QUESTIONS AND ANSWERS | APPRENTICESHIP IN PAEDIATRIC AND CHILD HEALTH | CMT NTA LEVEL 6

1. A 15 years old girl has a 1 month history of increased urinary frequency without dysuria and recent onset of itch rash beneath both breasts.  She is afebrile with erythematous, macular rash beneath both breasts. Urinalysis is significant for 2 + glycosuria but no pyuria.  

Which of the following is the most likely diagnosis?

A. Diabetes mellitus

B. Occult malignancy

C. Nephrotic syndrome

D. Human immunodeficiency virus

E. Long term use steroid (immune compromise)

 

2. A 2 day-old infant has significant nasal and rectal bleeding.  He was delivered by a midwife at home and umbilical cord was clamped properly which of the following vitamin deficits might explain this condition?

Which management intervention is contra indicated in a child admitted for kerosene poisoning:

A. Vitamin A

B. Vitamin B₁

C. Vitamin C

D. Vitamin D

E. Vitamin K

 

3. A breastfed infant is expected to have a lower incidence of which of the following?

A. Asthma

B. Impetigo

C. Diarrhea

D. Conjunctivitis

E. Urinary  Tract Infections

 

4. A baby was born by cesarean section to a 34 years old mother whose pregnancy was complicated by hypertension and abnormal fetal heart monitoring.  At delivery she is covered in thick, green meconium and is limp, apneic and bradycardic.  Which of the following is the best first step in her resuscitation?

A. Administer 5% dextrose by NGT

B. Administer RL by intravenous infusion

C. Initiate ambu bag – mask ventilation

D. Initiate chest compression

E. Do suction meconium and intubate

 

5. A term infant requires resuscitation after spontaneous vaginal delivery.  The Apgar score at 1, 5 and 10 minutes were 2, 7 and 9 respectively.  The nurse tells you that the father seamed very agitated and mentioned “suing the obstetrician” if the baby doesn’t turn out normal.  Your examination of baby reveals no abnormalities.  In counseling the parents, which of the following is appropriate?

A. Tell them your examination findings indicate everything is fine

B. Tell them the low Apgar score at 1 and 5 minute indicate the baby suffered perinatal asphyxia

C. Tell them any neurological deficit that the baby may likely develop can be contributed to events during delivering

D. Tell them your examination findings are reassuring and that you will perform a careful developmental assessment on every child’s visit

E. Avoid speaking to the parents until you have speaking to the obstetrician

 

6. A 30 hour old full term infant has face and chest jaundice.  He is breastfeeding well and has an otherwise normal examination.  His bilirubin level is 15.5mg/dL.  Which of the following is the most appropriate course of action?

A. Start phototherapy

B. No action is needed.

C. Start an exchange transfusion

D. Wait 6 hours and retest the serum bilirubin level

E. Recommend cessation of breastfeeding for 48 hours and supplement with formula

 

 

7. A 4 month old boy present at Kidodi Health Centre on a cold winter’s night with complaint of wheezing.  The father has given two puff of salbutamol inhaler, but the difficulty in breathing has not improved significantly.  Upon examination of the child, he is pale and perioral cyanosis. Respiratory rate 60 breaths/min and loud wheezes throughout the chest that obscure the heart sound.  Which of the following is the most likely diagnosis?

A. Pneumonia

B. Bronchiolitis

C. Cystic fibrosis

D. Gastro esophageal reflux

E. Trachea-esophageal fistula

 

8. A 13 year old boy has a 1 day history of fever and lethargy and was unable to be awaken this morning.  At emergency center his respiratory rate is 7 breath/min, heart rate 55 beats per minute, temperature (41C) and blood pressure 60/40 mmHg.  He has altered mental status, a stiff neck and purpuric rash over this trunk which of the following is the most appropriate next step in the management of this patient?

A. Call for help

B. Do lumber puncture

C. Give intravenous antibiotics

D. Do cardiopulmonary resuscitation

E. Give paracetamol to lone temperature

 

9. A 2 year old boy developed emesis and intermittent abdominal pain yesterday, with several small partially formed stools.  His parents were not overly concerned because he seemed fine between the pain episodes.  Today however he has persistent billions emesis and has had several bloody stools episodes.  Upon examination the abdomen is diffusely tender with vague tubular mass in right upper quadrant.  What is the most likely diagnosis?

A. Dysentery

B. Perianal trauma

C. Intussusception

D. Bleeding peptic ulcer

E. Hemolytic disease of the new born

 

10. A 2 years old child suddenly develops inspiratory stridor, tachypnea and chest retractions.  He had been playing with his 6 year old brother before this episode.  He is afebrile and apart from strider, his huge sounds are clear and his physical examination is otherwise normal.  A chest radiograph reveals no abnormalities.  

Which of the following is the best first line management?

A. Do ventilation by ambu bag

B. Administer oral dexamethasone

C. Administer parenteral antibiotic

D. Administer nebulized salbutamol

E. Evaluate the airway for obstruction

 

11. The baby presented with lower limb edema, muscle wasting poor appetite the food intake is adequate but have insufficient protein. What type of malnutrition is this?

A. Stunting

B. Kwashiorkor

C. Marasmus

D. Failure to thrive

E. Marasmic kwashiorkor

 

12. It is recommended to give zinc supplement to a child with diarrhea because:

A. Zinc is lost during episode of diarrhea

B. Zinc increase the appetite to drink ORS

C. Zinc reduce duration and severing of diarrhea

D. Zinc is macronutrient for a child over development

E. Zinc is antidiarrheal drugs for severe dehydration

 

13. An 18 years old primigravida at 36 weeks gestation age with eclampsia delivered a baby boy of 2.5 kg after prolonged labour.  Which among the following is most likely complication to the baby?

A. Hypoglycemia

B. Hyaline membrane

C. Meconium aspiration

D. Neonatal asphyxia

E. Anemia of prematurity

 

14. Which among the following is common cause of heart failure in school aged children?

A. Severe anemia

B. Fluid overload

C. Rheumatic fever

D. Tetralogy of fallout

E. Severe malnutrition

 

15. Which among the following urinalysis results may indicate urinary tract infection in children?

A. Proteunia + 3 with cast

B. Cast with red blood cells

C. Epithelial cells with proteomic

D. More than 15WBC/HPP with epithelial cells

E. More than 15 WBC/HPF in centrifuged urine with proteinuria

 

16. Which among the following drugs is used as prophylaxis in sickle cell disease?

A. Quinine

B. Artemether

C. Vitamin B12

D. Chloroquine

E. Ferro-sulphate

 

17. Which among the following investigation is useful in diagnosis of Tuberculosis in children?

A. Mantoux tuberculin skin test

B. Gastric aspirate

C. Chest X-Ray

D. Sputum

E. ESR

 

18. Which among the following is the first line treatment for HIV in children less than 36 months?

A. Zidovudine (AZT) + lamivudine (3CT) + Efavirenz (EFZ)

B. Stavudine (d4T) + LAMIVUDINE (3tc) + Efavirenz (EFZ)

C. Abacavir (ABC) + Lamivudine (3TC) + Efavirenz (EFZ)

D. Zidovudine (AZT) + lamivudine (3TC) + Nevirapine (NVP)

E. Stavudine (d4T) + lamivudine (3TC) Efavirenz (EFZ)

 

 

19. HIV infected children not yet eligible for ART should be monitored with CD4+ count in every:

A. Three month

B. Four month\five month

C. Five month

D. Six month

E. Seven month

 

20. Which among the following is a sign of moderate dehydration:

A. Grossly sunken eyes

B. Cyanotic extremities

C. Very dry mucus membranes

D. Tissue turgor retract slowly

E. Anterior fontanel very sunken

 

 

SECTION B: MULTIPLE TRUE/FALSE QUESTIONS       - 20

INSTRUCTIONS:

· Write the word TRUE for the correct statement and FALSE for the wrong statement in the space provided

· A half (½) of a mark will be awarded for each correct answer

 

1. The following is true in management of severe pneumonia:

A. TRUE : Give oxygen in nasal prong to prevent hypoxia

B. FALSE : Give inhaled steroids so to reduce inflammatory process

C. TRUE : Give intravenous antibiotic to resolve Para pneumonic effusion

D. FALSE : Give maintenance fluid to prevent dehydration

E. FALSE : Give bronchodilator to prevent bronchial obstruction

 

2. The following is true in management of neonate or young infant who has fit:

A. FALSE : If hypoglycemia give 10ml/kg of 10% glucose

B. TRUE : If hypocalcaemia give 2ml/kg of 10% calcium gluconate

C. FALSE : Manage the airway by giving oxygen in nasal prongs

D. TRUE : If hyperemic give paracetamol 15mg/kg every 6 hourly

E. TRUE : If convulsing give diazepam 0.5mg/kg rectally

 

 

 

 

3. In management of sickle cell crisis the following are true:

A. FALSE : Folic acid prophylaxis used to prevent vaso-occlusive crisis

B. TRUE : I.V. normal saline can be used in treatment of painful crisis

C. TRUE : Sequestration crisis can be treated with packed red blood cell

Transfusion

D. TRUE : Acute chest syndrome can be treated with exchange blood

Transfusion and oxygen

E. TRUE : A plastic crisis splenectomy recommended after age 5 – 6 years

 

4. You should suspect esophageal foreign body if any of the following symptoms occur:

A. FALSE : Hematochezia

B. TRUE : Cough

C. FALSE : Abdominal distension

D. TRUE : Chest pain

E. TRUE : Weight loss

 

5. The following can be applied in treatment of measles:

A. FALSE : Give  antiviral therapy to eliminate the virus

B. FALSE : Give humidified oxygen to relieve respiratory distress

C. TRUE : Avoid from exposure to strong light

D. TRUE : Give vitamin to all children with measles

E. TRUE : Rehydrate the patient with maintenance fluid

 

6. The following is true in management of MASTOIDITIS:

A. FALSE : It should be treated as a case of osteomyelitis

B. TRUE : It can be treated with intravenous antibiotic

C. TRUE : Chronic mastoids will require mastedectomy

D. FALSE :  it should be treated with oral antibiotics when it occur with   chronic suppurative otitis media

E. TRUE : antibiotics should aim to common causative organism like H.influenza and S. pneumonia

7. In management of Nephrotic syndrome which of the following is true?

A. TRUE : Sodium restriction is indicated in severe symptomatic edema.

B. TRUE : Protein restriction is indicated during the course of treatment

C. TRUE : Increased  peripheral oedema can be measure by daily weight

D. FALSE : Antibiotics is indicated if you suspect spontaneous bacterial peritonitis

E. FALSE : it can be only treated with oral certicusteroids

 

  

8. In performing/conducting neonatal resuscitation:

A. FALSE : Clean the infant immediately with wet clothes

B. TRUE : Keep warm by kangaroo method

C. TRUE : Suction only if there is mouth secretion

D. TRUE : Drying is enough for stimulation

E. TRUE : Ventilate with bag and mask at rate 40 – 60 b/m

 

1. Match the following disease/conditions in column A with their corresponding signs/symptoms in column B.

 

COLUMN A	COLUMN B
DISEASE	SIGHN/SYMPTOMS
1.  H    Laryngotracheobronchits 2.  F     Pertussis 3. A     Nephrotic syndrome 4. E     Measles 5. B     Meningitis	A.  Periorbital oedema B. Erythematous macula rests C. Non-pitting oedema D. Cerebral oedema E. Koplik spot F. Whopping cough G. Stridor H. Barking cough

 

2. Match the drug used to treat tuberculosis in column A with  its associated side effect in column B by writing the letter of the correct answer in the space provided

 

The concomitant drug is used only once.

 

COLUMN A	COLUMN B
DRUG	SIDE-EFFECTS
1. H   Isoniazide for Tuberculosis 2. D   Didanosine for HIV 3. F   Quinine for malaria 4. B   Methotrexate for Burkitt’s 5. E   Cotrimoxazole for PCP	A.  Constipation B. Retrobulbar neuritis C. Reflactory severe damage D. Vestibulocochlear severe damage E. Flune like symptom F. Turns body fluid orange G. Vaguo nesse damage H. Neuropathy

 

1. A 5 years old female presented with history of high grade fever and cough for three days.  On examination the patient appeared febrile with temperature of 40⁰C, dyspnoic, cyanotic on respiratory system examination respiratory rate is 42 breaths /min, lower chest wall in-drawing on auscultation there is bronchial breathing and and scattered crackle all over the chest.

 

i) What is your diagnosis

 

Answer:

Severe Pneumonia (1 mark)

 

ii) Mention two investigation that you will order at hospital level (1 mark)

 

Answer

-  CXR

- FBP

 

iii) Mention four organism that can cause the above condition in children

 

Answer

 

i) Streptococcus pneumonia

ii) Haemophiilms influenza (1 mark)

iii) Group A streptococcus

iv) Mycoplasma pneumonia

 

iv) Mention four complications of the above condition

 

Answer

i) Lung abcess formation

ii) Pleural effusion

iii) Lung collapse

iv) Pneumothrax

v) Bronchiocteris

2. A three years old child who is known HIV patient present with history of altered mental status, vomiting everything taken per oral, on examination she was on opisthotonus and rigid posture with unequal size of pupil:

 

i) What is your diagnosis                                                                           (1 mark)

 

Answer

Cryptococcal meningitis

 

ii) Which investigation will you perform                                                    (1 mark)

 

Answer

a) Lumber puncture with CSF analysis

b) CSF Indian ink preparation or cryptococcal antigen (serum)

 

iii) What is the responsible causative organism                                          (1 mark)

 

Answer

a) Cryptococcus neofomans

b) Cryptococcus gattii

 

 

iv) How will you treat that condition                                                            (1 mark)

 

Answer

Amphotericin 0.5 – 1.5/kg per day for 14 days

Then fluconcole 6 – 12mg/kg for 8 weeks

 

3. A 6 years old boy come to the OPD with his mother complaining of high grade fever, vomiting and generalized body malaise, on examination, he is pale not jaundice, febrile.  Your ordered the rapid diagnostic test for malaria and Hb level, the results were + MRDT and Hb was 4mg/dL

 

a) What is your diagnosis

 

Answer:

Severe malaria with severe anemia                                                  (1mark)

 

b) How will you manage the patient

 

Answer

- Transfuse with 10ml/kg packed cells or 20ml/kg of whole blood over 3 – 4 hr.                                                                                                                                 (1mark)

- Quinine IM  10mg/kg for 3 days then followed by oral quinine or complete dose of ALU                                                                                            (1mark)

- Give ferrous sulphate or iron syrup for 14 days.                                     (1mark)

 

4. A 4 years old female presented with history of lower abdominal pain vomiting and fever.  The mother mentioned that she has noticed change in frequency of urination which accompanied with pain.

 

a) What is your diagnosis                                                                                        (1mark)

Answer

Urinary Tract Infection

 

b) What are the risk factors for the above condition                                               (1mark)

 

Answer

i) At young age more common in girls

ii) Congenital anatomical abnormalities

 

c) Mention two common organism responsible for the above condition              (1mark)

 

Answer

i) E.coli

ii) Klebsiella

iii) Proteins

iv) Staphylococcal

 

d) How will you treat the patient                                                                        (1mark)

 

Answer

- Cotrimoxazole 240 mg BD for 7 days or

- Nitrofurantoin   5mg/kg day in 3 three divide dose for 7 days

- Paracetamol 15mg/kg every 4 – 6 hr.

 

 

 

5. A 5 years  old boy newly diagnosed Diabetic mellitus presented in OPD with history of altered level of consciousness, on examination, he is dehydrated kussmaul breathing and you noticed the boy has acetone smell, you ordered RBG was 15mmoL/L and ketone ++ in urinalysis

 

a) What is your diagnoses

 

Answer:

Diabetic ketoacidosis

 

b) Mention the principal components of treatment

 

Answer

i) The administration of insulin

ii) Fluid replacement

iii) Potassium replacement

iv) Administration of antibiotic if infection present

 

c) Mention complications of treatment

 

Answer:

i) Cerebral edema

ii) Aspiration

iii) Cardiac arrhythmia

iv) Venus thrombosis

 

SECTION E: GUIDED ESSAY QUESTIONS

1. Malnutrition is a major health problem especially in developing countries; malnutrition in all its form increases the risk of disease and early death.  Describe severe acute malnutrition basing on definition, general management of acute severe malnutrition complication of malnutrition

 

Answer:

Definition:  Severe acute malnutrition is defined as the presence of edema of both feet and severe wasting (weigh – for – height/length < - 3SD or mid upper arm circumference <115mm).  This include kwashiorkor and marasmus)                              (3 )

General management                                                         (1 mark each point)

- Hypoglycemia - Give 50ml of 10% glucose by once

- Hypothermia - Rewarm, give 10%  glucose or I.V or 1.M antibiotics

- Dehydration - use resomal 5-10ml/kg/h for 12hour by NGT

- Electrolyte imbalance Give extra potassium 3- 4 mmL.kg/day, magnesium 04 – 0.6mmol/kg/day

- Infection - Give broad spectrum antibiotic either oral amoxicillin or I.V. benzyl penicillin

and gentamycin, treat parasitic infection with mebendazole, if HIV determine the need for ART

- Micronutrient deficiency -Give vitamin A on day 1  repeat on day 2 and 14 only, < 6 months 50000 IU, 6-12 month, > 12 month 200000U, start iron at 3mg/kg per days after 2 days , if child is not in any of pre- mixed therapeutic food give:folic acid 5mg on day1,

Multivitamin syrup  5ml, zinc at 2mg/kg , Copper at 0.3mg/kg per day

- Initial re-feeding - give F75 – 130m/kg per day or 100mL/kg per day every 2 – 3 hr.

- Catch up growth feeding – make gradual transition from F 75 – F100

- Sensory stimulation - provide tender loving care stimulating environment, provide suitable toys.

- Prepare for follow-up - follow up to outpatient care until full recovery. child should weigh week after discharge.

Complication                                                                               (2 )

i) Stunted growth

ii) Shock

iii) Septicemia

iv) Mental retardation

v) Sudden death

 

2. Describe neonatal sepsis basing on definition, classification, causative organism, clinical presentation, differential diagnosis, investigation and treatments, prevention

 

 

Answer:

 

Definition (1mark)

Neonatal sepsis is a clinical syndrome of bacteria with systemic sign and symptoms of infection occurring in the first 4 weeks of life

 

Classification                                                                                              (1 mark)

- Early onset septicemia – onset within 7 days

- Late onset – onset after 7 days of birth

 

Causative organisms                                                                               (2 )

S. aureus

E.coli

Pseudomonas aerogeniosa

Entrobacter and anaerobes

 

Clinical presentation                                                                            (5 )

- Diminished activity (lethargy)

- Poor sucking

- Apnea

- Brachycardia

- Hypothermia

- Tachypnea

- Respiratory distress

- Vomiting

- Diarrhoea

- Abdominal distension

- Seizure of  convulsion

- Jaundice

Differential diagnosis                                                                     ( 2)

- Meningitis

- Pneumonia

- Birth asphyxia

- Respiratory distress syndrome

- Protozoa disease

Investigation                                                                                     (2 )

- FBP

- ESR

- Blood/urine culture

- Urinalysis

Prevention                                                                                       (2)

- Good antenatal care women with UTI  should be treat accordingly

- Cord should kept clean

- Hand washing

- The nursery environment should be clean

- All procedure should be done aseptically

- Unnecessary invasive procedure should be avoided.