Mount Kenya University · School of Medicine · Paediatrics and Child Health
Paper details
- Paper: Mount Kenya University Year 6 MBChB end of semester CAT. No date is printed, so it is filed as undated.
- Questions: Section A has 30 multiple choice questions with five choices each, one mark each, no negative marking. Choose the best answer.
- What this page has: 29 of the 30 MCQs. Question 30 (malathion poisoning) is cut off at the bottom of the last page of the scan, so it is left out.
- Topics tested: gastro-oesophageal reflux, Wilms tumour, cerebral palsy, Duchenne muscular dystrophy, congenital hypothyroidism, severe pneumonia, immunisation, malaria, visceral leishmaniasis, respiratory distress syndrome, neonatal jaundice, nephrotic syndrome, tetralogy of Fallot, diabetes, fluid and electrolyte disturbances, asthma, breastfeeding, helminths, hepatitis B, haemophilia, urinary tract obstruction, heart failure, HIV, anaemia, schistosomiasis, shock and malnutrition.
- Answers: written by OmpathStudy for revision. They are not the official MKU marking scheme.
- Questions that need care: Many of these questions are tricky, and several have more than one defensible option. The ones to be careful with are Q1, Q4, Q8, Q9, Q12, Q14, Q15, Q17, Q20, Q22, Q23, Q24 and Q26. The explanation says which option is best and why.
Multiple choice questions
1. Andrew, 8 months, has vomited since birth and has recurrent pneumonia. A barium oesophagogram shows gastro-oesophageal reflux (GOR) without an abnormal structure. A barium study at 2 months was reported as normal. Which is true?
- A. This condition might abate by 2 years without treatment
- B. Medical therapy is better at his age than in older children
- C. Keeping Andrew prone with the head elevated 30 degrees is a therapeutic measure
- D. The initial oesophagography missed the reflux due to the fact that GOR is an episodic event
- E. Iron deficiency is common in patients with severe disease
2. The following is true of pure red cell aplasia in a child:
- A. Growth is normal
- B. Corticosteroids may produce remission
- C. There is an increased risk of developing diabetes mellitus
- D. Chronic congestive cardiac failure is a known complication
- E. Iron supplementation is recommended
3. Atieno, 1 and a half years, has abdominal distension and blood in the urine, and a mass in the left flank. Which is true?
- A. Abdominal pain is a common feature in this condition
- B. Blood pressure is elevated in about two thirds of patients with the condition
- C. Immediate surgical excision of the organ is recommended before drug treatment
- D. Hemihypertrophy is associated with this condition
- E. Her prognosis is poor due to her age
4. Kamau, 4 years, started walking 6 months ago and has always had stiff lower limbs. He was born at home after a difficult delivery and did not cry for 3 days. He sat at 18 months, his intelligence and growth are normal. The following are true EXCEPT:
- A. Apparently normal intelligence is consistent with this condition
- B. Occupational therapy is crucial in Kamau's management
- C. He is at risk of developing epilepsy
- D. When Kamau is suspended by the axilla he will maintain a scissoring posture of the lower limbs
- E. This condition is largely preventable
5. Juma, 8 years, has a waddling gait and progressive weakness. He is intelligent and has large prominent calves. The following is true EXCEPT:
- A. The clinical diagnosis is based on finding a positive Gower sign
- B. The creatinine kinase level is elevated
- C. This condition is inherited as an X-linked dominant trait
- D. Cardiomyopathy is a constant feature of this disease
- E. Physiotherapy may prolong ambulation
6. Susan, 7 months, cannot support her head and is not sitting. She is often constipated, has a hoarse voice and a rough skin. The following are true EXCEPT:
- A. She has retarded bone development
- B. Delay in treatment is associated with severe mental retardation
- C. Children with this condition are normally hyperactive
- D. Treatment is curative and life-long
- E. Oedema is a feature of this condition
7. Kioko, 3 years, has a 3-day history of cough and body hotness, lower chest wall indrawing, and is unable to feed or drink. A chest X-ray shows diffuse opacities in the lower lobe. Which is true?
- A. She has pneumonia according to the WHO Acute Respiratory Infections classification
- B. Should be prescribed oxygen 5 to 6 L/min by nasal prongs
- C. Kioko should be put on a course of gentamicin and crystalline penicillin
- D. There is no effective vaccine against the most common offending pathogen
- E. Crystalline penicillin monotherapy is inadequate for treatment
8. Which is true about immunisation?
- A. High fever and severe pain following pentavalent vaccine administration is due to the pertussis antigen
- B. Presence of diarrhoea does not affect oral polio vaccination
- C. Hepatitis B, Hib, DPT, polio and measles vaccines may be given during a single visit to a 2-year-old child who has never had a vaccination before
- D. The hepatitis B vaccine given as per KEPI targets prevention of horizontal transmission of hepatitis B virus
9. The following are true of Plasmodium falciparum malaria EXCEPT:
- A. Hyperglycaemia is one of the features that characterise severe malaria
- B. Eight doses of Co-artem are required for a full course of treatment of non-severe malaria
- C. Severe malaria is not common among neonates born in malaria-endemic areas
- D. Acute renal failure is a common complication of malaria
- E. It is associated with increased susceptibility to bacterial infections among its victims
10. Daniel comes from Kitui and has a gross splenomegaly of 6 cm, anaemia and weight loss. A splenic aspirate reveals LD bodies. Which is true?
- A. His blood count is likely to show thrombocytosis
- B. Daniel has a decreased tendency to develop bacterial infection
- C. Response to treatment is usually very rapid and the spleen is likely to be impalpable after 4 weeks
- D. This condition is transmitted by a mosquito
- E. He should be screened for tuberculosis if he responds poorly to the treatment
11. A baby weighing 1.3 kg has severe chest indrawing and tachypnoea soon after birth. The baby is estimated to be 30 weeks gestation. Which is true?
- A. Administration of aminophylline is recommended
- B. A history of prolonged rupture of membranes is associated with reduction in the severity of the condition
- C. A chest X-ray is necessary for diagnosis
- D. The baby is unlikely to have an infection
- E. Even severe forms of this condition have a good outcome in intensive care nurseries
12. Baby Millicent, born 6 hours earlier, is jaundiced. The total bilirubin is 102 micromol/L with an indirect level of 90 micromol/L. The baby is blood group B rhesus negative. Which is true?
- A. This is likely to be rhesus incompatibility
- B. Plans should be made for an immediate exchange transfusion
- C. Baby Millicent should be put on phototherapy and bilirubin estimated again the following day
- D. This condition is associated with deafness
- E. If phototherapy is administered the photo-box should be placed 15 cm above the baby for maximum effect
13. A 6-year-old boy has a 3-week history of body swelling. He weighs 24 kg and has anasarca. The blood pressure is normal but he has poor capillary refill. Urinalysis shows proteinuria of 4+ and no blood. Urea 13.2 mmol/L, creatinine 154 micromol/L, sodium 121 mmol/L, protein 48 g/L. Which is true?
- A. The patient requires a normal saline infusion to correct the serum sodium
- B. Intravenous albumin solution is required
- C. Patients should receive intravenous antibiotics
- D. A low serum C3 is suggestive of minimal change glomerular disease
- E. He requires a liver biopsy
14. Two-year-old Njeri has varying blueness of the nail beds, lips and mucous membranes. The pulses and blood pressure are normal. She has a bulging left hemithorax, a loud harsh systolic murmur best heard over the left sternal border and a single second heart sound. The chest X-ray shows a boot-shaped heart and diminished pulmonary vascularity. Which is true?
- A. The systolic murmur is likely to be due to a ventricular septal defect
- B. Antibiotic prophylaxis is not indicated for dental procedures
- C. Heart failure is a common complication at this age
- D. Diarrhoeal illness is associated with a decreased risk of cerebral ischaemia
- E. Anaemia (relative iron deficiency) despite having a haematocrit level in the normal range is a common complication
15. A 7-year-old girl drinks more water than usual, has secondary enuresis and weight loss. Urinalysis shows sugar 3+, protein nil, blood nil. Random blood sugar is 17.4 mmol/L. Which statement is true?
- A. Emotional stress is not a known precipitating factor
- B. During follow-up, a level of glycosylated haemoglobin A of 12% indicates excellent control of blood sugar
- C. Administration of insulin results in translocation of potassium into the intracellular compartment
- D. Insulin requirement is likely to increase with onset of puberty
- E. Avoidance of refined sugar is unnecessary in children
16. Regarding fluid and electrolyte disturbances:
- A. Sodium bicarbonate is indicated in a patient with metabolic acidosis associated with respiratory failure
- B. Correction of metabolic acidosis in a patient with asymptomatic hypocalcaemia is likely to be associated with tetany
- C. Systemic acidosis results in translocation of potassium into the intracellular compartment
- D. Early salicylate poisoning is associated with respiratory acidosis
- E. Vomiting causes metabolic acidosis associated with hypokalaemia
17. Muasya, 3 years, 14 kg, is admitted with cough and difficulty in breathing, severe chest indrawing and wheezing. This is the fourth admission for the same condition in the last 6 months. The following is false EXCEPT:
- A. Bronchitis is a likely diagnosis
- B. A course of steroids is not recommended
- C. PCO2 is likely to be low
- D. Muasya's condition is not likely to improve with age
- E. Preventive strategies have a significant role in the management of this condition
18. The following is true of breastfeeding and breast milk:
- A. Human milk is a good source of vitamin C
- B. Breast milk has adequate vitamin D to meet the daily requirement of a four-month-old baby who is exclusively breastfeeding
- C. The regulation of milk production in full lactation is based primarily on maternal nutrition
- D. Exclusive breastfeeding prolongs the period of lactational amenorrhoea
- E. About 50% of children aged less than 4 months are exclusively breastfed in Kenya
19. Regarding helminthiasis in children:
- A. Ascaris lumbricoides infects the human host by penetrating the skin
- B. Hookworm infection is associated with intestinal obstruction in children with heavy infection
- C. Thiabendazole is the treatment of choice in strongyloidiasis
- D. Enterobius commonly causes nocturnal pruritus in symptomatic individuals
- E. Enterobius commonly causes rectal prolapse in heavily infected children
20. The following is true of hepatitis B:
- A. Morbidity is not significant in children
- B. In Kenya the prevalence of HBsAg is 8%
- C. Kenya belongs to the high endemic zone for hepatitis B
- D. Up to 40% of the Kenyan population receive the hepatitis B vaccine
- E. The incubation period of hepatitis B from exposure to onset of jaundice is 4 to 6 weeks
21. Njeru, 4 years, has a grossly swollen left knee joint. He had a similar episode before and there was no precipitating trauma. One of his maternal uncles bleeds excessively after minor injuries. Which is true?
- A. This condition is an X-linked trait
- B. All his sons are expected to be normal
- C. If the factor VIII levels are 80% of normal values, this is consistent with severe disease
- D. Fresh frozen plasma has no role in the management of this boy's condition
- E. Intramuscular injections should be given to this child
22. A 2-year-old male has had several episodes of febrile urinary tract infection, a poor urine stream and a distended bladder. The following is false:
- A. A micturating cystourethrogram is indicated
- B. A renal ultrasound is indicated
- C. Initial management includes a suprapubic tap to decompress the bladder
- D. Radionuclide renal scanning with DMSA is indicated to rule out obstruction
- E. Conservative management is recommended
23. The following statements are true about congestive heart failure in young infants:
- A. Hepatomegaly is not a common finding in infants with heart failure
- B. Pedal oedema is not a common finding in infants with heart failure
- C. Congenital heart lesions are frequent causes of heart failure
- D. There is limited role for diuretics in the treatment of heart failure in infants
- E. Tachycardia and pulmonary rales are not common manifestations of heart failure in infants
24. The following factors increase the likelihood of an infant acquiring HIV-1 infection from the mother EXCEPT:
- A. Advanced maternal disease
- B. Elective caesarean section
- C. Preterm delivery
- D. Use of septrin (co-trimoxazole) during pregnancy
- E. Maternal breast infection if the mother is breastfeeding the infant
25. Regarding iron-deficiency anaemia in infancy, the following is true EXCEPT:
- A. Total iron is often reduced
- B. Stool examination is pertinent
- C. Treatment consists of iron therapy
- D. Prematurity is a known risk factor
- E. It frequently follows acute malaria infection
26. The following statement regarding schistosomiasis is true:
- A. It may be associated with a carrier state for Salmonella species
- B. Schistosoma mansoni causes pathology mainly by producing fibrosis of the ureter and the bladder
- C. Complications of schistosomal infection are largely due to cercariae
- D. The treatment of choice for Schistosoma mansoni is an antimony-based compound
- E. A rectal snip often gives a yield of schistosoma ova compared with fresh stool examination
27. A 13-month-old baby is triaged as an emergency because he is "floppy". He has had non-bloody diarrhoea for three days. He does not respond to stimulation, and has tachycardia, a weak radial pulse that is difficult to feel, sunken eyes and deep acidotic breathing. He weighs 9 kg. What is the best plan of action?
- A. Give 50% dextrose stat
- B. Give 10% dextrose stat
- C. Ensure the airway is patent, give oxygen and administer 180 ml of normal saline within 15 minutes
- D. Administer 180 ml of normal saline within 15 minutes then check the airway
- E. Administer 30 ml/kg of Ringer's lactate in 30 minutes
28. The following are contraindications for carrying out a lumbar puncture in a child suspected to have meningitis EXCEPT:
- A. Opisthotonus and rigid posture
- B. Unequal pupils
- C. Irregular breathing
- D. History of repeated convulsions
- E. Pupils reacting slowly to light
29. A 9-month-old baby is admitted with features of marasmus and oedema of the face. She has moderate pallor. Which is true?
- A. Prevention and correction of hypoglycaemia is the first step in the management of the child
- B. This condition is associated with low total body sodium
- C. Potassium supplementation is not indicated
- D. Iron and folate should be prescribed on the day of admission
- E. Initial feeds should have high protein and high calories