Paediatrics end of fourth year special supplementary exam: August 2019, Paper One, 87 of 100 MCQs — Year 4 Paediatrics & Child Health Notes

MKU Paediatrics special supplementary exam, August 2019 (MBPE 4300), Paper One: 87 of the 100 MCQs on shock, infections, genetics, neonatal problems, malnutrition, cardiology, respiratory disease, development and vaccination, 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, 2018/2019 university examination, end of fourth year MBChB.
Sitting: August 2019 (special supplementary), 2 hours. By the timetable August falls in Trimester 3 (May to August).
Format: 100 multiple choice questions with five responses each and no negative marking. Answer all.
What this page has: 87 of the 100 MCQs. Questions 30 to 34 and 93 to 100 are not in the scanned file. The scan repeats questions 25 to 29 in place of 30 to 34. Questions 28 and 56 are the same question, and 39 and 81 are the same question. They were kept as printed.
Topics tested: shock, SIDS, hepatitis A and B, pneumococcus, SIADH, rickets, bronchiolitis, cryptococcal meningitis, measles, genetics, Down syndrome, tuberculin testing, diabetes, brain tumours, febrile convulsions, malnutrition, thyrotoxicosis, nephrology, poisoning, vaccination and development.
Answers: written by OmpathStudy for revision. They are not the official MKU marking scheme.
Questions that need care: Q3, Q9, Q11, Q14, Q25, Q46, Q48, Q58, Q60, Q69 and Q89 are loosely worded or have more than one defensible option. The explanation says which option is best and why. The handwritten ticks on the scan were ignored.

Multiple choice questions

1. The following are signs of circulatory shock EXCEPT:

A. Cold extremities
B. Slow capillary refill
C. Strong peripheral pulse
D. Responds only to voice
E. Weak peripheral pulse

2. New parents ask how to reduce the chance of sudden infant death syndrome. You tell them to place the child in which position for sleep?

A. Supine position
B. Prone position
C. Seated position
D. Trendelenburg position
E. A hammock

3. Which is true about hepatitis A?

A. Children commonly recover spontaneously
B. Diagnostic laboratory tests should include IgM antibodies to hepatitis A
C. The diagnosis should not be considered if contacts have a history of jaundice
D. The vaccine is approved for children older than 2 years
E. The incubation period is 10 to 14 days

4. The following are true regarding Streptococcus pneumoniae EXCEPT:

A. The bacterium is identified in culture by partial (alpha) haemolysis
B. Children with sickle cell disease are susceptible to pneumococcal infection
C. Virulent strains are resistant to phagocytosis by alveolar macrophages
D. The anti-phagocytic properties of the capsule contribute to its virulence
E. Nasopharyngeal carriage consistently induces systemic immunity

5. Which finding is unlikely in the syndrome of inappropriate ADH secretion?

A. Serum sodium below 135 mEq/L
B. Urine osmolality above 100 mOsm/kg
C. Serum osmolality above 290 mOsm/L
D. Euvolaemic hyponatraemia
E. Excess urine sodium with normal intake

6. A 12-month-old has knob-like swellings on the anterior chest wall, soft cranial bones and delayed motor milestones. Which findings are expected?

A. High serum calcium
B. Low alkaline phosphatase
C. High inorganic phosphate
D. Decreased osteoblastic activity
E. High alkaline phosphatase

7. An 11-month-old girl has had cough and difficulty breathing for 1 day. She is in respiratory distress and the chest is hyperresonant. Which is FALSE?

A. Oxygen treatment is recommended
B. RSV is most likely the cause
C. Her prognosis is good
D. IV antibiotics should not be commenced
E. She should be started on aminophylline

8. Onyango, 3 years, has had a cough for 2 days, a temperature of 39 degrees, a respiratory rate of 66 and chest indrawing. There is no cyanosis and he is well nourished. Which is true?

A. A Mantoux test is recommended
B. A course of ceftriaxone is recommended
C. He should be put on oxygen with a non-rebreather mask
D. He should be isolated
E. A course of meropenem is recommended

9. A 6-month-old is HBsAg positive, anti-HBs negative, anti-HBc positive and HBeAg positive. Which statement about HBV infection or its treatment in this child is true?

A. Active and passive immunisation should begin immediately
B. Active replication of HBV is not occurring
C. Exposure to HBV occurred in the past but the infection has cleared
D. The infection was transmitted horizontally
E. Treatment with interferon-alpha may eradicate the virus

10. Jason, 7 years, is HIV-infected with nuchal rigidity and a positive CSF India ink stain. The acute phase of treatment consists of:

A. Amphotericin B
B. Fluconazole
C. Itraconazole
D. Amphotericin B and flucytosine
E. Pentamidine

11. Which is a differential diagnosis for a child with fever persisting for more than 21 days?

A. Previous drug administration
B. Psychosomatic illness in young infants
C. Occult infection
D. Munchausen disease
E. Systemic lupus erythematosus

12. A 2-year-old has rhinorrhoea, cough and fever with non-purulent conjunctivitis, and 7 days later a maculopapular rash. Which is NOT true?

A. Generalised lymphadenopathy is a feature
B. Transaminases are elevated
C. The rash spreads cranio-caudally
D. Leucocytosis is characteristic
E. Lymphopenia is characteristic

13. The earliest adolescent change in boys is:

A. Laryngeal enlargement
B. Development of pubic hair
C. Appearance of facial hair
D. Growth spurt
E. Testicular growth

14. Regarding X-linked recessive conditions:

A. They mostly affect females
B. They can be passed from father to son
C. They are not passed from father to son
D. Females with a linked recessive condition will have a 50% chance of having an affected son
E. Sickle cell disease is inherited in an X-linked recessive pattern

15. Regarding mitochondrial inheritance, the following are true EXCEPT:

A. Mitochondrial disorders show maternal inheritance
B. A woman with a mitochondrial disorder can have affected offspring of either sex
C. An affected father cannot pass on the disease to his offspring
D. Mitochondrial DNA mutations are often deletions or point mutations
E. Detection of a mitochondrial genome mutation does not require sampling of the affected tissue

16. Regarding Down syndrome, which statement is true?

A. Robertsonian translocation is the commonest cause
B. The risk increases with maternal age above 35 years
C. Affected individuals are not more prone to congenital heart defects
D. Social development is severely affected
E. Life expectancy is 70 years

17. A 10-day-old newborn has intermittent stridor. The most common cause is:

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

18. A child with Down syndrome has an increased risk of all the following EXCEPT:

A. Hydrocephalus
B. Duodenal atresia
C. Leukaemia
D. Hypothyroidism
E. Congenital heart disease

19. The following are associated with a false-negative Mantoux test EXCEPT:

A. Very young age
B. Severe malnutrition
C. Immunosuppression
D. Overwhelming TB
E. Obesity

20. A class two pupil presents with acute loss of consciousness and weight loss over two months. Random blood sugar is 26.8 mmol/L. One of the following is true:

A. The condition can be avoided by exclusive breastfeeding
B. The condition is associated with metabolic alkalosis
C. Hyperkalaemia is a common finding
D. Obesity is a key risk factor
E. Hypothyroidism occurs in 40% of affected patients

21. A 2-month-old born to an HIV-positive mother is followed in the comprehensive care centre. Which therapy should be considered?

A. Monthly evaluation for Kaposi sarcoma
B. Prophylaxis against Pneumocystis jirovecii pneumonia
C. Vitamin C supplementation
D. Oral polio vaccine
E. Bone marrow transplantation

22. Which of the following infections is LEAST likely to cause arthritis?

A. Malaria
B. HIV
C. Streptococcus
D. Staphylococcus
E. Salmonella

23. A 4-year-old from Siaya has painful knuckles and a temperature of 38.5 degrees, with no trauma. Which condition is MOST likely?

A. Thrombotic crisis of sickle cells
B. Malaria
C. Septic arthritis
D. Haemophilia
E. Juvenile idiopathic arthritis

24. In asymmetrical intrauterine growth restriction, which organ is spared?

A. Brain
B. Liver
C. Subcutaneous tissue
D. Heart
E. Spleen

25. Risk factors for neural tube defects include the following EXCEPT:

A. Pre-conceptual diet of the mother
B. Mother's age
C. Post-conceptual diet of the mother
D. Geographic region of residence of the mother
E. Family history of the same illness

26. Which statement is true?

A. In congenital laryngomalacia the infant is usually happy and growing
B. The goal of oxygen therapy is a saturation above 80%
C. The most common cause of bronchiolitis is respiratory syncytial virus
D. Bronchial asthma always presents with wheeze
E. The side effects of salbutamol include bradycardia and hypertension

27. Which is the most common type of astrocytoma in children?

A. Pilocytic astrocytoma
B. Diffuse astrocytoma
C. Craniopharyngioma
D. Anaplastic astrocytoma
E. Glioblastoma multiforme

28. A lesion in the frontal lobe causes:

A. Apraxia
B. Broca's (expressive) aphasia
C. Cortical blindness
D. Homonymous hemianopia
E. Visuospatial neglect

29. Bundi, a 10-month-old, has had 2 days of fever and convulsions, with no loss of consciousness between. All are true EXCEPT:

A. Family history is relevant
B. The first episode is an indication for CSF studies
C. Peak age is 3 months
D. It is the commonest cause of seizures in childhood
E. Convulsions cannot be prevented by using an antipyretic

35. Which statement applies to a 2-month-old baby with gastroenteritis who is 10% clinically dehydrated?

A. He has blood and mucus in his stools
B. He has a full fontanelle
C. He has a low packed cell volume
D. The urea level is elevated
E. He should not be given milk orally for at least 48 hours

36. Waterhouse-Friderichsen syndrome occurs in:

A. Tuberculous meningitis
B. Medulloblastoma
C. Fulminant meningococcaemia
D. Diabetes insipidus
E. Congenital adrenal hyperplasia

37. Juliet, 10 months, has abdominal pain and diarrhoea with pink staining, episodes of crying with drawing up of the legs, and a curved firm mass 10 cm long in 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, lymphoma)

38. A well-nourished 4-year-old has a firm bimanually palpable mass in the left lumbar region. The following are associated with this condition EXCEPT:

A. Asymmetry of body parts
B. Absent iris
C. Hypertension
D. Simian palmar crease
E. Haematuria

39. 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

40. A 12-year-old has had 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

41. 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 age below 60% of expected plus hair and skin changes
E. Weight for length 3 standard deviations below average

42. Which is NOT a recommendation of the Alma-Ata Declaration of Primary Health Care?

A. Provision of safe water and basic sanitation
B. Appropriate treatment of common childhood diseases
C. Provision of essential drugs
D. Increased immunisation against yellow fever
E. Provision of health education

43. Neuroblastoma:

A. Is an embryonic tumour
B. Usually has a familial incidence
C. Metastasises most commonly to the lungs
D. Is easily eradicated by radiotherapy
E. Is a non-secreting tumour

44. A complete unilateral facial hemiparesis is most likely caused by:

A. An intracranial tumour
B. Birth injury
C. Phenothiazine toxicity
D. Myasthenia gravis
E. Cerebellar atrophy

45. Polyhydramnios is often associated with which foetal abnormality?

A. Renal agenesis
B. Tracheo-oesophageal fistula
C. Hydrocephalus
D. Coarctation of the aorta
E. Cleft lip and palate

46. Conditions associated with an increased risk of malignancy in childhood include:

A. Aniridia
B. Ataxia telangiectasia
C. Fanconi anaemia
D. Asthma
E. Loeffler syndrome

47. Antidiuretic hormone (ADH):

A. Is stored in the anterior pituitary gland
B. Release is stimulated by hypernatraemia
C. Release is inhibited by hypotension
D. Release is inhibited by mannitol
E. Leads to water reabsorption by increasing water permeability of the ascending loop of Henle

48. A 2-year-old has a palpable abdominal mass. The following renal pathologies should be considered EXCEPT:

A. Autosomal recessive polycystic kidney disease
B. Obstructive hydronephrosis
C. Wilms tumour
D. Nephroblastoma
E. Autosomal dominant polycystic kidney disease

49. Which is associated with posterior urethral valve syndrome?

A. Polyhydramnios
B. Bilateral hydronephrosis on antenatal ultrasound
C. Hypospadias
D. Undescended testis
E. Adult polycystic disease

50. In Hirschsprung disease the following are correct EXCEPT:

A. Abdominal distension in the newborn period may be the presenting feature
B. The diagnosis can be made by rectal examination
C. The affected segment is grossly dilated on barium enema
D. The male to female ratio is 4:1
E. There is an increased familial incidence in long-segment disease

51. In the diarrhoea of cholera toxin, there is activation of which enzyme system?

A. Guanylate cyclase
B. ATP
C. Adenylate cyclase
D. Sodium-glucose co-transporter
E. Na+/K+ ATPase pump

52. Which statement is characteristic of acute hepatitis B infection?

A. Most patients present with splenomegaly
B. It confers immunity to hepatitis A
C. It commonly presents with distal joint arthritis
D. There is increased infectivity in the presence of the e antigen
E. Pruritus is an important early symptom

53. Which is true regarding Giardia lamblia?

A. It can cause intestinal malabsorption
B. It often causes bloody diarrhoea
C. It is a cause of haemolytic uraemic syndrome
D. It can be excluded by a single stool microscopy
E. It is treated with co-trimoxazole

54. Which would NOT be expected in an 18-month-old with poorly controlled hypothyroidism?

A. High plasma TSH
B. Delayed bone age
C. Umbilical hernia
D. Diarrhoea
E. Delayed developmental milestones

55. Which statement about puberty is correct?

A. In girls the first sign is the appearance of pubic hair
B. In boys the first sign is enlargement of the testes
C. Precocious puberty is more common in boys
D. Once the epiphyses fuse there is no further growth in stature
E. In girls menarche coincides with the peak of the growth spurt

56. A lesion of the frontal lobe causes:

A. Apraxia
B. Broca's (expressive) aphasia
C. Cortical blindness
D. Homonymous hemianopia
E. Visuospatial neglect

57. Two weeks after a viral illness, a 9-year-old girl has a drooping left mouth and cannot close her left eye. Her smile is asymmetric, and the rest of the examination is normal. She likely has:

A. Guillain-Barre syndrome
B. Botulism
C. Cerebrovascular accident
D. Brainstem tumour
E. Bell palsy

58. A 5-month-old has a generalised tonic-clonic seizure of about 30 minutes that stops with diazepam. The most helpful information to gather from the mother is:

A. Whether the child has had congestion without fever for 3 days
B. Whether the child is developmentally normal, as are his siblings
C. Whether the mother has been diluting the infant's formula to make it last longer
D. The number of pets at home
E. Whether the mother works as a secretary in an energy trading firm

59. The current recommendation for breastfeeding is that:

A. Exclusive breastfeeding should continue to 6 months, followed by supplementation with additional foods
B. Exclusive breastfeeding should continue to 4 months, followed by supplementation
C. Colostrum is the best food for a newborn but is best avoided in the first 2 days
D. The baby should be allowed to breastfeed till one year
E. Breastfeeding is contraindicated in all HIV-infected mothers

60. The following are part of standard management of congestive cardiac failure EXCEPT:

A. Oral digoxin
B. Oral ACE inhibitors
C. Beta blockers
D. Fluid restriction
E. No added salt diet in older children

61. Regarding the treatment of pneumonia, which statement is true?

A. Oral amoxicillin 40 mg/kg 12-hourly is an effective treatment
B. Cavitation on chest X-ray is mainly due to Staphylococcus epidermidis
C. IV chloramphenicol 50 mg/kg 6-hourly is an alternative treatment
D. Oxygen via a nasopharyngeal catheter is preferable
E. Unhumidified oxygen therapy with prongs may worsen the clinical picture

62. Dave, 5 months, has recurrent vomiting after feeds and has been treated twice for pneumonia, with the radiograph always showing upper lobe involvement. The following are true EXCEPT:

A. Surgical management has a role
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

63. The following suggest child abuse EXCEPT:

A. The child is promptly rushed to hospital even for minor injuries
B. A history that does not tally with the 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

64. The KEPI yellow fever vaccine is administered at:

A. 6 months
B. 7 months
C. 8 months
D. 9 months
E. 10 months

65. A 3-year-old has swallowed an organophosphate insecticide. Which 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

66. An 11-month-old cannot stand unsupported, has no teeth and has been admitted several times with pneumonia. Which is true about the condition?

A. Premature birth is associated
B. It is due to vitamin C deficiency
C. Serum phosphate is elevated
D. Blood gas analysis may be necessary as a useful diagnostic test
E. The serum alkaline phosphatase is usually below 200 IU/dL

67. An example of passive immunisation is:

A. Colostrum transfer of antibodies
B. That following a natural infection
C. That resulting from vaccine-derived polio
D. That induced by a live attenuated vaccine
E. That following a conjugate vaccine

68. 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. The incidence of atrioventricular septal defects is 90%
E. Brachycephaly is characteristic

69. 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

70. The mother of a 3-month-old girl brings her because of episodes of crying at the same time every day. You suspect colic. Which statement is true?

A. It starts at 3 months and peaks at about 6 months
B. Almost all cases are due to lactose intolerance
C. The episodes 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

71. A previously well 7-month-old has had a 2-day history of fever, cough, difficulty breathing and wheezing. Which statement is true?

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

72. A 2-year-old has a 2-day history of cough, runny nose and a fever of 38 degrees, with a respiratory rate of 36, an inflamed throat and clear lung fields. Which is true?

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

73. Which drug or toxin is NOT matched with its antidote?

A. Morphine and naloxone
B. Warfarin and protamine
C. Iron and deferoxamine
D. Carbon monoxide and oxygen
E. Carbamate and atropine

74. A baby born weighing 3.0 kg has 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

75. A 16-year-old girl has a late apical systolic murmur preceded by a click. Her mother also has a murmur. The most likely diagnosis is:

A. Atrial septal defect
B. Aortic stenosis
C. Tricuspid regurgitation
D. Mitral valve prolapse
E. Ventricular septal defect

76. Regarding pneumococcal conjugate vaccine, choose the correct statement.

A. It was introduced into the KEPI schedule in 2001
B. It is routinely given 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

77. Choose the correct statement regarding measles.

A. The commonest complication is laryngotracheobronchitis
B. Immunity after 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

78. An 18-month-old has recurrent cough. Which would make recurrent aspiration more likely?

A. Cerebral palsy
B. History of coughing not associated with feeds
C. Presence of dextrocardia
D. Presence of failure to thrive
E. Coughing spasms ending in vomiting

79. A normal infant sits briefly leaning forward on her hands, reaches for and grasps a cube, and transfers it from hand to hand. She babbles but cannot wave bye-bye nor grasp with finger and thumb. Her age is likely to be:

A. 4 months
B. 7 months
C. 10 months
D. 14 months
E. 18 months

80. A 17-year-old girl has eaten 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

81. 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

82. 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

83. Regarding a patient with rheumatic chorea:

A. The purposeless movements are evident in sleep
B. It follows kernicterus
C. Haloperidol is useful in treatment
D. Boys are three times more affected than girls
E. Hysteria is a common manifestation

84. In a patient 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

85. Clubbing of 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

86. Job, 10 years, has had a sickle cell crisis for the second time since being diagnosed 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

87. Which commonly occurs in congenital rubella syndrome?

A. Lung hypoplasia
B. Choanal atresia
C. Posterior urethral valves
D. Lissencephaly
E. Patent ductus arteriosus

88. A cyanotic newborn is suspected of congenital heart disease. The ECG shows left axis deviation and left ventricular hypertrophy. The most likely diagnosis is:

A. Transposition of the great arteries
B. Truncus arteriosus
C. Tricuspid atresia
D. Tetralogy of Fallot
E. Persistent foetal circulation

89. A 4-year-old boy with asthma presents with respiratory distress and wheeze. Which statement is true?

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 superior to a metered-dose inhaler with a spacer in delivering salbutamol
D. This state may be triggered by strenuous exercise
E. Oral salbutamol should be started immediately

90. A 12-year-old has had 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

91. A 2-year-old with diarrhoea and vomiting is severely wasted, weighs 6 kg, and has warm extremities. The fluid used to replenish his body fluids should contain:

A. High levels of sodium
B. No sugar
C. Lower levels of potassium
D. Deionised water
E. More potassium

92. 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 elemental iron to all preterm babies