College of Health Sciences

Faculty of Medicine
Department of Pediatrics & Child Health

Final written examination of pediatrics and child

health for Clinical II medical students

June 26, 2008

General instruction
 This examination paper contains 100 multiple choice
questions
 Try all the questions
 Read the instructions in each section carefully and answer
accordingly on the space provided; unclear or two answers
will not be checked
 Write your name and ID No. on each page

Name: ___________________________
ID. Number: ______________________

Time allowed 2½ hours

NB. Do not turn this page until you are told to do so!
__ Instruction- There is only one best answer for each
question; choose the best answer and write on the space
provided
____ 1. In the management of tuberculosis, administration of steroids is
indicated in some types of conditions. The steroid should be discontinued
slowly (tapered off) because,
A. The tuberculosis may relapse
B. The patient may develop adrenal insufficiency
C. The steroids have long duration of action so their effect lasts once they
are discontinued
D. There is no need to taper the steroids.

_______2. The most important thing to do before putting a patient on INH

prophylaxis is
A. to tell the care taker about the importance of INH
B. To assure good adherence to the drug to prevent development of
resistance
C. To exclude active tuberculosis
D. Do drug sensitivity test first
E. All are very important
______3. An infant is brought to the OPD, on examination she turns her head
when her name is called. She is able to say “mama”. Mother told you she
can also say “dada.” She can say bye – bye to you when she left the room.
What age of this child is most consistent with this developmental
milestones?
A. 5 mo
B. 7 mo
C. 9 mo
D. 11 mo
E. 24 mo.

2
Use the following case to answer questions 4 – 6

______4. A mother brings her 6 year old child to the OPD because over
the last week he developed reddish discoloration of the urine and puffiness
of the face. He has history of fever and sore throat 3 weeks back. On
physical examination, the blood pressure is 120/85, has peri-orbital
puffiness. Which of the following is the most likely diagnosis?

A. Alport’s disease
B. Acute Post streptococcal glomerlunephritis
C. Congestive Heart Failure
D. Hemolytic Uremic syndrome
E. Chronic glomerulonephrities
______5. Early initiation of oral penicillin therapy in the patient would mostly likely
A. elimination the pharengeal spread to others
B. prevent the development of glomerulonephrities
C. prevent recurrence
D. cure PSAGN
E. none

______6. The patient failed to pass urine on the second day. What will be the
first step you take?

A. Administer Lasix
B. Catheterize the bladder
C. Put him on maintenance fluid
D. Put him on low protein diet
E. None of the above

3
______ 7. Which of the following is not a principle in the management of acute
renal failure?

A. Institute fluid restriction

B. Follow vital signs
C. Diuretic therapy should be considered only after adequacy of blood
volume is achieved.
D. All are principles of therapy of acute renal failure
E. Avoid nephrotoxic drugs
______ 8. Which one of the following is false about the epidemiology of rheumatic
fever?
A. It is most frequently observed in children age 5 to 15 years.
B. Its epidemiology is basically the epidemiology of Group A
streptococcal pharyngitis.
C. Group A streptococcal carriers are at increased risk of developing
rheumatic fever.
D. The major epidemiologic risk factor for the development of rheumatic
fever is Group A streptococcal pharyngitis.
E. none

4
Use the case below to answer questions 8 – 10.

______ 9. A 9 year old child who is a known cardiac patient who undergone
dental extraction last week presented to you with low grade fever of 3
days duration. He has associated chills, night sweats. Physical examination
showed PR= 128/min, T = 38.9oc , has grade three pansystolic murmur
best heard at the apex. Spleen is palpable 2 cm below the left costal
margin. The lesion in this patient could be any of the following except
A. Ventricular Septic defect
B. Mitral regurgitation
C. Mitral stenosis
D. Mitral valve prolapse
E. All have the murmur mentioned above

______ 10. What diagnosis will you consider in this child as the most likely cause
of the symptoms?
A. congestive heart failure
B. Infective endocarditis
C. Malaria
D. Aortic stenosis
E. Acute rheumatic fever
______11. All of the following investigations should be ordered except

A. Blood culture
B. Hematocrit
C. Urinalysis
D. Cardiac troponine
E. All should be ordered

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 ______ 12. At what age would you start to worry if an infant does not start social
Smile?
A. 4 weeks
B. 5 weeks
C. 8 weeks
D. 12 weeks
E. At any age
______13. Kernicturus can best be described as
A. a major cause of blindness in new borns
B. un unpreventable event of hemolysis
C. deposition of conjugated bilirubun in the skin and skin and sclera
D. deposition of conjugated bilirubin in the brain
E. deposition of unconjugated bilirubin in the basal ganglia and
cerebellum
______14) A 5-month-old infant presents with diarrhea and decreased activities for the
past 3 days. On physical examination, his pulse is 162/min. His anterior
fontanelle is sunken, and he has skin tenting. Laboratory investigation reveals
sodium, 165 mEq/L; potassium, 5.8 mEq/L; chloride, 128 mEq/L,
bicarbonate, 14 mEq/L; creatinine, 0.9 mg/dL; blood urea nitrogen, 49 mg/dL;
and glucose, 154 mg/dL. Eight hours after IV fluid therapy is started, the
infant develops a generalized seizure. Which of the following is the most
likely etiology of the seizure?

A. Hyperglycemia
B. Hyperkalemia
C. Idiopathic epilepsy
D. Rapid correction of hypernatremia
E. Hypernatremia
______15) An infant in brought to the clinic for a routine healthy visit and vaccinations.
She is the product of an uncomplicated pregnancy and has been meeting
development mileposts. She is feeding well, and her mother reports that the baby
seems to be growing well as well. On physical examination, the infant is afebrile
with stable vital signs. She can lift her head to 90 degrees, her eyes follow past the
midline, she laughs, regards her own hand and has slight awareness of her mother.
Which of the following is the most likely age of this infant?
A. 2 months
B. 4 months
C. 6 months
D. 12 months
E. 18 months

6
______16. Which of the following is not important in the management of insulin dependent
diabetes mellitus?

A. dietary management
B. Exercise
C. Glucose monitoring
D. Health education for the child and family
E. Once daily admistration of insulin
________ 17. Which of the following is not a risk factor for developing
tuberculosis?
A. Children exposed to high-risk adults
B. Poor and indigent persons, especially in large cities
C. HIV positive children
D. All are risk factors
________ 18. A 4yr old child presented to you with sudden onset of high grade
fever, chills, chest pain. He had history of upper respiratory tract
symptoms for the last five days. You did physical examination. The results
were the child is in respiratory distress. RR = 45/min. Chest auscultation
revealed crepitations at the left sub-scapular area. The most likely etiology
is
A. Staphylococcus aureus
B. Streptococcus pneumoneae
C. E. coli
D. Group A ß-hemolytic streptococcus
E. Tuberculosis pneumonia

________ 19. What things should you consider when you are selecting emperical
antibiotic(s) for the above case?

A. The age of the child

B. The place where it was acquired
C. The nutritional status of the child
D. All of the above should be considered
E. Not mentioned

7
 ______20. Parents of a 3-year-old child family has been using a neighbor to care for
their child while the parents work. The neighbor is diagnosed with pulmonary
tuberculosis. PPD test of the 3-year-old is negative. Which of the following is
indicated for the 3-year-old?
A. Ethambutol chemoprophylaxis
B. Isoniazid chemoprophylaxis
C. Rifampin chemoprophylaxis
D. Streptomycin chemoprophylaxis
E. No chemoprophylaxis

______21. A 2-years old boy from Aleta wondo was brought to Hawassa referral
Hospital because he developed pallor and lethargy; his face looks swollen and
his mother reports that he has been urinating very little and had bloody
diarrhea a week back. Laboratory evaluation reveals low hematocrit and
platelet count and positive blood and protein in the urine. Which of the
following diagnoses is likely to explain these symptoms?
A. IGA nephropathy
B. Intussusception
C.Hemolytic-Uremic Syndrome
D. Meckel Diverticulum
E. Nephritic syndrome
______22. A 4-year-old boy presents with severe pains in both of his legs. On physical
examination, his temperature is 37.7 C (99.8 F), blood pressure is 108/68 mm
Hg, pulse is 96/min, and respirations are 17/min. He is noted to have marked
pallor on his lips and palpebral conjunctiva. Numerous purpura and petechiae
are noted on his skin. His spleen is palpable 3 cm below his left costal margin.
Laboratory evaluation reveals a white blood cell count of 1600/mm3;
hemoglobin, 6.1 g/dL; and platelets, 36,000/mm3. Which of the following
diagnoses is most consistent with these findings?

A. Acute lymphocytic leukemia

B. Aplastic anemia
C. Henoch-Schönlein purpura
D. Immune thrombocytopenic purpura
E. Thrombotic thrombocytopenic purpura

______23. Which one from TORCH syndrome causes congenital heart disease?

A. Toxoplasmosis
B. Cytomegalovirus
C. Herpes simplex virus
D. Congenital Rubella syndrome
E. Congenital syphilis

8
_____24. Children not at high risk of vitamin A deficiency
A. Infants < 6 months who are not breast fed
B. Children between 6-59 months
C. Children with diarrhoeal diseases
D. Children with protein energy malnutrition
E. None of the above

--------25. Which one of the following is not an indication for NG tube insertion in
patients with PEM?
A. Pneumonia with rapid breathing
B. Patient is taking > 75% of daily milk
C. Painful oral lesions
D. Disturbance of consciousness
E. Persistent vomiting
______26. Which of the following is not true about Tetanus?
A. Neonatal tetanus is the most common form in Ethiopia
B. Tetanus is caused by clostridium tetani; an invasive organism of the CNS
C. Respiratory failure & pneumonia are the usual causes of death
D. Tetanus is entirely preventable disease
______27. Not a reason for why airway obstruction is more severe in children:
A. Narrow airway caliber
B. Short & relatively straight airways
C. Abundant mucus glands
D. Soft & easily deformable rib cage
E. None of the above
______28. Choose the wrong statement about Coartem a fixed dose combination
of artemether-lumefantrine:
A. Fast malaria parasite clearance
B. Effective against multi drug resistant malaria
C. Rapid reduction in fever
D. Used in the treatment of uncomplicated P.falciparum infeiction
E. None of the above
29. Not indicated in the management of severe laryngotracheobronchitis?
A. Sedation if the child is restless
B. Dexamethasone to relieve the subglottic edema
C. Antibiotic(s) because bacteria are the commonest etiologies
D. Artificial airway for impending respiratory failure
E. A & C
30. Which one of the following conditions doesn't require wide antibiotic
coverage?
A. Pneumonia in immuno compromised children
B. Pneumonia in children with PEM
C. Bronchopneumonia
D. Hospital acquired pneumonia
E. C & D

9
 31. One is not true about pediatric tuberculosis:
A. It is usually primary
B. Post primary TB usually affects the lungs
C. The ghone focus & related LAPs form the primary complex
D. BCG vaccination prevents children from severe form of TB
E. None of the above
______32. Which of the following statement is incorrect?
A. Congenital heart disease are classified as cyanotic and a cyanotic
B. Tetra logy of fallot is the most common cyanotic congenital heart disease
C. Atrial septal defect (ASD) is the commonest of all congenital heart disease
D. Most congenital heart disease are asymptomatic
E. Congenital heart disease start to be symptomatic in the 1st- 2nd years of life
______33. Which of the following statement is incorrect?
A. Iron deficiency anemia is the most common hematologic disease of infancy
and childhood
B. On peripheral smear, we expect macrocytic hypochromic cells in iron
deficiency anemia
C. The hemoglobin starts to increase after 4 days of iron therapy
D. Children between 6-24 months are at risk of developing iron deficiency
anemia
E. Vitamin B12 deficiency is one of the DDx for macrocytic anemia

______34. A mother bring to you her 2 year old child (weight=14 kg) because she has
diarrhea of two days duration.the diarrhea was watery in consistency and with no
tensmus .when you examined her , you note that she is restless and irritable,
hereyes are not sunken, skin pinch goes back slowly and she drinks normally.
She doesn’t appear malnourished. What is the degree of dehydration?
A. No dehydration as the above signs are also signs of malnutrition
B. She has some dehydration
C. She has severe dehydration
D. Needs additional information because she is malnourished
E. None of the above.
______35. The total amount of fluid required to replace the deficit in this patient is
A. 1050ml
B. Replace ongoing loss
C. 1050ml+ ongoing fluid loss
D. 1400ml+ ongoing loss
E. 1400

______36. One of the following is false

A. Na+ 90mMol Resomal,90 mMol/l ORS
B. Glucose 125 mMol/l Resomal,111 mMol/l mMol/l ORS
C. K+ 40 mMol/l Resomal, 20 mMol/l ORS
D. Chloride 7 mMol Resomal,10 mMol/l ORS
E. Mg++ 3 mMol Resomal, 0 mMol/l ORS

10
_______37. Congenital hypothyroidism most often results from
A. congenital pituitary insufficiency
B. defective synthesis of thyroxin
C. maternal radio iodide intake
D. thyroid aplasia or ectopic thyroid
E. thyrotropin unresponsiveness
______38. A 3 years old boy presents with fever, malaise, headache and back pain. On
examination, he has asymmetric flaccid paralysis.
A. Duchenne Muscular dystrophy
B. Guillian barre syndrome
C. Post injection paralysis
D. Polyomyelitis

______39. which of the following statement is correct about immunization?

A. It is recommende that additional doses should be given if the interval between
vaccine doses exceeds those that are recommended.
B. It is recommended that vaccine should not be given simultaneously because this
interferes with effectiveness
C. Live virus vaccine should be administered with caution to children receiving
corticosteroids
D. The dose and the schedule of immunization should be adjusted for age in preterm
infants
E. Catch up immunization for measles usually conducted 2-3 years after follow up
campaign
______40. Optimal breast feeding practices include all of the following except
A. Exclusive Breast feeding for 6 months
B. Emptying of one breast before shifting to the other one
C. The enfant at least should fed during the day and early in the evening
D. Total feeding till the age of 18-24 month
E. Breast feeding the child for 8-12 times/day
______41. All of the following are true about breast milk EXCEPT
A. The best stimulus is frequent and regular sucking
B. Has less calcium compared to cow milk
C. Has more casin and less whey protein
D. Have better folate than Goat milk
E. The fore milk has more water than the hind milk

______42. In a child who has multiple ecchymosis, on the legs, buttocks and back, which of
the following is less likely
A. child abuse
B. hemophilia A
C. Henoch schnolen Purpura
D. Leukemia
E. Rickets

11
 ______43. All are true about Transition Phase of PEM management except
A. Usually takes 2-3 days
B. Mortality in PEM increases when it is omitted
C. This phase helps the child to adapt solid foods
D. The main principle of it is to avoid fluid and electro light over load
E. F100 is usually started in this phase

______44. Folic acid supplementation is recommended for women of reproductive age to

prevent
A. anemia of prematurity
B. Klumpk’s paralysis
C. Neural tube defect
D. Retinopathy of prematurity
E. Small left colon syndrome
______45. The prevalence of bone and jopint tuberculosis is in the order of
A. Vertebra-Hip joint-Knee joint-tibia- ankle joint
B. Vertebra -Knee joint-Hip joint -tibia- ankle joint
C. Hip joint- Vertebra-Knee joint-tibia- ankle joint
D. Hip joint-Knee joint-Vertebra-tibia- ankle joint
E. Knee join-Vertebra -Hip joint-small joints- ankle joint

______46. which one of the following is true about breast feeding and HIV
A. All breastfeeding mothers transmit HIV to their infants
B. Breast feeding for HIV exposed infant shoul be continued irrespective of the age
and AFASS
C. EFV/efaverenze is not recomonded for lactating mother
D. Breast feeding should continue for 18 months in Ethiopian context and the infant
should receive EBF in the first 6 months
E. None of the above

______47. The major mode of transmission of HIV infection in young children is in

order of
A. Intra partum-Intra uterine- breast feeding
B. Breast feeding-intra partum –intra uterine
C. Trans placental –during labor-breast feeding-intra uterine
D. Intra partum-breast feeding- intra uterine
E. The order can be in either of the above 4order depending on the condition
______48. NOT a correct combination
A. AZT/ZDV-ANEMIA
B. NVP –Hepatotoxicity
C. EFZ-Teratogenic/neural tube defect
D. ABC –anaphylaxis
E. d4T-hepatotoxic

12
______49. which one of the following is NOT the 1ST line Regimen
A. d4T/3TC/NVP
B. d4T/3TC/EVZ for Age>2yr , wt>10kg
C. AZT/3TC/NVP
D. AZT/3TC/ EVZ for Age>2yr , wt>10kg
E. D4T/AZT/NVP
______50. Which of the following is wrong about arthritis of rheumatic fever?
A. It is migratory in nature
B. It is extremely tender
C. The involved joints are red, warm and swollen
D. Monoartritis after introduction of aspirin may considered as a major criteria
E. Usually recover without sequelae
______51. One of the following statements is false about a hemophilic male married to a
normal female
A. All females become carrier
B. All males become normal
C. All males inherit the disease
D. No female inherit the disease
E. None of the above
______52. Hemophilic boy has developed hemarthrosis .this patient can be treated by
A. Administration of vitamin K 2.5im and 2.5mg iv.
B. Fresh frozen plasma
C. Platelete concentrate
D. Packed RBC
E. None of the above
______53. Which of the following statement is false about exposed infant diagnosis
A. DNA PCR is the most sensitive and preferred diagnostic test
B. DBS is technicque of blood sample collection for DNA PCR
C. All exposed infants will test positive for antibody tests
D. P24 assay forHIV diagnosis is highly specififc but less sensitve
E. Rapid/ELISA tests are mandatory before determination of CD4 and initiation of
ART
______54. One of the following is not a cyanotic congenital heart disease
A. TOF
B. TGA
C. Tricuspid Atresia
D. Coarctation of Aorta
E. TAPVR

55. Which of the following statement is incorrect?

F. Congenital heart disease are classified as cyanotic and a cyanotic
G. Tetra logy of fallot is the most common cyanotic congenital heart disease
H. Atrial septal defect (ASD) is the commonest of all congenital heart disease
I. Most congenital heart disease are asymptomatic
J. Congenital heart disease start to be symptomatic in the 1st- 2 years of life

13
______56. False about Cardiomyopathy
A. Dilated cardiomyopathy is the commonest type
B. Intrinsic disease of the myocardium in which there is no structural
deformity of the heart.
C. may be a sequale of a previous Entero virus myocarditis in early infancy
D. The prognosis of Cardiomyopathy following myocarditis is grave in 100%
of the cases
E. Acute myocaditis is found in up to 15% 0f the cases

______57. Which of the following statement is incorrect?

A. Leukemia is the most common childhood cancer
B. There is staging system for ALL
C. The diagnosis of Leukemia is confirmed by examination of bone marrow
D. Age < 1 year and >10 years are one of the poor prognostic factors
E. CNS metastasis has poor prognosis
______58. Which of the following is incorrect about portal hypertension?
A. Defined as portal venous pressure > 10-12 mm hg
B. Characterized by hypersplenism
C. In children intra hepatic causes are common
D. History of umbilical catheterization is a risk for portal hypertension
E. None of the above
______59. A 12-month-old infant presents with bilious vomiting and abdominal
distention for 10 hours. His mother states that the infant has been constipated
since birth and failed to pass meconium during the first 48 hours of life. On
examination, he is very irritable. His length and weight are both below the 5th
percentile according to his age. His abdomen is moderately distended. After a
digital rectal examination, a fair amount of stool ejects out from the anus.
Which of the following is the most likely diagnosis?
A. Duodenal atresia
B. Intussusception
C. Hirschsprung disease
D. Malrotation
E. Pyloric stenosis

______60. Which of the following tumors has no characteristics of small round cells on
pathology?
A. Neuroblastoma
B. NHL
C. Ewing's sarcoma
D. Rhabdomyosarcoma
E None

14
 ______61. A 13-year-old healthy boy presents to the physician for a routine health
maintenance visit. A urinalysis reveals 1+ proteinuria. There is no hematuria
or bacteruria. His physical examination is unremarkable, revealing no edema
and a normal blood pressure. Which of the following is the most likely
diagnosis?

A. Acute glomerulonephritis
B. IgA nephropathy
C. Minimal change disease
D. Orthostatic proteinuria
E. Urinary tract infection
______62. We doubt the cause of nephrotic syndrome to be minimal change disease, if
A. It occurs in <1yr or >8 yrs
B. There is gross hematuria
C. There is hypertension
D. it responds poorly for steroid
E. All the above
______63. Which of the following is not a pre renal cause of acute renal failure?
A. Urolithiasis
B. Sepsis
C. CHF
D. Dehydration
E. Hemorrhagic shock
______64. Which one of the following is false about TOF?
A. The commonest cyanotic congenital heart disease
B. TOF-has VSD, PS, RVH(Right ventricular hypertrophy).
and Transposition of great arteries.
C. Cerebrovascular accident common< 2 years
D. Brain abscess is common >2 year
E. Boot shape on CXR
______65. Which one of the following congenital heart diseases causes increased pulmonary
vascularity?
A. Atrial septal defect
B. Ventricular septal defect
C. Tetralogy of Fallot
D. All
E. A & B
________ 66. Which of the following is not a principle in the management of DKA?
A. Insulin Therapy
B. Rehydration
C. Bicarbonate Therapy
D. All are principles of therapy for DKA

15
_______67. Indications for steroids in TB include all of the following except
A. Tuberculous peritonitis
B. Laryngeal Tuberculosis
C. Tuberculoma
D. Pericardial Tuberculosis
________68. One of the following is NOT a contraindication for immunization

A. OPV is a contraindication for a child with diarrheal disease

B. BCG is a contraindication for a child with pediatrics AIDS
C. Convulsion/shock following recent dose is a contraindication for the next
dose of DPT-HepB-Hib
D. Neurological disease of the CNS or recurrent seizure is a contraindication for
DPT-HepB-Hib
E. Anaphylaxis’s for the previous dose of immunization

_________ 69. Which of the following statement WRONG about Measles?

A. It is a highly contagious disease characterized by fever, conjunctivitis,

coryza and maculopapular rash
B. Common below the age of 6 months
C. Koplik spots are pathogenomonic of measles
D. Eruptive phase manifested with high grade fever and maculopapular
rash
E. Pneumonia is the most common complications

________70. A maternal marker for increased transmission of hepatitis B viruse to the infant is
A. antibodies to the Australian antigens
B. antibodies to the hepatitis B surface antigen
C. Hepatitis B core antigen
D. Hepatitisa B e antigen
E. Hepatitis B surface antigen

______71. All are draw backs of live attenuated vaccine, EXCEPT

A. Reversion to wild type

B. Confer life long protection (e.g. measles)
C. Can cause severe disease in immunocompromised children
D. some exhibit hypersensitivity to viral antigen
E. None
______ 72. All of them are true about breast feeding except
A. Has higher level of lactose
B. Small amount of calcium level than cow milk
C. The calori content is 700kcal/1000ml
D. Has anti parasitic effect for Giardia.l and entamoeba.H
E. None of the above ??

16
 _______73. The most important chemical that should be replaced in dietary rehabilitation of
kwashiorkor is

A. sodium
B. zinc
C. potassium
D. calcium
E. iron

______74. 1,25 Dihydro-cholecaciferol is produced in the

A. liver
B. skin
C. kidney
D. intestines
E. bone
______75. All of the following can be from nutritional deficiency states except

A. splenomegaly
B. spoon shaped nails
C. Marasmus
D. Xerosis
E. Carpopedal spasm

_____76. The term “80% of the standard weight” for age refers to

A. the 80% of the median weight

B. the 80th percentile of the normal distribution
C. deviation by 80% from the median weight
D. 80% of the 100th percentile
E. None of the above
______77. One of the following is not the advantage of water law classification in
nutritional assessment
A. It differentiates severe form of PEM
B. It can detect mild form of PEM
C. It can distinguish acute from chronic malnutrition
D. It doesn't rely on age
E. All of the above
______78. Glomerular filtration rate is best measured by

A. urine specific gravity

B. urine volume
C. blood urea nitrogen
D. serum creatinine
E. urine osmolality

17
 _____79. A 4 years old girl was found to have 4+ protienuria(0.8gm/24 hrs),serum cholesterol
of 125mg% and ESR of 59 mm/hr. the most likely diagnosis in this patient is

A. nephritic syndrome
B. glomerunephritis
C. pyelonephjritis
D. cystitis
E. nephritic diabetes insepidus
______80. The best indicator of response in a child receiving steroids for minimal lesion
glomerulonephrities is

A. serum cholesterol
B. 24-hour urinary excretion of protein
C. Creatinine clearance
D. Serum albumin
E. Erythrocyte sedimentation rate

_______81. Children treated for leukemia are at increased risk of serious bacterial infection. the
primary cause is
A. compliment deficiency
B. hypogammaglobulinemia
C. Neutropenia
D. T cell dysfunction
E. Venus catheters
_______82. Complications of bacterial meningitis in an infant may include each of the following
except
A. hearing loss
B. hydrocephalus
C. language delay
D. seizure
E. sub durral hematoma
______83. All of the following serum ions may be decreased in pyloric stenosis EXCEPT
A. potassium
B. chloride
C. hydrogen
D. bicarbonate
E. sodium

______84. Fever and peteciae in a child warrant careful evaluation because of possibility of

A. autoimmune thrombocytopenia
B. enteroviral infection
C. Henoch-Schonlein purpura
D. Meningococcemia
E. Kawasaki disease

18
_______85. Lecithine sphingomyeline ratio in amniotic fluid can be used to assess
A. fetal growth
B. fetal Karyotype
C. fetal lung maturity
D. multiple gestational pregnancy
E. presence of ne3ural tube defect

______86. Which of the following is not a component of the apgar score?

A. Heart rate D. Muscle tone
B. Color E.Respiratory effort
C. Weight

______87. One minute post partum you find in a new born: heart rate above 100/min,irregular
breathing,blue-pink colour, weak muscle tonus, and some grimace when sucking
with a ccatheter in the nostrils. This baby has an APGAR score of:

A. 5 points
B. 6 points
C. 7 points
D. 8 points
E. 9 points
______88. The reason for administration of vitamin k prophylactically to a new born is to
A. thrombocytopenia
B. hypofibronogenemia
C. disseminated intravascular coagulation
D. hypoprothrombinemia
E. hemolytic anaemia
______89. The prerequisite for hemolytic disease of the newborn due to ABO incompatability
is most commonly fulfield with th e following blood group combination:
A. Mother –A Child -O
B. Mother –B Child -O
C. Mother –AB Child -O
D. Mother –O Child –A
E. Mother –O Child –O
______90. The most likely cause of neonatal hyperbillirubinemia in preterm infant is:
A. Increased red cell mass
B. Decreased Y-protein
C. Decreased red cell survival
D. decreased excreation of bile
E. Inceased intra medullary hemolysis of young erythrocytes.
________91. Urinary tract obstruction in boys is most commonly caused by
A. posterior urethral valve
B. renal stones
C. urethropelvic junction obstruction
D. urethrovisical junction obstruction
E. uretheral obstruction

19
 _______92. Choose the false statement
A. Caput succedaneum is edema of the scalp and crosses suture lines
B. Subgaleal hemorrhage is a boggy swelling of the scalp that does not
cross suture lines
C. Craniosynostosis is the premature fusion of sutures
D. Craniotabes is a normal variant in neonates
______93. A 4 month old infant weighing 6,180gms is admitted to hospital with a history of
sudden onset of severe pallor .Priliminary lab Ix. Showed Hb=18%, reticulocyte
count=15%,wbc=12,000,N=76%,L=18%myelocyte=3%,monocyte=2%,blasts=1%,
The most likely diagnosis is :
A. acute leukemia
B. iron deficiency anemia
C. Sickle cell diseases
D. hemolytic anemia
E. Hookworm infestation
_______94. Which of the following is not associated with thrombocytopenia?

A. disseminated intaravascular coagulation

B. Hemolytic uremic syndrome
C. Henoch schnolen purpura
D. Wiskoft Aldrich syndrome
______95. One of the following is a characteristic sign of isolated left heart failure.
A. enlargement of the liver
B. paroxysmal nocturnal dysenia
C. dependent edema
D. Ascites
E. Hepato-jugular reflex
______96. True about bronchial asthma in children
A. Concordance rate in monozygotic twins is 95%
B. RSV is the commonest participant in exacerbations
C. Occurs in 80% of under six children
D. There is a life time risk of 12.5% in under five children
E. All but A
________97.The purpose of CXR in patients with bronchial asthma can less likely be
A. To rule out asthma masqueraders
B. Its use as the main modality to settle the diagnosis
C. To look for complications
D. All
E. None

20
________98. True about atopic dermatitis
A. Affects more than 50% of children
B. Has ~80% association with allergic rhinitis &/or bronchial asthma
C. A clinically affected skin can reveal a normal microscopic finding
D. Patients with acute AD have increased no. of IFN γ and IL 12
producing cells
E. B &c
________99.Less effective treatment modality in AD
A. Systemic glucocorticoids
B. Antihistamines
C. Cyclosporine
D. IFN γ

E. None

______100. The initial complication of 30% BSA burn can be best prevented by:
A.feeding high protein high energy diet
B. administration of antibiotics
C.intensive burn wound care
D. administration of TAT
E. none

21
 ______101. Bone marrow smear of idiopathic thrombocytopenic purpura is expected to show
A. absent megakaryocytes
B. aplasia of all element
C. only fragmented megakaryocytes
D. Normal or increased number of megakaryocytes
E. Blast cells

______106. Suctioning of the airways at birth through an endotracheal tube can prevent
A. bronchopulmonary dysplasia
B. Hyaline membrane disease
C. Meconium aspiration syndrome
D. Pneumonia
E. Respiratory distress syndrome
______114. Which of the following is not important in the management of insuline dependent
diabetes mellitus?

F. dietary management
G. Exercise
H. Glucose monitoring
I. Health education for the child and family
J. Once daily admistration of insulin

______115. Hemolytic anemia can result from each of the following except

A. hemoglobilinopathies
B. red blood cell enzyme defect
C. structural abnormality of the RBC
D. traumatic destruction of the RBC
E. Vit-B 12 defficiency

______117. Which of the following cannot be the cause of pancytopenia

A. androgens
B. chloramphnicol
C. Hepatitis
D. Leukemia
E. Radiation

_______118. Which of the following is not a complication of otitis media?

A. cholesteatoma
B. conductive hearing loss
C. mastoiditis
D. persistent effusion
E. posterior auricular adenopathy

22
______119. Which of the following is not associated with Trisomy 21

A. Acute lymphocytic leukemia

B. Duodenal atresia
C. Endocardial cushion defect
D. Imperforate anus
E. Pyloric stenosis

______120. Not a manifestation of ALL

A. bone pain
B. fatigue
C. fever
D. jaundice
E. petichae

23
Birkneh use this questions to fill the gap
And use more simple questions

C1_______1. The most common type of extra-pulmonary tuberculosis is

A. Tuberculosis meningitis B. Scorfuloderma
C. Tuberculosis pericarditis D. Renal Tuberculosis

C1_______3. In the life history of tuberculosis, which one usually comes late?
A. Tuberculous meningitis
B. Tuberculoma
C. Renal Tuberculosis
D. Tuberculous pleurisy

C1_______4. Which one is a wrong Stage – symptoms combination in TB

Meningitis?
A. Stage 1: headache
B. Stage 2: meningeal signs

24
 C. Stage 1: convulsions
D. Stage 3: coma

C1________5. The commonest site of bone and joint tuberculosis is

A. vertebrae B. Ankle Joint
C. Knee Joint D. Tibia

C1 _______ 7. Which one is a wrong combination?

A. 15 months: walks alone
B. 48 months: rides tricycle
C. 60 months: draws triangle from copy
D. 30 months: refers to self by pronoun “I”

C1_________ 8. In developmental assessment, an ideal screening test will have

the
following characteristics except
A. It should have high specificity with reasonable sensitivity ??
B. It should have content validity
C. It should be relatively quick
D. It should have test-retest and inter-rater reliability

C1________9. The first visible sign of puberty in girls is

A. Appearance of menses B. Appearance of Breast buds
C. Peak in Height velocity D. Enlargement of the ovaries

C1________10. On the weight for age chart for boys, the weight of a 9 months
age
Line intersects the 25th percentile curve at 8.5 kg. What does this
mean?
A. Seventy-five percent of the 9 mo old boys weigh above 8.5 kg.
B. Twenty-five percent of them weigh above 8.5 kg.

25
 C. Twenty-five percent of them weigh 8.5 kg.
D. Seventy-five percent of them weigh 8.5 kg

C1________11. Which one of the following is false about the epidemiology of

rheumatic fever?
F. It is most frequently observed in children age 5 to 15 years.
G. Its epidemiology is basically the epidemiology of Group A
streptococcal pharyngitis.
H. Group A streptococcal carriers are at increased risk of
developing rheumatic fever.
I. The major epidemiologic risk factor for the development of
rheumatic fever is Group A streptococcal pharyngitis.

C1________12. Which manifestation of rheumatic fever results in chronic

complications?
A. Carditis B. Erythema marginatum
C. Chorea D. Polyarthritis

C1________13. Which valve is commonly affected by rheumatic carditis?

A. Aortic B. Mitral
C. Tricuspid D. pulmonary

C1________14. Which of the following is wrong about the arthritis of rheumatic

fever?

A. It is migratory in nature
B. It is extremely tender.
C. The involved joints are red, warm and swollen.
D. It commonly results in chronic joint disease.

26
C1________15. which of the following is false about the epidemiology of
tuberculosis?

A. PPD is negative in the infection stage.

B. Untreated infants with LTBI have up to a 40% likelihood of
developing tuberculosis, with the risk of progression
C. Risk of developing disease is highest in the first 2 years after
exposure.
D. All are true.

C1_______16. which of the following is the leading cause of infective

endocarditis?

A. staphylococcus aureus
B. Viridans type streptococci
C. E. coli
D. Pseudomonas aeruginosa

C1_______ 17. The commonest cause of bacterial pneumonia?

A. Streptococcus pneumoniae
B. E. coli
C. Staphylococcus aureus
D. Viral Pneumonia

C1_________18. Teething is associated with all of the following

A. Drooling of saliva
B. Rash and diarrhea
C. Relief with acetaminophen
D. Diarrhea and rash-c
E. Irritability

27
THE YEAR

Period
Period Time Kind
Morning 12 30 Get up

Morning 12 30 – 45 put cloth

Morning 12 45- 55 eat break-

Fast

After noon 10 30- 40 eat meal

After noon 10 40 - 55 change –

Cloth
After noon 10 55- 11 55 study

Night 11 55- 12 55 play

Night 12 55- 2 20 movie

Night 2 20-40 Dinner

28
 Tutorial

Period Time Kind

Night 1 00- 40 tutorial

ABENEZER

EPHREM
29