Paediatrics main exam (MBPE 4300): 24 January 2022, Paper One, 100 MCQs, 2 short essays and 2 long essays — Year 4 Paediatrics & Child Health Notes

MKU Paediatrics main exam (MBPE 4300), 24 January 2022, Paper One: 100 MCQs on cardiology, nephrology, nutrition, growth, newborn care, respiratory illness, vaccination and gastroenterology, plus short essays on breastfeeding and the cold chain, and long essays on childhood asthma and acute rheumatic fever, 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, University Examination 2021/2022, Medicine School, Department of Paediatrics and Child Health.
Sitting: Monday 24 January 2022, 8.00 AM, main exam, 3 and a half hours. By the timetable this is Trimester 2 (January to April).
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).
Topics tested: infective endocarditis and rheumatic fever, cyanotic and acyanotic heart disease, glomerulonephritis and nephrotic syndrome, rickets, malnutrition, growth and development, newborn problems, tuberculosis, respiratory illness, vaccination, hepatitis and inflammatory bowel disease.
Repeats: about a third of the MCQs (for example Q21 to Q40 and Q44 to Q58) are the same questions as in the 27 November 2018 first trimester paper. Papers recycle questions, so these are worth knowing well.
Answers: written by OmpathStudy for revision. They are not the official MKU marking scheme.
Questions that need care: Q2, Q10, Q14, Q20, Q63, Q65 and Q95 have more than one defensible option or a loosely worded stem. The explanation says which option is best and why.

Multiple choice questions

1. A 7-year-old girl has persisting fevers and a migratory murmur, and the doctor suspects infective endocarditis. Which is the truest answer that can be used to make the diagnosis according to the modified Duke criteria?

A. 2 major
B. 1 major and 3 minor
C. 5 minor
D. All the above
E. None of the above

2. The most common organism that causes infective endocarditis on a native valve is:

A. Streptococcus viridans
B. Staphylococcus aureus
C. E. coli
D. Group B streptococcus
E. HACEK group

3. 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

4. A newborn has worsening cyanosis that does not respond to high-flow oxygen. Which congenital heart condition is LEAST likely?

A. Tricuspid atresia
B. Transposition of the great vessels
C. Truncus arteriosus
D. Ventricular septal defect
E. Hypoplastic left ventricle

5. A 1-year-old boy with frequent cyanotic spells is diagnosed with tetralogy of Fallot. He is expected to have the following findings EXCEPT:

A. Overriding aorta
B. Right ventricular hypertrophy
C. Ventricular septal defect
D. Pulmonary stenosis
E. Atrial septal defect

6. In the management of a child with tetralogy of Fallot having an acute cyanotic spell, which medication is NOT used?

A. Propranolol
B. Sodium bicarbonate
C. Morphine
D. Phenobarbitone
E. Oxygen

7. A 2-year-old born preterm has a machinery murmur at the left 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

8. A 10-year-old girl has difficulty breathing, swollen legs, periorbital oedema, 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, bed rest and diuretics
D. Start antibiotics
E. Do a lumbar puncture

9. In a child with coarctation of the aorta, the following signs are expected EXCEPT:

A. Radio-femoral delay
B. Significant 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

10. Which sign is found in a patient with aortic regurgitation?

A. Loud P2
B. Pistol shots at the brachial pulse
C. Absent S1
D. Continuous machinery murmur at the apex
E. Corrigan sign

11. Medication that should be given to keep the patent ductus open in children with a duct-dependent lesion includes:

A. Prostaglandin E1
B. Prostaglandin D1
C. Prostaglandin I2
D. Prostaglandin E2
E. Indomethacin

12. A 1-week-old preterm baby weighing 1.2 kg has a haemodynamically significant PDA. Which is the correct step in management?

A. The patient can be observed until 1 year of age, then the PDA 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

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

A. Pulmonary stenosis
B. Patent ductus arteriosus
C. Atrioventricular canal defect (AVSD)
D. Aortic regurgitation
E. Tricuspid atresia

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 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. She had a sore throat 2 weeks before. Choose the most correct 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 statements are true

16. Concerning this child's condition, choose the true fact:

A. Serotype 49 causes post-streptococcal nephritis after an upper respiratory infection, mainly 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

17. In the management of acute post-infectious glomerulonephritis, choose the most correct statement.

A. Antibiotic therapy with penicillin in the early phase improves outcomes
B. Loop diuretics, fluid restriction and antihypertensives have a role
C. The 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
E. None of the above is true

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. 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 the gross oedema, which is 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

21. Radiological signs of rickets include all the following EXCEPT:

A. Splaying
B. Cupping
C. Fraying
D. Increased bone density
E. Pathological fractures

22. 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

23. A 14-year-old who is a pure vegetarian is most likely to suffer from which vitamin deficiency?

A. Vitamin A
B. Vitamin C
C. Vitamin B12
D. Vitamin B1
E. Vitamin E

24. Kwashiorkor is characterised by all EXCEPT:

A. Oedema
B. Hypopigmented hair
C. Dermatitis
D. Mental challenge
E. Hunger and eagerness to eat

25. A neural tube defect is prevented by:

A. Folic acid
B. Thiamine
C. Pyridoxine
D. Riboflavin
E. Vitamin E

26. 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

27. Julia is a 24-month-old girl. She is expected to do all the following at her age 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

28. 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 of age the average child cannot point to major body parts
E. Infants speak their first word around 15 months of age

29. A 12-year-old girl has sparse, lightly pigmented straight pubic hair and a small elevated mound of the breast and papilla. In what stage of sexual maturity is she?

A. 1
B. 2
C. 3
D. 4
E. 5

30. A severely malnourished child has diarrhoea, fever and is unable to feed. The following should be addressed in the first day of treatment EXCEPT:

A. Hypoglycaemia
B. Hypothermia
C. Dehydration
D. Start iron supplement
E. Correct electrolyte imbalance

31. Which is an expected laboratory finding in the malnourished child above?

A. Hyperglycaemia
B. Hypernatraemia
C. Hyperkalaemia
D. Hyponatraemia
E. Normal haemoglobin

32. Primitive neonatal reflexes include all EXCEPT:

A. Grasp
B. Moro
C. Suck
D. Root
E. Knee jerk

33. Breast milk is rich in all the following EXCEPT:

A. Lactalbumin
B. Calcium
C. Vitamin D
D. Immunoglobulin A
E. Lactose

34. 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

35. 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

36. The sense that is not fully developed at birth is:

A. Hearing
B. Smell
C. Taste
D. Touch
E. Vision

37. 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

38. A 3-year-old boy has cough, difficulty breathing and wheezing, with a strong family history of allergy. The following can be treatment EXCEPT:

A. Steroids
B. Sedatives
C. Theophyllines
D. Terbutaline
E. Oxygen

39. 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. Croup
B. Laryngomalacia
C. Foreign body obstruction
D. Acute bronchiolitis
E. Choanal atresia

40. 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

41. 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 is most likely to have respiratory distress syndrome
B. Most likely the baby has pneumonia
C. Its prevalence is affected by the gender of the baby
D. Specific procedures for this condition before delivery would have prevented this occurrence
E. Prior antibiotic treatment of the mother is beneficial in this condition

42. 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

43. Mary, a 10-month-old girl, has cough, wheezing and fever, with 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

44. 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 that 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

45. 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 before symptoms occur

46. 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

47. 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

48. 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

49. 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 vitamin supplements
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 that the mother can relax from the exhaustion of labour
E. Dummies, pacifiers and artificial nipples should not be given to newborns before breastfeeding is established

50. 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

51. 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

52. 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

53. 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

54. Added sounds in the lungs on auscultation include all EXCEPT:

A. Rales
B. Murmurs
C. Rhonchi
D. Wheezes
E. Crepitations

55. 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

56. 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

57. Complications that can occur in preterm babies include all EXCEPT:

A. Anaemia
B. Intracranial haemorrhage
C. Rickets
D. Meconium aspiration
E. Retinopathy

58. 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

59. 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

60. Concerning the chest X-ray, which statement is true?

A. The cardiothoracic ratio should be more than 50%
B. The AP view is better for interpreting the cardiac size than the PA view
C. The lateral view should be requested to complement the PA view in some cases
D. It is not important to label the X-ray as clinicians can orient with the structures
E. Poor quality X-rays cannot mislead a very competent doctor

61. Aisha, 3 years, has had an upper respiratory tract infection followed by acute diarrhoea, and now has anaemia, a low platelet count, azotaemia and reduced urine output. She most likely has:

A. Severe dehydration with renal failure
B. Acute post-streptococcal glomerulonephritis
C. Severe septicaemia
D. Haemolytic uraemic syndrome
E. Toxic nephropathy

62. In chronic kidney disease, which finding is characteristic?

A. Metabolic alkalosis
B. Hypokalaemia
C. Hypophosphataemia
D. Hypocalcaemia
E. Low uric acid

63. Proven interventions that prevent diarrhoea and pneumonia in children include the following EXCEPT:

A. Vaccination against measles, pertussis, pneumococcus, Hib and rotavirus
B. Prevention of HIV in children
C. Co-trimoxazole prophylaxis for HIV-infected children
D. Hand washing with soap
E. Oral zinc

64. A newborn should be given hepatitis B immunisation and specific immunoglobulin if:

A. The mother is Chinese
B. The mother is HBsAg negative
C. The mother is HBsAg and anti-HBe positive
D. The mother is anti-HBc positive
E. The mother is HIV positive

65. Which statement about childhood vaccination schedules in Kenya is true?

A. BCG is not important since the efficacy is very low
B. Rotavirus vaccine should be given up to 6 months of age if missed
C. Oral polio vaccine can be given at least once even if injectable polio vaccine has been given, to elicit mucosal immunity
D. A child with severe immunosuppression should be given live vaccines
E. There is no need to give any DPT booster after the 14-week vaccinations

66. In a young child with a 4-day history of bloody diarrhoea:

A. Shigellosis is a likely diagnosis
B. The finding of cysts of E. histolytica in the stools confirms a diagnosis of acute amoebic dysentery
C. Cholera is a likely diagnosis
D. A negative amoebic fluorescent antibody test excludes a diagnosis of acute amoebic dysentery
E. Giardiasis is the most common likely diagnosis

67. What is the expected height and weight of a 4-year-old?

A. Weight 19 kg, height 95 cm
B. Weight 16 kg, height 100 cm
C. Weight 14 kg, height 100 cm
D. Weight 14 kg, height 95 cm
E. Weight 18 kg, height 105 cm

68. Kwashiorkor is characterised by all EXCEPT:

A. Oedema
B. Hypopigmented hair
C. Dermatitis
D. Mental changes
E. Hunger and eagerness to eat

69. A 10-day-old newborn has intermittent stridor. The most common cause would be:

A. Croup
B. Laryngomalacia
C. Foreign body obstruction
D. Acute bronchiolitis
E. Choanal atresia

70. Which complement factor is affected in acute post-streptococcal glomerulonephritis?

A. C3
B. C1
C. C5b-9
D. C7
E. C5

71. Expected blood results in a child with active rickets include all EXCEPT:

A. Elevated alkaline phosphatase
B. Low vitamin D levels
C. Low phosphorus
D. Low calcium
E. Low alkaline phosphatase

72. Causes of a wheeze in a 2-year-old include all EXCEPT:

A. Bronchiolitis
B. Foreign body ingestion
C. Asthma
D. Gastro-oesophageal reflux disease
E. None of the above

73. The most common cause of primary idiopathic nephrotic syndrome is:

A. Focal segmental glomerulosclerosis
B. Membranous glomerulonephritis
C. Membranoproliferative glomerulonephritis
D. Minimal change disease
E. Acute renal failure

74. Inability to lower urine pH below 5.2 is a characteristic feature of:

A. Chronic renal disease
B. Cranial diabetes mellitus
C. Normal physiology of a functioning kidney
D. Renal tubular acidosis
E. Respiratory failure

75. Features of congestive cardiac failure include all EXCEPT:

A. Tachypnoea
B. Tachycardia
C. Oedema of the feet
D. Splenomegaly
E. Hepatomegaly

76. Regarding polio vaccine, all are true EXCEPT:

A. It can be given orally
B. It may cause paralytic polio
C. It may be given concurrently with DPT, hepatitis B and Hib vaccines on the same day
D. The injectable vaccine is live attenuated
E. It helps in herd immunity

77. The following are causes of rickets EXCEPT:

A. Vitamin D deficiency
B. Calcium deficiency
C. Phosphorus deficiency
D. Sickle cell disease
E. Chronic kidney disease

78. 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

79. Esther, who is diabetic, gave birth to a term baby weighing 4 kg. The liquor was not meconium stained and labour was not prolonged. The baby has respiratory distress that resolves within 3 days. Which statement is true?

A. Diabetes predisposes the child to respiratory distress
B. The child could be having meconium aspiration syndrome
C. The baby is most likely to have a serious congenital heart disease
D. Most likely the baby has pneumonia
E. Prior antibiotic treatment of the mother is beneficial in this condition

80. A 3-day-old baby has a serum bilirubin of 500 micromol/L. Which finding supports a possible diagnosis of rhesus incompatibility?

A. Mother's blood group B negative and father A positive
B. High fevers
C. Massive splenomegaly
D. Tender hepatomegaly
E. Ultrasound is unable to visualise the gall bladder

81. 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

82. 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

83. Which statement is true regarding vaccines?

A. OPV loses its potency at very low temperatures
B. Tetanus toxoid should be frozen
C. Measles should only be given once to a child
D. OPV and rotavirus should never be given at the same time
E. Pneumococcal vaccines should be stored between 2 and 8 degrees

84. A gluten-free diet is indicated in which of the following conditions?

A. Galactosaemia
B. Hirschsprung disease
C. Biliary atresia
D. Porphyria
E. Coeliac disease

85. Antibiotic prophylaxis against infective endocarditis is required in the following high-risk patients EXCEPT:

A. Complex unrepaired cyanotic congenital heart disease
B. Prosthetic heart valves
C. Repaired congenital heart lesions with prosthetic material
D. Secundum ASD
E. Previous infective endocarditis

86. Tony, 9 months, has cough, wheezing and fever, with 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

87. Chloe, 3 years, has a 3-day history of cough and body hotness, lower chest wall indrawing, and cannot feed or drink. A chest X-ray shows diffuse opacities in the right lower lobe. Choose the best option:

A. She has pneumonia according to WHO and should be given amoxicillin and come back for review in 24 hours
B. She needs oxygen at 10 to 15 litres by nasal prongs
C. She should be admitted and put on IV crystalline penicillin and oxygen
D. The disease is on the rise because of lack of vaccines
E. None of the above statements is correct

88. A 10-year-old has a one-day history of cough and difficulty in breathing, with diffuse bilateral wheezes and no fever, and responds very well to fast-acting bronchodilators. The most likely condition is:

A. Severe pneumonia
B. Bronchiolitis
C. Asthma
D. Foreign body aspiration
E. Tuberculosis

89. Causes of pulmonary haemorrhage may include the following EXCEPT:

A. Foreign bodies in the airway
B. Tuberculosis
C. Systemic lupus erythematosus
D. Obstructive sleep apnoea
E. Factor VIII deficiency

90. Peter's father and mother are both carriers for cystic fibrosis. Which statement is true regarding the inheritance of this condition?

A. There is a 50% probability of each child getting 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, so the children will not be affected
E. All the males from this family will suffer from cystic fibrosis

91. The diagnosis of cystic fibrosis is suspected if the work-up shows:

A. Sweat chloride of 30 mmol/L
B. Sweat chloride of 120 mmol/L
C. Stool faecal elastase of 500 microgram/g of stool
D. Sweat sodium of 140 mmol/L
E. Sweat sodium of 20 mmol/L

92. All of the following statements are TRUE about gastro-oesophageal reflux disease (GERD) EXCEPT:

A. GERD is a benign illness without any life-threatening complications
B. Many infants with GERD can be treated successfully with conservative measures alone
C. Symptoms are frequently non-specific, such as failure to thrive and irritability
D. H2-blocking drugs (for example ranitidine) have a role
E. Surgery should be done for severe cases with life-threatening aspirations

93. A 3-year-old girl has fever, vomiting, abdominal pain, right upper quadrant tenderness and hepatomegaly. Her transaminases are raised, but her bilirubin is only slightly above normal. Several other children in her day care have similar symptoms. Which statement is FALSE?

A. Most patients with this illness do not develop fulminant or chronic disease
B. Jaundice is common in young children with this illness
C. Highly effective vaccines exist against this disease
D. Most commonly transmitted by faecal-oral contact
E. None of the above

94. Chronic hepatitis B infection is indicated by:

A. Positive anti-HBc IgM antibody
B. Positive HBsAg for more than 6 months
C. Positive anti-HBs IgM antibody
D. Positive anti-HBc and anti-HBe
E. All of the above

95. In regard to ulcerative colitis versus Crohn disease, which statement is true?

A. Crohn disease involves the rectum only and has continuous lesions with high risk of malignant transformation
B. Crohn disease involves the mucosa of the entire GIT with a low risk of malignant transformation
C. Ulcerative colitis has transmural lesions that involve the entire GIT with high risk of malignant transformation
D. Ulcerative colitis has rectal involvement only and low risk of malignant transformation
E. A and C are true

96. About the treatment of GERD, choose the FALSE statement:

A. Lifestyle modification will improve the symptoms in most cases
B. Histamine receptor antagonists and proton pump inhibitors suppress gastric acid secretion
C. Metoclopramide and erythromycin are prokinetics
D. Sucralfate and dimethicone also suppress gastric acid secretion
E. Surgical intervention is not frequently preferred for children

97. Which statement is true regarding irritable bowel syndrome?

A. It is a very rare condition that often affects the elderly
B. Food-related triggers rarely cause flares
C. Abdominal pain, distension and episodes of diarrhoea alternating with constipation are the common presentations
D. Stool microscopy will always reveal the offending organism
E. It is not associated with any complications

98. Which statement is true?

A. Coeliac sprue and tropical sprue are one and the same disease entity
B. Coeliac sprue is an autoimmune disorder with inability to tolerate gluten
C. Tropical sprue is triggered by inability to tolerate gliadin in diets rich in gluten
D. Dental erosions and brittle nails are extra-intestinal complications of tropical sprue
E. Both coeliac and tropical sprue are self-limiting

99. A 3-year-old girl has a 3-day history of a barking cough, rhinorrhoea, low-grade fever and difficulty breathing. A neck X-ray shows a steeple sign. The following have a role in management EXCEPT:

A. Nebulised adrenaline
B. Dexamethasone
C. Oxygen
D. IV ceftriaxone
E. Avoid unimportant threatening procedures

100. Andrew, 6 years, has a dramatic history of high fevers, drooling and worsening difficulty in breathing. An X-ray after stabilisation shows a thumb sign. The most urgent treatment is:

A. Administer oxygen
B. Airway securing and stabilisation
C. Nebulised adrenaline
D. Fluid bolus of normal saline
E. IV antibiotics

Section B and Section C: essay questions

1. Section B, Question 1(a). Outline the benefits of breastfeeding (5 marks).

2. Section B, Question 1(b). Describe the physiology of milk let-down (5 marks).

3. Section B, Question 2. Outline the components of the cold chain system (10 marks).

4. Section C, Question 1. A 2-year-old girl has cough and difficulty in breathing for 1 day, with no fever. She has had daily night coughs, and coughs on exercise and on laughing. Her father and mother have a history of severe atopy. She has food allergy and eczema. On examination she is in respiratory distress with bilateral wheezes. (a) What is the most likely diagnosis (1 mark)? (b) What are the risk factors for developing this condition (4 marks)? (c) What are 3 other differentials for wheezing in this child (3 marks)? (d) Describe the treatment for this child in an acute setting (12 marks).

5. Section C, Question 2. Write short notes on acute rheumatic fever. (a) What is the most common infection and the organism implicated in the development of the condition (5 marks)? (b) What are the major criteria for diagnosis (5 marks)? (c) Describe the management of acute rheumatic fever (10 marks).

(a) The infection and organism

(b) Major criteria (the Jones criteria)

(c) Management