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Primary Care Pediatrics P03-P15.

1. Developmental Milestones.
***) At age of 4 months infant can do all of the following, except:
A. Orients to voice
B. Says "dad & mama"
C. Supports head well
D. Says "ah-goo"
E. Does not say clear words


***) A child can usually roll over by age:
A. 4 weeks
B. 12 weeks
C. 16 weeks
D. 28 weeks
E. 40 weeks


***) All of the following are present in an average child aged 11 months, except:
A. Bladder control by day
B. Can throw objects
C. Usually 2-4 teeth
D. Responds to simple commands
E. An index finger approach to objects


***) An average child of 12 months can do all, except:
A. Sits without support
B. Has an index finger approach to objects
C. Waves bye-bye
D. Enjoys looking at picture books
E. Control urination by day time


***) A 1 year old child would be expected to do all of this, except:
A. Build a tower of 3 cubes
B. Grasp a pellet
C. Reach for an object
D. Transfer an object from hand to hand
E. Stand alone



***) A normal 1 year old child can do all of the following, except:
A. Throw objects
B. Know own name
C. Speak in phrases
D. Walk with support
E. Pull self up and stand holding on the furniture


***) Child at one year of age can do all except:
A. Pulls self up and stand on furniture
B. Throw objects
C. Obeys simple requests
D. Knows own home
E. Speaks in phrases


***) Most normal children can walk at the age of:
A. 6 months
B. 8 months
C. 10 months
D. 12 months
E. 18 months


***) The most advanced language function a 14 months old child usually can perform is one of the
following:
A. Speak several recognizable words
B. Combine two different words
C. Speak in complete sentences
D. Use the past time
E. Refer to himself (I)


***) A 15 months old infant can do all of the following, except
A. Walks alone
B. Uses 4-6 words
C. Builds tower of 2 cubes
D. Creeps upstairs
E. Points to 8 body parts


***) The average 18 months old child is expected to know:
A. 10 words
B. 20 words
C. 40 words

D. 60 words
E. 100 words


***) A normal child of 18 months should do all of the following, except
A. Walks alone
B. Uses spoon himself
C. Puts two to three words together in a phrase
D. Uses at least 4 clear words
E. Understands requests and forbids


***) By age of 2 years the child can speak:
A. Three word sentences
B. Four words sentences
C. Five words sentences
D. Six words sentences
E. Seven words sentences


***) A 24 months old child is expected to do all of the following, except
A. Walk up and down stairs, one step at a time
B. Handle spoon well
C. Build a tower of 4 cubes
D. Can put 3 words together
E. Can draw a square


***) A child at the age of 36 months, can do all except:
A. Rides tricycle
B. Build lower of 10 cubes
C. Washes hands
D. Knows age and sex
E. Running well

***) A child can hop on one foot by age of:
A. One year
B. Two years
C. One year and a half
D. Two years and a half
E. Four years






***) Define the ability to abstract terms such as justice, honesty and dignity is expected to occur at age of:
A. Three years
B. Four years
C. Five years
D. Seven years
E. Ten years


2. Primitive Reflexes.
***) A normal full term newborn can demonstrate all of the following reflexes, except:
A. Moro reflex
B. Palmar grasp reflex
C. Sucking reflex
D. Parachute reflex
E. Rooting reflex


***) When examining a two months old infant you expect to find all the following reflexes except:
A. Moro Reflex
B. Parachute Reflex
C. Palmar Reflex
D. Rooting Reflex
E. Planter Reflex


***) All of the following statements about Babinski reflex are true, except:
A. Positive response is considered to be normal in the first year of life
B. Negative response is also considered to be normal in the first year of life
C. Asymmetrical positive response is considered normal in the first year of life
D. It is considered as pathological reflex
E. It is induces by stimulating the lateral aspect of foot


***) Following a difficult delivery a unilateral Moro reflex is elicited. This is often a presenting sign of a:
A. Subdural hematoma
B. Tentorial tear
C. Fractured clavicle
D. Sepsis
E. Depressed skull fracture





3. Vaccinations.
***) The first dose of DPT and oral polio vaccines is recommended at:
A. First day of life
B. 3 weeks
C. 2 or 3 months
D. 6 months
E. 9 months


***) DPT is a vaccine given to infants usually at 2 months of age, and protects from all of the following
disease, except:
A. Diphtheria
B. Pertussis
C. Measles
D. Tetanus
E. Diphtheria and tetanus


***) Concerning oral polio vaccine OPV (Sabin) all of the following are true, except:
A. OPV is a live attenuated vaccine
B. OPV is best stored at 2-8 C
C. It is easy to administer
D. It is of definite value on controlling epidemics of polio
E. One dose is sufficient and will give long life immunity


***) All these vaccines are alive attenuated, except:
A. Mumps
B. Measles
C. Yellow fever
D. Hepatitis B vaccine
E. Rubella


***) All of the following immunizations are generally performed using a live organism, except:
A. Poliomyelitis Sabin
B. Measles
C. Rubella
D. Whooping cough
E. Mumps

***) The following immunizations are generally performed using a live attenuated organism, except:
A. Poliomyelitis
B. Measles
C. Bacillus Calmette Guerin BCG

D. Pertussis
E. Influenza


***) In immunosuppressed children, all of the following vaccines are contraindicated, except:
A. Measles vaccine
B. Oral polio vaccine
C. Rubella vaccine
D. Pertussis vaccine
E. BCG


***) One of the following vaccines can be given to patient with T-cell deficiency:
A. Pertussis
B. Oral polio
C. Rubella
D. BCG
E. Measles


***) Measles vaccine is given in Jordan at age:
A. 3 months
B. 6 months
C. 9 months
D. 15 months
E. 24 months


***) Select the most appropriate statement:
A. Measles vaccine is a live attenuated virus
B. Prophylaxis against malaria is always effective
C. Tuberculosis can always be prevented by the BCG vaccine alone
D. The most important factor in the prevention of cholera is immunization with vaccine
E. The most important factor in the prevention of coronary heart disease are active exercises


***) All of the following about rubella vaccine are true, except:
A. It is a live attenuated viral vaccine
B. It should not be given to children before the age of one year
C. It should not be administered to pregnant women
D. It may be associated with arthritis in adult females
E. It should not be administered with other viral vaccines




***) Reactions to live MMR vaccine usually occur:
A. Within minutes after vaccination
B. Within 24 hours of injection
C. Within 48 hours of injection
D. After 6-8 days following the injection
E. After 14-21 days following the injection


***) The national vaccination program in Jordan includes vaccination against all of the following, except:
A. Measles
B. Whooping cough
C. Diphtheria
D. Hepatitis A
E. Poliomyelitis


4. Nutrition.
***) Colostrum has all of the following properties, except:
A. It has higher fat content than mature milk
B. It has higher protein content than mature milk
C. It has less sugar content than mature milk
D. Sodium and potassium content are higher than in mature milk
E. It contains protective antibodies and leukocytes


***) Regarding colostrum all are true, except:
A. Daily secretion is 10 to 40 ml
B. It has an alkaline reaction
C. Contains less fat than mature breast milk
D. Contains less carbohydrates than mature breast milk
E. Contains less protein than mature breast milk


***) Concerning breast feeding all of following are true, except:
A. It should be initiated immediately following child birth
B. Repeated feeding increases the flow of milk
C. Consuming fluids helps the mother to maintain breast feeding
D. Breast feeding is not recommended after introducing solid food
E. Colostrum contains antibodies that are useful to the newborn


***) In breast milk feeding all is true, except:
A. Less allergic symptoms than bottle feeding
B. Less incidence of gastroenteritis
C. Less incidence of URTI

D. Increased incidence of obesity than bottle feeding
E. Increased emotional attachment


***) Human milk is relatively low in one of the following:
A. Carbohydrates
B. Proteins
C. Fat
D. Calcium
E. Iron


***) All of the following regarding breast feeding is true, except:
A. Breast milk contains IgA which protects against gastrointestinal infections
B. Breast milk is relatively low in iron
C. The bioavailability of iron in human milk is very high
D. Breast feeding enhances the emotional bond between the mother and her infant
E. Breast feeding is not advisable in case of twins


***) Regarding human breast milk all are true, except:
A. Iron of human milk is poorly absorbed
B. Breast feeding should start as soon as possible after birth
C. Lactose content in human milk is higher than in cow's milk
D. Sodium content in human milk is lower than in cow's milk
E. Proteins are lower than in cow's milk


***) The advantages of breast milk include all of the following, except:
A. Always fresh and ready
B. Always at right temperature
C. Establishes healthy mother-child relationship
D. Contains less carbohydrate per 100 ml than cow's milk
E. Protects against infections


***) Compared to cow's milk with human milk, one of the following is true:
A. Sodium content is less in cow's milk
B. Carbohydrate content is more in cow's milk
C. Caloric content is almost the same
D. Unsaturated fatty acids are more in cow's milk
E. Folate content is less in cow's milk




***) The protein content of cows milk is:
A. 1.5 g
B. 2.5 g
C. 3.5 g
D. 5 g
E. 7 g


***) Human milk (breast milk) contains all of the following, except:
A. Vitamin A
B. Vitamin C
C. Vitamin B
12

D. Vitamin B
2

E. Vitamin D


***) Regular infant formulas are modified from cow's milk to resemble human milk. One of the following
statements is correct regarding these formulas:
A. They are safe to be used by infants with cow's milk allergy
B. They are supplemented by the daily requirements of vitamins
C. They are specifically indicated in patients with galactosemia
D. Their fat concentration is less than that of cow's milk
E. They do not contain lactose


5. Normal Physical Growth.
***) Children triple their birth weight by age of:
A. 1 year
B. 2 years
C. 6 months
D. 9 months
E. 3 months


***) In normal developing fetus, the most likely head circumference measurement at full term is:
A. 30 cm
B. 33 cm
C. 36 cm
D. 38 cm
E. 40 cm


***) The average head circumference of a normal child at one year of age is:
A. 40-42 cm
B. 43-45 cm

C. 46-48 cm
D. 49-52 cm
E. 53-56 cm


***) The average growth of head circumference during the first year is:
A. 5 cm
B. 8cm
C. 12 cm
D. 16 cm
E. 20 cm


***) In the majority of infants the anterior fontanel is closed by:
A. 3 months
B. 6 months
C. 10 months
D. 18 months
E. 24 months


***) Regarding development, all the following are true except:
A. The newborn regains his body weight by 10 days of age
B. Double birth weight by 5 months, triple by 1 year
C. Double birth length at 4 years
D. Increased head circumference 4-5 cm during the first year
E. Increased length 25-30 cm during first year


***) Growth charts of 1 year old child show length of one stand deviation (SD) below third percentile,
weight and head circumference of 2 SD's below the third percentile. The most likely primary diagnosis is:
A. Microcephaly
B. Failure to thrive
C. Short stature
D. Failure to thrive leading into short stature
E. Failure to thrive leading into microcephaly


6. Failure to Thrive (FTT).
***) Causes of failure to thrive include all of the following, except:
A. Emotional deprivation
B. Intestinal malabsorption
C. Renal tubular disorders
D. Chronic heart failure
E. Acute chest infection



***) Caloric requirements by the beginning of the second week of life are:
A. 60 kcal/kg
B. 80 kcal/kg
C. 100 kcal/kg
D. 120 kcal/kg
E. Over 140 kcal/kg


***) The daily requirement of vitamin D for the newborn is:
A. 40 IU
B. 400 IU
C. 4,000 IU
D. 40,000 IU
E. 400,000 IU


***) All of the following statements concerning daily needs of an infant are true, except:
A. 400 IU of vitamin D
B. 6 mg of iron
C. 50 mg of vitamin C
D. 110 calories per kg
E. 150 ml of water per kg


A. Rickets
B. Vitamin E deficiency
C. Hydrocephaly
D. Syphilis
E. Premature baby


***) Clinical signs of marasmus may include all of the following, except:
A. Loss of turgor of skin
B. Poor appetite
C. Hypotonia
D. Subnormal temperature
E. Never associated with edema


***) All are feature of Kwashiorkor, except:
A. Anorexia
B. Constipation
C. Liability to infection

D. Hair depigmentation
E. Moon face


***) Each of the following statements about Kwashiorkor is true, except:
A. It is primarily a caloric malnutrition
B. Loss of muscle tissue is present
C. Hepatomegaly is due to fatty infiltration
D. Pigmented skin is common
E. Edema of limbs is usually present


***) Regarding Kwashiorkor all of the following are true, except:
A. Caused by low protein diet
B. Failure to thrive and edema are presenting features
C. Caused by low caloric diet
D. Hypopigmentation of the hair is a feature
E. Abdominal distension is a feature


7. Circumcision.
***) Circumcision is contraindicated in babies with:
A. Long prepuce
B. Phimosis
C. Hypospadia
D. Hemophilia
E. Recurrent balanitis


8. Elimination Disorders.
***) An evaluation of every child who has enuresis should include all of the following, except:
A. Family history
B. Urine analysis
C. Urine culture
D. Intravenous pyelogram
E. Fasting blood sugar


***) Regarding Enuresis, all are true except:
A. Most children achieve bladder control during day time and night by age 5 years
B. Is more common in boys than in girls
C. Spontaneous resolution can occur
D. Conditioning devices is modality of treatment
E. No pharmacological therapy



9. Breath-Holding Spells.
***) All of the following are characteristic of breath holding spells, except:
A. It can occur up to age of 4 or 5 years
B. It is self-limited
C. It does not occur in mentally retarded children
D. It sometimes runs in families
E. It could lend to convulsions


***) Concerning breath holding attacks all are true, except:
A. Are common in toddlers (1-3 years of age)
B. Are easily confused with a generalized seizure
C. Should be treated with sedatives
D. May be precipitated by a minor injury
E. The history is very important for the diagnosis


Adolescent Medicine P17-P18.

1. Normal Sexual Development.
***) The first sign of puberty in males is:
A. Increase size of testicles
B. Appearance of facial hair
C. Appearance of axillary hair
D. Appearance of pubic hair
E. Appearance of body hair


***) The first visible sign of puberty in girls is:
A. The appearance of breast buds
B. Menses
C. Increased in height velocity
D. Enlargement of the external genitalia
E. Axillary hair


***) Precocious puberty is diagnosed in female when secondary sexual characteristics appear before:
A. 4 years age
B. 8 years age
C. 10 years age
D. 12 years age

E. 14 years age


Cardiology P18-P26.

1. Heart Murmurs.
***) Concerning innocent murmur all of the following are true, except:
A. Low-pitched vibratory murmur
B. Usually diastolic
C. Not more than grade 2/6 in intensity
D. No splitting in heart sounds
E. Best heard in midprecordium


***) Auscultatory features characteristic of a benign murmur include all of the following, except:
A. Confirmation to systoles
B. Audible in a restricted area of precordium only
C. A quiet musical quality
D. No variation with position
E. Short duration


2. Congenital Heart Disease.
***) The most common cause of central cyanosis in the neonates is:
A. Congenital heart disease
B. Lung disease
C. CNS disease
D. Hypoglycemia
E. Polycythemia


***) One of the following is the most common congenital heart defect in infants and children:
A. ASD
B. VSD
C. Aortic coarctation
D. Right ventricular hypertrophy
E. Pulmonary artery stenosis


***) All of the following statements are correct, except:
A. Cyanosis at birth may indicate transposition of the great arteries TGA
B. Aortic regurgitation is the most common heart lesion in rheumatic carditis
C. Ventricular septal defect VSD is the most common CHD

D. Patent ductus arteriosus PDA is more common in premature
E. Chest X-ray will show olgemic lung fields in pulmonary artery stenosis


3. Acyanotic Congenital Heart Disease.
***) All of the following are acyanotic congenital heart disease, except:
A. Ventricular septal defect
B. Fallot tetralogy
C. Aortic stenosis
D. Atrial septal defect
E. Pulmonary stenosis


***) All of the following are acyanotic congenital heart diseases, except:
A. Transposition of great vessels
B. Patent ductus arteriosus
C. Coarctation of aorta
D. Atrial septal defect
E. Ventricular septal defect


***) The commonest non cyanotic congenital heart disease is:
A. ASD atrial septal defect
B. VSD ventricular septal defect
C. PDA persistent ductus arteriosus
D. Aortic stenosis
E. Mitral insufficiency


***) Regarding left to right cardiac shunts all are true, except:
A. Cyanosis is a prominent feature
B. Oxygenated blood is shunted from left to right
C. Systemic flow is decreased
D. Pulmonary congestion is a prominent feature
E. Left heart pressures normally exceed those on the right


***) In Atrial Septal Defect (ASD) all are true except:
A. The murmur heard is secondary to flow through the ASD
B. Surgery is indicated once diagnosed in symptomatic patients
C. Secundum type is the most common
D. Usually asymptomatic in childhood
E. Surgery is contraindicated if severe pulmonary hypertension developed



***) Large VSD alone in infancy may present by all of the following, except:
A. Failure to thrive
B. Recurrent chest infections
C. Holosystolic murmur
D. Cardiomegaly and oligemic lungs on chest X-ray
E. ECG shows biventricular hypertrophy


***) All of the following could be manifestations of large VSD, except:
A. Feeding difficulties
B. Left to right shunt
C. Cardiomegaly
D. It is the commonest congenital heart disease
E. Absent femoral pulse


***) A 2 year old boy, presented with upper respiratory tract infection, the treating physician accidently
heard a pansystolic murmur during cardiac auscultation the most likely diagnosis is:
A. Atrial septal defect
B. Coarctation of aorta
C. Transposition of great vessels
D. Ventricular septal defect
E. Patent ductus arteriosus


***) Regarding coarctation of the aorta all are true except:
Affecting males more than females
The ascending aorta is the most common site
Can be presented with hypertension at childhood
In severe narrowing its indication for surgery
The surgical approach is through right rhoracolomy


***) All of the following does not require treatment in a newborn, except:
A. A scrotal hydrocele
B. Breast enlargement
C. Mongolian spot
D. An erupted tooth
E. Femoral pulses absent


4. Cyanotic Congenital Heart Disease.
***) Cyanotic congenital heart disease includes all of the following, except:
A. Transposition of great vessels
B. Fallot tetralogy

C. Isolated VSD
D. Tricuspid atresia
E. Pulmonary artery stenosis


***) Only one of the following is cyanotic congenital heart disease:
A. Fallot tetralogy
B. Patent ductus arteriosus
C. Atrial septal defect
D. Ventricular septal defect
E. Coarctation of aorta


***) Tetralogy of Fallot exhibits all of the following, except:
A. Cyanosis
B. Ventricular septal defect
C. Patients do not develop congestive heart failure in infancy
D. Obstruction to right ventricular outflow
E. Right ventricular hypertrophy


5. Congestive Heart Failure.
***) All of the following are common features of heart failure in infancy, except:
A. Hepatomegaly
B. Lower limb edema
C. Feeding difficulties
D. Tachycardia
E. Failure to thrive


***) Which one of the following is not common in acute heart failure of infancy:
A. Peripheral edema
B. Tachypnea
C. Tachycardia
D. Gallop rhythm
E. Hepatomegaly


***) Congestive heart failure in infancy is characterized by all of the following, except:
A. Enlarged palpable liver
B. Feeding difficulties
C. Heart rate over 150/min
D. Respiratory rate over 40/min
E. Oligemic lung fields in chest X-ray



***) Congestive heart failure in infancy commonly presents with all of the following, except:
A. Peripheral edema
B. Poor weight gain
C. Excessive perspiration
D. Weak cry
E. Tachypnea


***) The first sign of heart failure in infants is usually:
A. Peripheral edema
B. Engorged jugular veins
C. Basal crepitation
D. Tachypnea and tachycardia
E. Puffiness of eye lids


***) Goals of medical therapy for congestive heart failure in children include all the following except:
A. Reducing the preload
B. Enhancing cardiac contractility
C. Increase the after load
D. Improving oxygen delivery
E. Enhancing nutrition


Development P26-P29.

1. Intellectual Disability.
***) The following mental retardation may be caused by inherited errors of metabolism and can be treated by
dietary measures, except:
A. Phenylketonuria
B. Hypothyroidism
C. Galactosemia
D. Tyrosinemia
E. Maple syrup urine disease


***) All of the following can cause mental retardation, except:
A. Emotional disturbances
B. Birth trauma
C. Meningitis
D. Cerebral lipidoses
E. Protein losing enteropathy



Endocrinology P29-P36.

1. Diabetes Mellitus (DM).
***) Concerning diabetes mellitus in children all of the following are true, except:
A. Polydipsia
B. Polyphagia
C. Ketoacidosis
D. Does not always require injectable insulin
E. Usually is rapid in onset, often presenting as diabetic coma


***) A 3 years old child lost appetite over the last few days, ingested a lot of water, frequent urination, and
developed acute abdominal pain, vomiting and hyperventilation. Most probably he has:
A. Tumor in the forth ventricle
B. Acute renal failure
C. Acute appendicitis
D. Diabetic ketoacidosis
E. Diabetes insipidus


2. Hypothyroidism.
***) The most valuable test in the diagnosis of congenital hypothyroidism is:
A. T3
B. T4
C. Cholesterol level
D. TSH
E. Bone age by X-ray


***) Early manifestations of congenital hypothyroidism include all of the following, except:
A. Prolonged physiologic jaundice
B. Apneic spells
C. Constipation
D. Delayed osseous development
E. Increased appetite


***) Clinical features of hypothyroidism may include all of the following, except:
A. Mental retardation
B. Goitre
C. Short stature
D. Advanced bone age

E. Constipation


***) All of the following are features of congenital hypothyroidism, except:
A. Lethargy
B. Prolonged jaundice
C. Persistent diarrhea
D. Hoarse cry
E. Feeding difficulties


***) Signs of congenital hypothyroidism include all the following except:
A. Prolonged neonatal jaundice
B. Lethargy and poor feeding
C. Constipation
D. Early closure of anterior fontanel
E. Umbilical hernia


***) A 25 days old baby complains of prolonged jaundice, constipation, dry skin and umbilical hernia. The
most likely appropriate diagnosis is:
A. Breast milk jaundice
B. G6PD
C. Thalassemia major
D. Hypothyroidism
E. Crigler Najar disease


***) A 9 month old female was seen because of inability to sit or stand. Examination showed neck mass
anteriorly. The tongue was broad and thick; no erupted teeth, liver and spleen not palpable. One of the
following tests will establish the most likely suspected diagnosis:
A. Routine urine analysis
B. Serum calcium and phosphorus
C. Karyotyping
D. Urine for mucopolysaccharides
E. T4 and TSH


***) Congenital goiter in the newborn is least likely to be due to which of the following:
A. Maternal ingestion of large amount of iodine during pregnancy
B. Defect in the synthesis of thyroid hormones
C. Maternal iodine deficiency
D. Hashimoto's disease in the newborn
E. Maternal ingestion of antithyroid drugs



***) Regarding Hashimoto's thyroiditis, all are true except:
A. Most common cause of juvenile hypothyroidism
B. The etiology is autoimmune
C. Thyroid antiperoxidase antibodies are positive in 90%
D. Is 7 times more common in boys
E. Lead to growth retardation


3. Congenital Adrenal Hyperplasia (CAH).
***) 1 month old infant is seen with vomiting and severe dehydration. Physical examination reveals
ambiguous genitalia, laboratory test show hyponatremia. The best likely diagnosis is:
A. Gastroenteritis
B. Congenital hypothyroidism
C. Pseudohermaphroditism
D. Congenital adrenal hyperplasia
E. Congenital diaphragmatic hernia


4. Short Stature.
***) The short stature is associated with all of the following, except:
A. Chronic renal disease
B. Hypothyroidism
C. Down's syndrome
D. Low birth weight
E. Breast fed babies


***) Causes of short stature can be due to all of the following, except:
A. Emotional deprivation
B. Turner's syndrome
C. Kleinfelters syndrome
D. Primary hypothyroidism
E. Gluten enteropathy


***) All of the following can cause short stature, except:
A. Achondroplasia
B. Familial
C. Kleinfelters syndrome
D. Hypothyroidism
E. Corticosteroid therapy



***) Short stature may be associated with the following conditions, except:
A. Chronic kidney disease
B. Hypothyroidism
C. Down syndrome
D. Achondroplasia
E. Marfan syndrome


Gastroenterology P36-P43.

1. Tracheoesophageal Fistula.
***) The newly born regurgitates its entire first and every feed, pours saliva almost continuously. There are
manifestations of:
A. Imperforate anus
B. Congenital diaphragmatic hernia
C. Atresia of duodenum
D. Atresia of the esophagus
E. Meckel's diverticulum


***) All of the following are features of isolated esophageal atresia, except:
A. Excessive salivation
B. Inability to pass nasogastrial tube
C. Distended abdomen
D. Pneumonia
E. Cyanotic attacks after feeding


2. Pyloric Stenosis.
***) A narrowing and elongation of the pyloric channel on X-ray in a 12 days old infant most strongly
suggest:
A. Duodenal atresia
B. Duodenal ulcer
C. Duplication of the stomach
D. Infantile hypertrophic pyloric stenosis
E. Annular pancreas


***) Pyloric stenosis is characterized by all of the following, except:
A. Usually present between 3 and 8 weeks of life
B. Is commoner in first-born infants
C. Is commoner in girls
D. There is a family history of such disease

E. Projectile vomiting


***) All of the following are characteristics of pyloric stenosis, except:
A. Commonly seen in the first born baby
B. Bile stained vomiting
C. Metabolic alkalosis
D. Failure to thrive
E. Ultrasound is helpful in confirming diagnosis


***) Regarding pyloric stenosis all of the following are true, except:
A. Metabolic acidosis is presenting feature
B. Barium meal confirm the diagnosis
C. It affects more the first and male babies
D. The baby is usually alert and sucking strongly
E. Surgical management is pyloromyotomy


***) Concerning hypertrophic pyloric stenosis of following are true, except:
A. Manifestations start usually 3-4 weeks after birth
B. Bile stained projectile vomiting is the presenting symptom
C. A visible peristalsis may be seen passing from the left to right across the upper abdomen
D. Constipation and loss of weight are usually present
E. Surgery is the treatment of choice


***) Concerning hypertrophic pyloric stenosis all the following are true, except:
A. Non-bilious projectile vomiting is the most common
B. Visible peristalsis may be seen passing from left to right across the upper abdomen
C. An olive-size mass can be felt in the right hypochondrium
D. Constipation and loss of weight are usually present
E. The usual management is by antispasmodics and laxatives


***) Concerning hypertrophic pyloric stenosis, all the following statements are true, except:
A. First born male infants are most frequently affected
B. Symptoms usually begin in the third week of life
C. Bile stained vomiting after feeding is characteristic
D. Other gastrointestinal anomalies are usually not present
E. Preoperative preparation frequently requires potassium replacement





3. Duodenal Atresia.
***) A newly born presented with persistent bile stained vomiting. Straight, erect abdominal radiograph
showed double bubble appearance in the upper abdomen. This infant has:
A. Meconium ileus
B. Duodenal atresia
C. Imperforated anus
D. Hypertrophic pyloric stenosis
E. Congenital intussusception


***) All of the following are causes of non bile stained vomiting, except:
A. Feeding problem
B. Gastro-esophageal reflux
C. Pyloric stenosis
D. Duodenal atresia
E. Hidden infection (meningitis)


4. Vomiting.
***) Common causes of vomiting in children including all the following, except:
A. Over feeding
B. Duodenal atresia
C. Gastro-esophageal reflux
D. Gastroenteritis
E. Pyloric stenosis


***) The common cause of regurgitation in a normal young infant is:
A. Faulty feeding technique
B. Pyloric stenosis
C. Gastroesophageal reflux
D. Constipation
E. Lactose intolerance


5. Diarrhea.
***) The commonest cause for acute simple gastroenteritis is:
A. Escherichia
B. Shigella
C. Rotavirus
D. Salmonella
E. Adenovirus



***) All of the following are causes of chronic diarrhea in children:
A. Enterobius vermicularis
B. Lamblia giardia
C. Entameba histolytica
D. Celiac disease
E. Cystic fibrosis


***) One of the following measures is recommended in managing diarrhea in children:
A. Using antibiotics for Gram-positive bacteria
B. Using antibiotics for Gram-negative bacteria
C. Attempting to reduce intestinal motility by using suitable drugs
D. Attempting to stop vomiting by using suitable drugs
E. Attempting to prevent reaching the stage when intravenous therapy is needed


6. Celiac Disease.
***) Regarding celiac dieses all are true, except:
A. Manifestations start after birth immediately
B. Gluten-free diet is helpful
C. Some cases may develop lymphoma
D. Endomysial antibodies is useful test
E. The main problem is in absorption


***) All of the following are manifestations of celiac disease, except:
A. Short stature
B. Constipation
C. Delayed puberty
D. Pallor
E. Bloody diarrhea


7. Milk Protein Allergy.
***) Cow's milk protein allergy may present in all of the following ways, except
A. An exacerbation of eczema
B. Infantile colic
C. Chronic wheezing in the first year of life
D. Bloody colitis in infancy
E. Thrombocytopenia





8. Constipation.
***) Which of the following statements about Hirschsprung's disease is not true:
A. It may be a cause of neonatal intestinal obstruction
B. It may involve the entire colon
C. It may be associated with an increased incidence of Down's syndrome
D. It may be associated with enterocolitis
E. Barium enema is always diagnostic for infants older than one month


9. Acute Abdominal Pain.
***) Intussusception is a cause of all of the following, except:
A. A mass in the abdomen
B. Abdominal colic
C. Frequency of micturiuon
D. Passage of blood per rectum
E. Intestinal obstruction


***) A previously healthy 8 months old boy started to suffer from repeated abdominal pain, vomiting and red
currant jelly stool, he should be regarded to have:
A. Volvulus neonatorum
B. Intussusception
C. Gastroenteritis
D. Meconium ileus
E. Meckel's diverticulitis


***) Current jelly stools are usually associated with:
A. Hirschsprungs disease
B. Appendicitis
C. Intussusception
D. Bezoars
E. Enterocolitis


10. GI Bleeding.
***) Blood stained stools in an infant are associated with all of the following, except:
A. Anal fissure
B. Gastroenteritis
C. Intussusception
D. Appendicitis
E. Meckel's diverticulum



***) The most common cause of minimal bleeding per rectum in children is:
A. Volvulus neonatorum
B. Necrotizing enterocolitis
C. Fissure in anus
D. Hemorrhagic disease
E. Polyp


***) The most common cause of rectal bleeding in infancy and childhood is:
A. Anal fissure
B. Volvulus
C. Foreign body
D. Intussusception
E. Meckel's diverticulum


Genetics and Metabolism P43-P48.

1. Genetics.
***) All of the following are inherited as autosomal dominant, except:
A. Neurofibromatosis
B. Tuberous sclerosis
C. Achondroplasia
D. Cystic fibrosis
E. Adult type polycystic kidney disease


***) In autosomal dominant inheritance the trait will be found in one parent and:
A. 25% of daughters and 75% of sons
B. 75% of daughters and 25% of sons
C. 50% of sons and 50% of daughters
D. Only daughters
E. Only sons


***) In autosomal dominant inheritance, the chance of having affected offspring in each pregnancy is:
A. 25%
B. 50%
C. 75%
D. 100%
E. Only male



2. Genetic Syndromes.
***) Chromosomal study is indicated in all of the following, except:
A. Down syndrome
B. Meningomyelocele and hydrocephalus
C. Recurrent abortion loss
D. Turner syndrome
E. Ambiguous genitalia


***) The most likely reason for the extra chromosome in Down's syndrome is:
A. Anaphase lag
B. Translocation
C. No disjunction
D. Oogenesis
E. Fragmentation


***) All of the following are features of trisomy 21 (Down), except:
A. Hypotonia
B. Microcephaly
C. Clinodactyly
D. Recurrent chest infections
E. Normal development


***) Clinical features of Down's syndrome include all of the following, except:
A. Mental retardation
B. Microcephaly with flattening of occiput
C. Muscle hypertonia
D. Short and incurve little finger
E. Simian crease


***) All the following are findings in Trisomy 21 except:
A. Learning difficulties
B. Protruding tongue
C. Congenital heart defects
D. Single transverse palmar crease
E. Hypertonia


***) A cardiac disorder commonly associated with Turner's syndrome is:
A. Mitral stenosis
B. Coarctation of aorta
C. Pulmonary stenosis

D. Tetralogy of Fallot
E. Absence of pulmonary valves


3. Metabolic Disease.
***) Regarding acrodermatitis enteropathica all are true, except:
A. Chronic diarrhea is present
B. Caused by zinc deficiency
C. Perioral dermatitis
D. Loss of hair
E. Associated with multiple congenital anomalies


***) All of the following metabolic disorders are treated by a specifically modified formula and or diet,
except:
A. Phenylketonuria
B. Maple syrup urine disease
C. Galactosemia
D. Cystinosis
E. Fructosemia


4. Phenylketonuria (PKU).
***) All are recognized findings in Phenylketonuria PKU, except:
A. Seizures
B. Macrocephaly
C. Eczema
D. Blond hair and blue sclera
E. Failure to thrive


Hematology P48-P52.

1. Physiologic Anemia.
***) A 2 months old infant brought to you because his hemoglobin was 9,5gm%. One of the following is
true:
Give him iron
Give him blood
Assure the parents only
Do reticulocytes level
Do bilirubin level



***) The normal platelet count per cubic millimeter in one month old infant is:
10 x 10
20 x 10
40 x 10
70 x 10
250 x 10


***) A white blood cell count of 18,000/mm3 is normal for what age:
One day old full term
Two months
Six months
Twelve months
Six years


2. Iron Deficiency Anemia.
***) The most common cause of anemia worldwide is:
A. Folate deficiency
B. Vitamin B
12
deficiency
C. Thalassemia major
D. Iron deficiency
E. Glucose 6 phosphate deficiency


***) A major health problem in Jordan is:
A. Vitamin A deficiency
B. Thalassemia
C. Rickets
D. Iron deficiency anemia
E. Pellagra


***) The commonest type of anemia in pediatrics is :
Thalassemia
Sickle cell anemia
Hereditary spherocytosis
Iron deficiency anemia
Megaloblastic anemia


***) Effects of iron deficiency anemia in children may include all of the following, except:
A. Retardation of growth
B. Compromised cellular immunity
C. Direct effect on muscle function

D. Direct effect on respiratory function
E. Impaired intellectual function


3. Anemia of Chronic Disease.
***) All of the following about megaloblastic anemia in children are true, except:
Results from deficiency of folic acid or vitamin B12, or both
An important consideration in children fed exclusively with goat's milk
Considerable variation in red cell shape and size
More common in children than in adults
The neutrophils are large and hypersegmented


1. Immune Thrombocytopenic Purpura.
***) One of the following is true regarding Idiopathic thrombocytopenic purpura ITP:
A. Platelets count is less than 50,000
B. Normal WBC count
C. Normal PT and PTT
D. Decreased megakaryocytes in bone marrow
E. Normal RBC count


***) Which of the following statements about idiopathic thrombocytopenic purpura (ITP) in children is not
true:
Most children with acute ITP recover within 2 months
Bone marrow examination is not helpful in diagnosis
Early use of steroids may enhance platelet recovery but has no effect on chronicity
Intracranial bleeding is a risk at any stage of the disease
For older children with chronic ITP splenectomy offer the best chance of remission


***) Regarding ITP (idiopathic thrombocytopenic purpura) all are true, except:
High bleeding time
Decreased platelets count
Decreased megakaryocytes in bone marrow
Intracranial hemorrhage is the most serious complication
Steroid therapy is helpful







Infectious Diseases P52-P62.

1. Urinary Tract Infection (UTI).
***) The commonest causes of urinary tract infections are:
A. Proteus species
B. Escherichia coli
C. Klebsiella
D. Pseudomonas
E. Citrobacter species


***) A 3 year old boy presents to you with recurrent urinary tract infection. Renal ultrasound was normal.
Your next step of investigation would be:
Intravenous urogram
Isotope scan
No need for further investigations
Voiding cystourethrogram
Cystoscopy


***) The major organic cause of recurrent abdominal pain in children is:
Peptic ulcer
Urinary tract infection
Meckel's diverticulitis
Megacolon
Regional enteritis


***) The definitive test for urinary tract infection in a 10 years old girl is:
IVP
MCU (Micturating cystouretherogram)
CBC
Urine routine analysis
Urine culture with significant bacteriuria


2. Streptococcal Pharyngitis.
***) Which one of the following conditions needs treatment:
Erythema toxicum of the newborn
Withdrawal vaginal bleeding at third day of life
Mongolian spots
Mastitis neonatorum
Impetigo neonatorum



***) Concerning impetigo all of the following are true, except:
Is highly contagious
The drug of choice in children is tetracycline
Is usually caused by a staphylococcal infection
In an infant may be complicated by generalized exfoliation
It effects mainly the nostrils and perioral areas


3. Scarlet Fever.
***) All of the following about rash are true, except:
In measles the rash is a maculopapular, begins on the head and spread downwards
In scarlet fever the rash is vesicular and petechial
In erythema infectiosum the rash begins as a marked erythema of the cheeks
In varicella rash is polymorphic, but mainly vesicular
In rubella the rash is maculopapular, associated with postauricular and suboccipital lymphadenopathy


4. Rheumatic Fever.
***) Which one of the following is not a collagen disease in children:
Rheumatic fever
Sclerema
Rheumatoid arthritis
SLE (systemic lupus erythematodes)
Dermatomyositis


***)One of the following is the pathognomonic rash of rheumatic fever:
Erythema multiforme of the limbs
Erythema nodosum of the back
Erythema nodosum of the trunk
Purpura on the lateral aspect of buttocks
Purpura on the lower extremities


5. Infectious Mononucleosis.
***) All of the following are true about infectious mononucleosis, except:
Generalized lymphadenopathy
Splenomegaly in 50% of cases
The drug of choice in children is chloramphenicol
The classic picture is rarely seen in the blood film
Atypical lymphocytes are usually seen in the blood film



***) The lymph node enlargement in infectious mononucleosis most commonly involve:
Cervical group
Occipital nodes
Axillary group
Epitrochlear group
Inguinal group


***) In infectious mononucleosis all are true, except:
Hepatomegaly may present
Lymphadenopathy is presenting sign
Skin rash (maculopapular) may present
Aacyclovir is an effective therapy
The incubation period is 25-50 days


6. Pertussis.
***) All of the following are the characteristics of pertussis, except:
A. World-wide in distribution
B. May occur in both sexes
C. May occur at any age
D. Newborn immune for about three months
E. Lesions located principally in bronchiand bronchioles


???) Concerning whooping cough all of the following are true, except:
The incubation period is 7-10 days
The diagnosis is achieved if proved bacteriologically
There is typically marked lymphocytosis
The paroxismal stage lasts four to six weeks
Specific treatment in infancy includes erythromycin


7. Varicella (Chickenpox).
***) All of the following are the characteristics of varicella (chickenpox), except:
A. One attack confirms lifelong immunity
B. Distribution of lesion predominantly centripetal
C. The peripheral blood picture is essentially unchanged
D. Incubation period ranges from 10 to 20 days
E. Varicella is generally much more severe in children than in adults


***) The rash in chickenpox shows the following characteristic features, except:

A. Centripetal in distribution
B. All stages and sizes at the same time could be seen
C. Superficial
D. The causative agent is herpes virus
E. Scalp and mucous membranes are preserved (not involved)


***) Regarding chickenpox (varicella) all are true, except:
A. Incubation period is 14-21 days
B. Most common complication is subacute sclerosing panencephalitis
C. Polymorphic rash
D. The epidemics have been initiated by exposure to herpes zoster
E. Children receiving steroids are at great risk for severe chickenpox


***) Chickenpox is characterized by:
A. Long prodromal period around 4 weeks
B. Severe systemic symptoms in children
C. High contagion index
D. Maculo-papular rash
E. Frequent occurrence of associated pneumonia


***) Regarding varicella (chickenpox), all are true except:
A. It is vesicular rash
B. Incubation period less than one week
C. Different stages of maturation of skin lesions
D. Its more benign in children than in adults
E. Can lead to congenital varicella syndrome


8. Roseola.
***) Which one of the following statements concerning Roseola is true:
A. Etiology is believed to be due to Coxsackie virus
B. Fever is usually high at the onset
C. Rash begins with a slapped cheek appearance
D. The illness is not contagious
E. The rash leaves temporary hypopigmented areas after fading


9. Measles.
***) Regarding the incubation period all of the following are true, except:
A. Mumps 12-25 days
B. Measles 14-21 days

C. Rubella 14-21 days
D. Hepatitis A 3-8 weeks
E. Hepatitis B 6-24 weeks


***) Which one of the following infections typically has incubation period of less than 2 weeks:
A. Mumps
B. Varicella
C. Rubella
D. Measles
E. Rabies


***) All of the following are features of measles, except:
A. Prodromal signs such as fever and anorexia last 3 to 4 days
B. The sub-occipital lymph nodes are enlarged
C. Kopliks spots are visible 2 to 3 days before the onset of rash
D. The rash starts behind the ears and spreads to the forehead, face and down the body
E. The incubation period is one to two weeks


***) Regarding measles in Jordan all are false, except:
A. The peak of incidence is among infants
B. Vaccine coverage is complete
C. Incidence among children is shifting to older age group
D. The vaccine is made of killed bacteria
E. The cold chain is weak


***) In measles the rash and accompanying illness reach a climax on about the:
A. 2
nd
day
B. 3
rd
day
C. 6
th
day
D. 9
th
day
E. 12
th
day


***) Kopliks spots are pathognomonic of one of the following:
A. Rubella
B. Measles
C. Chicken pox
D. Scarlet fever
E. Mumps



???) Comparing measles (Rubeola) with German measles (Rubella) all of the following are true, except:
The incubation period is shorter
The temperature is higher
Pre-rash symptoms are of longer duration
Koplik's spots are pathognomonic
Sub-occipital lymph nodes are more prominent


10. Mumps.
***) Regarding Mumps, all are true except:
A. Incubation period is 12-25 days
B. Parotitis
C. Conjunctivitis
D. Orchitis
E. Encephalitis


***) The percent of persons who develop inapparent infection by Mixovirus parotitis (mumps) is:
A. 5%
B. 15%
C. 20%
D. 35%
E. 55%


???) An 3,5 year old boy is brought with the history of fever and swelling in the left side of the neck of 2
days duration. All are true about the management of this boy, except:
The extension of swelling behind the ear lobe helps pointing to mumps rather than cervical adenitis
In mumps the serum amylase is elevated while it is normal in cervical adenitis
The treatment of cervical adenitis is by penicillin G
The best way to differentiate mumps from cervical adenitis is by needle aspiration of the swelling for
culture purposes
If this proves to be mumps immunity will be lifelong


11. Rubella (German Measles).
***) Concerning rubella all of the following statements are true, except:
A. A large proportion of rubella cases are seen in infants and children
B. Preventing infection of the fetus is a major objective of immunization program
C. The only reliable evidence of rubella immunity is a history of having had the illness
D. 80-90% of young adults have serological evidence of post infection immunity
E. Incubation period of rubella is 7-10 days



***) The syndrome of congenital rubella includes all of the following abnormalities, except:
A. Heart disease
B. Cleft palate
C. Auditory defect
D. Hepatosplenomegaly and jaundice
E. Meningo-encephalitis


***) Which one of the following is usually not regarded as a manifestation of congenital rubella:
A. Cataracts
B. Deafness
C. Microcephaly
D. Meningocele
E. Hepatosplenomegaly


***) One of the following is true:
A. Incubation period of mumps 21-28 days
B. Incubation period of varicella 7-14
C. Incubation period of mononucleosis in adolescents is 2-3 weeks
D. Incubation period of rubella is 14-21 days
E. Incubation period of measles is 14-18 days


12. Erythema lnfectiosum.
***) The rash of erythema infectiosum appears first on the:
Face
Arms
Trunk
Legs
Hands


13. Reye Syndrome.
***) Reyes syndrome is a disease characterized by;
A. Encephalopathy
B. Encephalopathy with recent history of paracetamol intake
C. Encephalopathy with recent history of salicylate intake
D. Meningitis with history of salicylate intake
E. Meningo-encephalitis





14. Poliomyelitis.
???) Which of the following disease has the longest incubation period:
Mumps
Measles
Diphtheria
Chickenpox
Poliomyelitis


???) Poliomyelitis is characterized by all of the following, except:
Limbs weakness is symmetrical
Cerebrospinal fluid (CSF) cell count is high in the first weeks of illness
Fibrillations are present on electromyography examination
Caused by virus
Preventable by vaccination


Neonatology P62-P76.

1. Neonatal Care.
***) Which of the following might increase fetal lung maturity in preterm delivery:
A. Estrogen
B. Prolactin
C. Thyroxine
D. Glucocorticoides
E. Alpha fetoprotein


***) The umbilical stump of the newborn sloughs off after delivery about:
A. 2
nd
day
B. 5
th
day
C. 10
th
day
D. 15
th
day
E. 21
st
day


***) The tidal volume of a normal newborn is about:
A. 5 ml
B. 50 ml
C. 70 ml
D. 120 ml
E. 20 ml


***) The most common factor associated with neonatal death is:
A. Birth injury
B. Prematurity
C. Congenital malformations
D. Metabolic diseases
E. Intrauterine growth restrictions


***) One of the following is associated with small infants:
A. Mothers with untreated gestational diabetes
B. Multipara
C. Large parents
D. Maternal smoking
E. Post-date pregnancy


***) The fine downy hair covering the skin of a newborn is called:
A. Vernix caseosa
B. Lanugo
C. Milia
D. Erythema toxicum
E. Mottling


2. APGAR score.
***) An infant at birth exhibits pink body with blue extremities, pulse rate of 120/min, lusty cry, limp muscle
tone and irregular slow respiration. The Apgar score is:
A. 2
B. 4
C. 6
D. 8
E. 10


***) A newborn baby delivered with peripheral cyanosis, crying well, weak muscle tone, RR = 22/min
irregular and HR = 80/min, his Apgar score:
A. 4
B. 5
C. 6
D. 7
E. 8





***) An infant born with good respiration, vigorous cry, heart rate of 105, moving all extremities, body pink
and extremities blue. The Apgar score is
A. 10
B. 9
C. 8
D. 7
E. 6


***) All are component of APGAR score, except:
A. Heart rate
B. Blood pressure
C. Respiratory effort
D. Reflexes
E. Skin color


3. Sepsis in the Neonate.
***) Beta Hemolytic streptococci group A is responsible for all the following except:
A. Acute glomerulonephritis
B. Rheumatic fever
C. Neonatal sepsis
D. Scarlet fever
E. Impetigo


***) All of the following are predisposing factors of neonatal sepsis, except:
A. Hypothermia
B. Instrumental delivery
C. Twins
D. Amnionitis
E. Umbilical infection


***) Predisposing factors for neonatal septicemia include each of the following, except:
A. Febrile maternal illness
B. Twins
C. Frank amnionitis
D. Umbilical infection
E. Endotracheal intubation





4. Cyanosis.
***) All of the following can cause cyanosis, except:
A. Renal failure
B. Congestive heart failure
C. Polycythemia
D. Cold
E. Cor pulmonale


***) A newborn, 12 hours old, cyanosed when he is quiet, becomes pink on crying, the most probable
diagnosis is:
A. Respiratory distress syndrome
B. Congenital pneumonia
C. Diaphragmatic hernia
D. Intracranial hemorrhage
E. Bilateral choanal atresia

5. Respiratory Distress.
***) The most likely finding in a neonate with asphyxia is:
A. Alkalemia
B. Hypoxia
C. Hypocapnia
D. Tachycardia
E. Increased anal sphincter tone


***) The features of respiratory distress in newborn are the following, except:
A. Tachypnea
B. Flaring of nostrils
C. Cyanosis
D. Grunting on expiration
E. Projectile vomiting


***) Compliance of the lung is increased in which of the following:
A. Diffuse pulmonary fibrosis
B. Pleural thickening
C. Healed tuberculosis with scarring
D. Emphysema
E. Hyaline membrane disease





***) Regarding hyaline membrane disease all of the following are true, except:
A. Tachypnea is always present
B. Affects mainly premature babies
C. Expiratory grunting is present
D. The clinical picture will develop within 4-6 hours
E. Oxygen by mask is the best management


6. Diaphragmatic Hernia.
***) The high postoperative mortality for newborn with congenital diaphragmatic hernia is due to:
A. Increased intra-abdominal pressure
B. Persistent patent ductus arteriosus
C. Failure of the collapsed lung to expand
D. Mediastinal shift with impaired venous return
E. Abnormal pulmonary microvasculature


***) An infant is delivered at full term by a spontaneous vaginal delivery to a 29 year old primigravida. At
delivery, the infant is noted to have subcostal retractions and cyanosis despite good respiratory effort. The
abdomen is scaphoid. On bag and mask ventilation, auscultation of the lungs reveals decreased breath sounds
on the left, with heart sounds louder on the right:
A. Dextrocardia with situs inversus
B. Diaphragmatic hernia
C. Pneumonia
D. Pulmonary hypoplasia
E. Spontaneous pneumothorax


7. Hypoglycemia.
***) All the following are associated with hypoglycemia in the newborn, except:
A. Neonatal asphyxia
B. Cold stress
C. Diabetic mother
D. Sepsis
E. Rh-incompatibility


***) All of the following statements are correct about hypoglycemia, except:
A. It may associate neonatal asphyxia
B. It may be manifestation of nesidioblastosis
C. Glucagon and steroids may be used as treatment line
D. Blood sugar of 45mg% is normal in full term infants
E. Ketotic hypoglycemia is rare cause of hypoglycemia in childhood



8. Jaundice.
***) Neonatal jaundice is seen in all the following except:
A. Breast feeding
B. Hypothyroidism
C. Sickle cell disease
D. Galactosemia
E. Septicemia


***) Physiological jaundice is characterized by all of the following, except:
A. Onset after 36 hours of life
B. Disappears by 10-14 days of life
C. Associated always with anemia
D. The total serum bilirubin does not exceed 14 mg%
E. The direct bilirubin does not exceed 1.5 mg%


***) All of the following are criteria for physiological jaundice, except:
A. Starts within the first 24 hours
B. The total serum bilirubin does not exceed 14 mg/dl
C. The direct bilirubin does not exceed 1.5 mg/dl
D. It will disappear within 7-10 days in full terms
E. It does not need treatment by phototherapy


***) In a 12 hours old newborn that has jaundice the roost likely diagnosis of the following is:
A. Erythroblastosis fetalis
B. Physiological jaundice
C. Biliary atresia
D. Liver enzyme deficiency
E. Galactosemia


***) Jaundice appearing in the first day of life suggests one of the following:
A. Hemolytic disease of the newborn
B. Hypothyroidism
C. Bile duct atresia
D. Breast milk jaundice
E. Liver enzyme deficiency






***) All of the following are causes of neonatal jaundice during the first 24 hours of life, except:
A. ABO incompatibility
B. Spherocytosis
C. Biliary atresia
D. G6PD deficiency
E. Rh-incompatibility


***) A 2 months old baby is having loose yellow motions after each breastfeeds since birth, body weight is
4.5 kg. The most appropriate action is:
A. Stop breast feeding and give lactose free formula
B. Stop breast milk and start WHO solution
C. Admit to hospital for investigation
D. Give antidiarrheal medicine
E. Reassure the mother that her baby is well


***) All of the fallowing increases the risk of neonatal jaundice, except:
A. Prematurity
B. Trisomy 21
C. Elective caesarean section
D. Congenital hypothyroidism
E. Cephalohematoma


9. Necrotizing Enterocolitis (NEC).
***) All of the following are predisposing factors for developing necrotizing enterocolitis NEC, except:
A. Prematurity
B. Polycythemia
C. Breast milk feeding
D. Umbilical catheterization
E. Perinatal asphyxia


***) Concerning necrotizing enterocolitis all are true, except:
A. Affects mainly preterm babies
B. Pneumatosis intestinalis is pathognomonic
C. It has very good prognosis
D. Exchange transfusion is a predisposing factor
E. It may occur during the second or third week of life





10. Neonatal Skin Conditions.
***) Epstein's pearls on the hard palate of a newborn should be managed with:
A. Topical antibiotics
B. Topical steroids
C. Excision
D. Hydrogen peroxide
E. No therapy


***) One of the following conditions in the newborn needs immediate management:
A. Milia
B. Mongolian blue spots
C. Intact meningomyelocele
D. Capillary hemangioma
E. Erythema toxicum


Nephrology P76-P81.

1. Dehydration.
***) A 9 month old infant presented with the following lab results, scrum (Na 160meq/l), (K 4meq/l), BUN
28mg%, Blood sugar 180mg%, the calculated serum osmolality is:
A. 375
B. 184
C. 300
D. 248
E. 348

***) One year old child with gastroenteritis and moderate dehydration is vomiting, ORS is given to him, the
next most appropriate step is to:
Stop all feeds for 12 hours and try again
Dilute the ORS and give it
Give small frequent ORS amounts using spoon
Give i.v. fluids containing 10% G/W
Put nasogastric tube and give antibiotics i.m.


***) The simplest proper oral replacement solution is done by giving the infant with gastroenteritis is one of
the following:
Half strength milk
Plain water
Salt and glucose added to the water
Glucose added to the water

Salt added to the water


***) Regarding hyper-natremic dehydration all are true except:
Serum sodium is more than 155 mmol/L
Leads to intracellular dehydration
Doughy like skin
The correction should be done very quickly within 4-6 hours
Concentrated ORS could be the cause


***) All of the following are usually signs of severe dehydration, except:
Very sunken eyes
Decreased skin turgor
Oliguria
Rapid pulse
The child drinks fluids eagerly


***) One of the following measures is appropriate to the management of a 10 months old infant with mild
gastroenteritis:
Advise the mother to give him only rice water for 24 hours and to do stools culture
Advise the mother to give ORS (Aquasal) and to continue normal diet
Prescribe antiemetic suppositories
Prescribe antiperistaltic drugs to suppress gut motility
Avoid any food and milk for 24 hours and to give only amoxicillin syrup


***) All of the following are features of moderate dehydration, except:
Dry mucous membranes
Oliguria
Sunken eyes
Decreased skin turgor
Depressed anterior fontanel


2. Fluid and Electrolyte Therapy.
***) The average fluid requirement in a one year old child is:
A. 30-40 ml/kg/24hrs
B. 40-60 ml/kg/24hrs
C. 70-80 ml/kg/24hrs
D. 80-100 ml/kg/24hrs
E. 100-120ml/kg/24hrs



3. Hemolytic Uremic Syndrome (HUS).
***) The most common cause of acute renal failure in childhood is:
A. Acute glomerulonephritis
B. Hemolytic-uremic syndrome
C. Renal vein thrombosis
D. Minimal change nephrotic syndrome
E. Pyelonephritis


4. Nephritic Syndrome.
***) A child with early stage renal failure is at high risk of developing all except:
Edema
Polyuria
Hypertension
Seizures
Congestive heart failure


5. Nephrotic Syndrome.
***) About post streptococcal glomerulonephritis in children all are true, except:
Follows upper respiratory tract infections
Follows streptococcal skin infections
Most patients go into chronic phase
Causes low C3
Causes red blood cell casts in urine


***) All of the following in children with nephrotic syndrome are true, except:
A. Steroid resistance is associated with a poor prognosis
B. Patients should receive high protein, low fat diet
C. Minimal lesion nephrosis is the most common type seen in children
D. Low salt diet is important during relapse
E. Patients are susceptible to gram positive organisms during relapse


***) Concerning minimal lesion nephrotic syndrome all of the following are true, except:
A. It is the commonest cause of nephrotic syndrome in children
B. Always progresses to renal failure
C. Gross albuminuria is a recognized feature
D. Relapse is common
E. In children most cases respond to steroids




***) Nephrotic range proteinuria in children is defined as:
A. More than 150 mg protein in a 24 hour urine collection
B. More than 10 mg protein in urine per kg of body weight per day
C. More than 50 mg protein in urine per kg of body weight per day
D. More than 2.5 g protein in a 24 hour urine collection
E. Protein more than 50 mg per kg of body weight per hour in urine


???) Regarding nephrotic syndrome in children is correct:
Lupoid (minimal changes) type is the commonest
Most patients recover completely
Kidney biopsy is always indicated
Hyperkalemia is common
Most of them end in the end stage renal


Neurology P81-P87.

1. Seizure Disorders.
***) Concerning neonatal convulsions, all the following are true except:
The usual tonic-clonic are not common, but tonic convulsions are the commonest in pre-matures
Subtle type is the commonest form and hypoxic ischemia encephalopathy is the most common cause
Differential diagnosis includes Jitteriness
Phenobarbitone is considered to be the drug of choice for neonatal seizure
Etiology: hypoglycemia, hypocalcemia, and hypermagnesemia


***) Commonest type of neonatal seizures is:
Generalized tonic clonic
Subtle type
Tonic type
Clonic type
Myoclonic type


***) Possible causes of convulsions in neonate include all of the following, except:
Hypocalcemia
Hypoglycemia
Febril convulsions
Pyridoxine deficiency
Intracranial hemorrhage




***) Convulsions in a premature newborn could be caused by all of the following, except:
Brain anoxia
Hypokalemia
Hypoglycemia
Hypocalcemia
Kernicterus


***) Neonatal convulsions can be caused by all except:
Hypoglycemia
Hypoxic-ischemic encephalopathy
Pyridoxin deficiency (Vit B6)
High fever
Hypocalcemia


***) The differential diagnosis of "staring" in a child includes all of the following, except:
Absence seizure
Partial complex seizure
Day dreaming
Clonic seizure
Drug intoxication


2. Febrile Seizures.
***) Criteria for diagnosis of febrile convulsions include all the following except :
Age 6 months to 5 years
Presence of fever
Absence of CNS infection
Abnormal electroencephalography EEG
Positive family history of febrile convulsions


***) Concerning febrile seizures one of the following is true:
Do no harm to most healthy children
Are associated with low grade meningitis
Never occur after 3 years
Produce permanent EEG changes
Require therapy with rnysoline


***) All of the following are risk factors for increase recurrence of febrile convulsions, except:
Older age of onset (more than 4 years)
Prior neurological abnormality
Family history of febrile convulsions

Family history of non-febrile convulsions
Complex febrile seizures


***) All of the following statements are correct about simple febrile convulsions (SFC), except:
Age range is 6 months - 6 years
Incidence of subsequent epilepsy is double the general populations
Risk of recurrence for a 4 year old child presenting with first attack of SFC is 10%
The younger the age of onset of SFC the higher is the recurrence rate
IQ in late onset of SFC is usually decreased by 15 points below the mean of the general population

Answer: 5* IQ in late onset of SFC is usually decreased by 15 points below the mean of the general
population

3. Hypotonia.
***) Treatable causes of hypotonic infant include all of the following, except:
Myastenia gravis
Rickets
Malnutrition
Chronic demyelinating polyneuropathy
Dystrophies


***) One of the following statements is correct about floppy infant:
Suprasegmental (central) causes are commoner than segmental (peripheral) ones
Muscle disease is the commenest segmental (peripheral) cause of floppy infants
There are no treatable causes for floppy infant
Anterior horn cell disorder is considered to be supra segmental cause
Tongue fibrillation are caused only by suprasegmental causes (central)


4. Cerebral Palsy (CP).
***) In kernicterus infants staining of the brain is more intense in the:
A. Basal ganglion
B. Cerebellar vermis
C. Cerebral cortex, motor areas
D. Spinal cord
E. Corpus callosum


***) Patients with severe cerebral palsy usually die because of:
Urinary tract infections
Chest infections
Meningitis

Heart failure
Hepatic failure


***) All of the following are clinical features of basal ganglia disorders, except:
Chorea
Athetosis
Dystonia
Myotonia
Hypertonia


***) Methylphenidate (Ritalin) is a drug used in the treatment of one of the following disorders:
A. Migraine
B. Tension headaches
C. Hyperkinetic behavior
D. Vertigo
E. Epilepsy


Oncology P87-P90.

1. Leukemia.
***) The commonest malignancy in childhood is:
A. Acute monocytic leukemia
B. Acute lymphocytic leukemia
C. Chronic lymphocytic leukemia
D. Neuroblastoma
E. Ewing's sarcoma


2. Neuroblastoma.
***) Regarding neuroblastoma all of the following are true, except:
Elevated catecholamine level in urine is specific diagnostic feature
Increased vanillylmindalic acid in most cases
Final diagnosis depends upon the histological characteristic of tumor or biopsy
Polycythemia is common
Neuroblastoma is a tumor of young children


3. Rhabdomyosarcoma.
***) Rhabdomyosarcoma is:
Benign tumor of skeletal muscle

Malignant tumor of smooth muscle
Malignant tumor of skeletal muscle
Benign tumor of smooth muscle
Malignant tumor of bone


***) The most frequently seen malignant urinary bladder tumor in children is:
Melanocarcinoma
Epidermoid carcinoma
Squamous cell carcinoma
Rapdomyosarcoma botryoides
Leiomyosarcoma


Respirology P90-P95.

1. Croup.
***) Croup could be caused by all of the following, except:
Laryngomalacia
Foreign body
Tracheomalacia
Laryngitis
Tetany


***) Differential diagnosis of croup in children includes each of the following, except:
Foreign body
Cystic fibrosis
Laryngitis
Epiglottitis
Retropharyngeal abscess


***) Which of the following groups of viruses cause respiratory infection mainly in babies and infants:
Adenoviruses
Parainfluenza viruses
Enteroviruses
Coronaviruses
Rotaviruses





2. Bronchiolitis.
***) The most common cause of bronchiolitis is:
Respiratory syncitial virus
Adeno virus
Rhino virus
Metapneumo virus
Coxsakie virus


***) Concerning bronchiolitis all are true, except:
Affects children during the first year of life
More common in winter time
Caused by respiratory syncytial virus
Tachypnea and cyanosis are presenting features
Males are more affected than females


***) Concerning bronchiolitis all of the following are true, except:
The onset is sudden with dyspnea
Cough is present and severe always
Changes of developing cyanosis and acidosis is high
All of the diagnosed cases should be admitted and treated in the hospital
The drug of choice is cloxacillin


3. Asthma.
***) Concerning bronchial asthma in children all of the following is true, except:
A. Common disorder in children
B. Usually precipitated by viral infections in the toddler age group
C. Is characterized by alveolar collapse
D. Is common at night
E. Bronchospasm may be precipitated by house dust or mite in the bed clothes


***) A 5 years old boy admitted as a case of status asthmatics. All of the following are of value in the acute
management of this patient, except:
A. Chest X-ray
B. IgE level
C. Sinus X-ray
D. CBC (Complete blood count)
E. Arterial blood gases


***) Appropriate treatment of status asthmatics includes all of the following, except:

A. Aminophyllin
B. Mist tent
C. Oxygen by nasal catheter
D. Intravenous fluids
E. Corticosteroids


***) Regarding bronchial asthma in childhood all are true except:
Inflammatory respiratory disorders
Most children can out grow it by puberty
Prognosis depend on severity
Bronchiolitis is important differential diagnosis
B agonist are more effective orally than by inhalation


***) Concerning asthma all are true, except:
Inhaled steroids are useful in the treatment
Wheeze on auscultation is one of the symptoms
It is seldom a cause of hospital admission
Exacerbation of symptoms can occur with exercise
Patients should be excluded from sport at school


***) The commonest respiratory symptom is:
Sputum production
Hemoptysis
Cough
Breathlessness
Wheeze


4. Cystic Fibrosis (CF).
***) All of the following are presentations of cystic fibrosis, except:
Meconium ileus
Reccurent chest infections
Failure to thrive
Steatorrhea
Congenital heart disease







Rheumatology P95-P99.


***) In septic arthritis of the hip joint in infants, one of the following is not true:
Rapid destruction of the hip is the most striking feature
Staphylococcus aureus is now the predominant invader
A femoral venipuncture is a point of enter of the infecting microorganism
As a rule the baby is very ill with signs of general toxemia and high fever
Local examination may fail to reveal the true nature of the disease in its early stages especially if antibiotics
had been given


***) A 3 years old presents to you with a two months history of spiky fever and refusal to walk. Physical
examination revealed a sick looking child, painful movements of the extremities and splenomegaly. The
most likely diagnosis is one of the following:
Rheumatic fever
Scurvy
Juvenile ankylosing spondilitis
Dermatomyositis
Juvenile rheumatoid arthritis


1. Henoch-Schonlein Purpura.
***) Regarding Henoch-Schonlein purpura, all are true except:
Is a vasculitis of small blood vessels
Is the most common cause of non-thrombocytopenic purpura
Typically follow upper respiratory tract infection.
Most cases occur between 2-8 years of age
Platelets function is abnormal


2. Kawasaki Disease.
???) Concerning Kawasaki disease, all the following are true except:
Patients are more than 7 years old
Fever is present in all cases for over 5 days and does not respond to antibiotics
Coronary artery aneurysms develop during the second week of illness
Rash: truncal, polymorphous, non-vesicular
Bilateral conjunctival injection, injected pharynx, strawberry tongue






***) Regarding Kawasaki, all statements are true except:
Age of onset is less than 5 years
High grade fever more than 5 days is essential criteria
Is the commonest cause of acquired cardiac disease in developing countries
20% of untreated patients develop coronary artery abnormalities
Has differential diagnosis with scarlet fever


***) Gamma-globulin may be used in the management of children with all of the following conditions,
except:
Premature baby with sepsis
Child with X-linked agammaglobulinemia
Child with recurrent infection due to IgA deficiency
Measles prophylaxis in a susceptible child
Hepatitis A prophylaxis in a susceptible child