1.

Newborn baby noted to have abnormal facies with low-set eats, a small receding jaw and
widely separated eyes. At 30 hours of age the baby develops multiple muscular spasms.
Serum studies are notable for Ca 4.5mg/dL. which of the following is the most likely Dx
a. Bruton’s agammaglobulinemia
b. Common variable immunodef
c. Digeorge
d. Selective IgA def
e. Transient hypogammaglobulinemai of infancy
2. 6 mnth old previously healthy child is brought to the doctors office because of sudden onset
lethargy, constipation, gen. weakness, poor feeding. He has been meeting milestones and
immunization is up to date. On further questioning his parents mention that his diet was
recently advanced to a homemade formula of evap. Milk & honey. On PE he has stable VS,
clear lungs, normal skin turgor and full fontanelles. Which is most likely?
a. Botulism
b. Hishsprung
c. Hypernatremia
d. Hyponatremia
e. Hypothyroid
3. 7 yr old boy brought to the clinic for lifetime Hx of bedwetting. He is otherwise completely
healthy and has met dev. milestones. Parents deny Hx trauma, Hx not consistent with abuse.
Pt is wetting every night but not during day. No incontinence. Which is next best step in
evaluation
a. IVP
b. Renal USG
c. 24 hr urine collection
d. Urinalysis
e. CT pelvis
4. 7 yr old presents ot physician’s office with 3wk Hx of left sided anterior cervical lymph node
enlargement. The nodes are not tender to palpation. A few papules develoved on the left
forearm at onset of lymphadenopathy. The boy has a kitten at home. Which of the following
is the most likely organism?
a. Actinomyces israelii
b. Bartanella
c. __ tularensis
d. TB
e. S. aureus
5. 14 yr old boy evaluated for short stature. No significant past med Hx, parents consider him
otherwise healthy. He eats normal diet and has regular meals. His height and weight have
been consistently at 5th centile since early childhood. His PE is normal, with genitalia st
tanner stage 3. Which is most likely lab findings?
a. Bone age = chronologic age
b. Decreased complement C3
c. Decreased serum albumin conc
d. Decreased TSH
e. Increased serum creatinine
6. 17 yr old girl found unconscious in bathroom after ingesting a large amt of unknown
sleeping pills. On arriving at A&E she is somnolent. T – 37.2C (98.9F). BP – 120/74, P –
68/min, RR – 12/min. she responds to painful stimuli and to hearing her name loudly by
opening her eyes widely. However she returns to somnolent state immediately after. Which
is best intervention?
a. IV caffeine
b. IV droperidol
c. IV 500ml NS
d. Ipecac induced emesis
e. Gastric lavage
7. 5 yr old boy is brought to physician because of malodorous discharge from right nostril.
Parents report he developed frequent sneezing and mucus discharge for 1 week. They
thought it was a cold. Child is afebrile and in apparent good health. No Hx allergic disease or
recurrent infections. PE reveals obstruction of right nasal fossa with ass. purulent discharge
from right nostril. Which is dx?
a. Allergic rhinitis
b. Juvenile angiofibroma
c. Nasal foreign body
d. Nasal polyp
e. Rhinitis medicamentosa
8. 24 month old child is seen in the pedatrician’s office for a regular health supervision visit. No
Hx dev. delay. Born by uncomplicated SVD at term, no significant illnesss or injury prior to
visit. Which motor milestone is NOT consisten with his age
a. Building tower of 2 cubes
b. Copying circle
c. Scribbling
d. Throwing ball overhand
e. Walking backward
9. 5 yr old girl presents to emergency department with acute onset muscle weakness. The
mother carried the girl to the examination room and states that the weakness started in her
daughter’s legs yesterday. It became worse today and progressed to the trunk and both
arms. She was also complaining of difficulty breathing earlier today. She has been otherwise
healthy but had a common cold 10 days ago. On PE – RR – 26.min & shallow, profound
muscle weakness in lower limbs, mod. Weakness in upper limns. Deep tendon reflexes
absent. LP – increased protein conc but no pleocytosis. Which is most likely dx
a. Botulism
b. Dermatomyositis
c. GBS
d. Myasthenia gravis
e. Toxic neuropathy
10. A 4196g (9lb 4oz) infant is delivered via vaginal delivery to a 31 yr old mother with GDM.
The delivery was complicated by shoulder dystocia. His is taken to the newborn nursery
where his intial glucose is 20mg/dL. the intial Hct is 65%. Which congenital anomaly is this
baby likely to have?
a. Aniridia
 b. Cleft palate
c. Macroglossia
d. Omphalocele
e. Single palmar crease
f. Small left colon
11. 3 week old africna American boy is brought to the ER because of a generalized seizure 2hrs
ago. The infant is highly irritable with an incessant high pitched cry. The infants weight is
2.5kg (250g below birth wt). BP -70/40, P – 145/min, RR – 50/min. lab results show:
Blood glucose – 120ml/dL, BUN – 50mg/dL, Na – 170mEq/dL, Ca – 8.5mEq/dL, Mg –
1.5mg/dL
Which of the following is the most likely cause of the seizure
a. Hypocalcemia
b. Hypoglycaemia
c. Hypomagnesemia
d. Intracranial haemorrhage
e. Meningitis
12. 10 year old presents with a 2 month history of heavy menstrual bleeding. Menarche was 6
months ago, menses consisted of spotting for 3-4 days without cramps. Subsequent periods
were light in flow lasting 6-8 days. Which is most likely cause of bleeding?
a. vWF disease
b. ovarian tumour
c. thyroid disease
d. DUB
e. Pregnancy
13. 17 year old girl present to the office with a 5 day Hx of malodorous vaginal discharge. She is
sexually active and uses condoms for intercourse. PE shows a thin, white discharge with fishy
odor when KOH is added. Vaginal fluid had pH of 5.0. which is most likely microscopic
finding?
a. Clue cells
b. Gram –ve diplococcic
c. Lactobacilli
d. Pseudohyphae
e. Trichomonads
14. 16 year old boy brought to ED by friends. He is semicomatose with pulse – 60/min, RR – 6-8
/min. his pupils are constricted. Which of the following is most likely revealed on urine tox
screen
a. Amphetamine intoxication
b. Cocaine
c. Ethanol
d. Opiates
e. TCA
15. 16 year old female presents to ER with severe right sided abdominal pain. LMP was 2 wks
ago and felt to be normal. She displays painful difficulty in positioning herself on the exam
table. T – 38.5C (101.3F), BP – 128/75, P – 80/min, RR – 22/min. PE of throat reveals mild
pharyngitis. Abdomen is diffusely tender especially lower abd. Rectal exam reveals
 tenderness anteriorly on right side. Stool guaiac –ve. Pelvic exam shows cervical tenderness
and questionable fullness in right adnexal area. Most likely Dx?
a. Ovarian cyst
b. Pyelonephritis
c. PID
d. Constipation
e. Endometriosis
16. 15 yr old girl presents with 2day Hx of pain and swelling to left knee. She plays soccer
regularly on her school team. There is no Hx trauma. PE – marked swelling and tenderness
over anterior tibial tuberosity. XR of left knee – irregularities on tubercle contour and
haziness of adjacent metaphyseal border. Which is most likely explanation?
a. Avascular necrosis of hip
b. Legg-calve-perthes disease
c. Osgood schlatter disease
d. Septic arthritis
e. SCFE
17. 12 month old presents with bilious vomiting and abdominal distension for 10 hours. His
mother states that the infant has been constipated since birth and failed to pass meconium
in the 1st 48 hrs of life. PE – irritable, length & weight <5 centile for age. Abd moderately
distended. DRE done with fair amount of stool ejected from anus after. Which is lieky?
a. Duodenal atresia
b. Intussusception
c. Hirschsprung
d. Malrotation
e. Pyloric stenosis
18. Otherwise healthy 5 yr old boy is brought to ED of a small hospital for a simple 3cm lac to
forehead. The patient is crying and frightened. The practitioner decides to perform
conscious sedation before suturing. Support personnel and equipment are available for
monitoring vitals and doing resus if needed. Which is best pharmacologic agent?
a. Oral/rectal midazolam/diazepam
b. Concomittent opiod and benzodiazepine
c. IV propofol
d. IV ketamine
19. 4 week old boy brought to clinic by mother for 1 day Hx laboured breathing. Uneventful
birth and immunization up to date. Mother reports he had conjunctivitis on 4th day of life. PE
– breathing rapidly 40/min, afebrile. Chest reveals bilateral inspiratory crackles and slight
wheeze. CXR – bilateral pneumonia. Leukocyte count is elevated (15,000 with 40%
eosinphils). Most likely pathogen?
a. Ascaris lumbricoides
b. Chlamydia trachomatis
c. Mycoplasma pneumonia
d. PCP
e. VZV
20. 13 yr old boy is seen for right knee pain persisting for last 2 months despite over counter
analgesics. His mother states that he has been limping since pain started. The pain is of
 insidious onset but intensity sometimes increased. PE – obese, weight higher than 90th
centile, flexion of right hip causes marked outward rotation and reproduces pain. Internal
rotation is limited and right leg is slightly shorter than left. Which is most likely?
a. JRA
b. Legg-calve-perthes
c. Septic arthritis
d. SCFE
e. Toxic synovitis
21. Infant brought to clinice for routine vist and vaccinations. Shee is the product of an
uncomplicated pregnanacy and has been meeting dev. milestones. Shee is feeing well and
her mother reports that the baby seens to be growing well as well. On PE the infant is
afebrile with stable VS. she can lift her hand to 90 degrees. Her eyes follow past midline and
she has slight awareness of her mother. Which is most likely age?
a. 2 mnth
b. 4
c. 6
d. 12
e. 18
22. 9 yr old boy brought to paediatrician office for bedwetting. Mother states that he has never
been dry at night. Occassionaly has problems controlling bladder during the day. PE = BP =
98/56. Weight and height < 5th centile for age. Bladder is enlarged and palpable above pubic
symphysis. Which is most likely cause?
a. Unstable bladder
b. SC trait
c. Reflux nephropathy
d. 1°polydipsia
e. --- this is answer

25. previously healthy 13 yr old girl presents to ED with acute onset red uurine after playing soccer in
the morning. PE is unremarkable. Urinalysis shows red colour, pH 6.5, spec gravity – 1.02?, glucose
negative, blood +4 ,protein trace, nitrite negative, leukocyte esterase negative, WBC 0/hpf, RBC
1/hpf. Most likely?

a. glomerulonephritis
b. haematuria
c. ingestion of food colouring
d. myoglobinuria
e. presence of urates
f. trauma
g. UTI

26. 5 month old infant presents with diarrhea and decreased activity for past 3 days. PE shows P –
162, anterior Fontanelle sunken, skin tenting. Labs – Na – 165, K 5??, Cl -128, HCO3 – 14, Cr – 0.9,
BUN – 49, gluc – 154.8 hours after IVF theraphy is started he has a gen seizure. Which is cause?

a. Hypoglycaemia
 b. Hypercalcemia
c. Idiopathic epilepsy
d. Rapid correction of hyper Na
e. Rapid correction of met acidosis

27. 4 yr old girl with SCD presents to Ed with T – 39.6C (103.2F). other than irritability PE is
unremarkable. Labs WBC – 18000, **% PMN, 10% lymphocytes, 2% monocytes, Hb – 7.6. most
appropriate ?

a. Observe child pending blood culture results

b. Administer amoxicillin orally
c. Ceftazidime & gentamincin IV
d. Ceftriaxone IV
e. Vancomycin & gentamicin IV

3rd to last

1. Missing most. Best treatment for strep pharyngitis

a. 1 dose __ penicillin G IM
b. 1 dose ceftriaxone IM
c. 1 dose procaine penicillin G IM
d. Erythromycin po x 5/7
e. Penicillin V po x 5/7
2. 14 yr old girl present for annual checkup. Parents concerned that she is not meeting
milestones of growth. She reports no recent illness, is up to date on vaccines and is not
having trouble at school. She denies drug use and is active in sports. PE – vitals stable. Lungs
clear, heart regular rate & rhythm. Breast and areola enlargement is noted with no countour
separation of the areola. Pubic hair is noted to be dark. The patient reports that she started
menstruating 8 montha ago. Tanner stage?
a. I
b. II
c. III
d. IV
e. V
3. 16 yr old with incomplete vaccine record had 1 dose MMR during doctor’s visit. 1 month
later she finds out she is pregnant. She is concerned about birth defects. What is risk?
a. <1%
b. 3%
c. 5%
d. 8%
e. 10%
4. 1 ½ yr old girl sent to children;s hospital for nosebleed severe enough to require nasal
packing and transfusion of platelet concentrated. Blood sample drawn, lab notes clot formed
was unusual  failed to retract. Peripheral blood smear shows appropriate normal size plt,
all with no clumping. At hospital it was noted child’s parents were cousins. Platelet studies
show failure to aggregate with any physiologic agent. Dx
 a. Bernard – souler syndrome
b. Chediak- hegashi syndrome
c. May-heggin anomaly
d. Thrombosthenia
e. vW disease

cannot read next 3 pages

2nd to last

1. Most of question cut off. “she raised the concern of inhalant abuse. Which if the ?? is the
most ?? of chronic inhalant abuse
a. Arrhythmia
b. Bronchial asthma
c. Cerebral haemorrhage
d. Encephalopathy
e. Respiratory distress
2. 3 yr old brought to ED by father. Fever, Headache, neck pain developed over past several
hours. Child was adopted after birth mother abandoned. PE reveals???. There is
photophobia and mildly infected conjunctiva appreciated. Pupils equal and responsive. Neck
stiffness with positive kernig sign. CBC – leukocyte – 24000, segmented neutrophils & bands.
Growth on blood agar
a. H. ducreyi
b. Hib
c. N. meningitides
d. L. monocytogenes
e. S. pneumonia
3. 1 month old boy, brought by mother to ED for “projectile vomiting” past several days.
Everytime she feeds him it gets worse. He doesn’t seem to be in pain. She describes it as
non-bilious and he has had normal sttol with no blood. Infant is mildly dehydrated, abd –
soft and palpable olive-sized firm movable mass in RUQ
a. Duodenal atresia
b. Intussusception
c. Hirschsprung
d. Midgut volvulus
e. Pyloric stenosis

Last page:

1. T - ??Right forearm erythematous, edematous and tender to touch. Most appropriate

antibiotic
a. Ampicillin
b. Amoxicillin- clavulanate
c. Clindamycin
d. Doxycycline
e. TMP-SMZ
2. Toddler brough to ED with burns on both buttocks….u don’t even need rest of this is
obviously
a. Application of __acetate to burned area
b. __excision and grafting
c. Education of parents on accident prevention
d. Promt administration of fluid resus
e. Refer to authoorties for suspected child abuse
3. 8 yr old boy, left leg pain, high fever. Refusing to walk since yesterday. PE – T – 39.8C
(103.6F), BP 122/66, P – 120, RR – 20. Left femur tender to palpation 3 cm above kneed and
??swelling. plain film of leg is normal. A bone scan shows increased uptake arund metaphysi
of left femur. Which is pathogen?
a. E. coli
b. H. influenzae
c. ??
d. S. aureus
e. S. Pneumonia
Mcq from mars – from pretest

176 – B – polyarthritis in rheumatic fever

in same patient, which is not relieved by ASA or steroid

a. Carditis
b. Abd pain
c. Arthritis
d. Chorea
e. SQ nodules

202 – D – sweat chloride test

246 – GER

6 month old boy has brown urine and healing impetigo lesions. He presents with HTN, dyspnea,
periorbital edema, hepatomegaly. Cause?

a. IgA nephropathy
b. Post strep GN
c. Idiopathic hypercalciuria
d. STI

A newborn’s back reveals a small lump of soft tissue overlying lower spine. Evaluate with USG
demonstrate

a. Ebstein pearl
b. Mongolian stop
c. Cephalohematoma
d. Omphalocele
e. Spina bifida

Polyhydramnios frequently ass. with

a. Renal agenesis
b. Pulmonary hypoplasia
c. Urethral atresia
d. Amnion nodosum
e. Anencephaly

Trisomy 18 ass. with all but

a. Mental retard
b. Failure to thrive
c. Macrognathia
d. Low set ears
e. Heart disease

Which not associated with down?

 a. Hypotonia
b. Brushfield spots
c. Simian crease
d. Flat nasal bridge
e. Heart disease

Which is not ass. with HSP

a. Non thrombocytopenic purpura

b. GI bleed
c. Arthralgia/arthritis
d. ?
e. Poor prognosis

All are char of TOF cyanosis except

a. It is most prominent on MM of mouth and lips

b. Gives skin dusky colour
c. Always present at birth
d. Relieved by ↑FiO2
e. May give sclera grey discolouration

Some degree of cyanosis present in pt with PDA in all except

a. PDA + pulmonary stenosis

b. Pul. HTN
c. Right atrial pressure ↑
d. Tricuspid stenosis
e. VSD present

Child who vomits blood every morning. No other complaint.

a. Sinusitis
b. Adenitis
c. Nosebleed
d. PUD
e. Meckel

All except 1 is true concerning K+ replacement from diarrheal loss

a. Should not exceed 450ml

b. Renal fxn must be present
c. Loss must be replaced in 12 hrs
d. Loss is almost exclusively ICF

Infant with most common type of congenital esophageal malformation presents with

a. Coughing
b. Choking
 c. Excess oral secretions
d. Gasless abd
e. Cyanosis w/ feeding

Allopurinol is useful in treating acute leukemia

a. Induce remission
b. Maintain remission
c. Induce and maintain
d. Prevent vomiting
e. ↓hypercalicuria

Propranolol is useful to Rx

a. Asthma
b. Allergic rhinitis
c. T-C seizures
d. Cardiogenic shock
e. PSVT

A kid receiving primaquire for malaria develops jaundice and anaemia

a. SCd
b. Thal
c. HVSC
d. PK def
e. G6PDD

Name Fe chelator  desferoxine

Major cause of M&M w/ acetaminophen

a. Hepatic inj
b. Gastric bleed
c. Met. Acidosis
d. Methemoglobin
e. Hypoglycaemia

Working in clinic in mabaruma. 8 yr old w/ rectal T – 100, bilateral tender parotid swelling, pain on
neck flexion. Headaches, immunization Hx unknown.

a. Mumps w/ aseptic meningitis

b. Pneumococcal meningitis
c. Viral
d. Upper lobe pneumonia
e. Cervical spine arthritis

3 most common causes of bact. Meningitis

 a. S. pneumoniae
b. N. meningitides
c. Hib

Infant born to mother with little prenatal care. She is anxious, complains of heat intol, fatugie, no wt
gain despite increased appetitie. PE – mother tachycardic, tremor, neck fullness. Infant at risk of

a. Constipation
b. Heart failure
c. Macrocephaly
d. 3 °Heart block
e. Thrombocytosis

NB with abnormal facies – low set ears, small receding jaw, wide separated eyes. Day 1 develops
muscle spasms Ca – 4.5.

a. Brutton
b. Variable immunodef
c. Digeorge
d. IgA
e. Hypogammaglobulinemia

10 yr old wit heavy menstrual like bleeding. Menarch 6 months ago. 1st menses 3-4 days no cramps.
Others light flow 6-8 days. Cause?

a. vW disease
b. ?
c. Thyroid
d. Pregnancy

8 yr old boy brought for routine exam. Difficulty reading/concentrating. PE – café-au-lait spots, 2 soft
masses above orbit, axillary freckling. Mother has café-au-lait spots on arms

a. Neurofibromatosis
b. Congenital hypothyroid
c. Marfan
d. Osteogenesis imperfect
e. Tuberous sclerosis

42 wk postmature baby born immediately had RD. previously green tinged meconium amniotic fluid.
Most appropriate step

a. Tracheostomy
b. Mech ventilation
c. CXR
d. Supplement O2 via FM
e. Suction mouth and oropharynx
Mental retard, w/ arthritis, progressive renal failure, self mutilation  lip/finger biting. Others in
family same disorder

a. Lysch-nyhaan

Least likely RF ofr hearing impairment

a. Maternal exposiure to phenytoin

b. Neonatal jaundice
c. Family Hx
d. LBW

Infants sits with minimal support, attempts to meet toy beyond reach, rolls from supine tto prone,
no pincer grasp

a. 2mnth
b. 4
c. 6
d. 9
e. 1yr

Child brought for routine exam. Can dress with help, ride tricycle, knows own age, speak in short
sentences…..

a. 1yr
b. 2
c. 3
d. 4
e. 5