3. Congenital Adrenal Hyperplasia (cah).

***) 1 month old infant is seen with vomiting and severe dehydration. Physical examination reveals ambiguous genitalia, laboratory test show hyponatremia. The best likely diagnosis is:

1. Gastroenteritis

2. Congenital hypothyroidism

3. Pseudohermaphroditism

4. Congenital adrenal hyperplasia

5. Congenital diaphragmatic hernia

Answer: D* Congenital adrenal hyperplasia

4. Short Stature.

***) The short stature is associated with all of the following, except:

1. Chronic renal disease

2. Hypothyroidism

3. Down's syndrome

4. Low birth weight

5. Breast fed babies

Answer: E* Breast fed babies

***) Causes of short stature can be due to all of the following, except:

1. Emotional deprivation

2. Turner's syndrome

3. Kleinfelter’s syndrome

4. Primary hypothyroidism

5. Gluten enteropathy

Answer: C* Kleinfelter’s syndrome

***) All of the following can cause short stature, except:

1. Achondroplasia

2. Familial

3. Kleinfelter’s syndrome

4. Hypothyroidism

5. Corticosteroid therapy

Answer: C* Kleinfelter’s syndrome

***) Short stature may be associated with the following conditions, except:

1. Chronic kidney disease

2. Hypothyroidism

3. Down syndrome

4. Achondroplasia

5. Marfan syndrome

Answer: E* Marfan syndrome

• Gastroenterology p36-p43.

1. Tracheoesophageal Fistula.

***) The newly born regurgitates its entire first and every feed, pours saliva almost continuously. There are manifestations of:

1. Imperforate anus

2. Congenital diaphragmatic hernia

3. Atresia of duodenum

4. Atresia of the esophagus

5. Meckel's diverticulum

Answer: D* Atresia of the esophagus

***) All of the following are features of isolated esophageal atresia, except:

1. Excessive salivation

2. Inability to pass nasogastrial tube

3. Distended abdomen

4. Pneumonia

5. Cyanotic attacks after feeding

Answer: C* Distended abdomen

2. Pyloric Stenosis.

***) A narrowing and elongation of the pyloric channel on X-ray in a 12 days old infant most strongly suggest:

1. Duodenal atresia

2. Duodenal ulcer

3. Duplication of the stomach

4. Infantile hypertrophic pyloric stenosis

5. Annular pancreas

Answer: D* Infantile hypertrophic pyloric stenosis

***) Pyloric stenosis is characterized by all of the following, except:

1. Usually present between 3 and 8 weeks of life

2. Is commoner in first-born infants

3. Is commoner in girls

4. There is a family history of such disease

5. Projectile vomiting

Answer: C* Is commoner in girls

***) All of the following are characteristics of pyloric stenosis, except:

1. Commonly seen in the first born baby

2. Bile stained vomiting

3. Metabolic alkalosis

4. Failure to thrive

5. Ultrasound is helpful in confirming diagnosis

Answer: B* Bile stained vomiting

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

1. Metabolic acidosis is presenting feature

2. Barium meal confirm the diagnosis

3. It affects more the first and male babies

4. The baby is usually alert and sucking strongly

5. Surgical management is pyloromyotomy

Answer: A* Metabolic acidosis is presenting feature

***) Concerning hypertrophic pyloric stenosis of following are true, except:

1. Manifestations start usually 3-4 weeks after birth

2. Bile stained projectile vomiting is the presenting symptom

3. A visible peristalsis may be seen passing from the left to right across the upper abdomen

4. Constipation and loss of weight are usually present

5. Surgery is the treatment of choice

Answer: B* Bile stained projectile vomiting is the presenting symptom

***) Concerning hypertrophic pyloric stenosis all the following are true, except:

1. Non-bilious projectile vomiting is the most common

2. Visible peristalsis may be seen passing from left to right across the upper abdomen

3. An olive-size mass can be felt in the right hypochondrium

4. Constipation and loss of weight are usually present

5. The usual management is by antispasmodics and laxatives

Answer: E* The usual management is by antispasmodics and laxatives

***) Concerning hypertrophic pyloric stenosis, all the following statements are true, except:

1. First born male infants are most frequently affected

2. Symptoms usually begin in the third week of life

3. Bile stained vomiting after feeding is characteristic

4. Other gastrointestinal anomalies are usually not present

5. Preoperative preparation frequently requires potassium replacement

Answer: C* Bile stained vomiting after feeding is characteristic