Pediatric 250-308

Question 1

While reviewing expanded family pedigree for a child presented to the clinic for investgaton and diagnosis. It found that there is a 25% risk for 2 carrier parents to have afected child and the risk increase with consanguinity. Which of the following is the inheritance?
A. Autosomal recessive
B. Autosomal dominant
C. X-linked recessive
D. X-linked dominant

Answer 1

A. Autosomal recessive

Question 2

An 11-year-old presents to the clinic with the following features, macrocephaly, macro-orchidism long face, large everted ears and ECHO revealed the presence of mitral valve prolapse. He has signifcant joint laxity and moderate learning difcultes. Which of the following is the most likely diagnosis?
A. Hunter syndrome
B. Hurler syndrome
C. Friedreich ataxia
D. Fragile X syndrome

Answer 2

D. Fragile X syndrome

Question 3

Which of the following phases contribute the most for the fnal height of the child?
A. Fetal phase
B. Infantle phase
C. Childhood phase
D. Pubertal phase

Answer 3

C. Childhood phase

Question 4

A child presents to the clinic for pubertal assessment. He had pubic hair flling out towards adult distributon, and darkening of scrotal skin. Which stage of puberty he reached according to Tanner staging?
A. I
B. MI
C. IV
D. V

Answer 4

C. IV

Question 5

An 18-month-old girl presents with asymmetrical breast enlargement. There was no pubic hair growth or body odor and her height was in mid parental range. Her bone age was mildly advanced. Which of the following is the best next step in management?
A. ACTH test
B. MRI brain
C. CT chest
D. Pelvic ultrasound

Answer 5

D. Pelvic ultrasound

Question 6

A 2-year-old girl is brought by her mother with breast enlargement. There was no pubic hair growth or body dour and her height was in mid parental range. Which of the following is the most likely diagnosis?
A. Precocious puberty
B. Premature pubarche
C. Central precocious puberty
D. Premature breast development

Answer 6

D. Premature breast development

Question 7

A 24-hour-old neonate with ambiguous genitalia. 17-hydroxyprogesterone was abnormally high (see lab results). Test Result Normal Values Sodium 126 134-146 mmol/L Potassium 7.1 3.5-5.1 mmol/L Bicarbonate 15 21-28 mmol/L Glucose 2.6 2.8-5 mmol/L (Newborn) 3.3 -5.5 mmol/L (Child) which of the following is the correct management for this case?
A. Hydrocortsone and saline bolus
B. Saline bolus and glucose infusion
C. Antbiotcs, hydrocortsone and glucose infusion
D. Hydrocortsone, saline bolus and glucose infusion

Answer 7

D. Hydrocortsone, saline bolus and glucose infusion

Question 8

A 24-hour-old neonate with ambiguous genitalia. 17-hydroxyprogesterone was abnormally high (see lab resuits). Test Result Normal Values Sodium 127 134-146 mmol/L Potassium 6.8 3.5-5.1 mmol/L Bicarbonate 15 21-28 mmol/L Glucose 2.5 2.8-5 mmol/L. (Newborn) 3.3 -5.5 mmol/L (Child) Which of the following is the inheritance of this disease?
A. Multfactorial
B. X-linked dominant
C. Autosomal dominant
D. Autosomal recessive

Answer 8

D. Autosomal recessive

Question 9

A 24-hour-old neonate with ambiguous genitalia. 17-hydroxyprogesterone was abnormally high (see lab results). Test Result Normal Values Sodium 128 134-146 mmol/L Potassium 6.8 3.5-5. 1 mmol/L Bicarbonate 16 21-28 mmol/L Glucose 2.5 2.8-5 mmol/L (Newborn) 3.3 -5.5 mmol/L (Child) Which of the following is the most likely diagnosis?
A. 21-hydroxylase defciency
B. 17-hydroxylase defciency
C. 11-beta hydroxylase defciency
D. 36-hydroxysteroid dehydrogenase defciency

Answer 9

A. 21-hydroxylase defciency

Question 10

While counseling a new mother about the importance of the breasteeding, she mentoned that currently she had a yellow-white substance coming from the breast and she is worried about feeding her baby. Which of the following is correct regarding this yellow-white substance?
A. It has high content of proteins
B. It will contnue for 4 month normally
C. It should be discarded because the color
D. It has high content of lipid and glucose

Answer 10

A. It has high content of proteins

Question 11

A 3-year-old girl found during health campaign in poor area to have generalized edema, sever wastng, hyperkeratosis, distended abdomen and sparse hair (see lab results). Blood pressure 85/45 mmH Heart rate 80 /min Respiratory rate 25 /min Temperature 36.0 °C Test Result Normal Values Sodium 132 134-146 mmol/L Potassium 3.2 3.5-5.1 mmol/L Magnesium 0.4 0.7-1.0 mmol/L Glucose 3.1 2.8-5 mmol/L (Newborn) 3.3 -5.5 mmol/L (Child) Albumin 20 36-52 g/L Which of the following contributes to the fnding?
A. Vitamin B12 defciency
B. Vitamin D defciency
C. Sever protein malnutriton
D. Sever carbohydrate malnutriton

Answer 11

C. Sever protein malnutriton

Question 12

A 3-year-old girl found during health campaign in poor area to have generalized edema, sever wastng, hyperkeratosis, distended abdomen and sparse hair (see lab results). Blood pressure 85/45 mmH Heart rate 85 /min Temperature 36.0 °C Test Result Normal Values Sodium 132 134-146 mmol/L Potassium 3.0 3.5-5.1 mmol/L Magnesium 0.4 0.7-1.0 mmol/L Glucose 3.1 2.8-5 mmol/L (Newborn) 3.3 -5.5 mmol/L (Child) Calcium total 2.1 2.2-2.7 mmol/L Phosphate 1.2 1.3-2.3 mmol/L Albumin 18 36-52 g/L Which of the following is the most likely diagnosis?
A. Rickets
B. Marasmus
C. Kwashiorkor
D. Coeliac disease

Answer 12

C. Kwashiorkor

Question 13

A 3-year-old boy known case of celiac disease, presented to the clinic with frontal bossing, bowlegs and harrison sulcus. He missed the follow up in the clinic for the last 6 month. Which of the following can help in confrming the diagnosis?
A. X-ray of the wrist joint shows cupping
B. Flaky-paint skin rash with hyperkeratosis
C. Ultrasound abdomen shows enlarger liver
D. Low plasma albumin, potassium and magnesium

Answer 13

A. X-ray of the wrist joint shows cupping

Question 14

A 3-year-old boy with celiac disease presents to the clinic with frontal bossing, bowlegs and harrison sulcus. He missed the follow up in the clinic for the last 6 month. Which of the following is the best management?
A. Daily administraton of Vitamin D3
B. Daily administraton of Vitamin A
C. Daily administraton of Vitamin B12
D. Daily administraton of Vitamin C

Answer 14

A. Daily administraton of Vitamin D3

Question 15

A 3-year-old boy presents to the clinic with marked obesity. The mother gave history of persistent hyperphagia, and that he does not control his hunger. On examinaton, he is found to have dysmorphic facial features, hypotonia and undescended testes Which of the following is most likely diagnosis?
A. Noonan syndrome
B. Williams syndrome
C. DiGeorge syndrome
D. Prader-Willi Syndrome

Answer 15

D. Prader-Willi Syndrome

Question 16

Which of the following considered a complicaton of obesity in childhood?
A. Primary enuresis
B. Hypertension
C. Type 1 diabetes
D. Hyperventlaton syndrome

Answer 16

B. Hypertension

Question 17

A 6-month-old infant presents to the Emergency Room with sudden apnea and color change. The mother gave history of recurrent vomitng and multple chest infecton. On examinaton, wasted and underweight infant, with failure to thrive and dystonic neck posturing while crying. Which of the following contribute to the disease?
A. Hypertrophy of the pyloric muscles
B. Hypertrophy of the esophageal muscles
C. Inappropriate relaxaton of the upper esophageal sphincter
D. Inappropriate relaxaton of the lower esophageal sphincter

Answer 17

D. Inappropriate relaxaton of the lower esophageal sphincter

Question 18

A 6-month-old infant presents to the Emergency Room with sudden apnea and color change. The mother gave history of recurrent vomitng, and muitple chest infecton. On examinaton, he looks failing to thrive with dystonic neck posturing while crying. Which of the following considers as high-risk case for the above disease?
A. Obese baby
B. Preterm infant
C. Post pertussis infecton
D. Following inguinal hernia repair

Answer 18

B. Preterm infant

Question 19

A 6-month-old infant presents to the Emergency Room with sudden apnea and color change. The mother gave history of recurrent vomitng, and multple chest infecton. On examinaton, he looks failing to thrive with dystonic neck posturing while crying. Which of the following is the most likely diagnosis?
A. Pyloric stenosis
B. Cow’s milk allergy
C. Whooping cough
D. Gastrosophageal refux

Answer 19

D. Gastrosophageal refux

Question 20

A 3-week-old neonate presents to the Emergency Room with persistent projectle vomitng. The mother mentoned that he is immediately show sign of hunger afer vomitng, but he is not gaining weight as expected. Which of the following fnding associated with this presentaton?
A. Hypochloraemic metabolic alkalosis
B. Hyperchloraemic metabolic acidosis
C. Hypochloraemic metabolic acidosis
D. Hyperchloraemic metabolic alkalosis

Answer 20

A. Hypochloraemic metabolic alkalosis

Question 21

A 4-week-old neonate presents to the Emergency Room with persistent projectle vomitng. The mother mentoned that he is immediately show sign of hunger afer vomitng, but he is not gaining weight as expected (see lab results) Test Result Normal Values Sodium 130 134-146 mmol/L Potassium 2.8 3.5-5.1 mmol/L Chloride 88 97-108 mmol/L Bicarbonate 26 21-28 mmol/L Which of the following is the most likely diagnosis?
A. Intussuscepton
B. Pyloric stenosis
C. Intestnal obstructon
D. Gastrosophageal refux

Answer 21

B. Pyloric stenosis

Question 22

Which of the following common cause of vomitng in infants’ age group?
A. Coellac disease
B. Diabetc ketoacidosis
C. Urinary tract infecton
D. Cyclical vomitng syndrome

Answer 22

C. Urinary tract infecton

Question 23

What is the most appropriate counseling should be given regarding infantle colic?
A. It occurs in 80% of babies
B. Usually resolve by 6 weeks of age
C. Associated with excessive passage of flatus
D. Gripe water has proven evidence to control it

Answer 23

C. Associated with excessive passage of flatus

Question 24

A 5-year-old girl presents to the Emergency Room with history of severe abdominal pain, which is central and colicky, and repeated vomitng. The pain is getng worse by movement. On examinaton, there is generalized guarding in the abdomen, with more tendemess toward the right iliac fossa (see lab results). Blood pressure 110/70 mmHg Heart rate 135 /min Respiratory rate 22 /min Temperature 38 °C Oxygen saturaton 95 % Test Result Normal Values RBC 5 4.8-7.1 x 1012/L (Newbor) 4.6-4.8 x 1012/L (Child) Hb 132 165-195 g/L (Newborn) 112-165 g/L (Child)
Platelets count 320 150-400 x 109/L ESR 12 2-10 mm/h WBC 15.2 4.5-13.5 x 109/L (2-10 years) 4.5-11.1 x 109/L (11 years-older adult) Which of the following is the most appropriate counseling regarding this conditon?
A. Occurs in 2% of individual
B. Its uncommon below 3 years old
C. A sausage shaped mass ofen palpable
D. Passage of redcurrant jelly stool confrmed the diagnosis

Answer 24

B. Its uncommon below 3 years old

Question 25

Which of the following is the most appropriate counseling for celiac disease?
A. No diagnostc test is available for celiac disease
B. Intestinal biopsy is required to confrm the diagnosis
C. Diagnosis can be confrmed by positve serological test
D. Improvement afer usage of gluten-free diet can work as diagnostc test

Answer 25

B. Intestinal biopsy is required

Question 26

A 14-month-old child presents to the Emergency Room with history of paroxysmal, sever colicky abdominal pain, which comes and goes in bouts. He had vomitng and suddenly pass red currant jelly stool. Which of the following is the most appropriate counseling for this presentaton?
A. Shock is a common complication
B. Recurrence is common afer surgical correction
C. Treatment requires immediate surgical intervention
D. Reducton by therapeutc enemas is carried out in case of peritonits

Answer 26

A. Shock is a common complication

Question 27

Which of the following is the most common congenital heart lesion?
A. Persistent ductus arteriosus
B. Ventricular septal defect
C. Atrial septal defect
D. Tetralogy of fallot

Answer 27

B. Ventricular septal defect

Question 28

A 24-hour-old neonate found to have abnormal heart rhythm during admission exam. ECG done showed complete heart block. ECHO showed small persistent ductus arteriosus (see lab results). Test Result Normal Values RBC 5 4.8-7.1 x 1012/L (Newborn) 4.6-4.8 x 1012/L (Child) Hb 165 165-195 g/L (Newborn) 112-165 g/L (Child) HCT 0.45 0.44-0.64 (Newborn) 0.32-0.42 (Child) Platelets count 65 150-400 x 109/L WBC 11 9.1-30.1 x 109/L (Birth) 6.1-17.5 x 109/L (1-23 months) Which of the following maternal disorders contributes to the fnding?
A. Hypothyrodism
B. Diabetes mellitus
C. Rubella infecton
D. Systemic lupus erythematosus

Answer 28

D. Systemic lupus erythematosus

Question 29

A 2-year-old child presents to the Emergency Department with high-grade fever, persistent vomitng, diarrhea and cough for 3 days. On examinaton, a murmur with decrease air entry over the right lung. For the last 4 visit to the pediatrician, the patent had a normal exam including cardiac (see lab results). Blood pressure 110/70 mmHg Heart rate 125 /min Respiratory rate 22 /min Temperature 38.5 °C Oxygen saturaton 97 % Test Result Normal Values BC 4.5 4.8-7.1 x 1012/L (Newborn) 4.6-4.8 x 1012/L (Child) Hb 95 165-195 g/L (Newborn) 112-165 g/L (Child) MCH 20 28-33 pg/cell MCV 65 80-95 f1 Platelets count 200 150-400 × 109/L WBC 6 4.5-13.5 x 109/L (2-10 vears) 4.5-11.1 X 109/L (11 years-older adult) Which of the following is the best next step in management for the heart murmur?
A. Urgent referral to cardiology
B. Immediate ECHO and ECG
C. Admission in cardiac ICU for monitoring and interventon
D. Re-examine the heart murmur afer correcton of the underlying illness

Answer 29

D. Re-examine the heart murmur afer correcton of the underlying illness

Question 30

A 2-year-old child presents to the Emergency Department with high-grade fever, persistent vomitng, diarrhea and cough for 3 days. On examinaton, a murmur with decrease air entry over the right lung. For the last 4 visit to the pediatrician, the patent had a normal exam including cardiac (see lab results). Blood pressure 110/70 mmg Heart rate 110 /min Respiratory rate 22 /min Temperature 38.5 °C Oxygen saturaton 97 % Test Result Normal Values RBC 4.2 4.8-7.1 x 1012/L (Newborn) 4.6-4.8 x 1012/L (Child) Hb 92 165-195 g/L (Newborn) 112-165 g/L (Child) MCH 20 28-33 pg/cell MCV 65 80-95 f Platelets count 350 150-400 x 109/L Which of the following is the most likely diagnosis for the heart murmur?
A. Aortic stenosis
B. Innocent murmur
C. Pulmonary regurgitation
D. Ventricular septal defect

Answer 30

B. Innocent murmur

Question 31

An 8-week-old infant presents to the clinic with wheezing. coughing, poor feeding and poor weight gain for the previous 2 weeks. Before this, she had been well. Her routne neonatal examinaton had been normal apart from pansystolic murmur at lower lef sternal edge. On examinaton, the liver was enlarged below costal margin. Blood pressure 110/50 mmg Heart rate 95 /min Respiratory rate 32 /min Temperature 36.6 °C Oxygen saturaton 92 % Which of the following is the most likely diagnosis?
A. Cystc fbrosis
B. Bronchial asthma
C. Atrial septal defect
D. Ventricular septal defect

Answer 31

D. Ventricular septal defect

Question 32

An 8-week-old infant presents to the clinic with fever, wheezing. coughing, poor feeding and poor weight gain for the previous 2 weeks. Before this, she had been well. Her routne neonatal examinaton had been normal apart from pansystolic murmur at lower lef sternal edge. On examinaton, the liver was enlarged below costal margin (see report). Blood pressure 95/50 mmHg Heart rate 85 /min Respiratory rate 34 /min Temperature 38 °C Oxygen saturaton 92 % Chest X-Ray: Showed cardiomegaly and increase pulmonary vascular marking with bilateral patches in the lung. Which of the following is the most appropriate next step in management?
A. Referral for surgical intervention
B. Medical treatment with diuretics
C. Admit to ICU for diagnostc catheterization
D. Full course of IV antbiotcs then re-evaluate

Answer 32

B. Medical treatment with diuretics

Question 33

Which of the following represent the best management approach for signifcant atrial septal defect (ASD)?
A. Secundum ASD require surgical correction
B. Treatment usually undertaken at 3-5 years of age
C. Treatment usually undertaken within 8 weeks form birth
D. No need to treat signifcant ASD as it will close by age of 5 years

Answer 33

B. Treatment usually undertaken at 3-5 years of age

Question 34

An 18-month-old child diagnosed with congenital heart disease, presented to Emergency Room with severe cyanosis and hypercyantc spells. The mother mentoned that he was irritable and inconsolable crying for the last 1 hours and the cyanosis is getng worse. On examinaton, he looks cyanotce centrally, with loud harsh ejecton systolic murmur heard at lef sternal border (see report). Blood pressure 100/60 mmHg Heart rate 95 /min Respiratory rate 28 /min Temperature 37.8 °C Oxygen saturaton 85 %
Chest X-Ray: Showed small heart with decrease pulmonary vascular marking. Which of the following is to most appropriate management?
A. Sedaton and pain relief
B. Intravenous diuretcs bolus
C. Immediate cardiac catheterization
D. IV antbiotcs and total parenteral nutriton

Answer 34

A. Sedaton and pain relief

Question 35

A 2-day-old neonate presents to the Emergency Department with sudden sever cyanosis. On examinaton, he looks cyanotc, lethargic; with cardiac exam reveals no murmur and normal pulses (see report). Chest X-Ray: Showed egg on side appearance of the cardiac shadow and increased pulmonary vascular marking. Which of the following is the most likely diagnosis?
A. Tetralogy of fallot
B. Coarctaton of aorta
C. Transpositon of great arteries
D. Persistence ductus arteriosus

Answer 35

C. Transpositon of great arteries

Question 36

A 14-month-old presents to Primary Clinic with recurrent syncopal atack, associated with worsening heart failure manifestaton and poor growth. On examinaton, he has crackles all over the chest with palpitaton and abnormal cardiac rhythm (see report). ECG: Showed narrow complex tachycardia of 250-300 beats/min. Which of the following is the most likely diagnosis?
A. Atrial futer
B. Atrial fbrillaton
C. Ventricular tachycardia
D. Supraventricular tachycardia

Answer 36

D. Supraventricular tachycardia

Question 37

A 2-year-old girl brought to Primary Clinic because the mother notced she is pale. She had history of drinking 3 glasses of cow’s milk daily, very picky eater and refusing to eat meat. The mother gave history of similar presentaton on 2 of her brother (see lab results). Test Result Normal Values RBC 3 4.8-7.1 x 1012/L (Newborn) 4.6-4.8 x 1012/L (Child) Hb 4 165-195 g/L (Newborn) 112-165 g/L (Child) MCH 18 28-33 pg/cell MCV 62 80-95 f1 Retculocyte 3 0.2-1.2 % Platelets count 480 150-400 x 109/L Ferritn 9 20-200 g/L Which of the following is the most likely diagnosis?
A. Sickle cell disease
B. Alpha thalassemia trait
C. Iron defciency anemia
D. Anemia of chronic disease

Answer 37

A. Sickle cell disease

Question 38

A 2-year-old girl brought to Primary Clinic because the mother notced she is pale. History of drinking 3 pints of cow’s milk daily and is a very picky eater. The mother gave history of similar presentaton on 2 of her brother (see lab results). Test Result Normal Values RBC 3 4.8-7.1 x 1012/L (Newborn) 4.6-4.8 x 1012/L (Child) Hb 4 165-195 g/L (Newborn) 112-165 g/L (Child) MCH 18 28-33 pg/cell MCV 62 80-95 f Retculocyte 3 0.2-1.2 % Platelets count 480 150-400 x 109/L Ferritn 9 20-200 ug/L Which of the following is the most likely diagnosis?
A. Sickle cell disease
B. Alpha thalassemia trait
C. Iron defciency anemia
D. Anemia of chronic disease

Answer 38

C. Iron defciency anemia

Question 39

A 2-years-old boy presents to the clinic with complain of sudden jaundice, fever for the last 3 days and passage of dark urine. Family history is positve for one brother who has severe neonatal jaundice required exchange transfusion, and they are originated from Mediterranean region (see lab results). Blood pressure 110/70 mmHg Heart rate 120 /min Respiratory rate 22 /min Temperature 38.5 ‘C Test Result Normal Values RBC 4 4.8-7.1 x 1012/L (Newborn) 4.6-4.8 x 1012/L (Child) Hb 9 165-195 g/L (Newborn) 112-165 g/L (Child) Retculocyte 3 0.2-1.2 % Platelets count 300 150-400 x 109/L WBC 10 4.5-13.5 x 109/L (2-10 years) 4.5-11.1 x 109/L (11 years-older adult) Which of the following medicatons should be avoided in the management?
A. Aspirin
B. Amoxicillin
C. Ibuprofen
D. Acetaminophen

Answer 39

A. Aspirin

Question 40

Which of the following leukemia is the most common in pediatric age group?
A. Acute myeloid
B. Chronic myeloid
C. Acute lymphoblastc
D. Acute non-lymphoblastc

Answer 40

C. Acute lymphoblastc

Question 41

A 3-year-old boy is brought to the clinic by his mother because he was not eatng well, and had distended abdomen. Recently he appeared reluctant to walk and lost weight. On examinaton, he looks pale, with hypertension and distended abdomen. MRI abdomen, confrmed the presence of large upper abdominal mass extending toward the midline Which of the following is the most likely diagnosis?
A. Wilms tumor
B. Neuroblastoma
C. Hodgkin lymphoma
D. Non-Hodgkin lymphoma

Answer 41

B. Neuroblastoma

Question 42

A 4-year-old girl presents to the clinic with recurrent abdominal pain in additon to headaches She has poor appette and refuse feeding because the pain. The atacks of the abdominal pain are midline associated with vomitng and facial pallor. There is a family history of severe headache in 2 sisters.Which of the following is the most likely diagnosis?
A. Abdominal migraine
B. Chronic constpaton
C. Irritable bowel syndrome
D. Infammatory bowel disease

Answer 42

A. Abdominal migraine

Question 43

A 2-year-old girl presents to the Emergency Room with fever, vomitng and diarrhea for the last 4 days. On examinaton, she looks severely dehydrated, lethargic with altered conscious stat, with mild abdominal pain. The family mentoned that they tried to use oral rehydraton soluton at home but she is not drinking well. A rapid correcton by intravenous normal saline fuid established to manage her case. Afer 30 minutes, she starts to have abnormal movement and went in coma, which required resuscitaton intubaton and admission to Pediatric Critcal Care Unit (see lab results). Blood pressure 75/35 mmg Heart rate 110 /min Respiratory rate 28 /min Temperature 39 °C Oxygen saturaton 95 % Test Result Normal Values Sodium 162 134-146 mol/L Potassium 3.8 3.5-5.1 mmol/L Chloride 115 97-108 mmol/L Bicarbonate 14 21-28 mmol/L which of the following is the most likely cause her deterioraton?
A. The case complicated with meningits
B. Rapid correcton lead to cerebral edema
C. Delayed in startng fuid and antbiotcs
D. Sudden intraventricular hemorrhage because the high sodium

Answer 43

B. Rapid correcton lead to cerebral edema

Question 44

A 2-year-old child presents to the Emergency Room with fever, vomitng and diarrhea for the last 4 days. On examinaton, she looks severely dehydrated, lethargic with altered conscious stat, with mild abdominal pain. The family mentoned that they tried to use oral rehydraton soluton at home but she is not drinking well. A rapid correcton by intravenous normal saline fuid established to manage her case. Afer 30 minutes, she starts to have abnormal movement and went in coma, which required resuscitaton intubaton and admission to Pediatric Critcal Care Unit (see lab results). Blood pressure 75/45 mmH
Heart rate 120 /min Respiratory rate 28 /min Temperature 39 °C Oxygen saturaton 95 % Test Result Normal Values Sodium 162 134-146 mmol/L Potassium 3.6 3.5-5.1 mmol/L Chloride 115 97-108 mmol/L Bicarbonate 14 21-28 mmol/L which of the following is the most appropriate management?
A. Fluid defcit should be replaced over 48 hours
B. Fluid defcit should be replaced over 24 hours
C. Fluid defcit should be replaced over 12 hours
D. Fluid defcit should be replaced over 6 hours

Answer 44

A. Fluid defcit should be replaced over 48 hours

Question 45

Which of the following describes the role of ant-diarrheal drugs in the management of gastroenteritis?
A. They are effective
B. Can be associated with side effects
C. Can replace oral rehydraton in severe cases
D. May shorten the excreton of bacteria in stool

Answer 45

B. Can be associated with side effects

Question 46

A 12-month-old child presents to the clinic following an episode of gastroenterits as diarrhea returns back afer introducton of normal diet. The mother said that she used the oral rehydraton soluton as prescribed and followed the advices received from the pediatrician. On examinaton, the child looks mildly dehydrated with normal actvity. Which of the following is the most appropriate counseling should be given?
A. Change to gluten free formula
B. Change to cow’s milk free formula
C. Use oral rehydraton soluton for 5 days followed by introducton of normal diet
D. Use oral rehydraton soluton for 24 hours followed by introducton of normal diet

Answer 46

D. Use oral rehydraton soluton for 24 hours followed by introducton of normal diet

Question 47

A 12-month-old child presents to the clinic following an episode of gastroenterits as diarrhea returns back afer introducton of normal diet. The mother said that she used the oral rehydraton soluton as prescribed and followed the advices received from the pediatrician. On examinaton, the child looks mildly dehydrated with normal actvity. Which of the following can explain the new presentaton?
A. Temporary lactose intolerance
B. Temporary lactase intolerance
C. Temporary glucose intolerance
D. Temporary sucrose intolerance

Answer 47

A. Temporary lactose intolerance

Question 48

An 18-month-old child presents to the clinic with unilateral eye swilling for 2 days. On examinaton, there is clear proposis, painful and limited ocular movement with reduce visual acuity. The mother said they missed 12 and 18 months vaccines. Which of the following is the most appropriate next step in management?
A. Arrange for 18 month vaccines administraton
B. Brain MRI to roll out intraventricular hemorrhage
C. Urgent CT scan to assess the spread of the infecton
D. Perform funduscopic exam to roll out inclusion body

Answer 48

C. Urgent CT scan to assess the spread of the infecton

Question 49

An 18-month-old child presents to the clinic with unilateral eye swilling for 2 days. On examinaton, there is clear proposis, painful and limited ocular movement with reduce visual acuity. The mother said they missed 12 and 18 months vaccines. Which of the following is the most likely diagnosis?
A. Orbital myosits
B. Orbital cellulits
C. Periorbital cellulits
D. Thyroid-associated orbitopathy

Answer 49

B. Orbital cellulits

Question 50

A 2-year-old child presents to the clinic with skin lesions on the face, neck and hands. The mother said it was started as erythematous macules, which became vesicular then ruptured. On examinaton, ruptured vesicles with exudaton that look like honey colored crust lesions. The mother mentoned that her child complain of atopic eczema since infancy. Which of the following is the most likely diagnosis?
A. Boils
B. Impetgo
C. Atopic dermatts
D. Scalded skin syndrome

Answer 50

B. Impetgo

Question 51

A 2-year-old child presents to the clinic with skin lesions on the face, neck and hands. The mother said it was started as erythematous macules, which became vesicular then ruptured. On examinaton, ruptured vesicles with exudaton that look like honey colored crust lesions. The mother mentoned that her child complain of atopic eczema since infancy. The mother is asking if she can allow her child to return to the nursery. Which of the following is the most appropriate counseling should be given?
A. Lesions are not contagious and can go to nursery
B. Lesions are not contagious and can go to nursery afer 5 days
C. Lesions are contagious and should not go to nursery for 3 days
D. Lesions are contagious and should not go to nursery untl it become dry

Answer 51

D. Lesions are contagious and should not go to nursery untl it become dry

Question 52

A 2-year-old child presents to the clinic with 3-day history of vesicular lesions on the lips, gums and anterior surface of the tongue and hard palate. On examinaton, child looks dehydrated with dry mucus membrane the lesions look extensive, painful with mild bleeding. According to the mother, she is not eatng or drinking well because of the pain. Which of the following is the most likely diagnosis?
A. Impetgo
B. Gingivostomatts
C. Herpetc whitlows
D. Eczema herpetcum

Answer 52

B. Gingivostomatts

Question 53

A 2-year-old child presents to the clinic with 3-day history of vesicular lesions on the lips, gums and anterior surface of the tongue and hard palate. On examinaton, the lesions look extensive, painful with mild bleeding. According to the mother, she is not eatng or drinking well because of the pain. Which of the following is the most likely the causatve organism?
A. Herpes simplex virus
B. Varicella zoster virus
C. Staphylococcal aureus
D. Streptococcus pneumonia

Answer 53

A. Herpes simplex virus

Question 54

A 2-year-old child presents to the clinic with 3-day history of vesicular lesions on the lips, gums and anterior surface of the tongue and hard palate. On examinaton, child looks dehydrated and the lesions look extensive, painful with mild bleeding. According to the mother, she is not eatng or drinking well because of the pain for the last 2 days. Which of the following is the best management?
A. Acyclovir
B. Intravenous fuid and acyclovir
C. Intravenous fuid and topical antbiotcs
D. Narrow spectrum systemic antbiotcs and topical antbiotcs

Answer 54

B. Intravenous fuid and acyclovir

Question 55

A 2-year-old child presented to the clinic with high-fever of 5-day duraton. Examinaton showed ill child with mild conjunctvits, a rash, cervical lymphadenopathy, and cracked red lips (see lab results), Blood pressure 110/70 mmHg Heart rate 115 /min Respiratory rate 22 /min Temperature 39.5 °C Test Result Normal Values C-reactve peptde 135 0-0.5 mg/di RBC 4 4.8-7.1 x 1012/L (Newborn) 4.6-4.8 x 1012/L (Child) Hb 115 165-195 g/L (Newborn) 112-165 g/L (Child) Platelets count 550 150-400 x 109/L ESR 125 2-10 mm/h WBC 15 4.5-13.5 x 109/L. (2-10 years) 4.5-11.1 x 109/L. (11 years-older adult) Which of the following is the best management?
A. Aspirin
B. Ribavirin
C. Vitamin A
D. Acyclovir

Answer 55

A. Aspirin

Question 56

A 2-year-old child presented to the clinic with high-fever of 5-day duraton. Examinaton showed ill child, with mild conjunctvits, a rash, cervical lymphadenopathy and cracked red lips (see lab results), Blood pressure 110/70 mmHg Heart rate 120 /min Respiratory rate 24 /min Temperature 39.2 °C Test Result Normal Values RBC 5 4.8-7.1 x 1012/L (Newborn) 4.6-4.8 x 1012/L (Child) Hb 115 165-195 g/L (Newborn) 112-165 g/L (Child) Platelets count 550 150-400 x 109/L ESR 125 2-10 mm/h WBC 18 4.5-13.5 x 109/L (2-10 vears)
4.5-11.1 x 109/L (11 years-older adult) C-reactve peptde 135 0-0.5 mg/dl Which of the following is the most likely diagnosis?
A. Mumps
B. Rubella
C. Measles
D. Kawasaki disease

Answer 56

D. Kawasaki disease

Question 57

A 5-year-old child presents to the Emergency Room with severe sore throat, high-fever and increasing difculty breathing over 8 hours. On examinaton, ill toxic looking child with drooling of saliva and sitng immobile with open mouth. Blood pressure 110/70 mmHg Heart rate 115 /min Respiratory rate 32 /min Temperature 38.8 °C Oxygen saturaton 95 % Which of the following is the most appropriate immediate acton should be taken?
A. Urgent referral to ENT for tonsillectomy
B. Complete sepsis work up, followed by antbiotcs for 7 days
C. Send home on oral antbiotcs for 7 days and referral to ENT
D. Urgent admission to ICU for intubaton then sepsis work to follow

Answer 57

D. Urgent admission to ICU for intubaton then sepsis work to follow

Question 58

A 5-year-old child presents with severe sore throat, high fever and increasing difculty breathing over 8 hours. On examinaton, ill and toxic looking child with drooling of saliva and sitng immobile with open mouth. Blood pressure 110/70 mmHg Heart rate 120 /min Respiratory rate 28 /min Temperature 38.6 °C Oxygen saturaton 95 % Which of the following is the most likely diagnosis?
A. Bronchits
B. Pharyngits
C. Acute Croup
D. Acute epiglottis

Answer 58

D. Acute epiglottis

Question 59

which of the following considered as minor manifestaton of Jones criteria for diagnosis of rheumatc fever?
A. Pancardits
B. Polyarthralgia
C. Sydenham chorea
D. Subcutaneous nodules

Answer 59

B. Polyarthralgia

Question 60

A 3-year-old child presents to the clinic with history of passing red-brown urine. There is a positve history of fu-like prodrome 2 weeks ago. Which of the following has the highest diagnostc value?
A. High complement C3
B. Low complement C4
C. High complement C4
D. Low complement C3

Answer 60

D. Low complement C3

Question 61

A 4-month-old boy brought by his mother asking for circumcision. History revealed that he was diagnosed with mid-shaf hypospadias. Which of the following is the most appropriate counseling should be given?
A. No link between hypospadias and circumcision
B. It is late for circumcision as correcton is ofen undertaken before 4 month old
C. Infant with hypospadias must not be circumcised as the skin will used in the surgery
D. Proceed with circumcision as there is no need for surgical correcton for this type of hypospadias

Answer 61

C. Infant with hypospadias must not be circumcised as the skin will used in the surgery

Question 62

A 5-year-old child presented with bruising and skin rash that developed over 24 hours. She had had upper respiratory tract infecton a week ago. On examinaton, she appeared well but had purpuric skin rash with some bruises on legs. No lymphadenopathy or hepatosplenomegaly (see lab results). Test Result Normal Values RBC 4.7 4.8-7.1 x 1012/L (Newborn) 4.6-4.8 x 1012/L (Child) Hb 115 165-195 g/L (Newborn) 112-165 g/L (Child) MCH 30 28-33 pg/cell MCV 85 80-95 f1 Platelets count 17 150-400 x 109/L ESR 3 2-10 mm/h Clotng tme 5 5-10 min Bleeding tme 3 up to 4 min APT 35 30-40 sec INR 1.1 0.9.1.2 Prothrombin tme 13 12-14 sec WBC 6 4.5-13.5 x 109/L (2-10 years) 4.5-11.1 x 109/L (11 years-older adult) Color clear clear or light yellow Nitrite absent Absent Hemoglobin absent Absent Erythrocytes 0 0-2 per high power feld Which of the following is most likely the diagnosis?
A. Wiskot-aldrich syndrome
B. Bernard-souller syndrome
C. Immune thrombocytopenic purpura
D. Thrombotc thrombocytopenic purpura

Answer 62

C. Immune thrombocytopenic purpura

Question 63

A 2-month-old infant presents to Emergency Room with bronchiolits required non-invasive mechanical ventlaton as a respiratory support. Which of the following is the most appropriate destnaton?
A. Admission to paediatric word
B. Admission to neonatal care unit
C. Observaton in emergency department
D. Admission to pediatrics critcal care unit

Answer 63

D. Admission to pediatrics critcal care unit

Question 64

An 8-month-old infant admited to Pediatrics Critcal Care for close observaton. Which of the following standers contnuous monitoring in pediatrics critcal care measured as trans-cutaneous?
A. Blood pressure
B. Fluid balance
C. Glasgow coma scale
D. Arterial oxygen saturaton

Answer 64

D. Arterial oxygen saturaton

Question 65

A 7-year-old presents to Emergency Department with vomitng and abdominal pain for 1 day. The child has had history of polydipsia, polyuria and weight loss for the last 3 weeks. Examinaton reveals dehydraton and hypoactvity (see lab results). Blood pressure 90/50 mmH Heart rate 110 /min Respiratory rate 24 /min Temperature 38.6 °C Oxygen saturaton 95 % Weight 23 kg Test Result Normal Values ABG HCO3- 5 13-22 mmol/L ABG PCO2 22 27-40 mmHg pH 7.12 7.36-7.45 ABG PO2 100 8-24 mmHg (Newborn) 55-80 mmHg (Child) Base access -17 -2 to 2 mmol/L Color light yellow clear or light yellow Appearance clear clear pH 6 4.3-8 Specifc gravity 1025 1001-1030 Protein +1 Absent Glucose +4 Absent Ketones +4 Absent Nitrite absent Absent Leukocytes 3 0-3 per high power feld Which of the following is the most likely diagnosis?
A. Gastrits
B. Food poisoning
C. Diabetic ketoacidosis
D. Urinary tract infecton

Answer 65

C. Diabetic ketoacidosis

Question 66

A 3-year-old child presents to Emergency Department with fever, poor feeding and vomitng for 3 days afer a fu-like illness. On examinaton, she looks sick, lethargic and capillary refll is 4 seconds. Cardiopulmonary monitor atached and intravenous access atained. Blood pressure 62/46 mmH Heart rate 156 /min Respiratory rate 48 /min Temperature 38.2 °C Oxygen saturaton 92% Which of the following is the most likely diagnosis?
A. Sepsis
B. Bronchiolits
C. Encephilits
D. Septc shock

Answer 66

D. Septc shock

Question 67

A 4-year-old child presents with shortness of breath and cough following fu-like illness for 2 days. Examinaton reveals child in severe distress with increased efort of respiraton with bilateral wheeze and prolonged expiatory phase. He had slimier atacks before that required hospitalizaton. Blood pressure 100/65 mmHg Heart rate 124 /min Respiratory rate 33 /min Temperature 36.6 °C Oxygen saturaton 82 % which of the following is the most appropriate management?
A. Antbiotc and systematc steroid
B. Ventolin nebulizaton and antbiotcs
C. Intravenous fuid and ventalin nebulizaton
D. Ventolin nebulizaton and systematc steroid

Answer 67

D. Ventolin nebulizaton and systematc steroid

Question 68

A 9-month-old infant presents to Emergency Room with actve generalized tonic-clonic seizure for 5 minutes ago. He has fu-like illness today and the review of system was unremarkable. The child was connected to cardiopulmonary monitor and intravenous access immediately atained. Blood pressure 80/50 mmHg Heart rate 132 /min Respiratory rate 31 /min Temperature 39.6 °C Oxygen saturaton 95 % Which of the following is the most appropriate next step in management?
A. Oral lorazepam
B. Nasal diazepam
C. Rectal diazepam
D. Intravenous lorazepam

Answer 68

D. Intravenous lorazepam

Question 69

Which of the following is the most common cause of shock in children?
A. Septic
B. Hypovolemic
C. Cariogenic
D. Obstructive

Answer 69

B. Hypovolemic

Question 70

A 4-year-old child with bronchial asthma on ventolin inhaler. The mother gave history of cough atack more than twice per week and she brought her child to the Emergency Room last month twice. Which of the following is the most appropriate next step in management?
A. Start inhaled steroids
B. Increase ventolin frequency
C. Contnue same management
D. Admit to hospital for further workup

Answer 70

A. Start inhaled steroids

Question 71

A 12-year-old child brought by an ambulance to Emergency Room afer fall down from height. The primary survey reveals awake child, breathing with open wound in lef thigh covered with blood-sucked gauze. The capillary refll is 4 seconds. Blood pressure 70/50 mmHg Heart rate 118 /min Respiratory rate 22 /min Temperature 36.6 °C Oxygen saturaton 95 % Which of the following is the most appropriate next acton?
A. Send for imaging
B. Give morphine bolus
C. Call surgeon on duty
D. Give normal saline bolus

Answer 71

D. Give normal saline bolus

Question 72

A 6-year-old boy presented with recurrent cough and wheeze, He is on ventolin and fuxotde inhaler, labelled as bronchial asthma sine age of 4. The mother is concerned about poor weight gain and worsening lung conditon. His examinaton reveals thin child with weight less than 5th percentle and height at 25th percentle and has normal chest exam. Blood pressure 110/70 mmHg Heart rate 76 /min Respiratory rate 18 /min Temperature 36.6 °C Oxygen saturaton 95 % Which of the following is the most appropriate counselling should be given?
A. Reassurance and diettan referral
B. Need escalaton in bronchial asthma control
C. Start antbiotcs and follow up afer one month
D. Need further work out to roll out bronchial asthma mimicker

Answer 72

D. Need further work out to roll out bronchial asthma mimicker

Question 73

Respiratory distress syndrome is common disease encountered in newborn delivered prematurely. Which of the following is the most basic lung part affected?
A. Epithelial cell producing surfactant
B. Connective tssue protein
C. Alveolar space structure
D. Bronchial tssue enzyme

Answer 73

A. Epithelial cell producing surfactant

Question 74

Which of the following is the most common chronic disease in children?
A. Renal failure
B. Cystc fbrosis
C. Bronchial asthma
D. Diabetes mellitus

Answer 74

C. Bronchial asthma

Question 75

Which of the following is the most important elements in bronchial asthma management?
A. Control acute attacks
B. Annual infuenza vaccination
C. Compliance with inhaled steroids
D. Family educaton and awareness

Answer 75

D. Family educaton and awareness

Question 76

A 3-year-old child with suspected bronchial asthma disease. Which of the following has the highest diagnostc value at this age?
A. Bronchoscopy and lung biopsy
B. Pulmonary functon test and spirometry
C. Chest imaging and specifc immunological blood test
D. Detailed history and physical examinaton and response to bronchodilator

Answer 76

D. Detailed history and physical examinaton and response to bronchodilator

Question 77

A 10-year-old boy with recurrent wheeze and cough responded partally to asthma management. He has poor weight gain and strong family history of bronchial asthma. Which of the following supports diagnosis of cystc fbrosis? A. Partal response to brochodilaton B. Family history of bronchial asthma C. Recurrent wheeze and cough
D. Poor weight gain

Answer 77

D. Poor weight gain

Question 78

An 18-month-old child presents with stridor and barking cough for 2 days afer fu-like symptoms. Examinaton reveals actve well looking child and stable vital signs. Blood pressure 100/70 mmHg Heart rate 102 /min Respiratory rate 20 /min Temperature 37.6 °C Oxygen saturaton 95 % Which of the following is the most likely diagnosis?
A. Viral croup
B. Epiglots
C. Trachiaits
D. Foreign body aspiraton

Answer 78

A. Viral croup

Question 80

Which of the following is the most causatve organism of bronchiolits in infant?
A. Influenza
B. Adenovirus
C. Parainfunza
D. Respiratory syncytal virus

Answer 80

D. Respiratory syncytal virus

Question 81

Which of the following is the most common mode of inheritance in cystc fbrosis?
A. Autosomal recessive
B. Autosomal dominant
C. X-linked recessive
D. Multfactorial

Answer 81

A. Autosomal recessive

Question 82

A 2-year-old child presents with cough and fever for 1 week duraton following fu-like symptoms. On examinaton, well looking with decease air entry and crackles in right lower lung on auscultaton and just below this fnding there is stony dullness on percussion. Blood pressure 98/65 mmHg Heart rate 105 /min Respiratory rate 22 /min Temperature 38.6 °C Oxygen saturaton 95 % Which of the following is the expected fnding in chest X-ray match child’s chest finding?
A. Bronchopneumonia
B. Plural effusion
C. Pneumothorax
D. Lung collapse

Answer 82

B. Plural effusion

Question 83

A 3-month-old infant with noisy breath since birth change with positoning tends to disappears in prone positon and become more obvious with supine positon. Examinaton and growth parameter are normal. Which of the following is the most likely diagnosis?
A. Nasal atresia
B. Laryngomalacia
C. Subglotc stenosis
D. Vocal cord paralysis

Answer 83

B. Laryngomalacia

Question 84

A 3-month-old infant with noisy breath since birth change with positoning tends to disappears in prone positon and become more obvious with supine positon. Examinaton and growth parameter are normal. The mother concerned about this sound. Which of the following is the most appropriate counselling should be given?
A. Will worsen with time
B. Needs surgical correction
C. Normal developmental sounds
D. Will improve by her first birthday

Answer 84

D. Will improve by her first birthday

Question 85

An 8-month-old infant with recurrent wheeze and distress resistance to asthma management and required multple hospitalizatons. Afer detailed history and examinaton, his pediatrician suspects tracheomalacia. Which of the following has the highest diagnostc value?
A. Chest CT
B. Chest X-ray
C. Fluoroscopy
D. Bronchoscopy

Answer 85

D. Bronchoscopy

Question 86

An 8-year-old boy being evaluated for short stature that includes detailed history and careful examinaton. Which of the following is the most important bedside test of highest diagnostc value? A. Dipstck urinalysis B. Portable spirometry C. Arm circumference **D. Mid-parental target height
An 8-year-old boy being evaluated for short stature that includes detailed history and careful examinaton. Which of the following is the most important bedside test of highest diagnostc value?
A. Dipstck urinalysis
B. Portable spirometry
C. Arm circumference
D. Mid-parental target height

Answer 86

D. Mid-parental target height

Question 87

A 13-year-old girl screened for sport partcipaton found to have delayed puberty and short stature. On examinaton, she was found to have webbed neck and wide shield-like chest. Which of the following is the most likely diagnosis?
A. Noonan syndrome
B. Turner syndrome
C. Growth hormone defciency D. Consttutonal short stature

Answer 87

B. Turner syndrome

Question 88

A 13-year-old girl screened for delayed puberty and short stature. On examinaton, she found to have webbed neck and wide shield-like chest. Which of the following tests has the highest diagnostcs value?
A. Pelvic ultrasound
B. Bone age imaging
C. Growth hormone level
D. Chromosomal analysis

Answer 88

D. Chromosomal analysis

Question 89

A 3-week-old boy infant presents to Emergency Room with history of vomitng and lethargy. He is hypoactve with motled skin and no focus of infecton. Perinatal history was unremarkable (see lab results). Blood pressure 50/30 mmHg Heart rate 180 /min Respiratory rate 56 /min Temperature 36.6 °C Oxygen saturaton 95 %
Test Result Normal Values Sodium 122 134-146 mol/L Potassium 6.2 3.5-5.1 mmol/L Chloride 100 97-108 mmol/L Bicarbonate 21 21-28 mmol/L Calcium total 2.4 2.2-2.7 mmol/L Calcium ionised 1.5 1.2-1.3 mmol/L Blood urea nitrogen 3 0.7-6.7 mmol/L (Newborn) 1.8 to 6.4 mmol/L (Child) Creatnine 44 27-88 mol/L (Newborn) 27-62 umol/L (Child) Glucose 1.2 2.8-5 mmol/L (Newborn) 3.3 -5.5 mmol/L (Child) Which of the following is the most likely defnitve treatment?
A. Antibiotics
B. Fluid and dextrose
C. Dextrose and intralipid
D. Cortisone and hormonal therapy

Answer 89

D. Cortisone and hormonal therapy

Question 90

A 9-year-old child presents to Emergency Department with hypovolemic shock. Parents gave history of recent brain surgery and the child has polyurea and increased thirst since then (see lab results). Blood pressure 70/40 mmg Heart rate 136 /min Respiratory rate 18 /min Temperature 36.6 °C Oxygen saturaton 95 % Test Result Normal Values ABG HCO3- 20 13-22 mmol/L ABG PCO2 35 27-40 mmHg рн 7.37 7.36-7.45 ABG PO2 88 8-24 mmHg (Newborn) 55-80 mmg (Child) Base access -6 -2 to 2 mmol/L Sodium 177 134-146 mol/L Potassium 4 3.5-5.1 mol/L Chloride 140 97-108 mmol/L Bicarbonate 20 21-28 mmol/L Blood urea nitrogen 8 0.7-6.7 mmol/L (Newborn) 1.8 to 6.4 mmol/L (Child) Creatnine 60 27-88 mol/L. (Newborn) 27-62 mol/L. (Child) Glucose 4.5 2.8-5 mmol/L (Newborn) 3.3 -5.5 mmol/L (Child) Color colorless clear or light yellow Appearance Clear clear Specifc gravity 1003 1001-1030 Ketones absent Absent
Which of the following is the most likely diagnosis?
A. Diabetic ketoacidosis
B. Diabetes insipidus
C. Renal tubelur acidosis
D. Syndrome of inappropriate antdiuretc hormone secreton

Answer 90

B. Diabetes insipidus

Question 91

A 9-year-old child presents to Emergency Department with hypovolemic shock. Parents gave history of recent brain surgery and child has polyurea and increased thirst since then (see lab results). Blood pressure 70/50 mmH Heart rate 122 /min Respiratory rate 18 /min Temperature 36.6 °C Oxygen saturaton 95 % Test Result Normal Values ABG HCO3- 22 13-22 mmol/L ABG PCO2 36 27-40 mmHg pH 7.37 7.36-7.45 Sodium 167 134-146 mmol/L Potassium 4.5 3.5-5.1 mmol/L Chloride 122 97-108 mmol/L Bicarbonate 22 21-28 mmol/L Color colorless clear or light yellow Appearance Clear clear Specifc gravity 1004 1001-1030 Ketones absent Absent Which of the following is the most appropriate treatment?
A. Desmopressin replacement
B. Insulin replacement regime
C. Free water replacement
D. Fluid and caloric control

Answer 91

A. Desmopressin replacement

Question 92

What is the best tme to start educatng new mothers about breasteeding?
A. Afer delivery
B. Last trimester
C. Second trimester
D. Before planning for pregnancy

Answer 92

D. Before planning for pregnancy

Question 93

A full-term baby delivered normal vaginal delivery, received inital care and ready to be discharged home. Which of the following vaccines should be given before discharge?
A. BCG and HBV
B. HBV and MMR
C. BCG and DaP
D. MMR and DTaP

Answer 93

A. BCG and HBV

Question 94

An infant presents to Well Baby Clinic. She can keep her head up unsupported and need back support to set. She can smile and can reach mouth. What is the developmental age in months?
A. 3
B. 5
C. 7
D. 9

Answer 94

B. 5

Question 95

A 2-month-old infant with no risk factor screened in Well Baby Clinic. Which of the following measures need to be screened?
A. Autism
B. Lead level
C. Body mass index
D. Head circumference

Answer 95

D. Head circumference

Question 96

What is the recommended age (in months) to screen for haemoglobin level in infant with no risk factors?
A. 6
B. 12
C. 18
D. 24

Answer 96

B. 12

Question 97

A newborn delivered normally and discharged with the mother next day. What is the recommended sensory screening should be performed?
A. Hearing
B. Vision
C. Hearing and vision
D. Depends on clinical exam

Answer 97

A. Hearing

Question 98

A 2-week-old infant seen in the clinic. Rubbing side of the mouth with tp of the litle fnger is one of the primitve refexes (see image). Which of the following is the name of this refex?
A. Moro
B. Rooting
C. Sucking
D. Parachute

Answer 98

B. Rooting

Question 99

A 2-week-old infant seen in the clinic. Rubbing side of his mouth with tp of the litle fnger is one of the primitve refexes (see image). What is expected age (in months) for this refex to disappear?
A. 2
B. 4
C. 6
D. 8

Answer 99

B. 4

Question 100

A 5-year-old boy is brought to the clinic by his mother. She is concerned of bed-wetng overnight despite toilet training, compared to his sister when she was in his age she controls herself. Untl what age this is considered as a normal behaviour?
A. 5
B. 6
C. 7
D. 8

Answer 100

B. 6

Question 101

A 3-year-old child presents with history of increasing eye pufness for 1 week especially in the morning. He has had fu-like illness 2 week ago. On examinaton, he looks well, not in distress and no lower limb edema. Eye, chest and abdomen exams are normal (see lab results). Blood pressure 110/70 mmg Heart rate 76 /min Respiratory rate 18/min
Temperature 36.6 °C Oxygen saturaton 95 % Test Result Normal Values Color Clear clear or light yellow Protein +4 Absent Glucose Absent Absent Leukocytes 0 0-3 per high power feld Erythrocytes 0 0-2 per high power feld Which of the following has highest diagnostc value?
A. Serum albumin
B. Renal ultrasound
C. Serum electrolytes
D. Unine total protein

Answer 101

A. Serum albumin

Question 102

An 11-year-old boy is brought to the clinic by his mother. She is concerned of bed-wetng overnight despite toilet training and several sessions of discussion. He feels a shamed and asked help from his family and physician. Which of the following is the best management?
A. Avoid punishment
B. Desmopressin intra-nasal
C. Alarm beds with positve reinforcement
D. Family centred approach and techniques

Answer 102

D. Family centred approach and techniques

Question 103

A 9-year-old boy brought to the clinic by his mother. She is concered of bed-wetng overnight for one month. He was dry since age of 6 years and the mother gave history of fever and foul smell of his urine recently. Urine dipstck done (see lab result). Blood pressure 90/60 mmH Heart rate 76 /min Respiratory rate 18 /min Temperature 37.6 °C Test Result Normal Values Color dark yellow clear or light yellow Appearance cloudy clear Specifc gravity 1030 1001-1030 Nitrite present Absent Leukocytes 7 0-3 per high power feld Which of the following is the most likely diagnosis?
A. Nocturnal enuresis
B. Urinary tract infection
C. Improper personal hygiene
D. Normal patem at this age

Answer 103

B. Urinary tract infection

Question 104

A 2-month-old infant is brought to Well Baby Clinic by her mother, who is concems about her being not sleeping overnight and keeps crying intensely recently. These crying episodes are 2 to 3 tmes per week, last for 1 to 2 hours since the age of 1 month. Which of the following is the typical age of this conditon?
A. First 6 weeks of life
B. First 2 months of life
C. First 3 months of life
D. First 6 months of life

Answer 104

C. First 3 months of life

Question 105

A 2-month-old infant is brought to Well Baby Clinic by her mother, who is concems about her being not sleeping overnight and keeps crying intensely recently. These crying episodes are 2 to 3 tmes per week, last for 1 to 2 hours since the age of 1 month Which of the following is the most likely diagnosis?
A. Child abuse
B. Temper tantrum
C. Seizure attack
D. Infantile colic

Answer 105

D. Infantile colic

Question 106

A 2-month-old infant is brought to Well Baby Clinic by her mother because she is crying intensely recently and is not sleeping well overnight. The mother gave history of normal feeding. no fever or vomitng. These crying episodes are 2 to 3 tmes per week, last for 1 to 2 hours since the age of 1 month. Which of the following is the recommended revealing measure?
A. Changing formula
B. Oral colic drops
C. Getting a baby siter
D. Behavioural adaptation

Answer 106

D. Behavioural adaptation

Question 107

A 3-year-old girl is seen in the clinic. The mother gives history of yelling, hitng and saying “no” with other oppositonal behaviours. Which of the following is the most likely diagnosis?
A. Depression
B. Anxiety disorder
C. Temper tantrums
D. Mental retardaton

Answer 107

C. Temper tantrums

Question 108

A 2.5-year-old girl seen in the screening clinic. The mother gave history of yelling, hitng and saying “no” with other oppositonal behaviours. Which of the following is the most appropriate counselling should be given?
A. Ignorance behaviour
B. Antdepressant agent
C. Strict and frmness behaviour
D. Reinforcing positive behaviors

Answer 108

D. Reinforcing positive behaviors

Question 109

A 3-hour-old newborn seen in the Nursery for assessment. The mother gave a family history of early infancy death secondary to primary immunodefciency. Which of the following is the recommended frst vaccinaton (Saudi program)?
A. Do not give BCG vaccine
B. Give BCG and follow up in clinic
C. Give vaccines as per natonal program
D. Start intravenous immunoglobulin

Answer 109

A. Do not give BCG vaccine

Question 110

A 6-month-old infant presents to Vaccinaton Clinic. The mother gave history of fu-like symptoms and she is hesitant to give the vaccines as her child has a fever. On examinaton, the child looks healthy with normal exam. Heart rate 107 /min Respiratory rate 18 /min Temperature 38 °C Oxygen saturaton 95 % Which of the following is the best next acton?
A. Start antibiotic course
B. Re-schedule after 2 weeks
C. Proceed with vaccination
D. Give antipyretics and discharge

Answer 110

C. Proceed with vaccination

Question 111

A 2-month-old infant presents to Vaccinaton Clinic. What are the recommended vaccines according to natonal program?
A. IPV.HBV.DTP HIB.MMR
B. IPV,HBV,DTP,HAV,PCV
C. IPV.HBV.DTP.HIB,PCV
D. IPV.HBV.DTP HiB

Answer 111

C. IPV.HBV.DTP.HIB,PCV

Question 112

A 1-year-old infant presents to Vaccinaton Clinic with normal exam and growth What are the recommended vaccines according to natonal program?
A. OPV. MMR, HAV, PCV
B. Varecilla, PCV,HIB
C. OPV,MMR, varecilla, PCV
D. OPV,MMR, varecilla, DTP

Answer 112

C. OPV,MMR, varecilla, PCV

Question 113

According to natonal Saudi program of vaccinaton for children up to primary school admission, which of the following disease is efectvely prevented?
A. Q-fever
B. Japanese encephalits
C. Herpes simplex encephalits
D. Haemophilus infuenza meningits

Answer 113

D. Haemophilus infuenza meningits

Question 114

A 6-year-old child seen in pre-school screening clinic with normal growth and general health status. What are the recommended vaccines at this stage according to natonal program in Saudi Arabia?
A. MMR.DTP.OPV
B. MMR.HBV.DTP.HAV
C. MMR,varicella, DTP.OPV
D. MMR,varicella.OPV.PCV

Answer 114

C. MMR,varicella, DTP.OPV

Question 115

An 18-month-old boy is seen in screening clinic. The mother concerns about his growth. Which of the following fndings need referral for further management?
A. Persistence weight curve on 15% percentle
B. Persistence weight curve on 10 % percentle
C. Weight curve moves from 5% to 15% percentle
D. Weight curve drops one percentle but stll within normal ranges

Answer 115

D. Weight curve drops one percentle but stll within normal ranges

Question 116

A 2-year-old girl is seen in the clinic for pallor and tredness. On examinaton, she looks healthy with normal vital signs; growth parameter and physical exam apart from conjunctval pallor (see lab results). Blood pressure 90/70 mmHg Heart rate 97 /min Respiratory rate 18 /min Temperature 36.6 °C Oxygen saturaton 95 % Test Result Normal Values RBC 4.5 4.8-7.1 x 1012/L (Newborn) 4.6-4.8 x 1012/L (Child) Hb 87 165-195 g/L (Newborn) 112-165 g/L (Child) HCT 0.32 0.44-0.64 (Newborn) 0.32-0.42 (Child) MCH 25 28-33 pg/cell MCV 74 80-95 f Retculocyte 1.1 0.2-1.2 % Platelets count 350 150-400 x 109/L Iron 7 7.2-17.9 mol/L (Infant) 9-21.5 umol/L (Child) Total iron binding capacity 94 17.9-71.6 mol/L Ferritn 12 20-200 pg/L Which of the following is the most likely diagnosis?
A. Macrocytc anemia
B. Thalassemia trait
C. Sickle cell disease
D. Iron defciency anemia

Answer 116

D. Iron defciency anemia

Question 117

A 9-month-old infant is suspected to have iron defciency anemia. CBC and iron profle ordered pending the results. which of the following indexes is expected to be high?
A. MCV
B. Ferritn
C. Hemoglobin
D. Iron binding capacity

Answer 117

D. Iron binding capacity

Question 118

A 9-month-old infant is suspected to have iron defciency anemia. CBC and iron profle ordered pending the results. which of the following indexes is expected to be high? A. MCV B. Ferritn C. Hemoglobin **D. Iron binding capacity
A 4-month-old infant seen in the clinic with CBC result. The mother concern about the fndings (see lab results). Test Result Normal Values Hb 9 165-195 g/L (Newborn)
112-165 g/L (Child) MCH 25 28-33 pg/cell MCV 77 80-95 f Retculocyte 1.1 0.2-1.2 % Platelets count 330 150-400 x 109/L WBC 10 9.1-30.1 × 109/L (Birth) 6.1-17.5 x 109/L (1-23 months) Which of the following is the most likely diagnosis?
A. Physiologic anemia
B. Thalassemia trait
C. Sickle cell anemia
D. Lead poisoning

Answer 118

A. Physiologic anemia

Question 119

A 5-year-old child with bronchial asthma seen in the clinic because of uncontrolled course of disease despite using Ventolin regularly. Mother has asthma and using similar inhaler but she expresses poor technique of Ventolin delivery to her child. Which of the following is the most likely reason for her child’s problem?
A. Child neglect
B. Poor compliance
C. Improper technique
D. Need further evaluaton

Answer 119

C. Improper technique

Question 120

A 5-year-old child with bronchial asthma under control with inhalers. Mother concerned about the future of her child’s asthma during adulthood. Which of the following is the most likely prognosis?
A. Chronic lung disease
B. Most of the children grow out of it
C. Asthmatc during adulthood
D. No correlaton between childhood and adulthood asthma

Answer 120

B. Most of the children grow out of it

Question 121

A 3-year-old child with bronchial asthma on ventolin nebulizer at home as per needs. The mother expresses concern that the family cannot go out of the home most of the tme because the nebulizer machine need electricity power source. Which of the following is the most appropriate counselling should be given?
A. Agree and support their decision as the priority is asthma control
B. Find someone to take care of asthmatc child if family goes out of the home
C. Educate with clear instructons inhaler usage and advice to stop nebulizer
D. Find out nebulizer machine with portability feature

Answer 121

C. Educate with clear instructons inhaler usage and advice to stop nebulizer

Question 122

What is the most efectve treatment for moderate bronchial asthma severity?
A. Beta agonist agents
B. Beta agonist agents and steroids
C. Long actng beta agonist agents with steroids
D. Long actng beta agonist agents with antcholenergics

Answer 122

C. Long actng beta agonist agents with steroids

Question 123

A 6-year-old boy presents to Emergency Room with acute asthma atack responding to inital management with improved respiratory distress. His vitals afer stabilizaton are recorded. The decision made for hospitalizaton. Blood pressure 110/70 mmHg
Heart rate 97 /min Respiratory rate 20 /min Temperature 36.6 °C Oxygen saturaton 88 % Which of the following is the most likely reason for admission?
А. Нурохіа
B. Patent age
C. Hypotension
D. Asthma atack

Answer 123

А. Нурохіа

Question 124

A 2-year-old child diagnosed in the Emergency Room with pneumonia. The mother gave history of poor oral intake and vomitng for whatever orally introduced. Clinically, the child looks well with no distress. Blood pressure 88/56 mmH Heart rate 110 /min Respiratory rate 23 /min Temperature 36.6 °C Oxygen saturaton 95 % Which of the following reasons justfes the child hospitalization?
A. Age of the child
B. Vital signs findings
C. Inability to take orally
D. Primary diagnosis of pneumonia

Answer 124

C. Inability to take orally

Question 125

A 3-year-old child seen in the clinic with fever and cough for 5 days following fu-like prodrome. On examinaton, he had decrease air entry and crackles over right lung middle zone. Chest X- ray is done (see image and lab results). Blood pressure 90/64 mmH Heart rate 110 /min Respiratory rate 20 /min Temperature 36.6 °C Oxygen saturaton 97 % Test Result Normal Values Hb 12 165-195 q/L (Newborn) 112-165 g/L (Child) Platelets count 328 150-400 x 109/L Neutrophils 80 40-60% WBC 22 4.5-13.5 x 109/L (2-10 years) 4.5-11.1 x 109/L (11 years-older adult) Neutrophils 84% (2.4-7.3 × 109/L) 30%-77% (2-10 years) (2.7-6.5 x 109/L) 40%-75% (11 years-older adult) Lymphocytes 15% (2.8-9.3 x 109/L) 26%-56% (Birth) (3.7-10.7 × 109/L) 20%-64% (1-23 months) Which of the following is the most appropriate management?
A. Reassurance
B. Bronchodilator and steroids
C. Admit for intravenous antbiotcs
D. Discharge on amoxicillin for 7 days

Answer 125

D. Discharge on amoxicillin for 7 days

Question 126

A 2-month-old infant present to Emergency Room with cough, sneezing, circumoral cyanosis occasional with frothy secreton from mouth for the 3 days. On examinaton, she looks well with moderate tachypnea and intercostal retracton. Chest reveals scated rhonchi and crackles all over but good air entry. Blood pressure 80/50 mmH Heart rate 138 /min Respiratory rate 48 /min Temperature 36.6 °C Oxygen saturaton 91 % Which of the following is the most likely diagnosis?
A. Bronchiolits
B. Heart failure
C. Bronchial asthma
D. Gastrosophageal refux

Answer 126

A. Bronchiolits

Question 127

A 6-month-old infant with cough and fever diagnosed as bronchiolits. On examinaton, she had mild distress with intercostal retracton and chest auscultaton reveals difuse crackles. Blood pressure 92/67 mmHg Heart rate 145 /min Respiratory rate 56 /min Temperature 36.6 °C Oxygen saturaton 89 % Which of the following is the best management?
A. Admit for oxygen and hydraton therapy
B. Send home with instructon when to come back
C. Admit for antbiotcs and oxygen administraton
D. Admit for bronchodilaton and steroid management

Answer 127

A. Admit for oxygen and hydraton therapy

Question 128

Which of the following is the most common congenital heart defect in Down syndrome?
A. Cushion defect
B. Atrial septal defect
C. Coarctaton of aorta
D. Ventricular septal defect

Answer 128

A. Cushion defect

Question 129

A 4-month-old boy with Down syndrome seen in the screening clinic. Which growth chart should be used?
A. No special charts
B. Individualized chart
C. Down syndrome charts
D. Standard growth chart

Answer 129

C. Down syndrome charts

Question 130

A 4-day-old boy with Down syndrome seen in the screening clinic. Which of the following is the most striking feature?
A. Hypotonia
B. Doughy skin
C. Simian creases
D. Curved ffh litle fnger

Answer 130

A. Hypotonia

Question 131

What are the most common endocrine diseases associated with Down syndrome?
A. Hypothyroidism
B. Hyperthyroidism
C. Hypoparathyroidism
D. Panhypopituitarism

Answer 131

A. Hypothyroidism

Question 132

A 1-year-old diagnosed with Down syndrome, seen in the screening clinic. The mother who is 27-year-old is asking about risk of recurrence in future pregnancy. What is the most appropriate counselling should be given?
A. Carry no further risk
B. Depends on mother age
C. Depends on parents and child genetcs profle
D. Father genetcs has no role in recurrence rate

Answer 132

C. Depends on parents and child genetcs profle

Question 133

A 2.5-year-old boy seen in the clinic with skin rash. There is history of mild abdominal pain but the child looks healthy otherwise (see image). Which of the following is the most likely diagnosis?
A. Measles
B. Chickenpox
C. Meningococcemia
D. Henoch-schnlein purpura

Answer 133

D. Henoch-schnlein purpura

Question 134

A 6-year-old child seen in the clinic with fever and sore throat. She has had contact with child developed fu-like symptoms. Throat exam showed mild hyperaemia. Rapid throat test was negatve for streptococcal infecton and throat swab sent for culture Blood pressure 110/70 mmHg Heart rate 76 /min Respiratory rate 18 /min Temperature 36.6 °C Oxygen saturaton 95 % Which of the following is the best management at this stage?
A. Supportve treatment
B. Start antbiotcs pending culture result
C. Administer 1 shot of cefriaxone intramuscular
D. Start amoxicillin for 10 days regardless of culture result

Answer 134

A. Supportve treatment

Question 136

A 5-year-old child presents with history of increasing eye pufness for 1 week especially in the morning. He has had fu-like illness 2 week ago. On examinaton, he looks well, not in distress and no lower limb edema. Eye, chest and abdomen exams are normal (see lab results). Blood pressure 100/70 mmHg Heart rate 88 /min Respiratory rate 18 /min Temperature 36.6 °C Oxygen saturaton 95 % Test Result Normal Values Total Proteins 35 56-80 g/L Albumin 16 36-52 g/L Protein +4 Absent Which of the following is the most likely diagnosis?
A. Nephritc syndrome
B. Nephrotc syndrome
C. Hereditary angioedema
D. Protein losing enteropathy

Answer 136

B. Nephrotc syndrome

Question 137

A 6-year-old child presents with history of increasing eye pufness for 1 week especially in the morning. He has had fu-like illness 2 week ago. On examinaton, he looks well, not in distress and no lower limb edema. Eye, chest and abdomen exams are normal (see lab result). Test Result Normal Values Total Cholesterol 3 <5.2 mmol/L Triglycerides 10 <1.7 mmol/L Protein +4 Absent Leukocytes 0 0-3 per high power feld Erythrocytes 0 0-2 per high power feld Which of the following is the most appropriate management?
A. Anthistamine
B. Renal biopsy
C. Systematc steroids
D. Albumin replacement

Answer 137

C. Systematc steroids

Question 138

Which of the following is the most common cause of dehydraton in children?
A. Heat stroke
B. Food poisoning
C. Gastroenteritis
D. Drugs side efects

Answer 138

C. Gastroenteritis

Question 139

A 5-year-old child presents to Emergency Room with vomitng and diarrhea for 4 days. On examinaton, he looks dehydrated, hypoactve with sunken eyes, doughy skin and dry mucous membrane. The capillary refll is 4 seconds. Blood pressure 90/70 mmH Heart rate 130 /min Respiratory rate 22 /min Temperature 36.6 °C Oxygen saturaton 95 % Which of the following is the expected serum sodium level based on clinical fnding?
A. Low
B. High
C. Normal
D. No correlaton

Answer 139

B. High

Question 140

A 5-year-old child presents to Emergency Room with vomitng and diarrhea for 4 days. On examinaton, he looks dehydrated, hypoactve with sunken eyes and delayed skin turger with dry mucous membrane and capillary refll is 4 seconds. The child connected to cardiopulmonary monitor and IV access atained, blood sample sent for electrolytes. Blood pressure 60/40 mmH Heart rate 134 /min Respiratory rate 23 /min Temperature 36.6 °C Oxygen saturaton 95 % Which of the following is the most appropriate next acton?
A. Start inotropes
B. Give 5% albumin bolus
C. 20 ml per kg normal saline bolus
D. Start maintenance fuid waitng for serum electrolytes

Answer 140

C. 20 ml per kg normal saline bolus

Question 141

A 9-month-old infant presents with history of fever, irritability and right ear rubbing. Ear exam showed air-fuid levels and bulging tympanic membrane. Blood pressure 70/50 mmHg Heart rate 110 /min Respiratory rate 18 /min Temperature 38.8 °C Oxygen saturaton 95 % Which of the following is the most likely diagnosis?
A. Acute otts media
B. Acute otts externa
C. Chronic otts media
D. Chronic otts externa

Answer 141

A. Acute otts media

Question 142

A 3-month-old boy presented to the Emergency Room with history paroxysmal episodes of staccato cough, inspiraton between each cough. It is associated with perioral cyanosis and post-tussive vomitng. There is no history of diarrhea. This illness has been preceded by conjunctvits few days ago. On examinaton, the child looks unwell and tachypneic with auscultatory crackles. He has normal white blood cell count with elevated eosinophils on laboratory evaluaton. Which of the following is the most likely diagnosis?
A. Pertussis
B. Adenovirus pneumonia
C. Mycoplasma pneumonia
D. Chlamydia trachomats pneumonia

Answer 142

D. Chlamydia trachomats pneumonia

Question 143

A 3-year-old child present to the clinic with skin lesion that is not itchy. No history of fever and no previous illness (see image). Which of the following is the most likely diagnosis?
A. Cellulits
B. Folliculits
C. Impetgo
D. Toxic shock syndrome

Answer 143

C. Impetgo

Question 144

Which of the following interval (in days) defnes fever of unknown origin in paediatrics?
A. 7
B. 14
C. 21
D. 28

Answer 144

B. 14

Question 145

A 7-year-old girl presents with fever, abdominal pain and vomitng. On examinaton, she looks unwell with suprapubic tenderness, but no rebound tenderness nor guarding. Bed side dipstck done (see lab results). Blood pressure 110/70 mmH Heart rate 76 /min Respiratory rate 18 /min Temperature 39 °C Oxygen saturaton 95 % Test Result Normal Values Color turbid clear or light yellow Appearance cludy clear Nitrite pesent Absent Leukocytes 22 0-3 per high power feld Erythrocytes 3 0-2 per high power feld Which of the following is the most appropriate management?
A. Admit for surgery
B. Admit for iv antbiotcs
C. Discharge with oral antbiotcs
D. Call gynecologist on dutes

Answer 145

B. Admit for iv antbiotcs

Question 146

A 9-year-old boy seen in pre-sport screening clinic found to have fxed widely split second heart sound with grade 2 ejecton systolic murmur at upper lef steal border. ECG was normal. Blood pressure 110/70 mmH Heart rate 76 /min Respiratory rate 18 /min Temperature 36.6 °C Oxygen saturaton 95 % Which of the following is the most appropriate next acton?
A. Treadmill exercise test
B. Start diuretcs and captopril
C. Reassurance and discharge from clinic
D. Cardiology referral for catheterizaton

Answer 146

A. Treadmill exercise test

Question 147

A 3-year-old girl presents to the screening clinic found to have central obesity and short stature. On examinaton, she has moon face with hump on her back. Blood pressure 130/70 mmHg Heart rate 76 /min Respiratory rate 18 /min Temperature 36.6 °C Which of the following has highest diagnostc value?
A. Renal ultrasound
B. Height-weight chart
C. Thyroid functon test
D. ACTH stmulaton test

Answer 147

D. ACTH stmulaton test

Question 148

A 5-year-old child managed in Pediatrics Intensive Care Unit for diabetc ketoacidosis with insulin infusion and fuid correcton (see lab result). Test Result Normal Values Sodium 138 134-146 mmol/L Potassium 2.8 3.5-5.1 mmol/L Chloride 101 97-108 mmol/L Bicarbonate 22 21-28 mmol/L Which of the following is the most likely explanaton of low potassium?
A. Vomitng
B. Insulin therapy
C. Diuretcs therapy
D. Bicarbonate therapy

Answer 148

B. Insulin therapy

Question 149

A 2-month-old infant seen in the screening clinic and the red refex eye exam shown (see image). Which of the following is the most appropriate next step in management?
A. Send for brain imaging
B. Next available appointment
C. Reassurance as its normal fnding
D. Immediate referral to ophthalmology

Answer 149

D. Immediate referral to ophthalmology

Question 150

A 4-year-old boy previously healthy came to the clinic with history of limping for the last 2 days. On physical examinaton, he is keeping his lef leg fexed and refusing to move it or allowing anyone to touch it. Imaging is showing efusion of the lef hip. Blood pressure 90/61 mmH Heart rate 126 /min Respiratory rate 29 /min Temperature 38.8 °C Oxygen saturaton 98 % Which of the following is the most likely causatve organism?
A. Enterobacter
B. H. Infuenzae
C. Group B streptococcus
D. Staphylococcus aureus

Answer 150

D. Staphylococcus aureus

Question 151

A 4-year-old boy brought to the clinic. During the physical exam, a 7 cafe-au-lait macule over his trunk. The mother stated she and many of her family members have the same “birth-marks”. Which of the following is the best next step?
A. Order MRI brain
B. Family Counselling about neurofbromatosis type 1
C. Referral to medical genetcist for further evaluaton and genetc testng
D. Referral to genetc counsellor for further educaton about neurofbromatosis type 1

Answer 151

C. Referral to medical genetcist for further evaluaton and genetc testng

Question 152

A 3-year-old boy is diagnosed of tuberous sclerosis. There is no previous history of same disease in the family. Which of the following is the best opton of genetc testng?
A. Exome sequencing
B. Single-gene testng
C. Chromosomal microarray
D. Genetc testng panel of multple genes

Answer 152

B. Single-gene testng

Question 153

A 3-year-old boy is diagnosed of tuberous sclerosis. His mother has the same disease and was tested positve for a pathogenic mutaton in TSC1 gene. which of the following is the most appropriate genetc testng to be performed?
A. Exome sequencing
B. Single-gene testng
C. Genetc testng panel of multple gene
D. Targeted testng for the familial variant

Answer 153

D. Targeted testng for the familial variant

Question 154

A 4-month-old girl brought to well-baby visit. Her mother has complained of frequent episodes of spitng up afer each feeding. These episodes have goten worse over the past few weeks. There is no history of fever, cough or diarrhea. The giri has been exclusively breasted for good tme every 3-4 hours. On physical examinaton, her growth parameters are at 90th percentle for age. The rest of her exams are normal. Which of the following is the next step in the management?
A. Ph probe
B. Reassurance
C. Upper endoscopy
D. Ultrasound abdomen

Answer 154

B. Reassurance

Question 155

A 1-month-old boy presented to the Emergency Room with history of forceful, nonbilious vomitng. The mother is very concerned as he is her frst baby and was delivered by caesarean secton. She stated that he is always hungry no maters how much he feeds. Physical examinaton showed a palpable “olive” in the abdominal right upper quadrant. Which if the following is the likely fnding in his inital laboratory evaluaton?
A. Hyperkalemia
B. Hyponatremia
C. Hypochloremia
D. Metabolic acidosis

Answer 155

C. Hypochloremia

Question 156

A 1-month-old boy presented to the Emergency Room with history of forceful, nonbilious vomitng. The mother is very concerned as he is her frst baby and was delivered by caesarean secton. She stated that he is always hungry no maters how much he feeds. Physical examinaton showed a palpable “olive” in the abdominal right upper quadrant. Which of the following is the most appropriate inital imaging study?
A. CT abdomen
B. MRI abdomen
C. Upper GI series
D. Ultrasound abdomen

Answer 156

D. Ultrasound abdomen

Question 157

A 12-year old girl is complaining of nausea and vomitng when going on fight longer than 1 hour. Which of the following vomitng treatments is the best choice in her conditon?
A. Ginger
B. Ondansetron
C. Granisetron
D. Diphenhydramine

Answer 157

D. Diphenhydramine

Question 158

A 1-month-old boy presented to the Emergency Room with history of forceful, nonbilious vomitng. The mother is very concerned as he is her frst baby and was delivered by caesarean secton. He has no fever or diarrhea but seems hungry all the tme despite her best eforts feeding him. On examinaton, he looks dehydrated and his weight did not change in comparison to his birthweight. His abdominal palpaton revealed an olive on the right upper quadrant. Which of the following is the most appropriate immediate next step in the management?
A. Upper GI series
B. Prescribe promethazine
C. Abdominal ultrasonography
D. Correcton of dehydraton and electrolyte imbalance

Answer 158

D. Correcton of dehydraton and electrolyte imbalance

Question 159

A 2-year-old boy with Down syndrome is brought to the clinic afer his mother notced that his eyes are turning in. Which of the following is the most appropriate method to screen for strabismus?
A. Red Refex
B. Cover test
C. Visual Acuity
D. Corneal light refex

Answer 159

D. Corneal light refex

Question 160

Which of the following is the most appropriate age to do Red refex test?
A. All ages
B. 3-4 years
C. Pre-school at age 6
D. 6 months untl cooperatve for vision testng

Answer 160

A. All ages

Question 161

A 3-month-old girl is hospitalized for confrmed pertussis infecton. She is started on macrolide therapy. She has 2 other siblings at home, 3 and 5 years old who are both up to date for their vaccinatons. Which of the following is the most appropriate recommendaton for her asymptomatc sibling?
A. Immediate booster vaccine with DaP
B. Start chemoprophylactc therapy with macrolide
C. Close observaton for signs and symptoms of pertussis
D. Booster vaccine with DTaP if they are from high risk group

Answer 161

B. Start chemoprophylactc therapy with macrolide

Question 162

A 6-month-old boy presents to the Well Baby Clinic for the 6-month vaccinaton. The mother states that he has developed febrile seizure with his last DTaP vaccine. Which of the following is the best answer to the mother concerns?
A. Delay the vaccinaton untl he is 18 month old
B. Febrile seizure is true contraindicaton to DaP vaccinaton
C. He has to have the vaccine regardless of the adverse reactons
D. Febrile seizure does not have long-term sequelae and is not contraindicaton for subsequent vaccines

Answer 162

D. Febrile seizure does not have long-term sequelae and is not contraindicaton for subsequent vaccines

Question 163

A 6-month-old boy presents to the Well Baby Clinic for the 6-month vaccinaton. The mother states that he has developed fever of 41 “C with his last DTaP vaccine. Which of the following is the best answer for the mother concern?
A. Delay the vaccinatons untl he become 18 month old
B. This is a very high fever and he should not have subsequent DaP vaccines
C. Fever is not contraindicaton for subsequent vaccines as long as it is not associated with seizure
D. High fever does not have any long term sequelae and is not contraindicaton for subsequent vaccines

Answer 163

D. High fever does not have any long term sequelae and is not contraindicaton for subsequent vaccines

Question 164

Which of the following is an absolute contraindicaton to DTaP vaccinaton?
A. Seizure
B. Hypotonic-hyporesponsive episodes
C. Prolonged sever crying for 3 hours or more
D. Encephalopathy occurring within 7 days of previous dose not atributed to another cause

Answer 164

D. Encephalopathy occurring within 7 days of previous dose not atributed to another cause

Question 165

A 3-month-old girl presented to the Emergency Room with symptoms of paroxysmal episodes of cough followed by whooping sound at the end. It is occasionally associated with perioral cyanosis and post- tussive vomitng. These symptoms have goten worse when started to have fever of 39.5° C. History revealed she did not receive her 2-month vaccine. Which of the following is the most common expected complicaton?
A. Pneumonia
B. Dehydraton
C. Otts media
D. Pneumothorax

Answer 165

A. Pneumonia

Question 166

A 3-month-old girl presented to the Emergency Room with symptoms of paroxysmal episodes of cough followed by whooping sound at the end. It is occasionally associated with perioral cyanosis and post- tussive vomitng. History revealed that she did not receive her 2-month vaccine. Her mother has already given her 2 doses of antmicrobial treatment. What is the gold standard method to diagnose this conditon?
A. Blood culture
B. Serologic testng
C. Respiratory culture
D. Nasopharyngeal polymerase chain reacton

Answer 166

D. Nasopharyngeal polymerase chain reacton

Question 167

A 3-month-old boy presented to the Emergency Room with history paroxysmal episodes of cough followed by whoopi sounds at the end of each episode. It is associated with perioral cyanosis and post- tussive vomitng. There is no history of diarrhea. This illness has been preceded by runny nose a few days
ago. History revealed he did not receive his 2-month vaccine yet. On examinaton, the child looks unwell and tachypneic. Which of the following is the most likely diagnosis?
A. Pertussis
B. Adenovirus pneumonia
C. Mycoplasma pneumonia
D. Chiamydia trachomats pneumonia

Answer 167

A. Pertussis

Question 169

A 3-month-old boy presented to the Emergency Room with history paroxysmal episodes of cough associated with an inspiratory whoop and possessive emesis. It is associated with fever, conjunctval redness and diarrhea. His immunizaton is up to date. Which of the following is the most likely diagnosis?
A. Pertussis
B. Adenovirus infecton
C. Mycoplasma pneumonia
D. Chlamydia trachomats pneumonia

Answer 169

B. Adenovirus infecton

Question 170

A 9-month-old boy presents to the clinic with skin rash notced by his parent over the past few weeks. His parents are known to have eczema before. Which of the following is the typical site of eczematous plaques at this age?
A. Upper back
B. Diaper area
C. Dorsum of the feet
D. Scalp, cheeks, and forehead

Answer 170

D. Scalp, cheeks, and forehead

Question 171

An 8-year-old boy presents to the clinic with skin rash notced by his parent over the past few weeks. His parents are known to have eczema before. Which of the following is the typical site of eczematous plaques at this age?
A. Upper back
B. Dorsal feet
C. Flexural surface
D. Scalp, cheeks and forehead

Answer 171

C. Flexural surface

Question 172

A 14-year-old boy presents to the clinic with skin rash notced by his parent over the past few weeks. His parents are known to have eczema before. Which of the following is the typical site of eczematous plaques at this age?
A. Popliteal fossa
B. Perioral region
C. Antecubital fossa

Answer 172

B. Perioral region

Question 173

A 6-years-old boy who has been treated since infancy for eczema is coming now to be evaluated for honey-colored crusted lesion in antecubital skin area bilaterally. He has no fever but skin infecton is suspected. Which of the following is the most likely cause of the skin infecton?
A. Coxsackie virus
B. Herpes simplex virus
C. Staphylococcus aureus
D. Group A streptococcus

Answer 173

C. Staphylococcus aureus

Question 174

A 6-year-old boy who has been treated since infancy for eczema is coming now to be evaluated for severely itching umbilicated vesico pustular skin rash that is grouped in “clusters of grapes* appearance overlying difuse eczematous plaques. A superimposed skin infecton is suspected. Which of the following is the most likely etology?
A. Coxsackie virus
B. Herpes simplex virus
C. Staphylococcus aureus
D. Group A streptococcus

Answer 174

B. Herpes simplex virus

Question 175

A 5-year-old boy who has been treated for eczema with increasing strength of topical steroid is presentng with worsening eczematous plaques on feural surfaces of his elbows and knees. Which of the following is the best next step in the management?
A. Consider another diagnosis
B. Switch to topical calcineurin inhibitors
C. Referral to dermatologist to start narrow-band UV-B phototherapy
D. Inquire about parent compliance with the treatment and answer their concerns

Answer 175

D. Inquire about parent compliance with the treatment and answer their concerns

Question 176

A 10-year-old girl presented to the clinic with pruritc, eczematous plaques over her fexural region and xerosis. Good bathing practce and adequate hydraton are recommended to the patent. Which of the following is considered a good bathing practce recommendaton?
A. Emollients are not important afer good prolonged bathing
B. Olive oil is superior to coconut oil in decreasing severity
C. Using strong soap cleansers is more efectve than non-soap cleansers
D. Emollient choice is highly dependent on provider and patent predilecton

Answer 176

D. Emollient choice is highly dependent on provider and patent predilecton

Question 177

A 5-year-old boy presents to the clinic with pruritc, eczematous plaques over his fexural region and xerosis. Good bathing practce and adequate hydraton are recommended to the patent. Which of the following is considered a good bathing practce recommendaton?
A. Using non-soap cleansers is preferred to avoid irritaton
B. Emollients are not important afer good prolonged bathing
C. Lotons have been proven to be more efectve than creams
D. Olive oil is superior to coconut oil in decreasing severity

Answer 177

A. Using non-soap cleansers is preferred to avoid irritaton

Question 178

A 9-year-old boy presented to the Emergency Room with severe abdominal pain for 8 hours. Which of the following is the most common surgical emergency in such patent?
A. Appendicits
B. Cholecystts
C. Intussuscepton
D. Perforated ulcer

Answer 178

A. Appendicits

Question 179

An 8-year-old girl presented to the Emergency Room with severe abdominal pain for the last 6 hours. The pain is constant and not relieved by acetaminophen. She cannot stand up straight because of the pain. Physical Examinaton reveals a mild grade fever with severe abdominal tenderness over the right lower quadrant and rebound tenderness Which of the following imaging study is the most appropriate to confrm the diagnosis?
A. CT abdomen
B. US abdomen
C. MRI abdomen
D. Magnetc resonance cholangiopancreatography

Answer 179

A. CT abdomen

Question 180

A 2-year-old girl presented to the Emergency Room with intermitent, severe abdominal pain and unusual appearance of her stool “currant jelly”. On examinaton, she looks well and alert with sausage-shaped abdominal mass. Which of the following is the diagnostc method of choice in this conditon?
A. CT abdomen
B. MRI abdomen
C. Contrast enema
D. Ultrasound abdomen

Answer 180

D. Ultrasound abdomen

Question 181

A 2-year-old girl presented to the Emergency Room with intermitent, severe abdominal pain and unusual appearance of her stool “currant jelly*. On examinaton, she looks well and alert with sausage-shaped abdominal mass. Ultrasound abdomen revealed “target-shaped” fnding. Which of the following is the best opton in treatment?
A. Emergency surgical correcton B. Keep her NPO and start total parental nutriton
C. Warmed saline enemas under ultrasound visualizaton
D. Insert nasogastric tube to gravity drain and keep her NPO

Answer 181

C. Warmed saline enemas under ultrasound visualizaton

Question 182

A 3-year-old boy presents to the Emergency Room for the second tme with non-resolving high- grade fever (39.5 °C). Fever has started 6 days ago and was prescribed antpyretc, which did not help much in relieving the fever. Instead, He has developed bilateral non-exudatve conjunctvits. His immunizatons are up-to-date. On examinaton, he has difusely erythematous oropharynx, red cracked lips, and a strawberry tongue. He has non-exudatve congested throat with cervical lymph node that measure around 1.5 cm. Which of the following is the most likely diagnosis?
A. Mumps
B. Measles
C. Enterovirus
D. Kawasaki disease

Answer 182

D. Kawasaki disease

Question 183

A 3-year-old boy presents to the Emergency Room for the second tme with non-resolving high- grade fever (39.5 °C). Fever has started 6 days ago and was prescribed antpyretc when he was evaluated initally 3 days ago. However, Antpyretc did not help much in relieving the fever. Instead, He has developed develop bilateral non-exudatve conjunctvits. His immunizatons are up-to-date. On examinaton, he has difusely erythematous oropharynx, red cracked lips, and a strawberry tongue. He
has non-exudatve congested throat with cervical lymph node that measured around 1.5 cm. IVIG is ordered. Which of the following may indicate a poor response to IVIG in such patent? A. Anemia
B. Neutropenia
C. Elevated CRP
D. Hypernatremia

Answer 183

C. Elevated CRP

Question 184

A 4-year-old boy is diagnosed with Kawasaki Disease on day 8 of illness. He is admited to the hospital for further management. Which of the following is the most appropriate inital treatment regimen?
A. Aspirin and IVIG
B. Aspirin and IV cortcosteroid
C. IVIG and cyclosporine
D. Aspirin and infiximab

Answer 184

A. Aspirin and IVIG

Question 185

A 4-year-old boy is diagnosed with Kawasaki Disease on day 6 of illness. He is admited to the hospital for further management. He has received aspirin and IVIG without any complicatons. His fever has subsided and his conjunctvits has signifcantly improved. Which of the following modalites is the best to evaluate his coronary arteries?
A. Echocardiography
B. Cardiac catheterizaton
C. Magnetc resonance angiography
D. Computed tomographic angiography

Answer 185

A. Echocardiography

Question 186

A 4-year-old boy presented to the clinic with history of decreased appette and actvity over the past month. He lost signifcant weight since his last outpatent visit. Which of the following is the most common cause of cancer in such patent?
A. Leukemia
B. Lymphoma
C. Neuroblastoma
D. Retnoblastoma

Answer 186

A. Leukemia

Question 187

A 4-year-old girl is brought to the clinic because her mother had felt a mass in the abdomen last night when she was bathing her. She has been otherwise well with no weight loss, fever, or bone pain. Her blood pressure is 130/80 mmH. Physical examinaton shows a well-thriving kidwith a palpable frm mass in the right fank (see lab results). Test Result Normal Values Color Clear clear or light yellow Appearance Clear clear рн 6.5 4.3-8 Specifc gravity 1020 1001-1030 Protein trace Absent Glucose absent Absent Ketones absent Absent Urobilinogen absent No more than 6 mg/day Nitrite absent Absent Erythrocytes 40 0-2 per high power feld Hemoglobin +3 Absent which of the following is the most likely diagnosis?
A. Leukemia
B. Lymphoma
C. Wilms tumour
D. Neuroblastoma

Answer 187

C. Wilms tumour

Question 188

A 4-year-old girl is brought to the clinic because her mother had felt a mass in the abdomen last night when she was bathing her. She has been otherwise well with no weight loss, fever, or bone pain. Her blood pressure is 130/80 mmH. Physical examinaton shows a well-thriving kid with a palpable frm mass in the right fank (see lab results). Test Result Normal Values Color Clear clear or light yellow pH 7.0 4.3-8 Specifc gravity 1010 1001-1030 Protein Absent Absent Glucose Absent Absent Ketones Absent Absent Nitrite Absent Absent Hemoglobin +*+ Absent Leukocytes Absent 0-3 per high power feld Erythrocytes 50 0-2 per high power feld Which of the following is the most appropriate next step in her diagnostc work-up?
A. Plain abdominal radiography
B. Abdominal computed tomography
C. Abdominal magnetc resonance imaging
D. Plain abdominal radiography and abdominal ultrasonography

Answer 188

D. Plain abdominal radiography and abdominal ultrasonography

Question 189

A 2-month-old girl brought to the Well Baby Clinic. On examinaton, she has absent red refex in her lef eye. She is otherwise healthy and growing well with no concerns from her parents. Which of the following is the most appropriate next step evaluaton?
A. CT of the brain and orbits
B. MRI of the brain and orbits
C. Reassurance of the parent as this is a normal variaton
D. Dilated eye examinaton under sedaton by an ophthalmologist

Answer 189

D. Dilated eye examinaton under sedaton by an ophthalmologist

Question 190

A 2-month-old girl brought to the Well Baby Clinic. On examinaton, she has absent red refex in her lef eye. She is otherwise healthy and growing well with no concerns from her parents. Which of the following is the most likely tumour in such patent?
A. Fibrosarcoma
B. Retnoblastoma
C. Teratoma
D. Sof tssue sarcoma

Answer 190

B. Retnoblastoma

Question 191

A healthy 8-month-old circumcised boy brought to the clinic by his parents with history of fever since morning. He has not had nasal congeston, cough, or diarrhea. He had 1 episode of emesis when he was given acetaminophen. He has contnued to breasteed and has had a normal number of wet diapers. He is mildly ill appearing. There is no clear focus of infecton on examinaton. Temperature 39.4 °C
which of the following factors is most strongly associated with an increased probability of having a urinary tract infecton?
A. Being male
B. Episode of vomitng
C. Temperature of 39.4°C
D. Duraton of the fever

Answer 191

C. Temperature of 39.4°C

Question 192

A healthy 3-month-old uncircumcised boy brought to the clinic by his parents with history of fever since morning. He has not had nasal congeston, cough, or diarrhea. He had 1 episode of emesis when he was given acetaminophen. He has contnued to breasteed and has had a normal number of wet diapers. He is mildly ill appearing. There is no discernible focus of infecton on examinaton. Temperature 38.4 °C Which of the following factors is most strongly associated with an increased probability of having a urinary tract infecton?
A. Being male
B. Duraton of fever
C. Being uncircumcised
D. Temperature of 38.4°C

Answer 192

C. Being uncircumcised

Question 193

A 4-month-old uncircumcised boy brought to the Emergency Department with a 2-day history of fever. He has not had vomitng, diarrhea, cough, or nasal congeston. There has been no known contact with ill persons. He has contnued to breasteed and has not had a decrease in the number wet diapers. He is mildly ill appearing but alert and interactve. Examinaton shows no focus of infecton. A bag urine sample is collected and sent for urinalysis (see lab results). Temperature 39.1 °C Test Result Normal Values Color light yellow clear or light yellow pH 8 4.3-8 Specifc gravity 1030 1001-1030 Protein Absent Absent Glucose Absent Absent Ketones Absent Absent Nitrite Positve Absent Leukocytes 11 0-3 per high power feld Which of the following results of urinalysis would increase the probability of having a urinary tract infecton?
A. Nitrite
B. Urine pH
C. Leukocytes
D. Specifc gravity

Answer 193

A. Nitrite

Question 194

A 3-month-old boy presented history of fever for the last 2 days. On examinaton, he is circumcised and has no focus of infecton. Urine sample obtained by bladder catheterizaton is performed. He was started on oral trimethoprim-sulfamethoxazole. Afer being at home, his mother is called and states that he is back to his normal actvity with no more fevers. The mother is advised to have him complete the 10-day course of trimethoprim-sulfamethoxazole (see report)
Urine culture: Grows 80,000 colony-forming units (FU) per milliliter of Escherichia coli that is susceptble to trimethoprim-sulfamethoxazole. Which of the following is the most appropriate next step in management?
A. Renal ultrasonography
B. Voiding cystourethrogram
C. No further imaging or treatment is indicated
D. Antbiotc prophylaxis with trimethoprim-sulfamethaxole untl 2 years of age

Answer 194

A. Renal ultrasonography

Question 195

A previously healthy 4-month-old uncircumcised boy is brought to the Emergency Department with a 2-day history of fever. He has not had vomitng, diarrhea, cough, or nasal congeston. There has been no known contact with ill persons. He has contnued to breasteed and has not had a decrease in the number wet diapers. He is mildly ill appearing but alert and interactve. Examinaton shows no focus of infecton. Urinary catheterizaton is performed (see lab results). Temperature 39.1 °C Test Result Normal Values pH 7.5 4.3-8 Specifc gravity 1010 1001-1030 Protein Absent Absent Glucose Absent Absent Ketones Absent Absent Nitrite Positve Absent Leukocytes 30-40 0-3 per high power feld Erythrocytes 5-10 0-2 per high power feld which of the following is the most appropriate empirical therapy? A. Oral cephalexin
B. Oral azithromycin
C. Intravenous cefepime
D. Intravenous cefriaxone

Answer 195

A. Oral cephalexin

Question 196

Which of the following is the most suggestve of hemolysis as a cause for neonatal hyperbilirubinemia?
A. Low retculocyte count
B. Negatve direct Coombs test result
C. Increased conjugated bilirubin level
D. Increased unconjugated bilirubin level

Answer 196

C. Increased conjugated bilirubin level

Question 197

A 3-week-old boy is brought to the Emergency Department because of fever, poor feeding, watery stools. and abdominal distenton. He was a product of a full-term pregnancy with normal spontaneous vaginal delivery. He has history of intrauterine growth restricton. He has full sepsis and meningits workup which came back to be negatve. Which of the following features is associated with a lower risk for developing necrotzing enterocolits?
A. Being male gender
B. Being full-term baby
C. Age less than 4 weeks
D. Negatve sepsis and meningits work up

Answer 197

B. Being full-term baby

Question 198

A male neonate born by cesarean secton at 31 weeks’ gestaton with birth weight 1300g. He has developed apnea, high gastric residual levels, and bloody stools. Necrotzing enterocolits is suspected. which of the following features is associated with a higher risk for developing necrotzing enterocolits?
A. Male gender
B. Bloody stool
C. Cesarean secton delivery
D. Birth weight of less than 1500g

Answer 198

D. Birth weight of less than 1500g

Question 199

A 4-month-old girl with unilateral purulent efusion, decreased tympanic membrane mobility with pneumatc otoscopy, no fever, and no other symptoms. She is breasteeding very well and does not use pacifer. She has no recent history of infectons. Which of the following is the best next step in management?
A. Start amoxicillin treatment
B. Start amoxicillin-clavulanate
C. Observe with follow-up in 48hr
D. ENT referral for evaluaton of tympanostomy tubes

Answer 199

A. Start amoxicillin treatment

Question 200

A 19-month-old boy presented to the clinic with right lower eyelid swelling, erythema, and tenderness for 1 day. He has fever reaching up to 38.5° C with decreased appette and actvity. He was given diphenhydramine without any improvement of the eyelid swelling. His parent denied any visual disturbances, diplopia or any other swelling. Which of the following is the most likely diagnosis?
A. Cellulits
B. Hypoproteinemia
C. Allergic reactons
D. Subperiosteal hematomas

Answer 200

A. Cellulits

Question 201

A previously healthy 13-month-old girl has 2-day history of fever and increasing cough. She contnued to be breasted with no vomitng. Her immunizatons are up to date. She is alert and mildly ill appearing. On examinaton, there is no gruntng or chest retractons. There are crackles heard over the right lung base. The remainder of the examinaton fndings are normal. She has no known allergies. Blood pressure 110/70 mmHg Heart rate 146 /min Respiratory rate 45 /min Temperature 38.6 °C Oxygen saturaton 95 % Which of the following is the most likely pathogen?
A. Moraxella catarrhalis
B. Mycoplasma pneumonia
C. Streptococcus pneumonia
D. Haemophilus infuenza type B

Answer 201

C. Streptococcus pneumonia

Question 202

A 7-year-old girl is complaining of sore throat for the last 2 days. Today, she has developed fever of 38.7 °C when measured at home, which has been relieved by acetaminophen. On examinaton, she was found to have tender anterior cervical adenopathy and pharyngeal and tonsillar exudate. The rest of her physical exam is unremarkable. Which of the following is best next step toward diagnosis?
A. Throat culture
B. Echocardiography
C. Rapid antgen detecton test
D. Fine needle aspiraton for cervical adenopathy

Answer 202

C. Rapid antgen detecton test

Question 203

A 13-year-old boy who has palpable lymph node in his neck. One of his close relatves has been diagnosed recently with lymphoma and his family are very worry about it. Which of the following is most suggestve of a malignant rather than an infectous cause of lymphadenopathy?
A. Age of less than 5 years
B. Cervical Lymphadenopathy
C. Duraton of less than 4 weeks
D. Supraclavicular lymphadenopathy

Answer 203

D. Supraclavicular lymphadenopathy

Question 204

An 11-year-old girl brought to the clinic for physical exam because one of her cousins has been diagnosed with lymphoma recently. She is worried about palpable lymph node in her neck. Which of the following lymph nodes locatons would be most concerning for malignancy?
A. Cervical lymphadenopathy
B. Inguinal lymphadenopathy
C. Submandibular lymphadenopathy
D. Supraciavicular lymphadenopathy

Answer 204

D. Supraciavicular lymphadenopathy

Question 205

A 4-year-old girl presented to the clinic with history of fever for last 3 days associated with sore throat and decrease oral intake. She also has difculty in swallowing solid food. On examinaton, she has palpable cervical lymph node that is about 2 cm in size. Which of the following is the most important step in evaluaton?
A. Chest radiograph
B. Lateral neck radiograph
C. Contrast-enhanced CT neck D. Fine needle aspiraton of the lymph node

Answer 205

B. Lateral neck radiograph

Question 206

A 4-year-old girl presented to the clinic with history of fever for last 3 days associated with sore throat and decrease oral intake. She also has difculty in swallowing solid food. Her vaccinaton is up to date. On examinaton, she has palpable cervical lymph node that is about 2 cm in size, tender and fuctuates. Which of the following is the most likely causatve organism?
A. Pneumococcus
B. Streptococcus pyogenes
C. Staphylococcus epidermidis D. Haemophilus infuenzae type B

Answer 206

B. Streptococcus pyogenes

Question 207

A 13-year-old boy who has palpable lymph node in his neck. One of his close relatves has been diagnosed recently with lymphoma and his family is very worry about it. Which of the following may infuence the physician to consider lymph node biopsy?
A. Associated with hepatosplenomegaly
B. Size more than 1 cm
C. Tender on palpaton
D. Absence of fever

Answer 207

A. Associated with hepatosplenomegaly

Question 208

A previously healthy 13-month-old girl comes to the clinic with 2-day history of fever and increasing cough. She contnued to be breasted with no vomitng. Her immunizatons are up to date. She is alert and mildly ill appearing. On examinaton, there is no gruntng or chest retracton. She has crackles heard
over the right lung base. The remainder of the examinaton fndings is normal. She has no known allergies. Bacterial community-acquired pneumonia is suspected. Respiratory rate 36 /min Temperature 38.6 °C Oxygen saturaton 96 % Which of the following would indicate a need for hospitalizaton?
A. Age of 13 month
B. Crackles on auscultaton
C. Respiratory rate of 36 breath per min
D. Inability to maintain hydraton or oral intake

Answer 208

D. Inability to maintain hydraton or oral intake

Question 209

A 7-year-old girl presents to the clinic with fever and skin rash for 1 day. She has also pain and swelling in her both knees and wrists. The family gave a history of fever and sore throat two weeks ago which has been recovered completely. On examinaton, she has pain, swelling and limited movement in both knees and wrists. She has erythema marginatum rash. The remaining exam is unremarkable. She is started on antbiotc and ant-infammatory medicatons. Which of the following is the best next step in management?
A. Echocardiography
B. Musculoskeletal MRI
C. Pulse methylprednisolone
D. Intravenous immunoglobulin

Answer 209

A. Echocardiography

Question 210

A 5-year-old boy is diagnosed with group A streptococcus tonsillits and started on antbiotc treatment. He has a 2-year-old brother who is well and asymptomatc. Which of the following is the best approach for his brother?
A. Observaton
B. Throat culture
C. Start antbiotc treatment
D. Throat swab for rapid antgen detecton test.

Answer 210

A. Observaton

Question 211

A 2-month-old boy is being evaluated in Well Baby Clinic. He is the frst child for a young mother who is concerned about his fussiness and spitng up afer feeds and in between feeds. He is otherwise healthy. His growth parameters are normal. Which of the following is the most likely cause of his conditon?
A. Gastroenterits
B. Eosinophilic esophagits
C. Gastrosophageal refux disease
D. Physiologic gastrosophageal refux

Answer 211

D. Physiologic gastrosophageal refux

Question 212

A 2-month-old boy is being evaluated in Well Baby Clinic. He is the frst child for a young mother who is concerned about his fussiness and spitng up afer feeds and in between feeds. He is taking cow-milk based formula and otherwise healthy. His growth parameters are normal. His physical examinaton is normal What would be your next step in his management?
A. Observaton
B. Pyloric ultrasonography
C. 24-hour impedance pH study test
D. Refux precautons and reassurance

Answer 212

D. Refux precautons and reassurance

Question 213

A 2-month-old boy is being evaluated in Well Baby Clinic. He is the frst child for a young mother who is concerned about his fussiness and spitng up afer feeds and in between feeds. He is taking cow-milk based formula and otherwise healthy. His growth parameters are normal. His physical examinaton is normal. Which of the following is an indicaton for further evaluaton?
A. Male gender
B. Failure to thrive
C. Spitng up while asleep
D. Spitng up between feeds

Answer 213

B. Failure to thrive

Question 214

A 6-year-boy diagnosed previously with gastrosophageal disease. He is on proton pump inhibitor for long tme is complaining of dysphagia and epigastria discomfort. Which of the following is important history clue for Eosinophilic Esophagits?
A. Overweight
B. History of snoring
C. Chewing food excessively
D. Worsening of epigastric pain at night

Answer 214

C. Chewing food excessively

Question 215

Which of the following statements is normal weight gain in infants?
A. Double their birth weight at 10 months
B. Mean weight gain by 10 g/day in the frst 3 month
C. Mean weight gain by 15 g/day in the frst 3 month
D. Mean weight gain by 30 g/day in the frst 3 month

Answer 215

D. Mean weight gain by 30 g/day in the frst 3 month

Question 216

Which of the following is the most appropriate advice to a mother about breasteeding schedule for her full term newborn in the frst year?
A. On demand for frst 4 month
B. On demand every 2-4 hr for frst 2 month
C. On demand 6 tmes per day for frst 2 month
D. On demand 6-8 tmes per day at age 8-12 month

Answer 216

B. On demand every 2-4 hr for frst 2 month

Question 217

A newborn baby boy is born to unbooked 25-year-old mother. The mother has developed febrile illness immediately afer birth but she is otherwise stable. She does not have record for any of the transmissible infectons. She asked if she can breasted her baby. In which of the following conditons breasteeding or expressed breast milk in the immediate postpartum period is acceptable?
A. Breasteeding of HIV mother
B. Expressed breast milk of HIV mother
C. Breasteeding in untreated actve tuberculosis
D. Expressed breast milk of untreated actve tuberculosis

Answer 217

D. Expressed breast milk of untreated actve tuberculosis

Question 218

An 8-year-old boy has been complaining of recurrent abdominal pain for the past several months. Which of the following would prompt an immediate search for an organic explanaton?
A. Pain is around his umbilicus B. It last for more than 10 minutes
C. Occurs primarily around awakening
D. Occurs primarily around sleep tme

Answer 218

B. It last for more than 10 minutes

Question 219

A 7-year-old boy has had frequent periumbilical pain and nausea in the moming. He occasionally vomits. The symptoms started just afer he started going to school. School phobia and separaton anxiety are suspected. Which of the following is the most appropriate in management?
A. Start domperidone
B. Start amitriptyline
C. Keeping the child out of school for at least 3 months
D. Increasing the child’s partcipaton in age-appropriate actvites

Answer 219

D. Increasing the child’s partcipaton in age-appropriate actvites

Question 220

A 13-year-old boy is complaining of recurrent abdominal pain for the last year. The pain takes about 5 to 7 days to improve and it is usually associated increased frequency of stooling. In these occasions, his stool is watery and explosive. No history of vomitng, constpaton or blood passage. Irritable bowel syndrome is suspected. Which of the following is the most appropriate in management?
A. Avoid peppermint oil
B. Avoid lentl ingeston
C. Increase Fruit Ingeston
D. Increase Honey ingeston

Answer 220

B. Avoid lentl ingeston

Question 221

A 4-year-old girl presents with morning limp and swelling of her right knee that has been worsening for the last 2 months. On physical examinaton, she clearly has decreased range of moton as well as swelling and warmth of right knee. She has negatve antnuclear antbody (ANA). When should she be screened for uveits by an ophthalmologist?
A. Every 3 months
B. Every 6 months
C. Every 12 months
D. Not recommended if her ANA is negatve

Answer 221

B. Every 6 months

Question 222

A 4-year-old girl presents with morning limp and swelling of her both knees that has been worsening for the last 2 months. She has no other symptoms. On physical examinaton, she clearly has decreased range of moton as well as swelling and warmth of both knees. She has normal laboratory investgaton except a positve antnuclear antbody (ANA). Juvenile idiopathic arthrits (JIA) suspected. Which of the following is the best classifcaton of her disease?
A. Polyartcular JIA
B. Oligoarthrits JIA
C. Systemic-onset JIA
D. Undiferentated JIA

Answer 222

B. Oligoarthrits JIA

Question 223

A 2-year-old boy brought to the Emergency Room for the second tme with non-resolving high grade fever 39.5 °C. Fever started 6 days ago and was prescribed antpyretc when he was evaluated initally 3 days ago. However, antpyretc did not help much in relieving the fever. Kawasaki disease suspected. Which of the following is one of the fve principal clinical features of Kawasaki disease?
A. Arthrits
B. Myocardits
C. Anterior uveits by slit lamp examinaton
D. Bilateral bulbar conjunctval injecton without exudate

Answer 223

D. Bilateral bulbar conjunctval injecton without exudate

Question 224

A 6-year-old girl presents to the clinic complaining of morning neck stfness and pain in her fngers joints to the degree that she needs help in butoning herself. She has fat erythema over the malar eminences that are sparing the nasolabial folds. One examinaton, she had painless mouth ulcer. On her fnger’s
joints. there is clear swelling and tenderness. Which of the following will make her fulfl 4 of the 11 American College of Rheumatology criteria for the classifcaton of Systemic Lupus Erythematosus?
A. Weight loss
B. Erythema marginatum
C. Positve rheumatoid factor
D. Hemolytc anemia with retculocytosis

Answer 224

D. Hemolytc anemia with retculocytosis

Question 225

A 12-year-old girl diagnosed with systemic lupus erythematosus 10 months ago. She is currently on high doses of immunosuppressive treatment. Her immunizaton status is not known. Which of the following vaccines should be recommended?
A. MMR
B. BCG
C. Varicella
D. Annual Infuenza vaccine

Answer 225

D. Annual Infuenza vaccine

Question 226

A 12-year-old girl who is known to have systemic lupus erythematosus (SLE). Her disease is controlled on immunosuppressive medicaton. She is complaining of mild grade fever and dysuria. Her examinaton is unremarkable. The urinalysis is suggestve of urinary tract infecton. Which of the following should be avoided in her conditon as it may cause SLE fare?
A. Cephalexin
B. Amoxicillin
C. Nitrofurontoin
D. Sulfamethoxazole

Answer 226

D. Sulfamethoxazole

Question 227

Which of the following is not necessary to diagnose Nephrotc Syndrome?
A. Edema
B. Proteinuria
C. Hypertension
D. Low serum albumin

Answer 227

C. Hypertension

Question 228

A 5-year-old boy presented with eye pufness and lower limb edema. He has no fever, vomitng or abdominal pain. His physical examinaton revealed well perfused extremites and lower limb pitng edema. The rest of his exam is unremarkable (see lab results). Color Clear clear or light yellow pH 6 4.3-8 Specifc gravity 1010 1001-1030 Protein ++ Absent Glucose Absent Absent Ketones Absent Absent Nitrite Absent Absent Hemoglobin Absent Absent Leukocytes 0 0-3 per high power feld Erythrocytes 0 0-2 per high power feld Which of the following is the most common cause of nephrotc syndrome in such patent?
A. Finish type
B. Minimal change disease
C. Membranous nephropathy
D. Focal segmental glomeruloscierosis

Answer 228

B. Minimal change disease

Question 229

A 5-year-old boy who is known to have nephrotc syndrome presents to the clinic with severe abdominal pain and distenton. He has omited once a clear stomach content of his last meal. No diarrhea or constpaton. Which of the following this patent is at higher risk to have?
A. Hepatts
B. Gastrits
C. Peritonits
D. Appendicits

Answer 229

C. Peritonits

Question 230

A 5-year-old boy presented with eye pufness and lower limb edema. He has no fever, vomitng or abdominal pain. His physical examinaton revealed well-perfused extremites and lower limb pitng edema. The rest of his exam is unremarkable. His laboratory testng confrmed the diagnosis of nephrotc syndrome. Afer startng him on treatment, which of the following defnes complete remission?
A. Normal serum albumin
B. Complete resoluton of his edema
C. Urine dipstck negatve or trace reading for 3 consecutve days
D. Urine dipstck negatve or trace reading for 5 consecutve days

Answer 230

C. Urine dipstck negatve or trace reading for 3 consecutve days

Question 231

A 5-year-old boy presented with eye pufness and lower limb edema. He has no fever, vomitng or abdominal pain. His physical examinaton revealed well-perfused extremites and lower limb pitng edema. The rest of his exam is unremarkable. His laboratory testng confrmed the diagnosis of nephrotc syndrome. He is started on steroid treatment. Which of the following used to defne steroid resistant nephrotc syndrome?
A. Inability to induce a remission within 4 weeks of daily steroid therapy
B. Inability to induce a remission within 4 month of daily steroid therapy
C. Inability to induce a remission within 12 days of daily steroid therapy
D. Inability to induce a remission within 12 weeks of daily steroid therapy

Answer 231

A. Inability to induce a remission within 4 weeks of daily steroid therapy

Question 232

A 5-year-old boy presented with eye pufness and lower limb edema. He has no fever, vomitng or abdominal pain. His physical examinaton revealed well-perfused extremites and lower limb pitng edema. The rest of his exam is unremarkable. His laboratory testng confrmed the diagnosis of nephrotc syndrome. Which of the following is the frst line of treatment in this patent?
A. Rituximab
B. Prednisone
C. Cyclosporine
D. Cyclophosphamide

Answer 232

B. Prednisone

Question 233

A 2-week-old neonate is brought by his mother with complains of poor oral intake for the last 2 days. On examinaton, he has oral thrush and diaper dermatts. Which of the following is the most applicable management?
A. Oral ant-fungal for 7 days
B. Topical ant-fungal for 5 days
C. Systemic ant-fungal for 5 days
D. Oral and topical ant-fungal for 5 days

Answer 233

B. Topical ant-fungal for 5 days

Question 234

A 3-day-old neonate start to develop skin lesions look like erythematous macules on an erythematous base, over the upper chest and the back (see lab results).
Blood pressure 85/55 mmHg Heart rate 110 /min Respiratory rate 18 /min Temperature 36.6 °C Oxygen saturaton 99 % Test Result Normal Values RBC 5 4.8-7.1 x 1012/L (Newbor) 4.6-4.8 x 1012/L (Child) Hb 145 165-195 g/L (Newborn) 112-165 g/L (Child) Platelets count 250 150-400 x 109/L WBC 9 9.1-30.1 x 109/L (Birth) 6.1-17.5 x 109/L (1-23 months) Which of the following is the best management approach?
A. Topical antbiotcs for 5 days
B. Consult dermatology for skin biopsy
C. Reassurance as it is a benign conditon
D. Full sepsis work up and oral antbiotcs for 7 days

Answer 234

C. Reassurance as it is a benign conditon

Question 235

Which of the following is the most causatve factor for retnopathy of prematurity?
A. Acidosis
B. Hyperoxemia
C. Apnea of prematurity
D. Gram negatve sepsis

Answer 235

B. Hyperoxemia

Question 236

A 4-month-old infant is brought to Emergency Room with complain of excessive sweatng, pallor and altered level of conscious. The mother said he is not eatng normally for the last 2 days and has recurrent vomitng (see lab results). Test Result Normal Values Blood urea nitrogen 2 0.7-6.7 mmol/L. (Newborn) 1.8 to 6.4 mmol/L (Child) Creatnine 34 27-88 mol/L (Newborn) 27-62 pmol/L (Child) Glucose 1.8 2.8-5 mmol/L (Newborn) 3.3 -5.5 mmol/L (Child) Which of the following is the best inital management?
A. Intravenous infusion of glucose 2 ml/kg of 10% dextrose
B. Intravenous infusion of glucose 2 mi/kg of 12.5% dextrose
C. Intravenous infusion of glucose 4 ml/kg of 12.5% dextrose
D. Intravenous infusion of glucose 10 ml/kg of 10% dextrose

Answer 236

A. Intravenous infusion of glucose 2 ml/kg of 10% dextrose

Question 237

A 2-month-old infant presented to the clinic with history of prolonged jaundice, constpaton, large tongue and motled dry skin. There is a positve family history of autoimmune disease (see lab results). Test Result Normal Values ACTH 10 2-11 pmol/L Insulin fastng 15 10-104 pmol/L Thyroid stmulatng hormone 22 1-25m IU/L (1-4 days)
1.7-9 mlU/L (2-20 weeks) 0.7-6.4 mlU/L (21 weeks-14 years) Thyroxine T4 (serum) 55 125-215 mol/L (1-3 days) 100-200 mol/L (1-12 months) 94-193 nmol/L (1-5 years) 80-150 mol/L (5-15 years) Triodothyronine T3 0.6 1.54-11.4 mol/L (1-3 days) 1.6-4 nmol/L (1-12 months) 1.2-3.2 mol/L (1-5 years) 1.2-3.2 mol/L (5-15 years) Which of the following is the most appropriate step in management?
A. Oral thyroxine for 1 month
B. Life-long thyroxine replacement
C. Repeat the blood test afer 1 month
D. Prednisolone replacement for 6 weeks

Answer 237

B. Life-long thyroxine replacement

Question 238

A 9-year-old boy presented with history of recurrent vomitng, lethargy, brown pigmentaton of gum and skin crease with growth failure (see lab results). Test Result Normal Values Sodium 130 134-146 mmol/L Potassium 6 3.5-5.1 mmol/L Calcium total 3 2.2-2.7 mmol/L Blood urea nitrogen 11 0.7-6.7 mmol/L (Newborn) 1.8 to 6.4 mmol/L (Child) Creatnine 80 27-88 mol/L (Newborn) 27-62 mol/L (Child) Prolactn 800 < 652 pmol/L (Male) < 870 pmol/L (Female) Cortsol 8 a,m. 66 138-635 mol/L which of the following is the best management opton?
A. Daily hydrocotrisone
B. Daily thyroxine
C. Daily vitamin D
D. Daily vitamin B6

Answer 238

A. Daily hydrocotrisone

Question 239

An 8-year-old child presented to Emergency Room with constpaton, anorexia, lethargy and behavioural abnormality. Bony erosion of the phalanges was seen on wrist radiography (see lab results). Test Result Normal Values Blood urea nitrogen 3.2 0.7-6.7 mmol/L. (Newborn) 1.8 to 6.4 mmol/L. (Child) Creatnine 45 27-88 umol/L. (Newborn) 27-62 umol/L (Child) Glucose 4 2.8-5 mmol/L (Newborn) 3.3 -5.5 mmol/L (Child) Alkaline phosphatase 200 150-420 U/L (Infant) 100-320 U/L (Child) Parathyroid hormone (Intact PTH levels) 6.2 1.1-5.3 pmol/L Parathyroid hormone (N-terminal fracton) 3.1 0.8-2.5 pmol/L Parathyroid hormone (C-terminal fracton) 11 0-35.8 pmol/L Calcium total 5.3 2.2-2.7 mmol/L Phosphate 1.2 1.3-2.3 mol/L
Magnesium 0.9 0.7-1.0 mol/L Which of the following is the best management approach?
A. Rehydraton and statns
B. Diuretcs and rehydraton
C. Bisphosphonates, diuretcs and statns
D. Rehydraton, diuretcs and bisphosphonates

Answer 239

D. Rehydraton, diuretcs and bisphosphonates

Question 240

Which of the following is the most appropriate approach to manage nutritonal rickets?
A. Daily administraton of vitamin D1
B. Daily administraton of vitamin D2
C. Daily administraton of vitamin D3
D. Daily administraton of vitamin D4

Answer 240

C. Daily administraton of vitamin D3

Question 241

A 3-year-old child presented with fever, headache, difculty swallowing and throat pain. On examinaton, there is intense infammaton of the tonsils with purulent exudate that is more membranous in appearance. Blood pressure 110/70 mmHg Heart rate 150 /min Respiratory rate 28 /min Temperature 38.8 °C Oxygen saturaton 96 % Which of the following is the most likely causatve organism?
A. Corona virus
B. Infuenza virus
C. Epstein barr virus
D. Respiratory syncytal virus

Answer 241

C. Epstein barr virus

Question 242

A 7-month-old baby presented to the clinic with history of fever, irritability and disturb sleeping for 2 days. Ear examinaton showed perforaton of the eardrum with pus visible in the external canal. Blood pressure 110/70 mmHg Heart rate 115 /min Respiratory rate 22 /min Temperature 38.8 °C Oxygen saturaton 97 % Which of the following is the most likely diagnosis?
A. Acute otts media
B. Serious otts media
C. Chronic otts media
D. Otts media with efusion

Answer 242

A. Acute otts media

Question 243

A 7-month-old baby presented to the clinic with history of fever, irritability and disturb sleeping for 2 days. Ear examinaton showed perforaton of the eardrum with pus visible in the external canal. Blood pressure 110/70 mmg Heart rate 115 /min Respiratory rate 24 /min Temperature 39 °C Oxygen saturaton 97 % Which of the following is the most common causatve organism?
A. Rotavirus
B. Rhinovirus
C. Adenovirus
D. Coronavirus

Answer 243

B. Rhinovirus

Question 244

Which of the following asthmatc patents require hospital admission?
A. Heart rate more than 120 PPM
B. Whenever presented in acute atack
C. Afer 3 presentaton to emergency room
D. Oxygen saturaton below 92% afer high dose therapy

Answer 244

D. Oxygen saturaton below 92% afer high dose therapy

Question 245

A 4-year-old child presented with recurrent chest infecton and poor growth. On examinaton, chest auscultaton revealed inspiratory crepitaton with expiratory wheeze and fnger clubbing. Further exploraton in the history revealed the presence of very ofensive and greasy stools. Which of the following is expected to be further identfed in the physical examinaton?
A. Nasal polyp
B. Gynecomasta
C. Inguinal hernia
D. Small joint swelling

Answer 245

A. Nasal polyp

Question 246

A 3-year-old child presented to Emergency Room with complains of fever, headache and lethargy. On examinaton, clear purpuric rash, sign of shock and positve Kernig sign present. Eye exam revealed the presence of papilledema. The parents are bedside and worried about child conditon and prognosis. Which of the following complicaton is important for the parents?
A. Vision loss
B. Hearing loss
C. Renal failure
D. Retnal haemorrhage

Answer 246

B. Hearing loss

Question 247

A 4-year-old child presented with itchy and scratching skin lesions that started on head and trunk then progress to peripheries. On examinaton, he was febrile with skin lesions appear as crops of papules, vesicles with surrounding erythema. The mother gave history of similar incident happen last week in his school. The parents are worried since there is an immunodefcient child at home. What would be the best acton plan to protect the immunodefcient kid?
A. Avoid skin contact
B. It is a self-limitng disease with no risk
C. Oral antviral therapy for the immunodefcient child
D. Specifc immunoglobulin for the immunodefcient child

Answer 247

D. Specifc immunoglobulin for the immunodefcient child

Question 248

which of the following represent a fetal complicaton from maternal infecton with Parvovirus B19?
A. Usually asymptomatc
B. May lead to fetal hydrops and death
C. Fetal arrhythmia and limp anomalies
D. Sever fetal skin disease with eye involvement

Answer 248

B. May lead to fetal hydrops and death

Question 249

Newborn with normal physical examinaton. Upon reviewing the history with the mother, she mentoned that she had a daughter died with suspicion of immunodefciency disease. The newborn is to be sent
home and the parents ask about birth vaccines. Which of the following is the most appropriate management plan?
A. Receive Hepatts B vaccine only
B. Receive routne birth vaccines
C. Order the birth vaccines and follow-up with Immunology team
D. Defer vaccines untl full assessment by immunology team

Answer 249

A. Receive Hepatts B vaccine only

Question 250

During counseling an HIV positve mother who is pregnant and had several concerns regarding the outcome of her pregnancy. Her viral load is detectable although she is on treatment. What would be the best advice during counselling the mother?
A. The neonate should not receive any therapy afer delivery
B. She can breasteed normally if she contnued on the therapy
C. She should deliver by cesarean secton to decrease the chance of transmission
D. Therapy during pregnancy will not prevent the transmission of the virus to the baby

Answer 250

C. She should deliver by cesarean secton to decrease the chance of transmission

Question 251

A 3-year-old child presented to Emergency Room with difculty breathing, lip swelling and spreading skin rash. On examinaton, marked airway swelling observed with rash cover all the body. The mother said he was atending a party at his friend’s house and she was not with him Which o of the followings will likely reveals the diagnosis?
A. Family history
B. Social history
C. Allergy history
D. Nutritonal history

Answer 251

C. Allergy history

Question 252

A 4-year-old child presented to Emergency Room with difculty breathing. lip swelling and spreading skin rash. On examinaton, marked airway swelling observed with rash cover all the body. The mother said he was atending a party at his friend house and she was not with him. Which of the following is the most likely diagnosis?
A. Trauma
B. Insect bites
C. Food allergy
D. Drug reacton

Answer 252

C. Food allergy

Question 253

A 2-month-old infant found dead at his bed. According to the mother, he was feeding normally with usual actvity. No history of fever or other abnormality. On examinaton, no sign of trauma or bruises on the skin. Baby gram was negatve for fracture. Which of the following history’s part is important to make the diagnosis?
A. Social history
B. Allergic history
C. Blood transfusion history
D. Materal Medicaton history during pregnancy

Answer 253

A. Social history

Question 254

A 2-month-old infant found dead at his bed. According to the mother, he was feeding normally with usual actvity. No history of fever or other abnormality. On examinaton, no sign of trauma or bruises on the skin. Baby gram was negatve for fracture. Mother is divorced and known smoker. Which of the following is the most likely diagnosis?
A. Child abuse syndrome
B. Maternal smoking syndrome
C. Sudden infant death syndrome
D. Apparent life threatening events

Answer 254

C. Sudden infant death syndrome