PAEDIATRICS PAST PAPER SEQs 2016-19

(SEGREGATED ACCORDING TO TOS)

Nutrition/ Growth and Development/ IRMNCH & Nutrition (IMNCI):

1. A two year old girl weighing 9 kg is brought with triangular foamy whitish raised lesions on
both conjunctivae.
a. What is the most likely condition? (02)
b. What is the most likely cause of this condition? (02)
c. Name the drug and dose to treat this condition. (02) [Annual 2016]
2. a. Describe updated EPI schedule of vaccination. (04)
b. Enlist live attenuated vaccines in EPI schedule. (02) [Annual 2016]
Neonatology:
1. A 2-hours-old post-term neonate born at home, was admitted with history of delayed cry and
poor feeding. He is drowsy, grunting, tachypneic, with increased capillary refill time. ABGs
shows metabolic acidosis, while his CBC, blood glucose and other lab tests are normal.
a. What is the most likely diagnosis? (02)
b. Name 4 risk factors that can lead to this condition. (02)
c. What 4 long-term complications that can occur in this condition? (02) [Annual 2019]
2. A preterm born at 28 weeks of gestation is admitted in nursery. On 3rd day of life he develops
sudden pallor along with lethargy and fits. On examination he has tense, bulging anterior
fontanel.
a. What is most probable cause? (02)
b. How you can confirm diagnosis? (02)
c. Give two complications of this condition. (02) [Supplementary 2019]
3. a. Define Infant Mortality Rate, Neonatal Mortality rate and Under five mortality rate. (02)
b. Enlist 5 important causes of infant mortality in Pakistan. (02)
c. Enlist 5 important steps to reduce infant mortality rate in Pakistan. (02) [Annual 2016]
Infections:
1. A 9-month-old unvaccinated child with history of diarrhea, presented with sudden onset of
weakness of right lower legs. He is febrile, irritable with decreased tone, diminished reflexes
and power of 2/5 in right lower limb. Rest of neurological and systemic examination is
unremarkable.
a. What is the most likely diagnosis? (02)
b. What 2 diagnostic investigations will you carry out? (02)
c. Enumerate steps of management. (02) [Annual 2019]
2. A 7-year-old unvaccinated child presented with fever and hoarseness of voice for 4 days. On
examination, he looks toxic and has bull neck appearance, drooling of saliva, and greyish
white membrane covering tonsils and uvula.
a. What is the most likely diagnosis? (01)
b. Enumerate 3 steps of management. (03)
c. Name 2 complications of the disease. (02) [Annual 2019]
3. A 7 year unvaccinated boy brought with fever, sore throat and hoarseness of voice for few
days. He looks toxic and his throat examination show a greyish white adherent membrane on
the tonsils and pharynx.
a. What is the diagnosis? (02)
b. How will you manage this case? (02)
c. What complications can occur in this condition? (02) [Annual 2017]
Respiratory:
1. A 15-month-old child is seen with fever, coryza and seal like barking cough. He is alert &
active with audible stridor and clear chest on auscultation.
a. Name 2 important differential diagnosis. (02)
b. For the most likely diagnosis, what finding is expected on X-ray Neck? (02)
c. Enumerate 2 important steps of management in a severe case. (02) [Annual 2019]
2. A 9-year-old girl, known case of asthma presented to emergency with history of cough and
breathlessness. On examination, her respiratory rate 40/min and has bilateral ronchi audible all
over the chest.
a. Write down 4 emergency steps for her treatment. (02)
b. Name at least 2 precipitating factors for this condition. (02)
c. What will be your long-term treatment plan? (02) [Supplementary 2019]
3. A 15 months old child is seen with short history of fever, coryza and seal like barking cough.
He is alert & active with audible stridor and clear chest on auscultation.
a. What 3 important differential diagnosis will you consider in order of priority? (03)
b. For the most likely diagnosis, what finding is expected on X-ray Neck? (01)
c. Enumerate 2 important steps of management in a severe case? (02) [Annual 2018]
4. A 9-year-old girl, known case of asthma presented to emergency with history of cough and
breathlessness. On examination she is in respiratory distress with respiratory rate 40/min and
bilateral ronchi audible all over the chest.
a. Write down 4 emergency steps for her treatment. (02)
b. Name at least 4 precipitating factors for this condition. (02)
c. What will be your long term treatment plan? (02) [Annual 2018]
5. A 5-month-old child presents with history of cough, fever and respiratory distress. On
examination, he is lethargic, his respiratory rate is 65/min, heart rate 138/min, O2 saturation
87% in air, has subcostal recessions and bilateral crepitations on auscultation.
a. What is most likely diagnosis? (01)
b. What 2 investigations will you do? (02)
c. Enumerate 2 complications of the disease. (02)
d. Name at least one vaccine that can prevent this disease. (01) [Annual 2018]
6. A 5 year old presented with short history of cough and breathlessness. He has been visiting ER
off and on for similar complaints. On examination, he is in respiratory distress with RR >
40/min and bilateral ronchi audible all over the chest.
a. What 4 emergency step will you take for his treatment? (02)
b. Enumerate at least 4 precipitating factors for this condition. (02)
c. What will be your long term treatment plan? (02) [Annual 2017]
Neurology:
1. A 10-year-old child is admitted with high grade fever, generalized fits, altered sensorium and
neck rigidity. His CSF examination shows: TLC 850/cmm, polys – 75%, glucose 20 mg/dl,
proteins 110 mg/dl.
a. Name three causative organisms that can cause this illness. (02)
b. What 4 complications can occur in this condition? (02)
c. What steps can be taken to prevent this disease? (02) [Annual 2018]
2. A full term baby was born at home by normal vaginal delivery. She was limp and pale at birth,
did not have a spontaneous cry and required lot of stimulation by LHV. She was admitted to
nursery where she started having fits at 3 hours of life.
a. Name 2 possible causes of fits in such a child. (02)
b. What other organ systems can be involved? (02)
c. What is the prognosis of newborns suffering from this condition? (02) [Annual 2018]
3. A 10-year-old boy was admitted in emergency with history of fever and generalized fits. He is
drowsy with GCS of 10/15, no signs of meningism. CSF examination shows TLC 45/cmm,
60% lymphos, RBCs 300/cmm, sugar 72 mg/dl and proteins 89 mg/dl.
a. What is the most likely diagnosis? (01)
b. What is the most likely causative organism in this case? (02)
c. How will you manage this patient? (03) [Annual 2018]
4. A full term baby born by emergency Caesarean section because of fetal distress. She was limp
and pale at birth with Apgar score of 2 at 1 minute and 4 at 5 minutes. After resuscitation she
was transferred to nursery where she started having fits.
a. Name 2 possible causes of fits in such a child. (02)
b. What other organ systems can be involved? (02)
c. What is the prognosis of newborns suffering from this condition? (02) [Annual 2017]
5. A 2 years old unvaccinated child was admitted with high grade fever, generalized fits, altered
sensorium and neck rigidity.
a. Name three causative organisms that can cause this illness. (02)
 b. What 4 complications can occur in this condition? (04) [Annual 2017]
6. A 10 year old vaccinated boy presented with sudden onset of weakness of both legs associated
with tingling sensations.
a. What 4 important differential diagnoses will you consider? (02)
b. What 2 investigations will you carry out? (02)
c. Enumerate 4 steps of management. (02) [Annual 2017]
7. A five year old girl is suffering from intermittent fever, headache and occasional vomiting for
last 3 weeks. On the day of admission, she developed prolonged tonic clonic fits and became
unconscious. She is partially vaccinated. O/E her Pulse = 78/min, Respiratory rate = 26/min,
Temp = 101F, BP = 125/85 mmHg. She has features of left sided weakness of arm and leg
along with left sided internal squint.
a. Enlist 3 provisional diagnoses. (02)
b. Enumerate 5 relevant investigations. (02)
c. Give five steps of management. (02) [Annual 2016]
Cardiology:
1. A 2 year old boy presented with episodes of becoming dusky. On examination, there was
central cyanosis and clubbing. There was no pallor, oedema or respiratory distress. The heart
was normal sized with parasternal heave. A systolic thrill is present over left middle sternal
border. First heart sound was normal and only aortic component was audible in the second
heart sound. Liver was not enlarged.
a. What is the most likely diagnosis? (02)
b. How will you investigate? (02)
c. Elaborate the management steps? (02) [Supplementary 2019]
2. A 5 month-old-child is brought to emergency with episodes of excessive irritability and
increasing cyanosis. On examination she is cyanosed with an ejection systolic murmur along
sternal border. Chest X-ray shows boot shaped heart and oligemic lung fields.
a. What is most likely diagnosis? (01)
b. How will you confirm your diagnosis? Give details of expected findings. (02)
c. Enumerate 4 steps of management. (03) [Annual 2018]
3. A 12 months old child is brought with cyanosis since early infancy. She is cyanosed with an
ejection systolic murmur at left upper sternal border.
a. What is the most likely diagnosis? (02)
b. What investigations will you do to confirm diagnosis? (02)
c. Enlist treatment options in this case. (02) [Annual 2017]
4. A 10 year old girl presents with pain in her right knee. She had history of similar pain and
swelling in her left elbow 12 days back which resolved on its own. She had a past H/O sore
throat 3 weeks back. On examination, her heart rate is 120/min with pericardial rub.
a. What is most likely cause of this condition? (02)
b. What investigations are required to confirm diagnosis? (02)
c. If left untreated, what complications may develop? (02) [Annual 2016]
5. A 9 month old infant is brought to pediatric emergency for episode of bluish discoloration and
difficult breathing for last one hour. Parents have noted three similar attacks in last 6 months.
On examination, infant is found to have irritability, central cyanosis, with respiratory rate
60/min, along with ejection systolic murmur at left parasternal area.
a. What is most likely clinical diagnosis? (02)
b. Give steps of emergency treatment. (02)
c. Enlist 4 important complications. (02) [Annual 2016]
Haem-oncology:
1. A 6-year-old boy presented with painful swelling of right knee joint after a trivial injury. There
is history of prolonged bleeding from circumcision site and spontaneous bruises off and on. His
elder brother also has similar history.
a. What is the most likely diagnosis? (02)
b. What investigations will you do to confirm the diagnosis? (02)
c. What is the inheritance pattern of this condition? (01)
d. What is the definite long-term treatment? (01) [Annual 2019]
2. A seven years old girl presented with 20 days history of fever fatigue and leg pains. On
examination she is pale, patechiae on her abdomen and extremeties and hepatosplenomegaly.
 a. What is likely diagnosis? (02)
b. What are differential diagnoses? (02)
c. How will you confirm? (02) [Annual 2019]
3. A 12-year-old previously fit and healthy girl presents with 3 weeks history of fever, oral ulcers,
spontaneous bruises & poor appetite. She is markedly pale with multiple bruises but no
visceromegaly. Her complete blood counts show Hb 7.1 gram%, WBC 1.3 x109/L, platelet
count 23 x109/L.
a. What is the most likely diagnosis? (01)
b. What laboratory tests will you do to confirm the diagnosis? (02)
c. Name 3 causes that can lead to this condition. (03) [Annual 2018]
4. A 10 years old boy presented with recurrent episodes of hemarthrosis. There is history of
prolonged bleeding from circumcision site and spontaneous bruises off and on. His elder brother
also has similar history.
a. What is the diagnosis? (02)
b. What investigations will you do to confirm diagnosis? (02)
c. What is the inheritance pattern in this condition? (01)
d. What is the definite long term treatment? (01) [Annual 2017]
Nephrology:
1. A 5-year-old child was admitted with history of fever, sore throat and passing cola colored
urine for the last 2 days. He has periorbital puffiness and blood pressure of 130/90 mmHg.
a. What is the most likely diagnosis? (01)
b. What 2 specific investigations will you carry out? (02)
c. Name 3 steps in management of such cases. (03) [Annual 2019]
2. A 6-year-old child was brought with history of peri-orbital puffiness followed by generalized
body swelling for the last 1 week. He is well nourished and other than generalized edema,
examination is unremarkable.
a. What is most probable cause? (02)
b. How you can confirm diagnosis? (02)
c. Give two complications of this condition. (02) [Supplementary 2019]
3. A 6 year old boy is brought with headache, eye swelling and high coloured urine for last 5
days. On examination, multiple scars of healed boils are seen along with BP=120/90 mmHg.
a. What is the most likely diagnosis? (02)
b. Enlist 5 relevant investigations in order of priority. (02)
c. Enlist 4 important complications. (02) [Annual 2016]
Endocrinology:
1. A 28-day-old full term baby was seen with jaundice. He is on formula milk and reportedly
very slow to feed. He has light yellow colored urine and passes hard stools every 3/4 day. He
weighs 4.18 kg, has dry mottled & cold skin, coarse facial features, hoarse cry and an
umbilical hernia. Serum bilirubin is 11 mg/dl with 0.5 mg/dl conjugated fraction.
a. What is the most likely condition this baby is suffering from? (02)
b. What investigations will you carry out to confirm the diagnosis? (02)
c. What specific treatment does he need? (02) [Annual 2019]
2. A 9-year old girl was seen in emergency with history of weight loss, polydipsia and polyuria
for months and history of altered sensorium for 1 day. On examination, she is dehydrated with
fast breathing and normal systemic examination. Her blood glucose is 380 mg/dl, urine
analysis shows glucose +++, ketones +++ and blood gas show pH 7.18, pCO2 8, pO2 89,
HCO3 8, BE 14.
a. What is the most likely diagnosis? (02)
b. What 4 steps will you take to manage this condition? (02)
c. Enumerate 4 steps for long term management of the underlying disease. (02)
[Supplementary 2019]
3. A 28-day-old full term baby was seen with jaundice. He is on formula milk and reportedly
very slow to feed. He has light yellow colored urine and passes hard stools every 3/4 day. He
weighs 4.18 kg, has dry mottled & cold skin, coarse facial features, hoarse cry and an
umbilical hernia. Serum bilirubin is 11 mg/dl with 0.5 mg/dl conjugated fraction.
a. What is the most likely condition this baby is suffering from? (02)
b. What investigations will you carry out to confirm the diagnosis? (02)
 c. What specific treatment does he need? (02) [Supplementary 2019]
4. A 28-day-old full term baby was seen with history of jaundice since the age of 7 days. He is on
formula milk and reportedly very slow to feed. He has light yellow colored urine and passes
hard stools every 3/4 day. On examination he weighs 3.98 kg, has dry mottled & cold skin,
coarse facial features and an umbilical hernia. Serum bilirubin is 11 mg/dl with 0.5 mg/dl
conjugated fraction.
a. What is the most likely condition this baby is suffering from? (02)
b. What investigations will you carry out to confirm the diagnosis? (02)
c. What specific treatment does he need? (02) [Annual 2018]
5. A 4 year old girl was brought because of chronic hypertension & short stature. She has been
slow in attaining developmental milestones from early infancy but has a normal birth history.
She has coarse facial features and swelling in front of the neck.
a. What three tests will you perform to clinch diagnosis? Give brief interpretation. (02)
b. What is the definitive treatment for this condition and how long will you continue? (02)
c. How can this condition be prevented? (01)
d. What is the prognosis? (01) [Annual 2017]
6. A 2 month old baby is brought with noisy breathing, persistent jaundice and stooling every 5-
6th day. On examination, he has poor eye contact, head control, protruding tongue and
umbilical hernia.
a. What is the most likely diagnosis? (02)
b. Enlist 4 relevant investigations. (02)
c. Give steps of treatment plan. (02) [Annual 2016]
Gastro-hepatology:
1. A two years old failure to thrive child presents with complaints of increasing lethargy diffuse
abdominal pain and loose stools for last nine months, on examination he is pale with mild
abdominal distension.
a. What is diagnosis? (02)
b. How will you investigate? (02)
c. How will you treat? (02) [Annual 2019]
2. A 3 year old child has presented with history of diarrhea for the last 6 months. He passes 5-6
loose, foul smelling, bulky stools daily. His height is 81 cm and weight is 10 kg and has
distended abdomen.
a. What 2 differential diagnoses will you consider? (02)
b. What diagnostic investigations will you carry out of these 2 differentials? (02)
c. What will be the management plan for most likely diagnosis? (02) [Supplementary 2019]
3. A 4-years-old girl from flood hit area is brought to emergency with severe dehydration. Her
mother gives history of loose stools that are rice watery in color with fishy smell.
a. What is the most likely diagnosis? (02)
b. Name the investigation to confirm diagnosis. (02)
c. What antibiotics can be given to treat? (02) [Supplementary 2019]
4. A 7 year old vaccinated girl seen with history of fever, abdominal pain and vomiting. She is
mildly icteric and has tender hepatomegaly.
a. What is the most likely diagnosis? (02)
b. Name 4 common causative organisms. (02)
c. How can this disease be prevented? (02) [Annual 2017]
5. a. Enlist 5 important causes of Acute Watery Diarrhea in children. (02)
b. Give composition of Oral Dehydration Salt (ORS) recommended by WHO. (02)
c. How will you give Zinc therapy in diarrhea in children? (02) [Annual 2016]
6. A 5 years old boy is brought to you for parental worries for not gaining adequate height. He is
on adult family diet. He appears pale with distended abdomen and wasted buttocks. His weight
and height are < 3rd centile. On enquiry, parents inform that he passes 1-2 large bulky foul
stools per day.
a. What is the most likely diagnosis? (02)
b. Enlist relevant investigations. (02)
c. Give dietary plan. (02) [Annual 2016]
Genetics:
1. A 6-year-old girl is brought with concerns of short stature. On examination her height is 93
cm, weight is 17 kg, has webbing of neck and shield shape chest.
a. What is the most likely diagnosis? (02)
b. How will you confirm the diagnosis? (02)
c. Name 4 other clinical features present in this girl. (02) [Annual 2019]
2. A 6-year-old girl is brought with concerns of short stature. On examination, her height is 90
cm, weight is 12 kg, has webbing of neck and shield shape chest.
a. What is the most likely diagnosis? (02)
b. How will you confirm the diagnosis? (02)
c. Name 4 other clinical features present in these girls. (02) [Supplementary 2019]
3. A 3-month-old baby is brought with history of poor weight gain and shortness of breath while
feeding. On examination, he has tachycardia, tachypnea and a loud pansystolic murmur heard
along left lower sternal border. He has a protruding tongue, flat face and occiput, upward
slanting eyes, clinodactyly, and umbilical hernia.
a. What is the most likely cardiac lesion? (01)
b. What underlying condition do you think he is suffering from? (01)
c. Name 1 confirmatory test each for the cardiac lesion and for the underlying condition.
(02)
d. Name 4 complications that can be seen in this condition. (02) [Annual 2018]
4. A 2 year old girl born to 40 years old mother was brought with developmental delay. On
examination, she has protruding tongue, flat face and occiput, upward slanting eyes.
Clinodactyly and microcephaly.
a. What is the diagnosis? (01)
b. How will you confirm the diagnosis? (02)
c. Name 4 complications that can be seen in this condition. (03) [Annual 2017]
Psychiatry:

Miscellaneous:
1. A 6 year old girl presented in emergency with H/O insect bite. She is having difficulty in
breathing along with urticarial rash development on her body B.P 100/60 mmHg.
a. What is the diagnosis? (02)
b. Enumerate steps of management. (04) [Supplementary 2019]