Q.1. 7-years-old girl has staring spells. Each attack lasts 9-10 seconds.

EEG shows bursts of 3/second spike waves. Her spells can be precipitated by hyperventilation.

These attacks are characteristic of:

a. b. c. d. e.

Myoclonic epilepsy Temporal lobe epilepsy Absence epilepsy Grand mal epilepsy Infantile spasms

Q.2. Child who had been vaccinated for hepatitis B in the past will show the following serological evidence that he has been vaccinated against hepatitis B.
a. b. c. d. e. Hepatitis B surface antigen Hepatitis B core antibody Hepatitis B e antibody Hepatitis B surface antibody Both hepatitis B surface antigen and surface antibody.

Q.3. 5-years old boy is brought to OPD who is small for his age. Which is most appropriate part of the body to be x-rayed for BONE AGE?

a. b. c. d.
e.

AP view of right hemi thorax Left hand and wrist Skull x-ray AP view of both ileosacral joints
Lateral view of left foot

Q.4. Mother brought her 2-years-old son in A/E with complaints of high grade fever and noisy breathing. Birth history is normal and is fully vaccinated. On examination he appears anxious, temperature 104 F, audible stridor & drooling Saliva. Most likely DIAGNOSIS?

a.

b. c. d. e.

Acute Tonsillitis Diphtheria Acute Epiglottitis Viral Croup Acute Tracheitis

Q.5. The above mentioned child is becoming increasingly distressed. Immediate step in the MANAGEMENT of this child would be:

a. b. c. d.
e.

Give IV cefotaxime Send him for X-ray neck lateral view Examine his throat Intubate and secure his airways
Take blood cultures

Q.6. 10-year old child was treated as viral URTI by his GP. Now he is brought in emergency with severe breathing difficulty. Past history is unremarkable and vaccination history is unknown. On exam, he is sick looking boy with bull neck appearance and grey membrane covering the pharyngeal tonsils. What will be the most likely DIAGNOSIS?
a.

b. c. d. e.

Pertussis Streptococcal sore throat Diphtheria Scarlet fever Infectious mononucleosis

Q.7. 2 years-old child is noted to assume squatting position frequently during play. Mother also notices bluish discoloration of lips during these episodes. On day of admission child becomes restless, dyspnenic and deeply cyanosed. Within 10 minutes, he becomes unresponsive. The most likely CAUSE is:

a. b. c. d. e.

Cardiomyopathy Anomalous coronary artery Tetralogy of Fallot Atrial septal defect Ventricular septal defect

8.

Which of following X-ray finding/s suggestive of above mentioned case? a. b. c. d. e. A globular heart shadow Egg on side appearance A boot shaped heart with oligemic lung fields A boot shaped heart with plethoric lung fields Figure of 8 shadow

9.

Term newborn presents with bilious vomiting shortly after first feed. Pregnancy was complicated by polyhydramnios. She has passed normal meconium stool. Abdomen is slightly distended and facial features are characteristic of Down syndrome. What is most likely DIAGNOSIS in this baby: a. b. c. d. e. Duodenal atresia Hirschsprung disease Meconium ileus Midgut volvulus Pyloric stenosis

10. Mother brings 9-month old girl for vaccination. On exam she looks quite pale with liver 1-cm and spleen 4-cm below costal margins. CP reveals microcytichypochromic anemia with retics 5 %. Which one statement is most likely to be true about HB ELECTROPHORESIS?
a. b. c. d. e. HbF HbA HbF HbA2 HbA of of of > 90 % of 30 - 40 % 1-2% 90 % of 90%

11. Lady comes in 20th week of second pregnancy. First child at birth had bilateral hydronephrosis & posterior urethral valves required surgical treatment. Mother wants her fetus to be evaluated for renal anomalies. MOST appropriate procedure for diagnosing fetal RENAL ANOMALIES is:

a. b. c. d. e.

Amniocentesis Chorionic villus biopsy Fetal ultrasonography Magnetic resonance imaging Measurement of fetal urine electrolytes

12. 35-year-old woman delivers son. Pregnancy complicated by polyhydramnios. Infant is hypotonic and dysmorphic features. Baby begins to have bile-stained vomitus after first feed. Radiography and surgery confirmed duodenal atresia. Most likely DIAGNOSIS is:

a. b. c. d. e.

Down syndrome Turner syndrome Prader- Willi syndrome Trisomy 18 Klinefelter syndrome

13. 6 month old child is brought with large head and inability to move his legs. According to mother child had soft mass which was removed after surgery. Exam reveals scar on back in mid thoracic region. Which of following if given during pregnancy will PREVENT THIS CONDITION? a. b. c. d: e. Vitamin A deficiency. Vitamin D deficiency Iron deficiency Folic acid deficiency B 12 deficiency.

14. 5-year old boy presents with 27 days history of fever and weight loss. For last 3 days he is having fits and drowsiness. Meningeal signs are positive. CSF shows WBC 500/HPF with neutros l0% and lymphos 90%, RBCs 50/HPF, protein 1000 mg/dl and sugar 30 mg/dl. Most likely DIAGNOSIS is:
a. b. c. d. e. Streptococcal meningistis Tuberculous meningitis Viral meningitis Encephalitis Cerebral malaria

15

3-years old child is brought to the OPD with delayed walking. He is bottle fed on diluted cow's milk and history of recurrent diarrhea. Exam reveals wide wrists, open anterior fontanelle and hypotonia. What will be the MOST LIKELY FINDING in this case?

a. b. c. d. e.

Increased serum calcium Decreased parathyroid hormone Increased serum phosphorous Raised alkaline phosphatase Increased 1,25 dihydroxycholecalciferol

16

A 6-day-old girl born at home is evaluated for bruising and GIT bleeding. Laboratory findings include partial thromboplastin time and prothrombin time > 2 minutes, serum bilirubin, 4.7 mg/Dl, alanine aminotransferase 18 IU, platelet count 330,000/mm3. MOST LIKELY CAUSE of her bleeding is?
a. b. c. d. e. Factor VIII deficiency Factor IX deficiency Idiopathic thrombocytopenic purpura Liver disease Vitamin K deficiency

17. 28 -years old mother who is on ATT for last 3 months delivers healthy baby. MOST appropriate step to PREVENT TUBERCULOSIS IN BABY?
a. b. c. Separate the baby from the mother till she completes her therapy Apply BCG immediately to the baby Give him Isoniazid prophylaxis for 3 - months Give full course of ATT Take a tuberculin skin test and manage according to response

d. e.

18. 6 years old girl with asthma was well managed on inhaled bronchodilators on as required basis. For last 2 months her episodes of wheezing have become more frequent occurring at night and more than 2 episodes per week but less than once per day. You will classify severity of her asthma as:
a. b. c. d. e. Acute attack Moderate persistent Mild intermittent Severe intermittent Moderate intermittent

19.

Normal infant of 12 months of age can:

a. b. c. d. e.

Walk few steps and fall Climb stairs Run Stand on one foot for few seconds Jump

20. 2-year-old child brought with complaint that he does not see well at night. On exam he has some dryness of conjunctivae and cornea. Child should be treated with:

a b. c. d. e.

200,000 1.U of vitamin A on day 1 200,000 I.U of vitamin A on day 1,2 and 14 1500 I.U of vitamin A daily 100,000 I. U of Vit A weekly for 4 weeks Diet rich in vitamin A

21. 2-years old boy has been diagnosed as cystic fibrosis. Mother wants to know risk in future pregnancy. What is the MODE OF INHERITANCE?

a. b. c. d. e.

Autosomal Dominant Autosomal Recessive X-linked Dominant X-Linked Recessive Multifactorial inheritance

22. 2-years old boy was diagnosed as VSD at 6 months age. He has recurrent chest infections and is failing to thrive. The optimal MANAGEMENT of child will be:

a.
b. c. d. e.

Wait till 5 years of age for VSD repair Give prophylactic antibiotics Continue diuretics only Do surgical repair now
Repeat an Echo

23. Student of class-10 is made fun of at school because of her short stature and slow in studies. She has not started menstruating yet. The parents gave history of edema of hands & feet when she was born. Which of following TESTS you would suggest for diagnosis of her suspected condition?

a. b. c. d. e.

Chromosomal analysis Growth Hormone level Serum Cortisol level Renal function tests Thyroid function tests

24. Mother brings her 18-months old child with complaints failure to walk and sits with support only. He was delivered at term after difficult delivery. On general exam his weight, height and OFC are on 5th Centile with drooling saliva, lateral squint of left eye and scissoring of legs. On neurological exam you would expect:
a. b. c. d. e. A sensory loss in lower limbs Brisk reflexes and up going plantars Bowing of legs Decreased tone with diminished reflexes VII - cranial nerve palsy

25. 5-years-old child recently diagnosed as epilepsy started on oral sodium valproate, is brought to A/E with jaundice for 10 days. On exam he is comatosed, jaundiced, multiple bruises all over body. Liver 3 cm below right costal margin. Most likely DIAGNOSIS is:

a. b. c. d. e.

Hepatitis B Hepatitis C
Hepatotoxicity caused by Sod. Valproate

Cholelithiasis Choledochal cyst

26. 7-years old girl presents with 3 days history of fever and rash. On exam she has multiple vesicular lesions all over body. Some lesions are maculopapular and some fluid filled. Most likely DIAGNOSIS would be:

a. b. c. d. e.

Erythema toxicum Staphylococcal scalded skin syndrome Chicken pox Herpes Zoster Herpes Simplex

27. 4 - years old girl comes with acute abdominal pain. Mother gives history of bilateral swellings below her jaws & extend behind ears. On exam she febrile and marked tenderness over the epigastrium. Which one of following TEST will help making diagnosis?

a. b. c. d. e.

Serum Amylase Liver function tests Barium meal examination Upper GIT Endoscopy Abdominal sonography

28. 7-years old child presents with acute migratory arthritis and fever for 10 days. He had sore throat 3-weeks back. On exam temp 101F, pulse 120/min, resp 40/min and pericardial rub. What is the most likely DIAGNOSIS?

a. b. c. d. e.

Acute rheumatic fever Acute rheumatic fever with carditis Juvenile Rheumatoid arthritis Septic arthritis Reactive arthritis

29. 10-years old boy with runny nose and fever is treated with cotrimoxazole. 2- days later, he develops sudden pallor, jaundice and dark colored urine. He had similar episodes in the past. On exam pale child, spleen 2 cm below costal margin, Hb 6 gm/dl, and retics 8%. Most likely diagnosis:

a. b. c. d. e.

Chronic liver disease Acute hepatitis Acute glomerulonephritis G 6 P D deficiency Malaria

30. 8-year-old boy suspected as Duchenne muscular dystrophy (DMD) is referred to your clinic. On exam has enlargement of both calves and while walking seems to have waddling gait. Which of following SIGNS is most consistent with DMD?
Foot drop" gait Positive Gower sign Increased deep tendon reflex Hyperreflexia Positive Babinski sign

a. b. c. d. e.

31. Total CALORIC INTAKE of a child weighing 15 Kg would be:

a. b. c. d. e.

1 000 Kcal per day 1250 Kcal per day 1500 Kcal per day 1700 Kcal per day 1900 K cal per day

32. 12-years old boy with H/O fever for Iweek. He also had diarrhoae for few days but now he is constipated and has headache. On exam febrile, acutely ill, liver and spleen slightly enlarged. There are palpable small erythematous spots on the trunk only. This child probably has: a. b. c. d. e. Measles Typhoid fever Scarlet fever Leptospirosis Meningococcal bacteremia

33. 2-week-old infant for follow-up visit. Mother tells that he has been very slow eater and is constipated, not having had bowel movement in 3 days. On exam, infant has poor muscle tone, enlarged tongue, umbilical hernia, enlarged anterior fontanelle, and hypothermia. He is slightly jaundiced, with dry skin and brittle hair. Which of the following is the most likely DIAGNOSIS? a. b. c. d. e. Beckwith-Wiedemann Syndrome Congenital hypothyroidism Hurler syndrome Trisomy 21 Turner syndrome

34. 6 -weeks old girl is brought by mother for first immunization. She has cold, but is afebrile and feeding normally. What is the most appropriate ACTION?

a. b. c. d. e.

Delay immunization, come back in 2-3 days Give half the dose of vaccine Immunize as per schedule Phone the consultant paediatrician for advice Split immunizations 1 week apart

35. 5-years old boy is being evaluated for TB due to chronic cough and weight loss. At birth he was immunized against TB. Mantoux applied. Which one of following would be highly suspicious for DIAGNOSIS OF TB?

a. b. c. d. e.

Induration between 5-10 mm Redness more than 10 mm Induration more than 10 mm Redness between 5-10 mm Induration less than 5 mm

36. 8-years-old boy developed high-grade fever with chills and rigors, headache and abdominal pain for 2 days. On exam he is pale, sweating and splenomegaly. Which one of following LAB TEST will be Most appropriate? a. b. c. d. e. Serum electrolytes Liver function tests Peripheral blood smear Lumbar puncture Ultrasound abdomen

37. Baby develops respiratory distress on 2nd-day of life. His blood gases are: PH-7.2, PC02-60 mmHg, P02-50 mmHg, HC03-18mEq and Fi02-70%. How will you INTERPRET these findings? a. b. c. d.
e.

Respiratory alkalosis Metabolic acidosis Respiratory acidosis Metabolic alkalosis

Normal blood gas

38. Mother of 1- year old child comes with the concern that baby is not talking well. You would tell the mother that at this age child is ABLE TO:

a. b. c. d. e.

Make noise only Speak 2-3 words Tell his name Form a proper sentence Speak around 20 words

39. Infant born prematurely and SGA quite ill, jaundice, fever, hepato-splenomegaly, rash, myocarditis and fits. CT shows hydrocephalus & intracranial calcifications. Mom has a cat and used to clean cat's litter box during pregnancy. Which of the following is the likely CAUSATIVE AGENT?
a. b. c. d. e. Cytomegalovirus Herpes simplex Rubella virus Toxoplasma gondii Treponema Pallidum

40.

10-years old boy presented with jaundice for 7 months. He also had one episode of haemetemesis. On exam he had hepatosplenomegaly, ascites and prominent abdominal veins. Lab showed:
S. bilirubin: 12 mg %, Direct: ALT: 150 IU/dl, AST: Alkaline Phosphatase: 800 IU/dl 6 mg % 440 IU/dl

The most likely CAUSE OF JAUNDICE in this child is: a. B. C. D. E. Acute lymphoma Acute leukemia Chronic liver disease Intestinal tuberculosis Acute hepatitis

41. 15-months old infant brought to clinic for follow up. There is h/o neonatal jaundice and required exchange transfusion. On exam he has motor and speech delay and slow response to loud noise. What is best ADVICE TO THE MOTHER? a. b. c. d. e. Perform tympanogram Perform auditory evoked responses Plan for cochlear implant Advise hearing aid Reassure the mother

42. 4-years female child brought with frequent rhinitis and chest infection. On exam she is short with coarse facies, corneal opacities, large tongue, kyphosis and hepatosplenomegaly. What is the most likely clinical DIAGNOSIS? a. b. c. d. e. Hypothyroidism Down's syndrome Mucopolysaccharoidosis Thalassemia Glycogen storage disease

43. 7-months-old child with H/O fever 2-days, presents with GTC fits for approximately 10 minutes. On exam he is irritable, lethargic, slightly bulging fontanelle, rectal temperature 103F. Which one of the following most appropriate initial DIAGNOSTIC TEST? a. B. C. D. E. CT scan head Electroencephalography Lumbar puncture Blood sugar Serum calcium

44. 9-years old child presented with jaundice, abnormal behaviour, involuntary movements. Family history of jaundice in two of his siblings. On exam he has abnormal body posture and hepato-splenomegaly. Lab showed; S.bilirubin: 8 mg/dl, ALT: 176 IU AST: 400 IU Next INVESTIGATION of choice would be: a. b. c. d. e. HBsAg Anti HCV antibodies MRI brain Serum ceruloplasmin level EEG

46. 9-months old child brought in ER with H/O watery stools 10-12 times in last 12 hours. Child is crying continuously and very thirsty when given water. His anterior fontanelle is slightly depressed and the skin goes back slowly after pinch. According to WHO programme recommended action in his MANAGEMENT is:
a. B. C. d. e. Set up an IV line and rehydrate the child Prescribe ORS and send child home Rehydrate the child with ORS under supervision for 4-6 hours Give no treatment and send child home Start IV antibiotics

47. 4-years-old boy presents with fever and cough for 5 days. On exam he appears acutely ill, temp 104F, resp rate 47/min. Chest reveals dullness on percussion and diminished breath sounds over lower left chest. CXR shows homogenous opacity in left lower lobe. Most likely ORGANISM causing this illness is:
a. b. c. d. e. Influenza virus Mycobacterium tuberculosis Mycoplasma pneumoniae Staphylococcus aureus Streptococcus pneumoniae

48. Most appropriate antibiotic for this patient is: a. b. c. d. e. Ampicillin Clarithromycin Gentamicin Ofloxacin Vancomycin

49. Mother brings 6 years old son to OPD for evaluation of enlarged lymph nodes in neck. He has H/O cough and low grade fever for 2 months. What is most important QUESTION IN THE HISTORY that will help you reaching diagnosis of tuberculosis? a. b. c. d. e. MMR vaccination Family history of TB Breathing difficulty Chest pain Shivering and rigors

50. 1-month-old baby exclusively breast-fed brought with H/O passing 5-7 stools / day since birth. On exam looks normal thriving, alert baby moving his limbs. What is the most likely EXPLANATION? a. b. c. d. e. He has diarrhea and should be treated with antibiotics Mother's milk is not suitable and should be bottle-fed He is well, mother should be reassured Mother should avoid taking beef in her diet Mother should stop breast feeding and give ORS

51. Previously healthy 14-months old child presents with acute onset of cough, choking, breathing difficulty for 24 hours. There is no family history of asthma. Elder sister told that both were playing and had eaten peanuts. Exam reveals respiratory rate 50 / min and wheezing. The most likely DIAGNOSIS is: a. b. c. d. e. Anaphylaxis Bronchiolitis Cystic fibrosis Foreign body aspiration Pneumonia

52. 6-weeks old infant brought with fever and cough for 4-days. On clinical exam he dyspneic and tachypneic. According to ARI protocol in this age group tachypnea is RESPIRATORY RATE of:

a. b. c. d. e.

60 breaths / min or more 50-59 breaths / min 40-49 breaths / min 30-39breaths / min 20-29 breaths / min

53. 4 - month baby is brought in A/E with complaint of breathing difficulty since morning. There is H/O of cough, coryza and low grade fever for 3-days. On exam he is cyanosed, resp rate 70 and marked subcostal recession. On auscul of chest fine inspiratory crackles and high pitched ronchi. Which of the following FINDINGS are expected on chest x-ray? a. b. c. d. e. Hyperinflated lung fields Enlarged cardiac shadow Prominent pulmonary plethora A lobar collapse Pleural effusion

54. What is the most common causative ORGAMISM resulting in the above mentioned clinical condition? a. b. c. d. e. Herpes simplex virus Coxsackie B virus Rubella virus Respiratory syncitial virus Ebstein virus

55. 10-years old boy presents with H/O headache and dark colored urine for past 1-week and low urine output for 4-days. On exam he is afebrile with BP of 135/90 mmHg and no other positive finding. What will you most likely finding on his urine examination?

a. b. c. d. e.

Gross hematuria Epithelial casts RBC Casts WBC Casts Pus cells

56. 3-years old girl brought by her mother who noticed mass in right side of her abdomen while bathing the child. Ultrasound confirmed mass to be renal in origin. What is the most likely DIAGNOSIS?

a. b. c. d. e.

Neuroblastoma Wilms Tumour Lymphoma Appendicular mass Tuberculous lymphadenitis.

57. 4-years-old child experienced URTI, which was followed 2-weeks later by generalized edema. His BP is normal. Urine analysis, shows 2-3 RBCs/hpf, Protein ++++, BUN 19, creatinine 0.6 mg/dl, serum cholesterol 402, albumin 1.2g/dl. Most likely DIAGNOSIS is: a. b. c. d. e. Post streptococcal Glomerulonephritis Membranous Glomerulonephritis Minimal change Nephrotic syndrome Rapidly progressive Glomerulonephritis Focal segmental Glomerolosclerosis

58. Above mentioned patient on third day of admission complains of severe abdominal pain and vomiting. On examination she is febrile with abdominal distention and tenderness all over abdomen. What is the most likely COMPLICATION that she has developed? a. b. c. d. e. Gastritis Peritonitis Intestinal obstruction Acute appendicitis Renal stones

59. 8-years-old girl presents with fever, vomiting and acute left loin pain for 5-days. Exam reveals a temp of l04F and BP 105/68 mmHg. Urine showed positive urine nitrite test, 100 WBCs/HPF, CP shows TLC 25,000/mm3, 4% bands and 80% neutrophils. MOST likely DIAGNOSIS in this child is: a. b. c. d. e. Acute appendicitis Acute cystitis Acute Pyelonephritis Mesenteric adenitis Left ureteric stone

60. While resuscitating a newborn, chest compressions should be started when heart rate is less than 100 beats per min 90 beats per min 80 beats per min 70 beats per min 60 beats per min

61. 2-years child presented in OPD with H/O fever, malaise for 4-days. He then develops inability to stand and walk. He is partially immunized. Exam revealed conscious irritable child with stable vitals, flaccid weakness and absent reflexes in left lower limb. Sensations are intact. Most important INVESTIGATION in this child is: a. b. c. d. e. CSF analysis Stool for virology Nerve conduction studies EMG MRI spine

62. Infant comes to office for I-year check up. His father is worried that his son is smaller than he should be. Child weighs 8.9 kg and length 71 cm. He appears to be growing appropriately on his growth chart. Which of the following is most appropriate EXPLANATION ABOUT GROWTH? a.
b.

c.
d. e.

Infants usually double their birth weight by 1 year Infants usually triple their birth weight by 1 year Infants usually quadruple their birth weight by 1 year Infants usually double their length by 1 year Infants usually triple their length by 1 year

63. 3-years old boy presents with pallor. He has poor appetite and like to take milk. He was never hospitalized and no history of transfusion. On exam he is pale, heart rate 110/min with short ejection murmur at the left sternal edge. CP showed Hb 6.0 gm/dl with microcytic hypochromic picture. What is the most APPROPRIATE TEST to confirm diagnosis?
a. b. c. d. e. Bone marrow aspiration Hemoglobin electrophoresis Serum ferritin level Osmotic fragility test Blood group

64. 9-years old girl is due for splenectomy. Which of following VACCINES should be given as prophylaxis?

a. b. c. d. e.

MMR Tetanus and Pneumococcal Hepatitis B and H. Influenzae (Hib) Pneumococcal and Hib Tetanus and Hib

65. A full term baby is delivered to 22 years old primigravida by SVD. After delivery baby is found to be gasping, lips and extremities are cyanosed, heart rate is 80/ min. Tone in the limbs is diminished and he responds weakly to stimulation. His APGAR SCORE is:
a. b. c. d. e. 2 4 6 8 10

66. 8 years old boy admitted with 2 weeks H/O increasing pallor and lethargy. On exam he is alert with petechiae all over his body. He does not have any lymphadenopathy or hepatosplenomegaly. CP shows Hb 6 gm/dl, Platelets 38,000/cmm, RBC 2.8 cubic mm and WBC 2,700/cmm. What is the most likely DIAGNOSIS? a. b. c. d. e. Idiopathic thrombocytopenic purpura Henoch-Schonlein purpura Aplastic anemia Acute Myeloid leukemia Severe sepsis

67. Which of the following findings would you expect in his bone marrow aspirate? a. b. c. d. e. Blast cells Hypo cellular Marrow Hpercellular Marrow Increased Magakaryocytes Microcytic cells

68. A previously well 2 years girl presents with 3-weeks H/O bruising, lethargy and irritability. On exam she has numerous bruises of different ages, easily palpable liver and spleen. CP reveals: Hb: 7.6 gm/dl MCV: 79fl WBC: 13,000/L Platelets: 26,OOO/L Which investigation/s would be the Most appropriate NEXT STEP? a. b. c. d. e. Bone marrow aspirate and trephine Serum iron, iron binding capacity and transferrin saturation Prothrombin time Factor VIII & von Willebrand factor level Serum anti-platelet antibodies

69. 15-months-old infant has severe watery diarrhea for 3 days. He now has a heart rate of 180/min, capillary refill >4 seconds, and parched mucous membranes. Serum sodium is 134 mmol/L, bicarb 12 mmol/L, and serum creatinine 0.9 mg/dl. What is the first FLUID to administer to this patient?
a. b. c. d. e. 3% NaCI solution IV 5% dextrose with 1/5 normal saline IV Ringer lactate IV 5% Dextrose 0.45 normal saline ORS orally

70. A full term infant born normally becomes cyanosed in delivery room. After intubation and attempts at stabilization, it is noticed that the infant has a scaphoid abdomen and decreased breath sounds over the left hemi thorax. The most likely DIAGNOSIS is:
a. b. c. d. e. Pneumothorax Cardiomegaly Diaphragmatic hernia Neuroblastoma Atelectasis

71.

Children with uncomplicated tuberculosis can attend school:

a. b. c. d. e.

As soon as effective ATT has been started 2 weeks after initiation of therapy Once negative sputum smears are confirmed Once therapy has completed When Mantoux test is negative

72. 2-years old child brought with poor feeding and irritability. He is fed breast milk 10-12 times/day. His mother gives him tea and fruit juices but he eats almost no solid food. His weight is below 70% of expected weight for age. His height is within normal range. His hair is friable, dry rough skin over his body and has ankle edema. What is the most likely DIAGNOSIS? a. b. c. d. e. Celiac disease Breast milk intolerance Kwashiorkor Cystic fibrosis Immune deficiency

73. Male baby born to diabetic mother at 38 wks gestation by Caesarian Section, wt 4.4 Kg. On second day of life has episode of seizure. On exam baby is afebrile, flat fontanel and appears to be lethargic. Most important NEXT STEP is?
a. b. c. d. e. Cranial Ultrasound Lumbar Puncture Complete Blood Count Serum Calcium Check glucose with Glucometer

74. Mother of 10-week old boy comes for immunization. He has been properly vaccinated before. According to the EPI (Expanded Programme of Immunization) which of the following vaccines will you give to this child?
a. b. c. d. e. OPT + BCG + Hepatitis B+HiB OPT + BCG + Measles+HiB OPV + DPT + BCG+HiB OPV + DPT + Hepatitis B+HiB OPT + Measles + OPV+HiB

75.

A female infant is born at 32 weeks of gestation. She is limp and blue with no respiration. Heart rate is 70 /minute. After drying and stimulation your NEXT STEP would be to:
a. b. c. d. e. Give mouth to mouth breathing Give oxygen via nasal cannula Give oxygen via ambu bag and mask Intubate the child immediately Give oxygen by positive pressure ventilation + closed chest massage

76.

15-month old infant presents with poor dietry history. His weight / height on 10th centile. Developmental status is appropriate for age. CP shows: TLC & platelet count - Normal Hb - 8.2 gm/dl MCV - 110 ft Retics - 0.8% These haematological findings are CONSISTENT WITH: a. b. c. d. e. Folate deficiency Iron deficiency Vitamin C deficiency Vitamin D deficiency Zinc deficiency

77. Well appearing 1 day old neonate has vomited fresh blood twice in last 12 hours. On exam baby is active, feeding well and in no distress. Which of following is likely CAUSE of neonates symptoms?

a. b. c. d. e.

Platelet Defect Vitamin K deficiency Factor VIII deficiency Von Willebrand's disease Swallowed Maternal blood

78. Persistence of neonatal reflexes is an indicator of developmental delay. The Moro reflex should DISAPPEAR by age: a. b. c. d. e. 1 month. 2 month. 6 month. 9 month. 12 month.

79. 5-years old girl presents with fever, cough, coryza, conjunctivitis and erythematous maculopapular rash on chest and back. Fine white spots are noted on buccal mucosa. Mother would like to know when she can return to school and not infect other children. You would ADVISE her that she can return to school: a. b. c. d. e. As soon as her temperature returns to normal Once rash has completely faded 5 to 7 days after the rash first appeared 10 to 14 days after the rash first appeared Once the cough has disappeared

80. What is the best parameter for assessing long term growth? a. b. c. d. e. Mid upper arm circumference between 1 and 5 year Weight for age Height for age Skin thickness Head circumference

81. 18 months old child brought to ER with H/O fever, cough, and respiratory distress. On exam his temp 101F, no cyanosis. Resp rate 55/min. with sub costal recessions. According to ARI programme disease is CLASSIFIED AS: a. No pneumonia (cough and cold) b. Very severe disease C. Severe pneumonia d. Pneumonia e. Brochiolitis

82. You are seeing an 8 year old boy with 100F temp, bilateral tender parotid swelling, and pain when you flex his neck. He has been complaining of headache. His immunization history unknown. Most likely DIAGNOSIS is:

a. b. c. d. e.

Brucellosis Typhoid fever Infectious mononucleosis Mumps Leukemia

83. 4-year old child brought to A/E having had a brief, generalized tonic clonic fit. He has acute bloody diarrhea for last 3- days. On exam, he is drowsy, dehydrated. His temp 104 OF. CSF is normal. Most likely ORGANISM causing this illness is:
a. b. c. d. e. Rotavirus Enterovirus Shigella Giardia lamblia Salmonella typhi

84.

10-months-old taken A/E after falling while learning to walk. Toddler has an enlarging, swollen bruise on his forehead, > 2- inches across. Parents say bruise is noticeably larger than it was when they entered A/E an hour earlier. Blood sample is drawn, and child oozes blood at puncture site for 25 minutes. Lab shows prolonged PTT and a normal PT. Followup studies show very low levels of factor VIII. Which of following is most likely DIAGNOSIS? a. b. c. d. e. Disseminated intravascular coagwlation Hemophilia A Hemophilia B Hyperhomocysteinemia Von Willebrand disease

85. You are called to the delivery of a baby at 42 weeks' gestation with thick meconium stained fluid. Nurse rapidly delivers the infant and hands him to you for care. Baby is hypotonic, cyanosed, apneic, and having bradycardia. Most appropriate NEXT STEP is to: a. b. c. d. e. Stimulate infant to breathe Provide positive-pressure bag-and-mask ventilation Intubate the trachea and provide positive pressure ventilation Intubate the trachea and clean airways of meconium Administer epinephrine

86.

BCG vaccine is given: a. b. c. d. e. Orally Subcutaneously Intra dermally Intravenously Intramuscularly

87. 3-year old child comes with H/O tonic clonic seizure at home lasted 5- minutes. Parents explain that he had similar episodes 7 months back. His temp 101 F & congested throat. Rest of the exam is unremarkable and he started playing with his elder brother. Which one of following would be most appropriate step in MANAGEMENT? a. b. c. d. e. Arrange admission for observation Arrange an EEG within the next 72 hours Perform lumbar puncture Start him on anti epileptic drugs Send him home on antipyretics after counseling.

88. 5-years old boy having pruritic eruption and disturbed sleep for 3 weeks. On examination he has lesions between digits, in the axillae and genitalia. Most likely DIAGNOSIS is:

a. b. c. d. e.

Atopic dermatitis Impetigo Scabies Chicken pox Urticaria

89. 6-week-old infant admitted with vomiting 5 days duration. Exam reveals dehydrated baby with rapid heart rate and ambiguous genitalia. Serum Na-120 meq/L, K-7.5 meq/L, HC03-12 meq/L, BUN-20mg/dL. In addition to IV fluid replacement with normal saline, administration of one of following would be most important?
a. b. c. d. e. Diuretics Potassium exchange resin Glucose and insulin Antibiotics Hydrocortisone

90. 3-year-old boy presents with nontender, large, rubbery anterior cervical lymph node. He has Amoxicillin Clavulinate for 10 days but no change in node. Results of Mantoux reveal 8 -mm of induration. Best DIAGNOSTIC PROCEDURE to undertake is:
a. b. c. d. e. Excision biopsy of the node CXR Gastric aspirate for culture Needle aspiration of the node PCR for mycobacterium tuberculosis

91. 1-year old child presents with fever, barking cough and stridor for 3 days. On exam he is irritable and in respiratory distress, however, taking his feeds. Most appropriate TREATMENT option includes: a. b. c. d. e. Salbutamol nebulization IV fluids Parenteral steroids Broad spectrum antibiotics Steam inhalation

92. Tuberculosis in Pakistan:

a. b. c. d. e.

Is a disease of poor people only Is a disease of middle class Occurs sporadically Will be eradicated within next 5 years Is a serious public health problem

93. One of following statements is true about BCG vaccination: a. b. c. d. e. It is live attenuated vaccine Dose is 1 mg/kg body weight Does not leave any scar mark It is given intramuscularly One dose provides life long protection

94. One of the following STATEMENTS is true: a. b. c. Most children with ARI have pneumonia To get an accurate count of resp rate you must wake up the child Giving an antibiotic to child with cough or cold will prevent from developing into pneumonia Fever is a danger sign in all children under 5 years of age Pneumonia is one of the major cause of mortality under 5 years in Pakistan

d. e.

95. 3-years old child presents with 1-year H/O recurrent bouts of nocturnal cough. Following would support the diagnosis of asthma except:

a. b. c. d. e.

Presence of eczema in parents Cough gets worst on exertion Father is a smoker History of choking before the onset of cough Cough is relieved by brochodilators

96. 5-months old child who was born at term after uncomplicated pregnancy will be considered developmentally normal if he:

a.
b. c. d. e.

Can stand without support

Can sit without support Has complete head control Holds objects with pincer movement Speaks 1-2 words.

97. One of following confirms diagnosis of bacterial meningitis in a child: a. b. c. d. E. CSF TLC count > 250 cells Child is unconsciousness at the time of presentation There is history of prolonged fit CSF shows Diplococci on Gram stain Child has marked neck stiffness

98. 6-years old child presents with recurrent afebrile seizures for 8 months. One of the following STATEMENTS is true about epilepsy: a. b. c. d. Normal CT brain excludes epilepsy For better control treated with 2 drugs He should not be treated with normal EEG He should not attend his school till complete control of epilepsy He is expected to be normal mentally

e.

99. Previously healthy 10 years old boy presents with progressive walking difficulty for last 2 years. Parents are first cousins and 15 years old sister is bedridden. He has generalized hypertonia, brisk tendon reflexes and upgoing plantars. Most likely DIAGNOSIS is: a. b. c. d. e. Cerebral palsy Leukodystrophy Duchenne muscular dystrophy Spinal muscular atrophy Caries spine

100. 8-years old child presents with headache for 6-months. It is mostly early morning and sometimes associated with vomiting. Now he has occasional fits and also complaining of walking difficulty because of double vision. Most appropriate NEXT STEP would be to have: a. b. c. d. e. X-ray skull CT head Urgent EEG CSF examaination Consultation from ophthalmologist