Kathmandu University
BIRAT MEDICAL COLLEGE
Budhiganga-02, Tankisinuwari, Morang
Level: Final MBBS (Batch: 2021)
Semester: 8th
Time: 2 hrs. 30 mins.
Date: March 22, 2026
Examination: End-Semester
Subject: Paediatrics
Marks: 50
#INSTRUCTION TO THE CANDIDATE
Answer each section in a separate answer book.
Write brief, relevant and legible answers.
Illustrate your answer with well labeled diagrams where required.
All questions are compulsory.
#SECTION 'B'
Short Answer Questions [5Q × 6 = 30 marks]
Discuss etiopathogenesis, management of iron deficiency anemia.
[3+3=6]Define Puberty and precocious puberty? How will you approach a case of precocious puberty from history and clinical examination?
[2+4=6]Define steroid-sensitive and steroid-resistant nephrotic syndrome. What are the indications for renal biopsy in Nephrotic syndrome?
[2+4=6]Explain the investigations and management of chronic liver disease.
[2+4=6]Define acute kidney injury and mention its eight important causes.
[2+4=6]
#SECTION 'C'
Problem Based Questions / Modified Essay Questions [2Q × 10 = 20 marks]
#Problem I
A 10-year-old boy presents with fever, joint pain, and swelling for 5 days. The pain started in the knees and shifted to ankles and elbows. On examination, there is tachycardia and a pansystolic murmur at the apex.
a. What is the most likely diagnosis? [1]
b. Name the major and minor criteria. [4]
c. What investigations will you do to establish the above diagnosis? [2]
d. Outline the treatment and secondary prophylaxis. [3]
#Problem II
An 8-year male child presented in emergency with complaint of cough for 3 days, fast breathing for 2 days, swelling of body for 2 days. Body swelling started from face and progressed to legs within 2 days. History of skin infection in the past 3 weeks before.
On examination: the child was sick looking, conscious, tachypneic. B/L pedal edema and puffiness of face, crusted healing skin lesion, HR = 165/min, BP = 130/80 mmHg, SpO₂ = 90% under non-rebreathing mask (NRM). B/L decreased air entry and crepitations present on respiratory examination. Other systems were normal.
a. What’s your differential diagnosis? [2]
b. What investigations would you like to do and why? [3]
c. What’s your diagnosis based on clinical signs and symptoms? [1]
d. How do you manage the case? [3]
e. Write the complications of the disease. [1]