5. Congestive Heart Failure.

***) All of the following are common features of heart failure in infancy, except:

1. Hepatomegaly

2. Lower limb edema

3. Feeding difficulties

4. Tachycardia

5. Failure to thrive

Answer: B* Lower limb edema

***) Which one of the following is not common in acute heart failure of infancy:

1. Peripheral edema

2. Tachypnea

3. Tachycardia

4. Gallop rhythm

5. Hepatomegaly

Answer: A* Peripheral edema

***) Congestive heart failure in infancy is characterized by all of the following, except:

1. Enlarged palpable liver

2. Feeding difficulties

3. Heart rate over 150/min

4. Respiratory rate over 40/min

5. Oligemic lung fields in chest X-ray

Answer: E* Oligemic lung fields in chest X-ray

***) Congestive heart failure in infancy commonly presents with all of the following, except:

1. Peripheral edema

2. Poor weight gain

3. Excessive perspiration

4. Weak cry

5. Tachypnea

Answer: A* Peripheral edema

***) The first sign of heart failure in infants is usually:

1. Peripheral edema

2. Engorged jugular veins

3. Basal crepitation

4. Tachypnea and tachycardia

5. Puffiness of eye lids

Answer: D* Tachypnea and tachycardia

***) Goals of medical therapy for congestive heart failure in children include all the following except:

1. Reducing the preload

2. Enhancing cardiac contractility

3. Increase the after load

4. Improving oxygen delivery

5. Enhancing nutrition

Answer: D* Increase the after load

• Development p26-p29.

1. Intellectual Disability.

***) The following mental retardation may be caused by inherited errors of metabolism and can be treated by dietary measures, except:

1. Phenylketonuria

2. Hypothyroidism

3. Galactosemia

4. Tyrosinemia

5. Maple syrup urine disease

Answer: B* Hypothyroidism

***) All of the following can cause mental retardation, except:

1. Emotional disturbances

2. Birth trauma

3. Meningitis

4. Cerebral lipidoses

5. Protein losing enteropathy

Answer: E* Protein losing enteropathy

• Endocrinology p29-p36.

1. Diabetes Mellitus (dm).

***) Concerning diabetes mellitus in children all of the following are true, except:

1. Polydipsia

2. Polyphagia

3. Ketoacidosis

4. Does not always require injectable insulin

5. Usually is rapid in onset, often presenting as diabetic coma

Answer: D* Does not always require injectable insulin

***) A 3 years old child lost appetite over the last few days, ingested a lot of water, frequent urination, and developed acute abdominal pain, vomiting and hyperventilation. Most probably he has:

1. Tumor in the forth ventricle

2. Acute renal failure

3. Acute appendicitis

4. Diabetic ketoacidosis

5. Diabetes insipidus

Answer: 4* Diabetic ketoacidosis

2. Hypothyroidism.

***) The most valuable test in the diagnosis of congenital hypothyroidism is:

1. T3

2. T4

3. Cholesterol level

4. TSH

5. Bone age by X-ray

Answer: D* TSH

***) Early manifestations of congenital hypothyroidism include all of the following, except:

1. Prolonged physiologic jaundice

2. Apneic spells

3. Constipation

4. Delayed osseous development

5. Increased appetite

Answer: E* Increased appetite

***) Clinical features of hypothyroidism may include all of the following, except:

1. Mental retardation

2. Goitre

3. Short stature

4. Advanced bone age

5. Constipation

Answer: D* Advanced bone age

***) All of the following are features of congenital hypothyroidism, except:

1. Lethargy

2. Prolonged jaundice

3. Persistent diarrhea

4. Hoarse cry

5. Feeding difficulties

Answer: C* Persistent diarrhea

***) Signs of congenital hypothyroidism include all the following except:

1. Prolonged neonatal jaundice

2. Lethargy and poor feeding

3. Constipation

4. Early closure of anterior fontanel

5. Umbilical hernia

Answer: D* Early closure of anterior fontanel

***) A 25 days old baby complains of prolonged jaundice, constipation, dry skin and umbilical hernia. The most likely appropriate diagnosis is:

1. Breast milk jaundice

2. G6PD

3. Thalassemia major

4. Hypothyroidism

5. Crigler Najar disease

Answer: D* Hypothyroidism

***) A 9 month old female was seen because of inability to sit or stand. Examination showed neck mass anteriorly. The tongue was broad and thick; no erupted teeth, liver and spleen not palpable. One of the following tests will establish the most likely suspected diagnosis:

1. Routine urine analysis

2. Serum calcium and phosphorus

3. Karyotyping

4. Urine for mucopolysaccharides

5. T4 and TSH

Answer: E* T4 and TSH

***) Congenital goiter in the newborn is least likely to be due to which of the following:

1. Maternal ingestion of large amount of iodine during pregnancy

2. Defect in the synthesis of thyroid hormones

3. Maternal iodine deficiency

4. Hashimoto's disease in the newborn

5. Maternal ingestion of antithyroid drugs

Answer: A* Maternal ingestion of large amount of iodine during pregnancy

***) Regarding Hashimoto's thyroiditis, all are true except:

1. Most common cause of juvenile hypothyroidism

2. The etiology is autoimmune

3. Thyroid antiperoxidase antibodies are positive in 90%

4. Is 7 times more common in boys

5. Lead to growth retardation

Answer: D* Is 7 times more common in boys