REPUBLIC OF SOMALILAND

PEDIATRICS WRITTEN EXAMNATION

INSTRUCTIONS:

THIS PAPER CONTAINS TWO PARTS. CHOOSE ONLY ONE ANSWER FOR PART 1
AND ANSWER ALL THE QUESTIONS IN PART 2.

1) The following statements about the influence of diet and lifestyle on lower esophageal sphincter
(LES) function are true except one. Identify the incorrect statement.

A. A high-protein diet increases LES pressure.

B. A fat meal results in sustained decrease in LES pressure.
C. Chocolate ingestion causes a decrease in LES pressure.
D. Peppermint produces a transient decrease in LES values.
E. Cigarette smoking produces no significant changes in LES pressures

2) First-line therapy for routine peptic duodenal ulcer disease includes:

A. Vagotomy and antrectomy.

B. Upper endoscopy and biopsy to rule out tumor.
C. Evaluation for Helicobacter pylori.
D. Serum gastrin determination.
E. C ream or milk-based “Sippy” diet.

3) Eight hours after birth, an infant exhibits excessive drooling and mild
respiratory distress. An abdominal x-ray shows complete lack of air in the
gastrointestinal tract. Which is the most likely diagnosis:

A. Tracheoesophageal fistula, H type

B. Pyloric atresia
C. Choanal atresia (bilateral)

D. Esophageal atresia with distal tracheoesophageal fistula

E. Isolated esophageal atresia

4) With regard to Hirschsprung’s disease, all the following statements are true
except:

A. It is more common in females

B. It may be complicated by enterocolitis

C. Barium enema studies may be normal

D. It is best diagnosed by rectal biopsy

E. Associated anomalies are not common

5) A 5-month-old child regularly regurgitates a large portion of her feeds. A pH

probe study showed significant periods of low esophageal pH. The child has
normal growth, and no other significant past medical history. The best
management at this point is

A. Barium swallow and upper GI series

B. Oral reflux medications

C. Esophageal manometry

D. Close observation only

E. Surgical correction with fundoplication

6) 8A patient has had years of intermittent diarrhea and abdominal pain, but
has never consulted a physician. Eventually he begins to pass fecal material in
his urine and he seeks medical attention. Which one of the following diseases is
most likely to cause this complication?
A. Celiac disease
B. Crohn's diease
C. Diverticulitis
D. Ulcerative colitis
E. Whipple disease

7) Factors involved inGERare following except :

A) high Solid diet.

B) Horizantal body position.

C) Short and narrow esophagus.

D) Immature lowers esophageal sphincter(LES)

D) Anatomical malformation

8) Which of the following is correct regarding Crohn's disease?

A. The distal small bowel and colon are most commonly involved.

B. The typical macroscopic features are fat wrapping, thickening of the bowel
wall, and patchy transmural inflammation.

C. Granulomas must be seen microscopically to make the diagnosis.

D. Extraintestinal manifestations include reactive arthropathy and erythema

nodosum

9) A previously healthy 6-mo-old child develops paroxysmal colicky

abdominal pain. The infant has occasional vomiting. Over the next 12 hr the
infant passes
stool containing blood and mucus and becomes progressively lethargic.
Following fluid

resuscitation, the most appropriate next step in management is:

A. Colonoscopy with polypectomy

B. Stool culture

C. Meckel scan

D. Air-contrast enema

C) Empiric antibiotic therapy

10) Which drug can aggravate GERD symptoms

A) Ranitidine.

B) H2blockers.

C) Omeprazole

D) Theophylline

11) Possible causes for acalculous cholecystitis except:

A) serious injury or burns

B) blood poisoning (sepsis)

C) severe malnutrition

D) HIV or AIDS

E) Gallstone

12) The following statement of Physiologic Jaundice are true except:

A. Jaundice seen in the newborn baby.

B. Usually noticed after 24 -48 hrs. of life

C. Not associated with kernicterus or any neurodevelopmental abnormality.

D. Increased rapidly Direct bilirubin

E. Increased Indirect bilirubin Mostly.

13) A 3-year-old child presents to your office for an evaluation of constipation.

The mother notes that since birth and despite frequent use of stool

softeners, the child has only about one stool per week. He does not have

fecal soiling or diarrhea. He was born at term and without pregnancy

complications.

The child stayed an extra day in the hospital at birth because he

did not stool for 48 h, but has not been in the hospital since. Initial evaluation

of this child should include

A. A child psychiatry evaluation for stool retention and parenting assistance

B. A barium enema and rectal manometry

C. Plain films of the abdomen

D. Dietary log and observation

E. Beginning oral antispasmotic medication

14) An 8-year-old is accidentally hit in the abdomen by a baseball bat. After

several minutes of discomfort, he seems to be fine. Over the ensuing 24 h,
however, he develops a fever, abdominal pain radiating to the back, and
persistent vomiting. On examination, the child appears quite
uncomfortable.The abdomen is tender, with decreased bowel sounds
throughout,but especially painful, with guarding in the midepigastric region.
The test likely to confirm your suspicions is

a. Serum amylase
b. Complete blood count with differential and platelets

c. Serum total and direct bilirubin levels

d. Abdominal radiograph

e. Electrolyte panel

15) Hirschsprung's disease are true except:

A) Post operative diarrhea from enterocolitis is a common occurrence

B) In a newborn infant with abdominal distention and/or vomiting no

mecconium or delay mecconum the first day of life.

C) A digital rectal examination carefully performed is most important in the

diagnosis of Hirschsprung's disease in anewborn infant.

D) Non above.

16) Cardinal features of Idiopathic hypertrophy pyloric stenosis are true except:

A) No bilious projectile vomiting

B) Visible peristaltic waves in the left upper abdomen

C) Hyperchloremic.

D) Non above.

17) Chronic reflux esophagitis is LEAST likely to result in the development of

(A) caused by infection.

(B) corrosive ingestions

C) Traumatic
D) All above.

18) Which of the following is the least common position of appendix is;

A) Retroileal

B) Retroceacal

C) Postileal

D) Pelvic

18)Persist vomting with hypertrophic pyloric stenos is usually causes what

electrolyte imbalance?

A) Metabolic acidosis.

b)Metabolic alkalosis.

C)Respiratory acidosis.

DRespiratory alkalosis

E)Non above

20) ) Extra-intestinal complications of crohn disease is:

A)Intestinal hemmorage.

B) Pyoderma gangrenosum

C) Erythema nodosum

D)B+C.

E)Nonabove.
part two. Answer all the questions briefly.

1)Describe the abdominal pain in children with cholecystitis?

2) What is Hirsch sprung disease and how can you reach the diagnosis?

3) How do ulcerative colitis and Crohn's disease vary in intestinal distribution?

4) Which test is most reliable for the diagnosis of GER?

5) How can you make the diagnosis of celiac disese?