1. What is active form of thyroid hormone?
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131. W hat is the most common congenital heart defect with a left to right shunt causing congestive heart failure in the pediatric age group? A. Atrial septal defect B. Atrioventricular canal C. Ventricular septal defect VSD D. Patent ductus arteriosus E. Aortopulmonary window
132. F ollowing resection of the terminal ileum, patients with short bowel syndrome will have additional requirements for vitamin A. B12 B. C
C. E D. B6
E. D
133. A ll of the following pathogens are a likely cause of early-onset neonatal sepsis EXCEPT A. Group B streptococcus B. Listeria monocytogenes C. Escherichia coli D. Staphylococcus epidermidis E. Haemophilus influenza
134. Which seromarker is specific for ulcerative colitis: A. ASCA B. ANCA
C. Serum albumin D. ESR
135. S pecify the paculiarities of the joint damage in children with rheumatoid arthritis: A. frequent damage of the knees, cervical spine, mandible joints B. relatively rare involvement in the pathological process of small joints of hands C. frequently than in adults, asymmetry of joint damage D. more frequently observed mono-and oligoartrity E. all of listed
136. E chocardiographic evidence of tamponade includes which of the following? A. Pericardial effusion >1 cm in largest diameter. B. Pericardial effusion with left ventricular collapse. C. Pericardial effusion with right ventricular collapse. D. Pericardial fluid collection.
137. A ll the following criteria are used routinely to determine evidence of malnutrition in children except
A. iron indices B. height for age C. growth hormone D. weight for height E. a and d only
138. W hich of the following is most appropriate for treating hyperbilirubinemia (190 micromol/L) in a 3-week-old, breast-fed infant with normal growth and development? A. Phototherapy B. Exchange transfusion C. Phenobarbital D. Intravenous immunoglobulin E.None of the above
139. I n a newborn with haemorrhagic disease: A. Platelet count is normal, prothrombin time prolonged, thrombin time is normal B. Platelet count is normal, prothrombin time prolonged, thrombin time prolonged C. Platelet count is low, prothrombin time is normal, thrombin time is normal
D. Platelet count is low, prothrombin time is normal, thrombin time prolonged E. None of the above
140. A 2700-g 36-week-gestational-age white male is born after 22 hours of premature rupture of the amniotic membranes. The Apgar scores are 3 and 5. He immediately develops respiratory distress and cyanosis requiring endotracheal intubation and mechanical ventilation with 100%
oxygen. Vital signs are: temperature 35,7C, heart rate 195, and mean blood pressure 22 mm Hg. Laboratory tests reveal a white blood cell count of 1.5x109/l and 59,000 platelets. The next most appropriate treatment for this infant is to administer A. Surfactant B. Intravenous ampicillin and gentamicin C. Intravenous immunoglobulin D. Intravenous indomethacin E. Enteral feeding
141. W hich of the following conditions is LEAST likely to be associated with neonatal seizures? A. E. coli meningitis B. Syndrome of inappropriate diuretic hormone secretion C. Transient tachypnea of the newborn D. Umbilical cord prolapsed E. Intracranial haemorrhage
142. P hototherapy effectiveness is based on A. Radiance energy B. Level of photooxidation C. Ability to convert indirect bilirubin into water-soluble forms D. Answers A,B,C E. Ability to stimulate glucuroniltransferase
143. W hat is diabetes mellitus by definition? A. Chronic metabolic disorder caused by an absolute deficiency of insulin
B. Chronic metabolic disorder caused by relative deficiency of insulin C. Chronic metabolic disorder caused by excess of insulin D. Chronic metabolic disorder caused by deficiency of insulin or it’s action E. Chronic metabolic disorder caused by antagonists to insulin
144. T he presence of hypoxemia with a normal A-a gradient usually implies A. an acid-base disturbance B. the presence of a shunt C. hypoventilation D. hyperventilation E. severe ventilation-to-perfusion (V/Q) imbalance
145. I ndicate the most likely localization of traumatic intracranial hemorrhage in a term newborn: A. Cerebral tissue B. Subarachnoid hemorrhage C. Subdural hemorrhage D. Intraventricular hemorrhage E. Epidural hemorrhage
146. T he mother of a 6-year-old with moderate persistent asthma is concerned about slow growth in her child, who is receiving beclomethasone dipropionate by CFC- propelled MDI 42 μg/puff at a dose of 6 puffs biD. He is well controlled on that dose. Which of the following is an appropriate recommendation? A. Switch the patient to montelukast 10 mg nightly B. Tell the mother there is no reason to be concerned C. Add a long-acting inhaled β2-agonist and reduce the beclomethasone dose D. Switch to fluticasone propionate 44 μg MDI 6 puffs biD. E. Add loratadine 5mg once a day
147. W hich form of rheumatoid arthritis in children is the most severe? A. Allergic subsepsis Wissler-Fanconi B. Articular-visceral, acute form C. Articular-visceral, chronic form D. Still's disease E. Shigren Syndrome
148. W hat disease leads to renal amyloidosis? A. Chronic glomerulonephritis B. Collagen nephropathy C. Renal tuberculosis D. Acute interstitial nephritis E. Diabetic nephropathy
149. C omplications commonly associated with parenteral nutrition therapy include A. nephrolithiasis B. pulmonary fibrosis C. hyperglycemia D. hypertension E. hypotension
150. A "tet spell" or "blue" spell of tetralogy of Fallot is treated with all of the following except: A. Oxygen B. Knee chest position. C. Morphine D. Digoxin E. Propranolol
151. What treatment method could be used in a newborn with cephalohematoma? A. Antibiotics B. Puncture with blood removal C. Diuretics D. Phototherapy E. Blood transfusion
152. A small baby (a low birth weight newborn) – is… A. A preterm infant with birth weight < 2 kg B. Any newborn with birth weight < 2,5 kg C. A growth retarded newborn with birth weight < 2,5 kg D. A term newborn with birth weight < 2,5 kg E. A preterm infant with birth weight < 2,5 kg
153. The upper gastrointestinal series refers to radiologic visualization of the A. rectum and pancreas B. esophagus, stomach, and small intestine C. large intestine and rectum D. pancreas and gallbladder E. rectum
154. A 24-week-gestation fetus of an Rh-negative,antibody- positive(sensitized) mother is noted on fetal ultrasonography to have bilateral pleural effusions, ascites, and scalp edema. The most effective way to evaluate this fetus is to perform A. Amniocentesis B. Percutaneous umbilical blood sampling C. Fetal real-time ultrasonography D. Maternal serum a-fetoprotein determination E. An oxytocin challenge test
155. T he single BEST way to assess whether your positive-pressure ventilations during neonatal resuscitation are adequate is: A. Allow the pressure gauge to rise above 30 cm H2O B. Auscultate breath sounds C. Auscultate/palpate heart rate (pulse rate) D. Watch for an improvement in colour E. Watch for an emergence of spontaneous respiratory efforts
156. W hat are six common etiologies of membranous nephropathies? A. Idiopathic, syphilis, Hepatitis B, SLE, gold salts, and malignancy B. Idiopathic, chronic heart failure, Hepatitis B, SLE, gold salts, and malignancy C. Idiopathic, syphilis, Hepatitis A, SLE, gold salts, and malignancy D. Idiopathic, syphilis, Hepatitis B, SLE, NSAIDs, and malignancy E. Idiopathic, syphilis, Hepatitis B, SLE, gold salts, and bronchial asthma
when prescribing empirical antimicrobial therapy to a newborn? A. Mycoplasma B. Group A Streptococcus C. Group B Streptococcus D. Pseudomonas E. Staphylococcus
158. The signs of elevated of intracranial pressure in newborns may include all of the following symptoms, EXCEPT A. Bulging anterior fontanel B. Lethargy C. Irritability D. Increasing head circumference E. Increasing blood pressure ?
159. When is epinephrine indicated? A. Persistent heart rate less than 100 beats per minute despite positive-pressure ventilation B. Persistent heart rate less than 60 beats per minute despite positive-pressure ventilation for 30 seconds followed by an additional 30 seconds of coordinated positive-pressure ventilation and chest compressions C. Initial heart rate of 0 D. Heart rate that has risen from 40 to only 80 beats per minute following 30 seconds of positive -pressure ventilation and an additional 30 seconds of coordinated positive-pressure ventilation and chest compressions
160. A 30-hour-old, 4300-g infant of a gestational diabetic mother has been feeding well but has become jittery during the past 30 minutes. Fifteen minutes later, the infant has a tonic-clonic seizure. The most likely diagnosis is A. Hypoglycemia B. Hypocalcemia C. Hypomagnesemia D. Hyponatremia E. Hyperviscosity
161. Pulse oximetry is least predictive of true oxygen saturation when (MVV) A. the PCO2 is elevated B. carbon monoxide is elevated C. the patient is febrile D. the patient is exercising E. the patient is slipping
162. Antenatal period lasts… A. From the 37th until the 42nd wk of pregnancy B.From the 37th wk of pregnancy until the 7th day of life C.During 28-40 wks of pregnancy D.From the 22nd wk of pregnancy until the onset of labor E.During 28-37 wks of pregnancy
163. What is recommended initial approach to increase blood volume in a newborn infant with septic shock?
A. Bolus 5% albumin, 10 ml/kg B. Bolus FFP, 20 ml/kg C. Normal saline, 10-20 ml/kg for 30-60 min D. Ringer lactate, 10-20 ml/kg for 3 hrs E. Refortan, 20 ml/kg for 2 hrs
164. Esophagogastroduodenoscopy is used to examine A. the esophagus B. the stomach C. the duodenum D. all of the above E. a and b only
165. Which of the following is the primary long-term controller medication for a 5-year-old girl with moderate persistent asthma? A. Salmeterol twice daily B. Fluticasone propionate twice daily C. Sustained-release theophylline twice daily D. Montelukast once daily E. Loratadine once a day
166. Complications commonly associated with parenteral nutrition therapy include A. nephrolithiasis B. pulmonary fibrosis C. hyperglycemia D. hypertension E. hypotension
167. Complications of parenteral nutrition include each of the following EXCEPT A. Sepsis B. Pulmonary emboli C. Liver disease D. Air emboli E. Irreversible atrophy of the mucosa of the small intestine
168. Which ONE of these is TRUE concerning the translocation that leads to the Philadelphia chromosome? A. It leads to increased expression of the c-ABL gene as it brings a strong gene promoter close to the c-ABL gene B. It is present in around 60% of cases of CML C. It is detected on a karyotype as t(8;21) translocation D. It leads to generation of a bcr-abl fusion protein ? E. bcr-abl fusion protein suppresses thyrosin kinase
169. In which situation the infant born to mother with positive nontreponemal test (VDRL, RW) must be treated with penicillin despite the absence of clinical symptoms? A. Any such an infant must be treated B. If mother had clinical symptoms during pregnancy C.If there is no reliable information about maternal treatment D.Only if mother’s treponemal test is positive E. Antibiotic should not be administered in absence of clinical symptoms in a newborn
170. One of your adult patients with severe chronic asthma recently was placed on two inhalations of salmeterol bid 3 months ago in addition to four inhalations of beclomethasone bid and as needed albuterol. He states that he has never felt better. On questioning him, he states that he occasionally awakens at night, although only once or twice per week, and that he did require a 7-day burst of prednisone for an upper respiratory tract infection last month. He is in to refill his albuterol, which was filled last month. This patient should A. continue with current therapy because he is improving B. consider increasing inhaled corticosteroid dose C. consider adding regular inhaled ipratropium bromide D. consider increasing salmeterol dose E. consider to use systemic steroids in the hospital
171. In premature infants, routine immunizations should be: A. Should not be administered during the first year of life B. Administered according to post-natal (chronological) age C. Administered according to corrected (post-conceptual) age D. Administered at a corrected age of two months. E. Administered at a post-natal age of two months.
172. Which of the following statements regarding short-acting inhaled β2-agonists is the most correct? A. Regular use of short-acting inhaled β2-agonists worsens asthma, increasing the morbidity from asthma B. Regular use of short-acting inhaled β2-agonists increases the risk of death and near death from asthma C. Short-acting inhaled β2-agonists should be used as needed so that their use can be employed as an outcome measure D. Regular use of short-acting inhaled β2-agonists produces tolerance so that patients will not respond during acute exacerbations E. a and b only
173. Which ONE of the following is TRUE about acute leukemia? A. It is most common oncological disease in children B. Lymph nodes enlargement is not typical for acute leukemia C. It is never associated with CNS involvement D. It is associated with less than 10% of blast cells in the bone marrow
E. DIC is not a presenting feature
174. How to feed the newborn with moderate RD? A. Carefully attach to the breast B. Should not be fed enterally C. With feeding tube D.With any alternative feeding method E. Should not be fed at all
175. Morphological features of immaturity are presented below, EXCEPT of: A. Flat pinna B. Slow recoil of the ear C. Breasts hardly recognized D. Складки шкіри підошов ? E. Increased fine hair
176. Which of the following is most true regarding renal transplantation? A. Renal transplantation is a reasonable option for all patients with end-stage renal disease B. Quality of life improves following renal transplantation C. HIV positivity is an absolute contraindication to renal transplantation D. Patients with polycystic kidney disease should be excluded from renal transplantation E. A and d only
177. Which of the following are NOT symptoms of myxedema? A. Dry, cold skin B. Lethargy C. Loss of hair D. Puffness of the face E. Bulging eyes
178. A major drawback to the use of nonsteroidal anti-inflammatory drugs in rheumatoid arthritis is that A. they may not alter disease progression B. they can cause decrease in renal function C. they may be contraindicated in a patient with aspirin hypersensitivity D. All of the above E. None of the above
179. The preferred drug treatment regimen for a penicillin-allergic H. pylori-positive 15-year-old boy with epigastric pain and a duodenal ulcer documented by radiography is A. lansoprazole + metronidazole B. ranitidine bismuth citrate + clarithromycin C. omeprazole + metronidazole + clarithromycin D. bismuth subsalicylate + metronidazole + tetracycline E. bismuth subsalicylate + metronidazole+ clarithromycin
180. W hich of the following are potential pulmonary complications among immunocompromised patients? A. Pneumocystis carinii B. Mycobacterium tuberculosis C. Mycobacterium avium complex D. All of the above E. a and c only
181. One of your adult patients with severe chronic asthma recently was placed on two inhalations of salmeterol bid 3 months ago in addition to four inhalations of beclomethasone bid and as needed albuterol. He states that he has never felt better. On questioning him, he states that he occasionally awakens at night, although only once or twice per week, and that he did require a 7-day burst of prednisone for an upper respiratory tract infection last month. He is in to refill his albuterol, which was filled last month. This patient should A. continue with current therapy because he is improving B. consider increasing inhaled corticosteroid dose C. consider adding regular inhaled ipratropium bromide D. consider increasing salmeterol dose E. consider to use systemic steroids in the hospital
182. After endotracheal intubation, it is appropriate to check the position of the tube by each of me following procedures EXCEPT A. Chest X-ray B. Auscultation for symmetric breath sounds C. Fiberoptic endoscopy D. Instillation of saline while listening for bubbling sounds E. Use of a magnet
183. In the treatment of acute exacerbations of chronic bronchitis, which of the following is true regarding treatment with ampicillin? A. Highly effective against penicillinase-producing bacteria B. Low incidence of gastrointestinal side effects C. Decreased compliance concerns due to recommended once-daily dosing D. None of the above E. All of the above
184. A n boy produced only 25 mL of urine in the past 24 hours. The urologist discovers that lymphatic hypertrophy is the cause. Which one of the following best describes this patient's acute renal failure? A. Prerenal oliguric B. Prerenal anuric C. Postrenal anuric D. Postrenal oliguric E. Intrinsic nonoliguric
185. N eonatal infections that are partially or completely preventable include all of the following EXCEPT A. Cytomegalovirus B. Group B streptococci C. Rubella D. Syphilis E. Tetanus F.Toxoplasmosis
186. A feature of grade III intraventricular haemorrhage (IVH) is … A. Localisation in germinal matrix B. Extension to cerebral tissue C. Bilateral haemorrhage D. Localisation in the fourth ventricle E. Ventricular enlargement
187. A n apneic newborn has not responded to suctioning, drying, and rubbing of the back. What is the appropriate next action? A. Provide supplemental oxygen. B. Flick the soles of the feet. C. Assess whether the baby is of term gestation. D. Begin positive-pressure ventilation.
188. W hen coordinating positive-pressure ventilation with chest compressions, approximately how many of each are performed each minute? A. 30 breaths, 90 compressions B. 40 breaths, 80 compressions C. 60 breaths, 60 compressions D. 60 breaths, 120 compressions
189. T he preterm newborn by definition is A. Born before completion of 38 weeks of gestation and has BW2500 g B. Born before completion of 37 weeks of gestation (less than 259 days) C. Born before completion of 37 weeks of gestation, has BW2500 g and BL45 cm D. Born before completion of 38 weeks of gestation (less than 267 days) E. Born alive before completion of 38 weeks of gestation (less than 267 days)
190. W hich of the following statements is true concerning the use of inhaled corticosteroids in children with mild persistent asthma? A. Inhaled corticosteroids are no more effective than cromolyn or nedocromil B. Inhaled corticosteroids are not recommended for children less than 5 years old C. Inhaled corticosteroids are the most effective and do not produce toxicity at recommended doses D. Inhaled corticosteroids in low doses are less effective than the leukotriene modifiers E. leukotriene modifiers are most effective than the inhaled corticosteroids in high doses
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