Pulse pediatric 6th year exam - 2018:

1 Child with sore throat, and fever. The child plays & active when afebrile. Yesterday his mother
gave him Amoxicillin/clavulanic acid. All are appropriate to tell the mother except:

A-This is mostly viral infection & will resolve spontaneously

B-Warm fluids & antipyretic can help to improve his condition
C-Next time she shouldn't give him antibiotic without doctor prescription
D-He should continue the course to prevent development of antibiotic resistant

ANSWER: D

2 Mostly associated with cerebrovascular accident :

A- ASD
B- Coarcation aorta
C- Aortic stenosis
D- VSD

ANSWER: A

3 11 year old girl complains of Morning headaches for 3 months, brought by her parents. MRI
was done and ruled out any pathology, Ophthalmic exm showed bilateral papilledema
Your next step in the diagnosis/management is

A-LP with increased opening pressure.

B-Measuring Visual evoked potentials

Answer: A

This is a case of benign intracranial HTN, aka pseudotumor cerebri

Once an intracranial mass lesion is ruled out,​ ​lumbar puncture​ is indicated.

https://emedicine.medscape.com/article/1214410-workup#c10

‫ ﻫﺎد اﻟﻤﻮﺿﻮع ﺑﺘﺎﺧﺪوه ﺑﺨﺎﻣﺴﺔ ﺑﺮوﺗﯿﺸﻦ اﻟﻨﯿﻮرو‬,‫اﻟﻰ ﻃﻼب راﺑﻌﺔ‬

4 Right to left shunt :

1.ASD
2.VSD
3. PDA
4. Transposition of great vessel
5. Pulmonary window.

ANSWER: 4 (PYQ)

5 All of the following cause hypocalcemia except:

1) hypomagansuim
2) aldosterone deficiency.
3) hypoalbinemia.

Answer: 2 (mostly this is the answer)

The relationship between total serum ​calcium​ and ​albumin​ is defined by the following simple
rule: the serum total ​calcium concentration​ falls by 0.8 mg/dL for every 1-g/dL fall in serum
albumin concentration
6 Case of child with fever, petechial rash on buttocks & thigh, platelet count is 20,000,
hypotension “shocked” and fever. What's the most likely diagnosis:

A-ITP
B-HSP
C-Meningococcemia

Answer:C

7 Male 8 yrs i think, Complaining of ear pain and discharge for 3 days, On exam external auditory
canal had purulent discharge, An area of redness tenderness and swelling was Found Behind
the left penna

Diagnosis?

A. Otitis externa
B. Acute Otitis media with perforated tymoainc membrane.
C. Acute mastoiditiS

Answer: A

8 A case of child with knee pain then ankle pain, redness and swelling, also blanchable rash on
the trunk with central clearing, most likely diagnosis:

A. Rheumatic fever
B. JIA
Answer: A (PYQ)
(Migratory polyarthritis & Erythema marginatum)

9 All are good prognostic factors in ALL except:

1- less than one year of age
2- WBC<10000
3- translocation 9;22
4- Pre-B cell lineage
5- No CNS involvemen

Answeer:3 (PYQ)
10 case of 4 years old girl with rudiment thumb, weight & height below 5th centile, microcephalic
and irregular pigmentation on her trunk & anogenital areas. What is the most likely
hematological disorder associated with her presentation?
a. Fanconi anemia
b. Diamond-blackfan syndrome
c. Bloom syndrome
d. ALL
e. Thrombocytopenia & absent radius (TAR) syndrome

Answer:A (PYQ)

Rudiment thumb: fanconi anemia

Diamond-blackfan syndrome: triphalangeal thumb

11 Pt with compensated respiratory failure, may need all following except:

A. IV fluid
B. intraosseus line
C. monitoring the vitals
D. ABGs
E. O2 sat

Answer: B
‫ﻣﺶ ﻣﺘﺎﻛﺪﯾﻦ ﻣﻦ اﻟﺠﻮاب ﺑﺲ ﻣﻦ ﻫﺎﻟﺨﯿﺎرات ﻫﺎد اﻻﻗﺮب‬

We need intraosseous line in cases of decompensated circulatory failure not in compensated respiratory
failure

12 All following could be caused by rickets except:

A-Craniotabes
B-Rachitic rosary & other chest deformity
C.Kyphoscoliosis
D-Mental retardation
E- widening metaphysis

Answer: D
‫ﺑﺎﻟﺴﻤﻨﺎر ﻛﻞ اﻟﺨﯿﺎرات اﻻﺧﺮى ﻣﺬﻛﻮر اﻧﻬﺎ ﺑﺘﺼﯿﺮ ﺑﺲ ﻣﺶ ﻣﺬﻛﻮر ﺧﯿﺎر‬
D
13 All following could be caused by E.coli, except:
A. pyelonephritis
B. Cystitis
C. osteomyelitis or arthritis

Answer: C

14 asthma ‫ﻓﻲ اﺷﻲ ﺟﻮاﺑﻮ‬

The qus was a typical case of asthma

3: ‫ﺑﺲ ﻣﺶ ﻗﺎدر اﺗﺬﻛﺮ ﻣﻨﻪ ﺷﻲ‬

15 asthma ‫اﺷﻲ اﻧﻮ ﺷﻮ اﻟﺪوا اﻟﻲ ﻣﻨﺰﯾﺪو ﻟﻌﻼج ال‬

ICS

‫اﻟﺴﺆال ﻛﺜﯿﺮ ﻣﻮﺟﻮد ﻣﺜﻠﻪ ﺑﺎﻟﺴﻨﻮات‬

‫ﺑﻜﻮن اﻟﻤﺮﯾﺾ ﺑﯿﺎﺧﺪ‬
Salbutamol
‫وﻋﻨﺪه اﻋﺮاض‬
Persistent asthma - mild
Next step? ICS

16 A qus about which of the following carries the highest risk to develop asthma?

Answer: If one of parents has asthma

17 the effect of insulin on potassium :
A. it neutralize potassium
B. keep it from going out the cell
C. bind to it and reduce free potassium
D. keep the cell healthy

Answer: B

18 all are characteristic of septic shock in 3 years old 15 kg child except :

A. thrombocytopenia
B. hypotension
C. urine output of 7 ml/kg/min
D. Hr 120
E. Bp 95/70

Answer : C

In cases of shock there is oliguria or anuria with urine output less than 0.5-1 ml/kg/hr

19 Best INITIAL test for diagnosis of celiac disease :

A. anti giladin antibody
B. bowel biopsy
C. Anti-tissue glutaminase (tTG) IgA antiboides and total IgA

Answer: C

20 What the best test for pancreatic insufficiency in cystic fibrosis ?

A. Fecal pancreatic enzyme

B. serum trypsinogen level

ANSWER: A
21 Pt come bcz of ​snake bite, what you will not do?
a. Reassure the pnt
b. Firm bandage
c. Cannula on the other hand
d. Incision and sucking
e. Immobilization of affected limb

Answer: D
‫ﻣﺶ ﻛﻞ ﺷﻲ ﺑﺘﺸﻮﻓﻪ ﺑﺎﻻﻓﻼم ﺑﺘﻌﻤﻠﻪ ﺑﺎﻟﻮاﻗﻊ‬
22 Wrong about breastfeeding:

a-Hind milk is deficient in fat

b-Predominant protein in breast milk is whey
c-Breast milk not sufficient for preterm babies
d-Breast milk is low in vitamin D

Answer: A

The term ​foremilk​ refers to the milk at the beginning of a feeding; ​hindmilk​ refers to milk at the
end of a feeding, which has a higher fat content than the milk at the beginning of that particular
feeding

23 1 year old child, with clear nasal discharge for 8 months, most likely cause:
A-Recurrent upper respiratory viral infection
B-Sinusitis
C-Food allergy
D-Gastroesophageal reflux disease
E -Pollen allergy

Answer: ‫اﻧﺎ ﻋﻦ ﻧﻔﺴﻲ ﺟﺎوﺑﺘﻪ‬

D
3: ‫اﻟﺴﺆال ﻛﺎن ﻣﺘﻞ ﻣﺎ ﻫﻮ ﻣﻜﺘﻮب ﺗﻤﺎﻣﺎ ﻣﺎﻛﺎن ﻓﻲ اي ﻣﻌﻠﻮﻣﺔ ﺗﻮﺟﻪ ﻻي ﺗﺸﺨﯿﺺ ﻣﻦ اﻟﺨﯿﺎرات اﻟﻤﺬﻛﻮرة ﺑﺸﻜﻞ واﺿﺢ‬
‫وال‬
GERD
‫ﻣﻤﻜﻦ ﯾﻈﻬﺮ ﺑﺎﻟﻌﻤﺮ ﻫﺎد‬
 ‫وﯾﻌﻤﻞ ﻫﯿﻚ ﻣﻀﺎﻋﻔﺎت‬
‫واﷲ اﻋﻠﻢ‬

24 2 weeks old with purulent eye discharge and conjunctivitis, What's the most causative
microorganism:

A-N.gonorrhoeae
B-Chlamydia
C-Moraxella catarrhalis

Answer: B

This is a typical step exam question, the idea is just to know the days as mentioned in the
following table

25 Child comes with a picture of bilateral otitis media and purulent eye discharge. The best
treatment for this case is:
A- No ttt
B- Amoxicillin regular dose
C- Amoxicillin high dose
D- amoxicillin + clavulanic acid

Answer: D
This is something called otitis conjunctivitis syndrome
It is probably caused by hib
 Choice C for otitis media alone, if it is resistant we give choice D
If allergic to penicillin we give azithromycin

26 The most common leukemia seen in with down syndrome:

M7
M6
M5
M3
M1

Answer: M7

27 Case of child with fever and different forms of rash (vesicle, papules, crusts):

Answer: Chickenpox (PYQ)

28 3 years old ... what can not he do:

A. copy a square
B. name pictures
C. walk alone
D. goes stairs up and down
ِ
Answer: A (at age of 4 years he can copy a sqaure)

29 5 years old girl with first time dysuria , urine culture was positive . the next investigation will be:

A-urinary tract ultrasound

B-urinary tract ultrasound and mcug and dmsa
C-US and MCUG
D-no further investigation

Answer: D (mostly)

This is a case of uncomplicated UTI so no need for further investigation we depend on the
clinical assessment.
30 The best investigation for renal function and GFR:

A- creatine and urea

B- microalbuminurea
C- creatine clearance.

Answer: C

31 Pt comes with lung crepitations,low albumin, ascites on urine analysis there were nephrotic
range proteinuria..the best combination is:

Albumin, prednisone, furosemide

Albumin, prednisone,Spironolactibe
Albumin, prednisone, acei

Answer: A
32 all of these indicate a high risk for renal failure in IgA nephropathy except :

A-increasing creatine
B-HTN
C-persistent microscopic hematuria

Answer: C
persistent microscopic hematuria is a benign finding in most of cases as long as there are no
gross hematuria, HTN, azotemia…etc

33 Secondary malignancy associated with retinoblastoma:

A-Osteosarcoma
B-Soft tissue sarcomas
C-Lymphoma
D-Melanoma

Answer:a
‫ﺻﯿﻐﺔ اﻟﺴﺆال ﻛﺎﻧﺖ ﻛﺜﯿﺮ ﻛﺜﯿﺮ ﻋﺠﻘﺔ‬
‫ﻛﺎﻧﺖ ﻣﺜﻞ ﻫﯿﻚ ﺗﻘﺮﯾﺒﺎ‬:
There is a cancer that happens with retinoblastoma. Which of the following is the most common
cancer associated with it
‫واﻋﺠﻖ ﻣﻦ ﻫﯿﻚ ﻛﺎن‬

34 live attenuated vaccine given in jordan:

A. penumoccoal
B. rota virus
C. tetanus
D. diphteria

Answer:B (PYQ)

35 Cause of newborn with cataract and bilateral sensorineural hearing loss, causative pathogen:
 A- CMV
B- Syphilis
C- Congenital Rubella syndrome

Answer: C

36 The most common cause for pharyngitis in healthy 7-year-old is:

A.​strep. pyogen
B.strep. Pneumonia

Answer: A

Answer: if there is no adenovirus the most probable one is strep pyogene, u can check it form
the lec to be sure
Read the URTI lec before entering the exam please :)

37 Newborn after feeding developed bilious vomiting, imaging showed stomach and duodenal
dilation, no air after that The disease is Mostly associated with.. is commonly associated with :

A. trisomy 21
B. trisomy 18

Answer: A

38 17 months old infant presents to the clinic for an additional vaccine or so that is not in the
Jordanian national programme, which vaccine could be given at this visit:

1. Capsular Pneumococcal
2. Hepatitis A
3. Rota vaccine

Answer:2

12 through 23 months for the ​first dose​; 2 through 4 years for the second ​dose​ (or sooner as
long as it's 6 to 18 months after the ​first dose​).

39 vegetarian mother who had a baby with macrocytic anemia and hybersegmented neutrophil .
what is deficient:

A. vitamin b12
 B. folic acid

Answer: A

40 Baby was admitted as a case of Gastroenteritis, what is the type of isolation:

A- Contact isolation
B- Droplet isolation
C- Airborne isolation

Answer: A (PYQ)

\
41 Most common type of cerebral palsy in extremely premature infant is?

A. Spastic Diplegia
B. Spastic hemiplagia
C. Spastic qudrapleiga
D. Ataxic
E. Dyskiensia

Answer:A

42 2 yrs patient had cough for 4 weeks, (i think was treated with ab) coming now with persistent
cough, no history of aspiration or fever or or.. it happened in the daycare. next step?

A. CXR

Answer: I am not sure of the answer and whether this was the real question or not :P

43 A few days old baby with coughing and stridor at and immediately after feeding . No stridor at
rest. Test?

A.Barium swallow
B. CT neck
C. Neck radiograph
D. Laryngoscope
 Answer: A

Case of TE fistula

https://emedicine.medscape.com/article/186735-workup

44 A patient presented with headache, long case of meningitis, the csf was done, found Wbc
Hundreds, gram negative bacilli. The patient had meningococcemia 6 months? Ago.
The most probable diagnosis:
A. x linked agamma globulinemia (recurrent encapsulated mo)
B. Terminal complement dificiency

Answer: A

45 drooling hoarseness fever ill looking, a case of epiglotitis, Best next in the management:

A. intubation + Antibiotics
B. laryngeoscope
C. Antibiotics and discharge home
D. XRAY

Answer: A

46 Hep A case , false about the disease:

A. In Most neonatal and young children there is no jaundice

B. Vaccine can fully protect against the disease
C. Progress to fulminant in most cases

Answer: C

47 36 week, 4.2 kg, DM1 mother, hba1c 9, most probable risk of admission to nicu is due to:

a. Low surfactant
B. hyperGlu
C. hyperCa+2

Answer: A
48 A case for a pt with headaches and it was mentioned that the MRI showed subependymal
nodule and cortical tubers ,all are true about the diagnosis except :

A -it is an autosomal recessive

B -the patient may have astrocytoma

Answer:A

(tuberous sclerosis case, which is autosomal dominant)

49 All of the following are true about ADHD except

1. Diagnosed by history only

2. Not associated with academic underachievement
3. They benefit from behavioral therapy
4. More common in males

Answer: 2

3: ‫ﺳﺆال ﺳﺎﯾﻜﻮ ﻋﺎﻣﻞ ﺣﺎﻟﻪ اﻃﻔﺎل‬

‫ﻋﺎﻻﻏﻠﺐ اﻟﺠﻤﻞ ﻫﺎي ﻛﻠﻬﺎ ﺻﺢ‬

50 Wrong about GERD:

a-Barium swallow confirm diagnosis
b-Antacids drugs used when non-pharmacological treatment fails
C-milk scan can show the milk reflux
D-Endoscopy is not necessary.

Answer: A (not needed)

51 girl patient with decrease growth parameters including head circumference ,developmental
delay, sometimes she put her hand in her mouth ....what is your diagnoses?

- Telangiectasia ataxia
 -Cerebellar ataxia
-Rodd or Robb syndrome
-Rett syndorme

Answer: Rett syndrome (PYQ)

53 Not in chronic lead poisoning:

A-proteinuria
B-basophilic stippling of red blood ceacid
C-increased amino levulinic acid
D-Increased coproporphyrin in urine

Answer: ?!?! according to different sources, all of them happen :3 ??!!

54 Baby apgar score at birth 1 (hr 80) , not responding for management:
Next is?

A- Positive airway pressure ventilation

B- chest compression

Answer: A

http://circ.ahajournals.org/content/122/18_suppl_3/S909

55 Newborn resuscitation, which of the following is true:

Answer: Start immediate chest compression if hr<60

http://circ.ahajournals.org/content/122/18_suppl_3/S909

56 About natural surfactant, all correct except:

A-produced by pneumocytes 2
B- recycled and regenerated
C- main component is phosphatidylglycrol
D- can be measeured after 33-34 weeks

Answer: C

This lipo-protein surfactant is 90% lipid and is composed predominantly of

saturatedphosphatidylcholine (lecithin), but also contains phosphatidylglycerol,
other phospholipids, and neutral lipids. The surfactant proteins, SP-A, SP-B, SP-C,
and SP-D, are packaged into the lamellar body and contribute to surface-active
properties and recycling of surfactant.

57 Surfactant can be used in all of the following except:

A-Large for gestational age baby with ground glass appearance

B- baby with gbs sepsis
C- meconium aspiration
D- rds
E- congenital pneumonia
 Answer: B

58 Baby with diarrhea for months ,growing well

ESR, Chemical tests , History , Physical, Stool analysis
ِALL ARE NEGATIVE

Diagnosis most likely?

A.celiac
B.cystic fibrosis
C. Primary intestinal lymphangiectasia

Answer: C

59 Intestinal Biopsy can be used to diagnose:

1- Chloride loosing enteropathy

2-tufting enteropathy

Answer: 2
All other choices can be diagnosed by presence of reducing sugar in stool

60 All makes u go toward neonatal sepsis except:

A.-maternal fever
B-chorioamnionitis
C-crp 25 first 18-24 hr
D- wbc 25000

Answer: D

61 most accurate test for surfactant:

A. phosphotiydlglecerol
B. l/s ratio
C. lamellar body count

Answer: B (PYQ)

62 Case of child with bilious vomiting, absent bowel sound & distress when touching his
distending abdomen, most likely cause:
 A. Volvulus
b. Pyloric stenosis

Answer:A

63 When to do imging in uti (to rule out obstruction i think was in the stem):
1- no lowering in fever after 48 hrs
2- no lowering of fever after 48 hrs of appropriate ab
3 - when Klebsiella +ve

Answer: 2

The answer is 2 as this might indicate the development of abscess

64 They gave us values for these things:

Hbs 70%
Hbf %?
Hba1 %?
Hba2 %?
Diagnosis?

B + thalassemia sickle
B 0 thalassemia sickle
Alpha thalassemia sickle

Answer: B + thalassemia sickle

‫اﻟﻨﺴﺐ اﻟﻲ ﻣﺶ ﻗﺎدرﯾﻦ ﻧﺘﺬﻛﺮﻫﺎ ﻛﺎﻧﺖ اﻋﻠﻰ ﻣﻦ اﻟﻄﺒﯿﻌﻲ‬
‫وﻣﺎدام ﻓﻲ اﻧﺘﺎج ﻟﻞ‬
Beta chain,
Then it is B+

65 Congenital diarrhea, causes by all except:

- elastase something
- cystic fibrosis
- celiac disease

Answer: celiac disease

‫ ﻟﻮ ﺟﺒﺘﻠﻜﻢ ﺳﺆال ﻃﻔﻞ ﻣﻮﻟﻮد ﺣﺪﯾﺜﺎ ﻋﻨﺪه اﺳﻬﺎل ﻣﺰﻣﻦ ﺷﻮ اﻻﺷﻲ اﻟﻲ ﻣﺶ ﻣﻤﻜﻦ ﯾﻜﻮن اﻟﺴﺒﺐ؟‬,‫اﻟﺪﻛﺘﻮر اﯾﺎد ذﻛﺮ ﻫﺎي اﻟﻔﻜﺮة ﺑﺎﻟﻤﺤﺎﺿﺮة‬
Celiac
‫ﻻﻧﻪ ال‬
Celiac is due to allergy to gluten, so the baby need to be exposed to it first
66 Few months baby brought by parents due to bluish discoloration of fingers
PE , no murmurs good pulses, central pink lip, (everything apears normal)..
Next?

a.Cardiologist referral
B. Echo
C. Reassure as this might be normal in babies aw neonate

Answer: C

67 Which of the following indicates innocent murmur:

A-harsh
B- grade 4/6
C-point of max change with position
D- diastolic murmur

Answer: C
68 Antiepileptics mismatch:
- Carbamazepine used in treatment of myoclonus
- Ethosuximide used in absence seizure

Answer: A (PYQ)

69 Which of the following might be an indication for admission of a baby presenting with neonatal
jaundice on day three:

- rh negative mother
- o+ mother a+ baby
- total bilirubin 15

Answer: ​total bilirubin 15

70 Which is correct regarding ASD?

- murmur is heard due to turbulent flow through p valve
- s2 VARIABLY splitting
- wide pulse pressure

Answer: ​murmur is heard due to turbulent flow through p valve

71 Case of a 4 yo child with limping for ...weeks, on physical examination there was difficulty in
abduction (not sure) & internal rotation, most likely cause:

A-DDH
B-Slipped capital femoral epiphysis
C- Avascular necrosis of the femoral head
D-transient synovitis-

Answer: A
although SCFE could be the answer but the age of presentation would be 9-13 along with
obesity.

3: ‫ﺣﺘﺎﺧﺪوا ﻫﺎﻟﻤﻮاﺿﯿﻊ ﺑﺨﺎﻣﺴﺔ ﺑﺎﻟﻌﻈﺎم‬

73 -abdominal mass and aniridia:

Answer: Wilms tumor

(WAGER syndrome)

74 picture of GBS, what is wrong :

Answer: conduction in sensory and motor neurons is fast

75 enterococcus not covers by:

ِ
A- vancomycin
B- Ceftriaxone

Answer: B

76 -Ampicillin not used to cover;

Answer: p.arguinsa

77 -picture of atypical atypical pneumonia (wheezing, fever, bilateral interstitial infiltrate...) Your
treatment is‫؟‬

Answer :azithromycin

78 3 weeks baby present with cyanosis after feeding

 Cvs Exam was normal no murmur......
Your next investigation?
ECG
Chloride sweat test
Neck X-ray
Barium swallow
ECHO

Answer: ECHO

‫ﻣﺶ ﻣﺘﺎﻛﺪﯾﻦ اذا اﻟﺴﺆال ﻛﺎن ﻫﯿﻚ ﺑﺎﻻﻣﺘﺤﺎن‬

79 -one can cause expiratory stridor ?

A. Intrathorasic mass
B. reteropharngeeal mass

Answer: a

80 -6 months old baby has stridor that doesn't change with position, very weak cough
The cause of his weak cough is?
Cp
Laryngomalacia

Answer: Laryngomalacia

81 Q about AR-polycystic kidney disease, which is wrong

-​ oligohydramnios
- respiratory failure
- Mode of inheritance is autosomal dominant

Answer: Mode of inheritance is autosomal dominan

82 All of the following could warrant future chronic renal failure except ( Not exact stem but same
principle)
1. Proteinuria
2. Renal scarring
3. Isolated hematuria

Answer: 3
83 ​ weeks old neonate brought by her mother as she is worried because her fingers and toes are
2
blue in color while her lips are pink. Other than that the child was doing well. What is your next
step
1. ECG
2. Refer to cardiologist
3. Echocardiography
4. This could be a normal finding at this age

Answer: 4

84 child suspected to have TB had 18 mm induration and the mother was identified to be the
source of the infection. Which is the best regimen to treat the patient
1. INH, Rifampicin and ethambutol
2. INH, Rifampicin, ethambutol, pyrazinamide and streptomycin

Answer: 2

True I checked it from nelson

The answer was: INH, rifampin, pyrazinamide +- ethambutol
So ethambutol is not necessary in the initial regimen unlike adults.

85 12 days old neonate was identified to have pneumonia, which of the following is the most likely
cause:
1. Strep pneumonia
2. Klebsiella pneumonia

Answer: 2