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Case 1. A 2-year-old child is found to have failure to thrive, polydipsia, polyuria and weakness of muscles. Laboratory tests show presence of phosphaturia, aminoaciduria, glucosuria, a metabolic acidosis.

This patient most likely has:

  1. De Toni-Debre-Fanconi syndrome.

  2. Renal glucosuria.

  3. Diabetes insipidus.

  4. Alport's syndrome.

  5. Hartnup diseases.

Case 2. A 5-month-old child is under pneumonia treatment. He is breast-fed. The physician advises to add non-milk food after child's recovery.

Which of following food-stuffs will he advise to use first?

  1. Mashes apples.

  2. Mashes vegetables.

  3. Yogurt.

  4. Semolina.

  5. Buckwheat porridge.

Case 3. A 12-month-old infant is admitted to the hospital because of dehydration and diarrhea of 3 day's duration. The infant weighed 10 kg at a well visit 1 week ago. She has had 10 to 12 stools per day for the past few days and a temperature of 39C. She has not urinated for the past 18 hours. Physical examination reveals sunken eyes and dry tenting skin.

Which of following would you do first?

  1. Order a complete blood count and blood cultures.

  2. Obtain a urine specimen for culture, electrolytes and specific gravity.

  3. Begin plasma, 10 ml/kg intravenously, after obtaining blood for electrolytes and blood urea nitrogen.

  4. Obtain stool for fats, reducing substances, and culture.

  5. None of the above.

Case 4. A 8-month-old child was hospitalized in the emergency room because of attack of clonic convulsions. He is found to have the "caput quadratum", the "rachitic rosary", the "rachitic bracelets", and Harrison's groove.

The most appropriate therapy for the replacement of the electrolyte requirements would be:

  1. Calcium gluconatis.

  2. Sodium chloride.

  3. Sodium bicarbonate.

  4. Potassium chloride.

  5. Ammonium chloride.

Case 5. The patient is a 6-month-old child with ІІ degree hypotrophy of infectious genesis. He received antibiotics and rehydratation at the infectious department.

Which one of following is the principle of diet therapy at 1st stage of treatment?

  1. To prescribe high-calorie meal in volume according to age.

  2. To prescribe partially adapted nonlactose formulas 1 l/day during 2-3 weeks.

  3. To prescribe artificial feeding with solid food since the first days.

  4. To add the fat up to 10 g/kg from 2nd week.

  5. To determine the tolerance to food.

Case 6. The patient is 2-month-old child. The X-ray examination reveals the extension of stomach, high level of fluid, and the delay of contrast substance in a stomach for a long time (10 hours), which does not disappear after atropine. The most likely diagnosis is:

  1. Pylorospasmus.

  2. Atresia of esophagus.

  3. Cystic fibrosis.

  4. Pylorostenosis.

  5. Hirshprung’s disease.

Case 7. A previously well 1-year-old infant has had a runny nose and has been sneezing and coughing for 2 days. Two other member of the family had similar symptoms. Four hours ago his cough became much worse. On physical examination he is moderate respiratory distress with nasal flaring, hyperexpansion of the chest, and easily audible wheezing without rales. The most likely diagnosis is:

  1. Bronchiolitis.

  2. Viral croup.

  3. Asthma.

  4. Epiglottitis.

  5. Diphtheria.

Case 8. An 8-month-old infant presents with fever, runny nose, cough, and hyperexpansion of the chest. Expiratory wheezes are present. The most likely diagnosis is:

  1. Croup.

  2. Bronchiolitis.

  3. Asthma.

  4. Acute epiglottitis.

  5. Cystic fibrosis.

Case 9. A 10-year-old boy complains on headache, weakness, pain in right ileac area, and vomiting. He is found to have fever (40°C), dyspnea, visible lag in respiration on the right. Physical examination reveals dullness, diminished breath sounds on the affected side. Abdomen is soft and painless at palpation.

Which of the following is the most likely diagnosis?

  1. Intestinal infection.

  2. Acute appendicitis.

  3. Acute cholecystitis.

  4. Pneumonia.

  5. Influenza.

Case 10. The patient is a 10-year-old girl with legionella pneumonia. The most appropriate antibiotics for this girl would be:

  1. Ceftriaxon.

  2. Penicillin.

  3. Gentamicin.

  4. Spiramycin.

  5. Nalidixic acid.

Case 11. Risk factors for asthma include all of the following EXCEPT:

  1. Family history of asthma.

  2. Eczema.

  3. Smoking in the family.

  4. Rural housing.

  5. Allergen exposure.

Case 12. The patient is 2-year-old boy with recurrent obstructive bronchitis. He is found to have situs inversus. The most likely diagnosis is:

  1. Cystic fibrosis.

  2. Dextrocardia.

  3. Bronchiectasis.

  4. Chronic bronchitis.

  5. Kartagener syndrome.

Case 13. The patient is a 14-year-old girl with acute rheumatic fever. The most reliable method of prevention of recurrent episodes of acute rheumatic fever for her is:

  1. Prophylactic penicillin for all dental and surgical procedures as well as for trauma and febrile illness.

  2. Prompt treatment with oral or intramuscular penicillin for 10 days for any signs or symptoms of pharyngitis.

  3. Prompt treatment with oral or intramuscular penicillin for 10 days for any febrile illness.

  4. An intramuscular injection of bicillin-5 every 4 weeks.

  5. Prompt administration of penicillin and corticosteroids for 14 days for any documented infection with group A beta-hemolytic streptococci.

Case 14. A patient is a 6-year-old girl with asthma. The most common roentgenographic abnormality in this child is:

  1. Bronchiectasis.

  2. Generalized hyperinflation.

  3. Lower lobe infiltrates.

  4. Pneumomediastinum.

  5. Right middle lobe atelectasis.

Case 15. The patient is a 1.5-year-old with tetralogy of Fallout. Suddenly he becomes hyperpneic and restless, cyanosis increases. The child assumes a squatting position. The most appropriate drug for immediate treatment of this child is:

  1. Obsidane.

  2. Prednisone.

  3. Digoxin.

  4. Furosemide.

  5. Riboxin.

Case 16. A 6-year-old child is admitted to the hospital with a temperature of 38.5C, tachycardia, and polyarthritis. The physician suspects acute rheumatic fever.

Major criteria for the diagnosis of this illness include all of the following EXCEPT:

  1. Increased anti-streptolysin O (ASO) titer.

  2. Carditis.

  3. Chorea.

  4. Polyarthritis.

  5. Subcutaneous nodules.

Case 17. A 7-year-old male presents with episodes of abdominal pain, nausea, and vomiting that last several hours and subside spontaneously. The past medical history, review of systems, family history, and physical examination are unremarkable. What imaging study would be most appropriate to begin his evaluation?

A. Gastroscopy.

B. Abdominal ultrasonography.

C. Barium enema.

D. Diuresis renography.

E. None of the above.

Case 18. A 10-year-old boy presents headache. The pediatrician suspects coarctation of the aorta. Feature of this congenital heart disease is:

  1. Most often seen just distal to the left subclavian artery.

  2. Difference in blood pressure in upper and lower extremities.

  3. Notching of the ribs.

  4. Left ventricular hypertrophy.

  5. All the above.

Case 19. A young girl with recurrent urinary tract infections develops moderate hypertension. An intravenous pyelography shows renal pelvic calyces bordering in the edges of both kidneys at the superior poles. Which exam is necessary for an exact diagnosis?

  1. Renal ultrasound.

  2. Renal arteriogram.

  3. Retrograde cystogram.

  4. Renal biopsy.

  5. Renal scan.

Case 20. A 5-month-old male infant has a urine output of less than 0.1 mL/kg/hr shortly after undergoing major surgery. On examination, he has generalized edema. His blood pressure is 94/48 mm Hg, pulse is 140/min, and respirations are 20/min. His blood urea nitrogen is 38 mmol/L, and serum creatinine is 0.2 mmol/L. Initial urinalysis shows a specific gravity of 1.018 and 2+ proteins. Microscopic examination of the urine sample reveals 1 WBC per high-power field (HPF), 18 RBCs per HPF, and 5 granular casts per HPF. His fractional excretion of sodium is 3.2 %. Which of the following is the most appropriate next step in diagnosis?

  1. CT of the abdomen and pelvis.

  2. Cystourethrography.

  3. Intravenous pyelography.

  4. Renal biopsy.

  5. Renal ultrasonography.

Case 21. A 2-year-old child is found to have failure to thrive and his lower extremities deformed. Laboratory tests show hypophosphatemia, hyperphosphaturia and a normal content of calcium in blood. The most likely diagnosis is:

  1. Fancony's syndrome.

  2. Rickets.

  3. Diabetes insipidus.

  4. Renal tubular acidosis.

  5. Diabetes mellitus.

Case 22. A child is seen for a well-baby examination. He can follow a bright toy with his eyes and smile. When he is on his belly he can lift up his head and hold it in lifted position, but this child can't sit. How old is the child?

  1. 2-month-old.

  2. 4-month-old.

  3. 5-month-old.

  4. 6-month-old.

  5. 7-month-old.

Case 23. A 5-month-old child is admitted to the hospital with salmonellosis. Physical examination reveals aphonia, dry skin and mucous membranes, sunken eyes and the fontanel, decreased turgor of tissues, and decreased skin elasticity. The content of protein in his blood is 86 g/l. The content of sodium in his blood is 160 mmol/L. The child most likely has:

  1. Isotonic dehydration.

  2. Hypertonic dehydration.

  3. Hypotonic dehydration.

  4. Hyperhydration.

  5. None of the above.

Case 24. A 18-month-old child presents with a crouplike voice and painful flexion of the wrists with extended fingers. The most likely diagnosis is:

  1. Hypocalcaemia.

  2. Hypoglycemia.

  3. Hyposodiumemia.

  4. Adrenal crisis.

  5. None of the above.

Case 25. The patient is a 5-month-old child. His birth weight was 3.4 kg. Now his weight is 3.7 kg. Appetite is normal. He is an artificial-fed. Infant is pale. Subcutaneous fat is absent everywhere. He does not hold head. He is found to have edema on legs. A stool is copious, greasy, 8 times per day.

The most likely syndrome and complications are:

  1. Alimentary hypotrophy.

  2. Acute intestinal infection, ІІ degree hypotrophy.

  3. Acute nephritis, III degree hypotrophy.

  4. Malabsorption syndrome, ІІІ degree hypotrophy, hypoproteinemia.

  5. Chronic pyelonephritis with renal insufficiency.

Case 26. A 4-month-old child has lost 22 % of weight after prolonged intestinal infection. He poorly keeps head. He is pale. His skin is dry. Turgor is sharply reduced. The subcutaneous fat is present only on face. The abdomen is distended. The stool is unstable.

The most likely degree of hypotrophy is :

  1. The 1st degree.

  2. The 2nd degree.

  3. The 3rd degree.

  4. The 4th degree.

  5. The 5th degree.

Case 27. The patient is a one-year-old boy with bronchiolitis. The most likely agent responsible for illness in this patient is:

  1. Staphylococcus aureus.

  2. Haemophilus influenzae.

  3. Corynebacterium diphtheriae.

  4. Respiratory syncytial virus.

  5. ECHO virus.

Case 28. The patient is a 7-month-old infant with acute bronchiolitis. Which of following statements about this illness is true?

  1. It is usually associated with high fever and rash.

  2. It is usually associated with bilateral infiltrates on chest roentgenogram.

  3. It is commonly associated with retractions, tachypnea, and wheezing.

  4. It is characterized by the absence of cough despite respiratory distress.

  5. It is most common between 2 and 5 years of age.

Case 29. A 6-year-old child is brought to the hospital with a 2 days history of fever to 38.9°C. He is noted to have respiratory distress, severe air hunger, and cyanosis. The physical examination of the chest reveals localized dullness to percussion. Auscultation reveals diminished breath sounds and fine, localized rales on the right. X-ray shows infiltrates on the right. A CBC test shows RBC – 3.9 T/l, Hb – 110 g/l, WBC – 17.8 G/l, banded – 10 %, segm. – 65 %, lymph. – 20 %, mon. – 3 %, ESR – 26 mm/hour. What is the most likely diagnosis?

  1. Pleural effusion.

  2. Pneumonia.

  3. Bronchiolitis.

  4. Asthma.

  5. Acute bronchitis.

Case 30. The patient is a 6-year-old boy with mycoplasma pneumonia. The most appropriate antibiotics for this girl would be:

  1. Cefuroxim.

  2. Chloramphenicol.

  3. Spiramycin.

  4. Gentamicin.

  5. Penicillin.

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