LE 2 PEDIA 2 2026 Flashcards
A 6-year-old diagnosed with acute asthma just received oxygen and salbutamol. What is the next step?
A. Start Inhaled Corticosteroids (Budesonide)
B. Give IV hydrocortisone
C. Add ipratropium bromide
D. Discharge if stable
A. Start Inhaled Corticosteroids (Budesonide)
Rationale: After initial bronchodilator and oxygen therapy in acute asthma, inhaled corticosteroids should be initiated early to reduce airway inflammation and prevent relapse. Budesonide is a commonly used inhaled steroid. Systemic corticosteroids may also be used, but the question points to inhaled steroids as the next logical step.
Q2: What is the most likely cause of head banging in a young child?
A. Focal seizures
B. Hypothyroidism
C. Improving mental status
D. Normal developmental/self-stimulatory behavior
D. Normal developmental/self-stimulatory behavior
Rationale: Head banging is commonly observed in infants and toddlers as a self-soothing behavior or self-stimulation. It is generally benign and only rarely indicates a neurological or psychiatric disorder unless associated with other red flags like developmental delays or regression.
Q3: A 15-year-old male smoker and basketball player is rushed to the ER after a game due to shortness of breath. On PE: pale, cyanotic nail beds, dullness to percussion. What is your impression?
A. Exercise-induced asthma
B. Pneumonia
C. Pulmonary embolism
D. Spontaneous pneumothorax
D. Spontaneous pneumothorax
Rationale: A tall, thin adolescent male smoker is at risk for spontaneous pneumothorax, especially during physical activity. Dullness to percussion suggests air in the pleural space with collapse of lung tissue. Cyanosis and sudden shortness of breath are classic presentations.
Q4: A 4-year-old child has a 3-day history of fever, barking cough, suprasternal retractions, and stridor. Suspecting laryngotracheobronchitis (croup), what is the most appropriate intervention?
A. Oral antibiotics
B. Salbutamol nebulization
C. Nebulize with racemic epinephrine
D. Chest physiotherapy
C. Nebulize with racemic epinephrine
Rationale: Croup is treated with nebulized racemic epinephrine in moderate to severe cases to reduce airway edema. The classic barking cough and stridor point to upper airway obstruction. Dexamethasone may also be given to reduce inflammation.
Q5: What is a characteristic feature of respiratory failure?
A. Hypernatremia
B. Hypertension
C. Hypoxia
D. Bradycardia
C. Hypoxia
Rationale: Respiratory failure is defined by the inability to maintain adequate gas exchange, resulting in hypoxemia (low arterial oxygen) and/or hypercapnia (elevated CO₂). Hypoxia is the most consistent and early indicator in respiratory failure.
Q6: What is the most significant finding of sinusitis in children?
A. Nasal congestion for 5 days
B. Sneezing with rhinorrhea
C. Common cold symptoms lasting more than 10 days
D. Fever for 1 day with clear nasal discharge
C. Common cold symptoms lasting more than 10 days
Rationale: The most reliable clinical sign of sinusitis in children is a viral URI (common cold) that persists beyond 10 days without improvement. This distinguishes bacterial sinusitis from a typical viral illness which usually resolves sooner.
Q7: Which of the following is NOT true about bacterial tracheitis?
A. Staphylococcus aureus is the most common pathogen
B. It is a primary infection
C. Presents with high fever and toxic appearance
D. It is usually secondary to a viral URI
B. It is a primary infection
Rationale: Bacterial tracheitis is typically a secondary infection, often following a viral upper respiratory tract infection such as croup. It presents with high fever, toxic appearance, and airway obstruction, and Staph aureus is the most common organism.
Q8: A 1-month-old infant presents with inspiratory stridor, noted since birth. He is otherwise healthy. What is the most important diagnostic tool?
A. Chest X-ray
B. Pulse oximetry
C. CT scan of the chest
D. Laryngoscopy
D. Laryngoscopy
Rationale: The most important diagnostic tool for evaluating stridor in infants is laryngoscopy, which directly visualizes the airway and identifies conditions such as laryngomalacia, the most common cause of congenital stridor.
Q9: A 2-year-old healthy child suddenly developed respiratory distress while playing. What is the most likely cause?
A. Asthma
B. Foreign body aspiration
C. Croup
D. Epiglottitis
B. Foreign body aspiration
Rationale: Sudden onset of respiratory distress in a previously healthy toddler while playing strongly suggests foreign body aspiration. It is a common pediatric emergency and often occurs during eating or playing with small objects.
Q10: A 1-year-old presents with 3 days of fever, barking cough, hoarseness, inspiratory stridor, and suprasternal retractions. What would you expect to see on neck X-ray?
A. Thumb sign
B. Steeple sign
C. Hyperinflated lungs
D. Ground-glass opacity
B. Steeple sign
Rationale: Croup (laryngotracheobronchitis) shows the “steeple sign” on neck X-ray — a narrowing of the subglottic trachea. It supports clinical diagnosis but is not always necessary if classic features (barking cough, stridor, hoarseness) are present.
Q11: A 1-year-old presents with difficulty of breathing, low-grade fever, cough, and rhinitis. He is playful and active, has mild respiratory distress with wheezing, and fine crepitant breath sounds. No prior history of wheezing. What is the most likely diagnosis?
A. Asthma
B. Acute bronchiolitis
C. Pneumonia
D. Foreign body aspiration
B. Acute bronchiolitis
Rationale: In infants with mild wheezing, low-grade fever, rhinitis, and crepitations without a history of asthma, the most likely diagnosis is acute bronchiolitis, commonly caused by RSV. The child being playful and feeding well also suggests a mild course.
Q12: Which of the following statements regarding bronchiectasis is inaccurate?
A. Bronchiectasis is permanent dilation of the bronchi
B. It commonly presents with recurrent productive cough
C. Cystic fibrosis is the most common cause worldwide
D. Hemoptysis may be a clinical feature
C. Cystic fibrosis is the most common cause worldwide
Rationale: While cystic fibrosis is a common cause in developed countries, it is not the most common cause worldwide. In many developing countries, post-infectious causes (like TB or severe pneumonia) are more frequent. Therefore, the statement is inaccurate.
Q13: A 5-year-old admitted for pneumonia was treated with Amikacin for 3 days but remains febrile with respiratory distress. PE shows dullness on percussion and decreased tactile fremitus on the right lung base. What is the most likely complication?
A. Bronchiolitis
B. Atelectasis
C. Empyema thoracis
D. Pulmonary edema
C. Empyema thoracis
Rationale: Persistent fever and respiratory distress despite antibiotic therapy, along with dullness to percussion and decreased fremitus, suggest a pleural space collection, most likely empyema thoracis, a complication of pneumonia due to pus accumulation.
Q14: Pleurisy (inflammation of the pleura) with pleural effusion is most commonly caused by which condition in children?
A. Congestive heart failure
B. Nephrotic syndrome
C. Pneumonia
D. Pulmonary embolism
C. Pneumonia
Rationale: The most common cause of pleural effusion in children is pneumonia, which can lead to parapneumonic effusion or empyema. Inflammatory effusions result from increased capillary permeability during infection.
Q15: An 8-year-old boy with known asthma has daytime symptoms more than 2 times a week and lung function less than 80%. What is his asthma classification?
A. Mild intermittent
B. Mild persistent
C. Moderate persistent
D. Severe persistent
C. Moderate persistent
Rationale: Moderate persistent asthma is defined by symptoms more than twice a week, some nighttime symptoms, and FEV₁ or PEFR 60–80% of predicted. These children often need daily controller therapy like ICS and possibly LABA.
Q16: A 5-year-old child is being treated for moderate asthma exacerbation. Which of the following interventions would be least likely done?
A. Oxygen therapy
B. Inhaled salbutamol
C. Systemic corticosteroids
D. Aminophylline
D. Aminophylline
Rationale: Aminophylline is rarely used today in the management of asthma due to its narrow therapeutic index and risk of toxicity. Current guidelines recommend oxygen, inhaled short-acting beta-agonists (SABA) like salbutamol, and systemic steroids for moderate exacerbations.
Q17: Which of the following is least likely seen in childhood tuberculosis?
A. Pulmonary aeration
B. Lymphadenopathy
C. Hilar opacities
D. Non-specific constitutional symptoms
A. Pulmonary aeration
Rationale: Decreased pulmonary aeration is expected in childhood TB due to airway obstruction by enlarged lymph nodes or consolidation. Hence, normal pulmonary aeration is least likely seen. TB in children often shows hilar lymphadenopathy, cough, weight loss, or fever.
Q18: What is the most widely used method to demonstrate TB infection in children?
A. Sputum culture
B. Chest X-ray
C. Mantoux test
D. GeneXpert
C. Mantoux test
Rationale: The Mantoux tuberculin skin test (TST) remains the most commonly used method to detect latent TB infection, especially in children. While GeneXpert and sputum tests are used to confirm active disease, Mantoux is widely used for screening.
Q19: What clinical manifestation is suggestive of tuberculosis disease in children?
A. Excessive weight gain
B. Loss of appetite
C. Productive cough only at night
D. Runny nose
B. Loss of appetite
Rationale: Loss of appetite, along with weight loss, prolonged cough, night sweats, and fever, is suggestive of TB disease in children. These are non-specific but concerning constitutional symptoms warranting further workup.
Q20: What is the recommended treatment for latent TB infection in children?
A. Rifampicin for 2 months
B. INH for 9 months
C. BCG vaccine booster
D. 4-drug anti-TB regimen
B. INH for 9 months
Rationale: The standard treatment for latent TB infection in children is Isoniazid (INH) for 9 months. This prevents progression to active TB and is preferred in high-risk populations, including young children and immunocompromised patients.
Q21: A 9-year-old boy with asthma uses salbutamol inhaler 3 times per week. For the past 2 weeks, he has been wheezing both day and night. On physical exam: diffuse wheezing and chest retractions. What is the next step in management?
A. Increase frequency of salbutamol use
B. Administer antihistamines
C. Give systemic corticosteroids (e.g., hydrocortisone)
D. Order a chest X-ray first
C. Give systemic corticosteroids (e.g., hydrocortisone)
Rationale: In a child with worsening asthma symptoms, including day and night wheezing with respiratory distress, the next step is to administer systemic corticosteroids to control inflammation. Hydrocortisone or prednisone helps prevent progression to severe asthma exacerbation.
Q22: Which of the following is an inaccurate statement regarding the most common clinical finding in Obstructive Sleep Apnea (OSA) in children?
A. Apnea during sleep
B. Snoring
C. Restless sleep
D. Mouth breathing
A. Apnea during sleep
Rationale: While apnea is a consequence of OSA, it is not the most common presenting symptom in children. The most common clinical findings are snoring, restless sleep, mouth breathing, and behavioral changes. Apnea episodes may occur but are less commonly noticed by caregivers.
Q23: A 5-month-old infant develops fever, rhinitis, barking cough, and inspiratory stridor. What is the most likely diagnosis?
A. Acute epiglottitis
B. Acute bronchiolitis
C. Croup (Laryngotracheobronchitis)
D. Foreign body aspiration
C. Croup (Laryngotracheobronchitis)
Rationale: The classic triad of barking cough, stridor, and preceding URI symptoms such as fever and rhinitis strongly suggest croup, especially in children aged 6 months to 3 years.
Q24: A toxic-looking child presents with high fever, stridor, respiratory distress, and drooling. What is the most likely diagnosis?
A. Foreign body aspiration
B. Acute epiglottitis
C. Bacterial tracheitis
D. Severe croup
B. Acute epiglottitis
Rationale: The combination of drooling, toxic appearance, high fever, stridor, and respiratory distress is classic for acute epiglottitis, a medical emergency often caused by Haemophilus influenzae type B (HiB). The child typically sits in a “tripod” position.
Q25: What virus most commonly causes croup in children?
A. Respiratory Syncytial Virus (RSV)
B. Influenza virus
C. Parainfluenza virus
D. Adenovirus
C. Parainfluenza virus
Rationale: The Parainfluenza virus is the most common causative agent of croup, especially in infants and young children. It leads to inflammation and narrowing of the subglottic area, resulting in the characteristic barking cough and stridor.
Q26: What is the most common causative agent of acute epiglottitis in children?
A. Streptococcus pneumoniae
B. Haemophilus influenzae type B (HiB)
C. Parainfluenza virus
D. Mycoplasma pneumoniae
B. Haemophilus influenzae type B (HiB)
Rationale: HiB is the classic and most common pathogen historically responsible for acute epiglottitis, especially in unvaccinated children. Since widespread HiB vaccination, its incidence has significantly decreased.
Q27: A 4-week-old infant presents with persistent stridor since birth, noisy breathing, suprasternal retractions, and is gaining weight adequately. What is the most likely diagnosis?
A. Tracheomalacia
B. Foreign body aspiration
C. Vocal cord paralysis
D. Laryngomalacia
D. Laryngomalacia
Rationale: Laryngomalacia is the most common cause of congenital stridor. It presents with inspiratory stridor that worsens when supine or feeding, but infants usually gain weight normally. It is often self-limiting.
Q28: A 3-year-old boy presents with fever and cough. On physical exam, which finding helps differentiate croup from acute epiglottitis?
A. Stridor
B. Drooling
C. Barking cough
D. Toxic appearance
C. Barking cough
Rationale: A barking (seal-like) cough is characteristic of croup and distinguishes it from epiglottitis, which presents with drooling, toxic appearance, and muffled voice. Both may have stridor, but the cough is the key differentiator.
Q29: A 3-year-old child tolerated the first 6 hours of surgery well. After surgery, the child developed dyspnea, tachycardia, and rapid respirations. On PE: decreased breath sounds and coarse rales on the right. What is the appropriate initial step in management?
A. Administer IV antibiotics
B. Order a chest X-ray
C. Deep breathing exercises, percussion, and postural drainage
D. Start bronchodilators
C. Deep breathing exercises, percussion, and postural drainage
Rationale: The child likely developed postoperative atelectasis or mucus plugging, a common cause of respiratory distress after surgery. Pulmonary hygiene (deep breathing, chest physiotherapy, and postural drainage) is the first-line intervention.
Q30: A term 3-kg newborn girl had a prenatal diagnosis of left congenital diaphragmatic hernia (CDH). At 24 hours of life, she developed tachypnea and retractions. Chest X-ray shows multiple lucent areas in the left lower thorax. Blood gases are normal. What is the most likely diagnosis?
A. Pulmonary hypoplasia
B. Neonatal pneumonia
C. Congenital cystic adenomatoid malformation (CCAM)
D. Meconium aspiration syndrome
C. Congenital cystic adenomatoid malformation (CCAM)
Rationale: Although the infant was diagnosed prenatally with CDH, the presence of multiple lucent areas in the thorax with normal blood gases suggests CCAM, a cystic lung lesion. CCAM can mimic CDH, but CDH typically leads to severe respiratory distress and abnormal ABGs due to lung compression and hypoplasia.
Q31: A 10-year-old boy developed pancreatitis after a blunt abdominal trauma. He was treated and discharged. Four weeks later, he presents again with abdominal pain and vomiting. What is the most likely diagnosis?
A. Acute recurrent pancreatitis
B. Pancreatic necrosis
C. Pancreatic pseudocyst
D. Cholelithiasis
C. Pancreatic pseudocyst
Rationale: A pancreatic pseudocyst is a known complication of pancreatitis, especially following trauma in children. It typically presents weeks after the initial episode with recurrent abdominal pain, vomiting, and sometimes a palpable mass or persistent elevated amylase.
Q32: A 6-week-old infant presents with a 3-week history of intermittent non-bilious vomiting. On PE: alert, mildly dehydrated, and a 1x1 cm olive-shaped mass is palpated in the right upper abdomen. What is the most likely diagnosis?
A. Gastroesophageal reflux
B. Intussusception
C. Congenital pyloric stenosis
D. Hirschsprung disease
C. Congenital pyloric stenosis
Rationale: The olive-shaped mass and projectile non-bilious vomiting in a first-born male infant are classic signs of pyloric stenosis, a hypertrophy of the pyloric muscle leading to gastric outlet obstruction.
Q33: Based on the diagnosis of congenital pyloric stenosis, which of the following electrolyte abnormalities is most expected?
A. Hyponatremic hyperkalemic metabolic acidosis
B. Hypochloremic hypokalemic metabolic alkalosis
C. Hypernatremic metabolic alkalosis
D. Hyperkalemic metabolic acidosis
B. Hypochloremic hypokalemic metabolic alkalosis
Rationale: Infants with pyloric stenosis lose hydrogen, chloride, and potassium from persistent vomiting, leading to hypochloremic hypokalemic metabolic alkalosis, a classic finding.
Q34: A 4-year-old girl presents with a 1-day history of painless maroon-colored stool. She is pale but not in distress. Hemoglobin is 9.8 g/dL, and PR is 110. What is the most appropriate test to establish the diagnosis?
A. Colonoscopy
B. Meckel scan (Technetium-99m pertechnetate)
C. Upper GI series
D. Abdominal ultrasound
B. Meckel scan (Technetium-99m pertechnetate)
Rationale: Painless lower GI bleeding in a young child is highly suggestive of Meckel’s diverticulum. The Meckel scan is the diagnostic test of choice as it detects ectopic gastric mucosa, which is often the source of bleeding.
Q35: An adolescent presents with recurrent abdominal pain, weight loss, and anemia. What is the most likely diagnosis?
A. Irritable bowel syndrome
B. Inflammatory bowel disease
C. Lactose intolerance
D. Peptic ulcer disease
B. Inflammatory bowel disease
Rationale: Chronic abdominal pain, weight loss, and anemia in adolescents strongly suggest Inflammatory Bowel Disease (IBD), especially Crohn’s disease or Ulcerative colitis, which also have extraintestinal manifestations and a relapsing-remitting course.
Q36: A 16-year-old girl presents with fever, anorexia, amenorrhea, and jaundice. Labs show total bilirubin 11 mg/dL, direct bilirubin 6 mg/dL. Hepatitis A, B, C, D, and E serologies are negative. Serum IgG is elevated (16.5 g/L). What is the most likely diagnosis?
A. Viral hepatitis
B. Autoimmune hepatitis (Chronic active hepatitis)
C. Wilson’s disease
D. Hepatitis E infection
B. Autoimmune hepatitis (Chronic active hepatitis)
Rationale: This is classic for autoimmune hepatitis, especially in adolescent girls, with elevated bilirubin, negative viral panel, and elevated IgG levels. Chronic active hepatitis is the older term for what is now referred to as autoimmune hepatitis.
Q37: A 10-year-old boy has a history of bloody diarrhea, tenesmus, and abdominal pain. He now presents with fever, hypotension, abdominal distension, and signs of toxic megacolon. What is the most likely diagnosis?
A. Crohn’s disease
B. Ulcerative colitis
C. Amebic colitis
D. Intestinal tuberculosis
B. Ulcerative colitis
Rationale: Toxic megacolon is a feared complication of ulcerative colitis, more common than in Crohn’s. The presence of bloody diarrhea, tenesmus, and systemic toxicity supports this diagnosis.
Q38: What is the gold standard diagnostic investigation for gastroesophageal reflux disease (GERD) in pediatric patients?
A. Chest X-ray
B. Barium swallow
C. Upper endoscopy
D. 24-hour esophageal pH monitoring
D. 24-hour esophageal pH monitoring
Rationale: The gold standard for diagnosing GERD in children is 24-hour pH monitoring, which quantifies acid exposure in the esophagus. Other tests like endoscopy or barium swallow may help but are not definitive.
Q39: A 6-month-old female presents with vomiting unrelated to feeds. Initially whitish, the vomitus becomes greenish. She is irritable, with sticky mucosa. PE reveals a soft, slightly tender abdomen with a palpable sausage-shaped mass. What is the most likely diagnosis?
A. Volvulus
B. Intussusception
C. Gastroenteritis
D. Hirschsprung disease
B. Intussusception
Rationale: The triad of colicky abdominal pain, vomiting (which becomes bilious), and a sausage-shaped abdominal mass is classic for intussusception, a common cause of intestinal obstruction in infants.
Q40: What is the next best step in the management of a stable infant diagnosed with intussusception?
A. Emergency surgery
B. Observation and IV fluids
C. Barium or air contrast enema
D. Upper GI endoscopy
C. Barium or air contrast enema
Rationale: The first-line treatment for intussusception in a hemodynamically stable child is a contrast enema (barium or air enema), which is both diagnostic and therapeutic. Surgery is reserved for complications or failed enema reduction.
Q41: A 5-year-old boy is being evaluated for dull, vague periumbilical abdominal pain for the past 3 months. Physical exam and labs are unremarkable. What is the most likely diagnosis?
A. Acute appendicitis
B. Functional abdominal pain
C. Constipation
D. Peptic ulcer disease
B. Functional abdominal pain
Rationale: Functional abdominal pain is common in school-aged children. It is typically periumbilical, vague, and chronic in nature without alarming signs (weight loss, blood in stool, or growth failure), and physical exam is usually normal.
Q42: A 5-month-old infant presents with vomiting for 1 day. On exam: alert, dry lips, moist mucosa, non-depressed fontanelle, and capillary refill time <2 seconds. Stool exam shows watery stool with <5 leukocytes. What is the appropriate management?
A. Start IV fluids
B. Admit for observation
C. Start Oral Rehydration Solution (ORS)
D. Begin antibiotics immediately
C. Start Oral Rehydration Solution (ORS)
Rationale: This is a case of viral gastroenteritis with mild dehydration. The child is alert with good perfusion, so the most appropriate management is oral rehydration therapy (ORS). No need for IV fluids or antibiotics at this stage.
Q43: A newborn developed increasing jaundice by the third week of life. On PE: soft, non-tender abdomen, with liver palpable 2 cm below left costal margin. You suspect biliary atresia. What is the most definitive test to confirm the diagnosis?
A. Hepatobiliary scan
B. Abdominal ultrasound
C. Serum direct bilirubin
D. Intraoperative cholangiography
D. Intraoperative cholangiography
Rationale: Intraoperative cholangiography is the gold standard for diagnosing biliary atresia. It directly visualizes bile duct patency. If biliary atresia is confirmed, early Kasai portoenterostomy (before 8 weeks) offers the best prognosis.
Q44: A 17-year-old student was struck in the abdomen with a paddle during fraternity initiation. After 24 hours, he develops fever, epigastric pain radiating to the back, and muscle guarding. What is the most appropriate diagnostic test?
A. Abdominal ultrasound
B. Serum lipase
C. Serum amylase
D. CT scan
C. Serum amylase
Rationale: Serum amylase is a widely used test for diagnosing acute pancreatitis, especially in the context of abdominal trauma. While lipase is more specific, amylase is still an acceptable and frequently used test in many settings.
Q45: What is the most likely cause of the patient’s pancreatitis in the previous case?
A. Gallstones
B. Viral infection
C. Cystic fibrosis
D. Traumatic injury
D. Traumatic injury
Rationale: In adolescents, blunt abdominal trauma (e.g., from a blow or injury during contact sports or hazing) is a common cause of acute pancreatitis, particularly when there’s no history of alcohol, gallstones, or systemic disease.
Q46: Why is it important to differentiate Crohn’s disease from ulcerative colitis?
A. Because of the presence of mucosal involvement only
B. Due to extraintestinal manifestations
C. Because Crohn’s never affects the colon
D. Because only Crohn’s is treated with steroids
B. Due to extraintestinal manifestations
Rationale: Both Crohn’s disease and ulcerative colitis can have extraintestinal manifestations, but they vary in frequency and severity between the two diseases. Crohn’s also has transmural and segmental involvement, while UC is continuous and limited to the mucosa.
Q47: An infant presents with severe respiratory distress immediately after birth. On PE, the infant has a barrel-shaped chest and a scaphoid abdomen. What is the most likely diagnosis?
A. Meconium aspiration syndrome
B. Tracheoesophageal fistula
C. Congenital diaphragmatic hernia
D. Pulmonary hypoplasia
C. Congenital diaphragmatic hernia
Rationale: A scaphoid abdomen and respiratory distress at birth, along with a barrel chest, are classic findings of congenital diaphragmatic hernia (CDH). Abdominal contents herniate into the chest, impairing lung development and function.
Q48: What is the most associated complication of congenital diaphragmatic hernia (CDH)?
A. Pneumothorax
B. Bronchopulmonary dysplasia
C. Pulmonary hypoplasia
D. Neonatal sepsis
C. Pulmonary hypoplasia
Rationale: The most significant and life-threatening complication of CDH is pulmonary hypoplasia, due to the herniated abdominal organs compressing developing lungs in utero, leading to underdeveloped alveoli and poor gas exchange.
Q49: A 4-year-old boy presents with chronic constipation. PE is normal, but on rectal exam: large ampulla, poor sphincter tone, and stool in the rectal vault are noted. What is the most appropriate management?
A. Immediate rectal biopsy
B. Refer for surgical intervention
C. Start on antibiotics
D. Advise reassurance and conservative management
D. Advise reassurance and conservative management
Rationale: These findings are more consistent with functional constipation rather than Hirschsprung’s disease (which would show a tight rectum with empty vault). Initial management includes reassurance, diet modification, and stool softeners before invasive testing.
Q50: An 18-year-old boy complains of recurrent epigastric pain relieved by antacids and milk. What is the most likely diagnosis?
A. Gastritis
B. Gastroesophageal reflux disease
C. Peptic ulcer disease
D. Functional dyspepsia
C. Peptic ulcer disease
Rationale: The classic presentation of peptic ulcer disease (PUD) is epigastric pain relieved by antacids or food (like milk). Risk factors include NSAID use, H. pylori infection, and stress. PUD can present in adolescents with chronic symptoms.
Q51: A full-term newborn presents with bilious vomiting, abdominal distension, has not passed meconium, and appears mildly dehydrated. What is the initial diagnostic procedure of choice?
A. Barium enema
B. Abdominal ultrasound
C. Plain abdominal X-ray
D. Upper GI endoscopy
C. Plain abdominal X-ray
Rationale: In a neonate with bilious vomiting and delayed meconium passage, intestinal obstruction (e.g., Hirschsprung’s disease, malrotation, or atresia) must be ruled out. Plain abdominal X-ray is the first-line imaging to identify air-fluid levels, bowel gas pattern, or signs of perforation.
Q52: A 14-year-old boy presents with jaundice, RUQ abdominal pain, nausea, vomiting, fever, and guarding. Chest exam is normal, and chest X-ray is unremarkable. What is the best diagnostic test to determine the cause of RUQ pain?
A. Abdominal CT scan
B. Chest X-ray
C. Liver function tests
D. Abdominal ultrasound
D. Abdominal ultrasound
Rationale: In a child with RUQ pain and jaundice, the most likely causes are hepatobiliary (e.g., cholecystitis, hepatitis, biliary obstruction). Abdominal ultrasound (UTZ) is the best initial imaging to assess gallbladder, bile ducts, and liver parenchyma.
Q53: Which of the following is the most common cause of lower intestinal obstruction in neonates, has a male predilection, and is associated with delayed passage of meconium?
A. Intussusception
B. Hirschsprung’s disease
C. Meconium ileus
D. Anorectal malformation
B. Hirschsprung’s disease
Rationale: Hirschsprung’s disease is the most common cause of lower intestinal obstruction in neonates. It’s characterized by aganglionic segments of the colon, leading to delayed meconium passage, abdominal distension, and often a male predilection (4:1 ratio).
Q54: In patients diagnosed with tracheoesophageal fistula (TEF), what is the most common type?
A. H-type fistula (without atresia)
B. Esophagus ends in a blind pouch; no fistula
C. Esophagus ends in a blind pouch with fistula from trachea to lower esophagus
D. Fistula from trachea to upper esophagus
C. Esophagus ends in a blind pouch with fistula from trachea to lower esophagus
Rationale: The most common type of TEF (over 85% of cases) involves a proximal esophageal atresia with a distal tracheoesophageal fistula, where the upper esophagus ends blindly and the lower segment communicates with the trachea.
Q55: Which of the following best describes esophageal achalasia?
A. Inflammation of the esophagus and lower esophageal sphincter
B. A primary motor disorder with loss of lower esophageal sphincter (LES) relaxation and peristalsis
C. Congenital narrowing of the esophagus
D. Mechanical obstruction due to esophageal varices
B. A primary motor disorder with loss of lower esophageal sphincter (LES) relaxation and peristalsis
Rationale: Esophageal achalasia is a primary esophageal motor disorder characterized by failure of LES to relax and absent peristalsis of the esophageal body. It leads to progressive dysphagia, regurgitation, and sometimes chest pain.
Q56: A neonate presents with bilious vomiting, abdominal distension, and tenderness. GI series reveals the ligament of Treitz abnormally located to the right of the midline. What statement is NOT correct about intestinal malrotation with volvulus?
A. It is a surgical emergency
B. Presents with bilious vomiting and abdominal distension
C. GI series confirms malrotation
D. It is not an emergency and will resolve spontaneously
D. It is not an emergency and will resolve spontaneously
Rationale: Malrotation with midgut volvulus is a surgical emergency due to the risk of intestinal ischemia and necrosis. Any suggestion that it will spontaneously resolve is incorrect. Prompt diagnosis and surgical intervention (Ladd procedure) is required.
Q57: A full-term newborn has copious oral secretions, drooling, and choking episodes. Nasogastric tube placement is unsuccessful and seen curling in the upper esophagus on X-ray. What is the most likely diagnosis?
A. Esophageal web
B. Tracheomalacia
C. Esophageal atresia
D. Pyloric stenosis
C. Esophageal atresia
Rationale: Esophageal atresia, especially with tracheoesophageal fistula, presents with drooling, difficulty feeding, and inability to pass an NGT (seen curling on X-ray). It is a neonatal emergency requiring surgical correction.
Q58: A 10-year-old boy presents with nausea, vomiting, loss of appetite, jaundice, and RUQ tenderness. Suspecting Hepatitis A, what is the correct serologic test to confirm diagnosis?
A. HBsAg and anti-HBc IgG
B. Anti-HAV IgM and anti-HAV IgG
C. Anti-HCV and RNA PCR
D. Liver biopsy
B. Anti-HAV IgM and anti-HAV IgG
Rationale: Hepatitis A is confirmed with anti-HAV IgM (indicates recent infection). Anti-HAV IgG indicates past infection or immunity. These serologic tests are non-invasive and diagnostic in the clinical setting of Hepatitis A.
Q59: Which of the following is a pathognomonic marker of active Hepatitis B infection?
A. Anti-HBs
B. Anti-HBc IgG
C. HBsAg (Hepatitis B surface antigen)
D. Anti-HBc IgM
C. HBsAg (Hepatitis B surface antigen)
Rationale: The presence of HBsAg is diagnostic of active Hepatitis B infection. It is the earliest marker to appear and indicates that the person is infected and potentially infectious.
Q60: A term newborn with features of Down syndrome presents with bile-stained vomiting four hours after feeding. Abdominal X-ray shows a double-bubble sign. What is the best initial step in management?
A. Give oral rehydration
B. Start immediate surgery
C. Insert nasogastric tube to decompress the stomach
D. Administer paracetamol
C. Insert nasogastric tube to decompress the stomach
Rationale: The double-bubble sign indicates duodenal atresia, which is common in infants with Down syndrome. The first step is to decompress the stomach with an NGT to prevent aspiration, followed by IV fluids and surgical correction.
Q61: A child with biliary atresia who underwent surgery 3 months ago develops esophageal varices. What physical exam finding suggests bleeding is from the esophagus?
A. Jaundice
B. Palmar erythema
C. Ascites
D. Splenomegaly
D. Splenomegaly
Rationale: Splenomegaly is a classic sign of portal hypertension, which can lead to esophageal varices in patients with chronic liver disease, such as those with biliary atresia post-Kasai. Variceal bleeding should be suspected in such cases with GI bleeding and splenomegaly.
Q62: A 17-year-old with fatigue, fever (38°C), jaundice, and a history of unprotected sexual intercourse has hepatomegaly and elevated AST (460) and ALT (760). Which viral hepatitis poses the highest risk for chronicity and cirrhosis?
A. Hepatitis A
B. Hepatitis B
C. Hepatitis C
D. Hepatitis E
C. Hepatitis C
Rationale: Among viral hepatitides, Hepatitis C carries the highest risk for chronic liver disease, including cirrhosis and hepatocellular carcinoma. While Hep B also poses a risk, Hep C is particularly insidious due to its often asymptomatic progression to chronicity.
Q63: A 10-year-old boy presents with localized right upper quadrant (RUQ) pain. Which condition is least likely the cause, considering typical location of pain and Alvarado Score findings?
A. Hepatitis
B. Acute cholecystitis
C. Acute appendicitis
D. Liver abscess
C. Acute appendicitis
Rationale: Appendicitis typically presents with right lower quadrant (RLQ) pain, not RUQ. Although early appendicitis may have vague periumbilical pain, RUQ tenderness specifically favors hepatobiliary causes. Alvarado Score is specific for appendicitis but relies on RLQ findings.
Q64: Gastroesophageal reflux disease (GERD) is the most common esophageal disorder across all ages. What is the most common symptom of GERD in infants?
A. Heartburn
B. Cough
C. Regurgitation
D. Failure to thrive
C. Regurgitation
Rationale: In infants, the most common symptom of GERD is regurgitation, due to immature lower esophageal sphincter tone. This is generally benign but may warrant evaluation if associated with poor weight gain or respiratory symptoms.
Q65: A 15-year-old boy presents with 2 weeks of fever, RUQ pain, hepatomegaly, and RLQ fullness. Four weeks prior, he took OTC medications for abdominal pain, nausea, and vomiting. There is no jaundice. What is the most likely diagnosis?
A. Hepatitis A
B. Acute appendicitis
C. Cholecystitis
D. Liver abscess
D. Liver abscess
Rationale: Prolonged fever, RUQ pain, and hepatomegaly, especially with a history of prior GI illness, point to liver abscess. It may be amebic or bacterial. Ultrasound is the diagnostic imaging of choice for confirmation.
Q66: A 5-year-old girl with known cirrhosis and portal hypertension presents with fever, increasing abdominal distension, and physical exam reveals shifting dullness and a positive puddle sign. What is the next best step in management?
A. Start empiric antibiotics
B. Chest X-ray
C. Paracentesis
D. Liver biopsy
C. Paracentesis
Rationale: In a child with ascites, fever, and cirrhosis, spontaneous bacterial peritonitis (SBP) must be ruled out. Paracentesis is the diagnostic procedure of choice. The most common causative organism in pediatric SBP is Streptococcus pneumoniae.
Q67: Which of the following statements about Hirschsprung’s Disease is false?
A. It presents with delayed passage of meconium
B. It involves aganglionic segments of the colon
C. It is associated with VATER syndrome
D. Rectal biopsy is the gold standard for diagnosis
C. It is associated with VATER syndrome
Rationale: Hirschsprung’s disease is a gastrointestinal motility disorder due to aganglionic segments of the colon. It is not typically associated with VATER syndrome, which includes vertebral, anal, tracheoesophageal, and renal anomalies. This makes option C false.
Q68: What is the primary cause of primary malnutrition in children?
A. Chronic disease
B. Malabsorption
C. Starvation
D. Infections
C. Starvation
Rationale: Primary malnutrition is due to inadequate intake of nutrients, commonly seen in cases of poverty, famine, or neglect—in short, starvation. This is in contrast to secondary malnutrition, which results from underlying diseases or conditions.
Q71: Refeeding syndrome is most commonly associated with which of the following electrolyte abnormalities?
A. Hyperphosphatemia
B. Hypophosphatemia
C. Hyperkalemia
D. Hypernatremia
B. Hypophosphatemia
Rationale: Refeeding syndrome occurs when malnourished patients are reintroduced to nutrition too quickly, leading to a shift of electrolytes into cells. The hallmark abnormality is hypophosphatemia, not hyperphosphatemia.
Q72: A child presents with bilateral lower extremity edema, irritability, and skin changes. What is the most likely diagnosis?
A. Marasmus
B. Kwashiorkor
C. Nephrotic syndrome
D. Beriberi
B. Kwashiorkor
Rationale: Kwashiorkor is a form of severe protein-energy malnutrition associated with edema, especially in the lower extremities, as well as irritability, fatty liver, and dermatoses. It differs from marasmus, which has severe wasting without edema.
Q73: According to WHO, what is the recommended vitamin A dose for the prevention of deficiency in a 2-year-old child?
A. 100,000 IU
B. 150,000 IU
C. 200,000 IU
D. 300,000 IU
C. 200,000 IU
Rationale: The World Health Organization recommends 200,000 IU of vitamin A every 4–6 months for children aged 12–59 months (including 2-year-olds) in areas with high risk of deficiency.
Q74: An infant who is exclusively breastfed by a vegan mother is most at risk of developing a deficiency in which of the following?
A. Vitamin A
B. Vitamin D
C. Vitamin B12
D. Folate
C. Vitamin B12
Rationale: Vitamin B12 is not found in plant-based foods, so vegan mothers may have low B12 stores, leading to B12 deficiency in exclusively breastfed infants, which can result in neurological damage and anemia if untreated.
Q75: What is the best tool to assess a child’s nutritional status?
A. BMI calculator
B. MUAC (Mid-upper arm circumference)
C. Growth chart
D. Weight-for-age alone
C. Growth chart
Rationale: The growth chart is the best and most comprehensive tool to assess nutritional status in children, as it tracks weight, height, and head circumference over time, allowing for comparison against standardized percentiles.
Q76: An 8-year-old boy presents with episodes of somnolence, cyanosis, hypoventilation, and sleep apnea. His BMI is 32 kg/m². What is the most important advice to give his mother?
A. Refer to ENT for adenoidectomy
B. Prescribe a stimulant
C. Start CPAP therapy immediately
D. Emphasize the need for weight reduction
D. Emphasize the need for weight reduction
Rationale: The child’s presentation is consistent with obesity hypoventilation syndrome or obstructive sleep apnea related to obesity. Weight reduction is the most important and sustainable intervention to address both the apnea and long-term health risks.
Q77: According to WHO, what is recommended as an additional primary treatment for diarrhea in children, along with ORS?
A. Multivitamins
B. Zinc
C. Iron supplements
D. Probiotics
B. Zinc
Rationale: Zinc supplementation is recommended by the WHO for 10–14 days in the treatment of acute diarrhea. It helps reduce severity, duration, and recurrence of diarrheal episodes in children.
Q78: Which feeding practice is associated with an increased risk of childhood obesity?
A. Offering a wide variety of fruits and vegetables
B. Scheduled meal times with balanced diet
C. Exposure to a limited range of food
D. Responsive feeding based on hunger cues
C. Exposure to a limited range of food
Rationale: Limited dietary variety often leads to nutritional imbalance and preference for high-calorie, low-nutrient foods, contributing to childhood obesity. A balanced, diverse diet with healthy choices is key to prevention.
Q79: An exclusively breastfed infant is brought to the clinic due to pallor. PE is unremarkable except for generalized paleness. What type of malnutrition is this?
A. Acute malnutrition
B. Chronic protein-energy malnutrition
C. Specific deficiency
D. Marasmus
C. Specific deficiency
Rationale: The most likely cause is iron deficiency anemia, a specific micronutrient deficiency. Exclusively breastfed infants beyond 4–6 months may need iron supplementation because breast milk is low in iron.
Q80: What is the most clinical indication of caloric malnutrition in children?
A. Night blindness
B. Edema
C. Growth failure
D. Angular stomatitis
C. Growth failure
Rationale: Caloric malnutrition leads to growth faltering, as energy intake is insufficient to support normal growth. It is often seen in undernutrition or wasting conditions like marasmus.
Q81: A 2-year-old boy with mild pneumonia is evaluated. PE shows: weight = 8 kg (Z-score < -3), height = 52 cm (Z-score < -3), MUAC < 11.5 cm, and bilateral pitting edema. According to WHO, how is his nutritional status classified?
A. Moderate acute malnutrition
B. Mild chronic malnutrition
C. Severe acute malnutrition
D. Specific micronutrient deficiency
C. Severe acute malnutrition
Rationale: WHO classifies severe acute malnutrition (SAM) based on weight-for-height Z-score < -3, MUAC < 11.5 cm, or presence of bilateral pitting edema. This child meets all three criteria, confirming SAM.
Q82: Which of the following is the most commonly used index to assess nutritional status in children?
A. Height-for-age
B. Weight-for-height
C. Weight-for-age
D. BMI-for-age
C. Weight-for-age
Rationale: Weight-for-age is the most widely used and easiest-to-measure index in many clinical settings to assess overall nutritional status, though it cannot distinguish between acute and chronic malnutrition.
Q83: For a child with Kwashiorkor Grade 2, what is the recommended transition period from stabilization to rehabilitation phase?
A. 1 day
B. 3 days
C. 7 days
D. 2 weeks
B. 3 days
Rationale: In the management of severe malnutrition, including Kwashiorkor, WHO recommends transitioning from the stabilization to rehabilitation phase over approximately 3 days, once the child is clinically stable and can tolerate higher-calorie feeds.
Q84: A child is diagnosed with Kwashiorkor. Which of the following findings is most likely?
A. Muscle wasting without edema
B. Sunken eyes and dehydration
C. Edema and hypopigmented hair/skin
D. Macroglossia
C. Edema and hypopigmented hair/skin
Rationale: Kwashiorkor is characterized by edema, hypopigmented hair, skin changes, and apathy, due to protein deficiency. It contrasts with marasmus, which presents with wasting without edema.
Q85: A child diagnosed with iron deficiency anemia is being treated with oral iron. To replenish stores and prevent recurrence, treatment should be continued for how long?
A. 2 months
B. 3 months
C. 5 months
D. 6 weeks
C. 5 months
Rationale: After hemoglobin levels normalize, oral iron supplementation should be continued for at least 2–3 months to replenish iron stores. Total treatment duration is usually around 5 months for full recovery and prevention of relapse.
Q86: A 6-week-old preterm infant presents with progressive pallor and peripheral edema. Peripheral blood smear shows anemia, elevated reticulocyte count, and thrombocytosis. What is the best management for this infant?
A. Iron supplementation
B. Blood transfusion
C. Administer vitamin E
D. Erythropoietin therapy
C. Administer vitamin E
Rationale: Preterm infants are at risk for vitamin E deficiency, which can lead to hemolytic anemia. The presentation of anemia with elevated reticulocyte count and thrombocytosis is suggestive of this. Vitamin E helps stabilize red blood cell membranes and correct the deficiency.
Q87: Once nutritional rehabilitation begins for a malnourished child, which of the following statements is incorrect?
A. Feeding should be gradual and monitored
B. Micronutrient supplementation should be started
C. Iron supplementation is immediately recommended
D. Electrolyte imbalances should be corrected
C. Iron supplementation is immediately recommended
Rationale: Iron supplementation is delayed until after the initial stabilization phase (usually after 7 days), once the child is stable and infection is addressed. Early iron therapy may worsen infections and oxidative stress during the early rehabilitation phase.
Q88: A child presents with a triad of tremor, neuropsychiatric symptoms, and gingivostomatitis. What is the most likely diagnosis?
A. Lead poisoning
B. Mercury poisoning
C. Arsenic poisoning
D. Iron toxicity
B. Mercury poisoning
Rationale: The classic triad for chronic mercury poisoning includes tremors, neuropsychiatric disturbances (like irritability or memory problems), and gingivostomatitis (inflammation of the gums and mouth).
Q89: A 2-year-old boy accidentally ingested isoniazid (INH) tablets prescribed to his older brother. He presents 4 hours later with a generalized seizure. What is the drug of choice to treat the seizure?
A. Diazepam
B. Phenytoin
C. Pyridoxine
D. Sodium bicarbonate
C. Pyridoxine
Rationale: INH toxicity causes seizures due to pyridoxine (vitamin B6) deficiency. The treatment of choice is pyridoxine, given in a dose equal to the amount of INH ingested (mg per mg). Benzodiazepines are ineffective in this scenario without B6 replacement.
Q90: A child presents with vomiting, metabolic acidosis, and an abdominal X-ray reveals multiple pill fragments after suspected iron overdose. What is the most effective decontamination procedure?
A. Gastric lavage
B. Whole bowel irrigation
C. Activated charcoal
D. Induced emesis
B. Whole bowel irrigation
Rationale: Iron tablets are not effectively bound by activated charcoal. In cases of iron overdose with visible pills on X-ray, whole bowel irrigation is the preferred method to flush out unabsorbed iron and reduce toxicity.
Q91: What is the initial management for a child who accidentally ingested a corrosive agent?
A. Induce vomiting
B. Administer activated charcoal
C. Administer large amounts of water or milk
D. Immediate endoscopy
C. Administer large amounts of water or milk
Rationale: In cases of corrosive ingestion, dilution with water or milk is the first-line management. Inducing vomiting or using charcoal is contraindicated due to the risk of re-exposing the esophagus to the corrosive substance.
Q92: What organ is primarily affected in acetaminophen poisoning in children?
A. Brain
B. Kidneys
C. Liver
D. Heart
C. Liver
Rationale: Acetaminophen (paracetamol) overdose causes dose-dependent hepatotoxicity, which can lead to acute liver failure. Hepatic necrosis is the most serious complication, and N-acetylcysteine (NAC) is the antidote.
Q93: Why are pedestrian injuries common in children aged 5–9 years?
A. They are often left unsupervised
B. They run impulsively across roads
C. They have poor ability to judge distance and speed of traffic
D. They often cross at night
C. They have poor ability to judge distance and speed of traffic
Rationale: Children between 5–9 years often lack the cognitive and perceptual skills to accurately judge the speed and distance of oncoming vehicles, making them vulnerable to pedestrian injuries, especially when crossing streets.
Q94: A 6-year-old boy crossing the street alone is hit by a car. Why are injuries in this age group common?
A. They are not taught to look both ways
B. They often chase balls into the street
C. They have poor ability to judge traffic speed and distance
D. They are small and less visible to drivers
C. They have poor ability to judge traffic speed and distance
Rationale: Like question 93, this highlights the developmental limitations of children in estimating the relative speed and distance of moving objects, making them more prone to traffic-related injuries.
Q95: Which of the following is NOT a typical injury seen in a 2-year-old child?
A. Falls from furniture
B. Burns from hot liquids
C. Accidental ingestion of poisons
D. Bicycle accidents
D. Bicycle accidents
Rationale: Bicycle accidents are more common in older children. In 2-year-olds, typical injuries include falls, burns, and accidental ingestion. They lack the coordination and size for independent bicycle riding, making this the exception.
Q96: Which of the following is NOT an indication for hospitalization of a pediatric burn patient?
A. Burns involving the face or perineum
B. Inhalation injury
C. Burns involving more than 10% of the body surface area (BSA)
D. Burns that are 10% or less of the BSA and superficial
D. Burns that are 10% or less of the BSA and superficial
Rationale: Minor burns (<10% BSA, superficial) can usually be managed outpatient, unless located in critical areas (e.g., face, hands, perineum) or associated with complications. The rest are valid indications for hospital admission.
Q97: The use of helmets, seatbelts, and protective gear (like knee and elbow pads) in children primarily serves to:
A. Eliminate the risk of injury
B. Prevent all forms of accidents
C. Reduce likelihood of injury by modifying energy transfer to the body
D. Ensure legal compliance with traffic laws
C. Reduce likelihood of injury by modifying energy transfer to the body
Rationale: These protective devices work by absorbing or redirecting energy during impact, thereby reducing injury severity. They do not eliminate injury entirely but mitigate the effects of trauma during accidents.
