[PEDIA2] LE6 2026

Question 1

A male child presents with repeated urinary tract infections and failure to gain weight. Micturating cystourethrogram (MCUG) shows dilation of the prostatic urethra and posterior urethral valves. What is the most likely diagnosis?

A. Vesicoureteral reflux
B. Posterior urethral valves
C. Urethral stricture
D. Bladder outlet obstruction

Answer 1

B. Posterior urethral valves

Rationale:

Posterior urethral valves are a common cause of urinary tract infections (UTIs) and failure to thrive in male infants.

They cause bladder outlet obstruction, leading to dilation of the prostatic urethra and hydronephrosis.

MCUG is typically used to diagnose posterior urethral valves.

Question 2

A 6-month-old male has bilateral abdominal masses and hypertension. His older sister died as a neonate, and his mother had polyhydramnios during pregnancy. What is the most likely diagnosis?

A. Polycystic kidney disease
B. Hydronephrosis
C. Renal vein thrombosis
D. Acute tubular necrosis

Answer 2

A. Polycystic kidney disease

Rationale:

Polycystic kidney disease (PKD) can present in infancy with bilateral abdominal masses and hypertension.

The family history (sister dying as a neonate) and polyhydramnios during pregnancy are strong indicators of autosomal recessive PKD, which often presents in neonates or infants with renal failure and enlarged kidneys.

Question 3

The most common intrinsic cause of acute kidney injury in childhood is:

A. Glomerulonephritis
B. Acute tubular necrosis
C. Interstitial nephritis
D. Renal artery thrombosis

Answer 3

B. Acute tubular necrosis

Rationale:

Acute tubular necrosis (ATN) is the most common intrinsic cause of acute kidney injury (AKI) in children.

It is often caused by ischemia or nephrotoxic agents (such as medications or infections).

ATN results in damage to the renal tubules, impairing their function and leading to acute kidney injury.

Question 4

The classic electrolyte disturbance seen in renal tubular acidosis is:

A. Hyperkalemic metabolic acidosis
B. Hypokalemic metabolic acidosis
C. Hyperchloremic metabolic acidosis
D. Hypochloremic metabolic acidosis

Answer 4

C. Hyperchloremic metabolic acidosis

Rationale:

Renal tubular acidosis (RTA) results in hyperchloremic metabolic acidosis, which is due to a failure in renal acidification.

The kidneys cannot properly excrete hydrogen ions, leading to increased chloride in the blood to maintain electrochemical balance.

Question 5

A newborn presents with gross hematuria noted when the diaper was changed. It was born at term and was further complicated by gestational diabetes. Physical examination reveals lethargy, dry mucous membranes, hypertension, and a right-sided flank mass. What is the most likely cause of hematuria?

A. Renal vein thrombosis
B. Polycystic kidney disease
C. Hydronephrosis
D. Urinary tract infection

Answer 5

A. Renal vein thrombosis

Rationale:

Renal vein thrombosis (RVT) is a common cause of gross hematuria in newborns and can be associated with gestational diabetes.

Abdominal mass, hypertension, and lethargy are typical features.

RVT can lead to kidney ischemia and hematuria due to impaired venous drainage.

Question 6

Hemolytic uremic syndrome (HUS) is characterized by the triad of:

Microangiopathic hemolytic anemia, thrombocytopenia, and kidney dysfunction.
What is the evidence of renal injury in HUS?

A. Proteinuria
B. Hematuria
C. Hyperkalemia
D. Increased serum creatinine

Answer 6

B. Hematuria

Rationale:

Hemolytic uremic syndrome (HUS) often leads to kidney dysfunction, and hematuria is one of the early signs of renal injury in HUS.

Other renal manifestations may include proteinuria, increased creatinine, and oliguria, but hematuria is a key feature associated with kidney involvement in HUS.

Question 7

A 12-year-old girl is diagnosed with nephrotic syndrome secondary to systemic lupus erythematosus (SLE). What is the most common type of secondary nephrotic syndrome in SLE?

A. Minimal change disease
B. Focal segmental glomerulosclerosis
C. Membranous nephropathy
D. IgA nephropathy

Answer 7

C. Membranous nephropathy

Rationale:

Membranous nephropathy is the most common form of secondary nephrotic syndrome in patients with systemic lupus erythematosus (SLE).

It is characterized by thickening of the glomerular basement membrane and is commonly associated with nephrotic-range proteinuria.

Question 8

Alport syndrome is a progressive disorder involving the glomerular basement membrane (GBM). Which of the following is NOT a feature of Alport syndrome?

A. Sensorineural deafness
B. Hematuria
C. Proteinuria
D. Visual impairment
E. Renal failure

Answer 8

D. Visual impairment

Rationale:

Alport syndrome is characterized by sensorineural deafness, hematuria, proteinuria, and renal failure.

While visual impairment can occur in some patients, it is not a hallmark feature of Alport syndrome. The primary issues are related to the kidneys, ears, and eyes, but visual impairment is not as characteristic as the other listed features.

Question 9

In a patient with post-streptococcal glomerulonephritis (PSGN), the most specific antibody marker is:

A. Anti-streptolysin O (ASO)
B. Anti-DNase B
C. Anti-hyaluronidase
D. Streptococcal antibody titer

Answer 9

B. Anti-DNase B

Rationale:

Anti-DNase B is the most specific antibody marker in post-streptococcal glomerulonephritis (PSGN).

Elevated anti-DNase B levels indicate recent streptococcal infection, which can trigger PSGN.

Question 10

A 5-year-old patient has growth retardation secondary to chronic kidney disease. Which of the following is NOT recommended for management?

A. Increased caloric intake
B. Increased protein intake
C. Recombinant growth hormone
D. Vitamin D analogs

Answer 10

B. Increased protein intake

Rationale:

In chronic kidney disease (CKD), especially in growth retardation, it is not recommended to increase protein intake as it can worsen kidney function due to increased nitrogenous waste.

The management usually includes increased caloric intake, recombinant growth hormone for growth, and vitamin D analogs for bone health and calcium-phosphorus metabolism.

Question 11

A 10-year-old boy presents with cola-colored urine, oliguria for 3 days, facial puffiness, edema, and hypertension. Urinalysis is positive for proteinuria and hematuria, and C3 levels are decreased. He had a skin infection 2 weeks prior. What is the most likely diagnosis?

A. Acute post-streptococcal glomerulonephritis
B. Nephrotic syndrome
C. IgA nephropathy
D. Henoch-Schönlein purpura

Answer 11

A. Acute post-streptococcal glomerulonephritis

Rationale:

The presentation of cola-colored urine, edema, hypertension, proteinuria, and hematuria with a history of a skin infection (likely impetigo) two weeks prior is classic for acute post-streptococcal glomerulonephritis.

The decreased C3 levels also support the diagnosis, as this is a key finding in PSGN.

Question 12

Straining and dribbling of urine in a male child with recurrent urinary tract infections (UTIs) should raise suspicion for:

A. Vesicoureteral reflux
B. Posterior urethral valves
C. Urethral stricture
D. Bladder outlet obstruction

Answer 12

B. Posterior urethral valves

Rationale:

Posterior urethral valves are a common cause of straining and dribbling of urine in male children and can lead to recurrent UTIs.

This condition results in bladder outlet obstruction, leading to urinary retention and recurrent infections.

Question 13

The most accurate diagnostic test for acute pyelonephritis in children is:

A. Urinalysis
B. Ultrasound
C. Dimercaptosuccinic acid (DMSA) scan
D. Voiding cystourethrogram (VCUG)

Answer 13

C. Dimercaptosuccinic acid (DMSA) scan

Rationale:

The DMSA scan is the most accurate test for diagnosing acute pyelonephritis in children. It detects renal cortical scarring and inflammation, which is characteristic of acute pyelonephritis.

Other tests like urinalysis or ultrasound may help, but the DMSA scan is the gold standard for acute kidney involvement.

Question 14

A 16-year-old boy notices a painless mass in the left side of the scrotum. What is the most likely diagnosis?

A. Hydrocele
B. Epididymitis
C. Varicocele
D. Testicular torsion

Answer 14

C. Varicocele

Rationale:

Varicocele is a common cause of a painless scrotal mass in adolescent males.

It is characterized by dilated veins in the spermatic cord and is often described as a “bag of worms” upon palpation.

Varicoceles can cause infertility and are more prominent when standing.

Question 15

A newborn delivered to a G2P1 mother with oligohydramnios and abdominal findings of the newborn showed a single umbilical artery. This condition is most commonly associated with:

A. Renal agenesis
B. Polycystic kidney disease
C. Neonatal lupus
D. Down syndrome

Answer 15

A. Renal agenesis

Rationale:

A single umbilical artery is commonly associated with renal agenesis or renal hypoplasia.

Oligohydramnios often results from renal agenesis, as the kidneys are not functioning properly to produce amniotic fluid.

While polycystic kidney disease and other conditions may also present with abnormal findings, renal agenesis is the most common association with a single umbilical artery.

Question 16

A 10-year-old boy presents with gross hematuria, loin pain, and a recent history of diarrhea. On laboratory workup, urinalysis is unremarkable, and serum C3 levels are normal. What is the most likely diagnosis?

A. IgA nephropathy (Berger disease)
B. Hemolytic uremic syndrome (HUS)
C. Post-streptococcal glomerulonephritis (PSGN)
D. Alport syndrome

Answer 16

A. IgA nephropathy (Berger disease)

Rationale:

IgA nephropathy (Berger disease) typically presents with gross hematuria following an upper respiratory infection or gastrointestinal infection like diarrhea.

The normal serum C3 levels help differentiate IgA nephropathy from post-streptococcal glomerulonephritis (PSGN), which is associated with low C3 levels.

The unremarkable urinalysis is consistent with the diagnosis.

Question 17

Answer 17

B. Renal biopsy

Rationale:

In APSGN, persistent low serum C3 levels, persistent hematuria, and elevated serum creatinine after 4 weeks suggest complicated PSGN or the possibility of a secondary renal disease.

Renal biopsy is the most appropriate next step to evaluate the kidney’s pathology and rule out other conditions, such as IgA nephropathy or focal segmental glomerulosclerosis.

Corticosteroids are not typically indicated for PSGN, and dialysis is only required if there is acute kidney failure.

Question 18

Answer 18

Question 19

Which of the following statements about acute osteomyelitis in children is CORRECT?

A. It is most commonly caused by viral infections.
B. It only affects flat bones.
C. Blood cultures are rarely positive.
D. It can result from either streptococcal pharyngitis or staphylococcal infections.

Answer 19

Question 20

Wilms tumor is the most common malignant tumor of the genitourinary tract in children. What is the most common presenting sign?

A. Hematuria
B. Hypertension
C. Painful abdominal mass
D. Painless abdominal mass

Answer 20

D. Painless abdominal mass

Rationale:

The most common presenting sign of Wilms tumor in children is a painless abdominal mass.

Hematuria and hypertension can also occur but are less frequent than a palpable mass.

The mass is typically detected during routine examination or when parents notice abdominal enlargement in the child.

Question 21

Which of the following statements about pyuria in children is INACCURATE?

A. Defined as urine output <0.3 mL/kg/hr
B. May be caused by acute tubular necrosis
C. Presence of ≥5 WBCs/high power field (hpf) is normal in girls
D. Post-renal causes should be ruled out in obstructive symptoms

Answer 21

C. Presence of ≥5 WBCs/hpf is normal in girls

Rationale:

Pyuria is defined as the presence of ≥5 WBCs/high power field (hpf) in the urine.

While pyuria can be caused by acute tubular necrosis, it is not considered normal in girls to have ≥5 WBCs/hpf without the presence of infection.

Post-renal causes should always be ruled out in cases of obstructive symptoms, as these may lead to urinary tract infections or other complications.

Question 22

How is renal failure defined in children in terms of urine output?

A. Urine output <0.5 mL/kg/hour
B. Urine output <0.3 mL/kg/hour
C. Urine output <1 mL/kg/hour
D. Urine output <2 mL/kg/hour

Answer 22

B. Urine output <0.3 mL/kg/hour

Rationale:

Oliguria is defined as urine output of <0.3 mL/kg/hour in children.

This is one of the key indicators used in diagnosing acute renal failure or acute kidney injury (AKI) in pediatric patients.

Question 23

Which of the following is the least commonly observed clinical feature in post-streptococcal glomerulonephritis (PSGN)?

A. Hematuria
B. Edema
C. Hypertension
D. Renal failure

Answer 23

D. Renal failure

Rationale:

The classic presentation of post-streptococcal glomerulonephritis (PSGN) includes hematuria, edema, and hypertension.

Renal failure is not commonly observed in PSGN, as the condition usually resolves with supportive care. Severe renal failure may occur in rare, complicated cases, but it is not a typical feature.

Question 24

A 1-year-old child presents with recurrent urinary tract infections (UTIs). Renal ultrasound reveals bilaterally enlarged kidneys. What is the best next diagnostic test?

A. Renal biopsy
B. Voiding cystourethrogram (VCUG)
C. Urinary protein test
D. MRI of the kidneys

Answer 24

B. Voiding cystourethrogram (VCUG)

Rationale:

A VCUG is indicated in children with recurrent UTIs and bilateral kidney enlargement to assess for vesicoureteral reflux (VUR), a common cause of recurrent infections in children.

The test helps to evaluate if urine is refluxing back into the kidneys, leading to infections.

Question 25

Answer 25

B. Ureteropelvic junction (UPJ) obstruction Rationale: Ureteropelvic junction (UPJ) obstruction is a common cause of hydronephrosis in children, often presenting with recurrent UTIs and an abdominal mass. E. coli is a common pathogen in UTIs, and the finding of hydronephrosis on imaging further supports the diagnosis of UPJ obstruction.

Question 26

Which of the following statements about the management of nephrotic syndrome in children is CORRECT? A. Most children require immediate renal biopsy. B. Diuretics are the first-line treatment. C. Antibiotics are routinely used for prevention. D. Steroids are ineffective in children. E. Most children with minimal change disease respond well to steroids.

Answer 26

E. Most children with minimal change disease respond well to steroids.

Question 27

What is the most common infection in a child with nephrotic syndrome? A. Urinary tract infection (UTI) B. Spontaneous bacterial peritonitis (SBP) C. Pneumonia D. Meningitis

Answer 27

B. Spontaneous bacterial peritonitis (SBP) Rationale: Children with nephrotic syndrome are prone to encapsulated bacterial infections, particularly spontaneous bacterial peritonitis (SBP), due to hypogammaglobulinemia, edema, and loss of complement factors. Streptococcus pneumoniae is the most common causative organism in SBP.

Question 28

What is the most common underlying anomaly in children with recurrent urinary tract infections (UTIs)? A. Hydronephrosis B. Vesicoureteral reflux (VUR) C. Posterior urethral valves D. Ureteropelvic junction obstruction

Answer 28

B. Vesicoureteral reflux (VUR) Rationale: Vesicoureteral reflux (VUR) is the most common underlying anomaly in children with recurrent UTIs. VUR allows retrograde flow of urine from the bladder to the ureters and kidneys, increasing the risk of recurrent pyelonephritis, renal scarring, and chronic kidney disease if left untreated.

Question 29

In post-streptococcal glomerulonephritis (PSGN), which complement and antibody levels are altered? A. C3: Increased, ASO titer: Decreased B. C3: Decreased, ASO titer: Increased C. C3: Decreased, ASO titer: Decreased D. C3: Normal, ASO titer: Increased

Answer 29

B. C3: Decreased, ASO titer: Increased Rationale: In post-streptococcal glomerulonephritis (PSGN), C3 levels are decreased due to activation of the alternative complement pathway. Anti-streptolysin O (ASO) titers are typically increased, reflecting a recent streptococcal infection. The C3 levels usually normalize within 6-8 weeks after the onset of PSGN.

Question 30

A child presents with a history of hematuria, fever, and tea-colored urine. During the course of this disease, all of the following complications may occur EXCEPT: A. Hypertension B. Acute kidney injury C. Encephalopathy D. Electrolyte disturbances E. Hypoalbuminuria

Answer 30

E. Hypoalbuminuria

Question 31

Which of the following are known complications of post-streptococcal glomerulonephritis (PSGN)? A. Hypertensive encephalopathy B. Acute renal failure C. Metabolic acidosis D. All of the above

Answer 31

D. All of the above

Question 32

In approximately 25% of children under 10 years old with recurrent urinary tract infections (UTIs), which underlying condition is commonly associated? A. Hydronephrosis B. Ureteropelvic junction (UPJ) obstruction C. Vesicoureteral reflux (VUR) D. Posterior urethral valves

Answer 32

Question 33

Generalized edema in nephrotic syndrome is best treated with? A. Prednisone B. Diuretics C. Angiotensin-converting enzyme (ACE) inhibitors D. Immunosuppressive therapy

Answer 33

Question 34

Which of the following is a common anomaly of the urinary tract in children? A. Hypospadias B. Polycystic kidney disease C. Renal agenesis D. Ureterocele

Answer 34

Question 35

Answer 35

Question 36

What is the most common cause of chronic renal failure in children that leads to renal transplantation? A. Glomerulonephritis B. Obstructive uropathy C. Polycystic kidney disease D. Diabetes mellitus

Answer 36

Question 37

Which of the following findings is an indication for performing a renal biopsy in a child with nephrotic syndrome? A. Age between 2–6 years B. Excellent response to steroids within 2 weeks C. Normal serum complement levels D. Low serum complement levels at presentation

Answer 37

D. Low serum complement levels at presentation

Question 38

In a child with recurrent urinary tract infections (UTI), ultrasound of the kidneys and urinary bladder (KUB) is done to rule out which of the following? A. Vesicoureteral reflux (VUR) B. Posterior urethral valves C. Renal cell carcinoma D. Acute pyelonephritis

Answer 38

B. Posterior urethral valves

Question 39

A 4-month-old infant is brought in for a routine well-baby consultation. Which of the following findings would NOT suggest a neurodevelopmental problem? A. Poor head control B. Absence of social smile C. Persistent primitive reflexes D. Positive Babinski sign

Answer 39

D. Positive Babinski sign Rationale: A positive Babinski reflex (dorsiflexion of the big toe when the sole is stroked) is normal up to 1–2 years of age and does not suggest a neurodevelopmental problem. The other findings (poor head control, absence of social smile, and persistent primitive reflexes) are red flags for delayed neurodevelopment.

Question 40

In making a diagnosis of meningitis in children, which of the following statements is NOT correct? A. Fever and altered mental status are common symptoms B. A positive Kernig or Brudzinski sign should always be present C. Lumbar puncture is the gold standard for diagnosis D. Seizures may be a presenting feature

Answer 40

B. A positive Kernig or Brudzinski sign should always be present Rationale: Kernig and Brudzinski signs are classic signs of meningeal irritation, but they may be absent, especially in infants or young children. The absence of these signs does not rule out meningitis. Lumbar puncture is the gold standard for diagnosing meningitis, and fever, altered mental status, and seizures may be present.

Question 41

Answer 41

D. Subtle seizure Rationale: Subtle seizures are most commonly seen in neonates and may not present with overt tonic-clonic activity. They are often misinterpreted as normal movements but, when repetitive and stereotyped, they indicate seizure activity. Other signs of subtle seizures may include staring, apnea, chewing, or autonomic changes.

Question 42

A 5-year-old girl is described by her mother as intelligent, but she occasionally experiences brief episodes during which she has a glassy stare and is unresponsive. EEG shows spikes in a localized region of the brain. What is the most likely diagnosis? A. Absence seizure B. Simple partial (focal aware) seizure C. Generalized tonic-clonic seizure D. Complex partial (focal impaired awareness) seizure

Answer 42

Question 43

A 7-month-old infant develops head-nodding spells, consisting of 4–6 repetitive nods per minute. What is the most likely diagnosis? A. Infantile spasms (West syndrome) B. Tonic seizures C. Myoclonic seizures D. Focal seizures

Answer 43

Question 44

Viral meningitis is usually managed with supportive care. However, which specific viral cause requires antiviral treatment? A. Varicella-zoster virus (VZV) B. Herpes Simplex Virus type 1 (HSV-1) C. Enterovirus D. Cytomegalovirus (CMV)

Answer 44

Question 45

Answer 45

Question 46

A mother reports that her daughter has daily staring spells that last for a few seconds, often accompanied by eyelid fluttering. There are no postictal symptoms or other behavioral changes. Which of the following findings is most helpful in diagnosing a generalized absence seizure? A. Presence of postictal confusion B. Duration longer than 2 minutes C. Onset after age 12 D. Average seizure duration is less than 2 minutes

Answer 46

D. Average seizure duration is less than 2 minutes

Question 47

Head unsteadiness, difficulty sitting or walking, and clumsiness of the arms and legs in a child are most commonly seen in: A. Vestibular dysfunction B. Cortical motor lesion C. Basal ganglia disorder D. Cerebellar dysfunction

Answer 47

D. Cerebellar dysfunction

Question 48

You are evaluating a 5-year-old girl who presents with fever, vomiting, and nuchal rigidity. CS analysis reveals: * WBC count: 1,650/mm* with 85% neutrophils (segmenters), 15% lymphocytes * Glucose: 20 mg/dL * Protein: 2.53 g/L (very high) * Diagnosis: Suspected pneumococcal meningitis What is the best empiric parenteral antibiotic therapy for this child? A. Ampicillin B. Acyclovir C. Vancomycin D. Ceftriaxone

Answer 48

D. Ceftriaxone

Question 49

Which of the following are characteristic CSF findings in bacterial meningitis? A. Lymphocytic pleocytosis, normal glucose, decreased protein B. PMN (neutrophilic) pleocytosis, increased glucose, increased protein C. PMN (neutrophilic) pleocytosis, decreased glucose, increased protein D. Lymphocytic pleocytosis, increased glucose, normal protein

Answer 49

C. PMN (neutrophilic) pleocytosis, decreased glucose, increased protein

Question 50

Answer 50

Question 51

What is the most important clinical sign of hydrocephalus in infancy? A. Vomiting B. Bulging fontanelle C. Accelerated rate of head enlargement D. Seizures

Answer 51

C. Accelerated rate of head enlargement Rationale: Hydrocephalus in infants is most commonly identified by an accelerated rate of head enlargement, which is due to an accumulation of cerebrospinal fluid in the ventricles. The bulging fontanelle can also be a sign but typically occurs after the rapid increase in head size. Other signs like vomiting, seizures, and bulging fontanelle can also occur, but rapid head growth is the hallmark clinical feature in infants.

Question 52

Which of the following statements about brain abscess is INCORRECT? A. It can present with fever, headache, and focal neurologic deficits B. CT or MRI with contrast is essential for diagnosis C. Common in children with cyanotic congenital heart disease D. The most common causative organism is Haemophilus influenzae

Answer 52

Question 53

In tuberculous meningitis, where are the meningeal exudates typically most prominent? A. At the top of the brain B. At the base of the brain C. In the lateral ventricles D. In the posterior fossa

Answer 53

Question 54

Which of the following statements about Guillain-Barré Syndrome (GBS) is INCORRECT? A. It is often preceded by a viral or bacterial infection B. It is characterized by ascending flaccid paralysis C. Steroids are the mainstay of treatment D. IVIG or plasmapheresis can be used as effective therapies

Answer 54

Question 55

A 5-year-old child experiences staring spells and stops blinking for 20 seconds. There is no postictal confusion. What is the most likely diagnosis, and what is the drug of choice? A. Tonic-clonic seizure, Phenytoin B. Absence seizure, Valproate C. Simple partial seizure, Carbamazepine D. Complex partial seizure, Lamotrigine

Answer 55

Question 56

Which group of children with febrile seizures has the highest risk of developing epilepsy later in life? A. Children with a history of head trauma B. Children with neurodevelopmental abnormalities C. Children with simple febrile seizures D. Children with a family history of seizures

Answer 56

Question 57

A febrile seizure is considered complex if it lasts for: A. More than 10 minutes B. More than 15 minutes C. More than 20 minutes D. More than 30 minutes

Answer 57

Question 58

Answer 58

Question 59

An adolescent schoolgirl complains of repeatedly dropping objects from her hands, especially in the morning or during times of stress (like exams). There is no loss of consciousness. She has a family history of epilepsy (cousin with similar symptoms), and EEG reveals epileptic spikes. What is the most likely diagnosis? A. Juvenile Myoclonic Epilepsy (JME) B. Absence seizures C. Temporal lobe epilepsy D. Generalized tonic-clonic seizures

Answer 59

Question 60

Answer 60

Question 61

What are the typical cerebrospinal fluid (CSF) findings in tuberculous (TB) meningitis? A. High glucose, high protein, polymorphonuclear pleocytosis B. Low glucose, high protein, lymphocytic pleocytosis C. Normal glucose, normal protein, polymorphonuclear pleocytosis D. Low glucose, normal protein, lymphocytic pleocytosis

Answer 61

Question 62

What is the most common sequela of periventricular leukomalacia (PVL) in premature infants? A. Spastic diplegia (a form of cerebral palsy) B. Ataxic cerebral palsy C. Hemiplegic cerebral palsy D. Intellectual disability

Answer 62

Question 63

A 2-year-old girl is brought by her parents due to developmental delay and the presence of multiple hyperpigmented macules (café-au-lait spots) on her skin. What is the most probable diagnosis? A. Tuberous sclerosis B. Neurofibromatosis Type 1 (NF1) C. Sturge-Weber syndrome D. von Recklinghausen disease

Answer 63

Question 64

Arnold-Chiari Malformation is characterized by all of the following features EXCEPT: A. Herniation of cerebellar tonsils through the foramen magnum B. Associated with myelomeningocele C. Hypoplasia of the cerebral hemispheres D. Hydrocephalus may be present

Answer 64

Question 65

What is the drug of choice for infantile spasms (West Syndrome)? A. Phenobarbital B. Adrenocorticotropic hormone (ACTH) C. Lamotrigine D. Levetiracetam

Answer 65

Question 66

What is the drug of choice for infantile spasms in a child with tuberous sclerosis? A. Phenobarbital B. Vigabatrin C. Levetiracetam D. Phenytoin

Answer 66

Question 67

A 7-year-old boy presents with a right-sided facial hemangioma and left-sided focal seizures. What is the most likely diagnosis? A. Tuberous sclerosis B. Sturge-Weber syndrome C. Neurofibromatosis Type 1 (NF1) D. Hemimegalencephaly

Answer 67

Question 68

Lennox-Gastaut Syndrome is characterized by all of the following EXCEPT: A. Onset usually before 3 years of age B. Slow spike-and-wave pattern on EEG C. Multiple seizure types D. Weight gain and growth acceleration

Answer 68

Question 69

Which of the following statements about febrile seizures is NOT true? A. Occurs in children aged 6 months to 5 years B. Typically associated with viral infections C. Most febrile seizures are generalized tonic-clonic D. Febrile seizures are always associated with neurologically abnormal children

Answer 69

Question 70

Which of the following is NOT true about migraine headaches in children? A. May be unilateral or bilateral B. Often associated with nausea and photophobia C. Typically occurs upon waking in the morning D. May improve with sleep

Answer 70

Question 71

A unilateral or bilateral cleft in the cerebral hemisphere extending from the surface to the ventricle is called: A. Lissencephaly B. Schizencephaly C. Hydranencephaly D. Porencephaly

Answer 71

Question 72

In a CSF examination, albuminocytologic dissociation (increased protein with normal WBC count) is typically seen in: A. Multiple sclerosis B. Guillain-Barré Syndrome (GBS) C. Tuberculosis meningitis D. Viral meningitis

Answer 72

Question 73

Which of the following best differentiates hydranencephaly from hydrocephalus? A. Enlarged ventricles B. Presence of the cerebral cortex C. Cerebral cortex is deficient or hypoplastic D. Presence of abnormal CSF flow

Answer 73

Question 74

What is the most common cause of congenital hydrocephalus? A. Aqueductal stenosis B. Chiari malformation C. Dandy-Walker malformation D. Spina bifida

Answer 74

A. Aqueductal stenosis Rationale: Aqueductal stenosis is the most common cause of congenital non-communicating hydrocephalus. It occurs due to the narrowing of the cerebral aqueduct of Sylvius, which prevents normal CSF flow from the 3rd to the 4th ventricle, leading to ventricular dilation.

Question 75

Which of the following is NOT a typical sign of raised intracranial pressure in a 9-month-old infant? A. Bulging anterior fontanelle B. Vomiting C. Papilledema D. Irritability

Answer 75

Question 76

Oligomyelocele (a form of spina bifida) most commonly affects which region of the spine? A. Cervical region B. Thoracic region C. Lumbosacral region D. Sacral region

Answer 76

Question 77

Answer 77

Question 78

In which of the following types of febrile seizures is prophylactic anticonvulsant therapy NOT indicated? A. Febrile seizure with focal onset B. Recurrent febrile seizures within 24 hours C. Simple febrile seizure D. Febrile seizure lasting more than 15 minutes

Answer 78

Question 79

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Question 80

A 4-year-old child is diagnosed with diarrhea but shows no signs of dehydration. Management is according to IMCI Plan A (home treatment for no dehydration). How much extra fluid should be given in addition to the child’s usual intake after each loose stool? A. 50 mL of Oral Rehydration Solution (ORS) B. 100 mL of Oral Rehydration Solution (ORS) C. 200 mL of Oral Rehydration Solution (ORS) D. 500 mL of Oral Rehydration Solution (ORS)

Answer 80

Question 81

While giving ORS to a child with no dehydration, the child vomits during the process. What is the most appropriate next step? A. Wait for 5 minutes, then continue giving ORS quickly B. Wait for 10 minutes, then continue giving ORS slowly C. Immediately switch to intravenous fluids D. Give a higher volume of ORS at once to compensate

Answer 81

Question 82

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Question 83

A 4-year-old child complains of soft, mucoid stools for the past 48 days (more than 14 days). There is no blood, no dehydration, and the child appears active and feeding well. What is the most appropriate management? A. Treat as acute diarrhea and administer antidiarrheal medications B. Treat as persistent diarrhea — consider giving oral Ciprofloxacin for 3–5 days if bacterial infection is suspected C. Refer immediately for intravenous rehydration D. Continue feeding and no further treatment is necessary

Answer 83

Question 84

Answer 84

Question 85

A child presents with fever and comes from a high malaria-risk area. On examination, the child has a stiff neck. How should this child be classified under IMCI guidelines? A. Severe febrile disease (possible meningitis or severe malaria) B. Simple febrile disease with no danger signs C. Malaria with moderate dehydration D. Severe pneumonia with fever

Answer 85

Question 86

Answer 86

Question 87

What is the first-line antibiotic for a 6-month-old baby with acute respiratory infection according to IMCI? A. Ampicillin B. Amoxicillin C. Ceftriaxone D. Azithromycin

Answer 87

Question 88

Severe acute malnutrition (SAM) is suspected if the Mid-Upper Arm Circumference (MUAC) is: A. Less than 100 mm B. Less than 110 mm C. Less than 115 mm D. Less than 120 mm

Answer 88

Question 89

A child has tender swelling behind the ear with pain and signs of ear infection. What is the most likely diagnosis? A. Otitis externa B. Mastoiditis C. Acute otitis media D. Cholesteatoma

Answer 89

Question 90

What are the essential components of counseling caregivers regarding home care under IMCI? A. When to return immediately B. How to give ORS or medications C. Continue feeding D. All of the above

Answer 90

Question 91

A newborn infant presents with jaundice at 28 hours of life. On examination, palms and soles are not yellow. How should this jaundice be classified under IMCI guidelines? A. Severe jaundice – Refer immediately B. Jaundice – Not severe C. No jaundice D. Severe jaundice – Needs referral

Answer 91

Question 92

A child presents with white patches on the tongue and inside of the mouth, which do not easily rub off. The mother reports difficulty feeding. What is the most likely type of feeding problem based on this examination finding? A. Oral thrush (Candidiasis) B. Herpes simplex virus infection C. Oral leukoplakia D. Glossitis

Answer 92

Question 93

A newborn is brought to the clinic with an erythematous umbilical area that is draining pus. What is the most appropriate management? A. Treat as local bacterial infection — clean the umbilicus and give oral antibiotic (e.g., oral amoxicillin) B. Treat as omphalitis — administer intravenous antibiotics and refer immediately C. Clean the umbilical area with antiseptic and apply topical antibiotic cream D. Wait for 2-3 days and monitor for any worsening symptoms

Answer 93

Question 94

When should a mother be advised to return immediately with her baby during exclusive breastfeeding? A. If the baby is unable to breastfeed or stops feeding well B. If the baby is feeding well and showing no signs of illness C. If the baby is gaining weight consistently D. If the baby is sleeping for extended periods without any other symptoms

Answer 94

Question 95

A 3-week-old baby is brought in with diarrhea. The baby was previously irritable and crying but eagerly started feeding when offered the breast. The baby’s eyes are not sunken, and skin pinch returns immediately. How should this baby be classified according to IMCI diarrhea guidelines? A. Diarrhea with severe dehydration B. Diarrhea with some dehydration C. No dehydration (IMCI Plan A) D. Diarrhea with possible sepsis

Answer 95

Question 96

A 5-month-old baby weighing 6 kg is diagnosed with some dehydration according to IMCI. How much ORS solution should this baby be given, and over how many hours? A. 150 mL over 4 hours B. 300 mL over 6 hours C. 450 mL over 4 hours D. 600 mL over 6 hours

Answer 96

Question 97

A 5-month-old baby weighing 6 kg is diagnosed with some dehydration. She is to receive 50 mL of ORS per kg body weight. In how many hours should the total ORS be given? A. 2 hours B. 4 hours C. 6 hours D. 8 hours

Answer 97

Question 98

A 2-year-old boy is assessed to have anemia after presenting with some palmar pallor. He is started on iron supplementation. What else should be given to this child according to IMCI guidelines? A. Vitamin D supplementation B. Mebendazole (deworming), if age >12 months and in a high-risk area C. Zinc supplementation D. Folic acid supplementation

Answer 98

Question 99

A 5-day-old infant is brought in with jaundice that started on the third day of life. On examination, palms and soles are yellow. How should this infant’s condition be classified according to IMCI guidelines? A. Jaundice – Not severe B. Severe jaundice C. Physiologic jaundice D. Jaundice with some dehydration

Answer 99