Primary Care Pediatrics P03-P15.

1. Developmental Milestones.***) At age of 4 months infant can do all of the following, except:

A. Orients to voiceB. Says "dad & mama"C. Supports head wellD. Says "ah-goo"E. Does not say clear words

***) A child can usually roll over by age:A. 4 weeksB. 12 weeksC. 16 weeksD. 28 weeksE. 40 weeks

***) All of the following are present in an average child aged 11 months, except:A. Bladder control by dayB. Can throw objectsC. Usually 2-4 teethD. Responds to simple commandsE. An index finger approach to objects

***) An average child of 12 months can do all, except:A. Sits without supportB. Has an index finger approach to objectsC. Waves bye-byeD. Enjoys looking at picture booksE. Control urination by day time

***) A 1 year old child would be expected to do all of this, except:A. Build a tower of 3 cubesB. Grasp a pelletC. Reach for an objectD. Transfer an object from hand to handE. Stand alone

***) A normal 1 year old child can do all of the following, except:A. Throw objectsB. Know own nameC. Speak in phrasesD. Walk with supportE. Pull self up and stand holding on the furniture

***) Child at one year of age can do all except:A. Pulls self up and stand on furnitureB. Throw objectsC. Obeys simple requestsD. Knows own homeE. Speaks in phrases

***) Most normal children can walk at the age of:A. 6 monthsB. 8 monthsC. 10 monthsD. 12 monthsE. 18 months

***) The most advanced language function a 14 months old child usually can perform is one of the following:

A. Speak several recognizable wordsB. Combine two different wordsC. Speak in complete sentencesD. Use the past timeE. Refer to himself (I)

***) A 15 months old infant can do all of the following, exceptA. Walks aloneB. Uses 4-6 wordsC. Builds tower of 2 cubesD. Creeps upstairsE. Points to 8 body parts

***) The average 18 months old child is expected to know:A. 10 wordsB. 20 wordsC. 40 words

D. 60 wordsE. 100 words

***) A normal child of 18 months should do all of the following, exceptA. Walks aloneB. Uses spoon himselfC. Puts two to three words together in a phraseD. Uses at least 4 clear wordsE. Understands requests and forbids

***) By age of 2 years the child can speak:A. Three word sentencesB. Four words sentencesC. Five words sentencesD. Six words sentencesE. Seven words sentences

***) A 24 months old child is expected to do all of the following, exceptA. Walk up and down stairs, one step at a timeB. Handle spoon wellC. Build a tower of 4 cubesD. Can put 3 words togetherE. Can draw a square

***) A child at the age of 36 months, can do all except:A. Rides tricycleB. Build lower of 10 cubesC. Washes handsD. Knows age and sexE. Running well

***) A child can hop on one foot by age of:A. One yearB. Two yearsC. One year and a halfD. Two years and a halfE. Four years

***) Define the ability to abstract terms such as justice, honesty and dignity is expected to occur at age of:A. Three yearsB. Four yearsC. Five yearsD. Seven yearsE. Ten years

2. Primitive Reflexes.***) A normal full term newborn can demonstrate all of the following reflexes, except:

A. Moro reflexB. Palmar grasp reflexC. Sucking reflexD. Parachute reflexE. Rooting reflex

***) When examining a two months old infant you expect to find all the following reflexes except:A. Moro ReflexB. Parachute ReflexC. Palmar ReflexD. Rooting ReflexE. Planter Reflex

***) All of the following statements about Babinski reflex are true, except:A. Positive response is considered to be normal in the first year of lifeB. Negative response is also considered to be normal in the first year of life C. Asymmetrical positive response is considered normal in the first year of lifeD. It is considered as pathological reflexE. It is induces by stimulating the lateral aspect of foot

***) Following a difficult delivery a unilateral Moro reflex is elicited. This is often a presenting sign of a:A. Subdural hematomaB. Tentorial tearC. Fractured clavicleD. SepsisE. Depressed skull fracture

3. Vaccinations.***) The first dose of DPT and oral polio vaccines is recommended at:

A. First day of lifeB. 3 weeksC. 2 or 3 monthsD. 6 monthsE. 9 months

***) DPT is a vaccine given to infants usually at 2 months of age, and protects from all of the following disease, except:

A. DiphtheriaB. PertussisC. MeaslesD. TetanusE. Diphtheria and tetanus

***) Concerning oral polio vaccine OPV (Sabin) all of the following are true, except:A. OPV is a live attenuated vaccineB. OPV is best stored at 2-8° CC. It is easy to administerD. It is of definite value on controlling epidemics of polioE. One dose is sufficient and will give long life immunity

***) All these vaccines are alive attenuated, except:A. MumpsB. MeaslesC. Yellow feverD. Hepatitis B vaccineE. Rubella

***) All of the following immunizations are generally performed using a live organism, except:A. Poliomyelitis SabinB. MeaslesC. RubellaD. Whooping coughE. Mumps

***) The following immunizations are generally performed using a live attenuated organism, except:A. PoliomyelitisB. MeaslesC. Bacillus Calmette Guerin BCG

D. PertussisE. Influenza

***) In immunosuppressed children, all of the following vaccines are contraindicated, except:A. Measles vaccineB. Oral polio vaccineC. Rubella vaccineD. Pertussis vaccineE. BCG

***) One of the following vaccines can be given to patient with T-cell deficiency:A. PertussisB. Oral polioC. RubellaD. BCGE. Measles

***) Measles vaccine is given in Jordan at age:A. 3 monthsB. 6 monthsC. 9 monthsD. 15 monthsE. 24 months

***) Select the most appropriate statement:A. Measles vaccine is a live attenuated virusB. Prophylaxis against malaria is always effectiveC. Tuberculosis can always be prevented by the BCG vaccine aloneD. The most important factor in the prevention of cholera is immunization with vaccineE. The most important factor in the prevention of coronary heart disease are active exercises

***) All of the following about rubella vaccine are true, except:A. It is a live attenuated viral vaccineB. It should not be given to children before the age of one yearC. It should not be administered to pregnant womenD. It may be associated with arthritis in adult femalesE. It should not be administered with other viral vaccines

***) Reactions to live MMR vaccine usually occur:A. Within minutes after vaccinationB. Within 24 hours of injectionC. Within 48 hours of injectionD. After 6-8 days following the injectionE. After 14-21 days following the injection

***) The national vaccination program in Jordan includes vaccination against all of the following, except:A. MeaslesB. Whooping coughC. DiphtheriaD. Hepatitis AE. Poliomyelitis

4. Nutrition.***) Colostrum has all of the following properties, except:

A. It has higher fat content than mature milkB. It has higher protein content than mature milkC. It has less sugar content than mature milkD. Sodium and potassium content are higher than in mature milkE. It contains protective antibodies and leukocytes

***) Regarding colostrum all are true, except:A. Daily secretion is 10 to 40 mlB. It has an alkaline reactionC. Contains less fat than mature breast milkD. Contains less carbohydrates than mature breast milkE. Contains less protein than mature breast milk

***) Concerning breast feeding all of following are true, except:A. It should be initiated immediately following child birthB. Repeated feeding increases the flow of milkC. Consuming fluids helps the mother to maintain breast feedingD. Breast feeding is not recommended after introducing solid foodE. Colostrum contains antibodies that are useful to the newborn

***) In breast milk feeding all is true, except:A. Less allergic symptoms than bottle feedingB. Less incidence of gastroenteritisC. Less incidence of URTI

D. Increased incidence of obesity than bottle feedingE. Increased emotional attachment

***) Human milk is relatively low in one of the following:A. CarbohydratesB. ProteinsC. FatD. CalciumE. Iron

***) All of the following regarding breast feeding is true, except:A. Breast milk contains IgA which protects against gastrointestinal infectionsB. Breast milk is relatively low in ironC. The bioavailability of iron in human milk is very highD. Breast feeding enhances the emotional bond between the mother and her infantE. Breast feeding is not advisable in case of twins

***) Regarding human breast milk all are true, except:A. Iron of human milk is poorly absorbedB. Breast feeding should start as soon as possible after birthC. Lactose content in human milk is higher than in cow's milkD. Sodium content in human milk is lower than in cow's milkE. Proteins are lower than in cow's milk

***) The advantages of breast milk include all of the following, except:A. Always fresh and readyB. Always at right temperatureC. Establishes healthy mother-child relationshipD. Contains less carbohydrate per 100 ml than cow's milkE. Protects against infections

***) Compared to cow's milk with human milk, one of the following is true:A. Sodium content is less in cow's milkB. Carbohydrate content is more in cow's milkC. Caloric content is almost the sameD. Unsaturated fatty acids are more in cow's milkE. Folate content is less in cow's milk

***) The protein content of cow’s milk is:A. 1.5 gB. 2.5 gC. 3.5 gD. 5 gE. 7 g

***) Human milk (breast milk) contains all of the following, except:A. Vitamin AB. Vitamin CC. Vitamin B12

D. Vitamin B2

E. Vitamin D

***) Regular infant formulas are modified from cow's milk to resemble human milk. One of the following statements is correct regarding these formulas:

A. They are safe to be used by infants with cow's milk allergyB. They are supplemented by the daily requirements of vitaminsC. They are specifically indicated in patients with galactosemiaD. Their fat concentration is less than that of cow's milkE. They do not contain lactose

5. Normal Physical Growth.***) Children triple their birth weight by age of:

A. 1 yearB. 2 yearsC. 6 monthsD. 9 monthsE. 3 months

***) In normal developing fetus, the most likely head circumference measurement at full term is:A. 30 cmB. 33 cmC. 36 cmD. 38 cmE. 40 cm

***) The average head circumference of a normal child at one year of age is:A. 40-42 cmB. 43-45 cm

C. 46-48 cmD. 49-52 cmE. 53-56 cm

***) The average growth of head circumference during the first year is:A. 5 cmB. 8cmC. 12 cmD. 16 cmE. 20 cm

***) In the majority of infants the anterior fontanel is closed by:A. 3 monthsB. 6 monthsC. 10 monthsD. 18 monthsE. 24 months

***) Regarding development, all the following are true except:A. The newborn regains his body weight by 10 days of ageB. Double birth weight by 5 months, triple by 1 yearC. Double birth length at 4 yearsD. Increased head circumference 4-5 cm during the first yearE. Increased length 25-30 cm during first year

***) Growth charts of 1 year old child show length of one stand deviation (SD) below third percentile, weight and head circumference of 2 SD's below the third percentile. The most likely primary diagnosis is:

A. MicrocephalyB. Failure to thriveC. Short statureD. Failure to thrive leading into short statureE. Failure to thrive leading into microcephaly

6. Failure to Thrive (FTT).***) Causes of failure to thrive include all of the following, except:

A. Emotional deprivationB. Intestinal malabsorptionC. Renal tubular disordersD. Chronic heart failureE. Acute chest infection

***) Caloric requirements by the beginning of the second week of life are:A. 60 kcal/kgB. 80 kcal/kgC. 100 kcal/kgD. 120 kcal/kgE. Over 140 kcal/kg

***) The daily requirement of vitamin D for the newborn is:A. 40 IUB. 400 IUC. 4,000 IUD. 40,000 IUE. 400,000 IU

***) All of the following statements concerning daily needs of an infant are true, except:A. 400 IU of vitamin DB. 6 mg of ironC. 50 mg of vitamin CD. 110 calories per kgE. 150 ml of water per kg

A. RicketsB. Vitamin E deficiencyC. HydrocephalyD. SyphilisE. Premature baby

***) Clinical signs of marasmus may include all of the following, except:A. Loss of turgor of skinB. Poor appetiteC. HypotoniaD. Subnormal temperatureE. Never associated with edema

***) All are feature of Kwashiorkor, except:A. AnorexiaB. ConstipationC. Liability to infection

D. Hair depigmentationE. Moon face

***) Each of the following statements about Kwashiorkor is true, except:A. It is primarily a caloric malnutritionB. Loss of muscle tissue is presentC. Hepatomegaly is due to fatty infiltrationD. Pigmented skin is commonE. Edema of limbs is usually present

***) Regarding Kwashiorkor all of the following are true, except:A. Caused by low protein dietB. Failure to thrive and edema are presenting featuresC. Caused by low caloric dietD. Hypopigmentation of the hair is a featureE. Abdominal distension is a feature

7. Circumcision.***) Circumcision is contraindicated in babies with:

A. Long prepuceB. PhimosisC. HypospadiaD. HemophiliaE. Recurrent balanitis

8. Elimination Disorders.***) An evaluation of every child who has enuresis should include all of the following, except:

A. Family historyB. Urine analysisC. Urine cultureD. Intravenous pyelogramE. Fasting blood sugar

***) Regarding Enuresis, all are true except:A. Most children achieve bladder control during day time and night by age 5 yearsB. Is more common in boys than in girlsC. Spontaneous resolution can occurD. Conditioning devices is modality of treatmentE. No pharmacological therapy

9. Breath-Holding Spells.***) All of the following are characteristic of breath holding spells, except:

A. It can occur up to age of 4 or 5 yearsB. It is self-limitedC. It does not occur in mentally retarded childrenD. It sometimes runs in familiesE. It could lend to convulsions

***) Concerning breath holding attacks all are true, except:A. Are common in toddlers (1-3 years of age)B. Are easily confused with a generalized seizureC. Should be treated with sedativesD. May be precipitated by a minor injuryE. The history is very important for the diagnosis

Adolescent Medicine P17-P18.

1. Normal Sexual Development.***) The first sign of puberty in males is:

A. Increase size of testiclesB. Appearance of facial hairC. Appearance of axillary hairD. Appearance of pubic hairE. Appearance of body hair

***) The first visible sign of puberty in girls is:A. The appearance of breast budsB. MensesC. Increased in height velocityD. Enlargement of the external genitaliaE. Axillary hair

***) Precocious puberty is diagnosed in female when secondary sexual characteristics appear before:A. 4 years ageB. 8 years ageC. 10 years ageD. 12 years ageE. 14 years age

Cardiology P18-P26.

1. Heart Murmurs.***) Concerning innocent murmur all of the following are true, except:

A. Low-pitched vibratory murmurB. Usually diastolicC. Not more than grade 2/6 in intensityD. No splitting in heart soundsE. Best heard in midprecordium

***) Auscultatory features characteristic of a benign murmur include all of the following, except:A. Confirmation to systolesB. Audible in a restricted area of precordium onlyC. A quiet musical qualityD. No variation with positionE. Short duration

2. Congenital Heart Disease.***) The most common cause of central cyanosis in the neonates is:

A. Congenital heart diseaseB. Lung diseaseC. CNS diseaseD. HypoglycemiaE. Polycythemia

***) One of the following is the most common congenital heart defect in infants and children:A. ASDB. VSDC. Aortic coarctationD. Right ventricular hypertrophyE. Pulmonary artery stenosis

***) All of the following statements are correct, except:A. Cyanosis at birth may indicate transposition of the great arteries TGAB. Aortic regurgitation is the most common heart lesion in rheumatic carditisC. Ventricular septal defect VSD is the most common CHDD. Patent ductus arteriosus PDA is more common in prematureE. Chest X-ray will show olgemic lung fields in pulmonary artery stenosis

3. Acyanotic Congenital Heart Disease.***) All of the following are acyanotic congenital heart disease, except:

A. Ventricular septal defectB. Fallot tetralogyC. Aortic stenosisD. Atrial septal defectE. Pulmonary stenosis

***) All of the following are acyanotic congenital heart diseases, except:A. Transposition of great vesselsB. Patent ductus arteriosusC. Coarctation of aortaD. Atrial septal defectE. Ventricular septal defect

***) The commonest non cyanotic congenital heart disease is:A. ASD atrial septal defectB. VSD ventricular septal defectC. PDA persistent ductus arteriosusD. Aortic stenosisE. Mitral insufficiency

***) Regarding left to right cardiac shunts all are true, except:A. Cyanosis is a prominent featureB. Oxygenated blood is shunted from left to rightC. Systemic flow is decreasedD. Pulmonary congestion is a prominent featureE. Left heart pressures normally exceed those on the right

***) In Atrial Septal Defect (ASD) all are true except:A. The murmur heard is secondary to flow through the ASDB. Surgery is indicated once diagnosed in symptomatic patientsC. Secundum type is the most commonD. Usually asymptomatic in childhoodE. Surgery is contraindicated if severe pulmonary hypertension developed

***) Large VSD alone in infancy may present by all of the following, except:A. Failure to thrive

B. Recurrent chest infectionsC. Holosystolic murmurD. Cardiomegaly and oligemic lungs on chest X-rayE. ECG shows biventricular hypertrophy

***) All of the following could be manifestations of large VSD, except:A. Feeding difficultiesB. Left to right shuntC. CardiomegalyD. It is the commonest congenital heart disease E. Absent femoral pulse

***) A 2 year old boy, presented with upper respiratory tract infection, the treating physician accidently heard a pansystolic murmur during cardiac auscultation the most likely diagnosis is:

A. Atrial septal defectB. Coarctation of aortaC. Transposition of great vesselsD. Ventricular septal defectE. Patent ductus arteriosus

***) Regarding coarctation of the aorta all are true except:Affecting males more than femalesThe ascending aorta is the most common siteCan be presented with hypertension at childhoodIn severe narrowing its indication for surgeryThe surgical approach is through right rhoracolomy

***) All of the following does not require treatment in a newborn, except:A. A scrotal hydroceleB. Breast enlargementC. Mongolian spotD. An erupted toothE. Femoral pulses absent

4. Cyanotic Congenital Heart Disease.***) Cyanotic congenital heart disease includes all of the following, except:

A. Transposition of great vesselsB. Fallot tetralogyC. Isolated VSDD. Tricuspid atresia

E. Pulmonary artery stenosis

***) Only one of the following is cyanotic congenital heart disease:A. Fallot tetralogyB. Patent ductus arteriosusC. Atrial septal defectD. Ventricular septal defectE. Coarctation of aorta

***) Tetralogy of Fallot exhibits all of the following, except:A. CyanosisB. Ventricular septal defectC. Patients do not develop congestive heart failure in infancyD. Obstruction to right ventricular outflowE. Right ventricular hypertrophy

5. Congestive Heart Failure.***) All of the following are common features of heart failure in infancy, except:

A. HepatomegalyB. Lower limb edemaC. Feeding difficultiesD. TachycardiaE. Failure to thrive

***) Which one of the following is not common in acute heart failure of infancy:A. Peripheral edemaB. TachypneaC. TachycardiaD. Gallop rhythmE. Hepatomegaly

***) Congestive heart failure in infancy is characterized by all of the following, except:A. Enlarged palpable liverB. Feeding difficultiesC. Heart rate over 150/minD. Respiratory rate over 40/minE. Oligemic lung fields in chest X-ray

***) Congestive heart failure in infancy commonly presents with all of the following, except:

A. Peripheral edemaB. Poor weight gainC. Excessive perspirationD. Weak cryE. Tachypnea

***) The first sign of heart failure in infants is usually:A. Peripheral edemaB. Engorged jugular veinsC. Basal crepitationD. Tachypnea and tachycardiaE. Puffiness of eye lids

***) Goals of medical therapy for congestive heart failure in children include all the following except:A. Reducing the preloadB. Enhancing cardiac contractilityC. Increase the after loadD. Improving oxygen deliveryE. Enhancing nutrition

Development P26-P29.

1. Intellectual Disability.***) The following mental retardation may be caused by inherited errors of metabolism and can be treated by dietary measures, except:

A. PhenylketonuriaB. HypothyroidismC. GalactosemiaD. TyrosinemiaE. Maple syrup urine disease

***) All of the following can cause mental retardation, except:A. Emotional disturbancesB. Birth traumaC. MeningitisD. Cerebral lipidosesE. Protein losing enteropathy

Endocrinology P29-P36.

1. Diabetes Mellitus (DM).***) Concerning diabetes mellitus in children all of the following are true, except:

A. PolydipsiaB. PolyphagiaC. KetoacidosisD. Does not always require injectable insulinE. Usually is rapid in onset, often presenting as diabetic coma

***) A 3 years old child lost appetite over the last few days, ingested a lot of water, frequent urination, and developed acute abdominal pain, vomiting and hyperventilation. Most probably he has:

A. Tumor in the forth ventricleB. Acute renal failureC. Acute appendicitisD. Diabetic ketoacidosisE. Diabetes insipidus

2. Hypothyroidism.***) The most valuable test in the diagnosis of congenital hypothyroidism is:

A. T3B. T4C. Cholesterol levelD. TSHE. Bone age by X-ray

***) Early manifestations of congenital hypothyroidism include all of the following, except:A. Prolonged physiologic jaundiceB. Apneic spellsC. ConstipationD. Delayed osseous developmentE. Increased appetite

***) Clinical features of hypothyroidism may include all of the following, except:A. Mental retardationB. GoitreC. Short statureD. Advanced bone ageE. Constipation

***) All of the following are features of congenital hypothyroidism, except:A. LethargyB. Prolonged jaundiceC. Persistent diarrheaD. Hoarse cryE. Feeding difficulties

***) Signs of congenital hypothyroidism include all the following except:A. Prolonged neonatal jaundiceB. Lethargy and poor feedingC. ConstipationD. Early closure of anterior fontanelE. Umbilical hernia

***) A 25 days old baby complains of prolonged jaundice, constipation, dry skin and umbilical hernia. The most likely appropriate diagnosis is:

A. Breast milk jaundiceB. G6PDC. Thalassemia majorD. HypothyroidismE. Crigler Najar disease

***) A 9 month old female was seen because of inability to sit or stand. Examination showed neck mass anteriorly. The tongue was broad and thick; no erupted teeth, liver and spleen not palpable. One of the following tests will establish the most likely suspected diagnosis:

A. Routine urine analysisB. Serum calcium and phosphorusC. KaryotypingD. Urine for mucopolysaccharidesE. T4 and TSH

***) Congenital goiter in the newborn is least likely to be due to which of the following:A. Maternal ingestion of large amount of iodine during pregnancyB. Defect in the synthesis of thyroid hormonesC. Maternal iodine deficiencyD. Hashimoto's disease in the newbornE. Maternal ingestion of antithyroid drugs

***) Regarding Hashimoto's thyroiditis, all are true except:

A. Most common cause of juvenile hypothyroidismB. The etiology is autoimmuneC. Thyroid antiperoxidase antibodies are positive in 90%D. Is 7 times more common in boysE. Lead to growth retardation

3. Congenital Adrenal Hyperplasia (CAH).***) 1 month old infant is seen with vomiting and severe dehydration. Physical examination reveals ambiguous genitalia, laboratory test show hyponatremia. The best likely diagnosis is:

A. GastroenteritisB. Congenital hypothyroidismC. PseudohermaphroditismD. Congenital adrenal hyperplasiaE. Congenital diaphragmatic hernia

4. Short Stature.***) The short stature is associated with all of the following, except:

A. Chronic renal diseaseB. HypothyroidismC. Down's syndromeD. Low birth weightE. Breast fed babies

***) Causes of short stature can be due to all of the following, except:A. Emotional deprivationB. Turner's syndromeC. Kleinfelter’s syndromeD. Primary hypothyroidismE. Gluten enteropathy

***) All of the following can cause short stature, except:A. AchondroplasiaB. FamilialC. Kleinfelter’s syndromeD. HypothyroidismE. Corticosteroid therapy

***) Short stature may be associated with the following conditions, except:A. Chronic kidney disease

B. HypothyroidismC. Down syndromeD. AchondroplasiaE. Marfan syndrome

Gastroenterology P36-P43.

1. Tracheoesophageal Fistula.***) The newly born regurgitates its entire first and every feed, pours saliva almost continuously. There are manifestations of:

A. Imperforate anusB. Congenital diaphragmatic herniaC. Atresia of duodenumD. Atresia of the esophagusE. Meckel's diverticulum

***) All of the following are features of isolated esophageal atresia, except:A. Excessive salivationB. Inability to pass nasogastrial tubeC. Distended abdomenD. PneumoniaE. Cyanotic attacks after feeding

2. Pyloric Stenosis.***) A narrowing and elongation of the pyloric channel on X-ray in a 12 days old infant most strongly suggest:

A. Duodenal atresiaB. Duodenal ulcerC. Duplication of the stomachD. Infantile hypertrophic pyloric stenosisE. Annular pancreas

***) Pyloric stenosis is characterized by all of the following, except:A. Usually present between 3 and 8 weeks of lifeB. Is commoner in first-born infantsC. Is commoner in girlsD. There is a family history of such diseaseE. Projectile vomiting

***) All of the following are characteristics of pyloric stenosis, except:A. Commonly seen in the first born babyB. Bile stained vomitingC. Metabolic alkalosisD. Failure to thriveE. Ultrasound is helpful in confirming diagnosis

***) Regarding pyloric stenosis all of the following are true, except:A. Metabolic acidosis is presenting featureB. Barium meal confirm the diagnosisC. It affects more the first and male babiesD. The baby is usually alert and sucking stronglyE. Surgical management is pyloromyotomy

***) Concerning hypertrophic pyloric stenosis of following are true, except:A. Manifestations start usually 3-4 weeks after birthB. Bile stained projectile vomiting is the presenting symptomC. A visible peristalsis may be seen passing from the left to right across the upper abdomenD. Constipation and loss of weight are usually presentE. Surgery is the treatment of choice

***) Concerning hypertrophic pyloric stenosis all the following are true, except:A. Non-bilious projectile vomiting is the most commonB. Visible peristalsis may be seen passing from left to right across the upper abdomenC. An olive-size mass can be felt in the right hypochondriumD. Constipation and loss of weight are usually presentE. The usual management is by antispasmodics and laxatives

***) Concerning hypertrophic pyloric stenosis, all the following statements are true, except:A. First born male infants are most frequently affectedB. Symptoms usually begin in the third week of lifeC. Bile stained vomiting after feeding is characteristicD. Other gastrointestinal anomalies are usually not presentE. Preoperative preparation frequently requires potassium replacement

3. Duodenal Atresia.***) A newly born presented with persistent bile stained vomiting. Straight, erect abdominal radiograph showed “double bubble” appearance in the upper abdomen. This infant has:

A. Meconium ileusB. Duodenal atresiaC. Imperforated anusD. Hypertrophic pyloric stenosisE. Congenital intussusception

***) All of the following are causes of non bile stained vomiting, except:A. Feeding problemB. Gastro-esophageal refluxC. Pyloric stenosisD. Duodenal atresiaE. Hidden infection (meningitis)

4. Vomiting.***) Common causes of vomiting in children including all the following, except:

A. Over feedingB. Duodenal atresiaC. Gastro-esophageal refluxD. GastroenteritisE. Pyloric stenosis

***) The common cause of regurgitation in a normal young infant is:A. Faulty feeding techniqueB. Pyloric stenosisC. Gastroesophageal refluxD. ConstipationE. Lactose intolerance

5. Diarrhea.***) The commonest cause for acute simple gastroenteritis is:

A. EscherichiaB. ShigellaC. RotavirusD. SalmonellaE. Adenovirus

***) All of the following are causes of chronic diarrhea in children:A. Enterobius vermicularisB. Lamblia giardia

C. Entameba histolyticaD. Celiac diseaseE. Cystic fibrosis

***) One of the following measures is recommended in managing diarrhea in children:A. Using antibiotics for Gram-positive bacteriaB. Using antibiotics for Gram-negative bacteriaC. Attempting to reduce intestinal motility by using suitable drugsD. Attempting to stop vomiting by using suitable drugsE. Attempting to prevent reaching the stage when intravenous therapy is needed

6. Celiac Disease.***) Regarding celiac dieses all are true, except:

A. Manifestations start after birth immediatelyB. Gluten-free diet is helpfulC. Some cases may develop lymphomaD. Endomysial antibodies is useful testE. The main problem is in absorption

***) All of the following are manifestations of celiac disease, except:A. Short statureB. ConstipationC. Delayed pubertyD. PallorE. Bloody diarrhea

7. Milk Protein Allergy.***) Cow's milk protein allergy may present in all of the following ways, except

A. An exacerbation of eczemaB. Infantile colicC. Chronic wheezing in the first year of lifeD. Bloody colitis in infancyE. Thrombocytopenia

8. Constipation.***) Which of the following statements about Hirschsprung's disease is not true:

A. It may be a cause of neonatal intestinal obstruction

B. It may involve the entire colonC. It may be associated with an increased incidence of Down's syndromeD. It may be associated with enterocolitisE. Barium enema is always diagnostic for infants older than one month

9. Acute Abdominal Pain.***) Intussusception is a cause of all of the following, except:

A. A mass in the abdomenB. Abdominal colicC. Frequency of micturiuonD. Passage of blood per rectumE. Intestinal obstruction

***) A previously healthy 8 months old boy started to suffer from repeated abdominal pain, vomiting and red currant jelly stool, he should be regarded to have:

A. Volvulus neonatorumB. IntussusceptionC. GastroenteritisD. Meconium ileusE. Meckel's diverticulitis

***) Current jelly stools are usually associated with:A. Hirschsprung’s diseaseB. AppendicitisC. IntussusceptionD. BezoarsE. Enterocolitis

10. GI Bleeding.***) Blood stained stools in an infant are associated with all of the following, except:

A. Anal fissureB. GastroenteritisC. IntussusceptionD. AppendicitisE. Meckel's diverticulum

***) The most common cause of minimal bleeding per rectum in children is:A. Volvulus neonatorumB. Necrotizing enterocolitis

C. Fissure in anusD. Hemorrhagic diseaseE. Polyp

***) The most common cause of rectal bleeding in infancy and childhood is:A. Anal fissureB. VolvulusC. Foreign bodyD. IntussusceptionE. Meckel's diverticulum

Genetics and Metabolism P43-P48.

1. Genetics.***) All of the following are inherited as autosomal dominant, except:

A. NeurofibromatosisB. Tuberous sclerosisC. AchondroplasiaD. Cystic fibrosisE. Adult type polycystic kidney disease

***) In autosomal dominant inheritance the trait will be found in one parent and:A. 25% of daughters and 75% of sonsB. 75% of daughters and 25% of sonsC. 50% of sons and 50% of daughtersD. Only daughtersE. Only sons

***) In autosomal dominant inheritance, the chance of having affected offspring in each pregnancy is:A. 25%B. 50%C. 75%D. 100%E. Only male

2. Genetic Syndromes.***) Chromosomal study is indicated in all of the following, except:

A. Down syndromeB. Meningomyelocele and hydrocephalus

C. Recurrent abortion lossD. Turner syndromeE. Ambiguous genitalia

***) The most likely reason for the extra chromosome in Down's syndrome is:A. Anaphase lagB. TranslocationC. No disjunctionD. OogenesisE. Fragmentation

***) All of the following are features of trisomy 21 (Down), except:A. HypotoniaB. MicrocephalyC. ClinodactylyD. Recurrent chest infectionsE. Normal development

***) Clinical features of Down's syndrome include all of the following, except:A. Mental retardationB. Microcephaly with flattening of occiputC. Muscle hypertoniaD. Short and incurve little fingerE. Simian crease

***) All the following are findings in Trisomy 21 except: A. Learning difficultiesB. Protruding tongueC. Congenital heart defectsD. Single transverse palmar creaseE. Hypertonia

***) A cardiac disorder commonly associated with Turner's syndrome is:A. Mitral stenosisB. Coarctation of aortaC. Pulmonary stenosisD. Tetralogy of FallotE. Absence of pulmonary valves

3. Metabolic Disease.***) Regarding acrodermatitis enteropathica all are true, except:

A. Chronic diarrhea is presentB. Caused by zinc deficiencyC. Perioral dermatitisD. Loss of hairE. Associated with multiple congenital anomalies

***) All of the following metabolic disorders are treated by a specifically modified formula and or diet, except:

A. PhenylketonuriaB. Maple syrup urine diseaseC. GalactosemiaD. CystinosisE. Fructosemia

4. Phenylketonuria (PKU).***) All are recognized findings in Phenylketonuria PKU, except:

A. SeizuresB. MacrocephalyC. EczemaD. Blond hair and blue scleraE. Failure to thrive

Hematology P48-P52.

1. Physiologic Anemia.***) A 2 months old infant brought to you because his hemoglobin was 9,5gm%. One of the following is true:Give him ironGive him bloodAssure the parents onlyDo reticulocytes levelDo bilirubin level

***) The normal platelet count per cubic millimeter in one month old infant is:10 x 1020 x 1040 x 10

70 x 10250 x 10

***) A white blood cell count of 18,000/mm3 is normal for what age:One day old full termTwo monthsSix monthsTwelve monthsSix years

2. Iron Deficiency Anemia.***) The most common cause of anemia worldwide is:

A. Folate deficiencyB. Vitamin B12 deficiencyC. Thalassemia majorD. Iron deficiencyE. Glucose 6 phosphate deficiency

***) A major health problem in Jordan is:A. Vitamin A deficiencyB. ThalassemiaC. RicketsD. Iron deficiency anemiaE. Pellagra

***) The commonest type of anemia in pediatrics is :ThalassemiaSickle cell anemiaHereditary spherocytosisIron deficiency anemiaMegaloblastic anemia

***) Effects of iron deficiency anemia in children may include all of the following, except:A. Retardation of growthB. Compromised cellular immunityC. Direct effect on muscle functionD. Direct effect on respiratory functionE. Impaired intellectual function

3. Anemia of Chronic Disease.***) All of the following about megaloblastic anemia in children are true, except:Results from deficiency of folic acid or vitamin B12, or bothAn important consideration in children fed exclusively with goat's milkConsiderable variation in red cell shape and sizeMore common in children than in adultsThe neutrophils are large and hypersegmented

1. Immune Thrombocytopenic Purpura.***) One of the following is true regarding Idiopathic thrombocytopenic purpura ITP:

A. Platelets count is less than 50,000B. Normal WBC countC. Normal PT and PTTD. Decreased megakaryocytes in bone marrowE. Normal RBC count

***) Which of the following statements about idiopathic thrombocytopenic purpura (ITP) in children is not true:Most children with acute ITP recover within 2 monthsBone marrow examination is not helpful in diagnosisEarly use of steroids may enhance platelet recovery but has no effect on chronicityIntracranial bleeding is a risk at any stage of the diseaseFor older children with chronic ITP splenectomy offer the best chance of remission

***) Regarding ITP (idiopathic thrombocytopenic purpura) all are true, except:High bleeding timeDecreased platelets countDecreased megakaryocytes in bone marrowIntracranial hemorrhage is the most serious complicationSteroid therapy is helpful

Infectious Diseases P52-P62.

1. Urinary Tract Infection (UTI).***) The commonest causes of urinary tract infections are:

A. Proteus speciesB. Escherichia coliC. KlebsiellaD. PseudomonasE. Citrobacter species

***) A 3 year old boy presents to you with recurrent urinary tract infection. Renal ultrasound was normal. Your next step of investigation would be:Intravenous urogramIsotope scanNo need for further investigationsVoiding cystourethrogramCystoscopy

***) The major organic cause of recurrent abdominal pain in children is:Peptic ulcerUrinary tract infectionMeckel's diverticulitisMegacolonRegional enteritis

***) The definitive test for urinary tract infection in a 10 years old girl is:IVPMCU (Micturating cystouretherogram)CBCUrine routine analysisUrine culture with significant bacteriuria

2. Streptococcal Pharyngitis.***) Which one of the following conditions needs treatment:Erythema toxicum of the newbornWithdrawal vaginal bleeding at third day of lifeMongolian spotsMastitis neonatorumImpetigo neonatorum

***) Concerning impetigo all of the following are true, except:Is highly contagiousThe drug of choice in children is tetracyclineIs usually caused by a staphylococcal infection

In an infant may be complicated by generalized exfoliationIt effects mainly the nostrils and perioral areas

3. Scarlet Fever.***) All of the following about rash are true, except:In measles the rash is a maculopapular, begins on the head and spread downwardsIn scarlet fever the rash is vesicular and petechialIn erythema infectiosum the rash begins as a marked erythema of the cheeksIn varicella rash is polymorphic, but mainly vesicularIn rubella the rash is maculopapular, associated with postauricular and suboccipital lymphadenopathy

4. Rheumatic Fever.***) Which one of the following is not a collagen disease in children:Rheumatic feverScleremaRheumatoid arthritisSLE (systemic lupus erythematodes)Dermatomyositis

***)One of the following is the pathognomonic rash of rheumatic fever:Erythema multiforme of the limbsErythema nodosum of the backErythema nodosum of the trunkPurpura on the lateral aspect of buttocksPurpura on the lower extremities

5. Infectious Mononucleosis.***) All of the following are true about infectious mononucleosis, except:Generalized lymphadenopathySplenomegaly in 50% of casesThe drug of choice in children is chloramphenicolThe classic picture is rarely seen in the blood filmAtypical lymphocytes are usually seen in the blood film

***) The lymph node enlargement in infectious mononucleosis most commonly involve:Cervical groupOccipital nodesAxillary groupEpitrochlear group

Inguinal group

***) In infectious mononucleosis all are true, except:Hepatomegaly may presentLymphadenopathy is presenting signSkin rash (maculopapular) may presentAacyclovir is an effective therapyThe incubation period is 25-50 days

6. Pertussis.***) All of the following are the characteristics of pertussis, except:

A. World-wide in distributionB. May occur in both sexesC. May occur at any ageD. Newborn immune for about three monthsE. Lesions located principally in bronchiand bronchioles

???) Concerning whooping cough all of the following are true, except:The incubation period is 7-10 daysThe diagnosis is achieved if proved bacteriologicallyThere is typically marked lymphocytosisThe paroxismal stage lasts four to six weeksSpecific treatment in infancy includes erythromycin

7. Varicella (Chickenpox).***) All of the following are the characteristics of varicella (chickenpox), except:

A. One attack confirms lifelong immunityB. Distribution of lesion predominantly centripetalC. The peripheral blood picture is essentially unchangedD. Incubation period ranges from 10 to 20 daysE. Varicella is generally much more severe in children than in adults

***) The rash in chickenpox shows the following characteristic features, except:A. Centripetal in distributionB. All stages and sizes at the same time could be seenC. SuperficialD. The causative agent is herpes virusE. Scalp and mucous membranes are preserved (not involved)

***) Regarding chickenpox (varicella) all are true, except:A. Incubation period is 14-21 daysB. Most common complication is subacute sclerosing panencephalitisC. Polymorphic rashD. The epidemics have been initiated by exposure to herpes zosterE. Children receiving steroids are at great risk for severe chickenpox

***) Chickenpox is characterized by:A. Long prodromal period around 4 weeksB. Severe systemic symptoms in childrenC. High contagion indexD. Maculo-papular rashE. Frequent occurrence of associated pneumonia

***) Regarding varicella (chickenpox), all are true except:A. It is vesicular rashB. Incubation period less than one weekC. Different stages of maturation of skin lesionsD. Its more benign in children than in adultsE. Can lead to congenital varicella syndrome

8. Roseola.***) Which one of the following statements concerning Roseola is true:

A. Etiology is believed to be due to Coxsackie virusB. Fever is usually high at the onsetC. Rash begins with a slapped cheek appearanceD. The illness is not contagiousE. The rash leaves temporary hypopigmented areas after fading

9. Measles.***) Regarding the incubation period all of the following are true, except:

A. Mumps 12-25 daysB. Measles 14-21 daysC. Rubella 14-21 daysD. Hepatitis A 3-8 weeksE. Hepatitis B 6-24 weeks

***) Which one of the following infections typically has incubation period of less than 2 weeks:

A. MumpsB. VaricellaC. RubellaD. MeaslesE. Rabies

***) All of the following are features of measles, except:A. Prodromal signs such as fever and anorexia last 3 to 4 daysB. The sub-occipital lymph nodes are enlargedC. Koplik’s spots are visible 2 to 3 days before the onset of rashD. The rash starts behind the ears and spreads to the forehead, face and down the bodyE. The incubation period is one to two weeks

***) Regarding measles in Jordan all are false, except:A. The peak of incidence is among infantsB. Vaccine coverage is completeC. Incidence among children is shifting to older age groupD. The vaccine is made of killed bacteriaE. The cold chain is weak

***) In measles the rash and accompanying illness reach a climax on about the: A. 2nd day B. 3rd day C. 6th day D. 9th day E. 12th day

***) Koplik’s spots are pathognomonic of one of the following:A. RubellaB. MeaslesC. Chicken poxD. Scarlet feverE. Mumps

???) Comparing measles (Rubeola) with German measles (Rubella) all of the following are true, except:The incubation period is shorterThe temperature is higherPre-rash symptoms are of longer durationKoplik's spots are pathognomonicSub-occipital lymph nodes are more prominent

10. Mumps.***) Regarding Mumps, all are true except:

A. Incubation period is 12-25 daysB. ParotitisC. ConjunctivitisD. OrchitisE. Encephalitis

***) The percent of persons who develop inapparent infection by Mixovirus parotitis (mumps) is:A. 5%B. 15%C. 20%D. 35%E. 55%

???) An 3,5 year old boy is brought with the history of fever and swelling in the left side of the neck of 2 days duration. All are true about the management of this boy, except:The extension of swelling behind the ear lobe helps pointing to mumps rather than cervical adenitisIn mumps the serum amylase is elevated while it is normal in cervical adenitisThe treatment of cervical adenitis is by penicillin GThe best way to differentiate mumps from cervical adenitis is by needle aspiration of the swelling for culture purposesIf this proves to be mumps immunity will be lifelong

11. Rubella (German Measles).***) Concerning rubella all of the following statements are true, except:

A. A large proportion of rubella cases are seen in infants and childrenB. Preventing infection of the fetus is a major objective of immunization programC. The only reliable evidence of rubella immunity is a history of having had the illnessD. 80-90% of young adults have serological evidence of post infection immunityE. Incubation period of rubella is 7-10 days

***) The syndrome of congenital rubella includes all of the following abnormalities, except:A. Heart diseaseB. Cleft palateC. Auditory defectD. Hepatosplenomegaly and jaundiceE. Meningo-encephalitis

***) Which one of the following is usually not regarded as a manifestation of congenital rubella:A. CataractsB. DeafnessC. MicrocephalyD. MeningoceleE. Hepatosplenomegaly

***) One of the following is true:A. Incubation period of mumps 21-28 daysB. Incubation period of varicella 7-14C. Incubation period of mononucleosis in adolescents is 2-3 weeksD. Incubation period of rubella is 14-21 daysE. Incubation period of measles is 14-18 days

12. Erythema lnfectiosum.***) The rash of erythema infectiosum appears first on the:FaceArmsTrunkLegsHands

13. Reye Syndrome.***) Reye’s syndrome is a disease characterized by;

A. EncephalopathyB. Encephalopathy with recent history of paracetamol intakeC. Encephalopathy with recent history of salicylate intakeD. Meningitis with history of salicylate intakeE. Meningo-encephalitis

14. Poliomyelitis.???) Which of the following disease has the longest incubation period:MumpsMeaslesDiphtheriaChickenpox

Poliomyelitis

???) Poliomyelitis is characterized by all of the following, except:Limbs weakness is symmetricalCerebrospinal fluid (CSF) cell count is high in the first weeks of illnessFibrillations are present on electromyography examinationCaused by virusPreventable by vaccination

Neonatology P62-P76.

1. Neonatal Care.***) Which of the following might increase fetal lung maturity in preterm delivery:

A. EstrogenB. ProlactinC. ThyroxineD. GlucocorticoidesE. Alpha fetoprotein

***) The umbilical stump of the newborn sloughs off after delivery about:A. 2nd dayB. 5th dayC. 10th dayD. 15th dayE. 21st day

***) The tidal volume of a normal newborn is about:A. 5 mlB. 50 mlC. 70 mlD. 120 mlE. 20 ml

***) The most common factor associated with neonatal death is:A. Birth injuryB. PrematurityC. Congenital malformationsD. Metabolic diseasesE. Intrauterine growth restrictions

***) One of the following is associated with small infants:A. Mothers with untreated gestational diabetesB. MultiparaC. Large parentsD. Maternal smokingE. Post-date pregnancy

***) The fine downy hair covering the skin of a newborn is called:A. Vernix caseosaB. LanugoC. MiliaD. Erythema toxicumE. Mottling

2. APGAR score.***) An infant at birth exhibits pink body with blue extremities, pulse rate of 120/min, lusty cry, limp muscle tone and irregular slow respiration. The Apgar score is:

A. 2B. 4C. 6D. 8E. 10

***) A newborn baby delivered with peripheral cyanosis, crying well, weak muscle tone, RR = 22/min irregular and HR = 80/min, his Apgar score:

A. 4B. 5C. 6D. 7E. 8

***) An infant born with good respiration, vigorous cry, heart rate of 105, moving all extremities, body pink and extremities blue. The Apgar score is

A. 10B. 9C. 8D. 7E. 6

***) All are component of APGAR score, except:A. Heart rateB. Blood pressureC. Respiratory effortD. ReflexesE. Skin color

3. Sepsis in the Neonate.***) Beta Hemolytic streptococci group A is responsible for all the following except:

A. Acute glomerulonephritisB. Rheumatic feverC. Neonatal sepsisD. Scarlet feverE. Impetigo

***) All of the following are predisposing factors of neonatal sepsis, except:A. HypothermiaB. Instrumental deliveryC. TwinsD. AmnionitisE. Umbilical infection

***) Predisposing factors for neonatal septicemia include each of the following, except:A. Febrile maternal illnessB. TwinsC. Frank amnionitisD. Umbilical infectionE. Endotracheal intubation

4. Cyanosis.***) All of the following can cause cyanosis, except:

A. Renal failureB. Congestive heart failureC. PolycythemiaD. ColdE. Cor pulmonale

***) A newborn, 12 hours old, cyanosed when he is quiet, becomes pink on crying, the most probable diagnosis is:

A. Respiratory distress syndromeB. Congenital pneumoniaC. Diaphragmatic herniaD. Intracranial hemorrhageE. Bilateral choanal atresia

5. Respiratory Distress.***) The most likely finding in a neonate with asphyxia is:

A. AlkalemiaB. HypoxiaC. HypocapniaD. TachycardiaE. Increased anal sphincter tone

***) The features of respiratory distress in newborn are the following, except:A. TachypneaB. Flaring of nostrilsC. CyanosisD. Grunting on expirationE. Projectile vomiting

***) Compliance of the lung is increased in which of the following:A. Diffuse pulmonary fibrosisB. Pleural thickeningC. Healed tuberculosis with scarringD. EmphysemaE. Hyaline membrane disease

***) Regarding hyaline membrane disease all of the following are true, except:A. Tachypnea is always presentB. Affects mainly premature babiesC. Expiratory grunting is presentD. The clinical picture will develop within 4-6 hoursE. Oxygen by mask is the best management

6. Diaphragmatic Hernia.***) The high postoperative mortality for newborn with congenital diaphragmatic hernia is due to:

A. Increased intra-abdominal pressureB. Persistent patent ductus arteriosusC. Failure of the collapsed lung to expandD. Mediastinal shift with impaired venous returnE. Abnormal pulmonary microvasculature

***) An infant is delivered at full term by a spontaneous vaginal delivery to a 29 year old primigravida. At delivery, the infant is noted to have subcostal retractions and cyanosis despite good respiratory effort. The abdomen is scaphoid. On bag and mask ventilation, auscultation of the lungs reveals decreased breath sounds on the left, with heart sounds louder on the right:

A. Dextrocardia with situs inversusB. Diaphragmatic herniaC. PneumoniaD. Pulmonary hypoplasiaE. Spontaneous pneumothorax

7. Hypoglycemia.***) All the following are associated with hypoglycemia in the newborn, except:

A. Neonatal asphyxiaB. Cold stressC. Diabetic motherD. SepsisE. Rh-incompatibility

***) All of the following statements are correct about hypoglycemia, except:A. It may associate neonatal asphyxiaB. It may be manifestation of nesidioblastosisC. Glucagon and steroids may be used as treatment lineD. Blood sugar of 45mg% is normal in full term infantsE. Ketotic hypoglycemia is rare cause of hypoglycemia in childhood

8. Jaundice.***) Neonatal jaundice is seen in all the following except:

A. Breast feedingB. HypothyroidismC. Sickle cell diseaseD. GalactosemiaE. Septicemia

***) Physiological jaundice is characterized by all of the following, except:A. Onset after 36 hours of lifeB. Disappears by 10-14 days of lifeC. Associated always with anemiaD. The total serum bilirubin does not exceed 14 mg% E. The direct bilirubin does not exceed 1.5 mg%

***) All of the following are criteria for physiological jaundice, except:A. Starts within the first 24 hoursB. The total serum bilirubin does not exceed 14 mg/dlC. The direct bilirubin does not exceed 1.5 mg/dlD. It will disappear within 7-10 days in full termsE. It does not need treatment by phototherapy

***) In a 12 hours old newborn that has jaundice the roost likely diagnosis of the following is:A. Erythroblastosis fetalisB. Physiological jaundiceC. Biliary atresiaD. Liver enzyme deficiencyE. Galactosemia

***) Jaundice appearing in the first day of life suggests one of the following:A. Hemolytic disease of the newbornB. HypothyroidismC. Bile duct atresiaD. Breast milk jaundiceE. Liver enzyme deficiency

***) All of the following are causes of neonatal jaundice during the first 24 hours of life, except:A. ABO incompatibilityB. SpherocytosisC. Biliary atresiaD. G6PD deficiencyE. Rh-incompatibility

***) A 2 months old baby is having loose yellow motions after each breastfeeds since birth, body weight is 4.5 kg. The most appropriate action is:

A. Stop breast feeding and give lactose free formulaB. Stop breast milk and start WHO solutionC. Admit to hospital for investigationD. Give antidiarrheal medicineE. Reassure the mother that her baby is well

***) All of the fallowing increases the risk of neonatal jaundice, except:A. PrematurityB. Trisomy 21C. Elective caesarean sectionD. Congenital hypothyroidismE. Cephalohematoma

9. Necrotizing Enterocolitis (NEC).***) All of the following are predisposing factors for developing necrotizing enterocolitis NEC, except:

A. PrematurityB. PolycythemiaC. Breast milk feedingD. Umbilical catheterizationE. Perinatal asphyxia

***) Concerning necrotizing enterocolitis all are true, except:A. Affects mainly preterm babiesB. Pneumatosis intestinalis is pathognomonicC. It has very good prognosisD. Exchange transfusion is a predisposing factorE. It may occur during the second or third week of life

10. Neonatal Skin Conditions.***) Epstein's pearls on the hard palate of a newborn should be managed with:

A. Topical antibioticsB. Topical steroidsC. ExcisionD. Hydrogen peroxideE. No therapy

***) One of the following conditions in the newborn needs immediate management:A. MiliaB. Mongolian blue spotsC. Intact meningomyeloceleD. Capillary hemangiomaE. Erythema toxicum

Nephrology P76-P81.

1. Dehydration.***) A 9 month old infant presented with the following lab results, scrum (Na 160meq/l), (K 4meq/l), BUN 28mg%, Blood sugar 180mg%, the calculated serum osmolality is:

A. 375B. 184C. 300D. 248E. 348

***) One year old child with gastroenteritis and moderate dehydration is vomiting, ORS is given to him, the next most appropriate step is to:Stop all feeds for 12 hours and try againDilute the ORS and give itGive small frequent ORS amounts using spoonGive i.v. fluids containing 10% G/WPut nasogastric tube and give antibiotics i.m.

***) The simplest proper oral replacement solution is done by giving the infant with gastroenteritis is one of the following:Half strength milkPlain waterSalt and glucose added to the waterGlucose added to the waterSalt added to the water

***) Regarding hyper-natremic dehydration all are true except:Serum sodium is more than 155 mmol/LLeads to intracellular dehydrationDoughy like skinThe correction should be done very quickly within 4-6 hoursConcentrated ORS could be the cause

***) All of the following are usually signs of severe dehydration, except:Very sunken eyesDecreased skin turgorOliguriaRapid pulseThe child drinks fluids eagerly

***) One of the following measures is appropriate to the management of a 10 months old infant with mild gastroenteritis:Advise the mother to give him only rice water for 24 hours and to do stools cultureAdvise the mother to give ORS (Aquasal) and to continue normal dietPrescribe antiemetic suppositoriesPrescribe antiperistaltic drugs to suppress gut motilityAvoid any food and milk for 24 hours and to give only amoxicillin syrup

***) All of the following are features of moderate dehydration, except:Dry mucous membranesOliguriaSunken eyesDecreased skin turgorDepressed anterior fontanel

2. Fluid and Electrolyte Therapy.***) The average fluid requirement in a one year old child is:

A. 30-40 ml/kg/24hrsB. 40-60 ml/kg/24hrsC. 70-80 ml/kg/24hrsD. 80-100 ml/kg/24hrsE. 100-120ml/kg/24hrs

3. Hemolytic Uremic Syndrome (HUS).***) The most common cause of acute renal failure in childhood is:

A. Acute glomerulonephritisB. Hemolytic-uremic syndromeC. Renal vein thrombosisD. Minimal change nephrotic syndromeE. Pyelonephritis

4. Nephritic Syndrome.***) A child with early stage renal failure is at high risk of developing all except:EdemaPolyuriaHypertensionSeizuresCongestive heart failure

5. Nephrotic Syndrome.***) About post streptococcal glomerulonephritis in children all are true, except:Follows upper respiratory tract infectionsFollows streptococcal skin infectionsMost patients go into chronic phaseCauses low C3Causes red blood cell casts in urine

***) All of the following in children with nephrotic syndrome are true, except:A. Steroid resistance is associated with a poor prognosisB. Patients should receive high protein, low fat dietC. Minimal lesion nephrosis is the most common type seen in childrenD. Low salt diet is important during relapseE. Patients are susceptible to gram positive organisms during relapse

***) Concerning minimal lesion nephrotic syndrome all of the following are true, except:A. It is the commonest cause of nephrotic syndrome in childrenB. Always progresses to renal failureC. Gross albuminuria is a recognized featureD. Relapse is commonE. In children most cases respond to steroids

***) Nephrotic range proteinuria in children is defined as:A. More than 150 mg protein in a 24 hour urine collectionB. More than 10 mg protein in urine per kg of body weight per dayC. More than 50 mg protein in urine per kg of body weight per dayD. More than 2.5 g protein in a 24 hour urine collectionE. Protein more than 50 mg per kg of body weight per hour in urine

???) Regarding nephrotic syndrome in children is correct:Lupoid (minimal changes) type is the commonestMost patients recover completelyKidney biopsy is always indicatedHyperkalemia is commonMost of them end in the end stage renal

Neurology P81-P87.

1. Seizure Disorders.***) Concerning neonatal convulsions, all the following are true except:The usual tonic-clonic are not common, but tonic convulsions are the commonest in pre-maturesSubtle type is the commonest form and hypoxic ischemia encephalopathy is the most common causeDifferential diagnosis includes JitterinessPhenobarbitone is considered to be the drug of choice for neonatal seizureEtiology: hypoglycemia, hypocalcemia, and hypermagnesemia

***) Commonest type of neonatal seizures is:Generalized tonic clonicSubtle typeTonic typeClonic typeMyoclonic type

***) Possible causes of convulsions in neonate include all of the following, except:HypocalcemiaHypoglycemiaFebril convulsionsPyridoxine deficiencyIntracranial hemorrhage

***) Convulsions in a premature newborn could be caused by all of the following, except:Brain anoxiaHypokalemiaHypoglycemiaHypocalcemiaKernicterus

***) Neonatal convulsions can be caused by all except:HypoglycemiaHypoxic-ischemic encephalopathyPyridoxin deficiency (Vit B6)High feverHypocalcemia

***) The differential diagnosis of "staring" in a child includes all of the following, except:Absence seizurePartial complex seizureDay dreamingClonic seizureDrug intoxication

2. Febrile Seizures.***) Criteria for diagnosis of febrile convulsions include all the following except :Age 6 months to 5 yearsPresence of feverAbsence of CNS infectionAbnormal electroencephalography EEGPositive family history of febrile convulsions

***) Concerning febrile seizures one of the following is true:Do no harm to most healthy childrenAre associated with low grade meningitisNever occur after 3 yearsProduce permanent EEG changes Require therapy with rnysoline

***) All of the following are risk factors for increase recurrence of febrile convulsions, except:Older age of onset (more than 4 years)Prior neurological abnormalityFamily history of febrile convulsionsFamily history of non-febrile convulsionsComplex febrile seizures

***) All of the following statements are correct about simple febrile convulsions (SFC), except:Age range is 6 months - 6 yearsIncidence of subsequent epilepsy is double the general populationsRisk of recurrence for a 4 year old child presenting with first attack of SFC is 10%

The younger the age of onset of SFC the higher is the recurrence rateIQ in late onset of SFC is usually decreased by 15 points below the mean of the general population

Answer: 5* IQ in late onset of SFC is usually decreased by 15 points below the mean of the general population

3. Hypotonia.***) Treatable causes of hypotonic infant include all of the following, except:Myastenia gravisRicketsMalnutritionChronic demyelinating polyneuropathyDystrophies

***) One of the following statements is correct about floppy infant:Suprasegmental (central) causes are commoner than segmental (peripheral) onesMuscle disease is the commenest segmental (peripheral) cause of floppy infantsThere are no treatable causes for floppy infantAnterior horn cell disorder is considered to be supra segmental causeTongue fibrillation are caused only by suprasegmental causes (central)

4. Cerebral Palsy (CP).***) In kernicterus infants staining of the brain is more intense in the:

A. Basal ganglionB. Cerebellar vermisC. Cerebral cortex, motor areasD. Spinal cordE. Corpus callosum

***) Patients with severe cerebral palsy usually die because of:Urinary tract infectionsChest infectionsMeningitisHeart failureHepatic failure

***) All of the following are clinical features of basal ganglia disorders, except:ChoreaAthetosisDystonia

MyotoniaHypertonia

***) Methylphenidate (Ritalin) is a drug used in the treatment of one of the following disorders:A. MigraineB. Tension headachesC. Hyperkinetic behaviorD. VertigoE. Epilepsy

Oncology P87-P90.

1. Leukemia.***) The commonest malignancy in childhood is:

A. Acute monocytic leukemiaB. Acute lymphocytic leukemiaC. Chronic lymphocytic leukemiaD. NeuroblastomaE. Ewing's sarcoma

2. Neuroblastoma.***) Regarding neuroblastoma all of the following are true, except:Elevated catecholamine level in urine is specific diagnostic featureIncreased vanillylmindalic acid in most casesFinal diagnosis depends upon the histological characteristic of tumor or biopsyPolycythemia is commonNeuroblastoma is a tumor of young children

3. Rhabdomyosarcoma.***) Rhabdomyosarcoma is:Benign tumor of skeletal muscleMalignant tumor of smooth muscleMalignant tumor of skeletal muscleBenign tumor of smooth muscleMalignant tumor of bone

***) The most frequently seen malignant urinary bladder tumor in children is:Melanocarcinoma

Epidermoid carcinomaSquamous cell carcinomaRapdomyosarcoma botryoidesLeiomyosarcoma

Respirology P90-P95.

1. Croup.***) Croup could be caused by all of the following, except:LaryngomalaciaForeign bodyTracheomalaciaLaryngitisTetany

***) Differential diagnosis of croup in children includes each of the following, except:Foreign bodyCystic fibrosisLaryngitisEpiglottitisRetropharyngeal abscess

***) Which of the following groups of viruses cause respiratory infection mainly in babies and infants:AdenovirusesParainfluenza virusesEnterovirusesCoronavirusesRotaviruses

2. Bronchiolitis.***) The most common cause of bronchiolitis is:Respiratory syncitial virusAdeno virusRhino virusMetapneumo virusCoxsakie virus

***) Concerning bronchiolitis all are true, except:Affects children during the first year of lifeMore common in winter timeCaused by respiratory syncytial virusTachypnea and cyanosis are presenting featuresMales are more affected than females

***) Concerning bronchiolitis all of the following are true, except:The onset is sudden with dyspneaCough is present and severe alwaysChanges of developing cyanosis and acidosis is highAll of the diagnosed cases should be admitted and treated in the hospitalThe drug of choice is cloxacillin

3. Asthma.***) Concerning bronchial asthma in children all of the following is true, except:

A. Common disorder in childrenB. Usually precipitated by viral infections in the toddler age groupC. Is characterized by alveolar collapseD. Is common at nightE. Bronchospasm may be precipitated by house dust or mite in the bed clothes

***) A 5 years old boy admitted as a case of status asthmatics. All of the following are of value in the acute management of this patient, except:

A. Chest X-rayB. IgE levelC. Sinus X-rayD. CBC (Complete blood count)E. Arterial blood gases

***) Appropriate treatment of status asthmatics includes all of the following, except:A. AminophyllinB. Mist tentC. Oxygen by nasal catheterD. Intravenous fluidsE. Corticosteroids

***) Regarding bronchial asthma in childhood all are true except:Inflammatory respiratory disordersMost children can out grow it by puberty

Prognosis depend on severityBronchiolitis is important differential diagnosisB agonist are more effective orally than by inhalation

***) Concerning asthma all are true, except:Inhaled steroids are useful in the treatmentWheeze on auscultation is one of the symptomsIt is seldom a cause of hospital admissionExacerbation of symptoms can occur with exercisePatients should be excluded from sport at school

***) The commonest respiratory symptom is:Sputum productionHemoptysisCoughBreathlessnessWheeze

4. Cystic Fibrosis (CF).***) All of the following are presentations of cystic fibrosis, except:Meconium ileusReccurent chest infectionsFailure to thriveSteatorrheaCongenital heart disease

Rheumatology P95-P99.

***) In septic arthritis of the hip joint in infants, one of the following is not true:Rapid destruction of the hip is the most striking featureStaphylococcus aureus is now the predominant invaderA femoral venipuncture is a point of enter of the infecting microorganismAs a rule the baby is very ill with signs of general toxemia and high feverLocal examination may fail to reveal the true nature of the disease in its early stages especially if antibiotics had been given

***) A 3 years old presents to you with a two months history of spiky fever and refusal to walk. Physical examination revealed a sick looking child, painful movements of the extremities and splenomegaly. The most likely diagnosis is one of the following:Rheumatic feverScurvyJuvenile ankylosing spondilitisDermatomyositisJuvenile rheumatoid arthritis

1. Henoch-Schonlein Purpura.***) Regarding Henoch-Schonlein purpura, all are true except:Is a vasculitis of small blood vesselsIs the most common cause of non-thrombocytopenic purpuraTypically follow upper respiratory tract infection.Most cases occur between 2-8 years of agePlatelets function is abnormal

2. Kawasaki Disease.???) Concerning Kawasaki disease, all the following are true except:Patients are more than 7 years oldFever is present in all cases for over 5 days and does not respond to antibioticsCoronary artery aneurysms develop during the second week of illnessRash: truncal, polymorphous, non-vesicularBilateral conjunctival injection, injected pharynx, strawberry tongue

***) Regarding Kawasaki, all statements are true except:Age of onset is less than 5 yearsHigh grade fever more than 5 days is essential criteriaIs the commonest cause of acquired cardiac disease in developing countries20% of untreated patients develop coronary artery abnormalitiesHas differential diagnosis with scarlet fever

***) Gamma-globulin may be used in the management of children with all of the following conditions, except:Premature baby with sepsis

Child with X-linked agammaglobulinemiaChild with recurrent infection due to IgA deficiencyMeasles prophylaxis in a susceptible childHepatitis A prophylaxis in a susceptible child