Of the ff, the most appropriate finding to

distinguish between acute rheumatic fever

and infective endocarditis is:
a) A positive ASO titre
b) A positive blood culture
c) A prolonged pyrexia
d) An abnomal echocardiogram
e) An elevated ESR
 A 6 year old male who had prolonged bleeding
after circumcision in the newborn period now
presents with a swollen knee following a fall. Of
the ff, the most appropriate investigations are
a) APTT and clotting time
b) Bleeding time and APTT
c) Fibrin degraded product and PT
d) Ristocetin cofactor level and PTT
e) PT and APTT
 Erythema marginatum is best described as
a) Iris lesions with relatively normal centres and active
slightly elevated edges distributed throughout the body
b) A slowly expanding erythematous papule that is painful
and pruritic with a raised border and central clearing
c) Macular lesions with irregular edges that may be
exacerbated by warm baths
d) Tender violatous subcutaneous plaques that are usually
found over the anterior shins but can be found elsewhere
e) Yellow white postules frequently noted in the newborn
period that resolve spontaneously
 A 4yr old girl presents with peri-orbital odema and
multiple skin lesions on her lower limbs. Her blood
pressure is above the 99th percentile. Urinalysis is
negative for protein. Of the following, the most
appropriate intervention is:
a) Review in 1 week and repeat her BP
b) Topical antibiotic and review in 1 week
c) Give diphenyl hydramine orally and review in 48hrs
d) Titrate BP with hydralazine
e) High dose oral corticosteroid and review in 48hrs
 A 12 yr old boy presents with a hx of pyrexia and
cough for 4 days. One day prior to admission, he
developed a rash characterised by target lesion
more marked periorbitally and mucosal erosion.
The most likely dx of the boy is:
a) Erythema multiforme
b) Kawasaki disease
c) Rheumatoid disease
d) Scarlet fever
e) Varicella zooster
 A 4 year old girl is brought in by her mother.
The mother states that her daughter is
suffering from nightmares and sores. She has
a history of recurrent ear infections. On
examination, the child has large tonsils and
nasal speech. The most likely dx is:
a) Adenoidal hyperplasia
b) Sleep apnea
c) Asthma
d) Nasal polyps
e) GERD
 Conductive hearing loss may be a feature of
a) Adrenal hypertrophy
b) Congenital rubella syndrome
c) Fracture of the base of the skull
d) Hypothyroidism
e) mucopolysaccharidoses
 A 13 year old boy presents with a serum blood
glucose of 28mmol/L and 3+ ketones in urine. In
the initial mgmt of his condition, which of the ff is
the most appropriate?
a) A fluid bolus of 20ml/kg normal saline
b) Potassium 2mmol/kg should be added to IV
c) Slow acting insulin can be given subcutaneously
d) Administration of bicarbonate in a patient with
pH of 7.28
e) A fluid bolus of 20ml/kg of 1/5 normal saline
 A 10 month old baby presents to the paediatric
emergency with a hx of fever, lethargy and poor
feeding for 5 days. Examination reveals weight 8kg,
oxygen saturation 96% in air, pulse 150/minute, BP
100/60mm Hg, Capillary refill 5sec. The most
appropriate mgmt for the patient is to give:
a) A bolus of 180ml 5% Dextrose/0.2 saline
b) A bolus of 100mls of normal saline
c) A bolus of 160mls of normal saline
d) A bolus of 180mls Ringers lactate solution
e) A bolus of 80mls of albumin
 A 3 year old boy is admitted with 10% dehydration
secondary to diarrhoea and persistent vomiting.
Investigations:
BUN 23mg/dl Creatinine 0.6mg/dl
Cl 101mmol/L K 3.6mmol/l
Na 156 mmol/l. The fluid of choice for his rehydration
following resuscitation is:
a) Normal saline
b) Ringers lactate
c) 10% Dextrose
d) 5% Dextrose/0.2% saline
e) 5% Dextrose/0.45% saline
 A 12 month old child presents with a 3 day history of
diarrhoea with a frequency of 10 motions a day. The stools
are watery and of a large volume. O/E he seems to be
drowsy, his eyes were sunken and he does not seem to be
interested in feeding. His weight is 10kg. The most
appropriate initial mgmt is to give:
a) 800mls of oral rehydration salt solution over the next hour
b) 800mls of oral rehydration salt soln over next 4hrs
c) 200mls of 0.9% saline IV over the next hour
d) 110mls of 0.9% saline IV over the next hour
e) 110ml of dextrose 5% in 0.45% saline solution IV over the
next hour
 A 2 year old male infant presents to the ED with a hx of
swelling of his legs, vomiting and loss of appetite for a
week. Both parents are unemployed and there are 3 older
siblings under the age of 6years. Initial investigns show Hb
2.2g/dl, WBC 27 * 109, Film microcytic hypochromic, HIV
negative ELISA.
The most likely explanation is
a) Ancyclostome duodenale
b) Ascaris lumbricoides
c) Strongyloides stercorulis
d) Enterobius vermicularis
e) Giardia lamblia
 A 4yr old presented to the ED with a 3 week hx of
puffiness around the eyes and increasing weight. Since
2days ago, he has experienced abdominal pain and
occasional loose stools. O/E he has shifting dullness
and tenderness. Of the ff the most likely organism
causing the abdominal problem is:
a) E. coli
b) H. influenzae
c) Streptococcus faecalis
d) Streptococcus pneumoniae
e) Staphylococcus aureus
 Of the ff, the best response related to a 2 yr
old is:
a) Able to follow 2 step commands
b) Able to use sentences routinely
c) Able to have a vocabulary of 1 to 3 words
only
d) Able to name 4 colours
e) Able to copy a cross
 An 8yr old girl comes to the clinic complaining of
secondary enuresis (bedwetting) associated with increased
uinary frequency and volume over the past week. She has
no fever, dysuria or abdominal pain, no noticeable weight
loss over the period of her illness and maintains a healthy
appetite. She has experienced headaches associated with
difficulty seeing the board at school. The most important
clinical sign to elicit is
a) Papilloedema
b) Crackpot sign
c) Abnormal deep tendon reflexes
d) Caf au lait lesion
e) Dehydration
 A 6month old boy had repeated episodes of vomiting since the age
of 1 month. His mother reports that the vomiting is usually large
volume sometimes mixed with streaks of blood that he had
jaundice during the first few days of life. Anthropometric
measurements
Weight 7kg (9th centile)
Length 67.5cm (on the 50th centile)
Head circumference 45cm (just above 50th centile)
Of the ff, most likely diagnosis
a) Congenital esophageal varices
b) Galactosemia
c) Gastroesophageal reflux
d) Rotavirus gastroenteritis
e) UTI
 An 8 year old girl comes to the clinic with a recent onset of
bedwetting associated with increased urinary frequency
and volume over the past week. She has no fever, dysuria
or abdominal pain, no noticeable weight loss over the
period of her illness and maintains a healthy appetite. She
has experienced headaches associated with visual
difficulties at school. The most likely diagnoses is
a) Diabetes mellitus
b) Diabetes insipidus
c) UTI
d) Urethrocoele
e) Hypercalcemia
 An 18 month old child with normal
development is able to
a) Hop
b) Ride a bicycle
c) Be dry during the day
d) Understand simple commands
e) Draw a vertical line
 The ff are normal developmental features of
an 18month old child:
a) Follows simple commands
b) Says 25 words
c) Stacks a tower of 6 cubes
d) Stoops and recovers
e) Names 2 colours
 A 7 yr old boy with neurogenic bladder self
catheterises 4x a day. He develops fever and a
urine sample is sent for Gram staining culture and
sensitivity. Of the ff, the most likely organisms
isolated is:
a) E. coli
b) Klebsiella
c) Proteus mirabilis
d) Pseudomonas sp
e) Staphylococcus aureus
 A 5 yr old presents with a 2 week hx of recurrent
left knee pain and a limp. O/E the joint is warm
and swollen.
Of the ff she is most likely to test positive for
a) Anti nuclear antibody
b) Anti streptolysin O antibody
c) Gonococcal antigen
d) Rheumatoid factor
e) Smith antigen
 Of the ff, which is the most appropriate mgmt
option for a child who ingested kerosene?

a) Should have gastric lavage

b) Must be given an emetic
c) May require oxygen therapy
d) Should be given IV fluid for 24hrs
e) Should be given charcoal
 Clinical vignette for next 2 MCQs
A 9 month old male presents to ER with
suspected kerosene ingestion. He is retching
and crying. The kerosene had spilt on his
clothes and on the floor. He recently had
upper respiratory tract infection associated
with a mild fever. On examination he is
lethargic and tachypnoeic, RR 60/minute,
pulse 130/min and temperature 100deg F.
There is no stridor, but mild intercostal and
subcostal recession
 Of the ff, the most likely cause of the childs
presentation is:
a) Upper airway obstruction
b) Lower airway obstruction
c) Pneumonitis
d) Pneumonia
e) Lung collapse
 Of the following, the most appropriate initial
mgmt in this patient is to:
a) Take blood for CBC
b) Do an urgent chest radiograph
c) Give oxygen by face mask
d) Give normal saline bolus
e) Pass a nasogastric tube
 A 2 yr old child was found by his mother chewing a
paracetamol tablet while holding the empty bottle in
his hand. The mother knows that there were 10tablets
of 500mg strength in the bottle. She brought the child
to the ED within half an hour. He was playful and
active. The most appropriate mgnt is to:
a) Reassure the mother and send the child home
b) Admit the child and institute forced alkaline diuresis
c) Administer ipecac to induce vomiting
d) Take blood for serum paracetamol levels
e) Administer N-acetylcysteine orally
 A previously healthy 9month old girl presents
with moderate respiratory distress. On
auscultation there is bilateral generalised
crepitations and wheeze. The most likely
causative agent is
a) Mycoplasma sp.
b) Chlamydia sp
c) Pneumocystis jirovecii
d) Parainfluenza type 1
e) Streptoccus pneumoniae
 A 3 month old male was seen in ED with a respiratory rate
of 64/min, audible wheezing and intercostal and subcostal
recession. Mother gives a hx that this has been occuring for
4 days and was getting progressively worse. Her 4 yr old
daughter had a similar episode when she was 4 months old
requiring hospital admission. Auscultation revealed rhonchi
bilaterally, anteriorly and posteriorly. Of the ff, the most
likely dx is:
a) Acute asthmatic attack
b) Bronchiolitis
c) Viral pneumonia
d) Milk aspiration
e) Bacterial pneumonia
 An 8 yr old presents with multiple generalised petechiae following a
recent viral upper respiratory tract infection. The rest of his
examination is unremarkable. His CBC shows
Hb 12.2 g/dl WBC 8.3 * 109
Platelets 35 * 109
The blood film shows no blasts or abnormal cells but a decreased
platelet count. Of the ff, the most appropriate treatment for the child
is
a) Expectant management
b) Commence oral steroids
c) Infuse IV gamma globulin
d) Perform bone marrow biopsy
e) Transfuse with platelets
 A 7 month old male infant is admitted to the
ward with a hx of aspiration after a feed. The
chest xray changes are expected to be found in
the:
a) Left lower lobe
b) Left upper lobe
c) Right lower lobe
d) Right middle lobe
e) Right upper lobe
 A 3yr old boy is dx with croup and discharged to
his parents care from ED. The parents should be
advised to return if there is
a) An increase in loudness of the barking sound
b) An increase in the pitch of the stridor
c) Increased work of breathing
d) Persistence of respiratory symptoms for more
than 7days
e) Persistence of hoarseness for more than 1 day
 A 7yr old girl presents with a 4day hx of fever and
cough. O/E of her chest, she has decreased breath
sounds in the right middle and lower zones, with
decreased percussion note and decreased vocal
fremitus. No crepitations are heard.
The most likely cause is
a) Bronchospasm
b) Lobar consolidation
c) Hemothorax
d) Pleural effusion
e) Pneumothorax
 A 12 year old girl presents with a 3day hx of
cough and temperature of 37.5deg C. O/E she is
not toxic and has crepitation in the bases
bilaterally. Of the following, the most appropriate
antibiotics for the pt is:
a) Ampicillin
b) Azithromycin
c) Benzyl penicillin
d) Ceftriaxone
e) Ciprofoxacin
 A 4 yr old boy presents with a 5day hx of fever
and cough. His chest x ray shows opacification
obscuring the right heart border. The antibiotic of
choice is:
a) Amoxicillin
b) Cefotaxime
c) Cotrimoxazole
d) Erythromycin
e) Vancomycin
 Questions that are not in pp
1. Baby had dehydration etc pointing towards
some signs dehydration as the child could
tolerate fluids and the question was what
maintenance fluids you would give and the
answers were
a) 1000ml hypoosomolar ORS solution
b) 1000ml isoosmolar ORS solution
c) 800ml hyperosmolar ORS
d) 800ml hypoosmolar soln etc.
 Kerosene ingestion question

Answers included a variation from the one in the

pp as it included an option on doing both bloods
for paracetamol levels and administering N
acetylcysteine
Questions on azithromycin and ampicillin came
twice exactly the same question repeated
(under resp)
 The question on slide 38 of initial set
platelets were reduced to 5 instead of 35 but
no bleeding. Dont know if that makes a
difference in the management
 A scenario with a child with deepening
jaundice etc. The picture seemed to point
towards intrahepatic challenges as the stools
etc were normal. The answers were
something like more unconjug bili; more
unconj bili but with some conjug etc. Just
review the scenarios with pre intra and post
hepatic jaundice stuff to see what happens
 There were 2 questions on CVS congenital d/o
1 was on coarctation of the aorta with the coarc
distal to the left subcalvian artery and described
options as a) weaker lower limb pulses on the
right, b) stronger upper rt limb pulse, c) weaker
lower limbs etc. Just revise what happens with
coarc distal and proximal to LSA
The 2nd question described a baby crying etc and
going blue with feeds. It wasnt quite the same as
the one in pp but if u review the one in pp you
get the gist
 They brought a question about child who had
trauma at home but on admission has no
neuro findings etc. The scenario was very
similar to the one in pp although they
changed a few things and the options are
a) Admit for 24hours
b) CT scan
c) Monitor in A & E for 4hours
d) Send home etc
 A 3 yr old presents with an enlarged cervical
lymph node for which he has prescribed
antibodies with no response. The Mantoux test
was 8mm. The next best line of action is:
a) Excision biopsy of node
b) INH therapy
c) Request ESR
d) Order chest X ray
e) Give follow up rx
 A 3yr old boy is dx with croup and discharged to
his parents care from ED. The parents should be
advised to return if there is
a) An increase in loudness of the barking sound
b) An increase in the pitch of the stridor
c) Increased work of breathing
d) Persistence of respiratory symptoms for more
than 7days
e) Persistence of hoarseness for more than 1 day
 The agent most likely associated with croup in
a child is:
a) Bordetella pertussis
b) Haemophilus influenza
c) Influenza A H1N1 strain
d) Parainfluenza virus
e) Streptococcus pneumoniae
 A 6 month old infant was seen in the A &E in moderate
respiratory distress with a RR of 60/min, HR 220/min
and is febrile. There is a 1 week hx of cold and cough
prior to his presentation at the A &E dept. He has
received the primary immunisations. The most likely dx
is
a) Aspiration pneumonitis
b) Atypical pneumonia
c) Bronchiolitis
d) Viral myocarditis
e) bronchopneumonia
 A 5 yr old presents with a 2 week hx of recurrent
left knee pain and a limp. O/E the joint is warm
and swollen.
Of the ff she is most likely to test positive for
a) Anti nuclear antibody
b) Anti streptolysin O antibody
c) Gonococcal antigen
d) Rheumatoid factor
e) Smith antigen
The scenario in our exam was changed
to generalised tonic clonic seizures
they did not state febrile.
The most likely EEG finding in a child who has
just had a febrile seizure is:
a) No abnormalities
b) 3 per sec spike and wave changes
c) Generalised slowing
d) Hypsarrythmia
e) Sharp waves
 The most likely cause of fulminating nephritis
in a child is:
a) Minimal change glomerulonephritis
b) Focal segmental glomerulosclerosis
c) Membraneous glomerulonephritis
d) Post streptococcal glomerulonephritis
e) Ig A nephropathy
 The scenario started off with 3 week
hx of periorbital edema they didnt
state nephrotic directly ff by 2 days of
A 4 yr old boy with steroid dependent nephrotic
syndrome presented to the ED with a 2day hx of
abdominal pain and occasional loose stools. O/E of the
abdomen, he has shifting dullness, guarding and
rebound tenderness. Of the ff, the most likely organism
causing the abdominal problem is
a) E. coli
b) H. influenzae
c) Streptococcus faecalis
d) Streptococcus pneumoniae
e) Staphylococcus aureus
49. The statement that best describes cerebral palsy
is that:
a) It involves a motor deficit
b)It is a progressive neurological disorder
c) It should be diagnosed before the 2nd year of life
d)Physical signs remain the same as child grows
e) The insult is sustained by a fully mature brain
 The most likely presentation of a 1 month old
child with cerebral palsy is
a) Head lag
b) Sleeping difficulties
c) Abnormally increasing head circumference
d) Caf au lait spots
e) Absent deep tendon reflexes
 A 3month old baby who is well grown and pink is found
to have high volume pulses in all limbs, a systolic thrill
in the left infra clavicular area, normal apex beat and
normal heart sounds with a continuous murmur at the
left infra-clavicular area. Of the ff, the most likely dx is
a) Congenital aortic stenosis
b) Patent ductus arteriosus
c) Pink atrio-ventricular canal defect
d) Transposition of the great vessels
e) Ventricular septal defect
 A term newborn baby product of an uncomplicated
pregnancy is noted to be turning blue during feeds
however she is pink while crying. Of the following, the
most appropriate diagnostic procedure is
a) Pass a nasogastric tube through each nostril
b) Direct a laryngoscopy of the airway during crying
c) Inspiratory and expiratory films during normal
breathing
d) Measurement of arterial blood gas during the
cyanotic spells
e) Review maternal notes for a hx of polyhydramnios
 The ff are features found in children with
Down Syndrome
a) Polydactyly
b) Single palmar crease
c) Hypoplastic nails
d) Clinodactyly
e) Syndactyly
 Concerning ocular findings at birth, a healthy
baby may have
a) A paralytic squint
b) A white reflex
c) Brushfield spots
d) Leukokorea
e) Sub-conjuctival hemorrhages
 The scenario was a child a few weeks
old with blood in stool but answers the
same as per below
 A 3yr old presents with an enlarged cervical
lymph node for which he was prescribed
antibiotics with no response. The Mantoux test
was 8mm. The next best line of action is:
a) Excision biopsy of the node
b) ?therapy
c) Request ESR
d) Order chest x ray
e) Give a ff up appointment
 Of the ff, a poor prognostic indicator for Acute
Lymphoblastic Leukemia (ALL) is
a) Anemia at presentation
b) Detection of t(9:22) translocation,
Philadelphia chromosome
c) DNA index greater than 1
d) Presence of RBC in CSF
e) WBC less than 50 * 109 at presentation
 A 6 yr old girl presents with ataxia, headaches
associated with early morning vomiting and
nystagmus. The tumor most likely to cause her
symptoms is:
a) Astrocytoma
b) Brain cell glioma
c) Craniopharyngioma
d) Ependymoma
e) Supratentorial primitive neuro-ectodermal
tumor
 AGE REQUIREMENT
(Kcal/kg/day)

0 - 6months 110

12 months 95

1 4 years 100

5 - 9 years 80

A 4 yr old who weighs 9kg has a daily caloric

intake of
a) 500kcal
b) 650kcal
c) 900kcal
d) 1200kcal
e) 1500kcal
 Breastfed infants in the first 2 weeks of life
have a normal stool consistency that is:
a) Formed
b) Pasty
c) Putty like
d) Pellet like
e) Watery with small clumps
Of the ff the risk factor that has the most
consistently been associated with physical abuse is:
a) Age of the child
b) Gender of the child
c) Maternal educational attainment
d) Sibling rivalry
e) Socioeconomic status
 Of these, a recognised side effect of phenytoin
is
a) Hyperphagia
b) Peripheral retinal atrophy
c) Hirsutism
d) Acne
e) rickets