MCQs

Question 1

1. An infant who sits with only minimal support and who rolls over from supine to prone position, but does not say a word. Which of the following is the most likely age of the infant?
   a) 1 month.
   b) 3 months
   c) 6 months.
   d) 8 months.

Answer 1

d) 8 months.

Question 2

2. An infant can move his head from side to side while following moving objects can lift his head from prone position 45 degrees off the examining table, smiles when encouraged but cannot maintain a seated position. Which of the following is the most likely age of the infant?

a) 1 month.
b) 3 months.
c) 6 months.
d) 9 months.

Answer 2

b) 3 months.

Question 3

3. An infant can move his head from side to side while following moving object, can lift his head from prone position 45 degrees off the examining table, smiles when encouraged and can sit without support. Which of the following is the most likely age of the infant?
   a) 1 month.
   b) 3 months.
   c) 7 months.
   d) 9 months.

Answer 3

c) 7 months.

Question 4

4. A child is brought to your clinic for routine examination. She can dress with help, knows her own age and can speak short sentences. Which of the following is the most likely age of the infant?
   a) 1 year.
   b) 2 years.
   c) 3 years.
   d) 4 years.

Answer 4

c) 3 years.

Question 5

5. An infant can stand unsupported, walk with support and says 2 meaningful words. Which of the following is the most likely age of the infant?
   a) 12 months.
   b) 16 months.
   c) 18months
   d) 24 months.

Answer 5

a) 12 months.

Question 6

6. An infant can walk unsupported, points to several body parts, climbs over furniture and can ascend or descend stairs .Which of the following is the most likely age of the infant?
   a) 1 year.
   b) 2 years.
   c) 3 years
   d) 4 years

Answer 6

b) 2 years.

Question 7

7. An infant can wave bye-bye, points to body parts and feed with spoon. He walks unsupported, but still unable to give foil name, age and sex; Which of the following
   is the most likely age of the infant?
   a) 1 year.
   b) 2 years.
   c) 3 years.
   d) 4 years.

Answer 7

b) 2 years.

Question 8

8. A child is brought to your clinic for routine examination. He can descend stairs like an adult, know her own age, recognize most of colors, and can speak short sentences. Which of the following is the most likely age of the infant?
   a) 1 year.
   b) 2 years.
   c) 3 years.
   d) 4 years.

Answer 8

d) 4 years.

Question 9

9. A child can jump and starts to hop , can copy a square , can draw a person with three parts and dress with supervision but still unable to write his name . Which of the following is the most likely age of the child?
   a) 1 year.
   b) 2 years.
   c) 3 years
   d) 4 years.

Answer 9

d) 4 years.

Question 10

10. You are evaluating a 15 months old infant for motor and mental development. He can walk alone, wave bye-bye and says 3 words. He has difficulty in ascending stairs. You are going to tell the mother that
    a) Her infant has a mental delay
    b) Her infant has a motor delay.
    c) Her infant is developmentally normal.
    d) We need to do an x ray to exclude rickets.

Answer 10

c) Her infant is developmentally normal.

Question 11

11. During examination of a 7 months old infant, you notice that he can support his head, recognize his mother, sit unsupported but he does not respond to his own name. You are going to tell the mother that:
    a) Hearing assessment is essential.
    b) Her infant has a mental delay.
    c) Her infant has a motor delay.
    d) Her infant is developmentally normal

Answer 11

d) Her infant is developmentally normal

Question 12

12. A child is brought to your clinic for routine follow up. She can identify three colors, say her full name, age and sex, ascend and descend stairs in an adult manner, can draw a man with all features and can write her name. Which of the following is the most likely age of the child?
    a) 2 years.
    b) 5 years
    c) 3 years.
    d) 4 years.

Answer 12

d) 4 years.

Question 13

13. A child is brought to your clinic for a routine examination. She can dress with help, make a tower of 10 cubes, knows her own name and age and can say short sentences. She had difficulty in copying a square. The age of this child is most likely?
    a) 36 months.
    b) 4 years.
    c) 5 years
    d) 6 years.

Answer 13

a) 36 months.

Question 14

14. An infant, lies smiling, and babbling, he can roll over, sits briefly, leaning forward on his hands, with rounded back. He can stand with support, he reaches out and grasps for large objects using the palms, and laughs and giggles when shown himself in the mirror. Estimated age of development is?
    a) 3 months.
    b) 5 months.
    c) 7 months.
    d) 9 months.

Answer 14

d) 9 months.

Question 15

15. A 5-year-old girl presents with short stature. Her height is less than the 5thpercentile, and her weight is in 10th percentile. Heart auscultation revealed ejection systolic murmur on the left sternal border. What would the most useful investigation be?
    a) Complete blood count.
    b) Karyotyping.
    c) Kidney function test.
    d) Thyroid function test

Answer 15

b) Karyotyping.

Question 16

16. A 7 year old boy presents to your clinic for evaluation of short stature. Parents report
    that he has always been the shortest boy in his class. He has been well with no chronic medical problems. His height is below the 5th percentile with weight on the 25th percentile. His mother is 145 cm. The patient’s father is 155 cm. There is no family history of any medical problems. What is your diagnosis?
    a) Constitutional delay in growth.
    b) Familial short stature
    c) Growth hormone deficiency
    d) Hypothyroidism

Answer 16

b) Familial short stature

Question 17

17. A 7 year old boy presents to your clinic for evaluation of short stature. He has no
    history of any chronic symptoms. His Height is below the 5th percentile with weight on the 1 Othth percentile. He has no abnormal features. What is the first most appropriate step to do?
    a) Growth hormone assay.
    b) Measure the height of the mother and father.
    c) Serum protein and full blood count.
    d) Thyroid function test

Answer 17

b) Measure the height of the mother and father

Question 18

18. This is a 12 year old boy who is seen by his physician for short stature. His past
    medical history is normal. No family history of short stature but he has an older male sibling age 18 years with history of delayed onset of puberty. What is most likely the cause of short stature?
    a) Constitutional delay in growth and puberty.
    b) Familial short stature.
    c) Growth hormone deficiency
    d) Hypothyroidism

Answer 18

a) Constitutional delay in growth and puberty.

Question 19

19. A 5-year-old boy presents with proportionate short stature. His height is less than the 5th percentile, and his weight is in 10th percentile. He is asymptomatic with normal
    features. His mid-parental height percentile was the 50th. What is the most useful investigation?
    a) Growth hormone assay.
    b) Karyotyping.
    c) Kidney function test.
    d) Skeletal survey.

Answer 19

a) Growth hormone assay.

Question 20

20. A 3- year- old child with short stature, height below the 5th percentile, upper segment to lower segment ratio is 1.5/1. Which of the following investigation is most likely to be helpful?
    a) Cranial CT.
    b) Endocrine testing for growth hormone level and pituitary function.
    c) Examination of both parents.
    d) Skeletal survey

Answer 20

d) Skeletal survey

Question 21

21. A 13 -year- old boy was reviewed at school for moderate learning difficulties. His height was more than the 95th percentile with weight at the 50th percentile. He had bilateral testicular volumes of 2ml and no pubic or axillary hair. His mid-parental height percentile was the 50th. What is the most likely diagnosis?

a) Constitutional tall stature.
b) Down syndrome.
c) Marfan syndrome.
d) Klinefelter syndrome.

Answer 21

d) Klinefelter syndrome.

Question 22

22. The parents of a 14 year old boy are concerned about his short stature and lack of sexual development. He had a normal growth pattern, although he was always shorter than children of his age. Examination revealed height at the 5thpercentile, upper segment to lower segment ratio is 0.98. A small number of fine axillary and pubic hairs are present. Which of the following is the most appropriate action?
    a) Measure pituitary gonadotropin.
    b) Measure seium testosterone
    c) Obtain a CT scan of pituitary gland..
    d) Reassure the parents

Answer 22

d) Reassure the parents

Question 23

23. An otherwise healthy 6- year- old girl is brought to you to be evaluated because he is the shortest child in his class, careful measurement of his upper and lower segments demonstrates normal body proportions for his age .Which of the following disorders of growth is most likely?
    a) Achondroplasia
    b) Growth hormone deficiency.
    c) Mucopolysaccharidosis
    d) Marfan syndrome.

Answer 23

b) Growth hormone deficiency.

Question 24

An 18-month-old boy is brought to his pediatrician for follow up. He has been healthy since birth. During the examination, the baby walks and runs, and his mother states that he can climb stairs. However, he has not been observed to jump. He is able to grasp objects with his finger and thumb and bang cubes together. Which of the following assessments of his motor development is correct?
a) Delayed gross motor skills, delayed fine motor skills
b) Delayed gross motor skills, normal fine motor skills
c) Normal gross motor skills, delayed fine motor skills.
d) Normal gross motor skills, normal fine motor skills.

Answer 24

d) Normal gross motor skills, normal fine motor skills.

Question 25

25. A 2-year -old girl is brought to her pediatrician because her parents are concerned that she is not talking as well as her older sister did at the same age. She is able to point to 4 pictures and combines 2 words together and sometimes 3 words together. Which of the following is the most likely diagnosis for this patient? a) Attention deficit disorder. b) Hearing loss. c) Mental retardation. d) Normal language development.

Answer 25

d) Normal language development.

Question 26

26. A 6-year-old boy is brought to your office because his mother is concerned that he is not eating enough and may need vitamins. On growth curve, his weight is at the 97th percentile for age and 50th percentile for height. Physical examination is otherwise normal. Which of the following statements best reflects the appropriate management for this child? a) A dietary history should be taken. b) Investigations to exclude endocrine disorders. c) No intervention is required at this time d) Subcutaneous skin fold thickness should be followed closely.

Answer 26

a) A dietary history should be taken.

Question 27

27. A 16 month-old child’s parent is concerned because she says no words other than “mama” and “dada.” Which of the following is appropriate? a) Refer for audiology evaluation.. b) Parent reassurance c) Order MRI brain d) Order EEG

Answer 27

a) Refer for audiology evaluation..

Question 28

28. The highest rates of somatic growth after birth occur during a) First 10 years of life. b) First 4 years, and adolescence. c) First year, second year, and with adolescence. d) First month, 2nd year of life, and late childhood.

Answer 28

c) First year, second year, and with adolescence.

Question 29

29. Which of the following is false? a) Anterior fontanel closes at 10 months b) The average height at 4 years is 100 cm. c) The permanent canines usually erupt at 11 years. d) The skull circumference at 6 months is around 43 cm.

Answer 29

a) Anterior fontanel closes at 10 months

Question 30

30. At 4 years age, the weight of a normal child is expected to be about? a) About 12 kg b) About 18 kg. c) About 14 kg. d) About 16 kg

Answer 30

d) About 16 kg

Question 31

31. What is the average weight of a normal 18-month-old infant? a) 14 kg. b) 8 kg c) 11 kg. d) 9 kg.

Answer 31

c) 11 kg.

Question 32

32. Increased skull circumference is not due a) Chronic hemolytic anemia. b) Fanconi anemia c) Hydrocephalus. d) Rickets.

Answer 32

b) Fanconi anemia

Question 33

33. Causes of microcephaly do not include a) Congenital infections b) Down syndrome. c) Fanconi anemia d) Neurofibromatosis

Answer 33

d) Neurofibromatosis

Question 34

34. The milk dentition (primary) that commonly erupts first is? a) Lower canine teeth. b) Lower central incisors c) Upper canine teeth d) Upper central incisors

Answer 34

b) Lower central incisors

Question 35

35. The primary tooth that commonly erupts at 18 months is? a) Canine teeth. b) First molar teeth c) Lower central incisors. d) Lower lateral incisors

Answer 35

a) Canine teeth.

Question 36

36. The first permanent dentition is normally expected to erupt at? a) 6 months. b) 6 years. c) 12 months. d) 18 years.

Answer 36

b) 6 years.

Question 37

37. Bone age is best evaluated by X-rays of a) Elbow joint. b) Hand and wrist c) Hip. d) Knee joint.

Answer 37

b) Hand and wrist

Question 38

38. Retarded bone age is not expected in a) Constitutional delay in growth b) Hypothyroidism c) Pituitary dwarfism. d) Precocious puberty.

Answer 38

d) Precocious puberty.

Question 39

39. Increased skull circumference is not observed in a) Chronic hemolytic anemia. b) Congenital rubella syndrome c) Chronic subdural effusion. d) Rickets.

Answer 39

b) Congenital rubella syndrome

Question 40

40. The first physical change associated with puberty in boys is? a) Height spurt. b) Penile lengthening. c) Pubic hair development. d) Testicular enlargement.

Answer 40

d) Testicular enlargement.

Question 41

41. The first physical change associated with puberty in girls is? a) Areolar elevation. b) Breast budding. c) Height spurt. d) Menarche

Answer 41

b) Breast budding.

Question 42

42. As regard childhood obesity which is true? a) BMI more than 80th percentile b) Endogenous obesity is the most common etiology c) Hyperthyroidism may be an etiology d) Prader-Willi syndrome have feeding difficulties in infancy

Answer 42

d) Prader-Willi syndrome have feeding difficulties in infancy

Question 43

3. Investigations of a case microcephaly includes ? a) Liver function tests b) Karyotyping c) Kidney function tests d) Thyroid profile

Answer 43

b) Karyotyping

Question 44

44. Short stature in children is not associated with: a) Achondroplasia b) Congenital hypothyroidism c) Down syndrome d) Marfan syndrome

Answer 44

d) Marfan syndrome

Question 45

45. Obesity in children is defined as BMI >

Answer 45

d) 95th percentile

Question 46

46. Which one of the following is a cause of disproportionate short stature? a) Congenital hypothyroidism b) Cushing syndrome c) Familial short stature d) Growth hormone deficiency

Answer 46

a) Congenital hypothyroidism

Question 47

47. Factors affecting physical growth do not include? a) Mentality. b) Race c) Socioeconomic factors. d) Sex.

Answer 47

a) Mentality.

Question 48

48. Regarding growth curves, which criterion is false? a) Composed for different aspects of physical growth b) Vary from boys to girls c) No difference between countries d) The child should follow the same percentile level throughout the growth period.

Answer 48

c) No difference between countries

Question 49

49. Values of serial measurements of growth curves include? a) Assess the growth rate b) Detect abnormal growth c) Should follow same percentile through the growth period d) All of the above

Answer 49

d) All of the above

Question 50

50. The birthweight usually quadruples by the age of? a) Year b) 2 year c) 2.5 year d) 3 year

Answer 50

c) 2.5 year

Question 51

51. The first permanent tooth to erupt is a) Central incisor at 6 year b) Molar at 6 year c) Premolar at 6-7 year d) Lower canine at 6-7 year

Answer 51

b) Molar at 6 year

Question 52

52. The parent asks you when their child’s full set of primary teeth should come in. Which of the following is correct? a) 12 to 17 months b) 18 to 24 months c) 25 to 33 months d) 3 years

Answer 52

c) 25 to 33 months

Question 53

53. The limit age for fear of strangers is: a) 10 months b) 7 months c) 8 months d) 6 Months

Answer 53

a) 10 months

Question 54

54. Which one of the following is a sign of normal mental development? a) Gives full name starting at 5 years b) Says 2 words at one year c) Tells a story at 2 years d) Waves ’bye-bye’ at 2 years

Answer 54

b) Says 2 words at one year

Question 55

1. A 3-week-old baby girl is brought to her pediatrician for checkup. She was bom at term with a birth weight of 3400 g. The infant is exclusively breast fed, nurses every 2 to 3 hours, and has 6 to 8 wet diapers and 2 to 4 seedy stools daily. At the time of her examination, she weighs 3450 g. Results of the physical examination are normal. The most appropriate next step is: a) Continue breast feeding only b) Continue breast feeding with supplemental cow’s milk formula between feeds c) Continue breast feeding with supplemental soy formula between feeds d) Continue breast feeding and add rice cereal to her diet

Answer 55

a) Continue breast feeding only

Question 56

2. A family arrives to your clinic for their first newborn. You are counseling the mother on breast feeding. One of the following is a contraindication to breast feeding? a) A newborn screening that is positive for phenylketonuria b) A newborn screening that is positive for hypothyroidism c) Maternal hepatitis B infection d) Maternal smoking

Answer 56

a) A newborn screening that is positive for phenylketonuria

Question 57

3. An 8-week-old boy is brought by his mother for a routine checkup. He was delivered at 38 weeks. He is exclusively breastfed, and his mother has a balanced diet. Which one of the following nutritional supplements should you recommend for the baby at the present time? a) Fluoride b) Iron c) Vitamin C d) Vitamin D

Answer 57

d) Vitamin D

Question 58

4. A 3- week-old infant is brought for checkup, he sleeps 16 hours a day, weighs 3600 gram and takes 60 ml of humanized milk four times /day, no vitamin or iron supplementations. He did not take any vaccine yet. Which of the following is the most appropriate first step in the care of this patient? a) Advise the mother regarding the proper amount and frequency of feeds b) Advise the mother to arouse her infant frequently, as he sleeps much c) Give vitamin C and iron supplementation d) Start vaccination

Answer 58

a) Advise the mother regarding the proper amount and frequency of feeds

Question 59

5. A mother arrives to your clinic for her first baby. You are counseling the mother on breast feeding. Which one of the following items is appropriate for breast milk? a) Better given without any additional feeds only for the 2-3 months of life b) Demand feeding is preferred c) Don’t feed for more than 5 minutes for each breast d) Should start 2 hours after birth

Answer 59

b) Demand feeding is preferred

Question 60

6. A 6-day -old girl is brought for a routine follow-up visit. The mother is concerned that the baby is not eating enough. The baby drinks humanized milk 60 ml every 2-3 hours in addition to breast feeding. The mother complains that her breasts are full and tender. Which of the following is the correct advice? a) Reassurance b) Stop formula feeding c) Stop breast feeding d) Stop formula feeding and frequent breast evacuation

Answer 60

d) Stop formula feeding and frequent breast evacuation

Question 61

7. A mother brings her two weeks old son for follow up. She will be returning to work in one week. She is seeking your advice concerning her infant's nutrition. The best regimen for this mother will be ? a) Complementary feeding b) Supplementary feeding c) Substitutive feeding d) Start weaning with iron-fortified cereals

Answer 61

b) Supplementary feeding

Question 62

8. An 8-months old infant presenting with gastroenteritis, He is on diet with the following contents for the last 5 months: Carbohydrates 55%, fat 40% and protein 5% with total calories 100 K calorie/kg/day. Which one of the following manifestations would you expect to find? a) Broadening of the ends of long bones. b) Edema of the dorsum of the feet. c) Loss of fat from the abdominal wall. d) Wheezy chest.

Answer 62

b) Edema of the dorsum of the feet.

Question 63

9. A 6-month- old infant presenting with 1 day histoiy of diarrhea 5 motions/day. He is on diet with the following contents for the last 4 months: Carbohydrates 50%, fat 35% and protein 15 % with total calories 70 K calorie/kg/day. Which one of the following findings would you expect to find? a) Edema of the dorsum of the feet b) Hypovolemic shock because of diarrhea. c) Increased muscle fat ratio. d) Loss of fat from the abdominal wall and buttock

Answer 63

d) Loss of fat from the abdominal wall and buttock

Question 64

10. You are counseling a mother about the value of breast milk in preventing enteric infections. Which one of the following statements is correct? a) More alkaline stool pH in breastfed infants b) More acidic pH of the GIT in breast fed infant. c) Predominance of Clostridium in the gut of breast fed infants d) The presence of IgE in breast milk

Answer 64

b) More acidic pH of the GIT in breast fed infant.

Question 65

A mother brings her 1- year- old boy for follow up. He is pale, on the 75th percentile for weight; otherwise he is completely normal. Which item in the history may explain the condition? a) Family history of chronic anemia. b) Family history bleeding disorders. c) Nutritional history with stress on the type of weaning food. d) Neonatal history

Answer 65

c) Nutritional history with stress on the type of weaning food.

Question 66

12. You are examining a preterm newborn in the nursery. You recommend the use of preterm infant formula because? a) Preterm formulas have lower protein and calories than humanized formula. b) Preterm formulas have higher protein and calories than humanized formula. c) Preterm formulas have higher lactose and calories than other formulas d) Preterm formulas have lower lactose and calories than other formulas

Answer 66

b) Preterm formulas have higher protein and calories than humanized formula.

Question 67

A mother arrives to your clinic with her 5 months old baby who is exclusively breast fed. She wants to learn more about weaning practice, she is asthmatic and her young brother has type 1 diabetes. Which instruction is the most important to tell her about? a) Avoid excessive breast milk after 6 months b) Avoid introduction of cow milk except after the first year. c) Avoid the use of spoon in feeding the baby till after the first year d) Introducing any new food item should be after breast milk feed.

Answer 67

b) Avoid introduction of cow milk except after the first year.

Question 68

14. A 14 months old boy presenting with recurrent chest infections, he is exclusively breast fed with no history of intake of any vitamins or minerals. Examination revealed a large head, distended abdomen. Which of the following investigation is recommended? a) Bronchoscopy. b) Calcium, phosphorus and alkaline phosphatase. c) Thyroid profile d) Serum albumin, creatinine and CBC.

Answer 68

b) Calcium, phosphorus and alkaline phosphatase.

Question 69

15. An 18 months old boy presenting with delayed walking, he is exclusively breast fed with no history of intake of any vitamins or minerals. Examination revealed, distended abdomen and wrist thickening. Which of the following investigations would be correct in this case? a) Low serum calcium, phosphorus and alkaline phosphatase. b) Normal serum calcium, phosphorus and alkaline phosphatase. c) Normal phosphorus, low serum calcium and high alkaline phosphatase d) Normal calcium, low serum phosphorus and high alkaline phosphatase.

Answer 69

d) Normal calcium, low serum phosphorus and high alkaline phosphatase.

Question 70

16. A 16 months old boy presenting with delayed walking, delayed dentition and recurrent chest infections, he is exclusively breast fed. He received several medications and injections but mother cannot remember them. Recently he developed constipation, vomiting and polyuria. What is the most probable diagnosis? a) Diabetic ketosis b) Hepatic rickets c) Renal rickets d) Rickets with Hypervitaminosis D

Answer 70

d) Rickets with Hypervitaminosis D

Question 71

17. An 18 months old boy who is exclusively breast fed presenting with convulsions. He has rectal temperature: 37.7 C°, B.P 100/ 70, anterior fontanelle width: 1 finger not bulging. Which one of the following investigations might explain the cause of convulsions? a) CBC b) CSF examination. c) CT brain. d) Serum calcium.

Answer 71

d) Serum calcium.

Question 72

18. A 9-months old infant presenting with lower limb edema, He is on diet with following contents for the last 5 months: Carbohydrates 55%, fat 40% and protein 5 % with total calories 100 K calorie/kg/day. Which one of the following investigations is correct? a) Low serum protein, high serum sodium. b) Low semm protein high serum potassium. c) High gamma globulins, low serum sodium. d) Low alpha and beta globulins, with high serum sodium.

Answer 72

c) High gamma globulins, low serum sodium.

Question 73

19. This is a 7 month old boy who is not giowing well. His birth weight was 3.5 kg and his cunent weight is 4 5 kg (less than the 5th percentile). Mother states that he drinks 60 ml of humanized of infant formula every 4 hours, she also feeds him a small amount of rice cereal since he was 5 months old. Which sign of the following you are expecting to find in examination? a) Ascites. b) Hepatomegaly c) Loss of fat from the abdomen. d) Microcephaly

Answer 73

c) Loss of fat from the abdomen.

Question 74

20. A 14 months old boy who is exclusively breast fed, brought by his mother because of delayed walking, he received multiple injections for treatment of this condition. History revealed recent development of vomiting, constipation, and polyuria. One of following investigations might be positive in this case. a) Plain X ray abdomen showing multiple radio-opaque lesions. b) Senrm calcium 10 mg%. c) Serum calcium 8 mg%. d) Serum phosphorus 5 mg%.

Answer 74

a) Plain X ray abdomen showing multiple radio-opaque lesions.

Question 75

21. A 9 months old infant presenting with edema on the dorsum of the feet. He is on diet mainly carbohydrates. Examination reveals an enlarged liver 6 cm below the costal margin. Investigations to reveal the cause of hepatomegaly is a) Doppler to visualize the portal area. b) Liver enzymes: ALT and AST. c) Serum protein and lipids. d) Upper GIT endoscopy.

Answer 75

c) Serum protein and lipids.

Question 76

22. A 3 year old boy presenting with chronic diarrhea and recurrent chest infections since birth. On examination he has a large head, broad wrist, deformed thoracic cage and distended abdomen. The most likely diagnosis is a) Cystic fibrosis b) Chronic hemolytic anemia c) Cow milk allergy. d) Vitamin D deficiency rickets

Answer 76

d) Vitamin D deficiency rickets

Question 77

23. An 18 months old boy who is exclusively breast fed presenting with convulsions and contraction of his finger and toes. He is not feverish. The best action to control convulsions in this patient is a) IV diazepam. b) IV phenobarbitone. c) IM calcium gluconate. d) IV calcium gluconate.

Answer 77

d) IV calcium gluconate.

Question 78

24. A 7 month old boy presenting with gastroenteritis. He is on diet with total calories 75 k cal/kg/day. Examination reveals weight less than the 5th percentile and a temperature 35.9°C. He has generalized fat loss and muscle wasting. The first step in the management of this patient is: a) Adequate clothing and external heating. b) IV fluids to correct dehydration. c) TV albumin. d) Nasogastric tube placement and start feeding.

Answer 78

a) Adequate clothing and external heating.

Question 79

26. A 17 months old baby has been irritable over the past month. She now refuses to walk and seems to have tenderness in both of her legs. She has a low grade fever and petechiae on her skin and mucous membranes. Manifestations are due to deficiency of vitamin? a) Vitamin A b) Vitamin C c) Vitamin D d) Vitamin E

Answer 79

b) Vitamin C

Question 80

27. A 3 years old baby whose diet consists mostly of cheese and cola begins to ha ve a problem on walking at night, complaining that he cannot see well. In addition, his skin has become dry and scaly. Manifestations are due to deficiency of: a) Vitamin A b) Vitamin C c) Vitamin D d) Vitamin E

Answer 80

a) Vitamin A

Question 81

8. A 14-month-old baby has had diarrhea with vomiting for 3 wks. She also had measles a month back. On examination she is wasted, irritable, skin can be pinched up and tongue is moist, systemic examination revealed a slightly enlarged Liver. Het weight is 6 kg. She also has pedal edema. Her grandmother who lives in same house has history of chronic cough. The most likely diagnosis: a) Gastroenteritis with 50% dehydration b) Hepatitis c) Marasmic kwashiorkor d) TB meningitis

Answer 81

c) Marasmic kwashiorkor

Question 82

29. A 7-week old baby is referred with a 2-week H/O of vomiting. He is being formula fed (160 ml) every 2-3 hrs. On examination he is well thriving, on the 95'" percentile and has a normal examination. What is the most likely diagnosis? a) Gastroenteritis b) Gastro-esophageal reflex c) Over-feeding d) Pyloric stenosis

Answer 82

c) Over-feeding

Question 83

30. A male child 1.5 years old presented with delayed walking. He is breast fed. Mum started weaning at the age of 1 year and she mentioned that he has cough for the last 2 days. Examination showed broad ends of bones at wrists and ankles. Chest examination revealed respiratory rate 30 per min without specific findings over the chest Liver and spleen are palpable. To treat this case you will give: a) Oral calcium b) Oral vitamin D3 c) Orthopedic surgery consultation d) Physiotherapy

Answer 83

b) Oral vitamin D3

Question 84

31. Male infant 6 months was breast fed till the age of 4 months, then weaned gradually, the mother is complaining of failure to thrive of her child. Examination revealed marked wasting of his muscles and loss of subcutaneous fat with senile facies and continuous crying. Which of these data is correct? a) Chronic diarrhea is uncommon b) Iron deficiency anemia is uncommon c) The patient has 3rd degree marasmus d) The patient has KWO

Answer 84

c) The patient has 3rd degree marasmus

Question 85

32. Female child aged 1 year is referred to the ER due to delayed motor milestones. Examination reveals macrocephaly, broad lower ends of radius and ulna, bow legs and pigeon chest, Which of the flowing is false? a) Pathologic fracture may occur b) The child has cerebral palsy c) Tetany may occur d) X-ray of wrists or ankle is diagnostic

Answer 85

b) The child has cerebral palsy

Question 86

33. A male infant aged 8 months old presents with failure to thrive associated with excessive vomiting and recurrent cough and wheezing. One of the following statements is incorrect: a) Pneumonia is a complication b) 24 hours esophageal PH monitoring is diagnostic c) The patient has GERD d) The patient has esophageal atresia

Answer 86

d) The patient has esophageal atresia

Question 87

34. An 18-month-old boy is brought to the clinic for evaluation. The mother complains that he is always sick with cough and diarrhea. On examination, the toddler is anxious, and appears thin. Vital signs are appropriate for age. Weight is 9 kg (<3rd percentile); height is 72 cm (<3rd percentile); head circumference is 47 cm (10th percentile). Examination is significant for subcutaneous wasting, sparse hair, dry skin, and a red oozy rash in the diaper area. What is the initial management step of such a child? a) Correct dehydration and manage infection b) Give proper supplements c) Nutritional management d) Topical cream for napkin dermatitis

Answer 87

a) Correct dehydration and manage infection

Question 88

35. The most important cause of mortality in such infants is: a) Anemia b) Infection c) Mineral deficiency d) Vitamin deficiency

Answer 88

b) Infection

Question 89

36. An 18 months old infant presents to the ER with generalized edema affecting the dorsum of the hands and feet, yet no puffiness of the eyelids. He has been breast fed till the age of 1 year then weaned on starchy food. The possible diagnosis is: a) Heart failure. b) Kwashiorkor. c) Marasmus d) Nephrotic syndrome.

Answer 89

b) Kwashiorkor.

Question 90

37. A mother brought her infant aged 8 months to the ER due to delayed milestones in the form of inability to grasp objects (pincer grasp). Examination revealed body weight 8 kg, height 70 cm, good head support, social smile present, good rolling over and crawling. What is your instruction: a) The infant has rickets. b) The infant must be hospital admitted. c) The infant should receive IV calcium. d) The mother should be reassured.

Answer 90

d) The mother should be reassured.

Question 91

38. A 20 month-old child is seen in clinic because of an acute respiratory infection. General examination reveals prominent forehead, distended abdomen, and thickening at the wrists and ankles. Plain X-ray film reveals widened epiphyseal plate. The most likely biochemical finding is: a) Hypercalcemia b) Hypophosphatemia c) Hypophosphatasia d) Hyponatremia

Answer 91

b) Hypophosphatemia

Question 92

39. When examining an infant, you note bilateral genu varum, widening of her wrists, and frontal bossing. The mother states she noticed her child bow legs when the child started walking and it has been getting worse with time. What additional possible clinical features would you expect in this patient? a) Clinodactyly b) Delayed posterior fontanelle closure c) Harrison sulcus d) Microcephaly

Answer 92

c) Harrison sulcus

Question 93

0. A one month old full term female baby presented to the routine check-up. Her birth weight was 3 kg. The mother is worried about her breast milk is it enough for her baby or not. What is the single most important indicator of adequate breast milk feeding? a) Adequate sleep after feeding b) Appropriate weight gain c) Defecation 3 times or more with semisolid stools d) Urination 6 times or more per day

Answer 93

b) Appropriate weight gain

Question 94

41. Concerning iron requirement in children, which statement is false? a) Cow’s milk is a poor source of bioavailable iron b) Iron present in animal protein is more bioavailable than that found in plants c) Iron deficiency is the most common mineral deficiency d) Iron should be given since birth in all infants

Answer 94

d) Iron should be given since birth in all infants

Question 95

42. The recommended daily requirement of vitamin D in the first year of life is: a) lOOIU/day b) 200IU/day c) 400 IU/day d) 800 IU/day

Answer 95

c) 400 IU/day

Question 96

43. An absolute contraindication to breastfeeding is a) Alcohol intake b) Active pulmonary tuberculosis c) Hepatitis C infection of the mother d) Herpes simplex lesion of the lips

Answer 96

b) Active pulmonary tuberculosis

Question 97

44. Regarding breast engorgement; Which of the following is correct? a) Is a relative contraindication to breastfeeding b) Usually associated with breast milk jaundice c) Usually happens after the first week of life d) Usually happens in the first stage of lactogenesis

Answer 97

d) Usually happens in the first stage of lactogenesis

Question 98

5. During treatment of malnutrition, the signal of entry to the rehabilitation phase is a) Constant blood sugar level b) Disappearance of signs of micronutrient deficiency c) Reduced edema d) Resolution of infection

Answer 98

c) Reduced edema

Question 99

46. Colostrum is Breast milk secreted in the first post-natal: a) One week. b) One month c) 2-3 days d) 3-5 days

Answer 99

c) 2-3 days

Question 100

47. Which of the following is correct about breast milk: a) Iron is low in breast milk. b) It is poor in vitamin A c) It should be stopped during diarrhea d) Its caloric content is much higher than cow milk

Answer 100

d) Its caloric content is much higher than cow milk

Question 101

48. The fat which disappears last in marasmus is : a) Abdominal fat b) Buccal pads of fat c) Buttocks fat d) Subscapular fat

Answer 101

b) Buccal pads of fat

Question 102

49. The active form of vitamin D is: a) 1-24 dihydroxycholecalciferol (DHCC) b) 1-22 DHCC c) 1-23 DHCC d) 1-25 DHCC

Answer 102

d) 1-25 DHCC

Question 103

50. Kwashiorkor is due to a) Energy deficiency. b) Malabsorption of vitamin c) Protein and energy deficiency d) Protein deficiency

Answer 103

d) Protein deficiency

Question 104

51. When weaning an infant one of the following is true: a) Cows' milk can be introduced before the age of one year b) Excess sugar intake is advisable c) Solids shouldn’t be introduced before 4 months of age d) The weaning diet will fully replace the milk by 10 months of age

Answer 104

c) Solids shouldn’t be introduced before 4 months of age

Question 105

52. For breastfed babies which vitamin should be supplemented early in life? a) Vitamin A b) Vitamin C c) Vitamin D d) Vitamin E

Answer 105

c) Vitamin D

Question 106

53. Which of the following may be a predisposing factor for Vitamin D deficiency rickets? a) Excessive wrapping of the infants b) Ingestion of row milk c) Lack of fog d) White colored infants

Answer 106

a) Excessive wrapping of the infants

Question 107

54. Inorganic phosphorus in rickets is raised in a) Chronic renal failure b) Dietary calcium deficiency c) Fanconi syndrome d) Vitamin D deficiency

Answer 107

a) Chronic renal failure

Question 108

55. 25-hydroxy vitamin D level is reduced in a) Autosomal recessive hypophosphatemic rickets b) Autosomal dominant hypophosphatemic rickets c) Fanconi syndrome d) Vitamin D deficiency

Answer 108

d) Vitamin D deficiency

Question 109

56. Urinary phosphorus is reduced in a) Autosomal dominant hypophosphatemic rickets b) Autosomal recessive hypophosphatemic rickets c) Chronic renal failure d) Fanconi syndrome

Answer 109

c) Chronic renal failure

Question 110

57. Causes of delayed closure of anterior fontanel don’t include a) Craniostenosis. b) Cretinism. c) Hydrocephalus. d) Rickets

Answer 110

a) Craniostenosis.

Question 111

58. The standard method for determining a patient’s vitamin D status is a) 25-hydroxylase level b) 2 5-hydroxy vitamin D level c) 1, 25-dihydroxy vitamin D level d) Parathyroid hormone level

Answer 111

a) 25-hydroxylase level

Question 112

59. The baby that is least vulnerable to develop vitamin K bleeding tendency is a) A three-day old neonate of a healthy mother that started immediate breastfeeding after birth b) A three-year old child who spent 21 days in intensive care unit receiving total parenteral nutrition c) A nine-month old infant with prolonged history of diarrhea and multiple antibiotics therapy d) A six-month old infant with cystic fibrosis missed to be diagnosed during early neonatal period

Answer 112

a) A three-day old neonate of a healthy mother that started immediate breastfeeding after birth

Question 113

60. Factors that increase breast milk production include: a) Demand feeding. b) Feeding babies in the nursery at night c) Mother baby separation d) Use of supplemental milk formula

Answer 113

a) Demand feeding.

Question 114

61. Respiratory infection in rickets can be caused by: a) Aspiration b) Chest deformity c) Immunodeficiency d) Lung anomaly

Answer 114

b) Chest deformity

Question 115

62. Advantages of breast feeding include: a) Decreases colonic lactobacilli b) Decrease IQ level c) Decreases the risk of type 1 diabetes d) Decrease the risk of vitamin D deficiency.

Answer 115

c) Decreases the risk of type 1 diabetes

Question 116

63. Bottle feeding may be associated with: a) Less risk of gastroenteritis b) Less risk of necrotizing enterocolitis (NEC) c) More prolactin production. d) Nipple confusion

Answer 116

d) Nipple confusion

Question 117

64. The causes of death in protein energy malnutrition don’t include a) Anemic heart failure b) Electrolyte disturbances c) Hypothermia d) Parasitic infestation

Answer 117

d) Parasitic infestation

Question 118

65. Constant features of Kwashiorkor don’t include a) Growth failure b) Hepatomegaly c) Mental changes d) Pitting edema

Answer 118

b) Hepatomegaly

Question 119

66. Which of the following drugs is contraindicated in breastfeeding: a) Acetaminophen b) Cephalosporins c) Ergot preparations d) Insulin

Answer 119

c) Ergot preparations

Question 120

67. As regard the mature breast milk, which is the correct statement: a) Caloric content is 57 Kcal / 100 ml b) Fat content is 2.5 g/100 ml c) Protein content is less than 1.5 g/100 ml d) Water constitutes 80%

Answer 120

c) Protein content is less than 1.5 g/100 ml

Question 121

68. Which of the following drugs is not a manifestation of vitamin A deficiency: a) Bleeding gums b) Bitot spots c) Keratomalacia d) Xerophthalmia

Answer 121

a) Bleeding gums

Question 122

69. Complications of rickets do not include a) Diarrhea. b) Kyphosis. c) Pathological fractures. d) Pneumonia.

Answer 122

a) Diarrhea.

Question 123

70. Complications of marasmus do not include a) Edema. b) Hypothermia. c) Hypoglycemia d) Recurrent infections.

Answer 123

a) Edema.

Question 124

1. A newborn infant has dysmorphic features. The pregnancy was complicated by breech presentation, decreased fetal movements, and polyhydramnios. The child demonstrates hypotonia, a flat face, flattened occiput, epicanthal folds, and abdominal distention. The most likely cause of this child's dysmorphology is: a) Edwards syndrome b) Fragile X syndrome c) Trisomy 18 d) Trisomy 21

Answer 124

d) Trisomy 21

Question 125

2. A couple comes to you following the diagnosis of trisomy 21 in their 18-week fetus. They ask what medical problems may be anticipated for a child who has Down syndrome. Of the following, the medical problem that is encountered most frequently in infants who have trisomy 21 is: a) Cardiac defect b) Duodenal atresia c) Hypotonia d) Polycythemia

Answer 125

c) Hypotonia

Question 126

3. A small for gestational age newborn is delivered at term following an uneventful pregnancy to a gravida 3, para 2, 34-year-old woman by normal spontaneous vaginal delivery. On physical examination, the newborn is noted to have a small chin, a clenched fist and hypotonia . Which of the following, the most likely diagnosis? a) Trisomy 13 b) Trisomy 18 c) Trisomy 21 d) Turner syndrome

Answer 126

b) Trisomy 18

Question 127

4. During health supervision visit for a 5-year-old boy with hemophilia A, her mother reports that she herself is currently 16 weeks pregnant. She expresses concern about this pregnancy because her brother and two of her maternal uncles died from complications of hemophilia A. She was told at the time of her most recent ultrasonography that she is carrying a male fetus. What is the pattern of inheritance in this case? a) Autosomal dominant b) Autosomal recessive c) X linked recessive d) X linked dominant

Answer 127

c) X linked recessive

Question 128

5. The parents of a child who is suffering from a metabolic disease characterized by an autosomal recessive inheritance pattern ask for your advice they intend to have a second baby. What is the risk of having affected child? a) 50% b) 100% c) 25% d) 75%

Answer 128

C) 25%

Question 129

6. A mentally retarded 15-yr-old boy is found to have macroorchidism and large, prominent ears. What is the most likely diagnosis? a) Acromegaly b) Fragile X syndrome c) Hypothyroidism d) Trisomy 21

Answer 129

b) Fragile X syndrome

Question 130

7. The mother of 1 year old boy complains that her child still can’t sit unsupported. On examination the child has dysmorphic features and a transverse palmar crease. Local examination of the heart reveals a murmur over the left parasternal area. One of the complications of this condition is: a) G6PD deficiency b) Hypothyroidism c) Lymphoma d) Pyloric stenosis

Answer 130

b) Hypothyroidism

Question 131

8. A 7 month male boy presented with acute onset of pallor & jaundice. Hb = 3 gm/dl & reticulocytes = 10 %, the baby was completely healthy till he shared food with his family yesterday. What do you want to ask about? a) A brother with G6PD b) Family history of G6PD c) Parental consanguinity. d) All of the above

Answer 131

d) All of the above

Question 132

9. A 6 -year- old child has growth retardation and dysmorphic features had a history of surgically repaired endocardial cushion defect. This case might be: a) Down syndrome b) Klinefelter syndrome c) Marfan syndrome d) Turner syndrome

Answer 132

a) Down syndrome

Question 133

10. The mother of a 4 months old boy complains that her child still can’t support his head. On examination the child has a flat occiput, and a transverse palmar crease. Local examination of the heart shows a hollow systolic murmur over the left parasternal area. One of the complications of this condition is: a) G6PD deficiency b) Leukemia c) Lymphoma d) Pyloric stenosis

Answer 133

b) Leukemia

Question 134

11. A 4 -year- old child has brachiocephaly, intellectual delay had a history of surgically repaired duodenal atresia at birth. This case might be: a) Down syndrome b) Klinefelter syndrome c) Marfan syndrome d) Turner syndrome

Answer 134

a) Down syndrome

Question 135

12. An infant with severe vomiting since birth. Abdominal X-ray shows double-bubble sign. Pan-systolic murmur is present over the pericardium. What is most helpful in his examination? a) Assessment of vision and hearing. b) Examination of the tone. c) Inspection of the back. d) Palpation of the abdomen.

Answer 135

b) Examination of the tone.

Question 136

13. A 6 years old male infant with Down syndrome is brought by his mother because of prolonged fever. On examination he is found to have an enlarged spleen 5 cm below left costal margin. What is the most appropriate investigation to be ordered? a) Abdominal ultrasound b) Blood culture. c) Complete blood picture d) Echocardiography

Answer 136

c) Complete blood picture

Question 137

14. An infant 2 days old presenting with persistent vomiting. He has dysmorphic features and severe hypotonia. What is the likely diagnosis? a) Congenital myopathy b) Congenital myotonic dystrophy c) Down syndrome d) Werdnig Hoffman disease

Answer 137

c) Down syndrome

Question 138

15. A four - month- old female infant is brought for follow up. On examination she is found to have a systolic murmur on the left side of the chest. The skin on both sides of the neck was unusually redundant. What would you expect to find in the rest of the examination? a) Gynecomastia. b) Hypotonia. c) Simian crease. d) Weak femoral pulse

Answer 138

d) Weak femoral pulse

Question 139

16. A routine prenatal ultrasound reveals a male fetus with meningomyelocele. You counsel her about the etiology of this defect and the risk of recurrence. The correct statement is a) Diagnosis can be made by detection of very low levels of alpha fetoprotein in the amniotic fluid b) Environmental factors will not affect the incidence of the disease. c) Supplementation of maternal diet with folate decreases the incidence of this condition d) This condition is transmitted as autosomal recessive

Answer 139

c) Supplementation of maternal diet with folate decreases the incidence of this condition

Question 140

17. A 5 -year- old girl had surgery for aortic lesion. She is always short for her age. . This case might be a) Down syndrome b) Klinefelter syndrome c) Marfan syndrome d) Turner syndrome

Answer 140

d) Turner syndrome

Question 141

18. The mother of a boy with Duchenne muscular dystrophy tells you that her brother was similarly affected and died in his teenage years. What is the pattern of inheritance in this case a) X linked recessive b) X linked dominant c) Autosomal dominant d) Autosomal recessive

Answer 141

a) X linked recessive

Question 142

19. A 14 -year- old boy was referred because of tall stature. His height was more than the 95th percentile. He had bilateral small testes, no pubic or axillary hair. The cause of such condition is a) Delayed puberty b) Down syndrome c) Klinefelter syndrome d) Marfan syndrome

Answer 142

c) Klinefelter syndrome

Question 143

20. A female infant bom to a 24-year-old woman has been diagnosed clinically as having Down syndrome. The mother is concerned about her risk of having another baby with Down syndrome. The most appropriate investigation to determine the risk of recurrence is a) Determination of serum alpha-fetoprotein in the infant b) Determination of serum alpha-fetoprotein in the mother c) Karyotyping for the infant and mother d) Karyotyping for the infant only

Answer 143

c) Karyotyping for the infant and mother

Question 144

21. A two- day- old male infant is referred to the hospital for bilious vomiting and a heart murmur. The baby was born at 37 weeks gestation to a 39 year old woman who had no prenatal care. X ray chest and abdomen were done. Which of the following is the most likely to be in the x ray? a) Double bubble sign b) Multiple air fluid levels c) Normal X ray d) White lung

Answer 144

a) Double bubble sign

Question 145

22. A 17-year-old girl is 138cm tall. Her father is 175cm tall and her mother is 164cm tall. She has always been short and she had cardiac surgery at the age of 1 year. Her pubertal breast stage is Tanner Bl. Which of the following is most likely to diagnose the cause of all her medical problems? a) Chromosomal analysis b) Serum testosterone levels c) Thyroid function studies d) X-ray for Bone Age

Answer 145

a) Chromosomal analysis

Question 146

23. A disease affecting all of the daughters but none of the sons of an affected father, and 50% of the sons or daughters of an affected mother, is most likely: a) Autosomal dominant b) Autosomal recessive c) X-linked dominant d) X-linked recessive

Answer 146

c) X-linked dominant

Question 147

24. A disease passed only through the mother and affecting both sons and daughters, with variable manifestations in the affected siblings, is most likely: a) Mitochondrial inheritance b) Multifactorial inheritance c) X-linked dominant inheritance d) X-linked recessive inheritance

Answer 147

a) Mitochondrial inheritance

Question 148

,25. Genetic diseases of numerical chromosomal abnormalities include: a) Down syndrome b) Gaucher disease c) Hemophilia d) Thalassemia major

Answer 148

a) Down syndrome

Question 149

26. One of the following anomalies is not associated with Down syndrome: a) Congenital heart disease b) Macroorchidism c) Mental retardation d) Simian crease

Answer 149

b) Macroorchidism

Question 150

27. A patient with 45 XO karyotype and short stature is likely to have: a) Down syndrome b) Edward syndrome c) Klinefelter syndrome d) Turner syndrome

Answer 150

d) Turner syndrome

Question 151

28. Autosomal recessive disorders are characterized by: a) Greater incidence of parental consanguinity b) Greater incidence in males c) No skipping of generations d) No carriers

Answer 151

a) Greater incidence of parental consanguinity

Question 152

29. Characteristic feature of autosomal recessive inheritance is: a) 50% risk of recurrence b) Both parents can be normal c) Male predominance d) Male to male transmission

Answer 152

b) Both parents can be normal

Question 153

30. X-linked recessive inheritance is characterized by: a) All daughters of a carrier mother will be carriers b) Female preference c) The affected father never transmits the disease to his sons d) Vertical transmission

Answer 153

c) The affected father never transmits the disease to his sons

Question 154

31. Ring chromosome is a special type of chromosomal a) Duplication b) Inversion c) Deletion d) Translocation

Answer 154

c) Deletion

Question 155

32. Chromosomal structural abnormalities include: a) Monosomy b) Trisomy c) Non- disjunction d) Translocation

Answer 155

d) Translocation

Question 156

33. Chromosomal numerical abnormalities include: a) Duplication b) Eversion c) Translocation d) Trisomy

Answer 156

d) Trisomy

Question 157

34. Sex linked disorders do not include a) G-6-PD deficiency b) Hairy pinna c) Hemophilia d) Myasthenia gravis

Answer 157

d) Myasthenia gravis

Question 158

35. The following is not a feature in newborn term infant with Down syndrome: a) Brachydactyly b) Clinodactyly c) Hypotonia d) Webbing of the neck

Answer 158

d) Webbing of the neck

Question 159

36. If a parent had hereditary spherocytosis, the chance to have an affected baby is: a) 25%. b) 50% c) 75% d) 100%

Answer 159

b) 50%

Question 160

37. X-linked recessive disorders include: a) Achondroplasia. b) Duchenne muscular dystrophy c) Sickle cell anemia. d) Vitamin-D resistant rickets

Answer 160

b) Duchenne muscular dystrophy

Question 161

38. Autosomal recessive inheritance is found in: a) G-6-PD deficiency. b) Galactosemia. c) Hemophilia-B. d) Neurofibromatosis.

Answer 161

b) Galactosemia.

Question 162

1. A 6-year-old boy is brought to the emergency room with a 3-hour history of fever 39.5C and sore throat. The child appears anxious and toxic. He has mild inspiratory stridor and he is drooling. He is sitting on the examination table leaning forward with his neck extended. Which of the following is the most appropriate immediate management of the patient? a) Place him in a mist tent b) Examine the throat and obtain a culture c) Obtain an arterial blood gas and start an IV line d) Prepare to establish an airway

Answer 162

d) Prepare to establish an airway

Question 163

2. A 9 months old child presents to ER department with croup. On examination he has marked stridor at rest and a barking cough. What should this baby be treated with? a) Intramuscular adrenaline. b) Intravenous antibiotics. c) Nebulized adrenaline and oral dexamethasone. d) Nebulized salbutamol.

Answer 163

c) Nebulized adrenaline and oral dexamethasone.

Question 164

3. A 6y old boy presents to ER with throat tightness, urticarial rash, lip and tongue edema. On examination he has tachycardia, heart rate 200 beats/min, hypotension and wheezy chest. What is the initial lifesaving medication for this child? a) Antihistaminic b) Corticosteroids. c) Fluid bolus. d) IM adrenaline.

Answer 164

d) IM adrenaline.

Question 165

4. You have just given a 10-year-old boy an injection of pollen extract as prescribed by his allergist. The boy starts to complain about nausea and chest tightness. You note that his face is flushed and his voice sounds muffled and strained. Which of the following is the first priority in managing this episode of anaphylaxis? a) Administration of corticosteroids b) Administration of oxygen c) Endotracheal intubation d) IM injection of 1:1000 epinephrine

Answer 165

c) Endotracheal intubation

Question 166

5. Seven years old child presented to ER after a car accident. He was in deep coma with convulsions. His pupils were dilated fixed and non-reactive. He had irregular breathing, bradycardia and hypotension. Initial investigations showed low hemoglobin (5 g /dl). What is the first management step? a) Anticonvulsants b) Blood transfusion c) IV fluids d) Keep clear airway and good ventilation

Answer 166

d) Keep clear airway and good ventilation

Question 167

6. A 5-year-old girl presents to the emergency department with a 12-hour history of fever and respiratory distress. On physical examination, the girl appears toxic, is drooling, and leaning forward with her chin extended. She has a temperature of (40° C) and a respiratory rate of 32 breaths per minute. Which of the following is the most likely diagnosis? a) Anaphylaxis b) Bacterial pneumonia c) Croup d) Epiglottitis

Answer 167

d) Epiglottitis

Question 168

7. You are evaluating a 10-year-old male who was struck by a car. On physical examination, he is breathing spontaneously. There is a large hematoma on his forehead. His eyes open in response to painful stimuli, and his pupils are equal and reactive to light. He vocalizes by incomprehensibly moaning. When you pinch his right arm, he attempts to push your arm away. Which of the following is appropriate to start with? a) Administer supplemental oxygen b) Measuring the pulse and blood pressure c) Transfuse with O negative packed red blood cells d) IV antibiotics

Answer 168

b) Measuring the pulse and blood pressure

Question 169

8. Regarding the previous case, what is this patient’s Glasgow Coma Scale score? a) 7 b) 9 c) 11 d) 13

Answer 169

b) 9

Question 170

9.A 2-month-old baby presented with severe pallor, cold extremities and poor pulses, you suspected hemorrhage. After administration of 02, Which of the following is the most appropriate to give initially? a) Fresh frozen plasma b) Inotropes c) Isotonic crystalloids d) Packed red blood cells transfusion

Answer 170

c) Isotonic crystalloids

Question 171

10. While you are working at a community pediatric clinic, a patient’s mother calls for help from an adjacent examination room. You see a 4-month-old infant lying motionless on the table. He is not breathing spontaneously. He has no pulses. You determine that this unresponsive pulseless child is in cardiopulmonary arrest. Which of the following is the most common cause of pediatric cardiopulmonary arrest? a) Cardiac arrhythmias b) Metabolic abnormalities c) Malignancies d) Respiratory problems

Answer 171

d) Respiratory problems

Question 172

11. 3-month-old female infant presents to your emergency department unresponsive and with fever, tachypnea, bradycardia, and hypotension. What order should you follow in your initial assessment? a) Airway, breathing, circulation, disability, exposure b) Breathing, airway, circulation, disability, exposure c) Circulation, airway, breathing, exposure, disability d) Exposure, breathing, airway, circulation, disability

Answer 172

a) Airway, breathing, circulation, disability, exposure

Question 173

12. A 5-year-old boy presents to the emergency department with complaints of dizziness confusion and ataxia. 3 days before presentation, he developed a low-grade fever, vomiting and diarrhea 8 to 10 loose motions per day. The boy’s mother has been afraid to give him anything but water. Which of the following electrolyte disturbances is likely the cause of the child condition? a) Hyperkalemia b) Hypochloremia c) Hyponatremia d) Metabolic alkalosis

Answer 173

c) Hyponatremia

Question 174

13. A 2-year-old toddler was playing with candies and sweets in a playroom when he developed an attack of wheezing and shortness of breath. The parents brought the child to emergency room. Respiratory rate was 68/min with subcostal retractions, and 02 saturation was 92%. Which of the following is the definitive treatment? a) Arrange for bedside chest x ray b) Arrange for CT chest c) Arrange for urgent bronchoscopy d) Encourage coughing

Answer 174

c) Arrange for urgent bronchoscopy

Question 175

14. You are evaluating a 3-year-old conscious child with palpable central pusses and poor perfusion in the emergency department. Which of the following is the most important first step in the treatment? a) Epinephrine therapy b) Maintaining adequate perfusion by chest compression c) Maintaining the airway and assisted breathing d) Treating precipitating factors as hypoglycemia

Answer 175

c) Maintaining the airway and assisted breathing

Question 176

15. A five-year-old boy was brought to the Emergency room with ongoing convulsions. His mother said that he was playing in the kitchen alone two hours before. On examination he was drowsy, with pin point pupils. What is your first action? a) Give anticonvulsants. b) Give antidote for organophosphorus toxicity. c) Order MRI brain d) Wait to see investigations results.

Answer 176

a) Give anticonvulsants.

Question 177

16. A 5 year old boy presented to the emergency room with impaired level of consciousness and shallow irregular breathing. The PaC02 was 62 mmHg and P02 was 98 mmHg at room temperature. There was a history of blunt trauma to the head since 3 hours. Which of the following disorders the child may have? a) Metabolic acidosis b) Metabolic alkalosis c) Type 1 respiratory failure d) Type 2 respiratory failure

Answer 177

d) Type 2 respiratory failure

Question 178

17. A 3 months old infant presents to emergency department because of increased agitation and restlessness. Auscultation reveals crackles and decreased breath sounds bilaterally. Chest x-ray films show bilateral pneumonia. Arterial blood gas analysis reveals an oxygen tension of 45 mm Hg and a carbon dioxide tension of 65 mmHg. What is the most appropriate next step in management? a) Administer antibiotics. b) Administer oxygen by mask. c) Obtain blood cultures. d) Start assisted ventilation

Answer 178

d) Start assisted ventilation

Question 179

18. Following a motor car accident, a child presents with chest pain and dyspnea. Examination reveals tachypnea, tachycardia, and left-sided thoracic bulge with limitation of movement and absent air entry on the left side. Which of the following is the specific treatment of this condition? a) Bronchoscopy b) Intercostal tube insertion c) conservative management d) Pericardiocentesis

Answer 179

b) Intercostal tube insertion

Question 180

19. A 12-month-old infant received a dose of an intramuscular antibiotic. Few minutes later, he developed respiratory distress, stridor, skin rash, tachycardia and hypotension. Which of the following is the immediately required therapy? a) Intramuscular adrenaline b) Intramuscular antihistaminic c) Intravenous beta blocker d) Intravenous corticosteroid

Answer 180

a) Intramuscular adrenaline

Question 181

20. A 1 -year-old male arrives in the emergency room with a 4-day history of vomiting and fast breathing. On examination; he is cold with delayed capillary refill. His heart rate is 150/minute and respiratory rate 60/minute. On abdominal exam his liver edge is 4 cm below the right subcostal margin. On auscultation, a gallop is heard and coarse lung sounds throughout. Which of the following is the most likely diagnosis? a) Cardiogenic shock b) Hypovolemic shock c) Kinetic shock d) Septic shock

Answer 181

a) Cardiogenic shock

Question 182

21. You are in a pediatric ward when you are called to check a 10-month-old baby girl who was admitted for high grade fever and now she is not responding to voice You find her, poorly perfused with weak pulse, rate of 50/min with no breathing. Which of the following is the best action? a) Attach cardiac and respiratory monitor b) Open the airway by head tilt - chin lift maneuver c) Start chest compression d) Start mouth to mouth breathing

Answer 182

c) Start chest compression

Question 183

22. 2-year-old infant developed noisy breathing on inspiration, marked retractions of the chest wall, flaring of the nostrils, and a barking cough. He had a mild upper respiratory infection for 2 days. Which of the following is the most likely diagnosis? a) Asthma. b) Bronchiolitis c) Epiglottitis. d) Viral croup

Answer 183

d) Viral croup

Question 184

23. A 4-year-old boy was brought to the emergency department following an insect bite. He had tachycardia, tachypnea and hypotension. The most likely cause of his condition is: a) Anaphylactic shock b) Cardiogenic shock c) Hypovolemic shock d) Septic shock

Answer 184

a) Anaphylactic shock

Question 185

24. A 2 year old girl presented with cough, wheezes and shortness of breath. After arrival to hospital, she became more ill with cyanosis and inability to talk. On examination she is lethargic, with marked chest retractions and silent chest Oxygen saturation is 66%.Which in this scenario suggests type two respiratory failure? a) Cyanosis b) Lethargy c) Marked chest retraction d) Inability to talk

Answer 185

b) Lethargy

Question 186

25. A child was brought to the emergency room following a motor car accident. Which of the following is correct regarding the primary survey? a) It is performed after taking history b) It is performed to determine the need for resuscitation c) It is performed after emergency CT scans d) It includes metabolic screening

Answer 186

b) It is performed to determine the need for resuscitation

Question 187

26. An infant, 6 -month- old, was hospitalized with respiratory distress. On auscultation bronchial breathing and crepitations were heard on both sides of the chest Which test can diagnose respiratory failure? a) Complete blood picture b) Arterial blood gases c) Pulmonary functions d) Lung ultrasound

Answer 187

b) Arterial blood gases

Question 188

27. Patient with 02 saturation 84% is a) Mildly hypoxic b) Moderately hypoxic c) Not hypoxic d) Severely hypoxic

Answer 188

d) Severely hypoxic

Question 189

28. Regarding oxygen therapy which of the following is true? a) It is always necessary to start with 02 100% b) Self-inflating bag can deliver oxygen 40% only c) Self-inflating bag can deliver 100%02 % if connected to oxygen reservoir. d) Venturi face mask is not different from simple o2 mask

Answer 189

c) Self-inflating bag can deliver 100%02 % if connected to oxygen reservoir.

Question 190

29. The most important indication of mechanical ventilation in respiratory acidosis is a) Concomitant metabolic acidosis b) Hypoxia that responds to oxygen c) Pco2>75 mm Hg with low pH d) Slowly responsive underlying disease

Answer 190

c) Pco2>75 mm Hg with low pH

Question 191

30. The best fluid bolus given to a child with isolated vomiting and severe dehydration is a) 5% dextrose + half-normal saline b) Half-normal saline c) 4: 1 glucose :saline d) Ringer lactate

Answer 191

d) Ringer lactate

Question 192

31. A one-year-old toddler entered the emergency department with his mother. He was not talking but was normally interactive, had normal skin color but stridor was evident. What problem is present according to the Pediatric Assessment Triangle? a) Cardiopulmonary failure b) Abnormal appearance only c) Abnormal appearance and breathing d) Abnormal breathing only

Answer 192

d) Abnormal breathing only

Question 193

32. Respiratory acidosis occurs in a) Acute renal failure b) Guillain Bare syndrome c) Hypotension d) Severe anemia

Answer 193

b) Guillain Bare syndrome

Question 194

33. The most common cause of hypokalemia in children is a) Alkalemia b) Diabetic ketoacidosis c) Gastroenteritis d) Loop diuretic

Answer 194

c) Gastroenteritis

Question 195

34. Which of the following is not regarded as first therapy of increased intracranial pressure a) Controlled mechanical ventilation b) Head of bed elevation c) Intubation d) Phenobarbitone infusion

Answer 195

d) Phenobarbitone infusion

Question 196

35. Which is false Regarding Glasgow Coma scale in pediatrics? a) In modified type it uses 15 score points b) Score <8 require aggressive management c) Valid as a prognostic scoring system d) Verbal response component has 5 possible points

Answer 196

d) Verbal response component has 5 possible points

Question 197

36. Symptoms of hypovolemic shock don’t include a) Acidosis. a) Cardiac enlargement. b) Tachycardia. c) Low central venous pressure

Answer 197

a) Cardiac enlargement.

Question 198

37. Which of the following is not a sign of increased intracranial pressure (1CP) and impending brain herniation a) Isolated 4th cranial nerve palsy b) Bradycardia c) Pupillary dilation d) Systemic hypertension

Answer 198

a) Isolated 4th cranial nerve palsy

Question 199

38. Septic shock usually shows a combination of hypovolemic and distributive shock in addition to a) Acute respiratory distress syndrome b) Cardiogenic shock c) Disseminated intravascular coagulation d) Obstructive shock

Answer 199

b) Cardiogenic shock

Question 200

39. Normal capillary refill time is: a) 4 seconds b) More than 5 seconds c) Up to 2 seconds d) 3 seconds

Answer 200

c) Up to 2 seconds

Question 201

40. Signs of circulatory failure in a 2 year old include which of the followings: a) Capillary refill time <2 seconds and reduced urine output b) Cold extremities and a capillary refill time of 3 seconds c) Fever >37.5°C d) Pulse rate >150 bpm

Answer 201

d) Pulse rate >150 bpm

Question 202

41. Regarding shock, which of the following is true a) Grade 3 shock is irreversible shock b) Hypotension occurs in grade 1 shock c) Multiple organ system failure is shock grade 4. d) Septic shock is caused mainly by gram negative bacteria.

Answer 202

d) Septic shock is caused mainly by gram negative bacteria.

Question 203

42. Which is true regarding pulse oximetry? a) It can detect hyper oxygenation b) It measures FiO2 c) It measures oxygen pressure d) It measures oxygen saturation

Answer 203

d) It measures oxygen saturation

Question 204

43. Which statement is false a) Blood pressure decrease in early shock b) In distributive shock systemic vascular resistance decreases c) In hypovolemic shock systemic vascular resistance increases d) Increase core -peripheral temperature difference is sign of poor perfusion

Answer 204

a) Blood pressure decrease in early shock

Question 205

44. Complications of oxygen therapy do not include? a. Decreased surfactant production b. Oxygen dependency c. Polycythemia d. Retinopathy of prematurity

Answer 205

c. Polycythemia

Question 206

45. Which of the following is not correct regarding the indications of mechanical ventilation? a. Apnea not responding to simple measures b. HCO3 more than 32 mEq/ L. c. Hypercapnia not responding to simple measures d. Hypoxia not responding to simple measures

Answer 206

b. HCO3 more than 32 mEq/ L.

Question 207

46. Type 1 respiratory failure, which is a false statement? a. Is associated with respiratory distress and cyanosis b. Is due to lung disease c. Mechanical ventilation is always needed d. Pa02 less than 50 mmHg

Answer 207

c. Mechanical ventilation is always needed

Question 208

47. Which is not a common cause of coma in children? a) Diabetic ketoacidosis b) Renal failure c) Severe dehydration d) Vascular strokes

Answer 208

d) Vascular strokes

Question 209

8. Which of the following is false regarding treatment of hyperkalemia? a) Glucose insulin infusion. b) Insulin infusion c) Intravenous calcium d) Sodium bicarbonate

Answer 209

b) Insulin infusion

Question 210

49. In poisoning related coma, which step is not routinely done in all cases? a) Do life support measures when needed b) Give antidote when available c) Induce vomiting in all cases d) Support the failing system(s)

Answer 210

c) Induce vomiting in all cases

Question 211

50. In the management of an unconscious patient, the first thing to do is: a) Chemical analysis of stools. b) Establish airway c) Gastric wash. d) Take a detailed history.

Answer 211

b) Establish airway

Question 212

51. The barking cough typical of croup is rare in a) Acute epiglottitis b) Acute infectious laryngitis c) Laryngotracheobronchitis d) Spasmodic croup

Answer 212

a) Acute epiglottitis

Question 213

52. Advantages of flow-inflating (anesthesia) bags don’t include a) Any leak is determined b) Delivers 100% oxygen at all times c) Easy to use d) Stiff lung can be recognized

Answer 213

c) Easy to use

Question 214

53. Bacterial tracheitis is not characterized by a) Considered a primary bacterial illness b) Incidence and severity do not differ by sex c) More common than epiglottitis in vaccinated populations d) Staphylococcus aureus is the most commonly isolated pathogen

Answer 214

a) Considered a primary bacterial illness

Question 215

54. Which is not a common cause of stridor during infancy ? a) Acute spasmodic laryngitis. b) Hypocalcemic tetany c) Large adenoids d) Laryngeal foreign body.

Answer 215

a) Acute spasmodic laryngitis.

Question 216

55. Which of the following is true regarding stridor? a) Antibiotic is not routinely given to all cases of stridor b) Common causes of stridor in infants are not due to infectious causes c) Most cases of stridor are bacterial in origin d) Steroids are of no role in stridor treatment

Answer 216

a) Antibiotic is not routinely given to all cases of stridor

Question 217

56. Regarding respiratory failure which is true a) Acute metabolic acidosis is the typical finding in type 2 respiratory failure b) Acute respiratory acidosis is the typical finding in type 1 respiratory failure c) Basic defect in type 1 respiratory failure is in CO2 elimination. d) Basic defect in type 2 respiratory failure is in CO2 elimination.

Answer 217

d) Basic defect in type 2 respiratory failure is in CO2 elimination.

Question 218

57. The main steps in the management of coma in children don’t include a. Cardiac decompression b. Check blood sugar c. Keep airway open d. Maintain oxygenation

Answer 218

a. Cardiac decompression

Question 219

58. Which of the following is true about croup? a. Causes harsh inspiratory sound b. Cold air aggravates the condition c. Corticosteroids are contraindicated d. It is due to bacterial infection

Answer 219

a. Causes harsh inspiratory sound

Question 220

59. Regarding stridor which of the following is true? a. Bacterial infection is the most connnon etiology b. Grade one classification is stridor at rest c. Never treated at home d. Warm steam inhalation relieves minor obstruction

Answer 220

d. Warm steam inhalation relieves minor obstruction

Question 221

60. In type 1 respiratory failure which is true? a. Arterial hypoxemia is the basic defect b. Caused by respiratory depression c. Deep coma is an important cause d. Respiration is shallow

Answer 221

a. Arterial hypoxemia is the basic defect

Question 222

61. Oxygen is not likely to improve cyanosis a. Interstitial lung disease b. Intra-cardiac right to left shunt c. Left ventricular failure d. Upper airway obstruction

Answer 222

b. Intra-cardiac right to left shunt

Question 223

62. Acute respiratory insufficiency is often the most prominent clinical manifestation of a) Congenital myotonic dystrophy b) Guillain-Barre syndrome c) Duchenne myopathy d) Spinal muscular atrophy

Answer 223

b) Guillain-Barre syndrome

Question 224

63. Which of the following viruses are most commonly associated with viral croup? a. Adenovirus b. Parainfluenza viruses c. RSV d. Varicella virus

Answer 224

b. Parainfluenza viruses

Question 225

64. Type II respiratory failure is always associated with: a. Metabolic acidosis b. Respiratory acidosis c. Respiratory alkalosis d. Severe hypoxemia

Answer 225

b. Respiratory acidosis

Question 226

65. The below blood gas arterial blood gas report shows: a. Compensatory decrease in bicarbonate b. Mixed metabolic and respiratory acidosis c. Moderate hypoxemia d. Normal ventilation

Answer 226

b. Mixed metabolic and respiratory acidosis

Question 227

66. Venous blood gases can assess a) Ventilation and oxygenation b) Ventilation and acid-base status c) Oxygenation and acid-base status d) Oxygenation, ventilation and acid-base status

Answer 227

b) Ventilation and acid-base status

Question 228

67. Oxygen will improve PaO2 in one of the following conditions: a) Hyaline membrane disease b) Hypoplastic Left \heart syndrome c) Tetralogy of Fallot d) TGA

Answer 228

a) Hyaline membrane disease

Question 229

68. Coma due to a metabolic etiology due to: a. Acute renal failure b. Head trauma c. Hypertensive encephalopathy d. Hypoxia

Answer 229

a. Acute renal failure

Question 230

69. One of the following is a manifestations of hypokalemia: a. Abdominal pain b. Convulsions c. Hyperreflexia d. Muscle weakness

Answer 230

d. Muscle weakness

Question 231

70. Which one of the following arterial blood gas changes would you expect in a patient with a massive pneumothorax? a. High pCO2, high pH and low pO2 b. High pCO2, low pH and low pO2 c. Low pCO2, high pH and high pO2 d. Low pCO2, low pH and low pO2

Answer 231

b. High pCO2, low pH and low pO2

Question 232

71. In coma which of the following is true: a. In deep coma always no spontaneous breathing b. In Glasgow coma score 3 domains are assessed c. In Glasgow coma score the best response takes the lowest score d. In stupor the patient cannot be aroused by painful stimuli

Answer 232

b. In Glasgow coma score 3 domains are assessed

Question 233

1. A 2-year-old child is admitted to your hospital with painful joint swelling. The child's doctor has been following the child for several days before and has noted her to have had high fever, peeling skin, abdominal pain, and a bright red throat. Which one of the following is likely to be the diagnosis? a) Rheumatic arthritis b) Rheumatoid arthritis c) Rubella arthritis d) Septic arthritis

Answer 233

a) Rheumatic arthritis

Question 234

2. A 3 -year- child presents with a 3-day history of malaise, fever 41.1°C, cough, coryza, and conjunctivitis, then develops erythematous maculopapular rash on the face. He is noted to have white pinpoint lesions on a bright red buccal mucosa in the area opposite his lower molars. Which of the following is the most likely diagnosis? a) Measles b) Roseola infantum c) Rubella d) Scarlet fever

Answer 234

a) Measles

Question 235

3. A 12-year-old girl awakens with a mild sore throat, low-grade fever, and a diffuse maculopapular rash. On examination mild tenderness and marked swelling of posterior cervical and occipital lymph nodes was observed. Which of the following may complicate this condition? a) Aplastic crisis b) Encephalitis c) Febrile seizures d) Mastoiditis

Answer 235

b) Encephalitis

Question 236

4. A 14-month-old infant presents with a 4-day- history of high fever without any localizing signs. On the peak of fever, the baby suffers a short convulsive fit and is admitted for observation. On the next day fever subsides, but a maculopapular rash develops over the trunk and abdomen. Which of the following is the most likely diagnosis? a) Measles b) Roseola infantum c) Rubella d) Scarlet fever

Answer 236

b) Roseola infantum

Question 237

5. A 5-year-old child presents with a 2-day- history of high fever, sore throat and abdominal pain. On the next day fever raises up more and a maculopapular rash develops all over the body. Which of the following is the most likely diagnosis? a) Measles b) Roseola infantum c) Rubella d) Scarlet fever

Answer 237

d) Scarlet fever

Question 238

6. A 14-month-old infant presents with a 1 -day- history of low grade fever. On the next day a vesicular rash develops over the trunk and abdomen. The rash is itchy. Which of the following is the most common complication for that disease? a) Encephalitis b) Neuritis c) Skin infections d) Subacute sclerosing panencephalitis

Answer 238

c) Skin infections

Question 239

7. A 14- year-old boy presenting with a 3-week history of fever between 38.3°C and 38.9°C, lethargy. Physical examination reveals marked cervical and inguinal adenopathy, enlarged tonsils with exudates, palpable spleen 2 cm below the left costal margin. Which of the following is the most likely diagnosis? a) Infectious mononucleosis b) Streptococcal throat infection c) Tuberculosis d) Varicella

Answer 239

a) Infectious mononucleosis

Question 240

8. A 2 year- old girl presents with a 24- hour history of being febrile 40°C, looks miserable and has developed a rapidly spreading non blanching rash. She has cool peripheries and is drowsy. Which of the following is the most likely diagnosis? a) Bacteremia b) Scarlet fever c) Septicemia d) Viremia

Answer 240

c) Septicemia

Question 241

9. A previously healthy 8-year-old boy has a 3-week history of low grade fever of unknown source, fatigue, weight loss, myalgia, and headache. On repeated examinations during this time, he is found to have developed a heart murmur, petechiae, and mild splenomegaly. Which of the following is the most likely diagnosis? a) Endocarditis b) Rheumatic fever c) Scarlet fever d) Tuberculosis

Answer 241

a) Endocarditis

Question 242

10.. A 14- year-old boy presenting with a 3-week history of fever between 38.3°C and 38.9°C, lethargy. Physical examination reveals marked cervical and inguinal adenopathy, enlarged tonsils with exudates, palpable spleen 2 cm below the left costal margin. WBC differential has 50% lymphocytes (10% atypical). Which of the following is the diagnostic investigation? a) ESR and CRP b) Lymph node biopsy c) Throat culture d) Viral capsid antigen antibodies (VCA) IgG and IgM

Answer 242

d) Viral capsid antigen antibodies (VCA) IgG and IgM

Question 243

11. A 14-month-old infant suddenly develops a fever of 40.2°C .No physical abnormalities are noted. The white blood cell count is 22.000/uL with 78% polymorphonuclear leukocytes, 18% of which are band forms. Which of the following is most likely diagnosis? a) Pneumococcal bacteremia b) Roseola c) Streptococcal infection d) Typhoid fever

Answer 243

a) Pneumococcal bacteremia

Question 244

12. A 3 year- old child presents with a 3-day history of malaise, fever 41.1 °C, cough, coryza, and conjunctivitis, then develops erythematous, maculopapular rash on the face. He is noted to have white pinpoint lesions on a bright red buccal mucosa in the area opposite his lower molars. Which of the following is the most likely diagnosis? a) Measles b) Roseola infantum c) Rubella d) Scarlet fever

Answer 244

a) Measles

Question 245

13. A 12-year-old girl awakens with a mild sore throat, low-grade fever, and a diffuse maculopapular rash. During the next 24h, 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. Which of the following is the most likely diagnosis? a) Measles b) Roseola infantum c) Rubella d) Scarlet fever

Answer 245

c) Rubella

Question 246

14. A 4-year-old child presents in the clinic with mild fever and swelling in front of and in back of the ear on the affected side, as well as altered taste sensation. Correct statements about this condition include which of the following? a) Arthritis is a common presenting complaint in children b) Involvement of the CNS may occur 10 days after the resolution of the swelling c) Orchitis can occur and is almost exclusively seen in prepubertal males d) The disease could have been prevented by prior immunization with killed whole-cell vaccine

Answer 246

b) Involvement of the CNS may occur 10 days after the resolution of the swelling

Question 247

15. A 14-month-old infant presents with a 4-day- history of high fever without any localizing signs. On the next day fever subsides, but a maculopapular rash develops over the trunk and abdomen. Which of the following is the most likely diagnosis? a) Measles b) Roseola infantum c) Rubella d) Scarlet fever

Answer 247

b) Roseola infantum

Question 248

16. 5-year-old child presents with a 2-day- history of high fever, sore throat and abdominal pain. On the next day fever rises up more and a maculopapular rash develops all over the body. Which of the following is the most likely diagnosis? a) Measles b) Roseola infantum c) Rubella d) Scarlet fever

Answer 248

d) Scarlet fever

Question 249

17. A 4-year-old child presented with a painful swelling in front of and in back of the left ear, analgesics were prescribed with some improvement. 2 days after, the child had headache, vomiting and then convulsions. Which of the following is the most likely diagnosis? a) Brain abscess as a complication of mastoiditis b) Febrile convulsions c) Meningitis d) Mumps encephalitis

Answer 249

d) Mumps encephalitis

Question 250

18. A 5- day-old baby presenting to the emergency department with generalized tonic convulsions and failure to suckle. Examination reveals dirty inflamed umbilical stump, umbilical swab is performed reveals a gram positive organism with tennis racket appearance. What should be to done to prevent this condition? a) DPT vaccine to the baby at birth b) DPT vaccine to the mother during pregnancy c) DT vaccine to the baby at birth d) Tetanus toxoid to the mother during pregnancy

Answer 250

d) Tetanus toxoid to the mother during pregnancy

Question 251

19. A 4-year-old child presented with a painful swelling in front and behind the ears, analgesics were prescribed with complete improvement. 10 days after, the child had severe abdominal pain and vomiting. Examination reveals diffuse abdominal tenderness without organomegaly. Which of the following is the most likely diagnosis? a) Acute appendicitis b) Acute intestinal obstruction. c) Brain abscess as a complication of mastoiditis d) Mumps pancreatitis

Answer 251

d) Mumps pancreatitis

Question 252

20. A 3-year-old child presented with high fever and a painful swelling in front and behind the right ear. Examination reveals temperature 39.5, toxic ill child and severe tenderness over the swelling. Pressure on the swelling results in white discharge from the parotid duct. Which of the following is the most likely diagnosis? a) Dental abscess b) Mumps parotitis c) Suppurative parotitis d) Parotid stones

Answer 252

c) Suppurative parotitis

Question 253

21. A 15 month old boy is brought by his mother with fever for 24 hours which doesn't decrease with acetaminophen. His temperature is 3^.8 C degrees. Despite the fever he has been playing with his toys but has refused solid foods. Blood picture reveals leucocytosis 12,000 mostly lymphocyte band cell ratio 6% with normal ESR. Which of the following is most likely the initial diagnosis? a) Bacteremia b) Viremia c) Septicemia d) All of the above

Answer 253

b) Viremia

Question 254

22. A 20 -month- old child is brought to emergency department because of fever and irritability and refusal to move his right lower limb. Physical examination reveals a swollen and tender right knee that resists passive motion. Which of the following is the most important test to confirm the possibility of septic arthritis? a) Complete blood count and differentia b) ESR c) Examination of joint fluid d) X ray of the knee

Answer 254

c) Examination of joint fluid

Question 255

23. A 9-month-old girl presents with a 3-day history of fever to (39.4° C). This morning, the girl developed a rash. On physical examination, the girl is afebrile and has an erythematous, maculopapular rash over her trunk, arms, and legs. Which of the following is the most likely cause of this patient’s illness? a) Chickenpox b) Human herpesvirus 6 c) Human parvovirus B19 d) Measles

Answer 255

b) Human herpesvirus 6

Question 256

24. An 8-year-old boy presents to your office with a 3-day history of fevers, sore throat, and headache. His mother also states that he occasionally has been complaining that his abdomen hurts. This morning, the boy’s mother noticed that he has developed a red, bumpy rash on his neck and under his arms. On physical exam, his tonsils are erythematous and enlarged. Which of the following is the most likely diagnosis? a) Measles b) Roseola infantum c) Rubella d) Scarlet fever

Answer 256

d) Scarlet fever

Question 257

25. Crops of papular lesions starting on the trunk and spreading to the extremities, in addition to small, irregular red spots with central gray or bluish-white spots that appear on the buccal mucosa were observed in a 5 year old child. Which of the following is most likely diagnosis? a) Hand-foot-mouth disease b) Measles c) Rubella d) Zoster (shingles)

Answer 257

b) Measles

Question 258

26. 6-year-old boy is brought to the pediatrician because of a 3 day history of skin lesions. On physical examination, he has multiple yellow, ciusted erosions below the nares and on the cheeks, chin, and upper extremities. Vital signs are within normal limits. The rest of the examination is normal. Which of the following is the most likely diagnosis? a) Impetigo contagiosa b) Measles c) Rubella d) Zoster (shingles)

Answer 258

a) Impetigo contagiosa

Question 259

27. 12 years old boy develops an abrasion while playing in the school yard. Vaccination record reveals that his last booster was at 6 years, in this situation, which of the following is appropriate? a) DPT booster dose b) No immunization is required c) Tetanus toxoids d) Tetanus toxoids and tetanus immunoglobulin

Answer 259

c) Tetanus toxoids

Question 260

28. A family arrives to your clinic for their 11 month- baby who received obligatory vaccines only. They are wondering about non-compulsory vaccines. Which of the following is correct? a) Chickenpox vaccine is given below 1 year. b) DT vaccine cannot be given in children above 6 years c) Haemophilus influenza type b vaccine is best given early in life at 2, 4, 6 month. However it can be given to their baby d) Meningococcal vaccine is ineffective above 2 years.

Answer 260

c) Haemophilus influenza type b vaccine is best given early in life at 2, 4, 6 month. However it can be given to their baby

Question 261

29. The mother of a 7 day old infant has developed chickenpox. Which of the following is the most appropriate step in the management? a) Administer acyclovir b) Administer varicella-zoster immunoglobulin to the infant c) Hospitalize the infant in the isolation ward d) Isolate the infant from the mother

Answer 261

b) Administer varicella-zoster immunoglobulin to the infant

Question 262

30. You have examined a 16-year-old boy and you are suspecting that he has got infectious mononucleosis caused by EBV. The following are the tests available in your hospital lab, how would you confirm your suspicion? a) Blood fdm for atypical cells b) EBV nuclear antigen (EBNA) IgG c) EBV viral capsid antigen (VGA) IgG d) EBV viral capsid antigen (VCA) IgM

Answer 262

d) EBV viral capsid antigen (VCA) IgM

Question 263

31. A seven-month-old infant comes for check-up. You discover that he received vaccination at birth and at 2 months’ old only; and did not receive vaccinations since then. What is the suitable approach? a) Do not give any vaccines as the parents are non-compliant b) Give both doses of 4 and 6-months’ vaccination simultaneously c) Give the 4 months’ vaccination and schedule the 6 months’ vaccination after 1- 2 months d) Give the 4 months’ vaccination only and ignore the 6 months’ vaccination as it will be so much delayed

Answer 263

c) Give the 4 months’ vaccination and schedule the 6 months’ vaccination after 1- 2 months

Question 264

32. A 10-year old child is being referred to you to assess the need for vaccination, following an emergency splenectomy done after a road traffic accident. You discuss with the parents his past vaccinations & the necessity to receive some vaccines. Which of the following vaccines is mandatory t0 protect the child following splenectomy? a) Haemophilus influenzae serotype b (Hib) b) Hepatitis B vaccine c) Pertussis d) Tetanus toxoid

Answer 264

a) Haemophilus influenzae serotype b (Hib)

Question 265

33. Two brothers coming to the ER with sudden onset of high-grade fever, coryza and scattered itchy papular rash on his back and trunk. They were prescribed antibiotics and antipyretics. Two days later, they came with scattered vesicular rash all over their bodies. What is your diagnosis? a) Cytomegalovirus b) Epstein bar virus c) Herpes Simplex virus d) Varicella-zoster virus

Answer 265

d) Varicella-zoster virus

Question 266

35. The final dose of rotavirus vaccine must be administered no later than a) 6 month of age b) 8 month of age c) 10 month of age d) 12 month of age

Answer 266

b) 8 month of age

Question 267

36. Scarlet fever is an upper respiratory tract infection associated with a characteristic rash. Which of the following, statements is true? a) Before desquamation, the reddened papillae are prominent, giving the tongue a strawberry appearance b) It is caused by an infection with pyrogenic endotoxin producing group A Streptococcus c) The milder form can be confused with Kawasaki disease d) The rash begins to fade after 1-2 weeks

Answer 267

c) The milder form can be confused with Kawasaki disease

Question 268

37. Regarding measles, which statement is false? a) Incubation period is 8-12 days b) Koplik spots have been reported in 50-70% of measles cases c) The rash begins on the forehead, behind the ears, and on the upper neck d) The rash fades over about 3 days in the same progression as it evolved

Answer 268

d) The rash fades over about 3 days in the same progression as it evolved

Question 269

38. The most common finding among infants with congenital rubella syndrome is a) Cataracts b) Deafness c) Neonatal purpura d) Patent ductus arteriosus

Answer 269

b) Deafness

Question 270

39. Mumps is characterized by a) A morbilliform rash is rarely seen b) Incubation period ranges from 7-11 days c) Pale opening of the Stensen duct d) Unilateral parotitis rarely becomes bilateral

Answer 270

a) A morbilliform rash is rarely seen

Question 271

40. The most common complication of mumps is a) Conjunctivitis b) Aseptic meningitis c) Optic neuritis d) Thrombocytopenia

Answer 271

b) Aseptic meningitis

Question 272

41. CNS involvement in mumps is characterized by : a) Encephalitis most commonly manifests 2-10 days after the parotits b) CNS symptoms usually resolve in 3 days c) CSF protein content is usually elevated d) Facial palsy is a less-common CNS complication

Answer 272

d) Facial palsy is a less-common CNS complication

Question 273

42. The most common cause of recurrent aseptic meningitis is a) Mumps b) Adenoviruses c) HSV d) Influenza virus

Answer 273

c) HSV

Question 274

43. Regarding Varicella, which of the following is true a) It usually begins 4-6 days after exposure b) Subclinical varicella is common c) Mild abdominal pain may occur 24-48 hours before the rash appears d) Lesions often appear first on the extremities

Answer 274

c) Mild abdominal pain may occur 24-48 hours before the rash appears

Question 275

44. Infectious mononucleosis is not characterized by a) Aplastic anemia b) Convulsions. c) Elevated liver enzymes. d) Generalized lymphadenopathy and splenomegaly.

Answer 275

b) Convulsions.

Question 276

45. Complications of Measles do not include a) Congenital anomalies. b) Encephalitis. c) Myocarditis. d) Subacute sclerosing panencephalitis.

Answer 276

a) Congenital anomalies.

Question 277

46. One of the following is not a live vaccine a) BCG. b) MMR. c) Pneumococcal. d) Sabin.

Answer 277

c) Pneumococcal.

Question 278

47. About Rota virus vaccine: a) It is a trivalent vaccine. b) It is given subcutaneous. c) The first dose is given at the age of 4 months. d) Vaccination should be completed before 8 months of age

Answer 278

d) Vaccination should be completed before 8 months of age

Question 279

48. Causes of maculopapular rash don’t include . a) German measles b) Herpes simplex c) Roseola infantum d) Scarlet fever

Answer 279

b) Herpes simplex

Question 280

49. The following infection has an incubation period of less than 1 week: a) Mumps. b) Rubella. c) Scarlet fever. d) Varicella.

Answer 280

c) Scarlet fever.

Question 281

50. Regarding measles: which of the following is true? a) The most common complication is otitis media b) The rash starts in the creases c) The rash starts on the chest and abdomen. d) Transmission is via the fecal-oral route.

Answer 281

a) The most common complication is otitis media

Question 282

51. Regarding measles: which of the following is false? a) Fever rises as rash appears b) Koplik spots is late sign c) The rash starts on face. d) Vitamin A may be of value in the treatment.

Answer 282

b) Koplik spots is late sign

Question 283

52. Which is not a complication of measles ? a) Appendicitis b) Encephalitis c) Erythema nodosum d) Gastroenteritis

Answer 283

c) Erythema nodosum

Question 284

53 The incubation period of rubella is: a) 3-5 days. b) 2-3 weeks. c) 4 weeks. d) 4 weeks

Answer 284

b) 2-3 weeks.

Question 285

54. Regarding Rubella, infection which is true: a) Causes a severe systemic manifestation b) Causes tender enlargement of occipital lymph nodes c) Incubation period is 10 days d) Rash duration is longer than that of measles

Answer 285

b) Causes tender enlargement of occipital lymph nodes

Question 286

55. Rubella is not characterized by : a) Highly contagious by droplet infection. b) Koplik spots c) Rash starts on face. d) Retro-auricular and posterior cervical adenitis.

Answer 286

b) Koplik spots

Question 287

56. The infectious agent in Roseola infantum is : a) Herpes simplex Type 1. b) Herpes simplex type II. c) Human herpes virus type 1. d) Human herpes virus type 6

Answer 287

d) Human herpes virus type 6

Question 288

57. Roseola infantum differs from German measles in: a) Degree and duration of fever preceding the rash. b) Peripheral WBC count. c) Presence of lymphadenopathy. d) Type of the rash.

Answer 288

a) Degree and duration of fever preceding the rash.

Question 289

58. Which of the following is not characteristic for infectious mononucleosis? a) Atypical lymphocytosis. b) Cervical adenopathy c) Pancreatitis d) Tonsillar exudates and sore throat.

Answer 289

c) Pancreatitis

Question 290

59. A child developed acute rheumatic fever. He has recently recovered from fever with rash. Most probably the rash was due to: a) Chickenpox. b) German measles c) Roseola infantum. d) Scarlet fever.

Answer 290

d) Scarlet fever.

Question 291

60. A false statement regarding scarlet fever is a) Acute onset of high fever, chills, headache, and pharyngitis. b) Fine vesiculo-papular rash appears 24 hours after fever. c) Desquamation of the skin occurs by end of 1st week. d) Acute post -streptococcal glomerulonephritis may occur

Answer 291

b) Fine vesiculo-papular rash appears 24 hours after fever.

Question 292

61. Regarding vesicular rash which is true a) Herpes simplex rash occurs in the trunk. b) Herpes zoster rash occurs at the angle of the mouth. c) Papular urticaria rash may be recurrent d) Varicella rash is not itchy

Answer 292

c) Papular urticaria rash may be recurrent

Question 293

62. About Varicella, which statement is false? a) Cerebellar ataxia may be a complication. b) Infectivity starts 24 hours before rash appears. c) Prodromal stage may pass unnoticed.. d) The rash does not affect the mucous membranes.

Answer 293

d) The rash does not affect the mucous membranes.

Question 294

63. Which of the following is true regarding chickenpox? a) Characteristically, the rash is more on the limbs. b) Has an incubation period of 7 to 14 days. c) Is caused by the varicella-zoster virus. d) Is treated by oral antibacterial drugs

Answer 294

c) Is caused by the varicella-zoster virus.

Question 295

64. Which is not a complication of varicella? a) Encephalitis. b) Hemorrhagic vesicles. c) Orchitis. d) Pneumonia.

Answer 295

c) Orchitis.

Question 296

63. Chicken pox is not characterized by a) Incubation period is 2-3 weeks. b) Pleomorphic rash. c) Rash is never itchy. d) Short Prodroma.

Answer 296

c) Rash is never itchy.

Question 297

66. The incubation period of chickenpox is usually about a) 2 days. b) Less than 1 week. c) 1-2 weeks. d) 2-3 weeks.

Answer 297

d) 2-3 weeks.

Question 298

67. Which of the following statements about mumps is a false one? a) Incubation period is 2-5 days. b) Orchitis occurs in adolescent patients. c) Parotids are the most commonly involved salivary glands. d) Serum amylase is usually elevated.

Answer 298

a) Incubation period is 2-5 days.

Question 299

68. Mumps is not characterized by a) Unilateral parotid involvement is more frequent than bilateral affection. b) Orchitis is usually more common after puberty. c) Bronchopneumonia is a common complication. d) Deafness is a rare complication

Answer 299

c) Bronchopneumonia is a common complication.

Question 300

69. The incubation period of mumps virus infection is: a) 12 hours. b) 2-3 days. c) 2-3 weeks. d) One month.

Answer 300

c) 2-3 weeks.

Question 301

70. Which statement is false about tetanus? a) Carpopedal spasm is characteristic early in the disease. b) Is caused by Gram positive, anaerobic, spore forming bacilli.. c) Non-immune pregnant mothers should be vaccinated. d) The most common site of infection in the ne wborn is the umbilicus.

Answer 301

a) Carpopedal spasm is characteristic early in the disease.

Question 302

71. About fever which is true a) Empirical antibiotics should be given in every case with prolonged fever. b) Investigations of prolonged fever may include bone marrow examination c) Prolonged fever is fever lasting for more than 4 days d) Septicemia can be managed at home

Answer 302

b) Investigations of prolonged fever may include bone marrow examination

Question 303

72. Which of the following is a true statement? a) BCG vaccine is indicated in children with proven immune deficiency. b) Hepatitis A is recommended after the 1st year of life c) Hepatitis B vaccines need cold chain system. d) MMR vaccine is a heat killed vaccine given at 9 months.

Answer 303

b) Hepatitis A is recommended after the 1st year of life

Question 304

73. True statement regarding contraindication to vaccination is: a) DPT vaccine can be given in a child with cerebral palsy. b) German measles vaccine is contraindicated during pregnancy. c) Measles vaccine is contraindicated during a measles epidemic. d) Pneumococcal vaccine is contraindicated in sickle cell disease.

Answer 304

b) German measles vaccine is contraindicated during pregnancy.

Question 305

74. A false statement regarding contraindication to vaccination is: a) DPT should not be given to febrile infants. b) MMR vaccine is contraindicated in patients under steroid therapy. c) Oral polio vaccine is contraindicated in immunodeficiency d) Tetanus vaccine is contraindicated during pregnancy.

Answer 305

d) Tetanus vaccine is contraindicated during pregnancy.

Question 306

75. Vaccination with BCG characteristically produces a papule approximately a) 1 week after vaccination b) 2 weeks after vaccination c) 3 weeks after vaccination d) 6 weeks after vaccination

Answer 306

d) 6 weeks after vaccination

Question 307

76. Which is not a red flag feature suggesting serious illness in a feverish child? a) Pale and mottled skin b) Pulsating anterior fontanel c) Reduced level of consciousness d) Significant respiratory distress

Answer 307

b) Pulsating anterior fontanel

Question 308

77. Which of the following is a non-compulsory vaccine? a) Poliovirus vaccine b) Pneumococcal vaccine c) BCG vaccine d) Hepatitis B vaccine

Answer 308

b) Pneumococcal vaccine

Question 309

78. Contraindications to vaccination don’t include a) Patient on high dose steroids b) Patient on iron therapy c) Patient with high fever d) Severe combined immunodeficiency

Answer 309

b) Patient on iron therapy

Question 310

79 Meningococcal vaccine is: a) A capsular polysaccharide b) Dose is 1 ml c) Given by IM injection d) Given within the first year

Answer 310

a) A capsular polysaccharide

Question 311

80 Which one of the following statements about rabies vaccine is correct? a) Given immediately post exposure b) Given in 4 doses c) Given subcutaneous d) Inactivated

Answer 311

a) Given immediately post exposure

Question 312

81 Which of the following statements about roseola infantum is correct? a) Characterized by sudden onset of high fever b) The fever persists after the maculopapular rash appears c) The diagnosis can be confirmed by sputum culture d) The incubation period is 4 weeks

Answer 312

a) Characterized by sudden onset of high fever

Question 313

82 Which one of the following statements about DPT vaccine is correct? a) It can be given after the age of 6 years b) It can be given in febrile states c) It contains toxoid and live attenuated vaccine d) Mild fever may occur within 12-24 hours

Answer 313

d) Mild fever may occur within 12-24 hours

Question 314

83 Which of the following is not a complication of mumps? a) Orchitis b) Pancreatitis c) Sensorineural deafness d) Septic meningitis

Answer 314

d) Septic meningitis

Question 315

84 Which disease cannot be prevented by vaccination ? a) Poliomyelitis b) Staphylococosis c) Tetanus d) Viral B hepatitis

Answer 315

b) Staphylococosis

Question 316

85 Contraindications to vaccination don’t include a) Patient on antibiotics b) Patient on high dose steroids c) Patient with high fever d) Severe combined immunodeficiency

Answer 316

a) Patient on antibiotics

Question 317

86 5-in-l (pentavalent) infant vaccine protects against: a) Diphtheria, pertussis, polio, rotavirus and Hib b) Diphtheria, tetanus, pertussis, hepatitis B and Hib c) Meningococcus, diphtheria, pertussis, polio and Hib d) Pneumococcus, pertussis, polio, diphtheria and Hib

Answer 317

b) Diphtheria, tetanus, pertussis, hepatitis B and Hib

Question 318

87 Which one of the following statements about the MMR vaccine is correct? a) Convulsions are rare but serious side effects b) MMR is a live attenuated vaccine c) MMR protects against measles, meningococcus and rubella d) The MMR booster is given to immunocompromised children

Answer 318

b) MMR is a live attenuated vaccine

Question 319

88 Which one of the following statements about the immunization schedule is correct? a) BCG can be given after the first year without precautions b) Fever, swelling at the injection site and irritability are signs of anaphylaxis and the child should not be given the vaccine again c) If a child misses an immunization, the course should be restarted according to the schedule d) Presence of moderate or severe acute illness is a precaution to administration of all vaccines

Answer 319

c) If a child misses an immunization, the course should be restarted according to the schedule

Question 320

1. A 2-hour-old full-term neonate is noted by the nurses to have episodes of cyanosis. When they try to feed him, his oxygen level drops to 60%. But when he is stimulated and cries, his oxygen levels increases above 90%. Which of the following should be done to diagnose this case? a) Bronchoscopic evaluation of palate and larynx. b) Echocardiogram c) Hemoglobin electrophoresis d) Passage of catheter into nose

Answer 320

d) Passage of catheter into nose

Question 321

2. A full-term male infant is delivered by an emergency caesarean section for fetal distress. At birth, the boy is limp, cyanotic, and has no respiratory effort. He is dried, suctioned, and stimulated. However, no clinical improvement is noted. His heart rate is 60/minute. Which of the following is the most appropriate next step? a) Bag-and-mask ventilation b) Chest compression c) Endotracheal intubation d) Free-flow oxygen

Answer 321

a) Bag-and-mask ventilation

Question 322

3. A 7-day-old term female infant presented to the outpatient clinic for routine checkup. Mother stated that her daughter was not breast feeding adequately. Her present weight is 3.2 kg while her birth weight was 3.4 kg. Physical examination was unremarkable. Which of the following is the next step in the management? a) Give high caloric formula b) Reassurance and continue breast feeding c) Start bottle feeding d) Start IV hydration

Answer 322

b) Reassurance and continue breast feeding

Question 323

4. A newborn has hepatosplenomegaly, purpuric rash, jaundice, thrombocytopenia, and microcephaly. Computed tomography of the head showed cerebral calcifications. Which of the following is the most diagnostic test for this case? a) Abdominal Ultrasound b) CBC, CRP c) Organic acids in urine d) TORCH Screen

Answer 323

d) TORCH Screen

Question 324

5. A full term male baby with birth weight of 4.7 kg is bom by elective caesarean section. His mother has uncontrolled diabetes mellitus. Which of the following should be done in the initial management of this case? a) Call the laboratory to collect a PKU screening test b) Check the baby’s serum glucose level c) Clean the umbilical cord with Betadine to prevent infection d) Order an urgent echo to exclude congenital heart disease

Answer 324

b) Check the baby’s serum glucose level

Question 325

6. A male full term baby delivered vaginally is noted to be jaundiced at 20 hours, requiring intensive phototherapy. Maternal blood group is B positive while his blood group is O positive. On examination he is jaundiced, pale but is alert and active. Which of the following is the most likely cause of jaundice in this baby? a) ABO incompatibility b) Breast milk jaundice c) G6PD deficiency d) Physiological jaundice

Answer 325

c) G6PD deficiency

Question 326

7. A 2.5kg male neonate presents with respiratory distress at 18 hours after birth. Pregnancy was uncomplicated but the mother had premature rupture of membranes for 20 hours before labor and did not receive parenteral antibiotics. The baby required intubation and mechanical ventilation. What is the most probable cause for respiratory distress in this neonate? a) Pneumothorax b) Early onset sepsis c) Transient tachypnea of newborn d) Meconium aspiration

Answer 326

b) Early onset sepsis

Question 327

8. During resuscitation of an asphyxiated newborn by positive pressure ventilation via endotracheal intubation and chest compression, the heart rate increased to 80 bpm. What is the most appropriate next step in management? a) Discontinue both chest compression and positive pressure ventilation b) Discontinue chest compression c) Discontinue positive pressure ventilation d) Remove the ETT

Answer 327

b) Discontinue chest compression

Question 328

9. You are attending the emergency delivery by cesarean section. The gestation was complicated by hypertension. At birth, the baby has poor tone and minimal respiratory effort. Which is the initial management in this baby? a) Begin tactile stimulation and provide free flow oxygen supplementation b) Warm, dry, stimulate, positioning ± suction c) Initiate bag-mask ventilation d) Insert an umbilical catheter and administer naloxone

Answer 328

b) Warm, dry, stimulate, positioning ± suction

Question 329

10. A term infant is placed under a radiant wanner, the skin is dried. After tactile stimulation, there is minimal respiratory effort, dusky color, and a heart rate of 86 beats/min. Bag and mask ventilation is performed for 30 seconds starting by 21% oxygen at a rate of 40 breaths/min. The heart rate increases to 100 beats/minute .What should be the next step? a) Administer sodium bicarbonate b) Continue bag/mask ventilation at a rate of 20 to 40 breaths/min c) Continue ventilation and begin chest compressions d) Observe for spontaneous respiration and withdraw PPV gradually

Answer 329

d) Observe for spontaneous respiration and withdraw PPV gradually

Question 330

11. During delivery of a 42 weeks gestational age baby, the amniotic fluid contains thick particles of meconium. The most important initial step in resuscitation of the infant is to? a) Aspirate the gastric contents b) Initiate endotracheal intubation c) Provide positive pressure ventilation d) warm, dry, stimulate, positioning ± suction

Answer 330

d) warm, dry, stimulate, positioning ± suction

Question 331

12. A full term male baby was bom at 37 week gestation by cesarean section. At one minute postnatal, the neonate had no spontaneous respiration, a heart rate of 80, had some flexion of extremities with acrocyanosis and no reflex irritability. His one minute Apgar will be? a) 0 b) 1 c) 3 d) 5

Answer 331

c) 3

Question 332

13. The most appropriate next step in managing a neonate 37 w, after warming, drying, stimulation and positioning yet no spontaneous respiration and HR 80? a) Chest compression b) IV epinephrine c) Positive pressure ventilation d) Umbilical line placement

Answer 332

c) Positive pressure ventilation

Question 333

14. During active labor, meconium staining of the amniotic fluid is noticed. Initial steps in the management of this newborn should include? a) Intubate the trachea and suction b) Stimulate and initiate positive pressure ventilation c) Suction the oropharynx if needed d) Umbilical line placement

Answer 333

c) Suction the oropharynx if needed

Question 334

15. A full-term neonate in resuscitation is dried, suctioned, and stimulated. The initial heart rate is less than 100/m and positive pressure ventilation is delivered with bag mask ventilation for 30 seconds, however his heart rate remains less than 100/m. Which of the following does not contribute to the worsening of the baby's condition? a) Anatomic obstruction b) Mask is not held tightly on face c) Excessive neck flexion d) Head in midline position

Answer 334

d) Head in midline position

Question 335

16. The infant of a 35-year-old female is seen with severe anemia. There is history of profuse vaginal bleeding during pregnancy. Physical examination reveals a pale, limp shocked infant. Which volume expander from the following is not suitable to resuscitate this case? a) 0.9% sodium chloride b) 10% dextrose solution c) O-negative blood d) Residual placental blood

Answer 335

b) 10% dextrose solution

Question 336

17. A full-term neonate is delivered by emergency cesarean section .After 30 seconds of effective PPV then 60 seconds of co-ordinated chest compression; his heart rate is still less than 60/m. The most appropriate next step is? a) Administer epinephrine and continue chest compressions b) Continue positive pressure ventilation c) Continue chest compressions d) Observation

Answer 336

a) Administer epinephrine and continue chest compressions

Question 337

18. A 5 day-old infant presents with large pale blue lesions over the buttocks. The lesion is not warm or raised. The mother denies trauma and reports that it has been present since birth. The most appropriate action is? a) Check platelets count b) Give plasma infusion c) Give vitamin K d) Reassurance

Answer 337

d) Reassurance

Question 338

19. The most likely diagnosis for the condition in the previous question is? a) Hemorrhagic disease of the newborn b) Hemophilia c) Mongolian spots d) Neonatal purpura

Answer 338

c) Mongolian spots

Question 339

20. A 3 day old girl presents with enlargement of both breasts, there is no tenderness or hotness. The most likely diagnosis is? a) Mastitis b) Neonatal gynecomastia c) Precocious puberty d) Premature thelarche

Answer 339

b) Neonatal gynecomastia

Question 340

21. A 3-day- old girl is brought to her pediatrician. The mother states that while she is changing the diaper of her baby, she noticed a blood tinged mucous discharge. The most appropriate action is? a) Ask for history of trauma or sexual abuse b) Coagulation profile c) Complete blood picture d) Reassurance

Answer 340

d) Reassurance

Question 341

22. A foil term newborn baby was delivered by normal vaginal delivery .On examination; this baby had a diffuse edematous swelling of the soft tissues of the scalp extending across the suture lines. The most likely diagnosis is? a) Caput succedaneum b) Cephalhematoma c) Moulding d) Subdural hematoma

Answer 341

a) Caput succedaneum

Question 342

23. An 18-year-old female at 33 weeks gestation with pre-eclampsia, delivered a baby whose birth weight is 1450 g (<10th percentile), crown-heel length is 38 cm (10th percentile), and head circumference is 30 cm (50th percentile).The most likely complication in this infant is? a) Neonatal pneumonia b) Hyperglycemia c) Meconium aspiration d) Perinatal asphyxia

Answer 342

d) Perinatal asphyxia

Question 343

24. A male infant is born at an estimated gestational age of 35 weeks. His measurements at birth are: weight, 1,200 g (less than 10th percentile); crown-heel length, 45 cm (50th percentile); and head circumference, 31.5 cm (50th percentile). From the following, the most likely explanation for the growth pattern of this infant is? a) Chromosomal abnormality b) Congenital viral infection c) Gestational diabetes d) Pregnancy-induced hypertension

Answer 343

d) Pregnancy-induced hypertension

Question 344

25. A 4.3 kg infant is delivered to a woman whose diabetes mellitus is poorly controlled. Of the following, the most likely neonatal complication of maternal diabetes is? a) Diabetic ketoacidosis b) Hirschsprung disease c) Hypercalcemia d) Polycythemia

Answer 344

d) Polycythemia

Question 345

26. A 3-day-old infant presenting with jaundice, the baby's direct serum bilirubin is 0.2 mg/dl, with a total serum bilirubin of 11.8 mg/dl. Both the mother and baby have O- positive group, the infant's white cell count is 13.000/uL with normal differential count the hemoglobin is 15 g/dl, and the platelet count is 278.000/U1. Reticulocyte count is 1.5%. Which of the following is the most likely cause? a) Biliary atresia b) Congenital spherocytic anemia c) Physiologic jaundice d) Rh or ABO hemolytic disease

Answer 345

c) Physiologic jaundice

Question 346

27. A 3-week-old infant breast fed, developed jaundice, first noticed 12 days ago. On examination, he is active with good sulking. Total bilirubin: 8 mg/dl; direct bilirubin, 4.5 mg/dl. The most likely diagnosis is? a) Biliary atresia b) Breast milk jaundice c) Congenital hypothyroidism d) Sepsis

Answer 346

a) Biliary atresia

Question 347

28. A well, breast-fed term infant presented with jaundice at 36 hours of age. The total serum bilirubin was 20 mg/dl, direct bilirubin 0.9 mg/dl direct. Blood film showed reticulocytes 6%. The baby's blood group was A rhesus negative and mother's blood group O rhesus negative. Which of the following is the most likely diagnosis? a) ABO incompatibility b) Breast milk-associated jaundice c) Hereditary spherocytosis d) Rhesus hemolytic disease

Answer 347

a) ABO incompatibility

Question 348

29. A 24- hour- female infant presented with jaundice. Her total serum bilirubin was 18 mg/dL, direct bilirubin 0.8 mg/dl. Both the baby and mother blood group were A rhesus positive. The mother states that she has another child on regular blood transfusions. Which of the following is the most likely diagnosis? a) ABO incompatibility b) Glucose 6 phosphate dehydrogenase deficiency c) Hereditary spherocytosis d) Rhesus hemolytic disease

Answer 348

c) Hereditary spherocytosis

Question 349

30. A newborn whose estimated gestational age is 42 weeks is stained with meconium. The infant has respiratory distress. A chest radiograph is obtained. Which of the followings is the most likely radiographic finding? a) Coarse lung infiltrates b) Decreased lung volumes c) Mediastinal shift d) Reticulogranular pattern

Answer 349

a) Coarse lung infiltrates

Question 350

31. A term, 4200 g female infant is delivered via cesarean section, the amniotic fluid was clear, and the infant cried almost immediately after birth. Within the first 15 min of life, however, the infant's respiratory rate increased to 80 breaths/ min, and she began to have mild retractions. Oxygen saturation was 94%. A chest radiograph showed fluid in the fissure, and prominent pulmonary vascular markings. Which of the following is the most likely diagnosis? a) Meconium aspiration b) Pneumonia c) Respiratory distress syndrome d) Transient tachypnea of the newborn

Answer 350

d) Transient tachypnea of the newborn

Question 351

32. A 28- week- gestational premature infant who is delivered by CS presented with respiratory distress. On examination, respiratory rate is 80/m with retractions, heart rate 130/ minute. By auscultation there is diminished air entry in both lungs. The chest x ray most probably will show? a) Cardiomegaly b) Increased pulmonary vascular markings c) Mediastinal shift d) White lung

Answer 351

d) White lung

Question 352

33. A newborn infant develops respiratory distress immediately after birth. His abdomen is scaphoid. No breath sounds are heard on the left side of his chest, but they are audible on the right. Immediate intubation is successful with little or no improvement in clinical status. Which of the following is most likely explanation for this infant's condition? a) Choanal atresia b) Diaphragmatic hernia c) Pneumonia d) Pneumothorax

Answer 352

b) Diaphragmatic hernia

Question 353

34. A 4-hour-old newborn has copious oral secretions and episodes of coughing, choking, and cyanosis. The pregnancy was complicated by polyhydramnios. You suspect esophageal atresia with tracheoesophageal fistula. The most helpful test to confirm the diagnosis is to? a) Inject a contrast medium through a nasogastric catheter and obtain a neck radiograph b) Obtain computed tomography of the neck c) Perform flexible bronchoscopy d) Place a nasogastric tube and obtain a chest radiograph

Answer 353

d) Place a nasogastric tube and obtain a chest radiograph

Question 354

35. A newborn infant is delivered by emergency cesarean section at 41 weeks' gestation following a pregnancy complicated by a prolapsed umbilical cord and meconium-stained amniotic fluid. At 6 hours of age, the infant has a generalized tonic-clonic seizure. Of the following, the most likely explanation for this seizure is? a) Hyponatremia b) Hypoxic-ischemic encephalopathy c) Meningitis d) Intracranial hemorrhage

Answer 354

b) Hypoxic-ischemic encephalopathy

Question 355

36. A 3-day-old term infant is seen with seizures. The infant had an unremarkable delivery and postnatal course. Which of the following is not a cause of seizure in this infant? a) Hypermagnesemia b) Hypoglycemia c) Hypocalcemia d) Pyridoxine deficiency

Answer 355

a) Hypermagnesemia

Question 356

37. A 1 day old infant develops jitteriness and convulsions. He was bom at 34 weeks gestation to a woman whose pregnancy was complicated by diabetes and pregnancy induced hypertension. Which one of the following values explains this condition? a) Serum calcium of 6.2 mg /dl b) Serum glucose of 45 mg/dl c) Serum magnesium 2mg /dl d) Serum sodium level of 140 mEq/L

Answer 356

a) Serum calcium of 6.2 mg /dl

Question 357

38. A 2 -day-old baby is brought to ER after a generalized seizure lasting 3 minutes. If the seizure were related to birth trauma, the most likely finding would be? a) Concussion b) Focal brain contusion c) Subarachnoid hemorrhage d) Subdural hemorrhage

Answer 357

c) Subarachnoid hemorrhage

Question 358

39. A 2 day- old, full term male newborn presented with intermittent posturing while in the nurseiy. Labor was complicated by prolonged fetal descent and fetal heart decelerations. The most likely pattern is? a) Athetosis b) Chorea c) Jitteriness d) Subtle convulsions

Answer 358

d) Subtle convulsions

Question 359

40. A 2-kg full-term neonate was delivered to a mother with severe preeclampsia. The patient appears wasted with little subcutaneous fat but is active and not distressed. The baby is jittery in the nursery. Serum glucose was <20 mg/dl. The most likely cause of this infant's hypoglycemia is? a) Bacterial sepsis b) Decreased glycogen stores c) Insulin-secreting tumor d) TORCH Infection

Answer 359

b) Decreased glycogen stores

Question 360

41. A previously healthy 4-day-old male who was bom at home develops bruising and melena. The pregnancy, delivery, and postnatal course were unremarkable. Laboratory testing reveals: hemoglobin, 8.1 g%, white cell count 8,500, platelet count, 242,000/ m. Which of the following is the most likely cause of the bleeding? a) Disseminated intravascular coagulation b) Hemophilia A c) Liver disease d) Vitamin K deficiency

Answer 360

d) Vitamin K deficiency

Question 361

42. A term baby bom after difficult vaginal delivery is noted to be pale. Hemoglobin 5.5 g/dl; white cell count 14,000; platelets 286,000, normal blood film. The baby remains well and is transfused with packed red blood cells. A cranial ultrasound scan is normal. In order to establish the cause of the anemia. Which of the following is the next investigation? a) Abdominal ultrasound scan b) Bone marrow biopsy c) Coagulation screen d) Hemoglobin electrophoresis

Answer 361

a) Abdominal ultrasound scan

Question 362

43. A 7-day-old term boy is admitted to hospital with bruising and bleeding from the umbilical stump. He was bom at home and was not given vitamin K after birth. What is the best treatment for the baby? a) Intramuscular vitamin K only b) Intramuscular vitamin K plus fresh frozen plasma if needed c) Intravenous vitamin K plus fresh frozen plasma d) No treatment

Answer 362

b) Intramuscular vitamin K plus fresh frozen plasma if needed

Question 363

44. A 6-week-old infant bom at 32 weeks' gestation presenting for follow up. Mother states that her baby looks pale. Laboratory evaluation reveals a CBC within the reference range with the exception of hemoglobin level which is 12 gram%. Knowing that at birth hemoglobin level was 16 gram%. What is the best management? a) Blood transfusion b) Bone marrow aspiration c) Complete blood picture d) Reassurance

Answer 363

d) Reassurance

Question 364

45. A baby is bom by spontaneous, vaginal delivery at 35 weeks' gestation following rupture of membranes 30 hours before birth. The mother was well and was not treated by antibiotics during labor. A vaginal swab was taken on admission. The baby was well and the mother asks to be discharged home as soon as possible. What is the most appropriate management for the baby at this time? a) Discharge home b) Take a sepsis screen and start intravenous antibiotics c) Take a sepsis screen and give intravenous antibiotics if results are suggestive of sepsis d) Wait for the result of vaginal swab and treat the baby accordingly

Answer 364

b) Take a sepsis screen and start intravenous antibiotics

Question 365

46. A 15 day old newborn presents to the emergency room with a temperature of 39.9 rectal. The parents complained that their baby was irritable and not sucking well. What should the work-up of this patient include? a) Blood Culture b) Complete blood count with differential c) CSF examination d) All of these answers are correct

Answer 365

d) All of these answers are correct

Question 366

47. A baby is born by spontaneous, vaginal delivery at 35 weeks' gestation following rupture of membranes 30 hours before birth. The mother was well and was not treated by antibiotics during labor. A vaginal swab was taken on admission. The baby was well and the mother asks to be discharged home as soon as possible The proper antibiotics to use for this patient include? a) Ampicillin only b) Ampicillin plus Gentamicin c) Ceftriaxone only d) Vancomycin only

Answer 366

b) Ampicillin plus Gentamicin

Question 367

48. A 1-week-old neonate presents with erythema around the umbilicus extending to the abdominal wall. Which of the following is the management of this patient? a) Discharge on oral antibiotics and recheck the next day b) Perform a full sepsis workup and admit the patient c) Reassurance and continue with alcohol wipes of umbilicus d) Topical antibiotic ointment and recheck the patient the next day

Answer 367

b) Perform a full sepsis workup and admit the patient

Question 368

49. A 4-day-old baby is brought by his mother because of lethargy and poor feeding. His skin is cold and mottled and his temperature is 36.8 c .After stabilization, which one of the following is the most appropriate investigation? a) Blood gases b) Chest x ray c) Lumbar puncture d) Serum electrolytes

Answer 368

c) Lumbar puncture

Question 369

50. A 2- day- full term newborn baby was delivered after prolonged vaginal delivery. On Examination, this baby had swelling of the soft tissues of the scalp and scalp abrasions. The swelling was not extending across the suture lines. The most likely diagnosis is? a) Caput succedaneum b) Cephalhematoma c) Moulding d) Subdural hematoma

Answer 369

b) Cephalhematoma

Question 370

51. An 8- hour’s old neonate develops respiratory distress, hypothermia and hypotension. The CBC shows leucopenia with 80% bands. The most likely diagnosis is? a) Diaphragmatic hernia b) Group B streptococcal pneumonia(congenital pneumonia) c) Respiratory distress syndrome d) Transient tachypnea of the newborn

Answer 370

b) Group B streptococcal pneumonia(congenital pneumonia)

Question 371

52. A mother delivers a neonate with meconium staining and low APGAR scores .The delivery was by emergency cesarean section for severe fetal bradycardia. Which of the following complications could be expected to develop in this neonate put on mechanical ventilation? a) Cataract b) Hyperactive bowel sounds c) Pulmonary hypertension d) Thrombocytosis

Answer 371

c) Pulmonary hypertension

Question 372

53. A mother whose blood type is O positive gives birth at term to an infant who has A positive blood and a hematocrit of 55%.A serum bilimbin level obtained at 36 h of age is 12.2 mg/dl. Which of the following laboratory results can diagnose this case? a) Crescent -shaped RBCs in the blood film b) Normal reticulocyte count c) Positive direct coombs test d) Thrombocytopenia

Answer 372

c) Positive direct coombs test

Question 373

54. A premature infant bom at 32 weeks gestation, is now 1 week old, was doing well on nasogastric feeding , today he was observed to have tense distended abdomen with decreased bowel sounds. The nurse reports that the infant has vomited the last two feedings. By examination, the baby has bloody stools. The most likely diagnosis is? a) Aspirated maternal blood b) Hemorrhagic disease of the newborn c) Intussusception d) Necrotizing enterocolitis

Answer 373

d) Necrotizing enterocolitis

Question 374

55. A 3 -day- old infant bom at 32 weeks gestation and weighing 1700gram has three episodes of apnea, each lasting 20-25 seconds and occurring after feeding. Between episodes the baby shows normal activity. Blood sugar is 50 mg/dl and serum calcium 9 mg/dl. Which of the following is true regarding the cause of the apneic attacks? a) Immature respiratory centre b) Part of periodic breathing c) Secondary to hypoglycemia d) Underlying pulmonary disease

Answer 374

a) Immature respiratory centre

Question 375

56. 1 day old infant bom by difficult forceps delivery is seen unable to move her left arm during a Moro reflex examination. The arm is internally rotated; the forearm is extended and pronated. The most likely diagnosis is? a) Erb’s paralysis left side b) Fracture left clavicle c) Fracture left humerus d) Klumpke paralysis

Answer 375

a) Erb’s paralysis left side

Question 376

57. A 20 -year- old woman with pre-eclampsia delivered at 38 weeks gestation a 2100 gram infant with low APGAR scores. Laboratory studies at 18 hour of age reveal a hematocrit of 79%, platelet count of 160,000/pl, glucose 40 mg/dl., magnesium 2.5 mEq/1 and calcium 8.7 mg/dl. Soon after, the infant developed generalized convulsions. Which of the following is the most likely cause of the seizures? a) Hypocalcemia b) Hypoglycemia c) Hypermagnesemia d) Polycythemia

Answer 376

d) Polycythemia

Question 377

58. Shortly After birth, a newborn develops abdominal distention. She begins to drool, when she is given her first feeding. She coughs and chokes, physical examination reveals respiratory distress. The most likely diagnosis is? a) Cleft palate b) Esophageal atresia with tracheoesophageal fistula c) Pyloric stenosis d) Pharyngeal paralysis

Answer 377

b) Esophageal atresia with tracheoesophageal fistula

Question 378

59. About neonatal resuscitation, which of the following is true? a) Diaphragmatic hernia is an indication for early intubation b) Endotracheal intubation is done in all neonates c) The first step in resuscitation is the use of bag and mask ventilation d) The presence of meconium is an indication for chest compressions

Answer 378

a) Diaphragmatic hernia is an indication for early intubation

Question 379

60. Regarding drugs given in resuscitation, which of the following is false ? a) Adrenaline increases heart rate and force of contraction b) Atropine is given for bradycardia c) Naloxone is given only when there is history of maternal intake of narcotics d) Sodium bicarbonate is given with prolonged cardiac arrest

Answer 379

b) Atropine is given for bradycardia

Question 380

61. During neonatal resuscitation, after tactile stimulation a baby born apneic, this is an indication for which step? a) Adrenaline through umbilical vein b) Bag and mask ventilation, then if failed endotracheal intubation c) Endotracheal intubation d) Prolonged tactile stimulation

Answer 380

b) Bag and mask ventilation, then if failed endotracheal intubation

Question 381

62. Which of the following is not part of the Apgar score? a) Blood pressure b) Color of the skin c) Heart rate d) Muscle tone

Answer 381

a) Blood pressure

Question 382

63. Which of the following is abnormal in a full-term new born? a) Apex in the 4th intercostal space b) Heart rate 140/minute c) Respiratory rate 40/ minute d) Skull circumference 50 cm

Answer 382

d) Skull circumference 50 cm

Question 383

64. Which statement about a normal full term neonate is false? a) Anterior fontanel is closed at birth b) Length is 50 cm. c) Skull circumference is 35 cm d) Weight is about 3250 gm

Answer 383

a) Anterior fontanel is closed at birth

Question 384

65. Vaginal bleeding in a 3 days old neonate is mostly due to a) Birth trauma b) Maternal blood c) Tumor of the genital tract d) Withdrawal of maternal hormones

Answer 384

d) Withdrawal of maternal hormones

Question 385

66. Which disorder is not screened at birth? a) Hypothyroidism b) Galactosemia c) Phenylketonuria d) Pheochromocytoma

Answer 385

b) Galactosemia

Question 386

67. Which is false about Moro reflex? a) Absence at birth may be due to birth asphyxia. b) Disappears by the 3rd month of life. c) Its persistence suggests cerebral palsy. d) Unilateral Moro reflex may indicate Erb's palsy.

Answer 386

b) Disappears by the 3rd month of life.

Question 387

68. About neonatal reflexes, which of the following is not true a) Absence of tonic neck reflex in neonate indicates spinal cord lesion b) Planter reflex is positive in neonates c) Rooting reflex is elicited by introducing a finger in infant’s mouth. d) Stepping reflex is elicited by holding the baby with his feet touching a table

Answer 387

c) Rooting reflex is elicited by introducing a finger in infant’s mouth.

Question 388

69. Which of the following is not a correct definition? a) Large for gestational age infants have a birth weight more than 90th percentile b) Premature infants are babies with birth weight less than 2.500 gram c) Premature infants are those with gestational age less than 37 weeks d) Small for gestational age infants have a birth weight less than 10th percentile

Answer 388

b) Premature infants are babies with birth weight less than 2.500 gram

Question 389

70. An extreme preterm baby does not have this as a characteristic physical sign a) Skin is dark red b) Good muscle tone(flexed position) c) Excessive lanugo hair over the back d) Incomplete sole creases

Answer 389

b) Good muscle tone(flexed position)

Question 390

71. A premature neonate is more liable to the following a) Hypoglycemia b) Hypothermia c) Intracranial hemorrhage d) All of the above

Answer 390

d) All of the above

Question 391

72. Small for gestational age is commonly associated with a) Antenatal infections b) Chromosomal disorders c) Maternal hypertension d) All of the above

Answer 391

d) All of the above

Question 392

73. A newborn infant of diabetic mother may present with a) Anemia b) Hypercalcemia c) Hypoglycemia d) Hyponatremia

Answer 392

c) Hypoglycemia

Question 393

74. In hemolytic disease of newborn, a false statement on exchange transfusion is a) It is carried out with group O Rh-Ve blood in ABO and Rh incompatibility respectively b) is indicated when cord bilirubin is 5 mg% or more c) Serum conjugated bilirubin of 20 mg% or more is another indication d) The volume of blood needed for exchange=85X 2 X weight in kg

Answer 393

c) Serum conjugated bilirubin of 20 mg% or more is another indication

Question 394

75. The most common cause of neonatal jaundice in the first week of life is a) Biliary atresia b) Neonatal hepatitis c) Physiological jaundice d) Thalassemia

Answer 394

c) Physiological jaundice

Question 395

76. Which is not a cause of jaundice appearing or persisting after the first week of life a) Breast milk j aundice b) Hereditary spherocytosis c) Neonatal hepatitis d) Physiologic jaundice

Answer 395

d) Physiologic jaundice

Question 396

77. Breast-milk jaundice is not characterized by a) Discontinuation of breast-feeding for 48 hours, is followed by a rapid fall in serum bilirubin.. b) Hyperbilirubinemia is of the unconjugated type c) If breast-feeding is resumed again after 48 hours, hyperbilirubinemia does not recur. d) It may lead to bilirubin encephalopathy if not adequately managed.

Answer 396

d) It may lead to bilirubin encephalopathy if not adequately managed.

Question 397

78. Persistent jaundice after the neonatal period may be due to a) Biliary atresia b) Galactosemia c) Hypothyroidism d) All of the above

Answer 397

d) All of the above

Question 398

79. Side effects of phototherapy don’t include a) Constipation b) Hyperthermia c) Retinal damage d) Skin rash

Answer 398

a) Constipation

Question 399

80. Exchange transfusion is indicated in: a) Cord indirect bilirubin level is 5gm% or more b) Neonatal polycythemia c) Neonatal septicemia d) Sickle cell anemia

Answer 399

a) Cord indirect bilirubin level is 5gm% or more

Question 400

81. Which is not a complication of exchange transfusion a) Acidosis b) Hypocalcemia c) Hypoglycemia d) Hypokalemia

Answer 400

d) Hypokalemia

Question 401

82. Which is not a feature of respiratory distress syndrome? a) Less frequency and severity after maternal steroid intake b) More common after cesarean section c) More common in post-term delivery d) More common in premature babies

Answer 401

c) More common in post-term delivery

Question 402

83. Transient tachypnea of the newborn is not characterized by a) Caused by delayed absorption of fetal lung fluid b) Cannot be clearly differentiated from early pneumonia c) It may require CPAP d) Occurs more commonly in infants delivered by cesarean section

Answer 402

c) It may require CPAP

Question 403

84. Regarding meconium aspiration syndrome, which is not true? a) Caused by plugging of the airways by meconium b) Increases risk of pneumothorax c) Occurs commonly in asphyxiated infants d) Resolves over 24 to 48 hours

Answer 403

d) Resolves over 24 to 48 hours

Question 404

85. A baby born at 31 weeks gestation has recurrent apneic episodes, which statement is wrong? a) Caffeine can be used b) Hypothermia may contribute to its occurrence c) May need ventilation d) Normal finding and no treatment is required

Answer 404

d) Normal finding and no treatment is required

Question 405

86. Causes of seizures in the neonatal period do not include : a) Asphyxia b) Hyperkalemia c) Hypoglycemia d) Hypomagnesemia

Answer 405

b) Hyperkalemia

Question 406

87. Regarding jitteriness, which is true? a) EEG is usually abnormal b) No abnormal gaze or eye movement c) Movements are always asymmetrical d) It is not related to stimuli

Answer 406

b) No abnormal gaze or eye movement

Question 407

88. Neonatal hypoglycemia may be caused by? a) Infant of diabetic mother b) Intrauterine growth retardation c) Perinatal asphyxia d) All of the above

Answer 407

d) All of the above

Question 408

89. Regarding a neonatal metabolic disturbance which of the following is not true? a) Hyperthermia in the newborn can cause febrile convulsions b) Hypocalcemia is serum Ca less than 7 mg/dl c) Hypomagnesemia is serum Mg less than 1.6 mg/dl d) Hypothermia refers to body temperature less than 35.5 C

Answer 408

a) Hyperthermia in the newborn can cause febrile convulsions

Question 409

90. Hemorrhage in the neonatal period is not caused by? a) Anemia b) Disseminated intravascular coagulopathy c) Maternal idiopathic thrombocytopenic purpura d) Vitamin K deficiency

Answer 409

a) Anemia

Question 410

91. Hemorrhagic disease of the newborn, which is not correct? a) Can be treated by fresh plasma b) Can present between 2nd and 7th day of life c) Can result in intracranial hemorrhage d) Is prevented by administering vitamin E to all neonates

Answer 410

d) Is prevented by administering vitamin E to all neonates

Question 411

92. In congenital infections, which is not a common finding? a) Hepatosplenomegaly b) Most cases are due to bacterial infections b) Microcephaly c) Jaundice

Answer 411

b) Most cases are due to bacterial infections

Question 412

93. The commonest organism producing septicemia in Egypt is? a) B streptococci b) E-coli c) Klebsiella d) Pseudomonas

Answer 412

c) Klebsiella

Question 413

94. Sepsis in infants does not manifest by a) Diarrhea and vomiting b) Hyper or hypothermia c) High pitched cry d) Not doing well

Answer 413

c) High pitched cry

Question 414

95. In a newborn, the most common source of infection with oral moniliasis is? a) Broad spectrum antibiotic therapy b) Contact with hospital carriers c) Contaminated instruments d) Maternal birth canal

Answer 414

d) Maternal birth canal

Question 415

96. A false statement about cephalhematoma is? a) Aspiration is the treatment of choice b) May lead to hyperbilirubinemia c) No discoloration of the overlying skin d) Noticed several hours after birth

Answer 415

a) Aspiration is the treatment of choice

Question 416

97. In the first 24 hours of life it is normal? a) Not to pass meconium b) To be jaundiced c) To have vaginal discharge in females in the diaper d) To lose 15 % of birth weight

Answer 416

c) To have vaginal discharge in females in the diaper

Question 417

98. Concerning neonatal jaundice, a true statement is? a) Acidosis increases the risk of kemicterus b) Hepatitis A is a common cause of neonatal jaundice c) Kemicterus commonly complicates biliary atresia d) Physiologic jaundice usually starts on the 1 st day of life

Answer 417

a) Acidosis increases the risk of kemicterus

Question 418

99. Which is not encountered during hypothermia? a) Bradycardia b) Metabolic acidosis c) Shivering d) Tachypnea

Answer 418

c) Shivering

Question 419

100. Which physical finding is most consistent with prematurity rather than intrauterine growth retardation? a) Creases over entire sole of foot b) Descended testes with deep rugae of the scrotum c) Gelatinous translucent skin d) Raised areola and 3 mm breast buds

Answer 419

c) Gelatinous translucent skin

Question 420

1. A 15 months old boy presents with seizures associated with fever. He has been in good health except for a high fever that developed today (39.9 C). He has slight cough and mild nasal congestion .Just prior to the seizures he was playing with some toys. Past medical history is unremarkable. During examination convulsions completely stopped. Which of the following is the most appropriate next step? a) Lower the body temperature b) Perform an EEG c) Perform CSF examination d) Start IV diazepam

Answer 420

a) Lower the body temperature

Question 421

2= A 4-yr-old boy is evaluated for his first generalized tonic-clonic seizure, which lasted more than 10 min. There is no history of illness or fever. Examination an hour after the seizure was completely normal. Which of the following is the most appropriate management? a) Begin therapy with carbamazepine b) Order an EEG c) Order a CT scan of the brain d) Order an MRI study of the brain

Answer 421

b) Order an EEG

Question 422

3. A 5-yr-old child is referred with a 6 weeks history of morning headaches, often associated with vomiting. His parents have noted that during this period he has become irritable and moody. Which of the following would be the most likely to be identified during the physical examination? a) Marked elevation of blood pressure b) Papilledema c) Significant refractive error d) Tenderness on percussion of frontal sinuses

Answer 422

b) Papilledema

Question 423

4. A 5-yr-old child has a 6-mo history of increasing difficulty in walking associated with urinary incontinence. Physical examination shows an alert child with increased deep tendon reflexes, clonus and bilateral Babinski reflexes in the lower extremities with grade 3/5 weakness symmetrically in all extremities. Which of the following is the most likely diagnosis? a) Guillain-Barre syndrome b) Medulloblastoma c) Myasthenia gravis d) Spinal cord tumor

Answer 423

d) Spinal cord tumor

Question 424

5. 7-month-old girl is presented to the emergency department with gradual onset of fever, lethargy, and irritability. Her immunizations are up to date. Examination reveals a febrile infant who does not interact with the examiner and cries inconsolably. A lumbar puncture is performed, and the cerebrospinal fluid shows increase lymphocyte, normal sugar and mild elevation of protein. What is the most likely etiologic agent for this condition? a) Enterovirus infection b) Group B streptococci c) Haemophilus influenzae type b d) Neisseria meningitides

Answer 424

a) Enterovirus infection

Question 425

6. A mother brings in her otherwise healthy 4-year-old son because he was unable to walk since this morning. He had an upper respiratory tract illness with a fever 1 week ago. On physical examination, the boy appears well, but he complains of leg pains bilaterally. Examination reveals bilateral weakness in the lower limbs. Which of the followings is most suitable investigation? a) lumbar puncture b) Magnetic resonance imaging of the spine c) Nerve conduction studies/electromyography d) X ray hip joints

Answer 425

c) Nerve conduction studies/electromyography

Question 426

7. During the health supervision visit for a healthy 4-month-old boy, you note that his head circumference is 46 cm (>98th percentile) and his length and weight are at the 50th percentile. He has mild frontal bossing and widely split cranial sutures. The fontanelle is flat. Arm and leg movements, tone, and reflexes are normal. In reviewing prior growth parameters, you note that his head circumference was at the 75th percentile at birth and the 90th percentile at 2 months. Which of the following is the most diagnostic procedure? a) Electroencephalography b) Head computed tomography scan c) Head ultrasonography d) Lumbar puncture

Answer 426

b) Head computed tomography scan

Question 427

8. A 4 year old boy’s parents complain that their child has difficulty walking. The child rolled, sat and first stood at normal ages and first walked at 13 months of age. Over the past several months however, the family has noticed an increase inward curvature of the lower spine as he walks and that his gait has become more waddling. On examination, the child is oriented and interactive with the physician with an average body built. Enlargement of his calves has been noticed. What is the most diagnostic procedure? a) Echocardiography b) EMG c) Muscle biopsy d) Muscle enzymes

Answer 427

c) Muscle biopsy

Question 428

9. The parents of a 3-year-old child are worried about the child’s apparent clumsiness with frequent falls and a waddling gait. The child had normal development of motor skills during the first year of life and has normal language development. Which of the following is consistent with Duchenne muscular dystrophy? a) Female sex b) Gower sign c) Hypertrophy of the quadriceps d) Positive antinuclear antibodies in the blood

Answer 428

b) Gower sign

Question 429

10. While at school, a 6-year-old boy is noted by his teacher to experience 10- to 20- second lapses in consciousness, sometimes with clonic movements of the face. His parents have not noticed this behavior at home. What is your diagnosis? a) Absence seizures b) Lack of concentration c) Partial seizures d) Psychic

Answer 429

a) Absence seizures

Question 430

11. A 9 year old girl is referred because of declining academic performance over the last 6 months. Her class teacher was concerned that she has been inattentive and disinterested. She often asks people to repeat what they have said. On examination she looks well. Which investigation is most likely to reveal the diagnosis? a) CT b) EEG c) Hearing assessment d) MRI

Answer 430

c) Hearing assessment

Question 431

12. A 2-year-old boy brought by his parents with acute onset of high fever followed by convulsions, there is no history of headache or vomiting. On examination his temperature is 39.7, he is fully conscious with no convulsions, no neck rigidity but he has congested pharynx. What is the next step in the management? a) EEG b) Give antipyretic c) Give diazepam IV d) Perform lumbar puncture to rule out meningitis

Answer 431

b) Give antipyretic

Question 432

13. A 4-year-old child falls from the back of a three-wheeled vehicle hitting his head. He experiences no loss of consciousness. In the emergency room he is alert and oriented. CT scan of the head was normal. What is the best step? a) Do spinal tap b) Perform fundus examination c) Reassurance, advice parent not do anything further. d) Repeat CT exam after 48 hours

Answer 432

d) Repeat CT exam after 48 hours

Question 433

14. A 6 month old boy is brought by his mother because he is floppy. He doesn’t seem to be interested in reaching for toys. At 4 month old his head support was week and had a persistent Moro reflex. The most likely diagnosis is a) Astrocytoma b) Atonic cerebral palsy c) Down syndrome d) Werding Hoffman disease

Answer 433

b) Atonic cerebral palsy

Question 434

15. A 9 year old child comes to the hospital with acute onset of generalized convulsions and disturbed conscious level. The parents didn’t report any similar attacks before; on examination he has normal temperature and mild puffiness. What is your first step? a) Blood pressure measurement b) CSF examination c) CT scan d) Fundus examination

Answer 434

a) Blood pressure measurement

Question 435

16. A 5 year old boy was brought to emergency room with intractable convulsions. His mother said that he was playing in the swimming pool just before his friends noticed convulsion and he never had such condition before. On examination he was in coma with dilated non-reactive pupils. Which of the following investigations you should start with? a) Blood sugar b) CT scan of the head c) Lumbar puncture d) Skull x ray

Answer 435

a) Blood sugar

Question 436

17. A five -year - old physically active boy developed sudden paralysis of his left arm and leg. His mother believed that he has poliomyelitis because she was not regular with his vaccination. On examination in the emergency room he showed spasticity and hyperreflexia on his left arm and leg. Cardiac examination revealed systolic parasternal murmur. What is your diagnosis? a) Embolic hemiplegia b) Hemiplegic cerebral palsy c) Poliomyelitis d) Post diphtheritic paralysis

Answer 436

a) Embolic hemiplegia

Question 437

18. A 2 year old boy with an otitis media is brought to casualty. His father reports that child has had a convulsive attack. Temperature is 39.8 .The attack was very brief and his elder brother suffered the same when he was 18 months old. On examination, the child is active playful and alert. What is your probable diagnosis? a) Brain tumor b) CNS infection c) Febrile seizures d) Generalized epilepsy

Answer 437

c) Febrile seizures

Question 438

19. A 3 months old infant brought to the emergency department because of vomiting and irritability of 3 days duration. Today the boy had seizures, temperature is 39 C°, he has mottling of the skin, slow capillary refill and few petechiae. He has also decreased responsiveness, bulging fontanelle but negative kemig’s and Brudzinski’s signs. Which of the following is true? a) Febrile seizure is a possible diagnosis b) Lumber puncture is urgently needed. c) Negative meningeal signs exclude diagnosis of meningitis d) The infant is developing septic shock

Answer 438

d) The infant is developing septic shock

Question 439

20. A five - year old boy was brought to the emergency room with intractable seizures. His mother said that he was playing in the kitchen alone 2 hours before. On examination he was drowsy with pin point pupil. What is the best step to do first? a) CT head b) Give antidote for organophosphorus toxicity c) Give drugs to stop convulsions d) Screening for toxins

Answer 439

c) Give drugs to stop convulsions

Question 440

21. A 10 year old boy presented with impaired level of consciousness of 12 hours duration. The patient could be aroused for only short periods during which he can respond to simple verbal commands. The mother says he was perfectly normal when he went to play football with his neighbor. On arrival his hemoglobin 7 gram /dl, temperature 37.2, heart rate 55 / minute, blood pressure 110/ 70. The cause of his coma is likely to be? a) Acute hepatic failure b) Diabetic ketoacidosis c) Intracranial hemorrhage d) Poisoning

Answer 440

c) Intracranial hemorrhage

Question 441

22. A 2 days old infant is referred to the hospital for bilious vomiting. The baby was bom at 37 weeks gestation to a 37 old women who had no prenatal care. On examination he has severe hypotonia but no fasciculation. What is the appropriate initial step? a) Early feeding with nasogastric tube b) EMG c) Karyotyping d) Plain x ray of the abdomen

Answer 441

d) Plain x ray of the abdomen

Question 442

23. A 6 year old child is hospitalized for observation because of a short period unconsciousness after a fall from a poly ground swing. He has developed unilateral pupillary dilatation, focal seizures and hemiplegia. Which of the following is the most appropriate management at this time? a) CT scan b) EEG c) Ophthalmic consultation d) Spinal tap

Answer 442

a) CT scan

Question 443

24. An 11 year old boy presents in a confused state. He developed a fever 2 day previously and had been complaining of headache, fever and photophobia. He had vomited 3 times. On examination, his temp was 39.6 C and he has neck stiffness. What is the diagnostic investigation? a) CBC and ESR b) CSF examination c) CT scan d) Fundus examination

Answer 443

b) CSF examination

Question 444

25. A 9 month old boy is brought by his mother because he is floppy. He doesn’t seem to be interested in reaching for toys. At 4 month old his head support was not complete. More reflex is present. What is the investigation that may reveal the cause? a) EMG b) MRI brain c) Muscle biopsy d) Nerve biopsy

Answer 444

b) MRI brain

Question 445

26. About 12 days after a mild upper respiratory infection, an 8 years old boy complains of weakness in his lower limbs. Over several days, the weakness progresses to include his trank and respiratory muscles. Oxygen saturation is 85% .What is the most appropriate initial step? a) Immediate IV steroids b) Plasmapharesis c) IV gamma globulin d) Mechanical ventilation

Answer 445

d) Mechanical ventilation

Question 446

27. A 10 year old child has developed headache that is more frequent in the morning. Over the previous few days his family noticed a change in his behavior, he becomes more irritable than usual. Neurological examination revealed hypertonia and hyperreflexia and positive planter reflex in both lower limbs. Which of the following might be. the cause? a) School stress. b) Supra tentorial lesion c) Intraventricular lesion d) Sub tentorial lesion

Answer 446

d) Sub tentorial lesion

Question 447

28. A 12 months old boy presents with seizures associated with fever. He has been in good health except for a high fever that developed today (40.1 C). He has slight cough and mild nasal congestion. The top priority in the management during seizures is to a) Control fever b) Ensure patent airway c) IV diazepam d) IV antibiotics

Answer 447

b) Ensure patent airway

Question 448

29. A 6 month old boy is brought by his mother because he is floppy. He doesn’t seem to be interested in reaching for toys. At 4 month old his head support was weak. He has a history of NICU admission for neonatal hyperbilirubinemia. What is the most likely diagnosis? a) Atonic cerebral palsy b) Congenial muscular dystrophy. c) Down syndrome d) Werding Hoffman disease

Answer 448

a) Atonic cerebral palsy

Question 449

30. An 11 year old girl has a 4 month history of abnormal behavior in the form of repeated crying and abnormal movements. On the examination she has jerky involuntary, arrhythmic movements especially in the upper limbs. No history of previous drug intake. The rest of neurological examination is normal. What is the next best step? a) CT brain b) Detailed cardiac examination c) EMG d) Prescribe haloperidol

Answer 449

b) Detailed cardiac examination

Question 450

31. A 4 year old boy’s parents complain that their child has difficulty walking. The child first walked at 13 months of age. On examination, the child is oriented and has enlargement of his calves has been noticed. Family history revealed that the elder son of his aunt has the same condition. Which is true regarding the prognosis of this case? a) Distal muscles is affected very early in the disease b) Heart failure never occur c) Most cases die in the 2nd decade d) The condition is intermittent

Answer 450

c) Most cases die in the 2nd decade

Question 451

32. A 7 year old female presents to the emergency room with lower limbs weakness One week prior, she had a fever of 38.5 with vomiting and diarrhea that resolved within 3 days. Neurological examination revealed bilateral symmetrical weakness of the lower limbs. Which of the following is best line of treatment? a) Immediate physiotherapy b) IV gamma globulins c) Mechanical ventilation d) Plasmapharesis

Answer 451

b) IV gamma globulins

Question 452

33. A 17-month-old male was seen in clinic for evaluation of spells. His first episode was 5 months prior to presentation when he slipped at the poolside and hit the back of his head. He had no loss of consciousness and got up on his own, looked pale and floppy. Since then he has had 3 similar episodes. Neurological examination was free. What is your possible diagnosis? a) Absence seizures b) Myoclonic seizures c) Pallid breath holding spells d) Infantile spasm

Answer 452

c) Pallid breath holding spells

Question 453

34. A 6 year old child has a 2 months history of headache that is more frequent in the morning and is followed by vomiting. His family noticed a change in his behavior; he became more irritable. Neurological examination revealed hypertonia and hyperreflexia in the lower limbs. What is your possible diagnosis? a) Astrocytoma b) Brain abscess c) Intracranial hemorrhage d) Medulloblastoma

Answer 453

d) Medulloblastoma

Question 454

35. A developmentally delayed 6 months infant has CT brain showing intracranial calcification. Neonatal history revealed a history of intrauterine growth retardation, hepatosplenomegaly, prolonged neonatal jaundice and purpura. Which of the following is the most likely the cause? a) Congenital rubella b) Congenital syphilis c) Congenital CMV d) Congenital toxoplasmosis

Answer 454

c) Congenital CMV

Question 455

36. A mother brings in her otherwise healthy 4-year-old son because of problems in walking. He is unable to walk since this morning. He had an upper respiratory tract illness with a fever 1 week ago. Examination reveals bilateral weakness of the lower limbs and tender calf muscles. Which of the following is the most appropriate initial diagnostic procedure? a) Antinuclear antibody measurement b) Lumbar puncture c) Magnetic resonance imaging of the spine d) Nerve conduction studies/electromyography

Answer 455

d) Nerve conduction studies/electromyography

Question 456

37. A 17-month-old male was seen in clinic for evaluation of spells. His first episode was 5 months prior to presentation when he developed cyanosis at the end of crying. Since then he has had 3 similar episodes. Neurological examination was free. Which one of the following is correct regarding this condition? a) Are commoner over the age of 3 % years. b) Can be confused with myoclonic seizures. c) May be associated with iron deficiency anemia d) Should be treated with sedatives.

Answer 456

c) May be associated with iron deficiency anemia

Question 457

38. A 6-year-old boy appears in a clinic with history of hyperactivity and poor school performance. Tie cannot watch television more than a few minutes at a time. Physician also noted a reduced attention span and an impulsive behavior. What is the most likely diagnosis? a) ADHD (attention deficit hyperactivity disorder) b) Ding ingestion c) Normal child d) Schizophrenia

Answer 457

a) ADHD (attention deficit hyperactivity disorder)

Question 458

39. A 3-year-old boy is brought to you, as his mother is concerned about his attention span. You note that he has very poor eye contact and poor verbal skills (having only a four-word vocabulary). His weight and height are appropriate for his age. Which one of the following is the most likely diagnosis? a) Attention deficit hyperactivity disorder b) Autism spectrum disorder c) Depression d) Temper tantrums

Answer 458

b) Autism spectrum disorder

Question 459

40. A newborn infant is noted to be profoundly hypotonic at birth; he has a good heart rate but is in respiratory distress. He has a tongue fasciculations. Which of the following investigations is recommended to reach a diagnosis? a) EMG b) Karyotyping c) MRI d) Muscle enzymes

Answer 459

a) EMG

Question 460

41. A 14-year-old girl is brought to your office by her mother because she is complaining of “seeing double.” The history is significant for headaches that waken the patient from sleep in the morning but are relieved by vomiting. On physical examination, you note that she is unable to abduct either eye. Lower extremity reflexes are slightly exaggerated. Which of the following physical signs is likely to be present in this patient? a) Hypotension b) Papilledema c) Patency of the anterior fontanelle d) Tachycardia

Answer 460

b) Papilledema

Question 461

42. A 2 years old male is admitted to the hospital with weakness on the left side. History revealed dental extraction 1 week ago, followed by very high fever. By examination he is found to have a presystolic muimur on the left parasternal are .Which of the following is the most likely diagnosis? a) Infective endocarditis b) Poliomyelitis c) Rheumatic fever d) Septicemia

Answer 461

a) Infective endocarditis

Question 462

43. A six-month-old breast fed infant presents to the emergency room with generalized tonic clonic seizure activity of about 30-min duration that stops upon the administration of diazepam. Which of the following questions is important to ask about? a) Does the child have fever? b) Family history of similar conditions c) The mode of delivery either it is vaginal or CS d) Type of feeding whether it is breast or formula?

Answer 462

a) Does the child have fever?

Question 463

44. A 17 months old boy is brought for evaluation because of two episodes in which he abruptly stopped breathing, lost consciousness and had shaking of all four extremities. Both episodes occurred after his older brother took away his favorite toy. After few cries, he stops breathing, turns blue, then becomes stiff and had this jerking of all extremities. What might be these episodes? a) Generalized tonic convulsions b) Generalized tonic clonic convulsion c) Cyanotic breath holding spells d) Infantile spasms

Answer 463

c) Cyanotic breath holding spells

Question 464

45. Which is not a cause of obstructive hydrocephalus? a) Aquiductal stenosis. b) Dandy-Walker malformation. c) Posterior fossa tumor. d) Subarachnoid hemorrhage.

Answer 464

d) Subarachnoid hemorrhage.

Question 465

46. In spastic cerebral palsy, which of the following is not commonly present? a) Exaggerated deep tendon reflexes is common b) Mental retardation. c) Sensations are free d) True bulbar palsy.

Answer 465

d) True bulbar palsy.

Question 466

47. Cerebral palsy is characterized by: a) Acquired in late childhood. b) Inherited as autosomal recessive. c) Non-curable. d) Slow progression

Answer 466

c) Non-curable.

Question 467

48. Causes of mental retardation include a) Fragile X syndrome b) Galactosemia c) Tuberous sclerosis d) All of the above

Answer 467

d) All of the above

Question 468

49. Management of status epilepticus should include: a) Intramuscular diazepam immediately on arrival in hospital b) IV Phenytoin if appropriate initial therapy is ineffective. c) No need for oxygen at any time during therapy d) IV diazepam is contraindicated because of respiratory centre depression

Answer 468

b) IV Phenytoin if appropriate initial therapy is ineffective.

Question 469

50. Find the statement which does not characterize bacterial meningitis: a) In newborns, the only feature may be bulging of anterior fontanel b) Neck rigidity is absent in infancy c) Neisseria meningitides is commonest cause in pediatric age groups d) Convulsions are common

Answer 469

c) Neisseria meningitides is commonest cause in pediatric age groups

Question 470

51. An absence seizure is usually not characterized by? a) EEG findings are characteristic. b) Precipitated by hyperventilation. c) There is no aura d) Typically the child falls to the ground during an attack.

Answer 470

d) Typically the child falls to the ground during an attack.

Question 471

52. Simple febrile convulsions a) Frequently occur in neonates b) It is due to an extra cranial cause of fever c) May sometimes occur without fever d) Should always be investigated by lumbar puncture to exclude meningitis

Answer 471

b) It is due to an extra cranial cause of fever

Question 472

53. Which is not true about febrile convulsions? a) Occurs in children aged from six months to five years. b) Often involve other children in the family c) Simple febrile seizures are more common d) Usually occurs after drop of fever.

Answer 472

d) Usually occurs after drop of fever.

Question 473

54. The following anticonvulsant treatment is not appropriate? a) ACTH for infantile spasm. b) Ethosuximide for absence seizures c) Phenytoin as first choice for absence seizures d) Sodium valproate for primary generalized tonic clonic seizures

Answer 473

c) Phenytoin as first choice for absence seizures

Question 474

55. Find the statement which characterizes bacterial meningitis in infancy. a) Convulsions never occur b) CSF protein may be normal c) Neck rigidity is absent d) Neisseria meningitides is commonest cause

Answer 474

c) Neck rigidity is absent

Question 475

56. Acute bacterial meningitis cannot cause a) Acute adrenal failure. b) Blindness. c) Deafness d) Decrease sugar and protein

Answer 475

d) Decrease sugar and protein

Question 476

57. In aseptic meningitis, protein and glucose CSF show: a) Increased protein and decreased glucose. b) Increased protein and glucose. c) Normal glucose and protein may increase d) Normal protein and decreased glucose.

Answer 476

c) Normal glucose and protein may increase

Question 477

58. In acute bacterial meningitis, the CSF protein and glucose will show: a) Increased protein and decreased glucose. b) Increased protein and glucose. c) Normal protein and decreased glucose. d) Normal protein and glucose.

Answer 477

a) Increased protein and decreased glucose.

Question 478

59. Flaccid paralysis is not seen in a) Acute infectious polyneuritis b) Cerebral diplegia. c) Poliomyelitis. d) Werdnig Hoffmann disease.

Answer 478

b) Cerebral diplegia.

Question 479

60. One of the following is not a feature of Werdnig Hoffman disease: a) Choking and dysphagia. b) Mental retardation c) Muscle wasting. d) Tongue fasciculations.

Answer 479

b) Mental retardation

Question 480

61. Hypotonia without significant weakness is a characteristic of: a) Down's syndrome. b) Duchenne muscular dystrophy. c) Guillain-Barre syndrome. d) Werdnig-Hoffmann disease.

Answer 480

a) Down's syndrome.

Question 481

62. Select the true statement regarding Guillain-Barre syndrome: a) Is caused by lesions in the anterior horn cells. b) It is genetically determined. c) Mechanical ventilation may be needed d) Respiratory muscles are never affected.

Answer 481

c) Mechanical ventilation may be needed

Question 482

63. In Guillain-Barre syndrome, Which is false ? a) Ascending paralysis. b) Asymmetrical paralysis c) IV immunoglobulin is one of the lines of therapy. d) Sensoiy manifestations may be present

Answer 482

b) Asymmetrical paralysis

Question 483

64. Which statement is not suggestive of Guillain-Barre syndrome? a) Acute onset of paresthesia in lower extremities. b) Elevation of blood pressure may occur c) Marked weakness and tenderness of muscles. d) Plasmapharesis is the initial treatment of choice

Answer 483

d) Plasmapharesis is the initial treatment of choice

Question 484

65. Characteristic features of upper motor neurone lesion include: a) Ankle Clonus. b) Fasciculation. c) Hyporeflexia. d) Muscle hypertrophy

Answer 484

a) Ankle Clonus.

Question 485

66. A false statement about Duchenne muscular dystrophy is: a) Cardiomyopathy is an important cause of death. b) Creatine phosphokinase (CPK) is highly elevated. c) EMG shows neuropathic changes. d) The gait is usually waddling.

Answer 485

c) EMG shows neuropathic changes.

Question 486

67. Contraindications to performing a lumbar puncture does not include a) Suspected mass lesion of the brain b) Symptoms and signs of impending cerebral herniation c) Skin infection at the site of the lumbar puncture d) Thrombocytopenia with a platelet count <50 * 109/L

Answer 486

d) Thrombocytopenia with a platelet count <50 * 109/L

Question 487

68. The most common type of cerebral palsy (CP) associated with seizures is a) Ataxic CP b) Spastic diplegia c) Spastic hemiplegia d) Spastic quadriplegia

Answer 487

c) Spastic hemiplegia

Question 488

69. Which of the following is the drug of choice for treating infantile spasm? a) Phenobarbitone b) Phenytoin c) Sodium valproate d) Steroids

Answer 488

d) Steroids

Question 489

70. The most common precipitant of status epilepticus in children is a) CNS infection b) Fever c) Medication change d) Trauma

Answer 489

b) Fever

Question 490

71. Status epilepticus is defined as continuous seizure activity or recurrent seizure activity without regaining of consciousness lasting for more than a) 5 min b) 15 min c) 30 min d) 45 min

Answer 490

a) 5 min

Question 491

72. The most common neurologic sequelae of bacterial meningitis is a) Cognitive impairment b) Delay in acquisition of language c) Hearing loss d) Visual impairment

Answer 491

c) Hearing loss

Question 492

73. In Guillain-Barre syndrome, the most likely respiratory infection that triggers the disease is a) Chlamydia trachomatis b) Haemophilus influenzae c) Mycoplasma pneumoniae d) Staphylococcal aureus

Answer 492

c) Mycoplasma pneumoniae

Question 493

74. In spinal muscular atrophy (SMA) type 1, which feature/muscle is not spared? a) Diaphragm b) Extraocuiar muscles c) Heart d) Intelligence

Answer 493

a) Diaphragm

Question 494

75. Which feature is abnormal in cerebral palsy? a) Cognitive abilities b) Motor functions c) Auditory functions d) Sensory functions

Answer 494

b) Motor functions

Question 495

76. Which of the following conditions does not mimic seizures? a) Apnea b) Jitteriness c) Infantile spasms d) Breath holding spells

Answer 495

c) Infantile spasms

Question 496

77. Which is not encountered in Guillain-Barre syndrome : a) Altered mental status b) Bulbar weakness c) Weakening or tingling sensation in the legs d) Weakness in the arms and upper body

Answer 496

a) Altered mental status

Question 497

78. Which of the following is not related to the diagnosis of simple febrile seizures in a one year old boy? a) All the seizure episodes were associated with fever b) The seizure does not occur more than one time during the febrile illness c) The seizures episodes were all generalized d) The seizures last more than 15 minutes

Answer 497

d) The seizures last more than 15 minutes

Question 498

79. Conditions that mimic seizures do not include a) Apnea b) Breath holding spells c) Carpopedal spasm d) Tics

Answer 498

c) Carpopedal spasm

Question 499

1. An acyanotic newborn presents with a harsh heart murmur at the left sternal edge. The chest radiograph shows cardiomegaly with increased pulmonary vascular markings. What is the most likely diagnosis? a) ASD b) Tricuspid atresia c) Transposition of the great arteries d) VSD

Answer 499

d) VSD

Question 500

2. During regular checkup of an 8 year old child, you note a loud first heart sound with fixed and widely split second heart sound at the upper left sternal border that does not change with respiration. The patient is otherwise active and healthy. Which of the following most likely explains these findings? a) Aortic stenosis b) Atrial septal defect c) Tetralogy of Fallot. d) Ventricular septal defect.

Answer 500

b) Atrial septal defect

Question 501

3. A 7-year-old boy had a sore throat two weeks ago. His mother is worried that he may be at risk for rheumatic fever. You tell her that several criteria must be met to make the diagnosis. The most common finding in rheumatic fever is: a) Arthralgia. b) Carditis. c) Erythema marginatum. d) Subcutaneous nodules.

Answer 501

a) Arthralgia.

Question 502

4. A 1-month-baby presents with breathlessness and poor feeding. Her mother says she has been getting worse over the last week. On examination she is found to have a large liver, a respiratory rate of 60/min, and an active precordium with a soft murmur. Her oxygen saturation is 94% and she has good femoral pulses. What would you advise as the most appropriate treatment? a) Restrict milk feeds and fluids. b) Start captopril in casualty and follow her in the clinic in 1 month. c) Start digoxin and diuretics and follow her in the clinic after 3 months. d) Start diuretics and admit to the ward for observation.

Answer 502

d) Start diuretics and admit to the ward for observation.

Question 503

5. One day old baby who is otherwise asymptomatic presents with a loud harsh heart murmur at the 2ud left space. There are no features of heart failure present, the oxygen saturation is normal. What is the most likely diagnosis in this case? a) Atrial septal defect. b) Large muscular ventricular septal defect. c) Pulmonary stenosis d) Small muscular ventricular septal defect.

Answer 503

c) Pulmonary stenosis

Question 504

6. A 1 month baby severely cyanosed is diagnosed as having Fallot tetralogy following an echocardiogram. After stabilization parents ask you to tell them what will be the next step? a) A balloon atrial septostomy is the treatment of choice. b) The baby should be taken to theatre to have the ventricular septal defect closed c) The baby should be taken to theatre to have a Blalock-Taussig shunt inserted. d) The baby should be taken to theatre to have a pulmonary artery band applied

Answer 504

c) The baby should be taken to theatre to have a Blalock-Taussig shunt inserted.

Question 505

7. One month-old baby is seen after turning blue when feeding. Auscultation of the heart reveals a harsh systolic ejection murmur over the pulmonary area that radiates to the back. Chest x-ray reveals mild heart enlargement with a reduced main pulmonary artery segment. What is the most probable diagnosis? a) Atrial septal defect. b) Patent ductus arteriosus. c) Tetralogy of Fallot. d) Ventricular septal defect.

Answer 505

c) Tetralogy of Fallot.

Question 506

8. An acyanotic 1-month-old male is seen with a complaint of sweating on his forehead during feeding, tachypnea and irritability. Auscultation reveals a harsh holosystolic murmur at the lower left sternal border. The most likely diagnosis is: a) Severe pulmonary stenosis b) Transposition of the great arteries c) Total anomalous pulmonary venous return d) Ventricular septal defect

Answer 506

d) Ventricular septal defect

Question 507

9. A 3 day old infant with cyanosis since birth and respiratory distress. Chest X-ray demonstrates cardiomegaly. What is the most probable diagnosis? a) Coarctation of the aorta b) Mitral valve prolapse c) Transposition of the great arteries d) Ventricular septal defect

Answer 507

c) Transposition of the great arteries

Question 508

10. A 3-week-old full term baby is referred to the hospital. He has recently been having problems completing his feeds and today appears short of breath. On examination, his heart rate 180/min, respiratory rate 70/min and a 5 cm hepatomegaly. What is the most likely diagnosis? a) Heart failure b) Neonatal pneumonia c) Neonatal hepatitis d) Respiratory distress syndrome

Answer 508

a) Heart failure

Question 509

11. A 4 year old male presents for a preschool physical examination. His mother mentions that he seems to get short of breath with exercise recently. On examination radial pulse is prominent while femoral pulse is not felt. A systolic murmur is heard on the left side of the chest. What is the most likely diagnosis? a) Congenital aortic stenosis b) Coarctation of the aorta c) Severe pulmonary stenosis d) Ventricular septal defect

Answer 509

b) Coarctation of the aorta

Question 510

12. An 11- year - boy presents with fever 39°C with shortness of breath. The symptoms have been present now for 12 days, but getting worse on the last 2 days. Examination reveals heart rate 100 /m, respiratory rate 40/m. He has a pansystolic murmur at apex radiating to the axilla and mild splenomegaly. What is the most likely diagnosis? a) Heart failure b) Infective endocarditis. c) Pericardial effusion. d) Ventricular septal defect.

Answer 510

b) Infective endocarditis.

Question 511

13. A 2 years old boy has been doing well despite diagnosis of teratology of Fallot. He presented to the emergency room few days ago with fever, lethargy and headache. What is the most likely explanation of these symptoms? a) Brain abscess b) Brain tumor c) Infective endocarditis d) Meningitis

Answer 511

a) Brain abscess

Question 512

14. Regarding the previous case, the most appropriate first step is to do: a) Blood culture b) CSF examination c) CT brain d) Echocardiography

Answer 512

c) CT brain

Question 513

15. A 6 weeks old female presents to the emergency room with complaints of lethargy, poor feeding, and respiratory distress. Her parents report that she sweats a lot on her forehead when feeding. She is acyanotic with mild to moderate subcostal and intercostal retractions. The liver edge is palpable 4 cm below the right costal margin. What is the most likely diagnosis? a) Heart failure b) Neonatal pneumonia c) Neonatal hepatitis d) Respiratory distress syndrome

Answer 513

a) Heart failure

Question 514

16. A newborn presents with cyanosis, the X-ray chest revealed decreased broncho vascular markings and normal sized heart. The most likely diagnosis is: a) Pulmonary atresia b) VSD c) Transposition of great arteries d) Tetralogy of Fallot

Answer 514

d) Tetralogy of Fallot

Question 515

17. A 3 day old newborn with single second heart sound has had progressively deepening of cyanosis since birth but no respiratory distress. Chest X-ray demonstrates cardiomegaly with special configuration. What is the most probable diagnosis? a) Mitral valve prolapse b) Total anomalous pulmonary venous return c) Transposition of the great arteries d) Ventricular septal defect

Answer 515

c) Transposition of the great arteries

Question 516

18. An ill appearing 2-week-old girl is brought to the emergency room. She is pale and dyspneic with respiratory rate 80/min, heart rate 195/min. Heart sounds are distant and a gallop is heard. X ray revealed cardiomegaly. What is the most likely diagnosis? a) Endocarditis b) Glycogen storage disease c) Myocarditis d) Pericarditis

Answer 516

c) Myocarditis

Question 517

19. An 18 months old child is noted to assume a squatting position. The day of admission, the child becomes restless, and deeply cyanotic. Within 10 minutes, the child becomes unresponsive. The most likely underlying lesion is: a) Anomalous coronary artery b) Tetralogy of Fallot c) Coarctation of the aorta d) VSD

Answer 517

b) Tetralogy of Fallot

Question 518

20. A previously well 3 months old boy presents with poor feeding and poor growth. RR 70/min, pulse 175/min and BP 90/65 mmHg in the upper and lower extremities. The cardiac examination reveals a palpable parasternal lift and a systolic thrill. On auscultation, there is a holosystolic murmur (grade 4). The chest radiograph reveals cardiomegaly. The most likely diagnosis is: a) Cardiomyopathy b) Coarctation of the aorta c) Transposition of the great arteries d) VSD

Answer 518

d) VSD

Question 519

21. A neonate presents with cyanosis and hepatomegaly. There is a grade 4/6 systolic ejection murmur. The ECG reveals right ventricular hypertrophy. The best method to evaluate this patient is to perform: a) Chest x-ray b) Echocardiogram c) Immediate cardiac catheterization d) MRI heart

Answer 519

b) Echocardiogram

Question 520

22. A 12 year old boy has previous history of a heart murmur as an infant, now he experiences severe dyspnea. At your office, he has a normal rhythm, pulse, and blood pressure. 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 most likely diagnosis in this patient is: a) Aortic stenosis b) Pulmonary stenosis c) Patent ductus arteriosus d) VSD

Answer 520

a) Aortic stenosis

Question 521

23. A 6 months old infant is presenting 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) Aortic stenosis b) Patent ductus arteriosus c) Pulmonary stenosis d) Total anomalous pulmonary venous return

Answer 521

b) Patent ductus arteriosus

Question 522

24. A 7 year old girl presents with a tender and swollen right knee joint, as well as fever. Recently. She developed arthritis of the left wrist. Which of the following modified Jones criteria does this patient have? a) 1 major & 1 minor b) 2 major c) 2 major & 1 minor d) 2 minor

Answer 522

a) 1 major & 1 minor

Question 523

25. What is the most appropriate treatment for the previous case? a) Antibiotics b) NSAIDs c) Salicylates d) Steroids

Answer 523

c) Salicylates

Question 524

26. An 8-yr-old boy presents with fever of 2 weeks' duration, shortness of breath, ankle edema, intermittent painful swelling of the wrists, elbows, and knees unrelated to edema, and a new systolic murmur. One month ago he had a sore throat that lasted for 5 days, which resolved spontaneously. The most likely diagnosis is: a) Infective endocarditis b) Juvenile idiopathic arthritis. c) Meningococcal sepsis d) Rheumatic fever

Answer 524

d) Rheumatic fever

Question 525

27. A 3 months old female infant has a history of poor feeding, shortness of breath during feedings, failure to thrive and chronic cough. Examination reveals tachycardia and a gallop rhythm but no murmur. There is hepatomegaly but no cyanosis. Chest x ray reveals cardiomegaly. The appropriate diagnostic test is: a) Echocardiogram b) Electrocardiogram c) Blood culture d) Serum amino acids

Answer 525

a) Echocardiogram

Question 526

28. A 9-month-old infant accidentally ingests an unknown quantity of digitalis. Which of the following is the most important non cardiac manifestation of toxicity in this infant? a) Dizziness. b) Fever. c) Vomiting. d) Visual disturbances.

Answer 526

c) Vomiting.

Question 527

29. A 2-years-old boy presents with a murmur heard in both systole and diastole at the upper sternal edge, which disappears upon lying down. Physical examination was otherwise normal. He is a well, asymptomatic child and there are no signs of cardiac failure. What do you consider to be the best management plan? a) Perform an electrocardiogram, chest radiograph, and oxygen saturation and then refer for echocardiography. b) Refer for echocardiography and specialist opinion. c) Reassure them that the murmur is imiocent. d) Say that you suspect the murmur is caused by a persistent arterial duct.

Answer 527

c) Reassure them that the murmur is imiocent.

Question 528

30. Which of the following statements concerning VSD is false? a) It causes left to right shunt b) Spontaneous closure may occur c) Prophylaxis against infective endocarditis is not needed if asymptomatic and small lesion d) Heart failure is a known complication

Answer 528

c) Prophylaxis against infective endocarditis is not needed if asymptomatic and small lesion

Question 529

31. Regarding patent ductus arteriosus (PDA), which is the correct statement? a) Allows right-to-left shunting of blood. b) Associated with narrow pulse pressure. c) May be due to maternal rubella during early pregnancy. d) Occurs only as an isolated anomaly.

Answer 529

c) May be due to maternal rubella during early pregnancy.

Question 530

32. Regarding patent ductus arteriosus (PDA), It is characterized by: a) Classically it presents with a machinery murmur. b) Is the commonest cardiac lesion in patients with Turner syndrome. c) Is associated with right ventricular hypertrophy. d) The chest X-ray shows pulmonary oligemia.

Answer 530

a) Classically it presents with a machinery murmur.

Question 531

33. Which is not true regarding coarctation of aorta? a) Dorsalis pedis pulsations are weak or not palpable. b) Is associated with hypertension. c) Is a common finding in Klinefelter syndrome. d) Systolic murmur can be heard.

Answer 531

c) Is a common finding in Klinefelter syndrome.

Question 532

34. Regarding coarctation of aorta, It is characterized by: a) Big volume femoral pulse. b) Is the commonest cardiac lesion in patients with Turner syndrome. c) Pulmonary hypertension d) Systemic hypotension

Answer 532

b) Is the commonest cardiac lesion in patients with Turner syndrome.

Question 533

35. Rheumatic fever may be a complication following: a) Acute glomerulonephritis. b) Measles. c) Otitis media. d) Scarlet fever.

Answer 533

d) Scarlet fever.

Question 534

36. Carey comb murmur of rheumatic fever is: a) Apical Pansystolic murmur b) Apical early diastolic murmur c) Apical mid diastolic murmur d) Basal ejection systolic murmur

Answer 534

c) Apical mid diastolic murmur

Question 535

37. Which of the following is not a major criterion of acute rheumatic fever? a) Carditis. b) Erythema nodosum. c) Polyarthritis. d) Subcutaneous nodules.

Answer 535

b) Erythema nodosum.

Question 536

38. Major criteria of rheumatic fever include: a) Fever. b) Prolongation of P-R interval. c) Mono- arthritis d) Subcutaneous nodules.

Answer 536

d) Subcutaneous nodules.

Question 537

39. Minor criteria of rheumatic fever include: a) Arthralgia. b) Chorea. c) Erythema marginatum. d) Subcutaneous nodules.

Answer 537

a) Arthralgia.

Question 538

40. Which presentation suggests the diagnosis of rheumatic Fever? a) Arthralgia with fever b) Carditis with arthralgia and fever. c) Chronic recurrent tonsillitis with high ESR. d) Arthralgia with prolonged PR interval.

Answer 538

b) Carditis with arthralgia and fever.

Question 539

41. Concerning rheumatic polyarthritis, which is the correct statement? a) It is usually associated with chorea b) It usually affects the small joints. c) Joint deformities develop if the appropriate treatment is not introduced in time d) The affected joints are swollen, warm, and movements are painful

Answer 539

d) The affected joints are swollen, warm, and movements are painful

Question 540

42. Which of the following is a feature of acute rheumatic carditis? a) Accentuated heart sounds. b) Bradycardia c) Arthralgia must be present. d) Chest pain due to pericarditis.

Answer 540

d) Chest pain due to pericarditis.

Question 541

43. False statement about rheumatic carditis includes a) It may lead to heart failure. b) It occurs in about 50% of the initial attacks of rheumatic fever. c) The pulmonary valve is commonly affected d) There is tachycardia disproportionate to fever.

Answer 541

c) The pulmonary valve is commonly affected

Question 542

44. Concerning infective endocarditis. Which is the correct statement? a) Blue clubbing is common b) Cardiac vegetations is a minor Duke criterion c) It can affect normal heart d) It may complicate ASD secundum

Answer 542

c) It can affect normal heart

Question 543

45. The following is not a feature of infective endocarditis: a) Cerebral strokes b) Clubbing c) Dysuria d) Splenomegaly

Answer 543

c) Dysuria

Question 544

46. Laboratory findings of rheumatic fever include: a) High C-reactive protein b) Leukopenia c) Lymphocytosis d) Low ESR.

Answer 544

a) High C-reactive protein

Question 545

47. The following is typical of Fallot tetralogy: a) Cyanosis at birth. b) Peripheral cyanosis. c) Huge cardiomegaly. d) Right ventricular hypertrophy.

Answer 545

d) Right ventricular hypertrophy.

Question 546

48. Regarding Fallot tetralogy, which is the correct statement? a) Anemia is a common complication. b) Blalock-Taussig operation connects the subclavian artery to left pulmonary artery. c) Left ventricular hypertrophy is common d) Systolic thrill at the apex can be detected.

Answer 546

b) Blalock-Taussig operation connects the subclavian artery to left pulmonary artery.

Question 547

49. Which is false Fallot tetralogy? a) Cyanosis may be only during exertion. b) Clubbing of the fingers is due to tissue anoxia. c) Growth is usually not affected. d) Squatting position improves cyanotic spells.

Answer 547

c) Growth is usually not affected.

Question 548

50. After recent scarlet fever, diagnosis of rheumatic fever is most probable when a child has: a) Carditis, arthralgia and high ESR. b) Erythema marginatum and high ASO titer. c) Polyarthritis, arthralgia and high ASO titer. d) Subcutaneous nodules and high ASO titer.

Answer 548

a) Carditis, arthralgia and high ESR.

Question 549

51. Diagnosis of rheumatic fever is most probable when a child has a) Arthritis, arthralgia and prolonged PR interval. b) Arthritis, erythema marginatum and prolonged PR interval. c) Carditis, prolonged PR interval and high CRP d) Erythema marginatum, mono-arthralgia and high ASO titer

Answer 549

b) Arthritis, erythema marginatum and prolonged PR interval.

Question 550

52. In patent ductus arteriosus, which of the following is incorrect: a) Even small PDA should be closed. b) Early operation prevents progressive pulmonary vessel changes. c) If large, heart failure is common. d) The commonest congenital acyanotic heart disease.

Answer 550

d) The commonest congenital acyanotic heart disease.

Question 551

53. The definition of hypertension in children is: a) Average systolic blood pressure and/or diastolic BP that is > 90th percentile for age and sex on > 2 occasions b) Average systolic blood pressure and/or diastolic BP > 95th percentile for age and sex on > 3 occasions c) Average systolic blood pressure and/or diastolic BP that is > 99th percentile for age, sex, and height on > 3 occasions d) Average systolic and /or diastolic blood pressure that is > 95th percentile for age, sex, and height on >3 occasions

Answer 551

d) Average systolic and /or diastolic blood pressure that is > 95th percentile for age, sex, and height on >3 occasions

Question 552

54. Regarding childhood hypertension, which is the correct statement? a) Drug therapy is not indicated b) Essential type is the major etiology c) Hypothyroidism may be the cause d) It may be complicated by encephalopathy

Answer 552

d) It may be complicated by encephalopathy

Question 553

55. In rheumatic fever: a) Normal ESR is usually observed in chorea. b) Long acting penicillin must be given for life in some cases. c) Rheumatic arthritis is treated with salycilates. d) All of the above.

Answer 553

d) All of the above.

Question 554

56. Rheumatic arthritis is not characterized by a) Big joints affection b) Dramatic response to salicylates. c) Fleeting in nature. d) Normal ESR.

Answer 554

d) Normal ESR.

Question 555

57. Which is not a major criterion of rheumatic fever? a) Arthritis. b) Chorea. c) Prolonged P-R interval. d) Subcutaneous nodules.

Answer 555

c) Prolonged P-R interval.

Question 556

58. Minor criteria in diagnosis of rheumatic fever include: a) Mono arthralgia. b) High ESR and positive CRP. c) Prolonged P-R interval. d) All of the above.

Answer 556

d) All of the above.

Question 557

59. The radiographic finding of notching of the ribs is associated with: a) Anomalous pulmonary venous return above the diaphragm b) Coarctation of the aorta c) Pulmonary hypertension d) Systemic hypertension

Answer 557

b) Coarctation of the aorta

Question 558

60. A 14 year old girl suddenly develops jerky movements. The diagnosis is a) Febrile convulsion. b) Huntington’s chorea. c) Myoclonic epilepsy d) Rheumatic chorea

Answer 558

d) Rheumatic chorea

Question 559

61. In rheumatic chorea a) Acute phase reactants are usually normal. b) It is due to involvement of the cerebellum. c) Males are affected more. d) Movements increase during sleep.

Answer 559

a) Acute phase reactants are usually normal.

Question 560

62. Which of the following is not a feature of rheumatic chorea? a) Common in female. b) High ESR. c) Irregular semi purposive movements. d) Static irregular movements.

Answer 560

b) High ESR.

Question 561

63. In rheumatic chorea, which statement is true? a) More common in males. b) There is muscle hypertrophy. c) It is due to affection of the basal ganglia. d) There is hypertonia.

Answer 561

c) It is due to affection of the basal ganglia.

Question 562

64. Regarding innocent murmur, which is true? a) Classic vibratory murmur is heard below clavicles. b) Physiological pulmonary flow murmur is continuous murmur. c) Venous hum is systolic murmur. d) None of the above.

Answer 562

d) None of the above.

Question 563

65. Treatment of choice to prevent recurrence of rheumatic fever a) Digoxin b) Haloperidol. c) Long-acting penicillin. d) Salicylates.

Answer 563

c) Long-acting penicillin.

Question 564

66. Regarding innocent murmur, which is true? a) It is always diastolic murmur b) Sometimes, Echocardiography is abnormal c) Soft faint murmur, mostly systolic d) Usually associated with mild symptoms

Answer 564

c) Soft faint murmur, mostly systolic

Question 565

67. Long acting penicillin for prevention of rheumatic fever is given: a) Every day. b) Every 2-3 weeks. c) Every 4 weeks. d) Every 6 weeks

Answer 565

b) Every 2-3 weeks.

Question 566

68. Infective endocarditis is prevented by a) Antibiotic prophylaxis for dental extraction. b) Proper general dental care and oral hygiene. c) Surgical repair of the cardiac defect. d) All of the above.

Answer 566

d) All of the above.

Question 567

69. Tetralogy of Fallot is not characterized by : a) Blood is shunted from left-to-right side. b) Cyanosis may be absent at birth. c) Cyanotic spells may be treated with P-blockers. d) Cyanosis degree is determined by severity of pulmonary stenosis.

Answer 567

a) Blood is shunted from left-to-right side.

Question 568

70. Complications of Fallot tetralogy do not include : a) Brain abscess. b) Bacterial endocarditis. c) Cerebral thromboses. d) Congestive heart failure.

Answer 568

d) Congestive heart failure.

Question 569

71. The following sign may accompany transposition of the great arteries a) Anginal pain on effort. b) Diagnostic X ray at birth. c) Central cyanosis d) Wide pulse pressure.

Answer 569

d) Wide pulse pressure.

Question 570

72. Which is false about transposition of the great arteries: a) Arterial switch procedure is done b) Central cyanosis early after birth. c) May be complicated by heart failure. d) The condition improves when the ductus arteriosus closes.

Answer 570

d) The condition improves when the ductus arteriosus closes.