1. 1. An 8 – year – old girl is brought in to the hospital while a actively seizing. She has been hospitalized many times before for status epilepticus. She is receiving valproic acid at home to control the seizures. The first step in the management of this patient is to:
Administer 20 mL/kg 0.9% normal saline
Establish secure intravenous access and administer an anticonvulsant
Administer activated charcoal via NG tube
Stabilize airway and provide 100% oxygen
Perform gastric lavage

2. Syndrome of inappropriate antidiuretic hormone (SIADH)
2. An 8 – year-old, 40-kg child presents with a history of vomiting for 3 days. There is no fever or diarrhea. Her mother reports bedwetting and increased fluid consumption for the same period. Her vital signs are as follows: HR 140, RR 35, BP 94/60. available laboratory data includes Na 114 mEq/L, K+ 4.0 mEq/L, C1 95 mEq/L, HCO -3 less than5 mEq/L, BUN 14mmol/l, and creatine 95 umol/L. The most likely cause for these electrolyte abnormalities is:
Syndrome of inappropriate antidiuretic hormone (SIADH)
Renal salt wasting
Acute tubular necrosis
Diabetic ketoacidosis (DKA)
Hemolytic – uremic syndrome (HUS)

3. 3. A 1-year-old child presents with severe, watery diarrhea for the last 4 days. You suspect rotaviral diarrhea. His eyes are sunken, the pulse is 190 beats/minute, and his extremities are cool. His weight on admission is 10 kg. His serum sodium is 175 mEq/L. Assuming body water is 60% of the body weight and his normal serum sodium is 140 mEq/L, which of the following is closet to his child’s calculated free water deficit?
500mL
750mL
1000mL
1500mL
2000mL

4. Meckel’s diverticulum Primary peritonitis Intestinal worm infestation
4. A 1-year-old child is being seen with a history of nausea, vomiting, and severe abdominal pain. There is no history of fever or rash. The mother reports no history of trauma. The physical examination is pertinent for significant, diffuse abdominal pain to palpation with no rebound tenderness. The laboratory evaluation is significant for an amylase of 1400 U/L, and a lipase of 3000 U/L. what is the most likely etiology of this patient’s disease?
Pancreatitis
Meckel’s diverticulum
Primary peritonitis
Intestinal worm infestation
Acute appendicitis

5. Extrapyramidal cerebral palsy Quadriplegia Dystonic cerebral palsy
5. A 6-month-old infant was delivered at 33 weeks gestation. The neonatal course was complicated by grade II intraventicular hemorrhage on the left and initial slow feeding. The baby required ventilation for 3 days and was weaned off of oxygen after 10 days. The neuro-developmental out come expected for this infant is
Diplegia
Hemiplegic CP
Extrapyramidal cerebral palsy
Quadriplegia
Dystonic cerebral palsy

6. Fractured nasal cartilage Choanal stenosis Snuffles
6. A 2-week-old infant is admitted with history of troubled breathing. The parents report that hits child has had a stuffy nose since birth. Since their discharge home after delivery, they report that their child is congested. He struggles to breath and can eat only 1 oz of his bottle at a time. The parents have been taking turns getting up to feed him every hour.. The most likely diagnosis is:
Nasal polyps
Fractured nasal cartilage
Choanal stenosis
Snuffles
Nasal encephalocoele

7. HIV DNA qualitative PCR HIV RNA quantitative PCR
7. You are seeing a 1-month-old infant in your office. The birth history reveals that the mother is HIV positive. The child has been doing well and tolerating AZT. The physical examination is unremarkable except for some mild thrush. Which laboratory test would help rule out infection in this infant?
HIV DNA qualitative PCR
HIV RNA quantitative PCR
HIV ELISA/Western blot
HIV viral load
HIV culture

8. The most common side effect of AZT treatment to be expected in this patient is:
Myopathy
Pancreatitis
Anemia
Diarrhea
Rash

9. CBC, CRP Blood culture Ct- brain EEG CSF study
8. A 3-week-old infant is hospitalized with fever, poor feeding, and fussiness for the last 2 days. The fever increased to 38.5C0 on the day of admission. Maternal history is unremarkable and the delivery was uneventful. The mother is breastfeeding. Her diet is unremarkable, although she does use an unprocessed cheese that she procures at a local market. On examination, the baby is fussy irritable, The lungs are clear and there is no skin rash. The most important test to help in the diagnosis
CBC, CRP
Blood culture
Ct- brain
EEG
CSF study

10. The most likely organism will be
Escherichia coli (E. coli)
Hemophilus influenzae
Staphylococcus aureus
Listeria monocytogenes
Clostridium perfringens

11. impetigo Sinusitis Nasal foreign body Allergic rhinitis
9. A 3-year-old boy is brought to your office with the complaint of persistent rhinorrhea. No history oh head trauma. The following can be considered in diagnosis; Except
impetigo
Sinusitis
Nasal foreign body
Allergic rhinitis
Basal skull fracture

12. Chemical conjunctivitis Gonococcal conjunctivitis
10. A 10-day-old baby presents to your office with a 1-day history of unilateral conjunctivitis. The upper and lower eyelids are mildly swollen, the sclera is inflamed and red, and there is a mucopurulent discharge. The baby is acting well and has no fever. The mother denies any sexually transmitted diseases (STDs) during pregnancy. In the delivery room, the baby received prophylactic erythromycin eye drops. The most likely cause of this child’s problem is:
Chemical conjunctivitis
Gonococcal conjunctivitis
Chlamydial conjunctivitis
Allergic conjunctivitis
Dacryostenosis

13. Infants treated with erythromycin should be followed for signs and symptoms of
Renal impairment
Malabsoebtion syndrome
Hepatitis
Hypertrophic pyloric stenosis
Bone marrow depression

14. Reactive airway disease (asthma)
11. A 5-year-old girl is seen in the ED because of fever, sore throat, and respiratory distress that developed rapidly over the past 3 hours. She is drooling and holding her neck in a hyperextended position. She has mild inspiratory stridor but does not have a barky cough.
Viral croup
Spasmodic croup
Epiglottitis
Bacterial tracheitis
Reactive airway disease (asthma)

15. Enteroviral encephalitis Guillain-Barré syndrome
12. A 9-year-old boy comes to your office because of progressive, generalized, bilateral lower extremity weakness and ataxia. He has also been complaining of some diminished sensation in his fingers and toe. On physical examination, you cannot elicit DTRs in his legs, and there appears to be mild facial weakness. Aside from a URI about 10 days ago, he has been healthy. CSF shows elevated protein with minimal pleocytosis. What is the most likely diagnosis?
Viral meningitis
Tick paralysis
Enteroviral encephalitis
Guillain-Barré syndrome
Acute lymphoblastic leukemia

16. Cow’s mild protein allergy Starvation diarrhea
13. A 9-year-old infant who was previously healthy and gaining weight was recently discharged from the hospital. The hospitalization was the result of a bout of severe rotavirus diarrhea that required rehydration with IV fluids. Four days later, he is brought to your office because he continues to have loose stools after each feeding. He is now dinking his regular cow’s milk-based formula well. On physical examination he appears to be happy and well hydrated. A repeat rotavirus test is negative. What is the most likely reason for the baby’s continue loose stools?
Cow’s mild protein allergy
Starvation diarrhea
Secondary lactose intolerance
Viral gastroenteritis
Cystic fibrosis

17. Staphylococcus aureus E. coli Shigella rotavirus
14. A 15-month-old boy comes to your office because of bloody diarrhea that started today. The previous night he was seen in the local emergency room for management of a febrile seizure. The child had no previous history of convulsions. You collect a stool sample for microscopic examination and note that the stool contains many polymorphonuclear cells. Which organism is most likely responsible for this child’s illness?
Group A Streptococcus
Staphylococcus aureus
E. coli
Shigella
rotavirus

18. Constitutional growth delay Familial short stature
15. A 10-year-old boy is brought to your office because of intermittent, unexplained fevers over the past 18 months. His mother is especially concerned because she thinks her son has stopped growing. In fact, when you look at the boy’s growth chart, you note no height increase since age 8 and his height percentile has fallen from the 25th percentile to well below 5th percentile for age. A CBC demonstrates very mild anemia, but the patient’s erythrocyte sedimentation rate (ESR) is elevated. The urine pH is 5 and the serum bicarbonate is normal. The mother’s height and father’s height both fall at the 25th percentile
Constitutional growth delay
Familial short stature
Inflammatory bowel disease (IBD)
Renal tubular acidosis
Pituitary tumor and growth hormone deficiency

19. 16. An 18-month-old child is admitted to the hospital because of a 2-day history of fever and extreme irritability. The CSF analysis shows 2000 WBCs of which 90% are polymorphonuclear cells. The spinal fluid glucose is markedly depressed. The patient is started on cefotamine and vancomycin. Eight hours after admission, the child has a generalized convulsion. What would be your next course of action?
No additional diagnostic tests or treatment are needed
Start aggressive antipyretic treatment to decrease the chance of febrile seizure
Change antibiotics to provide a broader spectrum of coverage
Order a set of electrolytes
Order a computerized scan of the head to rule out a brain abscess.

20. Place baby on the belly (prone) Place baby on the side
17. A mother brings her 2-month-old baby girl for a regular checkup. She says that a friend told her she should always put the baby to sleep on her belly to prevent choking, in case the baby spits up. With regard to infant sleeping position, how should you counsel the mother?
Place baby on the belly (prone)
Place baby on the side
Place baby on the back (supine)
Elevate head of infant’s crib
Elevate foot of infant’s crib

21. Guillain-Barré syndrome Infant botulism Hypothyroidism
18. A 4-month-old boy comes to your office for a well-baby check-up. His mother expresses concern about his slow growth and poor motor development that she noticed over the last month. There is no history of constipation. On physical examination, the baby appears to be hypotonic and weak. You are unable to elicit DTRs. There is visible atrophy and fasciculation's of the tongue, but no ptosis or facial weakness. The most likely diagnosis is:
Guillain-Barré syndrome
Infant botulism
Hypothyroidism
Spinal muscular atrophy
Myasthenia gravis

22. Otitis externa from the bath water
19. A 5-month-old baby presents to the Urgent Care Center with a fever and history of chronic, draying ear. You note a severe diaper rash, cradle cap, and a scailing, purpuric, papular rash appearing over the trunck on your thorough physical examination. Your diagnosis is:
Otitis externa from the bath water
Contact dermatitis from the laundry detergent
Langerhans cell histiocytosis
Atopic dermatitis
scabies

23. Echocardiogram Electrocardiogram Cardiology consult Reassurance only
20. The parents of a 6-month-old Saudi boy report that the child has been “turning blue” since birth. In the first few weeks of his life, they noted that his fingers and toe seemed bluish, although that condition has resolved. Now they notice that the skin around his mouth is blue, especially when he is outside in cool air. The child has been otherwise well, growing, gaining weight, and developing appropriately. Vital signs and physical examination are normal, with normal pulses in all extremities, and no audible murmurs or abnormal cardiac sounds. What is the next step in evaluating this child?
Echocardiogram
Electrocardiogram
Cardiology consult
Reassurance only
Chest radiograph

24. 21. A 14-month-old-boy is seen in your office because his mother is concerned about his bowlegs. He began walking at 10 months, and since then she has noticed that his gait is becoming worse. On examination, you find he does have significant leg bowing bilaterally, and x-rays reveal evidence of rickets. Regarding his diagnosis, which one or the following is true?
Rickets of any kind is always associated with low serum calcium
Alkaline phosphates is high in this child
Parathyroid hormone is high in all forms of rickets
This boy cannot have vitamin D-resistant rickets if his mother is normal
Patients with vitamin D-deficiency rickets frequently have normal serum phosphorus

25. Vesicoureteral reflux Psychological problem
22. A 6-year-old boy comes to your office for a well-child checkup. His mother tells you that she is concerned about his nightly bedwetting. The boy has never had a prolonged period of nighttime dryness, and he never has “accidents” while awake. He has no dysuria and his urinary stream is normal. What is the most common cause of primary nocturnal enuresis
UTI
Vesicoureteral reflux
Psychological problem
Normal developmental variant
Unstable bladder

26. 24-hour blood pressure monitoring
23. Your are seeing a 10-year-old boy for his well-child checkup and notice that he is hypertensive. He has otherwise been doing well. When looking back through his old chart, you realize that his previous blood pressures were normal. What would be your next course of action?
Urinalysis
Renal ultrasound
24-hour blood pressure monitoring
Rechecking his blood pressure in 1 week
Basic metabolic

27. 24. A 7-month-old male is being seen in your office after hospitalized with streptococcus pneumoniae bacteremia and pneumonia. When looking through his chart, you notice that he has had multiple otitis media, and both his height and weight are at the 5th percentile. Which of the following is the most likely diagnosis?
X-linked agammaglobulinemia
Wiskott-Aldrich syndrome
Chronic granulomatous disease
Chediak-higashi syndrome
Leukocyte adhesion defect