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Transcript
1-Incontinentia pigmenti or Bloch-Sulzberger syndrome is an X-linked
dominant genodermatosis. Which is NOT a criterion for diagnosis?
A.
B.
C.
D.
E.
Neonatal vesicular rash with eosinophilia
Multiple congenital nevi
Blaschkoid hyperpigmentation on the trunk fading in adolescence
Linear, atrophic hair less lesions
Family history
2-All of the following medications are definite contraindications to breastfeeding EXCEPT:
A.
B.
C.
D.
E.
cyclophosphamide
cyclosporine
phenobarbitone
methotrexate
heroin
3-Breast-feeding is NOT advisable if one or more of the following
conditions are present EXCEPT:
A.
B.
C.
D.
E.
an infant diagnosed with galactosemia
a mother with mastitis and fever of 39°C
a mother taking cancer chemotherapy agents
a mother infected with HIV virus
a mother suffering of untreated active tuberculosis
4-Transient neonatal pustular melanosis is characterized by vesicles, superficial
pustules and pigmented papules. Which following statement is WRONG?
A.
B.
C.
D.
It is present at birth
Its etiology is unknown
It is more frequent in pigmented population
A Tzank smear will reveal a predominance of neutrophils without
evidence of bacteria
E. It needs immediate septic work-up and antibiotherapy
5- A six hour-old Full-Term infant has cloudy corneas on Examination. Re-exam
at 72h of age shows no change in ocular findings. Which of the following is
the most appropriate management?
A.
B.
C.
D.
E.
Evaluate the infant for increased ocular pressure
Treat the infant with propranolol
Reassure the parents that these findings are benign
Evaluate the infant for retinoblastoma
Evaluate the infant for renal abnormalities
1
6-All of the following are factors influencing the immunologic properties of
human milk EXCEPT:
A.
B.
C.
D.
E.
Ig A
Macrophages
Lysosyme
Long chain polyunsaturated fatty acids
Lactoferrin
7- Organic acidemias should be suspected in all of the following clinical
presentations except:
A.
B.
C.
D.
E.
A newborn with sudden onset of lethargy that progressed to coma
A 2-year-old child with splenomegaly and dysmorphic features
A 1-year-old infant with progressive developmental delay
A newborn with wide anion-gap metabolic acidosis
A 6-month-old infant with sweaty-feet odor of urine
8- Hypoglycemia is a common problem in newborns, infants and children.
All of the following statements are true Except:
A. Hypoglycemia, hepatomegaly and hyperlipidemia suggest glycogen
storage
disease
B. Hypoketotic hypoglycemia suggests fatty acid oxidation defect
C. Hypoglycemia, hepatosplenomegaly and large tongue suggest BeckwithWiedemann syndrome
D. Hypoglycemia and metabolic acidosis suggest urea cycle disorder
E. Hypoglycemia and ketosis in a child after prolonged overnight fasting suggest
ketotic hypoglycemia
9-All of the following matches between each vitamin deficiency state and its
characteristic clinical findings are true Except:
A.
B.
C.
D.
E.
Vitamin A Night blindness
Vitamin C Scurvy
Vitamin D Craniotabes
d. Niacin Pellagra
Pyridoxine Beriberi
10- Which of the following best describes the external genitalia of a
newborn male infant with adrenogenital syndrome?
A. ambiguous genitalia
B. virilized male phallus
C. normal male genitalia
D. penile-scrotal transposition
E. micropenis
2
11-Of the following verbal skills, which is most likely to be apparent in the
normal 2-yeal-old:
A.
B.
C.
D.
E.
Two-word sentences and 50 words vocabulary
Ability to name 4 colors consistently
Ability to demonstrate 3 prepositional commands
Ability to say his full name and sex
5-word sentences
12- A male infant was found to have low T4 levels in newborn screening.
Further evaluation reveals normal free T4 and TSH levels. All the
following are true except
A.
B.
C.
D.
E.
atients are usually asymptomatic
It is an x-linked disorder
The level of thyroid binding globulin is high
It requires no treatment
It may be a source of confusion with hypothyrodism
13-In Kawasaki syndrome the coronary involvement in nontreated
children is estimated to be:
A.
B.
C.
D.
E.
5%.
8%.
10%.
20%
40%
14-. A FT AGA male infant with HC = 41 Cm, + transillumination over the
frontal & parietal parts of the skull. Mom states that 2 of her
brothers who died in infancy had large heads. Which of the following
is the most likely diagnosis?
A.
B.
C.
D.
E.
Normal varient
Familial macrencephaly
Aqueductal stenosis
Dandy-Walker syndrome
Tay-Sachs disease
15-Ebstien anomaly can be characterized by all of he following except:
A.
B.
C.
D.
E.
right axis on the ECG.
right to left shunt.
tricuspid regurgitation.
atrialized right ventricle.
huge heart on x-ray.
3
16-Snowman sign on a chest- X- Ray is typical of:
A.
B.
C.
D.
E.
Total pulmonary venous anomaly.
Tetralogy of Fallot.
Transposition of great arteries.
Truncus arteriosus.
None of the above
17-Disproportionate dwarfism is an important feature of one of the
following Conditions:A.
B.
C.
D.
E.
Achondroplasia.
Constitutional short stature.
Nutritional deprivation.
Familial short stature.
Psychological deprivation.
18-Which malignancy you expect to find in a child with aniridia and
congenital genitourinary abnormalities?
A.
B.
C.
D.
Lymphoma
Sarcoma
Neuroblastoma
Wilms
E. Adrenal carcinoma
19-Which of the following conditions should be considered specifically for
children with head growth deceleration, abnormal respiration,
seizures, and hand wringing in whom Autism Spectrum Disorder is
suspected?
a. Lead poisoning
b. Celiac disease
c. Fragile X syndrome
d. Rett Syndrome
e. Krabbe disease
20-Growth hormone may be used in the treatment of short/small stature
associated with all of the following conditions except:A.
B.
C.
D.
E.
Turner syndrome.
Prader Willi syndrome.
End stage renal failure (before kidney transplantation).
d. Intra uterine growth retardation.
Achondroplasia.
4
21-A mother brings her 8-months old daughter to your clinic for evaluation
of colic. While interviewing the parent, you observe the child
repeatedly flex her upper and lower extremities all at once. The child is
developmentally normal. On physical examination, you find four
irregular, hypopigmented spots on her trunk. Neurological
examination results are otherwise normal. Of the following the test
MOST likely to lead to this child’s diagnosis is
A.
B.
C.
D.
E.
Karyotyping.
Lumbar puncture.
Magnetic resonance imaging of the brain.
Skin punch biopsy for fibroblasts
Urine organic acid assessment
22-The triad of ipsilateral facial port wine stain, eye abnormalities, and
leptomeningeal and brain abnormalities is known as:
a.
b.
c.
d.
the Crow sign.
PHACE syndrome.
Kassaback-Merritt syndrome.
Sturge-Weber syndrome.
e. Klippel- Trenaunay syndrome
23-Which of the following conditions constitutes the need for renal biopsy in
a patient who has nephrotic syndrome?
A.
B.
C.
D.
E.
Age between 2 to 6 years at initial presentation.
Lack of response after 2 weeks of prednisone therapy
Low serum complement level at initial presentation.
Relapse 1 year after initial diagnosis.
Serum albumin level less than 2 g/dL (20 g/L).
24-Among the following, the most sensitive laboratory test to diagnose
primary hypothyroidism is measurement of serum
A.
B.
C.
D.
E.
Free T4
Thyroglobulin
Thyroid Antibodies
Total T3.
TSH
25-a 4 years old child with nephrotic syndrome. He presented to the emergency
department with abdominal pain and fever. You suspect spontaneous
bacterial peritonitis. Which of the following micro organisms is the most
likely cause of this clinical condition?
A.
B.
C.
D.
E.
Aspergillus species.
Candida albican.
Klepsiella.
Amebiasis.
Pneumococci
5
26-- The absolute neutrophil count of a patient who complains of fever is
200 cells/ mm3. Which of the following micro organisms should be
taken into consideration when you treat this patient?
A.
B.
C.
D.
Pseudomonas aerogenosa.
Staphylococcus aureus.
Both.
Neither
27-Hypo parathyroidism is reported in which of the following diseases?
A.
B.
C.
D.
E.
Ataxia talengectasia.
Wisckott Alrdrich syndrome.
Digeorge syndrome.
Bruton's disease.
ADA deficiency causing SCID.
28- Influenza virus vaccine is usually administered annually because of
antigen shift and limited duration of protection. Which of the following
groups should receive the vaccine?
A.
B.
C.
D.
E.
Infant with Still’s murmur
Government employees
Infants under 6 months of age
Patients on long-term aspirin therapy
Young patients with seizure disorder
29-Criteria for SIADH (syndrome of inappropriate anti diuretic hormone)
include all of the following except:
A.
B.
C.
D.
E.
Hyponatremia a.
Hypoosmolality
Hypovolemia
High urinary sodium
Concentrated urine
30- Chronic lead poisoning causes all of the following except:
A.
B.
C.
D.
E.
Failure to thrive
Constipation
Glomerulonephritis
Macrocytic anemia
Encephalopathy
31-You suspect constitutional short stature in a 14-year-old boy who is 5
ft 3 in (160 cm) tall. Among the following, the clinical finding that is
most supportive of this diagnosis is:
A.
B.
C.
D.
E.
Bone age of 12 years
Diagnosis of cystic fibrosis
Elevated alkaline phosphatase activity
Genital SMR of 4.
Low thyroid-stimulating hormone level
6
32-Of the following major Jones criteria for rheumatic fever, the one that
is sufficient to make the diagnosis when encountered alone is:
A.
B.
C.
D.
E.
Polyarthritis
Sydenham chorea
Erythema marginatum
Carditis
Huntington’s chorea
33-The best screening test for immunodeficiency in a patient after her
second episode of meningococcal meningitis is:
A.
B.
C.
D.
E.
34.
Quantitative immunoglobulins
CH50
T cell subsets
IgG subclasses
Nitroblue tetrazolium (NBT) test
A FT NB infant has complex cyanotic congenital heart
disease. Peripheral Blood Smear reveals: Marked anisocytosis,
poikiloctosis & spherocytosis ≥ 25% RBCs have autophagic
vacuoles, Howell-Jolly bodies or both. Which of the following is the
most likely diagnosis?
A.
B.
C.
D.
E.
septicemia
DIC
Asplenia
Drug induced hemolysis
ABO hemolytic disease
35.Anemia of prematurity is best explained by which of the following?
A.
B.
C.
D.
E.
Inadequate iron stores in the preterm infant
Production by the liver of a complex erythropoietin that is inactive
Rapid destruction of fetal Red Blood Cells
Circulating antagonist to erythropoietin
Inadequate erythropoietin production by the kidney
36-Which of the following statements best describes the adjustments that
should be made in the DTP immunization schedule of preterm
infants?
A. No adjustment should be made
B. Immunization schedule should be adjusted according to corrected age
C. Immunization should start when the infant reaches 2 kg of body weight
D. Immunization schedule should be adjusted according to corrected age,
unless disease prevalence in the community indicates otherwise.
E. Immunization should start at 2 months or discharge from the hospital
(whichever comes first)
7
37-In Down syndrome the following are TRUE EXCEPT:
A.
B.
C.
D.
E.
An increased incidence of ALL.
In translocation the total number of chromosomes is always 47.
Mosaiscism accounts for 1-2% of cases.
The commonest form is non-disjunction.
Duodenal Artesia is common in Down syndrome
38.All are true regarding Familial Mediterranean fever (FMF) EXCEPT
A. Is an inherited disorder characterized by brief, acute, self-limited episodes
of fever and polyserositis
B. FMF appears to be transmitted as an autosomal dominant disease
C. FMF occurs among ethnic groups of Mediterranean origin
D. Attacks of FMF can be prevented by prophylactic colchicine therapy
E. One third to one half of untreated patients with FMF develop amyloidosis
that may progress to nephrotic syndrome and renal failure over a period of
months to several years
39-A 6-yr-old girl presents with breast enlargement and pubic hair
development. Otherwise, she is asymptomatic. Her serum LH level is
elevated. The most likely diagnosis is:
A.
B.
C.
D.
E.
Central precocious puberty
Hypothyroidism b.
Exposure to exogenous estrogen
An estrogen-secreting tumor
An adrenal tumor
40.Hypoketotic hypoglycemia occurs in all of the following disorders
except:
A.
B.
C.
D.
Hyperinsulinism
Growth hormone deficiency
Fatty acid oxidation defects
Ketogenesis defects
E. Maple syrup urine disease
41-You are evaluating a 5 years old male for excessive obesity. He was
extremely hypotonic in the first 2 years of his life, and then the muscle tone
became gradually normal. Later he developed uncontrollable appetite. He
has global developmental delay. His testis and penis are small. The scrotum
is atrophic. The most likely diagnosis is:
A.
B.
C.
D.
E.
Fragile X syndrome.
Down syndrome.
Trisomy 13.
Prader- Willi syndrome.
Klinefelter syndrome
8
42-Of the following, the MOST common fetal anomaly associated with
maternal parvovirus B 19 Infection during pregnancy is:
A.
B.
C.
D.
E.
Neural tube defect
Dwarfism
Nonimmune fetal hydrops
Cataract
Cardiomyopathy
43-Neonatal hyperammonemia can be the result of the following EXCEPT:
A.
B.
C.
D.
E.
Urea cycle defects
Hypothyroidism
Disorders of Branch chain amino acid metabolism
Severe perinatal asphyxia
Liver failure
44- A 12—year old boy presents with two weeks history of frontal
headaches. He has had morning vomiting for the last three days.
Upon further questioning you discover he is doing poorly in school
and that his parents have recently divorced. His only medication has
been aspirin for the headaches and tetracycline taken daily for the
last six months for acne. Examination reveals facial acne and
bi-lateral papilledema without focal neurological signs. Skull
roentgenogram and computed tomography of the head (CT scan) are
negative. The most likely diagnosis is:
A.
B.
C.
D.
E.
Craniopharyngioma
Pseudo tumor cerebri
Tension headache
Ependymoma
Migraine
45-The prenatal diagnosis of all the following may be accomplished by
chorionic villous sampling EXCEPT:
A.
B.
C.
D.
E.
Neural tube defects
Thalassemia
Sickle cell anemia
Hurler disease
Glycogen storage disease type II
46.All of the following are manifestations of Infantile Autism except
a. The autistic child is withdrawn and often spends hours in solitary play
b. Non-developed or poorly-developed verbal and non-verbal communication skills.
c. Tantrum-like rages may accompany disruptions of routine daily activities
d. Eye contact is prolonged and persistent
e. Stereotypic body movements
9
47-One of the following is true concerning Guillain Barré Syndrome
(GBS):A. Motor conduction velocities are within normal ranges
B. Urinary incontinence or retention is against the diagnosis of GBS
C.
Bulbar involvement is a rare
occurrence
D. DTRs reflexes are exaggerated
E. CSF studies are essential for diagnosis. Normal CSF findings in the 1st
days do not rule out GBS.
48-Each of the following anti-epileptic drugs is matched correctly with one
of its side effects except
a. Diazepam // sedation
b. Phenobarbital // irritability
c. Carbamazepine // skin lesions
d. Valproic Acid // hepatic dysfunction
e. Phenytoin // gum hypoplasia
49- Which of the following cells are usually absent in the circulation of a
boy with Bruton's disease?
a. T helper lymphocytes.
b. B lymphocytes.
c. Natural killer cells.
d. Monocytes.
e. T suppressor lymphocytes
50-A positive ANA test in a 7 years old child who has juvenile idiopathic
arthritis (JIA) puts the child at a higher risk to develop which of the
following complications?
A.
B.
C.
D.
Anterior uvietis.
Glomerulonephritis.
Gastritis.
Splenomegally.
E. Liver failure
51-Cystic hygroma and lymphatic channel malformations are associated
with which of the following karyotypes?
a. 47,XX,+18
b. 69,XXX
c. 46,XX
d. 45, X
10
52- Common clinical findings in children with phenylketonuria include all
of the following except: a. Mental retardation.
b. Musty odor.
c. Seizures.
d. Macular cherry-red spots.
e. Recurrent vomiting
53-management of the newborn with large cephalhematoma is:
a. surgical drainage
b. needle aspiration
c. observation
d. head CT scan
e. EEG
54-The patient in the given picture has fever daily for the last 6 days, he is
irritable and the focus of fever was not localized. He has cervical
lymphadenopathy and balanitis.
The treatment of choice in this patient at this point is
A.
B.
C.
D.
E.
Intravenous pulse dose of methylpredniselone.
Intra venous high dose of vitamin A.
Intravenous immune globulins and high dose aspirin.
Supportive only.
Methotrexate.
55- A 4 years old child has persistent (even when not febrile) neutrophil
count of 30 K/ mm3. Pseudomonas speciecs was isolated from her skin
lesion. She has poor wound healing and recurrent oral ulcerations. The
most likely diagnosis is
A.
B.
C.
D.
E.
Common variable immune deficiency.
Severe combined immune deficiency.
Leukocyte adhesion defect type I.
Simple eczema.
Dermatographism
11
56-All of the following are features of asthma except
a. Recurrent wheezing.
b. Reversibility of pulmonary function tests especially FEV1.
c. Finger clubbing.
d. Familial tendency.
e. Night time symptoms indicate severity of the disease
57-A 15-year-old girl presents to your office with a 3-month history of facial
rash, headaches, swollen knees, and pallor. Urine dipstick analysis
shows the presence of protein and blood. You are highly suspicious that
she has SLE. Her parents are seeking as much information as possible
as you proceed with her evaluation to confirm the diagnosis. The organ
system involvement in SLE that is most likely to cause the most serious
morbidity and mortality is:
A.
B.
C.
D.
E.
Cardiac.
Central nervous system
Gastrointestinal
Hematologic.
Renal.
58-An obstetrician is closely monitoring a 25-year-old pregnant woman who
has SLE. Her pregnancy, even with the history of SLE, has been stable.
You are consulted to advise the woman about the risks for her
newborn. You advise her that her infant is most likely to develop
neonatal lupus erythematosus if the mother has:
A.
B.
C.
D.
E.
a.A low C4 concentration
b.Anti-Ro antibodies
c.Anti-Sm (Smith) antibodies.
d.Proteinuria.
e.Thrombocytopenia.
59-You are asked to see a 21-day-old boy who has jaundice. Physical
examination findings are normal except for yellow discoloration of the
skin and sclera. Serum bilirubin is 10 mg/dL (171 mcmol/L), with the
direct component of 5 mg/dL (85.5 mcmol/L). Serum alpha-1antitrypsin concentrations are normal. Ultrasonography of the
abdomen shows a nondilated biliary tract. Which of the following is the
most appropriate next step
A.
B.
C.
D.
E.
Computed tomography of the abdomen.
Doppler velocities measurement of hepatic artery and venous blood flow.
Endoscopic retrograde cholangiopancreatography.
Hepatobiliary nuclear medicine scan
Magnetic resonance imaging of the abdomen
12
60-At times, the pediatrician must discern between the clinical
manifestations of bleeding seen in patients who have hemophilia and
those seen in a child who has thrombocytopenia. The type of clinical
manifestations of bleeding seen in a patient who has classic hemophilia
compared with a child who has thrombocytopenia is most likely to be
A.
B.
C.
D.
E.
Central nervous system
Epistaxis.
Gingival.
Hematuria.
Large joints
61-A 32-year-old female who is grava 2 para 1 reports that her first infant
had severe bruising and nosebleeds and died of a central nervous system
hemorrhage at 5 days of age. You suspect that this first newborn died of
neonatal alloimmune thrombocytopenia. Her second infant, for whom
you are now caring, has mucous membrane bleeding and petechiae, and
a laboratory evaluation demonstrates a platelet count of 5x103/mcL
(5x109/L) at 48 hours of age. The treatment that could help control this
infant’s bleeding as well as diagnose the cause of the thrombocytopenia
is:
A.
B.
C.
D.
E.
Anti-D immunoglobulin
Corticosteroids
Exchange transfusion
Maternal donor platelet transfusion
Random donor platelet transfusion
62-The mother of a 2-year-old boy expresses concern during a health
supervision visit that her child has had increased problems with snoring
and periods of breathing difficulties during his sleep. You suspect the
boy has obstructive sleep apnea (OSA) due to adenotonsillar
hypertrophy. Of the following, the most serious complication if this
condition is not recognized and treated is:
A.
B.
C.
D.
E.
Cor pulmonale
Craniofacial abnormalities
Daytime narcolepsy
Failure to thrive
Severe behavioral problems
63-A 16-month-old boy is brought to your clinic for an evaluation. His mother
reports that he has had more than 10 episodes of otitis media and one
hospitalization for pneumonia. Her only other complaint is that he bruises
easily. On physical examination, you note multiple bruises and patches of
eczema over his arms and legs. Of the following, the most likely diagnosis is:
A.
B.
C.
D.
E.
Ataxia-telangectasia
Chronic granulomatous disease
Combined variable immunodeficiency
Wiskott-Aldrich syndrome
.X-linked agammaglobulinemia
13
64-Name the syndrome associated with LGA, macroglossia, hypoglycemia,
hepatoslenomegaly and omphalocele:
a- Prader willi syndrome
b- Beckwith Weidemann syndrome
c- Sotos syndrome
d- Silver Russell syndrome
65- The usually benign .self limited reddening of one side of the infant with
a sharp line of demarcation At the midline possibly related to
autonomic factors is called:
A.
B.
C.
D.
Allagillie syndrome
Harlequin color change
Horner syndrome
Red man syndrome
66- What is generally the length of time considered an apneic period of
clinical importance?
a- Greater than 6 seconds
b- Greater than 30 seconds
c- Greater than 20 seconds
d-Greater than 45 seconds
67- Platelets trapping, consumptive coagulapathy associated with congenital
hemangioma is called:
A.
B.
C.
D.
Kasabach –merrit syndrome
TAR syndrome
HUS syndrome
Strawberry hemangioma syndrome
68-What is the cause of roseola infantile?
a- mycoplasma pneumonia
b- human herpisvirus 6
c- parvovirus 19
d- parainfluenza A
69- Somogyi phenomenon is:
a- early morning hyperglycemia associated with rebound from severe nocturnal
hypoglycemia
b- early morning hypoglycemia associated with hyperinsulinemia from nocturnal
hyperglycemia
c- early morning hyperglycemia due to lack of insulin and rising cortisol
d- early morning hypoglycemia due to high evening insulin dose
70- The following may be associated with Down syndrome:
a- Hirschsprung disease
b- Hypothyroidism
c- Increased risk of leukemia
d- Celiac disease
e- all of the above
14
71- Pansinusitis, bronhiectasis, male infertility and situs inversus is a
condition called:
a- Eisienmenger syndrome
b- immotile cilia syndrome or Kartagener syndrome
c- Rubenstein Taybi syndrome
d-combined immune deficiency syndrome
72- Precocious puberty is defined as puberty beginning before:
a- boys 9-10 years, girls 8 years
b- boys 8 years, girls 11 years
c- boys 12 years, girls 12 years
d- boys 14 years, girls 13 years
73-A 12-year-old boy who is at the 90th percentile for weight complains of
slight pain in the right thigh and knee for about a month. His complaints
are made worse by physical activity and he has a mild limp. He has no
history of recent infections or trauma. Physical examination reveals a
slight decrease in internal rotation of the right hip. There is mild rightsided
metaphyseal
osteopenia
on
radiograph.
Of the following, which would be the MOST likely diagnosis in this boy?
A) Transient synovitis
B) Septic arthritis
C) Osteomyelitis
D) Slipped capital femoral epiphysis
E) Legg-Calve-Perthes disease
74- An infant is born at 28-weeks gestation with severe Respiratory Distress
Syndrome (RDS). The infant requires assisted ventilation and
surfactant replacement therapy. Secondary to poor oxygenation, the
positive end-expiratory pressure (PEEP) is increased from 4-6 cm H20.
Shortly thereafter, you are called to the bedside for an acute decrease
in oxygenation and an increase in the partial pressure of carbon
dioxide (PaC02). Which of the following therapeutic interventions
would be MOST indicated at this time?
A) Transillumination of the chest
B) Increase the ventilator peak inspiratory pressure (PIP)
C) Decrease the PEEP
D) Begin oscillatory high-frequency ventilation
E) Administer a bolus of normal saline at 10 cc/kg
15
75- A 9 years old child with follicular tonsillitis developed diffuse
erythematous maculopapulr rash after staring treatment with oral
amoxicillin, the child most likely has had:
CMV infection
influenza type A
Parainfluenza virus
EBV infection
Simple cold
76-
2 months old girl presents to you with fever, skin rash,
hepatosplenomegaly and an enlarged left axillary lymph node. You confirm
suspected disseminated BCG vaccine infection. Select the incorrect
statement: Treatment is not indicated.
A.
B.
C.
D.
Type 1 cytokines deficiency is a possible explanation.
Severe combined immune deficiency is still possible.
Chronic granulamatous disease is also a possible diagnosis.
Hyper IgM syndrome is likely as well.
77-Among the following clinical findings, the one most suggestive of a
diagnosis other than rotavirus infection is:
A.
B.
C.
D.
E.
Fever
grossly bloody stools
Low serum bicarbonate concentrations
Non-bilious vomiting
Reducing substance-positive stool
78- How long is a child infectious with chickenpox after the lesions erupt?
A.
B.
C.
D.
7-10 days
14 days
3 weeks
3 days
79- In malabsorption all of the following are correctly matching with the
corresponding disease Except:
A.
B.
C.
D.
E.
Acanthocytes - Abetalipoproteinemia
Pellagra-like rash - Hartnup disease
Lymphopenia - Shwachman-Diamond syndrome
Chronic sinopulmonary disease - Cystic fibrosis
Responds to oral zinc sulfate -Acrodermatitis enteropathica
16
80-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.
B.
C.
D.
perform endotracheal intubation.
administer 20 mL/kg of lactated Ringer solution
administer naloxone
administer mannitol
E. obtain a head CT scan
81-All are correct associations with the corresponding mineral deficiency
EXCEPT:
Zinc – Dwarfism.
Chloride – Alkalosis.
Selenium - Cardiomyopathy.
Iodine – Caries.
E. Phosphorus – Rickets.
A.
B.
C.
D.
82-Examination of the cerebrospinal fluid of a 2-year-old child supports the
diagnosis of bacterial meningitis. The child is moderately dehydrated.
The BEST approach to prescribing fluid therapy for this child would
be to
A. restrict fluid to prevent the syndrome of inappropriate antidiuretic hormone
(SIADH)
B. treat the dehydration immediately
C. consider the possibility of the SIADH only if the child’s urine sodium
concentration is greater than 60 mEq/L
D. treat the dehydration after antibiotic therapy has been provided for 24 hours
83-A 10-month-old boy has lethargy, pinpoint pupils, and excessive
salivation His mother reports that he has vomited twice within the past
hour and has had one liquid stool. Two days earlier, the home was
sprayed with an unknown pesticide to eliminate fleas You suspect either
organophosphate or carbamate poisoning.
A TRUE statement about
the similarities and differences between
organophosphate and
carbamate poisoning is:
A.
B.
C.
D.
Both classes of drugs inhibit acetylcholinesterase
Carbamates cross the blood-brain barrier more readily than do
Organophosphates
Measurement of erythrocyte cholinesteraSe activity is more useful for
detecting Carbamates than organophosphates
E. Administration of pralidoxime is contraindicated in the treatment of
organophosphate poisoning
17
84-A TRUE statement about acute pancreatitis in children is:
A. Abdominal pain is a rare symptom
B. An elevated serum amylase level is the most specific indicator of pancreatic
infIammation,
C. Obstructive lesions may be diagnosed by ( ERCP ) retrograde
cholangiopancreatography
D. Ultrasonography is not helpful in diagnosis
E. Immediate surgical intervention is the treatment of choice
85-The parents of a 3-year-old boy are concerned because he stutters.
A TRUE statement about stuttering is:
A.
B.
C.
D.
It is indistinguishable from nonfluency of speech
It occurs with equal frequency among children and adolescents
Anxiety can be a contributing factor in its occurrence
It rarely is influenced by parental speech habits
86-Of the following possible explanations for the occurrence of falsenegative
results of rapid antigen detection tests for streptococcus,
the LEAST likely is
A. variability in technique
B. low numbers of organisms in infected patients
C. low levels of antigen among asymptomatic controls who have positive
cultures
D. weak antigenicity of the organism
87-A 6 week-old male infant is admitted to hospital with 10-15%
dehydration. The serum sodium is 160 mmol/l and the serum potassium
is 3.3 mmol/l. THE CORRECT ANSWER IS :
A. Congenital adrenal hyperplasia is a likely diagnosis.
B. Loss of skin Turgor is usually present.
C. The dehydration should be corrected over the next 2-4 hours.
D. Bloody diarrhea suggests a bacterial cause.
E. Initial fluid replacement should be with D/W 4.3%-0.18N/S.
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88- Computed tomography of the head in an 8-year-old child with heacache
and vomiting reveals hydrocephalus without evidence of tumor. You
consider the possibility of a tumor in the brain stem. True statements
about intracranial tumors in children include each of the
following EXCEPT:
A. Less than 15% of intracranial tumors are located in the brain stem
B. Hydrocephalus is a common presenting finding of brainstem tumors
C. MRI is more helpful than computed tomography in diagnosis.
D. Early detection of brainstem tumors does not substantially affect
prognosis
89-A 16-year-old boy received radiation therapy for acute lymphoblastic
leukemia when he was 4 to 6 years old. His mother is concerned about
late effects of the treatment. A TRUE statement about the late effects of
antileukemic treatment is:
A. Risk of a second malignancy is greater than 25%
B. Osteosarcoma is the most common second malignancy
C. Neurotoxicity
from
current
protocols
involving
limited
cranial
irradiation generally is benign
D. Reduced secretion of growth hormone occurs in less than 10% of patients
90-A 2-year-old boy presents with rales, pallor, chronic failure to thrive,
recurrent thrush, diarrhea, and oxygen saturation of 84% in room air.
Echocardiography demonstrates an enlarged left ventricle with
diminished systolic function.
Of the following, the blood test MOST likely to establish the diagnosis in
this child is:
A.
B.
C.
D.
E.
antibody testing for Epstein-Barr virus
antibody testing for human immunodeficiency virus
antibody testing for human parvovirus
serum carnitine level
serum selenium level
91-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:
A.
B.
C.
D.
E.
gastric stress ulcer
gastroesophageal reflux
gastrointestinal food allergy
intussusception
midgut volvulus
19
92-A 12-year-old girl has had recurrent episodes of scleral icterus,
particularly following viral illnesses. She is otherwise well and is taking
no medications. Laboratory studies reveal an indirect bilirubin of 58.1
mcmol/L (3.4 mg/dL) and direct bilirubin of 5.13 mcmol/L (0.3 mg/dL).
Serum transaminase concentrations, prothrombin time, partial
thromboplastin time, and serum ammonia levels all are within normal
limits.
Of the following, the MOST likely etiology of this girl's hyperbilirubinemia is:
A.
B.
C.
D.
E.
chronic active hepatitis
Dubin-Johnson syndrome
Gilbert syndrome
hepatitis A infection
infectious mononucleosis
93-A 3-year-old child was found drinking from a bottle of liquid drain
cleaner. Upon evaluation in the emergency department, he appears quite
irritable and has difficulty swallowing. Examination of his oral cavity
reveals no evidence of burns or ulcerations. Of the following, the MOST
appropriate management is:
A.
B.
C.
D.
E.
computed tomography of the abdomen
computed tomography of the chest and mediastinum
discharge to home on a liquid diet for 48 to 72 hours
esophagoscopy within 48 hours of ingestion
indirect laryngoscopy within 12 hours of ingestion
94-You are evaluating a 2-month-old infant for microscopic hematuria. He
has a history of respiratory distress syndrome and bronchopulmonary
dysplasia and currently is receiving caffeine and furosemide. Urinalysis
reveals: specific gravity, 1.010; pH, 6.5; 15 to 20 red blood cells; no
protein; and 0 to 2 white blood cells. Electrolyte levels are normal Of
the following, the MOST likely cause of the hematuria
is:
A. benign familial hematuria
B. hypercalciuria
C. multicystic kidney dysplasia
D. tumor
E. urinary tract infection
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95-A 4-year-old girl who has presumed minimal change nephrotic syndrome
presents at your office because of a recent rapid weight gain. The mother reports
that the urine protein determinations have been 4+ for 2 weeks. Physical
examination reveals generalized edema, blood pressure of 115/74 mm Hg, and
heart rate of 85 beats/ min. Findings on the remainder of the examination are
normal. The urine protein is 4+. You prescribe oral prednisone. Two days later
the mother reports that the girl's urine is dark, she has not voided for 12 hours,
and she has abdominal pain Of the following, the most likely cause of this girl's
hematuria and decreased urine output is
A.
B.
C.
D.
E.
acute glomerulonephritis
hemorrhagic cystitis
pyelonephritis
renal vein thrombosis
tubulointerstitial nephritis due to steroid therapy
96-Of the following, the class of drugs MOST likely to cause bladder outlet
obstruction is:
A.
B.
C.
D.
E.
antiarrhythmics
anticholinergics
antihistamines
antipyretics
Antitussive
97-A 10-year-old boy presents for his annual preparticipation sports physical
examination. 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 (0.7 mg/dL). Renal ultrasonography shows enlarged kidneys, with
three renal cysts in each. Of the following, the MOST likely diagnosis in this
child is:
A.
B.
C.
D.
E.
autosomal dominant polycystic kidney disease
autosomal recessive polycystic kidney disease
juvenile nephrophthisis
medullary sponge kidney
multicystic dysplastic kidney disease
98-A 20-month-old child is brought to the emergency department because of
fever and irritability and refusal to move his right lower extremity. Physical
examination reveals a swollen and tender right knee that resists passive
motion. The most important test to confirm the impression of septic arthritis
is
A.
B.
C.
D.
Examination of joint fluid
X-ray of the knee
Erythrocyte sedimentation rate (ESR)
Complete blood count (CBC) and differential
E. Blood culture
21
99-A mentally retarded 14-year-old boy has a long face, large ears,
micropenis, and large testes. Chromosome analysis is likely to
demonstrate which of the following?
A.
B.
C.
D.
E.
Trisomy 21
Trisomy 18
Trisomy 13
Fragile X syndrome
William syndrome
100-A fully immunized 2-year-old presents to the emergency room with
several days of low-grade fever, barking cough, and noisy breathing.
Over the last few hours he has developed a fever to 40°C (104°F) and
looks toxic. He has inspiratory and expiratory stridor. The family has
not noticed drooling, and he seems to be drinking without pain. Direct
laryngoscopy reveals a normal epiglottis. The management of this
disease process includes
A.
B.
C.
D.
E.
Intubation and intravenous antibiotics
Inhaled epinephrine and oral steroids
Inhaled steroids
Observation only
Oral antibiotics and outpatient follow-up
22