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1. What is the primary pathophysiological cause of respiratory distress syndrome in a 32 weeks old newborn?
2 A. Pulmonary
B. Systemic
C. Infection
D. Maternal diseases

Recheck 2. Charaterizes the tetralogy fallot

a) Left ventricular hypertrophy
b) right venticular hypertrophy
c,) overriding of aorta

3. Lymphocyte and Antibodies constitute......

(A) Innate immunity
2 (B) Addaptive Immunity
(C) Natural immunity
(D) No specific Defence mechanisms

4. Characterized tetralogy of fallout

A. Obstruction to left ventricular outflow tract
B. A malalignment type of ASD
1 C. Dextroposition of the aorta so that it overrides vsd by <50%
D. Left ventricular hypertrophic

5. You examine a 1 day old baby with abnormal femoral pulse, weak upper extremity pulse and systolic murmur. What is the most appropriate impressions?
A) Pulmonary stenosis
B) Aortic stenosis
C) Translocation of great vessels
1 D) Coarctation of aorta

6. BP classification for 95th to 99 th percentile:

A) pre hypertensive
B) normal
C) stage 1 hypertension
D) stage 2 hypertension

7. At 1 minute of life, a newborn was noted to have cyanosis of hands and feet, heart rate 130bpm, grimaces to stimulation, good respiration, active movement of extremities. What is the Apgar score at this time?
A. 9
B. 8
C. 7
D. 6

8. A 17 year old apparently healthy male suddenly had cardiac arrest while playing basketball, what is the possible condition commonly associated with sudden death in young athletes?
A. Dilated cardiomyopathy
B. Hypertrophic cardiomyopathy
C. Restrictive cardiomyopathy
D. Constrictive pericarditis

9. There are 5 main type of neonatal seizures: subtle, clonic, tonic, spasm and myoclonic. Which of the following is not likely to be associated with electrical discharge?
A. Subtle
B. Focal clonic
C. Spasm
D. Focal tonic

10. What is chemical barrier which prevents entry of pathogens.

A. Flow of secretory fluids
B. Secretion of gastrointestinal cells
C. Sebaceous glands secretion
D. Muco-ciliary movement of ciliate column of Respiratory tract

11. What anti-epileptic drug primary tonic clonic seizure?

A. phenytoin
B. carbamazepine
C. phenobarbital
D. valproate

12. A new born was noted to have __. While the mother is O+ and baby is B+. What is the cause of jaundice?
A. Hemolysis secondary to membrane defect
B. Hemolysis secondary to enzyme deficiency
C. Increased production secondary to increased mediated hemolysis
D. increase in bilirubin is secondary to increase in entero hepatic circulation

13. A 5 years old female came in for skin lesions noted a day prior to consult. The physician rule out urticaria and diagnose the patient with vasculitis. which one of the following clinical feature support the diagnosis.
A. Itchy rash
B. Pigmened or purpuric rash
C. A wheat ad flare reaction
D. History of recurrent skin disorder

14. This step of EINC prevents hypothermia, infection and hypoglycemia.

A) immediate drying
B) early skin to skin contact
C) proper cord clumping and cutting
D) non separation of new born

15. Theraputic hypothermia of patients with HIE will be given

1) within 6 hours of life for 72hrs
2) within 6 hours pf life for 48 hrs
3) within 12 hours of life for 48 hrs
4) within 24 hours of life for 72 hrs

16. Which of the following is the not clinical features of tension type headache
A)
B) doesn't change by activity
D) Increase mild to moderate

17. A 30 week old newborn develops sudden abdominal distension.no bowel sounds and bloody stools, necrotizing colititis was entertained. what is your next step?
A. Refer to surgery
B. observed the patient
C. Order for chest x-ray
D. Stop breastfeeding then shift to formula

18. Prophylaxis used for dental procedure in Infective endocaridities

A. Erithromycin
B. Azithromycin
C. Amaxicillin (Ans)

19. When do we schedule a follow up of a new born discharger before 48 hours?

A. Immediately see the LHC once they reach home
B.2-3 days after discharge
C. 5 days after discharge
D. 1 week after discharge

20. What is the hallmark of Atopic Dermatitis?

A. Cutaneous reactivity
B. Intense pruritus
C. Severely dry skin
D. Macro papular lesion

21. These are examples of second generation antihistamines:

A. Loratidine & hydroxyzine
B. Hydroxyzine & loratidine
C. Diphenhydramine & cetrizine
2 D. Loratadine & cetrizine

22. Secondary immunodeficiency transient to permanent can occur in?

A. Newborn to a HIV mother
B. Inhaled corticosteroids use
C. Measles before 6 months
2 D.4 year olds weight <2 SD

23. You examined a 7 year old Male child with recurrent episodes of brief staring spells, at the have of seizure he is unresponsive but can resume immediately to his previous activities. This condition happens 5-10 time a day. Patient had no fever during the seizure. What is you consideration?
2 A. Absence seizure
B. Simple partial seizure
C. Complex partial seizure
D. Myoclonic seizure

24. Which among following is an absolute contraindication to breastfeeding?

2 A. Baby diagnosed with galastosemia
B. Covid positive mother
C. Mother diagnosed with TB and treated with anti TB for 1 month
D. Mother with mastitis without abscess

25. Diffuse reticulo granular pattern of both lungs of chest radiography of a preterm neonate of respiratory distress is more consistent with
1 A) congenital pneumonia
B) transient tachypnea of the newborn
C) hyaline membrane disease
D) COVID 19 infection

26. ground glass appearance of both the lungs of chest radiogragy?

a. hyaline membrane disease
b. pneumania
c. CHF
d.?

27. 15yrs/f was seen at OPD with mild Diarrhea...history reveals that this condition is caused after eating milk products. What is the cause??
A) Ige mediated food allergy
B) non Ige mediated food allergy
C) food mediated with allergy
D) food mediated with toxins

28. A 4 month old Female was seen at the ER with difficulty in breathing. She had fever cough cold for 7 days, tachycardiac and sweating. There is cracking wheezing hepatomegaly, fair pulse. what is the possible diagnosis.
A. kawasaki disease
B. pericarditis
C. Heart Failure
D. Infective endocarditis

29. What is the Contraindications of performing lumbar puncture of including EXCEPT:

A) Suspected mass lesion of brain
B) Sign & Symptoms of impending cerebral herniation
C) Infection at the site of lumbar puncture
1 D Thrombocytopenia with the platelet count< 50 to 190/L

30. Major cause of neonatal mortality in full-term newborn is

A. Respiratory distress syndrome
B. Necrotizing enterocolitis
C. Bronchopulmonary dysplasia (BPD)
D. Congenital anomalies
E. Intraventricular hemorrhage

31. A new born have complete heart block on delivery, which maternal illness is associated with congenital complete heart block...???
A) alcohol abuse
1 B) SLE
C) preeclampsia
D) hypertension

32. Which of the following Jones criterion diagnosis Rheumatic fever?

1.Arthralgia
2.prolonged pr interval
2 3.hematoma mangnatia
4.Fever

33. A 1y old pateint came to ER with 7 days fever, unilateral cervical lymphadenopathy, erythema, strawberry tongue ,cracked lips,and has also conjunctivitis ,the impression is said to be Kawasaki disease, what type of conjunctivitis should the patient posess In order to show Kawasaki disease
A) unilateral
B) Inclusions in extremities up limbus
2 C) non-exudative
D) honey comb type conjunctivitis structure

34. Minor risk factor for recurrence febrile seizures except?

A. Complex febrile seizures
2 B. Age <1 yr
C. Male gender
D. Family history of febrile seizures

35. A 36 weeks old male, preterm neonate develops seizures and capillary blood glucose taken revealed a value of 20 mg/dl. The appropriate treatment is giving ____ through the peripheral vein.
A) 1 ml/kg of 50% dextrose
1 B) 1 ml/kg of 12.5% dextrose
C) 2 ml/kg of 10% dextrose
D) 5 ml/kg of 20% dextrose

36. The baby born with tachypnea and intercostal retraction noted few minutes after the birth. The PE revealed audible bowl sound from the left side of the chest to the abdomen. What will the initial management for the neonate........................?
A) Needle decompression of left side hemithorax
B) transillumination of right side hemithorax
C) decompression of the stomach with a nasopharyngeal tube
D)positive pressure ventilation T-piece resuscitator

37. Secondary immunodeficency can be transient or permanent can occur in any age and can be seen in one of the following conditions?
A) Baby born to HIV positive mother
B) asthmatic patient on inhaled corticosteroids > 2 weeks
C) Measles 6 months ago
D) 4 years old child whose weight is < -2 SD

38. What does not belong to the triad of Allergic Dermatitis

A. Nasal congestion
B. Rhinorrhea
C. Itching
D. Cough

39. A 5 yr old child seen in a opd with colour discoloration, clubbing of fingers and harsh murmur on pe. What's Ur consideration
a) VSD
b) ASD
c) TOF
d) PDA

40. On chest x-ray showed lateral downward movement of Apex which chamber is enlarged
a) right atrium
b) right ventricle
c) left ventricle
d) left atrium

41. A 6 years old complains of headache when arising in the morning from past 2 months, in addition from past 2 days he is experiencing head tilt, physical examination reveals difficulty in performing rapid alternating hand movements, the fundi is difficult to visualize, what should be the next evaluation?
A) An EEG
B) A CT
C) Lumbar puncture
D) A visit to the school psychologist

42. 5 year old child in OPD visit due to bluish discoloration, clubbing of nails and respiratory dystress?
A. ASD
B. VSD
C. AORTIC STENOSIS
D. PDA

43. Lymphocytes and antibody constitute the

A. Adaptive immunity
B. Innate immunity
C. natural immunity
D. Non-specific immune

44. Upon birth, murmur noted after being done with physical examinations, which of the ff disease can cause this murmur?
A) atrial septal defect
B) pulmonary Stenosis
C) hypoxic ischemic encephalopathy
D) sepsis

45. What is the ballade score of Neuromuscular

maturity=17 and Physical maturity=18 what is age of gestation (AGA)
A) 35
B) 36
C) 37
D) 38

46. By the age of 7 months old the Infant is able to do all the following, EXCEPT?
A. Transferring object from hand to hand, bounce actively
B. Cruise
C. Grasping with radial palm
D. Rolling over

47. You examine a 1day old baby with abnormal femoral pulse, weak upper extremity pulse and systolic murmur. What is the most appropriate impressions?
 A) Pulmonary stenosis
B) Aortic stenosis
C) Translocation of great vessels
D) Coarctation of aorta

48. Clinical features that be seen in patients with complement defects.

A. Recurrent diarrhea
B. Recurrent skin, mucosal and peri dontal disease.
C. Hereditary angioedema
D. Recurrent candidiasis

49. Headache for 2 year happen once every few months, feeling blur vision before headache not specific side but only one side What u do?
A) CT head
B) Lumbar puncture
C) Ergotamine
D) Reassures it is migraine benign

50. Which of the following about the epileptic seizure is considered at all levels for epileptic diagnosis for etiologic categories?
A. Genetic, structural, Metabolic, Immune, infectious, unknown.
B. Focal, generalized, and unknown onset.
C. Motor onset and non-motor onset.
D. Unclassified

51. What is the major Jones Criteria for the diagnosis of Rheumatic Fever.
A. Arthralgia
B. Prolonged PR interval
C. Fever
D. Erythema marginatum

52. A 16 year old female came to the OPD with a complaint of chest pain. She has no complaint of dyspnea and syncope. Persistant chest pain brought her to the opd. which of the following cardiac examinations will least benefit for diagnosis?
A) inspection
B) palpation
C) percussion
D) auscultation

53. Which of the following is not a drug management for congested heart failure
A. Flurosemide
B. Atropin
C. Carvedilol
D. Digoxin

54. A 3 days old A 40 week newborn develop jaunlice Exclusion breastfed......15 mg/dl. What is you mangement
incomple A. Phototherapy
B. Discontinuous breastfeeding
C. Observe only
D. ...............

55. Which of the following is not the major features of Atopic Dermatitis?
A. Flexural eczema in adolescent
B. Facial eczema in infant
C. Pruritic pustular rashes in hands feet and mouth
D. Extensor eczema in children

56. cranial ct is helpful for evaluation following condition except?

A. skull fractures
B. cranial hemorrhage
C. infarction
D. hydrocephalus

57. Apnea in a neonate is defined as

A. Sudden and brief cessation of respiration
B. Cessation of breathing for a period of ≥ 20 sec <20 sec associated with change in tone
C. Depressed respiratory center where there is a cessation of output from the central respiratory
D. Regular cycles of short apneic pauses and breath not associated with cyanosis and bradycardia

58. Antiepileptic drug in given in children in tonic clonic seizures

A. Phenobarbital
B. phenobarbital
C. Carbazepine
D. valporic acid

59. guidelines on the evaluation of a first unprotected nonfebrial seizure. Which of the following ———- Specific clinical situation.
A) head CT
B) head MRI
C) spinal top
D) EEG

60. What is clinical diagnosis for the first provoked afebrile seizure?
A. CT MRI
B. CT scan
C. EEG

61. A newbrom was noted complete heart block upaon delivery, which maternal illiness is associated with congenetive heart disease?
A) Alcohol absue
B) Hypertension
C) SLE
D) Preecalsemia

62. What is the most important risk factor for necrotizing enterocolitis (NEC) in preterm infants?
A- Cesarian Delevey
B- ... low brest feeding
C- exposure to glucocorticoids in the frist week of life
D- gestational age and birth weight

63. A newborn delivered at a lying in center was brought to the ER. On physical examination, the weight was 1.4kg, ballards scoring is 33 weeks, respiratory rate of 65 cpm, grunting with intercostal and subcostal retraction. What is the initial impression?
A) neonatal sepsis
B) neonatal pneumonia
C) respiratory distress syndrome
D) Transient tachypnea of the newborn

64. Infectious diseases that can cause intrauterine growth retardation include the following, EXCEPT:
A) Urinary tract infection
B) Rubella
C) CMV
D) Toxoplasmosis

65. The empirical treatment for Neonatal sepsis

A. Amoxicillin and aminogylcosides
B. Cefuroxime and ceftriaxone
C. Piperacillin and salbuctam
D. Ceftriaxone and Macrolides.

66. Physical examination of child finger you noted loss of angle between nail and cuticle area?
2 A. Clubbing
B. janeway lesion
C. Golum sign
D. Osler node

67. Which of the following is correct statement regarding fetal circulation?

A) The dominant ventricle is left ventricle
2 B) Circuit is a parallel type of circulation
C) Oxygenation mainly occurs in liver
D) Ligamentous arteriosum is a fetal structure

68. A lumbar puncture was done to patient with fever and seizure. CSF is reveal elevated open pressuring. Leucocyte 100000 protein 500 glucose<50 serum glucose. What ‘s plausible is initially.
2 A. Bacterial meningitis
B. Viral meningitis
C. Brain access
D. Tuberculous meningitis

69. What is the BP classification if between 95th and 99th percentile?

A. Pre hypertension
B. Normal
2 C. Stage 1 hypertension
D. Stage 2 hypertension

70. The most common status epilepticus.

2 A. Fever
B. CNs infection
C. medication change
 D. trauma

71. This sign is associated with Long standing arterial desaturation of more than 6 months
A. Hoff man rigler
B. Corrigan sign
C. Quincke's pulse
2 D. Schamroth sign

72. Which of the following Recommendation for prevention of food allergy

A. Use goat milk formula for high risk infant
B. Avoidance of high risk food
C. Early introduction of Soy
2 D. Introduction of low risk complementary food one at a time

73. A 3 day old a 40 weeks old was seen with jaundice. He was exclusively breastfed with bilirubin of 15mg/dl. What is your management?
2 A. Phototherapy
B. Exchange transfusion
C. Stop breast feeding
D. Observe

74. A 2yr old was admitted for 10 days of fever with conjunctivitis, lymphadenopathy, strawberry tongue , erthymeatous palms, check up done . Which among the following cardio sequencal is diagnosed and need repeated ECG
A. Myocarditis
B. Mitral Regurgitation
C. Peripheral Effusion
2 D. Coronary artery Abnormalities

75. A 2 months old had fever for 10 days with conjuctivities, lymphadenopathy, strawberry tongue and erythematous palm. Work up was done what is the cardiac sequela that needs close follow up and repeat echocardiogram
A. Myocarditis
B. Mitral regurgitation
C. Pericardial effusion
2 D. Coronary artery abnormalities

76. Which of the following is not helpful in diagnosis asthma in the patient in last 5 years?
A. Symptoms patter cough wheeze breathlessness nocturnal symptom
2 B. Past history of atopic dermatitis and allergic rhinitis
C. Therapitic trails of inhaled corticosteroids or PRN SABA
D. Evidence of variable airflow limitation by spirometry

77. 4 year old male child came in for sudden onset of tonic clonic seizures with circumoral cyanosis, upward rolling of eyeballs snd stiffening of both upper and lower extremities was brought to the ER seizures lasted > 15 minutes as a physician at the ER what is your initial management?
1. Airway, breathing, circulation
2 2. Give benzodiazepines
3. Management of underlying etiology
4. EEG

78. Rowena 10/f at ER, you diagnosed as Anaphylaxis and administered 1dose of Epinephrine which showed futher imrpovement what is your next step?
A. Send Rowena home
2 B. Monitor for 4hrs if there are no further complications send her home
C. Administer another dose or extra dose of epinephrine
D. Admit her

79. Neuroimaging is warranted in children with headache with following conditions except?
A) Abnormal Neurological examination
B) Afternoon headed
2 C) Headache in children
D) Brief cough headache

80. A 1 yr old baby refferered to op department cardiac patient section for a progressive cyanosis in infancy.mother assured that he is well from the beginning .only cyanosis noted 4 mnths ago.what drug did the mother used during pregnancy to cause congenital anomalies?
A) phenobarbital
B) valproic acid
2 C) retinoic acid
D) phenytoin

81. A new born delivered at a lying in central brought to ER. Weight 1.4kg, ballards score of 33 weeks and RR 65cpm with intercoastal and subcostal retractable. What is your initial impressions?
1. Neonatal sepsis
2. Neonatal pneumonia
3. RDS
4. Transient tachypnea

82. Which of the following statement is correct about management of atopic dermatitis?
A. Aims to cure the disease or this can be severe and fatal
B. Aims to induce remission of rash
C. Pharmacological treatment is the only way to prevent Recurrence to disease
D. No need to eliminate known triggers with available treatment.

83. An 18-month female, fell from a bed, a1- foot height while playing with her father. Patient cried and ran to her father. No loss of consciousness, vomiting nor changes in sensorium. PE was unremarkable. What is the risk score for intracranial injury of the patient?
A. Low
B. Moderate
C. High risk
D. Moderate to high

84. Which is true of fetal circulation?

A) ligamentum arteriosum
B) fetal oxygenation is through fetal lung
C) fetal circulation is parallel

85. A 4 y/o male with TOF came to emergency room for cyanosis, dyspnea and decreased sebsorium. What is the emergency management?
A. Prone Positioning
B. Withhold oxygen administration
2 C. Oral administration of morphine sulfate
D. Calming the child

86. A 17yr old male suddenly went into cardiac arrest while playing basketball. Which of the following is the most common condition of sudden death in the younger athelets?
A. Dilation cardiomyopathy
2 B. Hypertrophic cardiomyopathy
C. Restrictive cardiomyopathy
D. Congenital pericarditis