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Author: Dr Mobin Date: 11/11/11

Specialty: Pediatrics Medicine Examination: IMM/FCPS II/MCPS

Question 1.

A 2 year old boy presented with abdominal distention for the last 15 days. The mother also

complains of low grade fever. On examination the child is toxic and has a temperature of 101 F.

There is a palpable mass in the left lumber area measuring 5 x 6 cm. X-ray shows calcification in

the left lumber area.

a) Hepatoblastoma

b) Hydronephrosis

c) Hydroureter

d) Neuroblastoma

e) Wilms tumor

Key: Correct option is e

Importance: Essential

Difficulty level: Easy

Reference: Nelson Textbook of Pediatrics, page no 2137

Signature:
Author: Dr Mobin Date: 11/11/11

Specialty: Pediatrics Medicine Examination: IMM/FCPS II/MCPS

Question 2.

A 2 month old boy presents with history of fits for last 10 days. The mother explains that

she is hypertensive during pregnancy and developed fits herself. She has lost two kids in

infancy in the last two years. On examination the baby is irritable, crying and extending.

Anterior frontella is 2x2cm and he has high arched palate. He has fisting and tone and

reflexes are increased. His hemoglobin is 10g/dl, TLC 4000/mm3, Platelets 300000/mm3.

Serum calcium is 6.0 mg/dl, Serum Phosphate is 2.8 mg/dl and serum alkaline

phosphatase is 900 IU. The most likely diagnosis is:

a) Congenital Vitamin D Deficiency

b) Hyperparathyroidism

c) Vitamin D Resistant Rickets

d) Vitamin D Dependent Rickets type I

e) Vitamin D Dependent Rickets type II

Key: Correct option is a

Importance: Essential

Difficulty level: Easy

Reference: Nelson Textbook of Pediatrics, page no 50

Signature:
Author: Dr Mobin Date: 11/11/11

Specialty: Pediatrics Medicine Examination: IMM/FCPS II/MCPS

Question 3

A three year old girl presented with fever for two weeks. She has received a number

of antimalarials and antibiotics but to no avail. She also complains of severe pain in

her limbs and the pain is accompanied by pallor and bluish discoloration. On

examination she is 10 kg, temperature is 102 F, pulse rate 120/min, respiratory rate

40/min. Chest has bilateral crepatations, liver is 10 cm total liver span and spleen is 2

cm. She fights off any attempts to touch her limbs. Her blood CP shows Hb of 9.0

gm/dl, TLC of 9000/mm3, Platelets 10000/mm3 and ESR is 90 mm in 1st hour. Her

MP, urine DR and MCUG is negative for reflux. The most likely diagnosis is:

a) Juvenile Rheumatoid Arthritis

b) Osteomyelitis

c) Scurvy

d) Septic arthritis

e) Systemic lupus erythematosis

Key: Correct option is e

Importance: Essential

Difficulty level: Easy

Reference: Nelson Textbook of Pediatrics, page no 997

Signature:
Author: Dr Mobin Date: 11/11/11

Specialty: Pediatrics Medicine Examination: IMM/FCPS II/MCPS

Question 4.

A nine year old girl presented with difficulty in walking for the last six years. She can

barely walk ten steps and then she has to rest. Her mother tells you that she started

walking at the age of three years. She has had a trial of steroids from a neurologist. On

examination her vitals are stable. Gower sign is negative, there are no signs of proximal

muscle weakness, but her tone and reflexes are decreased bilaterally. She also has

trunchal weakness and cannot lift herself in prone position. There is no organomegaly.

Her ESR is 5mm/hr, CPK is 1190, LDH is increased, and SGPT is increased. Her NCV is

normal but EMG shows evidence of myopathy. The most likely diagnosis is:

a) Benign congenital hypotonia

b) Central core disease

c) Dermatomyositis

d) Nemaline rod myopathy

e) Polymyositis

Key: Correct option is e

Importance: Essential

Difficulty level: Easy

Reference: Nelson Textbook of Pediatrics, page no 2548
Signature:
Author: Dr Mobin Date: 11/11/11

Specialty: Pediatrics Medicine Examination: IMM/FCPS II/MCPS

Question 5

A three years old girl presented with pallor. Her mother states that she developed these

symptoms for the last seven months. She has been admitted repeatedly in hospitals for

blood transfusions. Examination shows a malnourished girl with height for weight < 3

SD. Her liver is 3 cm below costal margin and spleen is 7 cm enlarged in its long axis.

Her blood examination shows Hemoglobin 4 gm/dl, Total leukocyte count 2,000/mm3,

platelet count 80,000/mm3. Peripheral smear shows normochromic microcytic anemia

and spherocytes. Her Retic count is 8%. Hemoglobin electrophoresis is normal. Coombs

direct test is positive. What is your most likely diagnosis?

a) Alpha thallesemia

b) Auto immune hemolytic anemia

c) B thallesemia Major

d) Hereditary Spherocytosis

e) Systemic lupus erythematosis

Key: Correct option is b

Importance: Essential

Difficulty level: Easy

Reference: Nelson Textbook of Pediatrics, page no 2042

Signature:
Author: Dr Mobin Date: 11/11/11

Specialty: Pediatrics Medicine Examination: IMM/FCPS II/MCPS

Question 6

A 16 years old boy presents to OPD with complaints of muscular weakness. His father states that

the boy has never been to school and was late in walking. On examination the boy has coarse

facies, his height is 136 cm and lower segment is 62, his weight is 42 kg. There is no visible

goiter and muscle power is Grade 5/5. The calf muscles seem to be hypertrophied. The most

likely test to reveal the diagnosis is:

a) Blood glucose levels

b) Creatinine Phosphokinase

c) Growth hormone levels

d) Parathyroid hormone levels

e) Thyroid Stimulating Hormone

Key: Correct option is e

Importance: Essential

Difficulty level: Easy

Reference: Nelson Textbook of Pediatrics, page no 2319

Signature:
Author: Dr Mobin Date: 11/11/11

Specialty: Pediatrics Medicine Examination: IMM/FCPS II/MCPS

Question 7

A two year old girl presented with pallor and decreased appetite. She has never been breast fed

and weaning was started at one year. On examination she is pale with sparse hair, weight and

height are below 3rd centile. She also has marked Hepatosplenomegaly. Her blood complete

shows Hemoglobin 6.0gm/dl, TLC 2700 mm3, Platelet 40,000/mm3. MCV 104 fl, Hb A 97 %,

Hb F 3%, Hb A 2 1%. The most likely diagnosis is

a) Celiac disease

b) Megaloblastic anemia

c) Thallesemia Intermedia

d) Thallesemia Minor

e) Viseral leshmeniasis

Key: Correct option is c

Importance: Essential

Difficulty level: Easy

Reference: Nelson Textbook of Pediatrics, page no 46

Signature:
Author: Dr Mobin Date: 11/11/11

Specialty: Pediatrics Medicine Examination: IMM/FCPS II/MCPS

Question 8

A 16 years old girl is brought to OPD for the reasons of not having started her menaces yet. The

mother is concerned because all the patients’ sisters had menarche at 13 years. On examination

the girl is short with height at 3rd centile and weight at 25 centile. She is not dysmorphic but a

murmur is present at upper right sternal border. The rest of clinical examination is normal. The

most likely diagnosis is

a) Down syndrome

b) Fragile X syndrome

c) Noonan syndrome

d) Turner syndrome

e) William syndrome

Key: Correct option is d

Importance: Essential

Difficulty level: Easy

Reference: Nelson Textbook of Pediatrics, page no 504

Signature:
Author: Dr Mobin Date: 11/11/11

Specialty: Pediatrics Medicine Examination: IMM/FCPS II/MCPS

Question 9

A 3 year old boy from interior Balochistan presents with low grade fever and abdominal

distention for the last 7 months. The boy is not vaccinated and his current caloric intake is

400/Kcal/day. On examination he is pale and emaciated. His height and weight are below 3rd

centile and he has mild coarse facies. His upper segment to lower segment ratio is 1.3:1. His liver

is enlarged 7 cm below coastal margin and spleen is enlarged 5 cm in its long axis. There is a

gibbus in his thoraco- lumbar spine and bronchial breathing is heard over Right upper lung. The

most likely diagnosis is

a) Tuberculous spine

b) Primary malnutrition

c) Morquio syndrome

d) Metaphysial dysplasia

e) Hurler syndrome

Key: Correct option is a

Importance: Essential

Difficulty level: Easy

Reference: Nelson Textbook of Pediatrics, page no 1240

Signature:
Author: Dr Mobin Date: 11/11/11

Specialty: Pediatrics Medicine Examination: IMM/FCPS II/MCPS

Question 10

A 3 year old boy developed dysentery one week ago. He was treated in Out Patients Department,

now he has come back again with increasing pallor and lethargy for the last two days. On

examination the child is pale, jaundiced and his face is swollen. His blood pressure is 110/60 mm

Hg and chest examination is clear. His abdomen is distended but there is no organomegaly.

Hb 7.0 gm/dl Serum creatinine 4 mg /dl

TLC 24x10 9 Serum Sodium 126 mEq/l

Platelets 50x 10 9 Serum Potassium 5.3 mEq/L

What is the diagnosis?

a) Acute Renal Failure

b) Disseminated Intravascular coagulation

c) Idiopathic thrombocytopenic purpura

d) Hemolytic Uremic syndrome

e) Henoch Schonlein purpura

Key: Correct option is d

Importance: Essential

Difficulty level: Easy

Reference: Nelson Textbook of Pediatrics, page no 2181

Signature:
Author: Dr Mobin Date: 11/11/11

Specialty: Pediatrics Medicine Examination: IMM/FCPS II/MCPS

Question 11

A 5 years old girl is brought to pediatric OPD by her mother for reasons of failing multiple times

in her class. Her mother states that the girl can’t stop talking. Examination reveals weight for

height <3SD, epicanthic folds and wide mouth. Auscultation of the precordium reveals grade II

systolic murmur at left sternal edge. Rest of the examination is within normal limits. The most

likely diagnosis is

a) Down syndrome

b) Fragile X syndrome

c) Noonan syndrome

d) Turner syndrome

e) William syndrome

Key: Correct option is e

Importance: Essential

Difficulty level: Easy

Reference: Nelson Textbook of Pediatrics, page no 1591

Signature:
Author: Dr Mobin Date: 11/11/11

Specialty: Pediatrics Medicine Examination: IMM/FCPS II/MCPS

Question 12

A 6 year old girl presented to OPD because the parents have noticed that she does not hear since

birth. The parents also tell you that she was admitted in Nursery because she did not cry for 30

minute. Examination reveals malnourished girl with weight 15 kg, height 112 cm. She does not

seem to respond to voice commands. A smooth goiter is also noticed on Neck extension. What is

the likely diagnosis?

a) Growth hormone deficiency

b) Hyperthyroidism

c) Hypopitutrism

d) Hypothyroidism

e) Hypoparathryoidism

Key: Correct option is d

Importance: Essential

Difficulty level: Easy

Reference: Nelson Textbook of Pediatrics, page no 2319

Signature:
Author: Dr Mobin Date: 11/11/11

Specialty: Pediatrics Medicine Examination: IMM/FCPS II/MCPS

Question 13

A 9 year old girl is brought to emergency with complains of not walking for 5 days. She also has

urinary and fecal incontinence. There is no history of trauma. Examination reveals decreased

tone, power and reflexes in both her legs. The upper limb neurological examination and cranial

nerve examination is normal. There is a sensory level at T 8. The most likely diagnosis is

a) Devic’s Disease

b) Gillian Barre syndrome

c) Spinal cord compression

d) Spinal cord infarction

e) Transverse myleitis

Key: Correct option is b

Importance: Essential

Difficulty level: Easy

Reference: Nelson Textbook of Pediatrics, page no 2522

Signature:
Author: Dr Mobin Date: 11/11/11

Specialty: Pediatrics Medicine Examination: IMM/FCPS II/MCPS

Question 14

A 2 years old girl is brought to your OPD with the complaints that she is walking unlike her

other children. On examination the baby has swollen wrists, Harrison sulcus and bow legs. Her

investigations show the following.

S calcium 6 mg/dl

S Phosphate 4mg/dl

S Alkaline phosphate 1560

PTH Normal

What is the most likely diagnosis?

a) Fanconi syndrome

b) Lowe syndrome

c) Vitamin D Deficiency Rickets

d) Vitamin D Dependent Rickets

e) Vitamin D Resistant Rickets

Key: Correct option is e

Importance: Essential

Difficulty level: Easy

Reference: Nelson Textbook of Pediatrics, page no 290

Signature:
Author: Dr Mobin Date: 11/11/11

Specialty: Pediatrics Medicine Examination: IMM/FCPS II/MCPS

Question 15

You are called to attend a neonate for loose motions that have started since birth. Examination

reveals an irritable neonate with pulse rate of 160/min, respiratory rate of 60/min, Blood pressure

90/60 mm Hg. The baby is jaundiced, liver is enlarged with total liver span of 10 cm, the eyes

are puffy and on extension of neck a goiter is visible. On inquiry the mother states that she has a

thyroid problem and is on medication. The most likely diagnosis is

a) Inborn error of metabolism

b) Neonatal graves’ disease

c) Neonatal Hepatitis

d) Sepsis

e) Torch infection

Key: Correct option is b

Importance: Essential

Difficulty level: Easy

Reference: Nelson Textbook of Pediatrics, page no 692

Signature:
Author: Dr Mobin Date: 11/11/11

Specialty: Pediatrics Medicine Examination: IMM/FCPS II/MCPS

Question 16

A 4 year old girl was brought to pediatric OPD because of pallor and respiratory distress.

Examination revealed a pale girl whose liver is enlarged 10 cm total liver span and spleen is 6

cm in its long axis. The child is febrile and the chest X ray shows slight cardiomegaly. Her blood

CP shows Hb 6 gm/dl, TLC 2300/mm3, Platelets 40x 10 9 Peripheral smear shows Hypochromic

microcytic anemia with few sickle cells. The most likely diagnosis is

a) Alpha Thallesemia

b) B Thallesemia Major

c) Leukemia

d) Sickle cell anemia

e) Sickle thallesemia

Key: Correct option is e

Importance: Essential

Difficulty level: Easy

Reference: Nelson Textbook of Pediatrics, page no 2026

Signature:
Author: Dr Mobin Date: 11/11/11

Specialty: Pediatrics Medicine Examination: IMM/FCPS II/MCPS

Question 17

A 2 year old baby is brought to your emergency with unconsciousness. The step mother states

that baby fell from her hands. Examination shows a GCS of 8/15, right pupil is dilated more than

the left, tone and reflexes are increased on right side of body. During examination the child

develops a fit confined to right side of body. The most likely diagnosis is

a) Child abuse

b) Cerebral Hemorrhage(idiopathic)

c) Encephalitis

d) Meningitis

e) Pontine Hemorrhage

Key: Correct option is a

Importance: Essential

Difficulty level: Easy

Reference: Nelson Textbook of Pediatrics, page no 174

Signature:
Author: Dr Mobin Date: 11/11/11

Specialty: Pediatrics Medicine Examination: IMM/FCPS II/MCPS

Question 18

An 8 year old boy presented with decreased vision and bed wetting since birth. Examination

reveals a chubby boy whose weight is 45 kg and height is 136 cm. he is wearing glasses. His

blood glucose fasting is 260mg / dl and urine sugar is 3 +. The most likely diagnosis

a) Cushing syndrome

b) Hypothyroidism

c) Lawrence Moon Beadle syndrome

d) Simple Obesity

e) Prader Walli syndrome

Key: Correct option is c

Importance: Essential

Difficulty level: Easy

Reference: Nelson Textbook of Pediatrics, page no 43

Signature:
Author: Dr Mobin Date: 11/11/11

Specialty: Pediatrics Medicine Examination: IMM/FCPS II/MCPS

Question 19

A 7 years old girl from naseerabad presents with low-grade fever and bloody cough for the last 2

weeks. The child is vaccinated and there is no family history of tuberculosis. The family lives on

a farm and father is Sheppard. On examination she is afebrile, BCG scar is present and

Respiratory rate is 50/min, trachea is central, Apex beat not displaced, chest movements

decreased on Right side, Percussion note is dull on Right side, Air entry is decreased no added

sounds. Liver is enlarged 14 cm total liver span. What is the most likely diagnosis?

a) Allergic bronchopulmonary aspergillosis

b) Coagulopathy

c) Hydatid cyst

d) Pulmonary hemosidrosis

e) Pulmonary tuberculosis

Key: Correct option is c

Importance: Essential

Difficulty level: Easy

Reference: Nelson Textbook of Pediatrics, page no 1518

Signature:
Author: Dr Mobin Date: 11/11/11

Specialty: Pediatrics Medicine Examination: IMM/FCPS II/MCPS

Question 20

A 4-month-old infant presented with a history of fits for the last 3 months. The fits occur 3-4

times /day, are focal and more at night. Six of the 10 siblings have died from similar complaints

at similar age. When you see the child his weight, height, and head circumference are on the 50th

centile. He exhibits a rounded face with protruded abdomen. Neurological examination reveals

post ictal drowsiness, decreased tone, reflexes and power. Liver is palpable 4 cm below coastal

margin. The most likely diagnosis is

a) Cerebral palsy

b) Epilepsy

c) Hypocalcaemia

d) Hypoglycemia

e) Von Gierke disease

Key: Correct option is e

Importance: Essential

Difficulty level: Easy

Reference: Nelson Textbook of Pediatrics, page no 2551

Signature:
Author: Dr Mobin Date: 11/11/11

Specialty: Pediatrics Medicine Examination: IMM/FCPS II/MCPS

Question 21

A 2-year-old boy from Zhob presented with swelling of his hands and feet for the last 5 days. He

has been receiving transfusions since 6 months of age. His caloric intake before admission is

300/ Kcal/ day, and he has never been weaned. Examination reveals a pale chubby child with

swelling of his hands and feet. His pulse rate is 130/minute and respiratory rate is 50/ minutes.

Both his liver and spleen can be felt to be enlarged. The most likely diagnosis is

a) Malnutrition

b) Sickle cell anemia

c) Sickle thallesemia

d) Thallesemia Intermedia

e) Thallesemia Major

Key: Correct option is c

Importance: Essential

Difficulty level: Easy

Reference: Nelson Textbook of Pediatrics, page no 2026

Signature:
Author: Dr Mobin Date: 11/11/11

Specialty: Pediatrics Medicine Examination: IMM/FCPS II/MCPS

Question 22

A 10 years old boy presented with severe abdominal pain and dehydration. The abdominal

pain is crampy and diffuse for the last two weeks. On examination he has pulse rate of

110/min and blood pressure is 140/80 mm Hg. His blood sugar is 130-mg/ dl and urine is

negative for glucose, proteins and ketones. His Blood CP does not show any sickle cells and

TLC and Hemoglobin are normal. His serum Amylase is normal as his abdominal ultrasound.

a) Acute Intermittent Porphyria

b) Acute cholecystitis

c) Acute pancreatitis

d) Renal colic

e) Sub acute intestinal obstruction

Key: Correct option is a

Importance: Essential

Difficulty level: Easy

Reference: Nelson Textbook of Pediatrics, page no 2480

Signature:
Author: Dr Mobin Date: 11/11/11

Specialty: Pediatrics Medicine Examination: IMM/FCPS II/MCPS

Question 23

A 6-year-old girl from Afghanistan presented with one-year history low-grade fever and

abdominal pain. Examination reveals a pale, malnourished girl with total liver span of 16 cm and

spleen 14 cm in its long axis. There is no free fluid. Blood CP reveals Hemoglobin is 5 gm/dl,

TLC 3000/cm3, and Platelets 20,000/mm3. The most likely diagnosis is

a) Abdominal tuberculosis

b) Chronic liver disease

c) Malaria

d) Thallesemia

e) Visceral Leishmaniasis

Key: Correct option is e

Importance: Essential

Difficulty level: Easy

Reference: Nelson Textbook of Pediatrics, page no 1469

Signature:
Author: Dr Mobin Date: 11/11/11

Specialty: Pediatrics Medicine Examination: IMM/FCPS II/MCPS

Question 24

A 6-year-old girl comes to your OPD with complains of recurrent chest infections and sweating

during feeding and cyanosis when crying. Examination shows a cooperative your girl with heart

rate of 120/min, respiratory rate 40/min, and Apex beat is in 5th intercostals space, there is no

thrill and a grade 3 systolic murmur is heard over the upper left sternal border. The dorsalis pedis

and posterior tibial are full and bounding. The most likely diagnosis is

a) Atrial Septal Defect

b) Cardiomyopathy

c) Myocarditis

d) Patent ductus arteriosis

e) Ventricular Septal defect

Key: Correct option is d

Importance: Essential

Difficulty level: Easy

Reference: Nelson Textbook of Pediatrics, page no 1891

Signature:
Author: Dr Mobin Date: 11/11/11

Specialty: Pediatrics Medicine Examination: IMM/FCPS II/MCPS

Question 25

A 6-year-old girl presented with severe headache for the last 2 weeks. On examination she is

lying in bed with her neck extended. She avoids light and motor examination shows increased

deep tendon reflexes and babiniski is extensor. Fundoscopy shows papilledema. Cerebrospinal

fluid examination is clear. MRI scan shows a rounded well defined opacity in the posterior

cranial fossa.

a) Astrocytoma (low grade)

b) Cerebral Abcess

c) Cerebellar hemengioma

d) Ependymoma

e) Medulloblastoma

Key: Correct option is a

Importance: Essential

Difficulty level: Easy

Reference: Nelson Textbook of Pediatrics, page no 2129

Signature:
Author: Dr Mobin Date: 11/11/11

Specialty: Pediatrics Medicine Examination: IMM/FCPS II/MCPS

Question 26

An anxious mother brings her 6-year-old child to your OPD. She narrates that the child has had

two episodes of fits in the last one year. Since then the mother has notices that since then he has

been short of hearing and does not talk now. On Examination he is wasted child with height,

weight and head circumference > 3rd centile. He stares continuously at the examiners and does

not appear to hear and is unable to pronounce his own name.

a) Landau- Kleffner syndrome

b) Fragile X syndrome

c) Autism

d) Neurodegenerative disease

e) Deafness

Key: Correct option is a

Importance: Essential

Difficulty level: Easy

Reference: Nelson Textbook of Pediatrics, page no 2464

Signature:
Author: Dr Mobin Date: 11/11/11

Specialty: Pediatrics Medicine Examination: IMM/FCPS II/MCPS

Question 27

A 12 months old girl presented with unable to sit for one month and swelling of feet for last 7

days. She has never been breast fed or weaned. Examination shows a pale girl with pedal edema.

Her height and weight are below 3rd centile. Her pulse rate is 110/min, respiratory rate 60/min,

liver is palpable 3 cm below coastal margin and there is a gibbus in lumbar spine. Her tone, poor

reflexes are decreased in both limbs, power is grade II bilaterally.

a) Tuberculous spine

b) Morquio syndrome

c) Hurler syndrome

d) Hunter syndrome

e) Metaphysial dysplasia

Key: Correct option is a

Importance: Essential

Difficulty level: Easy

Reference: Nelson Textbook of Pediatrics, page no 2522

Signature:
Author: Dr Mobin Date: 11/11/11

Specialty: Pediatrics Medicine Examination: IMM/FCPS II/MCPS

Question 28

A 7-year-old boy presented with short stature and hunchback. His father states he is the shortest

among all his four brothers. On examination his height is 110 cm, weight is 15 kg, upper

segment: lower segment ratio is 1: 1. There is Gibbus in thoraco-lumbar spine. Chest X-ray

shows a consolidation over right middle lobe. What is the most likely diagnosis?

a) Metaphysial dysplasia

b) Tuberculous spine

c) Morquio syndrome

d) Achondroplasia

e) Hypochondroplasia

Key: Correct option is b

Importance: Essential

Difficulty level: Easy

Reference: Nelson Textbook of Pediatrics, page no 2522

Signature:
Author: Dr Mobin Date: 11/11/11

Specialty: Pediatrics Medicine Examination: IMM/FCPS II/MCPS

Question 29

A 10 years old boy presented to emergency with difficulty in breathing. The attending doctor

concluded that there was no pneumonia and sent the child home. Next morning the boy is

brought again in coma. You notice that the respiratory rate is 70/min and GCS is 10/15. Also the

child is dehydrated. Which of the following tests is most likely to reveal the diagnosis?

a) Blood acetaminophen levels

b) Blood glucose

c) Chest X-ray

d) Echocardiography

e) Serum Electrolytes

Key: Correct option is b

Importance: Essential

Difficulty level: Easy

Reference: Nelson Textbook of Pediatrics, page no 2404

Signature:
Author: Dr Mobin Date: 11/11/11

Specialty: Pediatrics Medicine Examination: IMM/FCPS II/MCPS

Question 30

An 8-year-old boy presented to your emergency with complaints of passing dark colored urine

for the last seven days. He was admitted for jaundice in the neonatal period and received an

exchange transfusion. On examination he is pale, liver is palpable 2 cm below costal margin,

spleen is 2 fingers enlarged but there is no free fluid in the abdomen. The most likely diagnosis is

a) Portal vein obstruction

b) Glucose 6-phosphate dehydrogenize deficiency

c) Cirrhosis

d) Crigler najjar syndrome type II

e) Budd chari syndrome

Key: Correct option is a

Importance: Essential

Difficulty level: Easy

Reference: Nelson Textbook of Pediatrics, page no 1709

Signature:
Author: Dr Mobin Date: 11/11/11

Specialty: Pediatrics Medicine Examination: IMM/FCPS II/MCPS

Question 31

A five year old boy presents with precious puberty which started one year ago. Pubic hair tanner

staging is 4 and both testes are > 4 ml. Abdominal examination reveals a mass in the left lumber

area. The boy is most likely suffering from

a) Central precious puberty

b) Adrenal adenoma

c) Adrenal carcinoma

d) Testicular tumor

e) Pituitary tumor

Key: Correct option is b

Importance: Essential

Difficulty level: Easy

Reference: Nelson Textbook of Pediatrics, page no 303

Signature:
Author: Dr Mobin Date: 11/11/11

Specialty: Pediatrics Medicine Examination: IMM/FCPS II/MCPS

Question 32

A nine year old girl presents with swelling of her right wrist for the last 6 months. She has been

taking various analgesics but to no avail. Examination reveals a cooperative intelligent girl with

swelling of her wrist and deformity of her thumb. Her investigations show the following

Hemoglobin 10 gm/dl, WBC 15000/m m3 , Platelets 500,000 mm3, ESR 50 mm/hr, Rheumatoid

factor Negative, ANA Negative. What would be the appropriate therapy for this girl?

a) Hydroxycholoroquine

b) Methotrexate

c) NSAIDS

d) Steroids

e) Sulphasalazine

Key: Correct option is b

Importance: Essential

Difficulty level: Easy

Reference: Nelson Textbook of Pediatrics, page no 999

Signature:
Author: Dr Mobin Date: 11/11/11

Specialty: Pediatrics Medicine Examination: IMM/FCPS II/MCPS

Question 33

A 8 year old boy presented with swelling of his Right knee joint for the last two weeks. He was

diagnosed as suffering from Rheumatic fever and received Aspirin but failed to improve. On

examination he was febrile, and the Right knee joint is swollen and hot. The movements are

decreased to 10 degrees flexion. The precordium is clear, Air entry is normal. Spleen is palpable

3 cm in its long axis. Which of the following is most likely diagnosis?

a) Systemic lupus erythematosis

b) Rheumatoid arthritis

c) Rheumatic fever

d) Septic arthritis

e) Osteomyelitis

Key: Correct option is b

Importance: Essential

Difficulty level: Easy

Reference: Nelson Textbook of Pediatrics, page no 997

Signature:
Author: Dr Mobin Date: 11/11/11

Specialty: Pediatrics Medicine Examination: IMM/FCPS II/MCPS

Question 34

An 8 year old child presented to Pediatric OPD with complaints of lethargy, breathlessness and

passing dark colored urine. This started two days ago when he took anti malarial. Examination

reveals a pale, jaundiced child. His liver is palpable 2 cm below costal margin and spleen is 1 cm

enlarged. His blood tests show the following: Hemoglobin 4 gm/dl, TLC 21,000 mm3, Platelets

500,000 mm3, Retic count 10 %, Serum Bilirubin 3 mg/dl, and Coombs direct test is negative.

Which of the following is most likely?

a) Glucose 6 phosphate Dehydrogenase

b) Hereditary Spherocytosis

c) Thallesemia Major

d) Autoimmune hemolytic anemia

e) Hereditary elliptocytosis

Key: Correct option is a

Importance: Essential

Difficulty level: Easy

Reference: Nelson Textbook of Pediatrics, page no 2041

Signature:
Author: Dr Mobin Date: 11/11/11

Specialty: Pediatrics Medicine Examination: IMM/FCPS II/MCPS

Question 35

A 7 year old boy presented to emergency after fall in the toilet. He had an episode of diarrhea 7

days ago and he subsequently recovered. He had been clumsy since morning but now he could

not bear weight. Examination reveals an irritable boy who does not have signs of meningeal

irritation. He has right facial palsy and tone power, reflexes are decreased in the lower limbs but

normal in the upper limbs. His CSF shows the following Protein 80 mg/dl, Glucose 40 mg/dl, 5

lymphocytes.

a) Cauda equina syndrome

b) Encephalitis

c) Gillian Barre Syndrome

d) Transverse Myleitis

e) Spinal cord compression

Key: Correct option is c

Importance: Essential

Difficulty level: Easy

Reference: Nelson Textbook of Pediatrics, page no 1347

Signature:
Author: Dr Mobin Date: 11/11/11

Specialty: Pediatrics Medicine Examination: IMM/FCPS II/MCPS

Question 36

A 10 year old boy has presented with testicular swelling. The swelling has been present for last

six months and the matter has noticed that his voice has become hoarse and he has grown

rapidly. Examination reveals Tanner stage 4 pubic hair, and left testes is 5 cm and right testis is

10 cm in volume. His serum testosterone is 15nmol/l and FSH and LH are not detectable. Which

of the following is most likely to detect etiology of precocious puberty?

a) Abdominal ultrasound

b) Testicular Ultrasound

c) B- HCG

d) Biopsy of enlarged testis

e) Alpha Feto Protein

Key: Correct option is d

Importance: Essential

Difficulty level: Easy

Reference: Nelson Textbook of Pediatrics, page no 2154

Signature:
Author: Dr Mobin Date: 11/11/11

Specialty: Pediatrics Medicine Examination: IMM/FCPS II/MCPS

Question 37

A 3 year old girl presented with loose motions for the last 3 months. She was born SVD, never

breast fed and weaned at the age of 2 years. Her height and weight both are below 3rd centile.

Her Stool D/R report shows H Nana. What is the most appropriate drug for this organism

according to WHO?

a) Albendazole

b) Mebendazole

c) Niclosamide

d) Metronidazole

e) Pyrantel pamoate

Key: Correct option is e

Importance: Essential

Difficulty level: Easy

Reference: Nelson Textbook of Pediatrics, page no 1452

Signature:
Author: Dr Mobin Date: 11/11/11

Specialty: Pediatrics Medicine Examination: IMM/FCPS II/MCPS

Question 38

You are asked to examine a 6 months old for the complaints of not sitting. Her length and weight

are below 3rd centile. The head circumference is 34 cm. The eyes are set wide apart, facies are

coarse and testes are undecended. You also note that the child has broad thumbs and big toes.

The baby is most likely

a) Down syndrome

b) Turner syndrome

c) Klinefelter syndrome

d) Rubinstein-Taybi syndrome

e) Noonan syndrome

Key: Correct option is d

Importance: Essential

Difficulty level: Easy

Reference: Nelson Textbook of Pediatrics, page no 192

Signature:
Author: Dr Mobin Date: 11/11/11

Specialty: Pediatrics Medicine Examination: IMM/FCPS II/MCPS

Question 39

A 3 day old baby presented with fits confined to left side of his body. His Blood CP and serum

electrolytes are normal. CT scan shows porencephalic cysts. The baby is most likely to develop

which of the following in future.

a) Cerebral palsy

b) Mental retardation

c) Blindness

d) Deafness

e) Hemiplegia

Key: Correct option is e

Importance: Essential

Difficulty level: Easy

Reference: Nelson Textbook of Pediatrics, page no 2449

Signature:
Author: Dr Mobin Date: 11/11/11

Specialty: Pediatrics Medicine Examination: IMM/FCPS II/MCPS

Question 40

A 2 year old boy presents with loose motions for the last one year. She was breast fed for one

year after which weaning was started. Examination reveals a pale, malnourished girl with height

and weight <3rd centile. She has wasted buttocks and protruded abdomen. You also notice small

papules and vesicles on her shins. These skin lesions are most likely

a) Erythema Nodusum

b) Erythema Multiforme

c) Dermatitis Herpatiformis

d) Acrodermatitis Enteropathica

e) Scabies

Key: Correct option is c

Importance: Essential

Difficulty level: Easy

Reference: Nelson Textbook of Pediatrics, page no 1592

Signature:
Author: Dr Mobin Date: 11/11/11

Specialty: Pediatrics Medicine Examination: IMM/FCPS II/MCPS

Question 41

A one year old boy is brought to you because of respiratory distress. The patient is a diagnosed

case of Tetralogy of Fallot and underwent B-T shunt two days ago. On examination Respiratory

is 60/min and Air entry is decreased on right lower zone and Vocal resonance was decreased.

What is the most likely cause for his respiratory distress?

a) Consolidation

b) Collapse

c) Pherenic nerve injury

d) Aspiration

e) Shunt failure

Key: Correct option is c

Importance: Essential

Difficulty level: Easy

Reference: Nelson Textbook of Pediatrics, page no 1910

Signature:
Author: Dr Mobin Date: 11/11/11

Specialty: Pediatrics Medicine Examination: IMM/FCPS II/MCPS

Question 42

You are asked to examine a baby for reasons of bilious vomiting. The baby is one day old and

the vomiting started two hours ago. You notice that the upper abdomen is distended and the child

has up slanting eyes and depressed bridge of nose. The most likely cause of this baby vomiting is

a) Duodenal Artesia

b) Jejunal Artesia

c) Illeal Artesia

d) Hirschsprung disease

e) Sepsis

Key: Correct option is a

Importance: Essential

Difficulty level: Easy

Reference: Nelson Textbook of Pediatrics, page no 1559

Signature:
Author: Dr Mobin Date: 11/11/11

Specialty: Pediatrics Medicine Examination: IMM/FCPS II/MCPS

Question 43

A 29 weeks gestation baby who was being ventilated for Respiratory distress collapsed. There is

no murmur heard over the precordium and chest x ray shows endo-tracheal tube is correctly

placed. The most likely step in management would be

a) Do Arterial blood gases

b) Ultra sound brain

c) Echocardiography

d) Reinsert endotracheal tube

e) Give I/v fluids

Key: Correct option is c

Importance: Essential

Difficulty level: Easy

Reference: Nelson Textbook of Pediatrics, page no 1891

Signature:
Author: Dr Mobin Date: 11/11/11

Specialty: Pediatrics Medicine Examination: IMM/FCPS II/MCPS

Question 44

A 6 years old girl who is a know case of celiac disease presents with fits. The fits are generalized

tonic clonic and last for few minutes. What is the most likely cause of fits?

a) Celiac crises

b) Hypoglycemia

c) Hypocalcaemia

d) Hypomagnesaemia

e) Hypophosphotemia

Key: Correct option is c

Importance: Essential

Difficulty level: Easy

Reference: Nelson Textbook of Pediatrics, page no 1591

Signature:
Author: Dr Mobin Date: 11/11/11

Specialty: Pediatrics Medicine Examination: IMM/FCPS II/MCPS

Question 45

A two years old boy presented with acute loss of vision for two days. He was vaccinated three

days ago and yesterday he was noted to bump in into things. He is afebrile and has a GCS of

15/15. Fundoscopy reveals swollen optic disc. What is the most likely diagnosis?

a) Devic disease

b) Optic Neuritis

c) Papilledema

d) Raised Intracranial pressure

e) Transverse myleitis

Key: Correct option is b

Importance: Essential

Difficulty level: Easy

Reference: Nelson Textbook of Pediatrics, page no 2607

Signature:
Author: Dr Mobin Date: 11/11/11

Specialty: Pediatrics Medicine Examination: IMM/FCPS II/MCPS

Question 46

A nine year old boy presented with yellowish discoloration of eyes and dark colored urine. He

has had multiple episodes like this in the past. On examination his eyes are yellow; his spleen is

palpable 4 cm below costal margins. He does not have hepatomeglay and he is not febrile. He is

most likely suffering from

a) Gilbert syndrome

b) Rotor syndrome

c) Dubin Johnson syndrome

d) Crigler Najjar syndrome

e) Hereditary Spherocytosis

Key: Correct option is e

Importance: Essential

Difficulty level: Easy

Reference: Nelson Textbook of Pediatrics, page no 2020

Signature:
Author: Dr Mobin Date: 11/11/11

Specialty: Pediatrics Medicine Examination: IMM/FCPS II/MCPS

Question 47

A 6 weeks old girl presented with episodes of cough. The cough is associated with cyanosis and

vomiting. During one of the episodes the child suffered from apnea which lasted for 10 sec. Her

Respiratory rate is 50/min and there are no sub costal and intercostal recessions. Blood CP shows

Hemoglobin is 12 gm/dl, TLC 35000/mm3, DLC shows DLC shows 60% lymphocytes. Chest X

ray shows hyperinflation. Echo is normal, Barium studies are normal too. Which is the treatment

of choice?

a) Amoxicillin

b) Cefaclor

c) Erythromycin

d) Cefixime

e) Ceftriaxone

Key: Correct option is c

Importance: Essential

Difficulty level: Easy

Reference: Nelson Textbook of Pediatrics, page no 1115

Signature:
Author: Dr Mobin Date: 11/11/11

Specialty: Pediatrics Medicine Examination: IMM/FCPS II/MCPS

Question 48

You are asked to examine a cerebral palsy child. When pulled to sitting position the child can

hold his neck, He cannot sit with support and he has scissoring when held vertically. When made

to lie prone he can’t lift his head. The age of the child is

a) 2 months

b) 4 months

c) 6 months

d) 8 months

e) 10 months

Key: Correct option is a

Importance: Essential

Difficulty level: Easy

Reference: Nelson Textbook of Pediatrics, page no 272

Signature:
Author: Dr Mobin Date: 11/11/11

Specialty: Pediatrics Medicine Examination: IMM/FCPS II/MCPS

Question 49

A 6 months old girl presents with fever for one month duration. She had been diagnosed at birth

with Down syndrome. On examination her temperature is 100 F, pulse 120/min, Respiratory rate

46/min. Her total liver span is 10 cm and spleen is 4 cm below costal margin. She has been

treated with multiple antibiotics and antimalarials. She has a pan systolic murmur at lower left

sternal border. Which of the disorders is most likely?

a) Cardiac failure

b) Kawasaki disease

c) Pneumonia

d) Sepsis

e) Sub acute infective endocarditis

Key: Correct option is e

Importance: Essential

Difficulty level: Easy

Reference: Nelson Textbook of Pediatrics, page no 1890

Signature:
Author: Dr Mobin Date: 11/11/11

Specialty: Pediatrics Medicine Examination: IMM/FCPS II/MCPS

Question 50

A 1 year old girl was brought to pediatric OPD because the mother thought she could feel the

child chest beating. This problem has persisted since the child was born. On examination there is

pan systolic murmur heard over the mitral area, which radiates to the axilla. Chest X ray shows

cardiomegaly and echo confirms Mitral valve Prolapse. What would you advise the parents?

a) Benign nature of this condition

b) Treatment of heart failure

c) Aspirin to prevent embolus formation

d) Mitral valve replacement

e) Mitral valve repair

Key: Correct option is a

Importance: Essential

Difficulty level: Easy

Reference: Nelson Textbook of Pediatrics, page no 1905

Signature:
Author: Dr Mobin Date: 11/11/11

Specialty: Pediatrics Medicine Examination: IMM/FCPS II/MCPS

Question 51

A 4 year old boy presents with inability to walk for the last 4 weeks. The baby was born SVD

and breast feeding was done for one month. The baby was then put on formula milk. Weaning

was stated at the age of 2 years. On examination the baby weighs 10 kg, length is 110 cm, and

there is severe limitation of movement in the right leg. The thigh is swollen and child cries on

touching it.

a) Rickets

b) Scurvy

c) Osteomyelitis

d) Septic arthritis

e) Hemophilia

Key: Correct option is b

Importance: Essential

Difficulty level: Easy

Reference: Nelson Textbook of Pediatrics, page no 44

Signature:
Author: Dr Mobin Date: 11/11/11

Specialty: Pediatrics Medicine Examination: IMM/FCPS II/MCPS

Question 52

A ten year old boy presented to your emergency with one month’s history of Headache. The

headache is becoming severe and is associated with vomiting. On examination he is febrile, has

left facial nerve palsy. Signs of Meningeal irritation are present and tone in the right upper limb

and lower limb is increased. His Red tympanic membrane is red and bulging. What is likely

diagnosis?

a) Cerebral Abcess

b) Meningitis

c) Encephalitis

d) Otitis Media

e) Mastoidistis

Key: Correct option is a

Importance: Essential

Difficulty level: Easy

Reference: Nelson Textbook of Pediatrics, page no 2520

Signature:
Author: Dr Mobin Date: 11/11/11

Specialty: Pediatrics Medicine Examination: IMM/FCPS II/MCPS

Question 33

Key: Correct option is e

Importance: Essential

Difficulty level: Easy

Reference: Nelson Textbook of Pediatrics, page no 272
Signature: