Paediatrics Senior Clerkship end of 2nd semester exam: 4 October 2021, 50 MCQs

Mount Kenya University · School of Medicine · Senior Clerkship in Paediatrics and Child Health

Paper details

• Sitting: 4 October 2021, headed "End of second semester exam". By the timetable this is Trimester 1 (September to December).
• Questions: 50 multiple choice questions, one correct answer each. Answer all.
• Pictures: Q23 shows a chest X-ray in the original. It is not reproduced, and the question can still be answered from the text.
• Topics tested: cystic fibrosis, vasculitis (Henoch-Schonlein purpura, Kawasaki disease, Takayasu), juvenile arthritis, lupus, inheritance patterns, pulmonary haemorrhage, interstitial lung disease, malaria, sickle cell disease, neonatal jaundice, bronchiolitis, asthma, HIV, immunisation, nephrotic syndrome, hydrocephalus and rickets.
• Answers: written by OmpathStudy for revision. They are not the official MKU marking scheme.
• Questions that need care: Q3, Q9, Q10, Q22, Q31, Q32, Q35, Q41, Q47 and Q49 have more than one defensible option or a garbled stem. The explanation says which option is best and why.

Multiple choice questions

1. Allan, 3 years old, has cystic fibrosis. Which is NOT a common presentation of the disease?

• A. Failure to thrive
• B. Loose stools
• C. Recurrent chest infections
• D. Severe mental retardation
• E. Diabetes mellitus

2. The genetic dysfunction in cystic fibrosis is inherited as:

• A. Autosomal dominant
• B. Autosomal recessive
• C. X-linked dominant
• D. X-linked recessive
• E. Multifactorial

3. 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

4. In the management of cystic fibrosis, which statement is FALSE?

• A. Timely antibiotics give good outcomes
• B. Physiotherapy improves lung function and is key
• C. All children develop diabetes mellitus and need insulin by 5 years of age
• D. Enzyme replacement improves weight gain and stool consistency
• E. The organisms that colonise the airway matter and reduce lung health if not treated well

5. Secondary causes of vasculitis in children include the following EXCEPT:

• A. Infections
• B. Malignancy
• C. Drugs
• D. Other rheumatological conditions
• E. Consuming too much sugar in the diet

6. An example of an ANCA-associated vasculitis with granulomatosis is:

• A. Rheumatoid arthritis
• B. Churg-Strauss syndrome
• C. Systemic lupus erythematosus
• D. Henoch-Schonlein purpura
• E. Goodpasture disease

7. Mary, 16, has a malar rash, multiple joint pains, pleuritis and was recently found to be anaemic. The most likely condition is:

• A. Dermatomyositis
• B. Juvenile rheumatoid arthritis
• C. Systemic lupus erythematosus
• D. Sjogren syndrome
• E. Goodpasture disease

8. Which vasculitis is associated with pulselessness?

• A. Kawasaki disease
• B. Takayasu disease
• C. Henoch-Schonlein purpura
• D. All the above
• E. None of the above

9. Which statement is true of rheumatoid arthritis in children?

• A. The rheumatoid factor is always positive
• B. Conversion of pauciarticular to polyarticular disease is associated with a good prognosis
• C. Joint pains and stiffness occur late in the evening and rarely in the morning
• D. It may be associated with other rheumatological conditions
• E. Severe bone destruction is a key feature

10. Concerning the management of juvenile rheumatoid arthritis, which statement is true?

• A. NSAIDs should be avoided since they cause acidity
• B. Extensive exercise should be done during flare-ups
• C. Systemic manifestations and chronic uveitis are associated with a good outcome
• D. Polyarticular arthritis involves 2 or more joints
• E. As many as 20 to 40 joints can be affected

11. Cardiovascular findings in systemic lupus erythematosus include:

• A. Pericarditis
• B. Endocarditis
• C. Myocarditis
• D. All the above
• E. None of the above

12. Haematological findings expected in SLE include all EXCEPT:

• A. Haemolytic anaemia
• B. Anaemia
• C. Leucopenia
• D. Polycythaemia
• E. Lymphopenia

13. Coagulopathies expected in SLE include:

• A. A hypercoagulable state
• B. Hypocoagulable states
• C. Thrombotic thrombocytopenic purpura
• D. All the above
• E. None of the above

14. Which antibodies are likely positive in drug-induced SLE (for example from procainamide or hydralazine)?

• A. Anti-Sm
• B. Anti-phospholipid
• C. Anti-histone
• D. Anti-glomerular basement membrane
• E. Rheumatoid factor

15. A 5-year-old has small bluish-purple spots on the lower legs and buttocks, abdominal pain, and haematuria on urine dipstick. The likely diagnosis is:

• A. Scleroderma
• B. Henoch-Schonlein purpura
• C. Dermatomyositis
• D. Juvenile rheumatoid arthritis
• E. Kawasaki disease

16. Concerning the condition in question 15, which statement is true?

• A. Most children do not recover and die within days of diagnosis
• B. It affects large vessels
• C. It is IgG mediated
• D. It is a small-vessel vasculitis that is IgA mediated
• E. None of the above

17. Which is NOT an expected finding in the acute phase of Kawasaki disease?

• A. High fevers
• B. Red eyes
• C. Cervical lymphadenopathy
• D. Swollen hands
• E. Desquamation of fingers and toes

18. Which statement is true of Kawasaki disease?

• A. It is also called mucocutaneous lymph node syndrome
• B. Prolonged fever is a hallmark of the disease
• C. It is more common in children of Asian origin
• D. None of the above
• E. All the above

19. Which statement is true of X-linked recessive disorders?

• A. All the male offspring are affected
• B. 50% of the male offspring are affected
• C. All the females are affected even though some are carriers
• D. All the male children die
• E. 25% of the children are affected

20. An example of an autosomal recessive disorder is:

• A. Red-green colour blindness
• B. Duchenne muscular dystrophy
• C. Sickle cell disease
• D. Haemophilia A
• E. Haemophilia B

21. Joseph's father and mother are both carriers for cystic fibrosis. Which statement is true?

• 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 in the family will suffer from cystic fibrosis

22. Concerning pulmonary haemorrhagic syndromes, which statement is true?

• A. The bronchial circulation is low capacitance and supplies the conducting airways
• B. The pulmonary circulation is high capacitance and supplies the respiratory airways
• C. Infections rarely cause pulmonary haemorrhage and should not be suspected as a cause
• D. The bleeding should be stopped immediately with surgery as soon as the child presents
• E. Foreign bodies can cause localised bleeding in the airways

23. Miriam, 8 years old, has had cough and difficulty in breathing for 12 months and a haemoglobin of 4. Her chest X-ray has not changed despite 6 months of anti-TB treatment. What is the next best step?

• A. Start multidrug-resistant TB treatment
• B. Continue TB treatment for another 6 months
• C. Consult a senior colleague, possibly with expertise in pulmonology
• D. Order as many tests as possible that can be done at the facility
• E. Give very strong antibiotics for at least two weeks

24. A 7-year-old is brought in coughing up a large amount of blood, is restless and in shock, still coughing up clots. What is the ideal sequence of management?

• A. Open and secure the airway, clear secretions, give oxygen, give a fluid bolus, and blood as soon as it is available
• B. Get an urgent chest X-ray, give oxygen, start a 5% normal saline drip
• C. Urgently order blood, then secure the airway and call the paediatric surgeon on call
• D. Shout for help, give fresh frozen plasma, check the airway and give oxygen
• E. Suction as deep as possible, and get the anaesthetist to intubate because this is critical

25. Regarding the prognosis of children with interstitial lung disease, which is true?

• A. Children with surfactant protein B deficiency have a very good prognosis
• B. Children with Heiner syndrome due to cow's milk allergy do very well once the milk is withdrawn
• C. The prognosis of vasculitis-associated disease is also fair and resolves
• D. Immune suppressants should not be used because they suppress immunity
• E. Heart-lung transplant improves 5-year survival to almost 100%

26. Which is a common indicative feature of severe malaria in children?

• A. Renal failure
• B. Acidosis with respiratory distress
• C. Diarrhoea
• D. Hyperpyrexia
• E. Skin rash

27. A 2-year-old has painful swelling of the hands and feet and a haemoglobin of 9 g/dL. Which test will support the diagnosis?

• A. Skeletal survey
• B. VDRL
• C. Bone marrow aspiration
• D. Haemoglobin electrophoresis
• E. Serum calcium

28. A 5-year-old with sickle cell disease has 2 days of cough and fever, and a chest X-ray shows pneumonia. The most appropriate drug therapy is:

• A. Amoxicillin
• B. Ceftriaxone
• C. Azithromycin
• D. Ceftriaxone and azithromycin
• E. No antibiotics, likely viral

29. An 18-month-old is pale and drinks up to 2 litres of cow's milk a day. Which test reveals the diagnosis?

• A. Chest X-ray
• B. Stool for ova and parasites
• C. Complete blood count
• D. Serum haptoglobin
• E. Bone marrow aspirate

30. A baby is born by caesarean section for severe maternal hypertension. The birth weight is 4 kg. What is the total fluid requirement on the first day?

• A. 84 ml
• B. 240 ml
• C. 140 ml
• D. 60 ml
• E. 80 ml

31. A boy aged 48 hours, 3.1 kg, is deeply jaundiced with an indirect bilirubin of 310 micromol/L. Choose the correct statement.

• A. Phototherapy would be adequate
• B. Dubin-Johnson syndrome is the likely cause
• C. Breast milk jaundice is the most likely diagnosis
• D. Exchange transfusion is appropriate treatment
• E. Haemolytic disease of the newborn is likely to be the cause

32. A one-week-old neonate has about 12 scattered pustules on the face and head. Choose the correct statement.

• A. This is likely scorbutic dermatitis
• B. This is likely heat rash
• C. Flucloxacillin is the best intervention
• D. Gentian violet should be applied to the lesions
• E. Application of 3% tetracycline ointment is adequate

33. Choose the correct statement about a congenital umbilical hernia found at birth.

• A. Strangulation is an early complication in the neonatal period
• B. The defect should be repaired surgically within three months
• C. Dressing with a silver coin is a useful intervention
• D. Colic is probably coming from the defect
• E. The chance of spontaneous closure is high

34. Which is true about the physiology of lactation?

• A. After delivery prolactin drops, leading to increased milk synthesis
• B. Lactation does not occur if pregnancy does not progress beyond weeks
• C. Obesity does not interfere with lactogenesis
• D. Oxytocin causes the milk ejection (let-down) reflex
• E. The rate of milk synthesis is not related to how full the breast is

35. Which is true of breath-holding attacks?

• A. They are commoner over the age of 3 and a half years
• B. They can be confused with generalised seizures
• C. They may be precipitated by a minor injury
• D. They should be treated with sedatives
• E. They are never fatal

36. Which is true about necrotising enterocolitis in babies?

• A. It does not occur in term babies
• B. Oral feeds should be continued
• C. It most often presents with abdominal distension
• D. Abdominal X-rays are usually not contributory to diagnosis
• E. It only occurs in premature babies with perinatal stress

37. A 4-month-old has a 3-day history of low-grade fever, worsening wheeze and difficulty feeding. Which is true?

• A. This infection is common in children older than 1 year
• B. The child is not at risk of later asthma
• C. Inhaled bronchodilator therapy plays a key role in treatment
• D. Hypoxaemia complicates severe cases
• E. Steroids have been shown to reduce the duration of wheezing

38. A 9-year-old who recently returned from a malaria-endemic region has progressive loss of consciousness, pallor and high fever. Which is true of treatment?

• A. Rectal artemether may not be given
• B. A lumbar puncture should be included in his management
• C. Parenteral artemether (or artesunate) is first-line treatment
• D. A negative malaria smear rules out malaria
• E. Artemisinin combination treatment is only used in uncomplicated disease

39. A 10-month-old last received vaccination at 10 weeks. What should the child receive?

• A. Pentavalent, pneumococcal, measles-rubella, IPV, OPV
• B. Pentavalent, pneumococcal, measles-rubella, IPV, OPV, rotavirus
• C. Pentavalent, pneumococcal, measles, rotavirus
• D. Pentavalent, pneumococcal, hepatitis B, measles-rubella, IPV, OPV
• E. Pentavalent, pneumococcal, measles, IPV, OPV

40. A 4-year-old known asthmatic has nocturnal cough and wheeze. Which is true?

• A. Special devices (spacers) are not needed since he is above 2 years
• B. Oral corticosteroids are contraindicated in pre-pubertal children
• C. Mycoplasma pneumoniae is a common asthma trigger in this age group
• D. He should not swim, since this is a known trigger
• E. 6 to 10 puffs of salbutamol by metered-dose inhaler may be given

41. Regarding a 2-week-old infant born to an HIV-infected mother on antiretroviral treatment, which is true?

• A. He should start co-trimoxazole prophylaxis from 6 weeks
• B. He should be on nevirapine prophylaxis for 12 weeks if breastfed
• C. He may not breastfeed because the risk of infection outweighs the benefits
• D. HIV DNA PCR done before 6 weeks may be falsely positive and is not recommended
• E. He should not receive BCG

42. Which is FALSE about an 8-year-old with a papulovesicular rash (chickenpox)?

• A. A vaccine is available
• B. He is infectious until the lesions form scabs
• C. The incubation period can be up to 21 days
• D. A mother infected 3 days before delivery passes antibodies to the infant, protecting from neonatal chickenpox
• E. Aciclovir may be given to exposed children at risk of severe disease

43. A 10-year-old has sudden onset of rice-water diarrhoea. Which statement is FALSE?

• A. He must be given antibiotics
• B. A two-dose oral vaccine exists
• C. ORS and zinc have a key role in treatment
• D. Most infections are mild
• E. Antidiarrhoeal medication is not recommended

44. A 16-year-old has been on a strict vegetarian diet for 5 years. You order a complete blood count because you are concerned about:

• A. Lymphocytosis
• B. Macrocytic anaemia
• C. Microcytic anaemia
• D. Normocytic anaemia
• E. Thrombocytosis

45. The current recommendation for breastfeeding is:

• A. Exclusive breastfeeding for 6 months, then supplementation with additional foods
• B. Exclusive breastfeeding for 4 months, then supplementation with additional foods
• C. Colostrum is the best first food but should be avoided in the first 2 days
• D. Breastfeeding is contraindicated in an HIV-infected mother
• E. Prelacteal feeds are recommended

46. A previously well 2-year-old has been ill for 4 days and has not passed urine for 20 hours. Which finding strongly supports pre-renal kidney failure?

• A. A history of recurrent colicky abdominal pain
• B. A serum potassium of 6.7 mmol/L
• C. A urine sodium concentration of 20 mmol/L (low)
• D. Presacral and periorbital oedema
• E. Red cell casts in the urine

47. A 12-year-old has generalised oedema and 3+ proteinuria, with no blood in the urine. High-dose prednisolone was started. Which is an indication for a renal biopsy?

• A. Lack of response to therapy after 1 week
• B. Microscopic haematuria of more than 5 red cells per high-power field
• C. A reduced serum C3 (complement)
• D. Nephrotic syndrome in a 5-year-old
• E. Minimal change disease

48. The following parasitic infections are predominantly ectoparasites EXCEPT:

• A. Tunga penetrans
• B. Scabies
• C. Cutaneous larva migrans
• D. Pediculosis pubis
• E. Fleas

49. A 3-month-old is found to have an increased head size at a routine visit. Regarding the child's condition:

• A. The infant most likely survived meningoencephalitis that was not detected
• B. Communicating hydrocephalus is the most likely type in this infant
• C. Acetazolamide is as effective as surgery
• D. Hydrocephalus is associated with more severe neurological problems than hydranencephaly
• E. MRI and cranial ultrasound identify the specific cause and severity of hydrocephalus

50. Maina, 9 months old, has delayed milestones, no teeth, frontal bossing, prominent costochondral junctions and widened wrists. Which is NOT a consistent finding in this condition?

• A. Hypocalcaemia
• B. Low vitamin D levels
• C. Hyperphosphataemia
• D. High parathyroid hormone
• E. High alkaline phosphatase