Promotion Exam 2016

1.Pt with chronic renal failure what extra vaccine should be given?
-Pneumococcal polysaccaride conjugated vaccine
-Varicella vaccine
-meningiococcal vaccine

2.Pt with croup treated with racemic epinephrine and dexamthasone,

admitted to PICU, after 2 hours, developed stridor and respiratory
distress, what is the appropriate action?
-Intubation and MV
-Cool mist and observe
-Repeated dose of racemic epinephrine
-Albuterol

3. A 6 months old infant with history of pneumonia at age of 3

months, 2 croup attacks, one at age of 4 then age of 5 months,
current examination revealed inspiratory and expiratory stridor,
otherwise normal ex. , what is the most likely diagnosis?
-Laryngeomalacia
-Tracheomalacia
-Ciliary dyskinesia
-?

4.Teenage girl present with hx of syncope at school after feeling

warm and sweating when she was about to song for the first time, no
family hx of cardiac disease or seizure, what is the most likely
cause?
-Vasovagal syncope
-Prolonged QT syndrome
-Panic attack
-?

5.Pt (girl) diagnosed with celiac disease by colonoscopy, what is your

advice?
-Repeat colonoscopy after 6 months to confirm the diagnosis
-Start gluten free diet lifelong
-Gluten free diet till age of 18 year
-Gluten free diet till become pregnant to hold during pregnancy

6.Pt with down syndrome and abdominal distention, intemittent

diarrhea, FTT, what antibody
will help in the diagnosis?
-Antiendomyseal
7.Neonate didn't pass meconium x-ray abdomen shows dilated
descending colon and normal sigmoid and rectum? ( not sure of the
description)
Next step?
-rectal biopsy
-CT ?

8.Child with FTT, pancreatic insufficiency, what is the most likely

diagnosis?
-Cystic fibrosis

9.Child with cystic fibrosis presented with sudden sharp chest pain
and respiratory distress what can be the cause?
-Pneumonia
-Atelectasis
-Pneumothorax
-Lung abscess

10.Neonate 26 weeks, PROM , MSL, there was had respiratory

distress after delivery, cxr: bilateral patchy infiltrate, what is the most
likely organism?
-Listeria
-Klebsiella
-GBS
-Streptococcus pyogens

11.During routine ex. of healthy newborn you find bounding carotid

pulse and cranial bruit, you send the pt to NICU for observation, what
does this finding suggestive of?
-Congestive heart failure
-Progressive cyanosis
-Syncope
-Siezure

12.Pt present with vomiting, bouts of crying, on ex. sausage like

mass in Rt upper quadrant, which of the following is useful to reach
the diagnosis?
-Barium enema
-Abdominal US
13.Pt presented with puffiness after history of viral URTI, has
proteinuria, but no hematuria, normal albumin and RFT, what is the
most likely diagnosis?
-Membraneous glomerulonephritis
-Membranoproliferazive glomerulonephritis
-Minimal change nephrotic syndrome
-Rapidly progressive glomerulonephritis

14.Pt present with hx of progressively enlarging left sided neck

swelling over the last 4 months, 2 weeks hx of stridor, on ex.
Enlarged left upper lobe of thyroid, no lymphadenopathy, normal
other ex., what is the most helpful to establish the diagnosis?
-Radionucleoid scan
-Thyroi US
-FNA biopsy of thyroid
-Thyroxin level

15.Which of the following is seen in anorexia nervosa?

-Low T3
-Menorrhagia
-?

16. A 18 month old baby brought to the ER with noisy breathing

started suddenly when he was playing outdoor. On examination he
was distressed with decrease air entry on right side.
What is the most useful investigation?
- Neck X-Ray
- Bronchoscope
- Chest CT
- Barium swallow

17. A 12 year old boy presented with one month history of scaly
lesion over scalp, eye brow, elbow, knee and buttock.
What is the diagnosis?
- Psoriasis
- Scabies
- Atopic dermatitis
- Seborric dermatitis
18. At which age in year a normal child with have a visual acuity
equivalent that of adult?
- 1-2
- 4-5
- 9-10
- 12-13

19. A 9 years old girl come to clinic with history syncope and she
mentioned feeling of warmth , head funny , when she was sing on her
own in auditorium in school , no family hx cardiac ,seizure , excesice
intolerance , or palpitation
- Panic disorder
- Long QT
- Vasovagal
- Seizure disorder

20. Male with scanty long mildly pigmented pubic hair with enlarged
scrotum what is stage of puberty
-1
-2
-3
-4

21. Term newborn delivered at home , came to hospital on

examination he is pale other examinations normal his lab
Hgb:110. Retic: 5%. Direct Coombs test normal Mother A
positive
Baby O positive what is dx
- Rh Iso
- ABO iso
- Physiological Anaemia
- Transplacental hge

22. A 2 month old baby came to clinic examinedand found to have

firmly attached umbilical cord
- occult ompgalocele
- umbilical granuloma
- IgG subclass deficiency
- LAD
23. The following are seen with anorexia
- mennoraghia
- poor school performance
- Increased growth velocity
- low T3

24. A 20 month old child brought to clinic by her parents complaining

that she has lost consciousness twice recently. The parents describe
the episodes as the child crying vigorously then turns purple and
passes out. No history of fever.No family history of seizures or
cardiac disease.
The next appropriate step is:
- reassurance
- ct brain
- ECG and chest x-Ray
- glucose level and electrolytes

25. A 6 month old presented with history of pneumonia at age of 3

month and 2 attacks of croup at age of 4 and 5 month on
examination found to have inspiratory and expiratory stridor dx.
- laryngomalacia
- tracheomalacia
- subglottic stenosis
- unilateral vocal cotd palsy

26. A 6 years old came with history of 2 years abdominal pain,

distenstion and intermittent diarrhea small intestinal biopsy confirm
celiac disease.. what is the advice to the family:
- start glutin free diet lifelong
- glutin free diet untill 18 of age
- repeat biopsy after 6 month for confirmation.
- glutin free diet until pregnancy then resume normal diet.

27. three years old came to ED sleepy with trouple breathing he was
playing 2 hour earlier in a farm. On examination he was in respiratory
distess with wheeze prefusly sweating with lacrimation and salivation.
The cause:
- gazolin
- pesteside
- drain cleanser
28. A boy presented with abdominal pain , fever,mild joint swelling
,,mother gave hx of sore throat few days befor which was tt with
antibiotic properly ,,pt had on exam new onset murmur , no
hepatosenomegaly & normal joint exam ,,
Whats your diagnosis ?
- Rheumatic fever
- Juvenile arthritis
- Reactive arthritis
- VSD

29. Second baby of a mother who is 25 yrs old ,was born hydropic
,edematous ,hepatosplenomegaly , first delivery was at home with
her aunt who helped her,
Mother bld group O-
Father bld group O+
Whats baby blood group ?
- A-
- A+
- O-
- O+

30. A 6 month old presented with history of pneumonia at age of 3

month and 2 attacks of croup at age of 4 and 5 month on
examination found to have inspiratory and expiratory stridor dx.
- laryngomalacia
- tracheomalacia
- subglottic stenosis
- unilateral vocal cotd palsy

31. A 6 years old came with history of 2 years abdominal pain,

distenstion and intermittent diarrhea small intestinal biopsy confirm
celiac disease.. what is the advice to the family:
- start glutin free diet lifelong
- glutin free diet untill 18 of age
- repeat biopsy after 6 month for confirmation.
- glutin free diet until pregnancy then resume normal diet.
32. A three years old came to ED sleepy with trouple breathing he
was playing 2 hour earlier in a farm. On examination he was in
respiratory distess with wheeze prefusly sweating with lacrimation
and salivation. The cause:
- gazolin
- pesteside
- drain cleanser

33. A 4 years old girl with hx of acute GE ..

Urine RBS - ve
Urine protein ++
What is your diagnosis ?
- IgA neuropathy
- Glomerulonephritis
- Transient proteomic
- HUS

34. A 13 years old girl diagnosed as case of acne . Prescribed for her
vitamin A preparation .. winch of the following indicates vitamin A
toxicity ?
- Alopecia
- Diarrhea
- Photophopia
- Gum bleeding

35. pt present with ingestion of clenning toilet material

What to do?
- Upper gi endoscopy
- Intubation

36. pt present with seizure mother give her herps

- Csf
- Pbf basiphilic stipping
- Dignosis
- Lead poisoning

37. 3 years old with sudden irritability and crying came unresponsive
with ecg showing narrow complex and absent p wave
Best action
A. Defibrillation
B. Vagal maneuver
C. Ice packing on eyes
D. Synchronized cardioversion
38. A 13 years old with neck swelling over rt thyroid lobe with no
lymphadenopathy had hoarseness few days back
To confirm diagnosis
- us thyroid
- radio-nuclear scan thyroid
- FNA of thyroid
- ???

39. A 2 y.o. rt eye red reflex changed to yellow:

- retinoblastoma
-severe hyperopia
- rhabdomyosarcoma
- retinitis pigmentosa

40. craniosynthosis of sagital suture can cause:

- microcephaly
- scaphocephaly
-hydrocephaly
- ....

41. A 4 years old boy came with periorbital swelling in upper and
lower eyelids bilateral.... other examination and systemic review all
with normal .... what additional vaccine you will give
- Meningococcal
- pneumococcal
- h influenza b

42. A 13 year old girl presented with preasthsia in both lower limb,
she had URTI 10 days back.
&I she has proximal muscle weakness:
What is the treatment:
- IV antibiotic
- IV steroid
- IV immunoglobulin
- IV

43. A14 year old she brought with Amenorrhea , hight & weight below
5 th centlie , No breast swelling.
What could not be the cause:
- hypothyroidism
- anorexia nervosa
- 21- hydroxylase deficiency
- constitutional growth deficiency
44. A girl with Anorexia nervosa
- low triiodothyronine
- low school performance

45. Newborn has pallor &splenomegaly

Lab Hgb 13 retic 7% blood group mother A+ baby O +
His brother has mild anemia & splenomegaly
What is the cause
- ABO incompatibility
- Rh isomerization
- physiological anemia
- spherocytosis

46. If child has headache what is the feature that suggest life
threatening
- pulsatile thruping headache
- sudden sever headache in the 1st min
- progressive headache
- headache for 2-3days every 4 months with normal neurological
examination

47. Present in both rhumatic fever and infective endocarditis

- osler nodule
- Erythema nedosam
- gallop rhethem
- petichi

48. A 4 years old child admitted to ER after parent notice while he

playing with small plastic toy on examination he has respiratory
distress and stridor
- Intubation
- Back blow
- Finger sweep
- Racemic inhalation

49. At which age in week pretem able feed orally adequatly without
gauge or NGT
- 32
- 28
- 36
- 37
 50. A 8 month old presented with Hx of vomiting and screeming for
12 hrs . Abd. Examination reveled a susage like mass in RUQ
What is the next / most benificial investigation for diagnosis (( I'm not
sure about the statment )!!
- CT abdomen
- U/S abdomen
- barium enema
- stool for ova or cyst

51. A 2 month old boy presented with Hx of fever and poor

feeding for 1 day ..
Examination reveled a bulging anterior fontanells ..
V/S : BP: 60\37 HR : 170 Temp: 39.5
CSF : gram positive cocci in chain
The most likely cause :
- enterovirus encephalitis
- meningitis
- H.infl type B meningitis
- GBS meningitis
☝poor feeding

52. A 4 yo came to ER with generalized tonic clonic convulsion

lasting for 45 min aboarted by diazepam .. History and examination
normal ...
What is the most urgent investigation ...
- EEG
- CT brain
- Serum glucose and electrolyte
- Toxicology screening

53. A 1 Y/O came with copius nasal discharge .. Had corase feature
in form of thick lip , falt nasal bridge delivers normally and was
normal after birth On examination hepatospleenomegaly :
- Hurler disease
- Osteogenesis imprafacta
- Congintal pain insenstivty

54. In a comparison between cows' milk and human milk :

- Human milk contain more protein
- human milk contain more Vit K
- the whey to casein ratio in human milk is lower
- the water and solid content is equal in both
55. An infant who's a known case of TOF currently having a cyanotic
spell all of the following
should be done except;
- morphine
- digoxin
- chest knee position
- propranolol

56. A child who got difficulties in reading were he substitute letters

and disarrange them but can talk clearly and understand what heard;
- Dyslexia
- Dysarthria

57. Hand preference

Will be established by ;
- 1-18 months
- 2-24 months
- 3-36 months
- 4-12 months

58. A 15 m old male came with recurrent chest infection , wt 8.5kg ,

hight 70cm , low K , low Na , low cl , plt normal , wbc 12
What is the diagnosis :
- Cystic fibrosis
- Immotil cillia
- Hemosedrosis

59. A 4 yrs old Failure to grow with exocrine pancreatic insufficiency

What is the diagnosis
- Cystic fibrosis
- Schwachman
- Absent pancreas
60. A 6 yr old Present with puffiness of eyes swelling of hand and
foot 1wk following URTI ,normotensive
Systemic examination unremarkable apart from swelling of hand feet
and face
Albumin 35
Bun 6
Creatinine 75
Urine protein ++++
Urine RBC -
What is the diagnosis
- Minimal change
- Rapidly progressive glomerulonephritis
- Membranous nephropathy
- membranoproliferative glomerulonephritis

61. A 12 yrs old girl with hx of bilateral lower limb tenderness on

examination swelling on anterior aspect of both legs what you will do
next:
- Answer is throat culture
- Urine analysis
- Stool analysis

62. Infant present with jaundice, broad forehead, small chin with
butterfly vertebrae what is diagnosis
- Answer alagille syndrome

63. A 10 m old boy , brought by his mother concern about delayed

teething.his wt 9 kg ,ht 73 cm Hc 47 cm. His systemic examination
unremarkable. What is the cause of delayed teething?
- idiopathic
- hypothyroidism
- hypoparathyroidism
- nutritional Ricket

64. A 10 month old boy brought by his mother as noticed to be pale ,

difficulty in feeding . On examination he looks pale tachycardic up to
188 B/M
Investigation show Hb:3 g/dl
You will transfuse PRBC?
- 20 cc/kg over 12h
- less than 3 cc/kg/hr over 4 hr
- 10 cc/kg over 4 h and another unite after 12 h
- 15 cc/kg over 6 h , then start him on oral iron supplementation
65. A13 y/o girl with heamolysis and elevated liver enzymes and
detoriorated school performance
- Answer is Wilson disease

66. Child living in farm with h/o distress , conjunctivitis and Coryza
-

67. Most life threatening complication

- Myocarditis
- Pneumonia
- Encephalitis
- Hemorrhagic shock

68. A 7 year girl teased in school .. Daily stool in underwear .. 6 m of

constipations
PR full rectum
- course of laxative
- fleet enama X2
- GI consultation

69. A 6 year BA ABG

PO2 43
Pco3 50
Hco3 21
- intubate
- pulmonogist
- theophylline

70. A neonate with jaundice

Direct and indirect bilirubin level was provided mainly indirect,
elevated AST, ALT elevated
US done, show normal liver
Gallbladder not visualized, DX:
- Biliary atresia

71. A 2 years old child accidentally ingested 10 tablets

of Ibuprofen, 500 mg/tab, two hours before coming
to ER, What is the appropriate management:
- take drug level 6 hours after the ingestion.
- induce emesis.
- activated charcoal.
- arrange for hemodialysis.
72. What is the common risk factor for Meconium aspiration
syndrome:
-Fetal distress

73. Patient with polyurea, increase oral fluis intak and c/o abdominal
pain, what is the initial invetigation
- Urine analysis

74. A 9 year old female with frontal headache for the last 6 month
lasted 2-3 days associated with dizziness and vomiting on
examination normal
What is most likely the cause
- frontal sinusitis
- migraine
- subdural hematoma
- pseudo tumor cerebri

75. A 28 week preterm weight 700 gm in 3rd day of life found to

have IVH in us with mild dilated ventricles with no symptom
What best action
- CT brain
- repeat US after 1-2 weeks
- LP
- EEG

76. Neonate of mother with hepatitis

What is the next step
- Hepatitis B vaccine only
- IVIG only
- Hepatitis B vaccine + IVIG

77. A 13 ...patient had croup , was managed in the pediatric ER with

nubalized epinephrine, shifted two the PICU after 2 hours patient
was assessed was to have moderate strider and moderate
tachepnia
V/S.................
- albutarole
- give more epinephrine
- cold mist , observation
78. A 15 year boy had PPD 12 mm no fever no contact with TB
patient
- Do nothing
- Give INH for 9 months
- Delay intrey to school till PPD -ve

79. A 3 year old with FFT presented with fever and vomiting blood
gas showed normal anion gap MA . low Po low K . urine ph 6.6
- proximal RTA

80. A ? year old girl got upset with her mother few hours later found
to be drowsy with T 37.9 high heart rate with flushing and dry skin
- mostly amphetamine

81. A 5 years old female dignosed as preaucricular JIA with positive

ANA, MOST probably found to have :
- Uveitis.
- nephritis.
- pericarditis.
- splenomegaly.

82. Caustaive organism of 5th disease is :

- Parvovirus B19

83. A 6 years old girl presents with unilateral non-painful,

nonsupportiveconjunctivitis and preauricular lymphadenitis. What is
the most likely causative organism?
- mycobacterium avium.
- Bartonella henselae.
- Adenovirus.
- Staphylococcus aureus.
- Chlamydia trachomatis.

84. 7y/o boy e down syndrome.. found to have hight and wt below 5th
centile for age when plotted on chart specific for down syndrome.
What is the appropriate antibody to investigate for ?
- antineuclear
- anticardiolipin
- anti-endomysial
- anti??
 85. A pregnant lady in labor , has fever 38.9 and tenderness in lower
abdomen , givin penicillin then deliver after 3 hours.
At age of 2 hour her baby assessment was normal
What is the next appropriate action ?
- Observe baby for 48 hrs
- discharge baby e his mother
- take septic work and start antibiotic
- administer to the baby one dose intramuscular ceftriaxone.

86. A 8 month old boy referred fo FTT polyure

NA 133 K 2.8 pco215 Cl 98
Diagnosis:
- Barter
- RTA
- CCLD
87. regarding CAH &ht
- Final ht taller
- Final ht shrter
- Equal to usual ht of other peer

88. A 13 yo male , known case cystic fibrosis ... Complaining of acute

chest pain and tachypnea ...
What is the most likely diagnosis:
- Pneumonia
- Atelectaisis
- Lung abscess
- Pneumothorax ...

89. Child can understand the different between goegraphical shapes

.......... I forgot the rest:
- 2 Years
- 4 Years
- 5 Years
- 6 Years

Good Luck for all of us

Dr Khalid Alshaigi
KFSHRC Riyadh