Transcript The most likely diagnosis is - KSU Faculty Member websites

General pediatric in training
Examination for medical student
Dr. Abdul-Rahman Alnemri, MD
Associate professor of pediatric
Consultant Neonatologist
DIRECTION
Each of the questions or incomplete
statements below is followed by five
suggested answers or completions. Select
the one that is BEST in each case and mark
your answer sheet by filling in the circle
containing the corresponding letter.
1. A 30-month old, previously healthy girl is brought to the
emergency department after her mother grabbed her by the
wrist to prevent her from running into the street. The child is
alert but the right arm hangs limply at her side with the
elbow slightly flexed. She does not seem to be able to
straighten the arm nor will she move it actively on request.
There are no bruises and no other evidence of trauma. The
remainder of the findings on physical examination is
normal.
Your next step in the management of this child would be
to :
A.
B.
C.
D.
Order an x-ray of the right wrist
Order an x-ray study of the entire right arm.
Splint the forearm
Supinate the forearm with the elbow in flexion
1. A 30-month old, previously healthy girl is brought to the
emergency department after her mother grabbed her by the
wrist to prevent her from running into the street. The child is
alert but the right arm hangs limply at her side with the
elbow slightly flexed. She does not seem to be able to
straighten the arm nor will she move it actively on request.
There are no bruises and no other evidence of trauma. The
remainder of the findings on physical examination is
normal.
Your next step in the management of this child would be
to :
A.
B.
C.
D.
Order an x-ray of the right wrist
Order an x-ray study of the entire right arm.
Splint the forearm
Supinate the forearm with the elbow in flexion
2. For a child who has had re-current otitis media and serous
otitis, the therapy among the following that is most likely
to prevent recurrences of acute otitis media is:
A.
B.
C.
D.
Administration of polyvalent pneumococcal vaccine
Myringotomy and tympanostomy tube
Adenoidectomy
Daily administration of an antihistamine.
2. For a child who has had re-current otitis media and serous
otitis, the therapy among the following that is most likely
to prevent recurrences of acute otitis media is:
A.
B.
C.
D.
Administration of polyvalent pneumococcal vaccine
Myringotomy and tympanostomy tube
Adenoidectomy
Daily administration of an antihistamine
3. Tachypnea and progressive weakness gradually develop
in a 4-month old boy who appeared normal at birth. He
has fed poorly for the past month. Physical
examination shows diffuse muscular weakness, a
large tongue and hepatomegaly. An x-ray study of the
chest demonstrates marked cardiomegaly. An
electrogram showed massive voltage and s short PR
interval.
This clinical picture is most likely associated with
A.
B.
C.
D.
Congenital hypothyroidism
Beckwith-Weidman Syndrome
Prader-Willi Syndrome
Glycogen storage disease
3. Tachypnea and progressive weakness gradually develop
in a 4-month old boy who appeared normal at birth. He
has fed poorly for the past month. Physical
examination shows diffuse muscular weakness, a
large tongue and hepatomegaly. An x-ray study of the
chest demonstrates marked cardiomegaly. An
electrogram showed massive voltage and s short PR
interval.
This clinical picture is most likely associated with
A.
B.
C.
D.
Congenital hypothyroidism
Beckwith-Weidman Syndrome
Prader-Willi Syndrome
Glycogen storage disease
4. A 2 ½ -year old boy is referred to you for evaluation of
short stature. His height is 82.5 cm (<3rd percentile).
His weight is 10.8 kg (<3rd percentile).
Which of the following would be most helpful in the
evaluation of this patient’s condition?
A.
B.
C.
D.
Developmental history
Urinalysis
Previous growth record
Determination of bone age
4. A 2 ½ -year old boy is referred to you for evaluation of
short stature. His height is 82.5 cm (<3rd percentile).
His weight is 10.8 kg (<3rd percentile).
Which of the following would be most helpful in the
evaluation of this patient’s condition?
A.
B.
C.
D.
Developmental history
Urinalysis
Previous growth record
Determination of bone age
5. A 4 years old child is found to have the classical murmur of
a patent ductus. He is under weight for age but otherwise
well. Which of the following would you recommend for
this patient ?
A. Recommend early operative closure?
B. Review the child constantly, expecting spontaneous
closure within the next five years?
C. recommend prophylactic penicillin until operation is
performed?.
D. Delay operation until the child has reached its expected
weight for age?
5. A 4 years old child is found to have the classical murmur of
a patent ductus. He is under weight for age but otherwise
well. Which of the following would you recommend for
this patient ?
A. Recommend early operative closure?
B. Review the child constantly, expecting spontaneous
closure within the next five years?
C. recommend prophylactic penicillin until operation is
performed?.
D. Delay operation until the child has reached its expected
weight for age?.
6. An 11-year old child has had leukemia for some time. It
is now clear that the child will die soon. The parents
request that their child have the opportunity to die at
home, where there are two other children, ages 8 and
15 years. The patient has begun to ask whether he will
die or will get better.
The issue of impending death in this 11-year old
child with leukemia should
A. Not be discussed with the 8-year old sibling
B. Be discussed with anyone who raises the question
C. Be discussed with each family member, including
the dying child
D. Be discussed with parents only
6. An 11-year old child has had leukemia for some time. It
is now clear that the child will die soon. The parents
request that their child have the opportunity to die at
home, where there are two other children, ages 8 and
15 years. The patient has begun to ask whether he will
die or will get better.
The issue of impending death in this 11-year old
child with leukemia should
A. Not be discussed with the 8-year old sibling
B. Be discussed with anyone who raises the question
C. Be discussed with each family member,
including the dying child
D. Be discussed with parents only
7. Three to four times each while sleeping, a 3 year
old girl suddenly sits up and screams. The eyes
are open, she appears frightened and she is
difficult to console initially. The next morning. She
has no memory of the events.
Of the following, the most likely diagnosis is:
A.
B.
C.
D.
Sleep apnea
Somniloquism
Nightmares
Night terrors
7. Three to four times each while sleeping, a 3 year
old girl suddenly sits up and screams. The eyes
are open, she appears frightened and she is
difficult to console initially. The next morning. She
has no memory of the events.
Of the following, the most likely diagnosis is:
A.
B.
C.
D.
Sleep apnea
Somniloquism
Nightmares
Night terrors
8. In children with acute lymphocytic leukemia who are
receiving intensive maintenance chemotherapy, the
greatest reduction in incidence of pneumonia due to
Pneumocystis carinii has been achieved by which of
the following ?
A. Deletion of Prednisolone from the maintenance
regimen
B. One-week courses of vincristine every ten weeks
C. Regular prophylactic injections of pentamidine
isethionate
D. Regular prophylactic oral administration of
trimethroprim with sulfamethoxazole
8. In children with acute lymphocytic leukemia who are
receiving intensive maintenance chemotherapy, the
greatest reduction in incidence of pneumonia due to
Pneumocystis carinii has been achieved by which of the
following ?
A. Deletion of Prednisolone from the maintenance
regimen
B. One-week courses of vincristine every ten weeks
C. Regular prophylactic injections of pentamidine
isethionate
D. Regular prophylactic oral administration of
trimethroprim with sulfamethoxazole
9.The mother of an 18-month old girl consults you regarding
her daughter’s language development. The infant’s
tympanic membranes appear normal and are mobile on
pneumatic otoscopy. The patient has a 12-word
vocabulary and uses a considerable amount of jargon,
but she does not use any two-word phrases.
A. Refer the infant for brain stem-evoked audiometry
B. Refer the infant to a speech pathologist
C. Assure the mother that language development is
normal
D. Refer the infant for a complete developmental
evaluation
9.The mother of an 18-month old girl consults you regarding
her daughter’s language development. The infant’s
tympanic membranes appear normal and are mobile on
pneumatic otoscopy. The patient has a 12-word
vocabulary and uses a considerable amount of jargon,
but she does not use any two-word phrases.
A. Refer the infant for brain stem-evoked audiometry
B. Refer the infant to a speech pathologist
C. Assure the mother that language development is
normal
D. Refer the infant for a complete developmental
evaluation
10.Which of the following decreases the
serum half-life of theophylline?
A.
B.
C.
D.
Phenobarbital
Carbohydrates
Liver Disease
Erythromycin
10. Which of the following decreases the
serum half-life of theophylline?
A.
B.
C.
D.
Phenobarbital
Carbohydrates
Liver Disease
Erythromycin
11. A
15-year old boy with a history of juvenile-onset obesity
expresses his concern with his small genitals. He is
somewhat withdrawn, anxious, obese adolescent boy
whose height is at the 25th percentile and whose weight
is greater than 97th percentile. Sex maturity rating
(Tanner) of pubic hair is stage 5 and of genitalia is stage
4. Testes are normally firm, measuring 3.0 by 4.0 cm.
Which of the following statements most accurately describes
this boy’s pubertal development?
A. His developmental delay is likely the result of his
obesity
B. He has not attained the peak of his linear growth spurt
C. His bone age is expected to be at least two years
delayed in comparison with chronologic age
D. Sexual development is normal and appropriate for age.
11. A
15-year old boy with a history of juvenile-onset obesity
expresses his concern with his small genitals. He is
somewhat withdrawn, anxious, obese adolescent boy
whose height is at the 25th percentile and whose weight
is greater than 97th percentile. Sex maturity rating
(Tanner) of pubic hair is stage 5 and of genitalia is stage
4. Testes are normally firm, measuring 3.0 by 4.0 cm.
Which of the following statements most accurately describes
this boy’s pubertal development?
A. His developmental delay is likely the result of his
obesity
B. He has not attained the peak of his linear growth spurt
C. His bone age is expected to be at least two years
delayed in comparison with chronologic age
D. Sexual development is normal and appropriate for
age.
12. A 5-month old girl brought to your office
because of failure to gain weight and
intermittent vomiting during the past four weeks.
Five weeks ago, she was weaned from breast
feeding and a regimen of cow milk, fruits and
vegetables were initiated.
The most likely diagnosis is
A. Galactosemia
B. Hereditary fructose intolerance
C. Sensitivity to B-Lactoglobulin
D. Glycogen storage disease type I
12. A 5-month old girl brought to your office
because of failure to gain weight and
intermittent vomiting during the past four weeks.
Five weeks ago, she was weaned from breast
feeding and a regimen of cow milk, fruits and
vegetables were initiated.
The most likely diagnosis is
A. Galactosemia
B. Hereditary fructose intolerance
C. Sensitivity to B-Lactoglobulin
D. Glycogen storage disease type I
13. A 10-year old girl was treated successfully two months
ago for a urinary tract infection. Findings on renal
ultrasonography now are normal. A voiding
cystourethrogram demonstrates reflux into the lower
half of the left ureter during voiding.
Of the following, the most appropriate course of
action would be to
A. Schedule intravenous pyelography
B. Schedule voiding cystourethrography in two months
C. Schedule a renal nucleotide scan
D. Obtain a urine culture
13. A 10-year old girl was treated successfully two months
ago for a urinary tract infection. Findings on renal
ultrasonography now are normal. A voiding
cystourethrogram demonstrates reflux into the lower
half of the left ureter during voiding.
Of the following, the most appropriate course of
action would be to
A. Schedule intravenous pyelography
B. Schedule voiding cystourethrography in two months
C. Schedule a renal nucleotide scan
D. Obtain a urine culture
14. The average infant is able to pick up a
grain of cereal such as puffed rice
between thumb and forefinger at about
the same time he or she
A.
B.
C.
D.
Begins to pull to a standing position
Can walk without assistance
First exhibits a social smile
First transfers large objects from hand to
hand
14. The average infant is able to pick up a
grain of cereal such as puffed rice
between thumb and forefinger at about
the same time he or she
A.
B.
C.
D.
Begins to pull to a standing position
Can walk without assistance
First exhibits a social smile
First transfers large objects from hand to
hand
15. An 6-year old , previously well girl has had low grade
fever, headache, myalgia, malaise and a generalized
maculopapular rash for the past three days. He
frequently plays with a 3-month old kitten. You note
localized lymphadenopathy with hepatosplenomegaly
on physical examination.
The most likely diagnosis is
A.
B.
C.
D.
Rocky Mountain spotted fever
Infectious mononucleosis
Cytomegalovirus infection
Toxoplasmosis1
15. An 6-year old , previously well girl has had low grade
fever, headache, myalgia, malaise and a generalized
maculopapular rash for the past three days. He
frequently plays with a 3-month old kitten. You note
localized lymphadenopathy with hepatosplenomegaly
on physical examination.
The most likely diagnosis is
A.
B.
C.
D.
Rocky Mountain spotted fever
Infectious mononucleosis
Cytomegalovirus infection
Toxoplasmosis
16. A neonate does not pass meconium for 48 hrs
after birth. A fortnight later his mother states that
he is not passing stool regularly. He has been
bottle fed since discharge. Investigations reveal
massive dilatation of the colon proximal to the
rectum
Where is the developmental abnormality responsible
for this child’s presentation?
A.
B.
C.
D.
Ectoderm.
Neural crest.
Neural ectoderm.
Splanchnic mesoderm
16. A neonate does not pass meconium for 48 hrs
after birth. A fortnight later his mother states that
he is not passing stool regularly. He has been
bottle fed since discharge. Investigations reveal
massive dilatation of the colon proximal to the
rectum
Where is the developmental abnormality responsible
for this child’s presentation?
A.
B.
C.
D.
Ectoderm.
Neural crest
Neural ectoderm.
Splanchnic mesoderm
17. A 12-year old boy has been drinking at least 6 L of fluid
each day for the past year. Serum urea nitrogen
concentration is 4 mg/dL and serum creatinine
concentration is 0.6 mg/dL. Results of urinalysis and
determination of serum electrolyte concentrations are
normal. After a 12-hour water deprivation test, urine
osmolality increased from 80 to 475 mOsm/kg H2O;
serum osmolality increased from 285 to 289 mOsm/kg
H2O. Body weight decreased from 42 to 40 kg.
DDAVP, 5 ug is administered intranasally. One hour
later, urine osmolality is 500 mOsm/kg H20. You
conclude that the
A.
B.
C.
D.
Patient has nephrogenic diabetes insipidus
Patient has hypothalamic diabetes insipidus
Patient has psychogenic polydipsia
Water deprivation test should be repeated
17. A 12-year old boy has been drinking at least 6 L of fluid
each day for the past year. Serum urea nitrogen
concentration is 4 mg/dL and serum creatinine
concentration is 0.6 mg/dL. Results of urinalysis and
determination of serum electrolyte concentrations are
normal. After a 12-hour water deprivation test, urine
osmolality increased from 80 to 475 mOsm/kg H2O;
serum osmolality increased from 285 to 289 mOsm/kg
H2O. Body weight decreased from 42 to 40 kg.
DDAVP, 5 ug is administered intranasally. One hour
later, urine osmolality is 500 mOsm/kg H20. You
conclude that the
A.
B.
C.
D.
Patient has nephrogenic diabetes insipidus
Patient has hypothalamic diabetes insipidus
Patient has psychogenic polydipsia
Water deprivation test should be repeated
18. A 7-year old boy is referred to you because of obesity.
By 18 months of age,he was at the 97th percentile for
weight and is now 20.5 kg (45 lb) overweight.
Developmental landmarks were all delayed. He is
presently repeating the first grade after also spending a
year in a transitional class between kindergarten and
first grade. Present height is at the 10th percentile. The
hands and feet are small. There is no family history of
obesity.
The most likely diagnosis is
A.
B.
C.
D.
E.
Prader- Willi Syndrome
Laurence –Moon-Biedl Syndrome
Lesch-Nyhan Syndrome
Hurler Syndrome
William’s Syndrome
18. A 7-year old boy is referred to you because of obesity.
By 18 months of age,he was at the 97th percentile for
weight and is now 20.5 kg (45 lb) overweight.
Developmental landmarks were all delayed. He is
presently repeating the first grade after also spending a
year in a transitional class between kindergarten and
first grade. Present height is at the 10th percentile. The
hands and feet are small. There is no family history of
obesity.
The most likely diagnosis is
A.
B.
C.
D.
E.
Prader- Willi Syndrome
Laurence –Moon-Biedl Syndrome
Lesch-Nyhan Syndrome
Hurler Syndrome
William’s Syndrome
19.For patients receiving intravenous
maintenance therapy, which of the
following doses of sodium for very 100
kcal metabolized is most appropriate?
A.
B.
C.
D.
E.
0.5 mEq
2 to 3 mEq
4 to 5 mEq
6 to 7 mEq
8 to 10 mEq
19.For patients receiving intravenous
maintenance therapy, which of the
following doses of sodium for very 100
kcal metabolized is most appropriate?
A.
B.
C.
D.
E.
0.5 mEq
2 to 3 mEq
4 to 5 mEq
6 to 7 mEq
8 to 10 mEq
20. The Stanford-Binet test and the
Wechsler Scale for children are
commonly used with children to measure
A.
B.
C.
D.
E.
Cognitive functioning
Social development
Neurologic development
Emotional stability
Academic achievement
20. The Stanford-Binet test and the
Wechsler Scale for children are
commonly used with children to
measure
A.
B.
C.
D.
E.
Cognitive functioning
Social development
Neurologic development
Emotional stability
Academic achievement
21. A 12-year old male is tall and pubertal
developmental is normal for age. He has
hypermobility of joints, a high-arched
palate, and arm span exceeding his
height.
Which of the following studies should be
included in the examination?
A.
B.
C.
D.
E.
Ultrasonography of the kidneys
Echocardiography
Computed tomography (CT scan) of the head
Liver-spleen scan
X-ray study of the long bones
21. A 12-year old male is tall and pubertal
developmental is normal for age. He has
hypermobility of joints, a high-arched
palate, and arm span exceeding his
height.
Which of the following studies should be
included in the examination?
A.
B.
C.
D.
E.
Ultrasonography of the kidneys
Echocardiography
Computed tomography (CT scan) of the head
Liver-spleen scan
X-ray study of the long bones
22. You are called to examine a 3-year old boy who has
been brought to the emergency department because of
increasing lethargy and irritability. His mother states that
he has had diarrhea and abdominal cramps for the past
two days and was treated with diphenoxylate with
atropine to relieve his symptoms. Physical examination
reveals a somnolent boy with shallow respirations; his
rectal temperature is 36.C0. The remaining of the
physical examination is normal.
Which of the following would you do at this time?
A.
B.
C.
D.
E.
Examine the cerebrospinal fluid
Administer physostigmine
Perform a guaiac test of the stool for occult blood
Order a determination of the blood ammonia
concentration
Administer Naloxone
22. You are called to examine a 3-year old boy who has
been brought to the emergency department because of
increasing lethargy and irritability. His mother states that
he has had diarrhea and abdominal cramps for the past
two days and was treated with diphenoxylate with
atropine to relieve his symptoms. Physical examination
reveals a somnolent boy with shallow respirations; his
rectal temperature is 36.C0. The remaining of the
physical examination is normal.
Which of the following would you do at this time?
A.
B.
C.
D.
E.
Examine the cerebrospinal fluid
Administer physostigmine
Perform a guaiac test of the stool for occult blood
Order a determination of the blood ammonia
concentration
Administer Naloxone
23. A 5-year old girl toes on the left side.
Of the following, the most likely diagnosis is
A.
B.
C.
D.
E.
Femoral anteversion
Ligamentous lxity
Blount disease
Tibial torsion
Metatarsus adductus
23. A 5-year old girl toes on the left side.
Of the following, the most likely diagnosis is
A.
B.
C.
D.
E.
Femoral anteversion
Ligamentous lxity
Blount disease
Tibial torsion
Metatarsus adductus
24 . The mother of a 2-year old child enrolled in a
day care center is concerned that he has had
eight upper respiratory tract infections between
October and April. The child should
A. Be removed form the day care center
B. Be given Gamma Globulin injections monthly until
age 4 years
C. Have a throat culture every two weeks during the
winter months
D. Receive prophylactic antibiotic therapy
E. Be regarded to have upper respiratory tract infections
at a frequency within normal limits
24 . The mother of a 2-year old child enrolled in a
day care center is concerned that he has had
eight upper respiratory tract infections between
October and April. The child should
A. Be removed form the day care center
B. Be given Gamma Globulin injections monthly until
age 4 years
C. Have a throat culture every two weeks during the
winter months
D. Receive prophylactic antibiotic therapy
E. Be regarded to have upper respiratory tract
infections at a frequency within normal limits
25. A 10 years old boy presents with a history of passing
smoky coloured urine for 3 months intermittently. On
the day of admission he is admitted with sever right
loin pain radiating to the groin coming in spasms every
few minutes. On examination he is intermittently
writhing around the bed and crying. He is apyrexial but
sweating. Respiratory rate is 15/min and heart rate
95/min. He has slight tenderness in the right loin.
What is the most likely diagnosis?.
A. Benign familial Haematuria
B. Renal calculi.
C. Urinary tract infection
D. IgA nephropathy
E. Glomerulonephritis.
25. A 10 years old boy presents with a history of passing
smoky coloured urine for 3 months intermittently. On
the day of admission he is admitted with sever right
loin pain radiating to the groin coming in spasms every
few minutes. On examination he is intermittently
writhing around the bed and crying. He is apyrexial but
sweating. Respiratory rate is 15/min and heart rate
95/min. He has slight tenderness in the right loin.
What is the most likely diagnosis?.
A. Benign familial Haematuria
B. Renal calculi.
C. Urinary tract infection
D. IgA nephropathy
E. Glomerulonephritis.
26. A mother complains that her 4-year old son wets the
bed almost every night. She reports that his sister
achieved bladder control at night before 3 years of
age. There are no other symptoms. Findings on
urinalysis are normal.
Which of the following courses of action would you pursue?
A. Schedule voiding cystourethrography
B. Reassure the mother that this situation is normal
C. Prescribe imipramine and restrict fluids after 5 PM
D. Prescribe DDAVP
E. Set up a program to reward the boy when he is dry
and punish him when he wets
26. A mother complains that her 4-year old son wets the
bed almost every night. She reports that his sister
achieved bladder control at night before 3 years of age.
There are no other symptoms. Findings on urinalysis
are normal.
Which of the following courses of action would you pursue?
A. Schedule voiding cystourethrography
B. Reassure the mother that this situation is normal
C. Prescribe imipramine and restrict fluids after 5 PM
D. Prescribe DDAVP
E. Set up a program to reward the boy when he is dry
and punish him when he wets
27 A patient with acute asthma is most likely
to have decreased
A.
B.
C.
D.
E.
Forced expiratory volume in 1 second
Residual volume
Functional residual capacity
Total lung capacity
Tidal volume
27 A patient with acute asthma is most likely
to have decreased
A.
B.
C.
D.
E.
Forced expiratory volume in 1 second
Residual volume
Functional residual capacity
Total lung capacity
Tidal volume
28. A 1-day old , 3.0 kg, full term infant has a grade 3/6
ejection murmur. On the third day after birth,
hepatomegaly develops. Heart rate is 160/min and
respiratory rate is 60/min. Blood pressure is 100/60
mmHg in the upper extremities and 60/40 mmHg in the
lower extremities.
Which of the following forms of therapy would be
most effective ?
A.
B.
C.
D.
E.
Ballon atrial septostomy
Intravenous administration of Prostaglandin
Restriction of fluid intake
Systemic to pulmonary artery shunt
Intravenous administration of Indomethacin
28. A 1-day old , 3.0 kg, full term infant has a grade 3/6
ejection murmur. On the third day after birth,
hepatomegaly develops. Heart rate is 160/min and
respiratory rate is 60/min. Blood pressure is 100/60
mmHg in the upper extremities and 60/40 mmHg in the
lower extremities.
Which of the following forms of therapy would be
most effective ?
A.
B.
C.
D.
E.
Ballon atrial septostomy
Intravenous administration of Prostaglandin
Restriction of fluid intake
Systemic to pulmonary artery shunt
Intravenous administration of Indomethacin
29. A 2.9 kg newborn infant has pink skin, a thick vernix,
thin ear cartilage with good recoil, raised breast areolae
with 1 to 2 mm breast nodules, a prominent clitoris with
size of labia minora equal to size of labia majora, frog
leg position and flexion in all limbs. She has no edema,
no facial lanugo and no prominent arm recoil. Her
gestational age most closely approximates
A.
B.
C.
D.
E.
28 weeks
32 weeks
36 weeks
38 weeks
40 weeks
29. A 2.9 kg newborn infant has pink skin, a thick vernix,
thin ear cartilage with good recoil, raised breast areolae
with 1 to 2 mm breast nodules, a prominent clitoris with
size of labia minora equal to size of labia majora, frog
leg position and flexion in all limbs. She has no edema,
no facial lanugo and no prominent arm recoil. Her
gestational age most closely approximates
A.
B.
C.
D.
E.
28 weeks
32 weeks
36 weeks
38 weeks
40 weeks
30. A 10-year old boy has osteomyelitis due to
pseudomonas aeruginosa. You elect to treat the patient
with Amikacin. When administering this drug, which of
the following rules should be observed?
A. The drug should not be administered with meals
B. Measurement of peak concentrations and trough
concentration should be obtained
C. The patient should be tested fro conductive hearing
loss before therapy is started
D. The drug should not be administered if there is
evidence of abnormal liver function
E. The drug should not be administered for more than
ten days
30. A 10-year old boy has osteomyelitis due to
pseudomonas aeruginosa. You elect to treat the patient
with Amikacin. When administering this drug, which of
the following rules should be observed?
A. The drug should not be administered with meals
B. Measurement of peak concentrations and trough
concentration should be obtained
C. The patient should be tested fro conductive hearing
loss before therapy is started
D. The drug should not be administered if there is
evidence of abnormal liver function
E. The drug should not be administered for more than
ten days
31. A 7-month old boy has been treated for short
bowel syndrome with total parenteral nutrition
(TPN) for six months. Perioral and perianal
erythema and scaling develop.
Among the following, the TPN solution is most likely
deficient in :
A. Copper
B. Folic Acid
C. Zinc
D. Iron
E. Vitamin B12
31. A 7-month old boy has been treated for short
bowel syndrome with total parenteral nutrition
(TPN) for six months. Perioral and perianal
erythema and scaling develop.
Among the following, the TPN solution is most likely
deficient in :
A. Copper
B. Folic Acid
C. Zinc
D. Iron
E. Vitamin B12
32. An 11-year old boy has hematuria detected on a routine
examination in your office. Three years ago findings on
urinalysis were normal. He has had no recent illnesses,
trauma, bleeding disorders or ingestion of medications. He
looks and feels well. Physical examination discloses no
abnormalities. His blood pressure is 90/60 mmHg.
Laboratory studies show the erythrocyte sedimentation rate
(ESR) is 3 mm/hr. The serum complement concentration,
prothrombin time and partial thromboplastin time are
normal. Normal urea nitrogen, creatinine, and electrolytes
concentrations. An antistreptolysin O titer is normal.
Findings on an ultrasonographic examination are normal.
Which of the following is the management of choice?
A. Order a renal biopsy
B. Arrange for a cystoscopic examination
C. Begin prophylactic therapy with penicillin
D. Arrange for an intravenous pyelogram
E. Arrange for periodic re-examinations and urinalyses
32. An 11-year old boy has hematuria detected on a routine
examination in your office. Three years ago findings on
urinalysis were normal. He has had no recent illnesses,
trauma, bleeding disorders or ingestion of medications. He
looks and feels well. Physical examination discloses no
abnormalities. His blood pressure is 90/60 mmHg.
Laboratory studies show the erythrocyte sedimentation rate
(ESR) is 3 mm/hr. The serum complement concentration,
prothrombin time and partial thromboplastin time are
normal. Normal urea nitrogen, creatinine, and electrolytes
concentrations. An antistreptolysin O titer is normal.
Findings on an ultrasonographic examination are normal.
Which of the following is the management of choice?
A. Order a renal biopsy
B. Arrange for a cystoscopic examination
C. Begin prophylactic therapy with penicillin
D. Arrange for an intravenous pyelogram
E. Arrange for periodic re-examinations and urinalyses
33. During fetal life, the development of male
external genitalia is directly determined by
the action of which of the following?
A.
B.
C.
D.
E.
Testosterone
Dihydrotestosterone
Dehydroepiandrosterone
Androstenedione
H-Y antigen
33. During fetal life, the development of
male external genitalia is directly
determined by the action of which of the
following?
A.
B.
C.
D.
E.
Testosterone
Dihydrotestosterone
Dehydroepiandrosterone
Androstenedione
H-Y antigen
34. A 3 year old boy in nursery school makes
frequent silly excretory activities.
The most likely explanation for this is
A. Age appropriate behavior
B. An excessively stimulating nursery school
environment
C. Sexually stimulating parental attitudes
D. Regressive behavior
E. Fear of the toilet
34. A 3 year old boy in nursery school makes
frequent silly excretory activities.
The most likely explanation for this is
A. Age appropriate behavior
B. An excessively stimulating nursery school
environment
C. Sexually stimulating parental attitudes
D. Regressive behavior
E. Fear of the toilet
35- A 17-yeard old girl has primary amenorrhea.
Her height is normal for her age. The sex
maturity rating (Tanner) of breast development
is stage 5. She has a paucity of axillary and
pubic hair. Vaginal examination reveals a 2 cm
in depth with no visible cervix. A 3-4 cm ovoid
mass is palpable in each inguinal canal.
The most likely result of chromosome analysis in
this patient is
A.
B.
C.
D.
E.
46,XY
45,X
47 XXY
46, XX
47,XXX
35-A 17-yeard old girl has primary amenorrhea.
Her height is normal for her age. The sex
maturity rating (Tanner) of breast development
is stage 5. She has a paucity of axillary and
pubic hair. Vaginal examination reveals a 2 cm
in depth with no visible cervix. A 3-4 cm ovoid
mass is palpable in each inguinal canal.
The most likely result of chromosome analysis in
this patient is
A.
B.
C.
D.
E.
46,XY
45,X
47 XXY
46, XX
47,XXX
36-A 10-year old boy with asthma has failed to
respond to a home treatment program. He is
admitted to the hospital and treated with
intravenous administration of fluids,
Aminophylline, and corticosteroids. One hour
after admission, he appears exhausted.
Determination of arterial blood gas and Ph
values while the patient is in a 40% humidified
oxygen atmosphere reveal a Ph of 7.15, PO2
of 60 mmHg and PCO2 of 60 mmHg.
The next step in the management of this patient
would be
A.
B.
C.
D.
intravenous administration of sodium bicarbonate
Intubation and mechanical ventilation
intravenous administration of Dexamethasone
Subcutaneous administration of epinephrine
36-A 10-year old boy with asthma has failed to
respond to a home treatment program. He is
admitted to the hospital and treated with
intravenous administration of fluids,
Aminophylline, and corticosteroids. One hour
after admission, he appears exhausted.
Determination of arterial blood gas and Ph
values while the patient is in a 40% humidified
oxygen atmosphere reveal a Ph of 7.15, PO2 of
60 mmHg and PCO2 of 60 mmHg.
The next step in the management of this patient
would be
A.
B.
C.
D.
intravenous administration of sodium bicarbonate
Intubation and mechanical ventilation
Subcutaneous administration of epinephrine
intravenous administration of Dexamethasone
37-A 6-year old boy is sent home from
school because of an itchy scalp. On
examination, you note small ovoid
attachments to several otherwise normal
hair shafts.
The most likely diagnosis is
A.
B.
C.
D.
E.
Normal hair
Seborrhea
Pediculosis capitis
Tinea Capitis
Trichorrhxi nodosa (kinky hair disease)
37-A 6-year old boy is sent home from
school because of an itchy scalp. On
examination, you note small ovoid
attachments to several otherwise normal
hair shafts.
The most likely diagnosis is
A.
B.
C.
D.
E.
Normal hair
Seborrhea
Pediculosis capitis
Tinea Capitis
Trichorrhxi nodosa (kinky hair disease)
38. Daily caloric and protein requirements per
kg of body weight are greatest in the
A.
B.
C.
D.
E.
Adult
Infants with malabsorption
Toddler
Adolescent
Infant born prematurely
38. Daily caloric and protein requirements per
kg of body weight are greatest in the
A.
B.
C.
D.
E.
Adult
Infants with malabsorption
Toddler
Adolescent
Infant born prematurely
39. In an infant who appeared healthy at birth,
vomiting and diarrhea developed at 1 week of
age. She gained weight poorly despite a change
from breast milk to infant formula feeding at 2
weeks of age. At 3 weeks of age, she is brought
to the emergency department where she is found
to be lethargic and to have hepatomegaly. Of
the following, the most likely diagnosis is
(A) Inspissated bile syndrome
(B) Crigler-Najjar Syndrome
C) Galactosem
(D) Gilbert Syndrome
(E) Dubin-Johnson Syndrome
39. In an infant who appeared healthy at birth,
vomiting and diarrhea developed at 1 week of
age. She gained weight poorly despite a change
from breast milk to infant formula feeding at 2
weeks of age. At 3 weeks of age, she is brought
to the emergency department where she is found
to be lethargic and to have hepatomegaly. Of
the following, the most likely diagnosis is
(A) Inspissated bile syndrome
(B) Crigler-Najjar Syndrome
C) Galactosem
(D) Gilbert Syndrome
(E) Dubin-Johnson Syndrome
40. A 12-year old boy is struck in the eye by
a tennis ball. He is examined by an
Ophthalmologist who finds the optic globe
to be intact. He comes to you one week
later and reports that he has double
vision.
Of the following, the most likely diagnosis is
A.
B.
C.
D.
E.
Glaucoma
Intraocular hemorrhage
Fracture of the floor of the orbit
Oculomotor nerve paralysis
Sinusitis
40. A 12-year old boy is struck in the eye by
a tennis ball. He is examined by an
Ophthalmologist who finds the optic globe
to be intact. He comes to you one week
later and reports that he has double
vision.
Of the following, the most likely diagnosis is
A.
B.
C.
D.
E.
Glaucoma
Intraocular hemorrhage
Fracture of the floor of the orbit
Oculomotor nerve paralysis
Sinusitis
41. A 14-month old infant has had a clear nasal discharge
and a mild cough for about two weeks. Despite therapy
with Amoxicillin, his condition has not improved. The
cough has worsened and the infant has been vomiting
at each feeding. The leukocyte count is 20,000/mm3
with 80% lymphocytes, 15% neutrophils and 5% band
forms. X-ray study of the chest shows bilateral perihilar
infiltrates with shaggy heart border.
The most likely diagnosis is
A.
B.
C.
D.
E.
Acute bronchial asthma
Acute lympocytic leukemia with pulmonary infiltration
Influenza virus infection
Pertusis
Hemophilus influenzae pneumonia
41. A 14-month old infant has had a clear nasal discharge
and a mild cough for about two weeks. Despite therapy
with Amoxicillin, his condition has not improved. The
cough has worsened and the infant has been vomiting
at each feeding. The leukocyte count is 20,000/mm3
with 80% lymphocytes, 15% neutrophils and 5% band
forms. X-ray study of the chest shows bilateral perihilar
infiltrates with shaggy heart border.
The most likely diagnosis is
A.
B.
C.
D.
E.
Acute bronchial asthma
Acute lympocytic leukemia with pulmonary infiltration
Influenza virus infection
Pertusis
Hemophilus influenzae pneumonia
42. A 10 years old male presents with acute sever
asthma. On examination his peripheral pulse
volume decreased during inspiration.
Which one of the following is the most likely
explanation for this clinical sign?
A. The cardiac effect of high dose beta agonist
bronchodilator drugs.
B. A falling heart rate on inspiration.
C. Peripheral vasodilatation
D. Myocardial depression due to hypoxia
E. Reduced left atrial filling pressure on inspiration
42. A 10 years old male presents with acute sever
asthma. On examination his peripheral pulse
volume decreased during inspiration.
Which one of the following is the most likely
explanation for this clinical sign?
A. The cardiac effect of high dose beta agonist
bronchodilator drugs.
B. A falling heart rate on inspiration.
C. Peripheral vasodilatation
D. Myocardial depression due to hypoxia
E. Reduced left atrial filling pressure on inspiration
43. A 4-year old child has a grade 2/6 high-pitched
continuous murmur at the right base with maximum
intensity in the right supraclavicular fossa. The murmur
is not audible when he is in the supine position, and the
intensity changes with rotation of the head. There is no
thrill. The first and second heart sound are normal.
Blood pressure is 94/64 mmHg in the upper extremities
and 10 mmHg higher in the lower extremities.
The most likely source of the murmur is
A.
B.
C.
D.
E.
Patent Ductus Arteriosus
Arteriovenous fistula
Venous hum
Right pulmonary artery stenosis
Aortic valvular insufficiency
43. A 4-year old child has a grade 2/6 high-pitched
continuous murmur at the right base with maximum
intensity in the right supraclavicular fossa. The murmur
is not audible when he is in the supine position, and the
intensity changes with rotation of the head. There is no
thrill. The first and second heart sound are normal.
Blood pressure is 94/64 mmHg in the upper extremities
and 10 mmHg higher in the lower extremities.
The most likely source of the murmur is
A.
B.
C.
D.
E.
Patent Ductus Arteriosus
Arteriovenous fistula
Venous hum
Right pulmonary artery stenosis
Aortic valvular insufficiency
44.Regarding steroid inhaler therapy for a 4year old child with asthma, you should
tell the mother
A. It is most effective with acute exacerbation
B. It should be administered every two hours when the
child is having an acute episode of asthma
C. The primary value is in the prevention of episodes of
asthma
D. It will not be of value in the management of the child’s
exercise-induced episodes of asthma
E. The most common side effect is the development of
oral candidiasis.
44.Regarding steroid inhaler therapy for a 4year old child with asthma, you should
tell the mother
A. It is most effective with acute exacerbation
B. It should be administered every two hours when the
child is having an acute episode of asthma
C. The primary value is in the prevention of episodes
of asthma
D. It will not be of value in the management of the child’s
exercise-induced episodes of asthma
E. The most common side effect is the development of
oral candidiasis.
45. A healthy 15-month old girl has been growing
along the 25th percentile for length and weight.
Her mother is concerned now because the infant
is losing her appetite. Of the following , the most
appropriate statement to make to the mother at
this time would be
A. The infant’s weigh should be checked more often
B. This may be the first sign of a chronic illness
C. She will have to make an effort to find special foods
the infant will eat
D. The decrease in appetite is normal, in response to a
decelerating growth rate.
E. This is an early manifestation of the normal negativism
of infants at this age.
45. A healthy 15-month old girl has been growing along the
25th percentile for length and weight. Her mother is
concerned now because the infant is losing her appetite.
Of the following , the most appropriate statement to
make to the mother at this time would be
A. The infant’s weigh should be checked more often
B. This may be the first sign of a chronic illness
C. She will have to make an effort to find special foods
the infant will eat
D. The decrease in appetite is normal, in response to
a decelerating growth rate.
E. This is an early manifestation of the normal negativism
of infants at this age.
46. A 10-month old infant has had a respiratory tract
infection, fever and vomiting for two days. There
is evidence of mild dehydration. Which of the
following sets of laboratory data would be most
consistent with these findings.
Sodium potassium
A.
B.
C.
D.
E.
135
125
120
155
130
4.0
6.8
3.0
5.0
3.5
Chloride
102
100
92
135
80
Bicarbonate
15
15
15
20
35
46. A 10-month old infant has had a respiratory tract
infection, fever and vomiting for two days. There
is evidence of mild dehydration. Which of the
following sets of laboratory data would be most
consistent with these findings.
A.
B.
C.
D.
E.
135
125
120
155
130
4.0
6.8
3.0
5.0
3.5
102
100
92
135
80
15
15
15
20
35
47. An infant seated in a high chair turns his body around to
see you as you approach. You place two cube before
him, he takes one in his right hand and the other in his
left. When a third cube is presented, he bangs and
pushes it with the first. You demonstrate a tower of two
cubes and encourage him to take a tower, he hold one
cube on top for a second but does not release it. You
show him how to release a cube into a cup. He follows
suit at once. You ask him for a cube in his hand,
extending yours. He drops the cube in your hand. On
the floor he walks with one hand held. When he leaves
he waves bye-bye. The developmental age of this infant
seems closes to
A.
B.
C.
D.
E.
6 months
9 months
12 months
15 months
18 months
47. An infant seated in a high chair turns his body around to
see you as you approach. You place two cube before
him, he takes one in his right hand and the other in his
left. When a third cube is presented, he bangs and
pushes it with the first. You demonstrate a tower of two
cubes and encourage him to take a tower, he hold one
cube on top for a second but does not release it. You
show him how to release a cube into a cup. He follows
suit at once. You ask him for a cube in his hand,
extending yours. He drops the cube in your hand. On
the floor he walks with one hand held. When he leaves
he waves bye-bye. The developmental age of this infant
seems closes to
A.
B.
C.
D.
E.
6 months
9 months
12 months
15 months
18 months
48. A 2-1/2 year old child has had cough for two weeks
after having been hospitalized one month ago for
pneumonia in the right lower lobe. X-ray study of the
chest reveals persistence of pneumonia in the right
lower lobe. Of the following , the most likely
diagnosis is
A. Staphylococcal pneumonia
B. Foreign body aspiration
C. Cystic Fibrosis
D. Pneumonia due to Mycoplasma pneumoniae
E. Pneumonia due to respiratory synctial virus
48. A 2-1/2 year old child has had cough for two weeks after
having been hospitalized one month ago for pneumonia
in the right lower lobe. X-ray study of the chest reveals
persistence of pneumonia in the right lower lobe. Of the
following , the most likely diagnosis is
A. Staphylococcal pneumonia
B. Foreign body aspiration
C. Cystic Fibrosis
D. Pneumonia due to Mycoplasma pneumoniae
E. Pneumonia due to respiratory synctial virus
49. On routine examination of a 2-year old boy, you
noticed a moderate degree of peritibial
bruising. The finding of the physical
examination are normal. Of the following , the
most appropriate management at this time
would be to
A. Order x-ray studies of the long bones
B. Order determination of the bleeding and clotting
times
C. Re-assure the mother
D. Suggest limited activity for several days
E. Request a psychosocial consultation
49. On routine examination of a 2-year old boy,
you noticed a moderate degree of peritibial
bruising. The finding of the physical
examination are normal. Of the following , the
most appropriate management at this time
would be to
A. Order x-ray studies of the long bones
B. Order determination of the bleeding and clotting
times
C. Re-assure the mother
D. Suggest limited activity for several days
E. Request a psychosocial consultation
50. A full term, 3-week old infant is pale, irritable,
restless, and feeding poorly. Pulse rate is
250/min, respiratory rate is 60/min. The liver
edge is palpable 3 cm below the right costal
margin. Findings on physical examination are
otherwise normal. The most likely diagnosis is
A. Sepsis
B. Impending shock
C. Congestive heart failure due to a structural
congenital heart lesion
D. Paroxysmal atrial tachycardia
E. Sinus tachycardia
50. A full term, 3-week old infant is pale, irritable,
restless, and feeding poorly. Pulse rate is
250/min, respiratory rate is 60/min. The liver
edge is palpable 3 cm below the right costal
margin. Findings on physical examination are
otherwise normal. The most likely diagnosis is
A. Sepsis
B. Impending shock
C. Congestive heart failure due to a structural
congenital heart lesion
D. Paroxysmal atrial tachycardia
E. Sinus tachycardia
51. A 3-year old child is brought to you because her speech
consist only of single words . She sat at 6 months,
walked at 11 months and was toilet trained at 2 years
of age. She dresses and undresses herself, except
that sometimes she puts the shoes on the wrong feet.
She responds to simple requests. Findings on
examination except for speech are normal.
Which of the following statements concerning this clinical
situation is true?
A.
B.
C.
D.
E.
this child is probably mentally retarded and should be referred
for an IQ test
The child’s hearing should be tested
The child should be referred to a psychiatrist
The parents can be assured that nothing is wrong and that the
child will learn to talk in time
The parents should be instructed not to give the child anything
unless she asks for it using more than one word
51. A 3-year old child is brought to you because her speech
consist only of single words . She sat at 6 months,
walked at 11 months and was toilet trained at 2 years
of age. She dresses and undresses herself, except
that sometimes she puts the shoes on the wrong feet.
She responds to simple requests. Findings on
examination except for speech are normal.
Which of the following statements concerning this clinical
situation is true?
A.
B.
C.
D.
E.
this child is probably mentally retarded and should be referred
for an IQ test
The child’s hearing should be tested
The child should be referred to a psychiatrist
The parents can be assured that nothing is wrong and that the
child will learn to talk in time
The parents should be instructed not to give the child anything
unless she asks for it using more than one word
52. School phobias (school refusals) in
grade-school children most commonly
result from
A.
B.
C.
D.
Fear of a strict teacher
Concern about failing school
Fear of separation from parent
Desire to avoid unfriendly classmates
E. Inability to do school work
52. School phobias (school refusals) in
grade-school children most commonly
result from
A.
B.
C.
D.
Fear of a strict teacher
Concern about failing school
Fear of separation from parent
Desire to avoid unfriendly classmates
E. Inability to do school work
53. A 6-year old boy suffers major abdominal trauma in a
motor vehicle accident. One hour later in the
emergency department, blood pressure is 65/40
mmHg. Hemoglobin concentration is 6.0 g/dL. Arterial
blood gas and pH analysis while the patient is
breathing room air shows pH 7.47, PO2 45 mmHg and
PCO2 30 mmHg, FiO2 is 0.21. An x-ray study of the
chest reveals diffuse bilateral pulmonary infiltrates.
Which of the following will provide the greatest improvement
in oxygen transport?
A. Vasopressors
B. Intubation and ventilation with positive endexpiratory pressure (PEEP)
C. Administration of 100% oxygen
D. Blood transfusion
E. Diuretics
53. A 6-year old boy suffers major abdominal trauma in a
motor vehicle accident. One hour later in the
emergency department, blood pressure is 65/40
mmHg. Hemoglobin concentration is 6.0 g/dL. Arterial
blood gas and pH analysis while the patient is
breathing room air shows pH 7.47, PO2 45 mmHg and
PCO2 30 mmHg, FiO2 is 0.21. An x-ray study of the
chest reveals diffuse bilateral pulmonary infiltrates.
Which of the following will provide the greatest improvement
in oxygen transport?
A. Vasopressors
B. Intubation and ventilation with positive endexpiratory pressure (PEEP)
C. Administration of 100% oxygen
D. Blood transfusion
E. Diuretics
54. 7 years old female attends pediatric clinic and
is noted to have scattered small, raised lesions
on her trunk and axillary freckles. No family
history of the same lesions.
What is the likely mode of inheritance of this
condition?
A.
B.
C.
D.
E.
Autosomal recessive.
X- linked recessive
Trinucleotide repeating
Autosomal dominant
multifactorial
54. 7 years old female attends pediatric clinic and
is noted to have scattered small, raised lesions
on her trunk and axillary freckles. No family
history of the same lesions.
What is the likely mode of inheritance of this
condition?
A.
B.
C.
D.
E.
Autosomal recessive.
X- linked recessive
Trinucleotide repeating
Autosomal dominant
multifactorial
55. You are discusing with a resident who has just evaluated a 4year-old who has classic varicella lesions and a history that is
consistent with this diagnosis.he put small pox as D/D. Of the
following, the MOST accurate statement about the tow
pathologies is that
A. lesions of both varicella and smallpox follow a 7- to 10-day
course from eruption to resolution
B. lesions of both varicella and smallpox frequently produce
deep, pitted scars
C. varicella lesions are transient vesicles; smallpox lesions are
persistent pustules until resolution of the illness
D. varicella lesions are concentrated on the face; smallpox
lesions are concentrated over bony Prominences
E. varicella lesions appear in stages or crops; smallpox lesions
are uniformly in the same stage of development
55. You are discusing with a resident who has just evaluated a 4year-old who has classic varicella lesions and a history that is
consistent with this diagnosis.he put small pox as D/D. Of the
following, the MOST accurate statement about the tow
pathologies is that
A. lesions of both varicella and smallpox follow a 7- to 10-day
course from eruption to resolution
B. lesions of both varicella and smallpox frequently produce
deep, pitted scars
C. varicella lesions are transient vesicles; smallpox lesions are
persistent pustules until resolution of the illness
D. varicella lesions are concentrated on the face; smallpox
lesions are concentrated over bony Prominences
E. varicella lesions appear in stages or crops; smallpox
lesions are uniformly in the same stage of development
56. A 14-yeard old girl with hyperthyroidism did
not respond to antithyroid medication. A
subtotal thyroidectomy was performed. After
the operation, she had a unilateral convulsion.
The best initial means to stop such a seizure is
administration of
A. Paraldehyde, rectally
B. Diazepam, intravenously’
C. Phenobarbital, intramuscularly
D. Calcium, intravenously
E. Phenytoin, intravenously
56. A 14-yeard old girl with hyperthyroidism did
not respond to antithyroid medication. A
subtotal thyroidectomy was performed. After
the operation, she had a unilateral convulsion.
The best initial means to stop such a seizure is
administration of
A. Paraldehyde, rectally
B. Diazepam, intravenously’
C. Phenobarbital, intramuscularly
D. Calcium, intravenously
E. Phenytoin, intravenously
57. A 10-yeard old girl has a one-month history of
progressive symmetrical weakness leading to
an inability to walk. She appears ill and has
generalized tenderness of the muscles. The
face is swollen and the eyelids are discolored.
The laboratory test result most likely to be normal
in this patient is
A. Serum aldolase activity
B. Anti-DNAse B titer
C. Muscle biopsy
D. Serum Creatinine kinase activity
E. Electromyography
57. A 10-yeard old girl has a one-month history of
progressive symmetrical weakness leading to
an inability to walk. She appears ill and has
generalized tenderness of the muscles. The
face is swollen and the eyelids are discolored.
The laboratory test result most likely to be normal
in this patient is
A. Serum aldolase activity
B. Anti-DNAse B titer
C. Muscle biopsy
D. Serum Creatinine kinase activity
E. Electromyography
58. A 2-year old asymptomatic child is brought to the hospital
30 minutes after ingesting an unknown quantity of
kerosene that had been stored in a soda bottle. From the
amount of kerosene left in the bottle and the odor of the
child’s clothing, it is subsequently estimated that a
maximum of 10 ml of kerosene may have been ingested.
Among the following, the treatment of choice one hour
after ingestion would be
A.
B.
C.
D.
E.
Induction of emesis with ipecac syrup, 30 ml orally
Gastric lavage
Gastric lavage after placement of cuffed endotracheal
tube
Administration of olive oil, 60 ml orally
Observation only
58. A 2-year old asymptomatic child is brought to the hospital
30 minutes after ingesting an unknown quantity of
kerosene that had been stored in a soda bottle. From the
amount of kerosene left in the bottle and the odor of the
child’s clothing, it is subsequently estimated that a
maximum of 10 ml of kerosene may have been ingested.
Among the following, the treatment of choice one hour
after ingestion would be
A.
B.
C.
D.
E.
Induction of emesis with ipecac syrup, 30 ml orally
Gastric lavage
Gastric lavage after placement of cuffed endotracheal
tube
Administration of olive oil, 60 ml orally
Observation only
59. A 12-year old boy is referred to you by a family
physician because of a pectus excavation
deformity he has had since birth. Physical
examination confirms the diagnosis of pectus
excavatum. As a consultant to this boy, you
should know that the most common indication for
operative correction of pectus excavatum is
A. Development of congestive heart failure
B. Psychological discomfort with cosmetic
appearance
C. Progressive pulmonary deterioration
D. Failure to thrive stinal problems
E. Associated gastrointestinal problems
59. A 12-year old boy is referred to you by a family
physician because of a pectus excavation
deformity he has had since birth. Physical
examination confirms the diagnosis of pectus
excavatum. As a consultant to this boy, you
should know that the most common indication for
operative correction of pectus excavatum is
A. Development of congestive heart failure
B. Psychological discomfort with cosmetic
appearance
C. Progressive pulmonary deterioration
D. Failure to thrive stinal problems
E. Associated gastrointestinal problems
60. A 16 years old female presents with
hypertension and increasing weight. Which of
the following features would be most
suggestive of cushing’s syndrome rather than
simple obesity?
A. Moon face.
B. Acanthosis Nigricans
C. Abdominal striae.
D. Proximal myopathy
E. Buffalo Hump
60. A 16 years old female presents with
hypertension and increasing weight.
Which of the following features would be
most suggestive of cushing’s syndrome
rather than simple obesity?
A. Moon face.
B. Acanthosis Nigricans
C. Abdominal striae.
D. Proximal myopathy
E. Buffalo Hump
61. A 24 month old boy presents with high fever of
6 days duration, tender neck, red eyes and
cracked lips. In the second week he developed
maculopapular erythematous rash and
blanching.
What is the most likely diagnosis
A. Kawasaki disease
B. Stevens-Johnson syndrome
C. Acute toxoplasmosis
D. Meningococcal sepsis
E. Measles.
61. A 24 month old boy presents with high
fever of 6 days duration, tender neck, red
eyes and cracked lips. In the second
week he developed maculopapular
erythematous rash and blanching.
What is the most likely diagnosis
A. Kawasaki disease
B. Stevens-Johnson syndrome
C. Acute toxoplasmosis
D. Meningococcal sepsis
E. Measles.
62. A 15 years old female underwent a
renal transplant. She was concerned
about the effects of long-term
Cyclosporin treatment.
Which on of the following is a common
adverse effect of this
A.
B.
C.
D.
E.
Alopecia.
Paraesthesiae.
Hepatotoxicity
Nephrotoxicity.
Bone marrow depression
62. A 15 years old female underwent a
renal transplant. She was concerned
about the effects of long-term
Cyclosporin treatment.
Which on of the following is a common
adverse effect of this
A.
B.
C.
D.
E.
Alopecia.
Paraesthesiae.
Hepatotoxicity
Nephrotoxicity.
Bone marrow depression
63. A 7 years old male presented with a strongly
positive Mantoux test. Which one of the
following statements regarding his immune
reaction is correct?
A. The reaction typically develops within 24 hours
B. It is a cell mediated immune response
C. The area of induration will be less than 10 mm in
diameter
D. The response is mediated by B lymphocytes
E. If a skin biopsy were taken, immunohistochemistry
would show immune complex deposition.
63. A 7 years old male presented with a
strongly positive Mantoux test. Which
one of the following statements regarding
his immune reaction is correct?
A. The reaction typically develops within 24 hours
B. It is a cell mediated immune response
C. The area of induration will be less than 10 mm in
diameter
D. The response is mediated by B lymphocytes
E. If a skin biopsy were taken, immunohistochemistry
would show immune complex deposition.
64. The mechanism for Alo-immune
thrombocytopena in the newborn infant is
A. Production of antifetal platelet antibodies by the
mother
B. Production of antiplatelet antibodies by the fetus
C. Transfer of antimaternal platelet antibodies across
the placenta
D. Impairment of megakaryocytic function caused by
autoantibodies
E. Platelet aggregation secondary to occult infection
64. The mechanism for Alo-immune
thrombocytopena in the newborn infant is
A. Production of antifetal platelet antibodies by the
mother
B. Production of antiplatelet antibodies by the fetus
C. Transfer of antimaternal platelet antibodies across
the placenta
D. Impairment of megakaryocytic function caused by
autoantibodies
E. Platelet aggregation secondary to occult infection
65. A 5-year old girl is brought to your office by her mother
who reports that the child is one of four children in her
nursery school class who have similar rashes. Two
days ago the patient had a low grade fever with the
temperature reaching 38 C . The cheeks became red.
She denied having sore throat. Today she has a
generalized, discrete maculopapular rash.The most
likely diagnosis is
A.
B.
C.
D.
E.
Rubella
Measles
Scarlet fever
Erythema infectiosum
Pityriasis rosea
65. A 5-year old girl is brought to your office by her mother
who reports that the child is one of four children in her
nursery school class who have similar rashes. Two
days ago the patient had a low grade fever with the
temperature reaching 38 C . The cheeks became red.
She denied having sore throat. Today she has a
generalized, discrete maculopapular rash.The most
likely diagnosis is
A.
B.
C.
D.
E.
Rubella
Measles
Scarlet fever
Erythema infectiosum
Pityriasis rosea
66. Stridor, tachypnea and wheezing develop
suddenly in a 10-year old girl who has received
an injection of contrast medium for intravenous
pyelography. Large urticarial lesions appear
over the face , chest and extremities.
Of the following agents, you should first administer
A.
B.
C.
D.
E.
Diphenhydramine
Epinephrine
Theophylline
Corticosteroids
Antibiotics
66. Stridor, tachypnea and wheezing develop
suddenly in a 10-year old girl who has received
an injection of contrast medium for intravenous
pyelography. Large urticarial lesions appear
over the face , chest and extremities.
Of the following agents, you should first administer
A.
B.
C.
D.
E.
Diphenhydramine
Epinephrine
Theophylline
Corticosteroids
Antibiotics
67. Fever and a swollen eye have been present for
one day in a 5-year old boy following an upper
respiratory tract infection. There is no history of
trauma. The boy is irritable and has proptosis
and chemosis of the left eye.
Among the following, the most likely diagnosis is
A.
B.
C.
D.
E.
Corneal foreign body
Retinoblastoma
Post-septal orbital Cellulitis
Hyphema
Battered child syndrome
67. Fever and a swollen eye have been present for
one day in a 5-year old boy following an upper
respiratory tract infection. There is no history of
trauma. The boy is irritable and has proptosis
and chemosis of the left eye.
Among the following, the most likely diagnosis is
A.
B.
C.
D.
E.
Corneal foreign body
Retinoblastoma
Post-septal orbital Cellulitis
Hyphema
Battered child syndrome
68. A 2-yeard old boy is brought to you because his
mother has never noted his testes. On physical
examination the testes are not palpable in the
scrotum. The penis is normal.
Which of the following would be indicated at this
point?
A.
B.
C.
D.
Examination with the patient in a squatting position
Administration of human chorionic gonadotropin
X-ray studies to determine bone age
Determination of the plasma testosterone
concentration
E. Assurance of the mother that the testes will ultimately
descend
68. A 2-yeard old boy is brought to you because his
mother has never noted his testes. On physical
examination the testes are not palpable in the
scrotum. The penis is normal.
Which of the following would be indicated at this
point?
A.
B.
C.
D.
Examination with the patient in a squatting position
Administration of human chorionic gonadotropin
X-ray studies to determine bone age
Determination of the plasma testosterone
concentration
E. Assurance of the mother that the testes will ultimately
descend
69. A 1-year old infant is admitted to the hospital because of
bacterial meningitis. He is treated with intravenous
administration of antibodies in 5% glucose with 30
mEq/L of sodium chloride at 5 ml/kg/hour. Six hours
after therapy is initiated, he has a generalized tonic
clonic seizure. Physical examination reveals a lethargic
but responsive infant. Temperature is 39.30C , Pulse
rate is 108/min, and blood pressure is 92/78 mmHg.
Which of the following would be the most
appropriate at this time?
A.
B.
C.
D.
E.
A second examination of the cerebrospinal fluid
Computed tomography (CT scan) of the head
Determination of serum electrolyte concentrations
Bilateral subdural taps
Intravenous administration of Phenobarbital
69. A 1-year old infant is admitted to the hospital because of
bacterial meningitis. He is treated with intravenous
administration of antibodies in 5% glucose with 30
mEq/L of sodium chloride at 5 ml/kg/hour. Six hours
after therapy is initiated, he has a generalized tonic
clonic seizure. Physical examination reveals a lethargic
but responsive infant. Temperature is 39.30C , Pulse
rate is 108/min, and blood pressure is 92/78 mmHg.
Which of the following would be the most
appropriate at this time?
A. A second examination of the cerebrospinal fluid
B. Computed tomography (CT scan) of the head
C. Determination of serum electrolyte
concentrations
D. Bilateral subdural taps
E. Intravenous administration of Phenobarbital
70. A 4-week old girl was found shortly after birth
to have a cardiac murmur. Her color is now
good and weight gain has been satisfactory.
Pulse rate is 160/min and respiratory rate is
70/min. Her mother has noted that the infant
sweats despite normal ambient temperature
and that she sleeps poorly.
The infant most likely has
A.
B.
C.
D.
E.
Pneumonia
Sepsis
Paroxysmal Atrial tachycardia
A left to right shunt circulation
A Septal defect that has begun to close
70. A 4-week old girl was found shortly after birth
to have a cardiac murmur. Her color is now
good and weight gain has been satisfactory.
Pulse rate is 160/min and respiratory rate is
70/min. Her mother has noted that the infant
sweats despite normal ambient temperature
and that she sleeps poorly.
The infant most likely has
A.
B.
C.
D.
E.
Pneumonia
Sepsis
Paroxysmal Atrial tachycardia
A left to right shunt circulation
A Septal defect that has begun to close
71. A woman who is positive for hepatitis B surface antigen
(HbsAg) but negative for hepatitis Be antigen (HbeAg),
delivers at term. After careful bathing, the BEST
management for this woman’s infant would be to:
A.
B.
C.
D.
E.
Administer gamma globulin intramuscularly
immediately and at 1 month of age.
Administer HBIG and HB vaccine immediately and HB
vaccine again at 1 month and 6 months of age.
Administer hepatitis B immunoglobulin (HBIG) if cord
blood is positive for HBSAg.
Administer hepatitis B (HB) vaccine immediately and at
1 month and 6 months of age
Advise mother that breast feeding is contraindicated.
71. A woman who is positive for hepatitis B surface antigen
(HbsAg) but negative for hepatitis Be antigen (HbeAg),
delivers at term. After careful bathing, the BEST
management for this woman’s infant would be to:
A.
B.
C.
D.
E.
Administer gamma globulin intramuscularly
immediately and at 1 month of age.
Administer HBIG and HB vaccine immediately and
HB vaccine again at 1 month and 6 months of age.
Administer hepatitis B immunoglobulin (HBIG) if cord
blood is positive for HBSAg.
Administer hepatitis B (HB) vaccine immediately and at
1 month and 6 months of age
Advise mother that breast feeding is contraindicated.
72. The parents of an 18-month old boy bring the infant to
you as a new patient. They state that he has been
constipated since early infancy. He has been managed
with fair success with glycerin suppositories and
laxatives. Physical examination discloses no distention of
the abdomen. A copious amount of fecal material is
palpated in the large bowel. The rectal ampulla is empty.
The management of choice would be to
A. Continue the present treatment regimen
B. Continue the present treatment regimen but add more
bulk to the diet
C. Prescribe mineral oil
D. Order a barium enema examination
E. Discontinue all medications and observe the patient
72. The parents of an 18-month old boy bring the infant to
you as a new patient. They state that he has been
constipated since early infancy. He has been managed
with fair success with glycerin suppositories and
laxatives. Physical examination discloses no distention of
the abdomen. A copious amount of fecal material is
palpated in the large bowel. The rectal ampulla is empty.
The management of choice would be to
A. Continue the present treatment regimen
B. Continue the present treatment regimen but add more
bulk to the diet
C. Prescribe mineral oil
D. Order a barium enema examination
E. Discontinue all medications and observe the patient
73. 10 years old boy presented with fever,
headache and neck stiffness for 24 hours. He
had an identical illness requiring admission to
hospital at 8 year of age
Of the following, the most likely immune defect is
A.
B.
C.
D.
E.
B lymphocytes.
Complement pathway.
Immunoglobulin production.
Neutrophil count.
Neutrophil function.
73. 10 years old boy presented with fever,
headache and neck stiffness for 24
hours. He had an identical illness
requiring admission to hospital at 8 year
of age
Of the following, the most likely immune defect is
A.
B.
C.
D.
E.
B lymphocytes.
Complement pathway
Immunoglobulin production
Neutrophil count
Neutrophil function
74. A 2-month old boy is hospitalized because of cough and
rapid respirations. The infant has been well since birth
except for a mild mucoid conjunctivitis. Length and weigh
are at the 15th percentile. An x-ray study of the chest
reveals hyperinflation and bilateral interstitial
pneumonia. His temperature is 38.0C and his respiratory
rate is 56/min. Leukocyte count is 10,000/mm3 with 60%
Neutrophil, 5% band forms, 35% lymphocytes, and 10%
eosinophils. The serum IgM concentration is markedly
increased.
The most likely diagnosis is
A.
B.
C.
D.
E.
Pertussis
Pneumonia due to Chlamydia Trachomatis
Pneumonia due to Myoplasma pneumoniae
Pneumonia due to Hemophillus Influenzae
Pneumonia due to Staphylococcus Aureus
74. A 2-month old boy is hospitalized because of cough and
rapid respirations. The infant has been well since birth
except for a mild mucoid conjunctivitis. Length and weigh
are at the 15th percentile. An x-ray study of the chest
reveals hyperinflation and bilateral interstitial
pneumonia. His temperature is 38.0C and his respiratory
rate is 56/min. Leukocyte count is 10,000/mm3 with 60%
Neutrophil, 5% band forms, 35% lymphocytes, and 10%
eosinophils. The serum IgM concentration is markedly
increased.
The most likely diagnosis is
A.
B.
C.
D.
E.
Pertussis
Pneumonia due to Chlamydia Trachomatis
Pneumonia due to Myoplasma pneumoniae
Pneumonia due to Hemophillus Influenzae
Pneumonia due to Staphylococcus Aureus
75. In infants with serious dehydration, the
clinical signs of tachycardia , poor turgor
and cool distal extremities result primarily
from
A.
B.
C.
D.
E.
metabolic acidosis
Starvation
Hypovolemia
Cortisol deficit
Oliguria
75. In infants with serious dehydration, the
clinical signs of tachycardia , poor turgor
and cool distal extremities result primarily
from
A.
B.
C.
D.
E.
metabolic acidosis
Starvation
Hypovolemia
Cortisol deficit
Oliguria
76. An infant who has not yet passed meconium begins
vomiting when he is 36 hours old. His abdomen has
doughy distension. The rectum is empty on
examination, no meconium was seen on the examiner’s
finger. An x-ray study of the abdomen shows distended
intestinal loops, but fluid levels are not present. The
abdomen has a granular, ground glass appearance with
flecks of calcium scattered throughout.
The most likely diagnosis is
A.
B.
C.
D.
E.
Aganglionic megacolon (Hirschsprung’s disease)
Intestinal Atresia
Meconium plug syndrome
Ruptured appendix
Cystic fibrosis, Meconium ileus and peritonitis
76. An infant who has not yet passed meconium begins
vomiting when he is 36 hours old. His abdomen has
doughy distension. The rectum is empty on
examination, no meconium was seen on the examiner’s
finger. An x-ray study of the abdomen shows distended
intestinal loops, but fluid levels are not present. The
abdomen has a granular, ground glass appearance with
flecks of calcium scattered throughout.
The most likely diagnosis is
A.
B.
C.
D.
E.
Aganglionic megacolon (Hirschsprung’s disease)
Intestinal Atresia
Meconium plug syndrome
Ruptured appendix
Cystic fibrosis, Meconium ileus and peritonitis
77. Your 4-yeard old patient who is receiving L-asparaginase
and vincristine therapy for acute lymphocytic leukemia
played for one hour with a child who has had a varicella
rash for 2 hours. The patient’s mother does not recall that
her child has had varicella in the past.
Of the following, the most appropriate course of management
would be to
A. Discontinue chemotherapy for about three weeks and
observe
B. Discontinue Chemotherapy for about three weeks and
administer zoster immune globulin
C. Discontinue chemotherapy for about three weeks and
administer live attenuated varicella vaccine
D. Continued chemotherapy and administer acyclovir
E. Continue chemotherapy without changing the regimen
77. Your 4-yeard old patient who is receiving L-asparaginase
and vincristine therapy for acute lymphocytic leukemia
played for one hour with a child who has had a varicella
rash for 2 hours. The patient’s mother does not recall that
her child has had varicella in the past.
Of the following, the most appropriate course of management
would be to
A. Discontinue chemotherapy for about three weeks and
observe
B. Discontinue Chemotherapy for about three weeks and
administer zoster immune globulin
C. Discontinue chemotherapy for about three weeks
and administer live attenuated varicella vaccine
D. Continued chemotherapy and administer acyclovir
E. Continue chemotherapy without changing the regimen
78. Which of the following has the most
potential for the subsequent
development of malignancy?
A.
B.
C.
D.
E.
Mongolian spot
Strawberry hemangiomas
Giant pigmented nevus
Nevus flammeus
Café-au-lait spot
78. Which of the following has the most
potential for the subsequent
development of malignancy?
A.
B.
C.
D.
E.
Mongolian spot
Strawberry hemangiomas
Giant pigmented nevus
Nevus flammeus
Café-au-lait spot
79. Which of the following is a feature of
Neurofibromatosis?
A.
B.
C.
D.
E.
Cushing’s syndrome.
Haemangiomas of the retina.
Infantile spasm.
Scoliosis.
Shagreen patch.
79. Which of the following is a feature of
Neurofibromatosis?
A.
B.
C.
D.
E.
Cushing’s syndrome.
Haemangiomas of the retina.
Infantile spasm.
Scoliosis.
Shagreen patch.
80. The mother of a previously healthy 2-year
old boy seeks medical advice because her
child is not using his left arm. No definite
precipitating event can be established but
the mother recalls that the boy and his
father were playing rather roughly the
evening before he stopped using the arm.
The most likely diagnosis is
A.
B.
C.
D.
E.
Fractured clavicle
Colles fracture
Subluxation of the radial head
Epiphyseal fracture of the upper extremity
None of the above
80. The mother of a previously healthy 2-year
old boy seeks medical advice because her
child is not using his left arm. No definite
precipitating event can be established but
the mother recalls that the boy and his
father were playing rather roughly the
evening before he stopped using the arm.
The most likely diagnosis is
A.
B.
C.
D.
E.
Fractured clavicle
Colles fracture
Subluxation of the radial head
Epiphyseal fracture of the upper extremity
None of the above
81. A 12 years old girl presented with acute
Guillain-Barre syndrome and has developed
worsening proximal muscle weakness. Which
one of the following tests should be used to
monitor her respiratory function?
A.
B.
C.
D.
E.
Arterial blood gas.
Vital capacity.
FEV1/FVC ratio.
Peak expiratory flow rate.
Chest expansion
81. A 12 years old girl presented with acute
Guillain-Barre syndrome and has developed
worsening proximal muscle weakness. Which
one of the following tests should be used to
monitor her respiratory function?
A.
B.
C.
D.
E.
Arterial blood gas.
Vital capacity.
FEV1/FVC ratio.
Peak expiratory flow rate.
Chest expansion
82. 8 years old boy presents with hypertension. Which of
the following statements concerning hypertension in the
young is true?
A. Sodium nitroprusside is useful for the long-term
treatment of sever cases.
B. Abnormalities are frequently seen on DMSA scan.
C. It is defined as systolic blood pressure above the
99th centile for age.
D. Headache is the usual presenting feature
E. Aortic coarctation is the commonest secondary
cause.
82. 8 years old boy presents with hypertension.
Which of the following statements concerning
hypertension in the young is true?
A. Sodium nitroprusside is useful for the long-term
treatment of sever cases.
B. Abnormalities are frequently seen on DMSA scan.
C. It is defined as systolic blood pressure above the 99th
centile for age.
D. Headache is the usual presenting feature
E. Aortic coarctation is the commonest secondary cause.
83. A child with chronic renal failure has persistent acidosis
with an increased anion gap. Increased serum
concentration of which of the following substances
would likely contribute most to this finding?
A.
B.
C.
D.
E.
Lactic acid
Protein
Urea
Inorganic acids
Keto acids
83. A child with chronic renal failure has persistent acidosis
with an increased anion gap. Increased serum
concentration of which of the following substances
would likely contribute most to this finding?
A.
B.
C.
D.
E.
Lactic acid
Protein
Urea
Inorganic acids
Keto acids
84. A 6-month old infant with tachypnea, dyspnea
prolonged expiration and an overly expanded
chest probably has
A. Obstruction in the upper respiratory tract (larynx or
above)
B. Obstruction in the lower respiratory tract (below the
larynx)
C. Obstruction in both the upper and lower respiratory
tracts
D. Extensive exudative disease involving the lung
parenchyma
E. An intracranial lesion stimulating the respiratory
center
84. A 6-month old infant with tachypnea, dyspnea
prolonged expiration and an overly expanded
chest probably has
A. Obstruction in the upper respiratory tract (larynx or
above)
B. Obstruction in the lower respiratory tract (below
the larynx)
C. Obstruction in both the upper and lower respiratory
tracts
D. Extensive exudative disease involving the lung
parenchyma
E. An intracranial lesion stimulating the respiratory
center
85. 17 years old boy presented with a non-blanching
rash over his legs, a swollen knee and painless
frank Haematuria. Investigations revealed:serum
creatinine: 210 uml/L (60-110). Urine dipstick
analysis: blood +++., protein +. Urine culture:
negative. Ultrasound of the kidneys was normal.
Which glomerular abnormality is most likely to be
present at renal biobsy
A.
B.
C.
D.
E.
Foot process fusion.
Linear deposition of IgG on the basement
membrane.
mesangial proliferative and focal lesions
Thickening of basement membranes.
Mesangial deposition of IgA
85. 17 years old boy presented with a nonblanching rash over his legs, a swollen knee
and painless frank Haematuria. Investigations
revealed:serum creatinine: 210 uml/L (60-110).
Urine dipstick analysis: blood +++., protein +.
Urine culture: negative. Ultrasound of the
kidneys: normal.
Which glomerular abnormality is most likely to be
present at renal biobsy
A.
B.
Foot process fusion.
Linear deposition of IgG on the basement membrane.
C. mesangial proliferative and focal lesions
D.
E.
Thickening of basement membranes.
Mesangial deposition of IgA
86. A mother reports that her 11-month old
son who was previously sleeping through
the night now awakens several times
during each night.
This most likely represents
A.
B.
C.
D.
E.
A normal developmental stage
Putting the infant to bed too early
Hunger
Inconsistent bedtime
Family disturbance
86. A mother reports that her 11-month old
son who was previously sleeping through
the night now awakens several times
during each night.
This most likely represents
A.
B.
C.
D.
E.
A normal developmental stage
Putting the infant to bed too early
Hunger
Inconsistent bedtime
Family disturbance
87. Hyperpnea, lethargy and fever have developed in a 2
year old girl with rheumatoid arthritis. She is not
dehydrated or disoriented. There is no nuchal rigidity
on physical examination. The lungs are clear. Findings
on x-ray study of the chest are normal. Blood oozes
from a venipuncture site. Urinalysis reveals reducing
substance but no ketones. An aunt has diabetes
mellitus.
The most likely diagnosis is
A.
B.
C.
D.
E.
Diabetic Ketoacidosis
Reactive airways disease
Gastroenteritis with acidosis
Salicylate intoxication
Oranophosphate ingestion
87. Hyperpnea, lethargy and fever have developed in a 2
year old girl with rheumatoid arthritis. She is not
dehydrated or disoriented. There is no nuchal rigidity
on physical examination. The lungs are clear. Findings
on x-ray study of the chest are normal. Blood oozes
from a venipuncture site. Urinalysis reveals reducing
substance but no ketones. An aunt has diabetes
mellitus.
The most likely diagnosis is
A.
B.
C.
D.
E.
Diabetic Ketoacidosis
Reactive airways disease
Gastroenteritis with acidosis
Salicylate intoxication
Oranophosphate ingestion
88. A young woman with rheumatoid arthritis
receives Prednisolone 15 mg every other
day throughout pregnancy. Her newborn
infant will most likely
A.
B.
C.
D.
E.
be small for gestational age
Have a cleft palate
Have a cushingoid appearance
Have adrenal insufficiency
Have no evident ill effects
88. A young woman with rheumatoid arthritis
receives Prednisolone 15 mg every other day
throughout pregnancy. Her newborn infant will
most likely
A.
B.
C.
D.
E.
be small for gestational age
Have a cleft palate
Have a cushingoid appearance
Have adrenal insufficiency
Have no evident ill effects
89. An infant weighing 5 kg has Hyponatremia
with shock and convulsions. The serum
sodium concentration is 118 mEq/L . He is
treated with 42 ml of (5.85%) sodium chloride
solution intravenously over a 30-minute period.
At the end of that time, the predicated serum
sodium concentration would be closest to
A.
B.
C.
D.
E.
130 mEq/L
160 mEq/L
146 mEq/L
152 mEq/L
140 mEq/L
89. An infant weighing 5 kg has Hyponatremia
with shock and convulsions. The serum
sodium concentration is 118 mEq/L . He is
treated with 42 ml of (5.85%) sodium chloride
solution intravenously over a 30-minute period.
At the end of that time, the predicated serum
sodium concentration would be closest to
A.
B.
C.
D.
E.
130 mEq/L
160 mEq/L
146 mEq/L
152 mEq/L
140 mEq/L
90.Thalassemia major has been diagnosed in a 2-yeard old
girl who weighs 12 kg. Her hemoglobin concentration
is 4 g/Dl. To increase her hemoglobin concentration to
10 g/dL by transfusion with packed erythrocytes having
a hemoglobin concentration of 22 g/dL the
approximate volume of packed erythrocytes needed
would be
A.
B.
C.
D.
E.
100 ml
250 ml
125 ml
150 ml
500 ml
90.Thalassemia major has been diagnosed in a 2-yeard old
girl who weighs 12 kg. Her hemoglobin concentration
is 4 g/Dl. To increase her hemoglobin concentration to
10 g/dL by transfusion with packed erythrocytes having
a hemoglobin concentration of 22 g/dL the
approximate volume of packed erythrocytes needed
would be
A.
B.
C.
D.
E.
100 ml
250 ml
125 ml
150 ml
500 ml
91. Routine physical examination of a 4-year
old boy reveals enlargement of the upper
and lower left limbs.
Which of the following conditions is
associated with this physical findings?
A.
B.
C.
D.
E.
lymphoma
Wilms tumor
Rhabdomyosarcoma
Neuroblastoma
Acute lymphocytic leukemia
91. Routine physical examination of a 4-year
old boy reveals enlargement of the upper
and lower left limbs.
Which of the following conditions is
associated with this physical findings?
A.
B.
C.
D.
E.
lymphoma
Wilms tumor
Rhabdomyosarcoma
Neuroblastoma
Acute lymphocytic leukemia
92. An afebrile 2-week old infant has cough and
tachypnea. X-ray study of the chest shows a
radiolucent area in the left upper lobe causing
a slight mediastinal shift to the right.
The most likely diagnosis is
A.
B.
C.
D.
E.
Cystic fibrosis
Congenital lobar emphysema
Pulmonary sequestration
Lung abscess
Pneumomediastinum
92. An afebrile 2-week old infant has cough
and tachypnea. X-ray study of the chest
shows a radiolucent area in the left upper
lobe causing a slight mediastinal shift to
the right.
The most likely diagnosis is
A.
B.
C.
D.
E.
Cystic fibrosis
Congenital lobar emphysema
Pulmonary sequestration
Lung abscess
Pneumomediastinum
93. An 18-month old boy who was circumcised as a
newborn infant has had pain on urination for one day.
Today his mother noticed blood on his diaper.
Physical examination shows a crusted meatal ulcer. Bag
collected urine contains 6 erythrocytes/hpf and no
bacteria smear. Further management would most
appropriately include
A.
B.
C.
D.
E.
Local application of petroleum jelly and advice to the mother
regarding prevention of primary irritant contact dermatitis
Obtaining a clear catch urine specimen for culture and colony
count
Treatment with sulfisoxazole and plans for subsequent
intravenous urography
Referral to a urologist
Immediate intravenous pyelography
93. An 18-month old boy who was circumcised as a
newborn infant has had pain on urination for one day.
Today his mother noticed blood on his diaper.
Physical examination shows a crusted meatal ulcer. Bag
collected urine contains 6 erythrocytes/hpf and no
bacteria smear. Further management would most
appropriately include
A.
B.
C.
D.
E.
Local application of petroleum jelly and advice to the
mother regarding prevention of primary irritant contact
dermatitis
Obtaining a clear catch urine specimen for culture and colony
count
Treatment with sulfisoxazole and plans for subsequent
intravenous urography
Referral to a urologist
Immediate intravenous pyelography
94- A 2-year-old boy presents with a 3-day history of diarrhea and
vomiting. He has been able to tolerate small amounts of fluids. He is
moderately dehydrated, with dry mucous membranes and a heart rate
of 145 beats/min.
Of the following, the BEST management for this patient's fluid status is
A. hospitalization with intravenous fluids and a restrictive
bland diet
B. hospitalization with intravenous fluids and gut rest for 24
hours
C. oral rehydration therapy at home followed by a diet of
fruits, vegetables, and meats
D. oral rehydration therapy at home followed by a clear
liquid diet for 24 hours
E. oral rehydration therapy at home followed by a restrictive
bland diet
94- A 2-year-old boy presents with a 3-day history of diarrhea and
vomiting. He has been able to tolerate small amounts of fluids. He is
moderately dehydrated, with dry mucous membranes and a heart rate
of 145 beats/min.
Of the following, the BEST management for this patient's fluid status is
A. hospitalization with intravenous fluids and a restrictive
bland diet
B. hospitalization with intravenous fluids and gut rest for 24
hours
C. oral rehydration therapy at home followed by a diet of
fruits, vegetables, and meats
D. oral rehydration therapy at home followed by a clear
liquid diet for 24 hours
E. oral rehydration therapy at home followed by a restrictive
bland diet
95. Increased blood concentration of free
erythrocyte protoporphyrin in chronic
lead poisoning is the result of
A. Impaired renal excretion of protoporphyrin
B. Impaired binding of protoporphyrin with iron
to produce heme
C. Increased synthesis of protoprophyrin
D. Increased hemoglobin breakdown
E. Increased binding of heme to the globin
molecule in hemoglobin synthesis
95. Increased blood concentration of free
erythrocyte protoporphyrin in chronic
lead poisoning is the result of
A. Impaired renal excretion of protoporphyrin
B. Impaired binding of protoporphyrin with
iron to produce heme
C. Increased synthesis of protoprophyrin
D. Increased hemoglobin breakdown
E. Increased binding of heme to the globin
molecule in hemoglobin synthesis
96. A mother brings her 10-month-old son to the emergency
department because he has been vomiting for the past
10 days. The child has not experienced any diarrhea. On
physical examination, he is lethargic and has dry
mucous membranes, reduced tears, a full anterior
fontanelle, and 2-second capillary refill. After a second
intravenous bolus of 20 mL/kg of normal saline, the boy
extends his arms and legs forcefully for 10 seconds. Of
the following, the MOST appropriate next step in the
management of this child is administration of
A. additional intravenous normal saline bolus of 20 mL/kg
B. intravenous fosphenytoin bolus at 20 mg/kg phenytoin
equivalents over 10 minutes
C. intravenous prochlorperazine of 5 mg
D. rapid intravenous lorazepam of 0.05 mg/kg
E. intravenous dexamethasone of 1 mg/kg
96. A mother brings her 10-month-old son to the emergency
department because he has been vomiting for the past
10 days. The child has not experienced any diarrhea. On
physical examination, he is lethargic and has dry
mucous membranes, reduced tears, a full anterior
fontanelle, and 2-second capillary refill. After a second
intravenous bolus of 20 mL/kg of normal saline, the boy
extends his arms and legs forcefully for 10 seconds. Of
the following, the MOST appropriate next step in the
management of this child is administration of
A. additional intravenous normal saline bolus of 20 mL/kg
B. intravenous fosphenytoin bolus at 20 mg/kg phenytoin
equivalents over 10 minutes
C. intravenous prochlorperazine of 5 mg
D. rapid intravenous lorazepam of 0.05 mg/kg
E. intravenous dexamethasone of 1 mg/kg
97. The parents of a child who has Down
syndrome and a 47,XX+21 karyotype come to
you for counseling about future pregnancies.
Of the following, their risk for giving birth to
another child who has trisomy is CLOSEST to
A. no greater than the general population at
risk
B. 1% added to the mother's age-related risk
C. 5% added to the mother's age-related risk
D. 10% added to the mother's age-related risk
E. 25% added to the mother's age-related risk
97. The parents of a child who has Down
syndrome and a 47,XX+21 karyotype come to
you for counseling about future pregnancies.
Of the following, their risk for giving birth to
another child who has trisomy is CLOSEST to
A. no greater than the general population at
risk
B. 1% added to the mother's age-related risk
C. 5% added to the mother's age-related risk
D. 10% added to the mother's age-related risk
E. 25% added to the mother's age-related risk
98. An 8-year old boy is brought to your office because he
has fever, bilateral knee pain, and a limp. The patient
is a black child with generalized lymphadenopathy, an
enlarge spleen and a swollen, tender knee. Laboratory
studies reveal a hemoglobin concentration of 5 g/dL
and a leukocyte count of 2500 mm3 with 80%
lymphocytes.
Which of the following studies would be most helpful in
confirming the diagnosis?
A. Erythrocyte sedimentation rate
B. Heterophil titer
C. Coagulation profile
D. Examination of a bone marrow aspirate
E. X-ray study of the knee
98. An 8-year old boy is brought to your office because he
has fever, bilateral knee pain, and a limp. The patient
is a black child with generalized lymphadenopathy, an
enlarge spleen and a swollen, tender knee. Laboratory
studies reveal a hemoglobin concentration of 5 g/dL
and a leukocyte count of 2500 mm3 with 80%
lymphocytes.
Which of the following studies would be most helpful in
confirming the diagnosis?
A. Erythrocyte sedimentation rate
B. Heterophil titer
C. Coagulation profile
D. Examination of a bone marrow aspirate
E. X-ray study of the knee
99. In an infant, chronic hypervitaminosis A
is most often manifested by
A.
B.
C.
D.
E.
Follicular hyperkeratosis
Excessive growth of hair
Lymphocytic leukocytosis
Nephrocalcinosis
Thickening of the periosterum of the long
bones
99. In an infant, chronic hypervitaminosis A
is most often manifested by
A.
B.
C.
D.
E.
Follicular hyperkeratosis
Excessive growth of hair
Lymphocytic leukocytosis
Nephrocalcinosis
Thickening of the periosterum of the long
bones
100. A diagnosis of Kawasaki Syndrome has
been made in a 6-year old girl. Four days after
hospitalization, abdominal pain and distention
develop. These developments are most likely
due to;
A. Hydrops of the gallbladder
B. Enterocolitis
C. Intussusception
D. Volvulus
E. Hepatic Haematoma
100. A diagnosis of Kawasaki Syndrome has
been made in a 6-year old girl. Four days after
hospitalization, abdominal pain and distention
develop. These developments are most likely
due to;
A. Hydrops of the gallbladder
B. Enterocolitis
C. Intussusception
D. Volvulus
E. Hepatic Haematoma