1.

Cyanosis in the newborn may be caused by which of the following:

A. Transposition of the great arteries.

B. VSD

C. Hyperbilirubinaemia.

D. Coarctation of the aorta.

E. Eisenmenger syndrome

2. An uncomplicated ventricular septal defect in a 5-year-old boy may be associated with

which

one of the following?

A. A collapsing pulse.

B. Wide and fixed splitting of the second heart sound.

C. Clubbing of the fingers.

D. A pansystolic murmur of grade 4/6 in intensity.

E. Splenomegaly.

. In an infant, which of the following make Cardiac failure unlikely?

A. A respiratory rate of more than 30 per minute

B. A heart rate of more than 180 per minute

C. An enlarged liver

D. Ascites

E. Excessive perspiration

. Which one of the following would lead you to

consider a murmur to be innocent in a four and a half year old child?

A. Pansystolic timing.

B. Association with a thrill.

C. Marked variation of loudness with change of posture.

D. Radiation towards the left axilla.

E. Association with fixed splitting of the second heart sound.

1
. A 15 year old female presents following a sore throat with chest pain, fever, and a

skin rash. Examination reveals a diastolic murmur. Her ASO titre is elevated. Which of

the following is a major criterion for the diagnosis of Rheumatic fever?

A. Fever

B. Raised ESR

C. Polyarthritis

D. Migratory erythema

E.Prolonged PR interval

6. Which one of the following options would not be expected in association with poorly
controlled hypothyroidism in an 18 month old infant?

A. High plasma TSH concentration

B. Delayed bone age

C. Umbilical hernia

D. Diarrhoea

E. Delayed development milestones

. A 16 year old female presents with hypertension and increasing weight. Which of the
following

features would be most suggestive of Cushing's syndrome rather than simple obesity?

A. Abdominal striae

B. Acanthosis Nigricans

C. Buffalo Hump (interscapular fat pad)

D. Moon face

E. Proximal myopathy

2
. Which of the following is correct concerning Type 1 Diabetes in children.

A. Insulin therapy should be given only when oral hypoglycaemic agents fail

B. There is a strong hereditary component

C. The onset of the disease is usually acute

D. Retinopathy is commonly seen upon diagnosis.

E. The adequacy of glycaemic control is most reliably assessed by twice daily urinalysis

. Which one of the following statements is correct concerning Glucose-6-phosphate

dehydrogenase deficiency?

A. It is inherited as an autosomal dominant condition.

B. The condition is more severe in males.

C. Is associated with drug induced haemolysis

D. Is an indication for splenectomy

E. Blood transfusions are not indicated

. A 3 month old boy is admitted unwell.

Investigations reveal a hypokalaemic alkalosis. Which of the following may be
responsible for this metabolic disturbance?

A. feeds that are too concentrated

B. congenital pyloric stenosis

C. cystic fibrosis

D. previous urinary diversion

E. renal failure

. Which of the following is a feature of

pseudohypoparathyroidism?

A. Increased urinary phosphate and cAMP with PTH infusion

B. Low serum PTH

C. Low serum calcium and low serum phosphate

D. Low serum calcium and high serum phosphate

E. Shortened 2nd and 3rd metacarpals

3
12. Which of the following is commonly associated with congenital hypothyroidism in
the neonatal period:

A. Hypothermia

B. Diarrhoea

C. Prolonged conjugated hyperbilirubinaemia

D. A small anterior fontanelle

E. Inguinal hernia

13. Which one of the following statements applies to congenital

adrenal hyperplasia:

A. It always presents shortly after birth

B. Boys more commonly present at an earlier age than girls

C. It is most frequently caused by 11 beta hydroxylase deficiency

D. It is commonly associated with genital pigmentation

E. Hypotension is invariably present.

14. Which of the following is true concerning Whooping cough (pertussis)?

A. is a greater threat to children during the second 6 months of life, after maternal
antibody has declined, than during the first 6 months

B. may lead to hemiplegia

C. is characteristically associated with a polymorph leucocytosis

D. is associated with convulsions less frequently than is the case with other febrile
conditions

E. rapidly resolves with antibiotic treatment

15. A 2 month old child presents with snuffliness and difficulty in feeding. He has a
crusty nose and low-grade fever. His respiratory rate is 40/min. Symmetrical
conducted secretion sounds are heard in the chest.

4
 What is the most likely diagnosis?

A. Allergic rhinitis

B. Upper respiratory tract infection

C. Sinusitis

D. Asthma

E. Croup

16. One of the surgical wards in your hospital notes an outbreak of Methicillin
resistant Staphylococcus aureus (MRSA) infections. What is the best mechanism for
reducing further transmission of this infection?

A. Cleaning the floors and walls of the ward with chlorhexidine

B. Close the ward for one month

C. Encourage regular hand washing by ward staff

D. Screen ward staff using nasal swabs and exclude those with positive cultures for
MRSA

E. Treatment of culture-positive patients with vancomycin

17. A 5 year old boy presents to Accident and Emergency complaining of acute pain
over his upper tibia. He is febrile and he refuses to move his leg. A diagnosis of
osteomyelitis is suspected

The likely infecting organism is?

A. Clostridium difficile

B. Haemophilus influenzae

C. Pseudomonas

D. Salmonella

E. Staphylococcus aureus

5
18. An 18-year-old boy is suspected of having cystic fibrosis. Which of the following
results would be most suggestive of this condition?

A. Abnormal pancreatic function tests

B. Abnormalities in lung function tests

C. Bronchiectasis on a chest x-ray

D. Elevated sweat chloride concentration

E. Low immunoreactive plasma trypsinogen

19. Which of the following statments is characteristic of acute hepatitis B

infection?

A. Most patients present with splenomegaly.

B. It confers immunity to hepatitis A.

C. It commonly presents with distal joint arthritis.

D. There is increased infectivity in the presence of the e antigen.

E. Pruritis is an important early symptom.

20. Which of the following statements correctly applies to a baby of 2 months who
is considered to be 10% clinically dehydrated with gastroenteritis:

A. He may have blood and mucus in his stools

B. He will have a full fontanelle

C. He will have a low packed cell volume

D. Urea level will be normal

E. Should not be given milk orally for at least 48 hours

21. Which one of the following is a reliable method of assessing dehydration in

infants:

A. Assessment of intra-ocular tension by palpation

B. Skin turgor over the dorsum of the hand

C. Palpation of the anterior fontanelle

D. Blood pressure

E. Serum sodium concentration

6
 22. Which of the following statements is true concerning: Intussesception in
children:

A. Is more common between the age of 3 months to 8 years

B. Bile stain vomiting is an early feature

C. Bleeding per rectum is the most common presenting symptom

D. Is usually caused by a polyp or pedunculated tumour

E. Hydrostatic reduction plays an important role in the management

23. Which one of the following statements is true regarding giardia

lamblia.

A. May cause intestinal malabsorption

B. Often causes a bloody diarrhoea

C. May cause of haemolytic uraemic syndrome

D. May be excluded by stool microscopy

E. May be treated with Co-Trimoxazole (Septrin)

24. An infant is suspected of having gastrooesophageal reflux.

Which one of the following statements relating to this diagnosis is correct?

A. He is unlikely to present with vomiting.

B. Vomitus will be bile stained.

C. He is likely to require drug treatment

D. He may have apnoeic episodes

E. A barium swallow would be the investigation of choice to diagnose it

25. A young child is admitted with a two day history of feeling unwell, fever and has
developed bloody

diarrhoea. Which of the following is the most likely cause?

A. Crohn’s disease

B. E.Coli 0157

C. Giardiasis

D. Polio [0]

E. Threadworm infestation

7
 26. Which of the following is associated with hypernatraemia.

A. Cholera

B. Pyloric stenosis

C. Inappropriate ADH secretion

D. Diabetes insipidus

E. Diabetes mellitus

F. 27. By the age of 2 years, a normal child should be able to build the following
structures using 1 inch cubes:

G. A. A train

H. B. A bridge

I. C. Steps (after demonstration)

J. D. A tower of 6 cubes

K. E. A pyramid

28. Features of Down’s syndrome include all of the following except:

A. A third fontanelle.

B. Duodenal atresia.

C. Ataxic gait.

D. Increased incidence of hypothyroidism.

E. Susceptibility to acute leukaemia

8
 29. A 3 year old by presents with a 2d history of coryza and cough, particularly at
night.

On examination he has Harrison's sulci and is on the 3rd centile for weight and
height.

Chest auscultation reveals scattered wheeze.

What is the most likely diagnosis?

A. Gastroesophageal reflux

B. Allergic rhinitis

C. Sinusitis

D. Asthma

E. Croup

30. A 10 year old boy attends A+E with a two daY history of a limp. He has
recently been unwell. On examination he is apyrexial and movement at his hip is
uncomfortable.

A. Congenetal dislocation.

B. Perthes disease

C. Septic arthritis

D. Slipped upper femoral epiphesis

E. Transient synovitis

31. Which one of the following conditions is transmitted by means of an X-linked

recessive inheritance :

A. Cystic fibrosis

B. Galactosaemia

C. Huntington’s chorea

9
D. Duchenne muscular dystrophy

E. Facio-humero-scapular dystrophy

F. 32. Early cardiac failure during the neonatal period is often associated with:

G. A. Hepatomegally

H. B. Failure to thrive

I. C. Feeding difficulties

J. D. Episodes of apnoea

K. E. A raised pulse rate but normal respiratory rate

33. Which of the following statement regarding Napkin rashes is correct?

L. A. Always caused by ammonia.

M. B. Less common in babies fed a soy protein milk.

N. C. Often successfully treated by exposure to air.

O. D. Evidence of early infantile eczema.

P. E. More common in boys

Q. 34. In children with Fallot’s tetralogy; the following statement is incorrect?

R. A. Cyanosis is always present shortly after birth

S. B. Heart failure is a rare complication

T. C. Auscultation reveals a systolic ejection murmur in the pulmonary area and a

single second heart sound

U. D. Squatting relieves cyanosis after exercise

V. E. Functional anaemia may be present in spite of a haemoglobin concentration

which is normal to age.

W. 35. The following conditions cause an increased anion gap Except:

X. A. Diabetic ketoacidosis.

Y. B. Proximal renal tubular acidosis.

Z. C. Aspirin poisoning.

10
AA. D. Lactic acidosis.

AB. E. Acute renal failure.

AC. 36. The following statement applies to a cephalhaematoma in the newborn.

AD. A. It usually manifests immediately after birth.

AE. B. The haematoma is formed beneath the periosteum.

AF. C. A common site is over the temporal bone.

AG. D. The treatment of choice is aspiration.

AH. E. Mother can be told it will disappear by the age of four weeks.

AI. 37. The following condition may be detectable by growth monitoring:

AJ. A. Hyperthyroidism

B. Hypothyroidism

AK. C. Pseudohypoparathyroidism

D. XYY Syndrome

E. Insulin dependent diabetes mellitus

38. In examination of the cardiovascular system in childhood; the folowing

statement is True:

A. A venous hum is best heard with the child lying flat

B. Ventricular septal defect is usually clinically detectable in the first few days of life

C. Intercostals recession is useful evidence for a left to right shunt

D. Normal femoral pulses at birth exclude coarctation of aorta

E. Peripheral oedema is a valuable sign of heart failure in infancy

39. Among the following, the condition that is MOST likely to predispose a pediatric
patient to the development of systemic candidiasis is

A. history of atopy

B. history of prematurity

C. immunosuppression

11
 D. presence of an indwelling catheter

E. recent tonsillectomy

40. The virus most commonly associated with the clincal picture of acute bronchiolitis in
infants and young children is

(A) adenovirus.

(B) respiratory syncytial virus.

(C) rhinovirus.

(D) coxsackievirus B

(E) herpes virus type 2

41. Which of the following is a common side effect of phenytoin (Dilantin) therapy?

(A) Raynaud's phenomenon

(B) Lymphoma syndrome

(C) Lupus erythematosus syndrome

(D) Gingival hyperplasia

(E) Optic atrophy

42. A child in the preicteric phase of hepatitis A moxt likely will exhibit

(A) fever, rash, and diarrhea

(B) headache, hepatosplenomegaly, and clay-colored stools

(C) anrexia, fever, and vomiting

(D) fever, coma, and convulsions

(E) stiff neck and photophobia

43. Which of the following is the most common cause of failure to thrive in infants?

(A) Renal disease

(B) Metabolic disorders

(C) Tuberculosis

(D) Endocrine disorders

12
(E) Nonorganic causes

44. Which of the following laboratory values is normally higher in childhood than in
adulthood?

(A) Hemoglobin concentration

(B) Serum alkaline phosphatase

(C) Serum bicarbonate

(D) Serum cholesterol

(E) Serum sodium

45. In most cases of ABO isoimmune hemolytic disease of the newborn, the mother is

(A) type A and the infant is type B

(B) type A and the infant is type AB

(C) type O and the infant is type A

(D) type O and the infant is type AB

(E) type O and the infant is type B

46. Physiologic 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 levels

(D) a decrease in serum bilirubin level after discontinuation of breast-feeding

(E) A rise in serum bilirubin level of less than 5 mg/dL/day

47. A 6-year-old girl experiences her second episode of meningococcal meningitis. The most
likely immunodeficiency disorder in this child is which of the following?

(A) Neutrophil dysfunction

(B) Deficiency of complement component C3

(C) Deficiency of C1 esterase inhibitor

13
(D) Deficiency of complement component C6

(E) Deficiency of T cells

48. A 6-year-old boy complains of itchy eyes, watery nose, and sneezing starting mid-May
and lasting through June. What is the first drug of choice or modality in your treatment of
this child?

(A) Antihistamines

(B) Avoidance of the offending allergen

(C) Desensitization

(D) Oral steroids

(E) Antibiotics

49. All of the following findings may occur in the systemic form of juvenile arthritis EXCEPT
which?

(A) High spiking fever

(B) Evanescent rash

(C) Iridocyclitis

(D) Lymphadenopathy

(E) Enlargement of the spleen

50. A healthy 15-month-old male infant is brought to your office for evaluation of diarrhea.
His growth, weight gain, activity, and appetite have been normal. The first stool of the day
appears normal, but they become increasingly loose and frequent as the day progresses.

Of the following, your BEST advice to the mother is to:

A. avoid fiber-containing foods

B. initiate the intake of balanced electrolyte solutions

C. limit the intake of fluids and fruit juice

D. restrict the intake of fatty foods

E. substitute lactose-free for other dairy products

51. A 9-year-old boy presents for evaluation of recurrent oral ulcers, weight loss, and joint
pain over the past 4 months.

Of the following, the MOST likely explanation for these findings is:

14
A. Crohn disease

B. cyclic neutropenia

C. hand, foot, and mouth disease

D. herpangina

E. herpetic gingivostomatitis

52. Which of the following hemolytic anemias is associated with an extracorpuscular defect?

(A) Hereditary spherocytosis

(B) Sickle cell anemia

(C) Autoimmune hemolytic anemia

(D) Glucose-6-phosphate dehydrogenase deficiency

(E) Pyruvate kinase deficiency

53. Proper management of a child who has an absolute neutrophil count of 100/mm 3
would be

(A) the start of broad-spectrum intravenous antibiotics

(B) careful physical examination and chest radiograph; close observation pending results
of blood cultures

)C) granulocyte transfusion

(D) nutritional support with oral iron and intramuscular injection of vitamin B12

(E) bone marrow transplant

54. The mechanism of thrombocytopenia in idiopathic thrombocytopenic purpura is

(A) Replacement of the bone marrow by autoreactive lymphocytes

(B) Consumption coagulopathy (disseminated intravascular coagulation)

(C) Splenic sequestration of antibody-coated platelets

(D) Defective megakaryocyte maturation

15
(E) Splenomegaly

55. All of the following are goals of newborn

screening for congenital hypothyroidism

EXCEPT

(A) to ensure normal linear growth

(B) to ensure normal intellectual function

(C) to facilitate genetic counseling

(D) to prevent sudden infant death syndrome

(E) to minimize need for expensive medical

56. Which of the following statements about

absence seizures of childhood is TRUE?

(A) The seizures are brief, lasting less than 30

seconds in most cases.

(B) The typical age of onset is 1 to 2 years of age.

(C) Typical electroencephalogram findings include localized spike discharges in the temporal
areas.

(D) Phenytoin and carbamezepine are drugs

of choice for these seizures.

(E) Twenty-five percent of children who have

this seizure type will experience remission

57. Which of the following statements best characterizes the diagnosis of urinary tract
infection 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 100000 organisms of a single

species

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

(E) Vesicoureteral reflux localizes the infection to the lower urinary tract

16
58. All of the following are problems commonly associated with cerebral palsy EXCEPT

(A) epilepsy

(B) mental retardation

(C) blindness

(D) behavioral problems

(E) strabismus

59. A 7-month-old boy previously diagnosed with tetralogy of Fallot is seen in the
emergency department because of irritability, hyperpnea, increasing cyanosis, and episodic
loss of

consciousness. Which of the following is the best course of management for this patient?

(A) Administration of digoxin

(B) Administration of supplemental oxygen and morphine sulfate

(C) Administration of epinephrine

(D) Administration of bronchodilators

(E) Emergency surgery to correct the abnormality

60. Which of the following symptoms would

suggest a diagnosis of recurrent abdominal

pain?

(A) Pain awakening a child from sleep

(B) Pain associated with vomiting

(C) Pain located periumbilically

(D) Pain radiating to the back

(E) Continuous pain

61. An otherwise healthy 3-year-old develops progressive, generalized, pitting edema.

Several urinalyses reveal the presence of heavy proteinuria and no other abnormality. The

17
creatinine is 0.4 mg/dL, the albumin 1.8 mg/dL, and the blood pressure is 95/60 mm Hg.
What is the next best course of action?

(A) Begin a course of oral prednisone

(B) Follow up the child and see if this nephrotic syndrome remits

(C) Perform a diagnostic renal biopsy

(D) Perform a 24-hour urine collection for determining creatinine clearance

(E) Obtain a urine culture

62- A 6-year-old boy with hemophilia A (factor VIII level 10%) strikes his elbow and
subsequently has swelling and tenderness at the site of trauma. What is the proper
treatment?

(A) Infusion of cryoprecipitate

(B) Infusion of desmopressin

(C) Infusion of fresh frozen plasma

(D) Infusion of factor VIII concentrate

(E) Injection of vitamin K

63. Acute rheumatic fever may cause which of the following disorders?

(A) Chronic joint disease

(B) Isolated pericarditis

(C) Pulmonary valve insufficiency

(D) Prolonged low-grade fever

(E) Aortic or mitral valvulitis

64. Which of the following is the best indica-

tor of cystic fibrosis?

(A) A positive family history of cystic fibrosis

(B) The presence of digital clubbing

(C) A sweat test with a chloride concentration

18
 of 70 mEq/L

(D) Bronchiectasis on a chest radiograph

(E) A history of meconium ileus

65. Which of the following conditions has a

better prognosis if it occurs in a child younger than 1 year of age?

(A) Neuroblastoma

(B) Acute lymphoblastic leukemia (ALL)

(C) Medulloblastoma

(D) Histiocytosis X

(E) Juvenile chronic myelogenous leukemia (CML)

66. Parents who wish to breast feed but want to supplement with formula should:

a) start supplementation at bedtime immediately after delivery

b) wait several weeks after delivery to supplement to ensure established breast-feeding

hormonal patterns

c) try a different formula each day until the baby shows a preference

d) pump and then mix the formula and breast milk in a one to one ratio

67. If dietary iron is not provided, infants begin to deplete their iron stores by:

a) 1 month

b) 2 months

c) 4 months

d) 6 months

e) 12 months

68. A 15 year old boy comes to your office for follow up of his reactive airway disease. He
describes his symptoms as daily and also experiencing nocturnal symptoms approximately 2x
per week. Spirometry performed in your office reveal that his FEV1/ PEFR is 75% of his
predicted value. These results classify his severity of asthma as:

A. Severe persistent

B. Moderate persistent

C. Mild persistent

19
D. Mild intermittent

69. Downs Syndrome is NOT associated with:

A. transposition between chromosome 14 and 21 (t14:21)

B. Epicanthal fold and single palmar crease

C. Increased risk of Leukemia and Alzheimers disease

D. Radial aplasia

E. Trisomy 21 from maternal dysjunction

70. All of the following are true regarding infantile spasms except:

a. Infantile spasms are mixed flexor-extensor spasms that last only a few seconds but may
repeat more than one hundred times in a row.

b. diagnosis is confirmed by hyposarrhythmia on EEG

c. developmental delay can be prevented by the use of corticotropin

d. Infantile spasms may develop into Lennox- Gestaut syndrome

71. Breath holding spells are not associated with

a. children 7 years old

b. episodes of anger, frustration, or scolding

c. short periods of drowsiness after spell

d. rhythmic clonic jerking of the extremities

e. none of the above

72. In a patient receiving theophylline on a regular basis, the drug that is MOST likely to
decrease the serum level of theophylline is

A. acetaminophen

B. erythromycin

C. carbamazepine

D. cimetidine

20
E. ranitidine

73. A 6-year-old boy is brought to the emergency room with a 3-hour his-tory of fever to
39.5ºC and sore throat. The child appears alert but anxious and he has mild
inspiratory stried. You should immediately

(A) examine the throat and obtain a culture

(B) obtain an arterial blood gas and start an IV

(C) order a chest x-ray and lateral view of the neck

(D) prepare to establish an airway

(E) admit the child and place him in a mist

74. A patient with staphylococcal pneumonia suddenly develops increas-ing respiratory

distrees. The possible diagnosis requiring the most urgent action is

(A) pneumatocele formation

(B) tension pneumothorax

(C) progression of the pneumonia

(D) severe anxiety

(E) pleural effusion

75. A 6-month-old infant has eaten a diet with the following content and intake for the past
5 months; protein 4 percent of calories, fat 60 percent of calories, carbohydrates 36 percent
of calories, calories 105/kg/day. The patient's disturbance is

(A) rickets.

(B) maraemus.

(C) obesity.

(D) tetany.

(E) kwashiorkor.

76. Characteristics of hypernatremic dehydration with Na+ in serum 170 mEq/L and 10
percent loss of body weight are all the following EXCEPT

(A) low blood pressure.

(B) convulsions.

(C) thirst.

21
(D) lethargy.

(E) hyperirritability

77. All the following viruses have been associated with congenital infection EXCEPT

(A) cytomegalovirus

(B) rubella virus

(C) hepatitis B virus

(D) herpes simplex virus

(E) rotavirus

78. All the following statements about acute asteomyelitis aretrue EXCEPT that

(A) it most commonly is caused by Staphylococcus aureus

(B) it often arises following development of deep cellulitis

(C) tenderness in the region of infection is diffuse, not localized

(D) bony changes are not visible radiographically for 5 to 10 days after onset of infection

(E) antibiotic therapy usually is required for at least 4 weeks

79. Which of the following infections typically has an incubation period of less than 2 weeks

(A) Mumps.

(B) Varicella.

(C) Rubella.

(D) Measles.

(E) Rabies.

80. A 12-year-old girl has a mass in her neck. Physical examination reveals a thyroid nodule,
but the rest of the gland is not palppable. A technetium scan reveals a “cold” nodule. The
child appears to be euthroid. Which of the following diagnosis is the LEAST likely?

(A) Simple adenoma.

(B) Follicular carcinoma.

(C) Papillary carcinoma.

(D) A cyst.

22
(E) Dysgentic thyroid gland

81. Glycosylated hemoglobin (hemoglobin A1c) is often used as an indicator of controlin

patients with diabetes mellitus. Its level usually reflects the blood concentration of glucose
over the preceding

(A) 8 hours

(B) 1 week

(C) 1 month

(D) 2 months

(E) 4 months

23