/**
 * PEDIATRICS BOARD EXAM MCQ - 100 QUESTIONS
 * Google Apps Script — paste this entire file into
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 *
 * Topics covered (board-level):
 *   Growth & Development · Neonatology · Nutrition · Immunisation
 *   Respiratory · Cardiology · GI & Hepatology · Nephrology
 *   Neurology · Haematology & Oncology · Endocrinology
 *   Infectious Diseases · Genetics · Dermatology · Emergency Paediatrics
 */

function createForm() {
  var form = FormApp.create("Pediatrics Board Exam Practice — 100 MCQs (Single Best Answer)");
  form.setDescription(
    "100 single-best-answer MCQs covering the entire pediatrics board syllabus.\n" +
    "Topics: Growth & Development | Neonatology | Nutrition | Immunisation | Respiratory | " +
    "Cardiology | GI & Hepatology | Nephrology | Neurology | Haematology & Oncology | " +
    "Endocrinology | Infectious Diseases | Genetics | Dermatology | Emergency Pediatrics\n\n" +
    "Time allowed: 2 hours 30 minutes   |   Passing score: 60%"
  );
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  var questions = getQuestions();

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      var isCorrect = (q.options[j] === q.answer);
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    }
    item.setChoices(choices);
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    // Add section header every 10 questions
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      // section break already handled by topic grouping in titles
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}


function getQuestions() {
  return [

    // ─── GROWTH & DEVELOPMENT (Q1–10) ───────────────────────────────────────

    {
      question: "A child can walk independently at 12 months, say 2–3 words, use a pincer grasp, and wave bye-bye. Which milestone is most DELAYED if this child cannot yet stand without support?",
      options: [
        "A. Language milestone",
        "B. Gross motor milestone",
        "C. Fine motor milestone",
        "D. Social milestone"
      ],
      answer: "B. Gross motor milestone"
    },
    {
      question: "At what age does the posterior fontanelle normally close?",
      options: [
        "A. 2–3 months",
        "B. 6–8 months",
        "C. 12–18 months",
        "D. 18–24 months"
      ],
      answer: "A. 2–3 months"
    },
    {
      question: "A 9-month-old infant can sit without support, transfers objects hand-to-hand, babbles 'mama/dada' non-specifically, and plays peek-a-boo. What is the NEXT expected gross motor milestone?",
      options: [
        "A. Rolls over",
        "B. Stands holding furniture (cruising)",
        "C. Walks independently",
        "D. Runs steadily"
      ],
      answer: "B. Stands holding furniture (cruising)"
    },
    {
      question: "Birth weight doubles by ____ and triples by ____.",
      options: [
        "A. 3 months; 9 months",
        "B. 5 months; 1 year",
        "C. 6 months; 18 months",
        "D. 4 months; 1 year"
      ],
      answer: "B. 5 months; 1 year"
    },
    {
      question: "The Denver Developmental Screening Test (DDST-II) screens for development in children up to:",
      options: [
        "A. 2 years",
        "B. 4 years",
        "C. 6 years",
        "D. 8 years"
      ],
      answer: "C. 6 years"
    },
    {
      question: "A 4-year-old child should be able to do all of the following EXCEPT:",
      options: [
        "A. Draw a cross (+)",
        "B. Hop on one foot",
        "C. Copy a triangle",
        "D. Know full name and gender"
      ],
      answer: "C. Copy a triangle"
    },
    {
      question: "Bone age assessment is MOST useful in evaluating:",
      options: [
        "A. Obesity",
        "B. Short stature",
        "C. Developmental delay",
        "D. Precocious puberty screening by family history"
      ],
      answer: "B. Short stature"
    },
    {
      question: "Tanner stage 2 in boys is characterised by:",
      options: [
        "A. Appearance of pubic hair only",
        "B. Testicular volume >4 mL (earliest sign of puberty in boys)",
        "C. Penile elongation",
        "D. Axillary hair growth"
      ],
      answer: "B. Testicular volume >4 mL (earliest sign of puberty in boys)"
    },
    {
      question: "According to WHO growth standards, a child with weight-for-height Z-score of –3 SD has:",
      options: [
        "A. Moderate acute malnutrition",
        "B. Severe acute malnutrition",
        "C. Mild wasting",
        "D. Stunting"
      ],
      answer: "B. Severe acute malnutrition"
    },
    {
      question: "Object permanence (searching for a hidden object) typically develops at:",
      options: [
        "A. 4 months",
        "B. 8–9 months",
        "C. 12 months",
        "D. 18 months"
      ],
      answer: "B. 8–9 months"
    },

    // ─── NEONATOLOGY (Q11–20) ───────────────────────────────────────────────

    {
      question: "A newborn has heart rate 90 bpm, weak respiratory effort, some flexion, grimace on stimulation, and blue extremities. What is the APGAR score?",
      options: [
        "A. 4",
        "B. 5",
        "C. 6",
        "D. 7"
      ],
      answer: "B. 5"
    },
    {
      question: "The MOST common cause of respiratory distress in a preterm neonate born at 28 weeks is:",
      options: [
        "A. Meconium aspiration syndrome",
        "B. Transient tachypnoea of the newborn",
        "C. Hyaline membrane disease (RDS)",
        "D. Congenital pneumonia"
      ],
      answer: "C. Hyaline membrane disease (RDS)"
    },
    {
      question: "Physiological jaundice in term neonates appears on day ____ and disappears by day ____.",
      options: [
        "A. 1; 4",
        "B. 2–3; 10–14",
        "C. 1; 7",
        "D. 4; 21"
      ],
      answer: "B. 2–3; 10–14"
    },
    {
      question: "Neonatal hypoglycaemia is defined as blood glucose below:",
      options: [
        "A. 1.1 mmol/L (20 mg/dL)",
        "B. 2.2 mmol/L (40 mg/dL)",
        "C. 2.6 mmol/L (47 mg/dL)",
        "D. 3.3 mmol/L (60 mg/dL)"
      ],
      answer: "C. 2.6 mmol/L (47 mg/dL)"
    },
    {
      question: "Erythroblastosis fetalis due to Rh incompatibility is BEST prevented by:",
      options: [
        "A. Early delivery",
        "B. Anti-D immunoglobulin to mother within 72 hours of delivery",
        "C. Exchange transfusion at birth",
        "D. Phototherapy to mother antenatally"
      ],
      answer: "B. Anti-D immunoglobulin to mother within 72 hours of delivery"
    },
    {
      question: "A term neonate born through meconium-stained amniotic fluid is vigorous at birth. The correct management is:",
      options: [
        "A. Immediate endotracheal intubation and suctioning",
        "B. Routine care; no oropharyngeal suctioning",
        "C. Oropharyngeal suctioning before delivery of shoulders",
        "D. Immediate CPAP application"
      ],
      answer: "B. Routine care; no oropharyngeal suctioning"
    },
    {
      question: "The drug of choice for neonatal seizures is:",
      options: [
        "A. Diazepam",
        "B. Phenobarbitone",
        "C. Levetiracetam",
        "D. Clonazepam"
      ],
      answer: "B. Phenobarbitone"
    },
    {
      question: "A neonate presents with bilious vomiting on day 1 of life. X-ray shows a 'double bubble' sign. The diagnosis is:",
      options: [
        "A. Pyloric stenosis",
        "B. Hirschsprung disease",
        "C. Duodenal atresia",
        "D. Meconium ileus"
      ],
      answer: "C. Duodenal atresia"
    },
    {
      question: "Which vitamin is routinely given IM to all newborns at birth to prevent haemorrhagic disease?",
      options: [
        "A. Vitamin A",
        "B. Vitamin C",
        "C. Vitamin D",
        "D. Vitamin K"
      ],
      answer: "D. Vitamin K"
    },
    {
      question: "Surfactant is produced by:",
      options: [
        "A. Type I pneumocytes",
        "B. Type II pneumocytes",
        "C. Clara cells",
        "D. Goblet cells"
      ],
      answer: "B. Type II pneumocytes"
    },

    // ─── NUTRITION & FEEDING (Q21–28) ──────────────────────────────────────

    {
      question: "WHO recommends exclusive breastfeeding for the first:",
      options: [
        "A. 3 months",
        "B. 4 months",
        "C. 6 months",
        "D. 12 months"
      ],
      answer: "C. 6 months"
    },
    {
      question: "Kwashiorkor is characterised by all of the following EXCEPT:",
      options: [
        "A. Pitting oedema",
        "B. Skin changes (flaky paint dermatosis)",
        "C. Severe muscle wasting",
        "D. Miserable affect"
      ],
      answer: "C. Severe muscle wasting"
    },
    {
      question: "The classic 'sunflower cataract' is seen in deficiency of:",
      options: [
        "A. Zinc",
        "B. Copper",
        "C. Iodine",
        "D. Vitamin E"
      ],
      answer: "B. Copper"
    },
    {
      question: "Bitot's spots are pathognomonic of deficiency of:",
      options: [
        "A. Vitamin C",
        "B. Vitamin A",
        "C. Vitamin D",
        "D. Riboflavin"
      ],
      answer: "B. Vitamin A"
    },
    {
      question: "Scurvy (Vitamin C deficiency) in infants classically presents with:",
      options: [
        "A. Craniotabes",
        "B. Subperiosteal haemorrhage and irritability",
        "C. Bow legs",
        "D. Night blindness"
      ],
      answer: "B. Subperiosteal haemorrhage and irritability"
    },
    {
      question: "Nutritional rickets is BEST confirmed by:",
      options: [
        "A. Serum calcium level",
        "B. X-ray wrist showing cupping, fraying, and widening of the physis",
        "C. Serum phosphorus alone",
        "D. Bone biopsy"
      ],
      answer: "B. X-ray wrist showing cupping, fraying, and widening of the physis"
    },
    {
      question: "The therapeutic food used for outpatient treatment of severe acute malnutrition is:",
      options: [
        "A. F-75 formula",
        "B. F-100 formula",
        "C. Ready-to-use therapeutic food (RUTF/Plumpy'Nut)",
        "D. Diluted cow's milk"
      ],
      answer: "C. Ready-to-use therapeutic food (RUTF/Plumpy'Nut)"
    },
    {
      question: "Iron-deficiency anaemia in a 1-year-old is MOST commonly due to:",
      options: [
        "A. Increased requirements with rapid growth and exclusive cow's milk feeding",
        "B. Hookworm infestation",
        "C. Coeliac disease",
        "D. Haemolysis"
      ],
      answer: "A. Increased requirements with rapid growth and exclusive cow's milk feeding"
    },

    // ─── IMMUNISATION (Q29–34) ──────────────────────────────────────────────

    {
      question: "The OPV (oral polio vaccine) is a live attenuated vaccine. Which of the following is a CONTRAINDICATION?",
      options: [
        "A. Fever >38°C",
        "B. Symptomatic HIV infection / immunodeficiency",
        "C. Diarrhoea",
        "D. Prematurity"
      ],
      answer: "B. Symptomatic HIV infection / immunodeficiency"
    },
    {
      question: "The MMR vaccine is given at:",
      options: [
        "A. 6 weeks and 10 weeks",
        "B. 9 months and 15–18 months",
        "C. 12 months and 4–6 years",
        "D. 15 months and 5 years"
      ],
      answer: "B. 9 months and 15–18 months"
    },
    {
      question: "BCG vaccine is given to protect against severe forms of tuberculosis (miliary TB and TB meningitis). The CORRECT route is:",
      options: [
        "A. Intramuscular",
        "B. Subcutaneous",
        "C. Intradermal",
        "D. Oral"
      ],
      answer: "C. Intradermal"
    },
    {
      question: "A 15-month-old child has received no vaccines so far. To catch up, which vaccine should NOT be given simultaneously with OPV?",
      options: [
        "A. MMR",
        "B. Varicella",
        "C. Yellow fever",
        "D. None — all vaccines can be given simultaneously in catch-up"
      ],
      answer: "D. None — all vaccines can be given simultaneously in catch-up"
    },
    {
      question: "The Hib vaccine prevents Haemophilus influenzae type b disease. The PRIMARY schedule starts at:",
      options: [
        "A. Birth",
        "B. 6 weeks",
        "C. 9 months",
        "D. 12 months"
      ],
      answer: "B. 6 weeks"
    },
    {
      question: "Cold chain temperature for most vaccines should be maintained at:",
      options: [
        "A. –20°C to –15°C",
        "B. 0°C to 4°C",
        "C. 2°C to 8°C",
        "D. 10°C to 15°C"
      ],
      answer: "C. 2°C to 8°C"
    },

    // ─── RESPIRATORY (Q35–42) ───────────────────────────────────────────────

    {
      question: "The MOST common bacterial cause of community-acquired pneumonia in children aged 5–12 years is:",
      options: [
        "A. Streptococcus pneumoniae",
        "B. Mycoplasma pneumoniae",
        "C. Staphylococcus aureus",
        "D. Haemophilus influenzae"
      ],
      answer: "B. Mycoplasma pneumoniae"
    },
    {
      question: "A 2-year-old presents with sudden-onset inspiratory stridor, drooling, and high fever. He appears toxic and prefers a 'tripod' position. The diagnosis is:",
      options: [
        "A. Viral croup",
        "B. Bacterial tracheitis",
        "C. Acute epiglottitis",
        "D. Foreign body aspiration"
      ],
      answer: "C. Acute epiglottitis"
    },
    {
      question: "Viral croup (laryngotracheobronchitis) is MOST commonly caused by:",
      options: [
        "A. Respiratory syncytial virus",
        "B. Parainfluenza virus type 1",
        "C. Adenovirus",
        "D. Influenza B"
      ],
      answer: "B. Parainfluenza virus type 1"
    },
    {
      question: "The 'steeple sign' on AP neck X-ray is characteristic of:",
      options: [
        "A. Epiglottitis",
        "B. Retropharyngeal abscess",
        "C. Viral croup",
        "D. Bacterial tracheitis"
      ],
      answer: "C. Viral croup"
    },
    {
      question: "A 6-month-old infant presents in winter with wheeze, hyperinflation, and feeding difficulty. The causative organism is MOST likely:",
      options: [
        "A. Rhinovirus",
        "B. Respiratory syncytial virus (RSV)",
        "C. Mycoplasma",
        "D. Bordetella pertussis"
      ],
      answer: "B. Respiratory syncytial virus (RSV)"
    },
    {
      question: "According to GINA guidelines, the FIRST-LINE controller therapy for persistent mild asthma in a child is:",
      options: [
        "A. Long-acting beta-2 agonist (LABA)",
        "B. Low-dose inhaled corticosteroid (ICS)",
        "C. Leukotriene receptor antagonist",
        "D. Theophylline"
      ],
      answer: "B. Low-dose inhaled corticosteroid (ICS)"
    },
    {
      question: "The classic 'whooping' cough (pertussis) is caused by Bordetella pertussis. The BEST diagnostic test in the catarrhal stage is:",
      options: [
        "A. Chest X-ray",
        "B. Nasopharyngeal culture",
        "C. PCR from nasopharyngeal swab",
        "D. Serology (IgG)"
      ],
      answer: "C. PCR from nasopharyngeal swab"
    },
    {
      question: "A child with cystic fibrosis is MOST at risk for chronic pulmonary infection with:",
      options: [
        "A. Streptococcus pneumoniae",
        "B. Pseudomonas aeruginosa",
        "C. Staphylococcus epidermidis",
        "D. Klebsiella pneumoniae"
      ],
      answer: "B. Pseudomonas aeruginosa"
    },

    // ─── CARDIOLOGY (Q43–50) ────────────────────────────────────────────────

    {
      question: "The MOST common congenital heart disease overall is:",
      options: [
        "A. Atrial septal defect",
        "B. Patent ductus arteriosus",
        "C. Ventricular septal defect",
        "D. Tetralogy of Fallot"
      ],
      answer: "C. Ventricular septal defect"
    },
    {
      question: "A cyanotic newborn whose SpO2 does NOT improve with 100% O2 administration (hyperoxia test negative) is MOST likely to have:",
      options: [
        "A. Persistent pulmonary hypertension",
        "B. Transposition of great arteries (TGA)",
        "C. Tricuspid atresia",
        "D. Tetralogy of Fallot"
      ],
      answer: "B. Transposition of great arteries (TGA)"
    },
    {
      question: "Tetralogy of Fallot consists of all of the following EXCEPT:",
      options: [
        "A. Ventricular septal defect",
        "B. Right ventricular hypertrophy",
        "C. Atrial septal defect",
        "D. Pulmonary stenosis and overriding aorta"
      ],
      answer: "C. Atrial septal defect"
    },
    {
      question: "A 'tet spell' (hypercyanotic spell) is managed by ALL of the following EXCEPT:",
      options: [
        "A. Knee-chest position",
        "B. Morphine sulfate",
        "C. Oxygen",
        "D. IV isoproterenol (isoprenaline)"
      ],
      answer: "D. IV isoproterenol (isoprenaline)"
    },
    {
      question: "The MOST common cause of acquired heart disease in children in developing countries is:",
      options: [
        "A. Kawasaki disease",
        "B. Infective endocarditis",
        "C. Rheumatic heart disease",
        "D. Dilated cardiomyopathy"
      ],
      answer: "C. Rheumatic heart disease"
    },
    {
      question: "Jones criteria (major) for acute rheumatic fever include all EXCEPT:",
      options: [
        "A. Carditis",
        "B. Chorea",
        "C. Elevated ASO titre",
        "D. Erythema marginatum"
      ],
      answer: "C. Elevated ASO titre"
    },
    {
      question: "Indomethacin is used to close a haemodynamically significant patent ductus arteriosus in a preterm neonate because it:",
      options: [
        "A. Is a prostaglandin synthesis inhibitor",
        "B. Increases pulmonary vascular resistance",
        "C. Is a calcium channel blocker",
        "D. Stimulates surfactant production"
      ],
      answer: "A. Is a prostaglandin synthesis inhibitor"
    },
    {
      question: "Coarctation of the aorta classically presents with hypertension in the upper extremities and reduced femoral pulses. The MOST common associated cardiac anomaly is:",
      options: [
        "A. ASD",
        "B. VSD",
        "C. Bicuspid aortic valve",
        "D. PDA"
      ],
      answer: "C. Bicuspid aortic valve"
    },

    // ─── GI & HEPATOLOGY (Q51–57) ───────────────────────────────────────────

    {
      question: "Pyloric stenosis classically presents at age 2–8 weeks with:",
      options: [
        "A. Bilious projectile vomiting",
        "B. Non-bilious projectile vomiting and olive-shaped mass",
        "C. Diarrhoea and dehydration",
        "D. Abdominal distension and constipation"
      ],
      answer: "B. Non-bilious projectile vomiting and olive-shaped mass"
    },
    {
      question: "The electrolyte abnormality in pyloric stenosis is:",
      options: [
        "A. Hyperchloraemic metabolic acidosis",
        "B. Hypochloraemic hypokalaemic metabolic alkalosis",
        "C. Hyperkalaemic metabolic acidosis",
        "D. Hyponatraemic metabolic acidosis"
      ],
      answer: "B. Hypochloraemic hypokalaemic metabolic alkalosis"
    },
    {
      question: "The 'currant jelly' stool (bloody mucus) in a 6–18 month-old infant is pathognomonic of:",
      options: [
        "A. Meckel's diverticulum",
        "B. Intussusception",
        "C. Hirschsprung disease",
        "D. Necrotising enterocolitis"
      ],
      answer: "B. Intussusception"
    },
    {
      question: "The gold standard investigation for Hirschsprung disease is:",
      options: [
        "A. Barium enema",
        "B. Anorectal manometry",
        "C. Rectal suction biopsy",
        "D. Colonoscopy"
      ],
      answer: "C. Rectal suction biopsy"
    },
    {
      question: "Wilson disease (hepatolenticular degeneration) is due to excess accumulation of:",
      options: [
        "A. Iron",
        "B. Copper",
        "C. Zinc",
        "D. Manganese"
      ],
      answer: "B. Copper"
    },
    {
      question: "Acute liver failure in a child with jaundice, coagulopathy (INR >2), and encephalopathy is MOST commonly caused by in developing countries by:",
      options: [
        "A. Hepatitis A virus",
        "B. Hepatitis B virus",
        "C. Hepatitis C virus",
        "D. Drug-induced (paracetamol)"
      ],
      answer: "B. Hepatitis B virus"
    },
    {
      question: "A 10-year-old with painless rectal bleeding and a 'technetium-99m scan' showing a focal area of ectopic gastric mucosa in the ileum has:",
      options: [
        "A. Intussusception",
        "B. Juvenile polyp",
        "C. Meckel's diverticulum",
        "D. Crohn's disease"
      ],
      answer: "C. Meckel's diverticulum"
    },

    // ─── NEPHROLOGY (Q58–64) ────────────────────────────────────────────────

    {
      question: "The MOST common cause of nephrotic syndrome in children aged 1–8 years is:",
      options: [
        "A. Focal segmental glomerulosclerosis",
        "B. Membranous nephropathy",
        "C. Minimal change disease",
        "D. IgA nephropathy"
      ],
      answer: "C. Minimal change disease"
    },
    {
      question: "Post-streptococcal glomerulonephritis (PSGN) presents with nephritic syndrome. The complement level that is characteristically LOW is:",
      options: [
        "A. C1q",
        "B. C3",
        "C. C4",
        "D. C5"
      ],
      answer: "B. C3"
    },
    {
      question: "A 3-year-old boy has oedema, heavy proteinuria (>3.5 g/day), hypoalbuminaemia, and hyperlipidaemia. He is started on prednisolone and responds completely. This pattern is consistent with:",
      options: [
        "A. Steroid-resistant nephrotic syndrome",
        "B. Steroid-sensitive (minimal change) nephrotic syndrome",
        "C. Membranoproliferative GN",
        "D. Focal segmental GS"
      ],
      answer: "B. Steroid-sensitive (minimal change) nephrotic syndrome"
    },
    {
      question: "Haemolytic uraemic syndrome (HUS) is a triad of microangiopathic haemolytic anaemia, thrombocytopaenia, and acute kidney injury. The MOST common cause in children is:",
      options: [
        "A. Streptococcus pneumoniae",
        "B. E. coli O157:H7 (STEC-HUS)",
        "C. Shigella dysenteriae",
        "D. Salmonella typhi"
      ],
      answer: "B. E. coli O157:H7 (STEC-HUS)"
    },
    {
      question: "Vesicoureteral reflux (VUR) grades 1–5: scarring leading to hypertension and renal failure is MOST common in which grade?",
      options: [
        "A. Grade 1",
        "B. Grade 2",
        "C. Grade 3",
        "D. Grades 4–5"
      ],
      answer: "D. Grades 4–5"
    },
    {
      question: "The FIRST line antibiotic for uncomplicated urinary tract infection in a non-allergic child is:",
      options: [
        "A. Ciprofloxacin",
        "B. Nitrofurantoin (for lower UTI) / trimethoprim-sulfamethoxazole",
        "C. Ceftriaxone IV",
        "D. Amoxicillin-clavulanate"
      ],
      answer: "B. Nitrofurantoin (for lower UTI) / trimethoprim-sulfamethoxazole"
    },
    {
      question: "Renal tubular acidosis type II (proximal RTA) is characterised by:",
      options: [
        "A. Normal anion gap metabolic acidosis with high urine pH",
        "B. Normal anion gap metabolic acidosis with urine pH <5.5 when acidaemic",
        "C. High anion gap metabolic acidosis",
        "D. Metabolic alkalosis"
      ],
      answer: "A. Normal anion gap metabolic acidosis with high urine pH"
    },

    // ─── NEUROLOGY (Q65–72) ─────────────────────────────────────────────────

    {
      question: "West syndrome (infantile spasms) is a triad of infantile spasms, hypsarrhythmia on EEG, and developmental regression. FIRST-LINE treatment is:",
      options: [
        "A. Phenobarbitone",
        "B. ACTH or vigabatrin",
        "C. Valproate",
        "D. Clonazepam"
      ],
      answer: "B. ACTH or vigabatrin"
    },
    {
      question: "A 7-year-old presents with absence seizures (blank staring, eye-fluttering, 5–20 s). The EEG pattern is:",
      options: [
        "A. 4 Hz spike-and-wave",
        "B. 3 Hz spike-and-wave",
        "C. Hypsarrhythmia",
        "D. Burst suppression"
      ],
      answer: "B. 3 Hz spike-and-wave"
    },
    {
      question: "Duchenne muscular dystrophy is caused by a mutation in the dystrophin gene (Xp21). The FIRST clinical sign is:",
      options: [
        "A. Facial weakness",
        "B. Gower sign (difficulty rising from floor)",
        "C. Ptosis",
        "D. Wrist drop"
      ],
      answer: "B. Gower sign (difficulty rising from floor)"
    },
    {
      question: "A neonate with hypotonia, absent deep tendon reflexes, and tongue fasciculations most likely has:",
      options: [
        "A. Cerebral palsy",
        "B. Spinal muscular atrophy type I (Werdnig-Hoffmann)",
        "C. Congenital myotonic dystrophy",
        "D. Hypothyroidism"
      ],
      answer: "B. Spinal muscular atrophy type I (Werdnig-Hoffmann)"
    },
    {
      question: "Bacterial meningitis in a neonate is MOST commonly caused by:",
      options: [
        "A. Neisseria meningitidis",
        "B. Streptococcus pneumoniae",
        "C. Group B Streptococcus (GBS) and E. coli",
        "D. Listeria monocytogenes"
      ],
      answer: "C. Group B Streptococcus (GBS) and E. coli"
    },
    {
      question: "Febrile convulsions are MOST common in which age group?",
      options: [
        "A. 0–6 months",
        "B. 6 months – 5 years",
        "C. 5–10 years",
        "D. 10–15 years"
      ],
      answer: "B. 6 months – 5 years"
    },
    {
      question: "Neurofibromatosis type 1 (von Recklinghausen disease) is diagnosed by finding ≥6 café-au-lait spots plus:",
      options: [
        "A. Acoustic neuromas",
        "B. Lisch nodules (iris hamartomas)",
        "C. Retinal angiomas",
        "D. Adenoma sebaceum"
      ],
      answer: "B. Lisch nodules (iris hamartomas)"
    },
    {
      question: "The MOST common intracranial tumour in children is located in the:",
      options: [
        "A. Cerebral cortex (supratentorial)",
        "B. Posterior fossa (infratentorial)",
        "C. Spinal cord",
        "D. Pituitary gland"
      ],
      answer: "B. Posterior fossa (infratentorial)"
    },

    // ─── HAEMATOLOGY & ONCOLOGY (Q73–80) ────────────────────────────────────

    {
      question: "The MOST common childhood malignancy is:",
      options: [
        "A. Neuroblastoma",
        "B. Wilms tumour",
        "C. Acute lymphoblastic leukaemia (ALL)",
        "D. Non-Hodgkin lymphoma"
      ],
      answer: "C. Acute lymphoblastic leukaemia (ALL)"
    },
    {
      question: "A 4-year-old with anaemia, pallor, splenomegaly, and target cells on blood film; haemoglobin electrophoresis shows HbF 90%, HbA2 elevated, absent HbA. The diagnosis is:",
      options: [
        "A. Sickle cell disease",
        "B. Beta-thalassaemia major",
        "C. Alpha-thalassaemia trait",
        "D. G6PD deficiency"
      ],
      answer: "B. Beta-thalassaemia major"
    },
    {
      question: "Painful vaso-occlusive crisis in sickle cell disease is managed FIRST with:",
      options: [
        "A. Exchange transfusion",
        "B. IV hydration, oxygen, and analgesia",
        "C. Hydroxyurea immediately",
        "D. Bone marrow transplant"
      ],
      answer: "B. IV hydration, oxygen, and analgesia"
    },
    {
      question: "Idiopathic thrombocytopaenic purpura (ITP) in a child aged 2–10 years characteristically follows:",
      options: [
        "A. A viral illness 1–4 weeks earlier",
        "B. A bacterial infection",
        "C. Trauma",
        "D. Drug intake"
      ],
      answer: "A. A viral illness 1–4 weeks earlier"
    },
    {
      question: "Haemophilia A is a deficiency of factor:",
      options: [
        "A. VII",
        "B. VIII",
        "C. IX",
        "D. XI"
      ],
      answer: "B. VIII"
    },
    {
      question: "Wilms tumour (nephroblastoma) peak incidence is at age:",
      options: [
        "A. <1 year",
        "B. 3–4 years",
        "C. 8–10 years",
        "D. Adolescence"
      ],
      answer: "B. 3–4 years"
    },
    {
      question: "G6PD deficiency haemolytic crisis in children is precipitated by all EXCEPT:",
      options: [
        "A. Primaquine",
        "B. Fava beans",
        "C. Penicillin",
        "D. Naphthalene (mothballs)"
      ],
      answer: "C. Penicillin"
    },
    {
      question: "The chromosomal abnormality in acute lymphoblastic leukaemia associated with the BEST prognosis is:",
      options: [
        "A. Philadelphia chromosome t(9;22)",
        "B. Hyperdiploidy (>50 chromosomes)",
        "C. t(4;11) MLL rearrangement",
        "D. Hypodiploidy"
      ],
      answer: "B. Hyperdiploidy (>50 chromosomes)"
    },

    // ─── ENDOCRINOLOGY (Q81–86) ─────────────────────────────────────────────

    {
      question: "A 2-year-old presents with short stature, lethargy, constipation, coarse hair, macroglossia, and umbilical hernia. TSH is very high; T4 is low. The diagnosis is:",
      options: [
        "A. Growth hormone deficiency",
        "B. Congenital hypothyroidism",
        "C. Down syndrome",
        "D. Cushing syndrome"
      ],
      answer: "B. Congenital hypothyroidism"
    },
    {
      question: "Diabetic ketoacidosis (DKA) in children: the MOST common precipitating cause in a known type 1 diabetic is:",
      options: [
        "A. Missed insulin doses",
        "B. Dietary indiscretion",
        "C. New-onset diabetes",
        "D. Stress fracture"
      ],
      answer: "A. Missed insulin doses"
    },
    {
      question: "Central precocious puberty in girls is defined as development of secondary sex characteristics before age:",
      options: [
        "A. 6 years",
        "B. 8 years",
        "C. 10 years",
        "D. 12 years"
      ],
      answer: "B. 8 years"
    },
    {
      question: "Congenital adrenal hyperplasia (CAH) is MOST commonly due to deficiency of:",
      options: [
        "A. 11-beta-hydroxylase",
        "B. 21-hydroxylase",
        "C. 17-alpha-hydroxylase",
        "D. 3-beta-hydroxysteroid dehydrogenase"
      ],
      answer: "B. 21-hydroxylase"
    },
    {
      question: "A 10-year-old obese boy has acanthosis nigricans, polyuria, polydipsia, and HbA1c of 8%. Fasting C-peptide is elevated. He most likely has:",
      options: [
        "A. Type 1 diabetes mellitus",
        "B. Type 2 diabetes mellitus",
        "C. MODY (maturity-onset diabetes of the young)",
        "D. Diabetes insipidus"
      ],
      answer: "B. Type 2 diabetes mellitus"
    },
    {
      question: "Short stature in a child with normal growth hormone levels, normal bone age, and normal thyroid function, with both parents having short stature is MOST consistent with:",
      options: [
        "A. Constitutional delay of growth",
        "B. Growth hormone deficiency",
        "C. Familial short stature",
        "D. Hypothyroidism"
      ],
      answer: "C. Familial short stature"
    },

    // ─── INFECTIOUS DISEASES (Q87–93) ───────────────────────────────────────

    {
      question: "A febrile 4-year-old has Koplik spots (white spots on buccal mucosa). The NEXT expected finding is:",
      options: [
        "A. Vesicular rash on palms and soles",
        "B. Maculopapular rash starting on face/hairline spreading downward",
        "C. Petechial rash on trunk",
        "D. Desquamating rash on hands and feet"
      ],
      answer: "B. Maculopapular rash starting on face/hairline spreading downward"
    },
    {
      question: "Kawasaki disease diagnostic criteria require fever for >5 days plus at least 4 of 5 features. Which ONE is NOT a classic feature?",
      options: [
        "A. Bilateral non-purulent conjunctivitis",
        "B. Cervical lymphadenopathy >1.5 cm",
        "C. Splenomegaly",
        "D. Strawberry tongue"
      ],
      answer: "C. Splenomegaly"
    },
    {
      question: "Treatment of Kawasaki disease to prevent coronary artery aneurysm includes:",
      options: [
        "A. IV immunoglobulin (IVIG) + high-dose aspirin",
        "B. Steroids alone",
        "C. Antibiotics",
        "D. Anticoagulation with warfarin"
      ],
      answer: "A. IV immunoglobulin (IVIG) + high-dose aspirin"
    },
    {
      question: "The treatment of choice for typhoid fever in children is:",
      options: [
        "A. Ampicillin",
        "B. Ceftriaxone or azithromycin",
        "C. Chloramphenicol",
        "D. Ciprofloxacin"
      ],
      answer: "B. Ceftriaxone or azithromycin"
    },
    {
      question: "Paediatric malaria: severe malaria is defined by WHO as P. falciparum with organ involvement. The DRUG OF CHOICE for severe malaria in children is:",
      options: [
        "A. Oral artemether-lumefantrine",
        "B. IV artesunate",
        "C. IV quinine",
        "D. Chloroquine"
      ],
      answer: "B. IV artesunate"
    },
    {
      question: "A child with HIV has CD4 count <200 cells/μL. She should receive prophylaxis against Pneumocystis jirovecii pneumonia (PCP) with:",
      options: [
        "A. Azithromycin",
        "B. Trimethoprim-sulfamethoxazole (cotrimoxazole)",
        "C. Fluconazole",
        "D. Dapsone (first choice)"
      ],
      answer: "B. Trimethoprim-sulfamethoxazole (cotrimoxazole)"
    },
    {
      question: "The Mantoux tuberculin skin test (TST) in a BCG-vaccinated, HIV-negative child is considered POSITIVE if induration is ≥:",
      options: [
        "A. 5 mm",
        "B. 10 mm",
        "C. 15 mm",
        "D. 20 mm"
      ],
      answer: "B. 10 mm"
    },

    // ─── GENETICS (Q94–97) ──────────────────────────────────────────────────

    {
      question: "Down syndrome (Trisomy 21) is associated with all of the following EXCEPT:",
      options: [
        "A. Atrioventricular septal defect",
        "B. Brushfield spots",
        "C. Single palmar crease",
        "D. Aortic coarctation"
      ],
      answer: "D. Aortic coarctation"
    },
    {
      question: "Turner syndrome (45,X) is characterised by all EXCEPT:",
      options: [
        "A. Primary amenorrhoea",
        "B. Webbed neck",
        "C. Tall stature",
        "D. Bicuspid aortic valve and coarctation"
      ],
      answer: "C. Tall stature"
    },
    {
      question: "Phenylketonuria (PKU) is screened by the Guthrie test (neonatal heel-prick). If untreated, the child develops:",
      options: [
        "A. Hypercalcaemia",
        "B. Intellectual disability and mousy odour",
        "C. Organomegaly",
        "D. Haemolytic anaemia"
      ],
      answer: "B. Intellectual disability and mousy odour"
    },
    {
      question: "Fragile X syndrome is the MOST common inherited cause of intellectual disability in males. The inheritance pattern is:",
      options: [
        "A. Autosomal dominant",
        "B. Autosomal recessive",
        "C. X-linked recessive",
        "D. X-linked dominant (with anticipation)"
      ],
      answer: "D. X-linked dominant (with anticipation)"
    },

    // ─── DERMATOLOGY (Q98) ──────────────────────────────────────────────────

    {
      question: "Impetigo in a child caused by Staphylococcus aureus typically presents with:",
      options: [
        "A. Target lesions",
        "B. Golden-crusted lesions around mouth and nose",
        "C. Deep ulcers with black eschar",
        "D. Diffuse erythema with sandpaper texture"
      ],
      answer: "B. Golden-crusted lesions around mouth and nose"
    },

    // ─── EMERGENCY PAEDIATRICS (Q99–100) ────────────────────────────────────

    {
      question: "In a child with severe septic shock, the FIRST-LINE fluid resuscitation is:",
      options: [
        "A. 5% dextrose 10 mL/kg over 30 minutes",
        "B. 0.9% Normal saline 20 mL/kg IV bolus over 5–10 minutes",
        "C. Albumin 4% 20 mL/kg over 60 minutes",
        "D. Oral rehydration solution"
      ],
      answer: "B. 0.9% Normal saline 20 mL/kg IV bolus over 5–10 minutes"
    },
    {
      question: "A 2-year-old ingests paracetamol (acetaminophen) 250 mg/kg. The ANTIDOTE is:",
      options: [
        "A. Flumazenil",
        "B. Naloxone",
        "C. N-acetylcysteine (NAC)",
        "D. Atropine"
      ],
      answer: "C. N-acetylcysteine (NAC)"
    }

  ];
}