Pediatric Fel… / First Part Exa…

First Part Exam - March 2015

1. Aschoff's nodules of rheumatic carditis affect mainly:
a. Posterior wall of right atrium
b. Anterior wall of right atrium.

c. Posterior wall of left atrium

d. Anterior wall of left atrium

e. Left ventricle.
2. Microscopically, the vegetations of infective endocarditis show:
a. Platelets
b. Red blood cells
c. Eosinophils
d. Lymphocytes
e. All of the above
3. Which of the following types of malignant neoplasms is least frequent in children?

a. leukemias
b. sarcomas
c. neuroblastoma
d. adenocarcinomas
e. lymphomas
4. Microscopically, the pathognomonic cells of Hodgkin lymphoma are:
a. Histiocytes.
b. Lymphocytes.
c. Eosinophils.
d. Reed-Sternberg cells.
e. Foamy cells.
5. In the stage of grey hepatinization of lobar pneumonia:

a. The red blood cells are present in large number.

b. The polymorphs and macrophages are present in large number.
c. The exudate cells show a healthy appearance
d. Leads to interstitial lung fibrosis.
e. None of the above.
6. Crohn's disease is characterized by:

a. X-linked inheritance.
b. Granulomatous non-specific inflammation of the lower ileum.
c. Granulomatous non-specific inflammation of the stomach
d. History of chloramphenicol therapy
e. presents as pseudomembrane
7. Presence of red cell casts in urine analysis indicates:

a. Glomerulonephritis
b. Nephrotic syndrome
c. Urinary Tract Infection
d. Renal stone

e. Polycystic kidney
8. Regarding macrophages the following is a TRUE statement:

a. Derived from blood lymphocytes.

b. Have a shorter life span than neutrophils

c. Produce cytokines
d. Not related to delayed hypersensitivity response

e. is present in the bloodstream only

9. Hashimoto's disease is characterized by:
a. Asymmetrical thyroid enlargement
b. Adherence to surrounding tissues.
c. Predominance in males than females
d. Presence of excess lymphoid tissue between thyroid acini

e. Presents mostly as hyperthyroidism.

10. Regarding neurofibromatosis which of the following is NOT TRUE?

a. Association with pigmented iris hamartomas

b. Inheritance in an autosomal dominant fashion.

c. Cafe au lait skin pigmentation

d. No malignant potential.

e. Association with paroxysmal hypertension,

11. A 13-year-old boy who has insulin-dependent diabetes mellitus is in severe ketoacidosis. Blood
studies reveal: pH, 7.0; glucose, 632 mg/dL; and potassium 3.0 mEq/L. You begin treatment to
correct the acidosis using isotonic saline. For each rise of 0.1 unit in serum pH, the serum
potassium concentration is MOST likely to:
a. decrease 0.1 mEq/L
b. decrease 1.0 mEq/L
c. increase 0.1 mEq/L

d. increase 1.0 mEq/L

e. remain unchanged
12. The sinus venosus forms:
a. Aorta

b. Left ventricle
c. Right ventricle

d. Left atrium
e. Right atrium
13. A 1500 g infant is born at 33 weeks' gestation. His weight is at the 15th percentile for gestational
age. Among the following, the BEST description of this infant is
a. preterm, appropriate for gestational age

b. preterm, large for gestational age

c. preterm, small for gestational age

d. term, appropriate for gestational age

e. term, small for gestational age
14. A 1200 g infant born at 30 weeks' gestation requires ventilator support for 2 months. During this
time, enteral feedings provide 40% of caloric requirements and parenteral nutrition provides the
remainder. At 2 months of age, the infant is noted to have a fracture of the eighth right rib. Of the
following, the MOST likely etiology of this fracture is deficient intake of

a. carbohydrate
b. medium-chain triglyceride

c. phosphorus
d. protein
e. vitamin D
15. Pea soup-like meconium was noted at rupture of the membranes in a term pregnancy. During
labor, fetal heart rate monitoring shows a normal pattern. Among the following, the MOST
appropriate care for this infant at birth is to:

a. deliver the infant and intubate immediately

b. deliver the infant and observe

c. deliver the infant and provide positive pressure ventilation by bag and mask
d. intubate the infant when the head is delivered

e. suction the mouth and hypopharynx

16. An 1800 g infant born at 34 weeks' gestation is being fed enterally with a 24 kcal/oz formula
developed for preterm infants. The formula contains supplemental medium-chain triglycerides.
Among the following, the BEST explanation for using medium-chain triglycerides is to is to:

a. decrease water in stools

b. enhance absorption of calcium

c. enhance absorption of iron

d. enhance absorption of vitamin C

e. prevent malabsorption of fat

17. Findings of a newborn screen done on a term infant at 3 days of age include a filter paper
thyroxine (T4) level of 6.9 mcg/dL (normal, 11.5 to 24 mcg/dL) and a thyroid-stimulating hormone
(TSH) level of 28 mcU/mL (normal, 3 to 18 mcU/mL). The BEST next step in assessing this infant
is to:
a. begin oral thyroxine therapy

b. measure the serum thyroid-binding globulin level

c. observe for symptoms of hypothyroidism

d. obtain a radioisotope scan of the thyroid

e. remeasure the T4 and TSH levels
18. A 2-month-old girl is brought to the emergency room with a history of persistent vomiting and
loose, watery stools. Which of the following would be the EARLIEST sign indicating shock?

a. Capillary refilling time greater than 3 sec

b. Heart rate greater than 120 beats/min

c. Rectal temperature less than 34.4°C (94°F)

d. Respiratory rate greater than 40 breaths/min

e. Systolic blood pressure less than 70 mm Hg

19. A newborn has anomalies of the external ear, micrognathia, and glossoptosis. You suspect Pierre
Robin sequence. Of the following the condition MOST likely to be associated with these findings
is:

a. cleft palate
b. coloboma

c. duodenal atresia
d. hypothyroidism

e. spina bifida
20. A 3-year-old boy who has had a fever and nasal discharge for 2 days is brought to the emergency
room following a generalized seizure. Past history reveals that he has received all appropriate
immunizations. He is receiving oral theophylline and nebulized albuterol for asthma. He is
lethargic but arousable. The neck is lax. All other findings are normal Of the following, the test
MOST likely to determine the etiology of this boy's seizure is:

a. blood culture
b. cerebrospinal fluid analysis

c. electroencephalogram
d. serum sodium level

e. serum theophylline level

21. An 18-month-old boy is believed to have swallowed a hearing aid battery. He has slight drooling
but is in no acute distress. The BEST course of action at this time is to:
a. have the child drink milk to neutralize the caustic contained in the battery
b. monitor stools for spontaneous passage of the battery
c. obtain radiographs of the chest and abdomen to determine the position of the Battery
d. refer for emergency laparotomy to remove the battery
e. refer for an emergency upper endoscopy to remove the battery
22. A 2100 g infant born at 34 weeks' gestation by cesarean section because of fetal distress
develops respiratory distress soon after birth. Testing of the amniotic fluid 4 days previously
revealed immaturity of the fetal lungs. Thin meconium was noted in the amniotic fluid at delivery.
Chest radiography demonstrates a ground glass appearance bilaterally. The MOST likely cause of
this infant's respiratory distress is:

a. group B streptococcal pneumonia

b. meconium aspiration syndrome

c. Persistent pulmonary hypertension

d. surfactant deficiency

e. Transient tachypnea
23. An 8-week old infant who has extrahepatic biliary atresia undergoes an unsuccessful Kasai
procedure. Postoperatively, tests of liver function reveal: alanine aminotransferase activity, 230 IU;
gamma-glutamyl transferase activity, 859 IU; total bilirubin, 10.0 mg/dL; and direct bilirubin, 9.3
mg/dL. of the following, the BEST formula for this infant is:
a. casein-based formula

b. fat-modified formula with medium-chain triglycerides

c. modular formula with branched-chain amino acids

d. soy-based formula
e. whey-based formula
24. A 2000 g healthy infant born at 33 weeks' gestation is discharged at 7 days of age. The
hematocrit at birth was 50%. Among the following the hematocrit level at 6 weeks of age is MOST
likely to be:
a. 22%

b. 30%
c. 38%

d. 46%
e. 54%
25. At birth, a 2000 g infant is noted to be apneic and to have a heart rate of 50 beats/min.
Cardiopulmonary resuscitation is begun immediately. The MOST appropriate ratio of chest
compressions to interposed breaths is:

a. 1:2
b. 1:1

c. 2.1
d. 3.1
26. Among the following the MOST common etiology of status epilepticus in a 6-month old infant is:
a. benzodiazepine ingestion

b. hyponatremia
c. medulloblastoma

d. Reye syndrome
e. ruptured cerebral aneurysm
27. The hormone produced by Kidneys is:
a. Erythropoietin
b. ADH (ant diuretic hormone)
c. Angiotensin II

d. ANP (atrial natriuretic peptide)

e. Cholecalciferol
28. Release of which ONE of the following increases the pH of duodenal content:
a. Secretin

b. Gastrin
c. Intrinsic factor

d. Cholecystokinin
e. Gastrin releasing peptide
29. Calcium uptake in the intestine:

a. is passive
b. Requires a carrier protein on the mucosal side

c. is by facilitated diffusion
d. is less than 10% of dietary intake
e. is facilitated by phosphate
30. Which immunoglobulin would exist as a monomer in tears, saliva & mucus:

a. IgA
b. IgG

c. IgM
d. IgE

e. IgD
31. Antithrombin Ill affects (inactivates) which coagulation factor?

a. Xlla
b. Xa

c. IIa
d. IXa

e. All of the above

32. Hemoglobin contains:
a. One protoporphyrin ring and 4 ferrous ions
b. Four protoporphyrin rings and one ferrous ion

c. Four protoporphyrin rings and four ferrous ions

d. One protoporphyrin ring and one ferrous ion

e. One protoporphyrin ring and 2 ferrous ions.

33. Which ONE of the following is a water-soluble vitamin?

a. Vitamin A
b. Vitamin B

c. Vitamin D
d. Vitamin E

e. Vitamin K
34. The energy value of 1g of carbohydrate is:

a. 3 kcal
b. 4 kcal

c. 5 kcal
d. 7 kcal

e. 9 kcal
35. Tidal volume of a neonate:

a. 1 ml/kg
b. 3 ml/kg

c. 7 ml/kg
d. 15 ml/kg

e. 30 ml/kg
36. Maternal-fetal ABO incompatibility is less common than Rhesus incompatibility because:
a. Fetal antibodies to ABO are less developed
b. Maternal ABO antibodies do not cross the placenta

c. Maternal ABO antigens don’t cross the placenta

d. Fetal ABO antigens are less immunogenic

e. Maternal antigens are less immunogenic

37. A pulse oximetry reading is underestimated by:

a. Methemoglobinemia
b. Carboxyhaemoglobinaemia

c. Fetal hemoglobin
d. Sickle cell anemia

e. Hyperbilirubinemia
38. Effects of hypokalemia include:

a. Short PR interval
b. Ventricular extrasystole

c. Elevated ST segments
d. Long QRS interval

e. Long QT interval
39. Arterial gases including pH 7.46 bicarbonate 31 mmol/l PCO2 46mm

a. Metabolic alkalosis with respiratory compensation

b. Respiratory alkalosis

c. Respiratory acidosis with compensation

d. Metabolic acidosis with respiratory compensation

e. Mixed metabolic and respiratory alkalosis

40. At birth the following circulatory changes occur:

a. A rise in right atrial pressure

b. Flap closure of the foramen ovale

c. Anatomical closure of the ductus arteriosus

d. Functional opening of the ductus venosus
e. A 20-fold increase in lung blood flow
41. Immediately after a large hemorrhage:

a. pulse pressure is increased

b. thirst occurs

c. anaerobic glycolysis decreases

d. coronary vasoconstriction occurs

e. carotid chemoreceptors are inhibited

42. The following is NOT recognized cause of cyanosis in the newborn:

a. Persistent fetal circulation

b. Severe anemia.

c. Congenital pneumonia.
d. Transient tachypnoea of the newborn

e. Hypoplastic left heart syndrome.

43. Which of the following drugs may produce kernicterus in neonates by displacing bilirubin from its
plasma albumin-binding sites?
a. Sulphonamides
b. Phenobarbitone
c. Theophylline

d. Paracetamol
e. Vitamin B6
44. Which of the following can induce acute hemolysis in patients with glucose phosphate
dehydrogenase deficiency in their red cells?

a. Propranolol
b. Primaquine

c. Salbutamol
d. Atropine

e. Succinylcholine
45. Captopril produces all of the following EXCEPT:

a. Inhibition of angiotensin-converting enzyme

b. Inhibition of degradation of bradykinin

c. Inhibition of secretion of aldosterone

d. Reflex sympathetic stimulation

e. Lowering of blood pressure in hypertensive patients

46. Adverse effects of furosemide include all of the following EXCEPT:
a. Hypercalcemia
b. Hyperlipidemia
c. Hypokalemia
d. Ototoxicity

e. Hypotension and dehydration

47. Toxic dose of paracetamol causes:
a. Gastrointestinal bleeding
b. Cardiac arrhythmias
c. Sharp rise in blood pressure
d. Hepatic necrosis
e. Extrapyramidal reactions
48. Adverse effects associated with the use of Theophylline include all of the following Except:

a. Nausea and vomiting

b. Convulsions
c. Cardiac arrhythmias
d. Hypotension
e. Sedation
49. Which of the following steroids has virtually No Na+ retaining effect?

a. Cortisone
b. Cortisol
c. Aldosterone
d. Fludrocortisone
e. Dexamethasone
50. Fanconi syndrome may be caused by taking which of the following after their expiry date?

a. Penicillin V
b. Erythromycin

c. Tetracycline
d. Chloramphenicol
e. Clindamycin
51. Which of the following routes of drug administration produces the m absorption?
a. Inhalation
b. intravenous

c. Oral
d. Rectal
e. Sublingual
52. Administration of prostaglandin synthesis inhibitors (e.g. NSAIDs) w furosemide can:
a. Increase urine output
b. Decrease furosemide's K-sparing effects

c. Antagonize diuresis
d. Potentiate chloride excretion

e. Lower blood glucose level

53. The following antibiotic may cause Gray syndrome in a premature infants:
a. Ampicillin
b. Chloramphenicol

c. Gentamycin
d. Cephalexin

e. Clindamycin
54. The main unwanted effect of penicillin is:
a. Vestibular dysfunction
b. Depression of bone growth
c. Brown discoloration of teeth
d. Hypersensitivity reactions

e. Gray baby syndrome

55. Insulin requirements are increased by all of the following EXCEPT:
a. Exercise
b. Infection
c. Pregnancy
d. Obesity
e. Glucocorticoids
56. Action of insulin on the liver include all the following EXCEPT:

a. Decreased gluconeogenesis
b. Decreased glycogenolysis
c. Decreased triglyceride synthesis
d. Decreased protein catabolism
e. Increased glycogen storage
57. Inhaled glucocorticoids produce the following adverse effect :

a. Tremors
b. Oropharyngeal candidiasis
c. Tachycardia
d. Drowsiness
e. Nausea and vomiting
58. Which of the following NSAIDs is used to treat PDA in neonates:

a. Ketoprofen
b. Mefenamic acid

c. Nabumetone
d. Phenylbutazone
e. Indomethacin
59. Sodium valproate is:

a. An inducer of hepatic microsomal enzyme synthesis

b. A dopamine antagonist

c. Safe in pregnancy
d. Effective against absence seizures
e. Metabolized to Phenobarbital
60. The preferred treatment of status epilepticus is intravenous administration
a. Benztropine
b. Meperidine

c. Trimethadione
d. Chlorpromazine

e. Diazepam
61. The diet of a child suffering from Maple syrup Urine disease should be low in which of the
following amino acids content?
a. Branched chain amino

b. Phenylalanine
c. Alanine.

d. Methionine
e. Tryptophan
62. Casein, a milk protein is a
a. Nucleoprotein

b. Chromoprotein
c. Phosphoprotein

d. Glycoprotein
e. Non of the above
63. Many vasodilators cause smooth muscle relaxation and vasodilatation by increasing the level of:
a. AMP
b. cGMP
c. ADP

d. ATP
e. CAMP
64. Glucose uptake is insulin independent in the following tissues:
a. Liver
b. Heart
c. Brain
d. RBCs
e. Kidney
65. Glycolysis means the oxidation of glucose to:

a. Citrate
b. Lactate
c. Pyruvate
d. Citrate and lactate
e. Lactate and pyruvate
66. Favism is due to deficiency of:

a. Glucose-6-phosphatase
b. Pyruvate kinase
c. Glucose-6-phoshate-dehydrogenase
d. Aldolase
e. None of the above.
67. Galactosemia is mainly due to deficiency of:

a. UDP-glucose-4 epimerase
b. Galactokinase

c. Galactose-1-P-uridyl transferase
d. None of the above
e. b&c
68. Deficiency of Sphingomyelinase leads to
a. Gaucher's disease
b. Tay sach's disease

c. Fabry's disease
d. Niemann Pick disease

e. None of the above

69. Which of the following is NOT a feature of infective endocarditis
a. It commonly affects the mitral and aortic valves.
b. It may be complicated by development of cerebral or mesenteric aneurysms

c. The kidneys may develop glomerulonephritis

d. The affected cusps are commonly perforated

e. Splenomegaly may occur

70. Which of the following statements for chronic inflammation is TRUE:
a. Giant cells are always detected
b. It always occurs in the form of granulomas
c. Lymphocytes are common chronic inflammatory cells
d. The course of most chronic inflammations is resolution

e. Necrosis is a constant finding

71. Which one of the following is NOT true about nephroblastoma (Wilms tumor):
a. It is a malignant embryonic tumor that may sometimes affect both kidneys.
b. It most commonly affects children under the age of 15 years
c. It consists of a variable mixture of blastemal epithelial and mesenchymal structures
d. Cartilage may be seen within the tumor

e. Usually presents with painful abdominal swelling

72. A 4-year-old girl presents with nephrotic syndrome. A renal biopsy is performed There are no
abnormal findings on light microscopic or immunofluorescence examination. Which of the
following findings with electron microscopy is most likely in this biopsy?
a. Subepithelial electron-dense humps
b. Reduplication of glomerular basement membrane
c. Areas of thickened and thinned basement membrane
d. Increased mesangial matrix

e. Effacement of podocyte foot processes

73. You are addressing a group of expectant mothers. Of the following the recommendation
regarding the introduction of complementary foods you are MOST likely to make is:
a. exclusive breastfeeding should continue until 12 months of age, followed by the introduction
of any solid food.
b. Iron-containing cereal mixed with formula should be offered via a bottle at age 3 months

c. Iron-containing cereal should be offered via a spoon between 4 and 6 months

d. juice and supplemental water should be offered via a bottle at age 2 months

e. once solid food is initiated, several foods should be offered at once to improve acceptance
74. During the 1-week health supervision visit, a mother who is exclusively breastfeeding asks about
vitamin and iron supplementation for her healthy term infant. She explains that her previous child,
who was born at 30 weeks' gestation, was discharged with an oral iron supplement and vitamins
of the following, the MOST appropriate oral supplement to initiate for this infant at this visit is:
a. calcium

b. folic acid
c. iron

d. vitamin D
e. vitamin K
75. During the health supervision visit for a 14-year-old boy, you note that his body mass index (BMI)
is at the 95th percentile. At last year's health supervision visit, his BMI was at the 85 percentile. Of
the following, the complication for which this boy is at the HIGHEST risk is:
a. atrial fibrillation

b. hypothyroidism
c. narcolepsy
d. social isolation
e. steatorrhea