Paediatrics end of second semester exam (MBPE 4300): 4 October 2022, cardiology, hepatology and gastroenterology, 47 of 50 MCQs

MKU Paediatrics end of second semester exam (MBPE 4300), 4 October 2022: 47 of 50 MCQs on cyanotic and acyanotic heart disease, endocarditis, rheumatic fever, ECG, patent ductus, hepatitis, gastro-oesophageal reflux, liver failure and ascites, with answers.

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.
Sitting: 4 October 2022, 1 hour, 50 multiple choice questions with one best answer. By the timetable this is Trimester 1 (September to December).
What this page has: 48 of the 50 MCQs. Questions 14 and 15 depend on an ECG strip and are left out, because the strip is not reproduced here. Q10 shows a rhythm strip, which is described and not reproduced. Q21 shows a chest X-ray in the original, and its answer comes from the typical boot-shaped heart.
Topics tested: cyanotic and acyanotic congenital heart disease, tetralogy of Fallot, patent ductus arteriosus, infective endocarditis, acute rheumatic fever, the ECG, hepatitis A and B, gastro-oesophageal reflux disease, inflammatory bowel disease, pancreatitis, liver failure and ascites.
Note: a student's marked answer sheet is attached to the scan. It was ignored.
Answers: written by OmpathStudy for revision. They are not the official MKU marking scheme.
Questions that need care: Q2, Q9, Q10, Q28, Q33, Q37, Q41, Q45 and Q48 are loosely worded, have more than one defensible option, or have a faulty option list. The explanation says which option is best and why.

Multiple choice questions

1. A term newborn weighing 3.5 kg has worsening cyanosis and respiratory distress that is not responding to oxygen. The following are possible causes EXCEPT:

A. Community-acquired pneumonia
B. Tricuspid atresia
C. Total anomalous pulmonary venous return
D. Critical pulmonary stenosis
E. Hypoplastic left ventricle

2. Congenital causes of cyanotic heart disease include the following EXCEPT:

A. Ventricular septal defect
B. Aortic stenosis
C. Mitral valve regurgitation
D. Atrial septal defect
E. Atrioventricular canal defect

3. The Duke criteria are used to diagnose infective endocarditis. Which can NOT be used?

A. 1 major and 3 minor
B. 2 major
C. 5 minor
D. All the above
E. Migratory polyarthritis

4. An organism that causes acute infective endocarditis is:

A. Streptococcus viridans
B. Staphylococcus aureus
C. Staphylococcus epidermidis
D. Pseudomonas aeruginosa
E. Klebsiella

5. The valves most commonly affected in rheumatic heart disease are:

A. Aortic
B. Mitral
C. Tricuspid
D. Aortic and mitral
E. Pulmonary

6. In the diagnosis of acute rheumatic fever, the following are part of the major criteria EXCEPT:

A. Sydenham chorea
B. Migratory polyarthritis
C. Erythema marginatum
D. Fever
E. Carditis

7. A child with a significant ventricular septal defect needs prophylaxis against infective endocarditis for the following:

A. Combing hair aggressively
B. Brushing teeth
C. Tooth extraction
D. Minor lip injury
E. Swimming

8. The causative agent linked to acute rheumatic fever is:

A. Group B streptococcus
B. Lancefield group A beta-haemolytic streptococcus
C. Staphylococcus aureus
D. Lancefield group A alpha-haemolytic streptococcus
E. Streptococcus viridans

9. For a child diagnosed with acute rheumatic fever, choose the most correct statement.

A. Children with valvular damage should be on lifelong monthly benzathine penicillin
B. Children without valvular involvement should receive prophylaxis up to 10 years of age
C. Children allergic to penicillin should be given amoxicillin
D. Macrolides have no role in prophylaxis
E. The risk of throat infection is lower after 8 years of age and many children do not need to come for monthly injections

10. Identify the rhythm below. (ECG strip: a regular, fast rhythm of uniform wide sine-wave-like complexes with no distinct P waves.)

A. Supraventricular tachycardia
B. Ventricular fibrillation
C. Atrial fibrillation
D. Atrial flutter
E. Ventricular tachycardia

11. The most common arrhythmia found in children is:

A. Supraventricular tachycardia
B. Atrial fibrillation
C. Ventricular tachycardia
D. Ventricular fibrillation
E. Atrial flutter

12. The following are present in a child with tetralogy of Fallot EXCEPT:

A. Right ventricular outflow obstruction
B. Right ventricular hypertrophy
C. Overriding aorta
D. Ventricular septal defect
E. Aortic stenosis

13. In the management of tetralogy of Fallot, which has NO role?

A. Sodium bicarbonate
B. Morphine
C. Propranolol
D. Phenobarbitone
E. Knee-chest positioning

16. What does the P wave signify?

A. Ventricular repolarisation
B. Atrial depolarisation
C. Ventricular depolarisation
D. Atrial repolarisation
E. Atrioventricular conduction time

17. What does the QRS signify?

A. Atrial repolarisation
B. Ventricular depolarisation
C. Atrial depolarisation
D. Ventricular repolarisation
E. Atrial relaxation

18. In a child with right ventricular hypertrophy, the following ECG features are expected EXCEPT:

A. Peaked P waves
B. Right axis deviation
C. Tall R waves in lead V1
D. Right bundle branch block pattern
E. Deep S waves in lead V1

19. John has renal failure and a potassium of 7.6 mmol/L. The expected ECG changes include:

A. Depressed T waves
B. Peaked T waves
C. Narrow QRS complex
D. U waves
E. Prolonged PR interval

20. The ideal PR interval should be:

A. 1.2 seconds
B. 5 seconds
C. 1 minute
D. 25 seconds
E. 0.12 seconds

21. The chest X-ray shown (a boot-shaped heart) is in keeping with which cardiac condition?

A. Total anomalous pulmonary venous return
B. Tetralogy of Fallot
C. Truncus arteriosus
D. Tricuspid atresia
E. Transposition of the great vessels

22. A term newborn has severe respiratory distress and cyanosis, and a PDA murmur is heard. Which prostaglandin keeps the PDA open while awaiting surgery?

A. Prostaglandin E2
B. Prostaglandin E1
C. Prostaglandin D
D. Prostaglandin I2
E. Prostacyclin

23. Which feature helps in suspecting coarctation of the aorta?

A. Bounding peripheral pulses
B. Easily palpable dorsalis pedis pulse
C. Radio-femoral delay
D. Pistol shots at the femoral artery
E. Collapsing pulse

24. The most common cardiac lesion in children with Down syndrome is:

A. Atrial septal defect
B. Atrioventricular septal defect (AVSD)
C. Pulmonary stenosis
D. Mitral regurgitation
E. Aortic regurgitation

25. The most appropriate management for a child with a very large VSD is:

A. Monitor closely as the defect is likely to close as the child grows up
B. Primary suture by the surgeon even if stitches are under tension
C. Introduce a closure device such as an umbrella to obstruct the defect
D. Open heart surgery and closure of the defect with a patch under cardiopulmonary bypass
E. Palliative care as the lesion is inoperable

26. The most correct statement concerning the PDA murmur is:

A. It is a diastolic murmur best heard at the left lower sternal border
B. It is a continuous machinery murmur best heard at the upper left sternal border
C. A grade 6 murmur is accompanied by a thrill
D. It is best heard at the apex
E. It radiates to the back

27. Regarding patent ductus arteriosus, the most correct statement is:

A. A PDA in preterm babies should always be closed as it is unlikely to close on its own
B. The presence of a PDA in the first 24 hours is uncommon
C. Term children with a persistent PDA should be monitored for spontaneous closure, which is very likely
D. Preterm infants with respiratory distress and a PDA should not have fluid restriction as we need them to grow
E. A PDA in a child with worsening cyanosis at birth should be kept open and prevented from closing, as it may be the one sustaining the newborn's life

28. A child born to a mother with rubella is most likely to have which cardiac lesion?

A. Pulmonary stenosis
B. Patent ductus arteriosus
C. Both A and B
D. Mitral valve stenosis
E. Tricuspid atresia

29. Mary, 3 years, had a VSD with left-to-right shunting. She returned a year later with recurrent pneumonias and cyanosis, and the blood now shunts right to left. This reversal is called:

A. Cor pulmonale
B. Eisenmenger syndrome
C. Blalock-Taussig shunt
D. Fontan procedure
E. Tet spell

30. The following are true about atrial septal defects EXCEPT:

A. Ostium secundum defects are the most common
B. Most children with ASDs have normal growth and development
C. Ostium primum defects are near the superior vena cava
D. Defects can lead to paradoxical strokes
E. The foramen ovale is a primitive communication channel

31. Which is true regarding hepatitis B virus (HBV)?

A. It is a double-stranded DNA virus of the Hepadnaviridae family and replicates in the liver
B. It is transmitted by percutaneous or per-mucosal exposure to infectious body fluids
C. Perinatal transmission can occur from an infected mother to her infant
D. Persons with chronic carrier states are predisposed to chronic liver disease and have a more than 200-fold increased risk of hepatocellular carcinoma
E. All of the above

32. Extrahepatic manifestations of HBV EXCLUDE:

A. Gianotti-Crosti syndrome
B. Vasculitis
C. Membranous glomerulonephritis
D. Arthralgia
E. Sjogren syndrome

33. With regards to HBV laboratory testing, which statement is true?

A. Surface antigen (HBsAg) appears before the onset of symptoms, peaks during overt disease, and then declines to undetectable levels in 3 to 6 months
B. Acute HBV infection is characterised by the presence of HBsAg as well as anti-HBc IgG in the serum
C. Hepatitis B e antigen and HBV DNA appear in the serum soon after HBsAg and signify active viral replication
D. IgM anti-HBc becomes detectable shortly before the onset of symptoms, with the onset of elevated aminotransferases
E. Over months, the IgM antibody is replaced by IgG anti-HBc

34. Preventing perinatal HBV transmission includes all the following EXCEPT:

A. Universal screening of pregnant mothers for HBsAg during each pregnancy
B. Prompt initiation of antiviral therapy and pegylated interferons to all exposed infants
C. Case management of HBsAg-positive mothers and their infants
D. Immunoprophylaxis for infants born to infected mothers, including hepatitis B vaccine and hepatitis B immune globulin within 12 hours of birth
E. Routine vaccination of all infants with the hepatitis B vaccine series, with the first dose within 24 hours of birth

35. Risk factors for gastro-oesophageal reflux in children include all EXCEPT:

A. Immature lower oesophageal sphincter
B. Predominantly liquid diet
C. Prone positioning and left lateral sleeping position
D. Neurodevelopmental disability such as Down syndrome and cerebral palsy
E. All of the above

36. Common non-gastrointestinal presentations of GERD include the following EXCEPT:

A. Dental caries
B. Persistent irritating cough and wheezing
C. Sandifer syndrome
D. Recurrent otitis media
E. Cryptic meningitis

37. As pertains to the management of GERD in children, choose the most correct statement.

A. Feed thickening and smaller frequent feeds relieve most infants instantly
B. Supine positioning reduces episodes of reflux in infants
C. Proton pump inhibitors are quite useful in relieving symptoms
D. Cimetidine and ranitidine are useful PPIs commonly used in children
E. Endoscopy and upper GI studies are often indicated before initiating treatment

38. Which feature is MORE common in ulcerative colitis than in Crohn disease?

A. Abdominal pain
B. Growth failure
C. Rectal bleeding
D. Mouth ulceration
E. Strictures

39. The correct statement regarding management of diarrhoea in chronically malnourished children is:

A. Intravenous therapy with Ringer's lactate
B. Standard osmolarity oral rehydration solution
C. Reduced osmolarity oral rehydration solution
D. Slow resumption of feeds
E. Nothing by mouth for 24 hours

40. The test of choice for acute pancreatitis is:

A. Serum amylase
B. Serum lipase
C. Hyperglycaemia
D. Hypocalcaemia
E. Elevated gamma-glutamyl transpeptidase

41. In which of the following hepatotropic viruses does parenteral transmission NOT occur?

A. HAV
B. HBV
C. HCV
D. HDV
E. HEV

42. HBV is present in high concentrations in which body fluid?

A. Serous exudates
B. Saliva
C. Vaginal fluid
D. Semen
E. Urine

43. Which is the MOST common cause of ascites in children?

A. Neoplasia
B. Hepatic
C. Cardiac
D. Trauma
E. Infection

44. About hepatic encephalopathy, the FALSE fact is:

A. In infants or older children there is usually a prodromal phase of malaise, anorexia and jaundice
B. Jaundice may not always develop, especially when the cause of acute liver failure is metabolic or toxic
C. Haemorrhage may occur spontaneously and involves mainly the digestive tract
D. Severe hypoglycaemia, which may lead to seizures, is frequently observed
E. Hepatic encephalopathy sets in with severe liver dysfunction and with classical symptoms of asterixis

45. Concerning the aminotransferases AST and ALT, which statement is true?

A. They are markers of hepatocellular injury
B. They participate in gluconeogenesis by catalysing the transfer of amino groups
C. AST is present in cytosolic and mitochondrial isoenzymes and is found in the liver, cardiac muscle, skeletal muscle, kidneys, brain and pancreas
D. Both are highly sensitive and specific markers of liver dysfunction
E. All the above statements are true

46. Liver synthetic function is assessed by:

A. Serum albumin levels
B. Cholesterol and triglyceride levels
C. Serum microalbumin
D. GGT and ALP levels
E. All of the above

47. Regarding the pathogenesis of paediatric liver failure, the FALSE fact is:

A. Enteric normal flora helps in the breakdown of ammonia in the absence of liver detoxification
B. Astrocytes in the brain are sensitive to a rapid increase in serum ammonia, causing an increase in intracellular glutamine
C. Increased osmotic gradient and influx of water into the astrocytes cause cerebral oedema and intracranial hypertension
D. Ammonia that bypasses the urea cycle is converted to glutamine in astrocytes, skeletal myocytes and hepatocytes
E. Convulsions are attributed to raised intracranial pressure and elevated glutamate levels

48. About ascites in children, the FALSE fact is:

A. In the underfilling theory, the primary abnormality is inappropriate sequestration of fluid within the hepatic artery and the entire coeliac trunk
B. In the overflow theory, the primary abnormality is inappropriate renal retention of sodium and water in the absence of volume depletion
C. Neurohumoral excitation increases, more renal sodium is retained, and plasma volume expands, leading to overflow of fluid into the peritoneal cavity
D. Reduced oncotic pressure leads to pooling of fluid in the interstitial spaces
E. Increased production of inflammatory exudate in the peritoneal space

49. In the assessment of ascitic fluid, all are true EXCEPT:

A. Colour and opacity are indicators of the likely aetiology
B. A polymorphonuclear count of more than 250 cells/microlitre is highly suggestive of bacterial peritonitis
C. In tuberculous peritonitis and peritoneal carcinomatosis, lymphocytes usually predominate
D. SAAG is the serum albumin minus the ascitic fluid albumin, and correlates directly with portal pressure
E. A total protein of more than 2.5 g/dL is suggestive of a transudate

50. Regarding hepatitis A virus, choose the FALSE statement.

A. It is a Picornaviridae
B. Transmission is faecal-oral
C. It is a non-enveloped DNA virus
D. It is a potential cause of acute liver failure
E. It is not associated with progression to hepatocellular carcinoma