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  • Question 1 - Neurofibromatosis is characterised by which of the following? ...

    Incorrect

    • Neurofibromatosis is characterised by which of the following?

      Your Answer: Nephroblastoma

      Correct Answer: Scoliosis

      Explanation:

      Neurofibromatosis (aka Von Recklinghausen’s disease) includes: neurofibrosarcomas, pheochromocytoma, optic nerve tumours, scoliosis and acoustic neuromas.

    • This question is part of the following fields:

      • Child Health
      14.9
      Seconds

  • Question 2 - A previously well 7-week-old infant was admitted complaining of projectile vomiting following each...

    Correct

    • A previously well 7-week-old infant was admitted complaining of projectile vomiting following each feed. He was dehydrated on admission and IV fluids were started. What is the most probable diagnosis?

      Your Answer: Hypertrophic pyloric stenosis

      Explanation:

      Projectile vomiting is the hallmark symptom of hypertrophic pyloric stenosis. It is the most common cause of intestinal obstruction in infancy, which has a male-to-female predominance of 4-5:1. Current management recommendations include ultrasonography for diagnosis, correction of electrolytes, and surgical intervention.

    • This question is part of the following fields:

      • Child Health
      11.5
      Seconds

  • Question 3 - A 4 year old boy presented in the sixth day of fever, with...

    Correct

    • A 4 year old boy presented in the sixth day of fever, with erythema of the palms and soles and maculopapular rash. His eyes and tongue were red. Which of the following is the most probable diagnosis?

      Your Answer: Kawasaki Disease

      Explanation:

      Kawasaki disease is an acute febrile illness of early childhood characterized by vasculitis of the medium-sized arteries. Diagnostic criteria include fever of at least 5 days duration along with 4 or 5 of the principal clinical features – extremity changes, polymorphous rash, oropharyngeal changes, conjunctival injection and unilateral nonpurulent cervical lymphadenopathy.

    • This question is part of the following fields:

      • Child Health
      14.9
      Seconds

  • Question 4 - A 12-year-old girl is recovering from bilateral parotitis. She complains of a continuous...

    Correct

    • A 12-year-old girl is recovering from bilateral parotitis. She complains of a continuous headache and drowsiness. A CT brain is done which is normal. What is the best definitive investigation in this case?

      Your Answer: Lumbar puncture

      Explanation:

      This patient might have viral meningitis as he recently suffered viral parotitis(Mumps). Microscopy and culture of the CSF would show a CSF lymphocytosis.

    • This question is part of the following fields:

      • Child Health
      10.6
      Seconds

  • Question 5 - A 8 year old boy who had not wet his bed for the...

    Correct

    • A 8 year old boy who had not wet his bed for the past 3 and half years, presented with bed wetting for 2 weeks. Which of the following is the most appropriate management?

      Your Answer: Investigate for secondary causes

      Explanation:

      As this boy was dry for a considerable period, there is a high chance of a secondary cause for the bed wetting, such as bladder infections, constipation, diabetes, psychological stress and hormonal problems etc. These have to be excluded.

    • This question is part of the following fields:

      • Child Health
      8.8
      Seconds

  • Question 6 - An 11-week-old baby with abnormal facies presented to the paediatric clinic with recurrent...

    Incorrect

    • An 11-week-old baby with abnormal facies presented to the paediatric clinic with recurrent chest infections. CXR showed an absent thymic shadow. What is the most likely diagnosis?

      Your Answer: Fragile X syndrome

      Correct Answer: DiGeorge syndrome

      Explanation:

      DiGeorge syndrome usually presents at a young age with abnormal faces. Chest x-ray is characterised by an absent thymic shadow and recurrent infections due to an abnormal T-cell mediated immune response. Sometimes it presents by convulsions of the new-born due to hypocalcaemia as a result of a malfunctioning parathyroid gland and low levels of PTH.

    • This question is part of the following fields:

      • Child Health
      20.4
      Seconds

  • Question 7 - A 6 year old boy presents with a history of repeated respiratory and...

    Incorrect

    • A 6 year old boy presents with a history of repeated respiratory and gastro-intestinal infections since birth. His birth was, however, uncomplicated. His mother claims that he's not growing as he should for his age. What is the most likely diagnosis?

      Your Answer: Primary T cell immunodeficiency

      Correct Answer: Cystic fibrosis

      Explanation:

      Cystic fibrosis is a genetic disease that interferes with the normal development of the child. It manifests with recurrent episodes of pneumonia accompanied by coughing, wheezing and dyspnoea. The appetite is normal but weight gain seems difficult. This condition also affects bowel habits with repeated gastrointestinal infections. The gold standard for the diagnosis is considered the sweat test which reveals abnormally high levels of Cl-.

    • This question is part of the following fields:

      • Child Health
      25.8
      Seconds

  • Question 8 - All of the following drugs tend to worsen the symptoms of myasthenia gravis...

    Incorrect

    • All of the following drugs tend to worsen the symptoms of myasthenia gravis except?

      Your Answer:

      Correct Answer: Prednisolone

      Explanation:

      Prednisone is used for the treatment of myasthenia gravis if there is no initial response to the anticholinesterase medications. Pyridostigmine can make the symptoms of myasthenia gravis worse if used  in the initial stages of treatment. 

    • This question is part of the following fields:

      • Child Health
      0
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  • Question 9 - A child presents to the clinic with the complaints of pale stools and...

    Incorrect

    • A child presents to the clinic with the complaints of pale stools and jaundice. Which of the following tests would be most helpful in establishing a diagnosis?

      Your Answer:

      Correct Answer: US abdomen

      Explanation:

      The patient is most likely suffering from obstructive jaundice. Ultrasound of the abdomen is the superior diagnostic tool in detecting and assessing biliary system obstruction, because it is easy, available, accurate and non-invasive.

    • This question is part of the following fields:

      • Child Health
      0
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  • Question 10 - A 10 year old boy presents with generalized swelling. This includes puffiness in...

    Incorrect

    • A 10 year old boy presents with generalized swelling. This includes puffiness in the face and swollen ankles - these symptoms have been present for 4 days. The swelling began just a few days after he suffered from a mild cold with a runny nose. His only past medical history is that of eczema. His urine analysis showed the following: haematuria; proteinuria (10g/24h); creat60umol/l; and albumin of 15g/l. From the list of options, what is the single most likely diagnosis for this patient?

      Your Answer:

      Correct Answer: IgA nephropathy

      Explanation:

      A 10 year old child, with a history of URTI and haematuria, presents a picture consistent with a diagnosis of IgA nephropathy. This condition can present with proteinuria and generalized swelling. However, an important differentiating point from rapidly progressive GN is the duration. IgA nephropathy is usually <10 days (commonly 4-5 day history of infection).

    • This question is part of the following fields:

      • Child Health
      0
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  • Question 11 - A child cannot wave goodbye or grasp objects with her fingers and thumb...

    Incorrect

    • A child cannot wave goodbye or grasp objects with her fingers and thumb but can sit briefly supported by leaning forward on her hands. She can reach and grasp objects with the whole hand and then pass it from one hand to the other and is babbling. What is her expected age?

      Your Answer:

      Correct Answer: 7 months

      Explanation:

      At 7 months, children are expected to sit briefly leaning forward on their hands, reach and grasp objects, transfer objects from hand to hand, and babble. Children are usually expected to wave goodbye or grasp objects with their fingers or thumb at around 10 months and older.

    • This question is part of the following fields:

      • Child Health
      0
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  • Question 12 - A 30-day-old female was diagnosed with a case of breast milk jaundice. She...

    Incorrect

    • A 30-day-old female was diagnosed with a case of breast milk jaundice. She has no other symptoms. Which is the most suitable next step of management?

      Your Answer:

      Correct Answer: Continue breastfeeding

      Explanation:

      Breast feeding should be continued for babies with breast milk jaundice as this is a benign condition.

    • This question is part of the following fields:

      • Child Health
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  • Question 13 - A 4-year-old boy presents with offensive stool, clubbing of fingers, and recurrent chest...

    Incorrect

    • A 4-year-old boy presents with offensive stool, clubbing of fingers, and recurrent chest pain. Choose the single most appropriate investigation?

      Your Answer:

      Correct Answer: Sweat test

      Explanation:

      Cystic fibrosis is a progressive, genetic disease. A defective gene causes a thick, sticky build-up of mucus in the lungs, pancreas, and other organs. In the lungs, the mucus clogs the airways and traps bacteria leading to infections, extensive lung damage, and eventually, respiratory failure. In the pancreas, the mucus prevents the release of digestive enzymes that allow the body to break down food and absorb vital nutrients. Since the digestive enzymes are not being made, the food is not completely digested making them bulky, smelly, and hard to flush away. Finger clubbing is a prominent feature of cystic fibrosis on most patients.

    • This question is part of the following fields:

      • Child Health
      0
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  • Question 14 - A 2-year-old baby sustained a wound to her hand whilst playing in the...

    Incorrect

    • A 2-year-old baby sustained a wound to her hand whilst playing in the garden. She is unvaccinated as the parents are concerned regarding side effects. There is no contraindication to vaccinations. What is the most appropriate action?

      Your Answer:

      Correct Answer: Give complete DPT vaccine course

      Explanation:

      A complete course of DPT should be given.

    • This question is part of the following fields:

      • Child Health
      0
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  • Question 15 - From the options provided, which statement would most likely points towards Munchausen's syndrome...

    Incorrect

    • From the options provided, which statement would most likely points towards Munchausen's syndrome by proxy?

      Your Answer:

      Correct Answer: It is a cause of sudden infant death

      Explanation:

      Munchausen syndrome by proxy is a mental illness and a form of child abuse. The caretaker of a child, most often a mother or a father, either makes up fake symptoms or causes real symptoms to make it look like the child is sick. The person with MSP gains attention by seeking medical help for exaggerated or made-up symptoms of a child in his or her care. As health care providers strive to identify what’s causing the child’s symptoms, the deliberate actions of the mother or caretaker can often make the symptoms worse.
      The person with MSP does not seem to be motivated by a desire for any type of material gain. People with MSP may create or exaggerate a child’s symptoms in several ways. They may simply lie about symptoms, alter tests (such as contaminating a urine sample), falsify medical records, or they may actually induce symptoms through various means, such as poisoning, suffocating, starving, and causing infection.

    • This question is part of the following fields:

      • Child Health
      0
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  • Question 16 - A healthy 8 month old baby boy was brought in by his parents,...

    Incorrect

    • A healthy 8 month old baby boy was brought in by his parents, who claimed that the baby had come into close contact with another child with measles two days ago. Which of the following is the most appropriate management?

      Your Answer:

      Correct Answer: She should receive the MMR vaccine now together with measles immunoglobulin

      Explanation:

      People who are at risk for severe illness and complications from measles, such as infants younger than 12 months of age, pregnant women without evidence of measles immunity, and people with severely compromised immune systems, should receive immunoglobulin. Intramuscular immunoglobulin should be given to all infants younger than 12 months of age who have been exposed to measles. For infants aged 6 through 11 months, MMR vaccine can be given in place of IG, if administered within 72 hours of exposure.

    • This question is part of the following fields:

      • Child Health
      0
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  • Question 17 - A 5 year old boy visited Ghana with his family and arrived back...

    Incorrect

    • A 5 year old boy visited Ghana with his family and arrived back home 6 weeks ago. 2 days ago he developed neck stiffness, a fever, and vomiting. He did not present with a rash and was treated with malaria prophylaxis. Choose the correct diagnosis from the list of options.

      Your Answer:

      Correct Answer: Cerebral malaria

      Explanation:

      Due to malaria’s incubation period being between 7 and 30 days, malaria prophylaxis cannot provide a patient with confirmed protection. Prophylaxis treatment also often fails. The symptoms such as neck stiffness, fever, and vomiting are also consistent with the cerebral malaria diagnosis.

    • This question is part of the following fields:

      • Child Health
      0
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  • Question 18 - An 8-month-old baby was investigated for failure to thrive. On examination, he was...

    Incorrect

    • An 8-month-old baby was investigated for failure to thrive. On examination, he was irritable with evidence of weight loss. His stools were pale, bulky and malodorous. What is the most appropriate test that can be done to confirm the diagnosis?

      Your Answer:

      Correct Answer: Jejunal Biopsy

      Explanation:

      Pale, bulky, malodorous stools are evidence of fat malabsorption syndrome. The diagnostic test is jejunal biopsy to rule out other differential diagnoses such as celiac disease, giardiasis or Crohn’s disease etc.

    • This question is part of the following fields:

      • Child Health
      0
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  • Question 19 - An 8-year-old girl returns from holiday in Greece, complaining of ear discharge and...

    Incorrect

    • An 8-year-old girl returns from holiday in Greece, complaining of ear discharge and tragal tenderness. The exam shows a normal tympanic membrane and ear cleaning was done. What is the next step in management?

      Your Answer:

      Correct Answer: Antibiotic drop with steroid

      Explanation:

      The symptoms and signs described are suggestive of otitis externa. The key treatment for otitis externa is ear cleaning and antibiotic drops with steroid.

    • This question is part of the following fields:

      • Child Health
      0
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  • Question 20 - A baby boy born 5 weeks ago with a birth weight of 3.5kg...

    Incorrect

    • A baby boy born 5 weeks ago with a birth weight of 3.5kg presents to the clinic with jaundice. He is being breastfed and his current weight is 4.5kg. Which of the following is most likely responsible for the baby's jaundice?

      Your Answer:

      Correct Answer: Breast Milk Jaundice

      Explanation:

      Breast milk jaundice is associated with breast-feeding. It typically occurs one week after birth and can sometimes last up to 12 weeks, but it rarely causes complications in healthy, breast-fed infants. The exact cause of breast milk jaundice isn’t known. However, it may be linked to a substance in the breast milk that prevents certain proteins in the infant’s liver from breaking down bilirubin. The condition may also run in families. Breast milk jaundice is rare, affecting less than 3 percent of infants. When it does occur, it usually doesn’t cause any problems and eventually goes away on its own. It is safe to continue breast-feeding.

    • This question is part of the following fields:

      • Child Health
      0
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  • Question 21 - A 16-month-old infant presented to ER with multiple bruises on his right arm....

    Incorrect

    • A 16-month-old infant presented to ER with multiple bruises on his right arm. According to his mom, he has been unable to move it since yesterday and is crying more than usual. A relative attended the child while his mother was on a night shift. X-ray revealed a fracture of the right humerus, which was put in a cast. What is the next step in this case?

      Your Answer:

      Correct Answer: Admit under care of paediatrician

      Explanation:

      Certain lesions present on x-ray are suggestive of child abuse including rib, humerus and skull fractures. It is the doctors responsibility to follow up on these cases to determine whether domestic abuse has occurred.

    • This question is part of the following fields:

      • Child Health
      0
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  • Question 22 - An 8 year old boy was admitted following a MVA. His BMI is...

    Incorrect

    • An 8 year old boy was admitted following a MVA. His BMI is 28 kb/m2 and he's been found to have glycosuria, which resolved after his recovery. Which investigation is necessary to perform as part of the follow-up?

      Your Answer:

      Correct Answer: Fasting blood glucose concentration

      Explanation:

      The boy has an increased BMI which implies he is overweight. Possible trauma to his pancreas might have led to a diabetes-like condition, induced by damage to the beta cells. Fasting blood glucose should be measured as a follow-up strategy to see if the damage is reversible or irreversible and to conclude if the glycosuria is related to his metabolic profile or to his accident.

    • This question is part of the following fields:

      • Child Health
      0
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  • Question 23 - Which of the following are not a recognized feature of Down's syndrome? ...

    Incorrect

    • Which of the following are not a recognized feature of Down's syndrome?

      Your Answer:

      Correct Answer: Ataxic gait

      Explanation:

      Ataxic gait is not a direct association of Down’s syndrome. All other given responses are associated with Down’s syndrome.

    • This question is part of the following fields:

      • Child Health
      0
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  • Question 24 - What serious side effect would you expect, after giving IV lorazepam to a...

    Incorrect

    • What serious side effect would you expect, after giving IV lorazepam to a 4-year-old boy suffering from febrile convulsions?

      Your Answer:

      Correct Answer: Apnoea

      Explanation:

      Lorazepam is known to cause respiratory depression and finally apnoea as a side effect.

    • This question is part of the following fields:

      • Child Health
      0
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  • Question 25 - An 8-year-old girl was bought immediately to the emergency department. She is fully...

    Incorrect

    • An 8-year-old girl was bought immediately to the emergency department. She is fully conscious but has stridor, is wheezing and has a generalised erythematous rash. She has known allergies. What is the single immediate management?

      Your Answer:

      Correct Answer: Give 0.3ml in 1000 adrenaline by IM injection

      Explanation:

      This is a case of an anaphylactic reaction that requires immediate intervention. IM adrenaline dose for 6-12 year old children is 300 micrograms IM.

    • This question is part of the following fields:

      • Child Health
      0
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  • Question 26 - A 7-month-old baby boy was brought by his parents due to frequently regurgitating...

    Incorrect

    • A 7-month-old baby boy was brought by his parents due to frequently regurgitating his milk. On examination, he was pale and lethargic. FBC showed a microcytic anaemia. Which of the following is the most probable diagnosis?

      Your Answer:

      Correct Answer: Hiatus hernia

      Explanation:

      Frequent regurgitation of milk and microcytic anaemia is suggestive of a hiatus hernia. The reflux causes regurgitation of milk and frequent ulceration of the lower oesophageal mucosa potentially resulting in blood loss and anaemia. Duodenal atresia usually presents with bilious vomiting and pyloric stenosis presents with projectile vomiting. Alpha 1 antitrypsin deficiency and cystic fibrosis usually do not present with vomiting.

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      • Child Health
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  • Question 27 - A 2 year old boy is brought by his mother to the emergency...

    Incorrect

    • A 2 year old boy is brought by his mother to the emergency department with colicky pain. The boy has experienced such episodes of pain in the past, which radiates from his loin to the groin. After clinical examination and investigations, a 7mm stone has been found in his ureter. What is the single most appropriate next step?

      Your Answer:

      Correct Answer: Conservative treatment

      Explanation:

      Renal stones < 5mm generally pass spontaneously with adequate fluid intake. Stones 5mm-10mm with pain not resolving, require medical expulsive therapy with Nifedipine or Tamsulosin. For stones larger than 10mm, ESWL or Ureteroscopy is indicated. For stones as big as 2cm, percutaneous nephrolithotomy should be applied.

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      • Child Health
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  • Question 28 - A 13 year old patient presents in the A&E with a fracture of...

    Incorrect

    • A 13 year old patient presents in the A&E with a fracture of his left femur. He was a passenger in a car involved in a traffic accident. Upon clinical examination, his left posterior tibial and dorsalis pedis arteries are not palpable. Which of the following is most probably injured?

      Your Answer:

      Correct Answer: Femoral artery

      Explanation:

      The femoral artery is the one accompanying the femoral shaft, being the most important blood supplier of the leg. Femoral artery injury during a femur shaft fracture is quite common as a result of blunt trauma.

    • This question is part of the following fields:

      • Child Health
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  • Question 29 - A 2-year-old child, who is not very active, presented with bruises on the...

    Incorrect

    • A 2-year-old child, who is not very active, presented with bruises on the back as well as on the chest. X-ray showed a radiolucent area around the ribs indicating callus formation. Which of the following is the most important investigation in this case?

      Your Answer:

      Correct Answer: Skeletal survey

      Explanation:

      Because the initial chest X-ray returned an anomaly, a skeletal survey is the best option. Also known as a bone survey, the skeletal survey is a series of X-rays that will help analyse the structure of all the bones in the body. Because the child is not very active yet presents with bruising, the child protection register should also be checked but only after a skeletal survey has been conducted.

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      • Child Health
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  • Question 30 - A 7 day old baby weighed 3.5kg when born. His weight is now...

    Incorrect

    • A 7 day old baby weighed 3.5kg when born. His weight is now 3kg. Choose the most appropriate next step for this child.

      Your Answer:

      Correct Answer: Continue regular child care

      Explanation:

      In the first week after birth, it is normal for the baby to lose weight and then gain it again. Therefore, regular child care should be maintained.

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      • Child Health
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  • Question 31 - A 5-year-old pre-schooler complains of ear pain and fever. He has taken paracetamol...

    Incorrect

    • A 5-year-old pre-schooler complains of ear pain and fever. He has taken paracetamol several times for relief. It is noted that he increases the volume of the television and has a symmetric loss of 40db on a hearing test. What is the most likely diagnosis?

      Your Answer:

      Correct Answer: Otitis externa

      Explanation:

      Increasing the volume of the TV and the child’s loss of hearing may suggest that he has otitis media with effusion but the fever and the ear pain and fever strongly points to otitis externa as the diagnosis.

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      • Child Health
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  • Question 32 - A 3-year-old boy was brought at the hospital by his mother due to...

    Incorrect

    • A 3-year-old boy was brought at the hospital by his mother due to sudden onset pyrexia with emesis and bilateral facial swelling. Upon history taking, she mentions that she brought her son to the GP who suggested analgesics for his bilateral parotid pain, 2 days ago. What would be the next step of your management?

      Your Answer:

      Correct Answer: Reassurance

      Explanation:

      The history is suggestive of mumps. Mumps is a viral disease with initial signs and symptoms including fever, muscle pain, headache, poor appetite, and feeling tired. This is then usually followed by painful swelling of one or both parotid salivary glands. Mumps is a self-limiting condition treated only for symptomatic relief. As he currently is taking analgesics for pain relief, one should only offer reassurance.

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      • Child Health
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  • Question 33 - A father brought his 6-year-old son with cystic fibrosis to the ER department...

    Incorrect

    • A father brought his 6-year-old son with cystic fibrosis to the ER department due to massive hematemesis. He is hypotensive and has a tachycardia. Which is the most likely diagnosis?

      Your Answer:

      Correct Answer: Bleeding oesophageal varices

      Explanation:

      Bleeding oesophageal varices secondary to portal hypertension can cause a massive gastrointestinal haemorrhage resulting in shock. Perforated ulcer is less likely in this age group. Mallory Weiss tear would not likely result in a massive haemorrhage. Aorto-intestinal fistula is more common in older patients with abdominal aneurysms. Boerhaave’s syndrome is a result of a ruptured oesophagus following excessive vomiting.

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      • Child Health
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  • Question 34 - A 6 year old presents with fever and multiple vesicles on his back....

    Incorrect

    • A 6 year old presents with fever and multiple vesicles on his back. What is the single most appropriate next step?

      Your Answer:

      Correct Answer: None

      Explanation:

      This clinical picture is typical of chickenpox, which is treated with antihistamines and calamine lotion. In the case of fever, acetaminophen can be used. Generally treatment is purely for symptomatic relief.

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      • Child Health
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  • Question 35 - A 6 month old baby can squeeze an object against his palm, can...

    Incorrect

    • A 6 month old baby can squeeze an object against his palm, can vocalize and can sit with support. But he cannot hold objects between his index finger and the thumb. He cannot sit without support and he doesn't have stranger fear. Which of the following is correct regarding his development?

      Your Answer:

      Correct Answer: Normal development

      Explanation:

      Children are able to use a palmar grasp by the age of 6 months and use a pincer grasp by the age of 9 to 10 months. They can sit with support by 6 months and sit without support by 7 to 9 months. They can vocalize by 3 months. Stranger fear appears from 7 to 10 months. So this baby’s development is normal.

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      • Child Health
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  • Question 36 - A 2-year-old boy was admitted in the A&E with a history of a...

    Incorrect

    • A 2-year-old boy was admitted in the A&E with a history of a 38.4°C fever and 15 minute tonic clonic seizure episode at home. However, he is conscious now, his temperature is normal and the fit has stopped. What is the most likely diagnosis?

      Your Answer:

      Correct Answer: Febrile convulsion

      Explanation:

      Febrile seizures are convulsions that can happen when a child, most often between the ages of six months and three years, has a fever. They usually last for less than five minutes and although the child may lose consciousness, they are relatively harmless. However, sometimes they can last for up to 15 minutes and when they are termed complex febrile seizures.

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      • Child Health
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  • Question 37 - A mother came to the clinic, with her 7 month old baby. She...

    Incorrect

    • A mother came to the clinic, with her 7 month old baby. She anxiously explained that he was not responding to loud sounds. He was vocalizing at the presentation and he had normal motor milestones. Which of the following is the most appropriate management?

      Your Answer:

      Correct Answer: Arrange Hearing test

      Explanation:

      History is suggestive of a possible hearing impairment. As the baby is vocalizing and has normal motor development, an isolated hearing problem is possible. A hearing test will confirm the diagnosis.

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      • Child Health
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  • Question 38 - A child on 70% O2 suddenly crouches down whilst playing to help with...

    Incorrect

    • A child on 70% O2 suddenly crouches down whilst playing to help with breathing. What is the most likely diagnosis?

      Your Answer:

      Correct Answer: Tetralogy of Fallot

      Explanation:

      Tetralogy of Fallot (TOF), a congenital heart defect, includes the following: right ventricular hypertrophy, ventricular septal defect, abnormal position of the aorta and pulmonary valve stenosis. The O2 saturation in patients with TOF is typically lower than normal and the condition usually becomes symptomatic early in life. A feature of the disease with high diagnostic significance is squatting or crouching of the infant as a compensatory mechanism to increase the peripheral vascular resistance.

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      • Child Health
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  • Question 39 - A 6-month-old baby boy presented to the paediatrician with yellow discolouration of his...

    Incorrect

    • A 6-month-old baby boy presented to the paediatrician with yellow discolouration of his skin and sclera. His mother says his stools are pale. On examination, he was found to be below average weight. What is a likely diagnosis?

      Your Answer:

      Correct Answer: Biliary atresia

      Explanation:

      Pale stools suggest obstructive jaundice. Initially, the symptoms of biliary atresia are indistinguishable from those of neonatal jaundice, a usually harmless condition commonly seen in infants. However, infants with biliary atresia develop progressive conjugated jaundice, pale white stools and dark urine.

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      • Child Health
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  • Question 40 - A 4 year old girl is brought to the emergency due to fever...

    Incorrect

    • A 4 year old girl is brought to the emergency due to fever and urinary urgency. The temperature is recorded to be 39C. Which of the following is the best investigation in this case?

      Your Answer:

      Correct Answer: Clean catch of urine

      Explanation:

      Urine culture and sensitivity is used to diagnose a urinary tract infection (UTI). A mid-stream clean catch urine sample is the most common type of sample collected. It is important to follow the clean catch process to have accurate results from an uncontaminated sample. Urine cultures can also check for infections of the bladder or kidney.

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      • Child Health
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  • Question 41 - A 15-year-old boy observed a bluish painless swelling in his left scrotum. It...

    Incorrect

    • A 15-year-old boy observed a bluish painless swelling in his left scrotum. It is soft and can be compressed. What would you do next?

      Your Answer:

      Correct Answer: Reassurance

      Explanation:

      The boy seems to have a varicocele so the most appropriate next step would be reassurance. A varicocele is an enlargement of the veins within the scrotum called the pampiniform plexus. A varicocele only occurs in the scrotum and is very similar to varicose veins that can occur in the leg. Because a varicocele usually causes no symptoms, it often requires no treatment.

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      • Child Health
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  • Question 42 - A 3-year-old was brought to the ED after falling down while playing. The...

    Incorrect

    • A 3-year-old was brought to the ED after falling down while playing. The mother reports hearing a popping sound when his face hit the floor. Examination revealed swelling and bruising on the right mandible. Which of the following investigations should be ordered next?

      Your Answer:

      Correct Answer: Facial XR

      Explanation:

      The swelling and bruising on the mandible needs to be checked for fractures. A facial X-ray can adequately visualize this.

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      • Child Health
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  • Question 43 - An 8-year-old girl presented to the outpatient clinic with fever, pain and discharge...

    Incorrect

    • An 8-year-old girl presented to the outpatient clinic with fever, pain and discharge from her left ear. Which of the following antibiotics should be used first?

      Your Answer:

      Correct Answer: Amoxicillin

      Explanation:

      Amoxicillin has high efficacy against haemophilus influenza and streptococcus pneumonia, the most common organisms of otitis media. It is an oral drug with high bioavailability.

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      • Child Health
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  • Question 44 - A 3-year-old girl presented with faecal incontinence for 2 weeks. Abdominal examination revealed...

    Incorrect

    • A 3-year-old girl presented with faecal incontinence for 2 weeks. Abdominal examination revealed a mass in right lower quadrant. Which of the following is the most appropriate management for this girl?

      Your Answer:

      Correct Answer: Laxatives

      Explanation:

      Laxatives have been shown to be beneficial in the treatment of chronic childhood constipation. Studies have shown that polyethylene glycol, mineral oil, magnesium hydroxide, and lactulose are effective and can be used for a prolonged periods without risk.

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  • Question 45 - A female 4-week-old baby was admitted with jaundice. Her appetite for breast milk...

    Incorrect

    • A female 4-week-old baby was admitted with jaundice. Her appetite for breast milk is preserved and she is playing actively and well without any other disturbances. What is the most probable cause of jaundice?

      Your Answer:

      Correct Answer: Breast milk Jaundice

      Explanation:

      Breast milk jaundice is thought to be associated with one or more abnormalities in the maternal milk itself. Breast milk jaundice syndrome generally needs no therapy if serum bilirubin concentrations remain below 270 mmol/l in healthy full-term infants. When the serum bilirubin concentration is above 270 mmol/l and rising, temporary interruption of breastfeeding may be indicated.

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      • Child Health
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  • Question 46 - A 3 year old child was brought in by her father with complaints...

    Incorrect

    • A 3 year old child was brought in by her father with complaints of watery diarrhoea, vomiting and low grade fever. She looked slightly dehydrated. According to her parents, the other children in the school also have a similar illness. The most likely causative organism in this case would be?

      Your Answer:

      Correct Answer: Rotavirus

      Explanation:

      Rota virus is the leading cause of vital gastroenteritis among children from 6 months to 6 years of age. It is transferred by feco-oral route and it damages the transport mechanism in the intestinal mucosal cells which leads to electrolyte imbalance that’s why the child suffers from dehydration. Treatment of choice is rehydration and correction of electrolyte imbalance.

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  • Question 47 - A 9 year old boy was admitted with gastroenteritis. The boy's symptoms started...

    Incorrect

    • A 9 year old boy was admitted with gastroenteritis. The boy's symptoms started two days ago with profound diarrhoea and emesis. Blood exams show the following: Sodium=148mmol/l, Potassium=2.2mmol/l, Urea=20mmol/l, Glucose=4.3mmol/l. What would be the best management?

      Your Answer:

      Correct Answer: V normal saline and potassium supplement

      Explanation:

      The boy needs re-hydration and hydro-electrolytic re-balancing due to fluid losses from the gastroenteritis and subsequent dehydration.

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      • Child Health
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  • Question 48 - Which of the following signs suggests an absence seizure instead of a partial...

    Incorrect

    • Which of the following signs suggests an absence seizure instead of a partial complex seizure?

      Your Answer:

      Correct Answer: Induction by hyperventilation

      Explanation:

      Absence seizures are induced by over breathing or hyperventilation, while the other features suggest partial seizures.

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      • Child Health
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  • Question 49 - A 6 year old boy has been taken to his local hospital for...

    Incorrect

    • A 6 year old boy has been taken to his local hospital for his third sore throat in one month. Doctors have discovered bleeding from his gums and nose. He is also presenting with pale conjunctiva. From the list of options, what is the single cell type most likely to be seen on microscopy?

      Your Answer:

      Correct Answer: Blast cells

      Explanation:

      Many of the symptoms favour blast cells: the patient’s young age; a reoccurring sore throat caused by neutropenia and abnormal lymphoblasts; pale conjunctiva due to reduced production of red blood cells (this is because the marrow has been occupied by blast cells). There are no risk factors present for aplastic anaemia, and congenital aplastic anaemia would present itself earlier in life. A bone marrow aspiration would be needed to confirm the diagnosis.

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  • Question 50 - A 2 year old male is able to run down the stairs and...

    Incorrect

    • A 2 year old male is able to run down the stairs and say mama and dada. He can understand what he is saying and can say one word. How is this child developing?

      Your Answer:

      Correct Answer: Delayed speech

      Explanation:

      This child is experiencing delayed speech. By the age of 2, a child should be able to combine at least 2 words to make a very simple sentence.

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  • Question 51 - What would you administer to a child with a clean wound that has...

    Incorrect

    • What would you administer to a child with a clean wound that has never been immunized before, assuming there is no contraindication to immunization?

      Your Answer:

      Correct Answer: Full course of diphtheria, tetanus, polio

      Explanation:

      A not immunized patient with a clean wound requires an immediate vaccination against diphtheria, tetanus and polio, according to the Green Book of Immunisation against infectious disease. (The Green Book has the latest information on vaccines and vaccination procedures, for vaccine preventable infectious diseases in the UK.)

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  • Question 52 - A 12 year old boy with type I diabetes was reluctant to go...

    Incorrect

    • A 12 year old boy with type I diabetes was reluctant to go to school. According to him, he was unhappy at the school. Which of the following is the next appropriate step?

      Your Answer:

      Correct Answer: Clinical psychologist

      Explanation:

      The child’s problem should be assessed properly to find the reason for unhappiness at the school. There can be many reasons such as bullying at school, abuse etc. A clinical psychologist should assess this child to take the necessary details and plan the further management.

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  • Question 53 - A 4-year-old girl with an abnormal facial appearance has an ejection systolic murmur...

    Incorrect

    • A 4-year-old girl with an abnormal facial appearance has an ejection systolic murmur radiating to between her scapulae. A radio-femoral delay was also found. Which of the following is the most probable cause?

      Your Answer:

      Correct Answer: Turner's syndrome

      Explanation:

      These cardiovascular findings are suggestive of coarctation of the aorta, which is common among patients with Turner’s syndrome. Physical features of Turner’s syndrome include a short neck with a webbed appearance, a low hairline at the back of the head, low-set ears, and narrow fingernails and toenails that are turned upward.
      Atrioventricular septal defect is the most common cardiac anomaly in Down’s syndrome.
      Structural heart defects at birth (i.e., ventricular septal defect, atrial septal defect, patent ductus arteriosus) are common in Edward’s syndrome.
      Pulmonary stenosis with or without dysplastic pulmonary valve and hypertrophic cardiomyopathy are common in Noonan’s syndrome.
      Supravalvar aortic stenosis and peripheral pulmonary stenosis are found in William’s syndrome.

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  • Question 54 - A 6 week old female patient was brought by her mother to the...

    Incorrect

    • A 6 week old female patient was brought by her mother to the emergency department with icterus. Although she's had a good appetite, and breast-feeding well, she hasn't gained any weight. Her mother noticed that her stools are pale while her urine is noticeably dark. What is the most probable diagnosis?

      Your Answer:

      Correct Answer: Biliary atresia

      Explanation:

      Biliary atresia is a rare condition that usually becomes symptomatic 2 to 8 weeks after birth. It can be congenital or acquired. Typical symptoms include jaundice, weight loss, dark urine and pale stools.

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  • Question 55 - A 3-year-old girl was accompanied by her mother to the hospital due to...

    Incorrect

    • A 3-year-old girl was accompanied by her mother to the hospital due to a change in speech, which is now an indistinct nasal speech. She is always tired by day, has restless sleep and even snores at night. What is the best management strategy?

      Your Answer:

      Correct Answer: Refer to ENT surgeon

      Explanation:

      Adenoid tissue sometimes swell as a result of fighting off the infection as germs are trapped in the adenoids. Adenoid enlargement is suspected.

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  • Question 56 - A 3-year-old boy presents with a patchy rash after treatment for an enlarged...

    Incorrect

    • A 3-year-old boy presents with a patchy rash after treatment for an enlarged cervical lymph node and sore throat. What is the antibiotic that caused this rash?

      Your Answer:

      Correct Answer: Ampicillin

      Explanation:

      An enlarged lymph node does not necessarily need treatment especially if it is caused by a virus. If it is bacterial, antibiotics should be prescribed. Amoxicillin is first line treatment in non-penicillin allergic patients and side effects include allergic reactions like skin rash and itching

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  • Question 57 - A 7 year old boy who had significant dry spells in the past...

    Incorrect

    • A 7 year old boy who had significant dry spells in the past presented with a recent history of wetting himself. Which of the following is the most appropriate management?

      Your Answer:

      Correct Answer: Desmopressin

      Explanation:

      As this boy has experienced significant dry spells in the past, it is unlikely that a structural abnormality is causing the enuresis. The only therapies that have been shown to be effective in randomized trials are alarm therapy and treatment with desmopressin acetate or imipramine. Bladder training exercises are not recommended. Desmopressin acetate is the preferred medication for treating children with enuresis.

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  • Question 58 - An 8 week old baby presents with a fever of 38 degrees. What...

    Incorrect

    • An 8 week old baby presents with a fever of 38 degrees. What is the most appropriate course of action?

      Your Answer:

      Correct Answer: Admit for infection screen and start IV antibiotic

      Explanation:

      This temperature is considered to be a mild fever and is most often caused by a minor infection in children of this age. Therefore, an infection screen should be conducted and an IV antibiotic.

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  • Question 59 - A 15-month-old child is due for his measles, mumps and rubella (MMR) vaccines....

    Incorrect

    • A 15-month-old child is due for his measles, mumps and rubella (MMR) vaccines. He is feverish due to an acute otitis media and the mother gives a family history of egg allergy. What is the most appropriate action?

      Your Answer:

      Correct Answer: Defer immunization for two weeks

      Explanation:

      Vaccines should not be given to a feverish child.

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  • Question 60 - A 12 year old boy has a high HbA1c and is being checked...

    Incorrect

    • A 12 year old boy has a high HbA1c and is being checked by the diabetic specialist nurse. He has been skipping meals lately and his school teachers have noticed that he's been unhappy. Who do you suggest his parents take him to?

      Your Answer:

      Correct Answer: Clinical psychologist

      Explanation:

      The boy is most probably a type 1 diabetic patient. Such a condition can affect the behaviour and psychological state of a young child reflected in their behaviour. The parents should seek the help of a clinical psychologist.

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  • Question 61 - A 10 year old boy is being bullied by his classmates because he's...

    Incorrect

    • A 10 year old boy is being bullied by his classmates because he's obese and he is the shortest in his class. His mother is worried and brings him in to the clinic. History reveals he had a renal transplant last year. What is the most likely diagnosis?

      Your Answer:

      Correct Answer: Cushing’s syndrome

      Explanation:

      The boy had a renal transplant, for which he needs immune suppression. For the exogenous immune suppression an exogenous steroid is needed, which in this case is responsible for the primary Cushing syndrome manifesting with short stature. The administration of steroids before the physiological fusion of the growth plate can lead to premature fusion with permanent cessation of bone growth.

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  • Question 62 - An infant born at 34 weeks was kept in the incubator for almost...

    Incorrect

    • An infant born at 34 weeks was kept in the incubator for almost a month. Physical examination revealed a heart murmur, which however was not present at discharge. What is the most probable cause of this murmur?

      Your Answer:

      Correct Answer: PDA

      Explanation:

      PDA is particularly common in premature babies and it is managed by indomethacin administration. However, if PDA is not the only defect, prostaglandin E1 can be administered in order to keep the ductus open until the surgery takes place.

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  • Question 63 - A 3 year old boy is brought to the emergency by his parents...

    Incorrect

    • A 3 year old boy is brought to the emergency by his parents with worsening ataxia. They also mention that the boy's urine has a distinct sweet odour. Further investigations reveal the presence of leucine, isoleucine and valine in the urine. What is the diagnosis?

      Your Answer:

      Correct Answer: Maple Syrup Urine Disease

      Explanation:

      Maple syrup urine disease (MSUD) is an autosomal recessive metabolic disorder affecting branched-chain amino acids. It is one type of organic academia. The condition gets its name from the distinctive sweet odour of affected infants’ urine, particularly prior to diagnosis, and during times of acute illness. MSUD, also known as branched-chain ketoaciduria, is an aminoacidopathy due to an enzyme defect in the catabolic pathway of the branched-chain amino acids leucine, isoleucine, and valine.

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  • Question 64 - A 3-year-old girl presents to A&E following a few days of being lethargic,...

    Incorrect

    • A 3-year-old girl presents to A&E following a few days of being lethargic, having runny nose, sore throat, and fever. She has unceasing stridor and drooling of saliva while her body is inclined forward. What is the most important next step in her management?

      Your Answer:

      Correct Answer: Call ENT specialist

      Explanation:

      A consultation with an ENT is required to establish the reason for the child’s drooling and stridor indicating and obstructive process. Enlarged tonsils and adenoids should be checked.

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  • Question 65 - A 10 year old boy presented with episodic bluish pale skin while crying...

    Incorrect

    • A 10 year old boy presented with episodic bluish pale skin while crying and brief episodes of loss of consciousness. On examination he has clubbing, cyanosis and a pansystolic murmur. Which of the following is the most probable diagnosis?

      Your Answer:

      Correct Answer: Tetralogy of Fallot

      Explanation:

      Except Tetralogy of Fallot, the others are acyanotic heart diseases. The cyanotic spells and loss of consciousness are due to spasm of the infundibular septum, which acutely worsens the right ventricular outflow tract obstruction. The given murmur is due to a ventricular septal defect.

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  • Question 66 - A 2 year old female was taken to her local emergency department with...

    Incorrect

    • A 2 year old female was taken to her local emergency department with jerking movements in her limbs. This lasted for around 10 seconds, and then she fell unconscious. She soon regained consciousness - she was disorientated but afebrile with no symptoms of meningeal irritation. From the list of options, chose the most appropriate investigation route for this patient.

      Your Answer:

      Correct Answer: 24 hour EEG

      Explanation:

      Many of the symptoms favour an epilepsy diagnosis: uncontrollable jerking of the limbs and a loss of consciousness. A 24-hour EEG is used to diagnose epilepsy.

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  • Question 67 - All of the following conditions because feeding problems for a neonate except for...

    Incorrect

    • All of the following conditions because feeding problems for a neonate except for which one?

      Your Answer:

      Correct Answer: Physiological jaundice

      Explanation:

      Physiological jaundice is the condition in which there is a yellow discolouration of the eyes and the skin of the baby caused by the build up of bilirubin in the blood due to an immature liver. No other symptoms accompany physiological jaundice, thus it will not present with difficulty in feeding. All the other conditions listed can present with feeding problems.

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  • Question 68 - What is the appropriate management for a child who has repeated UTIs? ...

    Incorrect

    • What is the appropriate management for a child who has repeated UTIs?

      Your Answer:

      Correct Answer: Prophylactic antibiotics

      Explanation:

      Prophylactic antibiotics should be given to the child to avoid infections and renal injury.

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      • Child Health
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  • Question 69 - A 12-year-old child has developed a fever and maculopapular rash on his back....

    Incorrect

    • A 12-year-old child has developed a fever and maculopapular rash on his back. What diagnosis should he be given?

      Your Answer:

      Correct Answer: Chicken pox

      Explanation:

      Chickenpox is caused by the varicella-zoster virus. The clinical signs of infection are fever and a maculopapular rash – this is a unique rash with both flat and raised lesions on the skin.

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  • Question 70 - A lethargic 2-month child was brought in with symptoms of diarrhoea and vomiting...

    Incorrect

    • A lethargic 2-month child was brought in with symptoms of diarrhoea and vomiting for 6 days. What is the appropriate initial investigations?

      Your Answer:

      Correct Answer: Urea and electrolytes

      Explanation:

      The most commonly requested biochemistry tests for renal function are the urea and electrolytes. They supply important information when it comes to homeostasis and excretion. Glomerular filtration rate is also the essential standard marker of kidney health and is assessed by checking the creatinine levels. In this case as the child has lost fluids and electrolytes, this test will indicate the extent of the loss and allow for more appropriate replacement.

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  • Question 71 - An 8 year old boy presented with easy bruising following falls. FBC showed...

    Incorrect

    • An 8 year old boy presented with easy bruising following falls. FBC showed leucocytosis and thrombocytopenia with normal haemoglobin levels. His ESR was high and Paul-Bunnell test was positive. Which of the following is the most probable diagnosis?

      Your Answer:

      Correct Answer: Glandular fever

      Explanation:

      Glandular fever (Infectious Mononucleosis) is caused by Epstein–Barr virus (EBV). Leucocytosis rules in infectious mononucleosis and thrombocytopenia is not an uncommon association. ESR is elevated in most of the cases. Paul-Bunnell test is a rapid test for infectious mononucleosis due to Epstein–Barr virus (EBV).

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  • Question 72 - Which one of the following factors is the most likely etiological factor for...

    Incorrect

    • Which one of the following factors is the most likely etiological factor for abnormally short stature amongst children?

      Your Answer:

      Correct Answer: Familial short stature

      Explanation:

      Familial/inherited short stature is the most likely and commonest factor resulting in short stature among the children. Klinefelter syndrome is characterised by tall stature, widely spaces nipples and infertility. Other factors include congenital heart disease, maternal deprivation and diabetes mellitus but these are the rare causes.

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  • Question 73 - A 12-month-old baby with HIV is scheduled for his MMR vaccine. What is...

    Incorrect

    • A 12-month-old baby with HIV is scheduled for his MMR vaccine. What is the most appropriate action?

      Your Answer:

      Correct Answer: Don’t give the vaccine

      Explanation:

      Live attenuated vaccines such as the MMR, should be avoided in HIV+ patients.

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      • Child Health
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  • Question 74 - A 3-year-old child choked on a foreign object, which was removed at the...

    Incorrect

    • A 3-year-old child choked on a foreign object, which was removed at the hospital. The parents are now asking for advice on how to manage future occurrences at home. What do you advise?

      Your Answer:

      Correct Answer: Turn the child on his back and give thumps

      Explanation:

      Give up to five back blows: hit them firmly on their back between the shoulder blades. Back blows create a strong vibration and pressure in the airway, which is often enough to dislodge the blockage.

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  • Question 75 - A 6-year-old male was brought to the OPD with complaints of weight loss...

    Incorrect

    • A 6-year-old male was brought to the OPD with complaints of weight loss and fatigue for the last few months. On examination he was pale and had hepatosplenomegaly. A full blood count was ordered and it revealed immature white blood cells. Which of the following is the most likely diagnosis?

      Your Answer:

      Correct Answer: Leukaemia

      Explanation:

      The age of the patient and the presence of immature white blood cells are suggestive of leukaemia. Hodgkin’s disease is unlikely in this age group and it usually presents with lymphadenopathy. In HIV, immature white blood cells are not present in the blood.

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  • Question 76 - A Blood group A-ve mother gives birth to a baby who develops severe...

    Incorrect

    • A Blood group A-ve mother gives birth to a baby who develops severe jaundice within the first 24 hours of delivery. What is the most probable diagnosis?

      Your Answer:

      Correct Answer: Rh incompatibility

      Explanation:

      Jaundice is considered pathologic if it presents within the first 24 hours after birth. Although up to 60 percent of term new-borns have clinical jaundice in the first week of life, few have significant underlying disease.1,2 However, hyperbilirubinemia in the new-born period can be associated with severe illnesses such as haemolytic disease, metabolic and endocrine disorders, anatomic abnormalities of the liver, and infections. The risk factors here is the mothers blood ground which suggests the cause is fetal-maternal blood group incompatibility.

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  • Question 77 - A young girl is brought to the ED by her parents because of...

    Incorrect

    • A young girl is brought to the ED by her parents because of increased body temperature, rhinorrhoea and an unusual bark-like cough. The girl is also drooling because of excessive salivation. What would be the most appropriate management?

      Your Answer:

      Correct Answer: Corticosteroids

      Explanation:

      The symptoms and signs described are typical for epiglottitis which represents a paediatric emergency and the child should be put immediately on corticosteroids.

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  • Question 78 - An 8-month-old infant is presented to the paediatrics ward with a history of...

    Incorrect

    • An 8-month-old infant is presented to the paediatrics ward with a history of delayed developmental milestones since birth. On examination, he has poor muscle tone and balance, and a head circumference, which is greater than normal. Imaging of the patient's head revealed a diminished cerebellar vermis, a large fourth ventricle, and an enlarged posterior fossa. What is the most likely diagnosis?

      Your Answer:

      Correct Answer: Dandy-Walker syndrome

      Explanation:

      Dandy-Walker syndrome is characterised by symptoms of brain maldevelopment that are seen in this patient. A large cranium indicates hydrocephalus, and the hypotonia indicates poor limb development.

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  • Question 79 - A term infant delivered via C-section develops tachypnoea, grunting, flaring, and intercostal retractions...

    Incorrect

    • A term infant delivered via C-section develops tachypnoea, grunting, flaring, and intercostal retractions 10 minutes after birth. A chest radiograph reveals well-aerated lungs with fluid in the fissure on the right, prominent pulmonary vascular markings, and flattening of the diaphragm. His oxygen saturation is 90%. He improves within a few hours and requires no oxygen. What condition is this infant most likely suffering from?

      Your Answer:

      Correct Answer: Transient tachypnoea of the new-born

      Explanation:

      Transient tachypnoea of the new-born is a condition associated with the delayed clearance of amniotic fluid from the new-born. The X-ray findings are typical of this condition. As the name implies and was noted in this patient, it is not a lasting condition and resolves within 24-72 hours after birth. The differential diagnoses usually present with different chest X-ray findings:
      – Aspiration pneumonia shows infiltrates in the lower lobes of the lungs
      – Congenitally acquired pneumonia shows patchy, asymmetrical densities
      – Meconium aspiration shows hyperinflation and patchy asymmetric airspace disease
      – Pulmonary oedema shows cephalization of pulmonary veins and indistinctness of the vascular margins.

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  • Question 80 - A 2 year old male was brought to the A&E following an car...

    Incorrect

    • A 2 year old male was brought to the A&E following an car accident. On examination bowel sounds were heard in the chest. A nasogastric tube was inserted and a chest x-ray showed a curved NG tube. Which of the following is the most probable reason for it?

      Your Answer:

      Correct Answer: Diaphragm rupture

      Explanation:

      Bowel sounds in the chest and curved NG tube are suggestive of a diaphragm rupture, which has caused herniation of bowel into the thoracic cavity through the defect in the diaphragm.

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  • Question 81 - An 18-month-old girl already speaks ten words but her father says she cannot...

    Incorrect

    • An 18-month-old girl already speaks ten words but her father says she cannot form a sentence. What is the best management strategy?

      Your Answer:

      Correct Answer: Reassurance

      Explanation:

      Not being able to form a sentence at the age of 18 months is quite normal. A combination of two words to form a sentence can be done by 2 yrs of age.

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  • Question 82 - A 5-month-old baby was brought by the mother for assessment. The baby can...

    Incorrect

    • A 5-month-old baby was brought by the mother for assessment. The baby can sit with support but not on his own. On examination, there is palmar grasp. How is the current development of this child?

      Your Answer:

      Correct Answer: Normal

      Explanation:

      All the given development milestones are compatible with the given age.

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  • Question 83 - Parents of a new-born are worried about cot death. What advice will you...

    Incorrect

    • Parents of a new-born are worried about cot death. What advice will you give?

      Your Answer:

      Correct Answer: Child should sleep on the back with legs towards the end of the cot

      Explanation:

      Cot death also know as SIDS or Sudden Infant Death syndrome. Putting a baby to sleep on his back has been shown to reduce the risk of SIDS.

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  • Question 84 - A 6 year old boy presented in the emergency department with a cough...

    Incorrect

    • A 6 year old boy presented in the emergency department with a cough and knee swelling after falling on the road. He had a non-blanching rash on his buttocks and investigations revealed: PT=13, APTT=71, Hgb=11, WBC=8, Plt=200. Which is the most likely diagnosis?

      Your Answer:

      Correct Answer: Haemophilia

      Explanation:

      From the options mentioned here, the closest diagnosis is haemophilia. This is a mixed picture, as a purpuric rash on the buttocks does not correlate with this diagnosis. However, the most appropriate diagnosis is haemophilia.

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  • Question 85 - A 7 year old boy who never had a history of incontinence presented...

    Incorrect

    • A 7 year old boy who never had a history of incontinence presented with bed-wetting. Which of the following is the best approach?

      Your Answer:

      Correct Answer: Sleep alarms

      Explanation:

      As this boy didn’t have a previous history, a structural abnormality is unlikely. Parents should be asked to take the child to the bathroom to void before bedtime. Either alarm therapy or pharmacologic therapy should be considered if the above method doesn’t work after 3 months. From the above 2 therapies, neither one is superior than the other, so alarm therapy should be tried first.

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  • Question 86 - A 3-year-old girl presents with pallor and marked gland enlargement. She has been...

    Incorrect

    • A 3-year-old girl presents with pallor and marked gland enlargement. She has been unwell for the past three weeks. She had a full term normal delivery with no neonatal problems. Her immunisations are up to date. There is no family or social history of note. On examination, her temperature is 37.6°C, and she looks pale and unwell. She has a few petechiae on the neck and palate, with moderate generalised lymphadenopathy and a 3 cm spleen. Which is the most likely diagnosis?

      Your Answer:

      Correct Answer: Acute leukaemia

      Explanation:

      Non-Hodgkin Lymphoma: The history is of enlarged reticuloendothelial system with abnormalities in all 3 cell lines of the bone marrow (pallor, fever and petechiae). The most likely diagnosis is therefore acute (lymphoblastic) leukaemia. Lymphadenopathy may be prominent: mediastinal nodes are characteristic of T-cell leukaemia. In lymphoma the marrow involvement tends to be much less.

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  • Question 87 - A 6 month old baby presents with uncontrollable movements of her hands and...

    Incorrect

    • A 6 month old baby presents with uncontrollable movements of her hands and feet, shortly after being unconscious for a while. What is the most likely diagnosis?

      Your Answer:

      Correct Answer: Infantile spasm

      Explanation:

      Infantile spasm belongs to the spectrum of seizure disorders. Infantile spasm manifests itself with loss of consciousness and jerky movements. The peak age of onset is between 4 and 6 months. Approximately 90% of infantile spasms begin before 12 months of age. It is rare for infantile spasms to begin during the first 2 weeks of life or after 18 months.

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  • Question 88 - A 5-month-old baby presents with symptoms of irritability, blood in the stools and...

    Incorrect

    • A 5-month-old baby presents with symptoms of irritability, blood in the stools and vomiting. Examination reveals a rigid abdomen and drawing of knees upon palpation. Which is the most appropriate action you should take for this baby?

      Your Answer:

      Correct Answer: Refer to paediatric surgeons

      Explanation:

      Intussusception is the most suggested case here based on the child’s symptoms. The urgent course of treatment is to bring the child to a paediatric surgical unit. If air reduction attempts fail, surgery will have to be done. Risk factors for intussusception include viral infection and intestinal lymphadenopathy.

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  • Question 89 - A child presents with a history of recurrent tonsillitis. His mother claims he...

    Incorrect

    • A child presents with a history of recurrent tonsillitis. His mother claims he had three attacks in one year. What is the best management?

      Your Answer:

      Correct Answer: Treat when ill

      Explanation:

      At least seven episodes in the previous year, five episodes in each of the previous two years, or three episodes in each of the previous three years are indications for tonsillectomy. Antibiotics should be administered in the conventional dosage for proved or suspected streptococcal episodes. For now the child should be treated on a case by case basis.

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  • Question 90 - A 10 month infant was brought in a drowsy condition with a 4...

    Incorrect

    • A 10 month infant was brought in a drowsy condition with a 4 day history of vomiting and diarrhoea. His skin turgor was reduced and skin appeared mottled. Vital signs showed decreased BP, reduced capillary refill and a heart rate of 145/min. The best choice of treatment in this case would be?

      Your Answer:

      Correct Answer: IV fluid bolus over 20 minutes

      Explanation:

      According to WHO, the treatment protocol in severely dehydrated children, is to infuse a bolus of isotonic crystalloid over 20-30 min at 30ml/kg to children less than 12 months of age followed by giving the remaining fluid over 5 hours for infants. Reference: World Health Organisation, the treatment of diarrhoea, a manual for physical and senior health workers.

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  • Question 91 - A 40-week-old baby presented with a weak cry and failure to thrive. The...

    Incorrect

    • A 40-week-old baby presented with a weak cry and failure to thrive. The mother gives a history of prolonged neonatal jaundice and says it is common in her family. On examination, a large tongue was noticed. What is the most likely diagnosis?

      Your Answer:

      Correct Answer: Congenital hypothyroidism

      Explanation:

      Congenital hypothyroidism is associated with failure to thrive, macroglossia, prolonged jaundice of a new-born and constipation.

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  • Question 92 - A 4 year old boy presented with bruises on bilateral buttocks and thighs....

    Incorrect

    • A 4 year old boy presented with bruises on bilateral buttocks and thighs. His mother denied any history of trauma. The boy had a sore throat few weeks ago. What is the most appropriate management of this patient?

      Your Answer:

      Correct Answer: Coagulation profile

      Explanation:

      This history is suggestive of Henoch-Schönlein Purpura following a respiratory infection. A typical rash involving thighs and buttocks is often seen in this age group. Coagulation profile is the suitable answer from the given answers.

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  • Question 93 - A 2 month old baby presents to the clinic with vomiting. On examination...

    Incorrect

    • A 2 month old baby presents to the clinic with vomiting. On examination he has ambiguous genitalia. The labs are as follows: Na: 125mmol/L, K: 6mmol/L. Which of the following is the most likely diagnosis responsible for this patient's presentation?

      Your Answer:

      Correct Answer: Congenital adrenal hyperplasia

      Explanation:

      Congenital adrenal hyperplasia (CAH) comprises a group of autosomal recessive defects in enzymes that are responsible for cortisol, aldosterone, and, in very rare cases, androgen synthesis. All forms of CAH are characterized by low levels of cortisol, high levels of ACTH, and adrenal hyperplasia. The exact clinical manifestations depend on the enzyme defect. The most common form of CAH, which is caused by a deficiency of 21β-hydroxylase, presents with hypotension, ambiguous genitalia, and virilization (in the female genotype), and/or precocious puberty (in both males and females). It is further characterized by hyponatremia, hyperkalaemia, and metabolic acidosis. Increased levels of 17-hydroxyprogesterone confirm the diagnosis of 21β-hydroxylase deficiency. Treatment of CAH involves lifelong glucocorticoid replacement therapy. Patients with a 21β-hydroxylase deficiency also require mineralocorticoid replacement with fludrocortisone. Complications of CAH include severe hypoglycaemia, adrenal insufficiency, and/or a failure to thrive.

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  • Question 94 - A 4 year old boy is wetting his bed at night or whenever...

    Incorrect

    • A 4 year old boy is wetting his bed at night or whenever he gets excited. His parents are concerned. What is the best strategy?

      Your Answer:

      Correct Answer: Behavioural therapy

      Explanation:

      Generally, bed-wetting before age 7 isn’t a concern as the child may still be developing night-time bladder control. The child is less than 5 years and most children will outgrow bed-wetting on their own. Therefore only reassurance and behavioural therapy are suggested at this stage.

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  • Question 95 - A 1-week-old baby presents with a large blue bruise-like mark on his back....

    Incorrect

    • A 1-week-old baby presents with a large blue bruise-like mark on his back. His mother noticed the mark that same morning and she is concerned about its severity. What is the most probable diagnosis?

      Your Answer:

      Correct Answer: Mongolian spot

      Explanation:

      Mongolian spots, otherwise called congenital dermal melanocytosis, are pigmented birthmarks. They are usually located on the buttocks or back and although they’re usually present at birth, they may appear soon after. They are flat and have a blue-grey colour (bruise-like). They are benign and present no health risk.

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  • Question 96 - A 13 year old male, who is overwise healthy, has presented with reoccurring...

    Incorrect

    • A 13 year old male, who is overwise healthy, has presented with reoccurring episodes of swelling in his face and tongue. He also complains of abdominal pain. His father has had similar episodes. Choose the most likely diagnosis for this patient.

      Your Answer:

      Correct Answer: C1 esterase deficiency

      Explanation:

      C1 esterase deficiency is most often associated with swelling of the peripheries and laryngeal oedema. Severe pain in the abdomen is also consistent with this diagnosis. It is also an autosomal dominant condition.

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  • Question 97 - A woman gave birth to an infant at 39 weeks' gestation. The infant...

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    • A woman gave birth to an infant at 39 weeks' gestation. The infant has a pulse of 110 bpm, grimaces upon nasal stimulation and has good muscle tone. Moreover, the colour of the infant is pink except for the extremities, which are blueish. What is the infants APGAR score?

      Your Answer:

      Correct Answer: 7

      Explanation:

      Apgar is a quick test performed on a baby at 1 and 5 minutes after birth. The 1-minute score determines how well the baby tolerated the birthing process. The 5-minute score tells the health care provider how well the baby is doing outside the mother’s womb. More specifically, five components are assessed and these are the appearance (A), the pulse (P), the grimace (G), the activity (A) and the respiration (R). A normal APGAR score is considered to be 10 points, 2 points given for each normal component. In this case, 1 point is given for the appearance due to the bluish extremities, 2 points are given for the pulse which is higher than 100 bpm, 1 point is given for the grimacing, 2 points are given for the activity due to the good muscle tone and 1 point is given for the respiration due to gasping. Total score is 7 points.

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  • Question 98 - A 12-year-old child has hypertrophic villi found on biopsy. The most possible diagnosis...

    Incorrect

    • A 12-year-old child has hypertrophic villi found on biopsy. The most possible diagnosis is?

      Your Answer:

      Correct Answer: Allergy

      Explanation:

      Hypertrophic villi is a response to chronic irritation by allergic reactions

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  • Question 99 - A 2-year-old boy's illness started with a 4-day history of fever and cough....

    Incorrect

    • A 2-year-old boy's illness started with a 4-day history of fever and cough. Crepitations are noted upon auscultation. Other examination results are temperature 38.9C, O2 sats 94% on air, respiratory rate is 45/min, and capillary refill time 1 sec. Urine is also negative on dipstick. What is the single investigation most likely to lead to a diagnosis?

      Your Answer:

      Correct Answer: Blood for culture and sensitivity

      Explanation:

      Blood culture and sensitivity will distinguish the bacteria that is responsible for the infection and the effective antibiotic treatment to which the bacteria is sensitive.

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  • Question 100 - A 7-year-old child presented to the paediatric clinic with a swollen face, hands...

    Incorrect

    • A 7-year-old child presented to the paediatric clinic with a swollen face, hands and feet. She gained 2 kilograms over the last month despite poor feeding. What is the investigation of choice in this case?

      Your Answer:

      Correct Answer: Urinary albumin

      Explanation:

      This is a case of nephrotic syndrome that can be confirmed by the presence of urinary albumin. It should be further investigated by a tissue sample to confirm the diagnosis.

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Child Health (4/7) 57%
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