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تحميل الدليل التدريبي

أسئلة شائعة


Sample 1:


Directions:  Each of the questions or incomplete statements below (1-50) is followed by four or five suggested answers or completions.  Select the ONE that is BEST in each case and fill in the circle containing the corresponding letter on the answer sheet.


1)         Which of the following pulmonary function tests is most likely to yield normal results in a child with an obstructive airway disease?


A.                  Peak flow rate

B.                   One-second forced expiratory volume (FEV)

C.                  Residual volume

D.                  Diffusion capacity

E.                   Maximal midexpiratory flow rate



2)         A 10-year-old girl has had intermittent periumbilical abdominal pain for six months.  The pain usually lasts for one hour and she frequently goes home early from school because of the pain.  There is no history of diarrhea or constipation; however, with the pain she occasionally experiences nausea and vomiting.  Results of the physical examination are normal with the exception of slight diffuse abdominal tenderness.


Laboratory data include:


            Hemoglobin 12.8 g/dl; hematocrit 39%

            Leukocyte count 7600/mm3 with normal differential cell count

            Erythrocyte sedimentation rate 18 mm/hr

            Stool guaiac test negative


With the information provided, your next step in evaluating this patient would be to:


A.                  request a psychiatric consultation

B.                   order an upper gastrointestinal X-ray study

C.                  give a trial of an antidepressant medication

D.                  order a breath hydrogen analysis

E.                   explore the possible psychosocial basis for dysfunctional pain



3)         Increasingly noisy respirations have been present for two weeks in a 7-week-old boy (weight 3.6 kg; 7.9 lb).  He had no difficulties during the neonatal period and feeds without difficulty.  He has a high-pitched crowing sound on inspiration, which diminishes when he is prone and relaxed.  His cry is normal. 


            The MOST likely diagnosis is:


A.                  vocal cord paralysis

B.                   congenital stridor

C.                  laryngeal web

D.                  subglottic hemangioma

E.                   tracheal papilloma



4)         Among the following, the most appropriate therapy for Bell palsy is:


A.                  surgical decompression of the acoustic canal

B.                   protection of the cornea on the affected side

C.                  daily electrical stimulation of the facial nerve

D.                  therapy with diuretics

E.                   daily facial massage



5)         A 6-month-old infant has had vomiting and diarrhea for three days.  He is moderately dehydrated (estimated loss of 100 mL/kg of body weight).  Laboratory data include serum sodium concentration 138 mEq/L, potassium 4.2 mEq/L, chloride 115 mEq/L and bicarbonate 10mEq/L.  Among the following solutions, which is indicated for initial intravenous theraphy?


A.                  35 mEq/L sodium chloride in 5% glucose ein water

B.                   Lactated ringer solution with 5% glucose in water

C.                  Sodium bicarbonate solution (50 mEq/L)

D.                  5% glucose in water

E.                   500 mEq/L sodium chloride with 5% glucose in water.



6)         Among the following, the laboratory result most likely to be found in a plethoric twin recipient of a twin-to-twin transfusion is:


A.                  thrombocytopenia

B.                   hypoglycemia

C.                  hyperbilirubinaemia

D.                  hyponatremia

E.                   hypocalcemia


7)         A mother reports that her 11-month-old son, who was previously sleeping through the night, not awakens several times during each night.  This most likely represents:


A.                  hunger

B.                   putting the infant to bed too early

C.                  a normal developmental stage

D.                  inconsistent bedtime

E.                   family disturbance


8)         An 18-month-old boy is brought for a diphtheria-tetanus-pertussis (DTP) booster.  His mother reports that he had a brief convulsion with fever after receiving his third DTP vaccination at 6 months of age.  The most appropriate next step would be to:


A.                  reduce the dose of DTP booster

B.                   give standard dose of DTP booster

C.                  give a diphtheria-tetanus (DT) booster

D.                  withhold his DTP booster

E.                   administer Phenobarbital with DTP booster


9)         Among the following, which contributes most to the osmotic pressure (osmolality) of serum?


A.                  Glucose

B.                   Urea

C.                  Protein

D.                  Chloride

E.                   Bicarbonate



10)       A 4-month-old infant has had recurrent episodes of diarrhea and has gained weight abnormally slowly.  He is dehydrated.  The following laboratory data are reported:  serum sodium concentration 135 mEq/L; potassium 3.0 mEq/L; chloride 88 mEq/L; bicarbonate 31 mEq/L, blood urea nitrogen 8 mg/dL; serum glucose 85 mg/dL.


            Among the following conditions, which is most likely in this patient?


A.                  Pyloric stenosis

B.                   Bartter syndrome

C.                  Congenital adrenal hyperplasia

D.                  Cystic fibrosis

E.                   Intake of feeding low in calcium content



11)       A 5-year-old boy has five large café-au-lait spots and has an acoustic neuroma removed.  His mother is normal clinically.  Assuming that the boy’s condition is a genetic disorder, the risk of involvement for future siblings is:


A.                  25% for both and girls

B.                   50% for both boys and girls

C.                  50% for both boys; 50% of girls will be unaffected carriers

D.                  50% for girls; 50% of boys will be unaffected carriers

E.                   Inestimable from available data



12)       A 7-day-old infant with achondroplasia is hypotonic and has a head circumference above the 97th percentile.


            Which of the following statements regarding this condition is TRUE:


A.                  Macrocephaly in achondroplasia is commonly associated with hydrocephalus

B.                   Mental development of affected children is usually normal

C.                  The usual mode of inheritance is autosomal recessive

D.                  Muscle tone will be normal by 12 months of age

E.                   Scoliosis is a common complication




13)       A 10-month-old girl who was born after 32 weeks’ gestation does not pull to stand or walk with support.  She sits well alone, reaches, and transfers.  The neonatal course was complicated by mild hyaline membrane disease and mild physiologic jaundice.  Head circumference is 42 cm (16.8 in, 3rd percentile); length is 66 cm (26.4 in, less than 10th percentile); and weight is 7.1 kg (15.6 lb, less than 3rd percentile).


Of the following, the most appropriate next step in the evaluation of this patient is to:


A.                  obtain X-ray studies of the skull

B.                   order TORCH antibody screening examination

C.                  order determination of thyroid-stimulating hormone and serum thyroxine concentrations

D.                  refer the child for formal developmental testing

E.                   schedule another appointment in two months



14)       A 3-year-old child ingested approximately 25 of his mother’s ferrous sulfate tablets.  Emesis was induced with recovery of a few tablets in the vomitus.  Gastric lavage with water did not yield any tablets.  X-ray studies of the abdomen show many tablets still in the stomach.  The most appropriate next step would be:


A.                  continued lavage with water

B.                   continued lavage with dilute sodium biophosphate solution

C.                  instillation of dilute deferoxamine mesylate solution into the stomach

D.                  instillation of magnesium sulfate solution into the stomach

E.                   removal of the tablets by endoscopy



15)       A 6-year-old girl is short and moderately obese.  Her thyroid gland is palpable.  For the pas two years she has had a persistent cough diagnosed as chronic bronchitis.  Her cough medication contains iodides.


            Her clinical problem is most likely related to:


A.                  the role of iodides in the pathogenesis of Hashimoto thyroiditis

B.                   the capacity of large doses of iodides to induce thyrotoxicosis

C.                  an idiosyncrasy to iodides

D.                  the fact that large doses of iodides interfere with thyroxine release from the thyroid gland

E.                   the fact that iodides block the capacity of growth to stimulate somatotrophin synthesis in the liver


16)       A routine health maintenance examination of an asymptomatic 12-year-old girl reveals a grade 3/6 late systolic murmur, loudest at the apex.  There is a midsytolic click heard also at the apex. The precordium is quiet.  There are no thrills or heaves.  The second heart sound (S2), is normal.  Findings on the remainder of the physical examination are normal.  You have observed this patient since she was 6 years of age and have noted no murmurs previously.


            The MOST likely diagnosis is:


A.                  mitral insufficiency

B.                   innocent systolic murmur

C.                  acute myocarditis

D.                  mitral valve prolapse

E.                   innocent pleuropericardial sound



17)       A 6-year-old child is stung on the foot by a honeybee.  Within a few minutes sneezing and nasal congestion are noted, followed by progressive hoarseness and inspiratory stridor.  The child is brought to the emergency room.


            The MOST appropriate immediate response is to:


A.                  initiate scratch test for insect sensitivity

B.                   administer epinephrine, subcutaneously

C.                  administer glucocorticoids, intravenously

D.                  determine if there has been a previous honeybee sting

E.                   administer an antihistamine, orally



18)       A 4-year-old girl has fever (temperature 40.00C) and a swollen right knee.  Which of the following investigations would be most important at this time?


A.                  X-ray studies of the knee joints

B.                   Slit-lamp examination of the eyes

C.                  Determination of antinuclear antibodies in the serum

D.                  Joint fluid analysis

E.                   Latex fixation test for rheumatoid dactor



19)       Appropriate daily water intake for a 27-month-old weighing 12 kg (26.4 lb) who is receiving a mixed diet is CLOSEST to:


A.                  500 ml

B.                   700 ml

C.                  1100 ml

D.                  1300 ml

E.                   2000 ml



20)       Ptosis and variable double vision gradually develop over two weeks in a previously healthy 11-year-old girl.  Results of physical examination are normal except for the visual findings.  Among the following, the MOST useful diagnostic study is likely to be:


A.                  computer tomography (CT scan) of the head

B.                   determination of a measles antibody titer in cerebrospinal fluid

C.                  an edrophonium chloride (Tensilon) test

D.                  determination of the muscle antibody titer

E.                   a stool culture for Clostridium toxin



21)       A 6-year-old boy with acute lymphocytic leukemia in remission has had headache and vomiting for two days.  Physical examination shows only bilateral papilledema.


            Which of the following would you order first?


A.                  Platelet transfusion

B.                   Examination of cerebrospinal fluid

C.                  Intravenous administration of ampicillin and gentamicin

D.                  Bone marrow aspiration

E.                   Brain scan



22)       During fetal life, the development of male external genitalia is directly determined by the action of which of the following?


A.                  Testosterone

B.                   Dihydrotestosterone

C.                  Dehydroepiandrosterone

D.                  Androstenedione

E.                   H-Y antigen



23)       A 3-month-old infant has a large cavernous hemangioma involving the left arm and shoulder.  Which of the following is most likely to be associated?


A.                  Thrombocytopenia

B.                   Absence of the radius

C.                  Intracranial calcification

D.                  Aplastic anemia

E.                   Left ventricular hypertrophy



24)       Which of the following data sets can be accepted as representing a realistic situation?


A.                  Serum:  sodium (Na) 145 mEq/L, potassium (K) 5.4 mEq/L, chloride (Cl) 110 mEq, bicarbonate (HCO3), 21 mEq/L, osmolality 260 mOsm/kg/H2O

B.                   Serum:  Na 135 mEq/L, K 5.4 mEq/L, Cl 115 mEq/L, HCO3 22 mEq/L

C.                  Urinalysis:  specific gravity 1.025, pH 5.8, glucose negative, protein negative, 2 to 5 leukocytes/hpf, osmolality 850 mOsm/kg H2O.

D.                  Arterial blood gas  analysis:  pH 7.2, PCO2, 30 mmHg, HCO3 19 mEq/L;

E.                   Serum:  Na 135 mEq/L, K 3.2 mEq/L, Cl 80 mEq/L, HCO3 31 mEq/L;  arterial blood gas analysis: pH 7.3, PCO2 35 mmHg


25)       A 5-year-old child has had polydipsia and polyuria for three weeks.  She has been well otherwise.  After six hours of water deprivation the following laboratory data are obtained:  urine osmolality 150 mOsm/kg H2O, serum osmolality 305 mOsm/kg H2O.  Of the following, which diagnosis is most likely?


A.                  Diabetes mellitus

B.                   Diabetes insipidus

C.                  Psychogenic polydipsia

D.                  Hypercalcemia

E.                   Potassium deficiency



26)       A 2-month-old, breast fed infant has had prolonged neonatal jaundice and has been anorectic, with diarrhea and vomiting.  Examination of the infant reveals hepatomegaly and hypotonia.


            Among the following, the most appropriate initial test would be to:


A.                  Examine the urine for reducing substances

B.                   Perform a glucose tolerance test

C.                  Perform a lactose tolerance test

D.                  Determine serum amino acid level

E.                   Determine the serum concentration of thyroid-stimulating hormone (TSH)



27)       A 4-year-old girl who has been treated with Phenobarbital for the past two years for an idiopathic seizure disorder is brought to the emergency room because of a continuous seizure which has lasted for one hour and twenty minutes.


            The MOST likely cause for the onset of status epilepticus in this patient is:


A.                  failure to take medication as prescribed

B.                   inappropriate secretion of antidiuretic hormone

C.                  occult infection

D.                  changing seizure pattern

E.                   ingestion of excessive amount of folic acid



28)       A 2-month-old infant has fever, frequent vomiting and failure to thrive.  Physical examination reveals an 8 by 10 cm mass in the right upper quadrant of the abdomen.  Blood and urine culture yield Escherichia coli.  Among the following, the MOST likely cause of this condition is:


A.                  pyloric stenosis

B.                   Wilms tumor

C.                  renal vascular thrombosis

D.                  adrenal hemorrhage

E.                   obstruction of the ureteropelvic junction  


29)       The mother of an 18-month-old infant consults you regarding her child’s language development. The child’s tympanic membranes appear normal and are mobile on pneumatic otoscopy. The child has 12-word vocabulary, and uses a considerable amount of jargon, but does not use any two-word phrases. Of the following, the best course of action at this time would be to


      refer the child for tympanometry

      refer the child for brain stem-evoked audiometry

      refer the child to a speech therapist

      assure the mother that language development is within normal   


      refer the child for a complete development evaluation


30)       A 7-year-old child has had malaise, loss of appetite and frequent headaches for two

months. Findings on physical examination are normal except for hypertensive changes in her optic fundi. Blood pressure in her right arm is 190/120 mmHg; peripheral pulses are normal. After admission to the hospital.  Which of the following would be the most appropriate initial therapy?


      Low sodium diet

      Propranolol, orally

      Furosemide, intravenously

      Diazoxide, intravenously

      Chrolothiazide, orally


31)       The mother of a 7-year-old girl reports that the girl’s teacher has complained that the child has many short periods during the school day when she suddenly ceases voluntary activity, has a blank expression on her face and seems unaware of what is going on.


            The most urgent step in evaluation of this patient would be


A.            electroencephalography

B.             psychologic testing

C.            computer tomography (CT scan) of  the head

D.            determination of blood glucose and calcium concentrations

E.             examination of cerebrospinal fluid


32)       Among the following, the LEAST likely side effect of phenytoin therapy is


A.            generalized lymphadenopathy

B.             hepatosplenomegaly

C.            rash

D.            peripheral neuropathy

E.             nystagmus on lateral gaze


33)       Which of the following is LEAST likely to be found in a 12-hour-old infant with congestive heart failure?


A.            Pulmonary rales

B.             Tachycardia

C.            Tachypnea

D.            Peripheral edema

E.             Hepatomegaly


34)       A 3-year-old boy has a port-wine stain on the left side of the face in the distribution of the trigeminal nerve. Of the following, which is LEAST likely  to be an associated findings?


A.            Seizures

B.             Glaucoma

C.            Hemiparesis

D.            Thrombocytopenia

E.             Intracranial calcification



35.       Vascular ring:


A.            Esophagogram is the fundamental diagnostic study

B.             Bronchography is the fundamental diagnostic study

C.            Surgery has to be done for all patients as soon as possible

D.            In double aortic arch usually the posterior arch is the smaller one

E.             Children with this problem typically has  a normal expiratory phase

(i.e., the problem is mainly inspiratory)


36.       Peutz-Jeghers syndrome is characterized by:


A.            X-linked recessive inheritance

B.             Mucocutaneous pigmentation and gastrointestinal polyps

C.            Malignant transformation of the hamartoma is common

D.            Painless rectal bleeding

E.             Polyposia usually involves the large intestine



37.       The following are the most constant features of Schwachman-Diamond syndrome EXCEPT.


      Exocrine pancreatic insufficiency and metaphyseal dysostosis

      Mental and growth retardation

      Neutropenia which is often cyclic

      Manifests in infancy as failure to thrive

      An Autosomal dominant inheritance



38.       In gastroesophageal reflux (GER), which of the following statements is  CORRECT:


      Majority of affected infants have onset of symptoms after 6 weeks of age

      Vomiting in patients with GER is never projectile

      Symptoms resolve without treatment in over half of affected children by 2 years of age

      Delayed gastric emptying occurs in minority of infants

      Esophagitis resulting from GER leads to stricture in about one third of patients


39.       Which one of the following neurocutaneous syndromes will reveal retinal hemangiomas on Fundoscopy?


A.            Struge Weber’s syndrome

B.             Ataxia telangiectasia

C.            Von Hippel-Lindau syndrome

D.            Incontinentia pigmenti

E.             Tuberous sclerosis



40.       In Wilson’s disease; the following statements are correct EXPECT:


A.            The basic genetic defect is located on chromosome 13.

B.             It is cause of hemolytic anemia

C.            Kayser-Fleischer rings are usually bilateral.

D.            There is an excess biliary excretion of copper

E.             Fanconi’s syndrome may be the first indication of the disease


41.       A screening program for iron deficiency finds a 10-month-old child to have an increased free erythrocyte protoporphyrin level. Subsequent determinations of serum iron and transferring levels show normal results.


The most likely explanation for the increase erythrocyte protoporphyrin level would be


A.            thalassemia minor

B.             lead poisoning

C.            acute intermittent porphyria

D.            sickle cell trait

E.             erythropoietic protoporphyria


42.       A previously well 8-year-old boy developed sinusitis two weeks ago, for which an appropriate antibiotic regimen was prescribed and given. One week ago he began to have generalized headache, lethargy and some vomiting. Examination now shows blurred optic disc margins but no other abnormal physical or neurologic signs. The most appropriate next step in management would be


A.            X-ray studies of the sinuses

B.             Cerebral angiography

C.            Computer tomography (CT scan) of head

D.            Examination of cerebrospinal fluid

E.             Electroencephalography

43.       Which of the following statements concerning sudden infant death  syndrome (SIDS) is TRUE?


A.            A warm and dry climate increases risk

B.             All socio-economic classes are at equal risk

C.            Avoidance of family members with acute viral illnesses reduces risk of SIDS

D.            An infant whose prior sibling had SIDS is at increased risk

E.             Breast feeding of the infant has been shown to decrease risk


44.       Among the following, a 3 month-old infant who has Werdnig_Hoffman  disease is most likely to have.


A.            a decrease in the number of anterior horn cells

B.             internal strabismus

C.            an absence of clavicles

D.            spina bifida

E.             a positive Chvostek sign



45.       Anemia is found in a 7-month-boy who is hospitalized with pneumonia. He  has been breast fed since birth, and solid foods were started at 4 months of age. Of the following, the most appropriate method to assess his body stores of iron is by determination of


A.            free erythrocyte protoporphyrin level

B.             serum iron level

a.       serum transferring level

C.            erythrocyte indices

a.       serum ferritin level


46.       A previously healthy 18-month-old with a high fever remains febrile after  one day of intravenous therapy with ampicillin and chloramphericol. After 24 hours leukocyte count is 4800/mm3 with neutrophils 7%, bands 8%, lymphocyctes 82%, monocytes 3% and platelet count 25,000/mm3. Hemoglobin is 11.4 g/dL. Fibrinogen level was low.


Among the following, the most likely explanation for the thrombocytopenia is


A.            splenic sequestration

B.             chloramphenicol-induced aplastic anemia

C.            antiplatelet antibodies

D.            thrombopoietin deficiency

E.             disseminated intravascular coagulation


47.       A 4-year-old boy is noted on routine physical examination to have the left upper and lower extremities larger than the right.


            The patient is at increased risk of


A.            lymphoma

B.             acute lymphocyctic leukemia

C.            ganglioneuroma

D.            cerebral gigantism

E.             Wilms tumor



48.       Erythematous, vesicular, scaling lesions develop around the anus and mouth of a 3-year-old boy who has Crohn disease. He is very irritable. Of the following, the most appropriate therapy for this clinical situation is administration of


A.            nystatin, topically

B.             vioform-hydrocortisone, topically

C.            hydrocortisone acetate, topically

D.            zinc supplemtents, orally

a.       cholestyramine, orally


49.       A 6-year-old girl has for one month intermittent fever, malaise, and facial edema. She now has palpably enlarged supraclavicular lymph nodes. Her laboratory studies reveal eosinophilia (14.0%), hypercalcemia (12.0 mg/dL), and hyperglobulinemia (4.8 g/dL). An x-ray study of the chest reveals bilateral perihilar adenopathy. The most helpful additional diagnostic study would be:


A.            biopsy of an involved lymph node

B.             magnetic resonance imaging study of chest

C.            quantitative urinary calcium determination

D.            examination of stool for ova and parasites

E.             determination of serum cold agglutination concentrations


50.       A 6-year-old boy is brought to your office by his mother because he has been having increasing difficulty running and climbing stairs for the previous three to four weeks. He has also had some vague discomfort  in his back and says his legs feel “funny”.


            Scoliosis, lower limbs weakness and hyperreflexia are noted on the

physical examination. Your tentative diagnosis would be


A.            Guillain-Barré syndrome

B.             Spinal cord tumor

C.            Muscular dystrophy

D.            Acute transverse myelitis

E.             Myasthenia gravis














































































































Sample 2:





(1)                    Features of moderate dehydration may include each of the following, except.


A.                 Sick looking child

B.                 Oliguria

C.                 Depressed anterior fontanel

D.                 Sunken eyes

E.                  Dry mucous membrane



(2)                    Diarrhea is an important feature of:


A.                 Peptic ulcer

B.                 Acrodermatitis enteropathica

C.                 Ancylostomiasis

D.                 Diabetes Mellitus

E.                  Hypertrophic pyloric stenosis



(3)                    Intestinal biopsy is pathognomonic in:


A.                 Celiac disease

B.                 Protein-energy malnutrition

C.                 Endemic tropical sprue

D.                 Abetalipoproteonemia



(4)                    Clinical features of celiac disease may include each of the following, expect:


A.     Manifests a few months after introduction                            

       of gluten-containing foods.

B.     Chronic diarrhea

C.     Growth failure with multiple deficiencies

D.     Abdominal distension

E.            Anorexia

F.            Response well to folic acid/B12









(5)                    Features of cystic fibrosis may include each of the following, except:


A.                 Chronic/recurrent diarrhea from early


B.                 Recurrent respiratory infections from early infancy

C.                 Growth failure

D.                 Anorexia

E.                  High incidence of rectal prolapsed and nasal polyp.



(6)                    Cystic fibrosis may present in a newborn as each of the following expect:


A.                 Meconium ileus

B.                 Meconium peritonitis

C.                 Ileal atresia

D.                 Duodenal atresia



(7)                    Which of the following is not a manifestation of acrodermatitis-enterpathica?


A.                 Chronic diarrhea

B.                 Multiple congenital anomalies

C.                 Symmetrical bullous skin lesions

D.                 Loss of hair



(8)                    Important clinical features of congenital megacolon include each of the following,



A.                 Constipation right from birth

B.                 Abdominal distension

C.                 Growth failure

D.                 Palpable loops of bowel

E.                  Loaded rectum






1:       (B)                     2:       (B)                     3:       (D)                    4:       (F)

5:       (D)                    6:       (D)                    7:       (B)                     8:       (E)





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