Indonesian Child Health Collegium

NATIONAL KNOWLEDGE BASED EVALUATION

OF INDONESIAN PEDIATRIC RESIDENT
December, 12, 2013

FOR EACH OF THE FOLLOWING MULTIPLE CHOICE QUESTIONS,

SELECT THE ONE - MOST APPROPRIATE ANSWER

1. For each of the following diseases choose the most specific mucuous or cutaneous
manifestation of Measles?:
A. Koplik Spots
B. Erythema Multiforme
C. Erythema nodosum
D. Dermatitis Herpetiformis
E. Vitiligo

2. For each of the following children who present with an itch, select the most appropriate
diagnosis from the list of option: A child complains of an itchy rash over his arms. His
brother and sister have similar symptoms.
A. Enterobiasis vermicularis
B. Chlamydia
C. Candidiasis
D. Tinea pedis
E. Scabies

3. For each description below choose the single most likely viral infection from the list of
options: Caused by a gram negative pleomorphic bacillus
A. Measles
B. Rubella
C. Mumps
D. Pertussis
E. Hepatitis A

4. Select the most appropriate pathogen that would account for the following presentations: A
5 year old boy presents with painful red swellings of his shins. Examination of his throat
reveals an exudative tonsillitis.
A. Group B Streptococcus
B. Haemophilus Influenza
C. Mycoplasma pneumonia
D. Respiratory syncytial virus
E. Staphylococcus aureus

5. For each description below choose the single most likely viral infection from the list of
option: May result in a Keratoconjuctivitis.
 A. Rubella
B. Chicken Pox
C. Herpes Simplex
D. Glandular fever
E. Polio myelitis

6. For each of the following children who present with an itch, select the most appropriate
diagnosis from the list of options: A child has itching in the vulva region mostly at night.
A. Enterobiasis vermicularis
B. Tinea pedis
C. Pityriasis rosea
D. Lichen sclerosis
E. Napkin dermatitis

7. For each description below choose the single most likely viral infection from the list of
options: Is caused by a paramyxovirus.
A. Measles
B. Rubella
C. Mumps
D. Pertussis
E. Hepatitis A

8. For each presentation of infectious disease choose the single most likelydiagnosis from the
list of options: Associated with a maculo-papular rash that typically starts on face and
extends to rest of body
A. Chicken Pox
B. Measles
C. Pertussis
D. Rubella
E. Tuberculosis

9. For this patient with breathlessness, select the most likely diagnosis: A three-year-old boy
who presents with worsening cough and breathlessness of 3 weeks’ duration. His mother
was an intravenous drug abuser. He has always been prone to infections. When he was 2
years old he had chicken pox for 4 weeks. On examination, he has an emaciated
appearance, his weight is below the 0.4th centile, he has a temperature of 37.6°C and he
has generalized crepitations on auscultation of his chest. A blood count shows severe
lymphopenia.
A. Asthma
B. Hyperventilation
C. Cystic Fibrosis
D. Pneumocystis carinii
E. Ventricular septal defect

10. Select the most appropriate emergency treatment for the following children: A term baby
is born in poor condition. Apgar scores 3 at 1 minute and 5 at 5 minutes. CPR is
commenced. At 10 minutes he remains bradycardic.
A. Adenosine
B. Adrenaline
C. Atropine
 D. DC shock
E. Dobutamine

11. The infant was born after a difficult forceps delivery and the head appeared to be swollen
in the right parieto-occipital area. Jaundice developed after 24 hours. The haemoglobin is
12 g/dl; there is indirect hyperbilirubinaemia.
A. Breast milk jaundice
B. Cephalhaematoma
C. Galactosaemia
D. Preterm birth
E. Sepsis

12. The baby has a temperature of 38 oC and tends to bring up its feeds. The circulating white
cell count is 18x109 /l. Microscopy of urine from a suprapubic aspirate shows large
numbers of neutrophil polymorphs.
A. Breast milk jaundice
B. Cephalhaematoma
C. Galactosaemia
D. Preterm birth
E. Sepsis

13. Select the most appropriate option from the list that would account for this presentations:
A baby on the postnatal ward is seen to have a cyanotic episode during feeding.
A. Tracheo-oesophageal fistula with atresia
B. Gastro-oesophageal reflux
C. Meconium plug syndrome
D. Meckel's Diverticulum
E. Necrotising enterocolitis

14. Select the most appropriate option from the list that would account for this presentations:.
By day 4 the abdomen appears erythematous and the baby becomes apnoeic.
A. Tracheo-oesophageal fistula with atresia
B. Gastro-oesophageal reflux
C. Meconium plug syndrome
D. Meckel's Diverticulum
E. Necrotising enterocolitis

15. Select the most appropriate option from the list that would account for this presentations:
A term baby is admitted to Special Care Baby unit with hypoglycaemic episodes. His
mother is a poorly controlled diabetic. By day 4 the hypoglycaemia has resolved but the
baby has not yet opened his bowels.
A. Tracheo-oesophageal fistula with atresia
B. Gastro-oesophageal reflux
C. Meconium plug syndrome
D. Meckel's Diverticulum
E. Necrotising enterocolitis

16. Which of the vaccines listed would be contra-indicated in HIV positive patients.
A. BCG
B. Diphtheria Tetanus Pertussis
 C. Haemophilus Influenzae B
D. Measles Mumps Rubella
E. Tetanus

17. Which of the vaccines listed would be contra-indicated in subjects with progressive
neurological conditions.
A. BCG
B. B. Diphtheria Tetanus Pertussis
C. Haemophilus Influenzae B
D. Measles Mumps Rubella
E. Tetanus

18. Select the most appropriate option from the list: Can copy a circle and a cross and climbs
and descends stairs, one foot per step.
A. 18 months
B. 2 years
C. 3 years
D. 4 years
E. 5 years

19. Select the most appropriate option from the list: A child can scribble and draw a straight
line but not yet a circle.
A. 18 months
B. 2 years
C. 3 years
D. 4 years
E. 5 years

20. An 18 month old boy because of maternal concerns about delayed speech. He was born
at 39+4/40 weighing 2.6kg and there were no neonatal problems. He sat at 12/12, and now
pulls to stand. He is able to make a tower of 2 inchhigh bricks. He is saying 2-3 single
words which his mother can understand and seems to hear well. He drinks from a bottle.
He is fully immunized, on no medications, and there is no FH/SH of note. On examination
he looks well. He is on the 25th centile for height and weight and OFC. There are no
specific findings of note. What is the most likely diagnosis?
A. Speech delay, isolated
B. Pervasive developmental disorder
C. Global developmental delay
D. Impaired hearing
E. Autism

21. A 2.5 year old boy is referred with behaviour problems and poor speech. He speaks very
seldom, and is unable to sustain a conversation. He always prefers to play on his own,
lining up his Thomas the Tank engine set repetitively, ignoring his older and younger
siblings. He throws tantrums when his routine is disturned. He was born at 37+3/40
weighing 3.51kg and there were no neonatal problems. Pregnancy had been
uncomplicated. On examination he is apyrexial, and there are no specific abnormalities to
find. What is the most likely diagnosis?
A. Speech delay, isolated
B. Pervasive developmental disorder
 C. Global developmental delay
D. Impaired hearing
E. Autism

22. Which of the following diseases have a very close relationship with protein energy
malnutrition?
A. Tuberculosis
B. Measles
C. Diarrhea
D. Pertusis (whooping cough)
E. Common cold

23. When intruducing solid food, it is usually best start with:

A. Wheat cereal
B. Yellow vegetables
C. Rice cereal
D. Fruits
E. Egg

24. The most important criteria for admission of a child with protein energy malnutrition
coming to a hospital are:
A. Age < 1 year plus severe PEM
B. Severe PEM plus dehydration
C. Severe PEM plus hypothermia
D. Severe PEM plus infection
E. Recurrence of the situation in the same child

25. Syndrome of vitamin A deficiency is as follows: xerophthalmia, keratomalacia,

hyperkeratosis, growth failure and death. Which of the following option is most likely a
part of the syndrome.
A. Conjunctivitis
B. Hordeolum
C. Bitot spots
D. Subconjunctival bleeding
E. Retinal ablation

26. The new additives to infant formulas that are supposed to support a child’s development
are:
A. Calcium and Iron
B. DHA and ARA
C. Comfort protein
D. Whey and casein
E. Vitamin D

27. For this patient with breathlessness, select the most likely diagnosis: A 4-month-old baby
has not gained much weight since birth and only takes small milk feeds, as he appears to
become breathless on feeding. He is tachypnoeic, sweaty and has a tachycardia. His liver
is enlarged and he has a harsh grade 2-pansystolic murmur at the left lower sternal edge
A. Asthma
B. Hyperventilation
 C. Cystic Fibrosis
D. Pneumocystis carinii
E. Ventricular septal defect

28. Which the most likely diagnosis in this case: A 13-year-old girl is referred for evaluation
of her short stature. She isprepubertal. On auscultation she has an ejection systolic murmur
in the second and third left intercostals spaces radiating to the back, but is a symptomatic.
A. Ventricular septal defect
B. Atrioventricular septal defect
C. Pulmonary valve stenosis
D. Coarctation of the aorta
E. Tetralogy of Fallot

29. Which is the most likely diagnosis in the following case: An infant is seen for his 6-week
check and found to have a loud ejection systolic murmur in the third left intercostal space
and a single second heart sound on examination. There is no obvious cyanosis but a
suggestion of mild desaturation. On the chest X ray there is a concavity on the left heart
border and decreased pulmonary vascular markings.
A. Ventricular septal defect
B. Atrioventricular septal defect
C. Pulmonary valve stenosis
D. Coarctation of the aorta
E. Tetralogy of Fallot

30. Select the most appropriate diagnosis from the list of options of rash with the illness for
which they are the most typical exanthem: A 3 year old child presents swith high fever for
7 days, conjunctival injection, fissuring of the lips and strawberry tongue, erythema
followed by desquamation of the hands and feet, and a macular rash over the trunk with
cervical lymphadenopathy.
A. Staphylococcal scalded skin syndrome
B. Rubella
C. Kawasaki’s disease
D. Infectious mononucleosis
E. Henoch – Schonlein purpura

31. Which is the most likely diagnosis in the following case?: A 3-week-old premature infant
born at 27 weeks gestation remains ventilated following surfactant deficient respiratory
distress syndrome. On auscultation of his chest a systolic murmur is heard at the left
sternal edge and pulses are very easy to feel. There is pulmonary plethora on chest X ray.
A. Atrioventricular septal defect
B. Coarctation of the aorta
C. Hypoplastic left heart syndrome
D. Patent ductus arteriosus
E. Pulmonary valve stenosis

32. A child has short stature and is noted to have a large head with a prominent forehead.
Select the most appropriate diagnosis:
A. Achondroplasia
B. Anorexia nervosa
C. Constitutional delay
 D. Familial short stature
E. Growth hormone deficiency

33. 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. Select the most appropriate diagnosis:
A. Achondroplasia
B. Anorexia nervosa
C. Constitutional delay
D. Familial short stature
E. Growth hormone deficiency

34. In a child with a suspected genetic disorder and the clinical abnormalities of Simian
creases choose the single most likely diagnosis from the list of options:
A. Bloom's syndrome
B. Cockayne's syndrome
C. Down's syndrome
D. Hunter's syndrome
E. Prader-Willi syndrome

35. For each of the following descriptions of clinical abnormalities choose the single most
likely genetic disorder of eye manifestations such as squints, refractive errors and
Brushfield’s spots.
A. Fragile X
B. Triploidy
C. Trisomy 9
D. Trisomy 18
E. Trisomy 21

36. A 12 day old girl presents with poor feeding, vomiting and lethargy. Born at 37+6/40,
2.98kg, no neonatal problems. Uncomplicated pregnancy and delivery. No drugs or
medications. No immunizations. No FH/SH of note. On examination she is thin and
wasted. She has occasional twitching of the eyelids and mouth. She responds slightly to
voice. Weight <3%, OFC 25%, temperature is 36.5°C (tympanic), RR 40/min, HR
150/min. Chest clear, no murmur. No organomegaly. No rash or dysmorphic features.
What is the most likely diagnosis?
A. Congenital adrenal hyperplasia
B. Congenital heart disease
C. Inborn errors of metabolism
D. Sepsis
E. Enchephalitis

37. For each of the following jaundiced babies, select the most likely cause: 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 baby. Her bilirubin is checked and is found to be elevated and
mainly unconjugated. The community midwife has been unable to gain access to the home
for the last week.
A. Physiological jaundice
B. Biliary atresia
C. Hypothyroidism
 D. Rhesus incompatibility
E. Congenital spherocytosis

38. For the following children presenting with diarrhoea which is the most likely Diagnosis?:
A 8 month old infant has recurrent diarrhoea. Mother dates the start of symptoms from the
an episode of gastroenteritis. The diarrhoea is explosive in nature
A. Coeliac disease
B. Crohns disease
C. Ulcerative colitis
D. Toddlers diarrhoea
E. Lactose intolerance

39. Select one option from the list that is most suitable for the following Patients: Accepted
as the most common cause of infectious diarrhoea in children in the developed society.
A. Adenovirus
B. E. Coli
C. Hepatitis A
D. Norwalk virus
E. Rotavirus

40. Select one option from the list that is most suitable for the following Patients: Can follow
ingestion of dust containing dried faecal material.
A. Adenovirus
B. E. Coli
C. Hepatitis A
D. Norwalk virus
E. Rotavirus

41. Select the most likely underlying causative agent from the list of option: A 7 year old
male child is referred to hospital by the general practitioner with acute renal failure. The
child had bloody diarrhoea and a low grade fever a week ago; both resolved with
rehydration.
A. Epstein-Barr virus
B. Escherichia coli
C. Pseudomonas aeruginosa
D. Respiratory syncytial virus
E. Streptococcus pneumoniae

42. Select one option from the list that is most suitable for the following patient: A 2 day old
breast fed baby is vomiting after each feed. Abdominal x-ray demonstrates a double
bubble.
A. Cyclical vomiting
B. Duodenal atresia
C. Meckel's diverticulum
D. Gastro-oesophageal reflux
E. Urinary tract infection

43. Select one option from the list that is most suitable for the following patient: A 4 month
old baby who is thriving has persistent vomiting which is occasionally blood stained.
A. Cyclical vomiting
 B. Duodenal atresia
C. Meckel's diverticulum
D. Gastro-oesophageal reflux
E. Urinary tract infection

44. A 30-year old lady delivered a healthy baby at 37 week of gestation. She was a known a
case of chronic hepatitis B infections she was positive for HBsAG but negative for
HBeAG. Which of the following is the most appropriate treatment for the baby
A.Both active and passive immunization soon after birth
B. Passive immunization soon after birth and active immunization at 1 year of age
C. Only passive immunization soon after birth
D. Only active immunization soon after birth
E. Contraindication for immunination

45. Select the most appropriate diagnosis from the list of options that would best explain the
following case: A 2 year old boy is admitted with a history of bloody diarrhoea, abdominal
pain and puffiness around his eyes. He is found to be slightly jaundiced. His urea is 12.6
and Creatinine 163 mmol / liter
A. Haemolytic uraemic syndrome
B. Henoch Schonlein purpura
C. Renal tubular acidosis
D. Renal vein thrombosis
E. Systemic lupus erythematosus

46. Select the most appropriate diagnosis from the list of options that would best explain the
following case: A 5 year old girl presents with puffiness around the eyes. Urinalysis
confirms proteinuria with a trace of blood.
A. Henoch Schonlein purpura
B. Nephrotic syndrome
C. Polycystic kidneys
D. Pyelonephritis
E. Renal tubular acidosis

47. Select the most appropriate diagnosis from the list of options that would best explain the
following case: A 1 year old girl with a 3 month history of vomiting is investigated for
failure to thrive. She is found to be mildly acidotic.
A. Haemolytic uraemic syndrome
B. Henoch Schonlein purpura
C. Renal tubular acidosis
D. Renal vein thrombosis
E. Systemic lupus erythematosus

48. Which diagnosis is most appropriate for this patient?: A 4 1/2 year old girl was admitted
to hospital with a 10 day history of progressive shortness of breath and puffiness of the
face. Clinical examination revealed a raised JVP, pulse rate of 160/min, normal heart
sounds, hepatomegaly 2cm and bilateral basal lung crepitations. She was seen by her
family doctor for a sore throat 2 weeks previously.
A. Acute nephritis
B. Nephrotic syndrome
C. Diabetes insipidus
 D. Urinary tract infection
E. Chronic renal failure

49. Which diagnosis is most appropriate for this patient?: A 4 month baby boy is admitted
because of inconsolable crying. He had been thriving otherwise and was well previously.
He seems settled during assessment, feeds well and is afebrile. Urinalysis reveals white
cells 45/HPF, red cells 10/hpf, organisms >100,000/ml.
A. Acute nephritis
B. Nephrotic syndrome
C. Diabetes insipidus
D. Urinary tract infection
E. Chronic renal failure

50. Which diagnosis is most appropriate for this patient?: A 14 year old boy with a history of
recurrent urinary tract infections present with severe abdominal pain radiating to his back.
Dysuria and haematuria.
A. Polycystic kidneys
B. Pyelonephritis
C. Renal Calculi
D. Renal tubular acidosis
E. Systemic lupus erythematosus

51. Which diagnosis is most appropriate for this patient?: A 1 year old girl with a 3 month
history of vomiting is investigated for failure to thrive. She is found to be mildly acidotic.
A. Polycystic kidneys
B. Pyelonephritis
C. Renal Calculi
D. Renal tubular acidosis
E. Systemic lupus erythematosus

52. A 17 year old male with a 4 day history of cough and fever presents with altered
sensorium and vomiting.
A. Cerebral tumour
B. Encephalitis
C. Meningitis
D. Migraine
E. Tension headache

53. For this children with lower limb weakness select the most likely diagnosis: A 6-year-old
child presents with acute onset symmetrical flaccid paralysis initially affecting the legs
then involving the trunk, and now some mild weakness in the arms. 2 weeks prior to this
he had been unwell with URTI and fever. On examination there is minimal movement
with gravity eliminated in all muscle groups in the lower limbs, deep tendon reflexes are
absent, plantar responses are up-going. Distal sensory losses are demonstrable. The CSF
shows raised
protein but no pleocytosis.
A. Guillain-Barre syndrome
B. Juvenile Multiple sclerosis
C. Chronic fatigue syndrome
D. Congenital myopathy
 E. Duchenne muscular dystrophy

54. Select the most appropriate diagnosis from the list that would explain this case: A 16 year
old girl develops headache and vomiting. She has a fever and develops a non-blanching
rash.
A. Cerebral tumour
B. Cluster headache
C. Extradural haematoma
D. Meningitis
E. Migraine

55. For this children with lower limb weakness select the most likely diagnosis: A 4 year old
boy is brought to clinic by his mother who feels he has weak legs and is finding climbing
the stairs difficult. He walked independently at 20 months and has received speech therapy
for a mild speech delay. On examination his lower limb reflexes are normal, his muscles
are well developed distally although weak proximally.
A. Guillain-Barre syndrome
B. Chronic fatigue syndrome
C. Congenital myopathy
D. Duchenne muscular dystrophy
E. Fascioscapulohumeral dystrophy

56. For each patient below, choose the most probable diagnosis: A two week old baby has
microcephaly, seizures and chorioretinitis.
A. Cytomegalovirus (CMV)
B. Hepatitis B
C. Rubella
D. Herpes simplex
E. Toxoplasmosis

57. A 6 yr old child with acute onset of fever of 1040 F developed febrile seizures and was
treated. To avoid future recurrence of seizure attacks what should be given
A. Paracetamol 400 mg + phenobarbitone daily
B. Oral Diazepan 6 hourly
C. Paracetamol 400 mg 6 hourly
D. I.V. diazepam infusion over 12 hrs
E. Oral Luminal 6 hourly

58. Choose the most probable diagnosis from the list of option: A six month old baby
presents with high fever,breathlessness, cough and feeding difficulties. Chest examination
reveals dull percussion note over the right base posteriorly with bronchial breath sounds
on auscultation.
A. Bronchiolitis
B. Croup
C. Pneumonia
D. Influenza
E. Epiglottis
 59. Choose the most probable diagnosis from the list of option: A 1 year old baby boy is
wheezy, coughing, cyanosed and breathless with intercostal recession.
A. Asthma
B. Bronchiolitis
C. Croup
D. Epiglottis
E. Pneumonia

60. All of the infectious diseases described below occur in children. For each one, select the
most likely underlying causative agent from the list of options: A 4 month old female
infant is brought to the hospital with severe respiratory distress. Five days previously, she
had a cough and rhinitis. On examination her temperature is 38.9 oC, pulse 180/min and
the respiratory rate 80/min. She had subcostal retractions and nasal flaring. On
auscultation, there are rhonchi and wheezes all over her chest.
A. Epstein-Barr virus
B. Escherichia coli
C. Pseudomonas aeruginosa
D. Respiratory syncytial virus
E. Streptococcus pneumoniae

61. Choose the most probable diagnosis from the list of option: A nine month old baby girl is
upset and has stridor. Her voice is hoarse and has a barking cough. She has a low grade
fever.
A. Asthma
B. Bronchiolitis
C. Croup
D. Epiglottis
E. Pneumonia

62. For each patient below, choose the most probable diagnosis from the list of options: A 1
year old baby boy is wheezy, coughing, cyanosed and breathless with intercostal
recession.
A. Bronchiolitis
B. Croup
C. Diphtheria
D. Epiglottis
E. Pneumonia

63. For each patient below, choose the most probable diagnosis from the list of options: A
nine month old baby girl is upset and has stridor. Her voice is hoarse and has a barking
cough. She has a low grade fever.
A. Bronchiolitis
B. Croup
C. Diphtheria
D. Epiglottis
E. Pneumonia

64. A 14 year old girl presents with a history of cough and breathlessness on exercise. She
has seasonal rhinitis, and admits to have started smoking. Clinical examination is
unremarkable. What is the most likely diagnosis?
 A. Gastroesophageal reflux
B. Allergic rhinitis
C. Sinusitis
D. Asthma
E.Croup

65. A 17 year old female presents with acute breathlessness. She has had
asthma for approximately 3 years and recently commenced new therapy. Which agent may
be responsible for this exacerbation?
A.Salmeterol
B.Theophylline
C.Beclomethasone
D.Ipratropium bromide
E.Monteleukast

66. Select the most appropriate diagnosis from the list of options that would best explain the
following case: An 11 year old with a previous history of chronic glomerulonephritis
presents with bruising and epistaxis. A full blood count confirms a pancytopenia.
A. Haemolytic uraemic syndrome
B. Henoch Schonlein purpura
C. Renal tubular acidosis
D. Renal vein thrombosis
E. Systemic lupus erythematosus

67. Select the most appropriate diagnosis from the list of options of the following
descriptions of rash with the illness for which they are the most typical exanthem: A 12
year old boy develops petechiae and papules, some of which become purpuric over his
buttocks and legs, associated with painful swollen knees. There is microscopic haematuria
on testing. The platelet count is normal.
A. Staphylococcal scalded skin syndrome
B. Infectious mononucleosis
C. Henoch – Schonlein purpura
D. Meningococcal infection
E. Systemic onset juvenile chronic arthritis

68. For the following children presenting with diarrhoea which is the most likely diagnosis: A
4 month baby girl has severe atopic eczema and is regularly reviewed in the paediatric
clinic. She had now developed diarrhoea and her weight has been static in recent weeks. A
full blood count shows a slight eosinophilia.
A. Cows milk protein allergy
B. Toddlers diarrhoea
C. Lactose intolerance
D. Irritable bowel syndrome
E. Haemolytic uraemic syndrome

69. A 12 year old boy complains of persistent clear nasal discharge during the spring and
summer. He constantly rubs his nose and his eyes. Sometimes he has an associated cough.
The symptoms usually get better in the autumn. He was diagnosed with asthma at 2 years,
but this has improved with age. He rarely requires beta agonist inhaler. On examination he
has a clear nasal discharge, nasal speech, and pink nonpurulent
 conjunctivae. What is the most likely diagnosis?
A. Gastroesophageal reflux
B. Allergic rhinitis
C. Sinusitis
D. Asthma
E. Croup

70. Rash and mucous membrane lesions develop in an infant being 5 days in the course of an
upper respiratory infection with otitis media, and being treated with amoxillin. The most
likely diagnosis of this disease is:
A. Urticaria
B. Measles
C. Steven-Johnson syndrome
D. Kawasaki disease
E. Scarlet fever

71. Select the most appropriate diagnosis from the list of options of the following
descriptions of rash with the illness for which they are the most typical exanthem: A
salmon-coloured, reticulate macular rash develops mainly over the extensor surfaces of the
limbs in a 5 year old boy with swinging temperature; hot, swollen, painful knees and left
elbow and palpable spleen. The ESR is 95. The blood count, C-reactive protein and chest
X-ray are normal.
A. Staphylococcal scalded skin syndrome
B. Infectious mononucleosis
C. Henoch – Schonlein purpura
D. Meningococcal infection
E. Systemic onset juvenile chronic arthritis

72. A thirteen-year-old girl who has intermittent episodes of breathlessness, which tend to
occur in crowded shops. She feels the need to take deep breaths and then breathes very
quickly, complaining of pins & needles around her mouth and in her hands. Her chest is
clear and her blood gases show a normal pO2 and low pCO2.
A. Hyperventilation
B. Tuberculosis
C. Cystic Fibrosis
D. Pneumocystis carinii
E. Ventricular septal defect

73. A 15 mo old child is in your office with stridor at rest and cyanosis with the presumptive
diagnosis of viral croup. You should do all of the following except:
A. Transport immediately in the parent's car to the nearest emergency department
B. Administer oxygen
C. Administer dexamethasone
D. Administer racemic epinephrine
E. Transport after EMS personnel arrive 20 min later

74. Based on an orientation to child development, when would you tellparents the highest risk
of poisoning in children is present?
A. 6 mo
B. 1 yr
 C. 2 yr
D. 4 yr
E. 6 y

75. Two weeks after a viral syndrome, a 2-year-old child develops bruising and generalized
petechiae, more prominent over the legs. No hepatosplenomegaly or lymph node
enlargement is noted. The examination is otherwise unremarkable. Laboratory testing
shows the patient have normal hemoglobin, hematocrit, white blood count and
differential. The platelet count is 15,000/µ. The most likely diagnosis is :
A. Von Willebrand disease
B. Acute leukemia
C. Idiopathic (Immune) thrombocytopenic purpura
D. Aplastic anemia
E. Thrombotic thrombocytopenic purpura

76. Which of the above drugs, when prescribed to the mother, is associated with the
following abnormalities in the breast-fed infant: May result in platelet dysfunction.
A. Amiodarone
B. Aspirin
C. Aspirin
D. Sulfasalazine
E. Warfarin

77. Select the most appropriate oncological diagnosis from the list of options to explain the
following scenario: A baby is born with a solitary mass over the right buttock.
A. Ewing sarcoma
B. Hepatoblastoma
C. Neuroblastoma
D. Teratoma
E. Wilm's tumour

78. Select the most appropriate chemotherapeutic agent from the above list that corresponds
with the following actions and side effects: An anthracycline with a serious risk of cardio-
toxicity.
A. Actomyosin D
B. Asparaginase
C. Doxorubicin
D. Methotrexate
E. Vincristine

79. Select the most appropriate oncological diagnosis from the list of options to explain the
following scenario: A young child presents with fevers and a mass in the femur is noted
and a diagnosis of malignancy is made. This malignancy is 30 times more common in
white children compared to black children.
A. Ewing sarcoma
B. Hepatoblastoma
C. Neuroblastoma
D. Teratoma
E. Wilm's tumour
80. A 5 year old girl came with history of progressively increasing pollor since birth and
hepatosplenomegaly. Which of the following is the most relevant test for achieving
diagnosis
A. Hb electrophoresis
B. Peripheral smear examination
C. Osmotic fragility test
D. Bone marrow examination
E. Lumbal punction test