Pediatrics rmony Final Exam 2021 Final Ex: Harmony F mite Univer— fash Si ui H-U-M ' Srereve e, Pio mi mm. Meath School Co pois) Gaal) Ata! oo ae vit 4a)1. All of the following are true regarding autosomal recessive inheritance except: a) Males and females are equally affected b) Recurrence risk is 25% for parents with a previous affected child ©) itis horizontal in transmission d) Male to male transmission essentially confirms this pattern of inheritance e) Sickle cell disease is one example on this pattern of inheritance Answer: D 2. All of the following are possible causes of growth retardation in chronic kidney disease (CKD) in children except: a) Inadequate intake of calories and protein b) Water and electrolytes imbalance ©) Renal osteodystrophy Growth hormone deficiency e) Acid base disturbance Answer: D 3. In gastroenteritis caused by Giardia Lamblia, all are true except: 2) Stool typically contains blood and leukocytes, b) The illness is usually self-limited, lasting 2 to 6 weeks, but may become chronic. ©) The life cycle consists of 2 stages: the trophozoite (motile form), and the cyst. d) Chronic symptoms can include steatorthea, lactose intolerance, and growth retardation. e} The treatment of choice for both symptomatic and asymptomatic patients is, metronidazole. Answer: A 4. All of the following about cyanosis is correct, except: a) it isa physical sign characterized by blue mucus membranes and nail beds and skin b) it appears when the concentration of desaturated hemoglobin is greater than Sem/dl ¢) Newborns with acrocyanosis have blue mucus membranes d) Cyanosis in the newborn can occur from cardiac, pulmonary or neurological causes e) The appearance of cyanosis depends on the hematocrit level Answer: 5. All of the following regarding d-Transposition of Great Arteries are true except: a) ASD alone is enough for effective mixing in this case b) Degree of saturation will depend on the degree of mixing of the 2 "parallel" circuits. ¢) History of cyanosis from birth is always present. d) The S2is single and loud e) Chest x-ray revealed "egg on a string” Answer: A. 6. Treatment of Apnea of prematurity, all true EXCEPT: a) Nasal continuous positive airway pressure b)_ Gentle Tactile stimulation ©) Paracetamol d) Caffeine e) TheophyllineAnswer: C 7. A.10-year-old male, presented to emergency room with palpitation, ECG showed no tachycardia with HR of 85/min, but with short PR interval, delta wave and wide QRS, in this case the child is at risk of a) Ventricular tachycardia b) Ectopic atrial tachycardia ) Multifocal atrial tachycardia d) Supraventricular tachycardia e) Atrial flutter Answer: A 8. One of the followings is rapid acting Insulin: a) Glullsine b) glargine ©) detemir 1d) degludec fe) NPH Answer: A 9. The most common cause of congenital hypothyroidism is: a) Ectopic thyroid b) Dyshormonogenesis ©) Iodine deficiency d) Maternal Hashimoto's disease ) Thyroid agenesis Answer: A 10. A newborn baby is supposed to triple his birth weight at: a) 18 months of age b) 12 months of age ©) 9months of age 4) 24 monthe of age e) 6 months of age Answer: B 111. One is false regarding Pearson syndrome: a). Refractory sideroblastic anemia by 6 months of age 'b) Endocrine pancreatic dysfunction (Diabetes mellitus) ©) mild neutropenia, thrombocytopenia d) Bone Marrow: ringed sideroblasts ) Median survival 3 years Answer: B 12. All of the following disease pathologies can cause wheezing in the lungs except: a) Heart failure b) Foreign bouy asp ) Cystic fibrosisd) Asthma e) Croup Answer: E 13. 6-year-old girl, complaining of progressive headache, lethargy, early morning vomiting, deteriorated school performance and diplopia. The examination of choice to diagnose the case is: a) Brain CT scan ) Brain MA ¢) Technetium scan d) CFS (cerebrospinal fluid) histology e) Alpha-fetoprotein Answer: B 14. All of the following are associated wi a) Maternal rubella infection b) Increased paternal age ©) DTP vaccine d) Tuberous sclerosis complex e) Family history of autism Answer: C 15. The most common cause of peripheral precocious puberty a) Testicular tumors b) McCune Albright syndrome ©) Congenital adrenal hyperplasia d) Adrenal tumors e) Exogenous androgen Answer: C 16. A 5-year-old male was suspected to have meningitis, so lumber puncture was done and showed the following results: WBC: 2000, PMN: 90%, protein: 400 mg/dl, CSF/blood glucose: less than 30%. Regarding the previous laboratory findings, what is the most likely interpretation? a) Normal CSF b) Bacterial meningitis ©) Viral meningitis d) Fungal meningitis e) TB meningitis Answer: B 17. One of the following statements fulfill the Jones criteria of acute rheumatic fever: a) Chorea plus history of previous strep infection b) Subcutaneous nodules plus fever ¢)_ Fever plus prolong PR interval d) Arthralgia plus positive strep test e) arthritis, plus positive throat swab culture for GAS Answer: A}. Regarding the Indications for intrapartum antibiotic prophylaxis to prevent early onset GBS. disease, all TRUE EXCEPT: a) Previous infant with invasive GBS disease b)_ Positive GBS screening culture during current pregnancy c) GBS bacteriuria during any trimester of current pregnancy d) Cesarean delivery before onset of labor regardless of GBS colonization e) Unknown GBS status at onset of labor and amniotic membrane rupture ? 18 hr Answer: D ). Which one of the following statements is correct regarding a S-month-old boy with urinary tract infection (UTI)? a) Catheter urine sample in this age is contraindicated b). Treatment with an oral antibiotic Is usually preferred 9) Seven-day course of an appropriate antibiotic is usually sufficient. d)_ Symptoms of UTI are usually clear and specific e) Isotope scans are usually preferred for the diagnosis of renal scars. Answer: E All of the following are true regarding some chromosomal anomalies except: a) Turner syndrome may associate with coarctation of aorta b)_ Noonan syndrome is a chromosomal defect that affects only females 9) Down syndrome is at risk of congenital heart diseases 4) Edward syndrome isa trisomy 18 €) Mosaicism type of turner has an increased risk of developing gonadoblastoma Answer: B . A few hours old, full term, normal vaginal delivery newborn, started to have cyanosis few hours after delivery with 02 sat of 60% that didn’t improve with 02 therapy, all of the following may be a cardiac cause of this presentation except: a) Transposition of great arteries b)_Ebstein anomaly ©) Pulmonary atresia d) Tricuspid atresia e) Atrioventricular septal defect Answer: E . The risk of RDS increases in all except: a) Prematurity b) Maternal diabetes c) Prolonged rupture of membrane d) Asphyxia e) Cold stress Answer: C }. One of the followings is NOT an acute complication of sickle cell disease: a) Transient pure red cell aplasia b) Acute chest syndrome©) Renal failure d) Splenic sequestration e) Priapism. Answer: C 24. The testicular volume before puberty is less than: a) smi by smi ©) 4mi a) 3mi e) imi Answer: D 25. The definition of epllepsy Includes all the following components except: a) Seizures need to be recurrent b)_ Seizures resulting from paroxysmal involuntary disturbances of brain function ©). Focal seizures indicate localization in one area in the brain d) Symptomatic epilepsy refers to seizures with specific motor or sensory symptoms €) Epileptic seizure should not be provoked by electrolyte disturbances Answer: D 26. One of the following statements is true regarding healthy individuals with selective IgA deficiency? a) Lymphopenia is a common finding in selective lgA deficiency b) They are more likely to develop Lymphoma than those with normal IgA levels. ©) Will always have a high risk of HIV infection d) They have 2 high risk of a recurrent serious bacterial infection e) They have @ higher risk of developing an organ specific autoimmune disease than the general population, Answer: E 27. One of the following is a typical character of innocent murmur: a) Pansystolic murmur at apex b)_ Vibratory systolic murmur Grade I! at left sternal border ©) Harsh Ejection systolic murmur at Left sternal border Grade IV Systolic murmur Early diastolic murmur Grade Il Answer: B 28. A 3-day-old infant presents to the emergency department with vomiting, lethargy, hypotonia, and jaundice. Physical examination reveals hepatomegaly and neurologic depression. A full sepsis evaluation is undertaken, and the Gram stain of the cerebrospinal fluid reveals gram- negative organisms. Which one of the following is the most likely diagnosis? a) Galactosemia b)_ Glycogen storage disease ©) Tyrosinemia d)_ Fatty acid oxidation defect e) PhenylketonuriaAnswer: A 23, Previously healthy 4-year-old child presented with language regression, (acquired aphasia) with normal hearing assessment, EEG was pathologic and showed frequent epileptiform activity, What is your diagnosis? a) Childhood absence epilepsy b).Rolandic epilepsy ©) Landau Kleffner syndrome d) West syndrome e) Lennox Gastaut syndrome Answer: C 30. Regarding G6PD deficiency, which is NOT a feature of this disease: a) Mode of inheritance Is X-linked recessive b) Neonatal jaundice is the earliest symptom ©) Treatment includes avoidance of oxidative drugs d) Anemia and reticulocytopenia e) Patient may need blood transfusion during acute hemolysis Answer: D 31. Which one of the following aspects of the history is characteristic of breath holding spells? a) Usually start at age of 2 months b) There is a postictal state ©) Developmental delay d)_ Positive family history for epilepsy e) Precipitated by crying or anger Answer: E 32. All of the following are expected complications in a child with frequent relapsing primary nephrotic syndrome except: a) Pneumococcal peritonitis b) Trace element deficiency. ) Deep venous thrombosis. d)_ Recurrent meningitis e) Short stature. Answer: D 33. One of the following tests can be used to confirm the diagnosis of asthma: a) OR b) CBC eosinophil count ©) Spirometry with a positive bronchocilator response d) CT scan of the lung e) Skin test for allergic sensitization. Answer: C 34, One week old newborn presented with severe indirect hyperbilirubinemia; Kernicterus was suspected. This baby is at risk for which one of the following types of cerebral palsy: a). Spastic hemiplegic cerebral palsySpastic diplegic cerebral palsy Spastic quadriplegic cerebral palsy Ataxic cerebral palsy Athetoid cerebral palsy Answer: E 35. You are evaluating a 2-months old floppy baby, you are concerned about spinal muscular atrophy typel (SMA1). Regarding SMA1, all of the following are true except: a) Patients usually have myopathic faces. b) Absent deep tendon reflexes ©) Tongue fasciculation d) The genetic defects are localized on chromosome Sq13, ©) Most of the patients die in the first year of life Answer: A 36. All of the following are criteria to diagnose Systemic lupus erythomatosis, EXCEPT: a) Photosensitivity b) pleuritis ©) glomerulonephritis 4) Positive Antiphospholipid antibody @) leukocytosis Answer: E 37. All of the following are vaccines that ar a) Hepatitis B vaccine b) Haemophilus influenza non typable ©) Rota vaccine d) Polio vaccine e) Diphtheria, tetanus, Pertussis vai Answer: B 38. All of the following are symptoms of ADHD except: a) Inattention b). impulsivity c) Fidgeting d) Stuttering ©) Excessive talking Answer: D 39, The recommended age to start solid foods is: a) 6 months b) 3 months ©) 9 months d) months e), 12 months Answer: A40. An infant with diarthea is 10% dehydrated. His weight is 5 kg. The child's serum sodium concentration is normal. What is the approximate total amount of fluid (maintenance and. deficit) you should deliver to the patient in the first 24 hours? a) 750 mL. b) 1000 mt. ©) 1250 mt. d) 1500 mt. e) 1750 mt. Answer: B 41. All the following are true about the respiratory rate in a child, except: a) Very important measure of respiratory distress b) The number of breaths per minutes gets lower 3 the child grows up ©) elevated respiratory rates In Infants can be associated with pneumonia d)_ The respiratory rate is very regular and can be taken over 15 seconds and multiplied by 4, to get a breath per min number e) infants who have a fever have an increased respiratory rate Answer: D 42, Which of the flowing is true about pertussis? a) itis also known as whooping cough b) Itisnot a significant cause of apnea in infants 6) Treatment with azithromycin is curative a) The cough usually lasts about a week €) Infants can be fully protected by vaczination. Answer: A 43, A T-year-old child known case of end stage renal disease, on hemodialysis, presented with fever (38 C), conjunctival hemorrhage, and tender subcutaneous nodules on finger pads, echo showed myocardial abscess. One of the following microorganisms is more likely to cause his condition: a) Staph. aureus b) Candida ¢). Strep. pneumonia d) Enterococci e) Haemophilus influenza Answer: A 44, Which of the followings is NOT a clinical feature of thalassemia patients? a) Cardiomyopathy, heart failure b) Diabetes mellitus ©) Leg ulcers, gallstones and Skin bronzing d) precocious puberty e) splenomegaly Answer: D 45. 13-year-old male, strict vegetarian, presented to your clinic complaining of pallor and ‘numbness in hands and feet. Otherwise, is healthy. His labs will show one of the followings:Low MCV Hyper segmented neutrophils Low RBC folate levels High reticulocytes count Indirect hyperbilirubinemia Answer: B 46, Precocious puberty is the appearance of secondary sexual development before the age of: a) 9 years in boys or 8 years in girls b) 8 years in boys or 7 years in girls ©) 8 years in boys or 9 years in girls d) 8 yearsin boys or 7 years &) 9years in boys or 6 year: Answer: A 47. The most common cause of food allergy during infancy: a) Allergy to eggs b) Allergy to peanuts €) Allergy to fish d) Allergy to cow's milk protein e) Allergy to chocolates Answer: D ‘48. In a 6-year-old child with recurrent chest infections and failure to thrive, all of the following features are suggestive of cystic fibrosis except: a) Chronic cough b) Chronic sinusitis ©) Family history of similar condition d) Prolonged neonatal jaundice e) Recurrent skin absences Answer: E 49. A 2-year-old child is supposed to do one of the following: a) Ride a tricycle b) Tell story ©) Have hand preference dd) Make tower of 10 cubes e) Copyacircle ‘Answer: C 50. Regarding BCG vaccine, one of the following is TRUE: a) Allimmunocompromised patients should receive the vaccine b) History of receiving the vaccine does not affect the PPD test ¢) itisa live attenuated vaccine d)_ Regional lymphadenitis occurs in all newborns receiving the vaccine 2) Itis given orally Answer: C (also B should be correct but I'm not sure)51. All of the following matches between congenital heart defect and murmurs/heart sounds are true except: a) Ventricular septal defect and Pansystolic murmur b) Tetralogy of fallot and Pansystolic murmur ©) Mitral valve prolapse and systolic click d) Patent ductus arteriosus and machinery murmur ) Pulmonary stenosis and ejection systolic murmur Answer: 8 52. Concerning H-pylori gastritis in children, all are true except: a) H pylori is a gram-negative, S-shaped rod b) Mode of transmission is fecal-oral ©) Risk factors for infection with h pylori are low socioeconomic status and affected fe members All children infected with H pylori are often symptomatic. In children, H. pylori infection can manifest as refractory iron deficiency anemia Answer: D 53. Which one of the following is the most common cause of nephrotic syndrome in @ 2-month- old infant? a) Minimal change disease. b) Focal segmental glomerulosclerosis Membranous nephropathy. 4) Congenital nephrosis. @) Alport syndrome. Answer: D 54, 4-year-old boy, newly diagnosed case of AML, after initiating the induction chemotherapy, he developed vomiting, muscle cramps and seizure. You are suspecting tumor lysis syndrome. What laboratory results support your diagnosis? a) Low potassium, high sodium, high phosphate b) High potassium, low calcium, low phosphate ©) High uric acid, high potassium, low calcium d) High calcium, low potassium, high phosphate e) Low uric acid, high potassium Answer: C 55. A 1-year-old with pallor has a hemoglobin of 8 mg/dl, his MCV was 59 normal (75-80), he is breast fed exclusively, all of the following is true except: a) Most likely the infant has iron deficiency anemia b) He is likely to be vitamin D deficient. ©) Reticulocyte count is usually elevated d)_ Serum ferritin is probably low in iron deficiency anemia e) Breast fed infants need to be started on iron supplementation at 4 months of age Answer: C 56. All of the following are symptoms and signs of measles infection, EXCEPT: a) Itchy vesicular rashPresence of koplik spots Fever Dry cough conjunctivitis Answer: A 57. Which ONE of the following type/s of precautions is/are used to prevent transmission of Varicella zoster virus? a) Standard precautions alone b) Droplet precautions alone ©) Standard and droplet precautions d) Standard and contact precautions e) Standard, contact, and airborne precautions Answer: E 58. All of the following are signs of increased intracranial pressure EXCEPT: a) Systemic hypertension b) Tachycardia ¢) Altered level of consciousness 4) Bulging anterior fontanel ) Irregular respiration Answer: B 59. All of the following regarding Tetralogy of fallot are true except: a) TOF is the most common cyanotic heart disease b) Pulmonary valve Stenosis is one of its features ©) Cerebral thrombosis is one of its complications if not treated d) ECG revealed left ventricular hypertrophy e) Chest x-ray showed boot shaped heart Answer: D 60. All of the following are true regarding an infant with neonatal lupus, EXCEPT? a) Congenital Heart block is permanent b) Hematological changes are transient )_ Result from the passive transfer of maternal IgM antibodies to the fetus d) Might develop SLE in adulthood ©) Associated with maternal anti-Ro and anti-La antibodies Answer: C 61. Regarding Henoch-Schonlein purpura, all of the following is correct except: a) Complement C3 and C4 level is normal b) Renal involvement may present with mixed nephritic-nephrotic picture €)_ Intussusception is a recognized acute complication d) Knee and ankle arthritis may lead to permanent damage. e) Sepsis should be included in the differential diagnosis Answer: D 62. Regarding transient tachypnea of newborn, one is CORRECT:Disease of prematurity Onset of respiratory distress is within 1-2 hours Treatment is surfactant Ground glass appearance and air bronchogram X-ray finding Usually require 100% 02 to resolve Answer: B 63. In the management of DKA all of the following should be avoided except: a) Sodium bicarbonate b) Bolus of insulin at presentation ©) Rapid rehydration d) Rapid decrease in glucose e) Normal saline for more th Answer: A |. All of the following is considered a red flag in recurrent abdominal pain except: a) Jaundice b) Occult blood in stool ©) Periumbilical pain d) Oral aphthous ulcer e) Delayed puberty Answer: C . All of the following microorganisms are COMMON causes of bacterial meningitis in newborns, EXCEPT a) Group B streptococcus b) E.Coli ©) Enterobacter d) Listeria monocytogene e) Streptococcus pneumonia Answer: E . An 8-month-old infant is brought to the ER, in the winter. He has a cough and shortness of, breath and low-grade fever, he has bilateral wheezing on chest exam, his pulse oximeter reading is 85%, this is his first episode. All the following is true about his condition except: a) RSV virus can be a cause of his symptoms. b)_ Bronchiolitis is his most likely diagnesis. ) This patient has a higher risk of getting asthma when older. 4d) Infants under 6 months do not get this disease. e) Premature infants are at a higher risk for more severe disease Answer: D . Antenatal steroids reduce all except: a) Necrotizing enterocolitis b)_ RDS ©) Severe IVH d) Neonatal sepsis e) Neonatal mortalityAnswer: D 68. Maternal chorioamnionitis is a well-recognized risk factor for early onset neonatal sepsis, includes all except: a) Maternal fever b) Neonatal fever ©) Fouksmelling vaginal discharge d)_ Maternal leukocytosis>15,000 e) Fetal tachycardia-160 Answer: B 69. A 4-year-old presented with fever, cough and shortness of breath, he has tachypnea and crackles over his right lower lobe. His oxygen saturation was 87%, he has been less active with almost no oral Intake all day, the following sentences are true about this patlent except: a) His condition can become complicated by a pleural effusion b) ACBC, CPR and electrolytes tests are useful ©) Ablood culture can reveal the causative organism d) Sputum culture is an essential part of the workup e) CXR if obtained will most likely show an infiltrate Answer: D 70. A 9-month-old unvaccinated male was admitted to the hospital with severe dehydration secondary to gastroenteritis. Regarding Rota virus vaccine, all of the following are true, EXCEP) a) Itis given orally b) One rare complication of Rota vaccine is Intussusception ©) According to our Jordanian National Program it is given as 3 doses, d) We can give it to a one-month-old infant e) Itisa live attenuated vaccine Answer: D 71. 5-year-old girl known case of acute lymphoblastic leukemia. During admission to receive chemotherapy, she developed lower abdominal pain, gross hematuria, urinary urgency and the sensation of incomplete bladder emptying. The diagnosis was hemorrhagic cystitis. What is the most likely chemotherapeutic agent causes this side effect? a) Daxorubcin b) Asparginase ¢) Cyclophosphamide d) Mercaptopurine e) methotrexate Answer: C 72. At which age does beta chain production exceeds gamma chain production? a) During fetal life b)_ At birth ©) At age of 4 months d) At age 10 months e) Atage 1yearAnswer: C 73. All of the following statements are TRUE about pyloric stenosis EXCEPT: a) itis associated with usage of macrolides during infancy. b)_Bilious vomiting is the classic presenting complaint. ©). patients may have a hyperchloremic. hypokalemic metabolic alkalosis. d) This diagnosis can be made by contrast studies or ultrasonography, e) The hypertrophied muscle can sometimes be felt on abdominal exam. Answer: B + C (both are correct) 74, An 8-month-old male infant, presented with history of shortness of breath, general fatigue and cold extremities, ECG showed HR: 200/1min, narrow QRS with absent P wave. The most likely etiology is: a) Myocarditis b) Supraventricular tachycardia ©) Ventricular tachycardia d) Rheumatic fever e) Severe anemia Answer: B 75. While assessing a child with diarrhea you noticed that his diarrhea stopped whenever he was fasting. This means that the mechanism of this diarthea is: a) Secretory b) Osmotic ©) Increased motility d) Mucosal invasion e) Decreased surface Answer: B 76. During the examination of a well looking 1-month-old infant with jaundice you note that his liver span is 15 cm and his diaper was full of clay colored stool. The most important pathology to rule out is: a) Biliary Atresia b) Galactosemia Cystic fibrosis, d) Tyrosinemia ©) Alpha-one anti-trypsin deficiency Answer: A. 77. All of the following increase the chance of pathological hyperbilirubinemia except a) Presence of jaundice in the first day of life b)_ Serum bilirubin is rising at a rate faster than 2 mg/dL/24 hr. ©). Serum bilirubin is >12 mg/dL in a full-term infant or 10-14 mg/dL in a preterm infant d) Jaundice persists after 10-14 days of life e) Family history of hemolytic disease, pallor, hepatomegaly, splenomegaly Answer: B 78. Fat maldigestion or malabsorption results in all the following manifestations except:Weight loss and malnutrition Rickets Diarrhea Coagulopathy Dermatitis herpatiformis Answer: E 79. All the following statements about Glucose-Galactose malabsorption are true except: a) itis an autosomal recessive. b) It presents in the neonatal period. ©) Diarthea persists on breast feeding as well as on standard infant formula. d)_Hyponatremic dehydration is often present. ©) Intestinal adaptation to glucose and galactose with age Answer: D 80. All are features of the most common type of congenital adrenal hyperplasia except: a) Low aldosterone b) Hyperkalemia ©) Lowsenin a) Hypoglycemia ) Elevated ACTH Answer: C 81. All the following are correct statements regarding urinary tract infection (UTI) in children except: a) Primary vesicoureteral reflux is a common cause of UTI. b) Kidneys in infants are more susceptidle to renal scar formation as compared to older children. Supra-pubic urine culture specimens an acceptable procedure in children younger than 3 years of age. Voiding cysto-urethrogram is required if the ultrasound reveals hydronephrosis. Candida is a rare cause of UTI Answer: C £82. All are causes of pancreatic insufficiency except: a) Shwachman-Diamond syndrome Johanson-Blizzard syndrome Pearson syndrome Cystic Fibrosis Alpha-one anti-trypsin deficiency Answer: E ‘83, A premature baby who was born on 32 weeks gestation, presented to your clinic at age of 5 months for developmental assessment, he should be able to do one of the following: a). Reach out for object, b) Coos ) Laughs out loudly d) Good head controle) Sits with support Answer: B ‘84, All of the following are manifestations of juvenile dermatomyositis, EXCEPT: a) Elevated creatinine kinase b) Heliotrope dermatitis c) Might develop muscle contracture and wide spread calcinosis d)_ Fiber necrosis and inflammation on muscle biopsy e) Associated with increased risk of cancer Answer: E £85. All of the following congenital heart defects associated with plethoric ung except: a) Large ventricular septal defect, b). Large patent ductus arteriosus ©) Pulmonary atresia d) Atrioventricular septal defect e) Transposition of great arteries Answer: C ‘86, The following are true about asthma and atopy, except: a) Atopy is an important risk factor for the development of asthma b) About 40-80% of children with asthma have a positive allergy skin test to an allergen ¢) Ahistory of allergic rhinitis and eczema are clues to the presence of atopy d)_Ig€ levels are usually low in patients with atopy e) infants with atopy and recurrent wheezing are more likely to become asthmatic after the age of 6 years, Answer: D ‘87. A 4-year-old child has an episode of cough with shortness of breath, has been recurrent, he had many prior episodes, he usually had an immediate respond to a medication given a nebulizer, most likely this medication is: a) Theophylline b) Inhaled steroid 6). Salbutamol/Albuterol d) Tpratropium bromide e) Terbutaline Answer: C 88, Regarding neurofibromatosis type 1, all are true except: a) Cafe au lait spots should be six or more, more than Smm prepubertal and more than 15mm post pubertal b) Itis associated with optic nerve glioma ©) Patients have increased risk of epilepsy d) itis usually inherited as autosomal recessive e) About 50% of the cases are new mutations Answer: D 89. A G-year-old child has type 1 DM, the probability of his brother to have the same disease is:50% 30% 25% 6% 2% Answer: D All of the following may raise the suspicion of chronic kidney disease in children except: a) Small asymmetric kidneys on ultrascund b) Radiological evidence of rickets ©) Previous history of acute kidney injury d)_ Single kidney ©) Persistent proteinuria Answer: . One year-old-male had fall from chair. He developed bruises and knee hemarthrosis. The ‘mother said that he was healthy and denied any similar previous episodes. His cousin has the similar bleeding problem. Which of the followings results support your diagnosis? 2) Prolonged prothrombin time (PT), normal activated partial prothrombin time (aPTT) b) Prolonged bleeding time. prolonged aPTT ) Prolonged aPTT, normal PT 4d) Normal bleeding time prolonged thrombin time ) Prolonged aPTT. prolonged PT Answer: € . All of the following statements are correct regarding nephrotic syndrome (NS) in a S-year-old child except: a) The most common cause of NS is minimal change disease (MCNS). b) Most patients are responsive to steroid therapy. ©) Gross hematuria may occur occasionally. d)_ Kidney biopsy is required if he proves to be steroid resistant. e) Levamisole may be of benefit if his course reveals steroid dependence. Answer: C All the following conditions can cause (pre-renal) acute renal failure in children except: a) Cardiac tamponade b) Diuretics and ACE inhibitors ¢) Dehydration d) Hemolytic uremic syndrome e) Sepsis ‘Answer: D |. One of the following regarding immune response to vaccination is TRUE: a) Elderly has better immune response than children b)__ Immune response is not affected by nutritional status ©) Two different life attenuated vaccines can be given 2 weeks apart d) Chronic diseases can diminish the immune response e) Vaccines with adjuvants can be given subcutaneousAnswer: D 95. All of the following may cause red-dark urine where NO hematuria is present except: a) Hemolysis due to G6PD deficiency b) Alkaptonuria ©). Acute post strep. nephritis d) Urate crystals €) Rhabdomyolysis Answer: C 96. A one-year-old infant weighs 10 kilograms ertives to the emergency department with a 2-day history of diarthea and poor fluid intake. On examination reveals a lethargic child; his heart rate is 180, and his blood pressure is low for age. He has poor skin turgor, 5-second capillary reflll, and cool extremities. Which of the following Is the most appropriate Initial management? a) 1000 cc of Dextrose 5% in 1/4 normal saline (D5 1/4 NS) per 24 hours b) 1500 cc of Dextrose 5% in 1/2 normal saline (D5 1/2 NS) per 24 hours ©) 200 cc of normal saline over 20 minutes d) 50 ce of whole blood over 4 hours e) 200 cc of dextrose 10% in water (D10W) over 15 minutes Answer: C 97. 5-Month-old female previously healthy, presented to the emergency department with fever and irritability. All of the following signs and symptoms might present in a) headache b) Poor oral intake ©) Projectile vomiting d) Generalized seizure e) Lethargy and hypoactivity Answer: A 98, All of the following statements regarding infantile spasms (West syndrome) are correct except: a) The onset peaks at age 4-8 months b) They are characterized by a sudden tonic flexor or extensor spasm ©) They occurin clusters d) The EEG classically shows a 3 per second spike and wave e) They are associated with encephalopathy Answer: D ‘99. All of the following findings in cyanotic heart defects are true except: a) Tachypnea may present but usually without retractions b) Heart murmur may be absent in serious forms of cyanotic heart defects c) Dramatic improvement in PaQ2 with oxygen administration d) Lack of crackles or abnormal breath sounds unless congestive heart failure is present @)Cyanosis appears when deoxygenated hemoglobin is more than 5 gram/kg Answer: C1100. All of the following congenital heart diseases associated with Left to Right shunt except: a) Atrial septal defect (ASD) b) Ventricular septal defect (VSD) ) Patent ductus arteriosus (PDA) d) Atrioventricular septal defect (AV CANAL] e) Tetralogy of fallot (TOF) Answer: E