Q1

a) Describe the lesion in two days 1

old baby?
a) What is diagnosis? 2
b) How will you treat? 2
 KEY 1
a) Picture of newborn showing multiple 1
erythematous lesions.
b) Erythema Toxicum Neonatorum. 2
c) Mainly self limiting.
• No treatment is required. 2
• Reassurance of parents.

(Ref. Nelson 19th ed. 2219)

 Q2
a) Identify the picture. 1
b) At which time surgery is done 2
c) Name two complications if untreated. 2
 KEY 2
a) Cleft lip with Cleft Palate. 1
b) Cleft Lip at 3 months. Cleft Palate at 6 2
months to 1 year.
c) Feeding problems. 2
 Speech delay.
 Recurrent ENT infections.
 Cosmetic problem/psychosocial depression.

(Ref. Nelson 19th ed. 1252-53)

 Q3
a) Identify the picture? What abnormality it
shows? 1
b) What is diagnosis? 1
c) Name 3 clinical features of disease? 3
 KEY 3
a) Karyotyping showing Trisomy 21. 1
b) Down’s syndrome. 1
c) Flat occiput, depressed nasal bridge, 3
simian crease, Low set ears, Brushfield iris,
mental retardation, Atlantoaxial subluxation.

(Ref. Nelson 19th ed. Page 400-403)

 Q4
6 years old child after having dinner at some
Chinese restaurant now develop sudden respiratory
distress, throat tightness , flushing hoarseness of
voice. On examination his BP was 60/40 mmHg.
A) What is most likely diagnosis? 1

B) Give steps of management? 4

Reference Nelson 19th edition page 816, 817

 Key 4
A) Anaphylaxis 1
B) Maintain airway, breathing and circulation 4
– Oxygen
– Injection adrenaline 1:1000 solution 0.1ml / kg
subcutaneous stat
– Antihistamine
– I/V fluids
– Inotropic support if needed
– Counselling
– Steroids if needed

– Reference Nelson 19th edition page 816-819

 Q5
A 10 days old boy presented with history of
intractable fits from day seven. Baby was delivered
in home by Dai . Fits are triggered by handling
a) What is most likely diagnosis? 1

b) Name steps of treatment? 2

c) How will you prevent? 2

Reference Nelson 19th edition page 992, 993

 Key 5
a) Tetanus neonatorum 1
b) Antitoxin, TIG, antibiotics (penicillin,
metronidazole, sedation, nursing care) 2
c) Vaccination of mother according to WHO
schedule. 2

Reference Nelson 19th edition page 992, 993

 Q6
A 6 year old child presented with history of
fever. maculopapular rash appeared on day 5 .
The rash started behind the ear along the
hairline.
Child has clouding of cornea
a) What is most likely diagnosis
according to IMCI? 1
b) How will you manage 4
 Key 6
a) Severe complicated Measles 1
b) Give first dose of antibiotic 4
c) Prevent low blood sugar
d) First dose of paracetamol
e) Vitamin A
f) Refer urgently

• Reference Nelson 19th edition page 1069-1075

 Q7
A 4 year old boy presented with history of
sudden onset of stridor, drooling of saliva and
toxic look.
a) What is most likely diagnosis? 1
b) Name the causative organism? 1
c) Name steps of management? 3
 Key 7
a) Acute epiglottitis 1
b) H. influenza type B 1
c) Following steps
1. Airway management e.g., intubation /
tracheostomy 3
2. Injection ceftriaxone or chloramphenicol
3. Fluid and electrolyte balance

Reference Nelson 19th edition page 1447, 1448

 Q 8
A 7 year old girl presented with history of fever
for 10 days and chest pain for 5 days, on
examination there is bulge on left hemithorax,
with dull percussion note and reduced chest
movements.
a. What is most likely diagnosis? 1
b. How will you investigate? 2
c. How will you manage? 2
 Key 8
a) Left sided pleural effusion 1
b) CBC, ESR, CXR, USG chest, Pleural fluid examination 2
c) Steps 2
1) Maintain airway
2) Maintain breathing
3) Maintain airway
4) i/v antibiotics
5) Treatment of cause
6) ATT if tuberculosis

Reference Nelson 19th edition page 1505

 Q 9
A 3 years old girl presented with history of
chronic diarrhea, that started from age of 6
month, when weaning was started. On
examination there are features of macro and
micronutrients deficiency.
a) What is most likely diagnosis? 1
b) Two most important investigation? 2
c) Name steps of management 2
 Key 9
a) Celiac disease. 1
b) Investigations 2
a) Anti-gliadin antibodies IgA, IgG.
b) Anti-tissue-transglutaminase
c) Jejunal biopsy
c) gluten free diet, micronutrients addition in
diet 2

Reference Nelson 19th edition page 1308 - 11

 Q 10
A 9 year old boy presented with history of fever
and fits from 1 day, is known case of some
congenital heart disease. On examination there
is ejection systolic murmur at left 2nd intercostal
space and clubbing.
a) What is most likely diagnosis? 1
b) Name four important investigations? 2
c) Steps of management? 2
 Key 10
a) TOF with brain abscess 1
b) CBC, ECG, Echo, CT brain with I/V contrast 2
c) Management include 2
a) I/V antibiotics ( inj. Benzyl penicillin, Ceftriaxone,
metronidazole for 3 weeks)
b) Anticonvulsant if needed
c) Antipyretics
d) Treatment of underlying pathology.

Reference Nelson 19th edition page 1573 – 77

 Q 11
A 7 year old girl presented with history of off
and on fever for 2 months not responding to
antibiotics and antimalarial. She was operated
for some heart disease in past. On examination
she has petechiae on back.
A) Most likely diagnosis? 1
B) 4 other clinical findings? 4
 Key 11
a) Infective endocarditis 1
b) Others findings 4
i) Roth’s spots
ii) Janeway’s lesion
iii) Hepatomegaly
iv) Splenomegaly
v) Clubbing
vi) Osler’s node
• Reference Nelson 19th edition page 1622 – 25
 Q 12
A 4 year child presented with uncontrolled
seizures lasting for one and half hours with loss
of consciousness.

a) Most likely diagnosis? 1

b) Enlist steps of treatment? 4
 Key 12
a) Status epileptics 1
b) Steps of managements follows 4
a) Maintain airway
b) Maintain breathing
c) Maintain circulation
d) Send all labs
e) Treat Hypoglycemia if present
f) Injection diazepam 0.2 mg/kg/dose
g) Inj phenytoin 20mg/kg I/V
h) Inj phenobarbitone 20mg/ kg
i) Ventilator support if needed

Reference Nelson 19th edition page 2038 – 39.

 Q 13
A 10 year old boy presented with history of
gradually increasing difficulty in walking and
standing up from sitting position.
a) What is most likely diagnosis? 1
b) Name three investigations? 3
c) Name pattern of inheritance? 1
 Key 13
a) Duchene muscular dystrophy 1
b) CPK, EMG, Muscle biopsy. 3
c) X – linked recessive 1

• Reference Nelson 19th edition page 2119 – 22.

 Q 14
A 12 year old boy presented with gradually
increasing weakness of lower limbs from 1 day.
He had also history of respiratory tract infection
about one week back. On examination tendon
reflexes not ellicitible in lower limbs.
a) Most likely diagnosis? 1
b) Two differential? 2
c) Two bad prognostic signs? 2
 Key 14
a) Guillain-Barre Syndrome 1
b) Differentials 2
a) Hypokalemic paralysis
b) Polio
c) Transverse myelitis
d) Tic paralysis
c) Bad prognostic Sign 2
a) Rapidly developing disability
b) Need for intubation
c) Autonomic disturbance

Reference Nelson 19th edition page 2143 – 45.

 Q 15
9 months old child presented with progressive
palllor . He has splenomegaly and one sibling
affected with similar problem needs blood
transfusion monthly.
a) Most likely diagnosis? 1
b) How will you investigate ? 2
c) Give Steps of management ? 2
 Key 15
a) Beta thalassemia 1
b) CBC, Retics counts, Peripheral film, Hb
electrophoreses. 2
c) Blood transfusion,desferoxamine,hydroxyurea,
bonemarrow transplantation 2

Reference Nelson 19th edition page 1674 – 75.

 Q 16
A 5 year old child presented with history of
pallor, some petechiae on back. On examination
there is no Hepato-splenomegaly or
lymphadenopathy.cbe shows depressed 3 cell
lines
a) What is most likely diagnosis? 1
b) Write investigations? 2
c) How will you manage? 2
 Key 16
a) Aplastic anemia 1
b) CBC, Retics, Bone marrow biopsy 2
c) Management include 2
a) Isolate
b) Blood transfusion
c) Platelets transfusion
d) Steroids, cyclosporine
e) Bone marrow transplant
f) Reference Nelson 19th edition page 1690-91
 Q 17
A 5 year old boy come to you with history of
prolong bleeding after tooth extraction. His labs
shows, Hb = 11 g/dl, platelets = 270,000 /mm3,
BT > 15min, factors assay= normal.
a) What is most likely diagnosis? 1
b) What are investigations 2
c) Name types of that disease? 2
 Key 17
a) Platelets dysfunction 1
b) Platelets aggregometry, platelet function
analyzer 2
c) Bernard – Soulier syndrome, Glanzamann
thromboasthenia, Aspirin intake 2

Reference Nelson 19th edition page 1721

 Q 18
A 10 year old child presented in emergency with
respiratory distress. Patient has previous history
of polyuria, polydipsia. RBS is 450mg/dl.
a) Most likely diagnosis? 1
b) Steps of management? 4
 Key 18
a) Diabetic ketoacidosis 1
b) Admit in ward,blood sample ( for CBC, 4
serum electrolytes,renal parameters ,
urine for ketones) fluid replacement,insulin
and monitoring of blood sugar

Reference Nelson 19th edition page 1974

 Q 19
You are called to see a new born who has
ambiguous genitalia. On lab investigations Na+ =
110 mmol/L and K+ = 6 mmol/L, RBS = 40mg/dl.
a) Most likely diagnosis? 1
b) Name three other important
investigations 3
c) What is inheritance? 1
 Key 19
a) Congenital adrenal hyperplasia 1
b) 17 hydroxy progestrone level,Pelvic USG, 3
karyotyping
c) Autosomal recessive

Reference Nelson 19th edition page 1930-39

 Q 20
a) Identify procedure? 1
b) Write indications(diagnostic,therapeutic) 2,2
 Key 20
a) Lumber puncture 1
b) Diagnostic
a) To diagnose meningitis,encephalitis,T.B.M 2
b) Therapeutic 2

a) For giving spinal anaesthesia

b) Sometime to lower raised ICP (drainage lp)
c) CNS chemoprophylaxis
Reference Nelson 19th edition page 2087-2095
 Q 21
• Identify picture.
A) Describe skin finding 2
B) Write any three diseases associated 3
with such skin finding?
 Key 21
a) Café au lait spots 2
b) Neurofibromatosis, tuberous sclerosis, 3
Ataxia telangiectasia, Basal cell nevus
syndrome, Benign congenital skin lesion,
Bloom syndrome, Chediak Higashi syndrome,
Congenital naevus, Gaucher disease, Hunter
syndrome.
Reference Nelson 19th edition page 2046-2047,2237
 Q 22
a) Write findings in picture in a 3 years old child. 2
b) Describe three associated features of that 3
disease.
 Key 22
a) Crossing seizure of lower limbs , 2
standing with support.
b) Mental retardation, joint deformities, 3
developmental delay,
Reference Nelson 19th edition page 2061-2065
 Q 23
a) Identify karyotyping 2
b) Give three clinical features of that disease. 3
 Key 23
a) turner’s syndrome 2
b) Webbed neck, widely spaced nipple, low 3
posterior hair line, short stature, cubital
valgus, congenital lymphedema, gonadal
Dysgenesis.
Reference Nelson 19th edition page 409-410
 Q 24
a) Identify karyotyping. 2
b) Give three clinical features of that syndrome 3
 Key 24
a) klinefelter’s syndrome 2
b) Metal retardation, behavioural problem, 3
long limbs, Gynaecomastia,
hypogonadism and hypogenitalism
Reference Nelson 19th edition page 410
 Q 25
a) What are clinical findings in given image . 3
b) How can you differentiate upper motor neuron 2
lesion from lower motor neuron lesion
 Key 25
a) Loss of nasolabial fold on left side , 3
deviation of angle of mouth to right,
wide palpebral fissure on left
b) Wrinkling of forehead is present in upper 2
motor neuron lesion but absent in
lower motor neuron lesion.
Reference Nelson 19th edition page 2146-47
 Q 26
a) Write CT scan findings. 2
b) What are three causes? 3
 Key 26
a) Dilated ventricles and compensated 2
decreases in brain matter.
b) Cerebral aqueduct stenosis, congenital 3
intrauterine infections, Chiari malformation,
brain tumor, Dandy – Walker malformation,
tuberculosis meningitis.
Reference Nelson 19th edition page 2008-2011
 Q 27
A 4 week old infant has severe vomiting for one
week. Vomitus never contains blood or bile.
After vomiting a mass is palpable in epigastrium,
baby is vitally stable and afebrile.
a) What is most likely diagnosis? 1
b) How will you confirm it? 1
c) What are differential diagnoses? 3
 Key 27
a) Hypertrophic pyloric stenosis 1
b) USG abdomen 1
c) Esophageal stenosis, annular pancreas,
congenital adrenal hyperplasia,
inborn error of metabolism 3
Reference Nelson 19th edition page 1274-1275
 Q 28
a) Describe X-ray abnormality 1
b) Most likely diagnosis? 1
c) How will you manage? 3
 Key 28
a) Double bubble with no distal bowel gases 1
b) Duodenal atresia 1
c) Nasogastric decompression, I/V fluids,
Surgery 3
Reference Nelson 19th edition page 1277-1278
 Q 29
a) Identify following 1
b) What are uses? 1
c) What are complications? 3
 Key 29
a) I/V cannula 1
b) Get venous access for giving fluids 1
and medications.
c) Local pain, infection, bleeding 3
 Q 30
a) Identify organism 1
b) Give two clinical manifestations caused 2
by that organism?
c) Name two drugs for treatment? 2
 Key 30
a) Ascaris lumbericoides 1
b) Mostly asymptomatic, abdominal pain, 2
Loffler's pneumonia, intestinal obstruction,
peritonitis
c) Mebendazole, pyrantel pamoate,
Albendazole, Piperazine 2
Reference Nelson 19th edition page 1217
 Q 31
• 6 months old child who is overweight and
constipated. On examination,child is hypoyonic with
large tongue , lethargic, no social smile, no head
control and puffy face. Picture is shown
a;What is most likely diagnosis? 1
B;How will you confirm ? 3
C;How will you treat? 1
 KEY 31
• a; Congenital hypothyroidism 1

• b; T3, T4, and TSH level in blood 3

•
•Sodium l thyroxine is given orally. 1
Reference Nelson 19th edition page 1895-1901
 Q 32

a) What is diagnosis (2)

b) Enlist 3 differential diagnosis? (3)
 Key 32
• Microcytic hypochromic anemia 2
• Iron deficiency anemia, Thalassemia, 3
Anemia of chronic disease, Lead poisoning
Reference Nelson 19th edition page 1655-1658
 Q 33
A 14 months old boy has history of uncontrolled bleeding after
falling from stairs. One of his auntie ‘s son has same complaints.
Examination is unremarkable. On getting CBC, Hb 12.5 g/dL, TLC
9000/microL, Platelet count 250000/ microL.

a) What is the type of inheritance shown in figure? 1

b) What is the diagnosis? 1
c) Enlist investigations to confirm the diagnosis. 3
 KEY 33

a) X-linked recessive inheritence 1

b) Hemophilia 1
c) Platelet count: Normal 3
Clotting time: Prolonged
Bleeding time: Normal
Prothrombin time (PT): Normal
Partial thromboplastin time (PTT): Prolonged
Factor VIII: Decreased
Reference Nelson 19th edition page 1699-1703
 Q34
A 5 years old boy had history of progressive pallor, off and on
fever and mouth ulcerations for 6 months. He also had
history of gum bleeding 3 weeks back. On examination, he
was febrile (temp. 102 F), pale. Generalized
lymphadenopathy with hepatosplenomegaly .

a) What is the diagnosis? (1)

b) Write down 3 differential diagnoses? (2)
c) What are the investigations you will advise
to confirm diagnosis? (2)
 KEY 34

a) Leukemia 1
b) Lymphoma, Infectious mononucleosis, 2
Aplastic anemia, Myloproliferative disorders.
c) CBC 2
Peripheral blood film
LDH
Bone marrow examination
Reference Nelson 19th edition page 1732-1739
 Q35
A 7 months old child brought to emergency with 4 days
history of fever , cough and respiratory distress. On
examination, patient is febrile, tachypnic with nasal flaring ,
recessions and crepitations on right upper chest.

a) What is the finding in figure? 1

b) Enlist 4 complications. 2
c) Give steps of management. 2
 KEY 35

a) CXR showing opacity in upper lobe of right lung, 1

b) Empyema, Lung abscess, Pleural effusion, 2
Pneumothorax
c) Oxygen inhalation if saturation drops 2
Antipyretics if needed
Fluid electrolyte balance
Antibiotics initially empirical
After getting culture report then specific antibiotic
treatment.
Reference Nelson 19th edition page 1474-1479
 Q 36

a) Give x-ray findings 1

b) Enlist 4 causes? 2
c) Give management steps.2
 KEY 36

a) Chest x-ray showing left sided Pleural effusion 1

b) Pneumonia, Tuberculosis, , nephrotic syndrome, 2
Malignancy
c) Treatment of underlying cause (Pneumonia, TB, etc) 2
In large pleural effusion, drainage with chest intubation
is done.
Reference Nelson 19th edition page 1003-1004,1479
 Q 37
• A term new-born male infant is being examined. On
examination you have found flat face, epicanthal
fold, short and broad hands, hypotonia, and single
transverse crease on hands.
a;What is most likely diagnosis ? 1
B;What is most common risk factor? 1
• c; What are other clinical findings? 3
 Key 37
a;Down’s syndrome 1
b; old maternal age 1
C;low posterior hair line,flat occiput,large 3
protruded tongue,mental
retardation,congenital heart diseases,low set
ears
• Reference: Nelson’s book of paediatrics 19th edition page no.
400 – 403.
 Q38
• A 10years old boy presented with history of
generalized edema, fatigue, and abdominal pain.
His past medical history is insignificant. On
examination B.P. 110/70 mmHg and heart rate is
80/min, edema, puffiness of face, rest of
examination unremarkable. Urinalysis shows
proteinuria 4+.
A;What is most likely diagnosis? 1
B;What are the further tests to confirm diagnosis? 2
C;What are complications? 2
 Key 38
A;Nephrotic syndrome 1
• B; 2
–24 hour urine protein
–Serum creatinine
–Serum albumin
–Serum triglyceride
–Spot urine protein to creatinine ratio.
• C;skin Infections, bacterial peritonitis, 2
thromboembolism
• Reference: Nelson’s book of paediatrics 19th edition
page no. 1801 – 1807.
 Q39
• 3 months old child presented with poor feeding,
vomiting, and irritability. On examination child has
head circumference 46cm, bulging fontanella, widely
spaced sutures, scalp veins are prominent. Picture is
shown
A;What is most likely diagnosis? 1
B;What are its types? 2
C;What are complications, any three? 2
 Key39
A;Hydrocephalus 1
B; 2
– Obstructive hydrocephalus
– Non – obstructive hydrocephalus
C;Headache, papilledema, 2
sixth nerve palsy, seizures,
• Reference: Nelson’s book of paediatrics 19th edition page no.
2008 – 2011.
 Q 40
•
• 7 years old boy brought to consultant by his
mother with complaint of passing stool at
inappropriate places. On examination patient is
vitally stable, no evidence of any disease. On PR
examination you have found hard stool. X-ray
plain abdomen is normal. You are suspecting
some psychological issue.
A;What does this psychological problem called? 1
B;What are its types? 2
C;How will you manage that case? 2
 KEY 40
A;Encopresis 1
B; 2
– Primary encopresis
– Secondary encopresis
C;
– 1st clear gut with short term use of mineral oil or laxative 2
– Regular postprandial toilet training
– Behavioural management
– High fiber diet
– Familial support for behavioural modification
– Psychotherapy

.
• Reference: Nelson’s book of paediatrics 19th edition page no. 73 – 75.