(1) Growth
1abcde-
Read carefully and choose one best answer
All the following are correct about growth except
Growth in the first year of life is growth hormone dependent
Maternal deprivation may negatively affect growth
Head and neck comprises 25% of body length at birth
A one year old child should have mid arm circumference13.5cm
Lymphoid system in childhood exceeds the adult size
2The normal pattern of physical growth is characterized by
a- Rapid during infancy and childhood then slows
b- Rapid in infancy then gradually slows to steady pace from 5 years to speed up again
during puberty
c- Slow at first then accelerates until completion of puberty
d- Steady during infancy and childhood and then progressively more rapid in late
childhood and puberty
e- Rate of growth is stationary throughout infancy , childhood and puberty
3abcde-
All the following about normally distributed observation are correct except
The mean, median and mode are essentially equal
-1SD equals about 16 percentile
from -1SD to +1SD comprises 68.2% of the observations
2SD denotes 90% of the median
3SD comprises > 99% of the observations
4- A girl has weight for age markedly below the 5 percentile. Which of the following
statements is unlikely?
a- Wasted but not stunted
b- Stunted but not wasted
c- Wasted and stunted
d- Normal nutritional state
e- None of the above
5-The ratio of upper to lower segments is about
a- 2:1 at birth and 1.5:1 at adolescence
b- 1.7:1 at birth and 1:1 at adolescence
c- 1.2:1 at birth and 1:1.2 at adolescence
d- 1:1.7 at birth and 1:1 at adolescence
e- 1.2:1 at birth and adolescence
6-Regarding growth which of following statements is not correct
a- Height doubles at 4 years
b- Weight doubles at 4 months
c- Head circumference increases 2-3cm in the first 3 months
d- Recumbent length is more than height by 1.5-2cm
e- From 6 to 7 years of age the height increases 5-6cm
- 1-
7-Which of the following head circumference percentiles at 4, 6, 8 weeks of life are
unlikely to be denoting progressive hydrocephalus
a- 28, 60, 78 percentiles
b- 5, 25, 43 percentiles
c- 18, 35, 49 percentiles
d- 20, 34, 49 percentiles
e- 88, 90, 90 percentiles
8-The first permanent teeth to erupt are
a- First molars
b- First premolars
c- None of the above
d- Upper central incisors
e- Lower central incisors
9-An infant is falling just below the 5 percentile weight for age at 3, 4 and 5 months
of age. Which of the following statements is correct?
a- Cannot decide if rate of growth is normal or not
b- Slowing of growth (faltering)
c- Normal growth rate
d- Losing weight
e- Flattening of the weight curve
10-All the following are correct about growth of the head except
a-Regular measurement of HC is the best way of early detection of hydrocephalus
b- Posterior fontanelle closes at birth of shortly afterwards
c- Head size at 5 years reaches 80% of adult size
d- Anterior fontanelle closes at 9-18 months
e- Pulsating anterior fontanelle denotes increased intracranial tension
11-The following are recognized of growth except
a- General
b- Neural
c- Genital
d- Muscular
e- Lymphoid
(2) Development
Read carefully and choose ONE best answer
1- All the following statements are correct regarding gross motor development
except
a- By 8 months most infants are able to assume a sitting position without help
b- By 9-10 months of age most infants are able to creep or crawl
c- By 15 months most infants are able to walk alone
d- By 16 months most infants are able to descend stairs
e- By 18 months most infants are able to ascend stairs
- 2-
2-The ability to copy forms develops in a regular order, which of the following is
the correct sequence
a- Copy a square, a cross, a circle
b- Copy a square, a circle, a cross
c- Copy a cross, a circle, a square
d- Copy a circle, a square, a cross
e- Copy a circle, a cross, a square
3- All the following are warning sings of poor development except
aDrooling at 18 months
bPuts toys in the mouth at 10 months
cClenched hands at 3 months
dPrefer to use the right hand at one year
eMoro reflex present at 6 months
4- A four and half year old child is able to do all the following
aButtons clothing
bGoes to toilet
cAsks questions about meaning of wards
dNames 2-4 colours
eDraws a person with 5-7 parts
5-All the following are among the general characteristics of development except
aRate of development is the same among different children
bA continuous process
cCephalocaudal direction
dFrom massive to specific
eAffected by genetics and heredity
6- All the following development milestones are correct except
a- Cooing at 3 months
b- Blinking to flashing light at birth
c- Dray by day and night at 2 years
d- Aware of strange faces at 7 month
e- Grasps with thumb and forefinger at 10 months
7- A 5 month old infant is able to perform all the following except
a- Recognizes the mother
b- Reaches and catches an object by the palm
c- Laughs loudly
d- turns to sound
e- puts things in the mouth
8- Who of the following children is more likely to be mentally retarded
a- She is 8 months old and cannot sit but can manipulate objects
b- She is 4 months old and cannot smile but can blink to flashing light
c- He is one year old with delayed standing and walking and head circumference at 5
percentile
d- He is 14 months old and is able to hold cup and drink but cannot speak
- 3-
e- She is 4 years old and wets herself at night and refuses to draw a person on two
separate occasions
9- Which of the following findings on developmental assessment of a 13 month
developmental evaluation
aUnable to walk independently
bThe child says only 4 words
cThe is afraid of strangers
dThe child does not eat with a spoon and is not able to drink from a cup
eThe child appears to be left handed
10- All the following are correct age acquiring a development milestone except
a- Laughs loudly 4 months
b- Chews; 7 months
c- Imitates mother; 12 months
d- Turns to sound; 2 months
e- Grasp by palm; 5months
11- About draw a person test which of the following is correct
aIt can be used from the age of 5 years
bIt can be used to diagnose mental retardation
cShow the child to be tested how to draw first
dIt can be used for illiterate children
eThe number of parts drawn is equal to the developmental age
(3) Behaviour and Emotions
Read carefully and choose ONE best answer:
1- All the following behaviour disorders have some relation to adverse or improper
family environment except
a- Secondary enuresis
b- Attention deficit hyperactivity disorder
c- Breath holding attacks
d- Refusal of feeding
e- Functional constipation
2- Which of the following behavior disorders is related to family environment and
behavior
a- Tics
b- Autism
c- Attention deficit hyperactivity disorder
d- Temper tantrum
3- Features of attention deficit hyperactivity disorder include all the following
except
a- Poor eye to eye contact
b- Inattention
c- Impulsiveness
d- Disorganized
e- Dangerous activities
- 4-
4-Features of infantile colic include all the following except
a- Onset is usually in the first month of life
b- Disappears at about 3 months of age
c- Does not occur in breastfed infants
d- More common among infants of anxious mothers
e- Exact cause is unknown
5-All the following are risk factors for emotional and behavioral disorders in children
except
a- Unclear, hostile discipline
b- Large family
c- Diabetes mellitus in the child
d- Deafness in the child
e- Working mother
6- All the following age incidences are correct except
a-Temper tantrum; 1-5 year
b= Functional abdominal pain; 6-16 years
c- Infantile colic; 3-6 months
d- Breath holding attacks; 6 months to 5 years
e- Attention deficit hyperactivity disorder; 3-12 years
7-Anorexia can be caused by all the following except
a- Chronic renal failure
b- Pulmonary TB
c- Kwashiorkor
d- Nutritional marasmus
e- Iron deficiency anemia
8- All the following are correct about pica except
a- All cases have subnormal IQ
b- It may cause lead poisoning
c- It is commonly observed in toddlers
d- It is commonly associated with iron deficiency anemia
e- It may cause gastrointestinal obstruction
9-All the following are correct about enuresis except
a- The term is limited to children more than 4 years of age
b- Secondary enuresis is always of organic a etiology
c- Boys are affected more than girls
d- Urinalysis in required for preliminary assessment in all cases
e- No organic enuresis does not persist into adult life
10- Which of the following features suggests organic nature of recurrent
abdominal pain
a- Episodes are almost daily
b- Associated with constipation
c- Associated with anorexia
- 5-
d- Pain is per umbilical
e- Stools are some times streaked with blood
11- All the following are correct about functional constipation except
a- Palpable faecal masses
b- Moderate to marked abdominal distension
c- Rectal examination reveals lax anus
d- Associated soiling is common
e- Associated encopresis is common
12- All the following are correct about anorexia in the toddler and preschool child
except
a- Most cases are no organic
b- Misunderstanding by parents of the normal growth pattern and appetite is a
factor
c- Snacks between meals is contributing
d- It is more common if there is no other child in the household
e- Unhappy tense family environment diminishes child's appetite
13- A 2 months exclusively breastfed baby has frequent episodes of crying every day
especially at night and often last for up to 3 hours. In between the episodes the baby
appear well. Stools are loose about 5-6 days weight is increasing along the 60
percentile, 0/E no abnormality detected. You should
a- Reassure the mother and continue routine follow up
b- Admit the baby to hospital for close observation
c- Request abdominal ultrasound to exclude sub acute intussusceptions
d- Ask for stools analysis and culture to exclude intestinal infection
e- Regulate breastfeeding and stop night feeds
14- Among the no organic causes of crying, all the following can be a cause in an
infant aged 3 months except
a- Excessively hot weather
b- Wet nappy
c- To get attention
d- Thirst
e- Hunger
- 6-
(4) Neonatology
Read carefully and choose ONE best answer
1- The definition of small for dates is
a- Birth weight < 2000 g
b- Birth weight < 1500 g
c- Birth weight < 1500 g, length < 47 cm and head circumference < 33 cm
d- Neonate born before 37 weeks (completed) and weighing < 2500 g
e- Birth weight < 10 percentile for that gestational age
2- A 3400 g infant has the following findings at 5 minutes of age; heart rate
144/minute, respiratory rate 42/minute, cyanosis of hands and feet but body is pink,
catheter in the nostril causes grimace and limbs show some flexion but no active
movements. The apgar score is
a- 5
b- 6
c- 7
d- 8
e- 9
3- All the following finding are of little concern in a newborn except
a- Sub conjunctival hemorrhage
b- Upper and lower limbs are in extension position
c- blue-black pigmented areas on the lower back and buttocks
d- jaundice in a 5 days old newborn extending to the face and trunk but not the
limbs
e- two successive counting of respiratory rate show 65 and 51/minute
4-A newborn of 38 weeks gestation and weighing 2 kg, he is considered
a- Small for dates and low birth weight
b- Preterm and low birth weight
c- Small for dates and preterm and low birth weight
d- Small for dates and preterm
e- Preterm
5-All the following are correct about mouth to mouth breathing except
a- It is not contraindicated if heart beats are inaudible
b- The head should be extended
c- Cover the mouth and nose of the baby tightly by your mouth
d- Blow air vigorously
e- Give regular puffs 30/minute
6-Kernictus is suspected if a jaundiced newborn shows
a- Vomiting repeatedly
b- Bulging fontanelle
c- Poor feeding
d- Fever
e- Excessive crying
7-Which of the following infants has the greatest risk of developing an early iron
deficiency anemia
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abcde-
A premature
An infant with ABO incompatibility
An infant with physiological jaundice
A post mature
An infant with polycythaemia
8-Neonatal cyanosis may be observed in the following conditions except
a- Meningitis
b- Hypoglycemia
c- Respiratory distress syndrome
d- Hemorrhagic shock
e- Congenital heart with right to left shunt
9-If you are allowed to ask only one question to assess a newborn with jaundice
which one to choose?
a- Blood group of the mother
b- Day of onset of jaundice
c- Presence of infection during pregnancy
d- Any treatment given
e- Color of urine
10-All the following are characteristic of cephalhaematoma except
a- The swelling is soft fluctuating with well defined margins
b- It does not cross the suture lines
c- A large cephalhaematoma may aggravate physiological jaundice
d- The skin overlying may be discolored
e- Spontaneous resolution is expected within few
11-Jaundice reaching the hands and feet in a newborn denotes serum bilirubin is
more than
a- 6 mg /di
b- 10 mg /di
c- 15 mg/di
d- 20 mg/di
e- this depends on skin colours
12-In the hospital delivery room with suitable facilities newborn failed to start
respiration spontaneously after tapping his back. Your first action is to
a- Give epinephrine IV
b- Give puffs of oxygen by mask and bag
c- Put an end tracheal tube
d- Start cardiac massage
e- Perform mouth to mouth breathing
13- Your are seeing a breastfed 2 week old infant from a remote area with poor
health services. The mother complains that the infant is constipated and excessively
- 8-
sleepy. O/E you find mild jaundice and distended abdomen in a sleepy infant. Your
first action is
a- Evaluate thyroid function
b- Ask if the mother is receiving sedatives or tranquillizers
c- Supplement breastfeeding and advise the mother to eructate the baby after
feeding
d- A arrange for haemogram, reticulocyte count and serum bilirubin
e- Reassure the mother and continue routine follow up
14- All the following are correct about neonatal hypothermia except
a- The skin feels hard and fixed to underlying structures
b- It is commonly a sign of infection
c- Hypoglycemia is usually present
d- The skin is pale
e- Sucking is poor
15- A newborn is noted to have cyanosis limited to the extremities, but otherwise no
other abnormality is detected. The most likely cause of this finding is
a- Patent duct us arteriosus
b- Respiratory distress syndrome
c- Cyanotic congenital heart disease
d- Methaemoglobinaemia
e- Poor vasomotor control
16- Which of the following is recommended as routine care of the newborn
a- E. coli
b- Staphylococcus aurous
c- Group A beta hemolytic streptococci
d- Group B beta hemolytic streptococci
e- Listeria monocytogenes
17- Which of the following is recommended as routine care of the newborn
a- Giving glucose 5% orally for physiological jaundice
b- Applying antibiotic eye drops once daily for the first 5 days of life
c- Keeping the baby above the level of the placenta before cutting the cord
d- Painting the umbilical stump with 70% alcohol daily until dry
e- Bathing the infant shortly after birth
18- Neonatal seizures may present with any of the following except
a- Eyes rolling
b- Blinking apnea
c- Change of colours with vacant look
d- Chewing
e- Severe crying
19- Infant of diabetic mother may have any of the following except
a- Hyperglycemia
b- Overweight
c- Plethoric
d- Respiratory distress syndrome
e- Hyperbilirubinaemia is common
- 9-
- 10-
20- All the following are among the causes of small for dates except
a- Chronic renal failure in the mother
b- Grand multiparty
c- Chromosomal anomaly in fetus
d- Twins
e- Excess smoking during pregnancy
21- All the following are physiological difficulties of prematurity except
a- Poor thermal stability
b- Tendency to develop polycythaemia
c- Respiratory difficulty
d- Increased susceptibility to hemorrhage
e- Feeding difficulty
22- All the following are more frequently associated with small for dates except
a- Above average prenatal mortality
b- Congenital malformations
c- Permanent physical retardation
d- Respiratory distress syndrome
e- polycythaemia
23- Which of the following is abnormal or not excepted in a 3-4 day old infant?
a- Vaginal bleeding
b- Breast enlargement
c- Heart rate 138/minute
d- Respiratory rate 51/minute
e- Increase in body weight compared to birth weight
24- Retinopathy of prematurity is most likely related to
a- Excessive and prolonged oxygen administration
b- Severe and prolonged jaundice
c- Neonatal cold injury
d- Repeated seizures
e- Hypoglycemia
25- The cause of large size of infant of diabetic mother is
a- Hyperglycemia
b- Excess growth hormone
c- Insulin excess
d- Excess thyroid hormones
e- Unidentified cause
(5)Genetics
Read carefully and choose ONE best answer:
1- All the following definitions in genetics are correct except No disjunction;
failure of two members of a chromosome pair to disjoin during gametogenesis .
a- Polyploidy; an abnormal chromosomal complement which exceeds the
diploid number e.g. 47 or more
b- Alleles; the alternate forms of a gene at the same locus
c- Trisomy; three copies of a given chromosome per cell
- 11-
d- Is chromosome; an abnormal chromosome in which there is loss of one arm
and two identical copies of the other
2- In a family where 2 boys has Duchene muscle dystrophy and both parents are
clinically free, the risk of recurrence of this condition in the future is
a- 50% of boys and none of girls
b- All boys and none of girls
c- 75% of boys and 25% of girls
d- 50% of boys and 25% of girls
e- all boys and 25% of girls
3- Both father and mother have achondroplasia, their first offspring is found
normal, the chance that the next offspring will be also normal is
a- 100%
b- 75%
c- 50%
d- 25%
4- Further study is required to find if the parents are homozygous or heterozygous
A 36 years old pregnant woman has prenatal testing that reveals trisomy 21.
during counseling you give some information about this condition. Which
information is not correct ?
a- It is the most common chromosomal abnormality
b- No environmental insult during pregnancy caused this condition
c- Heart defects are more frequent
d- Risk of recurrence in future pregnancy is similar to the general
population
e- Mental retardation is present in 50-75% of cases
5- A pregnant woman has smoked significantly throughout pregnancy. You explain
to her that cigarette smoking may cause
a- Normal child
b- Dysmorphic weight
c- Low birth weight
d- Developmental delay
e- Early onset degenerative cerebrovascular disease
6- Down syndrome is characterized by all the following except
a- Increased susceptibility to infection
b- Leukemia is more frequent
c- Easily diagnosed at birth
d- Epilepsy
e- Sterility in males
7- All the following are correct about klinefelter syndrome except
a- Can be diagnosed clinically in early infancy
b- Abnormal behaviour
c- Long extremities
d- Hypogonadism
e- Chromosomal complement is 47,XXY
- 12-
Each of the following chromosomal disorders has the correct clinical finding
except
a- 45,X;webbed neck
b- 47,XX 21+; simian crease
c- 47,XYY; peculiar features
d- 47,XXY; tall stature
e- 49,XXXXX; severe mental retardation
9-Regarding autosomal recessive inheritance which of the following is correct
a- The gene mutation is expressed in the heterozygous state
b- One parent is a carrier
c- Males are more often affected than females
d- If one parent is affected and the other is normal and not carrier the chances
of each child being affected is 50%
e- Each child of two heterozygous parents has a 25% chance of being affected
and 50% chance of being a carrier
- 13-
10- Chromosomes are characterized by all the following except
a- There are 2 long and short arms
b- They are divided transversely during mitosis
c- Length and Centro mere position help in their identification
d- Monosomy of autosomes is lethal
e- Always present in the nucleus
11- A physician finds that a newborn has down syndrome, which is the preferable
way of telling the parents
a- Postpone telling them until they discover gradually that the baby is abnormal
b- Tell them gradually by mentioning that the baby is somewhat weak
c- Tell the father first and ask him advice about how his wife should be told
d- Tell the father only and ask him not to tell the mother for several months
e- Let the nurses tell them gradually
12- Genetic counseling includes all of the following except
a- Establish exact diagnosis
b- Inform the parents about diagnosis, prognosis and possible treatment
c- Inform the parents about risks of recurrence in future pregnancies
d- Describe to the parents prenatal diagnosis if available
e- Describe for the parents the suitable option
13- All the following are correct about fragile X syndrome except
a- Occurs only in males
b- Mild to severe mental retardation
c- Large testes developing during puberty
d- Abnormal behaviour
e- Large ears
14- All the following are correct about autosomal dominant conditions except
a- Results in marked excess of affected males
b- Have an increased frequency in consanguineous marriage
c- Are not transmitted from male
d- Female carriers do not show manifestations
e- All daughters of an affected father are carriers
15- All the following are correct about autosomal dominant conditions except
a- usually result in equal numbers of affected males and females
b- may be transmitted from males to males or females
c- often show variable expression
d- advanced maternal age is a factor
e- may be non-penetrate
16- A 14 years old girl shows no signs of breast development and has not started
menstruating. Examination reveals stature well below the 5th percentile with
- 14-
normal facial appearance. There prominent cubit us valgus deformity. Which of
the following studies is most likely to reveal the etiology of this patient' condition?
a- Abdominal ultrasound
b- Karyotype
c- Gonadotropin level
d- Growth hormone level
e- Thyroid birth weight
17- All the following may be features of the infant with Down syndrome except
a- Hypotonic
b- Simian crease
c- Hyperplasia of distal phalanx of 5th finger
d- Growth hormone level
e- Thyroid hormone weight
18- All the following statements are true about down syndrome except
a- About 4-5% are due to translocation
b- The incidence is increased with advanced maternal age
c- There is an increased incidence among males
d- Some degree of mental retardation is always found
e- Friendly no aggressive behaviour
19- Clinical picture of Turner syndrome include all the following except
a- Epilepsy
b- Mental retardation
c- Cardiac defect
d- Short stature
e- Infertility
20- The picture of XXY syndrome does not include
a- Increased pituitary gonadotropins
b- Absent secondary sexual characters
c- Mental retardation may be present
d- Short stature
e- Males only affected
21- Chromosomal karyotyping is least likely to be value in which of the following
findings
a- Dysomorphic features
b- Major congenital anomalies
c- History of maternal exposure to teratogens
d- Ambiguous genitalia
e- Recurrent seizures
- 15-
(7) NUTRITION
Read carefully and choose ONE best answer
1- A 23 years old woman delivers a small-for-dates full term newborn. Mother is
underweight and examination of the midline lumbosacral region. There is flaccid
paralysis in the lower limbs. Which of the following nutritional supplements could
have prevented the condition?
a- Folic acid
b- Vitamin A
c- Vitamin B2
d- Vitamin B6
e- Essential amino acids supplement
2- All the following requirements of a 4 years old (16 kg) are correct except
a- Water ; 1600dl
b- Energy ; 1300-1400 kcal
c- Protein ; 45 g
d- Iron ; 10-20 mg
e- Fat ; 35% of energy intake
3- Compared to mature breast milk, colostrums is characterized by all the following
except
a- Higher in protein
b- Higher in fat
c- Lower in lactose
d- Higher in vitamin A
e- Amount 30-100 ml/day
4- Compared to mature breast milk, buffalo milk is characterized by all the
following except
a- Higher in energy
b- Higher in fat
c- Higher in protein
d- Higher in lactose
e- All the above
5- All the following are correct about manual expression of breast milk except
a- It is helpful to relief engorgement
b- Prepare the breast by wrapping a warm towel around it
c- The process takes about 5 minutes
d- It can be kept at room temperature for up to 6 hours
e- It can be kept in the refrigerator for up to 24-48 hours
6- The amount of formula milk required daily for an infant aged 2 months and
weighing 5 kg is
- 16-
abcde-
320ml
550ml
750ml
950ml
1050ml
7- Yoghurt is characterized by all the following except
a- It is suitable for persistent diarrhea
b- The fat contain is usually 3%
c- It does not contain lactose
d- Also suitable when mixed with cereal or mashed bananas
e- Should not be given undiluted before 9 months
8- The energy content of a mixture composed of 100ml of cow milk plus 4g sucrose
and 2ml vegetable oil is about
a- 2.5 kcal/ml
b- 2.0 kcal/ml
c- 105 kcal/ml
d- 1 kcal/ml
e- 0.5 kcal/ml
9- The following are figures of percentage of the standard. Which of the following
combination of figures denotes stunting only without wasting according to water
low classification.
A
B
C
D
E
98
84
81
59
73
Wt/age
94
92
98
76
83
Length/age
101
86
82
77
95
Wt/length
10- Medium chain triglycerides are
a- A dietary fat that is useful in diet of cases of obstructive jaundice
b- An essential component of brain metabolism
c- Useful in lowering serum cholesterol
d- Useful in assessing the lipid profile
e- Helpful in preventing rancidity of food
11- All the following vitamins are present in green leafy vegetables except
a- Foliate
b- Thiamine
c- Vitamin A
d- Niacin
e- Vitamin C
12- Which of the following is a feature of cow milk
a- low protein content
- 17-
bcde-
low electrolyte content
low water content
low iron content
low energy content
13- The breastfed infant of a strict vegetarian mother may show which vitamin
deficiency
a- B12
b- B6
c- K
d- Foliate
e- Essential fatty acids
14- In an established case of kwashiorkor which of the following investigations are
least necessary
a- Tuberculin test
b- Chest x-ray
c- Urinalysis
d- Blood glucose
e- Plasma proteins
15- All the following are more likely to be associated with familial hypophataemic
vitamin D resistant rickets except
a- Age of onset after 2 years of age
b- Signs are more marked in the chest
c- Short stature
d- Normal muscle tone
e- Good general condition
16- All the following are correct about foliate and its deficiency except
a- The anemia of deficiency in macrocytic norm chromic
b- May be associated with kwashiorkor
c- It can be stored in the liver for later use
d- Deficiency may develop in thalasaemia major
e- It is head labile
17-Which vitamin is incorrectly matched with its advisable daily intake
a- foliate; 50-400 mg
b- vitamin K; not required
c- vitamin D; 400 IU
d- vitamin A; 1200-3500 IU
e- vitamin C; 100-200 mg
18- Clinical disorders associated with its increased incidence of rickets include all
the following except
- 18-
abcde-
Obesity
Celiac disease
Chronic renal failure
Obstructive jaundice
Hepatic disease
19- Manifestations of hypervitaminsis A include all of the following except
a- Hepatomegaly
b- Polyuria
c- Seborrhea
d- Bulging fontanelle
e- Tender swelling of long bones
20- Manifestations of hypervitaminsis D include all of the following except
a- polyuria
b- hypotonic
c- vomiting
d- diarrhea
e- kidney calcification
21- Pyridoxine (vitamin B6) is characterized by all the following except
a- Deficiency may occur with prolonged INH therapy
b- Deficiency may present with microcytic hypo chromic anemia
c- Deficiency may present with convulsions
d- Dietary deficiency is rare
e- Dietary sources are mainly of animal origin
22- Which vitamin is incorrectly matched with its deficiency manifestation
a- B1; generalized edema
b- B2; glossitis
c- Niacin; neuropathy
d- A; Bitot's spots
e- C; bleeding gums
23- Sub clinical forms of iodine deficiency may lead to any of following except
a- Repeated infections
b- Difficulty in education
c- Congenital malformations in the developing fetus
d- Motor in coordination
e- Infertility
24- Which of the following is least recommended as complimentary food for an 8
months old infant
a- Cottage cheese (karees)
b- Stewed beans
c- Boiled mashed vegetables
- 19-
d- Jelly with boiled apples
e- Mashed sweet potatoes
- 20-
25- Which of the following children with PEM are more likely to show negative
impact on mental development
a- Marasmus kwashiorkor in a 14 months old infant
b- Marasmus in a 2 months old infant
c- Kwashiorkor in a 10 months old infant
d- Kwashiorkor in a 24 months old infant
e- The insult is equal in all
26- All the following are correct about dietary management of severs PEM except
a- The calorie content of starter formula is 75 kcal/100ml
b- High protein content of starter formula about 3-4 g/100 is required
particularly in kwashiorkor
c- Loose frequent stools during therapy but with weight gain should not cause
concern
d- The main danger of aggressive dietary management is heart failure
e- Catch-up formula is given from the 7th day of treatment
27- A child aged 18 months is almost exclusively cow milk fed is very likely to
develop
a- Iron deficiency anaemia
b- Systemic hypertension
c- Protein deficiency
d- Rickets
e- Folic acid deficiency
28-A11 the following are manifestations of vitamin A deficiency except
a- Dry scaly rough skin
b- Xerophthalmia
c- Increased susceptibility to diarrhoea
d- Retarded growth
e- Hypotonia
29- Which of the following is a more common cause of fissured nipple
a- Bacterial infection
b- Irritating clothes
c~ Improper position
d- Biting by the teeth
c- Monilial infection
30- Breastfed infants are less likely to develop all the following except
a- Diarrhoea
b- Infantile eczema
c- Acute otitis media
d- Haemorrhagic disease of newborn
e- Bronchial asthma
31- A boy aged 21 months, weight 10.1 kg, length 90 cm, expected weight for age is
12 kg, expected length for age is 85 cm and expected
- 21-
weight for length is 13 kg. He is considered.
a- Normal
b- Stunted
d- Wasted
c- Wasted and stunted
e- The information is not sufficient
32- In Waterlow classification of PEM which anthropometric ratios are utilised
a- Weight for age and length for age
b- Weight for length and length for age
c- Weight for age, weight for length and length for age
d- Weight for length only
e- Length for age only
(8) Immunology
Read carefully and choose ONE best answer
1- A tuberculous child is accidentally vaccinated with BCG, the
expected reaction will be
a- A papule starts to appear after 2-3 weeks
b- A papule starts to appear after 2-3 days
c- Severe reaction with deeper persistent ulcer
d- Disseminated reaction
e- No reaction
2- All the following about passive immunity are correct except
a- Preterm Infants may not get sufficient protective transplacental antibodies,
b- The antibodies that cross the placenta are of the IgG type
c- Protective for the first 3-4 months against measles
d- Protective for the first 3-4 months against pertussis
- 22-
e- Immunoglobulin injection gives immunity for about 3 months
3- Which of the following is a live attenuated vaccine
a- BCG
b- Meningococcal vaccine
c-Salk (lPV)
d- Typhoid (conventional)
e- Pertussis
4- A the following are correct regarding the national (routine)
schedule of vaccination in Egypt except
a- MMR is given at 18 months
b- BCG is given at birth or in the first 2 months of life
c- First dose of hepatitis B vaccine is given at 2 months
d- A booster dose of DPT is given at 18 months
e- Four doses of TOPV are given during the first year
5- Which of the following vaccines are more likely to cause fever in the 1st 24 hours
following vaccination?
a- Hepatitis B
b- BCG
c- DPT
d- MMR
e-TOPV
6- Which of the following is considered a contraindication to DPT
a- Degenerative brain disease
b- Child receiving antibiotic prophylaxis for urinary tract infection
c- Severe malnutrition
d- A 3 year old child who was never vaccinated before
e- History of febrile convulsions
7- Regarding the type of vaccine all the following are correct except
a- H. influenzae vaccine: capsular polysaccharide
b- Measles: living attenuated organisms
c- MMR: living attenuated viruses
d- Salk (IPV): killed organisms
e- Meningococcal vaccine: living attenuated organisms
8- Which of the following vaccines is destroyed by freezing
a- Measles
b-TOPV
c- MMR
d- Hepatitis B
e- BCG
9- Which of the following precautions and possible reactions about
TOPV is correct
a- Breastfeeding should be avoided 2 hours before vaccination
b- Fever may develop after vaccination
- 23-
c- Diarrhoea is not a contraindication
d- It should be postponed if the infant is premature born at 32 weeks
e- Accidental ingestion of more than 5 drops may precipitate paralysis
10-All the following conditions have protective vaccines except
a- Rabies
b- Toxigenic E coli diarrhoea
c- Cancer of the cervix
d- 5. pneumoniae meningitis
e- Varicella
11- Which of the following vaccines can be given before 1 year of age
a- Varicella vaccine
b- Hepatitis A vaccine
c- Meningococcal vaccine
d- H influenzae type b vaccine
e- Oral typhoid vaccine
12-An unvaccinated child comes for the first time what vaccine(s) should be given
at the 1st visit
a- BCG
b- TOPV and DPT
c- TOPV, DPT and Hepatitis B
d- BCG,TOPV and DPT
e- BCG, TOPV, DPT and Hepatitis B
13-Which of the following vaccines is contraindicated in HIV positive
individuals
a- BCG
b- Inactivated polio vaccine
c- DPT
d- Hepatitis B
e- Hepatitis A
14-The preferable place for storage of TOPV in the refrigerator in a
health centre is
a- The freezer
b- The shelf immediately below the freezer
c- The shelves in the door
d- The lowest drawer
e- Any where in the refrigerator
- 24-
(9) Infections and Parasitic Infestation
Read carefully and choose ONE best answer
1-Hyperthermia (not fever) is characterised by all the following except
a- Excessive sweating
b- Muscle rigidity
c- Dilated pupil
d- Not responding to antipyretics
e- Hypothalamic thermoregularity mechanism is not functioning
2-Which of the following does not make a case of fever potentially serious
a- First 2 months of life
b- Inconsolable child
c- Difficult to awake
d- Associated chills and rigors
e- Few petechial spots on the skin
3-A11 the following are correct about fever except
a- To feel for body temperature touch the epigastrium better than the hands
b- Remittent fever means that it is present for some hours during the 24hr
c- Sponging with cold water is better avoided
d- Nonspecific viral illness is among the commonest causes
e- Fever causes minimal rise of respiratory rate (1-2 cycles per 1°C)
4-AII the following are causes of maculopapular rash except
a- Measles
b- Roseola infantum
c- Rubella
d- Drugs
e- Varicella
5-Which of the following infectious diseases have the shortest incubation period
a- Mumps
b- Pertussis
c- Bacterial meningitis (non-TB)
d- Poliomyelitis
e- Enterica
- 25-
6-AII the following are correct about measles except
a- Dry irritating cough is always present
b- Infectivity starts with the appearance of the rash
c- Koplik's spots disappear with the onset of the rash
d- Fever continues with onset of rash for 2-3 days then starts to drop
e- Pneumonia is among the common complications
7-Long term immunity follows all the following infections except
a- Measles
b- Rubella
c- Mumps
d- Chickenpox
e- Tetanus
8-The following incubation periods are correct except
a- Scarlet fever: 1-2 weeks
b-Diphtheria: 2-4 days
c-Vivax malaria: 10-20 days
d-Rubella: 2-3 weeks
e-Measles: 10-14 days
9- ALL the following are correct about varicella except
a- Complications are rare
b- Infectivity remains until the rash is crusted
c- Lesions heal without scarring
d- Rash is pleomorphic
e- Rash is more on the limbs than on the trunk
10-A11 the following are correct about rubella except
a- Manifestations are mild
b- Rash Is macular or maculopapular
c- Immune serum globulin is highly protective for a susceptible contact
d- Rash develops within 24 hrs after onset of fever
e- Transmission is by droplet or direct contact
11- A11 the following are common features of congenital rubella
syndrome except
a- Microcephaly
b- Small for dates
c- Cataract
d- Conductive deafness
e- Congenital heart disease
12- How long should rifampicin be given to a household susceptible contact of a
case of meningococcal meningitis
a- Two days
b- Four days
c- One week
d- Two weeks
- 26-
e- Only given if immunocompromised
13- Which of the following manifestations of bacterial meningitis in a 6
month old infant is least likely to be present
a- Fever
b- Neck stiffness
c- Tense bulging fontanelle
d- Poor feeding
e- Irritability
14- All the following are correct about infectious mononucleosis except
a- Most commonly transmitted by Infected saliva
b- Infection in young children is asymptomatic or nonspecific
c- Maculopapular rash occurs in about 5% of cases
d- The course takes 1-3 weeks
e- Throat shows tonsillo-pharyngitis with exudate
15- If a pregnant woman in the first trimester is exposed to a case of
rubella, which of the following actions is recommended
a- Terminate pregnancy
b- Immunise her with rubella vaccine
c- Determine rubella specific antibody titre, if already high or not rising allow
pregnancy to continue
d- Give IM immune serum globulin
e- Observe for several weeks and if she does not develop clinical rubella, then there
will be no risk to the fetus
16- Compared to rubella, measles is characterised by all the following
except
a- Incubation period is longer
b- Fever is higher
c- Prodromal symptoms are severer
d- Prodromal period is longer
e- Complications are more frequent
17-AII the following are correct about mumps except
a- Transmission by droplet
b- Infection is sometimes subclinical
c- Rarely affects the testes before puberty
d- Unilateral nerve deafness is a possible complication
e- Bed rest decreases the risk of complications
18-Characteristic features of faucial diphtheria include all the following except
a- Incubation period is 2-4 days
b- Dysphagia
c- Enlarged cervical lymph nodes
d- High fever
e- Tonsillar dirty greyish membrane
- 27-
19-The usual course of pertussis in a child is characterised by
a- Sudden onset of fever, cough and whooping
b- High fever for 4-5 days followed by cough and whooping
c- Mild cough and fever followed by gradual worsening of cough with development
of whoop
d- Mild cough and fever followed by gradual worsening of cough with development
of whoop and high fever
e- None of the above
20- In a 2 year old child, the three most common bacterial causes of
meningitis are
a- N. meningitides, H. influenzae, Staphylococcus
b- N. meningitides, H. influenzae, S. pneumoniae
c- N. meningitides, Streptococcus, Staphylococcus
d- H. influenzae, S. pneumoniae, E. coli
21-A 10 month old infant has fever 40°C without other signs. On the
4th day a maculopapular rash appears and the fever drops. The most
likely diagnosis is
a- Measles
b- Roseola infantum
c- Rubella
d- Scarlet fever
e- Allergic rash
22-Which of the following is a complication of diphtheria
a- Convulsions
b- Haemolytic anaemia
c- Polyneuritis
d- Transverse myelitis
e- Tetany
23-The rash of scarlet fever is characterised by all the following except
a- Appears within 24 hours of the onset of fever
b- Red finely granular diffuse erythema
c-Tendency to desquamate
d- Face is minimally affected
e-Tendency to spare areas of skin folds such as axillae and groins
24-Which of the following infections is transmitted by faeco-oral route
a- Poliomyelitis
b-Diphtheria
c- Meningococcal meningitis
d- Pertussis
e-Mumps
- 28-
25-AII the following infections may be caused by H. influenzae except
a- Otitis media
b- Pneumonia
c- Septic arthritis
d- Impetigo
e- Meningitis
26-A one month old infant is coming to the outpatient clinic and has
fever 38.9°C starting in the last 24 hours, 0/E she is completely free
and able to feed normally. The mother has had a viral upper
respiratory infection in the past several days. The most appropriate
action is to
a- Give paracetamol drops and monitor at home
b- Arrange for re-examination after 2 days
c- Admit to hospital urgently for investigations and antibiotic coverage
d- Ask for CBC and if normal, reassure mother that baby has viral infection
e- Give oral amoxicillin and monitor at home
- 29-
27-Which of the following is correct about parasitic infestations
a- Enterobiasis usually cause recurrent abdominal pain
b- Ascaris worms inhabit the large intestine
c- Transmission of ancylostomiasis is by faeco-oral route
d- H nana infestation causes iron deficiency anaemia
e- Mebendazole is effective in treating pinworm, roundworm and hookworm
28-AII the following actions towards a susceptible child exposed in the last 48
hours to infectious disease are correct except
a- Mumps: IM Immunoglobulins
b- Measles: immunise immediately
c- H. influenzae meningitis; rifampin orally for 4 days
d- Pertussis: erythromycin orally for 10 days
e- Rubella: nothing can be done
29-A positive tuberculin test in a 9 year old child denotes
a- Immunity to TB
b- Previous infection with TB bacilli
c- TB disease
d- Positivity is due to previous BCG in infancy
e- Positive test >15 mm denotes disease
30-AII the following are characteristic of primary TB except
a- Ghon's lesion in the lung is subpleural in the lower part
b- Draining lymph nodes are always enlarged
c- Haematogenous spread is common
d- Infectivity is high
e- Healing by calcification
31-The major antituberculous drugs are isoniazid (H), rifampin [R],
pyrazinamide (Z), Ethambutol (E) and streptomycin (S). Treatment
regimen of an uncomplicated pulmonary TB in a 6 year old child is
a- HRZ for 6 months
b- HRZ for 2 months then HR for 4 months
c- HZ for 2 months then HR for 4 months
d- HR5 for 6 months
e- HE for 2 months then HZ for 4 months
32-Prednisolone is indicated in all the following cases of TB except
a- Miliary TB
b- TB peritonitis
c- TB meningitis
d- TB cervical lymphadenitis
e- TB of mediastinal lymph nodes causing wheeze
33- Which of the following statements about TB is correct
- 30-
a- Tabes mesenterica is almost always caused by bovine bacilli
b- Previous BCG gives no protection against severe TB e.g. TB meningitis
c- Pulmonary Ghon's focus may not be detected radiologically
d- Tuberculin test with induration 18 mm in an adolescent is diagnostic of TB disease
e- In miliary TB tuberculin test is always negative
34-On routine tuberculin testing of an apparently healthy 1 year old
infant who did not receive BCG, the result showed 13 mm induration . The
preferred action is to
a- Repeat the test
b- Do chest x-ray and treat only if result is abnormal
c- Follow up clinically for 3 months for appearance of symptoms and manage
accordingly
d- Give INH chemoprophylaxis
e- Treat as a case of TB disease
35- ALL the following are causes of false negative tuberculin test except
a- Measles
b- Corticosteroid therapy
c- INH chemoprophylaxis
d- Severe TB e.g. miliary TB
e- Severe PEM
36- Which of the following is the least likely indication for admitting
TB patient to hospital
a-Young infant
b- Loss of weight in a 10 year old child therapy
c- Doubtful compliance
d-TB pneumonia
e- During corticosteroid
37-ALL the following anti TB drugs have the correct stated role except
a-Isoniazid: always used in all cases
b-Streptomycin: used in selected cases in initial phase
c- Ethambutol: used in selected cases after 8 years of age
d-Pyrazinamide: only used in severe cases
e- Para amino salysilic acid: not used now
38-Which drug is not a suitable chemoprophylaxis
a-Acute bacterial meningitis (undetermined cause): cotrimoxazole
b-Malaria; chloroquine
c-TB: isoniazid
d- Pertussis: erythromycin
e-Infective endocarditis; amoxacillin
39- A 2 year old child presents with fever and rash, all the following
questions to the mother are helpful to reach the diagnosis except
a- Does the fever respond to antipyretics
- 31-
b- Is there sore throat
c-Is there history of recent contact to one of the specific exanthemata
d-Is there associated runny nose, sneezing and cough
e- When the rash appeared after the onset of fever
40-ALL the following are complications of bacterial meningitis except
a- Acute adrenal failure with circulatory collapse
b- Subdural effusion
c- Arthritis
d- Hydrocephalus
e- Gastro intestinal haemorrhage
41- Which of the following means of transmission is not the main one
for the corresponding infection
a- Abdominal TB: ingestlon of contaminated milk
b- Botulism: eating improperly canned food
c- Hepatitis B: parenteral
d- Rubella: droplet
e- Cholera: feco-oral
42- Which statement about Koplik's spots in measles is correct
a- Appears with the onset of the rash
b- Appears with the onset of fever but disappears with the onset of rash
c- Similar to (b) but only in severe cases
d- Appears with the onset of fever and continues during the period of rash
e- Giving antibiotics may hinder the appearance of Koplik's spots
43- A 3 year old child has cough for 2 weeks, pertussis is likely to be
diagnosed by
a- Culture of throat swab
b- Blood culture
c- Chest x-ray
d- Auscultation of the chest
e- History
44- ALL the following are correct about poliomyelitis except
a- The polio virus is one of the enteroviruses
b- The period of infectivlty is 6-8 weeks
c- About 50-60% of polio infections are silent
d- Feco-oral route Is the main method of transmission
e- The incubation period is 7-14 days
45- AII the following are correct about enterica except
a- The spleen is mildly enlarged and soft
b- In children less than 5 years the disease Is milder
c- Intestinal haemorrhage is among the complications
d- Rash in form of macular spots appears in first 2 days of illness
e- Disorientation and lethargy is common In the second week of illness
46- All the following are correct about food poisoning except
- 32-
a- The incubation period of salmonella food poisoning is 12-24 hours
b- Gastrointestlnal manifestations are minimal in butolism
c- A boll in a finger of food handler is a common source of staphylococUK food
poisoning
~flB
d- The incubation period of staphylococcal food poisoning Is 2-3 days
e- In salmonella food poisoning antibiotics are not needed
47- All the following are correct about ancylostomiasis (hoohworn)
a- Infection is through ingestion of food contaminated with infective larvab- Migration through the lungs is part of the life cycle
48-All the following are corn
a- Infection is through ingestion of food contaminated with eggs
b- Most cases present with recurrent abdominal pain
c- Larvae migrating through the lungs may cause transient pulmonary symptoms
d- Occasionally worms are seen in the stools
e- Faecal smear usually shows ascans ova
49- A11 the following children should be suspected of having a defect in the
immune system except
a- Varicella with unusual severity
b- Brain abscess without a predisposing cause
c- Eight attacks of common cold with fever, one of them complicated by pneumonia
in few months period
d- Three episodes of pneumonia at different sites in one year.
e- An attack of bacterial meningitis and 2 months later an attack of
osteomyelitis
50- Who of the following children should be suspected of having a
defect in the immune system
a- Bronchiectasis in the right lower lobe
b- Chronic otitis media
c- Pneumonia not responding to adequate doses of broad spectrum antibiotics
d- Repeated tonsillitis with almost continuous nasal discharge
e- Pneumocystis carinii pneumonia
51- All the following children may have acquired immune deficiency
Except
a- Pulmonary TB
b- Kwashiorkor
c- Acute leukaemia under chemotherapy
d- Minimal change nephrotic syndrome
e- Prolonged use of corticosterolds
52- Regarding diphtheria which of the following statements is correct
a- The main line of treatment is daily injection of antldlphthentic serum
b- Blood culture is negative
c- Albumlnuria is an unusual finding
d- Myocarditis Is only a late complication
e- Cervical lymph node enlargement is minimal
- 33-
(10)Digestive system
Read carefully and choose ONE best- answer:
1-All the following conditions can be associated with stomatitis
a- Measles
b- Acute leukaemia
c- Uraemia
d- Agranulocytosis
e- Vitamin A deficiency
2-Which of the following symptoms would suggest the diagnosis of functional
abdominal pain
a- Pain awakening the child from sleep
b- Pain associated with vomiting
c- Pain radiating to the back
d- Pain located penumbilically
e- pain responding to anti-spasmodic
3- A11 the following are possible causes of ascites ejccfiot
a- Nephrotic syndrome
b- Lymphatic obstruction
c- Kwashiorkor
d- Malignancy
e- Portal hypertension
4- Which of the following is not a cause of recurrent abdominal pain
a- Oxyuriasis
b- Familial Mediterranean fever
c- Sickle cell anaemia
d- Lead poisoning
e- Diabetes mellitus
5- Which of the following is a more frequent cause of recurrentabdominal pain
a- Chronic appendicitis
b- Functional abdominal pain
c- Lead poisoning
d- Lactose intolerance
e- Giardiasis
- 34-
6-A11 the following are among the causes of haematemesis except
a- Swallowed blood from bleeding gums
b- Corrosive ingestion
d- Reflux oesophagitis
e- Intussusception
7- A 3 month formula fed old infant has vomiting after feeds starting few weeks
after birth and continuing till now. At 1, 2, 3 months of age, his weight for age is
always around 25-30 percentiles. Your actions should be
a- Reassure the mother and continue weight follow up
b- Use half strength formula for 1-2 weeks
c- Change the formula to the low fat type
d- Use metoclopramide suppositories
e- Ask for barium follow through
8- A 9 year old girl presents with vague abdominal pain, loss of weight and
anorexia for several months. 0/E the weight for length is markedly below 5th
percentile, the temperature is 37.6°C, abdominal examination reveals some
generalized rigidity but no organomegaly. The chest is clinically free. The most
likely diagnosis is
a- Heavy ascaris infestation
b- Chronic appendicitis
c- Chronic lead poisoning
d- TB peritonitis
e- Peptic ulcer
9- All the following are correct about mouth lesions except
a- The exact aetiology of aphthous stomatitis Is unknown
b- Tongue tie usually does not interfere with speech
c- Thrush is common among normal infants up to 2 years of age
d- Herpetic gingivo-stomatitis usually causes high fever
e- Some B complex vitamins deficiency may cause stomatitis
10- A young boy presents with history of vomiting, abdominal pain and dehydration
and is lethargic. Which of the following tests would you do first?
a- Abdominal ultrasonography
b- Blood glucose
c- Lumbar puncture
d- WBC and differential count
e- Chest x-ray
11- Hypertrophic pyloric stenosis is not characterised by
a- The onset Is usually at age of 2-3 weeks
b- The infant takes feeds well
c- It is more frequent in males
d- The vomitus usually contains bile
e- Constipation with small green stools is frequent
12- All the following are characteristics of functional constipation except
- 35-
a- Onset at 3-6 years of age
b- Normal weight gain
c- Moderate to marked abdominal distension
d- Rectal examination reveals a loaded rectum
e- Anal tone is decreased
13- All the following are correct about intussusception except
a- Between the attacks of colicky pain the infant appears not distressed
b- The presence of blood and mucus in the stools
c- A mobile sausage-shaped mass is usually palpated in the abdomen
d- It usually occurs in the first 2 years of life
e- The affected infant is usually under weight
14- A child aged 12 years presents with history of recurrent episodes of fever and
abdominal pain associated with joint pains without swelling. An episode lasts about
48 hours. Between the attacks the child is completely free. The most likely diagnosis
is
a- Familial Mediterranean fever
b- Rheumatic fever
c- Functional abdominal pain
d- Renal stones
e- Chronic appendicitis
15- A 6 year old child has 2 day history of colicky abdominal pain, low grade fever
and bleeding per rectum. 0/E purpuric rash on buttocks and lower extremities is
observed but no abdominal tenderness. The likely diagnosis is
a- Ruptured typhoid ulcer
b- Henoch-Schoenlein Purpura
c- Food allergy
d- Intussusception
e- Amoebic dysentery
16- All the following are correct about Hirschsprung disease except
a- There is failure to thrive
b- Abdominal distension is present
c- The rectum is empty
d- Anal tone is increased
e- Faecal soiling is frequent
17- A 2 year old child presents with a 2 day history of painful ulcerative lesions of
the mouth with fever. o/E she is irritable, temperature 39°C, mouth shows
numerous erythematous ulcerative lesions on the buccal mucosa, gums and tongue.
No other abnormality was detected. The most likely diagnosis is
a- Herpetic gingivostomatitis
b- Monilial stomatitis
c- Aphthous stomatitis
d- Acute leukaemia
e- Infectious mononucleosis
- 36-
18- 2 month old infant has a moderate size umbilical hernia. The
defect only admits one examining finger. The appropriate next step in management
would be
a- Order thyroid function tests
b- Obtain ultrasound abdominal scan
c- Advice the parent that the defect will close spontaneously
d- Instruct the parents how to strap the defect
e- Refer the infant to surgeon
19- An 8 year old girl has faecal soiling for several years. She is reluctant to discuss
the problem but denies any associated illness or abdominal pain. Her general
health and school performance have been good. O/E left sided mass. Rectal
examination reveals a large impaction of fecal mass. Most likely diagnosis is
a- Intra-abdominal malignancy
b- Acquired megacolon
c- Hirschsprung disease
d- Hypothyroidism
e- Psychiatric dysfunction
20-Coeliac disease is characterised by all the following egcept
a- Unresponsive anaemia
b- Stools are foul smelting, greasy and pale
c- Abdominal distension
d- Autosomal recessive inheritance
e- Poor appetite
21- Which of the following is least useful sign in assessing the degree of
dehydration in a case of diarrhea?
a- General condition: well, irritable or lethargic
b- Thirst: drinks normally, poorly or inability to drink
c- Sin pinch goes back; normally, slowly or very slowly
d- Eyes; normal or sunken
e- Mouth and tongue: moist, dry or very dry
22- A nine months old infant was healthy until developed diarrhea 3 weeks ago.
Stools are watery but sometimes contain mucus. She has anorexia and seems to lost
weight. She was weaned from breast milk to buffalo milk 6 weeks ago- What is the
type of diarrhea?
a- Acute diarrhea
b- Persistent diarrhea
c- Chronic diarrhea
d- Dysentery
e- Allergic diarrhoea
23- Factors increasing the risk of acquiring diarrhoea do not include
a- Bottle feeding
b- Storing cooked food at room temperature
c- Measles
d- Failing to wash the hands before preparing the infant's food
e- Failing to wash the breast before breastfeeding
- 37-
24- Giving soft drinks during diarrhoea increases its severity due to
osmotic effect and may lead to
a- Hypokalaemia
h- Hyperkalaemia
c- Hyponatraemia
d- Hypernatraemia
e- Acidosis
25- Giving trimethoprim sulfamethoxazole will most likely shorten the course of
diarrhoea caused by
a- Salmonella
b- Campylobacter
c- Shigella
d- Staphylococci (food poisoning(
e- Cryptosporidium
26- An infant aged 4 months weighing 6 kg has watery diarrhea for 2days. Eyes are
sunken and he is irritable and eager to drink. The
amount of ORS needed to rehydrate the infant in 4 hours is
a- 250 ml
b- 450 ml
c- 650 ml
d- 850 ml
e- 1050ml
27- All the following are correct about persistent diarrhoea
a- It causes about 35% of diarrhoea related mortality
b- The case fatality rate is about 15%
c-Not all cases require hospital admission
d- Simple sugars e.g. sucrose are better tolerated than starch
e-Yoghurt in place of animal milk is preferable
28-Ringer's lactate is the IV fluid of choice for correction of severe
dehydration, the next suitable alternative is
a- Glucose 5%
b- Glucose 5% with added potassium
c- Normal saline
d- Half normal saline
e- Glucose saline 1:1
29-The main reason for selection of Ringer's lactate for IV correction
of severe dehydration is
a- It causes less load on the heart
b- It contains less sodium to avoid hypernatraemia
c- It provides carbohydrate (lactate) to prevent hypoglycaemia
d- It corrects the fluid deficit more rapidly
e- It corrects acidosis and provides some potassium
30-Hypokalaernia in a case of diarrhoea is manifested by
- 38-
a- Abdominal distension and may be paralytic ileus
b- Deep rapid breathing
c- Muscular rigidity
d- Restlessness
e- Convulsions
31-AII the following are correct about diarrhea and dehydration except
a- A patient suffering from acute diarrhoea is more likely to die than a
patient with persistent diarrhoea
b- Irritability is a sign of some dehydration
c- The level of serum sodium does not affect the treatment plan
d- Rota virus causes secretory diarrhoea
e- Palpation of anterior fontanelle is less useful in assessing dehydration
32-A child aged 14 months weighing 10 kg and is Formula fed with
other complimentary foods developed watery diarrhea for 2 days.
0/E eyes are sunken, skin pinch goes back slowly and there is eagerness to drink.
Temperature is 38°C. The following statementsare correct about treatment except
a- Antibiotics are not required
b- Rehydration by ORS solution 750 ml by cup and spoon
c- The rehydration phase takes about 4 hours
d- The same formula is continued after rehydration with same concentration
e- Admission to hospital is required
33-The preferable way to stop vomiting in a child with diarrhoea is
a- Give IV fluid therapy immediately
b- Stop oral feeding
c- Give ORS solution slowly
d- Give chlorpromazine drops
e- Give metochlopramide injection
34-The function of glucose in ORS is to
a- Act as source of energy
b- Promote sodium absorption
c- Increase the shelf life of ORS packets
d- Prevent hypoglycaemia
e- Improve the taste
35-A six month old infant has diarrhea for 3 days. Stools are watery
with mucus and has bad odor. Vomiting occurred 3 times in the last
6 hours. Skin pinch goes back normally, eye are sunken and the child
drinks normally. Temperature is 38.2°C. Which is the suitable
management plan
a- Give OR.S solution by NGT
b- Plan B without antibiotics
c- Plan B with antibiotics
- 39-
d- Plan A without antibiotics
e- Plan A with antibiotics
36-The base present in ORS to correct acidosis is
a- Bicarbonate
b- Lactate
c- Citrate
d- Acetate
e- None of the above
37-You are working in a primary health care facility and an infant aged 9 months
presents with diarrhea for 2 days. All the following are indications to give
antibiotics except
a- Stools are offensive with mucus and there is severe dehydration
b- Bloody diarrhoea with no signs of dehydration
c- Accompanied by cough and respiratory rate 57/minute
d- Accompanied by cough and respiratory rate 44/minute with chest
indrawing but no wheeze
e- Accompanied by discharging ear in the last 24 hours
38-After successful rehydration of a child aged 17 months suffering
from diarrhea, the advice to the mother regarding ORS at home is
a- Do not give ORS unless dehydration develops again
b- Give ORS 50-100 ml after each watery stools
c- Give ORS only on demand
d- Do not give ORS for 24 hours and then restart if diarrhoea is still present
e- Give ORS 100 ml/kg/24 hours
39-Adding sugar to ORS solution may lead to
a- Hyperglycasmia
b- Abdominal distension
c- Increased vomiting
d- Acidosis
e- Increased diarrhea
40-An infant aged 7 months has diarrhoea for 2 days, eyes are sunken, skin pinch
goes back slowly, he is eager to drink but is calm. The weight loss due to
dehydration is
a- 2-4%
b- 5-9%
c-10-12%
d- > 12%
e- None of the above
41-A11 the following are indications to treat a case of persistent
diarrhoea in hospital except
a- Associated protein energy malnutrition
b-Associated pneumonia
c- Presence of dehydration
d- Duration of diarrhoea more than 4 weeks
- 40-
e- Age below 4 months
42- All the following are proper dietary recommendations to a case of persistent
diarrhoea for home management except
a- Give yoghurt
b- Mix the milk with the child's cereal
c- Add vegetable oil to the servings or cooked vegetables
d- Dilute the milk offered with water 1:1
e- Limit animal milk to 50 ml/kg/24 hours
43-Regarding practical aspects of oral rehydration and preparation of ORS
solution all the following are correct except
a- The packet in the Egyptian market is to be dissolved in 200 ml
b- Tap water is usually used without boiling
c- Keeping the prepared solution for more than 3 hours is not recommended
d- Do not give ORS solution after stoppage of diarrhoea
e- ORS solution is given 1 teaspoonful/1-2 minutes
44-A11 the following food substances can promote sodium absorption if
incorporated with the oral rehydration salts except
a- Vegetable oil
b- Sucrose (plain sugar)
c- Maltodextrin (partially digested starch)
d- Cooked rice starch
e- Some aminoacids
45-All the following are correct about chronic nonspecific diarrhoea
a- Usually observed between 6 months and 4 years of age
b- No treatment is required
c- Stools contain mucus and undigested food
d- Growth is unaffected
e- Bouts of constipation are sometimes present
- 41-
46-A11 the following foods are contraindicated in coeliac disease except
a- Belila
b- Macaroni
c- Rice
d- Bread (baladi)
e- Bread (fino)
47-All the following are correct about lactase deficiency except
a- It may be caused by drugs containing neomycin
b- More common to develop with acute diarrhoea than with persistent diarrhoea
c- Stools are acidic (low pH)
d- Glardiasis may cause lactase deficiency
e- Amaebiasis does not cause lactase deficiency
48-A11 the following may cause malabsorption except
a- Hirschsprung disease
b- Giardiasis
c- Gluten sensitivity
d- Cholestatic jaundice
e- Massive intestinal resection
- 42-
(11) Hepatology
Read carefully and choose ONE best- answer:
1- All the following are manifestations of liver disease except
a- Caput medusae
b- Spider naevi
c- Clubbing
d- Erythema nodosum
e- Palmar erythema
2- All the following are correct about laboratory investigations of jaundice except
a- In haemolytic jaundice urine does not contain bilirubin
b-In hepatocellular jaundice stools are always normal coloured
c- Urobilinogen is not present in urine in cholestatic jaundice
d-In hepatocellular jaundice both conjugated and unconjugated bilirubin are raised
e- In haemolytic jaundice ALT and AST are normal
3- All the following agents can cause hepatitis as part of systemic disease except
a- Human immunodeficiency virus (HIV)
b- Epstein Barr virus
c- Toxoplasma gondii
d- Cytomegalovlrus
e- Herpes simplex virus
4- All the following are correct about viral hepatitis
a- HAV and HEV are transmitted by faeco-oral route
b- HBV can be transmitted by sexual contact
c- HBV and HCV can predispose to hepatocellular carcinoma
d- HAV has the shortest incubation period among the hepatotropic viruses
e- HAV vaccination should be avoided In patients with chronic hepatitis C
5- Which of the following individuals is least likely to develop hepatitis B if not
protected by vaccination
a- Children in classroom with a child who is a hepatitis B carrier
b- Infants born to women who test positive for HbsAg
c- Children requiring chronic haemodialysis
d- Children with thalassaemla major
e- Technicians working In a blood bank
6- Among the following causes of hepatomegaly which of them has the least sizable
liver
a- Right sided heart failure
b- Glycogen storage
c- Thalassaemia major
d- Gaucher's disease
e- Advanced cirrhosis
7- Cholestatic jaundice is characterised by all the following except
a- Conjugated hyperbilirubinaemia
b- Pale coloured stools
- 43-
c- Billrubinuria
d- Increased urobillnogen in urine
e- Raised serum alkaline phosphatase
8- Mother of a healthy full term infant is hepatitis B carrier. Which of the
following actions is most appropriate for the newborn
a- Administer I" dose of hepatitis B virus (HBV) vaccine only
b- Administer 1st dose of HBV vaccine with hepatitis B immunoglobulin
c- Administer hepatitis B immunoglobulin only
d- Explain to the mother that nothing is required
e- Studying the Infant serology at age of 2 weeks and art accordingly
(12) Respiratory System
Read carefully and choose ONE best- answer:
1- Definition of stridor is
a- Soft musical noise when the child breathes out
b- Harsh sound when the child breathes in
c- Cracking sounds over the lungs when the child breathes in
d- Short rough sound that the child makes at beginning of expiration
e- None of the above
-2- All the following are correct about acute laryngotracheo-bronchitis except
a- Almost all cases are of viral aetiology
b- Nebulised epinephrine will reduce the severity of airflow obstruction
c- Manifestations develop following few days of upper respiratory catarrh
d- Mist therapy is usually helpful
e- Irritability should be relieved by mild sedation
3- All the following disorders are usually associated with cough except
- 44-
a- Inhaled foreign body
b- Acute laryngotracheobronchitis
c- Epiglottitis
d- Asthma
e- Pneumonia
4- Croup is
a- A term describing several acute Infections of the larynx and trachea
b- A harsh Insplratory crowing sound due to laryngeat or tracheal obstructwn
c- A harsh sound during sleep due to enlarged adenoids
d- A term describing allergic disorders of upper respiratory tract
e- A harsh expiratory sound due to narrowing of large bronchi
5- A 3 year old girl is brought to hospital after choking while eating
peanuts. She was wheezing for several minutes but is now asymptomatic. Which
statement is correct?
a- A chest x-ray has no value because a peanut is not radio-opaque
b-Discharge home without investigation if she remains asymptomatic for 24 hours
and physical examination remains normal
c- The risk of lung damage is less because the inhaled material is organic
d-Presence of unilateral auscultatory wheeze supports a diagnosis of v
Inhaled foreign body,
e- Bronchoscopy is rarely indicated
6-Deviation of trachea and mediastinum to the right may be caused by
a- Left lower lobe consolidation
b- Cardiomegaly
c- Hypoplastic right lung
d- Congenital right middle lobe emphysema
e- Right pleural effusion
7-Which of the following statements about acute respiratory infections in infants
and children 2 months to 5 years is correct
a- Sinusitis is a common complication of common cold
b- Staphylococci are among the most common causes of pneumonia
c- S. pneumoniae and H. influenzae are among the most common causes of acute
otitis media
d- Bronchitis is commonly of bacterial origin
e- In common cold, appearance of thick greenish discharge is an indication to give
antibiotics
8-Among the causative agents of pneumonia after the age of 5 years the commonest
is
a- Mycoplasma
b- S. pneumoniae
c- Beta haemoiytic streptococci
d- Kfebslella
e- None of the above
9-All the following are correct about acute respiratory tract Infections in the first 5
years of life except
- 45-
a- On average each child may have 5-8 episodes per year
b- Pneumonia is the commonest cause of death in this age group
c- Fever does not increase significantly the respiratory rate
d- In a one year old child with cough and fever 39°C of 2 days duration the
commonest cause Is pneumonia
e- Signs of pneumonia are less marked in a severely malnourished child
10- A previously well 3 year old child is presenting with a 2 day history of coryzal
symptoms and a one day history of cough productive of sputum. Physical
examination reveals rhinorrhoea, low grade fever, respiratory rate 3 2/minute, but
no other abnormalities. Which statement is correct?
a- The commonest cause of these symptoms would be acute bronchitis
b- The presence of cough following viral infection makes the diagnosis of
asthma likely
c-The picture is suggestive of early bronchlolltis
d- Production of sputum implies secondary bacterial infection
e- An expectorant will be helpful in ameliorating the condition
11- A11 the following are correct about acute bronchiolitis except
a- There is low grade fever
b- It is usually preceded by few days of upper respiratory catarrh
c- If the child Is unable to drink, fluids are safer to give by NGT than by IV
d- Wheezes are usually heard by auscultation
e- Downward displacement of the liver is Indicative of heart failure
12-The cough associated with asthma is least likely to increase or
appear with which of the following
a- Excitement
b- Ingestion of food
c- Exposure to cold
d- Exercise
e- At night
13-Which of the following is a selective p; agonist
a- Cromoglycate
b- Beclomet-hazone
c- Theophylline
d- Terbutallne
e- Ipratropium
14-Which of the following is correct about H. influenzae pneumonia
a- Its incidence increases with age
b- It is unusual In the first 5 years of fife
c- It is only seen in the neonatal period
d- It is the most common cause of bacterial pneumonia in the age period 2 months to
5 years
e- None of the above
15-Cromoglycate used in bronchial asthma has which of the following effects.
a- Prevents asthmatic attacks
b- Helps in liquefaction of sputum
- 46-
c- Prolongs the bronchodilator effect
d- Improves oxygenation
e- Counteracts anxiety
16-All the following are correct about the aetiology of pneumona in children 2
months to 5 years except
a- Bacterial pneumonia comprises about 70% of cases
b- S. pneumoniae is the most common cause of bacterial pneumonia after 2
months of age
c- Lobar pneumonia is almost always caused by S. pneumoniae
d- Respiratory syncytial virus is among the common causes of viral pneumo
e- Same lobe recurrent pneumonia may be caused by Immunodeficiency
17-All the following conditions may cause haemoptysis except
a- Primary pulmonary tuberculosis
b- Whooping cough
c- BronchiectasiS
d- Mitral stenosis
e- All of the above
18- All the statements are correct about bronchial asthma except
a- prophylactic therapy is required between thr attacks for all cases
b- Whooping cough
C- Bronchiectasis
d- Mitral stenosis
e- All of the above
19- Which of the following signs are compatible with pneumothorax
a- Breath sounds are heard more louder on the affected side
b- Dull percussion on the affected side
c- Increased vocal resonance on the affected side
d- The trachea is deviated to the other side
e- The unaffected side moves less
20- All the following statements are correct about acute bronchiolitis except
a- Most cases are seen In the first year of life
b- It is more frequent in winter
c- Cough Is marked and may be paroxysmal
d- Wheezes are often but not always present
e- Respiratory distress is more marked than auscultatory findings
21- Which of the following signs denote severe asthmatic attack in a 4
year old child
a- Respiratory rate: 42/minute
b- Heart rate 100/mlnute
c- Generalised wheezes
d- Air entry decreased
e- Wheezes are expiratory
22- All the following are correct about lobar pneumonia except
- 47-
a- Usually occurs in previously healthy children
b- Fever is almost always present
c- It is sometimes of viral origin
d- Blood culture may be positive in 10-15% of cases
e- Most cases are treated at the outpatient level
23- In taking history about an acute respiratory illness in a 10 month
old infant which question is least informative
a- Is the cough productive?
b- Is the infant able to feed normally?
c- Is fever present?
d- Does the infant appear dyspnoeic?
e- Are there any previous simitar attacks7
24- All the following are correct about management of epistaxis except
a- Cold compresses on the nose
b- Leaning backward with compression of the nose between thumb and index finger
c- Local application of 1% neosynephhne
d- Anterior nasal pack in persistent cases
e- Cautery in some recurrent cases
25- All the following are correct about acute upper respiratory tract
infections except
a- Sinusitis is uncommon In young children
b- Most cases of tonsillitis are of viral aetiology
c- Adenoids slowly atrophy after the age of 5 years
d- Oral amoxicillin Is effective in treating acute otitis media In most cases
e- The upper respiratory tract comprises the nose, sinuses, throat, ear and
larynx
26- A 2 year old child has 3 hour history of cough, choking, stridor,
wheezing sternal retractions. Chest x-ray at time of admission revealed normal
findings. She is afebrile. Despite 6 hours of therapy
appropriate for croup, her condition is deteriorating. The most likely
diagnosis is
a- Asthma
b- Epiglottitis
c- Laryngeal foreign body
d- Bronchlolltis
e- Pneumonia
27- A 2 year old child is coming to the emergency department for noisy breathing
for the last 2 days. The condition started by fever, cough and runny nose. Then
breathing became noisy with a loud sound during inspiration. He is able to eat and
drink. 0/E there is mildmrespiratory distress with a loud inspiratory stridor but the
child is alert and afebrile. Breath sounds are normal with no wheeze. Which of the
following organisms is the most likely cause.
a- H. influenzae
b- Para Influenza virus
c- Respiratory syncytial virus
- 48-
d- Group A streptococcus
e- S pneumoniae
(13) Cardiology and ECG
Read carefully and choose ONE best- answer:
1- Characteristics of a normal heart include all the following except
a- Apex beat at the 5th intercostals space at MCL at 3 years of age
b- Heart rate around 100 at 2 year of age
c- Right axis deviation at 18 months of age
d- Heart rate accelerates during inspiration
e- Pulmonary component of 82 is loud
2- All the following about innocent murmurs are correct except
a- Change with position
b- Soft, musical
c- Midsystolic
d- Mainly heard at the apex
e- Easily heard after exercise
3- All the following are among the usual manifestations of congestive
heart failure in infancy except
a- Breathlessness on feeding
b- Fast breathing
c- Enlarged tender liver
d- Forehead sweating
e- Lower limbs oedema
4-Cardiac involvement with heart failure may occur in any of the
following except
a- Thiamine deficiency
b- Pellagra
c- Diphtheria
d- Thalassaemia major
e- Duchenne muscle dystrophy
5- All the following signs of RV hypertrophy are correct except
a- Epigastric pulsation
b- Apex beat is slapping in character
c- Apex beat Is shifted downwards and to the left
d- Left parasternal heave
e- Dullness by light percussion on the lower right part of the sternum
6- The signs and symptoms of an infant with moderate VSD include All the
following except
a- Tachypnoea and dyspnoea
b- Feeding difficulties
c- Slow growth
d- Recurrent pulmonary infection
e- Intermittent cyanosis
7-In VSD the murmur Is
- 49-
a- Continuous
b- Harsh pansystolic
c- Rumbling mid-dlastofic
d- Soft early diastolic
e- Variable
8-Aortic stenosis is characterised by all the following except
a- Isolated aortic stenosis is almost always congenital
b- Systolic thrill
c- Lv hypertrophy
d- Water hammer pufse
e- Harsh ejection systolic murmur
9- A11 the following are among the causes of clubbing except
a- Pericarditis
b- Biliary cirrhosis
c- Bronchlectasis
d- Transposition of great arteries
e- Infective endocarditis
10-Central cyanosis is characterised by all the following except
a- Clubbing
b- Polycythaemia
c- Cold extremities
d- Oxygen Inhalation does not cause improvement of cyanosis
e- Difficult to develop in anaemic individuals.
11- All the following are correct about congenital heart disease except
a- Ten to 15% have additional noncardlac congenital anomalies
b- Ten to 15% have multiple cardiac defects
c- Always associated with murmur
d- May be asymptomatic
e- VSD is the commonest congenital cardiac defect.
12-All the following are correct about heart sounds except
a- S1 Is louder than normal In mitral stenosis
b- Splitting of S-z in the pulmonary area denotes pulmonary hypertension
c- S3 Is a normal finding and heard in early diastole
d- S4 Is an abnormal sound heard just before Si
e- Gallop rhythm is usually heard In heart failure with tachycardia
13-Peripheral cyanosis of the hands and feet are observed in
a- Some normal newborns
b- Aortic stenosis
c- ASD
d- VSD
e- Multiple extrasystoles
14- All the following are correct about Pallet's tetralogy except
a- The heart appears small in x-ray
- 50-
b- Cyanosis develops few months after birth
c- There is RV hypertrophy
d- Hypercyanotic spells are common
e- Heart failure usually develops In mid childhood
15-Water hammer pulse is a sign associated with all the following except
a- Aortic regurgitation
b- PDA
c- Severe anemia
d- Large VSD
e- Thyrotoxicosis
16- All the following are correct regarding Eisenmenger's syndrome except
a- It is a complication of VSD, ASD or PDA
b- It causes central cyanosis
c- It is associated with pulmonary hypertension
d- It induces polycythaemia
e- It is an Indication for surgical repair of the cardiac defect
17-All the following are correct about PDA except
a- Many cases close spontaneously in childhood
b- It is more frequent in females
c- There is machinery murmur
d- Usually the LV is hypertrophied
e- Chest x-ray shows plethoric lung
18- Severe exercise is particularly dangerous in
a- PDA
b- Aortic stenosis
c- Mitral stenosis
d- Mitral regurgitatlon
e- Pulmonary stenosis
19- All the following are correct about ASD (ostlum secondum defect(except
a- Many cases are asymptomatic
b- There Is RV hypertrophy
c- Chest x-ray shows pulmonary plethora
d- The murmur is due to flow of blood through the atrlal defect
e- Spontaneous closure is not expected
20-A11 the following are correct about transposition of the great arteries except
a- It is more common
b- Cyanosis develops within hours or days after birth
c- A loud pansystolic murmur is heard all over the heart
d- There is progressive cardlomegaly
e- If not corrected death usually occurs in the first year erf Vite
21- Polycythaemia is present in
a- PDA
- 51-
b- Transposition of great arteries
c- Coarctation of the aorta
d- Pulmonary stenosis
e- ASD
22-Which of the following meets the diagnostic criteria of rheumatic fever
a- Arthralgia, prolonged P-R interval and positive acute phase reactants
b- Fever, arthralgia, pallor, abdominal pain and raised ESR
c- Fever, large joints pain, raised ESR and ASO >400 units
d- Fever, signs of carditis and prolonged P-R interval
e- None of the above
23-At the apex Carey-Coomb's murmur is
a- Short early diastolic
d- Harsh pansystolic
b- Ejection systollc
e- None of the above
c- Mid-diastollc
24- A child aged 10 years complains of pain in her right knee joint in
the last 24 hours. Two week ago she had a sore throat. She is a tennis
player. Examination reveals swollen, tender, hot knee with effusion
No other abnormality is detected. What will be your action?
a- Give analgesic but not anti-inflammatory (aspirin) medication and wait to clarify
the course of the condition
b- Consider as rheumatic fever and start standard treatment
c- Consider the condition as traumatic and treat accordingly
d- Arrange for ASO, ESR and throat culture and consider the condition as rheumatic fever if
any of these are positive
e- Septic arthritis is suspected, arrange for WBC count and culture of joint aspirate
25- In a 14 year old child with rheumatic mitral stenosis which of tr
following should be restricted or avoided
a- Schooling in cold weather
b- Involvement in sport
c- Yellow fever vaccine for travel to an endemic area
d- Usual salt intake
e- None of the above
26-All the following are characteristic of rheumatic chorea except
a- Sedation is required in severe or incapacitating cases
b- Muscle weakness and hypotonia are present
c- Cardltls.may be associated
d- ESR and CRP are raised
e- It is self limited
27- AII the following are correct about infective endocarditis except
a- Streptococcus viridans is a common causative organism
b- Most cases are left sided
c- It rarely affects a falling heart
d- Long acting penicillin every 2-3 weeks Is protective
e- Fever of any type Is almost always present
- 52-
28- Which of the following is most useful in follow up of rheumatic
activity
a- ECG
b- ESR
c- ASO titre
d- Temperature chart
e- Auscultation
29- All the following are correct about infective endocarditis except
a- Most cases are acute in onset
b- It can occur on top of rheumatic or congenital heart disease
c- Blood cultures are critical for appropriate treatment
d- Poor dental hygiene is an important predisposing factor
e- Treatment requires IV antibiotics for 4-6 weeks
30- A 5 year old child has blood pressure consistently above 95 percentile for age,
which of the following should be investigated first
a- Thyroid function
b- Urinary excretion of vanillyl mandellc acid
c- Kidney and urinary tract
d- Brain CT and or MRI
e- Urinary excretion of aldosterone
31- Long acting penicillin every 3 weeks should be given to patients
with
a- Chronic tonsillitis
b- Recurrent- tonsillitis
c- Rheumatic fever if associated with carditis
d- All cases of rheumatic fever
e- All of the above
(14) Collagen Vascular Diseases
Read carefully and choose ONE best answer
- 53-
All the following are correct about collagen diseases except
a- Autoimmune mechanism Is Involved in the aetiology
b- Vasculitis is an important pathological finding
c- There is overlapping clinical pictures of different collagen diseases
d- More than one body system are usually affected
e- Malignancy is a common complication
2- Arthritis in a common finding in all the following except
a- Acute leukaemia
b- Familial Mediterranean fever
c- von Willebrand disease
d- Henoch Schonlem purpura
e- SLE
3- All the following are correct about JRA except
a- Large joints are rarely affected
b- There is no specific laboratory findings
c- Ophthalmologic evaluation and surveillance are necessary
d- Response to NSAID takes 3-4 weeks
e- Cardiac involvement may occur In systemic type
4- Which of the following collagen diseases is more common in males
a- 5LE
b- Henoch Schdnlein purpura
c- Rheumatic fever
d-JRA
e- Dermatomyosltis
4- An 8 year old child has colicky abdominal pain, oedema of the feet petechial
rash on buttocks and extensor surfaces of arms and legs.
All the following are correct about this condition except
a- Gross bloody stools may occur
b- Urinalysis may show protelnuria
c- Intussusception may develop
d- Thrombocytopenia usually present
e- Complete recovery is expected
6- Which of the following conditions is least likely to be included in the differential
diagnosis of Henoch Schonlein purpura
a- Rheumatic fever
b- Acute poststrept. glomerulonephritis
c- Intra-abdominal surgical condition
d- ITP
e- Infectious mononucleosis
7- A 5 year old girl has had multiple joint swellings for 7 months. She
is slow to move in the morning. She has no rash with mild limitation
of range of motions. The most likely diagnosis is
- 54-
a-Dermatomyositis
b- Rheumatic fever
c-Juvenile rheumatoid Arthritis
d- Henoch-Schoenlein Purpura
e- Septic arthritis
(15) Genito- Urinary system
Read carefully and choose ONE best answer
1- All the following findings in urine denote glomerular origin of
haematuria except
a- Brown smoky urine
b- Red cells
c- Red cell casts
d- Proteinuria
e- Blood clots
2 - All the following are among the causes of polyuria except
a- Chronic renal failure
b- Early phase of acute renal failure
c- Hypercalcaemla
d- Nephrogemc diabetes insipidus
e- Psychogenic
- 55-
3- Which of the following causes of haematuria is of glomerular origin
a- Systemic lupus erythematosus
b- Urinary tract infection
C- Wllms' tumour
d- Infective endocarditis
e- Schistosomlasis
4- Which of the following is not a cause of proteinuria
a- Fever
b- Exercise
c- Kwashlorkor
d- Heart failure
e- Dehydration
5- Poststreptococcal glomerulonephritis is not characterised by
a- Age 3-10 years
b- Smoky or tea coloured urine
c- Hypertension in most cases
d- Marked oedema
e- Complete recovery is expected in 90-95% of cases
6- In acute poststreptococcal glomerulonephritis kidney biopsy is
indicated in
a- Age above 10 years
b- Raised blood pressure
c- Reduced C3
d- Microscopic haematuria after 2 months
e- Moderate albuminuria
7- Causes of haematuria in children include all the following except
a- Wilms' tumour
b- Poststreptococcal glomerulonephritis
c- Minimal change nephrotic syndrome
d- Infective endocarditis
e- Urinary stone
8- Laboratory findings in acute poststreptococcal glomerulonephritis
include all the following except
a- Raised ESR
b- Decreased serum C3
c- Mild normochromic anaemia
d- Proteinuria
e- Increased serum lipids
9- Which of the following about poststreptococcal glomerulonephritis
is correct
a- It occurs mainly in adolescence
b- Haematuria disappears in one to two weeks
c- Raised btood pressure is present in all cases
- 56-
d- Restriction of protein intake is required In all cases
e- Some cases show only asymptomatic haematuria
10- Discoloured urine may be observed in all the following situations
except
a- Rifamplcin treatment
b- Chronic renal failure
c- Beets ingestlon
d- Urates In urine of newborn
e- Haemogloblnuna
11- All the following statements regarding haematuria are correct
Except
a- In presence of casts, haematuria is glomerular
b-Bright red urine that clots usually suggests renal or upper urinary tract
source of bleeding
c- The additional finding of proteinuna suggests renal cause
d- More than S red cells per high power field denote microscopic haematuria
e- It can be a cause of anaemia
12- All the following are usually present in minimal change nephritic syndrome
except
a- Proteinuna
b- Hyperliptdaemla
c- hypertension
d- Hypoproteinaemia
e- oedema
13 - All the following are consistent with minimal change nephrotic
syndrome except
a- Onset: is usually between 2 and 8 years of age
b- Pathological renal changes are seen only by electron microscopy
c- Kidney functions are normal
d- Decreased C3
e- Absent haematuria
14- The following statements about minimal change nephrotic
syndrome are correct except
a- Restriction of protein intake Is required
b- There is increased susceptibility to infection
c- Most cases are steroid responsive
d- Some cases are steroid dependent
e- Ultimate recovery is expected
15- The following statements about urinary tract infection are correct except
a- E. coli is the commonest causative organism
b- Symptoms are nonspecific in infancy
c- Chronic constipation is a predisposing factor
d- In infancy. It is more common in girls
e- Cotnmoxazole is usually the antibiotic of choice
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16- Seizures occurring in poststreptococcal glomerulonephritis are
most likely the result of
a- Hypocalcaemia
b- Raised blood urea nitrogen
c- Cerebral thrombosis
d- Hyponatraemia
e- Hypertension
17- In a 2 year old child potyuria is considered if urine volume in ml
per 24 hours exceeds
a- 300
b- 700
c-900
d- 1100
e- None of the above
(16) Haematology
Read carefully and choose ONE best answer
1- Iron deficiency anaemia can be caused by all the following
a- Bone marrow infiltration
b- Prolonged exclusive breastfeeding
c- Chronic diarrhoea
d- Low birth weight
e- Ancylostomlasis
2- Which of the following is least necessary for red cell production
a- Folate
b- Vitamin C
c- Thyroid hormones
d- Calcium
e- Iron
3- All the following can cause hypochromic anaemia except
a- Iron deficiency
b- Thalassaemla major
c- Lead poisoning
d- Thalassaemia minor
e- G6PD deficiency
4- All the following are manifestations of anaemia except
a- Tiring while feeding in infants
b- Insomnia
c- Anorexia
d- Poor school performance
e- Haemic murmur
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5- A 10 year old girl has had chronic anaemia since infancy that is
characterised by severe hypochromia and microcytosis. Examination
reveals height <5 percent! Ie, hepatosplenomegaly and prominent
facial bones. Which of the following statements is correct
a- Management should include supplemental iron
b- Retlcutocytic count is below normal
c- Haemochromatosis is a likely future complication
d- The next pregnancy has 50% chance of being affected
e- Blood smear shows spherocytes
6- A 16 year old girl presents with heavy bleeding in her regular
menstrual cycles. She has history of nosebleeds since early childhood,
No history of joint bleeding or drug intake. Otherwise, she is healthy.
The most likely diagnosis is
a- Haemophilia A
b- Haemophilia B
c- Vitamin K deficiency
d- Idlopathic thrombocytopenic purpura
e- von Wlllebrand disease
7- At 4 year of age all the following haematological parameters can be considered
as normal except
a- Hb >ll g/dl
b- Reticulocytic count 0-2-2% of the total red cell count
c- White cell count 10,000/mm3
d- Polymorphs 70% of the total white cell count
e- No nucleated red cells
8- Haematological investigations in a child with B thalassaemia major reveal all
the following except
a- Normocytic normochromic anaemia
b- Reticulocytosis
c- Increased serum iron
d- Erythroid hyperplasia of bone marrow
e- Raised Hb F
9-All the following are correct about G6PD deficiency anaemia except
a- It is inherited as X-linked
b- Haemolysis can develop after exposure to sulphonamides
c- All types of legumes can precipitate haemolysis
d- During an attack urine is dark red to brownish black
e- There is normocytic normochromic anaemia
10- All the following are correct about sickle cell disease except
a- Most cases seen in Egypt are originating from Aswan and New valley
b- The spleen progressively increases in size with age
c- Sickled red cells tend to stick to capillary walls causing obstruction and infarction
d-.Patient may present with severe joint, muscle and bone pain
e- There is normocytic normochromic anaemia
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11- Which of the following is a more common cause of death in B thalassaemia
major?
a- Renal failure
b- Heart failure
c- Cirrhosis
d- Diabetes mellitus
e- Intestinal obstruction
12- All the following are correct about haemorrhagic disorders except
a- A Normal bleeding time excludes platelets and vascular disorders
b- Joint bleeding suggests a coagulation defect
c- Coagulation time is sensitive in detecting a coagulation disorder
d- Petechiae and mucous membranes bleeding suggest platelets disorders
e- Activated partial thromboplastin time is increased in haemophilia
13- An infant or young child whose spleen is removed following
traumatic rupture has an increased risk of developing
a- Thrombocytopenia
b- Haemolytic anaemia
c- Haemosiderosis
d- Polycythaemia
e- Severe bacterial infection
14- A preponderance of lymphocytes in the differential white cell count is found in
all the following except
a- Pertussis
b- Infants at birth
c- Infants at 3 months
d- Children at 10 years
e- Infectious mononucleosis
15- Which of the following about idiopathic thrombocytopenic purpura is correct?
a- The general condition is usually not affected
b- Most cases are seen after the age of 8 years
c- Treatment essentially involves corticosteroids in all cases
d- The majority have a chronic relapsing course
e- It is usually associated with moderate splenomegaly
16 - Which of the following investigations should be performed as a first step in
diagnosis of a patient with possible haemostatic defect
a- Bleeding time
b- Coagulation time
c- Platelet count
d- Thrombin time
e- Prothrombin time
17- The following are correct about haemophilia A except
a- It is the commonest hereditary coagulation disorder
b- It is inherited as X-linked recessive
c- Bleeding is spontaneous
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d- Patients should not receive aspirin
e- It is caused by factor VIII deficiency
18- Which of the following about B thalassaemia major is correct?
a-Dietary iron deficiency frequently exacerbates the anaemia
b-The interval between blood transfusions should be prolonged as much as
possible to prevent iron overload
c- Anaemia and other manifestations usually appear at one month of age
d- Splenectomy is curative
e- Puberty is commonly delayed
19- Hypersplenism is characterised by all the following laboratory
findings except
a- Reduced number of red cells in the peripheral blood
b- Reduced number of granulocytes in the peripheral blood
c- Reduced number of platelets in the peripheral blood
d- Hypocellular bone marrow
20-All the following are commonly observed in aplastic anaemia
except
a- Increased liability to bleeding
b- Splenomegaly
c- Decreased reticulocytes In peripheral blood
d- Recurrent infections
e- Normocytic normochromic anaemia
21-An 8 year old child was unwell in last 2 days with dyspnoea. Urine
became dark coloured. 0/E: pallor, just palpable spleen, no rash,
normal BP and no other abnormal clinical findings. Lab.: normal
electrolytes, kidney function and platelet count. Hb 6g/dl, WBC
22,000/cmm. Urinalysis: no WBC or R8C. The most likely cause of
discoloured urine is
a- Bllirubin
b- Urobilinogen
c- Haematuna
d- Haemoglobinuria
22-Regarding splenectomy in young children all the following are advisable except
a- The operation should be postponed until 6 years of age
b- Live attenuated vaccines are contra indicated in splenectomised children
c- Use of long term penicillin prophylaxis after the operation is recommended
d- Any febrile illness require immediate medical attention In splenectomised children
e- Splenectomy improves but does not cure thalassaemia major
23-Among the causes of purpura which of the following conditions is
not associated with thrombocytopenia
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a- von Willebrand disease
b- Aplastic anaemia
c- Disseminated intravascular clotting
d- Hypersplenism
e- Acute leukaemia
(17)Oncology
Read carefully and choose ONE best answer
1- The commonest malignancy in infancy and childhood is
a- Wilms' tumour
b- Leukaemia
c- Hodgkin lymphoma
d- Brain tumour
e- Neuroblastoma
2- The following conditions have some association with malignancy
except
a- Down syndrome
b- HIV Infection
c- Infectious mononucleosis
d- Brucellosis
e- Neuron bromatosis
3- Which of the following infectious agents has some association with malignancy?
a- Epstein Barr virus
b- ECHO virus
c- Rubella
d- Mycoplasma
e- Usteria
4-Which of the following is not a common site of malignancy in
paediatrics
a- Brain
b- Bone marrow
c- Adrenal medulla
d- Lymph nodes
e- Spleen
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5-Childhood cancer may present with any of the following except
a- Persistent fever
b- Palpable abdominal mass
c- Bone and joint pains
d- Petechiae and bruises
e- Enlarged tender lymph nodes
6-Regarding malignancy in childhood each of the following tumours
has the corresponding common presentation except
a- Infratentorial brain tumour: recurrent seizures
b- Wilms' tumour: abdominal mass
c- Acute leukaemia: prolonged fever with ecchymosis
d- Non-Hodgkin lymphoma: Abdominal mass with ascltes
e- Hodgkm lymphoma: painless cervical lymphadenopathy
7-All the following are correct about acute leukaemia except
a- Acute lymphocytic leukaemia has better prognosis than acute myelobiastic
b- Sore mouth and throat are common at presentation
c- Infiltration of the CNS may occur
d- It Is excluded If no blast cells are seen in the peripheral blood film
e- By treatment the child Is at grave risk of infection by varicella or measles
8-AII the following are correct about acute leukaemia except
a- Female sex has better prognosis
b- Leucocytic count is always excessively high
c- Anaemia present Is normocytic normochromic
d- Treatment should always be in specialised centre
e- With proper treatment long term survival is more than 80%
9-The following are common manifestations of acute leukaemia except
a- Petechiae and bruises
b- Persistent fever
c- Jaupdice
d- Joint and bone pain
e- Hepatosplenomegaly
10-A11 the following are correct about Hodgkin disease except
a- Painless cervical fymphadenopathy is common mode of presentation
b- Fever (periodic or continuous) is commonly associated
c- Abdominal manifestations are rare
d- TB cervical lymphadenopathy Is an important differential diagnosis
e- Most cases occur before the age of 10 years
11-Hypertension is sometimes observed in
a- Supratentorlal brain tumours
b- Hodgkin lymphoma
c- Non-Hodgkin lymphoma
d- Acute leukaemia
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e- Neuroblastoma
12- AH the following are correct about neuroblastoma excer
a- It has a worse prognosis in the first year of life
b- It may present by mediastinal mass with respiratory distress
c- Abdominal mass is the commonest presentation
d- Metastasis are common at presentation
e- It may be a cause of spinal cord compression
13- All the following are correct about lymphomas except
a- They are the commonest malignancy after 10 years of age
b- Non-Hodgkin lymphoma is slower in growth than Hodgkin lymphoma
c- Periodic fever is sometimes present in Hodgkin lymphoma
d- Commonest presentation in non-Hodgk'n lymphoma is abdominal mass
e- Burkitt lymphoma affects the Jaw
14- All the following are correct about brain tumours except
a- They are the second common malignancy In childhood
b- Headache is characteristically more marked in the morning
c- Two-thirds of brain tumours are supratentonal
d- Cerebellar tumours usually present with ataxia
e- Prognosis is better in older children
15- Congenital anomalies are sometimes associated with
a- Brain tumour
b- Neuroblastoma
c- Hodgkin (ymphoma
d- Wilms' tumour
e- Non-Hodgkin lymphoma
16- A 10 year old girl presents with a 2 day history of fever and a 4 cm warm,
tender and fluctuating cervical lymph node. The most likely diagnosis is
a- Hodgkin disease
b- Acute leukaemia
c-Acute bacterial lymphadenitis
d-TB
e- Metastatic neuro blastema
17- The commonest malignant solid tumour in childhood is
a- Brain tumour
b- Hodgkin lymphoma
c- Neuroblastoma
d- Wilms' tumour
e- Non-Hodgkin lymphom
(18) Endocrine and Metabolic Disorders
Read carefully and choose ONE best answer
1- Type I Diabetes mellitus is characterised by all the following except
a- Majority of cases present acutely
b- Obesity is an important predisposing factor
c- Insulin therapy is always needed
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d- Positive family history Is less common than in type II
e- Islet cells antibodies are present in majority of cases
2- All the following are correct about insulin therapy in uncomplicated type I
diabetes mellitus except
a- Dose Is 0.3-1 U/kg/ day
b- The intermediate acting comprises 2/3 of the dose
c- Majority of patients are managed by twice daily injections.
d- Confinement in bed due to fracture hip needs decrease of the dose
e- Infection needs increase of the dose by 10-15%
3- Hypoglycaemic symptoms include all the following
a- Pallor
b- Irritability and bad behavior
c- Dizziness
d- Tiredness
e- Dry skin
4- All the following are correct about diet in type I diabetes mellitus
except
a- Daily caloric intake of a 6 year old child should be around 1000 Kcal
b- Timing and caloric content of meals and snacks should be fixed
c- The caloric intake should be 50-55% from carbohydrates
d- High fibre food is encouraged
e- Complex carbohydrates are preferable than simple sugars
5- In the management of DKA all the following are correct except
a- The starting IV fluid is saline
b- Regular insulin is given In a dose of 0.1 U/kg/hour
c- Potassium chloride is added after 12-24 hours
d- Drop of blood glucose level should not exceed lOOmg/dl/hour
e- NGT is Introduced to empty the stomach if the patient is in coma
6-All the following are early manifestations of congenital
hypothyroidism except
a- Feeding difficulties
b- Large protruding tongue
c- Large anterior fontanelle
e- Prolonged neonatal jaundice
d- Excessively sleepy
7- All the following are correct about congenital hypothyroidism except
a- Most cases are due to aplasia
b- A case starting treatment at 6 months of age is not likely to be
mentally normal In the future
c- Delay in the screening test for few weeks makes it insensitive
d- The dose of thyroxin per kg decreases with age
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e- Fever and diarrhoea are common manifestations of overdosage
8-All the following are correct about constitutional delay in growth
and puberty except
a- Normal birth size
b- Short stature becomes evident at adolescence
c- Bone age is delayed
d- Height of parents is average
e- Final height is short
9-Which of the following is correct about growth hormone deficiency
a- It is the commonest cause of short stature
b- BMI is below average
c- Birth weight and length are lower than average
d- Infantile body proportions
e- Mentality is below average
10-Children with constitutional delay in growth and puberty can
expect to be ultimately
a- Of normal height and weight
b- Short and obese
c- Short but of proportionate weight
d- Tall but of proportionate weight
e- Tall and obese
11-According to current theory, the most likely cause of insulin
dependent (type I) diabetes mellitus is
a- Chromosomal imbalance
b- An enzyme defect preventing proper action of Insulin
c- Autoimmune destruction of beta cells in the pancreas
d- High carbohydrate diet over a long period
e- Chronic emotional stress
12- In a full term normal weight newborn, thyroid screening tests
carried shortly after birth revealed decreased T4 and increased TSH.
The most likely diagnosis is
a- Congenital hyperthyroldism
b- Congenital hypothyroldism
c- Transient hypothyroidism
d- Secondary hypothyroidism due to hypopituitarism
e- None of the above
13-Manifetations of overdosage of thyroxin in management of hypothyroidism in a
young child may include any of the following except
a- Tachycardia
b- Fever
c- Sleeplessness
d- Diarrhoea
e- Vomiting
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14- All the following are correct about national screening programme for
congenital hypothyroidism except
a- A dry blood spot on filter paper is taken from a prick heel capillary blood
b- The sample is collected from the 3'° to 7th day of life
c- TSH is measured
d- Positive cases should start immediately life long treatment
e- Blood sampling of premature should not be delayed
15- Match the height curves in the figure shown with the most
appropriate diagnosis among the following conditions
a- Acquired hypothyroidism
b- Growth hormone deficiency
c- Precocious puberty
d- Familial short stature
e- Constitutional delay in growth and puberty
16- All the following statement about familial short stature are true
except
a- Growth retardation is present from early childhood
b- Ultimate height is below average
c- The bone age is usually retarded
d- Onset of puberty usually occurs at the normal time
e- The shape of growth curve is normal
17 - All of the following may be manifestations of an insulin reaction
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(hypoglycaemia) in an insulin dependent diabetic patient except
a- Loss of appetite
b- Sweating
c- Lethargy
d- Bizarre behaviour
e- Slurred speech
18- Factors most likely to contribute to the development of diabetic
ketoacidosis include all of the following except
a- Overeating
b- Vomiting
c- Omission of insulin doses
d- Infection
e- Lack of patient education
19- Nutritional obesity may be complicated by all the following except
a- Hypertension and cardiovascular disease
b- Gall bladder disease
c- Type II diabetes mellitus
d- Type I diabetes mellitus
e- Hypercholesterolaemia
20- A 7 year old child has weight for length on the 85 percentile and
his length for age on the 10th percentile, which of the following is the
most likely diagnosis
a- He Is normal
b- Nutritional obesity
c- Nutritional stunting
d- Chronic renal failure
e- Acquired hypotnyroldism
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19 Nervous System
Read carefully and choose ONE best answer
1. A child aged 2 years is brought to the physician because of recent episode of
generalised seizure for the first time. History revealed that the child was crying
excessively then suddenly stopped respiration, then developed cyanosis followed
by a short episode of generalized clonic jerks. The probable diagnosis is
a. Absence (petit mal) epilepsy
b. Grand mal epilepsy
c. Infantile spasms
d. Psychomotor epilepsy
e. None of the above
2. AII the following are correct about absence (petit mal) except
a. Falling does not occur
b. Attack lasts 1-5 minutes
c. The common age is 5-9 years
d. Rarely persists into adult life
e. May cause school failure
3. According to the international classification of epilepsy which of the following
is considered partial seizures
a. Psychomotor (temporal lobe epilepsy)
b. Atonic (akinetic)
c. Absence (petit mal)
d. Infantile spasms
e. Myoclonic
4. Infantile spasms are associated with
a. Normal EEG pattern
b. Responslveness to phenobarbitone treatment
c. Poor neurological and intellectual development
d. d- Hypocalcaemia
e. Abnormality of skeletal muscle metabolism
5. All the following are among the recognized side effects of the corresponding
anticonvulsant except
a. Phenobarbitone: overactivity
b. Phenytoin: gum hypertrophy
c. Sodium valproate: liver dysfunction
d. Ethosuximide: megaloblastic anaemia
e. Clonazepam: drowsiness, behaviour changes
6. Craniosynostosis is characterised by or associated with
a. Delayed closure of the anterior fontanelle
b. Risk of intraventricular haemorrhage
c. Premature closure of cranial sutures
d. Head circumference > 95 percentile
- 69-
e. Deposits of granulomatous tissues in skull bones
7. The drug of choice in status epilepticus is
a. Phenytoin
b. Sodium valproate
c. Phenobarbitone
d. Diazepam
e. Carbamazepine
8. AII the following are characteristic of childhood migraine except
a. Never responds to simple analgesics
b. Positive family history is common
c. Duration of headache often > I hr
d. May be associated with visual disturbances
e. In young children may be replaced by cyclic vomiting
9. The earliest sign of hydrocephalus is
a. Head/chest ratio more than one at 3 months
b. Papillaedema
c. Sun-set appearance of the eye
d. Increasing percentlles of the head circumference curve
e. Head circumference more than 95 percentile
10. Each of the following types of epilepsy has the corresponding drug of choice
except
a. Psychomotor epilepsy: carbamazepine
b. Grand mal: phenobarbitone
c. Myoclonic epilepsy: clonazepam
d. Infantile spasm: ACTH
e. Absence; sodium valproate
11. AII the following are correct characteristics of febrile seizures
a. Age: 9 months to 5 years
b. Normal development
c. Short duration of the episode not exceeding 15 minutes
d. The seizure is of the generalised tonic type
e. Post ictal phase is short in the form of drowsiness
12. A 10 year old girl has weakness in the lower limbs for 3 days. There is no
history of chronic medical condition. 0/E there is symmetrical weakness of
lower limbs with hypotonia and absent reflexes. Which of the following
statements is most consistent with the most likely diagnosis?
a. There is no sensory changes
b. The condition is infectious, isolation is recommended
c. CSF shows increased lymphocytes
d. Residual paralysis is expected in majority of cases
e. Respiratory muscles are never affected
13. An 8 year old boy is noted by his teacher to have brief staring spells throughout
the day. Neurological examination is normal. Which of the following
statements is most consistent with the most likely diagnosis?
- 70-
a.
b.
c.
d.
The patient usually loses bladder control during the event
Staring spells would be expected to last less than 10 seconds each
Postictai period may be prolonged
The child should be protected because falling may occur during the
episode
e. EEG usually shows nonspecific changes
14. A 4 month old girl is noted to have frequent brief jerking episodes with sudden
arm extension followed by flexion of the head. Which of the following
statements reflects the expected outcome?
a. Poor mental development
b. The condition gradually disappears by 2-3 years of age
c. Most cases develop grand mal epilepsy
d. Autism is the expected outcome in majority of cases
e. Generalised hypotonia is an expected outcome
15. A11 the following conditions are usually associated with hypotonia except
a. Chorea
b. Down syndrome
c. Infantile spasms
d. Guillain Barre syndrome
e. Duchenne muscle dystrophy
- 71-
16. A previously healthy 3 year old boy has 3 day history of unsteady gait. No
history of trauma or medications and no other symptoms. 0/E he is well
appearing and afebrile, intension tremors are observed. Which of the following
is the next step in management?
a. Order a head CT scan
b. Order an EEG
c. Obtain CBC, serum electrolytes and glucose
d. Perform a lumbar puncture
e. Reevaluate next day to monitor progress
17. Two hours ago a 2 year old girl had a 5 minute episode of whole body shaking
with fever 39.4°C- She has runny nose and cough for past 24 hours. She now
acts normal except for cold symptoms, Parents say that this is her second febrile
seizure. Physical examination is normal with no focal neurological signs.
Which of the following you recommend?
a. Order head CT scan
b. Order an EEG
c. Begin treatment with phenobarbitone
d. Admit ^he patient to hospital for overnight observation
e. Reassure the parents that only antipyretics are necessary
18. A one year old child has head injury. 0/E she is unconscious but opens her eyes
to pain and also has flexion of extremities to pain. She does not cry but rather
grunts with stimulation. What is her Glasgow coma scale?
a. 4
b. 5
c. 6
d. 7
e. 8
19. The EEG is diagnostic in
a. Grand mal epilepsy
b. Absence seizures
c. Jacksonian (focal) seizures
d. Psychomotor epilepsy
e. Autism
(20) Muscles, Bones and Joints
Read carefully and choose ONE best answer
1. Which statement about Duchenne muscular dystrophy is not correct
a. Cardiomegaly is common
b. The gait is ataxic
c. Early symptom is difficulty in ascending stairs
d. Inheritance is X-linked
e. There no specific treatment
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2. AII the following are correct about achondroplasia except
a. Short extremities especially upper arms and legs
b. Kyphoscoh'osis
c. Mentality is not affected
d. Fingers are short of nearly equal length
e. Inheritance is autosomal dominant
3. Which of the following is correct about toxic (transient) synovitis of the hip
a. Pain may be referred to the knee
b. Age is usually around adolescence
c. WBC count is moderately to markedly raised
d. Fever is moderate to high
e. Antibiotics are required
4. All the following are among the causes of limping except
a. Bone tumour
b. Cellulitis in the foot
c. Rheumatic fever
d. Contracture of Cendo-achilles
e. Gullialn-Barre syndrome
5. All the following are correct about osteomyelitis and septic arthritis except
a. Most cases are seen in infancy and toddler age
b. Fever and leucocytosis are present
c. X-ray is not helpful in early diagnosis
d. Oral antibiotics are required for one week
e. Stapnylococcus aureus is the predominant causative organism
6. A 5 year old boy has waddling gait and prominent calf muscles, Which of
the following studies is likely to aid in the diagnosis
a. Radiograph of the spine
b. Brain CT
c. Serum creatinine phosphokinase
d. Karyotype
e. Nerve conduction velocity
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(21)The Child with Special Needs
Read carefully and choose ONE best answer
1. Which type of cerebral palsy is more likely after kernicterus
a. Spastic hemiplegia
b. Mixed
c. Athetoid
d. Spastic hemiplegia
e. Ataxic hypotonic
2. Early diagnosis of cerebral palsy is important because it permits
a. Genetic counselling to prevent subsequent cases
b. Treatment of underlying lesion and prevention of progression
c. Guidance that may minimise or prevent secondary physical or
emotional problems
d. Prophylactic anticonvulsants to be instituted prior to onset of seizures
e. None of the above
3. Certain conditions may be confused with mental retardation and need to be
carefully excluded. These include all the following except
a. Duchenne muscular dystrophy
b. Autism
c. Deafness
d. Blindness
4. AII the following are characteristic of cerebral palsy except
a. Nonprogressive
b. The cause in most cases is unknown
c. There is disorder of posture and movement
d. Hearing and or visual defects are common
e. Some degree of mental retardation is always present
5. AII the following conditions can lead to below average intelligence or
mental retardation except
a. Congenital hypothyroidism
b. Hypopituitarism
c. Excessive neonatal unconjugated hyperbilirubinaemia
d. Perinatal asphyxia
e. Chronic lead poisoning
6. The management of mentally retarded child includes all the following
except
a. Attention to the associated handicap
b. Stimulating environment at home with suitable play
c. Brain stimulants
d. Suitable schooling according to level of intelligence
e. Emotional support to the family
7. AII the following are correct about cerebral palsy except
- 74-
a. Low birth weight and intrauterine growth retardation are commonly
associated
b. Head circumference is at average or above average range
c. Persistence of Moro reflex is an early sign
d. Seizures are common
e. Some cases are due to postnatal insult
8. The preferred method of management in stuttering is
a. Ask the child to speak slowly
b. Correct the child's speech and ask him to repeat
c. Remove the child from kindergarden for few weeks
d. Give mild sedatives
e. Do not interfere
(22) Sfcm
Read carefully and choose ONE best answer
1. The correct definition of vesicle is
a- A flat circumscribed small pink area
b- A solid elevated pink area <lcm in diameter
c- An elevated lesion <lcm in diameter containing serous fluid
d- An elevated lesion <lcm in diameter containing purulent exudates
e- None of the above
2. Which rash among the following, more likely denotes a nonsystemic
disorder (local skin disorder)
a- Centripetal rash
b- Rash symmetrically distributed in the four iimbs
c- Pleomorphic rash
d- Rash more extensive in one side of the body
e- Any rash with itching
3. AII the following are true about scabies except
a- Always accompanied by itching particularly at night
b- In infants palms, soles and face are usually affected
c- Rash of tiny papules is associated
d- Impetigo may be superadded
e- Benzyl benzoate emulsion is applied to the whole body for treatment
4. AII the following statements about papular urticaria are correct except
a- Usually observed in first few years of life
b- Accompanied with itching in most cases
c- Lesions are more seen In the trunk
d- Vesicles are thick walled
e- Usually recurrent
5. A 7 year old child presents with tender erythematous mauve nodules over
the front of the tibia of few days duration, which of the following
investigations are more helpful in reaching the diagnosis
a- Urinalysis
b- ASOtitre
- 75-
c- Biopsy
d- Liver function tests
e- ESR
6. Which of the following denotes atopy
a- Mild form of asthma
b- Recurrent urticaria
c- Life threatening asthma
d- Hay fever
e- All of the above
7. Which of the following is not a cause of urticaria
a- Impetigo
b- Consumption of eggs
c- Penicillin administration
d- Ascaris infestation
e- Exposure to cold
8. AII the following statements are correct about skin disorders except
a- In moniliasis of the napkin area the gluteal folds are not affected
b- In infantile eczema itching is marked
c- Erythema nodosum is sometimes associated with throat infection
d- Impetigo is caused by staphylococcal or streptococcal skin infection
e- In pediculosis the occipital lymph nodes are usually enlarged
9. The most appropriate and effective initial treatment of infantile eczema in a
6 month old infant is
a- Oral corticosteroids
b- Topical corticosteroids
c- Oral antihistaminics
d- Soy based formula
e- Control of house dust
10. AII the following are correct about erythema nodosum except
a- Fever and arthralgia may be present
b- Lesions may be seen in the pretibial region
c- Lesions are usually tender
d- Lesions may ulcerate in severe cases
e- TB may be an underlying problem
(23)Emergencies, Injuries and Poisoning
Read carefully and choose ONE best answer
1. You are asked to resuscitate a 3 year old child in cardio-respiratory arrest
which of the following is the correct order of steps for the initial
management
a. Open the airway, check the pulse, administer rescue breaths, start chest
compression
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b. Check the pulse, open the airway, start chest compression, administer
rescue breaths
c. Check the pufse, start chest compression, open the airway, administer
rescue breaths
d. Open the airway, administer rescue breaths, start chest compression
check the pulse
e. Open the airway, administer rescue breaths, check the pulse, start chest
compression
2. Burn causes which type of shock?
a. Hypovolaemic shock
b. Septic shock
c. Neurogenic shock
d. Anaphylactic shock
e. Cardiogenic shock
3. AII of the following are correct about anaphylaxis except
a. Most often the exposure to foreign substance is parenteral
b. Symptoms are observed usually within minutes.
c. Chest tightness and wheezing may be observed.
d. Hydrocortisone is a life saving measure
e. Laryngeal oedema is among the main causes of death
4. Contraindications to induction of vomiting in childhood poisoning include
all of the following except
a. Unconsciousness
b. Age younger than 6 months
c. Ingestion of iron tablets
d. Potash ingestion
e. Kerosene ingestion
5. Afl the following specific clinical features of the corresponding poisoning
are correct except
a. Diarrhoea: iron
b. Dilated pupils; organophophates
c. Tachypnoea: salicylates
d. Hypothermia: barbiturates
e. Bradycardia: digitalis
6. AII the following specific antidotes for the corresponding poison are correct
except
a. Paracetamol: acetylcysteine
b. Iron: desferrioxamine
c. Pethidine: nafoxone
d. Isoniazid (71MH); sodium thiosulphate
e. Lead : BAL
7. A 3 year old child is found unconscious in a garden. In the emergency
room he shows wheezing, profuse sweating, bradycardia, fasciculation and
constricted pupils. The best drug therapy is
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a.
b.
c.
d.
e.
Activated charcoal
Atropine
Furesemide and naloxone
Methylene blue and diazepam
Acetyl cysteine
8. The best initial treatment for scald burn is to
a. Apply cold water
b. Apply butter or margarine
c. Only give oral analgesic
d. Debride the wound
e. Cover the burn with bandage
9. Acetylcyteine is antidote for which poisoning
a. Iron
b. Tricyclic antidepressants
c. Inorganic phosphorus
d. Carbamate
e. Paracetamol
10. Regarding emergencies and poisoning which of the following is correct
a. Third degree burns are severely painful
b. Iron poisoning causes constipation
c. Death in drowning may be due to laryngeal spasm causing cerebral
anoxia
d. Choking by foreign body in a 7 year old child is best managed by
strong slap on the back in a 7 year old child
e. Atropine is the antidote for tricyclic antidepressant poisoning
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24 Preventive Paediatrics
Read carefully and choose ONE best answer
1. All the following are correct about screening test except
a. The disease to be screened for should have effective treatment.
b. The test is performed on a large number of individuals
c. It can be carried at any age
d. The disease to be screened for should have serious consequences if left
untreated,
e. If positive, treatment should be started immediately
2. Which of the following screenings for a particular condition is least useful
a. Congenital hypothyroidism
b. Type 1 Diabetes mellitus (presymptomatic state)
c. Sickle cell anaemia
d. Neural tube defect (prenatal)
e. Hearing defect
3. Which of the following is considered primary prevention
a. Anti-D globulin to Rh negative mothers after birth
b. Screening for hypothyroidism at birth
c. Prenatal screening for neural tube defect
d. Long acting penicillin to a child with rheumatic heart disease
e. Screening for anemia
25 Antipyretics And Anti-Inflammatory Agents
Read carefully and choose ONE best answer
1. All of the following are among the complications of NSAID except
a. Reduced platelet aggregation causing bleeding
b. Nephropathy after prolonged use
c. Hepatic injury
d. Fluid and electrolyte imbalance
e. Gastric and intestinal mucosal damage
2. AII of the following are among the complications of prolonged
corticosteroid therapy except
a. Growth retardation
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b. Increased susceptibility to infection
c. Hypertension
d. Hirsutism
e. Excess sodium excretion
3. All the following are recommendations and precautions during prolonged
corticosteroid therapy except
a. High protein diet and calcium
b. Reduce the dose when there is significant infection
c. Low sodium and high potassium diet
d. Periodic monitoring of length/height
e. Dexamethazone is not suitable for prolonged use
4. All of the following are among the indications of corticosteroid therapy
except
a. Bacterial meningitis
b. After organ transplant
c. Acute leukaemia
d. Acute poststreptococcal glomerulonephritis
e. Chronic ITP
5. All the following are correct about corticosteroids except
a. Hydrocortisone has minimal sodium retaining effect
b. Use for up to 5 days has no side effects
c. Dexamethazone has more potent anti-inflammatory effect than
prednisone
d. Cortisone is biologically inert synthetic steroid
e. Beclomethasone inhalation has no systemic absorption
6. Acetyl salicylic acid has limited use as antipyretic, however it is particularly not
recommended in which of the following conditions
a. Influenza
b. Scarlet fever
c. Lobar pneumonia
d. Enterica
e. Malaria
(26) Antibiotics
Read carefully and choose ONE best answer
1. Which of the following antibiotics are not absorbed by the oral route?
a. Clindamycin
b. Penicillin V
c. First generation cephalosporins
d. Aminoglycosides
e. Macrolides
2. Which of the following antibiotics is nephrotoxic
a. Amikacin
b. Chloramphenicol
c. Erythromycin
d. Second generation cephalosporins
e. IV metronidazole
3. Ampicillin and amoxiciUin are characterised by all the following except
a. When given parenterally they reach sufficient concentrations in tissues
including inflamed meninges
b. Broad spectrum semisynthetic penicillins
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c. Solution reconstituted from powder for parenteral use is stable for 24
hrs
d. Inactive against p-lactamase producing staphylococci
e. Amplcillln should be given on empty stomach, absorption of
amoxicillin is not affected by food
4. All the following are the preferable antibiotics for the corresponding
infection except
a. Brucellosis in a 10 year old child: tetracyclines
b. Uncomplicated pneumonia in a one year old child: erythromycin
c. Otitis media; amoxicillin
d. Urinary tract infection: co-trimoxazole
e. Epiglottitis: Chloramphenicol
5. All the following situations are contraindications (or use with caution) for
the corresponding antibiotic except
a. Tetracyclines: below age of 8 years
b. Nitrofurantoin: G6PD deficient individuals
c. Gentamicin; renal disease
d. Cephalosporins; penicillin sensitive individuals
e. Co-trimoxazole: first year of life
6. Prophylactic antibiotics are indicated for susceptible contacts for the
following infections except
a. Diphtheria
b. TB
c. H. influenzae meningitis
d. Pertussis in the first week of clinical picture
e. Scarlet fever
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