All TAS Exams Recall

Index
Oct 21 2
Jun 21 38
Feb 21 62
Oct 20 87
Feb 20 117
Oct 19 130
Jun 19 138
Feb 19 153
Oct 18 157
Jun 18 167
Feb 18 173
Oct 17 187
Jun 17 202
Feb 17 207
Oct 16 221
Jun 16 227
Oct 16 234
Jun 15 247
Oct 13 255
Mix 13,15,16 267
Oct 13 315
Jun 11 342
Feb 11 355
Feb 09 367
All TAS Exams Recall 1 of 381

Tas October 2021
EMQ
EMQ 1:
A-part of DNA non-coding separating exons
B- the coding part of DNA involved in protein synthesis
C-cell contain one copy of chromosomal number.
1- Axon
2- Intron
3- Haploid
4- Allele
5- Gene
6- chromosome
EMQ 2:

Tas October 2021
SPIROGRAPH:
X = tidal volume
S= FRC functional residual capacity
Y=FEV1
EMQ3:
A-HGB C
B-HGB H
C-hereditary spherocytosis
1- quantitative defect of one gene of beta chain

2- qualitative alpha Chain A.A substitution
3- defect of 2 genes of alpha chain
4- defect of 3 genes of alpha chain

Tas October 2021
5- defect in proteins for RBC cytoskeleton of cell

membrane
6- qualitative beta chain A.A substitution
7- qualitative gamma chain A.A substitution
8- pyruvate kinase deficiency
EMQ 4:
A-Rt temporal visual field loss, Lt nasal visual
field loss
B- Bitemporal hemianopia
C- Rt temporal lower quadrant visual field loss, Lt
nasal lower quadrant visual field loss
1-LT optic tract
2-RT optic tract
3-optic chiasma
4-LT parietal optic tract
5-Rt parietal optic tract
6- Rt temporal optic tract
7-Lt temporal optic tract
8-pretectal nucleous
9-optic nerve

Tas October 2021
EMQ5:
Vitamins and minerals:
A- component part of cytochrome enzyme,
involved in myelin and connective tissue and
iorn utilization
B-ca and phosphorous absorption from the gut
and ca and phosphorous retention from the
kidney
C-intracellular component mainly stored in
bone and involved in ms contraction
1- Vitamin D
2- Copper
3- Iron
4- Mg
5- Phosphate
6- Vitamin k
7- Vitamin A
N.B VIP
There was no Ca, k, hepcidin.
EMQ6:

Tas October 2021
Drugs Mechanism of action:

1-Ca channel blocker
2- beta 1 adrenoreceptor antagonism
3- alpha and beta adrenoreceptor agonism
A- atenolol
B- propranalol
C- captopril
D- nifedipine
E- enalpril
F- epinephrin
G- isoprenaline
EMQ7:
Mechanism of action of antibiotic
A- Scenario of 6 yrs. old child presented with
(Mycoplasma pneumonie)treated with
clarithromycin
B- Scenario of pt taking trimethoprim for
prophylaxis of UTI

Tas October 2021
C- Neonate presented pale,lethargic statrting of

gentamycin
1-protein synthesis ribosome 50

2-bacterial folate synthesis
3-DNA gyrase
4- protein synthesis ribosome 30
EMQ8
BIAS
Researcher conducting study in adolescents with
epilepsy regarding their ttt of epilepsy and effect on
quality of life
a-The research was advertised by poster on OPD clinic
b-Adolescent give response
c-Adolescents requested to study examining health
related qulaity of life submitted fewer responses at
time point 2 than at time point 1
1. Lead time bias
2. Long-time bias
3. Spectrum bias

Tas October 2021
4. Systematic bias
5. Response bias
6. Reporting bias
7. Sampling bias
EMQ9
Breast milk component
a-antimicrobial by binding to free iorn
b-neutralizing and binding to Antigen leading to
tolerance
c-produce acidic media and allow lactobacilli to
flourish
1-lactoferrin
2-immunoglobulin A
3-oligosaccharides
4-T cell associated CTLA (cytotoxic t cell
associated)
N.B.
there was no beta lactoglobulin
and alpha lactalbumin

Tas October 2021
EMQ10:
Organisms:
a- 9 days neonate preterm 29 weeks on ventilator for
RDS, tolerating 2ml of trophic feeding and the rest of
feeding on TPN via long line
b- 25-29 days old preterm 28 weeks baby receiving
multiple antibiotics for 2 weeks for neonatal sepsis,
now on ceftazidime and vancomycin, had long line,
there is hyperglycaemia and baby on insulin
c- Full term NVD with rupture of membrane of 4 hrs
before delivery, baby was well then at 4 hrs of age
presented by tachypnoea, lethargy, pallor
1-GBS
2-LISTERIA
3-CONS
4-MRSA
5-FUNGAL
6-ECOLI

Tas October 2021
Best of five:
1- Mechanism auto acoustic emission test

A- need external noise below 20 dp
B- impaired cochlear hair echo when stimulated
C- detect outer hair cell function in cochlea
D- affect by fluid the middle ear
E- detect high amplitude signals from inner ear
2- New-born 8 days type of IG in alloimmune :

A- IGG
B- IGM
C- IGA
D- IGE
E- IGD
3- In HBb neonate when to give Ig in the following

cases:
A- HBb c AB positive and HBe AB positive
B- HBs AB POSITIVE AND HB e antibody positive
C- HBc AB positive and HB s AB positive
D- HB S antigen positive and HB e antigen positive
E- Hb C ANTIGEN NEGATIVE AND HB S AB positive

Tas October 2021
4- 12-year-old Child with type 2 dm tension headache

and BMI 33 on Exam liver palpable 3cm soft Came
for assessment
LFT:
Bilirubin normal ALT 265
AST374 ALP Normal
What is the histopathology finding in this child liver
biopsy?
A- Lobular disarrange and ballooning and degeneration of
hepatocytes Kupffer cell activation and lymphocyte
predominant lobular and portal inflammations
B- Eosinophilic hyaline intracytoplasmic globules in periportal
hepatocytes and bile duct epithelium
C- Macro vesicular steatosis and mix mild lobular inflammation
and hepatocytes ballooning
D- Hepatic necrosis hepatoportal sclerosis and sinusoidal
dilation
E- Portal inflammation with predominant of plasma cell and
hepatocellular rosette formation
F-
5- 2monthes girl with thigh haemangioma 1cm that is
increasing in size from the age of 3 weeks till now
bleed when scratch , What is the origin of capillary
haemangioma from the following skin layers:
A- Dermis
B- Hypodermis
C- basal cell layer
D- cornium cell layer

Tas October 2021
E- spinosum cell layer

F- Subcutaneous
6- Hirschsprung disease pathophysiology:

A- Cholinergic activity decreases throughout large bowel
B- Absent myenteric and submucosal plexuses in the large
bowel
C- Cholinergic inhibitory activity predominates over excitatory
adrenergic in control of smooth muscle tone
D- Innervation is patchy throw out large bowel
E- Control of smooth muscle is predominantly intrinsic
7- Neonate 3 weeks screening done showed high TSH then

radioisotope show no uptake And absent thyroid tissue
what is the reason of this finding :
A- Defect migration of thyroglossal duct
B- Transcription defect of the development of thyroid gland
C- Defect in binding of free thyroxin to the thyroid TSH receptor
D- Defect iodin transport into thyroid follicle
E- Defect in coupling of tyrosine residue rescute in defective
thyroglobulin
8- Gram negative coccobacilli producing toxin

increase tissue susceptibility to histamine ans
serotine and produce significant lymphocytosis
A. HIB
B. portadella pertussis
C. Chlamydia
D. Neisseria
E. Pneumococcal

Tas October 2021
9- In study prophylactic intravenous indomethacin to

prevent mortality and morbidity in preterm 19 trails
done with 2872 neonates participating randomly
allocated in to control group( not receiving treatment)
and experimental group( received indomethacin)
Background: duct closure with side effect
Objective to detect effect of the drug on morbidity and
mortality
Result:
Treated pt to not treated pt RR :
1-symptomatic PDA RR 0.44 CI 95% ( 0.38-0.50)
2-PDA surgical ligation of pulmonary trunk RR 0.51 CI 95%
(0.37-0.71)
3-sevser intraventricular haemorrhage RR 0.66 CI 95% (

0.53-0.82)
4- mortality rate RR 0.96 CI 95% (0.81-1.12)
What is the conclusion of the study?
A. Mortality rate significantly decreased

B. Neonate should be treated with indomethacin
C. Sever intraventricular heamorrger significantly decrease
with treatment
D. Three Way trail with placebo indomethacin and ibuprofen
needed

Tas October 2021
E. Surgical ligation more in pt exposed to indomethacin
10 -Cardiac catheterization:
1 year old
Saturation:
RA 74 RV 74 PA 74
RV 93 LV 84 Aorta 84
Pressure:
RA. 7 RV 88/20 PA 18/3
LA 6 Lv normal Aorta normal
A. TOF
B. VSD with eismminger
C. C-ASD with septum scandium
11-How many half - life cycles needed to eliminate 97 % of

drug from circulation?
A. 3
B. 4
C. 5
D. 6

Tas October 2021
E. 9
12- neonate on a ventilator with ABGs results what is shows?
PH 7.23
Hco3 13 (n 14-28)
O2 normal
A- Metabolic acidosis
B- metabolic acidosis with respiratory alkalosis
C- respiratory acidosis
D- Metabolic alkalosis
13- 3 months old presented with 3 months old presented

with poor feeding, was only breastfed initially, since one
month shifted to formula milk, now having loose stools ,
develop normal, growth normal. mother notice him pale
CBC: Hb 10 (11-18)
MCV 85 (80-95)
MCH: 73 (70 -)

Tas October 2021
Plat 450 (150-450)
A- Cow milk protein allergy

B- Cong chloride diarrhea
C- Physiological anaemia
14- Total lung capacity IS :
A- RV + TLC
B- VC + RV
C- IRV+FRC
15- baby given Dopamine beside increasing blood pressure what else
Dopamine will do?
A- Peripheral vascular consitriction

B- Bronchospasm
C- . Descreas urine output

Tas October 2021
16- Methicillin-resistant staphylococcus aureus is a problem

increasing worldwide. How dose staphylococcus become
methicillin resistant?
A- BACREIA BIND TO Specific protein allowing influx in to cell

membrane
B- beta lactamase
17-methotrexate used in oncology pt., with known major side

effect, what supplement to give to reduce the risk?
A- folic acid
B- Ascorbic acid
C- pyridoxine
D- Erythropoeitin
18- pt with ALL on methotrexate what mech of action ?
A- Tetrahydrofolate dehydrogenase
19- 15 yrs. old child with cystic fibrosis controlled on his

medication, afebrile ,chest: clear normal air entry
Spirometry done showing the following
FEV1:1.36 PREDICTED:2.02 Z SCORE:-3.2

Tas October 2021
FVC:1.96 PREDICTED?2.3 Z SCORE:-1.62
B- predominantly obstructive with no significant restriction

C- predominantly restrictive with no significant obstruction
D- combined restriction with mild obstruction
E- restrictive
20--what is the type of insulin in continuous subcutaneous

insulin infusion pump
A- insulin aspart
B- insulin glargine
C- insulin isophane
D- Insulin determir
E- sulin degludec
21-6-child with road traffic accident(RTA) RESPIRATION OK

,CVS HR 120 SPO2 98, RESPONSIVE TO PAIN GCS:13
left pupil: 2mm reactive Rt pupil: 5mm non-reactive
What the underlying cause of this finding?
A- uncal herniation compressing rt 3rd cranial nerve

B- compression on oculomotor nucleus
C- optic chiasmal compression

Tas October 2021
D- tentorial herniation compressing the medulla oblongata
22- in adolescent smoking greater or more adverse effect in

electronic cigarettes more than conventional smoking:
A- 2nd hand vapour exposure

B- increase carcinogenic risk
C- increased CVS risk
D- more nicotine dependence
E- lung irritation by exposure to inhalational benzaldehyde
23--what commonest among children associated with HLA

B27
A- oligoarticular Jia
B- polyarticular Jia
C- systemic onset Jia
D- enthesis related arthritis
E- psoriatic arthritis
24-IN UK law there is a list of protected characteristics in

discrimination law which of the following is a protected cc?

Tas October 2021
A- gender reassignment
B- political beliefs
C- social class
D- age under 16 yrs.
E- refugee status
25- PROM what is the function of antenatal steroid
Dexamethasone in RDS
A- maturation of pneumocyte type 2

B- release of prestored surfactants from pneumocytes type 2
C- Increase in no. of pneumocyte type 2
D- Increase surface tension
26--which of the following drugs increase pulse pressure (

increase gap bet systolic and diastolic pressure)
A- Isoprenaline
27--which of the following bacteria attacked by T cell

mediated immunity

Tas October 2021
A- klebsiella
B- strept pneumonia
C- psuedomonas
D- mycobacteria
E- neisseiria
28-neoborn is diagnosed with leigh disease he is suffering

from developmental delay, seizure, dysmorphic features,
his mother has mild cognitive delay, father normal, genetic
testing is done for mother show mitochondrial DNA
mutation, what is the risk of having another affected child?
A- 50% of all males will be affected

B- 100% of all males
C-
D- 4-75% female
29-which of the following is an example aneuploidy?
A- 46xx
B- 96xy
C- 70xxxy
D- 47xyy

Tas October 2021
30-15yrs old girl, taking OCP, cigarettes smoking presented

by headache
MRI brain: normal LP: high pressure 30!
Fundoscopy: bilateral papilledema, diagnosed as IIH, And

on acetazolamide
What is the most common cause of IIH?
A- obesity
B- OCP
C- smoking
31- child obese started on metformin what is the

mechanism of action:
A. Inhibit hepatic glycogenolysis pathway

B. Bind to k ch and increase insulin secretion from beta cell of
pancreas
C. Increase binding of insulin to its receptor in adipose tissue
D. binding to PAP ( plaplaplpapla ???? it may be receptor or
channel ) leading to glucose entering to skeletal muscle
E. Another option about increase insulin secretion from
pancreas

Tas October 2021
32- what can cause unconjugated hyperbilirubinemia in

neonate from the following
A- Increase activity of G6PD enzyme

B- Reduce activity of galactose 1 UDP
C- Reduce enterohepatic recirculation
D- Reduce UDP glucorenyltransferase
E- Decrease B glucoranidase activity
33- ADHD child started on methyphenedate what the

mechanism of action is
A- Increase dopamine activity

B- Increase Ach
C- Decrease noradrenaline activity
D- There was no option for both dopamine and noradrenaline
34- neonate his mother with HIV on antiretroviral what is

the side effect of protease inhibitor
A- Renal impairment
B- Increase liver transaminase level

Tas October 2021
C- Fever
D- Lactic acidosis
35- child known case of coeliac disease mainly affecting

duodenum he was pale. Which elements is more affected:
A- Folic acid
B- Iron
C- Vit b12
D- Zinc
36- child with epilepsy on lamotrigine what is the side effect:
A- Steven Johnson syndrome

B- Headache
C- Hirsutism
D- Weight loss
E- Electrolytes disturbance
37- neonate antenatal US with hydronephrosis after delivery

came with left lumber mass US showed pelvic 2cm and
calyceal dilation

Tas October 2021
Proximal ureter 8mm in diameter, bladder wall no thickness
A- Post urethral valve obstruction

B- Backward flow from the bladder
C- stenosis in the proximal ureter at PUJ
38- neonate with dysmorphic feature microcephaly seizer we

were to specify disease based on this clinical manifestation
so arrangement for microarray CGH was done. Which of the
following advantage of the microarray over the karyotyping:
A- can detect single gene A.A substitution

B- can detect unbalanced translocation and inversion more
than karyotyping
C- can detect mosaicism more than karyotyping
D- allow more detection of chromosomal abnormality
E- result with 7 days
39- girl presented with diarrhoea followed by puffiness and

oedema, lethargic, petechial rash over her body:
Investigation showed HB low urea and creatinine high

plat low diagnosed with HUS.

Tas October 2021
Which of the following describe pathophysiology?
A- Mechanical distraction of the RBC due to passage in altered

renal vasculature
B- Complement mediated intravascular haemolysis
C- Toxin destruct RBC??????? To be reviewed
40- hypernatremia occur in extreme premature what is the

cause of hypernatremia
A- Trans epidermal water loss

B- Lack of Sweat gland
C- Less response of the tubular cells to aldosterone
41- girl 14 year high 0.4 and weight 2nd centile, both mother
father average high, mild dyslexia, she was short,
prepubertal, and bullied at school she is embarrassed to
participate in physical education. What is finding in the
investigations
A- 45xo karyotyping
B- Elevated Antitissue transglutaminase
C- GH low

Tas October 2021
D- Hypothyroidism low T4
E- Familial
42- girl 15 year with eating disorder (anorexia nervosa) BMI

13 admitted stared with feeding with NGT investigation
showed:
Low K 3 (normal 3.5) Low ph. 0.9 LOW NA 129

(135-145) what is the cause of this electrolytes finding:
A- extra cellular shifting electrolytes due to high insulin and

metabolism of protein and A.A
B- Intra cellular shifting of electrolytes by stimulation of by
NA-K ATPase
C- GIT loss of electrolytes
D- Renal loss of electrolytes
E- Extra cellular shifting of electrolytes due to increase
insulin and glycogenesis and lipogenesis
43- 14 year come from party drinking alcohol and stay outside,
mother is asking what is responsible for risk taking behaviour in
adolescent
A- Maturation of prefrontal cortex

B- Frontal lobe maturation

Tas October 2021
C- Temporoparietal lobe
D- Brain stem
44- 7-year-old child have generalized tonic colonic on waking up in

the morning this happened for 2 months. Sleep EEG at night show
which of the following:
A- 3 spikes and waves

B- Unilateral centrotemporal spikes
C- Hypsarrhythmia
D- Symmetrical poly spikes
45- 12 year old after RTA with head contusion child on mechanical
ventilator after discussion between the medical team and the family
about irreversibility of full returen of neuronal function what is in the
following included in the NDDC ( neurological determination of death
criteria)
A- absent cranial motor Reflexes

B- Chyne stock breathing
C-
D- Asymmetrical pupillary reflex
E- Persistent hypothermia less than 35c
46- complete trochlear nerve injery:

Tas October 2021
A- Superolateral
B- Inferolateral
C- Horizontal diplopia
D- Mydriasis
47- neonate 3 weeks antenatal US polyhydramnios with diarrhoea

since birth birth wt 3.5Kg
Know losing weight investigation showed:
CL 89(low) NA 122 (low) k low HCO3 28(high) PH

7.48(high) urea (high)
What is the most likely diagnosis?
A- Barter syndrome
B- Congenital Chloride losing diarrhoea
C- Microvillous inclusion disease
48- what is the cause of normal anion gap metabolic acidosis
A- DKA
B- Salicylate poisoning
C- GE
D- Propionic academia
E- Pyloric stenosis

Tas October 2021
49- 4 months old baby with loss of consciousness which of the

most statistically significant associated with NAI:
A- Retinal haemorrhage
B- Lateral parietal skull fracture
50- baby with filaggrin gene defect in chromosome 1 which of the

following associated with gene defect
A- Pemphigus
B- Atopic eczema
C- Acne vulgarises
D- Psoriasis
51- steroid potency increasing pattern
A. Hydrocortisone. 5%, clobetasole. 05%,clobetasone . 05%

B. Clobetasol. 05%/clobetasone. 05 %/ hydrocortisone 1%
C. Clobetasone. 05%/ betamethasone. 025 / clobetasole. 05%
D. D.hydrocrtisone. 5%, clobeasone. 05%/clobetasole. 05%

Tas October 2021
52- 11 year old boy presented after recent coryzal symptoms

presented with face swelling , haematuria, proteinuria, high blood
pr, what is the most likely organism cause this finding:
A. Streptococcus pneumonia
B. Group A streptococcus
C.
D. Mycobacterium
E. Salmonella
53- mechanism of action of proton pump inhibitor:
A. Inhibit secretion of gastrin in G cell

B. Bind and Inhibition of H-K ATPase enzyme
C. BLOCK NA-K channel in the parietal cells
54- Toxic shock syndrome what is the mechanism of action of toxin :
A. activation of B cells
B. activation of T cells
C. activation of Macrophages
55- 5 years old boy with no hair but enlarged testis and penis and
bone age of 9 1/2 years this is due to which?
A. testosterone

Tas October 2021
B. gonadotropin
C. DHEA
D. Premature adrenarche
E. 21-hydroxylase
56- In review of medical guidelines and how they written study

strength in from high to low order:
A. Systemic review, case control, cohort,

B. Randomized trial, meta-analysis, case series
C. Systemic review, RCT, cohort, case control
D. Meta-analysis, case series, RCT
57- child known case of CP with drooling saliva , treated with

hyoscine patch what is the mechanism of action of hyoscine in
decreasing saliva production:
A. Non- selective muscarinic receptor antagonism

B. Muscarinic receptor antagonist at M1
C. Block release of Ach at NMJ
58- infant with sequent, given cyclopentolate eye drops for fundus
exam. What is the mechanism of action?

Tas October 2021
A. Act on muscarinic receptor as antagonist on optic nerve

B. Ciliary muscle muscarinic receptor antagonist
C. Adrenoreceptor antagonism
59- teenager boy with urethral purulent discharge, sexually active,

has new girlfriend, which of the following investigation can lead to
the diagnosis:
A. NAAT(nucleic acid amplification tests) from urine catch

sample
B. Mid urine sample
C. Urethral swap for gram satin
60- pt. on chemotherapy developed tumour lysis syndrome started

on allopurinol what is mechanism of action:
A. Prevent purine conversion into uric acid

B. Conversion of uric acid into soluble allantoin
61- boy is taking desmopressin for nocturnal enuresis presented with

seizure and his mother reported being lethargic, having vomiting,
abdominal pain has Hx of collapse
Investigation: NA :120 low K : 5.6 high
Glucose : low 2.3 Cortisol : 20 nmol ( 100 - 300) low

Tas October 2021
Urine osmolality 225 Plasma 265
A. Failure of adrenal gland to secret mineralocorticoids and

glucocorticoids
B. Increase ADH
C. Increase desmopressin
62. What is the mechanism of action of azithromycin:
A. Inhibit protein synthesis at ribosome 50

B. Inhibit protein synthesis at ribosome 30
C. Inhibit cell wall synthesis
D. Inhibit DNA
63.child with anaphylaxis, hypotensive given Adrenaline to elevate

blood pressure what is the mechanism of action of Adrenaline?
A. Promote mast cells to degranulate

B. Act on alpha receptor to increase prephral vascular
resistance
C. act on B1 receptor to cause bronchospasm
D.

Tas October 2021
64. FISH fluercent in situ hybridization is used in which of the

following conditions?
A. William syndrome
C. Down syndrome mosaic type
D. SMA
65.preterm baby was on TPN and extravasation discovered after 48

hr how will you proceed?
B. Inform parents after all investigations are done and

completed
C. Explain promptly and fully clearly what happened
D. Tell parents after legal authority
E. Do everything by yourself without
F. Complete incident report then inform family
66. Patient need urgent blood transfusion, his parents tell you his
blood group is A +ve, what blood group you will transfuse to him?
A. blood group O Rhesus positive

B. B. Blood group O Rhesus negative
C. Blood group A Rhesus positive
D. Blood group AB Rhesus positive

Tas October 2021
67. What is the correct sequence of the following describing

mechanism of cough?
A. Deep inhalation, close larynx, contraction of chest wall

muscle, open larynx, forced expulsion
B. Deep inhalation, open glottis, contraction of muscles, close,
forced expulsion
C. Change in sequence in choices
68. Neonate with sever hyperammonemia which of the following

enzyme is inherited as x-linked ressisive condition?
A. Glutaric aciduria
B. B. Methylmalonic acedmia
C. Glycogen storage disease
D. Ornithine transcarboxylase
69. Where is the lesion in spinal muscular atrophy?
a. Degeneration of anterior horn cells
70. Neonate with biliary atresia, kasai operation done, now mother
says he has diarrhea, and he is not gaining weight and she said he is
on formula?

Tas October 2021
A. Soya milk
B. B. Extensive hydrolyzed formula
C. High carb high protein, enhanced medium chain
triglycerides
D. High carb, high protein, long chain polyunsaturated fatty
acid
Group OCT 2021 .....

1) Piperacillin/Tazobactam : Pseudomonous
2) Azithromycin : Mycoplasma
3) Amphotricin : Aspergillosis
(c-Amp activate the chloride channel , Bacterial toxin

interfere with , faiure of Cl & Hco3 exchanger ,transient
deficiency in lactase Enzyme , panceriatic insuffecency
causes steatorrhea, )
1) Mechanism of diarrhea in Cholera . cAmp activated ca
channel
2) Mechanism of persistant diarrhea for 2 weeks after Viral
Gastroentrites . Transient deficiency in lactase Enzyme ?!
3) Mechanism of diarrhea in Single gene defect only
affects the bowel . Failure of Cl&Hco3 Exchange ?!

( Bartter S , CAH , RTA , Pyloric stenosis )
1) 1 months Baby with 10 days history of vomiting &
lethargy with (low Na , low K , low CL & high hco3) urine
Na less than 20 ,urine ph=5 . Pyloric Stenosis
2) 1 months Baby with 10 days history of vomiting
&lethargy with( low Na , Low K , high Cl ) urine ph =5 .RTA
3) 1 months Baby with 10 days history of vomiting
&lethargy with (low Na , high K ) with metabolic acidosis
urine ph =5 . CAH
( lymphgranuloma venerum , trapenoma pallidum , HSV1,

HSV2 , HPV , HIV )
1) 14 years old boy with itching, bleeding from down , non
tender peranal lump. HPV
2) 14 years old boy with erythematous skin Rash & Sore
throat ,with 1 months ago painless lump at glans penis .
Syphilis
3) 14 year old boy with painful vesicles on glans penis
HSV2

(Pounding pulse ,Fixed spiliting S2, High blood pressure )
1) Loud Continuous Murmur at LUSE & Biventricular
enlargement. Pounding pulse
2) Systolic Murmur LUSE & ECG shows RBBB. Fixed
splitting S2
3) Systolic Murmur radiating to the Back , with left
ventricular hypertrophy . High blood pressure
(Furosamide , PGs ,Iburofen, Morphien , Omeprazol )

1) Respiratory depression & Hyperthermia .PGs
2) Metabolic Alkalosis , Hyponatremia &
Nephrocalcinosis.Furoamide
3) Deftct Platlet aggregation & Renal imparment.Iburofen
( ITP , VWD , DIC ,ALL , Hemophilia , HDN ,NAI , HSP )

1) Baby under child protection programe with extensive
bruises on his shin & forehead ,with history of chicken pox
Platlets count 18 , otherwise he is well .ITP
2) Baby with Prolonged both (PT , PTT) high INR , low
Fibrinogen , High D-dimer . DIC
3) Baby deliverd at home , at day 9 came e bleeding after
circumsission , PT prolonged , PTT normal . HDN

(False -ve , False +ve , Sensitivity , Specifity , +ve predictive
value , -ve predictive value )
1) A/A+C . Sensetivity
2) A/A+B . +ve Predictive value
3) C . False +ve
( GBS , Staph Epidermidis , Lesteria , E coli , Strept

pneumonie)
1) Term Baby 7 hours age with RDS after 24 hours PROM.
GBS
2) Preterm Baby with long line . Staph Epedermidis
3) Term Baby, Meconium stained with G +ve Bacillus
.Listeria
Child diagnosed with type 1 DM :-

(Fatty acid distruction ( Lipolysis) , decrease glucose
absorbtion from gut , increase cellular uptake of glucose ,
hepatic glycogeness , defect glycogenolysis , increase
Glycogenylsis, increase utilizing of HCo3)
1) Effect of insulin. Increase cellular uptake of glucose
2) Cause of Decrease of Hco3 in DKA.Increase Utlizing of
Hco3
3) Cause of Ketosis in DKA. FA Disraction (Lipolysis)

Baby on vancomycin 7 &Gentamycin level
Predose 1.5 (Normal < 2) , post dose high ?(100%)
1) Same interval with Decrease dose
2) Increase interval with increase dose
3) Same dose & Interval
4) Decrease dose & increase interval
5) Decrease interval & decrease dose
Girl with hypertension , hyperthermia & dilated

pupils , What is the causative drug ?(100%)
1) Amphetamine
2) TCA
Site of action of ADH (vassopresin)

1) DCT
2) PCT
3) Loop of henel
How to DD betw DM1& DM2,according to type2 :-

1) C-peptide
2) Glucose tolerance test

Mechanism of closure of Foramen Ovale :-
1) Pulmonary vasodilatation
2) Increase of systemic resistance
3) Increase Right atrial pressure
Most common type of Angelman Syndrome :-

1) Maternal deletion of ch 15q11-13
2) Maternal Disomy of ch 11-15
3) Paternal Disomy of ch 11-15
4) Paternal deletion of ch 15q11-13
After exercise child presented with long QT , what

is the Drug to be avoided? (100%)
1) Clarithromycin
2) Cimotedine
Caucasian mother with balanced food ,Baby

exclusive Breastfeeding till 1 year old what vit to be
defficent
1) Vit D
2) Vit E
3) Vit K

Father 59 yrs old , Mother 23 yrs old , they have A
Down S baby , what is the common cause ? (100%)
1) Maternal non disjunction
2) Paternal non disjunction
3) Unbalanced translocation
Down syndrome come with sudden onset of

Quadriplegia, what is the cause?
1) AtlantoAxial sublaxation
2)hydrocephalus
A 9 year old Boy on the 9th centile for the last 3

years what is the expected for his height centile to
be on his chart (100%)
1) 2-9th centile
2) Along 9thcentile
3) 9-25th centile
4) 25-50 centile
Suggest Acute renal failure rather than Pre-renal
1) High urine Na
2) Low urine K
3) Low Urine Ca

The best to be used with Paramedric study(100%)
1) Apgar score
2) APVU
3) Height
4) Blood group
The best of them with high Confidence interval :-

1) Birth wt less than 1000kg
2) Wt centile on 10th
3) Tempreture
The deepest layer to be affected in a full

thickness Burn is :- Recheck !
1) Dermis 100% tas case ?!
2) Adipose tissue 100% ?!
3) Granulosa layer
4) Spinosum layer
15ys Boy with Epidedimorchitis the best test for

diagnosis by (100%%)
1) NAAT (Nucleic Acid Amplification Test )
2) Urine dipstick Test
3) Urine culture

Baby with history of cough with drooling & high
fever , culture with gram ve cocobacilli (100%)
1) HIB
2) Chlamydia
3) Klebseila
4)Pseudomonus
Mechanism of Action of Theophyline

1) Phosphodisterae inhibitor
2) 5-HT3
3)Alfa receptor blocker
Cause of Enterococcus bacterial resistance t to

Chephalosporin (100%)
1) Production of Beta-lactamase
2) Inhibition of efflux through cell wall synthesis
3) Inhibit DNA gyrase
What is the cause of hydrops fetalis in new born?

1) Parvovirus B19
2) Rubella
3) CMV

Family history of SIDS , which one will be the
most to do screening for Early in Childhood , with a
clinical importance , from these Autosomal
Dominant diseases? Not sure (Recheck)!
1) Long QT type 1 ?! 100%
2) HOCM
3) Purghada syndrome ?!
4) Arrhythsmogenic cardiomyoathy
Cause of Hypernatremia in Preterms ?(100%)

1) Transepidermal water loss
2) Sweat glands dosent appear before 28 wk
CSF done for 3 times with RBCs number (9 &10 &11

*1000) ,WBCs (6000) , Normal glucose, Most coomon
cause ?
1) Subarachinoid hge
2) Herpes Simplex virus
Senario of 9 days baby with suspected IMD &

Respiratory Alkalosis. (100%)
1) Urea cycle defect
2) MCAD
3) Organic academia

Baby delevierd by ventose after prolonged labour with
swelling in head & cross suture line what is the most
common layer to casue this presentation & Hb low , with
(picture):- Answer was( Subglial Hematoma )
1) Layer A
2) Layer B
3) Layer C
4) Layer B&C
What is the Cause of Diaphragmatic hernia ?(100%)

1) PleuroPericardial canal defect
2) PleuroPretonial foramen defect
3) Septum Transversum defect

Pulmonary function diaphragm Z represented what,
with (Spirometry):- about (RV)
1) Residual volume
2) Tidal volume
what is the Cause of TGA in embryo

1) Migration of endocardial Cushion
2)Neural tube defect
According to the UK law what is the Discrimination

between protected to be considered (100%)both
1) Sexual orentation
2) Refugee
3) Social status
4) Under 16 years
5) Political believes

Echo finding in Presistant Pulmonary hypertension
1) Tricuspid Regure
2) Pulmonary Stenosis
3) Aortic Regurge
A case diagnosed as a TAPVD & X-ray was done what

the cause of this finding. (100% cardio)
1) Obstruction of pulmonary veins
2) PHTN
3) Pleural effusion
4) Poor venous drainage
A girl with erythematous itchy skin in the site of her

Nickel ear piercing , what is the type of hypersensitivity
here :-(100% Derma , Immun)
1) Type 1
2) Type 2
3) Type 3
4) Type 4
5) Type 5

A prterm with intarventrecular and periventricular
hge what is the cause? (100 Neuro & Neonate)Recheck!
1) Hypoxia ?!
2) Flactuation of blood preesure
3) Flactuation of cerebral blood flow ?!
4) Immature platlets dysfuction
5) Dearranged coagulation
Baby deleivered by ventose , well with prolonged (

PTT & APTT ) what is the cause (100 Neonate& Hemate)
1) VWD defeciency
2) Heparinzed sample
3) Vit K
4) Factor 8
5) Factor 9
Baby diagnosed with Hepatoblastoma , Marker to

indicated (100%)
1) Alfa fetoprotein
2) CA 125
3) Beta HCG
4) Carcino Embryonic Antigen (CEA)

What is the following is true regarding the immunity
1) T cell kills interacellular Falcultative organism
2) B cell continuously produced from Lymph nodes
3) NK cells is a part of adaptive immunity
Machrophages is derived from (100%)

1) Monocytes
2) plasma Cells
3) T Cells
Manifestation of Eating Disorder , what is the most

important complication to be aware , at admission ? (100%
Pychaitry & Nutrition)
1) High Liver enzymes
2) Hypophosphatemia
3) Hypokalemia
4) Hypercalcemia
5) Hyponatremia
The primary Excitatory Neurotransmiter :-

1) Glutamate
2) Acytelcholine
3) GABA
4) Glycine

Mechanism of action of Botox is :- (Recheck)!
1) Increase Ach release at NMJ
2) Block release of Ach Receptor at NMJ?!
3) Decrease release of Ach at prepheral Nerve Ending?!
What is the action of Carbamazepines ?

1) Na Chanel Blocker
2) Ca chanel Blocker
3) Cl chanel Blocker
What is the Mechanism of action of Infliximab ?

1) TNF-Alfa
2) IL_1
3) IL_2
A baby girl with Axial Ascending paralysis with absent

reflex diagnosed as GBS what is the Pathophysiology ?
(100% Neuro)
1) Antiganglioside defect
Mechanism of action of Methylephenedate in ADHD :

1) Non-selective reuptake of NorEpeniphrine & Dopamine
2) Selestive reuptake of Nor Epeniphrine

PVC (Pnemoccocal cojucated vaccine) Privinar made
by ?
1) Multiculture in nonhuman source
2) Killed by formalin
3) Protein added to polysaccharide group
Asthamtic girl on Salbutamol & Ipratrpium promide

presented with dilated pupil how to diagnose (100%)
1) 0.1 Pilocarpine Eye drop (TAS case)
2) Fundoscopy
Term baby with spontinous onset of labour after

transetion to extrautrine life what indicate Nromal cardiac
vascular anatomy (100% cardio& Neonate)
1) Catecholamine help in fluid clearance from lung
2) Removal of placenta result in increase in left atrium
pressure ?!
3) Placenta give oxygenated blood via Umbilical Artery
4) Very low Fetal pulmonary Vascular Resisrtance
Omeprazole Mechanism of action ?

1) H/K Adenosine Triphosphate acts in parietal cell
2) Na/K Adinosine Triphosphate acts in gastric cell
3) CL/H Adenosine

Girl driving Bike with her older brother ,broughted
with her Father , what is the sure sign of sexual Abuse
1) Posterior Forchette
2) Tear of Hymen
3) Labia majora injury
A School student research for a new spacer device in

Ashtmatic pupils what is ethically here
1) the right of Child objection withdrawal with acceptance
of patient
2) company should give medication as free for 1 year
HBF Compared to HBA which of the following is true

1) High Affenity to O2 , low 2,3 DPG , Shifted to left
2) Low Affenity to O2 , low 2,3 DPG , shifted to left
3) Low Affenity to O2 , High 2,3 DPG , shifted to right
4) High Affenity to O2 , High 2,3 DPG , Shifted to right
A mother with HBs AG +ve & Anti e +ve what to do

(Not sure) Recheck!
1) Give the mother IGs with Vaccine
2) Give Accelerate HB vaccine ?!
3) Give HB vaccine as scheduled ?!
4) shift to CS for her baby

Asthmatic Patient on salbutamol 6 puffs daily ,came
with high HR 190 , RR high , Oxygen saturation 95 , then
after oxygenation RR 22 , Normal HR ,, Oxgygen saturation
droped to 88 what is the cause (100% Resp&ER) Recheck!
1) Salbutamol worsen V/Q mismatch ?!
2) Exhausted asthma & in Respiratory failure ?!
3) Improper Salbutamol Dose
Patient with chronic renal failure on Haemodialysis

what is the cause of Pathological fracture ?
1) high PTH , low 1,25 vit D
2) low PTH , High 25 Vit D
3) Failure of Phosphate excresion
Mechanism of Urea Haemofiltiration :

1) Osmotic gradient across membrane
Right ans
2) Ultration of pressure gradient a cross membrane
3) Adsorption throw haemofilter membrane
4) Concentration gradiant a cross membrane

What is true about Vestibuloccular reflex (100%
Neuro& Opthalma &ENT) Recheck!
1) Intact visual Pathway
2) Intact tympanic membrane?!
3) Pupils will be fixed dilated in +ve test
4) Caloric stimulation
5) If head rotated Right , Both eyes will goes to the left?!
Pathophysiology Hirchsprung Disease

1) Congential Autonomic neuropathy
2) Apaptosis of the ganglion cells
3) Failure of migration of neural crest cell ?!
According to light reflex done on rt eye with rt

contracted & lt not changed , turned to the lt side lt not
changed & rt contacted what is the cause
1) Lt occulomotor nerve injury
2) cilliary ganglion
3) RT occulomotor nerve injury

Vesicles on Rt ear with pain rash ,vesicles on the
anterior 2/3 of the tongue affected
1) UMNL facial nerve
2) LMNL facial Nerve
3) Trigiminal Nerve injury
Case Control study on preschool children with OM &

their Mothers are Smookers , Frequency of OM is
increased with smoker mother more than preschool
children with non smookers mothers what is your
coclusion (100% stats)
1) Smooking is the cause of OM
2) Mother should stop SMooking
3) There is an association btw smooking & OM
Child on Anti TB medication, Mixing his colors during

drawing & Pumping objects what is the cause
1) Isoniaziod
2) Ethambutol
3) Rifampicin
4) Streptomycin
5) Praziquantal

Baby with hypotonia , diagnosed as SMA what is the
pathological defect
1) AHC
2) PHC
3) Spinothalamic tract
Girl with Polyurea & drinking 5 litre of water per day

what is the test to DD
1) Water dipreviation tset
2) short synactin test
Term baby girl with hypoglycemia given Insulin & on

Glucose Infusion rate GIR (8) but still hypoglycemic what is
the cause
1) Increase production of Insulin
2) Defect in Glycogenesis
Baby born 37 wk , wt 2.3 kg , at day 9 presented still

Jaundiced , wt 1.95 & blood glucose ( 2.1 ) , liver 1 cm
below costal margin , Investigations was done with
creatinine 100 (high)
Urea high
blood glucose 1.9
cortisol Normal

serum NA 123 low
serum K 5.7 high
urine NA 75
Insulin undetectable (lower limit to be detected was 3)
what is the diagnosis ? (100 % Metabolism) Recheck
1) MCAD
2) Galactosemia ?!
3) Glycogen storage disease-1
4) CAH ?!
5) Small for Gastetional Age
Mother,her 10 days old Baby can't move his arm, X-

Ray done ,what confirmed that it happened during birth?
1) Callous formation
2) Hip Fracture
Which one is Duct Dependant Systemic flows lesion

1) Critical Aortic Stenosis
2) Tricuspid Atresia
3) Pulmonary Stenosis
A case with Hypoparathyroidism , low Ca , low PTH ,

what is the Mechanism
1) Defect in Osteolytic osteolysis
2) Increase Ca Absorption by Gut

Prechool child , what is the Cause of Senseroneural
Hearing loss during infancy (100%)
1)CMV
2)Rubella
3)Toxoplamosis
Last Q , we can't Remember it (sorry) !

TAS February 2021
EMQS:
1. (A) Coronary sinus drain in:
(B) Y wave in JVP represent opening of:
(C) Ductus venosus open in:
RT atrium A
Ductus venosus
Tricuspid regurge
tricuspid opening B
Left atrium
Svc
IVC C
2. ( folate , B12, water, CHO, Iron, Protein )
(A) The primary site of Absorption in colon: water

(B) The primary site of Absorption in all small intestine CHO
© The primary site of Absorption in distal Ileum B12
3. (A) what is the site of secretion of the following?
1. Melatonin
2. Glucagon

TAS February 2021
3. Calcitonin
Pinealocytes 1
Arcuate nucleus Hypothalamus
Alpha cells in Langerhans island 2
Beta cells in Langerhans island
Para follicular cells of thyroid (C cells) 3
4. Statistic questions on sensitivity, negative predictive value,

odds ratio, mean interval, false negative, relative risk
Specificity
Likelihood
RR
A. Probability of -ve people among non-diseased specificity
B. Probability of +ve results among people exposed to ttt liklihood
RR
divided by probability of +ve result among people not
exposed to ttt
C. Probability of outcome in those exposed to non-exposed RR
5. Vitamins:
Obese child on orlistat.... Vit D
Acrodermatitis.... Zinc
Vegan mother.... Vit b12
(Same Q from recalls)

TAS February 2021
6. EMQ
1. 16 yr. old girl come to your clinic crying, with multiple sexual
partners , un protected sex with vaginal discharge, foul smell,
oozing and easy bleeding from the vagina , ask about the
mechanism of action of ttt, smear result in gram negative diplo
cocci ;
Inhibit cell wall synthesis 100 pharma Ciphalosporin
Bind to ribosome 50
Bind to ribosome 30
Inhibit DNA synthesis
7. Mode of action of the following drugs which used in ttt of JIA
(A) Drug working as INL 1 inhibitor- anakinra
(B) Calcineurin inhibitor - cyclosporine,
(c) TNF inhibitor- infliximab
8. (GBS, Staph aureus, strept pneumonia, klibsiella, pertedella

pertussis, Corynebacterium, Moraxella)
1. Gram positive diplococci GBS vs strept

2. Gram negative bacilli klibsella
3. Gram negative coccobacilli portedella ,Hib, chlamydia
no one got 100 in infection

TAS February 2021
9. (same Q in recalls, same sample paper Q)
3 scenarios of platelet
Options :
(alloimmine, maternal, ITP, CMV, congenital leukaemia,
SLE)
A. FT 2.3 kg, with petechiae and hepatosplenomegaly 2cm, mother
PLT, normal 195 = CMV
B. mother PLT > 200 , FT baby wt. 3.2kg with pastiche , liver , spleen
just palpable= Alloimmine
C. PLT mother 23, mother well, FT baby wt. 3.2kg with pastiche liver
and spleen just palpable= Maternal ITP
10. EMQ
Vit D dependent ricktis
X linked hypophosphatemic ricktis
Vit D resistant ricktis
Primary hyperparathyroidism
Acute renal failure
Chronic renal failure
Vit D deficiency
(A). 18 years old girl, faltering growth:

Urea normal
Creatinine 40 (up to 39 normal),
4

TAS February 2021
Normal calcium
Normal phosphate,
Raised alk ph.
PTH :8 ( raised)
25 oh but D (very low )
1,25 :80 (normal range)
CA :Creatinine ratio low
vit D def
(B). 2nd scenario: 100 nephro,endocrine
urea normal
Creatinine 40 high (normal up to 39)
High Ca
low phosphate ,,
raised alk phosph,,
raised pth 15 (high)
calcium creatinin ratio : normal
1ry hyper parathyroidism
(C ). 3rd scenario: 100 nephro,endocrine
Normal Urea
Creatinine 40 (normal up to 39)
Normal calcium
decreased phosphate,
high ALP
PTH normal
Normal vitamin D
increased cal:creatinin ratio
X linked hypophosphtemic rickets

TAS February 2021
11. EMQ
Vancomycin inhibits glycopeptide in cell wall,

ciprofloxacin dna gyrase,
chloramphenicol 50s ribosome,
dobutamine b1 agonist,
theophylline phosphodiesterase inh
12. EMQ
mechanism of drugs used in medication of asthma:
( formetrol, salbutamol, montelukast, thiophyllin)
1. leukotriene receptor antagonist montelukast

2. prolonged action on B2 formetrol
3. Phosphodiesterase inhibitor thiophyllin

TAS February 2021
BOF QS:
1. What the metabolite increased in DKA:

increase cellular osmolality
increase intracellular shift of k
increase beta-hydroxybutyrate 100 diabetes +acetone and acetoacetate
bicarbonate retention
increase gluconeogenesis
2. GBS CSF analysis: 100 neuro

Normal lymph, high protein, normal glucose
High lymph, high pnt, normal glucose
High lymph, low pnt, high glucose
Normal lymph, normal pnt, low glucose
High lymph, high pnt, low glucose
3. Father has sickle cell ,mom and father from the same area
mother does not know if she has the disease ,now mother is
pregnant in a monozygotic twins females, the grandfather was
died by sickle cell crisis before , the chance to be a carrier for
each one:
25%
50% 100 genetic
7

TAS February 2021
O%
100%
33%
4. Positive bacilli causing meningitis in neonate:
Listeria monocytogenes 100 neonate

E.coli
GBS
Strep pneumonia
5. Diabetic patient and screened for celiac , what is the

associations:
HLA DQ2, DQ8 100 GIT
6. What the initial Diagnostic test in celiac:
IgA anti-tissue glut + total IgA 100 GIT

total IgA
IgA anti-tissue glut + total IgG
AEM (anti-endomyseal)

TAS February 2021
7. Baby with conjunctivitis treated with chloramphenicol, what
the mechanism of action:
Binding to ribosome 30 and inhibit pnt synthesis

Binding to ribosome 50 and inhibit pnt synthesis 100 pharma
Inhibit cell wall synthesis
8. Case of HDN which lab will be more dearrnged :
both PT, APTT 100 neonate, heamatology

PT
PTT
Bleeding time
9. What changes we can make in model of improvement:
Plan, do , study, act
10. Child with diarrhoea and vomiting for 3 days, low glucose
and drowsy and +++ketones in urine, what you will find in his
lab:
raised insulin raised ammonia

Low insulin and high cortisol 100 endocrine,diabetes
High insulin, low cortisol
Low insulin, low cortisol
11. Where is the defect in Morgagni hernia:
Failure of retrosternal pleuro-peritoneal canal wrong

TAS February 2021
Failure of migration septum transversum
Defect in retrosternal part of septum transversum
12. Most common type of tracheoesophageal fistula: 100 GIT
Proximal atresia, distal tracheal and oesophageal fistula

Proximal and distal oesophageal atresia
Proximal tracheal and distal oesophageal fistulas
H type ( not mentioned clearly but describe it )
13. Where is the primary site of IVH 1st occur in PT baby:
Floor of lateral ventricle

Foramen of monro
Body of Forth ventricle
Choriod plexus
Sub ependymal germinal matrix 100 neonate,neuro
14. Gallick competence of a girl15 yr old with ALL who refuses
chemo for 40% chance cure. She does not like to complete her ttt
Parents want her to proceed:
Go with parent wishes
Seek legal advice 100 ethics

Health committe
10

TAS February 2021
15. Patient with RTA,
signs which go with brain stem death? (same scenario in TAS
cases)
100 neuro,neonate
Absent brain stem reflexes
Persistence Hypothermia for less than 35 degree
Burse suppression pattern in EEG with prolonged period of
absent activity
Chyne-stoke breathing
Abnormal pupillary reflex
16. Radioisotope is favourable than skeletal survey in non-

accidental injury to check for which type of fracture:
diifferent doctors chose different answers ,
Epiphyseal fracture propaply all answers were right, 100%
Metaphyseal fracture safeguarding,MSK,safety
Spiral fracture of tibia

Post Rib fracture
Skull fracture
17. MOA of Methylphenidate:
Dopamine reuptake inhibitor
18. Female with painless palate ulcer, pleurisy not responding to

ttt, diffuse hair loss, Lymphopenia, low C3, C4, low HG and low
albumin, normal IgM and IgG, high liver enzymes ALT ,AST in the
lab, fatigue.... Diagnostic test
11

TAS February 2021
dsDNA 100 MSK
cANCA
PNCA
ANA
19. tha main Action of adrenaline in anaphylaxis?
Increased peripheral vascular resistance and reduce
angioedema 100 pharma, infection
Work on beta2 to increase heart contractility
Work on bata1 to cause bronchodilation
Mast cell stabiliser
20. Tidal volume in baby 3kg newborn?
12-16
10-14
28-33
18-24 100 respiratory
21. Corneal reflex:
Nerves.. V and VII
22. Which drug is potent vasoconstrictor?

Noradrenaline 100 pharma
Dobutamine
Dopamine
Milrinone
23. RT complete Oculomotor nerve palsy
RT ptosis 100 ophthalma,neuro
Up and out
Down and in
12

TAS February 2021
Miosis
24. There was a case about headache and convergent squint
with, failure to move the eye laterally with double vision.
cranial nerve 6 abducens
25. Anorexia patient, admitted to hospital, asking what factor

most contributes to future bone density, BMI <13
Oestrogen def. 100 nutrition please search the answer again

Calcium def.
Cortisol high
Low IGF
Low Growth hormone
26. In DKA, what leads to hypokalaemia?

Osmotic diuresis
metabolic acidosis
insulin therapy
27. How to prepare live attenuated vaccine:
Culture in Non-human host to produce low virulent strain

Inactivation of disease causing pathogen by formaldehyde
and heat exposure
Inactivation of toxin which produce symptoms by
formaldehyde
Mixing part of polysaccharide capsule with protien
Recombinant vaccine no one got 100 in infection, search the
answer again
13

TAS February 2021
28. How Strep Pneumonia strains become resistant to
Fluoroquinolones mechanism
Mutation of DNA Gyrase, decreasing antibiotics binding to

bacteria 100 pharma
Produce beta lactamase

Decrease efflux of antibiotic across cell wall
29. 1 month old baby herpetic encephalitis why there is

increased risk of severe infection in this age:
No trans placental Ab 100 infection

Macrophage low response to antigen
CD8 cells low response
Immunoglobulin reach nadir in 3m
Defect in neutrophilic chemotactic response
30. Plasmalyte composition (same as in oct 2020)
31. During sleep, in normal child, how body responding to

hypoxia:
Medulla rasp centre
Carotid body chemoreceptor 100 cardio,emergency,resp
Diaphragmatic Vagal nerve sensation
Chest wall receptors
Larynx receptors
14

TAS February 2021
32. PT 8 yrs old, with operated spinabifida and Arnoldchiari
malformation with hydrocephalus with Kyphoscoliosis, with low
oxygen 80% on room air, and 86% on 60% oxygen, FEV1 1.31
(90% of predicted), FVC 1.51(90% of predicted), PH and CO2
normal. They were asking about mechanism
VQ mismatch 100 respiratory
Decreased alveolar surface
Restrictive lung Disease
Moderate airway obstruction
Lung hypoventilation
33. Starting of ventricle relaxation in ECG-
T wave 100 cardiology
St segment
PR interval
P wave
J point
34. Burn superficial partial-thickness, what's the deepest layer

affected?
Papillary dermis 100 derma,emergency
Reticular dermis
Stratum basal layer
Stratum cornium
Stratum Granulosa
15

TAS February 2021
35. Term new-born losing 10% of his wt in 1st 10 days
mechanism?
Large body surface insensible water loss
Increase ANP due to increase blood flow from lung to lt
atrium 100 neonate
Pass meconium in term baby which decreased water content
In adequate fluid intake
36. Paracetamol mechanism of conjugation in children
Glucuronidation 100 pharma
Sulphation
Cytochrome 450
37. Commonest enzyme defect causing un-conjugated jaundice

in neonate:
U5DPG transferase
G6PD 100 neonate, heamatology
Pyruvate kinase
GGT
Beta glucorinidase
38. 3 yr boy, diabetic type 1, fits at home, parents gave IM

glucagon, and then fits stopped immediately. Mechanism of
action?
Stimulates hepatic glycogenolysis 100 diabetes
Have anti-epileptic effect
16

TAS February 2021
Lipolysis
Increase cortisol secretion
39. Baby 6 month, with Nephrocalcinosis, hyperchloremic normal

AG metabolic Acidosis, and Nephrocalcinosis, F/H of similar
condition, urine PH 7 .Asked about mechanism...
Decrease H+ secretion in distal renal tubules due to H/K

ATPase defect. 100 nephro,endocrine
Failure of h2co3 reabsorption in proximal CT

Failure to excrete ammonia .
40. Frusemide site of action.
Ascending loop of Henle 100 nephro
Descending loop of Henle

PCT
DCT
41. Patient has abdominal pain, petechial rash in LL and Buttocks,

diagnosed as HSP , ask about the pathophysiology :
IgA leucocytic vasculitis 100 heamaeology,nephro
Toxic vasculitis
Necrotic vasculitis
42. Lorazepam mechanism of action...
GABA agonist (chloride channel) 100 pharma,neuro
NA channel blocker
17

TAS February 2021
Glutamate antagonist
Calcium channel blocker
43. Turner, mechanism
Chromosomal non-disjunction 100 genetic

Microdeletion
Imprinting
Uni-maternal disomy
44. Congenital myotonic dystrophy ( clear Q)
Genetic anticipation
45. Baby with cleft palate and other physical signs

What other genetic association mostly present...
Xo
Methylation
22q11 microdeletion
46. H/O headache, Hormone deficient in central DI
vasopressin
47. CP child need Botox inj, Botox mechanism of action

Decrease A. Choline release in neuromuscular junction 100
pharma,neuro
Block ACH-choline receptor blocker
48. Anorexia nervosa, most imp. Factor for her future bone
disease "osteopenia", BMI < 13.
Increased cortisol
18

TAS February 2021
Decreased calcium
Decreased food intake
Hypothyroidism
Estrogen decrease
49. Girl 15 years e ALL has 40% chance of survival e

chemotheraby , but she donot want to complete chemotherapy ,
parents want her to complete ,what to do (fop)
Donot treat according to her wish
Treat as parents want
Seek legal advice
50. Child e K 7.1 ECG showed tall T wave, widened QRS complex,
what more may be seen in ECG...
Prolonged PR interval 100 cardio

Prolonged QTc
Third degree complete heart block
Raised ST segment
51. Girl 3 days, she came with vomiting,H/O SIDS, 1 of her siblings
screen
no one got 100 metabolic, please search it again
Carnitine and lactate*
Ammonia and lactate.
Ammonia, acyl carnitine
Urea, Lactate
52. Vancomycin mech. Of action...
Bacterial cell wall inhibition
19

TAS February 2021
53. Type of study, RCT trial (it was clear)
Study on Group of patients from 3 hospitals between (2008-

2009), with bronchiolitis, study the effect of giving hypertonic
saline on the rate of hospital admission, patients divided into two
groups, part of them had inhaled hypertonic saline with
salbutamol, and the other part had NS with salbutamol, both
groups were blind.
Conclusion: statistically no difference in rate of admission in both

groups, but clinically there was a difference, so they need to
repeat the study on a large group.
What is the best to describe the study?
RCT 100 statistics
Case control
Cohort study
Systemic review
55. When you give IV medication, which follow the 1st order
kinetic:
the drug cause toxic effect until all the metabolic

enzymes becomes saturated
increasing the dose of drug increases the volume of
distribution
the rate of drug elimination depend on plasma concentration
100 pharma
20

TAS February 2021
Doubling the dose given, halves the time needed to reach
the steady state concentration.
56. decrease the catabolism of proteins in, unwell child,
L carnitine
Insulin 100 diabetes,endocrine
Cortisol
glucagon
57. Pro-Coagulation factor synthesized by endothelial blood

vessel wall :
prothrombin
fibrinogen
VWF , 100 heamatology
Thrombin
58. 6 yr old girl with recurrent nausea vomiting followed by

drowsiness and confusion, precipitated by recurrent infection,
brother died in infancy due to IEM, negative consanguity, What
the enzyme defect in here:
Arginisuccinate synthase def

no one got 100 in metabolic
MCAD ??
Methyl malonic mutase

Glucose 6 phosphate
21

TAS February 2021
59. Repeated Q of statistics CF screening test Negative predictive
value 100% ( same Q in recalls)
60. A female teenager, previously well, started throwing fits,

vacant spells, abnormal posturing of one limb, jerking, behaviour
change, poor school performance, memory loss. Area of brain
involved
frontal 100 neuro, neurodisability, behavioural
Temporal.
Occipital
None of the above
61. in a trial to study oxygen saturation in a PT well baby, the

saturation of 43 preterm babies was recorded all after they
received a mechanical ventilation for less than 6 hours, and
supplemental O2 for less than 48 hours.
The median saturation was 95% (92-99)
The median time of saturation between (85-90) was 2%
The median time of saturation between (80-85) was 1%
What is the most appropriate statement?
1. This study is done to implement change of clinical practice.
2. The lower limit of normal saturation of these population is
92%
3. The percent of time at which saturation is less than 91% is
3%. 100 statistic
4. In BPD saturation should be lower than 90% ??
5. The most frequent saturations recorded is 95% ??
22

TAS February 2021
62. Girl with proptosis and lid lag symptoms.
They asked What Ab?
TSH Receptor Ab. 100 endocrine
Thyroid Peroxidase Ab
Thyroglobulin Ab
63. in pneumothorax :
Decrease Nitrogen concentration 100 emergency,respiratory
Improve ventilation
64. in the family of H/O child death due to abuse, the
most common family factor predispose to this:
Domestic violence 100 safeguarding, safety
Alcohol intake
Drug abuser Parents
Carers were in foster care
65. In Liver disease, what affects the ADEK vitamins absorption?
Bile acids 100 GIT,endocrine
Decrease chylomicrons
66. Which of the following has polysaccharide vaccine
HIB
Pneumococci 100 infection
Diphtheria
23

TAS February 2021
67. Skin prick test, what type of allergy
Type 1 hypersensitivity
68. Baby boy with antenatal US shows pelvicalceal system, and
normal bladder. Asking how to check if there is an obstruction:
MAG3 with frusemide 100 nephro
MAG3
DMSA
69. Ichthyosis vulgaris associated with:
Fillagrin gene mutation
70. Changes after birth
Decrease pulmonary blood flow
Increase pulmonary resistance
Increase peripheral vascular resistance 100 neonat
71. Calcium resin effect on K excretion

Exchange Catatonic.
72. The main action of Dobutamine:
B1 agonist 100 pharma
Alpha1 agonist
B2 agonist
D1,D2 receptors
24

TAS February 2021
73. Operated chylothorax, what type of diet should be given:
Diet with high MCT to pass directly the portal venous
circulation 100 nutrition,GIT
High protein and fat diet
Long chain fatty acid diet
Thank you to all the doctors who participated to collect

this recall
25

TAS October 2020
tas oct 2020
EMQ1 100%Q regarding Pulmonary Function test interpretation:

options (neuromuscular disease, cystic fibrosis, asthma,
pulmonary hypertension, interstitial lung disease, primary
ciliary dyskinesia, vascular ring, laygrngeomalacia)
1. 14 years girl with SOB
FEV1 decreased ( Z score - 3.5)
FVC decreased (Z score -0.2.5)
Tlco decreased
Answer: Neuromuscular disease
2. 13 years old girl with SOB ON exercise
FEV1 decreased (z score -3.0)

FVC Normal (Z score 0.4)
TLCO increased
Answer: ASTHMA
12 years old with SOB Saturation before exercise is normal and

during
1 exercise low
FEV1 (z score)
FVC (Z score)
Tlco Decreased
Answer: Intersitial lung disease

TAS October 2020
EMQ2 Palliative 100%

option: (oral morphine, fentanyl lozenges,
slow release morphine, paracetamol,
ibuprofen, ametrptalain, omeprazole
naloxone, gabapentin, hyosicin , buscopan)
Patients all intracranial tumour end stage, all is
controlled pain on Oral Morphine
1. Patient came take 6 Sachets of Movecol and
laxatives and she feeling discomfort with
constipation answer: buscopan
2. Patient on IV Morphine frequently and PRN
Slow release Morphine
3. Patient with Gastrostomy tube and pain has pain
during manipulation and she is for Discharge.
fentanyl lozeng.
EMQ3 Statistics Assessment for causation

1-Dosethe association fit with other Biological
Knowledge Scenario about Coherence
2

TAS October 2020
2-Is the same associations found in many studies
Scenario about Consistency
3-3-Large relative risk - Scenario about
Temporality
EMQ4 GIT Site of secretion 100%

1. Somatostatin delta cell in pancreas
2. leptin adipocyte
3. Ghrelin antral cell of stomach (DP)
EMQ 5 100%
Regarding Neonatal hypoglycemia:
options: (cong. hypopiturism hyperinsuline-
amia-mma-bw$)
1. 8 days old male Blood glucose 0.9 moml/l with
small penis 1.5 cm&underdeveloped scrotum mildly
jaundice - congenital hypopituritism
2. Baby from India had one sibling died before
came with PH acidotic, Hypoglycemia, with picture
of encephalopathy methylemalonic academia
3. Patient came with persistent Hypoglycemia +
3

TAS October 2020
macroglossia + umbilical hernia, High glucose
infusion rate 13 mg/kg/min, BWS
EMQ 6 Immunology:100%
options: (mast cell degranulation,
macrophages, neutrophil, phagocytes, b
cells , helper cells, cytotoxic cell, nkc, ige)
1. If this cell stimulated, it will be degranulated
..Mast cell degranulation
2. produce cytokines ,can lyse bacteria by its on enzymes -
Macrophages
3. Cell bind to MHC type 1 express by virally infected, Or
neoplastic cells cytotoxic T cell
EMQ7: Chemotherapy Side Effects: 100%

options: (doxorubicin- dexamethazone
- vincristine ifosfamide)
1. Osteosarcoma treated pt, breathless at night:

Doxorubicin (PND)
4

TAS October 2020
2. Glycosuria anti- cancer drug dexamethasone
3. What causes peripheral neuropathy vincristine
EMQ8 GIT 100%

options (amylase, alpha 1 antitrypsin, ggt,
immunoreactive trypsinogen. feacal elastase)
1. Secreted by acinar cells of exocrine pancreas for
screening Fecal Elastase
2. Deficiency Causes disease of lung and liver Alpha
1 antitrypsin
3. Released by obstructed outflow biliary tract GGT
EMQ9 CARDIO 100%

Which of the following ECG phase coincides with
the following scenario?
options: (t wave, p wave, pr interval, qt
interval, j wave, u wave)
1. Ventricular repolarization t wave
5

TAS October 2020
2. Atrial depolarization p wave
3. Av node conduction PR interval
EMQ10 PHARMA 100%

side effects of drugs:
carbamazepine, metoclopramide, vigabatrin
1. Drug cause acute Dystonia- metoclopramide
2. Drug cause Visual field defect, Vigabatrin
3. Drug cause SJS -- Carbamazepine

TAS October 2020
BOF
1. Epidermolysis bullosa simplex site of lesion
a. Intra epidermal With Scaring
b. Basement cell membrane
c. Dermoepidermal Junctional
d. intra epidermal without scar 100%
2. Organisms that make you suspect sexual abuse

given many scenarios included
a. HSV Type 2
b. mixed Coliform Organism
c. chlamydia in 8years old female 100%
d. Anal Warts in infant
3. Antibiotic that prolong QT interval option

included:
a. Clarithromycin 100%
b. Amoxicillin

TAS October 2020
4. During night shift what is the best strategy to
improve quality & effective work as doctor?
a. Take a nap less than 45 min 100%
b. To do exercise 10 min during work

c. NO rest
d. To work all Night shifts
e. Take a nap for 4 hours
5. Patient came with Syncope Cardiac Catheter

interpretation?
a.AS
b.PS
c. NO CoA in the Options
6. ABG Interpretation
PH 7.35
PCO2 2.4
HCO3 13

TAS October 2020
Answer Compensated Metabolic Acidosis
7. Neonatal screening program What enzyme use
for screen MCAD?
a. Acylcarntine
b. MACD enzyme
c. Lactate
d. MACD gene
8. What is the cause of Anemia of Prematurity?
a. Attenuated response to Erythropoietin 100%

b. Low absorption of ion from immature Gut
Rapid growth
9. Unimmunized child came with Fever, drooling,

cultures shows gram Negative Bacilli What is the
causative organism?
a. Haemophilus influenza B 100%
b. Staphylococcus Aureus
c. Streptococcus pneumonia
9

TAS October 2020
10. What is the HALA Association with Coeliac

disease?
a. HLADQ 2 & DQ8
b. HLA Dr4
c. HLA B27
11. known case of CF came with pneumonia, with

low urine output, Investigation shows
Hyponatremia
A. SIADH 100%
B. Loss of Na in Sweat
C. Cerebral salt wasting
12. Diabetic Patient came with picture of DKA WITH

Hyperkalemia, high urea, and Creatinine. What is
the cause of hyperkalemia?
a. failure of intracellular shift K 100%
b. failure of K excretion from the kidney

10

TAS October 2020
13. Patient undergoes cranial radiation and

developed 2ndry Hypothyroidism. What you will
find in Investigation?
a. Low TSH, low T4 100%
b. High TSH, Low T4

c. High TSH, High T4
d. Normal TSH, Low T4
14. What is the mechanism of Microarray?
a. whole Chromosome Micro deletion & duplication

detection, 100%
b. detect micro deletion and duplication in DNA
segment FISH
c. Gene micro deletion and duplication detection
15. Scenario about Myasthenia gravis baby with

bilateral ptosis response to pyridostigmine,
Mechanism of action of pyridostigmine acts on
which receptor?
11

TAS October 2020
a. Nicotinic 100% post synaptic
b. muscarinic
c. NAMDA
d. Dopamine receptor
e. Alpha Receptor
16. Baby with anterior Pituitary tumor What is the

visual filed defect?
a. Bitemporal hemianopia 100%
B.Hemonymous hemianopia
17. Which cranial Nerve is responsible for

oculocephalic Reflex? (Doll eye sign)
a. 3,6,8, CN 100%
b. 3,4,6 CN
c.1,2,4 CN
d.3,6 CN
18. Neonate with HIE one month old, Comatose GCS

3 which test will confirm Brain Death?
12

TAS October 2020
a. Failure of response of respiratory drive by when
PCO2 reach 8.5 kpa after separation from
Ventilator. 100%
b. No activity on EEG
c. Middle cerebral artery Doppler show no circulation
19. Difference between ARF and CRF?
a. HB
b. Corrected Ca,
c. Po4
d. PTH
e. Urea
20. Infant came with poor feeding with Vesicles on

foot hand & lip ulcers what is the causative
organism?
Coxsackie virus 100%

typa A
a.
b. varicella.
c. HSV6
d. Chicken POX
13

TAS October 2020
21. baby with history of NEC as Neonate with ileum

resection, watery Diarrhea, not improving on
treatment, Parents has concern about diarrhea.
How to explain?
a. Bile salt malabsorption 100%

b. B12 deficiency
c. Iron deficiency
d. Folic deficiency
22. PT baby 32 weeks , Weight 1.6 kg came to the

hospital at day 6 of life with poor feeding ,leathery
at day 9 vesicular rash appear in the trunk. Mother
had History of PROM before delivery What is the
causative organism?
a. Herpes Simplex 100%

b. GBS
c. Varicella
d. Staph Auras
14

TAS October 2020
23. Adolescent came with poor concentration, easy
fatigue. INVESTIGATION SHOWS: Hyponatremia,
Hyperkalemia, Hypoglycemia. What is the cause?
a. Addison diseas 100%
b. DKA
c. Panhypoputrisim
24. Neonate diagnosed antenatally with truncus

Arteriosus what else should be excluded after
birth?
a. Thyroid hypoplasia
b. Parathyroid hypoplasia
c. .VSD
d. Lung hypoplasia
25. NICU patients Cases with Increasing MRSA in

last year what is most appropriate Study to know
the cause? Option was
15

TAS October 2020
a. Case control
b. cohort study
c. Meta-analysis
d. RCT
e. Report audit
26. An infant 8 months presented with lethargy,

swelling wrist, growth parameters below 0.4 centile
with low Calcium, low Phosphate, Alkaline
phosphatase 1800U/L, Parents were Normal What
is the cause?
a. Fanconi $
b. Nutritional rickets
c. Hypophosphatemic rickets
27. Cancer patient treated with radiotherapy What is

the Effect of Ionized radiation therapy on Cells?
a. Single Stranded DNA break
b. Double Stranded DNA breakage
c. Programmed cell death
16

TAS October 2020
d. Chromosomal abrasions
e. Mitosis
28. What is the definition of genomic Imprinting?
a. One set of chromosome inherited from one parent only

b. Methylation to change expression of gene 100%
c. Environmental factors
d. Epigenetic from one parents
29. Which artery is a component of Circle of willis?

a. Anterior cerebral artery 100%
b. Basilar artery
c. Superior cerebral artery
d. Inferior cerebral artery
30. Child presented with SVT , not responding to

vagal stimulation given adenosine What is the
Mechanism of action of adenosine?
a. Slow conduction in AVN 100%
17

TAS October 2020
b. Slow conduction in SAN
c. Affect the purkinje fibers
31. Patient came with SSSS and received

streptomycin with Clindamycin. What is the action
of Clindamycin?
a. inhibition of bacterial toxin synthesis 100%
b. inhibition of DNA synthesis TAS case NO 10
c. inhibition of cell wall synthesis

d. Inhibit of protein synthesis
32. In Non REM sleep what happens?

a. Increase RR
b. Increase HR
c.Increase airway resistance
d. Increase muscle tone
e. Increase minute ventilation
18

TAS October 2020
33. 2 years old child came with fever, lethargy,
vomiting, received 2 boluses of NS 20ml/kg, HR
185 then 200/min, RR 45/min then 55, BP 80/60 then
78/58, CRT 3sec then 3 sec.What is the reason?
a. Depletion of intra vascular volume
b. Poor myocardial contractility 100%
34. 12 year old boy with Duchene muscular

dystrophy, is happy to have Mask Tracheostomy
with respiratory support. Parents refuse the
procedure as they had one son who died of this
disease and now do not want to have it done with
this boy. What make your decision legally
prospective?
a. Competence of child 100%
b. Age of the patient
c. interest
d. Court
e. Autonomy of the child
19

TAS October 2020
35. Syringomyelia at T6. What will be lost?
a. Affected below bilaterally
b. pain &temp at level of T6 & below it 100%
36. Which of the following enzyme deficiency

causes vomiting, fasting Hypoglycemia ,CVS
collapse and death in early years of life?
a. Galactose - 1 Phosphate Uridyl transferase
b. MCAD 100%
37. Child presented after RTA with Lt. Eye non-

reactive, with pupil constricted fixed in the middle,
Rt. eye looking down word and laterally. Which
cranial Nerve is affected?
a. III CN 100%
b. IV CN
c. I & II
d. III & IV
20

TAS October 2020
38. Teenager Girl, riding bicycle, has trauma in the
leg, came with history of headache 2 weeks before
the trauma. On eye examination she has Marcus
gun Pupil (Afferent Pupillary reflex) What is the
cause?
a. Optic neuritis 100%
b. Pituitary tumor
c. Optic nerve trauma.
39. Girl came with polyuria, polydipsia and

diagnosed as Type 1 DM. What is expected to find?
a. Anti-GAD antibodies 100%.
b. High Insulin
c. Type II DM
40. The oxygen release from Hb in peripheral

circulation is increased by;
a. Fever
21

TAS October 2020
b. Newborn
c. hyperventilation
d. CO
e. Metabolic alkalosis
41. Which drug block CD 20 molecule in B cells?

a. Rituximab 100%
b. Methotrexate
c. Infliximab
d. Etanercept
42. What is the mechanism of action of Vigabatrin?
a. GABA Transaminase inhibition 100%

b. Block NA channel
c. Block Ca Channel
43. Homosexual Teenager boy came with epidedm-

oorchitis. What is the organism?
a. Gonorrhea
b. Chlamydia 100%
22

TAS October 2020
c. E.Coli
d. Staph Aurius
e. Trachomons
44. Site of absorption of CSF:

.a. Arachidonic villi 100%
c. Choroid plexus
45. Antenatal U/S in Boy baby shows renal

pelvicalyceal system dilatation, Postnatal U/S
done shows pelvicalyceal system dilatation with
normal bladder What is diagnosis?
a. PUJO
b. PUV
c. VUR
46. Researchers want to conduct a study to detect

the effect of new drug on a group of patient taken
standard drug. Same patient take the medication
23

TAS October 2020
and placebo (no sample size or chronic disease)
,Staff and patient don not know
What is the best study?
a. Double blinded randomized control trial
b. Double blinded randomized cross over
47. What is Montelukast mechanism of action?

a. Leukotriene receptor Antagonist 100%
b. Mast cell receptor inhibitor
48. What is the enzyme deficient in the urea cycle?
a. Ariginosuccinate
49. Mechanism of anemia in parvovirus

a. RBCs progenitor in bone marrow (red cell aplasia)
24

TAS October 2020
50. Child came in the follow up with increasing
HC. Head U/S shows Mild Dilatation of 3rd
ventricle and with sever dilatation in the fourth
ventricle. Where is the site of Obstruction?
a. luschka and magendie obstruction 100%

b. Forman of Monro Obstruction.
c. Aqueduct of Sylvius
51. Marfan syndrome case (long baby) in which

mother and son both have The disease but
different symptoms, son has the mutation but
normal phenotype. What is the explanation?
a. Non penetrance 100%
b. variable expression
c. incomplete penetrance
52. What is the mechanism of action of
omeprazole?100%
a. Suppress gastric acid secretion by specific
inhibition of the H+/K+ ATPase enzyme system at the
secretory surface of the Gastric parietal cell
25

TAS October 2020
53. Mechanism of anemia in celiac disease
a. Decreased Iron absorption in upper part of intestine
b. decrease absorption of Vitamin B12 in the ileum
54. Mechanism of action of atomoxetine 100%

a. act mainly on noradrenaline pathway and has long
term effect
b. Block Dopamine and Noradrenaline transport
55. Mantoux test is which type of

hypersensitivity?
a. delayed Type 4 hypersensitivity 100%

b. Immune complex
c. Type I
56. What is the Mechanism of action
zidovudine? 100%
a. Reverse transcriptase inhibitor
b. Protease inhibitor
c.integrase inhibitor
d. Non nucleotide reverse transcriptase inhibitor
26

TAS October 2020
57. What is the Nitric Oxide mechanism of

action? 100%
a. selective pulmonary Vasodilator
b. Pulmonary and systemic vasodilator
c. Increase cAMP
d. systemic vasodilator
58. What is the Mechanism of action of
metformin?100%
a. increase insulin sensitivity
b. decrease reabsorption of glucose from GIT
c. Increase pancreatic production of insulin
59. What is the correct Plasma-lyte
composition?
27

TAS October 2020
60. Pedigree diagram X linked Recessive
61. 14 years old girl diagnosed with Anorexia
nervosa, her BMI 14 , HR 40 beat/min on Cardiac
monitor Started programmed introduction of
diet 20 Kcal/kg, aim 2000 Kcal/day Which
electrolyte disturbance you are afraid from?
a. Hyperkalemia
b. Hypernatremia
c. Hypercalcemia
d. Hypomagnesemia
e. Hypophosphatemia 100%
62. A preterm baby 29 weeks, age after

ventilation he is now Full enteral feeding
Expressed breast milk and on Nasal prong,
stable with Na 128mmol/L, CL 101mmol/L. What
is the explanation of this results?
a. Fluid overload
b. Hypoosmolar fluid
c. decrease in kidney function to concentrate urine
d. immature renal tubules 100%
28

TAS October 2020
63. tidal volume
64. Which is true in statistics:

a. drop pt in cohort study are they entered in
calculation
b. in cross over there is confounding.
65. fecal calprotectin indicator of which

disease:
a. Inflammotry Bowel dis 100%
b. celiac dis.
c. irritable bowel $
66. scenario of pt with peanut allergy, which is

the1st cell response from the epithelium?
a. esinophil.
29

TAS October 2020
b. dendertic cell 100%
c. macrophages.
67. There is relation b/w GH and?

a. IGF.
b.
68. what is mechanism of action of therapeutic
hypothermia in HIE?
a. decrease basal metabolic rate (BMR)
b. glutamate ??
69. what is mech. Of action of cephalosporine?

a. inhibition of cell wall synthesis.
B. inhibition of DNA synth.
30

TAS exam Feb 2020
EMQ
1- genetics:
a- intron
b- exon
c- haploid
d-locus
1. Part of DNA, non-coding, separate exons -- intron

2. Areas of DNA that carry code for proteins-- exon
3. when cell has only one copy of each chromosome -- haploid
2- Drugs:
a. phenylephrine
b. Salbutamol
c. Salmeterol
d. Dobutamine
e. Adrenaline
f. isoprenaline
1- alpha 1 agonist, decrease mucous secretion-- phenylephrine

2- long acting beta 2 agonist-- Salmeterol
3- selective beta 1 agonist, prone to arrhythmia-- Dobutamine
3- ABG:
a. acute respiratory acidosis
b. acute respiratory alkalosis
c. compensated chronic respiratory acidosis
d. compensated chronic respiratory alkalosis
e. Metabolic acidosis
f. metabolic alkalosis
1. Scenario with ABGs – Low ph , high co2 , normal Hco3 , base excess -2 (-2 --+2)
acute respiratory acidosis
2- Scenario with ABGs – Normal ph (low normal) , high co2 , high Hco3
compensated chronic respiratory acidosis
3- Scenario with ABGs – Low ph , high co2 , normal Hco3 , base excess -7 (-2 --+2)
acute respiratory acidosis
4- antibiotics:
1- augment sulfa: trimethoprim
2- same class as gentamicin: amikacin
3- antimicrobial with antifolate activity: trimethoprim

5- lung volumes
Exactly this graph, with only letters
Y
X
.
1. What ‘X’ represent? tidal volume

2. What ‘S’ represent? functional residual capacity
3. What ‘Y’ represent? forced expiratory volume in first second
6- Minerals & vits:

a. Vit B12
b. Vit B1
c. Vit D
e. Copper
f. PO4
g. Mg
1- intracellular, stored in bone, important for muscle contraction-- Mg

2- Ca and po4 absorption from gut, reabsorption of kidney-- Vit D
3- part of Cytochrome oxidase, important for iron utilization, myelination & connective
tissue -- Copper
7- bilirubin
Options were list of pathophysiology of jaundice
a. RBCs destruction
b. increased RBCs mass
c. failure of conjugation
d. defect in execration of conjugated bilirubin
1- pallor and jaundice 1st day

RBCs destruction
2- 6 weeks old , jaundice , pale stool
defect in execration of conjugated bilirubin
3- teenager got jaundice every time he got a viral illness
failure of conjugation

8- cardio:
Options were list of pathophysiology of congenital heart diseases
a. All the four pulmonary veins fail to drain in left atrium & drain in rt side
b. the pulmonary artery arise from left ventricle, aorta arise from rt ventricle
c. misaligned ventricular septum with over-riding aorta & rt ventricular outflow
obstruction
d. narrowing of left ventricular outflow at Valsalva of ascending aorta
e. narrowing of descending aorta
f. septal defect and rt to left shunt
1- 10 days old, cyanosis, O2 sat -88%, systolic murmur on left

sternal edge 1/6, lung plethora answer: A
2- cyanosis, lung oligemia, ((scenario about Fallot)) answer: C
3- murmur radiating to back, hypertension, headache , good saturation answer: E
9- renal
a. Nephrogenic DI
b. Central DI
c. SIADH
e. Habitual drinking
1- newborn, failing to gain weight, many wet nappies, his uncle has kidney problem since
birth,
* Labs:
Serum osmolarity high
Serum Na high
Urine output 10ml/kg/h
Urine osmolarity low
Urine Na low
Answer: Nephrogenic DI
2- post meningitis, oliguria, labs

Urine osmolarity 500
Plasma osmolarity low
Serum Na low
Answer: SIADH
3- Child drinking 2 liters of water every day, during the day but
sleep through the night, growing well
Labs normal
Answer: Habitual drinking

10- Optic pathway:
a. Rt optic tract
b. left optic tract
c. Optic chiasma
d. Rt parietal optic tract
e. Left parietal optic tract
f. Rt temporal optic tract
e. left temporal optic tract
1-RT temporal field loss, left nasal field loss -- left optic tract
2- bitemporal hemianopia -- Optic chiasma
3- Rt temporal lower quadrant field loss & left nasal lower quadrant field loss –
Left parietal optic tract
!!!!!!!!!!!!!!!!
BOF:
1. Listeria, what type?
a.Gram positive rods
2. 6 year old child , you suspected meningitis , CSF show gram positive cocci, what is the
most probably organism?
a. stretp pyogenes
b. strept pneumonia
c. GBS
d. H.influinza
e. Niesseria
3. Common infection with complement deficiency?

a. Neisseria
4. Girl with asymptomatic chlamydia, what ttt?

a. Azithromycin
5. Teenager have unprotected sex, now came with purulent discharge, how to diagnose?
a. NAAT
b. swab
c. antibodies
6. child present with poor feeding then develop heart failure, possible cause?
a. Coxackie b virus

7. Child with sensory neural hearing loss, thought it was due to intrauterine infection,
what is the organism?
a. CMV
b. Rubella
c. Toxoplasma
8. Regarding immunity:
a. B cells are continuously produced from lymph nodes
b. Natural killer cells are part of adaptive immunity
c. T cells protect against intracellular facultative organisms
9. Conjugated PCV vaccine what benefits?

a. cross immunity as it contains diphtheria toxoid
b. boost immunity response
c. covers more strains
10. Defect in chronic granulomatous disease:

a. Failure in phagocytosis
b. Decrease No of neutrophils
c. Defective oxidative burst
11. Site of production of CSF:

a. Choroid plexus
b. arachidonic villi
12. girl with absence seizures , what appear on EEG?

a. 3 spikes & a wave
13. defect in lissencephaly?

a. Failure of migration of neuronal cells
14.Child was in a trip, came back with headache, diplopia , failure to abduct eye ,
nerve affected?
a. Abducent 6th cranial nerve
15. Colles fracture , which nerve will be injured?

a. Median nerve

16. Indian girl, 4 years old has 3 healthy siblings, presented with lethargy, unable to get
up from bed, parents said this start 4 days ago as she start to drop things, on examination
, hypotonia in all limbs , power 3/5 , absent reflexes, diagnosis??
a. Guillian barrie syndrome

b. polio
c. herpes encephalitis
d.nile encephalitis
e.varicella encephalitis
17. Child with ALL on multiple drugs e.g vincristine , present with foot drop , what is
cause?
a. side effect of chemotherapy & it is reversible
18. Drug block inosine monophosphate?

a. Mycophenolate/mofetil
19. Drug block IL-6 ?

a. Tocilizumab
20. Which area of brain commonly affected in HIE?

a. basal ganglia
b. thalamus
c. cerebral cortex
d. subcortical white matter
e. internal capsule
21. drug cause prolonged QT ?

a. Erythromycin
b. amoxicillin
c. ranitidine
d. lansoprazole
22. Antihypertensive drug with antiproteinuric effect?

a. Enapril

23. Cardiac catheter:
a. TOF
b. Eisenmenger
c. Coarctation
Saturation Pressure
Rt atrium 77% Rt ventricle 88/8
Rt ventricle 77% Pulmonary artery 18/8
Pulmonary artery 77% Left atrium 88/100
Left atrium 94% Left ventricle 88/100
Left ventricle 88%
24. Most common cause of CAH?

a. 21 hydroxylase deficiency
25. Cause of hypokalemia in DKA?

a. Osmotic diuresis
26. Hypocalcemia occur in:

a. inactivation ca sensing receptor mutation
b. chronic kidney disease
27. Secreted from alpha cells of pancreas ?

a. Glucagon
28. Action of insulin:

a. Fat deposition, glycogenesis, inhibit gluconeogenesis
b. Lipolysis, glycogenesis, inhibit gluconeogenesis
Other options like this, with part incorrect
29. girl Indian, breast feeding, refusing to eat varied food , not exposed to sun , present
with delayed walking, frontal possing
a. inadequate intake of vit D
30. hypoglycemia in 3-hour old baby, normal insulin, no ketones:

a. defective glycogenolysis
b. defective gluconeogenesis after 10 hours
c.GH deficiency
d. hyperinsulinemia
e. dysregulated insulin secretion

31. cause of hypophosphatemia in refeeding syndrome:
a. hyperinsulinemia with intracellular shift of po4
b. due to low ca
32. A 14 years old girl, short stature 2 centile, weight 2 centile prepubertal, mild dyslexia,
what investigation to diagnose?
a. Karyotype
b. low growth hormone
c. Anti-tissue transglutaminase
33. drug to be avoided in interstitial nephritis?

a. omeprazole
b. ibuprofen
c.
34. Renal pelvicalyceal system dilatation ,proximal ureter dilated

What is diagnosis?
a. PUJO at proximal ureter
b. reflux back from bladder
35. HUS scenario, history of diarrhea , pale , oliguria , labs show low RBCs &
low palatelets , what is the causative organism?
a. E.coli
36.In chronic kidney disease:

a. High parathyroid hormone , low 1,25 calcitriol
b. High parathyroid hormone , low 25 vit d
c. low parathyroid hormone , low 1,25 calcitriol
d. low parathyroid hormone , low 25 vit d
37. another ABG

Low ph , low Hco3 , Normal pco2, elevated lactate
a. metabolic acidosis
b. metabolic alkalosis
c. respiratory acidosis

38. child with blue eyes, fair skin, dislocated lens, anemia with increase MCV ,
come with rt hemiparesis, what investigation to diagnose ?
a. plasma amino acid level

b. brain MRI
39. 1000 person were screened for a disease , 10 got positive results & 2 of them were
confirmed to be diseased , 990 got negative results & non of them have the disease
What is the positive predictive value for this screening test??
a. 100%
b. 20%
c. 0.2 %
d. 80 %
40. Researchers what to conduct a study to detect the effect of new melatonin drug on
the quality of sleep for patients with neurodegenerative disease, 250 person will be
recruited from same city
What is the best study?
a. Double blinded randomized control trial

b. cohort study
c. ecological study
d. qualitative study
41. study on a drug, 1000 patient received ttt vs 1000 didn’t receive it , incidence of
condition tested in treated group 0.8/1000
& in untreated group 1,7/1000
ask about NNT
( no need to calculate , answers show the equation & numbers)
a. NNT= 1/ARR (1000/1,7-,8)
42. Research on a group of people to test the effect of a drug on their sleep, the study
compares their sleeping hours before and after the drug, what best statistical test to
analyze data?
a. paird t-test
b. ANOVA
c. unpaired t-test

43. Mechanism of cough:
a. Inhalation, closure of larynx, muscle contraction, glottis open, forced expulsion
of air
b. inhalation, glottis open, muscle contraction , glottis close , forced expulsion of air
( other options like this with missing step or incorrect order)
44. Asthmatic child , controlled asthma , using metered dose inhaler with proper
technique , parents want to know why do you encourage him to use a spacer ??
a. less effect on growth

b. less prone to adreno-cortical insufficiency
c. because this is guidelines recommendations
d. less oropharyngeal side effects
45. Montelukast mechanism of action:

Weird options "
a. prevents release of interleukins from mast cells via specific receptors
b. act as chemoattractant to interleukins make them less potent
c. lipophilic act on genes to reduce synthesis of inflammatory cells
46. what is the main component in surfactant?

a. Protein A
b. Protein B
c. Protein c
d. Phosphatidyl choline
e. phosphatidyl glycerol
47. Cause of anemia in celiac ?

a. occult blood in stool
b. decreased iron absorption
48. What decrease lower esophageal sphincter pressure?

a. caffeine
b. anticholinergic drugs
c. cough
49. Neuronal component involved in gastric emptying?

a. Vagus nerve

50. 3 months old baby ,has been operated for biliary atresia , now present with failure to
gain weight & steatorrhea what is best formula composition?
a. high carb, high protein, rich in MCT

b. soy milk formula, rich in MCT
c. high carb, high protein, high long chain fatty acids
51. Child present with hematemesis, on examination he has splenomegaly , dilated veins
on abdomen , where is problem ?
a. portal vein
b. superior mesenteric
c. coeliac artery
52. Otoacoustic emission , what it test ?

a. cochlear hair cells function
53. What is true regarding bilirubin metabolism in neonates?

sop p 202
a. conjugation occurs by GGT enzyme
b. glucuronyl transferase rate limiting enzyme in bilirubin excretion
54. Drug used orally in palliative care to reduce respiratory secretions:

a. Glycopyrrolate
55. Role of adrenaline in anaphylaxis?

a. cause vasoconstriction
56. Dopamine given in shock to increase heart rate, what else it does?
a. bronchospasm
b. increase peripheral vascular resistance
c. decrease urine output
57. How many half-life cycles needed to eliminate 97% of drug from circulation?
a. 3
b. 4
c. 5
d. 6
e. 9
58. Child with ALL started chemotherapy, his uric acid become elevated, what explain
this?
a. Nucleic acid destruction

59. Pathophysiology of ITP:
a. Antibody coated platelets are destroyed by splenic macrophages
60. Methylphenidate mechanism of action:

a. increase dopamine activity
61. Aneuploidy:
a. 47 xxy
b. 96 xy
c. 96 xx
62. baby with suspected velocardiofacial syndrome ( 22q11) , how to confirm?

a. FISH
b. Karyotyping
c. microarray
63. What is characteristic about Comparative genomic hybridization (CGH) :

a. Can detect mosaicism
b. More efficient than karyotyping in detecting unbalanced down
c. increase detection of chromosomal anomalies
d. Fast can be done in 7 days
e. can detect single gene mutations
64. Filaggrin gene associated with which condition:

a. atopic eczema
b. acne vulgaris
65. Most common cause of child abuse in UK?

a. Neglect
b. physical
c. emotional
d. sexual
66. which condition need skeletal survey?

a. child was witnessed falling from height
b. child was hit in an accident
c. A twin of 6 months old baby with two posterior fractured ribs

67. parents bring their little girl with injury, they told you she fall while riding her
bicycle, what is the most common site for accidental injury?
a. Labia majora
b. labia minora
c. hymen
d. posterior fourchette
e. perineum
68. a child with nasojujenal tube , which extrvaste as it isn’t been checked for 48 hours,
What should be done?
a. tell parents after informing the legal team
b. explain to parents what happened fully & promptly
69. 10-year-old child started chemotherapy showing respond to ttt, parents want to stop
chemo and try homeopathic medicine, but child want to continue chemo,
What shall you do as the primary doctor of this child?
a. respect child autonomy

b. accept parents wishes
c. seek legal action
d. multi-disciplinary team to decide
e. seek expert opinion in homeopathic medicine
70. 5 year old, limping , pain in rt hip, x-ray show sclerosis & destruction of head of femur
Cause?
Answers were pathophysiology
a. avascular necrosis (AVN) of the proximal femoral head

b. stress around hip cause fracture of growing epiphysis
! ‫ﻧﺳﺄﻟﻛم اﻟدﻋﺎء‬
"‫اﻟﻠﮭم ﺗوﻓﯾﻘﺎ و ﻧﺟﺎﺣﺎ‬

TAS exam Oct 2019
1. Statistic:
A. a+c/a+b+c+d : Prevalence
B. d/b+d: Specificty
C. b: False positive
2. Drugs used in NICU S/E mentioned:
A. Renal toxicity, GIT toxicity & platelet dysfunction. Indomethacin
B. Metabolic alkalosis, hyponatremia. Lasix
C. Flushing, hypotension, hyperthermia, apnea and bradycardia. Prostaglandin
3. Drugs & organisms
A. Gram negative diplococcic organism responds to piperacillin/ tazobactam: Pseudomonas
B. Organism responds to Azithromycin: Mycoplasma
C. Organism responds to Amphotericin b: Aspergillosis
4. Organisms NICU:
A. Term baby born after PROM 7 hours. Breast fed well in 1st day. Next day was pale and lethargic: GBS
B. 27 weeks baby on neonatal unit, breast feed and rest of his nutrition by long line: Staph Epidermidis/ CONS
C. Neonate received antibiotics for one month without improvement on vanco/tazo: MRSA
5. Genetic tests:
A. SMA ????????????????
B. Prader willi : Methylation
C. Consangious parents & multiple anomalies with same conditions: ????????????????
6. Calcium profile:
A. Girl 2 years with bowing leg & wide wrist : Calcium low - PO4 low - PTH high: VITAMIN D DEFICIENCY
B. Short stature with brachydactly in 4th & 5th : Calcium 0.6 , PO4 high 2.3 & PTH normal or high:
PSEUDOHYPOPARATHYROIDISM

C. Neonate with seizures & murmur not like his parents. Calcium low , PO4 normal or high, hypoparathyroidism:
DIGEORGE
7. Hematology:
A. Term baby born at home presented by bleeding from umbilicus .home delivery, PT prolonged: VITAMIN K
DEF
B. Child with her grandparents suddenly developed petechiae on her body. She was well, had fever last week
given paracetamol. investigations : prolonged APTT ,PT , high D dimer : DIC
C. Child under protection plan with bruises.... platlets 18,000: ITP
8. Monoclonal antibodies:
1. INL1: Anakinra
2. TNF alpha: infliximab
3. IgE: Omalizumab
9. Nerves:
Which branch of cranial nerve V has motor and sensory: Mandibular
If its branch is injuried post surgical and lead to stridor: vagus nerve
Abducens is the 1st CN affected in increased ICT
10. Murmurs:
A. Child 2 years with chest infection and continuous LUSE murmur, chest x-ray normal. ECG left ( ?? or bi- )
ventricular hypertrophy: ( there was ECG and image of x-ray in the question ) PDA with bounding pulse ( was
asking for the sign which is bounding pulse )
B. 10 years. Intolerant to exercise. HTN. Murmur refer to back. ECG shows left ventricular hypertrophy: Co-
arctation of Aorta + HTN ((was asking for the sign which is HTN )
C. 10 years with chest infection, Systolic murmur LUSE, chest x-ray plethoric lung. ECG shows RBBB: ASD ((was
asking for the sign which is wide fixed second heart sound )

BOF
1. Organism that is transmitted transplacental? ( Listeria Dengue virus )
2. Child on anti TB drugs , mother noticed child

green and red which drug causes this ?
- INH
- Ethambutol
- Isoniside
3. Mechanism of action of Methotrexate? antifolate
4. left Congruous homonymous hemianopia with macular sparing :

- Left cortical lesion
- Right optic tract lesion
- Right cortical lesion
5. Dilatation of pelvicalyceal system. Best Investigation? MAG3 with lasix
6. Neonate breast-fed , brought collapsed , RBS 0.8 , liver 2 cm , GIR 8 . Still hypoglycemic. What is the
cause ?
-High insulin ???
-Glycogen storage disease
-MCAD
-Others ??
7. Urea cycle defect with X linked inheritance? OTC

8. In coeliac disease, there is iron defeciency anaemia. Where in small bowel iron absorbed ?
-Jujenum
-Duodenum
-Ileum
9. 6 years with scanty pubic hair, testicular and scrotal enlargement, bone age at 9 and ½ years, normal
blood pressure???? Central Precocious Puberity ( was asking for investigation needed: gonadotropin
levels for central precocious puberty)
10. 2 or 3 month with cough. investigation -ve coccobacilli + lymphocytosis?

(Gram -ve coccobacilli release toxins make tissue susceptible to histamine and lymphocytosis??)
B.Pertussis
11. Nutrient will be deficient to infant if mother is deficient? Vitamin D - iron vitamin B12
12. Superior axis deviation: AVSD
13. Metabolic acidosis with normal Anion Gap? - GE
14. Vigabatrin side effect? Visual field defect

15. 4 years old male child came with RR 45:
Gas : pH 7.49 ,PCO2 25, bicarbonate 30, What is this gas present ?
-Resp alkalosis
-Compensated resp alkalosis
-Mixed respiratory and metabolic alkalosis
-Normal gas
16. What is the cause of hyponatremia in PDA? diuretics or ANP or (What is the cause of hyponatremia in
premature? diuretics or ANP)
17. Allupurinol mechanism of action? ---------------------------------------.
18. Patient with DM ( and found to have celiac disease. Which HLA ? DQ2- DQ8
19. Right eye with upward and lateral direction Trochlear nerve injury
20. Chest physiotherapy best for? SMA
21. Child postures & polydepsia .. water deprevation & desmopressin no apparant change in serum &
urine similarity? (failure to concentrate urine after desmopressin) Nephrogenic DI
( long question and give readings of urine osmolarity and serum )
22. Why cow milk should be modified? Due to high phosphate
23. No red reflex on examination in newborn? CMV Rubella
24. Proton pump inhibitors mechanism of action ( H2 blockers, H-K ATP, gastrin inhibitor)
25. Site of ADH synthesis: Hypothalamus --- (Site of ADH secretion : posterior piturirty )
26. Total lung capacity equal:
-Forced expiratory volume at 1 sec +ERV
-Vital capacity +RV
-FRV+IRV
27. Mechanism of action of Lasix: unclear answers need to know the mechanism well ???????????
28. 12 years girl diagnosed DM1 started insulin .. what is mechanism of its action?
(Insulin I think stimulate formation of G6phosphate to promote glycogen ) - NADPH ????????????
29. Cause of congenital diaphragmatic hernia ( type not mentioned) ?

-Pleural peritoneal defect

-Pericardio peritoneal defect
30. Child with rash at external auditory meatus (herpes infection) presented with earache hearing loss,
dizziness, right facial pain and anterior 2/3 of the tongue affected. Which nerve involved?
-Left UMNL at 7th nerve left
-Left LMNL at 7th nerve
-5th nerve
-Hypoglossal nerve
31. Test to diagnose chlamydia ? NAAT -
32. Order of topical steroid potency. From low to high potency ( 4 drugs were given and to order them )
33. 12 years girl with joint pain & malaria rash. Investigation to diagnose? dsDNA - antids DNA
34. HbF is characterized by what compared to HbA? Low affinity to DPG
35. Cause of cerebral oedema in DKA: ???????????????????????????????????/

36. Child with insect bite allergy in her face , which blood test confirm allergy
( basophil count , mast cell tyrptase, IgE, Histamine )
37. Gram -ve diplococcic: Neisseria
38. Infant with loose diarrhoea & faltering growth + history of polyhydramnious. & metabolic alkalosis?
Congenital chloride diarrhoea
39. Mechanism of Adrenaline in anaphylaxis: Vasoconstriction
40. Mechanism of methylphenidate: Reuptake of dopamine and epinephrine
41. Mechanism of PDA closure: increase pulmonary blood flow
42. Where is the lesion in SMA ? AHC
43. Most common cause of Angelman syndrome
-Maternal unidisomy
-Genomic imprinting of maternal 15
-Maternal deletion 15
-Paternal deletion 15
44. TAPVD blablabla.. obstruction of pulmonary flow ( repeated question )
45. How ivacaftor works in cystic fibrosis? Facilitate CFTR channels Modification of CFTR gene - ??????
46. Theophylline mechanism of action: Phosodiesterase inhibitor

47. why babies need higher dose of gentamycin
-Increased renal execration
-Lipophyllic
-Hydrophyllic
48. A neonate with hypoglycemia low sodium high postassium liver palpable insulin not recorded and
cortisol low: CAH ( asking for the enzyme 21-hydroxylase deficiency )
49. baby with severe developmental delay (Leigh syndrome). His mother diagnosed with mitochondrial
disease . what is the incidence to have another diseased baby ?
-100 % children will be affected
-100 % of males will be affected
-50 % of males will be affected
-25 % of children will be affected
50. 3 years old child brought to ER , parents said she fall down her 3 wheels bicycle .what injury suspect
sexual abuse ?
-Labia majora injury
-Labia minora injury
-Torn hymen ( repeated )
-Perineal redness
-Clitoris injury
accidental
-Posterior fourchette
51. In study of new inhaler for management BA . True?
-child can reject even if parents accept
-consent from parents
52. cause of meiosis in organophosphorus insecticide poisoning ( effect on eye receptors )
-Muscarinic receptor
-Cholinergic receptor
- Inhibiton of MAO
- Inhibition of acetylcholinesterase reuptake

53. What is the type of immunoglobulin in alloimmune thrombocytopenia
-IgM
-IgG
-IgD
54. B ray showed clavicular fracture. What
suggestion from xray ?
-Callous formation
-Overlapping clavicle
-Boe remodelling
-Briding
55. Mechanism of action of metformin

-Activate G protein to secrete insulin
-Decrease resistance of insulin
-Inhibit glycogenolysis in the liver
gluconeogenesis
56.
-Totally preventable
-No usually reported
SMN1 gene associated
with respiratory destress
57. calcinurin inhibitor : Cyclosporin
58. Most useful investigation for spinal muscle atrophy: IGHMBP2 gene Study
molecular genetic study
59. Most useful investigation for neurodegenerative disease: ???????????????

NCS ??
60. 27 wks with fluid loss ???????????????????? MRI
-Fluid loss from intercellular spaces
-Hypernatremia in 4 weeks old preterm due to dermal fluid loss
-Sweat gland blablabla
- Wide surface area blablabla ???????????
61. Term SVD , normal antenatal history , developed cataract. What is the organism ? Rubella
62. 7 years old girl wakes up every morning having generalized seizures . This is happening for 2 months
now what EEG finding at night ?
-3 spikes with wave
Rolandic
-Centrotemporal spikes
-Occasional frontal waves?
63. Hyosine is :
-M1 muscarinic blocker
-Non selective muscarinic inhibitor
64. Drug causes wide pulse pressure:

(Drug increase pulse pressure...increases or maintain systolic and decrease diastolic....isoprnaline)
-Labetolol
-Atenolol
-Isoprenaline beta agonist b1 b2
-Adrenaline selective
short acting

65. Baby with severe feeding difficulties . many investigations done . nasojujenal tube placed. What is the
single investigation that will exposed baby to less radiation ??????????????????????????
-Chest xray for possible pneumonia

-Chest xray to check for NJ in situ
-Fluoroscopy
-CT scan chest
-Barium meal and follow through
66. Terminal child with frequent choking . parents refused to place NG tube . which ethical explanation
you will give to parents ??????????????
-Place NG tube to prevent aspiration pneumonia !!!!!?? ( repeated )

-To improve quality of life
67. Child with brain tumor, brainstem tests done. When is official time of death ?
-When started 1st set of test ( SOP )

sop p 682
-When finished 1st set of test
-When started 2nd set of test
-When finished 2nd set of test
-After circulatory criteria
68. How is conjugated pneumococcal vaccine made?
-Polysaccharide with added protein
-Recombinant
-Live attenuated
69. Relative risk with CI in study about benefit of endomethacin in PDA statistics ?????????????
70. 7 years old presented with fever, oedema, high BP, haematuria, lethargy after URTI? IgA
Nephropathy
71. Nerve affected after surgery on the neck: Vagus ( or recurrent laryngeal nerve if vagus is not in the
choices )
72. Level of evidence : Pyramid of studies ( unusual order to order them correctly )
73. 2 years old boy with child protection programme, post chicken pox for 10 days. Recovered
completely. Came after 3 weeks with ecchymosis, bruises on his chin. CBC: wbc 6000, Hb 10 PLT
18000
-Post chickenpox infection
-ALL
-ITP
74. Mechanism of hypophosphatemia in refeeding check???

Tas june 2019 complete
Emq
emq1: about organism
PORTODELLA
Strep pneumonia
Morrexia
Klebsiella
GBS
Nesseria
Corynobacterum
staph
A_ bacilli G -ve= klebseilla
B_ ,cocco bacilliG -ve botadella pertusiss BHC>> HIB, CHLAMYDIA ANSD BORTIDIELLA
C_ ,G +ve diplococci =strept pneumoni) , ENTROCOCCUS
EMQ2 about child with petechi :
a_ FT 2.3 kg, with pteichie and hepatosplenomegaly 2cm , mother PLT

normal 195 =cmv
b_ mother PLT > 200 , FT baby wt 3.2kg with petichi , liver , spleen
just palpable=alloimune
c_ PLT mother 23 ,,mother well ,FT baby wt 3.2kg with petichi liver
and spleen just palpable= maternalL ITP,
opthion :
(alloimmine,
maternalL ITP,
cmv)
congenital leukaemia
SLE

emq3
test of statistic
1/a/a+b=positive predictive
2/c indicate=false -ve
3/a/a+c=sensetivity
opthion :
(sensitivity
+vepredictive value
-false negative)
occulomotor>>LP sup, constrictor pup>>mydiasis>>ptosis>>out and down
emq4 cranial nervesabducens>>LR6>> fail abduct, horizontal diplopia
opthion :
trochlear SO4>>UP AND OUT, HEAD TILT, VERTICAL DIPLOPIA
>ophthalmic>sens
trigeminal mandib>>sens, mot,auto
5th>>all face excwpt angle of mandible>>trigem neuralgia, >>UNILATERAL FACIAL PAIN
hypoglossal( all tongue ms exceptpalatoglossal ms, prog bulbar pals difficult speech, swallow,tongue deviate to same side
glossopharyngealaff>sens>orophar,eustach tube, middle ear, postthird of tongue and carot sinu>>loss taste of post third
eff>motor> stylopharyn ms>>
a_ child with vertical diplopia , head tilt= trochlear

to the opposite side
b_ child with sever unilateral facial pain =trigeminal

c_ child with chronic headache on examination noted to have deviation
of the tongue to the RT when protruded tongue=hypoglosal
emq 5 site of absorbtion

1/ colon-=water
,2/terminal ilium-=B12
3/,all small intestine absorption Carbohydrate
Opthion :
Carbohydrate
Water ,,Vit b 12
emq6 , all of them 1 mon baby with pregrossive vomiting and lethergay
and givin electrolyte
a_ NA 125, K 2.3 , CL 90, bicarb 30 =PYLORIC STENOSIS

urine PH 5, NA <20
b_ NA 125, K 6, bicarb 12
urine PH 5, NA high 50 =CAH
metabolic acidosis with
normal anion gap due to
high cl level
c_ NA low , k low , bicarb 12 CL 119
urine PH 5, NA 85 =RTA
opthion
cah
,pyloric stenosis,
Rta
CF
parter
gastrointeritis
emq7, about supplement to give
a_ obese child failed to decrease WT on diet and givin orlistat) =,vitD
b_ child with diarrhea perioral and perianal dermatitis , spared scalp
hair=ZINC
c_ baby on breast milk and his mother want to wean hime , she is vegan
=B12
opthion:
vit A
vit K
vit D
vit E
zinc
vit b12
emq8 about sinus

a_ coronary art drain on=rt atrium
sinus
b_ ductus venosus=inferior venacava-
c_ Y descent = tricusp opening
opthion:

rt atrium
tricuspid
IVC
EMQ9
Nephrogenic DI()
Central DI)
SiADA
Opthion:
Defect in V2 receptor in kidney =NEHROGENIC DI
Poly depsia Craniopharyngeaoma=CRANIAL DI
Hyponatraemia after pneumonia=SIDAH
ectasy also
EMQ10
A_ Long Lasting b 2agonist (fometerol)
B_ Phosphodiestrase inhibitors (theophylline)
C_ Leukotriene antagonist ( monteleukast)
Bo5 mody1>>HNF4 ALPHA>>sulphonylurea

mody 2>>glucokinase>>no TTT
mody 3>>HNF1ALPHA>>SULPHONYLUREA
MODY5>>hnf1beta>renal cyst, uterine abnormal, gout
1-HNF1a function MODY
1/Increase pancreatic threshold for glucose
2/reduce insulin production from pancrease
3/Autoimmune destruction of B cells
4/decrease insulin resistance
5/decrease gluconiogenisis in liver
2-/Fibrillin gene marfan form protein in= FBN gene on ch 15
1/microfibrils in extracellular matrix

2/Elastin fibers in extracellar matrix
3/Intracellular
4/collagen fiber

3-Icthyosis vulgaris defect in
fillargin gene
4- 20 /day meaning
(meaning cholera )
Mechanism of diarrhea
1/activate cholide channel
2/increase cell membrane permability
3/increase lactose in lumen
5-PPHN echo finding :

1/increase pulmonary blood flow
2/tricusp reguir
3/increase pulmonary resistance
4/increase pulmnary blood vilocity
6-Tof time of onset:

1/embryonic phase 3-6
2/Pseudoglandular phase
3/canalecular
4/sacular
5/alveolar
(Choices all stages of lung develop)
7-Inflixumab bind to
TNf alfa
8-Omeprazole mech:
1/ hk atpase at parietal cells
2/hk atp in endocrine cell
2/NA K ATPASE
4/cl -h chanel

9-unequal eye in child with sever asthma treated by ipratropium
bromide , normal eye movement , but eye unreactive how to diagnose
Pilocarpine no response in this case
10-Baby cong diaph hernia on oxygen fio2 0.85 predctal 90

Post ductal 75
causing PPHN
Cause ??
1/Pulm vascular abnormalities and insff ventilation
2/Lt to rt shunt intracardiac in the septum
3/increase pulmonary blood flow
4/ v q mis match
11-Inhaled nitrous oxide

1/Work only on respiatory system
2/Activate C amp CGMP
3/
12-mechanism of action carbamazepine

voltage gated na ch
13-dravet syndrome mutation on SCN 1A pathophysiology

(na channelopathy )
K channelopathy
Ca channelopathy
14-In quality improvement project to assess small improvement
1/pLan-do-study-act (pdsa)
2/plan act study do
3/act plan do stuay
4/

15-Child on mv by progressive neurodegenerative disease in PICU , not
hear or see or feed
Want to to remove from mv
Best resonable explanation for this discion ??
1/Buden of disease
2/Burden of treatment
3/Inevitable death
4/Iminment death
5/Lack of benefit of the treatment
16-Confidence interval def ??

1/range people most likely fall between true
2/reject null hypothesis
17-anorexia nevosa senario with HR 44and BMI 13 collapsed the cause

if collapse ?
1/hypokalemia,
2/Cardiyopathy
3hypometabolic state
4/long qt
18-ABO incombatibility senario blood film finding?

1/polychormesia ,
2/spherocytosis, spherocytes
3/ howell jewel,
4/target cells)
19-preterm found ?
1/decrease sweat gland ,
2/hypernayremia due transepidermal fluid loss ,
3/ absent pain receptors

20-dka cause of hypokalemia ?
1/osmotic diuresis .
2/
21-toxic shock syndrome mechanism

1/ large scale t cell activation
2/Toxins activate B cells
super Ag mediated
causes major MHC T
3/Toxin activate T cell cell activation
4/Toxins activate macrophages

5/decrease interlukin
22-poor diagnostic of leukemia ? male, 1<>10, wbc>50,b cell more, philadelphia ch, residual dse
Cytogenetics
23-16 y girl with BMI on 91 centile on OCP , smoking , with bilateral

papilledema and MRI normal diagnosed with IIH ,,what is the common
cause of IIH?
1/smoking
2/obesity
3/OCP
24-Fursemide site of action ?

1/ascending loop of henle
2/proximal renal tube
3/desending loop
4/collexting ducut
5/distal renal tubule
25-Botox mech?
1/Prevent release of ach at periph nerve endings
2/Neutralize ach at neuromuscular junction

26- child with sever asthma treated by Iv sabutamol what is metabolic
disturbance corresponding this treatment ?
1/Increase glucose , decrease lactat
2/Decrease glucose , decrease lactat
3/ increase glucose increase lactate hypoklemia, hypoph+. hypotension
4/normal glucose increase lactate

(Choices interchangeable about glucose and lactate )
27-Mechanism of action of one of macrolide

-1/ribosome 50
2/maseger tRNA
3/Cell wall
4/folate
28-Mechanism of action of aminoglycosides

1/inhibit protein synthesis
2/ihibit bacteria DNA
3/CELL WALL
29-Hetrosexual ,,un protective sex,,male came with epididomorchitis

which organism ?
1/ Gonorrhea
2/ chlamydia
3/STREP FECALIS
4/E. coli
30-Baby boy with ammonia 400 and resp alkalosis history of deaths in
male relatives ?
(Chioces all types of urea cucle defects ) >otc
N acyteyl glutamate synthtase deficency

31-16 yrs old girl competent refuse to continue on chemotherapy ,
treat ment 40% ,,parents want to treat
What to do can consent but can not
refuse
1/ do not start acc to patient wishes can refuse at 18 in UK
can refuse at 16 in
2/ request for legal action, correct scotland
3/get consent from parents

4/medical team to decide
32-4 variables odd ratios with figures which one statistically significant (
all choices include 1 except one choice not include one )
1/BWT < 1000 GM
2/Temp
3/Gestational age
4/Asking about which one signficant
33- child with CF become breathless , clear sputum

Lung function done
FVC 1.96 , predicted 2.3, Z score -1.64 Normal
FEV 1.36 , predicted > 2 , Z score 3.2

1/obstructive , Low FEV1
2/RESTRICTIVE, with mild obstruction

3/MIXED MAILY RESTRICTIVE
4/MIXED MAINLY OBSTRUCTIVE normal VD level
34-Ca 1, ph 2.8, pth 0.05, vit d 100 what is the cause ?

1/failure for osteoclastic osteolysis response, PTH non functioning
2/failure of ph excretion
3/ca absorption
35-Pedigree = autosomal dominant

36-Inhibit protein carabolism
1/Glucagon
2/Cortisol
3/insulin
4/ l carnitine
37-Cause increase diastolic blood pressure

1/Exposue to cold
2/Hypoxia obesity
DM
3/PDA hypothyroidism
smoking
4/Disruption sympathetic supply
5/aortic stenosis
38-4mon child ,, cry on touching leg ,, which indicate NAI ,,

1/ metaphysial fracture of rt femur
2/suprachondilar #
3/clavicle#
4/spiral fracure of tibia
39-statistic about 1000 CF pt screened 10 tested for disease 2 of them +

ve, non of 990 have diseases?? About NPV ?
1/100%
40-morgagni diaghragmatic hernia what is the defect ?

1/Failure of formation of retrosternal part of septum transversum of
diaphragm
2/Failure of migration of primitive septum transversum to form pleura
41- child with persistant vomiting and diarrhea for 3 days

Hypoglycemia 2.3
Ketones +++ GE with starvation

What findings in blood result?
1/Low insulin high cotisol
2/Variables choices about both
42-Association with sufe ? more in girls,, teenagers and obesity

1/Acquired hypothyroid
2/obicity
3/precorious puperty
43- child shocked received NS bolous then started on noradrenaline ,,

act on ?
1/Alfa receptor vc
44-Down sudden quadriplegia

1/Atlantoaxial dislocation
45--Nephrocalcinosis acidosis with FH multiple member with renal

stone
Urine ph 7 Mechanism ?
1/Failure of hydrogen excretion DRTA
2/failure of nahco3 absorption
46-Cp child with bruises without explanation most imp risk for him for
child abuse__>
1/ being disabled
2/single parent
3/alot of sepling
4/change home
47-Fish for which >

William

48-Neonate almost -5 day with pan systolic murmur on LT lower
sternal age , hepatomegaly,
and signs of heart failure
Most probable patho physiology?
1/large VSD Lt to rt shunt ,
Increase pulnonary blood flow
lt vent overload)
49-Mech for closure foramen ovale ?

1/Pulmonary vasodilation
2/increase pulmonary pressure
3/increase pulmonary blood follow
50-Hydrops intrauterine organism causing ?

Parvovirus
51-Chylothorax nutrition ?
MCT
52-Phototherapy mech?
Photo isomerization
53-7yr Polyurea polyuria wt loss ?? (fop)???

What to do ?
Glucose random Bl g
Glocose tolerance test
54-Diff bet type 1and2 ? C peptide is high
C peptide sex globulin hormone is

high
55-Prick skin test for?

type 1 hypersensitivity (choices all types if hypersensitivity )

56-Puv prenatal diagnosis Most poor impact on baby ?
Lung hypoplasia oliguria
57-Scenario Most confirm Acute renal failure rather than pre renal ?
High urine loss of sodium
protinurea
high serum NA
high serum creatinine
58-Alfa thalassemia trait ? 4 GENES
2alfa gene deletion

Alfa chain duplication
59-Occulomotor nerve injury rt?

Rt ptosis
Rt eye superomedial
Rt eye inferomedial
rt superiolatral
60-Paracetamol metabolism in children ?

Glucuronidation
Sulfation in neonates
61-CHD Dependant on pda for systemic circulation

Critical AS
Tricuspid atresia
62-Diagnosis of chronic granulomatous disease?

Decfect in respiratory burst
63-Vaccine against capsular polysaccharide Ag?? pure polysachh

Strept pneumonia HIB
strept
strept
meningococci
NM salmonella
conjugated poly sacch klibsiella
ecoli
plus HIB salmonella
strept
meningococci
All TAS Exams Recall salmonella
151 of 381
64-neonate Boy Did not pass urine in first 24 hr
All invest normal k 7.5 high serum NA 134(134-145) , bilirubib 160 (
below phtotheraputic zone)
Haemolysed sample
Puv
65-Cause of deficiency of fat soluble vitamines in liver disease

Deficiency of bile acids
2/CHILOMICRON DEF
66-Dka pathophysiology
Increase beta hydroxy butaryte
67-Origin of macrophages
Mononcytes
MAST CELL philippa p 98
68-Scenario of graves (palpitation proptosis wt loss)

Cause ??
Ab against tsh receptor anti peroxidase also
anti thyroglobulin
69- calcium Resins mech of action in hyperkalemia?

1/Increase renal excetion of k
2/ exchange cataionic
intracellular shift to k
70-dyspnea, stridor, monophasic wheeze: extrathoracic obstruction

TAS FEB 2019
1. Vancomycin mechanism of action=glycopeptide in cell wall inhibition(bacteriocidal)

2. Atraçurium mechanism of action==muscle relaxant copetitive inhibtor with acetylcholin in post
cynaptic neuron
3. Cyclopenataolate mechanism of action=block action of acetylcholine cause madriasis in circular
muscle(constrictor papillae) ..fundus exam and before OR
4. Site of secretion of somatostatin==delta cell in pancreas
5. ,leptin== adipocyte
6. ,gherlin==antral cell of stomach ,small intstine, hypothalam, pancreas
7. What's the 1ry excitatory neurotransmitter?glutamateACH,CA, high dose glycin and INHIB>> GABA and low dose glycin
8. Baby 2 wk history of vomiting and diarrhea presented with hypoglycemia action,,baby was well
1/ IV g10 2/ oral glucose 3/ glucagon
9. Baby 3 days post infection proteinuria hematuria Puffy hypertensive ?! ....mode of pathology
1/IgA,Ig., ,2/IgA nephropthy,,3/immune complex >>ttt>>ACE, immunosupp and mayb tonsillectomy and omega 3
10. case about baby 8 week vomiting and lethargy FTT with metabolic alkalosis but he Said his urine
is acidotic==Pyloric stenosis
11. Epidermolysis bullosa simplex site of lesion ?!==1/basal layer ,,2/intra epidermal without scar
12. Most common finding in family with an infant died from abuse ?!1/domestic violence page123
13. Spastic diplegia MRI finding =
asnswer=prevenricular leucomalacia low IQ, impaired communication and visual defect
14. Gentamycin high what to do pre level high(trough)==
answer: increase interval
15. Mechanism of adenosine=
answer= A V node block
16. Clindamycin in SSSS=
answer=Antitoxin
17. Benzodiazepines Mechanism of A=
answer==GABA mediated chloride chancel ( in sop neurology 569)
18. Case neonatal sepsis obvious but he said it's diplococci that is among common cause of Early
onset sepsis
... 1/strepto pneumonae
answer== 2/ GBS??
19. Organisms that make you suspect sexual abuse given many scenarios included 1/hsv2 oral
multiple gram _ve 2/, chlamydia in 8years old female, 3/Anal Warts in infant
20. Antibiotic that prolong Qt interval option included
answer:-clarithromycin which is true( sop 361)==ABCDEH
A=ANTIARRYTHMIC QUINIDINE,,,B ANTI BIOTIC =MACROLTE,,C =TCA
D ANTI DEPRESSION =FLEXOTIN E ANTI EMETIC =ONDANSTRON,,H ANTIHISTAMINIC
=CIMITIDINE starvation and AN
21. steady non.rem sleep which of the following may increase ?1/! Hart rate 2/RR 3/tone
4/increase upper airway resistnce(GOOGLE)??REM =PAGE( 71)
22. How to count QTc==QT/RR

23. IN SOP(P 732--733)
24. Drug of choice for SVT==adenosine
25. Prader willi inheritance (senario of obece child with small hand)==uniparental diosomy
26. SMA cause==antrior horn cell distruction WRONG THIS IS FOR KILLED
27. life attenuated vaccine preparation==chemical,,recopenant,,deactivation with formalin???(to be
revew)CHABTER 33 CORRECT IS REPEATED C/S
28. One neonate with blood gas normal values

29. 1/FEV1=1.7(z score-3.5) fvc (-3.4)2 transfer factor2.3 3 scenarios in (z score any value less than
- NORMAL Z score -1.64-1.64........transfer factor normal > 0.5
-1.96 is abnorma)=MIXDl2/ FEV1 1.8(-3.3)FVC 2.8(z 0.4) TRANSFER FACTOR 1.9( Z 0.6)
OBSTRUCTIVE3/FEV1 1.4 Z(-3.54) FVC 1.5(Z -3.8)transfer factor(-5.4)=RESTRICTIVE SPO2
=93%AT REST with excesice 96%(asthma--interstial lung disease-mixed -cystic fibrosis)question
to be review from rep sheet of Carole-RESP SURVIVAL PAGE 41
Z SCORE -= MEASURE - PREDICTED /SD
Z SCORE UPER NORMAL LIMIT = +1.64,,,MEAN =0,,LOWER NORMAL LIMIT -1.64
TRANSFER FACTOR =INCRESE BY ATHSMA DECREASE BY RESTRICTIVVE
NORMAL VALUE FROM 25 -30 except in bw<1.5,
hepb virus>10*6
FEV1/FVC 1ry infection during preg
IF >80%=NORMAL OR restrictive
if<60 =obstructive
if b/w 60%-- 80% =mixed
30. Lung volumes graph. Asked about tidal volume=IN RESP CHABTER=Ask about tidal volum
31. Pedigree with only male affected==x link recesive
32. 12 years old male having duchenne muscular dystrophy >10 needmins. cpr>40 ventilation.
mechanical min, ph<7.1,His
po2<8,
persisent
brother having same condition died. Parents are prefer not to ventilate. But patient willing to do
so. What determines you to proceed (something like this)1_age of patient, 2competence
33. What micronutrient deficiency in baby with exclusive breast feeding with mother strict
vegetarian==vit B12
34. What vitamin deficiency in baby with exclusive breast feeding==vit D
9 6 3
35. Term formula composition==Calories ,,fat,,protein(calories 66 was answer) ph=1/2 CA, iron 5.6-23
-dec vit D>> dec ca, ph
high PTH and ALP 36. Emq about rickets 3 stems with lab result interpritarion= difference in Vit D,25. PTH and
phosphate-hypophastemic (ca.. ,, ph,, ALP,,PTH ,,25OH VITD.,,.1'25 HO ,,CA CREATININERATIO)
-dec PTH> dec ca and inc ph
hypoph rickets only dec PH
37. 3 months infant on cow milk with pallor. Cbc showing normocytic normochromic
anemia.=Physiological aneamia.
38. Mode of action of adrenaline in anaphylaxis==alpha receptor vasoconstrictor(case TAS 30)
39. Lip swelling and rash after cow milk intake. What is the mechanism=IgE meadiated
40. Hormone released from aciner pancreas used in screening for exocrine function=amylase(FECAL
ELASTSEAS FOR SCREENIG ) IRT for CF
41. Hormone increased in biliary disorders GGT
42. Hormone released from lungs and liver. A1AT(ALPHA 1 ANTI TRIPSIN)
43. Hormone acting on V2 receptor in kidney==DESMOPRESIN

44. Drug antagonise aldosterone spirinolactone
45. Mode of action of Acetazolamide==inhbit absorption of HCO3 in proximal convluted tubules NA-H channel
46. Drug acting on loops of henle==frusemide
47. Cause of hypokelemia in DkA==ausmotic diuresis
48. Cause of cerebral edema in dka during treatment==rapid fall of Na or glucose
49. Cause of hyponatremia in child with cerebral meningitis..there was lab result==SIADH
50. One question 40ml bolus given no improvement BP drop=NORADRENALINE,,PRBCS,,
51. Right sided look central with ptosis. Left eye down and
outward==oculomotor,,Oculomotor+trocholer,,
52. Hepatitis c positive mother mode of delivery==NVD
53. Calprotectin can help in diagnosis of==Crohns disease
54. For a study in school, what measurement taken for obesity==BMI(USED IN PT MORE THAN
2YRS)LESSTHAN 2YR BY CENTILE
55. relative risk they asked about what it indicates==RR INTERPRETATION
INCIDENCE OF EXPOSE/INCIDENCE OF NON EXPOSE =A*D/B*C
56. Girl with x-ray of rickets and mother with bow legs. Mode of inheritance.=XLINK Dominant..
57. Physiological changes at birth... 4 options, chose correct one= decrease pulmonary vascular
resistance
58. Cause of weight loss in 1st week after birth==decrease intake,,skin surface area,, ANP Diuresis
59. Reteniods mechanism of action in acne== inhibit cebum production(oral act in 4pathogenic
factor eg bcteria,) comedogenesis
60. mecanism of action of alloprinol==xanthine oxidase inhibitor

61. EMQ, Toxicity of Chemo Drugs
1. Osteosarcoma treated pt, breathless at night: Doxorubicin (PND)
2. Glycosuria anti- cancer drug: ifosfamide,,dexamethazone 6 mercapturine
NA valp
3.what causes pripheral neuropathy??vincistin (REVERSABLE) mayb the two but hyperglycemia with dexa
62. There was a question of neoborn 6 days develops erythema around umblicus and 3 blisters on
buttocks, What is the causative organism???(FOP) ssss
1_ group b sterpt2- pneumococci 3-staph aureus4- E Coli
63. Antibodies to a disease of ascending axonal muscle weakness ..... GBS >>CSF cytoalbumin dissociation ratio
A.antiphospholipid B.anti ganglioside
64. Monoclonal antibody against CD20 antigen drug? rituximab sop 540
65. Metabolic screen is positive for PKU..what nt?(fop)
??blood levels of phenylalanine
66. Memory loss, altered behavior. Which lobe involved
Frontal lobe, Parietal Lobe, Temporal lobe
ANSWER= frontal loop
67. Case of PDA with thrombocytopenia +sign of heart failure
Ibuprofen versus indomethacin,,frusomide(if there is sign of heart failure)
68. mechanism of action of mrtformin==decrease glucose uptake,,decrease tissue resistance to
insulin
answer decrease tissue resistance to insulin

SMA 1
CMDtext here
Type
asphyxiated chest
69. ababy born with sever hypotonic on mechanical ventilation syndrome
`
70. baby delivered by NVD difficult labour 4.3kg post deliver not moving hand..what's your action?
- xr humerus -xr clavicle -xr wrist -chest xr -reassure(fop)
71. Another case about a girl who is angry about her mom when she brings her friend to home
The girl had vacant attack with gerking and recovered soon with normal consciousness
She had history of one attack of febrile convulsion can not recal the event(fop)= coplex according to the
partial(can not recall the event) scenario it maybe
syncope
72. baby with bruises with umbilical bleed ,home birth==1/non accedental,,2/vit k
73. premature age 72hrs with hyonatremia==mother related,,prematurity??? TAS Cases
74. scenario about complication of re feeding in anaroxia==hypo phosphatemia

75. in ABO incompatibility==IgM(IgG IN RH AINCOMBATIBILITY)SOP(200)
76. antibiotic Not to use in pt with G6PD== SULPHA CONTANING =+ANTIMALARIA dapsone, chloamphenicol,
nitrofurantoin, aspirin, napphthalin
77. MCAD long scenario investigation to do==lactate &carnitine ,,amonia &carnitine?? and herbals
78. question about poor prognosis of drawning==ph PH less than 7.1
79. pt with petechial hemorrhage ==1/immune compex ,,2/ IgA >10 mins. cpr>40 min,
80. scenario intial investigation of celiac disease==total IgA+ anti tissuetransglutamite ph<7.1, po2<8,
persisent warm
81. scenario about immunization in baby with mother hepatitis b(all will receive both
except in bw<1.5,
(IMMUNOGLOBULIN AND VACIN EXCEPT IF e antibody +ve THEN GIVE ONLY VACCIN hepb virus>10*6
82. His maternal uncle had bilateral cataract. His mother doesn't smile when visiting him. What1ry infection
is during preg
the inheretance of disease of the baby ? myotonic dystrophic
1-genetic anticipation 2- X linked R 3- Autosomal recessive..,,outosomal dominant
ANSWER outosomal dominant
THANK YOU

TAS OCT 2018
1. EMQ - mechanism of Action of medications:

Ranitidine - H2 blocker
propranolol - B1 B2 blocker
chlorpheramine - H1 blocker
2. EMQ genetics
Intron -DNA Has intron + Extron
Exon -RNA has only Etron
Haploid -Present in gamtocyte
3. EMQ - site of secretion
Melatonin - pineal gland hypothalamus
Glucagon - Alpha cells of islet of langerhans
Calcitonin - C cell in thyroid parafollicular from 4th pouch follicular from floor pharynx for thyroxin
4. EMQ - Anatomy of heart
SA node situated in - Right atrium
Ductus arteriosus connect left pulmonary artery to aortic arch
Coronary arteries arise from - right cusp of the aortic valve, at
right aortic sinus(From sop page 342)there is 3 sinous of
valsava tow of them give rise to rt& lt coronary artery
5. EMQ statistics
(-ve predictive value - Relative risk - Odd ratio - likelihood ratio -
Specifity - +vepredictie )
Probability of positive result to people have disease sinsitivity
Probability of positive result to people have disease to people
does not likelihood ratio
Exposed to outcome to control relative risk
6. EMQ about bilirubin causes
neonate with pallor and anemia- red cell break
four week with jaundice pale stool - failure to secrete bile

pt. recurrent jaundice with febrile condition - failure of
conjugation
7. EMQ - Vitamins
Vitamin needed for myelin and connective tissue - Vit B12
???
Vitamin needed for absorption of calcium and phosphorus - VIT E???
VIT D
Vitamin found in bone and necessary for muscle contraction -
Ca or Mg
8. EMQ - Congenital heart disease all with pulmonary oligemia
and pulmonary plethora
Cyanotic baby within 24 hrs. no murmur - TGA
Cyanotic baby with injection systolic murmur - TOF
Low volume pulse in 4 limbs - HLHS
9. EMQ - Trace elements and minerals
Part of cytochrome. play role in iron metabolism - Hepcidin better copper
Absorb calcium and phosphorus - Vit D
Intercellular and important in muscle contraction - K
10. Absorption site of csf
Choroid plexus
Arachnoid villi
11. Inhibitors of inosine 5 monophosphate
Mycophenolateimmunosupp>>organ transplant
Anankinra
Cyclosporine
Mofetil(same drug ??)
12. One child shown with bilateral cataract. Ask what causes?
Maternal DM
CMV
13. Positive Monteux test - What type of hypersensitivity?

Type 3 hypersensitivity OR patch test
14. Then one child with immediate allergic reaction after peanut
at some party? The most
correct mechanism
Release of histamine after IgE bounded to mast cell.
15. Gastric emptying by which nerve
Vagus
Celiac
Superior mesenteric
Phrenic
16. How parvovirus B19 causes anaemia?
Cytotoxicity of red cell progenitor cells
17. Neonate with prolonged seizure. Calcium was low. What is
the investigation that most
likely confirm the diagnosis?
Parathyroid hormone (PTH)
18. Hormone deficient in diabetes insipidus
Growth Hormone no ADH in choice
19. Haemorrhagic disease of new born prolong
PTT - partial thromboplastin time
PT - Prothrombin Time(both pt and ptt is prolong)
20. Which of the following should be given irradiated blood
Hodgkin lymphoma (and SCID,NEUROBLASTOMA
TYPE4,,DONER AND RECPIENT OF BONEMAROW
TRANSPLANT)guide line p124
21. What drug avoid when renal function test deranged.
Phenytoin
omeprazole NSAIDS, ACE, vanco, aminoglycosides, and amphotrixcin B
ondansetron
22. One toxicity drug with hypertension dilated pupils and
tachycardia.

Amphetamin antidote is
benzodiazepine phentolamine and SNP
ibuprofen
paracetamol
23. Layer of skin affected by scalded skin syndrome?
Stratum granulosum
24. The circle of Willis is composed of the following
Anterior cerebral artery
2posterior cereb,,1 anteror com ,2 anterior cereb,enternal
carotid
25. Girl got unconscious her brother died SIDS investigations
high ammonia normal lactate
low glucose lactate
OTC(there is depeate in answer could be MACAD but latate
will be high )
propionic academia
26. Mechanism of omeprazole?
Suppress gastric acid secretion by specific inhibition of the
H+/K+ ATPase enzymesystem at the secretory surface of the
gastric parietal cell
27. Mechanism of anemia in celiac disease
Celiac disease cans cause damage to the small intestine
where iron, folat, and
vitamin B12 are absorbed. The most common sign of celiac
disease in adults is iron deficiency
anaemia that is unresponsive to iron therapy.
28. Marfans syndrome case in which mother and son both have
the disease but different
symptoms, son has the mutation but normal phenotype
non penetrance(penterance all symptom will apear,, veriable
excep not all symptom apear
29. Male and female went surgery some die other survive which
best statistical test for
male group? Total male was 70s
fisher
when you need to
compare proportions
>>>choose chisquare
if small group < 50

large group >50
Chi square
Welcoxon
T test
Student t test
30. Best food for regarding biliary atresia post syrgery

protein
carbohydrate
fatty acid
31. Mechanism of salbutamol induce hypokalemia
Na receptor
H receptor
Na and k receptor
32. Psychogenic polydipsia method to diagnose
Paired urine and serum osmolality
Water deprivation
33. Jaw thrust during resus what is the method it helps in
opening the airway?
pull the epiglottis
pull the tongue
34. Methylphenidate act on which receptor
decrease reuptake
dopamine and norepinephrine
35. Klippelfeil syndrome of cervical abnormalities
Fusion of cervical vertebral bodies
36. Reason give high supplement o2 in pneumothorax
Nitrogen washout.
37. Child was penicillin allergy. What antibiotic is suitable for
him, he has symptoms of
exudative tonsillitis , foul mouth odour??

if mentioned that he is
taking carbamazepin
Cephalexin
Clarithromycin
Ciprofloxacin
clindamycin
38. One child born preterm, but mother has chicken pox 2 weeks
ago. Developed frequent
desaturation at day 6, then at day 9 vesicles appear. What
organisms causing this condition?
Varicella??
Herpes?? (threre is depeate)
39. Skin biopsy in HSP
IgA vasculitis(igA mediated vasculities)
40. Ultrasonography of the kidneys, enlarged kidney with
pelvicalyceal dilatation and
proximal ureter dilatation. Where is the obstruction?
Vesicoureteral reflux (VUR) PUG
cystic dilatation
41. ECG which present ventricular relaxation (repolarization)
T wave
42. child mild moderate asthma o2 94 received 6 puffs Ventolin
mdi with valved spacer
his breathing get better but spo2 fell to 89 what is the cause?
Exhausted and worsening asthma
inappropriate dosage and worsening asthma
43. High nitric oxide in a child with respiratory distress what s
the diagnosis
bronchial asthma
44. Risk associated behavior in a teenager
Sleep deprivation???
Prefrontal cortex immaturation(ADHD)

Dopamine(ADHD)
45. Which of the following is not toxin mediated
Toxic shock syndrome
Cholera
Ssss
HSP
46. Mechanism of action of IGF-1
IGF-1 is a primary mediator of the effects of growth hormone
(GH). Growth hormone(ihibit GH by -ve feedback)
stimulates the liver to produce IGF-1. IGF-1 then stimulates
systemic body growth,
and has growth-promoting effects on almost every cell in the
body, especially
skeletal muscle, cartilage, bone, liver, kidney, nerve, skin,
hematopoietic, and lung
cells. In addition to the insulin-like effects, IGF-1 can also
regulate cellular DNA
synthesis
47. Treatment for chlamydia (STD)
single dose of azithromycin or a week s course of doxycycline
48. Dilatation of fourth ventricle due to
luschka and magendie obstruction
49. Preterm in NICU and developed an infection what is the
organism
CONS(Coagulase-negative staphylococci)- also with vp shunt
50. What test should be done to confirm brain death?
apnea test
51. What type of diet will you give to a child post op Kasai
Procedure?
MCT oil is meditative oil for weight for infants.
52. Mechanism of action of Insulin

fat deposition ,. synthesis of glycogen,, and inhibit
gluconeogenesis

53. cardiac catheterization,, aortic pressure 130/80
Aortic stenosis??
54. Mechanism of action of adrenaline in anaphylaxis
Vasoconstriction( act on alpha)( also adrenaline has effect in
beta 1&beta2)
55. Short stature with intellectual impairment(Learning difficulty)
45XO - turner syndrome
56. Baby with widening of the wrist and metabolic acidosis

distal RTA??(proximal) ???? proximal early and distal late
57. indication of skeletal survey
child Abuse
58. what is the congenital defect I d DiGeorge syndrome
3 rd and 4th pharyngeal arch pouch
59. Potent vasoconstrictor
noradrenaline
angiotensin
60. Syringomyelia at T6 what will be lost
-pain &temp at level of T6 &below it
tough, posture and maintain balance.
61. A mother who was taking anti epileptics during pregnancy
And was worried about
child s intelligence
62. Pedigree with 2 affected males XLR
G6PD
open -close -open
63. Mechanism of Cough
64. Meningitis caused by listeria
gram positive rod(all rod gram -ve except (LBC2)
65. Blood gas interpretation
low ph high co2 low Hco3 mixed acidosis
high Hco3 . co2. Normal ph
High co2 with ph 7 25 ..

66. 14 yo girl prolong cough already been given beclomethasone
for 18 months she didn t
respond to medication and spirometry seems restrictive then the
exhaled nitric oxide
was very high. What s the reason for high nitric oxide?
primary cilia dyskinesia(should be low)??(high nasal-low oral
increase in infection,,
67. Abnormal direct papillary light reflex?
cilliery ganglia PAGE 597 SOP
68. DMD with high CPK how do you confirm
DNA study
69. Visual field defect in optic tract pathway lesion

hemonomus hemianopia
left temporal and right nasal
70. DM Enzyme
71. 3 samples with CSF >9000 RBC
SAH
72. Why give conjugated pneumococcal vaccine to boost immunity
73. lung function test

FEV1/FVC
IF >80%=NORMAL OR restrictive
if<60 =obstructive
if b/w 60%-- 80% =mixed
Z SCORE -= MEASURE - PREDICTED /SD
Z SCORE UPER NORMAL LIMIT = +1.64,,,MEAN =0,,LOWER NORMAL LIMIT -1.64
TRANSFER FACTOR =INCRESE BY ATHSMA DECREASE BY RESTRICTIVVE
NORMAL VALUE FROM 25 -30
74. cyanotic heart disease

75. How can you differentiate between Dm1 and Dm2
C cepetite high in DM2 or (GAD antibody +ve in type 1)
76. 4 years with bronchial asthma with 3 times MDI poor spacer
use and not responding
what is the cause??
poor adhernt

77. Mechanism of hypokalaemiain patient on salbutamol
shift k to intracellular by Na -k atpase
78. how does the shift of K occur and in exchange for what
in exchange withe Na
79. how does hypokalaemia in DKA occur
hyperglycemia cause osmotic duresis and glucose execreted in
urine along with Na and k
also incsulin can cause hypokalemia by shifting k to intracellular
thank you

TAS Exam For June2018
EMQ:
1/-Drugs with side effects:
a/ Visual field defect __ vegabatrin
b/ Acute dystonia__ metaclopramide central and peripheral >>also occulogyric

antidote>procycliozine, antihistamine anti ch and benzodia
d/ Causing Steven Jonson syndrome__ carbamezapine
_2/cardiology
a/ Transitional change at birth:
What increased pulmonary bloodfollow __
PDA closure__
decrease in pulmonary
vascular resistance
PGE2 ,,Close if foremen
ovale to close __
Physical signs:
3/Baby with continuous murmur __ bounding pulse==PDA
Child with soft systolic murmur at LUSE__ fixed S2 ASD
Child with systolic murmur radiated to back at LUSE and ECG showed LVH
=HTN_(COARTICATION OF AORTA)
4/Causes of hypoglycemia:
a/8 days old male BG 0.9 moml/l with small penis &underdeveloped scrotum mildly
jaundice__ congenital hypopituritism
Senario about one baby from India had one sibling dead before__ methylemalonic acidemia?
Haematology :
b/ 8 days delivered at home bleeding from umbilical __HDN(haemolytic disease of

newborn)
3 weeks baby bleeding after circumcission PT normal prolonged APTT__haemophilia

Pt with high PT,,APTT,,INR LOW fibrinogen__ DIC
5/Calcium metabolism :
Low calcium ,low po4,, PTH 7__??vit d
v. low calcium with seizure hypoparathyroid __Digoerge syndrome 6yrs
female short stature calcium 1.2, po4 2,3 PTH 6_7__??pusdo hypo dec CA, high PH, high PTH
named albright osteodystrophy>>methylation
para(Derange in action of parathyroid h due to receptor defect)
7/ Immunology :
Cells when activated cause degranulation__mastcells ??
Cells making phagocytosis__ macrophages?
Cells recognize antigen in ass with MHC type1__NK?? T helper cell >>CD8>>cytotoxic cells
MHC2>>CD4>>T helper
mhc1==CD8==cytoxic cell
MHC2-==CD4==Helper1 & helper 2
8/Monoclonal antibodies:
A/ Anakinra__IL1
Infliximab__antTNF
Calcinurnin inhibitors=
=tacrolimus (NOT USED IN
LESS 2YRS)
9/Anatomy of Cranial nerves: motor>4,6,11,12

sens>128+ophth
all>.10973
Branch of trigamenal that carry sensory and motor __mandibular
Nerve when affected cause horseness of voice__ vagus nerve(RECURRENT LARNGEAL
False localized injury __abducent nerve
10/Statistics:
Given diagram..?
BOF:

1/Mechanism of loop diuratics NA K 2CL CO TRANSPORT BLOCK
2/Mode of action of methotrexate__ Antifolate metabolism (DIHYDRO folate REDUCTASE

INH & block DNA block purine, pyrimidine and thymidine
3/Mode of action of anaemia in HUS__Rbcs destruction in altered vessels +HSP, renal V thromb
3/Causes of anaemia in prematurity_ _low iron absorption from immature gut
low erythropitin production,,reduce rbcs life spam?? rapid body growth,,placental iron
transport not occur
4/Mechanism of low sodium in PDA__increase ANP(due to stresh of wall)
5/Physiotherapy(chest) is best for SMA
6/Child with interstitial lung disease follow up __Fev1/fvc ratio >>spirometry
7/Total lung capcity __vital capacity +residual volume
8/Site of ADH action __on collecting duct >>aquapurine recep
9/Mechanis of lissencephaly ?? failure
neuronal migration
10/Enzyme deficiency in CAH __21 oh deficiency
11/Hb F shifted to left because he has decrease binding in 2,3 dpg
12 /Pco2 3.9 Po2 8 kpa ph 7.48 ventilation setting for ABG__ decrease vR
13/ Hyosine action __non selective muscarnic receptors inhibitor
14 / Child with swelling of his face immediately after some thing he taken__ type1
hypersensitivity reaction
15/ CGD defect __defective oxidative burst(neutrophil defect NADPH oxidation)

blue nitrozolium
16/One baby with cataract__ rubella
17/ One child with absence sizure, mother is afraid of antiepilepsy what medicine not to
give__ carbamezapine
18/ Normal AG metabolic acidosis __gastroenteritis==HARD UP
high anaion gap MUDPILES=
19/Mode of action of methylephenidate __block dopamine transporters leading to increase

dopamine and norepinphrine, S.E>>growth retard, arryth, sleep disturb
20/Side effect of anti TB that cause colour blindness__ ethambutol +optic neuropathy

12-16 week >pseudoglandular
^^^
21Mechanism of diaphragmatic hernia=Failure of puloproteneal canal devolopment posterolat
morgagni>>retrosternal>>anteromed>>transverse septum
22/ 3 nerve palsy_ _down and outward gaze problem
rd
23/ Celiac HLA association__ HLADQ2/DQ8
24/ Angleman syndrome most common cause__maternal deletion chro 15
25/Organism that is transplacental transferred to baby __ GBS?? TORCH- listeria
26/Pedigree of XLD
27/Boy received chemotherapy his uric acid level increased __breakdown of nucleic acid
28/Causes of cyanosis in TOF_ _ Rt ventricular outflow obstruction

hypothermia and hypotension
29/Child with brainstem death What pathological event occur 1st apear first??__
??hypothermia with peripheral vasodilatation ,,, hypertension,,P.HTN,, baroreceptors
para sympathetic stimulation???
30/ Mother found baby drawing what most indicator of poor out come __core body temp
32,,, ABG6.7
coccobac>>Prim. Health Care>>
30/ Cocci bacillus with ,,lymphocytosis_==bortedella(pertusis) ? pertussis,HiB,Chlamydia
31/Pt with recurrent chest infection has ulcer on palate ,,,
IgAdef??
Athletic amenorrhea??(in fop)
32/Child with yellowish hand and trunk white sclera__ carrotinemia
33/Scenario of difficulty of feeding became irritable and vomit after feed who exclusive
breast feed __ GORD??,, cow milk in diet of mother ?? CMPA associated with
it could be GOR only ocult blood in the stool
no loss of wt and loss of wt
34/Mechanism of hypo phosphataemia in refeeding syndrome in malnourished ??
baby age not mentioned
to exclude chips
depletion of intracellular phosphate SHIFTING INTRACELLULAR
35/Steroid potency..dermovate(clobetazole) betnovate(betamethazone)

,imovoate(clobetazone) hydrocortisone
36/Management of orbital cellulitis__ 3rd generation cephalosporin
37/Mechanism of transdermal loss of water in premature baby??large
surface area ,,skin thin non keratinize ,,permeable skin(sop 207)m
38/Statistic:

level of evidence RCS_meta-analysis
What doneto minimize
bios Scenario about
type of study
Ethics:
39/13yrs boy terminal want to try new drug of chemotherapy but parents refuse what will
do ? ass competence
40/Mom discover OCP in her daughter's room?(fop)
41/ take 20 tabs of paracetamol not found in ward we 'll call who ?? 42/ call police
Regarding research in children take money & child refuse, they has
right of withdraw
43/free treatment Mother had HIV biological father not know what will
she has to discuss with her
do ?(FOP) husband
44/ Vancomycin?? inhibit cell wall synthesis
45/Child injured when riding bicycle had foot drop?__ common preneal nerve
injury charcot marie tooth, vincristine, fridriech ataxia
46/ Site of action of dobutamine? beta receptor 1
47/Mode of action of adrenaline ? vasoconstriction
48/Mechanism of hypothermia in HIE? prevent brain cell in latent phase
damage,,atinuation to glutamate,,decrease apoptosis
,,sop(221)
49/ DRUG that reduce salvia secretion _ _ glycopyrrolate?(glycopronium promide) anti

mascarnic drug
50/10yrs female went to Egypt c/o vaginal bleeding o/e no signs of puberty :
Female genital mutilation(FGM)
????? 51/8
yrs with strong family history of premature IHD father on statine regarding screening
what will do(FOP)
Screen now(screenig should be from 5yrs and above) in FAP do early
screening at age 10y
After 12 yrs of age??? in IHD do early if there

is risk factors in the
family at 2y
IN BRCA GENE
mutation wait until child
grow up and give
consent by himself

may be associated with
RD
SMN1
52/ SMA level of the lesion __ AHCs(anterior horn cell)

53/Baby with 2 mm red lesion with blue margin easy to bleed otherwise we'll what will do
Reassure and follow up after 2 weeks
54/ Baby with CAH what the investigation give information in the first 2nd day electro
3rd 17-oh, urinary steroid
day of life ?kerotyping,, Urinary steroids

and US
55/visual lesion in posterior Fossa tumor_ bitemporal ,,hemonomus haemanopia with
macular sparing occipital cortex
Rt opticradiation
56/Mechanism of hypokalermia in DKA osmotic
durisis ,, if hyperK>> no insulin
DKA management :insulin
57/CSF; protein 4( glucose 1,6 wbcs 200 neutrophil 30% lymph 70% __ TB meningitis.
thank you

TAS FEB 2018
EMQ:-
1/.EMQ about Clarithromycin ,,amikacin,,,teicoplanin..,trimethoprim

1.Antimicrobial with Same class of gentamycin?==amikacin
2.antimicrobial that enhance action of Sulphanmide?=trimethoprin
3.antimicrobialthatworkontetrahydrofolat?=trimethoprine
2./EMQ about dobutamin,,,Phenylpherine ,,isoprenone,,,dopamine,,,clondine
1.selective B1 adrenergic receptors used in heart failure? dobutamin
2.Beta2 agonist long Acting ?==isobrinone formetrol, salmetrol
3.Alpha1 adrenergic receptor cause decrease mucous production

?==phenylepherine
3/EMQ about .Temporality,Coherence,consistency,

1.Does the association fit with other biological
Coherence.
2.Is the same associations found in many ,consistency,
3.Large relative risk temporality anything related to a cause
4./EMQ about component of breast milk:-lactoferrin,,,IgA..,.,,oligosacchride

1.has antimicrobial activity and giving
iron=lactophrine
2.responsible of intolerance== IgA

3.give nutrient for normal flora?== oligosaccharide =prebiotic
good bacteria>> probiotic

5. EMQ About absorption in GIT which element maximally absorbed in each of the
following? vitB12,Water,,protein,carbohydrte,calcium?
1-Distal ileum==vit B 12
2-Colon=water
3-All small intestine ==carbohydrate
6. EMQ about micronutrient
Vitk,vitD,vitE,vitA,vitB12,carbohydrte,zinc,protein
1-12years obese BMI 91 always on T.V and playing video game given orlistst>>lipase inhib>
which micronutrient will given along with=vit D dec fat absorb
2-Scenario for a child of a vegan mother on breast feeding and would like to wean
him on vegan regimen what he will require;=B12
3-Scenario of child with recurrent diarrhea ,nappy rash and develop scalp fair
hair,=zinc
7.EMQ Options
Congenital leukemia,,,Congenital CMV,,,congenital rubella,,, Toxoplasmosis,
,,maternal autoimmune thrombocytopenia ,All immune thrombocytopenia ITP,
Aplasticanemia
1-about 1/12 infant his weight 2.2kg mother platelet 195 with concern regarding
his mild petechiae over his trunk and has spleen and liver 2cm BCM with
healthy family and mother =congenital CMV
2-Another one about 1/12 infant his wt 3.2kg with concern regarding his more
increased petechiae and has spleen and liver 1cm BCM with mother platelets
325 with healthy family and mother=alloimmune
3-about 1/12 infant with concern regarding his more increased petechiae over his
body and has spleen and liver 2cm BCM with mother platelets 95=autoimmune
8EMQ about.new born with incease work of breathing on ventilator options staph
epidemics,,, listeria,,,RSV,,MRSA,,,group B strep,,E coli
1-One month old sepsis with long line
Staphepidermidis(CONS)
2-One month old sepsis on vancomycin
MRSA

3-One month old rupture membranes and NVD
Group B if meconium stain>>listeria
9-EMQ 1moth old baby came with10 days with vomiting and lethargy given blood
result each as follow
Urine out put mentioned in each senarioin 10ml/kg /h , 6ml/kg/h 0,6ml/kg/h
partter
SIDAH
Congental adrenal hyper plasia
1/-low NA low K alkaline ph ==bartter

-2/LOW NA HIGH K=CAH (LOW URINE OUT PUT)
10-EMQ list of diagnosis SIADH ,NEPHORGENIC DI ,DM ,,habitual drink

,RENALTUBULAR
ACIDOSIS,CONGENITAL ADRENAL HYPEPLASIA,HEMOLYSED SAMPLE.,,PUV
1-Newborn pass urine for 24 hrs k:7.6 Cr 60 bilirubin120==??HAEMOLYSIS

SAMPLE
2-boy with enuresis urine NA is 90 normal serum NA Low k, Cl is 118 urine ph5
=proximal RTA
3-baby well drinking 2litres per day always with sleep through the night.
=Habitual drink.
BOF:-
1. 3rdcranial nerve palsy:-
.the eye deviated inferiory and laterally +mydriasis and ptosis
2.child came from Afghanistan with hx of possible CNS infection Untable to abduct
his eye wi
6thcranialnervepalsy true localizing >> occulomotor
3.Lt Congruous homonymous himinopia

optic radiation
incongranous obtic tract
4.Mechanism of action of metformin
gluconeogenesis
1/Inhibit enzymes of hepatic glycogenolysis
2/Increase uptake by activating(s...blablabla) in adipose tissue
5.Mechanism of action carbamazipine:
1/presynaptic calcium channel ,2/Na channel ,blockage, 3/GABBA, NMDA

6.Mechanism of action zidovudine
Reverse transcriptase inhibitor
7.Mechanismofaction atomexite
increase release of epinephinrine and decreasere up take of dopamine??
IT act mainly in norephrine pathway and has long term effect sop p75
used in tics and tourette>> S.E>> suicidal an hepatic insufficiency
7.Scenario about pttaking multiple chemotherapy ciclosporin ,vincristin came with

foot drop what you will say to them?
reversible side effects
8.26week preterm on ventilator given dopamine in addition toincease BP what can
cause
,miosis1- urinary retention2-increase peripheral vascular resistant,Bronchospam
9.Pt with asthma given salbutamol and ipratropium nebulizer came

withnonreactivenonequal pupilwhatdotoguideyoutodiagnosis Pilocarbineeyedrop
10.MechanismofactionofInfliximab?
intiTNFalpha
11.Mechanismof actionof Tocilizumab
intiIL-6
12.Scenario given high ph high HCO3 and lowPCO2
Mixedmetabolicandrespiratoryalkalosis
13.Scenario given low ph low HCO3 and high
. mixed metabolic and respiratory acidossis
14.5years old pt with high RR 45 what can cause
Respiratory alkalosis
15-One question showed double blind trial inseveralhospitalsfrom2008to2010to

study treatment effect Ithink
in between mentioned double blind asked about type of the study
randomizedcontroltrial,systemicreview
16-scenario want to measure effects of drug which study appropriate for this
cohort
17.1000pts uder doing test to confirm diagnosis of cystic fibrosis 10pt with positive
test 2 of them have a real disease.
Non of the rest990 have a disease what is negative
15year girl came with high blood sugar with family history of DM type2 how to
know this girl have type1 or type 2DM?
1/Blood kentone 2.Glocuse tolerance test
3.Anti thyroid antibodies 4.C-peptide
19.14years old girl with proptosis and goiter what is cause of goiter in this girl?
Iodine dificiency,,,Antithyroid antibodies,TSH receptor abs
(TRAB)/immunoglobulins\r/TRH antibodies

20-how the body respond when there is hypocalcaemia given box with 5 options
I increasePTH,increase phosphate in urine,increase intestinal absorption and
increase bone resorption
Which of the following take part in the kidney?

1-7hydroxycholecalcifrolto25-OHvitaminD3
2-Calcifediolto2,25-OHvitaminD3
3-25-OHvitaminD3tocalcitriol
4-Cholecalciferolto7hydroxycholecalcifrol
23.Inscreening test fort ype 1DM for ceoliac disease was negative which of
following will support this disease?
HLADR4
HLADQ2/HLADQ8
24.pt came with loose motion abd.Distension and poor growth which of the
following guide you to diagnosis?
IgAlevel
Anti-tissuetransglutaminase
antibodyAntiendomusealantibody
of staph scalded skin syndrome
excoliative toxin type B
26.Icchyosis due to
Mutation of filagrin gene
27.qwhich test to confirm the
fishStudy,, DNA analysis, arrayCGH,,,,

28.aby with hydrops fetalis what is causative organism during pregnancy?
PARVOB19
29.pt took multiple antibiotics withno improvement novan comycinand tazobactam

what is causative organism?
MRSA
30.pt with chylothorax what nutrient to be given?
5.Highfatdiet
6.Verylongchainfattyacid
7.Medium chain triacylglyceride
8.Highfatandprotein
31.ptwithColles'fracturewithpalmparesthesiawhichnervedamage?
Mediannerve,C5&6root,C7 C6,7,8,T1
32.pt with diarrhea faltering growth history of polyhydramnios with low chloride
and low sodium and increase ph and high albumin
Congenital chloride diarrhea
33.pt with congenital adrenal hyperplasia will
come with
1.Low cortisol high ACTH low rennin
2/Low cortisol low ACTH low rennin
3/ Low cortisol high ACH high rennin
4/hihg cortisol high ACH low rennin
5/high cortisolhighACHhighrennin

34.Pt with HUS what is causative organism...
E.Coli
35.Skin prick test type of hypersensitivity..
.Type1
36Leukemia patient WBC 30 ph high I think hb 6.5 plts 50 start on allopurinol

what to give with this.
RBSransfusepacked
Transfuseplt
Abs(hewasafebrile)
SalineIV
37-pt with congenital diaphragmatic hernia whichof thefollowing indicate poor

prognosis?
lunghypoplasia
colonintheLtsideofchest
mediastinalshift...
38-ask
aboutAutoacousticemissionbeingDoneroutinelyinUKasscreeningtestpostnatally,he
askedabouthowitworks?
Cochleaactasmicrophone
Cholea hair cell function
39-Scenario ofsexuallyactiveteenager with suspected chlamydia urthritis how it will

be confirmed
1-NAAT,
2-serology,
3-checkantigenthrough.
4-Bloodtest
boost immunity
T and B cells activation <2yrs
40_question about pnuemococal vaccine 13 how it work.

41-down syndrome child was ok with no sickness brought toemergency as he
became Unable to ambulate ithink !But found in ER quadriplegic asking what the
reason is,
1-atantolaxatlantoaxialjoint
2-cp 3-
42-L.p reading done three times with these results color

dark!Proteino.4(normal1.4gm), glucose2.6wbc10.Rbcs9000
1-TB,
2-viral infection,
3-traumatic taping
subarchnoid haemmorage,
43-22deletion asked what is the other association?

1-thyroiddysgenesis,
2-hypopituitarism,
3-iodinedeficiency,
4-parathyroidhypoplasia
44asking about there as on behind the need for making modified cow mild for
preterm in stead of givin git directly?
1-due to high fàt,

2-high carbo,
3-high case inway,
4-high ca
5-Hi phphosphate???

45-PT with feature so f SLE! child would like to know the best test for diagnosis?
1-anti-DNA,
2-antiRo,
3-anti-neutrophilantibodies,
4-RF
5-Anti double strand DNA
46-Scenario of patient around 7/12 came to ER distressed with affected saturation

can't remember exactly,found to have lt sided pansystolic murmur his CxR showed
congested lungs spo298%with cardiolmegaly asked about the pathophysiology
behind the scenario;different options;
1-left to right shunt with low pulmonary resistance and high pulmonary flow!
2-LargeVSD
3-Rt to lefts hunt
4-Eisenmengersyndrome
?????
47-Scenario of around 5yrs child with brain stem tumour post shunted
hydrocephallus,post chemotherapy and radiotherapy Ithink parent saware of his
prognosis,told you he feel difficulty when given water orfeeding orally!Seemedto
be inpalliative stage!Itisabout
insertingforhimNGTashisparentsdon'tpreferNGTthinkingwillbotherhimmore!!heis
chokingwhendrinking
1-tell them if hedidnothaveNGTwithdehydratetodeath,
2-givehim.hisfeedingthroughparenteral!, 3-continuehiminchemotherapy,
4-tellthemNGTwillnotirritatehimetc..
5-Prevent aspiration pneumonia?

48_12yroldwith historyo of headach and nocturnal eneursis for1yrNA133 k3 cl80
glucose5....urineNa90k5Cause of diueresis
1-LackofAldosterone,
2-D.I,
3-SIADH,
4-D.M,
5-psychogenicpolydipsia
cerebral salt wasting
49_Mech of k depletion in DKA
osmotic diurisis
Insulin therapy
50.Mechof CGH (coperative genomic hepridization )?

compair pt DNA with control DNA
51.Cystic fibrosis FEV1 1.39 FVC 1.9
FEV1(-2.3SD)FVC-1.3SD
Interpretation
Obstructive with insignificant
restrictive Restrictive
Mixed
52.Father 55 mother 25 down?

maternal nondisjunction
Paternal nondisjunction
Unbalanced
Balanced

53.Mechanism of phsiological anemia of newborn
decrease EPO/folic acid depletion
54.Girl with lt lower pansystolicmurmur andpulmonary plethora,heptomegaly

mechanism? decreasesd
including pulmonary vascular resistance increased ordecreased within cord

ecpulm blood flow and lt to right shunt
55.Mechanism of retinopathy of prematurity
Heroxia ,,Then hypoxia ,,ischemia then leading to new vasculaization
56.Mech of
phototherapy
isoisomerization
oxidationof
bilirubin
58.Aneuploidy?
47xyy
59.Gram negative dipoloccoci?
Neisseriameningitidis
60.Got one asking when sleeping y decreased oxygen requirement by15%d
increaseairwayresistance
Vqmismatch
Decreasediaphragmatic activity
Physiologicalapnea

61.28weeks nono with transepidermalis
Sweat gland appear before 24weeks
pain ccur
hypernatremia
62.Onequestion regarding leukemia prognostic factor?
Cytogenetics or other options
63.aAdjustment of ventilator setting question

Ph
alkalosis
Po2 8.5
Pco2 4.5...S Rate was60Ithink
And one option decreases to 50 Iamnotsure
64.boy with stridor?
This is due to (extra thoracic lesion/intrapulmonary lesion/extrapumonary
intrathoracic
65.Mother Chronichep C
What to advice
(Cs/putbabyunderobservationafterdelivery/giveIVIGtobabyafterdelivery/normal
vaginal/nobreast feeding)
66.Cause of brain oedema in DKA

Rapid fallinglucose
Severeacidosisph
<7Inadequate fluids

67-newborn well and thriving with NA155 osmolality 325urine NA 90with normal
urea and creatinine
options 1puv 2SIADH 3FABRICATEDilness
68-pt with tachypnia spo290 % given salbutmol neb spo2became89%

Optionventolinnoteffective,ventolin perfusion mismatch, worsening asthma or worsening pneumonia
69-pt came with meningitis with lab features of SAIDH
70_2scenarios about innate and humeral immunity
............................................
71/Mother with GDM .down syndrome Related Congenital anomaly.
Trochlear nerve palsy

72/Obstructive sleep apnea diagnosis
Polysomgrqphy
Orsaturation at night
Ithinkthisfop
agenesis.Sacral
lt microcolon synd,
(Ithinkthisfop)

TAS 3.10.2017
EMQ
1-From where is each of the following secreted
1/LIPTIN for satiety
2/SOMATOSTATIN d cells stomach inhibit pepsis and acid

in pncreas inhibit insulin and
glucagon
3/GHRELIN small intestine,antral cells, epslon of pncreas, hypoth
Options:
Adipocytes
Delta cell in pancreas
Alpha cell in pancreas
Hypothalamus
2-Genetic tests:
MICROARRY (&methylation 1st)
FISH
DNA TESTING
AUOTOZIGOUSITY
a/ -6YS OLD , CLEFT PALAT , SPEECH DELAY , MICROCEPHALY ?

- b/ 6 MS , VELCARDIOFAICAL ABNORMALITY ?
c/MISCARRIAGES BEFORE , WITH CHILD E MULTIPLE
ABNORMALITY?
3- NAME OF DRUGE With THE FOLLOWING ADVERSE EFFECTS:

RESPIRTORT DEPRESION , APNEA , HYPERPIREXIA PG
- OLIGO HYDRAMINOS , RENAL IMPERMEINT , INHIBATION OF
PLATLETS AGGREGATION ? ibuprofen
HYPONATREMIA , NEPHROLIOCOSIS , METABOLIC ALKLOSIS ? furo
- OPTION:-
a/DEXAMETHASONE
b/DOPAMINE
c/VANCOMYCINE
d/MORPHINE
e/ PG E2
f/ SILDENAFEl
g/MORPHINE
LIPOSOMAL AMPHETIRCIN
4-
INABILITY TO CONCENTRATE URINE AFTER VASOPRESSIN V2

RECEPTOR DEFECT?
EXCESSIVE WATER INTAKE AFTER DIAGNOSIS WITH

CRANIOPHARINGIOMA?
LOW NA , LOBAR PNEMONIA?
OPITION:
CENTRAL DI
CYSTIC FIBROSIS
Nephrogenic DI

SIADH meningitis, encaph, ICH, GBS, tb, THYMOMA,LYMPHOMA
5. Mechanism of action of:
Ondanstron, hyosine, domperidone
-Dopamine antagonist ==domperidone
-5HT3 receptor --=ondanstron
-5H1 receptor
-Muscarinc antagonist ==hyocine
6.What is the pathophysiology in the following diseases;
a. HbC
b. HbH
c. Hereditary spherocytosis
i. Options;
ii. Qualitative defect in beta chain of Hb ==hb c
iii. Quantitative defect of beta chain
iv. RBC membrane reduced ability for oxidative stress ==spherocytosis
v. Deficiency of alpha chain ==hbH
vi. Excess of alpha chain
7.What is pathophysiology behind each of these diseases; choose from the

following options;
a. Immune complex
b. IgA,
c. IgE mediated
d.
e. vii. Newborn with severe thrombocytopenia, but otherwise well
looking ==immune complex ITP

viii. Scenario like HSP ==igA
8.Which type of BIAS is introduced in the following examples;

d. Selection
e. Attrition
f. Sampling not everyone in society had chance for study
g. Reporting
h. Etc.
i. After an RCT the researcher found that there is no difference between
reporting bias
ii. Incompletely filled data sheets=attrition bias
iii. Patients are selected by inviting them through a poster in OPD =sampling bias
9.Which of the following ECG phase coincides with the following;
i. Ventricular repolarization=twave
j. Atrial depolarization p wave
k. Av node conduction PR interval
i. T wave, P wave, PR interval,<< QT interval, J wave, U wave,
10.Which are the drugs of choice in the following situations, (scenario)
l. Stable SVT, = adenosine dec cAMP>>efflux >>hyperpolarization
m. Critical aortic stenosis =prostaglandin E2(E1 NO LONG USED)???
n. PDA in a baby with low plt =Iburofin
i.Adenosine, prostaglandin E1, alprostenol( E2), indomethacin,
ibuprofen
11.For the evaluation of following diseases which investigation should be

done;
o. Congenital hypothyroid
p. Graves disease TRAB
q. Central hypothyroidism
i.TSH, TSH receptor stimulation ,,autoantibodies, TSH,

12.year child with suspected inhaled foreign body, diagnostic investigation?--
Rigid bronchoscopy
- 7 year old child with recurrent wheeze, diagnostic investigation

r. Spirometery > 5 yr if < 5yr>>clinical
-Infant with GERD

s. 24 hour ph study
13.For which organism these drugs are most effective
t. Tazo/piperacillin, azithromycin, amphotericin

i. MRSA ==vancomycin
ii. Mycoplasma pneumonia
iii. Aspergillus fumigatu
iv. Pseudomonas and genta,tobra,aztreonam,merop,cipro,cefipim.ceftazid
14.Out of the following options, choose for the given scenario

u. amylase, Alpha 1 antitrypsin, GGT , Immunoreactive trypsinogen,
i. Secreted by acinar cells of exocrine pancreas amylase
ii. Deficiency Causes disease of lung and liver
iii. Released by obstructed outflow biliary tract
BOF
1
- tarnsmural inflammation with skip lesions.
>>increased lympho, patchy erosions, lymphoid aggregate

2. 6 year old boy with history of upper resp. infection two weeks back
presents with red urine and eye lid puffiness. What is pathophysiology for
the immunological process ; PSGN
subepith humps
a. IgG, IgM mediated mesangial proliferation
3. 5 year old child presents with bowing of legs and renal failure. What is the
reason for skeletal changes;
a. Failure to convert 25, dihydroxycholecalciferol to 1,25 dihydroxycholecalciferol
4. For which of the organism polysaccharide vaccine is present;

a. Streptococcus pneumonae and N.mening
b. H. influenza Hib and typhoid v1>>conjugated
c. Rubella
5. An infant with spastic diplegia, what should MRI would show
a. Preiventricular leukomalacia low IQ and visual spatial space
b. Microgyri
c. Bil dilated lateral ventricles
6. In management of HIE, what is the principle behind therapeutic
hypothermia;
a. Prevent cellular necrosis apoptosis not necrosis
b. Increase blood flow to brain

c. Maintain liver and renal function
7. In normal midgut rotation what is the position;
a. 3rd part of duodenum lies in front of mesenteric vessels
b. Caecum up in front of the duodenum
8. For well thriving exclusively breast fed infant, which vitamin deficiency can
occur;
a. Vit K
b. Vit D

c. Vit B
9. In celiac disease what is the mechanism of injury;
a. Cd4 interact with gluten sensitive-T cells to target immunological response to
gluten
10. CSF of a neonate shows gram positive bacilli
a. Listeria monocytogenes
b. Group B streptococcus
c. Nisseria meningitides
11. What is the pathophysiology for epidermolysis bullosa
a. Inflammation of junctional layer of epidermis causing scarring
b. Inflammation of intra-epithelial dermal layer causing scarring
c. Inflammation of intra-epidermal layer basal membrane without causing
scarring
12. In Primary apnea after birth;
a. Newborn does not breath due to decrease oxygen
b. Lung oxygenation should not be done without chest compression
c. After primary apnea gasping does not occur
13. Mechanism of action of metformin
a. Decrease glucose absorption ,,DECREASE Hepatic glucose production.,,InCrease
insulin sensitivity
14. What is most significant to suspect sexual abuse in child
a. Chlamydia urine infection in 8 year old of girl
b. Swab for type 2 herpes simplex positive in 3 yr old
c. Perianal warts in infant with mother had HPV infection
15. Vit D deficiency rickets;
a. ALP; High, Ca, Phos, Parathyroid levels
b. ca low,,ph low PTH high ALP high
16. Ideal milk formula 100ml , should contain how much of ? a Carbohydrate,
fat, protein(10gm, 4.1gm,3gm) etc 9,6,3

17. 3 year old boy with severe dilated pelvicalyceal system, which investigation
is best to see the obstruction
a. MAG3 scan followed by furosemide
b. DMSA scan
c. MCUG
d. MAG3
18. Mechanism of action of omeprazole;
a. H-k atpase pump blocker in parietal cells
19. Which factor to decrease occurrence of RDS is significant,(Confidence
interval )
significant
a. Birth wt (1.027-1.567)
b. Antenatal steroid(0.987-1.556) non significant
20. How to calculate corrected QT interval;

a. Measured QT/ sqaue root RR
21. Cold Water instillation in rt auditory meatus cases deviation of eye in
which direction;
srt ipsilatral devation &lt nystagmu
a. Righ eye position<<rt, left, middle>> , fast component of nystagmus << rt,left,>
22. 3 months old baby is on standard milk formula, mother notices that baby is
pale;
a. Hb; 10, MCV; 85, Hct; 33
i.Physiological anemia of infancy
23. In Non REM sleep what happens;
a. Increase RR REM ALL INCREASE EXCEPT MXS TONE DEC>>NIGHTMARE
b. Increase HR NON REM ALL DEC EXCEPT AIRWAY RESIS DEC AND
MS TONE MAINTAINED>>NIGHT TERRORS
c. Increase airway resistance
d. Increase muscle tone
e. Increase minute ventilation
24. In & year old child, Hb; 7.8, which represents hemolytic anemia
a.

25. Baby is admitted with indirect hyper bilirubinemia. DCT is positive, anti
body negative ,mom is O+, baby is A+. What is the immunological reason
for hemolysis(placental transfer)
a. Maternal IgG anti A antibodies
b. Maternal Anti e
c. Maternal anti kell
26. 2 year old child presents with shock and after receiving NS 20ml/kg, the
vital change;
a. HR 185 > 200, RR 45 > 55, BP 80/60 > 78/58, Cap. ref. time 3sec > 3sec
b. What is the reason:
i.Poor myocardial contractility
. Depletion of intra vascular volume
27.defect in DMD: -
Ganglioside deficiency
DYSTROPHIN GENE
28. 3 year old child with acute gastroenteristis is having some dehydration with
RBS; 2.3mmol urine ketones +++. What will be the expected value of the following
a Low insulin, high cortisol
b .low insulin ,high ammonia
29.Which of the following is gram negative diplococous

d. Neisseria meningococcus
e. Group B streptococcus
f. Gonorrhea
30.Which is the main site of CSF production
g. Choroid plexus

h. Arachnoid villi
31. 6 months old child is presnts with tet spell(scenario), having no mummer
right now. Mum says that such episodes used to occur at home as well, when
child turns blue, draws legs towards chest. What is the cardiac lesion;
i. Over-riding of aorta
j. Ventricular septal defect
k. Right ventricular hypertrophy
l. Rt ventricle outflow tract obstruction.
32.Mechanism of action of theophylline in asthma

m. Phosphodiesterase inhibitor
n. Anticholinergic
o. Increase CAMP
p. Increase NO
33.How Antenatal steroids decrease RDS

q. Increase in number of type 2 pneumatocytes
r. Release of already stored surfactant
induce endogenous surfactant formation
34. Ten months old boy presents with recurrent infection, petechial rash,
atopic dermatitis, with Plt; 45, WBC;7 x 10, Hb; 13. What is possible etiology;
s. Wiskot Aldrich syndrome
35.For the following pathologies which disease results

t. Defective V2 receptors in collecting ducts nephrogenic
u. Polyuria after cranial irradiation due to meduloblastoma cranial
v. Hyponatremia after pneumonia SIADH

i.Nephrogenic diabetes insipidus, cranial diabetes insipidus,
SIADH
36. 12 year old boy with Duchene muscular dystrophy, is happy to have
tracheostomy with resp support. Parents had one son who died of this disease
and now do not want to have it done with this boy. How decision of
tracheostomy be seen in legal perspective
w. Competence of child
x.
37. How does defective CFTR gene in cystic fibrosis produces the effects
y. Inability to secrete chloride by epithelial cells

z. Decrease Na content in body fluids
aa. Decrease viscosity of body fluids
38.What is the mechanism of action of allopurinol;

bb .Xanthenes oxidase inhibitor
cc. Urate oxidase inhibitor
39.What is the mechanism for functional closure of ductus arteriosus in

immediate newborn period;
-Decrease pulmonary blood pressure causes ductal collapse
-Intimal fibrosis
-Prostaglandin release (decrease the release==increase metabolism)
-Number of Ca influx

40.Which structures are derived from fetal aortic aches;
-Recurrent laryngeal nerve is associated with 6th aortic arch
-Origin of ductus artriosus << from (1,2,3,4,5) arch
-Origin of pulmonary artery<< from (1,2,3,4,5) arch
41. After a road traffic accident, left eye is in the middle, right eye is looking
down and out, which nerve palsy
-Oculomotor nerve
-occulomotor and trochlear
42.Mechanism of action of retinoids in acne -

Inhibit propionibacterium acne (g+ve
anarobic rod )
-Decrease sebum production
43.Spinal muscular atrophy, where is the defect;

-Ant. Horn cell degeneration
-Decrease merosin in muscles
-Selective degeneration of skeletal muscles type 2
-Decrease neuromuscular junctions
44-Which phenomenon is seen in congenital muscular dystrophy

AR
-Genetic anticipation???
-X linked recessive FRIDRIECH, HUNTIGTON, SPINOCEREBELLAR
FRAGILE X,
-Uni-parental disomy
45.In myasthenia gravis, antibodies are seen against;

Muscarinic receptors
nicotinic receptor post synaptic
46. Which fracture is most significant to suspect Non Accidental Injury;

Undisplaced spiral fracture of distal tibia
Clavicles fracture
Metaphysical femur fracture
48. In the treatment of DKA, what can ppt cerebral edema;

-Rapid fall in serum Na levels ??/
49.In ROP pathogenesis;

-Hyperbaric oxygen causes changes then low O2 causes
revascularization MOST DANGEROUS ZONE 1 AND POST ZONE 2
50.Baby diagnoses to have severe post urethral valves at 20 weeks

anomaly7 scan. What can be immediate serious risk after delivery
-Pulmonary hypoplasia
51. When to give Hep B immunoglobulin within 24 hours of birth

-Hep B s antibody and Hep B e antibody is positive
heptitis Be antBODY+VE(ONLY case no need for ig
see sop415
52.Why clindamycin is used in Toxic shock synd
-It suppresses toxin synthesis
-suppresses RNA synthesis

53.Which of the following enzyme deficiency cases vomiting, fasting
hypoglycemia CVS collapse and death in early years of life;
-Galac. 1 Phos. Uridyl transferase
-MCAD
54.The oxygen release from Hb in peripheral circulation is increased by;

-Fever
55.Macrophages come from which cells

-Monocytes
56.Defective role of filaggrin gene, which plays imp role in epidermal

homeostasis, is proposed in the pathogenesis of which of the disease;
-Atopic eczema (also in echsyosis)
-Psoriasis
-Epidermolysis bullosa
57.Which drug is derived from CD 20 molecule in B cells

-Rituximab -Infliximab
-Methotrexate
58.How botulinum toxin injected to release muscle spasm in CP children

causes its effect
-Blocks acetyl choline release from nerve endings

-hydrolysis of acetylcholine at neuromuscular junction
59. Female with day and night enuresis inves:
-u/s post voiding to check for any residual

urine associated with
neurogenic bladder
60. Use of calproctin:
Inflammatory bowel dz
Irritable bowl dz
61. 4.Na channel blocker in contra in Dravet syndrome:

- phenytoin -Na
channelopathy SCN1
gene
(carbamezabinll
valproate

June tas 2017
Acustic .... Pure tone .... ?? Nothing or audiogram Constitutional stall stature ... see equations .. midparental birth>50
1-hearing test in new born =outo oc...child 6 years old=pure tone.....child with hearing aid =brain evoke 1yr>75
2-9 years old child grow in 9th centile for the last 3 years ..what is the growth velocity expected next =5-7cm/ys1-2 yr>12.5/y
>2>>5-7/yr
3-child is over weight ...weight ~99th centile or BMI ~91th centile or weight ~45kg over>91, obese>98, morbid > 99.6
3-correct prescription of trimethoprim in mg or ml with different conc 8 mg/ kg / day divided q 12 hr 40 mg / 5 ml)
4-child with eczema his mother noticed lymph node in posterior cervical what to do ...reassure and discharge or
reassure and follow with investigation if persist after 3 months 2 wks
reactive lymphadenopathy >reassurance& discharge
5-6 week infant with jaundice and clay stool INR 5 what to do ...IV or oral or IM vit K or fresh frozen plasma or
cryoprecipetate
answer vit k IV
high
|
6-csf with 30 neutrophil and 30 lymphocyte ...protein 1.6 glu 1.4 and 3 weeks history of irritability 6. survival; partially
EMQ treated meningitis
mayb herpes>>low glu

7- csf done 3 times and RBC 9000=SAH
neut=lymph or post head trauma lead to intracranial hge
Thrombosis lead infarction area easy to oozing and bleeding
8-chid 7 days fever with couph

and red eyes =PERTUSIS ttt erythro
9-vancomycin overdose after 24 houre in 10 days infant = side effect intrstial nephritis after 1 week neutropenia
10-vancomycin mech of action=cell wall disfunction
11-omeprazole mech of action = ppi(h-k ATBASE)
12 -y descent in jagular venous pressure is for opening of what ? opening of tricuspid vave
13-second heart sound is represented with what in ECG T wave
14-child with burn with sever pain and screaming Morphine IV
EMQ 15- child with head injury and fractured femur .in sever pain nerve block avoid opioid in head trauma
16-meningococcal prophylaxis in 1 month old child=cipro ...and girl taking COP=cipro ,,,and pregnant female=ceftrixone
age ciprofoxacine
ciprofloxacin
17-chemotherapy SE abdominal pain...glucosuria= Dexamerhasone...constipation =vincristin..

--> ciprofloxacine
18-infection ass with T cell dysfunction Di George not to give rifampicine
c1-4>>encapsulated and rheumatic dse
19 -infection with complement dysfunction Nisseria in C5-C9 -- --> ceftriaxone
20- gram -ve bacilli..=e coli...gram +diplococci.=g b streptococi /pnmococi...gram -ve cocci =nesseria, moraxella
21-emberyological defect in digoerge syndrome 3,4 pharyngeal pouch
22-element in cytochrome oxidase help in utilization of iron Vit . C & acidity Increase
absorption/////??????????copper?????? or hipcidin
VIT D if immediate decrease absorption tea, anti acid, poi
action
=PTH
23-help in ca absorption from kidney and gut frequent seizures fat soluble vitamin ADEK
24-child wih macrocytic aneamia and rickets and bruises and dry skin what is the operation lead to this vit B 12 Iliac resection
25-15 years old girl with paracetamol toxicity level at 4 hours is below threupetic treatment she denied any prop problem
lem at home ..ask her if she is pregnant or do pregnancy test or discharge

ask if she pregnant, as giliak she iscompetent for consentadmit and referred forsocial & CMHC
26 -brain dead child and his family refuse removal of live assisstence who can consent family, health committee/VS COURT -
> ifarguing ethic committee or refer to psychiatry
27 child need appendecectomy come with his grand parents who will consent consent by senoior, consultant .. inform mother by phone
28-newborn his mother has bruise around her eyes and older sibling in social service records what to do ->Social services/VS Midwife
29-DKA you give saline bolus what to give next NS inf then Insulin infusion If acute harm ->call police
30-hormone deficiency in DI =ADH

31-light reflex when light to LT eye RT contract and LT NOT CHANGED when light to RT eye RT contract an
d LT unchanged =Lt oculomotor injury
32-where the defect in homonymas hemianopia=optic tract/radiation ...bitemporal hemanopia=chisma ...lower
quadrant homonymos hemiano pia .upper obtic radiation/parital..TAKE CARE IS IT RT OR LT LESION
33-statistic was 7 question 2 is direct and rest is strange
34-7 days old boy with glucose 1 and insulin 15 if insulin high > do C-peptides if high insulinoma.. if low exogenous
35-First investigation in celiac disease IgA tTG

36-DNA part which contains genes exon... And the part separte exons not contain genes introne.... Cell have half
of chromos ome haploid/gamitocyte
37- Child on penicillin prophylaxis from 4 months come with sever tooth decay the dentist said this because of p
enicillin what should u do?? stop drug or change to sugar free penicillin or ignore dentist opinion
38-Pathophysiology of myasthenia gravis there is no option for anti ACh receptor antibody i shoose decrease in
motor nerve conduction EMG IS TRUE and tensilon test
39-case about treatment of the EEG choatic appearance > infantile spasm ACTH or >>hypsarrythmia
vigabatrin ?? stop analgesia ..
rebound headache
EMQ 40-tention headache and take paracetamol and morphine no improvement ..what to do next analgesia not more
41-child has fever 39 and his limbs shake stop when you hold them ...mainly rigor 3 time/ week
42-monoclonal antibody for ,,res sensitial virus=plavisumab and TNF =inflaximab adlilomab and IgE
omalizomab
43-child with itchy rash and swelling around eye completely disappear next day his mother has swelling around
her eyes when exposed to pollens Allergy .. atopic dermatitis
44-lamotrigene side effects skin rash up to SJS, renal stone diplopia,sleep dist
45-test supporting diagnosis of rheumatic fever ASOT
46- Effect of 6th Nerve lesion (horizontal diplopia)
47-drainage site of coronary sinus .=rt atrium....ductus
venosus.=ivc..
45-EMQ about lung function interpretation and diagnosis
46-EMQ about cardiac catheter diagnosis
47-child with hypothyroidism on thyroxin replacement and get high dose by mistake what is the clinical sign of
toxicity =any sign of thyrotoxicosis sleep disturbance and
irritability
48-short stature ..what is initial step...midparental height
49-child 4 month with abnormal head shape prominent RT parietal and LT occipetal Plagiochrphaly
50-mode of inheretance in case of prader willi=imprinting....myotonia OD....rickets in child and her mother have genu valgum
= X linked dominant hypophosphatemic
rickets
51- what is the defenition of genetic imprenting =Gene copy from only one parent
52-child need pyloric stenosis surgery his mother on methadone for opioid withdrawl program and both child an
d mother in foster care.....who can give the consent
Mother can give

consent

53-DRUGS ,,,Ca antagonist .=verabamil,,...B1 antagonist =atenolol,,,,non specific adrenoceptor
agonist=adrenaline
54-drugs ,,,,anti proteinuria=ACE . INH.,,..potent vasoconstrictor ==Angotensin 2
55-child vomiting And hypokalmic hypo chlormic alkalosis I think pyloric stenosi loss of acid from stomach
56-child need urgent blood transfusion his parent told u that his blood group is A +ve ...what type of blood grou
p u will use O -ve
57-case with heamolytic ureamic syndrome what u will find in blood film =fragmented RBS schistocyte
58-what is the difference between renal and pre renal renal failure =survival table NA in prerenal < 10-20 and renal high
59-drainage site of CSF arrachnoide villi
60-nitric oxide actions Cyclic Gmp=
61-LT eye ptosis with normal eye movement and normal equal pupil size... = elevotor papilliae superior
muscle sample paper same
62-Ramsay hunt syndrome...type of lesion Lower motor neuron lesions of cranial n from hepes lesions nerve vii and viii
63-Exitatory neurotransmiter GABA, glycine are inhibitory .. the rest are excitatory main exitotory glutamite A.CH
64-pathophysiology of ITP =anti platelet antibody Glycine is excitatory
centrally and inhibitory
65-neonate with hypoxia improved after O2 head pox cause? ?? respiratory causeperipherally
66-mech of hypersensitivity after peanut ingestion IgE
67-Layer affected in staph scaled skin syndrome=granular layer
68-Child with UTI prophylactic drug & developed jaundice G6PD
69-Case of neonatal jaundic & pale stool .. Most likely biliary atresia .. What is first investigation first step ---> bilirubin
total&directmost accurate ---> US or HIDA
1. serum bilirubin
70-cyanotic spells of fallot ... Increase systemic resistance terminate it morphine to relieve pain and to
2. US
release spasms of infundibulum 3. HIDA
71- SSSS given ceftriaxone why need to add clindamycin =anti toxin
72-Whole class having sever watery diarrhoea with presence of ova in stool. What is the organism Giardiasis
73-Mechanism of anemia in parvovirus =RBS progenator in bonemarrow(red cell aplasisa)
74-About the 12 years old child with hyperglycemia .. His father & grandfather had DM when they were 22-25y
ears... Mechanism of this MODY non obese
75-DKA...what increase in the blood....ketone
76-child after appendectomy increase heart rate and prolonged capillary refill...what is next step give bolus NS for
shock
77-case with hyperammonia & normal glucose UCD mainly if no acidosis.. may OTC
78-what is inhibiting protein catabolism anabolic to muscle ( growth hormone,,,insulin

,Testesterone ,ILGF)
79-diet after kasai operation for biliary Artesia; medium chain triglycerides ,high protein, fat soluble vitamin.
80-Collapse after playing football.. Investigation long QT syndrome for ECG

81- Hirshsprung.. The deficient cells ganglion cell
82-Splenomegally & dilated veins on anterior abd wall.. Site of lesion .. Portal vein capital medusa in portal HTN
83-Protenuria & haematuria after throat infection .. Post strept glomerulonephritis.. What is the finding of immu
noflorescence microscope discete granular deposit of IGg and c3 in capilary loop and mesengeal
distripuion(light microscopy) in electrone microscopy hump in subepthilum
84-there was a pedigree and want mode of inheretence
85-case with foul smelling stool undigested vegetable will child and open her bowel 3 times daily grow on 9th c
entile ...management =GARDIASIS V/S TOLDER DIARRHEA

86- case with soiling and since he start school and start to refuse also to do at home.... afraid of school toilet
87-Hand preference at 9 months with normal development her father use the same
hand( Less than 1yrs red flage sop)
88-Case of absence seizures and ask about ch.ch EEG finding =3spick andwave per
second if rolandic>>centrotemporal
89-Best measured by parametric tests.=normal distripution (measure mean),, in non parametric used for not
normal distripution( measure median )
90-Definition of obesity .. option obesity diagnosis
Wt > 99th centile BMI
> 91st centile cant
remember the rest
WT > 98% Mrbid
obicity99.6%
,,BMI >30
91-EMQ Asthmatic child on high dose of steroid inhaler. .not controlled. .appear less than his colleque is same
class and also Asthmatic.
Ans :do short synacyin test
92-child have stony dullness in lt lower zone of chest .. chest us
93-baby with doubtful dislocation dislocation of hip what to do ? u/s if
less 4 -6 month (case tas p 127)
<10 yr>perth
94-Child present with limping and failure to abduction of hip following sport = perthe disease ,,SUFE(Sport, >10 SUFE
,obsce ,age)
95-14 yrs girl has obesity and tall for her peers, with breast development stage 3
what to do ?
MRI Brain
Do lft.lipd profile.
life style and wt management Correct answer
refer for assessment by dietician
96-Child sizable 4kg. .before discharge nurse discover the is no movement in rt arm..what you do?1/ clavicle X-ray 2/
answer of one with 100% in neonate
97-Child with severe eczema interfere with his daily life mother keep dairy milk what to-do next ?
1% hydrocoticosone or topical tacrolimus ?????
may be cmpa
98-EMQ hearing assessment neonate
... brain evoked potentials / outo
ocoustic emision
5 or 6 years PTA = pure tone odumetry
HEARNING AID ... either speech discrimination or parents questionarre but i am not sure
99-girl with short stature and learning disability what investigation to-do
Karyotype for turner
100-EMQ Hematology
baby taking cow milk .. serum ferittin or iron low and TIBC high for iron
deficiency anemia
baby with HUS blood film = look for fragments cell
baby and his sister have pica= lead level or abd X-ray paraaortic Ln
^^
101-baby have testicular enalargment nd inguinal lymph node or testicular malignancy ???
102-Child presented with pallor and abdominal distention what investigation to do ?
Celiac tissue trans-glutaminase IgA

103-4month presented with fever and vomiting weight loss, what sign if there make urgent refer is needed .... i c
hosse drowiness ... but not sure
104- BOF case og polyuria and polydispa wt loss ... investigation ?? Blood glucose
105-BOF of child with whezee with infection ,, family hx of atopy and asthma ,,, clear chest ... i choose reassure
this is viral induce wheeze
106-CP child with gastrostomy NA 190 normal K ? I choose Fabricated illness ???? if disturbed conscious>>salt poison

TAS Feb 2017
Time 2.5hr
EMI 14
BOF 61
1. Diagnose DM type 1 Vs DM type 2

Anti GAD ( no option for c-peptide )
2. Reason for hyponatraemia in PDA infant?

-Used diuretic for treatment for heart failure
-ANP
ANSWER OVERHYDRATION
3. Action of insulin ;
- causes lipolysis, glucogenesis and glyconeogenesis
-fat deposition in cells , glycogenesis,and
LIPOGENESIS GLYCOGENESIS- GLUCOSE UPTAKE ,PROTEIN SYNTHESIS-
GLYCOLYSIS- INC UP TAKE OF IONS AS K+

2. A senario of a female with blue eyes and dislocated lens (describing features that
was clearly homocyctinuria) what investigation will you do to reach the diagnosis -
amino acid level tall, acrodactyly, joints stiff,thrompocytpsis, venoocculosive dse
Homocystinuria: elevated total homocysteine in the blood. A plasma amino acid profile reveals
hypermethioninemia.
4. A baby who has TAPVD with bilateral diffuse shadowing on CXR ,what expalins these CXR
findings?
a. Obstruction b.PHTN c. pleural effusion d. poor venous drainage
e. ? intracardiac left to right shunting
OBSTRUCTION

5.Tuner syndrome
a. Robertsonian translocation b.non disjunction C Uniparentral monosomy
d. methylation defect. e. microdeletion
NON DYSJUNCTION(ANAPHASE LAG) IN MIOSIS 1
6. Which one is absorbed in duodenum?
a. iron b.folate c.pyridoxine
IRON
7. Level of evidence..
a.Meta-analysis, RCT, case series, case repots,
b.systemic review- RCT- case series and case reports
wash out NO
8. In patiensts with pneumothorax , giving high O2 support
a/.to decrease resp effort b./increase o2 supply to brain c./decrease cardiac load
D/. NITROGEN WASH AND CHANGING INTRATHORACIC PRESSURE
9. Mechanism of action of Methotrexate
- INHIBIT DEHYDROFOLATE REDUCTASE(it ihibit cell synthesis BYinhibt DNA by

antifolateredactase enzyme inhibit tetraphosphate which involve in syntheses of thymidylate
essential component of DNA)
10. Mechanism of action of proton pump inhibitors
binds irreversibly to a hydrogen/potassium ATPase enzyme (proton pump) on gastric parietal
cells and blocks the secretion of hydrogen ions, which combine with chloride ions in the
stomach lumen to form gastric acid. PPIs block secretion of hydrogen ions into the stomach
11. Mechanism of action of ethanol in alcohol toxicity

ihibit alcohol dehydrogenase
12. Mechanism of action of dobutamine

a. B2 agonist b. B1 agonist c.alpha and B agonist d. alpha agonist
Dobutamine is a sympathomimetic drug used in the treatment of heart failure and cardiogenic
shock. Its primary mechanism is direct stimulation of 1 receptors of the sympathetic nervous
system
13. Mechanism of action of azithromicin ==mRNA
inhibits protein synthesis ( antiribosome 50 )--clarthromycin and erythromycin=p450 in sop page
702

14. Mechanism of action of adenosine
a. block conduction through AV node b. block conduction through SA node(sop 360)
negative anotropic and chrontropic action
15. where is the defect in SMA

anterior horn cells
16. aPTT high, ratio 2.5, platelets 15 , K 5.9 and high renal function test , fibronegen 0.5 , low
platelets
a. DIC b.HUS
17. which of the following depends on a patent Ductus arteriosus to maintain systemic
circulation
a/. critical pul stenosis b./critical aortic stenosis c/.tricuspid atresia
d./Ebstein e/.TAPVD
18. coeliac is associated wih

a.HLA-DQ2 DQ8 b/. HLA 27
Behket ----DR b5
19 . prem formula in comparison to term formula contains :

-Highercarbohydrate, high fat, high protein
HIGH PROTIENS
HIGH CA- PHOSPHATE -VITAMINES - MINERAL

20. why do patients with liver failure have low Vitamin K,, dependent vitamin ?
a. bile acids b. chylomicrons
21. what type of hypersensity is involved in manteaux test.?

-type 4 hypersnsitivity
22. syrngomyelia at T6
bilateral a/.loss of pain &temp below T6 b./ loss of propioceprtion and vibration below T6
in spinal cord lesion ipsilatral proproceptive & vaibration and contralatral loss of pain and
temp(spinothalmic tract)
23.vigabatrin is known to cause
a. visual field defects b. night blindness
24. in neonatal jaundice , which one is true

a.breast mother milk increase enteroheptic circulation(beta glucorinidase cause increase in
enteroepatic circulation ,, increase pregnandiole)
b.increased urobilinogen if cause is biliary atresia
25. family pedigree

-?autosomal dominant
26. Diagnosis of duchenne is by:.

a. DNA b.nerve conduction c.muscle biopsy d. CK level(initial)

(genetic testing is diagnostic muscle biopsy no more use)
27. In which of the following should irradiated blood be used in :

a.Hodgkin lymphoma b. Nephroblasoma c.Neuroblasoma d. leukemia
guide line heamatology stage 4 neuroblastoma hodgkin lymphoma,,scid,donner and recepiant of
bone marrow transplant ,,
28. bilateral dilatation of renal pelvis , normal bladder without ureteric dilatation.
a. Pelviureteric reflux b. PUJ obstruction c. VUR
29. patient presents with drooling of saliva , what will his gram stain be?
a.gram -ve coccobacill b. gram -ve diplococci c. gram positive bacilli
HIB
30. pt has diarrhea then had resp infection later, heart rate 110,hypertension, muffled heart
sounds. What is the most likely organism
- coxacki virus (dilated cardiomyopathy) and adenovir
myocarditis
if Upper --- parietal, Medial
31. Left upper quadranopia cause by lesion at
a /.lateral geniculate body b./ right lower optic radiation
Temporal OR Lateral
32. Which antiepileptic should be avoided in absence seizure

-carbamazepine .
if myclonic avoid carbama and lamotri
33. A child who has vomiting and hyperammonia what investigation will be found in urea cycle
disorder
a. low urea b.hypoglycemia c. metabloic acidosis
34. A drowning kid , taken out after 15 minutes and a blood gas was done immediatley, what
will it show?
Diving Reflex
a/.mixed resp n metabolic acidosis with hyponatraemia
---bradycardia and
b/.respiratory acidosis , normal souim apnea reflex hypoxia
and acidosis,
tachycardia,
laryngeal spasm, mixed
resp and met acidosis.
35. The question about ABG ...I answered normal value dilutional hyponatremia

36. Otoaccoustic emission
sounds of cochlear origin, which can be recorded by a microphone fitted into the ear canal. They
are caused by the motion of the cochlea's sensory hair cells as they energetically respond to
auditory stimulation.
37. defect causing

-is caused by defective numerical migration of neuronal cells
38. foot drop..common peroneal nerve vincristin and charcot

marrie
39 trochlear nerve injury ..the eye inferior &lateral superior and latral
40 .effect of glucagon ..glycogenolysis,gluconeogenisis..lipolysis
41. How does Iv salbutamol cause hypokalemia ?

Intracellular shift of K act on NA K ATPase
42 . Insulin action on K : it moves potassium intracelluarly cell
43 CSF with high WBC mainly lymphocytes , high and protein 4gm, sugar 1.6 mmol/l ..child is
not in his being for some.days disoriented and cannot walk....
a. TB meningitis
i did encephalopathy otion confuse bywn tb meningitis
43. How does Diaphragmatoc hernia develop ?

a.peritophreno canal failure b. failure of Morgagni c. failure of gut migration
pleuroperoteneal canal with or with out defect in diaphram it self
44. order of potency of steriod creams;dermovite then betenovate emovate hydrocortsone
(other name clobetazole+diphleocortilone,,(in sop =490))
-hydrocortisone eurmovate then dermovate
45.TGA ..failure of migration of neural crest cells? sop 345

in 4&5wk neural creast migrate
grave>trab>tsh low>t4 high
central hypo>all low
tsh high ansd t3 low>> agenesis >>no goitre or dyshormon>>goitre
46. Neoante , found to have giotre, TSH high , free T 3 low, what is the most likely cause?
a. a.central hypothyriodism b/,pituatry c.maternal anti TSH anitbodies
d. materanl anitthyroid antibodies e./ some enzyme defect thyroid biosynthesis
dyshormonogenesis
47. patient who devepoled sudden renal impairement and was admitted to the ward, should
avoid which medication?
-ibuprofen omeprazole,vanco,NSAIDs, ACE
48.labs in hemorrhagic disease of the newborn

-prolonged aPTT and prolonged PT
49.a senario of diarhhea, decreased urine output and low platlets

-HUS Typical HUS
50.patient who has seizure disorder, on desmopressin for nocturnal enuresis,

Na 121 , K 5.9 cortisol low
a.failure of adrenal gland to produce mineralocoriciods and corticosteriods??
b. excess desmopressin
51. adolescent came with vaginal discharge, found to have clamydia, which treatment shoul she
receive?
single dose
-azithromicin
52. cath results , showing RV 77% ( and high pressure in RV ) . LV 88% , others are normal
a.VSD with eisimenger b. TOF
53. a senario, then he tells you ECG shows QRS axis between 280-340
a. AVSD b. PDA c. ASD

54. senario , with results of water deprevaition test ( low urine osmaolarity that fails to be
concentrated , even after giving dessmopressin , so it was nephrogenic DI, ) and the question
was what is the cause?
- end organ restant to ADH(receptor defect for vasopressin)
-
55.a senario of Fanconi syndrome
56. patient with hypoclacemia . hyperphophatemia , low PTH, normal ALP

-? hypoparathyriodism
58. another senario that was fanconi syndrome but the question was
a.failure of reabsorption of HCO3
b .failure of secretion of acid in
59 . In a study with 1000 patients, 10 tested positive, 2 of them were found to have the disease,
and from the rmaining 990 none were found t have the disease.
calculate the positve predictive value
a. 0.2 % b. 20 % c. 2 %
EMI
1.choose a Drug for the following side efects
a.hyperglycemia and something about affecting IQ when used in neonate less one week of life?
Dexamehasone
b.Causes hypotension bradycardia apnea and urine retention...morphine
c.renal and Liver toxicity with thrombophlebitis of vein.it was amphotricin
2. Statistics
1. Sensitivity

2. Specificity
3. Positive predictive values
4. Negative predictive value
5. Risk ratio
6. Likelihood risk
7. Odd ratio
8. False positive
9. False negative
specificity
10.Relative risk
a. probability of negative test among those without the disease=. Negative predictive value??
b. probability of outcome in the treated group divided by the probability of outcome in the
RR
control group in a RCT ( randomised control study )= Odd ratio??
c. I can't remember the last one but it was something like probability of positive test in those
who test positive with the disease ?? . Positive predictive values??
3. Also another set of drugs with side effects

a. Nephrotoxic = ibuprofen
b .Hepatotoxic =methotrexate
c .Growth retardation =prednisolone
4. Respiratory graph (graph given ask to label)

a.tidal volume
b.functional residual capacity
c.FEV
sop 322
5. From where is each of the following hormone secreted

a.melatonin hormone secreted by pineal body

b.glucagon secreted by alpha cell of pancreas
c.calcitonin secreted by thyroid(para folicular cell)
6.Immunology: he gave a descrptions of cells and wants us to choose which cell does the
a. ?? IG E..mast cell degranulation

b. ? produce cytokines: Cytokines are produced by a broad range of cells, including immune
cells like macrophages, B lymphocytes, T lymphocytes and mast cells, as well as endothelial
cells, fibroblasts, and various stromal cells; a given cytokine may be produced by more than one
type of cell
c.??antigen presentin , MHC ?1?2..involved in malignant and infalmmed cells?
( all these I am not sure , Iam just trying to remember )
7. In fetal circulation how does each of the following happen

a.closure of foramen ovals ..due to increase pulmonary venous flow
b.closure of ductus arteriosus..due to decrease in prostaglandin
c. increase flow to lungs
Changes at Birth and the Transitional Circulation At birth when an infant takes its first breath,
the lungs expand and the pulmonary vascular resistance f a l l s rapidly. As a result blood starts
to flow into the lungs and the increased pulmonary blood flow back to the [eft atrium causes
functional closure of the foramen ovale. Occlusion of the umbilical cord removes the low
resistance capillary bed and results in an increase in the systemic vascular resistance. Functional
closure of the ductus arteriosus usually occurs within the first twenty-four to forty-eight hours
after birth and is facilitated by the loss of pro"staglandins from the placenta, reduced sensitivity
of the ductus to prostaglandins and an increased pO2 after the onset of breathing. Anatomical
closure of the ductus arteriosus usually occurs within 3 w e e ks. Prior to birth the pulmonary
blood vessels have a thick layer of smooth muscle, which plays a key role in pulmonary
vasoconstricton. After birth, this muscle begins to thin and becomes less sensitive to changes in
oxygenation. Any clinical situation that causes hypoxia, especially in the first few hours of life,
with pulmonary vasoconstriction and a subsequent increase in pulmonary vascular resistance,
can cause a delay in these normal circulatory changes potentiating right-to-left shunting across
the ductus arteriosus and foramen ovale. This is known as persistent pulmonary hypertnsion
8.interpretation of gentamicin level

a. pre dose high post normal: same dose increase interval
b.pre dose normal post high: same interval reduce dose

c.pre dose normal post normal: continue same
9. Asthma medication
a.long acting beta agonist flumertol
b. leukotriene receptor antagonist-montelukast
c.phosphodiesterase inhibitor-theophylline
milironin p diestraese 3 sedenifil 5
10.Immunosupprasant that works on

a.interleuken -1==ANAKERNA =canakinumab=Rilionacept
b.Tumour necrotic factor : interferon=adilumab-=intercept = inflexamab
c.CNI inhibitor : cyclosporine
11.Endocrine
a.6 years girls, pubic hair, genetalia other wise looks normal, adult odour ,tall, bone age 9 years
? CAH ? premature adrenarche non classical type CAH
b./boy, behavioral problems, pubic hair, left testes 3ml, right testes 9 ml ? testiculat tumour
c.3 years old girl ,unilateral breast enlargement, mom thinks it has been there since birth,
otherwise she is normal , abit taller than others
12. Cranial nerves

a.a branch of the trigeminal nerve, has sensory and motor component : mandibular branch
b.the first nerve to be affected in increased ICP : abducnet nerve
c.trauma to one of its brach during surgery causes stirdor: vagus(recurrent larengeal)
13.neonatal infections:
a.2 days old, fever, CSF gram positive cocci : GBS
CONS
b.10 days old,has IV line , blood grows gram positive cocci: staph epi
c.neoante ( senario geiven) grows gram positive bacilli : Listeria

14.
a.nephrotic syndrome , sudden decrease urine output, high blood pressure, urine dipstick :
protein +++. blood ++++ : answer is renal vein thrombosis
b.3 months old, has gained weight slowly, came with sudden vomitting and diarrha for 12 hours
c. ?
not complete
N.B
Breast milk jaundice (BMJ) is the most common etiology of prolonged unconjugated
hyperbilirubinemia in a newborn infant. role of breast milk ,,due o beta-glucuronidase
prevent conguation=
priganadol can ihibit conjugation in breast milk &also fatty acid in milk
Insulin
Insulin is a peptide hormone, produced by beta cells of the pancreas, and is central to regulating
carbohydrate and fat metabolism in the body
Glucogon
Glucagon secretion is stimulated by the ingestion of protein, by
low blood glucose concentrations (hypoglycemia), and by exercise. It is inhibited by the
ingestion of carbohydrates, an effect that may be mediated by the resultant increase in blood
glucose concentrations and insulin secretion.
TAS OCT 2016

TAS EXAM OCTOBER 2016
1. Achild on Chemotherapy & foot drop ...you tell him this effect is ?
Answer = reversible vincristin will causeprephral neuropathy nerve afected common
preneal N
2. Bleeding after circumcision .. Prolonged pt (>100) , normal ptt ...

No factor 7 deficiency was in the answers (Answers included hemophilia A , factor 12 ,
DIC , vit K def , hemorrhagic chickenpox, vWD) ... maybe it's vit K def.. (although pt is
strangely high)
3. Platelet 18 .. normal pt,ptt .. but extensive ecchymosis over chin and forehead and epistaxis
(with parental negligence & child under protection) ..
I choosed Non Accidental Injury ( ITP was in the answers but abnormal bruising sites
allowed me to exclude it)
4. Fever + prolonged pt , ptt , D-dimers > 500 ....diagnosis?
= DIC
5. Unilateral severe Facial pain ... cause?
= trigeminal N. >>ttt carbamazepine
6. Vertical diplopia + head tilting .. cause ?
= Trochlear n. palsy
7. Tongue deviated on protrusion .. nerve injury ?
= hypoglossal N.+5>>same side 7+10>>to opposite
8. Trauma to oculomotor nerve .. effect ?
= ptosed eye
(Other options included : superior medial / superior lateral position of eye .. but all are
false .. eye is downward lateral)
9. pituitary adenoma visual effect ...
bitemporal hemianopia
10. Case .. baby pt 26w with ventilatory need .. causative organism ?
GBS ? GEL>>+ecoli and lesteria late onset seps>>Hib, kleb and amoeba
11. Baby age 26 days + sepsis + on vanco ...
MRSA ?
12. Baby FT after PROM ... causative organism ?
GBS ?
13. hypoglycemia persistent + macroglossia + umb hernia ...
= BWS
14. Most common cause of angelman
= (uni-maternal deletion)
15. FISH ... uses ?
William $
16. Infliximab mechanism ?
= anti TNF-alpha
17. A monoclonal antibody for ttt of rheumatoid arthritis .. asked about mechanism of its action ..
can't remember the name .. but after some search .. mostly it's Tocilizumab which inhibits IL-
6
18. Which drug Potentiate sulfonamide ?TRIMETHOPRIN
19. Young female , Harsh continuous murmur up left sternal + biventricular hypertrophy .. what
clinical sign ?
PDA ? Bounding pulse ?
20. plethoric lung + soft esm ...
fixed s2 widening (ASD)

21. LVH , syst murmur front , Continuous murmur on back
(CoA .. measure blood pressure ?)
22. d/b+d
= Specificity
23. a+c/a+c+d+b
Pre-test probability(PREVALANCE)
24. "b" represents ? systemic review
False positive ?
25. A Statistical study (copied from Pubmed) and asks what have you concluded from this study
26. A statistical study with 3 final Risk Ratios then ask what have you concluded ..
27. A Study written .. what is this study design type ? mataanalysis
case report
28. Closure of PDA due to ...
dropped pulm Vascular Resistance
increase pg metabolism,, increase po2 +increase pradykinin
29. Steps of baby after separation from placenta ?
(Apnea then breath (or vise versa) then bradycardia followed by tachy (or vise versa)
then hypotension (or stable BP) ) ... all these options are interchangeable.. he was
asking about the correct order of events .. not 100% sure of the right answer
sop 178=breath ,,tachycardia primary apnea ,,pradycardia,hypotension
30. 6 Cases of IEM (EMQ) .. 3 asking about diagnosis and 3 asking about investigations
31. How differentiate between type 1 & 2 DM ?
= c -peptide Level( OR GAD)
32. Case with small penis , undescended testis .. what investigation ?
Mostly this is a case of PanHypopituitarism... i think the answer was gonadotrophins
level (no option for cortisol or insulin test or provocation tests)
33. a case of male , 5 years , bone age 9.5 years, pubic hair .. normal BP ( CAH) .. Diagnosis ?
= Mostly Tumor intracranial ?
CAH
34. HUS causative organism?
= (E COLI)
35. Which of these diseases Not has pathogen ?
= HSP
36. Mechanism of DKA ?
No insulin + no glucose consumption + excess FA oxidation and increased KB production
37. Adolescent becomes jaundice after febrile .. mechanism ?
= decreased conjugation (Gilbert)
38. Baby jaundice day 1 mechanism ?
= RBCs destruction
39. HUS Mechanism ?
= toxins disrupt RBCs membrane integrity(Disrupt indotheleal vessel membrane)
40. Clay stool and jaundice .. mechanism ?
= biliary obstruction
41. Snoring increase at what sleep stage ?
Options include (all stages / REM / Stage 1/ Stage 2 / another option ) ... not sure of the
right answer

42. SJS can occur with which drug of these ?
Answer was = Carbamazepine
43. BLISTERS over buttock and nail dystrophy .. What layer affected ?
epidermis ?juntonal -derrm= dystrophic
44. TB patient .. developed Color mixing (color blindness) .. abnormal move .. ?
= ethambutol.
45. Dyslexia , short .. wt 2 centile ... delayed puberty
.. turner / pws / celiac / i can't remember (choosed turner and I was almost sure it is
wrong :D but no other satisfying diagnosis)
46. dystonia side effect of drug ?
Metoclopramide
47. Visual field defects ..
vigabatrinethambutol,desferoxam, hydroxychlorq,oxybutine,amiodarone
48. Milk content which attach to iron and prevent its consumption by bacteria ?..
= lactoferrin ?
49. Milk content which provide beneficial acidic medium for lactobacilli and gut microflora ..
= oligosacch (pre biotic)
50. Cow milk ..
high phosphate
51. Milk content responsible for tolerance to antigens ?
alpa lac albumin--beta lact globulin -casean
52. ABG Interpretation ..
Showed Mixed alkalosis
53. A family pedigree interpretation
XLR
54. Ranitidine acts on ?
H2 antagonist
55. Chlorpheniramine
H1 antagonist citrizine, cyclizine,, disloratidine, loratidine
56. Propranolol
B antagonist(non selective)
57. Adrenaline why used in anaphylaxis .. ?
VC effect
58. k 2.3 , na 135 .. normal cl , normal bicarb
Although of almost low normal sodium ... But by exclusion I think the answer was
Hyperaldosteronism//????
59. teenager , hypoG, hypoNa , hyperK
Addison disease
60. Duchenne in need for mechanical vent but parents refuse because of a previous dead
brother... how to take decision? ..
I choosed to check if the boy is competent
61. Tidal vol of 3kg baby .. calculated (4-6/kg)
(weight*6-7) ..so answer was 18-20

62. Unequal pupil after nebulizer .. diagnosed by ?
pilocarpine

63. Dilated calyces of kidney .. what investigation to exclude upper obstruction ?
Mostly MAG-3 ?
64. Infant + Cough + apnea + occasional vomit ... investigation ?
= nasal swab ? (mostly pertussis)
65. Boy 7 years + Wheezes + mother has hay fever .. what investigation ? major criteria>family hx,atopic dermat
minor>allergic rh, food allerg,essoniphila>4
Choosed spirometry ? one major or 2 minor
66. Vague history of sudden cough / probably FB aspiration last week .. what investigation?
Choosed flexible laryngoscopy ? rigid bronchoscopy
67. Boy + skin allergy resistant to ttt + neutropenia ...diagnosis?
= Wiskott aldrich
68. Defect of chronic granulomatous disease ..
Respiratory Burst
69. Anaphylaxis after eating eggs ...?
= type 1 hypersensitivity
70. TEFmost common type ?
= proximal esophageal atresia + distal fistula between trachea and distal esophagus
71. TOF severity depend on what ?
= degree of RV outflow obstruction
72. Test dislocatablehip ...
Barlow >dislocate and ortolani put back
73. AVSD ..ECG finding ?
= partial BBB in V1
74. Abducent n. Injury , unilateral facial weakness , general examination normal (no fever , normal
bp) .. what is the cause ?
= pontine tumor because 6 & 7 damaged
75. Asian baby with jaundice .. most common enz defect for it in asia and africa ?
= G6PD
76. Which pathogen of these can cross placenta ?
answer = Listeria
77. Case of meningitis + hypoNa ?
Diagnosis = SIADH
78. Mechanism of furosemide (Or some other question related to furosemide)
Na/k/Cl cotransport at ascending loop
79. Mechanism/site of ADH ..
answer = Collecting Ducts
80. Child 9 years , with ALL , What of these give bad prognosis
No options for age / others haploid bad prognosis, L1 better and L2,3 bad
Only "cytogenetics" listed (mostly he means philadelphia chromosome .. so I selected it)
81. Cardiac catheterization interpretation (LV pressure > Femoral ... normal saturations)
.. I choosed "AS"
82. ABG for Mechanical Ventilation .. Low O2 + increased CO2 wash .. how to deal ?
answer = reduce Rate ==increase peep
83. Ichthyosis Vulgaris .. disorder ?
= Filaggrin
84. DM1 , celiac disease HLA association ?

= HLA DQ2 , DQ8 `
85. A history of a condition .. mostly HUS .. what causative organism ?
= E-Coli
86. A case with oligohydramnios , had to go for C.S at 32 w .. most common morbidity?
Answer = Lung Hypoplasia
87. Esophageal Atresia , mostly associated with ( Cardiac / skeletal / anorectal / renal ?
.. He is referring to VACTERL ? .. answer = mostly Cardiac ? ECHO
88. Trisomy 21 presented with paraplegia , why ? ..
answer = atlantoaxial joint instability
89. A chylothorax after surgery .. what is best feeding ?
Use MCT because absorbed directly into portal vein or FFA
90. Retinopathy of prematurity .... mechanism ?

Hyperoxia reduce Vascular Endothelial Growth Factor(hypoxia increase v ef
91. Cutaneous Nerve supply to palm of the hand
Median n.
92. A drug inhibits Bacterial thymidine?
TMP ?
93. A drug of the same family of gentamicin ....
answer = Amikacin
94. Drug used in palliative ttt for excess secretions ?
Glycopyrrolate
95. A case of absence seizure .. drug of choice ?
No option for Ethosuximide ... choosed valproate

June 2016 exam
mixed fop+tas
1. neuromuscular junction receptor >> nicotinic acetylcholine
2. hip dislocation:
1.internal reduction 2. external reduction 3.double pampers*
3. changes in fetal circulation

4. Hb f best of 5 =
work on 2,3DPG and decrease it so shifting the curve to Left and increasing the affinity to
oxygen
5. Hbc,, Hbh ,,spherocytosis ,,,deletion

note
2 or 1 deletion of alpha chain, = alpha thalessemia trait
3 deletion of alpha chain, = HbH disease
4 deletion ==Hb part (alpha thalathemia major)
2 deletion of beta chain, =
B. major
1 deletion of beta chain=
B .minor
electrophoresis, = HbC , HbS
fragility test = spherocytosis EMA TEST(now EMA test is diagnostic)
, abnormal Na channel =???

deravate disease has abnormal NA channel(Mutation) channel A1 gene
6/ statistic: bias information bias,

research from the clinic, =sampling bias
research without publication, = reporting bias
research the forms where not completed =artesian bias -late
look
7. bof diarrhea polyhydramnious >> bicarbonate 28, ph 7.5, cl 89 low Na low,

*cl loosing enteropathy (if there is polyhydraminous with hypo chloremic hypokalemic metabolic
alkalosis this fit with barter syndrome)

8. child has be well until early no fever bruising around the mouth / bleeding from
mouth , low GCS , bruises in abdomen
if social withdrawal>>depression
?? NAI BMI<18
^^
9. abnormal eating habit ( anorexia - bulimia ,, etc )
bmi>18, binge eating and vomiting or diarhea inducing
10. what is the way that children metabolise paracetamol - *sulfation(in neonate)
gluconridation in children
11. . which layer in epidermolysis bullosa symplex >> 1/ junctiona layer with scar,
2/junctional layer without scar,
3/*intraepidermal without scar,4/ intraepidermal with scar
12. pathophysiology of VSD: *1/hyperemic lung lt ventricular over load ,

2/oligeromic lung with rt ventricular overload,,,3/ increase pulmonary blood pressure,
13. *experiment to know the cause of increase MRSA: case control, cohrt,
*randamized control trial
Notes : Observational - prevelance and diagnosis = cross sectional
- common disease , causes , risks , prognosis = cohort
- rare diseases , causes , risks = case control
- association in population = Ecology
14. statistic: experemint 4 CI most statistical seqnificant
15. defenitions :
16. which of the following should measured in anaphylasis ( insect bite):
1/histamine, *2/mast cell tryptase,3/ IgE,
inculation and contarst and unknown ellergene= tryptase is specific

17. antibodies : - responsible of villous atrophy in celiac disease, = anti-tissue transglutaminas
IgA
18. - neonate delivered by CS due to bradycardia which persist after delivery, = anti Ro
- teenager malar rash arthritis red urine = anti douple stranded DNA
18. evoked auto acoustic emission response: 1/*choclear, 2/echo,

3/high amplitude voice ^
19. the test for obstructive sleep apnea: 1/paradoxical movement of

the thoracoabdominal,
*2/desaturation,
3/wake up more than 10
times

20. aortic arches Note :-:
6 branchials , 1 , 2 , 5 dissappear
3 left and right carotid arteries
4 letf - aortic arch , right -,,,,, rt brachiocephalic and rt subclavian
6 left and right pulmonary a. and ductus artrusus,
21. bilirubin characteristic of bilirubin.. phototherapy mechanism

phototherpy will convert the unconjugated to water soluble ^
22. SMA pathophysiology affect which cell>> ant. horn cell
23. pulmonary hypertention: pathophysiology:

pulmonary vascular resistance increase , delay in normal
circulatory changes potentiating right to left shunt across ductus
arteriosus and foramen ovale .
^25.allergic to penicillin + taking carbamezapine: ??! rifampicin, *ciprofloxacin, cefelexine

pastest - effectiveness of oral contraceptive is reduced with enzyme inducer like
( carbamezipine , phenytoin , phenobarb , tobiramite , rifampicin )
26. corrected QT= QT/ square root of RR
27. mode of action of monoclonal antibody

IL6= tocilizumab,
CD20 = rutixumab ,
^inositol monophosphate inhibitor == lithum
28. adrenaline==action cardiac - act on beta 1 receptor increase cardiac contractility and heart
rate,
- act on alpha 1 receptor and decrease mucous production,
- has long effect of beta 2 receptor and cause bronchodilator
Notes : a1( vessels ) = vasoconstriction a2=
sympatholytic
b1 ( heart ) = increase HR and contractility b2 ( lungs ) = bronchodilator , "
vasodilator " , increase insulin so affecting pottasium other similar q :
- drugs with following mecahnism :
1/alpha agonist cause inhibition of mucous sectestion = phenylphrine
2/ long acting b agonist = salmetrol
, 3/ short acting b agonist = salbutamol
29. pharma side effect

note:
metabolic acidosis + hyperkalemia + hyponatremia, *? spironolactone

apnea
PGE
respiratory center depression + hyperthermia, * ? opoid(cocaine -morphine)* ?
Notes : metabolic acidosis = carbonic anhydrase inhibitor (acitazolamide) , k+sparing (
spironolactone ) metabolic alkalosis = loop diuretics ( furesimide ) , thiazide hypercalciuria =
loop diuretics - hypocalcemia - nephrocalcinosis hypocalciuria = thiazide - hypercalcemia
weakest diuretics = carbonic anhydrase inhibitor = glucoma
all duretic cause alklosis except acetazolamide and k sparing cause acidosis
furosmide=hypocalcemia and hypercalceurea
thiazide=hypercalcemia TAS case 40
30. drug used in neonatal emergency:

1/ 34wk + low PLT with PDA indomethacin =*ibuprofin,
2/ severe aortic stenosis =
*PGE1 PGE2
3/ 35wks features of renal impairement (close PDA) ?? may be heart failure so
will use furesmide
31. acyclovir:
a. water soluble b. *excreated by kidney
c. metabolised and execreated by liver
d.( low or high ) bound to plasma protein Note
from 1st aid :
Mode of Action : Guanosine analogs
Side effect : Acute Renal failure if not adequatly hydrated
32. drug used for MRSA: vancomycin
33. Botox in botulism mechanism of action: destruction of Achestrase, *bind to
presenaptic receptor, bind to postsynaptic receptor
*NOTE:
* It also prevent the release of Ach at NMJ
34. diaphragmatic hernia occur
*8 - 12 wk, 12- 16 wks, 16- 24 wks, { 24 wks
35. double ureter insertion of the ureter on the bladder upper lobe ureter
inserted medial and below the lower lobe, *medial and above, lateral and
below, lateral and above.
36. optic nerve pathway bitemerol hemanopia, quadrantopia, homonomous

hemianopia
optic chiasma= bitemerol hemanopia
37. enzyme deficient in the urea cycle = ariginosuccinate
38. cardiac cycle: atrial depolarization = p wave ,, av node conduction =P-R
interval ? venticular depolarization QRS
ventricular repolarization = T wave

39. infection EMQ
*previously well child refuse feeding develop heart failure , = ?may be viral mycorditis (coxaki )
periventricular calcification = CMV, toxoplasmo>>intracerebral calcific
registrar cant illist red reflex = rubella
40. Heb influenzea = gm -ve coccobacilli
listeria baby with green color muconium = gm+ve rods,
meningococcal = gm -ve diplococci >>N.meningitidis
41. BOF polysaccharide vaccine used against post splenectomy:=

peumococci
42. vaccine table:I dont remmeber exactly, immunocompromized with his

brother 2month,
14 yrs, know the table by heart
43. BOf mother with hep B immunoglobulin to the baby:

HBs ag+ antiHbc ag, anti HBSag + Hbeag,
= Immunoglobulin + vaccine
44. vitamins EMQ Nutrient supplement for pt wit

perioral dermatits = zinc
vegitarian diet = ? b12
obese lazy diatery management not improved they give him drug
( i cant remmeber the name trade name ) = ? Note : drugs may
be used with obesity
orlistat - lipase inhibitor = all fat soluble vitamins ( ADEK )
Metformin - biguinade increase insulin sensitivity
45.vitamin absorbtion : small intestine, ( * iron , folate

= proximal small bowel , colon, ? *water
distal ilium = * vit b12 , bile salts
46. investigation
18month constipation failure to thrive, = ? cystic fibrosis
3month vomiting metabolic alkalosis, = ? Pyloric stenosis -- US
47. BOF direct effect parathyroid hormone increase ostoeclast activity,

* inhanced 1 alpha hydroxelase enzyme.
48. luekemia, dengue fever, malairia, typhoid

(fever+ bradycardia = typhoid )
(fever,from kenya, has fatique, malaise, vomiting, took antimalarial drug =
malaria )
( fever and bone pain = ?leukemia )

Notes : dengue fever : ( south east asia , caribbean , central and south
america ) headache , back pain , myalgia , arthralgia , nausea and
vomiting hemorrhagic fever ,,retroorbital pain,,bone breaking pain
49. vit D in the kidney: a. 1,25 dihydroxylase or 24 ,25 hydroxlase
50. osteopenia occur Chronic Kidney Disease : 1/ increase execretion of
phosphate, 2/*decrease excretion of phosphate , 3/decrease absorbtion in the
instine, decrease reabsorbtion of ca in the kidney
Note : - phosphate retention leads to hypocalcemia increased phosphate and
decrease calcium stimulate secondary hyperparathyroid :subperiosteal bone
resorption
- defecient renal 1 hydroxylase activity and defecient 1,25 (oh)2-d3 contribute
to hypocalcemia and rickets
51. cystic fibrosis pathophysiology of CFRT gene: C Note : fails to secrete chloride ions in
lung
fails to absorb chloride in sweat gland == so high sweat test ???
52. pulmonary function test
53. Di George, neonate delivered with cleft palate = 22q11
54. drug the block the Na channel = phenytoin
55. *von willibrand = PT normal APTT prolong boy with gum bleeding, mother the same
condition
56. epilepsy: day dreaming, benign vertigo ( pale, tearing blinking), complex partial ( aura)
57. .6 yrs old boy with headache and enuresis, NA 124, k 5.6, cortisol low, 1/*adrenal
insufficiency,2/ SIADH,3/ RTA
58. 10 yrs old boy with aneuresis camping =desmopression,
headache,osmolarity given
>> 1/cranial DI,
2/ increase dose of desmopresein
59. circle of Willis except = *ant cranial
60. down syndrome unbalance translocation ( young female )
61. anemia 6 month mother think he is pale, infrequent diarrhea, low MCV PLT 495 Retic low ,
formula milk started
= 1/ cow milk allergy, 2/*iron deficiency ,3/ folate B12, 4/physiological
62. neonate hypoglycemia replacement 8 mg per Kg not resolved: liver 2 cm
*hyperinsulinemia
, GSD
63. protusion of the eye and kidney problem = ?neuroblastoma
64. what is the indication of non accidental injury >> retinal hemorrhage
65. girl not eating, loss of wt. withdrawal from friends
*depression, bipolar
66. pitit mal eilepsy ECG = 3 spikes and waves =absence
67. prophylasis of meningitis: *ciprofloxacin, ceftriaxone inj once
68. . Hb dissociation curve which is the characteristic of HBF to HBA that cause its high affinity
= HBF decrease binding to 2,3 DPG
69 CAH enzyme the commonest: = *21 hydroxylase

70.drug causes metabolic acidosis, nephrocalcinosis, hyponateremia : spironoloactone??
71. neonate become cyanosed on feeding and well on crying there is single 2nd heart sound>>
upper airway obstruction ( choanal atresia charge disease )
72. which nerve responsible for gastric emptying >> vagus nerve
73. the cause of total K depletion in DKA:
*hyperosmolR, POLYURea, acidosis, insulin, polydipsia
- senario about headache = tension

- management in kwash ( BOF )
- senario about Asperge==type of autism milder type

1. A child on Chemotherapy & footdrop ...you tell him this effect is ?
o Answer = reversible
o Common perineal nerve injury
2. Bleeding after circumcision .. Prolonged pt (>100) , normal ptt ...
o No factor 7 deciency was in the answers (Answers included hemophilia A , factor
12 , DIC , vit K def , hemorrhagic chickenpox, vWD) ... maybe it's vit K def..
(although pt is strangely high)
3. Platelet 18 .. normal pt,ptt .. but extensive echimmosis over chin and forhead and
epistaxis (with parental negligence & child under protection) ..
o I choosed Non Accidental Injury ( ITP was in the answers but abnormal bruising
sites allowed me to exclude it)
4. Fever + prolonged pt , ptt , D-dimers > 500 ....diagnosis?
o = DIC
5. Unilateral sever Facial pain ... cause?
o = trigeminal n.
6. Vertical diplopia + head tilting .. cause ?
o = Trochlear n. palsy
7. Tongue deviated on protrusion .. nerve injury ?
o = hypoglossal n.
8. Trauma to occulomotor nerve .. effect ?
o = ptosed eye
o (Other options included : superior medial / superior lateral position of eye .. but all
are false .. eye is downward lateral)
9. pituitary adenoma visual effect ...
o bitemporal hemianopia
10. Case .. baby pt 26w with ventilatory need .. causitive organism ?
o GBS ? CONS
11. Baby age 26 days + sepsis + on vanco ...

o MRSA ?
12. Baby FT after PROM ... causative organism ?
o GBS ?
13. hypoglycemia persistant + macroglossia + umb hernia ...
o = PWS
14. Most common cause of angelman
o = (uni-maternal deletion)
15. FISH ... uses ?
o William $

16. Infliximab mechanism ?
o = anti TNF-alpha
17. A monoclonal antibody for ttt of rheumatoid arthritis .. asked about mechanism of
its action .. can't remember the name .. but after some search .. mostly
it's Tocilizumab which inhibits IL-6
trimethprime
18. Which drug Potentiate sulfonamide ?
19. Young female , Harsh continuous murmer up left sternal + biventricular
hypertrophy .. what clinical sign ?
o PDA ? Bounding pulse ?
20. plethoric lung + soft esm ...
o fixed s2 widening (ASD)
21. LVH , syst murmer front , Continuous murmer on back
o (CoA .. measure blood pressure ?)
22. d/b+d
o = Specificity
23. a+c/a+c+d+b
o Pre-test probability
24. "b" represents ?
o False positive ?
25. A Statistical study (copied from Pupmed) and asks what have you concluded from
this study
26. A statistical study with 3 final Risk Ratios then ask what have you concluded ..
27. A Study written .. what is this study design type ?
28. Closure of PDA due to ...
o dropped pulm Vascular Resistance
29. Steps of baby after separation from placenta ?
o (Apnea then breath (or vise versa) then bradycardia followed by tachy (or vise
versa) then hypotention (or stable BP) ) ... all these options are interchangeable.. he
was asking about the correct order of events .. not 100% sure of the right answer
30. 6 Cases of IEM (EMQ) .. 3 asking about diagnosis and 3 asking about investigations
31. How differentiate between type 1 & 2 DM ?
o = c-peptide Level
32. Case with small penis , undescended testis .. what investigation ?
o Mostly this is a case of Hypopituitirism... i think the answer was gonadotrohins
level (no option for cortisol or insulin test or provocation tests)
33. a case of male , 5 years , bone age 9.5 years, pubic hair .. normal BP (exclude CAH)
.. Diagnosis ?
non classical CAH

o = Mostly Tumor intracranial ?
34. HUS causative organism?
o = (ECOLI)
35. Which of these diseases Not has pathogen ?
o = HSP
36. Mechanism of DKA ?
o No insulin + no glucose consumption + exccess FA oxidation and incresed KB
production
o Infection increase cortisol level lead to something
o Release of counter regulatory hormones lead to .
37. Adolescent becomes jaundice after febrile .. mechanism ?
o = decreased congugation (Gilbert)
o Increase in enterohepatic circulation
o Decrease renal excretion
38. Baby jundice day 1 mechanism ?
o = RBCs destruction
39. HUS Mechanism ?
o = toxins disrupt RBCs membrane integrity
40. Clay stool and jaundice .. mechanism ?
o = biliary obstruction
41. Snorring increase at what sleep stage ?
o Options include (all stages / REM / Stage 1/ Stage 2 / another option ) ... not sure of
the right answer
42. SJS can occur with which drug of these ?
o Answer was = Carbamazepine
43. BLISTERS over buttock and nail dystrophy .. What layer affected ?
o epidermis ?
44. TB patient .. developed Color mixing (color blindness) .. abnormal move .. ?
o = ethambutol.
45. Dyslexia , short .. wt 2centile ... delayed puberty
o .. turner / pws / celiac / i can't remeber (choosed turner and I was almost sure it is
wrong :D but no other satisfiying diagnosis)
46. dystonia side effect of drug ?
o Metoclopramide
47. Visual field defects ..
o vigabatrin
48. Milk content which attach to iron and prevent it's consumption by bacteria ?..

o = lactoferrin ?
49. Milk content which provide benificial acidic medium for lactobaccilli and gut
microflora ..
o = oligosacch ?
50. Cow milk ..
o high phosphate
51. Milk content responsable for tolerance to antigens ?
52. ABG Iterpretation ..
o Showed Mixed alkalosis
53. A family pedigree interpretation
o XLR
54. Ranitidine acts on ?
o H2 antagonist
55. Cholrphenramine
o H1 antagonist
56. Propranolol
o B antagonist
57. Adrenaline why used in anaphylaxis .. ?
o VC effect
58. k 2.3 , na 135 .. normal cl , normal bicarb
o Although of almost low normal sodium ... But by exclusion I think the answer was
Hyperaldosteronism
59. teenager , hypoG, hypoNa , hyperK
o Addison disease
60. Duchenne in need for mechanical vent but parents refuse because of a previous
dead brother... how to take decision? ..
o I choosed to check if the boy is competent
61. Tidal vol of 3kg baby ..
o (weight*6-7) ..so answer was 18-20
62. Unequal pupil after nebulizer .. diagnosed by ?
o pilocarpine
63. Dilated calyces of kidney .. what investigation to exclude upper obstruction ?
o Mostly MAG-3 ?
64. Infant + Cough + apnea + occasional vomit ... investigation ?
o = nasal swap ? (mostly pertusis)
65. Boy 7 years + Wheezes + mother has hay fever .. what investigation ?
o Choosed spirometry ?

66. Vague history of sudden cough / probably FB aspiration last week .. what
investigation?
o Choosed flexible laryngoscopy ?
67. Boy + skin allergy resistant to ttt + neutropenia ...diagnosis?
o = Wiskott aldrich
68. Defect of chronic granulomatous disease ..
o Respiratory Burst
69. Anaphylaxis after eating eggs ...?
o = type 1 hypersensitivity
70. TEF most common type ?
o = proximal esophegeal atresia + distal fistula between trachea and distal esophegus
71. TOF severity depend on what ?
o = degree of RV outflow obstruction
72. Test dislcable hip ...
o Barlow
73. AVSD ..ECG finding ?
o = partial BBB in V1
74. abducent n. Injury , unilateral facial weakness , general examination normal (no fever
, normal bp) .. what is the cause ?
o = pontine tumor
75. Asian baby with jaundice .. most common enz defect for it in asia and africa ?
o = G6PD
76. Which pathogen of these can cross placenta ?
o answer = Listeria
77. Case of meningitis + hypoNa ?
o Diagnosis = SIADH
78. Mechanism of furosemide (Or some other question related to furosemide)
o Na/k/Cl cotransport at acending loop
79. Mechanism/site of ADH ..
o answer = Collecting Ducts
80. Child 9 years , with ALL , What of these give bad prognosis
o No options for age / others
o Only "cytogenetics" listed (mostly he means philadelphia chromosome .. so I
selected it)
81. Cardiac catheterization interpretation (LV pressure > Femoral ... normal
saturations)
o .. I choosed "AS"

82. ABG for Mechanical Ventilation .. Low O2 + increased CO2 wash .. how to deal ?
o answer = reduce Rate
83. Icthyosis Vulgaris .. disorder ?
o = Filaggrin
84. DM1 , celiac disease HLA association ?
o = HLA DQ2 , DQ8
85. A history of a condition .. mostly HUS .. what causative organism ?
o = E-Coli
86. A case with oligohydraminos , had to go for C.S at 32 w .. most common
morbidity?
o Answer = Lung Hypoplasia
87. Esophegeal Atresia , mostly associated with ( Cardia / skeleteal / anorectal / renal ?
o .. He is referring to VACTREL ? .. answer = mostly Cardiac ?
88. Trisomy 21 presented with paraplegia , why ? ..
o answer = atlanto-axial joint instability
89. A chylthorax after surgery .. what is best feeding ?
o Use MCT because absorped directly into portal vein
90. Ritinopathy of prematurity .... mechanism ?
o Hyperoxia induce Vascular Endothelial Growth Factor
91. Cutaneous Nerve supply to palm of the hand
o Median n.
92. A drug inhibits Bacterial thymidine?
o TMP ?
93. A drug of the same family of gentamicin ....
o answer = Amikin
94. Drug used in paliative ttt for excess secretions ?
o Glycopyrolate
95. A case of absensce seizure .. drug of choice ?
o No option for Ethuxamide ... choosed valproate
embryology q was on commonest TOF .

-anatomy q on what nerve injury in achild with colles fracture and lost sensation of most of
palm.
-diagram of x linked recessive condition and asked type of inheeitence.
-FISH can diagnose which conditions antenatally.
-case of down suddenly got quadriplegia..atlanto axial dislocation.
-angleman syndrome type of inheritence.

-wiscot aldrich sydrome...case of recurrent infection+on ttt for eczema+cbc show
thrombocytopenia.
-bacterial infectikn can be transmitted transplacental and one of choices was listeria.
-type of reaction in peanut allergy.
-if pituitary adenoma what visual defect can develop.
-unilat facial weakness+recent covergent squint and one of choices was potine mass.
-tidal volume in healthy full term.
-action of frusemide.
-site of action of ADH.
-case 11y with new onset attacks of salt loosing crises.
-mechanism of cough.
-physiology of DKA.
-murmurs 3 in EMQ
-case of oesophageal atresia..common ass anomalies and choices (cvs-musculoskeletal-
genitourinary-neuro).
*the commonest type of tracheoeospophygeal fistula is ....

*celiac dse is associated with HLA .......
*in chronic granulomatous dse the defect in........
*child receiving anti tuberculous medication prisented with visual defec name of the drug
*child having vertical diploia what is the nerve affected
*affection of this nerve causes tongue deviation when protruded
*a girl with car accident need urgent surgery only her grandmother at home from whom you
will take the confirmation
*a beautiful question in FOB hhhhhh asking about the measurements of children's
sphingomanometer choiced
Length 60% from the arm and 80% width or length 80% and 40% wedth something like that
can't remember the exact choices
*Angelman syndrome the genetic defect
*FISH test is used for diagnosis of which dse
*mech od cough choices
Deep inspiration , closure of larynx , contraction of chest muscles , open glottis , forced
expiration this is one choice can't remember the other 4 so really no time to think for the
answer
*case neoborn put 1day on ventilator and started AB after 2d culture negative after 5 d

detorirated again what to give
Bicarb or dopamine
o CGD Respiratory brust
Newborn delived by ventose delivery had forehead haematoma you sent lab PT 18
APTT 60 what is the most probable cause
o Factor deficiency
o Specimen contamination by heparin
o Vit k deficincy
Extended matching questions that i remember

Different referrals (psychiatrists... etc)
Fluxitine
Encourage sleeping with parents
1) child with ADHD and sleeping difficulty
2) child with autism, wales parents up at night multiple times and its affecting their
relationship
3) i cant remember sorry
Whats the organism
N.Meningitis
Strep A
Staph aureus
1) rash+ fever + increased capillary refill + irritable + hupoglycemia
2) periumbilical redness* left buttock blisters
Question about vitamin deficiencies
1) asian parents. Developed seizure after 1 week of life
2) oral and peri anal redness
3) gum bleeding
Child had hx of seizure at conduction of previuos surgery.now he had seizure after diarrhea
Qt synd/simple epilepsy/ mccAAd
Mcaad
Guys what was the answer to the question (extended)with the female and left lower quadrant
pain and different pain scores ?
Question telling that after some accident a child had colle; s fructure and lost sensation over the
palm of the hand what is the affected nerve
Radial or ulner or median or T1 or C5&C6 or 7
Median nerve injury is typical with colle s fracture

A child presented with triangular burn on his inner thigh and the mother says its by accident .
The child is in child protection register.
Non accidental- admit

Non accidentsl- inform social services
Accidental- discharge
Extended matching
Iv acyclovir
Vaccination + ivig
Vaccination after rash develops
Ivig after rash develops
... other options
1) mother had chickenpox 24 hours after delivery

2)monther had chickenpox 10 days before delivery
3 mother had chickenpox 5 days before delivery
Only 1 question about development and no vaccination
A child presented with triangular burn on his inner thigh and the mother says its by accident .
The child is in child protection register.
Non accidental- admit

Non accidentsl- inform social services
Accidental- discharge
best of five questions:

1. mechanism of cough.
2. FISH used to diagnose ..........
3 complete oculomotor nerve paralysis.
4 mechanism of action of frusemide.
5 mechanism of action IM adrenaline in baby develop rash and lip swelling (?? anaphlyxis)
6 mechanism of action of infliximab in treating R.A and crohn disease.
7. site of action ADH.
8. visual field defect in child with pituitary adenoma.
9 child with antiT.B develop vision problem.
10. pathogensis of chronic granulomatous disease.
11 causative organism of bloody diarrha and reduced urine.
12 physiological response of fetus to asphyxia after placental separation.
13. child after bicycle accident has cole fracture with lost of sensation of palm which nerve
affected.
14. pallitive treatment of secretions.
15. tidal volume of 3 kg baby.
16 predigree
17 cardiac catherization data

18 baby with bacterial meningitits with hyponatremia.
19 vbg ph 7.49 pco2 3.8 kpa hco3 31
20 most common form of oseophageal atresia.
21 most likely system abnormality with oseophageal atresia. respiratory,cardiac, skeletal.
22.baby with recurrent chest infection and low platalet.
23 most prognostic factor for ALL.
24,25,26 3 statistical questions about type of study , cl
27 most common cause of angleman syndrome
28 14 ys female short stature and prepubertal
29 child with chemotherapy with vincristin methotrexate and dobrubcin develop foot drop
and peripheral neuropathy what is explaination.
30 ethics question 12ys old child with duchenn develop respiratory failure he agree to do
trechestomy as respirator support but parent refuse as they had one previous child suffer
before before death
31-What is the organism that can pass the placenta
32 how to defferinate between type 1 and 2 DM investigation
33 pathogenesis of DKA
34 case of baby with normal Na , hypokalemia and hypochloremia what is defect
I think barter
35 associated HLA with caeliac disease
36 baby with down syndrome develop quadriplegia what is explaination
cardiac problem in down syndrome AVSD cause ? ? my answer superior axis
38 stage of sleep in which baby can snoring
39 treatment of ?? absence seizure with 3 HZ spike
40 typical question from sample paper adjust ventalitor setting according to vbg answer is
reduce rate
41 pathogenesis of HUS
42 how to confirm that unequal pupil in pt with asthma due to ipratropium
43 baby with blister where is defect in skin layer
44 5 ys old boy with enlarged penis and testis bone age 91/2
45 how to differeniate dislocatable hip from dislocated hip
·
some of TAS questions yesterday exam:
Extended matching questions:
EMQ1 mechanism of action of rantidine,chloraphenramin,propranlolo.(receptors).
EMQ2 causative organism of
1 baby 27 week 600 gm 8 days old need increase ventlitor support tolerate feeding 2ml/2hr and rest by
IVF .
2 baby 27 week 600 gm 26 day old need increase ventilator support after course of antibiotic now on
vancomycine .......
3 baby delievered with H/O PROM and after 4 hours develop grunting and distress.
EMQ3 ANTIBIOTICS:
1 one potentiate action of sulphmixazole.

2 one of member of group of gentamycine.
3 one inhibit bacterial thymidine.
EMQ4 composition of breast milk (difficult to remember)
EMQ5 cranial nerves
1: paralysis lead to diplopia and convergent squnit.
2 nerve of pain sensation in face.
3 : paralysis lead to deviation of protruded tongue.
EMQ6 pathogensis of jaundice
1: jaundice in 1st 24 hrs of old .
2: 4 week old baby with jaundice and pale stool.
3: teenager with recurrent jaundice after each febrile illness.
EMQ7 2 x 2 table screening tests
1: d/d+c
2: b
3: a+c / a+c+b+d
EMQ8 bleeding tendency .
EMQ 9 cases of hypoglycemia , IEM
EMQ10 enzymes
1. baby with jaudice and hepatomegaly blood culture E.coli.
2. screening test of coelic disease.
3 i canot remember i think urea cycle defect.
EMQ11 investigations of child with persistent cough and wheeze.
still 3 questions i will try to remember.if somebody remember these questions please post them.
EMQ 12 anticonvulsants 1 one with visual field defect 2 one make acute dystonia 3 steven junson syndrome
Infection not toxin mediate ( cholera TSS Fulmint purpura)
Patient with dilated calyx kidney what investigation to confirm obstruction ?

47 type of diet in chylothorax after cardic surgery
Icthyosis vulagaris defect ( filgren defect, ..
49 type of hypersensitivity of peanut allergy

52 newborn deliver by forcep with bruises in the face blood was taken from arterial line
showed PT 18 PTT 60
( Vitamin k def, heparin effect ....)
51 complication of oligohydramonis
Another question about diabetic control in sick patients (extended matching)
Obese child with small penis and normal testes. No family history . Most appropriate next
test, dna analysis/ cortisol level/ thyroid hormones/ glucose tolerance
Prader willi sync DNA test
Laurence moon piedle syn

the this is he was just obese ... normal development and normal appetite .. only obese with
small penis
Adrenal hyperplasia or adrenal tumor u answer
Hypopitutirism ... Measure cortisol ..
In some cases if there's public bad of fat, may falsely penis look short
If every thing normal exclude Cushing and hypothyroidism, revise food habits and exercise
The question of down I think he had sudden onset paraplegia

Icthiosis vulgaris enzyme defect I answered elastase but searched the right answer is
something sulfate
What about the question of biliary atresea I choosed obstruction of the pathway of bilirubin
About Icthyosis.. did he say enzyme ! I noticed fillagrin and I know it's a common pathology
with eczema so I choosed it .. maybe you mean elastin ??
About down .. yes , even if sudden he is liable for such insult
And yes biliary obstruction (clay colored stool)

Yes he mentioned enzyme unfortunately we didn't have time to read
Question of down was quadri
Also difference between DM1&2 I have answered antibodies not sure about the right answer
In clinical practice , we always choose c-peptide
Esraa S. Alhamadany In sop it is written to diff by glucose tolerance test with baseline
peptide
Esraa S. Alhamadany Fascial and squint i think answer is pontine tumor
Great job.. I have a note
Q3/ NAI will not result in platelet 18 and there is no delay in presentation.. I think ITP
ITP would rather present with purpera or at least epistaxis alone. I think it's a more
significant insult (also platelets are 18 .. not that significantly low) ...
Low platelets can be explained by previous viral infection (I think he said so in the
question?)

Mahmoud Al-Haj Ali As I remember there was epistaxis in question and it is preceded by
viral infection which make me choose ITP
Mahmoud Al-Haj Ali Another confusion point, in the same question, is that the child is
under child protection registrar
The problem is that we understand the question very well .. And the differential
very well .. But don't know what to choose exactly :Deven after the exam we don't know the
true answer 100%
it
.

Scanned by CamScanner
GBS !!!!!!!

Main pathology in cystic fibrosis
A lot of Q about down syndrome
Obstructive sleep apnoea
Acid base disturbances
Condition related to normal and high anion gap
Causes of micro and macrocephaly
Family pedgree
Renal vein thromboses as complication of nephrotic syndrome
Minerals and vitamin normal function and common defecinces
Breast milk Vs cows milk
Preterm exclusivly fed Vs preturm formula
Pertusis
Enzyme used to chech pancreatic exocrine function
Conduct disorder
Pregnant Mother with hepatitis A what action must be done for the baby
Which malignancy need to irradiate blood before they recieve it
Much Q on bile stain vomitus
Axillary lymhadenities after BCG which type of hypersensitivity
A lot of Q on urea cycle defect
Condition associated with cataract
Paracetamol poisoning
Vit D and calcium metabolism
ECG changes specialy p wave abnormalaties
Dopamine side effect
Manual blood measurement technique
1. Current screening programme in uk 2014

2. Function of placenta
3. Site of Action of spirnolactone

4. Site of action of vasopressin on the kidney
5. Nitric oxide
6. Contraindication if circumsion
7. Anatomy of the heart
8. Lower O2 in fetal circulation ; at Rt atrium , Rt ventricle , desending aorta, carotid
arteries
9. Any thing related to diabestes and its detailed manegment specialy insulin
10. Precosious pubirty and all about sex hormones
Ayman Gad abducent n.damage ,duane synd,SLE,bells palsy,angiotensin,spironolactone,first order

kinetic,CHD,alot of statistic and ethics qs,severe B.A management,acid base and metaolic
qs,hypersensitivity types,nitric oxide,dopamine,HUS,non accidenal accidents and i will try to remember
more 4 benefits of all with my est wishes for all

October Exam 2013 ASM
Modified by me Dr Ahmed Tawfeek @ 6-2016 & adding some noes from other college about
June2015 exam
------------------------- red collore by me !!!!!!!!! or agree for selecting answer!!!!!! -------------------------------------------
-----------
1. Best antibiotic for:
Salmonella infection
A cystic fibrosis patient with acute pseudomaonas infection
2. Most important side effects for
3. Tidal volume for a baby weighing 3 kg
4. Sensations carried by the posterior column fine touch, vibration &

proprioception. Pressure is sometimes included, though less
frequently,
5. CSF
6. Calculation of the serum osmolarity Serum Osmolality = (2 x (Na + K)) + (BUN

/ 2.8) + (glucose / 18).
7. Site of action of furosemide
8. OSIS interval represent, Q wave

represents
9. Diseases transmitted by mosquitoes (T/F)
Dengue fever
Yellow fever
Relapsing fever
Rocky mountain spotted fever
Typhus
1
10. Causes of bilious vomiting (T/F)
Biliary atresia
Malrotation x
Malrotation x
Volvulus
11. Mechanism of diarrhea for shigella, rotavirus, E. coli
12. An asthmatic patient received salbutamol and Ipratropium bromide nebulizer. The patient improved but
developed nausea and headache with unequal pupils. The left one is 5 mm and the right one is 3 mm and
unresponsive to light but there is spontaneous eye movements. What is the best test to diagnose the underlying
cause:
Application of pilocarpine eye drops
Application of fluorescence eye drops
CT brain
13. A newborn with jaundice secondary to ABO incompatibility, required exchange transfusion 2 times, later the
baby developed signs of cerebellar dysfunction. What is the affected tracts?
Pyramidal tracts
Cerebellar tracts
Negrostriatal tracts
Spinothalamic tracts
14. An infant with congenital neutropenia with his family in a camp, the infant developed fever 38.5 and the
mother called you. What is the best advice to the mother:
Go to the hospital as soon as possible
Give paracetamol and observe the baby
15. Cardiac catheter question
16. Forest plot A forest plot is a graphical representation of a meta-analysis.
17. What is treatment of lyme disease at 8 years old male patient:
In addition, doxycycline is relatively contraindicated in children <8 years of age and in women
who are pregnant or breast-feeding.
or age <8 years, may be treated with rifampin for 7 10 days using a dosage regimen of 300 mg twice per day
by mouth for adults and 10 mg/kg twice per day for children (maximum, 300 mg per dose) (B-III).
Rifampintreated patients should be closely observed to ensure resolution of clinical and laboratory
abnormalities.
2
Because rifampin is not effective therapy for Lyme disease,
For prevention of Lyme disease after a recognized tick bite, routine use of antimicrobial prophylaxis or
serologic testing is not recommended (E-III). A single dose of doxycycline may be offered to adult patients
(200 mg dose) and to children 8 years of age
ampicillin
cefuroxime
benzylpenicillin
doxycycline
ceftriaxone
18. For focal segmental glomerulosclerosis, ESRD will develop after how many years:
2 months
2-6 months
1-2 years
5-10 years
> 10 years
19. Drugs that can be given via the UAC
20. What about that boy 3 years old presented to ER with burn 4 cm on his chest his mother said that he was
running to his grandmother and the tea is thrown up on his chest now he received opiate and is good the boil
now is 4 cm what to do: put ice
give antibiotic
IV fluids
refer to dermatologist
neglection
refer to social services
21. position of the eye in oculomotor nerve palsy With unilateral third cranial nerve palsy (ie, oculomotor nerve
palsy), the involved eye usually is deviated "down and out"
22. Circle of Willis
23. gastrin hormone
24. limping and groin pain scenarios
25. physiology of renal electrolyte transport
26. Mechanism of cooling in newborns with HIE
27. Child presented with hemorrhagic manifestations. There is family history of 2 relatives died from intracranial
hemorrhage. PT and APTT are normal. What is the most likely diagnosis
Check factor XIII
Hemophilia
3
28. A baby boy is born to mother blue, heart rate 40/min, irregular breathing, mother is given morphine 1 hr
before birth, what is the most immediate step?
Adrenaline
Intubation
Chest compressions
IM naloxone
29. Baby with ambiguous genitalia, you told parents that you have to consult ... what is the next step:
Karyotyping
Send blood for U & Es
30. Newborn baby blood glucose was low (1.9 capillary and 1.6 venous), next step is:
Give bolus (dextrose 10%)
Give oral feeds
Do a septic screen
31. You are designing a clinical trial to test a new chemotherapy regimen. What is the most important message
that parents need to understand?
If relapse happens, there will be numerous alternatives for treatment
Your child will be looked after more than kids who r not in the trial
We would like to know if the new regimen has good outcomes
The expected results from this drugs
32. In which cases ? (T/F)
Focal segmental glomerulosclerosis
Nephrotic syndrome
Post streptococcal glomerulonephritis
IgA nephropathy
33. You are giving vancomycin 10 mg/kg every 6 hours. You check the levels (trough is 4.9 (normal < 5) and
peak was high (slightly), What do u do?
make it every 8 hours (10 mg/kg)
Decrease the dose to 8 mg/kg, every 6 hours
dose
34. IV or V
4
EMQ
35/Steven Jonson syndrome--
>Carbamazepine Acute dystonia--
>metochopramide Hirsutism----> ?
36/MCQ>> If there is renal disease, avoid which

medication? The answer was Ibuprofen
You are designing a screening programmed for obesity
- Waist circumference>90%
- wt and ht above 90
FISH can be used to diagnose which of the following?
- Williams syndrome
- Zellweger syndrome
37/Shifting of Oxygen dissociation curve to the left:
Diagnosis of Measles?
IgM
IgG
PCR
38/T or F quest. Teratogenic drugs:

A. Aspirin
B. Na valproate
C. Nicotine replacement therapy
D. thyroxine E. insulin
39/A 5 month old African boy brought in by mother that he is not moving his left leg, he has viral Flu like illness
last week, 2 days back he also fell from sofa, she suspected her elder son a 3yr old pulled him On exam he has
runny nose, and not moving his left leg and afebrile, what's the cause? Osteomyelitis
Non Accidental
injury Transient synovitis
????? Sickle cell disease
40/ 3 week baby with poor wt gain (his wt was 3.6kg). He is formula fed and his grandmother is giving him 100
ml every 4 hours strictly. He takes his feed well but he is miserable. What to do? Give 140 ml every 4 hours
diluted formula

5
Demand feeding
Follow on formula milk
?
?
4 hrs is too long
On demond feeding is principal for breastfeeding & formula on condtion do not decrease total caloric intake
41T/F Sudden unexpected death in

infancy: Apnea monitor decreased the
incidence. (F)
Smoking,,,
42MCQ: Keep PDA open is most important in:

Critical aortic stenosis systemic
Critical pulmonary stenosis

Tricuspid atresia pulmonary
?
pulmonary
?
43/T/F regarding MMR vaccination:

Grandmother can consent
Dad who is separated but divorced
A stranger......!
A sister (can't remember the
age) ?
44/* A mother of a 5 yr old who has eczema noticed a swelling beneath her ear while combing his
hair? Refer to dermatologist
Reassure n send home
Refer to otolaryngologist
Review after 6 wks
45/A 5 yr old girl is brought by mother, she has lost 5 kg weight for past few months, agitated and can't sleep in
night? Prescribe some sleep remedy
Malignancy Hyperthyroi
d
Abuse

6
bone pain at night

and pt cant not sleep)
46Exam question 1B
Abducent
Mandibular
Oculomotor
Mandibular
Lacrimal Zygomati
c
Vagus
Troclear
Scenarios
1)which branch of trigeminal has both sensory n motor supply he mandibular nerve has sensory and motor
functions.
2)branch of which nerve if damaged cause postoperative stridor
3)which nerve is the first to damage in case of increase Cranial pressure
47Which is not a part of circle of Willis?

Vertebral arteries
Internal carotid
Anterior communicating artery
Posterior communicating artery
(The Circle of Willis is a part of the cerebral circulation and is composed of the following
arteries: Internal carotid artery (left and right)
Anterior cerebral artery (left and right)

Anterior communicating artery
Posterior cerebral artery (left and right)
Posterior communicating artery (left and right)
The basilar artery and middle cerebral arteries, supplying the brain AND vertebral arteries, are not considered part of
the circle
?????????????????????
48/A 3 year old girl, whose elder sis is subjected to sexual abuse, complains of perineal soreness which sign on exam
confirm sexual abuse
Vaginal discharge
Torn
hymen Perianal
warts
49/Strept infection on swab

7
49/Which of the following is contraindication for circumcision: T..F
1. Paraphimosis
2. Hypospadius
3. Napkin rash 4. Cystitis
5.
50/Patient with atopic eczema and itchy skin lesion on top of eczema then manifestation of cerebellar ataxia started
to appear:
1 post infectious encephalomyelitis
2 chicken box
3 herpes
4 ...
5....
51/Which of the following is most likely to confirm diagnosis of Pyloric

stenosis : 1 Hypochloremia
2. Hypokalemia
3. Non bilious vomiting
4. Metabolic acidosis
5. Increased urea
52/ ????M acidosis
Prescription writing answer (T/F)

1- Dose should be written as 0.5ml (True)
2- Dose in microgram can be abbreviated as 'mcg' (False)
3- Latin abbreviations can be used. (True)
4- Dose less than 1 gram should be written in mg (True)
5- Doses in millilitres are recommended in place of cubic mm (True)
53/Cause of congenital diaphragmatic hernia
1. Failure of closure of septum transversus
2. failure of the GIT contents to return to the abdomen

8
Extended Matching Questions (EMQ)
1/ EMQ (paper B- PHARMACOLOGY)
options
Muscrininc antagonist,
dopamine antagonist,
H1recptor antagonist,
canabinoid recteptor antagonist,
HT5 recptor antagonist.
mechanism of action of the following drugs:
Domperidome.
hyoscine hudrbromide.
Ondesartan rececptor .
2/ EMQ (PAPER B MICRO_PHARMA)
OPTIONS:
pseudomonas
aspregillus
mycoplasama
DRUGS:
1-
2-azithromycine
3-amphotricin
3/EMQ (PAPER B- STATISTICS)
OPTIONS:

9
TABLE 2-2
Incidence.
senstivity .
specificity.
positiv predictive value.
CHOOSE ONE :
1. a/a+c
2. c
3. a/a+b
4/ EMQ (PAPER B- ANATOMY)
OPTIONS:
Right atrium
Tricuspid valve
Inferior vena cava
Superior vena cava
Anatomical structures:
1. Coronary venous sinus.
2. Ductus venosus.
3. Strcture open on y descent in JVP.
5/ EMQ(PAPER B)
one emq about genetics
1-4 years old child present with picture of rickets and his mother has genu varum
this is xlinked dominant
2-one questation about prader willi
parental disomy
3-one questation about
hypotonic child his uncle has cataract and his mother doesn't smell when she meets you
this gene anticepation(trinuclotide repeate disorder)
6/ EMQ(PAPER A)

10
about immunization
1- 3 months old boy with his young brother treated from leukemia dapt+hib+ipv
2-baby boy with hiv what is contrindicated vaccine bcg
3-immunization given b4 splenctomy ppv
not pcv
7/ EMQ
one emq about investigation:
1-picture of leckemia i dont remeber the ques
blood film is the investigation
2-one questarion about coeliac dis
antitissue transglutaminase
3-one queatation about child with bloody diarrhea renal function impaired
blood film also
8/EMQ
one emq about bile stained vomiting:
1-1day old baby hypotonic looks dysmorphic with bile stained vomiting
down syndrome --------biliary atresia
2-6 days with progressive abdominal distension since birth pass stool once time only now present with bile
stained
vomiting
hirshsprung disease
3-4days child vey well breast feed today in the morning his cousin has cyctic fibrosis present with vomiting
capillary refill time 4 sec
malrotation and volvolus
9/EMQ
one emq about sick day rules in diabetes
1- 14 well controlled diabetic has infect

give extradose of insuline
2-one questation about morning hyperglycemia, smogy phenomenan should decrease basal insulin

11
3-4 year child fever 39 with vomiting and abdominal pain and nausea
increase fluid intake
10/EMQ
14 years old girls take overdose of unknown drug
1-hot flushed hypertensive tacchycardia convlsion occure in ambulance
i answer it methyphenadit cz this picture of amphetamine toxicity
2-girl with vomiting buy tablets from nearby super market all vital signs are normal
i was confused between paracetamol and aspirin but i found respiratory rate normal so i choose paracetamol
3-girl with vomiting stained with blood and hypotensive
this ferrous sulfate
11/EMQ
1-newborn with rash liver and spleen palpable 2cm below costal margine
healthy mother maternal platelet count is
194000
2-newborn with rash liver and spleen are just palpble health mother
Maternal platalt count is 23000
3-new born with rash and no organomegaly maternal blood count is 95000
12/EMQ
one emq about pain management:
1-4 year old boy with burn
i answer it iv morphine
2-child with accident and u request ct scan but orthopedic want to take him first to do thomson split I
answer it femoral nerve block
3-girl with headache now receive 1gm paracetamol every six hour and brufen 400 mg every 8 hour wt will u
give her

12
i answer no treatment bcz this is rebound headache
13/EMQ
one emq about hair falling and treatment
1-one was alopecia areata and i choose treatment with topical steroid
2- one was tinea capitis and choose oral grasiofluven
3-one was telgon effluvium this girl which has pneumonia 3 monthes ago
i choose no treatment reassurance
14/EMQ
One cardiology emq
About wt is the sign u will found
1-baby with continous murmur was pda and the sign is bounding pulse
2-baby also with systolic murmur and rt bundle branch this is asd and sign is fixed splitting s2
3-15 year old girl with systolic murmur on lt second intercostal space and continous murmur on back this is
pulmonary atresia with asd and collatralls im not sure about it but I choose single s2 bcz pulmonary valve is
atreric
15/EMQ

13
Best of Five (BOF)
1. 25 years old woman married to 51 years old man, what is most probably the cause of their baby having down
syndrome?
a) Balance translocation
b) Unbalance translocation
c) Paternal disomy ?????????/
d) Maternal disomy

14
e) Mosaic
2. 3
level. What is the another test that is helpful in the diagnosis?
a) Anti-thyroid peroxidase antibodies
b) Anti-thyroglobulin antibodies
c) Free T4 level
d)
e)
Thyroid autoantibodies: Presence of typically anti-TPO (anti-thyroid peroxidase) and anti-Tg (anti-thyroglobulin) antibodies
delineates the cause of hypothyroidism as Hashimoto thyroiditis or its variant; however, 10-15% of patients with
Hashimoto thyroiditis may be antibody negative
3. A child with constipation and impacted feces up to the umbilicus. What you will do? a) Start laxative and
review
b) Enema to relieve impaction
c) Admit to the ward for disimpaction
???????????????????/
NICE 2014 :;;Do not use rectal medications for disimpaction unless all oral medications have failed and only if the
child or young person and their family consent.
4. A 15 days old baby with an umbilical stump granuloma, 2 mm in size, and oozing a serous fluid. What is
your intervention?
a) Reassurance and review
b) Refer to surgery
c) Silver nitrate cauterization
d) Antibiotic powder
5. A child with swelling of both knee joints and one elbow joint. To which doctor you should refer the patient?
a) Orthopedic
b) ENT
c) Physiotherapy
d) Ophthalmologist (i.e. a case of oligoarticular arthritis, for fear of anterior uveitis) e) Surgery
6. A 3 years old child with a small membranous tongue tie. He has a difficulty in speaking the letters B, R, T.
his grandfather refused to do surgery. To which doctor you should refer the patient? a) Occupational
therapist
b) Speech and language therapist
c) Surgery

15
d)
e)
7. A 10 years old child with oral painful mouth ulcers and anal fissures. What is your diagnosis? a)
disease
b) Ulcerative colitis
c) Celiac disease
d)
8. A 2 years old girl with an injury to the vulvar area and mild bleeding, while cycling in the park with her
brother. What is your next step?
a) Call your senior pediatrician
b) Refer to a gynecologist
c) Suturing the vulvar wound
9. A 10 years old tall boy with gynecomastia and small testes. What is your possible diagnosis? a) 47 XXY
b) 46 XO
c) drome
10. A 6 months old infant with facial eczema, found to have a palpable LN over the neck, which is about 3 cm in
size, smooth, and non-tender. What you will do?
a) Refer to a surgeon
b) Reassurance
c) Start antibiotic therapy
11. A full-term neonate, delivered by LSCS, and developed respiratory distress 2 hours after birth. What is the
possible cause of respiratory distress?
a) Transient tachypnea of newborn
b) Respiratory distress syndrome
c) Meconium aspiration syndrome
12. What is the most important investigation before starting treatment with sodium valproate? a) Liver
function tests
b) Serum ammonia level
13. A small child with painless, soft, cystic scrotal swelling. Both testes are palpable. What is your possible
diagnosis?
a) Hydrocele
b) Torsion testes
c) Incarcerated inguinal hernia
d) Mumps orchitis
16
e) Epididymo-orchitis
14. A small child with left testicular mass, prominent pallor and bruises. What is your possible diagnosis? a)
ALL
b) Testicular tumor
15. A 2 years old child with croup. Oxygen and budesonide were given but no improvement. What is your next
step?
a) Nebulized adrenaline, 400 mcg/kg, of 1:1000
solution b)
16. A 3 years old child with fever, vomiting, and dysuria. Abdominal US revealed renal stones. Urine routine
showed leukocytes 2+, protein +, and trace blood. What is your possible diagnosis? a) Nephrocalcinosis
b) Renal tubular acidosis
c) Proteus UTI
??????????????????????????????????????????
17. A 2 years old boy with severe pain during night and was crying excessively. The parents can calm the baby
with milk. He was pale with bruises over the chin, but an active child. What is your possible diagnosis? a)
Trauma
b) ALL
c) Chronic hemolytic anemia
d) Iron deficiency anemia
18. A 3 years old child with a small VSD. He has to do adenoidectomy. What you will do for prophylaxis against
infective endocarditis?
a) Give amoxicillin before the procedure
b) No prophylaxis is indicated
19. A child with ptosis, meiosis, and anhydrosis. What is your possible diagnosis?
a)
b)
20. A 6 weeks old infant with jaundice and pale stool. ALT, AST, and conjugated bilirubin levels are elevated.
What is your immediate action?
a) Intramuscular vitamin K
b) Intravenous vitamin K
c) Oral vitamin K
d) Vitamin A
e) Surgery
??????????????????????????????

17
21. A 5 years old child suddenly collapsed after entering the swimming pool, but he regains conscious few
minutes after transfer to the hospital. His uncle had a similar attack 10 years ago and had a long term follow
up with a cardiologist. What is your possible diagnosis?
a) Prolonged QT syndrome
b) Hypertrophic obstructive cardiomyopathy
c)
22. A 5 mo old infant presented with developmental delay. He was born vaginally, with a birthweight of 4.5 kg
and APGAR score of one at 1 minute and 8 at 5 minutes. What is the possible cause of developmental delay?
a) Inflicted brain injury
b) Congenital brain malformation
c) Hypoglycemia
d) Hypoxic ischemic encephalopathy
23. A child with bloody diarrhea, anemia, and poor urine output. What is the next investigation to do? a)
Serum complement levels
b) Serum creatinine level
c) Serum urea level
May s creatin for triad of HUS ??????????????/
24. An IUGR baby with periventricular calcifications on the CT scan. What is the immediate complication? a)
Hearing loss
b) Visual impairment
c) Neurodevelopmental sequelae
??????????CMV as hearing loss may bedelayed after infancy!!!!!!!!!!!!!???????????
25. A 2 years old child with generalized oedema and rash over the chest and abdomen. What is the next
investigation to do?
a) Urine dipstick
b)
26.
59/ BOF
And other about child with left testicular mass and brusies

18
SUGGESTED ANSWER: leukemia
1/ BOF (PAPER B-Statistics) Q @ Relative risk.
2/ BOF
Q@Odds ratio.
3/ BOF
Q@Numebr needed to treat.
4/ BOF
Q@Confidence interval.
5/ BOF
Type of study
6/ BOF
PT FAIL TO ABDUCT EYE
SUGGESTED ANSWER : SIXTH NERVE PALSY.
8/ BOF(PAPER B- )
1.seizures
2.neurodevelpmental disablity,
3.neurodvelpmntal delay,
4.globaldevelpmental delay

19
10/ BOF (PAPER A )
Girle 6 y with unilat breast mass .. pubertal development show breast 2 ...all rest 1
1. precoius puberty
2. unilat mastitis
3.premature thelarche
4. premature adrenarche
SUGGESTED ANSWER: premature thelarche.
11/ BOF(PAPER B)
8 year old presented with annular scaly lesion on back parents were applying ketocanazole for two week.now
presentedwith fever headche.history of travelling 3 weeks before. What is caustive organism: 1.
Borrelia burgdorferi
2.leishmania
3. Ricktesia
ANSWER: Borrelia burgdorferi( lyme dis.)
12/ BOF(PAPER B)
What arteries contrbute in Circle of willis?
1.basilar
2. vertebral.
3. internal carotid.
13/ BOF(PAPER B)
Side effects of frequent usage of Furosemide?
1. Hypomageseamia.
2. Hypocalcaemia.
3. Nephrocalcinosis

20
4.
5.
Metabolic side effects including hypokalemia, hypomagnesemia, and an increase in serum uric acid, have
been relatively common especially with higher doses. 14/ BOF(PAPER B)
Action of Spironolctone?
1. Compete aldosteron
2.
3.
4.
5.
Competitively attach to aldosterone receptors & prevent its action
15/ BOF(PAPER B)
A girl with half facial weakness, was lower motor facial palsy with convergent squint?
1. cerebraltumour .
2. benign idiopatic hypertion.
3. oculomotor nerve plsy
4.bells palsy,
5.pontine tumor,
ANSWER: pontine tumor
16/ BOF(PAPER B)
narrowest part of upper airway?
ANSWER: SUBGLOTIS
17/ BOF(PAPER B)

21
Cardiac cthetrization showing BP AND SATURATION in all chambers of heart and main artries what is result
interpretation?
1. Aortic regure.
2. Pulmonary diltation.
3. Aortic stenosis.
4.
5.
ANSWER: AORTIC STENOSIS.
18/ BOF(PAPER B)
FEV 1 ,PEFR ,FVC....results interpretation to differentiate b/w restrictive and obstructive lung disease
ANSWER: OBSTRCTION LUNG DISEASE.
19/ BOF(PAPER B)
ECG changes in AVSD?
SUGGESTED ANSWER: CROHN S DISEASE.
21/ BOF(PAPER B)
Gentamicin....drug levels adjustment...pre dose n one hour post dose values given ......we had to increase or decrease
the dose according to drug levels
23/ BOF
craniopharyngioma cause which field
defect? i choose bitemporal hemianopia
24/ BOF about formula ... premature infant now 3 m old... weaning completly from breast feed since 1 month
..have diarroea start from 10 days give :
-premature formula
- soye formula

22
- cow f
25/ BOF anaomaly in gastrochiasis(complete abscence af anterior abdominal wall layers)
26/ BOF most common type of oesophageal atresia
atresia with distal fistula
27/ BOF pathophysiology in vsd
28/ BOF
one questation was about congenital chloride

darrhea chloride was low and he has metabloic alkalosis
he is 4 weeks with persistent diarrhea and history of ployhydrammnois
31/ BOF(PAPER A)

23
that for pregnant women with hepatitis a and will have labour after one week all
year u study hepatitis b and in exam u find it hepatitis a
SUGGESTED ANSWER: LOW RISK OF TANSMISION.
32/ BOF
also another questation about absence epilepsy which
drug if used will increase the frequency of attack? i
choose carbamazepin
33/ BOF
apnea breath test for brain stem death
??????????????// a posi2ve apnea test (lack of spontaneous respiratory efforts in

the presence of an elevated PaCO2)
35/ BOF
PT WITH EGG ALLERGY WHAT TYPE OF HYPERSENSTIVITY?
1. hypersenstivity reaction type 1.
2. TYPE 1 AND 4.
3. TYPE 2
4. TYPE 3
5. TYPE 4
36/ BOF
PT WITH NEURODEVELOPMENTAL REGRESSION AND USING OF HANDS FREQUENTLY WHAT IS THE

DIAGNOSIS?
SUGGESTED ANSWER: Rett syndrome
37/ BOF
wischot aldrich syndrome
38/ BOF

24
klinfilter syndrome
39/ BOF children complain from abdomnal pain and fever headache abdominal examination mild right
upper quadrent this questaion was on pastest
i choose lobar pneumonia
40/ BOF(PAPER A)
1-neonate born cs mother taking methadone baby not responding no breathing HR=80 i
choose inflation awith bag
!!!!!!!!!!!!!! methadone is an opioid
41/ BOF(PAPER A)
2- 3 years old boy found on floor of shop no other one with you wt u will do
i choose shout for help
42/ BOF(PAPER B)
How to differrentiate between dislocatable hip and dislocated hip? positive
barlow test
Barlow manoeuvre: tests for dislocatable hip
The hip is held fl exed and adducted. The femoral head is pushed
downwards. If dislocatable, the femoral head will be pushed posteriorly
out of the acetabulum.Ortolani manoeuvre: tests for dislocated hip
Abduct hip with upward leverage of femur. A dislocated hip will return
with a palpable clunk into the acetabulum.
If examination is questionable hip ultrasound is undertaken at 4 6
weeks of age. Urgent orthopaedic referral is required for a
dislocated or dislocatable hip.
43/ BOF(paper A) children looks mildly dysmorhic and mild learning disability and was taken into foster care for
social causes wt is ur diagnosis? i choose fetal alcohol syndrome
44/ BOF(PAPER B)
mechanism of action of adrenaline in anaphy;axis

25
rise peripheral vasculare resistannce
45/ BOF(PAPER A)
Gp see newborn will examine it he found click in hip but when registrerar examine her again was normal wt will u do?
Us
Review after 6 monthes
Refer to orthopedic
Do not remember the other
?????????????if at doubt do US after 4-6 wks
46/ BOF
one bof about obese girl with elevated liver enzyme
i choose non alcoholic steatohepatitis
48/ BOF(PAPER A)
Q about assesment of hearing .. what most important event to search for
I choose bilateral otitis media affected him 2 weeks ago
49/ BOF
ONE QUES ABOUT TUBEROUS SCLEROSIS
4 MONTHE CHILD WITH ATTACK OF FLEXTION POOR INTERACTION AND HIS MOTHER TREATED
FROM HTN

26
50/ BOF
in ca absorption which is under direct effect of parathyroid hormone?
-1 alpha hydroxylation
-kidney...absorptuon...of.....phosphate
-intestinal reabsorption
- bone resoption is correct
51/ BOF(PAPER A)
Q about anemia ... child ..his mother and father farmers and Hb
? ..mcv ?
My answer is lead poisoning
53/ BOF
this is the 4th sample and contain
9000 rbcs glucose
6mmol
protien 0.7
two vague answers
trumatic tape
subarachnoid hge i choose
subarachnoid he
bcz this is the 4th sample taken
if u exaime csf sample and found rbcs u should take 3 concecutive sample and rbcs count should be decrease in every
sample
but in the 4th sample it still 9000
54/ BOF one bof about wy cow milk should be
modified?
SUGGESTED ANSWER: high phosphate content

27
55/ BOF(PAPER A)
38w newborn after c.s with tachyapnea HIS APAGAR WAS 5 AFTER 1 MINUTE AND BCM TACCYPENIC
AFTER 4 HOURS
SUGGESTED ANSWER: TTN
56/ BOF one bof about complication of infant of
diabetic mother
- microcolon
- sacral agenesis
-other choices
57/ BOF
ABOUT GIRL ATHELTE COMPLAIN FROM AMENORRHEA FOR LAST 6 MONTHES
SHE IS THIN SLIM AND EXCRCISE 2 TIMES PER DAY
JOINED TO OLYMEPAD TEAM
BODY MASS INDEX 18
- ATHELETE AMENORRHEA
- Anorexia nervosa
61/ BOF
ONE CHILDREN TREATED FOR RESPIRATORY INFECTION FOR 5 DAYS WITH AMOXICILLIN AND NOT
IMPROVING HE HAS PAINFULE NODULE ON CHIN OF TIBIAWT IS THE MOST COMMON ORGANISM? -
MYCOPLASMA
-TB
62/ BOF
ONE PHARAMA QUES
ABOUT BOY TREATED FOR TB AND NOW CANT DIFFERRENTATITE BETWEEN COLOURES
WT IS MOST DRUG TO CAUSE?
I CHOOSE ETHAMBUTOL(IT CAUSE OPTIC NEURITIS)

28
63/ BOF
ONE BOF ABOUT CHILD WHO SET NEAR TV AND OTOMERTIST FOUND VISUAL ACUITY IN LT EYE
6/18 AND RT EYE 6/6 AND HE HAS RECURRENT OTITIS MEDIA AND FOLLOW UP WITH ENT AND HAS
MULTIPLE BROWN PIGMENTED ON BACK
WT IS THE CAUSE OF IMPAIRED VISION?
I CHOOSE OPTIC NERVE GLIOMA(I THINK THIS MAY BE NEUROFIBROMATOSIS
64/ BOF children has appendictomy receive fluid for 48 hour 100ml kg now bcm confusion and headache serum
sodium was low wt type of fluid u will used: i answer 20%mannitol
65/ BOF
BRAIN STEM APNEA TEST
dxt should be more than xxmol/L (i think was

7) patient must be put on room air for 10 minutes
PCO2 must be within xx mmHg range (sorry i really cant remember the values)

29
A. Procedure of the apnea test
Disconnection of the patient from the respirator
If continuous or intermittent oxygen supply is preceded by denitrogenation of blood gases, high PaO 2 levels
can be sustained for very long periods of time.[26] Preoxygenation removes alveolar nitrogen stores and
facilitates oxygen transport.[27] There are several techniques for ascertaining that there is sufficient
oxygenation during AT.[15] The first method is to disconnect the patient from the respirator and to insert a
catheter or cannula into the endotracheal tube down to the level of the carina and provide pure oxygen at a
rate of 4 10 l/min. This would ensure sufficient alveolar ventilation and transport of oxygen to the blood
even without any respiratory movements.[17]
In the second procedure the patient is not disconnected from the respirator but the minute volume is
decreased to a very low level (0.5 2 l/min), with the respirator in the synchronized intermittent mandatory
volume ventilation mode and with pure oxygen provided for inspiration. In this procedure, the patient is not
disconnected until the required PaCO2 is achieved. Lang and coworkers prefer this method as it prevents
tracheopulmonary complications and allows the examiner to detect any spontaneous respiratory effort.
[14,15] Al Jumah et al, have proposed a third procedure of biphasic intermittent positive airway pressure
28]
66/ BOF
FACIAL NERVE PALSY
1. DROOLING OF SALIVA AT SAME SIDE
2.
3.
4.
5.
67/ BOF
Q ABOUT PT. WITH KAWASAKI DISEASE ON ASPIRIN CAME WITH PROLONG PT AND APTT WHAT
MOST PROPLY THE CAUSE?
SUGGESTED ANSWER IS: LIVER DYSFUNCTION.
68/ BOF(PAPER A)
this boy 8 days come with poor feeding and vomiting and deepening jaundice
at 4 day present with jaudice and put under phototherapy and at 6 day go out of incubator noramlly
temp35
ABG show metabloic acidosis glucose
2.1mmol

30
bilirubin 201mmol conjugated 8 liver
palpable 2cm below costal margine
what is ur diagosis?
1-hypoplastic left heart
2-glycogen storage
3-sepsis 4-kernictrus my explanation that this is case of galactosemia and
present with e coli sepsis
and i choose sepsis
69/ BOF(PAPER B)
ORDER OF CORTICOSTERIOD ACCORDING TO POTENCY
70/ BOF
PREDICTION OF METABOLIC SYNDROM
Low birth weight coupled with adult obesity is a strong determinant of the metabolic syndrome in postmenopausal
women.
MCQS
1/ MCQ
Q/RECOGNISED CAUSES OF NOSE BLEEDING IN CHILDREN?
1. VON WELLBIRAND DISEASE.
2. HEAMOPHILIA
3. UPER RESPIRATORY TRACT INFECTION.
4.
5.
2/ MCQ

31
Q/RECOGNISED CAUSES OF ALKALOSIS?
1. ANXIETY.
2. PYLORIC STENOSIS.
3. DIURETICS.
4.
5.
3/ MCQ (PAPER A)
unicef .......... for breast milk
4/ MCQ(PAPER A)
POLICY TO WRITE PRESCRIBITION OF DRUGS?
1. U sing latin abbrevation/term in prescription is acceptable mcg stands for

micrograms
2. all prescription less than 1gram should be written in microgram

0.5mg is an acceptable form of prescription
3. H ow to write 0.5 mg in numbers or letters
4.
5.
5/ MCQ(PAPER B)
Q about CA and NA and phosphate and CL and k which is more intracellular?
6/ MCQ (PAPER A)
MILE STONE IN 3 YEAR OLD BABY
7/ MCQ
Q ABOUT RSV
1. INCUBATION PERIOD.
2.

32
3.
4.
5.
The incubation period-the time from exposure to RSV until you have symptoms-ranges from 2 to 8 days but
usually is 4 to 6 days.1
8/ MCQ
Q ABOUT FASCIAL NERVE
1. HAVE SIX TERMINAL BRANCHES x only 5
2. NERVE TO STAPIDUS RUNING IN EXTERNAL CANAL arises at facial canal
3. SUPPLY POSTERIOR 2/3 OF THE TONGUE. x
4.
5.
intermediate nerve
near origin
geniculate
greater petrosal
pterygopalatine ganglion
inside facial nerve to the stapedius

canal
chorda tympani
lingual nerve
submandibular ganglion
posterior auricularsuprahyoid
digastricstylohyoid
at stylomast parotid plexus

oid foramen temporal
zygomatic
buccal
mandibular

33
cervical

34
Facial motor nucleus

Solitary nucleus
Nuclei
Superior salivary nucleus
9/ MCQ
RESTRECTIVE LUNG DISEASE VERSUS OBSTRUCTIVE LUNG DISEASE
10/ MCQ
SIDE EFFECTS OF ADENOSINE.
11/ MCQ
SIDE EFFECTS OF PROSTAGLANDIN
12/ MCQ
MET HB
13/ MCQ
IMMUNITY IN NEONATE VS IMMUNITY IN CHLIDREN
14/ MCQ
HB-O2 DISOCIATION CURVE
15/ MCQ
21-HYDROXLASE DEFICIENY

35
16/ MCQ
LIVE ATTENUTED VACCINES
17/ MCQ
SENSATION CARRIED ON POSTERIOR COLUMN
18/ MCQ
LIFE THREATING ASTHMA
the lovely big topic of acid base and electrolyte imbalance
1-addisone disease
2-diabetes insipdius

36
3-SIADH
4-congenital adrenal hyperplasia
5-pyloric stenosis 6-habitual
drinks
alot of questation in hematology
2 queation about g6pd one about
hereditry spherocytosis
3 about leukemia
2 about hemolytic uremic syndrome
1. causes of normal anion gap
2. mechanism of action of adenosine , adalimumab , Etanercept , dopamine

3. child 3 years with elevated creatinine kinase , to confirm which investigation
4. Q forest plot
5. Ophthalmology pathway defects
6. Differences between pre renal and renal failure 7. Hb dissociation curve
8. About billirubin :
1. most are carry by albumin
2.
9. physiology of neonates : sweat gland formation , evaporation from skin
10. causes of white shadows in TAPVD x ray
11. pain management ( EMQ )
--------------------------------------------

37
MRCPCH Exam june 2015

RH. fever recently diagnosis : inventigastion ?? a.ASOT,b.ESR,c.ECHO
sever sudden abdominal pain with vomiting ,ass with pain left testicle ?diag: a. LF tortion of tests, b. tortion of
morgagni
neonate had vomting ( 3 senario ) :1,day 1 vomiting bilios ,2. day 6 bilious vomiting ,3. may be day 2 non-bilious
vomting
3 senario about eye condition : night blindness,options : retinitis pegmentosa,retinal detachment,retinal

hge,clomboma,bilatral cataral,nystagmus
nocternal neuresis ,had abnormality in renal scan : what he had : duplex kidney ,cyst kidney,horsehole kidney child
had chest infection:on exam : stony dull chest :what investigation: CT Scan, U/S chest,and other option
12 yrs old took 6 tabs of paracetamol,bulling in school,level under treatment,plan to dischage, how you reasure the
parent he is ready to go home ?? child not on child protection list,,,,,,, he didn't try to suicidal before.,other option
,,,,,,,,,,,,,,,
aneamia and inestigative
Other options in paracetam Qs Supporting
mother
senario about celiac type of HLA ?
t is well known that CD is strongly associated with specific HLA class II genes known as HLA-DQ2 and HLA-DQ8 located on
chromosome 6p21.
Guidelines for CD diagnosis from the European Society for Paediatric Gastroenterology, Hepatology, and Nutrition
(ESPGHAN) propose the option to omit the duodenal biopsy in the diagnosis of CD if all 4 of the following criteria are met in
children and adolescents[4, 5, 6, 7]:
1. Signs and symptoms suggestive of CD

2. Anti-transglutaminase type 2 antibody (anti-TG2) levels more than 10 times the upper limit of normal
3. Positive confirmation tests of anti-endomysium-IgA antibodies (EMA)
4. At-risk HLA-DQ2 or HLA-DQ8
38
aboy hitby abicycle develop progressive drop foot : nerve supply : common peroneal nerve Colle's
fracture .......loss of sensation of in palm : nerve supply : median .
suxamethonium contraindcation in : a. mutiple sclorosis,b. ducheane muscular destrophy,c. spinal bifida occulta,d.
spinal muscular atrophy type 3
succinylcholine (Rx)Anectine, suxamethonium

Classes: Neuromuscular Blockers, Depolarizin
Contraindications
Malignant hyperthermia, lack of ventilatory support, ocular surgery, penetrating eye injuries, closed-angle glaucoma,
genetically determined disorders of plasma pseudocholinesterase, history of malignant hyperthermia, myopathies associated
with elevated serum creatine kinase
tuberculin test type of hypersensivity reaction : type 1 to 5 answrType 4 hypersensitivity
motor and sesory ( both ) branch of trigeminal nerve : a. maxillary,b.mandibular,c. optic, d. occulomoter
answer mand
39
1st cranial nerve to be affacted by incease intracranial pressuer : optic and other options
vassopresin effect ,there data about NA osmolality of urin ( baby has 2 hrly feeds thristy,wet diappers,normal
developmental,his height and weight of 0.2% ,0.4 % of centile ),
The single most important effect of antidiuretic hormone is to conserve body water by reducing the loss of water
in urine. A diuretic is an agent that increases the rate of urine formation. Injection of small amounts of antidiuretic
hormone into a person or animal results in antidiuresis or decreased formation of urine, and the hormone was
named for this effect.
Antidiuretic hormone stimulates water reabsorbtion by stimulating insertion of "water channels" or aquaporins
into the membranes of kidney tubules. These channels transport solute-free water through tubular cells and back
into blood, leading to a decrease in plasma osmolarity and an increase osmolarity of urine.
data num.before water depravation test and after vasoperssin ( plasma osmolality ) he
asked about diagnosis: a,neprogenic DI , b. central DI ,c. SIADH,d. water toxication
1000 people of reseach ,new test of CF ,out of 1000 .............10 detected positive of which 2 with disease ,what is
nagative predicted value ?? a. 10%,b. 80%,c.99.2%
May answer is 2diseased of 10 positive test so 20%
40
neonatal screen or test to detect CF : immunoreactive trypsin,b. alpa 1 anti-trpsin , c. fecal elastase
41
A sample of blood is either taken from the bottom of the baby's foot or a vein in the arm. A tiny drop of
blood is collected onto a piece of filter paper and allowed to dry. The dried blood sample is sent to a lab for
analysis.
The blood sample is examined for increased levels of immunoreactive trypsinogen (IRT). This is a protein
produced by the pancreas that is linked to CF. grandmother has give antipyretic ........child developed bleeding
,incease APTT (53 sec ),febrin 0.5 , what the diagnosis : a. DIC ,b. asprin toxicity
Aspirin chronic doses cause increase apttt not one dose

Severe, rapid-onset DIC causes severe thrombocytopenia, very prolonged PT and PTT, a rapidly declining
plasma fibrinogen level, and a high plasma D-dimer level.
So answer may be DIC
4 months old with ECG axis ( 280-350):diagnosis : a. AVSD,b, ASD,c. VSD ,d. PDA,e. tetraloy of fallot
Answer may be AVSD as it always has Rt vent hyper trophy !!!!!
Extreme Axis Deviation

Ventricular rhythms e.g.VT,AIVR, ventricular ectopy
Hyperkalaemia
Severe right ventricular hypertrophy
baby has GE developed heart faluire : organisum :strept ,coxasacki
baby had high pitch cty,CSF analysis: growth of gram positive rod : organasim : listeria,HIB ,E.coli, sterpt,staph
extended match : treatment of samonlla ,Rx of listeria ,Rx of necrotis fascitis swab growth of MRSA : options :
cefriaxon,cefotaxime,amoxicillin,pencilin,vancomycin gentamin
newborn on gantamcin twice daily :
A the dose andA interval ,A the doas and lenght the interval ,A the dase and interval ,no change

42
baby born after 6 days lethrgic ,after 9 days developed vesciles : HSV,varicella,staph,listeria
child had obesity ,dislipideamia,hyperglyceamia,and .................,what the risk factor for her
when she was born :
a. perterm 2.5 kg @ 1 yr old 7.5 kg
b. perterm 2.5 kg @ 1 yr old 10 kg
c. term 2.5 kg @ 1yr old 10 kg
d. term 2.5 kg @ 1 yr old 7.5 kg
e. term 4.5 kg @ 1 yr old 10 kg
boy playing football,suden syncope,become well and neurological normal ,what is the best investigation to giagnosis:
EEG,MRI,ECG,Blood sugar.
Build 3cubes,palmar grasp,know his name,....
What is develpmental age for the child
Stummering child the cause may be
Autisic spectrum disorders
Bilingual parents Tie
tongue
suxamethonium
limp pain
6tabs paracetamol and he is stable level not reach toxic dose what is your action plan
Sudden infant death syndrome
Risk decrease if mother smoke outdoor
You need metabolic screening for the next baby

43
It decrease die to nursing in prone position to avoid respiratory obstruction
Use of apnea alarm decrease its incidence Mother
need to train about cpr
statistic best types
of study design according to
following order
seldomly smile when she see him
Scissoring in leg; arching of back, crying,,,,,,,
vegetarian mother and child come with bilous vomiting
Extended maching
vitamin The most NG tube
likely organism
spiral fracture
Action
Ask senior
Tell parents possibility of NAI
Make skeletal survey

44
child physical abuse
notric ...test
To detect smoking
Severe asthma
Murmer split with respairation
Mechanism if action of PPI
Negative predictive value
13 bleeding from vulva
Whats is ur action
Suture
Send to obs and gynea
Call child protection
Call ur senior pediatricion

45
8yrs came wih ataxia and convulsion
Best inv is
Ct
Mri
Eeg
Chromosomal breakage
Girl her father abused her sexually came with
(funny spills)
Whts best investigation
Mri
Ct
Eeg
Refer to phychtrist
start walking at 15months then develop motor regression proceded
by upper respiratory infection
The diagnosis is
start walking at 15months then develop motor regression
proceded by upper respiratory infection duchen muscular
dystrophy dystrophyduchen muscular dystrophy
Becker muscular dystrophy
Chronic fatigue syndrome
Female with short stature examination is normal
Mid parental height at 25%
Her ht 0.4 centile

46
Xo
X linked recessive
X linked dominant
Autosomal recessive
Multifactorial
Mother has cataract her uncle has problem
Her baby boy has myopathy
What is inheritance
Mitochondrial
X linked recessive
Xlinked dominant
Autosomal recesive
A newborn on examination found to have ambiguous genitalia with hypospadias
Parents want to name their baby what is your action plan:
Tell them the sex of baby is uncertain and advice them to wait
Tell them to choose a name match for both girl and boy
Tell them to ascertain sex after karyotyping
End of june2015 exam

47

48
less than 9y

may be diluted formula

and micropenis ,
ambigous genetalia

hirshsprung D

maybe brain
malformation

cricoid cartilage

NASH
DD------GSD

H/O TS

optic glioma

Posted: Fri Sep 11, 2009 3:07 pm Post subject: questions from September exam
Extended matching question: List of ages then 3 questions - 1) At what age can a person
legally consent for medical or dental treatment, 2) At what age can a person legally refuse
potentially life-saving treatment, 3) At what age can a person legally buy cigarettes
Extended matching Q: List of infections (eg HSV, varicella, parvovirus, CMV, toxoplasmosis
etc) then 3 questions which the infectious agent must be matched to- 1) A child is born at
term with no antenatal problems but is noted to have hydops fetalis, 2) If the mother
acquires this infection during the last 2 weeks of pregnancy she should be given
immunoglobulin 3) Mother with multiple sexual partners and baby born with vesicular rash
on body True/false question on features of parvovirus infection Best of 5 - question lead
describes a 7 year old-girl with molloscum contagiosum (not named but clasic features
given) who is being bullied by her friends. what is the most appropriate treatment option:
1) Reassure, 2) Cryotherapy, 3) Laser, 4) Topical silver nitrate, 5) Topical salicylate
preparation
1. The drugs which can be given intrathecally- Baclofen, Hydrocortisone, methotrexate,

vincristine, vinblastine-true/ false 2. Cong Diaphramatic hernia- T/F Has to be repaired in
48 hours common site 3. Catch 22 causes transient hypocalcaemia Truncus arteriosus
defect in 1st and 2nd pouch
3 months old boys is presenting with bruses and nose bleeding. He had past history of NAI
by her mum. Choose one investigation to get diagnosis. 1. Blood film 2. Platelet count 3.
Factor 8 4. VonWillibrand Factor 5. Bleeding Time
1/Baby born with short limps, syndromes 2/1 month old vomiting + lythergic, match
electrolytes with syndrome 3/Law questions, a lot 4/Nenonate that needs transfussion,
parents disagree for religion reasons 5/Prolonged requirement of 02 and creputations in
infant followins bronchiolitis, virus? 6/Term baby with abnormal movements + poor
feeding, 1 investigation for definitive diagnosis. 7/self harm attack in 16 years old girl with
pararcetamol, mictuarting , suspicion of pregnancy 8/boy in child protection register
requires argent operation, Mum cant be found, unknown dad, who should agree for the
preocedure 9/smoking permitted after which age in uk 10/fresh bood in stools in a 4 years
old once every month, diagnosis?Merckel , fistures or polyps?
A newborn baby is transferred to NNU from SCBU due to hypotonia, hiccups and abnormal
movements. Which investigation would lead to a definite diagnosis? A. Plasma ammonia B.
Plasma phytanic acid C. CSF glycine D. EEG E. Cranial USS
a baby was had an antenatal u/s scan done at 20 weeks which showed bilaterally dilated
renal pelvices, scan was repeated at 36 wk of life, showing renal pelvic dilatation of 16mm
each baby was born term when should the next investigation be done? 1) renal u/s 2
weeks later 2) renal u/s 2 months later 3) DMSA scan 3 months later 4) MAG-3 scan 2
months later 5) renal u/s 2 days later

feb 2009
.Childcan skip,ride a cycle, understand in front of/behind, fasten but not
unfasten buttons/ knows 4 colours age?=3yr
2.Vaccines C/I in HIV ==BCG +YELLOW FEVER
3.Vasculitis :
Kawasaki==
HSP/=
ITP/=
=
4.Floppy baby with absent LL reflexes, smiles, feeds poorly what investigation to
do==SMA GENATIC STUDY
5.Hypoglycemia found during illness in otherwise normal child-?MCAD
6.Systemic onset ==JIA- ,,steroids Rx/,, RF +ve/seen in under 5?
7.Autism-
8.Enuresis in ==horseshoe kidney/duplex rt. Kidney/renal pelvis dilatation/ single

kidney
commonest /ass.== With characteristic cough/best assessed by Ba
swallow/ maternal polyhydramnios/ ass. With hemivertebrae
10.Short stature from birth with learning difficulty- ?Russel Silver-(50% HAS
LEARNING DIFFICULTY WITH NORMAL IQ)
11.Cleft palate, truncus arteriosus, microcephaly- ?Patau /?di George
12.Distal not proximal RTA if--- aminoaciduria/ glycosuria/pH >

5.6/hyperchloremia/ hypokalemia
13.6 mth old Kid with polyuria, polydipsia compared to elder sibling : low K+,
Normal Cl-, sugar and prt + in urine--?DM/ RTA? / ?Nephro.DI
14.Facial dermatitis 3 mo. Ago, now jOINT. Pains,what investing--? anti DS DNA
15.Violaceous scrotal swelling, no pain, extending to perineum and groin

?=idiopathic
as / diarrhea prsnt in enterocolitis/ absent Ach
esterase in affected bowel
17.Low grade fever,malaise, loss of appt, shoulder and chest pain 1 wk., worse
at night, not relieved by ibuprofen, low platelets, normal WBC, low neutrophils,
low Hb, painful shins, film
lymphocytosis, x- ray shoulders normal what inv? BM aspiration/ blood c/s / joint
aspiration
18.EMQ stats tests
a)to test new drug launched for acne
b)celiac disease-improvement with one Rx or another - ?single blind RCT
18. c)small group with constipation- to test effect of some
drug ?cross over
19.At birth, pH 7.31, low HCO3, low pO2, min. improvement wth O2 -?TGA /
?hypoplastic heart

20.AT birth,pH 7.31,low HCO3, diabatic. Mother, looks cyanosed, pO2 =75
,increased to 135 wth 100%
O2
?polycythemia
21.H/o recurrent. UTI trted wth Abx & improved, loin mass + , what
inv? DMSA/ USG kidneys
22.Fever, cystic mass in rt. Upper quadrant,rt.flank pain---?pyonephrosis
/?pancreatic //pseudocyst
23.Fever, epigastric pain, mass encasing IVC
?pancreatic . pseudocyst
24.Migratory arthralgia wth heart murmur, no joint. Swelling -
?rheumatic fever
25.Cardiac cath in 1 yr old: low spO2 LV 85%,LA 95%, HIGH PAP -- ? TA wth
VSD/?TOF /
26.ECG- LV predominance in 1st week?
27.Baby has central core disease- walked at 15 mth, short stature inv?
28.VSD wth heart failure--- digoxin 1st line if HR=220/min. ?/ ACE C/I /
?surgery within 1-2 wks
/spironolactone instead of lasix
29.Unbooked pregnancy, baby wth severe meatab. Acidosis,mottled---

?hypoplastic lt. heart
30.PROM 30 hrs ago, delivered at 38 wks by LSCS --inv? Blood c/s etc..
31.Newborn circulation Increased O2 content in ascending compared to

descending aorta/ pul.
Vasc.resistance falls in 1 wk /post ductal spO2 OF 90% NORMAL IN TERM
INFANT?
32.Single gene single polymorphism -- Cri du chat/ di George/ Hb H/ Hb C /

myotonic dystrophy
33.Rx of VF -20ml/ kg 10% dextrose bolus / unsynchronized DC 4 J/Kg /
10mic/kg IO adrenaline / Amiodarone
34.High ASOT, low C3- after 4 mths,ASOT decreased but not normal,C3 still
low---what next-?USG kidney ?/ kidney biopsy
35.Grandma died at 46 yrs of IHD baby diabetic ,brother has same
36.Trans. humerus # in baby elder bro had 2 # during

cricket --?Ostogenic Imperfecta
37.Painful cough, purulent sputum,fever unresponsive to \Abx, rt. Lower lobe
shadowing + dullness, not BCG immunized inv? Mantoux/ bronchoscopy/ sweat
test / V/Q scan
38.Itchy rash on trunk, 7th nerve palsy --?B.burgdorferi serology
39.Obese, headaches,papilloedema--?benign IC HT

40.Normal weight, afternoon headaches, not affecting life quality --?cluster
headache/ tension headache/ hydrocephalus
41.Early morn headaches 3 mths, normal wt., vomiting, nystagmus, appears

pale during attacks -?tumour/ migraine
42.At 3 mths, eyes not following parents around room,smiled at 9 wks, --

EEG/ complete neuro assessment, review after 3 mths /orthoptist/ paed
ophthalmologist
43.What will affect pt. wth Crohn,s most in coping wth disease poor
relationship with parents
(mother psoriatic, father also has some prob) / denial of chronicity of illness/
not talking to others with IBD
44.Postural hypotension, wt. loss, mom hypothyroid what asso? Recurrent

moniliasis?
- G-6-P-D def./ Factitious/

Rhabdomyolysis
46.Signs of renal failure like low Hb, high PO4, raised BUN/Creat etc. chronic
glomerulonephritis/ rapidly progressive crescentic glomerulonephritis?
47.Low C3 --= FSGS/Lupus nephritis/MCGN?
48.Mother develops chickenpox 2 days before delivery---give

VZIg to baby
49.EMQ: Recurrent abd. Pain,now unwell with low grade fever, pain in RIF (no
opion of appendicitis given)
50.Colicky pain during night, passes blood-stained stools in the morning-

?campylobacter jejunii
51.7 mth old passed large amount of blood P/R ,red mixed with dark, now
completely OK- / Intussusception/ Factitious
52.Investigated for celiac disease-= jejunal Bx normal, antigliadin Ab+ , H.pylori
+ in antrum----What next hydrogen breath test/ trile therapy for H.pylori/ gluten
free diet?
53.Lead poisoning Lead lines in bones diagnostic/ levels in blood give

indication of toxicity/
macrocytic anemia?
54.Beta thalassemia at birth on Rx, in adolescence high S.ferritin/short

stature/delayed puberty/hypersplenism?
55.Severe metabolic acidosis, labored breathing--

?aspirin overdose
56.Teenager Refusing to eat breakfast,abdominal swelling presents after taking
10gm Paracetamol ,what next send for HCG/ ask if pregnant?
57.Asso. wth obesity hirsutism/cutis laxa/telangiectasia/acanthosis nigricans
58.Ambiguous genitalia- what inv.? (17-OH-progesterone)

59.2yrs 11 mth old with intermittent breast enlargement. Precocious puberty if--
--palpable breast nodules/ advanced bone age/ vaginal discharge?
60.Mild facial weakness,hypotonia with scoliosis, for surgery-what risk

asso.----hypoglycemia/ metabolic acidosis/ cord compression/resp. failure
61.Wt. 3.2kg, then reduced, now more than 97th percentile Prader Willi?
62.Vitamins (true/ false): A -deficient in vegetarian diet

C in South Asians
E in cystic fibrosis
D in 6 mth old breastfed
K in vWD
63.Previous h/o non-RSV bronchiolitis, required O2 at birth,still O2 dependent---

bronchiolitis obliterans/ chronic lung disease of prematurity?
(hemolysis, no jaundice) one scenario with mildly low Ca2+ and raised ALP--
?undernutrition
65.Persistent microscopic haematuria, no proteinuria or symptoms- what

next check urine dipstick for 6 mths./ hearing test/ protein creatinine ratio/
urine Ca2+ / nephrocalcinosis
66.Recurrent macroscopic haematuria, no protein, creatinine normal----check
protein creatinine ratio?
67.Boy with slow growth and hypothyroidism and parents worried he will have
--next---to check hearing defect?
68.Made from recombinant DNA---Factor 8/ VZIg/ DNAase /

Erythropoietin ?IFN alpha
69.Abd. mass, hypertension in 2 yr. old--?
Neuroblastoma
70.Newborn requiring CPAP- mild abd. Distension,soft, increased O2 requirement-
what next a)CXR,ABG, C/S
b)Stop feeds, CXR,ABG, C/S
c)Reduce CPAP, aspirate stomach gas,CXR,ABG, C/S
71.Cystic fibrosis (true/ false)-----Burkholderia cepacia infection transmitted

between patients / Delta F 508 asso. Wth preserved pancreatic function / IRT
diagnostic
72.Jaundice of 200 micromol on 5th day--?physiological (false)
73.Child with CF distressed by extensor spasms Rx---Baclofen/ clonazepam (no

option of vigabatrin or ACTH)
74.Insulin regimen table given-high RBS at bedtime Rx----increase long

acting insulin at bedtime/ increase short acting insulin at lunch and supper?

75.Symptoms of ulcerative colitis (bloody
diarrhea etc.)
76.Best of five: Vancomycin levels peak and trough high----decrease dose and
increase frequency?
77.Hearing aids-----to be prescribed in less than 6 mths / cochlear implant in

less than 2 yrs. / may have vision problems / child with hearing aid does not have
to learn sign language?
78. 1yr old child on exclusion diet for eczema - 25th centile at 4 mths, now less
than 0.4th centile--undernutrition / celiac disease?
79.Headache with torticollis- neuro. Exam normal----USG of
sternomastoid / ? MRI brain
80.Child on inhaler (beta agonists + steroids) presents wth acute asthma- 1st
Rx----salbutamol by spacer / IV hydrocortisone / iv theophylline
81.Multiple true/ false: Retrocaecal appendix lies above pelvic rim / lumen of
appendix proportionately larger in infancy
82. H/o LRTI- now has wheeze, no crackles, CXR- perihilar shadowing---
?mycoplasma pneumonia / ?chronic adeno virus infection


All TAS Exams Recall

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All TAS Exams Recall

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Index

All TAS Exams Recall 1 of 381

All TAS Exams Recall 2 of 381

1- quantitative defect of one gene of beta chain

All TAS Exams Recall 3 of 381

5- defect in proteins for RBC cytoskeleton of cell

All TAS Exams Recall 4 of 381

All TAS Exams Recall 5 of 381

Drugs Mechanism of action:

All TAS Exams Recall 6 of 381

C- Neonate presented pale,lethargic statrting of

1-protein synthesis ribosome 50

All TAS Exams Recall 7 of 381

All TAS Exams Recall 8 of 381

All TAS Exams Recall 9 of 381

1- Mechanism auto acoustic emission test

2- New-born 8 days type of IG in alloimmune :

3- In HBb neonate when to give Ig in the following

All TAS Exams Recall 10 of 381

4- 12-year-old Child with type 2 dm tension headache

All TAS Exams Recall 11 of 381

E- spinosum cell layer

6- Hirschsprung disease pathophysiology:

7- Neonate 3 weeks screening done showed high TSH then

8- Gram negative coccobacilli producing toxin

All TAS Exams Recall 12 of 381

9- In study prophylactic intravenous indomethacin to

3-sevser intraventricular haemorrhage RR 0.66 CI 95% (

4- mortality rate RR 0.96 CI 95% (0.81-1.12)

What is the conclusion of the study?

A. Mortality rate significantly decreased

All TAS Exams Recall 13 of 381

E. Surgical ligation more in pt exposed to indomethacin

RA. 7 RV 88/20 PA 18/3

LA 6 Lv normal Aorta normal

11-How many half - life cycles needed to eliminate 97 % of

All TAS Exams Recall 14 of 381

12- neonate on a ventilator with ABGs results what is shows?

13- 3 months old presented with 3 months old presented

All TAS Exams Recall 15 of 381

Plat 450 (150-450)

A- Cow milk protein allergy

14- Total lung capacity IS :

A- Peripheral vascular consitriction

All TAS Exams Recall 16 of 381

16- Methicillin-resistant staphylococcus aureus is a problem

A- BACREIA BIND TO Specific protein allowing influx in to cell

17-methotrexate used in oncology pt., with known major side

18- pt with ALL on methotrexate what mech of action ?

19- 15 yrs. old child with cystic fibrosis controlled on his

Spirometry done showing the following

FEV1:1.36 PREDICTED:2.02 Z SCORE:-3.2

All TAS Exams Recall 17 of 381

FVC:1.96 PREDICTED?2.3 Z SCORE:-1.62

B- predominantly obstructive with no significant restriction

20--what is the type of insulin in continuous subcutaneous

21-6-child with road traffic accident(RTA) RESPIRATION OK

left pupil: 2mm reactive Rt pupil: 5mm non-reactive

What the underlying cause of this finding?

A- uncal herniation compressing rt 3rd cranial nerve

All TAS Exams Recall 18 of 381

D- tentorial herniation compressing the medulla oblongata

22- in adolescent smoking greater or more adverse effect in

A- 2nd hand vapour exposure