Paediatrics

MBBS MCQ PRACTICE QUESTIONS

FOOTNOTES

Answer for Question 18.

Review Question 29.
Finished at Question 30 on 11th March, 2024.
Question 1
The developmental age of a baby born at 28 weeks gestation and now 9 months
of age is MOST likely closest to that of:
a) 6 months
b) 8 months
c) 7 months
d) 10 months

khalisa
Question 2
A 6 year old boy presented with a history of not bearing weight for 3 weeks because
of pain and swelling in the joints. He had a sore throat 4 weeks ago. On examination
he is unwell. There is a grade 4/6 pansystolic murmur heard best at the left sternal
edge radiating to the axilla. He has pulmonary crackles and a 5cm hepatomegaly.
Which of the following treatment options would you consider most appropriate?
a) Aspirin, enalapril and penicillin
b) Aspirin, corticosteroids and intravenous gamma globulin
c) Aspirin, corticosteroids and penicillin
d) enalapril and intravenous gamma globulin

khalisa
Question 3
A 14 year old girl presented with decreased appetite and abdominal pain that
wakes her up at night. She also has intermittent diarrhea, weight loss, no fever
and demonstrates no signs of puberty as yet. BMI for age is a z score between -2
and -3. What is the most likely cause of her symptoms ?

A. Anorexia
B. Irritable Bowel Syndrome
C. Inflammatory Bowel Disease
D. Bulimia

Paige
Question 4
A 6-month-old male infant is brought into the emergency room with a 2-day history
of vomiting and diarrhoea. He is lethargic, mucosae are dry and his capillary refill
is 3 seconds. His pulse rate is 152 beats/min and his blood pressure is 70/30
mmHg.
Which of the following is the MOST APPROPRIATE fluids to administer now?
a) A trial of oral rehydration fluids - 10 ml every 5 minutes
b) IV 5% dextrose/normal saline at maintenance rate
c) IV 5% dextrose/0.45% saline at 1.5 x the maintenance rate
d) 20 mls/kg of normal saline, intravenously

Paige
 Question 5
An HBSS patient presented with acute chest syndrome. Their steady state is 8 and their Hb
is currently 6. What of the following is the best choice of management?

A) Antibiotic (Cefotaxime) + Macrolide (atypical agent eg. Chlamydia)+ IV Fluids +

exchange transfusion + aggressive pain control
B) Antibiotic (Cefotaxime) + Macrolide + IV Fluids + top up transfusion + pain control
C) Antibiotic (Cefotaxime) + iv fluids + top up + aggressive pain control
D) Antibiotic (Cefotaxime) + iv fluids + exchange transfusion + aggressive pain
management

Paige
Question 6
A 2-year-old girl who is appropriately immunized is brought into the emergency department by
her mother with fever. At triage, her temperature is 38.7°C (101.7ºF). Her other vital signs all
within normal limits. She is reviewed 90 minutes after antipyretics were administered when
her temperature is now 37.7°C (99.9ºF). Clinical examination reveals a well-hydrated and
clinically well child with good social interaction. There are no localizing features and no
apparent source for her fever. Which of the following is the MOST APPROPRIATE next stage
in her care?
A. Request a urine dipstick
B. Request a chest X-ray
C. Take a blood culture
D. Take bloods for inflammatory markers
Ted
Question 7
An 8-day-old neonate is seen in the emergency department with a history of fever.
The infant is breastfeeding appropriately. His temperature in the emergency
department is 101.3 ºF (38.5 ºC), and his physical examination findings are normal.
His mother denies any history of genital herpes, and she had no peripartum or
postpartum fever. A CRP level is 2.7 mg/dL (27 mg/L). Urinalysis, blood culture, and
cerebrospinal fluid studies are pending. Which of the following is the MOST
APPROPRIATE empirical antimicrobial regimen?
a. IV ampicillin and vancomycin
b. IV ceftriaxone and vancomycin
c. IV ceftriaxone, vancomycin, and acyclovir.
d. IV ampicillin and gentamicin
Ted
Question 8
You are seeing a 20-month-old child in clinic. As you walk in the room, you notice the child
using a bottle filled with milk. The mother states that he uses a bottle and rarely uses a
“sippy cup”. In addition, he sometimes falls asleep with the baby bottle in his mouth. What
oral pathology are you MOST LIKELY to note during your examination of this child?
a. Localized atrophy of the filiform papillae on the tongue
b. Erythema and thin scaling formation of the lips
c. Tooth decay on the maxillary incisors
d. Crowding of the maxillary teeth

Ted
Question 9
A 7 year old girl is brought by her mother with bright red staining of her
underpants. She also gives a history that her daughter recently started taking
horse riding lessons. What is the single most appropriate next action?
a. Local exam
b. Exam under GA
c. Continue regular child care
d. Inform child protection services
e. Inform police
Denelle
Question 10
A 7 year old child is brought to the AED with a 1 day history of being listless. On
examination, the child is drowsy with an extensive non-blanching rash. What
advice would you give the parents?
a. All family members need antibiotic therapy
b. Only the mother should be given rifampicin prophylaxis
c. All family members need isolation
d. All family members should be given rifampicin prophylaxis
Denelle
Question 11

A mother attends the GP surgery with her 7-week-old child for their routine 6-week check. The
child is smiling and interacting well throughout the assessment. Whilst examining the patient you
notice weak femoral pulses bilaterally. The rest of the examination is unremarkable.

What is the single most appropriate management plan?

a) Advise the mother these can be normal findings, fill in the red book and safety net
b) Advise the mother to take the child to the emergency department immediately
c) Make an appointment in 2 weeks to re-check
d) Refer routinely to paediatrics
e) Same day discussion with paediatrics
Janine
Question 12
A man with glucose-6-phosphate dehydrogenase deficiency asks for advice regarding his son. Given
the x-linked recessive inheritance of the condition, what is the chance his son will also develop the
disease?

a) 2 in 3
b) No increased risk
c) Will definitely be affected
d) 1 in 2
e) 1 in 4

Janine
Question 13
A mother presents with her baby to the GP for review. She asks for advice regarding her milestones and
explains that her son was born was born prematurely at 32 weeks gestation.

With the premature age in mind, when should this baby begin to show a responsive social smile?

a) 5 to 7 weeks
b) 8 to 10 weeks
c) 11 to 13 weeks
d) 14 to 16 weeks
e) 17 to 19 weeks
Janine
Question 14
A 12 year old girl presents with complaints of dizziness, palpitations and diaphoresis on mornings.
She is a known Type 1 diabetic and is on a N/R insulin regime. Her BMI for height is between -1
and 0 z score. Her blood glucose diary levels were provided in a table with almost all of her PRE-
BREAKFAST measurements being <60 mg/dl. Her 2h postprandial (after dinner) values ranged
from 120-180 mg/dl.

What is the MOST APPROPRIATE change to her regimen?

a) Reduce her evening N insulin
b) Increase her morning N insulin
c) Increase her bedtime snack as she can afford to gain weight
d) Allow her to have a small sugary drink at 2am

{KARUNA}
Question 15

A 2 month old presented with conjunctival pallor. Her parent is quite worried.
She is anicteric and his blood results showed low Hb and reticulocyte count
was quite low (0.1). Abdominal exam was normal. No organomegaly. Of
note, the patient is bottle fed.
A) Congenital red cell aplasia
B) IDA
C)Thalassemia
D)hereditary spherocytosis
{KARUNA}
Question 16
Child 2 months, crying between feeds, parent worried, he’ll cry
uncontrollably and behaviours like drawing up his legs to his chest. Only
time he’ll stop crying between episodes is after passing gas or a bowel
movement. What’s the diagnosis?

A) Intussusception
B) Infantile colic
C) Constipation
D) Lactose intolerance
{KARUNA}
Question 17

You are seeing 1 year old Andrew and his mother for his well care visit.
His mother is most anxious to introduce a 'baby tablet' to him as all the
other kids at daycare use one and she does not want him to be left
behind.
What would be the ideal time for a tablet to be introduced?

A) at 12 months for educational content

B) At 15 months for video chatting and educational content only
C) At 18 months for video chatting only
D) at 24 months for video chatting and entertainment purposes.

kayle
Question 18

17 year old girl want to start COCP. She and her 18 year old boyfriend previously
used condoms but he doesn't want her to use them anymore. She is a sensible
girl so you are not worried about the nature of her relationship, but when you
explain the COCP she does not understand. So you encourage her to continue
using condoms but she does not want too. She is adamant about the COCP. She
doesn't want her mom to know about this. What should you do?

A) call the boyfriend to come in and discuss

B) inform her mother because you are suspicious
C) Call her school and inform them of her sexual activity (lol, no)
D) keep it confidential and not inform her mother even though she does not
understand
Question 19
How long after IVIG can the MMR vaccine be given in a child who tested positive for COVID-
19?
a. 6 months
b. 8 months
c. 3 months
d. 1 month

Sarah
Question 20
Male delivered at 37 weeks because of maternal preeclampsia. Mother obese and chronic hypertensive. Baby
weighs 1.9 kg. Bedside glucose is 35 mg/dL at 18 hours after birth shortly after breastfeeding & formula
supplementation. No signs of respiratory distress. What is the most likely explanation for the glucose level?
a. Congenital hyperinsulinemia (shows up earlier)
b. Maternal hyperglycemia (shows up earlier)
c. Physiologic hypoglycemia (if baby was normal birth weight, asymptomatic and ketotic {living off their fat})
d. Decreased glycogen stores (likely because this baby over skinny .-.)

Sarah
Question 21
A 4-year-old boy presents to the emergency department with a history of recurrent urinary tract
infections (UTI). His investigations revealed that he has posterior urethral valves with decreased
renal function in the left kidney. Which of the following is a known complication of recurrent UTI?

A. Obstructive uropathy
B. Chronic kidney disease
C. Nephrotic syndrome
D. Amyloidosis

Amanda
Question 22
A child presented with cervical lymphadenopathy, oral candidiasis and bilateral
parotitis.

a. HIV
b. DiGeorge syndrome
c. Wiskott aldrich syndrome
d. Acute lymphoblastic leukemia

Amanda
Question 23
HIV pos mother newborn with positive HIV Antibody assay at birth. Two Elisa in his

first 4 months are negative. How long does it take for the HIV antibody assay to

revert to negative?

A. 6 months

B. 12 months

C. 18 months

D. 24 months

(narissa)
Question 24
Mother is concerned that her daughter who is 12 hasn’t started menarche. Daughter:

breast enlargement started at 11 one breast is at B2 and the other at B3. Mother had

menarche at 11.5. What do you tell the mother?

A. Child will have late menarche as she started puberty late

B. Menarche normally doesn’t happen until the age of 14

C. Menarche usually occurs about 2 years after breast buds start to develop

(narissa)
Question 25
2 week old baby with jaundice, total bilirubin 12.9, conjugated bilirubin 6.9? What is

the cause?

A. Breastfeeding jaundice (mostly unconjugated bili)

B. Breast milk jaundice (unconjugated bilirubinaemia)

C. Choledocal cyst

D. Crigler najar (unconjugated bilirubinaemia)

(narissa)
Question 26
A normally developed child who is just able to run, build a tower of two cubes,
pretend play with a doll, and speak in two word sentences is closest to what age?

A. 12M
B. 15M
C. 18M
D. 24M

(narissa)
Question 27
A 3 ½ year old boy is seen with a history of cold a few weeks prior to presentation. Petechiae are
noted on examination but no hepatosplenomegaly is seen.

Which of the following is the most likely diagnosis ?

A. Henoch-Schonlein Purpura (palpable purpura)

B. ITP
C. Leukemia (child will be generally unwell)
D. Non-accidental injury

(Narissa)
A 6-year-old boy presented with a history of not bearing weight for 3 weeks because of pain and swelling of his joints. He
had a sore throat 4 weeks ago. On examination, he is unwell. There is a grade 4/6 pansystolic murmur heard best at the left
sternal edge radiating to the axilla. He has pulmonary crackles and a 5cm hepatomegaly. Which of the following treatment
options would you consider the MOST APPROPRIATE?

A. Aspirin, enalapril and penicillin - dr singh - enalapril because of hepatomegaly

B. Aspirin, corticosteroids and intravenous gamma globulin
C. Aspirin, corticosteroids and penicillin
D. Corticosteroids, enalapril and intravenous gamma globulin

(narissa)
Question 28
A 9-year-old girl is brought to the physician by her father because of abnormal movements of her limbs for 4 days. She has
had involuntary non-rhythmic movements of her arms and legs, and has been dropping drinking cups and toys. The
symptoms are worse when she is agitated, and she rarely experiences them while sleeping. During this period, she has
become increasingly irritable and has had episodes of inappropriate crying. She had a sore throat 5 weeks ago. Her
temperature is 37.2°C (99.0°F), pulse is 102/min, respirations are 20/min, and blood pressure is 104/64 mm Hg.
Examination shows occasional grimacing with abrupt purposeless movements of her limbs. Muscle strength and muscle
tone are decreased in all extremities. Deep tendon reflexes are 2+ bilaterally. She has a wide-based and unsteady gait.
When the patient holds her arms in extension, flexion of the wrists and extension of the metacarpophalangeal joints occurs.
When she squeezes the physician's index and middle fingers with her hands, her grip increases and decreases
continuously. The remainder of the examination shows no abnormalities. Which of the following is the most likely underlying
cause of these findings?

A.Cerebral viral infection

B.Tumor in the posterior fossa
C.Antibody cross-reactivity

D.Trinucleotide repeat mutation

E.Autosomal recessive genetic mutation
 Question 29
A 14-year-old boy is brought to the physician because of fever, malaise, and severe right knee joint pain
and swelling for 3 days. He has also had episodes of abdominal pain and epistaxis during this period.
Five days ago, he had swelling and pain in his left ankle joint which has since resolved. He reports
having a sore throat 3 weeks ago while he was camping in the woods, for which he received
symptomatic treatment. His immunizations are up-to-date. His temperature is 38.7°C (101.6°F), pulse is
119/min, and blood pressure is 90/60 mm Hg. Examination shows a swollen, tender right knee; range of
motion is limited. There are painless 3 to 4-mm nodules over the elbow. Cardiopulmonary examination
is normal. His hemoglobin concentration is 12.3 g/dL, leukocyte count is 11,800/mm3, and erythrocyte
sedimentation rate is 63 mm/h. Arthrocentesis of the right knee joint yields clear, straw-colored fluid.
Analysis of the synovial fluid shows a leukocyte count of 1350/mm3 with 17% neutrophils; no organisms
are identified on Gram stain. Which of the following is the most likely diagnosis?
A. Acute rheumatic fever
B. Acute lymphoblastic leukemia
C. Kawasaki disease
D. Juvenile idiopathic arthritis
Nandini
Question 30
A 24-year-old woman comes to the physician because of intermittent episodes of stabbing facial pain for 4 months.
The pain occurs over her left cheek, is 9 out of 10 in intensity, radiates towards her mouth, and lasts around half a
minute before subsiding. These episodes commonly occur when she washes her face, brushes her teeth, or eats a
meal. She does not have visual disturbances, weakness of her facial muscles, or hearing loss. She had a tooth
extracted about 2 months ago, but the facial pain has persisted. She has hypothyroidism and vitiligo. Her mother
has major depressive disorder. Current medications include levothyroxine and herbal cream. She appears
anxious. Vital signs are within normal limits. Cardiopulmonary examination shows no abnormalities. Neurological
examination shows no focal findings. Which of the following is the most appropriate next step in management?

A. Amitriptyline

B. Botulinum toxin injection

C. Radiofrequency rhizotomy

D. Carbamazepine

Nandini
Question 31
A newborn baby has a thyroid screening test on day 7 that shows a thyroid stimulating hormone
level that is >100 pg/dL (normal <10 pg/dL). When counselling the parents about the need to
perform a confirmatory test as soon as possible, they enquire what is the urgency as the baby
appears to be well. Which of the following is the MOST IMPORTANT benefit of confirming the
diagnosis?

A. Avoiding of early overweight problems

B. Preservation of final adult height
C. Preservation of intellectual function
D. Avoiding prolonged jaundice

Adita
Question 32
A 7-year old girl presents to her GP as she has been suffering from daily epistaxis for the last week. On
examination, her legs are covered with petechiae and bruises. She is otherwise well and has no other
symptoms. Blood tests show low platelets, with no abnormalities. On follow-up, the symptoms have
completely resolved after 4 months. Which of the following would you expect to precede these
symptoms?

A. Stress
B. Glandular fever
C. Constipation
D. Asthma attack
E. Epileptic fit

Adita
Question 33
A 4-year-old referred for right-sided breast development for the past 8 months. No change in shape or size for the last 3 months.
No moodiness, vaginal discharge or adult odor. Mother is on the OCP.

On examination she had tanner breast stage 3 on the right and stage 1 on the left. No acne or pubic hair. What is the most likely
cause for her findings?

A) Premature thelarche

B) Early Puberty - would have right any pubic hair after six months further and other signs of puberty like height acceleration but
none of this happened.

C) Exogenous oestrogen – would not be unilateral only

D) right-sided ovarian tumor: rapid estrogenation / virilisation are hallmarks of this

Yohance
Question 34
66. A 12-year-old child had asthma and was given a ‘Turbuhaler’ but his asthma still got

worse. Why?

A) He did not shake the inhaler – not needed with turbohalers but required for dry powder inhalers

B) He is not using a spacer

C) He turned the bottom in both directions before use: turn to right then return to left to activate.

D) He takes long, slow, deep breaths while inhaling the meds – YOU SHOULD: “breathe in quickly and
deeply through your mouth and hold your breath for 10s after.

Yohance
Question 35

A 6-year-old child presents with a seizure, she has had acute gastroenteritis for the past 2 days. Her
electrolytes are normal. Which of the following is the most likely cause?

a) Salmonella – bloody diarrhoea and requires treatment with non-ampicillin based (causes carrier state to
be prolonged) – IF associated with systemic signs as well.

b) Campylobacter

c) Yersinia

d) Vibrio: profuse watery diarrheoa

e) Shigella – shigea toxin produces bloody diarrheoa, low glucose and seizures. Invades bowel wall and
can cause bowel performation – therefore mandates antibiotic treatment

Radha
QUESTION 36

A female neonate, 38 weeks gestation was delivered vaginally to a multiparous mother who
was treated for gestational diabetes. The delivery was complicated by a prolonged second
stage with shoulder dystocia. At the initial examination, her birth weight was 4,260 grams
and she was noted to be lying with the left arm extended at the elbow, internally rotated and
with flexion at the wrist. This arm was also hypotonic with minimal spontaneous movement.
Which one is the most likely cause of the appearance in the newborn described above?

a) Left Hemiplegia – just the UL and not entire side is given in description

b) Septic Arthritis – no real reason given here

c) Fracture of the left Humerus – rare

d) Fracture of the left clavicle – poor movement and a ipsilateral swelling

e) Brachial Plexus injury – Erbs palsy – see also Klumkle palsy is another Bpiinjury

Radha
Question 37
A 5-month-old infant presented with a history of intermittent cough and SOB for the last 6 weeks. She
was having difficulty feeding with diaphoresis during feeds. She has gained little weight since her visit
last 6 weeks. Of the following the MOST likely cause for this presentation would be?
a) Inappropriate Feeding Technique – but gained wt in the 1 st 6/52 no reason to develop a poor
technique now.
b) Tracheoesophageal Fistula: as congenital I think should present from closer to birth and not at the
time period stipulated here
c) Pneumonia – no reason and intermittent nature goes against this.
d) Gastro-Oesophageal Reflux (disease) – should not cause difficulty feeding though
e) Ventricular Septal Defect – now becoming symptomatic as a result of cardiac overload during the
larger feeds needed as well as the time and changes in pulmonary pressures and flow now causing
symptoms

Radha
Question 38
In a patient with newly presenting type 1 diabetes:

(a) A blood pH < 7.30 indicates severe ketoacidosis (mild – to 7.25, mod 7-7.25 and severe < 7.0)

(b) It is more common to see diabetic ketoacidosis in children <5 years and teenagers than children age 5–11 years - < 5
aggressive destruction and teenagers skip insulin doses resulting in DKA

(c) Blood ketones are low when insulin levels are low in ketoacidosis – insulin levels are low and ketones are high in DKA
– acetoacetate and beta hydroxybutyric acid

(d) A random blood glucose >7 mmol/L (126) is diagnostic of type 1 diabetes: (FBS > 126; 2-hour pp > 200, random > 200
with symptoms or HbA1c > 6.5% (2 of these criteria)

(e) Autoantibodies to islet cells are seen in all patients with type 1 diabetes – while antibodies are a necessity in setting to
diagnose type 1 DM – they can be any of islet cell, insulin or GAD antibodies and not necessarily all will have islet cell
antibodies

Yivana
Question 39
Which of the following is true for children with Atopic dermatitis (eczema)?

(a) Frequent warm baths help moisturize the skin and reduce eczema – deprive the skin of oils if frequent

(b) The majority of babies with eczema have cow milk protein intolerance – not “the majority of” – some do
but not majority of

(c) Topical steroids should not be applied to the skin of the face: can sparingly use mild topical steroids to
induce a remission if severe for short times

(d) Acute lesions can include vesicular patches: can happen in fact

(e) The nappy areas is usually affected: not usually – think of candidia infection (satellite lesions seen and
creases are affected) or ammonia dermatitis (inside of the skin folds of the nappy area are not affected) if
in nappy area
Yivana
Question 40. Ravisha

A 4‐year‐old girl is brought to the emergency department by her babysitter because the child has
suddenly become clumsy, and her speech has become slurred over the last hour. On physical
examination, the girl is afebrile and dysarthric. She has prominent vertical and horizontal nystagmus,
along with truncal and appendicular ataxia. Deep tendon reflexes are normal, as are results of the
remainder of the physical examination. Of the following, the MOST likely diagnosis is

A. Brain tumour – likely happen over a couple of days / weeks and if the cause will still present
suddenly like this due to “B” below ie a bleed into the tumour.

B. Cerebellar Haemorrhage – sudden and correct area – maybe a congenital vascular abnormality
that bled????

C. Guillain‐Barre Syndrome – absent reflexes

D. Meningoencephalitis – febrile and seizures

Question 41 Ravisha

The following statement is true of puberty

A) a girl has entered puberty early if she experiences menarche by 13 years – hallmark of entry
into puberty for a girl is B2 breast budding (usually 50% by age 11 and 2% by age 8 and
98% by age 14 – menarche is 2 years post thelarche)
B) Boys can attain a reversible B2 breast development – this is true (66%) some get to B3
C) Boys require investigation if they have not entered puberty by age 12 years (boys enter at
about 12 years – 50%, 9 YEARS 2% AND 15 years 98%)
D) Pubic hair rating PH2 is the best indicator of a boy entering puberty (hallmark of entry is
testicular volume of 4ml)
E) The first clinical sign of female pubertal development is an increase in linear growth - usually
the forst sign and tends to occur due to testosterone accompanying pubic hair growth 6/12
after entry into puberty.
Question 42 Narad

During the selection of subjects for a study on infantile vitamin deficiencies, a child is examined by the lead investigator. She is at the 75 th percentile

for head circumference and the 80 th percentile for length and weight. She can lift her head up when in a prone position but cannot roll over from a

prone position. Her eyes follow objects without crossing the midline. She coos and makes gurgling sounds. When the investigator strokes the sole of

her foot, her big toe curls upward and there is fanning of her other toes. She makes a stepping motion when she is held upright and her feet are in

contact with the examination table. Which of the following additional skills or behaviors would be expected in a healthy patient of this developmental

age?

A) Reaches out for objects – usually about 4 months

B) Responds to calling of own name – about 6-10 months

C) Cries when separated from mother – older separation anxiety not before about 13 months (8 at earliest)

D) Rolls over from her back – harder to do than roll from belly to back – which she cannot do as yet as per the statement above

E) Smiles at her mother – is present at 2-3 months of age

Question 43 Narad

A 15-day-old female newborn is brought to the physician for evaluation of red eyes with discharge for 3 days. She was born at 37 weeks' gestation to a 26-year-

old woman. Pregnancy and delivery were uncomplicated. The mother received irregular prenatal care during the 3rd trimester of pregnancy. Examination of the
newborn shows watery discharge in both eyes and mild eyelid swelling. Which of the following is the most likely cause of this patient's presentation?

A) Silver nitrate exposure – will be earlier as AgNO3 drops are placed in some places at birth

B) Staphylococcus Aureus – after week 1

C) Chlamydia Trachomatis – usually presents at 2nd week of life and is associated with reactive pneumonia at about 6 weeks therefore mandates
treatment with a macrolide antibiotic as chlamydia has no cell wall (rasping cough and wheeze typical at 6 weeks). Diagnosis requires eye swab with acquition
of conjunctival cells and then treatment of mother and partner{s}.

D) Neisseria Gonorrhoea – presents 1st 24 hours and rapidly progressive

E) Herpes Simplex Virus 2 – painful and if maternal related will be more severe swelling not mild as described
Question 44 Avelana

You are called to see a hospitalized 9-year-old girl who suddenly has become dystonic, with her neck hyperextended and is unable to move
her eyes, now superiorly deviated. The nurses relate that this girl has non Hodgkin's Lymphoma and has been taking highly emetogenic
chemotherapy.

Of the following, the drug MOST LIKELY to have caused this girl's sign and symptoms is:

A. Aprepitant
B. Diphenhydramine – this is the MOST LIKELY cause as asked for in the question
C. Lorazepam – sedation
D. Metoclopramide – possible but not the MOST LIKELY – not used as often as B above
E. Ondansetron – relatively little side effects
Question 45 Avelana

The MMR (Measles, Mumps and Rubella) vaccine is contraindicated in children

A. Who are diagnosed with Autisim Spectrum Disorder

B. Who have neomycin allergy – true – it has chick embryo and to avoid bacterial growth has neomycin embedded in it.
C. Who received intravenous gamma globulin 6 months previously – 6 months should be okay – brands allow 3-6 months post iv IgG
D. With a history of mumps-like symptoms – not a contraindication
E. With eczema aggravated by egg ingestion – but egg anaphylaxis (documented) is in fact a contraindication. Failure to eat eggs, refusal
to eat and dislike of eggs ARE NOT CONTRAINDICATIONS.
Question 46 Avelana

An infant boy is born by vaginal delivery at 42 weeks gestation after several episodes of fetal bradycardia. Thick meconium is detected in the
amniotic fluid. The infant is immediately intubated. Of the following radiographic changes, this patient’s chest x-ray is likely to show:

A. Decreased lung volume – pulmonary hypoplasia

B. Ground glass appearance – surfactant deficiency – usually preterm <34 weeks or IoDM <37 weeks
C. Lobar collapse – not typical
D. Patchy areas of increased density - - some areas of collapse / atelectasis and some areas of compensatory hyperinflation of the lungs
E. Severe pulmonary interstitial emphysema
Question 47 (Repeat)
A 6-year-old girl presented with a history of not bearing weight for 3 weeks because of
pain and swelling of her joints. She had a sore throat 4 weeks ago. On examination, she
is unwell. There is a grade 4/6 pansystolic murmur heard best at the left sternal edge
radiating to the axilla. She has pulmonary crackles and a 5cm hepatomegaly. Which of
the following treatment options would you consider the MOST APPROPRIATE?

A. Aspirin, enalapril and penicillin

B. Aspirin, corticosteroids and intravenous gamma globulin

C. Aspirin, corticosteroids and penicillin

D. Corticosteroids, enalapril and intravenous gamma globulin

Question 47
A boy fell from a tree and was brought to the emergency department, he is
stable. He did not open his eyes spontaneously but did so on verbal command.
He was awake but disoriented and he had localized to pain. What is the best
next step for this patient? – Manual in line stablisation of the spine!!!!
A. CT Brain
B. Lateral and AP radiographs of the c spine – brain injury and not spine here
– although may co-exist.
C. Observe the patient – no: clearly has reduced GCS
D. Inform child protective services of neglect – need more info
Question 48 Prishni

You are attending a morbidity and mortality meeting after a child

has died on the 20th day after birth. Which of the following is the
correct classification of the death in this case?
A. Late perinatal death – viability to 7 days after birth
B. Neonatal death – up to 28 days of life
C. Puerperal death – maternal side and up to 42 days (6/52)
D. Early perinatal death – viability to 7 days after birth
Question 49 Prishni
A 6-year-old boy is reviewed in clinic due to nocturnal enuresis. His mother has tried
using a star-chart but unfortunately this has not resulted in any significant improvement.
Of the following options, what is the most appropriate initial management strategy?

A. Restrict fluids in the afternoon and evening – seems rather early as afternoon is
starting after 12 MD.
B. Trial of oral desmopressin: used temporarily for sleep overs or sleep in non-home
settings >7 years try 2/52 and then see a drug-free night
C. Enuresis alarm – probably the best of the stated options as worded
D. Trial of intranasal desmopressin used temporarily for sleep overs or sleep in non-
home settings >7 years
Question 50 Prishni
A newborn female infant at 4 weeks has had persistent jaundice since 48 hours after birth.
Her parents also noticed she is reluctant to take on breastfeeding and her urine appears
quite dark. Upon examination, you confirm the infant is jaundiced and notice a firm,
enlarged liver. You review her bloods which show a conjugated hyperbilirubinaemia. Her
serum alpha 1 antitrypsin levels and electrophoresis are normal and the neonatal heel
prick test performed at birth was negative (for congenital hypothyroidism). What is the
treatment of choice for this condition?

A. IV antibiotics
B. Early surgical treatment early here is the operative word
C. Oral ursodeoxycholic acid
D. Infusion of alpha-1 antitrypsin
Question 51 (Repeat)
A 2-month-old had conjunctival pallor. His parents are worried. He is
anicteric. His blood results showed low Hb and reticulocyte count of 0.1.
Abdominal examination was normal and there was no organomegaly. The
parents state that he is bottle fed. What is the diagnosis?
A) Congenital red cell aplasia
B) IDA
C) Thalassemia
D) Hereditary spherocytosis
SECOND SESSION WITH
DR SINGH
IS FINISHED FOR TONIGHT 
 Question 52
A 6-year-old presents to his paediatrician with left ear pain. His parents state that
he had been in his usual state of good health until he went swimming in a lake a
few days ago. The patient’s vital signs are within normal limits for age. He is
afebrile and appears non-toxic. Physical examination of the left ear reveals edema
and erythema of the ear canal, as well as a greenish otorrhea. It is difficult to
visualize the tympanic membrane. Pain is increased by manipulation of the pinna
and pressure on the tragus. Which of the following is the most likely pathogen
producing this patient’s symptoms?

(A) Haemophilus influenzae

(B) Pseudomonas aeruginosa (C) Moraxella catarrhalis

(D) Streptococcus agalactiae (E) Escherichia coli

 Question 53

A young woman with phenylketonuria (PKU) who wants to become pregnant asks her physician if any special preparation is required
before conception to ensure that her baby is healthy. Her physician tells her that women with PKU who are not on low-phenylalanine
diets have a higher risk of spontaneous abortion than the general population and often give birth to infants with mental retardation,
microcephaly, and other congenital anomalies; high levels of phenylalanine seem to be the cause of these problems. Therefore,
prospective mothers who have PKU should be placed on a low-phenylalanine diet before conception. Which of the following values
represents the highest blood phenylalanine concentration that provides a high probability of avoiding untoward complications?

(A) 1 mg/dL

(B) 6 mg/dL (Google answered this  )

(C) 11 mg/dL

(D) 16 mg/dL

(E) 21 mg/dL
Question 54
Concerning children with learning disorders, the MOST accurate statement is that they:

a) Usually present before the age of 5 years

b) Require special schools
c) Are at higher risk for depression
d) Frequently have an IQ less than 70
Question 55

A newborn baby was brought to the nursery because of feeding difficulties and respiratory
difficulties on the 2nd day of life. Of the following findings, a diagnosis of congenital cyanotic heart
disease is supported by:

a) Bilateral air bronchogram on a chest X-RAY – characteristic of PNEUMONIAS

b) Blue peripheries and pink tongue – central cyanosis is characteristic of CCHD with blue
tongue
c) A blue tongue that becomes pink on 100% oxygen – hyperoxic test is used to differentiate
lung for CCHD – in the latter the patient does NOT improve when 100% O2 is applied to the
face snuggly for 5 minutes.
d) A single-second heart sound
Question 56
A 3-year-old boy has a crop of six small pedunculated lesions with a central
punctum on his trunk. They are not itching and he is otherwise well and thriving.
His older sister has similar lesions on her trunk. Which of the following is the most
appropriate management?

a. Laser removal of the lesions – congenital hemangiomas

b. Topical steroid therapy – hemangiomas
c. No treatment required – as it is not disfiguring and not symptomatic
d. Investigation of immune function (de novo and widespread rapidly spreading
lesions – indicate T-Cell functional disorders)
e. Silver nitrate cautery of lesions (liquid nitrogen is used not AgNO3)
Question 56
A 35-year-old man, known to have haemophilia A (factor VIII deficiency), presents to the GP
surgery. His wife is currently 28 weeks pregnant with their first son and has no family history
of clotting disorders. The patient is concerned that the new baby could inherit haemophilia
A.

What is the percentage chance that this male pregnancy will be affected?

A. 0% - based on the information given here!

B. 25%
C. 50%
D. 100%
E. Impossible to calculate – impossible to calculate but the chance of a de-novo mutation
in the population
Question 57
An oral rotavirus vaccine has recently been introduced into the NHS immunisation
schedule. When should it be given?

A. 2 months + 4 months
B. 2 months + 3 months B and D are viable but this option allows the 2-3/12 old
some protection that option D does not!
C. 3 months + 12-13 months
D. 3 + 4 months
E. 4 months + 12-13 months
 Question 57
A 2-week-old newborn is brought to the physician for a follow-up examination after the initial newborn examination showed
asymmetry of the legs. She was born at term to a 26-year-old woman, gravida 3, para 2. Pregnancy was complicated by a breech
presentation and treated with an emergency lower segment transverse cesarean section. The newborn's head circumference is 35 cm
(13.7 in). She is at the 60th percentile for length and 75th percentile for weight. Cardiac examination shows no abnormalities. The
spine is normal. Abduction of the right hip after cupping the pelvis and flexing the right hip and knee causes a palpable clunk. The
feet have no deformities. Ultrasonography of the hip determines the angle between lines along the bone acetabulum and the ilium is
50°. Which of the following is the most appropriate next step in management?

A. Reassure the mother and schedule follow-up appointment in 4 weeks – but y??? It makes this visit a useless one from the
start!
B. Immobilize the hips with a spica cast – used 6-18 months of age
C. Obtain an xray of the right hip – not adding anything
D. Perform closed reduction of the right hip
E. Treat using a harness: used in the younger child less than 6 months
F. Perform open reduction of the right hip
Question 58

Which is not a risk factor for developing cerebral palsy? (A static encephalopathy
caused by an insult to the developing brain. It has motor manifestations that vary
according to developmental age and may have associated sensory, and autonomic
disabilities)

A. Preterm birth
B. Low birth weight
C. Chorioamnionitis
D. Placental abruption
E. Significant Head injury at 16 years old
Question 59

A 9-month-old child presents for well-child care. The patient’s head circumference is noted to be +2 z-
scores. In addition, the child also has frontal bossing, translucent skin, and eyes that manifest a “setting
sun” sign. A meningomyelocele is also evident on physical examination. A computed tomography (CT)
scan of the head would show which of the following?

(A) Type I Chiari malformation – usually associated with SMALL or misshapen head causing the
downward displacement of the brain

(B) Chronic subdural hematoma

(C) Shaken baby syndrome

(D) Protruding cerebellar tonsils – congenital malformation associated with T2 Chiari malformation

(E) Leptomeningeal cyst – associated with skull fractures

(F) Epidural hematoma

Question 60
A five-year-old girl is brought to A&E following a nosebleed. She has recently suffered a
viral infection. On examination, you note evidence of generalised bruising. Routine
investigations demonstrate a haemoglobin of 14 g/dL, a platelet count of 60 × 10/L, normal
liver function tests and an INR of less than 1. What is the most likely diagnosis?

a Haemophilia A X linked not a girl

b Haemophilia B X linked not a girl

c Autoimmune thrombocytopenic purpura most likely the answer

d Von Willebrand’s disease normal PLT counts

e Disseminated intravascular coagulation low PLTS and elevated bleeding and INR
Question 61
A four-year-old boy is brought to A&E by his mother following a fall. On examination,
you note a small cut on his knee that is failing to stop bleeding. Investigations confirm
a diagnosis of hemophilia A. What is the next most appropriate step in management?

a Factor VIII – a mild bleed so raise the Factor VIII level by 25%

b Factor IX – hemophilia B

c Mefenamic acid – Abnormal Uterine Bleeding

d Tranexamic acid – acute traumatic bleeds

e Aspirin – why give this to a bleeder 

Question 62
A 10-year-old girl is referred to the orthopaedic team following pain and swelling in her
right leg. An X-ray demonstrates evidence of an onion skin type appearance. What is the
most likely diagnosis?

a Ewing’s sarcoma

b Osteochondroma a well-defined protuberance on the surface of a bone, usually in the

metaphyseal region, and projecting away from the epiphysis.

c Osteoid osteoma

d Osteosarcoma – sunburst sign

e Osteoclastoma -