5th year pediatrics exam 2017

1- A full-term infant is born after a normal pregnancy; delivery, however, is complicated

by marginal placental separation. At 12 hours of age, the child, although appearing to
be in good health, passes a bloody meconium stool. For determining the cause of the
bleeding, which of the following diagnostic procedures should be performed first?
A. A barium enema
B. An Apt-Downey test
C. Gastric lavage with normal saline
D. An upper gastrointestinal series
E. A platelet count, prothrombin time, and partial thromboplastin time

2- A primiparous woman whose blood type is O positive gives birth at term to an infant
who has A-positive blood and a hematocrit of 55%. A total serum bilirubin level
obtained at 36 hours of age is 12 mg/dL. Which of the following additional laboratory
findings would be characteristic of ABO hemolytic disease in this infant?
A. A normal reticulocyte count
B. A positive direct Coombs test
C. Crescent-shaped red blood cells in the blood smear
D. Elevated hemoglobin
E. Petechiae

3- The mother of a 2-week-old infant reports that since birth, her infant sleeps most of the
day; she has to awaken her every 4 hours to feed, and she will take only an ounce of
formula at a time. She also is concerned that the infant has persistently hard, pellet-like
stools. On your examination you find an infant with normal weight and length, but with
an enlarged head. The heart rate is 75 beats per minute and the temperature is 35C
(95F). The child is still jaundiced. You note large anterior and posterior fontanelles, a
distended abdomen, and an umbilical hernia. This clinical presentation is likely a result
of which of the following ?
A. Congenital hypothyroidism
B. Congenital megacolon (Hirschsprung disease)
C. Sepsis
D. Infantile botulism
E. Normal development

4- The signs and symptoms of meningitis in an infant can be different than those in an
adult. Which of the following signs and symptoms of meningitis is more helpful in an
adult patient than in a 4-month-old?
A. Lethargy
B. Jaundice
C. Vomiting
D. Brudzinski sign
E. Hypothermia
5- All of the following are gastrointestinal manifestations of cystic fibrosis EXCEPT:
A. Intussusception
B. Appendicitis
C. Colonic mucosal thickening
D. Gastric outlet obstruction
E. Inguinal hernias

6- A 7 yr old child with a 3-yr history of cough, intermittent wheezing, and poor growth
has 2 sweat chloride values of 36 and 41 mEq/L. Additional diagnostic testing to rule
out cystic fibrosis should include:
A. Chest CT
B. Nasal potential difference measurement
C. Fat balance measurement (72-hr stool collection)
D. DNA analysis for the F508 mutation
E. Sweat chloride analysis in siblings
7- All of the following statements regarding hereditary spherocytosis are true EXCEPT :
A. Individuals with hereditary spherocytosis may be asymptomatic without
anemia
B. The newborn with hereditary spherocytosis may present with anemia and
hyperbilirubinemia severe enough to require phototherapy and exchange
transfusions
C. Isoimmune hemolytic anemia due to ABO incompatibility may mimic hereditary
spherocytosis
D. Thermal injury can cause spherocytosis
E. Splenectomy does not eliminate most of the hemolysis of hereditary
spherocytosis
8- Expiratory wheezing generally indicates what pathology :
A. Intrathoracic airway obstruction
B. Extrathoracic airway obstruction
C. Alveolar disease
D. Increased compliance
E. Interstitial disease
9- A 2 yr old new to your practice has a history of multiple respiratory illnesses. You note
the presence of mild stridor on exam. Which of the following tests is indicated?
A. Pulmonary function test
B. Polysomnogram
C. Barium swallow
D. CT angiogram
E. Sinus radiograph

10- Clubbing is associated with what disease :

A. Cystic fibrosis
B. Chronic congestive heart failure
C. Thalassemia
D. Cirrhosis
 E. All of the above

11- Which of the following is not a typical complication of bacterial pneumonia?

A. Sepsis
B. Empyema
C. Pneumothorax
D. Pleural effusion
E. Endocarditis

12- A 15-mo-old child is in your clinic with stridor at rest and cyanosis with the presumptive
diagnosis of viral croup. You should do all of the following EXCEPT:
A. Transport immediately in the parent's car to the nearest
B. emergency department
C. Administer oxygen
D. Administer budesonude
E. Administer racemic epinephrine
F. Transport after ambulance with medical personnel arrive 20 min later

13- Which of the following tests is the gold standard for diagnosis of IBD?

A. Abdominal computed tomography scan.

B. Endoscopy and colonoscopy with biopsy.
C. Fecal lactoferrin.
D. Serologic panel.
E. Wireless capsule endoscopy.

14- a 2-year-old child who has been referred for poor weight gain. Before seeing the
patient, his growth chart, reveals weight below the 5th , height at the 25th percentile,
and head circumference at the 50th percentile. Solely considering the growth chart
parameters, which of the following is the most likely reason for his poor weight gain?

A. Cystic fibrosis.
B. Growth hormone deficiency.
C. Inadequate caloric intake.
D. Metabolic disorder.
E. Underlying genetic disorder.

15- 1-week-old boy presents with a history of poor feeding, lethargy, and rapid breathing
for 1 day. Examination reveals a sick-appearing infant whose extremities are pale and
mottled. His weight is 3 kg. His vital signs are: rectal temperature ,33 C, heart rate, 145
beats/min, respirations, 48 breaths /min, and blood pressure, 64/40 mmHg. His pulses
are equal in all extremities. His chest is clear to auscultation, his heart sounds are
normal, and no abnormality is noted on his abdominal examination. Pulse oximetry on
supplemental oxygen shows 100% saturation. Intravenous access is obtained. Of the
following, the most appropriate next step in management is:

A ) Endotracheal intubation
B ) Infusion of 60 ml 0.9% saline over the next 20 minutes
 C ) Infusion of fresh frozen plasma over the next hour
D ) Infusion of dopamine at 5 mcg/kg per minute
E ) lumber puncture

16- What is the most common congenital heart defect with a left to right shunt causing
congestive heart failure in the pediatric age group ?

A ) Atrial septal defect

B ) Arterio-ventricular septal defect
C ) Ventricular septal Defect
D ) Patent ductus arteriosus
E ) Aortopulmonary window
17- A 3-year-old boy has had severe abdominal pain and cloudy urine. On microscopic
examination his urinalysis demonstrates red blood cells too numerous to count ( TNTC
), many white blood cells, and bacteria. He subsequently has passed what you suspect
is a struvite renal stone. The cause of his urinary tract infection and this stone is most
likely due to an infection with:

A ) Clostridium difficile
B ) Enterococcus sp.
C ) Escherichia coli
D ) Proteus sp.
E ) Staphylococcus aureus
18- A3-week-old infant is admitted with vomiting of 5 days duration. Physical examination
reveals a rapid heart rate, evidence of dehydration, and ambiguous genitalia. Serum
electrolytes are Na+ 120 meq/L, K+ 7.5 meq/L, HCO3 12 meq/L, BUN 20 mg/dL. In
addition to intravenous fluid replacement with normal saline, administration of which
of the following would be most important?
A. Diuretics
B. potassium exchange resin
C. glucose and insulin
D. antibiotics
E. hydrocortisone

19- The most common complication of mumps in childhood is:

A. Arthritis
B. Meningoencephalitis
C. Myocarditis
D. Orchitis
E. Pancreatitis
20- Ostium secundun is most common and least likely to cause valvular insuffiecincy
21- Hyperglycemia > 800 , without ketoacidosis , labs showed hyponatremia ,
hyperkalemia , which is false :
A. Excessive normal saline may exacerbate the condition
B. K will return to normal upon saline infusion
 C. Functional Lab error causes sodium to decrease
22- Criteria for Kawasaki
Fever , conjunctivitis , rash
23- Intussusception treatment :
Contrast enema
24- Which of the following is not transient proteinuria
Orthostastic proteinuria

25- A case most likely to be Minimal change disease , which is true :

A. Steroids remove most of the symptoms by the 1st week
B. Steroids is predictor of renal histopathology

26- Empyema is found in all of these except :

A. Staphylocccoal infection
B. Chest injury
C. Bronchial asthma
D. Measles
27- Cyanosis , ejections systolic murmur , left-axis deviation and left ventricular
hypertrophy (LVH). Which of the following is the most likely diagnosis?
A. Transposition of the great arteries
B. Truncus arteriosus
C. Tricuspid atresia
D. Tetralogy of Fallot

28- Most common cause of pulmonary insuffiecieny in obese child :

A. Bronchial asthma
B. Sleep apnea
29- Child with seborrheic dermatitis , treated by corticosteroids , not improved :
A. Eczema
B. Pityriasisrosea
C. Langerahans cell histoicytosis
30- Which of the flowing is autosomal recessive :
A. Neurofibromatosis
B. Marfan
C. Adrenoleukodystrophy
D. Friedrich ataxia
E. None of the above

31- Classic homocystinuria present with all of the fllowing except :

A. Lens dislocation
B. Skleletal abnoramlites
C. Thromboembolism
D. Cardiomyopathy
32- Wilson disease complications include all :
A. Neuropsychiatric
B. Cardiac
C. Respiratory
D. All of the above
E. None of the above

33- Tyrosenemia type 1 ( hepatorenal syndrome ) present with all of the fllowing except :
A. Coagulopathy
B. Cirrhosis
C. Hyperkeratosis
D. Hypophostaic rickets

34- Which of the fllowing doesn't rasie the suspicion of metabolic dz :

A. Relentless deteriors
B. Symptom free interval
C. Ketonuria
D. Urine odor
E. Leucopenia

35- Fever , chills , malaise , blood in urine , diastolic murmur in sitting position , what to
do:
A. Blood culture
B. Urine culture
C. Transesopheal echo

36- Bilateral abdominal mass , with calcification ,periorbital ecchymosis , where it doesn't
make metastasis ,:
A. Skin
B. Brain
C. Lungs
D. Liver
E. Lymph nodes

37- measles
A. It is waterborne infection
B. It starts in the abdomen then spread to head and trunk and extremities
C. Its severitiy is related to rash distribution
D. Otitis media , pneumonia , are more common in adults

38- which of the following is a complication of chickenpox :

A. cerebral encephalitis
 B. ataxia
C. nystagmus
D. Gullian Bare syndrome
E. All of the above

39- which of the following vaccines are given in 1st year :

A. MMR
B. Rota
C. Hepatitis A
D. Hepatitis B
E. Varicella
F. B+D
G. All of the above

40- 1st sign of congestive heart failure in lung on xray :

A. Increased central pulmonary vascular congestion
B. Kerley b lines
C. Cardiomegaly

41- Isolated manifestation of rheumatic fever

A. Arthritis
B. Fever
C. Chorea
D. Carditis

42- A child with fecal incontinence , urinary incontinence , recurrent UTI three times , on
TMP Sulfa :
Refer to pediatric surgeon
43- 6 months old female , with UTI :
A. Broad spectrum antibiotics
B. Renal ultrasound
C. catheter for culture and consider antibiotic
44- Pain awakening from sleep , poor weight gain , which Is false :
A. Peptic ulcer
B. Eosinophilic enetris
C. Celiac
D. Functional abdominal pain
45- A 6 year child , with fecal incontinence , what to do :
A. Reassure mother
B. Behavioral changes to toilet training

46- A child with diarrhea many times , no other changes in growth :

Restrict juices
47- A gamma globulinema
48- Lecucytoclasticvasculitis :
A. Henoch shonlein purpura
B. Kawasaki
49- PNH , which is false :
A. Extracellular chronic hemolysis
B. Acute myelogenous Lekemia
C. Aplastic anemia

50- Differential diagnosis for ITP :

A. amegakaryocytic thrombocytopenia
B. TAR
C. Early fanconi
D. All of the above

51- Anti eplipetic in breast feeding , problem in which vitamin :

A. K
B. A
C. D
D. E

52- Which of the following doesn't trigger asthma :

A. Steroids
B. Cold night
C. Dut mite

53- 34- which of the following doesn't casue hyperpyrexia :

A. Salicylate
B. Anticholinergic
C. Phenobarbitone
D. Cocaine
E. Amphetamine

54- Anti dote for paracetamol :

N acetylcystine

55- Which of the following is not an early manifestation of aspirin :

A. Hypoventilation
B. Vomiting
C. tinnutis

56- Speech & language abnormalities , most important to do :

hearing test
57- When the baby crawl
A. 7 mo
 B. 8 mo
C. 12 mo
D. None of above
58- About Risk for UTI , which is true :
A. In 1st year , it is more common in male
B. Cirmucision decrease the risk
59- problems of premature babies include all EXCEPT:
A. polycythemia
B. hypoglycemia
C. Hypothermia
D. All of the above
E. None of the above

60- Klinefelter , which is false :

A. Gynecomastic appears in infancy and children
B. Increased risk for osteopenia and osteoporosis

61- which is false about celiac :

A. DQ2 , DQ8 increase the risk
B. Non Hodgkin lymphoma is most common cause of death
C. Silent celiac is symptomatic with negative serology and histology

62- Anemia of prematurity cause :

A. Iron stores are low in premature
B. Rapid destruction of RBCs
C. Liver produce inactive erthropetin
D. Renal

63- Weakness after exercise , on physical exam , ptosis , what test to do :

Antibody test
64- A case of Duchene muscular dystrophy
65- Gullian barre syndrome , which is true :
A. Involvement of anterior horn cells
B. Ascending weakness
C. Hyperreflexia
D. Other choice ?
E. B+D

66- Case of , Absence epilepsy , how to diagnose :

A. EEG , 3 hz spike ans slow wave
B. Clinical
67- spastic hemiplegic cerebral palsy
68- Ophthalmologic manifestation of SJA :
A. Cataracts
 B. Glaucoma
C. Corneal ulceration
D. Iridocyclitis
69- Sja , with leucopenia , thrombocytopenia , anemia
Macrophage activation syndrome
70- Cause of pulmonary hypertension
A. MAS
B. RDS
C. DIAPHRAGMATIC HERNIA
D. All of the above

71- Head circumference 50 , length 25 , weith below 5 percentile :

A. Inadequate calorie intake
B. Growth hormone deficieny
72- CF screening test :
Immuno reactive trypsinogen
73- Kernicturs : unconhungated bilirubinema

74- A child with bllod pressure 140/90 , asymptomatic , confirmed svereal time
A. Repeat
B. Give Nicardipine
C. Long standing most likely
75- Blood pressure is not affected by :
A. Weight
B. Taller
C. None of the above
76- 5 year old girl , fever , inability to bear weight , limp :
A. Irritable hip
B. HSP
C. Perths disease
D. DDH

77- Lost fluids in diarrhea , 5% dehydaroion , in 1st day :

A. 80% extra , 20% intra
B. 60% extra , 40% intra
C. 40% extra , 60% intra
D. 20% extra , 80% intra
E. None of the above

78- Girl admitted with dehydration ,elevated BUN . elevated Cr , improved on oral
hydration , most likely cause , FeNA ?
pre renal azotemia Fena< 0.7%

79- Which of the following is not a cause of neonatal meningitis ?

 A. GBS
B. Klebsiella
C. Enterobacter
D. Neisseria

80- 12 hr newborn , Vomitied yellow material :

A. observe ,
B. upper gi series ,
C. lower gi series
81- Shoulder dystocia , weakness in one hand , intact palmar grasp :
A. Erbs
B. Clavicle fracture
C. Klumpke

82- Non Hodgkin lymphoma which is false :

RADIOTHERAPY
83- Holoprocencephaly : TRISOMY 13
84- Level of deoxy hemoglobin to cause cyanois : 3-5
85- Which factor distinguish DIC from liver coagulopathy :
A. Factor 7
B. Fibrinogen
C. Factor 8

86- blood gases IN DKA case : High anion gap metabolic acidosis
87- can't roll from back to front and can't bring arm to middline: asymmetric tonic neck
reflex
88- Newoborn cyanotic , what to give ?
Indomethacin
Prostaglandin E1

89- Down , which is true :

A. Normal birth weight
B. Mosaicism 1-2%
C. Polycythemia may require treatment
D. 50% have cardiac abnormalities
E. Leukemoid reaction resolve spontaneously
F. All of the above
90- Doesnt cause increased pulmonary vascularity !
Tricuspid Atresia
91- Hirchprung !
92- Cardiology question , remember the word Atrioseptostomy in the quesuion !
TGA
93- All are true about infant of diabetic mother except :
Hyperglycemic dehydration
94- Fluids Question
95- About AD inheritance :
A. No skip generations
B. Male to male is possible
C. Female = Male incidence
D. All of the above
96- Rheumatic fever , carditis , arthritis , what to do :
A. Penicillin to kill remenant bacteria
B. Give anti-inflammatory
C. Treat hear failure
97- Hematuria , edema , oliguria , systemic review free , her twin brother has sore throat ,
which of the following is true :
A. C3 , C4 is low
B. If you treat the brother with antibody you prevent him from getting the same
disorder
C. She has high increased risk for RF
D. She has low risl of renal complications , and if there biopsy is indicated
98- Best to diagnose H.Pylori
Endoscope with biopsy
99- A child , with jaundice , not vaccinated for hepatitis A , what is true :
It may be Hepatitis A