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, University Examination 2018/2019, Department of Paediatrics and Child Health, end of fourth year MBChB.
- Sitting: 1 July 2019, 8.00 AM, main exam, 2 hours. By the timetable July falls in Trimester 3 (May to August).
- Structure: Section A has 100 multiple choice questions with five choices each and no negative marking. Section B has 2 short essays (20 marks). Section C has 2 long essays (40 marks).
- What this page has: 99 of the 100 MCQs, and the essays of Sections B and C. Question 71 (the ECG axis question) is left out because its answer could not be settled from the options as printed. About a third of the MCQs are repeated in the August 2019 special supplementary paper.
- Topics tested: respiratory infections, tetanus, rheumatic fever, development milestones, dehydration, hepatitis C, congenital heart disease, Down syndrome, malnutrition, haemophilia, sickle cell disease, childhood cancers, breastfeeding, vaccination and the ECG.
- Answers: written by OmpathStudy for revision. They are not the official MKU marking scheme.
- Questions that need care: Q5, Q10, Q11, Q26, Q37, Q43, Q45, Q46, Q54, Q56, Q71 and Q90 are loosely worded or have more than one defensible option. The explanation says which option is best and why. The handwritten marks on the scan were ignored.
Multiple choice questions
1. A previously well 1-year-old infant has had a running nose, sneezing and coughing for 2 days. Four hours ago his cough became much worse. He is in moderate respiratory distress with nasal flaring, hyperexpansion of the chest and easily audible wheezing without rales. The most likely diagnosis is:
- A. Bronchiolitis
- B. Viral croup
- C. Asthma
- D. Epiglottitis
- E. Diphtheria
2. Which of the following is true of tetanus?
- A. Failure to culture Clostridium tetani from the wound would make the diagnosis doubtful
- B. Infection confers lifelong immunity
- C. There is a characteristic EEG
- D. Clostridium-specific intravenous immunoglobulin is of no benefit once spasm has started
- E. Cephalic tetanus causes severe dysphagia
3. Stiff neck in a young child is a feature of the following conditions EXCEPT:
- A. Acute poliomyelitis
- B. Retropharyngeal abscess
- C. Rubeola (measles)
- D. Subarachnoid haemorrhage
- E. Tuberculosis
4. Two weeks after a viral illness, Mukiri, 9 years, has a drooping left mouth and cannot completely shut her left eye. Her smile is asymmetric, and the examination is otherwise normal. She likely has:
- A. Guillain-Barre syndrome
- B. Botulism
- C. Cerebrovascular accident
- D. Brainstem tumour
- E. Bell palsy
5. In the diagnosis of acute rheumatic fever, which one of the following is most helpful?
- A. A generalised papular rash
- B. Elevated ASOT titres
- C. Polyarthritis
- D. Splinter haemorrhages
- E. Positive blood culture of viridans streptococci
6. An infant can move his head from side to side while following a moving object, lift his head from a prone position 45 degrees off the examining table, smile when encouraged and make cooing sounds. He cannot maintain a seated position. The most likely age is:
- A. 1 month
- B. 3 months
- C. 6 months
- D. 9 months
- E. 12 months
7. Orio, 11 years, has bilateral cervical lymphadenopathy, and a lymph node biopsy shows nodular sclerosing Hodgkin disease. Which feature indicates a poorer prognosis?
- A. Fatigue
- B. Mediastinal mass of 3 cm
- C. Night sweats
- D. Pruritus
- E. Recent Epstein-Barr virus infection
8. An 8-month-old infant has had a 2-day history of diarrhoea and poor fluid intake. You diagnose 10 to 15% dehydration. Which fluid is appropriate to begin immediate resuscitation?
- A. Oral rehydration solution
- B. 5% dextrose with half normal saline
- C. Normal saline
- D. Ringer's lactate solution
- E. Half-strength Darrow's solution
9. Juma, 4 years, has the classical murmur of patent ductus arteriosus. Which is characteristic of this murmur?
- A. Continuous
- B. Mid-diastolic
- C. Pansystolic
- D. Ejection
- E. Early diastolic
10. Hepatitis C virus:
- A. The incubation period is 7 to 9 weeks
- B. Food is the usual mode of transmission
- C. Has a DNA genome
- D. Is commonly transmitted through breast milk
- E. Is a predominantly non-cytopathic virus that causes injury by immune-mediated processes
11. The following is consistent with brainstem death:
- A. Absence of consensual pupillary light reflexes
- B. Absence of the cold caloric reflex
- C. Periodic breathing
- D. Absent tendon reflexes
- E. Cheyne-Stokes breathing
12. Metabolic alkalosis is characteristically found in one of the following:
- A. Pyloric stenosis
- B. Mineralocorticoid deficiency
- C. Cholera
- D. Salicylate poisoning
- E. An infusion of Ringer's lactate
13. The following is true of chromosomal disorders:
- A. Down syndrome is most commonly due to an extra copy of chromosome 21 inherited from the father
- B. A haploid cell has 46 chromosomes
- C. A foetus with triploidy will have 47 chromosomes
- D. The normal human karyotype consists of 44 pairs of autosomes
- E. Robertsonian translocation involving chromosome 21 accounts for 3 to 4% of Down syndrome
14. A 1-year-old infant is known to have heart disease and is noted to be cyanosed. Which is the most likely diagnosis?
- A. Atrial septal defect
- B. Coarctation of the aorta
- C. Patent ductus arteriosus
- D. Tricuspid atresia
- E. Ventricular septal defect
15. Features of a third nerve (oculomotor) lesion include:
- A. Proptosis
- B. Convergent squint
- C. Loss of corneal reflex
- D. Dilatation of the pupil
- E. Loss of lacrimation
16. Which statement regarding acute severe asthma is correct?
- A. Agitation should be managed with a benzodiazepine
- B. Inhaled salmeterol is indicated as first-line therapy
- C. A high inspired oxygen concentration should be used routinely
- D. Absence of a wheeze is reassuring
- E. Tachycardia is not a reliable sign of severity
17. A previously healthy 18-month-old child has unilateral nasal obstruction and foul-smelling discharge. Which is the most likely diagnosis?
- A. Foreign body
- B. Nasal polyps
- C. Frontal sinusitis
- D. Deviated septum
- E. Choanal atresia
18. A child with trisomy 21 is at risk of all the following EXCEPT:
- A. Duodenal atresia
- B. Hirschsprung disease
- C. Hypothyroidism
- D. Hydrocephalus
- E. Atlanto-axial instability
19. Developmental delay should be considered in all the following EXCEPT:
- A. Not able to roll over by 5 months
- B. No social smile by 3 months
- C. Not able to walk by 16 months
- D. Not able to stand without support by 9 months
- E. Not able to sit with support by 5 months
20. Failure of tooth eruption by 1 year of age is likely to be due to one of the following:
- A. Hypothyroidism
- B. Rickets
- C. Scurvy
- D. Iron deficiency
- E. Ectodermal dysplasia
21. The recommended parenteral antibiotic in treating acute rheumatic fever is:
- A. Benzyl penicillin
- B. Crystalline penicillin
- C. Benzathine penicillin
- D. Ampicillin
- E. Ceftriaxone
22. In an infant, which of the following makes the diagnosis of cardiac failure unlikely?
- A. A respiratory rate of more than 50 per minute
- B. A heart rate of more than 180 per minute
- C. An enlarged liver
- D. Ascites
- E. Excessive perspiration
23. Doughy skin in a child with acute diarrhoea is associated with:
- A. Hypernatraemic dehydration
- B. Isotonic dehydration
- C. Hypotonic dehydration
- D. Oedema of heart failure
- E. Cholera
24. The mother of a 6-month-old infant asks about teething. The first teeth to erupt in most children are:
- A. Mandibular central incisors
- B. Maxillary lateral incisors
- C. Maxillary first molars
- D. Mandibular canines
- E. First premolars (bicuspids)
25. An awake, alert infant with a 2-day history of diarrhoea has a depressed fontanelle, tachycardia, sunken eyes and loss of skin elasticity. Which is the correct percentage of dehydration?
- A. Less than 1%
- B. 1% to 5%
- C. 5% to 9%
- D. 10% to 15%
- E. More than 20%
26. All the following enter the human body by piercing the skin EXCEPT:
- A. Necator americanus
- B. Strongyloides stercoralis
- C. Schistosoma mansoni
- D. Toxocara
- E. Entamoeba histolytica
27. Otundo, a 4-week-old boy weighing 4.2 kg, has had a week of forceful vomiting after feeds. He is alert and eager to feed and has loss of skin elasticity and an apparent distension in the left hypochondrium. Which statement is correct?
- A. The most likely diagnosis is hiatus hernia
- B. He has hyperosmolar dehydration
- C. Features are consistent with Hirschsprung disease
- D. Metabolic acidosis would be anticipated
- E. He is likely to have hypokalaemia
28. Which of the following is a live attenuated vaccine?
- A. Pertussis
- B. Yellow fever
- C. Hepatitis B
- D. Tetanus
- E. Diphtheria
29. Juliet, a 10-month-old girl, has abdominal pain and diarrhoea with recent pink staining, episodes of crying and holding her abdomen, and a curved firm mass 10 cm long at the right iliac fossa. The most likely diagnosis is:
- A. Inborn errors of metabolism
- B. Constipation or encopresis
- C. Intussusception
- D. Polycystic kidney disease
- E. Malignancy (neuroblastoma, Wilms tumour, lymphoma)
30. Haemorrhagic cystitis, conjunctivitis, diarrhoea and bronchiolitis have all been linked to one of the following:
- A. RSV
- B. Rotavirus
- C. HSV
- D. Adenovirus
- E. Influenza type B
31. Achieng, 5 years, has a three-week history of cough and dyspnoea, with stony dullness on the right side of the chest. Which is true?
- A. The tactile fremitus would be reduced on the right
- B. The mediastinum may be shifted to the right
- C. The protein level of the fluid from thoracentesis will be less than 3 g/dL if tuberculosis is the cause
- D. The LDH of the fluid will be elevated if heart failure was the cause
- E. A chest tube insertion is not feasible as part of management since Achieng is still a toddler
32. Aaron, 6 years, has had diarrhoea and vomiting for two days, is alert, with a respiratory rate of 56, deep breathing, cold hands and a weak radial pulse. In managing this child:
- A. A fever of more than 38.3 degrees should be a priority during treatment
- B. The immediate action is to open the airway and administer oxygen
- C. An intraosseous line at the proximal fibula should be attempted after 2 failed attempts to get an intravenous line
- D. A bolus of 20 ml/kg of Hartmann's solution should be given over the next two hours
- E. IV 20 ml/kg of 50% dextrose should be infused within 15 minutes
33. Compensatory changes in heart failure include all the following EXCEPT:
- A. Activation of the parasympathetic nervous system
- B. Release of catecholamines
- C. Increased heart rate
- D. Myocardial hypertrophy
- E. Activation of the renin-angiotensin-aldosterone system
34. A one-year-old admitted with pneumonia has just collapsed. There is no respiratory movement and the peripheral pulse is not palpable. The immediate measure is:
- A. Initiate external cardiac massage
- B. Give oxygen by nasal catheter
- C. Clear the airway and establish respiration by bag and mask
- D. Establish the cause of the sudden change in condition
- E. Give IV 10% dextrose
35. A 2-month-old baby has a cough and difficulty in breastfeeding. The mother says she sweats a lot during feeding. The baby is afebrile, neither pale nor cyanosed. The respiratory rate is 70/minute with no chest indrawing, and there are fine crepitations on auscultation. The heart rate is 160 beats per minute and the liver is 5 cm below the costal margin. The most likely diagnosis is:
- A. Pulmonary tuberculosis
- B. Pertussis
- C. Congestive cardiac failure
- D. Bronchiolitis
- E. Acidosis
36. The following are helpful in the establishment of successful breastfeeding:
- A. Allowing the mother to rest after delivery before initiation of breastfeeding
- B. Provision of extra water to the mother during the first few days of breastfeeding
- C. Establishing a support system within the community
- D. Daily weighing in the immediate post-partum period
- E. Introduction of pre-lacteal feeds
37. A baby born at term with a weight of 3.2 kg and a head circumference of 35.6 cm. Which of the following will apply when he is 6 months old?
- A. A weight of 9 kg
- B. Head circumference of 44.6 cm
- C. No weight bearing on the legs when supported in a standing position
- D. Laughs when stimulated
- E. Transfers objects from one hand to another
38. At age 12 months a normal infant:
- A. Weighs triple the birth weight
- B. Becomes attentive to their name
- C. Waves bye
- D. Measures 67.5 cm
- E. Is able to draw a circle
39. A 2-year-old child is admitted with refusal to feed, gross oedema of the legs and crying a lot. He has mild diarrhoea. The anticipated problems during management include all the following EXCEPT:
- A. Gram-negative septicaemia
- B. Hyperglycaemia during the first two days of admission
- C. Worsening of the diarrhoea after feeding with milk
- D. Congestive cardiac failure
- E. A slow weight gain
40. Which of the following are priority signs during triage of children in a health facility?
- A. A child with cold hands and a capillary refill of 4 seconds
- B. Child with a body temperature of 37 degrees
- C. All babies more than 6 months
- D. A child who is convulsing
- E. A child with a history of poisoning
41. The following is a differential diagnosis of a 3-year-old wheezy child:
- A. Loeffler syndrome
- B. Bronchiolitis
- C. Tonsillitis
- D. Meconium aspiration
- E. Tinea capitis
42. In the treatment of shock secondary to severe dehydration:
- A. In the absence of intravenous access, drinking water is given through an NG tube
- B. IV 100 ml/kg of normal saline is given as the initial bolus
- C. Calcium replacement is mandatory
- D. Intraosseous is an alternate route for rehydration
- E. Intravenous insulin with glucose is indicated to lower the high potassium
43. The following statements are true regarding childhood tuberculosis EXCEPT:
- A. Mostly acquired from adults
- B. Tuberculous meningitis is often the first presentation
- C. Treatment in the initial phase requires a four-drug combination
- D. Diagnosis rests on the identification of Mycobacterium in body fluids
- E. Can reliably be diagnosed using several scoring systems
44. A 4-year-old has had a running nose for 2 days. His mother now notices skin lesions that appear at different stages and feel itchy. A child in the same school had similar lesions the previous week. The following is true:
- A. She should be isolated from her sister who is two years younger
- B. This condition is caused by the pox virus
- C. She should be started on prophylactic antibiotics to prevent pneumonia
- D. A poor outcome is expected
- E. This is not a vaccine-preventable illness
45. Regarding HIV infection in children:
- A. Absolute CD4 T-cell count is an important indicator of disease progression in children above 5 years
- B. CD4 T-cell percentage is not an important indicator of disease progression
- C. Cotrimoxazole is beneficial to children with a low CD4 percentage
- D. Encephalopathy occurs in about one fifth of the children
- E. It is an absolutely preventable condition
46. Achieng is born to a 36-year-old mother. She has a prominent occiput, low-set ears, a small mouth, clenched hands and micrognathia. Which is true regarding this condition?
- A. This is most likely a congenitally acquired infection
- B. This is most likely a chromosomal anomaly
- C. The prognosis is often poor
- D. Septal defects may be an association
- E. The mother's age is important in causation
47. Which of the following antiretroviral drugs is correctly matched with its common side effect?
- A. Zidovudine: elevated liver enzymes
- B. Nevirapine: raised serum amylase
- C. Stavudine: peripheral neuropathy
- D. Efavirenz: neutropenia
- E. Nelfinavir: neuropsychiatric disorders
48. The following is true regarding acute kidney injury in children:
- A. Red blood cell casts in the urine indicate pre-renal failure
- B. Urine output less than 0.5 ml/kg per hour
- C. Low protein diet is part of the standard management
- D. All children should be dialysed
- E. Gastrointestinal bleeding is common
49. Musonge, 5 years, has recurrent yellowing of the eyes, three blood transfusions and skull bossing. The following is true about this condition:
- A. The condition follows sex-linked inheritance
- B. Hydroxyurea treatment leads to complete cure
- C. Distribution in Kenya follows ethnic lines
- D. Diagnosis requires bone marrow examination
- E. Infection by encapsulated bacteria can be fatal
50. A pertinent investigation in a male child with joint swelling, easy bruising and bleeding of the gums is:
- A. Liver function test
- B. ELISA for HIV antibodies
- C. Urea and electrolytes
- D. Haemoglobin electrophoresis
- E. Factor VIII assay
51. Causes of a small pupil include:
- A. Carbon monoxide poisoning
- B. Sub-arachnoid haemorrhage
- C. Methanol poisoning
- D. Narcotic use
- E. Third nerve palsy
52. In the management of a child with diabetic ketoacidosis, which are the two most important interventions in the first two hours?
- A. Insulin and intravenous normal saline
- B. Insulin and intravenous dextrose
- C. Insulin and potassium supplementation
- D. Insulin and bicarbonate
- E. Insulin and parenteral antibiotics
53. The following are part of the standard management of congestive cardiac failure EXCEPT:
- A. Oral digoxin
- B. Oral angiotensin-converting enzyme inhibitors
- C. Beta blockers
- D. Fluid restriction
- E. No added salt diet in older children
54. Factors associated with a favourable outcome of acute lymphoblastic leukaemia include one of the following:
- A. Age below two years at diagnosis
- B. White cell count below 20,000/mm3 at diagnosis
- C. Testicular involvement in boys
- D. Hyperdiploidy
- E. Occurrence in a child with trisomy
55. While bathing her 4-year-old son, Wambui notices a firm mass in the child's abdomen. He is well nourished and has a bimanually palpable mass in the left lumbar region. The following are associated with this condition EXCEPT:
- A. Asymmetry in the various body parts
- B. Absent iris
- C. Hypertension
- D. Simian palmar crease
- E. Haematuria
56. Atieno, 6 years, has progressive unilateral jaw swelling and displacement of some teeth. The rest of the examination is normal. True about this condition:
- A. Parasitic infection has a role in the girl's illness
- B. Late treatment complications may include infertility
- C. Diagnosis must be made with open biopsy for histology
- D. The finding of Reed-Sternberg cells is diagnostic
- E. A poor outcome can be anticipated with appropriate treatment
57. Dave, 5 months, has recurrent vomiting after feeds and has been treated twice for pneumonia, with the chest film always showing upper lobe involvement. The following are true EXCEPT:
- A. Surgical management may be indicated
- B. Pulmonary tuberculosis should be considered
- C. Positioning in the sitting position and diet modification suffice in most cases
- D. Severity of the symptoms rises to a peak at 1 year before declining
- E. He has a higher than average chance of having a congenital anomaly of the diaphragm
58. The following is true regarding atopic dermatitis in children:
- A. It presents initially with flexural lesions
- B. Pruritus is a constant feature
- C. Systemic corticosteroids are indicated in many cases
- D. Expected to resolve spontaneously
- E. More common in boys than girls
59. The following are suggestive of child abuse EXCEPT:
- A. A child promptly rushed to hospital even for minor injuries
- B. History not tallying with severity of the injury
- C. Multiple fractures in different parts of the body
- D. Injuries in a child with severe mental handicap
- E. Isolated fractures in a 2-month-old baby
60. The following statement is NOT true concerning meningococcal meningitis:
- A. If it is suspected, benzyl penicillin should be administered prior to hospital admission
- B. Vaccination is available against all strains of meningococcus
- C. Sensorineural deafness has been shown to be the most common permanent sequela
- D. It has been shown to be more common in those children in contact with cigarette smoke
- E. Antibiotic prophylaxis has been recommended for close contacts
61. The KEPI yellow fever vaccine is administered at:
- A. 6 months
- B. 7 months
- C. 8 months
- D. 9 months
- E. 10 months
62. A 3-year-old boy has swallowed an insecticide known to contain an organophosphate. The following statement is true:
- A. Gastric lavage is contraindicated
- B. He is likely to have urinary retention
- C. He is likely to have dilated pupils
- D. Pralidoxime is an effective antidote
- E. Atropine is not useful in management
63. An 11-month-old infant cannot stand unsupported, has no dentition and has been admitted several times with pneumonia. The following is true about this condition:
- A. Premature birth is associated
- B. It is due to vitamin C deficiency
- C. Serum phosphate levels are elevated
- D. Blood gas analysis may be necessary as a useful diagnostic test
- E. The serum alkaline phosphatase level is usually below 200 IU/dL
64. The following is an example of passive immunisation:
- A. Colostrum transfer of antibodies
- B. That following a natural infection
- C. That resulting from vaccine-derived polio
- D. That induced from a live attenuated vaccine
- E. That following a conjugate vaccine
65. In children with Down syndrome:
- A. The infant is usually hypertonic
- B. Asthma is more common
- C. Most mothers are over 35 years of age
- D. Atrioventricular septal disorders incidence is 90%
- E. Brachycephaly is characteristic
66. Oral rehydration therapy:
- A. Works by active absorption of glucose
- B. Is effective in 50% of moderately dehydrated infants
- C. Should not be used in hypernatraemic dehydration
- D. Contains 5 mmol/L of potassium
- E. Can be made up safely at home using salt and sugar
67. The mother of a 3-month-old girl brings her because of episodes of crying at the same time every day. You suspect colic. The following statement is true about colic:
- A. It starts at 3 months and peaks at about 6 months
- B. Almost all cases are due to lactose intolerance
- C. The episodes of crying typically occur in the late afternoon or evening
- D. Hyoscine should generally be prescribed
- E. Patients with any degree of abdominal distension should have a CT scan of the abdomen
68. In a previously well 7-month-old girl with 2 days of fever, cough, difficulty breathing and wheezing:
- A. A trial of bronchodilators should not be given at casualty
- B. A chest X-ray is likely to show segmental consolidation
- C. Influenza virus is the most likely causative agent
- D. The first-line treatment is a slow intravenous infusion of aminophylline
- E. Corticosteroids are not indicated in the management of this condition
69. A 2-year-old presents with a 2-day history of cough, running nose, a fever of 38 degrees, a respiratory rate of 36 breaths per minute, an inflamed throat and clear lung fields:
- A. The most likely diagnosis is pneumonia
- B. A full blood count is mandatory for diagnosis
- C. Sputum culture is positive in more than 70% of cases
- D. The commonest causative organism is Mycoplasma pneumoniae
- E. The major cause of this condition is viruses
70. A class four pupil was recently treated as an outpatient with symptoms of drinking a lot of water and passing urine many times, especially at night. His weight is appropriate for age. Which is true?
- A. His condition is likely to be autoimmune in cause
- B. His C-peptide levels are most likely elevated
- C. A random blood sugar of 7 mmol/L is diagnostic
- D. He will not require renal function assessment
- E. Insulin sensitivity is low
72. The following drugs and toxins are appropriately linked to the substances that reverse their action EXCEPT:
- A. Morphine and naloxone
- B. Warfarin and protamine
- C. Iron and deferasirox
- D. Carbon monoxide and oxygen
- E. Carbamate and atropine
73. A baby was born weighing 3.0 kg and had a head circumference of 45 cm at birth. Choose the correct response.
- A. This finding is a normal variation
- B. A cyst in the fourth ventricle is likely to be a cause
- C. Furosemide is useful in management
- D. Folic acid deficiency in the mother is a contributing factor
- E. Spontaneous cure usually occurs
74. Which of the following promotes breastfeeding?
- A. Being firm on the approach to the baby
- B. Intermittent administration of glucose water to the baby
- C. The mother keeping silent when with the baby to practise minimal handling
- D. The mother gets delighted upon seeing the baby
- E. The baby should be separated from the mother for the first 24 hours
75. Regarding pneumococcal conjugate vaccine, choose the correct statement.
- A. It was introduced in the KEPI schedule in 2001
- B. It is routinely administered at 6 months of life
- C. It helps protect against pneumonia and meningitis
- D. It is usually administered orally
- E. Four doses are routinely given
76. Choose the correct statement regarding measles.
- A. The commonest complication is laryngotracheobronchitis
- B. Immunity after administration of the vaccine lasts 3 years
- C. The disease may precipitate acute malnutrition
- D. The rash is usually vesicular starting on the trunk
- E. Corneal lesions are unlikely in this disease
77. Regarding Vibrio cholerae gastroenteritis:
- A. The incubation period is 6 days
- B. The clinical presentation is a result of bacteraemia
- C. The diarrhoea and vomiting are painless and effortless
- D. Vaccination against cholera confers lifelong immunity
- E. The organism is a Gram-positive bacillus
78. A normal infant sits briefly leaning forward on her hands, reaches for and grasps a cube and transfers it from one hand to the other. She babbles but cannot wave bye-bye nor grasp objects with the finger and thumb. Her age is likely to be:
- A. 4 months
- B. 7 months
- C. 10 months
- D. 14 months
- E. 18 months
79. A 17-year-old girl has been eating a strict vegetarian diet for 5 years. You order a complete blood count because of concern about which condition?
- A. Lymphocytosis
- B. Macrocytic anaemia
- C. Microcytic anaemia
- D. Normocytic anaemia
- E. Thrombocytosis
80. A 4-month-old with birth weight 3.5 kg now weighs 3.7 kg and has visible wasting. Which is an UNLIKELY immediate life-threatening problem?
- A. Hypothermia
- B. Hypoglycaemia
- C. Dehydration
- D. Hyperkalaemia
- E. Infection
81. A mother says her 5-month-old, who weighs 6 kg and weighed 3 kg at birth, is "getting fat". What do you explain?
- A. It is expected that a baby doubles their birth weight by the age of 6 months
- B. The baby is prone to obesity
- C. The baby will have an eating disorder
- D. The baby is underweight
- E. The baby has failure to thrive
82. A 9-year-old has several days of progressive arm and leg weakness. She was well except for an upper respiratory tract infection 2 weeks ago. The BP ranges between 90/60 and 149/90 mmHg. Respirations are shallow at a rate of 50/min. There is symmetric weakness of the face and four extremities. Deep tendon reflexes are absent. The most likely diagnosis is:
- A. Polymyositis
- B. Myasthenia gravis
- C. Guillain-Barre syndrome
- D. Transverse myelitis
- E. Viral encephalitis
83. A 3-year-old boy has fever, dysuria and gross haematuria. Examination shows a prominent suprapubic area which is dull to percussion. Urinalysis shows red blood cells but no proteinuria. The most likely diagnosis is:
- A. Acute glomerulonephritis
- B. Acute pyelonephritis
- C. Posterior urethral valves
- D. Teratoma
- E. Nephritic syndrome
84. Regarding a patient with rheumatic chorea:
- A. The purposeless movements are evident in sleep
- B. This follows kernicterus
- C. Haloperidol is useful in treatment
- D. Boys are three times more affected than girls
- E. Hysteria is a common manifestation
85. In a patient presenting with infective endocarditis:
- A. Intravenous antibiotics are given for 14 days
- B. Microscopic haematuria is a common finding
- C. A blood culture is usually an unnecessary investigation
- D. Streptococcus pyogenes is the causative organism
- E. Fever usually occurs in late presentation
86. Clinical clubbing of the fingers and toes is a presenting feature in:
- A. Severe pneumonia
- B. Patent ductus arteriosus
- C. Subacute bacterial endocarditis
- D. Coarctation of the aorta
- E. Atrial fibrillation
87. Job, 10 years, has had a sickle cell crisis for the second time since diagnosis at 2 years. The following are true:
- A. Hydroxyurea should be commenced immediately
- B. His peripheral blood film will show a hypochromic microcytic picture
- C. Haemoglobin electrophoresis should be done annually
- D. Good adherence to vaccinations and medicines may have reduced the incidence of crises
- E. Permanent sequelae in other patients with sickle cell and frequent crises are rare
88. Which commonly occurs in congenital rubella syndrome?
- A. Lung hypoplasia
- B. Choanal atresia
- C. Posterior urethral valves
- D. Lissencephaly
- E. Patent ductus arteriosus
89. The following would lead you to consider a murmur to be innocent in a four-and-a-half-year-old child:
- A. Pansystolic timing
- B. Association with a thrill
- C. Marked variation of loudness with change of posture
- D. Radiation towards the left axilla
- E. Association with fixed splitting of the second heart sound
90. A 4-year-old boy with asthma presents at the casualty with respiratory distress and wheeze on auscultation.
- A. Intravenous dexamethasone is the most potent in relieving bronchospasm
- B. A chest X-ray should be done to evaluate severity and rule out pneumonia
- C. Nebulisation is more superior to the use of an inhaler with a mask and spacer in delivering salbutamol
- D. This state is triggered by strenuous exercise
- E. Oral salbutamol should be started immediately in this patient
91. A 12-year-old has popping eyes, muscle wasting and heat intolerance. Positive examination findings would include:
- A. Cold and moist skin
- B. Bradycardia
- C. Hyperactivity and tremors
- D. Poor or low appetite
- E. Non-pitting oedema
92. A 2-year-old with diarrhoea and vomiting is severely wasted, weighs 6 kg and has warm extremities. The fluid used to replenish the body fluids of this child should contain:
- A. High levels of sodium
- B. No sugar
- C. Lower levels of potassium
- D. Deionised water
- E. More potassium
93. The following public health measures would reduce the incidence of iron-deficiency anaemia:
- A. Using cow's milk from 6 months of age
- B. Giving young children tea rather than fruit juice
- C. Delaying the introduction of mixed feeding until 9 months of age
- D. Giving 0.5 mg per day of elemental iron to all preterm babies
- E. Continuing breastfeeding until 2 years of age
94. A 2-year-old has a one-day history of high fevers, neck stiffness, generalised convulsions and prolonged loss of consciousness. Which finding is most likely to be present?
- A. Spinal fluid glucose the same as serum
- B. Spinal fluid proteins 0.4 g/L
- C. Spinal fluid cell count 20/microlitre
- D. Normal muscle tone
- E. Ability to feed
95. Which of the following is an acyanotic congenital heart disease?
- A. Tricuspid atresia
- B. Eisenmenger syndrome
- C. Truncus arteriosus
- D. Coarctation of the aorta
- E. d-Transposition of the aorta
96. Regarding a term newborn with a cystic swelling at the lumbosacral spine and a clear liquid draining from the site:
- A. The anal opening is usually closed
- B. Hypospadias is a common association
- C. This condition is genetic in aetiology
- D. Folic acid given to the mother in the antenatal period is preventive
- E. Surgical intervention is indicated at 6 months of age
97. If a female carrier for Duchenne muscular dystrophy marries a normal male:
- A. Half of the male offspring will have the disease
- B. Half of the female offspring will have the disease
- C. All the female offspring will have the disease
- D. None of the male offspring will have the disease
- E. All the male offspring will have the disease
98. Which is the correct diagnostic criterion for severe acute malnutrition?
- A. Weight for age below 70% of expected
- B. Weight for age more than 3 standard deviations below average
- C. Height for age 85% of expected
- D. Weight for length 3 standard deviations below average
- E. Weight for age below 60% of expected plus hair and skin changes
99. A child with a psychosocial disorder presents with all the following EXCEPT:
- A. Depression
- B. Anxiety
- C. Conduct disorder
- D. Passive-aggressive disorder
- E. Hearing loss
100. In acute bronchiolitis:
- A. Ribavirin is the treatment of choice for all hospitalised cases
- B. Lung volume is usually decreased
- C. Bronchodilators are usually effective
- D. Feeding difficulties are common
- E. Upper airway obstruction is a common feature
Section B and Section C: essays
1. Section B, Question 1. Describe the biosynthesis of vitamin D in the human body (10 marks).
2. Section B, Question 2. Arimi, a four-year-old boy from Thika, has a history of prolonged diarrhoea and fever, and is said to have lost both his parents two years ago. Further evaluation reveals moderate malnutrition and oral thrush. (a) What is the likely underlying diagnosis (1 mark)? (b) Which WHO stage can he be classified in and why (1 mark)? (c) Describe the life cycle of the aetiological agent (8 marks).
3. Section C, Question 1. Discuss paediatric acute kidney injury (AKI) under the following headings: (a) Definition (2 marks). (b) Causes of AKI, giving examples in each category (8 marks). (c) Explain the pathophysiological mechanisms of hypertension, hyperkalaemia and anaemia in a patient with AKI (10 marks).
(a) Definition
(b) Causes
(c) Pathophysiology