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respiratory rate,nasal flaring,and intercostal retractions . What is the most likely diagnosis? A. Pneumonia B Bronchiolitis C. Asthma D. Croup 35. A 3-year-old presents with a high fever irritability, and a bulging fontanelle. On examination there is nuchal rigidity and photophobia . What is the most likely diagnosis? A. Meningitis B. Encephalitis C.Hydrocephalus D. Sinusitis 36. A 3-year -old child presents with poor growth , delayed development , and frequent infections.On examination, the child has a distended abdomen and thin, sparse hair. What is the most likely cause of these symptoms? A. Iron deficiency anemia B. Vitamin D deficiency C. Protein -energy malnutrition D. Zinc deficiency 37. A 4-year-old child is brought to the clinic with complaints of frequent infections . slow wound healing, and easy bruising.. On examination , the child has pale skin and brittle nails .What is the most likely cause of these symptoms? A. Iron deficiency anemia B. Vitamin D deficiency C. Protein -energy malnutrition D.Zinc deficiency 38. A 2-year -old child presents with fever, rapid breathing, and lethargy. On examination , the child has cool. mottled skin and a weak pulse. What is the most likely cause of these symptoms? A. Pneumonia B. Urinary tract infection C. Meningitis D. Sepsis 39. A 10-year-old child is brought to the emergency department after falling into a cold lake The child is lethargic, with slurred speech and difficulty walking.On examination the child has a weak pulse and low body temperature. What is the most likely cause of these symptoms? A. Drowning B . Hypothermia C. Concussion D. Dehydration

D. Atelectasis 17. Two weeks 2500 -gram male neonate was admitted to Sabian General Hospital at NICU ward. The mother said the newborn had repeated vomiting, skin rash, and Irritable. On physical examination, the neonatologist finds a bulged anterior fontanel , lethargy, and baby arched backward. The CSF laboratory result indicates there is a bacterium and a decrease in the amount of glucose and Protein. The neonate temperature was 380C and the respiratory rate was 60 breath per minute. based on the above information what is most likely the new-born diagnosis? A. Tetanus B. Meningitis C. Poliomyelitis D. Measle 18. A pediatric nurse wants to give routine immunization in an EPI room for a Ten -week-old infant in the Health Facility. What is the correct vaccine name? A. Penta 2, PCV 1, OPV 2, Rota 2 B. Penta 1, PCV 1. DPT1. OPV1 C. Penta3, PCV3.OPV 3. Rota 1 D. Penta 2, OPV 2, PCV2, Rota 1 19. A 3-year-old boy has a 3-day history of intermittent abdominal pain. The parent reports small amounts of liquid stools in the boy's pull-up diaper pants for the last 10 days. For several minutes every day the boy bends over, crosses his legs and holds his stomach in pain. He has also had cold symptoms for the past week but has not had fever, vomiting , or a change in appetite. Physical examination reveals a well-appearing child with normal vital signs and clear rhinorrhea. The abdomen is slightly distended, but there are no masses or tenderness. Firm stool is palpable on rectal examination. The stool tests negative for occult blood. Which of the following is the most likely diagnosis? A. Constipation B. Gastroenteritis C. Mesenteric lymphadenitis D. Intussusception 20. A 8-year-old child with a history of pneumonia presents to the emergency room with fever, cough, chest pain and difficulty of breathing.On examination, the child has decreased breath sounds on the affected side and dullness to percussion . The chest X-ray also shows a patchy infiltrate and pleural effusion. What is the most likely complication of pneumonia in this child? A. CHF B. Empyema C. Lung abscess D. Acute respiratory distress syndrome

38. A 2-year-old child presents with fever, rapid breathing, and lethargy . On examination, the child has cool. mottled skin and a weak pulse. What is the most likely cause of these symptoms? A. Pneumonia B. Urinary tract infection C. Meningitis D. Sepsis 39. A 10-year-old child is brought to the emergency department after falling into a cold lake. The child is lethargic, with slurred speech and difficulty walking. On examination, the child has a weak pulse and low body temperature. What is the most likely cause of these symptoms? A. Drowning B. Hypothermia C. Concussion D. Dehydration 40. A 8-year-old child presents to the emergency department of Sabian General hospital with high grade fever, chills, headache , vomiting and body aches . On examination, the child has enlarged spleen, low red blood cell count, jaundice and an enlarged liver. What is the most likely cause of these symptoms? A. Hepatitis B. Malaria C. Encephalitis D. Gastroenteritis 41. A 10-year-old I child presents to the Dilchora general hospital with fever, abdominal pain, and diarrhea. On examination, the child has an enlarged spleen, low blood pressure, a rose-colored rash on the chest and abdomen. What is the most likely diagnosis? A. Gastroenteritis B. Typhoid fever C. Influenza D. Dengue fever

A medical director of a hospital assessed the overall activities of the organization and found out different problems that hindered the achievement of the set goals. The director ranked the listed problems according to their criticality and frequency. What is the most likely next step of planning process in this scenario? a. Selecting objectives and targets b. Situational analysis c. Identifying potential obstacles d. Designing strategies A mother brought her three-month-old infant to a pediatric OPD to ask when to start solid foods for her baby. Assessment result shows all primitive reflexes are intect and anthropometric. measurements are in normal range. What is the most appropriate advice to be given in this case? a. Start pureed solids at this age if fed via the bottle b. Infants do not require solid food until 12 months of age c. Good time to start solid foods is at age 6 months d. Solid foods should be delayed until age 9 months A medical director of a hospital assessed the overall activities of the organization and found out different problems that hindered the achievement of the set goals. The director ranked the listed problems according to their criticality and frequency. What is the most likely next step of planning process in this scenario? a. Selecting objectives and targets b. Situational analysis c. Identifying potential obstacles d. Designing strategies A mother brought her three-month-old infant to a pediatric OPD to ask when to start solid foods for her baby. Assessment result shows all primitive reflexes are intect and anthropometric. measurements are in normal range. What is the most appropriate advice to be given in this case? a. Start pureed solids at this age if fed via the bottle b. Infants do not require solid food until 12 months of age c. Good time to start solid foods is at ago 6 months d. Solid foods should be delayed until age 9 months

A primigravida pregnant woman was admitted to a gynecology ward I with hyperemesis gravid arum . During admission, her blood pressure was 80/50mmHg and Pulse rate was 100/min . She had dry mouth and poor concentration . Laboratory investigation results show urine ketone 3+ urine proteins 2+ and her HCT is 35 percent. She has been managed with two bags of ringer lactate with two vials of 40 percent dextrose. What is the most appropriate sign that indicatesher improvement? a. Increase blood glucose b. Ketone free urine c. Protein free urine d. Increased hematocrit level