Selection 2018

By Adl Alarabi
By Nena Alhaj
By Gihad Ahmed

1- A 36 month old child,presente to the OPD with FTT and SOB , cardiac catheterization showed the
following :
RA O2 saturation 74 pressure 3. , RV. O2 74 pr. 110/40. , PA. 74 , 25/10. LA and LV 96.

which one of the following is most likely diagnosis?

A. Truncus arteriousus.
B. TOF.
C. Tricuspid atresia.
D. pulmonary stenosis.
E. Esinemenger Syndrome

2- 11 yrs old boy present with joint Pain and swelling for the last eight weeks on examination he looks ill has
bilateral ankle knee and wrist swelling he finds it difficult to chew solids
What is the most Specific diagnostic test ?
A- ANA profile
B- anti Ds DNA
C - rehumatoid factor
D- anti CCP
E- C3/C4 profile

3- 12 yrs old female presented with fever, vomiting, abdominal and right shoulder pain/ 1 wk , examination
revealed pallor , jaundice and right hypochondrial tenderness, splenomegaly 8 cm bcm , no hepatomegaly , CBC
revealed HB 8 Retics 5% U/S multiple gallstones, she had history of neonatal jaundice on day one
What’s the most likely diagnosis?
A- SCA
B- thalassemia
C- sickle thalassemia
D- hereditary spherocytosis
E- Dobin Johnson syndrome

4- 25 wks gestation neonate born by emergency C/S following a pregnancy complicated by polyhydromnios he
was noted to extreme frothing at birth with evident respiratory distress
The diagnosis is best confirmed by?
A- direct laryngescopy
B- insert NG tube & do CXR
C- ABG analysis
D- fibroptic flexible bronchoscopy
E- chest U/S

5- 10years old child presented with history of fever and convulsion for 7days you suspected meningitis which
one of following is absolute contraindication of lp
a-Glasgow Coma score 11
b-recurrent focal seizure
c-left lower limb muscle power 2
d-twbcs 25,000
E-platlet count les than 40,000
6- In which one of the following children is hearing screening indicated?
A. A three yr old Child with acute secretory otitis media.
B. A well neonate who developed jundice on day 2.
C. An IUGR neonate with birth wt 1300grams.
D. A newborn whose brother had grommets
E- 36 weeks newborn with respiratory distress

7- You are asked to go to village with a recent epidemic of measles among children to assess and manage
situation..
what would be your appropriate action??
A. identify acutely ill pts and refer for hospital treatment.
B. Mass immunisation of all village children.
C. Isolate and treat cases, mass vaccination and healthy education.

D. Identify the cases and send a report to tertiary hospital.

E. Notification and management of acutely ill pt.

8- 5 yr old boy presents to the OPD with pallor and fatigability for 3 months. O/E He has normal growth
parameters but looks pale and afebrile.spleen is palpable 2cm below costal margin. liver span is normal. No
lymphadenopathy.Hb is 5.3 gm/dl ,plt 600000. WCC 4000 PBP. shows microcytic hypocromic anaemia.. In
trying to elucidate the cause, what investigation. will you order next?
A. serum ferritin and TIBC.
B. BM aspiration.
C.osmotic fragility test.
D. beta globin chain synthesis studies.
E. Hb electrophoresis

9- Vomiting three days he has been otherwise well with unremarkable past medical history On examination he
had GCS 13 , PR 150 , RR 50 , CRT 4 He had full fontanel and petechial non blanching rash on his lower limbs
What is the most likely diagnosis ?
A- Rocky Mountain spotted fever
B- streptococcal septicemia
C- Tuberculous Meningitis
D- Meningococcal septicemia
E- herpes encephalitis

10- You are counseling a primiparous Mother about supplementary feeding which one of the following
statements is correct?
A- Honey based feeds Should be started after 12 months of age
B- Egg is Recommended at the age of six months
C- puréed Vegetables not to be started before nine months of age
D- Meat and fish should be avoided in the first year
E- Cereal based meals are the best starters

11- Which of the following medications correctly match to the most expected side effect?
A-carbamezapine & Visual field defect
B- lamotrigene & Skin rash
C- valproate and cognitive impairment
D- phenobarbitone and Thrombocytopenia
E- Phenytoin and hepatotoxicity

12- A two month old exclusively breastfed neonate with birth wt of 3 Kg. present with excessive crying for hrs
over the previous 3 nights. He feed well and sleeps well through the day.He has no fever or vomiting. clinical
examination was unremarkable..wt 5 kg..
what's most likely diagnosis?
A. Gut malrotation.
B. GERD.
C. infantile colic.
D.increased intracranial pressure.
E. lactose intolerance

13- Five-year-old child with unilateral red painful eye for six hours , No History of trauma he is otherwise well ,
Which one of the following conditions should be excluded first ?
A- foreign body
B- glaucoma
C- bacterial conjunctivitis
D- Subcojunctival hemorrhage
E- allergic conjunctivitis

14- 10 years old boy from Gadarif state present with eight weeks history of fever and epistaxis On examination
he was febrile, pale and had Cervical lymphadenopathy Livered was 5 cm bcm and spleen Was palpable 12 cm
bcm CBC revealed pancytopenia what Is the most likely diagnosis?
A- ALL
B- Brucellosis
C- disseminated TB
D - visceral leishmaniasis
E- Hyper reactive malaria syndrome

15- A term neonate is found to be jaundiced At the age of 18 hours mother’s blood group is O +ve Hemoglobin
is 8 touch and serum bilirubin 24 direct coomb’s test positive What is the best management for this baby ?
A- Exchange transfusion
B- Top up Blood transfusion
C- Phototherapy
D- FFP Transfusion
E- IV immunoglobulins

16- 7 yr old child known to hace CRF is on haemodialysis for the last yr.. He presents to the ER with
fatigability, nausea and vomiting for 2 days. investigation show : urea 120 mg/dl creatinine 3.1 Na, 145moml/l
K 7 ECG showed tall tented T wave. What's the first urgent medication?

A. rectal ion exchange resins.

B. insulin and glucose.
C. IV calcium gluconate.
D. oral salbutamol.
E. Na bicarbonate

17- 20 Hour neonate Pro to ER as he was sleepy and Has Poor sucking, clinical examination revealed an afebrile
lethargic baby with no umbilical erythrema or discharge what is the initial investigation is likely to be most
helpful?
A- Urinalysis
B- CSF Analysis
C- Blood C/S
D- blood Glucose
E- CRP

18- You are suspecting an ASD and six years old. Which of the following features support the diagnosis?
A- Fix split second heart sound in the pulmonary area
B- Pulsus paradoxus
C- Finger clubbing
D- gallop rythm
E- pan-systolic Murmur in the left lower sternal border

19- Three years old child present with nasal discharge and snoring for three months He recently developed apnea
What is the most likely underlying cause?
A- Chronic sinusitis
B- Allergic rhinitis
C- enlarged adenoids
D- Severe asthma
E- Laryngeal web

20- Which one of the following Vitamins/ nutrients is correctly matched to its most common deficiency ?

A. cobalamin and Berberi.

B. riboflavin and chelosis.
C. niacin and megaloblastic anaemia.

D.folic acid and peripheral

neuropathy.
E. Vit D and acrodermatitis enteropathica

21- A fifteen yr old female has short stature and primary Amenorrhea. FSH 50(4-11) LH 60 (3-18) .
The expected abnormal investigation in this pt is?

A. pitutary tumor on MRI brain. B. absent uterus in U/S.

C. Karyotype OX 45.
D. low T4 and high FSH.
E. delayed bone age

22- nine month old infant. has macrocephaly, delayed speech and impaired motor skills. His CT scan of the
brain revealed hydrocephalus and cerebral calcification. What's the most likely
Underlying antenatal infection?
A. CMV.
B. rubella.
C. toxoplasmosis.
D. human immunodeficiency virus.
E. herpes infection

23- 12 yr old child with sickle cell disease presented with sever back and lower limbs pain. She has been
started on fluids, antibiotics and regular oral paracetamol ,codeine and NSAIDs with no relief.
The next best management option is to add:
A.morphine.
B. IV paracetamol.
C.change antibiotics.
D. packed cell transfusion.
E. Orthopedic consultation

24- 5 yr old boy presents with night blindness for the last one month. O/E he looks pale,stunted and has bitot
spots.
The most appropriate Vit A dosing??
A. 200000 IU once.
B. 200000 IU at day 1,2 and 14.
C.100000 IU for 1 wk.
D.200000 IU for 3 consecutive days
E- 50,000 IU for 4 wks

25- two yrs old child presents to the ER with generalized body swelling for the last 4 wks. Wt 8 kg, MUAC
11.5 cm. He has no other acute problems. The immediate appropriate action is to:

A. refer to acute emergency services.

B. refer him to targeted supplementation food program.
C. refer to inpatient services and start F 100.
D. Admit to hospital and start F 75.
E. insert an NG tube and start feeding with F 75 at home

26- A Three yr old child presents with FTT and refractory Anaemia. O/E He looks pale. Wt and Height are
less than third centile. repeat prescription Iron and metronidazole were used with no benefit.
which one of the following investigation confirm the suspected diagnosis ?

A. CBC and ESR.

B. tissue transglutaminase antibodies.
C. antigliadin peptide antibodies.
D. Endoscopy and small bowel biopsy
E- HLA DQ2 and DQ8 testing

27- 3 day old Neonate Is brought with difficulty breathing he is a product of full Term spontaneous vagina
delivery following and an uneventful pregnancy he had normal early neonatal course and examination he has a
central cyanosis with Normal peripheral pulses which of the following initial test with different pulmonary from
cardiac cause?
A- ABG
B- hyperoxia test
C- CXR
D- ECG
E- Echocardiography

28- 4 years old Present with ataxia and blurring of vision for six months on examination he has convergent
squint in his left eye as well as nystagmus he had one brief seizure on admission what is the best action to
confirm the suspected diagnosis ?
A- EEG
B- CT brain
C- MRI brain
D- Opthalmology assessment
E- LP

29- 18 month old otherwise well toddler Presents with fever conjunctivitis cough and maculopapular rash what is
the best management option ?
A- Paracetamol and cough syrup
B- IV benzyl Penicillin and topical calamine lotion
C- Paracetamol and single-dose vitamin A supplement
D- Vitamin A full therapeutic dose three doses
E- Erythromycin and ibuprofen

30- Which one of the following neonatal growth parameters considered normal?
a. birth wt of 2 kg.
b. head circumference 31 cm.
c.length. 60 cm.
d. an upper to lower segment ratio. 1:1.1.
e. The Wt on day 10 equals the birth wt

31- 11 Years old child present with polyuria & polydipsia your in output is 6ML/KG/ HR
Urine osmolality is 250 urine specific gravity is 1005 , upon Overnight fast early-morning urine osmolality was
found to be 700 what is the most likely diagnosis?
A- psychogenic polydipsia
B-sickle-cell nephropathy
C- renal tubular acidosis
D- Central Diabetes insipidus
E- nephrogenic Diabetes insipidus

32- 13 year old female presented with three month history of joined pain & Swelling and difficulty of breathing
on examination she looks ill pulse rate 120 respiratory rate 40 temperature 37 no lymphadenopathy CBC
revealed HB 8 WBCs 4000 PLT 100,000 ESR 100 CXR left sided pleural effusion
What is the underlying diagnosis
A- AML
B- TB
C- post pneumonic effusion
D- SLE
E- NHL

33- Which of the following is the right order of pubertal stages in a normal female?
A- growth spurt , breast bud ,Pubic hair, menarche
B- breast bud , menarche , growth spurt , Pubic hair
C- Pubic hair , growth spurt , breast bud, menarche
D- breast bud, menarche , Pubic hair , growth spurt
E- growth spurt , breast bud , pubic hair, menarche

34- 5 years Girl with down syndrome present with lethargy and excessive sleepiness over the last three months
her clinical examination is unremarkable and she has normal CBC
Which of the following investigation will be most helpful initially ?
A- blood culture
B- CRP
C- T3/TSH
D- urine culture
E- bone marrow

35- Two weeks old neonate is being evaluated for abnormal genitalia the baby has no palpable gonads with big
phallus and single arifice
Serum electrolytes Na 120 k 7 The most likely diagnosis is
A- Hypopituitarism
B- 11 beta hydroxylase deficiency
C- Complete androgen insensitivity syndrome
D- 21 hydroxylase deficiency
E- Adrenal hypoplasia

36- Seven day old neonate is admitted With poor feeding a recurrent seizures
On examination he is Jaundiced with hepatomegaly 5 cm bcm , U/G Is positive for reducing Substances his
blood glucose is 30. The most likely diagnosis is
A- Maple syrup urine disease
B-Galactosemia
C-Persistent hyperinsulinemia hypoglycemia of infancy
D-Ketotic hypoglycemia of infancy
E- Phenylketonuria

37- nine month old child had chronic constipation and abdominal distention..you suspect Hirschsprung disease.

What's best diagnostic investigation? a. barium anema.

b.upper GI endoscopy.
c.plain abdominal X ray.
d. abdominal CT.
e. rectal biopsy

38- The height velocity (cm/yr) in a six yrs old male is expected to be:
A.12. b.10.
c. 6. d.4.
e. 2

39- One yr old infant present with loss of Wt ,vomiting and limping for one month. O\E Had periorbital
ecchymosis and hepatomegaly.. CBC revealed pancytopenia. What's most likely diagnosis?
A. wilm 's tumor.
B. renal cell carcinoma. C. NHL.
D. Neuroblastoma. C. rhabdomyosarcoma

40- Which one of these worm infestation correctly paired to its therapeutic. treatment?
A. E. vermcularise and metronidazole. B. S. hematobium and pentostam.
C. A.duodenale. and mebendazole. D. Ascarid. and praziquantel.
E. E. histolytica. and Albendazole

41- Which of the following disorders is considered always abnormal. warranting urgent assessment?
A. stealing.
B. lying.
C. Oppositional behavior. D. Temper tantrum. E. School refusal
42- You are in call at the. PICU. An ABG belonging to a ventilated with meningeococcal septicaemia show:
PH 7.25 PCO2 60 mmhg p O2 100 mmhg HCO3 28. BE 7.
This pt has?
A. normal ABD. B. Metabolic Alkalosis. C. Respirator Acidosis.
D. Metabolic. Acidosis. E. Respirator Alkalosis

43- A six yrs old child was diagnosed as having ADHD. Which one of the following medications will you
recommended? A. Risperidone. B. SSRIs.
C. Methylphenidate D. halopridol.
E. promethazine

44- Which one the following condition is trinucleotide repeat expansion. disorders?
A. Prader willi Syndrome. B. Angleman Syndrome.
C. Noonan Syndrome. D. Ataxia Telengiectasia. E. Friedreich
ataxia

45- Which one of the following is not indicated in school health programm ?
A.physical Education. B. Nutritional services. C. Health Education.
D. counselling and psychological services. E.
Secondary level medical care

46- Five yrs old child has fulminant Hepatic failure.

which one of the following drugs would you particularly avoid ? A. Diazepam.
B.Mannitol C.Albumin.
D. Vitamin K. E. broad spectrum Antibiotics

47- 18 months old boy with the genue valgus deformity X-ray suggestive of rickets Wt 13 , Ca 8 , phosphate 1.5 ,
ALP 2000 and PTH 90
What is the most likely cause of rickets?
A- RTA
B- hypophosh rickets
C- Vitamin D deficiency
D- Chronic renal failure
E- Ca deficiency

48- Asphyxiated newborn Resuscitated Intubation and positive pressure ventilation baby is bradycardic HR 56
Immediate Next step ?
A- endotrachial adrenaline
B- iv dobutamine
C- NS bolus infusion
D- Cardiac compressions
E- high Frequency ventilation

49- 4 years presented with asthma on salbutamol inhaler he has nocturnal cough Disturbs four nights per week
and missing school activities due to difficulty in breathing What treatment you will add to improve his asthma
control?
A- aminophylline tabs
B- montelokast tabs
C- Oral prednisolone tabs
D- inhaled beclomethasone
E- Long acting beta agonists ( terbutaline)
50- Four weeks old girl from Khartoum state Presented with goiter Is being evaluated for neonatal jaundice TFT
Results TSH 100 , free T4 6 The most likely diagnosis is
A- Thyroid dysgenesis
B- Iodine deficiency
C- Hypopituitarism
D- dyshormonogensis
E-hashimoto’s thyroiditis

51- Six years old child was previously well presented with inability to close her right eye and mouth deviation to
the left The cranial nerve lesion is:
A- Left upper motor neuron Facial palsy
B- Left lower motor neuron Facial palsy
C- Right lower motor neuron Facial palsy
D- Left trigeminal nerve palsy
E- Right oculomotor nerve palsy

52- A boy with recent sore throat and now complains of right knee And left wrist pain and swelling which one of
the following Will support rheumatic fever suspicion?
A- erythrema nodosum
B- Prolonged to QT interval
C- Neutropenia
D- Pericardial rub
E- Cardiomegaly

53- 18 months developmental assessment is needed If not able to :

A- Build three cube tower
B- Draw horizontal line
C- Follow two steps instruction
D- Speak in 2 words sentence
E- Indicate his toilet needs

54- Otherwise well normal 7 day neonate bilateral purulent eye discharge c/s chlamydia ttt?
A- Gentamicin eyedrops
B- Topramycin / dexamethasone eyedrops
C- Oral erythromycin
D- Iv ampicillin
E- Topical fusidin ointment

55- According to 2014 Ministry of health data which of the following epidemiological Parameter related To
maternal and child health in Sudan is correct?
A- The under-five mortality rate is 100/1000 live birth
B- the maternal mortality rate is 73/100,000 live birth
C- the infant mortality rate is 55/1000 live birth
D- the neonatal mortality rate is 60/1000 live birth
E- the prenatal mortality rate is 137/1000 live birth

56- Which one of the following statements is true regarding evidence based medicine (EBM)?
A- Meta-analysis and systemic review yield weak recommendations
B- EBM He is used to design policies that apply to population
C- EBM Is unnecessary at a level of primary healthcare
D- level two Evidence is obtained through at least one properly designed randomized control trial
E- no need to appraise the Meta-analysis studies
57- Four year old child presented with acute renal failure urea 300 creatinine 4 , K 5.5 , Na 130
Which one of the following favours are prerenal cause?
A- urine osmolality < 500
B- urine Na < 20
C- urine revealing no haematuria and Proteinuria
D- BUN/ Serum CR ratio < 20
E- urine specific gravity 1.030

58- 5 years Old female presented with a skin bruising following bumps To her leg clinical examination was
otherwise unremarkable Her CBC revealed HB 9 WBCs 6000 PLT 23 PT and PTT were both normal
What is the most likely provisional diagnosis?
A- Idiopathic thrombocytopenia Purpura
B- ALL
C- AML
D- TTP
E- Aplastic anaemia

59- When year old infant present with excoriated Crusted itchy maculopapular rash Involving the Balmes cancels
and scalp for the last four weeks his six year old brother developed a similar rash with interdigital burrows There
was a transient response to Topical steroids
A- scabies
B- dermatitis herpetiformis
C- eczema
D- papular urticaria
E- chickenpox

60- Six years old child presents with fever joint pain and difficulty breathing on examination he looks ill sweaty
clammy peripheries PR 120 , RR 50 , JVP was raised And pericardial Rub was heard He had a pansystolic
murmur radiating to the axilla liver was 4 cm bcm
Which one of the following Therapeutic modalities is best indicated to the management of this child?
A- frusemide, Penicillin and aspirin
B- spironolactone , Penicillin and digoxin
C- propranolol, Penicillin and aspirin
D- digoxin, propranolol and aspirin
E- ACEI, aspirin and ceftrixone

61- 11 year old child Was Admitted with purpuric rash involving the buttocks And thighs for 2 days Was
associated-with self-limiting knee joint arthritis urinalysis Revealed proteinuria and haematuria vital signs were
otherwise stable on day two of admission he had a sudden collapse with pallor GCS of 3
What complication was occurred?
A- Intestinal perforation
B- uremic encephalopathy
C- herpetic encephalitis
D- SLE vasculitis
E- meningococcal meningitis

62- Six year old child present with hoarseness of voice low-grade fever and stridor O/E a Grayish was noted
overlying the tonsils
A- Ceftriaxone and dexamethasone
B- Penicillin and Igs
C- phenoxymethyl Penicillin and vaccination
D- Vancomycin and antitoxin
E- Penicillin and antitoxin

63- Nine months has diarrhoea for seven days and his mother was Replacing his losses with formula milk as
refused water and soft drinks on arrival to the hospital was thirsty and irritable with a normal skin turgor PR 100,
RR 40 , Temp 37, CRT 3 , serum Na 155 , osmolality 300
What does the best appropriate flui to be used?
A- dextrose 10% with 0.45 NS
B- dextrose 5% with NS
C- Ringer lactate
D- dextrose 5% with 0.45 NS
E- ORS

64- 4 yrs old child present with Generalized body swelling for 4 wks O/E , Bp 120/80 (>99th centile) , urinalysis
revealed +++ protein
+++ RBCs
Creatinine 1.5 , ASO titre 400
What next investigation will you order?
A- serum C3 level
B- serum C4 level
C- ANA titre
D- renal U/S scan
E- renal biopsy

65- 41 wks Gestation neonate was brought by spontaneous vaginal delivery with meconium stained liquor he was
noted to be hypotonic and bradycardic
What is the first step in resuscitation of this infant?
A- bag and mask ventilation
B- Oxygen through nasal canula
C- Chest compressions
D- Epinephrine via endotracheal tube
E- endotracheal suction and intubation

66- Two years old child present to the Er with 2 days history of fever and vomiting on examination he looks ill
Pale lethargic HB 4 WBCs 2000 BFFM positive
the most appropriate anti malaria drug is
A- IV quinine
B- oral Coartam
C- IM quinine
D- IM artemether
E- oral artemisinin Based combined therapy (ACTs)

67- Three yrs old child presented to ER in status epilepticus. He didn't recieve in any medication in his way to
hospital. following ABC stabilization of this pt..what's will treatment of choice?
A- rectal diazepam.
B- IV phenytoin. C- buccal midazolam.
D- oral phenobarbitone. E- anaethesia with thiopental

68- Nine months old is expected to do :

A- Stand alone for few minutes
B- Manage sitting with straight back
C- Rise up to standing position without help
D- Point with an index finger To a subject of interest
E- Respond to his own name

69- 10 months old infant present with recurrent generalized afebrile seizure, His antenatal postnatal
developmental history was unremarkable His cousin is being treated for the Epilepsy clinical examination was
unremarkable EEG Revealed Generalized seizure activity
Which of the following is used to prevent RHD according to RHD control program ?
a- adaption of primary prevent based on positive throat swab to treat bacterial pharyngitis
b- a patient with carditis should give benzathine penicillins 3week for life
C-patient without carditis should give give benzathine penicillin every 3week for 5years
D-treat acute pharyngitis 1,000000if pencilling 6hourly for 5days
E-treat acute pharyngiti by third generation cephalosporin for 5days

70- Which one of the following vaccines has shown a decrease in mortality in under five year ?
A- Chickenpox
B- Hepatitis B
C- Rotavirus
D – pneumovax
E- Mumps

71- 36 month old female presented to the outpatient department because of speech Regression she was noted to
be hyperactive poor social skills and stereotyped hand movements examination reveals Microcephaly
What is the most appropriate action?
A- Repeat MRI brain scan
B- do genetic test
C- Refer to a child psychologist
D- Request an EEG
E – perform hearing test

72- 15 years old child resent with anorexia weight loss and fatiguability for six months On examination she looks
ill temperature 37.8 deeply Jaundiced investigation serum bilirubin 10 mg/dl Direct bilirubin 5 mg/dl ALT 1000
IU AST 800 IU ANA and ASMA were positive
What is the most likely diagnosis?
A- SLE
B- Autoimmune hepatitis
C- wilson dx
D- Chronic persistent hepatitis B
E- alpha anti trypsin deficiency

73- 3day boy presented dehydrated and loss of 20%of his wt o/E out come of v.D complicated by
polyhydrominus Na122, cl 79 ,k 2,2 urea 31 creatnine 3,1 normal mg and elevated renin and aldesterone
Diagnosis
A .Gitelman syndrome
B .bartter syndrome
C .CAH
D . Nephrogenic DI
E- pyloric stenosis

74-three years old child brought to the ER with sudden onset of vomiting ,fever and seziure,as he was playing un
-witnessed in his grand father room O/E he notably he has dry skin despite tempratire 39C,PR150/min,regular
and pupil were markely dilated .which substance is most likely has been ingested?
A-salicyclate
B -Bnzodiazpein
C-organophosphate
D-Anticholinergic
E-paracetmol

75-three month old infant has fever ,vomiting,abdominal distension ,urine analysis reveales nitrete+,pus
cell++,hematuria,which one of the following medication is best uesd for emprical treatment pending culture
result?
A-co-amoxiclav
B-Trimethoprime
C-Benzypenicillin
D-cefotaxime
E-ciproflaxin

76-four-years old boy present with headache for three months,on assement ,his blood pressure was
170/110mmhg,further test revealed hight renin and aldestron ,what is most likely diagnose?
A-pheochromyctoma
B-congential adrenal hyperplasia
C-cushing disese
D-increase intracranial pressure
E-renal artery stenosis

77-six week old infant present with poor feeding seziure ,irritability ,O/E he has tense fontanelle ,and he had
oozing from puncture site,Pt and PTT are both prolonged,bleeding time was normal,what is underlying diagnosis?
A-dissimineted intravascular coagulation
B-late onset vitamin k deficiency
C-von willberand disese
D-factor vii deficiency
E-hemophilia A

78-six years old child present with delay walking,normal congotion and speech,O/E he has pes cavus,toe walking
and steeping gaite,what is more likely diagnoses?
A-spastic diplegia cerebral palsy
B-congential myopthy
C-muscular dystrophy
D-heredity spastic paraparesis
E-heredity sensory and motor neurophthy

79-in a sample of pleural aspirate,which one of biochemical finding indicate exudate rhather than transudate?
A-hight LDH
B-normal cholestrol
C-low lymphocyte count
D-low protein
E-hight glucose

80-while you transfusing pateint with AML,he suddenly collapse,what is your immediate action?
A-intubate and ventilate
B- start i.v adrenaline
C-start i.v dexamethazone
D-stop transfusion
E-start neublizer sulbatomol

81-full term baby was noted to have omphalocele,clincal examination other wise un remarkable,what is your
immediate managment?
A-intubation and ventilation
B-start intravenous antibiotic
C-fix umbical catheter
D-start nasogastic tube feed
E-cover with non adhesive dressing

82-which one of the following vaccine should be with held in HIV positive childe?
A-varicella
B-pnemococcal
C-rota virus
D-pertussies
E-Hemophlius influza

83-Anine years old child has chronic kidney disese which one of the following is most likely cause of his
refractory anemia despite adequate nutrition and iron and folic,vitamin suuplement?
A-occult GIT blood loss
B-Erythropoietein deficeincy
C-Toxic effect of uremia on bome marrow
D-sever parathyroid disese
E-Achlorohydria

84- As comparing formula milk , breast milk contain more

a.water
b.protein
c.fat
d.salt
e.vitamin D

85-Developmetal assesmen is neededfor 18month toddler if he is not able to?

A-draw horizontal line
B-indicate his toilet needing
C-build three cube tower
D-following two step instruction
E-spaeke in two word sentence

86- Which one of the following statement is true regarding pharmacokinetics of drug is true ?
a-when the drug is given intravenously it’s bioavailability 80%
b-the half life of drug is the time it’s take to lose its full pharmakologic activity
C-therapeutic index is the amount of drug that causes therapeutic effect that cause toxicity
D-enzym inducer that drug increased activity of an adjuvant drug
E-enzym inhibitor that drug decrease activity of an adjuvant drug

87- An 8year old child diagnosed as having mump his mother ask you on the same day of the appearance of
swelling about the duration (in days )of keeping away from school .thebest answer is :
a-3
b-5
C-7
D-10
E-14

88- One wk old neonate presents acutely with respiratory distress. O/E. RR 60 Temp. 37 , O2 saturation 92% in
air. ECG revealed narrow complex tachycardia. Which one of the following is best
drug. to administer?? A. Amiodarone. B.
Flecanide. C. Adenosine. D. Digoxin

89- Which of the following is true regarding the helping babies breath program (HBB)?
a-you should apply bag mask ventilation only if the apgar score less than 5 at 2 minuets
b-drying ,warming ,cleaning the airway and stimulating breathing should be done at the first minut of life
c-if the baby need bag and mask ventilation he should be referred immediately to nearby hospital
d-you can stimulate breathing by putting the child in the left lateral position and apply 5back slap
e-the program is targeting the health of baby in first 24 hour of life

90- Three years old child present with repeated episode of streak of Fresh blood in his stool On examination he
looks pale but normal weight and hight for age, No other symptoms were noted , CBC Reveals microcytic
hypochromic anaemia which one of the following is most likely the diagnosis?
A- Ulcerative colitis
B- Hook worm infection
C- Anal fissure
D- Chron disease
E- Rectal polyp

91- You are about to prescribe drug for your patient on reviewing the literature which of the following will
provide the best evidence?
A- Systemic meta-analysis
B- Case control study
C- prospective observational study
D- retrospective observational study
E- cohort study

92- You are asked to asses the growth of 9 yrs old child, his hight is -4 SD , upper to Lower segment ratio is one
, CBC, urea, creatinine are all normal, bone age 6 years he gained 2 cm in hight in the last 6 months
What’s the most likely diagnosis?
A- malnutrition
B- growth hormone deficiency
C- constitutional growth delay
D- achondroplasia
E- hypothyroidism

93- And otherwise well seven month old infant present with paroxysmal cough & vomiting , He was afebrile But
had subconjunctival hemorrhage, WBCs 11,000 , lymphocytes 90 %, neutrophils 10%, PT, PTT, INT were all
normal
What is the most likely causative organism?
A- bordetella pertusis
B- EBV
C- mycoplasma pneumoniae
D- RSV
E- coxsackie virus
94- the fallowing true about teething:
A/ in most of children the first eruption decidious teeth at 12 month
B/if no eruptions in 9 month indicated hypocalcemia
C/ teething is known cause of diarrhea
D/ the frist permanent teeth to erupt are the molars
E/ the first deciduous teeth to erupt are the upper incisors

95- Five months old infant present to ER with fever and shortness of breath he had an Upper respiratory tract
infection Five days prior to presentation on examination RR 70, PR 170, Normal breath and heart sound No
added sounds liver span is 8 cm
CXR Cardiothoracic ratio 65%
Which one of the following is the most likely diagnosis?
A- Viral myocarditis
B- viral pericarditis
C- bronchio- pneumonia
D- Pericardial effusion
E- Dilated cardiomyopathy

96- For years old child presented abdominal pain bloody diarrhoea And tenesmus Stool analysis revealed pus
cells ++, RBCs +++
Which one of the following drugs is the best choice?
A- cefixime
B- metronidazole
C- ORS
D- Erythromycin
E- tetracycline

97- Two year old toddler Accidentally ingested hair dye ( PPD) Six hours prior to admission on arrival to ER he
had a PR 150 , RR 45, Swollen tongue and facial angioneurotic edema
What is the most urgent initial live saving intervention ?
A- Haemodialysis
B- Peritoneal dialysis
C- Gastric lavage
D- activated charcoal administration
E- tracheostomy

98- Six year old girl develop a Major anaphylactic reaction following a peanut Ingestion few months ago
Which one of the following drugs should be regularly prescribed from now onwards?
A- Epinephrine pen
B- Oral prednisolone
C- Regular antihistamine
D- Inhaled salbutamol
E- Inhaled beclomethasone

99- 12 years a boy evaluated for obesity BMI more than 95th Hight 90th centile Normal IQ acanthosis nigricans
& striae With no acne BP on 90th centile Diagnosis ?
A- Nutritional obesity
B- Adrenal ca
C- pituitary adenoma
D- burdet-biedel syndrome
E- Prader-Willi syndrome
100- 10 months old infant present with recurrent generalized afebrile seizure, His antenatal postnatal
developmental history was unremarkable His cousin is being treated for the Epilepsy clinical examination was
unremarkable EEG Revealed Generalized seizure activity
The best anti epileptic treat ment of choice?
A- Phenobarbitone
B- Carbmezapine
C- Vigabtrin
D- phenytoin

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