Pediatrics

By: Alhag Abu Anzeh Muhammad (baghdats@yahoo.com)

07.10.2013:
51.9 years old boy is seen with skin rash, he has had for the past 2 days. The rash is mostly on the trunk and seems to come and
go. The rash is red and slightly raised, appears to migrate and is non pruritic. He gave a history of having a sore throat about 2
weeks ago, and has had some low grade fevers and joints pains. An ASO titer is 1625.
Which one group of findings would confirm the diagnosis of acute rheumatic fever?
A. arthralgia, no fever, rash resembling erythema multiform.
B. subcutaneous nodules, fever, arthralgia
C. erythema multiform, arthralgia, prolonged PR interval on ECG
D. arthralgia, fever, no rash, ESR 120
E. arthritis, no fever, ESR 10
52. A 2 year old boy is seen because of pallor, he drinks 600 cc of cows milk per day ,a CBC reveals hemoglobin 8.2 g/l , MCV 65,
which of the following indicates is compatible with the patients diagnosis?
A. decrease red blood cell distribution width
B. increase serum ferritin
C. increase total iron biding capacity
D. increase reticulocyte count
E. increase serum iron level

53.1 month old baby is seen for regular checkup. Examination is completely normal, but the mother is concerned that her
baby's feet are crooked. The forefoot is deviated medial and there is a prominence at the base of the fifth metatarsal. The
forefoot can be easily manipulated into the normal position. In discussion the child condition with the mother,
which is the most accurate information to discuss.
A. The condition is usually unilateral
B. radiological evaluation should be performed early
C. Most cases will resolve spontaneously without treatment
D. Even if the foot is flexible casting is needed if the foot is not straight by 2-3 months
E. Surgery is required in about half of cases
54. An 18 year old female, u have followed for 6 years, has recently married , she & husband are planning to
start a pregnancy .u advise her to start taken folic acid , this is important to prevent ?
a.prematurity
b.skull defects
c.chromosomal defects
d.neural tube defects
e.osteopenia

55. you are seeing a 2 year old boy for evaluation of speech delay. the mother says he has 5 words and answers all commands.
after detailed history you are concerned about hearing deficit.
what would be the best next step in the evaluation?
A. audiogram
b. head MRI
c. EEG
d. speech therapy referral
e. head ct with special attention to inner ear

56. a 4 year old boy presents to you with fever of 39C and cough. on physical examination you hear crackles over his left lower
lobe region. there is no wheezing and he has been previously healthy. you order chest x ray in which you find a consolidative
infiltrate in the left lower lobe behind the heart consistent with the diagnosis of pneumonia.
what is the most likely pathogen to be found in this case?
a. staphylococcus aureus
b. streptococcus pneumonia
c. mycobacterium tuberculosis
d. neisseria meningitis
e. respiratory syncytial virus

57. full term newborn infant is having episodes of cyanosis and apnea which are worse with attempting to feed but seem better
with crying.
which of the following is the most important next step to quickly establish the diagnosis ?
a. echocardiogram
b. ventilation perfusion scan
c. passage of catheter into nose
d. hemoglobin electrophoresis e. bronchoscopic evaluation of palate and larynx
58 : As you are about to step out of a newly delivered mothers room, she mentions that she wants to breast-feed her healthy
infant, but that her obstetrician was concerned about one of the medicines she was taking.
Which of the womans medicines, listed below, is clearly contraindicated in breast-feeding?
a.Ibuprofen as needed for pain or fever
b.Labetalol for her chronic hypertension
c.lithium for her bipolar disorder
d.Carbamazepine for her seizure disorder
e.Acyclovir for her HSV outbreak
59. A 2-year-old boy has been doing well despite his diagnosis of tetralogy of Fallot. He presented to an outside ER a few days
ago with a complaint of an acute febrile illness for which he was started on a pink antibiotic. His mother reports that for the
past 12 hours or so he has had a headache and is more lethargic than normal. On your examination he seems to have a severe
headache, nystagmus, and ataxia.
Which of the following would be the most appropriate first test to order?
a.Urine drug screen
b.Blood culture
c.Lumbar puncture
d.CT or MRI of the brain
e.Stat echocardiogram

60. A 6-year-old boy had been in his normal state of good health until a few hours prior to presentation to the ER room. His
mother reports that he began to have difficulty walking, and she noticed that he was falling and unable to maintain his balance.
Which of the following is the most likely cause for his condition?
a.Drug intoxication
b.Agenesis of the corpus callosum
c.Ataxia telangiectasia
d.Muscular dystrophy
e.Friedreich ataxia
61.A previously healthy 8-year-old boy has a 3-week history of low-grade fever of unknown source, fatigue, weight loss,
myalgia, and headaches. On repeated examinations during this time, he is found to have developed a heart murmur, petechiae,
and mild splenomegaly. Which of the following is the most likely diagnosis?
a.Rheumatic fever
b.Kawasaki disease
c.Scarlet fever
d.Endocarditis
e.Tuberculosis
62.Regarding resuscitative efforts in child, the most important goal is:
a.Restoration of age-appropriate heart rate.
b.Appropriate movement of the chest wall.
c.Auscultation of equal breath sounds in both lungs field.
d.Adequate oxygen delivery and utilization for the body tissues.
e.Palpation of equal pulses in all four extremities.
63.A 9 month old boy is brought to the emergency room in limp and unresponsive state. Initial examination shows a pulse rate
of 35 /min and occasional irregular breaths. After initiation of cpr (including tracheal intubation) delivery of oxygen via positive pressure breaths and chest compression, multiple attempts to insert an intra - venous line fail.
The most appropriate next step in management should be:
a.obtain an arterial blood gas sample
b.place in intraosseous needle and administer fluids and intropic agents
c.obtain a "state" head ct study to evaluate reasons for unresponsiveness
d.place transthoracic cardiac pacemaker
e.place a thoracotomy tube to evacuate a possible pneumothorax

64.The recommended treatment for severe combined immunedeficiency is:

a.gene therapy
b.monthly IVIG
c.monthly IVIG and IFN-g
d.monthly IVIG and IL-8-monoclonal antibody
e. stem cell transplantation

65.A 12-yr old white girl present with arthralgia of the knees and elbow and swollen hands of 6 months duration. She has
intermittent fever and has lost 5 kg in weight. Other than swollen joints, findings on physical examination are normal. 3 years
earlier, she was found to have thrombocytopenia and was diagnosed with idiopatic thrombocytopenia purpura . In addition,
one summer, she had severe sunburn, and 2 years ago she had mouth sores. Today she has a positive combs test, and the
urinalysis shows multiple Red Blood Cells. The most likely diagnosis is:
a.JRA
b.ITP
c.evans syndrome
d.periarteritis
e.SLE
66. A newborn is found to have congenital heart block. Which of the following is the most likely etiology?
a.Group B streptococcal infection.
b.Neonatal echovirus infection.
c.Gestational diabetes.
d.Maternal lupus .
e.Gray baby syndrome
67. A 12-years old boy develops progressive symptoms of fever, lassitude, arthralgias, headache and abdominal pain. Physical
examination shows hepatosplenomegaly. Further questioning discovers that he and his family live in a rural area and include
unpasteurized dairy products in their diet.
The the most likely etiologic agent of this illness is:
a.actinomyces
b.bartonella hensallae
c.brucella
d.francisella tularensis
e.Yersinia enterocolitica

68.A 5 years old is noted by the parents to snore at night. The child also has had problems staying awake in preschool and has
had behavioral problems. The father also snores. Physical examination of the child reveals large, pink, nonexudative tonsils. The
most appropriate next step is:
a.Laryngoscopy
b.Polysomnography
c.Ambulatory apnea monitoring
d.Telemetry
e.Arterial blood gas analysis

69.The appropriate therapy for severe obstructive sleep apnea syndrome in a 4 years old boy is :
a.Adenotonsillectomy
b.Tracheostomy
c.Parapharyngeal muscle surgery
d.Ventolin
e.Bilevel positive airway pressure

70. A 7 months-old girl present with temperature 40 C, BP 70/30mmHg, diffuse petechiae first noted 4 hours before
presentation. Platelets count 88,000/mm3, and white blood cell count of 43,000/mm3 with 23% neutrophils and 42% bands.
The infant has received all recommended vaccination.
Which of the following is the most likely bacterial etiology of this presentation?
a.staphylococcus aerus
b.streptococcus pneumonia
c.neiserria meningitides
d.haemophyllus influenza type b
e.Escherichia coli o 157:H7

71. A 10 year old boy with 4 day fever, temperature 40, with watery diarrhea. Presented with a generalized seizure.
Which of the following is the causative agent?
a. salmonella gastroenteritis
b. aeromonas gastroenteritis
c. shigella gastroenteritis
d. rotavirus
e. drug ingestion
72.Which of the following reflexes is normally absent in a newborn?
a. Startle (Moro)
b. hand grasp
c. crossed adductor
d. Asymmetric tonic neck
e. parachute
73.A 2 year old boy is admitted to the hospital with high fever for 6 days, swelling of the hands and fee ,
scarlentin form changes of the tongue, generalized red macular rash, high sedimentation rate and thrombocytosis.
Which of the following is the best initial management?
a. cardiac catheterization
b. IVIG & aspirin orally
c. low dose aspirin orally
d. I.V pulse corticosteroids
e. methotrexate orally
74 .10-month-old infant has poor weight gain, a persistent cough, and a history of several bouts of pneumonitis.
The mother describes the child as having very large, foul-smelling stools for months.
Which of the following diagnostic maneuvers is likely to result in the correct diagnosis of this child?
a. CT of the chest
b. Serum immunoglobulins
c. TB skin test
d. Inspiratory and expiratory chest x-ray
e. Sweat chloride test

75.A 7-month old with short hut syndrome receives total parenteral nutrition.
Which of the following is most typical complication of this therapy?
a. sepsis
b. renal failure
c. chronic diarrhea
d. vitamin A deficiency
e. irreversible atrophy of the mucosa of the small intestine
76.The signs and symptoms of meningitis can be different than in adult.
Which of the following signs and symptoms of meningitis is more helpful in adult patient than in a 3-month old?
a. lethargy
b. jaundice
c. vomiting
d. Brudzinsky sign
e. hypothermia
77.You are called to delivery of a women with no parenteral care. Her examination reveal oligohydroamnion.
When you get to the newborn at the nursery you should carefully evaluate him for which of the following:
a. anencephaly
b. trisomy 18
c. renal agenesis
d. duodenal atresia
e. tracheoesophageal fistula
78 .A newborn infant become markedly jaundiced on the second day of life and faint petechia eruption first noted at birth. He
has now a generalized purporic rash. Hematology study for hemolytic disease are negative.
Acute management should include which of the following?
a. liver ultrasound
b. isolation of infant from pregnant hospital personnel
c. urine drug screen of the infant
d. discharge with early follow-up visit in 2 days
e. thyroid hormone assessment
79. 18 month boy was seen by his 15 year old brother that he is holding in his mouth the contents of a bottle with drain cleaner.
Best treatment:
a.Induce vomiting
b.Endoscopy within 12-24hrs
c.Activated chorcal
d.Neutralize with special liquid for balanced ph.
e.Administer big amounts of water or milk.

80. you see a 12 months boy because he is refusing to walk. His mother tells you that he started walking at 10 month and was
developing normally until this moment.
On examination: t 39.0C, baby looks mildly ill with medially rotated left hip and limitation of active and passive motions.
a.Neisseria gonorrhea
b.Adenovirus
c.S. aureus
d.Group A streptococcus
e.Group B streptococcus
81. Because of abnormal spleen functions and high risk of bacterial infections, infants, who have sickle cell anemia get penicillin
prophylaxis at age of 4 weeks.
To which organisms infants with sickle cell anemia are mostly sensitive?
a.Gram negative
b.Encapsulated organisms
c.Fungal infections
d.Viruses
e.Staphylococcus
82. A 9 year-old patient asthmatic patient uses albuterol 3 times per week, for the last 10 days she had wheezing day and night
,increased the inhaler to 3-4 times a day.
on examination there is a diffuse wheezing with moderate subcostal retraction, next step in management:
a. order chest XR to assess for pneumonia
b. Systemic steroids
c. Lekutriens
d. Low dose inhalation steroids
e. Start 5 days course of systemic corticosteroid
83. 12 months old girl is development delay noted with watery diarrhea with odor 2 times a day. Serological analysis reveals
increased levels of antibodies to transglutaminasa in serum.
Which product does not cause exacerbation or symptoms of this disorder?
A. rice
B. wheat
C. oat
D. barley
E. rye
84. 4 year old boy with impaired verbal and nonverbal communication and lack of empathy.
Doesnt have any friends in the kindergarden.
Diagnosis:

a.Attention deficit hyperactivity disorder

b. Deaf mutism
c.Autism
d.Cerebral palsy

85. 1 month old boy with food intolarence, slow weight gain and a large tongue.
On examination you note a large rear fontanelle and umbilical hernia.
The next step in diagnosis:
a.Abdominal x-ray
b.CBC and blood culture
cX-ray with barium contrast
d.Serum TBG
e.Hispitalization for further examination.
86. patient with Down syndome refers to you as during the week he had bleeding gums.
Chils less energetic than usual.
Examination: t 37.8C per os, pallor, splenomegaly, bleeding gums and bruising on the lower extremities.
Diagnosis:
a.Aplastic anemia
b.ITP
c.Leukemia
d.Leukemoid reaction
e.Megaloblastic anemia

87. A recommended diet for a 3 years old child with cystic fibrosis ?
a. Folate
b. Sodium
c. Vitamin C
d. Vitamin D
e. Vitamin B12
88. A 6 month healthy girl having fever 38.9c , no accompanying symptoms, urinalysis shows 1+ leukocytes 10WBC per
high - powered field and moderate bacteria. Most reasonable step to take?
A. Obtain relabel US
B. begin broad spectrum intravenous antibiotic
C. Obtain DMSA renal scan
D. Obtain a urine culture by catheter and start antibiotic
89. 10 years old girl has a cold for 14 days, in the 2 days prior to the visit she has developed a fever of 39c, purulent nasal
discharge, facial pain and dry cough. Examination of the nose after topical decongestant shows pus in the middle meatus, which
is most likely diagnosis ?
A. Brain abscess
B. maxillary sinusitis
C. Streptococcal throat infection
D. Retro pharyngeal abscesses

90. 2 months old child is seen in your clinic for the first time, the child was born at home and this is the first well child visit. Risk
factors for infant botulism that should be communicated to the parents include?
A. Gardening
B. Homs construction
C. Frozen vegetables
D. Honey
E. Eggs

91. Which of the following cancers occur primarily during childhood ?

A. Breast cancer
B. renal cel cancer
C. Wilm's tumor
D. Prostate cancer
E. Colon cancer
92. 10 years old girl has had diplopia and ptosis and weakness of her neck flexors for 2 months, symptoms are worse in the
evening and are usually less severe at awakening in the morning, she has no fasciculation or myalgias and her deep tendon
reflexes are normal.
The most likely diagnosis?
A. Hysterical weakness
B. muscular dystrophy
C. Spinal muscular atrophy
D. Botulism
E. Myasthenia gravis
93. 7 days old boy is admitted to the hospital for evaluation of vomiting and dehydration. Physical exam is normal except for
minimal hyper pigmentation of the nipples. Serum sodium and potassium concentrations are 120meq/L ( low) and 9meq/ L (
high ).
Respectively which of the following is the most likely diagnosis ?
A. Pyloric stenosis
B. congenital adrenal hyperplasia
C. Secondary hypothyroidism
D. panhypopituitarism
E. Hyper aldosteronism
94. 12 year old girl experience acute monocular blindness of 2 days duration, past medical history reveals that she has had
headache for the past 3 years that she cannot characterize on the brief episode of diplopia and one episode of parethesiasis of
the feet, these episodes were not related in time did not occur in immediate proximity to the headache and resolved
spontaneously. Findings on physical examination including funduscopic examination are unremarkable other than reduced
visual acuity.
The most important diagnostic step is to perform ?
A. CT
B. MRI
C. An ECG
D. Peripheral nerve conduction test
E. A sural nerve biopsy
95. Trisonomy 21 is most commonly associated with:
a.malrotacion
b.atrioventricular canal
c.cleft palate
d.renal failure
e.sensory neural hearing loss
96. infant sits with minimal support who attempts often a toy beyond renal and who roles our prone supine to the prone
position didnt have pincer grasp which is level development:
a.2 month
b.4 month
c.6 month
d.1 year

97.a previously healthy full term 15 month old present to the emergency room with a history of sudden onset of rectal
bleeding . his parents deny fever , diarrhea abdominal pain 3 times bright red blood per rectum stable hemodynamic , hb 11
mg dl ,
Which of the following test most likely to the correct diagnosis:
a.shunt x-ray to the abdomen
b.abdominal ultrasound
c.ct of the abdomen
d.mickel scan
e.upper GI series
98. A 16-year-old girl presents with lower abdominal pain and fever. On physical examination, a tender adnexal mass is felt.
Further questioning in private reveals the following: she has a new sexual partner; her periods are irregular; she has a vaginal
discharge.
Which of the following is the most likely diagnosis?
a. Appendiceal abscess
b. Tubo-ovarian abscess
c. Ovarian cyst
d. Renal cyst
e. Ectopic pregnancy
99.7 y.o boy has crampy abdominal pain and rash in the back and his legs and buttocks .
Laboratory test proteinuria and microhematouria wich of the following is the most likely diagnosis:
a.SLE
b.Henoch-Schonlein purpura
c.PSGN
d.Takayasu arthritis
e.Dermatomiosites
100.which of the following causes of conginital infection is associated with cats:
a-cytomegaloviros
b-rubella
c-toxoplasma gondo
d-syphilis
e-parvoviros b 19

18.02.2013:
1. The breast fed infant of a mother who is a strict vegetarian may experience deficiency of which of the following vitamins if
the mother is not receiving supplements of the vitamin?
A. Vit B1
B. Vit B4
C. Vit B12
D. Vit C
E. Vit D
2. A 6-year-old girl who was previously healthy presents with a 1 week history of nocturnal perianal itching. There are no other
symptoms and findings on physical examinations are normal. The most appropriate therapy is:
A. Bacitracin ointment to the perianal area
B. Diphenhydramine orally as needed for itching
C. Single oral dose of mebendazole repeated in 2 weeks
D. A 2 week course of amoxicillin/clavulanate
E. Ketoconazole in a single dose

3. A child suffers a provoked bite from a stray dog that was captured by animal control and appears healthy. The most
appropriate action would be to:
A. Confine and observe the dog for 10 days for signs suggestive of rabies
B. Submit the dog's head for examination for rabies
C. Begin rabies vaccination
D. Administer human rabies immune globulin (HRIG) and begin rabies vaccination
E. None of the above because it was a provoked attack

4. A mentally retarded 14-year-old boy has long face, large ears, micropenis and large testes. Chromosomal analysis is likely to
demonstrates which of the following?
A. Trisomy 21
B. Trisomy 18
C. Trisomy 13
D. Fragile X syndrome
E. Williams syndrome
5. A 10-year-old boy is examined because of recurrent headaches. The headaches started 6 months ago and occur about once a
month. He is asymptomatic between episodes. Each headache begins with blurry vision and abdominal pain, followed by rightsided, throbbing pain. It lasts about 60 minutes, during which he feels better if he takes some ibuprofen and rests in a darkened
room. The most likely diagnosis is:
A. Brain abscess
B. Seizure disorder
C. Migraine
D. Todd's paralysis
E. Maxillary sinusitis

6. A 2-year-old boy is seen in your office because of fever, ear pain, and postauricular swelling, erythema, and tenderness. The
pinna protrudes out on the involved side. The tympanic membrane is red and bulging, with decreased mobility seen on
pneumatic otoscopy. The angle of the jaw is easily palpated and the opening to Stensens duct appears normal. The patient has
never had an MMR vaccine. The most likely diagnosis is:
A. Bacterial parotitis
B. Mumps
C. External otitis
D. Acute mastoiditis
E. Chronic mastoiditis

7. New parents ask you how to reduce the chance of their baby suffering from sudden infant death syndrome (SIDS). You tell
them to place the child in which of the following for sleep?
a. Supine position
b. Prone position
c. Seated position
d. Trendelenburg position
e. A hammock
8. An 8-year-old girl is brought to the hospital while actively seizing. She has been hospitalized many times before for status
epilepticus. She is receiving valproic acid at home to control the seizures. The first step in the management of this patient is to:
A. Administer 20 mL/kg 0.9% normal saline
B. Establish secure intravenous access and administer an anticonvulsant
C. Administer activated charcoal via NG tube
D. Stabilize airway and provide 100% oxygen
E. Perform gastric lavage
9. A 5-year-old boy presents with a history of grossly bloody urine, puffy eyes, and headache for one day. He has been a well
developed child, but he did have a fever and sore throat about 10 days ago which resolved without treatment. The most likely
diagnosis is:
A. Acute cystitis
B. IgA nephropathy
C. Acute pyelonephritis
D. Postinfectious glomerulonephritis
E. Benign hematuria
10. A 3-yr-old boy presents to an urgent care clinic with a 3-day history of abdominal pain and difficulty walking. Abnormal
findings include blood pressure of 120/80 mm Hg, diffuse abdominal tenderness, purpuric rash of the hands and ankles, and
diffuse periarticular tenderness and swelling of the ankles. The most likely diagnosis is:
A. Systemic lupus erythematosus
B. Kawasaki's disease
C. Juvenile rheumatoid arthritis
D. Henoch-Sch nlein purpura
E. Stevens-Johnson syndrome

11. What is the most significant serious complication arising from Kawasaki disease?
A. Coronary aneurism
B. Kidney failure
c. Stroke
d. Pulmonary embolism
e. Acute leukemia
12. A 12 months old male infant Mediterranean origin noted to have pallor and has been fed similac with iron since birth ,his
exam otherwise normal except for palpable spleen .HB:9.9 / MCV:67/MCHC:32/RDW:12/Reticulocyte 1.5% /PLT:240000 which
one is true?
a. Hb level of 9.9 gm/dl is the lower limit of normal for this 12 months old
b. The dietary history is probably not true since the patient is iron deficient
c. The reticulocyte is high suggest hemolytic process
d. The infant must he losing blood and stool should be checked for occult blood
e. Hg electrophoresis should make the correct diagnosis

13.15 year old complaining of fever, abdominal pain, sexually active with 2 partner complaint of dyspareunia on examination
yellow thick vaginal discharge but no visible genital lesion most probably infected with:
a. H.influenza
b. Candida albicans
c. Chlaymidea palledum
d. Trepenoma
e. Human papilloma virus
14. Parents awakened at night by 2 years old son develop noisy breathing inspiration ,marked retraction of chest ,flaring nostril
,barking cough has mild upper respiratory tract infection 2 days ago. Which the most likely diagnosis:
a. Asthma
b. Epiglottitis
c. Bronchilitis
d. Viral croup
e. Foreign body in RT bronchus
15. The most important extra medullary site for relapse in childhood acute lymphatic leukemia (ALL):
a. Adrenal gland
b. Kidney
c. Lung
d. Heart
e. Central nervous system
16. Newborn develops sepsis and shock which pathogens most likely can system or focal infection of newborn:
a. Staph aureaus
b. Group A strept
c. Group B strep
d. E.coli
e. Herpes simplex virus

17. A 4 years old girl seen 10 days following upper respiratory infection ,her knees and ankle swollen and painful and temp 39 C
,cardiac examination 4/6 systolic murmur at the apex, antistreptolysin titer high. These findings consist with:
a. Acute rheumatic fever
b. Septic arthritis
c. Juvenile idiopathic arthritis
d. Viral pericarditis
e. Acute leukemia

18.12 years old boy presented with 24 h history of sharp pleuritic chest pain worsen in supine position, temperature 38.5 C,
pericardial rub is heard. The most likely diagnosis is:
a. Muscloskletal chest pain
b. Pericarditis
c. Bacterial endocarditis
d. Mycoplasma pneumonia
e. Pulmonary embolism
19. The most common cause of syncope in childhood:
a. Tachycardia ass with wolf parkinsonian white syndrome
b. Long Q-T syndrome
c. Breath holding spell
d. Hypertrophic cardiomyopathy
e. Neurocardiogenic syncope
20. A 6 weeks boy known congestive heart failure due to cardiomyopathy Wg 4 Kg taken 360 ml formule daily ,which of the
following most likely consequence of decrase intake in this infant:
a. Hypocalcemia
b. Hypoglycemia
c. Hypokalemia
d. Poor growth in length
e. Poor weight gain
21. The stinging insect most likely to cause an anaphylactic reaction in a child is:
A. Mosquito
B. Sand fly
C. Honey bee
D. Ant
E. Head lice
22. The chest x-ray of a 3-day infant with congenital heart disease demonstrates an abnormally shaped heart and no thymic
shadow. What immunodeficiency should you suspect?
A. Ataxia-telangiectasia
B. X-linked hyper-IgM syndrome
C. Wiskott-Aldrich syndrome
D. DiGeorge syndrome
E. Leukocyte adhesion deficiency

23. A 12 month-old infant was diagnosed with X-linked agamaglobulinemia, a recessive B-cell deficiency after having had
multiple sinopulmonary tract infections such as otitis media, sinusitis, and pneumonia. What is an appropriate treatment for
him?
A. Plasmaphoresis
B. Intravenouse immunoglobulin
C. Chemotherapy
D. High dose steroids
E. Enzyme replacement therapy

24. A mother of a 6-year-old girl states that her daughter's academic performance has decreased during the last year. Her
teacher notices her staring frequently throughout the day. Sometimes she seems "off in her own world" and does not respond
to questions. An EEG examination reveals a 3-Hertz generalized spike and wave pattern. What seizure type is this patient most
likely to have?
A. Absence
B. Tonicclonic
C. Myoclonic
D. Salaam attacks
E. Complex partial

25. A 2.5 year old boy is seen because of a second febrile seizure. The two episodes occured 4 months apart and described as
generalized tightening of the body followed by jerking involving all four extremities and lasting 3 to 5 minutes each time. On
both occasions the temprature was 38.8C. At this time, your recommendation would be:
A. Further tests including EEG and MRI scan
B. Treatment with phenobarbital
C. Treatment with valproate
D. Admit to hospital for cardiac respiratory monitoring
E. Education and counseling for the family

26. The skills of kicking a ball and jumping in place are gross motor milestones that occur at which age?
A. 15 months
B. 18 months
C. 24 months
D. 30 months
E. 36 months

27. Based on orientation to child development, when would you tell parents the highest risk of accidental poisoning in children
is present?
A. 6 months
B. 1 year
C. 2 years
D. 4 years
E. 6 years

28. Which of the following is a frequent manifestation of enterovirus infection?

A. Ataxia
B. Intussusception
C. Parotitis
D. Herpangina
E. Renal failure
29. A 6-year-old girl is hospitalized after a convulsion. On examination she is alert and without distress. On her skin you notice
the presence of cafe-au-lait spots, a Shagreen patch, and subungual fibromas. What is the most likely diagnosis?
A. Neurofibromatosis
B. SturgeWeber syndrome
C. McCune-Albright syndrome
D. Addisson's disease
E. Tuberous sclerosis
30. A 15-month old male is brought to the pediatrician because he seems much smaller than his two older brothers were at
that age. He has been generally healthy except for 2 episodes of otitis media and occasional "cold". He began walking at 11
months and can now say "mama" "dada" and names of his brothers. What is the most likely appropriate next step?
A. Perform a Danver Development screening test
B. Ask the mother to complete a 3 day diary of all the food that the child has eaten
C. Send blood for quantitive immunoglobulins
D. Plot his height and weight on growth chart and compare to previous charts
E. obtain a sweat chloride test

31. A 1-month-old infant is seen because of prolonged jaundice. He was born at home after a normal pregnancy. On
examination you notice a jaundice of the skin. His liver is not enlarged. There is a white pupillary reflex in both eyes, and the
urine examination is positive for reducing substances. What is the most likely diagnosis?
a. Sepsis
b. Glucose-6-phosphate dehydrogenase deficiency
c. Phenylketonuria
d. Viral hepatitis
e. Galactosemia
32. Which of the following statements about neuroblastoma is true?
a. Neuroblastoma is a benign tumor of the neural crest cells that form the adrenal cortex and the paraspinal parasympathetic
ganglia
b. The majority of neuroblastoma tumors occur in the thoracic cavity
c. Neuroblastoma is the most common solid malignant tumor in infancy
d. In neuroblastoma of the abdomen, displacement of the kidney and distortion of the calyceal system often occurs
e. Most patients are treated with surgery alone because distant metastases are rare

33. No red reflex is seen on fundoscopic examination of a newborn. Which is the most likely diagnosis?
a. Retinoblastoma
b. Congenital cataract
c. Pigmentary keratitis
d. Congenital glaucoma
e. Toxocariasis

34. A neonate born at 28 weeks' gestation is now 2 weeks of age. Nasogastric feeds are started. Forty-eight hours after starting
feeds, the neonate develops a distended abdomen, bloody stool, pneumatosis intestinalis, and free air on abdominal
radiograph. Laboratory studies reveal thrombocytopenia. The child becomes persistently hypotensive despite maximal medical
therapy. The most likely diagnosis is:
a. Necrotizing enterocolitis
b. Sepsis
c. Aspiration pneumonia
d. Malrotation
e. Jejunal atresia
35. A 12-year-old male adolescent presents with a 1-month history of fever, weight loss, fatigue, night sweats, and
pain andlocalized swelling of the midproximal femur. Which of the following is the most likely diagnosis?
a. Ewing's sarcoma
b. Osteosarcoma
c. Chronic osteomyelitis
d. Benign bone tumor
e. Eosinophilic granuloma

36. An afibrile 5-year-old girl presents with tachycardia at 220 beats per minute. On ECG a regular narrow-complex tachycardia
is seen. The rhythm converts with one dose of adenosine intravenously to normal sinus rhythm with pre-exitation (delta waves)
noted throughout the precordial leads. There is no cardiomegaly on chest X-ray. The tachycardia is most likely consistent with:
a. Long Q-T syndrome
b. Wolf-Parkinson-White syndrome
c. Sinus tachycardia
d. Atrial flutter
e. Atrial fibrillation
37. A 5-year-old boy presents with prolonged fever and a new 1/6 systolic ejection murmur heard best at the right upper
sternal border. On extremity examination, splinter hemorrhages and petechia are noted. Which of the following is the most
likely diagnosis based on clinical description?
a. Endocarditis
b. Rheumatic heart disease
c. Kawasaki disease
d. Pericardial effusion
e. Dilated cardiomyopathy

38. A 6-week-old breast fed infant is seen appearing quite well. His mother states that for the last week the infant has had
numerous periods of inconsolable crying lasting few hours each. Nothing seems to help. Most of the spells occur in the late
afternoon and evening and between the episodes the infant looks and feeds well. What is the most likely diagnosis?
a. Otitis media
b. Intussusceptions
c. Milk protein intolerance
d. Colic
e. Celiac disease
39. A previously healthy 2-wk-old now has progressive lethargy. Physical examination reveals muscle rigidity, opisthotonos
posture, periods of hypertonicity, and flaccidity. Laboratory data reveal Hypoglycemia, metabolic acidosis, and cerebral edema.
Plasma levels of leucine, isoleucine, and valine are elevated. The most likely diagnosis is:
a. Hartnup disease
b. Maple syrup urine disease
c. Phenylketonuria
d. Homocystinuria
e. Galactosemia

40. Short stature and growth failure may be the presenting complaints for which of the following conditions?
a. Juvenile idiopathic arthritis
b. Insulin-dependent diabetes mellitus
c. Crohn's disease
d. Acute leukemia
e. Familial Mediterranean Fever

41. A 16 year old female patient present with short stature and no secondary sexual characteristics. Which diagnosis should be
mostly?
a. Turner syndrome
b. Isolated growth hormone deficiency
c. Cushing disease
d. Familial short stature
e. Addison disease

42. A 3-year old girl is diagnosed with new onset insulin dependent diabetes mellitus. Which of the following laboratory findings
is consistent with diabetic ketoacidosis?
a. Hypoglycemia
b. Hypercarbia
c. Ketones in urine
d. Increased venous blood pH
e. Decreased BUN

43. An infant who was born at home presents to your office at 3 days for check up. The teenaged mother did not receive
prenatal care. You notice bilateral purulent discharge from the eyes of the baby. There is marked eyelid edema and conjunctival
swelling. What is the most likely pathogenic agent?
a. Chlamydia trachomatis
b. Neisseria gonorrhea
c. Group B streptococcus
d. Toxoplasma gondii
e. Treponema pallidum

44. Which of the following clinical presentation is most consistent with an infant with pyloric stenosis?
a. Projectile non bilious emesis
b. Bilious emesis
c. Bloody diarrhea
d. Violent episodes of intermittent colicky pain and emesis
e. Right lower quadrant abdominal tenderness
45. A 4-year old boy presented with a 5 day history of generalized edema. On examination you notice puffy eyes, scrotal edema
and ascites. Urinalysis reveals a specific gravity of 1.020,PH-7.0, 4+ proteinuria and is otherwise unremarkable. Serum
cholesterol is 648 mg/dl (elevated, albumin is 2.3 g/dl(low), C3 is 83 mg/dl (normal) and serum creatinine 0.3 mg/dl.
What is the next step in managing this child?
a. Perform kidney biopsy
b. Begin therapy with amoxicillin
c. Begin therapy with oral prednisone
d. Admit the patient for intravenous fluids
e. Start peritoneal dyalisis

46. A 19-year old female you have followed for 10 years in your practice has recently married, she and her 22-year old husband
are planning to start a pregnancy. You advice her to start taking folic acid. This is important to prevent:
a. Prematurirty
b. Skull defects
c. Chromosomal defects
d. Neural tube defects
e. Osteopenia

47. A-6 day old infant is reported to have an abnormal screening test for congenital hypothyroidism, the most likely etiology for
this result is:
a. Maternal graves' disease treated with propylthiouracil
b .Maternal antithyropin antibodies
c. Iodine deficiency
d. dysgenetic thyroid gland
e. The newborn screen was performed at 12 hours of age

48. A 3-year old boy is brought to the emergency room with complaint of persistent rhinorrhea for the past 6-weeks. Otherwise
the patient has been asymptomatic on examination, you note that the patient has mouth breathing and has dark circles under
his eyes. In the nose you find watery discharge and edematous, swollen, bluish mucous membrane without erythema.
The most likely diagnosis is:
a. Chronic upper respiratory infection
b. Sinusitis
c. Nasal foreign body
d. Allergic rhinitis
e. CSF leak

49. A previously healthy 18-month-old has been playing in a separate room from his family. The family notes the sudden onset
of coughing which resolved in a few minutes, subsequently the patient appears to be normal except for increased amounts of
drooling and refused to take foods orally. Which of the following is the most likely explanation for this toddler's condition?
a. Severe gastro esophageal reflux
b. Foreign body in the air-way
c. Croup
d. Epiglottitis
e. Foreign body in the esophagus

50. A previously healthy and fully immunized 13 year-old boy presents with 2-week history of nonproductive cough and lowgrade fever. On examination you note normal respiratory rales are deleted at the bilateral lung bases. Which of the following is
the most likely cause of pneumonia in this adolescent?
a. Pneumocyctis carnii
b .Staphylococcus aureus
c. Group B streptococcus
d. Haemophilus influenza type B
e. Mycoplasma pneumonia

20.09.2012:
1. 6 years old boy has stool in his underwear daily. He was toilet trained at 2 without difficulty. Over the
last2 years he had developed chronic constipation. The fecal soiling developed over the last 3 months. He
is otherwise normal. Examination reveals stool in rectal vault.
Initial management should include which of the following?
a. barium enema followed by rectal biopsy
b. time out from school when he has stool in his underwear
c. family consulting
d. clear fecal impaction and short term stool softener use
e. daily enemas for 4 weeks

2. A 2 year old child has multiple episodes of brief shrill cry followed by a prolonged expiration and apnea.
He was born after normal pregnancy and delivery. Growth and development are normal. The first episode
occurred immediately after the mother refused to give the child some juice; the child became cyanotic,
unconscious, and had generalized clonic jerks. A few moments later the child awakened and had no
residual effects. Physical examination is normal. Which of the following is most likely diagnosis?
a. Seizure disorder
b. Drug ingestion
c. Hyperactivity with attention deficit
d. Pervasive development disorder
e. Breath-holding spell

3. A 5-month-old child with poor growth presents to the ER with generalized tonic-clonic seizure activity of about 30minute duration that stops upon the administration of lorazepam. Which of the following information gathered from the
mother will be most helpful?
a. The child has had rhinorrhea
b. The child is developmentally normal, as are his siblings
c. The mother has been diluting the infants formula to make it last longer
d. number and type of pets
e. The mother is single and unemployed
4. Full term newborn infant is having episodes of cyanosis and apnea which are worse with attempting to feed but
seems better with crying. Which of the following is most important next step to quickly establish the diagnosis?
a. Echocardiogram
b. Ventilation perfusion scan
c. Passage of catheter into nose
d. Hemoglobin electrophoresis
e. Bronchoscopic evaluation of palate and larynx

5. 3 month old child is been crying at the same time each day, you suspect colic. What is true about colic?
a. onset at 3 month and peak at 6 months
b. almost all cases are due to lactose intolerance
c. typical at afternoon and evening
e. with any degree of abdominal distension should have CT abdomen

6. 3 year old has persistent rhinorrhea for the last past 6 weeks. Otherwise the patient has been
asymptomatic. On physical examination you notice mouth breathing and dark circles under the eyes. In the nose, watery
discharge and edematous boggy bluish mucous membrane with no erythema. Most likely diagnosis:
a. chronic bronchitis
b. sinusitis
c. nasal foreign body
d. allergic rhinitis
e. CSF leak
7. 5 year old immunized girl is seen in the emergency department because of fever, sore throat and
respiratory distress that has developed in the last 3 hours. She is drooling, holding her neck in a
hyperextended position, she has mild stridor but does not have barky cough. The patient most likely to have:
a. viral croup
b. spasmodic cough
c. epiglottitis
d. bacterial tracheitis
e. asthma
8. A 9 mounts boy, previously healthy and normally gaining weight was recently discharge from the
hospital. The hospitalization was due to a severe rotavirus diarrhea that requires rehydration. 4 days later the baby still has loss
stools. He is now drinking his regular cow's milk formula well. On physical examination he is happy and well hydrated. Repeat
rotavirus test is negative. What is the reason for the baby's continued diarrhea?
a. cow milk protein allergy
b. starvation diarrhea
c. secondary lactose intolerance
d. viral gastroenteritis
e. cystic fibrosis
9. a mother brings her 2 year old baby for regular checkup. She is confused about which position to put her baby to sleep. With
regard to infant sleeping position, how should you consult the mother?
a. place the baby on the belly
b. place the baby on the side
c. elevate head of the baby's crib
d. elevate the foot of infant crib
e. place on the back

10. The most common neurological sequela associated with bacterial meningitis, and usually presents at the time of initial
infection is?
a. mental retardation
b. chronic seizure disorder
c. impaired vision
d. impaired hearing
e. behavioral disturbances

11-THE MOST COMON CAUSE OF VIRAL MENINGOCEPHALITIS IN CHILDREN IS:

A-ENTEROVIROS
B-HERPES SIMPLEX VIROS
C-ARBOVIROS
D-MUMPS VIROS
E-RESPIRATORY VIROS

12-A 12 YR OLD BOY PREZENTS WITH A 1 YR HISTORY OF WORENING POLIYURIA AND A 2 TO 3

WEEKS HISTORY OF NAUSEA ,FATIGUE AND MALAISE . SERUM CREATENIN IS 4.0 MG .BICARBONAT 15
MG, URINALISIS SHOWS SPECIFIC GRAVITY OF 1.OO4 , TRACE LEUKOCYTES , TRACE BLOOD , AND NO PROTEIN , WITH 3-5 WBS
PER HIGH POWER FIELED , 3-5 BBC PER HIGH POWER FIELED , AND NO RBC CASTS. WHICH OF THE FOLLOWING IS THE MOST
LIKELY DIAGNOSIS:
A-ACUTE POST STREPTOCOCAL NEPHRITIS
B-CHRONIC INTERSTITIAL NEPHRITIS
C-MINIMAL CHANGE NEPHROTIC SYNDROM
D-ACUTE INTERSTITIAL NEPHRITIS
E-CHRONIC GLOMERONEPHRITIS

13-TRISOMY 21 IS ASSOCIATED WITH:

A-MALROTATION
B-HYPOTONIA
C-CLEFT PALATE
D-RENAL DISEASE
E-PER CAVUS

14-PECAUSE OF SPLENIC DYSFUNCTION AND AN INCREASED RISC OF BACTERIAL

INFECTION , CHILDREN WITH SIKLE CELL ANEMIA SHOUD PLACED ON PROPHYLACTIC PENICILIN
VK BY 4 WEEKS . AGE CHELDREN WITH SIKLE CELL ANEMIA ARE PARTICULARY SUSCEPTIBLE TO :
A-GRAM NEGATIVE RODS
B-ENCAPSULATED ORGANISMS
C-FUNGAL INFECTION
D-VIRAL INFECTION
E-STAPHLOCOCUS AUREUA

15-YOU HAVE JUST GIVEN A 10 YR OLD AN INJECTION OF POLLEN EXSTRACT AS

PRESCRIPED BY HIS ALLERGIST IN HIS CHEST. YOU NOTE THAT HIS FACE IS FLASHED AND HIS
VOICE SOUNDS MUFFLED AND STRAINED. WHICH OF THE FOLLOWING IS THE FIRST PRIORITY IN
MANAGIG THIS EPISODE OF ANAPHYLAXIS:
A-ENDOTRACHEAL INTUBATION
B-INTRAMUSCULAR INJECTION OF DIPHENHYDRAMINE
C-ADMINISTRATION OF INHALED BRONCHODILATOR
D-INTRAMUSCULAR INJECTION OF EPINEPHRINE
E-ADMINISTRATION OF INTRAVINOS CORTICOSTEROIDS

16-A 15 YR OLD GIRL WITH SHORT STATURE , NECK WEBBING AND SEXUAL INFANTILISM IS FOUND
TO HAVE COARCATION OF AORTA. A CHROMOSOMAL ANALYSIS IS LIKELY TO DEMONSTRATE
WHICH OF THE FOLLOWING:
A-MUTATION AT CHROMOSOME 15 Q 21.1
B-TRISOMY 21
C-45 XO KARYOTYPE
D-DEFECT AT CHROMOSOME ANALAYSIS
E-NORMAL CHROMOSOME ANALYSIS:

17-A 2 MONTH OLD BOY IS SEEN FOR NONBILOUS VOMITING AFTER HE HAD BEEN
BREASTFEEDING WELL UNTIL 2 WEEKS AGO, WHEN VOMITING WORSENED. ON PHYSICAL EX HE HAS
JAUDANCE AND GASTRIC PERISTALTIC WAVES ARE SEEN ON THE ABDOMEN.
BLOOD TEST REVEAL HYPOKALEMIC , HYPOCHLOREMIC ALKALOSIS. THE MOST LIKLEY
DIAGNISIS IS:
A-ACUTE HEPATITIS
B-DUODENAL ATRESIA
C-UTI
D-PYLORIC STENOSIS
E-MILK ALLERGY

18-YOU ARE SEEING A 10 YR OLD BOY WITH COMPLAINT OF DOUBLE VISION ESPECIALLY IN THE
AFTERNOON. HE TIRES FASTER THAN HIS CLASSMATS IN GYM CLASS DUE TO
MUSCLE FATIGUE WITHAWT RESPIRATORY SYMPTOMS. HIS PUPILS AND VISUAL ACUITY ARE
NORMAL BUT YOY NOTICE A DISTINCT PTOSIS. THE MOST LIKELY DIG IS:
A-PITUITARY TUMOR
B-AMBLYOPIA
C-BOTULISM
D-MYASTHENIA GRAVIS
E-TICK PARALAYSIS
19-A 4 MONTH OLD CHILD WITH VITAMIN D DEFICIENTY RICKETS WOULD BE EXPECTED TO SHOW
ALL OF THE FOLLOWING EXCEPT:
A-CRANIOTABES
B-BOWLEG
C-ROSARY
D-LOW SERUM PHOSOHATE LEVELS
E-HIGH ALKALINE OHOPHATASE LEVELS

20-WHICH OF THE FOLLOWING CAUSES OF CONGINITAL INFECTION IS ASSOCIATED WITH CATS:

A-CYTOMEGALOVIROS
B-RUBELLA
C-TOXOPLASMA GONDO
D-SYPHILIS
E-PARVOVIROS B 19
21. Obese, 9 years old girl, history of persistent headache and blurred vision. Mild vomiting . No fever. In physical
examination papilledema. Visual field testing inferior nasal blind spot. MRI normal. LP pressur IS elevats, CSF
composition IS normal. Lab. Normal. What IS the most likely diagnosis?
Pseudotumor cerebri

22. 4 day old infant, noted to be sucking on a honey- filled pacifier. You caution the mother against its isr because its
contents can cause:
Infantile botulism

23. Infant 8 day old, high TSH and low T4. If this condition IS Left untreated:
Prolonged jaundice

24. Complication of hypernatremic dehydration IS:

Cerebral edema.

25. you are evaluating an Obese, 10 years old boy for diabetes. He has strong Family history of type2
diabetes mellitus. His mother is concern about recent symptoms of polyuria and polydipsia. What of the following is a
diagnostic for diabetes mellitus:
a. Non fasting plasma glucose of 210 mg/dl
b. fasting plasma glucose of 110 md/dl
c.2-hour glucose during glucose tolerance test of 165mg/dl
d. acanthosis nigricans on neck
e. symptomes alone are enough to make the diagnosis.

26. Hb 8.5 mcv110fl, reticulocyt count 0.5. Most likely diagnosis is:
Vitamin B12 deficiency
27. Women O positive give birth at term infant A positive. Ht 55% , bilirubin 12 mg/dl. Wich of the following
lab findings ABO hemilytic disease:
a positive coombs test

28. 1 years old, failur to thrive, frequent large voids of diluted urine, excessive thirst and episods of
dehydration without vomiting and diarea. Over the years family members reports similar history . The most likely
diagnosis is:
Diabete insipidus.
29.10 years old , Is having "cold" for 14 days, purulent nasal discharge, facial pain. Most likely diagnosis:
Maxillary sinusitis
30. A 6 month infant with large foul smelling stools Is not gaining weight.
Chloride 68 ????
31. A 5 month old child regularily regurgitates large portions of her feeds. PH probe study showed significant
periods of low esophageal PH. The child has normal growth and no other significant past medical history.
Which is the best management at this point:
a. barium swallow and upper (GL) gastrointestinal series
b. oral reflux medications
c. esophageal manometry
d. close observation only
e. surgical correction
32. a 6 week old is admitted with jaundice, total Bilirubin is 12mg/dl with direct Bilirubin 5mg/dl. What is most likely
the disorder?
a. ABO incompability
b. biliary atresia
c. Rh incompability
d. Gilbert disease
e. breast-milk jaundice

34. a 2 year old boy has Teratology of fallot. Today he arrives with acute febrile illness. On examination,
he complains of headaches, lethargy, has nystagmus and ataxia. What will be the most appropriate first test
to order?
a. Urine drug screen
b. Blood culture
c. lumbar puncture
d. CT of brain
e. echocardiogram

41- 2 Year old boy is seen because of pallor. His mother sees e drinks 4 glasses of cow's milk a day. A
CBS reveals a hemoglobin of 8.2 g/DL an a MCV of 65 fl. Which of the following is compatible with this patients?
A-decreased red blood cell distribuition
B- decreased serum feritin
C- increased reticolocyt count
D- increased serum iron level
E- increased white blood cell count

42- Which of the following reflexes is normally absent in a newborn ?

A- STARTLE (moro)
B- hand grasp
C- crossed adductor
D- Asymmetric tonic neck
E- parachute

43- A 2 year old boy is admitted to the hospital with high fever four 6 days, swelling of the ands and feets,
scarlentiniform changes of the tongue, generalized reed macular rash, dray sedmentation reet &
thrompocytosis. Which of the following is the best initial mangmanet?
A- cardiac catheterization
B- IVIG & aspirin orally
C- naproxen orally
D- I.V pulse corticosteroids
E- methotrexate orally
44- A 9 month old girl present to the ER with respiratory distress, grunting & cyaiosis . u start O2 by face mask, but the child is
still in a significant respiratory distress & become apnoic. The best next step is?
A- start chest compretion
B- performe Heimlich maneuver, maybe the child aspirate something C- obtain
blood gas
D- send the child for RX-chest
E- start bag - valve mask ventilation with 100/100 o2
45- A 5 year old boy present with a history of grossly blood urine, puffy eyes & headache for 1 day. He
has been will with fever & sore throat about 10 days which resolved with out treatment;
most likely diagnosis:
A- acute cystitis
B- IgA nephropathy
C- acute pyelonefritis
D- postinfaction glomerulonephrtis
E- benign hematuria

46- 10 years old female with fever, pain , swelling in her left elbow for 2 days & right knee for 3 days,
today her right knee us OK . The arthritis was preceded by a 3 days history of fever & sore throat 2
weeks ago. Laboratory results reveal un elevated antistreptolwsin. The most likely diagnosis is ?
A- S.L.E
B- idiopathic R.A
C- acute rheumatic fever
D- gonococal arthritis
E- psoriatic arthritis

47- Which of the following cancer occurs primarily during childhood?

A- Breast cancer
B- Renal cell cancer
C- Wilms tumor
D- Thyroid cancer
E- Colon cancer

48- The most important extramedullary site of relapse in childhood acute lymphoblastic leukemia is?
A- Adrenal glands
B- kidney
C- lung
D- heart
E-Central Nervous System
49- Very-low-birth -weight ( < 1500 g ) infant are best describes as?
A- predominantly growth restricted
B- predominantly PREMATURE
C- predominantly postdate
D- the result of maternal illness
E- the result of placental infraction

50- An 18 year old female, u have followed for 6 years, has recently married , she & husband are planning to
start a pregnancy .u advise her to start taken folic acid , this is important to prevent ?
A- prematurity
B- skull defects
C- chromosomal defects
D- neural tube defects
E- osteopenia

01.03.2012:<<
11. You are seeing a 4 week infant who appears jaundiced he is growing well without any
problem and is exclusively breastfed ,his physical examination is notable only for some
scleral icterus and jaundice to the appear chest your next course of action would be?
a. abdominal ultra sound examination
b. fractionated serum bilirubin
c. observation with follow up appointment in 1 month
d. liver function tests urine culture

12. what would be the best first line management in preventing exacerbations in patient with chronic
asthma?
a. inhaled albuterol (ventolin)
b. leukotriene inhibitors
c.antiimmunogglobulin E
d. inhaled corticosteroids
e. cromolyn sodium
13. You are seeing a 12 year old female with h fever arthritis oral ulcers malar rash and
photo sensibility you suspect she may have an immunologic disease, which of the following tests would be
most specific for her disease:
a. antiendomesial antibody
b. anti double sranded DNA
c. anti strepolysin antibody
d. serum immunogobulines levels
14. Which of the following co morbidity complications is associate with overweight in adolescents?
a. slipped capital femoral epiphysis
b. hypoglycemia
c. angina
d. osteomalasia
e. fat necrosis
15. nasal polyps in children:
a. may cause serous otitis
b. are common in early infancy
c. may cause suffocation or apnea
d. are associate with cystic fibrosis
e. are most often cancerous

16. Which of the following causes of congenital infection is associate with cats?
a. cytomegalovirus
b. rubella
c. toxoplasma gondi
d. syphilis
e. parvovirus B19

17. Patient who should receive prophylaxis for pneumocystis carini pneumonia mor than others include
those with:
a. X linked agammaglobulinemia
b. HIV infection
c. chronic granulomatous disease
d. sickle cell disease
e. congenital neutropenia

18. A worried mother calls into report that her 2 days old newborn is bleeding from her bottom, her
prenatal and birth history were unremarkable. On physical examination you noticed a bloody
serosanguious fluid oozing from the vagina. There is no bruising or
patechia. The most likely diagnosis is:
a. hemophilia A
b. child abuse
c. birth trauma
d. hemangioma of the vulva
e. withdrawal bleeding

19. A 10 years old white female presents with pain and swelling of the right elbow,
accompanied with fever of 39 c, she reports that 3 days ago she had painful swelling of the left ankle the
subside this morning. 2 weeks ago she had sore throat. Laboratory results reveal elevated sediment rate, a
negative antinuclear antibody, and an elevated anti
streptolysine. The most likely diagnosis is:
a. SLE
b. juvenile idiopathic arthritis
c. acute raumatic fever
d. gonoccocal arthritis
e. septic arthritis

20. A 12 months old boy is examined because of refusal to walk. He started to walk at 10
month and has been doing well until this point. On physical examination he is moderately ill child with
fever of 39.2 c , externally rotated left hip with limit to passive and active motion. The CRP level is high.
The most likely diagnosis is:
a. osteomyelitis of the left femur
b. septic arthritis of the left knee
c. legge perthes disease
d. septic arthritis of left hip
e. ewing sarcoma of the left femur.
21-3 years -old boy presents to an urgent care unit with 3 days history of abdominal pain and difficulty
walking. Abdominal findings includ blood pressure of 120/80 mm Hg , diffuse abdominal tenderness,
purpuric rash of hands and ankles, and diffuse periarticular tenderness and swelling of the ankles.the mos likele diagnosis is:
a. Systemic lupus erythematosus
b. Kawasaki desease
c. Juvenile rheumathidarthritis
d. Henoch -Schonlein purpura
e. Stevens _ Johnson syndrome

22-A 10 years-old boy present to clinic routine preparticipation sports physical. He reports no recent illness
or unusual syntoms.on examination you hear a distinct short systolic eyection murmur. It is l oudest at the left lower sternal
border and is low pitched and somewhat musical nature. When the patient sits upright the murmur is less intense.Which of the
following is the most likely diagnosis?
a-Aortic valve regurgiatation
b- ventriculo septal defect
c-Atrial septal defect
d- pulmonary valve stenosis
e-vibratory innocent murmur

23-Trisonomy 21 is most commonly associated with:

a-malrotacion
b-atrioventricular canal
c-cleft palat
d-renal failure
e-sensory neural hearing loss
24- What is the most significant serious complication arising from kawasaky desease?
a-coronary aneurisms
b- kidney failure
c- gallbladder stones
d- gastrointestinal bleeding
e-hypertension
25- a 20 months-old toddler is seen in the emergency department because of an 8 hours
history of difficult breathing. Previously he had been perfectly well. During supper he began having
paroxysmal coughing and wheezing. He has not hat any previous similar episodes .
He has moderately increaded work of breathing. On auscultation the wheezing is heard only over his right
chest. His vital signs are: temperature 37C, pulse 136, respiratory rate 60. The most likely diagnosis is:
A. Asthma
B. Cystic fibrosis
C. Pneumonia
D. foreign body aspiration
E. Peanut allergy with anaphylaxis
26-A 10 months-old infant has poor weight gain and persistent cough. The mother describes the child as
having very large , foul smelling stools for months . Which of the following diagnostic modalities is lakely to result in correct
diagnosis of the child?
a-CT examination of the chest
b-serum inmunoglobulins
c- PPD. Skin test
d-inspiratory and expiratory chest X-ray
e-Sweat chloride test
27- 15 years -old girl with short stature ,neck webbing and sexual infantilism is found to have heart
murmur , and weak femoral pulse. Which of the following is the most likely diagnosis?
a-Achondroplasia
b-Turner Syndrome
c- Di George Syndrome
d- congenital hipotiroidism
e-Celiac disease

28-a 6 year- old is hospitalized for observation because of short period of unconsciousness after fall from
plauground swing. He had developed unilateral papillary dilatation , focal seizures, recurrence of depressed conscioness and
hemiplegia. Which of the following is the most appropriate measure at this time?
a-spinal tap
b- CT scan of the head
c-rapid fluid hydratation
d-naloxone
e-bilateral burr holes

29-6 year- old boy present with the sudden set of ataxia which of the following is the most likely cause?
a-drug intoxication
b- agenesis of corpus callosus cataxia telangiectasia
d-muscular dystrophy
e-Friedrich Ataxia

30-a 3 year- old boy parents complain that their child has difficult walking Tha child perfomed adequately until a few months
ago when the family notical an increased inward curvature of the lower spine as he walks and gait became wadding On
examination he has anlargedcalves. Which of the following is the most likely diagnosis?
a-spina bifida oculta
b-muscular dystrophy
c-brain tumor
d-Guillain Barre syndrome
e-Botulism

31- A 14-year-old girl awakens with a mild sore throat, low-grade fever, and a diffuse
maculopapular rash. During the next few hours, she develops tender swelling of her wrists and redness of
her eyes. On examination there is marked swelling with mild tenderness of her posterior cervical and
occipital lymph nodes. Four hours later the rash has vanished.
Which of the following is the most likely diagnosis?
a. Measles
b. Roseola
c. Erythema multiforme
d. Rubella
e. Erythema infectiosum

32- Which of the following conditions is contraindicated to a diagnostic lumbar puncture?

a. Thrombocytopenia
b. Bulging fontanelle
c. Lumbar puncture 2 days before
d. Marked uncooperativeness on the part of the patient
e. Significantly elevated WBC count consistent with bacteremia Correct

33- 2 weeks ago, 2 year old boy developed diarrhea, which has persist to the present time
despite dietary management. His stools have been watery, pale and frothy without traces of
blood. He has been febrile. Examination of his stool is likely to reveal which of the following?
a. Salmonella sonnei
b. Enterobius vermicularis
c. Cryptosporidium jejuni
d. Toxoplasma gondii
e. Rotavirus

34- An 18 month child presents with a brief, generalized tonic-clonic seizure. He is now
postictal and has a temperature of 40C. During the lumbar puncture (which ultimately
proves to be normal), he has a large, watery stool that has both blood and mucus in it.
Which of the following is the most likely diagnosis in this patient?
a. Salmonella
b. Enterovirus
c. Shigella
d. Campylobacter
e. Rotavirus

35- 12 years old ashkenazy jewish girl has mild anemia , leukopenia and thrompocytopenia . pfysic
examinations revealsan enlarged spleen. An x-ray of the femur is described as appearing to be Erlenmeyer flask. Bone
marrow examination shows abnormal cells. Which of the following the most likely diagnosis?

a. Tay-sachs disease
b. Gaucher disease
c. Mucopolysaccharidosis
d. Canavan disease
e. Glycogen storage disease

36- Which of the following cancer has the highest incidence in young children (<7 years)?
a. Ewing sarcoma
b. Hodgkin disease
c. Testicular cancer
d. Retinoblastoma
e. Osteosarcoma

37- A12 month-old female infant with failure to thrive is brought to the office. Her parents
note that she is very fussy and often spits up after feeding. she also has two loose foul- smelling stool each day. Which of the
following foods can she eat safely without aggravating her symptoms?
A) Rice
B) Wheat
C) Oats
D) Barley
E) Rye
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39- An infant born 35 weeks gestation to a mother with no parental care is noted to be
jittery and irritable and having difficulty feeding. You note coarse tremors on examination with high
pitched cry. Diarrhea and enuresis. You suspect the infant is withdrawing from which of the following?
a.Alcohol
b.Marijuana
c.Heroin
d.Cocaine
e.Tobacco

40- A primiparous woman whose blood type is O positive gives birth at term to an infant who has A-positive
blood and a hematocrit of 55%. A total serum bilirubin level obtained at 36 hours of age is 12 mg/dL. Which
of the following additional laboratory findings would be characteristic of ABO hemolytic disease in this infant?

a. A normal reticulocyte count

b. A positive direct Coombs test
c. Crescent-shaped red blood cells in the blood smear
d. Elevated hemoglobin
e. Petechiae

Q41 - a 3 year old boy is evaluated because of pallor and weakness. Laboratory tests reveal microcytic and
hypochromic anemy. The ferritin level is low. Which of the following is the most likely diagnosis?
a - folate deficiency
b - thalassemia minor
c - aplastic anemia
d - iron deficiency
e - vitamin B12 deficiency

Q42 - a 6 year old boy is examined because of nighty bedwetting. The boy has never had a prolonged
period of nighttime dryness and never has "accidents" while awake. He has no dysuria and his urinary
steam is normal. What is the most common cause of his primary nocturnal enuresis?

a - urinary tract infection

b - vesicoureteral reflux
c - psychological problem
d - normal developmental variant
e - unstable bladder

Q43 - a 5 year old boy presents with a history of grossly bloody urine, puffy eyes and
headache for a 1 day. He has been a well child but did have a fever and sore throat 10 days ago, which
resolved without treatment. The most likely diagnosis is:
a - acute cystitis
b - Ig A nephropaty
c - acute pyelonephritis
d - postinfectious glomerulonephritis
e - benign hematuria

Q44 - which of the following is regarded as a known complication of treatment with total parenteral
nutrition (TPN)?
a - sepsis
b - renal failure
c - chronic diarrhes
d - vitamin A deficiency
e - irreversible athropy of the mucosa of the small intestine Correct
Q 45 - a 3 month old infant presents for a well child evaluation. Which of the following would be a
cause for concern in the infant?
a - regurgitation of 15-30 ml of formula 3 times a day
b- one bowel movement every other day
c - 3 bowel movements per day
d - liver span of 5 cm
e - hemoccult-positive stool

Q46 - during routine screening CBC, a 1 year old is noted to have pronounced eosiniphilia.
Which of the following is the most likely explanation?
a - bacterial infections
b - chronic allergic rhinitis
c - fungal infections
d - helminth infestation
e - tuberculosis
Q47 - an 17 year old male is seen in the student clinic for urinary frequency, dysuria and uretheral
discharge. Which of the following is not likely to explain this condition?
a - herpes simplex
b - Escherichia coli UTI
c - chlamydial urethritis
d - syphilis
e - HIV infection
Q48 - a 6 week old baby presents to the office. His weight is still near his birth weight. He
had a normal gestation and delivery and has not had any signs of illness. The physical
examination is normal. A diagnosis of failure to thrive (FTT) is made. Which of the following is indicated?
a - immediate hospitalization and extensive laboratory tests.
b - increasing the caloric content of formula and frequent weight measurements
c - starting solid foods since formula is not resulting in good growth.
d - report the child to the health services and immediate placement in foster care
e - switching formula to a different cow's based formula

Q49 - you are evaluating a 5 year old for the first time. His height just below the 5th
percentile. Previous growth chart reveals that since 9 months his weight and height are just below the 5th
percentile. His mother height is 155cm and his father's height is 163. History and physical examination is
otherwise normal. What is the most likely diagnosis?
a - constitutional growth delay
b - growth hormone deficiency
c - noonan syndrome
d - familial short stature
e - hypothyroidism
Q50 - a 15 month old male is brought to the pediatrician because he seems much smaller
than his two older brothers were at that age. He has been generally healthy exapt for 2
episodes of otitis media and occasional "colds". He began walking at 11 months and can now say "mama"
"dada" and names of his brothers. What is the most appropriate next step?
a - perform a denver development screening test.
b - ask the mother to complete a 3 day diary of all the food that the child has eaten.
c - send blood for equantitative immunoglobulins
d - plot his height and weight on growth chart and compare to previous charts.
e - obtain a sweat chloride test.
51 . a 4 year old presents with a dry scaling rash wish recurs intermittently. The family history is positive for asthma ,allergy and
eczma. Treatment of his eczma includes which of the following?.
a . keeping the skin scrupulously clean with baths twice daily
b . allergy testing and allergy shots
c . a strict elimination diet
d . steroid cream and moisturizing lotion
e . oral steroid
52 . a teenager who gets stung by a bee develops uriticaria within 30 minutes of the sting this reaction is
most likely mideted by ?
a . complement C3
b . IgE antibodies
c . neutrophilis
d . T cells
e . Ig A
53 . a 1 month female is examined because she spits up about a tablespoon of milk-like
material after each feed .it does not come out forcefully and contains no blood or bile . she
takes 50 cc of formula every 2-3 hours the spitting up often occurs after she is placed on her back in the crib
the physical examination and growth percentiles are normal .the most likely diagnosis is ?
a . pyloric stenosis
b . volvulus
c . gastroesophageal reflux
d . gastroenteritis
e . tracheoesophageal fistula
54. malrotation with volvulus is most likely to be present in which of the following patients?
a . 15 months old with severe paroxysmal abdominal pain and vomiting
b . 15 year old sexually active girl with lower abdominal pain
c . 3 day old term infant with bilious emesis .lethargy and abdominal distention
d . 4 day old premature ( 33 w ) baby who just started nasogastric feedings he has abdominal distention bloody stools and
thrombocytopenia
e . 7 year old girl with abdominal pain vomiting fever diarrhea

55 . in female which of which of the following events signifies the onset of puberty ?
a . menarche
b . growth spurt ( height )
c . pubic hair
d . thelarche
e . voice dranges
56 . a full term neonate is noted to have circumoral cynosis and twitching of his left hand at 12 hours of age
on physical examination he is found to have an absent pupillary response to light and a small penis
which of the following is the most likely diagnosis:
a .hypocalcemia
b . hypoglycemia
c . congenital hypothyroidism
d . congenital heart disease
e . idiopathic epilepsy

57 . a 14 year old adolescent female has insulin dependent diabetes mellitus for the past 7 year she now
has a hemoglobin A1C of 14.9% this laboratory test indicates which of the following ?

a . her glucose control is poor

b . she does not have insulin dependent diabetes mellitus
c . she has entered the honey-moon phase of her diabetes
d . she has an underlying infection
e . she is demonstrating the somogy phenomenon Correct

58 . a newborn infant has mild cyanosis , diaphoresis ,poor peripheral pulses, hepatomegaly and
cardiomegaly . respiratory rate is 60 breaths per minute and heart rate is 250 bmp the child most likely has
congestive heart failure caused by which of the following ?
a . a large atrial septal defect and valvular pulmonic stenosis
b . transposition of great vessels and ventricular septal defect
c . total anomalous pulmonary venous return
d . Hhypoplastic left heart syndrome
e . paroxysmal atrial tachycardia

59 . a 6 year old girl underwent removal of a craniopharyngioma 3 mo. Previously she is on a thyroid
replacement regimen but her mother reports she is very fatigued the next step would be to ?
a . increase the dose of her thyroid medication
b .schedule a growth hormone stimulation test
c . measure ACTH and cortisol
d . obtain an M.R.I study of her hand
e . measure IGF-1 and IGFBP-3
60 . a 20 mo.old child has fever irritability and refusal to move his right lower extremity physical examination reveals a swollen
and tender right knee that resists passive motion which of the following is the most important test to confirm the
impression of septic arthritis?
a . examination of joint fluid
b . x - ray of the knee
c . erythrocyte sedimentation rate
d . complete blood count
e . blood culture

03.10.2011:
29. A 6 year old girl is sent home from summer camp with a fever of 38.5C, stiff neck, photophobia and headache.
LP shows WBC 380 cells/mm3 with 65% polymorphonucleat cells and 35% lymphocytes, normal protein and glucose level,
negative gram stain. Which pathogen is most likely to cause her symptoms:
a. Nisseria meningitidis.
b. Strep. pneumonia.
c. Enterovirus.
d. Borrelia burdorferi.
e. Mycobacterium tuberculosis.

31. A 10 year -old girl has had a cold for 14 days prior to the visit, she has developed a fever of 39*C, purulent
discharge, facial pain, and daytime cough. Examination of the nose after topical descongestants shows pus in the
middle meatus. Which of the following is themost likely diagnosis?
a.brain abscess
b.maxillary sinusitis
c.streptococcal throat infection
d.retrofaringeal abscess
e.middle ear infection

32. Boy of 2 years-old, who developed noisy breathingon inspiration, marked retractions of the chest wall, flaring of the nostrils
, and barking cough, He has had mild apper respiratory infection for the past 2 days .
Which of the following is the most likely diagnosis?
a.Asthma
b.epiglotitis
c. bronchiolitis
d. viral croup
e.foreing body in the right bronchus

33. In which of the following a 10 years-old patient would isolation of pseudomona Aeruginosa from the sputum be likely?

a. Child with tetralogia of Fallot undergoing cardiac repair

b. Child with fibrosis cystic who has moderate cough severe lung desease
c. a previously well child presenting with temperature of 40*C, a left lower lobe infiltrate, and white blood cell
count of 20.000/m3
d. Child with asthma previouslu under good control, who presents with wheezing unresponsive to bronchiodilators
e. An adolescent who has recently been using hot tub

34. 2 month old child is seen at your clinc for the first time. The child was born at home , and this is the first well child visit.
Risck factorsfor infant botulism that should be communicated to the pearents include:
a. gardening
b. home construction
c. frozen vegetables
d. honey
e. all of the above

35. A 15 years-old white girl develops bloody diarrhea on the 6 day of hospitalization
for therapy of presumed bacterial neumonia.She has recived intravenous Ampicilin.
Fever and tachipnea resolved and her oxygenation now is normal. In fact, she was
scheduled for discharge. Which of the following action would be most apropiate?
a. Swicht tha antibiotic to 3erd generarion cephalosporines
b. Discontinue Ampiciline
c. Obtain ventilation -perfusion scan
d. Obtain CT scan of the abdomen
e. Add erythromycin or doxycyline

36. Newborn develops sepsis and shock , the pathogen that most commonly causes systemic and focal infection
in newborn is :
a-staphylococcus Aureus
b- group A streptococci
c-group B streptococci
d-eschearichia coli
e-herpex simplex virus

37. Which of the following tumors is associated with Epstein -Barr virus infection
a. Kaposi sarcoma
b. Burkit lynphoma
c. neuroblastoma
d. wilms tumor
e. Carcinoma of colon
38. Which of the following cancers occurs primarity during childhood?
a. Breast cancer
b. Renal cell cancer
c. Wilms tumor
d. Prostate cancer
e. Colon cancer

39. A 4 year- old boy with anemia has a bone marrow biopsy that shows 4% blasts . No blasts are seen on
peripheral blood smear. Finding on physical examination and another studios are normal. Most likely diagnosis?
a. Acute Lymphoblastic leukemia
b. Acute myelogenous leukemia
c. chronic myelogenous leukemia
d. preleukemia Syndrome
e. this is a normal bone marrow biopsy

40. Most important extramedullary site of relapse in childhood acute lyphoblastic leukemia (ALL):
a. Adrenal glands
b. Kidney
c. Heart
d. Lung
e. Central nervous system

41. The developmental appropriate age of child who scribbles, walks alone, speaks one real word and pretends to
drink from a cup is:
a. 7 months.
b. 13 months.
c. 20 months.
d. 24 months.
e. 30 months.

42. The developmental appropriate age of child who rolls back to front, has a thumb finger grasp, self inhibits to
no and bangs two cubs is:
a. 8 months.
b. 12 months.
c. 15 months.
d. 3 months.
e. 18 months.

43. A 10 years old girl has had diplopia, ptosis and weakness of her neck flexors for 2 months. Symptoms are
worse in the evening and usually less severe awaking on the morning. No fasciculation or myalgia, her deep tendon reflexes are
normal. The most likely diagnosis:
a. Hysterical weakness.
b. Muscle dystrophy.
c. Spinal muscular atrophy.
d. Botulism.
e. Myasthenia Gravis.

44. A 4 year old boy is evaluated for his first generalized tonic-clonic seizure which lasted 10min. No history of
illness or fever and findings on examination after the seizure are completely normal. The most appropriate
management is:
a. Begin therapy with Carbamazepine.
b. Order EEG.
c. Order CT scanner of the brain.
d. Order MRI of the brain.
e. Order psychometric testing.

45. A 15 months old girl is evaluated for a 10 min long generalized seizure associated with a temperature of 40C.
Which of the following factors in the list is most likely to increase the risk of future seizers?
a. Apgar 3-5.
b. Family history of epilepsy.
c. Clinical evidence of roseola.
d. Female gender.
e. Presence of 2-caf au lait spots.

46. A 3 months old infant presents for a well-child evaluation. Which of the following complaints would be a cause
of concern?
a. Regurgitation of 15-30ml formula 3 times a day.
b. One bowel movement every other day.
c. Three bowel movements per day.
d. Liver edge palpable 2 cm below the right costal margin.
e. Hemoccult-positive stool.

47. A 3 years old hearing impaired child playing with his hearing aid. No battery can be found, and the child is
noted to be drooling. The most appropriate next step in treatment would be:
a. Ensuring consumption of fluids.
b. Ipecac administration.
c. Activated charcoal administration.
d. Chest and abdominal X-ray studies.
e. Observation and follow up in 24hours.

48. Nosebleeds in children arise most commonly from:

a. Turbinates.
b. Nasopharynx.
c. Post septum.
d. Kiesselbachs plexus (ant septum).
e. Maxillary sinus.

49. A 30 minutes old term 3-4kg baby born of spontaneous vaginal delivery is noted to have acrocyanosis.
Most important next step:
a. Perform a sepsis evaluation.
b. Perform a CBC followed by a sepsis work up if neutropenia is found.
c. Keep infant warm.
d. Begin oxygen administration.
e. Hold oral feedings until acrocyanosis resolves.

50. Bilateral and multiple retinal hemorrhages, presenting in the sixth weak of life in a previously normal lethargic
neonate, without any other physical founding. Are most likely due to:
a. Birth trauma.
b. Nuchal cord.
c. Vacuum extract.
d. Being large for gest age.
e. Child abuse.
51. Very low birth weight <1500 gr infants are best described :
a. predominantly growth restricted
b. predominantly premature
c. predominantly post dates
d. the result of maternal illness
e. the result of placental infarction

52. A 3 year old boy presents to your office with sudden onset of cola colored urine
progressive facial swelling over the past 3 days, and decreased urine volume over the
past day. On examination: blood pressure 130/80 mmHg, periorbital edema, bibasilar
rales, and ankle swelling. His urinalysis is remarkable for 3+ hematuria, 1+ proteinuria, 100 red blood cells, and red blood cell
casts, his serum electrolytes are normal and the serum albumin is 3.2 g/l.
this clinical presentation is most consistent with:
a. acute renal failure
b. acute pyelonephritis
c. nephrotic syndrome
d. acute glomerulonephritis
e. chronic renal failure

53. A 3 year old boy presents to an urgent care clinic with a 3 day history of abdominal pain and difficulty walking. Abnormal
findings include blood pressure of 120/80 mmHg diffuse abdominal tenderness. Purpuric rash of the hands and ankles and
diffuse periarticular tenderness and swelling of the ankles. The most likely diagnosis is :
a. systemic lupus erytimatosis
b. Kawasakis disease
c. juvenile rheumatoid arthritis
d. henoch-schonlein purpura
e. stevens jhonson syndrome

54. A 3 year old girl presents acute onset of lethargy and pallor the child has bloody diarrhea for 5 days that
cleared one day prior to presenting to your office, she also notes acute onset of cola colored urine. On
examination the patient is pale and lethargic pressure 120/80 mmHg. The most appropriate next step:
a. urinalysis
b. x ray of the abdomen
c. midstream urine culture
d. blood cell count and smear
e. prothrombine time

55. 1 month female infant is presented with chief complaint of poor feeding and lethargy, the parents report that the child was
well until 3 days earlier when poor feeding began pulse rate is 280 beats/min, respiratory rate is 50/min blood pressure is 80/50
mmHg. Physical examination shows a gallop rhythm and an enlarged liver palpable 2-3 cm below the right costal margin. The
most appropriate diagnostic test for this patient would be:
a. chest radiograph
b. CBC complete blood count
c. ECG
d. arterial blood gases
e. blood culture

56. 2 month old infant with supraventricular tachycardia a initial management:

a. vagal stimulation
b. cardioversion
c. defibrillation
d. digitalization
e. intravenous verapamil

57. A previously healthy 7 year old girl has a 3-wk history of fever, myalgias, and appositive blood culture for
staphylococcus aureus . the past medical history is negative including a normal camp physical examination 6-mo ago, which did
not reveal any heart murmur. After repeating a blood culture, the next step in her evaluation should be:
a.chest radiograph
b.complete blood count
c. echocardiogram
d. bone scan
e. dental clinic appointment

58. The most frequent presenting manifestations of pheochromocytoma in children is :

a. night mares
b. abdominal pain
c. polyuria and polydipsia
d. weight loss
e. hypertension

59. A 7 day is admitted to the hospital for evaluation of vomiting and dehydration, physical examination is normal except for
minimal hyperpigmentation of the nipples. Serum sodium and potassium concentrations are 120 meq/l (low) and 9 meq/l
(high), respectively. Which of the following is the most likely diagnosis :
a. pyloric stenosis
b. congenital adrenal hyperplasia
c. secondary hypothyroidism
d. panhypopituitarism
e. hyperaldosteronism

60. A 6-wk has gained no weight since birth. Her skin appears mottled, and an indirect bilirubin level is measured at
15 mg/dl (high) her extremities are cold and her temp. is 35c, the most likely diagnosis is:
a. kernicterus
b. sepsis
c. galctosemia
d. hypothermia
e. hypothyroidism

61. A 12 years jewish girl suffer from anemia , leukopenia ,thrompocytopenia, large spleen on x-ray femur show erlenm eyer
flask, abnormal bone marrow the most likley diagnosis?
a. tay-sachs disease
b. guncher disease
c. mucopolysaccheridosis
d. canavan disease
e. glycogen storage disease

62. The disease pass through mother affect sons and daughter in variable manifestation in affect sibling. most likely ?
a. mitochondrial inheritance
b. multifactorial inheritance
c. x-linked recessive inheritance
d. autosomal rcessive
e. enviromentaly induce

63. RAST determinds?

a. bronchial reactivity serotonin
b.bronchial reactivity after inhalation bronchial provocation test
c.the proportion to the allergic immunoglobiulin
d. antigen specific serum ige concentration
e.overal allergic risk profile based on absolute eosinophil , total ige and skin test

64. A 12 years boy complain from sneezing, clear rhinorrhea , itching physical exam reveals boggy pale nasal
edema clear discharge most likely diagnosis ?
a. foreign body
b. vasomotor rhinitis
c. netrophilic rhinitis
d. nasal mastocytosis
e. allergic rhinitis

65. 3 year old female pt. coughing and wheezing what the strong risk factor for persistent asthma in toddler
with recurrent wheezing?
a. eczema
b. colic
c. living on farm
d. female gender
e. OM with effusion

66. What the effective screening test for T cell function?

a.absoult lymphocyte count
b. flow cytometry for CD4 (helper) + CD8 (cytotoxic)
c. respiratory burst assey
d. candida skin test
e. mump AB titer after mumps vaccination

67. Infection typical to pt. with cellular immunodeficiency?

a. plasmodium vivax
b. strep. Pneumonia
c. staphy. Aureus
d. pneumocytocysitis carini pneumonia
e. hemephilus influenza

68. 4 year white female pt. joint swelling with multiple joint for 6 month slow to move in morning , move as if
stiff for first hour of day , very active child , No rash very little limitation of range motion , ESR= 4 what the
diagnostic ?
a. hypermobility syndrome
b. Dermatomyositis
c. SLE
d. JRA
e. HSP

69. Component of diagnostic criteria SLE in children ?

a. leukocytosis (more 15000 WBC)
b. persistent proteinuria
c. subcutaneous nodule
d. false-positive heterophile test
e. erosive arthritis involving two or more peripheral joint

70. Newborn ,congenital heart block, most like etiology ?

a. GB strep.
b. neonatal Echovirus infection
c. gestational DM
d. maternal lupus
e. gray baby syndrome

71. Regarding resuscitative efforts in child, the most important goal is:
a.Restoration of age-appropriate heart rate.
b.Appropriate movement of the chest wall.
c.Auscultation of equal breath sounds in both lungs field.
d.Adequate oxygen delivery and utilization for the body tissues.
e.Palpation of equal pulses in all four extremities.

72. Which statement is true relative to childhood atopic dermatitis?

a.The prevalence of atopic dermatitis is decreasing.
b.It's usually caused by dietary protein allergy.
c.The condition usually improves by age 5 years.
d.Atopic dermatitis is associated with dry skin.
e.Atopic dermatitis is usually asymptomatic.

73. A 2 day old well-appearing full term white neonate experience multiple firm,
yellow-white, 1 - to 2 mm pupules or pastules with a surrounding erythematous flare
on the trunk. wright strain of the lesion shows numerous eosinophils. The most likely diagnosis:
a.Erythema toxicum.
b.Pustular melanosis.
c.Acropustulosis.
d.Eosinophilic pustular folliculitis.
e.Herpes simplex virus infection.

74. A 2-year old boy is noted to be drinking from a container filled with kerosene. He immediately coughs,
becomes tachypnic, and is brought to the hospital. The best approach to his treatment is to:
a.Induce emesis.
b.Perform nasogastric tube lavage.
c.Instill mineral oil.
d.Administer steroids.
e.None of the above.

75. A Previously healthy 5 months-old infant develops bronchiolitis. On the fourth day of illness she is noted to have
bulging, opaque, white ear drums bilaterally. which of the following treatment regimens is the most appropriate to
institute?
a.High dose oral amoxcillin.
b.Intramuscular Ceftriaxone.
c.Oral Cefixime.
d.No initial antibiotic treatment.
e.Oral azithromycin.

05.06.2011:
86. A preterm bay 27 week 1050 gr, was ventilated post delivery due to RDS and his condition improved to 85%O2 after 1.5
hour of surfactant is given the exp[ecte change in lood gases is:
a. decrease bicaronate
b. increase pco2
c. increase po2
d. metaoliacidosis
e. respiratory acidosis
87. A five days baby is sleepy and refuse to be feed for several hours, in his anamnesis (past hstory (was noted that he was orn
to a mother with g6pd deficiency in the physical exam it was revealed that he is suffering from severe jaundice specially
arching around his neck during the exam it was revealed that he is suffering from apnea and seiaures followed y asystole and all
cpr failed, what is the clinical test that should e oerformed at the age of two days to avod such complication?
a. bilrubin level
b. setum sodium
c. serum potassium
d. serum
e. seum calcium level

88.In asysmptomatic infant is diagnosed with congenital CMV infection y urine culture taken at the age of 3 days ,parente are
requiring regarding future complication, which of the following correct?
a. autism is expected
b. possile progressive neural hearing impairment
c. blindness by age of year is expected
d. chronic liver failure is expected most prominent liver injury
e. cardiac defect is most common isolated finding

89. Tweelve year old child is eing followed in clinic for asthma, his treatment is inhale but he is still coughing you are
considering wether to increase the steroid dosing, which of the following will assisst with desicion making:
a. pulmonary function test
b. chest x-ray
c. seum IgE levels
d. CBC wit differential
e. skin test

90 .Which of the following is considered a risk for a sudden death syndrome :

a. pertusis vaccine
b. milk energy
c. lying down in cold eviorment
e. prone position

91.A 9 year old exammind in clinic for right otitis with purolent discharge, she has been treated 3 times previosly for otitis in the
past. Addisional history child has a cronic cough for years and even had pneumonia 3 times in the past. Which of the folowing
may assist in identifying the sendromm in which these findings are commen:
a. asses signs of maturity
b. urin analysis and urinary add blood protein
c. asses child is breathing with an open mouth
d. asses tonsil size
e. heart auscultation

92. A 2 year old has surgery for bowel obstruction, the cause is thick meconium with no other anatomic abnormality. Which of
thefollowing tests should be preformed?
a. sweat test
b. abddomen US to rule out other malformations
c. barium enema to rule out cronic malformations
d. barium swallow to rule out proximal malformation
e. rectal biopsy

93. A 9 year old child is being examind for bilateral knee and right elbow pain and mild sweling. On the posterior aspect of the
thighs and buttocks she has mildly raised rash that dos not dissapear when compressed. What should the family be
recommended:
a. there is no need for follow up if the rash resolves
b. follow blood press and urianalysis
c. complement and IgA levels should be tested
d. the child should be admited for treatment with high dose methylprednison
e. oral penecilin treatment for 10 days should be given

94. A 4 year old checked in clinic for paraorbital and paratibial swelling, on fisical examm there is pitting edema to the level of
the knees with normal blood pressure, urinalysis protein plus 4 , traces of blood. Lab normal, creatinin, low albumin and
elevated colesterol.which is correct regarding the childs diseas:
a. tow days of albumin infusion are recommended
b. kidney biopsy and steroids
c. macroscopic hematuria will follow
d. in most cases ne reacurance after treatment
e. no increesd risk for infectius diseases

95. The parents of a 5 year old notice he is snoring during sleep. The child has problems staying awake in prescool and has
behaverol problems, the father allsow snors. On fisical exam large tonsils with no exudat. What is the next step?
a. laryngoscopy
b. sleep lab
c. apnea ambulatory monitoring
d. telemetry
e.arterial blood gas testing

96.Regarding resuscitative efforts, the most important goal is ?

a. Restoration of age appropriate heart rate
b. Appropriate movement of the chest wall
c. Auscultation of equal breath sounds in both lung fields
d. Adequate oxygen delivery and utilization for the bode tissue
e. Palpation of equal pulses in all four extremities

97. A 5 year old is noted by the parents to snore at night . the child has also had problems staying awake in preschool and has
had behavioral problems. The father also snores. physical examination of the child reveals large , pink , nonexudative tonsils .
the most appropriate next step is ?
a. Laryngoscopy .
b. Sleep laboratory
c. Ambulatory apnea monitoring
d. Telemetry
e. Arterial blood gas analysis

98. Infant botulism is suspected in a-2 month old infant what is the best test to confirm the diagnosis?
a. lumbar puncture
b. ct scan
c. muscle biopsy
d. electromyography
e. stool simple

99. an 8 year old boy is having repeated episodes of minimal change nephroitic syndrome one every episode was treated
prednisone till the proteinuria resolved however it recurred immediately after treatment cessation for which of the following is
the boy increased risk for?
a. reduced fertility
b. Chronic renal failure
c. Wilms tumor
d. Osteoporosis
e. E-deafness

100. A 1 year old infant is having an intermittent rash in the face in extremity folds that itches mostly at night , his brother had a
similar rash during infancy that has resolved . what is the most probably diagnosis ?
a. Atopic dermatitis
b. Scabies
c. Seborrheic dermatitis
d. Contact dermatitis
e. Psoriasis

101. Which of the following is correct regarding an immune deficient in a child?

a.
b.
c.
d.
e.

antibiotics should be avoided

live attenuated vaccine can be given to a patient with agammaglobulinemia
agammaglobulinemia is clinicaly symptomatic at 1-3 month
Di george syndrom involves B cell deficiency
patient with only IgA deficiency may be asymptomatic

102. A 1.5 year old is brought to the clinic by his parents due to lack of appetite and palor. on physical examination his weight is
7 kg HR-120, Hgb-7, MCV- 60 , MCH- 19, WBC-5300, PLT- 200000. what is the diagnosis?
a.
b.
c.
d.
e.

gluten sensetivity (celiac)

parvovirus B19
ALL
gaucher disease
thallasemia major

103. An 8 day old infant is brought to the ER because of palor and increase bleeding following circumcision. Hgb-7, MCV-90,
WBC- 5600, PLT-340000, PT- 98%, PTT- 100 sec. which is the most likley diagnosis that cause the prolonged PTT?
a.
b.
c.
d.
e.

factor XIII
factor VII
factor X
factor VIII
factor XII

104. A 5 year old broght by his parents to the ER due to fever, weakness and abdominal pain for the last 2 weeks. The boy is
usually healthy. He looks ill, liver is palpated 4 cm and the spleen 5 cm below the rib-cage. On CBC: hgb-5, MCV-80, WBC-34000,
PLT- 24000, reticulocytes- 0.5%. What test will assist the diagnosis?
a.
b.
c.
d.
e.

direct coombs test

coagulation panel
bone marrow aspiration
abdominal US/CT
chest X ray

105. A 4 year old boy is reffered for evaluation due to abdominal distension. Abdominal US demonstrate a mass of the left
kidney.what is the diagnosis?
a.
b.
c.
d.
e.

burkitts lymphoma
neuroblastoma
clear cell sarcoma
adenocarcinoma
wilm's tumor

106.A 2.5-years-old toddler is bought to the ER by his parents due to general seizure at home that lasted about a minute.at the
ER his temperature is 39.5 and acute otitis is identfed.his physical examination is otherwise normal(including neurologic
examination)what is the next step at the ER.:
a. head CT
b. LP
c. EEG
d. Observation for a few hours
e. blood gases,lactate

107. Sever hypotonia whitout tendon reflex is identifiedon routine examination of a 2 months-old infant.whatis the most
probable diagnosis ?
a. Werding-tloffman(spinal muscular)atrophy
b. tay-sacki
c. canvan
d. krabbe
e. neurofibromatosis type 1

108. Which of the following is the most likely diagnosis of 3-years -old boy that run in circles,avoids eye contact ,and does not
talk?
a. ADHD
b. CD
c. Dyslexia
d. infantile autism
e. mental retardation

109. The treatment of cyanotic spell in a child with tetralogy of fallot include all of the following exept;
a. Oxygen delivery
b. Ice bag over the face
c. Calming down the child
d. morphine
e. Phenylephrine

110.A 3 years-old boy refered for evaluation of recurrent nasal bleeding for past 2 weeks,on CBC:PLT-3,000 which of the
following is not associated with the diagnosis of acute immune thrombocytopenia purpuia(ITP)?
a. Neutropenia (absolute neutrophil cout=200)
b. viral infection a month prior to admission
c.Iron deficiency anemia(hgb=9)
d. mild spleen enlarge(2 cm below the rib cage)
e. blood urine

1. A 12 year old boy is complaining of fever,fatigue,sore throat and abdominal pain for 10 days . on physical examination there
are tonsils exudates ,diffuse lymphadenopathy ,and enlarged spleen up to 3 cm under the rib cage. 2 days ago throat swab was
sent for culture and moxypen(amoxicillin) treatment initiated, the cultures are negative but in the meantime a diffuse rash
appeared. What is the fastest and simplest test that will support the most probable diagnosis?
a. blood cultures
b. blood smear
c. repeated throat swab
d. urinalysis

2.An 8 month infant arrives to the ER due to fever ,vomiting and somnolence that started today. The infant appears ill and
somnolent and on examination he has bulging fontanelle and nochal rigidity. There are no other abnormal findings. On CBC 25000 mostly neutrophils, Hgb-11, PLT -320000. What are the most likely diagnosis, investigations, and treatment?
a. viral meningitis , stool cultures,blood cultures ,L.P, antibiotics
b. bacterial meningitis ,L.P ,dexamethasone,immediately followed by antibiotics
c. bacterial meningitis with minigismus ,head CT, L.P, antibiotics according to results
d. the beginning of roseola infantum, L.P ,decision based on results

3. A usually healthy with up to date immunizations 3,5 year old girl is having fever and cough for 2 days. On physical
examination, saturation is normal with decreased air sounds and crepitus over the base of the right lung. On CBC, WBC-19000
with 80% PMN. Chest X RAY demonstrates right lower low infiltrate.
Which of the following is the recommended first choice treatment?
a. Azithromycin(azenil)
b. Ceftriaxone
c. Amoxicillin-clavulanate(Augmentin)
d. i/v Gentamycin
e. Amoxicillin (Moxypen)

4.a 3 year old child is having fever 40 c ,bloody diarrhea .Which of the following complications is not likely??
a. confusion,headache and seizures
b. hemolysis ,anemia and reduced kidney function
c. electrolytes abnormalities ,mainly hyponatremia
d. Gram negative bacteria ,growth on stool culture
e. Dyspnea and pneumonia

5.a baby is born at 40 weeks term following a pregnancy with no medical observation or tests performed by the mother-the
baby 1,9 Kg ,ead diameter 28 cm ,and there is purpuric rash and enlarged spleen and liver,thrombocytopenia ,increased liver
enzymes ,head U.S -calcification around the ventricles . what is the most probable intra uterine infection??
a. EBV
b. Varicella
c. Parvovirus B 19
d. CMV
e. Syphilis
6. which of the following children should be admitted for urinary tract infection?
a. a 1 year child that also passed diarrhea X3 today
b. a 6 year girl complaining of flank pain
c. a 5 year girl with a history of uti at the age of 1 year
d. a 3 week old infant with fever 38.5c
e. a 4 year girl with fever of 39c, with burning sensation and urinary urgency
7. a 4 year old boy is brough to the ER with high fever and swelling of the right eye. The eye is shut with swelling and redness of
the eyelid. The ophthalmologist finds conjunctival edeme with yellowish discharge and the eye ball movments are limited.
What is the most appropriate therapeutic approach?
a. i.v. antibiotic and orbital and nasal cavities ct scan
b. oral antibiotic and antibiotic eye drops
c. i.v. antibiotic without imaging
d. i.v. antibiotic and right orbital us
e. urgent surgery to save the right eye
8. a 2 year child is admitted for high fever, difficulty in eating and drooling. On examination, there is a right torticolis. With right
submandibular lymphadenopathy. The parents describe his voice as blurry. Inspection of the right pharynx reveals tonsils
exudates. What is the appropriate treatment?
a. neck imaging and initiate in treatment
b. initiate oral penicillin
c. tube feeds due to difficulty in eating
d. initiate fluid support (for mononucliosis)
e. immediate intubation

9. a usually healthy 6 month old infant has a 5 days of fever up to 40c and no other complains. For the past 24 hours there is a
maculopapular rash over the face and body. Today the fever is decreasing . what is the most likely diagnosis?
a. measles
b. varicella
c. roseola infantum
d. Kawasaki
e. scarlet fever

10. an infant has swallowed several pills at his grandmothers house. He is found unconscious and later develops a seizure. On
ECG there is QRS widening. What did he most likely swallow?
a. ibuprofen
b. carbamazepine
c. tricyclic antidepressant
d. oral hypoglycemic agent
e. salicylates

12. Which of the following is correct about type 1 diabetes?

a. Incidence is constantly increasing.
e. simillar incidence in western countries

13. 5 years old boy diabetic. prot+1 ketons+4 gluc+4:

a. chetoacidosis
c. meckle diverticle

17. 1 month old comes to the ER with distended abdomen ,vomit... ... metabolic alcalosis:
a. Diagnosis with abdominal US
b. Diagnosis will show nefrologic disfunction
c. Examination will show a palp olive abdomen
d. The patient can be with out jaundice
e. Plain abdominal film is the best management choice

18. 10 year old child is going under a upper endoscopy test for a complain of epigastric pain , ulcers was found:
a.
b.
c.
d.
e.

the ulcer are all a cause of H.pylori

pain will be showed immidiatly after meals
iron deficiency anemia can accompany
pain while sleeping is Atypical
no antibiotic therapy is needed

19. 2 year old male with FTT , diarrhea,distended abdomen, in blood test was found to be positive to TransGlutaminasAntibody:
a.
b.
c.
d.
e.

higher incidence in trisomy 21

start gluten free diet
constipation cancelled the suspected diagnosis
avoid rice
biopsy will be normal

20. 15 year old with mononucleosis 2 weeks ago , comes now to your office the mom complaint of restless and apathy and
bilious vomiting of the child, for a correct diagnosis:
a. abdominal ulta sound
b. administer Ampicillin immediately
c. bowel restraction
d. 60% chance of recurrence
e. The more probable diagnosis is meckel s diverticulum

23. which of the following is CORRECT regarding normal development of a 2 year old child?
a. independently copies an image
b. gets dressed without sentences
c. uses tow word sentences
d. identifies colours
e. draws a circulated human face

24. Which of the following that seem as advanced progress of neurological development is suspicious of significant pathology
and requires investigation??
a. steady seating at the age of 6 months
25. a 2 mounth old girl has a rapidly growing hemangioma involving the perioral region bilaterally. With symmetric extension
into the chin and neck. She was born 8 week premature with an other wise benign medical history. The most appropriate next
step in patient management is?
a. laser surgery
b. skin biobsy
c. reassurance that the lesion will go away on its own
d. inhaler prescription
e. ENT evaluation

03.03.2011:
1. The most common neurological squela associated with bacterial meningitis in children is:
A. mental retaridation
B. chronic seizure disorder
C. impaired vision
D. impaired hearing
E. behavioral disturbance

2. The most common cause of viral meningoencephalitis in children is:

A. An enterovirus
B. Herpes simplex virus
C. An arbovirus
D. dmumps virus
E. A respiratory virus

3. A 12-year old girl experiences acute monocular blindness of 2 days duration past medical history reveals that she
has had headaches for the past 3 years that she cannot charatcerize one brief episode of diplopia, and one episode of
parasthesias of the feet. The episodes were hot related in time, did non occur in immediate proximity to the
headache, and resolved spontaneously. Finding of physical examination, including the funduscopic exmination, are
unremarkable other than reduced visual acuity. The most important diagnostic step is to perform:
A. CT scan
B. MRI
C. A electroencephalogram (EEG)
D. peripheral nerve conduction test's
E. A sural nerve biopsy

4. Which of the following is the etiology in most cases of mayasthenia gravis?

A. inheritance as a rcessive trait .
B. inheritance as an X- linked trait .
C. postinfectious usually after either influenza orchickenpox.
D. autoimmune disorder
E. idiopathic

5. A 3-year old boy presents to an urgent care clinic with a 3-day history of abdominal pain and difficulty walking, Abnormal
findings include blood pressure of 120 /80 mm Hg .diffuse abdominal tenderness and swelling of the ankles.
The most likely diagnosis is:
A. Systemic lupus erythematosus
B. Kawasaki's disease
C. Juvenile rheumatoid arthritis
D. Henoch-schonlein purpura
E. Stevens-johonson syndrome

6. A 12 year old boy presents with 1 year history of worsening polyuria and a 2 to 3 wk history nausea fatigue and
malaise serum creatinine is 4.0 mg dl bicarbonate is 15 mg dl. Urinalysis shows specific gravity of 1.004 trace
leukocytes trace blood and no protein with 3-5 WBCs per high-power field, 3-5 RBCs per high-power field and no
RBC casts which of the following is the most likely diagnosis?
A. acute poststreptococal glomerulonephritis
B. chronic interstitial nephritis
C. minimal-change nephritic syndrome
D. acute interstitial nephritis
E. chronic glomurulonephritis

7. Trisomy 21 is associated with?

A. malrotation
B. endocardial cushion defect
C. cleft palate
D. renal disease
E. sensonynural hearing loss

8. What is the most significant complication arising from Kawasaki disease?

A. coronary aneurysms
B. kidney failure
C. gallbladder hydrops
D. gastrointestinal bleeding
E. hypertension

9. Which of the following medication groupings most appropriate for a patient older than 5 years with moderate
persistent asthma?
A. none
B. a daily low dose inhaled corticosteroid
C. a daily low dose inhaled corticosteroid and a long acting inhaled beta 2 agonist
D. a daily oral corticosteroid
E. a daily medium dose inhaled corticosteroid and inhaled nedocromil
10. Peripheral pulmonic stenosis patent ductus arteriosus , retinopaty, cataracts, hepatosplenomagaly,
jaundice and nerve deafenss are the clinical manifestation typically associated with which of the following
congenital defects?
A. toxoplasmosis
B. syphilis
C. rubella
D. cytomegalovirus
E. hiv
11. A newborn has a dysmorphic feature. The pregnancy was complicated by a breach presentation. He shows
decreases movements, polyhydramnios, hypotonia, flat face, flat occiput, epicanthal folds and abdominal
distention. The couse of this is:
A. Trisomy 13
B. Trisomy 18
C. Edward syndrome
D. Trisomy 8
E. Trisomy 21

12. An 11 year old girl is examined because of fatigue, arthralgia and malar rash. Laboratory revels positive
anti nuclear anti bodies. You suspect SLE .What test if positive with be the most specific for diagnose SL:
A. Anti- smith antibodies
B. Anti double strand antibodies
C. Anti phospholipid antibodies
D. Anti cardiolipin antibodies
E. Antinuclear antibodies

13. An 18 month girls is examine because of a blood streak stools .the stool is
grossly positive for hemoccult blood test. She complain of constipation. What is the most likely the diagnosis:
A. Anal fissure
B. Peptic ulcer
C. Mallory Weiss syndrome
D. IBD
E. Necrotizing enterocolitis

14. Galactosemia, a disorder of carbohydrate metabolism, is inherited in an

autosomal recessive pattern .What are the risk of galactosemia in parents who are both carriers of the disorder:
A. 100
B. 75
C. 50
D. 25
E. 10

15. A 3 yr old present to the pediatrician with fever, pallor, anorexia, joints pain, petechiae and
hepatosplenomegaly. The most likely the diagnosis is:
A. Acute lympgenous leukemia
B. Acute Myelogenous Leukemia
C. Juvenile chronic myelogenous leukemia
D. Aplastic anemia
E. Osteosarcoma

16. Neonate born at 28 weeks gestation is now 2 weeks of age. Nasagastric feeds are started. 48 hours after
starting feeds the neonate develops a distended abdomen, bloody stool, pneumatosis intestinalis, and free air on abdomen
radiograph. Laboratory studies reveal thrombocytopenia. The child becomes hypotensive. The
most likely diagnosis is:
A. intestinal obstructions
B. aspiration pneumonia
C. malrotation
D. necrotizing enterocolitis
E. jejunal atresia

17. You are called to delivery room for a routine birth. The infant cries when the cord is cut. You examine the child
under the warmer and notice that when he stops crying, his chest heaves and he turns blue. You are unable to pass
the nasogastric tube through the nose for suctioning. Which condition is the most likely causing the
infants respiratory distress?
A. choanal atresia
B. vocal cord paralysis
C. subglottic stenosis
D. recurrent laryngeal nerve damge
E. laryngeal web

18. A 6-monthe old male infant presents to the pediatrician with arresting heart rate of 50 beat per minute. Physical
examination reveals no rash, and there is no history of rash. On chest radiograph there is no cardiomegaly. The
family history reveals maternal system lupus erythematosus. Which of the following diagnoses is the most likely cause of
bradycardia?
A. lyme disease
B. congenital complete heart block
C. sinus node dysfunction
D. cardiomyopathy
E. sinus bradycardia

19. A12 month-old infant present with hemoglobin level of 7.5 and hemotocrit 22% the mean corpuscular
volume 65 and the adjusted reticulocyte count is 1% . What is the most likely cause of the anemia in this child?
A. iron deficiency
B. chronic disease
C. transient erythrocytopenia of childhood
D. talassemia
E. parvovirus b19 aplastic crisis

20. Feeding between 6-12 months of age characterized by:

A. willing to be fed by a stranger
B. struggle for independence
C. the infant uses a spoon for feeding
D. poor weight gain reflectus a disease
E. the infant object to holding a spoon

21. Growth between 6 and 12 years is characterized by annual weight and height increments of:
A. 3.5 kg , 6 cm
B. 6 kg , 3.5 cm
C. 5 kg , 10 cm
D. 10 kg , 5 cm
E. 1.5 kg , 5 cm
22. Regarding resuscitative efforts in children, the most important goal is:
A. restoration of age appropriate heart rate
B. appropriate movement of the chest wall
C. auscultation of equal breath sounds in both lung fields
D. adequate oxygen delivery and utilization of the body tissues
E. palpation of equal pulses in all four extremities

23. A 9 month old boy is brought to the emergency room in limp and unresponsive
state. Initial examination shows a pulse rate of 35 /min and occasional irregular
breaths. After initiation of cpr (including tracheal intubation) delivary of oxygen via
positive - pressure breaths and chest compression , multiple attempts to insert an
intra - venous line fail. The most appropriate next step in manegment should be:
A. obtain an arterial blood gas sample
B. place in intraosseous needle and administer fluids and intropic agents
C. obtain a "state" head ct study to evaluate reasons for unresponsiveness
D. place transthoracic cardiac pacemaker
E. place a thoracostomy tube to evacuate a possible pneumothorax

24. The most recommended treatment for severe combined immunedeficiency is:
A. gene therapy
B. monthly iv gammaglobulin
C. monthly iv gammaglobylin and interferon-&(gama)
D. monthly iv gammaglobulin and il-8-monoclonal antibody
E. stem cell transplantation

25. Delayed separation of the umbilical cord after birth suggests which of the following types of
immune deficiency:
A. b-cell defect
B. t-cell defect c)combined b and t cell defect
C. phagocytic function defect
D. complement compenent deficiency

26. A 12-yr old white girl present with arthralgia of the knees and elbow and swollen hands of 6 months duration.
She has intermittent fever and has lost 7.5 kg in weight. Other than swollen joints, findings on physical
examination are normal. 3 years earlier, she was found to have thrombocytopenia and was diagnosed with ITP. In addition, one
summer, she had severe sunburn, and 2 tears ago she had mouth sores. Today she has a hematocrit of 25%, positive combs
test, and the urinanalysis shows multiple RBC. The most common likely diagnosis is:
A. juvenile rheumatoid arthritis
B. ITP
C. evans syndrome
D. periarteritis nodosa
E. SLE

27. A 75-yr old boy develops progressive symptoms of fever, lassitude, arthralgias,
headache and abdominal pain. Physical examination shows hepatosplenomegally.
Further questioning discovers that he and his family live in a rural area and consume
unpasteurized dairy products in their diet. The the most likely etiologic agent of this
illness is:
A. actinomyces
B. bartonella hensallae
C. brucella
D. francisella tularensis
E. Yersinia enterocolitica

28. A 5-yr old boy is noted by the parents to snore at night. The child has also had problems staying awake in
preschool and has had behaivoral problems. The father also snores. Physical examination of the child reveals
large, pink, nonexudative tonsils. The most appropriate next step is:
A. laryngoscopy
B. polysomnography
C. ambulatory apnea analysis
D. telemetry
E. arterial blood gas analysis

29. The appropriate initial therapy of severe obstructive sleep apnea syndrome in a child is:
A. adenotonsillectomy
B. tracheostomy
C. parapharyngeal muscle surgery
D. theophylline
E. bilerel positive airway pressure

30. A 7 months-old girl present with temp. 38.3 BP 70/30mm, diffuse petechia first noted 4 hours before
presentation. Platelets count 88,000/mm3, and white blood cell count of 43,000/mm3 with 23% neutrophils and
42% bands. The infant has received all recommended vaccination. Which of the following is the most likely
bacterial etiology of this presentation?
A. staphylococcus aerus
B. streptococcus pneumonia
C. neiserria meningitides
D. haemophyllus influenza type b
E. coli o 157:h7

31. A 10 mo-old child presents to the emergency department with a 4 day history of fever, with temp. 39 c, and
watery diareea, just expirienced a generalized seziure. What is the most common syndrome?
A. Sallmonela gastroenteritis
B. Aeromonas gastroenteritis
C. Shigella gastroenteritis
D. Rotavirus gastroenteritis
E. Drug ingestion

32. A 10 years old child prezents to the office with unilateral conjunctivitis, that has been present for 5 days. You
palpate an enlarged periauricular node on the same side. She has no history of recent travel, but her family
introduced a kitten aproximately 2 monthes ago. The most likely etiologic agent responsible for her condition:
A. Borellia burgdorferi
B. Francisella tularensis
C. Bartonella hensalea
D. Staphylococcus aureus
E. Toxoplasma gondii

33. A 2 mo-old infant is suspected of having infant botulism. Which is the best means to confirm the diagnosis?
A. Lumber puncture
B. CT-scan
C. muscle biopsy
D. electoromyography
E. fecal specimen

34. Which of the following is true?

A. ulcerative colitis is typically characterized by rectal sparing
B. crohns disease is typically characterized by skip lesions
C. ulcerative colitis typically involves the terminal ileum
D. ulcerative colitis is typically characterized by transmural disease
E. crohns disease is typically characterized by crypt abscesses

35. A 9 mo-old infant accidentally ingests unknown quantity of digitalis. Which is the most significant noncardiac
manifestation of toxicity in this child?
A. fever
B. dizziness
C. vomiting
D. visual disturbances
E. urticaria

36. A12 years old boy comes to the emergency department at midnight with a complaint of severe scrotal pain since 7 p.m.
there is no history of trauma. Which of the following is the most appropriate first step in his management?
A. order surgical consult immediately
B. order radioisotope scan as an emergency
C. order urinalysis and gram stain for bacteria
D. arrange for an elective ultrasound examination
E. order elective ultrasound examination

37. A 6 yr old boy whose past medical history is positive for three urinary tract infections, presents with a blood pressure of
150/90 mmhg. He is likely to exhibit which of the following symptoms or signs?
A. multiple cranial nerve palsies
B. headaches
C. hyporeflexia
D. increased urinary output
E. right ventricular hypertrophy

38. A 6 yr old girl underwent removal of craniopharyngioma 3 months previously. She is on thyroid replacement
regimen but her mother reports she is very fatigued. The next step would be:
A. increase the dose of her thyroid medications
B. schedule a growth hormone stimulatiom test
C. measure ACTH and cortisol
D. obtain MRI study of her head
E. measure IGF - 1 and IGFBP - 3

39. During routine screening CBC, a 1 yr old child is noted to have pronounced eosinophilia. Which of the
following is the most likely explanation?
A. bacterial infection
B. chronic allergic rhinitis
C. helmith infestation
D. tuberculosis

40. A 6 month old infant has been exclusively fed a commercially available infant formula. Upon introduction of fruit juices, the
child develops jaundice, hepatomegally, vomiting, lethargy, irritability and siezures. Test for urine reducing
substances are positive. Which of the following is likely to explain the childs condition?
A. tyrosinemia
B. galactosemia
C. fructose intolerance
D. alpha 1 anti tripsin deficiency
E. glucose 6 phosphate dehydrogenase deficiency.

41. 1 mo child is admitted during hot weather after generalized seizure. Head CT is
normal. Family members state that recently they have strated to dilute the child's
formula in order to add water to his diet. Most probably the seizures was caused by:
A. Hyperthermia
B. Child neglect
C. Hypernatremia
D. Hyponatremia
E. Convulsions associated increased temperature

42. All of the following are important in the investigation of tall patients except:
A. Family analysis
B. Plasma factor IGF-1
C. Homocustin
D. Chromosomal analysis
E. Long fatty acids

43. A 12 y, girl, complains on muscle cramps and tingling in hands and feet that are not related to effort. When she
grasps a door handle she cant release the grasp due to hand spasm. The most important lab analysis is:
A. Blood glucose determination
B. Blood calcium
C. EMG
D. Nerve conduction velocity
E. Arterial blood gas

44. A 16 y girl complains on headaches for the past 13 months, and visual changes for the past 2 weeks. Now she
has galactorrhea. Last menstrual period was 4 mo ago. The galactorrhea is most probably due to:
A. Stress of amenorrhea
B. Elevated prolactin level
C. Elevated estrogen level
D. Migren
E. Adrenal insufficiency

45. 14 y girl is admitted with vaginal bleeding which is longer and havier then her usual menstruation which is irregular and
started 13 mo ago. She is pale, tachycardic. Your next step in diagnosis:
A. Start medroxyprogesteron (provera)
B. Start conjugated estrogen (premarin)
C. Hct determination
D. Estrogen level determination
E. Platelets n determination

46. A 9 y, girl, was admitted with developmental delay and regression after normal development until 6 mo. Responds with fear
to loud noise, macrocephalus. On examination decresed visual contact, cheri red spots on retina. The diagnosis is probably:
A. Tay sachs
B. Gouchers disease
C. Fabrys disease
D. Galactosemia
E. Glycogen storage disease type 1

47. A 5 mo, prominent motor delay, hypotinia and cardiomegaly. CK-860U/I. DIAGNOSIS:
A. Spinal muscular atrophy
B. Hypothyroidism
C. Prader willi
D. Pompes disease
E. Dawn syndrome

48. Which of the following is an advantage of skin tests (Skin prick test -SPT) compared with the RAST
to identify specific IgE?
A. SPT are not influenced by antihistamin administration
B. Sensitivity of SPT is higher than RAST
C. SPT are semi quantitative
D. SPT are associated with low risk of allergoc reaction
E. SPR are not influenced by dernographics

49. Which is LEAST LIKELY physical sign on examination of child with moderate asthma?
A. Thacypnea
B. Wheezing
C. Clubbing
D. Decresed air conduction on auscultation in right middle lung loe
E. Increased size of anterio-posterior chest

50. Nurse states that a new born baby girl, 3.5 kg after repeated C-sectionwas breathing heavily/hoarsely after 10 min. After
birth, on examination there were no heavy breathing, breathing rate- 36/min. O2 saturation-96%. The child is reactive. Next
step:
A. Sepsis investigation
B. Chest x-ray
C. Observation, and if the heavy breathing will start again, hospitalization in new born ICU.
D. Surfactant therapy
E. Positive end expiratory pressure through nasal mask

04.10.2010:
1. A 5-mo-old infant develops signs of respiratory distress after coughing and sneezing for 3 days. He has marked subcostal and
intercostal retractions and a respiratory rate of 80 breaths/min. Breath sounds are markedly diminished on both sides. Diffuse
crackles can be heard bilaterally. There is no stridor. Arterial oxygen saturation in 100% oxygen by non-rebreather mask is 80%.
The skin is pale and peripheral arterial pulses are weak.
Which of the following is the most appropriate immediate course of action?
A.
B.
C.
D.
E.

Administration of corticosteroids
Intubation of the trachea and mechanical ventilation
Sampling of arterial blood and measurement of arterial pH and blood gases
Administration of normal saline
Administration of diuretics

2. A 2-yr-old boy is seen for his routine check-up, 4 weeks after an episode of bilateral acute otitis media that resolved
uneventfully with antibiotic treatment. He seems generally well, but his mother reports that he is not hearing as well as usual.
On pneumatic otoscopy, both his eardrums appear amber, opaque, and retracted, and both are immobile. Otherwise his ENT
examination is unremarkable.
Which of the following treatment regimens is the most appropriate to institute at this time?
A.
B.
C.
D.
E.

A 10-day course of amoxicillin

A 10-day course of amoxicillin-clavulanate
Short-course treatment with azithromycin
Observation without treatment for at least 2 more mo
Referral for consideration of myringotomy and tube insertion

3.Conductive hearing loss is:

A.
B.
C.
D.
E.

Common in children with chronic ear fluid

A permanent condition related to nerve damage
Always associated with ossicular abnormalities
An uncommon complication of otitis media
Unlikely when an intact tympanic membrane is present

4.A 2-mo-old girl has a rapidly growing hemangioma involving the perioral region bilaterally, with symmetric extension onto the
chin and anterior neck.She was born 8 wk premature with an otherwise benign medical history, although her parents wonder if
she may be developing asthma.
The most appropriate next step in patient management is:
A.
B.
C.
D.
E.

Laser surgery
Skin biopsy
Reassurance that hemangiomas will go away on their own
Inhaler prescription
ENT evaluation

5. A 6-mo-old infant is presented for evaluation of a tuft of thick black hair located on the sacrum. The child's mother states
that the lesion has been present since birth and seems to be asymptomatic, and the child is otherwise healthy. The most
appropriate next step in management is:
A.
B.
C.
D.
E.

Reassurance that the lesion will resolve spontaneously in time

MRI of the spinal cord
Referral to a plastic surgeon for excision
Counseling of the parents regarding melanoma risk
Watchful waiting

6. A blonde, blue-eyed girl was admitted at 2.5 mo of age with severe emesis to rule out pyloric stenosis. She had poor
development, eczema, and a musty odor. The most likely diagnosis is:
A.
B.
C.
D.
E.

Wiskott-Aldrich syndrome
Galactosemia
Cystinosis
Phenylketonuria (PKU)
Biotinidase deficiency

7. A previously healthy 2-wk-old now has progressive lethargy. Physical examination reveals muscle rigidity, opisthotonos
posture, periods of hypertonicity,and flaccidity. Laboratory data reveal hypoglycemia, metabolic acidosis, and cerebral edema.
Plasma levels of leucine, isoleucine, and valine are elevated.
The most likely diagnosis is:
A.
B.
C.
D.
E.

Hartnup disease
Maple syrup urine disease
Phenylketonuria
Homocystinuria
Galactosemia

8. Which of the following cancers has the highest incidence in young children (<7 yr of age)?
A.
B.
C.
D.
E.

Ewing sarcoma
Hodgkin disease
Testicular cancer
Retinoblastoma
Osteosarcoma

9. Which of the following cancers is the most closely associated with Epstain-barr virus?
A.
B.
C.
D.
E.

Osteosarcoma
Non-Hodgkin lymphoma (Burkitt lymphoma)
Ewing sarcoma
Wilms tumor
Hepatoblastor

10. An adolescent girl who is a cheerleader comes to you with a painful bump below her right knee. She denies fever or trauma.
Which of the following is the most likely diagnosis?
A.
B.
C.
D.
E.

Legg-Calv-Perthes disease
Osteoid osteoma
Osgood-Schlatter disease
Osteochondritis dissecans
Osteomyelitis of the tibial tubercle

11. A 9-mo-old boy is brought to the emergency room in a limp and unresponsive state. Initial examination shows a pulse rate
of 35/min and occasional irregular breaths. After initiation of CPR (including tracheal intubation), delivery of oxygen via
positive- pressure breaths, and chest compressions, multiple attempts to insert an IV line fail.
The most appropriate next step in management should be to:
A.
B.
C.
D.
E.

Obtain an arterial blood gas sample

Place an intraosseous needle and administer fluids and inotropic agents
Obtain a "stat" head CT study to evaluate reasons for unresponsiveness
Place a transthoracic cardiac pacemaker
Place a thoracostomy tube to evacuate a possible pneumothorax

12. A 12-yr-old girl experienced diarrhea, which lasted for 3 days, 2 wk before manifesting progressive weakness and inability to
walk. She has intermittent tingling of her fingers and toes. Physical examination reveals marked peripheral muscle weakness
without atrophy or fasciculations. The deep tendon reflexes are absent in her ankles and 1+ at her knees. Findings on the
sensory examination are normal. Motor involvement is symmetric. The most likely diagnosis:
A.
B.
C.
D.
E.

Transverse myelitis
Guillain-Barr syndrome
Polio
Myasthenia gravis
Mononeuritis multiplex

13. A 10 year-old girl has had diplopia and ptosis and weakness of her neck flexors for 2 mo. symptoms are worse in the evening
and are usually less severe on awakening in the morning. she has no fasciculations or myalgias, and her tendon reflexes are 12+. The most likely diagnosis is?
A.
B.
C.
D.
E.

Hysterical weakness
Muscular dystrophy
Spinal muscular atrophy
Botulism
Myastenia gravis

14. A 12-yr-old boy with cystic fibrosis experiences an acute exacerbation and is admitted for intravenous antibiotic therapy.
Sputum culture reveals Pseudomonas aeruginosa.The antibiotic recommended for treatment is:
A.
B.
C.
D.
E.

Ampicillin-sulbactam
Ceftazidime
Cefotetan
Ceftriaxone
Ciprofloxacin

15. All of the following are features of scarlet fever except:

A.
B.
C.
D.
E.

Pastia lines
Desquamation
White strawberry tongue
Red strawberry tongue
Impetigo (Preauricular lymphadenopathy)

16. Months old refuses to walk; began walking at the age of 10 months .Presents with 39 degrees fever, appears moderately-ill,
rotated left hip with limitation to passive and active movement; most likely causing pathogen:
A.
B.
C.
D.
E.

Neisseria
Adenovirus
Staphylococcus
Group A streptococci
Group B streptococci

17. Sickle cell anemia become asplenic infection risk?

A. Gram negative
B. Encapsulate

18. A 7-days old infant is found to have a significant elevated total bilirubin, but is other wise well . The fractionated bilirubin
reports direct of 3mg/dI and indirect 6mg/dI .the most like diagnosis?
A.
B.
C.
D.
E.

Breast milk jundice

Hereditary
Congenital infection.
Gilbert
Spherocytosis

19. A newborn develops sepsis and shock. The pathogen that most commonly causes systemic and focal infections in the
newborn is:
A.
B.
C.
D.
E.

Staphylococcus aureus
Group A streptococci
Group B streptococci
Escherichia coli
Herpes simplex virus

20. Which of the following is associated with a poorer prognosis for persons presenting with meningococcal disease?
A.
B.
C.
D.
E.

Presence of petechiae for <12 hr

Meningitis
Thrombocytosis
Leukocytosis
Low circulating levels of tumor necrosis factor

21. A previously healthy 18-month-old has been in a separate room from his family.the family notices the sudden onset of
coughing,which resolves in a few minutes.subsequently,the patient appears to be normal except for increased amounts of
drooling and refusal to take foods orally.
Which of the following is the most likely explanation for this toddler's condition?
A.
B.
C.
D.
E.

Severe gastroesophageal reflux

Foreign body in the airway
Croup
Epiglottitis
Foreign body in the esophagus

22. You have just given a 10 year-old boy an injection of pollen extract as prescribed by his
allergist. You are about to move on the next patient when the boy starts to complain about nausea and a funny feeling in his
chest. You note that his face is flushed and his voice sounds muffled and strained.
Which of the following is the first priority in managing this episode of anaphylaxis?
A.
B.
C.
D.
E.

Preparation for endotracheal intubation

administration of oxygen
subcutaneous injection of 1:1000 epinephrine
intramascular injection of diphenhydramine
administration of corticosteroids

23. A 15 year-old girl with short stature,neck webbing,and sexual infantilism is found to have.A chromosomal analysis likely
would demonstrate which of the following ?
A.
B.
C.
D.
E.

Mutation at chromosome 15q21.1

Trisomy 21
XO karyotype
Defect at chromosome 4q16
Normal chromosome analysis

24. A 5-year-old is noted by the parents to snore at night. The child has also had problems staying awake in preschool and has
had behavioral problems. The father also snores.Physical examination of the child reveals large, pink, nonexudative tonsils.The
most appropriate next step:
A.
B.
C.
D.
E.

Laryngoscopy
Polysomnography
Ambulatory apnea monitoring
Telemetry
Arterial blood gas analysis

25. A 4 year old boy is in the office for a routine health maintenance evaluation. his examination is normal except for multiple
deep dental cavities.you plan on referring him for dental evaluation.his mother tells you he has a "heart condition". which of
the following needs antibiotic as prophylaxis treatment?
A.
B.
C.
D.
E.

VSD repaired 8 months ago

Tetrollogy Of Fallot
History of uncomplicated Kawasaki disease
Tranposition of great vessels
Ostium secundum arterial septal defect

26. A 4-year-old white girl has had joint swelling in multiple joints for over 6 mo. She is slow to move in the morning and moves
as if stiff for the first hours of the day. Thereafter, she is a very active child. She has no rash and very little limitation of range of
motion. Her erythrocyte sedimentation rate is 4. The most likely diagnosis is:
A.
B.
C.
D.
E.

Hypermobility syndrome
Dermatomyositis
SLE
JRA
Henoch-Sch nlein purpura

27. Of the following signs of cancer, the most likely to occur in children is:
A.
B.
C.
D.
E.

Abnormal discharge from a body orifice

Change in a mole or wart
Focal neurologic deficit
Cough, hoarseness, or difficulty swallowing
Change in urination or defecation pattern

28. A 12-yr-old white girl presents with arthralgias of the knees and elbow and swollen hands of 6 months' duration. She has
had intermittent fever and has lost 15 lb. Other than swollen joints, findings on physical examination are normal. Three years
earlier, she was found to have thrombocytopenia and was diagnosed with idiopathic thrombocytopenic purpura (ITP). In
addition,one summer she had severe sunburn, and 2 yr ago she had mouth sores.Today she has a hematocrit of 25% and a
positive result on a Coombs test,and the urinalysis shows multiple red blood cells. The most likely diagnosis is:
A.
B.
C.
D.
E.

JRA
ITP
Evans syndrome
Periarteritis
SLE

29. A 13-year-old develops fever,malaise,sore throat,and a dry,backing cough over several days. He does not appear to be
particularty sick,but his chest examination is significant for diffuse rales and rhonchi.The chest radiograph is shown below.
Which of the following is the most likely pathogen ?
A.
B.
C.
D.
E.

Staphylococcus aureus
Mycobacterium tuberculosis
Haemophilus influenzae
Streptococcus pneumoniae
Mycoplasma pneumonia

30. A 9 year-old patient asthmatic patient uses albuterol 3 times per week,for the last 10 days she had wheezing day and night
,increased the inhaler to 3-4 times a day,on examination there is a diffuse wheezing with moderate subcostal retraction, next
step in management:
A.
B.
C.
D.
E.

order chest XR to asess for pneumonia

Systemic steroids
Lekutriens
Low dose inhalation steroids
Start 5 days course of systemic corticosteroid

31. Milk Cow allergy?

D. Check reducing agints in stool
E. Change his diet to an alternative protein source
32. A12 month-old female infant with failure to thrive is bronght to the office her parents note that she is very fussy and offen
spits up after feedings she also has two loose foul-smelling stool lach day.Which of the following foods can she eat safety
without aggravating or inducing her symptoms?
A.
B.
C.
D.
E.

Rice
Wheat
Oats
Barley
Rye

33. A 6-yr-old girl underwent removal of a craniopharyngioma 3 mo previously. She is on a thyroid replacement regimen, but
her mother reports she is very fatigued. The next step would be to:
A.
B.
C.
D.
E.

Increase the dose of her thyroid medication.

Schedule a growth hormone stimulation test
Measure ACTH and cortisol
Obtain an MRI study of her head
Measure IGF-1 and IGFBP-3

34. A 10-yr-old boy receiving vincristine for treatment of a malignancy has developed the syndrome of inappropriate
antidiuretic hormone secretion (SIADH), a known complication of this therapy.
All of the following parameters would be decreased in this patient except:
A.
B.
C.
D.
E.

Urine production rate

Serum osmolality
Intravascular volume
Uric acid
Serum sodium

35. A mother and her 14-yr-old daughter come to you because the girl has not begun to menstruate. Her medical history and
findings on the complete physical examination are normal. Breast development and pubic hair have been present for 18
months and are normal.
Which of the following would be the most appropriate next step in the management of this patient?
A.
B.
C.
D.
E.

Reassurance that she probably will begin menstruating within the year
Laboratory evaluation for systemic disease
Urinary estriol determination
Buccal smear
Referral for psychologic counseling

36. A newborn infant spends about 40 min with the mother but then falls asleep and does not respond to the mother's voice.
Which of the following statements regarding this lack of activity is true?
A.
B.
C.
D.
E.

It is suggestive of sepsis
It is suggestive of sedation
It is normal
It represents a seizure
It is due to apnea

37. A 4-yr-old boy is noted to have stereotypic body movements and poor verbal and nonverbal communication,with absence
of empathy. At daycare, he has not made any friends.The most likely diagnosis is:
A.
B.
C.
D.
E.

Attention deficit hyperactivity disorder

Dysthymic syndrome
Deaf-mutism
Autism
Cerebral palsy

38. The probable age of a child who rolls back to front, has a thumb-finger grasp, self-inhibits to "no" and bangs two cubes is:
A.10-12 mo
B.7-8 mo
C.12-15 mo
D.3-4 mo
E.15-18 mo

39. m/o, feeding intolerance, poor-weight gain and large tongue; large posterior fontanelle and umbilical herni.
Next step:
A.
B.
C.
D.
E.

Abdominal radiography
CBC and blood culture
Barium swallow test
Serum TSH level
Admission for FTT work-up

40. Small mandible on x-ray no thymos:

B. Di-George syndrome

41. A mother brings her 3 years old son with Down-syndrom to the clinic because his gums have been bleeding in the last
week.she reports that he has been less energetic than usual-Exam reveuls that the child has a temperature of 37.8 c orally
pallor, splenomegaly, gingival, which of the following is most likely ?
A.
B.
C.
D.

Aplastic anemia
Left shift
Leukemia
Leukmoid rxn

42. A 30 hour-old full term infant has face and chest jaundice,he is breast feeding well. And has an otherwise normal exam.his
bilirubin level is 16.5mg/dl. which is the following is the most appropriate course of action?
A.
B.
C.
D.

Stop breast feeding and give formoula

Start phototherapy
Phototx
Plasma exchange

43. Cystic Fibrosis (CF) vitamin supplement?

A.
B.
C.
D.
E.

Vitamin B
Folate
Vitamin C
Vitamin D
Vitamin B12

44. A 18 mo-old already walked now stopped walking,blow legs cause?

A. Primary hyperParathyroidsm
B. Rickets

45.
D. Obtain a urine culture by catheter and start antibody

46. A 14 year-old healty girl has a urinalysis a part of her well child visit.Urinc dipstick testing show specific gravity 1.014 ,Ph-6
,and 2+ proteinuria and is negative for blood,microscopic examination of the urine is unreveuling the most appropriate next
step in diagnosis is to?
B. Dip stick mid stream morning
C. 24 hours protein collection
D. Measure the urine protein to creatinine ratio an a first morning voided sampl

47. Child came to ER with an epileptic seizure, he is known to have epilepsy and had recieved valproic acid 30 min at home, he
is still seizing on arrival- what the next management?
A.
B.
C.
D.

Intubation
That u should make an IV access and give anticonvulsant,
Lorazepam
Stabilize airway and provid 100% O2

48. You are seeing 10 years old boy for his will-child checkup and notice that he is Hypertensive. he has otherwise been doing
weel when looking back throngh his old chart, tou realize that his previous blood pressure were normal. what would by your
next course of action ?
B.
C.
D.
E.

Urinanlisis
Ultrasound
Rechecking his blood pressure in 1 week
Basic hormonal and metabolic panel

49. Which of the following autoantibodies is most specific for SLE? ((which of the following tests would be most specific in the
diagnosis of SLE)):
A.
B.
C.
D.
E.

Anti-ribonucleic acid (RNA)

Anti double standed DNA antibody
Anti-nuclear
Anti-double-stranded deoxyribonucleic acid (dsDNA)
Anti-ribonucleoprotein

50. A 14-yr-old girl presents with vaginal bleeding that is more prolonged and profuse than her usual periods, which are
irregular and first started 13 mo ago. She has pallor and tachycardia. The next step in her evaluation is to:
A.
B.
C.
D.
E.

Administer medroxyprogesterone (Provera)

Administer conjugated estrogens (Premarin)
Determine the hematocrit
Determine the estrogen level
Determine the platelet count

01.03.2010:
1- an 8-mo-old girl is brought to your office with complaint that she has development delay. her head is enlarged, and
she feeds poorly and does not focus. you examine that baby and find her hypotonic and unable to sit. she has
considerable head lag. ad head circumference is above the 95 th percentile.
which of the following disease would consider the most probable diagnosis ?
a.birth asphyxia
b. familial hydrocephalus
c.rubella infection in utero
d.canavan disease
e.hunler disease

2- a serios complication of the treatment of hypernatremic dehydration is ?

a. cerebral thrombosis
b. cerebral edema
c. hypoglycemia
e. none of the above

3- the best feeding protocol for a temperamentally irregular infant is ?

a. a fixed schedule
b.one based on the parent's schedule
c. every 1-2 hr
d. one based on demand
e. 60 min for each feeding

4- during examination of an 8-mo-old child, the difficulty of optimal chest auscultation is due primarily to ?
a. recent meal with gastric distention
b. rapid respiratory rate
c. stranger anxiety
d. transmited nasal sounds
e. pliable chest wall
5- which of the following is a known complication of vascular ring?
a. renal failure
b. heart failure
c. cardiac arrhythmia
d. tracheomalacia
e. constipation

6- a 5-yr-old with AIDS who is receiving zidovudine, lamivudine, and ritonavir presents whith rapid respiratory
rate progressive dyspnea of 2 days duration. there is no fever. the chest radiograph reveals bilateral diffuse alveolar
disease. the most important diagnostic test whoud be?
a. CT scan of the chest
b. pharyngeal swab for viral and bacterial cultures
c. blood gas profile
d. serum lactate dehydrogenase level
e. bronchoalveolar lavage for cytology

7- A 6-yr-old girl who was previously healthy presents with a 1-wk history of nocturnal perianal itching
there are no other symptoms , and findings on physical examination are normal. the most appropriate therapy is ?
a. bacitracin ointment to the perianal area
b. diphenhydramine of mebendazole repeated in 2 wk
c.
d. a 2-wk course of amoxicillin/clavulanate
e. ketoconazole, in a single dose

8- A 4-mo-old child with vitamin D deficiency rickets would be expected to show all of the following except?
a. craniotabes
b. bowleg
c. rosary
d. low serum phosphate levels
e. high alkaline phosphatase leveles
9- A 5-yr-old boy who lives in an urban area is hospitalized because of low grade fever, flaccid
paralysis of both leges, sensory changes, and absent ankle deep tendon reflexes. the child received
only two immunizations with oral poliovaccine (OPV) , at the ages of 2 and 6 mo. the most probable diagnosis is?
a. acute paralytic poliomyelitis due to wild poliovirus
b. paralysis due to nonpolioenteroviruses
c. vaccine- associated poliomyelitis
d. guillain-barre syndrome
e. tick-bite paralysis
10- which of the following may be a manifestation of enterovirus infection?
a. ataxia
b. intususception
c. parotitis
d. herpangina
e. renal failure
21- a20-month-old child is brought to the ed because of fever and irritability and refusal to move his right knee
that resists-passive motion.
which of the following is the most important test to confirm the impression of septic arthritis:
A .x-ray of the knee
b. examination of the joint
c. erythrocyte sedimentation rate
d. complete blood count and differential
e. blood culture

22- as apart of your anticipatory guidance to new parents of healthy newborn you suggest putting the child in
which of the following position for sleep?
a.supine position
b.prone position
c.seated postion
d.trendelenburg postion
e.a hammock

23- amentally retarted 14-year old boy has along face, large ears ,micropenis,and large testes.
chromosome analysis is likely to demonstrate which of the following?
a.trisomy 21
b.trisomy 18
c.trisomy 13
d.fragile x syndrome
e.williams syndrome

24- amother wisches to breast-feed her newborn infant ,but is worried about medical conditions that would
prohibit her from doing so.you counsel her that of her listed conditions which of the following is acontraendication
to breast-feeding?
a.upper respiratory tract infection
b.cracked and bleeding nipples
c.mastitis
d.inverted nipples
e.hiv infection

25- afull-term infant is born after a normal pregnancy delivery however is complicated by marginal placental
separation .at 12 hours of age ,the child although appearing to be in good health ,passes a bloody meconium
stool .for determining the cause of the bleeding.
which of the following diagnostic procedures should be performed first?
a.a barium enema
b.an apst test
c.gastric lavage with the normal saline
d.an upper gastrointestinal series
e.a platelet count prothrombin time and partial thromboplastin time

26- during a regular checkup of an 8-year -old child you note a loud first heart sound with a fixed and
widely split second heart sound at the upper sternal border that does not change with respirations.the
patient is otherwise active and healthy.which of the following heart lesions most likely explains these findings?
a.atrial septal defect(ASD)
b.ventricular septal defect(VSD)
c.isolated tricuspidal regurgition
d.tetralgy of fallot
e.mitral valve prolapse

27- a2 year -old child has a 2 week history of splitting fevers which have been as high as 40. she has spindleshaped swelling of finger joints and complains of upper sternal pain.when she has fever , the parents note a faint
salamon -colored rash that resolves with the resolution of the fever.she has had no conjunctivitis or mucositis , but
her heart sound are muffled and she has increased pulsus paradoxus .
which of the following is the most likely diagnosis?
a.acute rheumatic fever
b.juvenile rheumatoid arthritis
c.toxic synovitis
d.septic arthritis
e.osteoarthritis

28- a 12 -yr-old girl is hospitalized in intensive care.she has a foley catheter and a urine culture is
positive for enterococcus .in addition to removing the catheter.
which antibiotics is the recommended agent for treatment of enterococcus infections?
a.penicillin
b.ampicillin
c.clindamycin
d.erthromycin
e.vancomycin

29- a 10 month -old infant has poor weight gain ,a persistent cough and a history of the several bouts of
pneumonitis . the mother describes the child as having very large foul -smelling stools for months. Which of the
following diagnostic maneuvers is likely to result in the correct diagnosis of this child?
a.ct of the chest
b.serum immunnoglobins
c.tb skin test
d.inspiratory and expiratory chst x-ray
e.sweeat chloride test

30- previously healthy active 18 month -old child presents with unilateral nasal obstruction and foul - smelling discharge .the
child's examination is otherwise unremarkable .which of the following is the most likely diagnosis?
a.foreign body
b.nasal polyps
c.frontal sinusitis
d.devaited septum
e.choanal atresia

31. A 5year old child with iron deficiency and severe episodes of grossly, bloody (maroon) stools.
Which is the most likely explanation for his anemia?
B: Meckel diverticulum.

32. A 7month old child recieves chron. total parenteral nutrition for short gut syndrom.
Which is the most typical complication of total parenteral nutrition?
A: Sepsis

33. A 14y old girls with a 9 month history of diarrhea, abdominal pain (periumbilical and postprandial), weight loss and blood in
stool. What is the most likely diagnose?
C: Chrons disease

34. Two weeks after a viral syndrome a 2year old develops bruising and petechia more prominent
over both legs. Examination shows no hepatosplenomegaly or lymph node enlargement. Blood tests
show normal haemoglobin, haematocrit and WBC count and 15.000 Thrombocytes. What is the most likely diagnosis?
D: Idiopathic thrombocytopenic purpura

35.On a routine screening for complet bloodtest a 1year old noted to have a microcytic anemia. A follow up haemoglobin
electrophorese demonstrates increased cencentration of haemoglobin A2.
The child is most likely to have?
B:Beta thalassemia trait.

36. Given folid acid to a pregnant woman prevents the child from having which defect?
D:Neural tube defect.

37. A 5year old boy has bloody urin, puffy eyes and headache for one day. He had fever and a sore throat 10
days ago which resolved without treatment. What is the most likely diagnosis?
D:Post infectious glomerulo nephritis.

38. A 18month old has 10 hours of fever and irritability. CSF 2000 WBC 90% polymorphnuklear. Spinal fluid
is depressed. He is treated with Cefotaxim and Vancomycin. 8 hours after treatment he gets general convulsions.
What is the next step?
D:Order sodium serum concentration.

39. A 6year old girl comes to the hospital after convulsion. She is alert without distress. On her skin you notice
caf-au-lait spots, a Shagreen patch and periungal fibromas.
Which is the most likely diagnosis?
E:Addison disease

40. Which of the following is an effective screening test for T-cell function?
a. Absolute lymphocyte count
b. Flow cytometry for CD4 (helper) and CD8 (cytotoxic) T cell
c. Respiratory burst assay
d. Candida skin test
e. Mumps antibody titer after mumps vaccination

41. Which of the following is a complication of intravenous immunoglobulin (IVIG) Therapy ?

a.Anaphylaxis
b.Renal failure
c.Trasmission of HIV
d.Hepatic toxicity
e.Hyperglycemia

42. The treatment of choice for a 3-years old boy suffering from acute otitis media is :
a.Azythromycin
b.Gentamycin
c.Chloramphenicol
d.Erythromycin
e.Amoxieillin

43. The state laboratory calls your office telling you that a newborn infant , now 8 days old, has an elevanted
thyroid stimulating hormone (TSH) and low thyroxin (Tn) on his newborn screen, If this condition is left
untreated , the infant is likely to demonstrate which of the following in the first few months of life?
a.Hyperreflexia
b.Hyperirritability
c.Diarrea
d.Prolonged jaundice
e.Hyperphagia

44. A 18-years old girl has hepatosplenomegaly, an intention tremor, disarthria, dystonia and
deterioration of her school performance, she also developed abnormal urine with excess glucare ,
protein and uric acid, she has a several-year history of elevated liver enzymes of unknown etiology .
Which of the following best explains her condition?
a.Galactosemia
b.1-antitrypsin deficiency
c.Gilbert syndrome syndrome
d.Dubin Johnson
e.Wilson disease

45. A 12-years-old boy has scent, long, slightly pigmented pubic hairs, slight enlargement of his penis , a pink testure
and enlarged scrotum, He is most likely at Which tanner stage?
a.1
b.2
c.3
d.4
e.5
46. An 18-years old male collage student is seen in the student health clinic for urinary frequency, dysuria, and
urethral discharge . Which of the following is likely to explain this condition?
a.Herpex simplex
b.Escherichia coli urinarytract infection
c.Clamydial urethritis
d.Syphilis
e.Hiv infection
47. Allergy to Which of the following food products is the most common in children?
a.Peanut
b.Sesame
c.Egg
d.Fish
e.Cow's milk

48. An 8-years old -----------next action ?

a.Explain that is a mild side effect of the drug .
b.Give the child oral anti histamine .
c.Inject corticosteroids IV
d.Inject epinefrin IM
e.Intubate and start mecchenical ventilation

49. The parents -----------next action ?

a.Secondary bacterial infection
b.Bathing with tepid water
c.Application of steroid scream before the emollient Cool,
d.humid ambient temperatures
e.Excessive use of Lubrification

50. A 1-month old infant who is otherwise and well and asymptomatic , has been brought in because of
a rash . the child has inflammatory scalp scale which has a combination of greasy, yellow and
erythematous features , as well as infiammation of the neck, axillary and inguinal creases.
the most likely diagnosis is?
a.Atopic dermatitis
b.Seborrheic dermatitis
c.Psoriasis
d.Langerhans cell histiocytosis
e.Candidiasis