ONE best answer for each question of
the Options from a) to e)
1- A 7-year-old with asthma presents with a 2-month
history of increased cough and shortness of breath on
exertion. He has been using his salbutamol inhaler
several times most days. His current regular medication
is 400 µg beclomethasone per day. What is the next step
in treatment?
a- Long-acting β2-agonist T
b- Leukotriene-receptor antagonist
c- Slow-release theophylline
d- Increase inhaled steroids
e- Use salbutamol regularly three time per day
2- A 3 year- old girl developed acute sore throat,
drooling of saliva, a high grade fever and difficulty of
breathing over 4 hours. She appeared toxic, unable to
speak and cyanosed. A soft inspiratory sound was heard
and there was suprasternal recession. What is the most
appropriate management?
a- Nebulised adrenaihne
b- Intravenous antibiotics
c- Warm moist air inhalation
d- Reassurance and follow-up
e- Intubation under controlled conditions T
3- A 3 year old boy presented with sudden onset of
cough and breathlessness, while he was playing.
Examination revealed diminished air entry and wheeze
on the right side. What is the most likely diagnosis?
a- Inhaled foreign body. T
b- Severe pneumonia.
c- Bronchial asthma.
d- Bronchiolitis.
e- Croup
4- An 8 year old boy has a long-standing history of a
productive cough, exercise intolerance and wheeze. He
is clubbed and has scattered crepitations on
auscultation. What is the most likely diagnosis?
a- Pulmonary tuberculosis.
b- Cystic fibrosis.
c- Bronchial asthma.
d- Pulmonary haemosidrosis.
e- Bronchiectasis. T
5- The commonest cause of pneumonia in the 2 month
to 6 month age group is:
a- Group A Streptococcus
b- Haemophilus influenzae
c- Mycoplasma pneumoniae
d- Respiratory syncytial virus T
e- Rhinovirus
6-A 2 year old boy presents with pallor, Hb 7 g/dl, MCV
50. He is treated with oral iron for three months, but
there was no response. A film shows Heinz bodies,
target cells, and reticulocytes. What is the most likely
diagnosis?
a- Marrow failure
b- Iron deficiency
c- Autoimmune hemolytic anemia
d- Alpha Thalassaemia minor T
e- G6PD
7-A 15-year-old student presented with fever, severe
headache and decreased level of consciousness. O/E
temperature of 39°C and a widespread petechial rash.
His Glasgow Coma Scale is 5. Investigations: Hb:10.5
g/dl , WCC:16.3 × 109 ,platelets:18 × 109/l,
Prothrombin time : 26 s (12–17) , Activated Partial
Thromboplastin Time :53 s (24–38), Thrombin Time :29
s (14–22).What is the most likely cause of his
coagulation problem?
a- Immune thrombocytopenic purpura
b- Disseminated intravascular coagulation T
c- Haemophilia
d- Blood loss
e- Acute myeloid leukaemia
8-A 16 year-old boy presents with sudden onset left
sided weakness of 24 hours duration. He has sickle cell
anemia, and has required admissions in the past for
management of chest crises. O/E he has left sided
weakness, with brisk reflexes and upgoing
plantar .What is the most appropriate management?
a- Hydroxyurea
b- Simple blood transfusion
c- I.V fluid
d- Thrombolytic therapy
e- Exchange transfusion T
9-A 6 year old child presents with fatigue. O/E ill, pale,
weight is 18 kg, height is 102 cm (<3rd percentile), and
BP is 135/90 mm Hg (above 95th
percentile).Investigation: HB 7.5 g/dL ,MCV 82
Fl .Reticulocyte count 0.4%, Blood urea 94 mg/dL
Serum creatinine 12.1 mg/dL. The stool is negative for
occult blood. Of the following, the most likely
explanation for this patient’s anemia is:
a- Chronic gastrointestinal blood loss
b- Erythropoietin deficiency T
c- Folic acid deficiency
d- Hemolysis
e- Iron deficiency
10-The most likely late complication of regular blood
transfusion in patients with B-Thalassemia is:
a- Anaphylactic shock.
b- Hyperpyrexia.
c- Dilated cardiomyopathy. T
d- Hemolysis.
e- Malaria transmission.
11- 4years old boy presented to emergency room
because he ingest large amount of kerosene one hour
ago. On examination he is distressed. What is the urgent
management of this boy?
a- Avoid to induce vomiting
b- Intravenous steroids
c- Intravenous antibiotics
d- Oxygen therapy T
e- Chest XR
12-A doctor was concerned about 20-hours old boy who
went blue and apnoeic when he was fed by a bottle. He
seemed better when he was crying. He was born at term
by forceps delivery for fetal distress and meconium-
stained liquor. He required oropharyngeal suction and
facial oxygen. What is the most likely diagnosis?
a- Meconium aspiration syndrome
b- Tetralogy of Fallot
c- Tracheo-oesophageal fistula
d- Choanal atresia T
e- Congenital diaphragmatic hernia
13- A newborn baby is born with spina bifida. The most
relevant question to ask to mother is:
a- Mother blood group.
b- Blood relationship between father and mother.
c- Ferrous supplementation during pregnancy.
d- Folate supplementation during pregnancy. T
e- Exposure to radiation during pregnancy.
14-A baby is referred to hospital at 3 weeks of age by
his midwife with prolonged jaundice. He has had pale
stools and yellow urine; his parents have noted that his
stool has got paler over the past week. What is the most
likely diagnosis:
a- ABO incompatibility.
b- Rhesus haemolytic disease of the newborn
c- Congenital syphilis
d- Extrahepatic biliary atresia T
e- Hereditary spherocytosis
15-A term baby presents at 36 hours of age with a
history of poor feeding. On examination he has a pulse
of 200 and a respiratory rate of 80, with peripheral
pulses being difficult to feel. A 4-cm liver edge is
palpable. What is the most likely diagnosis:
a- Gastro-oesophageal reflux
b- Patent ductus arteriosus
c- H-type tracheoesophageal fistula
d- Heart failure T
e- Neonatal sepsis
16-You are asked to attend the delivery of a term baby,
as the midwife noted meconium-stained liquor. The
baby is delivered. There is no respiratory effort and the
baby is blue. The first step to do is :
a- Start cardiac compressions
b- Listen for breath sounds
c- Clear the upper airway under direct vision T
d- Give five inflation breaths
e- Stimulate the baby to encourage respiration
17-A newborn baby present with bleeding from
umbilical cord and diagnosed as hemorrhagic disease of
the newborn. The most appropriate investigation to
reveal the diagnosis is:
a- PT measurement. T
b- PTT measurement.
c- Clotting time measurement.
d- Platelet count measurement.
e- Bleeding time measurement.
18-A 6 year old boy presents with cola-colored urine.
His mother reports that he had a sore throat 10 days
ago. On physical examination, his blood pressure is
136/88 mm Hg, and he has mild swelling of the face and
lower extremities. Of the following, the most likely
laboratory finding is:
a- Low C3 complement value T
b- Normal urinalysis results
c- Positive antineutrophil cytoplasmic antibody titer
d- Positive antinuclear antibody titer
e- Positive urine culture
19-A 2 year old boy is admitted with a history of bloody
diarrhea, abdominal pain and puffiness around his eyes.
He is found to be slightly jaundiced. His urea is
96mg/dL and Creatinine 7mg/dL. What is the most
likely diagnosis?
a- Haemolytic uraemic syndrome T
b- Viral hepatitis
c- Pyelonephritis
d- Bacillary dysentry
e- Wilm's tumour
20-A 7year-old boy presented with an 18 month history
of poor growth and poor appetite. O\E he was pale,
BP130/80.Investigation show:
HB: 4.5g/dl, K: 6.5mmol/l, Ca: 5.5mg/dl ,
Phosphate:3.19[high].
What is most likely diagnosis?
a- Chronic renal failure .T
b- Rickets
c- Hyperparathyroidism.
d- Celiac disease.
e- Aplastic anemia
21-A 4 year old boy was referred to an orthopedic clinic
because of knock knee. The following blood result was
obtained: Serum phosphate: decreased, Calcium:
normal, Parathyroid hormone: increased .What is most
likely diagnosis?
a- Chronic renal failure
b- Rickets
c- Hyperparathyroidism T
d- Hypoparathyroidism
e- Skeletal dysplesia
22- A female infant is diagnosed as failure to thrive,
mother had skin rash and fever during pregnancy,
which of the following investigations is the most likely to
reveal the diagnosis:
a- Echocardiography.
b- TORCH screening. T
c- Abdominal ultrasonography.
d- Stool examination.
e- Jejunal biobsy.
23- A 3year old child is diagnosed as PEM , parents are
dead and his uncle is not sure about his age. Which one
of the following is most suitable for assessment of child
growth: 6-13
a- Welcome classification.
b- Waterloo classification. T
c- Gomes classification.
d- Mid upper arm circumference.
e- Skin fold thickness.
24- A 12 year old girl has history of recurrent bulky
stools and abdominal pain since 3 years of age. She has
moderate pallor and her weight and height are below
the 3rd percentile. Which of the following is the most
appropriate investigation to make a specific diagnosis?
a- Small intestinal biopsy T
b- Barium studies
c- 24-hrs fecal fat estimation
d- Urinary d-xylose test
25-Which of the following statements correctly apply to
a baby of 2 months who is considered to be 10%
clinically dehydrated with gastroenteritis:
a- He may have blood and mucus in his stools .T
b- He will have a full fontanelle .
c- He will have a low packed cell volume.
d- Urea level will be normal.
e- Should not be given milk orally for at least 48
hours.
26-An infant is suspected of having gastro-oesophageal
reflux. Which one of the following statements relating to
this diagnosis is correct?
a- He is unlikely to present with vomiting.
b- Vomitus will be bile stained
c- He is likely to require drug treatment.
d- He may have apnoeic episodes T
e- A barium swallow is the investigation of choice.
27-A 2 months old baby presented with diarrhea and
vomiting .O\E there is cataract and hepatomegally.
Stool is positive for reducing substance. What is the
most likely diagnosis?
a- Galactosemia T
b- Fructosemia
c- TORSH infection
d- Coeliac disease
e- Rota virus infection
28-A 10 month old girl presents with abdominal pain
and diarrhea, which has recently had pink staining. She
was well until 12 hours ago, when she had loose stools
and episodes of crying and holding her legs . O\E HR
110/ min, RR 20/min, temperature 37.4°C and is well
perfused. Her abdomen is slightly distended and she has
a curved firm mass 10 cm long extending from the right
iliac fossa towards the hepatic flexure. What is the most
likely diagnosis?
a- Wilm's tumor
b- Constipation
c- Intussusception T
d- Right renal vein thrombosis
e- Neuroblastoma
29-A 16 year old girl presented with fever, headache
and photophobia.
Cerebrospinal fluid examination: Protein: 0.8 g/l (0.15-
0.45) Glucose: 75mg/dl (59-79). White cell count 60 per
ml (<5) .What is the most likely diagnosis?
a- Bacterial meningitis
b- Cryptococcal meningitis
c- Tuberculosis meningitis
d- Viral encephalitis T
e- Viral meningitis
30- A 15 year old girl presents with a two week history
of headache and double vision. She had also noticed an
episode where her vision dimmed after sneezing. , she
had bilateral optic disc swelling and partial left sixth
cranial nerve palsy. What is the most likely diagnosis?
a- Benign intracranial hypertension.
b- Migraine.
c- Multiple sclerosis.
d- Pituitary tumour . T
e- Sagittal vein thrombosis
31-A6 month old baby with microcephaly is brought to
the accident and emergency by his mother who gives a
history of the baby flexing forwards whilst sat in her
highchair. EEG shows hypsarrythmias .What is the
most likely diagnosis?
a- Breathholding spells
b- Tics.
c- Absence seizers
d- Infantile spasm. T
e- Juvenile myoclonic epilepsy
32- A 6year old boy with a previous history of
convulsions presents with tingling sensations in his
right thumb which precedes rapid jerking of his right
arm. Of the following, the most appropriate
investigation is:
a- EEG's
b- Lumbar puncture
c- MRI scan T
d- No investigation required
e- Skull x-ray
33-A 10 girl presented with rapidly progressive lower
limbs weakness. O\E there was flaccid paralysis in the
lower limbs, knee& ankle reflexes were absent. Normal
upper limbs. Her weakness continues to worsen after
admission to hospital. Which of the following should be
used to monitor her?
a- Arterial blood gases
b- Chest expansion size
c- Forced expiratory volume 1/forced vital capacity
(FEV1/FVC)ratio
d- Vital capacity T
e- Peak expiratory flow rate (PEFR)
34-A 16-year-old boy presents with a, painful swollen
right knee joint. No history of recent injury. On
examination the boy has injected conjunctivae .Of the
following, further evaluation most likely will reveal:
a- Alopecia areata
b- Gottron papules
c- Kayser-Fleischer rings
d- Malar rash
e- Urethritis T
35-A 4 year old boy present with 2 weeks history of
fever, joint pain and intermittent rash. O/E he has
cervical lymphadenopathy, awarm effusion in the left
knee joint and macular pink rash over his trunk. What
is most likely diagnosis?
a- Rheumatic fever
b- Measles
c- Juvenile rheumatoid arthritis
d- Kawasaki disease T
e- Polyarteritis nodosa
36-A 4 days old newborn delivered by C\S. Her mother
tells you that she is difficult to awaken, pale, and
breathing much more rapidly. O\E she has cool
extremities, weak pulses, and lethargy. Of the following,
the most likely cause is:
a- Aortic coarctation T
b- Atrioventricular septal defect
c- Tetralogy of Fallot
d- Transposition of the great arteries
e- Ventricular septal defect
37-A 12 year old girl presents with a swollen, painful,
erythematous right knee joint. She tells you that her left
knee felt and looked similar yesterday, but now feels
normal. O/E temperature 38.7°C, HR 125 beats/min,
RR 24 breaths/min, pansystolic murmur at the apex
radiated to the axilla. Of the following, the best plan of
management is:
a- Antibiotic therapy with doxycycline
b- Anti-inflammatory therapy with aspirin T
c- Aspiration of the right knee joint
d- Heat, elevation, and splinting of the right knee
e- Immunotherapy with azathioprine
38-A 6 month-old male is brought to hospital for
evaluation of cyanosis .O/E the child is alert ,cyanotic
and tachypneic .Normal first heart sound and ejection
systolic murmur at the left upper sternal border. He
was immediately placed in a knee-chest position .This
maneuver will improve patient's condition by which of
the following mechanism ?
a- Incsease systemic venous return
b- Decrease pulmnary blood flow
c- Increase systemic vasular resistance T
d- Increase respiratory drive
e- Increase right to left shunting
39-A 6 month old boy known case of Fallot,s tetralogy
you record a hematocrit of 67% .Of the following, this
child’s polycythemia puts him at increased risk for:
a- Brain abscess
b- Bacteremia
c- Cerebrovascular accident T
d- Congestive heart failure
e- Necrotizing enterocolitis
40-A 4 month- old baby is not gaining weight since birth
and he appears to become breathless on feeding. O\E
RR: 52\min, PR 130\min, sweaty , liver is enlarged ,
pansystolic murmur at the left lower sternal edge. What
is the most likely diagnosis?
a- Patent ductus arteriosus
b- b- Ventricular septal defect T
c- Atrial septal defect
d- Severe anemia
e- Hypoplastic left heart syndrome
41-Which one of the following is a characteristic feature
of hereditary spherocytosis?
a- It is transmitted as an autosomal recessive trait
b- It does not present during the neonatal period
c- In a 5-year-old child the spleen is likely to be
enlarged T
d- The Coombes test is usually positive
e- The majority of those affected will die before
reaching adult life
42-Which condition is inherited as an X-linked
dominant trait?
a- Haemophilia A
b- Achondroplasia
c- Colour blindness
d- Marfan syndrome
e- Familial hypophosphatemic rickets T
43-Of the following, the most likely diagnosis for a tall
slender girl
With joint laxity, dislocated lenses and mitral valve
prolaps is:
a- Acromegaly
b- Ehlers Danlos
c- Marfan syndrome T
d- Myotonic Dystrophy
e- Homocystinuria
44-Which of the following is more specific for the
diagnosis of rickets?
a- Normal serum calcium
b- Normal serum phosphate
c- High alkaline phosphatase
d- High parathyroid hormone
e- Low 25-hydroxycholycalciferol T
45- A 2 year old girl presents with generalized fatigue,
low-grade fever, and abdominal mass .O/E a nontender
mass deep in the right periumbilical area and purple
discoloration of the eyelids. Of the following, the MOST
likely diagnosis :
a- Hepatoblastoma
b- Hirschsprung disease
c- Intussusception
d- Neuroblastoma T
e- Wilms tumor
46-A baby has good head control with no head lag when
pulled from supine to sitting.
a- 2months
b- 4months T
c- 6months
d- 8 months
e- 10 month
47-Which of the following developmental milestones
would be expected of a normal 6-month-old child?
a- Shows strong hand preference
b- Sits without support
c- Uses a pincer grasp
d- Looks for a hidden toy
e- Takes everything to his/her mouth T
48-A12 years old known diabetic brought to the
casualty with abdominal pain, vomiting and drowsiness
diagnosed as DKA, the first option of management is:
a- Correction of electrolyte
b- Fluid therapy T
c- Insulin therapy
d- Antibiotics
e- Follow up by serial blood glucose measurement.
49-A 13 day old infant who was noted to have an
umbilical hernia and has very dry skin presents with
jaundice. She is a floppy. Her bilirubin is elevated and
mainly unconjugated. The most likely diagnosis is:
a- Physiological jaundice
b- Biliary atresia
c- Hypothyroidism T
d- Rhesus incompatibility
e- Galactosaemia
50-A baby is born on the 50th centile for height and
weight. By the age of 2, her length has fallen to the 2nd
centile and weight remains on the 50th. She has a
rounded face with small hands and feet. Of the
following, the most likely diagnosis is:
a- Achondroplasia
b- Constitutional delay
c- Familial short stature
d- Growth hormone deficiency T
e- Psychosocial poor growth
51-A 5 year old boy complains of an itchy rash over his
arms. His brother and sister have similar symptoms.
What is your diagnosis?
a- Candidiasis
b- Tinea pedis
c- Scabies T
d- Ringworm
e- Lichen planus
52-A 2 year old girl present to casualty with a 24-hour
history of being febrile and miserable and has
developed a rapidly spreading non-blanching rash. She
has cool peripheries and is drowsy. The most useful
investigation to do immediately is?
a- Blood culture
b- Full blood count
c- Lumber puncture T
d- Brain CT scan
e- Brain MRI
53-Which of the following is commonest route of
transmission of HIV in children:
a- Breast feeding
b- Vaginal delivery T
c- Transplacental
d- Blood transfusion
e- Sexual abuse
54- A 2 month old girl presents with severe cough. Like
her older brother, she developed a coryzal illness 10
days ago . However, since this morning she has been
coughing severely. Each episode can last up to 20-30
seconds. She goes red in the face, then vomits and seems
exhausted. O/E she looks well, afebrile and no signs of
respiratory distress. What is the most likely diagnosis?
a- Allergic rhinitis
b- Asthma
c- Gastroesophageal reflux
d- Inhaled foreign body
e- Pertussis T
55-A mother brings her 18-month-old son to the
emergency department because of a rash that developed
today. He has had a runny nose and temperature 40°C
for the last 3 days, but the fever resolved yesterday. His
immunizations are up to date.O/E he looks well,
afebrile, and has diffuse 2- to 3-mm erythematous
macules and papules over his trunk. Of the following,
the most likely cause of the rash is:
a- Adenovirus
b- Coxsackievirus
c- Epstein-Barr virus
d- Human herpesvirus 6 (Roseola infantum)T
e- Parvovirus B19
56-You have been treating a 2-year-old girl for
pneumococcal meningitis for the past 5 days. Of the
following, the most likely complication of her disease is:
a- Brain abscess
b- Cerebral infarct
c- Cranial nerve palsy
d- Hearing impairment T
e- Sagittal sinus thrombosis
57-A six week old baby is confirmed to have cataracts,
cardiac abnormalities, thrombocytopenia. Of the
following, the most likely diagnosis is:
a- Cytomegalovirus
b- Rubella T
c- Syphilis
d- Toxoplasmosis
e- Varicella
58- A father brought his 1-month old daughter because
his wife was recently diagnosed as pulmonary
tuberculosis. The child had negative skin test and chest
radiograph, and he wants to know if there is anything
that should be done for his child. Of the following, the
most appropriate treatment is to:
a- Administer the bacille Calmette-Guérin vaccine
b- Begin isoniazid therapy T
c- Provide reassurance
d- Remove the child from home for 3 months
e- Repeat the skin test in 1 month
59-A 12 years old child with huge spleen was suspected
to have hyperreactive malarial splenomegally
syndrome, the definitive diagnosis is achieved by:
a- ICT for malaria.
b- Blood film for malaria.
c- Liver biopsy. T
d- Serology for Ig M
e- Bone marrow aspiration.
60-A 10-year-old boy has fever, sore throat and malaise
with bilaterally enlarged tonsils, tonsil exudates, diffuse
cervical lymphadenopathy and splenomegaly. There is
lymphocytosis with atypical lymphocytes seen. What is
the most likely orgaqnism?
a- Coxsackie virus
b- Epstein–Barr virus (EBV) T
c- Haemophilias influenzae type B
d- Streptococcus pneumoniae
e- Measles virus
