Paediatrics

UNIVERSITY OF KELANIYA
Faculty of Medicine
Final Examination for Medical Degrees - September 1996
PAEDIATRICS Paper 2
18th September 1996
Time allowed : 3 hours

ANSWER ALL QUESTIONS
Answer each question in a separate book
1. A baby boy of healthy parents was born at term by a normal vaginal delivery, after an
uneventful pregnancy. The Paediatric House Officer was called to the labour room
because the liquor was meconium stained.
1.1 What special procedure/s other than routine care might you have to perform as
the Paediatric house officer during resuscitation of this baby ?
(25)
His birth weight was 2.9 kgs and he cried well at 1 min after birth. Half an hour later
he was noted to be tachypnoeic. Respiratory rate was 76 / min. The baby was taken to
the Special Care Baby Unit for further management.
1.2 What is the most likely condition that the baby was suffering from ?
(15)
1.3 What other clinical signs might this baby have at this stage ?
(20)
1.4 Mention 2 important investigations you would carry out in this baby on the first
day of life and what abnormalities would you expect to see ?
(15)
1.5 How would you manage this baby ?
(25)
2. A 4 year old boy is admitted to North Colombo Teaching Hospital, Ragama with a
history of fever of 2 days' duration and vomiting of 1 days' duration.
There was a history of passing loose stool for 1 day, 3 days prior to the onset of fever.
On the morning of the day of admission the child was noticed to be drowsy and he
had had a convulsion.
On examination, the child was very drowsy and had bilateral extensor plantar
reflexes. The liver was palpable 5 cm below the right costal margin and it was tender.
There were no other physical signs.
2.1 List 3 conditions which you would consider in the differential diagnosis ? (15)
2.2 What investigations would be useful in the management of this patient and what
results would you expect to see ?
(35)
2.3 How would you manage this patient ?
(50)
3. A 10 year old girl was brought to the Paediatric clinic by her mother. She complained
that the child's behaviour had changed during the last 2 weeks. She was crying
unnecessarily for unimportant reasons, and was very clumsy, breaking cups and
glasses in the house. The teacher had complained that her school performance was
deteriorating. She had also been punished in school for making funny faces at other
children and teachers.
3/29/20163/29/2016Students' Council , Faculty of Medicine , Ragama
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3.1 What is your differential diagnosis ?

(15)
3.2 What further questions would you ask from the mother to come to a diagnosis ?
(20)
3.3 What are the physical signs that you would look for in this child ?
(20)
3.4 What 5 investigations would you do to come to a diagnosis ? State the
abnormalities that you would look for in each of these investigations.
(25)
3.5 Outline the principles of management in 2 conditions that you mentioned in 3.1
(20)
4. A 1 year old boy presents to the Paediatric ward with a history of fever and vomiting
of 5 days duration. The mother also complains that the child strained on micturition
and passed small amounts of urine 10-15 times a day. Urine output was reduced.
On examination, the child was febrile and irritable. His mucous membranes were dry
and eyes were sunken.
Investigation showed the following:
Haemoglobin
11.4 g/dl
PCV
36 %
White cell count
12,800 / mm3 : N - 80 % ; L - 18 % ; E - 2 % :
Blood urea
20 mg / dl
Serum Sodium
134 mEq / L
Serum Potassium
3.8 mEq/L
Urine appearance - smoky
Protein
+
Sugar
nil
Microscopy - pus cells 8- 10 }
per high power field
Red cells 5- 6 }
( uncentrifuged sample)
Epithelial cells present
Granular casts +
4.1 What is the diagnosis ?
(10)
4.2 What further investigation would you do to confirm the diagnosis ? What
abnormality would you expect in this investigation ?
(10)
4.3 In the management of this patient, what immediate steps would you take ? (15)
4.4 In the long term management of this patient, what further investigations would
you perform ? What abnormalities would be commonly seen in each of these
investigations.
(40)
4.5 Outline the long term management of this patient.
(25)
5. A 6 month old girl was referred to the Paediatric clinic for investigation of
constipation. She has been having this problem for the last 405 months. There was no
history of vomiting, though she was slow to feed since birth.
She was born at term, by a normal vaginal delivery. Her birth weight was 2.75 kg.
Her post natal period was unremarkable except that she had had jaundice for 3 weeks.
She was on breast milk and on weaning food which was started at 4months.
She was the 1st child in the family. Her mother, 24 years, was a house-wife and father,
28 was a clerical officer.
On examination :
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Weight
7.4 kg
There was mild pallor, the skin was dry
Abdomen was mildly distended and soft and there was no hepatosplenomegaly.
5.1 What is the most likely diagnosis ?
(20)
5.2 What other details would you elicit in the history to help you to arrive at a
diagnosis ?
(40)
5.3 What other physical signs would you look for in this child ?
(20)
5.4 List the investigations you would perform to confirm your diagnosis ? What
results would you expect to see?
(40)
5.5 Outline in brief the management of this child ?
(20)
Faculty of Medicine
Final Examination for Medical Degrees - January 1997
PAEDIATRICS Paper 2
13th January 1997

1. A 2 year old girl was admitted to the Paediatric ward with a 3 day history of cough
and shortness of breath.
On examination she was dyspnoenic and irritable . Her weight was 6 kgs, pulse rate
164/ min. and there was pansystolic murmur heard at the left sternal edge.
Respiratory rate was 70/min. and there were crepitations and rhonchi in both lungs.
The abdomen was soft . The liver was enlarged 4 cm and was tender.
1.1 What is the clinical condition that this child is suffering from ?
What is the likely anatomical lesion causing the above condition ?
1.2 List 3 investigations you would carry out during the acute stage.
1.3 Briefly outline the acute management of this child.
1.4 List the important advice that you would give the mother on discharge.
(15)
(15)
(40)
(30)
2. A 3 year old boy was admitted to the Paediatric ward with a 2 week history of
intermittent fever, anorexia and malaise. Immunization was complete except for the
Japanese -B Encephalitis vaccine.
On examination he was febrile, pale, irritable. He had enlarged lymphnodes 2 cm in
size in the right cervical and both axillary regions. There were few echymotic patches
on limbs.The liver was enlarged 4 cm and it was firm and non-tender . The spleen
was enlarged 3 cm and it was firm.
2.1 List 3 differential diagnoses .
(20)
2.2 List the investigations you would do to arrive at the diagnosis.What
abnormalities would you expect to see in each investigation?
(50)
2.3 Briefly outline the management of one of the conditions mentioned in 2.1 (30)

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3. A 7 year old boy from Ja-Ela was admitted with a history of fever with chills of 5
days' duration. he complained of headache and generalized bodyache . He had
vomited several times prior to admission. On admission the vomitus was found to be
coffee grounds in colour. There was no response to treatment taken from a General
Practitioner 2 days prior to the admission.
On admission he drowsy, febrile and his face was flushed. The extremities were
called and few purpuric spots were observed in lower limbs.
Pulse was rapid and BP was 60/40 . The air entry was reduced at the base of the
right lung. The liver was enlarged 2 cm and was tender.
(20)
3.2 Mention 5 laboratory investigations which would help you to arrive at a diagnosis.
What abnormalities would you expect to see in each investigation?
(40)
3.3 Outline the management of the condition you mentioned in 3.1
(40)
4. A five year old boy was admitted to the Paediatric ward with a history of cough, fever
and generalized swelling of the body of three days' duration. His urine output was law
but the urine colour was normal. B.P was 90/60
The following results were obtained from the urine ward test
Sugar - nil
Protein +++
4.1 What is the most likely diagnosis?
(15)
4.2 List two investigations you would carry out to confirm your diagnosis. What
abnormality/ies would you expect to see in each investigation?
(20)
4.3 List two other investigations you would carry out in this child before starting
treatment.
(10)
4.4 Briefly outline the management of the condition mentioned in 4.1 while the
patient is in the ward.
(40)
4.5 List complications of the condition mentioned in 4.1.
(15)
5. A baby girl born at term weighing 3..0 Kg. Was found to be jaundiced at 12 hours of
age. The mother's blood group was AB negative. She gave a past history of her first
baby also becoming jaundiced at one day of her age.
5.1 What is the most likely cause of jaundice in this baby?
(10)
5.2 List investigations you would perform at this stage on this baby
(20)
5.3 Briefly outline the management of this child.
(40)
5.4 List the complications which may arise as a result of jaundice and as a result of
treatment.
(30)
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Faculty of Medicine
Final Examination for Medical Degrees - October 1997
PAEDIATRICS Paper 2
23rd October 1997
1. A 10 month old girl was transferred from the local hospital with a day history of fever
and vomiting. She was sleeping most of the time over the last 24 hours. Mother
gives a history of 2 episodes of abnormal movements in her baby involving all 4
limbs in the morning of the day of transfer.
Examination revealed that the baby was febrile and drowsy. There were no sings of
external injury. During the clinical examination, the child develop a generalized tonic
clonic convulsion.
1.1 State briefly the immediate steps you would take in this situation (do not mention investigations ) .
(30)
The results of some investigations are given below;

Haemoglobin 12.6 g/dl
White cell count 11,700 / mm3 N - 70% , L - 25%, E - 4%, M - 1%
Platelet count 220,000 / mm3
Serum electrolytes: Sodium 134 mEq/l , Potassium 4.2 mEq/l
Blood urea 26 mg /dl
Random blood sugar 90 mg /dl
SGOT 18 IU /L
SGPT 12 IU /L
1.2 List 4 investigations you would do to arrive at a diagnosis
1.3 Give 3 possible diagnoses
1.4 Outline briefly the management of one condition mentioned in 1.3
(15)
(20)
(35)
2. A 15 month old boy was brought to the Paediatric clinic by the mother with a 3 week
history of lethargy, irritability, anorexia. There was no family history of
consanguinity.
On examination, he was found to be pale. He did not have a significant
lymphadenopathy. He had a soft ejection systolic murmur at the pulmonary area. His
liver was 1 cm palpable and the spleen was not palpable.
Investigations:
Haemoglobin
5.2 g/dl
White cell count 7,800 / mm3 :
N - 65 % ; L - 31 % ; E - 4 % :
Blood for malarial parasites - Negative on 3 consecutive days.
Platelet count 250,000 / mm3
Reticulocyte count 1.2 %
Blood picture : Red cells are hypochromic and microcytic, Poikelocytosis
-5-
And anisocytosis +, No target cells.

(15)
2.2 What additional information you would obtain from the history to find out the
cause for his pallor ?
(45)
2.3 Briefly outline the management of this patient.
(40)
3. A 5 year old child was brought to the Paediatric clinic with a history of recurrent
attacks of coughs of 1 year's duration. The mother said that the child was woken up
by episodes of coughing during the early hours of morning. She also had bouts of
coughing after playing and running. The mother is a teacher and the father is an
accountant.
The clinical examination was normal .
Investigations :
ESR
5 mm. 1st hour.
White cell count 7200 / mm3 : N - 50 % , L - 46 % , E - 4 %
3.1 What three further questions would you ask in the history to arrive at
a diagnosis?
(30)
(15)
3.3 What 2 further questions would you ask to decide on the long term
management ?
(15)
3.4(a) What drug would you use if long term management becomes necessary ? (10)
(b) Discuss in brief the advice you would give the mother in using this drug. (30)
4. A 2 year old girl was admitted to the Paediatric ward with cough and cold of 3 days'
duration. She could walk only with support and could speak only 1-2 single words.
She is the 3rd child of a family of 5 children. Father is a private bus conductor and
consumes quarter bottle of locally made liquor daily. The mother is a 28 year old
house-wife.
On examination the patient's height and weight were just below the 10th centile.
4.1 What problems do you identify in this history ?
(30)
4.2 What further questions would you ask about her development ?
(25)
4.3 What further information would you ask from the mother to find out the cause of
her abnormal development ?
(25)
4.4 What advice would you give the mother to overcome the problem mentioned
in 4.1
(20)
5. A caesarian section is done for a primi mother at 38 weeks of gestation for foetal
distress. You are the Paediatric House Officer called to attend for the delivery.
5.1 List 10 important items that you will check before the delivery and list 3
important drugs that you will keep on the trolley.
(25)
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5.2 What physical signs would you check in the baby immediately after birth ? (20)
5.3 If the baby 's heart rate is 100 / min. and the baby is not breathing at 30 secs. ,
what initial steps would you take ?
(20)
5.2 After your initial resuscitation, the baby's heart rate is 140 / min. and the baby is
pink in colour. However, there is no spontaneous breathing at 3 mins. of age.
What are the probable causes for not establishing spontaneous breathing at this
stage and what other measures would you take in this situation ?
(35)
Faculty of Medicine
Final Examination for Medical Degrees - January 1998
PAEDIATRICS Paper 2
For displaced students - University of Jaffna
29th January 1998
1. A 30 year old diabetic mother went into spontaneous labour at a period of
Amenorrhoea of 33 weeks. She delivered a baby girl without any difficulty and the
baby cried immediately after birth. The baby developed tachypnoea within half an
hour after birth. Her birth weight was 1.8 kgs.
1.1 What is the most likely cause for her tachypnoea ?
(10)
1.2 Mention 5 other physical signs that you would look for in relevance to her
respiratory illness.
(20)
1.3 List 4 investigations that you would ask for in this baby within the 1st 24 hours .
(15)
1.4 Outline in brief the management of the condition mention in 1.1
(30)
1.5 List the complications which could arise in this baby as a result of maternal
diabetes mellitus.
(25)
2. A 12 month old boy was admitted to the Paediatric ward with a 2 day history of
severe vomiting and diarrhoea. The mother complained that his stool was mixed with
blood and mucous.
2.1 Mention important features that you would obtain in the history and elicit in the
physical examination of this child to assess the degree of dehydration.
(35)
2.2 The House Officer in the ward noted that the child was severely dehydrated on
admission. Mention in brief how you would rehydrate this child.
(20)
-7-
2.3 Briefly outline the subsequent management of this child in the ward.
(25)
2.4 List 7 complications which could occur in this child as a result of his illness.(20)
3. An 8 month old boy was admitted to the Paediatric ward with a history of poor
feeding and less activity.
On examination, he was found to be pale. There was no lymphadenopathy or
evidence of bleeding into the skin. The liver was enlarged 2 cm below right costal
margin and the spleen was 2 cm. Palpable.
3.1 List 3 likely diagnoses.
(15)
3.2 List 7 investigations with reasons that you would do in this patient.
(25)
3.3 Outline in brief the management of 2 conditions mentioned in 3.1
(60)
4. A 14 month old boy was admitted with a 2 week history of " on & off " dyspnoea.
On examination, he had mild central cyanosis and mild clubbing. The pulse rate was
118 / min. There was no clinical cardiomegaly. However, he had a systolic murmur
best heard at the pulmonary area. The liver and the spleen were not enlarged.
4.1 What is the most probable diagnosis?
(25)
4.2 List 3 investigations you would do to arrive at a definitive diagnosis.
(10)
4.3 The child was discharged form the ward after confirming the diagnosis. What is
the long term management of this child?
(40)
4.4 List complications of the condition mentioned in 4.1
(25)
5. A five year old boy was presented to the Paediatric clinic with a history of recurrent
falls in the class. The class teacher had informed the mother that the child was
unconscious during these episodes.
5.1 What questions would you ask from the mother to arrive at a diagnosis?
(40)
5.2 List important physical sings you would look for.
(20)
5.3 How would you manage this child, if he was found to be clinically normal? (40)
FACULTY OF MEDICINE
Final examinations for medical degrees SEPTEMBER 1998
PAEDIATRICS PAPER 2
04th September 1998

ANSWER ALL THE QUESTIONS
(1)
A 10 year old girl presented to the Paediatric ward with a 2 day history of pain
and weakness of both lower limbs.
1.1
What 6 important questions would you ask from the mother in order to
arrive at a diagnosis?
(20)
-8-
1.2
1.3
1.4
(2)
A 4 year old girl from Minuwangoda, presented to the casualty Paediatric ward
with a 2 day history of cough and shortness of breath.
On examination, her weight was 7 kgs. She was afebrile but was severely
breathless and her lips and tongue showed bluish discoloration. Her pulse rate was
176 per minute, and there were crepitations and rhonchi in both lung fields. Her
abdomen was slightly distended. The liver was enlarged 5 cm below the costal
margin and was tender. The spleen was not palpable.
2.1
2.2
2.3
2.4
(3)
What is the most likely diagnosis?

(20)
What is the immediate management of this child?
(40)
List 3 investigations you would request in the first 24 hours of admission
and what abnormality/ies would you expect to find in each of these
investigations?
(15)
She made a good recovery during the next 7 days. She was found to
be acyanoyic and not dyspnoenic. However, at this stage a murmur
was discovered. It was best heard in the pulmonary area and was
heard throughout the systoic and diastole. Outline in brief the long
term management of this child.
(25)
A 30 year old mother presented to the casualty obstetric unit with severe
abdominal pain and bleeding per vagina at 38 weeks of gestation. An emergency
caesarean section was done for foetal distress and a live baby boy of 2.9 kgs was
born.
3.1
If you are the paediatric house officer, what initial assessment would you
on this day?
(25)
3.2
At 5 minutes despite endotracheal and ambu ventilation his oxygen
saturation was low. List 6 possible causes for low oxygen saturation
at this age.
(25)
3.3
(4)
Mention 8 physical signs you would look for in this child.

(30)
List your differential diagnosis.
(25)
Discuss in brief the management of one condition mentioned in1.3 (25)
How do you manage each of the conditions that you mentioned in 3.2?
(50)
How do you manage the following clinical situations?

4.1
A 10 year old girl with rheumatic carditis being discharged from hospital.
4.2
4.3
(30)
A mother who has a normal weight, 6 week old baby, but thinks that her
breast milk is not enough for the child.
(30)
A 2 year old baby is brought to the Paediatric clinic who does not speak a
single word but can walk very well.
(40)
-9-
(5)
An 8 year old previously healthy boy from Polonnaruwa was admitted to the
Paediatric ward with a 3 day history of fever which was treated by a general
practitioner.
On examination the child was afebrile mildly jaundiced and very pale. There was
no lymphadenopathy or evidence of bleeding in to the skin. The liver was
enlarged 2 cm below the right costal margin and the spleen was just palpable.
5.1
5.2
5.3
5.4
Mention the most likely diagnosis in this child.

(30)
Mention 3 questions that you would ask from the mother which would
help you arrive at the diagnosis.
(20)
List 5 investigations that you would do in this child giving reasons.(25)
Outline in brief the management of this condition
(25)
FACULTY OF MEDICINE
Final examinations for medical degrees JANUARY 1999
PAEDIATRICS PAPER 2
14th January 1999

ANSWER ALL THE QUESTIONS
(1)
A 6 year old boy who was living in a slum area was admitted to the hospital with a
one day history with severe watery diarrhoea . His father was also admitted to the
medical ward with profuse watery diarrhoea the day prior to childs admission.
1.1 Enumerate 4 organisms likely to be responsible for the childs illness.
1.2 How will you manage this child?
1.3 List the complications of severe diarrhoea in childhood .
(2)
A baby born at 32 weeks of gestation, was found to be tachypnoeic 45 minutes after

birth.
(10)
2.2 Mention 4 other likely cause for his tachypnoea
(10)
2.3 Mention 4 important physical signs that you would look for in this child. (20)
2.4 What other acute complications can this baby develop as a result of his
premature birth?
(40)
2.5
(3)
(20)
(60)
(20)
Discuss the management of one complication mentioned in 2.4
(20)
A 12 year old boy was admitted to the ward with a one month history of low grade
fever and loss of weight. He also had a history of passing red coloured urine on
several occasions.

- 10 -
(4)
3.1
3.2
What is your differential diagnosis?

(25)
State the investigations that you would request to arrive at diagnosis, giving
reasons.
(50)
3.3
Discuss the management of one condition mentioned in 3.1
How do you manage the following problems in a well baby clinic;

4.1
A 6 month old baby who is growing at the 50th centile in all parameters, with
an umbilical hernia?
(20)
4.2
A one year old baby has bow legs. The distance between the medial femoral
condyles is 3 cm. When the child is standing with both feet together. (20)
4.3 A 6 month old baby with a squint?

4.4 A 3 day old baby girl with bleeding per vagina?
4.5 A new born baby with talipes equino varus (club foot) deformity?
(5)
(25)
(20)
(20)
(20)
An 8 month old baby was admitted with a one day history of fever and a fit, which
lasted for 35 minutes.
On examination, he was found to have a right side weakness which disappeared
after 24 hours.
(30)
5.2 What other conditions would you exclude in this clinical situation.
(20)
5.3 What is your long term management of this child?
(50)
FACULTY OF MEDICINE
Final examinations for medical degrees AUGUST 1999
PAEDIATRICS PAPER 2
06th August 1999
Answer all the questions in separate books
(1)
A 12 year old boy was admitted to the Paediatric ward at 10 a.m. with a history of
being unconscious for one hour. The grand mother and the father bought the child
to the ward. Mother is working in the Middle East as a house maid. Father is a
fisherman and he was smelling of alcohol when he brought the child to the ward.
1.1
1.2
1.3
List 8 relevant questions would you ask to arrive at a diagnosis. Give

reasons.
(25)
List 5 physical signs that you would look for in the general examination
and in the central nervous system to arrive at a diagnosis.
(25)
List 5 different diagnoses that you would consider.
(20)
- 11 -
1.4
Mention 5 investigations you would request in this child.

Give reasons.
(30)
(2) A 2 year old boy from Anamaduwa was brought to the paediatric ward with a 4 day
history of fever and cough. His mother was told that the child was born at term and
had a weight of 2.0 Kgs at birth. She also gave a history of her child becoming
jaundice in the first month of life. The mother told that he started to sit with support
at the age of 18 months and he could not speak a word up to date.
On examination his weight was 7.8 Kgs and his head circumference was 41 cm. He
had a bilateral cataracts.
Respiratory system examination revealed that he was mildly tachypnoeic and the air
entry was markedly less on right lower zone. He had crepitations in the lower zone
of the right lung. He was also noted to have a murmur in the pulmonary area which
was heard throughout the cardiac cycle.
2.1 List the problems that you have identified in this child (including
what you suspect )
(40)
2.2 What is the most likely aetiological factor for problems seen in this child? (15)
2.3 List the investigations you would request giving reasons to confirm the
problems you suspect in 2.1
(35)
2.4 What may have prevented the occurrence of the condition mentioned in the 2.2
(10)
(3) 3.1
3.2
What is the baby friendly hospital initiative concept?

(25)
Describe one aspect in 3.1 you is very important and give reasons for this
recommendation.
(25)
3.3
Enumerate the reasons for introducing complimentary foods (weaning foods)

and briefly describe preparation of a home made complimentary food.
(25)
3.4
Your brothers wife has a 3 month old baby. Since his wife has to go to work
they have a 12 year old female to look after the child. She is from a very poor
home and her father had died recently of tuberculosis. What advise would you
give your brother?
(25)
(4) A 20 year old married woman gave birth to her first baby at 38 weeks of gestation.
The mother developed a post partum haemorrhage 3 hour after the delivery. The
baby weighed 1.8 kgs at birth and he was not asphyxiated at birth .A nurse in the
postnatal ward noted that the baby has some abnormal involuntary movements
involving lips and upper limbs at 8 hours of age.
4.1 What is the most likely cause for these abnormal movements?
4.2 What other conditions would you consider in this baby?
4.3 What two important steps would you take to manage this child?
- 12 -
(15)
(25)
(20)
4.4 What is your subsequent management of this baby within the next 48 hours?
(40)
(5) What advise would you give a mother who comes to the well baby clinic with a
complaint of,
5.1 Hiccups in a 2 week old baby?
5.2 Crying while passing urine and stools by a by a 7 day old baby?
5.3 Sleeping for 14 to 16 hours per day by a 10 day old baby?
5.4 Loss of hair at the back of the head in an 8 month old child .
5.5 Absence of milk teeth in a one year old child?
(20)
(20)
(20)
(20)
(20)
FACULTY OF MEDICINE
Final examinations for medical degrees OCTOBER 1999
PAEDIATRICS - PAPER 2
For displaced students University of Jaffna
29th October 1999
Answer all the questions in separate books
1. A 5 day old baby developed neonatal meningitis. He was discharged after 3 weeks of
antibiotics. Cerebro spinal fluid examination on discharge was found to be normal.
1.1 List 5 possible late complications that this child could develop.
(30)
1.2 List the Physical signs that you would look for in the clinic to diagnose the
above complications.
(40)
1.3 Briefly outline the management of three of the conditions mentioned in 1.1
(30)
2. A 10 year old boy was brought to the Paediatric ward with a 2 week history of low
grade fever.
On examination he was found to have a maculopapular rash and hepatosplenomegaly.
Following investigations were performed
Blood for malarial parasite negative for 3 consecutive days.
S.A.T. negative
2.1 List 4 most likely differential diagnoses.
(20)
2.2 What other investigations would you do to arrive at a diagnosis.Give reasons.(40)
2.3 If all the investigations are inconclusive how would you manage this child? (40)
3. Write briefly the advise you would give parents in the following situations.
3.1 A 3 year old child presenting with his third typical febrile convulsion.
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(25)
3.2 A 3 week old baby diagnosed as having congenital hypothyroidism.
(25)
3.3 An 18 month old baby diagnosed as having an uncomplicated ventricular septal

defect.
(25)
3.4 A neonate with large bilateral cephalhaematomata.
(25)
4. A 9 year old boy was brought to the Paediatric ward with a 3 day history of fever and
vomiting. The mother said that the vomitus contained coffee coloured material on 3
consecutive occasions.
On examination he was found to be febrile, not pale and anicteric. He did not have
neck stiffness or photophobia.
On the second day after admission he was found to have tachycardia with a low
volume right radial pulse.
(10)
4.2 List 4 important physical signs you would look for in this child to support your
diagnosis.
(25)
4.3 Briefly outline the management of this child within the next 48 hours.
(50)
4.4 What advise would you give on discharge of this child?
(15)
5. Enumerate the
5.1 Classical features of physical abuse.
5.2 Clinical features of tracheo-oesophgeal fistula.
5.3 Clinical and laboratory features of Bacillary dysentery.
(30)
(40)
(40)
FACULTY OF RAGAMA
7th July 2000
Final examination for Medical Degrees - July 2000

Paediatrics - Paper 2
(answer all 5 questions)
PART A
1. A 9 year old boy is admitted to the Paediatric ward with a history of facial puffiness
and a reduced urine output of 2 days' duration.
On examination he has periorbital oedema. His blood pressure is 130/85 mmHg.
(10)
1.2 List 4 investigations you would order and the results that you would expect to
find in each of them.
(30)
1.3 Outline briefly the management of this child.
(45)
1.4 List 3 serious complications that this child could develop.
(15)

- 14 -
PART B
2. A 3 year old boy admitted to the Paediatric ward with a history of generalized tonic,
clonic convulsion lasting 30 minutes. He had developed high fever , irritability and
vomiting 3 days period of the onset of convulsion. A white cell count done by the
general practitioner prior to admission is available. Total count
- 15,500 /cmm
Neutrophils - 80%, Lymphocytes - 17%, Eosinophils - 3%
2.2 List 4 important physical signs you would expect to elicit in this child .
(10)
(20)
2.3 You are the house officer in the Paediatric ward when the child is admitted with
this convulsion.
List 4 important steps in the initial management of this patient.
(30)
2.4 Outline briefly the principles of management in the ward after you have
controlled the convulsion.
(40)
PART C
3. A 30 year old mother underwent an emergency caesarian section for uncontrolled
pregnancy included hypertension at 30 weeks of gestation . A baby boy with a birth
weight of 1.5 kg was delivered .
On examination at 30 minutes after delivery he has a respiratory rate of 100 per
minute with grunting and severe recession. The air entry is equal on both sides.
3.1
3.2
What is the most likely diagnosis

(10)
List 2 important investigations that you would request in the first 24 hours and
the abnormalities you would expect to find in each of them.
(30)
3.3
Outline briefly the principles of management of this child in the first 24 hours
(40)
He recovers from the acute illness and then develops gradual onset of difficulty
in breathing on day 9. On examination he has a pulse rate of 174 beats / minute
and a long systolic murmur at the left infra-clavicular area. His liver is enlarged
3 cm below the right costal margin.
What is the reason for his deterioration?
(20)
3.4
PART D
4.
4.1
An 18 month old boy is brought to the Paediatric clinic. His growth

parameters are given :Weight
6.8 kg
Length
83 cm
Head circumference 48 cm
Normal centile chart
- 15 -
Age
18 months
4.1.1
4.1.2
4.2
Weight (kg)
3
50
97
8.8 11.5 13.6
Length (cm)
3
50
97
75
83
86.5
Head circumference (cm)

3
50
97
45
47.5 50
What is your interpretation of his growth?

List 2 possible causes for his growth pattern.
(15)
(30)
A 2 year old boy is brought to the clinic with constipation. His growth parameters
are given below.
Weight
11.5 kg
Length
70 cm
Head circumference
48 cm
Normal centile chart
Age
Weight (kg)
2 years
4.2.1
4.2.2
4.2.3
Length (cm)
Head circumference (cm)
50
97
50
97
9.6
12.2
15
80
85.5
92
3
46
50
48
97
51
What is the possible reason for his growth pattern?

List 3 important questions would you ask the mother to arrive at a
diagnosis
What 3 investigations would you do to arrive at a diagnosis?
(15)
(20)
(20)
PART E
5.
A 3 year old girl presents to the out patient department with a history of diarrhoea
with blood and mucous of 3 days duration. The child has high remittent fever, and is
drowsy on admission.
5.1 What 5 important physical signs would you look for?
5.2 What 4 important aspects of advise/education would you give this mother?
(20)
(20)
5.3 On the 6th day of the illness her urine out put decreases and she is moderately
pale
5.3.1 What is the most likely complication?
(20)
5.3.2 List 3 other clinical features of this complication.
(20)
5.3.3 List 4 important investigations you would do to confirm this
complication.
(20)
2000 Oct
5th batch repeat
3 hours
(1) A 3 month old boy was brought to the Paediatric Clinic. His birth weight was 4.3 kg,
and the present weight is 4kg.The baby has had a history of fever on two occasions
during the past month, and the General Practitioner had treated him. There is no
history of diarrhoea or cough. The baby is exclusively breast fed and feeds well. On
examination no positive physical signs were found.
- 16 -
1.1. What is the most likely diagnosis?

(10)
1.2. What two investigations would you do to establish the diagnosis.
(10)
1.3. How would you interpret the investigations that you mentioned above? (20)
1.4. Mention two other investigations that would point to the underlying aetiology of
the condition. (20)
1.5. Mention five aetiological causes you may expect to find in the above
investigations.
(25)
1.6. What other investigations would you do to ascertain the complications? (15)
(2) An 8 year old boy is admitted with a one day's history of difficulty in breathing and
cough. He has been having this problem since the age of 5 years and he has has
several admissions to the hospital. He often wakes up in the night as he gets a
troublesome cough. He goes to school, and the teacher says that his work is not up to
standard. He likes to play cricket but starts coughing when playing. He is not
on regular medication.
On examination he is found to be drowsy, irritable, quiet and afebrile. The pulse rate
is 136/minute and the blood pressure is 100/70 mmHg. Precordial examination does
not reveal any abnormality. The respiratory rate is 60 breaths per minute and the air
entry was markedly reduced on both lung fields.
The abdominal examination reveals a 3 cm palpable liver and a 1 cm palpable spleen.
2.1. What is the most likely acute condition that he is suffering from?
(15)
2.2. Mention the 5 most appropriate measures that you would take in the immediate
management.
(30)
2.3. What is the most likely complication that this child could develop if there is a
delay in bringing him to the hospital?
(15)
2.4. Briefly outline the longterm pharmacological management, including advice given
to the mother on the use of the drug/s.
(40)
(3) A 25 year old primigravida presents in labour at 32 week of gestation. She delivers a
male infant weighing 1.2 kg, 24 hours after admission to hospital.
3.1. Name one intervention you would expect the obstetrician to perform in order to
reduce the morbidity and mortality in this neonate.
(10)
3.2. List 4 complications you would expect in this neonate in the first 24 hours of life.
(20)
3.3. List the principles of management of this neonate in the first 24 hours of life.(50)
3.4. He is discharged from the baby unit 6 weeks after birth. His growth is normal an
he is clinically normal. Write a prescription for him on discharge.(20)
(4) A 10 year old girl is brought to the growth and development clinic as she is shorter
than the other girls of her class.
On examination her height was well below the third centile.

- 17 -
4.1. List five possible causes for her short stature. (25)
4.2. List five important questions you would ask in the history to arrive at a diagnosis
(25)
4.3. List five physical signs you would look for on examination that are relevant to the
conditions you mentioned in 4.1.
(25)
4.4. List four investigations you would order in this child to arrive at a diagnosis.
(25)
(5) How would you handle following situations?
5.1. An 8 month old baby who has been given the BCG at birth but, he has no BCG
scar.
(25)
5.2. An 8 year old boy on 10 mg/kg/day of carbamazepine who has a history of
recurrence of fits.
(25)
5.3. A 3 year old girl who is brought with inability to speak.
(25)
5.4. A 10 year old boy with haemophilia A, who is brought to hospital with an acute
severe haemarthrosis of the right knee joint.
(25)
2001 May
6th batch proper
3 hours
(1) A previously healthy 4 year old child was admitted to the Paediatric casualty ward
with a 2 day history of fever and a 24 hour history of vomiting. The day after
admission he developed coffee ground vomitus. His temperature, pulse and blood
pressure charts are given below.
1.1. What is the most likely diagnosis?
(10)
1.2. List 3 other important physical signs you would expect to find in this child. (15)
1.3. What is the physiological basis for the change in blood pressure from point X to
point Y ?
(10)
1.4. Name the 3 most important investigations that you would do at this stage to
manage this child, indicating the expected results.
(30)
1.5. What immediate intervention would you do at point Y ?
(15)
1.6. Despite adequate measures the condition remained unchanged.
What 2 steps would you take at this stage?
(20)
(2) 2.1. A 10 year old child is admitted to the Ragama Teaching Hospital, within half an
hour following a bite by a pet monkey. The parents have not taken any action
apart from bringing him to hospital. On examination the child has multiple bites
on the face, the left ear is badly torn and bleeding.
How would you manage this child?
(50)
2.2. A 10 year old boy is brought to hospital with a
history of Cobra bite.
2.2.1. List 4 features of systemic envenomation. (20)
2.2.2. This child develops a severe reaction to antivenom. How would you
manage him?
(30)

- 18 -
(3) A 10 year old boy is seen in the Paediatric clinic for excessive tiredness over the last
5 months. In the past there is a history of fever at the age of 1 year. The general
practitioner had seen him and a urine full report had been done. As this was positive
he had been given a 3 day course of antibiotics. Since then he has had several
episodes of fever without respiratory symptoms. Each time the General Practitioner
had treated him with a 3-5 day course of antibiotics. Recently, he has had polyuria,
polydipsia and secondary nocturnal enuresis.
On examination his height weight are both below the 3rd centile. He is pale and the
blood pressure is 140/100.
3.1. What is the diagnosis?
(10)
3.2. List 4 investigations you would order at this presentation.
(20)
3.3. What was the condition the General Practitioner treated at 1 year?
(10)
3.4. Describe briefly how you would have managed him at 1 year while critically
evaluating the management of the General Practitioner.
(60)
(4) 4.1. A 2 hour old newborn has a moderate degree of respiratory distress.
List 5 important points in the history that you would obtain to find out the cause
For the respiratory distress.
(30)
4.2. A 20 day old boy has a systolic murmur which is best heard over the left sternal
edge.
List five important physical signs that you would look for in this child to arrive at a
Clinical diagnosis, indicating the appropriate abnormality.
(eg. Fixed splitting of second heart sound in atrial septal defect)
(30)
4.3. A 17 day old neonate has a moderate degree of jaundice. Her total bilirubin is
16.8 mg/dl, and the direct fraction is 10 mg/dl.
List 5 investigations that you would request to arrive at a diagnosis.
(40)
(5) Write notes on.
5.1.NCHS (National Centre for Health Statistics) standard and its application in Sri
Lanka.
5.2. The action you would take if a 6 year old girl presents with a foreign body in
the vagina.
(50)
-------------------------------------------------------------------------------FACULTY OF MEDICINE
PAEDIATRICS - ESSAY PAPERS
-------------------------------------------------------------------------------2001 Sep
6th batch repeat
3 hours

- 19 -
(1) How would you manage the following?

1.1. A 4 day old newborn baby who is sucking well active and afebrile is found to
have a purulent discharge from the umbilicus and periumbilica erythema.
(20)
1.2. A 2 day old newborn baby girl who is found to have mild vaginal bleeding.
1.3. A 2 day old baby boy who is found to have bilateral congenital talipes
equinovarus during the routine postnatal examination.
(25)
1.4. A 21 day old baby who has a weight of 2.5 kg. The baby had been born at term
weighing 2.8 kg. (35)
(2) Write notes on the following.
2.1. Clinical features and complications of bacillary dysentery.
2.2. Complex partial seizures.
(50)
(50)
(3) A 6 month old boy was brought to the emergency therapy unit of Teaching Hospital,
Ragama with a history of worsening breathlessness for 2 days duration.
He is the 2nd child of a low-income family and has had similar mild episodes
previously which were treated by a general Practioner. The mother had been told that
the child has 'Phlegm'.
Examination revealed an afebrile, dyspnoeic child with a respiratory rate of 70
breaths per minute. He was sweating.Auscultation of lungs revealed wide spread
crepitations over both lung fields and few ronchi. There was a significant pansystolic
murmur at the left lower sternal edge.
3.1. What is the most likely clinical diagnosis?
(15)
3.2. List 3 other important physical signs you would look for to arrive at your clinical
diagnosis. (15)
3.3. List 4 important steps in the management of this child at the ETU.
(20)
3.4. Once the child is transferred to the ward, indicate 3 parameters that you would
monitor in the next 24 hours.
(15)
3.5. List 3 investigations that you would request in order of priority.
(15)
3.6. List 4 other complications this child could develop.
(20)
(4) An 8 month old girl is referred to the Paediatric clinic by the midwife in the local
clinic due to developmental delay. The baby had been born at term weighing 2.8 kg.
During the neonatal period there had been noisy breathing and poor feeding. The
baby had also had prolonged jaundice.
On examination her weight, length and occipito frontal head circumference are all
just below the 10th centile. She keeps her tongue protruded.
4.1. List the two most likely diagnoses that you would consider in this child.
(10)
4.2. List 2 other physical signs you would expect to find in this child for each of the
two conditions mentioned.
(20)
4.3. List two investigations you would order to confirm each of the diagnoses and
indicate the expected results.
(20)

- 20 -
Her developmental history/assessment revealed the following

Smiles with mother.
Holds head straight.
Unable to sit with support.
Does not respond to distraction test.
Does not reach for objects.
4.4. What is your overall impression regarding her development?
(15)
4.5. What is her developmental age?
(15)
4.6. What important information would you convey to the parents regarding the
management of one of the conditions mentioned in 4.1?
(20)
(5)
A 10 year old boy was admitted to the Paediatric ward with a history of dark
coloured urine. He has had a similar illness six months ago, for which he had
taken treatment
from a General Practitioner. Urine full report done at that
time by the General Practitioner had shown field full of
red blood cells.
5.1. What four important questions would you ask from mother to arrive at a
diagnosis?
(25)
5.2. List three physical signs that you would look for in this child to arrive at a
diagnosis.
(15)
5.3. List four possible differential diagnoses that you would consider in this
patient.
(20)
5.4. List six investigations that you would do in this patient to arrive at a
diagnosis and indicate the expected results.
(40)
7 th PROPER, [MAY 2002]

1. 8 month year old boy is brought to the pediatric casualty ward with a history of
excessive crying for one hour. During the episode of crying he had developed bluish
discoloration of skin. Difficulty in breathing and loss of consciousness. He has had
similar episodes during the last 2 months. Which resolve spontaneously. His child health
development record showed poor weight gain.
Examination revealed deep central and peripheral cyanosis and clubbing. On auscultation
he has harsh systolic murmur at the left sternal edge.
1.1 What most likely disease condition that this child is suffering from(10)?
1.2 What is the most likely reason for this hospital admission?(10)?
1.3 List two other physical signs you would expect in this child?(10)
1.4 Name one immediate non pharmacological measure that you would do in the acute
situation.10)
1.5 List two drugs that you would use to treat this episode?(10)
1.6 Name one measure you would take to prevent occurrence of these episode?(10)
1.7 List 3 investigations you would do to confirm the diagnosis and indicate the
expected results.(25)
- 21 -
1.8
List 3 long term complications you would expect in this child.(15)

PART B
2. A 10 year old boy is admitted to hospital with a history of a chronic cough of two
months duration.
He was the 5th child in a family with a poor socio economical background. They lived in
an over crowded house with their grand father. The grand mother was treated for chronic
cough and wheezing and had died one month ago from a respiratory illness.
2.1 Mention five questions that you would ask from the mother to arrive at a
diagnosis?(15)
2.2 List five physical signs that you would look for in this child.(10)
2.3 List three differential diagnosis that you would consider.(15)
2.4 List 4 investigations you would do to arrive at a diagnosis.
2.5 Briefly outline the management of one condition that you have listed in 2.3 (30)
PART C
3.
3A An 18 month old child is admitted to the pediatric casualty ward with a 3 day history
of watery diahorrea and vomiting . T he mother complain that there has been no urine
output for the past 14 hours.
The child has sunken eyes. Reduced skin turgor with a low volume radial pulse of
160/min. His weight is 8 kg.
3A.1 What other important physical sign would you elicit in this child?(10)
3A.2 What is his immediate problem? (10)
3A.3 What is the immediate management?(15)
3A.4 Briefly outline the management plan for the next 24 hours?(15)
3B. A one year old boy is brought to the out patient department where you are the
medical officer. With a history of a fall off the bed 3 days previously. The mother who
brings him to the OPD is very agitated and wants to get back home as her older child of 5
years with step farther.
On examination you find that the childs left upper arm is swollen and tender and has
multiple bruises all over his body ranging from bluish to yellowish brown in color. There
are small circular healed scars on his left buttock.
3B.1 What is the most likely diagnosis? (10)
3B.2 List 5 factors in this history and examination which helps you to consider this
diagnosis? (20)
3B.3 What is the most important step you would take? (10)
3B.4 List two investigations that should be done on this child?
PART D
4. A 4 hour old newborn baby is admitted to the special care Baby Unit for mechanical
ventilation. He was born at 31 weeks of gestational and the birth weight was 1.2 kg. He
has clinical evidence of moderate to severe respiratory distress. Which started
immediately after birth.
4.1 List 4 other problems that could develop in this baby within 1st 24 hours of birth.(20)
4.2 Briefly out line the management of this baby in the 1st 24 hours. (40)
4.3 On day 2 while on the ventilator his clinical condition starts to deteriorate rapidly.
He is cyanosed. Pale and has bradycardia. Give 3 possible reasons for this
deterioration.
- 22 -
4.4 The baby recovers well and being discharged on day 30. What advice would you
give this mother?(mention 5)
PART E
A 5 month old boy is seen at the pediatric clinic with a history of episodic crying for 2
weeks duration.
Mother also has noticed that the child has brief attacks of sudden jerky movements of
trunk and the head falling asleep.
5.1 What is the most likely diagnosis?(10)
5.2 List 5 questions you would ask the mother to help you to justify the diagnosis? (30)
5.3 List 5 physical signs that you would look for? (30)
5.4 List 2 investigations that you would request.
5.5 List 3 drugs that you would use to treat this condition?
7 th batch repeat exam-sep 2002

PART A
1. A 10 month old boy presents with a history of lethargy and recurrent infections for
the past2 months. On examination he is found to pale.
The following reports are obtained on the blood tests performed on him.
Hemoglobin
6.5g/dl
WBC
8,000per cum.m,N60%,L30%E6%M4%
Blood picture Red cells are hypochromic,microcytic.Target cells present.
1.1 List 2 differential diagnosis? (20)
Based on the above differential diagnoses list the significant physical signs you would
attempt to elicit to differentiate the two conditions. (15)
Apart from a soft ejection systolic murmur at the left sternal edge, you do not find any
significant physical signs. What further questions would you ask the mother? (15)
What further investigations would you order? (15marks)
How would you treat this condition? (25)
What is the most likely explanation for the heart murmur? (10)
PART B
2. a. A baby is born at term weighing 4.5 kg.
a.1 Identify the problem in this neonate. (5)
a.2 List two other possible causes foe this problem. (20 marks)
a.3 List the complications this baby could encounter during the perinatal period. (25)
b. A baby is born at term weighting 1.9 kg.
b.1 Identify the problem in this neonate. (5marks)
b.2 List two possible fetal causes for this problem. (20)
b.3 List the complications this baby encounter during the perinatal period. (25)
PART C
3.A 4 year old presents with fever and cough of 5
days duration. He has had 2 episode of the left lower lobe pneumonia in the recent past
and had been admitted to the hospital on both occasions.
On examination, he is ill looking ,febrile and dyspnoeic. His weight is 12.8 kg.(just
below the 10th centile) and the height is 101cm(50 th centile) .Examination of the
respiratory system reveal reduced air entry on the left base.
3.1 What is the diagnosis?
(10)
- 23 -
3.2 List two important questions that you would ask in history . (20)
3.3 List 6 other physical signs that you would look for? (30)
3.4 List 5 relevant investigations that you would order on this and indicate the expected
results.
(40)
PART D
4.how would you handle the following situations?
4.1 A 3 year old child who has received BCG and two doses of DPT and oral polio
vaccines.
20 marks
4.2 A 4 month old boy who has developed a generalized fit on the same as the
administration of the 2 nd dose of the DPT vaccine.
20 marks.
4.3 A mother of a 4 month old child seeking advice regarding weaning.
4.4 A mother of a 2 week old baby presenting with painful engorged breasts?
(20)
PART E
5. A 4 month old previously healthy boy is admitted with a 3 day history of fever, refusal
of feeds, and vomiting. He has a history of 2 episodes of fits on the 2 nd and 3 rd days of
the illness.
He develops another convulsion while he is being examined.
5.1 How would you manage this acute situation?
(25)
5.2 The mother says that the child has not passed urine for the last 24 hours. What is the
most likely explanation for this?
(10)
5.3 What is the most important immediate therapeutic measure that you would take in
this situation? (20 marks)
5.4 Blood urea and serum electrolytes are taken immediately after the control of the
convulsion. Indicate the expected results.(Do not write the values. Indicate as high, low
or normal in each)
(20)
Mention briefly the management of this child in next 24 hours. (24)
March 2003- 8th PROPER

1. A 3 year old girl is admitted to the pediatric casualty ward with a history of a snake
bite 20 minutes prior to admission. The dead snake was brought by the relatives and was
identified as a common krait.
On examination she is restless and irritable. There are 2 fang marks on the dorsum of the
right foot with swelling around it. There are no other abnormal physical signs.
1.1
1.2
1.3
1.4
What would be your immediate management of this child? (indicate the reasons
for your action/s) (30)
List 4 different aspects you would monitor in this child in the next 2 hours,
indicating the reasons.
(30)
Eight hours after admission she has respiratory arrest .Describe how you will
handle this situation as a pediatric House officer. (30)
If an arterial blood gas analysis is done at time of the respiratory arrest what
changes would you expect to find ?(indicate high, low or normal in each
parameter)
- 24 -
PART B1
2.1 A 4 year old boy diagnosed as having asthma 2 years previously, presents with poorly
controlled, frequent episodic asthma. He has been on a salbutamol dry powder inhaler
device twice daily as prophylaxis, prescribed by his doctor for the past 6 months.
2.1.1
2.1.2
Comment on this patients present management? (10)

How would you manage this child? (30)
PART B2
2.2 A 9 month old boy presents with pallor and hepatosplenomegaly.The following
results were obtained from the blood tests performed on him.
1. Hb%-5g/dl
2. Blood picture-Hypochromic,microcytic,red blood cells, Target cells+
3. Hb electrophoresisa. Hb A 2%
b. Hb A2 6%
c. Hb F 92%
2.2.1
What is the diagnosis?
(5 marks)
2.2.2 Parents of this child share common maternal grand parents. They have one other
normal girl, aged 8 years.
Draw a pedigree chart of this patients family spanning 4 generations, using
acceptable symbols with the information given, in the space provided.
2.2.3 List the 4 main principles of managing this child. (15)
2.2.4 Parents are planning to have another child. Describe briefly how you would
handle this situation.
(20)
PART C
03. A 10 year old boy is admitted with a 7 day history of fever and pain in the limbs. He
also has a history of passing dark colored urine. On examination his weight is 30 kg,
height is 135cm and his surface area is 1.05m2. He is ill looking with red suffused eyes
and has muscle tenderness in the calves. He also has neck stiffness and 4 cm , enlarged ,
tender liver.
3.1
3.2
3.3
3.4
3.5
3.6
What is the most likely diagnosis (5 marks)

List 5 relevant investigations you would order giving reasons. (25)
What specific treatment is indicated? (15)
His urine output has been for the previous 24 hours on the second day after
admission and he is found to be drowsy.What is the likely complication that has
arisen? (10)
What is his fluid requirement for the next 24 hours? (15)
Briefly outline his further management. (30)

- 25 -
PART D
04. Comment on the following common beliefs among Sri Lankan parents and the advice
you would give to such parents in each situation.
4.1
Every child must be given anti helminthics regularly at 3-6 month intervals up to
the age of 5 years.
4.2
4.3
(30)
Teething and starting to crawl causes diahorrea. (30)

Since there is only a small quantity of breast milk secreted during after delivery, it
so important to give water and /or formula feeds to the newborn to prevent
dehydration fever in the first 72 hours.
(40)
PART E1
5.1
5.1.1
5.1.2
A 4 day old neonate is admitted to the pediatric casualty ward with fever, refusal
of feeds, lethargy and jaundice. He had been born at term weighing 2.9 kg.
List 2 possible causes for this abnormal behavior. (10)
List 4 important investigations that you would request indicating the expected
results.
(40)
PART E2
5.2 A 26 year old mother gives birth to twins at 39 weeks of gestation. The first twin is
pale and other is plethoric immediately after the birth.
5.2.1
5.2.2
What complications has occurred? (10)

What is the immediate most relevant investigations you would request on each of
these neonates to decide on the management and what results would you expected
to see? (10)
Twin one with pallor
Twin two with plethora.
5.2.3 List one complication that the pale baby could develop (10)
5.2.4 List two complications that the plethoric baby could develop. (20)
JULY2003 8 th REPEAT
PART A
01.A 2 hours old new born to a mother with diabetes mellitus is found to have respiratory
distress 30 minutes after birth. He was born by caesarean section weighing 4.2kg at birth.
1.1
1.2
1.3
List 4 possible causes for his respiratory distress, in order of priority. (20)
List 3 possible metabolic complications that this baby is most likely to develop.
(15)
Explain the basis for one of the complications listed in 1.2 . (15)

- 26 -
1.4
On examination this baby has evidence of moderated to severe respiratory

distress. Describe briefly how you would manage this child in the next 24 hours.
(50)
PART -B
02.A 5 year old boy from Puttalam is admitted with high fever of 7 days duration. He is
irritable and found to jaundice. There is 2 cm.liver and a 3cm.Firm,spleen.
2.1 What is the most likely diagnosis? (10)
2.2 What investigation/s will confirm your diagnosis? (20)
2.3 How would you manage this child? (25)
2.4 His condition starts to deteriorate on the day after admission. He is found to be
unconscious and responds only to deep pain.
What complications has arisen?
(10)
2.5 He develops a generalized tonic clonic seizure while you are examining him. How
would you manage this situation?
(35)
PART C
03. An 8 year old girl presents with a history of periorbital swelling and the passage of
reduced amounts of red coloured urine.
On examination,her weight is 25 kg,height is 125cm.and the surface area is 0.9m2.Her
urine output in the 24 hours had been 120ml.
3.1
3.2
3.3
3.4
3.5
What is the most likely diagnosis? (10)

Calculate her fluid requirement for the next 24 hours. (10)
Mention the most important physical sign that you would elicit. (10)
List the 4 most important investigations you would order indicating the expected
results in this child. (30)
Her serum potassium level 4 days after admission is found to be 6.5 mmol/L.As the
house officer in the the Pediatric ward what measures would you take to manage
this situation.
(40)
PART D
04. A 9 year old previously healthy boy presented to the paediatric ward with a fever of 5
duration. He has a painful swelling of the right knee joint . He has had a similar swelling
involving the left elbow joint 24 hours previously, which has now settled.
On examination his pulse rate is 140/minute. He has a pansystolic murmur at the apex.
He right knee joint to be red and swollen with painful restricted movements.
4.1
4.2
4.3
What is the most likely diagnosis? (10)

List the 3 most important investigations you would request,to confirm the diagnosis.
(15)
What is the most likely underlying cardiac lesion?
(10)

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4.4
Describe briefly the management of this child in the ward and on long term follow
up.(45)
4.5
3 days later he is found to be dyspnoeic at rest and his pulse rate is

180/minute.What complications has arisen? (10)
List 2 changes you would make in this childs initial management at this stage?
(10)
PART E
4.6
05.An eighteen month old child is seen in the paediatric clinic as he is unable to sit with
support. But his upper and lower limbs are stiff with the lower limbs involved more than
upper limbs. Deep tendon reflexes are exaggerated in all four limbs.
On developmental assessment you find the following
Head control present.
Unable to roll over.
Reaches for objects with palmar grasp.
Transfers objects from hand to hand.
No pincer grasp.
Hearing normal.
Speech-Amma only.
Stranger fear present.
Feeds from a cup with assistance, but not on his own.
5.1
5.2
5.3
5.4

(10)
What conclusions would you come to regarding his development? (30)
List 5 relevant questions you would ask the mother to find out the cause of the
underlying problem?
(20)
Discuss briefly the management of this child.(40)
JANUARY 2004 9th PROPER

PART A
1.A 7 year old boy with a past history of rhematic fever was given benzathine penicillin
intramuscularly in the clinic immediately after the injection, he developed breathing
difficulty and stridor. He had a rapid thready pulse and his blood pressure was not
recordable.
1.1 What complications has occurred?
(10)
1.2 Explain the physiological basis for this boys symptoms and signs described above.
(20)
1.3 You are the medical officer in charge of the injection room in the OPD at the time.
List the important steps you would take to manage this situation. (50)
1.4 Outline the plan of future management of this child.
(20)
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PART B
2.A 2 year old boy previously diagnosed as having tetralogy of fallot is admitted to
pediatric casualty ward with a history of fever for 7 days duration, associated with
headache and vomiting.
On admission he develops a left sided focal convulsion.
2.1
2.2
2.3
2.4
2.5
What is the most likely cause for this childs presentation? (10)
Explain why children with tetralogy of fallot are more prone to develop the
complication you mentioned in 2.1 above (20)
List the 5 most important physical signs you would expect to elicit when
performing a neurological assessment of this child. (20)
List 4 important investigations you would request on this child. (20)
List 4 other complications of tetralogy of fallot. (20)
PART C
3.You are called to attend an elective caesarian section of a mother, who is in the 39thw
week of her second pregnancy. Her previous baby had been born by an emergency
caesarian section. The mothers blood group is O Rh negative .A baby weighing 3 Kg is
delivered.
3.1
What other important information would you obtain in the history that would help
you to manage this child(list3) (15)
3.2 List 4 investigations you would request on the cord blood giving reasons. (30)
3.3 Later the baby develops jaundice and the serum bilirubin level(indicate) is 18mg/dl.
What important information would you require at this stage to decide on
management. (list 2 ) (20)
3.4 You decide to start phototherapy for the baby based on the investigation results.
3.4.1 List 2 aspects you would check on the phototherapy unit prior to using it. (10)
3.4.2 List 2 precautions you would take to prevent complications of phototherapy in
this baby. (10)
3.4.3. While on phototherapy, the mother complains that the baby has developed a rash
and increased frequency of passage of stools. How would you manage this situation?
(10)
3.5
List 2 indications to perform an exchange transfusion on this patient while in

phototherapy. (15)
PART D
4. An 18 month old boy is admitted to the pediatric casualty ward with acute onset stridor.

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4.1
4.2
4.
List 4 differential diagnosis.

(20)
On examination, you find that the child is febrile. List the two most likely
conditions out of those mentioned in 4.1 above.
What important information would you obtain in the history and examination to
differentiate these conditions.
(30)
Out line the principles of management of each the conditions mentioned 4.2
above.
(50)
PART E
5. A 5 year old girl presents on the pediatric ward with the first episode of nephrotic
syndrome.
5.1
5.2
5.3
5.4
5.5
List two features in the history and examination that would suggest a non minimal
histology as the a etiological basis for her nephrotic syndrome (10)
She is commenced on daily prednisolone therapy.How would you determine
whether she has steroid sensitive or resistant nephritic syndrome. (20)
She responds to steroid therapy and later she presents with several relapse over a
period of time.
When would you diagnose steroid dependency. (20)
She is found to be steroid dependent. Describe the different management options
available.
(30)
While in the ward for a relapse she develops severe abdominal pain. List 5 possible
causes.
(20)
9th REPEAT(May 2004)

1.A one year old boy with a history of profuse dirrhoea and vomiting for three days,is
admitted to the pediatric casualty ward.He is sevealy dehydrated.Intravenous cannulation
is attemted and is unsuccessful.
1.1 What is the urgent procedure indicated at this stage(10)
1.2 Name 3 physical signs you would elicit to assess the adequacy of his circulation and
indicate the abnormalities you would expect to find (15)
1.3 Describe how you would correct his dehydration.His weight on admission is 8 kg
(25)
1.4 Describe how you would manage this child during next 24 hrs, after his dehydration
is corrected?(30)
1.5 State the composition of the currently available WHO recommended oral
rehydration fluid prepared for use?
2.A 26year mother gives birth to a term baby weighing 2.9kg following a normal vaginal
delivery

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2.1
2.2
2.3
2.4
List 4 important routine measures that should be carried out on the baby during first
hale an hour after birth.(20)
List the reflexes that are involved in the establishment of breast feeding in the
mother and the baby?(20)
Describe good practices that would help in the successful establishment of breast
feeding of this baby?(40)
The baby is weighed on day 6 and is found to be 2.7 kg. Describe briefly how you
would handle this situation.(20)
3
3.1
An 8 month old boy is diagnosed to have beta thalassaemia major.He is the first
child of the family.The mother is 24 years and the father is 28 years old.Describe
briefly the management of this child?(35)
3.2 An 8 year old girl with beta thalassaemia major is found to have increased t
Transfusion requirements.
3.2.1 List 3 indications for splenectomy in this child?(15)
3.2.2 Describe briefly pre and post splenectomy management of this child (Details of
surgical management are not required)(30)
3.3 List 8 long term complications that could occur in a14 year girl with beta
thalassaemia major?(20)
4.An 8 month old boy is diagnosed to have urinary tract infection. His mother gives a
history of a poor urinary stream from birth.
4.1 What is the most likely underlying predisposing factor that had lead to the
occurrence of urinary tract infection in this child?(10)
4.2 List 4 other possible predisposing factors for urinary tract infections in childhood?
(15)
4.3 explain how you would have instructed the mother to collect the a sample of urine
for culture and antibiotic sensitivity testing from this child?(15)
4.4 List 3 important relavant physical signs that you would expect to elicit in this child.
(15)
4.5 List 4 bacteria which could cause urinary tract infection in this child,in order of f
frequency?(15)
4.6 Describe briefly how you would manage this child?(30)
5. A 9 month old child is admitted to the paediatrics casualty ward with a 2 day history of
cough and wheeze.
5.1 List the 2 most likely differential diagnoses?(10)
5.2 List factors in the history and physical examination that would help you to
differentiate the two conditions?(30)
5.3 List important factors in the history and examination thah would help you to assess
the severity of respiratory distress in this child?(30)
5.4 She is found to have severe respiratory distress.Outline the principles of
management?(30)
10th proper(24/11/2004)
Part A
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1. a 9y old girl presents with a 5 day history of fever and arthritis involving both knees
and the right wrist joint. The swelling had started in the left knee joint first and there had
been a gradual involvement of the right knee and then the wrist. On examination -she is
febrile with all axillary temperature of 100 F. She does not have
pallor or lymphadenopathy. She has swelling and tenderness of the right knee and wrist
Joints. Her pulse rate is 130 beats per minute and the apex beat is located at the 5th left
intercostal space, 2 cm lateral to the mid clavicular line. The 1st and 2nd heart sounds are
soft and there is a pansystolic murmur heard at the apex, radiating to left axilla. The
respiratory system, abdomen and the nervous system are clinically normal.
Following investigation results are available.
WBC/DC -10,000 per cu mm.
-N -60%, L- 35%, E- 3%, M 2%
ESR 105 mm in 1st hour
1.1 what is the most likely diagnosis? (10 marks)
1.2 indicate the most important investigation and its expected abnormality that would
help you to confirm your diagnosis. (20 marks)
1.3 describe the pathophysiological explanation for
a) the pan systolic murmur heard at the apex
b) the pulse rate ( 25 marks)
1.4 List two other relevant abnormal findings which you would look for in the
examination relation to your diagnosis mentioned in 1.1. (10 marks)
1.5 Outline the management of this child. (35 marks)
Part B
2.A a 6month old baby is brought to the well baby clinic at Ragama Hospital as he is
due for vaccination.
2.A.1 List the vaccines which this child should receive at this age, indicating the route
of administration and the site of administration. (20 marks)
2.A.2 what are the contraindications for administering the vaccines mentioned
in2.A.l(30 marks)
2.A.3 state the subsequent vaccination schedule for this child according to the
programme of immunization. (20 marks)
2.B
a 14 month old boy has been referred to the well baby clinic for vaccination. He
received the BCG vaccination at birth and the routine vaccines at 2 months of age,
his CHDR. No further vaccinations have been received. How would you manage
this situation. (30 marks)
Part C
3. A paediatric house officer is requested to attend the birth of a new born baby. The
baby is born by a vaginal delivery. The baby does not breathe at birth and the paediatric
house officer start resuscitating the baby.
3.1 List 4 causes of respiratory depression/ delayed establishment of respiration in this
new born. (20 marks)
3.2 the paediatric house officer assesses the baby by using the APGAR score. Describe
how the APGAR score is calculated. (25 marks)

- 32 -
3.3
the baby requires active resuscitation with endotracheal intubation and ventilation,
chest compressions and medications. The baby is brought to the special care baby
unit while being ventilated with the Amboo bag. Mention briefly 4 relevant initial
steps in the management of this baby in the special care baby unit.(20 marks)
3.4 he is noted to have several episodes of tonic seizures over the next 2 days. He is
found lethargic, opisthotonic and irritable. He is afebrile and is not icteric. What is
the condition that this child has developed.(10)
3.5 list the expected acute and long term complication of the conditions mentioned in
3.4(25)
Part D
4. a 12 month old girl is admitted for a micturating cysto-urethrogram(MCUG)
4.1 what information (including the examination) would you seek before you proceed
with the MCUG (list 4)(20 marks)
4.2 describe the therapeutic intervention that is indicated.(20 marks)
4.3 grade II bilateral vesico ureteric reflux was detected during theMCUG
4.3.1 describe the changes that would have been visualized in the X-Ray films.(20
marks)
4.3.2 how does vesico ureteric reflux increase susceptibility to urinary tract infections.(10
marks)
4.4 briefly out line the further management of this child.(30 marks)
Part E
5. a 10 month old boy is admitted to the paediatric casualty ward with a 2 day history of
diarrhea and vomiting. His weight is 7 kg.
5.1 name 5 clinical features that would indicate severe dehydration. Indicate the
expected abnormality in each of them.(25 marks)
5.2 the child is found to be severely dehydrated.
5.2.1 describe the immediate management of this child.(25 marks)
5.2.2 describe the management over the next 24h.(20 marks)
5.3 the child developed a generalized clonic convulsion 30 min after the admission. He
is found to be afebrile.
5.3.1 name 2 possible causes for the convulsion. (10 marks)
5.3.2 list 5 complications of acute diarrhea (other than dehydration and its
complications) (20 marks)
10th repeat [22/02/2005]

PART-A
1. A10 year old boy is referred to the Paediatric clinic by the general practitioner
due to the presence of an ejection systolic murmur, best heard at the pulmonary area.
1.1 List four possible differential diagnoses for this murmur.(20 marks)
1.2 On examination of this child, his growth is adequate and he is not cyanosed. There is
a left parasternal heave and the apex beat is at the 5th intercostals space just medial to
the midclavicular line. There is an ejection systolic murmur with a loud pulmonary
component of the 2nd hear sound at the pulmonary area. Mention the complete
clinical diagnosis. (10 marks)
- 33 -
1.3 Explain briefly the physiological basis for the murmur heard in the condition
mentioned in 1.2 above (20 marks)
1.4 List two other important physical signs you would expect to find in this child.
(20 marks)
1.5 List two abnormalities that you would expect to find in a tele-chest of this child.
(10 marks)
1.6 Describe briefly the management of this child. (20 marks)
PART-B
2. 5 y old boy is admitted to the Paediatric casualty ward with a history of ingestion of
six tablets of adult paracetamol, 1 hour prior to admission. His weight is 17 kg.
2.1 Describe the immediate management of this child. (10 marks)
2.2 How would you confirm whether this child has had a toxic dose of paracetamol?
(25 marks)
2.3 what symptoms and signs would you expect him to develop if there is
paracetamol toxicity? (25 marks)
2.4 What specific treatment in indicated if this child has had a toxic dose of
paracclamo1? (10 marks)
2.5 What steps can be taken to reduce the incidence of paracetamol poisoning in
childhood (30 marks)
3.1
3.2
3.3
3.4
3.5
PART-C
Explain briefly why some fetuses pass meconium in utero (15 marks)
As a Paediatric House Officer, you are called to attend an emergency caesarean
section to be performed, due to presence of thick meconium staining of liquor .
List six different action you would take prior to the commencement of the
caesarean section, in preparation for the resuscitation of this neonate. (30 marks)
Name the most important aspect in the management of this baby? (10 marks)
Baby is found to be depressed at birth and does not cry. Describe how you would
resuscitate this neonate. (35 marks)
Name two important complications this baby could develop. (10 marks)
PART- D
4. A 9 month old child is admitted to the Paediatric ward with 2 day history of high
intermittent fever, excessive crying and features of an upper respiratory tract infection.
The house officer examines the child, and a diagnosis of right sided, acute otitis media is
made.
4.1 List 3 features of acute otitis media on auroscopic examination. (15 marks)
4.2 List 3 common aetiological agents that cause otitis media at this age.(15 marks)
4.3 Describe briefly the management of this child. (30 marks)
4.4 The child develops vomiting and a left sided focal convulsion on the 3rd day after
admission.
Name one likely complication that has arisen. (10 marks)
4.5 Describe briefly the management of this complication. (30 marks)
PART-E
- 34 -
5. A 7 year old boy presents to the Paediatric ward with a 2 day history of passing
dark coloured urine. His weight on admission is 20 kg.
5.1 List four conditions that could cause dark coloured urine in this child.(20 marks)
5.2 Name one important investigation which would help you to differentiate the
conditions mentioned in 5.1. (10 marks)
5.3 He develops mild periorbital oedema and oliguria while in the ward.
Name the most important physical sign you would elicit in this child.(10 )
5.4 He has passed only 100 ml of urine over the previous 24 hours.
List two investigations that you would order at this stage. (10 marks)
5.5 Outline briefly the management of this child. (50)
OCTOBER 2005 - 11th PROPER

PART A
1. A 28 year old pregnant mother is admitted to the obstric ward with a history of
dribbling of 5 days. She has a period of amenorrhea of31 weeks. Three days following
admission, on emergency caesarian section is planned due to fetal distress. You are the
pediatric house officer who attends the delivery.
1.1
What other important information would you obtain to help you in the subsequent
management of the baby after birth?(list2)
(20)
1.2 Mention 2 complications you would anticipate in this baby after birth?
(20)
Following the caesarian section a baby boy was delivered. At 1 minute there was
irregular gasping respiration, with a heart rate of 40 per minute. He was floppy and there
was central cyanosis. He did not show any response to oro-pharyngeal suctioning.
1.3 Calculate the Apgar score at one minute, indicating how you calculated the score.
(20)
1.4 Describe briefly the important steps in resuscitating this baby.
(40)
PART B
2A 20 day old baby is admitted to the pediatric ward with yellow discoloration of the
sclera and body. The mother has noticed the discoloration from the Day 3.
2.1 Write down the problem that this neonate presented with.
(10)
2.2. His serum bilirubin level is 12mg/dl and the direct bilirubin fraction is
0.8mg/dl.What conclusions can you make these results?
(10)
2.3 List 5 conditions that you would consider in the differential diagnosis.
(20)
2.4 There is a history of poor feeding and he does not often wake up for feeds. He is
constipated but passes urine satisfactorily. He also has noisy breathing.
Write down the most likely diagnosis.
(10)
2.5 How would you manage this child?
(50)
PART C

- 35 -
3. A 4 year old girl is brought to the pediatric casualty ward with a history of accidental
ingestion of 6 adult tablets of paracetamol.2 hours prior to admission.Her weight is 15 kg
3.1 Describe in order of priority the steps you would take in the management pf this.
(50)
3.2 How would you confirm as to whether this child hah had a toxic dose of
paracetamol?
(20)
3.3 Paracetamol poisioning in child hood is a problem.Describe briefly he measure to
be taken in its prevention.
(30)
PART D
4 A one year old girl is admitted with a 3 day history of difficulty in breathing. On
examination she has head sweating and continuous murmur is heard at the 2nd left
intercostals space. There is a tender , soft enlargement of the liver.
4.1
4.2
4.3
4.4

(20)
Descibe the pathophysiological basis for the continuous murmur and the enlarged
tender liver.
(30)
List 3 other important physical signs you would attempt to elicit to clinically
establish the diagnosis you mentioned in 4.1
(15)
Your diagnosis of the cardiac lesion is confirmed by an echocardiogram. How
would you managed this child.
(35)
PART E
5. An 8 year old girl presents with acute onset weakness of both her lower limbs.
5.1
5.2
5.3
5.4
LIST 3 important conditions you would consider in the differential diagnosis.

(25)
Mention the relevant information ( list 4) that you would obtain in the history and
list the physical signs (List 4) that would help you in differentiating conditions
mentioned in 4.1 (30)
List 3 investigations which would help in the management of this child.
(50)
Outline briefly the principles of management of this child. (30)
FEBRUARY 2006 11th REPEAT

1. A 5 year old boy is admitted to the emergency treatment unit with a generalized tonic
clonic seizures lasting 15 minutes. He has had fever for last two days and the mother
complains that he was drowsy during the day of admission. He was given rectal
DIZEPAM by the medical officer and develops a respiratory arrest.
- 36 -
1.1
1.2
1.3
1.4
Out line the steps in resuscitating this child. (30)

Following successful resuscitation, the child is admitted to the pediatric ward.
List 5 physical signs you would elicit in this child.(20)
Mention 3 investigations that you would order. (15)
Briefly outline the management of this child ward.(35)
QUESTION B
2. A three day old boy is admitted pediatric casualty ward with a history of poor feeding
and being less active during the previous 24 hours.
The had been born at term and discharged home on day 2, following a routine postnatal
examination. On admission, an axillary temperature of 1000 F is recoded.
2.1
2.2
2.3
2.4
What relevant information (list 3) would you obtain in the history to help you to
arrive at a diagnosis.
(20)
List 4 important physical signs that you would expect to elicit in this baby.
(20)
List 4 investigations you would order in this baby. (20)
Briefly outline the management of this child.
(40)
QUESTION C
3. An 8 month old boy is brought to the pediatric clinic by the mother complaining of
duskiness around the mouth during crying.
On examination of the cardiovascular system, the apex is in the fourth intercostals space
and there is a left parastenal heave. On auscultation, an ejection systolic murmur is found
which is best heard at the pulmonary area.
(10)
3.2 Explain the physiological basis for the following physical signs.
3.2.1 Duskiness noted around the mouth. (15)
3.2.2. An ejection systolic murmur in the pulmonary area. (15)
3.2.3 Left parasternal heave.
(15)
3.3 . List 3 complications thus this child could develop. (15)
3.4. Briefly outline the long term management of this child. (30)
QUESTION D
4. A 6 year old girl is admitted to the pediatric ward with a three week history with cough.
She had been treated by her general practitioner with a course of Amoxycillin and a
course of cephelexin with no response.
4,1
List 3 possible differential diagnoses.
(15)

- 37 -
4.2
4.3
Her white cell count is 20109 (Neutrophils 23%,Lymphocytes77%)

Mention the most likely diagnosis.
(10)
What relevant information (List 4) would you obtain in the history to help you
arrive at the diagnosis mentioned in 4.2? (20)
QUESTION E
5. A three year old girl is admitted to the pediatric casualty ward with a history of facial
puffiness and reduced urine output of two duration.
5.1
List two possible differential diagnosis.
(10)
Urine analysis is performed and the results are as follows,
5.2
5.3
Protein +++
Red blood cells Nil
Hyaline casts ++
Granular casts Nil
(5)
Outline the important aspects of the management of this child in the ward.
(40)
While in the ward she develops severe abdominal pain. On examination, her blood
pressure is 40/30 mmHg and has a low volume pulse.
5.4
Mention the complication that has arisen? (10)
5.5
Briefly outline the management of this situation. (35)
PAEDIATRICS -12th proper[30/06/2006]

PART- A
01. A 4 month old boy is brought to the well baby clinic in the Ragama hospital for the
2nd dose of DPT and Hep-B vaccines. He has had no significant illnesses in the past and
has had no complications after the 1st dose of DPT and Hep-B vaccines.
Immediately following the 2nd dose of DPT vaccine he develops breathing difficulty with
stridor and become cyanosed. His pulse rate is 200/min and is thready.
1.1 Mention the complication that has occurred. ( 15marks)
1.2 Outline briefly the important aspects in the management of this infant. (30marks)
1.3 List 4 other complications of the DPT vaccine. (20 marks)
1.4 Describe briefly the advice you would give the mother regarding future
immunization of this infant. (15marks)
1.5 Indicate the site and route of administration of DPT and Hep-B vaccines
(20 marks )
PART- B
02. A 26y old primiparous mother has been in labour for 6h. An emergency
- 38 -
caesarean section is planned due to fetal distress. you are called to attend the delivery as a
paediatric house officer.
2.1 List 4,features that would indicate fetal distress. (20 marks)
2.2 Define the terms primary apnoea and terminal apnoea. (20 marks)
2.3 Following the Ceasarean section a term baby is born. The baby does not cry at birth.
On examination you find that the baby is cyanosed and limp. His heart rate is 20/min.
outline the important steps in the resuscitation of this baby. (40 marks)
2.4 After successful resuscitation the baby had spontaneous respiration at 15 minutes of
birth.
2.4.1 List 2 early complications that this baby may develop. (10 marks)
2.4.2 List 2 long term complications that this baby may develop. (10 marks)
PART- C
3. A 5 week old baby boy is admitted to the paediatric ward with a history of poor
feeding and irritability of 3 days duration. On examination he is found to be pale with
cold extremities and has puffy hands and feet. The pulse rate is 180/minute and a
pansystolic murmur is heard on the left lower sternal edge. His respiratory rate is
65/minute and there are intercostal and subcostal recessions. On palpation of the right
hypochondrium it is noted that he is more irritable.
3.1 State the complete diagnosis. (15 marks)
3.2 Explain the pathophysiology of the following observations in this child.
3.2.1 A heart rate of 180/minute. ( 15 marks)
3.2.2 Pan systolic murmur heard at the left lower sterna1 edge. ( 15 marks)
3.2.3 Irritability on palpating the right hypochondrium ( 15 marks)
3.3 Briefly describe the management of this child. (40 marks)
PART-D
4. A 6 month old baby is brought to the hospital as the mother is concerned about
abnormal movements involving the arms and body for about a week. The movements
were specially occurring during falling asleep and upon waking up. On detailed
questioning it is revealed that these movements involved bending of the trunk forwards.
Each time 5 or 6 of these events occurred in clusters. He is a product of a consanguineous
marriage. The birth history is uneventful with a birth weight of 2.8kg. Mother says that
the child is still not smiling with her. She cannot carry the baby upright. On examination
his weight and length are on the 25th centile and the head circumference is one standard
deviation below the 3rd centile. There are no dysmorphic features. On developmental
assessment he has total head lag on 'pull to sit. His hands are both fisted and grasp
reflexes are easily elicited on both sides. He is unable to fix on a bright light source. He
also has no startle response to sound.
4.1 List the problems you have identified in the history and examination of this child.
(20 marks)
4.2 Comment on the development of this child. (25 marks)
4.3 Mention 2 investigations that you would request in this child. (10 marks)
4.4 List the health personnel who need to get involved in the management of this child.
(20marks)
4.5 Mention 5 long term complications this child could develop. (25 marks)
- 39 -
PART-E
5. A 2 year old boy is admitted to the paediatric casualty ward with a 2 day history of
fever , vomiting and watery diarrhoea. On examination child has sunken eyes and is
lethargic. He is not interested in feeding. His heart rate is 140/min and the blood pressure
is 60/40mmHg. He has not passed urine for 6 hours prior to admission.
5.1 State the complete diagnosis. ( 15 marks)
5.1 Describe the immediate management of this child. (25 marks)
Eight hours after admission it is noted that the child has not passed any urine. On
examination the bladder is not palpable.
5.3. State the most likely complication that has arisen. (10 marks)
On the 2nd day after admission, he is stable and is feeding well and is being managed on
oral rehydration fluids.
5.4 State the rationale of using oral rehydration fluid in the management of this child.
(25 marks )
5.5 Describe briefly the advantages of starting oral feeds early in the management of
this child. (25 marks)
[12 R]- PAEDIATRICS

PART A
1.
A five year old boy is seen in Emergency Treatment Unit with a two hour history
of difficulty in breathing. He has been having an upper respiratory tract infection For the
past two days. On examination his respiratory rate is 65 per minute and there is an
audible wheeze. His heart rate is 130/min.intercostals and subcostal recessions are
present and there are bilateral rhonchi on auscultation. His oxygen saturation in air is
88%.
State the complete diagnosis.
(15 marks)
Describe briefly the management of this child in the Emergency Treatment Unit.
(40 marks)
Half an hour after admission he is still very dyspnocic on examination the trachea is
deviated to the left. There is a marked hyper-resonance on percussion with reduction of
air on the right side.
Sate the complication that has occurred.
(15 marks)
State how you would confirm the presence of this complication. (10 marks)
How would you treat this complication?
(20 marks)
PART B
2.
2.1
2.2
The mother of a three day old baby complains that her baby is lethargic and not
interested in feeds. On examination his axillary temperature is 100.6 F.
The baby was admitted to the special care baby unit and managed as having
neonatal sepsis.
List three(3) risk factors for neonatal sepsis.
(30 marks)
List two (2) other physical signs that you would expect to elicit in this child.
(20 marks)
- 40 -
2.3
2.4
2.5
It was decided to do a full septic screen on this baby.

List the investigations included in a full septic screen.
(25 marks)
Describe briefly the management of this baby in the Special Care Baby Unit.
(15 marks)
State the most important method of reducing neonatal sepsis in a Special care
Baby Unit.
(10 marks)
PART C
3.
A 14 month old baby is admitted to the paediatric ward with a history of watery
diarrhoea of 10 days duration. Initially the child has had fever and vomiting for three
days which settled, but profuse watery diarrhoea has continued. He is on a normal adult
diet and formula milk.
On examination he has abdominal distension and excoriation of perianal skin. Rest of the
examination is normal.
3.1
State the most likely diagnosis.
(10 marks)
3.2 Describe briefly how you would perform the bed side test to confirm the diagnosis.
(Give details of the procedure).
(25 marks)
3.3 Describe briefly the pathophysiological basis for the following observations of this
baby.
3.3.1 profuse watery diarrhoea.
(15 marks)
3.3.2 Abdominal distention.
(15 marks)
3.3.3 Perianal excoriation.
(10 marks)
3.4
(25 marks)
Describe briefly the management of this baby.

PART
4.
A three month old infant is admitted to the paediatric ward with a history of
jaundice since birth.
4.1
List three (3) clinical features that would suggest that the neonate has a direct
hyperbilirubinaemia.
(15 marks)
His serum bilirubin level on admission is as follows
Total bilirubin - 13 mg/dl
Direct bilirubin - 10 mg/dl
4.2
List three (3) possible causes for this infants jaundice.
4.3
List four (4) investigations that would help you to arrive at a diagnosis.
- 41 -
(30 marks)
(20 marks)
4.4
Discuss briefly the importance of arriving at an early aetiological diagnosis in
this child.
(20 marks)
4.5
Describe briefly how and what stages the primary health care system has failed
in this situation.
(15 marks)
PART E
5.
A two year old girl presents to the Paediatric casualty ward with a history of high
fever of two days duration, irritability and vomiting. Soon after admission she
develops a tonic clonic convulsion involving the right upper and lower limbs.
5.1
5.2
Describe briefly the immediate management of this child.

(30 marks)
List three (3) physical signs you would look for the convulsion is controlled.
(15 marks)
She was commenced on intravenous antibiotics. A lumbar puncture is performed
on second day. The following results are obtained in the cerebrospinal fluid.
Protein- 80 mg/dl(15-40)
Sugar - 30 mg/dl
Cells - 10 Lymphocytes mm3
2 Poly morphs mm3
Random blood sugar done at the time of lumbar puncture - 80 mg/dl
5.3
5.4
Comment on this result.

(15 marks)
Describe briefly the management of this child after the acute management of the
convulsion.
(40 marks)
PAEDIATRICS-13th proper
1.a three year old girl is brought to the OPD with a history of being bitten by a suspected
rabid dog about ten minutes ago. On examination there is a large laceration with mild
bleeding over the right thigh.
1.1
What first aid measures are indicated in this clinical situation to reduce the risk of
Rabies? (20 marks)
She is admitted to the pediatric casualty ward to give anti rabies serum and anti
rabies vaccine.
Explain why some animal bites are treated with both anti rabies serum and anti rabies
vaccine while anti rabies vaccine alone is given for some animal bites. (20 marks)
Outline the steps in performing a sensitivity test to equine anti rabies serum. (20 marks)
The sensitivity test for equine anti rabies serum was positive and human anti rabies serum
was ordered for the child.
list two differences in the treatment with human anti rabies serum compare to equine
anti rabies serum. (20 marks)
Mention the subsequent vaccination schedule for this child. (20 marks)
- 42 -
2.
2.1
discuss what you understand by the term baby friendly concept. (Baby Friendly
Hospital Initiative) (25 marks)
A twenty five day old male infant is brought to the clinic as he has passed stools only
once during the passed seven days. He was born at term by normal vaginal delivery with
a birth weight of 3.1 kg. he was discharged home on day 2 following a routine neonatal
examination which was normal. On examination his present weight is 3.2 kg, and there
were no abnormal physical signs
2.2
2.3
2.4
2.5
comment on this observation (20 marks)

list three other important information you need to know about this child. (15 marks)
list one investigation you request (10 marks)
discuss the management of this baby (30 marks)
3. A ten year old boy from a tea estate in bandarawela is admitted to a pediatric ward with
difficulty in breathing.
He has experienced weakness and difficulty in breathing on exertionduring the past
two months. He was awakened several times during sleep with difficulty in breathing
during the past two week
One year ago he had an episode of fever and joint pain which was treated by the estate
medical assistant. No follow up arrangement had been made. His past medical history
was otherwise unremarkable
On examination he is dyspnoeic at rest with a respiratory rate of 50 per min and basal
crepitation in both lungs. He is afebrile with poor oral hygiene. His pulse rate is 120 beats
per min. the apex is in the 6th intercostal space in the anterior axillary line. There is pan
systolic murmur radiating to the axilla and a mid diastolic murmur at the apex. The liver
was felt 2cm below the right costal margin and was tender.
3.1
3.2
3.3
3.4
3.5
3.6
state the most likely explanation for his present clinical features. (15 marks)
mention the most likely aetiological cause for the condition you mentioned in 3.1
(15 marks)
out line the steps in the treatment of this child. (20 marks)
three month after discharge he is re admitted to with fever of two weeks duration.
Examination revealed a pale child, who appears ill, with a just palpable spleen.
mention the complication that has occurred. (10 marks)
list two important investigations you would request. (20 marks)
describe briefly how the medical system has failed in the management of this child.
(20 marks)
4. a two year old boy is admitted to the paediatric casualty ward with a history of fever
of three days and photophobia of one day duration. On examination he had neck stiffness
and positive kernigs sign. Clinical diagnosis of meningitis was made and it was decided
to perform a lumbar puncture and start antibiotics pending result of lumber punctrure.

- 43 -
4.1
4.2
4.3
4.4
4.5
describe the procedure of performing the lumber puncture on this child. (30 marks)
mention the antibiotic/s you would start on this child (10 marks )
The lumbar puncture revealed pyogenic meningitis. List changes in the puncture
report that will suggest pyogenic meningitis? (20 marks)
Briefly discuss other aspects in the management of this child?(25 marks)
He developed a generalized tonic clonic seizure on the second day of admission.
Results of investigations done following the seizure are as follows.
RBS-88 mg/dl
Hb-10.8 mg/dl
WBC-14,200 per cu mm
N -80%
L -20%
Platelets-180,000 per cu mm
Serum sodium -116 mmol/l
Serum potassium -4mmol/l
Blood urea -3 mg/dl(5-15 mg/dl)
Mention the most likely cause for the seizure.
(15 marks)
5.A 10 year old boy was admitted to the paediatric casualty ward with a history of red
colour urine and reduced urine out put.The examination revealed periorbital swelling and
his blood pressure was 120/100.
5.1 What is the most likely diagnosis?(10 marks)
5.2 List 3 important investigations you would request?(15 marks)
5.3 What are the clinical parameters you will monitor in this child (20 marks)
5.4 List 2 different drugs that are effective in treating his hypertension indicating one
side effect of each?(10 marks)
5.5 List 3 complications that this child may develop?(15 marks)
5.6 Mention the clinical features of the 3 complication listed in 5.5?(30 marks)

- 44 -

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UNIVERSITY OF KELANIYA

Time allowed : 3 hours

3.1 What is your differential diagnosis ?

Time allowed : 3 hours

3/29/20163/29/2016Students' Council , Faculty of Medicine , Ragama

The results of some investigations are given below;

And anisocytosis +, No target cells.

04th September 1998

Time allowed : 3 hours

What is the most likely diagnosis?

Mention 8 physical signs you would look for in this child.

How do you manage the following clinical situations?

Mention the most likely diagnosis in this child.

14th January 1999

Time allowed : 3 hours

A baby born at 32 weeks of gestation, was found to be tachypnoeic 45 minutes after

Discuss the management of one complication mentioned in 2.4

3/29/20163/29/2016Students' Council , Faculty of Medicine , Ragama

What is your differential diagnosis?

Discuss the management of one condition mentioned in 3.1

How do you manage the following problems in a well baby clinic;

4.3 A 6 month old baby with a squint?

List 8 relevant questions would you ask to arrive at a diagnosis. Give

Mention 5 investigations you would request in this child.

What is the baby friendly hospital initiative concept?

Enumerate the reasons for introducing complimentary foods (weaning foods)

3.2 A 3 week old baby diagnosed as having congenital hypothyroidism.

3.3 An 18 month old baby diagnosed as having an uncomplicated ventricular septal

Final examination for Medical Degrees - July 2000

3/29/20163/29/2016Students' Council , Faculty of Medicine , Ragama

What is the most likely diagnosis

An 18 month old boy is brought to the Paediatric clinic. His growth

Head circumference (cm)

What is your interpretation of his growth?

Head circumference (cm)

What is the possible reason for his growth pattern?

5th batch repeat

1.1. What is the most likely diagnosis?

3/29/20163/29/2016Students' Council , Faculty of Medicine , Ragama

6th batch proper

3/29/20163/29/2016Students' Council , Faculty of Medicine , Ragama

6th batch repeat

3/29/20163/29/2016Students' Council , Faculty of Medicine , Ragama

(1) How would you manage the following?

3/29/20163/29/2016Students' Council , Faculty of Medicine , Ragama

Her developmental history/assessment revealed the following

7 th PROPER, [MAY 2002]

List 3 long term complications you would expect in this child.(15)

7 th batch repeat exam-sep 2002

March 2003- 8th PROPER

Comment on this patients present management? (10)

What is the most likely diagnosis (5 marks)

3/29/20163/29/2016Students' Council , Faculty of Medicine , Ragama

Teething and starting to crawl causes diahorrea. (30)

What complications has occurred? (10)

3/29/20163/29/2016Students' Council , Faculty of Medicine , Ragama

On examination this baby has evidence of moderated to severe respiratory

What is the most likely diagnosis? (10)

What is the most likely diagnosis? (10)

3/29/20163/29/2016Students' Council , Faculty of Medicine , Ragama

3 days later he is found to be dyspnoeic at rest and his pulse rate is

What is the most likely diagnosis?

JANUARY 2004 9th PROPER