Mount Kenya University · School of Medicine · Paediatrics and Child Health
Paper details
- Paper: Year 4 MBChB end of semester CAT. No date or unit code is printed, so it is filed as undated.
- Questions: Section A has 30 MCQs with five choices each (one mark each). Section B has 5 short answer questions.
- Topics tested: dehydration and shock, neonatal sepsis, pathological jaundice, malnutrition, tetralogy of Fallot, milestones, Down syndrome, meningitis, birth asphyxia, prematurity, breast milk and rickets.
- Answers: written by OmpathStudy for revision. They are not the official MKU marking scheme.
- Questions that need care: Q4, Q5, Q9, Q11, Q19 and Q27 are loosely worded or have a defective option list, and the explanation says which option is best and why.
Multiple choice questions
1. A 4-year-old has acute diarrhoea, cannot drink, has weak pulses and is not alert. The most correct statement is:
- A. A weak pulse supports a diagnosis of some dehydration
- B. The extremities are likely to be warm
- C. This is likely severe dehydration
- D. Boluses of 20 ml/kg of normal saline are recommended
- E. ORS will be sufficient for fluid replacement
2. Which is the most correct statement about a 4-day-old neonate who is hot and feeding poorly?
- A. Neonatal sepsis is among the likely diagnoses
- B. Klebsiella has not been implicated
- C. A viral infection is an unlikely cause
- D. C-reactive protein has no role in management
- E. Give oral antibiotics and allow home
3. Of pathological jaundice in neonates:
- A. The onset is after 24 hours of life
- B. It presents as severe hyperbilirubinaemia
- C. The baby is otherwise well
- D. It only occurs when mother and neonate have ABO or rhesus incompatibility
- E. IV immunoglobulin has no role in management
4. Which childhood statistic for Kenya, from the Demographic and Health Survey (KDHS), is correct?
- A. Infant mortality: 22 per 1000 live births
- B. Neonatal mortality: 32 per 1000 live births
- C. Under-5 mortality: 114 per 1000 live births
- D. 61% of infants are exclusively breastfed
- E. Full vaccination coverage: 73%
5. Which is an emergency sign in triage?
- A. Diarrhoea with sunken eyes
- B. Restless
- C. History of convulsions
- D. Tiny baby
- E. High temperature of 40 degrees
6. A 5-month-old passes bloody stools and then starts bilious vomiting. You feel a mass in the abdomen, and the rectum is empty.
- A. This is dysentery
- B. Ultrasound has no role
- C. Surgical review is indicated immediately
- D. Give antibiotics and allow home
- E. If the diagnosis is delayed, mortality is not increased
7. Akinyi, 3 years, 8 kg, has visible severe wasting:
- A. IV benzylpenicillin and gentamicin have a role
- B. A weight-for-height Z score of more than minus 3 supports the diagnosis
- C. Her weight for age is likely above 80% of expected
- D. She should be started on a high protein diet immediately
- E. Her total body potassium is increased
8. Concerning evaluation of an infant with suspected congenital heart disease, which statement is FALSE?
- A. The absence of a murmur rules out the possibility of congenital heart disease
- B. Confirmation of the diagnosis is by echocardiogram
- C. Cyanosis is determined by physical examination
- D. A chest X-ray has a role in diagnosis
- E. Some infants are asymptomatic
9. Matala, a 2-year-old with diarrhoea and vomiting, has cold peripheries, weak pulses and is unresponsive. His MUAC is 9 cm. Which is correct in managing his dehydration?
- A. Give 20 ml/kg of Ringer's lactate to run over 15 minutes
- B. Give 20 ml/kg of Ringer's lactate with 5% dextrose to run over 2 hours
- C. Give ReSoMal 1 ml/kg/hour
- D. Give Ringer's lactate with 5% dextrose 30 ml/kg over 30 minutes, then 70 ml/kg over 2.5 hours
- E. Give 20 ml/kg of normal saline with 5% dextrose over 2 hours
10. The components of tetralogy of Fallot include all EXCEPT:
- A. Ventricular septal defect
- B. Transposition of the great arteries
- C. Pulmonary stenosis
- D. Overriding aorta
- E. Right ventricular hypertrophy
11. GW is a 12-month-old child. You expect him to:
- A. Speak 10 to 15 words
- B. Stare at his own hands
- C. Build a tower of 6 blocks
- D. Run
- E. Draw a circle
12. The clinical features of Down syndrome include all EXCEPT:
- A. Hypotonia
- B. Low-set ears
- C. Mental retardation
- D. Cleft lip and palate
- E. Atrioventricular septal defect
13. The following organisms cause meningitis in infants aged 0 to 2 years EXCEPT:
- A. Streptococcus pneumoniae
- B. Haemophilus influenzae
- C. Entamoeba histolytica
- D. Neisseria meningitidis
- E. Listeria monocytogenes
14. Which is NOT an absolute contraindication to lumbar puncture in a child?
- A. Bulging fontanelle
- B. Infection at the lumbar puncture site
- C. Lateralising signs
- D. Active cardiopulmonary resuscitation
- E. Unequal pupils
15. In unconjugated hyperbilirubinaemia, the risk of kernicterus increases with the use of:
- A. Ceftriaxone
- B. Phenobarbitone
- C. Ampicillin
- D. Sulphonamides
- E. Metronidazole
16. All of the following may be required in a one-hour-old infant with severe birth asphyxia EXCEPT:
- A. Glucose
- B. Dexamethasone
- C. Calcium gluconate
- D. Normal saline
- E. Therapeutic cooling
17. All of the following are features of prematurity EXCEPT:
- A. No creases on the sole
- B. Abundant lanugo
- C. Thick ear cartilage
- D. Empty scrotum
- E. Thin transparent skin
18. A 25-year-old had premature rupture of membranes and delivered a boy who was lethargic and apnoeic on day 1 and went into shock. A vaginal swab grew beta-haemolytic colonies of Gram-positive cocci. The most likely organism is:
- A. Streptococcus pyogenes
- B. Streptococcus agalactiae
- C. Peptostreptococci
- D. Enterococcus faecium
19. A newborn drools after feeds, has respiratory distress and froths at the mouth. The diagnosis is:
- A. Tracheo-oesophageal fistula
- B. TOF (tracheo-oesophageal fistula)
- C. Respiratory distress syndrome
- D. Meconium aspiration syndrome
- E. None of the above
20. Full-term small-for-dates babies are at high risk of:
- A. Hypoglycaemia
- B. Intraventricular haemorrhage
- C. Bronchopulmonary dysplasia
- D. Hyperthermia
- E. Hyperglycaemia
21. Breast milk at room temperature can be stored for:
- A. 8 hours
- B. 12 hours
- C. 24 hours
- D. 4 hours
- E. 1 hour
22. The following are radiographic features of rickets EXCEPT:
- A. Rickety rosary
- B. Decreased bone density
- C. Subperiosteal bleeding
- D. Increased width of the growth plate
- E. Cupping
23. The composition of breast milk per 100 ml is about:
- A. 67 kcal, 3.5 g protein, 3.5 g fat, 4.5 g carbohydrate
- B. 67 kcal, 1.2 g protein, 4 g fat, 4.5 g carbohydrate
- C. 67 kcal, 1.2 g protein, 4 g fat, 7 g carbohydrate
- D. 100 kcal, 3.5 g protein, 4 g fat, 7 g carbohydrate
- E. 100 kcal, 3.5 g protein, 4.5 g fat, 5 g carbohydrate
24. The length of a newborn is about:
- A. 100 cm
- B. 75 cm
- C. 50 cm
- D. 30 cm
- E. 20 cm
25. Breathing and swallowing movements are seen in the foetus by:
- A. 13 to 14 weeks
- B. 18 to 24 weeks
- C. 15 to 18 weeks
- D. 30 to 36 weeks
- E. 28 to 32 weeks
26. The birth weight of a newborn doubles by 5 months. Birth length doubles by:
- A. 1 year
- B. 2 years
- C. 3 years
- D. 4 years
27. Preference for one hand (handedness) is evident by:
- A. 6 months
- B. 1 year
- C. 2 years
- D. 3 years
- E. 6 years
28. The order of development of secondary sexual characteristics in boys is:
- A. Testicular enlargement, pubic hair, axillary hair, beard
- B. Pubic hair, testicular enlargement, axillary hair, beard
- C. Testicular enlargement, axillary hair, pubic hair, beard
- D. Axillary hair, beard, testicular enlargement, pubic hair
- E. Pubic hair, axillary hair, testicular enlargement, beard
29. The most common cause of cholestatic jaundice in the newborn is:
- A. Hypoplasia of the biliary tract
- B. Neonatal hepatitis
- C. Choledochal cyst
- D. Physiological jaundice
- E. Schistosomiasis
30. Visual acuity reaches adult level at:
- A. 7 years
- B. 9 years
- C. 3 years
- D. 1 year
- E. 10 years