REGISTRATION No___________________________________

MUHIMBILI UNIVERSITY OF HEALTH AND ALLIED SCIENCES

SCHOOL OF MEDICINE

DEPARTMENT OF PAEDIATRICS AND CHILD HEALTH

DOCTOR OF MEDICINE (MD)

MID - SEMESTER UNIVERSITY EXAMINATION

SEMESTER 9/10
DATE: AUGUST 26, 2020 TIME: 08:00 - 10:00 Hours

INSTRUCTIONS
 ANSWER ALL QUESTIONS

 CIRCLE THE MOST CORRECT ANSWER

1. Asha is 3 years and 8 months old, she is admitted because of poor weight gain for the past 3 months, examination
reveal severely wasted child with angular stomatitis. She is given special therapeutic diet for the first 7 days and
a new diet has been introduced, which of the following will be consistent with appropriate weight gain for this
patient.
A. 5 g/kg per day
B. 6 g/kg per day
C. 7.5 g/kg per day
D. 10 g/kg per day
E. 12 g/kg per day

2. Joshua is 2 years and 11 months old. He has history of high grade fever and dysuria. He was attended at a
private hospital and mother was asked to do urine culture, she bought a urine bag and wrapped the child in 2
hours later she obtained urine which was sent to the lab. The lab reported growth of Staphylococcus epidermidis
sensitive to vancomycin. Upon seeing these results what will be your appropriate action
A. Refer the patient
B. Give vancomycin
C. Repeat urine culture
D. Do full blood picture
E. Give paracetamol only

3. Two years old child known to have VSD is admitted with a 2 day history of fever, nausea, vomiting, anorexia
chills, and night sweats. He is admitted to the hospital for possible endocarditis and blood specimens are drawn
for culture. What is the most common microorganism found in pediatric infective endocarditis?
A. Escherichia coli
B. Staphylococcus aureus.
C. Streptococcus viridans
D. Streptococcus pyogenes
E. Streptococcus Pneumoniae

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 4. A 5 weeks neonate born to a HIV positive mother was brought to the health facility for vaccination today. Her
mother was started on a combination of Effervirenz/Tenofovir/Lamivudine during pregnancy and has opted for
breastfeeding. In addition to the vaccination, Tanzania guidelines what is the recommended blood sample to be
taken from this child today?
A. CD4 testing
B. Viral load test
C. Dry blood spot
D. Rapid test for HIV
E. HIV resistance test

5. A five years old child is admitted with history of joint pain and myalgia, RDT test for malaria was positive, he
is weighing 25 kg. His FBP reveals Hb of 4.9 g/dL, MCV 53.2 fL and MCH 12.8 pg, but he is clinically well
with PR of 98/min, RR of 18/min. All of the following are correct regarding immediate management of this
child EXCEPT?
A. Doing serum ferritin
B. Doing serum total iron
C. Doing Total iron binding capacity
D. Giving ferrous sulphate 200 mg 12 hourly
E. Transfusing Packed red blood cells 250 mls

6. A 16 years old girl, newly diagnosed with HIV today, has CD4 count 980cells/mm3. She has been
apparently well until when she went for medical check-up as a requirement for her medical
examination report attached to her new school joining instruction. According to the Tanzania national
guideline which of the following statement is correct.
A. She should start Nevirapine prophylaxis
B. She should start Antiretroviral treatment
C. She should start Cotrimoxazole prophylaxis
D. She should start ARV when CD4 drops below 350 cells/mm3
E. She should start ARV when CD4 drops below 500 cells/mm3

7. A 3 years old child was admitted was referred to MNH because of delayed developmental milestone.
The patient also presented with recurrent fever, weight loss, generalised lymphadenopathy and oral
candidiasis. HIV test (Rapid antibody test) was positive. What is the most likely HIV stage of this
patient?
A. Stage I
B. Stage II
C. Stage III
D. Stage IV
E. Stage IVB

8. A 2-week-old infant develops fever (T 38.9⁰ C). Pregnancy and delivery were uncomplicated. On examination
the infant is irritable, has heart rate of 170 bpm and respiratory rate of 40 breaths/min. The anterior fontanelle is
full, but he has no neck stiffness; the rest of the examination is unremarkable. The following statement
regarding this infant’s condition is appropriate:
A. Prescribe oral amoxicillin for 10 days
B. Order cranial ultrasound followed by an LP
C. Prescribe i/m Ceftriaxone and follow-up in one week
D. Perform an LP, blood culture, urine culture, and admit the child
E. Neck stiffness is a reliable finding of meningitis even below 18 months of age

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9. Mwanahamisi is a 7-year-old girl who presents to hospital with history of palpitation, difficult breathing,
orthopnoea and lower limb swelling for the past 5-weeks. Upon examination: PR = 130 bpm, RR = 40 brpm and
lower limb oedema. Precordial examination: apex beat was at 7th ICS with a holosystolic murmur at the apex
radiating to the axilla. Regarding this patient:
A. Antibiotics are strongly recommended
B. The most likely diagnosis is infective endocarditis
C. Diuretics are likely to alleviate this patient’s symptoms
D. Surgery must be done before the patient reaches 10th birthday
E. Tricuspid regurgitation is the most likely cause of this patient’s symptoms

10. A 2 years old child is admitted because of abdominal distension and constipation for two days, 3 days
preceding the onset of these symptoms patient had diarrhoea with mucoid blood stained stool with
absence of bowel sounds with sodium of 132 meq/L and potassium of 3.4 meq/L. All of the following
are appropriate in managing this patient EXCEPT?
A. Giving nil orally
B. Catheterizing the patient
C. Inserting nasogastric tube
D. Doing MRI of the abdomen
E. Doing plain abdominal x-ray

11. John is 8 years old; he was admitted because of dyspnoea and cough for 4 weeks. For the past one week he has
been unable to lay down flat. He gave history of fever, joint pain and skin rashes 5 months prior to the onset of
above symptoms, the following is true regarding John’s illness;
A. He should receive penicillin prophylaxis three weekly
B. He should be vaccinated against bacterial endocarditis
C. He should receive Amoxillin for dental carries treatment
D. He should receive gentamycin prophylaxis before tooth extraction
E. He should receive Amox-clavulanic acid prophylaxis for abdominal surgery

12. A ten years girl is admitted because of fever and cough for 2 months. Her mother reports that she has lost 1 kg
in the past one month. After work up the diagnosis is reached and he is given several medications, which results
in jaundice after one week, which among the following is likely the cause of jaundice;
A. Isoniazid
B. Rifampicin
C. Ethambutol
D. Streptomycin
E. Pyrazinamide

13. Msumari is 9 years old, he is presenting with history of cough, difficulty in breathing easy fatiguability and
inability to lie flat. He had these symptoms for the past 2 months. Five weeks prior to onset of his illness he had
fever which was accompanied with joint pains, of which he was treated with antibiotics at local health facility.
On examination Msumari had precordial hyperactivity, left parasternal heave and an apical systolic murmur
with a thrill; regarding cardiovascular examination of Msumari, the murmur which was picked on cardiac
examination is
A. Grade I
B. Between grade I and II
C. Grade III
D. Between grade III and IV
E. At least grade IV

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14. Jane is a 7 years old child, who is complaining of somnolence (sleeping) during class hours, she also presented
history of excessive itching on perianal and perineal areas, and on physical examination no significant findings
were noted. The most likely diagnosis for Jane is
A. Syphilis
B. Gonorrhoea
C. Enterobiasis
D. Bacterial vaginosis
E. Vaginal candidiasis

15. A 35-week preterm female is 4 hours old. She was born by emergency LSCS due to breech position after preterm
labour. Her mother received 1.2 g IV benzyl penicillin 3hours before delivery. APGARs were 91 and 95
respectively and birth weight was 2600 g. She has now had 4 episodes of apnoea >20 seconds, with her HR
dropping to <80 beats per minute and her SPO2 to <70%. She requires firm stimulation to resolve these episodes
and between episodes her SPO2 goes up to 96% on room air. Her examination is normal. Which one is the
MOST appropriate next step in the management of her apnoea?
A. Administer IV caffeine
B. Place her on 100% oxygen
C. Intubate and ventilate the baby
D. Perform a septic work-up and start IV antibiotics
E. Start continuous positive airway pressure (CPAP) ventilation

16. A 4 years old child is brought to the emergency room, with history of high grade fever for 9 days, cough and
difficulty in breathing for 6 days. On examination he is febrile, with nasal flaring and lower chest wall in-
drawing, he has reduced chest movement on the right side, stony dull percussion note and reduced breath
sounds on the same side, the most likely diagnosis is;
A. Pericardial effusion
B. Pnemothorax on the right side
C. Lung collapse on the right side
D. Lobar pneumonia on the right side
E. Empyema thoracis on the right side

17. You are working in an EMD department and you receive a very sick child who required resuscitation. After
resuscitation you have admitted the child in the acute paediatric care unit. The nurse on duty has called you
asking for your advice on which will be the most suitable method of administering oxygen to the 5 months old
baby you just admitted. The most appropriate advice will be
A. Head box
B. Face mask
C. Nasal prongs
D. Nasal catheters
E. Nasopharyngeal catheters

18. A 3 months old child was delivered by mother who was noted to be HIV infected after delivery, the child had
good growth until the age of 2 months when she started having poor weight gain, and she was tested with DNA
PCR for HIV and was positive. The attending physician decided to give ART. Which of the following will be
ART combination of choice for this child?
A. AZT,3TC and EFV
B. AZT, 3TC and NVP
C. Tenofovir, 3TC and EFV
D. AZT, 3TC and indinavir/r
E. ABC, 3TC and lopinavir/r

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19. Aisha is a 4 years old girl, referred from Temeke hospital because of recurrent episodes of difficulty in
breathing since birth and has a tendency to squat very often when playing with friends. On examination she has
central cyanosis and prominent digital clubbing, chest x- ray shows the boot shaped heart. The following is true
about Aisha:
A. ECG will show left atrial hypertrophy
B. Chest x- ray will show increased vascular markings
C. On cardiac examination she will have left ventricular heave
D. She needs Benzathine penicillin monthly to prevent endocarditis
E. Echocardiogram will show right ventricular outflow obstruction

20. Ashura who is 7 years old is brought to the paediatric ward with history of recurrent fever for the past 2 months;
mother gave history of easy bruising and bleeding on teeth brushing. On examination she was pale, with
tachycardia PR 124/min, no peripheral enlarged lymph node was noted. FBC revealed WBC count of 0.8 K/µL,
platelets was 24 K/µL and Hb was 4.3 g/dL, reticulocyte was 0.5%. What is most likely diagnosis for this patient
A. Pure red cell aplasia
B. Acquired aplastic anaemia
C. Acute myelocytic leukaemia
D. Acute lymphoblastic leukaemia
E. Idiopathic thrombocytopenic purpura

21. Zuedi is a 5 years old orphan whose mother died 3 years ago due to recurrent fever, chronic cough and severe
wasting. He is brought to hospital because for the past 8 months he has developed painless, slowly progressive
dark skin lesions on the legs. His grandmother feels that he is growing too slowly compared to his peers though
he never had major illnesses. On examination you notice other lesions on the soft palate. The most likely
diagnosis for his skin lesions is:
A. Melanoma
B. Neuroblastoma
C. Kaposi’s sarcoma
D. Neurofibromatosis
E. Hodgikin lymphoma

22. A 7 year old male presents to his primary care physician with the chief complaint of dark "cola coloured" urine,
facial puffiness and abdominal pain for the past 2 days. He had been in his usual state of good health until 14
days ago when he had a sore throat and fever. His sore throat and fever resolved. He was not seen by a
physician at that time. Over the past 2 days facial puffiness has been noted, but no swelling of his hands or feet.
What is the commonest causative organism for this child’s illness?
A. Streptococcus faecalis
B. Staphylococcus aureus
C. Streptococcus pyogenes
D. Streptococcus pneumonia
E. Staphylococcus epidermidis

23. A seven years old sickle cell anaemia patient presented with rapid onset general body weakness without fever.
Upon examination, she had severe palmar pallor and pulse rate was 130 bpm. She had a gallop rhythm on
auscultation. She also had splenomegaly (8 cm) and tender hepatomegaly (5 cm). Haemoglobin level was
2gm/dl. The most likely cause of this patient’s presentation is:
A. Haemolytic crisis
B. Splenic sequestration
C. Acute chest syndrome
D. Sickle cell hepatopathy
E. Haemolytic uremic syndrome

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24. Anna is 3 years and 6 months old child has history of abdominal mass which was noted by her mother when
bathing the child, later the noted to have haematuria. An attending physician have requested a number of tests,
which of the following tests will you not immediately consider for this child:
A. Urinalysis
B. Chest x-ray
C. Full blood count
D. Electrocardiogram
E. Abdominal ultrasound

25. An eight months old child born to HIV infected mother was brought to you with a history of fever and weight
loss for 3 weeks and cough for 4 weeks. Mantoux test was 12mm. chest X-ray was normal. What is the
management of the child?
A. Start 2RHZE, 4RH
B. Observe for any changes
C. Start isoniazid prevention therapy
D. Repeat chest X ray after 3 months
E. Repeat Mantoux test after 6 months

26. A mother of a 2 years and 3 months old child brought the child to the EMD and she is worried that the child has
swallowed 15 tablets of paracetamol 6 hours ago, as she found the baby fondling with drug bottle and one tablet
in the mouth. Which of the following will you consider the appropriate treatment of choice for this child?
A. Atropine
B. Naloxone
C. Adrenaline
D. Acetylcystein
E. Desferioxamine

27. Joshua is 3 years old with history of poor weight gain and generalized body swelling; he was also
noted to have low grade fever for three weeks and peeling of the skin in the lower limbs. A diagnoses
of severe acute malnutrition and moderate anaemia were made, which of the following is correct
regarding this patient’s treatment
A. Ferrous sulphate should be started immediately
B. Metronidazole should be given to cover anaerobes
C. Ampicillin and gentamycin should be given to this patient
D. He should start to gain weight immediately on starting F75
E. Blood slide for malaria parasite is not indicated in view of duration of fever

28. A 5 year old boy with a known seizure disorder is brought to the emergency department for evaluation of
prolonged hemiparesis following one of his typical focal, right sided seizures. He has been sick with a cold for 2
days, but has been able to take his usual medicines for seizure control. On physical examination, he is found to
be appropriate but drowsy. His neurological examination is significant for right-sided weakness and a positive
Babinski reflex on the right. Over the next 24 hours, his symptoms completely resolve. The most likely
diagnosis is:
A. Stroke
B. Cerebral tumour
C. Todd’s paralysis
D. Status epilepticus
E. Transient Ischaemic Attack

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 29. Beata is 8 years old; she is admitted in the ward due to history of easy fatigability, shortness of breath and cough
especially on lying flat. Three weeks prior to the onset of these symptoms she had fever and skin infections on
both upper and lower limbs, she also had joint pain and swelling on the knees and elbows. On examination she
had pedal oedema, tachypnoeic, had tachycardia, and displaced apex beat and systolic murmur which was
radiating to the axilla. Regarding Beata’s condition which of the following is correct:
A. ASOT test is not important
B. Paracetamol is indicated for Beata
C. CXR will reveal normal size of heart
D. Propranolol should be given to Beata
E. Renal function tests should be performed

30. A 5 years old child has history of generalized body swelling and reduced urine output for three days, swelling
started on the face and later involved the abdomen and lower limbs. On examination he had some palmar pallor
and anasarca, BP was 85/54 mmHg. Urinalysis revealed protein +4. Which of the following tests will you request
in evaluation of this child
A. Esbach test
B. Urobilinogen
C. C-reactive protein
D. Urinary vanylmandelic acid
E. Erythrocyte sedimentation rate

31. A 7 years old child is admitted because of reduced urine output and passing blood in urine, on examination he is
noted to have puffy face, pedal oedema and BP of hypertension. He gave history of sore throat 15 days prior to
the onset of symptoms. His laboratory investigation results show creatinine 143 µmo/L, Na+ 126 mmol/L, K+
4.6 meq/L. All of the following are true regarding this child EXCEPT?
A. Chest x-ray is should be performed for this patient
B. Diuretics should be given to this child in view of oedema
C. Penicillin is indicated to prevent spread of infection to siblings
D. The patient should be given high salt diet because of hyponatremia
E. Urinary red blood cell casts is consistent with acute glomerulonephritis

32. Zainabu has a 2 years and 7 months old child who stopped breastfeeding at 2 years, she attended a well-baby
clinic and she is worried that her child is not taking adequate food. She asks you for advice as what will be the
proper feeding schedule for her child. Your appropriate advice should be
A. Give family foods 5 times a day and fruit juices twice a day
B. Give family foods 4 times a day and nutritious fluids twice daily
C. Give maize porridge with milk and margarine 3 times a day and family foods 2 times
D. Give family foods 3 meals each day. Also twice daily give nutritious snacks between meals
E. Give adequate servings of locally appropriate nutrient-dense foods or family foods 5 times a day

33. A new born was delivered by C/S and is admitted for care in the neonatal ward. The nurse consults you because
there is paternal dispute and the mother has confessed that she is not sure of the two men which one is the real
father of the child. Which of the following tests is the most reliable to solve this dispute?
A. RNA PCR
B. Minor blood group
C. Major blood group
D. Mitochondrial DNA
E. DNA finger printing

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 34. A 16-day-old female infant with birth weight 1750g is self-ventilating and has been on full NGT feeds of breast
milk with no medications. She is noted temperature of 37.6°C, PR 180 beats/min and RR 65 breaths/min. She
has been well covered. Septic work-up for infection is done and urine is collected using a collecting bag. Urine
microscopy results show: WBCs: 30 000/mL; RBCs: 20 000/mL; Epithelial cells: 30,000/mL and bacteria are
seen. Which one is the MOST appropriate next step in management?
A. Uncover the baby
B. Start oral antibiotics
C. Repeat the urinalysis
D. Collect a suprapubic aspirate
E. Perform a renal ultrasound scan

35. John is 3 months old child who is admitted because of history of diarrhoea for the past 3 weeks, there
is no history of blood in stool, on examination he is alert, with no sunken eyes, his abdomen is
distended with no bowel sound, his deep tendon reflexes were also absent. The most likely cause of
these signs is
A. Intussusception
B. Severe dehydration
C. Severe hyponatremia
D. Severe hypokalaemia
E. Severe hypocalcaemia

36. A 2 years old child is brought to the hospital with history of cough and fever for the past three days, on
examination he was noted to be febrile, tachypnoeic (RR 43 b/min),SO2 98%, on auscultations there were
crepitations on the right infra-mammary area. Which of the following will be appropriate treatment for this
child
A. IV Ampicillin
B. IV Cloxacillin
C. IV Ceftriaxone
D. Oral Amoxillin
E. Oral Cloxacillin

37. A 15 months old female presents to the Emergency department, with a history of bloody stool. She was well until
this afternoon when she developed episodes of inconsolable crying, as if she is in pain. The parents state that she
pulls her legs up and cries for 7 to 8 minutes and then seems to feel better. There has been no history of fever,
vomiting or diarrhoea. Just prior to arrival, she passed a maroon-coloured mucoid stool. The baby has a palpable
mass in the right upper abdomen. Which of the following is the most likely diagnosis?
A. Intussusception
B. Acute appendicitis
C. Acute cholecystitis
D. Viral gastroenteritis
E. E coli O157-H7 bacterial enteritis

38. Anifani is 12 years old and is presenting with history of weight loss for the past 2 months, on examination he
was noted to be wasted and enlarged lymph nodes on the axilla, which of the following is true regarding his
condition
A. DNA PCR for HIV should be done
B. He needs an urgent lymph node biopsy
C. There is no need for evaluating sputum for AFB
D. Kaposi sarcoma is one of the differential diagnosis
E. Pyridoxine may be contraindicated in his treatment

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39. Ahmed is a 13 years old boy. He was referred from Lindi due to fever for 6 weeks, easy fatigability, generalized
lymphadenopathy and hepatosplenomegaly. FBP showed WBC 87k/µl of which 97% are lymphocytes, Hb 3g/dl
and PLT 20k/µl. All of the following investigations should be done urgently except?
A. CXR
B. Peripheral smear
C. CSF for cytospin
D. Serum electrolytes
E. Blood grouping and cross matching

40. A two years old girl is brought to the EMD. She has a history of bloody diarrhoea for 3 days, and low grade fever.
On examination she is noted to be alert, to have some pallor, normal eyes and normal skin turgor. Her RR is
40bpm, PR 98bpm. Which of the following is the recommended treatment for this child?
A. Zinc, ORS and ceftriaxone
B. Zinc, ORS and erythromycin
C. Zinc, ORS and ciprofloxacin
D. Zinc, ORS and nalidixic acid
E. Zinc, ORS and Chloramphenicol

41. John is presenting with skin rashes which are itching and are confined to his hands and feet, especially on the
webs of fingers. His mother also has similar condition. After taking history and physical examination, the
attending clinician has decided to give treatment for this illness, what will be the appropriate treatment for John?
A. Acyclovir cream
B. Mupirocin cream
C. Miconazole cream
D. Hydrocortisone cream
E. Benzyl Benzoate Emulsion

42. Spana is 6 years old child presenting with history of fever for 3 days, dysuria and increased frequency of
micturition. On examination he had supra-pubic tenderness. Urinalysis showed 10 WBC/HPF, the most likely
organism causing her illness is;
A. Enterococci spp
B. Escherichia coli
C. Proteus mirabilis
D. Streptococcus faecalis
E. Staphylococcus aureus

43. A new born had normal APGAR score at birth but developed excessive frothing and chocking on attempted
feeds. The investigation of choice is:
A. CXR
B. MRI chest
C. Bronchoscopy
D. Esophagoscopy
E. Abdominal ultrasound

44. Asha has delivered a 3.5 kg baby by SVD, the baby is doing well and started breastfeeding one hour after
delivery. She was not tested for HIV during pregnancy but was tested one week after delivery and she was HIV
positive. The baby was also tested using rapid assay and the result showed HIV positive. Which of the
following is true regarding Asha’s baby;
A. Asha’s baby should stop breastfeeding
B. Asha’s baby is definitely infected with HIV
C. Asha’s baby need to be undergo DNA PCR for HIV at 6 weeks
D. Asha’s baby will need to start ART if the same test is positive at 6 weeks.
E. Asha’s baby should be given nevirapine prophylaxis until six months of age
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45. You have been called to a refugee’s camp to attend children who are sick; there is a group of children who are
sick. In order to treat those children you need to decide which ones you will attend to first, which of the
following will you consider as emergency sign
A. Severe pain
B. Sunken eyes
C. Respiratory distress
D. Severe palmar pallor
E. Temperature of 42°C

46. A baby who was born at home is brought to the hospital on the 4th day of life, you are informed that the
delivery was assisted by traditional birth attendant and no problem was encountered. You are doing physical
examination and you noted a pan systolic murmur on the lower left sternal border with, the rest of CVS
examination was normal, the most likely diagnosis is;
A. Atrial septal defect
B. Patent foramen ovale
C. Patent ductus arteriosus
D. Rheumatic heart disease
E. Ventricular septal defect

47. A seven years old child has history of generalized body swelling, reduced urine output and passing blood in
stool. On examination he is noted to have anasarca, and hypertension. Which of the following features is not
consistent with the diagnosis of nephrotic syndrome in this child
A. Protein +2 in urine
B. Normal serum urea
C. Oedema of the face
D. Hypoalbuminaemia
E. Hypercholesterolemia

48. Asha has delivered a 3kg male baby, whose APGAR score is 8-10 in the first and 5th minute respectively. The
following will be your correct advice regarding cord care of Asha’s baby
A. Cord stump should be cleaned with spirit
B. Cord stump should be cleaned with soap and water
C. Cord stump should be cleaned with medicated soap
D. Nothing should be put on the cord stump until it drops
E. Cord stump should be cleaned with boiled water with soap

49. Which of the following features may be used to distinguish anaemia of chronic inflammatory condition from
iron deficiency anaemia in a 5 years old child whose haemoglobin level is 9.6 g/dL
A. High serum ferritin level
B. Low serum ferritin level
C. Increased serum iron level
D. low total iron binding capacity
E. High total iron binding capacity

50. An 8 year old girl is brought into the hospital while actively seizing. She has been hospitalized many times
before for status epilepticus. She is receiving Valproic acid at home to control seizures. The first management
of this patient is to:
A. Administer rectal diazepam immediately
B. Administer activated charcoal via NG tube
C. Administer 20 ml/kg of 0.9% normal saline
D. Stabilize the airway and provide 100% oxygen
E. Establish secure intravenous access and administer an anticonvulsant

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 51. A 3.5kg newborn baby is referred to the emergency with difficulty in breathing and central cyanosis since birth.
On examination he has diminished breath sounds in the left chest and the abdomen is scaphoid. You suspect
congenital diaphragmatic hernia. The first clinic intervention you would do is?
A. Insert and IV line
B. Insert and nasogastric tube
C. Give oxygen 2 litre per minute
D. Bag and mask assisted ventilation
E. Ventilate with high frequency ventilator

52. Fred is a 3 year old brought to the emergency department due to sudden onset of cough and difficulty in
breathing with stridor for 1 day. On examination his temperature was 36.5ºC, respiratory rate 60 breaths/min and
he has decreased breath sounds on the right side of chest with wheezing on the same side. Your MOST likely
diagnosis will be?
A. Croup
B. Epiglottitis
C. Severe pneumonia
D. Acute asthmatic attack
E. Foreign body aspiration

53. Yohana is a 2-year-old infant noted to have mild cyanosis and assumes a squatting position during long walks.
He is noted to have increasing fussiness followed by increasing cyanosis, limpness and unresponsiveness. The
MOST appropriate sequence of managing his condition is?
A. Propanolol, knee chest position, oxygen, IV fluids, IV morphine
B. Oxygen, knee chest position, IV morphine, IV fluids, propranolol
C. Oxygen, knee chest position, IV morphine, propranolol, IV fluids
D. Knee chest position , oxygen, propranolol, IV fluids, IV morphine
E. Knee chest position, oxygen, IV morphine, propranolol, IV fluids

54. Innocent is 4 years old. He has history of bleeding easily for the past one week. This was preceded by febrile
illness. On examination he is relatively well except for some pallor and patechiae haemorrhage spots on his
chest, upper and lower limbs. Full blood count revealed WBC 6 K/µL, Hb 8.9 g/dL, platelets 65K/µL. The most
likely diagnosis is?
A. Acute leukaemia
B. Hodgkin’s Lymphoma
C. Von Willebrand disease
D. Idiopathic thrombocytopenic purpura
E. Disseminated intravascular coagulopathy

55. A 3 years old child is presenting with skin infection characterized by pustules and high grade fever, the most
likely organism responsible for this disease is?
A. Proteus mirabilis
B. Clostridium difficile
C. Klebsiella pneumoniae
D. Streptococcus pyogenes
E. Staphylococcus epidermidis

56. A 5 months and 2 weeks old infant is admitted with history of poor weight gain, on examination he is noted to
be severely wasted, with some pallor and with no pedal oedema. In the management of this child which of the
following will be the preferred diet
A. Breast milk
B. Formula 75 diet
C. Formula 100 diet
D. Diluted Formula 75 diet
E. Diluted Formula 100 diet
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 57. A 4.8kg baby is born at term by SVD. Four hours post-delivery he develops convulsions and RBG is found to
be 0.8mmol/L. The antenatal history was uneventful. The most likely cause of hypoglycaemia in this baby is
A. Patau syndrome
B. Hypothyroidism
C. Delayed feeding
D. Edward’s syndrome
E. Beckwith syndrome

58. You are examining the abdomen of the patient who is complaining of abdominal pain for 4 months. You have
noticed a mass on the left lumbar area, if this mass is the kidney which of the following features do you expect
to find:
A. Dull percussion note
B. Resonant percussion note
C. Stony dull percussion note
D. Absence of percussion note
E. Presence of succession splash

59. Agnes is a 6 months old child presenting with fever. Cough and difficulty in breathing for 3 days. She is noted
to have skin pustules, bluish discolouration of lips, respiratory rate is 66/min and temperature is 39.5°C. No
history of convulsion or loss of consciousness is reported. Chest X ray was performed and it showed diffuse
patchy opacification with pneumatocoele. Full blood count showed WBC count of 16K/µL with predominance
of neutrophils. Regarding this child what is the most likely aetiology of his disease
A. Staphylococcus aureus
B. Haemophilus influenzae
C. Streptococcus pyogenes
D. Streptococcus pneumoniae
E. Staphylococcus epidermidis

60. Juma is a 6 year old admitted due to fever, weight loss and recurrent cough. On examination his weight was 14
kg and his MUAC of 10 cm. You consider starting him on nutritional therapy but are cautious in monitoring.
Which of the following is NOT a consequence of re-feeding syndrome?
A. Tachycardia
B. Tachypnoea
C. Hyperkalaemia
D. Hypervolaemia
E. Hyperglycaemia

END

12
REGISTRATION No___________________________________

MUHIMBILI UNIVERSITY OF HEALTH AND ALLIED SCIENCES

SCHOOL OF MEDICINE

DEPARTMENT OF PAEDIATRICS AND CHILD HEALTH

DOCTOR OF MEDICINE (MD)

SEMESTER 9/10

MID - SEMESTER UNIVERSITY EXAMINATION

DATE: JANUARY 29, 2020 TIME: 08:00 - 10:00 Hours

INSTRUCTIONS
 ANSWER ALL QUESTIONS

 USE THE ANSWER SHEET PROVIDED

1. The parents of a 6-week-old male infant bring in their son for evaluation of noisy breathing of 2 weeks’ duration.
They state that delivery was normal and the infant has been exclusively breast feeding with appropriate weight
gain. The noise occurs during inspiration and worsens when the infant is placed supine or cries. The parents
have not noticed any rhinorrhoea, fever, or other symptoms consistent with an upper respiratory tract infection.
Of the following, the MOST likely explanation for the noisy breathing is:
A. Vascular ring
B. Laryngomalacia
C. Milk protein allergy
D. Airway foreign body
E. Gastroesophageal reflux

2. A 16-year-old girl presents to the emergency room with complaints of “heavy” vaginal bleeding. She had
menarche at the age of 13 years. Previously her menstrual cycles were regular, lasting 28 days with 5 days of
bleeding. For the past 6 months, her menstrual bleeding has lasted between 7 and 11 days. She has bled through
her clothes overnight. On the family history, her father required multiple cauterizations for frequent epistaxis.
Laboratory evaluation revealed an isolated prolongation of the PTT. Her most likely diagnosis is?
A. Haemophilia A
B. Haemophilia B
C. Lupus anticoagulant
D. Factor XI deficiency
E. Von Willebrand disease

3. A 2- year old boy was admitted due to fever and convulsions lasting for 10 minutes which was followed by loss
of consciousness. On examination, he was unconscious with a Glasgow Coma Scale of 7, febrile with neck
stiffness. CSF analysis showed Total cell count 200/µl (with lymphocyte 20 and polymorphs 180), protein
0.8g/dl and glucose 1.5 mmol/L. Regarding the complications of this condition:
A. Ventriculitis is rare in neonates and infants
B. The commonest cranial nerve affected is facial nerve
C. OFC should be monitored for early detection of hydrocephalus
D. Hypernatremia may indicate development of Syndrome of Inappropriate ADH Secretion
E. Steroids are indicated in all children with this condition to prevent neurological sequelae
1
4. A 6-year-old male presents to his primary care physician with the chief complaint of dark "cola
coloured" urine, facial puffiness and abdominal pain for the past 2 days. He had been in his usual state
of good health until 14 days ago, when he had a sore throat and fever which resolved. He was not seen
by a physician at that time. Over the past 2 days facial puffiness has been noted, but no swelling of his
hands or feet. What is the commonest causative organism for this child’s illness?
A. Streptococcus faecalis
B. Staphylococcus aureus
C. Streptococcus pyogenes
D. Streptococcus pneumonia
E. Staphylococcus epidermidis

5. You are evaluating a 12-year-old boy in the emergency department who presents with fever, chills, malaise, and
blood in his urine. On physical examination, he appears comfortable, alert and has a temperature of 39.3°C, a
blood pressure of 110/40 mm Hg, no rashes and clear breath sounds. He has a diastolic murmur heard best in the
sitting position. You elicit no abdominal or flank tenderness. Of the following, the BEST next step in the
management of this patient is
A. Urine culture
B. Blood cultures
C. Renal ultrasonography
D. Transoesophageal echocardiography
E. Administration of broad-spectrum antibiotics

6. A 13-year-old girl was diagnosed with chronic hepatitis B infection 5 years ago, her primary risk factor
was recurrent blood transfusions. Her liver disease is progressing, as measured by persistently elevated
alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels. A liver biopsy done 6
months ago, showed chronic active hepatitis. She has never been treated for chronic hepatitis. Which
of the following is the most important goal of treatment for chronic viral hepatitis B infection?
A. Improve symptoms
B. Decrease symptoms
C. Normalize ALT and AST
D. Reduce levels of HBV-DNA
E. Eliminate HBsAg from serum

7. A 2-month-old infant is being evaluated by a paediatric cardiologist. The infant was noted at birth to have an
upper left sternal border ejection murmur. The infant at that time was not cyanotic, but slowly developed
cyanosis over the next two months. The ECG showed right axis deviation and right ventricular hypertrophy and
chest x-ray film showed a small heart with a concave main pulmonary artery segment and diminished
pulmonary blood flow. Which of the following is the most likely diagnosis?
A. Tetralogy of Fallot
B. Hypoplastic left ventricle
C. Isolated atrial septal defect
D. Transposition of the great arteries
E. Complete atrioventricular canal defect

8. The parents of a 20-month-old female bring her to your office because she has lost consciousness twice recently.
They describe two episodes where the child was crying vigorously then “turned purple and passed out.” The
child is an otherwise healthy product of a term delivery. There is no history of head trauma and no family history
of seizures or cardiac problems. The episodes are not associated with fever or other symptoms. Physical
examination of the child is normal. Which one of the following would be most appropriate at this point?
A. Reassurance
B. Echocardiography
C. CT scan of the brain
D. ECG and chest radiograph
E. Measurement of serum glucose, electrolytes, and haematocrit

2
9. Lucy is a 7-years-old girl who presents to hospital with history of palpitation, difficult breathing, orthopnoea
and lower limb swelling for the past 5-weeks. Upon examination: PR = 130bpm, RR = 40brpm and lower limb
oedema. Precordial examination: apex beat is at 7th ICS with a holosystolic murmur at the apex radiating to the
axilla. Regarding this patient:
A. Antibiotics are strongly recommended
B. The most likely diagnosis is infective endocarditis
C. Diuretics are likely to alleviate this patient’s symptoms
D. Surgery must be done before the patient reaches 10th birthday
E. Tricuspid regurgitation is the most likely cause of this patient’s symptoms

10. A 4-year-old boy presents to the clinic for evaluation of a 3-day history of fever (temperature 38.5°C),
congestion, and sore throat. Physical examination of the well-appearing child shows only rhinorrhoea
and pharyngeal erythema. His mother and 6-year-old sister have had colds over the past week. Of the
following, the MOST appropriate treatment for this child, pending the results of the throat culture, is
A. Prednisone
B. Amoxicillin
C. Azithromycin
D. Pseudoephedrine
E. Nasal saline drops

11. A previously healthy 2-year-old girl had 3 days of bloody diarrhoea last week that spontaneously resolved. Her
mother now thinks she looks pale. On examination she is afebrile, her heart rate is150bpm, and her blood
pressure is 150/80 mm Hg. She is pale and irritable, has lower-extremity pitting oedema and has scattered
petechia. The following statement regarding this girl’s condition is true EXCEPT:
A. Steroids will not be helpful
B. Complete blood count will show thrombocytopaenia
C. Platelet transfusion will not be helpful in her management
D. Will need contrast upper GI series with small bowel delay films
E. Careful management of fluids and electrolyte balance is necessary

12. 7-year-old boy known to have sickle cell anaemia is admitted because of pain on the left lower limb which
makes him limp. On examination he is found to have a penetrating wound and tenderness around the left knee
joint. The X- ray shows features suggestive of osteomyelitis. The following statement is true regarding this
patient:
A. The patient has been sick for about one week.
B. Infarction is easy to distinguish from osteomyelitis.
C. He needs to be treated with IV antibiotics for 10 days to avoid complications.
D. Osteomyelitis could be caused by the usual bone infecting organisms in this patient.
E. The most common causative organisms include salmonella and staphylococcal species

13. A two-year-old child is due to travel in the next two weeks to India for treatment. She has never received either
Hepatitis A or B vaccines. What is the best choice for immunoprophylaxis against Hepatitis A?
A. A dose of Hepatitis A vaccine
B. A dose of IM immunoglobulin
C. A combination of Hepatitis A and Hepatitis B vaccine
D. A dose of IM immunoglobulin and a dose of hepatitis A vaccine
E. First dose of Hepatitis A vaccine today and a booster dose before she leaves

14. You are an intern doctor, unfortunately you got a needle stick injury while attending a child who is known to be
HBsAg- positive. You have been previously vaccinated against hepatitis B five years ago, and you are a known
non-responder. What post-exposure prophylaxis should you take?
A. One dose of Zidovudine
B. One dose Interferon -alpha
C. One dose of Hepatitis B vaccine
D. Testing for Anti-HBs levels and treat accordingly
E. One dose of HBIG and one dose of Hepatitis B vaccine
3
15. A 15 – month – old boy is brought to the emergency department with a fever and difficulty breathing. Right –
sided wheezing is noted on the physical examination. The patient does not improve with aerosolized nebulizer
treatment. The expiratory chest x-ray film demonstrates right-sided hyperinflation. The following is consistent
with this boy’s diagnosis EXCEPT?
A. Empyema is the likely diagnosis
B. Pneumothorax is unlikely diagnosis
C. The inspiratory CXR film may appear normal
D. Foreign body aspiration is the likely diagnosis
E. The condition is most common in children 6 to 30 months old

16. Suzan is a 16-year-old who was diagnosed with Hepatitis B infection 3 months ago, after she was
raped by her neighbour. During her follow up clinic, you noted that she is HBsAg negative and Anti-
HBs-positive. What is your comment on her Hepatitis B status?
A. She is a chronic carrier
B. She is currently in remission
C. She is developing chronic hepatitis
D. Her hepatitis infection has resolved
E. She is still in the acute phases of illness

17. You are called to review a 2-year-old child who is known to have ingested kerosene. Upon examination, the
child had severe respiratory distress with grunting, cyanosis and rhonchi. The following treatment options are
indicated except?
A. Gastric lavage
B. Assisted ventilation
C. Supplemental oxygen
D. Ipecac-induced vomiting
E. Pulse oximetry monitoring

18. A 4-year-old boy is brought to the emergency department suspected of ingesting poison 2 hours ago. Upon
examination he was restless, sweating with excessive lacrimation, tearing and had respiratory distress and
tremors. Pupils were constricted. Regarding this patients:
A. Atropine is urgently recommended
B. Succinyl choline is indicated in this patient
C. Pralidoxime is contraindicated in this patient
D. Tracheal intubation is the first treatment option
E. The most likely cause is paracetamol poisoning

19. A four-year-old child is presenting with fast breathing at the clinic, his mother reports that it has been there for
the past 12 hours. In the past two weeks prior to onset of fast breathing he has been feeling thirsty excessively
with increased frequency of passing urine with no dysuria. Which of the following laboratory findings will you
expect in this child?
A. Protein +3 on urinalysis
B. Haemoglobin of 2.5 g/dL
C. Blood glucose of 4.6 mmol/L
D. Glycated haemoglobin of 10%
E. Serum creatinine of 234 umol/L

20. A 2-year-old who had a simple brief febrile seizure is brought to the clinic 1 day later. He is afebrile, active and
is taking antibiotics for an ear infection diagnosed the previous day. His mother wants to know what to expect
in the future regarding his neurologic status. The following will be appropriate to tell her:
A. EEG is generally recommended
B. He does have a risk of future febrile convulsions
C. When he gets children, his children are unlikely to have seizures
D. He will need to take anticonvulsants for 6 to 12 months to prevent further seizures
E. He has no risk of further seizures because he was 2 years at the time of his first febrile seizure

4
21. An 11-year-old boy is seen at the clinic for growth delay. He has gradually fallen off the growth curve from the
50th percentile to below 3rd percentile for height over the past 2 to 3 years. His appetite has decreased and he is
sleeping more than usual. He has also developed nocturia. His examination, in addition to his growth delay,
reveals pallor and a BP of 180/110 mmHg. He also has enlargement of wrists and enlargement of costochondral
junctions. Which of the following is most likely to reveal the diagnosis?
A. Full blood picture
B. X-ray of the wrists
C. Serum BUN and Creatinine
D. Serum calcium and phosphorous
E. Measurement of the 1, 20-dihydrocholecalciferol

22. A 16-day-old female infant with birth weight 1750g is self-ventilating and has been on full NGT feeds of breast
milk with no medications. She has a temperature of 37.6 °C, PR 180 beats/min and RR 65 breaths/min. She has
been well covered. Septic work-up for infection is done and urine is collected using a collecting bag. Urine
microscopy results show: WBCs: 30 000/mL; RBCs: 20 000/mL; Epithelial cells: 30,000/mL and bacteria are
seen. Which one is the MOST appropriate next step in management?
A. Uncover the baby
B. Start oral antibiotics
C. Repeat the urinalysis
D. Collect a suprapubic aspirate
E. Perform a renal ultrasound scan

23. A 4-week-old, formula-fed male infant has a history of blood-stained stools with mucous for the past few days.
His mother reports that he has been crying more than usual lately but has had no fever or vomiting. Examination
reveals mild abdominal distension but is otherwise normal. You suspect cow’s milk protein allergy. The
following is the most appropriate regarding this patient’s diagnosis:
A. Change his diet to an alternative protein source
B. This infant is matured enough to respond to allergy skin testing
C. Abdominal radiographs are necessary for the diagnosis of this child
D. Small bowel biopsy is the appropriate next step to confirm diagnosis
E. Stool-reducing substances and abnormal pH will be found on stool examination

24. A 35-week preterm female is 4 hours old. She was born by emergency LSCS due to breech position. Her mother
received 1.2 g IV benzyl penicillin 3 hours before delivery. APGARs were 91 and 95 respectively and birth weight
was 2600g. She has now had 4 episodes of apnoea >20 seconds, with her HR dropping to <80 beats per minute
and her SPO2 to <70%. She requires firm stimulation to resolve these episodes and between episodes her SPO2
goes up to 96% on room air. Her examination is normal. Which one is the MOST appropriate next step in the
management of her apnoea?
A. Administer IV caffeine
B. Place her on 100% oxygen
C. Intubate and ventilate the baby
D. Perform a septic work-up and start IV antibiotics
E. Start continuous positive airway pressure (CPAP) ventilation

25. Previously healthy 5-day-old male who was born at home develops bruising and melena. The pregnancy,
delivery, and postnatal course were unremarkable. The infant is breastfeeding vigorously every 2 hours.
Findings on physical examination are unremarkable except for several large bruises. Laboratory testing reveals:
haemoglobin, 81 g/L (8.1 g/dL); white blood cell count, 9.4 x 109/L (9,400/mm3); prothrombin time, 37 seconds;
partial thromboplastin time, 39 seconds; platelet count, 242 x 109/L (242,000/mm3); and fibrinogen, 2.34 g/L (234
mg/dL). Of the following, the MOST likely cause of the bleeding is?
A. Liver disease
B. Vitamin K deficiency
C. Von Willebrand’s disease
D. Factor VIII deficiency haemophilia
E. Disseminated intravascular coagulation

5
26. A 5-week old male infant started having increasing frequency of vomiting after feeds. The vomitus is mainly
undigested milk and non-bilious. On examination he appears slightly wasted with a soft abdomen, non-tender,
olive shaped mass in the epigastrium. He has a normal urine output and is passing normal stools. Which is the
MOST appropriate diagnostic investigation?
A. Serum pH.
B. Abdominal ultrasound
C. Upper GI contrast study
D. Lower GI contrast study
E. Plain abdominal radiography

27. A 13-year-old adolescent male with HIV infection is being treated with trimethoprim-
sulfamethoxazole (TMP-SMX) for Pneumocystis pneumonia. Adverse reactions that can occur during
TMP-SMX therapy include all of the following EXCEPT?
A. Pancreatitis
B. Neutropenia
C. Renal dysfunction
D. Nausea and vomiting
E. Stevens-Johnson syndrome

28. A two-month-old child is seen at EMD with history of excessive sweating and interruption during breastfeeding.
The admitting doctor noted a pan-systolic murmur grade IV at left lower sternal border. Which of the following
is true regarding this child?
A. ECG will not be informative
B. He should get chest CT done
C. He has patent ductus arteriosus
D. He may benefit from spironolactone therapy
E. He should be screened for hepatitis A infection

29. Joan is a 7-year-old girl admitted to the hospital because of body swelling which started on the face
and later involved the abdomen and lower limbs. On examination he was noted to have puffy face,
with ascites. The doctor is considering Nephrotic syndrome is the likely diagnosis, which of the
following features is not consistent with this diagnosis
A. Proteinuria
B. Haematuria
C. Hyperlipidaemia
D. Hypoalbuminemia
E. Elevated serum creatinine

30. An eight months old child born to HIV infected mother was brought to you with a history of fever and weight
loss for 3 weeks and cough for 4 weeks. Mantoux test was 12mm. Chest X-ray was normal. What is the
management of the child?
A. Start 2RHZE, 4RH
B. Observe for any changes
C. Start isoniazid prevention therapy
D. Repeat Chest X-ray after 3 months
E. Repeat Mantoux test after 6 months

31. A grandmother brought her 3-year-old granddaughter with failure to thrive for 5 months. Her body weight is
8kg and her height is 100cm. Weight for Height is between -2SD and -3SD. The management of this child
includes
A. High protein diet
B. RUTF 2 Sachets a day
C. F75 110mls/kg for 24hours
D. F100 110mls/kg for 24hours
E. Ceftriaxone 100mg/kg od for 5 days
6
 32. Lilian, an 18-month-old child who presented with joint pain, jaundice and fever. She was diagnosed to have
Sickle cell anaemia and the mother wanted to know about the complications of this condition. All of the
following are complications of this condition EXCEPT?
A. Cholelithiasis
B. Hyposthenuria
C. Proliferative retinopathy
D. Avascular necrosis of the hip
E. Superior vena cava syndrome

33. Nancy is a 5 years old child recently diagnosed to be HIV positive. On examination the child has, extensive
wart virus infection, generalized lymphadenopathy, Molluscum Contagiosum, Herpes zoster and Kaposi
sarcoma, oral hairy leucoplakia, laboratory findings show thrombocytopenia (<50 × 109/L3). The attending
doctor says that this child is in WHO stage 4. Which of the following is a feature of stage 4 disease in this child?
A. Herpes Zoster
B. Kaposi sarcoma
C. Oral hairy leucoplakia
D. Molluscum Contagiosum
E. Extensive wart virus infection

34. A 4-year-old boy is presenting with recurrent cough and weight loss, the boy was recently diagnosed to be HIV
infected. On examination, he has generalized lymphadenopathy, parotitis, digital clubbing and cyanosis. Which
of the following is the most likely diagnosis?
A. Pulmonary tuberculosis
B. Mycoplasma Pneumonia
C. Pneumocystis pneumonia
D. Lymphoid interstitial pneumonitis
E. Mycobacteria avian complex (MAC) pneumonia

35. Infant of Zawad is a term female baby with birth weight of 2600g. She is admitted in your ward at 12hours after
delivery due to yellow discoloration of body, lethargy and inability to breastfeed. The MOST important
investigation to determine the cause of the jaundice presenting in the first 24 hours of life is?
A. Blood culture
B. Serum bilirubin
C. Blood grouping
D. Full blood picture
E. Random blood glucose

36. A 7-year-old girl is seen at your office because of significant multiple joints pain and swelling for the past two
weeks. She has had low grade fever, has some pallor and has had some malaise. There is no family history of
arthritis. An ASO titre is negative and her ESR is 80 mm/hr. One of your diagnostic considerations is Juvenile
Rheumatoid Arthritis (JRA). Which one of the following statements regarding this diagnosis is correct?
A. An ANA test would not be helpful in this case
B. The prognosis in polyarticular JRA is generally good
C. Polyarticular JRA occurs with equal frequency in both sexes
D. A rheumatoid factor is the best test to confirm the diagnosis of JRA
E. It is important to have an ophthalmologic consultation in polyarticular JRA

37. A ten months old infant is brought to health centre with cough for three days. On examination, respiratory rate
was 56 breaths/min. According to IMCI what is the management of choice?
A. Urgently refer the child
B. Intravenous 10% dextrose 5mg/kg bolus
C. Amoxicillin 40mg/kg twice a day for 5 days
D. Intravenous ceftriaxone 100mg/kg od for 5days
E. Intravenous ringer lactate 100mls/kg in 6 hours
7
38. A three years old child with generalized body swelling for two weeks, the swelling started on the face and later
involved the abdomen and lower limbs. On examination, he is afebrile, with some pallor, ascites, which of the
following is true regarding this child?
A. He should get MRDT test
B. He should get urinalysis done
C. Low density lipoprotein should be done
D. He is unlikely to get deep venous thrombosis
E. He should be given 2 mg/kg prednisolone for six months

39. A 15 months old female presents with a history of bloody stool. She was well until this afternoon when she
developed episodes of inconsolable crying, as if she is in pain. The parents state that she pulls her legs up and
cries for 7 to 8 minutes and then seems to feel better. There has been no history of fever, vomiting or diarrhoea.
Just prior to arrival, she passed a maroon-coloured mucoid stool. The baby has a palpable mass in the right upper
abdomen. Which of the following is the most likely diagnosis?
A. Intussusception
B. Acute appendicitis
C. Acute cholecystitis
D. Viral gastroenteritis
E. E coli O157-H7 bacteria enteritis

40. Clara is a 7- year-old girl develops behavioural changes, and her performance in school begins to deteriorate.
Several months later she develops a seizure disorder, ataxia, and focal neurologic symptoms. She is eventually
quadriplegic, spastic, and unresponsive. Death occurs within a year. This patient may have had which of the
following viral diseases at 1 year of age?
A. Mumps
B. Measles
C. Chickenpox
D. Parvovirus B19
E. German measles

41. A 15-year-old boy presents after 1 week of progressive fatigue followed by 2 days of jaundice.
Laboratory studies demonstrate serum ALT 225 IU/l, ALP of 330 IU/l and bilirubin of 88.9µmol/L
with normal albumin and INR. A liver ultrasound was normal. He recently returned from a one-week
vacation in the Uganda. A positive value for which of the following tests most likely explains this
situation?
A. Anti-HEV
B. Anti-HDV
C. Anti-HCV
D. Anti-HAV IgM
E. Anti-HB surface

42. You have assessed Alphonso, who is 3 years old, for airway and breathing and you found he has severe
respiratory distress but the airway is patent. What will you do next?
A. Quickly assess for circulation
B. Quickly secure an intravenous access
C. Give oxygen 2L/min by oxygen mask
D. Give IV DNS 20 mls/kg to treat shock
E. Complete assessment then initiate treatment

43. An 8-year-old girl is brought into the hospital while actively seizing. She has been hospitalized many
times before for status epilepticus. She is receiving valproic acid at home to control seizures. The first
management of this patient is to:
A. Administer rectal diazepam immediately
B. Administer activated charcoal via NG tube
C. Administer 20 ml/kg of 0.9% normal saline
D. Stabilize the airway and provide 100% oxygen
8
 E. Establish secure intravenous access and administer an anticonvulsant

44. A 10 months old girl was referred to the haematology clinic from Mwananyamala hospital for further
investigations. Her Full blood picture showed Hb 7.2g/dl, MCV 62fl and MCH 21pg. The aetiology of
anaemia in this child could be one of the following EXCEPT:
A. Thalassaemia
B. HIV infection
C. Iron deficiency
D. Copper deficiency
E. Sideroblastic Anaemia

45. You are asked to review a term newborn male infant because his mother is a hepatitis B carrier. The baby is now
2 hours of age and is starting to breastfeed from his mother. The mother's serology is as follows: HBsAg positive,
HBeAg negative, anti HBeAb positive. Which is the MOST appropriate next step in the management of this
baby?
A. Stop breastfeeding and start formula feeding
B. Administer Hepatitis B vaccine within 72 hours
C. Administer Hepatitis B immunoglobulin within 24 hours
D. No management is required because of low risk of transmission
E. Administer both Hep B immunoglobulin and Hep B vaccine within 10 hours

46. You are seeing a 2-year-old child in a Paediatric outpatient clinic for a recheck visit after a local emergency
department physician diagnosed sinusitis. She has continued to have symptoms of unilateral purulent nasal
discharge and fetid breath. She has not responded to a 10-day course of amoxicillin therapy. Of the following,
the MOST likely cause of her nasal symptoms is:
A. Recurrent sinusitis
B. Nasal foreign body
C. Seasonal allergic rhinitis
D. Antimicrobial-resistant sinusitis
E. Viral upper respiratory tract infection

47. A previously well child 12 year old girl is admitted because of painful swellings on the front of the legs of about
three days duration. Examination reveals tender erythematous nodules, 1 to 2 cm in diameter, on the extensor
surfaces of lower legs. The remainder of the physical examination is unremarkable. Which of the following is
most likely to confirm the cause of this condition?
A. HIV DNA PCR
B. Echocardiogram
C. Urinalysis and BUN
D. Throat culture and ASO titre
E. Slit lamp examination of the eye

48. At a routine healthy clinic visit of a 3-year-old child, you detect a systolic murmur that has never heard before.
In addition, the cardiac examination demonstrates a right ventricular impulse in the precordium and a widely
split second heart sound. An electrocardiogram demonstrates right ventricular hypertrophy. What is the most
likely heart lesion in this child?
A. Atrial septal defect
B. Coarctation of Aorta
C. Mitral valve prolapse
D. Patent ductus arteriosus
E. Isolated tricuspid regurgitation

49. Simon has been diagnosed with ALL. His chemotherapy was started 2 days ago, but he has not received enough
fluids. His condition has deteriorated and he is not passing adequate urine. You request serum biochemistry
panel and results come back urgently. You expect all of the following except?
A. Hypernatremia
B. Hyperkalaemia
9
 C. Hyperuricaemia
D. Hyperglycaemia
E. Hyperphosphatemia

50. The parents of a 6-year-old child bring him to your office for a “second opinion.” He is “sick all the time” and
his parents fear “something is wrong with his immunity.” Of the following observations generated from a
thorough history and physical examination, which one would suggest the need for additional laboratory or
radiographic studies to assess his immune competence?
A. Chronic constipation
B. Weight loss and failure to thrive
C. Six episodes of otitis media in the preceding ten months
D. Three episodes of impetigo in the preceding twelve months
E. Recent pneumonia secondary to Streptococcus pneumoniae

51. Jerome is a 2-year-old infant noted to have mild cyanosis and assumes a squatting position during long walks. He
is noted to have increasing fussiness followed by increasing cyanosis, limpness and unresponsiveness. The
MOST appropriate sequence of managing his condition is?
A. Propranolol, knee chest position, oxygen, IV fluids, IV morphine
B. Oxygen, knee chest position, IV morphine, IV fluids, propranolol
C. Oxygen, knee chest position, IV morphine, propranolol, IV fluids
D. Knee chest position , oxygen, propranolol, IV fluids, IV morphine
E. Knee chest position, oxygen, IV morphine, propranolol, IV fluids

52. Abdul is 4 years old. He has history of bleeding easily for the past one week. This was preceded by febrile
illness. On examination, he is relatively well except for some pallor and petechial haemorrhage spots on his
chest, upper and lower limbs. Full blood count revealed WBC 6 K/uL, Hb 8.9g/dL, platelets 65K/uL. Abdul’s
most likely diagnosis is?
A. Acute leukaemia
B. Hodgkin’s Lymphoma
C. Von Willebrand disease
D. Idiopathic thrombocytopenic purpura
E. Disseminated intravascular coagulopathy

53. A15 year old female presents following a sore throat with chest pain, fever, and a skin rash. Examination reveals
a diastolic murmur. Her ASO titre is elevated. Which of the following is a major criterion for the diagnosis of
Rheumatic fever?
A. Fever
B. Raised ESR
C. Migratory arthritis
D. Erythema multiforme
E. Prolonged PR interval

54. During a cardiovascular system examination in a child the blood pressure in the lower extremities as
compared to the arms is usually:
A. The same
B. 10 mmHg lower
C. 10 mmHg higher
D. 20 mmHg lower
E. 20 mmHg higher

55. A 2-year-old boy presents with rales, pallor, chronic failure to thrive, recurrent thrush, diarrhoea, and oxygen
saturation of 84% on room air. Echocardiography demonstrates an enlarged left ventricle with diminished
systolic function. Which of the following blood tests is MOST likely to establish this boy’s diagnosis?
A. Serum carnitine level
B. Serum selenium level
C. Antibody testing for human parvovirus
10
 D. Antibody testing for Epstein-Barr virus
E. Antibody testing for human immunodeficiency virus

56. A 9-year-old boy is seen in your clinic with a skin rash he has had for the past 2 days. The rash is mostly on his
trunk and seems to come and go. The rash is red and slightly raised, appears to migrate and is non-pruritic. He
gives a history of having had a sore throat about 2 weeks ago and has had low grade fevers and joint pains. An
ASO titre is 1:625. Which one group of findings would confirm the diagnosis of acute rheumatic fever?
A. Arthritis, no fever, ESR 10
B. Arthralgia, fever, no rash and ESR 120
C. Subcutaneous nodules, fever and arthralgia
D. Erythema multiforme, arthralgia and prolonged PR interval
E. Arthralgia, no fever, and a rash resembling erythema multiforme

57. A 5-year-old boy is hospitalized in January with fever and seizures. Lumbar puncture reveals clear cerebrospinal
fluid that has a white blood cell count of 47/cu mm, all of which are lymphocytes. On physical examination, he
appears he appears to have altered level of consciousness but arouses with painful stimuli. Neurologic
examination reveals no focal findings. Of the following, the diagnostic test that is MOST likely to reveal the
aetiology of this child's illness is:
A. Viral culture of cerebrospinal fluid
B. Bacterial culture of cerebrospinal fluid
C. Viral culture of nasopharyngeal and rectal swabs
D. Streptococcus pneumoniae bacterial antigen test of cerebrospinal fluid
E. Polymerase chain reaction test of cerebrospinal fluid for herpes simplex

58. A 5-year-old boy with epilepsy is admitted for evaluation of prolonged hemiparesis following one of his typical
focal, right sided seizures. He has been sick with a cold for 2 days but has been able to take his usual medicines
for seizure control. On physical examination, he is found to be appropriate but drowsy. His neurological
examination is significant for right-sided weakness and a positive Babinski reflex on the right. Over the next 24
hours, his symptoms completely resolve. The most likely diagnosis is:
A. Stroke
B. Cerebral tumour
C. Todd’s paralysis
D. Status epilepticus
E. Transient Ischaemic Attack

59. Baby of Elizabeth is term male baby who is now 12 hours old. He had a good Apgar score of 81 and 105. Twenty
minutes after delivery he was noted to have central cyanosis and tachypnoea of 100 breaths per minute. He was
placed on oxygen therapy, his cyanosis resolved but he still had persistent severe respiratory distress. The
diagnosis can be confirmed by Chest X-ray. Which condition is the MOST likely cause for his presenting
symptoms?
A. Pneumonia
B. Congenital Diaphragmatic hernia
C. Transposition of the great arteries
D. Transient Tachypnoea of newborns
E. Persistent Pulmonary Hypertension in newborns

60. A 7 years old sickle cell anaemia patient presented with rapid onset general body weakness without fever. Upon
examination, she had severe palmar pallor and pulse rate was 130bpm. She has a gallop rhythm on auscultation.
She also had splenomegaly (8cm) and tender hepatomegaly (5cm). Haemoglobin level is 2gm/dl. The most
likely cause of this patient’s presentation is:
A. Haemolytic crisis
B. Splenic sequestration
C. Acute chest syndrome
D. Sickle cell hepatopathy
E. Haemolytic uremic syndrome

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C
 B

A
 A

C
A

D
 C

C
D

C
 A

C
C

C
 E

CAUTION! THE ANSWERS IN THIS SCRIPT ARE NOT CORRECT.