1.

A 1-day-old baby who is otherwise asymptomatic presents with a loud harsh murmur at
the left sternal edge. There are no features of heart failure present, the oxygen saturations
are normal and the ECG performed is reported to be normal. What it the MOST likely
diagnosis in this case?
a) Atrial septal defect
b) Ventricular septal defect
c) Pulmonay stenosis
d) Tetralogy of Fallot
e) Persistent ductus arteriosus
2. During a regular checkup on an 8-year-old child, you note a loud first heart sound with
a fixed and widely split second heart sound at the upper left sternal border that does not
change with respirations. The patient is otherwise active and healthy. The mostly likely
heart lesion to explain these findings is

a) Atrial septal defect

b) Ventricular septal defect
c) Isolated tricuspid regurgitation
d) Tetralogy of Fallot
e) Mitral valve prolapsed

3 The examination of a newborn’s back reveals a quarter-size “lump” of soft tissue

overlying the lower spine. Evaluation with ultrasound of this lesion may demonstrate
a) Ebstein pearl
b) Mongolian spot
c) Cephalohematoma
d) Omphalocele
e) Occult spina bifida
4. A 7-year-old boy has crampy abdominal pain and a rash mainly on the back of his
legs and buttocks as well as on the extensor surfaces of his forearms. Laboratory
analysis reveals proteinuria and microhaematuria. He is most likely to be affected by

a) Systemic lupus erythematosus

b) Henoch Schonlein purpura
c) Poststreptococcal glomerulonephritis
d) Takayasu arteritis
e) Dermatomyositis

5. A 4-day-old, 1.5kg, premature infant recovering from hyaline membrane disease is

noted to have bounding peripheral pulsations and a hyperactive pericordium. A
continuous machinery murmur is most audible at the left infraclavicular area. Left
ventricular hypertrophy (LVH) is present on electrocardiogram (ECG). The chest x-
ray shows slight enlargement of the heart and increased pulmonary venous markings.
Which of the following is the most likely diagnosis?

a) Ventricular septal defect (VSD)

b) Atrial septal defect (ASD)
c) Patent ductus arteriosus (PDA)
d) Pulmonary stenosis
 e) Tetralogy of Fallot

6. A 2- day-infant is found profoundly cyanosed and lethargic. On auscultation there is a

soft systolic murmur heard inconsistently at the left sternal edge and a single second
sound. The chest x ray shows a narrow upper mediastinum, hypertrophied right
ventricle and increased pulmonary vascular markings
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7. A 7-week-old infant presents with breathlessness on feeding and failure to thrive. On

examination his femoral pulses are difficult to feel but present. Chest radiograph
shows cardiomegaly and increased vascular markings. co ortation oarta

8. A 9-year-old girl is brought to her pediatrician with the complaint ofsevere,

intermittent headaches for the last several months. The physicalexamination,
including a careful neurologic examination, is normal. Whichof the following
characteristics support the diagnosis of migrainein this patient?
A. Strong family history of migraine
B. Frequently isolated to the occipital region
C. Frequently associated with attention deficit hyperactive disorder
D. Duration of headache more than 24 h
E. Persistence of headache after sleep
9. A 3-year-old boy’s parents complain that their child has difficultywalking. The child
rolled, sat, and first stood at essentially normal ages andfirst walked at 13 months of age.
Over the past several months, the family has noticed an increased inward curvature of the
lower spine as he walksand that his gait has become more “waddling” in nature. On
examination,you confirm these findings and also notice that he has enlargement of
hiscalves. This child most likely has

A. Occult spina bifida

B. Muscular dystrophy
C. Brain tumor
D. Guillain-Barré syndrome
E. Botulism
10. A 7-year-old boy has crampy abdominal pain and a rash mainly on the back of his legs
and buttocks as well as on the extensor surfaces of his forearms. Laboratory analysis reveals
proteinuria and microhematuria. He is most likely to be affected by

A. Systemic lupus erythematosus

B. Anaphylactoid purpura
C. Poststreptococcal glomerulonephritis
D. Takayasu arteritis
E. Dermatomyositis
11. A previously healthy 8-year-old boy has a 3-week history of low-grade fever of unknown
source, fatigue, weight loss, myalgia, and headaches. On repeated examinations during this
time, he is found to have developed a heart murmur, petechiae, and mild splenomegaly.
The most likely diagnosis is

A. Rheumatic fever
B. Kawasaki disease
C. Scarlet fever
D. Endocarditis
E. Tuberculosis
12. Therapy of a "blue" or "tet" spell could include all of the following
Except:
A. Epinephrine
B. Knee-chest position
C. Oxygen
D. Morphine
E. Sodium bicarbonate
F. Phenylephrine

13. . An 18-mo-old child is noted to assume a squatting position frequently

during playtime at the daycare center. The mother also notices occasional episodes of
perioral cyanosis during some of these squatting periods. The day of admission, the
child becomes restless, hyperpneic, and deeply cyanotic. Within 10 min, the child
becomes unresponsive. The most likely underlying lesion is:
A. Cardiomyopathy
B. Anomalous coronary artery
C. Tetralogy of Fallot
D. Constipation
E. Breath-holding spell

14. A 2-day-old infant experiences cyanosis, hypotension, and metabolic

acidosis. On examination, the infant is lethargic, tachycardic, and gray-blue, with
hepatomegaly, a grade 2-3/6 systolic murmur, and poor radial and femoral pulses. A
chest radiograph reveals cardiomegaly, and an ECG demonstrates right ventricular
dominance with markedly reduced R waves in V5 and V6. The most likely diagnosis:
A. Myocarditis
B. Hypoplastic left heart syndrome
C. Anomalous coronary arteries
D. Total anomalous venous return
E. Tetralogy of Fallot

15.A previously well 3½-mo-old presents with poor feeding, diaphoresis

during feeding, and poor growth. Vital signs reveal a respiratory rate of 70/min, pulse
of 175/min, and blood pressure of 90/65 mm Hg in the upper and lower extremities.
The cardiac examination reveals a palpable 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

16.The initial treatment of choice for a symptomatic patient with isolated

pulmonic stenosis is:
A. Closed surgical blade valvotomy
B. Open surgical valvotomy
C. Balloon catheter valvuloplasty
D. Blalock-Taussig shunt
E. Valve replacement

17. . Pulsus paradoxus is associated with:

A. Pericarditis
B. Endocarditis
C. Rheumatic fever
D. Myocarditis
E. Postperfusion syndrome

18.The radiographic finding of notching of the ribs is associated with:

A. Pulmonary hypertension
B. Anomalous pulmonary venous return above the diaphragm
C. Coarctation of the aorta
D. Systemic hypertension
E. Aortic insufficiency

19.. An atrioventricular septal defect is different from an ostium secundum

ASD because the AV septal defect:
A. Does not manifest heart failure
B. Does not create volume overload
C. Has the same ECG findings
D. Produces an early tendency for pulmonary hypertension
E. Creates an atrial-level shunt

20. A 5-mo-old previously well infant is found to have a loud holosystolic

murmur (4/6) at the left sternal border. The first and second heart sounds are normal;
there is no tachycardia, rumble, or gallop; and hepatomegaly is not noted. The child
feeds well and has grown adequately. You suspect:
A. A restrictive VSD
B. Anomalous left coronary artery
C. A VSD with a 4:1 shunt
D. Tetralogy of Fallot
E. Single ventricle

21. A 6-mo-old is presented with tachycardia, tachypnea, and poor feedingfor 3 mo. 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

22. A 1-day-old infant is noted to be cyanotic. Physical examination

reveals a grade 2-3/6 systolic murmur and a single loud second heart sound. The chest
radiograph reveals a normal-sized heart and decreased pulmonary vascular markings.
The electrocardiogram (ECG) reveals left ventricular dominance. The next step in the
management of this neonate is to administer:
A. Sodium bicarbonate
B. Morphine
C. Prostaglandin E1
D. Digoxin
E. Positive pressure ventilation

23.. A neonate manifests cyanosis and hepatomegaly. There is a grade 4/6

systolic ejection murmur without an audible ejection click. The ECG reveals tall,
spiked P waves and right ventricular hypertrophy. The best method to evaluate this
patient is to perform:
A. Chest x-ray examination
B. Vector cardiography
C. Immediate cardiac catheterization
D. MRI
E. Echocardiogram
24.The most likely diagnosis in the patient described in Question 23 is:
A. Patent ductus arteriosus
B. Critical aortic stenosis
C. Critical pulmonic stenosis
D. Tetralogy of Fallot
E. Truncus arteriosus

24. The treatment of choice for the lesion in the neonate described in
Questions 23 and 24 is:
A. Digoxin
B. Propranolol (Inderal)
C. Surgical shunt
D. Balloon valvuloplasty
E. Valve replacement

26. A 12-yr-old boy tries out for a middle school hockey team. He has a
history of a heart murmur as an infant, but the doctor thought it would go away.
During the tryout, he experiences severe dyspnea and becomes light-headed. At your
office, he has a normal rhythm, pulse, and blood pressure and is no longer dizzy.
There is a grade 4/6 systolic ejection murmur that radiates to the neck. There is also
an ejection click. An ECG reveals left ventricular hypertrophy. The next step in his
management should be:
A. Chest x-ray examination
B. Exercise test
C. Digitalization
D. Echocardiography
E. Tilt table testing

27. The patient described in Question 26 most probably has:

A. Pulmonic stenosis
B. Mild aortic stenosis
C. Severe aortic stenosis
D. Patent ductus arteriosus
E. Williams syndrome

28.For the patient described in Question 36, treatment is best

accomplished with
A. Immediate valve replacement
B. A shunt
C. Digoxin
D. Propranolol
E. Balloon valvuloplasty

29.10. 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:
Hypermobility syndrome
Dermatomyositis
SLE
JRA
Henoch-Sch nlein purpura

30.. A 12-yr-old white girl presents with arthralgias of the knees and
elbow and swollen hands of 6 months' duration. She has had intermittent fever
and has lost 15 lb. Other than swollen joints, findings on physical examination
are normal. Three years earlier, she was found to have thrombocytopenia and
was diagnosed with idiopathic thrombocytopenic purpura (ITP). In addition,
one summer she had severe sunburn, and 2 yr ago she had mouth sores.
Today she has a hematocrit of 25% and a positive result on a Coombs test,
and the urinalysis shows multiple red blood cells. The most likely diagnosis is:
JRA
ITP
Evans syndrome
Periarteritis
SLE
31.. A 4-yr-old white girl has had a low-grade fever, intermittent
crampy abdominal pain with emesis, and swollen knees for 3 days. There is a
petechial rash on the lower extremity. The most likely diagnosis is:
Meningococcemia
Idiopathic thrombocytopenia purpura
Henoch-Sch nlein purpura
SLE
Rocky Mountain spotted fever
32. A previously healthy 11-year-old boy present a 3-week course of low-grade fever and
nonspecific complaints including fatigue, arthralgia, myalgia, weight loss, exercise intolerance, and
diaphoresis. On repeated examination during this time, he is found to have developed a heart
murmur, petechiae , and a mild splenomegaly.

a. What is the most likely diagnosis? Infective endocarditis

b. How do you approach the management of this patient? Antibiotics (Antibiotic
choice, dosage, and duration of treatment are dependent upon the underlying
causative microbial agent); Surgical intervention (Surgery is indicated in cases in
which the procedure is likely to result in a more favorable outcome than medical
management based upon an analysis of the relative risks and benefits).

33. An 18-month-old child presents to the emergency department having had a brief, generalized
tonic-clonic seizure. He is now post-ictal and has a temperature of 40oC. During the lumbar puncture
(which ultimately proves to be normal), he has a large, watery stool that has both blood and mucus
in it.

a. What is the most likely diagnosis ? Shigellosis

b. How do you confirm your diagnosis? Stool culture
c. What are the most important complication ? intestinal complication: Proctitis or
rectal prolapse; Toxic megacolon; Intestinal obstruction; Colonic perforation;

Systemic complications: Bacteremia; Metabolic disturbances; seizure; reactive

34. A 5-year-old male presents with a 48-h history of headache, and meningismus. Evaluation of the
CSF reveals clear fluid with normal protein and glucose content. The CSF cell count reveals 300
WBC/hpf, 90% lymphocytes. Which of the following is the most likely etiologic agent?

a. What is the most likely etiology agent? Viral ( commonly Enterovirus)

b. What is the best treatment? Supportive care : acetaminophen ; Intravenous fluid
therapy ( precaution on possibility of inappropriate secretion of antidiuretic
hormone); Empiric antivirals(acyclovir).

35. A 6-month-old presents with tachycardia, tachpnea, and poor feeding for 3 months. physical
examination reveals a continuous murmur and a wide pulse pressure with a prominent apical
impulse. the most likely diagnosis is

a. What is the most likely diagnosis? patent ductus arteriousus(PDA)

b. How do you manage ? Medical management: Inhibitors of prostaglandin
synthesis, such as indomethacin and ibuprofen for preterm infant; surgery :
ligation and percutanous occlusion.
36. A 3-year-old boy presents a 5-days history of intermittent fever spiking to 400C and
irritability. His examination was remarkable for bilateral conjuncivitis, oropharyngeal
injection, and dry, cracked lips. He was send home with symptomatic treatment.
Today he returns with persistent fever and irritability. The physical examination
findings noted previously are still present, but now he also has a maculopapular
truncal rash, hand and foot edema, and an enlarged but nonsuppurative right anterior
cervical lymph node.
 1. What is the most likely diagnosis? Kawasaki disease
2. What are the diagnostic features? Diagnosis criteria requires the presence of fever
lasting ≥five days, combined with at least four of the five following physical
findings, without an alternative explanation ( 1.Bilateral bulbar conjunctival
injection ,2. Oral mucous membrane changes,( including injected or fissured lips ,
injected pharynx, or strawberry tongue) , 3.Peripheral extremity changes,
including erythema of palms or soles, edema of hands or feet (acute phase) , and
periungual desquamation (convalescent phase) 4.Polymorphous rash, 5.Cervical
lymphadenopathy (at least one lymph node >1.5 cm in diameter).
3. What is the treatment for this condition? Intravenous immune globulin; Aspirin;
Glucocorticoids (controversial

37. What are the features of the Eisenmenger syndrome?

a. The triad of systemic-to-pulmonary cardiovascular communication, pulmonary
arterial disease and cyanosis is called Eisenmenger syndrome.
38. What are the features of innocent murmurs?
a. it caused by flow through normal heart, vessels, and valve
b. it soft, no thrill, systolic and short, never pansystolic, asymptomatic, at left sternal
edge, may change with posture, never greater than grade 2/6
39. Which features influence recurrence of febrile seizure in a child with febrile
seizure?
a. Young age at onset
b. History of epilepsy in a first-degree relative
c. High degree of fever while in the emergency department
d. long duration between the onset of fever and the initial seizure
e. older age at onset
40. Which one of the following is characteristic of the CSF in tuberculous meningitis?
a. The color is blood tinged
b. Protein is normal and glucose is low
c. Culture reveals tuberculous organisms within week
d. Elevated protein and lowered glucose concentrations with a mononuclear
pleocytosis
e. elevated protein and lowered glucose and Leukocytes predominate
41. A 6-year-old girl who is otherwise asymptomatic presents with a systolic ejection
murmur with maximal intensity at the left upper sternal border. She has no cyanosis
and has Splitting of the second heart sound. the most likely diagnosis is
a. Ventricular septal defect
b. Atrial septal defects
c. Pulmnoary stenosis
d. patent ductus arteriousus
e. Coartation of aorta
42. A 5-hour-old male newborn is noted to looks blue around the lips and tongue. The
baby was born by normal vaginal delivery and weighed 3.3 kg. The Apgar scores
were 7 at 1 min and 8 at 5 min. On examination, lips, tongue and extremities are cyanosed
.HR 168/m . Femoral pulses are palpable, heart sounds are normal and no murmur is
audible. Oxygen saturation is 70 per cent in air and does not rise with facial oxygen. The
most likely diagnosis is:
a. Tetralogy of fallot
b. tricuspid atresia
 c. transposition of great arteries
d. hypoplastic heart syndrome
e. large VSD with pulmonary hypertension
43. All the following cause neonatal seizure EXCEPT
a. Pyrodoxine deficiency
b. Hypoglycemia
c. Hypoxia-ischemia
d. Inborn errors of metabolism
e. Lissencephaly
f. Spina bifida