Paediatrics Questions - PDF

1 What is the nature of diarrhea in malabsorption syndrome? (A) Mushy abundant stools (B) Tenesmus (C) Sharp urges for defecation immediately after eating (D) A scant amount of stool with mucus (E) Melena 2 What is the most effective method of eradication of Helicobacter pylori infec...

1 What is the nature of diarrhea in malabsorption syndrome? (A) Mushy abundant stools (B) Tenesmus (C) Sharp urges for defecation immediately after eating (D) A scant amount of stool with mucus (E) Melena 2 What is the most effective method of eradication of Helicobacter pylori infection in the treatment of chronic gastroduodenitis in children? (A) Triple (B) single component (C) symptomatic (D) dual therapies (E) Quadruple 3 What disease causes pain in the epigastrium that occurs 1.5-2 hours after eating? (A) Gastric ulcer (B) sophageal inflammation (C) Gastritis (D) Duodenal ulcer (E) 4 A patient is vomiting with dark coloration of emesis (hematemesis). What is the most common reason of this symptom? (A) Gastric ulcer (B) Esophagitis (C) Acute gastritis (D) Duodenal ulcer (E) Crohns diseases 5 What type of treatment is NOT used for steroid ulcer (A) antibyotics (B) sparing diet (C) antisecretory drugs (D) abolition of prednisolone (E) cytoprotectors 6 A 12-year-old child was diagnosed with duodenal ulcer, in the stage of "new ulcer". What examination should be carried out to determine the tactics of treatment? (A) Helicobacter pylori testing (B) genetics of lactose metabolism (C) blood bilirubin (D) urinalysis for diastasis (E) antibodies to gliadin 7 What is the main pathogenetic factor in the formation of biliary tract dysfunction? (A) vegetative neurosis (B) eating disorders (C) hormonal imbalance (D) helminthic infestations (E) burdened heredity 8 A 1-month-old otherwise healthy child with daily periods of increased crying, fussiness, and passage of flatus during the evening hours. What is the most likely diagnosis? (A) Colic (B) Gluten-sensitive enteropathy (C) Malabsorbtion (D) Cystic fibrosis (E) Malnutrition 9 A 10-year-old boy has had abdominal pain for about 2 years both at night and during the day. Sometimes he vomits after the onset of pain. Occult blood was found in his stool. His father also has frequent stomachaches. What is the most likely diagnosis? (A) Peptic ulcer (B) Appendicitis (C) Intussusception (D) Pinworm infestation (E) Cholecystitis 10 A 15-year-old boy has a burning, gnawing pain, moderately expressed, almost always in the epigastric region. The pain is absent when he wakes up, appears in the middle of the morning and is relieved by eating, but returns 2–3 hours after eating. The pain often wakes him up at 1 or 2 am. What is the most likely diagnosis? (A) Duodenal ulcer (B) Acute gastritis (C) Chronic gastritis (D) Gastric ulcer (E) Crohn’s disease 11 A 12-year-old patient has hunger and night pain in the epigastrium for two weeks. In the last 2-3 days he complains of dull pains in the epigastrium, disappearing after eating and resuming after 1.5-2 hours, flatulence, mushy stools, loss of appetite. On examination: a tongue with a dense white- yellow coating, moderate muscle tension and pain in the epigastric region, bloating is determined. What is the most likely diagnosis? (A) gastric ulcer (B) chronic pancreatitis (C) chronic cholecystitis (D) gallbladder dyskinesia (E) acute pancreatitis 12 A 10-year-old girl has abdominal pain, regardless of food intake and physical activity, that occurs periodically two to three times a week. From the anamnesis: pain bothers for six months. Clinical and laboratory examination, esophagogastroduodenoscopy and ultrasound of the abdominal organs revealed no pathology. What is the most likely diagnosis? (A) functional dyspepsia (B) chronic gastritis (C) gallbladder dyskinesia (D) cholelithiasis (E) chronic pancreatitis 13 Protein requirment for 2 year old child (A) 20 gm (B) 10 gm (C) 15 gm (D) 30 gm (E) 25 gm 14 The baby was born at 30 weeks. Vomited, periodically with an admixture of bile. Belly swollen. Meconium passed on the first day, in the following days - meconium stool with mucus 2-3 times, in meager portions.Your preliminary diagnosis. (A) Necrotizing enterocolitis (B) ulcer (C) malnutrion (D) cystic fibrosis (E) Crohn`s disease 15 A 10-year-old girl with a new diagnosis of inflammatory bowel disease unclassified (IBDU) on histology. The last 2 months had arthralgia. Had performed rigid sigmoidoscopy for rectal bleeding, abdominal pain, and intermittent diarrhea. Which of the following extraintestinal manifestations of IBD is most likely to improve when a flare is successfully treated? (A) Episcleritis (B) Ankylosing spondylitis (C) Primary sclerosing cholangitis (D) pyoderma gangrenosum (E) Scleritis 16 Boy 2 years old. For 6 months, the child has liquefied, rapid, with mucus stools up to 5-6 times a day, for the last 3 weeks the admixture of blood in the feces is constant. Colonofibroscopy: The mucosa of the ileum is edematous, hemorrhages, linear ulcers up to 0.6 cm, contact bleeding pronounced. Preliminary diagnosis? (A) ulcerative colitis (B) peptic ulcer (C) gastritis (D) celiac disease (E) Necrotizing enterocolitis 17 Boy 1,5 years old. For 6 months, the child has liquefied, rapid, with mucus stools up to 5-6 times a day, for the last 3 weeks the admixture of blood in the feces is constant. Coprogram: feces of a semi- liquid consistency, food color with red patches, moderately undigested muscle fibers, neutral fat - no, fatty acids - a little, extracellular starch - quite a lot. Preliminary diagnosis? (A) ulcerative colotis (B) peptic ulcer (C) Necrotizing enterocolitis (D) cystic fibtosis (E) celiac disease 18 Boy 3 years old. For 5 months, the child has liquefied, rapid, with mucus stools up to 5-6 times a day, for the last 4 weeks the admixture of blood in the feces is constant. Histology of fragments of the colon mucosa: intense lymphoreticulus and eosinophilic infiltration of the mucosa and submucosal layer with leukostasis, a decrease in goblet cell crypts in the epithelium, cryptogenic abscesses. Preliminary diagnosis? (A) ulcerative colotis (B) necrotizing entericolitis (C) colitis (D) Crohn`s disease (E) cystic fibrosis 19 A 15-year-old girl with long-standing ulcerative colitis. She was on a maximum dose of 5- aminosalicylate treatment. Multiple bilateral nodules were noted on the her face. What is the most appropriate treatment of this her rash? (A) Oral corticosteroids (B) Induction and maintenance with infliximab (C) Topical emollient (D) Topical ibuprofen (E) Topical potassium iodide 20 A 15-year-old woman was admitted to the surgical team with abdominal pain that has worsened over the past week. She takes ibuprofen occasionally because of her headache. Which of the following makes Crohn's disease the most likely diagnosis? (A) Small bowel strictures on abdominal CT (B) Abdominal fistula on examination (C) Terminal ulceration of the ileum at colonoscopy (D) Focal rectal erythema on proctoscopy (E) Bright red rectal blood and family history of inflammatory bowel disease 21 A 15-year-old girl perirectal fistulas secondary to Crohn disease. She has been receiving Metronidazole for a long period of time. The side effect of long-term Metronidazole therapy is: (A) Neuropathy with paresthesias (B) Thrombocytopenia (C) Hepatic failure (D) Bone marrow suppression (E) Leukopenia 22 A 6 yr old boy has chronic abdominal pain, loose stools , and growth failure. Laboratory studies show elevated serum IgE, peripheral eosinophilia, anemia, and low serum albumin. Testing for parasites is negative. The next step in diagnosis is: (A) Endoscopy with biopsy (B) Bacterial stool culture (C) Helicobacter pylori testing (D) Barium esophagogram (E) Abdominal CT 23 An adolescent girl has 2 wk of bloody diarrhea, cramping, and weight loss. Endoscopy shows findings consistent with ulcerative colitis. It is important to perform what additional testing before starting steroid treatment for acute ulcerative colitis exacerbation? (A) All of the above (B) Bacterial stool culture, including Yersinia (C) Serology for entamoeba histolytica (D) Stool ova and parasites (E) Clostridium difficile NAAT 24 A 14-year-old boy with parents attended clinic with a new confirmed diagnosis of ulcerative colitis. In the outpatient clinic parents had several questions about ulcerative colitis. Regarding ulcerative colitis, which of the following statements is most accurate? (A) Around 25% of patients with pancolitis eventually have a colectomy (B) Maintenance 5-ASA therapy reduces colorectal cancer by 10% (C) The relapse rate is 20% per year (D) The incidence of colorectal cancer is 20% at 20 years, and 40% at 30 years (E) At 10 years, disease extent progresses in less than 10% of patients with proctitis 25 A 5-year-old boy was transferred from a poison control center 4 days after carbon tetrachloride poisoning. The patient has anuria, hyperazotemia , anemia, acidosis, hyperkalemia - 8 mmol / l. What should the child do first in this situation? (A) hemodialysis (B) correction of hyperkalemia (C) correction of metabolic disorders (D) prescription of diuretics (E) infusion therapy 26 A mother with a 7-year-old child turned to an endocrinologist. Complaints of weakness, fatigue, depression, loss of appetite, weight loss, delayed sexual development. Periodically there are such manifestations as nausea, vomiting, abdominal pain, unstable stool. These complaints are noted within a month. On examination, hyperpigmentation of the skin is noted mainly in open areas exposed to sunlight (face, hands, neck, as well as folds and scars of the skin). Skin color has a bronze tint. There is also a decrease in blood pressure. What disease are we talking about? (A) Addison (B) Waterhouse-Frideriksen (C) Itsenko-Cushing (D) Adrenogenital (E) Kona 27 Child 5 years old. From the anamnesis: from birth, the only right testicle is determined. The left one was not detected by any imaging methods. Your preliminary diagnosis. (A) Monorchism (B) hypergonadism (C) Cryptorchidism (D) Anorchism (E) Hypogonadism 28 A newborn from the first pregnancy, the 1st urgent delivery, which proceeded without pathology. At birth, weight 3000g, height 51cm. During the examination, an abnormal structure of the external genitalia was revealed (penis-like and hypertrophied clitoris, folded labia majora), hyperpigmentation of the external genitalia. From the 3rd day, the condition deteriorated sharply, vomiting appeared like a fountain. Heart sounds are muffled. The chair is frequent, liquid. After the tests, a preliminary diagnosis was made - adrenogenital syndrome, salt-losing form. What treatment would you prescribe as a basic therapy? (A) Glucocorticoid therapy (B) Antibacterial therapy (C) Immunosuppressive therapy (D) Plasmapheresis (E) Infusion therapy 29 A 1-month-old child, based on complaints of repeated vomiting, weight loss, loose stools, as well as existing disorders in the structure of the external genitalia, was diagnosed with a preliminary diagnosis of “congenital dysfunction of the adrenal cortex, salt-wasting form”. What is your treatment strategy for this pathology? (A) Glucocorticoid therapy (B) Antibacterial therapy (C) Immunosuppressive therapy (D) Plasmapheresis (E) Insulin therapy 30 A 5-year-old child suddenly had convulsions with a short-term loss of consciousness. During the examination: EEG data for epilepsy were not revealed, MRI of the brain without pathology. The level of calcium in the blood is increased. At what level of calcium does a hypercalcemic crisis develop?м (A) 3.5 - 4.0 mmol/l (B) 1.0 - 2.0 mmol/l (C) 2.5 - 3.0 mmol/l (D) 3.0 - 3.5 mmol/l (E) More than 4.0 mmol/l 31 The child is 4 years old. Parents noticed an increase in the genitals a year ago. Physical development corresponds to 6 years of age. Weight -20 kg, height - 118 cm. Bone age is 2- 2.5 years ahead of passport age. In the analyzes: 17 hydroxyprogesterone and testosterone levels are elevated. Choose from the following preliminary diagnoses the most probable one: (A) Precocious puberty (B) Dysfunction of the adrenal cortex (C) Panhypopitutarism (D) Epiphyseal chondrodysplasia (E) Pituitary adenoma 32 An 11-month-old child showed signs of acute respiratory viral infections three days ago, vomiting, lethargy, thirst, and muscle hypotonia are noted. On examination, the temperature is 37.5°C, hyperemia of the pharynx, the skin is covered with cold sweat, loose stools, blood pressure - 50/20 mm Hg, hermaphroditic structure of the genitals. In the anamnesis up to 3 months of age was vomiting "fountain". Surgeons ruled out pylorospasm. What is your presumptive diagnosis? (A) Adrenogenital syndrome (B) Vegetovascular dystonia (C) Cerebro-pituitary dwarfism (D) Intestinal infection (E) Precocious puberty 33 A 12-year-old boy complained of being overweight. On examination, the child has a hypersthenic build, with excessive deposition of fat in the waist and hips, the waist is 96 cm. BP is 140/90 mm Hg. Laboratory data: complete blood count without features. In a biochemical blood test: cholesterol - 7.2 mmol / l, fasting blood glucose - 6.1 mmol / l, and after a carbohydrate load - 9.8 mmol / l. Your preliminary diagnosis: (A) Metabolic syndrome (B) Hypertension (C) Type 2 diabetes (D) Type 1 diabetes (E) Diabetes insipidus 34 Girl 5 years old. Complaints about being tall compared to peers. A few days ago, for the first time, a discharge from the vagina of red color "menstruation" appeared. Objectively: height 135 cm, weight 26 kg. Sexual development according to Tanner: Ma IV, Ax IV, P IV. What diagnosis is most likely associated with tall stature in a child? (A) Precocious puberty (B) Adrenogenital syndrome (C) Chronic adrenal insufficiency (D) Accelerated sexual development (E) Violation of sex differentiation 35 Mean corpuscular hemoglobin (MCH) in iron deficiency anemia is (A) 15,2-20,4 pg (B) 25,4-34,6 pg (C) 35,5-43,2 pg (D) 45,5-43,2 pg (E) 55,5-43,2 pg 36 Hematocrit during oligocythemic normovolemia (A) is decreased (B) is increased (C) is decreased slightly (D) is normal (E) is increased slightly 37 What are the conditions with increased erythropoietin production? (A) exogenous hypoxia (B) arterial hypertension (C) arterial hypotension (D) acidosis (E) fever 38 In what normovolemia appears anemia and hypoxia? (A) olygocythemic (B) simple (C) inflamation (D) polycythemic (E) fever 39 Massive hemolysis of erythrocytes leads to (A) polycythemic hypovolemia (B) olygocythemic hypervolemia (C) polycythemic hypervolemia (D) olygocythemic hypovolemia (E) olygocythemic normovolemia 40 The causes of polycythemic hypovolemia are (A) dehydration (B) massive haemolysis (C) erythremia (D) anemia (E) hemorrhage 41 The first hours after acute hemorrhage are characterized by (A) simple hypovolemia (B) polycythemic hypovolemia (C) acute hypovolemia (D) olygocythemic hypovolemia (E) simple hypervolemia 42 What are the mechanisms of compensation during reflex phase after hemorrhage? (A) influence on baroreceptors from the reflexogenic regiones (B) activation of GIT system (C) decreased heart stroke volume (D) decreased peripheral resistance (E) activation of CVS system 43 What are the mechanisms of blood volume restoration after hemorrhage? (A) redistribution of the water between sectors (B) spasm of the peripheral vessels (C) activation of blood coagulation system (D) activation of Sympathic system (E) activation of blood anticoagulation system 44 What are the mechanisms of blood preassure normalization in reflex phase after hemorrhage? (A) output of blood from depot (B) increased parasympathetic ifluence on the heart (C) influence on baroreceptors from the reflexogenic regions (D) activation of ATP synthesis (E) activation of epinephrine synthesis 45 Aldosteron is produced by: (A) Adrenal gland (B) Hypothalamus (C) Thyroid gland (D) Parathyroid glands (E) Hypophysis 46 A 10-year-old boy complaints about constipation, cold intolerance, decreased attention span and sluggishness for the last six months. On exam reveals a diffusely enlarged, non- tender and firm thyroid gland. What of the following is most likely confirm the diagnosis? (A) Positive Anti-microsomal and anti-thyroglobulin antibodies (B) Elevated T4 and decreased TSH (C) Normal T4 and decreased TSH (D) Negative Anti-microsomal and anti-thyroglobulin antibodies (E) An increased Iodine in urine 47 Which of the followings increases the force of contraction of the heart chambers? (A) Thyroxine (B) Aldosterone (C) Somatostatin (D) Calcitonin (E) Oxytocin 48 In the test of an adolescent was found low TSH. Which of the followings you would most likely look for in a patient? (A) Palpitation (B) Carotenemia (C) Large tongue (D) Constipation (E) Dry skin 49 A 10-year-old boy complaints about constipation, cold intolerance, decreased attention span and sluggishness for the last six months. On exam reveals a diffusely enlarged, non- tender thyroid gland. In Labs there are decreased T4 and elevated TSH. Anti-microsomal and anti-thyroglobulin antibodies were strongly positive. What of the following is most likely the first choice treatment? (A) Levothyroxine (B) Thyroidectomy (C) Radioiodine therapy (D) Propylthiuracil (E) Potassium iodate 50 8 days newborn's neonatal screening test shows an elevated TSH. Which of the followings is most likely have to prescribe to this baby? (A) Levothyroxine sodium 50 mcg morning time per os (B) Propranolol hydrochloride10 mg every 6 h per os (C) Re-test of TSH in 4 weeks (D) Levothyroxine sodium 100 mcg 3 times per day (E) Metimazole 5 mg 4 times a day per os 51 The manifestation of congenital hypothyrosis in a child can be: (A) Weakening of the sucking reflex (B) Low birth weight (C) Lingering jaundice. (D) Low tone of voice. (E) High-pitched voice 52 On examination of 1-y-o girl reveals delay of the development. In Labs there are decreased T4 and elevated TSH. Which of the followings is most likely to be atypical in this case? (A) Dry skin (B) Dehydration (C) Large tongue (D) Carotenemia (E) Constipation 53 9-year-old boy has no complaints. His mother has noticed hair lost, swelling neck. Objectively status is satisfactory, skin is dry, HR is 66, rhythmical. Thyroid glands enlarged up to 2d level, elastic in palpation. What of the following is the main cause this condition? (A) Iodine deficiency (B) Calcium deficiency (C) Iron deficiency (D) Phosphorus deficiency (E) Magnesium deficiency 54 Pediatrician evaluates a 10-year-old child with short stature, constipation, cold intolerance and decreased attention span for the last six months. Thyroid gland is diffusely enlarged, non-tender. Labs reveals a decreased T4 and elevated TSH. Anti-microsomal and anti- thyroglobulin antibodies were strongly positive. What of the following is the most likely diagnosis? (A) Lymphocytic thyroiditis (B) Primary congenital hypothyroidism (C) Grave's disease (D) Hypopituitarism (E) Thyroid hormone unresponsiveness 55 13-y-o girl with short stature, overweight, constipation, and cold intolerance was tested for thyroid function. Result's shown an elevated TSH. Which of the followings is most likely have to prescribe to this patient? (A) Levothyroxine sodium 150 mcg morning time per os (B) Propranolol hydrochloride10 mg every 6 h per os (C) Prednisone 5 mg per day per os (D) Metimazole 5 mg 4 times a day per os (E) Potassium iodate 150 mcg per day per os 56 Vaccination of a newborn against hepatitis B in the maternity hospital should be carried out: (A) first 12 hours after birth (B) 2nd day after birth (C) 3d day after birth (D) 4 th day after birth (E) after discharge 57 When is the isoimmunization may be possible? (A) If the mother Rh factor negative and baby Rh factor positive (B) If the mother Rh factor negative and baby is negative (C) If the blood groups of the baby and mothers is same (D) If the mother Rh factor is positive and baby Rh factor positive (E) If the Fathers Rh factor is negative 58 The antenatal administration of magnesium sulfate before preterm delivery has been suggested to (A) decrease respiratory distress syndrome in premature infants (B) reduce rates of necrotizing enterocolitis (C) decrease the risk of cerebral palsy in surviving infants (D) improve overall survival (E) reduce rates of intraventricular hemorrhage 59 Group B streptococcus (GBS), or Streptococcus agalactiae, is a major cause of neonatal bacterial sepsis. Of the following, the MOST common syndrome associated with childhood GBS disease beyond early infancy is (A) bacteremia without a focus (B) meningitis (C) ventriculitis (D) septic arthritis (E) pneumonia 60 The preferable antibiotic in neonate with pertussis is (A) azithromycin (B) erythromycin (C) clarithromycin (D) trimethoprim-sulfamethoxazole (E) amoxycilline 61 What is the empiric choice of antibiotics for treatment of neonatal sepsis? (A) ampicillin+gentamicin (B) ampicillin+ceftriacson (C) ampicillin+vancomicin (D) meropenem+vankomocin (E) flukonazol+ceftriacson 62 The baby is newborn 16 days of age. At birth W-3200g, H-52cm By examination we can see yellowish color of the skin. Sucking reflex is not bad. Today W-2800, h-52cm. Respiration 38 beats per/min.By auscultation vesicular sound, heart rate 130 beats per/min. Lab. Test : CBC- Hb- 136g/l, erythrocytes- 3.8*10^12/l,Ht-41. TSB=13mg/dl. What is the choice of management is correct? (A) start phototherapy (B) start antibiotics (C) start exchange blood transfusion (D) give phenobarbitone (E) no need treatment 63 what changes will be in blood tests with hemolytic jaundice in newborns (A) anemia, reticulocytosis, increased indirect bilirubin (B) anemia, leukocytosis, increased direct bilirubin (C) anemia, increased direct bilirubin, eosinophilia (D) leukocytosis, elevated ESR, Hb=N (E) Anemia, ALT and AST normal, elevated ESR 64 What is the most important indicator of a successful PPV? (A) Increased heart rate (B) decreased heart rate (C) Increased blood pressure (D) decreased blood presure (E) decreased respiratory rate 65 Several risk factors during prenantal, intranantal and postnatal development have been proposed as predictors of cerebral palsy in preterm infants.Of the following , the highest rate of cerebral palcy among preterm baby is associated with: (A) brain parenchimal injury (B) bronchopulmonary displasia (C) severe rethinopathy (D) sepsis or mengitis (E) necrotizing enterocolitis 66 A child at the age of 2 days has a clearly expressed craniotabes. Do you find it necessary (A) observation (B) determine Ca, P, alkaline phosphatase (C) do a lumbar puncture (D) take x-ray of the skull (E) immediately prescribe vitamin D up to 5000 E per day 67 What should be the tactics in relation to sick newborns in the event of a group infectious disease in the maternity hospital (A) immediately transfer to the appropriate hospital (B) transfer to the observational department and prescribe treatment (C) leave in place, prescribing treatment (D) to do nothing (E) To call specialist 68 The most widely used treatment for neonatal jaundice with the total serum bilirubin is 400 mcmol/l in preterm baby at the 3d day of life : (A). exchange transfusion (B). sulphonomides (C) phototherapy (D) diazepam (E). surgery 69 The most widely used treatment for neonatal jaundice with the total serum bilirubin is 350 mcmol/l in term baby 4th day of life: (A) phototherapy (B). exchange transfusion (C). sulphonomides (D). surgery (E) diazepam 70 Which of the following steps of neonatal resiscitation do you provide if the heart rate is 80 beats per minute after 1 minute (A) ventilation (B) chest compression (C) stimulation (D) umbilical kathetherization (E) intubation 71 Which of the following steps of neonatal resiscitation do you provide if the heart rate is less than 60 beats per minute after 1 minute by the ventilation (A) chest compression (B) ventilation (C) intubation (D) stimulation (E) umbilical kathetherization 72 Which of the following steps of neonatal resiscitation do you provide if the heart rate is less than 60 beats per minute before 1 minute after birth (A) clear the airways (B) ventilation (C) chest compression (D) stimulation (E) umbilical kathetherization 73 Diastolic dysfunction and normal systolic function are recognized features of: (A) Arrhythmogenic right ventricular cardiomyopathy (B) Dilated cardiomyopathy (C) Hypertrophic cardiomyopathy (D) Left ventricular noncompaction (E) Restrictive cardiomyopathy 74 Chose the MOST common early cutaneous manifestation of Juvenile Systemic Scleroderma: (A) Edema of the dorsum of the hands and fingers (B) Induration and fibrosis of the skin (C) Flexion contractures at the elbows, hips, and knees (D) Skin ulceration over pressure points (E) Subcutaneous calcifications 75 In suspected acute rheumatic fever the following indicate carditis: (A) Short apical soft systolic bruit (B) An ESR of 120 mm per one hour (C) Erythema nodosum (D) Strong cardiac impulse at the apex, which is displaced laterally (E) Sinus arrhythmia 76 In the diagnosis of Acute Rheumatic Fever, which of the following may be helpful? (A) Polyarthritis (B) A generalized macular- papular rash (C) ASO titer of less than 1:200 (D) Splinter hemorrhages (E) Staphylococcus aureus grown on throat culture 77 A 10-year-old girl is being evaluated for fatigue, subfebrile fever and left elbow pain. She has been feeling fatige over past 2 weeks. Her left elbow has been swolen and tender for 2 days. She reports about similar event occured with her right knee one week ago and resolved on its own. Two month ago she had a sore throat. Objectively: her VS are withing the normal. She has blowing holosustolic murmur at the apex. Her left elbow is swolen and tender in palpation. What is more likely diagnosis? (A) Acute Rheumatic Fever (B) Juvenile Rheumatoid Arthritis (C) Septic Arthritis (D) Acute poststreptococcal arthritis (E) Brucella Infection 78 An 8-year-old girl is being evaluated for weakness, prolonged subfebrile fever and left knee pain. She has been feeling fatige over past 2 weeks. Her left knee has been swolen and tender for 3 days. She reports about similar event occured with her right elbow one week ago and resolved on its own. Recently she had a sore throat. Objectively: Well-developed, alert girl. Hervital signs are withing the normal. She has blowing holosystolic murmur at the apex. Her left knee is swolen and tender in palpation. What is more likely diagnosis? (A) Acute Rheumatic Fever (B) Juvenile Rheumatoid Arthritis (C) Brucella Infection (D) Acute poststreptococcal arthritis (E) Septic Arthritis 79 A 10-year-old girl is being evaluated for fatigue, subfebrile fever and left elbow pain. She has been feeling fatige over past 2 weeks. Her left elbow has been swolen and tender for 2 days. She reports about similar event occured with her right knee one week ago and resolved on its own. Two month ago she had a sore throat. Objectively: her VS are withing the normal. She has blowing holosustolic murmur at the apex. Her left elbow is swolen and tender in palpation. Of the following, in addition to a cardiology referral, the MOST appropriate next step in management for this girl is: (A) aspirin and penicillin orally (B) aspirin orally and intravenous immunoglobulin (C) penicillin and glucocorticoids orally (D) penicillin orally and intravenous immunoglobulin (E) glucocorticoids orally and intravenous immunoglobulin 80 A 12-year-old boy is being evaluated for fatigue, involuntary twitching of face nuscles, anccordinated movements of legs and arms. His parents report about recurrent sore throat infections. What are the most likely investigations should be done to determine the diagnosis? (A) Rapid streptococcal test; ESR; CRP; ECHO-KG test; (B) Rapid streptococcal test; ESR; CRP; EEG test; (C) CBC test; EEG test; Brain IMR test; CRP test (D) CBC test; ECG; ASO test; ANA test (E) CBC test; ECG; Brain IMR; ANA test 81 A 12-year-old boy is being evaluated for fatigue, involuntary twitching of face nuscles, anccordinated movements of legs and arms. His parents report about recurrent sore throat infections. Antistreptolysin O test is 1:360; ESR - 40 mm per hour. What is obligatory examination to be performed: (A) ECHO-KG (B) Brain IMR (C) Chest X Ray (D) EEG (E) ECG 82 A 14-year-old boy is being evaluated for dyspnea and fatigue. From the anamnesis: he suffered from frequent angina till 12 years-old; At 12 years he has an episode of pain and swollen of right knee join. Objectively: the apex beat is wide and shifted 2 sm left from the left mid-clavicular line. Left heart border extends to 2,5 sm left from mid-clavicular line. He has holosystolic murmur best heart at the apex and accentutation of II tone above PA. Of the following, in addition to a cardiology referral, the MOST appropriate investigations should be done to determine the diagnosis: (A) ESR; CRP; ASLO (B) Blood culture test; ECHO-KG; Chest X-Ray (C) Blood cultural test; CBC; Chest X-Ray (D) ECHO-KG; CRP; ASLO (E) ECG; ECHO-KG; Chest X-Ray 83 A 12-year-old boy is being evaluated for fatigue, involuntary twitching of face nuscles, anccordinated movements of legs and arms. His parents report about recurrent sore throat infections. Antistreptolysin O test is 1:360; ESR - 40 mm per hour. Chose the most apropriate A/B treatment: (A) Benzathine Penicillin G, I/M, 1.2 million Unit - single dose; (B) Benzathine Penicillin G, I/M, 0.6 million Unit - twice a week; (C) Azitromycin orally 500 mg twice a day during 5 days (D) Azitromycin orally 500 mg once a day during 10 days (E) Combintaion of Penicillyn V orally 500 mg and Azitromycin 250 mg orally once a day both during 5 days 84 An 8-year-old girl is being evaluated for weakness, prolonged subfebrile fever and left knee pain. She has been feeling fatige over past 2 weeks. Her left knee has been swolen and tender for 3 days. She reports about similar event occured with her right elbow one week ago and resolved on its own. Recently she had a sore throat. Objectively: Well-developed, alert girl. Hervital signs are withing the normal. She has blowing holosystolic murmur at the apex. Her left knee is swolen and tender in palpation. What is more likely additional laboratory investigation to confirm your diagnosis? (A) ASO test (B) ANA test (C) Blood culture test (D) Serum agglutination test (E) CBC test 85 A 10-year-old girl is being evaluated for fatigue, subfebrile fever and left elbow pain. She has been feeling fatige over past 2 weeks. Her left elbow has been swolen and tender for 2 days. She reports about similar event occured with her right knee one week ago and resolved on its own. Two month ago she had a sore throat. Objectively: her VS are withing the normal. She has blowing holosustolic murmur at the apex. Her left elbow is swolen and tender in palpation.. What is more likely additional laboratory investigation to confirm your diagnosis? (A) ASO test (B) Serum agglutination test (C) ANA test (D) CBC test (E) Blood culture test 86 An 8-year-old girl is being evaluated for weakness, prolonged subfebrile fever and left knee pain. She has been feeling fatige over past 2 weeks. Her left knee has been swolen and tender for 3 days. She reports about similar event occured with her right elbow one week ago and resolved on its own. Recently she had a sore throat. Objectively: Well-developed, alert girl. Hervital signs are withing the normal. She has blowing holosystolic murmur at the apex. Her left knee is swolen and tender in palpation. Of the following, in addition to a cardiology referral, the MOST appropriate next step in management for this girl is: (A) aspirin and penicillin orally (B) aspirin orally and intravenous immunoglobulin (C) penicillin and glucocorticoids orally (D) penicillin orally and intravenous immunoglobulin (E) glucocorticoids orally and intravenous immunoglobulin 87 I ron deficiency anemia in young children is established at the level of hemoglobin: (A) less than 110 g/l (B) less than 115 g/l (C) less than 120 g/l (D) less than 125 g/l (E) less than 130 gl 88 Which of the following does not relate to nutritional needs in childhood? nutrition and growth during 3-6 years of life predict adult stature and some health outcomes (A) (B) major risk period for growth stunting is between 4 and 24 months of age  estimated average requirement (EAR) is the average daily nutrient intake level estimated to meet the requirements for (C) 50% of the population recommended dietary allowance (RDA) is an estimate of the daily average nutrient intake to meet the nutritional needs (D) of >97% of the individuals in a population the 3 components of energy expenditure are the basal metabolic rate, thermal effect of food, and energy for physical (E) activity 89 Which of the following statements about iron requirements in children is incorrect? (A) cow’s milk is a good source of bioavailable iron (B) breast milk provides optimal intake of iron for the first 4 months (C) iron present in animal protein is more bioavailable than that found in vegetables (D) iron deficiency is the most common micronutrient deficiency (E) iron supplements can interfere with zinc absorption 90 The MOST commonly used index for nutritional status is : (A) weight-for-age (B) height-for-age (C) weight-for-height (D) body mass index (E) mid-upper arm circumference 91 The outward sign of cell damage in malnutrition is (A) edema (B) repeated infections (C) wasting (D) facial appearance (E) hepatomegaly 92 The WHO recommendation for antibiotic cover in the stabilization phase of treating malnourished boy free of initial complications is to use: (A) oral amoxicillin (B) parenteral penicillin (C) oral second generation cephalosporin (D) parenteral gentamicin (E) parenteral third generation cephalosporin 93 Regarding thiamine deficiency (A) hoarseness or aphonia is a characteristic sign (B) features develop within 2-3 weeks of deficient intake (C) poor mental concentration and depression are late features of the disease (D) the term (wet) beriberi reflects the features of renal dysfunction (E) the term (dry) beriberi reflects the features of raised intracranial pressure 94 The MOST convenient way to confirm a diagnosis of pellagra in children is (A) response to niacin treatment (B) skin biopsy (C) urinary 2-pyridone (D) physical signs of glossitis and dermatitis (E) urinary n1-methyl-nicotinamide 95 In consideration of preventing infections in stabilization phase of malnutrition in unimmunized 10- month-old boy. Of the following, the vaccine that is recommended to be given is (A) measles vaccine (B) oral polio vaccine (C) acellular pertussis vaccine (D) H. influenza vaccine (E) pneumococcal vaccine 96 Which of the following indicators would you choose for better assessment of chronic folic acid deficiency? (A) RBC folate level (B) serum folate level (C) CSF 5- methyltetrahydrofolate level (D) urinary folate level (E) bone marrow aspiration 97 Effective supplementation of folate for prevention of neural tube defect is started at least 1 mo before conception, and continued through the first 2-3 mo of pregnancy (A) (B) started at least 3 mo before conception, to be stopped after positive pregnancy test (C) started after positive pregnancy test and continued through the first 2-3 mo of pregnancy (D) started at least 1 mo before conception, to be stopped after positive pregnancy test (E) started at least 3 mo before conception, and continued through the first 2-3 mo of pregnancy 98 The class jf antibodies ivolved in the allergic reaction is: (A) Ig E (B) Ig A (C) Ig M (D) Ig G (E) Ig D 99 Diphenhydramine is included in the group of: (A) Antihistamines (B) Corticosteroids (C) Methylxanthines (D) Leukotriene modifiers (E) Bronchodilators 100 Immunodeficiency associated with heart malformation, palatal defects, absence of thymus and hypocalcaemia is a: (A) Duncan’s syndrome (B) Ataxia-teleangiectasia (C) Sachman’s syndrome (D) Wiskott-Aldrich syndrome (E) Di George syndrome 101 What grain products should be excluded in the complex treatment of celiac disease? (A) wheat (B) rice (C) corn (D) buckwheat (E) millet 102 What hormone enhances the contractility of the gallbladder? (A) cholecystokinin (B) glucagon (C) calciotonin (D) secretin (E) pancreozymin 103 What disorder of the gallbladder and biliary tract is characterized by a symptom complex: paroxysmal pain in the right hypochondrium, radiating to the right shoulder, right shoulder blade? (A) hyperkinesia of the gallbladder and hypertension of the sphincters (B) hyperkinesia of the gallbladder and hypotension of the sphincters (C) hypokinesia of the gallbladder and hypotension of the sphincters (D) chronic cholecystitis, remission period (E) hypokinesia of the gallbladder and hypertension of the sphincters 104 Which of the disorders is characterized by the following pain syndrome: constant non intensive, aching pain in the right hypochondrium, periodic feeling of heaviness and fullness in this area? (A) hypokinesia of the gallbladder and hypotension of the sphincters (B) hyperkinesia of the gallbladder and hypertension of the sphincters (C) hyperkinesia of the gallbladder and hypotension of the sphincters (D) chronic cholecystitis, exacerbation (E) hypokinesia of the gallbladder and hypertension of the sphincters 105 What Infusion therapy is prescribed for severe chronic malnutrition? (A) correction of water and electrolyte balance (B) dehydration (C) detoxification (D) providing forced diuresis (E) not assigned 106 How is dietary protein digested? (A) It’s broken into polypeptides by trypsin (B) It’s broken into amino acids by gastrin (C) It’s broken into polypeptides by hydrochloric acid (D) It’s broken into amino acids by bile acids (E) It’s broken into polypeptides by reductase 107 Fat emulsification occurs under the influence of the: (A) bile acids (B) stomach acid (C) duodenum bicarbonates (D) lipase (E) amylase 108 A 13-year-old child has pain in the right hypochondrium, frequent fever up to 37.5-38°C, positive Murphy and Ortner symptoms, moderate leukocytosis and accelerated ESR, thickening of the gallbladder walls on ultrasound. What is the most likely diagnosis? (A) cholecystitis (B) gastritis (C) biliary dyskinesia (D) peptic ulcer (E) cholelithiasis 109 A 14-year-old girl developed prolonged pain and a feeling of fullness in the right hypochondrium. On examination: no jaundice, positive Kera's symptom, subfebrile temperature, ESR - 30 mm/h. What is the most likely diagnosis? (A) Chronic cholecystitis in an exacerbation phase (B) Chronic pancreatitis in the phase of remission (C) Stomach ulcer in the phase of exacerbation (D) Chronic hepatitis in the phase of remission (E) Chronic gastritis in the phase of remission 110 A 13-year-old boy asthenic has recurrent acute pain in the right hypochondrium caused by stress against the background of neurocirculatory dystonia. On ultrasound - the bile ducts are not changed, the gallbladder is reduced in size. CBC and blood biochemistry are not changed. What is the most likely diagnosis? (A) Dyskinesia of the biliary tract in the hypomotor type (B) Chronic cholecystitis (C) Functional dyspepsia (D) Dyskinesia of the biliary tract in hypermotor type (E) Chronic pancreatitis 111 A 16-year-old girl was admitted to the hospital with an attack of cutting pains in the right hypochondrium. Pain radiates to the right shoulder and neck. The patient does not find a position that relieves pain. Before she ate a hamburger and sweet carbonated drinks. The attack occurred at night. Earlier, moderate aching pains in the right hypochondrium, nausea were noted. This is the first time such an attack has occurred. What is the most likely diagnosis? (A) cholelithiasis (B) chronic gastritis (C) peptic ulcer (D) acute appendicitis (E) acute esophagitis 112 A 14-year-old boy presents to the emergency room with the complaints of increased jaundice, abdominal pain, nausea, vomiting, and fever. On examination: remarkable for jaundice, pain of the right upper quadrant with guarding, and a clear chest. What is the most likely diagnosis? (A) Cholelithiasis (B) Pancreatitis (C) Gastritis (D) Pneumonia (E) Hepatitis 113 Cystic fibrosis is characterized by lesions: (A) Exocrine glands (B) Parathyroid glands (C) Adrenal glands (D) Exocrine and endocrine glands (E) Thyroid glands 114 A 13-year-old girl admitted with acute severe ulcerative colitis. She had been on a reducing dose of steroids while at home, but failed to respond. After 5 days of treatment with intravenous hydrocortisone. She complained of abdominal pain. Investigations: Hb 136 g/L (115–165) serum albumin 31 g/L (37–49) CRP 68 mg/L (< 10) (A) CT abdomen (B) CMV serum PCR (C) Faecal calprotectin (D) Stool for Clostridium difficile (E) Unprepared flexible sigmoidoscopy and biopsy 115 15-year-old girl with colonic Crohn's disease. Increased abdominal pain and diarrhea. She took infliximab (IFX) for 8 weeks; Test: Serum C-reactive protein 57 mg/l (< 10) human anti- chimeric antibodies (HACA) + What is the next most appropriate control step? (A) Continue azathioprine and change IFX to adalimumab (B) Continue azathioprine and increase the dosage of IFX infusions (C) Continue azathioprine and increase the frequency of IFX infusions (D) Stop IFX and increase the dose of azathioprine (E) Continue IFX and increase azathioprine dose 116 A 14-year-old boy complains of abdominal pain and vomiting. He had a previous diagnosis of ileocolic Crohn`s Disease that was controlled with azathioprine. Investigations: platelet count 502 x 10 9/l (150-400) Serum C-reactive protein 87 mg/l (< 10) Which statements are most accurate? (A) Type 1 helper T cells (T h 1) produce IL-2, IL-6, and tissue necrosis factor (TNF) (B) Environmental factors aff ect both innate and adaptive immunity (C) Adaptive immunity is responsible for cytokine production (D) IL-6 and IL-10 are anti-infl ammatory cytokines (E) T h 2 cells produce TNF, causing tissue infl ammation 117 A 14-year-old boy with Crohn's disease complains of pain in the right iliac fossa and hyperthermia. He underwent a resection of the ileum for stricture disease. On admission, he took azathioprine 1 mg/kg once a day and oral 5-ASA. Study: Serum C-reactive protein 358 mg/l (< 10) What is the most appropriate next step? (A) Cessation of azathioprine and prescribing of intravenous antibiotics (B) Intravenous antibiotics and infl iximab induction regime (C) Intravenous antibiotics and azathioprine 2 mg/kg (D) Radiologically guided percutaneous drainage and intravenous antibiotics (E) Laparotomy, ileocaecal resection, and end ileostomy 118 A 11-year-old girl was recently diagnosed with terminal ileal Crohn’s disease. Her mother is a complementary therapist and she asked you in clinic for more information on alternative therapies. Which of the following therapies is most likely to be of benefit to the girl’s symptoms? (A) Acupuncture (B) Boswellia serrata extract (C) Omega-3 free fatty acids (D) Aloe vera gel (E) Wheatgrass juice 119 A 13-year-old child recently developed extraintestinal manifestations of Crohn's disease despite maintaining azathioprine. Which of the following extraintestinal manifestations is most helpful from a biological treatment for Crohn's disease? (A) Pyoderma gangrenosum (B) Peripheral arthropathy (C) Aphthous ulcers (D) episcleritis (E) Primary sclerosing cholangitis 120 A 9-years old girl presented with rectal bleeding, tenesmus, and mucus discharge 3 years after a temporary loop ileostomy for refractory colonic Crohn’s disease. What is the most appropriate next step? (A) Short-chain fatty acid enemas (B) Acetarsol suppositories (C) Corticosteroid enemas (D) Referral to surgeons (E) 5-ASA enemas 121 6-year-old girl who had previously had a 2-week history of abdominal pain, fever, bloody stools 6 times a day. She has a sister with ulcerative colitis and she suspected inflammatory bowel disease.What is the best diagnostic test to perform in this case? (A) Unprepared flexible sigmoidoscopy (B) Computed tomographic (CT) colonography (C) Faecal calprotectin (D) Stool testing for microscopy, culture, and sensitivity (E) Colonoscopy 122 Parents of 13-year-old boy with inflammatory bowel disease attended the outpatient clinic asking if he could manage his disease with nutritional measures. Which of the following statements is most accurate? (A) The evidence base for elemental feed and polymeric diet is similar in Crohn’s disease (B) Evidence supports dietary strategies in mild ulcerative colitis Total parenteral nutrition and complete bowel rest are a useful adjunct to medical therapy in (C) resistant Crohn’s disease (D) Probiotics in the management of inflammatory bowel disease have no evidence base Good evidence supports a low-residue diet and avoiding insoluble fibre in stricturing Crohn’s (E) disease 123 A 15-year-old girl with colonic Crohn’s disease presented complaining of perianal pain and rectal discharge. Investigation: serum C-reactive protein 67 mg/L (< 10) Which of the following statements is the most accurate? (A) Sigmoidoscopy is useful in determining the management of perianal fistulae Routine assessment of perianal fistulae includes pelvic MRI, examination under anaesthesia (EUA), and anorectal (B) ultrasound (C) Perianal pain commonly occurs in fi stulae (D) Ileocolonic Crohn’s disease has a higher rate of perianal disease (E) Perianal disease presents late in the course of Crohn’s disease 124 A 15year-old girl with ulcerative colitis was seen for routine follow-up in an outpatient clinic. She had been on mesalazine for the last 3 years. Colonoscopy- active mild to moderate left-sided ulcerative colitis. What is the best choice of medication? (A) Oral budesonide (B) Corticosteroid suppositories (C) Aminosalicylate suppositories (D) Oral hydrocortisone (E) Oral prednisolone 125 A 15-year-old girl underwent 5 hemodialysis sessions due to anuria and severe homeostasis disorders. There was a significant improvement in the general condition, diuresis was restored, the level of urea in the blood serum decreased markedly. Against the background of a satisfactory condition, 10 days after the last dialysis, the patient had a rare pulse up to 40 per minute. What can cause bradycardia in a child? (A) hypokalemia (B) anemia (C) azotemia (D) hyponatremia (E) hypomagnesemia 126 A 10-year-old boy, his parents began to notice that from the age of 3 he began to lag behind in growth. On examination: height 110 cm, weight 18 kg. Tissue turgor is reduced, redistribution of the subcutaneous fat layer with excessive deposition in the chest and abdomen, dry, thin hair. X-ray of the hands - average bone age 5-6 years. IGF-1 hormone level -70ng/ml. A diagnosis of cerebral- pituitary dwarfism was made. What is your treatment strategy? (A) Norditropin (B) Prednisolone (C) Thyroid hormones (D) Calcium preparations (E) Testosterone preparations 127 A mother with an 8-year-old child complained of stunting. During the examinations, the diagnosis of pituitary dwarfism was established. Somatropin was prescribed daily s / c before bedtime. Upon reaching the expected growth, you recommend to him: (A) Stop the drug (B) Convert to analogue (C) Adjust dose (D) Continue treatment (E) Prescribe nadrolone 128 Boy 13 years old. Complaints from the mother's words about short stature. Anamnesis: a child from the age of 5 has been engaged in professional judo, has repeatedly won prizes. But lately I've started to worry about low growth. Father's height is 176 cm, mother's height is 173 cm. Objectively: height is 138 cm, weight is 36 kg. Eating right. Somatically healthy. Hormones within the normal range, MRI of the pituitary gland - without features. What recommendations would you give? (A) Add jumps and horizontal bar (B) Prescribe anabolics (C) Change your diet (D) Get karyoty (E) Hormone therapy 129 At the reception, a mother with a girl aged 3 years. Mom notes an increase in the mammary glands and external genitalia. Recently, the girl has been bleeding. Examination: DHEA - 18 g / dl, hormone 17 hydroxyprogesterone and FSH levels are elevated. Ultrasound of the pelvic organs - a tumor formation of the ovary was diagnosed. Bone age is 4 years ahead. Diagnosis: PPR (premature sexual development). What drug should be used in the treatment? (A) Diphereline (B) Dexamethasone (C) Prednisolone (D) Bromcretin (E) Levothyroxine 130 The child is 7 years old. Mom's complaints about the abnormal structure of the external genital organs - a hypertrophied clitoris, scrotum-shaped labia, the entrance to the vagina is narrowed. On examination: the hormone 17-on-progesterone is elevated. A diagnosis of "Congenital dysfunction of the adrenal cortex" was made. What drugs will you treat this pathology with? (A) Glucocorticoids (B) Androgens (C) Estrogens (D) Insulin (E) Anabolic steroids 131 A 14-year-old boy complained of overweight, headaches, skin changes in the form of red stretch marks. Objectively: fat deposition according to the "male" type, red striae on the skin of the abdomen and thighs. Weight 77 kg, height 164 cm. BP 160/90 mm Hg. According to blood tests: cholesterol 6.2 mmol/l, LDL 4.6 mmol/l, blood glucose 6.2 mmol/l. You performed an oral glucose tolerance test: fasting glycemia - 5.8 mmol / l, 2 hours after exercise - 7.8 mmol / l. What diagnosis will you make? (A) Metabolic syndrome (B) Impaired fasting glucose (C) Type 1 diabetes (D) Type 2 diabetes (E) Mody diabetes 132 The child is 5 years old, height and bone age corresponds to 4 years, lags behind in development, sexual development corresponds to 4 years. From the anamnesis, the mother's height is 150 cm, the father's height is 160 cm. STH growth hormone is normal. Your preliminary diagnosis: (A) Familial short stature (B) Congenital hypothyroidism (C) Cerebral pituitary dwarfism (D) Shershevsky-Turner syndrome (E) Syndrome of late puberty 133 At the reception, a mother with a child of 5 years. Complaints of repeated convulsions, not accompanied by loss of consciousness. The convulsions were of short duration. The level of ionized calcium was checked - 0.85 mmol / l. What is your preliminary diagnosis? (A) Hypoparathyroidism (B) Neurotoxicosis (C) Hypothyroidism (D) epilepsy (E) Spasmophilia 134 A 6-day-old child was delivered to the intensive care unit in serious condition with obvious signs of dehydration. According to the mother, on the 2nd day after birth, the child developed indomitable vomiting with a “fountain”, diarrhea, and weakness. You suspect a salt- wasting form of adrenogenital syndrome. What hormone should be tested to clarify the diagnosis? (A) 17-OH-progesterone (B) Triiodothyronine (C) Estradiol (D) Testosterone (E) Adrenocorticot 135 Mean corpuscular hemoglobin (МСН) in erythrocytes is (A) 25,4-34,6 pg (B) 15,2-20,4 pg (C) 30,2 pg (D) 43,2 pg (E) 40,2 pg 136 What conditions lead to polycythemic hypovolemia? (A) extensive burns (B) overcolding (C) water intoxication (D) erythremia (E) inflamation 137 The cause of simple hypervolemia is: (A) massive blood transfusion (B) nephrotic disease (C) erythremia (D) intravenous infusion of physiological solution (E) 138 The main links of pathogenesis of moderate hemorrhage are: (A) disorder of microcirculation and hypoxia (B) cells dehydration (C) cells overcolding (D) disorders of oxygen transport function of hemoglobin (E) cells rehydration 139 The reflex phase after acute hemorrhage is characterized by (A) hyperventilation (B) bradycardia (C) appearance of young red blood cells in blood (D) tachypnea (E) bradypnea 140 The reflex phase after acute hemorrhage is characterized by: (A) increased of the peripheral resistance (B) increased synthesis of angiotensin (C) increased synthesis of protein (D) increased synthesis of lipids (E) increased synthesis of glucouse 141 Adaptive response to acute hemorrhage after few hours is (A) centralization of blood circulation (B) decreased venous return (C) hyperventilation (D) peripheral tissue vasodilation (E) hypoventilation 142 In what anemia the color index is increased? (A) vitamin B12 (B) acute posthemorrhagic anemia (C) vitamin B6 (D) deficiency anemia (E) chronic posthemorrhagic anemia 143 What anemia is megaloblastic? (A) folic acid deficiency anemia (B) chronic posthemorrhagic anemia (C) hemolytic anemia (D) acute posthemorrhagic anemia (E) aplastic anemia 144 What kind of anemia is the result of radiation sickness? (A) aplastic anemia (B) iron deficiency anemia (C) hemolytic anemia (D) chronic anemia (E) acute anemia 145 What is a cause a diabetes insipidus? (A) Deficiency of ADH (B) Excess of ADH (C) Deficiency of TSH (D) Deficiency of STH (E) Excess of STH 146 On examination of 1-y-o girl reveals delay of the development. In Labs there are decreased T4 and elevated TSH. Which of the followings is most likely to be atypical in this case? (A) Rapid heart rate (B) Carotenemia (C) Dry skin (D) Constipation (E) Large tongue 147 8 days-old newborn's neonatal screening test shows a normal TSH level. Which of the followings is most likely cause have to screening this baby? (A) Hypothyroidism symptoms and signs are often minimal (B) Living in iodine deficiency area (C) Mother has thyroid disease (D) Elder children in that family has thyroid disease (E) Family has low income 148 A doctor prescribes L-Tyroxin to 2wks old baby according to the result of neonatal screening. Which of the following is the most likely reason to prescribe that medicine in this case? (A) An elevated TSH; decreased T4 (B) TSH and T4 are normal level (C) An elevated TSH and T4 (D) A decreased TSH; an increased T4 (E) TSH is normal; elevated T4 149 1-mo-old baby's neonatal screening test shows an elevated TSH and thyroid gland ectopy. Which of the following is mostly appropriate to this case? (A) Elevated TSH; reduced T3 and T4 (B) Normal TSH; T3; T4 (C) Normal TSH, increased T3 and T4 (D) Low TSH; elevated T3 and T4 (E) Low TSH, normal T3 and T4 150 13-y-o girl treated with symptoms of becoming irritable and emotionally instable, weight loss and neck swelling. Which of the following is most likely confirmed the diagnosis in this case? (A) Reduced TSH; elevated T3 T4 (B) Normal TSH and T4 (C) Normal TSH; reduced T4 (D) Reduced TSH and T4 (E) Elevated TSH; reduced T3 T4 151 A 10-year-old girl complaints about neck swelling. Enlargement of the thyroid gland was found at the other children in her group during a medical check-up. What the followings is the most likely indication to prescribe Potassium iodate to that child? (A) Low 24-h urinary iodine excretion value (B) Elevated TSH with low T4 and T3 levels. (C) Reduced serum Ferritin (D) Elevated serum cholesterol value (E) Increased lymphocytes in CBC 152 1-mo-old baby's neonatal screening test shows an elevated TSH. Which of the followings is most likely have to prescribe to this baby? (A) Levothyroxine sodium 50 mcg morning time per os (B) Levothyroxine sodium 15 mcg morning time per os (C) Levothyroxine sodium 50 mcg morning IV (D) Levothyroxine sodium 50 mcg twice a day per os (E) Levothyroxine sodium 75 mcg morning time per os 153 18 days-old neonate's mother interested in what reason to taking medicine if her baby looks healthy. Which of the following is most likely explanation in this case? (A) Hypothyroidism symptoms and signs are often minimal (B) Living in iodine deficiency area (C) Mother has thyroid disease (D) Elder children in that family has thyroid disease (E) Family has low income 154 9-year-old boy has no complaints. But mother has noticed his weakness, hair lost, swelling neck. Thyroid glands enlarged up to 2d level, elastic in palpation. Which of the following is most likely wouldn't be considered in the diagnosis? (A) Fasting plasma glucose 3,5 mmol/L (B) Elevated TSH; reduced fT4; elevated AB-to-TPO (C) Low woltage in ECG (D) Sonography enlarged thyroid gland (E) Cholesterol 6,2 mmol/L 155 After suffering from encephalitis in a 14-year-old boy, the growth rate has decreased, developmental delay, overweight are noted. Which of the following is most likely to confirm the diagnosis in this child? (A) Low free T4 and low TSH levels (B) Nodular thyromegaly in sonography (C) Cholesterol 5,2 mmol/L (D) Thyroid dysgenesis (E) Extremely elevated Antibodies to thyroid peroxidase enzyme 156 through which vein is an exchange transfusion performed in hemolytic jaundice (A) umbilical (B) cubital (C) jugular (D) subclavian (E) Femoral 157 The cause of hemolytic disease of the newborn is (A) isoimmune hemolytic anemia (B) immaturity of liver glucuronyltransferase (C) autoimmune hemolytic anemia (D) hemoglobinopathy (E) intrauterine infection 158 Osteitis may be a feature of one of the following transplacental infections (A) rubella (B) cytomegalovirus (C) herpes simplex virus (D) varicella-zoster virus (E) T. gondii 159 Limb hypoplasia may be a feature of the following transplacental infections (A) cytomegalovirus (B) herpes simplex virus (C) varicella-zoster virus (D) HIV (E) rubella 160 Common respiratory tract manifestations of neonatal bacterial infections is (A) mastoiditis (B) ethmoiditis (C) otitis media (D) empyema (E) retropharyngeal cellulitis 161 One of the following is not included in the definition of the systemic inflammatory response (SIRS) in neonates and pediatric patients (A) cardiac dysfunction (B) temperature instability (C) abnormal white blood cell (WBC) count (D) respiratory dysfunction (E) perfusion abnormalities 162 Persistence of the umbilical cord beyond which time should prompt consideration of an underlying abnormality (A) 40 days (B) 10 days (C) 20 days (D) 30 days (E) 50 days 163 The MOST important risk factor for necrotizing enterocolitis (NEC) in preterm infants is (A) apgar score (B) delivery by cesarean section (C) breast feeding (D) gestational age and birth weight (E) exposure to glucocorticoids during the first week of life 164 Which of the following is not a cause of hemolytic jaundice in newborns? (A) failure of phototherapy to lower serum bilirubin levels (B) bilirubin rise of >0.5 mg/dL/h (C) reticulocytosis >5% at birth (D) onset of jaundice before 24 hours of age (E) significant decrease in hemoglobin 165 When screening for intraventricular hemorrhage IVH, the best time to perform an ultrasound is (A) second day of life (B) first day of life (C) fifth day of life (D) third day of life (E) fourth day of life 166 Which of the following drugs do you provide if the heart rate is not responsing to the chest compression (A) epinephrine (B) aspirine (C) dopamine (D) diazepame (E) nitroglicerine 167 what dose of adrenaline should be administered to a child if the body weight is 3 kg (A) 0.3 ml (B) 0.1 ml (C) 0.2ml (D) 0.9ml (E) 0.6ml 168 When do you start neonatal resuscitation? (A) baby is blue, no crying, low muscle tone (B) baby is pink, good muscle tone, crying (C) baby is crying, feeding, no moving (D) baby has cough,rashes, fever (E) baby is yellow, crying,sleeping 169 At 43 weeksgestation, a long, thin infant is delivered. The infant isapneic, limp, pale, and covered with “pea soup” amniotic fluid. The first stepin the resuscitation of this infant at delivery should be (A) Suction of the trachea under direct vision (B) Artificial ventilation with bag and mask (C) Artificial ventilation with endotracheal tube (D). Administration of 100% oxygen by mask (E) Catheterization of the umbilical vein 170 A 1-day-old healthy infant with a superficial swelling over the right parietotemporal region that does not cross the suture lines. What is the diagnosis? (A) Cephalohematoma (B) Intraventricular hemorrhage (C) Caput succedaneum (D) Subdural hemorrhage (E) Subarachnoid hemorrhage 171 A baby was admited to the hospital with jaundice. On examination by Cramer scale zone is 3. What is the level of bilirubin ? (A) 8-10mg/dl (B) 5-6mg/dl (C) 6-8mg/dl (D) 12-14mg/dl (E) 10-12mg/dl 172 A baby was admited to the hospital with jaundice. On examination by Cramer scale zone is 5. Which of the following treatment do you choose ? (A) exchange blood transfusion (B) phototherapy (C) glucose (D) phenobarbitone (E) sunlight exposure 173 Reduced or absent femoral pulse could be detected in patients with: (A) PDA (B) TF (C) TGV (D) ASD (E) CA 174 Headackes, sinkope, diziness suggest presence of: (A) Hypertrophic cardiomyopathy (B) Infectous endocarditis (C) Acute myocarditis (D) Dylated cardiomyopathy (E) Rheumatic pancarditis 175 A 14-year-old boy is being evaluated for dyspnea and fatigue. From the anamnesis: he suffered from frequent angina till 12 years-old; At 12 years he has an episode of pain and swollen of right knee join. Objectively: the apex beat is wide and shifted 2 sm left from the left mid-clavicular line. Left heart border extends to 2,5 sm left from mid-clavicular line. He has holosystolic murmur best heart at the apex and accentutation of II tone above PA. In blood test: ESR - 45 mm per hour; CRP - 3 mg/dl; increased titers of ASLO; negative blood culture test. What is more likely diagnosis? (A) RHD. Mitral insuficiency (B) Mitral prolapse (C) Infective endocarditis (D) Dilated cardiomayopathy (E) Restrictive cardiomyopathy 176 A 12-months-old baby is being evaluated for difficult breathing and cyanosis appearance with physical or emotional stress. From the anamnesis: delay on physical growth from 2 months of age, when feeding - rapid fatigue up to refusal of the breast. Bronchitis and pneumonia were not observed. Objectively: skin and mucous membranes are cyanotic. RR - 40 per 1 min. Puerile breathing above the lungs, no wheezing, no rales. HR - 146 beats per min. Relative cardiac dullness borders: the right - along the right parasternal line, the left - along the left mid-clavicular line. Heart sounds are sonorous, rhythmic on apex. Weak S2 above PA; Systolic murmur 4/6 is heard on the left edge of sternum, with conduction to the back. Abdomen is soft and painless. The liver and spleen are not enlarged. What is MOST likely diagnosis? (A) CHD. Tetralogy of Fallot (B) CHD. Atria Septal Defect (C) Congenital Cardiomayopathy (D) Congenital myocarditis (E) Eisenmeiger Syndrom 177 During the routine examination of 4,5-old-month well appearing, well-developed male infant, the doctor detects: regular rhyth; S1 and S2 normal; 2/6 harsh systolic murmur best heard at the left lower sternal border and radiating to the back. Of the following, what is the MOST likely preliminary diagnosis? (A) CHD. Ventricular Septal Defect (B) CHD. Atria Septal Defect (C) CHD. Patent Ductus Arteriosus (D) Innocent murmur (E) Mitral Valve prolapse 178 During the routine examination of 3-old-year well appearing, well-developed male infant, the doctor detects: regular rhyth; S1 and S2 normal; 2/6 ejection systolic murmur best heard at the left 2nd intercostal space. Of the following, what is the MOST likely preliminary diagnosis? (A) CHD. Atria Septal Defect (B) CHD. Ventricular Septal Defect (C) Innocent murmur (D) Mitral Valve prolapse (E) CHD. Patent Ductus Arteriosus 179 A healthy term neonate, was noted to be cyanosed at 6 hours of age. There was no breathlessness and the baby had taken a feed. On examination, there was a soft systolic murmur. Pulse oximetry showed an oxygen saturation of 66%. Oxygen administration did not improve this significantly. What is his most likely diagnosis? (A) Congenital Cyanotic Heart Defect (B) Congenital pneumonia (C) Congenital Cardiomayopathy (D) Congenital Diaphragmatic Hernia (E) Congenital myocarditis 180 A 12-year-old boy complained about weakness, headache, cold feet, and rapid fatigue of the lower extremities. These complaints are present from the early childhood. His current blood pressure was 170/100 mmHg in the right arm and 122 mmHg systolic in the right ankle. There was a radio-femoral delay palpable. The ECG showed signs of left ventricular hypertrophy. What is the more likely diagnosis? (A) Congenital Heart disease. Coarctation of Aorta. (B) Congenital hypertrophic cardiomyopathy (C) Congenital dilated cardiomyopathy (D) Congenital Heart disease. ASD (E) Congenital Heart disease. Moderate VSD 181 An 8-year-old girl represents complaint about weakness, headache, cold feet, and weakness on legs. These complaints are present from the early childhood. Her current blood pressure was 170/100 mmHg in the right arm and 122 mmHg systolic in the right ankle. There was a radio-femoral delay palpable. The ECG showed signs of left ventricular hypertrophy. What is the more likely diagnosis? (A) Congenital Heart disease. Coarctation of Aorta. (B) Congenital dilated cardiomyopathy (C) Congenital hypertrophic cardiomyopathy (D) Congenital Heart disease. Moderate VSD (E) Congenital Heart disease. ASD 182 A 12-months-old baby is being evaluated for difficult breathing and cyanosis appearance with physical or emotional stress. From the anamnesis: delay on physical growth from 2 months of age, when feeding - rapid fatigue up to refusal of the breast. Bronchitis and pneumonia were not observed. Objectively: skin and mucous membranes are cyanotic. RR - 40 per 1 min. Puerile breathing above the lungs, no wheezing, no rales. HR - 146 beats per min. Relative cardiac dullness borders: the right - along the right parasternal line, the left - along the left mid-clavicular line. Heart sounds are sonorous, rhythmic on apex. Weak S2 above PA; Systolic murmur 4/6 is heard on the left edge of sternum, with conduction to the back. Abdomen is soft and painless. The liver and spleen are not enlarged. What is MOST likely findings on the chest X-Ray? (A) Concave Pulmonary Artery with dicreased pulmonary vascularity (B) Cardiomegaly with congested pulmonary vascularity (C) An air-fluid level on the left side of the chest with an absent gastric shadow (D) Small bilateral pleural effusions, cardiomegaly, and perihilar airspace opacities (E) Kerley B-line with normal pulmonary vascularity 183 A healthy term neonate, was noted to be cyanosed at 6 hours of age. There was no breathlessness and the baby had taken a feed. On examination, there was a soft systolic murmur. Pulse oximetry showed an oxygen saturation of 66%. After oxygen therapy what is most likely step in management? (A) Precautionary prostaglandin E2 infusion (B) Immediate Indometacin infusion (C) Precoutionary dobutamin infusion (D) Precoutionary epinephrin infusion (E) Precoutionary Ampicillyn infusion 184 A 12-year-old boy complained about weakness, headache, cold feet, and rapid fatigue of the lower extremities. These complaints are present from the early childhood. His current blood pressure was 170/100 mmHg in the right arm and 122 mmHg systolic in the right ankle. There was a radio-femoral delay palpable. The ECG showed signs of left ventricular hypertrophy. From the following, which pathognomonic sign could be find in a patient chest X-Ray? (A) Unilateral rib notching with normal pulmonary vascularity (B) Nonsegmental consolidation in both right and left lower lung fields (C) Multiple right sided rib fractures with several comminuted fractures (D) Concave Pulmonary Artery with dicreased pulmonary vascularity (E) Focal destruction of the lung parenchima on both sides 185 A 12-year-old boy complained about weakness, headache, cold feet, and rapid fatigue of the lower extremities. These complaints are present from the early childhood. His current blood pressure was 170/100 mmHg in the right arm and 122 mmHg systolic in the right ankle. There was a radio-femoral delay palpable. The ECG showed signs of left ventricular hypertrophy. From the following, which is the most likely clinical assesment step to determine the disease? (A) Palpation of 4-extremeties pulses (B) Percussion for evaluation borders of the heart (C) Auscultation of the Heart (D) Palpation for evaluation position of the apex beat (E) Palpation to evaluate the liver size 186 An 8-year-old girl represents complaint about weakness, headache, cold feet, and weakness on legs. These complaints are present from the early childhood. Her current blood pressure was 170/100 mmHg in the right arm and 122 mmHg systolic in the right ankle. There was a radio-femoral delay palpable. The ECG showed signs of left ventricular hypertrophy. From the following, which is the most likely clinical assesment step to determine the disease? (A) Palpation of 4-extremeties pulses (B) Percussion for evaluation borders of the heart (C) Palpation to evaluate the liver size (D) Palpation for evaluation position of the apex beat (E) Auscultation of the Heart 187 Bleeding, bruising easily,teeth loss occur in which disease: (A) hypovitaminosis of C (B) hypovitaminosis of B (C) rickets (D) anemia (E) hypovitaminosis of A 188 Which of the following is not an important mechanism for maintaining vitamin B12 nutrition? (A) acidic pH in the ileum (B) direct absorption (C) intestinal bacterial synthesis (D) enterohepatic circulation (E) binding with intrinsic factor 189 One of the following matching is TRUE regarding the trace elements deficiencies and their consequences (A) zinc and hypogonadism (B) selenium and dental caries (C) iron and hypothyroidism (D) fluoride and cardiomyopathy (E) manganese and decreased alertness 190 One of the following matching is TRUE regarding the trace element excess and its consequence (A) iron and abdominal pain (B) copper and congenital hypothyroidism (C) manganese and hyperuricemia (D) fluoride and nail changes (E) zinc and cholestatic jaundice 191 The valuable diagnostic feature that differentiate anemia of chronic disorder from iron deficiency anemia is (A) low or normal serum transferrin (B) low serum iron (C) leukocytosis (D) normal bone marrow cellularity (E) normochromic normocytic RBC 192 The first laboratory marker in progressive iron deficiency anemia is (A) depletion of bone marrow hemosiderin (B) falling of serum ferritin (C) decrease of serum iron and increase of the iron-binding capacity (D) decrease hemoglobin synthesis (E) hypochromic microcytic anemia 193 What is the most likely diagnosis of a 9 month old child who drinks excessive amounts of only whole cow's milk with blue sclerae and no history of trauma? (A) iron deficiency anemia (B) osteogenesis imperfecta (C) Wilson's disease (D) kwashiorkor (E) physiological anemia 194 In evaluating the cause of rickets, which test is convenient if malabsorption is a consideration? (A) PT (B) PTT (C) stool pH (D) barium study (E) hydrogen breath test 195 Which method is needed to determine the vitamin D status of a patient? (A) 25-hydroxy vitamin D level (B) 25-hydroxylase leve (C) PTH level (D) 1, 25-dihydroxy vitamin D level (E) D-binding protein 196 A 1-year-old child has folic acid deficiency since the age of 4 months, the best indicator of this deficiency is (A) decrease level of RBC folate (B) significant increment of mean corpuscular volume MCV (C) significant fall of reticulocytes count (D) high level of lactate dehydrogenase LDH (E) increase number of hypersegmented neutrophils 197 An extremely high RBC distribution width (RDW) is MOST likely consistent with (A) sideroblastic anemia (B) iron deficiency anemia (C) megaloblastic anemia (D) sickle cell anemia (E) thalassemia 198 Allergic rhinitis is based on the: (A) immediate hypersensivity (B) antibody-mediate hypersensivity (C) peculiar-type hypersensivity (D) immune complex-mediated hypersensivity (E) delay-type hipersensivity 199 atopic dermatitis is based on the: (A) delay-type hipersensivity (B) antibody-mediate hypersensivity (C) immediate hypersensivity (D) immune complex-mediated hypersensivity (E) peculiar-type hypersensivity 200 Triad of immune deficiency, thrombocytopenia and eczema is a: (A) Wiskott-Aldrich syndrome (B) Duncan’s syndrome (C) Ataxia-teleangiectasia (D) Di George syndrome (E) Chronic granulomatous disease