Nash Qbank

Q.1. A 12-year-old patient presents to the clinic with diarrhoea, vomiting, miosis, bronchoconstriction, sweating, and excessive salivation. On examination, the breath has a garlic odour. Which of the following is the most likely diagnosis?

A:

Organophosphate poisoning

B:

Diabetic ketoacidosis

C:

Cyanide ingestion

D:

Cocaine overdose

Q.2. A 6-week-old infant is admitted to the hospital with jaundice (see lab results). Test Results Normal Values Total bilirubin 65 <20.5 pmol/L Direct bilirubin 52 <5 pmol/L Which of the following is the most likely diagnosis?

A:

Choledochal cyst

B:

Gilbert syndrome

C:

ABO incompatibility

D:

Crigler-najjar syndrome

Q.3. A 3-year-old child is brought to the Emergency Room after swallowing a battery that is now lodged in the esophagus. Which of the following is the most appropriate intervention?

A:

Discharge home with reassurance

B:

Administering intravenous glucagon

C:

Observing the patient for 12 hours

D:

Immediate endoscopic removal

Q.4. A 2-year-old boy presents with irritability, lack of attention, and an abnormal craving for chalk to eat. He was born full-term by vaginal delivery and has had appropriate developmental milestones. He was breastfed and weaning started at the age of 9 months. The examination is normal except for pale conjunctivae (see lab results). Test Result Normal Values Hb 76 112-165 gL HCT 0.22 0.32042 WBC 5 4.5-10.5 x 109/L Platelets count 250 150-400 x 109/L MCV 65 80-95 fi MCH 22 28-33 pg/cell MCHC 248 260-340 gL Reticulocyte 0.9 021.2 % Total iron binding capacity 701 17.9-71.6 umol/L Which of the following is the most suitable treatment?

A:

Folic acid

B:

Vitamin B12

C:

Iron supplementation

D:

Packed cell transfusion

Q.5. A 2-week-old newborn presents to the Outpatient Department with mild jaundice of skin and conjunctivae that had begun 6 days ago. The baby was born full-term following a normal pregnancy and uncomplicated birth. Her birth weight was 3.45 kg. The girl is exclusively breastfed and gaining weight properly. No pathologic findings are evident on physical examination. Ultrasound examination of liver and biliary systems is normal (see lab results). Test Result Normal Values Indirect bilirubin 20 <19 pmol/L Direct bilirubin 1 <10 pmolL Alanine aminotransferase 25.8 13-45 UL Aspartate aminotransferase 23.7 12-40 UL Which of the following is most appropriate initial management?

A:

Observation

B:

Phototherapy

C:

Exchange transfusion

D:

Phenobarbital treatment

Q.6. A 12-month-old girl presents to the Emergency Department with cramping, colicky abdominal pain progressively developing over the past 12 hours. She has had 2 episodes of vomiting. On physical examination, the child is irritable, and there is abdominal tendemess. Vital signs are normal. During the examination, the child passed a bloody stool with mucus. Lab testing and ultrasound shows leucocytosis and a doughnut-shaped image, respectively. Which of the following is the most appropriate step in management?

A:

Watchful waiting

B:

Radiographic reduction

C:

Radiographic reduction

D:

Intravenous normal saline

Q.7. A 2-year-old boy presents with poor growth, abdominal distension and diarrhoea. On examination, he is at the 5th percentile on the growth chart. He looks pale, has abdominal distension, and wasting of the buttocks. Which of the following is the most likely diagnosis?

A:

Celiac disease

B:

Cystic fibrosis

C:

Crohn's disease

D:

Toddler diarrhoea

Q.8. A 7-month-old infant is brought to the clinic with a 2-day history of vomiting and diarrhoea. The stool is watery without mucous or blood. Examination reveals that the infant is only mildly dehydrated Which of the following is the most appropriate management?

A:

ORS1, and cefixime

B:

ORS and reassurance

C:

Antiemetics and ORS

D:

Anti-emetics, and cotrimoxazole

Q.9. A 4-month-old presents with frequent post-prandial regurgitation. The symptoms have been present since birth but have worsened when the mother increased the formula feeding volumes. : The patient's weight is less than it was at the three-month check-up. General examination is Blood pressure 80/40 mmHg Heart rate 120 /min : Respiratory rate 32 /min Temperature 36.6° C Which of the following is the most likely cause?

A:

Duplication of the gastric pylorus

B:

Erosion of the lower esophagus

C:

Infection of the gastric antrum

D:

Decreased Lower Esophageal Sphincter pressure

Q.10. A 12-year-old patient presents with recent onset of fever and abdominal pain. Just before arrival, the patient vomited. Pain began in the peri-umbilical area. After several hours, the pain localized to the right lower abdominal quadrant. The patient stated that any food offered would be refused. The patient is alert. Physical examination confirms guarding and rebound tenderness in the right lower abdominal quadrant and there are positive psoas and obturator signs (see lab result). Blood pressure 110/70 mmHg Heart rate 120/min Respiratory rate 22 /min Temperature 38.2° C Test Result Normal Value WBC 15.8 4-10.5 x 1091L Which of the following is the most likely pathophysiology?

A:

Crohn's disease

B:

Pin-worm infestation

C:

Intussusception of the ileum

D:

Obstruction of appendiceal lumen

Q.11. A 20-day-old infant has non-fading yellow discoloration of the skin and pale stool that began on the third day after birth. A week ago, the infant was diagnosed with normal physiological Jaundice and advised phototherapy (see lab results). Test Result Normal Value Total bilirubin 150 <19 pmol Direct bilirubin 98 <10 pmol Which of the following is the most likely diagnosis?

A:

ABO incompatibility

B:

Rhincompatiility

C:

GBPD deficiency

D:

Biliary atresia

Q.12. A 6-year-old boy complains of passing Coca cola-coloured urine for the last week On examination, he had a congested throat, and anterior cervical lymphadenopathy (see lab results). Blood pressure 155/100 mmHg Heart rate 125 /min Respiratory rate 20/min Temperature 38.5' C Urinalysis Result Normal Values Colour Brown Clear or light yellow Appearance Turbid Clear Leukocytes 3-5 0-3 per high power field Erythrocytes 20-30 0-2 per high power field Which of the following is the most likely diagnosis?

A:

Acute cystitis

B:

IgA nephropathy

C:

Alports syndrome

D:

Acute glomerulonephritis

Q.13. Which of the following methods of collection of urine for culture is most sensitive and reliable for establishing the diagnosis of a urinary tract infection?

A:

Midstream urine

B:

Catheter collection

C:

Suprapubic aspiration

D:

Bag applied to genitals

Q.14. A 6-month-old infant is brought to the clinic with a 3-day history of watery diarrhoea. On examination, the infant is awake and alert but restless and eager to drink, had a depressed fontanel, tachycardia, normal pulses and sunken eyes. What would be the expected percentage of dehydration?

A:

<1%

B:

13%

C:

49%

D:

>0%

Q.15. A 10-month-old presents with fever, vomiting and copious watery diarrhoea for the past 3 days. Examination reveals a lethargic child with cool, dry skin, sunken eyes, tachycardia and mild tachypnea. Which of the following tests is the most likely confirm the diagnosis?

A:

Serum viral culture

B:

Serum antibody

C:

Stool leukocyte

D:

Stool antigen

Q.16. A 12-year-old boy referred to the hospital for treatment of pneumonia. Detailed history reveals intermittent dysphagia retrostemal pain and regurgitation (see report). Barium swallow: Dilatation of the esophagus, lack of peristalsis, and many synchronous contractions. The lower end of esophagus shows gradual narrowing. Which of the following is the most likely diagnosis?

A:

Achalasia cardia

B:

Oesophageal malignancy

C:

Diffuse oesophageal spasm

D:

Gastroesophageal reflux disease

Q.17. A 7-year-old child presents with recurrent attacks of abdominal pain for the last 2 weeks, decreased appetite, and general weakness. On examination, she looks il. Abdominal palpation detected a tender mass located in the right lower quadrant: it was confirmed by rectal examination. Complete blood count shows leucocytosis with left shift Blood pressure 90/60 min Heart rate 100 min Temperature 37.5 C Which of the following investigations is most likely to confirm the diagnosis?

A:

Abdominal ultrasound

B:

Plain abdomen X-ray

C:

Abdominal CT scan

D:

Barium enema

Q.18. A 10-year-old girl is referred to the gastroenterologist after complaining about intense upper abdominal pain for the last 2 months. The pain is independent of meals and there is no vomiting or reflux. She has a normal stool and appetite. The patient's father has a history of peptic ulcer. Laboratory findings are normal. The C13-Urea-breath test is positive. The gastroenterologist performs a gastroscopy and takes a biopsy for microbiological testing. Which bacterium is most likely to be found in the biopsy?

A:

Helicobacter pylori

B:

Shigella dysenteriae

C:

Campylobacter jejuni

D:

Salmonella enteritidis

Q.19. A 6-year-old girl presents to the Emergency Department with a history of feeling unwell and tied over the last 10 hours. On examination, she looks pale, had a palpable liver and her spleen is 6 cm below the costal margin (see lab results). Blood pressure 93/55 mmHg Heart rate 169 /min Respiratory rate 28 /min Temperature 37.5" C Test Result Normal Values Hb 52 112-165 g/L Platelet count 102 150-400 x 109/L Sickle cell screen Positive Nil Which of the following is the most likely diagnosis?

A:

Sequestration crisis

B:

Evans syndrome

C:

Bacterial sepsis

D:

Aplastic crisis

Q.20. A 12-year-old girl presents with bleeding gums while brushing her teeth. This had started 1 week ago after a viral upper respiratory tract infection. On physical examination, the only finding are petechiae on her extremities and abdomen. There is no lymphadenopathy, or hepatosplenomegaly (see lab results and report). Test Result Normal Values Hb 130 112-165 gL HCT 0.39 0.32.0.42 MCV 88 80-95 fi WBC 8 4.5-10.5 x 109/L. Platelets count 20 150-400 x 109/L. Bone Marrow: Increased megakaryocytes. Which of the following is the most appropriate management?

A:

Azathioprine

B:

Prednisolone

C:

Splenectomy

D:

Cyclophosphamide

Q.21. A 4-month-old child presents to the Paediatric Outpatient Clinic with a 2-day history of constipation, lethargy, and fever. The child was bon to a 25 year-old primigravida and is being breastfed. On examination, the child has flattened facies, an inability to smile or gaze away when a light is shined directly in the eye. Blood pressure 110/70 mmHg Heart rate 140 /min Respiratory rate 26 /min Temperature 38.2° C Which of the following is the most likely diagnosis?

A:

Hirschsprung's disease

B:

Infantile botulism

C:

Hypothyroidism

D:

Amoebic colitis

Q.22. A 2-year-old boy presents with poor growth, abdominal distension and diarrhoea. On examination, he is at the 5th percentile on the growth chart. He looks pale, has abdominal distension, and wasting of the buttocks. Which of the following is the most appropriate investigation?

A:

Anti-endomysial antibodies

B:

Complete blood count

C:

Duodenal biopsy

D:

Colonoscopy

Q.23. A 1-month-old baby is brought to the clinic with signs of constipation, abdominal distension, and bilious vomiting. The parents explain that constipation has been & a problem since the baby's Which of the following tests has the highest diagnostic value?

A:

Plain X-ray

B:

Rectal biopsy

C:

Anal manometry

D:

US abdomen

Q.24. A 6-year-old girl presents to the Emergency Department with a history of feeling unwell and tired over the last 10 hours. On examination, she looks pale, had a palpable liver and her spleen is 6 cm below the costal margin (see lab results). Blood pressure 93/55 mmHg Heart rate 169 /min Respiratory rate 28 /min Temperature 37.5° C Test Result Normal Values Hb 52 112-165 g/L Platelet count 102 150-400 x 109/L Sickle cell screen Positive Ni Which of the following is the most appropriate treatment?

A:

Blood transfusion

B:

Immunoglobulin

C:

Clarithromycin

D:

Prenisolone

Q.25. A 10-year-old girl presents to the Paediatrics Clinic with a history of weight loss over the last 6 months. The body weight had fallen from the 50th to the 20th percentile. She has little appetite and complains of postprandial cramps and recurrent nausea. Physical examination confirms a bloated abdomen with diffuse tenderness on palpation and perianal skin tags (see reports). Endoscopy: Focal ulcerations are separated by otherwise intact mucosa which is spread over different GI Biopsy: Transmural inflammation. What part of the gastrointestinal tube is most likely to be affected?

A:

Jejunum

B:

Ileum

C:

Colon

D:

Rectum

Q.26. A 7-year-old boy presented with recurring upper abdominal pain and occasional vomiting after meals for the last 6 months. The child has not gained any weight since the beginning of the symptoms and has a loss of appetite. The father has a history of peptic ulcer. Physical examination confirms epigastric tenderness at palpation. A gastroscopy is performed and a biopsy is taken for microbiological testing. A triple treatment with amoxicillin, clarithromycin, and a proton pump inhibitor is recommended. Laboratory findings are normal (see report). 13C-Urea-breath test: Positive. Which of the following is the most appropriate way to monitor the response to treatment?

A:

Serologic testing

B:

Clinical manifestation

C:

13C-Urea-breath test

D:

Biopsy for microbiological testing

Q.27. A young child is brought to the Emergency Department after ingesting a large amount of baby aspirin. Which of the following is the most likely acid-base imbalance?

A:

Respiratory acidosis followed by metabolic acidosis

B:

Metabolic alkalosis followed by respiratory alkalosis

C:

Metabolic acidosis followed by respiratory alkalosis

D:

Respiratory alkalosis followed by metabolic acidosis

Q.28. A preterm newborn presents with abdominal distention and showed air lucency in the bowel Which of the following is the most likely diagnosis?

A:

Infection

B:

Malrotation

C:

Meconium ileus

D:

Oesophageal atresia

Q.29. What is the most common disorder of sexual differentiation in boys?

A:

Micropenis

B:

Buried penis

C:

Hypospadias

D:

Cryptorchidism

Q.30. A 7-year-old child is brought to the clinic. The parent reports yellowish-brown discoloration and carries on the occlusive surfaces of her teeth. Which of the following is the most appropriate treatment?

A:

Diet modification

B:

Antiseptic mouthwash

C:

Topical intraoral antibiotics

D:

Systemic fluoride supplementation

Q.31. Which of the following diets could cause kwashiorkor?

A:

High-protein and high-carbohydrate

B:

High-protein and low-carbohydrate

C:

Low-protein and high-carbohydrate

D:

Low-protein and low-carbohydrate

Q.32. A 5-month-old infant presents with acute onset of severe vomiting and diarrhoea for the last 2 days. On examination, the baby is lethargic; had an overall poor and ill appearance, dry mucous membranes, and crying with tears, while capillary refill is 3 seconds (see lab results). Heart rate 130 /min Respiratory rate 25 /min Temperature 38.6° C Test Resuit Normal Values Sodium 149 134-146 mmol/L Glucose 2.9 3.3-5.5 mmol/L Which of the following fluids should be administered?

A:

IV isotonic fluid 20 ml/Kg

B:

Pedialyte 10 ml over five min

C:

Dextrose 10 % in 1/2 normal saline

D:

ORS which has a 1:1 ratio of Na: glucose

Q.33. A 2-month-old boy is brought to the clinic with non-bilious and progressive vomiting. The symptoms have developed 2 weeks prior and the episodes of vomiting have been increasing in frequency. He is now vomiting after every feeding. His weight fel from the 50th percentie to the 25th percentile on the growth chart. The fontanels are sunken and skin turgor was reduced. Physical examination shows a small, firm, and movable mass located between the umbilicus and the sternum. Which of the following is the most likely laboratory result?

A:

Elevated sodium level

B:

A decreased haematocrit

C:

Elevated C-reactive protein

D:

Hypochloremic metabolic alkalosis

Q.34. Which of the following signs are more likely to be associated with haemophilia?

A:

Epistaxis

B:

Gum bleeding

C:

Haemarthrosis

D:

Petechial haemorrhages

Q.35. A 3-month-old breastfed child becomes anorexic and develops generalized edema with some degree of aphonia. The infant is diagnosed with infantile beriberi. What vitamin deficiency does this infant have?

A:

Vitamin B1

B:

Vitamin E

C:

Vitamin C

D:

Niacin

Q.36. A 14-year-old girl presents to the Paediatric Clinic with her mother, who is worried because her daughter has not started menstruating yet. The girl has always been short of stature and there has been no pubertal growth spurt. Physical examination confirms that the girl has low hairline, prominent and low-set ears, and a webbed, short neck. The lower legs are X-shaped and the : chest is broad. There is no sign of breast development or other signs of sexual maturation. The mother reports that the adolescent has difficulties focusing on classwork and remembering what she has learned. Height 150 cm (5th percentile) Weighs 65 kg (90th percentile) Which of the following is the most likely diagnosis?

A:

Constitutional short stature

B:

Endocrine short stature

C:

Normal growth stature

D:

Syndromic short stature

Q.37. A 7-year-old boy presents with recurring upper abdominal pain and occasional vomiting after meals over the fast 6 months. The child has not gained any weight since the beginning of the symptoms and has a loss of appetite. The father has a history of peptic ulcer. Physical examination confirms epigastric tenderness on palpation. A gastroscopy is performed and a biopsy is taken for microbiological testing. Treatment with metronidazole and a proton pump inhibitor is recommended. Laboratory findings are normal (see report). 13C-Urea-breath test: Positive. Which additional medication should be added to the treatment?

A:

Clarithromycin

B:

Tetracycline

C:

Prednisone

D:

Sucralfate

Q.38. A young boy developed gingival hypertrophy with enlarged, bluish purple friable gums. Which of the following vitamin deficiencies is the most likely the cause?

A:

A

B:

C

C:

D

D:

E

Q.39. A 9-day-old infant presentes to the clinic. The infant was born at 40 weeks’ gestation by spontaneous vaginal delivery and had an uneventful birth and nursery course. The infant is : breastfed and nursing well. On examination, the infant is mildly jaundiced with a yellow colouration to the face down to the mid-chest. The extremities do not appear jaundiced. The ; examination is otherwise normal. Which of the following is the most likely diagnosis?

A:

Deficiency of glucuronyl transferase

B:

Resolution of birth trauma

C:

Breast milk jaundice

D:

Hepatitis

Q.40. A 4-year-old boy presents with a rectal prolapse. His parents report that he has constipation and his stools are bulky and foul smelling. His growth chart indicated that he is below the 5th percentile in both height and weight. In the past, he has had 2 episodes of pneumonia. During investigation, he tested positive for the sweat chloride test. His parents and a 1-year-old brother are healthy and have no clinical symptoms. Which of the following would be the most appropriate investigation?

A:

Sibling’s sweat chloride test

B:

Parents’ Sweat chloride test

C:

Sibling's DNA analysis for the cystic fibrosis transmembrane conductance regulator gene

D:

Parents’ DNA analysis for the cystic fibrosis transmembrane conductance regulator gene

Q.41. A 5-week-old infant is brought to the clinic with a 3-week history of intermittent vomiting. After vomiting, the infant becomes very hungry and wants to feed again. Physical examination shows no alterations apart from a 2.50 kg weight loss (see lab results). Test Results Normal Values Sodium 147 134-146 mmol/L Potassium 2.9 3.5-5.1 mmol/L Bicarbonate 32 21-28 mmol/L Chloride 89 97-108 mmoliL. Which of the following is the most likely diagnosis?

A:

Gastric volvulus

B:

Cyclic vomiting syndromes

C:

Hypertrophic pyloric stenosis

D:

Intestinal malrotation with volvulus

Q.42. A newborn boy is brought to the Paediatric Clinic for a check-up. Examination shows a tense fluctuant, painless mass on the right side of the scrotum. Shining a bright light toward the enlarged right side of the scrotum by torch, a clear illumination is observed. Which of the following is the most likely diagnosis?

A:

Varicocele

B:

Hydrocele

C:

Haematocele

D:

Indirect inguinal hernia

Q.43. A 7-year-old boy complains of passing tea-coloured urine for the last 3 days. On examination, there is a congested throat, with no other abnormal findings (see lab results). Blood pressure 140/98 mmHg Heart rate 120 /min Respiratory rate 20/min Temperature 37.5° C Urinalysis Result Normal Values Colour Brown tea Clear of light yellow Appearance Turbid Clear Leukocytes 3-5 0-3 per high power field Erythrocytes 20-30 0-2 per high power field Which of the following is the most appropriate investigation?

A:

Urine culture and sensitivity

B:

Abdominal ultrasound

C:

Plain abdomen X-ray

D:

Serum creatinine

Q.44. A 7-year-old child presents to the Medical Outpatients with a parent who reports edema over the face. Examination of urine shows selective proteinuria (3.5 g/day). Which of the following is the most likely diagnosis?

A:

Kwashiorkor

B:

Nephritic syndrome

C:

Nephrotic syndrome

D:

Protein losing diarrhea

Q.45. What is the daily fluid maintenance requirement in mi for a nine month-old child whose weights 10Kg?

A:

500

B:

1,000

C:

1,500

D:

2,000

Q.46. A 5-year-old child presents with features of glomerulonephritis. A week later, she developed hemoptysis. Which of the following is the most likely diagnosis?

A:

Rapidly progressive glomerulonephritis

B:

Henoch Schonlein purpura

C:

Good pastures syndrome

D:

Lupus nephritis

Q.47. A 5-year-old child presents with drowsiness, abdominal pain, nausea and bloody diarrhea after ingesting an unknown number of iron tablets several hours before (see lab result). | Test Result Normal Value Iron 94 9-21.5 pmol/L. Which of the following is the most appropriate treatment?

A:

Haemodialysis

B:

Gastric lavage

C:

Oral activated charcoal

D:

Intravenous deferoxamine

Q.48. An 8-year-old girl presents with fever, many bruises over the entire body, and pain in both legs. Examination confirms pallor, ecchymoses and petechiae on the face, trunk and extremities (see lab results). Test Result Normal Values Hb 63 112-165 g/L WBC 2845-105 x 1091 Platelets count 29 150-400 x 1091L Which of the following would be the most appropriate diagnostic test?

A:

Bone marrow aspiration

B:

Coagulation profile

C:

Hb electrophoresis

D:

CT scan liver

Q.49. A 10-year-old boy presents to the clinic with a progressive yellow discoloration of his sclera and skin as well as abdominal distention. Examination reveals jaundice and a Kayser-Fleischer ring (see lab results). Test Result Normal Values Total bilirubin 81 <20.5 mol/L Aspartate aminotransferase 65 12-40 IU/L Aspartate aminotransferase 105 12-40 IU/L Ceruloplasmin 132 200-540 pg/L Which of the following is the most appropriate treatment?

A:

Ethylene diamine tetra acetic acid

B:

British anti-Lewisite

C:

Desferrioxamine

D:

Penicillamine

Q.50. A 3-week-old infant is brought to the Paediatrics Clinic. On examination, a right, non-tender scrotal mass is seen. Its non-reducible and not transparent to light. Which of the following is the most likely diagnosis?

A:

Orchitis

B:

Hydrocele

C:

Inguinal hernia

D:

Testicular torsion

Q.51. A 10-year-old child presents with a high-grade fever, generalized body swelling, decreased urine output, and dark-coloured urine. Which of the following is the most appropriate first investigation?

A:

Abdominal ultrasound

B:

Renal function tests

C:

Urinary analysis

D:

Kidney biopsy

Q.52. A child is brought to the Emergency Department after ingesting a potentially toxic dose of a relative's medication. Which of the following is the next step in management?

A:

Activated charcoal

B:

Gastric lavage

C:

Ipecac syrup

D:

Cathartics

Q.53. An 18 month-old girl presents to the Paediatric Clinic with imitability and decreased appelite. The baby was bor at 38 weeks’ gestation with a birth weight of 2.6 kg. She was breastfed for 9 months and then changed to a cow's milk-based formula. The infant is drinking about 1 ter of formula per day together with solid foods. The mother reports that the stool has been loose and | smelly over the last 3 days. Physical examination confirms pallor of the skin and mucous. membranes, and systolic heart murmur (see lab results). Heart rate 120 /min Respiratory rate 30 /min Temperature 37.3° C Oxygen saturation 95% on room air Test Result Normal Values Hb 90 112-165 g/L RBC 3.04.6-4.8 x 10121L Which of the following is the most likely underlying cause?

A:

Gastrointestinal infection

B:

Cow's milk consumption

C:

Bone marrow defect

D:

Low birth weight

Q.54. A 2-year-old boy presents to the Paediatric Clinic for a routine examination. He was born at full term with a birth weight of 3450 grams. The mother breastfed him, for a year, and since then he has been fed on whole formula milk with a balanced diet. His weight gain and development have always been normal for his age. At a routine check with one year, a haemoglobin level of 105 g/L was recorded and oral administration of ferrous sulphate drops was started. 6 months later the haemoglobin level was 103 g/L and led to an increase of the daily dose of ferrous sulphate. Another 3 months later there was no significant rise in the level again. The mother reports having continued giving the ferrous sulphate drops since then. The paediatrician orders a blood cell count (see lab results). Test Result Normal Values Hb 91 112-165 g/L. RDW 13.1 11.5-14.5 ym WBC 10.4 45-105 x 1091 MCV 62 80-95 fi Reticulocyte 0.8 0.2-1.2 % Platelet count 280 150-400 x 109/L Which of the following is the most appropriate next step in definitive diagnosis?

A:

Serum Vitamin B12 level

B:

Bone marrow aspiration

C:

Serum iron and ferritin level

D:

Haemoglobin electrophoresis

Q.55. A 3-year-old child presents for a routine physical examination. The parent is concerned that the child appears pale. The child's diet includes a lot of milk but very little red meat. Haemoglobin is 80 g/L with hypochromic and microcytic indices. Which of the following is the most appropriate management?

A:

Trial of iron and follow-up

B:

Trial of iron and follow-up

C:

Bone marrow biopsy

D:

Blood transfusion

Q.56. A newborn presents with a low weight and hypotonia. Tongue protrusion was observed on multiple occasions and has a single palmar crease. Cardiac auscultation confirms a systolic: murmur and ecocardiography confirms the presence of a ventricular septal defect. Which of the following syndromes is the most likely diagnosis?

A:

Down

B:

Alport

C:

Klinefelter

D:

Prader-Willi

Q.57. A 13-year-old girl has a 10-month history of diarrhoea, postprandial periumbilical abdominal pain, and fever with weight loss. She has had several episodes of blood in her stools. Which of the following is the most likely diagnosis?

A:

Peptic ulcer

B:

Biliary lithiasis

C:

Crohn's disease

D:

Chronic pancreatitis

Q.58. A 12-year-old boy presents to the clinic with his mother. She is concerned that he is the shortest boy inthe class. His mother's height is 155 cm. and father's height is 178 cm. The boy's height is 145 cm (between 5th - 10th percentile) and his bone age is 10 years. What will be the patient's target height in cm?

A:

135-150

B:

151-165

C:

166-180

D:

181-195 Co

Q.59. A 7-month-old baby presents to the Emergency Department with irritability, and intermittent crying during which he pulls up his legs, followed by periods with no discomfort for the last four hours. He had started to vomit just before his parents brought him. On examination, the child looked ill and lethargic, with a distended abdomen, and a palpable mass in the right upper quadrant. Heart rate 140 /min Respiratory rate 28 /min Temperature 38.6° C Which of the following is the most appropriate investigation?

A:

Contrast barium enema

B:

Abdominal ultrasound

C:

Plain Abdomen X-ray

D:

Abdominal CT scan

Q.60. A 2-year-old boy presents to the Paediatric Outpatient Clinic due to muscular weakness and bone pains. His legs are curved outwards. The child belongs to a strict vegetarian family. He has not been given vitamin supplements and is minimally exposed to the sun. Which of the following vitamins should be prescribed?

A:

A

B:

D

C:

E

D:

K

Q.61. A 12-year-old boy presents to the clinic with intermittent abdominal distention, abdominal colic and excessive flatulence. He first started noticing these symptoms when he moved into his | father's house and his stepmother insisted on milk at dinner every night. He is otherwise healthy, has normal growth, no weight loss, and no travel history. Which of the following tests has the highest diagnostic value?

A:

Serum lactose levels

B:

Esophageal manometry

C:

Upper gastrointestinal endoscopy

D:

Hydrogen breath test after oral lactose

Q.62. A 12-month-old boy is brought to the clinic with a complaint of decreased appetite. The child was bor at 36 weeks’ gestation and has been fed with cow's milk formula since the age of 9 months. The body weight is 13.6 kg (> 97th percentile) and the length is 75 cm (S0th percentile). Physical examination confirms pallor of the skin and buccal mucous membranes. There is also a systolic heart murmur and a palpable spleen (see image and lab results). Test Result Normal Values Hb 90 112-165 g/L RBC 3.046-48x 10121 : What additional laboratory finding is most likely to be significantly lower than the normal value?

A:

WBC

B:

MCV

C:

Platelets

D:

Reticulocyte count

Q.63. A 15-year-old patient presents for a routine check-up (see lab results). Test Result Normal Values RBC 5.34.4-4.8 x 10121 WBC 68 4.5-10.5 x 109. Hb 98 112-165 g/L MCV 60 80-95 fi MCHC 261 260-340 g/L Reticulocyte 1.0 0.2-1.2%. Which of the following is the most likely diagnosis?

A:

Sickle cell anaemia

B:

B-thalassemia trait

C:

Iron deficiency anaemia

D:

Anaemia of chronic medical disease

Q.64. A 3-year-old girl is brought to the Emergency Department with fever and dark urine. Her parents state that she had been constipated. On examination, she looks unwell and irritable with abdominal tenderness, but no palpable liver or spleen (see lab results). Blood pressure 125/86 mmHg Heart rate 125 /min Respiratory rate 29 /min Temperature 39.9°C Test Result Normal Values WBC 16.5 4.5-10.5 x 1091L Hb 81 112-160 g/L Platelets count 325 150-400 x 109/L Urinalysis Test Result Normal Values ; Leukocytes 16 0-3 per high power field Erythrocytes 18 0-2 per high power field Protein ++ Absent Which of the following is the most appropriate management?

A:

Furosemide

B:

Ceftrixone

C:

Prednisone

D:

Saltfree diet

Q.65. A 13-year-old girl presents to the clinic for an assessment of her short stature. On examination, the patient has a height and weight below the 5th percentie, a webbed neck. lack of breast bud development, a high-arched palate, and a low-set posterior hairline. Which of the following is the most likely diagnosis?

A:

Trisomy 21

B:

Turner's syndrome

C:

Fragile X syndrome

D:

Noonan's syndrome

Q.66. An 18-month-old Caucasian boy is evaluated in the clinic for failure to thrive, poor appetite, abdominal distention, diarrhoea and irritability. He was well until 12 months of age when he was weaned from milk to regular foods. Since then, his growth curve has flattened. Which of the following is the most likely diagnosis?

A:

Giardiasis

B:

Cystic fibrosis

C:

Celiac disease

D:

Whipple disease

Q.67. An 8-year-old boy presents to the Paediatrics Clinic with a history of recurring abdominal cramps and diarrhea over the last 3 months. His height and body weight had fallen from the 25th to the 3rd percentile during this same period. He has a decreased appetite and feels full after having eaten small quantities of food. Physical examination shows diffuse abdominal tenderness and a perineal fissure. There are no other abnormal findings (see reports) Blood pressure 100/60 mmHg Heart rate 80 /min Respiratory rate 20 /min Temperature 38.0° C Colonoscopy: Non-contiguous lesions in the proximal colon and terminal ileum. Biopsy proximal colon: Transmural inflammation. Which of the following is the most likely diagnosis?

A:

Crohn's disease

B:

Ulcerative colitis

C:

Behcet's syndrome

D:

Pseudomembranous colitis

Q.68. A child is brought to the Emergency Department after accidentally consuming a large dose of nutritional supplements 2 hours before. Now has developed nausea, vomiting, abdominal pain, and diarrhoea. The vomit is black. Blood pressure 90/60 mmHg Heart rate 100 /min Respiratory rate 18 /min Temperature 36.6° C Which of the following is the most likely diagnosis?

A:

Obstruction

B:

Iron poisoning

C:

Hypervitaminosis

D:

Hyperproteinemia

Q.69. A 53-day-old boy is referred to the Paediatric Clinic for investigation of anaemia. He was bom at full term and he is a known case of GGPD deficiency. On examination, both height and weight are in the 10th percentile, the rest of the examination is normal (see lab resuts). Test Result Normal Values Hb 70 112-165 gL Platelet count 350 150-400 x 109/1L Total bilirubin 25.1 <20.5 pmol/L Urinalysis Result Normal Values Color Clear Clear or light yellow Leukocytes 0 0-3 per high power field Erythrocytes 0 0-2 per high power field Which of the following is the most likely diagnosis?

A:

Haemolysis

B:

Iron deficiency

C:

Physiological jaundice

D:

Anaemia of chronic disease

Q.70. A 7-year-old girl presents to the Paediatric Clinic with her mother, who is worried that her daughter has developed growth of pubic hair. She has had a normal physical development. Her school performance is acceptable and she is socially well integrated with her peers. Physical examination reveals pubic hair on the mons and the labia majora, but there is no axillary or facial hair. The clitoris is of normal size for that age. There is no sign of masculinization and no breast development. Examination of the heart, lungs and abdomen shows normal results. Blood pressure 95/55 mmHg Heart rate 80 /min Respiratory rate 26 /min Temperature 36.8' C Height 90 cm (75th percentile) Weight 23 kg (50th percentile) Which of the following is the most likely diagnosis?

A:

Congenital adrenal hyperplasia

B:

Premature adrenarche

C:

Turner syndrome

D:

Normal puberty

Q.71. When should breastfeeding begin after the delivery?

A:

Immediately

B:

8hours

C:

24 hours

D:

48 hours

Q.72. A 1-year-old boy is noted to have a microcytic anaemia, on routine screening. A haemoglobin electrophoresis was performed that showed and increased fraction of haemoglobin A2. Which of the following is the most likely diagnosis?

A:

B-thalassemia

B:

Iron deficiency

C:

Sickle cell anaemia

D:

Folic acid deficiency

Q.73. Which of the following physical findings in boys is the earliest indicator that puberty has begun?

A:

Increased penile size

B:

Increased prostate size

C:

Increased testicular size

D:

Appearance of pubic hair

Q.74. A 4-week-old infant is brought to the clinic with progressive, projectile, non-bilious vomiting with a palpable ‘olive in right upper quadrant. Which of the following is the most appropriate first investigation?

A:

PH monitoring

B:

Scintigraphy

C:

Sonography

D:

Endoscopy

Q.75. A 19-year-old girl presents with short stature, wide-spaced nipples, and primary amenorrhea. What is the most likely karyotype?

A:

45X

B:

46XX

C:

47XXX

D:

47XX+18

Q.76. A 2-week-old newborn is brought to the clinic. The mother reports that her baby passes a small amount of unformed stool after each feed. The child is on breastfeed since birth. Which of the following is the most appropriate management?

A:

Prescription of lactose free milk

B:

Oral rehydration solution

C:

Reassure the mother

D:

Infant formula milk

Q.77. A 2-year-old girl presents with diarrheal stools and weakness over the last 4 days. There is no family history of any serious illness. Physical examination confirms pallor of the skin and ; mucous membranes and a scleral icterus. The spleen can be palpated 2 cm below the costal margin (see image and lab results). Heart rate 100 /min Respiratory rate 28 /min Temperature 38.6° C Test Result Normal Values Hb 55 112-165 g/L. WBC 154.5105 x 1091 Platelets count 200 150-400 x 109/L Reticulocyte 7.5 0.212% RBC24.6-4.8x10121L. Test Result - Direct Coombs test Positive, Indirect Coombs test Positive. Which of the following is the most likely diagnosis?

A:

Spherocytosis

B:

Fanconi anemia

C:

Autoimmune hemolytic anemia

D:

Glucose-6-phosphate dehydrogenase deficiency

Q.78. A 2-year-old African child is skinny with obvious muscle wasting, loss of body fat, and no edema | Which of the following malnutrition does this child have?

A:

Muscle wasting syndrome

B:

Kwashiorkor

C:

Marasmus

D:

Pica

Q.79. A 12-month-old boy is brought to the clinic with a complaint of decreased appetite. The child ; was born at 36 weeks gestation and has been fed with cow's milk formula since the age of 9 months. The body weight is 13.6 kg (> 97th percentile) and the length is 75 cm (50th percentile). Physical examination confirms pallor of the skin and buccal mucous membranes. There is also a systolic heart murmur and a palpable spleen (see image and lab results) Test Result Normal Values Hb 90 112-165 gL WBC 104.5-10.5 x 1091L Platelets count 500 150-400 x 109/L MCV 70 80-95 fl Reticulocyte 1.2 0.2%-1.2% RBC 3.0 4.64.8 x 10121 Which of the following components need to be replaced?

A:

Iron

B:

Folic Acid

C:

Vitamin B12

D:

Erythrocytes

Q.80. A newborn boy is brought to the Paediatrics clinic. Examination shows abdominal distension with palpable kidneys and a distended bladder (see report). Voiding cystourethrogram: Shows bilateral hydronephrosis and distension of the bladder and proximal urethra. Which of the following is the most likely diagnosis?

A:

Prune-belly syndrome

B:

Posterior urethral valves

C:

Polycystic kidney disease

D:

Ureteropelvic junction obstruction

Q.81. A 1-year-old boy is diagnosed with factor VII deficiency with level of less than 1%. Which of the following investigations will be affected?

A:

Bleeding time

B:

Platelet count

C:

Prothrombin time

D:

Activated partial thromboplastin time

Q.82. A 2-year-old boy presents to the paediatrician with severe testicular pain and swelling that had just started 2 hours before. The child is nauseous and has vomited twice. The parents report a similar episode that had happened 3 weeks ago but was of a very short duration. The scrotum is swollen and tender and does not transilluminate. No contraction of the cremaster muscle can be provoked by stroking the inner part of the thigh Blood pressure 110/70 mmHg Heart rate 160 /min Respiratory rate 50 /min Temperature 36.6° C Which of the following is the most appropriate treatment?

A:

NSAID

B:

Antibiotic therapy

C:

Surgical exploration

D:

Elevated scrotal position

Q.83. A 4-day-old infant is seen by a paediatrician in the newbom nursery, for bilious vomiting and abdominal distention. The newborn has been feeding poorly and is difficult to calm. The newborn passed meconium shortly after birth and has passed several seedy, yellow stools each day since then. The physical examination confirmed abdominal distention. Which of the following is the most likely diagnosis?

A:

Allergic reaction to formula

B:

Hirschsprung's disease

C:

Meconium ileus

D:

Midgut volvulus

Q.84. A 9-year-old child with gastroenteritis caused by Shigella species. Which of the following antibiotics should be prescribed?

A:

Amoxicillin

B:

Ceftriaxone

C:

Azithromycin

D:

Metronidazole

Q.85. A 2-year-old boy is brought to the Paediatric Emergency Department. The mother reports that the boy has become increasingly irritable and feeble over the last 2 days. He has passed very little urine and his skin has become pale. The mother had consulted the pediatrician 2 weeks before because the baby had suffered from bloody diarrhea, vomiting, and high fever. ‘Symptomatic treatment with acetaminophen and probiotics had been started. Physical examination shows mild petechiae on the lower extremities. Urinalysis reveals microhematuria and mild proteinuria (see lab results). Test Result Normal Values Hb 73 112-165 gL INR 1.10.9-1.2 WBC 48.6 4.5-10.5 x 100/1L Platelets count 95 150-400 x 109/L MCV 86 80-95 fi MCH 30 28-33 pg/cell RBC count 3.3 4.6-4.8 x 1012L Prothrombin time 12 12-14 sec APTT 34 30-40's Which of the following is the most likely diagnosis?

A:

HUS

B:

ITP

C:

TTP

D:

DIC

Q.86. Which of the following vitamins is administered to newborns to prevent haemorrhagic disease?

A:

A

B:

B

C:

C

D:

K

Q.87. A 13-year-old twins, one boy and one girl present with their parents at the clinic. The parent is concerned because one of the children appears to have entered puberty while the other has Which of the following should be explained about girls' puberty compared with boys?

A:

2-3 years earlier

B:

6-12 months earlier

C:

1 to 2 years after boys

D:

Almost same time as boys

Q.88. A 1-year-old infant presents with massive hepatosplenomegaly, skin bruises, and swelling in the lateral aspect of the neck. Which of the following is the most appropriate investigation?

A:

Bone marrow aspiration

B:

Lumbar puncture

C:

EBV serology

D:

MRI thorax

Q.89. A 4-year-old boy presents with a 1-day history of abdominal pain and vomiting. He was afebrile and had no diarrhea. He has bilateral knee pain, and there was some tenderness of the knee joints, but no effusions. Within 24 hours, he developed a rash on his legs and buttocks, which is petechial and purpuric, and his platelet count was normal. Which of the following is the most likely diagnosis?

A:

Systemic lupus erythematosus

B:

Hemolytic uremic syndrome

C:

Henoch-schonlein purpura

D:

Kawasaki disease

Q.90. An 8-year-old is brought to the clinic by his parents. The patient is overweight and looks much older than other children in the same age group. Weight and height are greater than the 95th percentile for the child's age, and body mass index is 30 Kg/m2. The rest of the examination is normal, Which of the following is the most appropriate management?

A:

Observation and revaluation in 12 months

B:

Referral for surgical intervention

C:

Prescription obesity medication

D:

Lifestyle modification

Q.91. Which of the following viral gastroenteritis can be prevented by vaccination?

A:

Adenovirus infection

B:

Astrovirus infection

C:

Norovirus infection

D:

Rotavirus infection

Q.92. What would be the best treatment of an uncomplicated cystitis in a 5-year-old girl?

A:

Oral amoxicilin

B:

Oral sodium bicarbonate

C:

Intravenous ciprofioxacin

D:

Intramuscular ceftriaxone

Q.93. A 15-month-old infant has been ill for the past 12 hours with apparent abdominal discomfort, emesis, and the passing of bloody mucous per rectum. The infant is slightly pale. On examination, found to have increased bowel sounds. The abdominal film shows an obstructive pattern. Which of the following is the most important step of management?

A:

Bowel rest and IV hydration until resolution

B:

Intravenous antibiotics

C:

Immediate surgery

D:

Barium enema

Q.94. Which of the following investigations is the most important to perform on a child with enuresis?

A:

Urinalysis

B:

Urine culture

C:

Complete blood count

D:

Intravenous pyelography

Q.95. A 6-year-old boy presents to the Emergency Room with severe scrotal pain. The parents report that he started complaining 5 hours before and that the pain has become increasingly worse. He: is otherwise healthy and there is no history of trauma. A physical examination confirms a swelling of the scrotum and tenderness of the left testicie. The cremasteric reflex is absent. Which of the following actions should be taken next?

A:

Surgical consult

B:

Testicular ultrasound

C:

Urinalysis and urine culture

D:

Analgesics and apply ice to scrotum

Q.96. A 53-day-old boy is referred to the Paediatric Clinic for investigation of anaemia. He was born at full term and he is a known case of G6PD deficiency. On examination, both height and weight are in the 10th percentile, the rest of the examination is normal (see lab results). Test Result Normal Values Hb 70 112-165 giL Platelet count 350 150-400 x 109/L Total bilirubin 25.1 <20.5 pmol/L. Urinalysis Result Normal Values Color Clear Clear or light yellow Leukocytes 0 0-3 per high power field Erythrocytes 0 0-2 per high power field Which of the following is the best management?

A:

Blood transfusion

B:

Iron supplement

C:

Reassurance

D:

Folic acid

Q.97. A 10-year-old boy presents to the clinic complaining of abdominal pain, frequent diarrhoea that is sometimes bloody, and pain usually accompanying defecation. His mother observed that he has lost weight over the last 3 months since the onset of the problem. The boy aiso has aches and pains of his joints. On examination, he looks i, pale, with a soft abdomen, no tendemess or organomegaly (see lab results). Blood pressure 110/70 mmHg Heart rate 100 /min Respiratory rate 16 /min Temperature 38.6° C : Test Result Normal Values Sodium 132 134-146 mmol/L Potassium 3.2 3.55.1 mmollL Creatinine 31 27-62 pmol/L. : Blood urea nitrogen 5.6 1.3 to 6.4 mmol Hb 82 112-165 g/L. : C-reactive peptide 1.1 0-0.5 mg/d! Albumin 32 36-52 g/L Which of the following is the most likely diagnosis?

A:

Celiac disease

B:

Crohn's disease

C:

Ulcerative colitis

D:

Chronic dysentry

Q.98. A 6-year-old boy presents with fever, On examination, he shows small white vesicles around his mouth and on his gum. Small discrete cervical lymph nodes are also palpable. Which of the following viruses is more likely to be associated with these symptoms?

A:

Ebestin bar virus

B:

Herpes simplex virus

C:

Varicella zoster virus

D:

Human pappiloma virus

Q.99. A 5-day-old infant was delivered normally at home attended by a midwife. He had never been to a hospital, but now noted to have bleeding from the umbilical cord that seems increasing in severity. He has been breasted since after delivery. The mother had a normal perinatal period, but was diagnosed with epilepsy 10 years ago, and has been taking phenobarbital (see lab results). Test Resuit Normal Values Bleeding time 3.8 up to 4 min Prothrombin time 21 12-14 sec APTT 46 30-40 sec Which of the following is the most appropriate treatment?

A:

Corticosteroids

B:

Platelet transfusion

C:

Fresh frozen plasma

D:

Parenteral 1 mg vitamin K1

Q.100. Which of the following radiographic signs is associated with Duodenal obstruction in a neonate?

A:

Kerley B lines

B:

Bird's beak sign

C:

Hampton's hump

D:

Double bubble sign

Q.101. An 11-month-old is brought to the clinic. The Parent reports that he has a 1-day history of passing bright red blood mixed with foul-smelling, dark brownish-black stool. The child is pale. Coagulation tests are normal (see lab result). Blood pressure 118/56 mmHg Heart rate 160 /min Respiratory rate 26 /min Temperature 36.6° C Test Result Normal Value. Hb 70 112-165 gL Which of the following investigations is most likely to confirm the source of bleeding?

A:

Abdominal ultrasonography

B:

Radioisotope imaging

C:

Barium enema

D:

Barium meal

Q.102. Which of the following is most appropriate management for Hirschsprung’s disease?

A:

Surgical resection

B:

Dietary alteration

C:

Antibiotic therapy

D:

Immuno-supressive agents

Q.103. A 5-year-old boy presents with fever and a rash on his lower limbs, 2 weeks after developing a sore throat. There is also a history of abdominal pain and painful knees and ankles. Physical ‘examination confirms palpable purpuric lesions on the lower limbs that do not blanch on pressure (see lab result). Test Result Normal Value ESR 922-10 mmh Which of the following is the most likely diagnosis?

A:

Vitamin C deficiency

B:

Factor VlI deficiency

C:

Hypersensitivity vasculitis

D:

Drug hypersensitivity reaction

Q.104. A 2-year-old boy with sickle cell anaemia presents to the Paediatric Outpatient Clinic for a second dose of hepatitis A vaccine. According to the mother, he was admitted 3 weeks before with a vaso-occlusive crisis and received a blood transfusion for anaemia. Which of the following is the most appropriate approach for vaccination?

A:

Vaccinate as per schedule

B:

Delay vaccine 3 months

C:

Delay vaccine until months

D:

First, evaluate hepatitis A serology

Q.105. A 6-year-old child is brought to the Emergency Department with chest pain and signs of respiratory distress. The chi has a minor upper respiratory tract infection, which suddenly worsened with temperature elevation. The physical examination found an increased pulmonic and systolic ejection murmurs (see fab results and report). Test Result Normal Values Hb 65 112-165 g/L WBC 18.4.5-10.5 x 1091 Reticulocyte 120.212 % Chest X-ray: Shows lobar infirates. Which of the following is the most likely diagnosis?

A:

Sickle cell disease

B:

Splenic sequestration

C:

Myocardial infarction

D:

Pneumococcal pneumonia

Q.106. A 16-year-old boy presents with 6-day fever and abdominal pain. He looks pale and toxic and had a tender and mildly enlarged spleen. What is the most sensitive culture to be recommended?

A:

Stool or urine culture

B:

A single blood culture

C:

Multiple blood cultures

D:

Bone marrow aspirate culture

Q.107. A 2-year-old boy presents to the Outpatient Clinic with a 2-week history of facial swelling, poor dietary intake and reduced activity with positive sacral oedema (see lab results). Blood pressure 95/65 mmHg Heart rate 95 /min Respiratory rate 28 /min Temperature 36.8° C Test Result Normal Values Hb 94 112-160 g/L Alanine aminotransferase 52 10-35 U/L Albumin 25 36-52 gIL Total Cholesterol 7.0 <5.2 mmol/L Which of the following is the most likely diagnosis?

A:

Congestive heart failure

B:

Chronic iver disease

C:

Nephrotic syndrome

D:

Protein malnutrition

Q.108. A 4-year-old girl is brought to the clinic for prolonged diarrhoea. On examination, she looks pale. She is drinking 3 pints of goat's milk/day, and is a very fussy eater (see lab results) Test Result Normal Values Hb 59 112-165 g/L MCV 102 80-95 fi MCHC 390 260-340 g/L Which of the following is the most significant in the past medical history?

A:

Hypothyroidism

B:

Aplastic anaemia

C:

Giardia parasitic infection

D:

Psychological deprivation

Q.109. A 6-week-old infant begins to exhibit forcefull vomiting after each meal. The infant was born at term to a 23 year-old primigravida whose pregnancy was uncomplicated and ended with a normal vaginal delivery. No congenital anomalies are noted upon examination of the infant. Which of the following is the most likely diagnosis?

A:

Congenital duodenal atresia

B:

Necrotizing enterocolitis

C:

Hirschsprung's disease

D:

Pyloric stenosis

Q.110. A preschool child presents for his routine preschool-entry examination (see lab results). Test Result Normal Values HB 90 112-165 RDW 20 15-16% Platelets count 490 150-400 x 109/L MCV 68 80-95 I MCH 26 28-33 pg/cell MCHC 241 260-340 gIL Reticulocyte 1.1 021.2% WBC 7.54.5-10.5 x 109/L RBC 54.6-4.8x 10121L Which of the following is the most likely diagnosis?

A:

Aplastic anaemia

B:

Thalassemia minor

C:

Iron deficiency anaemia

D:

Hereditary spherocytosis

Q.111. A 2-month-old baby is brought to the clinic. The mother reports her baby had been crying so much for the last 2 weeks and all her efforts to calm him had failed. The child was delivered normally at 36 weeks' gestation. He has been breast fed since birth, but the mother recently introduced an evening bottle to help calm the baby. On examination, he is crying and irritable. He is at the 50th percentile on the growth curve, and apart from abdominal distension there are no abnormal physical signs. Which of the following is the most likely diagnosis?

A:

Infant colic

B:

Infant constipation

C:

Infant regurgitation

D:

Cows milk intolerance

Q.112. A 5-day-old born at home to a 25-year-old primigravida at full term developed bruising over the thigh. Examination is normal, except for a few bruises on the left thigh. Weight and height are at the 95 percentile for age (see lab results). Test Result Normal Values Prothrombin time 21 12-14 5 APTT 66 30-40 s Platelet 280 150-450 Which of the following is the most likely diagnosis?

A:

Idiopathic thrombocytopenic purpura

B:

Neonatal hemorrhagic disease

C:

Deficiency of factor X

D:

Haemophilia

Q.113. A 3-year-old child presents to the Paediatric Emergency Department a half hour after ingesting a caustic material, The child is crying, drooling, and does not look well. Which of the following is the most appropriate initial management?

A:

Establish the airway

B:

Activated charcoal

C:

Identify the agent

D:

Immediate endoscopy

Q.114. A 6-year-old child is brought to the Paediatric Clinic. The parent reports intermittent fever, Vomiting, diarrhoea, and diffuse abdominal pain for the past week. The parent indicated that the child's eyes also appears to have a yellowish skin stain for the past 2 days. The liver is palpable | 5 cm below the costal margin and there is jaundice, scleral icterus, and mild abdominal tenderness on examination. Blood pressure 110/70 mmHg Heart rate 76 /min Respiratory rate 18 /min : Temperature 38.0° C Which of the following is the most likely type of viral hepatitis?

A:

A

B:

B

C:

C

D:

D

Q.115. A 14-year-old presents with photosensitivity, a malar rash, joint pains, and purpuric rashes on both legs. Urine examination shows red cells Which of the following is the most likely diagnosis?

A:

Idiopathic thrombocytopenic purpura

B:

Rheumatoid arthritis

C:

Aplastic anaemia

D:

Lupus nephritis

Q.116. A 6-year-old girl presents to the Emergency Department with a history of feeling unwell and tired over the last 10 hours, she had 2 previous similar attacks. On examination, she looks pale, has a palpable liver and her spleen is 6 cm below the costal margin (see lab results). Blood pressure 93/55 mmHg Heart rate 169 /min Respiratory rate 28 /min Temperature 37.5° C Test Result Normal Values Hb 52 112-165 g/L Platelet count 102 150-400 x 109/L Sickle cell screen Positive Nil Which of the following is the most appropriate management?

A:

Regular blood transfusions

B:

Hydrocortisone

C:

Splenectomy

D:

Hydroxyurea

Q.117. A 10-year-old boy presents to the clinic complaining of abdominal pain, frequent diarrhoea that is sometimes bloody, and pain usually accompanying defecation. His mother noted that he has lost weight over the last three months since the onset of the problem. The boy also has aches | and pains of his joints. On examination, he looked ill, pale, with a soft abdomen, and no tenderness or organomegaly (see lab results). Blood pressure 110/70 mmHg Heart rate 100 /min Respiratory rate 16 /min Temperature 38.6° C Test Result Normal Values Sodium 132 134-146 mmol/L Potassium 3.2 3.5-5.1 mmol/L Creatinine 31 27-62 pmol/L Blood urea nitrogen 5.6 1.8 to 6.4 mmol/L Hb 82 112-165 gL C-reactive peptide 1.1 0-0.5 mg/dl Albumin 32 36-52 g/L Which of the following treatments should be tried first?

A:

Metronidazole

B:

Corticosteroids

C:

Gluten free diet

D:

5 amino salicylates

Q.118. A 4-year-old boy with nephritic syndrome presents with vomiting, abdominal pain and diarrhoea. On examination, his abdomen is distended and there is an evidence of generalised and rebound tendemess. Which of the following is the most likely diagnosis?

A:

Peritonitis

B:

Gastritis

C:

Pancreatitis

D:

Appendicitis

Q.119. A 2-month-old girl has diarrhoea without vomiting. The mother is worried that she has dehydration and asks for advice on management Which of the following would be recommended?

A:

Changing milk

B:

Anti-diarrheal agent

C:

Oral rehydration fluid

D:

Intravenous saline infusion

Q.120. A 20-year-old woman gave birth to a boy who is severely jaundiced. She already has two children who were normal at birth. The woman has A-negative blood group and the newborn tested to be O-positive. Which of the following is the most likely cause?

A:

Maternal anti-RhD antibodies causing placental damage

B:

Fetal anti-RhD antibodies causing agglutination of fetal RBCs

C:

Fetal anti-RhD antibodies causing agglutination of matemal RBCs

D:

Maternal anti-RhD antibodies causing agglutination of fetal RBCs

Q.121. A 7-year-old child presents with a history of fever and pain in the lower abdomen for the past days. The parent reports that the child's urine has been foul smelling for the past 2 days (see report) Urine culture: Gram-negative bacteria, > 100,000 cells/ml. What is the most likely organism?

A:

Staphylococcus saprophyticus

B:

Kiebsiella pneumoniae

C:

Proteus mirabilis

D:

Escherichia coli

Q.122. A 5-year-old developed acute abdominal pain in the upper right quadrant, following an upper respiratory tract infection. On examination, there are normal bowel sounds and no rebound tendemess (see lab results and report). Blood pressure 110/70 mmHg Heart rate 110 /min Respiratory rate 24 /min Temperature 38.9° C Test Result Normal Values Hb 72 112-165 gL WBC 124.5-10.5 x 1091 Reticulocyte 7.2 021.2% Peripheral smear: Normochromic normocytic red blood cells with target cells and red cell inclusion bodies. Which of the following is the most likely diagnosis?

A:

GI infarction

B:

Lead poisoning

C:

Sickle cell disease

D:

Acute appendicitis

Q.123. A 7-year-old boy is brought to the clinic with the complaints of mild abdominal pain, constipation and aggression. The mother told the physician that he is used to eating tissue paper and chipped off wall paint (see lab results and report). Test Result Normal Values RBC 3.94.6-4.8x 10121 Hb 74 112165 giL MCH 23 28-33 pg/cell MCV 70 80-95 fi Peripheral blood smear: Microcytic hypochromic. Which of the following is the most likely type of anaemia?

A:

Aplastic

B:

Pernicious

C:

Haemolytic

D:

Iron deficiency

Q.124. A 1-year-old boy presents with prolonged bleeding after circumcision (see lab results). Test Result Normal Values Bleeding time 1.6 up to 4 min Prothrombin time 40 12-14 sec ; APTT 120 30-40 sec Platelets count 160 150-400 x 109/L Which factor deficiency is the most likely cause?

A:

VIII

B:

VIl

C:

IX

D:

X

Q.125. Which of the following is the most common intra-abdominal tumour in children?

A:

Rhabdomyosarcoma

B:

Hepatoma

C:

Wilm's

D:

Ewing

Q.126. A 2-month-old baby is brought to the clinic for evaluation of spitting up immediately after every meal. On examination, his abdomen is soft with no hepatosplenomegaly. stool is negative for occult blood, and he is at the 50th percentile for height and weight (see lab results). Test Results Normal Values Hb 150 112-165 g/L. WBC 6.1 4-105 x 109/L Platelets count 250 150-400 x 109/L Urinalysis: Protein Absent Absent Leukocytes 0 0-3 per high power field Erythrocytes 1 0-2 per high power field Which of the following is the most appropriate next step in management?

A:

Oral proton pump inhibitor

B:

Reassure the parents

C:

Surgical referral

D:

Abdominal CT

Q.127. A 5-day-old infant has significant nasal and rectal bleeding. He was delivered by a midwife at home. The pregnancy was normal and the baby had good Apgar scores. He is breastfeeding well. Which of the following vitamin deficiencies is the most likely the cause?

A:

B1

B:

C

C:

D

D:

K

Q.128. A 6-year-old child has asymptomatic haematuria. There is no significant past medical history and the physical examination is unremarkable (see lab result). Urinalysis Result Normal Value Erythrocytes 15 0-2 per HPF Which of the following should the initial evaluation include?

A:

Repeat urinalysis

B:

Urine cytology

C:

Renal biopsy

D:

Cystoscopy

Q.129. A 5-year-old child presents with bleeding from the nose and gums and easy bruising of the extremities for 3 days. Prior to this presentation, the child had a viral upper respiratory tract ; infection. Which of the following is the most likely diagnosis?

A:

Idiopathic thrombocytopenic purpura

B:

Henoch-schonlein purpura

C:

Meningococcemia

D:

Haemophilia A

Q.130. Which of the following findings would support a diagnosis of Turner's syndrome?

A:

A palpable liver 2 cm below the costal margin

B:

Redundant skin folds at the nape of the neck

C:

Hypertonia and ankle clonus

D:

Single palmer creases

Q.131. A 5-year-old boy presents with sudden and severe bone pain in his hands and feet. On examination, he appears dehydrated (see lab results) Blood pressure 110/60 mmHg Heart rate 125 /min Respiratory rate 28 /min Temperature 38.8" C rectal Test Result Normal Values Hb 108 112-165 gL HCT 0.30 0.32-0.42 MCV 76 80-95 fl Which of the following is responsible for this clinical presentation?

A:

Aplastic crisis

B:

Sequestration crisis

C:

Vaso-occlusive crisis

D:

Sickle chest syndrome

Q.132. A 7-year-old child developed attacks of post-meal nausea, abdominal distension, and central abdominal pain and cramps that usually followed by watery diarrhoea. On examination, the child looked well, with a slightly distended abdomen. Blood pressure 90/70 mmHg Heart rate 98 /min Respiratory rate 18 /min Temperature 36.6" C Which of the following is the most likely diagnosis?

A:

Chronic giardia lamblia infection

B:

Chronic salmonella infection

C:

Inflammatory bowel disease

D:

Carbohydrate intolerance

Q.133. An 8-year-old boy presents to the Paediatric Clinic with weakness, headache, nausea and anorexia that began 1 week before. Physical examination shows pitting edema, grade 2+ on the edema scale, over the eyelids and ankles. There is pallor of the skin, mucous membranes and nail beds. A 24-hour urine collection reveals a urine production of 20 mi per hour while the boy's body weight is 27 kg, the urine appears dark brown. Blood pressure 140/100 mmHg Heart rate 120 /min Respiratory rate 36 /min Temperature 38.6" C What clinical history would be most important for the diagnosis?

A:

Diagnosed sickle cell disease

B:

Recurrent urinary tract infections

C:

Abdominal trauma 1 week before

D:

Impetigo contagiosa 1 month before

Q.134. A 3-year-old girl is brought to the Emergency Department with a fever and dark urine. Her parents state that she had been constipated. On examination, she looks unwell and irritable with abdominal tenderness, but no palpable liver or spleen (see lab results). Blood pressure 125/86 mmHg Heart rate 125 /min Respiratory rate 29 /min Temperature 39.9° C Test Results Normal Values WBC 16.5 4.5-10.5 x 100/L Hb 81 112-160 g/L Platelets count 325 150-400 x 100/L Urinalysis Test Result Normal Values Leukocytes 16 0-3 per high power field Erythrocytes 18 0-2 per high power field Protein ++ Absent Which of the following is the most likely diagnosis?

A:

Hypertensive nephropathy

B:

Acute glomerulonephritis

C:

Acute pyelonephritis

D:

Acute cystitis

Q.135. Which of the following vaccines is used for immunization against Hepatitis B virus?

A:

Toxoid

B:

Inactivated

C:

Recombinant

D:

Live-attenuated

Q.136. A 6-month-old child regularly regurgitates a large portion of his feeds. A pH probe study shows significant periods of low oesophageal pH. The child has normal growth and no other significant past medical history. Which of the following is the most appropriate management?

A:

Oral antacids

B:

Close follow-up

C:

Oesophageal manometry

D:

Surgery with fundoplication

Q.137. Which of the following conditions can lead to hyposplenism?

A:

G6PD deficiency

B:

Sickle cell disease

C:

Vitamin B12 deficiency

D:

Hereditary spherocytosis

Q.138. A 2-year-old child with sickle cell disease had an upper respiratory tract infection, which was followed by shortness of breath, and pallor. On examination, looked pale, sick and had a splenomegaly (see lab results). Blood pressure 90/60 mmHg Heart rate 110 /min Respiratory rate 25 /min Temperature 38.6° C Test Result Normal Values Hb 34 112-165 g/L WBC 3.14.5-10.5 x 109/L Lymphocytes 52 20-40 % Neutrophils 58 40-60% Platelets count 166 150-400 x 100/L Reticulocyte 0.10212 % ESR 252.10 mm/h Which of the following is the best immediate management?

A:

Splenctomy

B:

Fluids and analgesia

C:

Intravenous antibiotics

D:

Packed red cell transfusion

Q.139. A 3-year-old girl presents with a high-grade fever and chills. Physical examination, confirms that she is anaemic with splenomegaly. Clinical image with giemsa stain is shown (see image). Which of the following is the most likely etiology?

A:

P. falciparum

B:

P.malariae

C:

P.ovale

D:

P.vivax

Q.140. A 10-month-old child has a 3-day history of green watery stools. She has also been vomiting for 1 day. Physical examination confirms an afebrile, iritabie baby with dry mucous membranes and sunken eyes. Which of the following is the most important management strategy?

A:

Start antibiotics

B:

Antidiarrheal drugs

C:

Order a stool culture

D:

Fluid and electrolyte replacement

Q.141. A 2-week-old infant presents with projectile, non-bilious vomiting that frequently contains clotted milk. After vomiting, the child still seems to be hungry. On examination, there is mid-dehydration. A firm, non-tender and mobile hard 1-2 cm in diameter mass is palpable in the right upper abdominal quadrant at the lateral edge of the rectus abdominus muscie (see report). Heart Rate 95 /min Respiratory Rate 25 /min Temperature 36.7 °C Abdominal X-ray: Shows a "single bubble” sign. Which of the following is the most likely cause?

A:

Gastroenteritis

B:

Pyloric stenosis

C:

Reyes syndrome

D:

Gastric mucosal atrophy

Q.142. A 7-month-old baby presents to the Emergency Department with irritability and intermittent crying during which he pulls up his legs, followed by periods with no discomfort for the last 4 hours. He had started to vomit just before his parents brought him. On examination, the child looked ill and lethargic, with a distended abdomen, and a palpable mass in the right upper quadrant. Heart rate 140 /min Respiratory rate 28 /min Temperature 38.6° C Which of the following is the most likely diagnosis?

A:

Pancreatitis

B:

Appendicitis

C:

Gastroenteritis

D:

Intussusceptions

Q.143. A 2-year-old child presents with painful sweling on the dorsal surfaces of the hands, feet, fingers, and toes (see lab results and report). Blood pressure 110/70 mmHg Heart rate 100 /min Respiratory rate 22 /min Temperature 38.9° C Test Result Normal Values Hb 77 112-165 g/L Reticulocyte 3.90.21. % Blood smear: Several elongated and crescent shaped red blood cells. Which of the following is the most appropriate on-going care?

A:

Vitamin B12

B:

Corticosteroids

C:

Iron supplement

D:

Penicillin and immunization

Q.144. A 10-year-old patient presents with a 3-day history of yellow discoloration of the sclera, anorexia and abdominal pain (see lab results). Test Result Normal Values Indirect bilirubin 140 <19 pmol/L Total bilirubin 260 <20.5 pmol/L Albumin 40 36-52 g/L Total Proteins 76 56-80 g/L Alanine aminotransferase 878 10-35 U/L Aspartate aminotransferase 1005 12-40 IU/L Which of the following is the most likely diagnosis?

A:

Gilbert's syndrome

B:

Infective hepatitis

C:

Obstructive jaundice

D:

Acute pancreatitis

Q.145. A 2-year-old boy presents to the clinic with abdominal pain, malaise, fever, nausea and vomiting. He has a history of 2 urinary tract infections. A contrast-voiding cysto-urethrogram is requested (see image). Which of the following is the most likely diagnosis?

A:

Ureterocele

B:

Urinary lithiasis

C:

Vesicoureteral reflux

D:

Agenesia of the left ureter

Q.146. Which of the following is the most appropriate management of an asymptomatic umbilical hernia in a 4-year-old?

A:

Reassurance

B:

Local cauterization

C:

Surgical correction

D:

Elastic support to the mid-abdomen

Q.147. A 12-year-old girl presents with bleeding gums while brushing her teeth. This had started 1 week ago after a viral upper respiratory tract infection. On physical examination, the only finding ~~ are petechiae on her extremities and abdomen. There is no lymphadenopathy, or hepatosplenomegaly (see lab results). Test Result Normal Values Hb 130 112-165 g/L HCT 0.390.32-042 MCV 88 80-95 fl WBC 8 4.5-10.5 x 109/L Platelets count 20 150-400 x 109/L Which of the following findings is expected in this patient's bone marrow?

A:

Hypoplasia

B:

Reduced iron stores

C:

Megaloblastic changes

D:

Increased megakaryocytes

Q.148. A 1-year-old boy is being investigated for pallor, jaundice, lethargy and delayed growth. On examination, found to be short for his age, with prominent forehead and splenomegaly (see lab results). Test Result Normal Values HB 40 112-165 RDW 14 11.5-14.5% MCV 70 80-95 Reticulocyte 2.4 021.2% WBC 5.54.5-10.5 x 100/L RBC 584.6-48x1012L HB electrophoresis Hb A2 30 2-3% ; Hb F 501.2% | Which of the following is the most likely diagnosis?

A:

Iron deficiency anemia

B:

B -Thalassemia

C:

sickle cell disease

D:

a - Thalassemia

Q.149. A 5-year-old boy presents with sudden and severe bone pain of his hands and feet, and on examination he appears dehydrated. Blood pressure 105/60 mmHg Heart rate 100 /min ; Respiratory rate 22 /min Temperature 38.8°C rectal Which of the following is the most likely diagnosis?

A:

Sickle cell disease

B:

Alpha thalassemia

C:

Thalassemia major

D:

Iron deficiency anaemia

Q.150. A 6-month-old child presents to the Paediatric Outpatient Clinic with a 2-day history of gastroenteritis. The examination reveals decreased skin turgor, a depressed anterior fontanel, and sunken eyes. What is the most likely percentage of dehydration?

A:

5

B:

10

C:

15

D:

20

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MOCK TEST 12

Q.1. A 12-year-old patient presents to the clinic with diarrhoea, vomiting, miosis, bronchoconstriction, sweating, and excessive salivation. On examination, the breath has a garlic odour. Which of the following is the most likely diagnosis?

Q.2. A 6-week-old infant is admitted to the hospital with jaundice (see lab results). Test Results Normal Values Total bilirubin 65 <20.5 pmol/L Direct bilirubin 52 <5 pmol/L Which of the following is the most likely diagnosis?

Q.3. A 3-year-old child is brought to the Emergency Room after swallowing a battery that is now lodged in the esophagus. Which of the following is the most appropriate intervention?

Q.7. A 2-year-old boy presents with poor growth, abdominal distension and diarrhoea. On examination, he is at the 5th percentile on the growth chart. He looks pale, has abdominal distension, and wasting of the buttocks. Which of the following is the most likely diagnosis?

Q.8. A 7-month-old infant is brought to the clinic with a 2-day history of vomiting and diarrhoea. The stool is watery without mucous or blood. Examination reveals that the infant is only mildly dehydrated Which of the following is the most appropriate management?

Q.13. Which of the following methods of collection of urine for culture is most sensitive and reliable for establishing the diagnosis of a urinary tract infection?

Q.14. A 6-month-old infant is brought to the clinic with a 3-day history of watery diarrhoea. On examination, the infant is awake and alert but restless and eager to drink, had a depressed fontanel, tachycardia, normal pulses and sunken eyes. What would be the expected percentage of dehydration?

Q.15. A 10-month-old presents with fever, vomiting and copious watery diarrhoea for the past 3 days. Examination reveals a lethargic child with cool, dry skin, sunken eyes, tachycardia and mild tachypnea. Which of the following tests is the most likely confirm the diagnosis?

Q.22. A 2-year-old boy presents with poor growth, abdominal distension and diarrhoea. On examination, he is at the 5th percentile on the growth chart. He looks pale, has abdominal distension, and wasting of the buttocks. Which of the following is the most appropriate investigation?

Q.23. A 1-month-old baby is brought to the clinic with signs of constipation, abdominal distension, and bilious vomiting. The parents explain that constipation has been & a problem since the baby's Which of the following tests has the highest diagnostic value?

Q.27. A young child is brought to the Emergency Department after ingesting a large amount of baby aspirin. Which of the following is the most likely acid-base imbalance?

Q.28. A preterm newborn presents with abdominal distention and showed air lucency in the bowel Which of the following is the most likely diagnosis?

Q.29. What is the most common disorder of sexual differentiation in boys?

Q.30. A 7-year-old child is brought to the clinic. The parent reports yellowish-brown discoloration and carries on the occlusive surfaces of her teeth. Which of the following is the most appropriate treatment?

Q.31. Which of the following diets could cause kwashiorkor?

Q.34. Which of the following signs are more likely to be associated with haemophilia?

Q.35. A 3-month-old breastfed child becomes anorexic and develops generalized edema with some degree of aphonia. The infant is diagnosed with infantile beriberi. What vitamin deficiency does this infant have?

Q.38. A young boy developed gingival hypertrophy with enlarged, bluish purple friable gums. Which of the following vitamin deficiencies is the most likely the cause?

Q.44. A 7-year-old child presents to the Medical Outpatients with a parent who reports edema over the face. Examination of urine shows selective proteinuria (3.5 g/day). Which of the following is the most likely diagnosis?

Q.45. What is the daily fluid maintenance requirement in mi for a nine month-old child whose weights 10Kg?

Q.46. A 5-year-old child presents with features of glomerulonephritis. A week later, she developed hemoptysis. Which of the following is the most likely diagnosis?

Q.47. A 5-year-old child presents with drowsiness, abdominal pain, nausea and bloody diarrhea after ingesting an unknown number of iron tablets several hours before (see lab result). | Test Result Normal Value Iron 94 9-21.5 pmol/L. Which of the following is the most appropriate treatment?

Q.50. A 3-week-old infant is brought to the Paediatrics Clinic. On examination, a right, non-tender scrotal mass is seen. Its non-reducible and not transparent to light. Which of the following is the most likely diagnosis?

Q.51. A 10-year-old child presents with a high-grade fever, generalized body swelling, decreased urine output, and dark-coloured urine. Which of the following is the most appropriate first investigation?

Q.52. A child is brought to the Emergency Department after ingesting a potentially toxic dose of a relative's medication. Which of the following is the next step in management?

Q.57. A 13-year-old girl has a 10-month history of diarrhoea, postprandial periumbilical abdominal pain, and fever with weight loss. She has had several episodes of blood in her stools. Which of the following is the most likely diagnosis?

Q.63. A 15-year-old patient presents for a routine check-up (see lab results). Test Result Normal Values RBC 5.34.4-4.8 x 10121 WBC 68 4.5-10.5 x 109. Hb 98 112-165 g/L MCV 60 80-95 fi MCHC 261 260-340 g/L Reticulocyte 1.0 0.2-1.2%. Which of the following is the most likely diagnosis?

Q.71. When should breastfeeding begin after the delivery?

Q.72. A 1-year-old boy is noted to have a microcytic anaemia, on routine screening. A haemoglobin electrophoresis was performed that showed and increased fraction of haemoglobin A2. Which of the following is the most likely diagnosis?

Q.73. Which of the following physical findings in boys is the earliest indicator that puberty has begun?

Q.74. A 4-week-old infant is brought to the clinic with progressive, projectile, non-bilious vomiting with a palpable ‘olive in right upper quadrant. Which of the following is the most appropriate first investigation?

Q.75. A 19-year-old girl presents with short stature, wide-spaced nipples, and primary amenorrhea. What is the most likely karyotype?

Q.76. A 2-week-old newborn is brought to the clinic. The mother reports that her baby passes a small amount of unformed stool after each feed. The child is on breastfeed since birth. Which of the following is the most appropriate management?

Q.78. A 2-year-old African child is skinny with obvious muscle wasting, loss of body fat, and no edema | Which of the following malnutrition does this child have?

Q.81. A 1-year-old boy is diagnosed with factor VII deficiency with level of less than 1%. Which of the following investigations will be affected?

Q.84. A 9-year-old child with gastroenteritis caused by Shigella species. Which of the following antibiotics should be prescribed?

Q.86. Which of the following vitamins is administered to newborns to prevent haemorrhagic disease?

Q.87. A 13-year-old twins, one boy and one girl present with their parents at the clinic. The parent is concerned because one of the children appears to have entered puberty while the other has Which of the following should be explained about girls' puberty compared with boys?

Q.88. A 1-year-old infant presents with massive hepatosplenomegaly, skin bruises, and swelling in the lateral aspect of the neck. Which of the following is the most appropriate investigation?

Q.91. Which of the following viral gastroenteritis can be prevented by vaccination?

Q.92. What would be the best treatment of an uncomplicated cystitis in a 5-year-old girl?

Q.94. Which of the following investigations is the most important to perform on a child with enuresis?

Q.98. A 6-year-old boy presents with fever, On examination, he shows small white vesicles around his mouth and on his gum. Small discrete cervical lymph nodes are also palpable. Which of the following viruses is more likely to be associated with these symptoms?

Q.100. Which of the following radiographic signs is associated with Duodenal obstruction in a neonate?

Q.102. Which of the following is most appropriate management for Hirschsprung’s disease?

Q.106. A 16-year-old boy presents with 6-day fever and abdominal pain. He looks pale and toxic and had a tender and mildly enlarged spleen. What is the most sensitive culture to be recommended?

Q.113. A 3-year-old child presents to the Paediatric Emergency Department a half hour after ingesting a caustic material, The child is crying, drooling, and does not look well. Which of the following is the most appropriate initial management?

Q.115. A 14-year-old presents with photosensitivity, a malar rash, joint pains, and purpuric rashes on both legs. Urine examination shows red cells Which of the following is the most likely diagnosis?

Q.118. A 4-year-old boy with nephritic syndrome presents with vomiting, abdominal pain and diarrhoea. On examination, his abdomen is distended and there is an evidence of generalised and rebound tendemess. Which of the following is the most likely diagnosis?

Q.119. A 2-month-old girl has diarrhoea without vomiting. The mother is worried that she has dehydration and asks for advice on management Which of the following would be recommended?

Q.120. A 20-year-old woman gave birth to a boy who is severely jaundiced. She already has two children who were normal at birth. The woman has A-negative blood group and the newborn tested to be O-positive. Which of the following is the most likely cause?

Q.121. A 7-year-old child presents with a history of fever and pain in the lower abdomen for the past days. The parent reports that the child's urine has been foul smelling for the past 2 days (see report) Urine culture: Gram-negative bacteria, > 100,000 cells/ml. What is the most likely organism?

Q.124. A 1-year-old boy presents with prolonged bleeding after circumcision (see lab results). Test Result Normal Values Bleeding time 1.6 up to 4 min Prothrombin time 40 12-14 sec ; APTT 120 30-40 sec Platelets count 160 150-400 x 109/L Which factor deficiency is the most likely cause?

Q.125. Which of the following is the most common intra-abdominal tumour in children?

Q.127. A 5-day-old infant has significant nasal and rectal bleeding. He was delivered by a midwife at home. The pregnancy was normal and the baby had good Apgar scores. He is breastfeeding well. Which of the following vitamin deficiencies is the most likely the cause?

Q.128. A 6-year-old child has asymptomatic haematuria. There is no significant past medical history and the physical examination is unremarkable (see lab result). Urinalysis Result Normal Value Erythrocytes 15 0-2 per HPF Which of the following should the initial evaluation include?

Q.129. A 5-year-old child presents with bleeding from the nose and gums and easy bruising of the extremities for 3 days. Prior to this presentation, the child had a viral upper respiratory tract ; infection. Which of the following is the most likely diagnosis?

Q.130. Which of the following findings would support a diagnosis of Turner's syndrome?

Q.135. Which of the following vaccines is used for immunization against Hepatitis B virus?

Q.136. A 6-month-old child regularly regurgitates a large portion of his feeds. A pH probe study shows significant periods of low oesophageal pH. The child has normal growth and no other significant past medical history. Which of the following is the most appropriate management?

Q.137. Which of the following conditions can lead to hyposplenism?

Q.139. A 3-year-old girl presents with a high-grade fever and chills. Physical examination, confirms that she is anaemic with splenomegaly. Clinical image with giemsa stain is shown (see image). Which of the following is the most likely etiology?

Q.140. A 10-month-old child has a 3-day history of green watery stools. She has also been vomiting for 1 day. Physical examination confirms an afebrile, iritabie baby with dry mucous membranes and sunken eyes. Which of the following is the most important management strategy?

Q.145. A 2-year-old boy presents to the clinic with abdominal pain, malaise, fever, nausea and vomiting. He has a history of 2 urinary tract infections. A contrast-voiding cysto-urethrogram is requested (see image). Which of the following is the most likely diagnosis?

Q.146. Which of the following is the most appropriate management of an asymptomatic umbilical hernia in a 4-year-old?