MBBS QIMS Final(A)2011,Pediatrics MCQS

1) The developmental level of an infant who sits without support , rolls from supine
to prone and attempts to attain toy beyond reach is:
a) 2 months
b) 4 months
c) 6 months
d) 9 months
e) 1 year
2) A 8 months old infant has two days history of diarrhea and fluid intake . On
examination he is found to have 10-15% dehydration. The most appropriate fluid
to begin resuscitation is
a) 5% Dextrose with 1/5 saline
b) 5% Dextrose with ½ saline
c) Normal Saline
d) Whole blood
e) 10% Dextrose
3) You are asked to see a two year old child who has high grade fever and refuses to
move his right leg. On examination he has a swollen and tender right knee that is
painful even on passive flexion. The single most important test to confirm you
diagnosis is :
a) Blood culture
b) Complete blood count
c) Erythrocyte sedimentation rate
d) Joint fluid examination
e) X-ray of knee joint
4) A two year old boy is brought by her mother because she noticed reddish
colored stools for the last two days. The child is otherwise well and has no fever
or vomiting. His pulse rate is 120/min and abdomen is soft to palpation. He is not
dehydrated. The test of choice for this child would be
a. Barium enema
b. Exploratory laparotomy
c. Radionucleotide scan
d. Stool culture
e. Ultrasound of Abdomen
5) A one year old boy is brought to you because the mother is concerned about her
vomiting since one month of life. His weight is 10 kg and height is 75 cm. The rest
of the physical examination is normal. The most likely diagnosis in this child
would be?

a) Gastroesophageal reflux disease

b) Hypothyroidism
c) Partial duodenal atresia
d) Pyloric stenosis
e) Trachea-esophageal fistula
6) A 10 months old boy is brought to you because of continuous crying since last
night . He has not vomited neither has he taken any feeds since the crying started. When
you examine the child, his legs are drawn to abdomen, temperature is 100 F ,abdomen is
tense and the baby is extremely irritable. Near the end of your examination he passes
loose watery stool. The single most important test in the diagnosis would be ?
a) Air contrast enema
b) Coagulation studies
c) Complete blood examination
d) Stool culture
e) Stool microscopy

7) A five year old boy is brought to you for constipation since birth. All his life , he
has been on laxatives. At birth he was kept in Nursery because he did not pass
stools for 3 days. Even on laxative he has one movement/ week. The most
important next step is
a) Barium enema
b) Oral anti spasmodic medication
c) Plain Abdominal X-ray
d) Psychiatry consult
e) Wait and see
8) A 12 year old boy presents with abdominal pain for the last one year. The pain
is more early in the day and before meals. His father is similarly affected since
childhood. The most likely diagnosis is ?
a) Appendicitis
b) Intussusception
c) Meckel diverticulum
d) Peptic ulcer
e) Pin worm infestation
9)A 10 week old boy presented with could and shortness of breath. On
examination respiratory rate is 64/min and there are bilateral rhonchi and
wheezes. There is history of eye discharge during the neonatal period. The most
appropriate therapy would be?
a) Acyclovir
b) Ceftriaxone
c) Erythromycin
d) Nafcillin
e) Penicillin G
10) A 9 year old presents with fever and cough. The cough usually occurs at day
and is accompanied by nasal discharge which is purulent. On Examination there
is tenderness on facial palpation and pus near the middle meatus. The boy has ?
a) Brain abscess
b) Maxillary sinusitis
c) Otitis media
d) Sphenoid sinusitis
e) Streptococcal throat infection
11) A 2 year old girl presents with 10 days history of unilateral foul smelling
nasal discharge and obstruction. Rest of examination is normal . The diagnosis
is ?
a) Choanal atresia
b) Deviated nasal septum
c) Foreign body
d) Frontal sinusitis
e) Nasal polyps
12) A 10 year old boy presents with inability to close his left eye. He suffered
from flu a few days back. You note that the face is deviated to one side and he is
drooling. The rest of examination is normal. The most likely diagnosis is ?
a) Brain stem tumor
b) Botulism
c) Cerebrovascular accident
d) Bells palsy
e) Guillain Barre syndrome
13)a one year old boy presents with low grade fever , runny nose and cough. On
examination his respiratory rate of 52/min, has nasal flaring, subcostal
recessions and wheeze present bilaterally. The most likely organism responsible
is ?
a) Corynebacteruium diptheriae
b) Echo virus
c) Haemophillus influenzae
d) Respiratory syncytial virus
e) Staphylococcus aureus
14)A known case of ventricular septal defect presents with poor feeding for last
2 weeks. On examination baby is apathic, respiratory rate is 64/min and he has
diffuse wheezes and crackles on auscultation. The age of the baby is 12 months
and his weight is same as was at 9 months. The most likely diagnosis is ?
a) Congenital heart block
b) Congenital heart failure
c) Cor pulmonale
d) Hypertrophic cardiomyopathy
e) Prolonged QT syndrome
15)A 10 year old girl presents with history of high grade spiking fever and
swelling of fingers. The most likely diagnosis is ?
a) Juvenile rheumatoid arthritis
b) Osteoarthritis
c) Rheumatic fever
d) Septic arthritis
e) Toxic synovitis
16) A 2 year old girl is brought to you because of fever and shortness of breath.
On examination she is pale , respiratory rate is 84/min, heart rate is 200/min,
heart sounds are muffled and gallop rhythm is heard. The most likely diagnosis is
?
a) Anomalous origin of left coronary artery
b) Endocardial fibroelastosis
c) Glycogen storage disease
d) Myocarditis
e) Pericarditis
17) A newborn is found to have congenital hear disease. What is the likely
incidence of heart disease in future children?
a) 1%
b) 2-6%
c) 8-10%
d) 15-20%
e) 25-30%
 18) A concerned mother brings her 4 days old newborn because of swelling in
the head. On examination there is a superficial swelling over the right parietotemporal
region that does not cross the suture lines. The most likely diagnosis is ?
a) Cephalohematoma
b) Caput Succedaneum
c) Intraventricular hemorrhage
d) Subarachnoid hemorrhage
e) Subdural hemorrhage
19)The signs and symptoms of meningitis in an infant can be different than those in
the adult patient. Which of the following is more helpful in an adult patient than an
infant?
a) Brudzinski sign
b) Jaundice
c) Hypothermia
d) Lethargy
e) Vomiting
20) A concerned grand mother brings a one day old newborn because she has
been advised by gynecology consult with the news that the mother is HBsAg positive.
The most appropriate action would be ?
a) Administer HBIG and Hepatitis B vaccine to the infant
b) Do nothing because it is self limiting
c) Isolate the neonate
d) Screen the neonate for HBsAg
e) Screen the mother for HBeAg
21) A 4 week old baby is brought by her concerned mother because of persistent
jaundice. You also find that the baby is constipated, sleepy and moves a bit. The
next step should be?
a) Starting L-thyroxin
b) X-ray of baby skull and extremities
c) Do laboratory test for bilirubin
d) Follow up in 2 weeks
e) Pediatric endocrinology consult
22) On day 3 a new born is found to have serum bilirubin of 15 mg/dl. Which of
the following is a risk for neurologic damage in this baby?
a) Hyperalbuminemia
b) Drugs such as sulfa drugs
c) Metabolic alkalosis
d) Neonatal Sepsis
e) Maternal ingestion of phenobarbital during pregnancy
23)Children with sicke cell disease need the following vitamin?
a) Vitamin A
b) Vitamin D
c) Vitamin K
d) Vitamin B complex
e) Folate
24)On day 1 of life, giving the following Vitamin is indicated ?

a) Vitamin A
b) Vitamin D
 c) Vitamin K
d) Vitamin B complex
e) Folate
25) A breast fed infant in cold damp Toba Achakzai needs which Vitamin?

a) Vitamin A
b) Vitamin D
c) Vitamin K
d) Vitamin B Complex
e) Folate
26) You are asked to assess the development of a child who can speak phrases, tells
you her age, can ride a tricycle. Your answer would be ?
a) 1 year
b) 2 years
c) 3 years
d) 4 years
e) 5 years
27) A 10 year old girl presents with 3 week history of fever an weight loss. On
examination she is toxic, has multiple petechiae and an apical murmur of grade 4/6 can
be heard. The most likely diagnosis is ?
a) Rheumatic fever
b) Aplastic anemia
c) Infective endocarditis
d) Systemic lupus erythematosis
e) Kawasaki disease
28) A very worried mother brings her 2 year old child because of fits. The fits occurred
after prolonged crying when the child was refused a toy in the super market. The child
becomes cyanosed and stopped breathing prior to fits. The next step would be to ?
a) Perform EEG
b) Perform ECG
c) Start anticonvulsants
d) Start Ritalin( Methyl phenidate)
e) Counsel the family about benign nature
29) You are asked to examine a 2 year old boy who happened to be present during
insecticide spray for dengue fever at his home. The boy on examination is short of
breath, drooling, has pin point pupils and is wheezing. The most likely cause is ?
a) Organophosphate
b) Cholorophenothane (DDT)
c) Cyanide
d) Warfarin
e) Paraquat
30) A one year old boy has presented with 3 days history of fever and loose motions. You
assess the patient to be with severe dehydration. The time over which he should be
rehydrated is ?
a) 1 hour
b) 3 hours
c) 4 hours
d) 6 hours
e) Half hour
31) If the EPI programme is implemented in letter and sprit with all infants receiving 3
doses of Hepatitis B vaccine, the incidence of which of the following diseases is likely to
go down?
a) Alcoholic liver disease
b) Dubin Johnson syndrome
c) Hepatocellular carcinomas
d) Hydrops of Gall Bladder
e) Neonatal hyperbilirubinemia
32) A foreign qualified PhD mother is concerned about her 1 month old baby that he
may die from sudden infant death syndrome. You advise the child to be placed in ?
a) Supine position
b) Prone position
c) Seated position
d) Trendelenberg position
e) Right lateral position
33) A 5 months old boy who has been given multiple OPV and Vitamin A during frequent
rounds of polio campaign is likely to suffer from ?
a) Edema
b) Kidney stones
c) Erythema of skin
d) Sensory neuropathy
e) Decreased cerebrospinal fluid pressure
34) You are asked about next pregnancy and newborn health by a 25 year old mother
who has a malar rash that becomes worse with sun exposure ,oral ulcer and joint
swelling. You are worried that the next child may have
a) Aniridia
b) Heart block
c) Spina bifida
d) Sacral agenesis
e) Microotia
35) A 3 day old newborn is brought to you because he becomes blue and unable to
breath. These episodes are worse during feeding and becomes better on crying. The
baby is likely to have ?
a) Choanal atresia
b) Congenital heart disease
c) Congenital lung malformation
d) Hemolytic anemia
e) Cleft palate
36) A 25 years old mother who has 7 days old newborn has developed chicken pox. The
most appropriate management step would be to ?
a) Isolate the infant
b) Admit the baby
c) Administer acyclovir to the infant
d) Administer varicella Zoster
e) Counsel the mother
37) an 0 positive 25 years old primigravida gives birth to a term newborn who is A
positive . His Hemoglobin on Day 1 is 19 gm/dl and his serum bilirubin is 10 mg/dl. You
suspect ABO incompatibility and you suspicion would be confirmed by
a) Increased Hemoglobin
 b) Positive direct Coombs test
c) Normal Retic count
d) Crescent shaped red blood cells on peripheral smear
e) Petechie
38) on your Nursery round , you notice a 1.5 kg preterm infant who has just been
brought up from the brought up from the labor room and is lying in cot. The room
temperature is 25 C. If the baby stays in that cot, you expect?
a) Cyanosis
b) Shivering
c) Tachypnea
d) Hypertension
e) Metabolic alkalosis
39) You are asked to examine two twins on day one of life. The first infant weighs 3 kg
and the second infant 1.5 kg. You are worried that the second infant may be more likely
to have ?
a) Hyperglycemia
b) Low hematocrit
c) Congenital malformation
d) Surfactant deficiency
e) Growth retardation in catch up phase
40) you see a newborn 1 day old whose birth was complicated by forceps delivery. You
note the baby has symmetric moro reflex, and left arm is internally rotated and forearm
is extended and pronated. The most likely diagnosis is ?
a) Fracture of left clavicle
b) Fracture of left humerous
c) Left sided Erb palsy
d) Left sided Klumpe palsy
e) Spinal injury
41) A 25 years heroin addict mother gives birth to a full term newborn. When reading
the operation/Labor room notes, you observe that the mother was given multiple
injections of mepridine. The infant is limp and breathing shallowly. The next step would
be ?
a) Intravenous 10% Dextrose
b) Intravenous Naloxone
c) Intravenous Vitamin K
d) Intravenous Antibiotic
e) Intravenous Hydrocortisone
42) A term neonate is born to known HIV positive mother who has been taking
antiretroviral medication. The next management step should be
a) HIV ELISA on infant
b) Intravenous antibiotic
c) Zidovudine for the infant
d) Chest X-ray
e) IVIG
43) A highly educated couple decides not to give vitamin K to their baby who is two days
old. They argue it is fancy since they read this on Google. You tell them that if not given
the baby can have?
a) Hemorrhage within first 2 days
b) Symptoms more likely in cows mild fed than breast fed
 c) Symptoms more likely in males
d) Prolonged PT and APTT and bleeding
e) No symptoms
44. An infant has just been shifted from jail ward. He is full term , has vomiting, loose
motions, coarse tremors, high pitched cry and is irritable. You suspect?
a) Alcohol withdrawal
b) Marijuana withdrawal
c) Heroin withdrawal
d) Cocaine withdrawal
e) Tobacco withdrawal
45) You are called to evaluate a newborn whose mother was noted to have
oligohydraminos . In your mind you plan to evaluate the infant for
a) Anencephaly
b) Trisomy 18
c) Renal agenesis
d) Duodenal atresia
e) Tracheo-osophageal fistula
46)A 10 months old infant presents with cough and shortness of breath. He had flu one
week ago. On examination he has nasal flaring, subcostal recession, bilateral wheezes
but no crepitation. The most likely diagnosis is ?
a) Bronchiolitis
b) Viral Croup
c) Asthma
d) Epiglottitis
e) Diphtheria
47)A two years old girl is brought to you because of cough , tachypnea, subcostal
recessions. She smells of petroleum. The first management step should be ?
a) Gastric lavage
b) Administer activated charcoal
c) Administer ipecac
d) Perform pulse oximetry
e) Forced diuresis
48) A one year old infant is brought to you for cough and shortness of breath. There
have been many such episodes in the past which required hospitalization. The mother
adds that the baby has lots of oily stools. Which of the following investigation is
indicated?
a) CT chest
b) Montoux test
c) Sweat chloride test
d) Serum immunoglobulins
e) Chest X-ray
49) Steroids are indicated in which form of tuberculosis?
a) Tuberculous meningitis
b) Joint tuberculosis
c) Lymph node tuberculosis
d) Abdominal tuberculosis
e) Potts disease
50. You receive a panicked family who hold a child have fits. The baby is one years old
and you take him to your ward. When you reach there the fit has stopped. The baby has
a temperature of 104 F , and the mother tells you that the baby had a similar episode
one year ago when he had high grade fever. You decide that the baby needs
a) Intravenous valium
b) Intravenous dextrose
c) Intravenous calcium
d) Antipyretics
e) Antibiotics
ATTEMPT ANY FOUR QUESTION 20 MARKS PART C
1) Describe only the fluid management of 30 kg child with diabetic ketoacidosis
2) Enumerate the five differences between simple and complex febrile fits?
3) List five differences between poliomyelitis and Gullain-Barre syndrome?
4) Describe the micronutrient deficiencies in severe malnutrition?
5) Can you recall the five differences between Croup and Epiglottitis?
ATTEMPT ANY THREE QUESTIONS
1. A four year old girl was brought to your busy OPD by a worried mother for rashes on
her shins since yesterday. She is otherwise well, playful and active. On examination there
are few bluish spots on her shins. She does not have any hepatosplenomegaly.
a) What is the most likely diagnosis? Give justification
b) How will you investigate this child?
c) What would be your treatment plan?
2. A ten year old boy is brought to your emergency with high grade fever and inability to
walk. On examination he is running a temperature of 102 F, there is swelling of right
knee joint and there is a pansystolic murmur heard at the apical area.
a) What is the most likely diagnosis?
b) How will you investigate this patient?
c) What is your treatment plan for now and in the future ?
3. A one year old boy is brought from Chamman because of high grade fever and rash.
His four sibling were similarly affected and two have died. On examination he has a
temperature of 104 F ,is drowsy and has a maculopapular rash covering all the body. On
auscultation there are bilateral crepitation’s and heart sounds are muffled. While you
are examining the child he suffers from generalized tonic clonic fits.
a) What is the most likely diagnosis?
b) How would you treat this child?
c) How could this disease been averted in the whole family?
4. A four year old girl is brought to you because she has been having loose motions for
last 3 months. On examination she is markedly pale, clubbed with height and weight
below 3rd centile. Rest of the physical examination is within normal limits.
a) What is the most probable diagnosis?
b) How will you investigate this girl?
c) How will you treat her?