اسئلة الاطفال 2018 (1)
1) The arterial blood gas of a comatose infant is as follows :
PH = 7.45 , PaCO2 = 25 , PaO2 = 90 , HCO3 = 12 . Which of the following best describes these numbers ?
A . Metabolic acidosis
B . Metabolic alkalosis
C . Respiratory acidosis
D . Respiratory alkalosis
E . Combined respiratory and metabolic acidosis
2) A normal infant sits without support easily and can walk while holding on to furniture , her age is ?
A . 4 months
B . 9 months
C . 14 months
D . 18 months
3) In regards to trisomy 21 ( Down syndrome ) which of the following is true ?
A . Only affects children born to very old mother .
B . Most common feature is hypertonia .
C . There is a 50 % risk the child will have congenital heart disease .
D . The older the father the more likely he is Down syndrome .
E . Social behavior is delayed for age .
4) Most common solid tumor for children is ?
A . CNS tumor
B . Neuroblastoma
C . Willms tumor
D . Bone tumor
E . Retinoblastoma
5) In DKA all are true except ?
A . Insulin should not be given until check the serum potassium .
B . KCL usually given when serum potassium is normal or low .
C . Mannitol is given when bicarbonate HCO3 is very low .
D . NaCl solution is the best choice .
E . Sodium bicarbonate should be given if PH less than 7 .
6) The ABG of a child on ventilator shows : PH = 7.5 , PaO2 = 90 , PaCO2 = 20 , HCO3 = 22 . Which of the following best describes these numbers ?
A . Respiratory alkalosis
B . Respiratory acidosis
C . Metabolic acidosis
D . Metabolic alkalosis
E . Mixed alkalosis
7) Which of the following is not associated with prolonged bleeding time ?
A . Uremia
B . Thrombocytopenia
C . Hemophilia
D . VWD
E . Glanzmann disease
8) ) What is the most common cause of IDA in Jordan ?
A . Gastrointestinal parasitic infection .
B . Drinking tea after each meal .
C . Inadequate exposure to the sun .
D . Family eats too much fast food .
E . Consumption of large amount of cow's milk
9) A 6 year old child presents with fever and sore throat . Exam shows red throat without enlarged neck lymph nodes . The next step in management is ?
A . Start amoxicillin for 7 days .
B . Start Azithromycin for 7 days .
C . Paracetamol for pain and follow up in second .
D . Refer to ENT specialist .
E . Obtain WBC and blood culture and make decision after result .
10) The most common cause of convulsion in a 2 years old infant is ?
A . Grand mal seizure
B . Petit mal seizure
C . Febrile convulsion
D . Brain tumor
E . Ruptured aneurysm
11) One of the following is included in Jordan nation immunization program ?
A . Pneumococcus
B . Rota virus
C . Meningococcus
D . Varicella
E . Hepatitis A
12) Regarding the treatment of jaundice , which of the following is correct ?
A . The use of phototherapy has no complications .
B . Premature babies have a higher risk for jaundice .
C . Physiologic jaundice results from the elevation of conjugated bilirubin .
D . Jaundice in breastfeed babies occurring at day 6_9 of life should managed by increased breastfeeding .
E . Jaundice in breastfeed babies occurring at day 1_3 of life should managed by discontinuing breastfeeding for a few days
13) A child is able to walk down stairs holding the side rail , throw a ball over hand , and initiate drawing a horizontal line , he could say 2 words sentence , he is most likely ?
A . 24 months
B . 30 months
C . 36 months
D . 48 months
E . 60 months
14) 10 day old boy presented with vomiting , dehydration , decreased feeding and hypotension . He was found to have serum sodium = 118 , potassium = 7 , glucose = 65 . The best management for this boy is to give ?
A . Antibiotics and IV fluid
B . Hydrocortisone and normal saline
C . Adrenaline sc
D . Normal saline
E . Sodium bicarbonate and calcium gluconate
15) A 9 year old Jordanian female presented with recurrent episodes and abdominal pain for few years . She has history of multiple hospitalization . Her father has also same scenario . The most likely diagnosis is ?
A . FMF
B . Appendicitis
C . Cholycystitis
D . UTI
E . Diverticulitis
16) In regards to bites , which of the following is correct ?
A . Dog bites generally get infected faster than cat bites .
B . Amoxicillin clavulanic acid is an excellent option for bites .
C . Dog and cat bites should be treated with ATS while human bites can be observed .
D . All children who have bitten should received antibiotics intravenously .
E . The treatment of bites from pet's is observed , while from stray animals should be admitted to the hospital .
17) Charcoal is used in ingestion of one of the following substances ?
A . Iron
B . Hydrocarbon
C . Corrosive materials
D . Lead
E . Carbamazepine
18) All are contraindications to breastfeeding except ?
A . Maternal drug abuse .
B . Mother receiving chemotherapy .
C . Maternal hepatitis .
D . Maternal active tuberculosis .
E . Infant diagnosed with Galactosemia .
19 ) vitamin D supplementation is recommended in infant from the age of ?
A . After birth
B . One month
C . Three months
D . Six months
E . One year
20) The following is an acceptable alternative for an infant with cow milk protein intolerance except ?
A . Hydrolyzed formula
B . Amino acid formula
C . Lactose free formula
D . Soy formula
E . Breast milk
21) All of the following are characteristic of a PDA except ?
A . Continuous machinery murmur .
B . Narrow pulse pressure .
C . Prominent pulmonary artery on CXR .
D . Risk of infective endocarditis .
E . Can cause pulmonary hypertension .
22) Regarding juvenile rheumatoid arthritis , one is false ?
A . The most common type is the pauciarticular .
B . More common in females .
C . Rheumatoid factor is positive in most of the case's .
D . NSAIDs and methotrexate are used in treatment .
E . May be complicated by iridocyclitis or uveitis .
23) A 12 year old boy brought to the E.R with wheezing , difficulty of breathing and hives . The BP 90/60 , HR 140 . His pulse ox was 88% . The father stated he is ingested Tuna 15 minutes before his symptoms started . The patient is known to have multiple food allergies . Of the following the most appropriate immediate action is ?
A . Administration of oxygen .
B . Administration of NaCl saline bolus .
C . Administration of epinephrine .
D . Administration of beta 2 agonist Nebulizer .
E . Administration of steroid and antihistamine .
24) Which of the following would you expect in a child with carbon monoxide poisoning ?
A . Bradycardia
B . Metabolic alkalosis
C . Headache , nausea and vomiting
D . HTN
E . Bradypnea
25) All of the following are causes of Corrigan pulse except ?
A . Fever
B . Aortic stenosis
C . Beriberi
D . Paget disease
E . Cor pulmonale
26) Which of the following is most concerning for failure to thrive in a child ?
A . Child does not finish his plate during meal .
B . Child is consistently below the 5th percentile for age on height , weight charts .
C . Child was exclusively breastfeed until age 6 months .
D . Child drinks a lot of fruit juice .
E . Child is playful and active .
27) All are causes of immunodeficiency except ?
A . Di_George syndrome
B . Wiskott Aldrich syndrome
C . Ataxia telangiectasia
D . Phenylketonuria
E . Hyper IgE syndrome
28) Although all of the following medications are used in treatment of Hyperkalemia in children . The only one that can remove the potassium from the body is ?
A . 10% calcium gluconate
B . Bicarbonate
C . Nebulized albuterol
D . Insulin
E . Kayexalate
29) A 3 weeks old infant is admitted with vomiting of 5 days duration , physical exam reveals a rapid heart rate , evidence of dehydration , ambiguous genitalia . Na= 120 , k =7 ,HCO3 = 12 . The best next step is ?
A . Diuretics
B . Potassium exchange resin
C . Glucose and insulin
D . Antibiotics
E . Hydrocortisone and normal saline
30) An 18 year old boy presents with cough , chest pain and low grade nightly fever for several weeks . CXR reveals a large mass in the mediastinum . Most likely diagnosis is ?
A. Adenocarcinoma
B . SCC
C . Small cell carcinoma
D . Lymphoma
E . Metastatic Willms tumor
31) A 3 day old term , healthy infant is noted to be jaundiced . Physical exam is otherwise normal , laboratory HB 16.8 g/dL , Reticulocytes 1% , unconjugated bilirubin 8.5 mg /dL , conjugated 0.8 mg dL . The most likely diagnosis is ?
A . Breastfeeding jaundice
B . Breast milk jaundice
C . Physiological jaundice
D . Crigler najjar syndrome
E . Erythroblastosis
32) Over the first week of life , a typical term newborn will ?
A . Gain approximately 30 g per day .
B . Gain approximately 60 g per day .
C . Neither gain nor lose weight .
D . Lose 10% of it's birth weight .
E . Lose 15% of it's birth weight .
33) Overdose of which of the following is most likely to be complicated by hypoglycemia ?
A . Salicylates
B . Lead
C . Tricyclic antidepressants
D . Opiods
E . Organophosphates
34) The recommended daily intake of protein for optimal growth during the first 6 months of life is about ?
A . 0.2 g/kg
B . 1 g/kg
C . 2 g/kg
D . 5 g/kg
E . 10 g/kg
35) Delayed dental eruption is considered when the child has no teeth by age ?
A . 6 months
B . 8 months
C . 11 months
D . 13 months
E . 18 months
36) The tonic neck reflex should disappear by the age ?
A . 3 months
B . 4 months
C . 6 _ 8 months
D . 12 _ 16 months
E . 17 _ 20 months
37) Acute bronchiolitis characterized by one of the following ?
A . Usually associated with high fever .
B . Usually associated with lobar infiltrates on CXR .
C . Commonly associated with retractions , tachypnea and wheezing .
D . Absent of cough .
E . Most common between 2 _ 5 years age
38) An infant with diarrhea is 10% dehydrated . The weight was 5 kg . What is the total amount of fluid you should deliver to meet maintenance needs and restore to normal hydration state in the first 24 hours ?
A . 750 ml
B . 1000 ml
C . 1250 ml
D . 1500 ml
E . 1750 ml
39) Pyruvate kinase deficiency is the most common glycolytic enzyme deficiency . Which of the following is a common clinical sign in neonatal presentation of this disorder ?
A . Sepsis and infections
B . Jaundice
C . Hepatomegaly
D . Hypertonia
E . Seizures
40) Which of the following is the most common clinical manifestations that follows infection with Campylobacter ?
A . Polyarticular arthritis
B . Encephalitis
C . Guillain barre syndrome
D . Inguinal lymphadenitis
E . Anterior uveitis
41) Which of the following is characteristic of the CSF in tuberculous meningitis ?
A . The color is blood tinged .
B . Protein is normal .
C . Culture reveals TB organisms within one week .
D . Glucose is low .
E . Leucocytes predominant .
42) The diagnosis of Werding Hoffman disease is most likely in an infant with severe hypotonia and ?
A . Normal deep tendon reflexes .
B . Seizures .
C . Fasciculations of the tongue .
D . Recurrent fever .
E . Atrophy of the optic nerve .
43) An 8 months old child has vomiting and scream episodes for 12 hours . Physical exam reveal a sausage shaped mass in the RUQ . Which of the following would be most useful ?
A . Passage of NG tube .
B . Exam of stool specimen for ova and parasites .
C . Blood culture .
D . Abdominal ultrasound .
E . Barium enema study .
44) Complex partial ( psychomotor ) seizures are characterized by ?
A . Lack of alternation in mental state , consciousness, responsiveness .
B . Brief tonic clonic phase .
C . Automatisms .
D . Three per second spike on EEG .
E . Lack of postictal phenomenon .
45) Rectal prolapse in an infant with failure to thrive is most suggestive of ?
A . Crohn disease
B . Functional constipation
C . Ehlers Danlos syndrome
D . Cystic fibrosis
E . Intussusception
46) Which of the following is most appropriate for the treatment of Mycoplasma pneumonia infection in a 4 year old child ?
A . Cefuroxime
B . Chloramphenicol
C . Erythromycin
D . Penicillin
E . Tetracycline
47) Neurotoxicity is a common adverse effect of which chemotherapy ?
A . Methotrexate
B . Cyclophosphamide
C . Chlorambucil
D . Bleomycin
E . Vincristine
48) After your intervention whole blood glucose is 500 mg /dL . Intravenous fluid and insulin are given . Which of the following metabolic abnormalities is most likely to occur during insulin therapy ?
A . Hyperkalemia
B . Hypokalemia
C . Hyperphosphatemia
D . Hypercalcemia
E . Hypermagnesemia
49) Patient with Down syndrome are at increased risk of ?
A . Hyperthyroidism
B . Arthritis of cervical spine
C . Streak gonads
D . Cardiac malformation
E . Rhabdomyosarcoma
PH = 7.45 , PaCO2 = 25 , PaO2 = 90 , HCO3 = 12 . Which of the following best describes these numbers ?
A . Metabolic acidosis
B . Metabolic alkalosis
C . Respiratory acidosis
D . Respiratory alkalosis
E . Combined respiratory and metabolic acidosis
2) A normal infant sits without support easily and can walk while holding on to furniture , her age is ?
A . 4 months
B . 9 months
C . 14 months
D . 18 months
3) In regards to trisomy 21 ( Down syndrome ) which of the following is true ?
A . Only affects children born to very old mother .
B . Most common feature is hypertonia .
C . There is a 50 % risk the child will have congenital heart disease .
D . The older the father the more likely he is Down syndrome .
E . Social behavior is delayed for age .
4) Most common solid tumor for children is ?
A . CNS tumor
B . Neuroblastoma
C . Willms tumor
D . Bone tumor
E . Retinoblastoma
5) In DKA all are true except ?
A . Insulin should not be given until check the serum potassium .
B . KCL usually given when serum potassium is normal or low .
C . Mannitol is given when bicarbonate HCO3 is very low .
D . NaCl solution is the best choice .
E . Sodium bicarbonate should be given if PH less than 7 .
6) The ABG of a child on ventilator shows : PH = 7.5 , PaO2 = 90 , PaCO2 = 20 , HCO3 = 22 . Which of the following best describes these numbers ?
A . Respiratory alkalosis
B . Respiratory acidosis
C . Metabolic acidosis
D . Metabolic alkalosis
E . Mixed alkalosis
7) Which of the following is not associated with prolonged bleeding time ?
A . Uremia
B . Thrombocytopenia
C . Hemophilia
D . VWD
E . Glanzmann disease
8) ) What is the most common cause of IDA in Jordan ?
A . Gastrointestinal parasitic infection .
B . Drinking tea after each meal .
C . Inadequate exposure to the sun .
D . Family eats too much fast food .
E . Consumption of large amount of cow's milk
9) A 6 year old child presents with fever and sore throat . Exam shows red throat without enlarged neck lymph nodes . The next step in management is ?
A . Start amoxicillin for 7 days .
B . Start Azithromycin for 7 days .
C . Paracetamol for pain and follow up in second .
D . Refer to ENT specialist .
E . Obtain WBC and blood culture and make decision after result .
10) The most common cause of convulsion in a 2 years old infant is ?
A . Grand mal seizure
B . Petit mal seizure
C . Febrile convulsion
D . Brain tumor
E . Ruptured aneurysm
11) One of the following is included in Jordan nation immunization program ?
A . Pneumococcus
B . Rota virus
C . Meningococcus
D . Varicella
E . Hepatitis A
12) Regarding the treatment of jaundice , which of the following is correct ?
A . The use of phototherapy has no complications .
B . Premature babies have a higher risk for jaundice .
C . Physiologic jaundice results from the elevation of conjugated bilirubin .
D . Jaundice in breastfeed babies occurring at day 6_9 of life should managed by increased breastfeeding .
E . Jaundice in breastfeed babies occurring at day 1_3 of life should managed by discontinuing breastfeeding for a few days
13) A child is able to walk down stairs holding the side rail , throw a ball over hand , and initiate drawing a horizontal line , he could say 2 words sentence , he is most likely ?
A . 24 months
B . 30 months
C . 36 months
D . 48 months
E . 60 months
14) 10 day old boy presented with vomiting , dehydration , decreased feeding and hypotension . He was found to have serum sodium = 118 , potassium = 7 , glucose = 65 . The best management for this boy is to give ?
A . Antibiotics and IV fluid
B . Hydrocortisone and normal saline
C . Adrenaline sc
D . Normal saline
E . Sodium bicarbonate and calcium gluconate
15) A 9 year old Jordanian female presented with recurrent episodes and abdominal pain for few years . She has history of multiple hospitalization . Her father has also same scenario . The most likely diagnosis is ?
A . FMF
B . Appendicitis
C . Cholycystitis
D . UTI
E . Diverticulitis
16) In regards to bites , which of the following is correct ?
A . Dog bites generally get infected faster than cat bites .
B . Amoxicillin clavulanic acid is an excellent option for bites .
C . Dog and cat bites should be treated with ATS while human bites can be observed .
D . All children who have bitten should received antibiotics intravenously .
E . The treatment of bites from pet's is observed , while from stray animals should be admitted to the hospital .
17) Charcoal is used in ingestion of one of the following substances ?
A . Iron
B . Hydrocarbon
C . Corrosive materials
D . Lead
E . Carbamazepine
18) All are contraindications to breastfeeding except ?
A . Maternal drug abuse .
B . Mother receiving chemotherapy .
C . Maternal hepatitis .
D . Maternal active tuberculosis .
E . Infant diagnosed with Galactosemia .
19 ) vitamin D supplementation is recommended in infant from the age of ?
A . After birth
B . One month
C . Three months
D . Six months
E . One year
20) The following is an acceptable alternative for an infant with cow milk protein intolerance except ?
A . Hydrolyzed formula
B . Amino acid formula
C . Lactose free formula
D . Soy formula
E . Breast milk
21) All of the following are characteristic of a PDA except ?
A . Continuous machinery murmur .
B . Narrow pulse pressure .
C . Prominent pulmonary artery on CXR .
D . Risk of infective endocarditis .
E . Can cause pulmonary hypertension .
22) Regarding juvenile rheumatoid arthritis , one is false ?
A . The most common type is the pauciarticular .
B . More common in females .
C . Rheumatoid factor is positive in most of the case's .
D . NSAIDs and methotrexate are used in treatment .
E . May be complicated by iridocyclitis or uveitis .
23) A 12 year old boy brought to the E.R with wheezing , difficulty of breathing and hives . The BP 90/60 , HR 140 . His pulse ox was 88% . The father stated he is ingested Tuna 15 minutes before his symptoms started . The patient is known to have multiple food allergies . Of the following the most appropriate immediate action is ?
A . Administration of oxygen .
B . Administration of NaCl saline bolus .
C . Administration of epinephrine .
D . Administration of beta 2 agonist Nebulizer .
E . Administration of steroid and antihistamine .
24) Which of the following would you expect in a child with carbon monoxide poisoning ?
A . Bradycardia
B . Metabolic alkalosis
C . Headache , nausea and vomiting
D . HTN
E . Bradypnea
25) All of the following are causes of Corrigan pulse except ?
A . Fever
B . Aortic stenosis
C . Beriberi
D . Paget disease
E . Cor pulmonale
26) Which of the following is most concerning for failure to thrive in a child ?
A . Child does not finish his plate during meal .
B . Child is consistently below the 5th percentile for age on height , weight charts .
C . Child was exclusively breastfeed until age 6 months .
D . Child drinks a lot of fruit juice .
E . Child is playful and active .
27) All are causes of immunodeficiency except ?
A . Di_George syndrome
B . Wiskott Aldrich syndrome
C . Ataxia telangiectasia
D . Phenylketonuria
E . Hyper IgE syndrome
28) Although all of the following medications are used in treatment of Hyperkalemia in children . The only one that can remove the potassium from the body is ?
A . 10% calcium gluconate
B . Bicarbonate
C . Nebulized albuterol
D . Insulin
E . Kayexalate
29) A 3 weeks old infant is admitted with vomiting of 5 days duration , physical exam reveals a rapid heart rate , evidence of dehydration , ambiguous genitalia . Na= 120 , k =7 ,HCO3 = 12 . The best next step is ?
A . Diuretics
B . Potassium exchange resin
C . Glucose and insulin
D . Antibiotics
E . Hydrocortisone and normal saline
30) An 18 year old boy presents with cough , chest pain and low grade nightly fever for several weeks . CXR reveals a large mass in the mediastinum . Most likely diagnosis is ?
A. Adenocarcinoma
B . SCC
C . Small cell carcinoma
D . Lymphoma
E . Metastatic Willms tumor
31) A 3 day old term , healthy infant is noted to be jaundiced . Physical exam is otherwise normal , laboratory HB 16.8 g/dL , Reticulocytes 1% , unconjugated bilirubin 8.5 mg /dL , conjugated 0.8 mg dL . The most likely diagnosis is ?
A . Breastfeeding jaundice
B . Breast milk jaundice
C . Physiological jaundice
D . Crigler najjar syndrome
E . Erythroblastosis
32) Over the first week of life , a typical term newborn will ?
A . Gain approximately 30 g per day .
B . Gain approximately 60 g per day .
C . Neither gain nor lose weight .
D . Lose 10% of it's birth weight .
E . Lose 15% of it's birth weight .
33) Overdose of which of the following is most likely to be complicated by hypoglycemia ?
A . Salicylates
B . Lead
C . Tricyclic antidepressants
D . Opiods
E . Organophosphates
34) The recommended daily intake of protein for optimal growth during the first 6 months of life is about ?
A . 0.2 g/kg
B . 1 g/kg
C . 2 g/kg
D . 5 g/kg
E . 10 g/kg
35) Delayed dental eruption is considered when the child has no teeth by age ?
A . 6 months
B . 8 months
C . 11 months
D . 13 months
E . 18 months
36) The tonic neck reflex should disappear by the age ?
A . 3 months
B . 4 months
C . 6 _ 8 months
D . 12 _ 16 months
E . 17 _ 20 months
37) Acute bronchiolitis characterized by one of the following ?
A . Usually associated with high fever .
B . Usually associated with lobar infiltrates on CXR .
C . Commonly associated with retractions , tachypnea and wheezing .
D . Absent of cough .
E . Most common between 2 _ 5 years age
38) An infant with diarrhea is 10% dehydrated . The weight was 5 kg . What is the total amount of fluid you should deliver to meet maintenance needs and restore to normal hydration state in the first 24 hours ?
A . 750 ml
B . 1000 ml
C . 1250 ml
D . 1500 ml
E . 1750 ml
39) Pyruvate kinase deficiency is the most common glycolytic enzyme deficiency . Which of the following is a common clinical sign in neonatal presentation of this disorder ?
A . Sepsis and infections
B . Jaundice
C . Hepatomegaly
D . Hypertonia
E . Seizures
40) Which of the following is the most common clinical manifestations that follows infection with Campylobacter ?
A . Polyarticular arthritis
B . Encephalitis
C . Guillain barre syndrome
D . Inguinal lymphadenitis
E . Anterior uveitis
41) Which of the following is characteristic of the CSF in tuberculous meningitis ?
A . The color is blood tinged .
B . Protein is normal .
C . Culture reveals TB organisms within one week .
D . Glucose is low .
E . Leucocytes predominant .
42) The diagnosis of Werding Hoffman disease is most likely in an infant with severe hypotonia and ?
A . Normal deep tendon reflexes .
B . Seizures .
C . Fasciculations of the tongue .
D . Recurrent fever .
E . Atrophy of the optic nerve .
43) An 8 months old child has vomiting and scream episodes for 12 hours . Physical exam reveal a sausage shaped mass in the RUQ . Which of the following would be most useful ?
A . Passage of NG tube .
B . Exam of stool specimen for ova and parasites .
C . Blood culture .
D . Abdominal ultrasound .
E . Barium enema study .
44) Complex partial ( psychomotor ) seizures are characterized by ?
A . Lack of alternation in mental state , consciousness, responsiveness .
B . Brief tonic clonic phase .
C . Automatisms .
D . Three per second spike on EEG .
E . Lack of postictal phenomenon .
45) Rectal prolapse in an infant with failure to thrive is most suggestive of ?
A . Crohn disease
B . Functional constipation
C . Ehlers Danlos syndrome
D . Cystic fibrosis
E . Intussusception
46) Which of the following is most appropriate for the treatment of Mycoplasma pneumonia infection in a 4 year old child ?
A . Cefuroxime
B . Chloramphenicol
C . Erythromycin
D . Penicillin
E . Tetracycline
47) Neurotoxicity is a common adverse effect of which chemotherapy ?
A . Methotrexate
B . Cyclophosphamide
C . Chlorambucil
D . Bleomycin
E . Vincristine
48) After your intervention whole blood glucose is 500 mg /dL . Intravenous fluid and insulin are given . Which of the following metabolic abnormalities is most likely to occur during insulin therapy ?
A . Hyperkalemia
B . Hypokalemia
C . Hyperphosphatemia
D . Hypercalcemia
E . Hypermagnesemia
49) Patient with Down syndrome are at increased risk of ?
A . Hyperthyroidism
B . Arthritis of cervical spine
C . Streak gonads
D . Cardiac malformation
E . Rhabdomyosarcoma
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