13.

Which of the following administration devices is MOST convenient to ensure

accurate peroral administration of liquid drug formulations?
A. Kitchen teaspoon
B. 5 ml syringe
C. Hypodermic syringe
D. 5 mL dosing spoon
E. Medication bottle cap

14. Regarding drug administration by inhalation, which of the following factors

has the LEAST effect on pulmonary drug absorption?
A. Drug particle size
B. Chemical stability of drug molecule in the lung
C. Internal airway diameter
D. Active versus passive drug delivery to tracheobronchial tree
E. Pulmonary surface area

15. A 24-month-old girl presents to the outpatient clinic with poor asthma
control, she received montelukast (4 mg chewable tablets) daily for the last 3
months without satisfactory control of symptoms, if you decided to start
inhaled corticosteroids for her, which of the following devices you will choose?
A. Metered-dose inhaler (MDI) alone
B. Ultrasonic nebulizer
C. MDI + spacer with mask
D. MDI + spacer without mask
E. Jet nebulizer

16. Drug-drug interactions can be defined as alteration of pharmacokinetic

and/or pharmacodynamic properties of drugs when ≥2 drugs are administered
to a patient at the same time.
Which of the following drug properties MOSTLY altered by drug interactions?
A. Absorption
B. Distribution
C. Metabolism
D. Elimination
E. Receptor binding

17. Drug interactions due to physicochemical incompatibility of 2 medications

when combined are potentially dangerous. In this regard, which of the following

79
cephalosporin antibiotics should be avoided in neonates receiving IV calcium-
containing products?
A. Cefixime
B. Ceftriaxone
C. Cefotaxime
D. Cefuroxime
E. Cefaclor

18. Which of the following drug-drug interactions is of antagonism type?

A. Fentanyl and midazolam
B. Penicillins and aminoglycosides
C. Paracetamol and codeine
D. Naloxone and pethidine
E. Penicillins and probenecid

19. Which of the following drugs can increase the hemorrhagic risk in patients
taking warfarin by displacement of warfarin from plasma protein binding?
A. Ibuprofen
B. Phenobarbital
C. Erythromycin
D. Cimetidine
E. Ketoconazole

20. Regarding the safety of dietary supplements, which of the following agents
can exacerbate gastroesophageal reflux?
A. Ginger
B. Magnesium
C. Peppermint
D. Chamomile
E. Zinc

21. Specific adverse drug reactions (ADRs) occur at a much greater frequency in
infants and children than in adults. In this regard, which of the following ADRs is
specific for infants <2 years of age?
A. Aspirin-associated Reye syndrome
B. Cefaclor-associated serum sickness-like reactions
C. Lamotrigine induced cutaneous toxicity.
D. Valproic acid-induced hepatotoxicity
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 E. Tetracycline induced dental discoloration

22. Which of the following is the BEST approach that can be used to facilitate
therapeutic compliance and adherence in pediatric patients of all age groups?
A. Using positive reinforcement
B. Improving drug formulation quality coupled with positive reinforcement
C. Ensuring that single caregiver is responsible for the medication of a
single child
D. Repetitive education of caregivers and older children
E. Increasing caregiver vigilance and repetitive education with positive
reinforcement

23. A 3-year-old boy presents with fever, mucopurulent nasal discharge,

productive cough, and wheezing for the last 48 hours without history of chronic
respiratory problem. The boy is a candidate for elective surgery to correct his
left inguinal hernia and hydrocele next week.
What would be your decision regarding safety of general anesthesia?
A. Treating chest infection and advice for using IV hydrocortisone before
induction of GA
B. Postpone the surgery for 6 wks
C. Adding prednisolone 1mg/kg for 5 days to the treatment regime of
chest infection
D. Postponed the surgery till symptoms subside
E. Treating chest infection and reevaluate the patient after 1 wk for fitness
to GA

24. A newborn presents with imperforated anus 36 hours after normal vaginal
delivery at home, following stabilization the pediatric surgeon was consulted
who prepared him for surgery.
Of the following, the MOST critical preanesthetic medication is
A. vitamin K
B. prophylactic antibiotics
C. atropine
D. H2-blockers
E. benzodiazepines
25. A 4-year-old girl presents to the outpatient clinic with frequent enuresis,
temper tantrums, and nighttime crying as well as fear of strangers 3 days after
her skin graft surgery to release contractures affecting her right elbow. She was
81
exposed to burn before 2 years and now undergoing scheduled operations to
improve her joints mobility. A diagnosis of postoperative behavioral changes
was made.
What is the BEST measure to be taken in order to reduce postoperative
behavioral changes in the next surgery?
A. Using IV midazolam as preanesthetic medication
B. Parental presence during induction
C. Preoperative psychological preparation program
D. Parental presence during induction and using oral midazolam
E. Preoperative psychological preparation program and using oral
midazolam

26. Regarding preoperative fasting guidelines, breast milk may be given to

infants up to
A. 2 hours before surgery
B. 4 hours before surgery
C. 6 hours before surgery
D. 8 hours before surgery
E. 10 hours before surgery

27. Benzodiazepines are sedative-anxiolytic agents which are very effective as

premedications, but they can severely depress respiration, especially when
administered with
A. propofol
B. barbiturates
C. opioids
D. chloral hydrate
E. ketamine

28. A 12-year-old boy presents to the E/D with severe abdominal pain mostly
localized over a sutured midline incision, he underwent laparotomy before 18
hours for removal of liver hydatid cyst which necessitated the use of skeletal
muscle relaxant. The boy was received the usual dose of morphine after
surgery which controlled his pain initially, in addition to abdominal pain he is
also suffering from moderate headache and generalized pain in all extremities.
Of the following, the skeletal muscles relaxant responsible for his condition is
A. atracurium
B. tubocurarine
82
 C. pancuronium
D. succinylcholine
E. vecuronium

29. Which of the following general anesthetic agents represent the gold
standard for providing analgesia?
A. Nitrous oxide
B. Midazolam
C. Ketamine
D. Thiopental
E. Fentanyl

30. A 5-year-old boy presents with severe pain, swelling, and obvious deformity
in the left arm following fall on the ground while he is playing. X-ray showed
supracondylar fracture of the humorous, he received opioid analgesia as a part
of his initial management, after 30 minutes, the boy developed swelling in his
lips, generalized urticarial rash, and inching all over the body.
Of the following, the MOST likely blamed opioid is
A. morphine
B. codeine
C. pethidine
D. methadone
E. tramadol

31. Malignant hyperthermia is critical condition that may develop during

general anesthesia, particularly when inhalational agents combined with certain
skeletal muscle relaxants.
Which combination has greater risk of triggering malignant hyperthermia in
susceptible individuals?
A. Nitrous oxide plus vecuronium
B. Halothane plus vecuronium
C. Halothane plus succinylcholine
D. Nitrous oxide plus succinylcholine
E. Sevoflurane plus vecuronium

32. Which of the following is the MOST commonly used inhalational agent for
induction and maintenance of general anesthesia in children?
A. Nitrous oxide
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 B. Isoflurane
C. Halothane
D. Sevoflurane
E. Desflurane

33. For children with vascular access, IV induction should be routine during
general anesthesia.
Of the following, the MOST commonly administered IV induction agent is
A. Fentanyl
B. Propofol
C. Etomidate
D. Ketamine
E. Sodium thiopental

34. A 5-year-old asthmatic boy presents to the E/D with severe shortness of
breath, agitation, interrupted speech, and cyanosis. On auscultation the chest
was silent, SpO2 65%. He was nebulized 5 times at home with alternating
salbutamol and ipratropium every 20 minutes and received oral dose of
prednisolone (2mg/kg) in addition to his regular medications. In the E/D he was
kept on continues nebulized salbutamol driven by oxygen and received IV
hydrocortisone, aminophylline and magnesium sulfate without significant
clinical improvement that necessitate ICU admission.
Of the following, the MOST appropriate drug for sedating this patient before
intubation is
A. diazepam
B. etomidate
C. ketamine
D. fentanyl
E. midazolam

35. Which of the following is the MOST commonly used benzodiazepine in

pediatric anesthesia?
A. Lorazepam
B. Clonazepam
C. Diazepam
D. Midazolam
E. Oxazepam

84
36. During recovery from general anesthesia, opioid reversal with naloxone may
increase the postoperative
A. pain
B. nausea and vomiting
C. hypoventilation
D. hypotension
E. hypothermia

37. Which of the following dietary supplements is recommended to prevent

antibiotic-associated diarrhea?
A. Zinc
B. Probiotics
C. Peppermint
D. Chamomile
E. Omega-3 fatty acids

38. Which of the following is the MOST likely complication of spinal anesthesia?
A. Infection
B. Epidural hematoma
C. Nausea and vomiting
D. Pruritus
E. Cephalad spread of blockade

39. Regarding house-hold products, ingestion of which of the following cleaning

agents is considered as caustic ingestion?
A. Soap solution
B. Electric dishwasher detergent
C. Single-use detergent sac
D. Powdered detergent
E. Glass cleaner

40. A 14-month-old girl frequently admitted to the hospital because of

recurrent chest infections. She always expresses fears from hospital
environment and resists physical examination since her first admission. Her CXR
shows slightly enlarged cardiac shadow; accordingly she was referred for
cardiac assessment.
Of the following, the MOST convenient sedating agent to perform
echocardiography for her is
85
 A. chloral hydrate
B. morphine
C. methohexital
D. nitrous oxide
E. phenobarbital

41. In the presence of an anesthesiologist and/or specially trained pediatrician,

which of the following drugs is the MOST effective sedating agent for painful
procedures like bone marrow aspiration in children?
A. Midazolam
B. Propofol
C. Diazepam
D. Fentanyl
E. Dexmedetomidine

42. Regarding pain categories, a sharp, pulsatile, and well localized pain is
characteristic for
A. deep somatic pain
B. visceral pain
C. superficial somatic pain
D. dysfunctional neuropathic pain
E. inflammatory neuropathic pain

43. Which of the following pain measurement tools is suitable for infants and
nonverbal children?
A. Visual analog scale
B. Likert scale
C. Wong-Baker face scale
D. FLACC scale
E. FACES-R scale

44. In the treatment of pediatric pain, which of the following NSAIDs has
extensive pediatric safety experience?
A. Aspirin
B. Ibuprofen
C. Diclofenac sodium
D. Ketorolac
E. Naproxen
86
45. Using sucrose solution via pacifier or gloved finger before starting
procedure; can provide significant analgesia that may last up to
A. 2 minutes
B. 4 minutes
C. 6 minutes
D. 8 minutes
E. 10 minutes

46. Which of the following NSAIDs is useful in treating pediatric patients with
moderate to severe acute somatic pain?
A. Aspirin
B. Ibuprofen
C. Diclofenac sodium
D. Naproxen
E. Ketorolac

47. Which of the following is the preferred antidote for cyanide poisoning?
A. amyl nitrite
B. sodium nitrite
C. sodium thiosulfate
D. pyridoxine
E. hydroxocobalamin

48. A 6-year-old boy, known case of sickle cell anemia, presents to the E/D with
severe intractable back pain for the last 6 hours.
Of the following, the drug of CHOICE to control his pain is
A. diclofenac sodium
B. ketorolac
C. morphine
D. naproxen
E. gabapentin

49. Which of the following drugs is useful in treating pediatric patients with
neuropathic pain?
A. Diclofenac sodium
B. Codeine
C. Acetaminophen
D. Ketorolac
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 E. Amitriptyline

50. In the treatment of chronic severe pain with opioid, what is the most
common, troubling, but treatable side effect?
A. Nausea and vomiting
B. Respiratory depression
C. Constipation
D. Pruritus
E. Addiction

51. A 5-year-old boy, previously healthy, exposed to trauma while playing

football with his peers. On ER arrival, a 3 cm long lacerated wound is observed
in this left arm.
Of the following, the MOST appropriate measure to control his pain during
suturing is
A. IV Morphine
B. IV acetaminophen
C. topical lidocaine
D. topical phenylephrine-tetracaine
E. IM tramadol

52. The diagnosis of carbon monoxide poisoning is confirmed by

A. determination of HbCO level by CO-oximetry
B. determination of O2 saturation by pulse-oximetry
C. measuring partial pressure of O2 by blood gas analysis
D. measuring partial pressure of CO2 by blood gas analysis
E. applying oxygen-hemoglobin dissociation curve

53. A 3-year-old boy presents to the E/D with agitation and delirium for the last
2 hours. He was completely healthy before accompanying his older brother in a
forest trip. Physical examination shows plethoric face, clear chest, dilated
pupils, and dry hot skin. HR 150 bpm, RR 24 bpm, and temp 38 ◦C. The boy was
witnessed holding a wild plant during the trip.
Of the following, the MOST likely plant poisoning is
A. foxglove
B. rosary pea
C. datura stramonium
D. rhododendron
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 E. conium maculatum

54. Pharmaceutical preparations account for approximately 60% of pediatric

poisoning cases.
Of the following, the MOST commonly reported category is
A. antibiotics
B. analgesics
C. anticonvulsants
D. antihypertensives
E. antidepressants

55. In children <6 years old, the majority of poisoning exposure can be managed
through
A. outpatient visit
B. emergency department visit
C. hospital admission
D. phone call to the poison control center
E. self-directed fist aids by caregivers

56. Which of the following agents is potentially toxic to young children (<6
years) in small doses?
A. Aspirin
B. Soap solution
C. Diphenoxylate and atropine
D. Diazepam
E. Paracetamol and chlorpheniramine

57. Some poisons are associated with characteristic odors that can be smelt in
exposed children.
Of the following, the agent that produces garlic odor is
A. cyanide
B. organophosphate
C. methyl salicylate
D. hydrogen sulfide
E. methanol

58. What is the MOST appropriate action for potentially toxic plant ingestions
present within 1-2 hours after ingestion?
89
 A. Supportive care and symptomatic treatment
B. Decontamination with activated charcoal
C. Decontamination with whole-bowel irrigation
D. Gastric lavage and toxicologic analysis of gastric content
E. Identification of the plant and toxicologic consultation

59. A 3-year-old girl presents to the E/D with diarrhea, vomiting, and drooling
from the mouth. Physical examination shows wheezy chest, bradycardia,
excessive sweating, and miosis in both eyes. The girl was found alone in the
house garden few minutes before the development of symptoms and poisoning
is suspected.
Of the following, the MOST likely recognizable poison syndrome (toxidrome) is
A. sympathomimetic
B. cholinergic
C. anticholinergic
D. sympatholytic
E. serotoninergic

60. Massive ingestion of which of the following drugs is associated with high
anion gap metabolic acidosis?
A. Acetazolamide
B. Ethanol
C. Salicylates
D. Barbiturates
E. Benzodiazepines

61. Regarding laboratory evaluation of poisoned children, liver transaminases,

as well as an international normalized ratio (INR) should be measured for every
patients has had overdose of
A. acetaminophen
B. aspirin
C. diazepam
D. ibuprofen
E. loratadine

62. For which of the following toxicants quantitative blood concentrations are
integral to confirming the diagnosis and formulating a treatment plan?
A. Organophosphate insecticide
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 B. Diclofenac sodium
C. Kerosene
D. Desloratadine
E. Iron

63. Physostigmine is effective antidote for poisoning with

A. morphine
B. atropine
C. organophosphorous compounds
D. sulfonylureas
E. heavy metals

64. A 16-year-old girl found unconscious in her bedroom and brought to the
hospital. On examination she is in deep coma with hypertonia, tachycardia and
both pupils were slightly dilated. CT-scan is normal and ECG shows widening of
QRS complex (150 milliseconds).
Which of the following drug overdose is highly suspected?
A. Barbiturates
B. Opioids
C. Tricyclic antidepressants
D. Benzodiazepines
E. Ethanol

65. Glucagon is the preferred antidote for poisoning with

A. acetaminophen
B. nifedipine
C. diazepam
D. atropine
E. propranolol

66. A 15-year-old girl is brought to the emergency department by her family two
hours after ingestion of many ferrous sulphate tablets as a suicidal attempt.
After stabilization, the MOST likely effective method of GI decontamination for
this patient is
A. whole-bowel irrigation
B. induction of emesis by syrup of ipecac
C. administration of activated charcoal
D. administration of magnesium sulphate as cathartic agent

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 E. gastric lavage

67. In the management of poisoning, gastrointestinal decontamination

strategies are most likely to be effective in the first or second hour after an
acute ingestion, but it may be considered more than 2 hours after ingestion of
A. cholinergic medications
B. massive amounts of liquid medications
C. enteric-coated salicylates
D. sympathomimetic agents
E. lipid soluble B-blockers

68. Which of the following poisonings is effectively adsorbed by activated

charcoal?
A. Ethanol
B. Cyanide
C. Lead
D. Carbamazepine
E. Lithium

69. Which of the following methods is no longer recommended in the

decontamination of most cases of pediatric poisoning?
A. Whole-bowel irrigation
B. Single-dose activated charcoal
C. Gastric lavage
D. Dermal decontamination
E. Ocular decontamination

70. A 10-year-old boy underwent removal of skin lesion under local anesthesia
using subcutaneous bupivacaine without adrenaline. Few minutes after surgery,
he develops severe postoperative headache, confusion and perioral
paresthesias. Physical examination shows hypotension and bradycardia, while
ECG demonstrates widening of QRS complex.
Of the following, the MOST likely treatment is
A. hemodialysis
B. intralipid emulsion therapy
C. peritoneal dialysis
D. multidose activated charcoal
E. forced diuresis with alkalinization of urine
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71. Alkalinization of the urine is MOST useful in managing poisoning with
A. acetaminophen
B. ibuprofen
C. carbamazepine
D. methotrexate
E. amphetamine

72. Which of the following toxic agents is effectively removed by hemodialysis?

A. Valproic acid
B. Cyanide
C. Lead
D. Amitriptyline
E. Warfarin

73. A 2-year-old girl presents to the emergency department with severe

cyanosis 4 hours following ingestion of two tablets of dapsone 50 mg previously
prescribed for her dermatitis herpetiformis. The recommended dose for her was
25 mg once daily. Physical examination shows HR 140 bpm, RR 30 bpm, SpO2
85%. ECG and CXR are normal. She partially responded to O 2 therapy, but
returned back to previous condition once O2 stopped.
Of the following, the MOST appropriate treatment is
A. continuous oxygen therapy and wait for spontaneous drug clearance
B. multidose activated charcoal
C. hemodialysis
D. forced diuresis with alkalinization of urine
E. exchange transfusion

74. Which of the following antidotes is useful in the diagnosis of coma due to
benzodiazepines overdose?
A. Physostigmine
B. Dimercaprol
C. Flumazenil
D. Pyridoxine
E. Naloxone.

75. In the general management of poisoning, gastrointestinal dialysis is the term

that BEST describes which of the following methods?
A. Whole-bowel irrigation
93
 B. Oral administration of magnesium sulphate
C. Gastric lavage
D. Repeated administration of oral sorbitol
E. Multidose activated charcoal

76. Which of the following doses of acetaminophen can be considered as a

lowest toxic after single ingestion?
A. 60 mg/kg
B. 120 mg/kg
C. 160 mg/kg
D. 220 mg/kg
E. 260 mg/kg

77. A 2-year-old boy weighing 11 kg presents to the emergency department, 12

hours after ingestion of 50 ml of acetaminophen syrup 250mg/5ml. The
expected clinical manifestations at this stage is
A. anorexia, vomiting, and malaise with normal hepatic transaminases
B. liver failure with peak transaminase elevation
C. right upper quadrant abdominal pain with normal hepatic transaminases
D. anorexia, vomiting, and malaise with elevated hepatic transaminases
E. right upper quadrant abdominal pain with elevated hepatic
transaminases

78. At which of the following durations after ingestion, a serum acetaminophen

level should be measured if a toxic ingestion is suspected?
A. 2 hours
B. 4 hours
C. 6 hours
D. 8 hours
E. 10 hours

79. A 15-year-old boy brought by his father to the emergency department 10

hours after ingestion of 2 sheets (8 tablets each) of paracetamol 500 mg as a
suicidal attempt. On examination the boy looks healthy with normal vital signs.
Of the following, the MOST appropriate management is
A. measurement of acetaminophen level and applying Rumack-Matthew
nomogram
B. forced diuresis with alkalinization of urine
94
 C. emergency hemodialysis
D. starting empiric N-acetylcysteine
E. observation for 24 hours followed by assessment of liver function

80. A 3-year-old girl has had high grade fever associated with URTI for the past 3
days. She received several doses of oral and rectal acetaminophen, collectively
about 80mg/kg/day for the last 2 days. You have been counseled about the
safety of the antipyretic regimen.
Of the following, the MOST appropriate advice is
A. measurement of acetaminophen level
B. no intervention is required
C. starting empiric N-acetylcysteine
D. requesting liver ultrasound
E. requesting AST, ALT, and INR

81. A 2-year-old boy presents to E/D with history of ingestion of large number of
unknown tablets before 3 hours. He vomits twice at home. Physical examination
shows altered mental state, HR 140 bpm, RR 40 bpm, temp 38 C ◦. Random
blood sugar 250 mg/dL and arterial blood gas reveals a primary respiratory
alkalosis. During his stay in the E/D, the kid developed seizures twice that
necessitate diazepam administration.
Of the following, the MOST likely culprit medication is
A. acetaminophen
B. carbamazepine
C. salicylate
D. tricyclic antidepressant
E. metformin

82. In acute salicylism, salicylate pills (especially enteric-coated forms)

occasionally form bezoars, which should be suspected if
A. the patient develops seizures
B. serum salicylate concentrations continue to rise
C. the patient develops abdominal cramps
D. respiratory alkalosis shifted to high anion gap metabolic acidosis
E. hyperglycemia shifted to hypoglycemia

83. What is the primary mode of therapy for salicylate toxicity?

A. Multidose activated charcoal
95
 B. Hemodialysis
C. Use of n-acetylcysteine
D. Urinary alkalinization
E. Rehydration with ringer solution

84. A 2-year-old boy weighing 12 kg presents to the emergency department 3

hours after ingestion of about the half of a 100 ml bottle containing Ibuprofen
suspension (100 mg/5ml). He is asymptomatic with normal vital signs.
Of the following, the MOST appropriate measure is
A. administration of activated charcoal
B. performing gastric lavage
C. urinary alkalinization
D. measurement of ibuprofen level
E. supportive care with observation

85. A 3-year-old girl presents to the emergency department, 2 hours after

ingestion of one tablet of a medication prescribed for her brother to control his
drug craving. She is in coma with pupils reacting to light but moderately
constricted, HR 70 bpm, RR 8 bpm, temp 35 C◦, SpO2
89 %.
Of the following, the MOST appropriate treatment is
A. Administration of activated charcoal
B. IV flumazenil and treating according to response
C. Starting IV naloxone therapy
D. Supportive care and request toxicological screen
E. Hemodialysis

86. Which of the following is considered to be the MOST toxic β-blocker in

overdose situations?
A. Propranolol
B. Atenolol
C. Bisoprolol
D. Carvedilol
E. Metoprolol

87. A 2-year-old boy presents to E/D with history of ingestion of large number of
unknown tablets before 6 hours. Physical examination shows altered mental
state, HR 60 bpm, Bp 65/45, RR 24 bpm, temp 37.2 ◦C, SpO2 96%. Chest
96
auscultation reveals diffuse expiratory rhonchi. Random blood sugar is 50
mg/dL and blood gas is normal.
Of the following, the MOST likely culprit medication is
A. oral antidiabetic
B. tricyclic antidepressant
C. calcium channel blocker
D. β-blocker
E. α- blocker

88. Which of the following is the MOST dangerous calcium channel blocker in
overdose situations?
A. Nimodipine
B. Diltiazem
C. Nifedipine
D. Amlodipine
E. Nicardipine

89. Which of the following is considered as the antidote of CHOICE in the

treatment of calcium channel blockers overdose?
A. Calcium salts
B. Dextrose
C. Adrenaline
D. Lipid emulsion therapy
E. Insulin

90. Which of the following is the antidote of CHOICE for both methanol and
ethylene glycol poisoning?
A. Ethanol
B. Fomepizole
C. Sodium bicarbonate
D. Folic acid
E. Pyridoxine

91. A 4-year-old girl presents to the E/D with nausea and vomiting for the last 6
hours. She is a known case of heart failure on digoxin therapy. Before one day
the girl was treated with a macrolide antibiotic for tonsillitis, because she is
allergic to penicillins. On examination she looks pale, lethargic, HR 50 bpm, with
irregular pulse. Investigations reveal serum digoxin level 16 ng/mL, serum K+ 5.6
97
mEq/L, creatinine 0.7 mg/dL, and ECG shows widening of QRS complex (110
milliseconds).
Of the following, the BEST predictor of poor outcome is
A. QRS widening
B. serum digoxin level
C. serum potassium
D. serum creatinine
E. heart rate

92. What is the expected time for development of GIT strictures following
massive ingestion of iron in children?
A. 5-10 days
B. 2-3 weeks
C. 4-6 weeks
D. 7-8 weeks
E. 9-10 weeks

93. A 2-year-old boy presents to the E/D with altered mental state for the last 6
hours. His mother noticed that her pills organizer is empty for the next two
days; she is a diabetic patient on oral antidiabetic therapy (glibenclamide 5mg
tablets twice daily). On examination the boy looks drowsy with profuse
sweating, HR 160 bpm, RBS 35 mg/dL, and serum electrolytes are normal. The
patient was treated with two bolus doses of IV dextrose that raises his blood
sugar to 50 mg/dL and partially improved his mental state.
Of the following, the MOST appropriate next step is
A. hemodialysis
B. continuous dextrose infusion
C. administration of glucagon
D. administration of a third bolus dose of IV dextrose
E. administration of octreotide

94. What is the expected toxicity following large overdose of metformin?

A. hypoglycemia
B. nephrotoxicity
C. neurotoxicity
D. lactic acidosis
E. hepatotoxicity

98
95. A 14-year-old boy found unconscious in his bedroom and brought to the
hospital. Before six months, he survived a suicidal attempt and kept on
antidepressant medications (imipramine 25 mg at bed time). The medication
container was found empty beside the victim. On examination he is in deep
coma with hypertonia, mydriasis, HR 130 bpm, Bp 70/50, temp 37.8 ◦C. ECG
shows widening of QRS complex (150 milliseconds) with multiple premature
ventricular contractions.
Of the following, the MOST appropriate initial treatment is
A. esmolol
B. sodium bicarbonate
C. hypertonic saline (3%)
D. lipid emulsion therapy
E. amiodarone

96. A 10-year-old boy presents to the E/D with visual disturbances and rapid
deep breathing 12 hours after accidental ingestion of a paint remover stored in
a carbonated beverages bottle. Visual disturbances include cloudy vision,
decreased acuity, and the “feeling of being in a snowstorm”. Ophthalmic
examination reveals dilated pupils, retinal edema, and optic disc hyperemia.
Of the following, the MOST likely ingested poison is
A. acetone
B. ethanol
C. methanol
D. ethylene glycol
E. benzene

97. A 2-year-old boy presents to the E/D one hour after ingestion of unknown
quantity of sewage cleaner. The boy has excessive drooling and he refuse to
swallow anything. Examination of the chest is normal.
Of the following, the MOST appropriate management is
A. performing gastric lavage
B. administration of activated charcoal
C. nothing by mouth and proton pump inhibitor therapy
D. corticosteroids therapy and prophylactic antibiotics
E. immediate endoscopy

98. Which of the following pesticides is MOST commonly used in home?

A. Pyrethrins
99
 B. Organophosphates
C. Carbamates
D. Organochlorines
E. Coumarins

99. A 2-year-old boy presents to the E/D with coughing and drooling 3 hours
following ingestion of unknown quantity of kerosene. On examination the boy is
drowsy with odor of kerosene clearly smelt in his breath, HR 100 bpm, RR 35
bpm, temp 37.5 ◦C, SpO2 95%, with clear chest. The boy vomited twice at home
and his cloths were found contaminated with kerosene.
Of the following, the MOST appropriate management is
A. supportive care and observation for 24 hours
B. start prophylactic antibiotics
C. start systemic corticosteroids
D. immediate CXR and treat accordingly
E. supportive care and request CXR after 6 hours

100. A 2-year-old girl presents to the E/D one hour after accidental ingestion of
kerosene which was stored in a domestic container. She is asymptomatic with
odor of kerosene clearly smelt on her cloths, otherwise normal physical
examination.
Of the following, the MOST appropriate decontamination method is
A. Emesis
B. Gastric lavage
C. Activated charcoal
D. removing contaminated clothing
E. whole-bowel irrigation

101. A 5-year-old boy presents to the E/D with difficulty in breathing few
minutes after spraying an insecticide in the garden by his father. He is conscious
with oral frothy discharge, diffuse expiratory wheeze, excessive sweating, and
slightly constricted pupils.
Of the following, the MOST appropriate way for decontaminating the victim is
A. activated charcoal
B. gastric lavage
C. whole-bowel irrigation
D. washing all exposed skin with soap and water
E. induction of emesis
100