Paeds Mcqs

The most common cause of acute gastroenteritis in childhood is: A. Viruses B. fungi C. toxins D. bacteria - Shigella, Salmonella, Campylobacter

answer: A. Viruses Rotavirus up to 60% of cases in less than 2 years old, adenovirus, novovirus and calcivirus, coronavirus and Astrovirus. Bacterial causes are less common in developed countries but may be suggested by the presence of blood in the stools.

What are the most common causes for infant mortality worldwide? A. HIV, malaria B. Congenital abnormalities, Prematurity C. malnutrition D. injuries, drownings

answer: B. Congenital abnormalities, Prematurity According to the Centers for Disease Control and Prevention (CDC), the leading causes were congenital abnormalities, low birthweight and preterm birth, maternal pregnancy complications, sudden infant death syndrome (SIDS) and unintentional injuries. The answer is also found in the lecture slide 3 - infants (0-12 month age ). The 3 main causes of infants' death (0-12mo age) 1. Prematurity, anoxia, other neonatal diseases - ~30-40% 2. Malformation - ~25% 3. Pneumonia and other respiratory diseases ~20% Resolve

Which of the following conditions is an absolute contraindication for breastfeeding? A. prematurity B. Galactosemia C. Breast milk jaundice D. Hypoglycemia

answer: B. Galactosemia Galactosemia is a genetic metabolic condition in which there is defect in the bodys ability to use the galactose sugar. Galactose makes lactose when combined with glucose, which the sugar found in milk, excess galactose in the body can cause many problems such liver, kidney, brain and cataract. Hence Milk products should be stopped. In breast milk jaundice, the condition is temporary and lasts for 4-5 weeks. It is prevented by reducing the frequency of breast feeding not cessation, in breast milk jaundice usually phototherapy is used or formula milk can be used. Breast milk does not cause the jaundice it might just make it worse, the cause is high levels of jaundice.

In persistent ductus arteriosus there is A. Reduced pulmonary vascular markings on chest X-ray B. continuous murmur below the left clavicle C. weak peripheral pulses D. Cyanosis

answer: B. continuous murmur below the left clavicle continuous mumur is present in left infraclavicular region, thrill may be palpable, murmur radiates along pulmonary arteries as well heard over the left back. Resolve there is widened pulse pressure on chest x-ray full pulmonary artery silhouttee and increased pulmonary vascularity it is a left to right shunt = Left-to-right shunts do not cause cyanosis at birth but can ultimately result in heart failure because of volume overload.

24. Haemorrhagic disease of the newborn is due to:(1 correct answer)(1 Point) A. hypofibrinogenemia B. deficiency of vit.K dependent factors of coagulation C. factor VII deficiency D. factor IX deficiency

answer: B. deficiency of vit.K dependent factors of coagulation Familial hypofibrinogenemia is a coagulation disorder characterized by mild bleeding symptoms following trauma or surgery due to a reduced plasma fibrinogen concentration.

Autoimmune hepatitis may occur in association with A. Wilson's disease B. Cystic fibrosis C. Inflammatory bowel disease (Autoimmune hepatitis is associated with other autoimmune diseases such as IBS; Hashimoto thyroiditis; SLE; Grave's disease etc) D. Thalassemia major

answer: C. Inflammatory bowel disease

17. Bilirubin can be found in the urine of newborns in all EXCEPT:(1 correct answer)(1 Point) A. neonatal hepatitis B. atresia of bile ducts C. haemolytic disease of the newborn D. congenital infection

answer: C. haemolytic disease of the newborn

A 5-year-old girl was hospitalized due to macroscopic hematuria for several days and a palpable mass in the right abdominal half, not crossing the midline. On physical examination she looks well. What is the most likely diagnosis?(1 correct answer)(2 Points) A. Nephroblastoma B. Pheochromocytoma C. Congenital hydronephrosis D. Neuroblastoma

A. Nephroblastoma Explanation Nephroblastoma or wilms tumor is Palpable abdominal mass (Non-tender Unilateral and large) but not crossing midline Smooth and firm Abdominal pain, presents with hematuria and hypertension. Neuroblastoma crosses the midline

The most common cause for obesity in children is A. Over-nutrition B. Type 2 Diabetes Mellitus C. Hypothalamic disorders D. Chromosome disorders

A. Over-nutrition

8. The innocent / accidental / heart murmurs are characterized by the following features: (1 correct answer)(1 Point) A. They are usually systolic. B. They are combined with cardiomegaly c. They often propagate to the axilla. D. They are usually loud - 3-4th degree.

A. They are usually systolic. Innocent heart murmurs are harmless sounds made by the blood circulating normally through the heart's chambers and valves or through blood vessels near the heart. They can be common during infancy and childhood and often disappear by adulthood. (5's => asymptomatic; soft; systolic murmurs only; heard on left sternal edge & normal S1 & S2 sounds heard)

23. Which of the following diseases is characterized by short stature and absent puberty: (1 correct answer)(1 Point) A. Turner syndrome B. Down syndrome C. Graves disease D. Kleinfelter syndrome

A. Turner syndrome

The triad of congenital heart defect, blindness and deafness is typical for which congenital infection:(1 correct answer)(1 Point) A. congenital rubella B. congenital cytomegalovirus infection C. congenital toxoplasmosis

A. congenital rubella (3 C's => Cardiac defect; cochlear defect & cataract)

35. What is NOT part of the extramedullary blast infiltration syndrome in acute lymphoblastic leukemia:(1 correct answer)(1 Point) A. petechial rash B. Lymphadenomegaly C. hepatomegaly D. renal involvement

A. petechial rash petechial rash occurs due to bone marrow infilteration not extramedullary, it is intramedullary.

The most common cause of acute bronchiolitis is: (1 correct answer)(1 Point) A.respiratory syncytial virus /RSV/ B. influenza virus C. adenovirus D. Rhinovirus

ANSWER: A.respiratory syncytial virus /RSV/ IN 80% OF THE CASES RSV IS THE CAUSE

25. Expiratory dyspnea is a sign in:(1 correct answer)(1 Point) A. viral laryngotracheobronchitis (croup) B. bronchial asthma C. retropharyngeal abscess D. Epiglottitis

ANSWER: B. bronchial asthma croup causes inspiratory dyspnea and so do other diseases because they affect the upper re

An 18-month-old boy is admitted at the Pediatric Department for abdominal bloating, irritability, loss of appetite and intermittent diarrhoea. On examination he looks unwell and is irritable, with reduced subcutaneous fatty tissue, distended abdomen. Laboratory results show significant increase of anti-tissue transglutaminase antibodies (anti-tTG Ab) and endomysial antibodies (EMA). What is your diagnosis: (1 correct answer)(2 Points) A. Milk protein intolerance B. Cystic fibrosis C. Coeliac disease D. Crohn's disease

Answer: C. Coeliac disease Explanation the presence of the Anti-tTG antibodies is a characteristic finding for celiac disease

4-year-old girl is admitted to hospital due to vomiting and watery stools for 2 days. On examination she is drowsy, has sunken eyes, reduced turgor and elasticity of the skin, acetone breath, HR 140/min, RR 30/min, BP 80/40 mmHg. Abdomen is soft, normal bowel sounds. Which urgent tests will you request: (1 correct answer)(2Points)? A. lumbar puncture to rule out meningitis B. stool culture C. blood for complete blood count, electrolytes, urea, creatinine, uric acid, blood glucose, CRP D. abdominal ultrasound to rule out intussusception

Answer: C. blood for complete blood count, electrolytes, urea, creatinine, uric acid, blood glucose, CRP Explanation 1. Ace tone breath - suggests Diabetic ketoacidosis 2. Dehydration signs due to vomitting 3. increased HR and low BP Due to suspecting of DKA, we need to test the glucose levels, CBC is needed for checking infection and CRP as well. AKI can develop due to secondary infection hence that would also be tested.

An 18-month-old, previously healthy, child develops diffuse petechial rash all over the body and bleeding from the gums 10 days after vaccination (measles, mumps, rubella). The rest of the physical examination is normal. Blood tests shows values of hemoglobin, RBC and WBC, but low level of PLT - 12 x10 / 9 / l. What is the right management in this case?(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. Immediate corticosteroid treatment B. Urgent platelet transfusion. C. Rituximab therapy D. Treatment with corticosteroid, but after a bone marrow biopsy E. Treatment with high-dose immunoglobulin

Answer: A Explanation The patient has developed thrombocytopenia, the thrombocytopenia is severe due to the PLT levels being less than 20x10/9/l. A - steroids are the first line B- only needed when life threatening C- Rituximab is started after 6 months or after chronic thrombocytopenia is established D - Bone marrow biopsy is not needed as only thrombocytes are low. E. it can be considered, if the first line which is corticosteroids do not work

A 16-year-old girl with a known small ventricular septal defect (VSD) had a tattoo done 10 days ago. For the last 6 days she has been having fever up to 39oC with chills, malaise and painful and swollen knees, ankles and wrist joints. On examination she has fever 38.1oC, RR 18/min, HR 110/min. The fore-mentioned joints are oedematous, with increased local temperature and reduced range of movement. Her initial lab results are: Hgb 88 g/l, MCV 85 fl, WBC 24x109/L, Plt 290x109/L,ESR 60mm/h, urine - protein 1+, RBC 40/hpf. Echocardiography confirms small VSD. Which of the following investigations will be most useful in guiding her management: (1 correct answer)(2 Points) A. several blood cultures B. urine culture C. serology for hepatitis B D. rheumatoid factor

Answer: A. several blood cultures Explanation from the findings, it shows that child has an infection - the presence of fever and chills, then also presence of swelling on joints which is a sign of inflammation - systemic. As this child has an congenital heart condition, she is more prone to developing infective endocarditis and in this case this child has a history of getting a tattoo which increases suspicion

A 16-year-old girl with a known small ventricular septal defect (VSD) had a tattoo done 10 days ago. For the last 6 days she has been having fever up to 39oC with chills, malaise and painful and swollen knees, ankles and wrist joints. On examination she has fever 38.1oC, RR 18/min, HR 110/min. The fore-mentioned joints are oedematous, with increased local temperature and reduced range of movement. Her initial lab results are: Hgb 88 g/l, MCV 85 fl, WBC 24x109/L, Plt 290x109/L,ESR 60mm/h, urine - protein 1+, RBC 40/hpf. Echocardiography confirms small VSD. Part 2: After admission her condition deteriorates with RR 30/min, crepitations at the lung bases, HR 130/min, and a new soft murmur is heard at the apex with radiation to the axilla. Liver is palpated at 4 cm below the costal margin, urine output is reduced. Thin red-brown lines appear under her nails. Her treatment should be: (1 correct answer)(2 Points)? A. high dose aspirin B. 4-8 weeks of antibiotics, diuretics and ACE-inhibitor C. high dose corticosteroids D. high dose immunoglobulins

Answer: B. 4-6 weeks of antibiotics, diuretic and ACE-Inhibitor Antibiotics for the IE and the antihypertensives due to the fluid overload, fluid overload is indicated due to the liver being detected at 4cm below the costal margin and decreased urine output hence diuretics also needed.

At what age you would expect a child to smile in response to his mother's smile? A. 15 weeks B. 6 weeks C. 18 weeks D. 1 weeks

Answer: B. 6 weeks

4-year-old girl is admitted to hospital due to vomiting and watery stools for 2 days. On examination she is drowsy, has sunken eyes, reduced turgor and elasticity of the skin, acetone breath, HR 140/min, RR 30/min, BP 80/40 mmHg. Abdomen is soft, normal bowel sounds. One hour later the child is still in the same condition, her urine output only about 10 ml of urine. Urine results - specific gravity 1038, ketones 2+, glucose- neg, protein 1+, sediment - normal.What is the most probable diagnosis? (1 correct answer)(2 Points) A. Fasting hypoglycaemia B. Diabetic ketoacidosis C. Prerenal acute kidney injury in a child with gastroenteritis D. Neuroinfection

Answer: B. Diabetic ketoacidosis Explanation presence of vomiting, ketones in urine and acetone breath all indicate the presence of DKA. in acute kidney injury there would by hyaline casts that are present.

22. In which condition is the "sunsetting eyes" sign observed? (1 correct answer)(1 Point) A. Microcephaly B. Hydrocephalus C. Spinal muscular atrophy D. Down syndrome

Answer: B. Hydrocephalus (In hydrocephalus => Bulging anterior fontanelle + eyes deviate downwards => Sun-setting eyes) - Sx of ↑ICP, disproportionately large head

A 5 years old boy suffers from severe Hemophilia A with hemarthrosis every week. What is best treatment option? A. Immobilization B. Prophylactic injection of coagulation factor concentrate C. Restricted physical activity D. On demand injection of coagulation factor concentrate (when bleeds occur)

Answer: B. Prophylactic injection of coagulation factor concentrate Explanation: hemarthrosis every week Hemophilias are disorders of blood clotting and consequently may lead to serious bleeding. In the majority of cases, these disorders are hereditary. There are three types of hemophilia, determined based on which clotting factor is deficient: hemophilia A (factor VIII), hemophilia B (factor IX), and hemophilia C (factor XI). All types result in impaired secondary hemostasis (plasmatic coagulation) that manifests as increased activated partial thromboplastin time (aPTT). Hemophilia presents with hemarthrosis (bleeding into joints) and muscular or soft tissue hematomas. Depending on the remaining clotting factor activity, bleeding may occur spontaneously or in response to trauma of varying severity. Repeated hemarthrosis can eventually lead to joint destruction, a serious long-term complication of hemophilia. Diagnosis is based on patient history and a mix of semiquantitative and quantitative measurements of clotting factor activity. Severe hemophilia (enzyme activity < 1%) is treated with prophylactic substitution of clotting factors, whereas mild hemophilia A, in particular, can also be treated with desmopressin, a synthetic vasopressin analog.

4-year-old girl is admitted to hospital due to vomiting and watery stools for 2 days. On examination she is drowsy, has sunken eyes, reduced turgor and elasticity of the skin, acetone breath, HR 140/min, RR 30/min, BP 80/40 mmHg. Abdomen is soft, normal bowel sounds.What emergency therapy would you start while waiting for the test results?(1 correct answer)(2 Points) A. I.v metoclopramide, followed by oral rehydration B. intravenous rehydration C. I.v. Dexametasone and 10% Mannitol to reduce cerebral edema insulin infusion

Answer: B. intravenous rehydration Explaination Metoclopramide - Metoclopramide is a medication used for stomach and esophageal problems. It is commonly used to treat and prevent nausea and vomiting. Metoclopramide is used to treat the symptoms of slow stomach emptying (gastroparesis) in patients with diabetes. It works by increasing the movements or contractions of the stomach and intestines. We can not use this yet there is no conformation that there are stomach problems or diabetes. Rehydration is needed but it is needed in an emergent way such through intravenous. No confirmations of brain edema or any infection or AKI

A previously well 1-year-old infant has had a runny nose and has been sneezing and coughing for 2 days. Two other members of the family had similar symptoms. Four hours ago, his cough became much worse. On physical examination, he is in moderate respiratory distress with nasal flaring, hyperexpansion of the chest, and easily audible wheezing without rales. Which of the following is the appropriate next course of action?(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. Continuous positive airway pressure (CPAP) B. IV Antibiotics C. Short-acting bronchodilators D. Monitoring oxygenation and fluid status E. Bronchoscopy

Answer: C, D Antibiotics are not given because infection in children occur with an etiological agent being viral and not bacterial. In this specific case, the symptoms resemble that of bronchoiolities hence this is the appropriate treatment.

A 6 months old child from normal pregnancy and delivery, with birth weight 3400g. Was admitted to hospital with complaints of persistent cough and recurrent pulmonary infections. On examination he was found in unsatisfactory general condition, with body weight 5300 g, pale skin and mucuses. RR - 50 / min, emphysematous chest, moderate dyspnea with wheezing of the lungs and crepitations bilaterally. HR-140/min, abdomen - soft, liver- 3 cm. The mother reported that the child had good appetite, but frequent voluminous, greasy stools. What investigations would you order to confirm 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. Anti-tTGantibodies C. Trypsininstools D. Faecal calprotectin E. Sweat test

Answer: C, E Explanation : C. because of greasy stools => to check for pancreatic function) E. to rule out CF, as the symptoms are suggestive of it. Cystic fibrosis look for meconium ileus, S aureus causes resp infections commonly A. Not needed, major concerning heart symptoms are not present. B. Antibodies to tissue transglutaminase (abbreviated as anti-tTG or anti-TG2) are found in patients with several conditions, including celiac disease, juvenile diabetes, inflammatory bowel disease, and various forms of arthritis. C. An abnormal result means the trypsin or chymotrypsin levels in your stool are below the normal range. This may mean that your pancreas is not working properly. Other tests may be done to confirm that there is a problem with your pancreas. D. Faecal calprotectin (or fecal calprotectin) is a biochemical measurement of the protein calprotectin in the stool. Elevated faecal calprotectin indicates the migration of neutrophils to the intestinal mucosa, which occurs during intestinal inflammation, including inflammation caused by inflammatory bowel disease. E. A sweat test measures the amount of chloride, a part of salt, in Sweat. It is used to diagnose cystic fibrosis (CF). People with CF have a high level of chloride in their sweat. CF is a disease that causes mucus build-up in the lungs and other organs. It damages the lungs and makes it hard to breathe.

55. What are the main clinical presentations of T-cell non-Hodgkin lymphomas in children? (From x 5 correct answers out of 5 possible answers; 1 point for each correct answer, minus 1 point for each wrong answers) A. Cervical lymphadenomegaly B. Abdominal mass C. Bone marrow infiltration D. Bone marrow aplasia E. Mediastinal tumor mass

Answer: C,E T cell malignancies characterised by mediastinal mass and bone marrow infiltration The other symptoms can be found in NHL but are not common for T NHL.

A 3 years old boy was consulted by a child rheumatologist because of high fever and suggested Kawasaki's disease. The consultant excluded this diagnosis because he observed one of the findings below. Which of these findings EXCLUDES Kawasaki's disease? (1 correct answer)(2 Points) A. Polymorphous rash B. Fever lasting >5 days C. suppurative bilateral conjunctivitis D. mucous membranes changes - dry, fissured lips, strawberry tongue

Answer: C- suppurative bilateral conjunctivitis Explanation All of the other symptoms are characterises of kawaskis disease but in the case of option C it is not true because in Kawaski disease the Conjuctivitis is Painless bilateral "injected" conjunctivitis without exudate. Also the diagnosis of Kawaski disease is made through the mnemonic CREAM C- nonpurelent, suppurative bilateral conjunctivitis R- rash polymorphous non-vesciular E- edema of the hands and feet A- adenopathy (cervical) M- mucosal development, fever Kawasaki disease is an acute, necrotizing vasculitis of unknown etiology. The condition primarily affects children under the age of five and is more common among those of Asian descent. The disease is characterized by a high fever, desquamative rash, conjunctivitis, mucositis (e.g., "strawberry tongue"), cervical lymphadenopathy, as well as erythema and edema of the distal extremities. However, coronary artery aneurysms are the most concerning possible manifestation as they can lead to myocardial infarction or arrhythmias. Kawasaki disease is a clinical diagnosis, further supported by findings such as elevated ESR or evidence of cardiac involvement on echocardiography. Treatment with IV immunoglobulins and high-dose aspirin is essential and should be initiated immediately after diagnosis.

A 16-year-old girl with a known small ventricular septal defect (VSD) had a tattoo done 10 days ago. For the last 6 days she has been having fever up to 39oC with chills, malaise and painful and swollen knees, ankles and wrist joints. On examination she has fever 38.1oC, RR 18/min, HR 110/min. The fore-mentioned joints are oedematous, with increased local temperature and reduced range of movement. Her initial lab results are: Hgb 88 g/l, MCV 85 fl, WBC 24x109/L, Plt 290x109/L,ESR 60mm/h, urine - protein 1+, RBC 40/hpf. Echocardiography confirms small VSD. Part 2: After admission her condition deteriorates with RR 30/min, crepitations at the lung bases, HR 130/min, and a new soft murmur is heard at the apex with radiation to the axilla. Liver is palpated at 4 cm below the costal margin, urine output is reduced. Thin red-brown lines appear under her nails. What is the most likely diagnosis?: (1 correct answer)(2 Points) A. Hepatitis B B. Heart failure due to VSD C. bacterial endocarditis D. polyarticular juvenile idiopathic arthritis

Answer: C. bacterial endocarditis Explanation A/ - if hepatitis was present it would show presence of jaundice or LFT findings, but no such thing is mentioned hence this is not it B/ Heart faliure symptoms - crepitations and ^ RR, new murmur(Mitral regurgitation b/c of backflow of blood to lungs which leads to crepitations) & symps of bacteremia , palpable liver(Right sided HF), reduced urine output, the heart faliure will due to IE not VSD C. there is an indication there are splinter hemorrhages which are signs of IE D. Rheumatoid factor needs to be investigated to make this conclusion

46. A 1year 7 months old boy from normal pregnancy and delivery is still only babbling and says no distinct words. He is able to walk, scribbles with pen and feed himself. He points to the objects he wants and looks at the eyes of his mum when frightened. What is the most appropriate first action? (1 correct answer)(2 Points) A. Perform a full developmental assessment B. Assessment for autism spectrum disorder C.Hearing test D. Reassurance of the parents

Answer: C.Hearing test Explanation around 18 months- they should be able to say 6-10 words, point, scribble with pen and walk steadily By 6 months of age an baby is able to speak with babbles, cooes and laughs. Causes of speech delay can include: 1. hearing impairment 2. lack of stimulus 3. psychiatric eg autism 4. familial 5. bilingual A. development seems fine, as the child is able to do most things by himself, hence (neurodevelopment is normal) B. Child looks at eyes of mum when frightened, austistic children dont usually do that. They dont play with other children D. reassurance of the parents is not as important as finding the cause of the speech delay

A 14-year-old girl became acutely unwell with fever, sore throat and malaise. Because symptomatic treatment had no effect the family doctor prescribed her Ampicillin. The next day she develops a maculo-papular rash on the body. On examination she is febrile- 38°C, has mild edema of the eyelids, severe nasal obstruction, neck lymphadenopathy, enlarged tonsils with grayish exudate on them. Lab results show: leucocytes18х10^9, with 70% lymphocytes, one third of them being similar to monocytes, Hgb and platelets within reference range. Mild elevation of ASAT and ALAT.CRP- 5 mg/ml.Which is the most likely diagnosis:(1 correct answer)(2 Points) A. Streptococcal tonsillitis B. Hodgkin's lymphoma C. Herpangina D. Infectious mononucleosis

Answer: D - Infectious Mononucleosis Explanation - The easiest way to make the conclusion fo the answer above is that after Ampicillin was given the rash developed, which pathogonomic if infectious mononucleosis is misdiagnosed for streptoccal tonsillitis. A- if this was present there would be no rash after prescription of ampicillin B- the swollen lymph nodes are less than 4 weeks and are not painful C. there would herpes like oral lesions D. - due to the lymphocytes being elevated and triggered by antibiotics. Infectious mononucleosis (IM), also called "mono" or the "kissing disease", is an acute condition caused by the Epstein-Barr virus (EBV). The disease is highly contagious and spreads via bodily secretions, especially saliva. To avoid misdiagnosis, suspected cases are confirmed with a heterophile antibody test (monospot test), or in some cases, positive serology. Patients exhibit lymphocytosis, often with atypical T lymphocytes on a peripheral smear. IM is also sometimes associated with a measles-like exanthem, especially in individuals who are falsely diagnosed with bacterial tonsillitis and given ampicillin or amoxicillin.

45. A 13-year-old girl presents with a runny nose, fever and sore throat. Her family doctor diagnoses her with acute tonsillitis, but also notices that she has a goitre. Family history - mother has thyroid disease. Laboratory studies - TSH- 4.2 (0.34 - 5.6) mIU / L; fT4-12 (7-14.4) pmol / L; anti-thyroid peroxidase (TPO) antibodies 584 (0-9) IU / mL; TSH-receptor antibodies-0.4 (0-1.8) IU / L. What is the most likely diagnosis: (1 correct answer)(2 Points) A. Graves disease B. Sporadic goiter C. Acute thyroiditis D. Hashimoto's thyroiditis

Answer: D. Hashimoto's thyroiditis Explanation due to presence of TPO antibodies A. graves - inceased TRAbs (specific), anti TPO and anti-tg antibodies B. Goiter- TSH levels increase and thyroid antibodies C. Thyroiditis - T3 and T4 increase, thyroglobulin increases and TSH decreases. Antithyroid antibodies are autoantibodies that target one or more components of the thyroid gland and can act as markers to help diagnose autoimmune thyroid conditions. For example, thyroid stimulating hormone receptor antibodies (TRAb) are seen mostly in Graves' disease, while thyroid peroxidase antibodies (TPOAb) and thyroglobulin antibodies (TgAb) are typical for Hashimoto's thyroiditis (but may also be present in Graves' disease). However, elevated thyroid antibodies do not always indicate disease, as somewhat increased levels may also be present in healthy individuals.

27. What is the most common type of diabetes in children? (1 correct answer)(1 Point) A. MODI B. Type 2 diabetes C. LADA D. Type 1 diabetes

Answer: D. Type 1 diabetes MODY is a rare form of diabetes which is different from both type 1 and type 2 diabetes, and runs strongly in families. Latent autoimmune diabetes in adults (LADA) is a slow-progressing form of autoimmune diabetes. Like the autoimmune disease type 1 diabetes, LADA occurs because your pancreas stops producing adequate insulin, most likely from some "insult" that slowly damages the insulin-producing cells in the pancreas.

An adult cardiologist examines the ECG of a 10 months old infant and finds lots of peculiarities. Which of the following is normal: 1 correct answer)(2 Points)l A. Left axis deviations B. physiological A-V block first degree C. Low-voltage of the QRS complexes D.right axis deviations

Answer: D.right axis deviations Explanation Fetal heart circulation still intact. Right side of heart has higher pressure until later to adult circulation

A 10-month-old infant, born at 38 gestational weeks with weight 2400 g and length 48 cm. For about 2 months he has had frequent vomiting, no diarrhea and is mainly breastfed. With a weight gain of 300 grams for the last 2 months. On examination the child has reduced subcutaneous fat tissue, weight 7000 g, height 71 cm and head circumference 44 cm. Normal lung and heart status, no hepatosplenomegaly. Laboratory tests - Hb -90g / l; RBC - 3.8x 10/12; WBC - 13x 10/9; PLT - 210x 10/9; ESR- 40mm. Urine: Protein +; sediment-7-8 erythrocytes, 30 leukocytes, 5-6 epithelial cells/ per field. What are your recommendations?(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. Urine culture B. ultrasound of the abdomen C. consultation with endocrinologist D. Examination of Trypsin in faeces E. Conducting a sweat test

Answer: Urine culture, ultrasound of the abdomen His weight, height and head circumference is normal, Labs - hemoglobin is low (anemia), birth weight - doubles in 6 months and triples in one year height at birth +2cm a month head circumference - at birth it is 33-35cm, 1cm a month for first year Normal hemoglobin - 120g/l

A 10-year-old girl is consulted because she became very distracted at school. Her mother also noticed that she has episodes when she stops her activity for a few seconds, stares and then resumes the activity as if she had never stopped. What you would 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. Send her to a child psychiatrist B. Perform an EEG C. Perform a brain CT D. Start behavioural therapy for ADHD E. Perform a hyperventilation provocative test

Answer: perform EEG, perform hyperventillation provocative test, start behaviour therapy for ADHD. A. Its not psychiatric disorder - two differentials are absence seizures and ADHD- in attention. B. EEG is needed to confirm or rule out the absence seizures C. brain CT is important to rule out any tumours, but EEG would be first before CT and MRI can be used. E. yes this is essential in diagnosis of absence seizures because hyperventilation and light can trigger absent seizures.

A 4-month-old infant is referred to the Gastroenterology Department due to chronic constipation since birth. He was born at home and has not been seen by a doctor so far. He is breastfed. According to the mother his birth weight was around 3000 gr. On examination his current weight is 4.2 kg, there is significant abdominal distension, severe developmental delay. Abdominal distension is mostly due to a massively air-filled bowel, although there is some palpable mass of stools. What additional laboratory tests and procedures will you consider to establish 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. Coeliac disease screening B. Suction Rectal biopsy C. Electrolytes in blood D. thyroid function tests E. stool culture

Answer: suction rectal biopsy and thyroid function tests Explanation - the possible diseases of concern are Hirshuprung, coeliac, hypothyroidism other gastrointestinal dymotility A- although constipation can occur in celiac disease, it is rare and more common symptoms of celiac disease include Chronic or recurring diarrhea: steatorrhea Flatulence, abdominal bloating, and pain, Nausea/vomiting, Lack of appetite, Constipation (rarely) B. suction Rectal biopsy - its a confirmatory test for Hirushprung, the symptoms that are found are also common for late hirsuhprung, Chronic constipation with possible inability to pass gas,Failure to thrive/poor feeding C. not relevant, CBC might be D. constipation can be sign of hypothyroidism E. no signs of infection

A 3-year old girl is brought to the emergency department because of generalised itchy rash on the face and body and dry cough after eating peanut butter. On examination she is hemodynamically stable, with generalized urticarial rash, vesicular breathing with prolonged expiration and wheeze bilaterally. The rest of her examination is normal. What tests would you perform to reach a 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. Lung function tests B. specific IgE C. skin-prick test for nut allergies D. Bronchoscopy E. Total IgE

Answers: B, C, From the symptoms it is visible that the girl has an allergic reactiom to the peanut butter.

This 2-year-old boy lives in Africa on a maize-growing farm. Which of the following is true: (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. his long-term intellectual development is not at risk B. he has severe protein deficiency but near normal calorie intake C. He is prone to protracted and severe infections D. the major macronutrient lacking in his diet is fat E. he is likely to have increased appetite

Answers: C, D Explanation Maize fram- means consuming less protein and more carbs. Most likely to develop kawashioker which means he will have a low appetite, protein is the major macronutrient lacking in his diet. Physical and intellectual development will be at risk.

Healthy infants double their birth weight around what age? A. 7 -8 months B. 4 -5 months C. 9 -10months D. 11-12 months

B. 4 -5 months

In congenital adrenal hyperplasia there is: A. Normal pubertal development B. False premature iso- or heterosexual puberty C. Delayed bone age D. True precocious puberty

B. False premature iso- or heterosexual puberty

30. Iron deficiency anemia is characterized by:(1 correct answer)(1 Point) A. Low iron; low ferritin; high MCV B. Low iron; low ferritin; low MCV C. High iron; high ferritin; high MCV D. Low iron; high ferritin; low MCV

B. Low iron; low ferritin; low MCV

After a difficult vaginal delivery of a 4200 grams boy you notice that the child does not move his right upper extremity. There is swelling around the shoulder and the passive movements in the shoulder are painful. On palpation you find the crepitus of the clavicle. Moro reflex is absent on the right, grasping reflex is symmetrical, biceps reflex is absent on the right. The rest of the physical examination showed no abnormalities. What is the most likely diagnosis? (1 correct answer)(2 Points) A. Pseudoparalisis of Parrot B. Right upper brachial plexus palsy (Erb's palsy) with clavicle fracture C. Distortion of the right shoulder D. Osteomyelitis of the right humerus

B. Right upper brachial plexus palsy (Erb's palsy) with clavicle fracture Explanation 1. Assymetric moro reflex - absent on affected side 2. biceps dysfunctional on affected side A- decreased movement, mainly in the upper limbs because of the intense pain caused by local periositis due to congenital syphillis. This condition does not develop due to difficult vaginal delivery, there paralysis is of the whole limb not just some muscles, pain in moving active muscles. In this case there was no history of congenital symphilis C. distortion of the right shoulder - shoulder gets stuck, but no information is mentioned about the shoulder being stuck, the clavicle is usually fractured, head is tilled to one side, distortion of the right shoulder would present the same as Erbs palsy with additional symptoms D. other symptoms would be present such as fever

36. 4 months old boy was admitted to the hospital for investigations. He was born from normal pregnancy with weight 2900 g. Shortly after the delivery a systolic heart murmur on the left impaired bone mineralization anemia + rickets sternal edge was heard on the routine examination of the newborn. Lately the mother has noticed that the child is more irritable, and his lips and tongue turn blue when crying. X-ray of the child is shown below.What is the most likely diagnosis? (1 correct answer)(2 Points) A. Transposition of the great arteries B. Tetrology of Fallot C. Myocardiopathy D. Coarctation of the aorta

B. Tetrology of Fallot Tet spells: intermittent hypercyanotic, hypoxic episodes with a peak incidence at 2-4 months after birth RVOTO: Right ventricular hypertrophy, Ventricular septal defect, Overriding aorta are the characteristics of Tetralogy of FallOt.

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

B. This is probably irritative mushroom poisoning, start treatment with rehydration and activated charcoal If the poisoning was from amanita phalloides it would be 6 hours onset not 2 hours. Liver faliure can be suspected if it was amanita phalloides after 2 to 4 days.

33. Which of the following statements is incorrect? (1 correct answer)(1 Point) A. Acute kidney injury in childhood has a good prognosis B. Acute kidney injury is usually a reversible decrease in kidney function C. Acute kidney injury is usually manifested with anemia due to erythropoietin deficiency and impaired bone mineralisation D. Oliguria is usually present in acute kidney injury

C. Acute kidney injury is usually manifested with anemia due to erythropoietin deficiency and impaired bone mineralisation anemia, eryropoetin is a chracteristic finding for chronic kidney injury as these characteristics take time to develop. in AKI there is edema, decreased urine output, uremic symptoms, seziures and maybe asterixes.

Which of the following conditions is common in patients with cerebral palsy and other severe brain injuries? A. Obesity B. Premature puberty C. Gastroesophageal reflux D. Macrocephaly

C. Gastroesophageal reflux

20. Which are the main prophylactic/preventer medications in asthma in children: (1 correct answer)(1 Point) A. Short acting beta-2 agonists B. Antihistamines C. Inhaled steroids D. Theophylline

C. Inhaled steroids Inhaled glucocorticoids such as fluticasone- 1st line) SABAs are reliving agents not preventing agents

19. The main characteristics of nephrotic syndrome are: (1 correct answer)(1 Point) A. Proteinuria, hematuria, hyperlipidemia, edema B. Proteinuria, leukocyturia, edema C. Proteinuria, hypoalbuminaemia, hyperlipidemia, edema D. proteinuria, hematuria, leukocyturia, edema

C. Proteinuria, hypoalbuminaemia, hyperlipidemia, edema

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

C. Severely premature neonates Bowel of preterm babies is vulnerable to ischemic injuries & bacterial invasion)

43. A 5-month-old infant has a dry cough almost every night. The infant has normal growth and neurodevelopment. Mother reports frequent regurgitations and some vomiting of breast milk. Examination of his respiratory system is normal. What is the most likely diagnosis? (1 correct answer) (2 Points) A. bronchiolitis B. asthma C. gastro-esophageal reflux D. cystic fibrosis

C. gastro-esophageal reflux Explanation - respiratory system is normal, if asthma was present we would hear wheezing on auscultation prolonged expiratory phase, hyperresonance on lung percussion. In bronchoiolitis we would hear wheezing or crackles and in cystic fibrosis the cough is productive. vomiting breast milk is common sign of GER.

Which of the following is NOT true for coarctation of the aorta in infants: A. presents with cardiogenic shock B. is one of the duct-dependent congenital heart defects in the neonatal period C. presents always immediately after birth D. chest X-ray shows cardiomegaly

C. presents always immediately after birth

Which of the following conditions predisposes to hypocalcemia and rickets. A. Cerebral palsy B. Congenital heart defect C. Recurrent urinary tract infections D. Coeliac disease

D. Coeliac disease Vitamin D malabsorption. This further reduces absorption of calcium => Rickets & Hypocalcemia)

32. In which condition is the "test with the three cups" positive for blood in the last cup? (1 correct answer)(1 Point) A. Urethral trauma B. Pyelonephritis C. Acute post streptococcal glomerulonephritis D. Hemorrhagic cystitis

D. Hemorrhagic cystitis The three cups test, is a test which takes three stages of the urine of a patient during micrutrtion. initial specimen contains RBC from the ureathra the last specimen contains rbc from bladder neck, triangle and postureathra. All specimens containg RBC means results from upper urinary tract, bladder urethral trauma - first cup pyelonephritis - all cups APSG - all ups

In case of a foreign body in the larynx there is A. Expiratory dyspnea B. Saliva leakage D. Inspiratory dyspnea E. Valve mechanism and emphysema

D. Inspiratory dyspnea

37. A 4 months old boy is transferred from another hospital with the diagnosis of Di George's syndrome. Which of the following findings proves this diagnosis?(1 correct answer)(2 Points) A. B-cell immune deficiency B. Disorders of phagocytosis C. Lack of neutrophils D. Lack of a thymus gland

D. Lack of a thymus gland CATCH-22 is the acronym for typical features of DiGeorge syndrome: Cardiac anomalies; Anomalous face; Thymic aplasia/hypoplasia; Cleft palate; Hypocalcemia; Chromosome 22. its a t cell deficiency

Which is the most severe consequence of hypoxic-ischemic encephalopathy? A. Brain calcifications B. Bilateral damage to the basal ganglia C. Intraventricular hemorrhage grade I D. Multicystic encephalomalacia

D. Multicystic encephalomalacia Encephalomalacia is the softening or loss of brain tissue after cerebral infarction, cerebral ischemia, infection, craniocerebral trauma, or other injury. The term is usually used during gross pathologic inspection to describe blurred cortical margins and decreased consistency of brain tissue after infarction. It makes sense as a complication of hypoxic-ischemic encephalopathy. Furthermore, HIE can cause major complications such as cerebral palsy, mental retardation, epilepsy, microencephalopathy. Mild global developmental delays, delays in speech and language, dyslexia, ADHD and clumsiness

28. Fluctuating during the day muscle weakness and bulbar manifestations аre typical for:(1 correct answer)(1 Point) A. Cerebral palsy B. Spinal muscular atrophy C. Progressive muscular dystrophy D. Myasthenia gravis

D. Myasthenia gravis Symptoms worsen with increased muscle use throughout the day and improve with rest. Sometimes associated with exacerbating factors, including:MedicationsPregnancy

Arterial hypertension with paroxysmal palpitations, flushing and sweating can be found A. Supraventricular tachycardia B. Congenital adrenal hyperplasia C. Coarctation of the aorta D. Pheochromocytoma

D. Pheochromocytoma 5ps - pain (headache), palpitations, pressure (hypertension), perspiration (diaphoresis and pallor, these are syptoms of excessive sympathetic nervous system activity, this activity occurs due to pheochromocytoma being a catecholamine secreting tumour, found in adrenal gland. Treatment of such tumour is alpha blockage with phenoxybenzamine then surgical resection.

42. The pubertal development of a 14 years old boy started at 11 years of age with testicular enlargement followed by an increase of the penis, pubic and axillary hair growth, mutation of the voice and growth spurt of about 10 cm during the last year. His bone age corresponds to his chronological age. What is the most likely diagnosis?( 1 correct answer)(2 Points) A. Gonadotropin-dependent / central premature puberty B. Gonadotropin-independent / peripheral premature puberty C. Constitutional delay in growth and puberty D. Physiological puberty

D. Physiological puberty Order (men 11-16yrs)- testicular enlargment, penile growth, pubarche, adrenache Women 8-12yrs- - thelarche, adrenche pubarche, menarche , growth spurt.

40. A 15-year old girl is finishing her treatment for tuberculosis (TB) of the tracheo-bronchial lymph nodes. For the last 10 days she has been complaining of chest pain which is worse on lying down and during deep inspiration and is relieved by sitting up. On examination her HR is 110/min at rest, there are no murmurs but her heart sounds are muffled. Chest X-ray shows cardiomegaly. ECG is with ST elevation. What is the most likely diagnosis: (1 correct answer) please (2 Points) A. dilated cardiomyopathy B. TB myocarditis C. TB endocarditis D. TB pericarditis

D. TB pericarditis Explanation: the most important finding is that the pain gets worse when lying down and improves when sitting up, that is a typical finding for pleruitic chest pain TB myocarditis will present as cardiogenic shock

39. A 16-year-old girl from normal pregnancy of a 40-year- old mother was born with mild intrauterine retardation / -1 SD / and swelling of the wrists and feet. During childhood she has had stunted growth and learning difficulties at school.The reason for consulting a pediatric endocrinologist is her short height -140 cm and absence of menstruation.What is the most likely diagnosis?(1 correct answer)(2 Points) A. Constitutional delay in growth and puberty B. Down syndrome C. Kleinfelter syndrome D. Turner syndrome

D. Turner syndrome

29. What is the mode of inheritance of glucose 6-phosphate- dehydrogenase deficiency anemia?(1 correct answer)(1 Point) A. Autosomal recessive B. None of the above C. Autosomal dominant D. X-linked

D. X-linked affects the males more

31. What are the possible complications of juvenile idiopathic arthritis: (1 correct answer)(1 Point) A. chronic anterior uveitis B. growth failure C. joint contractures D. all of the above

D. all of the above The complications include the following: 1. chronic anterior uveitis - leads to blindess 2. flexion contractures of the joint - genu valgum 3. Growth faliure - leg length discrepency and undergrowth such as micrognathia

34. What is NOT true for chronic non-specific diarrhea: (1 correct answer)(1 Point) A. the children have normal growth B. there are undigested vegetable particles in the stools C. usually in children who drink a lot of fruit juice D. the children often have anemia

D. the children often have anemia