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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

An infant who was born from a known HIV positive mother is brought to a pediatric OPD with the clinical features of cough, stridor and oral thrush. The HIV status of the infant was positive for antibody test and unknown for DNA/PCR test due to unavailability of the test. What is the appropriate management for the child according to IMNCI? a. Initiate ARV treatment b. Initiate PMTCT care c. Advise to stop breastfeeding d. Advise on HIV prevention

A mother is on anticonvulsant therapy with magnesium sulfate for severe pre- eclampsia. During the course her Pulse rate was 62/min Diastolic blood pressure was 100mmHg respiratory rate was 15/min and urine output was 20 ml per hour over preceding four hours. On physical examination, her patellar reflex is absent. Which management is the most appropriate for this case? a. Change the drug to diazepam b. Providing calcium gluconate c. Resuscitating the mother d. Continue administering magnesium sulfate