AKP Past Paper May 2023 PDF

AKP MAY 2023 AKP MAY 2023 1. EMQ: Fractures A. Non accidental injury B. Accidentally injury C. Hypophosphatemic rickets D. Osteoblastoma E. McCune-Albright syndrome F. Osteogenesis imperfecta G. Osteomyelitis H. Osteopetrosis From the list above choose...

AKP MAY 2023 AKP MAY 2023 1. EMQ: Fractures A. Non accidental injury B. Accidentally injury C. Hypophosphatemic rickets D. Osteoblastoma E. McCune-Albright syndrome F. Osteogenesis imperfecta G. Osteomyelitis H. Osteopetrosis From the list above choose the most appropriate diagnosis: - 2 days old neonate presented with reduced movement in the left leg. X - ray showed left fracture femur with callus formation, fracture left scapula, fracture radius and ulna. - 6 weeks old neonate presented with reduced movement in the left leg. X - ray showed spiral fracture of the femur and posterior fracture of right 5th and 6th ribs. - A Child fell from stairs X - ray showed left femur fracture and increased bone density. Investigations: low HB 9, WBCs low normal, PLT 135. AKP MAY 2023 2. EMQ: Chemotherapy side effects A. Vincristine B. Ciclosporin C. Infliximab D. Etoposide E. Cyclophosphamide F. Rituximab G. Dexamethasone H. Mycophenolate From the list above choose the most appropriate drug side effect: - A 5 years old child known case of ALL started on treatment then presented with foot drops and lower limb weakness. - Patient started on induction treatment for Crohn’s presented with high grade fever 40 c. - Patient of nephrotic syndrome on long term treatment, complains that her classmates tease her at school because of increased facial hair. 3. EMQ: Varicella A. Oral acyclovir B. IV acyclovir C. VZIG D. Viral serology E. Reassure the family that there is no risk for chickenpox F. Discharge home and return when baby develop symptoms G. Do septic screen and start antibiotics From the above list choose the most appropriate management: - 6 weeks old infant with herpetic ulcer on the mouth, feeding reasonably well, normal examination, birth weight 3.7kg and now 5.6kg, temp 37.6c. - A 4 days old neonate, his brother who is 2 years old developed chicken pox, mother said that she had chicken pox when she was a child. The baby is well and has good feeding. AKP MAY 2023 - 8 weeks previously, Preterm baby birth weight 950g had chronic lung disease, was on ventilator, discharged home. his brother developed chicken pox, now the baby presented mottled, hypotonic, with temp 39 c. 4. EMQ: epilepsy A. Juvenile myoclonic epilepsy B. Centrotemporal spike C. Severe myoclonic epilepsy of infancy (Dravet syndrome) D. Atypical febrile convulsions E. Absence seizure F. Generalized epilepsy with febrile seizure plus (GEFS+) G. Lennox gastaut H. West syndrome I. Panayiotopoulos syndrome (occipital lobe epilepsy) J. Congenital infantile spasms - A 7 years old patient wakes his parents on gurgling sound, which proceeded to generalized tonic clonic convulsions which terminated on itself after 5 minutes when his parents attended, he had previously 2 witnessed convulsions mainly twitching of face and drooling. - 4 years old with febrile convulsion involving one side of the body, first convulsion at 7 months, recurrent 6 times, with febrile and afebrile attacks. had regression of milestones in the last two years, family history of febrile convulsion. - Teenager girl history of generalized seizure diagnosis, clumsy, drops her breakfast, with day dreaming at school. AKP MAY 2023 5. EMQ: Ataxia A. Fredrich ataxia B. Charcot Marie tooth C. Huntington disease D. Varicella cerebellitis E. Posterior fossa tumor F. Ataxia telangiectasia G. SSPE H. Wilson disease From the list above choose the most appropriate diagnosis: - A 14 years old female with clumsiness, for a couple of years back, her peers make fun of her walk while playing, has pes caves and reduced reflexes and tone of lower limbs, with a 4 weeks history of chickenpox. - 7 years old boy, developed ataxia recently, reduced tendon reflexes, and intention tremors. He had a history of chicken pox 3 weeks back. - 14 year boy 6 months of episodes of falling, ataxia, drooling, standing with support, past pointing, +ve Romberg sign, nystagmus, muscle wasting, 3 weeks history of chickenpox, absent deep tendon reflex. father follows at the cardiac clinic. AKP MAY 2023 6. EMQ: palliative A. Sustained release morphine (MST) B. Fentanyl lozenges C. Buscopan D. Paracetamol E. Gabapentin F. Ondansetron G. Omeprazole H. Ibuprofen I. Hyoscine J. Naloxone K. Amitriptyline From the list above choose the most appropriate drug: - 13 year old with incurable brain tumor for discharge home, she is pain free on opiate, not pass stool for the last 4 days, is distressed when trying to open her bowel, she is receiving 6 sachets of macrogol and sodium docusate, with no improvement, what drug to add. - 13 years old girl with incurable brain tumor for discharge home, she is pain free on oral morphine 4 hourly, what treatment should you give her at home. - 13 years old with an incurable brain tumor for discharge home, her pain is well controlled with the exception of procedural pain during manipulation of her gastrostomy tube. AKP MAY 2023 BOF 1. 3 years old with unilateral breast enlargement, that mother thinks have been with her since birth, and she has mild eczema and her mother feels she is one of the taller kids in the nursery. What is the most appropriate diagnosis? 1. Premature thelarche 2. Premature adrenarche 3. Adrenal tumor 4. Central Precocious puberty 5. HCG secreting tumor 2. 9 month old with early morning eyes puffiness and pedal edema improved during day. On examination there is periorbital swelling, ascites and mild pedal edema HR 110, RR 54 min, BP 90/46. Investigation: Albumin 18(35_45), creatinine 55(high) protein /creatinine ratio 330 (30-50) What is the first step in the management? 1. Start prednisolone 60 mg/m2 once daily for 28 days 2. Discuss with nephrologist 3. N.S 20ML 4. Albumin 20% 5 ml/kg for 4 hours 5. U/S abdomen 6. 24 urine protein 3. Picture of cephalohematoma, full term newborn with vacuum delivery. what is the diagnosis? 1. Cephalohematoma 2. Caput succedaneum 3. Subgaleal hematoma 4. Non- accidental injury 5. Chignon 6. Plagiocephaly AKP MAY 2023 4. Picture of a child with palatal petechiae, asks about the diagnosis? 1. Glandular fever 2. HSV 3. Herpangina 5. picture of aniridia, child referred with nocturnal enuresis, and you noticed the abnormality in the picture. Asked for 2 associated conditions? 1. Nephroblastoma 2. Hepatoblastoma 3. Genital abnormality 4. Thrombocytopenia 5. Hepatomegaly 6. Cafe au lait spots 7. Thrombocytopenia 6. 3 years old, known case of citrullinemia, recent history of coryza, low grade fever, presented with vomiting, RBS 3.9 (normal 3-5), normal vitals. What would be the initial investigation for immediate Management? 1. Blood culture 2. Blood Ammonia 3. Urea and electrolytes 4. Blood glucose 5. Citrulline level  AKP MAY 2023 7. Chest X - ray of 13 years old Sudanese boy, came on a visit to the UK, 6 weeks history of cough and chest tightness. What is the diagnosis? 1. Non-Hodgkin’s lymphoma 2. Foreign body 3. Pulmonary tuberculosis 4. streptococcus pneumonia 8. A 2 years old girl her mother noticed that she was speaking fewer words and there is regression in her motor skills. On examination there was reduction in head circumference and she appeared as she was rubbing her hands together, and poor eye contact. What is the most likely diagnosis? 1. Rett’s syndrome 2. Autistic spectrum disorder 3. Landau kleffner syndrome 9. 3 weeks old baby was presented with vomiting, drowsiness, poor feeding and he was afebrile. There was a family history of +ve consanguinity. Investigations were done and antibiotics started. RBS 1, CBC, U&E were normal. Serum ammonia was 350. What is the next step in management? 1. IV D10% + 0.9% NaCL 2. NGT feeding 3. Lumbar puncture 4. Peritoneal dialysis 5. Urine analysis 6. CT brain AKP MAY 2023 10. an 18 months old boy presented with vomiting and watery diarrhea, diffuse lower abdominal tenderness and temp 37.8. Then vomiting stopped but still had diarrhea that became bloody. Mother described that the patient withdraws his legs toward his abdomen as if he is in pain. 1. Meckel’s diverticulum 2. Campylobacter gastroenteritis 3. Giardiasis 4. Rectal polyps 5. Rectal prolapse 11. an 11 year old girl with polyurea, polydipsia, weight loss and a picture of skin lesion was given ask about the associated lesion: (it was only one lesion similar to this one). 1. Erythema nodosum 2. Necrobiosis lipoidica 3. Erythema multiforme 12. A 2 days old, well baby developed 2 blisters on the foot, hours after birth, he was noted to have oral ulcers, treated with antibiotics without improving, developed more blisters in the shoulder and buttocks. What is the diagnosis? 1. Incontinentia pigmenti. 2. Congenital herpes 3. Congenital varicella 4. Epidermolysis bullosa. 5. SSSS AKP MAY 2023 13. 12 years old Romanian girl had a 6 months history of emotional lability, clumsiness, abnormal jerky movement of the upper limbs and face, slurred speech and a pansystolic murmur radiating to the axilla. What is the diagnosis? 1. Wilson disease 2. Sydenham chorea 3. Cerebellar stroke 4. Psychosomatic 5. Huntington disease 14. 14 Years old boy was brought to ER by his brother (In the back of the Car), stabbed by Kitchen knife, on examination: Bp 114/72, HR136, CRT 5 sec. Perfused bleeding from the femoral region. Nurse was applying direct pressure on the wound, IV access was successful. What is the most appropriate next step? 1. Assessment of Dorsalis pedis pulse 2. Assessments of abdomen for internal bleeding 3. Administration of NS 0.9% 20 ml/kg 4. Administration of D10% with 0.9% NS 5. Give 10 ml/kg packed RBCs 6. Give 10 ml/kg infusion of tranexamic acid 15. The serious most common complication within the first week for this 15 year old boy (picture of older child with a rash on buttocks and back of thigh and forearm) 1. Retinal hemorrhage 2. GIT hemorrhagic 3. Pulmonary hemorrhagic 4. Hypertensive crisis 5. Hemarthrosis 6. Septic arthritis AKP MAY 2023 16. 14 years old boy, diagnosed as DM 1 on Insulin pump, well managed and seems adjacent to his diagnosis, start to develop daytime hypoglycemia. What is the factor responsible for his daytime hypoglycemia? 1. Coeliac disease 2. Addison disease 3. Increase exercise level 4. Hypothyroidism 5. incorrect Insulin injection. 17. 12 years old child, presented with a 6hr history of sudden chest pain, SOB, and he was anxious, PR 130 on examination RR 40, Temp 37.6c, saturation 93% on room air and put on oxygen, clear chest examination (picture of pneumomediastinum/ pneumopericardium). What is the next most appropriate action? 1. Observe and monitor symptoms 2. No treatment 3. Admit 4. Pericardiocentesis 5. Thoracocentesis 6. Iv ceftriaxone and azithromycin 7. Salbutamol nebulizer 8. Iv hydrocortisone 18. 4 years old boy on Safeguarding plan for neglect, parents are smokers, no significant past medical history, speak 2 phrases sentence, have 3 siblings. What is the next step in management? 1. Refer to development pediatrician for further assessments 2. ENT for grommet implantation 3. Refer to Responsible Safeguarding pediatrician 4. Refer to social services 5. Audiology for hearing assessment 6. Refer for family smoking cessation program AKP MAY 2023 19. 3 weeks old baby with a history of intrauterine blood transfusion due to severe RhD incompatibility. Needs postnatal transfusion. Which type of blood to be given? 1. CMV -ve irradiated concentrated RBCs 2. CMV -ve irradiated RBCs 3. CMV-ve whole blood 4. CMV -ve irradiated whole blood 5. Irradiated whole blood 6. Irradiated concentrated RBCs 20. A 4 years old boy presented with a 7 weeks history of joint swelling and pain, stiffness in the morning that resolved throughout the day. Investigations: ANA -ve RF -ve Choose which DMAR drug to be given? 1. Methotrexate 2. Azathioprine 3. Naproxen 4. Infliximab 21. Baby born through normal vaginal delivery, birth weight 1.9kg to a mother primigravida with pre-pregnancy BMI 37. His APGAR at 1 min was 5 and at 5 min 9. Presented after 1.5 hours with an RBG of 1.6. What is the diagnosis? 1. IUGR 2. infant of diabetic mother 3. sepsis AKP MAY 2023 22. a young girl presented with pain in her right arm, mother pulled her by the hand to avoid RTA as she tried to cross the street, you suspect radius head subluxation (pulled elbow). What is the first step in management? 1. Attempt reduction 2. Apply arm sling 3. Intranasal fentanyl 4. Above elbow plaster cast 5. X-ray AP and Lateral 23. Girl with an episode of fainting while she was running. After 1 month she had a similar attack, and there was another episode of fainting with febrile illness. ECG shows QTc 490. What is the most appropriate management? 1. No treatment 2. propranolol 3. Adenosine 4. Amiodarone 24. Term baby was born by emergency cs for suspected fetal tachycardia ECG shown below done soon after delivery due to persistent tachycardia. 1. Av nodal reentry tachycardia 2. AF 3. Sinus tachycardia 4. Ventricular tachycardia 5. Atrial flutter AKP MAY 2023 25. ECG a girl had a caffeinated drink, collapsed and regained consciousness after 5 secs. 1. Atrial fibrillation 2. WPW 3. Long QT 4. Ventricular tachycardia AKP MAY 2023 26. ECG of a 6 years old boy who moved recently to the UK, on examination he is found to have a murmur. What is the diagnosis? 1. ASD secundum 2. Aortic stenosis 3. Muscular VSD 4. Partial AVSD 5. Coarctation of aorta ( The ECG on the exam showed RBBB and LAD) 27. 8 years old boy presented with chest pain and throat tightness increase after exercise, strong family history of atopy, on examination was vitally stable and cardiovascular and respiratory examination were all clear. (couldn't find a similar pic, but it was an X- ray of mediastinal mass, small, on both sides of the trachea but more to the right). What is the most likely diagnosis? 1. Superior mediastinal mass 2. Right aortic arch 3. Rt Hilar lymphadenopathy 4. Thymus enlargement AKP MAY 2023 28. Wrist (x ray of rt wrist fraying and cupping of the metaphysis, fracture ulna and radius, widened space). asking about the diagnosis? 1. NAI 2. Rickets 3. Osteogenesis imperfecta 4. Osteomyelitis 5. neuroblastoma 29. A 5 years old known case of asthma who is reasonably controlled on a low dose of inhaled corticosteroids, has been brought to the OPD because of episodes of unusually severe cough. 17 days previously he developed a nasal discharge which was followed by cough, mild wheeze and a series of events that his mother is familiar with. During the past 7 days however his bouts of coughing has become much worse especially during the night and are occasionally followed by vomiting, the wheeze has remained unchanged. On examination: he doesn't look ill, stable vitally, scattered rhonchi throughout the lung field. Inspiratory and expiratory images of no abnormality, other systemic examination was normal. BP 90/60. investigations: HB 12.2, WCC 18 (N.5.3, LY 12.1, E 0.6), PLT 380. What is the diagnosis? 1. Pertussis 2. Adenovirus infection 3. Mycoplasma pneumonia 4. Persistent worsening wheeze due to poor compliance 5. GERD AKP MAY 2023 30. Photo of a child with facial palsy (kind of similar to this picture). Asking about the diagnosis? 1. Left LMNL 2. Left UMNL 3. Right LMNL 4. Right UMNL 31. A 13 years old girl came in with right hip pain and limping, has a history of limping and hip pain 2 years ago. Her right leg was 5 cm shorter than the left. What is the diagnosis? (Head of femur was more destructed and looked slipping but not clear) ( The affected leg was the right) 1. Necrosis of the head of the femur 2. Perthes disease 3. SUFE 4. Dislocated right femur AKP MAY 2023 32. A photo of a boy, asking about the causative organism of his pathology? 1. Moraxella 2. Haemophilus influenzae 3. Pseudomonas 4. Staphylococcus aureus 33. An infant is presented with feeding difficulties, asking about the associated cardiac lesion? 1. AVSD 2. Pulmonary stenosis 3. Coarctation of the aorta 4. Supravalvular aortic stenosis 5. PDA 34. Neonate after 48 hours was reviewed for generalized seizure and vomiting. was drowsy, lethargic and hypotonic. investigations: PH 7.2 PCO2 normal HCO3 11 What is the diagnosis? 1. Organic acidemia 2. HIE 3. MCCAD 4. Glycogen storage disease type 1 AKP MAY 2023 35. A picture of an extremely preterm, who underwent bowel resection due to NEC, receiving TPN, presented with failure to thrive and dermatitis. What investigation would lead to the diagnosis? 1. Iron level 2. Zinc level 3. Lead level 4. B12 level 5. Vitamin C level 36. A picture of a 7 days old newborn, who was delivered via SVD. asking about the causative organism? 1. Neisseria gonorrhoeae 2. GBS 3. Staphylococcus aureus 4. Chlamydia trachomatis 5. Pseudomonas aeruginosa 37. In which case of the following would you withhold information from parents/carer? (The answers were a bit different language wise) 1. 9 year old who tell the nurse that her uncle touched her inappropriately 2. 9 months old in care who presents with fracture femur with mother’s boyfriend 3. 3 weeks old with a circular bruise on his cheek 4. One month old with a circular burn on the buttocks 5. A young girl with positive samples for hematuria but when tested in the hospital samples come as negative AKP MAY 2023 38. In which of the following situations, do you have a legal obligation to inform the police? 1. 13 years old female who stole makeup from the shop 2. 8 years old boy who is found to have made videos of himself showing sexualized behavior 3. 10 years old girl admitted with alcohol intoxication 4. 14 years old female who is admitted for cocaine use 5. 12 years old girl divulges to have sex relation with 14 years old boy 39. 13 Years old girl, complaining of headache, she is advised to do further tests, on ophthalmological review she is found to have high Intraocular Pressure of 25 mmHg. What is the best medication to start? 1. Ofloxacin 2. Tetracaine 3. Cyclopentolate 4. Timolol 5. Phenylephrine 40. 5 weeks old boy who is floppy, with internal rotation of upper limbs and flexed wrist, frog like position of the lower limbs, decreased muscle tone, spontaneous movement, brisk reflexes in upper and lower limbs. He was normal till the age of 2-3 weeks then he developed weight loss, difficulty feeding, drooling, cough with swallowing, and extended neck. What is the diagnosis? (The image was a bit different) 1. Arnold Chiari malformation 2. Neuronal migration disorder 3. Syringomyelia 4. Cervical compression 5. CMV infection 6. Posterior fossa tumor AKP MAY 2023 41. A child presented with right upper and lower facial palsy, diplopia and right convergent squint. What is the diagnosis? 1. Facial nerve palsy 2. Bell’s palsy 3. Intracranial tumor 4. Pontine tumor 42. Scenario about a young child with delayed motor milestones and delayed speech, stands from lying down with the help of his hands. What investigation would lead to the diagnosis? 1. CK level 2. MRI brain 3. Muscle biopsy 4. EMG 43. 4 years old girl known case of DM type 1, she is difficult to handle and her parents want her to take more responsibility of her daily life glucose control, she has lost 2.3kg in 3 months, from the history mother said she is skipping meals and previously ordered laxatives for a constipation for 4 days she also has occasional vomiting, her HbA1c was high 58 and now increased to 76. What is the most likely cause for her weight loss? 1. Eating disorder 2. Non-adherence to insulin treatment 3. Hypothyroidism 4. Hyperthyroidism AKP MAY 2023 44. A 2 Years old girl accidentally discovered by her parents to have right arm pain (there was an X-ray of humerus with a bone lesion) for 2 days, on examination there is right mid upper arm swelling and tenderness, with Normal overlying skin, she was vitally stable. X- ray of right arm showing osteolytic lesion. What is the most appropriate next step in management? 1. Request parathyroid and Vitamin D level 2. Discuss with pediatric oncologist 3. Administration of flucloxacillin and Clindamycin 4. Aspiration for microbiology 5. Bone screening 45. 5 years old boy, height on 2nd centile and weight on 25th centile, red book record showed his bone age of 4 years, Mother noticed that he wears the same size of clothes for the last 2 years, his sister who is 4 years old is outgrowing him, midparental height is between 25-50th centile, he has good school performance, and on examination he is proportionally short, and no other finding apart from mild mid facial hypoplasia. What would be the cause? 1. Growth hormone deficiency 2. Familial short stature 3. Primary Hypothyroidism 4. Skeletal hypoplasia AKP MAY 2023 46. Full term baby, had an uneventful pregnancy, apart from polyhydramnios, his delivery was difficult requiring forceps, his Apgar score 1 at 5 mins and 4 at 10 mins and hence was ventilated for 2 weeks and then he was extubated, but he remained floppy with poor feeding, on examination he is hypotonic and has unilateral talipes, the mother has learning disabilities, and she going to GP for what she called rheumatic hand. His father is well. The mother had a previous miscarriage. What would be the most likely diagnosis? 1. Warding Hoffman disease (SMA type 1) 2. Congenital myotonic dystrophy 3. Congenital myasthenia gravis 4. Cervical cord damage 5. Encephalopathy 47. A 16 years old girl with anorexia nervosa started on dietetic management and is gaining weight (moved from the 3rd to the 9th centile) and trying hard to take three meals per day, with restriction of her daily activity and exercise to 1 hour per day. She had a regular cycle but has a 6 months history of amenorrhea. She started her menarche at 13 years. DXSA scan was done and it showed a decrease in her bone density. What is the treatment option that would best improve her bone density? 1. Vit D supplement 2. Vit C supplement 3. Estrogen and progesterone treatment 4. Increase weight bearing exercise 5. Continue Increase caloric intake to increase the weight 6. Calcium supplement AKP MAY 2023 48. A baby with a 15% partial thickness burn, resuscitation was done, after stabilization, he wasn’t able to take orally, his renal function test and electrolyte were normal. What is the best type of fluid to give in the next hours? 1. Albumin 4.5% 2. 0.18% N.S and D5% 3. 0.45% N.S and D10% 4. Hartman solution (compound sodium lactate) 5. 0.9% N.S 49. 4 years old boy presented with a history of fever, URTI, diplopia, with painful restriction of eye movement. CT given. What is the diagnosis? 1. Blunt trauma to the head 2. Orbital cellulitis 3. Orbital osteomyelitis 4. Optic neuritis 5. Retinoblastoma 50. 2 months old infant with Down syndrome, parents are concerned that he can’t see asking about associated eye abnormality? 1. Congenital cataract 2. Congenital glaucoma 3. Optic glioma 4. Congenital CMV 5. AKP MAY 2023 51. A 4 years old boy, teacher reports that he has low attention span, and hyperactivity, parents also report that he is difficult to handle, diagnosed with mild ADHD. What is your advice for his family? 1. Offer parents a training education program. 2. Discuss with parent commence methylphenidate 3. Refer to CAMHS 4. Restrict cola and sweets 52. A previously healthy and well 8 years old boy from a large traveling community (gypsies), present with a short history of fever, abdominal pain and back pain. 2 weeks ago, he fell from a tree while playing with his friends. On examination: HR: 92, RR: 22, abdominal, respiratory, cardiovascular system examination normal, but unable to open his mouth, with some difficulty in speech. What is the diagnosis? 1. Gillian Barre syndrome 2. Congenital myotonic dystrophy 3. Rupture spleen 4. Hypothyroidism 5. Myasthenia gravis 6. Tetanus 7. polio 53. chest x-ray 7 days baby, who had an unremarkable antenatal history, presented with progressive shortness of breath. On examination: HR: 166, RR: 60, subcostal recession, tracheal tug, oxygen saturation 91% What is the diagnosis? 1. Congenital lobar emphysema of left upper lobe 2. Right lung collapse or consolidation 3. CCAM 4. Hypoplastic right lung 5. Left lung pneumonia AKP MAY 2023 54. 8 years old female presented with tall stature, mild growth acceleration and she was prepubertal, All investigation normal except T4 23 (11- 24), TSH 0.3 (0.4 - 0.9), +ve anti thyroid peroxidase antibodies. Was followed up and after 6 months, her investigations were as follow T4(30), TSH (0.01). She remains asymptomatic and her HR 96. What is your next step in management? 1. Start carbimazole 2. Start propranolol 3. Refer to Thyroid radioiodine 4. Refer to surgery 5. Start thyroxine 55. An infant 10 month presented with extensive burns; parents say he jumped on hot path before the cold water spilled on it. cold water was applied for 20 mins. On examination bilateral lesions on both lower limbs and lower abdomen, scattered lesions seen on the abdomen and chest, a 5 cm, deep red lesion on the buttocks, also on forearms but popliteal fossa is preserved, he is severely distressed. What is the first step in management? 1. O2 via mask 2. parenteral analgesia 3. Urgent refer to social service 4. Start him on antibiotic 5. IV fluids AKP MAY 2023 56. 7 years old boy with acute lymphoblastic leukemia in the induction phase, his parents came to you complaining that the boy is not patient with his sister like before, he is easily tearful and he had nightmares, with a history of weight gain in the past 2 weeks. Which drug would lead to these side effects? 1. Vincristine 2. Methotrexate 3. Dexamethasone 4. Carboplatin 5. Mercaptopurine 6. Asparaginase 57. 4 years old girl lives with new parents for 1 year in foster care. Parents came complaining that she has been always difficult to deal with, now presenting with increased thirst, but parents say that there is no change in micturition, she has cough and vomiting, and behavioral change (bizarre behavior). On examination: here GCS was 10, she was drowsy. Investigations: Blood: Na: 165 CL:120 Creatinine: 65 Urea:10 Glucose: 6.7 K: 4 Urine: Osmolality: 850 (>850) Na: 20 What is the diagnosis? 1. Primary hyperaldosteronism 2. SIADH 3. Psychogenic polydipsia 4. Salt poisoning 5. Central DI AKP MAY 2023 58. 5 years old boy presented with SOB and cola-like urine, reduced urine output from the previous day, he had a history of sore throat 1 week back, his vitals were as follows: HR: 114, RR: 24, BP: 130/98 (> 95th centile) On examination: he is found to have lower pedal edema, mild respiratory distress, normal heart sounds and no murmurs except for a 3rd heart sound, apex not displaced, chest with occasional basal Inspiratory crackles. What would be the next immediate management? 1. IV hydralazine 2. Sublingual Nifedipine 3. IV furosemide 4. Oral metoprolol 5. Oral Captopril 59. 2 years old boy referred by GP for evaluation of cardiac murmur, he is born at term with birth weight of 2.3 kg, his Weight and HC are now on the 2nd centile, he has 2 cafe au lait macules on abdomen (2 cm), short palpebral fissure. His CBC is as follows: (mild Pancytopenia) HGB 9 g/dl PLT 120 WBC 3 or 2 What’s the diagnosis? 1. Schwachman diamond Syndrome 2. Fanconi anemia 3. Fetal alcohol syndrome spectrum 4. Neurofibromatosis 1 60. 3 months old boy, presents with inconsolable crying, irritability, inability to move right arm, the mother said that the child rolled over and fell from the bed (18 inches) and there was a carpet under the bed when she was changing his nappy and went to bring a new one, father had a past history of 2 long bone fractures when he was a child. X- ray of baby showed spiral fracture of rt humerus. What is the diagnosis? AKP MAY 2023 1. Osteogenesis imperfecta 2. Vitamin D deficiency 3. Accidental injury 4. Non accidental injury 5. Infantile osteoporosis 61. 13 years old boy, presents with mild illness, RBS 10, glucosuria+3, no history of polyuria or polydipsia, after he improved, he still has glucosuria, and RBS 4.6. Which investigation to do? 1. 75 glucose OGTT 2. Paired glucose insulin test 3. Glycated HGB (HBA1c) 4. Random serum c peptide 5. Urine c peptide 62. A young boy who is a known case of mild hemophilia B (factor viii 15%) came to the emergency department with an attack of epistaxis that lasted for 20 min at home. On examination: there is no active bleeding now, he is generally well, severe bruises on his arm. What to give? 1. Intranasal desmopressin 2. IV desmopressin 3. Subcutaneous desmopressin 4. Factor VIII concentrate 5. Oral course of tranexamic acid AKP MAY 2023 63. child presented with pallor, history of travel to France, recurrent diarrhea that then become bloody, his investigations showed elevated RFT, thrombocytopenia, and anemia, he was drowsy. asking about the diagnosis? 1. Hemolytic uremic syndrome 2. Henoch Schoenlein purpura 64. A newborn, just delivered and a cardiac catheter was done. What is the diagnosis? 1. TGA Saturation Pressure 2. TOF RA 45 4/2 3. TGA with VSD 4. TGA with atrial septostomy RV 55 85/5 PA 78 33/15 LA 90 9/2 LV 78 60/5 Aorta 45 80/15 65. 6 years old ventilated for pneumonia. Ventilator settings were given as follow: PCO2: 14 (4.6 - 6), PO2: 20 (11 - 15), PIP: 26, PEEP: 6, TI: 0.8 What ventilatory setting to change? 1. Decrease PEEP 2. Increase PIP 3. Increase FIO2 4. Decrease ventilation rate 5. Increase TI AKP MAY 2023 66. case diagnosed clinically with left hemiplegia, has history of chickenpox 2 weeks ago, he can't walk and has tremors for 3 days. urgent investigation that will help in the management? 1. CT brain 2. MRA 3. Coagulation profile 4. Thrombophilia screen 67. preterm delivery 28 weeks and you are a trainee in a hospital with low facility, and the mother is primigravida, admitted for delivery, she has PPROM and high cervical swab positive for GBS on booking, mother wants to deliver. What to do for a good baby outcome? 1. IM betamethasone to the mother 2. Give mother intrapartum IV Amoxicillin 3. Arrange for delivery in a hospital with NICU 4. Give the mother tocolytics 5. Give IV antibiotic to the baby 68. chest x ray and scenario, asking about the diagnosis? 1. Left Round pneumonia 2. Left upper lobe consolidation with lobe collapse 3. Left pleural effusion 4. Right upper round pneumonia 5. Right upper lobe consolidation AKP MAY 2023 69. A 14 years old boy who is expelled from school, he is difficult to control by the teacher, blames others for his mistakes, his mother says that he behaves the same way at home, but he is friendly with his dog and takes him out for walks. What is the diagnosis of his behavioral problem? 1. ADHD 2. Oppositional defiant disorder 3. Conduct disorder 4. Pathological demand avoidance 70. Chest x - ray of a 14 years old boy had a history of fever, present with dyspnea on exertion and abdominal pain. On examination: he has tachypnea, tachycardia, tender upper abdomen, his apex was displaced on the sixth intercostal space. What is the diagnosis? 1. Acute pericarditis 2. Acute pancreatitis 3. Viral hepatitis 4. Gram -ve sepsis 5. Dilated cardiomyopathy 71. Teenage girl presented with high grade fever 40 c and right sided abdominal pain. On examination: there was a right sided abdominal tenderness and mass. Investigations: WBC: 11 HGB: 9.8 PLT: 500 ESR: 40 CRP: 2 (< 513) AKP MAY 2023 What is the most likely diagnosis? 1. Crohn's disease 2. Appendicular abscess 3. Ovarian torsion 4. Ulcerative colitis 72. Chest x- ray of a child with pneumonia, given antibiotic, with no improvement. On examination: there is decreased air entry to the right side and left side wheeze. What is the next investigation to perform? 1. US chest 2. High resolution CT scan 3. Thoracocentesis and aspiration 73. A photo of acanthosis nigricans. Asking about the associated condition? 1. Tuberous sclerosis 2. Neurofibromatosis type 1 3. Insulin resistance 4. Addison disease 5. McCune Albright syndrome AKP MAY 2023 74. A preterm 25 weeks old, presented with distended abdomen. x - ray abdomen was done. What is the finding on the x-ray? 1. Portal vein gas 2. Intramural gas 3. Endotracheal tube in the right bronchus 4. Air under the diaphragm 75. child with Acute lymphoblastic leukemia presented with acute history of abdominal distension, generalized tenderness and mildly elevated temp 37.8c. A picture of the child's abdomen was given. What is the diagnosis? 1. Acute pancreatitis 2. Acute peritonitis 3. Splenic infarction 4. Leukemic infiltrates AKP MAY 2023 76. A baby was with his grandparents as his mom was at work, and they noticed a swelling on his. skull x- ray was done. What is the finding on x-ray? 1. Left Parietal skull fracture 2. Right parietal skull fracture 3. Frontal skull fracture 77. Baby 18 months old, had been well and there was decoration at home, presented with cough, wheeze and decreased air entry on the left side. What is the diagnosis? 1. CCAM 2. Right side foreign body 3. Left side foreign body 4. Chemical pneumonitis 5. Left sided pneumothorax 78. 4 years boy had a mid-thoracotomy scar, presented with temp 39 c, splenomegaly, with pansystolic murmur best heard on the apex. Ask about the cardiac lesion? 1. VSD 2. Tricuspid regurgitation 3. Mitral stenosis 4. Mitral prolapse 5. ASD AKP MAY 2023 79. A young boy with developmental delay on anti-epileptic drugs, has muscle weakness, and recurrent chest infections, with purpuric rash on lower limb, he was a picky eater. What is the cause of his presentation? 1. AML 2. Vit C deficiency 3. Zinc deficiency 80. 1 month old presented with failure to gain weight, recently develop diarrhea Investigations: NA: 120 K: 6.6 Cortisol: 900 (200 - 700) Urine osmolarity: 850 (>850). What is the diagnosis? 1. CAH 2. Pseudo hypoaldosteronism 3. SIADH 4. Nephrotic Diabetes insipidus 81. A 16 year old female moved recently to the UK, came to see you as she wants to get HPV vaccine, she wants to go on holiday with her boyfriend. What advice would you tell her? 1. The vaccine is contraindicated if she is already sexually active 2. She has to do a pregnancy test before vaccine 3. She will need 3 doses of the vaccine 4. Vaccine cannot be given within 6 weeks of receiving other live attenuated vaccines AKP MAY 2023 5. HPV antibody should be tested prior to giving vaccine if she is already sexually active 82. A trainee pediatrician commences new post in DGH, which provides shared care service for patients with leukemia. A patient with leukemia is due to go to the theater within an hour to re-insert his central line which has split out and it has been agreed that the child’s scheduled intrathecal chemotherapy should be administered under the same anesthetic. The oncology registrar who has agreed to provide the prescription is now unavailable. Senior nurse in the PICU of the hospital requested from you to prescribe the intrathecal drug. What would be your action? 1. The trainee should refuse to prescribe it even in this unforeseen situation. 2. The trainee should agree to prescribe, knowing that prescription will be reviewed and counter signed by the oncology pharmacy 3. The trainee should agree to prescribe after discussing consultant or another registrar 4. The trainee should agree to prescribe because of this unforeseen situation 5. The trainee should agree knowing that chemotherapy has been prescribed by approved software prescribing program 83. A child diagnosed with ADHD on methylphenidate, what are the side effects of it? 1. Weight gain 2. Hypotension 3. Anxiety 4. Bradycardia AKP MAY 2023 84. 14 years old presented with tonic clonic seizure over the preceding 6 months, EEG showed generalized subclinical epileptiform discharges. It is recommended to start him on lamotrigine. What advice would you tell the parents? 1. Lamotrigine may be associated with excessive weight gain 2. If generalized skin rash develops, they should seek immediate medical advice 3. Mood changes is a known side effect that will require withdrawal of the therapy 4. Measurement of the level is required for monitoring of the treatment 5. Monitoring FBC is required for the initial treatment period 85. A previously healthy 19 months old child woke up with weakness in the left side of his body. A T2 weighted flair MRI was done. What is the diagnosis? 1. Localized encephalopathy 2. Meningitis 3. Ischemic stroke 4. Astrocytoma 86. A teenage patient presents with recurrent headaches, vomiting and oral pigmentation Investigations: Na: 123 K: 5.6 Urea: 12 Creatinine: 60 What investigation would help to reach the diagnosis? AKP MAY 2023 1. ACTH short synacthen test 2. MRI 3. Dexamethasone suppression test 87. 14 years old girl, has a boyfriend she is sexually active but denies sexual contact, complains of recurrent headaches, amenorrhea for 3 months, nausea, vomiting, high HCG in urine, low urine osmolality, low T4, normal pelvic and abdominal u/s. What investigation would you do to confirm the diagnosis? 1. MRI brain 2. Transvaginal u/s to detect 3. serum HCG 88. 9 months old boy, with failure to thrive, at 4 months mom started solid food, at the age of 5 months his height and weight began to decrease, he was constipated, mother changed the formula milk and the baby also took laxatives that did not help, urine showed glycosuria +1 and proteinuria +1, bicarb 11, ALP 1300. What is the most appropriate diagnosis? 1. Cystinosis 2. William syndrome 3. Primary hyperparathyroidism 4. Hypophosphatemic rickets 5. Celiac 89. 8 years old boy with height on 98th centile, weight 91st centile, scenario with pubic and axillary hair, BP: 125/78, but testicular size was 3 ML. (There was a picture of virilized male genitalia couldn’t find any similar or near picture) What is the diagnosis? AKP MAY 2023 1. Hypothalamic hamartoma 2. Premature adrenarche 3. CAH 4. Idiopathic precocious puberty 90. 2 years old, was seen regarding his motor skills. He was one of twins, born at 27 weeks, his twin brother walked at 20 months. He is hesitant to pull up to stand and cruise on his toes. He plays well with his twin brother and is just beginning to use two words phrases. He uses both his hands well and able to fully feed delayed walking and asking about the diagnosis? 1. DMD 2. Dyspraxia 3. DDH 4. Global developmental delay 5. Diplegic cp 91. infant presented with cleft palate, poor feeding, heart murmur, subtle facial dysmorphism. What is the diagnosis? 1. DiGeorge syndrome 2. Smith Lemli Opitz 3. Robin's sequence 4. William syndrome 92. 8 years old boy presented with abnormal head movement and behavioral change. They live in rural area, parents refuse any conventional medical treatment, that the last time they went to a doctor was years ago, and the children are homeschooled, the father is an alcoholic and is refused in his community. What is the most appropriate diagnosis? AKP MAY 2023 1. Alcohol ingestion 2. SSPE 3. Brain tumor 93. A neonate with irritability, sweating, HR 300, CRT 2, he is stable, well and alert. What is the next step in management? 1. Ice pack on the face 2. Adenosine 3. Amiodarone 4. DC shock 94. An 8-year-old boy was on a school trip together with his mother. They had an RTA and he sustained an injury and the mother was intubated and admitted to the ICU. The boy came with the teacher, and he required an urgent CT brain. There was a man talking to the teacher who confirmed that he was the biological father of the child who was not married to the mother for 2 years, but his name was not in the birth certificate but the child and the mother had the same last name. Who is the person responsible to give the consent for CT? 1. Emergency consultant 2. The biological father 3. The teacher 4. Court order 95. 5 years old boy who was on a family trip came to the ER with his mother. He is known Diabetic, was jumping a lot this morning, on examination he is sweaty and pale, drowsy but alert, RBG 2.3. What is the first action? 1. Give 2 ml/kg glucose 10% bolus 2. Buccal midazolam 3. IM glucagon 4. 3 glucose tablets AKP MAY 2023 96. 15 years girl known case of myasthenia gravis presents with respiratory difficulty and change in her voice, she is unable to lift her head from the pillow, with paradoxical chest movement. What would be the next most appropriate management? 1. Noninvasive ventilation 2. Call anesthesia and arrange for intubation and ventilation 3. Immunoglobulin 4. Edrophonium 97. A 14 year old girl came to the ER with her father complaining of a sore throat. After examining her the doctor discovered bruises on the right arm and shoulder. When asking her she states that there was an argument with her father. She is a smoker, a drug abuser, an alcoholic and is sexually active with a 16-year-old boyfriend and she is Gillick competent. What is your next step? 1. After taking her permission, arrange a meeting with her boyfriend as well as her parents to collect more information 2. Urgent referral to social service 3. Discharge her with a signpost about contraception, alcohol, and smoking 4. Send her to sexually transmitted infection clinic 98. 4 weeks presented with bilious vomiting. What is the diagnosis? 1. Gut malrotation 2. Atresia 3. Pyloric stenosis 4. Duodenal stenosis AKP MAY 2023 99. Background: Tobacco smoke exposure in adults is linked to adverse anesthetic and surgical outcomes. Environmental tobacco smoke (ETS) exposure, including passive smoking, causes a number of known harms in children, but there is no established evidence on its impact on intraoperative and postoperative outcomes. Objectives: To undertake a systematic review of the impact of ETS on the pediatric surgical pathway and to establish if there is evidence of anesthetic, intraoperative and postoperative harm. Outcome measures: Frequency of respiratory and other adverse events during anesthesia, surgery and recovery, and longer-term surgical outcome. Primary outcome: shows the outcome of the analysis, demonstrating ETS exposure risk ratio for adverse events in the preanesthetic period of 2.52 (95% CI 1.68 to 3.77) compared with not being exposed. There was moderate statistical heterogeneity (I2=62%). Subgroup analysis of studies focusing only on laryngospasm was undertaken, recognizing the variety of outcomes of adverse events would be assessed. This retained risk ratio of 3.54 (95% CI 2.37 to 5.28) and reduced heterogeneity (I2=23%). Secondary outcome: the impact of surgery on smoking behaviors for relatives of patients. Their analysis of survey data showed that parents who smoked were more likely to make a cessation attempt if their child had had recent surgery (OR 2.61 CI 95% 1.56 to 4.35), but the likelihood to maintain abstinence (OR 0.51 CI 95% 0.20 to 1.28). Asking about the most correct statement? 1. There is a significant increase in the risk of laryngospasm compared to all other pre anesthetic adverse events. 2. There is a significant likelihood for parents whose children underwent surgeries to become non-smokers. 3. There is a significant increase in the risk of pre anesthetic adverse events. AKP MAY 2023 100. Study: Ambulatory treatment of severe pneumonia. Aim: to determine whether home treatment with high dose of amoxicillin and inpatient treatment with ampicillin were equivalent for the treatment of severe pneumonia in children. Method: randomized open label equivalency trial was done at 7 study size in 2037 children aged 3 - 59 months (5 years) with severe pneumonia were randomized to either indicated treatments. Hospitalization and parenteral ampicillin for 48 hours (100 mg/kg 6 hourly) followed by 3 days oral amoxicillin, or to home based treatment for 5 days with oral amoxicillin. Follow up assessments were done at 1, 3, 6, and 14 days after enrollment. The primary outcome was treatment failure (critical deterioration) by day 6. Results: in pre protocol population 36 were excluded from the hospitalized group and 37 from the ambulatory group because of potential violations or loss of follow up. There was 87 (86%) treatment failure in hospitalized group, and 77 (75%) in ambulatory group, risk difference 1.1% (95% CI: - 1.3 - +3.5) on day 6. 10.2% died within 14 days of enrolment, one in ambulatory group and 4 in the hospitalized group. In each care treatment failure was detected before death and the antibiotic was changed. None of the deaths were considered to be associated with treatment allocation, there were no serious adverse events reported. Which of the following statements is the most appropriate? 1. There was no significant difference in success of treatment between the two groups 2. The trial design is likely to lead to observer bias and casts serious doubts on the results 3. The risk of treatment failure in the hospital group was significantly higher 4. There were significantly more deaths in the hospitalized group 5. There is no benefit to hospitalization of children with severe pneumonia AKP MAY 2023 101. Importance: There are potential benefits and harms of hyperoxia and hypoxemia for extremely preterm infants receiving more vs less supplemental oxygen. Objective: To compare the effects of different target ranges for oxygen saturation as measured by pulse oximetry (Spo2) on death or major morbidity. Design, setting, and participants: Prospectively planned meta-analysis of individual participant data from 5 randomized clinical trials (conducted from 2005- 2014) enrolling infants born before 28 weeks' gestation. Exposures: Spo2 target range that was lower (85%-89%) vs higher (91%-95%). Main outcomes and measures: The primary outcomes were a composite of death or major disability (bilateral blindness, deafness, cerebral palsy diagnosed as ≥2 level on the Gross Motor Function Classification System, or Bayley-III cognitive or language score