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1 DIRECTIONS ( Questions 1 through 24): Each ofthe numbered items or incomplete statements inthis section is followed by answers or completionsof the statement. Select the one lettered answer orcompletion that is best in each : Questions 1 and 2 are simple and straightfor-ward, each with only one possible correct this type of question , you can actually answerthe question before looking at the choices. Thenread the choices to verify that your answer is , review all the other choices to be sure thatnone is better than the one you have just confirmed the diagnosis of cysticfibrosis in a 3-year-old child. The parents areconcerned about future pregnancies. Youexplain to them that the pattern of genetictransmission of cystic fibrosis is(A) autosomal dominant(B) autosomal recessive(C) X-linked recessive(D) X-linked dominant(E) autosomal recessive in some familiesand X-linked in 12-year-old boy just returned from Boy ScoutCamp in Wisconsin.

2 He now has fever, myal-gia, and a 10-cm skin lesion which looks like atarget. You suspect Lyme disease, most likelycontracted by which of the following?(A) ingestion of unripe fruit(B) ingestion of spoiled fruit(C) drinking of contaminated water(D) the bite of a tick(E) the bite of a mosquitoClue:Unlike the preceding two Questions , the answerto question 3 cannot be anticipated before viewingthe list of suggested answers, because there are manypossible completions to the statement. Nevertheless,the question is simple and 2-year-old boy presents with extremityswelling and proteinuria and is found on urineanalysis. Minimal-change disease is suspectedand you explain to the child s parents that thisdiagnosis(A) is the most common cause of nephroticsyndrome in childhood(B) has a peak incidence in childrenbetween 10 and 15 years of age(C) usually results in end-stage renal dis-ease in 5 10 years(D) is characterized by normal serum lipidsand cholesterol(E) typically has a poor response to corti-costeroid treatmentClue:Pay attention to key words when you read aquestion.

3 question 4 contains the key words mostlikely. have just prescribed phenytoin for a 12-year-old boy with new onset of epilepsy. Ofthe following side effects, which is most likelyto occur in this patient?(A) lymphoma syndrome(B) Raynaud phenomenon(C) acute hepatic failure(D) gingival hyperplasia(E) optic atrophyQuestions2 Questions : 1 term infant is born to a mother who has beenusing crack cocaine. This infant is at increasedrisk for which of the following?(A) anemia(B) intrauterine growth retardation(C) hypercalcemia(D) macrosomia(E) examine an 18-year-old male college stu-dent with a 5-day history of fever, sore throat,and fatigue. Physical examination reveals anexudative tonsillitis and bilateral enlarged andslightly tender posterior cervical lymph spleen is palpable 3 cm below the rib agent is most likely responsible for thispatient s illness?(A) Group A -hemolytic streptococcus(B) Adenovirus(C)Toxoplasma gondii(D) Epstein-Barr virus(E)Corynebacterium diphtheriae7.

4 A term infant requires intubation in the deliv-ery room after aspiration of thick meconiumand is brought to the neonatal intensive careunit. Which of the following is the most likelyrisk factor for meconium aspiration syndromein this infant?(A) chromosomal anamoly(B) congenital heart disease(C) cystic fibrosis(D) fetal distress(E) tracheoesophageal newborn infant with stigmata of Down syn-drome has a heart murmur. Which of the fol-lowing cardiac lesions is most likely in this baby?(A) hypoplastic left heart syndrome(B) total anamolous venous return(C) coarctation of the aorta(D) anamolous coronary artery(E) atrioventricular mother of a 2-month-old wants more informa-tion about immunizations. Which of the follow-ing statements regarding immunization againstHaemophilus influenzaetype b (Hib) is correct?(A) It is indicated for high-risk children only.(B) Hib vaccine can be administered effec-tively as early as 2 months of age.

5 (C) Hib vaccine should not be given to childrenwho have had allergic reactions to eggs.(D) Hib vaccine should not be administeredto children with a history of reaction toDTaP immunization.(E) Hib vaccine should be deferred forinfants with history of febrile pertussis vaccine is recommendedfor infants, children, adolescents, and to the previously available wholecell vaccine, which of the following bestdescribes these products?(A) they are more immunogenic(B) they are less expensive(C) they are associated with fewer side effects(D) they require fewer doses(E) they can be combined with the varicellavaccine for the infant under age 1 is recommended that young infants shouldsleep in the supine rather than in the prone posi-tion. This is based on data suggesting that theprone position is associated with an increasedincidence of which of the following?(A) delayed eruption of the first deciduous teeth(B) gastroesophageal reflux and aspiration(C) macrognathia(D) strabismus(E) sudden infant feeding of honey to infants less than 6 monthsof age has been associated with which of thefollowing?

6 (A) anaphylaxis(B) hypernatremia(C) botulism(D) jaundice(E) listeriosis41:Warm-Up Questions and Exam-Taking 1-month-old infant presents with fever of 39 Cand vomiting. He was born at term vaginally toan 18-year-old mother who did not have prena-tal care. On examination, he is alert but fussyand cries with palpation of his abdomen. He isuncircumcised and both testes are evaluation for sepsis and meningitis isperformed. Urine analysis shows 50 100 WBC/HPF with positive leukocyte esterase andnitrites. CSF examination is normal and culturesfrom blood, urine, and CSF are pending. Youtell his mother that he has urinary tract infectionand she asks why this happened. Which of thefollowing is correct in explaining this infant smost likely risk for urinary tract infection?(A) The mother was colonized with GroupB streptococcus and did not receiveintrapartum prophylaxis.(B) The infant is uncircumcised.(C) The infant has prune belly syndrome.

7 (D) The infant has galactosemia.(E) There is a family history of vesicoureter-al 3-month-old infant presents with poor growthand inadequate weight gain. There is no historyof vomiting or diarrhea. Except for the appear-ance of malnutrition and lack of subcutaneous fat,the physical examination is normal. What is themost likely cause of this child s failure to thrive?(A) renal disease(B) a metabolic disorder(C) tuberculosis(D) an endocrine disorder(E) a nonorganic 2-year-old child is being evaluated becausethe mother notes that her right eye has beenturning in. Physical examination documentsstrabismus with a right esotropia. Attempts tovisualize the fundi are unsuccessful, but it isnoted that the red reflex is replaced by a yellow-white pupillary reflex in the right eye. This childmost likely has which of the following?(A) retinitis pigmentosa(B) retinoblastoma(C) rhabdomyosarcoma(D) severe hyperopia(E) severe 2-year-old child is admitted because of weak-ness proceeding to coma.

8 According to the par-ents, he had been well until several hours prior toadmission, when they noted diarrhea, cough,wheezing, and sweating. Physical examinationreveals a comatose child with diffuse weaknessand areflexia. Pupils are pinpoint and unrespon-sive. Examination of the chest reveals generalizedwheezing. Oral secretions are copious. Which ofthe following should you administer at this time?(A) adrenaline(B) atropine(C) cefotaxime(D) methylprednisolone(E) 3-week-old infant is admitted with vomiting of5 days duration. Physical examination reveals arapid heart rate, evidence of dehydration, andambiguous genitalia. Serum electrolytes are Na+120 meq/L, K+ meq/L, HCO3 12 meq/L,BUN 20 mg/dL. In addition to intravenous fluidreplacement with normal saline, administration ofwhich of the following would be most important?(A) diuretics(B) potassium exchange resin(C) glucose and insulin(D) antibiotics(E) previously well 12-year-old girl presents toclinic because of painful swellings on the front ofthe legs of about 3 days duration.

9 Examinationreveals tender erythematous nodules, 1 2 cm indiameter, on the extensor surfaces of the lowerlegs. The remainder of the physical examinationis unremarkable. Which of the following is mostlikely to confirm the cause of this condition?(A) stool smear and culture(B) urine analysis and BUN(C) throat culture(D) slit-lamp examination of the eye(E) echocardiogramQuestions: 13 18-year-old boy presents with cough, chestpain, and low-grade nightly fevers of severalweeks duration. He has a 4-year history ofsmoking two packs of cigarettes per day. Chestx-ray reveals a large mass in the mediastinumwith extension into the right upper chest. Whichof the following is the most likely diagnosis?(A) adenocarcinoma(B) squamous cell carcinoma(C) small cell carcinoma(D) lymphoma(E) metastatic Wilms 12-year-old child is seen because of a rash andsevere headache which began 2 weeks afterreturning from vacation in Massachusetts. Theskin lesion began as a red macule on the thigh,which gradually expanded over 1 week to reachapproximately 15 cm in diameter with red bordersand central clearing.

10 The lesion is slightly few days after the onset of the skin manifesta-tion, the child developed severe headache, myal-gias, arthralgias, and malaise. Low-grade feverwas present. The mother recalls that the child wasbitten by a tick about 1 week prior to the onset ofsymptoms. This patient s disorder is probablybest treated with which of the following?(A) corticosteroids(B) diphenhydramine(C) methotrexate(D) nonsteroidal anti-inflammatory drugs(E) 8-year-old child is hospitalized because ofparoxysms of severe colicky abdominal painwhich does not radiate to the back or the examination is unremarkable exceptfor generalized abdominal tenderness. Anexploratory laparotomy reveals an edematousintestine without specific lesions. The appendixappears normal but is removed. Postoperativelythe abdominal pain persists, and hematuriadevelops. Values for BUN and creatinine arenormal. On the second postoperative day,tender swelling of both ankles and knees isnoted.