Heart & Circulation
A full-term boy had a normal pregnancy and postnatal stay. At around four weeks of age, he becomes increasingly lethargic and develops cold sweating and breathing difficulties during feeding. On examination, he is irritable and has hepatomegaly. Infection tests are negative.
What is the most likely diagnosis?
A. Heart failure due to congenital heart disease
B. Pneumonia
C. Congenital metabolic disease
D. Brain malformation
A. Heart failure due to congenital heart disease
What is the most common cause of chronic wet cough lasting more than four weeks in preschool children?
A. Protracted bacterial bronchitis
B. Bronchopulmonary dysplasia
C. Cystic fibrosis
D. Primary ciliary dyskinesia
A. Protracted bacterial bronchitis
A two-year-old is admitted after gastroenteritis. Hemoglobin is low, platelet count is low, and the peripheral blood smear shows fragmented red blood cells/schistocytes.
Which complication should you be particularly alert for?
A. New severe infection
B. Acute kidney failure
C. Primary bleeding disorder
D. Heart failure
B. Acute kidney failure
Which motor subtype of cerebral palsy is the most common?
A. Ataxic CP
B. Spastic CP
C. Dyskinetic CP
D. Hemiplegic CP
B. Spastic CP
A full-term infant is delivered by emergency cesarean section after 26 hours of ruptured membranes. At eight hours of age, the infant is pale and breathing at approximately 100 breaths/min, although SpO₂ is 98%.
What must be done immediately?
A. Measure glucose/bilirubin and start glucose and phototherapy
B. Obtain a blood gas, chest X-ray, and echocardiography without treating for infection
C. Obtain a chest X-ray and use CPAP as the only initial treatment
D. Obtain infection markers and blood cultures and start intravenous antibiotics
D. Obtain infection markers and blood cultures and start intravenous antibiotics
Which combination correctly describes Tetralogy of Fallot?
A. Overriding pulmonary artery + malalignment VSD + aortic stenosis + left ventricular hypertrophy
B. Overriding aorta + muscular VSD + pulmonary stenosis + biventricular hypertrophy
C. Overriding aorta + malalignment VSD + pulmonary stenosis + right ventricular hypertrophy
D. Overriding pulmonary valve + muscular VSD + pulmonary stenosis + right ventricular hypertrophy
C. Overriding aorta + malalignment VSD + pulmonary stenosis + right ventricular hypertrophy
A 14-month-old girl with a known egg allergy accidentally eats food containing egg. Shortly afterward, she vomits and develops swelling of the lips. She currently has normal capillary refill and no reported breathing difficulties.
What is the correct assessment/acute treatment?
A. This may be anaphylaxis; give intramuscular adrenaline and further allergy treatment
B. Anaphylaxis is unlikely because circulation is normal; no treatment is required
C. Anaphylaxis; give adrenaline intravenously
D. Anaphylaxis is ruled out because she has no airway symptoms
A. This may be anaphylaxis; give intramuscular adrenaline and further allergy treatment
Which statement about celiac disease in children is most correct?
A. Absence of both HLA-DQ2 and HLA-DQ8 makes celiac disease very unlikely
B. A positive deamidated gliadin peptide test is an indication to start a gluten-free diet before any biopsy
C. Celiac disease is not associated with other autoimmune diseases
D. tTG-IgA more than ten times the upper reference limit is always sufficient by itself to establish the diagnosis
A. Absence of both HLA-DQ2 and HLA-DQ8 makes celiac disease very unlikely
What is the most common cause of neonatal seizures?
A. Infection
B. Cerebrovascular injury
C. Hypoxic-ischemic encephalopathy
D. Metabolic disturbance
C. Hypoxic-ischemic encephalopathy
A three-hour-old full-term boy develops increasing respiratory distress, marked grunting, and chest retractions. He is pale and has an SpO₂ of 83%. You plan to start CPAP and oxygen.
Which differential diagnosis must be assessed quickly because CPAP could make the condition more dangerous?
A. Pneumothorax — consider chest X-ray
B. Intracranial hemorrhage — cranial ultrasound
C. Congenital urinary tract obstruction — urinary tract ultrasound
D. Congenital heart disease — echocardiography as the first investigation
A. Pneumothorax — consider chest X-ray
When a newborn starts breathing, the circulation changes dramatically. Which option correctly describes the normal transition?
A. The foramen ovale closes, and blood then flows from the left ventricle to the pulmonary arteries
B. The ductus arteriosus closes, and blood flows from the right ventricle through the pulmonary arteries to the lungs
C. The ductus venosus closes, and blood passes through the liver directly to the left atrium
D. The ductus venosus closes, and blood flows from the left atrium through the tricuspid valve
B. The ductus arteriosus closes, and blood flows from the right ventricle through the pulmonary arteries to the lungs
A 12-year-old boy has recurrent dry cough and shortness of breath during exercise, a history of eczema, seasonal allergies, and spirometry showing approximately 12% reversibility in FEV₁. He has mild/moderate asthma.
Which inhalation strategy is most appropriate/preferred?
A. Low-dose ICS + LABA, used as maintenance treatment and the same combination used for symptom relief
B. Low-dose ICS together with regular SABA, plus additional SABA as needed
C. Regular ICS/LABA, but a separate SABA for all as-needed use
D. Regular low-dose ICS with SABA as the only reliever medication
A. Low-dose ICS + LABA, used as maintenance treatment and the same combination used for symptom relief
A 12-year-old returns home from Nepal. He has had watery diarrhea for three weeks, without fever or blood, has lost some weight, and describes foul-smelling/rotten-egg-like belching.
Which pathogen is most likely?
A. Campylobacter jejuni
B. Rotavirus
C. Staphylococcus aureus
D. Giardia lamblia
D. Giardia lamblia
A healthy 2½-year-old girl has had several episodes after hurting herself. She first cries, becomes bluish, collapses, and briefly loses consciousness for approximately five to six seconds. She quickly wakes up and immediately returns to normal. There are no obvious seizures. Clinical examination is normal.
What is the most likely diagnosis?
A. Epileptic seizure
B. Vasovagal syncope
C. Cardiac arrhythmia
D. Breath-holding spell
D. Breath-holding spell
A pregnant woman with type 1 diabetes asks how hypoglycemia can be prevented in her baby after birth.
Which measures are most important for prevention?
A. Good temperature control and early breastfeeding/formula feeding
B. Early glucose measurement and intravenous glucose if needed
C. Routine intravenous glucose and a warming mattress for all infants
D. Routine tube feeding and placement of an IV cannula for intravenous glucose
A. Good temperature control and early breastfeeding/formula feeding
A six-day-old girl arrives at the pediatric emergency department in very poor condition. She has had dry diapers for the past 24 hours, is pale-gray in color, has hepatomegaly, and you cannot palpate femoral pulses.
What should be given immediately?
A. Oxygen
B. Prostaglandin
C. Adrenaline
D. Fluid bolus alone
B. Prostaglandin
Which of the following measures was recommended for acute bronchiolitis in the relevant examination?
A. Systemic or inhaled corticosteroids
B. Saline nose drops to keep the upper airways open
C. Routine inhaled beta-2 agonist
D. Prophylactic penicillin in children younger than three months
B. Saline nose drops to keep the upper airways open
A three-year-old recently weighed 14 kg. He is now assessed to have a fluid deficit of 1000 mL. Sodium is normal. Oral rehydration is unsuccessful. He first receives a 200 mL intravenous fluid bolus, improves clinically, and has no ongoing vomiting or diarrhea.
The remaining deficit and maintenance requirement should then be given evenly over the next 24 hours.
What is the correct hourly rate?
A. 83 mL/hour
B. 108 mL/hour
C. 100 mL/hour
D. 92 mL/hour
A. 83 mL/hour
A 13-year-old had her first menstrual period one month ago. She is currently 163 cm tall, and her mother is 165 cm tall. What is most likely regarding her final adult height?
A. She will end up approximately the same height as her mother
B. She will end up approximately 4–5 cm taller than her mother
C. She will end up approximately 9–11 cm taller than her mother
D. She will end up approximately 15–20 cm taller than her mother
B. She will end up approximately 4–5 cm taller than her mother
A full-term infant is 12 hours old, appears clinically well, and has no hepatosplenomegaly or dysmorphic features, but is clearly jaundiced.
What is the most likely cause?
A. Isoimmunization/hemolysis, particularly ABO incompatibility
B. Biliary atresia
C. Physiological hyperbilirubinemia
D. Infection
A. Isoimmunization/hemolysis, particularly ABO incompatibility