MCQ Pediatric 6
"A 13-year-old adolescent female attained out-patient department OPD, with a complaint of feeling fat especially over the stomach and thighs; she is also feeling cold, tired, weak, and lacking energy. Examination reveals, heart rate 46 beats/min, blood pressure 70/40 mm Hg, weight below 3rd centile, dry skin, and lanugo-type hair growth on face; lab investigations shows hypokalemia and hypophosphatemia. Of the following, the MOST appropriate next action is A. admission to the hospital B. referral to psychiatrist C. referral to dietician D. make an scheduled OP visit to you and to psychiatrist E. offer partial hospital program"
A
"A 14-month-old boy has a 4-month history of intermittent diarrhea. He frequently has explosive bowel movements containing food particles. He is growing well, is otherwise healthy, and has a normal physical examination. What should be the next step? A. reassurance of parents B. stool culture C. total serum qualitative immunoglobulin measurement D. qualitative fecal fat E. prescribe oral antidiarrheal agent"
A
"A 15-month-old male child with failure to thrive, diarrhea, and fatty stool. Of the following, the MOST common possible cause of his illness is A. malabsorption B. intestinal parasites C. milk protein intolerance D. pancreatic insufficiency E. immunodeficiency"
A
"A 2-year-old boy presents with extremity swelling and proteinuria and is found on urine analysis. Minimal-change disease is suspected and you explain to the child's parents that this diagnosis A. is the most common cause of nephrotic syndrome in childhood B. has a peak incidence in children between 10 and 15 years of age C. usually results in end-stage renal disease in 5-10 years D. is characterized by normal serum lipids and cholesterol E. typically has a poor response to corticosteroid treatment"
A
"A 7-year-old child brought by his father to your clinic, the child often express fear of being injured by a car accident during transport to school. He expresses this fear to his teachers and parents. Of the following, the TRUE description of his reaction is A. non pathological anxiety B. school phobia C. separation anxiety D. generalized anxiety disorder E. panic disorder"
A
"A medical student asked you during the morning round about his observation of infants cry in response to the cry of another infant. Of the following, the MOST appropriate answer is that it represent A. an early sign of empathy development B. a sign of good hearing C. a startle reflex to a loud sound D. an early sign of fear development E. an early sign of autistic behavior"
A
"A parents came to your clinic complaining that their 5-year-old boy had attacks of frightening with imagination of a snake crawling over him and he is acting as trying to remove it. You assessed the child and find no acute physical illness and he is cooperative and quite intelligent. Of the following, the MOST appropriate explanation for the child behavior is A. acute phobic hallucination B. early sign of schizophrenia C. delusional infestation D. night terror E. bipolar disorder"
A
"A school nurse called you to see a 6-year-old boy with school refusal, he is always crying after parental leaving, refuses to stay in the class room, the school nurse informed you that she tried her best during the last 4 weeks; and she met with the parents frequently. Of the following, the BEST action is to A. refer the child to a pediatrics psychologist B. start selective serotonin reuptake inhibitor treatment C. asses the home environment D. arrange for parent management training E. give the child special attention from the teacher"
A
"A14-year-old female has progressive headaches. Examination shows bilateral papillary edema.CT-scan of the brain is normal. What should be the next diagnostic test? A. lumbar puncture with opening pressure B. MRI of the brain C. orbital CT-scan D. urine toxicology screen E. serum beta HCG measurement"
A
"Diagnosis of autistic spectrum disorder ASD. depends partly but importantly on assessment of language. All the following may raise your concern regarding language development and may indicate ASD EXCEPT A. absent babbling by 6 months B. absent gestures by 12 month C. absent single words by 16 month D. absent 2-word purposeful phrases by 24 month E. loss of language or social skills at any time"
A
"On routine examination of the children of a migrant farm worker, you notice that a 12-year-old child who has received little previous medical care is short and mentally retarded. Physical examination reveals that the liver is enlarged to 5 cm below the right rib cage, and the spleen is enlarged 6 cm below the left rib cage. Lumbodorsal kyphosis is prominent. The child has a peculiar facies with thick lips and a large tongue. Attempts to visualize the retina are unsuccessful because of clouding of the corneas. You expect that examination of this child's urine will reveal which of the following? A. dermatan and heparan sulfate B. galactose C. mannose D. the odor of maple syrup E. the odor of sweaty feet"
A
"Postanesthetic apnea is most common within the 1st 12 hr after surgery and has been reported in premature infants up to 48 hr later. General anesthesia should be avoided except for emergency surgery. in full-term infants younger than postconceptual age of A. 44 wk B. 46 wk C. 48 wk D. 50 wk E. 52 wk"
A
"You are evaluating a 5-year-old child with breath holding spells, the history given includes pallor with abnormal limb movement lasted for 5 minutes followed by sleep. All the following are true responses/advices EXCEPT A. reassurance, behavioral instruction to parents and follow up B. order MRI brain C. order an ECG D. order an EEG E. neurological consultation"
A
"You are managing a 10-year-old child with spastic quadriplasia, who is globally retarded, had recurrent seizures, and severe recurrent chest infections which requires frequent admissions to respiratory care unit RCU. and ventilation. You are trying to convince the mother about non-benefit of future RCU admissions. All of the following statements are true EXCEPT A. use an obligations of no bed availability B. consider mother emotional status and religious believes C. be empathetic D. explain disease chronicity and non-response status E. explain the suffering of child in each ventilation"
A
"You suspect the diagnosis of a brain tumor in a 2-year-old girl with a recent history of ataxia, slurred speech, and early morning vomiting. Which statement about childhood brain tumors is true? A. Most are located in the midline and/or below the tentorium cerebri. B. Brain tumors are a rare type of cancer in childhood. C. Signs of increased intracranial pressure are rare on presentation. D. seizures are the presenting complaint in most cases. E. Most cases occur in the first year of life."
A
"A newborn baby is diagnosed with a metabolic condition at 10 days of age, after she presented with vomiting, jaundice, hepatomegaly and liver failure. She was subsequently put on a lactose-free and galactose-free diet. Which enzyme is most likely to be deficient? select one answer only. A. Galactokinase B. Galactose-1-phosphate uridyl transferase C. Glucose-6-phosphatase D. Glucose-6phosphate dehydrogenase E. Phosphoglucomutase"
B
"A worried mother of a 4-year-old boy describing attacks of inconsolable crying episodes of her child, taking long time, she stated also that he prefers to play alone. Of the following, the MOST appropriate action is to A. reassures her that this is a normal phenomenon of temper tantrum B. seek more history regarding other skills and developmental domains C. refer her to pediatric psychiatry D. investigate social issues of the family E. investigate for the child abuse"
B
"A12-year-old boy has migratory arthritis with red, warm, and swollen joints. He has serologic evidence of recent group Astreptococcal infection. Arthritis in this condition is characterized by which of the following? A. usually nonpainful B. heals without deformity C. appears after the fever subsides D. seen only in patients with concurrent carditis E. involves large and small joints equally"
B
"A14-month-old boy has severe eczema, recurrent sinus and ear infections, and thrombocytopenia. What is the inheritance pattern of this disorder? A. X-linked B. autosomal dominant C. autosomal recessive D. random mutation E. multifactorial"
B
"A6-year-old girl presents with unilateral nonpainful, nonsuppurative conjunctivitis and preauricular lymphadenitis. What is the most likely causative organism? A. Mycobacterium avium B. Bartonella henselae C. Adenovirus D. Staphylococcus aureus E. Chlamydia trachomatis"
B
"A 2-week-old infant presents with apnea. The infant was born at term after an uncomplicated pregnancy. The mother of this baby had rhinorrhea and cough that started 3 weeks ago and now she has a severe persistent cough with post-tussive emesis. Which treatment should be initiated? A.ceftriaxone B. amoxicillin C. azithromycin D. vancomycin E. amantidine"
C
"A 3-year-old female child with repeated admissions as bleeding tendency in a form of spontaneous ecchymosis and bleeding through the nose and urine. She had another daughter who died because of similar undiagnosed illness. The mother is a staff nurse and she is highly concerned about her child illness. Lab investigations usually show either PT and/or PTT prolongation with normal platelets, which usually normalized after empiric vitamin K administration. The father is a petrol engineer and never seen accompanying the family. Of the following, the MOST helpful investigation is A. factor VII assay B. factor II assay C. drug level D. von Willebrand factor assay E. platelets function test"
C
"A 5-year-old girl presents with fever and headache. Imaging of the brain reveals a ringenhancing lesion. Which of the following is the most likely underlying condition in this child? A. chronic renal failure B. idiopathic or familial epilepsy C. congenital cyanotic heart disease D. chronic or recurrent tonsillitis E. Langerhans cell histiocytosis"
C
"A 7-year-old boy presented to the out-patient department with fever and cough, you have diagnosed him as a case of pneumonia and decided to admit and give parental therapy, the child refused. Of the following, the BEST response is to A. explain to father about dangers of omitting treatment B. try to explain the risk to the child C. give the chance for oral antibiotics and accept the child decision D. inform your consultant E. inform hospital ethical committee"
C
"A 7-year-old boy presented with recurrent eye blinking behavior and recurrent extension of extremities, mother describe the movement as sudden, rapid, and repetitive movements, it was present in the last 9 months. Of the following, the MOST appropriate diagnosis is A. Tourette's disorder B. persistent motor tic disorder C. provisional tic disorder D. post-viral encephalitis E. Sydenham chorea"
C
"A 9-year-old male with good school performance and normal behavior. In the last 2 months he had changed his classroom. His teacher observed that he became introverted and his school performance reduced dramatically. He was always described by some of his new school mates as a ""weak"". Of the following, the MOST likely diagnosis is A. school phobia B. anxiety disorder C. bullying D. hypothyroidism E. depression"
C
"A child with polyosteotic fibrous dysplasia of the bones and abnormal skin pigmentation is diagnosed with McCune-Albright syndrome. What other problem is this patient most likely to develop? A. anemia B. deafness C. precocious puberty D. multiple neurofibromas E. chronic glomerulonephritis"
C
"A concerned young parents asking about frequent lying behavior experienced by their 3-year-old girl. The following advices are true EXCEPT A. it is a method of playing with the language B. it is a part of their magical thinking C. it indicates a potential for future lying behavior D. it is an approach to avoid unwanted confrontation with adults E. it is a way to describe things as they wish"
C
"A full term neonate with Down syndrome and esophageal atresia admitted in Pediatric intensive care unit PicU.. The parents want "no interference"" approach. Of the following, the BEST response is to A. act according to parents well B. arrange the operation with the surgeon C. work for the patient best interest D. give supportive care only DANR. E. wait for a clear legislation"
C
"A mother to a 4-year-old child who has pauses and repetitions of initial sounds visited outpatients department. Of the following, the MOST appropriate advice is A. this is a normal phenomenon affecting about 5% of preschool children B. there is no need for action as 80% of affected children recover by their own C. tries to reduce pressures associated with speaking D. I'll refer him to ENT specialist for further evaluation E. I'll refer him to speech therapist"
C
"A mother to a well 2-year-old girl with thumb sucking behavior, she is worried that the behavior may continue or may cause dental problem. Of the following, the BEST response is to A. reassurance to mother B. leave the behavior as the complications usually started after 5 years C. ignore thumb sucking and encouraging a substituted behavior D. use of bitter ointments will resolve the problem early E. asses the social status of the family"
C
"A previously well 12-year-old girl presents to clinic because of painful swellings on the front of the legs of about 3 days' duration. Examination reveals tender erythematous nodules, 1-2 cm in diameter, on the extensor surfaces of the lower legs. The remainder of the physical examination is unremarkable. Which of the following is most likely to confirm the cause of this condition? A.stool smear and culture B. urine analysis and BUN C. throat culture D. slit-lamp examination of the eye E. echocardiogram"
C
"A young couples of a 2-month-old baby girl with excessive crying seek your medical advice. Mother said that the baby is crying about 3 hr in a day, 2-3 days per week. She is intermittently spitting but she is gaining weight adequately. She is bottle fed baby. Of the following, the leAST important advice is to A. master the situation in relaxed manner B. adhere to precry cues C. change milk formula D. avoid sensory overstimulation E. reassure about benign nature of illness"
C
"A16-month-old girl presents with acute onset of truncal ataxia with vomiting, nystagmus, and dysarthria. She is afebrile and has no nuchal rigidity. Which of the following historical items would help you to identify a cause for these symptoms? A. elevated lead level at the age of one year B. febrile seizure episode at the age of 13 months C. sore throat with blisters on palate 3 weeks ago D. febrile illness with rash 2 months ago E. first MMR vaccination 1 month ago"
C
"A3-month-old infant is hospitalized because of recurrent right focal seizures that are now generalized in nature. Birth and perinatal history are unremarkable. You note that the child has a flat, purplish-red skin lesion on the left side of the face extending onto the forehead. The remainder of the examination including a complete neurologic examination is within normal limits. The results of a lumbar puncture are normal. You order a CT scan of the head and anticipate seeing which of the following? A. agenesis of the corpus callosum B. a porencephalic cyst C. gyriform calcifications D. hydrocephalus E. normal findings"
C
"A38-week infant is born to a mother with gestational diabetes. Birth weight is 4255 g. What would you expect to see most commonly in this infant? A. neural tube defect B. small left colon syndrome C. cardiomegaly D. hydronephrosis E. renal dysplasia"
C
"A5-year-old girl diagnosed with pauciarticular juvenile idiopathic arthritis has a positive antinuclear antibody test. Which of the following would most likely be found in this patient? A. pericarditis B. nephritis C. uveitis D. splenomegaly E. lymphadenopathy"
C
"Acellular pertussis vaccine is recommended for infants, children, adolescents, and adults. Compared to the previously available whole cell vaccine, which of the following best describes these products? A. they are more immunogenic B. they are less expensive C. they are associated with fewer side effects D.they require fewer doses E. they can be combined with the varicella vaccine for the infant under age 1 year"
C
"An 8-year-old boy is referred for new-onset seizures. Which of the following would mostly support a diagnosis of complex partial psychomotor seizures? A. normal mental state, consciousness, and responsiveness during seizure B. a brief tonic-clonic phase C. automatisms D. three-per-second spike-and-wave pattern on EEG E. normal mental state, consciousness, and responsiveness after seizure"
C
"Anewborn has delayed passage of meconium stools and barium enema radiograph shows dilated proximal colon and small obstructed distal colon. What should be the next diagnostic test? A. abdominal CT-scan B. stool studies C. rectal suction biopsies D. sweat chloride testing E. chromosome analysis"
C
"Emily is a 2-year-old girl. She presents to the Emergency Department with a 2-day history of fever, vomiting and 'smelly' urine. She has no significant medical history and is not on any medication. On examination she has a temperature of 39°C and has a heart rate of 126 beats/min. She has generalized tenderness over her abdomen. What is the best way to collect a urine sample from her? select one answer only. A. Bag sample B. Catheter sample C. Clean catch D. Pad/cotton wool balls in nappy E. Suprapubic aspirate"
C
"Jonathan is an 8-year-old boy. He has a medical history of urinary tract infections. On this occasion he presents to hospital with acute spasmodic pain on the left side of his abdomen. He says it is the worst pain he has ever experienced. He played football yesterday but had not hurt himself. On examination he is afebrile and his abdomen is soft with no guarding. He is tender in his left loin and there are no palpable masses. He has 2+ of haematuria on dipstick of his urine but no protein or leucocytes. He is not on any medication. What is the most likely cause of his pain? select one answer only. A. Constipation B. Glomerulonephritis C. renal stone D. Trauma E. Wilms tumour "
C
"Postoperative nausea and vomiting PONV. occurs in the immediate postoperative period, within the 1st 1-2 hr, or several hours after surgery and anesthesia. All the following may decrease the incidence of PONV EXCEP A. hydration B. use of ketorolac C. preoperative fasting D. glucose supplementation E. prophylactic use of ondansetron"
C
"Samina is 12-years-old and has hepatomegaly. She is short for her age, suffers from hypoglycaemia and needs an overnight feed via a nasogastric tube. What is the most likely diagnosis? select one answer only. A. Congenital adrenal hyperplasia B. Familial hypercholesterolaemia C. Glycogen storage disorder D. Phenylketonuria E. Urea cycle defect"
C
"The well-child care anticipatory guidance. intends to promote the physical and emotional well-being of children. The tasks of each well-child visit which usually takes 18 min time. include all the following EXCEPT A. disease detection B. disease prevention C. treatment plans D. health promotion E. accident prevention"
C
"Worldwide, which of the following factors is most important in predicting neonatal mortality? select one answer only. A. Birth order B. Household wealth C. Maternal educational achievement D. Paternal educational achievement E. Urban versus rural residency"
C
"You are specialist explaining the developmental implication of a 6-month-old baby boy who ""transfers object hand to hand"" to college students. Of the following, the BEST statement describing that is a/an A. visuomotor coordination B. voluntary release C. comparison of objects D. ability to explore small objects E. increasing autonomy"
C
"You suspect the diagnosis of Werdnig-Hoffman disease in an infant with severe hypotonia. Which other finding will support this diagnosis? A. normal deep tendon reflexes B. seizures C. fasciculations of the tongue D. recurrent fevers E. atrophy of the optic nerve"
C
"retinal hemorrhages are an important marker of abusive head trauma AHT. Whenever AHT is being considered, a dilated indirect eye examination by a pediatric ophthalmologist should be performed. All the following are characteristic of retinal hemorrhage caused by AHT EXCEPT A. multiple B. involve more than one layer of the retina C. central D. traumatic retinoschisis E. various sizes"
C
"Amother of a 2-month-old wants more information about immunizations. Which of the following statements regarding immunization against Haemophilus influenzae type b Hib. is correct? A. It is indicated for high-risk children only. B. Hib vaccine can be administered effectively as early as 2 months of age. C.Hib vaccine should not be given to children who have had allergic reactions to eggs. D. Hib vaccine should not be administered to children with a history of reaction to DTaP immunization. E. Hib vaccine should be deferred for infants with history of febrile seizures."
B
"An 8-month-old infant with confirmed diagnosis of spinal muscular atrophy type 1 referred back from tertiary care center with ""DNAR"" status. This means during acute illness or an emergency the child should A. receive standard care and adrenaline injection B. receive supportive care C. receive active resuscitation but not mechanical ventilation D. O2 is not part of treatment options E. none of the above"
B
"Anormal 6-month-old infant has a continuous cardiac murmur and bounding peripheral pulses. What step should be taken next? A. karyotype evaluation B. surgical or catheter correction of the defect C. life-long endocarditis prophylaxis for atrisk procedures D. repeating examination at the age of 12 months E. reassuring of the parents"
B
"Aterm infant is born to a mother who has been using crack cocaine. This infant is at increased risk for which of the following? A. anemia B. intrauterine growth retardation C. hypercalcemia D. macrosomia E. postmaturity"
B
"Becky is a 7-year-old girl. She is seen by her general practitioner with a 2-day history of fever and abdominal pain. Her mother has noted that she is going to the toilet to pass urine more often than usual. On examination she is now afebrile and has no abdominal tenderness. What is the most likely diagnosis? select one answer only. A. Appendicitis B. Cystitis C. Diabetic ketoacidosis D. Glomerulonephritis E. Pyelonephritis"
B
"Fentanyl anesthesia used as analgesia to provide pain relief during operative procedures in neonates. reduces the incidence of all the following postoperative conditions EXCEPT A. acidosis B. tachycardia C. hypotension D. coagulation abnormalities E. intraventricular hemorrhage"
B
"Of those babies who have prolonged crying episodes in the first 2 mo of life, the percentage that will remain having similar episodes is about A. 1% B. 5% C. 10% D. 30% E. 50%"
B
"You have just confirmed the diagnosis of cystic fibrosis in a 3-year-old child. The parents are concerned about future pregnancies. You explain to them that the pattern of genetic transmission of cystic fibrosis is A. autosomal dominant B. autosomal recessive C. X-linked recessive D. X-linked dominant E. autosomal recessive in some families and X-linked in others"
B
"A 3-month-precious baby of a keen and highly EDucated family presented with history of URTI followed by deterioration of level of consciousness and seizure. CT brain shows intracranial bleeding with no evidence of skull fracture. Fundocscopy was normal. Mother gives history of difficult labour but with normal development, mild hypotonia, and macrocephaly which was reassured initially by general Pediatrician. Of the following, the MOST likely diagnosis is A. residual birth trauma B. arteriovenous malformation C. acute viral encephalitis D. glutaric aciduria type 1 E. abusive head trauma AHT."
D
"A term infant requires intubation in the delivery room after aspiration of thick meconium and is brought to the neonatal intensive care unit. Which of the following is the most likely risk factor for meconium aspiration syndrome in this infant? A. chromosomal anamoly B. congenital heart disease C. cystic fibrosis D. fetal distress E. tracheoesophageal fistula"
D
"A12-month-old infant is unable to sit by herself and parents have noticed an exaggerated startle response. What are you most likely to find on physical examination? A. holosystolic murmur B. absent knee-jerk reflex C. syndactyly D. cherry red macular spot E. bilateral inguinal hernias"
D
"A12-year-old boy just returned from Boy Scout Camp in Wisconsin. He now has fever, myalgia, and a 10-cm skin lesion which looks like a target. You suspect Lyme disease, most likely contracted by which of the following? A. ingestion of unripe fruit B. ingestion of spoiled fruit C. drinking of contaminated water D. the bite of a tick E. the bite of a mosquito"
D
"An 8-year-old child is hospitalized because of paroxysms of severe colicky abdominal pain which does not radiate to the back or the groin. Physical examination is unremarkable except for generalized abdominal tenderness. An exploratory laparotomy reveals an edematous intestine without specific lesions. The appendix appears normal but is removed. Postoperatively the abdominal pain persists, and hematuria develops. Values for BUN and creatinine are normal. On the second postoperative day, tender swelling of both ankles and knees is noted. Which of the following additional findings would most likely be present in this child? A. shock B. meningitis C. hepatitis D. a purpuric rash E. hemorrhagic pancreatitis"
D
"An infant is born to a mother who is HBsAg positive. What should be the next step? A. Check hepatitis B serology on infant and give hepatits B immune globulin if indicated. B. Give infant hepatitis B immune globulin. C. Vaccinate infant with hepatitis B vaccine. D. Give infant hepatitis B immune globulin and hepatitis B vaccine. E.Start infant on formula and discourage breastfeeding."
D
"James, aged 11 years, has type 1 diabetes mellitus. While playing football during the mid-morning break at a holiday camp, he suddenly feels faint. His classmates call the supervisor who finds him lying unresponsive in the playground. What should be his immediate management? select one answer only. A. Call an ambulance B. Check blood glucose C. Give a glucose drink D. Give buccal glucose gel E. Give insulin"
D
"Parents of a 4-year-old boy complaining that he is refusing to go to bed, he remains active and playing. Of the following, the MOST likely cause of this child problem is A. thyrotoxicosis B. ADHD C. primary sleep disorder D. limit setting; behavioral insomnia of childhood E. behavioral insomnia of childhood, sleep-onset association"
D
"Patient culture can change the doctor treatment options and even the way of behavior with the patient. All the following culture values are expected if he is dealing with Muslim patients EXCEPT A. fasting during Ramadan month B. modesty and female body cover C. forbiddance of touch and shake hands of opposite sex D. routine postmortem exam E. patriarchal way of decision making"
D
"Polly is a 2-year-old girl who is receiving chemotherapy for her acute lymphoblastic leukaemia. She is known to be neutropenic and has developed a fever of over 38.5°C. What is the most appropriate course of action? select one answer only. A. Be admitted to hospital for observation B. Be started immediately on oral antibiotics C. Have her blood count and inflammatory markers e.g. C-reactive protein. measured D. Have blood cultures taken and be started on intravenous antibiotics E. see her general practitioner for further assessment and decision regarding antibiotics"
D
"Postoperative nausea and vomiting PONV. may be related to the stress, trauma of surgery, and pain. Of the following, the MOST likely drug that cause PONV is A. ketorolac B. droperidol C. acetaminophen D. opioid analgesics E. local anesthetic agents"
D
"A 12-year-old girl develops jaundice, progressive tremors, and emotional lability. You are most likely to find which of the following during physical examination? A. head circumference greater than 95th percentile B. brown discoloration of the limbic region of the cornea C. bilateral conductive hearing loss D. generalized lymphadenopathy E. sacral hair tuft and dimple"
B
"A 2-year-old child is admitted because of weakness proceeding to coma. According to the parents, he had been well until several hours prior to admission, when they noted diarrhea, cough, wheezing, and sweating. Physical examination reveals a comatose child with diffuse weakness and areflexia. Pupils are pinpoint and unresponsive. Examination of the chest reveals generalized wheezing. Oral secretions are copious. Which of the following should you administer at this time? A.adrenaline B. atropine C. cefotaxime D. methylprednisolone E.edrophonium"
B
"A 2-year-old toddler has a large abdominal mass and pancytopenia. Which of the following diagnoses would most likely be established by bone marrow aspiration? A. hepatoblastoma B. neuroblastoma C. renal cell carcinoma D. rhabdomyosarcoma E. Wilms tumor"
B
"A highly careful mother of a 10-month-old baby boy complaining that her baby has inadequate weight gain. She explained to you how she is so strict and so careful to feed her baby by spoon, but he was always refusing. Of the following, the least helpful advice is to A. respect infant independence B. offer softer diet C. use 2-spoons 1 for the child and 1 for the parent. D. use finger foods E. use high chair with tray table"
B
"A mother of 4-month-old baby boy complaining that the baby never goes to sleep unless he is rocked for quite long time. She needs to repeat the same issue whenever he is awake at night. She was surprised as no one of her previous babies had the similar behavior. She feels tired because of insufficient sleep. Of the following, the MOST common cause of this baby problem is A. an early signs of ADHD B. behavioral insomnia of childhood, sleep-onset association C. primary sleep disorder D. restless legs syndrome E. sleep terrors"
B
"A 10-year-old boy has been having episodes of repetitive and semipurposeful movements of the face and shoulders. The parents believe these movements are worse when the child is under emotional stress. They also volunteer that they have never noted the movements while the patient is asleep. The movements have been present for more than 6 months. The parents are now especially concerned because the child has developed repetitive episodes of throat clearing and snorting. Physical and neurologic examinations are entirely normal. During the examination you note that the child has some blinking of the right eye, twitching of the right face, and grimacing. You ask him to stop these movements, and he is temporarily successful in doing so, but the movements recur. The home situation, social history, and child's development and social adjustment appear normal. A head CT scan is normal. Of the following, which would be the most appropriate next step? A. order an electroencephalogram B. prescribe carbamazepine C. prescribe corticosteroids D. prescribe haloperidol E. refer the child to a psychiatrist"
D
"A 16-year-old G1P1 mother complaining of reduced milk production and breasts engorgement. She stated that she feels unhappy and scared most of the times. Her husband is a soldier and she is living with his family. Of the following, the MOST appropriate action is to A. refer her to obstetrician B. explain the appropriate way of milk expression C. advice milk stimulant medications D. apply edinburgh postnatal scale E. stop breast feeding"
D
"A 2-month-old infant has severe dyspnea and cyanosis. Chest roentgenogram reveals minimal cardiomegaly and a diffuse reticular pattern of the lung fields. Which of the following best explains these findings? A. acute viral myocarditis B. hypoplastic left heart syndrome C. pulmonary artery atresia D. total anomalous pulmonary drainage with venous obstruction E. transposition of the great arteries"
D
"A 2-year-old African-American child presents with painful swelling of the hands and feet. Laboratory evaluation reveals hemoglobin of 9 g/dL with white blood cell count of 11,500 and platelet count of 250,000. Which additional laboratory test will support your diagnosis? A. skeletal survey B. VDRL testing C. bone marrow aspiration D. hemoglobin electrophoresis E. serum calcium measurement"
D
"A 3-month-old baby girl admitted to pediatric intensive care unit with severe head injury evident by CT scan., the history given by parents was trivial and not informative. You suspected child abuse. Of the following, the MOST helpful study to support your suspicion is A. infantogram one shot for entire body. B. lateral and AP view X ray of the spine C. lateral and AP view X ray of skull D. radionuclide bone scan E. MRI brain"
D
"Tariq, who is 6 weeks old, is admitted directly from the cardiology clinic with heart failure. He has a large ventricular septal defect. The cardiologist has recommended treatment with furosemide and spironolactone. His mother wants to know why he has only now started to have problems. Which of the following statements provides the best explanation? select one answer only. A. At birth and for the first few weeks the ductus arteriosus remained patent and this balanced the flow across the septal defect B. Pulmonary vascular resistance is increasing and blood is now flowing from right to left C. The left ventricle is now failing due to its progressive dilatation D. The pulmonary vascular resistance falls after birth and now flow from left to right across the septal defect is much greater E. Volume overload results in decreased return to the left ventricle and a reduction incardiac output related to a reduced end-diastolic filling pressure"
D
"You are resident in Pediatrics, called at midnight to attend delivery of expected baby with multiple malformations and oligohydromnias as had been reported in antenatal scan, mother in stage I labor so far. Of the following, your BEST plan of action is to A. counsel the parents that you will go for DNAR. status B. start your usual resuscitation waiting for your senior C. explain that the result of antenatal scan is final D. call your consultant or senior resident E. apply palliative care for the coming neonate"
D
"You are treating acutely ill 6-year-old child with ascending paralysis, he eventually needs mechanical ventilation. Now you are in a situation of using the last bed in respiratory care unit RCU.. Of the following, the BEST approach is to A. try to convince the parents that, there is no use of ventilation B. keep the bed for more treatable condition C. try bedside ventilation D. consider this case as potential treatable condition and use the last bed E. contact a nearby region RCU and transfer the child"
D
"You examine an 18-year-old male college student with a 5-day history of fever, sore throat, and fatigue. Physical examination reveals an exudative tonsillitis and bilateral enlarged and slightly tender posterior cervical lymph nodes. The spleen is palpable 3 cm below the rib cage. Which agent is most likely responsible for this patient's illness? A. Group A β-hemolytic streptococcus B. Adenovirus C. Toxoplasma gondii D. Epstein-Barr virus E. Corynebacterium diphtheriae"
D
"You follow a patient with craniosynostosis and congenital malformations of the head and face in your clinic. What other congenital malformations will you most likely find in this patient? A. trachea and esophagus malformations B. heart malformations C. genitourinary tract malformations D. extremity malformations E. spine malformations"
D
"You have just prescribed phenytoin for a 12-year-old boy with new onset of epilepsy. Of the following side effects, which is most likely to occur in this patient? A. lymphoma syndrome B. Raynaud phenomenon C. acute hepatic failure D. gingival hyperplasia E. optic atrophy"
D
"A 4-year-old boy has failed to grow and has evidence of exocrine pancreatic insufficiency.What is the most likely cause for this? A. acute pancreatitis B. biliary atresia C. Swachman-Diamond syndrome D. congenital absence of the pancreas E. cystic fibrosis"
E
"A concerned parents of an 18-month-child which expressed a brief tonic movement after being upset and cried. All the following are true advices EXCEPT A. investigate possibility of iron deficiency anemia B. avoid over concern behavior C. interfere early in the event by calming the child D. try to behave calmly, observe the child without being seen E. arrange for home rectal diazepam"
E
"A newborn has been diagnosed with aniridia. Which of the following tests should be performed on this patient? A.chest radiograph B. alpha-fetoprotein measurement C. renal function testing D. testicular examination E. renal ultrasound"
E
"A newborn infant with stigmata of Down syndrome has a heart murmur. Which of the following cardiac lesions is most likely in this baby? A.hypoplastic left heart syndrome B. total anamolous venous return C. coarctation of the aorta D.anamolous coronary artery E.atrioventricular defect"
E
"A12-year-old child is seen because of a rash and severe headache which began 2 weeks after returning from vacation in Massachusetts. The skin lesion began as a red macule on the thigh, which gradually expanded over 1 week to reach approximately 15 cm in diameter with red borders and central clearing. The lesion is slightly painful. Afew days after the onset of the skin manifestation, the child developed severe headache, myalgias, arthralgias, and malaise. Low-grade fever was present. The mother recalls that the child was bitten by a tick about 1 week prior to the onset of symptoms. This patient's disorder is probably best treated with which of the following? A. corticosteroids B. diphenhydramine C. methotrexate D. nonsteroidal anti-inflammatory drugs E. doxycycline"
E
"A3-week-old infant is admitted with vomiting of 5 days' duration. Physical examination reveals a rapid heart rate, evidence of dehydration, and ambiguous genitalia. serum electrolytes are Na+ 120 meq/L, K+ 7.5 meq/L, HCO3−12 meq/L,BUN 20 mg/dL. In addition to intravenous fluid replacement with normal saline, administration of which of the following would be most important? A. diuretics B. potassium exchange resin C. glucose and insulin D. antibiotics E. hydrocortisone"
E
"An 18-month-old toddler has microcytic anemia. Which dietary history finding best explains this? A. pica B. lack of fresh vegetables in the diet C. intake of inadequate amounts of fruit juice D. intake of excessive amounts of vitamin C E. intake of large amounts of unmodified cow's milk"
E
"An 8-month-old child has vomiting and screaming episodes for 12 hours. Physical examination reveals a sausage-shaped mass in the right upper quadrant. Which of the following would be most useful? A. passage of nasogastric tube B. examination of a stool specimen for ova and parasites C. blood culture D. abdominal ultrasound E. barium enema study"
E
"An infant has been diagnosed with congenital hypoparathyroidism. What are you most likely to find on evaluation? A. microcephaly B. hyponatremia C. hyperkalemia D. goiter E. candidiasis"
E
"Between 2-6 months of life, the infant start to achieve a regular sleep-wake cycles.All the following are true about infant sleep during this period EXCEPT A. total sleep hours are about 14-16 hr/24 hr B. sleeps about 9-10 hr concentrated at night C. sleeps 2 naps/day D. sleep electroencephalogram shows the mature pattern E. the sleep cycle time is similar to that of adults"
E
"Ellie, a 7-year-old girl, is newly diagnosed with diabetes mellitus. She has been drinking lots of fluid and has had to pass urine frequently. She has a markedly raised blood glucose 20 mmol/L. and heavy glycosuria. Which of the following is most likely to be true about her diabetes? select one answer only. A. Her diagnosis should be confirmed with an oral glucose tolerance test B. She can be managed with oral hypoglycaemic agents and dietary modification C. She will have gained weight in the last few weeks D. The incidence in the UK is falling E. There is autoimmune pancreatic β-cell damage"
E
"It is recommended that young infants should sleep in the supine rather than in the prone position. This is based on data suggesting that the prone position is associated with an increased incidence of which of the following? A. delayed eruption of the first deciduous teeth B. gastroesophageal reflux and aspiration C. macrognathia D. strabismus E. sudden infant death"
E
"John, who is 6 years old, presents to the Emergency Department feeling sick and dizzy. He was brought to hospital by a paramedic crew who were called after he became unwell at school. His heart rate was noted to be very quick, at 260 beats/min and supraventricular tachycardia is diagnosed. He says he can feel his heart beating quickly and looks pale. He is crying, saying he wants his mother. Which of the following should be undertaken by the attending team? select one answer only. A. Adenosine via a large bore intravenous line B. Bilateral carotid sinus massage C. Direct current cardioversion D. reassure that it will resolve spontaneously E. Vagal stimulation manoeuvre"
E
"Malignant hyperthermia is an acute hypermetabolic syndrome that is triggered by inhalational anesthetic agents and succinylcholine. Of the following, the MOST recognized clue to the risk of malignant hyperthermia is A. hypercarbia B. rapid onset of fever C. ventricular fibrillation D. acute hemoglobinuria E. rigid clenching of the masseter muscles"
E
"Which of the following causes of death in childhood is likely to increase most in the next 15 years? select one answer only. A. HIV infection B. Malaria C. Malnutrition D. Pneumonia E. Trauma"
E
"Worldwide, which of the following conditions is most likely to result in the death of an individual child before their fifth birthday? select one answer only. A. Gastroenteritis B. HIV Human immunodeficiency virus. infection C. Injuries D. Malaria E. Prematurity"
E
