Pediatric R2

1. A female infant born at 28 weeks is now 10 days old. She had been doing very well and
breast milk was started 2 days ago via nasogastric tube. She has become increasingly unwell
over the past 12 hours with abdominal distension, temperature instability and bile-stained
aspirates from the NG tube. Some blood is noted in the stools. AXR shows air within the
bowel walls. What is the most likely diagnosis?
a) Sepsis
b) Intestinal obstruction
c) Necrotizing enterocolitis
d) Malrotation
e) Duodenal atresia

2. An 8-year-old girl is brought to hospital following ingestion of a cercal bar containing

peanuts. She is noted to have a widespread urticarial rash and swelling of the face and lips.
She is finding it difficult to speak and there is widespread wheeze on auscultation. The single
most important step in her management is which of the following?
a) Intramuscular 1 microgram/kg adrenaline (epinephrine) (1:1000)
b) Intravenous adrenaline (epinephrine), 1 microgram/kg (1:10 000)
c) Intravenous hydrocortisone
d) Oxygen
e) Chlorphenamine

3. A newborn baby is noted to have coarse facies, a large fontanelle and hypotonia on routine
examination. He also has jaundice. His blood sugar levels are normal. Which of the following
investigations would be most likely to reveal the underlying diagnosis?
a) Growth hormone
b) Karyotype
c) Thyroid function tests
d) Blood group
e) СК

4.. A 3-year-old girl with complex congenital heart disease is admitted with fever. On
examination, her temperature is 39.5 C and there is a loud ejection systolic murmur. Her CRP
is 250 mg/L, and a transthoracic echocardiogram confirms vegetations. What is the most
likely causative pathogen?
a) Streptococcus pneumoniae
b) Streptococcus pyogenes
c) Streptococcus viridians
d) Group A hemolytic streptococcus
e) Group B hemolytic streptococcus
5. A 2-day-old baby is admitted to the neonatal unit with respiratory distress and jaundice. A
full septic screen is performed which yields E. coli positive blood cultures, Ophthalmological
assessment confirms the presence of cataracts. What is the most likely diagnosis?
a) Galactosaemia
b) Von Gierke's disease
c) Phenylketonuria
d) Medium-chain acyl-coenzyme A dehydrogenase deficiency
e) Maple syrup urine discase

6. A 10-year-old boy has a 2-week history of sore throat, fever and lethargy. Upon clinical
examination there is pharyngitis, hepatosplenomegaly and bilateral shotty cervical lymph
nodes are palpated. Blood tests reveal atypical lymphocytes and an ALT of 190 U/L. What is
the most likely causative pathogen?
a) Coxsackievirus
b) Herpes simplex virus
c) Varicella zoster virus
d) Epstein-Barr virus
e) Cytomegalovirus

7.. A 4-year-old boy presents with pain in his abdomen and joints for the past 24 hours. He is
afebrile. On examination he has diffuse abdominal tenderness but there are no masses, no
lymphadenopathy and no hepatosplenomegaly. A widespread purpuric rash is present over
the legs and buttocks. A urine dip shows 2p. blood. Routine blood is normal. What is the most
likely diagnosis?
a) Idiopathic thrombocytopenic purpura
b) Meningococcal sepsis
c) Acute lymphoblastic leukemia (ALL)
d) Vitamin C deficiency (scurvy)
e) Henoch-Schonlein purpura

8. A 6-year-old boy attends the out-patient clinic with a diagnosis of Down syndrome. He has
been pale and lethargic for the last 4 weeks and has some bruises on his shins. Which of the
following conditions is it important to rule out in view of his underlying diagnosis?
a) Parvovirus infection
b) ITP
c) Hemophilia A
d) Acute leukemia
e) Henoch-Schonlein purpura
9. A 14-month-old is seen in clinic as his mother is concerned that he may be having seizures.
The episodes occur when he is angry or upset. He has color change followed by collapse and
occasional jerking movements. The most likely diagnosis is?
a) Breath holding spells
b) "Tet' spells
c) Myoclonic epilepsy
d) Non-epileptic seizure
e) Vasovagal syncope

10. A 6-day-old baby who is breast feeding well and thriving is referred by the midwife
because she appears jaundiced. She has pigmented stools and is passing urine normally.
Examination is unremarkable. Her bilirubin is 68 (normal <100 mmol/L.) with a conjugated
level of 8 (normal <20 mmol/L). Which of the following would be your management of this
infant?
a) Complete a prolonged jaundice screen
b) Commence phototherapy
c) Top up feeds with formula milk
d) Repeat the bilirubin level in 8 hours
e) No treatment required

11. Female patient mother say that she eats a lot of potato chips what is best to asses nutrition
states?
a) height
b) weight
c) weight to height
d) skin fold thickness

12. First event in female puberty

Breast budding

13. Late walking hasn’t walked by age of > 18 /15/12

14. 2yr old child, can't walk alone or grasp pencil Initial?
a) Birth hx
b) MRI
c) CT

15. Case of spinal muscles dystrophy, what

a) chest recession and fasciculations
b) ptosis Ji cala, joint
c) hyperreflexia and muscles weakness
16. Vit k deficiency?
a) prolonged PT
b) prolonged PTT
c) prolonged Pt & PTT

17.Correct about Hepatitis A in childhood?

Clinical and lab recovery 4weeks

18. faltering growth occurs in which age group:

a) infantile stage
b) Childhood stage
c) Neonatal

Self-assessment|
19. Ji is a 12-month-old Japanese girl who presents to the Emergency Department. She has a
2-day history of fever and vomiting. Her mother is concerned that she is dehydrated. On
examination she is well hydrated and has marked coryza. She has an inflamed pharynx. A
urine sample from a bag is sent to the laboratory. You obtain the following result from the
microscopy and culture: white blood cells 100/mm3; red blood cells negative; organisms,
none seen, red cell casts, none seen; culture, not available.
Perineal contamination

20. Michael is a 2-year-old boy whose parents were born in Taiwan. He has been unwell now
for 6 days with a fever, sore eyes and throat. He is noted to have red eyes, an injected throat
and cervical lymphadenopathy. He also has a generalized maculopapular rash, and the skin is
peeling from his hands and feet. ttt?
a) Intravenous immunoglobulin
b) Antibiotics

21. Aparna is a 2-year-old girl of Indian ethnicity who lives in the UK. She presents to her
general practitioner as she has been unsteady on her feet for a day, having had diarrhea during
the previous week. On examination she is afebrile, has reduced muscle power and tone and
no tendon reflexes can be elicited in her lower limbs. She is referred urgently to the pediatric
hospital and 6 hours later she is unable to stand and the tendon reflexes in her upper limbs are
now absent. She has no other medical problems and has been fully immunized.
What is the most likely diagnosis? Select one answer only.
a) Guillain-Barré syndrome
b) Myasthenia gravis
c) Myotonic dystrophy
d) Poliomyelitis
e) Spinal muscular atrophy
22. Oliver, a 4-day-old infant, is having a
routine newborn check by the junior pediatric
doctor. The doctor notices some small white
spots on Oliver's nose and cheeks (Fig. 10.3).
Oliver was born by normal vaginal delivery
and is currently feeding well.
Milia

23. Philip is 4 years old and has recently

started school. He presents with a widespread
rash (Fig.15.8) that is intensely itchy.
Varicella zoster virus

24. Natasha, a female infant, is delivered by caesarean section at 32 weeks' gestation because
of maternal pre-eclampsia. Her birth weight is 1.9 kg. No resuscitation is required. At 2 hours
of age she develops respiratory distress, with a respiratory rate of 70 breaths/min, grunting
respirations, and indrawing of her rib cage. Respiratory support with CPAP (continuous
positive airway pressure) and 45% oxygen is required. A chest X-ray is taken at 4 hours of
age. diagnosis?
Respiratory distress syndrome
25. Jake, a 7-month-old infant, presents with a 2-day history of fever and runny nose. During
the night he has developed a harsh cough
in association with noisy inspiration. On examination, you note he has moderate stridor
mainly on inspiration and mild intercostal and subcostal recession. His respiratory rate is 30
breaths/min. He has a temperature of 37.8° C. His capillary refill time is normal. His oxygen
saturation is 96% in air.
Oral corticosteroids

26. Amelia is a 14-year-old girl who has not started puberty. Her friends at school have all
started their periods but she hasn't even started any breast development. She is an otherwise
well girl with no other medical complaints. Her mother mentions she had puffy hands and
feet as a baby. On examination you note that she is short (<0.4th centile for height) and has a
systolic heart murmur and diminished femoral pulse pressure compared with brachial pulses.
Diagnosis?
Turner

27. Charlie, aged 5 years, is troubled by recurrent nose bleeds, the last of which took 1.5 hours
to stop. He has no other medical problems. His examination is normal except for pale
conjunctivae Investigation reveals:
Hb (hemoglobin): 86 g/L
WBC (white blood cells): 10.2 x 109/L
platelet count: 350 * 109/L
prothrombin time: 16 seconds (control: 12-15 5)
activated partial thromboplastin time: 46 seconds (control: 25-35 s)
fibrinogen: 2.5 g/L. (normal: 2-4 g/L)
factor VIII: just below the normal range
Diagnosis?
VWD

28. Connor, a 5-month-old infant, from a travelling family visiting from Ireland, is admitted
to hospital with difficulty breathing and poor feeding. He was born at term with a birthweight
of 3.6 kg (S0th centile). His weight is now 5.2 kg (<0,4th centile). He has never fed well, and
has always tended to regurgitate his milk.
This is his first admission to hospital but he 'is always chesty'. On examination he has
temperature of 37.9° C, a respiratory rate of 50 breaths/min with widespread crackles on
auscultation of the chest.
Diagnosis?
Cystic fibrosis

29. Rodney, a boisterous 2-year-old, has had diarrhea for the last 3 months. He produces up
to four stools a day, which are loose, brown in color and usually contain undigested food. The
rest of the family are well. He has never been abroad. Examination is normal and his personal
child health record shows that he is growing along the 50th centile.
What is the most likely diagnosis?
a) Chronic non-specific diarrhea
b) Celiac disease
c) Cow's milk protein allergy
d) Inflammatory bowel disease
e) Lactose intolerance

30. Ahmed is a 5-year-old boy who presents to the outpatient clinic with weakness. His
parents report that he finds it difficult to climb the stairs at home. This has been becoming
progressively worse over the preceding 6-12 months. He is playing on the carpet with his
brother when his mother calls him over. He has to roll from his back onto his front in order
to stand up.
Gower sign

31. Amy, aged 8 years, is rapidly putting on weight. Cushioned face+ asthma+ IBD, she has
truncal obesity and striae on her abdomen.
Select one answer only.
a) Corticosteroid cream for severe eczema
b) Daily oral prednisolone therapy for the last 6 months
c) Ectopic ACTH (adrenocorticotropic hormone)-producing tumor
d) High-dose corticosteroid therapy for lung disease when she was a premature baby
e) Long-term use of inhaled corticosteroids