Paeds Mcqs 2 -

55. A 2-day-old neonate, born to mother with diabetes mellitus with birth weight 4000 gr and length 53 cm, has generalized tonic seizures. Which of the following medications would you use to treat the seizures?(From 1 to 5 correct answers out of 5 possible answers; 1 point for each correct answer, minus 1 point for each wrong answers) Calcium gluconate 10% Sodium bicarbonate 10% Vitamin C Glucose 25% Potassium chloride 15%

1. glucose 2.calcium gluconate Hypoglycemia - glucose as the mother had diabetes, the neonate can develop hyoglycemia, diabetic mothers have high risk of having child with hypocalcemia

4-year-old child with normal growth. Fully immunized. Does not suffer from frequent infections. On the day of the admission he was playing unsupervised when his parents heard him coughing violently. He also had a hoarse voice. A few minutes later the cough subsided, but his breathing was slightly faster than normal. On admission the child is in serious condition with perioral cyanosis. Dyspnea with tachypnea up to 55/min, reduced vocal fremitus and dull prcussion tone in the right lung. Tachycardia to 140/min, clear heart sounds, no murmurs. Abdomen- no hepatosplenomegaly. А. Which of the following tests would you request to make the diagnosis and plan for emergency treatment?(1 correct answer)(2 Points) A. Chest X-ray B. Troponin C. Echocardiography D. Blood gas analysis E. Virology

A. Chest X-ray The signs indicate foreign body. Dull sound on percussion is an indication for atelactasis, consolidation in cases of pneumonia or tumours. But in an infant that is normal with suddent onset of cyanosis indicates that foreign body is causing atelactasis

5. Hemorrhagic disease of the newborn is:(1 correct answer)(1 Point) A. Coagulopathy B. Vasculopathy C. DIC (disseminated intravascular coagulation) syndrome D. Thrombocytopenia

A. Coagulopathy Hemorrhagic disease of the newborn is due to defiency in vitmain K. All neonates are low on vitamin K. If vitamin K is low then all the caogulation factors that are dependent on vitamin K are also deficient. ↓Vit K dependent Coagulation factors - 2,7,9,10 - Hemophilia; von Willebrand disease; Liver disease; Vitamin K deficiency; Calcium deficiency & use of anticoagulants Vasculopathies include diseases such as HSP; Vitamin C deficiency & Cushing's disease

28. Which of the following disorders does NOT present with coagulopathy? (1 correct answer)(1 Point) A. Fanconi's anemia B. Liver cirrhosis C. Hemophilia D. Hemorrhagic disease of the newborn

A. Fanconi's anemia all the others cause coagulopathies Fanconi anemia is a rare disease passed down through families (inherited) that mainly affects the bone marrow. It results in decreased production of all types of blood cells

Which age period in childhood is termed "pre-school"? (1 correct answer)(1 Point) A. From 2 to 5 years B. From 1 to 2 years C. From birth to 3 years D. From birth to 5 years

A. From 2 to 5 years Explanation post-neonatal/infant -28 days to 1 year Toddler : 1 to 3 years Pre-schoolar: 3 to 6 years school ager: 6 to 10 years Pre-pubertal: 10 to 13 years Adolescent: 13 to 18+ years

4-year-old boy is admitted to hospital because his urine is red. For the last few days he has been micturating less than usual. A week ago he had transient diarrhea after a day in the mountains. On examination he looks unwell. He is pale, with subicterus, some petechia on the legs and buttocks. Normal respiratory examination. Tachycardia to 140/min, blood pressure 130/85 mmHg. Abdomen- soft, difusely painful. Hgb- 85 g/L, Plt 33×10 9/L, WBC 15×109/L, urea 11.1 mmol/L, creatinine 160 μmol/L, CRP- 35.2 mg/L., bilirubin - 75 μmol/L. Normal coagulation - АРТТ, INR. Urine - 1(+) protein, lots of erythrocytes.What is the most likely diagnosis?(1 correct answer)(2 Points) A. Hemolytic-uremic syndrome ХУС B. Sepsis C. Pre-renal acute kidney injury D. Henoch-Schonlein purpura

A. Hemolytic-uremic syndrome ХУС The patient is hypertensive, thrombocytopenia, leuckocytosis, high CRP, CR, hyperbilirubinemia and anemia

A 4-year-old boy, with normal development and no past medical history of note, is admitted to hospital because of profuse petechial rash, mainly on the face, neck and torso that occured the previous day. Physical examination does not reveal any other abnormalities. Blood tests on admission - normal levels of hemoglobin, WBC, RBC; PLT - 10 x10 / 9 / l, LDH - normal value. What is the right management? (From 1 to 5 correct answers out of 5 possible answers; 1 point for each correct answer, minus 1 point for each wrong answers) A. Monitoring only, as the patient is not currently bleeding profusely B. Splenectomy C. Immediate platelet transfusion D. I.v antibiotics E. Treatment with corticosteroids or high-dose immunoglobulin after F. confirmation of the diagnosis by bone marrow biopsy

A. Monitoring only, as the patient is not currently bleeding profusely

52. A 1-year-old child is consulted because of malaise, episodes of restlessness, crying, sweating and tachycardia to 200/min and blood pressure 150/90. Abdominal ultrasound showed a tumor, originating from the left adrenal gland. There is anemia. Urine is normal. Which of the following tumor markers are characteristic for the suspected malignancy?(From 1 to 5 correct answers out of 5 possible answers; 1 point for each correct answer, minus 1 point for each wrong answers) A. Neuron-specific enolase B. Carcinoembryonic antigen C. Vanillylmandelic acid in urine D. Alpha fetoprotein E. Chorion gonadotropin

A. Neuron-specific enolase C. Vanillylmandelic acid in urine The tumour suspected is neuroblastoma

An 8-year-old girl with normal growth and development. For the last 3 years during spring time, has complained of frequent sneezing and itchy nose and eyes. Parents always gave her antihistamines with good effect. During the last year she has had these symptoms when the weather is wet and foggy, especially in the morning. Sometimes she also has cough and wheeze. What tests would you recommend to make the diagnosis? (From 1 to 5 correct answers out of 5 possible answers; 1 point for each correct answer, minus 1 point for each wrong answers) A. Serum IgE B. chocardiography C. Lung function tests with bronchodilator test D. Nose swab for culture E. Sweat test

A. Serum IgE C. Lung function tests with bronchodilator test

24. Which is not typical for spinal muscular atrophy type 1? (1 correct answer)(1 Point) A. Tendon hyperreflexia and pathological reflexes B. normal intellectual development c. fascicultions of the tongue D. Muscle weakness

A. Tendon hyperreflexia and pathological reflexes Spinal muscular atrophy type 1 is called Werdnig-Hoffman disease, it is characterised by presence of muscle weakness, hypotonia, intercostal muscle weakness, diminished tendon reflexes due to the disease being a lower motor disease not an upper one, in upper motor disease there is hypereflexia not in lower. There are also fasiculations present in lower motor disease

Part 1: A-10-year-old boy has been complaining of fever and sore throat for the last 2 days. On examination there is pharyngitis. The rest of his examination is unremarkable. Part 2: 4 weeks later he returns because of palpitations and fatigue, especially after physical exercise. His knees are swollen, red and very painful. It becomes clear that his mother gave him the prescribed antibiotic for only 2 days as his fever and sore throat subsided quickly. On examination he has RR 35/min; crepitations at the lung bases, HR 130/min; systolic murmur at the apex, radiating to the left axilla. His liver is palpable 3 cm below the costal margin. No splenomegaly. He also has a wide spread rash. What is the likely diagnosis:(1 correct answer)(2 Points) A. acute rheumatic fever B. infective endocarditis C. post-streptococcal arthritis D. infectious mononucleosis

A. acute rheumatic fever

44. A 7-year old boy with Duchenne Muscular Dystrophy, who has not been properly followed up, develops dyspnea, orthopnea, tachycardia and hepatomegaly. What is the most likely cause: (1 correct answer)(2 Points) A. dilated cardiomyopathy B. myocarditis C. bronchial asthma D. bacterial endocarditis

A. dilated cardiomyopathy Dilated cardiomyopathy is found in DMD and leads to death as well in children with DMD

The dramatic reduction in child mortality in the developed world in the last decades is due to all EXCEPT? (1 correct answer)(1 Point) A. reduction in birth rate B. antibiotics and treatment of severe bacterial infections C. Immunizations and reductions of deaths due to infectious causes D. Mainly because of improved living conditions and health knowledge of the population

A. reduction in birth rate

6. A 2-day-old newborn with respiratory rate 24/min and heart rate 140/min has:(1 correct answer)(1 Point) A. Normal heart rate and bradypnea B. Normal respiratory and heart rate C. Bradycardia and bradypnea D. Tachycardia and bradypnea

Answer: A. Normal heart rate and bradypnea For resting heart rate: 1. Newborns 0 to 1 month old: 70 to 190 beats per minute. 2. Infants 1 to 11 months old: 80 to 160 beats per minute. 3. Children 1 to 2 years old: 80 to 130 beats per minute Normally, the newborn's respiratory rate is 30 to 60 breaths per minute.

A three-month old infant is admitted because of pneumonia. The patient was treated for two weeks at home without improvement. On the 3rd day after the birth of the infant a heart murmur was detected and parents were advised to consult a pediatric cardiologist after discharge from the neonatal unit, but so far they have not done it. On examination the child is pink but with tachydyspnea and bilateral crepitations. There is also a loud P2; soft pansytolic murmur, loudest at the lower left sternal border. Liver is palpable 3 cm below the costal margin.What are the expected findings from the following tests? A. chest X-ray - cardiomegaly with increased vascular markings B. infection C. ECG- partial right bundle branch block and right ventricular hypertrophy D. chest X-ray - boot-shaped heart with reduced vascular markings E. echocardiography - pulmonary hypertension with R-L shunt

Answer: A. chest X-ray - cardiomegaly with increased vascular markings From the clinical case, the following signs indicate it could be VSD - loud p2, pansystolic mumur at lower left sternal border, liver is palpable, as only pansystolic mumur is present it means the VSD is small and it will cause left to right shunt. The chest X-ray should be priority and indicates a possible infection.

16. What is true for cyanosis due to respiratory causes: (1 correct answer)(1 Point) A. improves with oxygen therapy B. is worse when the child is anaemic C. improves if the child squats down D. it worsens during crying

Answer: A. improves with oxygen therapy cyanosis due to a cardiac issue - oxygen therapy does not improve the cyanosis it worsens when they cry - that because you require more effort to cry that requires energy and oxygen. HF- improves when they squat- changes in venous return

13. The most common cause for arterial hypertension in YOUNG children is: (1 correct answer)(1 Point) A. brain tumors B. hypertension secondary to chronic kidney diseases C. metabolic syndrome D. essential hypertension

Answer: B. hypertension secondary to chronic kidney diseases brain tumours -can cause secondary hypertension but are not the common cause of arterial hypertension in young children metabolic syndrome - associated with obesity, and hypertension with high BMI children is common in obese children or adolescents. Essential hypertension - obese and adolescents.

20. The main characteristics of nephrotic syndrome are: (1 correct answer)(1 Point) A. Proteinuria, hematuria, leucocyturia, edema B.Proteinuria, hypoproteinemia, hyperlipidemia, edema C. Proteinuria, hematuria, hyperlipidemia, edema D. Proteinuria, leucocyturia, edema

Answer: B.Proteinuria, hypoproteinemia, hyperlipidemia, edema

33. What is characteristic for diabetes mellitus type II:(1 correct answer)(1 Point) A. Tendency for diabetic ketoacidosis B. Monogenic inheritance C. Is commonly associated with obesity D. Starts in early childhood

Answer: C. Is commonly associated with obesity

Wilson disease may present with: (1 correct answer)(1 Point) A.seizures B. heart failure C. Vit. B12 deficiency anemia D. hepatic presentation and neuropsychiatric features

Answer: D. hepatic presentation and neuropsychiatric features Wilson disease (hepatolenticular degeneration) is an autosomal recessive metabolic disorder in which impaired copper excretion causes copper to accumulate in the body. In its initial stages, Wilson disease leads to copper deposits in the liver. As the disease progresses, copper also accumulates in other organs, most importantly in the brain and cornea

A-10-year-old boy has been complaining of fever and sore throat for the last 2 days. On examination there is pharyngitis. The rest of his examination is unremarkable. His rapid streptococcal antigen test is positive, so you prescribe oral antibiotic for: (1 correct answer)(2 Points) A. 20 days B. 10 days C. 2 days D. 5 days

B. 10 days treatment for 10 days with penicillin V or erythromycin

21. In chronic granulomatous disease there is: (1 correct answer)(1 Point) A. T-cell immune deficiency B. Abnormal phagocytosis C. B-cell immune deficiency D. Absolute neutropenia

B. Abnormal phagocytosis CGD there is deficiency of superoxide production by polymorphonuclear neutrophils and macrophages Defective phagocytic nicotinamide adenine dinucleotide phosphate (NADPH) oxidase that results in:Defective reactive oxygen species (ROS) production (e.g., superoxide) → impaired ability to deactivate or kill ingested microorganismsDecreased respiratory burst in neutrophils

38. A previously healthy 3-year-old child wakes up at night with high fever of 39.5, hypo-to aphonia, drooling due to inability to swallow the saliva, inspiratory stridor The child looks severely ill and is sitting up and leaning forwards. What is your diagnosis?(1 correct answer) (2 Points) A. Foreign body aspiration B. Acute epiglottitis C. Asthma exacerbation D. Pseudo-croup (viral laryngotracheobronchitis)

B. Acute epiglottitis The history shows all the Ds of epiglottis - resp distress, drooling, dysphagia, dysphonia and the child is sitting in tripod position which is common for acute epiglottis A. there will be inspiratory stridor only not the other signs C. there will be expiratory dyspnea and wheezing D. it will not present with drooling

15. The characteristic physical findings in lobar pneumonia are:(1 correct answer)(1 Point) A. Dull percussion tone, vesicular breath sounds with localized crackles, positive bronchophony B. Dull percussion tone, bronchial breathing, positive bronchophony C. Hyperresonant percussion tone, reduced breath sounds with prolonged expiration , positive bronchophony D. Hyperresonant percussion tone, bronchial breathing, positive bronchophony

B. Dull percussion tone, bronchial breathing, positive bronchophony

4-year-old child with normal growth. Fully immunized. Does not suffer from frequent infections. On the day of the admission he was playing unsupervised when his parents heard him coughing violently. He also had a hoarse voice. A few minutes later the cough subsided, but his breathing was slightly faster than normal. On admission the child is in serious condition with perioral cyanosis. Dyspnea with tachypnea up to 55/min, reduced vocal fremitus and dull prcussion tone in the right lung. Tachycardia to 140/min, clear heart sounds, no murmurs. Abdomen- no hepatosplenomegaly. Chest X-ray shows opacification of the right lung, reduced intercostal spaces on the right and mediastinal shift to the right. The left lung is intact. FBC- within reference range. Blood gas- hypoxia, рСО2 - 55mmHg. Echocardiography shows normal myocardial contractility. What is your diagnosis? (1 correct answer)(2 Points) A. Empyema on the right B. Foreign body aspiration with atelectasis of the right lung C. Hypoplasia of the right lung D. Severe pneumococcal pneumonia of the right lung

B. Foreign body aspiration with atelectasis of the right lung In Atelactasis, the tracheal shift occurs on the affected side Empyema, large PE and Pneumothorax- shift towards the unaffected

The girl in the photo is 7 years old from the first normal pregnancy, born at term with weight 2500 gr - on the 3rd percentile and length 48 cm - on the 3rd percentile. She was operated for coarctation of the aorta in the neonatal period. Her heart condition has been monitored by a pediatric cardiologist - she has normal heart function. She has had recurrent upper respiratory tract infections and acute otitis. She has some learning difficulties at school. She is referred because she is the shortest in her class. What tests will be most helpful for the diagnosis?(From 1 to 5 correct answers out of 5 possible answers; 1 point for each correct answer, minus 1 point for each wrong answers) A. Echocardiography B. Growth hormone C. Cytogenetic test D. Thyroid hormones

B. Growth hormone C. Cytogenetic test D. Thyroid hormones The child is said to be short so short stature is related growth hormone and thyroid hormones. Cytogenetic tests are done to diagnose congenital abnormalities, as coarctation of aorta is found in Turner syndrome. whereas in down syndrome there is ASVD

46. A 10-year old boy started treatment with Trimethoprim-sulfamethoxazol (Biseptol) because of acute sinusitis. On the second day he had abdominal pain, acute palor and jaundice, fatigue, and his urine became darker. No other symptoms. On examination he is pale and jaundiced, has vesicular breath sounds, tachycardia to 110/min, rhythmic heart sounds, spleen -0.5 cm below the costal margin. Succusio renalis - negative. Lab results - Hgb 70g/l; RBC- 3.2 x10/12/l, WBC - 8.8 x10/9/l, PLT- 348 x10/9/l, АSAT - 50U; АLAT- 40U; bilirubin - 87μmol/l; direct bilirubin - 10 μmol/l, LDH - 2000U. Coombs ˋtest - negative. Family history - uncle with a few episode of acute anemia from early childhood. What is the most likely diagnosis?(1 correct answer)(2 Points) A. Acute viral hepatitis B. Hemolytic anemia due to glucose- 6-phosphate dehydrogenase deficiency (G-6-PD) C. Acute aplastic anemia D. Auto-immune hemolytic anemia

B. Hemolytic anemia due to glucose- 6-phosphate dehydrogenase deficiency (G-6-PD) Explanation A. no symptoms of hepatitis, ALAT and ASAT not affected. no prodromal symptoms B. the spleen is enlarged means its over working and hemolysis C.

Iron deficiency anemia is: (1 correct answer)(1 Point) A. Hypochromic macrocytic B. Hypochromic microcytic C. Microspherocytic D. Normochromic normocytic

B. Hypochromic microcytic

Kallmann's syndrome is associated with A. Ambiguous genitalia B. Hypogonadotropic hypogonadism C. Isosexual precocious puberty D. Hypergonadotropic hypogonadism klienfelter, turner

B. Hypogonadotropic hypogonadism The olfactory neurons and the gonadtropin neurons are damaged meaning GnRH arent produced, decreased LH and FSH and hence decrease in estrogen, progesterone and testosterone. hypogonadotropic hypogonadism with hyposmia/anosmia

27. Motor dysfunction in cerebral palsy is due to:(1 correct answer)(1 Point) A. Progressive damage to the brain B. Non-progressive damage to the brain C. Damage to the limb muscles D. Damage to the spinal cord

B. Non-progressive damage to the brain Cerebral palsy (CP) is a heterogenous group of disorders affecting the muscle tone and the development of movement and posture. CP results from a non-progressive damage to the brain in utero or during infantile development up to the age of 3 years.

29. What is characteristic for Henoch-Schonlein purpura: (1 correct answer)(1 Point) A. Prolonged bleeding time B. Normal clotting and bleeding time C. Thromocytopenia D. Prolonged clotting time

B. Normal clotting and bleeding time the platlet count increased, WBC increased

34. Which newborns are at risk of necrotizing enterocolitis: (1 correct answer)(1 Point) A. With congenital infection B. Severely premature neonates C. Neonates born to mother with poorly controlled diabetes mellitus D. Children with congenital abnormalities of the GIT

B. Severely premature neonates

A 6-year-old boy had purulent tonsillitis 10 days ago. Now he presents with macroscopic hematuria and periorbital edema. What is the right management?(From 1 to 5 correct answers out of 5 possible answers; 1 point for each correct answer, minus 1 point for each wrong answers) A. Start treatment with corticosteroids B. Test for urea, creatinine, uric acid, C3 and C4 complement fractions, electrolytes and antistreptolysin antibodies C. Kidney biopsy D. Monitoring of blood pressure and urine output E. Start treatment with albumin infusions

B. Test for urea, creatinine, uric acid, C3 and C4 complement fractions, electrolytes and antistreptolysin antibodies D. Monitoring of blood pressure and urine output

22. Which of the following is NOT a congenital heart defect with left to right shunt: (1 correct answer)(1 Point) A. Atrial septal defect B. Tetralogy of Fallot C. Persistent ductus arteriosus D. Ventricular septal defect

B. Tetralogy of Fallot it is right to left shunt, cynotic disease

A 6-month-old infant falls ill for the first time with fever and refusal to feed. There is no vomiting and diarrhea. Normal physical examination. Laboratory results show leucocytosis with neutrophilia, raised ESR. Which of the following test would you request next to clarify the diagnosis?(From 1 to 5 correct answers out of 5 possible answers; 1 point for each correct answer, minus 1 point for each wrong answers) A. Tests for immune deficiency B. Urine test - biochemistry, microscopy and culture C. Abdominal ultrasound D. Stool culture E. Pharyngeal aspirate for virology studies

B. Urine test - biochemistry, microscopy and culture C. Abdominal ultrasound In infants the most common cause of unpsecific fever is UTI and any abnormal urinary findings do a US of kidney, ureter and bladder and also check the urine for microgranisms

Which of the following statements regarding hemolytic disease of the newborn is true: (1 correct answer)(1 Point) A. jaundice appears after the 7th day B. it is due to antibodies against fetal erythrocytes because of incompatibility between maternal and fetal erythrocytic antigens C. kernicterus is due to the deposition of direct bilirubin in brain nuclei D. there is iron deficiency anemia - normocytic

B. it is due to antibodies against fetal erythrocytes because of incompatibility between maternal and fetal erythrocytic antigens A. jaundice appears within 24 hours after birth -phyisological jaudnice C. kernicterus - due to deposition of indirect bilirubin in the brain as it can cross the BBB. D. iron defiency anemia is microcytic anemia

37. A 1-month-old infant is brought to the family doctor because of persistent jaundice. The pregnancy and delivery were uneventful. The infant is breastfed and has gained 1 kg since birth. On examination it looks well, has good muscle tone, mild jaundice, pink mucous membranes. No hepatosplenomegaly, normal voice. Mother confirms that the urine is transparent and the stools are bright yellow. What is the most appropriate management?(1 correct answer)(2 Points) A. Hereditary spherocytosis should be ruled out B. reassure mother as this is most likely breast milk jaundice C. The infant has the mildest form of haemolytic disease of the newborn- haemolytic anemia D. X-ray of left knee for bone age

B. reassure mother as this is most likely breast milk jaundice pathological jaundice -less than 24 hours 24 hours to 14 days - physiological more than 21 days - breast milk.

A previously healthy 9- year-old boy has been having low grade fever, fatigue, reduced appetite and dry cough for the last 2 months. Recently the cough became productive with blood stained sputum occasionally. The grandfather, who lives with the family, has a chronic cough. On examination the child has normal respiratory status. Chest X-ray shows opacification of the right middle lobe. FBC and DCC are within reference range. ESR 42 mm.Which further tests would you recommend?(From 1 to 5 correct answers out of 5 possible answers; 1 point for each correct answer, minus 1 point for each wrong answers) A. skin-prick tests for allergies B.Interferon-gamma release assay(IGRA) for tuberculosis C.bronchodilator test D. bronchoscopy to rule out foreign body in the airways E. microscopy of sputum to look for acid-fast bacilli

B.Interferon-gamma release assay(IGRA) for tuberculosis E. microscopy of sputum to look for acid-fast bacilli

A previously healthy 7-year-old boy with normal intellectual development. Two hours after falling asleep he sits up in bed, unable to talk, with facial asymetry and tremor of the right oral angle for 3 min, followed by saliva drooling. After that he goes back to sleep. In the morning he remembers what happened, says he could hear people talking during the episode but could not answer back and had a choking feeling. He has normal somatic and neurological examination. EEG shows- centro-temporal spikes on the left. Which is the most likely diagnosis? A. Pseudo-croup B. Laryngeal spasm due to hypoparathyroidism C. Benign rolandic epilepsy D. Hysteria

C. Benign rolandic epilepsy there is presence of centro-temporal spikes it happened when he was sleeping age of onset is between 4 to 10. had an abnormal feeling

A 5-month -old infant from first normal pregnancy and delivery at term with birth weight 3300 gr and length 51 cm . Breast fed. Weaned at 4 months with cereal and fruit puree. Has 4 previous hospital admissions because of obstructive bronchitis and was treated with inhaled Salbutamol and parenteral corticosteroids. Afterwards at home usually takes oral steroid for a few days after each hospitalization. Examined by the family doctor because of significant weight gain. Currently weighs 8 kg- above the 97th centile, length 58 cm-below the 3rd centile. Blood pressure 110/70- above 95th centile. Normal respiratory examination. No hepatosplenomegaly. Hypertrichosis. Dilated blood vessels on the cheeks. Normal neurodevelopment. What is the cause of obesity and short stature? (1 correct answer)(2 Points) A. Metabolic syndrome B. Obesity because of overnutrition C. Cushing syndrome D. Probably familial

C. Cushing syndrome EXP: hypertrichosis, high Bp, weight gain, pink cheeks all indicate towards cushing as there is also history of corticosteroids use metabolic syndrome - there should be hypertension, diabetes, obesity and CVD, but they are not present over-nutrition history is not given no family history given either

4-year-old child with normal growth. Fully immunized. Does not suffer from frequent infections. On the day of the admission he was playing unsupervised when his parents heard him coughing violently. He also had a hoarse voice. A few minutes later the cough subsided, but his breathing was slightly faster than normal. On admission the child is in serious condition with perioral cyanosis. Dyspnea with tachypnea up to 55/min, reduced vocal fremitus and dull prcussion tone in the right lung. Tachycardia to 140/min, clear heart sounds, no murmurs. Abdomen- no hepatosplenomegaly. Chest X-ray shows opacification of the right lung, reduced intercostal spaces on the right and mediastinal shift to the right. The left lung is intact. FBC- within reference range. Blood gas- hypoxia, рСО2 - 55mmHg. Echocardiography shows normal myocardial contractility. What is management? (1 correct answer)(2 Points) A. Antibioics B. Oxygen therapy and monitoring C. Emergency bronchoscopy for extraction of foreign body D. Surgical drainage of the pleural effusion

C. Emergency bronchoscopy for extraction of foreign body

4-year-old boy is admitted to hospital because his urine is red. For the last few days he has been micturating less than usual. A week ago he had transient diarrhea after a day in the mountains. On examination he looks unwell. He is pale, with subicterus, some petechia on the legs and buttocks. Normal respiratory examination. Tachycardia to 140/min, blood pressure 130/85 mmHg. Abdomen- soft, difusely painful. Hgb- 85 g/L, Plt 33×10 9/L, WBC 15×109/L, urea 11.1 mmol/L, creatinine 160 μmol/L, CRP- 35.2 mg/L., bilirubin - 75 μmol/L. Normal coagulation - АРТТ, INR. Urine - 1(+) protein, lots of erythrocytes. What additional tests would you request to confirm the diagnosis?(1 correct answer) (2 Points) A. Bone marrow biopsy B. Blood culture C. Free hemoglobin, red blood cells morphology D. Toxicology screen of vomit

C. Free hemoglobin, red blood cells morphology

45. A 14-year-old girl had high fever, sore throat and enlarged submandibular lymph nodes for 3 days. On examination there was evidence of purulent tonsillitis, so she was prescribed Augmentin (Amoxicillin + clavulonic acid). Next day her fever persisted and she developed maculo-papular rash on the body. This time examination revealed hepatosplenomegaly, mild edema of upper eyelids and the rash. Lab results - Hgb 125g/l; increased WBC 15х 10/9 with lymphocytosis - 70% -1/3 of them similar to monocytes, neutrophils15%, Plt- 180х 10/9; ESR - 25mm, АSАТ - 150 U/l, АLАТ - 200 U/l, LDH - 600U/l. What is the most likely diagnosis? (1 correct answer)(2 Points) A. Acute agranulocytosis B. Acute streptococcal tonsillitis with allergic rash C. Infectious mononucleosis D. Acute lymphoblastic leukemia

C. Infectious mononucleosis

19. What is the first-line therapy in asthma exacerbation: (1 correct answer)(1 Point) A. Oxygen therapy B. I.v Novphyllin C. Inhaled Salbutamol D. I.v corticosteroids

C. Inhaled Salbutamol 2nd line - Iv corticosteroids

If a breastfed infant is weaned after 6 months of age there is risk of: (1 correct answer)(1 Point) A. Aplastic anemia B. Salt overload C. Iron deficiency anemia D. Folate deficiency anemia

C. Iron deficiency anemia Weaning is the process of gradually introducing an infant human or another mammal to what will be its adult diet while withdrawing the supply of its mother's milk.Solid foods should be slowly initiated in infants between 4-6 months of age, with continued breast/formula feeding. The recommended initial weaning food is rice cereal fortified with iron

25. Which is the most severe consequence of hypoxic-ischemic encephalopathy? (1 correct answer)(1 Point) A. Brain calcifications B. Porencephalic cyst C. Multicystic encephalomalacia D. Intraventricular hemorrhage grade I

C. Multicystic encephalomalacia causes cerebral palsy and quadraplegia

4-year-old boy is admitted to hospital because his urine is red. For the last few days he has been micturating less than usual. A week ago he had transient diarrhea after a day in the mountains. On examination he looks unwell. He is pale, with subicterus, some petechia on the legs and buttocks. Normal respiratory examination. Tachycardia to 140/min, blood pressure 130/85 mmHg. Abdomen- soft, difusely painful. Hgb- 85 g/L, Plt 33×10 9/L, WBC 15×109/L, urea 11.1 mmol/L, creatinine 160 μmol/L, CRP- 35.2 mg/L., bilirubin - 75 μmol/L. Normal coagulation - АРТТ, INR. Urine - 1(+) protein, lots of erythrocytes. In view of the probable diagnosis what do you think is the abnormality on this blood smear?(1 correct answer)Immersive Reader(2 Points) A.Normal morphology of erythrocytes, leukocytes and platelets B. Blast cells C. Schizocytes D. Hypersegmented neutrophils

C. Schizocytes

Part 1: A-10-year-old boy has been complaining of fever and sore throat for the last 2 days. On examination there is pharyngitis. The rest of his examination is unremarkable. Part 2: 4 weeks later he returns because of palpitations and fatigue, especially after physical exercise. His knees are swollen, red and very painful. It becomes clear that his mother gave him the prescribed antibiotic for only 2 days as his fever and sore throat subsided quickly. On examination he has RR 35/min; crepitations at the lung bases, HR 130/min; systolic murmur at the apex, radiating to the left axilla. His liver is palpable 3 cm below the costal margin. No splenomegaly. He also has a wide spread rash. Part 3: Which of the following medications would NOT be used :(1 correct answer)(2 Points) A. long-term antibiotic prophylaxis B. diuretics and angiotensin-converting enzyme inhibitor C. anticoagulants D. aspirin +/- corticosteroids

C. anticoagulants Antibiotics can be used to prophylaxis to prevent chronic rheumatic heart disease. diruetics and ACE inhibitors can be used as they help with the HF and volume overload asprin and corticosteroids are anti-inflammatory which can be used

A-4-month-old infant from normal pregnancy and delivery, with normal development so far. During a routine check-up the family doctor established tachypnea at 50/min. Mother confirms that it has been breathing like that since discharge from the neonatal unit. On examination there is also hyperresonant percussion tone with reduced breath sounds in the left suclavicular area. The infant is afebrile, without any cough. The heart sounds are loudest slightly to the right of where they are normally heard best. Which of the following diagnosis is most likely? (1 correct answer)(2 Points) A. right upper lobe aplasia B. right-sided pneumothorax C. congenital lobar emphysema of the left upper lobe D. Congenital pneumonia in the left upper lobe

C. congenital lobar emphysema of the left upper lobe Explanation A. no symptoms on the right side, aplasia means missing - there would be pathological findings on the right upper lobe but there werent any. B. The hyperresonance is on the left side not on the right and breathing would be diminished on the same side C. makes sense with the hyperresonant percusssion then also presence on the left side as well D. pneumonia produces dull percussion not hyperressance

31. What is NOT present in hemolytic anemia: (1 correct answer)(1 Point) A. increased LDH (lactate dehydrogenase) B. increased serum iron C. direct hyperbilirubinemia D. Reticulocytosis

C. direct hyperbilirubinemia in hemolytic anemia, indirect hyperbilirubnemia

4. The most common cause for weight faltering is: (1 correct answer)(1 Point) A. infections B. endocrine disorders C. inadequate food intake D. congenital malformations

C. inadequate food intake 90% of the cases the weight is alterated due to inadequate feeding.

А 2-year-old girl is admitted to hospital because of pneumonia. She was treated by her family doctor with an antibiotic at home but with no effect. She was born on time with birth weight 3100 gr and length 51 cm. Uneventful perinatal period. She has been suffering from frequent chest infections. She has good appetite , but frequent bulky, fatty stools. On examination she looks unwell, has non-productive cough, tachypnoea at 50/min, emphysematous chest, wheeze and crepitations bilaterally. Cardio-vascular system- no abnormalities detected. Abdomen- soft, slightly distended, no palpable organomegaly. Current weight 10.5 kg, height 80 cm ( both are < 3rd centile). What tests would be most useful in making the diagnosis?(From 1 to 5 correct answers out of 5 possible answers; 1 point for each correct answer, minus 1 point for each wrong answers) A. X-ray of sinuses B. anti-tTG antibodies C.chest X-ray D. Sweat test

C.chest X-ray D. Sweat test From the history - we are assuming that the patient is suffering from cystic fibrosis due to the frequent chest infections and fatty stools. so for that reason sweat test needs to be done and X-ray to look for consolidation or other masses of concern

41. A 14-month-old child was born by emergency cesarean section at 36 gestational weeks because of abruption of the placenta with birth weight 2400 gr, length - 48сm, head circumference - 33см, with mild asphyxia. He started smiling, cooing and following object on time. He was turning from back to front at 6 months, and sitting at 9 months of age. He was standing independently and cruising around furniture at 1 year. He is still not walking independently and walks on tiptoes when held by two hands with some crossing over of both legs (scissoring). The way he plays with bricks is adequate for his age. He waves "bye-bye" and blows kisses. Says 3 words. On examination there is increased muscle tone of the thigh adductors and difficult dorsiflexion of feet. Tendon hyperreflexia for lower limbs with clonuses of both feet and positive Babinski sign bilaterally. The rest of the examination is normal. What is the most likely diagnosis? (1 correct answer)(2 Points) Cerebral palsy - spastic diplegic form Global neurodevelopmental delay Cerebral palsy- spastic quadriplegic form Congenital muscular dystrophy

Cerebral palsy - spastic diplegic form cerebral palsy also presents symptoms of the upper motor neuron disease - hypereflexia, spasicity, babinski presence, all these indicates that the cerebral palsy is present, the only the legs are affected hence its diplegic. In muscular dystrophy depending on the type, the child can not sit either or stand, there would be gowers sign. But its not in this case. child mental devlopment is fine so it is not global.

8. Which of the following does NOT cause neonatal hepatitis:(1 correct answer)(1 Point) A. Congenital listeriosis B. Herpes simplex virus C. Cytomegalovirus D. Chlamidia trachomatis

D. Chlamidia trachomatis the congenital infections - TORCH affect liver or brain Both HSV and cytomaglovirus cause neonatal hepatitis, but not 100% of the congenital listerosis and chlamydia, but from the lecture it says liver is enlarged in congenital listerosis hence the answer is D

Тhe first sign of puberty in boys is: (1 correct answer) A. Pubarche B. Growth spurt C. Voice mutation D. Enlargement of the testes

D. Enlargement of the testes order of puberty in men- testicular enlargement, penile growth pubarche, adrenarche, voice mutation then growth spurt order The first visible sign of puberty in males is testicular enlargement, while in females it is breast development. Normal order of changes: adrenarche → gonadarche (age of onset 9-14 years) → pubarche (mean age of onset 13.5 years)→ growth spurt (mean age of onset 13.5 years)→ androgenic hair growth

26. Which is NOT a cause of constipation in the neonatal period: (1 correct answer)(1 Point) A. Hirschpung's disease B.Congenital hypothyroidism C. Lactose intolerance D. Hypocalcemia

D. Hypocalcemia hypercalcemia causes constipation

When unrecognized, which of the following congenital heart defects causes cardiogenic shock in the early neonatal period:(1 correct answer)(1 Point) A. Tricuspid insufficiency B. Tetralogy of Fallot C. Atrial septal defect D. Infantile type coarctation of the aorta

D. Infantile type coarctation of the aorta in infantile type of coarctation of the aorta there is poor feeding, respiratory distress and shock develop before 2 weeks of age tricuspid infsuffiency causes RSHF tetralogy of fallot - does not affect the hemodynamics, it is a right to left shunt

10. Which of the following antidotes must be applied in paracetamol (acetaminophen) poisoning?(1 correct answer)(1 Point) A. Atropine B. Ethanol C. Sodium bicarbonate D. N-acetylcysteine

D. N-acetylcysteine

32. Newborn with congenital hypothyroidism has: (1 correct answer)(1 Point) A. Tachycardia B. Ossified bones in the left wrist C. Diarrhea D. Prolonged jaundice

D. Prolonged jaundice due to decreased cojugation of the bilirubin

An 8-year- old child is brought to the Emergency department with complaints of repeated vomiting, profuse diarrhea and abdominal pain that started 1 hour after consumption of wild mushrooms. Choose the right statement:(1 correct answer) (2 Points) A. Plasmapheresis must be performed within the first 24 hours B. We should expect development of severe liver damage C. This is Amanita phalloides poisoning, start immediate treatment with Silibinin . D. This is probably irritative mushroom poisoning, start treatment with rehydration and activated charcoal

D. This is probably irritative mushroom poisoning, start treatment with rehydration and activated charcoal

40. An 18-month-old child had tests because of significant pallor. The results show Hgb - 87 g/l, RBC - 3.5 х10/12/l , MCV - 100 fl , MCH - 34 pg, WBC- 4.8 х10/9/l , platelets - 162 х10/9/l ; LDH - 584 E/l. At 6 months of age the child was diagnosed with cow's milk allergy, so for the last year it was fed mainly goat's milk. Which is the most probable diagnosis? (1 correct answer)(2 Points) A. Iron deficiency anemia B. Fanconi's anemia C. Folate deficiency anemia D. Leukemia

Folate deficiency anemia Explanation - low folate in goats milk iron defiency anemia - low mCH and MCV fanconi - thrombocytopenia not thrombcytosis

39. A 10-year-old girl has been complaining of severe abdominal pain for the last couple of days. Since this morning the pain has increased and the child started vomiting. She was examined by a pediatric gastroenterologist, who performed an abdominal ultrasound and found infiltration of the terminal ileum. Lab results- mild normocytic anemia and thrombocytopenia. LDH - 2000 E/L; chest X-rays reveals a group of enlarged lymph nodes next to the trachea. What is the most likely diagnosis? (1 correct answer)(2 Points) Crohn's disease Non-Hodgkin lymphoma Phlegmonous appendicitis Fecaloma

Non-Hodgkin lymphoma due to the presence of lymph nodes near the trachea, GI infiltration, thrombocytopenia, mediastinal LAD

18. What is NOT true for cephalhematoma in neonates?(1 correct answer)(1 Point) A. It extends beyond the margins of the skull bone B. It is confines within the margins of the skull sutures C. It usually involves the parietal bone D. It is a bleeding below the periosteum

answer: A. It extends beyond the margins of the skull bone subperiosteal hematoma that is limited to cranial suture lines Complications: calcification of the hematoma, secondary infection No treatment required; resolves within several weeks or months

11. Bile-stained vomitting is NOT characteristic for: (1 correct answer)(1 Point) A. intestinal malrotation with volvulus B. pyloric stenosis (non-bilious vomiting) C. duodenal atresia D. meconium ileus

answer: B. pyloric stenosis (non-bilious vomiting) General rule: bilious vomiting occurs when the disease or obstruction distal to the papilla of vateri. Any obstruction or atresia proximal to it does not resolve in bilious vomiting.

9. During the first year of life the height (length) increases with: (1 correct answer)(1 Point) A. around 50 cm B. around 12 cm C. around 6 cm D. around 25cm

answer: D. around 25cm Height of newborn is (51 cm), although the normal range is 46 cm to to 56 cm. Height at birth +2cm a month 12cm increase is in 1 to 2 year old after 3 years = it increased 6cm per year

17. The most common type of arrhythmia in children is: (1 correct answer)(1 Point) A. supraventricular tachycardia B. 1st degree A-V block C. ventricular tachycardia D. 2nd degree A-V block

answer:A. supraventricular tachycardia

43. A 3-year-old girl from the first normal pregnancy and term delivery. She has been having bulky, foul smelling stool once to twice /day since she turned 1 year of age. She is quite apathetic and a fussy eater. On examination she has reduced subcutaneous fat, wasted buttocks, distended abdomen, no hepatosplenomegaly. Normal respiratory and cardio-vascular examination. Her results are: Hb- 95 g / l, MCV 60 fl (75-87), serum iron 1.7 μmol / l (10.5 - 23 μmol / l)AST -35 IU/L(0-60); ALT 40 IU/L(0-45); Creatinine 60 μmol/ (35-75), urea-5.3 mmol/ll (2.6-7.2);Urine- protein-negative; sediment-3-4 leukocytes; Tissue transglutaminase antibodies - 240 IU/l(0-15) What is the most likely diagnosis?(1 correct answer)(2 Points) A. Crohn's disease B. Chronic anemia c Chronic kidney disease d. Celiac disease

d. Celiac disease due to presence of Transglutaminase antibodies