7/10/2013

Please keep in mind that this is the very first version of “reconstruction” process, mistakes are expected, correct them or point them to us, and I will, gladly, correct them, some of the questions are not complete and I simply wrote the key words with a proposed answer, if you do have the full text please post it, This file contains about 213-215 questions out of 220

Pediatrics

1. A 10-month-old infant has poor weight gain, a persistent cough, and a history of several bouts of pneumonitis. The mother describes the child as having very large, foul-smelling stools for months. Which of the following diagnostic maneuvers is likely to result in the correct diagnosis of this child?

   1. CT of the chest

   2. Serum immunoglobulins

   3. TB skin test

   4. Inspiratory and expiratory chest x-ray

   5. Sweat chloride test

2. The signs and symptoms of meningitis in an infant can be different than those in an adult. Which of the following signs and symptoms of meningitis is more helpful in an adult patient than in a 4-month-old?

   1. Lethargy

   2. Jaundice

   3. Vomiting

   4. Brudzinski sign

   5. Hypothermia

3. As you are about to step out of a newly delivered mother’s room, she mentions that she wants to breast-feed her healthy infant, but that her obstetrician was concerned about one of the medicines she was taking.

Which of the woman’s medicines, listed below, is clearly contraindicated in breast-feeding?

1. Ibuprofen as needed for pain or fever

2. Labetalol for her chronic hypertension

3. lithium for her bipolar disorder

4. Carbamazepine for her seizure disorder

5. Acyclovir for her HSV outbreak

4. You are called to a delivery of a woman with no prenatal care; she is in active labor but has no history of amniotic rupture. The biophysical profile done in the emergency center revealed severe oligohydramnios. When you get this infant to the nursery, you should carefully evaluate him for

which of the following?

1. Anencephaly

2. Trisomy 18

3. Renal agenesis

4. Duodenal atresia

5. Tracheoesophageal fistula

5. A newborn infant becomes markedly jaundiced on the second day of life, and a faint petechial eruption, first noted at birth, is now a generalized purpuric rash. Hematologic studies for hemolytic diseases are negative. Acute management should include which of the following?

   1. Liver ultrasound

   2. Isolation of the infant from pregnant hospital personnel

   3. Urine drug screen on the infant

   4. Discharge with an early follow-up visit in 2 days to recheck bilirubin

   5. Thyroid hormone assay

6. A 10-year-old girl has had a “cold” for 14 days. In the 2 days prior to the visit to your office, she has developed a fever of 39C (102.2F), purulent nasal discharge, facial pain, and a daytime cough. Examination of the nose after topical decongestants shows pus in the middle meatus. Which of the following is the most likely diagnosis?

   1. Brain abscess

   2. Maxillary sinusitis

   3. Streptococcal throat infection

   4. Sphenoid sinusitis

   5. Middle-ear infection

7. A 6-year-old boy had been in his normal state of good health until a few hours prior to presentation to the ER room. His mother reports that he began to have difficulty walking, and she noticed that he was falling and unable to maintain his balance. Which of the following is the most likely cause for his condition?

   1. Drug intoxication

   2. Agenesis of the corpus callosum

   3. Ataxia telangiectasia

   4. Muscular dystrophy

   5. Friedreich ataxia

8. A 2-year-old boy has been doing well despite his diagnosis of tetralogy of Fallot. He presented to an outside ER a few days ago with a complaint of anacute febrile illness for which he was started on a “pink antibiotic.” His mother reports that for the past 12 hours or so he has had a headache and is more

lethargic than normal. On your examination he seems to have a severe headache, nystagmus, and ataxia. Which of the following would be the most appropriate first test to order?

1. Urine drug screen

2. Blood culture

3. Lumbar puncture

4. CT or MRI of the brain

5. Stat echocardiogram

9. An 18-month-old child presents to the emergency center having had a brief, generalized tonic-clonic seizure. He is now postictal and has a temperature of 40°C (104°F). During the lumbar puncture (which ultimately proves to be normal), he has a large, watery stool that has both blood and mucus in it. Which of the following is the most likely diagnosis in this patient?

   1. Salmonella

   2. Enterovirus

   3. Rotavirus

   4. Campylobacter

   5. Shigella

(Some say that the age was 5 months and blood was absent)

10. A previously healthy 8-year-old boy has a 3-week history of low-grade fever of unknown source, fatigue, weight loss, myalgia, and headaches. On repeated examinations during this time, he is found to have developed a heart murmur, petechiae, and mild splenomegaly. Which of the following is the most likely diagnosis?

    1. Rheumatic fever

    2. Kawasaki disease

    3. Scarlet fever

    4. Endocarditis

    5. Tuberculosis

11. A 3-yr-old boy presents to an urgent care clinic with a 3-day history of abdominal pain and difficulty walking. Abnormal findings include blood pressure of 120/80 mm Hg, diffuse abdominal tenderness, purpuric rash of the hands and ankles, and diffuse periarticular tenderness and swelling of the ankles.

The most likely diagnosis is:

A. Systemic lupus erythematosus

B. Kawasaki's disease

C. Juvenile rheumatoid arthritis

D. Henoch-Sch nlein purpura

E. Stevens-Johnson syndrome

(similar picture: the answer was HSP)

12. Full term newborn infant is having episodes of cyanosis and apnea which are worse with attempting to feed but seems better with crying. Which of the following is most important next step to quickly establish the diagnosis?

a. Echocardiogram

b. Ventilation perfusion scan

c. Passage of catheter into nose

d. Hemoglobin electrophoresis

e. Bronchoscopic evaluation of palate and larynx

13. Because of splenic dysfunction and an increased risc of bacterial Infection , children with sikle cell anemia shoud placed on prophylactic penicillin Vk by 4 weeks . Age cheldren with sikle cell anemia are particulary susceptible to :

A-gram negative rods

B-encapsulated organisms

C-fungal infection

D-viral infection

E-staphlococus aureua

14. which of the following causes of conginital infection is associated with cats:

a-cytomegaloviros

b-rubella

c-toxoplasma gondo

d-syphilis

e-parvoviros b 19

15. A 10 years old girl has had diplopia, ptosis and weakness of her neck flexors for 2 months. Symptoms are

worse in the evening and usually less severe awaking on the morning. No fasciculation or myalgia, her deep tendon reflexes are

normal. The most likely diagnosis:

1. Hysterical weakness.

2. Muscle dystrophy.

3. Spinal muscular atrophy.

4. Botulism.

5. Myasthenia Gravis.

16. A 2 year old boy is admitted to the hospital with high fever four 6 days, swelling of the ands and feets,

scarlentiniform changes of the tongue, generalized reed macular rash, dray sedmentation reet &

thrompocytosis. Which of the following is the best initial mangmanet?

1. cardiac catheterization

2. IVIG & aspirin orally

3. naproxen orally

4. I.V pulse corticosteroids

5. methotrexate orally

17. Which of the following cancer occurs primarily during childhood?

1. Breast cancer

2. Renal cell cancer

3. Wilms tumor

4. Thyroid cancer

5. Colon cancer

18. An 18 year old female, u have followed for 6 years, has recently married , she & husband are planning to

start a pregnancy .u advise her to start taken folic acid , this is important to prevent ?

1. prematurity

2. skull defects

3. chromosomal defects

4. neural tube defects

5. osteopenia

19. Trisonomy 21 is most commonly associated with:

a-malrotacion

b-atrioventricular canal

c-cleft palat

d-renal failure

e-sensory neural hearing loss

20. A12 month-old female infant with failure to thrive is brought to the office. Her parents note that she is very fussy and often spits up after feeding. she also has two loose foul- smelling stool each day. Which of the following foods can she eat safely without aggravating her symptoms?

1. Rice

2. Wheat

3. Oats

4. Barley

5. Rye

21. 34. 2 month old child is seen at your clinc for the first time. The child was born at home , and this is the first well child visit. Risk factors for infant botulism that should be communicated to the pearents include:

1. gardening

2. home construction

3. frozen vegetables

4. honey

5. none of the above

22. A 7 day is admitted to the hospital for evaluation of vomiting and dehydration, physical examination is normal except for minimal hyperpigmentation of the nipples. Serum sodium and potassium concentrations are 120 meq/l (low) and 9 meq/l (high), respectively. Which of the following is the most likely diagnosis :

1. pyloric stenosis

2. congenital adrenal hyperplasia

3. secondary hypothyroidism

4. panhypopituitarism

5. hyperaldosteronism

23. Newborn ,congenital heart block, most like etiology ?

1. GB strep.

2. neonatal Echovirus infection

3. gestational DM

4. maternal lupus

5. ray baby syndrome

24. Regarding resuscitative efforts in child, the most important goal is:

a.Restoration of age-appropriate heart rate.

b.Appropriate movement of the chest wall.

c.Auscultation of equal breath sounds in both lungs field.

d.Adequate oxygen delivery and utilization for the body tissues.

e.Palpation of equal pulses in all four extremities.

25. A 5 yr old is noted by the parents to snore at night. The child also has had problems staying awake in preschool and has had behavioral problems. The father also snores. Physical examination of the child reveals large, pink, nonexudative tonsils. The most appropriate next step is:

1. Laryngoscopy

2. Polysomnography

3. Ambulatory apnea monitoring

4. Telemetry

5. Arterial blood gas analysis

26. The appropriate therapy for severe obstructive sleep apnea syndrome is:

1. Adenotonsillectomy

2. Tracheostomy

3. Parapharyngeal muscle surgery

4. Theophylline

5. Bilevel positive airway pressure

27. A 9 month old boy is brought to the emergency room in limp and unresponsive state. Initial examination shows a pulse rate of 35 /min and occasional irregular breaths. After initiation of cpr (including tracheal intubation) delivary of oxygen via positive - pressure breaths and chest compression , multiple attempts to insert an intra - venous line fail. The most appropriate next step in manegment should be:

1. obtain an arterial blood gas sample

2. place in intraosseous needle and administer fluids and intropic agents

3. obtain a "state" head ct study to evaluate reasons for unresponsiveness

4. place transthoracic cardiac pacemaker

5. place a thoracostomy tube to evacuate a possible pneumothorax

28. The most recommended treatment for severe combined immunedeficiency is:

1. gene therapy

2. monthly iv gammaglobulin

3. monthly iv gammaglobylin and interferon-&(gama)

4. monthly iv gammaglobulin and il-8-monoclonal antibody

5. stem cell transplantation

29. A 12-yr old white girl present with arthralgia of the knees and elbow and swollen hands of 6 months duration. She has intermittent fever and has lost 7.5 kg in weight. Other than swollen joints, findings on physical examination are normal. 3 years earlier, she was found to have thrombocytopenia and was diagnosed with ITP. In addition, one summer, she had severe sunburn, and 2 tears ago she had mouth sores. Today she has a hematocrit of 25%, positive combs test, and the urinanalysis shows multiple RBC. The most common likely diagnosis is:

1. juvenile rheumatoid arthritis

2. ITP

3. evans syndrome

4. periarteritis nodosa

5. SLE

30. A 75-yr old boy develops progressive symptoms of fever, lassitude, arthralgias, headache and abdominal pain. Physical examination shows hepatosplenomegally. Further questioning discovers that he and his family live in a rural area and consume unpasteurized dairy products in their diet. The the most likely etiologic agent of this

illness is:

1. actinomyces

2. bartonella hensallae

3. brucella

4. francisella tularensis

5. Yersinia enterocolitica

31. A 7 months-old girl present with temp. 38.3 BP 70/30mm, diffuse petechia first noted 4 hours before

presentation. Platelets count 88,000/mm3, and white blood cell count of 43,000/mm3 with 23% neutrophils and 42% bands. The infant has received all recommended vaccination. Which of the following is the most likely bacterial etiology of this presentation?

1. staphylococcus aerus

2. streptococcus pneumonia

3. neiserria meningitides

4. haemophyllus influenza type b

5. coli o 157:h7

32. A 9 year-old patient asthmatic patient uses albuterol 3 times per week,for the last 10 days she had wheezing day and night ,increased the inhaler to 3-4 times a day,on examination there is a diffuse wheezing with moderate subcostal retraction, next step in management:

1. order chest XR to asess for pneumonia

2. Systemic steroids

3. Lekutriens

4. Low dose inhalation steroids

5. Start 5 days course of systemic corticosteroid

33. A 4-yr-old boy is noted to have stereotypic body movements and poor verbal and nonverbal communication,with absence of empathy. At daycare, he has not made any friends.The most likely diagnosis is:

1. Attention deficit hyperactivity disorder

2. Dysthymic syndrome

3. Deaf-mutism

4. Autism

5. Cerebral palsy

34. m/o, feeding intolerance, poor-weight gain and large tongue; large posterior fontanelle and umbilical hernia

Next step:

1. Abdominal radiography

2. CBC and blood culture

3. Barium swallow test

4. Serum TSH level

5. Admission for FTT work-up

35. A mother brings her 3 years old son with Down-syndrom to the clinic because his gums have been bleeding in the last week.she reports that he has been less energetic than usual-Exam reveuls that the child has a temperature of 37.8 c orally pallor, splenomegaly, gingival, which of the following is most likely ?

1. Aplastic anemia

2. Left shift

3. Leukemia

4. Leukmoid rxn

36. Cystic Fibrosis (CF) vitamin supplement?

1. Vitamin B

2. Folate

3. Vitamin C

4. Vitamin D

5. Vitamin B12

37. which of the following is regarded as a known complication of treatment with total parenteral

nutrition (TPN)?

a - sepsis

b - renal failure

c - chronic diarrhes

d - vitamin A deficiency

e - irreversible athropy of the mucosa of the small intestine Correct

38. Which of the following reflexes is normally absent in a newborn ?

A. STARTLE (moro)

B. hand grasp

C. crossed adductor

D. Asymmetric tonic neck

E. parachute

39. A 12-year old girl experiences acute monocular blindness of 2 days duration past medical history reveals that she has had headaches for the past 3 years that she cannot charatcerize one brief episode of diplopia, and one episode of parasthesias of the feet. The episodes were hot related in time, did non occur in immediate proximity to the headache, and resolved spontaneously. Finding of physical examination, including the funduscopic exmination, are unremarkable other than reduced visual acuity. The most important diagnostic step is to perform:

1. CT scan

2. MRI

3. A electroencephalogram (EEG)

4. peripheral nerve conduction test's

5. A sural nerve biopsy

40. Which of the following is compatible with iron deficiency anemia? (יכול להיות שהניסוח שונה)

A-decreased red blood cell distribuition

B- increased serum feritin

C- increased total iron binding capacity

D- increased serum iron level

E- increased white blood cell count

41. A 16-year-old girl presents with lower abdominal pain and fever. On physical examination, a tender adnexal mass is felt. Further questioning in private reveals the following: she has a new sexual partner; her periods are irregular; she has a vaginal discharge. Which of the following is the most likely

diagnosis?

a. Appendiceal abscess

b. Tubo-ovarian abscess

c. Ovarian cyst

d. Renal cyst

e. Ectopic pregnancy

42. A 4 yr old girl presents with a 1-day history of a painless, maroon-colored stool. She appears comfortable and in no distress or pain but is pale. Pulse is 110 beats/min. Hemoglobin level is 9.8 g/dL. The most appropriate step to establish the diagnosis is:

1. Abdominal ultrasound examination

2. Air-contrast enema

3. Angiography

4. Colonoscopy

5. Meckel scan

43. A question regarding the criteria of acute rheumatic fever

44. A question regarding the developmental age of a child : the answer was 6 months

45. A question regarding intussusceptions: mostly they are ileocolic

46. A question regarding osteomyelitis/ septic arthritis in a child : it was Staph’ aureus

47. 8 months with UTI: culture and antibiotics

48. A newborn with crooked feet, true statement: 50% surgery, reassurance, radiology ?

49. Audiogram

50. Endoscopy 12-24 hours later

Surgery

1. Cytokines are which type of hormone?

   1. Polypeptide

   2. Amino acid

   3. Fatty acid

   4. Carbohydrate

2. The primary physiologic effect of nitric oxide (NO) is?

   1. Increased platelet adhesion

B.Increased leukocyte-endothelial adhesion

C.Increased microthrombosis

D. Increased Smooth muscle relaxation

3. Which of the following is the primary fuel source after acute injury ?

   1. Fat

   2. Muscle (protein)

   3. Glycogen

   4. Ketone bodies

4. The diagnosis of heparin-induced thrombocytopenia is made by ?

   1. >20% fall in platelet count

   2. Positive serotonin release assay

   3. Platelets <25,000 with clinical bleeding

   4. Prolonged aPTT

5. Pneumoperitoneum results in which of the following

   1. Decreased plasma rennin

   2. Decreased antidiuretic hormone (ADH)

   3. Decreased glomerular filtration rate

   4. Decreased free water absorption in the distal tubules

6. Which of the following does NOT require an electrical current to coagulase tissue?

   1. Monopolar cautery

   2. Bipolar cautery

   3. Mixed current cautery

   4. Ultrasonic shears device

7. A 2-cm invasive cancer of the toproximal transverse colon carcinoma should be treated with which of the following procedure ?

   1. Ileocecetomy

   2. Ascending colectomy

   3. Right hemicolectomy

   4. Extended right hemicolectomy

8. Which of the following patients would be considered candidate for bariatric surgery?

   1. 70 year old, BMI 48, with well-controlled diabetes

   2. 22 year old, BMI 34, with brittle (uncontrollable) diabetes

   3. 35year old, BMI 38, with no comorbidities

   4. 56 year old, BMI 42, with no comorbidities

9. Traction diverticula in the esophagus are the results of ?

   1. A congenital defect

   2. Infection or inflammation

   3. Motility disorders

   4. Trauma, usually iatrogenic

10. Which of the following gastric polyps is considered pre-malignant?

    1. Hamartomatous

    2. Heterotopic

    3. Inflammatory

    4. Adenomatous

11. In addition to regional lymphadenectomy, appropriate surgical treatment for T2 carcinoma of the

gallbladder is?

1. Cholecystectomy only

2. Cholecystectomy with resection of liver segments IVB AND V

3. Cholecystectomy with limited right hepatectomy

4. Cholecystectomy with extended right hepatectomy

12. Which of the following makes curative resection of esophageal cancer unlikely?

A. Tumor length >6cm

B. Weight loss > 10%

C. recurrent laryngeal nerve Palsy ( invasion)

D. >2 abnormal lymph nodes on CT scan

13. Which of the following is the best test to confirm eradication of H. pylori

    1. Negative histology after biopsy during EGD

    2. Negative fecal antigen

    3. Negative urea breath test

    4. Negative urea blood test

14. Which of the following is consistently the largest artery to the stomach?

    1. Left gastric artery

B Right gastric artery

C left gastroepiploic artery

D Right gastroepiploic artery

15. Which of the following drugs irreversibly inhibits platelet COX (cyclo-oxagenase)?

a. Ibuprofen

b. Clopidogrel

c. Aspirin

d. Celebrex

16. BRCA2 mutations are associate with all of the following EXCEPT?

A. Gastric cancer

B. Lung cancer

C. Ovarian cancer

D. Prostate cancer

17. .a women after lung cancer treatment at remission , when she will be considered cancer free

a: 2 years

b: 5 years

c: 10 years

d: Never

18. For average patients, routine screening is recommended for all but the following disease?

a. Breast cancer

b. Colorectal cancer

c.Cervical cancer

d. Pancreatic cancer

19. Which of the following is an indication for cholecystectomy in an asymptomatic patient with an

incidental finding of gallstones?

A. Any history of abdominal pain

B. Family history of complications of cholelithiasis

C. Porcelain gallbladder

D. Frequent travel out of the country

20. A 52-year-old man with gastric outlet obstruction secondary to a duodenal ulcer presents with

hypochloremic, hypokalemic metabolic alkalosis. Which of the following is the most appropriate therapy

for this patient?

a.Infusion of 0.9% NaCl with supplemental KCl until clinical signs of volume depletion are eliminated

b. Infusion of isotonic (0.15 N) HCl via a central venous catheter

c. Clamping the nasogastric tube to prevent further acid losses

d. Administration of acetazolamide to promote renal excretion of bicarbonate

e. Intubation and controlled hypoventilation on a volume-cycled ventilator to further increase PCO2

21. A 65-year-old man undergoes a low anterior resection for rectal cancer. On the fifth day in hospital,

his physical examination shows a temperature of 39°C (102°F), blood pressure of 150/90 mm Hg,

pulse of 110 beats per minute and regular, and respiratory rate of 28 breaths per minute. A computed

tomography (CT) scan of the abdomen reveals an abscess in the pelvis. Which of the following most

accurately describes his present condition?

1. Systemic inflammatory response syndrome (SIRS)

2. Sepsis

3. Severe sepsis

4. Septic shock

5. Severe septic shock

22. A 23-year-old woman undergoes total thyroidectomy for carcinoma of the thyroid gland. On the

second postoperative day, she begins to complain of a tingling sensation in her hands. She appears quite

anxious and later complains of muscle cramps. Which of the following is the most appropriate initial

management strategy?