WMC PedsMock Nov 2010

8/13/2019 WMC PedsMock Nov 2010

1/99

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


2/99

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.


3/99

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


4/99

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


5/99

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


6/99

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


7/99

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


8/99

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


9/99

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


10/99

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%


11/99

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


12/99

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


13/99

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.


14/99

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


15/99

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


16/99

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


17/99

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


18/99

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


19/99

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


20/99

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


21/99

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


22/99

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


23/99

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


24/99

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


25/99

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


26/99

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


27/99

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


28/99

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


29/99

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


30/99

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


31/99

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


32/99

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


33/99

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


34/99


35/99

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


36/99

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


37/99

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


38/99

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


39/99

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


40/99

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


41/99

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


42/99

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


43/99

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


44/99

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


45/99

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


46/99

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


47/99

48. Most appropriate antibiotic for this patientis:

a. Ampicillin

b. Clarithromycinc. Gentamicin

d. Ofloxacin

e. Vancomycin


48/99

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


49/99

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


50/99

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


51/99

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


52/99

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


53/99

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


54/99

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


55/99

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.


56/99

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


57/99

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


58/99

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


59/99

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


60/99

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


61/99

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


62/99

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


63/99

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


64/99

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


65/99

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


66/99

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


67/99

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


68/99

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


69/99

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


70/99

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


71/99

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


72/99

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


73/99

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


74/99

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


75/99

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


76/99


77/99

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


78/99

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


79/99

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


80/99

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


81/99

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


82/99

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


83/99

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


84/99

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


85/99

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


86/99

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.


87/99

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


88/99

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


89/99

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


90/99

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


91/99

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


92/99

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


93/99

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


94/99

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


95/99

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.


96/99

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


97/99


98/99

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


99/99

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

Documents

WMC PedsMock Nov 2010