1. What is active form of thyroid hormone?
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(CMV) infection at birth is A. Asymptomatic viruria B. Deafness C. Microcephaly D. Intrauterine growth retardation E. Retinitis F.Hepatosplenomegaly
519. E ffective antenatal prevention of RDS includes: A. Administration of dexamethason B. Administration of prednison C. Reduction of period of membranes rupture D. Cesarean section E. Administration of oxytocine
520. H ow would you distinguish between primary, secondary and tertiary hypothyroidism? A. Measure TSH B. Biopsy gland C. CNS MRI D. Give TRH and measure T4 E. All of the above
521. W hat are the appropriate for newborns doses of intravenous and intratracheal (via the endotracheal tube) epinephrine us a 1:10000 concentration? A. 0,1 to 0,3 mL/kg intravenously and 0,3 to 1 mL/kg intratracheally B. 0,3 to 1 mL/kg intravenously and 0,1 to 0,3 mL/kg intratracheally C. 1 to 3 mL/kg intravenously and 0,3 to 1 mL/kg intratracheally D. 1 to 3 mL/kg intravenously and 0,1 to 0,3 mL/kg intratracheally
522. T he most reliable method to detect CMV: A. PCR with infant’s blood/urine B. Serum ELISA C. Urine cytological study D. Electronic microscopy of saliva E. Hepatic biopsy
523. W hat is an indication for antibiotic administration to a newborn with respiratory distress? A. Any newborn with respiratory distress B. Suspicion for congenital heart disease C. Persistent or growing in severity respiratory distress D. Physical changes in lung E. Silverman score of 2
524. W hat is the most specific clinical symptom of congenital syphilis? A. Hepatosplenomegaly B. Jaundice C. Osteochondritis D. Pneumnitis E. Generalized lymphadenopathy
525. A 2-week-old infant is brought to the emergency room in coma with retinal hemorrhages and severe pallor. He was born at home and was first seen by a physician at 10 days of age and placed on amoxicillin for otitis media. His diet is breast milk. The day before admission, his parents took him in a 4-wheel-drive vehicle over a rough road in the mountains. Seizures began 8 hours later, and he steadily deteriorated for the next 16 hours. He oozes blood from all venipuncture sites. Diagnostic tests should include all of the following EXCEPT A. Coagulation studies B. Skeletal survey C. CT scan D. Complete blood count E. Lumbar puncture
526. T he most important counseling information to convey to a patient prescribed an H. pylori eradication regimen containing ranitidine bismuth citrate (RBC) is A. RBC may cause ringing in the ears
B. RBC may cause your urine to turn orange C. RBC may cause dry mouth D. RBC may cause dry skin E. RBC may cause your stool to turn dark brown or black
527. S pecify the most reliable laboratory test of dermatomyositis. A. leukopenia B. increasing of creatinphosphokinase C. increasing of lactatdehydrohenase D. increasing of γ-globulin in serum E. increasing of AST
528. S elect the appropriate feeding method for the preterm baby with a corrected age of 29 wks in satisfactory condition A. Breastfeeding B. Feeding tube C. Bottle feeding D. Cup feeding E. Spoon feeding
529. W hat is the feature of localized form of scleroderma? A. sclerodactyly B. telangiectasia C. absence of lesions of proximal extremities and trunk D. Raynaud's phenomenon E. calcinosis
530. C ommon clinical signs of hypothyroidism include: A. Weight gain, hyperthermia, bradycardia, constipation B. Weight loss, bradycardia, constipation C. Weight gain, bradycardia, infertility D. Weight loss, bradycardia, infertility E. Weight gain, tachycardia, hyperthermia
531. W hich of the following pharmacologic agents is detrimental to a patient with isolated diastolic heart failure? A. Furosemide B. Diltiazem C. Metoprolol D. Milrinone
532. W hat kidney structures are the most frequently affected at pyelonephritis? A. kidney glomerulus B. renal tubules C. ureters mucosa D. kidney capsule E. capillaries of the glomeruli
533. W hich 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
534. Which of the following factors should be strongly considered in determining whether an exchange transfusion is indicated in a term neonate with a total bilirubin of 350 μmol/l? A. Age of the neonate (time since birth) B. Whether the cause is hemolytic or non-hemolytic C.The presence of other clinical risk factors such as intraventricular haemorrhage or meningitis etc.
D. All of the above E. None of the above
535. I ndicate the most common cause of preterm delivery A. Preeclampsia B. Intrauterine growth retardation C. Rupture of membranes D. Foetal distress E. Uterine anomalies
536. W hat is the most specific clinical symptom of congenital syphilis? A. Hepatosplenomegaly B. Jaundice C. Osteochondritis D. Pneumnitis E. Generalized lymphadenopathy
537. I ndicate the most common viral vertical infection A. HSV B. HIV
C. Rubella D. CMV
E. Parvovirus
538. W hich of the following would be LEAST helpful in the immediate diagnostic evaluation of an infant with a neonatal seizure? A. Brain ultrasound B. Serum glucose level C. Cerebral spinal fluid Gram stain D. Serum calcium level E. None of the above
539. 3 -day old infant born at 32 weeks' gestation and weighing 1700 g has three episodes of apnea, each lasting 20 to 25 s and occurring after a feeding. During these episodes the heart rate drops from 140 to 100 beats per minute and the child remains motionless; between episodes, however, the child displays normal activity. Blood sugar is 50 mg/dL and serum calcium is normal. The child's apnoeic periods most likely are A. Due to an immature respiratory centre B. A part of periodic breathing C. Secondary to hypoglycaemia D. Manifestations of seizures E. Evidence of underlying pulmonary disease
540. Y ou are following a patient who is receiving chronic oral amiodarone. Because of the toxicities of amiodarone, which of the following tests would you monitor? A. Chest x-ray B. Thyroid function tests C. Liver function tests D. Ophthalmic examinations E. All the above
541. A n infant with a marked cyanotic congenital heart defect with decreased pulmonary vascularity should be treated with: A. Digoxin B. Indomethacin C. Prostaglandin E1 D. Epinephrine
542. What is the single most important and most effective step in cardiopulmonary resuscitation of the compromised newborn? A. Chest compressions B. Intravenous fluid boluses C. Drying and stimulation D. Ventilation of the lungs
543. M onitoring for cyclosporine includes which of the following? A. Renal function B. Blood pressure C. Glucose D. a and b E. All of the above
544. W hat is typical for Duchenne-Erb paralysis? A. Grasp reflex is absent on the affected side B. All reflexes are absent on the affected side C. The affected arm is externally rotated D. Moro reflex is absent on the affected side E. The entire arm is flaccid
545. A newborn female has a tracheoesophageal fistula. All of the following would be appropriate EXCEPT
A. Renal ultrasonography B. Cardiac ultrasonography C. Brainstem auditory evoked response testing D. Evaluation for anal atresia E. Vertebral radiographs
546. During the initial stages of positive-pressure ventilation, breaths should be delivered at a rate of times per minute. A. 10 to 20 B. 20 to 40 C. 40 to 60 D. 60 to 80 E. 80 to 100
547. You are called to the delivery of a boy at 42 weeks' gestational age with thick meconium stained fluid and type II decelerations. The obstetrician rapidly delivers the infant and hands him to you for care. The boy is hypotonic, cyanotic, apneic, and bradycardic. The most appropriate next step is to A. Stimulate the infant to breathe B. Administer epinephrine C. Provide positive-pressure bag-and-mask ventilation D. Intubate the trachea and provide positive pressure ventilation E. Intubate the trachea and apply negative pressure suction
548. W hich of the following is a true statement about chest compressions? A. Ventilation is not necessary if chest compressions are being provideD. B. Chest compressions decrease intrathoracic pressure. C. Chest compressions circulate blood to the vital organs. D. Chest compressions are the most critical technique of neonatal resuscitation.
549. S ulfasalazine may interact with which of the following drugs? A. Antibiotics B. Warfarin C. Iron supplements D. All of the above E. b and c only
550. 2 -year-old boy has vitamin D-resistant rickets. His investigations revealed serum calcium 9mg/dl, phosphate- 2,4mg/dl, alkaline phosphates 1040 IU, normal intact parathyroid hormone and bicarbonate 22 mEq/l. Which of the following is the most probable diagnosis? A. Distal renal tubular acidosis B. Hipophosphatemic rickets C. Vitamin D dependent rickets D. Hypoparathyroidism
551. Select an appropriate feeding method for the infant with corrected age of 32 wks. without any significant medical problems (mother has breast milk) A. Tube feeding B. Bottle (nipple) feeding C. Cup feeding D. Breastfeeding E. Parenteral feeding
552. The best method of preventing neonatal HSV infection in a mother who was seronegative at the start of her pregnancy is to A. Examine her genitourinary tract in early labor with intact membranes and if lesions are noted perform a cesarean section B. Treat the mother with a symptomatic primary HSV infection with acyclovir C. Monitor serial IgG titers to HSV-2 D. Treat all infants born to mothers with genital lesions with acyclovir after birth E.Do none of the above
553. Which of the following are signs of overdosing L-Thyroxine? A. Clinical signs of overdosing do not occur with T4 therapy B. Nervousness, restlessness, tachycardia C. Lethargy, bradycardia, hypothermia D. Polydipsia, polyphagia, polyuria E. Anuria, anasarca
554. A prescription is received for a 2-year-old to receive budesonide 500 μg once daily for asthma therapy. Which of the following is true? A. The budesonide should be administered as the suspension for nebulization with a facemask B. The budesonide should be administered with the Turbuhaler breath-actuated device C. The budesonide should be administered as an MDI with spacer and facemask D. The budesonide should be administered as an MDI with holding chamber and a mouthpiece E. The budesonide should be administered as a dry-powder inhaler (Diskus)
555. A 14-year-old girl says she feels tireD. On exam You note that she is tachycardic and pale. You order a CBC, which shows the following: HGB-10g/dL, MCV-75fL. Her reticulocyte count is not increaseD. Which of the following is most likely? A. Iron-deficiency anemia B. Megaloblastic anemia C. Hemolytic anemia D. Aplastic anemia E. Hypoplastic anemia
556. A 14-year-old girl, diagnosed with moderate persistent asthma, goes to her pharmacy to pick up her prescription for salmeterol. She is dispensed the medication in a dry-powder inhaler called a Diskus, which she has never used before. Which of the following is the appropriate way for her to use this device? A. Dispense the dose of medication, place lips around the mouthpiece, exhale into the device, inhale steadily and deeply, hold breath for 10 seconds, and breathe out slowly B. Shake the device, dispense the dose of medication, place lips around mouthpiece, breathe in steadily and deeply, hold breath for 10, and breathe out slowly C. Shake the device, dispense the dose of medication, place lips around mouthpiece, exhale into the device, inhale steadily and deeply, hold breath for 10, and breathe out slowly D. Dispense the dose of medication, place lips around mouthpiece, inhale forcefully and deeply, hold breath for 10 seconds, and breathe out slowly E. Dispense the dose of medication, place lips around mouthpiece, inhale slowly and breathe out Slowly
one of the following situations? A. Jaundice at 12 hours of age B. Serum bilirubin level increasing less than 5 mg/dL/24 hours in the first 2 to 4 days C. Direct (conjugated) serum bilirubin greater than 1 mg/dL D. Jaundice at 12 days of age
558. 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
559. A term infant is born with Apgar scores of 5 at 1 minute and 7 at 5 minutes. The infant has a heart rate of 170 and demonstrates pallor with hepatosplenomegaly. A Kleihauer-Betke test on maternal blood has positive results. The most likely diagnosis is A. Erythroblastosis fetalis B. Hereditary spherocytosis C. Chronic fetal-maternal hemorrhage D. ABO incompatibility E. Blackfan-Diamond syndrome
560. On questioning a mother about her 4-year-old child with asthma, you discover that he has allergies to cats and house dust as well as ragweed, the father smokes in the house, and they have radiant heat and refrigerated air conditioning. They have a cat, but it is not allowed in his bedroom. He has one younger sibling and goes to day care 4 days a week. He is currently being treated with two inhalations of fluticasone propionate 44 μg/puff bid and albuterol as needed, both using an MDI plus Aerochamber with mouthpiece. She states that he uses the albuterol three to four times weekly depending on how active he is and only awakens about once weekly with cough. Which of the following statements is true? A. Going to day care puts him at high risk for developing severe persistent asthma as an adult B. He is likely to grow out of his asthma as he gets older as long as he continues to take his fluticasone regularly C. He should limit his outdoor activity during the fall when the ragweed pollen is at its peak D. His would likely be able to reduce his medications if his exposures to smoke, cat dander, and dust mites were reduced E. b and c only
561. Specify the most reliable laboratory test of dermatomyositis. A. leukopenia B. increasing of creatinphosphokinase C. increasing of lactatdehydrohenase D. increasing of γ-globulin in serum E. increasing of AST
562. Which of the proposed periods defines duration of a term pregnancy? A. 36-40 wks B. 40-42 wks C. 37-42 wks D. 38-40 wks E. 36-38 wks
563. The most common major criterion of rheumatic fever is: A. Carditis B. Throat pain C. Arthritis D. Arthralgia
564. Cephalosporins (second or third generation) as single therapy for neonatal sepsis are inappropriate initial therapy because of all of the following EXCEPT A. Listeria are resistant B. Enterococci are resistant C. Staphylococcus aureus is moderately sensitive D. Escherichia coli may be resistant E. They penetrate the CSF poorly
565. Which of the following would be LEAST helpful in the immediate diagnostic evaluation of an infant with a neonatal seizure? A. Brain ultrasound B. Serum glucose level C. Cerebral spinal fluid Gram stain D. Serum calcium level E. None of the above
566. CBC of term infant at the age of 12 hrs who was born after 20 hrs of membrane rupture: leukocytes – 14,5 х109/л; eosinophils- 6 %, basophils- 0 %, bands - 5 %, segs - 45 %, lymphocytes - 30 %, monocytes - 14 %. What is immature-to-total neutrophil ratio in this baby? A. 0,33
B. 0,25 C. 0,2
D. 0,1 E. 0,3
567. Indicate neonatal lung disease which is usually associated with perinatal asphyxia A. Pneumonia B. Transient tachypnea of newborns C. Meconium aspiration syndrome D. Pneumothorax E. Lung oedema
568. Indicate the minimal gestational age in which fetal lungs are minimally mature ro provide effective gas exchange. A. 18-20 wks B. 20-22 wks C. 22-24 wks D. 24-26 wks E. 26-28 wks
569. What is the most common causative microorganism for neonatal meningitis? A. Haemophilus influenzae B. Listeria monocytogenes C. Staphylococcus aureus D. Staphylococcus epidermidis E. Pseudomonas aeruginosae
570. A baby girl is considered normal at birth but on the second day of age cyanosis is noted. No murmur is heard and there is no respiratory distress. On the third day, cyanosis is more obvious and the respiratory rate is increased. Which of the following is correct concerning this patient? Cyanosis is not most likely due to congenital heart defect. A. The baby’s colour should improve rapidly after giving 100% 02. B. Echocardiography can often tell the anatomic state of the newborn’s circulation. C. The baby’s chest x-ray shows a small heart. D. This is against the diagnosis of congenital heart disease. E. The lack of murmur is against the diagnosis of CHD
571. Reliability of the Ballard score in determination of real gestational age in newborns is… A. ± 2 days B. ± 1 wk C. ± 2 wks D. ± 1 day E. ± 4 wks
572. Which of the following features best distinguishes Crohn’s disease from Ulcerative colitis? A. Oral ulcers B. Crypt abscess C. Non-caseating granuloma D. Continuous colonic involvement on endoscopy
573. What kind of replacement therapy is the best choice for the treatment of patients suffering from Haemophilia B? A. Fresh-frozen plasma B. Cryoprecipitate C. Factor VIII concentrate D. Factor IX concentrate E. Desmopressin
574. You have been providing chest compressions and effective ventilation for 30 seconds. You check the heart rate and find a rate of 40 beats per minute. What should your next action(s) be? A. Continue chest compressions for an additional 30 seconds and recheck the heart rate.
B. Insert an umbilical catheter, administer epinephrine, and consider intubation. C. Switch to a different method of ventilation (eg, switch from a flow- inflating to a selfinflating bag). D. Discontinue chest compressions because they are ineffective. 575. Endoscopic retrograde cholangiopancreatography is used to evaluate and treat diseases of the A. stomach B. rectum C. biliary tree and pancreas D. large intestine and rectum E. colon
576. What should we have to do firstly to diagnose pyelonephritis of pregnant 17-years old patient? A. Retrograde urography B. Excretory urography C. Cystoscopy D. Radiologic examination E. Chromocystoscopy
577. In 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
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