1.

The Apgar score is recorded

a.1 and 5 minutes after delivery.
b.2 and 8 minutes after delivery.
c.2 and 10 minutes after delivery.
d.4 and 12 minutes after delivery.
e 3 and 6 minutes after delivery.
Answer: a
Explanation: the apgar score assess heart rate, respiratory effort,
reflex, irritability, muscle tone and color.

2. At 10 minutes an APGAR score of less than---- correlates with a poor outcome:

a.2
b.3
c4
c.5
d.6
Answer: d
Explanation: Although, early apgar scores are not good predictorof outcome.

3. The fetal period is from:

a.5th week of gestation to 28th week of gestation.
b.6th to 32nd week of gestation.
c.12th week of gestation to delivery.
d. 32nd week of gestation to 1st day of life.
Answer: c

4.Normal findings in anew born do not include:

a a mongolian blue spot.
b a strawberry naevus.
c.vaginal blood loss.
d.lanugo hair.
e.erythema toxicum.
Answer: a
Explanation: strawberry naevus, a vascular malformation , appeals over the first few
months of life and is rarely present in the early neonatal period.

5. There is an increased risk of neonatal respiratory difficulty, except:

aFollowing prolonged rupture of the membranes.
b in the infant of a diabetic mother.
c.after elective pre-labour caesarean section delivery.
d.with meconium stained liquor.
ewith a family history of asthma.
Answer: e
Explanation: a family history of asthma is not relevant.

6. Regarding the head of a newborn infant which of the following statement is true:
a cephalohaematoma will resolve within the 1st day of life
b.caput is due to oedema of the presenting part of the head.
c.a cephalohaematoma is due to bleeding into the skin.
d.overlapping of the skull bones is an abnormal finding .
e. a cephalohaematoma should be drained.
Answer: b
Explanation: cephalohaematoma are due to bleeding under the parietal periostium.
Overlapping of the skull bones is 0 normal finding.

7. A healthy newborn baby boy may have all of the following ,except:
a.have erythema of the umbilical skin which extends on to the abdomen.
b.produce .breast milk.
c.have a single palmar crease.
d.have an umbilical hernia.
e.vomit blood if breast fed.
Answer: a
Explanation: an umbilical 'flare' indicates infection and should be treated with
antibiotics.

8. In the mouth of a newborn normal findings includes all, except:

a.teeth.
b.ebstein pearls.
c.tongue tie.
d.submucous cleft
e.all of the above .
Answer: d
Explanation: a submucous cleft is not normal and may require repair as it interferes with
speech and swallowing .

9. In the first 24 hours of life it is normal:

a.to loose 15% of the birth weight.
b.not to pass meconium.
c.to be jaundiced.
d.to have blood sugar of 1mmol/l.
e.to have pink urine stains in the nappy.
Answer: e
Explanation: Breast fed babies may lose upto 12% of their birth weights by the 5th day
and usually regain it by 10 days. A blood sugar level below 2.6 mmol/l is abnormal.

10.Which of the following neonatal skin findings require no treatment or investigation:

a.umbilical flare.
b.milia.
c.generalized purpuric rash.
d.staphylococcal spots.
e.melanocytic naevi.
Answer: b
Explanation: Milia are tiny white spots over the nose and chin. They are due to blocked
sebaceous glands. Also, erythema toxicum donot require any treatment or investigation.

11. The small for gestation age newborn baby is at an Increased risk of
a.hypoglycaemia.
b.polycythaemia.
c.hypothermia.
d.all of the above.
e.none of the above.
Answer: d

12. There is an increased chance of a baby being larger for gestational age in all of the
following conditions, except:
the mother is large and heavy.
b.the baby has down syndrome.
c.the baby has an insulin secreting tumor.
d.the mother has diabetes.
Answer: b
Explanation: down syndrome babies are tend to be smaller.

13. Respiratory distress syndrome is not exacerbated by:

a.hypothermia.
b.acidosis.
c.hypoxia.
d.meconium aspiration.
e. withholding enteral feeding.
Answer: e
Explanation: withholding enteral feeds reduces the risk to the baby of a full stomach
compromising the diaphragmatic function and will reduce the risk of aspiration.

14. The incidence of idiopathic respiratory distress syndrome is increased in:

a.premature infants.
b.infants of mothers who were given steroids.
c.premature girls as compared to premature boys.
d.asphyxiated term babies.
e.prolonged rupture of the membranes.
Answer: a
Explanation: the incidence is increased in pre mature boys as compared to pre
mature girls.

15. Organisms implicated in transplacentally acquired pneumonia includes all, except:

a.cytomegalovirus,
b.listeria.
c.pneumococci.
d.varicella.
e.rubella.
Answer: c

16. Early clinical signs of respiratory distress syndrome includes all, except:
a.a respiratory rate greater than 60 breaths/minute.
b.expiratory grunting.
c.central cyanosis if breathing air.
d.intercostals recession.
e.pyrexia.
Answer: e
Explanation: IRDS does not cause pyrexia.

17. Another indication of fetal distress in labor is a fetal heart rate of:
a.100 beats/minute.
b.150 beats/minute.
c.180 beats/minute.
d.200 beats/minute.
e.250 beats/minute.
Answer: d

18. A baby born at 31st weeks gestation has recurrent apnoeic episodes. This may includes
all, except:
a.may be normal.
b.indicates infection.
c.treated with caffeine.
d.may be due to high oxygen concentration.
e.require ventilation.
Answer: d.

19. Infecting organism associated with neonatal septicemia include:

a. streptococcus pneumonia
b.H Influenza,
mycoplasma pneumonia.
d.group B hemolytic streptococci.
e.E. coli.
Answer: e

20. Neonatal hypoglycemia is associated with all, except:

intrauterirne growth retardation.
prematurity.
c.intrapartum asphyxia.
d.breast feeding.
e.high birth weight(>4.5kg)
Answer: d.

Explanation: breast-fed babies should not develop significant hypoglycemia.

21. Toddler is called to a child having

A) 3-4 years age
B) 1-2 years age
C) 2-4 years age
D) 5-6 years age
E) 7-8 years age
Answer: b

22. Measles vaccine as per EPI Schedule is given at

A) 9 months age only
B) 9 months age and 18 months age
C) 9 months age and 15 months age
D) 12 months age and 1 months age
E) 10 months age
Answer: c

23. Preterm means

A) gestational age less than 39 weeks
B) gestational age less than 37 weeks
C) gestational age less than 34 weeks
D) gestational age less than 42 weeks
E) gestational age less than 40 weeks
Answer: b
24. Infant sits unsupported by
A) 7 months age
B) 6 months age
C) 9 months age
D) 11 months age
E) 10 months age
Answer: c
25. Neonatal Mortality Rate in
Pakistan is
A) 42/1000 life births
B) 62/1000 life births
C) 52/1000 life births
D) 22/1000 life births
E) 40/1000 life births
Answer: b

26. Very low birth weight newborn weight is

A) weight less than 1000 grams
B) weight less than 1200 grams
C) weight less than 1500 grams
D) weight less than 1250 grams
E) weight less than 2000 grams
Answer: c

27. Causes of hypertension in a 2 year old girl include all, except:

a.neuroblastoma.
b.minimal change nephritic syndrome.
c.coarctation of the aorta.
d.reflux nephropathy.

Answer: b

28. Which of the following is true about nocturnal enuresis in 5 year old:
a.is commoner in girls than boys.
b.affects 20% of children aged 5.
c.can be treated with evening fluid restriction .
is effectively treated in at least 50% by bedtime administration of vasopressin
analogues.
is usually associated with daytime wetting.
Answer: c

Explanation: is effectively treated in at least 30% by bedtime administration of

vasopressin analogues.

29. Social smile appear by

A) 7 weeks age
B) 6 weeks age
C) 9 weeks age
D) 8 weeks age
E) 10 weeks age
Answer: d

30. All of the following are risk factors in children for the development of
hypothyroidism:
a.Down syndrome.
b.Diabetes mellitus
c Hydrocephalus.
c.Turner's syndrome.
d.Kline filter's syndrome.
Answer: c
Explanation: there is an association between chromosomal abnormalities and
hypothyroidism.

31. Which one of the following is true in a 2 year old with persistence of the ductus
arteriosis:
The murmur is continuous with a systolic accentuation
b.There is a narrow, pulse pressure.
c.The murmur quietens on lying the child down .
The ductus will be closed by administration of indomethacin.
There will be cyanosis on exercise.
Answer: b

32.A child is suffering from acute epiglottitis, which of the following would be
appropriate management:
a.Carefully inspect the pharynx for evidence of tonsillitis or foreign body.
b.Insert an IN cannula to obtain blood samples and start IN fluids.
c.Give oxygen.
d.Ask the anxious parents to leave the room as they may upset the child.
e.Send to x-ray for inspiratory and expiratory CXR to exclude a foreign body.
Answer: c.
Explanation: clinical features of epiglottitis includes high fever, increasing
respiratory difficulty, sore throat, dysphagia, drooling, hoarse voice. Child appears toxic
and anxious due to hypoxia.

33. .Mother of a 3 year old child has reported that her child has excessive thirst. Child
appears healthy and normally grown, on examination. We should:
a.carry out immediate urinanalysis.
b.Measure 24 hour fluid balance.
c.Admit immediately to hospital for a careful water deprivation test.
d.Request renal ultra sound and isotope scan.
Answer: a

34. .All of the following associations between type of stools and associated conditions,
are true, except:
a.Watery stool with visible vegetable material---------toddlers diarrhea.
b.Oily stool-----cystic fibrosis.
c.Explosive, watery stool----- lactose intolerance.
d.Bloody diarrhea ------------- rotavirus gastroenteritis.
e.Constipation------------------ hirschsprung's disease.
Answer: e
Explanation: in hirschsprung's disease there will be constipation, though if an
enterocolitis develops, bloody diarrhea may occur.

35. All are true about conjugated hyper bilirubinemia, except:

a.It is suggested by jaundice with pale stools and dark urine.
b.Is may be due to neonatal hepatitis.
c.Is caused by biliary atresia.
d.Is caused by chromosomal abnormalities.. .
e.Is significant only if the conjugated fraction is greater than 50% of the total bilirubin.
Answer: e
Explanation: levels of conjugated bilirubin are significant if the conjugated
fraction exceeds 20% of the total.

36. Which of the following condition is caused by single gene defect:

a.Turner's syndrome.
b.Duchenne muscular dystrophy.
c.Cleft lip.
d.Asthma.
Answer: b

Explanation: muscular dystrophy is an x-linked recessive single gene defect. Cystic

fibrosis is also caused by single gene defect.

37. A normal 2 years old child:

a.Has an hemoglobin level of 15-20g/dl.
b.Has a predominance of neutrophils over lymphocytes in the peripheral blood.
c.Has 25% fetal hemoglobin.
d.Will have an absolute neutrophil count of greater than 1 x1 0*9 /l
e.Will have an MCV of greater than 90ft.
Answer: d

38. At 3 months of age; hemoglobin level is:

a.10-11g/dl
b.12-15g/dl
c.15-17g/dl
d.17-20g/dl
Answer: a
39. An increased risk of pneumococcal is associated with all, except:

a.relapsed nephritic syndrome

b.splenectomy
c.sickle cell disease
d.thalassemia
Answer : d

Explanation: nephritic syndrome is relapse is associated with a high risk of pneumococcal

infection.

40. Ideal duralion of realment of tubercles mentalis hellen of Palling

A. 06 months
B. 09 months
C 12 months
D. 15 months
E. 18 months
Answer: c

41. Vesicular eruptions are a feature of all the following conditions, except:
a.scabies
b.measles
c.eczema herpeticum
d.insect bite
Answer: b.
Explanation: measles has an erythematousmaculo-popular rash.

42. Which of the following is true about condylomata acuminate:

a. lesions may be seen on the face, flexures and trunk

b. are caused by the human pox virus
c. are easily transmissible by normal social contact
d. occur only following child sexual abuse
e. are usually asymptomatic
Answer: e.

Explanation: they are caused by human papilloma virus. The virus is only transmitted by
close contact, commonly sexual contact in adolescents.
43. All of the following neonatal skin conditions usually require no investigation or
treatment; except:
a. erythema toxicum.
b. neonatal acne.
c. naevus flammus.
d. milia.
e. bullous skin eruptions.
Answer: e

Explanation: neonatal bullous skin eruptions should be vigorously investigated and

treatment for suspected Staphylococcal infection started immediately.

44. Recognized risk factor for congenital dislocation of the hip include:
prolonged labour.
a. oligohydraminos.
b. male sex.
c. hypertonic cerebral palsy.
d. premature delivery.
Answer: b

Explanation: others are; female sex, breech position during pregnancy, family history and
neuromuscular disorders.

45. The birth weight usually regains by

a)6-7 day's
b)10-12 day's
c)8-10 day's
d) 7-8 day's
Answer: d

46. The umbilical cord contains

a)artery and one vein
b)one artery and two capillary
c) two veins and one artery
d) two arteries and one vein

Answer: d

47. Female neonate with oedema suggesteds

a)nephritic syndrome
b)Turner's syndrome
c)Congential syphilis
d)septicaemia
Answers: b

48. The term 'pretern' is used if the gestational age is less than
a)35 weeks
b)36 weeks
c)37 weeks
d) 38 weeks
Answer: c

49. Clinical features of preterm infant include the following except

a)hypertonia
b)Langugo
c)frog-like position
d)poorly developed genitalia
Answer: b

50. The metabolic disorders associated with preterm baby

a)Hypoglycemia
b)Hyponatraemia
c)Hypokalaemia
d)Hypomagnesaemia
Answer: a