wmc pedsmock nov 2010
TRANSCRIPT
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Q.1. 7-years-old girl has staring spells. Each
attack lasts 9-10 seconds. EEG shows
bursts of 3/second spike waves. Her spells
can be precipitated by hyperventilation.
These attacks are characteristic of:
a. Myoclonic epilepsy
b. Temporal lobe epilepsy
c. Absence epilepsy
d. Grand mal epilepsy
e. Infantile spasms
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Q.2. Child who had been vaccinated for
hepatitis B in the past will show the
following serological evidence that he
has been vaccinated against hepatitis B.
a. Hepatitis B surface antigen
b. Hepatitis B core antibody
c. Hepatitis B e antibodyd. Hepatitis B surface antibody
e. Both hepatitis B surface antigen and
surface antibody.
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Q.3. 5-years old boy is brought to OPD who is
small for his age. Which is most appropriatepart of the body to be x-rayed for BONE AGE?
a. AP view of right hemi thorax
b. Left hand and wrist
c. Skull x-ray
d. AP view of both ileosacral joints
e. Lateral view of left foot
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Q.4. Mother brought her 2-years-old son in A/E with
complaints of high grade fever and noisy
breathing. Birth history is normal and isfully vaccinated. On examination he appears
anxious, temperature 104 F, audible stridor
& drooling Saliva. Most likely DIAGNOSIS?
a. Acute Tonsillitis
b. Diphtheriac. Acute Epiglottitis
d. Viral Croup
e. Acute Tracheitis
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Q.5. The above mentioned child is becoming
increasingly distressed. Immediate step in theMANAGEMENT of this child would be:
a. Give IVcefotaxime
b. Send him for X-ray neck lateral view
c. Examine his throat
d. Intubate and secure his airways
e. Take blood cultures
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Q.6. 10-year old child was treated as viral URTI by
his GP. Now he is brought in emergency with
severe breathing difficulty. Past history isunremarkable and vaccination history is
unknown. On exam, he is sick looking boy with
bull neck appearance and grey membrane
covering the pharyngeal tonsils. What will bethe most likely DIAGNOSIS?
a. Pertussisb. Streptococcal sore throat
c. Diphtheria
d. Scarlet fever
e. Infectious mononucleosis
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Q.7. 2 years-old child is noted to assume squatting
position frequently during play. Mother also
notices bluish discoloration of lips duringthese episodes. On day of admission child
becomes restless, dyspnenic and deeply
cyanosed. Within 10 minutes, he becomes
unresponsive. The most likely CAUSE is:
a. Cardiomyopathy
b. Anomalous coronary arteryc. Tetralogy of Fallot
d. Atrial septal defect
e. Ventricular septal defect
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8. Which of following X-ray finding/s suggestiveof above mentioned case?
a. A globular heart shadow
b. Egg on side appearancec. A boot shaped heart with oligemic
lung fields
d. A boot shaped heart with plethoric
lung fieldse. Figure of 8shadow
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9. Term newborn presents with bilious vomiting
shortly after first feed. Pregnancy was
complicated by polyhydramnios. She has
passed normal meconium stool. Abdomen is
slightly distended and facial features are
characteristic of Down syndrome. What is mostlikely DIAGNOSIS in this baby:
a. Duodenal atresia
b. Hirschsprung diseasec. Meconium ileus
d. Midgut volvulus
e. Pyloric stenosis
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10. Mother brings 9-month old girl for
vaccination. On exam she looks quite pale
with liver 1-cm and spleen 4-cm belowcostal margins. CP reveals microcytic-
hypochromic anemia with retics 5 %.
Which one statement is most likely to betrue about HB ELECTROPHORESIS?
a. HbF of > 90 %
b. HbA of 30 - 40 %c. HbF of 1 - 2 %
d. HbA2 of 90 %
e. HbA of 90%
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11. Lady comes in 20th week of second pregnancy.
First child at birth had bilateral hydronephrosis
& posterior urethral valves required surgicaltreatment. Mother wants her fetus to be
evaluated for renal anomalies. MOST
appropriate procedure for diagnosing fetal
RENAL ANOMALIES is:
a. Amniocentesis
b. Chorionic villus biopsyc. Fetal ultrasonography
d. Magnetic resonance imaging
e. Measurement of fetal urine electrolytes
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12. 35-year-old woman delivers son. Pregnancy
complicated by polyhydramnios. Infant is
hypotonic and dysmorphic features. Babybegins to have bile-stained vomitus after first
feed. Radiography and surgery confirmed
duodenal atresia. Most likely DIAGNOSIS is:
a. Down syndrome
b. Turner syndromec. Prader- Willi syndrome
d. Trisomy 18
e. Klinefelter syndrome
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13. 6 month old child is brought with large head
and inability to move his legs. According to
mother child had soft mass which was
removed after surgery. Exam reveals scar on
back in mid thoracic region. Which of following
if given during pregnancy willPREVENT THIS CONDITION?
a. Vitamin A deficiency.
b. Vitamin D deficiencyc. Iron deficiency
d: Folic acid deficiency
e. B 12 deficiency.
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14. 5-year old boy presents with 27 days history of
fever and weight loss. For last 3 days he is
having fits and drowsiness. Meningeal signs arepositive. CSF shows WBC500/HPF with neutros
l0% and l ymphos90%, RBCs50/HPF, protein
1000 mg/dl and sugar30 mg/dl. Most likely
DIAGNOSIS is:
a. Streptococcal meningistis
b. Tuberculous meningitisc. Viral meningitis
d. Encephalitis
e. Cerebral malaria
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15 3-years old child is brought to the OPD with
delayed walking. He is bottle fed on dilutedcow's milk and history of recurrent diarrhea.
Exam reveals wide wrists, open anterior
fontanelle and hypotonia. What will be the
MOST LIKELY FINDING in this case?
a. Increased serum calcium
b. Decreased parathyroid hormonec. Increased serum phosphorous
d. Raised alkaline phosphatase
e. Increased 1,25 dihydroxycholecalciferol
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16 A 6-day-old girl born at home is evaluated for
bruising and GIT bleeding. Laboratory findings
include partial thromboplastin time andprothrombin time > 2 minutes, serum bilirubin,
4.7 mg/Dl, alanine aminotransferase 18 IU,
platelet count 330,000/mm3.
MOST LIKELY CAUSE of her bleeding is?
a. Factor VIII deficiency
b. Factor IX deficiencyc. Idiopathic thrombocytopenic purpura
d. Liver disease
e. Vitamin K deficiency
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17. 28 -years old mother who is on ATT for last 3
months delivers healthy baby. MOST
appropriate step toPREVENT TUBERCULOSIS IN BABY?
a. Separate the baby from the mother till
she completes her therapy
b. Apply BCG immediately to the baby
c. Give him Isoniazid prophylaxis for
3 - monthsd. Give full course of ATT
e. Take a tuberculin skin test and manage
according to response
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18. 6 years old girl with asthma was well managed
on inhaled bronchodilators on as required
basis. For last 2 months her episodes ofwheezing have become more frequent occurring
at night and more than 2 episodes per week but
less than once per day. You will classify
severity of her asthma as:
a. Acute attack
b. Moderate persistentc. Mild intermittent
d. Severe intermittent
e. Moderate intermittent
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19. Normal infant of 12 months of age can:
a. Walk few steps and fall
b. Climb stairs
c. Run
d. Stand on one foot for few secondse. Jump
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20. 2-year-old child brought with complaint that he
does not see well at night. On exam he hassome dryness of conjunctivae and cornea. Child
should be treated with:
a 200,000 1.U of vitamin A on day 1
b. 200,000 I.U of vitamin A on day 1,2
and 14
c. 1500 I.U of vitamin A daily
d. 100,000 I. U of Vit A weekly for 4 weeks
e. Diet rich in vitamin A
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21. 2-years old boy has been diagnosed as
cystic fibrosis. Mother wants to know risk in
future pregnancy. What is theMODE OF INHERITANCE?
a. Autosomal Dominant
b. Autosomal Recessivec. X-linked Dominant
d. X-Linked Recessive
e. Multifactorial inheritance
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22. 2-years old boy was diagnosed as VSD at
6 months age. He has recurrent chest
infections and is failing to thrive. Theoptimal MANAGEMENT of child will be:
a. Wait till 5 years of age for VSD
repair
b. Give prophylactic antibiotics
c. Continue diuretics onlyd. Do surgical repair now
e. Repeat an Echo
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23. Student of class-10 is made fun of at school
because of her short stature and slow in
studies. She has not started menstruating yet.The parents gave history of edema of hands &
feet when she was born. Which of following
TESTS you would suggest for diagnosis of her
suspected condition?
a. Chromosomal analysis
b. Growth Hormone levelc. Serum Cortisol level
d. Renal function tests
e. Thyroid function tests
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24. Mother brings her 18-months old child with
complaints failure to walk and sits with support
only. He was delivered at term after difficultdelivery. On general exam his weight, height
and OFC are on 5th Centile with drooling saliva,
lateral squint of left eye and scissoring of legs.
On neurological exam you would expect:
a. A sensory loss in lower limbs
b. Brisk reflexes and up going plantarsc. Bowing of legs
d. Decreased tone with diminished reflexes
e. VII - cranial nerve palsy
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25. 5-years-old child recently diagnosed as epilepsy
started on oral sodium valproate, is brought to
A/E with jaundice for 10 days. On exam he iscomatosed, jaundiced, multiple bruises all over
body. Liver 3 cm below right costal margin.
Most likely DIAGNOSIS is:
a. Hepatitis B
b. Hepatitis Cc. Hepatotoxicity caused by Sod. Valproate
d. Cholelithiasis
e. Choledochal cyst
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26. 7-years old girl presents with 3 days history
of fever and rash. On exam she has multiplevesicular lesions all over body. Some lesions
are maculopapular and some fluid filled.
Most likely DIAGNOSIS would be:
a. Erythema toxicum
b. Staphylococcal scalded skin syndrome
c. Chicken pox
d. Herpes Zoster
e. Herpes Simplex
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27. 4 - years old girl comes with acute abdominal
pain. Mother gives history of bilateral swellings
below her jaws & extend behind ears. On exam
she febrile and marked tenderness over the
epigastrium. Which one of following TEST will
help making diagnosis?
a. Serum Amylase
b. Liver function testsc. Barium meal examination
d. Upper GIT Endoscopy
e. Abdominal sonography
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28. 7-years old child presents with acute
migratory arthritis and fever for 10 days.
He had sore throat 3-weeks back. Onexam temp 101F, pulse 120/min,
resp 40/min and pericardial rub. What is
the most likely DIAGNOSIS?
a. Acute rheumatic fever
b. Acute rheumatic fever with carditisc. Juvenile Rheumatoid arthritis
d. Septic arthritis
e. Reactive arthritis
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29. 10-years old boy with runny nose and fever is
treated with cotrimoxazole. 2- days later, he
develops sudden pallor, jaundice and darkcolored urine. He had similar episodes in the
past. On exam pale child, spleen 2 cm below
costal margin, Hb 6 gm/dl, and retics 8%.
Most likely diagnosis:
a. Chronic liver disease
b. Acute hepatitisc. Acute glomerulonephritis
d. G 6 P D deficiency
e. Malaria
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30. 8-year-old boy suspected as Duchenne
muscular dystrophy (DMD) is referred to your
clinic. On exam has enlargement of both calvesand while walking seems to have waddling gait.
Which of following SIGNS is most consistent
with DMD?
a. Foot drop" gait
b. Positive Gower signc. Increased deep tendon reflex
d. Hyperreflexia
e. Positive Babinski sign
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31. Total CALORIC INTAKE of a child weighing15 Kg would be:
a. 1 000 Kcal per day
b. 1250 Kcal per day
c. 1500 Kcal per day
d. 1700 Kcal per day
e. 1900 K cal per day
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32. 12-years old boy with H/O fever for I-
week. He also had diarrhoae for few days
but now he is constipated and hasheadache. On exam febrile, acutely ill,
liver and spleen slightly enlarged. There
are palpable small erythematous spots on
the trunk only. This child probably has:
a. Measles
b. Typhoid feverc. Scarlet fever
d. Leptospirosis
e. Meningococcal bacteremia
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33. 2-week-old infant for follow-up visit. Mother
tells that he has been very slow eater and is
constipated, not having had bowel movement
in 3 days. On exam, infant has poor muscletone, enlarged tongue, umbilical hernia,
enlarged anterior fontanelle, and hypothermia.
He is slightly jaundiced, with dry skin and
brittle hair. Which of the following is the most
likely DIAGNOSIS?
a. Beckwith-Wiedemann Syndromeb. Congenital hypothyroidism
c. Hurler syndrome
d. Trisomy 21
e. Turner syndrome
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35. 5-years old boy is being evaluated for TB due to
chronic cough and weight loss. At birth he wasimmunized against TB. Mantoux applied.
Which one of following would be highly
suspicious for DIAGNOSIS OF TB?
a. Induration between 5-10 mm
b. Redness more than 10 mm
c. Induration more than 10 mmd. Redness between 5-10 mm
e. Induration less than 5 mm
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36. 8-years-old boy developed high-grade fever with
chills and rigors, headache and abdominal painfor 2 days. On exam he is pale, sweating and
splenomegaly. Which one of following
LAB TEST will be Most appropriate?
a. Serum electrolytes
b. Liver function tests
c. Peripheral blood smeard. Lumbar puncture
e. Ultrasound abdomen
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37. Baby develops respiratory distress on
2nd
-day of life. His blood gases are:PH-7.2, PC02-60 mmHg, P02-50 mmHg,
HC03-18mEq and Fi02-70%.
How will you INTERPRET these findings?
a. Respiratory alkalosis
b. Metabolic acidosis
c. Respiratory acidosisd. Metabolic alkalosis
e. Normal blood gas
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38. Mother of 1- year old child comes with the
concern that baby is not talking well. You
would tell the mother that at this age child is
ABLE TO:
a. Make noise only
b. Speak 2-3 words
c. Tell his named. Form a proper sentence
e. Speak around 20 words
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39. Infant born prematurely and SGA quite ill,
jaundice, fever, hepato-splenomegaly, rash,
myocarditis and fits. CT shows hydrocephalus& intracranial calcifications. Mom has a cat and
used to clean cat's litter box during pregnancy.
Which of the following is the likely
CAUSATIVE AGENT?
a. Cytomegalovirus
b. Herpes simplexc. Rubella virus
d. Toxoplasma gondii
e. Treponema Pallidum
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40. 10-years old boy presented with jaundice for 7
months. He also had one episode of haemetemesis.
On exam he had hepatosplenomegaly, ascites and
prominent abdominal veins. Lab showed:
S. bilirubin: 12 mg %, Direct: 6 mg %
ALT: 150 IU/dl, AST: 440 IU/dl
Alkaline Phosphatase: 800 IU/dl
The most likely CAUSE OF JAUNDICE in this child is:
a. Acute lymphoma
B. Acute leukemia
C. Chronic liver disease
D. Intestinal tuberculosis
E. Acute hepatitis
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41. 15-months old infant brought to clinic for
follow up. There is h/o neonatal jaundice andrequired exchange transfusion. On exam he has
motor and speech delay and slow response to
loud noise. What is best
ADVICE TO THE MOTHER?
a. Perform tympanogram
b. Perform auditory evoked responses
c. Plan for cochlear implantd. Advise hearing aid
e. Reassure the mother
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42. 4-years female child brought with frequent
rhinitis and chest infection. On exam she isshort with coarse facies, corneal opacities,
large tongue, kyphosis and
hepatosplenomegaly. What is the most likely
clinical DIAGNOSIS?
a. Hypothyroidism
b. Down's syndrome
c. Mucopolysaccharoidosisd. Thalassemia
e. Glycogen storage disease
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43. 7-months-old child with H/O fever 2-days,
presents with GTC fits for approximately
10 minutes. On exam he is irritable,lethargic, slightly bulging fontanelle,
rectal temperature 103F. Which one of
the following most appropriate initial
DIAGNOSTIC TEST?
a. CT scan head
B. ElectroencephalographyC. Lumbar puncture
D. Blood sugar
E. Serum calcium
44 9 ld hild t d ith j di
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44. 9-years old child presented with jaundice,
abnormal behaviour, involuntary movements.
Family history of jaundice in two of his siblings.
On exam he has abnormal body posture andhepato-splenomegaly. Lab showed;
S.bilirubin: 8 mg/dl, ALT: 176 IU
AST: 400 IU
Next INVESTIGATION of choice would be:
a. HBsAgb. Anti HCV antibodies
c. MRI brain
d. Serum ceruloplasmin level
e. EEG
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46. 9-months old child brought in ER with H/O
watery stools 10-12 times in last 12 hours. Child
is crying continuously and very thirsty whengiven water. His anterior fontanelle is slightly
depressed and the skin goes back slowly after
pinch. According to WHO programme
recommended action in his MANAGEMENT is:
a. Set up an IV line and rehydrate the child
B. Prescribe ORS and send child home
C. Rehydrate the child with ORS undersupervision for 4-6 hours
d. Give no treatment and send child home
e. Start IV antibiotics
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47. 4-years-old boy presents with fever and cough
for 5 days. On exam he appears acutely ill, temp
104F, resp rate 47/min. Chest reveals dullnesson percussion and diminished breath sounds
over lower left chest. CXR shows homogenous
opacity in left lower lobe. Most likely
ORGANISM causing this illness is:
a. Influenza virus
b. Mycobacterium tuberculosisc. Mycoplasma pneumoniae
d. Staphylococcus aureus
e. Streptococcus pneumoniae
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48. Most appropriate antibiotic for this patientis:
a. Ampicillin
b. Clarithromycinc. Gentamicin
d. Ofloxacin
e. Vancomycin
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49. Mother brings 6 years old son to OPD
for evaluation of enlarged lymph nodes
in neck. He has H/O cough and lowgrade fever for 2 months. What is most
important QUESTION IN THE HISTORY
that will help you reaching diagnosis oftuberculosis?
a. MMR vaccination
b. Family history of TBc. Breathing difficulty
d. Chest pain
e. Shivering and rigors
50 1 month old baby exclusively breast fed
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50. 1-month-old baby exclusively breast-fed
brought with H/O passing 5-7 stools / day since
birth. On exam looks normal thriving, alert baby
moving his limbs. What is the most likelyEXPLANATION?
a. He has diarrhea and should be treated
with antibiotics
b. Mother's milk is not suitable and should
be bottle-fed
c. He is well, mother should be reassuredd. Mother should avoid taking beef in her
diet
e. Mother should stop breast feeding and
give ORS
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51. Previously healthy 14-months old child presents
with acute onset of cough, choking, breathing
difficulty for 24 hours. There is no family history
of asthma. Elder sister told that both were
playing and had eaten peanuts. Exam reveals
respiratory rate 50 / min and wheezing. Themost likely DIAGNOSIS is:
a. Anaphylaxis
b. Bronchiolitisc. Cystic fibrosis
d. Foreign body aspiration
e. Pneumonia
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52. 6-weeks old infant brought with fever and cough
for 4-days. On clinical exam he dyspneic and
tachypneic. According to ARI protocol in this
age group tachypnea is RESPIRATORY RATE
of:
a. 60 breaths / min or more
b. 50-59 breaths / min
c. 40-49 breaths / mind. 30-39breaths / min
e. 20-29 breaths / min
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53. 4 - month baby is brought in A/E with complaint
of breathing difficulty since morning. There is
H/O of cough, coryza and low grade fever for
3-days. On exam he is cyanosed, resp rate 70
and marked subcostal recession. On auscul of
chest fine inspiratory crackles and high pitched
ronchi. Which of the following FINDINGS areexpected on chest x-ray?
a. Hyperinflated lung fields
b. Enlarged cardiac shadowc. Prominent pulmonary plethora
d. A lobar collapse
e. Pleural effusion
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54. What is the most common causative
ORGAMISM resulting in the above
mentioned clinical condition?
a. Herpes simplex virus
b. Coxsackie B virus
c. Rubella virus
d. Respiratory syncitial viruse. Ebstein virus
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55. 10-years old boy presents with H/O headache
and dark colored urine for past 1-week and low
urine output for 4-days. On exam he is afebrilewith BP of 135/90 mmHg and no other positive
finding. What will you most likely finding on his
urine examination?
a. Gross hematuria
b. Epithelial casts
c . RBC Casts
d. WBC Casts
e. Pus cells
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56. 3-years old girl brought by her mother who
noticed mass in right side of her abdomen
while bathing the child. Ultrasound
confirmed mass to be renal in origin. What is
the most likely DIAGNOSIS?
a. Neuroblastoma
b. Wilms Tumour
c. Lymphomad. Appendicular mass
e. Tuberculous lymphadenitis.
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57. 4-years-old child experienced URTI, which was
followed 2-weeks later by generalized edema.His BP is normal. Urine analysis, shows 2-3
RBCs/hpf, Protein ++++, BUN 19, creatinine 0.6
mg/dl, serum cholesterol 402, albumin 1.2g/dl.
Most likely DIAGNOSIS is:
a. Post streptococcal Glomerulonephritis
b. Membranous Glomerulonephritis
c. Minimal change Nephrotic syndromed. Rapidly progressive Glomerulonephritis
e. Focal segmental Glomerolosclerosis
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58. Above mentioned patient on third day of
admission complains of severe abdominal
pain and vomiting. On examination she is
febrile with abdominal distention and
tenderness all over abdomen. What is the
most likely COMPLICATION that she hasdeveloped?
a. Gastritis
b. Peritonitisc. Intestinal obstruction
d. Acute appendicitis
e. Renal stones
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59. 8-years-old girl presents with fever, vomiting
and acute left loin pain for 5-days. Exam
reveals a temp of l04F and BP 105/68 mmHg.
Urine showed positive urine nitrite test, 100
WBCs/HPF, CP shows TLC 25,000/mm3, 4%
bands and 80% neutrophils. MOST likelyDIAGNOSIS in this child is:
a. Acute appendicitis
b. Acute cystitisc. Acute Pyelonephritis
d. Mesenteric adenitis
e. Left ureteric stone
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60. While resuscitating a newborn, chestcompressions should be started when heart
rate is less than
100 beats per min
90 beats per min
80 beats per min
70 beats per min60 beats per min
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61. 2-years child presented in OPD with H/O fever,
malaise for 4-days. He then develops inability to
stand and walk. He is partially immunized.Exam revealed conscious irritable child with
stable vitals, flaccid weakness and absent
reflexes in left lower limb. Sensations are
intact. Most important INVESTIGATION in thischild is:
a. CSF analysis
b. Stool for virology
c. Nerve conduction studies
d. EMG
e. MRI spine
62 I f ffi f I h k Hi
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62. Infant comes to office for I-year check up. His
father is worried that his son is smaller than he
should be. Child weighs 8.9 kg and length 71
cm. He appears to be growing appropriately on
his growth chart. Which of the following is most
appropriate EXPLANATION ABOUT GROWTH?
a. Infants usually double their birth weightby 1 year
b. Infants usually triple their birth weight by
1 year
c. Infants usually quadruple their birth
weight by 1 year
d. Infants usually double their length by 1 year
e. Infants usually triple their length by 1 year
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63. 3-years old boy presents with pallor. He has
poor appetite and like to take milk. He was
never hospitalized and no history of transfusion.
On exam he is pale, heart rate 110/min with
short ejection murmur at the left sternal edge.
CP showed Hb 6.0 gm/dl with microcytic
hypochromic picture. What is the mostAPPROPRIATE TEST to confirm diagnosis?
a. Bone marrow aspiration
b. Hemoglobin electrophoresisc. Serum ferritin level
d. Osmotic fragility test
e. Blood group
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64. 9-years old girl is due for splenectomy.Which of following VACCINES should be
given as prophylaxis?
a. MMR
b. Tetanus and Pneumococcal
c. Hepatitis B and H. Influenzae (Hib)
d. Pneumococcal and Hib
e. Tetanus and Hib
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65. A full term baby is delivered to 22 years old
primigravida by SVD. After delivery baby isfound to be gasping, lips and extremities are
cyanosed, heart rate is 80/ min. Tone in the
limbs is diminished and he responds weakly
to stimulation. His APGAR SCORE is:
a. 2
b. 4
c. 6
d. 8
e. 10
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66. 8 years old boy admitted with 2 weeks H/O
increasing pallor and lethargy. On exam he is
alert with petechiae all over his body. Hedoes not have any lymphadenopathy or
hepatosplenomegaly. CP shows Hb 6 gm/dl,
Platelets 38,000/cmm, RBC 2.8 cubic mm and
WBC 2,700/cmm. What is the most likelyDIAGNOSIS?
a. Idiopathic thrombocytopenic purpura
b. Henoch-Schonlein purpura
c. Aplastic anemia
d. Acute Myeloid leukemia
e. Severe sepsis
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67. Which of the following findings would you
expect in his bone marrow aspirate?
a. Blast cellsb. Hypo cellular Marrow
c. Hpercellular Marrow
d. Increased Magakaryocytes
e. Microcytic cells
68. A previously well 2 years girl presents with3 k H/O b i i l th d i it bilit
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3-weeks H/O bruising, lethargy and irritability.
On exam she has numerous bruises of different
ages, easily palpable liver and spleen.
CP reveals:
Hb: 7.6 gm/dl MCV: 79fl
WBC: 13,000/L Platelets: 26,OOO/L
Which investigation/s would be the Mostappropriate NEXT STEP?
a. Bone marrow aspirate and trephine
b. Serum iron, iron binding capacity andtransferrin saturation
c. Prothrombin time
d. Factor VIII & von Willebrand factor level
e. Serum anti-platelet antibodies
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69. 15-months-old infant has severe watery diarrhea
for 3 days. He now has a heart rate of 180/min,
capillary refill >4 seconds, and parched mucousmembranes. Serum sodium is 134 mmol/L,
bicarb 12 mmol/L, and serum creatinine 0.9
mg/dl. What is the first FLUID to administer to
this patient?
a. 3% NaCI solution
b. IV 5% dextrose with 1/5 normal saline
c. IV Ringer lactate
d. IV 5% Dextrose 0.45 normal saline
e. ORS orally
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70. A full term infant born normally becomes
cyanosed in delivery room. After intubationand attempts at stabilization, it is noticed
that the infant has a scaphoid abdomen and
decreased breath sounds over the left
hemi thorax. The most likely DIAGNOSIS is:
a. Pneumothorax
b. Cardiomegaly
c. Diaphragmatic herniad. Neuroblastoma
e. Atelectasis
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71. Children with uncomplicated tuberculosis can
attend school:
a. As soon as effective ATT has beenstarted
b. 2 weeks after initiation of therapy
c. Once negative sputum smears are
confirmedd. Once therapy has completed
e. When Mantoux test is negative
72. 2-years old child brought with poor feeding andi it bilit H i f d b t ilk 10 12 ti /d
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irritability. He is fed breast milk 10-12 times/day.
His mother gives him tea and fruit juices but he
eats almost no solid food. His weight is below
70% of expected weight for age. His height is
within normal range. His hair is friable, dry
rough skin over his body and has ankle edema.
What is the most likely DIAGNOSIS?
a. Celiac disease
b. Breast milk intolerance
c. Kwashiorkord. Cystic fibrosis
e. Immune deficiency
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73. Male baby born to diabetic mother at 38 wks
gestation by Caesarian Section, wt 4.4 Kg.On second day of life has episode of seizure.
On exam baby is afebrile, flat fontanel and
appears to be lethargic. Most important
NEXT STEP is?
a. Cranial Ultrasound
b. Lumbar Puncture
c. Complete Blood Countd. Serum Calcium
e. Check glucose with Glucometer
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74. Mother of 10-week old boy comes for
immunization. He has been properlyvaccinated before. According to the EPI
(Expanded Programme of Immunization)
which of the following vaccines will you give
to this child?
a. OPT + BCG + Hepatitis B+HiB
b. OPT + BCG + Measles+HiB
c. OPV + DPT + BCG+HiBd. OPV + DPT + Hepatitis B+HiB
e. OPT + Measles + OPV+HiB
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75. A female infant is born at 32 weeks of
gestation. She is limp and blue with norespiration. Heart rate is 70 /minute. After
drying and stimulation your NEXT STEP
would be to:
a. Give mouth to mouth breathing
b. Give oxygen via nasal cannula
c. Give oxygen via ambu bag and mask
d. Intubate the child immediatelye. Give oxygen by positive pressure
ventilation + closed chest massage
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76. 15-month old infant presents with poor dietry history.
His weight / height on 10th centile. Developmental
status is appropriate for age. CP shows:
TLC & platelet count - Normal
Hb - 8.2 gm/dl MCV - 110 ft
Retics - 0.8%
These haematological findings are CONSISTENT WITH:
a. Folate deficiency
b. Iron deficiencyc. Vitamin C deficiency
d. Vitamin D deficiency
e. Zinc deficiency
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78. Persistence of neonatal reflexes is anindicator of developmental delay.
The Moro reflex should DISAPPEAR by age:
a. 1 month.b. 2 month.
c. 6 month.
d. 9 month.
e. 12 month.
. - , ,coryza, conjunctivitis and erythematous
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maculopapular rash on chest and back. Fine
white spots are noted on buccal mucosa.
Mother would like to know when she can returnto school and not infect other children. You
would ADVISE her that she can return to
school:
a. As soon as her temperature returns to
normal
b. Once rash has completely faded
c. 5 to 7 days after the rash first appeared
d. 10 to 14 days after the rash first appeared
e. Once the cough has disappeared
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80. What is the best parameter for assessinglong term growth?
a. Mid upper arm circumference between
1 and 5 yearb. Weight for age
c. Height for age
d. Skin thickness
e. Head circumference
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81. 18 months old child brought to ER with H/O
fever, cough, and respiratory distress. On exam
his temp 101F, no cyanosis. Resp rate 55/min.
with sub costal recessions. According to ARI
programme disease is CLASSIFIED AS:a. No pneumonia (cough and cold)
b. Very severe disease
C. Severe pneumonia
d. Pneumoniae. Brochiolitis
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82. You are seeing an 8 year old boy with 100F
temp, bilateral tender parotid swelling, andpain when you flex his neck. He has been
complaining of headache. His immunization
history unknown. Most likely DIAGNOSIS is:
a. Brucellosis
b. Typhoid fever
c. Infectious mononucleosisd. Mumps
e. Leukemia
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83. 4-year old child brought to A/E having had a
brief, generalized tonic clonic fit. He hasacute bloody diarrhea for last 3- days. On
exam, he is drowsy, dehydrated. His temp
104 OF. CSF is normal. Most likely
ORGANISM causing this illness is:
a. Rotavirus
b. Enterovirus
c. Shigellad. Giardia lamblia
e. Salmonella typhi
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84. 10-months-old taken A/E after falling while learning to
walk. Toddler has an enlarging, swollen bruise on his
forehead, > 2- inches across. Parents say bruise isnoticeably larger than it was when they entered A/E an
hour earlier. Blood sample is drawn, and child oozes
blood at puncture site for 25 minutes. Lab shows
prolonged PTT and a normal PT. Followup studies show
very low levels of factor VIII. Which of following is mostlikely DIAGNOSIS?
a. Disseminated intravascular coagwlation
b. Hemophilia Ac. Hemophilia B
d. Hyperhomocysteinemia
e. Von Willebrand disease
85. You are called to the delivery of a baby at 42
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weeks' gestation with thick meconium stained
fluid. Nurse rapidly delivers the infant and
hands him to you for care. Baby is hypotonic,cyanosed, apneic, and having bradycardia.
Most appropriate NEXT STEP is to:
a. Stimulate infant to breatheb. Provide positive-pressure bag-and-mask
ventilation
c. Intubate the trachea and provide positive
pressure ventilation
d. Intubate the trachea and clean airways of
meconium
e. Administer epinephrine
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86. BCG vaccine is given:
a. Orally
b. Subcutaneouslyc. Intra dermally
d. Intravenously
e. Intramuscularly
87. 3-year old child comes with H/O tonic clonic
seizure at home lasted 5 minutes Parents
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seizure at home lasted 5- minutes. Parents
explain that he had similar episodes 7 months
back. His temp 101 F & congested throat. Restof the exam is unremarkable and he started
playing with his elder brother. Which one of
following would be most appropriate step in
MANAGEMENT?
a. Arrange admission for observation
b. Arrange an EEG within the next 72 hours
c. Perform lumbar punctured. Start him on anti epileptic drugs
e. Send him home on antipyretics after
counseling.
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88. 5-years old boy having pruritic eruption and
disturbed sleep for 3 weeks. On examination
he has lesions between digits, in the axillae
and genitalia. Most likely DIAGNOSIS is:
a. Atopic dermatitis
b. Impetigo
c. Scabies
d. Chicken poxe. Urticaria
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89. 6-week-old infant admitted with vomiting
5 days duration. Exam reveals dehydrated baby
with rapid heart rate and ambiguous genitalia.Serum Na-120 meq/L, K-7.5 meq/L, HC03-12
meq/L, BUN-20mg/dL. In addition to IV fluid
replacement with normal saline, administration
of one of following would be most important?
a. Diuretics
b. Potassium exchange resin
c. Glucose and insulin
d. Antibiotics
e. Hydrocortisone
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90. 3-year-old boy presents with nontender,
large, rubbery anterior cervical lymph node.He has Amoxicillin Clavulinate for 10 days
but no change in node. Results of Mantoux
reveal 8 -mm of induration. Best
DIAGNOSTIC PROCEDURE to undertake is:
a. Excision biopsy of the node
b. CXR
c. Gastric aspirate for cultured. Needle aspiration of the node
e. PCR for mycobacterium tuberculosis
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91. 1-year old child presents with fever, barking
cough and stridor for 3 days. On exam he isirritable and in respiratory distress, however,
taking his feeds. Most appropriate
TREATMENT option includes:
a. Salbutamol nebulization
b. IV fluids
c. Parenteral steroids
d. Broad spectrum antibiotics
e. Steam inhalation
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92. Tuberculosis in Pakistan:
a. Is a disease of poor people onlyb. Is a disease of middle class
c. Occurs sporadically
d. Will be eradicated within next 5 years
e. Is a serious public health problem
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93. One of following statements is true about BCG
vaccination:
a. It is live attenuated vaccineb. Dose is 1 mg/kg body weight
c. Does not leave any scar mark
d. It is given intramuscularly
e. One dose provides life long protection
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94. One of the following STATEMENTS is true:
a. Most children with ARI have pneumonia
b. To get an accurate count of resp rate
you must wake up the child
c. Giving an antibiotic to child with coughor cold will prevent from developing
into pneumonia
d. Fever is a danger sign in all children
under 5 years of agee. Pneumonia is one of the major cause of
mortality under 5 years in Pakistan
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95. 3-years old child presents with 1-year H/O
recurrent bouts of nocturnal cough.Following would support the diagnosis of
asthma except:
a. Presence of eczema in parents
b. Cough gets worst on exertion
c. Father is a smoker
d. History of choking before the onset ofcough
e. Cough is relieved by brochodilators
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96. 5-months old child who was born at term
after uncomplicated pregnancy will be
considered developmentally normal if he:
a. Can stand without support
b. Can sit without support
c. Has complete head control
d. Holds objects with pincer movement
e. Speaks 1-2 words.
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97. One of following confirms diagnosis ofbacterial meningitis in a child:
a. CSF TLC count > 250 cells
b. Child is unconsciousness at the time
of presentation
c. There is history of prolonged fit
d. CSF shows Diplococci on Gram stainE. Child has marked neck stiffness
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99. Previously healthy 10 years old boy presents
with progressive walking difficulty for last
2 years. Parents are first cousins and 15 years
old sister is bedridden. He has generalized
hypertonia, brisk tendon reflexes and upgoing
plantars. Most likely DIAGNOSIS is:
a. Cerebral palsy
b. Leukodystrophy
c. Duchenne muscular dystrophyd. Spinal muscular atrophy
e. Caries spine
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100. 8-years old child presents with headache for
6-months. It is mostly early morning and
sometimes associated with vomiting. Now he
has occasional fits and also complaining of
walking difficulty because of double vision.
Most appropriate NEXT STEP would be to have:
a. X-ray skull
b. CT head
c. Urgent EEGd. CSF examaination
e. Consultation from ophthalmologist