MCQ Februrary

Author: Dr Mobin Date: 11/11/11
Specialty: Pediatrics Medicine Examination: IMM/FCPS II/MCPS
Question 1.
A 2 year old boy presented with abdominal distention for the last 15 days. The mother also
complains of low grade fever. On examination the child is toxic and has a temperature of 101 F.
There is a palpable mass in the left lumber area measuring 5 x 6 cm. X-ray shows calcification in
the left lumber area.
a) Hepatoblastoma
b) Hydronephrosis
c) Hydroureter
d) Neuroblastoma
e) Wilms tumor
Key: Correct option is e
Importance: Essential
Difficulty level: Easy
Reference: Nelson Textbook of Pediatrics, page no 2137
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Question 2.
A 2 month old boy presents with history of fits for last 10 days. The mother explains that
she is hypertensive during pregnancy and developed fits herself. She has lost two kids in
infancy in the last two years. On examination the baby is irritable, crying and extending.
Anterior frontella is 2x2cm and he has high arched palate. He has fisting and tone and
reflexes are increased. His hemoglobin is 10g/dl, TLC 4000/mm3, Platelets 300000/mm3.
Serum calcium is 6.0 mg/dl, Serum Phosphate is 2.8 mg/dl and serum alkaline
phosphatase is 900 IU. The most likely diagnosis is:
a) Congenital Vitamin D Deficiency
b) Hyperparathyroidism
c) Vitamin D Resistant Rickets
d) Vitamin D Dependent Rickets type I
e) Vitamin D Dependent Rickets type II
Key: Correct option is a
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Question 3
A three year old girl presented with fever for two weeks. She has received a number
of antimalarials and antibiotics but to no avail. She also complains of severe pain in
her limbs and the pain is accompanied by pallor and bluish discoloration. On
examination she is 10 kg, temperature is 102 F, pulse rate 120/min, respiratory rate
40/min. Chest has bilateral crepatations, liver is 10 cm total liver span and spleen is 2
cm. She fights off any attempts to touch her limbs. Her blood CP shows Hb of 9.0
gm/dl, TLC of 9000/mm3, Platelets 10000/mm3 and ESR is 90 mm in 1st hour. Her
MP, urine DR and MCUG is negative for reflux. The most likely diagnosis is:
a) Juvenile Rheumatoid Arthritis
b) Osteomyelitis
c) Scurvy
d) Septic arthritis
e) Systemic lupus erythematosis
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Question 4.
A nine year old girl presented with difficulty in walking for the last six years. She can
barely walk ten steps and then she has to rest. Her mother tells you that she started
walking at the age of three years. She has had a trial of steroids from a neurologist. On
examination her vitals are stable. Gower sign is negative, there are no signs of proximal
muscle weakness, but her tone and reflexes are decreased bilaterally. She also has
trunchal weakness and cannot lift herself in prone position. There is no organomegaly.
Her ESR is 5mm/hr, CPK is 1190, LDH is increased, and SGPT is increased. Her NCV is
normal but EMG shows evidence of myopathy. The most likely diagnosis is:
a) Benign congenital hypotonia
b) Central core disease
c) Dermatomyositis
d) Nemaline rod myopathy
e) Polymyositis

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Question 5
A three years old girl presented with pallor. Her mother states that she developed these
symptoms for the last seven months. She has been admitted repeatedly in hospitals for
blood transfusions. Examination shows a malnourished girl with height for weight < 3
SD. Her liver is 3 cm below costal margin and spleen is 7 cm enlarged in its long axis.
Her blood examination shows Hemoglobin 4 gm/dl, Total leukocyte count 2,000/mm3,
platelet count 80,000/mm3. Peripheral smear shows normochromic microcytic anemia
and spherocytes. Her Retic count is 8%. Hemoglobin electrophoresis is normal. Coombs
direct test is positive. What is your most likely diagnosis?
a) Alpha thallesemia
b) Auto immune hemolytic anemia
c) B thallesemia Major
d) Hereditary Spherocytosis
e) Systemic lupus erythematosis
Key: Correct option is b
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Question 6
A 16 years old boy presents to OPD with complaints of muscular weakness. His father states that
the boy has never been to school and was late in walking. On examination the boy has coarse
facies, his height is 136 cm and lower segment is 62, his weight is 42 kg. There is no visible
goiter and muscle power is Grade 5/5. The calf muscles seem to be hypertrophied. The most
likely test to reveal the diagnosis is:
a) Blood glucose levels
b) Creatinine Phosphokinase
c) Growth hormone levels
d) Parathyroid hormone levels
e) Thyroid Stimulating Hormone
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Question 7
A two year old girl presented with pallor and decreased appetite. She has never been breast fed
and weaning was started at one year. On examination she is pale with sparse hair, weight and
height are below 3rd centile. She also has marked Hepatosplenomegaly. Her blood complete
shows Hemoglobin 6.0gm/dl, TLC 2700 mm3, Platelet 40,000/mm3. MCV 104 fl, Hb A 97 %,
Hb F 3%, Hb A 2 1%. The most likely diagnosis is
a) Celiac disease
b) Megaloblastic anemia
c) Thallesemia Intermedia
d) Thallesemia Minor
e) Viseral leshmeniasis
Key: Correct option is c
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Question 8
A 16 years old girl is brought to OPD for the reasons of not having started her menaces yet. The
mother is concerned because all the patients’ sisters had menarche at 13 years. On examination
the girl is short with height at 3rd centile and weight at 25 centile. She is not dysmorphic but a
murmur is present at upper right sternal border. The rest of clinical examination is normal. The
most likely diagnosis is
a) Down syndrome
b) Fragile X syndrome
c) Noonan syndrome
d) Turner syndrome
e) William syndrome
Key: Correct option is d
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Question 9
A 3 year old boy from interior Balochistan presents with low grade fever and abdominal
distention for the last 7 months. The boy is not vaccinated and his current caloric intake is
400/Kcal/day. On examination he is pale and emaciated. His height and weight are below 3rd
centile and he has mild coarse facies. His upper segment to lower segment ratio is 1.3:1. His liver
is enlarged 7 cm below coastal margin and spleen is enlarged 5 cm in its long axis. There is a
gibbus in his thoraco- lumbar spine and bronchial breathing is heard over Right upper lung. The
most likely diagnosis is
a) Tuberculous spine
b) Primary malnutrition
c) Morquio syndrome
d) Metaphysial dysplasia
e) Hurler syndrome
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Question 10
A 3 year old boy developed dysentery one week ago. He was treated in Out Patients Department,
now he has come back again with increasing pallor and lethargy for the last two days. On
examination the child is pale, jaundiced and his face is swollen. His blood pressure is 110/60 mm
Hg and chest examination is clear. His abdomen is distended but there is no organomegaly.
Hb 7.0 gm/dl Serum creatinine 4 mg /dl
TLC 24x10 9 Serum Sodium 126 mEq/l
Platelets 50x 10 9 Serum Potassium 5.3 mEq/L
What is the diagnosis?
a) Acute Renal Failure
b) Disseminated Intravascular coagulation
c) Idiopathic thrombocytopenic purpura
d) Hemolytic Uremic syndrome
e) Henoch Schonlein purpura
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Question 11
A 5 years old girl is brought to pediatric OPD by her mother for reasons of failing multiple times
in her class. Her mother states that the girl can’t stop talking. Examination reveals weight for
height <3SD, epicanthic folds and wide mouth. Auscultation of the precordium reveals grade II
systolic murmur at left sternal edge. Rest of the examination is within normal limits. The most
likely diagnosis is
a) Down syndrome
c) Noonan syndrome
d) Turner syndrome
e) William syndrome
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Question 12
A 6 year old girl presented to OPD because the parents have noticed that she does not hear since
birth. The parents also tell you that she was admitted in Nursery because she did not cry for 30
minute. Examination reveals malnourished girl with weight 15 kg, height 112 cm. She does not
seem to respond to voice commands. A smooth goiter is also noticed on Neck extension. What is
the likely diagnosis?
a) Growth hormone deficiency
b) Hyperthyroidism
c) Hypopitutrism
d) Hypothyroidism
e) Hypoparathryoidism
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Question 13
A 9 year old girl is brought to emergency with complains of not walking for 5 days. She also has
urinary and fecal incontinence. There is no history of trauma. Examination reveals decreased
tone, power and reflexes in both her legs. The upper limb neurological examination and cranial
nerve examination is normal. There is a sensory level at T 8. The most likely diagnosis is
a) Devic’s Disease
b) Gillian Barre syndrome
c) Spinal cord compression
d) Spinal cord infarction
e) Transverse myleitis
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Question 14
A 2 years old girl is brought to your OPD with the complaints that she is walking unlike her
other children. On examination the baby has swollen wrists, Harrison sulcus and bow legs. Her
investigations show the following.
S calcium 6 mg/dl
S Phosphate 4mg/dl
S Alkaline phosphate 1560
PTH Normal
What is the most likely diagnosis?
a) Fanconi syndrome
b) Lowe syndrome
c) Vitamin D Deficiency Rickets
d) Vitamin D Dependent Rickets
e) Vitamin D Resistant Rickets
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Question 15
You are called to attend a neonate for loose motions that have started since birth. Examination
reveals an irritable neonate with pulse rate of 160/min, respiratory rate of 60/min, Blood pressure
90/60 mm Hg. The baby is jaundiced, liver is enlarged with total liver span of 10 cm, the eyes
are puffy and on extension of neck a goiter is visible. On inquiry the mother states that she has a
thyroid problem and is on medication. The most likely diagnosis is
a) Inborn error of metabolism
b) Neonatal graves’ disease
c) Neonatal Hepatitis
d) Sepsis
e) Torch infection
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Question 16
A 4 year old girl was brought to pediatric OPD because of pallor and respiratory distress.
Examination revealed a pale girl whose liver is enlarged 10 cm total liver span and spleen is 6
cm in its long axis. The child is febrile and the chest X ray shows slight cardiomegaly. Her blood
CP shows Hb 6 gm/dl, TLC 2300/mm3, Platelets 40x 10 9 Peripheral smear shows Hypochromic
microcytic anemia with few sickle cells. The most likely diagnosis is
a) Alpha Thallesemia
b) B Thallesemia Major
c) Leukemia
d) Sickle cell anemia
e) Sickle thallesemia
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Question 17
A 2 year old baby is brought to your emergency with unconsciousness. The step mother states
that baby fell from her hands. Examination shows a GCS of 8/15, right pupil is dilated more than
the left, tone and reflexes are increased on right side of body. During examination the child
develops a fit confined to right side of body. The most likely diagnosis is
a) Child abuse
b) Cerebral Hemorrhage(idiopathic)
c) Encephalitis
d) Meningitis
e) Pontine Hemorrhage
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Question 18
An 8 year old boy presented with decreased vision and bed wetting since birth. Examination
reveals a chubby boy whose weight is 45 kg and height is 136 cm. he is wearing glasses. His
blood glucose fasting is 260mg / dl and urine sugar is 3 +. The most likely diagnosis
a) Cushing syndrome
b) Hypothyroidism
c) Lawrence Moon Beadle syndrome
d) Simple Obesity
e) Prader Walli syndrome
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Question 19
A 7 years old girl from naseerabad presents with low-grade fever and bloody cough for the last 2
weeks. The child is vaccinated and there is no family history of tuberculosis. The family lives on
a farm and father is Sheppard. On examination she is afebrile, BCG scar is present and
Respiratory rate is 50/min, trachea is central, Apex beat not displaced, chest movements
decreased on Right side, Percussion note is dull on Right side, Air entry is decreased no added
sounds. Liver is enlarged 14 cm total liver span. What is the most likely diagnosis?
a) Allergic bronchopulmonary aspergillosis
b) Coagulopathy
c) Hydatid cyst
d) Pulmonary hemosidrosis
e) Pulmonary tuberculosis
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Question 20
A 4-month-old infant presented with a history of fits for the last 3 months. The fits occur 3-4
times /day, are focal and more at night. Six of the 10 siblings have died from similar complaints
at similar age. When you see the child his weight, height, and head circumference are on the 50th
centile. He exhibits a rounded face with protruded abdomen. Neurological examination reveals
post ictal drowsiness, decreased tone, reflexes and power. Liver is palpable 4 cm below coastal
margin. The most likely diagnosis is
a) Cerebral palsy
b) Epilepsy
c) Hypocalcaemia
d) Hypoglycemia
e) Von Gierke disease
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Question 21
A 2-year-old boy from Zhob presented with swelling of his hands and feet for the last 5 days. He
has been receiving transfusions since 6 months of age. His caloric intake before admission is
300/ Kcal/ day, and he has never been weaned. Examination reveals a pale chubby child with
swelling of his hands and feet. His pulse rate is 130/minute and respiratory rate is 50/ minutes.
Both his liver and spleen can be felt to be enlarged. The most likely diagnosis is
a) Malnutrition
b) Sickle cell anemia
c) Sickle thallesemia
d) Thallesemia Intermedia
e) Thallesemia Major
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Question 22
A 10 years old boy presented with severe abdominal pain and dehydration. The abdominal
pain is crampy and diffuse for the last two weeks. On examination he has pulse rate of
110/min and blood pressure is 140/80 mm Hg. His blood sugar is 130-mg/ dl and urine is
negative for glucose, proteins and ketones. His Blood CP does not show any sickle cells and
TLC and Hemoglobin are normal. His serum Amylase is normal as his abdominal ultrasound.
a) Acute Intermittent Porphyria
b) Acute cholecystitis
c) Acute pancreatitis
d) Renal colic
e) Sub acute intestinal obstruction
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Question 23
A 6-year-old girl from Afghanistan presented with one-year history low-grade fever and
abdominal pain. Examination reveals a pale, malnourished girl with total liver span of 16 cm and
spleen 14 cm in its long axis. There is no free fluid. Blood CP reveals Hemoglobin is 5 gm/dl,
TLC 3000/cm3, and Platelets 20,000/mm3. The most likely diagnosis is
a) Abdominal tuberculosis
b) Chronic liver disease
c) Malaria
d) Thallesemia
e) Visceral Leishmaniasis
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Question 24
A 6-year-old girl comes to your OPD with complains of recurrent chest infections and sweating
during feeding and cyanosis when crying. Examination shows a cooperative your girl with heart
rate of 120/min, respiratory rate 40/min, and Apex beat is in 5th intercostals space, there is no
thrill and a grade 3 systolic murmur is heard over the upper left sternal border. The dorsalis pedis
and posterior tibial are full and bounding. The most likely diagnosis is
a) Atrial Septal Defect
b) Cardiomyopathy
c) Myocarditis
d) Patent ductus arteriosis
e) Ventricular Septal defect
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Question 25
A 6-year-old girl presented with severe headache for the last 2 weeks. On examination she is
lying in bed with her neck extended. She avoids light and motor examination shows increased
deep tendon reflexes and babiniski is extensor. Fundoscopy shows papilledema. Cerebrospinal
fluid examination is clear. MRI scan shows a rounded well defined opacity in the posterior
cranial fossa.
a) Astrocytoma (low grade)
b) Cerebral Abcess
c) Cerebellar hemengioma
d) Ependymoma
e) Medulloblastoma
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Question 26
An anxious mother brings her 6-year-old child to your OPD. She narrates that the child has had
two episodes of fits in the last one year. Since then the mother has notices that since then he has
been short of hearing and does not talk now. On Examination he is wasted child with height,
weight and head circumference > 3rd centile. He stares continuously at the examiners and does
not appear to hear and is unable to pronounce his own name.
a) Landau- Kleffner syndrome
c) Autism
d) Neurodegenerative disease
e) Deafness
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Question 27
A 12 months old girl presented with unable to sit for one month and swelling of feet for last 7
days. She has never been breast fed or weaned. Examination shows a pale girl with pedal edema.
Her height and weight are below 3rd centile. Her pulse rate is 110/min, respiratory rate 60/min,
liver is palpable 3 cm below coastal margin and there is a gibbus in lumbar spine. Her tone, poor
reflexes are decreased in both limbs, power is grade II bilaterally.
a) Tuberculous spine
b) Morquio syndrome
c) Hurler syndrome
d) Hunter syndrome
e) Metaphysial dysplasia
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Question 28
A 7-year-old boy presented with short stature and hunchback. His father states he is the shortest
among all his four brothers. On examination his height is 110 cm, weight is 15 kg, upper
segment: lower segment ratio is 1: 1. There is Gibbus in thoraco-lumbar spine. Chest X-ray
shows a consolidation over right middle lobe. What is the most likely diagnosis?
a) Metaphysial dysplasia
b) Tuberculous spine
c) Morquio syndrome
d) Achondroplasia
e) Hypochondroplasia
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Question 29
A 10 years old boy presented to emergency with difficulty in breathing. The attending doctor
concluded that there was no pneumonia and sent the child home. Next morning the boy is
brought again in coma. You notice that the respiratory rate is 70/min and GCS is 10/15. Also the
child is dehydrated. Which of the following tests is most likely to reveal the diagnosis?
a) Blood acetaminophen levels
b) Blood glucose
c) Chest X-ray
d) Echocardiography
e) Serum Electrolytes
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Question 30
An 8-year-old boy presented to your emergency with complaints of passing dark colored urine
for the last seven days. He was admitted for jaundice in the neonatal period and received an
exchange transfusion. On examination he is pale, liver is palpable 2 cm below costal margin,
spleen is 2 fingers enlarged but there is no free fluid in the abdomen. The most likely diagnosis is
a) Portal vein obstruction
b) Glucose 6-phosphate dehydrogenize deficiency
c) Cirrhosis
d) Crigler najjar syndrome type II
e) Budd chari syndrome
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Question 31
A five year old boy presents with precious puberty which started one year ago. Pubic hair tanner
staging is 4 and both testes are > 4 ml. Abdominal examination reveals a mass in the left lumber
area. The boy is most likely suffering from
a) Central precious puberty
b) Adrenal adenoma
c) Adrenal carcinoma
d) Testicular tumor
e) Pituitary tumor
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Question 32
A nine year old girl presents with swelling of her right wrist for the last 6 months. She has been
taking various analgesics but to no avail. Examination reveals a cooperative intelligent girl with
swelling of her wrist and deformity of her thumb. Her investigations show the following
Hemoglobin 10 gm/dl, WBC 15000/m m3 , Platelets 500,000 mm3, ESR 50 mm/hr, Rheumatoid
factor Negative, ANA Negative. What would be the appropriate therapy for this girl?
a) Hydroxycholoroquine
b) Methotrexate
c) NSAIDS
d) Steroids
e) Sulphasalazine
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Question 33
A 8 year old boy presented with swelling of his Right knee joint for the last two weeks. He was
diagnosed as suffering from Rheumatic fever and received Aspirin but failed to improve. On
examination he was febrile, and the Right knee joint is swollen and hot. The movements are
decreased to 10 degrees flexion. The precordium is clear, Air entry is normal. Spleen is palpable
3 cm in its long axis. Which of the following is most likely diagnosis?
a) Systemic lupus erythematosis
b) Rheumatoid arthritis
c) Rheumatic fever
d) Septic arthritis
e) Osteomyelitis
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Question 34
An 8 year old child presented to Pediatric OPD with complaints of lethargy, breathlessness and
passing dark colored urine. This started two days ago when he took anti malarial. Examination
reveals a pale, jaundiced child. His liver is palpable 2 cm below costal margin and spleen is 1 cm
enlarged. His blood tests show the following: Hemoglobin 4 gm/dl, TLC 21,000 mm3, Platelets
500,000 mm3, Retic count 10 %, Serum Bilirubin 3 mg/dl, and Coombs direct test is negative.
Which of the following is most likely?
a) Glucose 6 phosphate Dehydrogenase
b) Hereditary Spherocytosis
c) Thallesemia Major
d) Autoimmune hemolytic anemia
e) Hereditary elliptocytosis
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Question 35
A 7 year old boy presented to emergency after fall in the toilet. He had an episode of diarrhea 7
days ago and he subsequently recovered. He had been clumsy since morning but now he could
not bear weight. Examination reveals an irritable boy who does not have signs of meningeal
irritation. He has right facial palsy and tone power, reflexes are decreased in the lower limbs but
normal in the upper limbs. His CSF shows the following Protein 80 mg/dl, Glucose 40 mg/dl, 5
lymphocytes.
a) Cauda equina syndrome
b) Encephalitis
c) Gillian Barre Syndrome
d) Transverse Myleitis
e) Spinal cord compression
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Question 36
A 10 year old boy has presented with testicular swelling. The swelling has been present for last
six months and the matter has noticed that his voice has become hoarse and he has grown
rapidly. Examination reveals Tanner stage 4 pubic hair, and left testes is 5 cm and right testis is
10 cm in volume. His serum testosterone is 15nmol/l and FSH and LH are not detectable. Which
of the following is most likely to detect etiology of precocious puberty?
a) Abdominal ultrasound
b) Testicular Ultrasound
c) B- HCG
d) Biopsy of enlarged testis
e) Alpha Feto Protein
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Question 37
A 3 year old girl presented with loose motions for the last 3 months. She was born SVD, never
breast fed and weaned at the age of 2 years. Her height and weight both are below 3rd centile.
Her Stool D/R report shows H Nana. What is the most appropriate drug for this organism
according to WHO?
a) Albendazole
b) Mebendazole
c) Niclosamide
d) Metronidazole
e) Pyrantel pamoate
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Question 38
You are asked to examine a 6 months old for the complaints of not sitting. Her length and weight
are below 3rd centile. The head circumference is 34 cm. The eyes are set wide apart, facies are
coarse and testes are undecended. You also note that the child has broad thumbs and big toes.
The baby is most likely
a) Down syndrome
b) Turner syndrome
c) Klinefelter syndrome
d) Rubinstein-Taybi syndrome
e) Noonan syndrome
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Question 39
A 3 day old baby presented with fits confined to left side of his body. His Blood CP and serum
electrolytes are normal. CT scan shows porencephalic cysts. The baby is most likely to develop
which of the following in future.
a) Cerebral palsy
b) Mental retardation
c) Blindness
d) Deafness
e) Hemiplegia
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Question 40
A 2 year old boy presents with loose motions for the last one year. She was breast fed for one
year after which weaning was started. Examination reveals a pale, malnourished girl with height
and weight <3rd centile. She has wasted buttocks and protruded abdomen. You also notice small
papules and vesicles on her shins. These skin lesions are most likely
a) Erythema Nodusum
b) Erythema Multiforme
c) Dermatitis Herpatiformis
d) Acrodermatitis Enteropathica
e) Scabies
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Question 41
A one year old boy is brought to you because of respiratory distress. The patient is a diagnosed
case of Tetralogy of Fallot and underwent B-T shunt two days ago. On examination Respiratory
is 60/min and Air entry is decreased on right lower zone and Vocal resonance was decreased.
What is the most likely cause for his respiratory distress?
a) Consolidation
b) Collapse
c) Pherenic nerve injury
d) Aspiration
e) Shunt failure
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Question 42
You are asked to examine a baby for reasons of bilious vomiting. The baby is one day old and
the vomiting started two hours ago. You notice that the upper abdomen is distended and the child
has up slanting eyes and depressed bridge of nose. The most likely cause of this baby vomiting is
a) Duodenal Artesia
b) Jejunal Artesia
c) Illeal Artesia
d) Hirschsprung disease
e) Sepsis
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Question 43
A 29 weeks gestation baby who was being ventilated for Respiratory distress collapsed. There is
no murmur heard over the precordium and chest x ray shows endo-tracheal tube is correctly
placed. The most likely step in management would be
a) Do Arterial blood gases
b) Ultra sound brain
c) Echocardiography
d) Reinsert endotracheal tube
e) Give I/v fluids
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Question 44
A 6 years old girl who is a know case of celiac disease presents with fits. The fits are generalized
tonic clonic and last for few minutes. What is the most likely cause of fits?
a) Celiac crises
b) Hypoglycemia
c) Hypocalcaemia
d) Hypomagnesaemia
e) Hypophosphotemia
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Question 45
A two years old boy presented with acute loss of vision for two days. He was vaccinated three
days ago and yesterday he was noted to bump in into things. He is afebrile and has a GCS of
15/15. Fundoscopy reveals swollen optic disc. What is the most likely diagnosis?
a) Devic disease
b) Optic Neuritis
c) Papilledema
d) Raised Intracranial pressure
e) Transverse myleitis
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Question 46
A nine year old boy presented with yellowish discoloration of eyes and dark colored urine. He
has had multiple episodes like this in the past. On examination his eyes are yellow; his spleen is
palpable 4 cm below costal margins. He does not have hepatomeglay and he is not febrile. He is
most likely suffering from
a) Gilbert syndrome
b) Rotor syndrome
c) Dubin Johnson syndrome
d) Crigler Najjar syndrome
e) Hereditary Spherocytosis
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Question 47
A 6 weeks old girl presented with episodes of cough. The cough is associated with cyanosis and
vomiting. During one of the episodes the child suffered from apnea which lasted for 10 sec. Her
Respiratory rate is 50/min and there are no sub costal and intercostal recessions. Blood CP shows
Hemoglobin is 12 gm/dl, TLC 35000/mm3, DLC shows DLC shows 60% lymphocytes. Chest X
ray shows hyperinflation. Echo is normal, Barium studies are normal too. Which is the treatment
of choice?
a) Amoxicillin
b) Cefaclor
c) Erythromycin
d) Cefixime
e) Ceftriaxone
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Question 48
You are asked to examine a cerebral palsy child. When pulled to sitting position the child can
hold his neck, He cannot sit with support and he has scissoring when held vertically. When made
to lie prone he can’t lift his head. The age of the child is
a) 2 months
b) 4 months
c) 6 months
d) 8 months
e) 10 months
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Question 49
A 6 months old girl presents with fever for one month duration. She had been diagnosed at birth
with Down syndrome. On examination her temperature is 100 F, pulse 120/min, Respiratory rate
46/min. Her total liver span is 10 cm and spleen is 4 cm below costal margin. She has been
treated with multiple antibiotics and antimalarials. She has a pan systolic murmur at lower left
sternal border. Which of the disorders is most likely?
a) Cardiac failure
b) Kawasaki disease
c) Pneumonia
d) Sepsis
e) Sub acute infective endocarditis
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Question 50
A 1 year old girl was brought to pediatric OPD because the mother thought she could feel the
child chest beating. This problem has persisted since the child was born. On examination there is
pan systolic murmur heard over the mitral area, which radiates to the axilla. Chest X ray shows
cardiomegaly and echo confirms Mitral valve Prolapse. What would you advise the parents?
a) Benign nature of this condition
b) Treatment of heart failure
c) Aspirin to prevent embolus formation
d) Mitral valve replacement
e) Mitral valve repair
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Question 51
A 4 year old boy presents with inability to walk for the last 4 weeks. The baby was born SVD
and breast feeding was done for one month. The baby was then put on formula milk. Weaning
was stated at the age of 2 years. On examination the baby weighs 10 kg, length is 110 cm, and
there is severe limitation of movement in the right leg. The thigh is swollen and child cries on
touching it.
a) Rickets
b) Scurvy
c) Osteomyelitis
d) Septic arthritis
e) Hemophilia
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Question 52
A ten year old boy presented to your emergency with one month’s history of Headache. The
headache is becoming severe and is associated with vomiting. On examination he is febrile, has
left facial nerve palsy. Signs of Meningeal irritation are present and tone in the right upper limb
and lower limb is increased. His Red tympanic membrane is red and bulging. What is likely
diagnosis?
a) Cerebral Abcess
b) Meningitis
c) Encephalitis
d) Otitis Media
e) Mastoidistis
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Question 33

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Author: Dr Mobin Date: 11/11/11

Specialty: Pediatrics Medicine Examination: IMM/FCPS II/MCPS

the left lumber area.

Key: Correct option is e

Difficulty level: Easy

Reference: Nelson Textbook of Pediatrics, page no 2137

Specialty: Pediatrics Medicine Examination: IMM/FCPS II/MCPS

phosphatase is 900 IU. The most likely diagnosis is:

a) Congenital Vitamin D Deficiency

c) Vitamin D Resistant Rickets

d) Vitamin D Dependent Rickets type I

e) Vitamin D Dependent Rickets type II

Key: Correct option is a

Difficulty level: Easy

Reference: Nelson Textbook of Pediatrics, page no 50

Specialty: Pediatrics Medicine Examination: IMM/FCPS II/MCPS

a) Juvenile Rheumatoid Arthritis

e) Systemic lupus erythematosis

Key: Correct option is e

Difficulty level: Easy

Reference: Nelson Textbook of Pediatrics, page no 997

Specialty: Pediatrics Medicine Examination: IMM/FCPS II/MCPS

a) Benign congenital hypotonia

b) Central core disease

d) Nemaline rod myopathy

Key: Correct option is e

Difficulty level: Easy

Reference: Nelson Textbook of Pediatrics, page no 2548

Specialty: Pediatrics Medicine Examination: IMM/FCPS II/MCPS

platelet count 80,000/mm3. Peripheral smear shows normochromic microcytic anemia

direct test is positive. What is your most likely diagnosis?

b) Auto immune hemolytic anemia

e) Systemic lupus erythematosis

Key: Correct option is b

Difficulty level: Easy

Reference: Nelson Textbook of Pediatrics, page no 2042

Specialty: Pediatrics Medicine Examination: IMM/FCPS II/MCPS

likely test to reveal the diagnosis is:

a) Blood glucose levels

c) Growth hormone levels

d) Parathyroid hormone levels

e) Thyroid Stimulating Hormone

Key: Correct option is e

Difficulty level: Easy

Reference: Nelson Textbook of Pediatrics, page no 2319

Specialty: Pediatrics Medicine Examination: IMM/FCPS II/MCPS

Hb F 3%, Hb A 2 1%. The most likely diagnosis is

Key: Correct option is c

Difficulty level: Easy

Reference: Nelson Textbook of Pediatrics, page no 46

Specialty: Pediatrics Medicine Examination: IMM/FCPS II/MCPS

most likely diagnosis is

Key: Correct option is d

Difficulty level: Easy

Reference: Nelson Textbook of Pediatrics, page no 504

Specialty: Pediatrics Medicine Examination: IMM/FCPS II/MCPS

most likely diagnosis is

Key: Correct option is a

Difficulty level: Easy

Reference: Nelson Textbook of Pediatrics, page no 1240

Specialty: Pediatrics Medicine Examination: IMM/FCPS II/MCPS

Hb 7.0 gm/dl Serum creatinine 4 mg /dl

TLC 24x10 9 Serum Sodium 126 mEq/l