2 _2004-2005

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ItemText
On the third day of disease a 10 years old child with acute
respiratory infection developed productive cough. The
percussion is without pathologic features. The auscultation
reveals bilateral rales over the lung surface. What diagnosis
should be made?
An infant aged 1 year on the third day of common cold at
night developed inspiratory stridor, hoarse voice and barking
cough. Physical examination revealed suprasternal and
intercostal chest retractions. There is a bluish skin
discoloration moistly seen over the upper lip. The respiratory
rate is 52 per min and pulse rate 122 per min. The body
temperature is 37,50C. What disease does the infant have?
One week old male infant had one episode of vomiting
yesterday and 2 episodes of spitting up with poor feeding
today. There is no history of fever, diarrhea or coughing. His
urine output is decreased. He was born at term weight 3.2
kg. Weight now is 3.0 kg. Laboratory data: Na 128 mmol/l,
K 6.9mmol/l. What is the most probable diagnosis?
A 42-week-gestational-age, 3800-g, breast-fed, female is
noted to have persistent hyperbilirubinemia at 2 weeks of
age. The infant has not gained weight since birth, has hoarse
cry, dry skin, hypotonia, an umbilical hernia, constipation,
and an anterior fontanel measuring 4 - 6 cm. What is the
most likely diagnosis?
The infant is born with perinatal asphixia. At birth he is
apneic with a heart rate 70 per minute, so bag-and- mask
positive presurre ventilation with 100\% O2 was
immediately instituted. After 30 sec of ventilation the heart
rate is not increased. What is the most appropriate next step?
The boy is 10 years old. Two weeks ago he suffered from
acute tonsillitis. Now he complains on common weakness,
oedema of eyelids, ankle joints, headache, nausea. Skin is
pale, appetite is reduced, daily diuresis is 600 ml. In
urinalysis: protein 0,066 g/l, WBC 4-6, RBC 40-45.
The most probable diagnosis is?
A 1 year old boy does not walking, does not speak, not
active. He holds head since 9 months. Physical examination
shows pallor, oedema, saddle nose, large tongue. Skin is dry,
voice is gruff. Pulse rate - 100 per 1 min. The teeth are
absent. What diagnosis is the most probable?
4300-g infant was born at term gestation to a poorly
controlled insulin-dependent diabetic mother. Initially, the
infant did well, but at 2 hours of age he was noted to be
lethargic and than develop tonic-clonic seizures. Blood
glucose is 1.6 mmol/l. What is the most likely reason of
seizures?

DistrA
*acute bronchitis

DistrB
relapsing bronchitis

DistrC
obstructive bronchitis

Asthma

DistrD

DistrE
Pneumonia

*Acute infectious croup

Acute laryngitis
due to viral
laryngotracheitis grade II of
airway obstruction,
incomplete compensation
state

Bronchopneumonia
without complications

Acute bronchiolitis with

respiratory distress

Acute epiglottitis

Salt wasting form of

adrenal insufficiency

Birth trauma of central

nervous system

Gastroenterocolitis

Pylorospasm

Pylorostenosis

hypothyroidism

hereditary spherocytosis

neonatal hepatitis

biliary atresia

galactosemia

chest compression

tactile stimulation

to continue ventilation

intravenous sodium
bicarbonate

intravenous epinephrine

Glomerulonephritis with
nephritic syndrome

Interstitial nephritis

Pyelonephritis

Glomerulonephritis with
nephrotic syndrome

Polycystic kidney disease

Hypothyroidism

Hirschsprungs disease

Rickets

Downs syndrome

Hydrocephalus

hypoglycemia

hypocalcemia

hypomagnesemia

hyponatremia

pyridoxine deficiency

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Phenylketonuria was diagnosed in newborn male during

screening investigation. How long dietary restriction of
phenylalanine must continue?
A 9 year old female is referred to the hematology department
with a chief complaint of acute onset of easy bruising and
"rash" for 3 days. She had upper respiratory infection
symptoms approximately 2 weeks ago. A diffuse petechial
rash is noted on her neck, trunk, extremities and groin. CBC
shows Hgb 128 g|l, Hct 38.5, WBC 6,000x. Platelet count is
low at 5,000. What is the most probable diagnosis?
Boy is 2 months old. He was born in September. is on
breast feeding. What should a daily doze of ergocalciferol be
for prophylaxis of rickets?
A 10 year old boy has the history Diabetes Mellitus type I
during 6 years. He has headache, nausea, sweet smell of his
breath and he is breathing faster than usual. His lab studies
show Na 132 mmol/l, K3.3 mmol/l, glucose 28 mmol/l.
What treatment will you prescribe?
A 2-hour-old, 32-week-gestational-age infant develops
progressive cyanosis, grunting, nasal flaring, and chest
retractions. Silverman scores were 4. The chest radiograph
reveals a ground glassair bronchogram pattern. The infant
now requires oxygen therapy with continuous positive
airway pressure to maintain adequate oxygenation. What is
the most likely diagnosis?
A 7 year old male presents to physician with the chief
complaint of dark "cola colored" urine, facial puffiness and
abdominal pain for the past 2 days. 14 days ago he had a
sore throat and fever. He has had abdominal pain. His urine
is dark. Urine analysis shows an increased specific gravity,
RBCs are too numerous to count. What is the most
probable diagnosis?
A 4 year old female has been limping with swelling of her
right knee for several months. Physical examination
demonstrates swelling of her right knee, flexion contracture
of 10 degrees and flexion to 120 degrees. Lab. data: WBC 8
g/l, with 45\% neutr., 47 lymphs\%, 8\% mon. Hgb 120 g/l.
ESR 20mm/h. Rheum. factor neg., ANA 1:640 speckled.
What is the most probable diagnosis?
The laboratory data of patient's hemoglobin as 70 g/l, and
the reticulocyte count as 1\%. The published normal value
for the reticulocyte count is 0.7\% to 2.0\%, so the
reticulocyte count is within the laboratory's normal range.
How would you interpret this reticulocyte count?

8 10 years

1 year

2 years

5 years

Idiopathic
thrombocytopenic purpura

Bone Marrow Failure

Hemophilia A

Hemolytic uremic syndrome Acute lymphoblastic

leycosis

*400-500 IU

200-300 IU

300-400 IU

500-600 IU

100-200 IU

IV fluids and short active

insulin (0.1 u/kg)

IV fluids

Short active insulin (0.1

u/kg)

Combination of short active

insulin and intermediate
active insulin

Intermediate active insulin

respiratory distress
syndrome

intranatal asphyxia

congenital pneumonia

pneumothorax

congenital heart dis_ease.

Glomerulonephritis.
Nephritic Syndrome

Glomerulonephritis.
Nephrotic Syndrome

Acute heart failure

Acute infection of urinary

tract

Hemolytic uremic
syndrome

Juvenile Rheumatoid
Arthritis

Rheumatism

Lupus

Osteomyelitis

Infection Arthritis

This reticulocyte count

value is normal for a patient
with a normal hemoglobin,
but for a severely anemic
patient, the reticulocyte
count should be high.
Mother of a previously healthy 4 year old male complains of Foreign body aspiration
cough and wheeze. Boy had playing with a small toy. During
examination the right side of a chest show hyperresonance,
diminished vocal resonance and poor air entry. What is the
most probable diagnosis?

6 months

This reticulocyte count is

This reticulocyte count is
normal, so the patient's bone low.
marrow is making RBCs
adequately.

This reticulocyte count is too This reticulocyte count is

high.
depend from hemoglobin
level

Asthma

Bronchitis

Pneumonia

Bronchiolitis

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A previously healthy 14 year old female complains of a fast

heart rate, weight loss, and fatigue over the past 2 months.
Her family history is significant for a grandmother and aunt
with Hashimoto thyroiditis. During examination she has
mild tachycardia without murmurs or gallop and mild
tremor. Hyperthyroidism (Graves disease) was diagnosed.
What treatment will you prescribe?
1 month old female presents to the intensive care unit with
severe cyanosis, congestive heart failure, normal first sound,
single second sound and an insignificant one to two ejection
systolic murmur. The electrocardiogram shows right axis
deviation and right ventricular hyperthrophy. The thoracic
roentgenogram shows cardiomegaly with narrow base and
plethoric lung fields. What is the most probable diagnosis?
16 month old female presents with an acute onset of her
hands and feet "drawing up.Both her hands are flexed at the
wrists with hyperextended fingers at the proximal and distal
interphalangeal joints and flexion at the
metacarpophalangeal joints. Neurologic exam reveals
symmetric hyperreflexia, decreased muscle strength and
tone. Lab.data: Ca 0,9 mmol/l, P 0.4 mmol/l. What is the
most probable diagnosis?
A 7 month old male delayed in psycho-motor development
from 6 month. He developed pursuant to age up to 3 mo. His
hair is lighter than in parents, eyes are blue. There are
periodically cramps. It is marked the specific "mouth-like"
odor of urine. The diagnosis of phenilketonuria is made.
What is necessary to exclude from child diet?
A 8 year old boy has symptoms of polyuria, nocturia during
2 mo. He began to lose weight over this same period. He has
a noticeably sweet smell to his breath. His skin is warm to
his wrists and ankles. A urine shows 4+ glucose and 2+
ketones. His initial lab studies show Na 132 mmol/, K3.3
mmol/l, glucose 23 mmol/l. A urine analysis shows 4+
glucose and 2+ ketones. What is the most probable
diagnosis?
The child is 6 years old. He suffers from nervous arthritic
diathesis. What period is critical for development of this
diathesis?
Child is 2 months old. He is premature infant. What should a
daily doze of ergocalciferol be for prophylaxis of rickets?
Girl is 4 months old. She was born in October. She is on
breast feeding. To what age should prophylaxis of rickets
carry out?
Boy is 4 months old. is on breast feeding. Determine a
remedy for primary prophylaxis of spasmophilia.
Boy is 3 months old. He has signs of local manifestation of
exudative catarrhal diathesis. From what age should
preventive inoculations do to this child?

Propylthiouracil

Surgical treatment

Congenital heart disease,

right to left shunt

L-thyroxine

Prednizolone

Iodinated salt

Congenital heart disease, left Pneumonia

to right shunt

Congenital lung
malformation

Bronchiolitis

Vitamin D deficiency,
spasmophylia

Epilepsy

Acute infection of central

nervous system

DiGeorge syndrome

Glycogenosis

Phenilalanin

Metionin

Galactose

Glucose

Maltose

Diabetes Mellitus, Type I,

diabetic ketoacidosis

Acute infection of urinary

tract

Diabetes Mellitus, Type II

Enuresis

Chronic lymphocytic
thyreoiditis

* School

Preschool

Infancy

Neonatal

Perinatal

*1000-1200 IU

800-1000 IU

1200-1500 IU

400-500 IU

1300-1500 IU

*1,5 years

2 years

2,5 years

1 year

6 months

* Ergocalciferol

Calcium gluconate

Calcium chloride

Natrium chloride

Calcium pantothenate

*From 3 months

From 6 months

From 8 months

From 10 months

From 12 months

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Girl is 4 years old. She suffers from recurring bronchitis.

Through what time should prophylactic medical supervision
of this child at absence of recurrences stop?
Child is 3 months old. At investigation in a polyclinic rickets
was diagnosed. The basic process characteristic for rickets is
infringement of a metabolism.
The child is three months old. He suffers from rickets. What
acid does the important role play in an exchange of
phosphorus and calcium, influences on action of calciferol,
function of parathyroid glands?
The child is 7 months old. He suffers from spasmophilia.
What infringement of a kind of an exchange is a pathogenic
part at spasmophilia?
A 6-year-old boy with asthma has had mild wheezing only
four times since you began treating him 3 months ago with
Cromolyn inhalation twice each day. For the past 2 days, he
has again had mild coughing and wheezing. What should
you recommend to treat acute attack of asthma?
The child is 6 months old. He suffers from lymphatichypoplastic diathesis. What is the main pathogenic marker at
this diathesis?
Full term newborn has developed jaundice at 10 hours of
age. Hemolytic disease of newborn due to Rhincompatibility was diagnosed. 2 hours later the infant has
indirect serum bilirubin level increasing 14 mmol/L. What is
most appropriate for treatment hyperbilirubinemia in this
infant?
7 -year-old boy with chronic cinusitis and reccurent
pulmonary infections has chest a x-ray demonstrating a
right-sided cardiac silhouette. What is the most likely
diagnosis?
Parents of 3-year-old girl complain of rectal prolapse and
failure to gain weight in spite of a good appetite. Patient has
a history of recurrent prolonged respiratory infections and
frequent, bulky, greasy stools. Sweet chloride is 126 mmol/l.
What is the diagnosis?
2-year-old previously healthy boy had eaten peanuts and
suddenly presents with an acute onset of cough, choking, and
respiratory distress. Physical examination reveals a RR of 45
and wheezing, body temperature is normal. There is no
history of asthma or allergic reactions, and no one at home is
ill. What is the most likely diagnosis?
A 6-year-old girl has had a dry cough without sputum for 2
months. The cough is getting worse after exercises and at
night. Family history revealed that the parents have eczema.
On physical examination, you hear a wheeze in both lung
fields. She has none of the signs of chronic lung disease.
What is the most likely diagnosis?

*2 years

1 year

2,5 years

1,5 years

3 years

* Calcium and phosphorus

Calcium and potassium

Calcium and magnesium

Calcium and sodium

Calcium and zinc

* Citric

Acetic

Hydrochloric

Phosphoric

Sulfuric

*Phosphoric-calcic

Phosphoric-potassic

Phosphoric-sodium

Phosphoric-magnesion

Phosphoric-zinc

inhalation Salbutamol

inhalation corticosteroids

Loratadine

Aspirin

Theophylline

*Lymphocytosis

Lymphopenia

Neutrophylosis

Neutropenia

Monocytosis

exchange blood transfusion phototherapy

phenobarbital

intestinal sorbents

infusion therapy

Kartagener syndrome

cystic fibrosis

bronhiolitis obliterans

laryngotracheomalacia

(-antitrypsin deficiency

cystic fibrosis

(-antitrypsin deficiency

Kartagener syndrome

celiac disease

Hirschprungs disease

foreign body aspiration

acute bronchiolitis

attack of asthma

acute laryngitis

angioedema

bronchial asthma

pertussis

foreign body aspiration

bronchiectasis

interstitial pneumonia

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You are called to the delivery of a boy at 42 weeks'

gestational age with thick meconium stained fluid. The
obstetrician rapidly delivers the infant and hands him to you
for care. The boy is hypotonic, cyanotic, apneic, and
bradycardic. What is the most appropriate next step?
Baby was born by vaginal delivery follow_ing a term
gestation. Apgar score was 5 and 7. Physical examination
reveals scaphoid abdomen, slow respiration and reduced
chest movement. Breezing sounds are absent in a lower part
of left lung. Chest radiograph reveal shift of mediastinum to
right side, intestinal shadow on left side. What is the most
likely diagnosis?
A 2.9-kg term male infant is born to a mother who developed
polyhydramnios at 34 weeks' gestation. At birth, the Apgar
scores were 9 and 9. The infant develops choking and
cyanosis with the first feed. In addition, is unable to place a
nasogastric tube. What is the most likely diagnosis?
A 2-hour-old, 32-week-gestational-age infant develops
respiratory distress syndrome with progressive cyanosis,
grunting, and chest retractions. The infant now requires
oxygen therapy with continuous positive airway pressure
ventilation to maintain adequate oxygenation. Antibiotics are
administered. What you should prescribe to infant?
A 3 month child has vomiting, poor feeding, fever up to
38C for the 2 days. His stool is frequent, with slime. Infant
has lost 250 g of weight. He is pale, mucous are dry, fontanel
is fallen, turgor is reduced, the abdomen is moderately
inflated. The diagnosis of enterocolitis was made,
dehydratation of 2nd degree. What solution is necessary to
prescribe for rehydratation?
The child is 11 months old. He suffers from nervous
arthritic diathesis. The increased synthesis of what acid is
pathogenically at nervous- arthritic diathesis?
What anatomic - physiologic feature of lungs structure in
the first years of life infants causes exactly segmental
pneumonias?
The child of 7 months old who is suffering from tetralogy of
Fallot has admitted to hospital with attack of dyspnoea and
cyanosis. The respiration rate is 55 per minute, the heart rate
120 per minute. What is the treatment of this condition?
A 2.5 month girl has frequent vomiting irrespective of eat
period, growing thin, weakness during last 1,5 months. She
was born with bodyweight 3400. Present weight - 2900. Girl
is pale, has penis-like clitor, subcutaneous fat is absent. The
laboratory studies show K - 9.4 mmol/l, sodium - 86 mmol/l.
What is the most probable diagnosis?

intubate the trachea and

apply aspiration

stimulate the infant to

breathe

diaphragmatic hernia

administer epinephrine

provide bag-and-mask
ventilation

intubate the trachea and

provide positive pressure
ventilation

respiratory distress syndrome congenital bronhiectasis

congenital pneumonia

(- cystic fibrosis

esophageal atresia

choanal atresia

laryngomalacia

tracheal atresia

respiratory distress
syndrome

endotracheal surfactant

intravenous dexamethasone

intravenous epinephrine

intravenous sodium
bicarbonate

endotracheal ambroxol

Rehydron

5 \% glucose solution

Boiled water

Tea

Broth of a camomile
(medical)

* Uric acid

Acetic acid

Phosphoric acid

Hydrochloric acid

Sulfuric acid

*Segments removing with

soft connective tissue

Left bronchus deviation at

right angles

Wide right bronchus which Elastic tissue hypoplasia

is tracheas extension

Reduced aeration and

secretion evacuation

IV promedol, anaprilin;
oxygen supply

IV strophantin, glucose

IV euphyllin, prednisone

IV prednisone, furosemide

IV furosemide, albumine

Adrenogenital syndrome
(virilised and salt-wasting
form)

Pylorostenosis

Pylorospasmus

Enterocolitis

Partial intestinal ileus

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The girl is 3 years old. She has admitted to hospital with the
parents complaint on poorly walking. The excessive
development of shoulder muscles is noticed, the lower
extremities are poor developed, muscle hypotonia. The
borders of relative heart dullness are extended to the left on 2
cm. There is systolic murmur in 2nd intercostal interspace on
the right side of the sternum. Blood pressure on arms
100/70, on legs 40/20. Which diagnosis could be
suspected?
A mother consults her 3 years old daughter by pediatrician.
The child complains of hoarse voice, barking cough,
laboured breathing with difficult inspiration. The infectious
croup due to acute laryngitis is diagnosed. What anatomical
feature predisposes a child to laryngeal stridor?
The positive urine glucose test due to so-called
physiological glucosuria was revealed in a healthy 1 month
old infant on routine examination.. What feature of urinary
system in infant predisposes to this phenomenon?
A 10 years old child is ill with spastic cerebral palsy.
Supported on trying to walk the child has his legs flexed in
hip and knee joints and spastically scissored. The upper
extremities movements arent disturbed. What type of
spasticity distribution is there?
A newborn aged 3 days with hyperbilirubinemia (428
mkmol/l) developed followed disorders. From beginning
there were severe jaundice with poor suckling, hypotomia
and hypodynamia. Little bit later periodical excitation,
neonatal convulsions and neonatal primitive reflexes loss are
noted. Now physical examination reveals convergent squint,
rotatory nystagmus and setting sun eye sign. How to explain
this condition?
A 1.5 month male infant has frequent vomiting, weight loss
during last 3 weeks. X-ray examination shows the extension
of stomach, high level of fluid, the delay of contrast
substance in a stomach for a long time (8 hours), which does
not disappear after atropin injection. What is the most
probable diagnosis?
A girl aged 8 month has a large head with the circumference
up to 48 cm corresponded a value over 95 percentile and big
non bulged non pulsed fontanel. The preliminary diagnosis
is hydrocephalus. What cerebral spinal fluid findings do
you wait for in this case?
The child is 3 months old. He has admitted to hospital to
diagnose the reason for cardiac murmur. Complaints of
parents: low weight gain, attacks of dyspnoea and cyanosis
which amplify at a physical load. Systolic murmur in 3rd
intercostal interspace on the left side, systolic murmur under
2nd intercostals interspace on the right side of the sternum,
hypertrophia of right ventricle. What diagnosis should be
suspected?

Coarctation of aorta

Ventricle septal defect

Atrium septal defect

Tetralogy of Fallot

myocarditis

*Narrow vocal slit

Wide laryngeal lumen

Watering-pot form of the

larynx

Poor vascularization of the

mucous membrane

Diaphragmatic type of
respiration

* Immaturity of glucose
reabsorbtion in kidney

Big daily urine output

Transitory low urine

specific gravity

Small volume capacity of

bladder

Rather low position of the

kidney

*Lower paraplegic

Tetraplegic

Hemiplegic

Athetosis

Monoplegic

* Encephalopathy due to
hyperbilirubinemia

Skull injury

Brain tumour

Hydrocephalus

Spastic cerebral palsy

Pylorostenosis

Atresia of esophagus

Cystic fibrosis

Sepsis

Hirshprungs disease

* Cells 2-3 in 1 mkl, protein Cells 200-300 in 1 mkl,

0,2-0,4 g/l
protein 1,0-2,0 g/l

Lymphocytes cells 500600 in 1 mkl, protein 2,54,0 g/l

PMNL (polymorphonuclear
leukocytes) cells 50-100 in
1 mkl, protein 4,5-6,0 g/l

PMNL cells 100-200 in 1

mkl, protein 5,0-6,0 g/l

Tetralogy of Fallot

ventricular septal defect

hypertrophyc
cardiomyopathy

atrial septal defect

infectious endocarditis

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The child aged 12 yr complains of slight fever up to 38.0(C,

knee joints pain, a day before ankle pain, tenderness in
active and passive movements, common weakness and
cardiac pain. It is known he was ill with acute tonsillitis two
weeks ago. Physical examination reveals left heart border
external shift, non frequent cardiac premature bites. What
disease should be suspected?
A 7 years old boy is admitted to the hospital with complains
of thirst and polyuria. He is ill with diabetes mellitus within
5 years. In the clinical history there are 3 times happened
diabetic comas. Blood glucose is 15.54 mmol/l and in urine
5\%. The retinal angiopathy signs has been revealed by an
ophtalmologist. What dose of insulin will be administered to
this child more likely?
A 12 years old girl suffers with diabetes mellitus since 2
years of age. Clinical examination reveals the considerably
enlarged abdomen. The slightly tender liver is palpated 6cm
lower of the costal margin. The child has also Cushing type
of obesity, short stature, and pubertal delay. Blood glucose
is 17 mmol/l, glucosa in urine 4 \%. There are an increased
levels of blood cholesterol and ketoacidemia. What is the
suggested diagnosis?
The girl aged 14 years old complains of sleep disturbances,
body weight loss, palpitations, cardialgias, fatigue. 2nd
degree thyroid gland hyperplasia and exophthalmus were
noted by physical examination. What hormone level are the
most characteristic for this disease?
1 years old infant developed the signs of folic acid
deficiency anemia. What features of CBC are characteristic
for this pathology?

* Rheumatic fever

Now-rheumatic carditis

Rheumatoid arthritis.

Systemic lupus
erythematosus

Reactive arthritis

*1,5 units/kg.

0,25 unit/ kg

0,5 unit/ kg

1,0 unit/ kg

2,0 units/ kg

*diabetes mellitus I type,

Mauriacs syndrome

Diabetes mellitus I type,

Nobecurs syndrome.

Diabetes mellitus I type,

ketoacidotic coma.

Cushings disease.

Cushings syndrome.

* Free thyroxine and total

serum triiodothyronine
excess .

Free thyroxine deficiency

Serum thyroid-stimulating
hormone excess

Radioactive iodine uptake

excess test

serum triiodothyronine
deficiency

hyperchromic and microcytic

RBC (red bood cells),
reticulocytopenia,
thrombocytopenia,
leukopenia
2 weeks

hyporchromic and
microcytic RBC (red bood
cells), anisocytosis,
reticulocytosis,
thrombocytosis;
21 days

normochromic and
normocytic RBC (red bood
cells), thrombocytosis,
leukocytosis;

All answers are true.

3-4 weeks

6 months

High platelet and RBC (red

blood cells) counts
associated with bone marrow
hyperfunction

High WBC count in

peripheral blood normal or
depressed bone marrow
function

Low RBC, WBC and

platelet counts associated
wiht disorders of maturation
bone marrow-derived cells

Low RBC, WBC and

platelet counts associated
wiht bone marrow
hyperfunction

The administration of
bicillin-3 every month
during a year

The administration of
bicillin-3 every month
during 3 years

* hyperchromic and
macrocytic RBC (red bood
cells), reticulocytopenia,
thrombocytopenia,
leukopenia
1,5 years old infant has revealed iron deficiency. What is the *2-3 months
duration of treatment with oral iron preparations?
What is the most important suggestive clinical feature of
*The high blood leukocyte
CBC (complete blood count) and bone marrow examination count accompanied by low
which make it possible to suspect myelodysplastic syndrome platelet and RBC (red blood
in children?
cells) counts associated
with disorders of maturation
bone marrow-derived cells
8 years old girl had had a rheumatic fever manifested with *The administration of
chorea and carditis 6 months ago. She was treated in-patient bicillin-5 every month
department within 1,5 months. Now she is under long term during 5 years
observation by the rheumocardiologist in children outpatient department. The prevention therapy of rheumatic
fever relapse foresees:
2 years old child has simple dyspepsia with nausea and
* Oral rehydration solution
vomiting. There are not signs of dehydration. The
(ORS)
prevention of pathological fluid losses consists in the
following administration:

The administration of
The administration of
bicillin-5 every month during bicillin-5 every month
a year
during 3 years

Intravenous infusion 5\%

glucose in water solution

Starvation during 12 hours Antibacterial therapy

Gastric lavage

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The child aged 12 yr complains of cramping pain in the right

hypochondrium which is easily controlled with
antyspasmotic preparations. During attacks nausea and less
often vomiting occur. Palpation of the abdomen reveals
tenderness in the gallbladder projection point. The liver is
not enlarged. What additional method of clinical
investigation is the most informative in this case?
10-year old girl was admitted to the department with
symptoms of carditis. Well known that the exacerbation of
chronic tonsillitis was occurred 2 weeks ago. What
etiological trigger of carditis is the most possible in this
case?
A 11 month female has poor appetite, stool with plenty of
faeces, periodically vomiting after introduction of solid food
during last months. Temperature is normal. Bodyweight is 7
kg. On physical exam there are pale, oedema on legs,
enlargement of abdomen. Coprogram shows a lot of greasy
acids. The diagnosis of celiac disease was made, the
aglutenic diet was prescribed. What is necessary to exclude
from child diet?
A 1 month male infant has symptoms of excitation. His head
circumference is - 37 cm, the size of large fontanel is 2x2
cm. The child regurgitates after feeding by small portions of
milk (changed and unchanged); stool is normal. Muscle
tonus is normal. What is the most probable diagnosis?
A 1 month female infant vomits frequently by fountain
irrespective of eat period and has periodically liquid stool.
She is dehydrated, exhausted. There is clitoris hypertrophy.
What diagnosis is the most probable?
A 2 year boy has subfebrile temperature, dry, persistent,
prolonged, attacked cough, frequent breathing with hindered
exhalation. The breathing under auscultation is harsh, there
are diffuse dry sibilant rales. X-ray lung examination shows
increased transparency. There is leukopenia in blood. What
diagnosis is the most probable?
A 1,5 year old boy has non-productive cough with purulent
sputum, dyspnea, retardation in physical development,
polyfecalia, increasing of sweat chloride up to 150 mEq/l.
The cystic fibrosis was diagnosed. What treatment will you
prescribe?
A 2 year old girl has symptoms of cystic fibrosis: relapsed
pneumonia, secretion of a plenty purulent green sputum,
dyspnea, polifecalia, retardation in physical development,
increasing of sweat chloride up to 120 mEq/l. What is the
most suitable method of diagnosis?
A 1,5 year old boy with poor activity does not walking, does
not talking. Physical examination demonstrates pale and dry
skin, edema, large tongue, saddle nose, gruff voice. His
hairs are thick and rough. Large fontanel - 3,0x 3,0 cm, teeth
are absent. What diagnosis is the most probable?

*Ultrasound examination

Esophagogastroduedenoendo CBC (complete blood

scopy
count)

X-Ray upper
Gastrointestinal (GI) series

Coprologic examination

*streptococcus

staphylococcus

pneumococcus

klebsiele

proteus

Cereals

Milk products

Meat

Egg

Easy absorbed
carbohydrates

Pylorospasmus

Meningitis

Pylorostenosis

Microcephaly

Craniostenosis

Adrenogenital syndrome,
salt-wasting form

Pylorostenosis

Upper intestinal ileus

True hermaphroditism

Acute intestinal infection

Obstructive bronchitis

Pertussis

Pneumonia

Rhinitis

Bronchiolitis

Enzymes + antibiotics

Choleretics + adaptogens

2-histaminic blockaders
+ hepatoprotectors

Vitamins + antibiotics

Vitamins + mucolytics

Direct detection of a gene

by polymerase chain
reaction

Complete blood count

Karyotype

Determination of sex
chromatin

Family tree

Hypothyroidism

Downs syndrome

Rickets

Growth hormone deficiency Diabetes mellitus

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Boy is 3 years old. Complaints: dyspnoe, fast tiredness,

frequent episodes of respiratory diseases in history. Borders
of relative heart dullness are extended to the left,
strengthening of the 2nd heart sound in the 2nd intercostal
interspace on the left side, hard systolo-dyastolic murmur in
the second intercostal interspace on the left side and above
the clavicle (machine noise), which is conducted on
interscapular interspace. What is the most probable
diagnosis?
The infant aged 3 days become jaundice. The course of
pregnancy and delivery is without any complications. The
child was born with 3300 g of body weight and 8 Apgar
score. The general condition of newborn is good. The infant
blood group is O (I) Rh(-)ve, the mothers blood group is A
(II) Rh (+)ve. What is the most probable cause of this
jaundice?
The girl of 11 years old. She is ill for 1 month. She has
"butterfly"-type rash on face (spots and papules), pain and
swelling of small joints on arms and legs, signs of stomatitis
(small-sized ulcers in mouth). CBC - b 80 g/l, RBC 2,9
T/l, WBC 15 G/l, ESR - 40 mm/hour. Urinalysis - protein
0,33 g/l. What is the most probable diagnosis?
The infant aged 2 months complaints of restlessness,
subcutaneous fat wasting and underweight. The deficiency
calculated from the ratio between the actual and average
expected weight for his age is 14\%. The constipation and
little amount of stools with undigested bits are noted. The
child is in the breast feeding. The total day breast milk
volume is not known. There is not evidence of infection in
this case. What is the most probable diagnosis:
What kind of breathing can be heard above the lungs in
healthy children aged 7 years?
The girl is 5 years old. She has been hospitalised with the
complaints on generalized oedema (face, abdomen, lower
extremities), reduce of daily urine volume up to 300 ml, loss
of appetite. In urinalysis protein 3 g/l, RBC 1-2, WBC
6-7, specific gravity 1027. CBC Hb 110 g/l, WBC
10 G/l. What diagnosis is most probable?
The girl is 11 years old. She complains on pain in abdomen
and lumbar region, headache, increase of temperature up to
39 C, vomiting, reduce of appetite. Skin is pale, hot,
respiration is normal, heart rate 100 per minute, positive
Pasternatsky symptom. CBC: RBC 3,9 T/l, WBC - 18 G/l,
ESR-34 mm/hour. Urinalysis - protein 0,066 g/l, WBC 3040, RBC 1-2, bacteria - a lot of. Most probable diagnosis
is?

Open arterial duct

aortal stenosis

* Physioligic jaundice

atrial septal defect

ventricle septal defect

Isolated stenosis of arteria

pulmonalis

Infant`s hemolytic caused by Infant`s hemolytic anemia

Rh-incompatibility
caused by ABOincompatibility

Obstructive jaundice

Jaundice due to septicemia

systemic lupus
erythematodes

juvenile rheumatoid arthritis, periarteriitis nodosa

systemic type

Acute rheumatic fever

dermatomyositis

*Hyponutrition in
development

Mucoviscidosis, intestinal
form

Acute gastroenteritis

Chronic gastroduodenitis

Dehydration

*Vesicular

Puerile

Weakened vesicular

Coarse

Grunting

Glomerulonephritis with
nephrotic syndrome

Interstitial nephritis

Pyelonephritis

Polycystic kidney disease

Glomerulonephritis with
nephritic syndrome

Acute pyelonephritis

Acute glomerulonephritis

Cystitis

paranephritis

Polycystic kidneys disease

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The girl of 12 years old is suffering from acute

glomerulonephritis. Daily diuresis is 700 ml, heart rate 100
per minute, blood pressure 130/95, temperature 37,3 C.
In urinalysis RBC 30-40, WBC 5-6, protein 0,099
g/l. Which medicines should be prescribed in this case?
The girl is 12 years old. Yesterday she was overcooled. Now
she complains on pain in suprapubic area, frequent painful
urination by small portions, temperature is 37,8 C.
Pasternatsky symptom is negative. Urinalysis protein 0,033 g/l, WBC 20-25, RBC 1-2. What diagnosis is most
probable?
The polycystic kidney disease was diagnosed at the boy of 3
years old. Mother complaints that the boy has growth
retardation, poor appetite, vomiting. Skin is pale, turgor of
soft tissues is reduced, heart rate - 120 per minute, harsh
breathing at auscultation, abdomen is enlarged, soft.
Biochemical tests urea 14 mmol/l, creatinine 0,130
mmol/l, protein 58 g/l. Which condition has been
developed?
The boy of 9 years old. He is ill for 3 days. He has
complaints on pain and restriction of movements in right
knee and left elbow joints, dyspnoea. He was suffered from
acute tonsillitis 2 weeks ago. There are fever (38,5 C),
oedema of joints, extension of the borders of cordial dullness
on 2 cm left, HR - 110 per 1 min, weakness of 1st sound,
"soft" systolic murmur on an apex. What diagnosis should be
suspected?
The 7 years old boy developed an asphyxic attack,
expiratory wheezing and cough. In past history the child has
had relapsing rhinitis and red eyes syndrome. His sister
suffers with atopic dermatitis. The correct diagnosis is:
The course of tonsillar diphtheria in a 2-years old child was
complicated with appearance of early myocarditis.
Prednisolone in a dose of 1,5 mg/kg was introduced into
therapy . Which one from expected complications is not
related with prolonged glucocorticoid therapy ?
1,5 - years old infant was inoculated with live oral polio
vaccine (OPV). On the 16th day after being asymptomatic
the child suddenly developed the right low limb weakness
and stopped to walk. How to comment this event?
The child aged 3 years was admitted to the pediatric
department on the 3d day of illness. The general condition is
moderate. Body temperature is 38,5oC. One time of
vomiting, skin pallor, lost skin turgor, spasmodic colon
descendens are presented. The patient has stools with mucus
and blood 9-10 times per day. What is the initial diagnosis?

Antibiotic, hypotensive,
diuretic, vitamin C

Antibiotics + prednisone

Antihistaminic + vitamins

Antiaggregants + diuretics

Sulfanilamids + cytostatics

Acute cystitis

Dysmetabolic nephropathy

Acute glomerulonephritis

Acute pyelonephritis

Urolithiasis

Chronic renal failure

Acute renal failure

Encephalopathy

Interstitial nephritis

Pyelonephritis

Acute rheumatic fever

systemic lupus
erythematodes

juvenile rheumatoid
arthritis

Reiters disease

reactive arthritis

* bronchial asthma;

acute bronchitis;

viral croup;

acute obstructive bronchitis; pneumonia.

*Hyperthermic reaction

Elevation of blood pressure

Hypokalemia

Osteoporosis

Cushingoid syndrome

*Vaccine - associated
poliomyelitis

Poliomyelitis

Guillain - Barre syndrome

Landry syndrome

Polyradiculoneuropathy

Yersiniosis

Escherichiosis

* Acute bacterial dysentery Enteric fever (Salmonellosis) Rotavirus gastroenteritis

(Shigellesis)