An infant born at 27 weeks GA had tachypnea, grunting, chest retractions, and

central cyanosis. Secretory product of which type of cell is likely deficient?

Alveolar macrophages
Type I pneumocytes
Clara cells
Type II pneumocytes

2. Sixteen-year-old boy complains of blood in urine and reduced urinary output

of 3 days. He also has headaches, fast breathing, and weakness. Examination
revealed pedal oedema, multiple healed and unhealed hyperpigmented
patches on the lower limbs and blood pressure of 132/94mmHg. Which of the
following is the first step in treating this patient?
Bed rest
Fluid restriction
IV Albumin
IV Antibiotics

3.The CSF of a 3-year-old child who presented with complaints of progressive

lower limb weakness shows Protein – 156mg/dl; Glucose – 72mg/dl; WBC -
<5/HPF, Culture yielded no growth. She is fully conscious and reports a history
of catarrh 2 weeks earlier. What is her most likely diagnosis?
Meningoencephalitis
Disseminated encephalomyelitis
Gullian Barre syndrome
Transverse myelitis
4. A 3-year-old boy presents with a history of recurrent generalized body
swelling
And a day history of peri-umbilical abdominal pain. His pulses are small
volume and blood pressure 75/30mmHg. What is the most likely complication
in this child?
Hypovolaemia
Pulmonary thrombosis
Sepsis
Spontaneous peritonitis

5. About the pathogenesis of myocarditis, which is the most correct about the
staging?
In stage one, there is immune dysregulation
In stage two there is direct viral invasion of the myocardium
In stage three, there is autoantibodies formation
In stage one, there is direct viral invasion of the myocardium

6. About the investigation of childhood heart failure, what is the best option?
Electrocardiogram is quite useful
Brain natriuretic factor assay is diagnostic
Echocardiogram is diagnostic
Chest radiograph shows pulmonary oligaemia

7. A newborn baby is referred to the Neurology clinic with a cystic swelling at

his lower back associated with lower limb weakness. During counselling, the
mother was told that nutritional factor may be associated with the condition.
What nutritional deficiency is associated with the condition?
Vitamin B6
Folate
Calcium
Selenium

8. A 2-year-old healthy boy suddenly started coughing violently while eating.

He was rushed to the CHER. Examination revealed severe dyspnoea and an
abnormal respiratory sound. Which of the following is a delayed complication
of the primary diagnosis?
Obstructive emphysema
Hemoptysis
Pneumothorax
Tracheobronchial rupture

9. A 2-year-old boy presents to the CHER with complaints of fever and

vomiting. Further history revealed he has poor urinary stream and dribbling of
urine since birth. His weight is 10kg, height 79cm, and blood pressure
120/80mmHg. What relevant investigation will reveal the secondary condition
of this child?
Electrolyte Urea and creatinine
Complete blood count
Micturating cystourethrogram
Urine Microscopy, Culture and Sensitivity
10. Which of the following conditions will cause grade 4 finger clubbing in a 2-
year-old?
Persistent truncus arteriosus
Hepatitis A infection
Recurrent bronchopneumonia
Massive pericardial effusion

11. A 6-year-old girl living with her step-mother presented with burns. Physical
examination revealed multiple wounds and scars at different stages of healing.
What diagnostic investigation is indicated?
Blood culture
Skeletal survey
Abdominal ultrasound
Chest CT scan

12. Which of the following is unlikely in the pathogenesis of diabetic

ketoacidosis?
Absolute deficiency of circulating insulin.
Relative deficiency of circulating insulin.
Decrease in glucagon level.
Increase in catecholamine level.

13. A 12-month-old boy was brought to CHER with fever, cough and difficulty
with breathing of 2-day duration. Physical examination reveals pulse rate
120bpm, bradypnea Android SPO2 of 85%. Which is the next appropriate next
step?
Intranasal oxygen
Bag and mask ventilation
Mechanical ventilation
Chest compression

14. A 2800g infant is born at 38 weeks gestation. The Apgar scores were 7 and
9 at 1st and 5th min respectively. While examining the infant, the doctor noted
that she had a loud pan-systolic murmur at the left lower sternal border. What
is the most likely cause of this murmur?
Ventricular septal defect
Tetralogy of fallot
Patent ductus arteriosus
Coarctation of the aorta

15. An 8-year-old patient presented in CHER with cough, dyspnoea and

tachypnoea. Chest examination revealed left-sided tracheal deviation and
stony dullness of the right-hemithorax. The oxygen saturation is 90%. What
urgent therapeutic intervention is required in this patient?
Bag-Valve-Mask ventilation
Percutaneous thoracocentesis
Nasotracheal intubation
Medical thoracoscopy

16. A female newborn delivered via SVD at 32 weeks gestation. Mother was in
labour for 10 hours but drained foul-smelling liquor for about 2 days. The baby
cried immediately after birth but developed respiratory distress at the 8 th hour
of life and later developed apnea. Which of the following is the most likely
diagnosis?
Respiratory distress syndrome
Bronchopulmonary dysplasia
Congenital pneumonia
Apnea of prematurity

17. Which of the following is NOT a characteristic of secondary peptic ulcers?

They are usually of an acute onset
Presents with multiple lesions
Higher occurrence in the stomach than the duodenum
Greater affectation of the cardia region

18. An 8-month-old girl presented to the clinic with complaints of noisy

breathing noticed at the 3th week of life. Noisy breathing is worse with
feeding, crying and change in position. Nil history of cough or fever. On
examination, patient was not ill looking but had inspiratory stridor with sternal
in-drawing. What is the most likely functional derangement?
Acquired lower airway congestion
Congenital extra-thoracic upper airway obstruction
Congenital intra-thoracic upper airway obstruction
Acquired extra thoracic upper airway obstruction
19. In which of the following contacts of meningitis is prophylaxis indicated?
Staphylococcus aureus
Escherichia Coli
Neiserria meningitides
Ebstein Barr

20. Tunde is a 15-year-old and has just been diagnosed with tuberculosis. What
is the most appropriate approach in managing his 3-year-old brother who is
coughing?
Screen for tuberculosis and if negative commenced on isoniazid daily for 6
months
Commence on anti-tuberculous therapy since he is also coughing
Screen for tuberculosis and if found to be negative, no further action is
necessary
Commence on isoniazid daily for 6 months since his cough is mild

21. A 3-hour-old female newborn is observed to have ambiguous genitalia, and

she is diagnosed with classic salt-wasting congenital adrenal hyperplasia.
Which of the following laboratory parameter will be seen in this child?
a. Elevated aldosterone
b. Elevated Testosterone
c. Elevated 17-OH-progesterone
d. Elevated renin

22. Two minutes into the transfusion of a 5-year-old boy, the child developed
fever, chills and was screaming in pain. Which of the following is a
complication of this procedure?
Bone pain crisis
Acute kidney injury
Disseminated intravascular coagulopathy
Hypertension

23. A 20-month-old boy presented to CHER with complaints of fever,

headache and projectile vomiting all of 3 days duration. On examination,
patient was noted to have a right hemi paresis. Cranial CT scan showed a ring-
enhancing lesion on the left cerebral hemisphere. Which of the following is
NOT a risk factor for the development of the condition?
Immunodeficiency
Infective endocarditis
Hand and foot syndrome
Penetrating head injury

24. A 7-year-old boy was rushed in with a swollen thigh. He developed the
complaint after being hit while playing football. Swelling was tender with
erythema of the overlying skin. His maternal uncle has recurrent swollen joints.
What is the primary deficiency in this patient?
Christmas factor
Prothrombin
Fibrinogen
Von-Willebrand factor

25. Seven-year-old girl presented with fever and passage of dark coloured
urine of 2 days duration. There is previous episode of dark urine. Examination
revealed pallor, jaundice and pyrexia, temperature of 39◦C.What is the primary
diagnosis of this patient?
Severe malaria
Severe sepsis
Glucose-6-phosphate dehydrogenase deficiency
Warm autoimmune haemolytic anaemia

26. A newborn was delivered to an unbooked mother after three days of

labour at home. At birth, baby’s skin was wrinkled and discoloured; has
overgrown discoloured nails and has difficulty in breathing. Examination
revealed cyanosis and a barrel shaped chest? Which is NOT a complication of
the condition?
Pneumo-mediastinum
Pneumonia
Pneumo-peritoneum
Pneumothorax

27. In the management of severe acute malnutrition, which of these activities

commences before the rehabilitation phase?
Sensory stimulation
Administration of iron preparation
Catch up growth
Preparation for follow up

28. A 5-year-old boy presented in CHER with fever and cough of 4 weeks.
Physical examinations revealed nuchal rigidity and GCS of 8/12. SPO2 was 95%
and blood glucose was 100mg/dl. What is the most likely aetiologic organism?
Neiserria meningitidis
Candida albican
Mycobacterium tuberculosis
Mycoplasma pneumonia

29. A 3-year-old girl presents with a history of fever, and vomiting of 5days. 2
days after the onset of her illness she developed dark colored urine and
markedly reduced urinary output. Which of the following electrolyte
abnormality will be seen in this child?
Hypercalcinaemia
Hyperkalaemia
Hyperphosphataemia
Hypernatriemia

30. Which of the following organisms is the commonest cause of nosocomial

urinary tract infection?
a. Staphylococcus saprophyticus
b. Proteus mirabilis
c. Pseudomonas species
d. Staphylococcus epidermidis

31. A preterm brought in on the 4th day of life with fever and poor suck. His
diagnosis was neonatal sepsis. His cerebrospinal fluid microscopy yielded
growth of Gram-positive rods. What is the most likely offending organism in
this preterm?
Escherichia coli
Listeria monocytogenes
Group A beta-haemolytic Streptococcus
Klebsiella pneumoniae

32. A 9-year-old girl presented in CHER with fever, abdominal pain and
constipation of 5-day duration. There is consumption of food from vendors.
Her pulse rate was 64bpm and temperature 390 centigrade. What skin lesion is
likely to be present in this patient?
Roth spots
Koplik’s spots
Café-au-lait spots
Rose spots

33. A 10-year-old girl sustained burns injury covering about 45% of his body
surface area. She also has been anuric for 12hours. Which of the following
reasons is responsible for AKI in this child?
a. Disruption of glomerular auto-regulation
b. Peripheral vasodilation
c. Reduced cardiac output
d. Wide spread capillary leakiness

34. A 5-week-old boy has failed to gain weight adequately since birth despite
adequate exclusive breastfeeding. Examination revealed jaundice,
hepatosplenomegaly, ascites and variceal bleeding. What is the most likely
complication in this child?
Chronic hepatitis
Acute hepatitis
Liver cirrhosis
Hepatoblastoma

35. 1-year-old boy was brought in with grossly distended abdomen of 2

months duration. Examination revealed pyrexia, wasting and pallor. Abdominal
ultrasound showed a left-sided mass with downward displacement of the left
kidney. What is the most likely diagnosis?
Neuroblastoma
Hepatoblastoma
Nephroblastoma
Non-Hodgkin’s lymphoma

36. A 5-year-old male was bitten by snake. He subsequently developed

ecchymotic patches, shock and respiratory distress. Which of the following
laboratory parameters best describes the diagnosis?
Thrombasthenia
Decreased anti-thrombin III
Elevated D-Dimer
Elevated factor VIII

37. In a 3-year-old who presents with occipital lymph nodes and a

maculopapular rash. Which of the following considerations are correct about
the diagnosis of measles?
Disappearance of the rash within 3 days
The presence of occipital lymph nodes
Prior history of fever, cough, conjunctivitis
The presence of strawberry tongue
38. A 4-year-old was rushed into the children Emergency Room very weak. He
has been passing watery stools for more than 7 times per day for 3 days. His
mother mixed ORS for him with 1 sachet water. Which of the following
electrolyte derangement will be seen in this child?
Hypocalcaemia
Hyperkalaemia
Hypomagnesaemia
Hypernatriemia

39. An 8-year-old boy presented in CHER with a gradual increasing weakness of

the lower limbs of 4 days duration. He had a history of recent diarrhoea.
Physical examination revealed power of grade 2 in the lower limb and grade 4
in upper limb; other findings were normal. What is the most likely causative
organism of the diarrhoea?
Entamoeba histolytica
Candida albican
Rota virus
Campylobacter jejuni

40. A 12-hour-old neonate has just been delivered at 28 weeks gestation. The
Paediatrician on call is preparing to give surfactant therapy. Which of these
goals is he hoping to achieve first in this baby?
Promote lung maturity
Reduce lung compliance
Increase work of breathing
Increase respiratory rate

41. On examination of a 14-year-old girl who is being managed for acute

rheumatic fever, you discovered a high pitched, grade 3/6 pan-systolic murmur
loudest at the right upper sternal border. What pathology is most likely
responsible for this murmur?
Mitral insufficiency
Aortic insufficiency
Tricuspid insufficiency
Pulmonary insufficiency

42. Three-year-old boy was noticed to have a swelling on the left side of his
abdomen of 6 weeks duration. Mother noticed the swelling while bathing the
child. Examination was essentially normal. Which organ is most commonly
involved in metastatic disease?
Liver
Lungs
Brain
Heart

43. A 5-day-old newborn was rushed into the emergency room with stretching
of the body and fever. He developed difficulty sucking on the 3rd day of life.
Mother delivered at home and had no antenatal care during pregnancy. Which
of the following portrays a good prognosis of the primary condition?
Onset time of 48 hours
Incubation period of 24 hours
Provoked spasms
Hyperpyrexia

44. Which of this caloric content of food substances is INCORRECT?

1g of protein yields 4 kcal of energy
1g of short chain fatty acids yields 5.3kcal of energy
1g of medium chain fatty acid yields 8.3kcal of energy
1g of long chain fatty acid yields 9kcal of energy

45. A 3-year-old presents with vomiting and dysentery. The presence of which
of the following statements is correct?
Trophozoites containing red cells in the vomitus is diagnostic
Trophozoites containing red cells in the stool is diagnostic
Cysts containing red cells in the vomitus is diagnostic
Cysts containing red cells in the stool is diagnostic

46. In a child with short stature, which of the following suggest delayed bone
age?
Phenylketonuria
Congenital hypothyroidism
Congenital adrenal hyperplasia
Familial short stature

47. A 2-year-old girl was brought in with grossly distended abdomen of 2

months duration. Examination revealed pyrexia, wasting and pallor. Abdominal
ultrasound showed a left-sided mass with downward displacement of the left
kidney. Which vital sign should be closely monitored in this patient?
Pulse rate
Respiratory rate
Temperature
Blood pressure

48. A 6-month-old boy was brought to the clinic with complaints of noisy
breathing noticed at the 4th week of life. Noisy breathing is worse with feeding,
crying and change in position. Nil history of cough or fever. On examination,
patient was playful with inspiratory stridor. What is the most likely diagnosis?
Croup
Laryngomalacia
Epiglottitis
Foreign body aspiration

49. There has been an outbreak of amoebiasis in a camp for internally

displaced persons. Which of the following is a risk factor?
Drinking unpasteurized milk
Buying food from a food vendor
Eating warmed up food from the night before
Eating unripe fruits

50. A 3-day-old term female neonate delivered at home and exclusively

breastfed was brought to emergency room due to bleeding from the umbilical
cord. Which of the following clotting factors is most likely deficient?
Fibrinogen
Prothrombin
Tissue factor
Christmas factor

51. A 15-year-old girl presents with history of body swelling, body paleness,
poor appetite, weight loss, fever and malaise of 3mths. Additional history was
abdominal pain and reduced urine output of 2week. Urine examination
revealed haematuria and proteinuria. What is the most likely diagnosis?
Liver cirrhosis
Chronic kidney disease
Non-Hodgkin’s lymphoma
Acute lymphoblastic leukaemia

52. Which of the following parameter is unlikely in a child with growth

hormone deficiency?
Height less than 3rd percentile
Pre-pubertal growth velocity of 5cm per year.
Low IGF-1 and IGFBP-3 levels for age.
Resumption of growth following growth hormone therapy.

53. A 12-year-old sickle cell anaemia girl was brought to the hospital because
of difficulty with breathing, fever and chest pain of 2 days duration. Five days
earlier she complained of pains in her ribs. Her SP02 was 92%. Which is the
most likely pathophysiologic mechanism responsible for her illness?
Vaso-occlusion
Fat embolism
Hypoventilation
Sequestration

54. A 4-month-old has failed to gain weight adequately since birth despite
adequate exclusive breastfeeding. She has been jaundiced for 3 months with
pale stools and dark urine. The best formula for the infant should contain high
amounts of?
Polyunsaturated fatty acid
Polysaturated fatty acid
Medium-chain triglycerides
Short-chain triglycerides