1-All cultures in a child are negative.

The tracheal aspirate is positive for lipid laden

macrophages however, this will leading you to a diagnosis of
(A) Aspiration.
(B) Toxic shock syndrome
C) Viral pneumonia
(D) Mycoplasma infection
(E) Parainfluenza infection.

2. The residual lung dysfunction following acute hypoxic respiratory failure is

(A) Exercise intolerance/reactive airway disease.
(B) Chronic cough
(C) Increased diffusion capacity
D) sleep-disordered breathing
(E) No residual dysfunction.

3. Untreated GERD can lead to

(A) Chronic obstructive lung disease
(B) Esophageal dysplasia
(C) Vocal cord nodules
(D) B and C
(E) all of the above.

4-A 15 yr old white girl reports that she has had a fever, weight loss, and night sweats for 3
mo. On physical examination, she is found to have painless swelling of the left cervical and
supraclavicular ymph nodes. Her liver and spleen are not enlarged. The initial evaluation of
the patient should include
A. Bone marrow aspiration
B. Abdominal CT
C. Chest radiography
D. Head CT
E. Erythrocyte sedimentation rate

5-A 10-month-old boy presents to your office for well-child care. He sits unsupported, pulls
to stand but does not cruise, babbles using vowel sounds such as "oooh" and "aaah," is
beginning to use a crude pincer grasp, and waves bye-bye. Which of these prompts further
intervention?
A. Sits unsupported
B. Pulls to stand but does not cruise
C. Babbles using vowel sounds.
D. Uses a crude pincer grasp
E. Waves bye-bye.

6-A 4-year-old child is observed to hold his eyelids open with his fingers and to close one eye
periodically, especially in the evening. He has some trouble swallowing his food. He usually
appears sad, although he laughs often enough. He can throw a ball, and he runs well. Which
of the following is likely to result in the diagnosis?
A. Muscle biopsy
B. Creatine phosphokinase (CPK)
C. Effect of a test dose of endrophonium
D. Chest x-ray
E. Antinuclear antibodies (ANAs).

7- A man with hemophilia has come to you for genetic counselling Which of the following
statements would be incorrect regarding the inheritance of his condition
A. his mother is certainly the carrier from whom he inherited the disease
B. All his daughters will be carriers
C. All his sons will be normal
D. The condition is transmitted in an X linked recessive fashion
E. If his sister has an affected boy she must be a carrier

8- A 6-year-old boy during Physical examination reveals Sexual Maturity rating 3 pubic hair
and sphallus that appears androgen-stimulated (7 cm in stretched length), the MOSt
important additional step to guide your laboratory investigation is
A. Examination of testicular size.
B. Investigation of possible exposure to androgen
C. Investigation of the age of puberty in family members
D. Measurement of height and weight
E. Skin examination for café au lait macules.

9. Which of the following are the two most important prognostic indicators in children in
whom ALL is diagnosed?
A. Age and immunophenotype
B. Sex and white blood cell count
C. Platelet count and imm
D. Immunophenotype and white blood cell count
E. Age and white blood cell count.

10- In Cushing's syndrome, all the following are true EXCEPT

A. May give rise to hypertension, diabetes, and truncal obcsity
B. Is usually diagnosed by estimation of the urinary free cortisol followed by an overnight
dexamethasone suppression test
C. Could be associated with pigmentation
D. The most common cause is probably secondary
E. Nelson's syndrome is a complication of bilateral adrenalectomy for pituitary-dependent
Cushing's disease.

11-A four year old child is found to have the classical murmur of a patent ductus. He is
underweight for age but otherwise well. Which of the following would you recommend for
this patient?
A. Recommend early operative closure
B. Review the child constantly, expecting spontaneous closure within the next five years
tic penicillin until operation is performed.
D. Delay operation until the child has reached its expected weight for age
E. Explain to the parents that this is of little significance and can be ignored.

12- A 6-year-old boy presents with a 5-day history of worsening ataxia following an episode
of gastroenteritis 1 week ago. On physical examination, the child has mild facial diparesis and
areflexia. His gait is ataxic, and the child has weakness of the ankle flexor and extensor
muscles. The test MOST likely to lead to the correct diagnosis is
A. Computed tomography of the head
B. Lumbar puncture
C. Measurement of serum vitamin E levelD.Ultrasonography of the abdomen
E.Urine toxicology screen.

13-Over 70% of normocalcemic children with a calcium-containing kidney stone have at least
one of several risk factors that predispose to tone formation. Risk factors include all the
following EXCEPT:.
A. Female gender
B. Higher dietary purine intake
C. Reduced urinary citrate
D. Urinary infection
E. Hydropenic life-style

14- Typical features of hereditary spherocytosis include the following EXCEPT

A. Splenomegaly
B. Intravascular haemolysis.
C. Increased red blood cell osmotic fragility
D. Transient aplastic anaemia
E. Deficiency of red cell spectrin.

15- The following statements about severe haemophilia A are true EXCEPT
A. Prenatal diagnosis is possible
B. Usually not apparent until the age of 6 months
C. Activated partial thromboplastin time is prolonged
D. Factor VII has a biological half-life of about 12 days.
E. Desmopressin therapy increases factor VIII concentrations.

16-On the fifth day of life, an infant is noted to have a violaceous, circumscribed,
subcutaneous nodule immediately beneath fading forceps marks on one cheek. The infant is
otherwise well appearing. Which of the following is the most likely diagnosis?
A. An abscess
B. A hemangioma
C. A pericytoma
D. Periorbital cellulitis caused byHaemophilusinfluenzae
E. E Subcutaneous fat necrosis.
17- A term newborn expe riences generalized tonic-clonic seizures 1 hour after birth. NVD,
and apgar scores were 9 at both 1 and 5 minutes. The pregnancy was notable for the mother
reporting that the "baby had hiccups." Except for the ongoing seizures, Physical examination
results are normal, and the baby boy is afebrile. Despite full dosing of IV fosphenytoin and
phenobarbital, the seizures continue.Of the following, the MOST likely cause of the child's
seizures is
A. Aicardi syndrome
B. Benign familial neonatal seizures
C. Hypoxic-ischemic encephalopathy
D. Nonketcicn ierglycinemia
E. Pyridoxine dependency

18-Hyponatraemia is found in all of the followings except:

A Severe liver disease
B Bronchial carcinoma
C Cushings syndrome
D Untreated congestive cardiac failure

E Ingestion of ecstasy

19-Recognised complications of poisoning include all the following except:

A Ilypokalaemia with digoxin poisoning.
B Mctabolic acidosis associated with cyanide poisoning
C Increased anion gap with aspirin poisoning
D Hypoglycacmia with ethanol poisoning
E Recepratory alkalosis with theophylline poisoning

20-Hyperprolactinacmia with hypogonadism is found in:

A Hyperthyroidism
B Addison's disease
C A chromophobe adenoma ofthe pituitary.
D Sheehan's syndrome
E Post-cranial irradiation for acute lymphocytic leukaemia.

21-Hyperkalaemia is recognised in all the following except:

Л Type IV renal tubular acidosis
B Nephrotic syndrome
C X-linked hypophosphatacmi
D Rhabomyolysis
E Congenital adrenal hyperplusia.

22-Renal osteodystrophy is associated with all the following except:

A increased absorption of dietary calcium.
B Hyperparathyroidisnm
C Increased phosphate concentrations
D Low 1,25 Dihydroxycholecalciferol concentrations
E Osteomalacia.

23-lleinz bodies in red blood cells in haemolytic anaemia is present in

A paroxysmal nocturnal haemoglobinuria
B Glucose 6 phosphate dehydrogenase deficiency
C post splenectomy
D cold agglutinin disease
E clostridium welchii septicaemia.

24-The following adverse effects are associated with listed drugs Except:
A heart failure and indomethacin
B cutaneous vasculitis and allopurinol
C proteinuria and penicillamine
D myopathy and hydroxychloroquine
E myasthenia gravis and sulphasalazine

25-Klinefelter's syndrome is associated with all following except:

A due to non-dysjunction during meiosis
B inherited as an X-linked recessive condition.
C a cause of hypergonadotrophic hypogonadism
D associated wid-a 47 XXY karyotype
E associated with a delay in bone age

26-The Syndrome of inappropriate ADH secretion all the following are true except:
A is associated with hypothyroidism
B can present with seizures
C is best treated with doxycycline.

D when associated with pneumonia implies an underlying diagnosis of bronchial carcinoma.

e- can precede any radiological signs of cancer

27-Diarhoca can be a presenting feature of the following:

A hypoparathyroidism
B Carcinoid syndrome
C Cushing's syndrome
D Primary hyperaldosteronism.
E Thyrotoxicosis.

28-A loud first heart sound may be due to

A a long preceding diastolic interval
B mitral stenosis
C rupture of a papillary muscle
D increased systemic arterial pressure
E increased pulmonary arterial pressure

29-An 8-year-old boy needs to be coaxed to go to school, and often, while there, he
complains of severe headaches or stomach pain. Sometimes his mother has to take him
home because of his symptoms. At night, he tries to sleep with his parents. When they insist
he sleep in his room , he says there are monsters in his closet. These findings are most
consistent with which of the following diagnoses?
A. Childhood schizophrenia
B. Normal concerns of latency-age children
C. Separation anxiety disorder
D. Socialized conduct disorder
E. Symbiotic psychosis.

30-15- year-old boy has had two episodes of severe anaphylactic shock following bee stings.
Which of the following is the most appropriate intervention?
A. Administration of corticosteroids during the summer
B. Long-term prophylactic antihistamine therapy
C. Protective clothing
D. Desensitization with bee venom extract
E. Restrict him to the house during the summer months.

31-Gastrointestinal disease is the most likely diagnosis in a 10-year-old girl whose only
presenting symptom is
A polycythaemia
B reduced height velocity.**
C hypertrichosis

D. anemia

E cafe-au-lait spots.

32-A mother has contracted rubella during the last trimester of pregnancy. She is very
worried that her baby will be abnormal. You advise her that the most likely risk to the baby in
these circumstances is that he will have
A microcephaly and learning difficulties
B attention deficit hyperactivity disorder
C hepatomegaly with need for prolonged liver function monitoring
D impaired hearing which will require him to be me monitored for at least 2 years.
E visual impairment due to cataracts

33-A 7-year-old boy presents with a 10-day history of purpura on his arms and legs. He
has had 3 days of pain and swelling of his ankles and left knee but is ambulant. On
examination he is apyrexial his capillary refill is 1 second, pulse 100 beats per minute, blood
pressure 105/80 mmlig. Urine dipstick shows blood ++ and protein +++. Bloods on admission
revealed haemoglobin 132 g/L, white count 6.7 x 109/L, platelets 273 × 109/L, sodium 140
mmol/L, potassium 3.7 mmol/L, urea 3.0 mmol/L, creatinine 42 mol/L and C reactive protein
32 Which of the following actions would be the BEST?
A Commence intravenous cefotaxime
B Commence oral prednisolone
C Advise bed rest
D Measure his protein/creatinine ratio on early and morning urine for a Week.
E Measure his serum creatinine monthly for 6 months.

34-The following are true of retinoblastoma except:

A leukocoria is the most common presenting sign
B Calcification is common and can be detected by CT scan of the orbits.
C most cases result from a sporadic mutation in the retinoblastoma gene
D the risk of recurrence in unilateral disease in the unaffected eye is 10%
E patients are at risk of developing secondary malignant tumors at distant sites in later life

35-A 4mo male is brought to you for a well child check. No apparent abnormalities were
noted at birth (APGARS 8 and 9), but you hear a I/VI holosystolic murmur. The mother denies
any episodes of cyanosis or respiratory distress, but doesn't think hes growing very well
(birth wt. 2.7Kg, currently 5.6Kg). ECG shows evidence of left ventricular hypertrophy which
is also supported by CXR. What is your diagnosis?
a)small VSD
b)PDA
c)Aortic Stenosis
d)large VSD.
e)Aortic Coarctation

36-Which of the following statements regarding cooling treatment for perinatal hypoxic
ischemic encephalopathy is not true?
a-Candidates for cooling therapy have perinatal asphyxia, Apgar score of 0-3, acidosis, and
neurologic dysfunction
b-Coagulopathy is a contraindication for cooling therapy
c-Goal core temperature is 32-34°C during cooling therapy
d-During cooling therapy, shivering should be prevented with sedation and neuromuscular
blockade
e-After 72 hours, the patient should be rapidly rewarmed to 36°C

37-The following statements about stroke in children are true EXCEPT

a-The most common causes of ischemic stroke in children are sickle cell disease and heart
disease
b-Atherosclerotic plaque migration is responsible for the majority of ischemic str
c-Stroke presents clinically with focal neurologic deficits or coma in children
D-A diagnosis of stroke requires CT or MRI findings
e-Differential diagnosis of stroke in children includes complex migraine, seizures, and e

38-A 3-year-old child presents to your office for an evaluation of constipation-The mother
notice 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
hedid not stool for 48 h, but has not been in the hospital since. Initial evaluation of this child
should include
a. A child psychiatry eval luation for stool retention and parenting assistance
b- a brium enema and rectal manometry
c. Plain films of the abdomen
d. Dietary log and observation
e. Beginning oral antispasmotic medication

39 A 14-year old boy has sickle cell disease. He presents to the emergency room with the
complaints of increased jaundice, abdominal pain, nausea, vomiting, and fever. His
examination is remarkable for jaundice, pain of the right upper quadrant with guarding, and
a clear chest. Chest radiographs appear normal. The test most likely to reveal the cause of
this pain is
a. Serum chemistries
b. Complete blood count with platelets and differential
c. Ultrasound of the right upper quadrant.
d. Upper GI series
e. Hepatitis panel

40-A 14-year-old girl has a 9-month history of diarrhea , abdominal pain ( usually
periumbilical and postprandial), fever, and weight loss. She has had several episodes of
blood in her stools. Which of the following is the most likely diagnosis in this child?
a. Chronic appendicitis
b. Chronic pancreatitis
c. Crohn disease
d. Bulimia
e. Gallstones

41-A 6-month-old infant has eaten a diet with the following content and intake for the past 5
months: protein 4% of calories, fat 50% of calories, carbohydrates 46% of calories, calories
105per kilogram of body weight per day. The patient's disturbance is
a. Rickets
b. Marasmus
c. Obesity
d. Tetany
e. Kwashiorkor.

42-An 11-year-old child has been diagnosed with hepatitis C infection. Which of the following
may be considered in the treatment of chronic hepatitis C infection?
a. Active vaccination
b. Interferon.
c. Gamma globulin
d. Zidovudine
e. Low-protein diet.
43-An 18-month-old infant is found with the contents of a bottle of Drain cleaner in his
mouth. Which of the following treatment options is appropriate?
a. Emesis is the immediate emergency treatment
b. Endoscopic amnation is indicated within the first 12 to 24 h.
c. Decontamination by activated charcoal is effective-..
e. Having the patient drink copious amounts of milk or water is effective

44- Flat small intestinal mucosa maybe seen in all the following except:
d. Neutralization by drinking a solution of the opposite płH is effective
a-Giardiasis
b- Protein energy malnutrition

c- Eosinophilic gastroenteritis
d- Intesstinal lymphangiectasia.
e-Bacterial overgrowth

45-A neonate's blood differs from that of older children and adults in many respects. Which
of the following correctly describes a characteristic that is particular to the neonate?
a. The RBC of the neonate has a low MCV that increases as the patient ages
b. Newborns have a high hemoglobin concentration that declines over the first 2 days of life.
c. Neonatal RBCs contain primarily embryonic hemoglobin.
d. Newborn blood has higher oxygen affinity than that of a 1-year-old.
e. The neonate has higher levels of protein C than a l-year-old

46-A 15-year-old male had been diagnosed with ulcerative colitis Four weeks ago and is
currently being induced into remission with oral prednisone. he is concerned about the
consequences of taking his medication. What side effects of corticosteroids will you discuss
with the patient?
a. Adrenal insufficiency, hypertension, bone demineralization, and hyperglycemia
b. Adrenal insufficiency, weight loss, acne, and hypertension
e. Hyperglycemia, hypertension, muscle redistribution, and hirsutism
d. Acne, bone demineralization, cataracts, and leucopenia
e. Emotional disturbances, bone demineralization, vitamin D deficiency, and adrenal
insufficieney

47-Which of the following nutritional factors is least helpful in preventing later bone loss?
a. A high peak bone density in the third decade of life
b. High green vegetable intake
c. High cow's milk intake
d. High intake of phosphates.
e. High levels of human milk intake during infancy

48-Which of the following neonates should receive hepatitis B immune after birth?
a. A 38 weeks' gestation neonate (birth weight 3600 g) whose mother is hepatitis B surface
antigen (HBsAg) negative
b. A 39 weeks' gestation neonate (birth weight 3750 g) whose mother has HBsAg serology
that is unknown, but will be confirmed within 24 hours after delivery
c. A 37 weeks' gestation neonate (birth weight 3550 g) whose mother is positive for hepatitis
C antibody only
d. A 34 weeks' gestation neonate (birth weight 2500 g) whose mother is HBsAg negative but
developed chorioamnionitis in labor
e. A 36 weeks' gestation nconate (birth weight 1850 g) whose mother has HBsAg serology
that cannot be resulted until 36 hours after delivery

49- Which of the following statements is consistent with childhood schizophrenia?

a. The onset is usually prior to 5 years of age.
b. Hallucinations and delusions are rare globulin within 12 hours
c. Auditory hallucinations are more common than visual hallucinations.
e. Medications are not prescribed for children with schizophrenia

50-Which of the following is an advantage of pulse oximetry?

a. It is accurate even when there is motion or poor perfusion in the extremity
b. It is the only method of estimating oxygen content during carbon monoxide
c. It is most accurate in the setting of methemoglobinemia.
d. It gives accurate readings regardless of the quality and quantity of external light.
e. It is a noninvasive, nonpainful method of estimating hemoglobin oxygen saturation.
d. Having a parent with schizophrenia does not put a child at risk for schizophrenia.
poisoning.