Mount Kenya University · School of Medicine · Junior Clerkship in Paediatrics and Child Health (MBPE 4300)
Paper details
- Unit: MBPE 4300, Junior Clerkship in Paediatrics and Child Health, end of 3rd trimester exam.
- Sitting: 11 January 2022, 1 hour. By the timetable January falls in Trimester 2 (January to April), so it is filed there with the printed label shown.
- Structure: Part 1 is a 20-mark essay on congenital cardiac conditions. Part 2 has 20 multiple choice questions, with the most correct answer to be chosen.
- Repeats: these 20 MCQs are the same questions as Q1 to Q20 of the 24 January 2022 main exam, with small changes in wording.
- Topics tested: infective endocarditis, rheumatic fever, cyanotic and acyanotic heart lesions, tetralogy of Fallot, patent ductus arteriosus, coarctation, aortic regurgitation, urinary tract infection, post-streptococcal glomerulonephritis and nephrotic syndrome.
- Answers: written by OmpathStudy for revision. They are not the official MKU marking scheme.
- Questions that need care: Q1, Q11, Q14 and Q19 are loosely worded. The explanation says which option is best and why. The pen marks on the scan were ignored.
Multiple choice questions
1. The following are features of infective endocarditis EXCEPT:
- A. Fever
- B. Migratory polyarthritis
- C. Positive blood culture
- D. Elevated erythrocyte sedimentation rate
- E. Migratory murmur
2. To make a diagnosis of infective endocarditis using the modified Duke criteria, choose the correct combination that can be used to make a definite diagnosis.
- A. 2 major
- B. 1 major and 3 minor
- C. 5 minor
- D. All the above
- E. None of the above
3. The most common organism that causes infective endocarditis on native valves is:
- A. Streptococcus pyogenes
- B. Staphylococcus aureus
- C. E. coli
- D. Group B streptococcus
- E. HACEK group
4. The following form part of the major categories in the Jones criteria for acute rheumatic fever EXCEPT:
- A. Polyarthritis
- B. Carditis
- C. Sydenham chorea
- D. Erythema multiforme
- E. Subcutaneous nodules
5. A newborn baby presents with worsening cyanosis that does not respond to high-flow oxygen. Which congenital heart condition is LEAST likely to be present?
- A. Tricuspid atresia
- B. Transposition of the great arteries
- C. Truncus arteriosus
- D. Ventricular septal defect
- E. Hypoplastic left ventricle
6. The following are expected findings in a child diagnosed with tetralogy of Fallot EXCEPT:
- A. Overriding aorta
- B. Right ventricular hypertrophy
- C. Ventricular septal defect
- D. Pulmonary stenosis
- E. Atrial septal defect
7. In the management of a child with tetralogy of Fallot who has an acute cyanotic spell, which medication is NOT used?
- A. Propranolol
- B. Sodium bicarbonate
- C. Morphine
- D. Phenobarbitone
- E. Oxygen
8. A 1-year-old child who was born preterm has a machinery murmur at the right upper sternal border, bounding pulses and a wide pulse pressure. The most likely cardiac lesion is:
- A. Ventricular septal defect
- B. Aortic regurgitation
- C. Pulmonary regurgitation
- D. Patent ductus arteriosus
- E. Aortic regurgitation
9. A 10-year-old girl with rheumatic heart disease has difficulty breathing, swollen legs and face, a gallop rhythm, a loud murmur of mitral regurgitation and a tender enlarged liver. The most appropriate next step is:
- A. Do intense exercise to help with breathing and quicken recovery
- B. Advise a diet high in salt
- C. Start oxygen and diuretics
- D. Start antibiotics
- E. Do a lumbar puncture
10. In a child with coarctation of the aorta, the following signs are expected EXCEPT:
- A. Radio-femoral delay
- B. Blood pressure difference between upper and lower limbs
- C. Severe central cyanosis
- D. Weak pulses in the lower limbs
- E. Signs of circulatory failure in the lower limbs
11. Which of the following signs is found in a patient with aortic regurgitation?
- A. Loud P2
- B. Pistol shots at the brachial pulse
- C. Single S1
- D. Continuous machinery murmur at the apex
- E. Corrigan sign
12. Medication that should be given to keep the patent ductus open in children with a duct-dependent lesion includes:
- A. Prostaglandin E1
- B. Prostacyclin
- C. Prostaglandin I2
- D. Prostaglandin E2
- E. Indomethacin
13. A 1-week-old preterm baby with a birth weight of 1.2 kg has a haemodynamically significant patent ductus arteriosus. Which is the most correct step in management?
- A. The patient can be observed for a period of 1 year, then the ductus can be closed
- B. The ductus should be closed immediately since it is haemodynamically significant
- C. A trial of ibuprofen or indomethacin should be given to see if the ductus shall close
- D. There is no role for fluid restriction in this case
- E. Diuretics are dangerous at this age and should not be tried
14. Wairimu, 4 years, has a 2-day history of lower abdominal pain, painful micturition and a low-grade fever. The most likely urinalysis findings are:
- A. Red blood cell casts, 2+ protein, pyuria and red cells too numerous to count
- B. Numerous maltese crosses
- C. 4+ protein, 1+ ketones, 0 to 5 RBC/HPF, 0 to 5 WBC/HPF
- D. RBC and WBC casts, more than 50 RBC/HPF, 20 WBC/HPF and many bacteria
- E. None of the above
15. An 8-year-old girl has a seizure, a blood pressure of 180/110 mmHg, and several episodes of coca-cola coloured urine a few days ago. She was given an antibiotic for a presumed urinary tract infection, and has since had headaches and ankle swelling. She had a sore throat 2 weeks before. A CT of the head is normal. Choose the truest statement.
- A. An urgent renal biopsy is needed to confirm a diagnosis of nephrotic syndrome
- B. Alport syndrome is a likely diagnosis in this child
- C. Post-streptococcal glomerulonephritis is likely to be the diagnosis here
- D. An urgent haemogram and plan to transfuse should be the immediate next step, as the child is most likely in cardiac failure due to anaemia
- E. None of the above
16. Concerning the child in question 15, choose the true fact:
- A. Serotype 49 causes post-streptococcal nephritis after an upper respiratory infection, occurring primarily in the cold season
- B. Serotype 12 causes post-streptococcal nephritis after a skin infection, usually in a warm climate
- C. PSGN usually develops 1 to 3 weeks after an acute infection with specific nephritogenic strains of group A beta-haemolytic streptococcus
- D. The incidence of GN is approximately 50% in persons with pharyngitis and 35% in those with skin infections
- E. None of the above
17. In the management of children with acute post-infectious glomerulonephritis, which statement is true?
- A. Antibiotic therapy with penicillin in the early phase improves the outcomes
- B. Loop diuretics, fluid restriction and antihypertensives have a role
- C. Prognosis in most cases is guarded and the disease takes a prolonged and protracted course
- D. Haematuria resolves in about a week after initiation of treatment and the prognosis is excellent in most cases of AGN
- E. None of the above
18. A 3-year-old boy has oedema and shortness of breath, 3+ proteinuria, a serum albumin of 2 g/dL and 3 g of protein in a 24-hour urine. Light microscopy of a kidney biopsy would most likely reveal:
- A. Diffuse crescent formation
- B. Diffuse thickening of the glomerular basement membrane
- C. Mesangial cell proliferation
- D. Minimal change disease with fusion of podocyte foot processes
- E. All the above
19. After consultation with a paediatric nephrologist, what would be the most appropriate combination of medications for the above patient?
- A. ACE inhibitor, furosemide and prednisone
- B. Prednisone, ACE inhibitor, albumin
- C. Prednisone, furosemide, albumin
- D. Furosemide, spironolactone, digoxin
- E. Furosemide, ACE inhibitor, IV immunoglobulin
20. In regard to the pathophysiology of nephrotic syndrome in children, which statement is true?
- A. The predominant presentation is gross oedema, attributed to progressive nephron loss and loss of kidney filtration capacity
- B. Hyperlipidaemia is a common presentation and is associated with coagulation defects
- C. Acute bacterial peritonitis is a common complication in patients with ascites
- D. Hypoalbuminaemia and reduced oncotic pressure are attributable to progressive loss of nephrons
- E. None of the above