1. Topic: Corticosteroid Therapy in Acute Rheumatic Fever (ARF)

Correct Answer: A. The decrease in SV

Explanation: In the management of acute rheumatic fever (ARF) with corticosteroids, the decision to reduce therapy is typically guided by clinical improvement. A decrease in the severity of symptoms (SV) such as inflammation or joint swelling supports tapering of corticosteroids. Increased leukocytosis (B) indicates ongoing inflammation, suggesting that corticosteroids might need to be continued or adjusted. Decreases in antistreptokinases (C) and antistreptolysins (D) indicate a reduction in streptococcal activity, but they are not as direct indicators for adjusting corticosteroid therapy. The throat swab result (E) is more relevant for diagnosing streptococcal infection rather than adjusting corticosteroid therapy.

2. Topic: Risk of Osler Endocarditis in Congenital Heart Diseases

Correct Answer: C. Interauricular communication

Explanation: Osler endocarditis, also known as infective endocarditis, is a condition that can affect congenital heart diseases with turbulent blood flow or abnormal heart structures. Interauricular communication (C), or atrial septal defect, generally carries a lower risk for Osler endocarditis compared to other congenital heart defects. Tetralogy of Fallot (A), persistent ductus arteriosus (B), ventricular communication (D), and coarctation of the aorta (E) are associated with higher risks due to turbulent blood flow and increased susceptibility to infections in these areas.

3. Topic: Generalized Cyanosis

Correct Answer: D. An excess of reduced hemoglobin

Explanation: Generalized cyanosis is characterized by a bluish discoloration of the skin and mucous membranes due to an excess of reduced (deoxygenated) hemoglobin in the blood (D). This condition typically arises when there is insufficient oxygenation of blood, which can occur with severe hypoxia (C) or conditions affecting oxygen transport. Alveolar hypoventilation (A) and hypercapnia (B) can contribute to hypoxia, but the direct cause of cyanosis is the excess of reduced hemoglobin. Polycythemia (E) can increase blood viscosity but does not directly cause cyanosis.

4. Topic: Viral Bronchopneumopathy in Infants

Correct Answer: D. Acute respiratory failure

Explanation: In infants with viral bronchopneumopathy, acute respiratory failure (D) is the primary concern due to their smaller airways and less efficient respiratory systems, which can quickly become overwhelmed by the infection. While bacterial superinfection (A) and heart failure (B) are also potential complications, the immediate risk is the inability to maintain adequate oxygenation and ventilation. Pneumothorax (C) and interstitial emphysema (E) are less common but can occur in severe cases.

5. Topic: Primary Tuberculosis Infection in Children

Correct Answer: A. An erythema nodosum

Explanation:

In children, primary tuberculosis infection can present with erythema nodosum (A), a skin condition often associated with tuberculosis. This finding is more specific to tuberculosis compared to the other options. Diarrhea (B), angina with hyperlymphocytosis (C), and wheezing dyspnea (D) are not typically associated with primary tuberculosis in children. While they may occur in various infections or conditions, erythema nodosum is a more indicative sign of tuberculosis.

6. Topic: BCG Vaccine

Correct Answer: D. A live but attenuated strain of Mycobacterium bovis

Explanation: The BCG (Bacillus Calmette-Guérin) vaccine is composed of a live but attenuated strain of Mycobacterium bovis (D). This strain is weakened so it does not cause disease but stimulates an immune response. It is not a killed strain (C) or an extract of heated bacilli (B), and it does not involve a mixture of different mycobacteria (E). The vaccine’s live attenuated nature is crucial for its effectiveness in providing immunity against tuberculosis.

7. Topic: Asthma Onset in Children Before Age 5

Correct Answer: E. He is very often corticodependent

Explanation: Asthma in children before age 5 is often of allergic origin (A) and commonly associated with other atopic conditions such as eczema or allergic rhinitis (C). It can sometimes resolve or improve significantly by puberty (B), and it can lead to chest deformities if left untreated over a long period (D). However, it is not necessarily “very often corticodependent” (E); many children with early-onset asthma may not require long-term corticosteroid therapy, especially if their symptoms are well-managed or if they experience significant improvement with age.

8. Topic: Treatment of Gastroesophageal Reflux Disease in Infants

Correct Answer: A. Administration of anticholinergics

Explanation: In managing gastroesophageal reflux disease (GERD) in infants, the following strategies are useful: administration of metoclopramide (B), which helps in gastric emptying; positioning the infant in a prone position or in dorsal decubitus with a 45-degree incline (C and D), which can reduce reflux; and thickening milk to reduce regurgitation (E). However, anticholinergics (A) are not typically used in the treatment of GERD in infants due to their side effect profile and lack of efficacy in this context.

9. Topic: Hematemesis in Infants

Correct Answer: D. Peptic esophagitis

Explanation: In infants, the most common cause of hematemesis is peptic esophagitis (D), which can result from acid reflux or irritation of the esophagus. Conditions like gastric ulcers (A) and Meckel’s diverticulum (E) are less common causes. Cow’s milk protein intolerance (B) and thrombocytopenia (C) can cause gastrointestinal symptoms but are not the primary causes of hematemesis in infants. Peptic esophagitis stands out as the most frequent culprit in this context.

10. Topic: Dysenteric Syndrome in Infants

Correct Answer: C. Salmonella

Explanation: Dysenteric syndrome in infant stools, characterized by frequent and painful diarrhea with blood and mucus, is most commonly associated with infections caused by Salmonella (C). Rotavirus (A) typically causes watery diarrhea rather than dysenteric syndrome. Cervical bacillus (B) and Candida albicans (D) are less commonly linked to dysenteric diarrhea in infants. Therefore, Salmonella is the primary pathogen associated with this condition in infants.

11. Topic: Recommendations for Newborns of HBsAg and HBeAg Positive Mothers

Correct Answer: E. Serovaccination

Explanation: For a newborn whose mother is positive for both HBsAg and HBeAg, the recommended approach is serovaccination (E). This involves administering both hepatitis B vaccine and hepatitis B immunoglobulin (HBIG) to the newborn. This combined strategy provides immediate passive immunity and active vaccination to protect against hepatitis B virus infection. Options such as vaccination only (C) or specific immunoglobulins alone (D) are insufficient for full protection. Polyvalent immunoglobins (B) and no treatment (A) are not appropriate for this high-risk situation.

12. Topic: Diagnosis of Urinary Tract Infection in Children

Correct Answer: D. Uroculture 1,000,000 germs/ml 5,000 leukocytes/ml

Explanation: The diagnosis of a urinary tract infection (UTI) in children is supported by a high bacterial count and a significant presence of leukocytes. Option D indicates a uroculture with 1,000,000 germs/ml and 5,000 leukocytes/ml, which is indicative of a UTI due to the high bacterial count and elevated leukocytes, reflecting an infection and inflammation. Lower bacterial counts (A, B, C) with or without some leukocytes are not typically sufficient for diagnosing a UTI. Option E is incorrect because not all listed results are diagnostic for a UTI.

13. Topic: Diagnosis of Recurrent Pyelonephritis with Urography Findings

Correct Answer: B. Retrograde and voiding cystography

Explanation: In a case of recurrent pyelonephritis with no visible obstruction on urography but with renal atrophy and abnormal calyces, retrograde and voiding cystography are essential for diagnosing potential vesicoureteral reflux (VUR). VUR is a condition where urine flows backward from the bladder into the ureters and kidneys, which can lead to recurrent infections and renal damage. This test helps identify reflux, which is crucial for managing and preventing further renal damage. Other options like kidney biopsy (A), arteriography (C), lymphography (D), and ultrasound (E) are less specific in diagnosing VUR, which is a common underlying issue in such cases.

14. Topic: Diagnosis of Hematuria in Children

Correct Answer: D. Valves of the posterior urethra

Explanation: Hematuria in children can be associated with conditions like glomerulonephritis (A), Berger’s disease (B), and urinary lithiasis (C). These conditions commonly cause blood in the urine due to their effects on the renal and urinary systems. However, valves of the posterior urethra (D) primarily cause obstructive symptoms and may lead to urinary tract infections or hydronephrosis rather than hematuria directly. Hence, the discovery of hematuria is less commonly linked to this condition.

15. Topic: Childhood Nephrotic Syndrome

Correct Answer: A. It most often cortico-sensitive

Explanation: Childhood nephrotic syndrome is typically responsive to corticosteroid therapy (A), which is a key aspect of its management. Most cases of nephrotic syndrome in children do not require a renal biopsy before starting corticosteroid therapy (C) and are unlikely to progress to chronic renal failure (D). Although relapses can occur, the condition often does not require a sodium-restricted diet outside of flare-ups (E).

16. Topic: Impetigo

Correct Answer: E. It requires a bacteriological sample

Explanation: Impetigo is a highly contagious skin infection commonly affecting children (A) and typically involves crusty lesions around the face and mouth (C), and can sometimes present with bullous forms (D). It is generally advised to exclude affected children from school to prevent spread (B). While bacteriological samples can be helpful for diagnosis, they are not always required for clinical management (E). The diagnosis is often based on clinical presentation.

17. Topic: Infantile Scabies

Correct Answer: C. Involvement of the face

Explanation: Infantile scabies is characterized by pruritus (B) and lesions in the interdigital spaces (A) and on the soles of the feet (D). It is known for its widespread involvement in areas where adults might not typically see scabies, such as the soles and palms. However, it usually does not involve the face (C), which helps differentiate it from other skin conditions affecting infants. Thus, the face is not typically affected in infantile scabies, making C the correct answer.

18. Topic: Atopic Eczema in Infants

Correct Answer: A. It begins in the first month of life

Explanation:

Atopic eczema in infants typically does not begin within the first month of life (A). Instead, it often starts after the first few months of life and commonly begins on the face (C). The condition evolves with periods of flare-ups and remissions (B) and presents with erythemato-vesicular lesions (D). A family history of allergy is frequently observed (E), which aligns with the genetic component of atopic conditions. Thus, A is the exception as it is not characteristic of atopic eczema’s typical onset.

19. Topic: Tetanus Prophylaxis

Correct Answer: E. None of the above

Explanation: For a 7-year-old child who has been vaccinated correctly and has a minor scratch, routine prophylaxis typically involves checking the child’s tetanus vaccination status. If the child is up-to-date with vaccinations and the wound is minor, no additional prophylaxis is generally needed (E). Specific prophylaxis options like seroprophylaxis (B) or additional vaccination (A) are usually reserved for cases with higher risk or incomplete vaccination history. The correct choice is E because none of the listed options are necessary for a properly vaccinated child with a minor injury.

20. Topic: Measles Clinical Manifestations

Correct Answer: A. Dissociation of pulse and temperature

Explanation: Measles typically presents with a constellation of symptoms including conjunctivitis with photophobia (B), fever that often persists beyond the rash onset (C), redness and petechiae of the soft palate (D), and symptoms like coryza and cough (E). Dissociation of pulse and temperature (A) is not characteristic of measles; in fact, fever and pulse are usually correlated. Therefore, A is the correct answer as it does not align with the typical clinical manifestations of measles.

21. Topic: Kolick Sign

Correct Answer: C. Seeding of whitish spots on the oral mucosa

Explanation: The Kolick sign refers to the appearance of whitish spots on the oral mucosa, which are indicative of certain viral infections like measles. Options A, B, D, and E describe other clinical signs that do not correspond to the Kolick sign. Specifically, ulceration of the tonsils (A), gingival ulcers (B), purpura (D), and vesicles (E) are associated with different conditions or symptoms and do not define the Kolick sign.

22. Topic: Mumps Invasion Phase

Correct Answer: C. Turgor of the orifice of Stenon’s canal

Explanation: During the mumps invasion phase, the presence of turgor (swelling or tenderness) at the orifice of Stenon’s canal, which is the duct of the parotid gland, is a key diagnostic sign. This is due to inflammation of the parotid glands, leading to obstruction or swelling around this area. The other options—high fever with headache (A), erythematous pharyngitis (B), pre-tragal lymphadenopathy (D), and hypersalivation (E)—are less specific and can be associated with various conditions, not just mumps.

23. Topic: Facial Rash in a 9-Month-Old Child

Correct Answer: C. Herpes virus

Explanation: The facial rash resembling Kaposi-Juliusberg varioliform pustulosis in a 9-month-old child is caused by the herpes virus, particularly HSV (Herpes Simplex Virus). This condition can present with vesicular or pustular lesions on the skin. Varicella zoster virus (A) causes chickenpox, measles virus (B) leads to measles, and Staphylococcus (D) can cause impetigo but not the described rash. The term “unknown” (E) is not applicable as the herpes virus is a well-recognized cause.

24. Topic: Congenital Toxoplasmosis

Correct Answer: A. It is more frequent during the 3rd trimester of pregnancy

Explanation: Congenital toxoplasmosis occurs when the Toxoplasma gondii infection is transmitted from the mother to the fetus. The risk of transmission increases as the pregnancy progresses, making it more frequent in the 3rd trimester (A). While it is less common in the 1st trimester (B), the severity is not necessarily greater if contracted later in pregnancy; instead, earlier infections are often more severe. Pyrimethamine is used for treatment, but this is relevant for treating the infection, not the frequency of transmission (D). Fibroplasia is not the characteristic eye lesion in newborns; chorioretinitis is more typical (E).

25. Topic: Acute Leukemia in Children

Correct Answer: B. Lymphoblastic

Explanation: Acute lymphoblastic leukemia (ALL) is the most common type of acute leukemia in children, characterized by the proliferation of immature lymphoid cells (B). Acute myeloblastic leukemia (A) and other types such as monoblastic (C), promyelocytic (D), and erythroleukemia (E) are less common in the pediatric population.

26. Topic: Purpura in Children

Correct Answer: E. Rheumatoid purpura

Explanation: Rheumatoid purpura, also known as Henoch-Schönlein purpura, is characterized by purpura on the lower limbs, often accompanied by fever and a generally good condition (E). Acute leukemia (A) and Waldenstrom macroglobulinemia (B) are less common causes of purpura in this context. Flea bites (C) and monocyte angina (D) are unlikely to present with such systemic symptoms and purpura.

27. Topic: Hemophilia A

Correct Answer: D. Active partial thromboplastin time (APTT)

Explanation: In untreated hemophilia A, the Active Partial Thromboplastin Time (APTT) is prolonged due to deficiencies in clotting factors involved in the intrinsic pathway of hemostasis (D). Bleeding time (A), platelet count (B), Quick time (C), and thrombin time (E) are usually normal in hemophilia A. The APTT test is specifically sensitive to deficiencies in factor VIII, which is characteristic of hemophilia A.

28. Topic: Routine Vaccinations in Children

Correct Answer: C. Mumps

Explanation: In routine childhood vaccinations, children are vaccinated against pertussis (A), pneumococcal infections (B), Haemophilus influenzae type b infection (D), and diphtheria (E). Mumps (C) is included in the MMR (measles, mumps, rubella) vaccine, but it is not a standalone vaccination and is not separately emphasized in routine schedules as frequently as the others.

29. Topic: Medical Outcomes in Drowning

Correct Answer: C. Hypoxic brain damage

Explanation: In drowning, hypoxic brain damage (C) is the most serious medical outcome due to prolonged oxygen deprivation, leading to potential severe and irreversible neurological damage. Pulmonary edema (A) and acute renal failure (B) can occur, but they are secondary concerns compared to the immediate and profound impact of hypoxia on the brain. Blood loss (D) and cardiac arrhythmias (E) are less directly related to the primary consequences of drowning.

30. Topic: Causes of Sensory Hearing Loss in Children

Correct Answer: D. Acute otitis media

Explanation: Sensory hearing loss is primarily linked to conditions affecting the inner ear or auditory nerve. Acute otitis media (D) typically causes conductive hearing loss rather than sensory loss, affecting the middle ear. In contrast, rubella (A), meningitis (B), perinatal asphyxia (C), and the use of aminoglycosides (E) can lead to sensory hearing loss by impacting the inner ear or auditory pathways.

31. Topic: Complications of Perinatal Asphyxia

Correct Answer: B. Hyperemesis gravidarum

Explanation: Perinatal asphyxia is associated with complications that directly impact the fetus and the delivery process. Abrupt placenta (A), prematurity (C), pre-eclampsia (D), and amniotic fluid tinged with meconium (E) are complications related to or indicative of issues that can lead to perinatal asphyxia. Hyperemesis gravidarum (B), however, is a severe form of nausea and vomiting during pregnancy that does not directly relate to perinatal asphyxia.

32. Topic: Marfan Syndrome

Correct Answer: A. Aortic dilatation and loose joints suggestive of connective tissue disorder

Explanation: Marfan syndrome is a genetic disorder affecting connective tissue, which often presents with aortic dilatation and joint laxity (loose joints) (A). The other options relate to different conditions: excessive bone length and width suggest bone metabolism disorders (B), tendons and ligaments issues point to muscle metabolism disorders (C), and large size with excess subcutaneous tissue is indicative of growth factor disorders (D). Marfan syndrome is primarily characterized by connective tissue abnormalities, making option A the correct choice.

33. Topic: Melena in an 18-Year-Old

Correct Answer: E. Meckel’s diverticulum

Explanation: Meckel’s diverticulum is a congenital abnormality that can cause gastrointestinal bleeding and melena (black, tarry stools) due to the presence of ectopic gastric mucosa or ulceration. This condition can present with anemia and shock due to significant blood loss. Eosinophilic colitis (A) and hemolytic-uremic syndrome (B) are less likely to cause melena. Ulcerative colitis (C) usually presents with diarrhea and rectal bleeding, and juvenile polyps (D) are less commonly associated with such acute presentations. Hence, Meckel’s diverticulum is the most likely diagnosis in this case.

34. Topic: Prolonged Bleeding Time

Correct Answer: A. Hemophilia A

Explanation: Hemophilia A is a coagulation disorder characterized by a deficiency in clotting factor VIII, which primarily affects the clotting cascade and not the initial platelet function, thus it does not typically cause prolonged bleeding time. In contrast, Von Willebrand disease (B) affects both platelet function and clotting, resulting in prolonged bleeding time. Aspirin-induced thrombocytopathy (C) impairs platelet aggregation, extending bleeding time. Bernard-Soulier syndrome (D) involves platelet dysfunction, leading to prolonged bleeding time. Idiopathic thrombocytopenic purpura (E) results in reduced platelet count but can also affect bleeding time, making Hemophilia A the exception here.

35. Topic: Diabetic Ketoacidosis (DKA) in Type 1 Diabetes

Correct Answer: A. Overfeeding

Explanation: Diabetic ketoacidosis (DKA) is primarily triggered by factors that increase insulin requirements or decrease insulin effectiveness. Vomiting (B) can lead to dehydration and electrolyte imbalances, which can exacerbate DKA. Omission of insulin doses (C) directly leads to uncontrolled hyperglycemia and ketogenesis. Infection (D) can increase insulin needs and precipitate DKA due to inflammatory stress. Lack of patient education (E) can result in poor management and missed insulin doses. Overfeeding (A) is less likely to directly cause DKA compared to these other factors, making it the exception.

36. Topic: Delayed Skeletal Maturation in Adolescents

Correct Answer: B. Psychosocial deprivation

Explanation: Delayed skeletal maturation in adolescents can be due to several underlying conditions. Growth hormone deficiency (A) affects bone growth and development, leading to delayed maturation. Hypothyroidism (C) can result in delayed skeletal development due to its impact on metabolic processes. Late (non-classic) onset of 21-hydroxylase deficiency (D) affects adrenal steroid production, which can impact bone age. Constitutional delay of puberty (E) is a common cause of delayed skeletal maturation, as it affects the timing of puberty and skeletal development. Psychosocial deprivation (B) is less directly related to bone age delays compared to the other conditions, making it the exception.

37. Topic: Newborn Hypothyroidism Screening

Correct Answer: E. None of the above

Explanation: Newborn hypothyroidism screening aims to ensure normal linear growth (A), support normal intellectual function (B), and can aid in genetic counseling (C). Although screening does not directly prevent sudden infant death syndrome (D), it is still crucial in preventing long-term complications by addressing hypothyroidism early. Therefore, “None of the above” (E) is correct because all the listed goals are relevant to newborn hypothyroidism screening.

38. Topic: Pheochromocytoma in Children

Correct Answer: E. Sufficiency

Explanation: Pheochromocytoma, a tumor of the adrenal glands, can cause symptoms like headache (A), weight loss (B), convulsions (C), and sweating (D) due to excess catecholamines. However, “sufficiency” (E) is not a recognized symptom of pheochromocytoma. The condition is associated with excess hormone secretion, not sufficiency.

39. Topic: Rett Syndrome

Correct Answer: D. Autosomal recessive inheritance

Explanation: Rett syndrome is a neurodevelopmental disorder characterized by autistic behavior (A), microcephaly (B), hand-wringing movements (C), and progressive dementia (E). However, Rett syndrome is typically inherited in an X-linked dominant pattern, not autosomal recessive (D). The inheritance pattern distinguishes Rett syndrome from other genetic disorders.

40. Topic: Spina Bifida Cystica

Correct Answer: B. It is fatal if not treated within 24 hours

Explanation: Spina bifida cystica is a type of neural tube defect often associated with hydrocephalus (A), which can be diagnosed in utero by ultrasound (C). It can lead to urological problems (D) and often requires orthopedic care (E). However, while prompt treatment is important, it is not necessarily fatal if not treated within 24 hours; rather, early intervention helps reduce the risk of severe complications. Therefore, statement B is incorrect.