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Q 1:
In older children with Cushing syndrome, in addition to obesity, a common early
manifestation is:
a. Hyperglycemia
b. Short stature
c. Osteoporosis
d. Hypertension
e. Purplish striae on abdomen
ANSWER: A

Q 2:
The most common " long-term” sequelae of bacterial meningitis is:
a. Syndrome of inappropriate anti - diuretic hormone secretion
b. Subdural effusion
c. Brain abscess
d. Hemiparesis.
e. Sensorineural hearing loss

ANSWER: E

Q 3:

A previously healthy ten year old boy has a three day history of jaundice, fever,
malaise, loss of appetite, and vomiting. He is unvaccinated against hepatitis A.
Which of the following statements is an indication of admission for this child?
a. Administration of antiviral therapy
b. High level of bilirubin .
c. Presence of abdominal pain
d. Hyperglycemia
e. Prolongation of prothrombin time

ANSWER: E

Q 4:
You are seeing a six years old boy for his abnormal gait which started at 4 years of
age, and followed by toe walking and Frequent falls. On examination, he has
enlarged calf muscles What is the inheritance of this condition?
a. Autosomal recessive
b. X - linked
c. Most common in Ashkenazi Jews
d. Autosomal dominant
1

e. Sporadic / unknown
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ANSWER: B
Q 5:
A two year old girl is brought to the emergency department by emergency medical
services after being found in the family garage with significantly altered mental
status, wetting the bed with her urine with emesis around her mouth. Emergency
medical technicians suctioned her oropharynx and noted copious oral secretions.
She has a temperature of 38.5 ° C a heart rate of 75 beats / min a blood pressure of
95/65 mm Hg, and a respiratory rate of 14 breaths / min with shallow breaths and
poor effort. Her pupils are pinpoint bilaterally, and wheezing is heard throughout both
lung fields. There are no signs of head trauma. The skin is warm to the touch, and no
rashes are noted. The remainder of the physical examination findings are normal of
the following the BEST medication to administer is
a. naloxone
b. albuterol
c. beta - blocker
d. atropine
e. sodium bicarbonate
ANSWER: D

Q 6:

A four year old boy with symptoms of a viral respiratory infection for 3 days is being
evaluated for a sudden onset of fever to 390C. respiratory distress with barking
cough and inspiratory / expiratory monophasic wheezing. His medical history is
unremarkable. On physical examination, he appears ill and uncomfortable with
intercostal and suprasternal retractions of the following the pathogen MOST likely
associated with this boy's condition is
a. respiratory syncytial virus
b. Mycoplasma pneumoniae
c. Staphylococcus aureus
d. Adenovirus
e. Pseudomonas aeruginosa
ANSWER: C!!

Q 7:

A seven year - old girl with a three year history of intermittent cough wheezing with
viral respiratory infections and repeated episodes of respiratory distress with low
oxygen saturation is being evaluated Each time she is ill she has been treated with
bronchodilators and oral corticosteroids. inhaled corticosteroids have been
prescribed as an asthma controller medication, but her parents have not given the
medication consistently. Today the girls parents report that she has a 5 - day history
of worsening cough and nasal congestion but no fever or other somatic symptoms
2

Her parents have not heard her wheeze, but they do sense that she is having difficulty
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breathing. On physical examination she is afebrile with a room air oxygen saturation
of 92% on pulse oximetry, heart rate of 130 beats per minute, and blood pressure of
100/70 mm Hg. Her membranes are moist and there is good skin turgor. Moderate
intercostal and suprasternal retractions are seen with generally diminished breath
sounds and diffuse end - expiratory wheezes. No focal adventitious sounds can be
heard in the chest. After treatment with albuterol 25 mg with wet nebulization she
seems a bit more comfortable but her oxygen saturation is not improved wheezing is
not resolved, and she still has retractions Chest x - ray showed hyperinflation
peribronchial cuffing, and right middle lobe atelectasis of the following the MOST
appropriate next management step for this girl is
a. endotracheal intubation and admission to the intensive Care unit Thumb sign
& amp wheeze
b. Admit the patient and start IV antibiotic
c. hospital admission for frequent inhaled bronchodilators and systemic
corticosteroids
d. referral for urgent bronchoscopy and bronchoalveolar lavage
e. outpatient management with antibiotics with next day follow - up
ANSWER: C

Q 8:

A twelve year old boy with type 1 diabetes mellitus is brought to the emergency
department comatose and is taking rapid, shallow breaths Vital signs are
temperature 37 C (98.6f) . blood pressure 80/65 mm Hg. pulse 110 / min. and
respirations 17 / min. Oxygen saturation is 98% and a finger - stick glucose is 430
mg/dl. An intravenous line has been placed in the field and arterial blood gas and
basic chemistry panel has been sent to the laboratory. The next step in the
management of this patient is
a. an IV fluid and replacement with insulin
b. administer iv bolus sodium bicarbonate
c. obtain urgent CT brain
d. start IV antibiotic
e. Obtain chest x - ray
ANSWER:A

Q 9:

A 5 year old little girl with a chronically swollen right knee & suspected arthritis as JlA was
referred to you, the "BEST” radiological study to confirm the presence of synovitis is:
a. Right knee MRI with contrast.
b. Right knee ultrasound
c. Right knee MRI without contrast
d. Right knee CT scan
e. Right knee X ray two views
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ANSWER:A
Q 10:
A four year old boy presents with developmental delay and cognitive deficit. He cats
toys paper, wood and clay. What test are you going to order?
a. Liver function test
b. Lead level
c. Electroencephalogram
d. Thyroid function test
e. Cranial MRI

ANSWER: B

Q 11:
Your practice is creating an asthma program. During the discussion about whether
the spirometry should be included one of your associates ask what spirometry
measures? The best ANSWER is:
a. Absolute lung volume
b. Percent saturation of blood gases
c. Diffusing capacity
d. Forced expiratory volumes
e. Exhaled nitric oxide

ANSWER: D

Q 12:

One of the following is similar to a normal adult value at birth

a. WBCs in CSF
b. Protein in CSF
c. PTT
d. Platelets
e. WBCs in blood
ANSWER: D

Q 13:

One is false regarding bacterial meningitis:

a. Prior use of oral antibiotics can lead to partially treated meningitis
b. Absence of papilledema rules out meningitis
c. Diagnosis is confirmed by CSF analysis. Gram stain and culture
d. vancomycin and ceftriaxone are acceptable empirical therapy
e. Presenting symptoms are typically fever, headache, vomiting, photophobia,
neck rigidity
4

ANSWER: B
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Q 14:
A mother brings her 18 month old boy & her 6 year old girl for Immunizations Mom
tells you that her daughter has been diagnosed with ALL and started on induction
therapy, Regarding vaccines of these kids all of the following are true except:
a. The boy can get the OPV vaccine today
b. The boy can get his MMR vaccine today
c. The girl can get her Td booster vaccine today
d. The boy can get his DTaP vaccine today
e. The girl cannot get her OPV vaccine today

ANSWER:A

Q 15:

You are seeing a fourteen year old male a history of moderate mental retardation
and epilepsy. His brain MRI shows cortical tubes and sub - ependymal nodules.
What skin finding would be expected in this patient ?
a. Axillary frecking
b. Adenoma sebaceum
c. Trigeminal distribution port wine stain
d. Lipoma over the lumbar spine

ANSWER: B

Q 16:
All of the following problems are correctly matched with the CXR findings of EXCEPT:
a. RDS and air bronchogram
b. Meconium aspiration and hyperinflation
c. Pneumothorax and mediastinal shift to the contralateral side
d. Typical congenital diaphragmatic hernia and dextroposition of the heart
e. Chylothorax and translucent hemithorax to light in the affected side.

ANSWER: E

Q 17:

In neuroblastoma all the following are true except

a. Infants have better outcome
b. Opsomyoclonus is a recognized feature
c. more likely to have calcification than Wilms
d. Lung is the commonest site for metastasis
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e. Abdomen is the commonest site

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ANSWER: D
Q 18:
What is the most likely EEG finding in a five year old who is having numerous brief
staring spells daily ?
a. Hyps-arrhythmia
b. Centrotemporal spikes
c. Three Hz spike and wave discharges
d. Temporal spikes
e. Slow spine and wave discharges
ANSWER: C

Q 19:
A three year old boy presents to the emergency department with lower limbs
weakness and inability to walk over the last two days He was febrile the day before
admission . He is found to have hyperrefiexa and hypertonicity in his lower limbs .
There have been no cranial nerves palsies except for dysphagia.
What is the initial investigation to confirm the diagnosis ?
a. EEG
b. Nerve conducting study & amp;EMG(electrography).
c. CSF analysis
d. Brain MRI
e. Oligoclonl band in CSF and blood
ANSWER: C

Q 20:
Antibodies to islet cell antigens of the pancreas may be seen months to years before
the onset of beta cell dysfunction, all of these antibodies against antigen of
pancreas except:
a. antibodies to glutamic acid decarboxylase.
b. antibodies to tyrosine phosphatase lA – 2
c. zinc transporter 8 antibodies
d. islet cell antibodies
e. antithyroglobulin antibodies
ANSWER: E

Q 21:

Oliguria more likely to be due to pre - renal rather than intrinsic renal failure if :
a. rise in creatinine exceeds the rise in urea
b. urine free of red blood cells or casts
c. in the presence of hypertension
d. Low urine specific gravity of 1.005
e. Urine osmolality <350 mOsml/L
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ANSWER: B
Q 22:
Regarding Vitamin K deficiency bleeding (hemorrhagic disease of the newborn), all
of the following are true EXCEPT:
a. Classic cases appear after the first 24 hours and mainly affect GI
b. late onset disease is more common in breastfed babies
c. certain maternal drugs may predispose to the early - onset form
d. Treatment is by Vitamin K therapy
e. thrombocytopenia is a common finding
ANSWER: E

Q 23:

A previously healthy one year old girl has had several episodes in which she
becomes cyanotic and loses consciousness after crying. The physical &
developmental examination findings are normal. Of the following, the MOST
appropriate next step in the evaluation is to :
a. admit her to the hospital
b. order electrocardiography
c. order electroencephalography
d. order computed tomography of the head
e. reassure the parents
ANSWER: E

Q 24:

Which of the following milestones are expected in a 5 - month - old infant ?

a. Minimal head lag, fisting
b. Cruising, releases objects
c. Parachute reflex pointing
d. sits without support, pincer grasp
e. Rolling over, reaches to grab objects
ANSWER: E

Q 25:
A 7 year old girl known to have nephrotic syndrome, came to the emergency room
complaining of red discoloration of her urine, history revealed that she has been
started on a new medication, grossly urine was red and urine analysis showed a field
full of red blood cells. The most likely medication she has been started on is :
a. Cyclophosphamide
b. Prednisolone
c. Cyclosporine
d. Iron
7

e. Furosemide
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ANSWER: A
Q 26:

All of the following are live vaccines except

a. Hepatitis B vaccine
b. BCG
c. OPV (oral polio vaccine)
d. MMR (Measles· mumps· rubella)
e. VZV (Varicella-Zoster vaccine)

ANSWER: A
Q 27:

In childhood AML, all the following associations are true except :

a. M3 DIC
b. M2 and (t8,21)
c. M7 and Down syndrome
d. M5 gum hypertrophy

ANSWER:D
Q 28:

Of the following the cyanotic cardiac lesion with decreased pulmonary blood flow is
a. tricuspid atresia
b. total anomalous pulmonary venous return without obstruction
c. truncus arteriosus
d. transposition of the great vessels
e. single ventricle
ANSWER: A

Q 29:

A six month old boy regurgitates three times a day after feedings. He is otherwise
asymptomatic. His weight and height have remained at the 10th percentile for age.
His physical exam is normal. Anatomical upper gastrointestinal abnormalities were
excluded by barium study. The best initial management of this child would be:
a. Work up to role out metabolic disorders
b. Administration of H2 blockers and prokinetic medications
c. Administration of small, thickened oral feedings
d. Referral for endoscopy
e. Change to an elemental formula
ANSWER: C
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Q 30:

Splenectomy is indicated in which of the following:

a. Infectious mononucleosis
b. Hypersplenism
c. Glycogen storage disease
d. SLE
e. Leishmaniasis
ANSWER: B

Q 31:

Iron deficiency anemia, all the following statements are true except
a. Usually present after six months of life
b. Improvement of appetite is early in treatment
c. Duration of treatment is two months after normalizing hemoglobin
d. Pin worm is a recognized cause
e. A manifestation of reflux esophagitis
ANSWER: C

Q 32:

Which of the following is MOST likely seen in a child with Tetralogy of Fallot?
a. Increased pulmonary blood now
b. Increased incidence of heart failure
c. Increased pressure in the right ventricle
d. Increased left to right shunt
e. Increased systemic blood pressure
ANSWER: C

Q 33:

A three week old non-dysmorphic infant, who has jaundice and pale stool has a total
bilirubin of 9.8 mg/dl and a conjugated fraction of 6.0 mg/dL The baby is active and
feeding very well. Abdominal ultrasound showed polysplenia. Which of the following
is the most probable diagnosis?
a. Galactosemia
b. G6PD deficiency
c. Tyrosinemia
d. Congenital Hepatitis B
e. Biliary atresia
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ANSWER: E
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Q 34:

Regarding vitamin deficiencies, all are matched correctly, EXCEPT:

a. Vitamin D and Rickets
b. Vitamin K and prolongation of aPTT
c. Vitamin B12 and megaloblastic anemia
d. Vitamin A and night Blindness
e. Vitamin E and muscle weakness
ANSWER: B

Q 35:

What is your diagnosis of developmentally appropriate ten year old boy with a one
year history or chorea, dysarthria. emotional liability and a recent finding of mitral
valve insufficiency?
a. Fahr disease
b. Glutaric academia type 1
c. Neuroacanthocytosis
d. Sydenham chorea
e. Acute ischemic stroke
ANSWER: D

Q 36:

A six year old boy was admitted to the hospital with vomiting and bloody diarrhea.
Few days later he developed metabolic acidosis, hematuria and became pale. The
most likely diagnosis is
a. Post streptococcal glomerulonephritis
b. Hemolytic uremic syndrome
c. Histocytosis
d. Meningococcal sepsis
e. Acute leukemia
ANSWER: B
Q 37:

The most practical and reliable way for collecting urine in a 14 month old infant is:
a. an adhesive collection bag
b. a suprapubic sample
c. mid-stream sample
d. urine bag
10

e. catheterized sample
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ANSWER: A
Q 38:

All of the following are possible therapeutic options in babies with patent ductus
arteriosus (PDA) EXCEPT
a. Prostaglandin infusion
b. Observation
c. indomethacin
d. Lasix
e. Fluid restriction
ANSWER: A

Q 39:

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. 5% added to the mother's age-related risk
b. 1% added to the mother's age-related risk
c. 10% added to the mother's age-related risk
d. no greater than the general population at risk
e. 25% added to the mother's age-related risk
ANSWER: B

Q 40:

The following are complications of nephrotic syndrome with the exception of

a. Increased risk of thrombosis
b. Accelerated hypertension
c. Renal failure
d. Scrotal edema
e. Pneumococcal infection
ANSWER: B
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Q 41:

The emergency department physician performs a lumbar puncture on a nine year

old girl who has fever and vomiting, and calls you with the CSF analysis results. Which
of the following CSF analysis results would you consider "normal", given that the girl's
serum glucose 1s 70 mg/dL?
a. WBC 100, differential 95% lymphocytes, RBC 0, Protein 202mg/dl. glucose 45
mg/dl
b. WBC 4, differential 95% lymphocytes. RSC 0, Protein 20mg/dl, glucose 50 mg/dl
c. WBC 20. differential 80% lymphocytes, RSC 0, Protein 80mg/dl, glucose 60 mg/dl
d. WBC 400, differential 95% neu1rophTis, RBC 0, Protein 500mg/dl, glucose 20
mg/dl
e. WBC 100, differential 95% lymphocytes, RBC 0, Protein 500mg/dl, glucose 20
mg/dl
ANSWER: B
Q 42:

The least expected clinical sign of coarctation of the aorta is

a. differential blood pressure: arms > legs
b. notching of the inferior border of the ribs
c. pan systolic murmur
d. diminished or absent femoral or lower-extremity pulses
e. cardiac enlargement
ANSWER: C

Q 43:

All the following are signs of increased intracranial pressure (ICP) and impending
brain herniation EXCEPT
a. bradycardia
b. pupillary dilation
c. 4th cranial nerve palsy
d. extensor posturing
e. systemic hypertension
ANSWER:C
Q 44:

All of the following are abilities of a seven month old infant EXCEPT
a. Babbling
b. Parachute reflex
c. Sits without support
d. Radial grasp
12

e. Mouthing objects
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ANSWER: B
Q 45:

In a 2 day old male baby with pustular skin rash, positive Wright stain for eosinophils
with negative Gram stain is suggestive of
a. Benign pustular melonosis
b. Milia
c. Allergic reaction
d. Erythema toxicum
e. Staphylococcal scalded skin syndrome
ANSWER: D

Q 46:

A newborn who weighs 4,700 g and whose estimated gestational age is 37 weeks has
a blood glucose concentration of 18 mg/dl (1 .00 mmol) at 30 minutes after birth.
Maternal history is significant for type 1 diabetes mellitus. Blood count reveals
polycythemia. Echocardiographic examination reveals septal hypertrophy of the
heart. Of the following, the MOST important cause of hypoglycemia in this infant is:
a. abnormal glycogenolysis
b. depleted liver glycogen stores
c. abnormal gluconeogenesis
d. increased pancreatic insulin secretion
e. excess catecholamine secretion
ANSWER: D

Q 47:

Congenital rubella syndrome can cause of all of the following clinical findings
except:
a. Cataract
b. Burchfield spots
c. Blueberry-muffin rash
d. Congenital heart disease
e. Microcephaly
ANSWER: B
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Q 48:
A twelve year old girl has experienced daily periumbilical abdominal pain lasting
several hours for the past 2 years. She rarely misses school. She has gained weight
normally, She strains to defecate and passes small hard stools every 2 days, after which
she experiences some relief from pain but no complete resolution. Treatment with
polyethylene glycol has failed to resolve the problem. Her physical examination yields
normal results. Based on her history and examination. which of the following is the most
likely diagnosis?
a. Abdominal m19raine.
b. Irritable bowel syndrome
c. Intestinal obstruction
d. Functional dyspepsia
e. Inflammatory Bowel disease
ANSWER: B
Q 49:

A 12 year old adolescent boy is brought to the emergency department for evaluation of
difficult and painful swallowing. His symptoms began 5 hours ago after he ate ramen
noodles and chicken sausage. He noticed a feeling that something ‘’was stuck" in his
chest he has been retching and vomiting since then. He has a 2year history of dysphagia
but has never experienced symptoms to this degree. He has a history of multiple
environmental allergies, for which he receives immunotherapy, and a history of
anaphylaxis to eggs. On physical examination, the boy is uncomfortable appearing and
frequently retching and spitting clear liquid into the emesis basin near his bed. His
examination findings are otherwise normal. Chest radiograph is normal. Of the following,
the BEST next management step for this adolescent is
a. barium meal
b. abdominal ultrasonography
c. epinephrine injection
d. esophagography
e. therapeutic endoscopy
ANSWER: E
Q 50:

The parents of a child who was diagnosed at birth with Beckwith· Wiedemann syndrome
bring in the baby for his 2-month evaluation. They ask about future health problems and
his prognosis now that his omphalocele has been repaired. Of the following, the child is
MOST at risk for
a. astrocytoma
b. rhabdomyosarcoma
c. acute lymphocytic leukemia
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d. Wilms tumor
e. Hodgkin disease
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ANSWER: D
Q 51:

Immune hereditary angioedema is caused by

a. CS deficiency
b. Cl-inhibitor deficiency
c. Factor H deficiency
d. C4 binding protein deficiency
e. Properdin deficiency
ANSWER: B
Q 52:

A four year old boy presents with acute weakness and palpitations. Investigations
reveal: Sodium 143 mmol/L, Potassium 8.0 mmol/L, Urea 25 mmol/L, Creatinine 350
mmol/L, Bicarbonate 5 mmol/L What is the best immediate therapy?
a. intravenous insulin and glucose
b. intravenous calcium gluconate
c. sodium bicarbonate infusion
d. salbutamol nebulizer
e. dialysis A mother who is hepatitis 8s antigen positive gives birth 10 a 3Kg.

ANSWER: B
Q 53:

A mother who has hepatitis Bs antigen positive gives birth to a 3 kg full term baby
boy. The best treatment to administer for the baby trying to prevent hepatitis B
infection is:
a. hepatitis B vaccine only at birth
b. hepatitis 8 immune globulin only at birth
c. check bilirubin and liver enzymes and give hepatitis B vaccine only if elevated
TSB and ALT
d. no treatment at this time, wait until the baby is 2 months old to give hepatitis B
virus vaccine
e. hepatitis B vaccine and hepatitis B immune globulin at birth

ANSWER: E

Q 54:
At two weeks of life, a well growing healthy breast feeding infant was still having
jaundice by exam. The rest of examination was completely normal with no palor.
Indirect hyperbilirubinemia with total serum bilirubin of 8mg / dl. He passes 7 bowel
motions per day that are yellow seedy in nature.
15

The best next step of management would be:

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 a. Phenobarbital treatment for one month
b. G6PD enzyme level
c. Liver function test
d. Eye consultation for cataract
e. Assure mother this breastfeeding jaundice

ANSWER: E

Q 55:

A fifteen year old girl is diagnosed with generalized epilepsy, Her examination is
normal, with the exception of being a bit overweight which antiepileptic medication
should be avoided
a. Clonazepam
b. Sodium valproate
c. Lamotrigine
d. Topiramate
e. Levetiracetam

ANSWER: B

Q 56:

Triploidy means :
a. 47 chromosomes
b. Three different cell lines of chromosome
c. Three copies of somatic chromosomes
d. Three copies of X chromosome
e. 69 Chromosomes
ANSWER: E

Q 57:
Lactose free diet must be used for newborn suspected to have :
a. Phenylketonuria
b. Hyperglycemia
c. Galactosemia
d. Methylmalonic acidemia
e. Farber disease

ANSWER : C
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Q 58:

What is the most likely finding in a ten year old girl with symmetrical ascending limb
weakness ?
a. Dilated pupils
b. Positive Babinski sign
c. Increased CSF protein
d. Sensory level
e. Normal deep tendon reflexes

ANSWER: C

Q 59:

A six month old child who has a ventriculo-peritoneal shunt to relieve hydrocephalus
has vomited four times during the past 24 hours. Among the following the physical
finding that BEST supports a diagnosis of shunt malfunction would be
a. " setting sun " sign
b. hypotonia of the lower extremities
c. two - beat ankle clonus
d. abdominal pain
ANSWER: A

Q 60:
The duration of arthritis and age of the patient used in diagnosis of juvenile idiopathic
arthritis USA) are :
a. 6 days duration 6 years of age
b. 6 days duration 16 years of age
c. Any duration , 22 years of age
d. 6 weeks duration 16 years of age
e. 6 weeks duration 6 years of age

ANSWER: D

Q 61:

You are performing a physical examination for a well - child check on a 6 - month -
old male infant who was born at 38 weeks gestation. Mom is wondering if the baby's
growth and development are appropriate for his age as she noticed that his growth
slowed down in the past 2 to 3 months.
17

Which of the following findings is most consistent with normal growth and
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development in the first 6 months of this baby's life?

 a. Increased height by 8-10 cm
b. Slow weight gain in the first 3 months after birth, followed by a growth spurt in
the next 3 months
c. Weight gain of 10g per day
d. Doubling of the birth weight
e. Increased head circumference by 12cm since birth

ANSWER: D

Q 62:

Children with neutropenia are most likely vulnerable to one of the following
a. Chicken pox
b. Disseminated candidiasis
c. Toxoplasmosis
d. Staphylococcal infection
e. Pneumocyctis carinii

ANSWER: D

Q 63:

A six month old female infant is evaluated after the mother notes that she is strongly
left - handed and delayed in sitting and in using the right hand. MRI of the brain
reveals a large porencephalic cyst in the distribution of the left middle cerebral
artery. Which of the following information is most likely to contribute in establishing
the cause of this disorder?
a. Results of an EEG
b. History of delivery
c. Chromosome analysis
d. Evaluation for thrombophilic disorders
e. History of maternal drug ingestion

ANSWER: E

Q 64:

The perfusion pressure of brain cerebral perfusion pressure) equals to

a. mean blood pressure minus intracranial pressure
b. mean blood pressure plus CSF pressure
c. intracranial pressure
d. diastolic blood pressure minus intracranial pressure
18

e. mean blood pressure

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ANSWER: A
Q 65:

A twelve year old male patient presents to your office with a history of always being
short but having fallen from the 10th to the 3rd percentile in the last 2 years. His only
gastrointestinal symptom is periumbilical abdominal pain. His thyroid test results
were within normal limits. You decide to evaluate him for celiac disease. Of the
following, which is recommended as initial testing?
a. Antigliadin IgA antibody and serum IgA level
b. HLA resting for DQZ and DQ8
c. Tissue transglutaminase IgA antibody and serum IgA level
d. Tissue transglutaminase IgA antibody, IgA level, and deaminated gliadin
peptide
e. Deaminated gliadin peptide

ANSWER: C

Q 66:

A hospital laboratory is sent blood samples from five patients with five different
diagnoses. A blood smear from one sample shows a reduced number and macrocytic
erythrocytes numerous hyper segmented neutrophils and reduced number of platelets.
This blood sample has been probably drawn from the patient with
a. Hereditary spherocytosis
b. disseminated intravascular coagulation
c. B12 deficiency
d. Beta thalassemia
e. immune - mediated hemolytic anemia.

ANSWER: C

Q 67:

In congenital hypothyroidism, which of the following is TRUE

a. Screening is done after 1 month of life
b. Symptomatic infants are screened for the disease
c. it is easily recognizable at birth
d. Maternal hypothyroidism is often present
e. It is a treatable cause of mental retardation

ANSWER: E
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Q 68:

Neonatal sepsis should be suspected in all of the following except

a. Rupture of membranes 11 hours prior to delivery
b. Greenish foul smelling vaginal discharge
c. Maternal leukocytosis
d. Mother carrier for group b streptococcus
e. Maternal vaginal discharge
ANSWER: A

Q 69:
All of the following vaccines are live except:
a. Oral poliovirus vaccine
b. Injectable poliovirus vaccine
c. BCG
d. Rotavirus
e. MMR measles - mumps – rubella
ANSWER: B

Q 70:

A five year old boy presents with abdominal pain and non blanchable palpable skin
rash over the buttocks and lower limbs. He also has right knee pain and swelling. He
has history of runny nose last week.
One of the following is FALSE regarding this patient's disease:
a. It is a self - limiting disease
b. Presence of right knee arthritis is an indication to start steroids
c. Relapse may rarely occur
d. Skin biopsy of the rash typically shows IgA - mediated vasculitis
e. Renal involvement is of concern and urine analysis should be performed

ANSWER: B

Q 71:

A four month old female infant with a 5 - day history of diarrhea is brought to the
emergency department. She has been refusing to drink formula for 2 days. She has
no history of vomiting, fever, or abdominal distension. She is sleepy but has a high -
pitched cry on stimulation. She has a heart rate of 160 beats / min a respiratory rate
of 22 breaths / min, and a blood pressure of 70/38 mm Hg. Her skin feels doughy.
Her mucous membranes are dry. The rest of her physical examination findings are
unremarkable. Her serum sodium 170 mEq / L, potassium 4mEq / L, chloride 113mEq
20

/ L, Urea: 10 mmol / L of the following the infant the MOST likely complication of rapid
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correction of this's electrolyte disturbance is:

 a. subdural hemorrhage
b. cerebral edema
c. central pontine myelinolysis
d. pulmonary edema
e. Dural sinus thrombosis
ANSWER: B

Q 72:

A 2.700g male infant bom at 36 weeks gestation is being treated for suspected
neonatal sepsis following the development of respiratory distress shortly after birth.
His mother has fever 38.9 ° C during labor and delivery but reports that she had no
illness during pregnancy. Of the following the MOST appropriate antibiotic regimen
for the infant is :
a. meropenem and aminoglycoside
b. piperacillin and aminoglycoside
c. clindamycin and third generation cephalosporin
d. vancomycin and third generation cephalosporin
e. ampicillin and minoglycoside
ANSWER: E

Q 73:

which of the following is an absolute for an absolute contraindication for DTaP,

vaccine (diphtheria, tetanus, acellular pertussis) :
a. Prolonged crying for 3 hours or more within in 48 hours of Vaccine
b. Encephalopathy within 7 days of vaccination, not attributable to another
cause
c. Seizures within 48 hours
d. Temperature equal to 40.5 (104.8 F) or more
e. Hypotonic - hyporesponsive episode: collapse, or shock - like state

ANSWER: B

Q 74:
You are evaluating a 7 - year - old boy for staring episodes that lasts for 5-10
seconds. The child cannot remember what happened. His EEG shows bilateral
symmetric discharges 3CPS {cycles per second); What is the best treatment?
a. Methylphenidate
b. Oxcarbamazepine
c. Ethosuximide
d. Lamotrigine
e. Valproic acid
21

ANSWER: C
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Q 75:

A three year old child is expected to do all of the following EXCEPT:

a. Copies square
b. Names pictures Runs
c. Walks alone
d. Climbs up and down stairs
e. Runs
ANSWER : A

Q 76:

Interpretation of this arterial blood gases: P202 62 mmHg.

SaO2 of 91% pH 7.29, Paco2 52 mmHg, bicarbonate 27 meg/L. is :
a. Compensated Metabolic alkalosis
b. Respiratory acidosis
c. Metabolic alkalosis
d. partially compensated chronic metabolic acidosis
e. Partially compensated chronic respiratory acidosis
ANSWER: B

Q 77:

A fourteen year old girl has big fight with her mother. She suicide attempts by
ingesting 20 tablets of extra strength paracetamol. Her mother finds her and the
empty bottle a couple of hours later and immediately brought her to the ER. Which of
the following drugs will most likely be given to this patient?
a. Atropine
b. N-Acetylcysteine
c. Penicillamine
d. Protamine
e. Pralidoxime
ANSWER: B

Q 78:

Regarding PGALS (pediatric Gait Arms Legs and Spine) used for screening for
musculoskeletal abnormalities, all are true except
a. The patient can be examined with clothes and shoes on
b. Child can copy maneuvers as performed by the examiner
c. Observation of the patient should be done from the front behind and the sides
of the child
d. It is important to note the symmetry
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e. It starts with observing the child as he / she enters the room

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ANSWER: A
Q 79:
Which of the following is considered an epileptic event?
a. Night terrors
b. Sandifer syndrome
c. Neonatal sleep myoclonus
d. Staring spells
e. Breath holding spells
ANSWER: D

Q 80:

The thirteen year old patient with a three month history of fatigue, frequent diarrhea, and
weight loss has microcytic anemia. leukocytosis and thrombocytosis. Her erythrocyte
sedimentation rate is 70 mm / h, serum albumin is 3.0 g / dL (309 / L), and stool
calprotectin test result is positive, which of the following is most likely diagnosis?
a. Schwachman diamond syndrome
b. Irritable bowel syndrome, diarrhea predominant
c. Giardiasis
d. Inflammatory bowel disease
e. Amoebic gastroenteritis
ANSWER: D

Q 81:
A 4 year old previously healthy female presented with pubis hair and clitoromegaly, her
blood pressure is 120/90. Serum dihydroepiandosterone sulfate (DHEAS) is markedly
elevated. This girl most likely has
a. Adrenal tumor
b. 11 - hydroxylase deficiency
c. Ovarian tumor Od Precocious puberty
d. Precocious puberty
e. 21 hydroxylase deficiency
ANSWER: E

Q 82:
A six weeks old infant develops bloody diarrhea associated with fever and toxicity. He
had delayed passage of meconium at birth and has had severe constipation with small
caliber stool since that time. The abdomen was tender and distended on exam. The
MOST likely diagnosis is:
a. Hirschsprung disease
b. Bacterial gastroenteritis
c. Necrotizing enterocolitis
d. Meconium ileus
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e. Intestinal volvulus
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ANSWER: A
Q 83:
A 3year old girl is brought to your office for re - evaluation of a fever that began 6
days ago. Her mother tells you that her daughter's temperature has been as high as
39 degrees centigrade Her physical examination was unremarkable when you
examined her 3 days ago, but today you note injected sclera, red cracked lips
strawberry tongue and swollen, nontender cervical node. The most likely diagnosis
of this girls
a. Kawasaki disease
b. Atypical measles
c. Adenovirus infection
d. Acute Rheumatic fever
e. Hand foot mouth disease
ANSWER: A

Q 84:

A low birth weight neonate who passed meconium on the first day of life is started on
formula at 2 days of age. The infant develops abdominal distension and tenderness,
accompanied by findings suggestive of sepsis, including hypotension and
neutrophilia of the blood. Abdominal X - ray showed pneumatosis intestinalis. What
is most likely to be seen at emergency surgery?
a. Normal - appearing gastrointestinal tract
b. Bowel loops in the chest cavity
c. Gangrene of the terminal ileum and ascending colon
d. A massively dilated colon
e. A massive thickening of the pylorus
ANSWER: C

Q 85:

In an 18 month old patient, arthritis of at least 1 joint and daily fever for at least 3
days a week for a duration of 2 weeks, with salmon - pink rash, lymphadenopathy,
hepatosplenomegaly or serositis indicates a diagnosis of juvenile idiopathic arthritis
UIA) of the subtype:
a. Oligoarticular JIA
b. Polyarticular JIA
c. Systemic - onset JIA
d. Undifferentiated arthritis
e. Enthesitis - related arthritis
24

ANSWER: C
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Q 86:

All of the following cause normal anion gap metabolic acidosis except:
a. Hypoaldosteronism
b. Urinary diversion
c. Renal tubular acidosis
d. Diarrhea
e. Diabetic ketoacidosis
ANSWER: E

Q 87:

A two month old infant is evaluated for severe hypotonia and is diagnosed with
spinal muscular atrophy. Which of the following is true regarding this condition?
a. Respiratory muscles are spared
b. Microcephaly is expected
c. Absent deep tendon reflexes
d. Neurological prognosis is good
e. it is not hereditary
ANSWER: C

Q 88:

A fourteen year old boy presents with fever, headache, vomiting, photophobia and
purpuic rash. Physical exam demonstrates positive meningeal signs thus lumbar
puncture is performed and CSF collected, Gram stain of the CSF shows "Gram -
negative intracellular diplococci". The most likely bacterial agent causing meningitis
is:
a. Group A beta - hemolytic Streptococcus
b. Neisseria meningitidis
c. Group 8 strep (Streptococcus agalactiae)
d. Streptococcus pneumoniae
e. Haemophilus influenzae
ANSWER: B

Q 89:

What is the usual presentation of adrenal insufficiency in infancy?

a. ketosis
b. Hyperpigmentation
c. Orthostatic hypotension
d. hypernatremia
e. hypoglycemia
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ANSWER: E
Q 90:

The most common organism causing osteomyelitis & septic arthritis is:
a. Staphylococcus epidermidis
b. Staphylococcus aureus
c. Viridans group Streptococci
d. Streptococcus pyogenes (Group A Strep)
e. Streptococcus pneumoniae
ANSWER: B

Q 91:

All are risk factors for renal stone formation except

a. hypercitraturia
b. cystinuria
c. hyperuricemia
d. hyperoxaluria
e. Hypercalciuria
ANSWER: A

Q 92:

A biopsy from neck lymph nodes swelling of 10 year old boy confirms a diagnosis of
Non Hodgkin lymphoma (NHL). Which of the following is consistent with stage 4 NHL
a. Presence of mediastinal involvement
b. involvement of two or more lymph node in the same side of diaphragm
c. Presence of splenomegaly
d. Involvement of two or more lymph node above and below diaphragm
e. Presence of bone marrow infiltration with lymphoblast cells

ANSWER: E

Q 93:

Regarding the use of phototherapy in treating babies with jaundice all are true EXCEPT
a. It works by photoisomerization of bilirubin to water soluble form
b. It utilizes blue light with a wavelength range of 430-480 nm
c. Should not be used in the first 24 hours of life
d. Can be used before and after exchange transfusion
e. Contraindicated in direct hyperbilirubinemia

ANSWER: C
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Q 94:

All of the following are true regarding acute asthma in children EXCEPT
a. Anticholinergic drugs are contraindicated.
b. Corticosteroid is an essential drug during an acute attack
c. Aminophylline if used level must be monitored.
d. Beta - 2 - sympathomimetics are the mainstay of treatment
e. Ketamine may be used
ANSWER: A

Q 95:

A six year old presents with urinary incontinence Exam reveals a sacral
subcutaneous mass.
What is the expected diagnosis?
a. Hydrocephalus
b. Myelomeningocele
c. Chiari Il malformation
d. Scoliosis
e. Tethered spinal cord
ANSWER: B

Q 96:
You are attending the delivery of a 39 week baby by CS for breech presentation and
fetal bradycardia. At one minute of age the baby has blue hands and feet pink
centrally, showed minimal flexion, HR was 110 bpm, has irregular breathing with
minimal grimace.
What is his APGAR score:
a. Six
b. eight
c. four
d. five
e. Three
ANSWER: A

Q 97:
One of the following cause direct hyperbilirubinemia
a. Criglar Najar syndrome
b. G6PD deficiency
c. ABO incompatibility
d. alpha 1 antitripsin
27

e. Gilbert syndrome
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ANSWER: D
Q 98:
A 5 year old boy has learning difficulties, hyperactivity and macroorchidism, which
investigation is indicated for diagnosis:
a. FISH for Prader Willi syndrome
b. Thyroid function studies
c. PCR for fragile X syndrome
d. Karyotyping for Down syndrome
e. Mutation testing for Rett syndrome
ANSWER: C

Q 99:
A three years old boy has a history of cold for three days , then he developed high
fever , barking cough , the most likely diagnosis is :
a. Foreign body in the trachea
b. Laryngo - tracheobronchitis
c. Bacterial tracheitis
d. Epiglottitis
e. Retropharyngeal abscess

ANSWER: C

Q 100:
A seven year old boy who has dysentery develops self - limited generalized seizures.
Of the following the enteric pathogen MOST likely to cause these clinical findings is
a. Salmonella typhimurium
b. Giardia lamblia
c. Campylobacter jejuni
d. Shigella dysenteriae
e. Rotavirus
ANSWER:D
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