Mount Kenya University · Junior Clerkship in Paediatrics and Child Health
Paper details
- Unit: MBPE 4300, Junior Clerkship in Paediatrics and Child Health
- Sitting: 5 October 2021, headed "End of 2nd semester exam". By the timetable this is Trimester 1 (September to December), and the printed label is shown on the card.
- Time allowed: 1 hour 30 minutes. Choose the best answer.
- What this page has: MCQs 1 to 9 and 13 to 30 (27 of the 30 MCQs), and 2 short answer questions. MCQs 10 to 12 and the first part of the stem of MCQ 13 were not in the scanned file. MCQs 13 to 30 deal with gastroenterology, hepatology and haematology, so the booklet clearly combines several systems.
- Answers: written by OmpathStudy for revision. They are not the official MKU marking scheme. A few questions are badly worded, and those are marked.
- Topics tested: childhood pneumonia, asthma, interstitial lung disease, cystic fibrosis, pulmonary haemorrhage, pancreatitis, hepatitis B and C, liver disease, NAFLD, bone marrow failure, haemophilia, myelodysplasia.
Multiple choice questions
1. Ann, 3 years old, has a 3-day cough and fever, lower chest wall indrawing, cannot feed or drink, and a chest X-ray shows right lower lobe opacities. Choose the best option:
- A. She has pneumonia according to WHO and should be given amoxicillin and reviewed in 24 hours
- B. She needs oxygen at 10 to 15 litres by nasal prongs
- C. She should be admitted and given IV crystalline penicillin and oxygen
- D. The disease is on the rise because of lack of vaccines
2. A 10-year-old has difficulty breathing, bilateral diffuse wheeze, no fever, and responds well to a fast-acting bronchodilator. Most likely condition:
- A. Severe pneumonia
- B. Bronchiolitis
- C. Asthma
- D. Foreign body aspiration
- E. Tuberculosis
3. Causes of pulmonary haemorrhage include the following EXCEPT:
- A. Foreign bodies in the airway
- B. Tuberculosis
- C. Systemic lupus erythematosus
- D. Obstructive sleep apnoea
- E. Factor VIII deficiency
4. Causes of interstitial lung disease in infants include all EXCEPT:
- A. Surfactant protein B deficiency
- B. Surfactant protein A deficiency
- C. Surfactant protein C deficiency
- D. ATP-binding cassette (ABCA3) protein deficiency
- E. Neuroendocrine cell hyperplasia of infancy
5. The following are commonly expected in a child with cystic fibrosis EXCEPT:
- A. Failure to thrive
- B. Vitamin A, D, E and K deficiency
- C. Chronic lung disease
- D. Exocrine pancreatic insufficiency
- E. Severe vitamin B and C deficiency
6. Cystic fibrosis is inherited as:
- A. Autosomal dominant
- B. X-linked recessive
- C. Autosomal recessive
- D. Autosomal dominant
- E. Multifactorial
7. John's parents are both cystic fibrosis carriers. Which is true?
- A. There is a 50% probability of each child having the disease
- B. The probability of having an affected child is 25%
- C. Each sibling has a 100% chance of being affected
- D. The condition is not inherited
- E. All males in the family will have cystic fibrosis
8. Concerning pulmonary haemorrhagic syndromes, which is true?
- A. The bronchial circulation is low capacitance and supplies the conducting airways
- B. The pulmonary circulation is high capacitance and supplies the respiratory airways
- C. Infections rarely cause pulmonary haemorrhage and should not be suspected
- D. It is important to stop the bleeding immediately with surgery
- E. Foreign bodies can cause localised bleeding in the airways
9. Regarding the prognosis of children with interstitial lung disease:
- A. Children with surfactant protein B deficiency have a very good prognosis
- B. Children with Heiner syndrome due to cow's milk allergy do very well once cow's milk is withdrawn
- C. The prognosis of immune-mediated vasculitis is fair and resolves without treatment
- D. Immunosuppressants should not be used because they suppress immunity
- E. Heart-lung transplant improves 5-year survival to almost 100%
13. (The first part of the stem is missing.) Abdominal pain started last night after eating fast food. The two most common causes of acute pancreatitis are:
- A. High cholesterol and alcohol abuse
- B. History of diabetes and smoking
- C. Pancreatic cancer and obesity
- D. Gallstones and alcohol abuse
14. Very painful epigastric pain radiating to the back, high glucose, fever, vomiting, and bluish discolouration around the umbilicus. This is called:
- A. Grey Turner's sign
- B. McBurney's sign
- C. Homan's sign
- D. Cullen's sign
15. A patient with pancreatitis is given a pancreatic enzyme. Which finding shows the enzymes are working?
- A. Abdominal girth is decreased
- B. Skin turgor is less than 2 seconds
- C. Blood glucose is 250
- D. Stools appear formed and solid
16. Recurrent episodes of massive watery non-bloody diarrhoea, weight loss and severe right upper quadrant pain with biliary tract involvement. Which best suits?
- A. HIV enteropathy
- B. Ulcerative colitis
- C. Irritable bowel syndrome
- D. Cryptosporidium protozoan parasites
- E. Giardia parasite
17. Alcohol withdrawal needs benzodiazepines, but excessive sedation can precipitate which condition that must be avoided?
- A. Bleeding varices
- B. Electrolyte abnormalities
- C. Portal hypertension
- D. Portosystemic encephalopathy
18. True of hepatitis C infection:
- A. Hepatitis C virus is a DNA virus
- B. Infection is a risk factor for hepatocellular carcinoma
- C. Infection is commoner in women
- D. Commonly transmitted by sexual contact
- E. Alpha-interferon is an effective treatment to cure the infection
19. In parenchymal liver disease, which liver test is likely decreased?
- A. AST and ALT
- B. Alkaline phosphatase
- C. Albumin
- D. Prothrombin time
- E. Gamma-glutamyl transpeptidase
20. In obstructive liver disease, which test likely remains normal?
- A. AST and ALT
- B. Alkaline phosphatase
- C. Albumin
- D. 5'-Nucleotidase
- E. Gamma-glutamyl transpeptidase
21. The replication of hepatitis B includes which stage?
- A. Movement of the intact virus to the cytoplasm for replication
- B. Conversion of relaxed circular viral DNA into covalently closed circular (cccDNA) in the nucleus
- C. Virions produced in the cytoplasm by cellular DNA polymerase
- D. Oncogenic activity to transform liver cells
22. Which statement about hepatitis B virus is most accurate?
- A. The most reliable indicator that a person can transmit HBV is HBsAg in the blood
- B. HBV has a circular, partially double-stranded DNA genome and has a DNA polymerase in the virion
- C. Antibody to HBcAg (core antigen) protects from re-infection by the same strain
- D. A person in the "window period" is diagnosed as infected if HBsAg is present
23. Which is NOT true of primary biliary cirrhosis?
- A. Ursodeoxycholic acid is the only approved treatment
- B. Liver transplantation is the treatment of choice in decompensated cirrhosis
- C. The median age at diagnosis is 30 years
- D. Strong female preponderance
24. The odd one out in liver cirrhosis:
- A. INR over 1.3
- B. AST/ALT ratio over 1
- C. Thrombocytosis
- D. Small liver span
25. Risk factors commonly associated with non-alcoholic steatohepatitis EXCEPT:
- A. Sleep apnoea
- B. Heredity
- C. Polycystic ovarian syndrome
- D. Large bowel bacterial overgrowth
26. Factors known to modulate the evolution of non-alcoholic fatty liver disease, EXCEPT one:
- A. Adiponectin
- B. TNF-alpha
- C. Fatty acids
- D. None of the above
27. Idiosyncratic causes of bone marrow failure EXCEPT one:
- A. Drug induced
- B. HPV
- C. Commercial solvents
- D. Ionising radiation
28. Which laboratory test is wrongly matched?
- A. Bleeding time: intrinsic pathway
- B. aPTT: intrinsic pathway
- C. PT: extrinsic pathway
- D. Thrombin time: fibrinolytic pathway
29. The correctly matched statement on haemophilia:
- A. Haemophilia A is 60% of all haemophiliacs
- B. Haemophilia B has a prolonged aPTT
- C. Haemophilia B is 50% of all haemophiliacs
- D. None of the above
30. Which statement about myelodysplasia is incorrect?
- A. RCMD: dysplasia in 2 or more myeloid lineages
- B. RAEB: good prognosis
- C. 5q- syndrome: poor prognosis
- D. RA: dysplasia in red cells only