Primary Care Pediatrics

1.    Developmental Milestones.

***) At age of 4 months infant can do all of the following, except:

A.    Orients to voice

B.     Says "dad & mama"

C.     Supports head well

D.    Says "ah-goo"

E.     Does not say clear words

Answer: B* Says "dad & mama"

***) A child can usually roll over by age:

A.    4 weeks

B.     12 weeks

C.     16 weeks

D.    28 weeks

E.     40 weeks

Answer: C* 16 weeks

***) All of the following are present in an average child aged 11 months, except:

A.    Bladder control by day

B.     Can throw objects

C.     Usually 2-4 teeth

D.    Responds to simple commands

E.     An index finger approach to objects

Answer: A* Bladder control by day

***) An average child of 12 months can do all, except:

A.    Sits without support

B.     Has an index finger approach to objects

C.     Waves bye-bye

D.    Enjoys looking at picture books

E.     Control urination by day time

Answer: E* Control urination by day time

***) A 1 year old child would be expected to do all of this, except:

A.    Build a tower of 3 cubes

B.     Grasp a pellet

C.     Reach for an object

D.    Transfer an object from hand to hand

E.     Stand alone

Answer: A* Build a tower of 3 cubes

***) A normal 1 year old child can do all of the following, except:

A.    Throw objects

B.     Know own name

C.     Speak in phrases

D.    Walk with support

E.     Pull self up and stand holding on the furniture

Answer: C* Speak in phrases

***) Child at one year of age can do all except:

A.    Pulls self up and stand on furniture

B.     Throw objects

C.     Obeys simple requests

D.    Knows own home

E.     Speaks in phrases

Answer: E* Speaks in phrases

***) Most normal children can walk at the age of:

A.    6 months

B.     8 months

C.     10 months

D.    12 months

E.     18 months

Answer: D* 12 months

***) The most advanced language function a 14 months old child usually can perform is one of the following:

A.    Speak several recognizable words

B.     Combine two different words

C.     Speak in complete sentences

D.    Use the past time

E.     Refer to himself (I)

Answer: A* Speak several recognizable words

***) A 15 months old infant can do all of the following, except

A.    Walks alone

B.     Uses 4-6 words

C.     Builds tower of 2 cubes

D.    Creeps upstairs

E.     Points to 8 body parts

Answer: E* Points to 8 body parts

***) The average 18 months old child is expected to know:

A.    10 words

B.     20 words

C.     40 words

D.    60 words

E.     100 words

Answer: A*10 words

***) A normal child of 18 months should do all of the following, except

A.    Walks alone

B.     Uses spoon himself

C.     Puts two to three words together in a phrase

D.    Uses at least 4 clear words

E.     Understands requests and forbids

Answer: C* Puts two to three words together in a phrase

***) By age of 2 years the child can speak:

A.    Three word sentences

B.     Four words sentences

C.     Five words sentences

D.    Six words sentences

E.     Seven words sentences

Answer: A* Three word sentences

***) A 24 months old child is expected to do all of the following, except

A.    Walk up and down stairs, one step at a time

B.     Handle spoon well

C.     Build a tower of 4 cubes

D.    Can put 3 words together

E.     Can draw a square

Answer: E* Can draw a square

***) A child at the age of 36 months, can do all except:

A.    Rides tricycle

B.     Build lower of 10 cubes

C.     Washes hands

D.    Knows age and sex

E.     Running well

Answer: C* Washes hands

***) A child can hop on one foot by age of:

A.    One year

B.     Two years

C.     One year and a half

D.    Two years and a half

E.     Four years

Answer: E* Four years

***) Define the ability to abstract terms such as justice, honesty and dignity is expected to occur at age of:

A.    Three years

B.     Four years

C.     Five years

D.    Seven years

E.     Ten years

Answer: E* Ten years

2.    Primitive Reflexes.

***) A normal full term newborn can demonstrate all of the following reflexes, except:

A.    Moro reflex

B.     Palmar grasp reflex

C.     Sucking reflex

D.    Parachute reflex

E.     Rooting reflex

Answer: D* Parachute reflex

***) When examining a two months old infant you expect to find all the following reflexes except:

A.    Moro Reflex

B.     Parachute Reflex

C.     Palmar Reflex

D.    Rooting Reflex

E.     Planter Reflex

Answer: B* Parachute Reflex

***) All of the following statements about Babinski reflex are true, except:

A.    Positive response is considered to be normal in the first year of life

B.     Negative response is also considered to be normal in the first year of life

C.     Asymmetrical positive response is considered normal in the first year of life

D.    It is considered as pathological reflex

E.     It is induces by stimulating the lateral aspect of foot

Answer: E* It is induces by stimulating the lateral aspect of foot

***) Following a difficult delivery a unilateral Moro reflex is elicited. This is often a presenting sign of a:

A.    Subdural hematoma

B.     Tentorial tear

C.     Fractured clavicle

D.    Sepsis

E.     Depressed skull fracture

Answer: C* Fractured clavicle

3.    Vaccinations.

***) The first dose of DPT and oral polio vaccines is recommended at:

A.    First day of life

B.     3 weeks

C.     2 or 3 months

D.    6 months

E.     9 months

Answer: C* 2 or 3 months

***) DPT is a vaccine given to infants usually at 2 months of age, and protects from all of the following disease, except:

A.    Diphtheria

B.     Pertussis

C.     Measles

D.    Tetanus

E.     Diphtheria and tetanus

Answer: C* Measles

***) Concerning oral polio vaccine OPV (Sabin) all of the following are true, except:

A.    OPV is a live attenuated vaccine

B.     OPV is best stored at 2-8° C

C.     It is easy to administer

D.    It is of definite value on controlling epidemics of polio

E.     One dose is sufficient and will give long life immunity

Answer: E*One dose is sufficient and will give long life immunity

***) All these vaccines are alive attenuated, except:

A.    Mumps

B.     Measles

C.     Yellow fever

D.    Hepatitis B vaccine

E.     Rubella

Answer: D* Hepatitis B vaccine

***) All of the following immunizations are generally performed using a live organism, except:

A.    Poliomyelitis Sabin

B.     Measles

C.     Rubella

D.    Whooping cough

E.     Mumps

Answer: D* Whooping cough

***) The following immunizations are generally performed using a live attenuated organism, except:

A.    Poliomyelitis

B.     Measles

C.     Bacillus Calmette Guerin BCG

D.    Pertussis

E.     Influenza

Answer: D* Pertussis

***) In immunosuppressed children, all of the following vaccines are contraindicated, except:

A.    Measles vaccine

B.     Oral polio vaccine

C.     Rubella vaccine

D.    Pertussis vaccine

E.     BCG

Answer: D* Pertussis vaccine

***) One of the following vaccines can be given to patient with T-cell deficiency:

A.    Pertussis

B.     Oral polio

C.     Rubella

D.    BCG

E.     Measles

Answer: A* Pertussis

***) Measles vaccine is given in Jordan at age:

A.    3 months

B.     6 months

C.     9 months

D.    15 months

E.     24 months

Answer: C* 9 months

***) Select the most appropriate statement:

A.    Measles vaccine is a live attenuated virus

B.     Prophylaxis against malaria is always effective

C.     Tuberculosis can always be prevented by the BCG vaccine alone

D.    The most important factor in the prevention of cholera is immunization with vaccine

E.     The most important factor in the prevention of coronary heart disease are active exercises

Answer: A* Measles vaccine is a live attenuated virus

***) All of the following about rubella vaccine are true, except:

A.    It is a live attenuated viral vaccine

B.     It should not be given to children before the age of one year

C.     It should not be administered to pregnant women

D.    It may be associated with arthritis in adult females

E.     It should not be administered with other viral vaccines

Answer: E* It should not be administered with other viral vaccines

***) Reactions to live MMR vaccine usually occur:

A.    Within minutes after vaccination

B.     Within 24 hours of injection

C.     Within 48 hours of injection

D.    After 6-8 days following the injection

E.     After 14-21 days following the injection

Answer: D* Within minutes after vaccination

***) The national vaccination program in Jordan includes vaccination against all of the following, except:

A.    Measles

B.     Whooping cough

C.     Diphtheria

D.    Hepatitis A

E.     Poliomyelitis

Answer: D* Hepatitis A

4.    Nutrition.

***) Colostrum has all of the following properties, except:

A.    It has higher fat content than mature milk

B.     It has higher protein content than mature milk

C.     It has less sugar content than mature milk

D.    Sodium and potassium content are higher than in mature milk

E.     It contains protective antibodies and leukocytes

Answer: A* It has a higher fat content than mature milk

***) Regarding colostrum all are true, except:

A.    Daily secretion is 10 to 40 ml

B.     It has an alkaline reaction

C.     Contains less fat than mature breast milk

D.    Contains less carbohydrates than mature breast milk

E.     Contains less protein than mature breast milk

Answer: E* Contains less protein than mature breast milk

***) Concerning breast feeding all of following are true, except:

A.    It should be initiated immediately following child birth

B.     Repeated feeding increases the flow of milk

C.     Consuming fluids helps the mother to maintain breast feeding

D.    Breast feeding is not recommended after introducing solid food

E.     Colostrum contains antibodies that are useful to the newborn

Answer: D* Breast feeding is not recommended after introducing solid food

***) In breast milk feeding all is true, except:

A.    Less allergic symptoms than bottle feeding

B.     Less incidence of gastroenteritis

C.     Less incidence of URTI

D.    Increased incidence of obesity than bottle feeding

E.     Increased emotional attachment

Answer: D* Increased incidence of obesity than bottle feeding

***) Human milk is relatively low in one of the following:

A.    Carbohydrates

B.     Proteins

C.     Fat

D.    Calcium

E.     Iron

Answer: E* Iron

***) All of the following regarding breast feeding is true, except:

A.    Breast milk contains IgA which protects against gastrointestinal infections

B.     Breast milk is relatively low in iron

C.     The bioavailability of iron in human milk is very high

D.    Breast feeding enhances the emotional bond between the mother and her infant

E.     Breast feeding is not advisable in case of twins

Answer: E* Breast feeding is not advisable in case of twins

***) Regarding human breast milk all are true, except:

A.    Iron of human milk is poorly absorbed

B.     Breast feeding should start as soon as possible after birth

C.     Lactose content in human milk is higher than in cow's milk

D.    Sodium content in human milk is lower than in cow's milk

E.     Proteins are lower than in cow's milk

Answer: A* Iron of human milk is poorly absorbed

***) The advantages of breast milk include all of the following, except:

A.    Always fresh and ready

B.     Always at right temperature

C.     Establishes healthy mother-child relationship

D.    Contains less carbohydrate per 100 ml than cow's milk

E.     Protects against infections

Answer: D* Contains less calories per 100 ml than cow's milk

***) Compared to cow's milk with human milk, one of the following is true:

A.    Sodium content is less in cow's milk

B.     Carbohydrate content is more in cow's milk

C.     Caloric content is almost the same

D.    Unsaturated fatty acids are more in cow's milk

E.     Folate content is less in cow's milk

Answer: C* Caloric content is almost the same

***) The protein content of cow’s milk is:

A.    1.5 g

B.     2.5 g

C.     3.5 g

D.    5 g

E.     7 g

Answer: C* 3.5 g

***) Human milk (breast milk) contains all of the following, except:

A.    Vitamin A

B.     Vitamin C

C.     Vitamin B₁₂

D.    Vitamin B₂

E.     Vitamin D

Answer: C* Vitamin B₁₂

***) Regular infant formulas are modified from cow's milk to resemble human milk. One of the following statements is correct regarding these formulas:

A.    They are safe to be used by infants with cow's milk allergy

B.     They are supplemented by the daily requirements of vitamins

C.     They are specifically indicated in patients with galactosemia

D.    Their fat concentration is less than that of cow's milk

E.     They do not contain lactose

Answer: B* They are supplemented by the daily requirements of vitamins

5.    Normal Physical Growth.

***) Children triple their birth weight by age of:

A.    1 year

B.     2 years

C.     6 months

D.    9 months

E.     3 months

Answer: A* 1 year

***) In normal developing fetus, the most likely head circumference measurement at full term is:

A.    30 cm

B.     33 cm

C.     36 cm

D.    38 cm

E.     40 cm

Answer: C*36 cm

***) The average head circumference of a normal child at one year of age is:

A.    40-42 cm

B.     43-45 cm

C.     46-48 cm

D.    49-52 cm

E.     53-56 cm

Answer: C* 46-48 cm

***) The average growth of head circumference during the first year is:

A.    5 cm

B.     8cm

C.     12 cm

D.    16 cm

E.     20 cm

Answer: C* 12 cm

***) In the majority of infants the anterior fontanel is closed by:

A.    3 months

B.     6 months

C.     10 months

D.    18 months

E.     24 months

Answer: D* 18 months

***) Regarding development, all the following are true except:

A.    The newborn regains his body weight by 10 days of age

B.     Double birth weight by 5 months, triple by 1 year

C.     Double birth length at 4 years

D.    Increased head circumference 4-5 cm during the first year

E.     Increased length 25-30 cm during first year

Answer: D* Increased head circumference 4-5 cm during the first year

***) Growth charts of 1 year old child show length of one stand deviation (SD) below third percentile, weight and head circumference of 2 SD's below the third percentile. The most likely primary diagnosis is:

A.    Microcephaly

B.     Failure to thrive

C.     Short stature

D.    Failure to thrive leading into short stature

E.     Failure to thrive leading into microcephaly

Answer: E* Failure to thrive leading into microcephaly

6.    Failure to Thrive (FTT).

***) Causes of failure to thrive include all of the following, except:

A.    Emotional deprivation

B.     Intestinal malabsorption

C.     Renal tubular disorders

D.    Chronic heart failure

E.     Acute chest infection

Answer: E* Acute chest infection

***) Caloric requirements by the beginning of the second week of life are:

A.    60 kcal/kg

B.     80 kcal/kg

C.     100 kcal/kg

D.    120 kcal/kg

E.     Over 140 kcal/kg

Answer: C* 100 kcal/kg

***) The daily requirement of vitamin D for the newborn is:

A.    40 IU

B.     400 IU

C.     4,000 IU

D.    40,000 IU

E.     400,000 IU

Answer: B* 400 IU

***) All of the following statements concerning daily needs of an infant are true, except:

A.    400 IU of vitamin D

B.     6 mg of iron

C.     50 mg of vitamin C

D.    110 calories per kg

E.     150 ml of water per kg

Answer: B* 6 mg of iron

***) Craniotabes could be seen in all of the following conditions, except:

A.    Rickets

B.     Vitamin E deficiency

C.     Hydrocephaly

D.    Syphilis

E.     Premature baby

Answer: B* Vitamin E deficiency

***) Clinical signs of marasmus may include all of the following, except:

A.    Loss of turgor of skin

B.     Poor appetite

C.     Hypotonia

D.    Subnormal temperature

E.     Never associated with edema

Answer: E* Never associated with edema

***) All are feature of Kwashiorkor, except:

A.    Anorexia

B.     Constipation

C.     Liability to infection

D.    Hair depigmentation

E.     Moon face

Answer: B* Constipation

***) Each of the following statements about Kwashiorkor is true, except:

A.    It is primarily a caloric malnutrition

B.     Loss of muscle tissue is present

C.     Hepatomegaly is due to fatty infiltration

D.    Pigmented skin is common

E.     Edema of limbs is usually present

Answer: A* It is primarily a caloric malnutrition

***) Regarding Kwashiorkor all of the following are true, except:

A.    Caused by low protein diet

B.     Failure to thrive and edema are presenting features

C.     Caused by low caloric diet

D.    Hypopigmentation of the hair is a feature

E.     Abdominal distension is a feature

Answer: C* Caused by low caloric diet

7.    Circumcision.

***) Circumcision is contraindicated in babies with:

A.    Long prepuce

B.     Phimosis

C.     Hypospadia

D.    Hemophilia

E.     Recurrent balanitis

Answer: C* Hypospadia

8.    Elimination Disorders.

***) An evaluation of every child who has enuresis should include all of the following, except:

A.    Family history

B.     Urine analysis

C.     Urine culture

D.    Intravenous pyelogram

E.     Fasting blood sugar

Answer: D* Intravenous pyelogram

***) Regarding Enuresis, all are true except:

A.    Most children achieve bladder control during day time and night by age 5 years

B.     Is more common in boys than in girls

C.     Spontaneous resolution can occur

D.    Conditioning devices is modality of treatment

E.     No pharmacological therapy

Answer: E* No pharmacological therapy

9.    Breath-Holding Spells.

***) All of the following are characteristic of breath holding spells, except:

A.    It can occur up to age of 4 or 5 years

B.     It is self-limited

C.     It does not occur in mentally retarded children

D.    It sometimes runs in families

E.     It could lend to convulsions

Answer: E* It could lend to convulsions

***) Concerning breath holding attacks all are true, except:

A.    Are common in toddlers (1-3 years of age)

B.     Are easily confused with a generalized seizure

C.     Should be treated with sedatives

D.    May be precipitated by a minor injury

E.     The history is very important for the diagnosis

Answer: C* Should be treated with sedatives