Pediatric 5th year 2017

‫ فاستتمرارك فتا القتراءة‬،‫عزيزي القارئ؛ هذا المقطع من الملف بال فائدة لك فانصحك بعدم االستمرار بالقراءة والبدء باالسئلة‬
.‫قد يؤدي لتولّد بعض مشاعر البغض والكره للكاتب حيث تمت كتابة هذه الفقرة ليقرأها أحدهم فتا المستتقبا البعيتد ان لتم يمتت‬
،‫" ففتتا حتتاا امتتت ت حياتتتك وازدحمتتت بالتتذكريات أو أصتتابك متترض ينستتيك بعتتض تفاصتتيا حياتتتك فيتتذه الفقتترة كتتا تتتتذ ّكر‬
،2102 - 2102 ‫ الدفعة التا سكنت وجالت مرافق كلية الطب\جامعة القتدس فتا المتدة الزمنيتة‬،‫ األيام‬،‫كا تتذ ّكر تلك المواقف‬
‫ وال تغرّنتك الستنين‬،‫ ايّتاك وال ّنستيان‬،‫ تطبيالتيم واألهم انقساميم‬،‫ تنمّقاتيم‬،‫ خضوعيم‬،‫ خوفيم‬،‫ جبنيم‬،‫ قبح أقواليم‬،‫سوء أفعاليم‬
" .‫ ال تصالح‬،‫ فصفات المرء ال تتغيّر بمرورها‬،‫يا هذا‬

1- All of the followings are corrects statements in rickets except:

Select one:

a. The earliest sign of rickets is a ping-pong ball sensation of the skull (craniotabes)
b. Children with malabsorptive conditions such as cystic fibrosis, celiac disease and pancreatic
insufficiency can develop rickets
c. Blood tests usually show serum calcium is low or normal, phosphorus high and high plasma
alkaline phosphatase
d. Nutritional rickets still remains the major form of rickets in developing countries
e. The legs may become bowed

2- Which of the following is a liver function test:

Select one:
a. Alkaline phosphatase
b. Prothrombin time
c. Alanine Transferase (ALT).
d. Gama Glutamyl Transferase ( GGT )
e. Direct bilirubin

3- The best clinical sign of Pneumonia is:-

Select one:
a. Dullness to percussion
b. Increased respiratory rate
c. High temperature >39C
d. Crackles over the affected area
e. Chest indrawing
 4- A 4 year old child child presents with fever, vomiting, and shortness of breath on exertion.
Physical exam shows muffled heart sounds, fever, a gallop rhythm, and tachycardia. The
best diagnosis for this child is:

Select one:
a. Myocarditis
b. Costochondritis
c. None of them
d. Pericarditis
e. Mitral valve prolapse

5- Regarding Spherocytosis, one of the following are FALSE:

Select one:
a. Present with jaundice, anemia and splenomegaly
b. Hemoglobin electrophoresis is normal
c. Inherited mainly as autosomal dominant
d. There is defect in spectrin or ankyrin of the RBCs cytoskeleton
e. Stroke one of complications during acute attack

6- Normal anion gap metabolic acidosis can occur in:

Select one:
a. Severe anemia
b. Liver failure
c. Renal failure
d. Starvation ketoacidosis
e. Malignancy

7- The following statements are true concerning the examination of a child with respiratory
symptoms except:

Select one:
a. Babies have higher respiratory rates than older children
b. Auscultation is not reliable in locating the site of consolidation in young children
c. Upper airway sounds in young children can be mistaken for crepitations and rhonchi when
auscultation
d. Wheezing is always present in a child with severe asthma
e. Alar flaring, tachypnea and recessions are all indications of respiratory distress in children
 8- One of The following is true about abdominal examination of young children:

Select one:
a. It is normal to feel the liver 3-4 cm below costal margin in toddlers
b. It is acceptable to examine the abdomen of a child who is standing
c. A protuberant abdomen in a toddler is normal exam finding
d. An enlarged spleen extends towards the left iliac fossa
e. A rectal examination should be always form part of the examination

9- All are true regarding developmental dysplasia of hip (DDH) Except

Select one:
a. There is positive family history in 20% of cases
b. It is associated with breech presentation in 30%.
c. Barlow maneuver will relocate hip (the femoral hip will be pushed in to the acetabulum).
d. There is increased risk in infants with neuromuscular disorders
e. Recognition of DDH early in neonatal period is important as splinting in abduction reduce long
term morbidity.

10- Which of the following accounts for the greatest percentage of calories in skim milk?

Select one:
a. Whey
b. Cholesterol
c. Fat
d. Protein
e. Carbohydrate

11- A normal two year old child would be expected to all of the following except:

Select one:
a. Copy a circle
b. Kick a ball.
c. Drink from a cup
d. Build a tower of 5 blocks
e. Can make simple sentences
 12- A 3 day old 28 week preterm infant has systolic murmur best heard at left sternal border
you except all of the following are other finding in this infant except

Select one:
a. Tachycardia
b. Gallop rhythm
c. Apnea and Bradycardia episodes
d. Low diastolic pressure
e. Hypoactive pericardium

13- All the following skin lesions are considered to be present normally in newborns except:

Select one:
a. Superficial vesiculo‐pustular lesions rupture within 48 hours to leave small pigmented macules
with white surround
b. Bullous impetigo
c. Sharply demarcated blanching down one half of the body – one side of the body red while the
other is pale
d. Nevus flammeaus
e. Small, firm, white or yellow pustules on erythematous base

14- Regarding croup, all are true except:-

Select one:
a. Para influenza viruses are the most common cause
b. Age of presentation is usually between 6m-6y
c. Drooling with high fever and leaning forward is the classical presentation.
d. Symptoms are worst at night
e. It is the term used to describe laryngotracheobronchitis

15- Regarding whooping cough, all are true except:-

Select one:
a. It is a highly contagious infection
b. Vaccination does not give full protection
c. Prophylaxis should be given to contacts
d. Whooping cough is classically present in infants
e. It is characterized by a three phase course
 16- Regarding CMV congenital infection all are true except:

Select one:
a. May be transmitted in human milk or blood transfusion
b. Affected symptomatic patients need to be treated with Val Gancyclovir for 6 months
c. It is the Commonest congenital infection
d. Ventriculo-megaly with microcephaly and periventricular calcification are usually present in most
affected patients
e. It may result from reactivation of infection during pregnancy

17- All of the following are indications for Neuroimaging in a Child with Headaches, except :

Select one:
a. Abnormal neurologic signs
b. Bifrontal pulsating headache
c. child < 6 years whose principal complaint is a headache
d. Early morning headache , progressive in nature
e. Regression in school performance

18- A 2½ year old boy appears with intermittent loose stools for the past 1 month. Stools
typically occur during the day and not overnight. The boy is otherwise healthy. The growth
and development are normal. The most likely diagnosis is:

Select one:
a. Toddler's diarrhea
b. Salmonella enteritis
c. Food allergy
d. Rotavirus enteritis
e. Chronic enteritis

19- All of the following are associated with hypertension in children except

Select one:
a. cushing syndrome
b. acute glomerulonephritis
c. pheochromocytoma
d. coarctation of the aorta
e. minimal change nephrotic syndrome
 20- A cerebrospinal fluid specimen was examined and the following preliminary results were
obtained: Description: 3x 2.4mL, clear Protein: 0.55 g/L, Glucose: 2.9 mmol/L, WCC: 6 x
108 /L, 30% PMN, 70% Monocytes, This report is consistent with:

Select one:
a. a poorly collected specimen
b. an uninfected CSF specimen
c. bacterial meningitis
d. viral meningitis
e. a normal CSF

21- Which of the following is considered an abnormal clinical finding requiring interference
and investigation:-

Select one:
a. vaginal bleeding in a 2 days old girl
b. closed anterior fontanel in a 4-month old infant
c. Head circumference measuring 45cm in a 1 year old child.
d. Blue pigmented areas on the lower back in a newborn
e. Enlarged breast in a newborn boy

22- The preferred therapy for patients with chronic cholestasis without biliary obstruction is:

Select one:
a. Phenytoin
b. Kasai operation
c. Discontinue fatty foods
d. Ursodeoxycholic acid
e. Gentamicin

23- The first step of the management of comatosed child is :-

Select one:
a. To maintain airway, provide oxygen and vascular acces
b. To consult neurosurgeon in head trauma
c. To ask for lab test including CBC, blood sugar, blood gases, and electrolytes
d. to take good history and physical examination.
e. To do Brain CT looking for CNS injury
 24- A 6-month-old boy has chronic diarrhea. Findings include: weight less than the 5th
percentile and length at the 25th percentile for age; marked cachexia with protuberant
abdomen; sodium, 125 mEq/L; chloride, 90 mEq/L; albumin, 2.5 g/dL; and total protein,
4.3 g/dL. Stool is negative for reducing sugars but positive for neutral fats; a 72-hour fecal
fat collection shows a coefficient of absorption of 45% (normal, >93%). These findings are
MOST consistent with:

Select one:
a. Cow milk-soy protein allergy
b. Celiac disease
c. Giardiasis
d. Crohn disease
e. Cystic fibrosis

25- The most common type of tracheo-esophageal fistula

" ‫ طبعا الموست كومن هي االيزوفيجوس االبير سيجمينت مسكرة واللوير سيجمينت ماسكة بالتريكيا‬،‫كان في صورة هون‬
" ‫شوف صورة‬

Select one:
a. A
b. B
c. C
d. D
e. E

26- You are evaluating this 2- year old female in the emergency room with 1 day history of
fever, lethargy and this picture: The best management would be:
‫“ الصورة كانت ل‬meningococcal septicaemia purpuric rash”

Select one:
a. Reassure the parents
b. Send her home on amoxicillin therapy for 1 week
c. Immediate hospitalization for blood culture and i.v ceftriaxone
d. Immediate hospitalization for blood culture and i.v ampicillin
e. Send her home on cefuroxime P.O
 27- In a child with temper tantrums, one of the following is one of standard features of
management:

Select one:
a. Punish the child for bad behavior
b. Avoid tantrums by giving the child what he or she wants
c. Take the child out of the room for a short period of time during the tantrum
d. Tell the mother her child seem to be spoiled
e. Take away all the child’s toys during the tantrum

28- All of the following are problems may occur after cure of childhood cancer except

Select one:
a. secondary malignancy
b. school problems
c. mental retardation
d. growth hormone deficiency from pituitary irradiation
e. nephrectomy after Wilms tumor treatment

29- A stillborn male is delivered at 33 weeks' gestation after a pregnancy complicated by

oligohydramnios. He is noted to have dysmorphic features, including a blunt nose, recessed
chin, micrognathia, large low-set ears, and wrinkled facial skin. In addition, he has flexion
contractures of the knees and talipes equinovares. Of the following, the additional
abnormality that is MOST likely to be identified by postmortem examination is:

Select one:
a. Renal agenesis
b. Complex congenital heart defect
c. Diaphragmatic hernia
d. Hepatosplenomegaly
e. Lissencephaly

30- Recognized extrapulmonary complications of cystic fibrosis include all of the following
Except:
Select one:
a. Hypertrophic osteoarthropathy
b. Rectal prolapse.
c. Glomerulonephritis.
d. Azoospermia.
e. Diabetes mellitus
 31- Regarding management of patients with hyperbilirubinemia with phototherapy one is true

Select one:
a. Bronze discoloration is complication with conjugated hyperbilirubinemia
b. It is not associated with long term complications
c. It can result in hypothermia
d. Phototherapy depends on specific light wavelength that convert bilirubin into conjugated bilirubin
e. The bright light may cause retinal detachment

32- One of The following is correct advices for a mother who wants to breast feed except

Select one:
a. Increase maternal protein and energy intake
b. Place the baby on the breast immediately within 4hours after delivery
c. The infant should be fed every 3-4 hours
d. Have an undisturbed night’s sleep for the first night
e. If mastitis seems to be developing, stop breast feeding

33- All of the following can cause chorea , except :

Select one:
a. Huntington disease
b. Systemic lupus Eyrethematosus
c. Rheumatic fever
d. Hypothyroidism
e. Wilson disease

34- The most common site of pulmonary atelactasis in children is:

Select one:
a. Right upper lobe
b. Right middle lobe
c. Right lower lobe
d. Left upper lobe
d. Left lower lobe
 35- All of the following statements regarding language development are true EXCEPT:

Select one:
a. Deaf children may create their own language
b. The basics for language may be "hard-wired" in the brain
c. Environment and experience have minimal impact on the rate of language development
d. Delayed language may signify deafness
d. Delayed language may signify mental retardation

36- All of the following are true in reading chest radiograph in patient with transient tachypnea
of the newborn (TTN)

Select one:
a. prominent pulmonary vascular markings
b. flat diaphragms
c. fluid in the intralobar fissures
d. Patchy reticulo-granular pattern
d. Hyperinflation

37- All of the following are true regarding Aminoglycosides antibiotics use in pediatrics
EXCEPT

Select one:
a. Co administration with loop diuretics as this may potentiate toxicity
b. Pre dose gentamycin concentration should be checked to prevent excessive concentration that lead
to irreversible ototoxicity
c. Aminoglycosides are effective against anaerobic bacteria
d. An extended dosing interval is used in neonatal population (24-36 hours) to account for very
immature renal function
e. Peak concentration (1 hour post dose) is essential to asses therapeutic effectiveness

38- Hematuria is best defined as :

Select one:
a. The presence of more than 5 RBC per HPF
b. The presence of more than 15 RBC per HPF
c. The presence of gross blood in urine.
d. The presence of any RBC in a freshly voided urine sample.
e. Red color urine
 39- Folic acid deficiency can cause all of the following EXCEPT:

Select one:
a. Chronic diarrhea
b. Thrombocytopenia
c. Hypo segmented neutrophils
d. Reticulocytopenia
e. Macrocytic anemia

40- Renal tubular acidosis (RTA) is characterized by all of the following except:

Select one:
a. Relatively alkaline urine
b. Hyperchloremia.
c. Hyperkalemia in type IV
d. Wide anion gap metabolic acidosis
e. Low to normal serum potassium

41- In physiologic anemia of infancy, one of the following is FALSE:

Select one:
a. In premature infant the decline in hemoglobin is earlier and more severe
b. May be aggravated by folic acid deficiency
c. Occurs as a result of down regulation of erythropoietin production
d. Usually requires blood transfusion
e. Hemoglobin concentration decrease to 9 -11g/dl.

42- A baby undergoes thoracentesis for bilateral pleural effusion. A milky appearing fluid is
drained and sent to the laboratory. Concentrations of which of the following laboratory
markers are expected to be elevated in the fluid drained from this patient?

Select one:
a. Neutrophils.
b. Complements.
c. Cholesterol.
d. Bilirubin.
e. Triglycerides.
 43- an infant with bronchiolitis, the following are true except:-

Select one:
a. Respiratory syncytial virus (RSV) is the most common pathogen
b. Apnea is common in young infants
c. Hyperinflation is seen on a chest X-Ray.
d. IV antibiotics are usually not indicated
d. Active immunization against (RSV) is required for premature infants less than 31 weeks to prevent
bronchiolitis

44- The true statement regarding Bruton disease:-

Select one:
a. Pneumocystis carinii infection (PCP).
b. Early presentation in first months of life
c. Severe fungal and viral infection are characteristic
d. Abnormal cellular immunity
e. It is an X-liked disease.

45- All of the followings are true regarding childhood nutrition except:

Select one:
a. Premature infants have poor stores of fat and protein
b. The optimal nutrition for newborn infants is from breast-feeding
c. At 4 months of age 30% of infant energy intake is used for growth
d. Malnutrition continues as a major cause of morbidity in developing countries
e. The brain grows rapidly after the age of 2 years

46- Eleven months old male presented with pallor, his examination was normal except
tachycardia, his diet mainly consist of whole milk and pureed fruits, his Hb 6.0 gm/dl.
Which one of the following diagnostic test results is most likely?

Select one:
a. Hemoglobin A2 increased
b. Low serum ferritin level
c. Elevated mean corpuscular volume
d. Decreased iron binding capacity
e. Decreased free erythrocyte protoporphyrin
 47- A 10-month-old child presents with a temperature of 42C, Watery diarrhea, and a
generalized seizure . The most likely cause of this syndrome is:

Select one:
a. Salmonella gastroenteritis
b. Shigella gastroenteritis
c. Acromonas gastroenteritis
d. Rota virus infection
e. Rotavirus gastroenteritis

48- Match the items on the right to the items on the left.

Few cases have normal mental Answer 1

development. Neither

Characterized by localized partial Answer 2

scalp defect (partial cutis aplasia). Trisomy 13

Clenched hands, prominent heels Answer 3

and occiput are characteristic Trisomy 18

Recurrence risk for future

pregnancies after having an Answer 4
affected child with this disorder is Trisomy 13&Trisomy 18
≤ 1 %.

49- Skin is a commonly involved organ by SLE. There are different cutaneous manifestations.
All of the following skin manifestation that are suggestive of SLE in children EXCEPT:

Select one:
a. subcutaneous nodules
b. photosensitive rash
c. discoid rash
d. malar rash
e. livedo reticularis
 50- Vaccines are defined as whole or parts of microorganisms administered to prevent an
infectious disease. Which of the following is a live attenuated vaccine?
Select one:
a. hepatitis A
b. hepatitis B
c. pneumococcal
d. Varicella

51- One of the following matching is not correct regarding respiratory distress and causes:
Select one:
a. Anaphylaxis upper airway obsruction
b. Irregular shallow breathing…………..metabolic acidosis
c. Grunting & crepitations………… lung tissue disease
d. Expiratory wheezes……………… lower airway obstruction
e. Inspiratory stridor…………………upper airway obstruction

52- The true statement regarding the use of antibiotic in burns is:-
Select one:
a. Antibiotic should be started only in highly suspension or proved bacterial infection
b. Antibiotic should be started if develop fever
c. Antibiotics should be started routinely and immediately as prophylactic
d. The first drug of choice is Gentamycin (to cover staph).

53- Brudzinki sign is:-

Select one:
a. Flexion of the neck causes neck pain and rigidity
b. Bulging anterior Fontanel
c. With the child laying supine and hips flexed, there is back pain on extension of the knee
d. Flexion of the neck with child supine cause flexion of the knees and hips

54- A 7 month old boy presented with history of high fever and purpuric skin rash, your first
diagnosis is :-
Select one:
a. Measles.
b. Rubella.
c. Scalded skin syndrome
d. Kawasaki disease
e. Meningococcal infection
 55- Regarding Chickenpox all true except:-

Select one:
a. When the lesions appear, the child is no more infectious.
b. It may be complicated by by group A streptococcus infection
c. It is caused by VZV
d. Highly infectious by respiratory droplets
e. Crops of papules, vesicles and pustules can be seen

56- During your evaluation of an infant in the nursery, you note that the red reflex in one eye
seems paler than in the other. All of the following causes except

Select one:
a. Retinitis pigmintosa
b. Corneal opacity
c. Cataract
d. Retinoblastoma
e. Retinopathy of prematurity

57- Regarding nutritional properties of breast feeding one of the following is correct except

Select one:
a. The main protein is whey
b. Renal solute load is high
c. Calcium: Phosphorus ratio is 1: 2
d. Medium chain triglyceride is present and important in retinal development
e. Iron in breast milk is 10-20% absorbed

58- Of the following, the findings that are MOST suggestive of DiGeorge syndrome are

Select one:
a. mongoloid slant to the eyes and a congenital heart defect
b. hypocalcemia and a congenital heart defect
c. hypotonia and a congenital heart defect
d. cutis aplasia and a congenital heart defect
e. cataract and a congenital heart defect
 59- Cephalosporins are widely used in pediatric practice, both in oral and parenteral
formulations which of the following is a 2nd generation cephalosporin?

Select one:
a. Cefuroxime
b. Ceftazidime
c. Ceftriaxone
d. Cefazolin
e. Cephalexin

60- The following are common associated disabilities in children with cerebral palsy:

Select one:
a. Cortical visual impairment
b. Hearing impairment
c. Chronic Diarrhea
d. Feeding difficulties
e. Speech and language problems

61- The following features are characteristic of an inginal hernia swelling except:

Select one:
a. Resolves by 1 year of age
b. Risk of strangulation is low
c. Exacerbated by crying
d. Extends from the groin to the scrotum
e. Transillumination negative

62- The following diseases can cause floppy infant, except:

Select one:
a. congenital Myotonic dystrophy
b. Prader - Willi syndrome
c. Spinal muscular atrophy type 1
d. Becker muscular dystrophy
d. Nemaline rod myopathy
 63- Regarding breast feeding. One of the following is false?

Select one:
a. Infection is more common among cow milk fed.
b. Breastfed infants are protected against allergy.
c. breast milk has same calories as cow’s milk
d. There is higher incidence of tetany in cow-fed infant
e. Breast milk contains higher amount of vitamin K

64- The MOST devastating consequence of untreated hypernatremia is:

Select one:
a. seizures
b. central pontine myelinolysis
c. extra pontine myelinolysis
d. brain edema
e. brain hemorrhage

65- Which of the following clinical or laboratory criteria, when present in a child, establish a
diagnosis of acute rheumatic fever:-

Select one:
a. Carditis, alone
b. Carditis and arthralgia
c. Polyarthritis, fever and evidence f recent strep infection
d. Carditis, Polyarthritis, and evidence of recent strep infection
e. Prolonged P-R interval, fever, and arthralgia

66- Which of the following situations requires further clinical evaluation and work up?

Select one:
a. A newborn with a pulse rate of 90/min during sleep
b. A 2- years old with a heart rate of 110/min
c. A newborn with a heart rate of 130/min
d. A 2-months old infant with a pulse rate of 130-min
d. A crying 2 months- old infant with a pulse rate of 220/min (>200)
 67- When a normal boy triples his birth weight, he is expected to be fitting with all the following
except:-

Select one:
a. To be 75cm in length
b. To have a head circumference of 46cm
c. To stand without support
d. to do a 3 word sentence
e. To wave bye bye

68- Hyperkalemia is treated by all of the following except:

Select one:
a. Kayexalate.
b. Glucose and Insulin
c. β -2 Agonists
d. Diuretics.
e. Hemodialysis.

69- The most likely diagnosis in a 4-week-old male infant with vomiting and hypochloremic
metabolic alkalosis is ?

Select one:
a. Maple syrup urine disease
b. Adrenal insufficiency
c. Gastroenteritis
d. Pyloric stenosis
e. urea cycle defect

70- The following statement is false regarding the fifth disease:-

Select one:
a. it may cause severe fetal anemia if mother is infected
b. It may cause aplastic crisis in patients with hemolytic anemia
c. It characterized by lace type rash on trunk and limbs
d. Erythema infectiousum is another name of the disease
e. It is caused by (HHV6) Human herpes virus type 6.
 71- All are features of Kawasaki disease, except:-

Select one:
a. Unilateral lymphadenopathy
b. Peeling of hands and feet
c. Non Purulent conjunctivitis
d. Polymorphic skin rash
e. Slapped cheek face

72- In hemophilia, one of the following is FALSE:

Select one:
a. Partial thromboplastin time (PTT) is prolonged
b. Inheritance is x-linked dominant
c. Female carriers can show signs of the disease
d. Prothrombin time is normal
e. The hallmark is hemarthrosis rather than mucocutanous bleeding

73- In physiologic anemia, one of the following is false:

Select one:
a. May be aggravated by folic acid deficiency
b. In premature infant the decline in hemoglobin is earlier and more severe
c. Hemoglobin concentration decrease to 9 -11g/dl.
d. Usually requires blood transfusion
e. Occurs as a result of down regulation of erythropoietin production

74- In pediatric acute lymphoblastic leukemia one of the followings is true:

Select one:
a. T- cell less common than B-cell subtype
b. Less common in toddlers than infant
c. Less common in Down syndrome than general populations
d. More common in females than males
e. Exposure to radiations do not increase the incidence
 75- Neuroblastoma usually present with all of the following EXCEPT:

Select one:
a. Asymptomatic abdominal mass
b. Spinal cord compression
c. Intestinal obstruction
d. Respiratory distress
e. Diarrhea

76- About Down syndrome all the following are correct except:-

Select one:
a. Trisomy 21 nondisjunction is the usual cause
b. In the translocation type the number of chromosomes is 46
c. Recurrent respiratory infections are common
d. At birth an effected infant is usually overweight
e. Hypotonia is a common finding in the neonatal period.

77- Which of the following statements concerning the measurement of blood pressure in
children is true?

Select one:
a. With cuff technique blood pressure is normally lower in the leg than in the arm
b. Blood pressure measurements cannot be obtained until the age of 3years
c. A single BP reading is sufficient to diagnose hypertension
d. BP normal values are the same for children and adults
e. Using a cuff that is too small will result in a falsely high reading, and too large cuff will result in
falsely low reading

78- Which of the following statements is true in children?

Select one:
a. The first heart sound is due to closure of the semilunar valves
b. The second heart sound is due to closure of the atrioventricular valves
c. The third heart sound may be normal finding
d. The first heart sound is normally spilt
e. The second heart sound is normally spilt
 79- Turner syndrome is characterized by all the following except:-

Select one:
a. Coarctation of the aorta
b. Shielded chest with wide spaced nipples
c. Normal fertility
d. Short stature
e. Webbing of the neck

80- A newborn baby was noticed to have multiple problems at birth. Karyotyping was
requested and it showed 46,XY,5p-. This karyotype means that this child is affected with
which of the following conditions?

Select one:
a. Male with Velo Cardio Facial syndrome
b. Male with Miller Dieker syndrome
c. Male with Wolf Hirschhorn syndrome
d. Male with Cri-du-chat syndrome
e. Male with Williams syndrome

81- Regarding Autosomal Recessive inheritance, choose the Correct statement:-

Select one:
a. The gene mutation is expressed in a heterogeneous state and carrier
individuals usually show the manifestation of the disease.
b. Either parent can be a carrier
c. Males are more often affected than females
d. Each child of two heterozygous parents has 25% chance of being affected 50% chance of being a
carrier
e. None of them

82- All of the following about congenital hypothyroidism are true except:

Select one:
a. Approximately 20% of children with congenital hypothyroidism have neurosensory hearing deficit
b. During treatment, thyroxine cannot be mixed with soy protein formulas or iron for better
absorption
c. Distal femoral epiphysis which normally present at birth is often absent
d. Retardation of osseous development can be shown radiographically at birth in about 60%.
e. Most infants with congenital hypothyroidism are symptomatic at birth
 83- In familial short stature, all are true except:

Select one:
a. Birth length is normal
b. Bone age is delayed
c. Onset of puberty is normal
d. Parents are short (one or both).
e. Adult height is short

84- The most common presentation of congenital aganglionic megacolon (Hirschsprung disease)
in the newborn is?

Select one:
a. An abdominal mass
b. Diarrhea
c. Intestinal obstruction
d. Peritonitis
e. Intestinal perforation

85- 4-months old infant presented with history of poor feeding and difficulty of breathing, by
physical exam. Found to have normal temperature, RR=60/min,BP=79/45, cold extremities,
thread pulse, gallop rhythm, liver is 4cm BCM. The most probable diagnosis is:

Select one:
a. Hypotensive Cardiogenic shock
b. Hypovolemic shock
c. Septic shock
d. Compensated cardiogenic shock
e. Anaphylactic hypotensive shock

86- A 6-week-old infant is admitted to the hospital with jaundice. Her out- patient blood work
demonstrated a total bilirubin of 12 mg/dL with a direct portion of 3.5 mg/dL. Which of the
following disorders is most likely to be responsible?

Select one:
a. ABO incompatibility
b. Choledochal cyst
c. Rh incompatibility
d. Gilbert disease
e. Crigler-Najjar syndrome
 87- Immunizations should not be given in the following circumstances except:

Select one:
a. If there has been a serious reaction to a previous dose of the same vaccine
b. History of non progressive neurological problem
c. If the child is younger than the age indicated on the schedule
d. If the child has a high fever
e. Oral Polio vaccine to a child who has brother who was treated for ALL in induction phase

88- Recognized complications of the nephrotic syndrome include all of the following except

Select one:
a. Pyogenic infection
b. Pulmonary edema
c. Urinary tract infection
d. Acute tubular necrosis
e. Thrombo-embolism

89- Bone age will be retarded in short stature caused by each of the following Except:

Select one:
a. Chronic administration of glucocorticoids in high doses
b. Environmental deprivation syndrome
c. Hypopituitarism.
d. Hypothyroidism.
e. Congenital adrenal hyperplasia

90- Oligohydramnios is associated with all of the following EXCEPT:

Select one:
a. Pulmonary hypoplasia
b. Esophageal atresia
c. Posterior urethral valves
d. Potter syndrome
d. Skeletal contractures
 91- Features of Down’s syndrome include all of the following except:

Select one:
a. Webbing of neck
b. Susceptibility to leukaemia
c. Increased incidence of hypothyroidism
d. Brushfield spots
e. Duodenal atresia

92- Concerning febrile seizures, factors are associated with increased risk of later epilepsy
include all of the following, except:

Select one:
a. Positive family history of febrile convulsions
b. Delayed developmental milestones
c. An initial febrile seizure before 9 months of age
d. Positive family history of epilepsy
e. Complex febrile seizure

93- Which of the following is a critical event in the pathogenesis of haematogenous bacterial
meningitis?

Select one:
a. Nasopharyngeal colonization
b. Penetration of the blood-brain barrier
c. Inflammation of the meninges
d. Invasion of the blood stream
e. All of the above are critical events in the pathogenesis of this disease

94- A 3 years old female, was noticed to have poor social interaction, unresponsivness to verbal
commands, poor speech development, and hyperactivity, the most probable diagnosis is:

Select one:
a. Attention deficit hyperactivity disorder ADHD
b. Absence epilepsy
c. Pervasive developmental disorder
d. Day dreaming phenomena
e. Physiologic hyperactivity
 95- A 2 yr old boy is noted to be drinking from a container filled with kerosene. He immediately
coughs, becomes tachypneic, and is brought to the hospital. The best approach to his
treatment is to:

Select one:
a. Induce emesis
b. Instill mineral oil
c. Perform nasogastric tube lavage
d. None of them
e. Administer steroids

96- 10 yr boy having pain in chest on exercise, ejection systolic murmur grade 2/6 in right
upper external border, the most probable cause is:

Select one:
a. Angina
b. Asthma
c. Aortic stenosis
d. Coarctation of aorta
e. Muscular pain

97- most common cause of gross hematuria is:

Select one:
a. Meatal stenosis
b. Urinary tract infections
c. Glomerulonephritis
d. IgA nephropathy
e. Trauma

98- All of these congenital heart disease are associated with right axis deviation except.

Select one:
a. Large VSD.
b. TGA.
c. Tetralogy of Fallot
d. Tricuspid atresia
e. Total anomalies of venous return
 99- A 1day old full term baby has vomiting after feeding with greenish fluid. He passed
meconium once. On exam he has features suggestive of Down syndrome. The pregnancy
was complicated by polyhydramnios. The most likely diagnosis is

Select one:
a. Duodenal atresia
b. Meconium ileus
c. Volvulus
d. Hirschsprung disease
e. Pyloric stenosis

100- A 2-year-old arrives in the emergency center after having swallowed a button
battery from one of her toys. She is breathing comfortably, without stridor. Radiographs
show the battery to be lodged in the esophagus. Which of the following is the correct next
step?

Select one:
a. Immediate removal of the battery via endoscopy
b. Admit for observation, and obtain serial radiographs to document movement of the battery
c. Discharge home with instructions to monitor the stool for the battery.
d. Induce emesis with syrup of ipecac
e. Encourage oral intake to assist in passage of the battery

101- An awake, alert infant with a 2-day history of diarrhea presents with a depressed
fontanelle, tachycardia, sunken eyes, and the loss of skin elasticity. Which of the following is
the correct percentage of dehydration?
Select one:
a. Less than 1%
b. 1% to 5%
c. 5% to 9%
d. 10% to 15%
e. More than 20%

102- For failure to thrive, the false statement is:

Select one:
a. children with recent-onset failure to thrive usually maintain their height
b. Hospital admission is usually necessary for most cases of failure to thrive.
c. The child’s developmental progress may also be adversely affected.
d. Failure to thrive is present if an infant’s weight falls across two centile lines
e. Lab tests have low yield in diagnosing failure to thrive
 103- The following can cause failure to thrive except

Select one:
a. Cystic fibrosis
b. Celiac disease
c. Hypothyroidism
d. Emotional neglect
e. Gastro-esophageal reflux in infants

104- All of the following are signs of severe increased ICP in comatosed child except:-

Select one:
a. Anizochorea
b. Papilledema
c. Bradycardia
d. Tachycardia
e. Hypertention

105- Which of the following Cerebral palsy type is most likely associated with
intrapartum asphyxia in full term infants

Select one:
a. Diplegic CP
b. Hemiplegic CP
c. Dyskinetic CP
d. Ataxic CP
d. Quadriplegic CP with involvement of upper limps more than lower limps

106- Concerning Breath Holding Spells, all of the following statements are correct ,
except :

Select one:
a. Triggered
b. Mostly occurring in Toddlers , known to have psychomotor delay
c. Sometimes followed by motor convulsions
d. Self-limiting condition
e. Crying followed by apnea, then progress to LOC for seconds to a few minutes