Nash Qbank

Q.1. A 5-month-old baby was referred to the doctor from the Well-Baby Clinic. His mother is concerned, because he could not pass the developmental screening tests done by the nurse. What is the best developmental test would help the doctor to reassure the mother?

A:

Waves goodbye

B:

Has pincer grasp

C:

Sits independently

D:

Reaches for objects

Q.2. A 12-year-old girl presents to the Emergency Department with mild fever. Examination shows generalized vesicular rash on her chest, trunk and on her arms and legs. Which of the following laboratory tests have a higher diagnostic value?

A:

Mumps virus IgM

B:

HSV-1 IgM

C:

HSV-2 IgM

D:

VZV IgM

Q.3. A 6-year-old girl presents to the Paediatric Emergency Department with an unsteady gait and progressive difficulty climbing stairs over the last 10 days. The parents reported that the child has been repeatedly choking on her saliva. The symptoms began with a prickly sensation in the fingers and toes that developed with an ascending and symmetric numbness. There is a history of viral gastroenteritis three weeks before. A physical examination confirms absence of the knee jerk reflex (see reports). CSF Analysis: Elevated protein concentration with a normal cell count. Nerve Conduction Test: Reduced velocity. Which of the following is the most appropriate treatment?

A:

Plasma exchange

B:

Immunoglobulin

C:

Methotrexate

D:

Steroids

Q.4. A 6-year-old boy presents to the Medical Care Centre with a high fever and cough. Examination shows a maculopapular rash on his face end small white spots appeared on the inner part of his Which of the following agents is most likely responsible?

A:

Mumps virus

B:

Measles virus

C:

Varicella zoster virus

D:

Herpes simplex virus type-1

Q.5. A newborn child presents with cyanosis, tachypnea, irritability and difficulty feeding. Physical examination findings are a parastemal heave and a loud, single S2 on cardiac auscultation. No murmurs were heard. Which of the following is essential in the early management?

A:

NSAIDs

B:

Diuretics

C:

Dopamine

D:

Prostaglandin E1

Q.6. A 13-year-old girl comes to the clinic with her mother. The mother is anxious about her small stature. The girl had been born at full term with a birth weight of 3.5 kg. The subsequent physical development has been normal. There is no family history of any significant health problems. There is no sign of breast development or pubic hair growth Height 152 cm (25th percentile) Weighs 37 kg (10th percentile) Which of the following is the most likely cause?

A:

Chromosomal

B:

Constitutional

C:

Psychological

D:

Hormonal

Q.7. An infant sits in the tripod position, can roll from prone to supine and vice versa and attempts to reach a toy beyond reach but cannot pick up cereals between 2 fingers. What developmental age in months is this most consistent with?

A:

2

B:

4

C:

6

D:

9

Q.8. A full-term girl was born to a mother who is hepatitis B surface Ag positive (HbsAg +ve). The baby weighs 3.2 kg and is asymptomatic. What is the appropriate immuno prophylaxis that should be considered in the first 12 hours?

A:

Administer hepatitis B vaccine

B:

Give hepatitis B immunoglobulins

C:

Give hepatitis B vaccine and immunoglobulins

D:

Measure hepatitis B surface antigen in the newborn

Q.9. A 6-year-old child presents with a low-grade fever, malaise, conjunctivitis, coryza, and a cough. Recently, a rash of discrete pink macules began on the face and extends to the hands and feet. Which of the following is the most likely diagnosis?

A:

Gonococeal bacteremia

B:

Toxic shock syndrome

C:

Reiter's syndrome

D:

Rubella

Q.10. When a mother placed her infant on the examining table, the infant laughs out loudly. As the doctor approaches him, he squeals and reaches for his mother. What is the most likely developmental month for this child?

A:

2

B:

4

C:

6

D:

8

Q.11. Which of the following hormonal assay is routinely recommended for newborns?

A:

Prolactin level

B:

Testosterone level

C:

Insulin growth factor

D:

Thyroid function test

Q.12. A 4-month-old boy with down syndrome exhibits poor weight gain, tachypnea, a low-pitched grade 2 systolic murmur and a fixed splitting of S2. Chest X-ray reveals cardiomegaly and increased pulmonary vascularity. Electrocardiography documents biventricular hypertrophy and a superior frontal plane QRS axis. Which of the following is the most likely diagnosis?

A:

Coartation of the aorta

B:

Patent ductus arteriosus

C:

Ventricular septal defect

D:

Atrioventricular septal defect

Q.13. A 5-year-old overweight girl has systolic blood pressure above the 95th percentile and has a family history of hypertension. Physical examination reveals a strong radial pulses and weak femoral pulses. Which of the following is the most likely diagnosis?

A:

Pheochromocytoma

B:

Renal artery stenosis

C:

Essential hypertension

D:

Coarctation of the aorta

Q.14. A 9-year-old boy who presents to the Emergency Department with fever, headache, sore throat, and vomiting. He recently arrived from Africa with his parents. On examination, he shows abnormal reflexes, stiff neck and difficulty in lifting his head and legs when he was lying flat on his back. His laboratory investigations show a clear CSF with lymphocytosis, normal glucose level, and normal protein level. No bacteria were seen. Which of the following is the most likely organism responsible for his illness?

A:

Poliovirus

B:

Coronavirus

C:

Cytomegalovirus

D:

Epstein-Barr virus

Q.15. A 14-year-old has received all immunizations except chickenpox; but he has never had chickenpox. What varicella vaccination plan should be used?

A:

No vaccination is required

B:

1 dose of varicella vaccine

C:

2 doses given 4 weeks apart

D:

3 doses at 0, 1and 6 months

Q.16. What is the best way to provide immunologic protection against tetanus neonatorum in new borns?

A:

Inject the newborn with tetanus toxoid

B:

Inject the infant with human tetanus antitoxin

C:

Inject the mother with toxoid within 72 hours of the birth of her child.

D:

Immunize the mother with tetanus toxoid before or early in pregnancy

Q.17. During a routine check-up, a child shakes hands, knows his name, gender and age. He can dress with help and ride a tricycle. He points to red colours when asked to do so but had difficulty copying a square. What is the age in years this child is most likely at?

A:

2

B:

3

C:

4

D:

5

Q.18. Which of the following is a developmental screening tool that relies only on information from the parents?

A:

Brigance screens - II

B:

Ages and stages questionnaire

C:

Bayley scales of infant development

D:

Safety word inventory and literacy screener

Q.19. An adolescent has missed the second scheduled dose of a varicella vaccination, with the first injection have been administered 1 year ago. How should full immunity be achieved?

A:

Test for antibodies prior to revaccination

B:

Administer a double dose of vaccine

C:

Administer the second dose

D:

Repeat the entire series

Q.20. An apparently normal child is being evaluated. He runs around, tells short stories, and plays a "father role". He draws his brother with a head, hands and feet He undresses himself for the examination. What is the most likely age of this child?

A:

2

B:

3

C:

4

D:

5

Q.21. A 6-month-old boy presents to the Paediatric Outpatient Clinic to receive scheduled 6-month vaccinations. His mother reports that he required immediate admission after the 4 month vaccinations with anaphylaxis. She is not aware which vaccine is responsible for this reaction. Which of the following is the most appropriate way of management?

A:

Screen for allergens first

B:

Vaccinate, except with DTP

C:

Vaccinate and give reassurance

D:

Vaccinate and observe for 1 hour

Q.22. A 4-year-old boy presents with fever and abdominal pain after a fall on his right side a day ago. His mother noticed that his abdomen appears distended today, particularly on the right side. Examination shows a pale and hypertensive boy. Which of the following is the most likely diagnosis?

A:

Liver contusion

B:

Pyelonephritis

C:

Neuroblastoma

D:

Wilm's tumour

Q.23. A 1-year-old boy has come for vaccination. The mother explains that his 6-year-old sister has received a renal transplant 2 months ago and is currently on immunosuppressive medications. Which of the following vaccines should be avoided?

A:

Varicella

B:

Oral polio

C:

Injectable Influenza

D:

Measles, mumps and rubella

Q.24. A 2-year-old child presents with bruising and generalized petechiae, mostly on the legs. The child has always been healthy. The parents report that he had an upper respiratory infection 2 weeks before that resolved without medication (see lab results). Test Results Normal Values Hb 131 112-165 g/L HCT 0.39 0.32042 WBC 6.8 4.5-10.5 x 109/1L Lymphocytes 22 20-40 % Monocytes 2 2-8 % Neutrophils 58 40-60% Platelets count 15 150-400 x 109/L Which of the following is the most appropriate management?

A:

Splenectomy

B:

Platelet transfusion

C:

Factor VIll transfusion

D:

Intravenous Gamma-globulin

Q.25. A 9-month-old baby is brought to the Well-Baby Clinic. He is unable to sit, and on examination his hands are fisted and his legs are crossed. His mother said that he did not cry after the birth and resuscitation. Which of the following is consistent with these findings?

A:

Normal child

B:

Cerebral palsy

C:

Down syndrome

D:

Congenital hypothyroidism

Q.26. A 12-year-old girl presents for a routine physical exam. She is found to have a thyroid nodule about 4 cm in diameter. There is no pain, hoarseness or local symptoms. Serum TSH is normal, and fine needle aspiration was inadequate. Which of the following is the most appropriate next step in management?

A:

Thyroid scan

B:

Clinical follow up

C:

Total thyroidectomy

D:

Repeat fine needle aspiration

Q.27. A 3-year-old child falls out of a bunk bed. The child cries immediately, and there is no apparent loss of consciousness. Then he vomited twice and complained of a headache. The child has a normal mental status, normal neurological examination, and no evidence of a skull fracture. Which of the following is the most appropriate next step in management?

A:

Brain magnified resonance imaging

B:

Brain computed tomography scan

C:

Neurosurgical consultation

D:

Close observation

Q.28. An 11-year-old patient presents with increased thirst, hunger and urinary frequency. The patient has had nothing to eat or drink for 3 hours before the clinic visit. Examination is unremarkable (see lab result). Blood pressure 110/70 mmHg Heart rate 76 /min Respiratory rate 18 /min Temperature 36.6° C Test Result Normal Value Random Glucose 25.5 3.9-5.5 mmol/L Which of the following is the most likely cause?

A:

Elevated renin

B:

Elevated insulin

C:

Decreased insulin

D:

Absence of glucagon

Q.29. A 6-month-old infant develops a cough, coryza, fever, expiratory wheezing, grunting, tachypnea, rib retractions, and air trapping. Which of the following is optimal immediate treatment?

A:

Erythromycin

B:

Penicillin

C:

Steroids

D:

Oxygen

Q.30. A 12-year-old boy presents with difficulty walking for the last 2 days. He states that this weakness was preceded by pain in the muscles and a tingling sensation that started down the lower limb but kept ascending upwards to the upper limbs. He gave a history of a preceding upper respiratory tract infection 2 weeks before. On examination, he had total areflexia of both upper and lower limbs, with moderate sensory involvement Which of the following is the most likely diagnosis?

A:

Viral myelitis

B:

Epidural abscess

C:

Transverse myelitis

D:

Guillain-Barré syndrome

Q.31. A 2-year-old, severely ill chid has been iritable and pyrexia for 2 days. the child started vomiting, appeared drowsy, and has deteriorated rapidly during the day. In addition, a petechial rash started today which has spread extremely quickly around the body. Which of the following is the most likely diagnosis?

A:

Rocky mountain fever

B:

Kawasaki syndrome

C:

Meningococcemia

D:

Measles

Q.32. A 4-month-old boy is brought to the clinic for routine vaccinations. The mother reports that he has been having 2 days of diarrhoea; described as watery, 3-4 times per day. He is stil breastfeeding with no episodes of vomiting, Blood pressure 88/68 mmHg Heart rate 120 /min Respiratory rate 35 /min Temperature 37.3° C Which of the following is the best decision to take regarding vaccination?

A:

Delay vaccines

B:

Give all vaccines

C:

Give Hepatitis B vaccine

D:

Give all vaccines except OPV

Q.33. A 7-year-old boy has had recurrent upper and lower respiratory tract bacterial infections since infancy. On examination, he has eczema and areas of ecchymoses on his skin. His brother and a paternal uncle are similarly affected (see lab results). Test Result Normal Values Hb 108 112-165 g/L WBC 7.6 4.5-10.5 x 109/L Platelets count 40 150-400 x 109/L Which of the following is the most likely diagnosis?

A:

Severe combined immunodeficiency

B:

Bruton agammaglobulinemia

C:

Wiskott-Aldrich syndrome

D:

DiGeorge syndrome

Q.34. An 8-year-old girl is brought to the Paediatric Clinic with pain in the left wrist and right knee. These symptoms have occurred several times in the past 6 months with asymptomatic periods in between. Usually, the pain is worse in the morning and it improves during the day. She is otherwise healthy. On physical examination, there is swelling and a decreased range of motion of both joints. Which of the following is the most likely diagnosis?

A:

Septic arthritis

B:

Reactive arthritis

C:

Acute rheumatic fever

D:

Juvenile idiopathic arthritis

Q.35. A 7-year-old child is brought to the Emergency Department with a history of fever and vomiting for 2 days. On examination, he is dehydrated, comatose and acidotic (see lab results). CSF Test Result Normal Values Cells 20 0-3 / ul Total Protein 0.45 0.22-0.33 g/L Glucose 3.5 2.50-4.8 mmol/L Which of the following is the most likely the diagnosis?

A:

Tubercular meningitis

B:

Salicylate poisoning

C:

Diabetic coma

D:

Viral meningitis

Q.36. A 4-year-old has a 3-day history of fever, irritability, and anorexia. Examination confirms painful vesicles over the mucosa of the soft palate and posterior pharynx, sparing the gingiva and anterior oral cavity. Blood pressure 110/70 mmHg Heart rate 120 /min Respiratory rate 30 /min Temperature 39.0° C Which of the following is the most likely diagnosis?

A:

Congenital epulis

B:

Aphthous ulcer

C:

Gingival cyst

D:

Herpangina

Q.37. A 15-year-old girl presents to the clinic with her mother. The mother is concerned because she has never menstruated. On examination, the child has a short stature, short neck with a low : hairline and hypertension. Her parents’ stature is below average. Which of the following is the most likely diagnosis?

A:

Hypothyroidism

B:

Hypopituitarism

C:

Turner syndrome

D:

Familial short stature

Q.38. Which of the following findings is expected in a 6-year-old boy with Duchenne muscular dystrophy?

A:

Pes cavus

B:

Claw hands

C:

Muscle atrophy

D:

Positive gower's sign

Q.39. A 14-month-old asymptomatic boy has a grade 2 pan systolic murmur detected on a routine consultation. Echocardiography reveals a 2 mm ventricular septal defect in the muscular portion of the septum. Which of the following is the most appropriate management?

A:

Surgical repair

B:

Watchful waiting

C:

Afterload-reducing agents

D:

Interventional cardiac catheterization

Q.40. A full term baby born to a diabetic mother is brought to the clinic for assessment. The baby was bom by vaginal delivery. The Moro reflex is absent on the right side. Baby weight is 4.8 Kg. Which of the following is the most likely cause?

A:

Intracranial haemorrhage

B:

Neonatal hypoglycaemia

C:

Neonatal sepsis

D:

Erbs palsy

Q.41. A 2-week-old baby is brought to the clinic by the mother. She is concerned that her baby has little appetite, only passes stool once in 48 hours, and is always very sleepy and sluggish. On physical examination, the child has a distended abdomen with an umbilical hernia and mildly jaundiced Which of the following is the most appropriate next step in the investigation?

A:

Neonatal metabolic screen

B:

TSH and T4 of the newborn

C:

TSH and T4 levels of the mother

D:

Thyroid autoantibodies in the mother

Q.42. A child accompanied by his parents walked into the examination room. He is holding a ball. The doctor asks to let him see the ball; he threw the ball towards the doctor. Then he reaches out to catch it when the doctor threw the ball back to him. He draws a straight line on the paper and then picks up a few blocks from the floor and stacks one on the top of the other. What is the most likely developmental month for this child?

A:

9

B:

12

C:

15

D:

18

Q.43. A 5-year-old child is about to receive a flu vaccination, and the doctor asked the mother about any food allergies the child might have. Which of the following is the most important to note?

A:

Chickens

B:

Shellfish

C:

Eggs

D:

Nuts

Q.44. While at the clinic, an infant crawl toward the doctor, rolls over, sits briefly, transfers objects from hand to hand and grasps objects using his radial palm. The infant is unable to use a pincer grasp. What is the approximate age in months?

A:

3

B:

5

C:

7

D:

9

Q.45. A child is brought for a well-child visit. He is healthy and developing normally. The child can name 4 colours, define 5 words, understand prepositions, hops on 1 foot, and gets dressed with little assistance. What developmental age in months is this most consistent with?

A:

48

B:

36

C:

24

D:

18

Q.46. A 12-year-old child presents to the clinic with a worsening history of severe headaches that are unilateral, pulsating, exacerbated by movement, and aggravated by light. Which of the following is the most likely type of headache?

A:

Migraine

B:

Cluster

C:

Stress

D:

Sinus

Q.47. A 9-year-old boy is brought to the clinic. The mother is concerned that her child is short. She appears to be short. In a systemic review, he is asymptomatic. Physical examination is normal (see lab results and report). Blood pressure 130/85 mmHg Heart rate 75 /min Respiratory rate 16 /min Temperature 37.2° C Weight 25 kg Height 120 cm Test Result Normal Values Thyroid stimulating hormone 3.2 0.4 - 5.0 pUL Follicle stimulating hormone 1.4 1.0-1.6 IUL Luteinizing hormone 0.1 0.05-0.5 IU/L Growth hormone 4.9 2-10 ug/L. Free Testosterone 38.2 10.4-41.6 nmol/L. Insulin like growth factor -1 18 67-405 ng/mL. X-ray of left wrist and hand: The bone age is as a 6-year-old child. ‘Which of the following is the most likely diagnosis?

A:

Failure to thrive

B:

Familial short stature

C:

Growth hormone deficiency

D:

Constituitional delay of growth

Q.48. A 14-year-old boy has developed unilateral gynecomastia which makes him embarrassed. Which of the following is the most appropriate advice?

A:

Reassurance that most cases resolve within a few years

B:

Explaining that majority of men have this condition to a certain degree

C:

Using a compression bandage at night

D:

Decreased intake of soy protein

Q.49. A 3-year-old girl is brought to the clinic with weight loss of 1 kg over the last 2 weeks in spite of increased appetite and thirst. The parents report that the child has been tired and moody lately. The frequency of wet diapers had increased significantly. Physical examination confirms dry mucous membranes and a generally reduced skin tonus. The genito-anal zone is reddened and : inflamed (see lab result). Blood pressure 90/60 mmHg Heart rate 70 /min Respiratory rate 60 /min Temperature 36.8" C Test Resuit Normal Values Glucose 25 3.5-5.5 mmol/L. : Which of the following diagnostic tests is most important?

A:

Glycosylated hemoglobin

B:

Full blood cell count

C:

HLA DR3 antigen

D:

Urine dip stick

Q.50. A 4-week-old baby presents with tachypnea, tachycardia, differential cyanosis and irritability. Which of the following is the most common accompanying feature?

A:

Cough

B:

Ascites

C:

Difficulty feeding

D:

Jugular venous distension

Q.51. A 15-year-old boy is diagnosed with diabetic ketoacidosis. Which of the following types of insuiin is used in acute management?

A:

NPH

B:

Aspart

C:

Regular

D:

Ultralente

Q.52. A 3-year-old boy presents with painless abdominal distension, he has had occasional attacks of abdominal pain, vomiting, and bloody urine. On examination, there is a smooth firm mass in the fight loin, an absent iris and undescended testes (see lab results). Urinalysis Result Normal Values Color Clear Clear or ight yellow Appearance Turbid Clear Specific gravity 1.025 1.001-1.030 pH7.5438 Leukocytes 5 0-3 per high power field Erythrocytes 15 0-2 per high power field Color Clear Clear or ight yellow Which of the following is the most likely diagnosis?

A:

Hydronephrosis

B:

Nephroblastoma

C:

Urinary tract infection

D:

Polycystic kidney disease

Q.53. Which of the following language milestones is appropriate for a 4-year-old child?

A:

Speaks 50-100 words

B:

Can use the future tense

C:

Speaks 2-word sentences

D:

Can count to 4 and tell a story

Q.54. A 12-year-old girl was diagnosed with type 1 diabetes 3 years earlier and presents for a routine examination. She is on a basal bolus regime which she manages well. The total daily insulin dose is 32 units. Physical examination shows no abnormal findings. There are no signs of puberty (see lab result) Weight 40 kg (<50th percentile) Height 156 cm (75th percentile) Test Result Normal Value Glucose 6.0 3.5-5.5 mmollL Which of the following screening tests should be performed annually?

A:

Ophthalmoscopy

B:

Test for celiac disease

C:

Growth hormone test

D:

Ultrasound of kidneys

Q.55. A 9-year-old boy is brought for a check-up. Parents are worried because he is short. On examination, his height is below the 5th percentile for his age but increasing steadily. The parents ask if he will always be short in the future. What is the most important factor to answer the question?

A:

Sibling heights

B:

Parental height

C:

Weight for height and age

D:

Upper to lower segment ratio

Q.56. In which of the following conditions would you expect a bone age greater than the chronologic age?

A:

Hypothyroidism

B:

Chronic renal failure

C:

Familial short stature

D:

Congenital adrenal hyperplasia

Q.57. A 3-day-old baby is brought to the clinic with fever, vomiting, and hypothermia. Prior to labour, his mother was febrile. He was examined and a lumbar puncture was performed (see report). Cerebrospinal Fluid Gram stain It showed Gram-positive bacilli and was Beta hemolytic and catalase positive on culture. Which of the following antibiotics should be started empirically?

A:

Meropenem

B:

Cefotaxime

C:

Gentamicin

D:

Ampicillin

Q.58. A 10-year-old child presents with pain over the tibial tubercle. The child has recently had a growth spurt. Which of the following is the most likely diagnosis?

A:

Legg-Calve-Perthes disease

B:

Osgood-Schlatter disease

C:

Stress fracture

D:

Shin splints

Q.59. A 5-year-old girl presents to the clinic with pallor and irritability. On examination, she has mild jaundice and her spleen was enlarged by 4 cm (see lab resuils). Test Result Normal Values RBC 4.4 4.64.8 x 10121 Hb 82 112-165 g/L Reticulocyte 9 0.2-12 % MCH 39 28-33 pgcell MCV 80 80-95 fi Peripheral blood smear Test Result Microspherocytes ++ Anisocytosis Mild Which of the following is the most likely diagnosis?

A:

Biliary obstruction

B:

Sickle cell anaemia

C:

Hereditary spherocytosis

D:

Autoimmune haemolytic anaemia

Q.60. Cerebral palsy is a non-progressive disorder of motion and posture. Which one of the following risk factors is the most significant?

A:

Prematurity

B:

Perinatal asphyxia

C:

Birth weight less than 1.5 Kg

D:

Genetic / Metabolic / Metabolic abnormalities

Q.61. A 8-year-old boy presents with abdominal pain and swelling of his right ankle. He had had an upper respiratory tract infection 3 weeks earlier. On examination, he had multiple maculopapular lesions (see image and lab result). Test Result Normal Value Erythrocytes 15 0-2 per high power field Which of the following is the most appropriate management?

A:

Antibiotics

B:

Platelet transfusion

C:

Supportive treatment

D:

Factor VII transfusion

Q.62. A 12-year-old obese boy is being observed in the Paediatric Outpatient Clinic as he has short stature, purple striae over his abdomen and hips, and hypertension. Which of the following is the most important initial investigation?

A:

MRI of the brain

B:

Adrenal scintigraphy

C:

MRI of the adrenal glands

D:

Morning and evening cortisol levels

Q.63. A newborn presents with jaundice 12 hours after birth. At 36 hours after birth, the jaundice became worse and blood smear was performed (see image and lab results). Test Results Normal Values Hb 91 112-165 g/L Reticulocyte 7 0.212% Total bilirubin 2800 <205 pmoliL Which of the following is the most appropriate next step in the investigation?

A:

Osmotic fragility test

B:

Pyruvate kinase assay

C:

Haemoglobin electrophoresis

D:

Measurement of glucose-6-phosphate dehydrogenase activity

Q.64. A 7-day-old baby is brought to the clinic for a check-up. The mother raised the concen that his current weight is 3.1 Kg while his birth weight was 3.5 Kg. She is breastfeeding him every 2 to 3 hours for 10-15 min with good sucking. Physical examination is normal. Which of the following is the most appropriate management?

A:

Maternal nutrition counselling

B:

Reassure the mother all is normal

C:

Admit baby for further investigation

D:

Routine tests and reassess in one month

Q.65. A child's developmental assessment conforms the following (see table). Motor Walks alone, crawls up stairs Adaptive Makes a tower of three cubes, makes a line with crayons Language Jargon, follows simple commands Social Indicates desire by pointing Which of the following is the most likely age in months?

A:

6

B:

9

C:

15

D:

24

Q.66. While in the clinic, a child demonstrates an ability to run, is able to open a door and climb onto furniture. The child uses 3-word sentences, but does not know his full name and does not climb up stairs using alternate feet. Which of the following is the approximate age in years?

A:

1

B:

2

C:

3

D:

4

Q.67. A7-year-old chid is brought to the clinic with fever, headache and vomiting of 2 days. On examination, there is meningeal irritation. A lumbar puncture is done (see lab results and report). CSF Analysis Test Result Normal Values Total Protein 560 150-450 mg/L Glucose 2.9 2,504.8 mmollL Bacteriology Report: Gram positive cocci in pairs. Which of the following antibiotic combination would be most appropriate?

A:

Penicillin and vancomycin

B:

Vancomycin and rifampin

C:

Ampicillin and gentamicin

D:

Ceftriaxone and vancomycin

Q.68. A 5-year-old girl started growing pubic hair and an adult body odour 8 months ago. Examination shows her height is at the 75th percentile, weight is at the 95th percentile, and there was no acne or clitoromegaly. Which of the following is the most important initial screening study?

A:

Dehydroepiandrosterone sulphate

B:

Follicle stimulating hormone

C:

17-hydroxyprogesterone

D:

Testosterone

Q.69. Which of the following drugs would be most suitable for a 7-year-old child with absence seizures?

A:

Phenytoin

B:

Ethosuximide

C:

Phenobarbital

D:

Carbamazepine

Q.70. A 6-year-old girl presents to the Paediatrics Emergency Department with an unsteady gait and progressive difficulties climbing stairs over the last 10 days. The parents report that the child has been repeatedly choking on her saliva. The symptoms began with a prickly sensation in the fingers and toes that came along with an ascending and symmetric numbness. There is a history of viral gastroenteritis 3 weeks before. Physical examination confirms the absence of the knee-jerk reflex (see reports). ; CSF Analysis: Elevated protein concentration with a normal cell count Nerve Conduction Test: Reduced velocity. Which of the following is most likely long-term prognosis?

A:

Respiratory failure

B:

Residual weakness

C:

Complete recovery

D:

Progressive paralysis

Q.71. Which of the following is the main treatment of Kawasaki disease?

A:

Aspirin

B:

Ibuprofen

C:

Paracetamol

D:

Intravenous Immunoglobulin

Q.72. A 5-month-old boy presents to the clinic after missing his 4-month vaccinations. He appears to be well and thriving. The parents missed his 4-month visit due to transportation difficulties. What would be the best way to modify his immunization schedule?

A:

Arrange to give all missed vaccinations

B:

Disregard missed vaccinations, continue to next

C:

Give missed vaccinations, and next appointment

D:

Give missed vaccinations at 6 months with others

Q.73. A 14-month-old girl is brought to the clinic with vomiting and diarrhoea. The mother reports her child is less active. On examination, she has mild dehydration with an estimated fluid deficit of 5% (see lab results). Weigh 10 Kg Test Result Normal Values Sodium 128 134-146 mmol/L Potassium 3.3 3.5-5.1 mmol/L Chloride 94 97-108 mmol/L Bicarbonate 12 21-28 mmol/L How much intravenous fluid (ml/day) should be given?

A:

1000

B:

1250

C:

1500

D:

1750

Q.74. A 10-year-old girl is admitted to the Paediatric ICU after a car accident with extensive head trauma. 12 hours after being admitted she develops increased urine output, 100 mi (see lab results). Temperature 36.9°C Heart rate 102/min Blood pressure 120/70 mmHg Respiratory rate 18/min Test Result Normal Value Serum osmolality 326 280-300 mmol/kg 24 Urine Analysis Result Normal Value Osmolality 90 280-910 mOsm/kg H20 Which of the following is the most likely diagnosis?

A:

Central diabetes insipidus

B:

Nephrogenic diabetes insipidus

C:

Excessive intravenous fluid administration

D:

Syndrome of Inappropriate Antidiuretic Hormone Secretion

Q.75. An 18-month-old girl presents to the clinic to receive her scheduled vaccines. Her mother reports that she is currently completing a course of antibiotics for tonsils, diagnosed 4 days | ago. Initially she had fever, initability, and poor oral intake. Today she is better and started fo play and feed normally. Examination reveals a hyperaemic pharynx. Blood pressure 85/65 mmHg Heart rate 100 /min Respiratory rate 25 /min Temperature 37.3° C Which of the following is the best decision about the vaccination?

A:

Vaccinate as per schedule

B:

Wait unti antibiotics finished

C:

Postpone the Oral Polio Vaccine

D:

Do not administer diphteria-pertussis-tetanus

Q.76. A 6-year-old child presents with malaise, fever, cough, nasal discharge, and conjunctivitis. Several days later the patient develops a maculopapuiar rash starting on the face and rapidly spreading 10 the rest of the body. Which of the following viruses is most likely the cause?

A:

Epstein-bar

B:

Coxsackie

C:

Vaccinia

D:

Rubella

Q.77. A 6-month-old child is brought to the paediatrician for a weil-child visit. The infant was born at full term after a normal pregnancy and spontaneous vaginal delivery. The linear growth and the amount of weight gained over the past 6 months are both appropriate. The mother began feeding the infant pureed baby foods approximately 1 month before while also continuing breast feeding. The infant has been well since birth. The physical examination is normal for age. A developmental screening exam is performed. Which of the following gross motor skills is most appropriate at his age?

A:

Sits without support

B:

Stands while holding onto support

C:

Rolls from prone to supine position

D:

Rolls from supine to prone position

Q.78. A 12-year-old girl comes to the ciinic after developing progressive weakness and inability to walk. She has intermittent tingling of her fingers and toes. History reveals she had 3 days of | diarrhoea about 2 weeks ago. Physical examination confirms marked peripheral muscle weakness without atrophy or fasciculation. The ankle and patela reflexes are absent, anda sensory examination is normal. Motor involvement is symmetric. Which of the following is the most likely diagnosis?

A:

Guillain-Barré syndrome

B:

Mononeuritis multiplex

C:

Myasthenia gravis

D:

Polio

Q.79. A 2-year-old girl presents with low energy and failure to thrive. The child was bom at 38 weeks’ gestation with a birth weight of 3.3 kg. The actual body weight was 10 kg (3rd percentie). The mother reports poor appetite and litte interest in food. The family follows a strict vegetarian diet. A physical examination confirms pallor of the skin and the mucous membranes. There are cracks in the skin at the comer of the mouth and a peculiar appearance of the nails on the finger and toes (see image and lab results). Heart rate 110 /min Respiratory rate 36 /min Temperature 36.8° C Oxygen saturation 95% on room air Test Result Normal Values Hb 90 112-165 g/L. HCT 0.290.32.0.42 Platelets count 470 150-400 x 109/L MCV 78 80-95 fi MCH 25 28-33 pg/cell Which of the following is the most appropriate treatment?

A:

Transfusion of packed red blood cells

B:

Erythropoiesis-stimulating agents

C:

Oralferrous sulfate

D:

Parenteral iron

Q.80. A 3-year-old boy presents to the Outpatient Department with the complaint of lethargy and failure to thrive (see ab results.) Test Result Normal Values RBC 4.6 4.64.8 x 10121 Hb 88 112-165 gL Reticulocyte 5 0.2-12 % MCH 24 28-33 pg/cell MCV 65 80-95 fi Which of the following is the most appropriate management?

A:

Blood transfusion

B:

Intramuscular iron

C:

Oral ferrous sulfate

D:

Iron fortified cereal

Q.81. Which of the following is usually the first sign of puberty in boys?

A:

Acne

B:

Pubic hair

C:

Penile enlargement

D:

Testicular enlargement

Q.82. A mother of a 3-year-old child asks about his language development. He easily communicates with other children and 75% of his speech is understood by strangers. He asks questions frequently and follows 2-part commands. What is the best description of this language development?

A:

Receptive language delay

B:

Developmental disfluency

C:

Expressive language delay

D:

Normal development for age

Q.83. A 12-year-old child was prescribed antibiotics for treatment of a chest infection. 6 weeks after cessation of antibiotics, the patient presents with fever, abdominal pain, and profuse watery stools for the past month. Investigation confirms fecal leucocytes. Which of the following is the most likely pathogen?

A:

Clostridium perfringens

B:

Clostridium difficile

C:

Giardia lamblia

D:

Escherichia coli

Q.84. A 12-year-old girl presents with tiredness, frequent ptosis and diplopia. She has no myalgia or fasciculation and her deep tendon reflexes are 1-2+. She reports that the symptoms become worse as the day progresses and that she feels better in the moming. Which of the following is the most likely pathophysiology?

A:

Ingestion of botulinum toxin

B:

Antibodies against the AChRs

C:

Mutation in the dystrophin gene

D:

Antibodies against thyroid peroxidase

Q.85. In a prone position, an infant can lft his head 45° off the examination table and moves his head from side to side while following an object. He smiles and coos when the doctor plays with him, but cannot maintain a seated position. What is the age in months this child most likely at?

A:

1

B:

3

C:

6

D:

9

Q.86. A 4-month-old girl is brought to the Paediatric Clinic for a routine monthly exam. The baby smiles back at people and imitates facial expressions. She uses eyes and hands together and | reaches out with one hand for a toy. There is babbling along with a facial expression. The girl | pushes up to her elbows when lying on the tummy. Weight 7300 grams (=50th percentie) Length 67 cm (=75th percentile) Which additional developmental milestone is most likely to have?

A:

“A. Hold head steady without support

B:

Roll over in both directions

C:

Make crawling attempts

D:

Sitwithout support

Q.87. A child walks with one hand held, says a few words besides "mama" and "dada", and picks up pellets with an unassisted pincer grasp, but does not insert them into a bottle. What is the approximate age in months?

A:

7

B:

9

C:

12

D:

15

Q.88. A 7-year-old boy is brought to the clinic to receive the injectable influenza vaccine. The father said that last year he had taken the vaccine, but still got the flu. He thought he got flu because he had received the vaccine, and is sceptical about is value. Which of the following is the best advice?

A:

Killed vaccine have no such risk

B:

Attenuated vaccine has some risk

C:

Live vaccines have a risk of infection

D:

The nature of this vaccine may cause flu

Q.89. An 8-year-old child is brought to the clinic for a routine physical examination. During the exam, the physician notes a cardiovascular murmur that is high pitched and heard best at the midsternal border and late systolic in timing. The patter is crescendo-decrescendo in nature. Which of the following is the most likely type of murmur?

A:

Systolic regurgitation

B:

Systolic ejection

C:

Physiologic

D:

Innocent

Q.90. What is the most important measure to protect neonates against infection in a nursery?

A:

Thorough hand washing before and after exams

B:

Compulsory use of shoe covers and gowns

C:

Wearing sterile gloves before entry

D:

Use of prophylactic antibiotics

Q.91. A 15-month-old child is brought to the clinic with one day of fever and vomiting. A lumber puncture is performed (see lab results and report). CSF exam Test Rest Normal Values Total protein 300 150-450 mg/L. Glucose 32.50-4.8 mmol Cells 1200 0-3 micro mol CSF Culture: Gram-positive cocci in chains, pus cells, and WBCs with a predominance of Neutrophils. Which of the following is the most appropriate antibiotic or antibiotic combination?

A:

Ampicillin

B:

Vancomycin

C:

Ampicillin and gentamicine

D:

Ceftriaxone and Vancomycin

Q.92. A 14-year-old girl has been diagnosed with Turner's syndrome Which of the following disorders is most likely to have?

A:

Hypothyroidism

B:

Addison's disease

C:

Diabetes mellitus

D:

Hyperprolactinemia

Q.93. A 2-year-old girl with a high, relapsing fever of 9-day duration associated with marked irriabity, non-purulent conjunctivitis, red cracked lips, swollen and erythematous hands and feet, and a maculopapular erythematous rash on the trunk and extremities. Which of the following is the most likely diagnosis?

A:

Epstein bar viral infection

B:

Kawasaki disease

C:

Rubella infection

D:

Measles

Q.94. Which of the following can the average 3-year-old child perform?

A:

With alternating feet catch a ball

B:

Know days of the week

C:

Trace a triangle

D:

Climb stairs

Q.95. A 8-month-old child is brought to the Emergency Room due to low-grade fever, cough, and nasal congestion for several days. The previous night, her cough sounded "barky” like a seal and her parents are now worried about her ability to breathe. She has more difficulty breathing when she becomes upset and cries. On examination, she appears well hydrated without acute respiratory distress. However, audible breath sounds are noted when she began to cry with high-pitched barking cough. Which of the following is expected to be heard upon pulmonary auscultation?

A:

Overall decreased breath sounds

B:

Prominent expiratory wheezing and prolonged expiration

C:

Prominent inspiratory sounds due to subglottic airway narrowing

D:

Prominent inspiratory sounds due to mucus deposition in the large airways

Q.96. A 2-week-old boy is brought to the Paediatrics Clinic for a routine exam. The child was bom at 41 weeks' gestation and has been exclusively breastfed. Physical examination confirms large fontanels and an umbilical hernia. The muscle tone is reduced. The skin feels cool and dry and there is generalized jaundice. The infant's tongue appeared large for his mouth. Which of the following disorders is most likely to be found?

A:

Congenital adrenal hyperplasia

B:

Congenital hypothyroidism

C:

Biotinidase deficiency

D:

Galactosemia

Q.97. A 9-year-old child presents with a fever and sore throat associated with bilateral knee pain. The laboratory investigation shows a high sedimentation rate. Which of the following is the most likely diagnosis?

A:

Juvenile theumatoid arthritis

B:

Osgood-schiatter disease

C:

Infectious mononucleosis

D:

Acute rheumatic fever

Q.98. A 6-month-old baby is brought by his mother for assessment of feeding difficulties and constipation. On examination, the baby's growth curve is below the 25th percentile, and there is a marked delay in his milestones. He had spastic tone all over, with crossed legs, but both arms were less spastic. Blood pressure 90/50 Heart rate 120 /min Respiratory rate 22 /min Temperature 36.6 C Which of the following cerebral palsy types is most likely to have?

A:

Mixed

B:

Diplegic

C:

Hemiplegic

D:

Quadriplegic

Q.99. A 6-year-old boy is brought the Emergency Department after falling down 1 flight of stairs and hitting the floor with his head. On examination, he is alert, oriented and has no focal neurological findings. There is blood coming out of his left ear (see report). Otoscopy: Confirms a ruptured eardrum on the left side with bleeding. The external auditory canal is intact. Which of the following is the most likely diagnosis?

A:

Basilar skull fracture

B:

Subdural hematoma

C:

Subarachnoid haemorrhage

D:

Intraventricular haemorrhage

Q.100. Group B streptococci are a common cause of neonatal meningitis. Vaginal swab for group B streptococci is recommended in pregnant mother. At which gestational age should the vaginal swab be collected?

A:

15weeks

B:

25weeks

C:

35weeks

D:

40 weeks

Q.101. A 12-day new-born girl is brought to Emergency Department. Her mother complaining that the girl turns blue when she cries. After examination and investigation, the paediatrician explains to the mother that she had a congenital heart disease called Fallot's tetralogy. Which of the following is a part of Fallot tetralogy?

A:

Pulmonary stenosis

B:

Aortic valve stenosis

C:

Interatrial septal defect

D:

Hypertrophy of left ventricle

Q.102. A 4-year-old child suddenly developed a high fever, chills, and vomiting. Examination shows nuchal rigidity and a positive Kernig's sign. Petechial lesions are noted on both extremities and over the abdomen. Which of the following is the most likely diagnosis?

A:

Meningococcal meningitis

B:

Pneumococcal meningitis

C:

Aseptic meningitis

D:

Encephalitis

Q.103. A 4-month-old girl is brought to the clinic for vaccination. She was born preterm at 32 weeks gestation due to maternal pre-eclampsia. Which of the following is the best approach for the patient's immunization schedule?

A:

Reduce the vaccine dose for preterm infants

B:

Use the adjusted age to schedule vaccinations

C:

Use the calculated weight to schedule vaccinations

D:

Follow chronological age for administering vaccines

Q.104. A 16-year-old adolescent girl complains of galactorrhea for 3 months. Her menarche was at age 13 years and her menstrual cycles have been regular until two months ago. On examination, she is at Tanner stage 2. Which of the following is the most appropriate hormone to measure first?

A:

Prolactin

B:

Oestrogen

C:

Progesterone

D:

Luteinizing hormone

Q.105. A 6-month-old boy is brought to the clinic for follow up. He has active seizures and is on anti- epileptic medications. On examination, he has dysmorphic features; is hypotonic and does not roll over or sit up with support. He does not seem to be fixing and following. How shall the immunization schedule be modified?

A:

Give IPV instead of OPV

B:

Defer the DTP vaccine

C:

Defer all live vaccines

D:

Defer all vaccines

Q.106. While in the clinic, a child runs towards the doctor, walks upstairs with one hand held and pours out pellets from a bottle. The child does not handle a spoon well and cannot put 3 words together. What is the approximate age in months?

A:

12

B:

15

C:

18

D:

24

Q.107. A 9-year-old boy is brought to the clinic. The mother is concerned that her son is not eating well since early childhood. He is being teased for being small by his peers in the school. The mother has small body built and is short. In a systemic review, he is asymptomatic. Physical examination is normal (see lab results and report). Blood pressure 130/85 mmHg Heart rate 75 /min Respiratory rate 16 /min Temperature 37.2° C Weight 25 kg Height 120 cm Test Result Normal Values Thyroid stimulating hormone 3.2 0.4 - 5.0 WUIL Follicle stimulating hormone 1.4 1.0-1.6 IU/L Luteinizing hormone 0.1 0.05-0.5 IU/L Growth hormone 4.9 2-10 pg/L Free Testosterone 38.2 10.4-41.6 nmol/L Insulin like growth factor -1 18 67-405 ng/mL. X- ray of left wrist and hand: The bone age is as a 7-year-old child. Which of the following is the most appropriate management?

A:

High caloric diet

B:

Growth hormone

C:

Octerotide acetate

D:

Behavioural therapy

Q.108. A child is brought to the Paediatric Clinic with cough, fever, rhinorrhoea, malaise, and conjunctival erythema. There are small, grayish, irregular lesions surrounded by an erythematous base, on the buccal mucus membrane near the second molar teeth. Which of the following is the most likely diagnosis?

A:

Measles

B:

Rubella

C:

Parainfluenza

D:

Respiratory syncytial infection

Q.109. A 3-year-old child presents with a 1-week history of malaise, anorexia, nasal discharge, and conjunctivitis. The parent states that the child has also had 2 days of paroxysmal coughing spells with a stridor "whoop." Which of the following is the most likely diagnosis?

A:

Pertussis

B:

Epiglottitis

C:

Psittacosis

D:

Mycoplasma

Q.110. A 3-year-old child of a parent who was recently diagnosed with pulmonary tuberculosis has a tuberculin skin test. After 72 hours, the size of local induration is 10 mm. Which of the following is the most appropriate interpretation?

A:

Negative

B:

Positive

C:

Needed to be repeated

D:

Testis is not recommended any more

Q.111. A 1-month-old infant was referred to the dental clinic with the presentation of white plaques visible on the surfaces of the dorsal tongue and hard palate, which can be wiped off. A clinical diagnosis was made and the infant was started on nystatin 4 times a day for a period of 10 days. Which of the following is the most likely diagnosis?

A:

Erythematous candidiasis

B:

Gingivostomatitis

C:

Leukoplakia

D:

Oral thrush

Q.112. An infant lies with his head to one side and raises his head slightly, but the head lags when pulling up to a sitting position. The infant smiles when involved in social interactions and follows moving objects 180 degrees, but does not attempt to reach for them. What is the approximate developmental age in weeks?

A:

4

B:

8

C:

12

D:

16

Q.113. A 3-week-old girl presents with repeated vomiting over the last 4 days. The child was born full- term with a weight of 3.3 kg and weighs now 3 kg. There is no family history of any significant ~~ illness. Physical examination confirms reduced skin turgor and weak musce tone. The external genitalia showed an abnormally enlarged cltoris. The paediatrician initiates intravenous treatment with isotonic sodium chioride solution (see lab results). Test Result Normal Values PH7.257.36-7.45 Sodium 120 134-146 mmol/L Potassium 5.8 3.5-5.1 mmoilL Glucose 2.9 3.3 -5.5 mmollL Which of the following intravenous treatment is most appropriate?

A:

Cefotaxime

B:

Vasopressin

C:

Sodium bicarbonate

D:

Hydrocortisone

Q.114. A 6-year-old child is brought to the clinic with sudden onset of a clumsy gait and an inabilty to stand or walk without support. The child is irritable and has been vomiting over the last 3 days and had chickenpox 3 weeks before. Muscle strength testing does not reveal any abnormality, but there is a resistance to neck flexion. Which of the following disorders is most likely present?

A:

Friedrich's ataxia

B:

Meningoencephalitis

C:

Acute cerebellar ataxia

D:

Guillain-Barré syndrome

Q.115. A 16-year-old girl presents with throbbing headaches that last for 2 hours and occurs 3 to 4 times a week. The headaches are usually unilateral, begins with nausea, and exacerbated by noise and light. A recent brain CT scan was normal. Which of the following should be used to treat acute symptoms?

A:

Levofloxacin

B:

Sumatriptan

C:

Meclizine

D:

Aspirin

Q.116. During a well-baby vaccination supervision visit. the mother reports that her 9-month-old girl had received all her immunizations since birth and she is due for another vaccination. Which of the following vaccines would be recommended?

A:

Oral polio and hepatitis B

B:

Measles, mumps and rubella

C:

Diphtheria, tetanus and pertussis

D:

Measles and meningococcal conjugate

Q.117. A 16-year-old boy comes to the clinic complaining of severe headaches twice a week. He describes the pain as a tight band around the head with pressure behind the eyes with a throbbing and bursting sensation. The patient has been stressed with school work and sports. Which of the following is the most likely diagnosis?

A:

Sinus headache

B:

Tension headache

C:

Vascular headache

D:

Migraine headache

Q.118. A 9-year-old boy referred to his local hospital with a history of fever, headache, prostrationand nuchal rigidity. Gram stain done on the CSF smears shows gram positive cocci. Which of the following CSF findings is consistent with this diagnosis?

A:

Numerous lymphocytes, decreased glucose, normal protein

B:

Numerous neutrophils, increased glucose, normal protein

C:

Numerous lymphocytes, normal glucose, decreased protein

D:

Numerous neutrophils, decreased glucose, increased protein

Q.119. A 12-year-old boy with diabetes mellitus type 1 has been having recurrent attacks of hypoglycaemia for the last 2 weeks. They occur at different times of the day. He is compliant with his insulin dose and follows his dietary advice since diagnosis 2 months ago. On physical examination, he is normal. Blood pressure 125/85 mmHg Heart rate 85 /min Respiratory rate 16 /min Temperature 37.2° C Which of the following is the most likely explanation?

A:

Brittle diabetes

B:

Dawn phenomenon

C:

Honey-moon period

D:

Somogyi phenomenon

Q.120. A 2-month-old baby is brought for his first visit in the Well-Baby Clinic. He was born at 35 weeks by a normal vaginal delivery, and was 1.7 Kg at birth and was managed in an incubator for 2 weeks. He has done well since and is gaining almost 50 grams each day. Which of the following is the best immunization plan for this visit?

A:

Delay for 2 months

B:

TdaP instead of DTaP

C:

Usual schedule but half dose

D:

Usual schedule and usual dose

Q.121. A 15-month-old child is brought to the Emergency Department after having a generalized tonic- clonic seizure that lasted approximately 5 minutes. The parents say that the child had been previously well but developed cough and rhinorhoea earlier that day with a temperature of 302°C. Which of the following is the most appropriate management?

A:

Diazepam

B:

Phenytoin

C:

Head CT scan

D:

Control of the fever

Q.122. By what age in months should a child smile?

A:

1

B:

2

C:

4

D:

6

Q.123. A 6-month-old girl is brought to the clinic for routine vaccination. The mother reports that she had developed a fever associated with a local area of redness and swelling, after the previous 4 month vaccinations and is concerned. What modification, if any, shall be taken to the vaccination schedule?

A:

None, but give reassurance

B:

Do not give the DPT vaccines

C:

First, refer for allergen screening

D:

Antipyretic and antihistamine prophylaxis

Q.124. A 4-year-old girl is brought to the Paediatrics Emergency Department with vomiting and lethargy. The parents report a weight loss of 1 kg over the last 2 weeks. There has been little appetite, but a lot of thirst and frequent urination. The child appeared sleepy and irritable. Physical examination confirmed dry mucous membranes and a generally reduced skin tone. After running several exams, the pediatrician started IV treatment with ringer lactate plus added electrolytes and a low-dose insulin infusion (see lab results). Test Resuit Normal Values pH7.27.36-7.45 Glucose 20 3.5-5.5 mmoliL Urinalysis Result Normal Value Ketones Positive Negative Which of the following complications should be observed?

A:

Hypoglycemia

B:

Kidney failure

C:

Cerebral edema

D:

Metabolic alkalosis

Q.125. A 3-day-old infant is brought to the Paediatrics Clinic with refusal to feed, vomiting and inactivity. ‘The infant was born at term with no perinatal problems. The infant's urine smells like burned sugar. Which of the following is the most likely diagnosis?

A:

Maple syrup urine disease

B:

Urinary tract infection

C:

Urea cycle disorder

D:

Phenylketonuria

Q.126. A 15-year-old child presents to the Outpatient Clinic suffering from abdominal pain, diarrhoea, and tenesmus for the last 2 weeks. There is mucous and blood present in the stool. Which of the followings the most likely diagnosis?

A:

Amoebiasis

B:

Taenia saginata

C:

Bile salt deficiency

D:

Intestinal ascariasis

Q.127. During a health supervision examination, a mother reports that her son can say his name, feeds himself, separates easily from parents and rides a tricycle. What is the developmental age in years?

A:

2

B:

3

C:

4

D:

5

Q.128. A 12-year-old boy comes to the clinic with symptoms of unnatural tiredness and exertional dyspnoea. He has a past history of myopia. On physical examination, he has scoliosis and a pectus excavatum (see report). Height above the 90th percentile Weight below the 25th percentile Echocardiography: Mitral valve prolapse and dilatation of the ascending aorta. Which of the following is the most likely diagnosis?

A:

Aortic dissection

B:

Marfan Syndrome

C:

Congenital syphilis

D:

CHARGE association

Q.129. A 7-year-old girl is brought to the Paediatric Outpatient Clinic because she is already showing breast development, the appearance of pubic hair, and acne. She is otherwise asymptomatic. Which of the following is the most likely diagnosis?

A:

Ovarian tumour

B:

Central precocious puberty

C:

Gonadotropin-releasing tumour

D:

Lesion in central nervous system

Q.130. By what age in months should a child learn to speak a few words?

A:

3

B:

6

C:

12

D:

24

Q.131. A 4-year-old girl was involved in a motor vehicle accident and required splenectomy after severe abdominal trauma with splenic tears. What additional specific vaccination should she receive?

A:

Human papillomavirus vaccine

B:

Meningococcal vaccine

C:

Rotavirus vaccine

D:

Tetanus vaccine

Q.132. A 15-year-old boy is diagnosed with diabetes melitus type 1 and prescribed insulin. He and his family were educated about the use and recognition of adverse effects of insulin. Which side effect would be most important to receive education on?

A:

Hypoglycemia

B:

Lipodystrophy

C:

Hyperipidemia

D:

Hypersensitivity

Q.133. A 1-year-old boy is brought to the clinic for failure to thrive, recurrent oral thrush and hepatosplenomegaly. He had a brother who died at the age of 3 years with severe infection and septic shock. Which of the following vaccines must be avoided until a diagnosis is made?

A:

Varicella

B:

Influenza

C:

Injectable polio

D:

Pneumococcal conjugate

Q.134. Which of the following is the most typical milestone for a 4-year-old child?

A:

Write the first name

B:

Copy a square and triangle

C:

Speak clearly in sentences

D:

Prefer solitary or parallel play

Q.135. An 8-year-old boy presents for follow-up. He was diagnosed with diabetes Mellitus type 1a month ago. He is compliant with his insulin dose. Physical examination is normal. Blood pressure 115/75 mmHg Heart rate 88 /min Respiratory rate 16 /min Temperature 37.2° C When should an ophthalmology evaluation performed?

A:

Immediately

B:

After 1 year

C:

After 3 years

D:

After 5 years

Q.136. A child is brought for a health maintenance check. The parent states that the child sits up alone without support, pulls himself into a standing position, explores around furniture, and crawls without difficulty, grasps objects with a thumb and forefinger, uses repetitive consonants such as *dada", and responds to the sound of his own name. What age in months is the child most probably at?

A:

8months

B:

10 months

C:

12 months

D:

14 months

Q.137. A full term boy was born to a mother diagnosed antenatally with hepatitis B surface Ag positive (HBsAg positive). Her delivery was unremarkable and the newborn weighed 3.4 kg and was. normal on assessment. He received the hepatitis B vaccine and hepatitis B Immunoglobulins within the first 4 hours. The mother is very enthusiastic to breastfeed her child as she did with her previous children. Which of the following is the best advice?

A:

Wait 12 hours before

B:

Encourage breastieeding

C:

Advise not to breastfeed

D:

Measure HbsAg, then decide

Q.138. A 10-year-old boy presents to the Paediatric Clinic with weight loss of 4 kg over the last 3 weeks. The parents report that he had had little appetite and had wet his bed several times in ; the last week. The child has previously been healthy and there is no history of any major illness. The child appears lethargic and irritable. Physical examination confirms reduced skin fone and dry mucous membranes (see lab results). : Blood pressure 100/60 mmHg Heart rate 80 /min Respiratory rate 50 /min Temperature 37.0° C Weight 28 kg (10th percentie) Height 104 cm (50th percentie) Test Result Normal Values pH 7.27.36-7.45 Glucose 20 3.5-5.5 mmol/L. ; Urinalysis Result Normal Values Ketones Positive Negative Which of the following is the initial line of management?

A:

Electrolyte replacement

B:

Bicarbonate treatment

C:

Fluid replacement

D:

Insulin infusion

Q.139. What is the most common minor side effect with routine DTP vaccination?

A:

Injection site erythema

B:

Generalised pain

C:

Feverof 383°C

D:

Vomiting

Q.140. A child enters the clinic and says "hi" to the doctor then turns to the mother and says "milk". The mother gives her a bottle of milk, and the child tries to give her doll a drink. The mother shakes her head, and the child says "no". After which the child smiles and points to her own mouth and says “mouth”. When her mother wipes the doll's face, the child says "me" and begins to imitate the mother's action and gives the doll a hug. What developmental age in months is this most consistent with?

A:

12

B:

15

C:

18

D:

24

Q.141. A 6-year-old girl developed reddish urine. Her parents stated that she had been constipated for the last 2 weeks and recently became incontinent. On examination, there is abdominal tenderness, and no organomegaly (see lab rests). Blood pressure 115/76mmHg Heart rate 76/min Respiratory rate 27 /min Temperature 38.9° C Test Result Normal Values WBC 9.5 4.5105 x 109/1L Hb 79 112-165 gL Platelets count 325 150-400 x 109/L Urine Analysis Result Normal Values Leukocytes 25-30 0-3 per high power field Erythrocytes 30-35 0-2 per high power field Protein + Absent Blood +++ Absent Which of the following is the most likely diagnosis?

A:

Urinary tract infection

B:

Henoch-schonlein purpura

C:

Autoimmune haemolytic anaemia

D:

Post streptococcal glomerulonephritis

Q.142. A 9-year-old child has been declining in school performance for several months due to lack of attention and "daydreaming" in class. The child, of average intelligence, has brief spells of staring into space that last 10 or 15 seconds. They occur several times an hour but the child seems quite unaware of these incidences. EEG reveals frontally predominant, generalized 3-Hz spike and wave complexes. Which of the following drugs is most likely to be effective?

A:

Phentoin

B:

Imipramine

C:

Ethosuccimide

D:

Catbamazepine

Q.143. A full-term infant developed bilateral conjunctivitis at 2 weeks of age. The conjunctivitis is followed by severe coughing but the infant remained afebrile. When the infant was 4 weeks oid, a chest X-ray showed bilateral symmetrical interstitial infirates (see lab results). Test Result Normal Values WBC 144.5105 109 L Neutrophils 32 40-60% Lymphocytes 15 20-40 % Monocytes 2 2-8 % Eosinophils 4 14 % 19G 307.519 gIL 1988 14 gl 1gM35052-1.52 gL Which of the following is the most probable infectious agent?

A:

Streptococcus agalactiae

B:

Haemophilus influenzae

C:

Chlamydia trachomatis

D:

Adenovirus

Q.144. A 14-month-old boy is brought to the clinic with severe gram-positive bacterial pneumonia, was. referred to the hospital by the family physician. This is his third infection in 4 months. He has 2 healthy sisters aged 3 and 5 years. The family lost a boy at 10 months of age to bacterial pneumonia 6 years ago. The family doctor has sent along some blood test results that shows low all classes of serum immunoglobulin levels, few B cells, but normal numbers and functioning of T cells. Which of the following is the most likely diagnosis?

A:

Transient hypogammaglobulinemia of infancy

B:

Common variable hypogammaglobulinemia

C:

CD40 Genetic/Metabolic/Metabolic defect

D:

X-linked hypogammaglobulinemia

Q.145. Which of the following organs is most commonly affected by mumps in a 4-year-old boy?

A:

Skin

B:

Lungs

C:

Testes

D:

Parotid

Q.146. When assessing an adolescent girl with body mess index the 95th percentile for her age and Which of the following action should be taken?

A:

Avoid discussion of weight

B:

Initiate a multidisciplinary plan

C:

Provide a lst of low-calorie foods

D:

Confirm size larger than those of same age

Q.147. An 18-month-old child presents to the Emergency Department after a brief, generalized tonic clonic seizure. He had a large, watery stool that had both blood and mucus in it. He is now postictal Blood pressure 100/60 mmHg Heart rate 110 /min Respiratory rate 28 /min Temperature 40.0° C Which of the following is the most likely cause?

A:

Campylobacter

B:

Salmonella

C:

Rotavirus

D:

Shigella

Q.148. A 4-year-old child is brought to the clinic for a check-up. When performing a cover test, the child's left eye moves laterally when the right eye is covered. Which of the following is the most serious complication?

A:

Strabismus

B:

Nystagmus

C:

Amblyopia

D:

Leukocoria

Q.149. A 1-year-old boy is admitted for investigation of failure to thrive, recurrent oral thrush and hepatosplenomegaly. He had a brother who died at the age of 3 years with severe infection and septic shock What advice should be given to the parents regarding their child's vaccinations?

A:

Wait until child is 3 years-old

B:

No live vaccines to be given to this child

C:

Important that all vaccinations be given

D:

No killed vaccines until brother diagnosed

Q.150. A 4-year-old healthy child is found in the kitchen, comatose and cyanotic with peanuts in his hands. Which of the following is the most likely cause?

A:

Choking secondary to aspiration

B:

Trauma with CNS bleed

C:

Overwhelming sepsis

D:

Postictal state

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MOCK TEST 11

Q.1. A 5-month-old baby was referred to the doctor from the Well-Baby Clinic. His mother is concerned, because he could not pass the developmental screening tests done by the nurse. What is the best developmental test would help the doctor to reassure the mother?

Q.2. A 12-year-old girl presents to the Emergency Department with mild fever. Examination shows generalized vesicular rash on her chest, trunk and on her arms and legs. Which of the following laboratory tests have a higher diagnostic value?

Q.4. A 6-year-old boy presents to the Medical Care Centre with a high fever and cough. Examination shows a maculopapular rash on his face end small white spots appeared on the inner part of his Which of the following agents is most likely responsible?

Q.5. A newborn child presents with cyanosis, tachypnea, irritability and difficulty feeding. Physical examination findings are a parastemal heave and a loud, single S2 on cardiac auscultation. No murmurs were heard. Which of the following is essential in the early management?

Q.7. An infant sits in the tripod position, can roll from prone to supine and vice versa and attempts to reach a toy beyond reach but cannot pick up cereals between 2 fingers. What developmental age in months is this most consistent with?

Q.8. A full-term girl was born to a mother who is hepatitis B surface Ag positive (HbsAg +ve). The baby weighs 3.2 kg and is asymptomatic. What is the appropriate immuno prophylaxis that should be considered in the first 12 hours?

Q.9. A 6-year-old child presents with a low-grade fever, malaise, conjunctivitis, coryza, and a cough. Recently, a rash of discrete pink macules began on the face and extends to the hands and feet. Which of the following is the most likely diagnosis?

Q.10. When a mother placed her infant on the examining table, the infant laughs out loudly. As the doctor approaches him, he squeals and reaches for his mother. What is the most likely developmental month for this child?

Q.11. Which of the following hormonal assay is routinely recommended for newborns?

Q.13. A 5-year-old overweight girl has systolic blood pressure above the 95th percentile and has a family history of hypertension. Physical examination reveals a strong radial pulses and weak femoral pulses. Which of the following is the most likely diagnosis?

Q.15. A 14-year-old has received all immunizations except chickenpox; but he has never had chickenpox. What varicella vaccination plan should be used?

Q.16. What is the best way to provide immunologic protection against tetanus neonatorum in new borns?

Q.17. During a routine check-up, a child shakes hands, knows his name, gender and age. He can dress with help and ride a tricycle. He points to red colours when asked to do so but had difficulty copying a square. What is the age in years this child is most likely at?

Q.18. Which of the following is a developmental screening tool that relies only on information from the parents?

Q.19. An adolescent has missed the second scheduled dose of a varicella vaccination, with the first injection have been administered 1 year ago. How should full immunity be achieved?

Q.20. An apparently normal child is being evaluated. He runs around, tells short stories, and plays a "father role". He draws his brother with a head, hands and feet He undresses himself for the examination. What is the most likely age of this child?

Q.22. A 4-year-old boy presents with fever and abdominal pain after a fall on his right side a day ago. His mother noticed that his abdomen appears distended today, particularly on the right side. Examination shows a pale and hypertensive boy. Which of the following is the most likely diagnosis?

Q.23. A 1-year-old boy has come for vaccination. The mother explains that his 6-year-old sister has received a renal transplant 2 months ago and is currently on immunosuppressive medications. Which of the following vaccines should be avoided?

Q.25. A 9-month-old baby is brought to the Well-Baby Clinic. He is unable to sit, and on examination his hands are fisted and his legs are crossed. His mother said that he did not cry after the birth and resuscitation. Which of the following is consistent with these findings?

Q.29. A 6-month-old infant develops a cough, coryza, fever, expiratory wheezing, grunting, tachypnea, rib retractions, and air trapping. Which of the following is optimal immediate treatment?

Q.38. Which of the following findings is expected in a 6-year-old boy with Duchenne muscular dystrophy?

Q.39. A 14-month-old asymptomatic boy has a grade 2 pan systolic murmur detected on a routine consultation. Echocardiography reveals a 2 mm ventricular septal defect in the muscular portion of the septum. Which of the following is the most appropriate management?

Q.40. A full term baby born to a diabetic mother is brought to the clinic for assessment. The baby was bom by vaginal delivery. The Moro reflex is absent on the right side. Baby weight is 4.8 Kg. Which of the following is the most likely cause?

Q.43. A 5-year-old child is about to receive a flu vaccination, and the doctor asked the mother about any food allergies the child might have. Which of the following is the most important to note?

Q.44. While at the clinic, an infant crawl toward the doctor, rolls over, sits briefly, transfers objects from hand to hand and grasps objects using his radial palm. The infant is unable to use a pincer grasp. What is the approximate age in months?

Q.45. A child is brought for a well-child visit. He is healthy and developing normally. The child can name 4 colours, define 5 words, understand prepositions, hops on 1 foot, and gets dressed with little assistance. What developmental age in months is this most consistent with?

Q.46. A 12-year-old child presents to the clinic with a worsening history of severe headaches that are unilateral, pulsating, exacerbated by movement, and aggravated by light. Which of the following is the most likely type of headache?

Q.48. A 14-year-old boy has developed unilateral gynecomastia which makes him embarrassed. Which of the following is the most appropriate advice?

Q.50. A 4-week-old baby presents with tachypnea, tachycardia, differential cyanosis and irritability. Which of the following is the most common accompanying feature?

Q.51. A 15-year-old boy is diagnosed with diabetic ketoacidosis. Which of the following types of insuiin is used in acute management?

Q.53. Which of the following language milestones is appropriate for a 4-year-old child?

Q.55. A 9-year-old boy is brought for a check-up. Parents are worried because he is short. On examination, his height is below the 5th percentile for his age but increasing steadily. The parents ask if he will always be short in the future. What is the most important factor to answer the question?

Q.56. In which of the following conditions would you expect a bone age greater than the chronologic age?

Q.58. A 10-year-old child presents with pain over the tibial tubercle. The child has recently had a growth spurt. Which of the following is the most likely diagnosis?

Q.60. Cerebral palsy is a non-progressive disorder of motion and posture. Which one of the following risk factors is the most significant?

Q.62. A 12-year-old obese boy is being observed in the Paediatric Outpatient Clinic as he has short stature, purple striae over his abdomen and hips, and hypertension. Which of the following is the most important initial investigation?

Q.66. While in the clinic, a child demonstrates an ability to run, is able to open a door and climb onto furniture. The child uses 3-word sentences, but does not know his full name and does not climb up stairs using alternate feet. Which of the following is the approximate age in years?

Q.68. A 5-year-old girl started growing pubic hair and an adult body odour 8 months ago. Examination shows her height is at the 75th percentile, weight is at the 95th percentile, and there was no acne or clitoromegaly. Which of the following is the most important initial screening study?

Q.69. Which of the following drugs would be most suitable for a 7-year-old child with absence seizures?

Q.71. Which of the following is the main treatment of Kawasaki disease?

Q.72. A 5-month-old boy presents to the clinic after missing his 4-month vaccinations. He appears to be well and thriving. The parents missed his 4-month visit due to transportation difficulties. What would be the best way to modify his immunization schedule?

Q.76. A 6-year-old child presents with malaise, fever, cough, nasal discharge, and conjunctivitis. Several days later the patient develops a maculopapuiar rash starting on the face and rapidly spreading 10 the rest of the body. Which of the following viruses is most likely the cause?

Q.81. Which of the following is usually the first sign of puberty in boys?

Q.82. A mother of a 3-year-old child asks about his language development. He easily communicates with other children and 75% of his speech is understood by strangers. He asks questions frequently and follows 2-part commands. What is the best description of this language development?

Q.85. In a prone position, an infant can lft his head 45° off the examination table and moves his head from side to side while following an object. He smiles and coos when the doctor plays with him, but cannot maintain a seated position. What is the age in months this child most likely at?

Q.87. A child walks with one hand held, says a few words besides "mama" and "dada", and picks up pellets with an unassisted pincer grasp, but does not insert them into a bottle. What is the approximate age in months?

Q.90. What is the most important measure to protect neonates against infection in a nursery?

Q.92. A 14-year-old girl has been diagnosed with Turner's syndrome Which of the following disorders is most likely to have?

Q.94. Which of the following can the average 3-year-old child perform?

Q.97. A 9-year-old child presents with a fever and sore throat associated with bilateral knee pain. The laboratory investigation shows a high sedimentation rate. Which of the following is the most likely diagnosis?

Q.100. Group B streptococci are a common cause of neonatal meningitis. Vaginal swab for group B streptococci is recommended in pregnant mother. At which gestational age should the vaginal swab be collected?

Q.102. A 4-year-old child suddenly developed a high fever, chills, and vomiting. Examination shows nuchal rigidity and a positive Kernig's sign. Petechial lesions are noted on both extremities and over the abdomen. Which of the following is the most likely diagnosis?

Q.103. A 4-month-old girl is brought to the clinic for vaccination. She was born preterm at 32 weeks gestation due to maternal pre-eclampsia. Which of the following is the best approach for the patient's immunization schedule?

Q.104. A 16-year-old adolescent girl complains of galactorrhea for 3 months. Her menarche was at age 13 years and her menstrual cycles have been regular until two months ago. On examination, she is at Tanner stage 2. Which of the following is the most appropriate hormone to measure first?

Q.106. While in the clinic, a child runs towards the doctor, walks upstairs with one hand held and pours out pellets from a bottle. The child does not handle a spoon well and cannot put 3 words together. What is the approximate age in months?

Q.109. A 3-year-old child presents with a 1-week history of malaise, anorexia, nasal discharge, and conjunctivitis. The parent states that the child has also had 2 days of paroxysmal coughing spells with a stridor "whoop." Which of the following is the most likely diagnosis?

Q.110. A 3-year-old child of a parent who was recently diagnosed with pulmonary tuberculosis has a tuberculin skin test. After 72 hours, the size of local induration is 10 mm. Which of the following is the most appropriate interpretation?

Q.116. During a well-baby vaccination supervision visit. the mother reports that her 9-month-old girl had received all her immunizations since birth and she is due for another vaccination. Which of the following vaccines would be recommended?

Q.118. A 9-year-old boy referred to his local hospital with a history of fever, headache, prostrationand nuchal rigidity. Gram stain done on the CSF smears shows gram positive cocci. Which of the following CSF findings is consistent with this diagnosis?

Q.122. By what age in months should a child smile?

Q.125. A 3-day-old infant is brought to the Paediatrics Clinic with refusal to feed, vomiting and inactivity. ‘The infant was born at term with no perinatal problems. The infant's urine smells like burned sugar. Which of the following is the most likely diagnosis?

Q.126. A 15-year-old child presents to the Outpatient Clinic suffering from abdominal pain, diarrhoea, and tenesmus for the last 2 weeks. There is mucous and blood present in the stool. Which of the followings the most likely diagnosis?

Q.127. During a health supervision examination, a mother reports that her son can say his name, feeds himself, separates easily from parents and rides a tricycle. What is the developmental age in years?

Q.129. A 7-year-old girl is brought to the Paediatric Outpatient Clinic because she is already showing breast development, the appearance of pubic hair, and acne. She is otherwise asymptomatic. Which of the following is the most likely diagnosis?

Q.130. By what age in months should a child learn to speak a few words?

Q.131. A 4-year-old girl was involved in a motor vehicle accident and required splenectomy after severe abdominal trauma with splenic tears. What additional specific vaccination should she receive?

Q.132. A 15-year-old boy is diagnosed with diabetes melitus type 1 and prescribed insulin. He and his family were educated about the use and recognition of adverse effects of insulin. Which side effect would be most important to receive education on?

Q.133. A 1-year-old boy is brought to the clinic for failure to thrive, recurrent oral thrush and hepatosplenomegaly. He had a brother who died at the age of 3 years with severe infection and septic shock. Which of the following vaccines must be avoided until a diagnosis is made?

Q.134. Which of the following is the most typical milestone for a 4-year-old child?

Q.139. What is the most common minor side effect with routine DTP vaccination?

Q.145. Which of the following organs is most commonly affected by mumps in a 4-year-old boy?

Q.146. When assessing an adolescent girl with body mess index the 95th percentile for her age and Which of the following action should be taken?