Practice Paper 1

1. RVH is a feature of all except:

A TOF                           B. PDA with PAH

C. Tricuspid atresia        D. ASD

2. In which of the following disorders is penicillin not used for antimicrobial prophylaxis?

A. Diphtheria                 B. Meningococcal meningitis

C Rheumatic fever         D. Asplenia

3. The most common cause of severe obstructive uropathy in infants and children is:

A. Posterior urethral valves

B. Phimosis

C. Urethral atresia

D. Bladder neck obstruction

4. Riboflavin deficiency may cause all except:

A. Glossitis                   B. Peripheral neuropathy

C. Nasolabial dysbacea

D. Circumcorneal vascularization

5. Which disorder is associated with convulsions cataract and mental retardation?

A. Galactosaemia          B. Phenylketonuria

C. Tyrosinemia              D. Maple syrup disease

6. Which one of the following statements is not correct regarding Fifth disease?

A. It is caused by Parvovirus B 19

B. Patient has slapped cheek appearance

C. Arthritis is the most common complication

D. Incubation period varies from 2-4 days

7. Which of these clinical settings predisposes to neonatal hypoglycemia?

A. Small for date baby    B. Large for date baby

C. Birth asphyxia                         D. All of the above

8. Which one of the following problems is usually not seen in a pre-term baby of 28 weeks gestation?

A. Meconium aspiration synd.    B. PDA

C. RDS                                   D. Apnea of prematurity

9. Which is not associated with childhood obesity?

A. Wilson-Mikity syndrome

B. Cushing’s syndrome

C. Froehlich’s syndrome

D. Laurence-Moon-Bardet-Biedl syndrome

10. Which condition is not considered as AFP under polio surveillance programme?

A. Guillain – Barre syndrome.

B. Transverse myelitis

C. Parlysis due to severe hypokalemia

D. Paralysis due to intravascular injection

11. Which is not an indication for I/V Ig?

A. ITP                                       B. Kawasaki disease

C. Acute infective polyneuritis    D. SLE

12. In a 16-week old child which is expected

A. Make polysyllabic vowel sounds

B. Get excited at sight of food

C. Enjoy mirror              D. All of the above

13. Regarding congenital hypertrophic pyloric stenosis of infancy which is not correct?

A. It most commonly occurs in first born male child

B. It usually presents at 3 to 4 weeks of life

C. Feeding is followed by bilious vomiting

D. Baby is hungry soon after vomiting

14. Which is not a feature of Edwards’ syndrome?

A. Mental retardation     B. Stunting of growth

C. Hypotonia                 D. Congenital disease

15. The most common type esophageal atresia with tracheoesophageal fistula is:

A. Side to side.             B. Proximal end to trachea

C. Distal end to trachea

D. Proximal and distal end to trachea


16. All are life threatening features of acute severe asthma in children except:

A. Altered sensorium                 B. Pulsus paradoxus

C. Audible wheeze in both inspiration and expiration

D. All of the above are life threatening


17. The following conditions will have microscopic haematuria and decreased C3 Ievel, except.

A. Focal segmental glomerulosclerosis

B. Acute post streptococcal glomeulonephritis

C. Membrane proliferative glomerulonephritis

D. SLE nephritis

18. Acquired extra cranial infection that causes aqueductal stenosis is:          

A. Bacterial endocarditis            B. Mumps

C. Measles                    D. Staphylococcal septicemia

19. Which one of the following drugs cannot cause pseudo tumour cerebri?

A. Salicylic acid                        B. Nalidixic acid

C. Tetracycline              D. Nitrofurantoin

20. Which is not a feature of phenylketonuria?

A. Severe mental retardation  B. Reduced tendon reflexes

C. Enamel hyperplasia          D. Vomiting in early infancy

21. Which is not associated with jaundice in infancy?

A. Hereditary fructose intolerance

B. Maple syrup urine disease

C. Galactosemia                        D. Crigler- Najjar syndrome

22. Which statement is  true with regard to measles?

A. Vitamin A administration reduces the severity and mortality due to measles

B. Koplik’s spots appear on buccal mucosa on 3rd day of appearance of rash

C. Neurological complications are the most common complications following measles

D. Children with measles infection should be actively immunized to protect against future episodes

23. Which is a conjugated vaccine?

A. Hepatitis B                            B. Rubella

C. Hemophilus influenzae b        D. Pertussis

24. Which is the most common complication of measles infection in children?

A. Otitis media              B. Bronchopneumonia

C. Encephalitis              D. Diarrhoea

25. Which statement is true interpretations of the laws of normal child development?

A. The sequence and time of attainment of milestones may vary among individual children

B. Development always proceeds in a cephalocaudal sequence

C. Presence of primitive reflexes is essential for attaining voluntary actions

D. All of the above

26. Consider the following factors:

1. Head control             2. Social smile

3. Crawls                       4. Sits up

The correct sequence in the developmental milestones during the first year of life is:

A. 1,2,3,4          B. 2,1,4,3

C. 1,4,3,2          D. 2,1,3,4

27. Which is true regarding a 15 Month old child?

A. Crawl upstairs

B. Make a tower of 3 cubes

C. Name a familiar object

D. All of the above


28. You are attending a delivery. A baby weighing 3 kg is born and has not cried immediately. What sequence of resuscitation steps will you carry out.

A. Dry the baby; position the baby; tactile stimulation; suction of mouth and nose; free flow oxygen if required

B. Dry the baby; free flow oxygen; position the baby; suction of mouth and nose

C Position the baby; suction of mouth and nose; free flow oxygen; tactile stimulation; dry the baby

D. Dry the baby; position the baby; suction of mouth and nose; tactile stimulation; free flow oxygen if required


29. Daily requirement of calories and protein for a 10 kg weighing child are, respectively:

A. 800 kcal and 20 gm   B. 1000 kcal and 30 gm

C. 1000 kcal and25 gm  D. 1200 kcal and 25 gm

30. Microcytic hypochromic anaemia may result from the deficiency of:         

A. Folic acid     B. Cyanocobalamin

C. Pyridoxine    D. Riboflavin

31. Which is a constant feature of kwashiorkor?

A. Growth retardation     B. Skin changes

C. Hair changes             D. None of the above

32. Which statement is not true about epiglottitis?

A. The most frequent causative agent is Pneumococcus

B. Presents with high fever and stridor

C. Stridor diminishes with fatigue

D. Examination of throat may cause sudden death

33. WHO defines adolescent age group as:

A. 14-21 years                           B. 13-20 years

C. 10-19 years                           D. 10-17 years

34. Mental deterioration occur due to deficiency of:

A. Thiamine                   B. Vitamin D

C. Pyridoxine                D. Vitamin C

35. In adolescence, maximum gain in height for girls is observed during:

A. Post-menstrual stage                B. Pre-menstrual stage

C. Sexual maturity stage I    D. Sexual maturity stage II-III

36. A change in colour of the urine on standing is characteristic of:

A. Cystinuria’                 B. Phenylketonuria

C. Homocystinuria         D. Alkaptonuria

37. In children, the following are true of speech development, except:

A. Children pronounce simple sounds such as ‘da-da’ at 8 months

B. Children voice single, intelligible words at 13 months

C. Simple 2 to 3-word sentences are composed at 15 months

D. Children can identify 4 to 5 picture cards at 2 years

38. Primitive reflex that persists throughout life is:

A. Moro reflex                           B. Tonic neck reflex

C. Palmar grasp reflex               D. Parachute reflex

39. All are essential for diagnosis of very severe pneumonia as per ARI programme in a 3-yrs male child  except:

A. Respiratory rate 48/minute     B. Central cyanosis

C. Inability to feed

D. Extensive crepitations on chest auscultator

40. A 15-year old boy presents with weakness in both lower limbs that has progressed to involve the trunk over the last 6 days. Examination shows reduced power in muscles of the lower limbs, abdomen and chest; deep tendon reflexes are absent. CSF examination shows no cells, sugar-80 mg/dl and protein 80 mg/dl. The treatment of choice is:

A. I/V methylprednisolone          B. I/V immunoglobulin

C. I/V anti-thymocyte globulin

D. Oral cycIosporin and prednisolone

41. An 8-month old boy is referred for-evaluation following a UTI . Ultrasound examination of abdomen is normal. The most appropriate investigation to evaluate his lower urinary tract is:

A. Radionuclide cystogram        B. MCU

C. IVP                                       D. Cystoscopy

42. What is the venous hematocrit level at which you will diagnose polycythemia in a newborn?

A. 55%             B. 60%     C. 65%         D. 70%

43. The most frequent complication of mumps infection in young children is:

A. Meningoencephalitis    B. Orchitis

C. Oophoritis                  D. Migratory polyarthralgia

44. A 1-year old girl has polyuria and dehydration. Investigations show blood pH 7.26, serum Na 137 mEq/l, K 3 mEq/l, Ca 8 mg/dl, HCO3 14 mEq/l, PO4 5 mg/dl and Cl 16mEq/l. The blood anion gap is:

A 10     B. 13    C. 15      D. 24

45. A neonate is found to have central cyanosis and a cardiac murmur at 30 hours of age. The most probable diagnosis is:

A. Endocardial cushion defect   B. VSD

C. Transposition of great vessels           D. PDA

46. Expressed Breast Milk (EBM) can be stored in freezer for how long?         

A. 6 to 8 hours              B. 24 hours

C. One week                 D. One month

47. Which is best heard with the bell of stethoscope

A. S3                                                                                 B. Murmur of MR

C. Pulumonary ejection click      D. S2

48. In breast feeding, hind milk portion is richer in:

A.  Fats                                    B. Lactose

C. Vitamins                   D. Proteins

49. The most common enzymatic defect in congenital adrenal hyperplasia (adrenogenital syndrome) is:

A. 11-Hydroxylase deficiency

B. 17 – Hydroxylase deficiency

C. 21-Hydroxylase deficiency

D. 3-Beta dehydrogenase deficiency

50. Regarding simple febrile seizure, which one of the following statements is not correct?

A. It is usually seen in children between 6 months and 6 years of age

B. The seizure usually lasts for less than 15 minutes

C. Rectal diazepam given at the onset of febrile illness can reduce the incidence of recurrent febrile seizure

D. Oral phenobarbitone is usually prescribed after the first episode of seizure to prevent recurrences

51. HUS is characterized by all, except:           


B. Coombs positive hemolytic anemia

C. Thrombocytopenia    D. Neutrophilic leukocytosis

52. Erythrocyte sedimentation rate is zero in:-

A. Abetalipoproteinemia            B. Afibrinogenemia

C. Asplenia                   D. Aplastic anemia

53. Infant born to a diabetic mother is at risk for all of the following, except:

A. Neonatal hepatitis     B. Polycythemia

C. Hypoglycemia                       D. Congenital malformations

54. Which is not associated with cephalhematoma?

A. Swelling is present at birth

B. Usually involves parietal and occipital bone

C. Bleeding is subperiosteal

D. Usually reabsorbed in 2-3 months

55. 11/2 yrs old girl child, fed mostly on dilute cow’s milk, develops diarrhea which persists for 10 days. This was followed by swelling of feet. Diagnosis is?

A. Kwashiorkor              B. ARF

C. CHF                                     D. ICC

56. One life-threatening complication of this condition is: (of q. no. 55 )

A. Hyperkalemia                        B. Hypermatremia

C. Metabolic acidosis    D. Hypoglycaemia

57. Breath holding spells in children have the following features except:

A. They are preceded by minor trauma

B. Child stops breathing and is cyanosed

C. Child becomes suddenly pale and limp

D. Frequency becomes less on zinc supplementation

58. In which condition dactylitis is not seen?

A. Sickle cell anemia     B. Beta thalassemia

C. Congenital syphilis    D. Tuberculosis

59. A 3-year old child develops asynchronous clonic movements of one side of face and right upper limb. He does not lose consciousness and the episode subsides after 5 minutes. This is the first episode and the child is afebrile. The most likely diagnosis is:

A. Complex partial seizures        B. Infantile spasms

C. Simple partial seizures                       D. Febrile seizures

60. A 2-year old girl presents the recurrent episodes of diarrhea (mucus and blood at times), hepatosplenomegaly, perianal excoriation and resistant oral thrush. She weighs 6 kg and measures 78 cm in height. The most likely diagnosis is:

A. Necrotizing enterocolitis        B. Lactose intolerance

C. HIV infection

D. Campylobacter jejuni infection

61. All of the following statements with reference to childhood tuberculosis are correct, except:

A. Primary complex is mostly symptomation

B. Monteux test is useful to detect infection

C. Early morning gastric lavage for AFB is a useful test

D. Chest X -ray is the most important tool in diagnosis of military tuberculosis

62. A 3-year old child is able to perform all of the following activities, except:

A. Climbing stairs with alternate feet   B. Riding a tricycle

C. Cursive writing.                           D. Copying a circle

63. A 4-year old boy presents with a history of left ankle joint swelling and pain for four days. It was preceded by an upper respiratory infection. On examination, the left ankle is swollen and tender. There is a petechial rash over the lower limbs. He is admitted two days later with bleeding per rectum.

The most likely clinical diagnosis is:

A. Acute rheumatic fever            B. Juvenile rheumatoid arthritis

C. Pyogenic arthritis      D. Henoch-Schonlein purpura

64. Bag and mask ventilation in newborn resuscitation is contraindicated in:

A. Diaphragmatic hernia            B. Pulmonary hypoplasia

C. Tracheo-oesophageal fistula  D. Laryngomalacia

65. X-ray of the skull in an infant shows periventricular calcification in:

A. Tuberculous meningitis

B. Cytomegalovirus infection

C. Japanese B encephalities

D. Congenital syphilis

66. Most common cause for colic in an infant is

(A) Formula intolerance  (B) Otitis media

(C) Constipation                        (D) None of the above

67. Which of the following bacteria is a com­mon cause of infective endocarditis in adults but a rare cause of this infection in children?

(A) Enterococcus          (B) Staphyl. aureus

(C) Staphl. Epidermidis  (D) Viridians streptococcus

68. A 4-year-old boy is brought to you by a school worker because of concerns about evidence of injury to the child. Of the following injuries that you might discover, which would suggest child abuse?

(A) Forehead swelling with an underlying lin­ear skull fracture

(B) Multiple bruises of the extensor surfaces of the lower legs

(C) Unilateral periorbital bruising (“black-eye”)

(D) Linear bruises over the back

69. A 4-month-old infant has petechiae, pallor, and hepatosplenomegaly. Her Hb 7 g%, TLC 178,000/mm3 with 2% polymorph nuclear, 3% lymphocytes, and 95% blasts, and platelets 31,000/mm3. Her blasts are TdT-positive and CALLA- myeloperoxiaase, and nonspecific esterase-negative. Diagnosis?

(A) AML                          (B) Stage IV S. neuroblastoma

(C) Letterer-Siwe disease  (D) ALL


70. The best initial treatment for scald burns is to

(A) Debride the wound

(B) Apply cool water

(C) Apply butter or margarine

(D) Cover the wound with a bandage

71. A 2-year-old child presents to you with lethargy after a period of unobserved play. The child was previously healthy with normal development. The family history is significant for a sibling who has epilepsy and takes phenobarbital. The exami­nation reveals an afebrile, lethargic child who opens his eyes briefly to noxious stimuli. There are no signs of trauma or focal abnormality; Pupils are small, but reactive. Most likely etiology for child’s lethargy is

(A) Unobserved seizure       (B) Intoxication

(C) Intracranial hemorrhage  (D) Unobserved head injury

72. A positive HIV culture confirms the diagnosis of HIV infection in a 6-month-old girl. She has had the following problems: one episode of pneu­mococcal bacteremia, several episodes of otitis, chronic thrush, poor weight gain, and anemia. Her CD4 T-cell count is 2100/ml which is 22% of total T cells. Which of the fol­lowing is’ appropriate therapy for this child?

(A) Trimethoprim-sulfamethoxazole for prophylaxis against P.carinii pneumonia

(B) Monthly administration of intravenous gamma globulin (IVIC) to prevent further bacterial infections

(C) Zidovudine (ZDV, AZT)

(D) No therapy is needed because the child has a normal CD4 T-cell count for age

73. A mother is referred for Intrauterine growth failure. An ultrasound examination reveals that there is asymmetric growth retardation. A urinalysis reveals proteinuria. Cause of the growth failure is

(A) Trisomy 21               (B) Trisomy18

(C) Preeclampsia           (D) Cytomegalovirus infection

74. A 7 -year-old boy with hereditary spherocytosis has a high fever and is brought to the emergency room in a state of circulatory col­lapse. He has had no medical problems and has taken no medications since splenectomy was performed at 6 years of age. The most likely cause of his current condition?

(A) Pseudomonas sepsis

(B) Acute hemorrhage from splenic vessels

(C) H. influenzae meningitis

(D) Pneumococcal sepsis

75. An 18-month-old child is found to have dental decay in the upper central and lateral incisors. This is most suggestive of

(A) Excessive fluoride ingestion   (B) Milk-bottle caries

(C) Tetracycline exposure

(D) Insufficient fluoride intake

76. Occasionally, early adolescent girls with familial tall stature may be treated to reduce predicted adult stature. This treatment usually consists of which one of the following agents?”

(A) Glucocorticoid         (B) Thyroid hormone

(C) Estrogen                 (D) GnRH

77. A 9-year-old girl develops urticaria 2 month after a viral syndrome. The urticaria is still present more than 6 weeks after onset. All laboratory tests are normal. Most likely explanation for her urticaria is

(A) Food allergy                        (B) Connective tissue disease

(C) Drug allergy             (D) Idiopathic etiology

78. A 31-month-old boy presents with an 8-month H/O 3-5 watery stools daily, often containing undigested food particles. He is quite gassy and C/O abdominal pain. He is consuming an age-appropriate diet, although his physician suggests that he is given increased fluids to prevent dehydration. His CBC, stool examination and urinalysis is normal. Appropriate ini­tial dietary intervention would include

(A) Restriction of fatty foods

(B) Restriction of lactose-containing products

(C) Restriction of fluids, especially fruit juices

(D) Increased dietary fiber

79. A 6-year-old girl experiences staring spells once or twice a day. They last only 15-30 sec­onds. During these spells, she will stare, break­ing off in midsentence at times. Eyeblinking and lipsmacking are sometimes seen. After the spell, she will either continue talking or she may look momentarily puzzled. She has no other neuro­logic symptoms, and her schoolwork has not deteriorated. Diagnosis?

(A) Major motor seizures            (B) Partial complex seizures

(C) Absence seizures     (D) Daydreaming

80. A 12-year-old boy wants to tryout for a soccer team. On physical examination, a con­stant ejection click and a harsh systolic ejec­tion murmur characteristic of aortic valve ­stenosis are heard: Which is the best statement regarding AS?

(A) Patient should be restricted from” competitive sports

(B) The patient does not need endocarditis prophylaxis

(C) The ECG demonstrates RVH

(D) The aortic valve is probably calcified

81. A 7-month boy presents with oral candidacies and P. carinii pneumonia. Which is the best screening test for evaluating this child’s immune system?

(A) Quantitative serum immunoglobulin’s

(B) Delayed hypersensitivity skin testing to recall antigens.

(C) Total hemolytic complement (CH50)

(D) Nitroblue tetrazolium test

82. While riding his bike, a 14-year-old boy crashes into a parked car. He falls forward and has the “wind knocked out of him.” There is no head trauma, and several minutes later he is feeling fine. The next day, following breakfast, he complains of periumbilical and epigastric abdominal pain and vomits. The pain worsens over the next several hours and he becomes febrile to 38oC. The most likely diagnosis is

(A) Duodenal hematoma            (B) Appendicitis

(C) Mesenteric avulsion  (D) Pancreatitis

83. A 10-year-old boy presents with a history recurrent abdominal pain. There is a past history of bronchitis but no history of pneumo­nia. On examination, there has been no significant increase in weight over the past 3 years, with flattening of the growth curve. Trace digital clubbing is noted. Which is most appropriate test to be ordered at this time?

(A) Pulmonary function tests      (B) Sweat test

(C) Chest x-ray                          (D) Abdominal x-ray

84. A 3-year-old girl presents with acute onset of purpura, and epi­staxis. Her Hb 12 g/dl, TLC 5550/mm3, platelet count 2000/mm3. Diagnosis ?

(A) ITP                          (B) ALL

(C) Aplastic anemia       (D) DIC

85. Which of the following conditions has better prognosis if it occurs in a child younger than 1 year of age?

(A) Neuroblastoma                    (B) ALL

(C) Medulloblastoma                 (D) Histiocytosis X

86. In a child who is poisoned, the most active way to remove gastric contents is by the use of

(A) Saline lavage with a wide-bore nasogas­tric tube

(B) Tartar emetic                                    (C) Syrup of ipecac

(D) Manual induction of vomiting

87. A previously well 4-year-old girl presents with a 2-week history of morning headaches, vomiting, and unsteadiness of gait A CT scan shows a lesion in the cerebellar vermis. Most likely diagnosis is

(A) Brain abscess          (B) Medulloblastoma

(C) Glioblastoma multiforme

(D) Central nervous system leukemia

88. Physioiogic jaundice in term newborns is best characterized by

(A) The onset of clinical jaundice by 12 hours of age

(B) Persistence of clinical jaundice for at least 1 week

(C) Equal elevation of direct and indirect serum bilirubin values

(D) A rise in serum bilirubin concentration of less than

5 mg/dl/day.

89. A 5-year-old child presents with coarse facial feature hepatosplenomegaly, and pro­gressive loss of developmental milestones. Most likely cause is

(A) Mucopolysaccharidosis

(B) Carbohydrate metabolism disorder

(C) Aminoaciduria

(D) Urea cycle enzyme deficiency


90. An infant with atopic eczema will most likely present with which clin­ical manifestations?

(A) An erythematous, papulovesicular, exuda­tive rash

(B) Lichenified lesions on the flexural surfaces

(C) Urticaria

(D) Posterior subcapsular cataracts

91. A 2-year-old boy is brought you after his mother noted him passing several grossly bloody stools. There is no accompanying abdominal pain, fever, or vom­iting. Family history is positive for colonic cancer in several paternal uncles. On admis­sion, his hematocrit is 26%. The most likely diagnosis is

(A) Colonic polyp                   (B) Intussusceptions

(C) Iymphonodular hyperplasia (D) Meckel diverticulum

92. A 6-year-old child presents to you with headaches, fever, and pain over the left maxillary sinus. A sinus x-ray shows an air­-fluid level in the left maxillary sinus. Two most likely bacterial causes of this illness are

(A) Streptococcus pyogenes and Staphylo­coccus aureus

(B) Haemophilus influenzae and S. aureus

(C) H. influenzae and Streptococcus pneumoniae

(D) S. pyogenes and S. pneumoniae

93. A 4-month-old boy is brought to you. His parents report that the child stopped breathing at home, turned blue around his lips, and felt limp. After vigorous shaking of the infant and several mouth to ­mouth breaths, the boy’s color returned to nor­mal, and he resumed breathing. The infant’s condition is best described as

(A) Obstructive apnea                (B) Central apnea

(C) Apparent life-threatening event (D) Pneumonia

94. A 4-month-old boy develops a temperature of 101oF and is irritable for 2 hours after immu­nization with DTP vaccine. What is the appropriate procedure when this boy is seen at 6 months of age?

(A) Defer immunization with the pertussis vaccine, and instead administer DT vaccine

(B) Administer half the usual dose of the DTP vaccine

(C) Defer all immunizations until the infant is 12 months old.

(D) Administer the DTP vaccine with instruc­tions for fever control

95. The most common gene defect in idiopathic steroid resistant nephritic syndrome.

A. ACE                         B. NPHS 2

C. HOX 11                    D. PAX


96. A 9-month-old infant presents with extreme irritability alternating with lethargy. His parents note that he had an URTI several days ago and for the past 24 hours has been screaming or sleepy. He vomited once earlier in the day. He passed one stool four hours ago, which was loose and not bloody. He has a temperature of 38°C. On examination he is lethargic but arousable to painful stimuli. Abdominal examination shows diffuse tenderness and a mass in the right upper quadrant. The next, most appropriate diagnostic test would be

(A) CT head             (B) LP

(C) Barium enema.   (D) Abdominal ultrasound

97. A 2-year-old girl presents with poor weight gain and slow growth. She has episodes of vomiting and dehydration. Evaluation reveals hyperchloremic metabolic acidosis, normal creatinine, and a persistently alkaline urine. Therapy indicated is     

(A) High-caloric nutritional supplements

(B) Institution of antiesophageal reflux precautions

(C) Alkalinizing agents sufficient to normalize the serum CO2

(D) Acetazolamide (carbonic hydrase inhibitor)

98. A 16-year-old boy presents with shortness of breath. CXR reveal a large anterior mediastinal mass, and a moderate right-sided pleural effusion. The pleural fluid contains numerous Iymphoblasts that-are TdT-positive, and express the sheep red blood receptor and other T-cell antigens. On BM aspira­tion, Iymphoblasts with identical characteristics comprise 12% of the total cells. The diagnosis is

(A) Hodgkin disease      (B) T-cell ALL

(C) Burkitt lymphoma     (D) lymphoblastic lymphoma

99. A 10-year-old girl presents with a 2-week history of rectal bleeding. She states that she was well until 1 month ago, at which time her stools became looser and more frequent. Two weeks ago she noted blood streaking of the stool, and for the past 3 days her stools have been grossly bloody: There has been mild lower abdominal cramping during defecation. She denies vomiting, fever, arthritis, weight loss, or rash. Lab examina­tion shows a PCV of 38%, ESR of 15 mm/hr, serum albu­min of 4.3 g/dl, and normal serum amino­transferases. Most likely diagnosis is:

(A) Colonic polyp          (B) Crohn disease

(C) Meckel diverticulum  (D) Ulcerative colitis

100. An infant of a mother with IDDM has a PCV of 68%. On day 3 of life, he suddenly manifests gross hematuria and a flank mass on the left. Most likely diagnosis is

(A) Meconium plug                    (B) Neuroblastoma

(C) Renal venous thrombosis

(D) Ureteropelvic junction obstruction

101. A child who displays loss of developmen­tal milestones, or regression, should be investi­gated for

(A) Dysmorphic syndrome

(B) Neuronal storage disorder

(C) Chromosomal translocation

(D) Teratogenic exposure during fetal develop­ment

102. A 7-year-old boy with leukemia in remis­sion develops a fever, vesicular rash, and cough. A Tzanck test is positive, and a chest x-ray shows a small left lower lobe infiltrate. The boy’s mother is uncertain whether he has had chickenpox. What is the most appropriate initial course of action?

(A) Administer herpes zoster immune globulin.

(B) Administer antibiotics based oh Gram stain from bronchoscopic washings

(C) Administer intravenous acyclovir and ceftriaxone

(D) Admit patient to the hospital and observe closely

103. A 5-year-old boy is seen for the evaluation of clumsiness. His teacher noticed that he tended to fall easily and had an awkward gait. Examination reveals a healthy-appearing boy with prominent calf muscles. He waddles slightly when walking and demonstrates a mild lumbar lordosis. When asked to stand up from a sitting position on the floor, he uses his hands to push himself up. Deep tendon reflexes are normal, except at the ankles, where they are decreased. The most likely diagnosis in this case is

(A) Cerebral palsy       (B) Spinal muscular dystrophy

(C) Charcot-Marie- Tooth disease

(D) Duchenne muscular dystrophy

104. A 3-month-old infant has suffered recur­rent episodes of fever, skin pustules, and pneu­monia since the first week of life. Repeated blood counts have shown absolute neutrophil count (ANC) to be less than 500/mm3, whereas hemoglobin and platelet count are normal. The most likely diagnosis is

(A) Aplastic anemia       (B) Congenital leukemia

(C) Kostmann disease   (D) cyclic neutropenia

105. A 1 5-year-old boy presents with a large anterior mediastinal mass. Lab find­ings include a TLC of 180,000/mm3, with 97% blasts on differential; the blasts are positive for TdT. Most likely diagnosis is

(A) Juvenile CML                       (B) Adult CML

(C) AML                                    (D) T-cell ALL

106. The group b-hemolytic streptococcus may trigger an attack of acute rheumatic fever when it

(A) Spreads via the bloodstream

(B) Causes an upper respiratory infection

(C) Lodges in the myocardium

(D) Invades the joints

107. At 11 weeks gestation, a pregnant woman undergoes ultrasonography and is discovered to have quadruplets. She is electively hospital­ized at 21 week’s gestation to prevent this most common complication of a multiple gestation pregnancy.

(A) Premature birth        (B) Maternal hypertension

(C) Maternal anemia       (D) Hyperemesis

108. An 18-month-old girl is brought to you by her parents, who say she has had a fever of 104°F and has refused to walk since she awoke that morning. You obtain a hip x-ray, which shows a subtle widening of the left hip joint space. The most appropriate initial course of acting is

(A) Close observation in the hospital

(B) Administration of intravenous ceftriaxone

(C) Surgical drainage of the hip joint

(D) Administration of intravenous oxacillin

109. A 6-year-old boy with hemophilia a strikes his elbow and subsequently has swelling and tenderness at the site of trauma. The proper treatment of this is

(A) Infusion of cryoprecipitate

(B) Infusion of desmopressin

(C) Infusion of fresh frozen plasma

(D) Infusion of factor VIII concentrate

110. Hemoglobin Bart’s is found in:    

(A) Homozygous b thalassemia,

(B) Thalassemic hemoglobinopathy

(C) Homozygous a thalassemia

(D) Double heterozygote a and b thalassemic

111. Which of the following patients with acute lymphoblastic leukemia (ALL) has a good prognosis?

(A) A 14-year-old ‘with a WBC of 2000/mm3 and hyper­diploid, CALLA-positive pre-B cells

(B) A 7-year-old with a WBC of 79,000/mm3 and CALLA-negative B cells that have a t(8;14)

(C) A 4-year-old with a WBC of 7000/mm3 and hyperdiploid, CALLA-positive early pre-B cells

(D) A 7 -year-old with a WBC of 4000/mm3 and CALLA-positive early pre-B cells that have t(9 ;22)

112. The parents of a 4-month-old girl phone to you complaining that their daughter has a persistent diaper rash. On examination you  note that there are satellite lesions and bright red erosions involving the deep skin folds. This diaper dermatitis is most likely

(A) Candida                   (B) Infantile seborrheic

(C) Intertrigo                  (D) Staphylococcal

113. A full-term infant is noted to have circumoral cyanosis and twitching of his left hand at 12 hours of age. On exami­nation, he is found to have absent pupillary response and a small penis. Diagnosis is?

(A) Hypocalcaemia                    (B) Hypoglycemia

(C) Congenital hypothyroidism     (D) Idiopathic epilepsy


114. Starting mid-May and lasting through June, a 6-year-old boy’ complains of itchy eyes, a watery nose, and sneezing. The safest and most direct approach to the treatment of this child is with:

(A) Antihistamines

(B) Avoidance of the offending allergen

(C) Desensitization therapy     (D) Topical steroids

115. A patient with newly diagnosed AML who presents with neutropenia and a temperature of 40°C should be managed by

(A) Prompt institution of chemotherapy because the fever is most likely due to leukemia

(B) Prompt procurement of cultures and initiation of broad-spectrum parenteral antibiotics

(C) Administration of granulocyte transfusions to correct the neutropenia

(D) Extensive search for an underlying infec­tion and withholding antibiotics until one is found

116. A developmentally delayed 10-month-old girl is referred to a pediatrician for evaluation of small size for age, unusual facial features, abnormal palmar creases, and a heart defect. Which of the following is the LEAST likely eti­ology for this infant’s condition?

A. A sporadic syndrome      B. A single gene abnormality

C. A chromosome anomaly D. A multifactorial disorder

117. A 12-year-old boy presents with an erythematous, sandpaper-like rash, a temperature of 103 oF, and an infected laceration of the leg. A rapid streptococcal test performed on the purulent discharge is positive for group A b-hemolytic streptococcus. The most likely diagnosis is    

(A) Rheumatic fever       (B) Scarlet fever

(C) Erysipelas               (D) Impetigo

118. During fetal life, oxygen saturation is highest in organs that cannot sustain prolonged anaerobic metabolism without injury. In which blood vessel is the oxygen saturation likely to be the highest during normal and stressful periods?

(A) Carotid                    (B) Renal

(C) Mesenteric               (D) Pulmonary

119. An 18-month-old girl with a 4-month his­tory of no significant weight gain has failed to gain weight on a prescribed high-calorie diet. A thorough medical and routine laboratory testing have revealed no cause. Referral to a dietician has also been unsuccessful. Which would be the best next step?

(A) Repeat of routine laboratory tests, includ­ing stool culture to screen for ova and parasites

(B) Referral to a pediatric gastroenterologist

(C) Hospital admission

(D) Diagnostic imaging, including computed tomography scan of the head and abdomen

120. A 6-year-old child presents with her sec­ond episode of meningococcal meningitis. The most likely immunodeficiency disorder in this child is

(A) Neutrophil dysfunction

(B) Deficiency of complement component C3

(C) Deficiency of carboxypeptidase N

(D) Deficiency of complement component C6

121. A 2-day-old, full-term infant has generalized petechiae and has platelet count of 15,000/mm3. Her mother has no history of prior illnesses and has a nor­mal CBC.  Most likely diagnosis is?

(A) Consumption coagulopathy

(B) Passively acquired ITP

(C) von Willebrand disease

(D) Isoimmune thrombocytopenia

122. A 7 -month-old boy previously diagnosed with TOF is seen in the emer­gency room because of irritability, hyperpnea, increasing cyanosis, and episodic loss of con­sciousness. Which is the best course of management for this patient?

(A) Administration of digoxin

(B) Administration of O2 and morphine sulfate

(C) Administration of epinephrine

(D) Administration of bronchodilators

123. A neonatologist is called to attend the delivery of an infant whose fetal heart tracing is suggestive of fetal distress. It is likely that the infant will require resuscitation. Primary goal of resuscitation is to?

(A) Establish spontaneous breathing

(B) Improve the heart rate

(C) Reoxygenate the central nervous system

(D) Improve the infant’s color

124. A 2-year-old boy presents with fever, weight loss, pain in the legs, proptosis of the right eye, ecchymoses around the right eye, and a large left flank mass. The most likely diagnosis is

(A) Orbital rhabdomyosarcoma

(B) Hand-Schuller-Christian disease

(C) Metastatic neuroblastoma

(D) Wilms tumor

125. An anaphylactoid reaction can be caused by

(A) Pollen                      (B) Bee venom

(c) Aspirin                     (D) peanuts

126. A 5-year-old boy with IDDM on a single morning dose of insulin has begun to have nightly enuresis. His FBS level generally is 200-250 mg/dl, and his blood glucose level before supper generally is 75-150 mg/dl. Most likely cause of this patient’s enuresis is

(A) Glycosuria from under-insulinization overnight

(B) Stress of chronic disease

(C) Urinary tract infection     (D) Somogayi phenomenon

127. A 3-year-old girl with sickle cell anemia presents with pallor, tachycardia, hypotension, and massive splenomegaly. The most likely explanation is

(A) Hemorrhagic shock  (B) Splenic sequestration

(C) Septic shock                       (D) Carcinogenic shock

128. In late summer, a 2-year-old boy presents with a 2-day history of painful, ulcerative lesions of the mouth and a 1-day history of fever to a temp of 103°F. He refuses to eat. On examination he is irritable, temp of 102°F, and has numerous erythematous, ulcerative lesions on  buccal mucosa, & tongue. Diagnosis is?

(A) Herpangina              (B) Aphthous stomatitis

(C) Candidal gingivostomatitis

(D) Herpetic gingivostomatitis

129. Purpuric skin lesions and oozing from the gums develop in a 3-month-old male infant with congenital biliary atresia. CBC is nor­mal, but both PT and PTT are pro­longed. Diagnosis is?

(A) Hemophilia A                       (B) Hemophilia B

(C) Vitamin K deficiency            (D) DIC

130. The best indicator of cystic fibrosis is

(A) A positive family history of cystic fibrosis

(B) The presence of digital clubbing

(C) A sweat test with a chloride concentration of 70mEq/L

(D) Bronchiectasis on a chest x-ray

131. Which of the following statements best characterizes the diagnosis of UTI in children?

(A) The presence of fever localizes the-infec­tion to the renal parenchyma.

(B) The diagnosis is likely if there is pyuria with more than 10 white blood cells per high-power field

(C) The diagnosis is likely if a clean-catch specimen shows 105 organisms of a single species

(D) Diagnosis is difficult because the typical causative organisms grow poorly in culture

132. All of the following statements about pubertal growth spurt are true EXCEPT

(A) It is early in boys and late in girls

(B) It is associated with muscle development in boys

(C) It is the last of three growth spurts during childhood

(D) It is associated with fat deposition in girls

133. All of the following conditions are associated with hay fever EXCEPT

(A) Nosebleeds             (B) Nasal congestion

(C) Loss of small and taste

(D) Thick, yellow nasal discharge


134. During a private consultation with their pediatrician, the parents of a 5-year-old child reveal that they are about to be divorced. They would like to optimize custody arrangements and seek the pediatrician’s advice. In consider­ing what would be “in best interest of child,” which is LEAST important?

(A) Daily contact between the divorced par­ents to discuss the child and other issues

(B) Minimizing changes in school, friends, and lire routines for the child

(C) Assuring as much financial security for the child as possible

(D) Maintaining as much contact between the child and each parent as is possible and safe for the child

135. In a child receiving chemotherapy for T-cell leukemia, the tumor lysis syndrome with ARF develops. All lab result might be expected EXCEPT 

(A) Elevated serum K     (B) Elevated serum HCO3

(C) Decreased serum Na            (D) Elevated serum PO4


136. A chlamydial genital infection can result in all of the following EXCEPT

(A) Lower abdominal pain.         (B) Infertility

(C) Epididymitis                                    (D) Arthritis

137. A 2-week-old female infant has a head circumference of 40 cm (> 98%), with a large, tense fontanelle and downward deviation of the eyes. She has been vomiting her formula and she is irritable. Common cause of her symptoms include all EXCEPT

(A) Intraventricular hemorrhage   (B) Brain tumor

(C) Meningitis                            (D) Aqueductal stenosis

138. All of the following tests would be indi­cated in the evaluation of a 2-year-old child with x-ray documentation of recurrent pneu­monia EXCEPT

(A) Immunoglobulin analysis      (B) Sweat test

(C) Sputum culture                     (D) PFT

139. All are true about the management of an infant with a tracheo­esophageal fistula EXCEPT

(A) The fistula most commonly is found between the distal esophagus and trachea

(B) The proximal esophagus sometimes ends in a blind pouch

(C) The goal of initial management is to keep the airway clear of secretions

(D) A contrast study of the esophagus should have been performed to establish the diagnosis


140. A 5-year-old boy presents with indications of significant developmental delay or mental retardation. All of the following evaluations are indicated for this patient EXCEPT

(A) Chromosome analysis          (B) Fragile X study

(C) Urinalysis for aminoaciduria

(D) Serum a-fetoprotein (AFP) testing

141. All of the following findings may occur in juvenile rheumatoid arthritis (JRA) EXCEPT

(A) Uveitis                       (B) High, spiking fever

(C) Erythema marginatum  (D) Enlargement of the spleen

142. Bone marrow transplantation is a poten­tial therapeutic option for all EXCEPT

(A) A 4-year-old girl with stage IV neuroblas­toma with metastases to bone cortex and bone marrow

(B) A 6-year-old boy with AML in first remission who has a HLA-matched sibling

(C) A 2-year-old boy with good prognosis ALL who relapses during the first year of mainte­nance therapy

(D) A 7-year-old boy with good prognosis ALL in first remission who is on the second year of maintenance therapy


143. An infant is born at term and weighs 1600 grams. The infant’s weight, length, and head circumference are all less than the fifth percentile. Which is NOT a cause of the growth retardation?

(A) Congenital infection             (B) Chromosomal defects

(C) Cell toxins               (D) Preeclampsia

144. During an obstetrics rotation, a third-year medical student has the opportunity to follow a 17 -year-old pregnant adolescent. Which is LEAST likely to be a complica­tion of her pregnancy?

(A) Anemia                    (B) Pelvic complication

(C) Toxemia                  (D) Low-birth-weight infant

145. A 24-month-old child who has not begun to speak is brought to the pediatrician’s office. All of the following conditions should be con­sidered in the differential diagnosis EXCEPT

(A) Autism                     (B) Developmental delay

(C) Hearing impairment.   (D) Childhood schizophrenia

146. A 14-year-old girl experi­ences the sudden onset of gross hematuria, which persists for 2 days. All of the following are reasonable immediate steps in the evalua­tion of this patient EXCEPT

(A) Hb electrophoresis to exclude hemoglobin S

(B) Cystoscopy to establish the site of bleeding

(C) BUN and serum creatinine measurement

(D) Urine culture

147. A 3-month ­old infant should display all of the following reflexes EXCEPT

(A) Parachute reflex       (B) Tonic neck reflex

(C) Rooting reflex          (D) Moro reflex

148. Hyperbilirubinemia is diagnosed in a 2-day-old infant whose serum bilirubin con­centrations are 17.5 mg /dl (indirect fraction) and 0.2 mg /dl (direct fraction). All statements concerning the evaluation and management of this infant are true EXCEPT:

(A) The indirect and direct bilirubin concen­trations are consistent with a physiologic jaundice

(B) The initial evaluation should include a complete blood count with reticulocyte count, maternal and infant blood types, and Coombs’ test

(C) Breast-‘feeding may have contributed to the elevated bilirubin concentration

(D) Phototherapy should be administered

149. A 14-year-old girl is taken to you because she has not begun to menstru­ate. On examination, she is noted to be in less than the fifth percentile for height and weight. She has no breast development. The remainder of the history and physical examination are normal. Possible conditions responsible for this patient’s presentation include all EXCEPT

(A) Turner syndrome      (B) 21 -hydroxylase deficiency

(C) Hypothyroidism

(D) Constitutional delay of growth and puberty


150. A 16-year-old woman is brought in by her parents for evaluation of her weight loss. They claim that over the past year she has gradually dropped from 115 to 95 pounds. She does well at school and is very concerned about how she looks, often exercising several hours a day. To be able to make the diagnosis of anorexia nervosa, the physician needs to find all of the following factors EXCEPT

(A) Weight loss to at least 15% less than expected for height

(B) Obsessive and overachieving personality traits

(C) Disturbed body image

(D) Absence of at least three consecutive menstrual cycles

151. All are helpful in the evaluation of an infant with bronchopul­monary dysplasia EXCEPT

(A) Sleeping respiratory rate       (B) Oxygen saturation

(C) Chest x-ray                          (D) Sweat test

152. A nurse believes that a 12-hour-old infant has experienced a seizure lasting 2 minutes. Labor history includes rupture of the fetal membranes 24 hours before delivery and a difficult delivery with forceps. The Apgar score was 7 at 1 minute and 8 at 5 minutes. The nurse reports that the infant had been feeding poorly and was lethargic before the seizure. The differential diagnosis includes all EXCEPT:

(A) Asphyxia                 (B) Meningitis

(C) Kernicterus              (D) Intracranial hemorrhage

153. A 6-year-old boy is shorter than all of his classmates. Diagnostic testing supports a diag­nosis of idiopathic isolated growth hormone (GH) deficiency. All of the following are expected clinical findings in this patient EXCEPT

(A) Normal body proportions

(B) A growth velocity of 3 cm/yr

(C) Mild truncal obesity           (D) Hypertension

154. Toxic shock syndrome is associ­ated with all the following findings EXCEPT.

(A) Vomiting and diarrhea          (B) Disorientation

(C) Increased platelet count        (D) Abnormal LFT

155. All of the following are feature of normal children of 12- 18 month of age except:

A. Decreasing growth rate B. Increasing appetite

C. Decrease in sleep time D. Exaggerated lumbar lord sis

156. Which of the following children will require stringent developmental and physical assessment

A. Six month old taking every thing in to the mouth

B. An eight month old right handed child

C. Five month old not sitting unsupported

D. Ten month old month walking independently

157. Triceps skin fold thickness is a measure of :

A. Muscle nutrition         B. Muscle power

C. Body adiposity         D. Body stature


158. Stature is best measured using :

A. Inch tape                  B. Swing arm measuring sticks

C. Herpendens caliper   D. Stadiometer

159. Commonest cause of delayed tooth eruption is:

A. Hypothyroidism        B. Familial

C. Malnutrition               D. Idiopathic

160. The condition in which physical symptoms are induced by parents in their children is :

A. Over anxious parents            B. Conversion disorder

C. Hypochondriasis

D. Munchausen’s by proxy syndrome

161. Enuresis and encopresis  are examples of :

A. Psychosomatic disorder

B. infection of urinary and GI tracts respectively

C. elimination disorders                 D. sleep disorders

162. A Two years old male child was brought to you for an evaluation of delayed development. The mother also complained that the child remains withdrawn ,non demanding and does not interact either socially or verbally with his parents & siblings during play. His prenatal history & examination did not reveal any abnormally. Diagnosis is?

A. Childhood schizophrenia

B. Idiopathic mental retardation

C. Autism                      D. Retts syndrome

163. All of the following are treatment options for attention deficit hyperactivity disorder (ADHD) Except

A. Environment structuring  B. Positive reinforcement

C. long automobile trips               D. Psychotherapy

164. All of the following statement about human milk and cows milk as are true, except

A. Whey to casein protein ratio is high in cows milk as compared to human milk

B. Human milk has more proteins

C. Human milk has more positive effect on brain development to cow milk.

D. Cow Milks has more sodium

165. All of the following are cardinal features of kwashiorkor except:

A. Edema                                 B. Growth retardation

C. Psychological  changes .      D. Hair changes


166.  Most useful parameter for screening obesity in adolescents are all of the following except:

A. Weight for age percentile chart

B. Body Mass index                  C. Kanawati index

D. Skin fold thickness measurement

167. All of the following are reported as complications of childhood obesity except :

A. Hyperinsulinism                     B. Gall Stones

C. Pseudo tumor cerebri                        D. None of the above

168. Hypernatremia  can occur  in all of the following condition except :

A. Diabetes insipidus    B. Top fed neonates

C. SIADH                      D. Burns

169. A three year old female child was brought to the hospital with one day history of excessive cry, irritability, poor feeding and passing dark urine.There is history of brief diarrheal illness ten days back. Her examination findings were splenomegaly and few petechiae over the skin of the trunk. Investigation revealed    Hb 8 gms TLC 20000, platelet count 50000  retic. count 4 % Urine proteins 1+ RBCs 1+ Abdominal ultrasound revealed mild splenomegaly what is the most likely diagnosis?

A. Henoch – schonlein pupura    B. ITP

C. HUS                 D. Bilateral renal vein thrombosis

170. Wilm’s tumor may be associated with all of the following conditions except .

A. WAGR syndrome                  B. Carolis disease

C. Beckwith  weidemans syndrome

D. Denny drash syndrome

171. Drugs used in chemotherapy for wilm tumor are chosen on the basis of histological characteristic of the tumor. You will chose all of the following drugs for tumor with favorable histology except :

A. Vincristine                 B. Dactinomycin

C. Cyclophosphamide   D. Doxorubicin

172. A newborn baby is investigated for UTI and a sample for urine is required. Ideally which method should be used to collect such a sample:

A. Bladder cauterization

B. Suprapubic aspiration of bladder

C. Urinary bag collection

D. Diaper urinary specimen

173. Given below is a laboratory report of urinalysis of a two days old premature baby born at 32 week of gestation. Which finding is abnormal?

A. PH = 6                      B. Albumin = traces

C. Glucose = 1 +                       D. RBC = 10 / HPF


174. On routine screening during regular school health checkups  a seven year old , other wise healthy child  was  found to be having  persistent proteinuria. All investigation will be  a part of initial evaluation of this child except :

A. Renal Ultrasound       B. Serum C 3 Levels

C. Ultrasound guided renal biopsy

D. 24 hours urinary  protein


175. Proximal renal tubular acidosis has all the following features except ;

A. Hypokalemia             B. Bicarbonate wasting

C. Nephrocalcinosis      D. Hyperchloremia

176. Antiepileptic drug that cause severe skin rashes when especially used with sodium Valproate is   

A. Gabapentine                         B. Vigabatrin

C. Lamotrigine               D. Tailgating

177. True about congenital Nephrogenic diabetes insipidus are all of the following , except

A. It can lead to hypernatremic dehydration

B. Females are more severely affected than males

C. Hydronephrosis is one of the recognized complication

D. Thiazide diuretics are used in the treatment.

178. What is the pathophysiology of Barter syndrome

A. Hyperplasis of juxtaglomerular apparatus

B. Interstitial nephritis

C. Distal tubular dilatation   D. Distal tubular necrosis

179. A two old  toddler  was diagnosed as case of CRF in view of growth failure anemia and hypertension and raised serum creatinene level. Most likely underlying cause of his CRF is :

A. Primary glomerulopathy  B. Hereditary renal disorder

C. Toxins                        D. Anatomic abnormalities

180. Ten month old who was born at term gestation with birth weight of two kilogrms is brought to you for evaluation. Which of the following if present , will be of concern to you most :

A. Infants weight = 7 kilograms

B. Head circumferences = 42 cms

C. Takes breast feeding and one glass milk per day

D. Has a reducible umbilical hernia

181. Nile blue sulphate test is done to detect

A. Maturity of kidney     B. Maturity of liver

C. Maturity of lungs       D. Maturity of skin

182. Hepatitis A Vaccine is a from of :

A. Purified viral antigen .

B. Live attenuated viral vaccine.

C. Inactivated whole viral vaccine

D. Conjugated polysaccharide vaccine .

183. You hand administered DPT vaccine to an infant one month back when mother comes for next dose she complains of painless nodule at the injection site you next step would be

A. Vigorous rubbing at the site dissolve the nodule .

B. Incision and drainage of the abscess

C. Prescribe  antibiotic and analgesic

D. assurance to the mother without any active intervention

184. You  are called in the labour room to attend a newborn who is just delivered by a twenty year old primigravida brought in emergency on examination you find a grunting newborn kept under a 100 watt bulb with heart rate of 110 | minute and cyanosis   . drying suction has already been done by the nurse you next step would be .

A. To give tactile stimulation so that baby cries and becomes pink.

B. To wait for 30 second and re evaluate for respiration

C. To  administer 100% oxygen by tubing face mask and re evaluate after 30 seconds

D. To intubate and give IPPV with ambu bag and 100% oxygen till baby becomes pink and vigorous .

185. You are looking after newborn babies in the postnatal ward. One of  the mothers complain that her four day old spits out milk after taking breast feeds and has not passed stool since past one day , but passes urine frequently . On examining the baby  you do not find any positive finding except icterus your next step would step would be :

A. To  order an  X – ray abdomen in vertical suspension to see for evidence of intestinal obstruction

B. To prescribe domeridone    drops and 15 ml normal saline enema .

C. To advise discontinuation of breast – feeds and switch over to thickened formula feed

D. To advice to burp the child after feeds and continue exclusive breast – feeding .

186. A six day old neonate was brought to OPD for bluish large spots over back and buttocks. Otherwise clinical examination was non significant. most probable diagnosis.

A. Hemorrhagic disease of newborn

B. Battered baby

C. Erythema toxicum     D. Mongolian spots

187. A Preterm (32 weeks gestation age ) was kept in NICU . On the second postnatal day the child was suddenly found to be limp with no visible respiratory efforts and bradycardia. Blood glucose is 40% most likely cause of his condition is :

A. Hypoglycemia         B. Development immaturity

C. Periodic breathing

D. Hyaline membrane disease .

188. A Three day old ictric male new born (total S Bilirubin = 30 %, unconjugated = 28 mg % weighing 3 kgs was advised phototherapy and exchange transfusion. history reveals that his elder female sib who is now one year old, also underwent similar procedure in the neonatal period his father and uncle had a history of waxing and waning jaundice severity of which decreased after some abdominal surgical procedure. Most likely cause of this baby jaundice is :

A. G 6 PD deficiency     B. RH incompatibility

C. Hereditary spherocytosis

D. Criggler – najjar syndrome type 2

189.  An 8-year old child was brought to you for a high grade fever of 3 days duration with vomiting headache and decreased responsiveness. Examination revealed a distressed child , in shock with maculopapular and ecchymotic  rashes on the skin with bleeding from venepuncture sites and hepatomegly.     Investigation showed PCV = 65% WBC 4000 platelet 25000 & mildly prolonged PT. CXR revealing left sided pleural effusion. Diagnosis  is ?

A. Meningococcemia with DIC

B. Dengue heamorrhagic fever

C. Leptosporisis                        D. Complicated malaria

190. Which of the following hepatotropic viruses are most likely to be associated with chronic hepatitis

A.HBV                          B. HCV

C. HDV                                     D. HGV

191. You are examining a two year old toddler brought for refusal of feeds and rash over skin you find ulcerative lesions in the oral cavity, tender vesicular skin lesion on dorsum of hands and feet some non vesicular lesions are also seen on buttocks most likely agent causing this condition is:

A. HSV                                     B. Varicella – zoster virus

C. Coxsckies virus        D. Rickettsia

192. The drug of choice for rheumatic fever prophylaxis in a penicillin allergic patient is:

A. Erythromycin                        B. Clindamycin

C. Vancomycin              D. Gentamycin

193. A baby presents on the 14th day of life with icterus. The un. conjugated bilirubin level is 18 mg/dl. The following cannot be a possible cause

A. Hypothyroidism        B. Breast milk jaundice

C. G 6 PD deficiency     D. Neonatal cholangiopathy

194. The following is the first phenotypic expression of hereditary hemochromatosis

A. Post prandial increase in iron

B. Increased serum ferritin

C. Increase in transferrin saturation

D. Slate like skin pigmentation

195. All are features of rickets in infancy except

A. Bow legs                  B. Craniotabes

C. Rachitic rosary

D. Anterior fontanelle delayed closure

196. A 71/2 child with non productive cough, mild stridor, on oral antibiotics, patient is improving but suddenly developed wheeze, productive cough, mild fever and on X-ray hyper­lucency and PFT shows obstructive curve. The most probable diagnosis is,

A. Bronchiolitis obliterans     B. Post viral syndrome

C. Pulmonary alveolar microlithiasis

D. Follicular bronchitis

197. A child presents with recurrent ecchymoses, with past history of umbilical stump bleeding  The most appropriate diagnosis is,

A. Factor 9 deficiency   B. Factor 13 deficiency

C. Platelet                     D. GPlb deficiency

198. Commonest cause of renal artery stenosis in Indian children

A. Takayasu                       B. PAN

C. Fibromedial hyperplasia   D. Fibrointimal hyperplasia

199. A two-year-old male child was given 8 day course of cefaclor of 10 days Course. The child developed low grade fever, malaise, lymphadenopathy, irritability, generalized erythematous rash which are mildly pruritic. Most probable diagnosis is

A. Kawasaki disease     B. Partially treated meningitis

C. IMN                          D. Type 3 hypersensitivity

200. A boy suffering from acute pyelonephritis, most specific urinary finding will be.

A. Leucocyte esterase test    B. WBC casts

C. Nitrite test                         D. Bacteria in gram stain



  1. C
  2. B
  3. A
  4. B
  5. A
  6. D
  7. D
  8. A
  9. A
  10. C
  11. D
  12. B
  13. C
  14. C
  15. C
  16. C
  17. A
  18. B
  19. A
  20. B
  21. B
  22. A
  23. C
  24. A
  25. D
  26. B
  27. D
  28. D
  29. B
  30. C
  31. A
  32. A
  33. C
  34. A
  35. D
  36. D
  37. D
  38. D
  39. D
  40. B
  41. B
  42. C
  43. A
  44. A
  45. C
  46. D
  47. A
  48. A
  49. C
  50. D
  51. B
  52. B
  53. A
  54. A
  55. A
  56. D
  57. D
  58. B
  59. C
  60. C
  61. A
  62. C
  63. D
  64. A
  65. B
  66. D
  67. A
  68. D
  69. D
  70. B
  71. B
  72. C
  73. C
  74. D
  75. B
  76. C
  77. D
  78. C
  79. C
  80. A
  81. B
  82. D
  83. B
  84. A
  85. A
  86. C
  87. B
  88. D
  89. A
  90. A
  91. D
  92. C
  93. C
  94. D
  95. B
  96. C
  97. C
  98. D
  99. D
  100. C
  101. B
  102. C
  103. D
  104. C
  105. D
  106. B
  107. A
  108. C
  109. B
  110. C
  111. C
  112. A
  113. B
  114. A
  115. B
  116. D
  117. B
  118. A
  119. C
  120. D
  121. D
  122. B
  123. C
  124. C
  125. C
  126. A
  127. B
  128. D
  129. C
  130. C
  131. C
  132. A
  133. D
  134. A
  135. B
  136. D
  137. B
  138. D
  139. D
  140. D
  141. C
  142. D
  143. D
  144. B
  145. D
  146. B
  147. A
  148. A
  149. B
  150. B
  151. D
  152. C
  153. D
  154. C
  155. B
  156. B
  157. C
  158. D
  159. D
  160. D
  161. C
  162. C
  163. C
  164. B
  165. D
  166. B
  167. D
  168. C
  169. C
  170. B
  171. C
  172. B
  173. D
  174. C
  175. C
  176. C
  177. B
  178. A
  179. D
  180. C
  181. D
  182. C
  183. D
  184. C
  185. D
  186. D
  187. B
  188. C
  189. B
  190. B
  191. C
  192. A
  193. D
  194. D
  195. A
  196. A
  197. B
  198. A
  199. D
  200. D

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