‫‪Paediatrics SMLE Qs‬‬

‫‪Done By:‬‬

‫‪Mahdi‬‬
‫السالم عليكم ورحمة اهلل وبركاته‪.‬‬

‫اهلل يوفقنا جمي ًعا يارب؛ بحط رابط قوقل أرسلوا فيه اسئلة البيديا وأي سؤال واجهني سوا ًء في االختبار أو أعرف حله‬
‫راح أجاوب ؛ الحمدهلل درجاتي في البيديا كانت كلها ‪ %100‬في اختباراتي ‪.‬‬

‫ولوالدي 🤍‪.‬‬
‫ّ‬ ‫دعواتكم لي‬

‫هذا الرابط أرسلوا أسئلتكم‪.‬‬

‫‪https://forms.gle/tWHsvBdg5ZEbgH2A7‬‬

‫رابط القناة‬

‫‪https://t.me/smlepaediatrics‬‬

‫أي أحد عنده إستفسار‬

‫‪Telegram : Mahdi_Fataih‬‬

‫بإذن اهلل امللف راح يتحدث كل فترة‪.‬‬

‫
‬
2 day old infant came to hospital with complaints of seizure and decreased feeding since
yesterday. Inactive child with generalized increased muscle tone. CSF analysis is normal.

What is the most likely diagnosis?

A.Hypoxic ischemic encephalopathy ✅

B. Neonatal sepsis

C. Neonatal tetanus

D. Pyogenic meningitis

Most important ttt of(active rheumatic fever long acting peniciilin monthly_

daily dose steroid-

high dose aspirin-

ampicillin every 6 hrs-

‫ جاني وهذا الريكول الصح‬:

Case of child with fever and subcutaneous nodule and artherlagia you suspect acute
rheumatic fever, what is the most appropriate next step

A- IV penicillin every 6 h

B- high dose oral acetylsalicylic acid✅

C- high dose predisolone

When does bedwetting becomes alarming?

A. 5 years

B. 6 years

C. 7 years ✅

D. 8 years

Few Months old pt with vomiting blah blah including sign of moderate dehydration ( dry
mucus , lethargic ) . Glucose 2.9 and sodium 149 what to give :
1- ORT with 1:1 glucose Na ration

2- NS 20 ml / kg / hr

3- Dextrose 10% 2ml/kg✅

4- pedialyte solution

A 2 years old boy who took BCG vaccine came with his mother becuase of his grandfather
had open TB and they live in the same house, the boy asymptomatic but the mother
worried what should you do?

A- nothing since he took BCG vaccine

B- PPD, X-ray and wait for the result ✅

C- IGRA, X-ray and give INH

D- IGRA, X-ray and give 4 TB drug

Q2- Most common complication for meningitis WITHOUT papilledema ?

A. Hearing loss ✅

B. Vision loss

C. Cerebral palsy

D. Heart failure

*4 months* old girl, during Pneumatic otoscope unilateral non-purulent effusion and
decrease tympanic membrane motility , no fever pr other symptoms, and no hx of previous
infectious diseases, breast feeding very well and no use of paci er ,

What’s the best next step?

- use amoxicillin tx

- use of amoxicillin and clavulanate

- Observe and F/U for 48hrs

- Refer for ENT to evaluation for tympanostomy tube✅

420-What is the age in month of child talk 6-10 words, point to 2 body parts, immature
pencil grasp?
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A-17

B-19 ✅

C-12

D-24

‫✅ هذا الريكول الصح‬

190- child with pica, hepatosplenomegally and failure to thrive. Coming from a low

socioeconomic economic status family. HGB low

Lead - 2 high

PT normal

PTT normal

INR normal

Iron normal

What’s the most appropriate treatment?

A. Vitamin K

B. D-pinicillamine ✅

C. Iron supplements

Child with face swelling and sacral edam and LL edema with ubnormal liver test and
proteinuria Dx?

A-CHF

B-Chronic liver disease

C-Nephrotic syndrome✅

This Q came in my last exam, and it was vague but the hint was in the Labs> High
Triglycerides
Child presenting with croup and received the usual treatment with no improvement. What
is the important investigation to be done?

A- Lateral neck X- ray

B- Chest inspiration and expiration X-ray

C- Visualisation by laryngoscopy

D- Chest CT

‫السؤال اللي جاني في اختباري االول صراحة ناسي اغلبه 👇؛مدري إذا نفس السؤال أو ال‬

Toxic child with drooling of saliva , stridor, SOB , what is the best next step:

A- Lateral neck x ray✅

B- Laryngoscope in OR

12 yrs old will the Varicella vaccine, because he is never vaccinated before but also never
had chickenpox . how many doses she will have?

A- 2 doses separated by 4weeks in between✅

B- 1 dose

C- 3 doses in 1st, 2nd and 4th months

Adolescentmissed his varicella vaccination. His last varicella vaccine was 1 year ago.
What is the most appropriate action to ensure his immunity to varicella?

A- Give double dose vaccine

 B- Give second dose ✅

C- Assess immunity prior to give vaccination

D- Repeat vaccine series

Child is treated for eczema with topical steroid, comes to clinic with itching and
vesiculopustular lesions on top of his eczema, arranged in grape like pattern What is the
most likely organism that causes his superimposed infection?

A-Herpes simplex✅

B-Staphylococcus aureus

C-Group A streptococcus

D-Nesseria

I don't agree with Dr.Safdar.

This is eczema herpeticum which is caused by HSV.

child had meningitis, and he contacted his brother & sister, what will give as prophylaxis ?

A- penicillin + rifampicin 2 times

B– penicillin

C- Cipro oxacin one dose ✅

D- Ceftriaxone 3 doses IM

pediatric taking chemotherapy, contacted a child with chickenpox and now he has it, how
to treat?

A- Acyclovir

B- stop chemo sessions

C- varicella immunoglovlin

‫لو جاني كذا السؤال‬

Then it is A as he has the disease✅ .

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‫; اللي جاني‬

5-year-old boy k/c of leukemia, on chemotherapy and steroids for 6 weeks, presented to
the clinic with his parents as he had contact with a child who has chickenpox, what to do?

A- Administer Varicella-zoster immunoglobulin✅

B- Admit him and administer Acyclovir.

C- Give him Varicella vaccine.

D- Stop chemotherapy.

4 months year old boy sore throat decreased oral intake can’t swallow solid food has
enlarged lymph node. vaccinated up to date. What is the most likely organism ?

A- Hib

B- streptococcus pyrogens ✅

C- Staphylococcus arues

D- pneumococcus

6 m/o infant present to ER with sudden apnea & color change. Mother gave history of
recurrent vomiting and multiple chest infections. On exam he looks failing to thrive with
dystonic neck posturing while crying. Which of the following considers as high risk case for
the above disease?

A- Obese baby

B- Preterm infant ✅

C- Post pertussis infection

D- Following inguinal hernia repair

A doctor used the Foceps, place it in wrong position and injured the stylomastoid bone,
what is th result?

A.Baby cannot close his eyes ✅

B.Loss of taste in anterior ⅔

‫ ✅جاني ومتأكد منه‬.

Explanation:

Taste sensation is preserved due to chorda tympani raised before passing through the
stylomastoid foramen so it will not be affected🫡 .

See this pic👇 .

Case ( classical symptoms and signs of Pertusis ) the mother started Abx 2 day before

What’s the gold stander Investigation ?

1) Blood culture

2)serology testing

3) Respiratory culture ✅

4) nasopharyngeal PCR

- Child pt with decreased IQ, pica (eat dirt) < they wrote it :) With

Hepatosplenomegaly ! Labs showed *Hypochromic microcytic anemias.

What is the highest diagnostic labs ]

A- blood lead levels ✅

B- CBC with blood smear (they already do it )

C- Iron studies

An 8 years old girl ingested 2 pack of paracetamol after a ght with her mother come after
a 24 of ingestion with RUQ pain in which stage of toxicity she is

Stage 1

Stage 2 ✅

Stage 3

Stage 4

Milestones case, Child came at clinic carry a ball and release or kick it to the doctor. Also

when the doctor go away the child draw a stight

line. Age:

A- 12M

B- 15M

C- 18 M ✅

D- 9M
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107- Child sits in tripod position, reaches out to things, ips from prone to supine and vice
versa, cannot hold cereal properly between two ngers how old is he?

A- 3 months

B- 6 months ✅

C- 9 months

130- 2 month old baby at the clinic what to do?

A. BMI

B. Head circumference✅

Child , weight loss , atrophy of buttox , most appropriate invest?

A. Duodenal biobsy

B. Anti endomysial✅

A child with typical celiac disease symptoms (weight loss, abdominal bloating, attening of
buttocks) , what is the most appropriate step?

A- anti endomysial antibody✅

B- duedenal biopsy

C- other irrelevant

‫ جاني وماكان فيه‬anti-TGA

3 months boy circumcised presented with febrile UTI … what the most appropriate
management?

1-Renal US ✅

2-MCUG

5 year old male presented with a history of URTI 2 weeks ago, now he complains of RUQ
abdominal pain, no rebound tenderness. There is splenomegaly.
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 HB: 7

Retics: High

WBC: 16

Blood lm: Normocytic normochromic anemia with target cells and inclusion bodies

What is the most likely diagnosis?

A- IDA

B- Lead poisoning

C- Acute appendicitis

D- GI Infarction❌

‫هذا جاني وكان آخر خيار‬

SCD ✅ .

Child with croup recevied epniphrnie and he improved. What next?

A. Antibotic

B. Steroid✅

C. The rest of chocies were also medication

10 year old boy with a 3 day history of jaundice and abdominal pain. No mention of recent
infections. Labs show High indirect bilirubin High AST High ALT What’s the most likely
diagnosis?

A. Gilbert syndrome

B. Obstructive Jaundice

C. Infective Hepatitis✅

Croup case, with Sx of respiratory distress .. diagnosis is mentioned. Management:

A- Antibiotics

B- Epinephrine
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C- Steroid and Epinephrine✅

A newborn who is following objects 180

degrees, no head lag when pulled to sitting

position, social smiling. Age by weeks?

A) 4

B) 8

C) 12

D) 16✅

Infant or newborn with small skin lesions red round patch one on leg and other on lower
back and big one on the eyelid

-reassure

-refer to ophthalmologist✅

-forget other choices

\Pediatric patient had a fall from 1 story high and direct trauma to the head, presents with
hemotympanium No loss of consciousness, no vomiting , neuro exam Normal Ear :
Ruptured tympanic membrane with intact external auditory canal Most likely bone
fracture:

A- Mastoid

B- Maxillary

C- Basal skull✅

2 days old baby, mother report poor feeding, jaundice, sleepy. What to do:

A- Fetal TSH& T4

B- Mother tsh t4

C- Mother antibody screening

D- Metabolic screening for fetus

‫الريكول اللي جاني 👇؛‬

2 weeks + sleepy+ jaundiced + umbilical hernia + abdominal distension, what is the most
appropriate next step ?

Fetal tsh , t4✅

5 y complain of bleeding from nose mouth and easy brusing before this he had viral
infection whats Dx

A) ITP✅

B) Heamoplilia A

C) HSP

D) meningococcemia

Case about post streptococcal glumeronephritis what is the responsible organism:

A) Streptococcus pyogen✅

B) Staphylococcus aureus

Group A beta hemolytic🌟

Pediatrics age 11 or 12 and Multiple joint swelling and pain and painless subcutanous
nodules what is the most diagnostic:

A-Esr

B-Crp

C-Blood culture

D-Anti streptolysin ✅

16 years old female, pubic hair, and breast buds but amenorrhea, which puberty

stage ?
A. 1

B. 2

C. 3

D. 4

‫اللي جاني 👇؛‬

15-year-old girl has sparse pubic hair not reaching the mons pubis, breast budding with
areolar enlargement, but with no clear distinction between breast and areola. No contour
of breast was seen. What Tanner stage is she?

a. Tanner I

b. Tanner II ✅

c. Tanner III

d. Tanner IV

Mother came with her child he can walk with one hand held had good pincer grip cant put
cubes in a bottle

12✅

15

18

‫الريكول اللي جاني كان مكتوب زيادة على السيناريو‬

He says few words besides mama and dada.

6 months > raking (palmar) grasp

9 months > immature pincer grasp

12 months > mature pincer grasp

Pt with ascites and edema, severe muscle wasting, hyperkeratosis, lab show: slightly
decreased glucose, signi cantly decreased albumin, your

A. severe protein de ciency (kwashiorkor)✅

B. severe carbs de ciency (marasmus)

C-Rickets

D-Mild manutrition

10- Child presented with rash that that disappeared after 3 days, lymphadenopathy?

A- Rubella✅

B- Measels

C- Erythema infectiosum

Child complaing from coryza and conjunctivitis , macuopaplar rash started in face then the
body , what is the cause?

⁃ Gonccocal bactermia

⁃ Rubella ✅

⁃ Toxic shouck sydrome

⁃ Rotair syndrome

"No measals in answer 100% sure.. and it is rubella not rubeola"

‫👆جاني‬

Child had URTI 2 days ago, presented with erythematous rash that covers the jaw and
extends to the shoulder and back , without desquamation and occipital posterior cervical
post auricular lymphadenopathy (written in case like this)

- Rubella ✅

- Adenovirus
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- Measels
- Erythema infectiosum

133-11- a sickle cell disease patient had a blood transfusion, when to recieve hepatitis
vaccine;

- on schedule ✅

- delay 3 months

- delay 6 months

Hepatitis A 🌟

Child recurrent sinupulmonary infections; had repeated gardiasis 4 times; brother died
young;

A-omenn syndrome

B- X-linked agammaglubemia✅

C- SCID

Child dilver by ventos after that the chaild comlian of blood above suture

A- cabut socundom

B- CephalHemtoma

c- Neuritis hematoma or somthing like that

If above > caput

‫اللي جاني 👇؛‬

505- Case of neonate after ventouse there was bulging in head under periosteum within
line of head sutures?

A. Cephalohematoma✅
B- caput hematoma

‫السؤال هذا تكرر كثير وما أدري هل قد مر علي أو ال ولألسف ماعندي إجابة له 🙏؛‬

Child with DKA with Glucose 32 mmol

What is the appropriate management

A- decrease glucose by 3 mmol /h

B- decrease glucose by 6 mmol/h

Nelson > Serum glucose concentrations should decrease at a rate no faster than 100 mg/
dL/hr ( 5.6mmol/hr)

Amboss> The initial goal is to decrease blood glucose levels by 10% per hour (∼ 50–75
mg/dL/hour) ( 2.8-3.9 mmol/hr).

Don't forget that rapid decrease in blood glucose can precipitate cerebral edema🌟 .

Dr.Sadfar answer >A

A 4-month-old child who has had failure to thrive, chronic diarrhea, a variety of rashes, and
recurrent serious bacterial, fungal, and viral infections

A. Bruton's agammaglobulinemia

B. Severe combined immune de ciency✅

C. Common variable immunode ciency

D. DiGeorge syndrome

Child presents with fever, vomiting and diarrhea on exam of chest there is reduced air
entry to right side

and murmur was heard , the child CVS and chest exams were previously normal (prior
visits) what is the management of murmur?

A. Urgent echo
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B. Reexamine after these symptoms subsides ✅

C. Refer to cardio pediatrician

D. ECG

5 weeks child came with non bilious vomting., found to have metabolic alkalosis ,
hypokalemia. Best initial uid

A-ORS

B-Ringer lactate

C-Normal saline ✅

D-D5 water

Child of iron ingestion came after several hour Iron 90, What you will do?

A. Iv deferoxamine ✅

B. N acetylcysteine

C. Gastric lavage

D. Activated charcoal

‫الريكول اللي جاني تذكرت أغلبه 👇؛‬

5 year old child presents with drowsiness, abdominal pain , nausea and bloody diarrhea
after ingesting an unknown number of iron tablets many hours ago.

Iron more than 90 ( very high ).

The answer is IV deferoxamine ✅ .

10 y/o presented with chronic diarrhea for 3 months, some time it’s bloody and mucus.
Abdominal pain , bloating. History weight loss

Temperature was 38.5.. high ESR Diagnosis?

1- UC

2- Crohn’s disease
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3- Celiac disease

4- Chronic dysentery

‫السؤال اللي جاني نفس فكرته 👇؛‬

Postprandial pain, periumbilical pain , bloody diarrhea ?

No UC in choices

The answer is crohn's✅ .

4month old baby, presented with signs of UTI, stable not dehydrated. Alert and feeding
well.

Urinalysis: Positive nitrite. , Positive leukocytes.,Fever: 39.1

What’s the appropriate empirical antibiotic to be started

A- Oral azithromycin.

B- oral amoxicillin.

C- IV Ceftrixone.

D- IV Cefepime

‫اللي جاني كان فيه‬

Oral cephalexin which is correct✅ .

Child 6yrs old presented with history of 6month left knee and wrist pain with limitations of
movement and especially morning dif culty movement Otherwise no systemic symptoms
What is the most likely diagnosis?

A. rheumatic fever

B. reactive arthritis

C. septic arthritis
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D. juvenile idiopathic arthritis✅

5th month boy how to insure devolpment milestone ?

Try to reach for objects✅

infant exclusively breastfed then was given cow milk, now at 9 months after introducing
some iron, containing food , there’s still a concern that the infant, isn’t recovering enough
iron what would you do?

• A Add iron supplements ✅

• B Switch to formula

• C Stop cow's milk completely

• D-Add Vitamin

270- 3 month Preterm baby has a chronic lung disease, both parents are smokers, he was
sleeping in with his parents in there bed, parents brought him dead to the ER, what is the
most likely cause?

A- Sudden lung distress syndrome

B- Sudden infant death syndrome✅

Sudden infant death syndrome, which of the following decreased the incidence?

A- baby sleep on their back✅

B- parents stop smoking around the infant

602- Typical case on nephrotic syndrome, ask about highly diagnostic test ( no renal
biopsy )

A. Serum albumin✅

B. US
C. Urine total protein

D. Electrolytes

Child started to develop sense of individuality. She recognize strangers and frightens when
separated from her parents.

A- 6

B- 7

C- 10 ✅

D- 12

A 5 years old child presented with signs and symptoms of giardiasis, how to con rm the
diagnosis?

A- 3 consecutive stool samples

B- 3 samples on different days ✅

C- concentration method

D- stool immunoglobulins

baby with Ejection systolic murmur with click heard in the left second intercostal and left
parasternal heave distended JVP and ejection systolic murmur increase with inspiration:

A. AS

B. coarctation of aorta

C. VSD

D. congenital pulmonary stenosis✅

3 or 4 yrs old came to ER with fever, headache, muscle pain , stiff neck. Treated with
penicillin G. He has been in contact with his 6 yr old brother.

CSF> gram negative diplococci.

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What is the best management for his older borther?

Oral rifampicin✅

Also I got Q about hemophilus in uenza ( they wrote grame negative coccobacilli )
prophylaxis ?

Rifampicin✅

‫كلها جاتني تو تذكرتها وكتبتها‬.

Child with asthma , he is using leukotrienes antagonist and came to ER with asthma
exacerbation and he improved drastically when given B2 agonist

What to give for long term maintenance?

- Oral steroid + B2 agonist as neded

- Inhaled steroid +B2 agonist as neded

-inhaled steroid twice a day +B2 agonist as neded✅

-leukotriense antagonist +B2 agonist as

needed

Explanation: Although He is in step 2 Rx , he developed asthma exacerbation which

means either uncontrolled or partial controlled asthma

At this point we will step up his Rx to step 3

Among the given choices the option 3 will be the correct one.

See these pics👇

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Infant with diaphragmatic hernia, what rst step to manage this patient after stabilization?

-ABx

-chest tube

-immediate surgical repair

- Large NGT✅

Growth chart look like this And senario of. :

18 month present with abdominal bloating and loss of subcutaneous fat..

what diet should u prescribed ?

A. High calorie

B. Gluten free✅

C. Partial hydrolysed formula

D. Forget the option

‫جاني وكان‬

Growth chart indicating failure to thrive.

2 years old with UTI for admission, came with his mothers, further history reveals that he
vomits anything he eats. BP is 85/60 (Approximately). What is the reason for admission?

A-Vital signs

B-Unable to tolerate food✅

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Child with cheek vascular anomaly

What is the diagnosis

A- hemangioma✅

B- lymphatic malformation

C- venous malformation

D- arteriovenous stula

Q / around 10 months complain of mass RLQ and cross the medline and he cry when you
pull his legs and while the parents bring him to the hospital he had 2 episodes of vomiting
what is the diagnosis?

A - appendicitis

B - intussusception✅

I remembered this Q, there were also another hints in the scenario toward intussusception.

Patient with Bilateral Hydronephrosis, Distended Bladder and Dilated Urethra. with
*bilateral cryptorchidism* Cause?

A) Prune Belly Syndrome ✅

B ) Ureterovesicular Junction Obstruction

C) Posterior Urethral Valve

‫اللي جاني 👇؛‬

Newborn boy on examination there’s abdominal distention, investigation shows dilated

urethra, bilateral hydroureters, and bilateral hydronephrosis ( there wasn’t undescended
testis in this case) most likely diagnosis:

A- prune belly syndrome

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 B- posterior urethral valve ✅

Other 2 choices very unlikely

5 yeas old boy and known SCA and found came with respiratory distress ,fever and low
oxygen saturation

Which of following can prevent this condition

A-Antibiotic

B-Folic acid

C-Vaccination

D-Hydroxurea✅

6 years came with high fever and loin pain , on

examination he is looking toxic • Your antibiotic choice

A-Oral augemetin

B-Oral cefuroxime

C-IV ce traxone ✅

D-IV gentamycin

A child presented in a well baby clinc, mother showed concern that she is only breast
feeding her baby and he may need supplements, the doctor told her she can give him iron
next month, how old is the baby ?

A-1 mo

B-3 mo ✅

C- 6 mo

D- 8 mo

389- 17year old female, medically free, gymnast in her class, developed

breasts later and never menstruated, on examination she is tanner stage 5

but no menstruation, diagnosis?

fi
A. hypothalamic hypogonadism✅

B. imperforate hymen

C. gonadal agenesis

D. testicular feminization

‫ او جاني وكان السؤال واضح عشان كذا ماتذكرته‬، ‫ تكرر علي كثييير ج ًدا فالرابط؛ ماجاني صراحة‬..

-Age is not going with bronchiolitis.

- No fever, no signs of infection other than tachypnea.

It could be asthma, viral induced wheeze, ( also infection but not likely)

(A) is excluded> no obvious infection.

(D) Also is excluded .

(B) he is vitally stable, why should we give him IV uid.

By exclusion, choice C is a reasonable answer 🌟 .

I could be wrong, need double check.

A neonate 12 hours , after normal vaginal delivery is noticed to be jaundiced the blood lm
shows microcytic hyperchromic cells. The best investigation is

A- Osmotic fragility test

B- Pyruvate kinase level

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C- G6PD enzyme level

D- EMA✅

‫اللي جاني كان معها صورة‬

Hereditary spherocytosis on blood smear.

‫ ماكان فيه خيار‬EMA❌

‫وكانت اإلجابة‬

Osmotic fragility test.

‫لو جابوا اإلثنني ؟‬

The best is EMA🌟 .

child came with pallor and jaundice. His father and grandfather are both known to have
chronic hemolysis and

underwent gallbladder removal. What is the best test for diagnosis?

A. Hb electrophoresis,

B. Sickle cell test,

C. Coombs test,

D. Osmotic fragility test.✅

12 hours baby boy delivered and found to have jaundice and looks pale, jaundice
increased at 36 house What you will do next :

A-Osmotic fralgily test✅

B-G6PD

C-Electrophesis

D-Sicle test
 ‫كان فيه صورة‬

HS on blood smear.

Child 12 years old complaining of abdominal pain since 1 year and sometimes heartburn,
other wise he is completely normal, his mother have hx of chronic abdominal pain?

Omeprazole

Steroid

Azithromycin

Hypoallergenic diet

‫ماجاني هذا السؤال ؛ لكن جاني سؤال مشابه له وطالب انفستقيشن وهذا اللي قدرت اتذكره 👇؛‬

Child with epigastric pain, heartburn..., mother has the same problem, best to con rm?

Endoscopy✅

So i think the rst Q the answer could be A.

Neonatal lumbar puncture showed Gram +ve diplococci. Management?

A. Macrolide,

B. Ampicillin + Gentamicin, ✅

C. Ce traxone,
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 D. Cipro uxoacilin.

Ceftriaxone is contraindicated in patients aged < 1 month because of a higher risk of

biliary sludging and kernicterus🌟 .

Say few words> 12 months

More than 6 words > 18 months

Feeds doll> 18 months

Imitating parents> 18 months

Points to stuff and body parts > 18 months

Know body parts :

All other references ( kaplan, toronto, illustrated) say at 18 months the child can know
more than 1 body part, some of them say 1-5 body parts.

Except essential nelson > says at 2 years > know body parts.

For me; I would say 18 months.

‫ 🤍 🙏 اللي عنده رأي آخر أو مصدر أو عارف الريكول كويس يفيدنا بالرابط‬.

A child enters the clinic and says “Hi” to doctor turns to mother and asks for milk, then child
tries to give milk to her doll. She points at her own mouth and says “mouth”. When mother
wipes milk off doll, child says “me” and imitates the mother and gives the doll a hug. What
is developmental age of the child?

a) 12

b) 15

c) 18
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 d) 24✅

‫وصلني هذا الريكول ممكن يكون نفسه ف ركزوا 👇؛‬

Use of pronouns (me) > 2 years

4 y.o his went to doctor because parents recognize blood in stool this the only symptoms
Then the doctor examined him and said it’s common and can be preventable:

A- anal ssure✅

B- hemorrhoids

C- juvenile poly

D- Intusseption

15 years old and known typ1 DM for 10 years • Which is the rst sign of diabtic
nephropahty

A-Hematriua

B-Elevated renal function

C-Nephrotic syndrome

D-Microalbuminuria ✅

E-Hypertension

Neonate with abnormal heart rhythm, PDA, complete heart block, what maternal disease
causes this?

-congenital Rubella

- SLE✅

-DM

Pediatric patient presented with syncope, poor growth, HR 250-350 narrow QRS.

A. ventricular tachycardia

B. SVT✅
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 C. Atrial utter

D. Atrial brillation

7-year-old patient infected with a gram- positive diplococcus.Treatment is:

- A.Ceftriaxone

- B.Penicillin + gentamycin

- C.Gentamycin

- D.Gentamycin plus vancomycin

By exclusion, it is A✅ .

‫اللي جاني 👇؛‬

Meningitis case , gram positive cocci in pairs, treatment?

Ceftriaxone and vancomycin✅ .

A 15 months old child is brought to the emergency department after having a generalized
tonic-clonic seizure that lasted approximately 5 minutes. The parents say that the child had
been previously well but developed cough and rhinorrhea earlier that day with a
temperature of 39.2 C. Which of the following is the most appropriate management?

A. Diazepam.

B. Phenytoin.

C. Head CT scan.

D. Control of the fever.✅

After having+ lasted > means the patient is postictal and not in active seizure🌟 .

177- child born 5 hour ago presented with central cyanosis and there is different between
oxygen saturation in upper and lower extremities what is the initial Mx

A- IV prostaglandin infusion
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B- oxygen therapy

C- surgery referral

‫ماجاني بس قاعدة عامة ؛‬

Initially in any cyanotic baby, we give O2 test to differentiate between pulmonary and
cardiovascular, then treating accordingly.

CoA if severe usually presents within weeks of life ( this patient 5 hour ago so CoA is
unlikely).

It could be PPHTN, whatever the cause we would start with O2 therapy.

I would choose B🌟 .

Double check.

Child brought by his father in wheelchair

complaining of knee swelling and history of

falling on his knee. What is the best investigation?

A-Joint Aspiration.

• B-X-ray✅

• C-ANA

• D-ESR

3 mo boy with UTI and received abx and improved the mother was asking you about next

step in Mx?

A-renal US ✅

B-no other measures are needed

C-repeat urinalysis

D-VCUG
Baby came with clear picture of UTI and urine analysis showed UTI. Mum said she had
these symptoms multiple times. What to do?

A-Renal US

B-Voiding cystourethrogram

C-Renal US and cystourethrogram ✅

D-I think the last one was reassurance

Known SCA and received blood transfusion 3 weeks ago. Now he came for his hepatitis A
vaccine. You should:

A-Give the vaccine ✅

B-Ask him to come after 3 months

C-Ask him to come after 6 months

D-Ask him to come after 9 months

602- A female brought her baby to the well baby clinic ,he is still on formula /breast fed the

doctor advised her to give the baby iron supplement after the appointment. How old is the
infant now?

A- 1 month

B- 2 months

C- 3 months

D- 6 months✅

We give iron at 4 months to exclusively breastfed.

The doctor advised iron AFTER the appointment > that means the child is already older
than 4 months.

So the closest answer is 6 months🌟 .

If the Doctor advised iron in the NEXT visit or AFTER ONE MONTH then it will be 3
months🌟 .
Roll overs , sit brie y , transfer objects from hand to hand

A. 2m

B. 5m

C. 7m✅

A case highly suspicious of pyloric stenosis what is the diagnostic test ?

A- X- ray

B- Ultrasound✅

C- Endoscopy

Most effective treatment in kawasaki Disease

- aspirin

- IVIG✅

I’m with B

‫اول شيء ان االكتيفيتني تشاركول تعتبر‬

initial treatment

‫وهو اوردي رسم على النورموقرام وطالع‬

above the toxic level

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‫فما ينفع ابدا بها‬

‫ ساعات الن مثال قست وطلع نازل عشان ما صار‬٤ ‫وليش مانعتمد نتيجة النورموقرام قبل‬

complete absorption

‫ ساعات طالع لي اللڤل عالي‬٣ ‫بس هنا وانا لسى‬

---------------------------------------

‫أهم شيء تعرفون عنه هذي املعلومات 👇وماتطلع منها االسئلة؛‬

peaks around 6 weeks, resolved at 3-4 months.

Rule of 3: excessive crying 3 hours/day, 3 days/week, 3 weeks.

Everything normal + well-nourished baby

Mother brought her child for routine check up. The doctor played with the child as he threw
a ball and the child catch it and threw it back to the doctor, the child can draw his
brother head HANDS, and Feet After that the child undress himself for examination as
the doctor ask him, after examination was done and while the doctor was speaking to the
mother the child was playing with cubes and putting them above each other(he said many
not detect the No. of cubes ) the child also was able to draw straight line. What is the age
of this child

A- 2

B-3

C- 4years✅

D- 5

‫ماجاني بس واضح 👇 ؛‬

Draw 3 body parts > 4 years

Also in previous recalls, the child was able to tell stories> 4 years 🌟 .

Milestone of baby can x his head but can not sit without support:

3 months

5 months✅

7 months

No 4 months

- baby can xation of his head and sit withe father hand behind his back?

-5 months ✅

-7 months

-8 months

-9 months

No head lag= complete xation of head = holds head steadily/straight > 4 months🌟 .

Sit unsupported/ without support/ sits alone > 6 months 🌟 .

Child can tell story and undressed him self draw his sister head ,hand leg?

4yr✅

5yr

Undress > 3 years

Dress> 4 years

Ties shoes > 5 years

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Child able to put 3 cubes on top of each other, walks, and crawls up the stairs, points to
objects he wants, jargons and understands commands. Draws lines with crayons. How old
is he? It wasn’t draw or copy it was put line with crayons

A.9 months

B.12 months

C.15 months✅

D.24 months

Follow commands + points to stuff/interesting items + creeps/crawls up stairs + stack2-3

cubes + make line with crayons >> 15 months 🫡 🌟 .

2 or 4 days old came to you with apnea. PE: machinery murmur + wide pulse. CXR:
bilateral wet lung. Next initial treatment?

A. Fluid restriction+ diuretic ✅

B. NSAID ( prostaglandins inhbitors).

‫أنتبهوا للخيارات الباقية لو كان فيه‬

oxygen

‫ 🌟ممكن يكون اإلجابة الصحيحة‬.

Nelson👇
6 years old child, came for pre school checkup, on exam he looks normal except for grade
III heart murmur along the sternal border “ no speci c location or timing of the murmur
provided”, no thrill, the murmur accentuated with supine position,

DX?

• A. Still's murmur ✅

• B. VSD

• C. ASD

• D-Aortic stenosis

6 year-old child presented to the clinic for routine checkup. On auscultation, there was
ejection systolic murmur grade III in the left sternal border, vibratory in character. No thrills.
The murmur accentuated by setting position. Which of the following is the most likely
cause ?

A. Still murmur✅

B. Atrial septal defect

C. Ventricular septal defect

D. Aortic stenosis

5-year old child asymptomatic with painless Hematuria. Physical examination is normal
and vitally stable.

Urinalysis revealed RBC 15 cells

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What is the most appropriate next step?

A. Repeat urinalysis ✅

B. Urine cell analysis

C. Kidney biopsy

Child came to ER before 12hours with fever and SOB, yesterday he had sore throat and
dysphasia, on exam he looks toxic immobile in a chair opens his mouth with drooling of
saliva , tachycardic tackypnic and fever 40 what’s the next step?

A-Intubation in er

B-Transfer for picu

C-Admit to ward

D-Give nebuliser steroids

‫الريكول كامل؛‬

I am with B🌟 .

228- Pic of Peripheral blood lm show microcytic hypochromic cells with

scenario ...HB low/ RBCs low

What suspect to be low:

A-MCV✅

B-Reticulocytes

C-platelets

‫جاني السؤال ذا وكان واضح‬

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 Mother came with infant to the the clinic. When she put her baby on the examination table
he starts laughing. When the doctor approaches the baby he squeals and reach for his
mother: which month is the baby:

A. 2

B. 4

C. 6 ✅

D. 8

‫ماجاني بس واضح‬

Stranger anxiety > 6 months🌟 .

‫ كل املراجع تتفق على العمر هذا‬.

Tricycle> 3 years.

Dress with help> 3 years

Know age > 3 years

Drawing square> mostly 4 years, some references including Nelson says 5 years.

Knows colours> 4 years.

Dif culty in drawing square > supports 3 years.

Point to the colour when asked ; I don't know if it is the same as knowing the colour?! If
yes > then this supports 4 years.
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‫ممكن يكون الريكول ما تم نقله بشكل صحيح‬.

‫كل املراجع تقول‬

Know/identi es/names colours at 4 years.

Child know his name, say mama dada , ride tricycle, undressed with support , when the
doctor tell him red color he point to it " didn't say it just point to the color" , What is his age
in years?

A- 2

B- 3

C- 4

D- 5

‫لو كان نفس الريكول اللي فوق‬

I am with B ( 3 years )

265-Greenish vomit ,wt is the highest diagnostic test

A- upper gi contrast✅

B- Lowe gi contrast

C- endoscopy

D- abd x ray

‫جاني 👆 وكان عمره‬

5 months + obstruction signs

It is midgut volvulus🌟 .
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Scenario of pertussis in unvaccinated child , what is the most common complication !

A- otitis media

B- Pneumonia✅

-A child with widening of his joints , Ca 2.2 (normal 2.2- 2.7) P 2.1 (1.3- 2.3), alkaline
phosphatase > 1000 very high , No PTH is given. What is the most likely diagnosis ?

A- Hypophosphatasia ->Low ALP

B- Renal osteodystrophy

C- Vit D de ciency rickets✅

D- Familial hypophasphatemic rickets ->LOW Phosphate

An infant came with respiratory distress and found to have wheezing and O2 saturation of
90% Most important ttt?

A-Antibiotic

B-Nebulization

C-Oxygen and hydration ✅

D-Chest X ray

3 yrs child , the mother noticed blood in his diaper for 2 days , no abdominal pain or
constipation , he has similar episode 3months back .. what is the Dx ?

A. juvenile polyp

B. Michele’s diverticulum ✅

C. Intussusception

D. hirschsprung disease

18 month baby who receive immunoglobulin 2 monthe ago and came to vaccination what
to give ?

A- Dtap ✅

B- MMR
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C- measles

D- Varicella

Which of the following is consistent with rheumatic heart disease?

A- Mitral stenosis✅

B- Mitral regurgitation

‫ 💯 جاني‬.

scenarios about a child 2 years old with SOB and Expiratory wheeze and other respiratory
symptoms he had a viral illness 2 days ago?

A. Respiratory monitoring for hypoxia✅

B. Inhaled epinephrine and steroids

C. Intubation and antibiotics

D. SABA

‫ 💯 جاني‬.

A mother of asthmatic child is worried about the future of her child’s case. What you will tell
her?

A. He will have asthma for the rest of his life

B. Pediatric asthma will disappear by adolescence✅

C. Pediatric and adult asthma are unrelated to each other

D. His case will develop into chronic lung disease

Baby at 7 weeks with intermittent vomiting, dehydrated :

A- Hypertrophic pyloric stenosis✅ ✅

B- Cyclic vomiting syndrome

c- Gastric volvulos
‫هذا السؤال جاني بس الريكول كان فيه زيادة‬

intermittent vomiting for a long time i think like for months, he gets hungry after each time
and eats again.

and in physical exam nothing is remarkable, he has no further weight loss except 2kg
after birth, what's the diagnosis:

the same choices, the last last choice was

-midgut volvulus and intestinal malrotation

It is a clear case of pyloric stenosis🌟 .

Baby delivered at 38W, his weight 1.8 became jittery and hypotonic, then started to sieze
for few seconds, all his labs were normal expect glucose 2.5 considered (slightly low) what
is your next step in management?

A-Administer glucose✅

B-IV diazepam

C-IV antibiotic

Child came with a coca-cola urine, he also has a history of fever for 1 week, his throat is
congested and cervical lymph nodes are palpable, what is the likely cause?

IgA nephropathy

Acute glomerulonephritis✅

Alport syndrome

History of fever 1 week ago supports PSGN🌟 .

 If there is no mention of any history suggestive of infection a week ago; then it will be IgA
nephropathy.

Read the Q carefully in the exam👍 .

A > excluded because the age ( physiological anemia typical age is 6-9 weeks).

B > couold be.

C > no signs of hemolysis!! Just anemia

‫ انا متأكد الريكول فيه غلط او معلومات ناقصة وخيار ناقص‬.

6 weeks baby known case of G6PD came with HB low MCV low

(Only this is the question written like this no reticulocyte count no LFT )

1) hemolysis anemia ( normocytic )

2) iron de ciency anemia (microcytic)

3) physiological anemia ( normocytic )

‫ ممكن يكون نفس الريكول اللي فوق‬..

IDA usually develops at age more than 6 - 9 months.

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Physiological anemia of infancy at age 6-9 weeks.

‫ مع أن العمر ماهو ماشي مع‬IDA

‫ أال أنها الوحيدة اللي ممكن تكون صح بنا ًء على‬MCV.

‫ ممكن خيار‬D ‫يكون صح‬.

‫ لألسف ماقد مر علي وماني متأكد من اإلجابة‬.

‫اللي عنده ريكول أفضل يرسله‬.

Need double check.

Child in the clinic has pubic hair increases towards adult type and Dark scrotum

Tanner stage?

A-II

B-III

C-IV✅

D-V

Darkening of scrotum > 4

Reddening > 2

A mother brought her 4 years old child cause he frequently wakes up in the

middle of the night setting on the bed, eyes opened but unresponsive for 2-3

min then he go back to sleep , in the morning he doesn’t remember what

happened?

A- nightmares

B- night terror✅

C- night walking
 D – epilepsy

Nightmare: Awakens crying may or may not compain of bad dream.

Night terror: agitation, screaming1-2 hr after going to bed. Child may have eyes open but
not respond to parent. May occur at same time each night.

‫ يتذكر الحلم ؟‬، ‫بإختصار‬

nightmare🌟

‫ما يتذكر الحلم ؟‬

night terror🌟

8 days old newborn for diabetic mother came with SOB and cyanosis, looks irritable and
ruddy, no u like symptoms

RR 40-49

HR 169

Hb 24.1 (normal: 165-175)

Hct 0.75

Plt 120

Whats the diagnosis?

A. Polycythemia ✅

B. RDS

4 days baby brought by his mother with cyanosis

His labs:

Hgb 214 (very high)

Hematocrit 75% (very high) What is your management?

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A- partial exchange transfusion

B- Oxygenation

C- Hydration and monitor

D- No need for treatment

Next > C

Best > A

Child 12y , pneumonia , common cause?

M. pneumoniae✅

S. pneumoniae

13 months old girl present with fever 38 , bilateral lung in ltrate , she looks mildly ill , what
is the likely organism
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 • A. Moraxella catarrhalis

• B. Strep pneumoniae✅

• C. Hib in uenza

• D-Nesseria

13 old boy came with his mother , his mother complain about he is shorter compare to his
classmates , he is 145 Mother is 155 , Father 174 , His bone age 10 years old What is his
expected height will be ?

the answer was 160-181 cm

‫ في االختبار حاطها على شكل‬، 171 ‫ جاني بالضبط 💯 وكانت اإلجابة‬range.

Three years female brought to the well baby clinic After mother is concerned when she felt
a right ank mass for two days no history of pain no other clinical signi cance what is the
most likely diagnosis

A- neuroblastoma

b- wilms✅

I would choose Wilm's due to:

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 - Age (2-5 years)🌟 .

- Most common neoplasm of the kidney in children🌟 .

If you see crossing medline> neuroblastoma🌟 .

Most common intraabdominal tumor in children > neuroblastoma🌟 .

HTN, proptosis > neuroblastoma🌟 .

Mother discovered ank mass in her child, on urine analysis positive RBC and Hg

What is the most likely diagnosis?

Wilms tumor✅

Neuroplastoma

Lymphoma

6 years came with high fever and

loin pain, on examinaation he is

looking toxic ·Your antibiotic choice

A- Oral augemetin

B- Oral cefuroxime

C- IV ce traxone✅

D- IV gentamycin

5 years old irl with pubic hair and has adult smell , no clitoromegaly. Which of the following
would be excepted to be elevated

• A-DHEAS✅
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 • B-Testisterone

• C-17 hydroxypregestrone

• D-Estrogen

Child with meconium aspiration and the parents found to have pulmonary

hypertension. preductal oxygen 88% and post ductal oxygen is 77% what is

the best treatment

A. Surfactant

B. Inhaled Nitric oxide✅

C. Antibiotics

D. Sildena l

This picture;

2 or 3 weeks old baby, presented with yellow discoloration since birth, she is a known case
of G6PD (I think) had high bilirubin, this picture was provided, no other medical history,
what is the diagnosis:

A- IDA

B- spherocytosis

C- G6PD ✅

D- I forgot

20 years old female with a history of TOF repair when she was 3 years old. Now on
examination she has decrescendo diastolic murmur at the left sternal border does not
radiate, single S1,.. which of the following is her condition now?

A. Aortic stenosis

B. Ventricular septal defect

C. Pulmonary artery regurgitation ✅

D. Tricuspid regurgitation
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 After TOF :

PR ( diastolic murmur)🌟

TR ( systolic murmur)🌟

Pregnant lady and US showed polyhydramnios. Which of the following is associated with
this condition?

A. Bilateral renal agenesis ( oligo )

B. Trisomy 21✅

C. IUGR( oligo)

Child in the clinic has pubic hair increases towards adult type? Dark scrotum, Tanner
stage?

A. II

B. III

C. IV✅

D. V

A mother presented to you with her 2 years child who was yelling and throwing himself on
the oor, how would you deal with her

A- positive reinforcement counseling✅

B- Ignorance counseling

C- Strict and rm counseling

What is true regarding infantile colic?

A. Resolves after the rst 2 m of life.

B. Resolves after the rst 3 m of life✅

C. Resolves after the rst 6 w of life.

D. Resolves after the rst 6 m of life

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apgar score, Hr 120 (2) , irregular breath(1), exion with little movement(1), cough, rosy(2)
and blue extremities(1)

7🌟

male boy 2 days features of sunken sternum (pectus excavatum) or raised sternum
(pectus carinatum) Wide-set nipples. Short neck, often with extra folds of skin (webbed
neck) or prominent neck muscles

A. Down

B. Turner

C. Noonan ✅

Male > Noonan

Female > Turner

‫ ماجاني لكن بقول رأيي‬،‫سؤال تكرر علي كثير‬.

15 month boy came to ER complaining of abdominal discomfort, emesis, stool with blood
and mucus on phisycal examination he has increase abdominal sound

X-ray report shows obstractive bowel ( written like this )

A- give antibiotic❌

B- Go to OR and do surgery❌

C- Barium enema ✅

D- bowel rest, IV hydration and wait until symptoms gone❌

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D > will be excluded due to " wait till symptoms gone"! Urgent intervention is necessary for
intussusception to prevent potentially life-threatening complications as gangrene,
peritonitis, perforation.

C > is a good option as it is both diagnositic and therapeutic🌟 .

I would choose C.

Choose whatever you like.

Newborn with tachypnea , tachycardia and dif culty feeding , on auscultation there was
parasternal heave and single S1 heart sound , what is the essential part of the initial
management?

A-NSAID

B-Diuretics

C-Dopamine

D-Prostaglandine

‫ركزوا في السؤال اذا جاكم في اإلختبار؛‬

If there is CYANOSIS > Prostaglandin ( TGA > single S2 )🌟

If NO CYANOSIS > Diuretics.

‫على األغلب أنها‬

TGA.

Child who was severly ill, had pyrexia and irritability and vomiting, then developed purpuric
rash that started in his face than disseminate to the rest of body. Diagnosis?

-Rocky mountain
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 -Meningioccemia

Child with fever and vomiting and petechial rash on 2nd day rash become over All body?

A. Meningococcemia

B. Rocky mountain fever

‫ما مر علي؛ وباملعلومات هذي فيه صعوبة في اإلختيار؛‬

Rocky mountain rash:

-A pale, rose-red macular or maculopapular rash appears in 90% of cases usually 2-5
days after fever onset. The early rash blanches on pressure and is accentuated by
warmth. It progresses over hours or days to a petechial and purpuric eruption that appears
rst on the feet and ankles, then the wrists and hands, and progresses centripetally to the
trunk and head. A hallmark feature is the involvement of the palms and soles

-The face is usually spared. Involvement of the scrotum or the vulva is a diagnostic clue.

- The rash of RMSF (seen in about 90% of patients) may not be apparent until 2-5
days after onset of fever.

- The diagnosis of RMSF should be sus- pected with fever and petechial rash,
especially with a history of a tick bite or outdoor activities during spring and
summer in endemic regions

Meningococcemia:

-Patients are severely ill. Tachycardia and mild hypotension are present. Patients with
acute meningococcemia usually present with moderate fever .

-The early rash is erythematous, blanchable, and may be macular or macular and papular.
Scattered petechiae may be found in areas subject to friction, body folds, exor surfaces,
ankles, or mucosal surfaces. Within hours, the petechiae coalesce into well-demarcated,
large ecchymoses, usually concentrated on the limbs and trunk. Digits and limbs may
become gangrenous with well-demarcated gun-metal-gray discoloration.

- fever and rash appearing within 24 hours of infection.

‫اذا كانوا نفس الريكولني؛‬

I am with meningococcemia due to:

- severe presentation and severely ill.

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- the rash develops within 24 hours ( on 2nd days it spreads that means it is already there
🌟)

- Face is involved ( it is spared in Rocky mountain).

‫ممكن يكون الريكول ناقص وفيه أشياء تدل على تشخيص منهم‬.

‫اللي عنده رأي او ريكول كامل للسؤال ذا يرسله فالرابط‬.

Marfan features what investigation to do to rule out life threatening complications ?

Echo✅

Eeg

Ecg

CTA