NELSON'S MCQs Flashcards
A mother of a 2-week-fullterm baby noted doll’s-eye movement of her baby eyes.
Of the following, The MOST appropriate next action is to
A. reassures her by informing her that, this is a normal reaction
B. refer the baby to an ophthalmologist
C. takes a detailed history of perinatal period
D. order brain ultrasound
E. order brain MRI
A- Normal finding
he age at which the infant achieve early head control with bobbing motion when pulled to sit is A. 2 mo B. 3 mo C. 4 mo D. 5 mo E. 6 mo
(B). This is a developmental skill of 3 months of age which include also; lifts head and
chest with arms extended on prone; head above plane of body on ventral suspension;
reaches toward and misses objects; waves at toy; listens to music and says “aah, ngah”.
The age at which the infant can reach an object, grasp it and bring it to mouth and seems exited when see the food is A. 4 mo B. 5 mo C. 6 mo D. 7 mo E. 8 mo
(A). By this age he also able to lifts head and chest, with head in approximately
vertical axis; achieve no head lag when pulled to sitting position, enjoys sitting with full
truncal support when held erect, pushes with feet when sees raisin, but makes no
move to reach for it, laughs out loud; and may show displeasure if social contact is
broken.
By the age of 7 months the infant is able to do all the following EXCEPT A. transfer object from hand to hand B. bounces actively C. cruises D. grasp uses radial palm E. roll over
(C). Cruises or walks’ holding to furniture is by 10 months of age.
You are specialist explaining the developmental implication of a 6-month-old baby
boy who “transfers object hand to hand” to college students.
Of the following, the BEST statement describing that is a/an
A. visuomotor coordination
B. voluntary release
C. comparison of objects
D. ability to explore small objects
E. increasing autonomy
(C). The developmental implication reflects cognitive development.
A 10-month-old child can do all the following EXCEPT
A. follows one-step command without gesture
B. says “mama” or “dada”
C. points to objects
D. speaks first real word
E. inhibition to “no”
(D). This is a 12 months developmental skill.
You are observing a 15-month-old toddler, he was able to do all the following EXCEPT A. walks alone B. makes tower of 3 cubes C. inserts raisin in a bottle D. responds to his/her name E. identifies 1 or more parts of body
(E). This is an 18 months developmental skill.
The age by which the child can makes tower of 9 cubes and imitates circular stroke is A. 24 mo B. 30 mo C. 36 mo D. 42 mo E. 48 mo
(B). A 30 months old child also able to goes up stairs alternating feet, makes vertical
and horizontal strokes, refers to self by pronoun “I”; knows full name, helps put things
away and pretends in play.
These facts are true regarding the developmental stage of preschool children
EXCEPT
A. handedness is achieved by 3 years of age
B. boys are usually later than girls in achieving bladder control
C. knowing gender by 4 years
D. egocentric thinking
E. musturbation
(C). Bowel and bladder control emerge during this period, with “readiness” for
toileting having large individual and cultural variation. Bed-wetting is normal up to age
4 yr in girls and age 5 yr in boys. Thinking in this period characterized by magical
thinking (the child might believe that people cause it to rain by carrying umbrellas, that
the sun goes down because it is tired), and egocentrism which refers to a child’s
inability to take another’s point of view. Gender identification usually achieved by 3
years of age. Curiosity about genitals and adult sexual organs is normal, as is
masturbation. But excessive masturbation interfering with normal activity, acting out
sexual intercourse, extreme modesty, or mimicry of adult seductive behavior all
suggests the possibility of sexual abuse or inappropriate exposure.
A young couples of a 2-month-old baby girl with excessive crying seek your medical
advice. Mother said that the baby is crying about 3 hr in a day, 2-3 days per week. She
is intermittently spitting but she is gaining weight adequately. She is bottle fed baby.
Of the following, the LEAST important advice is to
A. master the situation in relaxed manner
B. adhere to precry cues
C. change milk formula
D. avoid sensory overstimulation
E. reassure about benign nature of illness
(C). Prolong crying episodes is present in about 20% of infants younger than 2 mo of
age.Crying (longer than 3 hr/day, longer than 3 days/wk lasting longer than 1 wk) and
more often crying/fussiness persisting longer than 3-5 mo might be associated with;
child abuse; behavioral problems when an older child (anxiety, aggression,
hyperactivity); decreased duration of breastfeeding and postnatal depression
(uncertain which is the cause or effect). Most infants with crying/fussiness do not have
gastroesophageal reflux, lactose intolerance, or cow-milk protein allergy.
Between 2-6 months of life, the infant start to achieve a regular sleep–wake cycles.
All the following are true about infant sleep during this period EXCEPT
A. total sleep hours are about 14-16 hr/24 hr
B. sleeps about 9-10 hr concentrated at night
C. sleeps 2 naps/day
D. sleep electroencephalogram shows the mature pattern
E. the sleep cycle time is similar to that of adults
(E). The sleep cycle remains shorter than in adults (50-60 min vs approximately 90
min). As a result, infants who arouses frequently during the night, considered as
behavioral sleep problem.
Of those babies who have prolonged crying episodes in the first 2 mo of life, the percentage that will remain having similar episodes is about 11 A. 1% B. 5% C. 10% D. 30% E. 50%
B
The birthweight usually quadruples by the age of A. 1.5 yr B. 2 yr C. 2.5 yr D. 3 yr E. 3.5 yr
C
The child who plays simple games (in “parallel” with other children); helps in
dressing and washes hands, his/her MOST appropriate developmental age is around
A. 15 mo
B. 18 mo
C. 24 mo
D. 30 mo
E. 48 mo
D
The child who is able to imitates construction of “gate” of 5 cubes; draws a man with 2-4 parts besides head and identifies longer of 2 lines, his/her MOST appropriate developmental age is around A. 24 mo B. 30 mo C. 48 mo D. 54 mo E. 60 mo
C
Regarding the physical growth of middle childhood (6-11 yr); all the following are true EXCEPT A. 3-3.5 kg wt increment/yr B. 6-7 cm height increment/yr C. brain myelinization stops by 8 yr D. first deciduous tooth falls by 6 yr E. risk for future obesity
(C). Brain myelinization continues into adolescence, with peak gray matter at 12-14
yr.
The first permanent tooth to erupt is A. central incisor at 6 yr 13 B. molar at 6 yr C. premolar at 6-7 yr D. lower canine at 6-7 yr E. upper canine at 6-7 yr
(B). The first permanent molars usually erupt between ages 6 and 7 years. For that
reason, they often are called the “six-year molars.” They are among the “extra”
permanent teeth in that they don’t replace an existing primary tooth. These important
teeth sometimes are mistaken for primary teeth. The six-year molars also help
determine the shape of the lower face and affect the position and health of other
permanent teeth. The first deciduous teeth to fall are central incisors.
The MOST common cause of sleeping difficulty in the first 2 months of life is
A. gastro-esophageal reflux
B. formula intolerance
C. colic
D. developmentally sleeping behavior
E. recurrent self resolving intussusceptions
(D). Most sleep issues that are perceived as problematic at this stage represent a
discrepancy between parental expectations and developmentally appropriate sleep
behaviors. Newborns that are noted by parents to be extremely fussy and persistently
difficult to console are more likely to have one of the mentioned medical issues.
A mother of 4-month-old baby boy complaining that the baby never goes to sleep
unless he is rocked for quite long time. She needs to repeat the same issue whenever
he is awake at night. She was surprised as no one of her previous babies had the similar
behavior. She feels tired because of insufficient sleep.
Of the following, the MOST common cause of this baby problem is
A. an early signs of ADHD
B. behavioral insomnia of childhood, sleep-onset association
C. primary sleep disorder
D. restless legs syndrome
E. sleep terrors
(B). In this situation, the child learns to fall asleep only under certain conditions or
associations, which typically require parental presence, such as being rocked or fed,
and does not develop the ability to self-soothe. In babies, gradually weaning the child
from dependence, and in older children introduction of more appropriate sleep
associations that will be readily available to the child during the night (transitional
objects, such as a blanket or toy), in addition to positive reinforcement (i.e., stickers for
remaining in bed), is often beneficial
All the following are compatible with the definition of obstructive sleep apnea
EXCEPT
A. repeated episodes of prolonged upper airway obstruction
B. apnea
C. ≥30% reduction in airflow
D. ≥ 30% O2 desaturation
E. disrupted sleep
(D). ≥ 3% O2 desaturation.
All the following amino acids are indispensable in human diet EXCEPT 44 A. leucine B. methionine C. threonine D. valine E. alanine
(E). Alanine, aspartic acid, asparagine, glutamic acid, and serine are dispensable
amino acids.
Essential fatty acids deficiency is associated with all the following features EXCEPT A. desquamating skin rashes B. alopecia C. thrombocytosis D. impaired immunity E. growth deficits
(C). Thrombocytopenia.
All the following statements concerning iron requirement in children are true EXCEPT
A. breast milk provides optimal intake of iron for the first 4 months
B. iron present in animal protein is more bioavailable than that found in
vegetables
C. iron deficiency is the most common micronutrient deficiency
D. cow’s milk is a good source of bioavailable iron
E. iron supplements can interfere with zinc absorption
(D). Cow’s milk is a poor source of bioavailable iron.
Zinc deficiency is associated with increased risk for all the following EXCEPT
A. stunting
B. impaired immune function
C. increased risk for respiratory diseases
D. increased risk for diarrheal diseases
E. increased risk for skin infections
(E). Zinc is Essential for proper growth and development, and an important catalyst
for about 100 specific enzymes.
Breast feeding has been suggested to have a possible protective effect against all the following EXCEPT A. otitis media B. urinary tract infections C. septicemia D. childhood cancer 45 E. skin infections
(E). Diarrhea, otitis media, urinary tract infections, necrotizing enterocolitis,
septicemia, infant botulism, celiac disease, childhood cancer, allergy, hospitalizations,
and infant mortality all are conditions in which breastfeeding has been suggested to
have a possible protective effect.
An absolute contraindication to breastfeeding is A. hepatitis c infection of the mother B. alcohol intake C. herpes simplex lesion of the lips D. active pulmonary tuberculosis E. maternal high grade fever
(D). Active pulmonary tuberculosis is a real contraindication to breastfeeding.
Herpes simplex infection of the breast is another contraindication.
Regarding breast engorgement; All the following are true EXCEPT
A. usually happens in the first stage of lactogenesis
B. poor breast feeding technique can cause engorgement
C. breastfeeding immediately at signs of infant hunger will eventually prevent
this
D. to reduce engorgement, breasts should be softened prior to infant feeding
with a combination of hot compresses and expression of milk
E. between feedings, cold compresses applied, and oral nonsteroidal antiinflammatory
medications administered
(A). Breast engorgement happens in the second stage of lactogenesis.
All the following organisms can cause mastitis EXCEPT A. Staphylococcus aureus B. Escherichia coli C. Haemophilus influenza D. Klebsiella pneumoniae E. group B streptococcus
(E). Group A streptococcus, not group B.
The MOST commonly used index for nutritional status is A. height-for-age B. weight-for-height C. body mass index D. mid-upper arm circumference E. weight-for-age
(E). Weight-for-age is the most commonly used index of nutritional status, although
a low value has limited clinical significance as it does not differentiate between wasting
and stunting. Weight-for-age has the advantage of being somewhat easier to measure
than indices that require height measurements.
For children <5 yr, the highest global prevalence of micronutrient and trace elements deficiencies is that of A. vitamin A deficiency B. zinc deficiency C. iron deficiency D. iodine deficiency E. copper deficiency
(A). For children <5 yr, the global prevalence is estimated to be 33% for vitamin A
deficiency, 29% for iodine deficiency, 17% for zinc deficiency, and 18% for irondeficiency
anemia. Prevalence of micronutrient deficiencies tends to be highest in
Africa.
In consideration of preventing infections in stabilization phase of malnutrition in unimmunized 10-month-old boy. Of the following, the vaccine that is recommended to be given is A. oral polio vaccine B. acellular pertussis vaccine C. measles vaccine D. pneumococcal vaccine E. H. influenza vaccine
(C). Measles vaccine is given to unimmunized children age >6 mo.
The hallmark of refeeding syndrome is the development of severe A. hypophosphatemia B. hypokalemia C. hypomagnesemia D. hypernatremia E. hyperglycemia
(A). The hallmark of refeeding syndrome is the development of severe
hypophosphatemia after the cellular uptake of phosphate duringthe 1st wk of starting
to refeed. Serum phosphate levels of ≤0.5 mmol/L can produce weakness,
rhabdomyolysis, neutrophil dysfunction, cardio-respiratory failure, arrhythmias,
seizures, altered level of consciousness, or sudden death.
The gastrointestinal hormone/response that stimulates appetite in children is A. cholecystokinin B. glucagon-like peptide-1 C. peptide yy D. vagal neuronal feedback E. ghrelin
(E). Gastrointestinal hormones, including cholecystokinin, glucagon-like peptide-1,
peptide YY, and vagal neuronal feedback promote satiety. Ghrelin stimulates appetite.
36.(E). Type 2 diabetes mellitus is a childhood obesity-associated comorbidity.
All the following are childhood obesity-associated comorbidities later in life EXCEPT A. hypertension B. gallbladder disease C. tibia vara D. asthma E. type 1 diabetes mellitus
(E). Type 2 diabetes mellitus is a childhood obesity-associated comorbidity.
Brown-Vialetto-Van Laere syndrome (BVVLS), a neurologic disorder characterized
by progressive neurologic deterioration, sensorineural hearing loss, and pontobulbar
palsy usually responds to treatment with high doses of
A. niacin
B. biotin
C. riboflavin
D. pyridoxine
E. thiamin
C-Mutations in genes coding for riboflavin transporter proteins have been
identified in children with BVVLS.
The MOST convenient way to confirm a diagnosis of pellagra in children is
A. skin biopsy
B. urinary 2-pyridone
C. response to niacin treatment
D. urinary n1-methyl-nicotinamide
E. physical signs of glossitis and dermatitis
C-Rapid clinical response to niacin treatment is an important confirmatory test.
The MOST characteristic manifestation of pellagra is A. dermatitis B. dementia C. diarrhea D. anorexia E. lassitude
(A). Dermatitis, the most characteristic manifestation of pellagra, can develop
suddenly or insidiously and may be initiated by irritants, including intense sunlight.
The dietary reference intake of pyridoxine for a healthy eight-month-old infant is A. 0.1 mg/day B. 0.3 mg/day C. 0.5 mg/day D. 1.0 mg/day E. 3 mg/day
(B). 0-6 months: 0.1 mg/ day; 7-12 months: 0.3 mg/ day; 1-3 yr: 0.5 mg/day; 4-8 yr:
0.6 mg/day; 9-13 yr: 1.0 mg/day 14-18 yr: 1.2 - 1.3 mg/day.
Pyridoxine is not affected in patients receiving A. isoniazid B. valproate C. phenytoin D. penicillamine E. corticosteroids
(B). Other distracters cause pyridoxine deficiency.
Folate is important during embryogenesis for the development of A. lungs B. genital organs C. gastrointestinal system D. central nervous system E. cardiovascular system
D
All the following can cause folate deficiency EXCEPT
A. celiac disease
B. sickle cell anemia
C. 6-mercaptopurine therapy
D. inflammatory bowel disease
E. methylene tetrahydrofolate reductase deficiency
C Methotrexate not 6-mercaptopurine
25-hydroxy vitamin D level is reduced in
A. vitamin D deficiency
B. autosomal recessive hypophosphatemic rickets
C. autosomal dominant hypophosphatemic rickets
D. Fanconi syndrome
E. tumor-induced rickets
A
The best indicator of the body stores of vitamin C is A. plasma ascorbate concentration B. leukocyte ascorbate concentration C. urinary ascorbate level D. urinary amino acid level E. plasma amino acid level
B
All the following are recognized causes of rickets EXCEPT A. Mccune-Albright syndrome B. epidermal nevus syndrome C. tuberus sclerosis D. neurofibromatosis E. aluminum-containing antacids
(C). Aluminum-containing antacids cause phosphorus deficiency. McCune-Albright
syndrome, epidermal nevus syndrome, and Neurofibromatosis enhance renal losses.
The first factor to be affected by deficiency of vitamin K is A. Factor I B. Factor II C. Factor VII D. Factor IX E. Factor X
(C). Factor VII has the shortest half life of the coagulation factors.
The MOST devastating consequence of untreated hypernatremia is A. brain hemorrhage B. seizures C. central pontinemyelinolysis D. extra pontinemyelinolysis E. brain edema
(A). As the extracellular osmolality increases, water moves out of brain cells, leading
to a decrease in brain volume, this decrease can result in tearing of intra cerebral veins
and bridging blood vessels as the brain moves away from the skull and the meninges,
patients may have subarachnoid, subdural, and parenchymal hemorrhages. Seizures
and brain edema are more common during correction of hypernatremia.
Hypervolemic hyponatremia is caused by A. cirrhosis B. cerebral salt wasting C. pseudohypoaldosteronism type I D. obstructive uropathy E. bowel obstruction
A
Asymptomatic hyponatremia is seen in A. cirrhosis B. tap water enema C. child abuse D. hyperglycemia E. tubule -interstitial nephritis
(D). Because the manifestations of hyponatremia are a result of the low plasma
osmolality, patients with hyponatremia resulting from hyperosmolality do not have
symptoms of hyponatremia.
Syndrome of inappropriate antidiuretic hormone secretion (SIADH) is characterized by A. extravascular volume expansion B. high serum uric acid C. high blood urea nitrogen D. euvolemic hyponatremia E. urine sodium <30 mEq/L
(D). Because SIADH is a state of intravascular volume expansion, low serum uric acid
and BUN levels are supportive of the diagnosis, the kidney increases sodium excretion
in an effort to decrease intravascular volume to normal; thus, the patient has a mild
decrease in body sodium(urine sodium >30 mEq/L).
The MOST common cause of hypokalemia in children is A. alkalemia B. distal rental tubular acidosis C. gastroenteritis D. diabetic ketoacidosis E. loop diuretic
C
The mechanism of hypokalemia in emesis is mainly due to A. gastric loss of potassium B. gastric loss of hydrochloric acid C. low aldosterone level D. dehydration E. hypomagnesaemia
(B). The gastric loss of hydrochloric acid (HCl), leading to a metabolic alkalosis and a
state of volume depletion. The kidney compensates for the metabolic alkalosis by
excreting bicarbonate in the urine, but there is obligate loss of potassium and sodium
with the bicarbonate. The volume depletion raises aldosterone levels, further
increasing urinary potassium losses and preventing correction of the metabolic
alkalosis and hypokalemia until the volume depletion is corrected.
The MOST common cause of hyperphosphatemia is A. acute hemolysis B. vitamin D intoxication C. renal insufficiency D. cow’s milk intake E. hypoparathyroidism
C
Normal anion gap metabolic acidosis can occur in A. renal failure B. liver failure C. severe anemia 69 D. malignancy E. starvation ketoacidosis
(A). In renal failure, there is retention of unmeasured anions, including phosphate,
urate, and sulfate. The increase in unmeasured anions in renal failure is usually less
than the decrease in the bicarbonate concentration. Renal failure is thus a mix of an
increased gap and a normal gap metabolic acidosis. The normal gap metabolic acidosis
is especially prominent in children with renal failure as a result of tubular damage, as
occurs with renal dysplasia or obstructive uropathy, because these patients have a
concurrent RTA.Other distractors are causes of high anion gap metabolic acidosis.
Measuring serum concentrations of renin and aldosterone differentiates children
with metabolic alkalosis; both renin and aldosterone are elevated in
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A. renovascular disease
B. glucocorticoid-remediable aldosteronism
C. Liddle syndrome
D. Cushing syndrome
E. 11β-hydroxylase deficiency
(A). Aldosterone is high and renin is low in patients with adrenal adenomas or
hyperplasia and glucocorticoid-remediable aldosteronism. Renin and aldosterone are
low in children with Cushing syndrome, Liddle syndrome, licorice ingestion, 17α-
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hydroxylase deficiency, 11β-hydroxylase deficiency, and 11β-hydroxysteroid
dehydrogenase deficiency.
Increased production of CO2 occurs in all the following EXCEPT A. fever B. emesis C. excess caloric intake D. high levels of physical activity E. increased respiratory muscle work
B
Very-low birth weight infants can have insensible losses of A. 10-20 mL/kg/24 hr. B. 30-40 mL/kg/24 hr. C. 50-60 mL/kg/24 hr. D. 70-80 mL/kg/24 hr. E. 100-200 mL/kg/24 hr.
E
For each 1°C increase in temperature above 38°C leads to increase in maintenance water needs by A. 5-10% B. 10-15% C. 15-20% D. 20-25% E. 25-30%
B
The best fluid bolus giving to a child with isolated vomiting and severe dehydration is A. normal saline B. ringer lactate C. half-normal saline D. hypertonic (3%) saline E. 5% dextrose + half-normal saline
A
The features of high quality CPR include all the following EXCEPT
A. rate at least 100/min
B. compression depth of 2/3 anterior-posterior diameter of the chest
C. allow complete chest recoil after each compression
D. minimize interruptions in chest compressions
E. avoid excessive ventilation
(B). The Depth of chest compression should be at least 1/3 anterior-posterior
diameter of chest, about 1 1/2 inches (4 cm) in infants and 2 inches (5 cm) in children.
After activation of emergency medical system, the next action to unresponsive child
is to
A. asses the air ways
B. check pulse
C. give rescue breathings
D. start chest compression
E. attach automated external defibrillator (AED) to find shakable rhythm
(B). After activation of EMS the next step is to check for pulse and find definite pulse
within 10 seconds.
Regarding Glasgow Coma scale in pediatrics, all the following are true EXCEPT
A. in modified type it uses 15 score points
B. it has 3 components
C. valid as a prognostic scoring system
D. score ≤8 require aggressive management
E. verbal response component has 5 possible points
(C). Although the GCS has not been validated as a prognostic scoring system for
infants and young children as it has been in adults, it is commonly used in the
assessment of pediatric patients with an altered level of consciousness. The GCS is the
most widely used method of evaluating a child’s neurologic function and has 3
components. Individual scores for eye opening, verbal response, and motor response
are added together, with a maximum of 15 points. Patients with a GCS score ≤8 require
aggressive management, including stabilization of the airway and breathing with
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endotracheal intubation and mechanical ventilation, respectively, and, if indicated,
placement of an intracranial pressure monitoring device.
In pediatrics advanced life support (PALS) curriculum, regarding the format of
ABCDE, all the following are true EXCEPT
A. A refers to assessment of airways
B. B refers to assessment of breathing
C. C refers to assessment of circulation
D. D refers to assessment of dehydration
E. E refers to assessment of unidentified injuries
(D). The D means Disability which refers to assessment of the child’s neurologic
function in terms of the level of consciousness and cortical function. It can be assessed
quickly by checking the pupilary light respose and using Glasgow Coma scale, so the
response D is only partially true. The causes of decreased level of consciousness in
children are numerous and include conditions as diverse as respiratory failure with
hypoxia or hypercarbia, hypoglycemia, poisonings or drug overdose, trauma, seizures,
infection, and shock. All that system is represent the primary assessment of critically ill
child.
You received a call from your neighbor, he had a 12-month-old baby boy who
suddenly chock with a candy. When you arrive you find the baby unconscious.
Of the following, the NEXT proper action is to
A. open airway and give rescue breathing
B. give 5 back blows
C. give 5 chest thrusts
D. a series of 5 back blows and chest thrusts
E. perform endotracheal intubation
(A). In unconscious child, the child should be gently placed on the ground, supine,
and then the provider should open the airway with the head-tilt/chin-lift maneuver and
attempt mouth-to-mouth ventilation. If ventilation is unsuccessful, the airway is
repositioned, and ventilation attempted again. If there is still no chest rise, attempts to
remove a foreign body are indicated. In an infant <1 yr old, a combination of 5 back
blows and 5 chest thrusts is administered, After each cycle of back blows and chest
thrusts, the child’s mouth should be visually inspected for the presence of the foreign
body. If identified within finger’s reach, it should be removed with a gentle finger
sweep. If no foreign body is visual, ventilation is again attempted. If this is unsuccessful,
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the head is repositioned, and ventilation attempted again. If there is no chest rise, the
series of back blows and chest thrusts is repeated. For a conscious child >1 yr old,
providers should give a series of 5 abdominal thrusts (Heimlich maneuver) with the
child standing or sitting; this should occur with the child lying down if unconscious.
All the following are an absolute indications for endotracheal intubation EXCEPT
A. inability to protect the airway against aspiration
B. failing to maintain adequate oxygenation
C. complete airway obstruction
D. failing to control blood carbon dioxide levels
E. paralysis is required for a procedure
(C). In settings of known complete airway obstruction, endotracheal intubation
should be avoided, and emergency cricothyroidotomy performed instead.
The MOST common pre-arrest rhythms in young children is
A. bradyarrhythmia
B. atrial flutter
C. ventricular fibrillation
D. supraventricular arrhythmia with WPW syndrome
E. atrioventricular block
A
You were engaged in CPR for 3-year-old child found unresponsive in the ward. You
were performing cycles of 15 chest compressions and 2 breathings alternatively with
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another medical personal. After 2 min of resuscitation you evaluate the pulse which
shows PEA (pulseless electrical activity) status. The AED already is attached.
Of the following, the correct NEXT action is to
A. give a shock of 0.5 joule/kg
B. give a shock of 1 joule/kg
C. give a shock of 2 joules/kg
D. give adrenaline 0.01mg/kg iv
E. give adrenaline 0.1mg/kg iv
(D). Pulseless electrical activity (PEA) is a clinical condition characterized by
unresponsiveness and lack of palpable pulse in the presence of organized cardiac
electrical activity. In this situation (and in asystole) adrenaline is indicated in cycles of 3-
5 min, considering an advanced airways and reevaluation for the pulse status; if it
became shockable give shock of 2 joules/kg. You need to look also for correctable
causes (the 6H and 5T). If it became normal that goes for (ROSC) post-cardiac arrest
care.
An 11-year-old adolescent boy came to your clinic with a complaint of been
collapsed while bathing with hot water after he felt dizzy. Father confirms that the boy
was extremely pale when founded. He added that he toke few minutes to recover, also
he had past history of similar condition one month ago when he was urinating.
Of the following, the MOST likely explanation for this condition is
A. long QT syndrome
B. hypertrophic cardiomyopathy
C. neurocardiogenic syncope
D. drug abuse
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E. seizure disorder
(C). Typically, the patient with syncope will have been standing for a period of time,
often on a hot day, or has gotten up suddenly from sleep or resting in a supine position.
Occurrence in the shower is common, presumably caused by standing and vasodilation
caused by hot water. For boys, the occurrence while urinating while standing is
sometimes reported. The occurrence of syncope in girls while sitting or standing and
having their hair brushed is common.
You are treating an 8-month-old baby in intensive care unit with cold shock. In the
first 15 min he received adequate fluid therapy and a colleague had started dopamine
for him. The baby condition is still unresponsive.
Of the following, the BEST option now is to start
A. epinephrine
B. hydrocortisone
C. norepinephrine
D. terlipressin
E. angiotensin
(A). After 15 min of treating shock, inotropes like dopamin need to be started, if the
shock still unresponsive epinephrine for cold and norepinephrine for warm shock
should be titrated. Hydrocortisone is considered after 60 min (Catecholamine resistant
shock). Other options are used in warm shock and usually after other options are
exhausted.
Septic shock usually shows a combination of hypovolemic and distributive shock in
addition to
A. obstructive shock
B. cardiogenic shock
C. acute respiratory distress syndrome
D. disseminated intravascular coagulation
E. decreased steroid synthesis
B
A 2-hour-old fullterm baby delivered to a mother with gestational diabetes by CS,
he developed an increasing respiratory distress and grunting with blood gases values
indicative of respiratory failure.
Of the following, the BEST mode to be used in mechanical ventilation is
A. intermittent mechanical ventilation (IMV)
B. synchronized Intermittent mechanical ventilation (SIMV)
C. synchronized Intermittent positive pressure ventilation (SIPPV)
D. pressure-regulated volume control (PRVC)
E. pressure support ventilation (PSV)
(D). IMV is not the choice because you need to paralyze the patient; options B and C
both are good choice as they provide synchrony with the patient and can achieve the
goal of ventilation by either controlling the pressure or volume values but in presence
the option D in your ventilator, making it the best because it will reduces both baro and
volutrauma.
In mechanical ventilation giving adequate PEEP can mainly reduces A. volutrauma B. barotrauma C. oxytrauma D. pneumonia E. post-extubation airway obstruction
C
You are ventilating a fullterm baby with meconium aspiration syndrome, he was
fine on the machine, suddenly the monitor shows severe drop in O2 saturation. You
checked the ventilator; it was working well with its connections.
Of the following, the MOST likely cause is
A. O2 source supply
B. endotracheal tube blockade
C. self extubation
D. low inspiratory pressure value
E. low PEEP value
(B). All the given options are true causes for sudden drop of O2. The possible causes
of desaturating baby on ventilator are; Oxygen supply, machine and it is connections,
settings, tube block, self extubation and the patient himself. In the given scenario, the
most likely cause is B because of meconium aspiration. The best action to such scenario
is to disconnect the baby from the machine and use Ambu bagging gently to check the
air entry and rise of O2 saturation. If no rise you need to change the tube. In case of
unequal air entry, pneumothorax is another possibility.
A 32-week-preterm baby on mechanical ventilation, he is recovering from RDS, his
blood gas is satisfactory, and you reduced the ventilatory settings in process for
weaning.
Of the following, the MOST valuable indicator that the baby is ready for extubation is
A. frequency of respiration 35
B. fraction of inspired o2 0.55
C. peak expiratory end pressure 6
D. inspiratory pressure 8
E. inspiratory time 0.4 sec
(D). In absence of tachypnea, increased work of breathing, hypoxemia, hypercapnia,
acidosis, diaphoresis, tachycardia, and hypotension and when the ventilator rate is <5
breaths/min or (between 5-10 cm H2O in pressure controlled devices) indicate that the
contribution of the ventilation to minute ventilation is minimal and the baby is ready to
be extubated.
Prior to extubation and in order to reduce airway narrowing after extubation it is advised to use A. dexamethasone IV B. betamethasone IV C. inhaled budesonide D. nebulized budesonide E. hydrocortisone IV
(A). Administration of intravenous dexamethasone 0.5 mg/kg every 6 hr for 4 doses
prior to extubation has been shown to minimize the incidence of postextubation airway
obstruction. In patients in whom postextubation airway obstruction develops, the need
for re-intubation may be obviated by administration of nebulized racemic epinephrine
and heliox.
All the following mechanisms are contributing in pathophysiology of drowning EXCEPT A. laryngospasm B. surfactant washout C. anoxic injury D. pulmonary aspiration E. circulatory overload
E
A 4-year-old female child, a known case of ALL, she is developing an increasing toxicity to methotrexate therapy. Of the following, the MOST useful test is 115 A. homocysteine level B. prothrombin test C. factor V leiden D. MTHFR DNA testing E. folate level
(D). Knowledge of individual genotypes (pharmacogentic genetic testing) will guide
pharmacologic therapy, allowing customization of choice of drug and dosage to avoid
toxicity and provide a therapeutic response. An example of this is testing for
polymorphisms within the methylenetetrahydrofolate reductase (MTHFR) gene for
susceptibility of potentially increased toxicity to methotrexate antimetabolite therapy
for treatment of acute lymphoblastic leukemia.
The following are indications for genetic counseling EXCEPT
A. paternal age > 50 years
B. maternal age > 45 years
C. family history of intellectual disability
D. consanguinity
E. infertility
(B). Maternal age > or equal to 35 is an indication for genetic counseling. Genetic
counseling is a communication process in which the genetic contribution to health is
explained, along with specific risks of transmission of a trait and options to manage the
condition and its inheritance. The counselor is expected to present information in a
neutral, nondirective manner and to provide support to the individual and family to
cope with decisions that are made.
The organ that can be spared in mitochondrial disorders is A. brain B. eye C. small intestine D. liver E. muscle
(C). The mitochondria are the cell’s suppliers of energy, so the organs that are most
affected by the presence ofabnormal mitochondria are those that have the greatest
energyrequirements, such as the brain, muscle, heart, and liver. Common
manifestations include developmentaldelay, seizures, cardiac dysfunction, decreased
muscle strengthand tone, and hearing and vision problems. Examples of
mitochondrialdisorders include MELAS (myopathy, encephalopathy, lactic acidosis,
andstrokelike episodes), MERRF (myoclonic epilepsy associated with ragged red fibers),
and Kearns-Sayre syndrome (ophthalmoplegia, pigmentary retinopathy, and
cardiomyopathy).
The MOST important reason for chromosomal analysis in persons suspected of having Down syndrome is to 120 A. confirm clinical diagnosis B. detect mosaicism C. reassure the family D. detect translocations E. detect rare cases of ring chromosome
(D). Chromosome analysis is indicated in every person suspected of having Down
syndrome. If a translocation is identified, parental chromosome studies must be
performed to determine whether one of the parents is a translocation carrier, which
carries a high recurrence risk for having another affected child.
All the following are features of Edwards syndrome (Trisomy 18) EXCEPT A. low birth weight B. closed fists C. cardiac malformations D. short sternum E. slopping forehead
(E). Slopping forehead is a feature of Trisomy 13.
All the following are features of Patau syndrome (Trisomy 13) EXCEPT A. scalp defects B. corneal abnormalities C. holoprosencephaly D. capillary hemangiomas E. prominent occiput
(E). Prominent occiput is a feature of Edwards’s syndrome.
All the following are examples of microdeletion syndromes EXCEPT A. Williams B. Prader-Willi C. Angelman D. DiGeorge E. Wolf-Hirschhorn
(E). Microdeletions involve loss of small chromosome regions so that the affected
individuals can have a distinctive phenotype depending on the number of genes
involved. All the mentioned syndromes are common microdeletions and the board
candidate should be familial with their phenotypic descriptions and clinical
manifestations. Wolf-Hirschhorn syndrome is chromosomal deletion syndrome.
All the following are recognized features of Turner syndrome EXCEPT A. female phenotype B. male phenotype C. hypothyroidism D. type I diabetes mellitus E. gonadal dysgenesis
(D). Male phenotype can occur with mosaic type of Turner syndrome, and type II
insulin resistance is the true answer.
A 28-day-old girl presented with lethargy, poor feeding, and repeated vomiting for
last 5 days; IV fluid and empirical antibiotics were started; later she develops repeated
seizures not responding to IV calcium, glucose, B6, and anticonvulsant drugs. Septic
screen is negative; serum ammonia is elevated with normal anion gap and normal pH.
Family history reveals 2 siblings died with same scenario.
Of the following, the MOST likely diagnosis is
A. galactosemia
B. hyperglycinemia
C. organic acidemias
D. phenylketonurea
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E. urea cycle defects
(E). Elevation of blood ammonia is usually caused by defects of urea cycle enzymes.
Infants with elevated blood ammonia levels from urea cycle defects commonly have
normal serum pH and bicarbonate values; without measurement of blood ammonia,
they may remain undiagnosed and succumb to their disease.
You suspect a metabolic problem in a 30-day-old girl presented with poor feeding,
vomiting, lethargy, and convulsion. Previous sibling died with the same condition.
Serum ammonia, pH, HCO3, and anion gap are normal.
Of the following, the MOST likely diagnosis is
A. porphyria
B. galactosemia
C. organic acidemia
D. urea cycle defect
E. aminoacidopathy
E
A 6-year-old boy with eczematoid rash, abnormal face, and prominent maxilla
complains from deterioration in school performance, hyperactivity, and seizures for the
last 2 years.
Of the following, the MOST likely enzymatic deficiency is
A. acid β-glucosidase
B. β-hexosaminidases
C. acid sphingomyelinase
D. phenylalanine hydroxylase
E. fumarylacetoacetate hydrolase
(D). Phenylketonurea is the most likely diagnosis; deficiency of the enzyme phenylalanine hydroxylase (PAH) or of its cofactor tetrahydrobiopterin (BH4) causes accumulation of phenylalanine in body fluids and in the brain.
A 10-month-old boy presented with failure to thrive, fever, jaundice, hepatomegaly,
and severe rickets. Investigations revealed hypoglycemia and normal anion gap
metabolic acidosis.
Of the following, the MOST likely enzyme deficiency is
A. acid β-glucosidase
B. β-hexosaminidases
C. acid sphingomyelinase
D. phenylalanine hydroxylase
E. fumarylacetoacetate hydrolase
(E). Tyrocinemia type 1 is a severe disease of the liver, kidney, and peripheral nerves
are caused by a deficiency of the enzyme fumarylacetoacetate hydrolase.
acid β-glucosidase —————– Gaucher disease
phenylalanine hydroxylase —— Phenylketonurea
acid sphingomyelinase —- Niemann-pick disease
fumarylacetoacetate hydrolase ——-Tyrosinemia
β-hexosaminidases ———–=– Tay-Sachs disease
The following are ocular manifestations of albinism EXCEPT A. red reflex B. strabismus 131 C. refractive errors D. foveal hyperplasia E. lack of binocular vision
(D). Ocular manifestations of albinism include hypopigmentation of iris and retina,
foveal hypoplasia, reduced visual acuity, refractive errors, nystagmus, alternating
strabismus, and a red reflex.
A 6-year-old girl that looks tall and thin with light skin. On examination she has a
peculiar malar flush, subluxation of the ocular lens, developmental delay, and severe
hypertension.
Of the following,the MOST likely cause of hypertension is
A. atherosclerosis
B. hyperthyroidism
C. thromboembolism
D. coarctation of aorta
E. renal artery stenosis
(C). In Homocystinuria, thromboembolic episodes involving both large and small
vessels, especially those of the brain, are common and may occur at any age. Optic
147
atrophy, paralysis, cor pulmonale, and severe hypertension (from renal infarcts) are
among the serious consequences of thromboembolism, which is caused by changes in
the vascular walls and increased platelet adhesiveness secondary to elevated
homocystine levels.
The MOST appropriate treatment of homocystinuria is A. betaine B. folic acid C. vitamin C D. vitamin B6 E. methionine restriction
(D). Treatment with high doses of vitamin B6 (200-1,000 mg/24 hr) causes dramatic
improvement in most patients who are responsive to this therapy.
A 2-year-old boy presented with failure to thrive, regression of developmental
milestone, and difficult to contact with surroundings. On examination, there are
hepatosplenomegaly and moderate lymphadenopathy.
Of the following, the MOST likely diagnosis is
A. Gaucher disease
B. Sandhoff disease
C. Tay-Sachs disease
133
D. Von Gierke disease
E. Niemann-pick disease
(E). Niemann-pick disease (NPD), inherited as autosomal recessive traits, the clinical
manifestations and course of type A NPD is uniform and is characterized by a normal
appearance at birth. Hepatosplenomegaly, moderate lymphadenopathy, and
psychomotor retardation are evident by 6 mo of age, followed by neurodevelopmental
regression and death by 3 yr. With advancing age, the loss of motor function and the
deterioration of intellectual capabilities are progressively debilitating; and in later
stages, spasticity and rigidity are evident. Affected infants lose contact with their
environment. Type B disease is a non-neuronopathic form observed in children and
adults NPD types A and B result from the deficient activity of acid sphingomyelinase.
Type C disease is a neuronopathic form that results from defective cholesterol
transport.
A 9-month-old boy presented with persistent head lag, rapid breathing, difficult
feeding, and hepatomegaly. Chest X- ray showed cardiomegaly.
Of the following, the MOST appropriate confirmatory test is
A. liver biopsy
B. muscle biopsy
C. electrocardiography
D. serum creatine phosphokinase
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E. enzyme assay in dried blood spots
(E). The confirmatory step for a diagnosis of Pompe disease is enzyme assay
demonstrating deficient acid α-glucosidase. The enzyme assay is usually done in dried
blood spots, leukocytes, blood mononuclear cells, muscle, and cultured skin fibroblasts.
A 28-day-old boy presented with prolonged neonatal jaundice, lethargy, poor
feeding, and failure to regain birth weight. On examination there are hepatomegaly
and cataract.
Of the following, the MOST likely injured organs in this disease are
A. eyes, liver, and brain
B. kidney, liver, and eyes
C. kidney, liver, and brain
D. kidney, heart , and brain
E. pancreas, liver, and brain
(C). In galactosemia, without the transferase enzyme, the infant is unable to
metabolize galactose-1-phosphate, the accumulation of which results in injury to
kidney, liver, and brain.
A 20-day-old girl presented with prolonged neonatal jaundice, lethargy, and poor
feeding treated as sepsis by empirical antibiotics and nothing by mouth. The patient
got partial response, when oral feeding resumed, the condition deteriorate again.
In this condition, the blood culture MOST likely reveals growth of
A. Escherichia coli
B. Staphylococcal aureus
C. group B streptococcus
D. Listeria monocytogens
E. Pseudomonas aeruginosa
(A). Patients with galactosemia are at increased risk for Escherichia coli neonatal
sepsis; the onset of sepsis often precedes the diagnosis of galactosemia.
All the following drugs are unsafe in acute intermittent porphyria EXCEPT A. nifedipine B. diclofenac C. cimetidine D. valproic acid E. carbamazepine
C
All the following are clinical features of acute intermittent porphyria EXCEPT A. neuropathy B. tachycardia C. abdominal pain D. bladder dysfunction E. cutaneous photosensitivity
E Porphyria cutanea tarda
The MOST common presentation of primary carnitine deficiency is A. liver disease B. cardiomyopathy C. skeletal myopathy D. endocardial fibroelastosis E. hypoketotic hypoglycemia
(B). The most common presentation of primary carnitine deficiency is progressive
cardiomyopathy with or without skeletal muscle weakness beginning at 1-4 yr of age.
Leukokoria (white pupillary reflex) in newborn infant suggests the following disorders EXCEPT A. cataracts B. tumor C. congenital glaucoma D. chorioretinitis E. retinopathy of prematurity
(C). A cornea >1cm in diameter in a term infant (with photophobia and tearing)
suggests congenital glaucoma and requires prompt ophthalmologic consultation.
A single umbilical artery in a newborn infant increases the risk for A. meningomyelocele B. occult renal anomaly C. omphalocele D. gastroschisis E. omphalitis
(B). A single umbilical artery increases the risk for an occult renal anomaly.
The following drugs can be given with caution to breast-feeding mother A. psychotropic drugs B. amphetamines C. bromocriptine D. chloramphenicol E. methimazole
(A). Amphetamines, bromocriptine, chloramphenicol, and methimazole are
contraindicated in breast-feeding mother.
One of the following drugs may cause pyloric stenosis if administered to a premature infant A. intravenous vitamin E B. indomethacin C. enteric gentamicin D. prostaglandins E. dexamethasone
(D). Prostaglandins and erythromycin may cause pyloric stenosis if administered to a
premature infant.
Seizures beginning in the delivery room or shortly thereafter may be due to
A. hypoxic-ischemic encephalopathy
B. unintentional injection of maternal local anesthetic into the fetus
C. intracranial hemorrhage
D. cerebral anomaly
E. hypoglycemia
(B). Seizures beginning in the delivery room or shortly thereafter may be due to the
unintentional injection of maternal local anesthetic into the fetus. Convulsions may
also result from hyponatremia and water intoxication in the infant after the
administration of large amounts of hypotonic fluid to the mother shortly before and
during delivery.
Vomiting in the neonatal period is usually due to A. pyloric stenosis B. milk allergy C. overfeeding D. stress ulcer E. an inborn error of metabolism
(C). Vomiting during the 1st day of life suggests obstruction in the upper digestive
tract or increased intracranial pressure. Roentgenographic studies are indicated when
obstruction is suspected. Vomiting may also be a nonspecific symptom of an illness
such as septicemia. It is a common manifestation of overfeeding, inexperienced feeding
technique, or normal reflux and is rarely due to pyloric stenosis, milk allergy, duodenal
ulcer, stress ulcer, an inborn error of metabolism (hyperammonemia, metabolic
acidosis), or adrenal insufficiency.
Early postnatal exposure to dexamethasone, within the 1st wk of life, in VLBW
infants, is associated with the following EXCEPT
A. metabolic derangements
B. poor growth
C. increased risk for sepsis
D. increased risk of spontaneous bowel perforation
E. cerebral palsy
(E). Infants exposed to postnatal steroids after the 1st wk of life have an increased
risk of cerebral palsy and developmental delay.
The following are true regarding apnea EXCEPT
A. apnea is a common problem in preterm infants
B. in term infants, apnea is always worrisome
C. obstructive apnea is characterized by absence of airflow but persistent chest
wall motion
D. serious apnea is defined as cessation of breathing for longer than 20 sec
E. bradycardia follows the apnea by 1-2 sec in more than 95% of cases and is most
often nodal
(E). Bradycardia follows the apnea by 1-2 sec in more than 95% of cases and is most
often sinus, but on occasion it can be nodal. Vagal responses and, rarely, heart block
are causes of bradycardia without apnea.
Regarding CPAP, the following are true EXCEPT
A. its prevents collapse of surfactant-deficient alveoli
B. its indicated, if oxygen saturation cannot be kept > 95%
C. its improves functional residual capacity FRC
D. its improves ventilation-perfusion matching
E. its reduces ventilatory needs
(B). Warm humidified oxygen should be provided at a concentration initially
sufficient to keep arterial oxygen pressure between 50 and 70 mm Hg (91-95%
saturation) in order to maintain normal tissue oxygenation while minimizing the risk of
oxygen toxicity. If oxygen saturation cannot be kept >90% at inspired oxygen
concentrations of 40-70% or greater, applying CPAP at a pressure of 5-10 cm H2O via
nasal prongs is indicated and usually produces a rapid improvement in oxygenation.
CPAP reduces collapse of surfactant-deficient alveoli and improves both FRC and
ventilation–perfusion matching.
One of the following is FALSE in the chest radiograph of transient tachypnea of the newborn (TTN) A. prominent pulmonary vascular markings B. fluid in the intralobar fissures C. overaeration D. flat diaphragms E. diffuse reticulogranular pattern
(E). The distinctive features of transient tachypnea are rapid recovery of the infant
and the absence of radiographic findings for RDS (hypoaeration, diffuse
reticulogranular pattern, air bronchograms) and other lung disorders.
The following are predisposing factors for persistent pulmonary hypertension of the newborn (PPHN) EXCEPT A. anemia B. meconium aspiration syndrome C. early-onset sepsis D. hypoglycemia E. birth asphyxia
(A). Persistent pulmonary hypertension of the newborn (PPHN) occurs in term and
post-term infants. Predisposing factors include birth asphyxia, MAS, early-onset sepsis,
RDS, hypoglycemia, polycythemia, maternal use of nonsteroidal anti-inflammatory
drugs with in utero constriction of the ductus arteriosus, maternal late trimester use of
selective serotonin reuptake inhibitors, and pulmonary hypoplasia due to
diaphragmatic hernia, amniotic fluid leak, oligohydramnios, or pleural effusions. PPHN
is often idiopathic.
Congenital diaphragmatic hernia (CDH) can be diagnosed on prenatal
ultrasonography (between 16 and 24 wk of gestation) in > 50% of cases.
Findings on ultrasonography may include the following EXCEPT
A. chest mass
B. mediastinal shift
C. gastric bubble
D. olighydramnios
E. a liver in the thoracic cavity
(D). Polyhydramnios
Absolute indication for surgery in neonatal necrotizing enterocolitis (NEC) include
A. positive result of abdominal paracentesis
B. failure of medical management
C. a single fixed bowel loop on radiographs
D. abdominal wall erythema
E. a palpable mass
(A). A surgeon should be consulted early in the course of treatment. Indications for
surgery include evidence of perforation on abdominal roentgenograms
(pneumoperitoneum) or positive result of abdominal paracentesis (stool or organism
on Gram stain preparation from peritoneal fluid). Failure of medical management, a
single fixed bowel loop on radiographs, abdominal wall erythema, and a palpable mass
are relative indications for exploratory laparotomy.
The following factors are associated with decreased risk of significant jaundice EXCEPT A. gestational age ≥41 wk B. male gender C. exclusive bottle-feeding D. black race E. discharge from hospital after 72 hr
(B). Male gender is a minor risk factor.
Jaundice, consisting of either indirect or direct bilirubin that is present at birth or
appears within the 1st 24 hr of life may be due to all the following EXCEPT
A. erythroblastosis fetalis
B. Crigler-Najjar syndrome
C. concealed hemorrhage
D. sepsis
E. congenital infections
(B). Jaundice that first appears on the 2nd or 3rd day is usually physiologic but may
represent a more severe form. Familial nonhemolytic icterus (Crigler-Najjar syndrome)
and early-onset breast-feeding jaundice are seen initially on the 2nd or 3rd day.
Early ultrasonographic signs of hydrops include A. double–bowel wall sign (bowel edema) B. polyhydramnios 162 C. ascites D. pleural effusions E. scalp edema
(A). Early ultrasonographic signs of hydrops include organomegaly (liver, spleen,
heart), the double–bowel wall sign (bowel edema), and placental thickening.
Progression to polyhydramnios, ascites, pleural or pericardial effusions, and skin or
scalp edema may then follow.
The blood smear of infant with hemolytic disease of the newborn (erythroblastosis
fetalis) typically shows the following EXCEPT
A. polychromasia
B. increasedreticulocyte count
C. a marked increase in nucleated RBCs
D. thrombocytopenia
E. low white blood cell count
(E). The white blood cell count is usually normal but may be elevated.
One of the following is FALSE in hemolytic disease of the newborn caused by Rh
incompatibility
A. infant is Rh Positive (D, sometimes C)
B. never occur in first-born infant
C. maternal antibody titers can help predict the severity of fetal disease
D. severe anemia is frequent
E. stillbirth/hydrops is frequent
B). 5% of first-born infants may be affected.
In Infants of diabetic mothers, the following are true EXCEPT
A. hypoglycemia develops in about 25-50% of infants of diabetic mothers
B. increased weight of the placenta and all infant organs
C. heart failure occurs in 5-10% of infants of diabetic mothers
D. the incidence of congenital anomalies is increased threefold in infants of
diabetic mothers
E. lumbosacral agenesis is one of most common congenital anomalies
(B). The probable pathogenic sequence is that maternal hyperglycemia causes fetal
hyperglycemia, and the fetal pancreatic response leads to fetal hyperinsulinemia; fetal
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hyperinsulinemia and hyperglycemia then cause increased hepatic glucose uptake and
glycogen synthesis, accelerated lipogenesis, and augmented protein synthesis. Related
pathologic findings are hypertrophy and hyperplasia of the pancreatic islet β cells,
increased weight of the placenta and infant organs except for the brain, myocardial
hypertrophy, increased amount of cytoplasm in liver cells, and extramedullary
hematopoiesis. The incidence of congenital anomaliesis increased 3-fold in infants of
diabetic mothers; cardiac malformations (ventricular or atrial septal defect,
transposition of the great vessels, truncus arteriosus, doubleoutlet right ventricle,
tricuspid atresia,
Agents that commonly cause nosocomialneonatal infection are A. group B streptococci GBS B. coagulase-negative staphylococci C. proteus D. gonococci E. chlamydiae
(B). Agents that commonly cause nosocomial infection are coagulase-negative
staphylococci, gram-negative bacilli (E. coli, Klebsiella pneumoniae, Salmonella,
Enterobacter, Citrobacter, Pseudomonas aeruginosa, Serratia), enterococci, S. aureus,
and Candida. Viruses contributing to nosocomial neonatal infection include
enteroviruses, CMV, hepatitis A, adenoviruses, influenza, respiratory syncytial virus
(RSV), rhinovirus, parainfluenza, HSV, and rotavirus. Community-acquired pathogens
such as Streptococcus pneumoniae may also cause infection in newborn infants after
discharge from the hospital.
Limb hypoplasia may be a feature of the following transplacental infections A. cytomegalovirus B. herpes simplex virus 166 C. varicella-zoster virus D. HIV E. rubella
C
Intracranial calcification may be a feature of one of the following transplacental infections A. cytomegalovirus B. herpes simplex virus C. varicella-zoster virus D. syphilis E. rubella
(A). Intracranial calcification may be a feature of CMV, HIV, toxoplasmosis, and T.
cruzi.
Pneumatosis intestinalis is pathognomonic for A. Hirschsprung's disease B. necrotizing enterocolitis (NEC) C. pseudomembranous enterocolitis D. neonatal ulcerative colitis E. meconium ileus
(E). Pneumatosis intestinalis can be seen in various other conditions, including
Hirschsprung’s disease, pseudomembranous enterocolitis, neonatal ulcerative colitis,
and ischemic bowel disease. However, it is a characteristic finding in 85% of patients
with NEC. Dark, concentric rings within the bowel wall represent hydrogen as a
byproduct of bacterial metabolism
The following are manifestations of hypocalcemia in the neonate EXCEPT A. jitteriness B. seizures C. carpopedal spasm D. high-pitched cry E. laryngospasm
(C). Chvostek’s sign (facial muscle twitching on tapping), and Trousseau’s sign
(carpopedal spasm) may be present, but more commonly these are absent during the
neonatal period.
Penile growth occur during SMR A. 1 B. 2 C. 3 D. 4 E. 5
C
Smoking during pregnancy is associated with an average decrease in fetal weight by A. 100 g B. 200 g C. 300 g D. 400 g E. 500 g
(B). Smoking during pregnancy is associated with an average decrease in fetal
weight of 200 g; this decrease, added to the already smaller size of infants born to
teenagers, increases perinatal morbidity and mortality.
Evaluation for pubertal delay in female should be done if she lacks any pubertal signs by the age of A. 12 yr B. 13 yr C. 14 yr D. 15 yr E. 16 yr
B
The age at which an evaluation for primary amenorrhea should be undertaken is A. 12 yr B. 13 yr C. 14 yr D. 15 yr E. 16 yr
D
A 3-year-old boy presented with recurrent attacks of pneumonia and otitis media
since the 1st birthday. Your diagnosis is X-linked agammaglobulinemia.
Of the following, the MOST likely offending organism is
A. CMV
B. Mycoplasma
C. Pneumocystis jiroveci
D. Staphylococcus aureus
E. Streptococcus pneumonia
(E). They acquire infections with extracellular pyogenic organisms, such as
Streptococcus pneumoniae and Haemophilus influenzae, unless they are given
prophylactic antibiotics or immunoglobulin therapy.
The following conditions can cause eosinophilia EXCEPT A. malaria B. filariasis C. giardiasis D. ascariasis E. amebiasis
(C). Eosinophilia are caused by tissue-invasive as helminth infections; ascariasis,
filariasis, amebiasis, malaria, and scabies whereas entrobius vermicularis and Giardia
lamblia are solely intraluminal in gastrointestinal tract.
The highest white blood cells count is seen at A. birth B. 12 hour of life C. 1 week of life D. 1 year of life E. adolescence
(A). For newborns, the mean WBC count at birth is high, followed by a rapid fall
beginning at 12 hr through the 1st wk of life. Thereafter, values are stable until 1 yr of
age, after which a slow steady decline in the WBC count continues throughout
childhood until adult values are reached during adolescence.
Severe neutropenia is defined as absolute neutrophil count (ANC) less than A. 500/μL B. 750/μL C. 1000/μL D. 1250/μL E. 1500/μL
(A). Mild neutropenia, is an absolute neutrophil count (ANC) of 1,000-1,500/μL.
Moderate neutropenia, is an absolute neutrophil count (ANC) of 500- 1,000/μL. Severe
neutropenia, is an absolute neutrophil count (ANC) <500/μL.
The MOST vital initial treatment in the management of severe asthma
exacerbations is
A. supplemental oxygen
B. inhaled β -agonist
C. intramuscular injection of epinephrine
D. inhaled ipratropium
E. intramuscular injection of β-agonist
A
The best ‘‘rescue’’ medication in the treatment of acute asthma symptoms is A. oral SABA B. inhaled SABA C. oral corticosteroid D. inhaled ipratropium E. inhaled corticosteroid
(B). Inhaled SABA, up to 3 treatments in 1 hr. If the child has an incomplete
response to initial treatment with rescue medication (persistent symptoms and/or a
PEF value <80% of personal best), a short course of oral corticosteroid therapy
(prednisone 1-2 mg/kg/day [not to exceed 60 mg/day] for 4 days), in addition to
inhaled β-agonist therapy, should be instituted.
A common finding of chest radiograph in a child with asthma is A. peribronchial thickening B. atelectasis C. pneumothorax D. bronchiectasis E. pneumomediastinum
(A). Peribronchial thickening and flattening of diaphragm.
The hallmark of atopic dermatitis is A. intense pruritus B. cutaneous reactivity C. lichenification D. fibrotic papules E. dry skin
(E). The hallmark of atopic dermatitis is dry skin, is results from compromise of the
epidermal barrier, which leads to excess transepidermal water loss, allergen
penetration, and microbial colonization.
The cardinal feature of atopic dermatitis is A. skin rash B. lichenification C. fibrotic papules D. intense pruritus E. dry skin
(D). Intense pruritus, especially at night, and cutaneous reactivity are the cardinal
features of atopic dermatitis.
The best choice of antibiotic in treating localized impetiginous lesions in patients with atopic dermatitis is A. oral erythromycin B. oral cephalexin C. topical mupirocin D. topical ampicillin E. topical gentamycin
(C). Erythromycin and azithromycin are usually beneficial for patients who are not
colonized with a resistant S. aureus strain; a first-generation cephalosporin (cephalexin)
is recommended for macrolide-resistant S. aureus. Topical mupirocin is useful in the
treatment of localized impetiginous lesions, with systemic antibiotics for widespread
infections.
One of the following statements is TRUE regarding skin tests in identifying food
allergies in patients with atopic dermatitis
A. negative skin and blood test results for allergen-specific ige have a low
predictive value for excluding suspected allergens
B. positive results of skin or blood tests using foods often correlate with clinical
symptoms and no need to be confirmed with controlled food challenges
C. extensive elimination diets are commonly required
D. even with multiple majority of patients react to more than 3 foods
E. potential allergens can be identified by a careful history and performing
selective skin prick tests or in vitro blood testing for allergen- specific IgE
(E). For the other stems; A- high predictive value, B- Positive skin test often do not
correlate with clinical symptoms, C- Rarely required, and D- The majority react to less
than 3 foods.
In atopic dermatitis, the presence of punched out erosions, vesicles, and infected
skin lesions that fail to respond to oral antibiotics suggests infection with
A. Herpes zoster
B. Herpes simplex
C. cutaneous warts
D. Trichophyton rubrum
E. Molluscum contagiosum
(B). Herpes simplex virus (HSV) can provoke recurrent dermatitis and may be
misdiagnosed as S. aureusinfection, which can be diagnosed by a Giemsa-stained
Tzanck smear of cells scraped from the vesicle base or by viral polymerase chain
reaction or culture.
Exfoliative dermatitis may develop in patients with atopic dermatitis and extensive
skin involvement, usually caused by inappropriate therapy or superinfection with
A. E. coli
B. Herpes zoster
C. Herpes simplex
D. Streptococcal pyogen
E. Trichophyton rubrum
(C). Exfoliative dermatitis associated with generalized redness, scaling, weeping,
crusting, systemic toxicity, lymphadenopathy, and fever, and is usually caused by
superinfection (e.g., with toxin-producing S. aureus or HSV infection) or inappropriate
therapy. In some cases, the withdrawal of systemic glucocorticoids used to control
severe AD precipitates exfoliative erythroderma.
The MOST common hypersensitivity response of the eye is A. allergic conjunctivitis B. vernal keratoconjunctivitis C. atopic keratoconjunctivitis D. giant papillary conjunctivitis E. contact allergy
(A). Allergic conjunctivitis is the most common hypersensitivity response of the eye,
affecting approximately 25% of the general population and 30% of children with atopy.
The MOST sight-threatening type of ocular allergy is A. contact allergy B. vernal keratoconjunctivitis C. giant papillary conjunctivitis D. seasonal allergic conjunctivitis E. perennial allergic conjunctivitis
(B). Vernal keratoconjunctivitis and atopic keratoconjunctivitis are sight-threatening
entities and causes visual morbidity and suspected cases need to be referred to an
ophthalmologist.
The drug of choice for cold-induced urticaria is A. loratadine B. epinephrine IM C. cyproheptadine D. diphenhydramine E. oral corticosteroid
C
Systemic lupus erythematosus can be caused by A. isoniazid B. sulfonamide C. hydrochlorothiazide D. allopurinol E. nonsteroidal anti-inflammatory drug
(A). Along with Hydralazine and procainamide.
Vasculitis can be cause by A. isoniazid B. sulfonamide C. penicillamine D. calcium channel blockers E. tetracycline
(C). Along with Hydralazine and propylthiouracil.
