing for 3 days. She has
been irritable and does not want to move her neck. Her appetite and intake have decreased and
she has vomited twice overnight. She has no symptoms of upper respiratory tract infection. Her
physical examination is remarkable for fever to 39 oC, bilateral tonsillar exudates and an
erythematous posterior oropharynx with right posterior pharyngeal wall swelling. What is the
most likely diagnosis?
a. Lemierre disease severe illness karena bakteri anaerob (fusobacterium nekroforum) pada
remaja, thrombosis, septic emboli
b. Streptococcal pharyngitis  “vigorous her neck”
c. Peritonsillar abscess  asymetric tonsillar bulge with uvula displacement + trismus remaja
d. Epiglotitis
e. Retropharyngeal abscess

22. A 3 year old boy develops edema, and his general pediatrician obtains laboratory results
revealing hypoalbuminemia, proteinuria, and hypercholesterolemia that are consistent with
nephrotic syndrome. He sends the patient to the emergency department because the boy has
not voided for 12 hours. On physical examination, he has anasarca and abdominal distention. His
mucous membranes are dry, and his skin turgor is decreased. He is less active than normal but
arousable. His heart rate is 145 beats/min and blood pressure is 70/40mmHg. Of the following,
the MOST appropriate initial therapy for this child is intravenous.
a. Lactated Ringer solution
b. Furosemide
c. Albumin and furosemide
d. Albumin
e. 0,9% sodium chloride solution  konsensus

23. Urinalysis obtained during a health supervision visit of a 10-year-old boy reveals 2+ protein. The
remainder of the urinalysis is normal. Results of family and personal medical histories as well as
physical examination of the boy are negative. Of the following, the BEST next step is to:
a. Arrange consultation with a nephrologist
b. Examine the urine of family members
c. Obtain renal ultrasonography
d. Perform a urinalysis on the first morning void  ACR, PCR
e. Obtain a 24-hour urine sample for protein quantification

24. A 8-year-old child with recently diagnosed leukemia lymphoblastic acute develops septic shock
after her first course of chemotherapy when her absolut neutrophil coung is 100/mm3.
Appropriate antibiotics are begun. She is resuscitated with 1 L of crystalloid and her pulmonary
capillary wedge pressure reading is 17 mmHg (normal 4-12). Epinephrine is begun at 4 g/minute
and her heart rate goes from 110 beats/minute to 160 beats/minute. Systolic blood pressure
which was initially 80 mmHg is now 85 mmHg. What is the most appropriate intervention at this
 time? Raised pulmonary capillary wedge pressure (PCWP)  left ventricular failure or severe
mitral stenosis
a. Begin norepinephrine at 1 g/kg/minute
b. Begin dopexamine at 2/kg/minute
c. Begin dobutamine at 7.5g/kg/minute  >5 mcg efek samping takikardi
d. Begin dopamine at 10 g/kg/minute  reseptor alfa aja  vasokonstriksi
e. Begin phenylephrine at 5/kg/minute  reseptor alpha
CARDIO

25. Boys age of 7 days complaining of two seeds testes are not in the scrotum bag, the physical
examination showed palpable both testes in inguinal. What is the priority inspection
immediately must be done to determine the prognosis of the child?
a. Analysis of chromosome
b. Testicle ultrasound
c. Testosterone hormone with stimulation HCG >4 bulan
d. Hormones FSH and LH
 e. The testosterone hormone randomly < 4 bulan

26. In emergency room, a 12 month-old boy came with shortness of breath. According to his
mother, the baby was look ill with symptoms of cough and fever since 2 days ago. Doctor in
primary care said that he was suffer from common cold and gave antipyretic medicine. After 2
days the baby looked distress and difficult to drink, wheezing were heard on both lung, with
prolonged expiration. No history of aspiration. What is the most cause of this disease?
Bronchiolitis
a. Human metapneumovirus
b. Influenza virus
c. Adenovirus 2
d. Parainfluenzae virus
e. Respiratory syncytial virus 1

27. A 6-year old girl came with a complaint often looked black since last 6 months. When stunned,
the child does not respond to any calls/questions. After the attack the child return to normal
activities. Physical and neurological examination were normal. On EEG shows a picture of
generalized slow spike wave 2-3 spd. What is the diagnosis of patient?
a. Juvenile absence epilepsy > 8 tahun
b. Childhood absence epilepsy
c. Temporal lobe epilepsy
d. Idiopathic generalized epilepsy
e. Day-dreaming

28. Mother of a 5 years old boy visit your clinic and seek for consultation regarding her son
nutritional status. The child seems healthy, however he is looking a little bit bigger for his age. If
the body mass index measurement of the child is between 85th and 95th percentiles of CDC 2000
curve, what would you inform the parents regarding their child nutritional status?
a. Risk of overweight BB/TB WHO 0-5 tahun
b. Well-nourished
c. Risk of obesity x
d. Obesity >p95
e. Overweight

29. A 10-year old girl suddenly not be able to stand and walk, the child was not able to control the
micturition and defecation. One week before there was a paralysis of the child and she has a high
fever for 3 days with cough and colds that are cured without treatment. What is the diagnosis in
this child?
a. Meningitis
b. Multiple sclerosis
c. Guillain-Barre Syndrome
d. Transverse myelitis
 e. Poliomyelitis

30. A 14-months old boy is brought to your outpatient clinic. The body weight is 20 kg and the body
length is 79.5 cm. The mother concerns about his body weight. What should you recommend for
the feeding?
a. Feed with low fat
b. Feed with low carbohydrate
c. Feed using feeding rule 3 x makan besar 2 x snack 2 x susu
d. Feed main course only (no snack)
e. Feed only day time

31. The girl baby was born with a length of clitoris 1.5 cm, her blood sugar levels was 40mg/dl, the
sodium 115 meq/dl, and levels of 17 OHP was 150 (n :0,5-2,1 ng/ml). The diagnosis of this infants
is:  Hipoglikemi dan Hiponatremia
a. HAK soft losing  salt wasting ????
b. 46 XY DSD  17OHP normal
c. HAK simple type  tidak ada hipo Na
d. HAK non soft losing
e. Mixgonadal dysgenesis
ENDOKRIN
32. A girl was brought by her mother to the growth and developmental outpatient clinic on
December 10, 2015. She was born on December 5, 2013 (36 weeks, premature). On examination
of the child revealed no abnormalities. Developmental status: can walk up step, feeding a doll,
undressed. How is the development of expressive speech that appropriate for this time? 2 th
a. Can make sentence
b. Can speak 2 words
c. Can speak 6-10 words  18 bulan
d. Papa and mama specifically  10 bulan
e. Can combine word

Soal lain: receptive speech

33. A 9-month-old infant with fever more than 5 days, red skin, red eyes, mouth and red tongue.
There is the lymph node enlargement in unilateral neck with diameter of 2 cm. Laboratory
examination showed 500,000 platelets/ul, ESR 60mm/h, CRP 80mg/dL. The very possible
diagnosis is:
a. Steven Johnson
b. Kawasaki
c. Scarlet fever
d. Measles
e. Rubella
34. A baby born to mothers with gestational age of 38 weeks. At birth the baby was not crying
immediately and weak of muscle tone. In accordance with the handling of newborns, what is
the action that needs to be done soon for the baby?
a. Preparation to refer
b. Positive pressure ventilation
c. Initial steps of resuscitation
d. Routine maintenance
e. Request approval of the family

35. A young woman, 14 years, with complaints of gums bleeding, and a history of menorrhagia in the
last 2 months. Blood tests obtained prolongation of clotting time (bleeding time and PPT).
Platelets and PT were normal. Examination of factor VII and factor I no results yet. What is the
most likely diagnosis is:
a. Hemolytic uremic syndrome
b. Drug-induced thrombocytopenia
c. Acquired platelet dysfuction  Bleeding time manjang
d. Imunotrombocytopenia purpura
e. Von Willebrand Disease

36. 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 episode. On
physical examination, he is afebrile, there is no stridor nor dyspnea, only looks rhinorrhea. What
is the likely diagnosis?
a. Organic foreign body aspiration
b. Spasmodic croup
c. Extraluminal compression of this trachea by a tumor
d. Thracheomalacia
e. Laryngitis

37. Two years of age boy was admitted to the hospital with respiratory problems. His respiratory rate
was 70 times per minute. Based on physical examination, chests x ray and blood gas analysis,
physician in charge consider him as having pneumonia infection with severe metabolic acidosis.
Besides administration of proper antibiotic, which of the following is best route for nutritional
support?
a. Oral route
b. Parenteral route ?  UGM
c. Orogastric tube
d. Nasogastric tube
e. Both enteral and parenteral route ? dr Meta
Kontraindikasi enteral :
 -Obstruksi
-Perdarahan UGI
- Tidak berfungsi sal cerna

38. Boys ages of 3 years were treated with septic shock suffered prolonged shock and persistent
hyponatremia despite given fluid resuscitation, correction of hyponatremia and administration of
inotropic drugs. This is because these children are in a state of.
a. Fluid resuscitation is less adequate
b. Primary adrenal crisis  kelenjar adrenal
c. Not adequate correction of sodium
d. Secondary adrenal crisis
e. Antibiotics are less adequate

39. A 2.5 months baby. BBL 3300 grams. Since the age of 3 weeks had frequent vomiting breast
milk/formula taken. Vomiting more often and spray. Doctors advise to give to drink a little and
the position of the child’s head elevated when put to sleep. The mother were asked to avoid
cow’s milk and its products. Complaints do not improve. On physical examination, the child looks
thirsty, weight 4100 grams, when given the drink, there was visible movement of abdominal
bowel to left to bottom right and found a palpable mass. What kind imaging studies to do next?
 HPS ??
a. Abdominal ultrasound  PYLORIC THICKNESS 3-4 MM, PYLORIC LENGTH 15-19 MM
b. Examination of the series gastrointestinal with contrast AFTER USG ; STRING SIGN Rail
Road Track Sign
c. CT scan of the abdomen
d. MRI of the abdomen
e. X-rays of the abdomen

40. A boy 5 years age, was taken to the emergency room due to a swollen on the face and body
followed by shortness of breath after a few minutes dinner with a menu of fried shrimp. A
month earlier the child also suffered swollen after eating fried shrimp. The correct procedures
that soon you provide are:
a. Epinephrine simultaneous with methylprednisolone, 1-2 mg/kg intravenous
b. Epinephrine simultaneous with diphenhydramine 1 mg/kg, intravenous
c. Evaluation of ABC simultaneous with salbutamol 250 micrograms inhalation
d. Evaluation of ABC simultaneous with epinephrine 0,01 mg/kg intramuscular
e. Epinephrine simultaneously with intravenous fluid 20cc/kg within 30 minutes

41. Prognostic factors in acute lymphoblastic leukemia (ALL) include ages and imuno-phenotyping
picture. Mention other prognostic factors to determine the success of ALL therapy:
a. Prolonged fever in acute phase
b. Sex/gender of the patient
 c. The presence of down syndrome
d. Levels of uric acid in the induction phase
e. Number of leukocytes time at diagnosis  >100.000 menentukan prognosis,
Usia, blast, massa mediastinum, Organomegaly, penjalaran ke SSP

42. You had a 3 month old baby with atopic dermatitis of both cheeks and bodies. According to the
mother, this has occurred since the age of 1 month. What is your priority in the treatment in this
case?
a. Use of emollients  1st
b. Give antihistamines
c. Elimination of cow’s milk
d. Give oral steroids  topikal
e. Give sofa formula

43. Murmur in congenital heart disease are already audible at birth, in which disease are already
audible at birth?
a. ASD
b. VSD
c. PFO
d. PDA
e. Pulmonary stenosis

??????????????

44. 4-year-old child was referred from the clinic with a 4 day history of fever, persistent vomiting,
abdominal pain, and bleeding gums. Physical examination showed weakness, loss of
consciousness. Lab results: NS1 (+), Hb was 13.1 g/dL, HCT 41.5%, Eos 2%, Bas 0,2%, Lymf 57%,
Neut 36%, Mono 5%, trmbo 141,000/uL. The working diagnosis of this patient is:
a. Dengue fever
b. Grade I DHF with bleeding
c. Grade III of DHF
d. Grade II DHF and encephalopathy
e. Dengue fever and encephalopathy

Table anemia WHO

4-10 th  hb 11.5

45. 16 hour old baby was taken to the emergency room (ER) of the hospital with complaints of
seizures. The gestational age was 40 weeks, birth weight 3500grams, with asphyxia. Babies cry
after resuscitation until positive pressure ventilation 3 x 30 seconds. Babies stabilization
 conducted at the health center hospitalization before referral. During stabilization appear
restless and fussy baby, there are still grunting. Baby suffers a seizure about 12 hours after
birth. What is the most likely cause of seizures in these infants?
a. Hypoxic Ischemic Encephalopaty
b. Electrolyte disorders
c. Extracranial hemorrhage
d. Intracranial hemorrhage
e. Intracranial hemorrhage

46. A 6-year old boy has a 5 day history of runny nose. He also had history a 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 breath/min. His examination is purulent rhinorrhea,
swollen nasal cavity and erythematous nasal turbinates. What is the most likely diagnosis?
a. Faringitis
b. Sinusitis  nyeri, post nasal drip
c. Common cold
d. Rhinitis bacterial  >10 hari, double sickening
e. Allergic rhinitis

47. A 19 year month old child was brought to your practice with complaints of delayed speech and
bizzare behavior, stereotype. Which kind of developmental screening is the most appropriate to
this case?  Autism
a. PEDS 0-8 tahun  kalau 19 bulan jawaban nya ini
b. Conners 6-18 tahun
c. PSC 6-18 tahun
d. CHAT 18 bulan
e. KMME 3-6 tahun

TUMBUH KEMBANG

48. A 9 month old boy was brought to the emergency room with febrile seizures. Fever appeared
since this morning, accompanied by cough and cold. Seizure lasted 1 minute. After seizure he was
crying, conscious, and there is no prior history of seizures. Physical examination revealed no
abnormalities except pharyngeal hyperemia. Laboratory results showed leukopenia. The day
before the fever he received measles vaccine. According to that case, which type of “adverse
events following immunization” classification?
a. Vaccine reaction
b. Not “adverse event following immunization”
c. Coincidence
d. Procedural error
e. Injection reaction
4  vaccine reaction, coincidence, ae following immunization,

49. A one-year-old boy was admitted to your hospital, the body weight was 7.0 kg, the length was
74.5cm, WHZ was below -3Z score on WHO growth chart. He suffered from recurrent diarrhea
since one month ago. What kind of nutritional management should be given?
a. Formula 75
b. Modisco
c. Rice and vegetables
d. Rice porridge
e. Soy formula

50. A one year old girl brought to the growth and developmental clinic for a scheduled visit. Clinician
performed developmental screening using the Denver II. The right end of developmental bar of
Denver II showed
a. 50% of children in the population can pass the task
b. 90% of children in the population can pass the task
c. 75% of children in the population can pass the task
d. 95% of children in the population can pass the task
e. 100% of children in the population can pass the task

51. A 6-year-old boy came with complaints of long fever, intermittent bone pain, gums bleeding.
Physical examination showed pallor, petechiae. No organomegaly. The results of laboratory
found Hb 7 g/dL, platelets 70,000/mm3, leucocytes 3,000/mm3. Reticulocyte <1%. What is the
investigations will be required to make a diagnosis?
a. Bone marrow biopsy
b. Tissue biopsy
c. Bone marrow aspiration
d. Molecular biology
e. Immunophenotyping

52. Egg on site on chest X ray is seen in:

a. TAPVD snowmann appearance
b. TGA
c. Truncus arteriosus
d. ToF
e. DORV
Egg-on-a-string sign, also referred to as egg on its side, refers to the cardiomediastinal
silhouette seen in transposition of the great arteries (TGA). The heart appears globular due to
an abnormal convexity of the right atrial border and left atrial enlargement and therefore
appears like an egg.

TapvC

Total anomalous pulmonary venous connection (TAPVC)

Total anomalous pulmonary venous return (TAPVR

53. A 1 year old child referred to our hospital with the diagnosis of dengue shock syndrome. He is
somnolent, tachycardia and clammy acral. No data for the last urine output. The previous
 hospital sent the patient because they found difficulty in inserting iv line. The lab result showed
thrombocytopenia 13,000 and increased hematocrit to 46%. The next management is:
a. Inserting nasogastric tube
b. Prepare central access
c. Do the intraosseous access
d. Venae section
e. Inserting iv line peripherally

54. The 10 months baby, 8 kg. Brought to the emergency department with a description often crying
since morning. Vomiting 1x, contents of the food. Two days earlier the child diarrhea, have been
treated and cured. Two hours prior to the ED, bleed diarrhea. On physical examination, a
palpable mass in the right upper abdomen. On ultrasound examination it was shointubatwn to
resemble a donut oval mass in the right upper abdomen. What is affects the baby?
a. The right kidney tumor
b. Invagination  pain, palpable mass (sausage in right upper abdomen), bloody jelly stool.
USG: Donut
c. Appendicitis
d. Skibala
e. Choledochal duct cyst

55. In the paroxysmal stage of child with pertussis may experience the following conditions:
a. Recurrent cough, high fever, and tachypnea
b. Subfebril fever, seizures, and shortness of breath
c. Letargis, lazy drink, and high fever
d. Colds, cough, and vomiting every time cough
e. Apnea, vomiting at the end of cough, seizures

1. Fever  stadium cataral (1-2 minggu)

2. Std paroksismal 2-6 minggu  batuk, whooping, membiru
3. Std konvalesen  membaik (2 minggu)

56. A 9 year old boy complains o lower gastrointestinal bleeding and mucous drainage. He appears
well and denies nausea or vomiting, but notes occasional crampy abdominal pain. Heart rate
and blood pressure are normal, and rectal examination reveals velvety polyps. The next
appropriate step is: Adenomatous Polyposis
a. Meckel scan
b. Colonoscopy
c. Air-contras enema
d. Stool culture
e. Empiric antibiotic therapy
57. An 18 months old girl was brought to hospital with edema on her both extremities. Physical
examination shows apathetic general appearance, no sign of breathing difficulties, increase heart
rate, organ enlargement or intra peritoneal fluid collection. Severe muscular wasting existed
following 1 month of moderate febrile illness. No protein was found in the urine. Which one of
the listed below is likely to explain the child condition?
a. Nephrotic syndrome
b. Kwashiorkor
c. Marasmus-keashiorkor
d. Marasmus
e. Pellagra

58. A boy 8 years old had a high fever since 6 days ago, initially not high, since the last 2 days had
continuous high fever with shivering and sometimes delirious when high fever. He got
antipyretic but body temperature remains high. Eating just 2-3 tablespoons, there were
complaints of nausea and vomiting. No defecation in the last 3 days. On physical examination
showed compos mentis, looked sick, weight 25kg, blood pressure 110/70 mmHg, temperature
39,8oC, pulse rate 120x/m, breath rate 28x/min. There was meterorismus, and enlarged liver
3x2x2 cm. What investigation is most appropriate for this patient?
a. Full blood and urine examination
b. Full blood and Ig M salmonella  >5 hari demam
c. Full blood and widal slide
d. Full blood examination
e. Full blood and Ig M and Ig G dengue

59. A boy baby, 7 days old was taken by his mother to the clinic with complaints swelling on the
head that began from the 2 day old. History of trauma after birth was denied. On physical
examination found swelling in the right parietal, demarcated, not passing the suture and
fluctuate. What is the diagnosis of this baby?
a. Caput succedanum
b. Bleeding subaponeurotik
c. Cephal hematoma
d. Bleeding subgaleal
e. Subdural hemorrhage
60. A 2 years child with cerebral palsy, came to the with complaints suffered of recurrent seizures
since six months ago. Seizures always preceded by high fever, and repeated each month. Each
episode of seizure lasts for 15-20 minutes, 2-3 times/day. The last seizures was 1 week ago.
What are your actions to prevent recurrent seizures later in his life?
a. Educational parents without giving any medicine
b. Giving long term prophylaxis with valproic acid during the first year  KDK as valproate atau
phenobarbital selama 1-2 th
c. Giving intermittent prophylaxis with oral diazepam if high fever
d. Giving of long term prophylaxis with valproic acid for 2 years
e. Giving intermittent prophylaxis with oral

Indikasi pengobatan rumat :

- Kejang fokal
- Kejang lama > 15 menit
- Terdapat kelainan neurologis nyata spt CP, Hidrosefalus, hemiparesis

61. A 12 years old boy present to the emergency department with a 3 day history of a tea colored
urine that began 2 days following an upper respiratory tract infection. There is no history of
dysuria, and findings on physical examination are normal. The family history is negative for any
kidney disease. His blood pressure is 115/70 mmHg. Urine analysis is reveal: specific gravity
 1.025; pH 6.0; red blood cell too numerous to count; + 1 protein; and 0-2 white blood cells.
Electrolyte levels are normal. Of the following, the most likely diagnosis is
a. Alport syndrome  hematuri + hearing loss
b. Hypercalciuria
c. Immunoglobulin A nephropathy
d. Focal segmental glomerulonephritis  hematuri + edema
e. Post infectious glomerulonephritis  HT

62. A 1 year old infant admitted to pediatric intensive care unit (PICU) with fever, shock and lethargy.
After administering fluid boluses and starting of inotropes, he was intubated and supported by
mechanical ventilation. Investigation showed leukocytosis and thrombocytopenia with severe
metabolic acidosis. Within 6 hours after admission, urine output decrease and he started
bleeding from the nasogastric tube. He had persistent tachycardia with cold extremities.
Investigation showed persistent metabolic acidosis, elevated liver enzymes, severe
coagulopathy and rising serum creatinin. Which is the appropriate renal replacement therapy
for this infant?  SEPSIS
a. Peritoneal dyalisis  neonates and infant, KI: GI bleeding
b. Intermittent hemodyalisis  hemodynamic stabil, KI: vs tdk stabil
c. Renal transplant
d. Continuous arteriovenous hemofiltration (CAVH)  hemofiltrasi aja (buang cairan aja)
e. Continuous venovenous hemofiltration (CVVH)  hemodiafiltrasi (acidosis, gangguan
elektrolit  seperti ECMO)
Indikasi Continuous Renal Replacement Therapy :
- Unstable hemodynamic
- Concomitant Sepsis
- Multiorgan Failure

63. An 18 hour old infant has bilious stained emesis following 3 initial feedings. The prenatal and
delivery history are unremarkable. On physical exam, the infant is quiet. The occasional
peristaltic waves are noted and the abdomen is not distended. Which of the following finding is
most likely on further radiologic evaluation of this infant? Dx: Obstruksi duodenum
a. A choledochal duct cyst
b. GE reflux
c. Pyloric hypertrophy
d. A double bubble sign
e. Malrotation

64. Baby B, 1600 gram, with gestational age 32 weeks, born spontaneously, from physical
examination revealed grunting, cyanosis and heart rate was 120 bpm. What should you do to
support the ventilation?
 a. Intubation and ventilator
b. Nasal CPAP FiO2 100% PEEP 7 cm H2O
c. Non invasive ventilation
d. High flow nasal canula
e. Nasal CPAP FiO2 40% PEEP 7 cm H2O

65. Among the following signs, which are the characteristic of Erb’s paralysis?
a. Extremity involved in the abduction position
b. Extremity involved in adduction position
c. Grasp reflex negative
d. Moro, biceps, and radial reflex still positive
e. Extremity involved in the position of external rotation

Erb’s palsy
Involves upper plexus (C5, C6)
In 50% of cases, C7 is affected
Arm held limply adducted, internally rotated, and pronated with wrist flexed and fingers flexed
(“waiter's tip” position)
Biceps reflex absent, Moro reflex with hand movement but no shoulder abduction, palmar
grasp present
Ipsilateral diaphragmatic involvement in 5%

66. A boy baby born from the mother, G2P1A0; 40 weeks, the amniotic was green. Directly cried,
body weight 3500 gram. A few minutes later the child whimpered, there was retraction. Breath
sounds enough. SpO2 95%. Glucose 60. Was installed CPAP, PEEP 8, FiO2 21%. Meconium
aspiration is suspected. On chest X-ray is expected to find a picture of:
a. Spotting reticulogranular in both lung fields with water bronchogram  RDS grade II-III
b. Second opaque lung fields, heart picture does not look  RDS grade IV
c. Rough patches in both lung fields with little pulmonary emfisematus
d. Appearance of round luscen in both lung fields to the peripheral  BPD, post surfaktan
e. Perihilar infiltrate and paracardial  pneumonia