1)A 12- month old boy presents to the emergency department with a 6 hour history of vomiting, colicky abdominal

pain, and irritability.On examination, a sausage like mass is palpable in the right upper quadrant of the abdomen. What is the most appropriate step in management?
A. Order a CT scan of the abdomen B. Order a barium swallow C. Obtain a surgical consultation D. Follow up examination after 4 hours

2) A 4-year old boy , whose past medical history is positive for 3 UTIs presents now with BP135/90 and renal scan shows bilateral renal scars . What should have been done to prevent this situation?
A. Give antibiotics for 3-5 days for each UTI. B. Do cystourethrography and give prophylactic antibiotics accordingly. C. Abdominal Ultrasound every 3 months D. Prescribe urinary effervescent.
__________________________________________________________________________________

3)A 10 months old infant presents with a day history of blanching confluent rash which started on his face and now covers his entire body. He is miserable with conjunctivitis and fever of 38 C. the illness

started with runny nose and cough 5 days previously What is the most likely diagnosis?
A. Scarlet fever B. Sweat rash C. Chicken pox D. Measles

4)A mother brings to the clinic her 4 years old son who began complaining of Rt knee pain 2 weeks ago, is limping slightly, is fatigued and has had a fever 38.2C. What is the important diagnostic Lab test to perform?
A. CBC with differential B. Sedimentation rate C. EBV titre D. Rheumatoid factor

5)A 12 years old female came to hospital with fever, difficulty in severe effort intolerance and joint pain which started in breathing later involved the lt. knee. By examination BP was the rt. wrist and and Temp. was 39 c. Abdominal 90/60, HR was 140, RR was 35 .examination revealed enlarged tender liver
The first action to be done :
A- Starting antifailure treatment B- NSAID administration C- IV fluid administration D- Blood culture

6)A 3 years old boy came to the outpatient's clinic complaining of runny nose, malaise and vomiting.On exam , there were hyperemia of the throat and fever . What is the most likely medicine to be given?

A-Oral Amoxicillin B- Paracetamol C- Multivitamin D-Acetylsalicylic acid

7)An 18 months old boy came to the emergency department with rapid respiration, drowsiness. He had a history of vomiting and diarrhea for 3 days before the onset of his condition. By examination HR was 160, RR was 60, Temp. was 38.5 and Bp was 60/40. He had delayed capillary refill. What is the most likely action to be done?
A- Chest x-ray. B- Giving oral ttt and follow up. C- Administration of IV fluids. D- Blood gas analysis

8)A 4week-old, full term, breast fed girl has worsening yellowish discolouration of the skin, that the parents first noticed 15 days ago. On her examination, she is well appearing with good suckling and reflex activity, and is noted to have a liver edge 4cm below her costal margin. Her total bilirubin is 12 and direct bilirubin is 9. What is the most likely diagnosis?
A. Biliary atresia B. Cholecystitis C. Sepsis D. Breast milk jaundice

9)A 7-week old baby is referred with a 2-week history of vomiting. He is being formula fed (160 ml)every 2-3 hrs. On examination he is well. thriving, on the 90"' percentile and has a normal examination. What is the most likely diagnosis:
A -Pyloric stenosis B -Gastro-oesophageal reflex C -Over-feeding

D Acute gastroenteritis

10)A 5-month-old girl presented with history of constipation and delayed developmental milestones. She had prolonged physiological jaundice. On exam, she is hypoactive, has an open mouth with large tongue. Other systemic examinations are within normal. What is the next step in management?
A) Checking T4 and TSH B ) Checking serum bilirubin C ) Doing CT scan of head D ) Follow up after 4 weeks

11)A 6-month-old boy is brought by his mother because he is floppy when placed in a sitting position. He does not seem to be interested in reaching for toys. At 4 month visit, his head support was weak and had a persistent Moro reflex. What is the most likely diagnosis?
A ) Duchenne muscular dystrophy B ) Cerebral palsy C ) Brain tumor D ) Meningitis

12)An infant can move his head from side to side while following moving object, can lift his head from prone position 45 degrees off the examination table, and smiles when encouraged. he can sit with support . The most likely age of this infant is:
A). 1 month B). 5 months C). 9 months D). 12 months

13)A 3 week old baby, who was full term, Is brought to the hospital. He has recently been having problems completing his feeds and today appears short of breath. On examination, his HR was 180/min, RR 72/min, rectal temperature 37.4, BP 80/50, and he had a 4 cm hepatomegaly. All blood tests were normal. What is the most likely diagnosis?
A. Neonatal hepatitis B. Respiratory distress syndrome C. Heart failure D. Congenital infection

14)A 3 day old infant presents with the complaint of yellowish skin. Both the mother and the baby have O +ve blood. The baby's direct serum bilirubin is 0.2 mg/dl. With a total serum bilirubin of 11.8 mg/dl. The hemoglobin is 17 gm/dl. Platelets count is 278,000/ul. Reticulocyte count is 1.5%. the peripheral smear doesnt show abnormalities. The most likely diagnosis:
A. Rh or ABO incompatibility B. Physiologic jaundice C. Sepsis D. Congenital spherocytic anemia E. Biliary atresia

15)A 15 months old infant presents to the emergency department with a 4-day history of high fever without any localizing sign. She suffers self limiting convulsion and is admitted for observation. The next day the fever subsides, but a red popular rash develops over her trunk and abdomen. What is the most likely diagnosis:
A. Measles B. Rubella C. Roseola

D. Chicken pox

16)A 7 year old boy was limping for 3 days presented to the surgical department with severe acute colicky abdominal pain. The surgery resident asked for medical consultation for a rash on the back of both lower limbs of the child. The acute abdomen is due to :
A. Rheumatic fever B. Appendicitis C. Henoch-schonlein purpura D. Rheumatoid arthritis

17)A 3 years old fully immunized child presents with fever and difficulty in breathing. She has had tonsillitis over the past week, for which she received oral antibiotics for 2 days. On examination, she looks unwell, she has mild recession, and a soft inspiratory sound is audible. What is the most likely diagnosis:
A. Bronchial asthma B. Retro-pharyngeal abscess C. Epiglottitis D. Pneumonia

18)A 10 month old female infant is brought to a clinic for routine health evaluation. Her diet consists of ordinary food and a lot of fresh whole milk. On examination, she is pale, hemoglobin is 7.5 gm% otherwise there are no abnormalities. The most likely diagnosis is:
A.Thalassemia B.Iron deficiency anemia C.Sickle cell anemia D.Anemia of chronic illness

19)A 2 week old infant has had no immunization, sleeps 18 h a day, weight 3.5 kg, and takes 60 ml of standard infant formula four times a day, but no solid food and no iron or vitamin supplements. What should be of most concern about this infant?
A.Immunization state B.Caloric intake C.Iron levels D.Circadian rhythm

20)A 2 month old boy with a 3 day history of mild fever and runny nose suddenly develops high fever, cough and respiratory distress. Within 48 hours, the patient deteriorated and has developed a peumatocele and a left sided pneumothorax. What is the most appropriate first action?
A.I.V. antibiotics B.Blood gases C.Chest tube D.Antipyretics

21)A 10 week old infant develops fever (38.5 C), vomiting, and irritability. His heart rate is 170/m and respiratory rate is 40/m. the infant's anterior fontanel is full, but there is no neck rigidity. The rest of the examination is unremarkable. What is the most appropriate diagnostic test?
A. CSF examination B. Complete blood count and ESR. C. X- ray skull D. chest x-ray

22)A 1 day infant who was born by a difficult forceps delivery is alert and active. She doesn't move her left arm and keeps it internally rotated by her side with the forearm extended and pronated. Which of the following is an expected clinical finding?

A. Intact both Moro and grasp reflex B. Lost both Moro and grasp reflex C. Intact Moro and lost grasp reflex D. Lost Moro and intact grasp reflex

23)A 4 month old infant presents with fever and poor feeding. Examination revealed moderate dehydration, poor perfusion, and screaming. The WBCs count is elevated with shift to the left. Urine analysis of a catheterized specimen reveals red blood cells, white blood cells, and scant bacteria. What is the most appropriate course of treatment?
A. B. C. D. Fluid restriction Surgical intervention I.V. antibiotics therapy

D. Wait for culture results

24)A 1 day old infant develops jitteriness and convulsions . He was born at 34 weeks gestation to a woman whose pregnancy was complicated by diabetes mellitus and pregnancy induced hypertension. Which of the following serum values could explain his condition?
A. serum bicarbonate level of 22 mEq/dl B. serum calcium of 6.2 mg/dl C. serum glucose of 45 mg/dl D. Serum sodium of 138 mEq/dl

25)An 8 years old girl present with low grade fever and a diffuse maculopapular rash. On examination her physician notes mild tenderness and marked swelling of her posterior cervical and occipital lymph nodes. Three days after the onset of illness , the rash has vanished. What is the most likely diagnosis ?
A.Measles.

B.German measles. C.Roseola infantum. D.Infectious mononucleosis

26)A 14 month old infant presents to clinic because of poor weight gain and delayed walking . History revealed exclusive breast feeding with little baby food. On examination he has large head, distended abdomen, and palpable swellings at costo-chondral junctions. What is the expected laboratory finding in this infant ?
A. Low calcium. B. Low alkaline phosphatase . C. Low phosphorus. D. None of the above

27) A 1-year-old infant is known to have heart disease and is noted to be cyanosed. Which of the following is the most likely diagnosis?
1.ASD 2.PDA 3.Coarctation of the aorta 4.Tricuspid atresia 5.VSD

28)A 14-year old boy presents with hypertension (HTN). Which of this statements regarding his condition is true ? :
1.Sodium Nitroprusside is useful in ttt of long-term cases. 2.Headache is the usual presenting feature. 3.It is defined as Systolic blood pressure above the 99th centile for age.

4.Abnormalities are frequently seen on DMSA scan. 5.Aortic coarctation is the commonest secondary cause.

29) A 3-month-old girl presents with apnea. She had been well that morning, but had become unsettled, crying inconsolably and gradually more mottled. Mother was bringing her to A and E when she stopped breathing. She responded to physical stimulation. She was born at 40+3/40 weighing 3.6kg and there were no neonatal problems. On examination she has a temperature of 36.3C (tympanic), RR 30/min and HR of 240/min. Her pulse in thready. She has a 3 cm liver and gallop rhythm. What is the most likely diagnosis?
1.Acute life-threatening event. 2.Cardiac dysrhythmias. 3.Seizures. 4.Sudden infant death syndrome (SIDS).

30) A 2 week old girl presents with a history of poor feeding, worse over the last 6 hours. 38+3/40, 2.95kg, no problems at birth. First pregnancy of healthy Caucasian mother. No FH/SH of note. No drugs nor immunisations. On examination temperature is 35.4C (tympanic), RR 60/min, HR 160/min on monitor (all pulses impalpable). Cold mottled peripheries, capillary refill time 6 seconds. O2 saturations 45% in air. Gallop rhythm, 4 cm liver, no spleen. No bruising or rash. What is the most likely diagnosis?
1.Congenital Adrenal Hyperplasia. 2.Congenital heart disease. 3.Inborn errors of metabolism.

4.Sepsis.

31) A 2 year old child has an uncomplicated coarctation of the aorta. The constriction is located distal to the left subclavian artery. Which of the following would be decreased in this patient?
1.Blood flow in the lower body. 2.Blood flow in the upper body. 3.Blood pressure in the upper limbs. 4.Vascular resistance in the lower limbs. 5.Vascular resistance in the upper limbs.

32) 7-year-old girl with Downs syndrome has central cyanosis. Examination of her chest shows only a soft mid-systolic murmur at the apex and in her abdomen there is a well healed scar in the epigastrium dating from the newborn period. Which of the following statements would be correct?
1.Her Hematocrit is likely to be 30% 2.She has Fallots Tetralogy. 3.Arterial blood gases show CO2 retention. 4.Dental extraction should be covered by Antibiotic prophylaxis.

33)A 15-year old female is diagnosed as having Turners syndrome . Which of the following is true?
1.She has a single-gene disorder. 2.She may have endocardial cushion defect. 3.She may have central cyanosis. 4.She may have Hypotension and Coarctation of the aorta.

5.She may have bicuspid aortic valves.

34) A 4-month-old baby has not gained much weight since birth and only takes small milk feeds, as he appears to become breathless on feeding. He is tachypnic, sweaty and has a tachycardia. His liver is enlarged and he has a harsh murmur on cardiac auscultation. Which of the following statements describes his condition ?
1. 2. 3. 4. He has an uncomplicated congenital heart disease. He has a high systolic blood pressure. He may have a ventricular septal defect complicated with HF. He may have hypervitaminosis D.

35) A 13-year-old girl is referred for evaluation of her short stature. She is pre-pubertal. On auscultation she has an ejection systolic murmur in the second and third left intercostals spaces radiating to the back, but is asymptomatic. Which statements best describes her condition?
1.She has Turners syndrome (45-X0) 2.She has Coarctation of the aorta. 3.She has Pulmonary valve lesion. 4.She has hypoplastic left heart syndrome.

36) An infant is seen for his 6-week check and found to have a loud ejection systolic murmur in the third left intercostal space and a single second heart sound on examination. There is no obvious cyanosis but a suggestion of mild desaturation. On the chest X ray there is a concavity on the left heart border and decreased pulmonary vascular markings. Which of the following best describes his condition?
1.This picture is suggestive of Transposition of great arteries(TGA) 2.The desaturation results from the right to left shunt across a VSD. 3.This infant may have an Atrial Septal Defect.

37) A 7-year-old boy is examined for a chest infection. An incidental finding of a short systolic murmur with fixed splitting of the second heart sound is detected. His blood pressure is normal and all pulses are normal. Which of the following is correct?
1.He may have an Ostium primum ASD. 2.He may have an Ostium secondum ASD. 3.He may have a Patent ductus arteriosus. 4.He may have a VSD.

38) A 16 month old boy is brought to clinic by his mother who is concerned regrading his development. Which of the following tasks should he be able to perform by this age?
1. Scribble spontaneously with pencil on paper. 2.Walk alone. 3.says no and shakes head. 4.He is unable to build a tower of 4 cubes. 5.Able to throw an object.

39) A 9 year old boy statemented for special educational needs is investigated for short stature. He has a weight over the 91st centile. He is noted to have small hands and feet and hypogonadism. Which of the following is correct?
1. 2. 3. 4. This child has Growth Hormone deficiency. This child has Prader-Willi Syndrome. The child has deletion of Chromosome number 18. The child has deletion of chromosome number 15 inherited from his mother.

40) A male child weighing 4.2kg is admitted at age 4 weeks with a one week history of forceful vomiting after feeds. He is alert and eager for food but exhibits a loss of skin elasticity

and has apparent distension in the left hypochondrium.

Which of the following statements is correct for this patient? 1.The most likely diagnosis is hiatus hernia. 2.He has hyperosmolar dehydration. 3.Metabolic acidosis would be anticipated. 4. Initial fluid replacement should comprise normal saline 10-20 ml/kg in one hour. 5. He should be started on an anticholinergic drug, e.g. Atropine Methylnitrate (Eumydrin), before feeds. 41) A 17 year old male student attends clinic complaining of right knee pain and left ankle pain. These pains have deteriorated when associated with episodic diarrhoea. The most likely diagnosis is :. 1.Amoebic dysentery. 2.Celiac disease. 3.Chronic appendicitis. 4.Ulcerative colitis. 5.Whipples disease. 42) A 6 week old infant presents with vomiting and failure to thrive. A diagnosis of pyloric stenosis is considered. Which one of the following statements is correct regarding congenital hypertrophic pyloric stenosis? 1. A double bubble is likely to be seen on abdominal X-ray 2. A hyperchloraemic alkalosis would be expected 3. Refusal of feeds is a feature 4. Vomitus is typically bile stained 5. Vomiting would have typically started between 2 to 4 weeks 43) A neonate does not pass meconium for 48 hrs after birth. A fortnight later his mother states that he is not passing stool regularly.

He has been bottle fed since discharge. Investigations reveal massive dilatation of the colon proximal to the rectum and manometry shows increased internal anal pressure on rectal distension with a balloon. What is the most likely diagnosis? 1. 2. 3. 4. 5. Cystic Fibrosis Cow's milk allergy Hirschsprung's disease Hypothyroidism Idiopathic Constipation

44) A young infant presents with a suspected diagnosis of pyloric stenosis. Which of the following is a feature of this diagnosis? 1.Projectile vomiting 2.Anorexia 3.Loose stools. 4.More frequent in girls. 5.Hyperchloremic acidosis. 45) A male child weighing 4.2kg is admitted at age 4 weeks with a one week history of forceful vomiting after feeds. He is alert and eager for food but exhibits a loss of skin elasticity and has apparent distension in the left hypochondrium. Which of the following statements is correct for this patient? 1. 2. 3. 4. The most likely diagnosis is hiatus hernia He has hyperosmolar dehydration Metabolic acidosis would be anticipated Initial fluid replacement should comprise normal saline 10-20 ml/kg in one 5. He should be started on an anti-cholinergic drug before feeds.

46) The following laboratory results were returned in a 6 week old boy admitted with 6 days of severe projectile vomiting:

Ph 7.51 PO2 12 KPa (95 mmHg) PCO2 4.7 KPa (35 mmHg) Blood Urea 11 mmol/l Na+ 131 mmol/l K+ 3 mmol/l Chloride 83 mmol/l Which of the following is true concerning this patient? 1. 2. 3. 4. He has respiratory alkalosis. He should receive normal saline immediately. He is likely to have a bulging anterior fontanelle. He should be commenced immediately on half strength soy protein low lactose formula. 5. X-ray of abdomen is likely to show dilated loops of small bowel.

47) A 12-year old child with Coeliac disease , which of the following is incorrect : 1.It is a gluten-induced enteropathy. 2.Is not provoked by rice or potatoes. 3.Results in both villus and crypt atrophy. 4.May produce abdominal distension.

48) A child aged 4 years has had fever, malaise, vomiting and rightsided abdominal pain for 48 hours . Which of the following is not likely to be the cause : 1.Acute pyelonephritis. 2.Right sided colonic neoplasm. 3.Shigella dysentery. 4.Lobar pneumonia.

5. A parasitic infestation. 49) An 8 month old child has been passing frequent watery stools for 5 days. His serum biochemistry revealed the following: Sodium 158 mmol/l Potassium 3.5 mmol/l Urea 13 mmol/l Creatinine 120 umol/l pH 7.08 PCO2 4.5 KPa PO2 13 KPa Base excess 18 mmol/l Which of the following statements concerning this child is correct : 1. The high serum sodium might have resulted from his being given only plain congee for the past 3 days at home 2. A rapid infusion of sodium bicarbonate should be given to correct the acidosis 3. Skin turgor is a good guide in assessing hydration state. 4. The condition might have resulted from taking concentrated feed before the onset of diarrhea 5. Replacement fluid to correct dehydration should be given over 6 hours to replenish the intravascular volume. 50) An 18 month old child presents with capillary pH 7.25, PCO2, 3.9 kPa, BE -8, serum Na 130mmol/l, serum K 7.9mmol/l, urine pH of 6.5. Which of the following is not likely to be the accurate diagnosis : 1.Proximal renal tubular acidosis. 2.Distal renal tubular acidosis. 3.Congenital adrenal hyperplasia. 4.Congenital adrenal hypoplasia.

51) A child presents at 10 months of age with scissoring of the legs. All of the following pointers may indicate a specific diagnosis except : 1. An apgar of 5 at 5 minutes 2. A blood glucose of 2.2mmol/L in the neonatal period 3. A history of ABO incompatibility 4. History of neonatal septicaemia 5. Midline cleft palate 52) The following laboratory results were returned in a 6 week old boy admitted with 6 days of severe projectile vomiting: pH 7.51 (7.35-7.45) PO2 12 KPa (95 mmHg) PCO2 4.7 KPa (35 mmHg) Blood Urea 11 mmol/l Sodium 131 mmol/l Potassium 3 mmol/l Chloride 83 mmol/l 1. He has respiratory alkalosis 2. He is likely to have a bulging anterior fontanelle 3. He might have pyloric stenosis 4. He should be commenced immediately on half strength soy protein, low lactose formula. 5. X-ray of abdomen is likely to show dilated loops of small bowel 53) A 7 year old girl presents with a 3 day history of rash and ankle swelling. She had a cold 4 weeks previously, but has otherwise been healthy. 39+1/40, 2.96kg. No neonatal problems. No drugs or medications. Fully immunized. On examination she has palpable nonblanching purple spots 1-4 mm in diameter especially over the shins and buttocks.Her left ankle is swollen, warm and tender, with restricted movement. What is the most likely diagnosis? 1. iral In ec on. 2.Trauma/child abuse.

3. trept. In ec on. 4.Thrombocytopenia. 5. asculi s. 54) A 16 year old girl presents with a 2 day history of deteriorating breathlessness and dyspnoea. Blood gas analysis shows a pH of 7.25, a PCO2 of 7.0kPa, a PO2 of 8.5kPa, and a base excess of -4. Which of the following interpretations is correct? 1. 2. 3. 4. 5. Results are consistent with bronchopulmonary dysplasia. Blood gases suggest type 1 respiratory failure. Immediate intubation is required. Results are consistent with late severe asthma. Bicarbonate may be necessary to correct the acidosis.

55) A 14 year old girl presents with a history of cough and breathlessness on exercise. She has seasonal rhinitis, and admits to have started smoking. Clinical examination is unremarkable. What is the most likely diagnosis? 1.GERD 2.Sinusitis. 3.Allergic Rhinitis 4.Asthma 5.Croup. 56) A 17 year old female presents with acute breathlessness. She has had asthma for approximately 3 years and recently commenced new therapy. Which agent may be responsible for this exacerbation? 1.MonteLukast. 2.Ipratropium

3.Theophylline. 4.Salmeterol. 5.Beclomethasone. 57) A newborn presents with an early onset of tachypnea with chest retractions, expiratory grunting and cyanosis following an uneventfual normal preterm labor. On examoination no cardiac murmurs are heard and the lungs appear clear. On plain X-Ray there is evidence of prominent pulmonary vascular markings and fluid lines in the fissures. The cyanosis improves with minimal oxgen. The most probable diagnosis is: a. Meconium aspiration syndrome. b. Transient tachypnea o the newborn. c. Persistent etal circulation. d. Hyaline membrane disease. 58) An eight years old girl with a history of congenital heart disease is found to be anemic and has a low grade fever. Physical examination reveals an enlarged spleen. Petechial hemorrhages are seen under the nails. Eye examination shows retinal hemorrhages with central area of clearing. The heart disease she has is least likely to be: a. Atrial septal defect b. Ventricular septal defect c. Patent ductus arteriosus d. Tetralogy of fallot 59) A 4 month old, 6 kg girl is admitted to the PICU for respiratory failure. She is cyanotic and retracting. She is intubated due to worsening tachpnea, increasing work of breathing, and fatigue. Her oxgen saturation has been falling and her PCO2 is 75 mmHg on an arterial blood gas analysis. An unlikely cause of her respiratory failure is: a. Pneumonia b. Sepsis c. croup d. Poliomyelitis

60) An 11-year old girl presents with a 3-day history of being unwell, feverish and off her food. She has a rash which covers her entire body, her cheeks are red and she is pale around her mouth. Her tongue and lips are red and pus is noted on her tonsils. Fever is recorded up to 39.5 What is the most likely diagnosis: a. Measles b. Scarlet fever c. Meningococcal disease d. Herpangina 61) A 14-month old girl presents with cough and fever up to 39.4. Her parents say that she is preferring milk, and she often refuses to feed. She is not waking or pulling up to stand. She looks pale and her head appears large. She is found to have swollen wrists. Skeletal survey shows abnormal epiphyses. What is the most likely diagnosis?
a. Osteomyelitis b. Thalassemia C. Rickets d. Hypothyroidism

62) A 5 year old boy presents with a 3 week history of polydipsia, polyuria and weight loss. On examination he is apyrexial ,dehydrated and unwell.Respiration is deep and rapid with peculiar mouth odor. Heart rate is 150/min. He is cold to the elbows with a capillary refill time 4 seconds. Which of the following is an expected finding?
a. Metabolic alkalosis b. Hypoglycemia c. Glycosuria d. Generalized oedema

63) A 12 years old boy develops petechiae and papules, some of which become purpuric over his buttocks and legs, associated with painful swollen knees.There is microscopic haematuria on testing. The platelet count is normal. What is the appropriate line of treatment?
a. Steroids b. Cytotoxic drugs

c. Antibiotic d. Dialysis

64) A term infant weighs 2100 gm at birth. Physical exam reveals a small infant with a disproportionately large head. Mother has a history of smoking during pregnancy. Apgar score was 4 and 6 at 1 and 5 min respecvel y. 12 hour s delivery the baby developed repeated episodes of frequent blinking and cycling movements of lower limbs. Whats the most likely diagnosis?
a. Neonatal meningitis b. Birth asphyxia c. Intracranial hemorrhage d. Nicotine withdrawal

65) A 15 month infant presents with a history of greenish, watery, loose stool for the past 4-5 days. The diarrhea occurs about 10 me s per day and leaks out of the diaper. He has temperature of 38.5C, heart rate, RR 40/m and BP 60/40 mmHg. On examinaon, he is irri tabl e, and has sunken eyes and anterior fontanelle. Lab values are: PH 7.1 and bicarbonate 10mEq/L. This infant may develop all EXCEPT:
a. Seizures b. Oliguria c. Bleeding tendency d. Elevated serum creatinine

66) A 7-month- old infant presents to the physician with a 3-day history of upper respiratory tract infection, wheezy cough, and breating difficulty. On examination, the infant has a temperature of 39 C, respirations of 60/m with nasal flaring and accessory usage. A CBC and differential are within normal and chest x-ray reveals hyperinflation of both lung fields. What is the most likely diagnosis?
a. Heart failure b. Bronchial asthma c. Foreign body inhalation d. Acute bronchiolitis

The main treatment for uncomplicated cases:

a. Ribavirin

b. Corticosteroids c. Inhaled salbutamol d. None of the above.

67) A 3-years-old child is prone to episodes of restlessness, cyanosis, and gasping respirations. Symptoms resolve when he is placed in the knee chest position.Examination reveals an under built child, with a harsh holosystolic murmur and a single second heart sound. All of the following are expected EXCEPT?
a. Clubbing of fingers b. Cerebral abscess c. Lung plethora d. Right axis deviation

68) A 1 years old boy presented with history of flu and low grade fever for the last 2 days. He developed noisy breathing characterized by inspiratory sound for the last 6 hours. The sound increases on crying and decreases while sleeping. What is the most likely diagnosis?
a. Acute epiglottitis b. Acute asthmatic attack c. Acute laryngotracheobronchitis d. Foreign body inhalation

Which of the following would be correct?

a. Hormone treatment is never appropriate b. Steroid therapy is indicated c. Chest x-ray is diagnostic d. Immunization is protective

69) A 4 year old boy presents with eye swellings and puffiness of the face. This has been worsening over the past few days, and is most prominent in the mornings. There is no previous history of note. On examination his respiratory rate 20/min, pulse 100/min; blood pressure is 80/60mmHg. He has edema around the eyes, with scrotal enlargement which transillluminates. His abdomen is distended and dull to percussion. Urine test shows 4+ proteinuria. What is the most likely diagnosis?
a. Angio-oedema b. Cardiac failure

c. Nephrotic syndrome d. Portal hypertension

Which is the best treatment for the patient?

a. Antihistamines b. Inotropic drugs c. Intravenous furosemide d. High dose corticosteroids

70) A 12 year old boy presents in a confused state. He developed a fever 2 days previously, and had been complaining of headache, fever and photophobia. He had vomited once. On examinaon hi s temp er at ur e wa s 38. 0 C and has mild neck stiffness and photophobia. What is the most likely diagnosis?
a. Cerebral abscess b. Diabetic ketoacidosis c. Drug intoxication d. Viral encephalitis

What treatment may be of help?

a. Naloxone b. Acyclovir c. Insulin d. Surgery

71) A 5-month-old girl presented with history of constipation and delayed developmental milestones. She had prolonged physiological jaundice. On exam, she is hypoactive, has an open mouth with large tongue. Other systemic examinations are within normal. What is the next step in management?
1.Checking serum Bilirubin 2.Checking T4 & TSH 3.Doing CT scan of the head 4.Follow up after 4 weeks

72) A 7 year old boy arrives at the emergency department, complaining of rapid breathing and vomiting, dating 3 days ago, he has been receiving IM antibiotics for 3 days with no improvement. On

examination, he has rapid deep breathing with RR 60/min, HR 90/min. chest x-ray was normal. What is the next investigation to do?
1.Chest X-ray 2. Upper GIT Endoscopy 3.ECG 4.Blood gases.

73) A 9 year old child comes to the hospital with an acute onset of generalized convulsions and disturbed conscious level. the parents did not report any similar neurological trouble beforehand. On examination, HR was 70/min, RR is 20/min What is the first action to do after control of convulsions?
A. Blood gases B. Blood pressure measurement C. CT brain D. Fundus examination

74) An 8 year old boy comes complaining of bedwetting for the past 2 weeks. He has previously been continent. On examination, his height is below 5th percentile. His Hb is 6.5% what is the most important next step?
A. Check blood sugar B. Give oral iron C. Try fluid restriction and rewarding for dry nights D. Check Blood urea and creatinine

75) A 1 year old infant is complaining of delayed sitting and repeated chest infection, on examination there is prominent costochondral junction, he is exclusively breast fed, He received multiple injections for treatment of his condition. All of the following are expected complication for his condition except:
1. Anorexia 2. Vomiting

3. Oliguria 4. Nephrocalcinosis

76) The mother of a 4 months old boy complains her child still cant support his head. On examination the child has a flat occiput, and a transverse plamar crease.local examination of the heart shows a hollow systolic murmur over the left parasternal area. One of the common complications of this condition is:
1. 2. 3. 4. ITP G6PD deficiency Leukemia Pyloric stenosis

77) A 9 year old child suffers from an acute onset weakness which initially started in the lower limbs and was preceeded 3 weeks earlier by a respiratoy tract infection. On examination there is hypotonia and hyporeflexia of both lower limbs. There is no history of convulsions. The most likely diagnosis is:
A. Brain tumour B. Poliomyelitis C. Guillan-barre syndrome D. Werding hoffman syndrome

78) A previously well 1 year old infant has had a runny nose and has been sneezing and coughing for 2 days. Two other members of the family had similar symptoms. Four hours ago, his cough became much worse. On physical examination, he is in moderate respiratory distress with nasal flaring, hyperexpansion of the chest and easily audible wheezing without rales (crepitations) by auscultation. Which of the following is the Most likely diagnosis?
A. Bronchilitis B. Viral croup C. Asthma

D. Epiglottitis

79) An infant weighing 1400 gm is born at 32 weeks.HR:140, RR:80, temp:35 C. the lungs are clear with bilateral breath sounds, there is no murmur. Which of the following is the most important first step in evaluating this infant:
1. 2. 3. 4. 5. Obtain CBC and differential Perform lumbar puncture Chest x-ray Place infant under warmer Administer oxygen

80) A 6 month old baby with microcephaly is brought to A&E. His mother gives a history of the baby flexing forwards whilst sat in her highchair. What is the most appropriate investigation to do?
1.EEG 2.CT scan of the head 3.MRI 4.NO investigations required.

81) A 2 year old boy with an otitis media is brought to casualty. His father reports that the child has had a fit. Temperature recorded is 38.8C. What is the most appropriate investigation to do?
1.EEG 2.CT scan of the head. 3.MRI 4.NO investigations required.

82) A 3 day old neonate is noted by ward staff to have had a seizure. Which of the following statements concerning neonatal convulsions is correct?

1.An abnormal EEG indicates a high risk of later developing epilepsy. 2.A blood glucose level of 1.7mmol/L in a term infant on Day 1 is invariably associated with convulsions or apnoea. 3. Convulsions occurring in the first 24 hours in a baby with an Apgar score of 8 at 5 minutes cannot be due to intrapartum asphyxia 4.Maternal narcotic addiction is a well-recognised cause. 5.If phenobarbitone is prescribed daily estimations of serum bilirubin are needed because of risks of Kernicterus.

83) A 15 year old boy presents with tremor of both hands. Over the previous months he has developed a mild dysarthria. He has a history of behavioural problems, of a depressive/psychotic nature. The most likely diagnosis is:
1.Alzehiemers disease. 2.Huntingtons disease. 3.Neuroacanthocytosis. 4.Wilsons disease. 5.Guillaine-Barre syndrome.

84) A 15 year old girl presents with a two week history of headaches and double vision. She had also noticed an episode where her vision dimmed after sneezing. On examination her BMI was 32.4 kg/m2, she had bilateral optic disc swelling and a partial left sixth cranial nerve palsy was present What is the most likely diagnosis?
1.Benign intracranial hypertension. 2.Multiple sclerosis. 3.Pituitary tumour. 4.Cavernous sinus thrombosis.

85) A 7 year old boy presents with pallor. He was a term 2.89kg infant born to a healthy Oriental mother. He is fully immunised, and on no medications. Hb 10.2 g/dl, MCV 69. He is treated with oral iron for three months, but there is no change in the FBC. A film shows Heinz bodies, target cells, anisopoikilocytosis and reticulocytes. Supravital staining shows inclusions of precipitated haemaglobin. What is the most likely diagnosis?
1.bone marrow failure 2.Iron Deficiency. 3.Occult blood loss. 4.Hemoglobinopathies most probably Thalassemia. 5.Malignancy.

86) A 3 year old girl presents with pallor, lethargy and bruising. She has been unwell for about 3 weeks, but seems to have deteriorated over the past few days. She was born at 40+2/40 gestation weighing 3.0kg and there were no neonatal problems. On examination she appears very pale, and has petechiae over the palate and arms. She looks unwell. She is on the 25th centile for height and weight and has no dysmorphic features. What is the most likely diagnosis?
1.Iron deficiency anemia. 2.Marrow failure. 3.Occult blood loss. 4.Thalassemia. 5.Malignancy.

87) A 16 month old West Indian by is referred because of reduced exercise tolerance. He has never been cyanosed, but seems to lack stamina compared with his peers. He was born at 39/40 weighing 4.1kg and there were no neonatal problems. On examination he appears pale but well nourished. He has slightly yellow sclerae. He is on the 75% for height and weight. He has a grade 2/6 ejection systolic murmur at the left sternal edge and 3 cm of spleen palpable. What is the most likely diagnosis?

1.Iron deficiency anemia. 2.Marrow failure. 3.Occult blood loss. 4.Thalassemia. 5.Malignancy.

88) A 3 year old boy presents with a 2 week history of pallor and lethargy. Today mother has noticed that he has a low grade fever and some spots on his chest. He was born at 36/40 gestation weighing 2.6kg. He was diagnosed with Down's syndrome in the neonatal period. He has had glue ear requiring grommet insertion. On examination he has a temperature of 37.8C (tympanic), RR of 15/min and HR of 100/min. He looks pale and lethargic. He has petechiae and ecchymoses over his chest. He has 3 cm of liver edge palpable. What is the most likely diagnosis?
1.Iron deficiency anemia. 2.Marrow failure. 3.Occult blood loss. 4.Thalassemia. 5.Malignancy.

89) An 18 month old girl presents with pallor. She has always been a poor eater, and survives mainly on bottles of milk. She was born at 37+2/40 weighing 2.7kg and there were no neonatal problems. On examination she looks pale but not icteric. Her temperature is 36.8C(tympanic), HR 100/min and RR 15/min. She has a grade 2/6 ejection murmur at the left sternal edge. She has no hepatosplenomegaly nor bruising. What is the most likely diagnosis?
1.Iron deficiency anemia. 2.Marrow failure. 3.Occult blood loss. 4.Thalassemia. 5.Malignancy

90) A 17 year old girl underwent emergency splenectomy after a domestic accident. Which one of the following organisms is most likely to cause lifethreatening infection in the future?
1.Hemophilus influenzae. 2.Pseudomonas aeuroginosa. 3.Staphylococcus aureus. 4.Streptococcal pneumonia. 5.Lactobacilli

91) A 4 year old girl presents with extensive bruising over the trunk, legs and palate. She had an URTI 4 weeks ago, but has otherwise been well. 39+5/40 3.8kg delivery, with no neonatal problems. No FH of note. On examination she is well. Temperature is 36.7C (tympanic), HR 90/min, RR 20/min. Extensive fresh bruising of irregular shape over trunk, thighs and shins. Old bruises over shin. What is the most likely diagnosis?
1.Streptococcal infection. 2.Thrombocytopenia. 3.Child abuse/Trauma. 4.Viral infection. 5.Vasculitis.

92) A 7 year old girl presents with a 3 day history of rash and ankle swelling. She had a cold 4 weeks previously, but has otherwise been healthy. 39+1/40, 2.96kg. No neonatal problems. No drugs or medications. Fully immunised. On examination, she has palpable non-blanching purple spots 1-4 mm in diameter especially over the shins and buttocks. Her left ankle is swollen, warm and tender, with restricted movement. What is the most likely diagnosis?
1.Streptococcal infection. 2.Thrombocytopenia. 3.Child abuse/Trauma.

4.Viral infection. 5.Vasculitis.

93) A 16-year-old girl with sickle cell disease presented with malaise and rapidly increasing dyspnoea. A full blood count showed: Hb 5.1 g/dL Reticulocyte count 5.5 x 109/L (25-85) What is the most cause?
1.Epstein-Barr virus. 2.Hepatitis E virus. 3.Human immunodeficiency virus. 4.Human papilloma virus-16 5.Parvovirus B19.

94) A 2-year old child who presents to the rapid referral pediatrics clinic with a 10-day history of fever , blood shot eyes , sore throat and a rash.He also has an occasional cough. He has a poor appetite. Examination revealed bilateral conjunctivitis, erythematous , cracked lips and an erythematous pharynx. Non-specefic maculopapular rash is noted on the trunk. Erythema of the hands is also noted. The most appropriate diagnosis is :
1.Chickenpox infection. 2.Kawasakis disease. 3. Scarlet fever. 4.Leukemia. 5.Kwashiorkor

Problem Solving Questions

Collected by : Alex Schriever M.Akram Bryan A.Matt