UNIVERSITY EXAMINATION 2017/2018

END OF YEAR EXAMINATION FOR DIPLOMA IN CLINICAL MEDICINE

HMCE 1221- Paediatrics And Child Health 1 2019
DATE: Tuesday, 23rd July, 2019 TIME: 2.00 pm – 4.00 pm
INSTRUCTIONS

Answer all questions in section A and B and one question in section C

SECTION A- MCQ- CHOSE THE SINGLE BEST ANSWER

1. Which one of the following is false in regards to hypoglycemia in children

a. If untreated, it is associated with increased permanent brain injury.
b. Patients with altered level of consciousness should be promptly treated with
50% dextrose.
c. Rebound hypoglycemia can prevented by giving intravenous fluid with glucose
d. Hyperosmolar brain injury can result from dextrose overdose
2. Rickets can present with the following key features except.
a. Widening of the wrist joints
b. Pigeon chest deformity
c. Diarrhea
d. Geno valgum
3. The following are emergency sign except
a. Obstructed breathing
b. Central cyanosis
c. Irritable child
d. Severe respiratory distress
4. One of the following is a classical Presentation of Kwashiorkor.
a. Apathy
b. Old man's skin
c. Edema is not a key finding
d. Child is usually alert and irritable
5. Sickle cell emergency don't include
a. Priapism
b. Acute chest syndrome
c. Diarrhea
d. Stroke

6. ALL of the following can trigger painful sickle cell crisis except.
Page 1 of 8
 a. Hypoxia
b. Hunger
c. Exposure to extreme Cold
d. Infections
7. One of the following is not a pre-renal cause of the acute kidney failure.
a. Burns
b. AGN
c. Shock
d. Hemorrhage
8. All of the following are functions of kidneys except
a. Excretion of toxic products of metabolism
b. Blood pressure control
c. Acid base balance
d. None of the above
9. True in regards to hemophilia
a. Hemophilia A is due to deficiency of charismas factor
b. All daughters of hemophilia's are carriers
c. Hemophilia B is the most common subtype
d. All the above are false
10. Vitamin B12 deficiency can be caused by all of the following except
a. Crones disease
b. Diphyllobothrium latum
c. Deficiency of gastric intrinsic factor
d. Hook worms
11. All are cardinal features of shock except.
a. Capillary refill time of more than 3 seconds
b. Cold extremities
c. Pulse of normal caliber
d. Deteriorating level of consciousness
12. Management of severe dehydration, which statement is true
a. Best managed with rehydration protocol plan B
b. Give bolus of Ringers lactate at 20ml/kg body weight to run in 20minutes
c. ORS is the best choice of fluid in this case
d. None of the above
13. The following will prevent neonatal infections except
a. Keeping the child warm
b. Hand washing
c. Antenatal care
d. Daily cord cleaning with saliva

Page 2 of 8
14. Cyanotic spells in a patient with TOF can be managed with the following measures
except.
a. Knee chest position
b. High flow oxygen
c. Morphine should never be used since it may cause respiratory deterioration
d. Propanol
15. Complications of phototherapy don't include.
a. Photo dermatitis
b. Pneumonia
c. Dehydration
d. Hyperthermia
16. One of the following is not a cause of prolonged jaundice in a neonate
a. Rhesus incompatibility
b. G6PD deficiency
c. Congenital biliary atresia
d. Congenital hypothyroidism
17. True about severe pneumonia except
a. Treated with crystalline penicillin's and Gentamycin
b. Oxygen can be administered with nasal prolongs
c. Central cyanosis may be present.
d. A chest x-ray is mandatory to aid in diagnosis.
18. One of the following is cyanotic heart disease
a. PDA
b. Tetra logy of fallot
c. VSD
d. ASD
19. Minor criteria in diagnosis of Rheumatic fever include
a. Sydenham's chorea
b. Fever
c. Carditis
d. Erythema marginatum
20. One of the following is not a Complication of meningitis.
a. Mental retardation
b. Hydrocephalous
c. Tuberculosis
d. Cerebral abscess
21. All are causes of Apnea except
a. Convulsions
b. Overfeeding
c. Hypothermia
Page 3 of 8
 d. Sepsis
22. True about fluid management in a child with malnutrition
a. Shock is best managed with Ringers lactate
b. RESOMAI is the fluid of choice in all cases of dehydration
c. ORS is save in all cases of malnutrition
d. None of the above
23. All of the following can trigger Aplastic crises except
a. Infections
b. Exposure to high oxygen concentration
c. Dehydration
d. Acidosis

24. Complications of tonsillitis include all of the following except:

a. Rheumatic fever.
b. Post streptococcal glomerulonephritis.
c. Quincy.
d. Cellulites
25. The immediate action you would take when managing a child who has just collapsed
and stopped breathing is;
a. Quickly attempt fixing I.V cannula.
b. Urgently determine blood glucose level.
c. Give 5 rescue breath with BVM
d. Give 15 chest compressions.
26. Exudative pleural effusion can result from all of the following conditions except
a. Lung abscess.
b. Pneumonia.
c. Nephritic syndrome.
d. Pulmonary Tuberculosis.
27. HIV exposed infants, which statement is true
a. They should never be breastfed.
b. Nevirapine has no role in its management.
c. Positive antibody test after 18 months defines if the child is HIV positive.
d. They do not require treatment with ARVS.
28. The following are predisposing factors of PTB except
a. Sharing utensils
b. Diabetes mellitus
c. HIV / AIDS.
d. Malnutrition.

Page 4 of 8
29. All are key features in diagnosing CCF in children except
a. Tender smooth hepatomegaly.
b. Cardiomegaly.
c. Bradycardia.
d. Tachycardia.
30. One of the following is a feature of severe malaria.
a. Hypothermia.
b. Sweating.
c. Increased appetite.
d. Convulsions.
31. True in regards to bacterial meningitis.
a. Elevated glucose level.
b. Turbid CSF macroscopically.
c. Normal CSF proteins.
d. Low CSF proteins.
32. The following is not true about a normal newborn.
a. Head circumference of about 35cm.
b. Well-developed suckling reflex.
c. Birth weight of 2.5kg and above
d. Depressed moral reflex
33. All are complications of long term use of steroids therapy except.
a. Skin atrophy.
b. Decreased immune response
c. Hypersensitivity reaction..
d. Growth retardation.
34. The following are features of hyperthyroidism except.
a. Excessively sweating.
b. Weight gain.
c. Tachycardia.
d. Irritability / anxiety.
35. The best readily available way to make a diagnosis of PTB in children is;
a. Gastric lavage for gene expert.
b. Chest x-ray.
c. Blood examination.
d. Sputum cultures.
36. In triaging process, priority signs includes all of the following except.

Page 5 of 8
 a. Hyperthermia.
b. Obstructed airway
c. Severe palmer pallor.
d. Severe burns.
37. The following can cause Neck stiffness in children except
a. Pneumonia.
b. Meningitis.
c. Quincy
d. Acute ear infection

38. All of the following are true except one regarding neonatal resuscitation
a. A newborn baby born through meconium should be dried and stimulated first as the
initial part of resuscitation
b. Routine suction of the lower airway is not recommended
c. Babies should be kept warm to avoid switch off of the surfactant production.
d. If the baby hasn't take the first breath, initiate ventilation with 5 slow breaths then
BVM at 30-50 breaths per minute for 1 minute.
39. The following except one are cardinal features of shock
a. Cold extremities
b. Capillary refill time of more 1 sec
c. Weak or absent pulse
d. Altered level of consciousness
40. The following are predisposing factors of thyroid crisis except
a) Thyroid surgery
b) Handling of thyroid gland
c) Infections
d) Overfeeding
41. Insulin therapy is indicated in all of the following cases except
a) All types of diabetes
b) Diabetic patients undergoing surgery
c) Diabetic patients with infections
d) Diabetic foot
42. The following are found in patient with diarrhea and shock
a) Pulse of normal character
b) Capillary refill of more than 3seconds
c) Warm estimates
d) AVPU equals to A
43. Regarding DKA
a) It is the commonest presentation in type 2 diabetes mellitus

Page 6 of 8
 b) Kussmauls breathing rarely occurs in this condition
c) May be the first symptom in a previously undiagnosed diabetis mellitus
d) Infections rarely triggers this condition

44. One of the following is a cause of infectious diarrhea

a. Rota virus infection
b. Antibiotic therapy
c. Malnutrition
d. Cow's milk
45. In IMCI danger signs includes the following except
a. Convulsing now
b. Vomiting everything
c. Inability to feed
d. Hyperpyrexia
46. Management of severe dehydration, which statement is true
a. Best managed with rehydration protocol plan B
b. Initial phase of rehydration, give 30ml/kg then 70ml/kg with specific age dependent
instructions
c. ORS is the best choice of fluid in this case
d. None of the above
47. The following will prevent neonatal infections except
a. Home delivery
b. Hand washing
c. Antenatal care
d. Kangoroo mother care
48. Cyanotic spells in a patient with TOF can be managed through the following measures
except.
a. Knee chest position
b. High flow oxygen
c. Morphine should never be used since it may cause respiratory deterioration
d. Propranal
49. Complications of phototherapy don't include.
a. Photo dermatitis
b. Pneumonia
c. Dehydration
d. Hyperthermia

50. One of the following is not a cause of prolonged jaundice in a neonate

a. Rhesus incompatibility
b. G6PD deficiency
Page 7 of 8
c. Congenital biliary atresia
d. Congenital hypothyroidism

SECTION B: SHORT ANSWER QUESTIONS ATTEMPT ALL.

1. Outline causes of convulsions in children 5mks

2. Briefly discuss the clinical features of measles infection 5mks
3. Briefly discuss various types of sickle cell crisis. 5mks
4. Briefly discuss complications of prematurity 5mks
5. Outline how you would carry out triaging process in pediatric outpatient clinic 5mks
6. Outline Jones major criteria in diagnosing acute rheumatic fever 5mks

SECTION C: ATTEMPT ONE QUESTION 20 MKS EACH

1. Discuss in details the 10 steps approach in management of a child with severe acute
malnutrition 20mks
2. Discuss causes, investigations and management of acute renal failure 20mks

Page 8 of 8