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9) Obligatory vaccination during the first year of life in Palestine includes all
except:
A. BCG
B. DPT
C. Polio-vaccine
D. Meningococcal vaccine
E. Hemophilus influenzae vaccine
14) Compared with human milk, cow milk formula is MORE likely to contain a(n)
A. greater concentration of essential fatty acids
B. higher protein concentration
C. increased lactose content
D. lower calcium-phosphorus ratio
E. lower iron concentration
15. A 6-year-old girl can write her name and can count 10 objects.
Of the following, the MOST likely additional activity of which she is capable is:
A. hitting a baseball
B. knowing her right hand from her left
C. making a simple meal
D. printing neatly in small letters
E. sounding out words while reading
17.A 4 month old with vitamin D deficiency rickets would be expected to show
all of the following except:
A. Craniotabes
B. Bow legs
C. Rosary
D. Low serum phosphate level
E. High alkaline phosphate levels
19. In the Palestinian National Immunization Program, all of the following are
correct EXCEPT:
A. Salk vaccine is given at one and two months of age.
B. Hep. B vaccine is given at birth, one month and six months of age.
C. A booster dose of DPT is given at six years of age.
D. MMR vaccine is given at age of 15 months (12 & 18)
E. Rubella vaccine is given to girls at age of 12 years.
20. all are causes of hypovolemic hyponatremia except :
Hypothrodism (euovolumic)
22. a 12 year old girl is at the 5th percentile for height .she is an otherwise
healthy child. The bone age is greater than two and half standard deviation
below the chronologic age. Of the following, the most likely cause of patient’s
short stature is
A. Constitutional growth delay
B. Genetic short-stature
C. Growth hormone deficiency
D. Hypothyroidism
E. Ulcerative colitis
23- A mother brings her previously healthy 2-year-old son to the emergency
department because he looked pale when he woke up this morning. She also
reports fever and decreased activity over the last few days. He was diagnosed
with a U T I and given trimethoprim-sulfamethoxazole 3 days ago. On physical
examination, he is markedly pale and appears jaundiced. His H R is 170 b/min,
and his R R is 30 b/min. The rest of his physical examination findings are
unremarkable. Lab .evaluation reveals a hemoglobin concentration of 5 g/dL Of
the following, the MOST likely cause of this boy's anemia is:
A. a plastic anemia
B. glucose-6-phosphate dehydrogenises deficiency
C. hereditary spherocytosis
D. sickle cell hemolytic crisis
E. transient erythroblastopenia of childhood
25. iron deficiency in a child who has unrepaired cyanotic congenital heart
disease is MOST likely to increase the risk for
A. congestive heart failure
B. digoxin toxicity
C. osteoarthropathy
D. pulmonary hemorrhage
E. stroke
Urine dipstick testing of a specimen obtained from a febrile 4-yr-old child with
acute viral gastroenteritis shows specific gravity 1.030, pH 5.0, 2+ proteinuria,
and no blood cells. The most likely cause of the patient's proteinuria is:
A - Transient proteinuria
B - Nephrotic syndrome
C - Orthostatic proteinuria
D - Acute glomerulonephritis
E - Chronic glomerulonephritis
33. A developmentally normal child who is just able to walk with one hand held
and says mama and dada with meaning is probably what age?
A. 8 months
B. 10 months
C. 12 months
D. 14 months
E. 16 months
34. A baby is jaundiced at 12 hours old. The causes to consider include all of the
following except:
A-Congenital infection.
B-Haemolytic diseases.
C-Congenital spherocytosis.
D-Biliary atresia.
E-ABO incompatibility
35. A 14-year-old girl awakens with a mild sore throat, low-grade fever,and a
diffuse maculopapular rash. During the next 24 h, she develops tender swelling
of her wrists and redness of her eyes. In addition, her physician notes mild
tenderness and marked swelling of her posterior cervical and occipital lymph
nodes. Four days after the onset of her illness, the rash has vanished. The most
likely diagnosis of this girl’s condition is
a. Rubella
b. Rubeola
c. Roseola
d. Erythema infectiosum
e. Erythema multiforme
36. ) A 14-year-old boy is evaluated for short stature. He has no significant past
medical history and is considered otherwise healthy by his parents. He eats a
normal diet and has regular meals. His height and weight have been consistently
at the 5th percentile since early childhood. His physical examination is normal,
with genitalia at Tanner stage 3. Which of the following is the most likely
laboratory finding for this boy?
A. Bone age that is equivalent to chronologic age
B. Decreased complement C3 level
C. Decreased serum albumin concentration
D. Decreased thyroid stimulating hormone
E. Increased serum creatinine concentration
37) A 6-day-old girl who was born at home is being evaluated for bruising and
gastrointestinal bleeding. Laboratory findings include partial thromboplastin
time and prothrombin time, greater than 2 minutes; serum bilirubin, 4.7 mg/dL;
alanine aminotransferase, 18 mg/dL; platelet count, 330,000/mm3; and
hemoglobin, 16.3 g/dL. Which of the following is the most likely cause of her
bleeding?
A. Factor VIII deficiency
B. Factor IX deficiency
C. Idiopathic thrombocytopenic purpura
D. Liver disease (no jaundice, normal liver enzymes!!!)
E. Vitamin K deficiency
38) A newborn girl is noted to be drooling saliva, and she chokes violently when
she is first fed. On physical examination, she is found to have abdominal
distention and an imperforate anus. There is no fistula to the perineum or
vagina. Examination of the urine reveals no meconium in it. Echocardiogram
and renal sonogram are reported as negative for other congenital defects. X-ray
films show abundant gas in the gastrointestinal tract. Pictures taken with a
metal marker taped to the anus, and the baby hanging upside down, show that
there is a significant distance (2.5 cm) between the blind end of the rectum and
the anal marker. Before a diverting colostomy is performed, which of the
following steps should be taken?
A. A soft nasogastric tube passed, and x-rays taken
B. Barium injected through the anal dimple
C. Barium swallow
D. Nasogastric suction for at least 24 hours
E. Surgical exploration of the perineum to see whether a primary repair is
possible
39. A 15-year-old girl with type 1 diabetes mellitus presents to her primary care
doctor for a routine check up. Perusal of her blood sugar chart indicates that her
recorded blood glucose levels are routinely between 120 and 150 mg/dL before
breakfast, dinner and bedtime, with the normal being 116 mg/dL. She is on NPH
and regular insulin. Which of the following is the next appropriate step?
A. Decrease the dosage of NPH
B. Decrease the dosage of Regular insulin
C. Make no changes and obtain a glycosylated Hb test
D. Increase the dosage of NPH
E. Decrease the dosage of Regular insulin
40. A 12-year-old girl with a history of asthma has been admitted to intensive
care units two times in the past and has had three emergency department visits
during the past 12 months. Her only medication is inhaled albuterol as needed,
and she uses it two to three times a day. She has nocturnal symptoms about
two times a week. She is free of symptoms now but reports that she gets short
of breath easily. Which of the following pharmacologic interventions is most
appropriate?
A. Anticholinergic agent
B. Cromolyn sodium
C. Inhaled corticosteroid
D. Long-term bronchodilator
E.Nedocromil sodium
41. An 11-year-old boy presents with fever and sore throat. A rapid-strep test
confirms streptococcal pharyngitis. He is leaving for a summer camp in 2 days.
In the past, he has had problem finishing the whole course of antibiotic
treatment. Which of the following is the best treatment for his streptococcal
pharyngitis?
A. A single dose of benzathine penicillin G intramuscularly
B. A single dose of ceftriaxone intramuscularly
C. A single dose of procaine penicillin G intramuscularly
D. Erythromycin orally for 5 days
E. Penicillin V orally for 5 days
42. A 3-week-old boy presents to the physician's office with a 1-week history of
forceful, projectile vomiting. He has been vomiting after almost every feeding.
The vomitus contains mostly undigested formula and is non-bilious. On
examination, his oral mucosa is dry, his anterior fontanel appears to be
depressed, and his capillary refill is 3-4 seconds. An abdominal examination
reveals an olive-sized mass in the epigastrium. Which of the following
electrolyte findings will most likely be seen?
A. Hypochloremic metabolic acidosis
B. Hypochloremic metabolic alkalosis
C. Normal electrolytes
D. Respiratory acidosis with metabolic compensation
E. Respiratory alkalosis
43. A term male infant is found to be cyanotic shortly after birth and requires
endotracheal intubation. On physical examination, his blood pressure is 68/34
mm Hg (equal in all four extremities), pulse is 180/min, and respirations are
32/min. His precordium is dynamic, has a grade III systolic murmur, and a single
S2. Chest radiography shows a normal heart size and increased pulmonary
vascular markings. An arterial blood gas on an FiO2 of 100% shows pH 7.34;
PaCO2, 47 mm Hg; PaO2, 46 mm Hg. Which of the following diagnoses is most
consistent with these findings?
A. Atrial septal defect
B. Hypoplastic left heart syndrome
C. Patent ductus arteriosus
D. Tetralogy of Fallot
E. Total anomalous pulmonary venous return
44. A 3 year old male has sudden onset of dry cough with a small amount of
bright red blood produced when he coughs. He has had no fevers, runny nose,
or vomiting. In the Emergency Department a chest x-ray shows hyperexpansion
of the right lung and clear lung fields. Which of the following is the most likely
etiology of this child's symptoms?
A. Bacterial pneumonia
B. Cystic fibrosis
C. Foreign body aspiration
D. Pulmonary arteriovenous malformation
E. Tuberculosis
49.. A 6-month-old boy developed a weepy, crusted dermatitis around the eyes,
nose, mouth, diaper area, hands, and feet about 4 weeks after being weaned
from human milk to formula. He is listless, recently developed diarrhea, and has
stopped gaining weight. In addition to the dermatitis, he has sparse hair that is
fine and lightly pigmented.
Of the following, this constellation of findings is MOST consistent with a
deficiency in
A. copper
B. thiamine
C. vitamin A
D. vitamin C
E. zinc
50. You are evaluating a 4-year-old boy for bowing of the legs and short stature.
Findings include: creatinine, 0.4 mg/dL; calcium, 9.2 mg/dL; phosphorus, 2.5
mg/dL; (normal value: 2.4 to 4.1 mg/dL) alkaline phosphatase, 950 IU/L; intact
parathyroid hormone, 40 pg/mL (normal, 10 to 60 pg/mL); 25-hydroxyvitamin D,
30 pg/mL (normal, 12 to 40 pg/mL); 1,25-dihydroxyvitamin D, 30 pg/mL
(normal, 25 to 45 pg/mL); and urinary tubular reabsorption of phosphorus, 50%
(normal, >85%).
The MOST likely cause of these findings is
A. familial x linked hypophosphatemic rickets
B. hypophosphatasia
C. renal osteodystrophy
D. vitamin D-deficiency rickets
E. vitamin D-dependent rickets
51. The parents of a healthy term baby ask you at the 12-month health
supervision visit what they should expect of the baby developmentally by the
15-month visit.
Of the following, the milestone MOST likely to be met by 15 months of age is
A. drawing a circle
B. drinking from a cup
C. having a vocabulary of at least 50 words
D. throwing a ball overhand
E. walking well without tripping
52. what is true about vesicourethral reflux: 30% of UTIs in children are caused
by VUR
79. 2,5 yrs , diarrhea 3-5 times daily for 2 mos with normal height, normal
weight, stool with undigested carrot: toddler diarrhea, malabsorption,
celiac(most likely)
80. young boy with watery diarrhea, vomiting for 3 days, the mother sought
medical help, describe ORS, given without improvement, after two days
convulsion, what is the cause: Metabolic acidosis, hyponatremia dehydration,
isonatremia, hypernatremia deh (not sure)
89. 10 min baby(CS), grunting after 2-5 min, stop and baby is vigorous, what is
your step: obtain chest x-ray, observe 10 min if repeat admit to NCU (not sure)
95. all true about erb's palsy except: may be associated with horner syn.
96. case about complex partial seizure (lip masking, blank stare, lack of
responsiveness), what is treatment: carbamazepine
97. all are true about infantile spasm except: occur in first 6 wks of life
98. what is true about simple febrile convulsion: occur in early stage of illness
99. all are true about neonatal infection except: when meconium is stained, you
suspect E.coli
100. case (girl look ill, peteicha ,cell line decreased), what is your diagnosis:
marrow failure
18. Baby 5 days after born at home come with mucocutaneous bleeding ,
pt:20 , ptt:27 , platelet 200,000 what is the cause
Von-wallebrand disease, Factor 8 deficiency, (Vitamin k deficient), Platelet
dysfunction
Thrombocytopenia
19. Apgar score for active crying baby, with grimace, lower limbs cyanotic:
6,7,8,9,10
20. Child with toxic appearance, drooling extended his neck, his vaccine is up
to date, what you will do?
Iv antibiotic against staphylococcus aureus, (Intubation with anesthesia)
21. Baby with wide pulse pressure , 1000 gram, 29 days after 5 days , come
with tachypnea, no need for oxygen saturation: what you will do Albuterol,
(Indomethacin)
22. Girl with 40 c temperature with purple lesion, vomiting, what is the cause
(Meningococcus), hemophilus influenza
23. CSF indicate 80 portion, predominant neutrophil, and negative gram stain,
what is the cause?
Viral, (partially treated bacterial), bacterial.
24. Baby sit with minimal support, does not have pincer grip, 6,9,12
25. Baby start creep on knee and hand, say bye bye? 10 weeks
26. 5 kg baby with 10% dehydration, with no sodium deficit, what is the
amount of fluid that you have to give in 24 hours?
750, 1000, 1500
Child with accidently positive dipstick +2 protein what you will do?
Repeat the dipstick, do 24 hour urine protein collection (not sure about the
answer)
Patient with absence seizure, 10 second with abnormal movement of his face,
the DOC?
Carbamezapin, (valproic acid), phenytoin
Baby well , with bleeding thrombocytopenia, after viral infection 1 week ago?
Give hime immuniglobuline, steroid, admit and iv antibiotic
Child with tanner stage 2, his height in the fifth percentile since early childhooh,
what you will expect?
Child 4 years old, with hieghth at 2 year age and bone age at 18 monthes , what
shall he have ?
Hypothyroidism, congenital adrenal hyperplasia, diabetes, psychological
depriviation
Baby born with good weight and normal height, since that he fail to gain weight
and failure to thrive with diarrhea and recurrent respiratory infection, what you
will do? Chloride sweat test
Diabetes type 2:
The etiology is antibody against beta cells, recently int decrease in the children,
strongly inhertid even more thant diabetes type 1
Baby with stridor that decrease when sleep and prone position: laryngeomalacia
Baby born with white reflex, hydrocephalus, he has congenital infection with :
rubella, CMV, syphilis
You have baby with PSCGN , you find that c3 in decrease , you give him
treatment , to confirm your diagnosis , when you will measure the c3 again
In 4 weeks, 8 weeks, 1 week
Baby cyanosed with no pulse in radial and femoral after 2 days , dominnt right
heart with decrease r in v5,6 what is the cause :
Hypoplastic left heart syndrome, transposition of the great vessels, total anomly
of pulmonary veins return
Child can reide tricycle, =no his age and sex, socially , when he first do these
skills
3-4 years,5-6 years, 2-3 years
Baby with sever dyspnea, wheeze, his old brother has common cold last week,
no history of asthma or allergy , what you will do
Oxgen 30%. Subutamlol for 4 hours, admit
Baby with no productive cough, well child, x ray show multiple infiltration in
both side of chest, what you will give him:
Doxcillin, azinthromycin, amoxicillin
Patient have shortness of breath 2-3 times in the year, what is the best
treatment
sulmotarol when needed, inhaled b2 agonist, inhaled steroids
What is wrong:
triple Wight at 1 year
double weight at 5 months
guardable Wight at 36 month
Patient with rocky bottom, clenched hand, with minimal dismorphic features in
the face he will have, trisomy 13, trisomy 18
Baby 6 weeks severe cyanosed with tachypnea, with no pulse in the femoral
artery ,you will do…ct for the brain, give him prostaglandine analog
Baby with sore throat and exudate over the tosilles after 2 weeks he developed
hematuria, smoky urine , what is the most appropriate test that you will
do,phalangeal swab culture, anti dnase antibody
What is true:, balckfan diamond present after 1 yeaer, common in fancon
20epatosplenomegaly, in fanconi hb f increased
All are present in 4 mohtes rickets baby except: bow legs, craniotabes, rickets
rosary
Child with sever flankd pain and ternderenss, hypotensive hsever high fever,
what you will do .. admit him with IV antibiotic + blood culture, admiht him with
IV antiobiotic + clean catch culture , IV antibiotic + lumber puncture
All are present in down syndrome except: cleft palate, brachydactaly, upward
palperable fissure
What is the best time eruption for teeth eruptionL first molar, central insciors,
cannins, second molar …… first molar, laternal insciores, cannies, first premolar
Baby with no murmer at birth ,after 9 weeks come iweh holosystolic muremer
in the left
Cow milk more than breast feeding in : essential fatty acids, more protein, more
iron
2. Which of the following vaccines should NOT be given to children with severe
combined immunodeficiency syndrome:
A. DPT.
B. Measles vaccine
C. Salk polio vaccine.
D. Hep. B vaccine.
E. Pneumococcal vaccine.
5. All of the followings are correct for live attenuated vaccines EXCEPT:
A. Contraindicated in immunodeficient patients.
B. Given only after 3 months of stopping immunosuppressive drugs or large
steroid dose therapy.
C. Not given within 3 weeks before or 3 months after giving immunoglobulins.
D. Two Live attenuated vaccines are not given together.
E. Measles vaccine is not given to a patient with T.B except after full treatment.
7. A 6 year old boy with severe factor VIII deficiency hemophilia develops
increased swelling of the right distal forearm. There is not history of trauma.
The peripheral circulation is normal and there is no joint involvement. The
MOST important complication of bleeding in this location is:
A. Blood loss
B. Muscular Damage
C. Neurologic Impairment
D. Tendon Shortening
E. Vascular Damage
10. An ambulance team brings a 6 year old girl to the ED. She had been
unrestrained in the back seat. The girl is unresponsive on arrival and is
bleeding profusely from a scalp wound. Her Glasgow Coma Scale is 3.
What is the BEST initial step in evaluation and management?
A. Control profuse scalp bleeding
B. Establish IV access
C. Order portable cervical spine radiographs
D. Remove all clothing
E. Secure an adequate airway
11. Which of the following sets of blood gas values is most compatible with
acute aspirine poisoning in a 16 month old child:
a-PH 7.60, pco2 40 mmHg, Hco3 40 mmol/L
b-PH 7.50, pco2 40 mmHg, Hco3 30 mmol/L
c-PH 7.25, pco2 20 mmHg, Hco3 8 mmol/L
d-PH 7.20, pco2 45 mmHg, Hco3 20 mmol/L
e-PH 7.00, pco2 35 mmHg, Hco3 8 mmol/L
13. A 2 week old presents with tachypnea, poor perfusion, gallop rhythm,
diminished pulses, and hepatomegaly. ABG shows metabolic acidosis.
Echocardiography reveals critical Aortic Stenosis.
What intervention is most likely to stabilize the infant’s condition?
A. Dobutamine
B. Epinephrine
C. Nitric Oxide
D. 100% oxygen
E. Prostaglandin E-1
14. A male infant born at 36 weeks gestation had a left testicle palpable in the
inguinal canal. At 12 months of age, the left testicle has failed to descend into
the scrotum.
What is most appropriate care for this infant?
A. Observation until 2 years of age
B. Orchiopexy
C. Radionuclide scan of left testicle
D. Treatment with human chorionic gonadotropin
E. Treatment with testosterone
20. A newborn female has an open neural tube defect, low set ears, VSD, and
rib and vertebral column malformations.
Which of the following MATERNAL conditions was most likely present during
pregnancy?
A. Alcoholism
B. Diabetes mellitus
C. Hypothyroidism
D. Iodine deficiency
E. Syphilis
A. Prematurity.
B. Trisomy 21.
C. Elective caesarean section.
D. Congenital hypothyroidism.
E. Cephalohaematoma.
29. A 5 year old male is hospitalized in January with fever and seizures. LP
reveals clear CSF with 47 WBCs/mm3 all of which are lymphocytes. On PE he
appears obtunded but arouses with painful stimuli. Neurologic exam reveals
no focal findings. Which diagnostic test is most likely to reveal this child’s
illness?
A. Bacterial culture of CSF
B. PCR test of CSF for HSV
C. Strepto.pneumoniae bacterial antigen test of CSF
D. Viral culture of CSF
E. Viral culture of nasopharyngeal and rectal swabs
30. A 11 year old girl complains of dysuria and abdominal pain for 2 days. She
denies nausea, vomiting, flank pain and vaginal discharge, mild suprapubic
tenderness, and otherwise normal findings.
What is the most likely diagnosis?
A. Bacterial vaginosis
B. Candidal vulvovaginitis
C. Chlamydia urethritis
D. Pelvic inflammatory disease
E. Urinary tract infection
31. A 3 year old girl comes to the ER with temperature of 40.0o C and acute
onset diarrhea. Stool is guaiac positive with leukocytes. There is no history of
foreign travel and the child has not received antibiotics recently.
What is the most likely organism?
A. Clostridium difficile
B. Giardia lamblia
C. Rotavirus
D. Salmonella enteritidis
E. Vibrio cholerae
32. You are evaluating a 4 week old boy for tearing of the right eye that has
worsened over the past week. Physical exam reveals slight tearing but no
evidence of purulent exudate or conjunctival erythema. All other findings are
normal.
The MOST appropriate initial management is…
A. Administration of amoxicillin
B. Endoscopic dacrocystorhinostomy
C. Instillation of silver nitrate in the eyes
D. Observation with intermittent massage of the duct
E. Surgical dilation of the nasolacrimal duct
33. The following can be the cause of a non-blanching rash except:
A. Idiopathic thrombocytopenic purpura.
B. Roseola infantum.
C. Henoch-Schönlein purpura.
D. Haemolytic uraemic syndrome.
E. Meningococcal sepsis.
40. In neonatal RDS (respiratory distress syndrome) all are true except:
A. Surfactant is useful in the treatment.
B. It is common in infants below 28 weeks gestation.
C. Antenatal steroids are beneficial.
D. Maternal opiate abuse increases the risk.
E. Maternal diabetes increases the risk.
A 1-year-old boy has been treated with a low-phenylalanine diet for the past
year after having been identified in infancy as having phenylketonuria.
Despite appropriate dietary restriction of phenylalanine, he has developed
neurologic symptoms.
Of the following, this child is MOST likely to be deficient in
Biotin
Cobalamin
Carnitine
Tetrahydrobiopterin
Thiamine
51. A 22-month-old girls is nonverbal. She sat alone at 7 months and walked
by 13 months, but now exhibits a wide-based stance, no longer ambulates,
and will not pick up or manipulate toys. Findings include: height and weight
at the 50th percentile; head circumference below the 5th percentile, with no
increase over the past 8 months; normal fundi, and no organomegaly.
Of the following, the MOST likely diagnosis is
Adrenoleukodystrophy
Cerebral palsy
GM2 gangliosidosis (Tay-Sachs disease)
Hypothroidism
Rett syndrome
52. Of the following, the MOST likely etiology of this decrease in hemoglobin is
Aplastic crisis
Folic acid deficiency
Hyperhemolytic crisis
Iron-deficiency anemia
Splenic sequestration
53. An 18-day-old term infant develops fever, lethargy, and focal seizures.
Findings include: an ill-appearing infant without exanthem, hepatomegaly, or
jaundice. Analysis of cerebrospinal fluid reveals white blood cells, 115/mm3;
45% neutrophils; 55% lymphocytes; red blood cells, 40/mm3; glucose, 45
mg/dL; protien 200 mg/dL; and negative Gram stain.
In addition to ampicillin and cefotaxime, the MOST appropriate treatment to
begin at this time is
Acyclovir
Amphotericin B
Dexamethasone
Metronidazole
vancomycin
57. A 14-year-old boy who has allergic rhinitis reports that he frequently
develops coughing and wheezing after about minutes of playing soccer.
These symptoms improve after resting for 30 minutes. Of the following, the
drug that will give the BEST response in this patient if administered just prior
to exercise is
A. Inhaled beta2-agonist
B. Inhaled corticosteroid
C. Oral beta2-agonist
D. Oral corticosteroid
E. Oral theophylline
3. A developmentally normal child who is just able to walk with one hand held
and says mama and dada with meaning is probably what age?
A. 8 months
B. 10 months
C. 12 months
D. 14 months
E. 16 months
5. A 4-year-old boy develops fever, swelling of the parotid gland, and headache.
Of the following, which complication is MOST likely to occur in this patient?
A. Conjunctivitis
B. Deafness
C. Meningitis
D. Myocarditis
E. Orchitis
6. A full-term infant becomes cyanotic in the delivery room. After intubation
and attempts at stabilization, it is noticed that the infant has a scaffold
abdomen and decreased breath sounds over the left hemithorax. The most
likely diagnosis is
A. pneumothorax
B. cardiomegaly
C. diaphragmatic hernia
D. neuroblastoma
E. atelectasis
10. A 6-year-old boy with absence seizure . Of the following pairs of drugs
MOST likely to be effective in the treatment of his condition:
A. ACTH or corticosteroid.
B. Amantadine or bromide.
C. Carbamazepine or gabapentin.
D. Ethosuximide or valproic acid.
E. Phenobarbital or phenytoin.
11. High risk lesions of bacterial endocarditis include all of the following EXCEPT:
A. PDA.
B. VSD.
C. ASD.
D. Blalock Taussig shunt.
E. Left-sided valvular lesions.
13. Which of the following vitamins is in higher concentration in cow's milk than
in human milk?
A. A
B. C
C. E
D. K
E. B6
14. Risk factors for fatal asthma include all of the following EXCEPT:
A. sudden severe obstruction
B. an allergic component
C. underuse of steroids
D. underestimation of the severity
E. poor compliance
20. A 4-month-old boy weighed 3500 g at birth. He now weighs 4.5 kg. He has
been formula fed since 1 week of age.
The MOST likely reason for this child's failure to thrive is:
A. absence of solids in his diet
B. exaggerated parental concern about overfeeding
C. improper feeding technique
D. omission of supplemental vitamins
E. withholding of nighttime feedings
2. The mother brought her 10-month-old son complaining that he is not thriving
well for the last 4 months although he did not have any disease, you find his
weight is just below -2 Z-score, his length is below -1 Z-score, and his head
circumference is below 0-Z-score, your correct comment will be as follows:
A. he has microcephaly
B. he has short stature
C. his feeding and weaning is proper
D. he has chronic problem since birth
E. he has recent improper feeding and weaning.
3. A 14_ month old boy is brought to your office because a visiting relative
noted that he appeared pale, he drinks 40-50 OZ of cow milk daily (1000-
1200 ml). He looks well except for pallor. WBC of (6.9× 109/L) ,hemoglobin of
5.9 g\dL ,MCV of 57 fL and platelet count of 775× 109/L .The most
appropriate next step is to:
A 3-yr-old boy presents to an urgent care clinic with a-3 day H/O abdominal pain
and difficulty walking. Abnormal findings include BP 120/80 mmHg, diffuse
abdominal tenderness, purpuric rash of the hands, and diffuse periarticular
tenderness and swelling of the ankles.
The most likely diagnosis is :
A. Systemic lupus erythematosus
B. Kawasaki's disease
C. Juvenile rheumatoid arthritis
D. Henoch-Sch nlein purpura
E. Stevens-Johnson syndrome
A 4-year-old boy develops fever, swelling of the parotid gland, and headache. Of
the following, which complication is MOST likely to occur in this patient?
A. Conjunctivitis
B. Deafness
C. Meningitis
D. Myocarditis
E. Osteomyelitis
An ambulance team brings a 6 year old girl to the ED. She had been
unrestrained in the back seat. The girl is unresponsive on arrival and is bleeding
profusely from a scalp wound. Her Glasgow Coma Scale is 3.
What is the BEST initial step in evaluation and management?
A. Control profuse scalp bleeding
B. Establish IV access
C. Order portable cervical spine radiographs
D. Remove all clothing
E. Secure an adequate airway
In meningococcal septicaemia:
A. Clinical features of meningitis are usually present .
B. Amikacin is a suitable choice for prophylaxis .
C. Prophylaxis does not reduce nasal carriage .
D. Treatment should await bacteriological confirmation .
E. A petechial rash is associated with DIC .
Which of the following is not one of the criteria for diagnosis of Kawasaki
Disease?
A. fever >5 days
B. bilateral conjunctivitis
C. polymorphous rash
D. hepatosplenomegaly
E. cervical lymphadenopathy
An atrial septal defect in a 7-year-old boy may be associated with which one of
the following?
A. A collapsing pulse.
B. Wide and fixed splitting of the second heart sound.
C. Clubbing of the fingers.
D. A pansystolic murmur of grade 4/6 in intensity.
E. Splenomegaly.
Two vaccine that does not give together 1 month apart MMR+ varicella
Encephalitis in Measles 1/1000
HUS defect in vascular damage
Wiskot aldor syndrome except neutropenia
ITP
Teeth eruption Except … Upper central 1st erupt.
Vitamin B12 except Intrinsic factors promote absorption
A 4 month old with vitamin D deficiency rickets would be expected to show all
of the following except:
A. Craniotabes
B. Bow legs
C. Rosary
D. Low serum phosphate level
E. High alkaline phosphate levels
8- A newborn female has an open neural tube defect, low set ears, VSD, and rib
and vertebral column malformations.
Which of the following MATERNAL conditions was most likely present during
pregnancy?
A. Alcoholism
B. Diabetes mellitus
C. Hypothyroidism
D. Iodine deficiency
E. Syphilis
Intussusception in childhood:
A. Has as the earliest sign the passage of red current jelly stools
B. Has a peak incidence in the first 3 months of life
C. Requires operative reduction in the majority of cases
D. May be initiated by ameckel's diverticulum
E. It has association with umbilical hernia
13- A 2 year old boy with spastic diaplegia from of cerebral palsy is being
evaluated. MRI for his brain is most likely to show :
A. Multicyctic encephalomalacia
B. Periventricular leukomalacia
C. Normal anatomy
D. Basal ganglia abnormalities
E. Agenesis of the corpus callosium
16- The following are poor prognosis sign of acute leukemia except :
A. Male child
B. Child more than 10 years
C. White blood cell count less than 50 000
D. Presence of philadephia chromosome
E. Child with mediastinal mass
17- a 11 month old child presents with irritability and pallor, he has Hbg level of
7 mg/dl and hypochromic microcytic blood film, serum ferritin is below normal,
the following state event are true except:
A. He probably has beta thalassemia major
B. A dilatory history is important
C. Occult blooding should be excluded
D. Low serum ferritin depletion of iron stores
20- a 12 year old girl is at the 5th percentile for height .she is an otherwise
healthy child. The bone age is greater than two and half standard deviation
below the chronologic age. Of the following, the most likely cause of patient’s
short stature is
A. Constitutional growth delay
B. Genetic short-stature
C. Growth hormone deficiency
D. Hypothyroidism
E. Ulcerative colitis
21- all are correct for measles except
A. Can cause activation of pulmonary T.B
B. Can cause suppression of purified protein derivative test
C. Morbidity is more in the age 2-20 years
D. Fever subsides after onset of rash
E. Enanthem is pathognomonic for the disease
23- all the following viruses have been associated with congenital infection
except :
A. Cytomegalovirus
B. Rubella virus
C. Hepatitis B virus
D. Herpes simplex
E. Rotavirus
24- the most serious acute medical out come of the drowning is
A. Pulmonary edema
B. Acute renal failure
C. Hypoxic brain injury
D. Blood loss
E. Cardiac arrhythemia
30- A 3-yr-old girl with congenital heart disease develops acute renal failure
during a prolonged stay in an intensive care unit. Possible contributory factors
include all of the following except:
A - E. coli cystitis
B - Nephrotoxic antibiotics
C - Hypotensive episodes
D - Contrast agent used for cardiac catheterization
E - Congestive heart failure
32- all of the following are true regarding breast feeding except:
A. Milk contain free oxygen radicals, which kill gardia and entamebia
Pre-test in Pediatrics
2.All of the following statements about DNA structure are correct Except:
A. there are two purine bases called adenine and Thymidine.
B. adenine always pairs with thymidine.
C. an amino acid codon consists of three bases.
D. each strand of DNA has a sugar-phosphate backbone with projecting bases.
E. there are 64 possible codons.
6.All of the following infections may be aquired from contact with animals or
animal products Except:
A. leptospirosis.
B. Tularaemia.
C. Plague.
D. Typhoid fever.
E. Brucellosis.
7.The following is correct for Hepatitis C virus:
A. is a DNA virus.
B. Has a seroprevalence rate of 60-90% in haemophiliacs.
C. Transmission is unknown in 70% of patients.
D. Rarely leads to chronic liver disease.
E. May be treated effectively with high dose acyclovir.
13. The data generated from observational assessment of a child's overall state
of well-being are greatly influenced by the child's developmental stage. This is
most importantly shown in which observational data?
A. Hydration
B. Skin color
C. Visual response
D. Respiratory effort
E. Motor tone
16. A developmentally normal child who just hops on one foot, copies a cross
and square, tells a story, and goes to the toilet alone is probably what age?
A. 24 months
B. 36 months
C. 48 months
D. 60 months
E. 72 months
18. The most rapid increase in height in girls is found in which Tanner SMR
stage?
A. 1
B. 2
C. 3
D. 4
E. 5
19. All of the following are diagnostic soft signs of ADHD EXCEPT
A. mixed hand preference
B. impaired balance
C. dysdiadochokinesia
D. astereognosis
E. none of the above
24.All are correct about bruise appearance and its age in days EXCEPT:
Yellow-brown (6-7 days).
Green (8-10 days).
Red-blue (1-2 days).
Blue-purple (4-5 days).
Resolved (10-15 days).
25.All of the following are true association with the corresponding vitamin
deficiency EXCEPT:
Photosensitivity – Riboflavin.
Bitot spots – A.
Tender nerves – Thiamine..
Alpoecia – Biotin
Cerebellar ataxia – E
27. Which of the following vitamins is in higher concentration in cow's milk than
in human milk?
A. A
B. C
C. E
D. K
E. B6
28. The normal fractional excretion of sodium in children older than 1 year on a
diet containing regular amounts of sodium is
A. 1%
B. 7%
C. 10%
D. 15%
E. 25%
29. A 10-year-old has a Glasgow Coma Scale score of 4 and develops irregular
respirations after head trauma. The next important step in the care of this
patient is to
A. perform endotracheal intubation
B. administer 20 mL/kg of lactated Ringer solution
C. administer naloxone
D. administer mannitol
E. obtain a head CT scan
33. The corresponding urine odor is correct in all of the following inborn errors
of metabolism except:
Glutaric academia (type II) – sweaty feet.
Phenylketonuria – mousy.
Methionine malabsorption – cabbage.
Trimethylaminuria – Tomcat urine
Hawkinsinuria – swimming pool.
38.All of the following signs and symptoms are correct for bulimia Except:
frequent weight fluctuations.
Esophagitis.
Amenorrhea.
Recurrent episodes of binge eating.
Onset at puberty.
42. Associated epidemiologic facts about asthma include all of the following
EXCEPT
A. another name could be chronic desquamating eosinophilic bronchitis
B. a child with two affected parents has a 50% risk of asthma
C. asthma is universally present in monozygotic twins
D. asthma is transferred with lung transplantation
E. both large and small airways are affected
43.All of the following are part of the revised diagnostic criteria for SLE EXCEPT
A. nonerosive arthritis
B. lymphopenia
C. Raynaud phenomenon
D. pleuritis
E. oral ulcers
45. All of the following are diagnostic features of Kawasaki disease EXCEPT
A. generalized lymphadenopathy
B. fever for at least 5 days
C. nonpurulent conjunctivitis
D. desquamation of the fingers
E. polymorphous rash
49. The differential diagnosis of diarrhea that persists for more than 2 weeks
includes
A. S. dysenteriae serotype 1, V. cholerae, Pleisomonas shigelloides
B. enterotoxigenic E. coli, enterohemorrhagic E. coli
C. enteropathogenic E. coli, enteroaggregative E. coli, nontyphi salmonella,
Aeromonas caviae
D. enteroinvasive E. coli, Rotavirus, Norwalk virus
E. C. jejuni, S. flexneri, Helicobacter pylori
50. Positive fecal leukocyte findings in a child with diarrhea allows the clinician
to make a presumptive diagnosis of
A. shigellosis
B. S. typhi
C. Entamoeba histolytica
D. Yersinia enterocolitica
E. colitis
52.In malabsorption all of the following are correctly matching with the
corresponding disease Except:
A. Acanthocytes - Abetalipoproteinemia
B. Pellagra-like rash - Hartnup disease
C. Lymphopenia - Shwachman-Diamond syndrome
D. Chronic sinopulmonary disease - Cystic fibrosis
E. Responds to oral zinc sulfate -Acrodermatitis enteropathica
55. A male born at term after an uncomplicated pregnancy, labor, and delivery
within a few hours develops severe cyanosis requiring supplemental oxygen and
supported ventilation. Results of routine cultures are negative. The chest
roentgenogram reveals a normal heart shadow and a fine reticulonodular
pulmonary infiltrate radiating from the hilum. Family history reveals that a male
and a female sibling with a similar clinical course died at 2 and 4 months of age,
respectively. What is the most likely diagnosis?
A. Neonatal alveolar proteinosis
B. Neonatal herpes simplex infection
C. Type II glycogenosis
D. Meconium aspiration syndrome
E. Carnitine palmityltransferase deficiency
56.Ebstein anomaly is associated with all of the following EXCEPT
A. dysrhythmias
B. patent ductus arteriosus (PDA) dependence in neonates
C. massive heart size on radiographs
D. VSD
E. tall, broad P waves
62. The most frequent cause of graft loss in pediatric renal transplant recipients
is
A. trauma to the graft
B. recurrence of the original renal disease in the graft
C. technical difficulties
D. infection
E. rejection reaction
63. A 4-year-old male developed an upper respiratory tract infection that was
followed in 2 weeks by general edema. His blood pressure is normal. Urinalysis
reveals 2 to 5 red blood cells per high-power field and 4+{plus} protein. His BUN
is 19 mg/dL, creatinine 0.6 mg/dL, cholesterol 402 mg/dL, serum albumin 0.9
g/dL, antistreptolysin O titer 1:16, and C3 92 mg/dL. The most likely diagnosis
would be
A. poststreptococcal glomerulonephritis
B. membranous glomerulonephritis
C. minimal lesion nephrotic syndrome
D. membranoproliferative glomerulonephritis
E. focal sclerosis
68. Physical findings in Graves disease include all of the following EXCEPT
A. motor hyperactivity
B. cold intolerance
C. tremor
D. smooth, flushed, warm skin
E. tachycardia
69. A child is below the third percentile for height. Growth velocity is normal,
but chronologic age is greater than skeletal age. This condition is called
A. primary hypopituitarism
B. secondary hypopituitarism
C. constitutional delay in growth
D. genetic short stature
E. primordial dwarfism
70. Causes of megalocephaly include all of the following EXCEPT
A. thalassemia
B. chronic subdural effusions
C. hydrocephalus
D. Canavan disease
E. congenital CMV
72. Of the following, the condition that is MOST likely to present with seizures
during the first 24 hours of life is
A .fetal alcohol syndrome
B .herpes simplex infection
C. hypoxic-ischemic encephalopathy
D. organic acidemia
E. urea cycle defect
75. A patient presents with recurrent infections with S. aureus and Serratia
marcescens in the form of
cutaneous abscesses, lymphadenitis, pneumonia complicated by empyema, and
peri-rectal abscess. His
defect is in which enzyme:
a) Super-oxide dismutase (SOD)
b) NADPH oxidase
c) catalase
d) G6PD
e) phosphofructokinase (PFK)
76. A nine year old boy presents to your office after a camping trip with his boy
scouts group one week ago. He looks fairly toxic with fever of 39.5C, headache,
myalgia, nausea, vomiting, and an
erythematous macular rash on the wrists, ankles and proximally on the trunk.
The best treatment for this illness is:
a) Ceftriaxone
b) Gentamycin
c) Acyclovir
d) Tetracycline
e) Aztreonam
77. A teenage boy presents to your office with a history of decreasing school
performance and increasingly
labile mood. Mom states he seems “confused” much of the time. On Physical
Exam he is jaundiced, tall
and thin, has mild hepatomegaly and slit-lamp exam shows Kayser-Fleisher rings
in both eyes. Laboratory
evaluation would most likely show which abnormality:
A. Absence of albumin
B. Excessive albumin
C. Decreased ceruloplasmin
D. Increased ceruloplasmin
E. Hepatic cell in the blood
80. The parents of a healthy term baby ask you at the 12-month health
supervision visit what they should expect of the baby developmentally by the
15-month visit.
Of the following, the milestone MOST likely to be met by 15 months of age is
A. drawing a circle
B. drinking from a cup
C. having a vocabulary of at least 50 words
D. throwing a ball overhand
E. walking well without tripping
81.A 6-year-old girl can write her name and can count 10 objects.
Of the following, the MOST likely additional activity of which she is capable is:
A. hitting a baseball
B. knowing her right hand from her left
C. making a simple meal
D. printing neatly in small letters
E. sounding out words while reading
82.A 12-year-old girl is at the 5th percentile for height. She is an otherwise
healthy child. The bone age is greater than two standard deviations below the
chronologic age.
Of the following, the MOST likely cause of this patient's short stature is:
A. constitutional growth delay
B. genetic short stature
C. growth hormone deficiency
D. hypothyroidism
E. ulcerative colitis
84. You note that a previously healthy 15-month-old boy appears pale. He has
been fed goat milk exclusively since birth. Laboratory findings include:
hemoglobin, 6.1 g/dL; white blood cell count, 4,800/mm3; platelets,
144,000/mm3; mean corpuscular volume, 109 fL; and differential count, 29%
neutrophils, 68% lymphocytes, and 3% monocytes. There also is
hypersegmentation of the neutrophils.
Of the following, the MOST likely cause of the hematologic abnormalities is
A. acute lymphoblastic leukemia
B. Fanconi anemia
C. folate deficiency
D. iron deficiency
E. vitamin B12 deficiency
85. You are evaluating a 4-year-old boy for bowing of the legs and short stature.
Findings include: creatinine, 0.4 mg/dL; calcium, 9.2 mg/dL; phos-phorus, 2.5
mg/dL; alkaline phosphatase, 950 IU/L; intact parathyroid hormone, 40 pg/mL
(normal, 10 to 60 pg/mL); 25-hydroxyvitamin D, 30 pg/mL (normal, 12 to 40
pg/mL); 1,25-dihydroxyvitamin D, 30 pg/mL (normal, 25 to 45 pg/mL); and
urinary tubular reabsorption of phosphorus, 50% (normal, >85%).
The MOST likely cause of these findings is
A. familial hypophosphatemic rickets
B. hypophosphatasia
C. renal osteodystrophy
D. vitamin D-deficiency rickets
E. vitamin D-dependent rickets
87. A 6-month-old boy developed a weepy, crusted dermatitis around the eyes,
nose, mouth, diaper area, hands, and feet about 4 weeks after being weaned
from human milk to formula. He is listless, recently developed diarrhea, and has
stopped gaining weight. In addition to the dermatitis, he has sparse hair that is
fine and lightly pigmented.
Of the following, this constellation of findings is MOST consistent with a
deficiency in
A. copper
B. thiamine
C. vitamin A
D. vitamin C
E. zinc
89. A female infant is born with unilateral cleft lip and palate. Findings on the
remainder of the physical examination are normal, and you inform the parents
that this apparently is an isolated birth defect.
During counseling of the family about their risk for having another similarly
affected child, the statement that you are MOST likely to include is that
A. because the defect is isolated, their risk is no greater than that of any
other couple
B. cleft lip and palate is a multifactorial trait that has a 4% risk of recurrence
C. the recurrence risk can be estimated only after a chromosome analysis has
been obtained
D. the risk is increased for future females, but not males
E. the risk would be increased only if one of the parents had cleft lip and
palate
92. At birth, a male infant exhibits bilateral cleft lip and palate. Further
examination in the nursery reveals microphthalmia, scalp defects in the
parietooccipital area, cryptorchidism, and a cardiac murmur.
Of the following, the MOST likely underlying condition is
A. holoprosencephaly sequence
B. retinoic acid embryopathy
C. trisomy 13
D. trisomy 18
E. valproate embryopathy
93. A newborn boy delivered at term is found to have bilateral colobomas,
choanal atresia, and cryptorchidism.
Of the following, the most appropriate INITIAL test to exclude other associated
conditions is a(n)
A. Barium swallow
B. Echocardiogaphy
C. Flexible fiberoptic bronchoscopy
D. Renal ultrasonography
E. Skeletal survey
94. A 27-year-old woman gave birth to a daughter who had trisomy 18 and died
during the newborn period.
Of the following, the MOST correct statement concerning her risk of having
another infant who has any chromosome abnormality is that it is
A. about 5% at any maternal age
B. dependent on the chromosome constitution of the mother
C. increased for all aneuploidies
D. independent of the age of the mother at the time of delivery
E. the same as that of any other women of the same age
95. Boys who have Klinefelter syndrome usually appear physically normal at
birth.
Among the following, the constellation of findings that is MOST consistent with
the diagnosis of Klinefelter syndrome in boys during childhood is
A. growth retardation, clinodactyly, and hypospadias
B. mental retardation, large ears, and large testicles
C. scoliosis, astigmatism, and inguinal hernia
D. short stature, cardiac murmur, and undescended testicles
E. tall stature, learning disability, and small testicles
96. A 2-year-old boy is placed on oral antibiotic therapy to treat otitis media.
Three weeks later he becomes febrile (temperature, 102°F [38.9°C]) and
develops abdominal distension and tenderness and bloody diarrhea.
Of the following, the MOST likely etiology of his bloody diarrhea is an infection
caused by:
A. Campylobacter jejuni
B. Clostridium difficile
C. enteropathogenic Escherichia coli
D. Salmonella sp
E. Shigella sp
97. A 5-year-old child who has acute lymphoblastic leukemia and is receiving
chemotherapy was exposed to varicella 2 days ago. He has no history of prior
varicella infection or vaccination.
Of the following, the MOST appropriate management is to prescribe
A. acyclovir intravenously
B. acyclovir orally
C. immunoglobulin G intravenously
D. varicella vaccine
E. zoster immune globulin intramuscularly
99. During the health supervision visit of a 12-year-old female, you find that her
thyroid gland is firm, nontender, symmetrically enlarged, mobile, and has a
granular texture. The thyroxine level is 5.2 mcg/dL (normal, 5.6 to 11.7 mcg/dL)
and the thyroid-stimulating hormone level is 17.5 mIU/mL (normal, 0.2 to 7.6
mIU/mL).
Of the following, the MOST likely diagnosis is:
A. acute suppurative thyroiditis
B. Graves disease
C. Hashimoto thyroiditis
D. simple colloid goiter
E. solitary thyroid nodule
A 17 year old male student attends clinic complaining of right knee pain and left
ankle pain. These pains have deteriorated when associated with episodic
diarrhoea. What is the most likely diagnosis?
1 ) Amoebic dysentery
2 ) Coeliac disease
3 ) Chronic appendicitis
4 ) Ulcerative colitis
1 ) Projectile vomiting
2 ) Anorexia
3 ) Loose stools
4 ) More frequent in girls
A male child weighing 4.2kg is admitted at age 4 weeks with a one week history
of forceful vomiting after feeds. He is alert and eager for food but exhibits a loss
of skin elasticity and has apparent distension in
the left hypochondrium.
Which of the following statements is correct for this patient?
1 ) The most likely diagnosis is hiatus hernia
2 ) He has hyperosmolar dehydration
3 ) Metabolic acidosis would be anticipated.
4 ) Initial fluid replacement should comprise normal saline 10-20 ml/kg
The following laboratory results were returned in a 6 week old boy admitted
with 6 days of severe projectile vomiting:
Ph 7.51
PO2 (95 mmHg)
PCO2 (35 mmHg)
Blood Urea 11 mmol/l
Na+ 131 mmol/l
K+ 3 mmol/l
Chloride 83 mmol/l
Which of the following is true concerning this patient?
1 ) He has respiratory alkalosis
2 ) He is likely to have a bulging anterior fontanelle
3 ) He should be resuscitated immediately with normal saline
4 ) He should be commenced immediately on half strength soy protein, low
lactose formula
1-The Virus most commonly associated with the clinical picture of acute
bronchiolitis in infants and young children is ?
(A) adenovirus
(B) respiratory syncytial virus
(C) Rhinovirus
(D)coxsackievirus B
(E) herpes virus type 2
2- It recently has been recommended that young infants should sleep in the
supine rather than in the prone position. This is based on data suggesting that
the prone position is associated with an increased in cadence of :
(A) delayed eruption of the first deciduous teeth
(B) gastroesophageal reflux and aspiration
(C) macrognathia
(D) strabismus
(E) sudden infant death
9- A 2-year-old infant has a chronic cough, clubbing, and rectal prolapse, the
most likely diagnosis to explain all of these findings would be :
(A) agmmaglobulinemia
(B) cirrhosis of the liver
(C) cystic fibrosis
(D) granulomatous colitis
(E) pinworms
10- A 2-year-old drinks some kerosene that had been left in a glass. After the
first swallow she cries and drops the glass . she is most likely to develop :
(A) aplastic anemia
(B) chemical pneumonitis
(C) coma and/or convulsions
(D) hepatitis
(E) peripheral neuritis
11- A 4-year-old child, previously well, presents with the rather sudden onset of
wheezing that does not respond to treatment with aerosolized albuterol. The
most likely diagnosis is :
(A) asthma
(B) foreign body
(C) infantile lobar emphysema
(D) pulmonary hypoplasia
(E) right middle lobe syndrome
13- Which of the following statements regarding acute bacterial otitis media in
childhood is correct ?
(A) fever is common, but pain is rare
(B) it is a common cause of deafiness
(C) infection is almost invariably bilateral
(D) the most frequent organism is staphylococcus aureus
(E) it usually can be treated successfully with antibiotics without
tympanocentesis.
16-All of the following statements concerning the incidence of the sudden infant
death syndrome (SIDS) are correct, except:
(A) the incidence of the sudden infant death syndrome is the highest at the age
of 5-6months
(B) it is more frequent in families with poor social conditions
(C) the incidence is higher among the subsequent siblings of SIDS victims
(D) the incidence is higher among girls.
19- Which childhood age is the onset of acute lymphoblastic leukemia most
frequent?
(A) 10-12 years
(B) The neonatal period
(C) Adolescence
(D) 3-5 years
(E) 6 months
20- Bleeding, due to thrombocytopenia occurs if the platelet count is less than:
(A) 150.000/ul
(B) 100.000/ul
(C) 80.000/ul
(D) 50.000/ul
(E) 20.000/ul
31- All of the following physical signs are characteristic of lobar pneumonia ,
EXCEPT:
(A) a duller percussion sound is heard over the affected lobe
(B) bronchophony is detected over the affected lobe
(C) bronchial respiratory sound are heard over the affected lobe
(D) a tympanic resonance is detected over the affected lobe
(E) crepitation is audible over the affected lobe
32- All of the following microorganisms are associated with lung abscess
formation,
except:
(A) streptococcus pneumoniae
(B) klebsiella pneumoniae
(C) Chlamydia trachomatis
(D) staphylococcus aureus
(E) Haemophilus influenzae
35- All of the following diseases are associated with a decreased production of
red blood cells except:
(A) iron deficiency anemia
(B) leukemia
(C) hypothyroidism
(D) the early type anemia of a premature newborn
(E) renal failure
36- Which of the following is the most important therapeutic intervention in
familial spherocytosis of a 6-year- old child, who frequently becomes anemic?
(A) a transfusion of packed red blood cells
(B) a splenectomy
(C) the prolonged administration of steroids
(D) immunosuppressive therapy
(E) iron replacement therapy
37- Symptoms and signs of hemolytic uremic syndrome (HUS) include all of the
following:
(A) fragmentocytes in the blood smear
(B) thrombocytopenic hemorrhagic diathesis
(C) oliguria , edema
(D) hypotension
(E) hyperkalemia
(F) acidosis
38 -You are examining an 18-month-old boy. The parents have noted the
occurrence of large hematomas on the skin following mild traumas during the
last 6 months. The results of the laboratory tests are not yet ready , when
theparents inform you that the child's finger started to bleed again , two
hoursafter the puncture . what is the most likely diagnosis ?
(A) thrombocytopenia
(B) von willebrand's disease
(C) hemophilia
(D) vasculopathy
(E) thrombocytopathy
43- Which of the following is the most likely diagnosis in an otherwise normal
adolescent with the sudden onset of respiratory distress, cyanosis , retractions,
and markedly decreased breath sounds over his left lung ?
(A) Empyema
(B) Chylothorax
(C) Pneumothorax
(D) staphylococcal pneumonia
(E) aspiration of a foreign body
45- The best way to identify the anatomy of a child with choanal atresia is :
(A) Ultrasonography
(B) Rhinoscopy
(C) Rhinogram
(D) MRI
(E) CT scan
46- A 3- year-old presents to your office with a 3-week history of unilateral
nasal discharge. The discharge is malodorous and lately has been blood tinged.
The most likely diagnosis is:
(A) Tertiary syphilis
(B) unilateral choanal atresia
(C) chronic rhinovirus infection
(D) foreign body
(E) wegemer granulomatosis
49- A 1-month-old male has had noisy breathing since birth . he is worse when
supine . the physical examination reveals retractions, mild thoracic deformity,
and inspiratory stridor. The most likely diagnosis is:
(A) diaphragmatic hernia
(B) tracheoesophageal fistula
(C) laryngomalacia
(D) choanal atresia
(E) vocal cord paralysis
50- Indicators for serious respiratory tract disease in children with chronic
pulmonary symptoms include all of the following except;
(A) clubbing
(B) cough that disappears with sleep
(C) cyanosis
(D) failure to thrive
(E) chronic purulent sputum
51- The most common manifestation of preliminary involvement in children
with cystic fibrosis is :
(A) cyanosis
(B) clubbing
(C) cough
(D) wheezing
(E) nasal polyps
52- A 3-year old has had recurrent episodes of cough, pneumonia , and sinusitis
repeated sweat chloride levels are normal, and the F 508 mutation is not
present. In the last year, the child has had repeated episodes of otitis media .
the chest x-ray reveals dextrocardia. The next diagnostic test should be :
(A) quantitative immunoglobulins
(B) IgG subclass determination
(C) CBC
(D) nasal scraping for electron microscopy
(E) HIV serology
53- A 3-day-old presents with fussiness and poor feeding, on examination , the
heart rate in noted to be 250. the ECG reveal a rate of 250, a QRS of 0.07
seconds ,, and no visible P waves. the most likely diagnosis is :
(A) ventricular tachycardia
(B) supraventricular tachycardia with aberrant conduction
(C) supraventricular tachycardia
(D) heart block
(E) none of the above
55- A previously well 3½ -month- old presents with poor feeding, diaphoresis
during feeding, and poor growth. Vital signs reveal respirations of 70, pulse of
175, and blood pressure of 90/65mmHg in the upper and lower extremities . the
cardia examination reveals apalpable parasternal lift and a systolic thrill. A grade
4 holosystolic murmur and a mid diastolic rumble are noted. The chest
radiograph reveals cardiomegaly. The most likely diagnosis is :
(A) cardiomyopathy
(B) myocarditis
(C) VSD
(D) coarctation of the aorta
(E) transposition of the great arteries
56- A 6-month-old presents with tachycardia, tachypnea, and poor feeding for 3
months. Physical examination reveals a continuous machinery murmur and a
wide pulse pressure with a prominent apical impulse . the most likely diagnosis
is :
(A) pulmonic stenosis
(B) aortic stenosis
(C) ventricular septal defect
(D) patent ductus arteriosus
(E) anomalous coronary artery
59 A 4-day- old previously healthy term infant presents in heart failure. There is
a gallop, a grade 3/6 systole murmur, hepatomegaly, and cardiomegaly on chest
x-ray. The blood pressure is 95/70. all of the following will be helpful in
evaluating the patient EXCEPT:
(A) arterial blood gas
(B) blood pressure in the upper and lower extremities
(C) complete blood count
(D) determination of splenomegaly
(E) chest x-ray
61- A 5-year- old white female has multiple bruises on her lower extremities
and oral mucosal bleeding of 3 day's duration. Two weeks before these signs,
she had a mild respiratory tract infection. Physical examination reveals multiple
ecchymoses and petechiae, no lymphadenopathy or hepatosplenomegaly is
noted. The next diagnostic step is:
(A) a complete blood count
(B) a prothrombin time
(C) a bleeding time
(D) a partial thromboplastin time
(E) an antinuclear antibody titer
63- A 5-day-old full term male presents with intense cyanosis, tachypnea, and
tachycardia. Physical examination reveals cyanosis of the skin and mucous
membranes, the lungs, heart, pulse, and general examination show no
abnormalities. Arterial blood gas determination reveals a PaO2 of 95 while the
patient is breathing room air and an oxygen saturation of 40%. The most likely
diagnosis is:
(A) transposition of the arteries
(B) pulmonary atresia
(C) pulmonary hypoplasia
(D) methemogloninemia
(E) Heinz body anemia
2. At 5 minutes after birth, a male neonate was noted to have blue extremities
with a pulse of 90 and a shallow, irregular breathing pattern. He was also
noted to be moving all 4 limbs. He showed no response when his foot was
slapped. What would be the appropriate Apgar score for this baby:
A. 3
B. 4
C. 5
D. 6
E. 7
F. 8
3. The most important parameters in the Apgar scoring system is(are):
A. Color
B. Reflex irritability
C. Muscle tone
D. Heart rate and respiration
E. All are equally important
4. All of the following are contraindications to breat feeding EXCEPT:
A. HIV +ve mother
B. Mother with active untreated TB
C. Mother on Chemotherapy
D. Mother taking Tetracycline
E. Mother with Hepatitis B infection
F. Active Herpes in the breast region
5. Presence of which of the following is considered abnormal in a neonate:
A. Erythema Toxicum
B. Epstein’s pearls
C. Mongolian spots
D. Capillary hemangioma (stork Bites)
E. Subconjunctival hemorrhage
F. Nevus flammeus (port wine stain)
6. On a routine exam of a 1 day old newborn, a non tender swelling of the scalp
was noted. It does not cross the suture lines. What is the most likely cause:
A. Caput succedeneum
B. Subperiosteal bleeding
C. Subdural bleeding
D. Epidural bleeding
E. Subcutaneous bleeding
11. A 4 months old male infant was brought to the clinic by his mother. She
has noticed a swelling of his left scrotum. On examintion, a non tender
swelling of the left scrotum was noted. Translumination is positive. The
swelling does not resolve on compression. He was a term infant, had an
uncomplicated delivery and had a normal routine newborn examination
before discharge from the hospital. What is the most appropriate approach in
this baby boy:
A. Surgical correction now
B. Observe until 1 year of age, and repair surgically if no resolution
C. Order an U/S
D. Aspirate fluid for analysis
E. Order an abdominal CT scan
13. A 4 day old female newborn is brought to the ER with a a 1 day history of
vomiting, fever and diarrhea in adition to being irritable with a hight pitched
cry. Her mother is known to be an IV drug abuser. The baby was delivered at
term by C-section due to inadequate maternal contractions. If the baby’s
symptoms, which of the following drug effects is known to cause such
presentation:
A. Cocaine Intoxication
B. Heroin intoxication
C. Methadone withdrawal
D. Heroin withdrawal
E. Cocain withdrawal
A 12 hour old male neonate is noticed to have rapid shallow breathing with
nasal flaring. The baby was delivered at 41 weeks gestation by C- section due to
difficult labour which was later complicated by meconuim staining of amniotic
fluid. He was suctioned properly after birth an APGAR scores were reassuring.
He has no cyanosis, and Blood pressure is normal. Temp. is normal. Xray shows
fluid in the fissures with increased vascular markings. The most appropriate
approach in this patient is:
A. Intubate with artificial ventilation
B. Observe and supplemental Oxygen if needed
C. Administer surfactants to baby, with ventilatory support
D. Order an Echocardiogram
E. Insert chest tube with an underwater seal
Soon after birth, a female infant developes tachypnea with nasal flaring and
grunting. Physical Examination reveals hyper-resonance on the right, with
absent air entry on the left and a displaced apex beat and heart sounds to the
right. No murmurs are heard and peripheral pulses are normal. The most likely
diagnosis in this baby is:
A. Pneumothorax
B. Pneumonia
C. Meconuim aspiration
D. Diaphragmatic hernia
E. Situs invertus
A 3 day old newoborn is noted to have poor feeding, irritability and vomiting.
His pulse was 170, RR is 70, temp is normal. Tense fontanelles were noted.
What is the most appropriate approach for this baby:
A. Ampicillin and Gentamicin therapy
B. Ceftriaxone therapy
C. Surgical evacuation of a hematoma
D. Steroid therapy
E. Reassurance and monitor feeding pattern.
A 10 day old female infant was brought to the emergency department after the
mother noticed that over the past 24 hours the baby started crying intensely
with poor feeding. She also noticed that the baby was lethargic and says that
she thinks the baby’s abdomen was becoming a little distended. She finally
brought her to the ER when she noticed some blood in her stool. The baby was
delivered at 32 weeks gestation vaginally when the mother went into preterm
labour. What is the most accurate statement regarding this condition:
A. Maternal diabetes will probably be revealed on further questioning of the
mother
B. Abdominal Xray may show pneumatosis interstinalis
C. The source of bleed is most probably ectopic gastric mucosa in meckels
diverticulum
D. Surgical intervention is urgently indicated
When assessing the need of nutritional supplements for a preterm infant, which
of the following is INCORRECT:
A. Vitamen K should be given at birth
B. Iron supplement should be started earlier at 6-8 weeks of age rather than
6 months
C. Fluoride supplement is recommended at 6 months of age if inadequate in
water supplies
D. Vitamen D is indicated if low birth weight
E. Folate supplement should not be given if goat’s milk is used for feeding.
A 2 months old male infant is brought to the ER. His mother states that over the
past 2 days he developed severe diarrhea and was feeding poorly. On
Examination, the child was irritable with sunken fontanelles, had dry mucosa
and was crying but no tears were seen. Blood pressure is low. Mother said that
his last urine output was very small and concentrated about 8 hour ago. He
weighs 5000 grams. The most appropriate next step in this patients
management is:
A. Draw blood for complete blood count, electrolytes and glucose
B. Infuse normal saline at a rate of 20 ml/kg
C. Start IV 0.33 Normal saline in 5% dextrose at a rate of 500 mls/day
D. Rehydrate using 0.45 normal saline in 5% dextrose IV over 48 hours
E. Rehydrate using 0.45 normal saline in 5% dextrose orally over 48 hours
A 6 year old boy was brought to your clinic by his family who have become
concerned over the child wetting his bed at night. The family states that the
child has been dry for about two years but has recently started wetting his bed,
especially at night, although daytime wetting is also noted. The family had just
relocated to this town 2 months ago. The child has no history of mental or
neurological disorders and has had a healthy childhood so far. The father says
that his son is about to join a summer camp and wants a relief for his child
before he goes away. Physical examination is normal. The most appropriate
next step in this child’s management is:
A. Reassurance
B. Urinalysis
C. Urine culture
D. Prescribe imipramine
E. Prescribe Oxybutynin
A 3 year old male child was brought to the ER 6 hours after he ingested 30
tablets of ASA pills at home. He was lethargic, tachypneic and tachycardic. He
had a seizure on his way to the ER. Arterial blood gasses on this child will most
probably reveal:
A. Metabolic acidosis with respiratory compensation
B. Respiratory Alkalosis
C. Respiratory Acidosis with renal compensation
D. Metabolic Alkalosis with respiratory compensation
E. Normal PH
Therapeutic measures for the above patient may include each of the following
EXCEPT:
A. Activated charcoal
B. Ipecac
C. Gastric lavage
D. Alkaline Diuresis
E. Vitamen K, glucose, and Fluid support
F. Dialysis
Lead poisoning can present with all of the following EXCEPT:
A. Microcytic Anemia
B. Haemolytic anemia
C. Wrist drop
D. Encephalopathy
E. Decreased erythrocyte protoporphyrins
A mother brings her 6 month old infant to your clinic for his routine
immunization update. He is to have his third DPTP and Hib vaccine. The mother
says that after his second immunization dose, the child developed redness and
swelling at the injection site with a fever of 38C for 2 days. Acetaminophen
given to her at the time helped relieve the complications. 4 days ago he was
diagnosed with acute otitis media and is currently on a 10 day course of
Amoxicillin. What is the best approach in this child regarding his immunization:
A. Defer immunization until after the child finishes his antibiotic course
B. Adminster both vaccines only after complete resolution of Otitis media
C. Give both vaccines now and continue antibiotic therapy
D. Substitute DT for DPTP in view of the child’s previous reaction of fever,
swelling and redness and administer with Hib now
E. Give both vaccines now but stop antibiotic therapy
A 5 year old child comes to your clinic with his mother who states that the child
started developing a rash 5 days ago. She states that the child first had
symptoms of upper respiratory tract infection with cough and conjunctivits
about 10 days ago. On examination, the child was febrile, with macular rash on
the head and trunk. She was also noted to have whitish leasions on the buccal
mucosa. There is no lymphadenopathy. The most common complication of the
above condition is:
A. Otitis Media
B. Encephalitis
C. Subacute sclerosing panencephalitis
D. Pneumonia
E. Myocarditis
F. Arthritis
A mother brings her 1 year old infant to your clinic complaining of a pink
coloured slightly raised rash that developed over the past 7 days covering the
face, neck and extremities. She says that the child first developed a high fever of
40C 10 days ago. The fever subsided three days later only to be followed by the
current rash. Examination shows, in adition to the rash, Occipital
lymphadenopathy. The child is afebrile. The most probable diagnosis is:
A. Measles
B. Rubella
C. Roseola
D. Scarlet fever
E. Erythema infectiosum
A 9 year old boy has microscopic heamturia. A maternal uncle receives chronic
dialysis to for treatment of glomerulonephritis. Which of the following findings
would be most supportive of a diagnosis of a hereditary renal disease:
A. Cherry red spot of macula
B. Chronic hypertension
C. Duplicated renal collecting system
D. Multiple café au lait spots
E. Sensorineural deafness
An 8 year old had a tonsillectomy and adenoidectomy 10 days ago, she has
complained of pain in the right ear for the past week. Examination of the ear is
normal. Which of the following is the most likely diagnosis:
A. Infected tooth
B. Nasopharyngitis as a complication of the surgery
C. Referred pain from pharynx
D. Subclinical otitis media due to edema of the Eustachian tube orifice
E. Temporomandibular joint pain referred to the ear.
A 23 month old boy has had two episodes of otitis media during the past year
and five episodes of bronchitis with wheezing during the past 6 months. The
appropriate first step in evaluating this child would be to:
A. Ask the parents about smoking in the houshold
B. Determine immunoglobulin levels
C. Place the child on prophylactic antibiotic therapy
D. Refer the child to an allergist
E. Perform an HIV Elisa test
a 4 year old previously healthy girl has had abdominal pain for 12 hours. There
has been no diarrhea or vomiting. She appears ill and has grunting respirations.
Vital signs are RR 50, HR 140, TEMP 39.5. She also has some neck stiffness.
Examination of the abdomen reveals tenderness with mild guarding in the right
upper quadrant. Which of the following is the next appropriate investiation:
A. A barium Enema
B. A cholecystogram
C. A chest Xray
D. An upper gastrointestinal Series
E. CT scan of the abdomen
A 7 year old has a persistant night time cough for 1 year. The most likely cause
of the patients cough is:
A. Foreign body aspiration
B. Immotile cilia syndrome
C. Psychogenic cough
D. Reactive airway disease
E. TB
A 5 year old boy has a seizure that began 45 minutes ago. Initial treatment
includes O2 and anticonvulsant. History and physical examination reveal no
precipitant cause. Which of the following tests would be most urgent to obtain:
A. Toxicology screen
B. EEG
C. CT scan of head
D. Serum Glucose
E. Serum Monia and lactic acid
A 4 year old girl has complained of joint pain for 6 weeks. Physical examination
reveals swelling and tenderness of the knees and right ankle. All other findings
are normal. Lab studies reveal a normal complete blood count, normal ESR, - ve
RF and + ve ANA. Patient with such findings are most likely to develop which of
the following:
A. Pericarditis
B. Iridocyclitis
C. Scaroiliitis
D. Severe destructive joint disease
E. Enthesitis
A 2 year old boy has had fever to 39C, irritability and drooling for 1 day. Physical
Examination reveals the uvula to be in the midline but erythematous and
swollen. The epiglottis appears normal on lateral radiograph of the neck. The
most likely causative organism in this patient is:
A. Coxackie virus
B. Heamophilus influenza type B
C. Non typeable H. flue
D. Pseudomonas aerogenosa
E. Staph. Aureus
A 9 year old boy had had fecal soiling for several years. He denies associated
illness, abdominal pain, or constipation. Physical examination reveals a left
sided mass. Rectal examination reveals stool present with a normal anal tone.
Which of the following is the most likely explanation for this boy’s soiling
problem:
A. Chronic constipation with stool impaction
B. Hirschprung disease
C. Hypothyroidism
D. Left sided colon tumour
E. Psychiatric dysfunction
A 2 year old girl who is in day care program has had persistent diarrhea for the
past 6 weeks. The stools are described as watery, green, occurring 4-5 times per
say with neither blood nor mucus. She has not gained nor lost any weight. Her
height and weight are both between the 25th and 50th percentile. Physical
examintion is normal. Which of the following is the most likely diagnosis:
A. Celiac disease
B. Giardia Lamblia infection
C. Crohn’s disease
D. Milk allergy
E. Pancreatic insufficiency
In addition to E coli and proteus species. The organism most likely to cause
urinary tract infections in children is:
A. Candida Albicans
B. Enterococcus species
C. Klebsiella species
D. Psudomonas
E. Staph. Saprophyticus
A 16 year old boy presents with a 6 month history of detrioration in school
performance, fatigue and now has become jaundiced. The mother states that
his handwriting has become illegible. His liver is enlarged and hard and the
spleen is also palpable. What is the most likely diagnosis:
A. Autoimmune hepatitis
B. Hepatitis A
C. Hepatitis C
D. Wilson Disease
E. Primary sclerosing cholangitis
A 15 month old infant presents with the sudden onset of rectal bleeding with
large amounts of blood mixed with loose stools. Each of the following should be
considered in the differential diagnosis EXCEPT:
A. Anal fissures
B. Meckel’s diverticulum
C. Intussusception
D. Intestinal polyps
E. Salmonella enteritis
Complications of bacterial meningitis in children include each of the following
EXCEPT:
A. SIADH
B. Deafness
C. Cerebral palsy
D. Seizures
E. Intraventricular haemorrhage
A six year old girl comes to your office for a routine annual check up. On
physical examination, you find that she has a heart murmur. Each of the
following findings would support a diagnosis of a pathological murmur EXCEPT:
A. Murmur occurs in diastole
B. Murmur is associated with a thrill
C. Child has mild finger clubbing
D. Murmur is louder in supine and softer when child sits upright
E. There is a loud P2 component of the heart sounds
A child who has ingested a large quantity of iron tablets will demonstrate each
of the following EXCEPT:
A. Hemorrhagic vomiting
B. Hemorrhagic diarrhea
C. Status epilepticus
D. Metabolic acidosis
E. Radiopaque particles in GI tract
Prostaglandin E2 infusion can be used for the intial management of each of the
following neonatal heart leasions EXCEPT:
A. Pulmonary atresia
B. Coarctation of aorta
C. Tetralogy of fallot
D. Patent Ductus arteriosus
E. Hypoplastic left heart syndrome
A 6 week old infant presents with recurrent vomiting, each of the following is
consistent with a diagnosis of pyloric stenosis EXCEPT:
A. Non bilious vomiting
B. Hypochloremic metabolic alkalosis
C. Palpable epigastric mass
D. Persistent unconjugated hyperbilirubinemia
E. Abdominal distention
The average 4 year old has 8 to 10 respiratory tract infections per year. Factors
contributing to this rate include each of the following EXCEPT:
A. The large number of different respiratory viruses
B. Lack of long lasting immunity after many respiratory viruses
C. Frequent Exposure to other children
D. Chronic excretion of respiratory viruses for months after infection
E. High degree of contagiousness of most respiratory viruses.
A 2 year old boy is brought to the ER with high fever, cough and respiratory
distress. Examination confirms right lung consolidation. There is no
lymphadenopathy and no splenomegally. He is also noted to have small tonsils.
his weight is below the 3rd percentile for his age. Review of records reveals
history of repeated pneumonias, sinusitis and otitis media since the age of 9
months. His immunization record is not available. Investigation later shows sub
normal levels of T lymphocytes and low levels of circulating B lymphocytes
associated with extremely low levels of IgG, IgM, IgE and IgA. What is the most
likely diagnosis in this patient:
AIDS
A. Child neglect (child abuse)
B. Incomplete immunization
C. Inherited Immune deficiency
D. Transient hypogammaglobulinemia of infancy
A 4 year old male child is seen by the doctor because of history of recurrent
respiratory tract and urinary tract infections associated with chronic diarrhea.
His investigation reveals low levels of IgA with normal levels of IgG, B and T cells.
Which of the following statements is correct:
Immunization with live attenuated vaccines should not be given to this child
A. Blood and Blood products should be carefully screened before
administering if this patient needs transfusion for any reason
B. This condition could have been prevented by careful screening of mother
during pregnancy
C. Adenosine deaminase deficiency is the defect found in most of these cases
D. NADPH Oxidase deficiency will be found on further testing
a 90 days old female child was brought to your clinic after her mom noticed that
the cord stump is still not separated. The child was born at term with no
complications. Examination is normal. Which of the following actions is
appropriate in this patient:
A. Reassure the mother that this is normal and it will separate on its own in 1
year
B. Surgically remove the stump
C. Investigate for immunological defects
D. Perform an HIV ELISA test
E. Send the child to the hospital for surgical closure of this umbilical hernia
A 3 week old baby boy was brought to the ER after experiencing a seizure. After
stabilization, the baby was noted to have wide spread eyes, low set ears, and a
narrow mouth opening with a small mandible. He had normal levels of Na, K,
and Glucose. Serum calcium was below normal. What is the most likely cause of
his seizure:
A. Fetal alcohol syndrome
B. DiGeorge syndrome
C. Wiscott Aldrich syndrome
D. McCune Albright syndrome
E. Congenital hypoparathyroidism
Management of the above diagnosis may, in general, include all of the following
EXCEPT:
A. Fluid adminstration
B. Bronchodilators
C. Ribavirin
D. RSV immune globulins
E. Steroids
a 4 year old girl presents to the ER with a 24 hour history of fever and
respiratory distress. She has newly relocated to this town with her parents. Her
immunization record is not available. History from her parents reveals that the
child was born at term with no complication during delivery but failed to pass
meconuim in the first 48 hours of life. She also later developed rectal prolapse
and required hospitalization. Examination reveals nasal polyps and suggests left
lung field consolidation with rales. What is the most likely underlying
mechanism causing her current presentation:
A. Thick mucus secretions
B. Abnormally cilliary movements
C. Incomplete immunization
D. Immune deficiency state
E. Increased chloride absorption
Which of the following congenital heart disease does not cause cyanosis:
A. Tetralogy of fallot
B. Transposition of great vessels
C. Truncus arteriosis
D. Ventricular septal defect
E. Coarctation of the aorta
A 12 hour old infant born at 32 weeks gestation was found to have a continuous
murmur over the left sternal border. There are no other findings. What is the
best action to take in this child:
A. Give endomethacin and restrict fluid intake
B. Transfer to surgery for closure of defect
C. Transfer to surgery for ligation of PDA
D. Give PGE1
E. Observe for spontaneous resolution
A 5 month old is brought to your clinic with a complaint of the child developing
cough and wheeze and sometimes apnea after feeds. The mother states that
the child has also been spitting up and vomitting since he was 1 month old. The
mother describes posturing of the child consistent with sandifer syndrome. The
child is at the 5th percentile for weight. What is the most likely cause of the
patients symptoms:
A. Tracheoesophageal fistula and atresia
B. Pyloric stenosis
C. Gastroesophageal reflux
D. Diaphragmatic hernia
E. Tracheomalatia
the most common cause of lower GI bleed in a child less than 1 year is:
A. Intussusception
B. Colonic polyps
C. Meckel diverticulum
D. Anal Fissure
E. Volvulus
an 10 months old infant is brought to the ER 12 hours after he started having
colicky abdominal pain. The mother states that the child was diagnosed with
viral gastroenteritis 7 days ago. He had since recovered well until today when he
started having severe pain with vomiting and a slight fever. There is no diarrhea
and the last bowel motion 8 hours ago was normal, although it seemed to have
temporarily relived the pain. On examination, a listless child is seen with a
tender abdomen. A sausage shaped mass is felt in the upper abdomen
associated with an empty left lower quadrant. Digital rectal exam shows normal
stool which is heme negative. What is the best next step in the management of
this patient:
A. Abdominal U/S
B. Baruim enema
C. Emergency laporotomy
D. Sigmoidoscopy
E. Observation with fluid support
4 year old girl presents to her clinician with dysurea. A diagnosis of UTI is made.
This was her first presentation with a UTI. What is the best course of action to
take in this patient:
A. Treat her infection as outpatient, and treat recurrence as it occurs, no
need to investigate
B. Treat her infection as outpatient, reculture urine at end of treatment and
perform renal US
C. Treat her infection, fully investigate only if recurrence occurs
D. Admit to hospital for treatment and immediate VCUG
E. Treat her infection and place patient on long term prophylaxis, no need for
investigation
After an abnormal U/S following the first episode of a UTI in a 3 year old, a
VCUG showed grade 3 vesicoureteric reflux. No renal scarring is seen on IVP.
What is the best action to take:
A. Place child on nitrofurantoin therapy and wait for spontaneous resolution
B. Treat only if infections occurs
C. Refer for surgical correction immediatly
D. No need for intervention at this time
E. Re evaluate in 1 month, and surgically correct if no resolution
All of the following are poor prognostic factors associated with Acute
Lymphoblastic Leukemia EXCEPT:
A. Male
B. Black
C. WBC > 100, 000/mm3
D. CNS involvement
E. Age between 2 and 10
Most common solid tumor in children is:
A. Wills Tumor
B. Brain Tumor
C. Neuroblastoma
D. Leukemia
E. Lymphoma
a 2 year old child was brought to the ER after having a seizure. The parents who
accompanied the child stated that the child had a fever of 38 the night before
associated with earache. The parents were planning to bring the child to his
physician today but because of the seizure, they decided to take him to the ER.
The seizure lasted 5 minutes, was a generalized tonic clonic and the child
recovered rapidly after the seizure ended. There is no family history of seizure
disorder. Examination reveals bulging, immotile and hyperemic right tympanic
membrane with a temp. of 39C. What is the most appropriate next step in
management:
A. Reassurance, antipyretic and antibiotic
B. Antibiotic, Anticonvulsant and EEG
C. Lumbar puncture, Anticonvulsant and Antipyretic
D. Reassurance, anticonvulsant and EEG
E. Lumbar puncture, Antibiotics and Anticonvulsant
F. EEG, Lumbar puncture and anticonvulsants
A 6 months old infant is brought to the clinic by his parents. They state that over
the last 2 months, they noticed that the child was having episodes of symmetric
rhythmic contractions of the trunk and extremities that were very brief but very
frequent. Suspecting a particular cause, the doctor orders an EEG, which
showed hypsarrhythmia. What is the best treatment modality for this condition:
A. Treatment with Phenytoin
B. No treatment required as spontaneous resolution is expected
C. Treatment with thyroid hormone
D. Diagnoses of the underlying condition is required before treatment can be
decided
E. Treatment with adrenocorticotropic hormone
In cerebral palsy, which statement is CORRECT:
A. Progressive motor deterioration is a common feature
B. Birth asphexia is a very common cause
C. Prematurituy does not increase risk
D. Has a higher incidence of scoliosis
E. Spastic cerebral palsy occurs in less than 30% of cases
Female child came with +ve nitrate & +ve leukocyte estrase. Regarding UTI
which of the following is most appropriate :
A. All children <5 years with recurrent UTI should be investigated
radiologically for anomalies.
Patient looking ill, high grade fever, drooling of saliva with inspiratory stridor:
A. Epiglottitis
B. Croup
Patient irritable, crying, pulling ear. Ear drum was erythematous and bulging on
examination. The most likely organism is:
A. Streptococcus Pneumoniae
B. Haemophilus influenzae
C. Moraxella catarrhalis
D. CMV
Patient, 4 years old, with exertional dyspnea, has ejection systolic murmur on
upper sternum, fixed splitted S2, normal S1, grade 2/6 murmur:
A. ASD
B. VSD
A case of short stature: a child shorter than his class peers but otherwise
healthy, his upper and lower segments found to be appropriate:
A. Growth Hormone Deficiency : Give growth hormone.
Infant with galactosemia most likely he will present with:
A. Vomiting, jaundice, hepatomegaly
B. Glucosuria
Patient with cystic fibrosis: sweat chloride test found to be > 40 mmol/L :
A. Pancreatic enzymes replacement.
A case of a child inhaled gasoline gas and started to vomit and then stopped
vomiting when arrived to the ER, the 1st thing to do in ER is:
A. Pulse oximetry, and ABGs.
B. Administer ipecac
Cause of polyhydrominous:
A. Oesophageal atresia
B. Cleft palate
C. Renal agenesis
A case of a newborn after his first feed developed abdominal distension,
drooling of milk, cough, choking:
A. Diaphragmatic hernia
B. Duodenal atresia
C. Oesophageal atresia with fistula
A case of a boy with URTI received antibiotic and he developed pallor and
jaundice:
A. G6PD deficiency
Q1) Among the following. Life threatening anaphylaxis in children occurs most
often as a result of exposure to :
A. Exercise
B. Foods
C. Latex
D. Preoperative drugs
E. Vaccine
Q2) which of the following clinical features is most likely to be associated with a
benign condition?
A. Bleeding 7 days after a tonsillectomy
B. Bruises over the bony prominences of the extremities, both proximal and
distal
C. Epistaxis (worse in winter)
D. Hemarthrosis
E. Menstrual bleeding that last 8 days.
Q3) which of the following findings on the newborn examination may be
normal?
A. Fixed S2
B. High-pitched murmur
C. Obscured S1
D. Precordial thrill
E. Systolic ejection murmur
Q5) which of the following symptoms of GERD is more common in older children
and adolescents than in infants and young children?
A. Apparent life-threatening event
B. Asthma
C. Failure to thrive
D. Hematemesis
E. Recurrent pneumonia
Q6) A previously healthy 5- year old boy presented with hematochezia. Physical
examination ?????????. the mother reports that he has had ????????? that did
not affect his activity. The most likely :
A. Henoch-schonlein purpura
B. Infective colitis
C. Juvenile polyp
D. Meckel diverticulum
E. Superior mesenteric aneurysm
F. Q7) postnatal immuno-prophylaxis is more effective against hepatitis B
During delivery
G. In utero
H. Through breast feeding
I. Through salivary transmission
J. Via feco-oral
Q11) A 4 week old breastfeeding boy is jaundiced and has a total billirubin
concentration of 1.3mg/dl . the laboratory test that maximizes diagnostic
efficiency is:
A. Complete blood count
B. A reticulocyte count
C. Billirubin fractionation
D. Gamma glutamyl transferase
E. Hepatic Aminotransferase
Q16) what is the most common underlying cause for mild to moderate
neutropenia?
A. Exposure to medication such as antibiotics
B. Immune neutropenia
C. Shwachman-diamond syndrome
D. Sequestration
E. Transient marrow suppression due to viral infection
Q18) A healthy 2 month old infant was born at 32 weeks gestation. She has
grown well since birth. On physical examination of this infant, the MOST likely
finding is:
A. Ability to fixate on a face and follow ???
B. Ability to reach and grasp a ???
C. Ability to watch an object and follow it to midline
D. Absence of the motor reflex
E. Dabbling and cooing vocalization
Q21) A TRUE statement about glumerular filtration rate, corrected for surface
area, at 2 years of age is that it is :
A. Double that observed at birth وهللا اعلم
B. Equal to that observed at birth
C. Double that observed at 6 months
D. Triple that observed at 6 months
E. Equal to that observed in adults
Q22) iron deficiency in a child who has unrepaired cyanotic congenital heart
disease is MOST likely to increase the risk for :
A. Congestive heart failure
B. Digoxin toxicity
C. Osteoarthropathy
D. Pulmonary hemorrhage
E. Stroke
Q23) A 1 day old term baby develops bilious vomiting and poor feeding. You
recall that the deferential diagnosis of vomiting is age related. Of the following,
the condition that is MOST likely to cause bilious vomiting in this infant is :
A. Gastric stress ulcer
B. GERD
C. Gastrointestinal food allergy
D. Intussusception
E. Midgut volvulus
3- All of the following true for Diet Management in Diabetes Mellitus EXCEPT?
A) Regular food pattern should be emphasized
B) Caloric intake 40% CHO
C) Encouraged low salt.
D) Encouraged low saturated fats and high fiber diet.
E) Distribute carbohydrate load evenly during the day preferably 3 meals & 2
snacks
11- All of the following associated with bacterial rather than viral GE EXCEPT?
A) Visible blood mixed with faeces
B) Febrile seizure
C) Diarrhoeal frequency more than 5 stool per day
D)Full blood count showing Hb 5.2 g/l,WBC14.5 PLT 102
E)Pulse rate 80/min. in a child of 2 years
12- All of the following causes the onset of persistent vomiting in 3 week old
child?
A)Disaccharidase intolerance
B)Duodential atresia
C) Pyloric stenosis
D)Hiatus hernia
E)Choledochal cyst
F)C+D
16- All of the following are reccgnised causes of nonorganic failure to thrive ?
A) Maternal eating disorders
B) Maternal depression
C) Inadequate housing
D) Inadequate social support
E)Lack of extended family
F)A+B
17- All of the following are though to be lung term out comes of early nutritional
deficiency?
A)Short stature
B) DM
C) Ischaemic heart disease
D) Obesity
E)Obstructive lung disease
18- All of the following are known disadvantages of milk formulae EXCEPT?
A) Approximately 25%of infants with cows milk protein intolerance with
developsoy intolerance
B) Soy milk formulae tastes worse than elemental milks
C) Infants respond poorer to vaccination than elemental milks
D) Infants have lower complement levels than elemental milks
E) Infants have lower aluminum levels than elemental milks
20- All of the following are true regarding the diagnosis of cows milk intolerance
EXCEPT?
A)Skin test usually confirm the diagnosis
B) RAST test of >grade 2 makes the diagnosis highly likely
C) Bloodly diarrhea excludes the diagnosis
D)It is common in breast-feed infants
E)Rechallenge should be extremely caution us in the comptred with bottle-fed
31- All of the following are nutrition delivery enteral feeding EXCEPT?
A) Oral feeding
B) NOT
C)Subcutaneous infusion
D) Gastrostomy feeding
E) Jejenostomy feeding
43-You are asked to help prepare an oral rehydration solution.You recall that, in
addition to water, the MOST important components of such a solution are:
A) bicarbonate and potassium
B) chloride and potassium
C) lactate and potassium
D) sodium and fructose
E) sodium and glucose
44-Which of the following vitamins is in higher concentration in cow's milk than
in human milk?
A. A
B. C
C. E
D. K
E. B6
47- Of the antibodies found in human colostrum and milk, the immunoglobulin
(Ig) that is MOST likely to prevent organisms from adhering to the infant's
intestinal mucosa is:
A) IgA
B) IgD
C) IgE
D) IgG
E) IgM
10. An infant who was born with myelomeningocele has hydrocephalus, and a
ventriculoperitoneal shunt is placed. His parents are concerned about
recognizing the signs and symptoms of shunt blockage. Of the following, the
BEST information you can give the parents is that
A. behavioral changes such as decreased spontaneity and mild lethargy may
indicate shunt malfunction
B. fewer than 30% of all shunts malfunction
C. most shunt failures occur more than 5 years after the initial surgery
D. seizures are the most common manifestation of shunt malfunction
E. shunt malfunction is usually due to infection
11. A 6-year-old girl is brought to your office for evaluation of swelling of her
eyes and legs. Three weeks ago she had a fever, bloody diarrhea, and abdominal
pain that resolved spontaneously. Laboratory studies reveal anemia, mild
thrombocytopenia, normal electrolyte levels, elevated blood urea nitrogen and
creatinine concentrations, and proteinuria. Of the following, the MOST likely
cause of this child's edema is
A. acute onset of nephrotic syndrome
B. Berger disease
C. hemolytic-uremic syndrome
D. Henoch-Schönlein purpura
E. poststreptococcal glomerulonephritis
14) You have been asked to evaluate a 7-year-old boy who has moderate
persistent asthma. He has not seen any primary care physician for more than 6
months. You decide to formulate an appropriate treatment plan for him.
Of the following, the BEST maintenance therapy is
A. inhaled beta-agonist
B. inhaled corticosteroid daily
C. leukotriene receptor antagonist daily
D. nebulized cromolyn sodium
E. oral theophylline
15) A7-year-old boy presents with left-sided proptosis and a 1-week history of
purulent nasal discharge and fever. On physical examination, you observe
downward and outward left-sided proptosis with good visual acuity but with
limitation of left lateral gaze.
Of the following, the MOST appropriate diagnostic test is
A. a lumbar puncture
B. computed tomography with contrast of the brain
C. computed tomography with contrast of the paranasal sinuses
D. magnetic resonance imaging of sinuses
E. sinus radiography
16) A 16-month-old boy has had severe emesis and diarrhea for 3 days. On
physical examination, he appears dehydrated. You administer fluids rapidly to
correct his volume loss and serum electrolyte abnormalities. On the next day,
he appears confused and exhibits quadriparesis and dysarthria. Magnetic
resonance imaging reveals demyelination of the central basis pontis.
Of the following, the rapid correction of which condition is MOST likely
responsible for these findings?
A. hyperkalemia
B. hypermagnesemia
C. hypocalcemia
D. hyponatremia
E. hypophosphatemia
17) A 6-month-old previously healthy infant presents with a 2-day history of
cough and difficulty breathing. On physical examination, she appears lethargic,
pale, and poorly perfused. She exhibits marked tachypnea, and auscultation of
the chest reveals decreased breath sounds bilaterally and poor aeration. She
has supraclavicular and intercostal retractions. Of the following, the MOST
appropriate therapy for this infant is
A. continuous positive airway pressure via face mask
B. endotracheal administration of surfactant
C. endotracheal intubation and positive pressure ventilation
D. negative pressure ventilation
E. nitric oxide
19) A newborn who weighs 600 g and whose estimated gestational age is 24
weeks at birth is admitted to the neonatal intensive care unit after successful
resuscitation in the delivery room. Arterial blood gas measurements on room air
are: pH, 7.35; PCO2, 42 mm Hg; PO2, 68 mm Hg; base deficit, 2 mEq/L.Of the
following, the MOST appropriate initial management is to
A. begin intravenous vancomycin
B. begin phototherapy
C. initiate enteral feeding
D. provide bicarbonate infusion
E. provide glucose infusion
20) You have been asked to evaluate a 15-month-old toddler who was admitted
to your community hospital for observation 6 hours ago after a near-drowning
episode. The nurse caring for the toddler reports that the child has become
more tachypneic and distressed. Her oxygen requirement also has increased.
Of the following, the MOST likely diagnosis is
A. adult respiratory distress syndrome
B. upper airway oedema
C. bacterial pneumonia
D. pneumothorax
E. reactive airway disease
21) Two days ago a 5-year-old girl undergoing chemotherapy for acute
lymphoblastic leukemia spent the morning with a playmate that now has
developed varicella. She has not received varicella vaccine and has no history of
having varicella.
Of the following, the MOST appropriate action is to
A. administer varicella vaccine
B. administer varicella-zoster immune globulin
C. begin oral acyclovir
D. discontinue chemotherapy for 3 weeks
E. obtain varicella titers to determine the need for therapy
24) You are examining a term newborn in the nursery. His weight is 3.27 kg
(50th percentile), and his length is 50.5 cm (50th percentile). The pregnancy,
labor, and delivery were unremarkable. There are no significant findings on
physical examination.
The MOST likely head circumference in this child, if it is consistent with his other
growth parameters, is
A. 31 cm
B. 33 cm
C. 35 cm
D. 37 cm
E. 39 cm
26. You are examining a 6-month-old boy who has infantile spasms. There is a
family history of tuberous sclerosis.
Of the following, the cutaneous finding MOST likely to be present in this infant
is
A. adenoma sebaceum
B. ash-leaf macule
C. forehead plaque
D. periungual fibroma
E. shagreen patch
27. A 6-year-old girl presents for evaluation of her shot stature. Chromosome
analysis reveals a 45,X karyotype that is consistent with Turner syndrome.
Of the following, the MOST appropriate evaluation to obtain is
A. echocardiography
B. hysterosalpingography
C. magnetic resonance imaging of the brain
D. pulmonary function tests
E. slitlamp ophthalmologic examination
31. A 4-year-old boy has a 1-month history of fevers to 39°C twice a day
accompanied by a rash. He feels well during his afebrile periods. Physical
examination reveals generalized lymphadenopathy.
Of the following, the MOST common other manifestation of this boy's illness
would be
A. iridocyclitis
B. headech
C. marked leukocytosis
D. presence of antinuclear antibodies
E. presence of rheumatoid factor
32. A 2-year-old girl presents with a 2-day history of cough, congestion, and
bilateral red eyes with an associated watery discharge. She denies any
photophobia or pain, and there is no edema of the eyelid.
The MOST likely diagnosis is
A. blepharitis
B. conjunctivitis
C. corneal abrasion
D. sclerouveitis
E. uveitis
33. A 3-year-old boy presents with a 3-day history of a sore throat,
temperature of 38.3°C, nasal congestion with cloudy rhinorrhea, and
conjunctivitis.
Of the following, a TRUE statement about acute pharyngitis is that
37. ron deficiency in a child who has unrepaired cyanotic congenital heart
disease is MOST likely to increase the risk for
A. congestive heart failure
B. digoxin toxicity
C. osteoarthropathy
D. pulmonary hemorrhage
E. stroke
40. An 8-year-old girl is evaluated for fever and vomiting of 2 days' duration.
Physical examination reveals a temperature of 39.9°C and blood pressure of
105/68 mm Hg; the remainder of the findings are normal. Results of laboratory
evaluation include a positive urine nitrite test, more than 100 white blood cells
per high-power field, and serum white blood cell count of 25 x 109/L
(25,000/mm3), with 4% bands and 80% neutrophils. A midstream clean catch
urine culture grows 10,000 to 100,000 CFU/mL of Escherichia coli.
Of the following, the MOST likely diagnosis in this child is
A. acute appendicitis
B. acute cystitis
C. acute pyelonephritis
D. renal abscess
E. viral gastroenteritis
41. The parents of a 5-year-old boy who has severe factor VIII deficiency
hemophilia bring him in for evaluation after he fell off his bicycle. He was not
wearing a helmet. He had no loss of consciousness and appears uninjured
except for a small hematoma over the right side of his forehead.
Of the following, the MOST appropriate next step is to
A. admit for observation without therapy
B. discharge home
C. infuse with factor VIII
D. obtain computed tomography
E. treat with desmopressin
42. You are examining a girl at her 1-year health supervision visit. Her weight,
length, and head circumference all were at the 10th percentile at birth. There
were no pregnancy, labor, delivery, or nursery complications. Physical
examination reveals her weight, length, and head circumference are at the 5th
percentile.
Of the following, this child's growth parameters MOST likely represent
a chromosomal abnormality
a malabsorptive disorder
an endocrine disorder
inadequate caloric intake
normal growth
43. A 1-day-old term infant develops bilious vomiting and poor feeding. You
recall that the differential diagnosis of vomiting is age-related.
Of the following, the condition that is MOST likely to cause bilious vomiting in
this infant is
gastric stress ulcer
gastroesophageal reflux
gastrointestinal food allergy
intussusception
midgut volvulus
47. A 5-year-old girl develops fever, swelling of the parotid gland, and
headache.
Of the following, the BEST diagnostic test for this child is
A. bacterial culture of parotid duct secretions
B. Epstein-Barr virus serology
C. mumps serology
D. serum amylase
E. viral culture of respiratory secretions
48. The mother of a 3-year-old reports that her son has begun to cough and
have difficulty breathing. She was keeping him home from preschool today
because he had a cough and upper respiratory tract infection without fever.
The MOST likely cause of this child's symptoms is
A.aspiration pneumonia
B. bacterial pneumonia
C. foreign body aspiration
D.reactive airway disease
E.vascular ring
49. Compared with human milk, cow milk formula is MORE likely to contain a(n)
A. greater concentration of essential fatty acids
B. higher protein concentration
C. increased lactose content
D. lower calcium-phosphorus ratio
E. lower iron concentration.
50. A newborn is recognized clinically to have Down syndrome. The parents are
very concerned about the disorder and its manifestations.
Of the following, the MOST important hematologic/oncologic complication is
A. aplastic anemia
B. leukemia
C. macrocytic anemia
D. platelet dysfunction
E. thrombocytosis
51. A 10-year-old boy presents with headache. His father has renal failure. On
physical examination, the boy's blood pressure is 145/100 mm Hg and pulse is
90 beats/min. Urinalysis reveals 10 to 20 red blood cells per high-power field,
and serum creatinine level is 61.9 mcmol/L). Renal ultrasonography shows
enlarged kidneys, with three renal cysts in each. Of the following, the MOST
likely diagnosis in this child is
A. autosomal dominant polycystic kidney disease
B. autosomal recessive polycystic kidney disease
C. juvenile nephrophthisis
D. medullary sponge kidney
E. multicystic dysplastic kidney disease
RESPIRATION
1) All of the following concerning the differentiation of viral and bacterial
pneumonias are correct EXCEPT :-
a. the white blood cell count in a viral pneumonia is lower than in bacterial
pneumonia
b. viral pneumonia of the infants is always of a mild severity
c. the progression of a viral pneumonia is slower
d. a lobar infiltration is usually indicative of a bacterial origin
6) Concerning bronchiolitis :-
a. most cases are in infants below 15 months
b. 25% of cases are due to respiratory syncytial virus
c. steroids are usually helpful
d. antiviral drugs are indicated in some cases
CARDIOLOGY
1) Which of the following would differentiate most clearly between a venous
hum & the murmur caused by a patent ductus :-
a. tha site of auscultation
b. auscultation during systole and diastole
c. a venous murmur is always soft
d. altering the paient's head position diminishes or accentuates the intensity of
the murmur
2) All of the following conditions are associated with a systolic murmur EXCEPT:-
a. anemia
b. aortic reguge
c. mitral incompetence
d. ventricular septal defect
NEUROLOGY
1)Which of the following is the most common cause of meningitis in infants and
children :-
a. meningococcus
b. enteroviruses
c. tuberculosis
d. haemophilus influenzae
2) All of the following statements concerning the Guillian Barre' syndrome are
correct EXCEPT :-
a. a symmetrical , flaccid pralysis and abnormality of sensation are characteristic
for the disease
b. the disease improves spontaneously despite its long clinical course
c. corticosteroids are the mainstay of ttt of acute cases
d. differentiation of the disease from poliomyelitis is difficult in some cases
4) All of the following statements about the epilepsy characterized by grand mal
(tonic- clonic ) seizures are correct EXCEPT :-
a. the seizures are characterized by flexion or extension positions of the lower
extremities
b. an interictal EEG is not sufficient for the diagnosis
c. phenytoin , Phenobarbital and valproate are the most important therapeutic
drugs
d. despite appropriate therapy , dementia develops in the majority of cases
5) Muscular hypotonia, without muscular weakness is characteristic for a.
Guillain-Barre' syndrome
b. Rickets
c. Down's syndrome
d. Werdnig-Hoffmann syndrome
7) All of the following steps in the therapy of marasmic infants are correct
EXCEPT :-
a. feeding during night is important
b. large volumes of parenteral infusions should be avoided to prevent overload
on the atrophic myocardium
c. vitamins, K+ and folic acid should be supplemented
d. the marasmic infant should be given large amounts of food, primarily milk
GENETICS
1)Characteristic features of autosomal recessive inheritance include
a)50%risk of recurrence
b)both parents can be normal
c)more males are affected
d)consanguineous marriage is not a feature
10-Possible causes of fever of non -infectious origin include all of the following
EXCEPT
a)Hyperthyroidism
b)Epilepsy
c)Systemic lupus erythematosus
d)A regulatory imbalance of the autonomic nervous system
Neonatology (M C Q)
1-WHICH OF THE FOLLOWING FACTORS LEADS TO NEONATAL
HYPERBILIRUBINEMIA:-
A-shortened neonatal red cell life span.
B-impaired excretion of unconjugated billirubin
C-limited conjugation of billirubin in liver
D-increased enterohepatic circulation
E-all of the above
HAEMATOLOGY
1) Which of the following is a typical symptom of Henoch-Scholein purpura :-
a. polyarthralgia
b. jaundice
c. a purpuric skin rush invoving the face
d. a prolonged bleeding time
4) All of the following results are indicative for iron deficiency , EXCEPT a.
anemia
b. large, hypochromic RBCs observed in the peripheral blood smear
c. a low serum ferritin
d. an elevated total iron binding capacity (TIBC
6) Which of the following interventions is not suitable for the therapy of ITP :-
a. glucocorticoid therapy
b. intravenus immunogloblin therapy
c. anabolic hormone therapy
d. plasmapheresis
7) All of the following laboratory findings are characteristic for ITP , EXCEPT :-
a. the platelet count is low
b. the prothrombin time (PT) , the partial thromboplastin time ( PTT) and the
thrombin time (TT) are all normal
c. the number of megakayocytes in the bone marrow is low
d. the WBC count is normal
8) Which of the following disorders may be associated with thrombocytopenic
purpura :-
a. meningitis
b. hypersplenism
c. Henoch-Scholein purpura
d. thrombasthenia
GIT
1- the minimal fluid requirement of a 6-months infant with mild diarrhea is :
a. 50 ml/kg
b. 75 ml/kg
c- 150 ml/kg
d. 300 ml/kg
2-what is the optimal initial therapy in case of moderately severe dehydration :
a. Transfusion of whole blood
b. infusion of half-isotonic sodium chloride –dextrose solution
c. infusion of 10 % dextrose solution
d. infusion of 0.9% sodium chloride solution
3- Disease in which a specific diet is indicated include all the following except :
a. post-enteric malabsorbtion
b. congenital sucrase-isomalatase deficiency
c. galactosemia
d. congenital hepatic fibrosis
Nephrology
1- All the following concerning acute post-streptococcal glomerulonephritis are
correct,Except:
a. it can be prevented by the early antibiotic therapy of streptococcal infections
b. steroids treatment Is usually helpful
c. the prognosis of the disease in childhood is usually good
d. a hypertensive encephalopathy may occur
2- Possible complications of acute post-streptococcal glomerulonephritis
include all the following, Ecxcept:
a. hypermagnesemia
b. hyperkalemia
c. anuria
d. pulmonary edema
5- findings usually detectable in acute renal failure include all the following ,
Except :
a. the serum creatinine in concentration is elevated
b. hyperkalemia
c. hyponatremia
d. hypophosphatemia
6- The average insensible water loss per day is :
a. 500 ml/kg
b. 500 ml/m2
c. 300 ml/kg
d. 300 ml/m2
ENDOCRINOLOGY
1)Which of the following laboratory data is possible to differentiate between
hypothalamic-pituitary secondary hypothyroidism & primary hypothyroidism?
A) A low serum T4 level & normal TSH levels
B) An elevated serum T4 level & low TSH levels
C) A low serum T4 level & elevated TSH levels
D) An elevated serum T4 level & elevated TSH levels
5)Which of the following is the first step in the therapy of a diabetic ketoacidotic
coma?
A)Correction of the acidosis with NaHCO3
B)The subcutaneous administration of insulin
C)Fluid replacement with the infusion of a solution containing no glucose & the
administration of a rapidly acting insulin preparation intravenously
D)Fluid replacement with the infusion of a glucose –containing solution
EMERGENCIES
1)Symptoms of hypovolemic shock include all of the following EXCEPT
A)Pallor & cold exteremities
B)Tachycardia
C)A low central venous pressure
D)Cardiac enlargement
E)Acidosis
2)Which of the following conditions associated with airway obstruction ,is NOT
life-thr?
A)Acute rhinopharyngitis
B)Acute epiglottitis
C)Laryngeal foreign body
D)Laryngeal oedema
E)None of the above
4)All of the following are guidelines for the therapy of circulatory failure in a
child EXCEPT
A)The administration of oxygen
B)The administration of digitalis in all cases
C)Discontinuation of oral feeding , infusion of volume expander
D)Mechanical ventilation for respiratory insufficiency
E)The elimination of the negative inotropic factors (acidosis, hypoglycemia,etc.)
MCQ PAPER 1
1-Concerning bronchiolitis:
A. Epidemics often occur during winter.
B. A chest radiograph usually shows a poorly inflated chest.
C. Poor feeding is an indication for treatment with ribavirin.
D. The disease is more benign in infants born prematurely.
E. Respiratory syncytial virus is the most common causative virus.
6-Concerning asthma:
A. Inhaled steroids are useful in the treatment.
B. Wheeze on auscultation is pathognomonic.
C. It is seldom a cause of hospital admission.
D. Exacerbation of symptoms can occur with exercise.
E. Sufferers should be excluded from sport at school.
MCQ PAPER 2
1-Concerning gastroenteritis (in the UK):
A. It can be fatal.
B. The most common cause is Salmonella spp. infection.
C. Broad-spectrum antibiotics are usually indicated.
D. A degree of lactose intolerance may follow gastroenteritis.
E. Blood pressure is a sensitive indicator of dehydration.
MCQ PAPER 3
1-The following congenital abnormalities are deformations:
A. Coarctation of the aorta.
B. Haemangioma.
C. Talipes.
D. Cleft lip.
E. Imperforate anus.
7-Concerning chickenpox:
A. The incubation period is 7 days.
B. Aspirin is a useful anti-pyretic.
C. Transmission is usually by contact or airborne.
D. Encephalitis is a recognized complication.
E. There is no effective vaccine.
MCQ PAPER 4
1-Concerning brain tumours in children:
A. A sixth cranial nerve palsy can be the presenting feature.
B. The majority are metastatic from other tumors.
C. They are the most common solid organ tumor.
D. Brain stem glioma usually present with personality change.
E. Medulloblastomas can metastasize to the spine.
MCQ PAPER 5
1-Concerning epilepsy in children:
A. There is an association with cerbral palsy.
B. Most forms of childhood epilepsy require lifelong treatment.
C. Infantile spasms may respond to corticosteroid treatment.
D. Consciousness is usually impaired in absence seizures.
E. A post-ictal hemi-paresis may occur.
2-The following are common findings in Trisomy 21:
A. Learning difficulties.
B. Protruding tongue.
C. Congenital heart defects.
D. Single transverse palmar crease.
E. Hypertonia.
3-Regarding rheumatic fever:
A. It occurs following a staphylococcal infection.
B. May present with chorea (a movement disorder).
C. Erythema marginatum is a "major" diagnostic criterion.
D. It requires treatment with immunoglobulin.
E. Renal impairment is the most serious long-term risk.
2) When you see the following ECG in cardiac arrest , the most appropriate
management is :
Defibrillation
Cardioversion (synchronized)
Give Atropine
Give Adenosine
Give lidocaine
10) A 4-year-old child was struck by a car traveling approximately 30 MPH and
was thrown approximately 15 feet. She is complaining of abdominal pain.
Physical exam reveals a blood pressure of 68/40 mmHg, a heart rate of 200
beats per minute, and a firm, tender abdomen. She weighs approximately 20 kg.
As long as the systolic blood pressure remains below 90 mmHg, what is the
most appropriate fluid management?
(A) 800 cc of normal saline followed by 400 cc of blood.
(B) 400 cc of normal saline followed by 200 cc of blood.
(C) 400 cc of normal saline repeated 3 times, then 100 cc of blood.
(D) 800 cc of normal saline repeated 3 times, then 400 cc of blood.
(E) 400 cc of normal saline repeated 3 times, then 200 cc of blood
11) A 2-year-old male is rushed in by his parents after being found unconscious
near open bottles of his grandfather's medications. The airway is secure, and
successful bag- valve ventilations are started. He is pulseless and unresponsive.
Intravenous access is being obtained. The cardiac monitor shows a wide
complex tachycardia at a rate of 260. What is the next step in management?
(A) Shock the patient with 200 J.
(B) Shock the patient with 0.5 J/kg.
(C) Shock the patient with 2 J/kg.
(D) Administer epinephrine 0.01 mg/kg IV.
(E) Administer atropine 0.01 mg/kg IV
12) Synchronized cardioversion shock is used for all of the following EXCEPT:
A- VF
B- VT
C- SVT
D- AT
E- AF
13) Which of the following actions helps deliver maximum current during
defibrillation?
A) Apply conductive paste to the paddles
B) Reduce the pressure used to push down on the defibrillator paddles
C) Decrease shock energy after the 2nd shock
D) Place alcohol pads between the paddles and skin
E) Use small paddles
14) The most appropriate method to open the airway in comatose patient with
suspected cervical injury is :
A) Jaw thrust
B) Head tilt
C) Head tilt ,chin lift
D) Extension of the neck
E) Flexion of the neck
18)- Advantages of the laryngeal airway mask compared with ETT include all of
the following EXCEPT
A- Less tramatic
B- Incidence of aspiration is less than the endotracheal tube
C- No laryngoscope needed
D- Quick
E- May be used in emergency situation
19) The cricoid cartilage in an infant is located at the level of which cervical
vertebra?
A. C1.
B. C2.
C. C3.
D. C4.
E. C5.
20)Which drug can be used to treat this ECG ?
Lidocaine
Atropine
Adenosine
Adrenaline
All of the above
6. A 10-yr-old girl is brought for evaluation because her mother was found to
have familial adenomatous polyposis coli (APC). Genetic screening identified
identical APC gene mutations in mother, aunt, and grandfather, but no
mutations were identified in the girl’s APC gene. The girl requires :
A. Colonoseopy
B. Proetoeolectomy
C. Annual physical examination
D. CT scan
E. Repeat genetic testing in 1 yr.
11. A 2.9-kg girl is born at term after having carried a prenatal diagnosis of left
congenital diaphragmatic hernia since 19 wk of gestation. Delivery and the early
postnatal period are uneventful, with mild tachypnea and retractions
developing at 24 hr of age. Chest film reveals a normal abdominal gas pattern
and multiple lucent areas in the left lower thorax. The most likely diagnosis is:
A. Congenital diaphragmatic hernia (Bochdalek
B. Congenital diaphragmatic hernia (Morgagni
C. Congential cystic adenomatoid malformation
D. Congenital diaphragmatic hernia (hiatal
E. Cystic fibrosis.
14. A 2-yr-old boy with the spastic diplegia form of cerebral palsy is being
evaluated. MRI of his brain is most likely to show:
A.Multicystic encephalomalacia
B.Periventricular leukomalacia
C.Normal anatomy
D.Basal ganglia abnormalities
E.Agenesis of the corpus callosum
15. Which of the following therapies has been found to be effective in long-term
follow-up for some patients with the X-linked neurodegenerative disease
adrenoleukodystrophy ?
A.Vegetable oil as a dietary supplement
B.Hyperbaric oxygen therapy
C.Bone marrow transplantation
D.Total volume exchange blood transfusion
E.Plasmapheresis
19. All of the following statements regarding Duchenne muscular dystrophy are
true except:
A.It is the most common hereditary neuromuscular disease
B.It is inherited as an autosomal dominant trait
C.Symptoms are rarely present at birth or in early infancy
D.The serum creatine kinase is consistently greatly elevated
E.It is more common in males
Q 4 - Plethoric lung fields are seen in all of the following conditions, except:
A. Atrial septal defect (ASD)
B. TAPVC (Total Anomalous Pulmonary venous connection)
C. Ebstein’s anomaly
D. Ventricular septal defect
Q 7 - Which of the following circulating antibodies has the best sensitivity and
specificity for the diagnosis of celiac disease?
A. Anti-endomysial antibody
B. Anti-tissue transglutaminase antibody
C. Anti-gliadin antibody
D. Anti-reticulin antibody
Q 11 - In a child with acute liver failure, the most important prognostic factor for
death is:
A. Increasing transaminases
B. Increasing bilirubin
C. Increasing prothrombin time
D. Gram negative sepsis
Q 18 - A premature infant is born with a patent ductus arteriosus. Its closure can
be stimulated by administration of:
A. Prostaglandin analogue
B. Estrogen
C. Anti-estrogen compounds
D. Prostaglandin inhibitors
Q 21 - All of the following drugs are used for managing status epilepticus except:
A. Phenytoin
B. Diazepam
C. Thiopentone sodium
D. Carbamazepine
Q 24 - All of the following are the complications in the new born of a diabetic
mother except:
A. Hyper bilirubinemia
B. Hyperglycemia
C. Hypocalcemia
D. Hypomagnesemia
Neonatology
Respiratory distress in newborn babies is recognized complication of all of the
following Except:
a- Group B streptococcal infection.
b- Congenital heart disease.
c- Sickle cell anaemia.
d- Cerebral disorders.
e- Diaphragmatic hernia.
An infant born at 32 weeks gestation is at increased risk from all of the following
Except:
a- Meconium aspiration.
b- Respiratory distress syndrome.
c- Hypoglycemia.
d- Hypocalcemia.
e- Intraventricular heamorrhage.
Infants of diabetic mothers are at increased risk from all of the following except:
A. Hypocalcemia.
B. Anaemia.
C. Jaundice.
D. Shoulder dystocia.
E. Congenital abnormalities.
Infants of diabetic mothers are at increased risk from all of the following except:
a- Hypoglycemia.
b-Hypocalcemia.
c-Intrauterine growth retardation.
d-Hypomagnesemia.
e-Hyperbilirubinemia.
10- All of the following are included in evaluating ABGAR score except:
A. Heart rate.
B. Respiratory effort.
C. Muscle tone.
D. Maturity of the newborn.
E. Response to catheter in nostrils.
11- Which on of the following is not utilized in determining an APGAR score.
A. Colour.
B. Heart rate.
C. Deep tendon reflexes.
D. Grimace.
E. Respiration.
Which are of the following finding is commonly seen in patient with Rt. to left
shunt:
A. cyanosis.
B. Clubbing of the fingers and toes.
C. Seundery polylythemia.
D. All of the above.
E. Non of the above.
Which of the following is not a clinical feature or recognized complication of
Tetra-logy of fallot:
A. Anoxic Spells.
B. Brain abscens.
C. Congestive heart failure.
D. Cyanosis.
E. Poor growth.
A child who skips, name four color and dresses and undresses is how old:
A. 15 months.
B. 24 months.
C. 30 months.
D. 18 months.
E. 60 months.(3y 3 color-4y 8color)
The ability to manipulate a small objects with the pincer grasp is La capacité de
manoeuvrer de petits objets avec la prise de pincer est habituellement notée à
quel âge ? usually noted at what age?
A. 0-2 months.
B. 3-5 months.
C. 6-7 months.األقرب إل الصحيح
D. 8-9 months.
E. 10-12 months.
A developmentally normal child who is just able to sit without support, transfer
objects from hand to hand, and speak in monosyllabic babble, is probably what
age:
A. 3 months.
B. 4 months.
C. 9 months.
D. 6 months.األقرب إل الصحيح
E. 11 months.
A6 month old infant differs from a 3 months old in regard to his or her ability to:
A. control bowel and bladder.
B. Crawl
C. Sit or almost sit, without support.
D. Simile socially.
E. Walk holding an to furniture.
Most infant loss weight immediately after birth, normal term infants generally
regain their birth, weight by:
A. 24 hours.
B. 48 hours.
C. 72 hours.
D. 3-5 days. (3-4 days loss weight )
E. 7-10 days. (1 week – 10 days regain their birth, weight )
A weight gain of about 1.2kg during the first 3 months of life is:
A. About average.
B. Above average but within normal limits.
C. Below average but within normal limits.
D. Below average and probably abnormal.
E. Above average and probably abnormal.
During the first years of life on infant who weighted (3.4kg) at birth ordinarily
would gain about:
A. 2.3kg.
B. 4.5kg.
C. 6.8kg.
D. 9kg.
E. 11.4kg.
During the second year of life, the average weight gain is about:
A. 1.5kg.
B. 3kg. (2kg)
C. 5kg.
D. 8kg.
E. 12kg.
During the first year of life, the average gain in body length is about:
A. 12.7cm.
B. 25cm
C. 38cm
D. 51cm
E. 64cm.
During the second year of life the average gain in body length is about:
A. 12 to 15cm.
B. 20 to 25cm.
C. 30 to 40cm.
D. 40 to 50cm.
E. Over 50cm.
One year old child would be able to do all of the following Except:
A. build a tower of three cubes.
B. Grasp a pellet
C. Reach for an object
D. Stand a lone
E. Transferee an object from hand to hand.
Rickets
Craniotabes could be seen in all of the following condition Except:
A. Rickets.
B. Vitamin E deficiency.
C. Hydrocephalus.
D. Syphilis.
E. Premature baby.
All of the following are true about the clinical manifestations of kwashiorkor
Except:
A. the presence of edema.
B. Rash in sun exposed area.
C. Hair changes.
D. Weak muscles.
E. An increased susceptibility to infection.
The recommended daily dietary allowance of vitamin D per young infant is:
A. 100 I.U
B. 400 I.U
C. 800 I.U
D. 1600 I.U.
E. 4000 I.U.
Which of the following Vitamin are Fat soluble:
A, D and C.
D, K and B1
A, D, K and E.
C, D, K and E
B1, K and E.
a 4 month old with Vitamin D-deficient rickets. Would be expected to show all
of the following Except:
A. Craniotabes.
B. Bow Legs.
C. Rosary.
D. Low Serum phosphate level.
E. High Alkaline phosphatase level
Nephrology
All of the following are consistent with the diagnosis of idiopathic nephrotic
syndrome of child hood Except:
A. Onset is usually between 2 and 6 years of age.
B. Pathologic renal changes are minimal by light microscopy.
C. C3 level is depressed.
D. Hypertension is unusual.
E. Hyperlipidemea.
All of the following statement are correct about routine urine examination,
Except:
A. Specific gravity of 1015 is normal.
B. Red blood cell cast is normal finding.
C. One red blood cell is normal finding.
D. One white blood cell is normal finding.
E. Negative sugar is normal finding.
Of the following, the most reliable for the diagnosis of urinary tract infection:
A. Fever and loin pain.
B. A numerous WBCs in the urine analysis.
C. Bacteria seen in the urine analysis.
D. The presence of a single isolated of < 105 /ml colory in urine.
E. Dysuria and frequency.
A child with chronic renal failure is expected to develop all of the following
Except:
A. Abnormal linear growth.
B. Hypophosphatemia.
C. Hypertension.
D. Hyperkalemia.
E. Rickets.
In minimal lesion nephrotic syndrome all are true Except:
A. There is proteinuria without gross hematuria.
B. Serum BUN and Creatinine are normal.
C. Ascites could be present.(pu etre)
D. Hypertension is constant finding.
E. Hepatomegally may be present.
Nephrotic syndrome is characterized by:
A. Proteinuria.
B. Hypoproteinemia.
C. Edema.
D. Hyperlipidemia.
E. All of the above.
The commonest cause of nephritis syndrome in child (3) years old is:
A. Idiopathic.
B. B-streptococcal group A infection.
C. System lupus erythematous.
D. Insulin dependent diabetic mellitus.
E. Urinary tract infection.
All of the following are not associated with acute Bronchiolitis EXCEPT:
A. Usually associated with High fever and rashes .
B. Usually associated with bilateral infiltrates on chest tray.
C. Commonly associated with retractions, tachypena and wheezing .
D. Characterized by the absence of cough despite respiratory distress
E. Most common between 2 and 5 years of age .
All of the following drugs could be used in controlling Acute attacks of bronchial
asthma Except:
A. Adrenaline.
B. Ketotifen (zaditin).
C. Ephidren sulfate.
D. Aminophylline.
E. Salbutamol inhaler.
The virus most commonly associated with the clinical Picture of acute
Bronchiolitis in infants and children is
A. Adeno virus.
B. Respiratory syncytial virus.
C. Rhino virus.
D. Coxsackie virus.
E. Herpes virus type 2.
16- In pneumonia consolidation all of the following is correct except:
a- there is Impaired percussion note.
b- Vocal resonanace is increased.
c- Type of breathing is harsh vesicular.
d- Mediastinum is central.
e- Chest pain may be a presenting symptom.
17- All of the following are not related to acute bronchiolitits except
a- Commonly caused by bacterial infections.
b- Associated with retractions, tachypnea and wheezing.
c- Physical examination reveals extensive signs of consolidation.
d- X-Ray reveals pneumatoceles.
e- Best treatment is broncho-dilator.
20- Physical signs of pulmonary collapse include all of the following except
a- Impaired percussion note.
b- Diminished breath sounds.
c- Shifted mediastinum.
d- Increased tactile vocal fremitus.
e- Decreased tactile vocal fremitus.
21- Stridor in the newborn may be caused by all of the following except
a- Congenital Goiter .
b- Vescular anomalies are rings.
c- Larynogo malacia .
d- Aspiration pneumonia .
e- Hypocalcemia.
22- All of the following are characteristic of Jaundice associated with breast
feeding except.
a- Significant elevations of unconjugated bilirubin .
b- A rapid fall in serum bilirubin after discontinuation of nursing.
c- Nursing can be resumed after several days without return of
hyperbilirubinemia.
d- Significant elevations of conjugated bilirubin.
e- Kernicterus has never been reported to occur as result of breast milk
jaundice.
Fever &rash
1-Compications of measles may include.
a- Encephalomyelitis.
d- Laryngitis.
c- Giant cell pneumonia.
d- Thrombocytopenic purpura.
e-All of the above.
4-Infection with which one of the following organisms does not require isolation
measures.
a- Diphtheria.
b-Chicken pox.
c- Pertussis.
d- Mumps.
e- Brucella.
12- maternal infection and viremia with rubella virus during the early weeks of
pregnancy may result in any of the following except:
a- Congenital malformation.
b- Stillbirth.
c- Abortion.
d- Macrosomia and large for gestational age in infant.
e- Chronic infection of the fetus.
Ordinarily, the first dose of live, attenuated measles vaccine (as MMR) should
be administered:
A. At about 3 months of age.
B. At 6 to 9 months of age.
C. At 15 months of age.
D. At about 24 months of age.
E. At the time of school entry.
Pneumococcal infection are more frequent and more sever in all of the
following condition Except:
A. Immunodeficiency.
B. Post splenectomy.
C. sickle cell disease.
D. Congenital heart disease.
E. Formula fed infants.
All of the following are signs of lower motor neuron disease Except::
A. Fibrillation.
B. Fasciculation.
C. Spasticity.
D. Muscle wasting.
E. Hyporeflexea.
Bloody stools are a recognized clinical feature in children affected by all of the
following except:
A. Vero toxin producing strains of Escherichocoli.
B. Giardia lamblea.
C. Cow's milk protein intolerance.
D. Ascaris lumbriocoides.
E. Shigelliosis.
All of the following are true about the laboratory manifestation of kwashiorkor
except:
A. Persistent ketonuria.
B. Hypoalbuminemia.
C. Hypoglycemia.
D. Potassium deficiency.
E. Low serum amylase levels.
Which of the following infection typically has an incubation period of less than 2
weeks:
A. Mumps. 12-28
B. Varicella.
C. Rubella. 12-21
D. Measles .07-14
E. Rabies.
When the mother contact german Measles "Rubella" early in pregnancy, effects
on the fetus may include all of the following except:
A. Thrombocytosis. (Thrombocytopenia)
B. Cataract.
C. Glaucoma.
D. PDA.
E. Hepatosplenomegally.
2- All of the following are recognized causes of recurrent cough in the pre-
school child ?
A) Parainfluenzae
B) Exercise
C) Retropharynageal abscess
D) Congenital ciliary dysmotility
E) Otitis media
11- All of the following symptoms are associated with respiratory tract
abnormalities EXCEPT?
A) Charge syndrome
B) Ciliary dyskinesi
C) Kartageners syndrome
D) Tay sachs disease
E) Cridu-chat syndrome
Emergycy
1. Laryngomalacia :
A. is due to abnormally complaint laryngeal cartilage.
B. is characterized by stridor which develops around 2 years of age .
C. causes lifelong symptoms in the majority of cases.
D. require endoscopic confirmation, even in mild cases.
E. requires tracheostomy in around 20% of cases.
6. You are called to the emergency department to evaluate a child with fever,
purpura, and a heart rate of 180. Your first priority in the resuscitation is to:
A. determine blood pressure
B. establish an IV line
C. administer ceftriaxone
D. supply supplemental oxygen
E. perform endotracheal intubation
10. A 2-yr old boy has fever, irritability and stiff neck, he was treated with oral
Amoxicillin for otitis media, a true statement about effect of previous Antibiotic
therapy on the ability to diagnose meningitis is it:
A. Interferes with reliability of counter immunoelectrophoresis
B. Decrease likelihood of diagnosing H. influenza type B. meningitis.
C. Can delay definitive diagnosis.
D. Decrease concentration of glucose in C.S.F.
11. A 6-week-old boy has had progressively worsening projectile vomiting over
the past 2 weeks. Physical examination reveals a wasted, dehydrated infant who
is avidly sucking on a nipple.Of the following, the laboratory values (in mEq/L)
MOST consistent with this child 's Problem would be:
Sodium Potassium Chloride Bicarbonate
160 3.0 125 A) 12
140 3.8 110 B) 23
138 2.5 110 C) 23
130 2.8 80 D) 35
123 3.2 93 E) 10
12. All of the following can be used acutely to lower serum K levels during
hyperkalemia EXCEPT:
A. glucose with insulin intravenously
B. albuterol aerosol
C. sodium bicarbonate infusion
D. captopril
E. all of the above
13. The finding of marked metabolic alkalosis with acidic urine indicates:
A. marked sodium depletion
B. marked potassium depletion
C. hyperventilation
D. diabetes mellitus
E. laboratory error
15. A 3-month-old infant who has a heart murmur has tachypnea and diffuse
expiratory wheezing. Chest radiography reveals an enlarged heart with
increased pulmonary vascular markings.Of the following, the MOST likely cause
of this infant's wheezing is
A) aspiration of a foreign body
B)bronchiolitis
C) congestive heart failure
D)pneumonia
E)vascular ring
5.All of the following are correct causative organisms for the corresponding
disease EXCEPT:
A. Measles – Robeola virus.
B. German measles – RNA virus.
C. Scarlet fever – Gp B strept. Toxin.
D. Roseola infantum – herpes simplex virus.
E. Erythema infectiosum – parvovirus.
10. In measles
a) the incubation period is 1 week
b) splenomegaly is common
c) photophobia is infrequent
d) Koplik spots are common (>50%)
e) lymphadenopathy is marked
11. All of the following statements are true of pertussis (whooping cough)except
:
a) immunization is effective in preventing the disease in over 95% of immunized
people
b) for well premature infants the immunization should be carried out 2 months
after birth
c) erythromycin has been shown to inhibit the growth of the aetiological agent
in vitro
d) children under the age of 3 months are at risk from the disease
e) the incidence of permanent neurological complications from immunization is
less than 1:150,000
13. An infant is born to a mother who was seropositive for CMV infection prior
to pregnancy. The infant acquired the virus from maternal cervical secretions
during labor and delivery. Which of the following outcomes is most likely for
the infant?
A.Asymptomatic infection.
B.A prolonged mononucleosis-like illness.
C.Development in a few months of microcephaly, mental retardation, and
chorioretinitis.
D.Sensorineural hearing loss .
14. Parasitic manifestations in the third world countries is best characterized as:
A. Common cause of diarrhea.
B. Common cause of nutritional deficiencies.
C. Responsive to Vitamin A.
D. Responding to oral rehydration prevention
E. Preventable by immunizations.
16. A 4-year-old child was seen by his physician because of fever, cervical
lymphadenopathy, small ulcerative lesions on his buccal mucosa, and small
vesicles on his fingers. Which of the following examinations would be most
helpful in the diagnosis?
A. Serum IgG and IgM antirubella antibodies
B. IgM antibodies against measles virus in the serum
C. Throat and stool culture for enterovirus
D. Antistreptolysin-O titer in serum
E. Herpes simplex titers
19-Typhilitis is:
a- Is necrotizing colitis of the caecum
b- Is not associated with severe neutropenia.
c- Localized left lower quadrant abdominal pain.
d- Klebsiella species is the most organisms are involved.
e- CT scan may reveal thickening of rectum and sigmoid colon wall or
pneumatosis intestinalis in advanced cases.
21. Which of the following vaccines should NOT be given to children with severe
combined immunodeficiency syndrome:
A. DPT.
B. Measles vaccine
C. Salk polio vaccine.
D. Hep. B vaccine.
E. Pneumococcal vaccine.
22. In the Palestinian National Immunization Program, all of the following are
correct EXCEPT:
A. Salk vaccine is given at one and two months of age.
B. Hep. B vaccine is given at birth, one month and six months of age.
C. A booster dose of DPT is given at six years of age.
D. MMR vaccine is given at age of 15 months.
E. Rubella vaccine is given to girls at age of 12 years.
24. All of the followings are correct for live attenuated vaccines EXCEPT:
A. Contraindicated in immunodeficient patients.
B. Given only after 3 months of stopping immunosuppressive drugs or large
steroid dose therapy.
C. Not given within 3 weeks before or 3 months after giving immunoglobulins.
D. Two Live attenuated vaccines are not given together.
E. Measles vaccine is not given to a patient with T.B except after
Question . 1. A 15-mo-old child is in your office with stridor at rest and cyanosis
with the presumptive diagnosis of viral croup. You should do all of the following
except:
A. Transport immediately in the parent's car to the nearest emergency
department.
B. Administer oxygen.
C. Administer dexamethasone
D. Administer racemic epinephrine
E. Transport after EMS personnel arrive 20 min later.
Question .4. A 12-yr-old presents with sneezing, clear rhinorrhea, and nasal
itching. Physical examination reveals boggy, pale nasal edema with a clear
discharge. The most likely diagnosis is:
A. Foreign body
B. Vasomotor rhinitis
C. Neutrophilic rhinitis
D. Nasal mastocytosis
E. Allergic rhinitis.
6. A 1-yr-old child presents with a history of recurrent fevers for several weeks.
On physical examination you find that the pupils fail to constrict. This finding is
associated with:
A. Toxoplasmosis
B. Ectodermal dysplasia
C. Juvenile rheumatoid arthritis
D. Hypothalamic dysfunction
E. Thyrotoxicosis
Question .7. A 9-yr-old boy presents with fever >39°C for 4 days,
myalgias, watery diarrhea, conjunctival infection, diffuse erythroderma,
strawberry tongue, blood pressure of 105/45mm Hg,
moderately elevated hepatic transaminases.
The most likely diagnosis is:
A. Staphylococcal scalded skin syndrome
B. Kawasaki disease
C. Toxic shock syndrome
D. Stevens-Johnson syndrome ( due to drugs or mycoplasma pneumonia
E. Toxic epidermal necrolysis
Question . 10. Which of the following is associated with a poorer prognosis for
persons presenting with meningococcal disease?
A. Presence of petechiae for <12 hr (Meningococcemia )
B. Meningitis
C. Thrombocytosis
D. Leukocytosis
E. Low circulating levels of tumor necrosis factor
Question . 12. Immunologic diseases of the mother that may affect the fetus
include all of the following except:
A. Systemic lupus erythematosus
B. Idiopathic thrombocytopenic purpura years after splenectomy
C. Myasthenia gravis
D. Graves disease
E. Multiple sclerosis
Question . 15. Low levels of complement may be associated with all of the
following except:
A. Nephrotic syndrome
B. Vasculitis
C. Nephritis
D. Serum sickness
E. Systemic lupus erythematosus
Question . 27. A 2-yr-old boy with the spastic diplegia form of cerebral palsy is
being evaluated. MRI of his brain is most likely to show:
A. Multicystic encephalomalacia
B. Periventricular leukomalacia
C. Normal anatomy
D. Basal ganglia abnormalities
E. Agenesis of the corpus callosum
Question . 16. A 4-yr-old white girl has had joint swelling in multiple joints for
over 6 mo. She is slow to move in the morning and moves as if stiff for the first
hours of the day. Thereafter, she is a very active child. She has no rash and very
little limitation of range of motion. Her erythrocyte sedimentation rate is 4. The
most likely diagnosis is:
A. Hypermobility syndrome
B. Dermatomyositis
C. SLE
D. JRA
E. Henoch-Sch nlein purpura
Question . 17. All of the following statements regarding Kawasaki disease are
true except:
A. It occurs in outbreaks
B. Exposure to an affected patient greatly increases the
C. risk of the disease
D. Asian children have the highest risk
E. 80% of patients are younger than 5 yr of age
F. It is the leading cause of acquired heart disease in children in the United
States
Question . 20. A 3-yr-old boy presents to your office with sudden onset of
colacolored urine, progressive facial swelling over the past 3 days, and
decreased urine volume over the past day. His examination is notable for blood
pressure 130/80 mm Hg, periorbital edema, bibasilar rales, and ankle swelling.
His urinalysis is remarkable for 3+ hematuria, 1+ proteinuria, 100 red blood cells
per high-power field, and red blood cell casts. His serum electrolytes are normal
and the serum albumin is 3.2 g/liter. This clinical presentation is most consistent
with:
A. Acute renal failure
B. Acute pyelonephritis
C. Nephrotic syndrome
D. Acute glomerulonephritis (edema – hematuria – proteinuria – high BP )
E. Chronic renal failure
Question . 22. A 3-yr-old boy presents to an urgent care clinic with a 3-day
history of abdominal pain and difficulty walking. Abnormal findings include
blood pressure of 120/80 mm Hg, diffuse abdominal tenderness, purpuric rash
of the hands and ankles, and diffuse periarticular tenderness and swelling of the
ankles. The most likely diagnosis is:
A. Systemic lupus erythematosus
B. Kawasaki's disease
C. Juvenile rheumatoid arthritis
D. Henoch-Sch nlein purpura
E. Stevens-Johnson syndrome