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 first trimester examination for 4th year MBChB.
- Sitting: 27 November 2018, 1 hour 30 minutes. There are 50 questions and only one answer is correct. By the timetable this is Trimester 1 (September to December).
- What this page has: 49 of the 50 MCQs. Question 50 is cut off at the bottom of the last page (only options A and B are in the scan), so it is left out. The scan also repeats page 5.
- Topics tested: rickets, kwashiorkor and marasmus, milestones and growth, breastfeeding, tuberculosis, asthma, croup, epiglottitis, neonatal jaundice, biliary atresia, neonatal sepsis, resuscitation and prematurity.
- Answers: written by OmpathStudy for revision. They are not the official MKU marking scheme.
- Questions that need care: Q20, Q26, Q28 and Q46 are loosely worded or have a faulty option list. The explanation says which option is best and why. The pen marks on the scan were ignored.
Multiple choice questions
1. Radiological signs of rickets include all the following EXCEPT:
- A. Splaying
- B. Cupping
- C. Fraying
- D. Increased bone density
- E. Pathological fractures
2. Risk factors for developing rickets include all the following EXCEPT:
- A. Lack of exposure to sunshine
- B. Chronic diarrhoea
- C. Taking a diet rich in dairy
- D. Chronic kidney disease
- E. Chronic liver disease
3. Investigations that can be done at the bedside in a newborn with respiratory distress, lethargy and hypothermia include all EXCEPT:
- A. CRP
- B. Full blood count
- C. Absolute neutrophil count with band counts
- D. Lumbar puncture
- E. CT scan of the head
4. Characteristics of kwashiorkor include all EXCEPT:
- A. Oedema
- B. Hypopigmented hair
- C. Dermatitis
- D. Mental challenge
- E. Hunger and eagerness to eat
5. Which vitamin prevents neural tube defects?
- A. Folic acid
- B. Thiamine
- C. Pyridoxine
- D. Riboflavin
- E. Vitamin E
6. Which nutrient reduces morbidity and mortality in children with severe measles?
- A. Vitamin C
- B. Vitamin E
- C. Vitamin A
- D. Folic acid
- E. Vitamin K
7. Mariam is a 24-month-old girl. She is expected to do all the following EXCEPT:
- A. Run well
- B. Put 3 words together (subject, verb, object)
- C. Make a tower of 7 cubes
- D. Handle a spoon well
- E. Hop on one foot
8. The following are part of gross motor development in a child EXCEPT:
- A. Sits without support
- B. Scribbles
- C. Runs
- D. Walks alone
- E. Pulls to sit with no head lag
9. By what age should a child's weight be expected to triple?
- A. 6 months
- B. 9 months
- C. 1 year
- D. 18 months
- E. 2 years
10. In terms of language development in a child, which statement is true?
- A. Expressive language precedes receptive language
- B. Receptive language precedes expressive language
- C. Toddlers do not enjoy polysyllabic jargoning
- D. By 15 months the average child cannot point to major body parts
- E. Infants speak their first word around 15 months
11. A 12-year-old girl has sparse, lightly pigmented straight hair on the pubic region and an elevated small mound of the breast and papilla. In which stage of sexual maturity is she?
- A. 1
- B. 2
- C. 3
- D. 4
- E. 5
12. A severely malnourished child has diarrhoea, fever and cannot feed. The following should be addressed on the first day of treatment EXCEPT:
- A. Hypoglycaemia
- B. Hypothermia
- C. Dehydration
- D. Start iron supplement
- E. Correct electrolyte imbalance
13. Which is an expected laboratory finding in the malnourished child above?
- A. Hyperglycaemia
- B. Hypernatraemia
- C. Hyperkalaemia
- D. Hyponatraemia
- E. Normal haemoglobin
14. Primitive neonatal reflexes include all EXCEPT:
- A. Grasp
- B. Moro
- C. Suck
- D. Root
- E. Knee jerk
15. Breast milk is rich in all the following EXCEPT:
- A. Lactalbumin
- B. Calcium
- C. Vitamin D
- D. Immunoglobulin A
- E. Lactose
16. The correct order for examining a child is:
- A. Palpation, auscultation, percussion, inspection
- B. Inspection, percussion, palpation, auscultation
- C. Inspection, palpation, percussion, auscultation
- D. Percussion, palpation, auscultation, inspection
- E. None of the above
17. A normal 3-year-old should be able to:
- A. Copy a triangle
- B. Separate from the primary caregiver with ease
- C. Skip
- D. Tell his or her gender
- E. Walk down the stairs one foot at a time without help
18. The sense that is not fully developed at birth is:
- A. Hearing
- B. Smell
- C. Taste
- D. Touch
- E. Vision
19. Which of the following is NOT a cranial nerve?
- A. Facial
- B. Pudendal
- C. Vagus
- D. Hypoglossal
- E. Oculomotor
20. Which of the following regarding childhood tuberculosis is true?
- A. Pulmonary cavitation is common
- B. The Mantoux test is useful even with a previous history of BCG vaccination
- C. The diagnostic yield of Mycobacterium from gastric aspirates is more than 40%
- D. Streptomycin, rifampicin and isoniazid are the recommended initial therapy
- E. Meningitis may be the first presentation
21. What is the expected average height and weight of a 4-year-old?
- A. Weight 19 kg, height 95 cm
- B. Weight 16 kg, height 101 cm
- C. Weight 16 kg, height 70 cm
- D. Weight 14 kg, height 95 cm
- E. Weight 18 kg, height 105 cm
22. A 7-year-old girl has cough, difficulty breathing and wheezing, no fever, and a strong family history of allergy. The following can be part of treatment EXCEPT:
- A. Steroids
- B. Sedatives
- C. Theophyllines
- D. Terbutaline
- E. Oxygen
23. A 2-year-old has inspiratory stridor, a hoarse voice and a barking cough, preceded by a runny nose and low-grade fever for 3 days. The most likely diagnosis is:
- A. Viral croup
- B. Laryngomalacia
- C. Foreign body obstruction
- D. Acute bronchiolitis
- E. Choanal atresia
24. The most common site of aspiration in a child lying supine is:
- A. The lower lobe of the left lung
- B. The lower lobe of the right lung
- C. The upper lobe of the left lung
- D. None of the above
- E. All of the above
25. Which should we expect of a 7-month-old infant?
- A. Crawling
- B. Social smile
- C. Control of bowel and bladder function
- D. Sitting unsupported
- E. Raising the head while prone
26. Baby John was born at term. His mother had a difficult labour with thick meconium-stained liquor. John has respiratory distress soon after resuscitation. Which statement is true?
- A. The baby most likely has respiratory distress syndrome
- B. The baby most likely has pneumonia
- C. The prevalence is affected by the gender of the baby
- D. Specific procedures before delivery would have prevented this
- E. Prior antibiotic treatment of the mother is beneficial in this condition
27. In a 3-week-old baby with a serum bilirubin of 275 micromol/L, which finding supports a possible diagnosis of biliary atresia?
- A. Absence of dark urine and pale stools
- B. Fevers
- C. Presence of dark urine and pale stools
- D. Tender hepatomegaly
- E. Ultrasound is able to visualise the gall bladder
28. Recognised consequences of ABO incompatibility do NOT include:
- A. Coombs-negative haemolysis
- B. Increased severity in further pregnancies
- C. Jaundice on the first day of life
- D. Reduced haemoglobin on the first day of life
- E. Spherocytes in the blood
29. Which is the best way to screen for wasting?
- A. Weight-for-age Z score
- B. Height-for-age Z score
- C. Weight-for-height Z score
- D. Mid-upper arm circumference
- E. Skin thickness
30. Mary, 10 months, has cough, wheezing and fever. She had sneezing and watery rhinorrhoea, and no history of atopy. The most probable diagnosis is:
- A. Pneumonia
- B. Tuberculosis
- C. Acute bronchiolitis
- D. Asthma
- E. Foreign body aspiration
31. About kangaroo mother care, which statement is true?
- A. It should only be started if the weight of the newborn is above 3 kg
- B. The mother is the only person who can provide kangaroo care
- C. The baby should be placed between the mother's breasts in an upright position
- D. The baby and mother should be fully clothed so that the skins do not touch
- E. It is the same as baby wearing
32. Concerning epiglottitis, which statement is true?
- A. The main cause is respiratory syncytial virus
- B. A radiograph of the neck shows the steeple sign
- C. It affects only children
- D. The airway has to be secured as early as possible
- E. It is preceded by a flu-like illness for 2 to 3 days
33. Risk factors for neonatal sepsis include all EXCEPT:
- A. Prolonged labour
- B. Prolonged rupture of membranes
- C. Treating maternal infections in the third trimester
- D. Poor maternal hygiene
- E. Septic techniques during delivery
34. The correct regimen for management of miliary tuberculosis in children is:
- A. 2RHZES 4RE
- B. 2RHZE 4RH
- C. 1RHZES 2RHZE 5RHE
- D. 2RHZE 8RH
- E. 2RHZE 10RH
35. A 4-year-old was playing with small beads and suddenly developed a persistent cough. On auscultation there are unilateral rhonchi. The most likely cause is:
- A. Pneumonia
- B. Acute bronchitis
- C. Foreign body aspiration
- D. Croup
- E. Asthma
36. To improve rates of exclusive breastfeeding in hospitals, the following are useful policies EXCEPT:
- A. Give nothing to drink or eat to exclusively breastfeeding infants except medicines or vitamins
- B. Hospitals should have a breastfeeding policy
- C. Mother and baby should be together at all times unless very sick
- D. Babies should be fed formula after delivery so the mother can relax
- E. Dummies, pacifiers and artificial nipples should not be given before breastfeeding is established
37. Which is a characteristic of late adolescence?
- A. Preoccupied with changing body
- B. Increased interest in sexual anatomy
- C. Increased bid for independence
- D. Self-conscious about appearance and attractiveness
- E. Future-oriented with a sense of perspective
38. To prevent haemorrhagic disease of the newborn, which vitamin should all newborns be given at birth?
- A. Vitamin D
- B. Vitamin C
- C. Vitamin K
- D. Vitamin B
- E. Vitamin A
39. Preterm babies are at risk of hypothermia by losing heat through the following ways EXCEPT:
- A. Radiation
- B. Conduction
- C. Evaporation
- D. Cooling
- E. Convection
40. Common causes of respiratory distress within the first hour of birth include the following EXCEPT:
- A. Transient tachypnoea of the newborn
- B. Respiratory distress syndrome
- C. Cyanotic congenital heart disease
- D. Pneumonia
- E. Rheumatic heart disease
41. Differential diagnosis for a 3-year-old with a chronic cough includes all EXCEPT:
- A. Pulmonary tuberculosis
- B. Asthma
- C. Gastro-oesophageal reflux disease
- D. Foreign body aspiration
- E. Bronchiolitis
42. Relevant specific investigations for pulmonary tuberculosis include:
- A. Full blood count
- B. Urea and electrolytes
- C. Erythrocyte sedimentation rate
- D. Sputum for microscopy and GeneXpert
- E. C-reactive protein
43. Added sounds in the lungs on auscultation include all EXCEPT:
- A. Rales
- B. Murmurs
- C. Rhonchi
- D. Wheezes
- E. Crepitations
44. Phototherapy should be initiated in newborns with jaundice caused by the following EXCEPT:
- A. ABO blood group incompatibility
- B. Rhesus factor incompatibility
- C. Biliary atresia
- D. Neonatal sepsis
- E. Cephalohaematoma
45. Which statement is true about marasmus?
- A. It is caused by lack of proteins only in the diet
- B. Affected children are dull and gloomy
- C. Affected children have oedema
- D. There is wasting of muscles and subcutaneous fat
- E. It has a poorer prognosis than kwashiorkor
46. The recommended newborn cardiopulmonary resuscitation for a baby born with no signs of life and one rescuer is:
- A. 1 breath to 3 cardiac compressions
- B. 1 cardiac compression to 15 breaths
- C. 1 cardiac compression to 3 breaths
- D. 2 breaths to 30 chest compressions
- E. 2 breaths to 15 chest compressions
47. Complications that can occur in preterm babies include all EXCEPT:
- A. Anaemia
- B. Intracranial haemorrhage
- C. Rickets
- D. Meconium aspiration
- E. Retinopathy
48. A child on treatment for TB meningitis passes red-coloured urine. The medication causing this is:
- A. Ethambutol
- B. Rifampicin
- C. Isoniazid
- D. Streptomycin
- E. Pyrazinamide
49. A 1-week-old neonate has fever and refuses to breastfeed. The most common organism causing this infection is:
- A. Neisseria meningitidis
- B. Group B streptococcus
- C. Streptococcus pneumoniae
- D. Haemophilus influenzae
- E. Staphylococcus aureus