Pediatric 6th year 18-5-2016

1- The following statements are true of attention deficit disorder except:

Select one:

a. Methylphenidate is of proven benefit in selected cases

b. Is more common in boys than girls
c. Is usually associated with impaired intelligence
d. The child finds it difficult to stay sitting still.
e. Symptoms improve during adolescence

2- You are evaluating a full term male infant in the neonatal intensive care unit (NICU) for a
seizure that occurred 1 day after birth. His neonatal course has been otherwise
unremarkable. The only significant finding on physical examination is an erythematous
patch involving the left side of the face, including the upper and lower eyelids (see picture)
Of the following, the MOST common ophthalmologic finding associated with this condition
is
‫هو انا مش عارف شو كانت الصورة بس وهللا اعلم كانت للبروت واين ستاين بالستيرج ويبور‬
Select one:
a. Coloboma
b. Cataract
c. Glaucoma.
d. Microphthalmia
e. Aniridia

3- A 2-year-old child drinks kerosene that had been left in a glass. After the first swallow, she
cries and drops the glass. She is most likely to develop which of the following?

Select one:
a. peripheral neuritis
b. aplastic anemia
c. chemical pneumonitis
d. coma and/or convulsions
e. hepatitis
 4- In addition to irritability, sweating, and difficulty breathing with feeding, the symptom that
is MOST indicative of congestive heart failure in a 3-week-old infant is:

Select one:
a. Ascites
b. Pretibial edema
c. Diminished feeding volume
d. Cyanosis
e. Cough

5- Hyperkalemia can be managed by all of the following except:

Select one:
a. Selective β- 2 blockers
b. Dialysis.
c. Glucose and Insulin
d. Sodium bicarbonate.
e. Kayexalate ( Sodium polystyrene sulfonate).

6- A 24-month-old, 10 kg boy with a history of epilepsy, develops a tonic-clonic seizure at

home. EMTs arrive and are unable to get IV access. He has been seizing for 60 minutes
when you are called. The EMTs have a vial of diazepam. Which route will achieve the safest
and quickest therapeutic serum diazepam level?

Select one:
a. administering the diazepam via transcutaneous route
b. administering the diazepam via oral/sublingual route
c. administering the diazepam via intranasal
d. administering the diazepam via rectal route
e. administering the diazepam via intramuscular route
 7- What is the most important test to obtain in diagnosis in a 14-year-old girl with primary
amenorrhea, and short stature, who has a history of repaired Coarctation of the aorta in
infancy?
Select one:
a. Fluorescent in situ hybridization (FISH) of chromosome 22q11
b. Pelvic ultrasonography
c. Sweat chloride testing
d. Lymphocyte subset analysis
e. Karyotyping

8- All of the following are true regarding jaundice in newborn infants except

Select one:
a. It is important as it may be a sign of another disorder as infection
b. It can be explained marked physiological release of hemoglobin from red cell break down
c. Entero-hepatic circulation is increased when milk intake is low
d. Conjugated bilirubin can be deposited in basal ganglia
e. It affects over 50 percent of newborns

9- Which of the following vaccines should NOT be given to children with severe combined
immunodeficiency syndrome?
Select one:
a. diphtheria, tetanus, pertussis (DTP) vaccine
b. Hepatitis B virus vaccine.
c. Salk polioveirus vaccine
d. Measles virus vaccine
e. PCV13

10- All the following problems are associated with infants of diabetic mothers except:
Select one:
a. Macrosomia
b. Hyperbilirubinemia
c. Small for gestational age
d. Hypoplastic left colon
e. Hemi hypertrophy
 11- An infant with failure to thrive has rectal prolapse. What test will most likely provide the
diagnosis?
Select one:
a. Rectal biopsies
b. Sweat chloride test
c. Liver function testing
d. Abdominal CT-scan
e. Barium enema study

12- A 7-year-old girl presents for the second time in a month with an eyelid nodule. Initially,
there was tenderness and erythema along the upper lid at the base of the lashes. She
responded to a short course of oral antistaphylococcal antibiotics. Now there is a new
nodule without erythema or induration. She has no fever, visual disturbance, or
conjunctival injection (see picture)
Of the following, the MOST appropriate management is:-
" ‫الصورة لم تُحفظ لألسف " معلش احنا ظعاف‬
Select one:
a. Topical ophthalmic antibiotic drops
b. Urgent referral to ophthalmology
c. Injection of dexamethasone into the lesion
d. Prompt incision and drainage
e. Application of warm compresses

13- One of the following is true regarding newborn screening:

Select one:
a. The test has to be done immediately after birth.
b. If the test is abnormal treatment should started immediately
c. The test result should be back by 1 month.
d. In Palestine it includes screening for cystic fibrosis
e. The test utilizes a dried blood sample

14- Congenital Aplastic Anemia is a bone marrow disease characterize by all of the followings
Except:
Select one:
a. Pancytopenia
b. Anemia since birth
c. Increase risk of malignancy
d. Bone marrow failure
e. Reticulocytopenia
 15- Which one of the following is considered a developmental warning sign?
Select one:
a. A two months old infant who does not have social smile
b. An 18 months old baby who does not walk alone
c. An 8 months old infant who does not wave bye-bye.
d. A 6 months old infant who does not have stranger anxiety.
e. A 7 months old infant who does not crawl

16- Which of the followings not a cause of thrombocytopenia due to increase peripheral
platelets destruction:
Select one:
a. Hemolytic uremic syndrome
b. Hypersplenism
c. Acute leukemia
d. DIC
e. Immune thrombocytopenia purpura

17- A 4 months old baby is expected to do all of the following Except:-

Select one:
a. Holds head steady while sitting.
b. Brings hands together in midline
c. Transfers objects hand to hand
d. Grasps rattle
e. Pulls to sit, with no head lag.

18- Which of the following is correct concerning Type 1 Diabetes in children.

Select one:
a. The adequacy of glycaemic control is most reliably assessed by twice daily urinalysis
b. Insulin therapy should be given only when oral hypoglycaemic agents fail
c. Retinopathy is commonly seen upon diagnosis
d. The onset of the disease is usually acute
e. There is a strong hereditary component
 19- One is true regarding Guillain-Barré Syndrome:
Select one:
a. High protein with moderate cellular CSF.
b. Ascending symmetrical muscle weakness
c. Altered level of consciousness
d. Symmetrically increased DTRs
e. May present with facial nerve palsy

20- All the following are characteristics of non-accidental injury, except:

Select one:
a. No Delay in presentation
b. Injury in very young children
c. Multiple types of injury
d. Multiple age of injury
e. Most commonly in developmental impaired children.

21- During follow-up of a child with congenital hypothyroidism, you find that TSH increased
significantly since previous visit, what would you do?
Select one:
a. Follow-up only, could be transient problem in absorption
b. Make sure that parents are giving the medication correctly.
c. Rule out another cause that affects thyroid
d. TSH is not so important, check FT3 level, if normal do not change the dose
e. Increase the dose and check TSH again the following day

22- A full term infant was born at 38 week by C/S. The pregnancy was complicated by
anhydraminous. Fetal ultrasound showed small abnormal kidneys. The baby looked
dysmorphic with severe respiratory distress. CXR showed left pneumothorax.
The most likely diagnosis explaining his distress would be:
Select one:
a. Respiratory distress syndrome
b. Pulmonary hypoplasia
c. Transient tachypnea of newborn
d. Meconium aspiration
e. Trachea-esophageal fistula with VECTRAL syndrome
 23- A 3-year-old child who is unresponsive presents with weakness, excessive salivation,
bradycardia, and constricted pupils. The most likely drug or toxin to cause these signs is
which of the following?
Select one:
a. phenobarbital
b. ethyl alcohol
c. an organophosphate
d. diphenhydramine
e. a hydrocarbon

24- 4-year-old boy has failed to grow and has evidence of exocrine pancreatic insufficiency.
What is the most likely cause for this?
Select one:
a. Cystic fibrosis
b. Congenital absence of the pancreas
c. Acute pancreatitis
d. Swachman-Diamond syndrome
e. Biliary atresia

25- The coagulation profile in a 13-year old girl with Menorrhagia having von Willebrands
disease is:
Select one:
a. Prolongation of thrombin time
b. Isolated prolonged PTT with a normal PT
c. Isolated prolonged PT with a normal PTT
d. Prolongation of both PT and PTT

26- G6PD deficiency, which of the followings are False

Select one:
a. Can be acute or chronic
b. Can cause life threatening anemia
c. More common in males than females
d. Characterized by Intravascular hemolysis
e. Gall bladder stone is a common complication
 27- “ You were called by the nurse in charge at the normal nursery to evaluate a 6 hour old
male newborn because of weak sucking and mild tachypnea. On exam, you noted that the
baby has mild tachypnea, poor sucking, dysmorphic features in the form of slanting eyes,
mild hypertelorism, epicanthal folds and single transverse palmar crease. Heart exam
revealed III/VI systolic murmur at the left lower sternal border but no cyanosis”.
The mother is 22 years old and she is asking about the risk of having a similarly affected
child in the future pregnancies. What will be your answer?
Select one:
a. 20%
b. 1 %
c. 25%
d. 5 %
e. 10%

28- All of the following about acquired hypothyroidism are true except:
Select one:
a. Adolescents typically have precocious puberty
b. Goiter may be a presenting feature
c. Osseous maturation is delayed
d. Protracted ingestion of medications containing iodides can cause hypothyroidism, i.e amiodarone
e. The most common cause of acquired hypothyroidism is chronic lymphocytic thyroiditis

29- Concerning Breath Holding Spells, all of the following statements are , except :
Select one:
a. Triggered
b. Some times followed by motor convulsions
c. Toddlers, known to have psychomotor delay
d. Self-limiting
e. Crying followed by apnea and LOC or seconds to a few minutes

30- The following statements concerning weaning (starting solid food) are correct except
Select one:
a. The baby should eat with the family at earlier age
b. Weaning should be delayed until the infant is 6 months old
c. Avoid introducing new tastes to the baby in its first year
d. Iron supplements should be started after 6 months
e. Breast milk is the only food a baby requires for the first 6 months
 31- All the following are true about SIDS, except:
Select one:
a. Home apnea monitoring of proven benefit
b. Back to sleep is preventive measurement
c. Peak 2-4 months.
d. Train caregivers in CPR.
e. Sepsis one of the main differential diagnosis

32- All the following are associated with polyhydramnios except:

Select one:
a. Prune belly syndrome
b. Esophageal atresia
c. Multiple gestation
d. Fetal hydrops with anasarca
e. Duodenal atresia

33- Hemolytic uremic syndrome (HUS) is characterized by all of the following except
Select one:
a. Most patients with HUS have central nervous system manifestations on presentation
b. Micrangipathic hemolytic anemia.
c. Treatment with antibiotics should be started as soon as possible
d. Thrombocytopenia.
e. Renal failure.

34- Honey is best avoided in the first year of life because of its association with :
Select one:
a. Meningitis
b. Botulism
c. Pertussis
d. Diptheria

35- Nutritional rickets may be associated with all the following EXCEPT :
Select one:
a. Hyperphosphatemia
b. Hypocalcemia
c. Elevated parted parathormone (PTH) level
d. Elevated alkaline phosphatise
 36- All lf the following are diagnostic features of kawasaki disease EXCEPT
Select one:
a. Generalized lympnadenopathy
b. Fever for at least 5 days
c. nonpurulent conjunctivitis
d. Desquamation of the fingers

37- A12-month-old child has had poor weight gain. The child started to have loose stools at the
age of 8 months and has a very poor appetite. On examination, you see a clingy, irritable
child with very little subcutaneous fat and a protuberant abdomen. What is the next best
test?
Select one:
a. Urine analysis
b. IgA-endomysial antibody
c. Fecal blood
d. Sweat chloride
e. Quantitative immunoglobulins

38- The following are causes of amblyopia except:

Select one:
a. Color blindness
b. chalazion
c. Retinoblastoma
d. Genetic
e. Squint (strabismus)

39- A 12-yr-old asthmatic boy has developed an asthma exacerbation in the past few days.
Asthma symptoms have continued to progress despite frequent albuterol use at home. He
comes to the emergency department with chest tightness, dyspnea, and wheezing, and in
moderate respiratory distress. In this setting, management should include all of the
following except:
Select one:
a. Close monitoring
b. Supplemental oxygen
c. Theophylline
d. Systemic glucocorticoids
e. Inhaled albuterol
 40- All of the following can cause chorea , except :
Select one:
a. Hypothyroidism
b. Huntington disease
c. Systemic lupus Eyrethematosus
d. Rheumatic fever
e. Wilson disease

41- A newborn infant was found to have swelling over parietal area after vacuum delivery. It
did not cross suture line. All of the following are true regarding this diagnosis except
Select one:
a. It is relatively common following instrumental delivery
b. The condition usually resolve in few days
c. The condition is due to sub-periosteal bleeding
d. It may predispose to significant neonatal Hyperbilirubinemia
e. It might be associated with skull fracture

42- All of the following could cause ischemic Cerebral vascular accident( CVA ) except
Select one:
a. Recent chickenpox infection
b. Rheumatoid artheritis
c. Sickel cell disease
d. Endocarditis
e. Homocystinuria

43- All the following maneuvers or treatments are can be used for control of cyanotic spells in a
child with tetralogy of Fallot's except:
Select one:
a. Morphine administration
b. Adrenalin administration
c. Squatting position
d. Emergency palliative surgical procedure [subclavian pulmonary artery shunt]
 44- The most common cause of status epilepticus in pediatrics is:
Select one:
a. CNS infection
b. Dravet syndrome
c. Anti epileptic drug withdrawal
d. Unknown
e. Complex Febrile seizure

45- Which of the following is true of tetanus?

Select one:
a. Clostridium-specific intravenous immunoglobulin is of no benefit once spasm has started
b. Cephalic tetanus causes severe dysphagia
c. Infection confers lifelong immunity
d. Failure to culture Clostridium tetani from the wound would make the diagnosis doubtful
e. There is a characteristic EEG

46- An 11 year old boy presents with a 10 day history of headache, sore throat, chest pain and
dry cough. His GP gave him a course of Amoxicillin 4 days ago but he is no better and is
now coughing up yellow sputum and is wheezy. He also complains of abdominal pain and
painful swollen knees. Which of the following organisms is MOST likely to be the cause of
his illness?
Select one:
a. Haemophilus influenza
b. Streptococcus pneumoniae
c. Mycoplasma pneumonia
d. Mycobacterium tuberculosis
e. Chlamydia trachomatis

47- All of the followings cause bleeding EXCEPT:

Select one:
a. Factor VIII deficiency
b. Von Willebrand disease
c. Hypofibrinogenemia
d. Glanzmann thrombosthenia
e. Factor XII deficiency
 48- An 18-month-old toddler has microcytic anemia. Which dietary history finding best
explains this?
Select one:
a. Intake of large amounts of unmodified cow’s milk
b. Lack of fresh vegetables in the diet
c. Pica
d. Intake of excessive amounts of vitamin C
e. Intake of inadequate amounts of fruit juice

49- Match the items on the right to the items on the left.

Molluscum contagiosum Multiple small papules w ith central umbilication

Answer 1

Erythema infectiosum slapped cheek syndrome

Answer 2

Erythema multiforme Central papule surrounded by an Erythematous ring

Answer 3

Erythema toxicum w hite pinpoint papules at the center of Erythematous base

Answer 4

Erythema nodusum tender nodules over the legs

Answer 5

50- “ You were called by the nurse in charge at the normal nursery to evaluate a 6 hour old
male newborn because of weak sucking and mild tachypnea. On exam, you noted that the
baby has mild tachypnea, poor sucking, dysmorphic features in the form of slanting eyes,
mild hypertelorism, epicanthal folds and single transverse palmar crease. Heart exam
revealed III/VI systolic murmur at the left lower sternal border but no cyanosis”.
If you do karyotyping for him, what is the expected result?
Select one:
a. 47,XYY
b. 47,XY,+18
c. 47,XY,+21
d. 47,XXY
e. 47,XY,+13
 51- A 12 yr old boy has migratory arthritis with red, warm and swollen joints. He has serologic
evidence of recent Group A streptococcal infection. Arthritis in this condition is
characterized by which of the following?
Select one:
a. Heals with deformity
b. Involves large and small joints equally
c. Usually is extremely painful
d. Seen only in patients with concurrent Carditis
e. Appears after fever subsides

52- An infant is born to a mother who is HBsAg positive. What should be the next step?
Select one:
a. Give infant hepatitis B immune globulin
b. Start infant on formula and discourage breastfeeding
c. Give infant hepatitis B immune globulin and hepatitis B vaccine
d. Check hepatitis B serology on infant and give hepatits B immune globulin if indicated
e. Vaccinate infant with hepatitis B vaccine

53- All of the following about normal puberty are true except:
Select one:
a. In boys acceleration of growth begins after puberty and is maximal at genital stage IV-V.
b. Serum LH concentrations increase earlier in the course of the pubertal process in boys than in girls
c. Peak height velocity in girls during puberty occurs at breast stage III-IV
d. GnRH is the major hormone responsible for the onset and progression of puberty
e. Estrogens rather than androgens are responsible for the process of bone maturation that ultimately
leads to epiphyseal fusion and cessation of growth

54- All of the following are indications for Neuroimaging in a Child with Headaches, except :
Select one:
a. Early morning headache , progressive in nature
b. Abnormal neurologic signs
c. Bifrontal pulsating headache
d. child < 6 yr whose principal complaint is a headache
e. Regression in school performance
 55- A 14-month-old boy has a 4-month history of intermittent diarrhea. He frequently has
explosive bowel movements containing food particles.
He is growing well, is otherwise healthy, and has a normal physical examination. What
should be the next step?
Select one:
a. Total serum qualitative immunoglobulin measurement
b. Stool culture
c. Reassurance of parents
d. Qualitative fecal fat
e. Prescribe oral antidiarrheal agent

56- The true statement in acute intussusceptions is:

Select one:
a. Most frequently occur in children between 3 years and 5 years of age.
b. Recurrence is common
c. Require urgent laparotomy and surgical reduction
d. Air enema is contraindicated
e. It is presented with severe screaming associated with pallor

57- A2-year-old girl is listless and pale. You obtain a complete blood count and find that the
patient has severe megaloblastic anemia. What additional history explains this?
Select one:
a. Has required phototherapy in neonatal period
b. Eats only organically grown products
c. Drinks exclusively goat milk
d. Has required multiple antibiotics for middle ear infections
e. Is an infant of a diabetic mother

58- All are true regarding developmental dysplasia of hip (DDH) Except
Select one:
a. There is positive family history in 20% of cases
b. It can be prevented if infants with breech presentation electively delivered by C/S.
c. Barlow maneuver will detect dislocatable hip (the femoral hip will be pushed out of acetabulum).
d. Early recognition of DDH is important as early splinting in abduction reduce long term morbidity
e. There is increased risk in infants with neuromuscular disorders
 59- All of the following are true about language development in pediatric age group Except:-
Select one:
a. The number of vocabulary at 1 year of age is around 10-12 words
b. Hearing evaluation is an important initial test in any child with language delay.
c. Language delays may be the first indication that a child has an intellectual disability
d. Language development occurs most rapidly between 2 and 5 year of
age.
e. between the ages of 2 and 5 years, the number of words in a typical sentence equals the child’s age
(2 by age 2 years, 3 by age 3 years
and so on).

60- The following statements about poor weight gain in children are correct except
Select one:
a. Majority is caused by a serious underlying medical condition
b. The child rarely need to be admitted to hospital for investigation
c. Can be associated with future educational problems
d. Needs a careful dietary assessment
e. Is usually detected by growth monitoring

61- All the following are true regarding fetal circulation Except:
Select one:
a. The blood to brain has highest O2
b. The pulmonary arteries are constricted with high resistance
c. The umbilical arteries carry oxygenated blood
d. The main oxygenation is supplied by placenta
e. The blood from right arm bypasses the lung through patent Ductus Arteriosus

62- Hypoglycemia is associated with which of the following condition:

Select one:
a. Mucopolysaccharidoses
b. Febrile convulsions
c. Fatty acid oxidation defects
d. None of them
e. Hypothyroidism
 63- The triad of eczema , thrombocytopenia and recurrent infections is characteristic of :
Select one:
a. Common variable hypogammaglobulinemia
b. Chediak- Higashi syndrome
c. Hyperimmunoglobulin E syndrome
d. Wiskott-Aldrich syndrome

64- A 4 year old girl was found sitting in bed 1 ½ hour after going to sleep. Her eyes wide open
but she is disoriented, confused and unresponsive to question with crying and distress. She
does not recall anything in the morning. The most likely diagnosis is
Select one:
a. night terror
b. Convulsions or seizure disorder
c. conversion reaction
d. nightmares
e. separation anxiety

65- The followings are features of Hemolytic Anemia Except:

Select one:
a. Normocytic Anemia
b. Jaundice
c. Splenomegaly
d. Thrombocytopenia
e. Hemoglobinuria

66- Ingestion of 8.5 g of acetaminophen. Therapy with which of the following should be
initiated?
Select one:
a. No therapy is indicated
b. Glutathione
c. N-acetylcysteine
d. Physostigmine
e. Deferoxamine.
 67- 2.8 kg neonate with excessive salivation develops respiratory distress. Attempts to pass an
orogastric catheter fail because the catheter coils in the back of the throat. A chest film is
obtained and shows right upper lobe atelectasis and a gasless abdomen. The most likely
diagnosis is:
Select one:
a. Proximal esophageal atresia with a distal tracheoesophageal (TE) fistula
b. H-type” TE fistula
c. Proximal esophageal atresia without a fistula
d. Esophageal atresia with both proximal and distal TE fistula

68- A 4-yr-old boy presents with sore throat and fever of sudden onset. He has difficulty
swallowing and his breathing is labored. He is drooling and sitting upright and leaning
forward in a tripod position. What is the appropriate next step in patient management?
Select one:
a. Dose of oral dexamethasone
b. Lateral radiograph of the neck
c. Complete physical examination including inspection of the oral cavity
d. Complete blood count and blood culture followed by immediate prophylactic intravenous
antibiotics
e. Direct laryngoscopy in the operating room

69- What is the most likely clinical finding in an 8-year-old with Wilson disease?
Select one:
a. Polyuria
b. Acro-cyanosis
c. Behavioral changes
d. Hepatitis-like illness
e. Poor visual acuity

70- Meckel's diverticulum most commonly presents as:

Select one:
a. Gastrointestinal bleeding
b. Diverticulitis.
c. Asymptomatic
d. Obstruction.
e. Intermittent abdominal pain
 71- Type 2 Diabetes Mellitus, all are true except:
Select one:
a. Effective initial therapy should include metformin (a biguanide), which decreases hepatic glucose
production.
b. occurs in individuals with hypertension and dyslipidemia
c. Most patients with T2DM remain asymptomatic for months to years
d. Acanthosis nigricans may be a marker for insulin resistance, hyperinsulinemia, and eventually type
2DM.
e. Type 1DM has a stronger genetic component than does Type 2DM

72- All of the following best describes atopic dermatitis in children except?
Select one:
a. it is frequently associated with uveitis
b. it tends to affect the face and arms
c. it is characterized by pruritus and lichenification
d. it is associated with elevated serum levels of IgE
e. it begins during the first 2 years of life

73- A five day old infant presented with increasing cyanosis and distress. His O2 saturation is
70%. Hyperoxic test was done and showed PO2 of 50 on 100 percent O2. Chest X-ray
reveals snow man appearance. The most likely condition will be;
Select one:
a. Transposition of great arteries
b. Total anomalous pulmonary venous return
c. Hypoplastic left heart syndrome
d. Tricuspid atresia
e. Tetralogy of Fallout

74- Sickle cell anemia, is an inherited disease characterize by all of the following except:
Select one:
a. increase risk of infection
b. increase risk of stroke
c. Hemolytic anemia
d. Splenomegaly
e. Recurrent attacks of pain throughout the body
 75- The following are recognized complication of cyanotic heart disease except:
Select one:
a. Cerebral abscess
b. Infective endocarditis
c. Psychosocial delay
d. Cerebral thrombosis
e. Hemolytic anemia

76- The following drugs used in the treatment of tuberculosis may cause the side effects
described, Except:-
Select one:
a. Isoniazid and peripheral neuropathy
b. Ethambutol and deafness
c. Pyrazinamide and Hyperuricemia
d. Streptomycin and deafness
e. Rifampicin and hepatitis

77- The following features indicate that a large head demands urgent investigation except
Select one:
a. Focal convulsion
b. Pulsating ant. Fontanelle
c. A baby with retinal hemorrhage
d. Irritability
e. Head trauma

78- A 24 months old male infant , previously healthy presented to ER with fever 39 c , decrease
level of conscoiusness , Rt. brachiofacial focal clonic seizure of 30 min duration followed by
weakness of the Rt.Upper limb. No vomiting , no neck rigidity , the most probable senario is
:
Select one:
a. Rasmussen Encephalitis
b. Hemiconvulsion hemiplegia syndrome
c. Viral encephalitis
d. Bacterial meningitis
e. Dravet syndrome
 79- 9-mo old girl presented with respiratory distress and irritability. Heart rate is 240
beats/min. The drug of choice for treatment of this condition is:
Select one:
a. Adenosine
b. Adrenaline
c. Dopamine
d. Lidocaine
e. Atropine

80- Human mature human milk as compared to mature cow milk is relatively low in
Select one:
a. Lactose
b. Fat
c. Ca
d. Vitamin C
e. Copper

81- 9-year-old girl who was diagnosed with influenza 3 days ago presents with fever
(temperature of 40.0°C), cough, and lethargy. On physical examination, the ill-appearing
girl has tachypnea, subcostal retractions, and crackles on auscultation of the right lung
field. She is intubated for respiratory distress. Tracheal secretions are purulent, and a blood
culture grows
gram-positive cocci in clusters.
Of the following, the MOST appropriate antimicrobial therapy for this girl is
Select one:
a. A third generation cephalosporin like Ceftriaxone or Cefotaxim
b. An aminoglycoside like Gentamycin
c. Penicillin G
d. A macrolide antibiotic like Azithromycin or Erythromycin
e. An anti-staphylococcal antibiotic like Nafcillin or oxacillin

82- A 2-year-old child drinks kerosene that had been left in a glass. After the first swallow, she
cries and drops the glass. She is most likely to develop which of the following?
Select one:
a. aplastic anemia
b. hepatitis
c. coma and/or convulsions
d. chemical pneumonitis
e. peripheral neuritis
 83- A term newborn presents with bilious vomiting shortly after birth. Her abdomen is
distended slightly, and facial features are characteristic of Down syndrome. She has passed
a normal meconium stool. The pregnancy was complicated by polyhydramnios. Of the
following, the MOST likely diagnosis is:
Select one:
a. Hirschsprung disease
b. Pyloric stenosis
c. Midgut volvulus
d. Meconium ileus
e. Duodenal atresia

84- Propionic, methylmalonic and isovaleric acidemias are the commonest organic acidemias in
our country. All of the following are true except:
Select one:
a. Coarse facial features are common with disease progression
b. Typically present with lethargy and vomiting
c. Metabolic acidosis is common during acute decompensation
d. May present with developmental delay
e. They are autosomal recessive disorders

85- A 10 yr old with weight 50 kg and height is 144 and his BMI around 24
Select one:
a. This patient is considered obese only if his BMI above 25
b. This patient is at risk to have renal stones
c. Adreno-cortical axis should be checked routinely to rule out Cushing’s syndrome
d. This patient should restrict screen time to less than 2 hours per day.
e. The patient condition tend to improve when become adult

86- A 1-year-old child presents with failure to thrive, frequent large voids of dilute urine,
excessive thirst, and three episodes of dehydration not associated with vomiting or diarrhea.
Over the years, other family members reportedly have had similar histories. The likely
diagnosis is
Select one:
a. Diabetes mellitus
b. Nephrotic syndrome
c. Water intoxication
d. Child abuse
e. Diabetes insipidus
 87- Positive Wright stain for neutrophils with negative Gram stain is suggestive of
Select one:
a. Milia
b. Staphylococcal scalded skin syndrome
c. Erythema toxicum
d. Benign pustular melanosis
e. Bullous impetigo

88- Concerning febrile seizures, factors are associated with increased risk of later epilepsy
include all of the following , except :
Select one:
a. An initial febrile seizure before 9 mo of age
b. Delayed developmental milestones
c. Positive family history of epilepsy
d. Positive family history of febrile convulsions
e. Complex febrile seizure

89- 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:
Select one:
a. Biotinidase deficiency
b. Cystinosis
c. Galactosemia
d. Wiskott-Aldrich syndrome
e. Phenylketonuria

90- You got the following lab results: Na 130, Cl 98, Glucose 180, BUN 28, Creat 0.5 , calcium 9
The estimated plasma osmolality is
Select one:
a. 310 mOsml
b. 280 mOsml
c. 270 mOsml
d. 290 mOsml
e. 300 mOsml
 91- A 10-month-old child presents with a temperature of 41 C , Watery diarrhea , and a
generalized seizure . The most likely cause of this syndrome is :
Select one:
a. Salmonella gastroenteritis
b. Shigella gastroenteritis
c. Acromonas gastroenteritis
d. Rotavirus gastroenteritis

92- Which of the following is True of BCG vaccination?

Select one:
a. Should be given to all children who have a strongly positive tuberculin test
b. It is given in Gaza not in West Bank
c. Is a killed polysaccharide antigen vaccine
d. Provides protection against leprosy
e. contraindicated in neonates

93- You are evaluating a 5-year-old boy in the emergency department for lethargy. His mother
reports that the boy has been lethargic since awakening this morning. She adds that he has
been complaining of headaches and has been having morning emesis for several weeks. She
also reports that he has become increasingly "clumsy" over the past 4 to 6 weeks.
On physical examination, the patient is difficult to arouse; has sluggish pupillary responses;
and has rapid, deep, sustained breaths at a rate of 35 breaths/min.
Of the following, the next BEST step in the initial management of this patient is:-
Select one:
a. administration of furosemide
b. noncontrast computed tomography scan of the head
c. urine toxicology screen
d. administration of dexamethasone
e. endotracheal intubation

94- In ataxia telangiectasia, the correct answer is:-

Select one:
a. Inheritance is X-linked recessive
b. The usual presentation is with lower respiratory infections
c. Chronic thrombocytopenia is an important feature.
d. Chromosome fragility is increased
e. The immunodeficiency primarily affects phagocyte function.
 95- A 16-year-old girl presents with complaints of recurring headaches that are becoming more
frequent. She was diagnosed with migraine headaches 2 years ago. Previously she had an
average of one migraine per month, but she now has one per week. She has no double
vision, vomiting, or awakening from sleep with headaches. Headaches can occur at any time
of day, are throbbing and bi-frontal, and are associated with nausea and photophobia. They
are relieved by nonsteroidal anti-inflammatory drugs and by lying down in the dark. They
rarely last more than 4 hours. The adolescent and her mother are concerned that the
increased headache frequency could be due to a brain tumor or aneurysm.
Of the following, the MOST appropriate next step is?
Select one:
a. lumbar puncture with manometry to rule out elevated intracranial pressure
b. brain magnetic resonance angiography to rule out aneurysm
c. brain magnetic resonance imaging to rule out brain tumor
d. perform no diagnostic testing at this time
e. head computed tomography scan with contrast to rule out brain tumor

96- The most common cancer in infancy is:

Select one:
a. Hepatoblastoma
b. Lymphoma
c. Leukemia
d. Neuroblastoma
e. Nephroblastma

97- All of the following are true about thyroid physiology except:
Select one:
a. In the pituitary and brain, approximately 80%of required T3 is produced locally from T4.
b. The metabolic potency of T4 is 3-4 times that of T3
c. About 70% of circulating T4 is firmly bound to thyroxine binding protein.
d. The recommended dietary allowance of iodine is 30mcg/kg/d for infants
e. The recommended dietary allowance of iodine is 30mcg/kg/d for infants
 98- A 6-week-old male infant is admitted to hospital with 10-15% dehydration. The serum
Sodium is 160 mmol/l (Normal 135-145) and the serum potassium is 3.3 ( normal 3.5-5.5)
mmol/l, choose the best response:
Select one:
a. Congenital adrenal hyperplasia is a likely diagnosis
b. normal saline (has Na of 154 mmol/l) can be helpful in management
c. Loss of skin turgor is likely to be present
d. if presented with diarrhea, these abnormal findings suggests a bacterial cause
e. The dehydration should be corrected over the next 8 hours

99- Enter viruses can cause all of the following condition Except.
Select one:
a. Hand mouth foot disease
b. Herpangia
c. Myocarditis
d. Gastroenteritis
e. Exanthem subitum

100- During a regular checkup on an 8-year-old child, you note a loud first heart sound
with a fixed and widely split second heart sound at the upper left sternal border that does
not change with respirations. The patient is otherwise active and healthy. The mostly likely
heart lesion to explain these findings is
Select one:
a. Tetralogy of Fallot
b. Ventricular septal defect
c. Mitral valve prolapse
d. Isolated tricuspid regurgitation
e. Atrial septal defect

101- The following features are related to the corresponding congenital infection Except
one:
Select one:
a. Fetal anemia – parvovirus
b. Limb hypoplasia – Varicella
c. Patent ductus arteriosus – rubella
d. Cerebral periventricular calcifications – toxoplasmosis
e. Myocarditis – enteroviruses
 102- A 9-year-old boy is admitted to the hospital because of altered consciousness and
fever. A lumbar puncture, performed because of a stiff neck and altered mental status,
reveals the following:- CSF protein of 100 mg/dL; cytologic findings of 100 white cells, 95%
lymphocytes, and 10 red blood cells; and glucose of 40 mg/dL. Additional serum laboratory
findings include: Glucose, 70 mg/dL; Sodium, 124 mEq/L; Potassium, 3.2 mEq/L ;
Chloride, 93 mEq/L and bicarbonate, 18 mEq/L Results of serum cortisol and ACTH
hormone concentrations are pending. Broad spectrum antibiotic therapy is initiated.
Of the following, the MOST appropriate next step is to:-

Select one:
a. restrict fluids to half of the maintenance requirement
b. administer an initial bolus dose of hydrocortisone 2 mg/kg intravenously
c. administer 0.9% saline with 10% dextrose 10 mL/kg intravenously over 4 hours
d. initiate sodium polystyrene phosphonate per rectum every 8 hours
e. administer 3% saline 10 mL/kg intravenously over 4 hours

103- X-linked inheritance is described in all of the following conditions Except:

Select one:
a. Vitamin D-resistant rickets
b. Spherocytosis
c. Lesch-Nyhan syndrome
d. Glucose-6-phosphate dehydrogenase deficiency
e. Duchenne muscular dystrophy

104- In a 6 - year - old child with nocturnal enuresis, one of the following should be
performed

Select one:
a. Serum creatinine
b. Referral to a psychologist
c. Referral to a urologist
d. Renal ultrasound scan
e. Urine for microscopy and culture
 105- All of the following lesions may be found in normal newborn that resolve
spontaneously except

Select one:
a. Tuft of hair over midline
b. Pink macules on the upper eye lids
c. Small bleeding from vagina
d. Small white pearls at midline of the palate
e. Breast enlargement

106- The best method for diagnosis of myasthenia gravis is :

Select one:
a. Nerve biopsy
b. Assay for anti-acetylcholine antibodies
c. Electromyogram (EMG)
d. Nerve conduction velocity (NCV) studies

107- All are major criteria for acute rheumatic fever except

Select one:
a. Arthritis
b. Carditis
c. Chorea
d. Erythema migrans
e. Sub- cutaneous nodules

108- Bleeding due to a platelets defect as opposed to a coagulation defect is suggested by

all of the following Except:

Select one:
a. Bleeding from superficial scratches
b. Mucosal bleeding
c. Haemarthrosis.
d. Immediate profuse bleeding following a tooth extraction.
 109- Hemorrhagic cystitis, conjunctivitis, pneumonia, and diarrhea all have been linked
to which of the following?
Select one:
a. Herpes simplex virus
b. Rhinovirus.
c. H1N1
d. Adenovirus
e. Respiratory syncytial virus

110- All the following are correct statement about rickets except
Select one:
a. Nutritional rickets can be diagnosed on bases of normal calcium with low phosphorus and high
plasma alkaline phosphatase
b. Children with rickets may present hypertonia
c. Prolonged exclusive breast feeding might be a risk factor to develop rickets
d. X-ray finding suggestive of rickets include poorly mineralized bones with fraying of metaphysis
e. It can be aggravated in patients with epilepsy on phenobarbital

111- All of the following are true regarding Glasgow coma scale except:
Select one:
a. GCS of comatosed patient is zero
b. GCS of less than 8/15 is indication for intubation
c. The three components are eye opening, verbal response, and best motor response
d. GCS of normal well child is 15/15.

112- Long term effects of childhood cancer include all except

Select one:
a. Some Chemotherapeutic agents may cause pulmonary fibrosis
b. More than 70 percent of patients will be dead by 5years of diagnosis
c. Short stature from radiotherapy
d. The risk of second malignancy of survivors is around 10 percent
e. Sterility
 113- Alpha Thalassemia Trait characterize by all of the below EXCEPT:
Select one:
a. Always asymptomatic
b. Normal Hb electrophoresis beyond neonatal period
c. Microcytosis
d. One or two alpha gene deletion
e. Decrease RBCs production

114- “ You were called by the nurse in charge at the normal nursery to evaluate a 6 hour
old male newborn because of weak sucking and mild tachypnea. On exam, you noted that
the baby has mild tachypnea, poor sucking, dysmorphic features in the form of slanting
eyes, mild hypertelorism, epicanthal folds and single transverse palmar crease. Heart exam
revealed III/VI systolic murmur at the left lower sternal border but no cyanosis”.
You have ordered a cardiac echo to assess the heart murmur; what will be the expected
finding
Select one:
a. Ventricular Septal Defect (VSD)
b. Coarctation of the aorta
c. Total Anomalous Pulmonary Venous Return
d. Atrial Septal Defect (ASD)
e. Patent Ductus Arteriosus (PDA)

115- In pediatric acute Leukemia , one of the followings is False:

Select one:
a. AML less common than ALL
b. More common in down syndrome
c. More common in infants than older children
d. One of the causes of pancytopenia
e. The most common cancer

116- A (26 week) preterm infant was born in delivery room and admitted to NICU. His
temperature was found to be 35c. All of the following are causes of his low temperature
except;
Select one:
a. Thin skin and permeable
b. Low body surface area to volume ratio
c. Little subcutaneous fat for insulation
d. They rely on brown fat which is significantly low
e. Relatively cold environment (37C to 21C)