Pediatrics MCQs for Review

Q.1 Which of the following vaccines is given thrice (3 doses) in the EPI vaccination program
of Pakistan?
A. Rotavirus vaccine
B. MR (measles rubella vaccine)
C. IPV (inactivated polio vaccine)
D. Pneumococcal vaccine

Q.2 Rota Virus vaccine is given at what age in the EPI vaccination program of Pakistan?
A. Birth
B. 6 weeks
C. 6 weeks and 10 weeks
D. 6 weeks, 10 weeks and 14 weeks

Q.3 A 12 months old girl presents in OPD. Weight of the child is 5.5 kg and his length is 70
cm. His MUAC (mid upper arm circumference) is 105 mm. How will you classify this child
in WHO malnutrition classification?
A. Malnutrition grade 2
B. Malnutrition grade 3
C. Moderate Acute Malnutrition
D. Severe Acute Malnutrition

Q.4 A 6 months old baby presents in OPD with diarrhea for the last 3 months. On
examination, perioral scaly rash is seen. Similar rash is present at groin area. Weight of
the child is 4.5 kg. Which of the following diseases would be the most appropriate
diagnosis in this child?
A. Acrodermatitis enteropathica
B. Chronic diarrhea
C. Vitamin B complex deficiency
D. Severe Acute Malnutrition

Q.5 Which of the following would be the most appropriate rehydration solution for a 9
months old baby having SAM (Severe Acute Malnutrition) and diarrhea?
A. ORS
B. low osmolality ORS
C. ReSoMal
D. Plain water

Q.6 A two year boy presents with frequent crying for the last 6 months. Mother complains
that the child has not started walking yet. On examination, child is noticed to have
 prominent costo-chondral junctions, wide wrists and knock knees. Which of the
following investigations will be most helpful in making a diagnosis in this child?
A. X-ray chest
B. X-ray wrist
C. X-ray knees
D. CT scan brain

Q.7 A four-year-old child presents with complaints of being short in his class. Expected
(median or average) weight and height and of a four year old child is:
A. Weight 13 kg Height 90 cm
B. Weight 16 kg Height 100 cm
C. Weight 16 kg Height 90 cm
D. Weight 13 kg Height 100 cm

Q.8 A 24 months old male infant presents with the concern that he is unable to walk. On
examination, baby is having smiling face and decreased muscle tone. He is also noticed
to have less than normal head size, upward and outward slanting eyes, open mouth,
visible tongue and single transverse palmer crease. Which of the following investigations
will be most useful to make a confirmed diagnosis in this child?
A. Serum AFP (alpha feto protein) level
B. Thyroid function tests
C. MRI scan Brain
D. Karyotype / Blood chromosome analysis

Q.9 Select the age at which an infant starts to roll over, transfer objects from one hand to
other and respond to his name.
A. 3 months
B. 6 months
C. 9 months
D. 12 months

Q.10 A 14 months old male infant presents with the cough and fever for the last 3 days. On
examination, his respiration is 35/min and chest indrawing is not present. Stridor and
wheeze are not audible. According to IMNCI (Integrated Management of Neonatal and
Childhood Illness) guidelines, you will classify this child as:
A. Cough and cold
B. Pneumonia
C. Severe pneumonia
D. Severe pneumonia or very severe disease

Q.11 A 6 months old male infant presents with the cough and fever for the last 3 days. On
examination, his respiration is 52/min and chest indrawing is present. There is no stridor
 or wheeze. According to IMNCI (Integrated Management of Neonatal and Childhood
Illness) guidelines, which of the following treatment advice will be suitable for this child?
A. Give Honey for cough
B. Oral antibiotics (Amoxycillin)
C. IM antibiotics
D. Refer for admission to hospital

Q.12 A 10 year old boy presents with cough and shortness of breath for the last 2 days. On
examination, oral temperature is 98.6 F. Intercostal recessions are visible on iinspection
of chest. Auscultation reveals bilateral rhonchi in the chest. Most likely diagnosis in this
child would be:
A. Influenza
B. Covid 19 infection
C. Asthma
D. Pneumonia

Q.13 A 3 year old unvaccinated child presents at the emergency with the complaints of fever
for the last 4 days and unable to take milk feeds for the last one day. On examination,
he has axillary temperature of 102 F. His respiratory rate is 50 per minute and chest
indrawing is present. A harsh inspiratory stridor is heard with respiration. His oxygen
saturation by pulse oximeter is 80 %. What emergency management will be appropriate
for this child?
A. Salbutamol Nebulization
B. Oral Amoxicillin
C. IV Ceftriaxone
D. Admit in the hospital

Q.14 A 3 year old unvaccinated child presents with the complaints of cough and fever for the
last 4 days and a skin rash which became visible today. Child is taking milk and is not
vomiting. On examination, he has a temperature of 102 F, and respiratory rate of 38 per
minute. A red colored maculopapular rash is visible on his face and trunk. According to
IMNCI (Integrated Management of Neonatal and Childhood Illness) guidelines, which of
the following treatment will you advise to this child.
A. Oral paracetamol
B. Oral paracetamol and cough syrup
C. Oral paracetamol and Vitamin A
D. Oral paracetamol and Amoxicillin

Q.15 A 7 year old child presents with the complaints of fever and skin rash for the last two
days. On examination, he has a temperature of 99 F and a papular rash is seen on face,
trunk and limbs. At places, rash is seen as small vesicles filled with clear fluid. What is
your most likely diagnosis in this child?
 A. Measles
B. Scabies
C. Rubella
D. Varicella (chickenpox)

Q.16 A 2 year old child presents with the complaints of fever and unable to walk for the last 2
days. There is no history of trauma. Parents are not sure about his vaccinations. On
examination, he has a temperature of 99 F. He does not put his right leg on ground.
Tone in right lower limb is decreased. Knee jerk and ankle jerk could not be elicited in
the right leg and present in the left leg. What is your most likely diagnosis in this child?
A. Guillain Barre syndrome (GBS)
B. Poliomyelitis
C. Transverse myelitis
D. Septic arthritis

Q.17 A 7 days old newborn baby presents with fits for the last one day. Baby is unable to open
his mouth and take mother feeds. On examination, he has stiff body and clenched jaw.
His umbilicus is red and draining pus. Most likely cause of fits like movements in this
baby is?
A. Hypocalcemia
B. Pyogenic meningitis
C. Intracranial hemorrhage
D. Tetanus neonatorum

Q.18 An 8-year-old child presents with fever for the last 8 days. Mother says child had gradual
rise of fever. Fever comes down with antipyretics but rises again with chills after a few
hours. He does not have cough. He has mild diarrhea. On examination, his temperature
is 104 F. Skin rashes or jaundice are not present. Respiratory rate is 25 per minute. Chest
auscultation is normal. Throat examination are normal. Liver and spleen are palpable
but not tender. SOMI are negative. What is the most likely clinical diagnosis in this child?
A. Malaria
B. Typhoid Fever
C. Liver abscess
D. Disseminated Tuberculosis

Q.19 A 6 months old infant presents with the complaints of vomiting and diarrhea for the last
4 days. Baby is restless and is taking water eagerly. On examination, his weight is 7 kg
and he has a temperature of 100 F. He has sunken eyes, and a skin pinch on his
abdomen goes back normally. According to IMNCI (Integrated Management of Neonatal
and Childhood Illness) guidelines, which of the following treatment will you advise to be
given to this child?
A. Oral antibiotics
B. Oral Rehydration Fluid 50-100 ml after each loose stool
C. Oral Rehydration Fluid 500 ml in next four hours
 D. IV Ringer Lactate 500 ml in next six hours

Q.20 A 4-year-old child presents with the complaints of passing loose stools often for the last
3 months. Child is taking Cow milk and household solid foods. On examination, his
weight is 13 kg, height is 94 cm. Skin, and conjunctival pallor is present. Abdominal
distension is noted with negative shifting dullness and no viscera palpable. What is your
most likely diagnosis in this child?
A. Cow milk protein allergy
B. Celiac Disease
C. Abdominal tuberculosis
D. Ulcerative colitis

Q.21 A 7-year-old child presents with the complaints of fever, vomiting, refusal to eat and
pain abdomen for the last 3 days. Further questions reveal that the child was well
before and has been vaccinated according to EPI schedule. On examination, he has a
temperature of 99.5 F. He is mildly dehydrated. Eyes show yellow tinge on sclera. On
abdominal examination, liver is palpable by 4 cm below the right costal margin and is
tender. Spleen is not palpable. What is your most likely clinical diagnosis in this child?
A. Viral Hepatitis A
B. Viral Hepatitis B
C. Viral Hepatitis C
D. Liver abscess

Q.22 A 10-year-old unvaccinated child presents with the complaints of hematemesis for the
last one day. On examination, child is pale. On abdominal examination, distended veins
are seen. A firm liver is palpable by 1 cm below the right costal margin. Spleen is
palpable by 5 cm. Shifting dullness is positive in abdomen. What is your most likely
clinical diagnosis in this child?
A. Acute Viral Hepatitis
B. Chronic Liver Disease
C. Acute leukemia
D. Hemolytic Anemia

Q.23 A 24 months old child presents with the complaints of vomiting and diarrhea for the last
one day. Child is taking orally but has vomited 4 times and passed 6 stools today. On
examination, his weight is 12 kg and he has a temperature of 98 F. He has sunken eyes,
and a skin pinch on his abdomen goes back very slowly. According to IMNCI (Integrated
Management of Neonatal and Childhood Illness) guidelines, which of the following
treatments will you give to this child?
A. IV antibiotics

B. Oral Rehydration Fluid 800 ml in next four hours

Q.24 During Resuscitation of a term newborn baby in the delivery room, the first step would
be:
A. Give oxygen by facemask
B. Ensure clear airway and stimulate
C. Bag and Mask Ventilation
D. Auscultate the chest

Q.25 A newborn baby presents on second day of life with jaundice. On examination, jaundice
is visible on whole of his body. Abdominal examination shows palpable liver and spleen.
On investigations, serum bilirubin is 17 mg/dl. Direct Coombs test is positive. Mother
blood group is A – ve and baby blood group is O + ve. Most likely diagnosis for cause of
jaundice in this baby would be ?
A. Physiological jaundice
B. ABO incompatibility
C. Rh incompatibility
D. Jaundice due to congenital TORCH infection

Q.26 A 6 hours old newborn baby presents with lethargy and subtle seizures. His mother was
having gestational diabetes. His blood glucose was ordered. What is the blood glucose
level below which a term newborn is considered to be having Hypoglycemia?
A. 30 mg/dl
B. 45 mg/dl
C. 60 mg/dl
D. 75 mg/dl

Q.27 A 12 hour old preterm newborn baby presents with respiratory distress, grunting and
poor feeding. Baby was delivered by C-section at 34 weeks of gestation due to APH. On
examination, his respiration is 70/min and chest retractions are seen. Chest X-ray shows
bilateral opacities with air bronchogram pattern. What is your most likely diagnosis in
this child?
A. Respiratory Distress Syndrome (RDS)
B. Transient tachypnea of newborn (TTN)
C. Meconium aspiration syndrome
D. Congenital Pneumonia

Q.28 During routine physical examination of a 7 days old male newborn, a short systolic
murmur was heard. An echocardiography was performed which showed patent foramen
ovale. Direction of flow of blood through foramen ovale in this newborn would be:
A. Right atrium to left atrium
B. Left atrium to right atrium
C. Right ventricle to left ventricle
 D. Left ventricle to right ventricle

Q.29 A 4 months old male infant presents with the complaints of respiratory distress during
mother feeding. On examination, his respiration is 65/min and chest indrawing is
present. A pansystolic murmur is heard at left lower sternal border. What is the most
likely diagnosis in this infant?
A. Pulmonary stenosis
B. Patent Ductus Arteriosus
C. Atrial septal Defect
D. Ventricular Septal Defect

Q.30 A 10 year old boy presents with history of fever and joint pains for the last 7 days. On
examination, a pansystolic murmur is heard at the apex of the heart. In order to make a
diagnosis of rheumatic fever, one of the major criteria would be:
A. Arthralgia
B. Carditis
C. ECG changes
D. Leukocytosis in blood

Q.31 A 6 months old baby presents with bluish discoloration and excessive crying. On
inspection, his respiratory rate is 60 per minute and intercostal recessions are visible.
Cyanosis and early clubbing are seen on fingernails. Auscultation reveals a heart
murmur. X-ray chest shows normal size of heart with raised apex. Most likely clinical
diagnosis in this infant would be:
A. Tricuspid atresia
B. Transposition of Great Arteries (TGA)
C. Tetralogy of Fallot
D. Truncus Arteriosus

Q.32 An 18 months old child presents to the pediatric emergency with sudden onset of jerky
tonic-clonic movements of body which lasted five minutes. There is no history of
previous seizures in this child, although his elder brother had seizures a year ago. On
examination, his weight is 10 kg and he has a temperature of 102 F. Baby is restless. He
does not have neck stiffness, and any neurological deficit is not detected on
examination. He is able to take feeds from his bottle. What will be your most likely
clinical diagnosis in this child?
A. Pyogenic meningitis
B. Febrile seizures
C. Poisoning
D. Idiopathic Epilepsy

Q.33 An 5 year old child presents to the pediatric emergency with sudden onset of jerky
tonic-clonic movements of body for the last one hour. On examination, his weight is 18
 kg and he has a temperature of 98 F. Child is unconscious with froth on his mouth.
Which medication will you use first to control the seizures in this child ?
A. Oral clonazepam
B. IM phenobarbitone
C. IV diazepam
D. IV leviteracetam

Q.34 An 3 year old child presents to the pediatric emergency with history of fever and
drowsiness for the last 3 days and sudden onset of jerky tonic-clonic movements of
body which occurred today. On examination, his weight is 12 kg and he has a
temperature of 102 F. child is unconscious with GCS 10. The doctor on duty requested
multiple investigations. Which of the following investigations will be most helpful to
reach a specific diagnosis in this child ?
A. CT scan Brain with IV contrast
B. Serum electrolytes
C. CSF examination
D. CBC with CRP

Q.35 A 10-year-old child presents to the pediatric emergency with inability to walk since
morning. Parents say the child was well before. On examination, his weight is 26 kg and
he has a temperature of 98 F. He is conscious and cranial nerves examination is normal.
Tone in both lower limbs is symmetrically decreased. He is able to raise his legs in
supine position but unable to stand. He is able to raise his arms but unable to make a
tight fist. Biceps, knee and ankle jerks are not elicited. Pain sensation of limbs is intact.
What will be your most likely initial diagnosis in this child?
A. Guillain Barre Syndrome (acute motor polyneuropathy)
B. Transverse myelitis
C. Myasthenia gravis
D. Poliomyelitis

Q.36 A two year old child presents to the pediatric emergency with inability to walk for the
last three days. Parents say the child was well before. On examination, his weight is 12
kg and he has a temperature of 98 F. He is conscious and crying. He does not put his
right leg on the ground. Tone in right lower leg is decreased and knee and ankle jerks
are not elicited. Your initial diagnosis is Acute Flaccid Paralysis (AFP). Which of the
following investigations will you perform as advised by the by the Poliomyelitis
surveillance Program of Pakistan?
A. Nerve conduction studies
B. Serum electrolytes
C. CSF examination
D. Stool examination for viral isolation studies

Q.37 A 4 months old baby presents to the OPD with the complaints of poor feeding and noisy
breathing and sluggish behavior. He remains constipated and passes stool once in 3
 days. Baby was born by SVD and was normal at birth. On examination, his mouth is open
and tongue is visible. He cries with a hoarse voice. His abdomen is distended and
umbilical hernia is seen. What is your most likely diagnosis?
A. Cerebral palsy
B. Cretinism
C. Hurler Syndrome (Mucopolysacchridosis)
D. Down syndrome

Q.38 An 8 years old boy presents to the OPD with the complaints of being short in his class.
On examination, weight of the child is 18 kg and his height is 110 cm. Which of the
following data/investigations would be most useful to decide about the cause of short
stature in this child?
A. Serum Ferritin
B. Serum Creatinine
C. Liver Function Tests
D. Bone age (X-ray wrist)

Q.39 A five-year-old boy presents with ankle joint swelling after minor trauma. There is
history of prolonged bleeding from circumcision at one year of age. Investigations show
Hb 9 gm/dl, TLC 7600/ul, Platelets 290000/ul, PT 13 seconds, APTT 67 seconds. What is
the most likely diagnosis in this child?
A. Hemophilia
B. Von Willebrand disease
C. Idiopathic Thrombocytopenic Purpura
D. Platelet function defect

Q.40 A 10 year old boy presents with fever and pallor for the last one month. On
examination, multiple petechiae are seen on face and trunk. He has significantly
palpable lymph nodes in cervical, axillary and inguinal areas. Liver and spleen are
palpable. Investigations reveal Hb 5 gm/dl, TLC 27600/ul, Platelets 29000/ul, PT 13
seconds, APTT 36 seconds. What is the most likely diagnosis ?
A. Aplastic anemia
B. Acute Leukemia
C. Idiopathic Thrombocytopenic Purpura
D. Infectious mononucleosis

Q.41 A two year boy presents with pallor and frequent crying for the last 6 months. On
nutritional history, mother says that the child takes one liter of animal milk daily and
does not like to eat other foods. On examination, he does not have any significant
finding apart from marked pallor. CBC shows Hb 5 gm/dl, TLC 7600/ul, Polymorphs 40 %,
Lymphos 60 %, Platelets 499000/ul, MCV 55 fl, MCH 15 pg, MCHC 22 gm/dl. Peripheral
film examination shows microcytic and hypochromic RBCs. What is the most likely
diagnosis ?
 A. B12 deficiency anemia
B. Hereditary Spherocytosis
C. Iron Deficiency anemia
D. Thalassemia Major

Q.42 A 4 year old child presents to the OPD with the complaints of swelling of face and body
for the last 6 days. On examination, his face is puffy and edema feet is present. His
abdomen is distended and umbilicus is everted. Urine examinations reveals protein 3+
and no cells on microscopy. Blood tests show serum Na 135 mmol/l, K 4 mmol/l,
albumin 2.2 gm/dl, Urea 33 mg/dl and creatinine 0.35 mg/dl. Which specific treatment
will you start in this child?
A. Albumin infusions
B. Furosemide
C. Captopril
D. Prednisolone

Q.43 An 8 years old boy presents to the OPD with the complaints of breathlessness on
exertion and passing dark urine for the last 4 days. Previously he was well. On
examination, weight of the child is 23 kg and his height is 124 cm. Physical examination
shows puffiness of face. There is pretibial edema present. Blood pressure of the child is
120/80. Urine examinations reveals protein trace and field full of RBCs on microscopy.
Blood tests show serum Na 135 mmol/l, K 5 mmol/l, albumin 4.2 gm/dl, Urea 53 mg/dl
and creatinine 0.65 mg/dl. What will be most likely diagnosis in this child?
A. Acute glomerulonephritis
B. Nephrotic syndrome
C. Chronic Renal Failure
D. Congestive Heart Failure

Q.44 A 13 year old boy presents with history of abdominal pain, respiratory distress,
salivation and lethargy for the last 3 hours. He was helping his father for spraying on the
crops. On examination, his heart rate is 60/min and respiration is 26/min. He is restless
and saliva is visible in mouth. GCS is 11/15 and pupils are constricted. Which of the
following medications will be most useful in the management of this child?
A. Atropine
B. Dobutamine
C. Naloxone
D. Salbutamol

Q.45 A 4 months old male infant presents with the complaints of failure to thrive and
frequent vomiting since birth. Further questioning reveals that the baby passes urine in
drops all the time. On examination, his weight is 4.5 kg heart rate is 140 and respiration
 is 65/min. His abdomen is distended. An ultrasound of abdomen shows distended thick
walled urinary bladder and bilateral severe hydronephrosis and hydroureter. What is
the most likely diagnosis in this infant ?
A. Neurogenic bladder
B. Bilateral Pelvi-ureteric junction obstruction
C. Posterior urethral valves
D. Urinary tract infection

Q. 46. An infant can regard his parent’s face, hold his head, follow the objects with his eyes, lift
his head from the examining table, smile spontaneously, and respond to a bell. At what
age these capabilities are achieved?
A. 1 month
B. 3 months
C. 5 months
D. 7 months

Q. 47. The 7 year old child presents with one day history of multiple oval lesions over her
body. These lesions are slightly raised above the skin, have irregular margins and are
slightly dark as compared to skin around them. There is marked pruritus. Which of the
following is the most likely diagnosis?
A. Urticaria
B. Contact dermatitis
C. Erythema multiforme
D. Scabies

Q. 48. A previously healthy 5-year-old boy has a 3-day history of low-grade fever, colicky
abdominal pain, and a rash on his lower extremities. He is well-appearing and alert. His
vital signs are normal. A diffuse, erythematous, maculopapular, and petechial rash is
present on his buttocks and lower extremities. He has no localized abdominal
tenderness or rebound; bowel sounds are active. Laboratory data demonstrate normal
CBC, and albumin and RBCs in urine. These findings are most consistent with which of
the following?
A. Meningococcemia
B. Henoch Schonlein Purpura
C. Acute Leukemia
D. Idiopathic Thrombocytopenic Purpura

Q. 49. A 10-year-old child presents with the complaints of new-onset bed-wetting for two
weeks. Mother says that the child has been drinking more water during last few days.
He has had no fever. Which of the following investigations point towards the likely
diagnosis?
A. Fasting plasma glucose of 135 mg/dL.
B. Random plasma glucose of 170 mg/dL
C. Serum electrolytes – Na 135. K 3.5
 D. Blood Urea 30 mg / dl, Creatinine 0.5 mg /dl

Q. 50. Your patient is a 24-month-old adopted boy with weight loss for the past 3 months.
Physical examination reveals a thin wasted child with weight of 8 kg. You note
generalized lymphadenopathy with hepatomegaly. In addition, you find a severe case of
oral candidiasis that apparently has been resistant to treatment. Which of the following
is the most appropriate next step in the evaluation and diagnosis of this child?
A. Send blood and urine cultures because this could be sepsis.
B. Perform a sweat chloride test because this is probably cystic fibrosis.
C. Send stool for fecal fat because this is probably a malabsorption syndrome.
D. Order human immunodeficiency virus (HIV) polymerase chain reaction (PCR).
 KEY FOR MCQs:

Question No. Key

10. A

11. B
12. C

13. D

14. C
15. D

16. B

17. D
18. B
19. C
20. B
21. A

22. B

23. D
24. B

25. C

26. B

27. A

28. B

29. D
30. B
31. C

32. B
33. C

34. C

35. A
36. D

37. B

38. D

39. A

40. B

41. C
42. D

43. A

44. A
45. C

46. B

47. A

48. B

49. A

50. D