AKP January2022

Paper 1
1. EMQ:
1. 3 weeks, offensive urine, WBC in urine sample> 100*106
2. 6 weeks, apnea, persistent cough WBC 17, lymphocyte10 (4-10)
3. 8 years, left loin pain, dysuria, can take orally, clean catch WBC >90*10 6
Options: 100 % infection&NEPHRO

● IV coamoxicalv
● IV Cefotaxime
● IV Cefotaxime+ amoxicillin (1 )
● IV Gentamycin+ IV Benzyl penicillin
● Oral cephalexin (3)
● Oral trimethoprim
● Oral clarithromycin ( 2 )

2. EMQ: ‫ كل سيناريو سطرين‬100 ms-sk and neuro

1. URTI ten days ago then developed weakness in lower limb and absent deep tendon
reflexes.
2. CK 600, calf muscle pain
3. rash on extensor surface of fingers and knee

Options:
● Guillain barre
● Acute myositis
● Juvenile dermatomyocitis
3. EMQ: 100 % endo and growth
1. Neurofibromatosis type1 testicular volume 12 ml
2. Testicular volume 3 ml, stage3 pubic and axillary hair
3. Gynaecomastia,testes 6 ml excluded from school, prepubertal

Options:
● MRI brain ( 1 )
● Urinary steroids ( 2 )
● Karyotyping ( 3 )
● Urinary catecholamines
● FSH, LH
4.Nephrotic syndrome on Prednisolone 60mg/m2 for 3 months was playing with his friends
who developed rash after 2 days, showed in picture (chicken pox on the back) what you will
do? 100 % Infection

● Oral acyclovir
● IV acyclovir
● IM varicella zoster immunoglobulins
● Check immunity
5.Newborn with seizure and rash, his mother and sister had the same rash after birth that
evolved over months, diagnosis: 100 % neonat and derma

● Incontinentia pigmenti
● Langerhans cell histocytosis
● Epidermolysis
● Eczema

6. 7 days old home delivery and received oral vit K , passed meconium after 36 hours,
presented with tachycardia , CRT 5 ,tachypnoea, low BP, tender distended abdomen and
blood in stool , diagnosis: 100 neonat and git
● Hirschsprung enterocolitis
● Coagulopathy
● NEC
● Intussusception
7. 4 months, breastfed, presented to A/E with seizure for 30 seconds, CT showed small
subdural haematoma, what to do next?
 ● Social service
● Skeletal survey
● Coagulation profile …( 100 % safeguarding )
● Urinary aminoacids
8. Johava witness parents, their newborn baby needs blood transfusion. HGB 4.8 ..He is still
shocked despite fluid resuscitation choose 2 options ….100 % emergency and ethics
● O-ve emergency transfusion
● Another senior opinion
● Crossmatched packed RBC ????
● Involve Hospital legal committee
● Follow the parents’ wish

9. 4 years old with progressive lower limbs weakness and confusion. On examination: power
is grade 3/4 in left leg, grade 3/5 in right leg, decreased tone and reflexes bilaterally. Upper
limbs and cranial nerves are normal except diplopia on lateral gaze in right eye in the extreme
gaze , diagnosis: 100 % neuro

● ADEM
● Guillain barre syndrome
● Multiple sclerosis
● Poliomyelitis
● herpes encephalitis

10. 4 years old with attacks of respiratory distress and tachypnea occurs when she runs,
(there was RVH in ECG , short PR?? ST elevation and prolonged QT) but he wants one option:

100 % cardio

● RVH
● Long QT
● Short PR interval
● ST segment elevation
● Delta wave

11. Photo: history of poor feeding and irritability in the neonatal period…( stellate iris in the
eye…puffiness in the eye…upturned nose…. typical picture) 100 % genetics

● William syndrome
 ● Angelman
● Prader willi

12. Photo: rash on dorsum of hand ……. 100 % derma

● eczema herpeticum
● Dermatitis enteropathica
● Impetigo
● Cigarette burn

13. 3 years old, going for adenotonsillectomy, discovered to have PDA, how to manage: 100 %
cardio

● Transcutaneous catheter occlusion

● Ibuprofen
● Ligation
● Wait for spontaneous closure

14. You are in a new placement as a junior doctor in an oncology ward. A patient is going for
OR for central line insertion after one hour. The nurse wants you to prescribe intrathecal
chemotherapy for him. You are not familiar with doses. Previous prescription missed from
file, nurse is aware about previous dose, what you will do? 100 % patient safety & ethics

● Your prescription needs to be checked by pharmacist

● Your prescription needs to be checked by registrar
● Your prescription needs to be checked by nurse in charge
● Say you will only prescribe on pre-printed proforma
● Say you will not prescribed the intrathecal chemo
15. Table of blood sugar readings in a diabetic patient on basal bolus regimen with high
readings in the mornings mainly (high readings are highlighted in red, you don’t need to look
for it), what you will do?( same as AKP case) ‫ سيناريو واضح‬100 % DM

● Increase evening long-acting lantus Glargine dose

● Increase short acting (nova rapid)

16. 16 yrs old, sexually active for 2 years, presented with dysuria, vaginal discharge …temp
??mildly High37.5??? …Supra pubic tenderness on examination , postcoital bleeding for the
first time, diagnosis: 100 % infection & 100 % adolescent

● Candida
● Chlamydia
● UTI
● TSS

17. Cystic fibrosis patient, was told that he will be transferred to adult service when he is 16.
He is not controlled, CF nurse noticed he is not collecting his prescriptions, will complete 16
years next month, he has questions regarding the fate of his disease …… 100 % ethics and
adolescent

● Education program with CF nurse to address his questions while assess his readiness for
transfer
● Arrange joint clinic meeting with adult next visit
● Tell mother to collect prescriptions
● Give him leaflet to explain concerns
● Send GP letter to arrange transfer to adult service

18. Scenario in the beginning like cow milk protein allergy.. 8 months old infant boy has
constipation, not improved on laxatives, faltering growth despite changing many types of
formulas . Investigations: Na135 , k 3.5 , phosphate 0.8 (lower limit 1) glycosuria…proteinuria
…high PTH. High ALP .. What is the Diagnosis:…… 100 % metabolic & 100 nephro

● Cystinosis
● Hypophophatemic rickets
● Renal artery stenosis
● Coeliac

19. 6 months old with vomiting and tetany…lab values : low Na, low K, metabolic alkalosis
(PH 7.49)….. 100 % nephro

● Barter
 ● Cystic fibrosis
● Pyloric stenosis

20. Cystic fibrosis, shocked, vomiting, received boluses Na 135 k 2.6 received potassium
replacement and IV fluids… after 3days presented with the following labs: Na133, K 2.9
management: 100 % resp

● Give Na and K orally

● Give potassium supplements
● Give Fludrocortisone

21. 11 months presented with cough and distress, bilateral wheeze and crackles, on milk
formula only no solid, vomitted 5 times, all labs normal except Na 122 K 3.2 CL 90 …what is
the cause of hyponatraemia:………. ‫خالف‬

● SIADH
● Barter
● Pseudobarter
● Recurrent vomiting

22. Teenager found Collapsed in toilet, BP 160/110 low oxygen saturation and bradycardia
…pupillary reaction bilaterally reactive (7 or 8 options): CT brain showed‫سؤال مكرر يف امتحان سابق‬
100 % emerg & neuro

- Intracerebral hrg
- Subarachnoid hrg
- Intraventricular hrg
- Ischemic stroke
- Astrocytoma

23. Neonate shocked received 2 boluses and CRT still poor …oxygen saturation despite
oxygen 88% what are the two next steps of management ? 100 % emerg & neonate
 ● intubate and ventilate
● inotropes

24. Child presenting with respiratory distress received Amoxicillin…came 4 weeks later with
prolonged cough…next investigation to do ? 100 % resp

● Ultrasound diaphragm
● Pleurocentesis
● CT Chest

25. Mother positive CMV and baby by Urine PCR Proved CMV …Microcephaly…periventricular
calcification on MRI…Petechiae…thrombocytopenia…initial assessment of hearing
normal…the decision to start a Gancyclovir was made…which of the next statements is
correct: NO 100 % PHARMA & INFECTION

● Haematological F/U as far as on treatment ( REVIEW GUIDLINES )

● Gancyclovir is better than Acyclovir because it is less toxic
● Shift to oral Valganacyclovir after 2 weeks ( 100% INFECTION )
● Treat at least for 3 months
● Treat as soon as possible after positive PCR

26. Asthmatic on Beclomethasone 200 microgram bid, what will you tell parents about its
effect on growth: NO 100 % PHARMA

● No effect on growth
● Decreased growth velocity but normal adult height
● Decreased growth velocity but final height less than mid-parental height
● After 1 year of treatment patient needs bone density scan

27. Atopic eczema, with severe exacerbation and skin breakage over cheeks, management:

100 % DERMA
 ● Mild potency steroids for 7 days
● Continue emollients
● Moderate potency for maximum of 5 days.
● High potency for 3 days.
● Oral steroid and Fucidic acid ointment

28. 14 years old with polyurea and polydypsea for 4 months, passes 6 L of urine per day, all
labs normal (serum Na, K and osmolarity), RBS 7.4 ( normal till 6) random urine osmolality
180, diagnosis: 100% NEPHRO &BEHAVIOR

● Impulsive water intake

● DM
● Central DI
● CKD
● Nephrogenic diabetes insipidus.

29. Ate cake in a party, developed anaphylaxis, received IM adrenaline, went to the nearest
emergency after five minutes , received Oxygen, IV access on place and still he has oedema in
the face and still tachypnic , what will do next: 100 % EMERG

● IM 150microgram adrenaline 1:1000

● IM 150 microgram adrenaline 1:10000
● Oral antihistaminic
● IV adrenaline 1:10000

30. 10 years female with day urinary symptoms with occasional fecal incontinence…X-ray
normal …(photo of sacral dimple with tuft of hair)…what to do next ? 100 % NEURO

● MRI spine
● MRI brain

31. 2 days old with bilious vomiting, tender abdomen on palpation, xray (big stomach bubble
with distal air): 100 % NEONATE AND GIT

● Midgut Volvulus
 ● Duodenal atresia

32. Newborn with distress, during last 3 weeks had polyhydramnios .. 100 % NEONATE

● CCAM
● Right sided diaphragmatic hernia
● Congenital lobar emphysema

33. A teenage female known case of progressive intrahepatic cholestasis, presented with
jaundice , pruritus with scratch marks ,ataxia and neurological signs, what is the cause?

100 % NUTRITION

● Vit E
● Vit B12
● Vit A
● Vit D

34. 4 years adopted child 2 years ago , has tonic clonic convulaions on Valproate, has
sexualized behaviour, remove her pants in front of other children, very friendly, sits on
people laps, mother was prostitute, history of abuse for one year before the adoption… what
will you do? 100 % SAFEGUARDING & BEHAVIORAL

● Multidisciplinary approach
● Change to Lamotrigine
● Parents training
● Withdraw Sodium Valproate
● Put in foster care

35. 16 years old boy , c/o attacks of lethargy, inability to sleep for 12 months active member
in sport team (not changed) during attack will have nausea no vomiting, all labs normal
including the FBC except high unconjugated bilirubin in 2 occasions.., between the attacks
there is no history of passing dark urine ..O/E no lymphadenopathy..diagnosis: 100%
GIT&HEPATOLOGY
 ● Gilbert
● Glandular fever
● Alpha 1 antitrypsin
● Autoimmune haemolytic anaemia
● Chronic fatigue syndrome

36. Anorexia nervosa, what will point to another diagnosis (as September 2020).. 100 %
BEHAVIORAL & ADOLESCENT

● Abdominal pain
● Amenorrhea
● Bradycardia
● High cortisol and hypokalemia
● Wearing baggy clothes

37. long scenario: child, live in farm wheezes in the night…on examination upper part of lung
wheezes on auscultation… bilateral supraclavicular LN, cough on bronchodilators, wide
mediastinum, investigation: 100 % ONCOLOGY

● LN biopsy
● CT chest

38. Romanian, 2 years old, cough on bronchodilators not responding, ,father is smoker,
mother is asthmatic, sister has eczema, wt 0.4th centile, ht in 9th centile, CXR: hyperinflation
and peri-bronchial shadowing. what to do: 100 % RESP

● Sweat test
● Nitric oxide
● Nasal brushing
● IgE and RAST
● Manteux test
● Therapy for father to stop smoking

39. Boy Child with recurrent attacks of otitis media, meningitis…uncle died of
meningitis…diagnosis ? ‫ سؤال مكرر يف كل اإلمتحانات‬100 % INFECTION

● X-linked agammaglobulinaemia
● CGD
● HIV
● IGA deficiency
40. Asthmatic received salbutamol and oral dexa …on auscultation no wheezes but still
tachypneic ..RBS 12 ,acidotic Ph and high lactate ..what is the cause of his breathlessness ?

NO 100 % PHARMA

● Salbutamol toxicity
● Oral dexa

41. Father died 42 yrs with ischaemic heart disease, during school screening program a
normal 8 yrs old child discovered to have high normal cholesterol, normal triglyceride and
upper normal glucose, what you do next: 100 % CARDIO & ETHICS

● LDL
● ECG
● OGTT

42. indication for Botulinum toxin in CP patients: 100 % NEURODISABILITY

● Generalized spasticity
● Focal limb spasticity
● Fixed Muscle contracture
● Spasticity with bone deformity

43. 2 years old, lethargy, pale, abdominal pain, treated as constipation, given laxatives, after
2 weeks, presented with the following labs: Hb 8, Normal MCV and MCH, Platelets 83, Ferritin
650, LDH 2550, need 2 investigations: 100 % ONCOLOGY & HEMATOLOGY

● Abdominal U/S
● Catecholamines
● BM biopsy
● IgA and TTG
● ?? Other scan similar to MIBG but not MIBG

44. Decreased vision sits near the TV …glue ear and hearing loss and brown skin
pigmentation…what is the cause of visual problems ? 100 % OPHTHA

● Optic glioma
● Acoustic neuroma

45. 3 year old child with problems with family members, through things, father and mother
separated and meets father every weekend…has three step siblings …attends nursery which
he seems to enjoy …mother is treated for depression…likes playing with Thomas the engine
toy…what to do ? 100 % BEHAVIORAL

● Parents training program

● Arrange meeting with worker in autistic team
● A choice about ADHD ???

46. 26 months old, mother has concerns about an abnormal movement which is increasing in
frequency lately…happened two times in the last week , when he was playing with his
brother in the garden and his brother hit him with a toy on his head,, he cries and falls down
with loss of consciousness and jerking movement of limbs for 2 minutes…. 100 % NEURO
AND BEHAVIORAL

● reflex anoxic seizures

47. Dm type 1, on pump, vomiting but tolerate orally: 100 % DM

● Give basal and bolus if hyperglycemia

● Stop pump and give IV insulin
● Stop insulin until the child starts to eat

48. Girl was at a wedding on Friday night. She had an unwitnessed fall and the girl said that
she hurt her arm but nothing was obvious on inspection. Next morning she had arm pain,they
presented to A/E. A diagnosis of buckle fracture was made and was treated appropriately,
what to do next:….. 100 % SAFEGUARDING

● Social service
● Bone profile
● Skeletal survey
● Discharge and follow in fracture clinic

49. photo of Rt lower facial nerve palsy

50. statistics: short term course antibiotics vs long (2 days plus short term)( same as sample
paper)

51. End stage glioma, pain controlled on oral morphine and paracetamol, developed urinary
retention? 100 % PALLIATIVE

● Transdermal fentanyl
● SC morphine
● Give Naloxone

52 Child with pneumonia not responding to treatment after 48 hours …second ultrasound
showed. loculated pleural effusion (description, no photo), how you will manage: 100 % RESP

● Chest drain with fibrinolytic

53. 16 years old Child had had generalized tonic-clonic convulsions since age of 9 years …he
6 attacks during last 7 years,and last one from 4 months …parents wants to start treatment
and the patient is good at school and doesn’t want to start treatment… 100 % NEURO

● Agree not to treat Unless the attacks become more frequent

● Treat and explain about the risks of sudden death due to epilepsy
● Convince the child to agree with his parents

54. A child with delayed speech, only parents can understand him, father is smoker. What will
you do? 100 % NEURODEVELOPMENT

● Refer to audiology for hearing assessment

● Social service for neglect
● Refer for Speech and language therapist
 Paper 2
1. 10 months old infant have 24 lesions like this picture, what will you do? 100 %
HEPATOLOGY AND DERMA

● Liver u/s
● Renal us
● Brain imaging

2. Neonate presented with cyanosis, CXR showed a small lung for age, cardiomegaly,
pansystolic murmur heard maximum at apex of heart, on exam there was hepatomegaly ..
100% CARDIO
● TGA
● TOF
● HLH
 ● Ebstein anomaly
● PS
3. 4 MS old baby presented with simple UTI( Ecoli) responded well to antibiotics, U/S done at
6 weeks time showing unilateral dysplastic kidney, which is confirmed by DMSA that showed
the other kidney is normal. What is your further management? 100 % NEPHRO
● Follow up in clinic for BP
● Prophylactic antibiotic for 2 years
● MAG3
● MCUG
4. An 8 years old, known case of type 1 DM on insulin pump presented with abdominal pain
and vomiting, blood sugar 18 mmol/l, PH 7.18 ??, ketones 3.6 went to ER. On exam: CRT 2
seconds, tachypnea, tachycardia and cold extremities,BP 100/70?, 5% dehydrated . What is
your next management? 100 % EMERG & DM
● 10ml /kg bolus of NS 0.9 at recommended rate
● Start iv infusion of D 5% + NS at recommended rate
● Start iv infusion of NS 0.9 + K at recommended rate
● 20ml /kg bolus of NS 0.9 at recommended rate
● Start NS 0.9% at recommended rate
5. Infant presented with recurrent chest infection, his stool is pale and greasy, FTT and lab
result showing HB 9.9 MCV 85 MCHC 32 TLC N neutropenia N 0.7, low fecal elastase, normal
sweat cl 19 test, DIAGNOSIS: 100 % HEMATOLOGY
● schawashman diamonds
● cystic fibrosis
● pearson disease

6. Neonate day 7 presented by jaundice, poor feeding, unilateral purulent conjunctivitis and
hepatomegaly, no skin rash cbc showing lymphopenia and neutropenia PT 200 and PTT 156
sec, AST AND ALT were elevated, blood sugar normal. What is the cause? 100 % NEONATE
● Herpes
● Chlamydia
● Galactosemia
● E.coli
● GBS
7. Female child presented with unsteady gait, headache. On exam she was a febrile reluctant
to stand and weak and had a hand shaking. There was a history of varicella (chicken pox) one
month ago. Investigation: 100 % NEURO
● MRI head
 ● Lp
● Toxicology screen
8. 10 years old female presented with intermittent abdominal pain. There was history of
constipation ?? On examination she was pale. Investigations showing anemia low MCV,
normal plt count, normal WBC, low ferritin, high ESR 40. What is investigation lead to
diagnosis? 100 % GIT
● Anti-tissue transglutaminase
● Upper and lower endoscopy
● IgA Assay
9. 27 years old female came with PROM at 23+1 gestation week by examination there was
fetal heart sound, Ask about resuscitations advice: 100 % ETHICS

● Resuscitation will not take place unless parents wish, despite informing them about the
poor prognosis.
● We will do all of our best but we can not promise you the treatment will be successful.
● We will not resuscitate unless the baby shows respiratory effort after delivery.
● Resuscitation decision is entirely up to parents
● Resuscitation is not recommended
10. Picture of a 14 years old boy, with progressive weight loss & poor appetite over the last 6
months, height of 9th centile, very active in school activities and sports. He has good school
performance, and otherwise normal. FBC, Electrolytes are normal. Normal bowel habits 100
%BEHAVIORAL

● DM
● Anorexia nervosa
● Hypothyroid
● celiac
11. 6 year old girl presented with pallor of 18 months duration, investigation showing low plt
low wbc, low retics and anemia on exam no organomegaly. What is the diagnosis .. 100%
HEMATOLOGY
 ● Iron deficiency anemia
● G6pd
● Aplastic anemia
● Shwashmnn diamond syndrome
12. 2 year old baby, 12 kg presented by gastroenteritis diarrhea and vomiting, +ve
consanguinity family history of SIDS. convulsion in the ambulance. BP 80/40 CRT 5, urine
ketone +1, hypoglycemia 0.6, hyponatremia. What is next step? (2 options) 100% EMERG

● 24 ml D 10%
● 240 ml normal saline
● 60 ml dextrose 10 %
13. girl drown in pond in which resuscitation was started for 40 min by no response even on
dc shock 3 times, IO Amiodarone AND adrenaline was given, ECG SHOWED VF, RECTAL temp
was low 26…… 100 % EMERG
● Give warm IV fluid, gastric and bladder lavage by warm saline
● Stop resuscitation
● Give IV NAHCO3
● IV bolus
● Increase dose of adrenaline
14. Long scenario about toddler 19 months old presented by delay walking with NVD and
abgar 1 at 5 min and 9 at 10 min, mom showed picture of his birthday sitting with toys held
by both hands, smiling mother mentioned that he climb himself to stand but can’t maintain it
or walk independently he can hold bottle and feed himself, localize sound and say
unrecognizable words
What is the diagnosis? 100% MS-SK AND NEURO

● Duchene muscular dystrophy

● DDH
● Global developmental delay
15. Picture of standing child, back of the knee, parents mentioned that his sister has been
treated for skin infection last week .. 100 % SAFEGUARDING
● Cigarette burn
● Impetigo
● Herpes
● mollascum

16. EMQ: jaundice 100 % HEPATOLOGY

1. History of NICU admission because of severe jaundice (unconjugated) in less than 24 h
of his life with phototherapy needed further in his childhood
2. Presented with conjugated jaundice and peripheral pulmonary stenosis
3. D1 Jaundice, hepatomegaly, cataract, sepsis
Options:
● Criggle najar ( 1 )
● Alagille ( 2 )
● Galactosemia ( 3 )
● Congenital Rubella syndrome
● ABO
● Rhesus incompatibility
● Pyruvate kinase deficiency

17. 12 years old male presented to A/E with attacks of falling off his chair at school two times
and one of them was followed by abnormal movement for 2 min. What is your action? ..
100% CARDIO

● EEG
● ECG
● MRI
● ECHO

18. EMQ: all with cleft palate 100% GENETICS

4. Cleft palate micrognathia, glossoptosis, breathing difficulties, poor suckling
5. Cleft palate dysmorphic feature, neonatal hypocalcemia, microcephaly, VSD
6. Cleft palate syndactyly between 2nd and 3rd, anteverted nose, hypospadias operation
was done, cryptorchidism, bilateral ptosis
options:
● 22q deletion
● Pierre robin
● Smith lemli opitz
19. Neonate with history of PROM, and + ve swab for GBS, history of brother who died due to
infection and mother refuses to give antibiotic or any IV intervention, What is your action?
…100% SAFEGUARDING
● Start the IV antibiotic despite of mother refusal
● Social worker to get Court Order
● Respond to mother wish
 ● Discharge with advice to come back to hospital if symptomatic
● Prescribe oral antibiotic course
20. Newborn Day1, antenatal scan at 20 and 32 wk showing bilateral dysplastic kidney and
oligohydramnios what is the next step in management? 100% NEONATE
● Urea and electrolytes
● Urgent postnatal us
● Follow urine stream
● Refer to urology
● Insert catheter

21. History of battery ingestion, the child was well and x ray was done showing circular 9.5
mm object in the upper third of esophagus, what is the next step?……. 100 % EMERG
● Discharge
● Urgent referral for endoscopic removal
● Keep NPO to do endoscopy tom morning
● Admission and observe
● Keep NPO to do endoscopy tom morning after repeat Xray indicating that

22. 12 years old boy presented with cough and breathing difficulty ….. 100 % EMERG AND
RESP

● Pneumothorax
● Pneumomediastinum
● Wide mediastinum
● Lingual consolidation
● Forging body
● Pulmonary oedema
● Congenital cyst
23. Boy presented with 3 weeks history of intermittent fever, limping, fleeting arthritis after a
history of travel to Scotland on a family holiday with outdoor activities, on examination, he is
afebrile, no hepatosplenomegaly, no rash , there are cervical lymph nodes and tender calf
muscle, investigations normal, What is your diagnosis?….. 100 % INFECTION
● JIA
● Lyme
● EBV

24. EMQ:…… NO 100 % PHARMA

1- Medulloblastoma on chemotherapy and presented with uncontrolled epistaxis not
responding to compression
2- 10 days Post renal transplantation presented with neutropenia
3- ALL newly diagnosed on induction therapy presented with sleep disturbance,
abnormal behavior ,anxiety and weight gain
Options :
● Carboplatin
● Cyclophosamide
● Cyclosporine
● Dexthamethasone
● Etoposide
● Infliximab
● Mycofenolate mofetil
● Rituximab
● Tacrolimas
● Vincristine

25. Pt presented with ptosis absent pupillary reflex eye deviated infero lateral …. 100%
OPHTHA AND NEURO
● third cranialnerve palsy
● 6th cranial nerve palsy
● 4th cranial nerve palsy
● Mobius syndrome

26. ECG of 10 month old infant presented with 6 hours history of poor feeding, irritability and
crying, when his mom was carrying him, she felt a rapid heart beats

On examination he is crying and CRT 2. ECG was done, what is your management? .. 100%
CARDIO
 ● Ice pack on face
● Dc shock
● IV Adenosine
● Ocular pressure

27. Abdominal xray of 17 days old term neonate presented with abdominal distention
bleeding per rectum post cardiac surgery for Hypoplastic Left Heart Syndrome … 100%
NEONATE AND GIT

● Bowel ischemia
● Bile duct gas
● Intussusception
● Midgut volvulus
● Intestinal obstruction
28. CT brain of case of leukemia on chemotherapy with febrile neutropenia, on aggressive
antibiotic but not improving, convulsion on right side … 100 % NEURO
 ● Fungal abscess
● Astrocytoma
● Leukocytic deposits
● Posterior reversible leucocystic syndrome

29. 1 year old boy presented with 1st degree burn after fall off a saucepan of boiled water on
his right leg, he was crying and appeared on a sever pain, HR 140 ,CRT 2 s, while the nurse
preparing for dressing his burn.
What is the most important step of management at this stage … 100 % PALLIATIVE
● Intranasal diamorphine
● Social worker
● Run cold water on his leg
● Antibiotic
● Start IV fluids

30. 10 years old presented with lethargy and severe abdominal pain. He had a recent history
of appendectomy. Investigations showing low Na 122 high K 6.1 and low or low normal
glucose, normal BP. What is your diagnosis?… 100% ENDO
● CAH late presentation
● Hypoadrenalism
● Cushing

31. 6 years Asian girl on Na valproate for absence seizure, presented with injured knee. Lab
showing Alp 1300, Ca 2.3(low normal), Ph 1 low normal, AST ALT insignificant elevation 55
what further investigation you will do? NO 100 % PHARMA
● Vit d level
● PTH
● GGT
 ● Na valproate level
32. Neonate with high TSH low normal T4 and goiter what is the diagnosis 100 % ENDO
● Dyshormonogenesis
● Hashimoto
● Agenesis

33. Pic of an infant with a history of inability to eat and no other lesions. What is your
diagnosis? (picture was showing perioral lesions with little crustation on lips and chin and
(vesicles over tongue and soft palate) ….. 100% INFECTION

● Cocasaki
● Herpes stomatitis
● Impetigo
● Scarlet fever

34. 8 months breastfed infant of africo-carribean origin, presented with facial twitches, high
ALP, CA 1.5, PO4 low normal. Diagnosis …. 100 NUTRITION

● Vit D def
● Hypoparathyroidism

35. A 12 years old male from Afghanistan, whose family were asylum seekers, presented with
change in behavior and decreased school performance, myoclonic seizure, History of measles
and rubella at two years ..(4 stages were described in details, it was a long scenario). What is
the Diagnosis …. 100 % NEURO
● SSPE
● Leukodystrophy
● ADEM
● Lead poisoning
● Brain tumor

36. Infant 3months old, parent concerned about excessive watering and shape of eye,
Diagnosis? 100 % OPHTHA
 ● congenital glaucoma
● Aniridia
● Catarct
● Coloboma

37. A 12 year old male presented with dyspnea when he lies flat, nocturnal wheeze, dyspnea
at rest, liver 2 cm, no lymph node ?? What is the next investigation you will request? 100 %
ONCOLOGY

● BM biopsy
● Monteux
● Cbc and film
● Tissue biopsy
● ACE1
38. Crainal U/S of preterm 26 weeks, after 15 days in NICU, 3 options?? …. 100% NEONATE
 ● Intraventricular hge
● Lateral vent dilation
● 3rd vent dilation
● PVL
● Absent septum pellcidum
● Absent corpus callosum
● Subdural hge
● Arnold chiari malformation
39. Teenage swimmer presented with history of 3 of syncope. ECG was done and showed
frequent torsade de pointe and Corrected QT 500. What is the management …. 100 % CARDIO
AND EMERG
● Start B-blocker and refer for intracardiac defibrillator
● Flecainide
● Genetics
● Echo
● Tilt test
40. 7 years old child with decreased school performance for which EEG was done. What is the
best description for EEG appearance ….. 100% NEURO
 ● 3 spike and waves
● Hypsarrhythmia
● Temporal lope epilepsy
● Centro temporal
41. Statistics, compare between IM Vit K administration with oral single and multiple dose
regimens (IM with single oral dose and IM with multiple oral doses). CI for those group who
actually took the drug and with the ITT statistics. ( NO SIGNEFIGANT DEFRENCE BETWEEN
MULTIPLR ORAL VIT K AND IM INJ ) … 100 % SOP
42. 14 years old with shortness of breath, fever and cough. 5 years ago diagnosed with SLE
lupus nephritis and anti phospholipid syndrome ,on steroids, enalapril and mycophenolate
mofitl, marivan for retinal infarcts poor compliance to treatment She has mild learning
problems. Now: pale, alert, fever, tachypnea, tachycardia, bilateral lower zone crepitations,
decrease air entry bilaterally. Bp 160/100, with high renal function, good urine output,
creatinine 555, thrombocytopenia K 3.2mmol, low Na, metabolic acidosis, bicarb 10, BE -6,
hepatomegaly 6 cm, bilateral pedal odema o2 was 88 and improved TO 98 WHEN PUT ON O2.
What is the most important next two actions? PICTURE LKE PREV EXAM …. 100 % EMERG &
NEPHRO

● Increase Enalapril dose.

● Mechanical Ventilation
● Oral nifedipine
● IV Furosemide.
● Platelet transfusion
● Hemodialysis
● Na bicarbonate iv
● IV nitroglyceride
● IV K
43. 6 months old presented with arching of back diagnosed as GOR at age of 4 ms old with
PARTIAL improvement on ANTI GERD treatment. On examination there is head lag, hypotonia
(delayed motor milestone) EEG was done …… NO 100% PHARMA

What TWO drugs of choice? (always double check no of needed options, most of us choosed
one answer)

● Na valoproate
● ACTH
● Prednisolone
● Vigabatrin
● lamotrigine
44. A known case of SMA arrested at home, they did the 1ry resus then went to ER in district
general hospital, where the pt is intubated but has no PICU. Pt admitted to the hospital
several times 2nd to resp infection, they approached the new genetic therapy (neurimilin) but
therapy was not appropriate, there is no active life plan or end of life plan discussed before as
the parents were not ready.

What is your next action? … 100 % PALLIATIVE & ETHICS

● Continue active treatment while arranging retrieval to tertiary hospital
● Extubate
● Discuss with parent the end of life plan as per futility of the management
● Call the neurology team for advice
● Withdraw all active resus plan while maintaining mechanical ventilation

45. 12 year old female presented with RBS 7, glucosuria +ve BMI 18 (50 th centile ). Her grand
mom on sulphonylurea and mom on lifestyle management program. Diagnosis? .. 100% DM

● MODY
● DM 1
● DM2
● DI
46. Photo of Newborn presented with eye bruises after NVD Face presentation …. 100%
NEONATE

Q1 what is inv?
● No investigation
● Coagulation profile
● Refer to ophthalma
Q2 next step?
● Reassurance and discharge
● Midwife check later

47. 11 year old female pt , known case of sickle cell disease presented with cough fever and
chest pain , xray was done …. 100% RESP

What is xray finding?

● Lingual pneumonia
● Left lower lobe pneumonia
48. 8 years old female presented with headache 3 ms ago, photophobia, seizure, confusion
bl/pr 230/140 puffy eyelid and increase urea and create, …… 100 % CARDIO& NO 100 %
PHARMA

● IV Na Nitroprusside
● Mannitol
● Oral nifidepine
● IV Furosemide

49. 7 years old male presented with severe pain for 2 days , woke him up at night screaming
but improved spontaneously, there is barely swelling of ankle or knee joint, otherwise no
abnormalities, all inv was normal (FBC, ESR CRP). Diagnosis?….. 100MS-SK

● Benign joint hypermobility

● Leukemia
● Osgood schlatter
● JIA
● Septic arthritis

50. Full term neonate during neonatal check at day 1 presented by this finding. What
investigation will help in the initial management? ( Pic was more ambiguous, empty scrotum
looked like labia majora with enlarged clitoris)….. 100% ENDO AND NEONATE

● Urea and electrolytes

● u/s abd
● cortisol level
● renin and aldosterone
● 17 oh progesterone

51. Neonate has been presented with blisters in feet and hands since birth in which
antibiotics were started, blisters became more extensive and oral ulcers appeared. What
investigation will lead to diagnosis? … 100% DERMA

● Skin biopsy
● TORCH screen
 ● Viral swab
● Skin swab for culture and sensitivity
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