Clinical test 1: Pulmonary function testing performed as long-term followup care of pediatric patients treated for parapneumonic effusions reveals which of
the following?
A: Persistent restrictive lung defect
B: Hypoxemia
C: Mild expiratory flow limitation
D: Reduced exercise tolerance from restrictive ventilatory limitations
E: None of the above
Clinical test 2: What organ systems are affected by CF and what are the
clinical manifestations?
A: Pulmonary
B: Gastrointestinal
C: Hepatic
D: Reproductive
E: All of the above
Clinical test 3. A 10-month-old girl has had vomiting and diarrhea for 3 days. She
has not had a wet diaper in 18 hours, her heart rate is 140 beats per minute, her
respiratory rate is 40 breaths per minute, and her blood pressure is 75/35 mm Hg.
Examination shows a minimally responsive infant with cool extremities, 4-second
capillary refill, parched lips, and very sunken eyes. Which of the following best
describes her state of hydration?
A: Mild dehydration
B: Moderate dehydration
C: Severe dehydration
D: Normal hydration
E: Hypervolemic
Clinical test 4. A 5-year-old presents to the clinic with a 1-week history of
vomiting and a 3-day history of abdominal pain. His mother notes a weight loss of
approximately 10 pounds and reports that he has been wetting the bed. Vital signs
are heart rate (HR) 135 beats per minute, respiratory rate (RR) 40 breaths per
minute (deep), and blood pressure (BP) 90/54 mm Hg. He is afebrile and sleepy.
His mucous membranes are dry. Capillary refill is 4 seconds. Heart, lungs, and
abdominal examination findings are normal. Laboratory data include glucose of
560, sodium of 140, potassium 5, chlorides 100, CO2 content 4, BUN 35, and
creatinine 2.0. Arterial blood gas shows pH of 7.02, PCO2 30, PO2 100 on room
air, and HCO3 4. Evaluation of his blood gas values indicates which of the
following?
A: He has a respiratory alkalosis with metabolic compensation.
B: The low pH is due to a high blood sugar.
C: He has metabolic acidosis with inadequate respiratory compensation.
D: His blood gas is within the reference range.
E: He has severe hypoxemia.
Clinical test 5. A child of 3 suddenly fell sick 16 hours ago with a sudden rise in temperature
to 39C and abdominal pain around the umbilicus. There was repeated vomiting and diarrhea.
The general state of the child was severe with a heart rate of 140 per min., muscular rigidity in
the right iliac fossa. What is the most probable diagnosis?
A.
B.
C.
D.
E.
Acute appendicitis
Acute gastritis
Acute gastroduodenitis
Gastroenteritis
Peritonitis
Clinical test 6. Diarrhea has been defined as a probable albeit not constant feature of
acute appendicitis. In which of the following cases is this sign likely to be evident?
A. In the first day of illness
B. In patients with a very high temperature
C. Pelvic position of the vermiform appendix
D. Retroperitoneal position of the vermiform appendix
E. In prolonged illness
Clinical test 7. A child of 2 and a half presented with abdominal pains, emesis and a
high temperature of 37.6C. The physical signs elicited did not point to a diagnosis of acute
appendicitis. What should be the physician’s course of action?
A. Repeat the examination in 12 hrs
B. Repeat the examination in 24 hrs
C. Immediate hospitalization and continuous monitoring
D. Discharge the patient
E. Prescribe an analgesic and antibiotics
Clinical test 8. In which position of the vermiform appendix is the rectal examination
most informative?
A. Retrocecal
B. Pelvic
C. Postileal
D. Medial
E. Paracecal
Clinical test 9. Which of the following signs is the most useful in diagnosis of acute
appendicitis in a febrile child of 8 presented with abdominal pains and emesis?
A. Local tenderness in the right iliac fossa
B. Local tenderness and muscular rigidity in the mesogastrium
C. Rigidity around the umbilicus
D. Local tenderness and muscular rigidity in the right iliac fossa
E. Rigidity in the mesogastrium
Clinical test 10. A child of 3 was taken ill 2 hrs ago with right iliac fossa and
suprapubic abdominal pains, a body temperature of 38.2C, recurrent emesis and diarrhea.
On examination, the abdomen was found to be tense around the umbilicus and in the
lower regions. Signs of peritoneal irritation were positive with a muco-purulent vaginal
discharge. Your diagnosis:
A. Acute appendicitis
B. Primary peritonitis
C. Acute intestinal obstruction
D. Acute non-specific mesenteric adenitis
E. Pelvic inflammatory disease
Clinical test 11. A boy of 12 presented with abdominal pains and a fever lasting for
the past 3 days. On examination an abdominal mass was suspected. Which of the
following would be most effective in verifying this diagnosis?
A. Plain abdominal radiograph
B. Endoscopy
C. Contrast abdominal radiography
D. Rectomanoscopy
E. Ultrasonography
Clinical test 12. What should be the surgeon’s course of action in an intra-operative
finding of an appendix mass while operating on a child of 12 for acute destructive
appendicitis?
A. Drainage of the peritoneal cavity without an appendectomy
B. Continue the appendectomy as usual
C. Complete closure of the peritoneal cavity without appendectomy
D. Remove the mass
E. Appendectomy with subsequent drainage of the peritoneal cavity
Clinical test 13. Which of the following is not a direct complication of acute appendicitis
A.
B.
C.
D.
E.
An appendix mass
Appendiceal abscess
Local peritonitis
Diverticulitis
Diffuse peritonitis
Clinical test 14. During the past week a one month old infant was reported to have
been having projectile vomiting. The child was in a severe state, adynamic with 2nd degree
hypotrophy. On palpation, the abdomen was found to be soft, intestinal peristalsis of the “sandclock” was evident. Which investigation would prove most appropriate at arriving at a
diagnosis?
A. Gastro-duodenoscopy
B. Plain radiography
C. Ultrasonography
D. Thermography
E. CT scan
Clinical test 15. Esophageal atresia is diagnosed immediately after birth on the basis of:
A. Excessive salivation and foaming at the mouth
B. Excessive vomiting on feeding
C. Esophageal catheterization
D. Respiratory distress
E. Abdominal distention
Clinical test 16. On a plain abdominal radiograph two liquid levels were visible. This
testifies to the child having:
A. Pyloric atresia
B. Ileal atresia
C. Hirschsprung’s disease
D. Ladd’s syndrome
E. Duodenal atresia
Clinical test 17. The most effective method of treating Ladd’s syndrome is:
A. Conservative management
B. Ladd’s operation
C. Soave’s operation
D. Colostomy
E. Hirschsprung’s operation
Clinical test 18. Which of the following is the pathogenetic basis for meconium ileus?
A. Congenital hepatitis
B. Ileal stenosis
C. Pancreatic cystic fibrosis
D. Portal hypertension
E. Volvulus neonatorum
Clinical test 19. Towards the end of the first day of life, the neonate was observed to
have bilious emesis after each feeding, earlier viscous grayish meconium had been discharged. A
plain abdominal radiograph revealed two levels of liquid in the epigastrium and absence of gas in
the lower gut. Which is the most probable diagnosis?
A. Hirschsprung’s disease
B. Meconium ileus
C. Esophageal atresia
D. Diaphragmatic hernia
E. Ladd’s syndrome
Clinical test 20. Which of the following is not a component of meconium disease of infancy?
A. Meconium ileus
B. Meconium peritonitis
C. Meconium plug syndrome
D. Meconium ileus equivalent (MIE)
E. Meconium stenosis syndrome
Clinical test 21. The conservative method of meconium ileus management is:
A. Gastrografin enema
B. Antibacterial therapy
C. Spasmolytic drugs
D. Intravenous infusion
E. Ultrasound therapy
Clinical test 22.. Marked abdominal distention was noticed in the fifth day of life of a
neonate female with intestinal loops visible on the anterior abdominal wall. Meconium was
discharged after an enema. On a plain abdominal radiograph, the large intestine was found to be
distended. What is the most probable diagnosis?
A. Ladd’s syndrome
B. Ileal stenosis
C. Hirschsprung’s disease
D. Portal hypertension
E. Intususception
Clinical test 23. A neonate in whom the anus was noted to be absent was observed to
be occasionally passing urine with traces of meconium, and clear urine on other occasions.
Which type of anomaly is present?
A. Anal atresia
B. Anal atresia with rectourethral fistula
C. Anal stenosis
D. Rectal atresia
E. Cloacal malformation
Clinical test 24. Which of the following is the most informative in diagnosis of HD?
A. Biopsy
B. Plain radiography
C. Contrast enema
D. Endoscopy
E. Ultrasonography
Clinical test 25.. Which of the following is not a method of surgical management in HD?
A. Duhamel’s operation
B. Swenson’s operation
C. Soave’s operation
D. Ladd’s operation
E. Rehbein’s operation
1.