SMLE

Pediatric

PRESNTED BY
DR OSAMA SAFDAR
 QUESTION 1

 3- What is the most common congenital abnormally

cause infective endocarditis ?
 A.ASD
 B.VSD
 C.Tetralogy of fallot
 D-Coarctation of aorta
 QUESTION 1

 3- What is the most common congenital abnormally

cause infective endocarditis ?
 A.ASD
 B.VSD
 C.Tetralogy of fallot
 D-Coarctation of aorta
 QUESTION 1

 Infective endocarditic is high in

 Cyanotic congenital heart disease
 Prosthesis valve
 Complex congenital heart disease
 Prior history of infective endocarditits
 QUESTION 2

 - Which of the following congenital heart disease is

the least associated with infective endocarditis?
 a. ASD
 b. VSD
 c. PDA
 d. Pulmonary stenosis
 QUESTION 2

 - Which of the following congenital heart disease is

the least associated with infective endocarditis?
 a. ASD
 b. VSD
 c. PDA
 d. Pulmonary stenosis
 QUESTION 2

 ASD secudnum is associated with a low jet lesion and

risk of endocarditis in very minimal
 QUESTION 3

 - A baby 8 month old breastfeed for 6 month

normally. He devolved vomiting and jaundice after
fruit juice. What component in the juice the baby is
allergic to?
 A. Glucose
 B. Fructose
 C. Sucrose
 D. galactose
 E. phenylalanine
 QUESTION 3

 77- A baby 8 month old breastfeed for 6 month

normally. He devolved vomiting and jaundice after
fruit juice. What component in the juice the baby is
allergic to?
 A. Glucose
 B. Fructose
 C. Sucrose
 D. galactose
 E. phenylalanine
 QUESTION 3

 Hereditary fructose intolerance (HFI) is

an inborn error of fructose metabolism caused by a
deficiency of the enzyme aldolase B.
 Individuals affected with HFI are asymptomatic until
they ingest fructose, sucrose, or sorbitol.

 Fatal condition and can lead to liver failure

 QUESTION 4

 What is the most common cause of acute

bronchiolitis?
 A. Respiratory Syncytial virus (RSV)
 B. Adenovirus
 C. parainfluenza
 D. Mycoplasma pneumonia.
 QUESTION 4

 What is the most common cause of acute

bronchiolitis?
 A. Respiratory Syncytial virus (RSV)
 B. Adenovirus
 C. parainfluenza
 D. Mycoplasma pneumonia.
 QUESTION 4

 Most common
 Broncholitis: RSV
 Congenital pneumonia: group B streptococcus
 Lobar pneumonia:
 Strep pneumonia
 Hemophilus
 Staphy
 School age penumonia: mycoplasma
 QUESTION 5

 - What is the single most important risk factor for

cerebral palsy?
 A. prematurity
 B. birth weight less than 1.5 kg
 C. prenatal asphyxia
 D. genetic mutations
 QUESTION 5

 107- What is the single most important risk factor for

cerebral palsy?
 A. prematurity
 B. birth weight less than 1.5 kg
 C. prenatal asphyxia
 D. genetic mutations
 QUESTION 6

 A child came to you with Café au lait spots in face

and neck. Which of the following features can
strengthen your diagnosis?
 A. Port-wine stain.
 B. Axillary freckling.
 C-Brushfield spot
 D-Webbed nexk
 E-Ash leaf macules
 QUESTION 6

 82- A child came to you with Café au lait spots in

face and neck. Which of the following features can
strengthen your diagnosis?
 A. Port-wine stain.
 B. Axillary freckling.
 C-Brushfield spot
 D-Webbed nexk
 E-Ash leaf macules
Lisch nodules
Optic glioma
Axillary freckling
Neurofibroma
Café au lait spot
 QUESTION 7

 2 month boy present with 2 cm of hemangioma in

the back .. Wt is the ttt?
 A. close f/u
 B. excision
 C. beta blocker
 D -steroid
 QUESTION 7

 117 -2 month boy present with 2 cm of hemangioma

in the back .. Wt is the ttt?
 A. close f/u
 B. excision
 C. beta blocker
 D -steroid
 QUESTION 7

 Most of hemangioma can be left for observation

 Treatment indicated if
 1-In critical site (visceral or around the eye)
 2-Interfere with feeding or respiration
 3-Increase in size significantly
 4-Associate with significant bleeding (Kasabach
merit phenomena)
 QUESTION 8

 6 years old child, came for pre school checkup, on

exam he looks normal except for grade III heart
murmur along the sternal border “ no specific
location or timing of the murmur provided”, no
thrill, the murmur accentuated with supine position,
DX?
 A. Still's murmur
 B. VSD
 C. ASD
 D. Mitral valve prolapse
 QUESTION 8

 224- 6 years old child, came for pre school checkup,

on exam he looks normal except for grade III heart
murmur along the sternal border “ no specific
location or timing of the murmur provided”, no
thrill, the murmur accentuated with supine position,
DX?
 A. Still's murmur
 B. VSD
 C. ASD
 D. Mitral valve prolapse
 QUESTION 9

 child parents Have TB-

 You read a PPD result after 48 hours. It showed 10
mm induration. What does that indicate?
 a. negative
 b. weakly positive
 c. strongly positive
 D-Inconclusive
 QUESTION 9

 348- child parents Have TB- You read a PPD result

after 48 hours. It showed 10 mm induration. What
does that indicate?
 a. negative
 b. weakly positive
 c. strongly positive
 D-Inconculsive
 QUESTION 10

 14 years old boy comes to your clinic with swollen

lips. He has similar episodes since 3 or 5 years.
Deficiency of which of the following caused his
presentation?
 a. Factor D
 b. Anaphylatoxin inhibitor
 c. C1 esterase inhibitor
 D-IgE
 QUESTION 10

 14 years old boy comes to your clinic with swollen

lips. He has similar episodes since 3 or 5 years.
Deficiency of which of the following caused his
presentation?
 a. Factor D
 b. Anaphylatoxin inhibitor
 c. C1 esterase inhibitor
 D-IgE
 QUESTION 10

 Compelement deficiency
 C1q esterase (angiodema)
 C2-C4 SLE like or vasculitis
 C5- C9 Menigiococcemia
 QUESTION 11

 Which of following vaccine is absolutely

contraindicated in HIV
 A-MMR
 B-Oral polio
 C-Rota vaccine
 D-DTP
 E-Pneumococcal vaccine
 QUESTION 11

 4-Which of following vaccine is absolutely

contraindicated in HIV
 A-MMR
 B-Oral polio
 C-Rota vaccine
 D-DTP
 E-Pneumococcal vaccine
 QUESTION 11

 HIV can receive live vaccine if:

 Asymptamatic
 CD4 < 200
 CD4/CD8 ratio (??)
 QUESTION 12

 1-5 years old with ARPKD, Which of following is

common is true
 A-usually lead to end stage renal disease in 5th
decade of life
 B-Cerebral artery aneurysm is common
 C-Congenital hepatic fibrosis is common
 D-Will affect all tubular segments
 E-Ultrasound of parents will typically show renal
cysts
 QUESTION 12

 1-5 years old with ARPKD, Which of following is

common is true
 A-usually lead to end stage renal disease in 5th
decade of life
 B-Cerebral artery aneurysm is common
 C-Congenital hepatic fibrosis is common
 D-Will affect all tubular segments
 E-Ultrasound of parents will typically show renal
cysts
 QUESTION 12

 ARPKD
 Fibrocystin gene
 Affecting collecting ducts
 Congenital hepatic fibrosis is common
 Renal failure by 10-12 years of life
 ADPKD
 Polycystin 1 and polycystin 2
 Affecting all tubular segments
 Cerebral artery aneurysm
 Renal failure by 5th-6th decade
 QUESTION 13

 Child known case of DM 1, lost his consciousness at

school. The last insulin injection is unknown.
 a. Take him to the hospital
 b. IV ranger lactate
 c. IM Glucagon
 D-SC insulin
 QUESTION 13

 Child known case of DM 1, lost his consciousness at

school. The last insulin injection is unknown.
 a. Take him to the hospital
 b. IV ranger lactate
 c. IM Glucagon
 D-SC insulin
 QUESTION 14

 110 - child with chronic diarrhea , endoscopy showed

sickle shaped parasite adherent to the bowl wall ,
what is it?
 A. Giardia
 B. Entemebea histolytica
 C-Cholera
 D-Ascaris
 QUESTION 14

 - child with chronic diarrhea , endoscopy showed

sickle shaped parasite adherent to the bowl wall ,
what is it?
 A. Giardia
 B. Entemebea histolytica
 C-Cholera
 D-Ascaris
 QUESTION 14

 Giardiasis
 Acute diarrhea
 Chronic diarrhea
 Malapsorbtion
 QUESTION 15

 5 years old child presented with constipation,

polyuria , growth retardation You found na 130 , k
3.1 , cl normal , hco3 above 40 high , the defect in :
 A. NaCl chanel excretion
 B-NaCl absorption
 C. H ion absorption
 D. H ion excretion
 QUESTION 15

 5 years old child presented with constipation,

polyuria , growth retardation You found na 130 , k
3.1 , cl normal , hco3 above 40 high , the defect in :
 A. NaCl chanel excretion
 B-NaCl absorption
 C. H ion absorption
 D. H ion excretion
 QUESTION 15

 Bartter syndrome
 AR
 Salt loser
 High renin
 Metabolic alkalosis
 Nephrocalcinosis
 Polyhdraminos
 Growth failure
 Hypomagensmia
 QUESTION 16

 The most common immunodeficiency in children:

 A-SCID
 B-Agammaglobulinemia
 C-Ataxia telangctacisa
 D-Hyper IgE sydnrome
 E-IgA deficiency
 QUESTION 16

 The most common immunodeficiency in children:

 A-SCID
 B-Agammaglobulinemia
 C-Ataxia telangctacisa
 D-Hyper IgE sydnrome
 E-IgA deficiency
 QUESTION 17

 2-The most common eye manifestation in sturge

weber syndrome
 A-Cataract
 B-Glaucoma
 C-Optic glioma
 D-Squint
 E-Retnionblastoma
 QUESTION 17

 2-The most common eye manifestation in sturge

weber syndrome
 A-Cataract
 B-Glaucoma
 C-Optic glioma
 D-Squint
 E-Retnionblastoma
 Sturger weber
 Sporadic
 Difficult focal seizures
 Port wine stain
 Glaucoma
 QUESTION 18

 7-Child known for ALL and started with

chemotherapy and now came with weakness and loss
of reflexes in both limps. Which of following is likely
cause
 A-Adiramycin
 B-Prednisone
 C-Vincrisitne
 D-Methotroxate
 E-L aspargenase
 QUESTION 18

 7-Child known for ALL and started with

chemotherapy and now came with weakness and loss
of reflexes in both limps. Which of following is likely
cause
 A-Adiramycin
 B-Prednisone
 C-Vincrisitne
 D-Methotroxate
 E-L aspargenase
 QUESTION 18

 Adiramycin: cardiac
 Vincristine: neuropathy , SIADH
 Methotroxate; liver failure , renal failure , mucositits
 Asparagenase:CNS
 Bleomycin: lung fibrosis
 QUESTION 19

 - bacterial meningitis in 14 month child , Gram

positive cocci, what is the management? A.
amoxicillin
 B. amoxicillin and gentamicin
 C. ceftriaxone and vancomycin
 D. vancomycin
 QUESTION 19

 172- bacterial meningitis in 14 month child , Gram

positive cocci, what is the management? A.
amoxicillin
 B. amoxicillin and gentamicin
 C. ceftriaxone and vancomycin
 D. vancomycin
 QUESTION 19

 Cefitraxone and vancomycin should be empirically

Tx of meningitis in children
 Cefotaxime and ampicilin should be empirically in
neonate with meningitis
 QUESTION 19

 Most common cause of menengitis

 In neonate: group B streptococcus
 Older than neontate:
 Streptococcus pneumonia
 Hemophils influenza
 Nessieria meninigisits
 With VP shunt: staph epidermidis
 QUESTION 20

 -Regarding SLE skin manifestation. which one is

true:
 a) Butterfly rash is pathognomonic
 b) Discoid lupus resolved without scarring
 c) Sunlight makes rash worse.
 d) Can be treated by local emollients
 e) Considered as atopic reaction
 QUESTION 20

 19-Regarding SLE skin manifestation. which one is

true:
 a) Butterfly rash is pathognomonic
 b) Discoid lupus resolved without scarring
 c) Sunlight makes rash worse.
 d) Can be treated by local emollients
 e) Considered as atopic reaction
 QUESTION 20

 Butterfly rash is not pathogonemic in SLE

 It can be found in dermatomyositis where the rash
crosses nasolabial fold but in SLE it does not
 QUESTION 21

 What is most sensitive indicator for factitious fever?

 a) Pulse rate
 B) Blood pressure
 C)Oxygen saturation
 D) Leg edema
 QUESTION 21

 What is most sensitive indicator for factitious fever?

 a) Pulse rate
 B) Blood pressure
 C)Oxygen saturation
 D) Leg edema
 QUESTION 21

 Factitious fever: Fever produced artificially by a

patient. This is done by artificially heating the
thermometer or by self-administered pyrogenic
substances.
 An artificial fever may be suspected if the pulse rate
is much less than expected for the degree of fever
noted.
 This diagnosis should be considered in all patients in
whom there is no other plausible explanation for the
fever. Patients who pretend to have fevers may have
serious psychiatric problems.
 QUESTION 21

 Causes of fever and relative bradycardia

 Factitious fever
 Typhoid fever
 Drug fever
 Central fever
 QUESTION 22

 - What is characterized about x fragile syndrome?

 A. Obesity
 B. Macrogonadisim
 C. Short stature
 D-Heart failure
 QUESTION 22

 - What is characterized about x fragile syndrome?

 A. Obesity
 B. Macrogonadisim
 C. Short stature
 D-Heart failure
 QUESTION 22

 (FRAX) 1 in 200 in frequency.

 Most common cause inherited mental retardation.
 ACharacteristic craniofacial finding :large
head,prominent forehead
 Characteristic neurobehavioral profile including (mental
retardation, autism spectrum disorder, pervasive
developmental disorder )
 Macro-orchidism
 Mild connective tissue disorder including (joint
laxity,patulous eustachian tubes ,mitral valve prolapse)
 QUESTION 23

 Child came with colicky abdominal pain, vomiting,

bloody stool. US showed doughnut sign. What is the
most important step in management of this case ?
 A- urgent surgery referral
 B- NGT decompression
 C- IV Fluid resuscitation
 D- Barium Enema
 QUESTION 23

 Child came with colicky abdominal pain, vomiting,

bloody stool. US showed doughnut sign. What is the
most important step in management of this case ?
 A- urgent surgery referral
 B- NGT decompression
 C- IV Fluid resuscitation
 D- Barium Enema
 QUESTION 23

 Intussusception in children
 Emergency condition
 ABC
 Air contrast enema for 3 times
 If failed:
 Surgical intervetion
QUESTION 23
 QUESTION 24

 -. 4 years old boy referred for evaluation of obesity.

Weight is 160% IBW (ideal body weight), height 125
cm and bone age is 5 years old. The most likely
diagnosis is:
 a) Exogenous (primary) obesity.
 b) Cushing syndrome
 c) Hypothyroidism
 d) Prader Willi
 e) Growth hormone deficiency
 QUESTION 24

 15-. 4 years old boy referred for evaluation of obesity.

Weight is 160% IBW (ideal body weight), height 125
cm and bone age is 5 years old. The most likely
diagnosis is:
 a) Exogenous (primary) obesity.
 b) Cushing syndrome
 c) Hypothyroidism
 d) Prader Willi
 e) Growth hormone deficiency
 QUESTION 24

 Obese and tall

 Primary obesity
 Obese and short
 Genetic
 Syndromatic
 Endocrine
 QUESTION 25

 21-Which one of the following can causes of

asymmetrical weakness:
 a) Guillain-Barre syndrome
 b) Poliomyelitis
 c) Myasthenia gravis
 d) Transverse myelitis
 e) Duchenne muscular dystrophy
 QUESTION 25

 -Which one of the following can causes of

asymmetrical weakness:
 a) Guillain-Barre syndrome
 b) Poliomyelitis
 c) Myasthenia gravis
 d) Transverse myelitis
 e) Duchenne muscular dystrophy
 QUESTION 26

 26-During the examination of a 2-month-old infant,

you note that the infant’s umbilical cord is still firmly
attached. This finding prompts you to suspect which
of the following?
 a) Occult omphalocele
 b) Leukocyte adhesion deficiency
 c) IgG subclass deficiency
 d) Umbilical granuloma
 e) Persistent urachus (urachal cyst)
 QUESTION 26

 26-During the examination of a 2-month-old infant,

you note that the infant’s umbilical cord is still firmly
attached. This finding prompts you to suspect which
of the following?
 a) Occult omphalocele
 b) Leukocyte adhesion deficiency
 c) IgG subclass deficiency
 d) Umbilical granuloma
 e) Persistent urachus (urachal cyst)
 QUESTION 27

27-Storage temperature of vaccines is:

 a) Room temperature
 b) 15 ° C
 c) 2-8° C
 d) - 2° C
 e) - 20 ° C
 QUESTION 27

27-Storage temperature of vaccines is:

 a) Room temperature
 b) 15 ° C
 c) 2-8° C
 d) - 2° C
 e) - 20 ° C
 QUESTION 28

 What is the most important long treatment

medications in sickle cell disease
 A-Hydroxyurea
 B-Prophylactic penicillin
 C-Folic acid
 D-Iron
 QUESTION 28

 What is the most important long treatment

medications in sickle cell disease
 A-Hydroxyurea
 B-Prophylactic penicillin
 C-Folic acid
 D-Iron
 QUESTION 28

 Cochrane library showed that long prophylactic

penicillin can help to decrease infection in SCD
especially in the first 5 years of life
 QUESTION 29

 child c/o unilateral nasal foul smelling discharge for

two weeks ,what is your treatment?
 A. x-ray of the head
 B. antibiotics
 C-Steroid
 D-Paracetamol
 QUESTION 29

 child c/o unilateral nasal foul smelling discharge for

two weeks ,what is your treatment?
 A. x-ray of the head
 B. antibiotics
 C-Steroid
 D-Paracetamol
 QUESTION 29

 Unilateral nasal discharge is suggestive of foreign

body
 X ray might be helpful to diagnose metallic foreign
body
 QUESTION 30

 2 years old found to have developmental delay. You

notice in the clinic that she had repetitive
movements of hands and also microcephaly
 Most likely diagnosis:
 A-Phenyketonuria
 B-TORCH
 C-Rett syndrome
 D-Gaucher disease
 E-Aicardi syndrome
 QUESTION 30

 2 years old found to have developmental delay. You

notice in the clinic that she had repetitive
movements of hands and also microcephaly
 Most likely diagnosis:
 A-Phenyketonuria
 B-TORCH
 C-Rett syndrome
 D-Gaucher disease
 E-Aicardi syndrome
 QUESTION 30

 A rare genetic postnatal neurological disorder that

almost exclusively affects females but has also been
found in male patients.
 The clinical features include small hands and feet
and microcephaly
 Repetitive stereotyped hand movements, such as
wringing and/or repeatedly putting hands into the
mouth, are also noted.
 QUESTION 31

 5 year old boy with known oligoarticular JRA

 He came with eye pain. Which of following is likely
cause for the pain:
 A-Anterior uveitis
 B-Cataract
 C-Conjuctivitis
 D-Papilodema
 E-Posterior uveitis
 QUESTION 31

 5 year old boy with known oligoarticular JRA

 He came with eye pain. Which of following is likely
cause for the pain:
 A-Anterior uveitis
 B-Cataract
 C-Conjuctivitis
 D-Papilodema
 E-Posterior uveitis
Juvenile Idiopathic Arthritis
 Juvenile Idiopathic Arthritis

 Oligoarticular: 4 or less joints

 Polyarticular: 5 or m
 Oligoarticular extended: 5 or more joints after 6
months
 Oligoarticular persistent: 4 or less joints after 6
months

 Minimal age to diagnose: 16 years

 Minimal duration 6 weeks
 QUESTION 32

 Wide fixed splitting 2nd heart sound found in:

 A-VSD
 B-PDA
 C-ASD
 D-Coarctation of aorta
 E-Mitral stenosis
 QUESTION 32

 Wide fixed splitting 2nd heart sound found in:

 A-VSD
 B-PDA
 C-ASD
 D-Coarctation of aorta
 E-Mitral stenosis
 QUESTION 32

 ASD: wide fixed spliiting 2nd heart sound

 PDA: continous machinery murmur radiates to back
 VSD: pansystolic murmur at lower left sternal border
 Coarctation of aorta: systolic murmur below left
clavicle radiets to the back
 QUESTION 33

 The most common cause of death in a patient with

hemophilia:
 A-HIV
 B-Hepatitis
 C-Toxoplasmosis
 D-Shock
 E-Intracranial bleeding
 QUESTION 33

 The most common cause of death in a patient with

hemophilia:
 A-HIV
 B-Hepatitis
 C-Toxoplasmosis
 D-Shock
 E-Intracranial bleeding
 QUESTION 34

 A child swallowed his Caramzepine. What is

the best way of gastric decontamination?
 a) Gastric lavage
 b) Total bowel irrigation (whole bowel wash)
 c) Syrup ipecac
 d) Activated charcoal
 QUESTION 34

 A child swallowed his Caramzepine. What is

the best way of gastric decontamination?
 a) Gastric lavage
 b) Total bowel irrigation (whole bowel wash)
 c) Syrup ipecac
 d) Activated charcoal
 QUESTION 34

 In poisoning
 ABC
 Gastric decontamination window time
 0-6 hous
 Antidote should be given if:
 Dose is toxic
 Clinical manisfration
 QUESTION 34

Ipecac (INDUCE VOMITING) NOT USED ANYNORE

Charcoal: Method of choice
WHOLE BOWEL IRRIGATON: Used for IRON,
lithium
GASTRIC ASPIRATION: USED FOR REMOVING OF
FLUID
 QUESTION 35

 Risk factor of sudden death syndrome

includes all of the following, EXCEPT:
 a) Cigarette smoking during pregnancy
 b) Old primigravida
 c) Crowded living room
 d) Prematurity
 e) Small gestational age
 QUESTION 35

 Risk factor of sudden death syndrome

includes all of the following, EXCEPT:
 a) Cigarette smoking during pregnancy
 b) Old primigravida
 c) Crowded living room
 d) Prematurity
 e) Small gestational age
 QUESTION 35

 1) smoking, drinking, or drug use during pregnancy

 2) poor prenatal care
 3) prematurity or low birth-weight
 4) Mothers younger than 20
 5) Smoke exposure following birth
 6) Overheating from excessive sleepwear and
bedding
 7) Prone position
 QUESTION 36

 Patient presented to the ER with diarrhea, nausea,

vomiting, salivation, lacrimation and abdominal
cramps. What do you suspect?
 a) Organophosphate poisoning
 B)Paracetamol poisoning
 C) Aspirin
 D)Penicilin
 QUESTION 36

 Patient presented to the ER with diarrhea, nausea,

vomiting, salivation, lacrimation and abdominal
cramps. What do you suspect?
 a) Organophosphate poisoning
 B)Paracetamol poisoning
 C) Aspirin
 D)Penicilin
 QUESTION 37

 5 years old came with a cute in his finger. He felled in

the school yard. His vaccination history is unknown
 You will give him
 A-Nothing
 B-Tetanus toxoid
 C-tetanus toxoid and tetanus immunoglobulin
 D-Antibiotic
 QUESTION 37

 5 years old came with a cute in his finger. He felled in

the school yard. His vaccination history is unknown
 You will give him
 A-Nothing
 B-Tetanus toxoid
 C-tetanus toxoid and tetanus
immunoglobulin
 D-Antibiotic
 QUESTION 38

 An infant with history of fever and convulsion EEG

show temporal discharge what the most likly
cause:
A-Shigellosis
B-Salmonella
C-HSV type 1
D-CMV
 QUESTION 38

 An infant with history of fever and convulsion EEG

show temporal discharge what the most likly
cause:
A-Shigellosis
B-Salmonella
C-HSV type 1
D-CMV
 QUESTION 39

 Symptoms of cystic fibrosis in neonate:

 a) Meconium ileus
 b) Pneumothorax
 c) Steatorrhea
 d) Rectal prolapse
 QUESTION 39

 Symptoms of cystic fibrosis in neonate:

 a) Meconium ileus
 b) Pneumothorax
 c) Steatorrhea
 d) Rectal prolapse
 QUESTION 40

 5-years old girl known tetralogy of fallot and came

with cyanotic spells. All are useful for management
except:
 A-Squatting position
 B-Oxygen
 C-Morphine
 D-Sodium bicarbonate
 E-Dirutics
 QUESTION 40

 5-years old girl known tetralogy of fallot and came

with cyanotic spells. All are useful for management
except:
 A-Squatting position
 B-Oxygen
 C-Morphine
 D-Sodium bicarbonate
 E-Dirutics
 QUESTION 40

 OSAMA
 O: oxygen
 S: Sodium bicarbonate
 A: Adrenergic antagonist: beta blocker
 M: Morphine sulphate
 A:Alpha agonist: phenylephrine
 QUESTION 41

 10 month old boy with failure to thrive.

 Blood gass : 7.20 , HCO3 15, CL 115, Na 140
 Most likely cause:
 A-DKA
 B-Organic acidemia
 C-Renal tubular acidosis
 D-Lactic acidosis
 QUESTION 41

 10 month old boy with failure to thrive.

 Blood gass : 7.20 , HCO3 15, CL 115, Na 140
 Most likely cause:
 A-DKA
 B-Organic acidemia
 C-Renal tubular acidosis
 D-Lactic acidosis
 QUESTION 41

 Causes of metabolic acidosis with normal anion gap

 RTA
 Gastroenteritis
 Hypoaldestronsim
 QUESTION 42

 What is the antidote for aspirin:

 A-N-acetycystine
 B-Sodium bicarbonate
 C-Naloxone
 D-Flumazeni
 QUESTION 42

 What is the antidote for aspirin:

 A-N-acetycystine
 B-Sodium bicarbonate
 C-Naloxone
 D-Flumazeni
 QUESTION 42

 Organiposphate: atropine
 Narcotics: Naloxone
 Benzodiazpine: Flumazenil
 Paracetamol: N-acetylcystine
 Aspirin: NaHCO3
 Methanol: ethanol, fomepizole
 TCA: Sodium bicarbonate
 QUESTION 43

 Mother has baby with cleft palate and asks you what
is the chance of having a second baby with cleft
palate or cleft lip:
 a) 25%
 b) 50%
 c) 1 %
 d) 4%
 QUESTION 43

 Mother has baby with cleft palate and asks you what
is the chance of having a second baby with cleft
palate or cleft lip:
 a) 25%
 b) 50%
 c) 1 %
 d) 4%
 QUESTION 43

 Multifactorial, or polygenic, meaning they are likely

associated with the effects of multiple genes in
combination with lifestyles and environmental
factors
 QUESTION 44

 asthma
 autoimmune diseases such as multiple sclerosis
 cancers
 ciliopathies
 cleft palate
 diabetes
 heart disease
 hypertension
 inflammatory bowel disease
 intellectual disability
 mood disorder
 obesity
 refractive error
 infertility
 QUESTION 45

 Known patients with steroid dependent nephrotic

syndrome and he was on oral cyclophosphamide and
he finished the course today. Mother asked when she
start giving him vaccines Best answer
 A-After 1 week
 B-After 1 month
 C-After 3 months
 D-After 6 months
 E-After 1 year
 QUESTION 45

 Known patients with steroid dependent nephrotic

syndrome and he was on oral cyclophosphamide and
he finished the course today. Mother asked when she
start giving him vaccines Best answer
 A-After 1 week
 B-After 1 month
 C-After 3 months
 D-After 6 months
 E-After 1 year
 QUESTION 46

 9 month came to your clinic and you notice that he

has pallor
 He is exclusively breast feeding
 Which of following lab is expected
 A-Increase HbF
 B-Decrease TIBC
 C-Increase RDW
 D-marcocytic anemia
 QUESTION 46

 9 month came to your clinic and you notice that he

has pallor
 He is exclusively breast feeding
 Which of following lab is expected
 A-Increase HbF
 B-Decrease TIBC
 C-Increase RDW
 D-marcocytic anemia
 QUESTION 47

 6 month old came to ED with heart rate 260 pulse

per minute. Blood pressure 60/30 mmHg. Your
initial management:
 A-Adenosine
 B-Digioxin
 C-Amlodipine
 D-Synchornized conversion with 2j/kg
 E-Carotid sinus message
 QUESTION 47

 6 month old came to ED with heart rate 260 pulse

per minute. Blood pressure 60/30 mmHg. Your
initial management:
 A-Adenosine
 B-Digioxin
 C-Amlodipine
 D-Synchornized conversion with 2j/kg
 E-Carotid sinus message
 QUESTION 47

 In SVT:
 Stable hemodynamic patients: Adenosine and should
be given as rapid infusion in a good IV line
 Carotid sinus message should not be attempted in
small children
 Unstable hemodynamic: Synchonized cardoversion
This is found in a blood film with a boy with fever
, hepatosplenomegally and joint pain
 QUESTION 48

 Most likely diagnosis

 A-Lymphoma
 B-CMV
 C-Acute leukemia
 D-Typhoid fever
 QUESTION 48

 Most likely diagnosis

 A-Lymphoma
 B-CMV
 C-Acute leukemia
 D-Typhoid fever
 QUESTION 49

 5 years old boy came with asthmatic exacerbation.

After salbuatmol and IV steroid he still has shotness
of breath
 Your next action
 A-Intubation
 B-Aminophyline
 C-IV salutamol
 D-MGSO4
 QUESTIOn 49

 5 years old boy came with asthmatic exacerbation.

After salbuatmol and IV steroid he still has shotness
of breath
 Your next action
 A-Intubation
 B-Aminophyline
 C-IV salutamol
 D-MGSO4
 QUESTION 49

 OSAMA
 Oxygen
 S: Steroid
 A:Adrenergic agonist (salbutamol)
 M: MGSO4
 A:Anticholenegic (atrovent)
 QUESTION 50

 6- 4 weeks old boy with acute onset forceful non

bilious vomiting after feeding. On abdominal
examination: There is olive mass at epigastric area.
What is the 1st investigation should you do?
 a. PH monitoring
 b. Abdominal US
 C-Abdominal X ray
 D-CT scan
 QUESTION 50

 6- 4 weeks old boy with acute onset forceful non

bilious vomiting after feeding. On abdominal
examination: There is olive mass at epigastric area.
What is the 1st investigation should you do?
 a. PH monitoring
 b. Abdominal US
 C-Abdominal X ray
 D-CT scan
 QUESTION 50

 Pyloric stenosis
 Come at 4-8 weeks
 Non bilious projective vomiting
 Common in boys
 Olive mass in epigastric area
 Question 51

 Liable to have:
 Metabolic alkalosis and hypokalemia
 Showed be given IV normal saline to correct
metabolic alkalosis to avoid apnic attack at time of
anesthesia
 QUESTION 51

 12 year old boy known to have recurrent hypoclymeic

attacks. When you check his urine during
hypoglycemia you found no ketones in the urine
 QUESTION 51

 Most likely diagnosis

 A-Organic acidemia
 B-Liver disease
 C-fatty acid oxidation defect
 D-Renal disease
 QUESTION 51

 Most likely diagnosis

 A-Organic acidemia
 B-Liver disease
 C-fatty acid oxidation defect
 D-Renal disease
 QUESTION 51

 Hypoglycemia with absence of ketones

 1-Hyperinsulnemia
 2-fatty acid oxidation defect
 3-Hypoptiturism
 QUESTION 52

 Earliest sign of puberty in girls

 A-Pubic hair
 B-Breast enlargement
 C-Menstruation
 D-Change in voice
 QUESTION 52

 Earliest sign of puberty in girls

 A-Pubic hair
 B-Breast enlargement
 C-Menstruation
 D-Change in voice
 QUESTION 52

 Earliest sign of puberty in boys:

 Testicular enlargement
 Earliest sign of puberty in girls
 Breast enlargement
 QUESTION 53

 10 years old boy and known to have type 1 DM. You

find that his blood sugar is controlled except early
morning where glucose is quite high, His on short
acting and NPH insulin twice a day (before breakfast
and before dinner)
 QUESTION 53

 A-Increase NPH insulin before dinner

 B-Increase short insulin before dinner
 C-Check glucose at 2 AM
 D-Nothing to do and just follow up
 A-Increase NPH insulin before dinner
 B-Increase short insulin before dinner
 C-Check glucose at 2 AM
 D-Nothing to do and just follow up
 QUESTION 53

 Chronic Somogyi rebound is a contested

explanation of phenomena of elevated blood sugars
in the morning.
 Also called the Somogyi
effect and posthypoglycemic hyperglycemia, it
is a rebounding high blood sugar that is a response
to low blood sugar
 Question 54

 A baby deliver to mother known with SLE

 He will likely to develop
 A-Arthritis
 B-Fever
 C-Seizures
 D-Nephrotic syndrome
 E-Congenital heart block
 Question 54

 A baby deliver to mother known with SLE

 He will likely to develop
 A-Arthritis
 B-Fever
 C-Seizures
 D-Nephrotic syndrome
 E-Congenital heart block
 QUESTION 54

 Neonatal lupus
 1-2 % of babies with SLE
 Skin rash
 Thrombcytopenia
 Congenital heart block
 Anit Ro , Anti LA antibodies
 QUESTION 55

 5- Child presented with petechiae and his platelets is

15, otherwise healthy. What will you do for him?
 a. Splenectomy
 b. IVIG
 c. Observations
 D. Steroid
 QUESTION 55

 5- Child presented with petechiae and his platelets is

15, otherwise healthy. What will you do for him?
 a. Splenectomy
 b. IVIG
 c. Observations
 D. Steroid
 QUESTION 55

 In ITP
 IVIG should be reserved for:
 Life threatening bleeding
 Or platelets below 10
 Supportive measurement
 Avoidance of trauma
 Avoid NSAID
 Question 56

 A pregnant lady admitted with labor

 You notice a vesicular skin rash
 Next action
 A-Proceed with labor
 B-Give mother acyclovir
 C-Proceed and give baby acyclovir
 D-Do cesarean section
 Question 56

 A pregnant lady admitted with labor

 You notice a vesicular skin rash
 Next action
 A-Proceed with labor
 B-Give mother acyclovir
 C-Proceed and give baby acyclovir
 D-Do cesarean section
 Question 57

 6 year old boy has associated frequent starring and

blinking episodes
 Which of following manuevers can increase these
episodes
 A-Sleep depriving
 B-Pinching
 C-Hyperventilation
 D-Eating salt
 E-Walking
 Question 57

 6 year old boy has associated frequent starring and

blinking episodes
 Which of following manuevers can increase these
episodes
 A-Sleep depriving
 B-Pinching
 C-Hyperventilation
 D-Eating salt
 E-Walking
 Absence seizures

 Associated with generalized 3-4 Hz spike-and-slow-

wave complexes on EEG
 QUESTION 57

 Absence
 Start brupt and ending abrupt (no post ictal)
 Less than 30 seconds
 Automatism (rare)

 Complex partial
 Start with warning signs and ends with post ictal
 Always automatism
 More than 30 seconds
 QUESTION 58

 5 years old and known SCA. She developed diabetes

melitus
 How you will monitor her glucose control
 A-HbA1c
 B-WBC
 C-Urine ketones
 D-Ceruoplasmin
 E-Fructose amine
 QUESTION 58

 5 years old and known SCA. She developed diabetes

melitus
 How you will monitor her glucose control
 A-HbA1c
 B-WBC
 C-Urine ketones
 D-Ceruoplasmin
 E-Fructose amine
 Question 59

 5 years old presents with bilateral weakness in lower

limps. He had URTI 2 weeks ago. O/E there is absent
knee reflex bilaterally
 Which is true regarding this condition
 A-Plasma exchange is the 1st line of management
 B-Most patients will have significant residual weakness
on long term
 C-The weakness is asymmetrical
 D-CSF will show high WBC count and high protein
 E-Having a good lung functional vital capacity indicates
good outcome
 Question 59

 5 years old presents with bilateral weakness in lower

limps. He had URTI 2 weeks ago. O/E there is absent
knee reflex bilaterally
 Which is true regarding this condition
 A-Plasma exchange is the 1st line of management
 B-Most patients will have significant residual weakness
on long term
 C-The weakness is asymmetrical
 D-CSF will show high WBC count and high protein
 E-Having a good lung functional vital capacity
indicates good outcome
 QUESTION 59

 Ascending weakness
 Symmetrical
 Autonomic changes
 Affect respiratory muscles
 Most 85-90% will recover within 4-8 weeks
 CSF: normal cells with high protein
 Treatment
 IVIG
 Plasma exchange
 QUESTION 60

 5 years old presents with BP 140-90 in ED

 He started to seize. After seizure control which of
following you want to give
 A-Nifedipine PRN
 B-Amlodipine regular
 C-IV Hydralazine regular
 D-Labetalol infusion
 E Enalpril infusion
 QUESTION 60

 5 years old presents with BP 140-90 in ED

 He started to seize. After seizure control which of
following you want to give
 A-Nifedipine PRN
 B-Amlodipine regular
 C-IV Hydralazine regular
 D-Labetalol infusion
 E Enalpril infusion
 QUESTION 60

 Hypertensive urgency
 PRN (hydralzine (IV or PO) or nifidepine)
 Hypertensive emergency
 Labetalol infusion
 Sodium nitroprusside infusion
 Hydarlazine infusion
 QUESTION 61

 Which of a following is a cause of precocious puberty

 A-Addison disease
 B-Hyperthyroidism
 C-Congenital adrenal hyperplasia
 D-DM
 E-Turner syndrome
 QUESTION 61

 Which of a following is a cause of precocious puberty

 A-Addison disease
 B-Hyperthyroidism
 C-Congenital adrenal hyperplasia
 D-DM
 E-Turner syndrome
QUESTION 61
 QUESTION 62

 Breastfeeding after delivery should start:

 A. Immediately
 B. 6 hr
 C. 8hr
 D. 24 hr
 QUESTION 62

 Breastfeeding after delivery should start:

 A. Immediately
 B. 6 hr
 C. 8hr
 D. 24 hr
 QUESTION 63

 5 years old with high fever and drooling of saliva.

Lateral neck ray showed thump printing sign
 Next action
 A-Cefitraxone
 B-Examining the throat
 C-Intubation
 D-Blood culture
 E-CT scan
 QUESTION 63

 5 years old with high fever and drooling of saliva.

Lateral neck ray showed thump printing sign
 Next action
 A-Cefitraxone
 B-Examining the throat
 C-Intubation
 D-Blood culture
 E-CT scan
Thumb print sign
Steeple sign
 QUESTION 64

 7 years old girl with precious puberty and café au lait

spots and thryotoxocosis
 What other finding in this disease
 A-Fibrous dysplasia
 B-Addison disease
 C-Brain tumor
 D-Recurrent candida
 QUESTION 64

 7 years old girl with precocious puberty and café au

lait spots and thryotoxocosis
 What other finding in this disease
 A-Fibrous dysplasia
 B-Addison disease
 C-Brain tumor
 D-Recurrent candida
 QUESTION 65

 In marfan syndrome , which of following is most

common congenital heart disease:
 A-Coarctation of aorta
 B-Mitral valve prolapse
 C-Aortic stenosis
 D-Supravlavular aortic stenosis
 E-AV canal malformation
 QUESTION 65

 In marfan syndrome , which of following is most

common congenital heart disease:
 A-Coarctation of aorta
 B-Mitral valve prolapse
 C-Aortic stenosis
 D-Supravlavular aortic stenosis
 E-AV canal malformation
 QUESTION 65

 Noonan syndrome: pulmonary stenosis

 Allagile syndrome: pulmonary stenosis , TOF
 Turner syndrome: coarctation of aorta
 Marfan syndrome: mitral valve prolapse
 William syndrome: supravalvular aortic stenosis
 Down syndrome: AV malformation
 Digeorge syndrome: Truncal lesion , TOF
 Question 66

 6 years old boy and diagnosed recently with

Duchene muscular dystrophy. Which of following is
true about this condition
 A-The calf muscle is usually wasted
 B-Distal muscle weakness is an early feature
 C-The paternal uncle will most likely to be affected
 D-Romberg sign usually positive
 E-Cardiac Echo should be done routinely in this
condition
 Question 66

 6 years old boy and diagnosed recently with

Duchene muscular dystrophy. Which of following is
true about this condition
 A-The calf muscle is usually wasted
 B-Distal muscle weakness is an early feature
 C-The paternal uncle will most likely to be affected
 D-Romberg sign usually positive
 E-Cardiac Echo should be done routinely in
this condition
 Duchenne muscular dystrophy

 X-linked recessive form of muscular dystrophy

affecting around 1 in 3,600 boys, which results in
muscle degeneration and premature death.
 The disorder is caused by a mutation in the
gene dystrophin, located on the human X
chromosome, which codes for the protein dystrophin
 Duchenne muscular dystrophy

 Progressive muscular weakness

 Unable to walk by 12 year
 Can associate with cardiomyopathy
 Early death due to respiratory failure
 Positive Gower sign
 Starts proximal muscles then distal
Gower sign
 QUESTION 67

 A boy with bilateral nasal polyps

 Most likely diagnosis
 A-Allergic rhinitits
 B-Foreign body
 C-Cystic fibrosis
 D-Wagner granulmatosis
 QUESTION 67

 A boy with bilateral nasal polyps

 Most likely diagnosis
 A-Allergic rhinitis
 B-Foreign body
 C-Cystic fibrosis
 D-Wagner granulmatosis
 QUESTION 68

 A boy suspected to have cystic fibrosis. His sweat

chloride test is posititve
 Which of following might help to confirm the
diagnosis
 A-FISH test
 B-Alpha fetoprotein
 C-Karyotype
 D-CFTR gene
 QUESTION 69

 A child known to have CNS disorder

 Which of following vaccine should be avoidable
 A-Polio
 B-BCG
 C-DTP
 D-Hepatitis B
 QUESTION 69

 A child known to have CNS disorder

 Which of following vaccine should be avoidable
 A-Polio
 B-BCG
 C-DTP
 D-Hepatitis B
 DTP should be avoidable and replaced with DTaP
 QUESTION 70

 5 years old with high fever for 6 days. You found

polymorph rash , non-purleunt conjuctivitis ,
bilateral lymphadenopathy
 What is the treatment of choice
 A-IVIG
 B-Aspirin
 C-Steroid
 D-NSAID
 E-Antibiotics
 QUESTION 70

 5 years old with high fever for 6 days. You found

polymorph rash , non-purleunt conjunctivitis ,
bilateral lymphadenopathy
 What is the treatment of choice
 A-IVIG
 B-Aspirin
 C-Steroid
 D-NSAID
 E-Antibiotics
 QUESTION 70

 C: Conjunctivitis
 R: rash (polymorph)
 A: adenopathy
 S: strawberry tongue
 H: hand and foot swelling

 Burn: fever for > 5 days

 QUESTION 70

 IVIG decrease coronary artery anuresym from 25 to

%
This is in blood film in 5 year child
 This child will likely to develop
 A-Neuropathy
 B-Seizures
 C-Diarrhea
 D-Hypertension
 This child will likely to develop
 A-Neuropathy
 B-Seizures
 C-Diarrhea
 D-Hypertension