Pediatric Fel… / First Part Exa…

First Part Exam - October 2020

1. Which of the following is no effect on hypocapnia?
a. Decreased cardiac output
b. Excitation of the vasomotor center

c. Marked increase in the systemic blood pressure

d. Generalized vasoconstriction including cerebral blood vessels

e. Decrease in the blood pH (acidosis)

2. Effects of positive end expiratory pressure (PEEP) may include any of the following except:
a. Increased intracranial pressure
b. Increased venous return
c. Improved lung recruitment
d. Increased oxygenation
e. Air trapping in patients with bronchospasm
3. The pathophysiologic basis of which of the following conditions is with damage to the myenteric
plexus?
a. Acute pancreatitis

b. Chronic pancreatitis
c. Tropical sprue
d. Achalasia cardia
e. Acute gastritis
4. A one-week-old infant has coarctation of the aorta just distal to the subclavian arteries. The blood
pressure distal to the constriction is 50% lower than normal. Which of the following is increased
in this infant?

a. Blood flow in the lower body

b. Glomerular filtration rate
c. Plasma levels of angiotensin II
d. Renal reabsorption of potassium
e. Renal excretion of sodium
5. Young infants are particularly susceptible to fluid and electrolyte or acid base abnormalities,
during acute illnesses. Which of the following is FALSE as regards characteristics of renal
physiology in normal young infants?

a. Renal tubular immaturity

b. Reduced glomerular filtration rat

c. Decreased urinary concentrating ability

d. Decreased number of nephrons

e. Diminished responsiveness to antidiuretic hormone (AD)

6. A 5-year-old boy has a severe sore throat, high fever and cervical adenopathy. It is suspected that
the causative agent is Streptococcus pyogenes, Which of the following is involved in producing
fever in this patient?
a. Increased production of Interleukins (ILs)

b. Decreased production of prostaglandins

c. Decreased set point temperature in the hypothalamus
d. Decreased metabolic rate

e. Vasodilatation of blood vessels in the skin

7. Which one of the following statements about the electrocardiogram (ECG) is TRUE?
a. The opening of the aortic valve coincides with the P wave
b. Isovolumetric contraction occurs during the P wave
c. During the ST segment all parts of the ventricle have been depolarized

d. During the T wave the tricuspid valve is normally open

e. The QT interval may he prolonged in hyperkalemia

8. A fetal hemoglobin chain that rapidly increases in first few months after birth is:

a. Alpha chain
b. Beta chain

c. Gamma chain
d. Delta china

e. Epsilon chain
9. The best indicator in amniotic fluid to detect the lung maturity of the fetus is:
a. Lecithin (L)
b. Sphingomyelin (S)
c. L: S ratio
d. Phosphatidyl glycerol

e. Phosphatidyl inositol
10. A female child appears in the ER with a severe asthma attack. Physical examination res reveals
tachypnea, intercostal and subcostal retractions, and expiratory wheezes. The MOST important
finding that suggests impending respiratory failure is:

a. Hypoxia
b. Hypercarbia

c. Fatigue
d. Lethargy
e. Hypovolemia
11. The usual opening pressures needed to inflate the airless lungs at birth range between:

a. 1-4 cmH2O
b. 5-9 cm cmH2O

c. 10-20 cmH2O

d. 21-60 cm 120

e. 61-75 cmH2O
12. The MOST common site of pulmonary atelectasis in children is

a. Right upper lobe

b. Right middle lobe

c. Right lower lobe

d. Left upper lobe

e. Left lower lobe

13. The life span of red blood cells is decreased in newborns due to:

a. Increased alkaline phosphatase in RBCs

b. Decreased alkaline phosphatase in RBCs

c. Increased glucose 6 phosphatase in RBCs

d. Increased phosphorylase in RBCs

e. Decreased glutathione in RBCs

14. The MOST important function of the juxtaglomerular apparatus is to:

a. Secrete water and sodium into the tubular fluid

b. Release renin in response to a drop in renal blood pressure or blood flow

c. Assure the diameter of efferent arteriole is kept larger than that of afferent arteriole
d. Produce antidiuretic hormone in response to increased glomerular filtration rate
e. Produce chemicals that change the diameter of the loop of Henle
15. Which one of the following statements about the control of the peripheral circulation and blood
pressure is TRUE?
a. Carotid chemoreceptors have no role in the control of blood pressure

b. The sudden assumption of an upright posture increases venous return

c. The sudden assumption of an upright posture results in bradycardia

d. The central vasomotor center is stimulated in the medulla oblongata

e. The arterioles account for about 90% of the total peripheral resistance
16. The MOST devastating effect of hypernatremia is:
a. Adrenal hemorrhage

b. Intestinal bleeding
c. Renal failure

d. Cardiac failure
e. Brain hemorrhage

17. A child developed hypothermia (temperature 95°F or 35°C) for the last 6 hours. Hypothermia
could be due all of the following, EXCEPT:

a. Hypothyroidism
b. Overuse of antipyretic.

c. Cold exposure
d. Overwhelming sepsis
e. Hypothalamic disorder

18. Which of the following is FALSE about the atrial natriuretic peptide (ANP)?

a. Stimulates sodium resorption

b. Inhibits vasopressin secretion

c. Stimulates natriuresis
d. Regulates relaxation of arterial smooth muscles

e. Has as an important effects on salt and water balance.

19. Oxygen dissociation curve appears shift to right (decrease in affinity, increase of oxygen release
to tissue) in:
a. Alkalosis

b. Hyperthermia
c. Hypothermia

d. Decrease CO2
e. Decrease ATP
20. A newborn is delivered by emergency cesarean section because of fetal distress following acute
abruption of the placenta. The infant is resuscitated and transferred to the nursery. 0 F. she
appears pale, and her extremities are cold to touch. The capillary refill is 8 seconds. Results of an
arterial blood gas analysis shows a pO2 of 48 mmHg. Of the following, the MOST likely additional
lab finding is:
a. Hyperglycemia

b. Hyponatremia
c. Decreased bicarbonate

d. Normal anion gap

21. Physical examination of a new born reveals hypoplastic nails. The medication used by mother
that can cause this problem is:
a. Lithium
b. Thalidomide
c. Phenytoin

d. Phenobarbital
22. All of the following medications can cause gynecomastia, EXCEPT

a. Isoniazid
b. Ketconazole

c. Metronidazole
d. Cimetidine
e. Streptomycin
23. Characteristics of drug safety to be use by lactating mothers do NOT include:

a. Plasma bound
b. Weaker acids

c. Small molecules
d. Poorly absorbed from maternal GI tract

e. Poorly absorbed from newborn GI tract

24. One possible side effect of Furosemide on premature infants is:

a. Apnea
b. IVH (intraventricular hemorrhage)

c. Edema
d. Deafness

e. Hypertension
25. The following statement is FALSE about Dopamine:

a. Predominantly-alpha-adrenergic agonist
b. Selective renal vasodilator effect

c. Useful in patients with a compromised renal function

d. Vasoconstriction predominates if the dose is increased above 15 microgram kg/minute

e. Increases cardiac contractility with little peripheral vasoconstriction at a dose 2-10

microgram/kg/minute
26. Which of the following describes an agonist?
a. Any substance that brings about a change in biologic function through its chemical action

b. A specific regulatory molecule in the biologic system where a drug interacts

c. A drug that binds to a receptor and stimulates cellular activity

d. A drug that binds to a receptor and inhibits or opposes cellular activity

e. A drug directed at parasites infecting the patient
27. Which of the following is the amount of a drug absorbed per the amount administered?

a. Bioavailability

b. Bioequivalence

c. Drug absorption
d. Bioinequivalence
e. Dosage
28. A nurse is administering cyclophosphamide (Cytoxan) to a child with leukemia. Which action by
the nurse would be appropriate?
a. Monitoring serum potassium levels

b. Checking for hematuria

Explanation

c. Obtaining daily weights

d. Getting neurological checks every 4 hours

e. Checking for arrhythmias

29. A complication of using a hydrogen pump inhibitor (e.g.. Omeprazole, Lansoprazole) is:

a. Acquired pyloric stenosis

b. Diarrhea

c. Vomiting
d. Gastroesophageal narrowing

e. Bacterial overgrowth

30. A previously healthy 10-year-old boy is brought to ED immediately a sudden onset of difficulty
breathing that began when he was stung on the arm by a bee. On arrival, he is in severe
respiratory distress. His temperature ,pulse 115/min, respirations 68/min, and bland pressure
80/40 mm Hg. Examination shows supraclavicular and intercostal retractions. There is diffuse
urticaria over the trunk. upper and lower extremities. Expiratory wheezes are heard bilaterally.
Which of the following is the MOST appropriate initial pharmacotherapy?
a. Oral diphenhydramine

b. Inhaled fluticasone
c. Intramuscular epinephrine

d. Intravenous methylprednisone
e. Intravenous ranitidine
31. Which of the following adverse effects is NOT commonly seen with cholinergic antagonists?
a. Blurred vision

b. Confusion
c. Miosis

d. Constipation
e. Urinary retention
32. The toxic effect of amphotericin B which definitely requires reduction dose is:
a. Myelosuppression

b. Hepatitis
c. Renal Toxicity

d. Hypotension
e. Infusion-related adverse effects
33. A 2-year-old girl has taken accidently overdose of Digoxin. The drug of choice in her treatment will
be:
a. Lidocaine

b. Phenytoin
c. Digoxin antibodies

d. Potassium chloride
e. Magnesium sulfate
34. A 3 year old boy suffering from cerebral edema will be best treated with:
a. Furosemide

b. Amiloride
c. Ethacrynic acid

d. Mannitol

e. Acetazolamide
35. A5-month-old infant suffered from recurrent attacks of hypoglycemia, All of the following drugs
can be used in treatment of hypoglycemia, EXCEPT:

a. Diazoxide
b. Somatostatin

c. Glucagon
d. Propranolol

e. Glucose infusion
36. Most common type of Infra-tentorial brain tumor in a 3-year-old boy is:

a. Gliomas (chiasmal)
b. Pineal region tumors.

c. Ependymama
d. Medulloblastoma

e. Craniopharyngioma
37. A male neonate has syndactyly of the index, middle, and third fingers of his left hand. Which of
the following cellular processes is MOST likely to have failed during development?
a. Apoptosis

b. Differentiation
c. Fusion

d. Migration
e. Proliferation
38. Which of the following casts found upon urine microscopy are suggestive of glomerulonephritis?
a. Red cell casts

b. White cell casts

c. Granular brown casts

d. Hyaline casts
e. Waxy casts
39. The TRUE statement about hematuria:
a. Less than 5 RBC per high pawer field
b. Hematuria means renal disease
c. Hematuria with proteinuria indicate kidney source

d. Does not occur in fever, exercise, and gastroenteritis

e. Does not occur in respiratory infection and viral infection
40. The first sign of liver damage is:
a. Increased SGOT

b. Increased SGPT
c. Increased alkaline phosphatase

d. Increased PT (prothrombin time)

e. Increased PIT partial thromboplastin time)
41. A 14-month-old male infant presents with an enlarging abdominal mass, Laboratory examination
reveals increased urinary levels of Vanillylmandelic acid (VMA). A histologic section reveals a
tumor composed of small, primitive appearing cells with hyperchromatic nuclei and little to no
cytoplasm. Focal groups of cells are arranged in a ring around a central space. The MOSI likely
diagnosis is:

a. Adrenal cortical turner

b. Ganglioneuroma
c. Neuroblastoma

Explanation

d. Nephroblastoma
e. Pheochromocytoma
42. The pathogenicity of the tubercle bacillus is due to which ONE of the following
a. Ability to multiply within macrophages

b. Delayed hypersensitivity reaction against the bacteria

c. Direct toxic effect on host cells

d. Effective antibody response
e. Necrosis caused by expanding granulomas
43. Serum alpha fetoprotein level is decreased in:
a. Omphalocele

b. Cirrhosis in early childhood

c. Meningomyelocele

d. Multiple gestation
e. Congenital nephrosis.
44. A 4-year-old girl presents with nephrotic syndrome. A renal biopsy is performed. There are no
abnormal findings on light microscopic or immunofluorescence examination. Which of the
following findings with electron microscopy is MOST likely in this biopsy?

a. Subepithelial electron-dense humps

b. Reduplication of glomerular basement membrane

c. Areas of thickened and thinned basement membrane

d. Effacement of podocyte foot processes

e. Increased mesangial matrix

45. Which of the following is NOT a useful effect of acute inflammation?
a. Swelling of tissues
b. Dilution of toxins

c. Fomation of fibrin
d. Phagocytosis

e. Stimulation of immune response

46. A 9-year-old boy was admitted to PICU with the diagnosis of bacterial meningitis. He had history
of fever 40 for the last 3 to 5 days. He was treated with ibuprofen for the diagnosis of UIT. the bus
subsequently became unresponsive and was placed on mechanical ventilator. He was receiving
dopamine drip for hypotension. A step-by-step progression from infection to death due to sepsis:
a. Infection, sepsis, SIRS "systemic inflammatory response syndrome", severe sepsis, septic
shock, MODS (multiple organ dysfunction syndrome), and death
b. Infection, SIRS, sepsis, severe sepsis, septic shock, MODS, and death

c. Infection, MODS, sepsis, severe sepsis, septic shock SIRS, and death
d. Infection, sepsis, severe sepsis, septic shock, SIRS, MODs, and deal
e. Infection, sepsis, severe sepsis, SIRS, septic shock, MODS, and death
47. A 12-year-old boy appears with history of pain, limping, and swelling in the lower end of left thigh.
The symptoms started 2 weeks ago while he was playing soccer game. He had history of trauma
during the game. Physical examination reveals swelling, redness, and tenderness in the lower left
thigh. X-ray of left femur reveals sunburst appearance. MOST likely diagnosis is:
a. Neuroblastoma
b. Neurofibroma
c. Osteoid osteoma

d. Ewing's sarcoma
e. Osteosarcoma

48. A 3-year-old girl is brought to the ED 30 minutes after she tripped and fell. Physical examination
shows blue sclera and edema and tenderness over the right proximal lower extremity. X-rays
show a fracture of the right femur, as well as several fractures of varying ages of the left clavicle,
right humerus, and right fibula. Which of the following is the MOST likely diagnosis?

a. Achondroplasia
b. Ehlers-Danlos syndrome

c. Hurler syndrome
d. Marfan syndrome
e. Osteogenesis imperfecta

49. Which of the following MOST commonly cause transudative pleural effusion?
a. Pneumonia
b. Pulmonary embolism

c. Nephrosis

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d. Rheumatic arthritis
e. Malignancy
50. Gram stain reveals no organisms. What is the MOST likely pathogen?
a. Mycobacterium tuberculosis

b. Hemophilus influenza

c. Streptococcus pneumonia
d. Enterovirus

e. Neisseria meningitides
51. Deficiency of essential fatty acids leads to any of the following, EXCEPT:
a. Fatty liver
b. Dermatitis
c. Sterility
d. Retarded growth

e. Microcytic anemia
52. The most common enzyme deficiency in urea cycle defects:
a. Ornithine transcarbamylase (OTC)

b. Carbamylphosphate synthetase (CPS)

c. N-acetylglutamate synthetase
d. Arginosuccinic acid synthetase
e. Arginosuccinic acid lyase
53. The true statement about pyloric stenosis is:

a. More common in first-born female child

b. Incidence of pyloric stenosis is 20% if father has pyloric stenosis
c. Usually presents with bilious vomiting
d. Hypochloremic metabolic alkalosis is present

e. Ultrasonography finding is not conclusive

54. A 7-year-old boy is diagnosed with primary hyperthyroidism. Thyroid function test (TFT) should
reveal: