MCQS# 06.5.2020

MCQ# 6.5.2020

A baby on the post-natal ward developed jaundice at 32 h of age. She was born at term, weighing 3300 g, to a 25 year-old mother with a healthy 5 year-old daughter. Mother was breastfeeding. The membranes had ruptured 28 h before delivery. No antibiotics were given to mother or baby.

Examination of the baby was normal, apart from jaundice. The weight was 3100 g. The serum bilirubin level was 19.5mg/dL. Mother was blood group O Rhesus negative; baby A Rhesus negative The direct Coombs test was weakly positive Hb 15.4 g/dL, white count 16700/dL (60% neutrophils) and platelets 212000/L

1. What is the most likely diagnosis? 

    A. Rhesus haemolytic disease

    B. Dehydration jaundice

    C. Neonatal infection

    D. Breast milk jaundice

    E. ABO incompatibility

2. What other investigations are necessary? 

    A. Conjugated/unconjugated bilirubin levels

    B. Urea and electrolytes

    C. Glucose-6-phosphate dehydrogenase levels

    D. Osmotic fragility test

    E. None of above

3. What is the correct treatment? 

    A. Withdraw breast feeds

    B. Phototherapy and Penicillin and gentamicin

    C. Double-volume exchange blood transfusion

    D. Just phototherapy

    E. No need of any therapy

For correct answers, plz click on 

https://pediatricmcqsseqsbank.blogspot.com/2020/03/serum-ascites-albumin-gradient-saag.html

PEDIATRIC MCQS: GASTROENTEROLOGY

PEDIATRIC MCQS: GASTROENTEROLOGY

MCQS#01

Vomiting is a common presenting symptom in general pediatrics. In addition, cyclic vomiting syndrome (CVS) has an estimated prevalence of 2%. 

Which of the following scenarios is consistent with a child with the diagnosis of CVS?

A. A 5-year-old boy with recurrent episodes of nonbilious vomiting that occur after he sleeps in during the weekend or after a high-protein meal

B. A 6-year-old girl with recurrent episodes of “fast”-paced vomiting (up to 4 emeses/h) every 3 weeks that begin in the morning and last about 24 hours

C. A 6-month-old girl with recurrent episodes of bilious vomiting and abdominal pain every 4 to 6 hours

D. A 5-year-old girl with recurrent episodes of nonbilious vomiting every 4 hours, occipital headache, and mild ataxia

E. A 6-week-old girl with recurrent episodes of nonbilious vomiting after every feed

MCQS#02

A 7-year-old girl presents to the emergency department (ED) after vomiting 15 times over the past 8 hours. The vomiting began suddenly on awakening that morning. After examining her medical record, you note that she has had similar 24-hour episodes of vomiting, approximately every 4 weeks for the past 3 months. All the episodes required intravenous fluid rehydration. Aside from the 24-hour vomiting episodes, she has been otherwise healthy.

She has a heart rate of 130 bpm, blood pressure of 105/76 mm Hg, and appears listless, but is able to answer your questions appropriately. She has urinated once earlier today. Physical examination reveals tacky mucous membranes. There are no focal neurologic findings or symptoms. She takes sips of water in the emergency room, but 10 minutes later, she has an episode of nonbloody, nonbilious emesis.

You suspect cyclic vomiting syndrome (CVS). What would be the next appropriate step in management of this patient?

A. Administer intravenous fluid rehydration.

B. Send blood for electrolytes, glucose, blood urea nitrogen, and creatinine.

C. Order an abdominal radiograph.

D. Administer an intravenous proton pump inhibitor.

e. Order head CT.

MCQS#03

An 11-year-old boy presents to clinic with a complaint of 1 to 2 episodes of vomiting at least 1 time per week over the past 3 months. He reports that vomiting consists of nonbloody, nonbilious food material and is preceded by several minutes of burning substernal pain. His body mass index is in the 80th percentile for age.

What is the next most appropriate step in the management of this patient?

A. A 2-week trial of H 2 -receptor antagonist.

B. Referral to pediatric gastroenterology clinic.

C. Send blood for CBC, AST, ALT, and pancreatic lipase.

D. Obtain upper gastrointestinal contrast study.

E. A 2-week trial of odansetron as needed for nausea.

MCQS#04

A 20-month-old female is seen in clinic with a 4-month history of 3 to 5 watery stools per day. She is in the 60th percentile for weight and 75th percentile for height. Her mother describes her as a playful child and has no concerns other than the diarrhea. Dietary history reveals that the girl eats 3 meals and at least 2 small snacks and drinks 2 to 3 cups of apple juice in addition to 12 oz of cow’s milk each day.

Which of the following is the next appropriate step in management of this patient?

A. Determination of stool electrolytes and osmolality

B. Determination of stool pH and reducing substances

C. Stool culture

D. Two-week trial of lactose-free diet

E. Two-week trial of juice-free diet

MCQS#05

A 32-month-old girl presents to clinic for evaluation of constipation. 

Which of the following findings in the child’s medical history suggests an organic cause of constipation rather than functional cause?

A. Daily fecal soiling in undergarments

B. Two urinary tract infections within the last 6 months

C. Large-caliber stools that sometimes clog the toilet

D. Small-caliber, thin-appearing stools

E. Episodes of posturing during which the child crosses legs and screams

ANSWERS today at 3pm

PEDIATRIC MCQS: Orthopedics

PEDIATRIC MCQS

Q1

A 12-hour-old infant undergoes a physical examination in the newborn nursery. It is noted that there is inward torsion of the forefoot bilaterally that is easily reduced with passive movement of the foot. You diagnose metatarsus adductus.

Given the diagnosis of metatarsus adductus, what other diagnosis should the patient be

evaluated for?

a. Clubfoot

b. Myelomeningocele

                                  c. Developmental dysplasia of the hip (DDH)

                                  d. Clavicular fracture

                                  e. Pes planus

Q2

A 6-year-old is brought to the office because her parents are concerned over her clumsiness. They state that she tends to trip over her feet when she walks. On your physical examination, you note an intoeing gait bilaterally. On closer inspection, it appears that

her patellae are inwardly deviating as she walks. Her neurologic examination, including muscle strength, is completely normal. 

The most common cause of this intoeing gait would be:

a. Internal tibial torsion

b. Femoral anteversion

c. Slipped capital femoral epiphysis

d. Metatarsus adduction

e. Bilateral Salter I fractures of the tibia

Q3

In the normal child, genu varum (bowlegs) is maximal at which age?

a. Adolescence

b. Age 10 to 12

c. Newborn period

d. Age 3 to 5

e. Age 6 to 9

Q4

A mother brings her 6-year-old daughter to your office for evaluation of her “knock-knees.” Your examination demonstrates symmetric valgus deformity of the knees bilaterally, normal range of motion of the hips, knees, and ankles, and no leg length discrepancy. The best

next step would be:

a. Radiographs of the legs to exclude fracture

b. Reassurance of the parent

c. Evaluations of serum calcium and phosphate

d. Prescription of orthotics

e. Referral to physical therapy for strength building exercises

Q5

Which of the following conditions is associated with developmental dysplasia of the hip?

a. Tibial torsion

b. Congenital scoliosis

c. Torticollis

d. Branchial cleft disorders

e. Femoral anteversion


ANSWERS on 13/9/2019

PEDIATRIC MCQS: Rheumatology

PEDIATRIC MCQS

MCQ#01

A 3-year-old child is brought to the emergency room with fever to 39°C and refusal to bear weight for the last several hours. She is ill-appearing and on exam has a swollen, tender right knee with surrounding erythema. Radiographs of the right knee demonstrate an effusion.

Which of the following tests would most likely to ensure a definitive diagnosis?

A. Blood culture

B. Bone culture

C. MRI of the knee

D. Synovial fluid culture

E. Ultrasound of the knee

MCQ#02

A child hospitalized 2 weeks ago and suffering from Kawasaki disease presents to your office for follow-up. His father reports that the child defervesced within 24 hours of receiving intravenous immunoglobulin and the fever has not recurred. He is now back to his normal activity and disposition, with the exception of swelling of the knees bilaterally that was first noticed while he was in the hospital and is still present.

Your next step would be which of the following?

A. Readmit the patient for another dose of IVIg

B. Change the patient’s low dose (5–6 mg/kg/day) aspirin to high dose (80–100 mg/kg/day)

C. Reassure the family that the joint swelling will resolve over time

D. Perform arthrocentesis and corticosteroid injections on both knees

E. Start chronic NSAID therapy

MCQ#03

A 15-year-old girl presents to your office with complaints of painful recurrent mouth sores that have occurred 6 times in the last year. She has also had 1 episode of genital ulceration 2 months ago. She underwent culturing of both the oral and genital lesions, which was negative. You note on exam that the patient has evidence of synovitis in her ankles bilaterally, as well as a pustular rash on her arms.

Which of the following tests is likely to be helpful in ascertaining the diagnosis?

A. A skin biopsy

B. A pathergy test

C. MRI/MRA of the brain

D. C-reactive protein

E. Rheumatoid factor

MCQ#04

Of the following medications used in the treatment of systemic lupus erythematosus, which would be considered a long-term maintenance medication?

A. Hydroxychloroquine

B. Prednisone

C. Cyclophosphamide

D. Aspirin

E. Azathioprine

MCQ#05

Children with juvenile systemic sclerosis are most likely to present with which of the following physical findings?

A. Sclerodactyly

B. Tightening of the skin on the face

C. Pulmonary hypertension

D. Esophageal dysmotility

E. Raynaud phenomenon

CORRECT ANSWERS tomorrow  11/9/2019 after 10am

PEDIATRIC MCQS

PEDIATRIC MCQS

MCQ#01

An 8-year-old girl with no significant history presents to your clinic for acute urticaria over the past 3 days. When discussing her history, you determine that she had a viral infection approximately 1 week prior to the onset of the urticarial lesions. 

Which of the following is the most appropriate initial medication for the treatment of acute urticaria lasting for more than 3 days?

a. Prednisone

b. Montelukast

c. Diphenhydramine

d. Cetirizine

e. Ranitidine

MCQ#02

A 3-year-old girl is girl is seen in clinic after a new diagnosis of a peanut allergy. Her mother asks you if her other children (the patient’s siblings) are likely to

develop a peanut allergy. 

Which of the following is an appropriate response?

a. Her other children will definitely also develop a peanut allergy

b. Her other children are 2 times more likely than the general population to develop a peanut allergy

c. Her other children are 6 times more likely than the general population to develop a peanut allergy

d. Her other children are 10 times more likely than the general population to develop a peanut allergy

e. Her other children have no increased risk for developing a peanut allergy compared to the general population

MCQ#03

Which of the following tests is the gold standard for diagnosing a suspected IgE-mediated food allergy?

a. Skin prick testing

b. Intradermal skin testing

c. Measurement of serum food-specific IgE antibodies

d. Oral food challenge

e. Patch testing

MCQ#04

A 5-year-old boy ate peanut butter, and within 5 minutes developed shortness of breath, tongue swelling, generalized urticaria, and vomiting. He underwent IgE specific food testing, which came back very elevated for peanut. The parents are very concerned, and want to do everything possible to prevent a future reaction.

Which of the following should be recommended for the patient’s treatment?

a. Careful elimination of peanut from the child’s diet, but no other daily treatment

b. Daily oral antihistamine use

c. Daily injectable epinephrine use

d. Oral glucocorticoids in the event of an acute food allergic reaction

e. Oral immunotherapy for desensitization

MCQ#05

Which of the following most likely represents an immunologically-mediated drug reaction?

a. A 14-year-old with infectious mononucleosis who develops a rash after receiving amoxicillin

b. A 16-year-old girl with acute renal failure while receiving vancomycin

c. A 12-year-old boy with nausea and vomiting while receiving penicillin

d. A premature infant boy with ototoxicity after receiving gentamicin

e. A 15-year-old girl with rash and fever while receiving minocycline

ANSWERS ON 10/9/2019

PEDIATRICS MCQS

MCQ#01

Patients with IgA deficiency should be given which of the following with caution?

A. Packed RBCs

B. Intravenous Immunoglobulin

C. GM-CSF

D. Pneumococcal immunization

E. Folic acid supplementation

MCQ#02

A 6-year-old male with juvenile idiopathic arthritis is brought to your office by his mother because she is worried that his arthritis medicine “keeps making him sick.” He is currently taking naproxen, calcium, and vitamin D. On review of his medical records, you note that he has had multiple respiratory infections in the past several years, as well as a history of chronic otitis media requiring tympanostomy tube placement which pre-dates his arthritis diagnosis. You suspect that he might have an underlying immunodeficiency.

Your advice to the mother would be which of the following?

A. The arthritis medication is worsening his immunodeficiency and will need to  be stopped

B. The arthritis and the immunodeficiency are unlikely to be related

C. More aggressive treatment of his arthritis may increase the patient’s risk of infection

D. Treatment of the arthritis will result in an improvement in his immunodeficiency

E. The patient will require IgA supplementation

MCQ#03

Recurrent infection with Neisseria is related to which of the following complement deficiencies?

A. C5 deficiency

B. C1-inhibitor deficiency

C. C2 deficiency

D. C3 deficiency

E. C1q deficiency

MCQ#04

Given the underlying defect in Ataxia Telangiectasia (AT), which of the following tests should be avoided in patient with the disorder?

A. Chest radiography

B. Bone marrow biopsy

C. In vitro lymphocyte proliferation assays

D. Flow cytometry for T-cell subsets

E. MR imaging of the brain

MCQ#05

Patients with disorders of B-cell development are susceptible to infections from encapsulated organisms and enteroviral infections. 

These patients typically become symptomatic at what age?

A. In the second decade of life

B. Between the ages of 5 and 10

C. In the first three months of life

D. Between the first 6 and 12 months of life

E. In the immediate postpartum period

ANSWERS ON 5/9/2019

WHAT IS THE BEST INITIAL TEST FOR WORK-UP FOR IMMUNODEFICIENCY? CAN YOU ANSWER IT?

MCQ#01

Of the following options, the best initial test for a workup for immunodeficiency is:

A. Serum levels of IgG, IgM, IgA, IgE

B. A complete blood count with differential

C. Peripheral T-cell phenotyping

D. Erythrocyte sedimentation rate

E. Post-immunization immunoglobulin levels

MCQ#02

A 5-month-old child is brought to your office for evaluation of failure to thrive. His mother reports that he has been suffering from constant diarrhea and failure to gain weight. On exam you note that the child is in the 50% percentile for a 1-month-old. Physical exam reveals diffuse erythroderma, a distended, tympanitic abdomen, and a palpable liver and spleen.

In addition to lymphopenia, what other abnormality would you expect to find on assessment of a complete blood count?

A. Macrocytosis

B. Small platelets

C. Neutrophilia

D. Basophilic stippling

E. Eosinophilia

MCQ#03

A 3-year-old boy returns to your office with his sixth upper respiratory infection this year. 

Which of the following factors would increase your index of suspicion for an underlying immunodeficiency?

A. The child is in daycare 4 days per week.

B. The child’s tonsils are grossly enlarged

C. He was hospitalized 3 times last year for infections

D. His thymic shadow is visualized on chest radiograph

E. He is maintaining steady growth at the tenth percentile for height and weight.

MCQ#04

A 6-month-old boy is brought to your office for evaluation of failure to thrive and persistent eczema. The child has had several upper respiratory infections and has been hospitalized for pneumonia twice in the last 2 months. He has not gained weight since the age of 2 months despite adequate intake, although his mother has made him switch from cow’s milk based- to soy-based formula in the hope of improving his severe eczema. Physical exam reveals an irritable child with an extensive eczematous rash on his trunk and legs. He has moderate hepatosplenomegaly and a few petechiae on his legs.

The most likely finding that might be seen on a complete blood count and smear would be which of the following?

A. Low numbers of neutrophils

B. Thrombophilia

C. Microcytosis

D. Low platelet volumes

E. Lymphoblasts

MCQ#05

Patients with hyper IgE syndrome, or Job syndrome, can have infections resulting in severe tissue damage without features of fever, localized erythema, or warmth. 

The immune defect thought to be responsible for this abnormality is which of the following?

A. Elevated IgE levels

B. Defective neutrophil chemotaxis

C. Impaired intracellular killing of organisms

D. Eosinophilia

E. Abnormal antibody cross-linking

ANSWERS TOMORROW 3/9/2019

PEDIATRIC MCQS

PEDIATRIC MCQS

MCQS#01

Posterior urethral valves, is the most common cause of severe obstructive uropathies in children.

0f the following, the MOST appropriate statement

A.  Its incidence 1 in 40,000 boys

B.  Vesicoureteral reflux occurs in 5% of patients

C.  The urinary stream is strong

D.  Foley catheter should be avoided

E.  It is adiverticulum in the penile urethra

MCQS#02

Family history in nocturnal enuresis is positive in

A. 10%
B. 30%
C. 50%
D. 70%
E. 90%

MCQS#03

The MOST effective way of treatment in older children with nocturnal enuresis is

A. Motivational therapy

B. Conditioning therapy

C. Desmopressin acetate

D. Oxybutynin chloride

E.  Imipramine

MCQS#04

The most common cause of micropenis is failure of the hypothalamus to produce an adequate amount of gonadotropin-releasing hormone.

0f the following, the syndrome associated with micropenis is

A. Kallmann syndrome

B. Fetal hydantoin syndrome

C. Apert syndrome

D. de Lange syndrome

E. Holt-Oram syndrome

MCQS#05

The consequences of cryptorchidism include all the following EXCEPT

A. Infertility

B. Hydrocele

C. Inguinal hernia

D. Testicular malignancy

E. Poor testicular growth

ANSWERS Dated: 31/8/2019

PEDIATRIC MCQS

PEDIATRIC MCQS

MCQ#01

A full-term female neonate weighing 3,700 g is born to a 32-year-old woman with hepatitis C virus infection. The mother was diagnosed during this pregnancy and has not received antiviral therapy. Her human immunodeficiency virus test results are negative. Her husband’s test results for hepatitis C virus infection are negative. As a child, she received a blood transfusion after sustaining an injury during a motor vehicle collision. She inquires about the long-term prognosis if the baby were to acquire hepatitis C virus infection from her.

Of the following, you are MOST inclined to inform the mother that

A. Decompensated cirrhosis in adulthood is likely

B. Hepatocellular carcinoma without cirrhosis is likely

C. Rapidly progressive fibrosis in adulthood is likely

D. Slowly progressive fibrosis in childhood is likely

E. Spontaneous clearance of the virus in infancy is likely

MCQ#02

A 4-year-old boy is brought to the urgent care center for fever, vomiting, diarrhea, and reduced urine output. On physical examination, the boy is alert and able to answer some questions. He has a mildly elevated heart rate, normal blood pressure, dry mucous membranes, and sunken eyes. You diagnose him with acute gastroenteritis, and begin treatment with oral ondansetron and frequent, small aliquots of oral rehydration solution (ORS). However, he resists any oral intake and after 1 hour, has taken only 5 mL/kg of ORS. You order placement of an intravenous (IV) line for hydration. Despite the staff’s best efforts, 3 attempts at placing an IV failed. His father is visibly upset and asks if there is another option for giving his son fluids.

Of the following, the BEST next step in managing this child’s dehydration is to

A. Administer ORS via nasogastric tube

B. Place an intraosseous line for hydration

C. Reattempt oral rehydration using small aliquots of ORS

D. Reattempt oral rehydration using small aliquots of water

E. Request that a nurse from the intensive care unit place the IV line

MCQ#03

You are evaluating a 10-day-old term newborn who is in the emergency department because of decreased activity, poor feeding, and respiratory distress. The baby was born by normal spontaneous vaginal delivery with no pregnancy or delivery complications. Maternal history is negative for premature or prolonged rupture of membranes, group B Streptococcus colonization, genital herpes, hepatitis B surface antigen, human immunodeficiency virus, and rapid plasma reagin.

The newborn is critically ill and has a temperature of 35.3°C. He is in respiratory failure and shock. Skin examination findings are normal. Laboratory data are significant for leukopenia, thrombocytopenia, disseminated intravascular coagulation, and severe hepatitis. A chest radiograph shows bilateral pulmonary infiltrates. Blood and urine cultures were obtained, but the newborn is not stable enough for lumbar puncture.

Of the following, the BEST initial antimicrobial treatment is ampicillin, cefotaxime, and

A. Acyclovir

B. Amphotericin B

C. Oseltamivir

D. Trimethoprim-sulfamethoxazole

E. Vancomycin

Pediatrics MCQs

MCQS

MCQ#01

A 14-year-old boy is diagnosed with diabetes. He is receiving insulin injection. The recommendation of insulin therapy for a regular exercise:

A. Increase the dose by 10% 

B. Increase the dose by 25% 

C. Increase the dose by 50% 

D. Decrease the dose by 25% 

E. Decrease the dose by 10%

MCQ#02

A 7-year-old girl had tonsillectomy 1 month ago. The true statement after tonsillectomy: 

A. Reduction in nasal allergy

B. Reduction of rheumatic fever

C. Reduction of number of infections 

D. Definitive improvement in nutrition

E. Definitive improvement in respiratory infections.

MCQ#03

The side-effect of rotavirus vaccine: 

A. Flu-like symptoms

B. Hepatitis

C. Intussuception

D. Localized abscess 

E. Mal-rotation

MCQ#04

A 15-month-old healthy boy is due to for his MMR vaccination. His parents are healthy. His paternal uncle has a HIV infection and he lives with them. 

The next step in the management:

A. MMR vaccine should not be given.

B. His uncle should look for another place to live before MMR is given. 

C. Give MMR in 18 months of age.

D. MMR should be given.

E. Isolate the child from his uncle.

MCQ#05

A 7-year-old boy is diagnosed to have a obstructive lung disease. 

All of the following are abnormal except: 

A. Residual volume 

B. Vital capacity

C. Total lung capacity

D. Functional residual capacity

E. Diffusing capacity of carbon monoxide

Pediatric MCQs

MCQS

MCQ#01

A newborn CBC reveals hemoglobin (11.0), MCV (106), WBC (12,600), platelet (296,000), and reticulocyte (2%). 

Most likely diagnosis:

A. Anemia of prematurity 

B. Iron deficiency anemia 

C. G6PD deficiency

D. Normal

E. ‘ABO’ incompatibility and Coombs positive

MCQ#02

A 4-year-old boy appears with severe watery diarrhea and recurrent, vague, crampy mid-abdominal pain for the last 2 days. The boy looks healthy. His mother is unsure of any obvious relation with milk ingestion. Physical examination reveals abdominal distension, flatulance, and borborygmi.

Most likely diagnosis: 

A. Lactase deficiency 

B. Sucrase deficiency

C. Galactase deficiency

D. Sucrase-isomaltase deficiency

E. Glucose-galactose malabsorption

MCQ#03

A pregnant mother took valproic acid in early first trimester. She was not sure about her pregnancy at that time. She is worried. Most likely complication:

A. VSD

B. Limb defects 

C. Spina bifida

D. Hydrops fetalis 

E. Hypoplastic nose

MCQ#04

A 24-week gestational age premature infant (550 grams birth weight) developed BPD (bronchopulmonary dysplasia). She has moderate to severe BPD changes in lungs. At present, the girl is 2 months old and still requiring oxygen by nasal canula. Mother wants to know the usual time of recovery in BPD patients:

A. 1 – 3 months 

B. 3 – 6 months 

C. 6 – 12 months 

D. 12 – 15 months 

E. 15 – 24 months

MCQ#05

All of the following statements are true about pertussis except:

A. Both disease and immunization against pertussis provides complete and lifelong immunity against disease or reinfection.

B. Erythromycin for 14 days is drug of choice.

C. Erythromycin can cause hypertrophic pyloric stenosis.

D. A severely ill infant may appear completely normal between episodes.

E. Prophylactic antibiotic is not recommended for exposed health care workers.