Mount Kenya University · School of Medicine · Paediatrics and Internal Medicine
Paper details
- Paper: a multiple choice set with no title page, date or unit code in the scanned file, so it is filed as undated. It looks like part of a joint paediatrics and medicine CAT.
- What this page has: MCQs 10 to 28 only. Questions 1 to 9 and anything after question 28 are not in the scan. The first of these (Q10) starts partly cut off.
- Pictures: Q15 and Q16 show ECG strips in the original. They are described here and not reproduced.
- Answers: written by OmpathStudy for revision. They are not the official MKU marking scheme. The pen marks on the scan were ignored.
- Topics tested: cystic fibrosis, the normal ECG and rhythm recognition, Hirschsprung disease, dehydration, gastro-oesophageal reflux, hepatitis A and B, and childhood diarrhoea.
- Questions that need care: Q12, Q15, Q18, Q26 and Q27 are loosely worded. The explanation says which option is best and why.
Multiple choice questions
10. The diagnosis of cystic fibrosis in the work-up is supported by which result?
- A. Sweat chloride of 30 mmol/L
- B. Sweat chloride of 120 mmol/L
- C. Stool faecal elastase of 500 µg/g of stool
- D. Sweat sodium of 140 mmol/L
- E. Sweat sodium of 20 mmol/L
11. In the management of cystic fibrosis, which statement is false?
- A. There is a role for timely use of antibiotics with good outcomes
- B. Physiotherapy improves lung function and is key in management
- C. All children develop diabetes mellitus and need insulin by 5 years of age
- D. Enzyme replacement therapy improves weight gain and stool consistency
- E. The type of organisms that colonise the child's airway matters and plays a role in reducing lung health if not treated well
12. Which wave on the ECG represents atrial repolarisation?
- A. R wave
- B. P wave
- C. T wave
- D. J wave
- E. U wave
13. What is the ideal interval of the PR duration on the ECG?
- A. 1.2 seconds
- B. 3 seconds
- C. 1 minute
- D. 5 seconds
- E. 0.2 seconds
14. What does the QRS complex represent?
- A. Atrial repolarisation
- B. Ventricular repolarisation
- C. Ventricular depolarisation
- D. Atrial depolarisation
- E. Both atrial and ventricular repolarisation
15. Identify the rhythm below. (ECG strip: a regular, fast, wide, sine-wave-like rhythm with no distinct P waves.)
- A. Supraventricular tachycardia
- B. Ventricular fibrillation
- C. Ventricular tachycardia
- D. Atrial fibrillation
- E. Sinus tachycardia
16. A 2-year-old child is brought to the emergency with a very high fever and a high heart rate. The ECG (lead II) shows regular narrow complexes, each preceded by a P wave. The most likely rhythm is:
- A. Sinus bradycardia
- B. Sinus tachycardia
- C. Ventricular tachycardia
- D. Supraventricular tachycardia
- E. Ventricular fibrillation
17. About Hirschsprung's disease, which statement is false?
- A. The classic triad is neonatal bilious vomiting, abdominal distension and delayed passage of meconium (over 48 hours)
- B. A small proportion of cases are diagnosed in infancy with severe chronic constipation
- C. Rectal biopsy may be indicated if growth faltering or abdominal distension persist
- D. It will often present within the first 3 days of life with feed intolerance
18. Risk factors for dehydration in acute gastroenteritis are the following EXCEPT:
- A. Age under 12 months, because of the large surface area to volume ratio
- B. Osmotic load of an exclusive milk diet
- C. Bottle feeding predominantly
- D. Frequent stools (more than 5 per day) and vomiting (more than twice a day)
19. Cardinal signs of hypovolaemic shock include all EXCEPT:
- A. Weak or absent pulse
- B. AVPU below A, or any alteration in the level of consciousness
- C. Cold hands with a temperature gradient
- D. Capillary refill over 3 seconds
- E. Sunken eyes
20. What is the common presentation of acute pancreatitis?
- A. Right hypochondrial pain that radiates to the back
- B. Severe abdominal pain that is initially epigastric and later generalised, with rebound tenderness and guarding
- C. Left hypochondrial pain with radiation to the neck
- D. Severe abdominal pain predominantly in the umbilical quadrant, with generalisation and rebound tenderness
- E. None of the above
21. All 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 (such as ranitidine) have a role
- E. Surgery should be done for severe cases with life-threatening aspirations
22. A 2-month-old boy has vomiting and no bowel movement for 4 days, with difficulty passing stools since birth, a distended abdomen, and stool palpable above the pubis. The rectum is empty on examination with no fissures, and he passes stool when you remove your finger. Which statement is TRUE about the cause of his constipation?
- A. Caused by neurotoxins produced by bacteria in the GI tract
- B. Caused by an absence of parasympathetic ganglion cells in the intestine
- C. Likely due to a combination of behavioural and environmental factors
- D. Caused by poorly functioning endocrine glands
23. A 3-year-old girl has fever, vomiting and abdominal pain. She has right upper quadrant tenderness and hepatomegaly. Total and direct bilirubin are only slightly above normal and transaminases are high. Several children in her day care are sick. 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
24. A 5-year-old boy has abdominal pain. Potential causes include:
- A. Pneumonia
- B. Streptococcal throat infection
- C. Testicular torsion
- D. Diabetic ketoacidosis
- E. All of the above
25. Among the hepatitis viruses, hepatitis B virus (HBV) is unique because:
- A. Liver injury is mediated through the immune system
- B. The presence of antibodies to HBV indicates protective immunity
- C. It has similarities to human retroviruses because it is a DNA virus that replicates through an RNA intermediate
- D. It is the only agent to cause fulminant hepatic failure
- E. It has a glycoprotein coat enclosing a viral nucleocapsid
26. Recognised complications of acute hepatitis A include all EXCEPT:
- A. Fulminant hepatic failure
- B. Hepatic adenocarcinoma
- C. Chronic hepatitis
- D. Cholestatic hepatitis
- E. Triggering autoimmune hepatitis
27. Common causes of secretory diarrhoea in children include all EXCEPT:
- A. Vibrio cholerae infection
- B. Clostridium (as printed)
- C. Giardia lamblia
- D. Cow's milk protein allergy
- E. Oral dextrose rehydration solutions
28. In the management of acute diarrhoeal disease in children:
- A. The preferred IV rehydration fluid is Ringer's lactate
- B. Zinc sulphate is very important to help restore gut flora
- C. Intravenous fluids are the fastest and preferred solution for rehydration
- D. IV metronidazole is recommended to treat severe cases admitted to hospital