PEDIATRICS (J)

Infectious Diseases

Sections
A. Section 1: (G)old - 74 Questions
 Section 1
G(old) – 74 Questions

All are correct for measles EXCEPT:

A. can cause activation of pulmonary T.B.
B. can cause suppression of purified protein derivative test.
C. morbidity is more in the age 2-20 years.
D. fever subsides after onset of rash.
E. enanthem is pathognomonic for the disease.

A 4-year-old child with fever, peeling skin, abdominal pain, and a red throat has been admitted
to the hospital because of overlap between presenting signs and symptoms of scarlet fever
and Kawasaki disease. Which of the following statements comparing these two
diseases are true?
A. Neither has cardiac complications.
B. Serologic tests are helpful in diagnosing both.
C. Kawasaki disease has mucocutaneous and lymph node involvement, but scarlet fever does
not.
D. Pharyngeal culture aids in the diagnosis of scarlet fever but not Kawasaki disease.
E. A specific therapy is recommended for scarlet fever, but supportive care only is
recommended for Kawasaki disease.

A 3-year-old boy with rash and fever He has a 2-day history of headache and is being treated
with amoxicillin for otitis media, finding include Alert child temperature 39,5 C injected
conjunctiva, a red nonpetechial maculopapular rash on his wrists and ankles, hyponatremia and
mild Which of the following the most appropriate treatment?
A. Atropine
B. Induction of amoxicillin
C. Doxycycline
D. Immnoglobin
E. Trimethoprim sulfamethoxazole

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You are seeing a 4-year-old child in the emergency department with abdominal pain, and acute
onset of bloody diarrhea. Due to a recent outbreak in the community related to a popular fast-
food restaurant, you suspect E coli 0157:H7. Which of the following is seen most commonly as a
complication of Shiga-toxin-producing E coli (formerly known as enterohemorrhagic E coli)
diarrhea?
A. meningitis
B. hemolytic-uremic syndrome
C. chronic diarrhea
D. endocarditis
E. pneumonia

A 13-day-old full-term girl is brought to the physician during winter with a runny nose, cough,
and fussiness over the past 2 days. Her birth history is unremarkable and she has been feeding
and growing well. The girl has a sibling in day care, where other children have been ill. Her
temperature is 37.8 C (1 00 F), respirations are 70/min, and pulse oximetry is 95% on room air.
Examination shows a crying infant with clear rhinorrhea and bilateral wheezes and crackles.
Which of the following complications is this patient at greatest risk of developing?
A. Apnea
B. Bacteremia
C. Bacterial pneumonia
D. Fungal pneumonia
E. Lymphoma

The most likely agent responsible for the infant's condition in the preceding question is:
A. Staphylococcus aureus
B. Haemophilus influenzae
C. Corynebacterium diphtheriae
D. Respiratory syncytial virus
E. Echovirus

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A previously healthy 13-year-old boy presents with a 2-week history of nonproductive cough
and low-grade fever. On examination, you note a normal respiratory rate and no evidence of
respiratory distress, but are surprised to also hear inspiratory rales at the bilateral lung bases.
Which of the following is the most likely cause of pneumonia in this adolescent?
A. Pneumocystis carinii
B. Staphylococcus aureus
C. Haemophilus influenzae type b
D. Mycoplasma pneumonia

week-old child develops increased respiratory rate and a nonproductive cough. Physical
examination is significant for rales and rhonchi. The past medical history for the child is
positive
for an eye discharge at 3 weeks of age, which was treated with a topical antibiotic drug. The
most likely organism causing this child's
condition is
A. Neisseria gonorrhoeae
B. Staphylococcus aureus
C. Group B streptococcus
D. Chlamydia trachomatis
E. Herpesvirus

One of the following is not a recognized complication of measles:

A. [Link] media
B. Gastroenteritis
C. Febrile convulsions
D. Corneal ulcerations
E. Infertility

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An 18-month-old boy is brought to the emergency department due to fever and facial rash for
2 days. The patient has a history of atopic dermatitis for which his parents occasionally apply
over-the-counter steroid cream. The boy had a flare-up of dry, thickened, itchy skin on his
cheeks 4 days ago. He then developed many overlying, painful bumps 2 days ago that have
since increased in number. His vaccinations are up to date. Physical examination shows an
uncomfortable-appearing child with numerous painful, clear vesicles over erythematous skin
on both cheeks as well as a few scattered lesions with overlying dark-red crusting.
Submandibular lymphadenopathy is present. The rest of the skin appears dry. The initial gram
stain of one of the lesions is negative. Which of the following is the most likely etiology of this
patient's rash?
A. Herpes simplex virus
B. Methicillin-resistant Staphylococcus aureus
C. Streptococcus pyogenes
D. Varicella zoster infection

In the neonatal nursery you see an infant who is very small, with bluish purpuric skin lesions,
and absent red reflexes. The baby also has a heart murmur. You suspect congenital infection.
What is the most likelyetiology?
A. Varicella
B. CMV
C. parvovirus
D. rubella

Mosquitoes are recognized as vectors in the transmission of encephalitis of which of the

following viruses?
A. arbovirus
B. coxsackievirus
C. enterovirus
D. influenza virus
E. mumps virus
A 10-year-old girl has had a rash for 4 days without other symptoms. She is taking no

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medications. Physic examination reveals erythematous cheeks and a lacy, reticulated
erythema involving the extremities. Which of the following is false?
A. This child's presentation is due to infection with human parvovirus B19.
B. In some patients, fever, malaise, myalgia, or headache precede the eruption by 7 to 10 days.
C. After 3 to 5 days, the eruption fades, although it may return for up to 4 months following
exercis, overheating, or sun exposure.
D. Infection during pregnancy, particularly during the first half of pregnancy, may cause fetal
hydro death
E. None of the above

A 2-year-old boy has high fever, irritability, and a stiff neck. He was treated recently with oral
amoxicillin for otitis media. A TRUE statement about the effect of previous antibiotic therapy
on the ability to diagnose meningitis is it
A. interferes with the reliability of counterimmunoelectrophoresis studies
B. decreases the likelihood of diagnosing Haemophilus influenzae type b meningitis
A. [Link] delay definitive diagnosis
C. decreases the concentration of glucose in cerebrospinal fluid

The following are associated with an increased risk of UTI except:

A. Duplex ureter
B. Myelomeningocele.
C. Chronic antibiotic use.
D. Constipation.
E. Vesico-ureteric reflux.

6-year old girl has vomiting, headache, irritability. She does not appear dehydrated. But when

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reviewing her vitals you notice her wt is up 3 k from just 3 weeks ago. Laboratory findings are:
Na 112 meq/L, K 4.0 meq/L; CI 75 me/L, HCO3 19 meq/L, BUN 10 mg/dl and creatinine 0.4 mg/dl.
A. A spot urine sodium concentration is 100 meq/L. The most likely cause of these findings is:
A. decreased glucocorticoid production.
B. decreased mineralocorticoid production.
C. decreased antidiuretic hormone secretion.
D. increased antidiuretic hormone secretion

A 4-year-old male is brought to the physician with fever and headache. His symptoms began
two days ago with low-grade fever, cough, and congestion. Last night, he developed a
temperature of 102° F (38.9° C) and became fussy and less active. Today, he is crying and
complaining of a headache. His parents report that he has vomited twice today. In the office,
his temperature is 102.5° F (39.0° C), pulse is 110/min, and respiratory rate is 20/min. On
examination, he is irritable and shows signs of photophobia. His oropharynx is erythematous.
Nuchal rigidity is present and when the neck is flexed, the patient flexes his lower extremities.
The remainder of the physical examination is normal. Lumbar puncture is performed and the
results are shown below. [Link] 60 mg/dL•Protein 80 mg/dL•RBC 10/mm>•WBC 100/
mm'•Neutrophils 10%Lymphocytes 70%•Monocytes 20%•Gram stain no organisms Which of the
following organisms is most likely responsible for this patient's presentation?
A. Streptococcus pneumoniae
B. Mycobacterium tuberculosis
C. Epstein-Barr virus
D. Neisseria meningitidis
E. Echovirus

A 6-year-old boy is brought to the clinic with 2 days of fever and facial swelling. The patient
initially had a right earache and subsequently developed pain of his right and left cheeks with

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overlying swelling. His medical history is significant for 2 episodes of otitis media as a toddler
and croup last year. The child is on a delayed vaccination schedule but is up to date as of age 3.
He recently returned from a week of vacation in Costa Rica. The patient is in first grade, and
his parents are not aware of any sick contacts at school. Temperature is 38.1 C (1 00.6 F), and
other vital signs are normal. Examination shows bilateral swelling and tenderness anterior to
the ears extending inferiorly and obscuring the angle of the mandible. The tympanic
membranes are flat, gray and mobile to insufflation. The rest of the examination is
unremarkable. Which of the following complication is this patient at greatest risk for
developing from this acute condition?
A. Arthritis
B. Aseptic meningitis
C. Facial nerve palsy
D. Mastoiditis
E. Pneumonia

Regarding raised Intracranial pressure the following is true except:

A. Drowsiness is seen with a rapidly increasing pressure
B. Convulsions are a common presentation
C. The headache is worse on movement
D. There may be a sixth nerve palsyBB
E. Signs take longer to develop in young children than in adults

All of the following are causes of acute gastroenteritis except:

A. Rotaviruses.
B. Caliciviruses (including the noroviruses).
C. Human metapneumovirus.
D. Astroviruses
E. Enteric adenoviruses (serotypes 40 and 41).

All of the following are correct causative organisms for the corresponding disease EXCEPT:
A. Measles-Robeola virus.

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 B. German measles - RNA virus.
C. Scarlet fever - Gp A B strept. Toxin.
D. Roseola infantum-herpes simplex virus.
E. Erythema infectiosum-parvovirus.

All of the following are true regard Shigella dysenteriae except:

A. It may cause disease by producing Shiga toxin, either alone or combined with tissue
invasion.
B. The incubation period is 1 to 7 days.
C. Infection is spread by person-to-person contact or by the ingestion of contaminated food.
D. High fever and seizures may occur, in addition to diarrhea.
E. The small intestines are selectively affected.

Most common cause of otitis externa in children is?

A. Adenovirus
B. Hemophillus influenza
C. Pseudomonas Aeruginosa
D. Strep. Pneumonia

Which of the following are true statements concerning pneumonia during infancy and
childhood EXCEPT:
A. Usually bacterial pneumonia follows a viral infection of the respiratory tract.
B. The commonest organisms are Strep. Pneumoniae and Staph. aureus.
C. The peek attack rate is between 2 and 4 years
D. Mycoplasma pneumonia is most frequently isolated in younger rather than older children.
E. Influenza A Viruses are an important cause of pneumonia in preschool children.

The recommended agent for treatment of pneumonia caused by Mycoplasma pneumoniae is:
A. A Amoxicillin or ampicillin
B. Ceftriaxone, cefotaxime, or cefotetan
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 C. Ceftriaxone, cefotaxime, or cefotetan
D. Erythromycin, clarithromycin, or azithromycin
E. Gentamicin or kanamycin
F. Trimethoprim-sulfamethoxazole

Concerning bronchiolitis:
A. Epidemics often occur during winter.
B. A chest radiograph usually shows a poorly inflated chest.
C. Poor feeding is an indication for treatment with ribavirin.
D. The disease is more benign in infants born prematurely.

Concerning gastroenteritis:
A. It can be fatal.
B. The most common cause is Salmonella spp. infection.
C. Broad-spectrum antibiotics are usually indicated.
A. V Blood pressure is a sensitive indicator of dehydration.

Concerning chickenpox:
A. The incubation period is 7 days.
B. Aspirin is a useful anti-pyretic.
C. Transmission is usually by contact or airborne.
D. There is no effective vaccine.

A7-mo-old child presents in late October with 3 days of fever with temperatures to 103.5°F, a
mildly injected pharynx, mild Cervical lymphadenopathy, and diarrhea. The child has been

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behaving normally and eating well and has no other symptoms. On the fourth day of the
illness the fever resolves, and a generalized measles like rash appears 12 hr. later. The child
appears normal on physical examination. The most likely diagnosis is:
A. Measles
B. Rubella
C. Drug-reaction to antipyretics
D. Human Herpes Virus – 6

A 7-mo-old girl presents with a temperature of 103.8°F, blood pressure of 70/30 mm Hg,
diffuse petechiae first noted 4 hr. before presentation, platelet count of 88,000/mm3, and
white blood cell count of4300/mm3, with 23% neutrophils and 42% bands. The infant has
received all recommended vaccinations. Which of the following is the most likely bacterial
etiology of this presentation?
A. Staphylococcus aureus
B. Streptococcus pneumoniae
C. Neisseria meningitidis
D. Haemophilus influenzae type b

All are correct for measles EXCEPT:

A. The incubation period is 8-12 days.
B. Infants are protected for at least 4 months after birth.
C. Koplik spots are pathognomonic for the disease.
D. Immunoglobulins are protective if given upto 7 days after exposure.
E. Measles vaccine is indicated for exposed children

All of the following are correct causative organisms for the corresponding disease EXCEPT:
A. Measles-Robeola virus.
B. German measles - RNA virus.
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C. and EScarlet fever-Gp B strept. Toxin.
D. Roseola infantum - herpes simplex virus.
E. Erythema infectiosum - parvovirus.
F. C+E*

A2-year-old boy is brought to the emergency department by his babysitter due to "noisy
breathing." The patient has had rhinorrhea, congestion, and cough for 2 days. The cough is
worse today, and he has developed a high-pitched noise during inspiration that worsens when
he cries. Earlier today, he was playing in the same room as his 6-year-old brother, who also has
cold symptoms. The babysitter is unsure of the patient's immunization status. On
examination, temperature is 38C (100.4F), pulse is 140/min, and respirations are 44/min. Pulse
oximetry shows 96% on room air. The patient is alert with mild suprasternal retractions and
has a dry, harsh cough. His pharynx is mildly erythematous without tonsillar enlargement or
asymmetry. The lungs are clear to auscultation. Which of the following is the most likely
diagnosis?
A. Bronchiolitis
B. Croup
C. Epiglottitis
D. FB aspiration
E. Laryngomalacia
F. Retropharyngeal abscess

A6-year-old boy is brought to the clinic with 2 days of fever and facial swelling. The patient
initially had a right earache and subsequently developed pain of his right and left cheeks with
overlying swelling. His medical history is significant for 2 episodes of otitis media as a toddler
and croup last year. The child is on a delayed vaccination schedule but is up to date as of age 3.

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He recently returned from a week of vacation in CostaRica. The patient is in first grade, and his
parents are not aware of any sick contacts at school. Temperature is 38.1C (100.6F), and other
vital signs are normal. Examination shows bilateral swelling and tenderness anterior to the
ears extending inferiorly and obscuring the angle of the mandible. The tympanic membranes
are flat, gray, and mobile to insufflation. The rest of the examination is unremarkable. Which
of the following complications is this patient at greatest risk for developing from this acute
condition?
A. Arthritis
B. Aseptic meningitis
C. Facial nerve palsy
D. Mastoiditis
E. Pneumonia

A7-year-old boy is brought to the office with sore throat, poor appetite, and malaise for the
last 2 days. He has no cough, rhinorrhea, or nasal congestion. The patient takes no medications
and has no known allergies, and his immunizations are uptodate. Temperature is 38.9C (102F),
blood pressure is 110/70 mmHg, pulse is 130/min, and respirations are 16/min. On examination,
the patient's tonsils are swollen and covered with thin white exudates. Small, tender anterior
cervical lymph nodes are palpated. What is the most appropriate next step in management of
this patient?
A. Amoxicillin
B. ASOT
C. Azithromycin
D. Rapid streptococcal antigen testing
E. Symptomatic treatment only

A 4-year-old girl is diagnosed with Bordetella pertussis infection after an outbreak at her
day care center. She has paroxysmal coughing fits and is prescribed a course of macrolide
antibiotics. The girl lives with her 30-year-old parents and 1-year-old sister. Her family
members have up-to-date immunizations and are asymptomatic. What is the most appropriate
way to limit the risk of infection in household contacts?

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 A. Administer pertussis immunization to all household contacts
B. Hospitalize the patient until symptoms resolve
C. Prescribe a macrolide antibiotic for the sister
D. Prescribe a macrolide antibiotic for all household contacts
E. No prophylaxis is needed

A 3-yr-old boy presents with a 7-day history of fever, cervical lymphadenopathy, foul breath,
and painful oral lesions on his tongue, gums, and lips. For the past 3 days he has had a red,
painful swollen area about the nail of his right thumb with an area of fluid by the nail bed,
unresponsive to warm soaks and a first- generation cephalosporin. The most likely etiologic
agent is:
A. Staphylococcus aureus
B. Mucocutaneous candidiasis
C. Coxsackievirus
D. Adenovirus
E. Herpes simplex virus

The most common cause of bronchiolitis is:

A. Respiratory syncytial virus
B. Parainfluenza virus
C. Mycoplasma pneumonia
D. Adenovirus
E. Human metapneumovirus

According bronchial asthma management all of the followings are TRUE EXCEPT:
A. Influenza immunizations are indicated for children with asthma
B. Inhaled corticosteroids are the most effective anti-inflammatory medications for the
treatment
A. of chronic, persistent asthma
B. Regular use of inhaled corticosteroids reduces the risk of death from asthma
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 C. Short-acting B2-agonist is used as prophylaxis before allergen exposure andexercise
D. Non of the above

A 2-year-old boy with cough and difficulty breathing is brought to the emergency department
by his mother. She says that he was well and playing with his toys until hours prior to
presentation. He is healthy, but his 6-year old brother has a peanut allergy. The patient's
temperature is 36.7 C, blood pressure is 92/48 mm Hg, pulse 114/min, and respirations are 48/
min. The patient's pulse oximetry shows 91% on room air. Physical examination shows nasal
flaring and grunting with both subcostal intercostal retractions. Wheezing is heard in the right
lung field; the left field is clear on auscultation. No rales are noted. The remainder of the
physical examination is in normal limits. Supplementary oxygen is applied. Chest x-ray reveals
mild hyperinflation of the right lung. Which of the following is the most appropriate next step
management of this child?
A. Racemic epinephrine
B. Bronchoscopy
C. Nebulized albuterol
D. Intramuscular epinephrine
E. Chest CT scan

According pediatric pneumonia all of the followings are TRUE EXCEPT:

A. Cultures performed on specimens obtained from the upper respiratory tract or sputum
generally do not accurately reflect the cause.
B. Viral pathogens are a prominent cause of lower respiratory tract infections in Infants and
children <5 year of age.
C. Mucosal congestion and upper airway inflammation suggest viral pneumonia.
D. Any case of pneumonia should be admitted to receive IV antibiotics.

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 E. Viral pneumonia characteristically shows diffuse, streaky infiltrates and hyperinflation.

A 2-year-old boy is brought to the emergency department due to difficulty breathing that
started 12 hours earlier. The child has had rhinorrhea, nasal congestion, and a chronic barking
cough for the past 3 days. His temperature is 37.7 C, blood pressure is 92/64 m Hg, pulse is 122/
min, and respirations are 30/min. His pulse oximetry shows 99% room air. He has inspiratory
stridor when crying. The patient is diagnosed with croup and given oral dexamethasone, and
observed in the emergency department. After minutes, his oxygen saturation drops to 96% on
room air and respirations increase 45/min. He develops subcostal and intercostal retractions
and inspiratory stridor at rest. What is the most appropriate next step in management of this
patient?
A. Administer nebulized albuterol
B. Administer nebulized racemic epinephrine
C. Administer supplemental oxygen via face mask
D. Intubate and mechanically ventilate
E. Place a peripheral intravenous line

A 2-month-old girl is brought to the physician during winter with a runny nose, cough, and
fussiness over the past 2 days. Her birth history is unremarkable and she has been feeding and
growing well. The girl has a sibling in day care, where other children have been ill. Her
temperature is 37.8 C, respirations are 70/min, and pulse oximetry is 95% on room air.
Examination shows a crying infant with clear rhinorrhea and bilateralwheezes and crackles.
The most likely diagnosis is:
A. Cystic fibrosis
B. Bronchial asthma
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 C. Foreign body aspiration
D. Pertussis
E. Bronchiolitis

The major predisposing factor for developing sinusitis is:

A- Pharyngitis
B- Common cold
C- Otitis media
A. D-Nasal Septal deviation
D- Adenoidal hypertrophy.

12-A 6-year-old girl is brought to the physician with a 10-day history of thick and persistent
earache. She has a history of intermittent asthma and her medications include inhaled nasal
discharge, nasal congestion, and cough. She has had no vomiting, headache, respirations are 15/
min. Physical examination shows yellow, purulent mucus dripping albuterol. Temperature is
37.2° C, blood pressure is 88/50 mm Hg, pulse is 90/min, and are tender to palpation. Lung
examination shows bilateral expiratory wheezes. Skin from the posterior nasopharynx. Nasal
turbinates are red and swollen. Maxillary sinuses examination shows no abnormalities. Which
of the following organisms is the most common cause of this condition?
A. Moraxella catarrhalis
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 B. Aspergillus fumigatus
C. Pseudomonas aeruginosa
D. Staphylococcus aureus
E. Streptococcus pneumoniae

True about hepatitis A:

A. Hepatitis A has a long incubation period (50 to 80 days)
B. Hepatitis A presents after a prolonged viremic stage
C. The presentation of hepatitis A is characterized by the sudden onset of fever, nausea, and
vomiting
D. Hepatitis A is spread by parenteral route
E. An infection with hepatitis A results in elevations of liver function studies and serum
bilirubin levels for 6 months or more

Which of the following is true about bacterial sinusitis in children?

A. Orbital complications, such as orbital cellulitis, usually follow ethmoiditis
B. Staph. Aureus is a common cause of acute sinusitis in children
C. Cultures of the sinus aspirates are necessary to confirm the diagnosis
D. Most cases don't resolve without the use of antimicrobial therapy

A Work-up for recurrent pneumonia should include all of the following EXCEPT:
A. Barium study of the upper gastro-intestinal tract
B. Sweat test
C. Immunoglobulins concentration in the serum
D. White blood cell (WBC) count
E. Serum electrolyte determinations

A 17-month-old girl presents to the emergency department in respiratory dress. Her

temperature 35.6 respiratory rate is 52 breaths/minute and associated with i deteriorates and
she requires intubation, during which time thick, por and pseudomembranes are noted. These
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clinical findings o preceding infection most often caused by which of the following?
A. Haemophilus influenzae type b
B. Adenovirus
C. Respiratory syncytial virus
D. Parainfluenza virus type

Which of the following is FALSE about brucellosis:

A. Definitive diagnosis is by blood culture, bone marrow culture or liver biopsy or culture
B. The causative organism is a Gram negative bacillusc.
C. Classic triad of fever, arthralgia/arthritis (where the ankle joint is most commonly affected),
and hepatosplenomegaly can be demonstrated in most patientsd.
D. Can be transmitted through inhalation, skin cuts, conjuctival sac, ingestion of contaminated
milk or meat and even transplacentallye.
E. None of the above
F. Doxycycline is the most useful antimicrobial agent and, when combined with an
aminoglycoside, is associated with the fewest relapses.

The following statements about hepatitis are true EXCEPT:

a. Hepatitis C rarely leads to a chronic condition
b. One single raised antibody titre confirms the diagnosis of hepatitis A
c. Hepatitis A vaccine is very effective.
E. Hbe Ag is associated with increased infectivity.
d. Hbs AB persists for more than 10 years.

A 13-day-old full-term girl is brought to the physician during winter with a runny nose, cough,
and fussiness over the past 2 days. Her birth history is unremarkable and she has been feeding
and growing well. The girl has a sibling in day care, where other children have been ill. Her

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temperature is 37.8 C (100 F), respirations are 70/min, and pulse oximetry is 95% on room air.
Examination shows a crying infant with clear rhinorrhea and bilateral wheezes and crackles.
Which of the following complications is this patient
at greatest risk of developing?
A. Apnea
B. Bacteremia
C. Bacterial pneumonia
D. Fungal pneumonia
E. Lymphoma

An 18-month-old boy is brought to the emergency department by his parents due to fever,
vomiting, and lethargy. This morning, he developed a fever that initially responded to
acetaminophen. Throughout the day, the patient developed a progressive rash on the lower
extremities and became increasingly lethargic. He was treated with antibiotics for acute otitis
media last month but is otherwise healthy. Immunizations are up to date. The patient lives
with his parents and 3-year-old brother. Both he and his brother attend day care. Temperature
is 40.2 C (104.4 F), and pulse is 124/min. On examination the patient is lethargic. He flexes his
hips when his neck is flexed. There is an erythematous, non-blanching, pinpoint rash on the
trunk and lower extremities. Which of the following is the most likely organism causing this
patient's symptoms?
A. Coxsackievirus
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 B. Group B Streptococcus
C. Haemophiles influenzae
D. Herpes simplex virus
E. Listeria monocytogenes
F. Neisseria meningitidis

A 16-year-old girl is brought to the emergency department with rash and joint pain. A pink
rash developed on her face yesterday and has spread to her chest, back, and extremities this
morning. She also awoke today with pain in her fingers and wrists. The patient feels tired and
has had a fever but no neck stiffness, nausea, or vomiting. She is sexually active with a male
partner and uses condoms inconsistently. She has received no vaccinations. Temperature is
38.2 C (100.8 F), blood pressure is 118/76 mm Hg, pulse is 86/min, and respirations are 14/min.
Physical examination shows a \'tell-appearing and \'tell-hydrated girl. There is a blanching,
erythematous maculopapular rash on the
face, chest, back, and extremities that spares the palms and soles. Posterior auricular and
suboccipital lymphadenopathy is present. The oropharynx is clear. Which of the following is
the most likely cause of this patient's symptoms?
A. Epstein-Barr virus
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 B. Measles virus
C. Neisseria gonorrhoeae
D. Rubella virus
E. Treponema pallidum
F. Varicella-zoster virus

A 5-year-old boy is brought to the office by his parents after exposure to a child with a rash.
Three days ago, the patient had a day-long playdate with a friend v1ho had lov1- grade fever
and a vesicular rash. That child and another child in the neighborhood were subsequently
diagnosed with chickenpox. The patient has no symptoms and no history of medical problems.
The boy received age-appropriate vaccinations in infancy but has not received any
immunizations after age 1. He lives at home with his mother, father, and 1-year-old brother.
The boy's mother is currently pregnant and immune to the varicella zoster virus. Vital signs
are within normal limits. Examination of the skin, ears, and mucous membranes is normal; the
remainder of the examination is unremarkable. Which of the following is the most appropriate
next step in management of this patient?
A. Administer acyclovir
B. Administer varicella immunoglobulin
C. Administer varicella vaccine
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 D. Administer varicella vaccine and varicella immunoglobulin
E. Reassurance
The MOST frequent pathogen of pneumonia in children 4 mo-4 yr is
A. Streptococcus pneumoniae
B. Mycoplasma pneumoniae
C. group A streptococci
D. H. influenzae (type b, non-typable)
E. Respiratory syncytial virus

The MOST common complication of mumps is

A. meningitis
B. conjunctivitis
C. optic neuritis
D. pneumonia
E. thrombocytopenia

The MOST common complication of acute severe meningococcal septicemia is

A. arthritis
B. focal skin infarction
C. endocarditis
D. pneumonia
E. peritonitis

The MOST common finding among infants with congenital rubella syndrome is
A. psychomotor retardation
B. cataracts
C. deafness
D. patent ductus arteriosus
E. neonatal purpura
The minimum interval between the 2 doses of MMR is
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‫مفتاح اإلجابات‬
 A. 2 weeks
B. 4 weeks
C. 2 months
D. 6 months
E. 1 year

Scarlet fever is an upper respiratory tract infection associated with a characteristic rash. Of
the following, which statement is TRUE?
A. it is caused by an infection with pyrogenic endotoxin producing group A streptococcus
B. the rash appears 96 hr after onset of symptoms
C. the rash begins to fade after 1-2 weeks
D. before desquamation, the reddened papillae are prominent, giving the tongue a strawberry
appearance
E. the milder form can be confused with Kawasaki disease

Patient with sickle cell anemia, what is the most common viral cause?
A. Parvovirus B19
B. Measles
C. Coxsackievirus
D. Rubella

A 19-day-old girl is brought to the emergency department due to difficulty feeding. The infant
was born at term to a woman age 24, gravida 2 para 2, following an uncomplicated pregnancy
and had been breastfeeding well and voiding and stooling normally until 2 days ago. Since
then, she has not been waking for feeds and has seemed much sleepier than usual. Today, she
is fussy and difficult to console. The patient lives at home with her parents, 2-year-old sister,
and 3 cats. Temperature is 35.1 C (95.2 F), blood pressure is 78/52 mm Hg, pulse is 150/min, and
respirations are 62/min. The infant has a full fontanelle, jaundice of the chest, mild scleral
icterus, and dry mucous membranes. Auscultation of the chest reveals mild tachypnea but

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‫مفتاح اإلجابات‬
clear lung fields. No murmur is present. Abdominal examination is normal. Neurologic
examination shows a lethargic infant with decreased tone. Total and direct bilirubin levels and
a complete blood count with differential are pending. Which of the following is the most
appropriate next step in management of this infant?
A. Bacterial cultures and antibiotics
B. CT scan of the head
C. Peripheral smear and reticulocyte count
D. Temporary cessation of breastfeeding
E. Thyroid function testing

An 18-month-old boy is brought to the emergency department by his parents due to fever,
vomiting, and lethargy. This morning, he developed a fever that initially responded to
acetaminophen. Throughout the day, the patient developed a progressive rash on the lower
extremities and became increasingly lethargic. He was treated with antibiotics for acute otitis
media last month but is otherwise healthy. Immunizations are up to date. The patient lives
with his parents and 3-year-old brother. Both he and his brother attend day care. Temperature
is 40.2 C (104.4 F), and pulse is 124/min. On examination the patient is lethargic. He flexes his
hips when his neck is flexed. There is an erythematous, nonblanching, pinpoint rash on the
trunk and lower extremities. Which of the following is the most likely organism causing this
patient's symptoms?
A. Coxsackievirus
B. Group B Streptococcus
C. Haemophilus influenzae
D. Herpes simplex virus
E. Listeria monocytogenes
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‫مفتاح اإلجابات‬
 F. Neisseria meningitidis

A 13-day-old full-term girl is brought to the physician during winter with a runny nose, cough,
and fussiness over the past 2 days. Her birth history is unremarkable and she has been feeding
and growing well. The girl has a sibling in day care, where other children have been ill. Her
temperature is 37.8 C (100 F), respirations are 70/min, and pulse oximetry is 95% on room air.
Examination shows a crying infant with clear rhinorrhea and bilateral wheezes and crackles.
Which of the following complications is this patient at greatest risk of developing?
A. Apnea
B. Bacteremia
C. Bacterial pneumonia
D. Fungal pneumonia
E. Lymphoma

An 18-month-old boy is brought to the emergency department by his parents due to worsening
cough and fever. The patient developed the cough 6 days ago; it increased in frequency over
the past day and caused him to wake frequently overnight. He has had fever to 38.3 C (100.9 F)
for 3 days. The child takes no medications and has no significant medical history. Temperature
is 38.8 C (101.8 F), and respirations are 45/min. Oxygen saturation is 96%. Physical examination
shows an active, alert, and playful toddler with mild tachypnea and intermittent suprasternal
retractions. Auscultation reveals scattered wheezing and crackles over bilateral lung fields.
The remainder of the physical examination is unremarkable. Chest x-ray is shown in the
exhibit. Which of the following is the best next step in the care of this patient?
A. Blood cultures and intravenous antibiotics
B. CT scan of the chest
C. Discharge with close follow-up only
D. Discharge with oral antibiotics
E. Inhaled bronchodilator trial and oral glucocorticoid.

Which of the following represent a major criterion for the diagnosis o staphylococcal toxic

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‫مفتاح اإلجابات‬
shock syndrome?
A. rash
B. conjunctival hyperemia
C. myalgia
D. thrombocytopenia
E. vomiting

50. Impetigo (or pyoderma) has traditionally been classified into 2 clinical forms: bullous and
nonbilious. Of the following, which statement is TRUE?
A. [Link] impetigo is more common.
B. nonbullous lesions are most common on the trunk and perineum.
C. regional lymphadenitis is commonly associated with nonbullous lesions.
D. nonbullous impetigo is generally accompanied by fever.
E. bullous impetigo usually involves the face and extremities.

58. Group B streptococcus (GBS), or Streptococcus agalactiae, is a major cause of neonatal

bacterial sepsis. Of the following, the MOST common syndrome associated with childhood GBS
disease beyond early infancy is:
A. bacteremia without a focus
A. [Link]
B. ventriculitis
C. septic arthritis
D. pneumonia

Of the following, the MOST effective agent for prophylaxis of meningococcal disease is
A. ceftriaxone
B. rifampin
C. ampicillin
D. penicillin
E. amoxicillin

Measles is a serious infection characterized by high fever, an enanthem, cough, coryza,

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‫مفتاح اإلجابات‬
conjunctivitis, and a prominent exanthem. All the following are true EXCEPT:
A. [Link] period is 8-12 days
B. Koplik spots have been reported in 50-70% of measles cases
C. the rash begins on the forehead, behind the ears, and on the upper neck
D. the rash fades over about 3 days in the same progression as it evolved
E. in more severe cases, generalized lymphadenopathy may be present

The MOST common cause of recurrent aseptic meningitis is

A. mumps
B. EBV
C. adenoviruses
D. HSV
E. influenza virus

122. Varicella is an acute febrile rash illness that is common in Iraq. Of the following, the TRUE
statement is:
A. it usually begins 4-6 days after exposure
B. subclinical varicella is common
C. mild abdominal pain may occur 24-48 hr before the rash appears
D. temperature elevation usually as high as 41.1°c
E. lesions often appear first on the extremities

All the following regarding assessment and care of infants with pertussis are true ЕХСЕРТ
A. А. infants with potentially fatal pertussis may appear well between episodes
B. a paroxysm must be witnessed before a decision is made between hospital and home care
C. suctioning of nose, oropharynx, or trachea should be performed on a preventive schedule
D. feeding in the period following a paroxysm may be more successful than after napping
E. family education, recruitment as part of the team, and continued support after discharge
are essential

All the following are true about varicella in unvaccinated individuals EXCEPT
A. simultaneous presence of lesions in the same stages of evolution
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‫مفتاح اإلجابات‬
 B. distribution of the rash is predominantly central
C. many children have vesicular lesions on the eyelids
D. exanthem may be much more extensive in children with skin disorders
E. hypopigmentation or hyperpigmentation of lesion sites persists for days to weeks in some
children

What is Mumps Incubation period?

A. 16-18
B. 14-21
C. 10-14
D. 7-10

What is the most common cause of OM with infusion?

A. St. Pneumonia
B. Hib
C. GAS
D. P. Pertussis

The MOST common complication of mumps is

A. meningitis
A. Conjunctivitis
B. optic neuritis
C. Pneumonia
D. Thrombocytopenia

The preferable antibiotic in neonate with pertussis is.

A. Azithromycin
B. Erythromycin
C. Clarithromycin
D. Trimethoprim-sulfamethoxazole
E. Amoxycillin
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‫مفتاح اإلجابات‬
A previously healthy 13-year-old boy presents with a 2-week history of nonproductive cough
and low-grade fever. On examination, you note a normal respiratory rate and no evidence of
respiratory distress but are surprised to hear inspiratory rales at the bilateral lung bases
Which of the following is the most likely cause of pneumonia in this adolescent:
A. Pneumocystis jiroveci
B. Staphylococcus aureus
C. Group B streptococcus
D. Bordetella pertussis
E. Mycoplasma pneumoniae

Q5.A 6-year-old girl is sent home from summer camp with a temperature of 38.5°C, stiff neck,
photophobia, and headache. Lumbar puncture in the emergency department reveals the
following results: WBC 380 cells/mm3 with 65% polymorphonuclear cells and lymphocytes
35% normal protein and glucose; and negative Gram stain. Which of the following pathogens is
the most likely cause of her meningitis:
A. Neisseria meningitidis
B. Streptococcus pneumoniae
C. Enterovirus
D. Borrelia burgdorferi
E. Mycobacterium tuberculosis

A 13-dayold full-term girl is brought to the physician during Winter with a runny nose, cough,
and fussiness over the past 2 days. Her birth history is unremarkable and she has been feeding
and growing well. The girl has sibling in day care, where other children have been ill. Her
temperature is 37.8c(100F), respirations are 70/min, and pulse oximetry is 95% on room
air. Examination shows a crying infant with clear rhinorrhea and bilateral
wheezes and crackles. Which of the following complications is this patient at greatest risk of
developing:
A. Bacteremia

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‫مفتاح اإلجابات‬
 B. Apnea
C. Fungal pneumonia
D. Bacterial pneumonia
E. Lymphoma

A 19-year-old boy, presents with high fever, headache, cough conjunctivitis, and a diffuse
macular rash over his trunk and face. He is unsure of his immunization status. You suspect
measles infection. Which of the following is correct regarding this diagnosis
A. Vitamin A may improve his outcome
B. Koplik spots would likely be present on examination of his mouth
C. Mortality is most commonly caused by measles encephalitis
D. Diagnosis is based on culture and direct fluorescent antigen testing
E. Corticosteroids will decrease symptoms and improve outcome

The MOST common cause of death in measles is:

A. meningitis
B. conjunctivitis
C. subacute sclerosing panencephalitis
D. pneumonia
E. thrombocytopenia
F. otitis media

Mohammed, a 5-year-old refugee from Syria, presents to ER with toxic general

condition. He has a 1-day history of sore throat and a high temperature (40.1°C). Over the
last 8 hours he has been having increasing difficulty breathing with quiet stridor. He has
never been immunized. He is noted to be unable to swallow his saliva. Regarding his
condition all of the following is true except?

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‫مفتاح اإلجابات‬
 A. the most likely causative organism is type B H. influenzae.
B. vaccination against causative organism reduce the rate of this disease.
C. you should avoid examination of throat before intubation.
D. Thumb sign can be seen on lateral neck Xray.
E. you should drown blood sample for investigation before intubation.

The MOST common neurologic sequelae of bacterial meningitis is

A. recurrent seizures
B. delay in acquisition of language
C. hearing loss
D. cognitive impairment
E. visual impairment

Mumps virus is in the family Paramyxoviridae and the genus Rubulavirus. Mumps is
characterized by:
A. incubation period ranges from 7-11 days
A. B unilateral parotitis rarely becomes bilateral
B. pale opening of the Stensen duct
C. parotid swelling peaks in approximately 7 days
D. a morbilliform rash is rarely seen

Which of the following statements regarding immunization against H. influenza (the Hib
vaccine) is true?
A. The vaccine prevents meningitis as well as some other conditions caused by h. influenza
B. The first dose pf hib vaccine should be given at the age of 2 months
C. If a child presents late for immunization, the full series of the vaccine may not be required
D. The Hib vaccine has not decreased the incidence of otitis media in infants and children
E. All of the above

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‫مفتاح اإلجابات‬
A 2-year-old boy is brought to the clinic by his parents due to 6 days of high-grade fever and
rash and a day of difficulty breathing. The rash began on the patient's face and subsequently
spread to his trunk and extremities. Prior to the onset of rash, he had a nonproductive cough,
tearing of eyes, runny nose, and intermittent nasal congestion. The family lives in a rural town
in Zambia and is in the United States to visit relatives. The child has received no
immunizations. Temperature is 38.7 C (101.7 F) and respirations are 44/min. Physical
examination shows a diffuse erythematous, maculopapular rash all over the body that spares
the palms and soles. Auscultation of the chest reveals bilateral crackles. The child is admitted
to the local hospital for further care. Which of the following has been shown to reduce
morbidity and mortality of patients with this infection?
A. Vitamin A may improve his outcome
B. Koplik spots would likely be present on examination of his mouth
C. Mortality is most commonly caused by measles encephalitis
D. Acute otitis media is the most common complication
E. B & C

3- An 18-month-old boy is brought to the emergency department by his parents due to

worsening cough and fever. The patient developed the cough 6 days ago; it increased in
frequency over the past day and caused him to wake frequently overnight. He has had fever to
38.3 C (100.9 F) for 3 days. The child takes no medications and has no significant medical
history. Temperature is 38.8 C (101.8 F), and respirations are 45/min. Oxygen saturation is 96%.
Physical examination shows an active, alert, and playful toddler with mild tachypnea and
intermittent suprasternal retractions. Auscultation reveals scattered wheezing and crackles
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‫مفتاح اإلجابات‬
over bilateral lung fields. The remainder of the physical examination is unremarkable. Chest x-
ray is shown in the exhibit. Which of the following is the best next step in the care of this
patient?
A. Blood cultures and intravenous antibiotics
B. CT scan of the chest
C. E. Discharge with close follow-up only
D. Discharge with oral antibiotics, Inhaled bronchodilator trial and oral glucocorticoid
An 18-month-old boy is brought to the emergency department by his parents due to fever,
vomiting, and lethargy. This morning, he developed a fever that initially responded to
acetaminophen. Throughout the day, the patient developed a progressive rash on the lower
extremities and became increasingly lethargic. He was treated with antibiotics for acute otitis
media last month but is otherwise healthy. Immunizations are up to date. The patient
lives with his parents and 3-year-old brother. Both he and his brother attend day care.
Temperature is 40.2 C (104.4 F), and pulse is 124/min. On examination the patient is lethargic.
He flexes his hips when his neck is flexed. There is an erythematous, non-blanching, pinpoint
rash on the trunk and lower extremities. Which of the following is correct?
A. The most likely diagnosis is meningococcal septicemia
B. The most likely diagnosis is meningitis only
C. When you do CSF smear, you expected to found gram-positive diplococci
D. high ESR, plts, WBC count are poor prognostic factors
E. B & C

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‫مفتاح اإلجابات‬
A 6-year-old boy is brought to the emergency department with severe shortness of breath.
He has had a runny nose for the past week and fever, chills, and productive cough for 2 days.
The patient was diagnosed with cystic fibrosis on newborn screening and has had multiple
hospitalizations since infancy for respiratory infections requiring intravenous antibiotics. He
also had multiple skin infections requiring incision and drainage over the past year.
Temperature is 39.4 C (103 F), blood pressure is 90/60 mm Hg, pulse is 130/min, and
respirations are 35/min. Pulse oximetry shows a oxygen saturation of 85% that improves to
92% after oxygen supplementation. Examination shows nasal flaring, intercostal retractions,
and grunting, and auscultation reveals bibasilar crackles and expiratory wheezing. Chest x-ray
reveals infiltrates in the right and left lower lobes. Influenza antigen testing is positive.
Cefepime and oseltamivir are administered. Which of the following empiric antibiotics
should also be administered in this patient?
A. Intravenous itraconazole
B. Intravenous nafcillin
C. Intravenous vancomycin
D. Oral amoxicillin
E. Oral azithromycin
F. Oral ciprofloxacin

Mumps virus is in family paramyxoviridae, regarding Mumps is true except

A. Mumps is RNA virus
B. the most common complication in mumps infection is meningitis
C. a morbilliform rash is rarely seen
D. parotid swelling peaks in approximately 7 days

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‫مفتاح اإلجابات‬
 E. MMR vaccine is live attenuated vaccine given at 12 & 18 months according to Palestinian
vaccination program

The following are indications for admission to a hospital in children with pneumonia EXCEPT:
A. age <6 mo
B. sickle cell anemia
C. multiple lobe involvement
D. moderate to severe respiratory distress
E. vomiting

A 6 year-old male presents to the emergency department following a human bite to the right
hand. His vaccinations are up to date. Physical examination is remarkable for erythema,
swelling and tenderness around the puncture wounds. Which of the following is the most likely
etiology of this patient's symptoms?
A. Polymicrobial
B. Pasteurella multocida
C. Staphylococcus aureus
D. Bartonella henselae
E. Bartonella henselae

A 31-year-old woman presents to an obstetrician for prenatal care. She is 12 weeks pregnant
based on her last menstrual period, and has been taking her prenatal vitamins during this
time. She has been pregnant twice before, and both pregnancies resulted in miscarriages. Her
medical history is significant for hypertension and a previous deep venous thrombosis. She
takes no other medications and is allergic to penicillin and cephalexin. As part of a routine
workup, she is tested for syphilis and HIV. Serologic testing for HIV is negative, and her rapid
plasma reagin (RPR) is reactive. What is the most appropriate next step in management?
A. Undergo penicillin-desensitization, followed by treatment with penicillin immediately

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‫مفتاح اإلجابات‬
 B. Testing for fluorescent treponemal antibody absorption (FTAABS) reactivity and screening
for autoantibodies
C. Undergo penicillin-desensitization, followed by treatment with penicillin at delivery
D. Administer penicillin now
E. Administer doxycycline now

The following is correct regarding matching the rickettsial disease with the causative
organism:
A. Brill-Zinsser disease – R. prowazekii
B. Boutonneuse fever– R. typhi
C. Scrub typhus – C. burnetiid
D. Murine typhus – R. conorii
E. Q-fever – R. tsutsugamushi

A 3-year-old boy is brought to the emergency department for fever. Since returning from a
family trip to Nigeria last week, he has been lethargic with constant nausea and headache. He
has had several episodes of vomiting and watery diarrhea each day and high spiking fevers,
chills, and drenching sweats every other day. The boy carries the sickle cell trait and has no
other medical problems. He takes no medications and his vaccinations are up to date. His
temperature is 40 C, blood pressure is 90/60 mm Hg, pulse is 132/min, and respirations are
24/min. Examination shows a tired-appearing boy with jaundice. Lungs are clear to
auscultation. The abdomen is soft and nontender. Hepatosplenomegaly is present. Range of
motion in his neck and extremities is normal. Laboratory studies show mild anemia and
thrombocytopenia. Which of the following factors is associated with decreased morbidity
from this illness?
A. Young age
B. Male sex
C. Prophylaxis with ciprofloxacin
D. History of meningococcal vaccination
E. Sickle cell trait

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‫مفتاح اإلجابات‬
A 2-yr old child of an African mother is noted to have poor weight gain, with development of
Pneumocystis jiroveci pneumonia, oral candidiasis, and cutaneous Kaposi sarcoma lesions.
Further evaluation reveals that the child is HIV seropositive, with an HIV viral load of 100,000
copies/mL and a CD4 cell count of 150 cells/µL. Treatment for P. jiroveci pneumonia and
candidiasis is Initiated. The most appropriate next step in management of the Kaposi sarcoma
lesions would be:
A. Intralesional injection with cidofovir
B. Initiation of antiretroviral therapy
C. Surgical excision
D. Combination chemotherapy

Recognized presentations of leishmaniasis include:

A. Fever, marked splenomegaly, hepatomegaly, and cachexia
B. Nasal mucosal involvement with recurrent epistaxis
C. Large nonulcerating papules that resemble leprosy
D. All of the above
E. A papular lesion on the face

A newborn infant is noted to have white plaques on his buccal mucosa that are difficult to
scrape off with a tongue depressor. When removed, a small amount of bleeding is noted by the
nurse. The infant just received a course of empiric antibiotics for suspected Group B β-
hemolytic Streptococcus infection. What is the best next step in management?
A. IV Amphotericin B
B. Hydrocortisone
C. None of the above
D. Oral Acyclovir
E. Oral nystatin

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‫مفتاح اإلجابات‬
A 12-year-old girl with sickle cell anemia presents with fever, chills and hematuria. She
returned from summer camp in Connecticut 3 weeks ago. Laboratory evaluation reveals a
hematocrit of 22% (she normally lives at 25%) and inclusion bodies in the red blood cells in
bunches of 4, like an X or “across”. What is the most likely cause of this patient's current
symptoms?
A. Malaria
B. Ehrlichiosis
C. Lyme disease
D. Babesiosis
E. Chagas disease

All of the following is true about coronaviruses EXCEPT:

A. They are a large family of single-stranded RNA viruses and belong to the Nidovirus family
B. MERS is spread by droplets, has a reservoir in cave bats and reaches us via the domestic
camel.
C. Being zoonotic viruses means that they emerge from animals to cross the species barrier
infrequently
D. SARS has caused thousands of deaths around the world as an 'emergent' virus
E. None of the above*

A 7-year-old female presents with a “lump under her arm.” She also complains of fatigue and
a low-grade fever. Her immunizations are up to date, she is eating well and has not lost any
weight. She has 2 kittens that she received 6 months ago for her birthday. Physical
examination is remarkable for a 4 cm tender right axillary lymph node with some overlying
erythema. She also has some scratches and red papules on her right hand. Which of the
following drugs hastens recovery of patients with this illness?
A. Amoxicillin-clavulanate

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‫مفتاح اإلجابات‬
 B. Ciprofloxacin
C. Azithromycin
D. Cefuroxime
E. Doxycycline
In Gaza Strip no cases of Leishmaniasis are reported due to:
A. Gaza free from Malaria
B. Good health services and high coverage of vaccine program
C. Gaza free from sand fly
D. None of the above
E. Good hygiene measures and sanitation

A 10-year-old boy is brought to the clinic due to malaise and headache for the past 2 weeks.
Three weeks ago, he went on a hiking trip with his family during which his mother found a tick
attached to his thigh. The mother removed the tick with tweezers, and a red "bump" remained
at the site where the tick was attached. One week later, a red ring developed around the
"bump" and has since grown larger. The rash is slightly itchy but not painful. The patient has a
history of eczema treated intermittently with topical hydrocortisone. Last year, he had tinea
pedis that resolved with terbinafine. Examination shows a nontender rash, approximately 8 cm
in diameter, on his right thigh (shown in the picture below). The remainder of his examination
is normal. What is the most appropriate next step in management of this patient?
A. Intravenous ceftriaxone
B. Oral doxycycline
C. Topical hydrocortisone
D. Oral itraconazole
E. Oral amoxicillin

Management for a newly diagnosed, asymptomatic 2 yr old HIV-infected child with a CD4 cell
count of 45/mm3 and HIV RNA of 110,000 copies/mL should include all of the following EXCEPT:
A. Clarithromycin prophylaxis for Mycobacterium avium complex infection
B. Antiretroviral therapy
C. Monthly IVIG prophylaxis for bacterial infections

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‫مفتاح اإلجابات‬
 D. Trimethoprim-sulfamethoxazole prophylaxis for Pneumocystis jiroveci infection
E. Tuberculin skin testing

A 2 yr old child of an African mother is noted to have poor weight gain, with development of
Pneumocystis jiroveci pneumonia, oral candidiasis, and cutaneous Kaposi sarcoma lesions.
Further evaluation reveals that the child is HIV seropositive, with an HIV viral load of 100,000
copies/mL and a CD4 cell count of 150 cells/µL. Treatment for P. jiroveci pneumonia and
candidiasis is initiated. The most appropriate next step in management of the Kaposi sarcoma
lesions would be:
A. Local radiation
B. Initiation of antiretroviral therapy
C. Surgical excision
D. Combination chemotherapy
E. Intralesional injection with cidofovir

Which of these terms is NOT a name for a form of leishmaniasis:

A. Kala-azar
B. Delhi belly
C. Dumdum fever
D. Baghdad boil
E. Black fever

What are the 3 major species of schistosome which cause the disease?
A. S. mekongi, S. pithecophaga, and S. echnoderma
B. S. haematobium, S. nyctea, and S. alula
C. S. japonicum, S. annelida, and S. mansoni
D. S. haematobium, S. japonicum, and S. mansoni

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‫مفتاح اإلجابات‬
According to the WHO reports regarding the recent outbreak of Acute Hepatitis of Unknown
Etiology, all of the following are correct EXCEPT:
A. Many reported cases have high fever.
B. Hepatitis viruses (A, B, C, D and E) were not detected in any case.
C. Elevations of liver enzymes to more than 500 IU/ L.
D. Adenovirus type 41 has been detected in many cases.
E. Abdominal pain, diarrhea and vomiting were preceding the acute hepatitis in many cases.

Which of the following Plasmodium species causes the most severe form of malaria and is
associated with the highest fatality rate?
A. None of the above; all malaria species are similar in disease severity
B. P. malariae
C. P. falciparum
D. P. vivax
E. P. ovale

According to diagnosis of Leishmania, all of the following are TRUE EXCEPT:

A. Identification of amastigotes in tissue smears or histology are commonly used methods of
diagnosis
B. Leishmania PCR is useless on blood samples
C. Antibody towards K39 antigen is proving useful especially in field diagnosis of visceral
leishmaniasis
D. Splenic aspirates are very sensitive and usually safe
E. Tissue cultures are used routinely
F. A & B

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‫مفتاح اإلجابات‬
Which procedure is most likely to yield Pneumocystis carinii from a patient with pneumonia
caused by this organism?
A- Induced sputum
B- Hypopharyngeal swab
C- Bronchoalveolar lavage
D- Gastric aspiration
E- Blood culture

Regarding malaria, which of the following is FALSE:

A- young children have decreased risk for cerebral malaria
B- infection transmitted by mosquitos
C- Diagnosis is made by thin &amp; thick peripheral blood smears
D- Hemoglobinopathies are protective factors
E- The febrile paroxysms parallel the waves of red blood cell invasion when parasites are
released from the liver into the bloodstream

How does a schistosome normally enter the body?

A- Through the nose
B- Through the skin
C- Through drinking water
D- Through the urethra

Regarding to treatment of Leishmania, all of the following are TRUE EXCEPT:

A- Leishmania in the immunosuppressed usually necessitates secondary prophylaxis
B- Liposomal amphotericin is effective but very expensive
C- Cutaneous Leishmania can be treated both by physical and pharmacological means
D- There are no oral medications to effectively treat Leishmania
E- Oral miltofisine is very effective in the treatment of Kala azar

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‫مفتاح اإلجابات‬
A 12 yr old adolescent boy presents with unexplained febrile illness. He had traveled to India
with his parents 6 mo previously, and both he and his parents confirm complete adherence to
the prescribed malaria prophylaxis regimen. Which of the following is true concerning the
need for investigation for malaria as the cause of his illness?
A- Investigation is necessary only if he has had unexplained fevers since his return
B- No investigation is necessary because prophylaxis was used
C- No investigation is necessary if mefloquine was part of the prophylactic regimen
D- Investigation is necessary only if another family member was ill
E- Investigation for malaria is necessary

The 12-yr-old son of diplomat parents presents with crampy abdominal pain, fever, migratory
arthralgias, and hepatosplenomegaly. Ultrasound examination of his abdomen shows
periportal fibrosis consistent with schistosomiasis. His kidneys and bladder are normal. Which
of the following schistosome species is unlikely to be the cause of his illness?
A- Schistosoma haematobium
B- Schistosoma mansoni
C- Schistosoma intercalatum
D- Schistosoma japonicum
E- Schistosoma mekongi

All of the following statements concerning HIV infection are true EXCEPT:
A- CD4 cell counts reflect the risk of opportunistic infections
B- Therapy can reduce HIV burden to undetectable levels
C- Adherence to therapy is crucial
D- HIV suppression is best achieved by regularly rotating antiretroviral regimens
E- Viral burden predicts disease progression

Each of the following statements concerning kala-azar is CORRECT EXCEPT:

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‫مفتاح اإلجابات‬
 A- Kala-azar occurs primarily in rural latin America
B- Kala-azar is caused by leishmania donovani
C- Kala-azar can be diagnosed by finding amastigotes in bone marrow
D- kala-azar is transmitted by the bite of sandflies

A 9-year-old girl presents to the emergency room with a 3 day history of fever, headache,
nausea and abdominal pain. She has no vomiting or diarrhea. She returned one week ago from
a trip to India with her family. She is up to date on immunizations and received Hepatitis A and
Yellow fever vaccines prior to her trip. She also mefloquine for malaria prophylaxis
throughout her visit. Her temperature is 101 degrees F and her heart rate is 55 beats/min.
Physical examination is remarkable for 3+ capillary refill and a faint, blanching, erythematous
rash over her chest and upper abdomen. Laboratory evaluation reveals a hemoglobin of 10.5
mg/dl, a slightly elevated white blood cell (WBC) count and moderately elevated liver function
tests. Which of the following is the most likely cause of her current symptoms?
A- Malaria
B- Yellow fever
C- Dengue fever
D- Typhoid fever
E- Kawasaki

A 12 year-old boy with Canavan disease is admitted for a complicated urinary tract infection.
He is on total parenteral nutrition (TPN) and oral supplementation with iron, calcium, and
magnesium. He has a vancomycin allergy as well as penicillin and cephalosporin intolerance.
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‫مفتاح اإلجابات‬
He has a G-tube and a port. The urine culture grows resistant Klebsiella pneumoniae. He will
be discharged to complete a 21-day course of ciprofloxacin administered by Gtube. Which of
the following is an important consideration when discharging this patient?
A- Ciprofloxacin is only available in tablets in the oral form
B- Ciprofloxacin is not compatible with TPN
C- Ciprofloxacin is contraindicated in Canavan disease
D- Ciprofloxacin forms insoluble compounds with calcium, magnesium, and iron
E- Ciprofloxacin is associated with tooth discoloration

A 22-year-old woman has just delivered a male infant at 41 weeks of gestation. Her medical
history is normal and her pregnancy was uncomplicated. She is an assistant in a veterinary
clinic. Examination of the infant reveals jaundice, hepatosplenomegaly, and generalized
lymphadenopathy. During the examination, he suddenly begins to have tonicclonic seizures.
The CT scan reveals active inflammatory lesions, hydrocephalus and intracranial calcifications.
What is the most likely diagnosis of this patient?
A- Congenital toxoplasmosis
B- Congenital syphilis
C- Congenital herpes simplex
D- Congenital rubella

Compared with respiratory tract diphtheria, cutaneous diphtheria is associated with

A- similar incidence of toxic complications
B- greater transmission to close contacts
C- shorter duration of shedding of organisms
D- less contamination of the environment

Regarding laboratory testing for COVID-19, which of the following is TRUE:

A- Lab testing should be performed for a patient with severe acute respiratory infection
requiring hospitalization without any clear etiology
B- All of the above

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‫مفتاح اإلجابات‬
 C- One or more negative PCR results do not rule out the possibility of COVID-19 virus infection
especially in areas with established virus circulation
D- At minimum, upper respiratory tract specimens should be collected in ambulatory patients
E- Serologic tests have less utility for diagnosis in the acute setting

All of the following are recognized routes of malaria transmission EXCEPT:

A- Blood transfusion
B- Out-of-home daycare
C- Use of contaminated needle
D- Mosquito bite
E- Transplacental, from pregnant woman to her fetus

Schistosomiasis affects the digestive organs. Which of these organs will schistosomiasis NOT
affect?
A- Heart
B- Small intestine
C- Liver
D- Gall bladder

A 29-year-old woman who is 18 weeks pregnant presents to her physician complaining of fever,
cough, myalgias, and a skin rash shown in the picture. She has no other medical problems and
has had regular prenatal care. Her only medication is a prenatal vitamin. She lives in a rural
area of Minnesota and has not traveled recently or had any sick contacts. What is the best
treatment option for this patient?

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‫مفتاح اإلجابات‬
 A- Erythromycin
B- Amoxicillin
C- Doxycycline
D- Penicillin G

Kala-azar is characterized by:

A- Irregular fever
B- Anemia
C- Enlargement of spleen
D- All of the above

All of the following may be diagnostic of HIV infection in an 8 mo old child EXCEPT:
A- Positive HIV Western immunoblot assay
B- A positive HIV antibody test
C- Positive result on p24 antigen assay
D- Positive HIV culture
E- Positive result on HIV DNA assay
F- Positive result on HIV RNA assay
G- C & F

A 14-year-old male from North Carolina presents with weight loss, abdominal pain and blood-
streaked stools. He also reports diarrhea and anal itching. He reluctantly reveals that he was
evicted from a family group home for refusing to wear shoes in the house. Physical
examination is remarkable for abdominal tenderness and voluntary guarding. Which of the
following is the most likely etiology of his current symptoms?
A- Strongyloides stercorali
B- Trichinella spiralis

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‫مفتاح اإلجابات‬
 C- Ascaris lumbricoides
D- Trichuris trichiura

All of the following are requirements for the diagnosis of allergic bronchopulmonary
aspergillosis, EXCEPT:
A- cutaneous reactivity to Aspergillus fumigatus antigens
B- hyperexpansion and hilar adenopathy
C- peripheral eosinophilia
D- asthma
E- elevated serum IgE level

The proportion of patients in whom measles (rubeola) is complicated by encephalitis is

CLOSEST to:
A- 1in100
B- 1 in 1,000
C- 1 in 10,000
D- 1 in 100,000
E- 1 in 1,000,000

All are correct for measles EXCEPT:

A. The incubation period is 8-12 days.
B. Infants are protected for at least 4 months after birth.
C. Koplik spots are pathognomonic for the disease.
D. Immunoglobulins are protective if given up to 7 days after exposure.
E. Measles vaccine is indicated for exposed children.

The following is correct for Rubella:

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‫مفتاح اإلجابات‬
 A. Incubation period is 10 days.
B. Patient is infectious for 10 days after onset of rash.
C. Infants with congenital rubella secretes the virus in urine for a year.
D. Transplacental antibodies are not protective.
E. Immunoglobulins has no role in protection.

All are recognized complications for scarlet fever EXCEPT:

A. Hepatitis
B. Otitis media
C. Pneumonia.
D. Meningitis.
E. Arthritis.

A 4-year-old boy develops fever, swelling of the parotid gland, and headache. Of the following,
which complication is MOST likely to occur in this patient?
A. Conjunctivitis
B. Deafness
C. Meningitis
D. Myocarditis
E. Orchitis

All are correct for measles EXCEPT:

A. The incubation period is 8-12 days.
B. Infants are protected for at least 4 months after birth.
C. Koplik spots are pathognomonic for the disease.
D. Immunoglobulins are protective if given up to 7 days after exposure
E. Measles vaccine is indicated for exposed children.

All of the following are correct causative organisms for the corresponding disease EXCEPT:
A. Measles – Robeola virus.
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‫مفتاح اإلجابات‬
 B. German measles – RNA virus.
C. Scarlet fever – Gp B strept. Toxin.
D. Roseola infantum – herpes simplex virus. Hhv6
E. Erythema infectiosum – parvovirus.

All are recognized complications for Scarlet fever EXCEPT :

A. Pancreatitis.
B. Otitis media
C. Pneumonia.
D. Meningitis.
E. Arthritis.

All of the following are correct incubation periods EXCEPT:

A. Measles 10 days.
B. Rubella 2-3 weeks.
C. Mumps 2-3 weeks.
D. Scarlet fever 7 days. 1-4
E. Chicken pox 11-20 days.

All are correct for measles EXCEPT:

A. The incubation period is 8-12 days.
B. Infants are protected for at least 4 months after birth.
C. Koplik spots are pathognomonic for the disease.
D. Immunoglobulins are protective if given within 3 days of exposure.
E. Measles vaccine is contraindicated in exposed children.

Vaccines can be given in all these conditions except:

A. Mild upper respiratory tract infection.
B. Two vaccines together.
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‫مفتاح اإلجابات‬
 C. Feeding.
D. Anaphylactic reaction to the vaccine.
E. Nasal block.

In measles
A. the incubation period is 1 week
B. splenomegaly is common
C. photophobia is infrequent
D. Koplik spots are common (>50%)
E. lymphadenopathy is marked

Contraindication to the vaccines include:

A. A-Severe illness with fever.
B. B-Mild upper respiratory tract infection.
C. C-Feeding.
D. D-Two vaccines given together.
E. E-Prematurity.

Which of the following vaccines should NOT be given to children with severe combined
immunodeficiency syndrome:
A. DPT.
B. Measles vaccine
C. Salk polio vaccine.
D. Hep. B vaccine.
E. Pneumococcal vaccine.

In the Palestinian National Immunization Program, all of the following are correct
EXCEPT:

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‫مفتاح اإلجابات‬
 A. Salk vaccine is given at one and two months of age.
B. Hep. B vaccine is given at birth, one month and six months of age.
C. A booster dose of DPT is given at six years of age.
D. MMR vaccine is given at age of 15 months.
E. Rubella vaccine is given to girls at age of 12 years.

In BCG vaccine all are correct EXCEPT:

A. It is live attenuated vaccine.
B. It is given after birth.
C. It has nearly 80% protection against pulmonary T.B.
D. It has nearly 60% protection against systemic T.B.
E. It can be given to asymptomatic HIV infant.

All of the followings are correct for live attenuated vaccines EXCEPT:
A. Contraindicated in immunodeficient patients.
B. Given only after 3 months of stopping immunosuppressive drugs or large steroid dose
therapy.
C. Not given within 3 weeks before or 3 months after giving immunoglobulins.
D. Two Live attenuated vaccines are not given together.
E. Measles vaccine is not given to a patient with T.B except after

18. Complications of bacterial meningitis include all of the following except:

A. Pleural effusion.
B. Convulsions.
C. Cerebral abscess.
D. Hydrocephalus.
E. Mental retardation.

A 17-month-old girl presents to the emergency department in respiratory distress. Her

temperature is 103.2° F respiratory rate is 52 breaths/minute and associated with inspiratory
stridor. Her respiratory status rapidly deteriorates and she requires intubation, during which

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‫مفتاح اإلجابات‬
time thick, purulent tracheal secretions, ulcerations, and pseudomembranes are noted. These
clinical findings are consistent with a known complication of a preceding infection most often
caused by which of the following?
A. Parainfluenza virus type 2
B. Respiratory syncytial virus
C. Adenovirus
D. Mycoplasma pneumoniae
E. Haemophilus influenzae type b

The following is incorrect regarding matching of the specific immunodeficiency and

organisms causing meningitis:
A. CSF leak – pneumococcal
B. Splenic dysfunction – HiB
C. T-lymphocyte defect – meningococcemia
D. Properdin deficiency – pneumococcal
E. Late complement deficiency – meningococcal

Pleurisy or inflammation 0f the pleura is often accompanied by an effusion. Of the following,

the MOST common cause of pleural effusion in children is:
A. heart failure
B. bacterial pneumonia
C. rheumatoid arthritis
D. tuberculosis
E. metastatic intrathoracic malignancy

HSV type 2 and varicella-zoster virus are human herpesviruses. Both viruses can cause
congenital infections especially when a pregnant woman has primary infection during the first
trimester. The stigmata can be similar enough that the diagnosis is occasionally confusing.

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‫مفتاح اإلجابات‬
Which one of the following stigmata is strongly associated with congenital varicella infection
only?
A. Limb hypoplasia
B. Encephalitis
C. Chorioretinitis
D. Vesicular skin lesions
E. Microcephaly

A 6-year-old male child appears with history of fever (103°F) and sore throat, then develops
vomiting and diarrhea with dark brown stools. Stools have no occult blood. Physical
examination reveals pale, puffy eyelids, and diffuse abdominal tenderness. Laboratory findings
reveal BUN 80, sodium 128, hematocrit 36, WBC count 16,500, polymorphs 70%, lymphocytes
25%, monocytes 5%, and platelet count 246,000. Most likely diagnosis:
A. Acute tonsillitis
B. Acute appendicitis
C. IgA nephreopathy
D. Hemolytic uremic syndrome
E. Acute pharyngitis

What is not most important preventive measure for preventing the spread of respiratory
syncytial virus (RSV)?
A. Avoiding crowds, tobacco smoke, and daycare in all children under 6 months
B. Palivizumab in all children under 6 months during RSV season
C. Wearing masks around all children who have fever and respiratory symptoms
D. Good hand washing hygiene
E. Influenza vaccine for caregivers of children under 6 months

A 10-month-old child has a temperature of 104F (40°C) for 4 days without other signs. On the
fourth day a rose pink, maculopapular rash appears and the temperature returns to normal.
What is the most likely diagnosis?
A. echovirus

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‫مفتاح اإلجابات‬
 B. human herpes virus 6
C. measles virus
D. group A streptococcus
E. typhus

3. A 3-year-old child is admitted to the hospital in February with temperature of 101.3°C

(38.5°C), vomiting, and diarrhea. The mother describes the stools as watery, green, and very
foul smelling. The most common organism causing this presentation is
A. adenovirus
B. rotavirus
C. Salmonella enteriditis
D. Shigella sonnei
E. Enterovirus

About meningitis which false?

A. Pneumococcal - properdin
B. Listeria - T lymphocyte
C. Pneumococcal - Austria
D. Hemophilus – splenic dysfunction
Pt with frequent haematuria (U/A= urine analysis) shows he has UTI, next step?
A. urine culture
B. biopsy
C. creatinine &calcium
D. Us
E. A+D
F. A+C+D
G. All

The eggs of the schistosome are what do the damage to your system. Choose true or false.
A. True
B. False

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‫مفتاح اإلجابات‬
About Hepatitis viruses all are true except:
A. in hep B chronicity in children 90% and adults 10%.
B. Hepatitis E ,RNA viruse , mortality rate 1_2%

What cause Cold agglutination test +ve

A. Mycoplasma pneumonia

Pivalizumab used in <2 y in which case?

A. Very low birth weight
B. cyanotic HD

Pertussis patient, which true about prophylaxis?

A. No prophylaxis to anyone
B. prophylaxis to his home contact for 14 days

‫مــفــتــاح اإلجــابــات‬
Questions No. Answer Questions No. Answer

1 E 21.6 D

2 D 21.7 B

3 C 21.8 E

4 A 22 B

5 C 23 F

6 D 24 A

7 A 25 D

8 C 26 B

9 D 27 C

10 D 28 A

11 B 29.1 B

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‫مفتاح اإلجابات‬
 12 A 29.2 C

13 C 29.3 B

14 C 29.4 A

15 A 29.5 C

16 B 30 A

17 C 31 C

18 C 32 E

19 C 33 A

20 E 34 A

21.1 A 35 C

21.2 E 36 B

21.3 C 37 G

21.4 A 38 A

21.5 F 39 E

Questions No. Answer Questions No. Answer

40 F 65 A

41 B 66 A

42 A 67 D

43 C 68 B

44 C 69 B

45 E 70 D

46 B 71 B

47 C 72 D

48 C 73 C

49 E 74 -

50 A 75

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‫مفتاح اإلجابات‬
 51 C 76

52 A 77

53 B 78

54 C 79

55 A 80

56 B 81

57 D 82

58 A 83

59 C 84

60 B 85

61 C 86

62 B 87

63 A 88

64 A 89

Last Update: Thursday, April 17, 2025

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‫مفتاح اإلجابات‬