MID TERM TEST PEDRIATRICS

Choose the best answer. Each question carries 1 mark.

TIME: 1 hour 30 minutes

Name: Roll Number:

Total: 50 Obtained:

1:To be effective for preventing myelomeningocele, administration of folic acid needs to

begin:

A: By 3 months of gestation

B: At the first missed period

C: Before conception

D: By 30 days of gestation

E: At 3 months prior to delivery

2. A 4-yr-old boy is evaluated for his first generalized tonic-clonic seizure, which lasted 10
min. There is no history of illness or fever, and findings on
examination an hour after the seizure are completely normal. The most appropriate
management is:
A: Begin therapy with carbamazepine
B: Order an EEG
C: Order a CT scan of the brain
D: Order an MRI study of the brain
E: Order psychometric testing

3: A 7-mo-old girl is presented to the emergency department with

gradual onset of fever, lethargy, and irritability. Her immunizations are up to date.
Examination reveals a febrile infant who does not interact with the examiner and
cries inconsolably. A lumbar puncture is performed, and the cerebrospinal fluid
contains 1,500 white blood cells/mm3, 84% of which are granulocytes; a glucose
concentration of 12 mg/dL; and a protein concentration of 70 mg/dL. Gram stain is negative.
The most likely etiologic agent for this infection is:
A:An enterovirus

B:Herpes simplex virus

C:Haemophilus influenzae type b

D:Neisseria meningitides

E:Group B streptococci

4: The Gowers sign demonstrates:

A: Poor reflexes
B: Spinal dysraphism
C: Tethered cord
D: Proximal motor weakness
E: Hysterical paralysis

5: Neurofibromatosis type 1, an autosomal dominant disorder (gene on chromosome 17), is

defined by six or more caf-au-lait macules greater than 5 mm in diameter in prepubertal
children or greater than 15 mm in postpubertal children
plus at least one of the following except:

A: Axillary or inguinal freckling

B: Lisch nodules of the iris

C: Two or more neurofibromas or one plexiform neurofibroma

D: Ash leaf macule

E: Osseous lesions (sphenoid dysplasia, scoliosis)

F: Optic gliomas

F:An affected first-degree relative

6: A 19-yr-old girl presents with headache, unsteadiness, and poor hearing that has worsened
over the past 5 yr. Her father's medical history includes some type of brain surgery, and he
has been deaf since the age of 35 yr. The most likely diagnosis is:

A: Neurofibromatosis type 2

B: Optic glioma
C: Neurofibromatosis type 1

D: Tuberous sclerosis

E: Late-onset congenital deafness

7:A 16-yr-old boy who has recently traveled to sub-Saharan Africa is diagnosed
with Plasmodium vivax malaria. The fever pattern is one of febrile periods every
other day. The term that best characterizes this fever pattern is:

A: Hectic fever

B: Remittent fever
C: Biphasic fever

D: Tertian fever

E: Periodic fever

8: Thirty minutes after admission, an 18-yr-old girl with meningococcemia has just finished
receiving the last of her 60 mL/kg infusion of normal saline. The nurse tells you that the
patient's heart rate is still 120/min, that her blood pressure is 70/30 mm Hg, and that pink,
frothy material is being suctioned from the patient's endotracheal tube. The patient's
extremities are warm, with bounding pulses. The next step in the resuscitation is to:

A: Administer 20 mL/kg of lactated Ringer's solution

B: Administer 10 mL/kg of 25% albumin

C: Administer NaHCO3

D: Administer nitroprusside

E: Administer norepinephrine

9: Question . 63. As a visiting physician in a developing country, you are asked to see a 2-yr-
old child who presents with a history of fever, dysphagia, and lethargy. Physical
examination shows a gray-brown leather-like adherent membrane over the posterior
oropharynx and hypopharynx. The most likely diagnosis is:
A: Epiglottitis
B: Bacterial tracheitis
C: Group A streptococcal infection
D: Vincent angina
E: Diphtheria

10: Which of the following is the recommended treatment for neonatal meningitis caused by
listeria?

A: Ceftriaxone

B: Ampicillin with or without an aminoglycoside

C: Cefotaxime with or without an aminoglycoside

D: Erythromycin

E: Vancomycin

11: A 7-mo-old girl presents with a temperature of 103.8F, blood pressure of 70/30 mm Hg,
diffuse petechiae first noted 4 hr before presentation, platelet count of 88,000/mm3, and
white blood cell count of 4300/mm3, with 23% neutrophils and 42% bands. The infant has
received all recommended vaccinations. Which of the following is the
most likely bacterial etiology of this presentation?

A: Staphylococcus aureus

B: Streptococcus pneumoniae

C: Neisseria meningitidis

D: Haemophilus influenzae type b

E: Escherichia coli O157:H7

12: 15-mo-old child who attends a child care center 5 days per week is diagnosed with
meningococcal infection. Which of the following agents should be used for prophylaxis for
the child care classmates of this infant?

A: Chloramphenicol

B: Cefixime

C: Rifampin

D: Ciprofloxacin

E: Trimethoprim-sulfamethoxazole

13: A child who has recently returned from a visit to a developing country experiences a 2-
wk illness characterized by gradually increasing fever with temperature that eventually
reaches 104F, associated with headache, malaise, cough, and abdominal pain. The most
likely diagnosis is:
A: Cholera
B: Diphtheria
C: Shigellosis
D: Typhoid fever
E: Tetanus

14: Hemolytic-uremic syndrome in which, microangiopathic hemolytic anemia with renal

failure is found is typically a complication of infection with :
A: Salmonella typhi
B: E. coli O157:H7.
C: Campylobacter jejuni
D: Yersinia
E: Rotavirus

15:A 1-yr-old child experiences ascending paralysis with peripheral neuropathy. The cranial
nerves are intact. The cerebrospinal fluid is normal except for an elevated protein level.
Which of the following is the likely infectious agent precipitating this syndrome?

A: Corynebacterium diphtheriae

B: Clostridium botulinum

C: S. dysenteriae serotype 1

D: Campylobacter jejuni
E: Clostridium tetani

16: A 3-yr-old child in whose mother tuberculosis was just diagnosed has a positive PPD skin
test result. A chest film shows a localized, nonspecific infiltrate in the peripheral segments of
the right lower lobe. The most appropriate course of action to confirm the diagnosis of
tuberculosis disease in this child is:

A: Culture of sputum

B: Culture of pulmonary secretions obtained by bronchoscopy

C: Culture of gastric contents obtained by gastric aspiration

D: Percutaneous lung and pleural biopsies for culture and

histopathology
E: Segmental lobectomy for culture and histopathology

17: . The preferred agent for treatment of Lyme disease in a child 13 yr of age
is:

A: Doxycycline

B:Amoxicillin
C: Ceftriaxone

D: Erythromycin

E:Trimethoprim-sulfamethoxazole

18: An 8-yr-old child presents with headache, fever, anorexia, and myalgias with onset 3 days
ago, now accompanied by a petechial rash that is prominent on the extremities, including the
palms and soles (Figure). The most likely diagnosis is:

A: Infective endocarditis

B: Meningococcemia

C: Rocky Mountain spotted fever

D: Henoch-Sch nlein purpura

E: Systemic lupus erythematosus

19: Which of the following features distinguishes paralytic polio from Guillain-Barr
syndrome?

A: fever is uncommon in paralytic polio

B: Paralysis is usually asymmetric in paralytic polio

C: The paralysis of polio is usually spastic

D: Sensory changes are common in paralytic polio

E: Paralytic polio only occurs in unimmunized persons

20: A 3-yr-old boy presents with a 7-day history of fever, cervical lymphadenopathy, foul
breath, and painful oral lesions on his tongue, gums, and lips. For the past 3 days he has had
a red, painful swollen area about the nail of his right thumb with an area of fluid by the nail
bed, unresponsive to warm soaks and a first-generation cephalosporin. The most likely
etiologic agent is:

A:Staphylococcus aureus

B:Mucocutaneous candidiasis

C:Coxsackievirus

D:Adenovirus

E:Herpes simplex virus

21: The lesion in above question is called as

A: herpes ulcer
B: Abscess
C: herpetic cutaneous infection
D: herpetic whitlow
E: unguaitis herpeticus

22:A 13-mo-old previously healthy child presents on New Year's Eve with a 2-day history of
fever, lethargy, and irritability. Earlier this afternoon he began to have twitching movements
of his left arm and on the left side of his face. His immunizations are up-to-date. Physical
examination reveals fever with a temperature of 39C and left-sided weakness, with no
rashes. Examination of the cerebrospinal fluid (CSF) reveals 70 WBCs/mm3with 85%
lymphocytes, 400 RBCs/mm3, protein of 140 mg/dL, glucose 80 mg/dL, and negative results
on Gram stain. MRI scan reveals right temporal abnormalities. The diagnostic study most
likely to identify a treatable illness in a timely fashion is:

A:Viral CSF culture

B:Herpes simplex virus polymerase chain reaction (PCR) assay

C:Acute and convalescent antibody titers

D:Comparison of maternal and infant antibody titers

E:CSF bacterial culture

23: Which of the following can cause Aplastic crisis:

A:Cytomegalovirus

B:Epstein-Barr virus
C:Human immunodeficiency virus (HIV)

D:Parvovirus B19

E:Toxoplasma gondii

24: 237. On examination of a full-term newborn, the physician notes mild hepatomegaly.
Other physical findings are normal, including head circumference and appearance of the
retinas. A urine culture grows cytomegalovirus (CMV). Results of head ultrasonography are
normal. Subsequent testing discloses no metabolic disorders. The deficit most likely to occur
in the next year is:

A:Visual loss

B:Hearing loss
C:Cirrhosis

D:Patent ductus arteriosus

E:Immunoglobulin deficiency

25: 244. A 7-mo-old child presents in late October with 3 days of fever with
temperatures to 103.5F, a mildly injected pharynx, mild cervical lymphadenopathy, and
diarrhea. The child has been behaving normally and eating well and has no other
symptoms. On the fourth day of the illness the fever resolves, and a generalized measles-
like rash appears 12 hr later. The child appears normal on physical examination. The most
likely diagnosis is:

A:Measles

B:Rubella

C:Drug reaction to antipyretics

D:HHV-6 infection
E:Enteroviral infection

26:the childhood exanthem present in the infant described in above question is:
A:Kawasaki syndrome
B:roseola
C:Scarlet fever
D:Measles
E:German measles
27: Mechanisms responsible for vertical transmission of HIV infection include:

A:Intrauterine fetal infection

B:Intrapartum (peripartum) transmission

C:Breast-feeding

D:All of the above

E: None of above

28:A 20-mo-old child develops hemolytic anemia, anuria, azotemia, and thrombocytopenia
after a bout of febrile bloody diarrhea. The most likely etiologic agent of this illness is:

A:Campylobacter jejuni

B:Salmonella typhi

C:Enterohemorrhagic Escherichia coli

D:Aeromonas
E:Non-typhi Salmonella

29:Factors that may affect the perinatal HIV transmission rate include:

A:Preterm delivery

B:Low maternal antenatal CD4 count

C:Duration of ruptured membranes

D:Vaginal versus cesarean delivery

E:All of the above

30: Which of the following causes of congenital infections is associated with

cats?

A:Cytomegalovirus

B:Rubella

C:Toxoplasma gondi
D:LSyphilis

E:Parvovirus B19

31: A 6-yr-old girl who was previously healthy presents with a 1-wk history of
nocturnal perianal itching. There are no other symptoms, and findings on physical
examination are normal. The most appropriate therapy is:

A:Bacitracin ointment to the perianal area

B:Diphenhydramine orally as needed for itching

C:Single oral dose of mebendazole repeated in 2 wk

D:A 2-wk course of amoxicillin/clavulanate

E:Ketoconazole, in a single dose

32: The use of quinidine gluconate should be considered in any child

experiencing malaria associated with:

A:Neurologic dysfunction

B:Pulmonary edema

C:Inability to retain oral fluids or medication

D:Parasitemia more than 5% of erythrocytes

E:Any of the above

ANS: E

33: A 9-yr-old with vomiting and diarrhea has a systolic blood pressure of 75 mm Hg. You
should:

A;Check the fundi for papilledema

B:Administer 20 mL/kg of normal saline

C:Administer 20 mL/kg of 5% dextrose in water

D:Obtain upper and lower limb blood pressure readings

E:Begin administration of epinephrine or atropine

34: .The factor most clearly predicting mortality in shock is:

A:Cardiac failure

B:Renal failure

C:Hepatic failure

D:Metabolic acidosis

E:Multiple organ system failure

35: Based on an orientation to child development, when would you tell parents the highest
risk of poisoning in children is present?

A:6 mo

B:1 yr

C:2 yr

D:4 yr

E:6 yr

36: 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?
A. Complete blood count and blood culture followed by immediate prophylactic
intravenous antibiotics
B. Lateral radiograph of the neck
C. Dose of oral dexamethasone
D. Direct laryngoscopy in the operating room
E. Complete physical examination including inspection of the oral cavity.

37: The type of adrenergic activity of drugs most desirable treatment of asthma is:
A:alpha1
B:alpha2
C:beta1
D:beta2
E:beta3

38: Question . 30. A 10-yr-old child has intermittent symptoms of mild asthma.
The most appropriate treatment option is:
A:Environmental control and patient education only and no medication is indicated

B:Oral theophylline

C:Cromolyn

D:Inhaled beta2-agonist as needed for symptoms

E:Daily inhaled corticosteroid

39: 31. The child described in Question 30 experiences worsening of

symptoms, which are now persistent and of moderate severity. The most
appropriate treatment option is:

A:Oral theophylline

B:Inhaled 2-agonist as needed for symptoms

C:Daily inhaled corticosteroid and oral theophylline

D:Daily inhaled corticosteroid and a long-acting inhaled

beta2-agonist

E:Daily inhaled corticosteroid, a long-acting inhaled 2-

agonist, and oral theophylline

40: The probable age of a child who rolls back to front, has a thumb-finger grasp,
self-inhibits to "no," and bangs two cubes is:

A:7-8 mo

B:10-12 mo

C:12-15 mo

D:3-4 mo

E:15-18 mo

41: The probable age of a child who skips, names four colors, and dresses and
undresses is:

A:15 mo

B:24 mo

C:30 mo

D:18 mo

E:60 mo

42: The best source of iron for 1-mo-old infants is:

A:Iron-fortified cereals

B:Yellow vegetables

C:Fruits

D:Breast milk

E:2% low-fat cow's milk

ANS:D
43: Physical features of vitamin D deficiency rickets include all of the following
except:

A:Bitot spots

B:Enlargement of the costochondral junctions

C:Thickening of the ankles and wrists

D:Large anterior fontanel

E:Bow leg

44:T he best description of the Apgar score is that it:

A:Accurately predicts who will develop cerebral palsy

B:Assesses neonates in need of resuscitation

C:Accurately predicts a low umbilical cord pH

D:Is unaffected by maternal opiate pain relief

E:Accurately predicts neonates who will die in the neonatal

period
45: An infant has the following findings at 5 min of life: pulse, 130/min;
cyanotic hands and feet; good muscle tone; and a strong cry and grimace. This
infant's Apgar score is:

A:7

B:8

C:9

D:10

E: 12

46: A 3-wk-old breast-fed infant has deepening jaundice. On physical

examination, the liver is 3 cm below the right costal margin. The most important
laboratory test in this child at this time is:

A:Serum ceruloplasmin determination

B:Direct and total bilirubin level

C:Hepatic ultrasonography

D:Complete blood count

E:Urine urobilinogen determination

47: The most common cause of pancreatic insufficiency in childhood is:

A. Chronic pancreatitis
B. Congenital lipase deficiency
C. Cystic fibrosis
D. Shwachman-Diamond syndrome
E. Pearson syndrome

48: A 6-wk-old male infant presents with a 3-wk history of intermittent

vomiting and a weight loss of 300 g. Serum electrolytes are as follows: sodium, 147
mEq/L; potassium, 2.9 mEq/L; HCO3 -, 32 mEq/L; and chloride, 89 mEq/L (i.e.
hypochloremic hypokalemic metabolic alkalosis). The most likely diagnosis is:
A. Gastric volvulus
B. Adrenogenital syndrome
C. Hypertrophic pyloric stenosis
D. Malrotation with volvulus
E. Cyclic vomiting

49: A previously healthy 6-mo-old child develops paroxysmal colicky

abdominal pain. The infant has occasional vomiting. Over the next 12 hr the infant passes
stool containing blood and mucus and becomes progressively lethargic. Following fluid
resuscitation, the most appropriate next step in management is:
A. Colonoscopy with polypectomy
B. Stool culture
C. Meckel scan
D. Air-contrast enema
E. Empiric antibiotic therapy

50: You are the pediatric consultant for a community emergency department.
The department's physician calls to ask advice about a 3-yr-old boy with fever and a
cough. He thinks the patient has croup but is also concerned about epiglottitis. Which of
the following physical findings is most helpful in attempting to differentiate croup from
epiglottitis?
A. Fever
B. Barky cough
C. Stridor
D. Drooling
E. Respiratory distress