FACULTY OF MEDICINE

END OF YEAR EXAMINATIONS

JULY 2021 INTAKE
PED 310
PAEDIATRICS I
DATE: 20th JUNE 2024

TIME: 3 HOURS TOTAL MARKS: 80

INSTRUCTIONS
1. There are 100 multiple choice questions/items in this paper.
Choose the best answer by shading in pencil or dark pen the
letter corresponding to the correct answer in the answer grid
provided. Answer ALL questions.
2. Write your computer number on both the question paper and the
answer grid and submit both at the end of the examination

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 1. Rachitic rosary
A. Is a late manifestation of congenital syphilis
B. Could be a manifestation of vitamin D deficiency
C. Is caused by the same organism that causes bilateral cataract
D. Is a feature of extra-pulmonary TB

2. Latent Tuberculosis infection (LTBI) in children

A. Means that the individual has M. Tuberculosis infection, has Chest X ray changes
but no clinical signs
B. Untreated infants with LTBI may spread the infection to others
C. Untreated infants with LTBI may go on to develop full-blown TB more likely that
adults
D. Does not need treatment

3. In the diagnosis of tuberculosis

A. The swellings of TB adenitis are usually very painful
B. Smear microscopy is not useful for treatment monitoring
C. The Xpert MTB/RIF detects resistance to Rifampicin
D. Culture of mycobacterium has a turnaround time of about 10 to 12 days

4. Tuberculosis in children
A. Bacteriological confirmation of TB is easier and more common in children than in
adults
B. Is typically polybacillary
C. May present as severe acute malnutrition
D. May present with a wheeze which is usually symmetrical and responds to
bronchodilator therapy

5. A chest X ray is a useful diagnostic tool in Paediatrics. When interpreting a chest Xray,
the following are true except
A. Each lung are divided into 3 zones which do not equate to lung lobes
B. A wide mediastinum could be due to a large thymus – totally normal in infants
C. The right diaphragm is higher than the left
D. To check for rotation the distance from the medial end of each clavicle to the
spinous process of the vertebra at the same level should be equal

6. All of the following may be used for the diagnosis of HIV in a 1-month-old infant, except:
A. HIV DNA PCR
B. NAT test
C. P24 antigen assay
D. HIV ELISA

7. Deficit in weight for age in a 3 year old child indicates

A. Chronic malnutrition
B. Acute malnutrition
C. Stunting

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 D. Wasting

8. A one year old girl child presenting with recurrent Urinary tract infections could have:
A. Constipation
B. Absent ureter on one side
C. Posterior urethral valves
D. Bladder inlet obstruction

9. A newborn baby born with normal APGAR score at birth develops excessive frothing and
chocking. She could have
A. Tracheo-oesophageal fistula
B. Choanal atresia
C. Tetralogy of fallot
D. Oesophageal reflux disease

10. Give one characteristic radiological feature of Transient tachypnea of the newborn
(TTN)?
A. Low volume lungs
B. Prominent horizontal fissure
C. Ground-glass appearance
D. Hyperinflated chest

11. Of the milestones mentioned below, which one is the earliest to be achieved?
A. Sit
B. Pincer grasp
C. Crawling
D. Babble

12. The following reflex is not present at birth

A. Rooting reflex
B. Asymmetric tonic neck reflex
C. Landau reflex
D. Moro reflex

13. Which of the following is an unlikely cause of hydrocephalus in children?

A. Perinatal birth asphyxia
B. Prematurity and intraventricular haemorrhage
C. Infections/meningitis
D. Brain tumors

14. All of the following are features of Necrotizing enterocolitis except for:
A. Increased peristalsis
B. Metabolic acidosis
C. Pneumoperitoneum
D. Bloody stool

15. Which of the following is true regarding Klinefelter’s syndrome?

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 A. Short stature
B. 47XYY
C. Subnormal intelligence
D. Hoarse voice

16. Exclusive breastfeeding may be associated with all of the following except:
A. Bloody stool
B. Constipation
C. Haemorrhage secondary to Vitamin K deficiency
D. Golden stools

17. In children the commonest cause of hypertension is

A. Phaeochromocytoma
B. Secondary hypertension
C. Parenchymal disease of kidneys
D. Renovascular disease

18. Which of the following congenital anomalies is mostly encountered in folic acid
deficiency?
A. Cardiac
B. Renal
C. Neuro-tube defects
D. Adrenals

19. In the management of severe acute malnutrition (SAM), which one of the following
statements is true:
A. F100 is the starter feed
B. Only shock is treated with intravenous fluids
C. F75 is good for tissue build up
D. Kwashiorkor requires more protein while marasmus patients requires more
carbohydrate

Mulele, an 8 year old boy of Rufunsa, presents with fever of 3 week duration. He was treated for
malaria a week ago despite a negative malaria thick smear. He has remarkably lost weight and
is complaining of abdominal pain associated with constipation. The mother says that he loses
his memory at times and would be incoherent in his speech.
20. The most likely diagnosis is:
A. Meningo-encephalitis
B. Cerebral malaria
C. Meningitis
D. Typhoid fever

21. What is the gold standard for diagnosis for the condition in Q20. above?
A. Lumbar puncture
B. Bone marrow aspirate
C. Blood culture
D. Thick blood smear

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Sandra, a 5 year old girl, has had a history of bony pains on and off for 2 weeks .On examination,
she is febrile, underweight, pale and in respiratory distress. She is jaundiced.
22. The following are likely questions that would give a hint towards the diagnosis, except:
A. Any bleeding in the knee joints?
B. History of recurrent abdominal pains?
C. History of recurrent blood transfusion?
D. Any cough?

23. The most likely diagnosis is:

A. Leukaemia
B. Disseminated tuberculosis
C. Sickle cell anaemia
D. HIV

24. The following investigations would help ascertain your diagnosis, except:
A. Full blood count
B. Peripheral smear
C. HB electrophoresis
D. Bone marrow aspirate

A 3 kg infant was born to a 17 years old Para 1 mother. Labour lasted about 18 hours and it is
reported that membranes ruptured 6 hours before the beginning of labor. Apgar score at birth
was 9/10. Two days after birth the child developed failure to feed, lethargy and a tinge of
jaundice.
25. From the scenario above, the following are risk factors for complications in the baby,
except:
A. 3 kg baby
B. 17 year old having a baby for the first time
C. Labour lasting about 18 hours in a primiparous mother
D. Rupture of membranes 6 hours prior to labor

26. The signs and symptoms displayed by the baby are consistent of the following
conditions, except:
A. Neonatal sepsis
B. Rhesus incompatibility
C. Down’s syndrome
D. Hyperthyroidism

27. Following investigations are indicated to ascertain this neonate’s condition, except:
A. Trans-fontanelle ultrasound
B. Malaria test
C. Blood group
D. Full blood count

Joshua, a month old infant, born at term, is admitted for jaundice that appeared on day 24 after
birth and has persisted. He is alert, sucks well, has normal tone, but no fever. His haemoglobin
is 15g/dl with total serum bilirubin of 250 micromol/l.
28. One of the valid questions that should be asked to ascertain Joshua’s condition is:
A. What are the mother’s and the immediate older sibling’s blood groups?
B. Has the mother been on drugs such as cotrimoxazole and sulfadiazine during pregnancy?
C. What is the colour of the urine and stool?

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D. How long did it take for lactation to be established in the mother?

29. Management plan for Joshua’s condition would involve the following, except:
A. Phototherapy
B. Abdominal ultrasound
C. Alanine amino-transferase
D. TORCH serology

30. Moono, an 9 year old school-going boy, presents to hospital with history of cough and
swelling of the face for 4 days. On examination He is dyspnoeic at rest. Possible
physical features you would elicit to help with the diagnosis would be the following,
except:
A. Cyanosis
B. Splenomegaly
C. Engorged jugular veins
D. Cardiac murmur

31. The most likely diagnosis is:

A. Severe Acute Malnutrition
B. Rheumatic Heart Disease in failure
C. Minimal Change Nephrotic syndrome
D. Protein Losing Enteropathy

Gondwe is referred from Samfya for a huge spleen. She has had few episodes of abdominal
pain which the mother attributed to worm infestation. On examination, she is underweight with
a tinge of jaundice. The night of her admission, she bled profusely from the nose and required
nasal packing.
32. The histopathology of the abdominal mass reveals Reed- Sternberg cells. What is your
diagnosis?
A. Leukaemia
B. Hodgkin’s Lymphoma
C. Burkitt’s Lymphoma
D. Nephroblastoma

33. A 3-year-old child presents with a seizure characterized by sudden turning of the eyes
and head on the left side, tonic-clonic movements of the left arm and leg followed after
few seconds by generalized tonic clonic movements of the four limbs with complete
loss of consciousness and urine loss. Which type of seizure did the child experience?
A. Left partial seizure with secondary generalization.
B. Generalized tonic clonic seizure.
C. Right partial seizure.
D. Myoclonic seizure

34. A chest x-ray is a useful investigation tool for cardiac disease in paediatrics. Signs of
increased pulmonary blood flow (increased pulmonary plethora) on CXR is compatible
with a diagnosis of:

A. Aortic Stenosis
B. Ventricular septal defect
C. Pulmonary atresia
D. tetralogy of Fallot

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 35. Diarrhoea is a common condition in children and thus most facts about it must be
known by all doctors. Which of the following statements concerning diarrhoea is true?

A. Oral rehydration therapy may be used to manage severe dehydration

B. The most common cause is enterovirus infection.
C. Broad-spectrum antibiotics are usually indicated.
D. A degree of lactose intolerance may follow diarrhoea due to Rotavirus infection

36. Causes of acute stridor in a two year old child include the following except
A. Bronchiolitis
B. Whooping cough
C. Epiglottitis
D. Foreign body aspiration

37. A 5-year-old male is admitted to AO1 with a 2-week history of fever and headache. On
examination he has a Glascow Coma Scale of 10, no neck stiffness and has a rash on
the body which the mother says appeared a few days prior to presentation at the
hospital. Which of the following statements concerning the above scenario is false?

A. This patients C.S.F is likely to have very low glucose levels.

B. A vaccine is given to prevent this condition in Zambian children.
C. Neisseria meningitis with sepsis is the most likely diagnosis.
D. Haemophilus influenza is a common cause of this clinical picture.

38. Which one of the following statements about glomerulonephritis is true:

A. Affects only the glomerulus
B. Affects both kidneys but asymmetrically
C. Is immunologically mediated
D. It is the commonest cause of Acute renal failure in Children

39. All the following characteristics of Post streptococcal glomerulonephritis are false,
except:
A. Antibiotics are preventive
B. Has a good prognosis
C. Ultimately results in end stage renal failure
D. Is the result of Streptococcal urinary tract infection

40. Regarding Urinary Tract Infection (UTI) in children, which of the following statement is
true?
A. Prevalence in the first year is more in boys than girls
B. Normally presents with non-specific symptoms in infants
C. Urine bag collection is the most preferred method of sterile specimen
D. Normal urinalysis can rule out UTI in an infant less than 8 weeks of age

41. A new born is brought to the delivery room. After assessing the infant’s heart rate,
colour, and respiratory effort, a decision is made that the infant should receive
ventilatory assistance. After 30 seconds of this therapy, cardiac compressions are
initiated. The most likely APGAR score at this point in time is:
A. 9

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B. greater than 6
C. 2
D. 8

42. A neonate presents with hepatosplenomegaly and maculopapular rash on the palms
and soles, the most likely diagnosis is :

A. HIV
B. CMV
C. Syphilis
D. Rubella

43. A neonate presents with small for gestation, periostitis and snuffles. The most likely
diagnosis is
A. HIV
B. CMV
C. Syphilis
D. Rubella

44. The following are known risk factors for tuberculosis in children, except:

A. Household contact with a newly diagnosed smear-positive case

B. Age less than 5 years
C. History of tuberculosis in the extended family
D. Severe malnutrition.

45. Late Onset Neonatal Sepsis is characterised by the following, except:

A. Group B Streptococcus is no longer among the causative organisms.

B. This infection is more localized
C. E.coli is the predominant causative organism
D. Occurs two weeks after birth

46. Only one statement is true about respiratory distress syndrome:

A. Affects only infants born under 34 weeks

B. Typically causes lobar collapse on chest X-ray
C. Maternal steroid therapy improves outcome
D. Is prevented by surfactant therapy

47. Common indications that a neonate has suffered intrapartum hypoxia are as follow,
except:

A. Hypotonia
B. Polyuria
C. Seizures
D. Excessive crying

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 48. Cerebral palsy can be best defined as :

A. Stiffness of all four limbs in an infant as a result of an insult on the fetal or infant brain
B. Limitation in the range of limbs movement caused by an infectious process on the fetal or
infant brain.
C. A condition characterised mainly by mental retardation as a result of an insult on a
developing fetal or infant brain
D. Permanent disorder of movement and posture due to non –progressive insult on a
developing infant brain

49. In gross prematurity, cerebral palsy is often as a result of:

A. Kernicterus
B. Birth asphyxia
C. Periventricular leukomalacia
D. Respiratory distress syndrome

50. Phototherapy is indicated in the following conditions, except:

A. Congenital spherocytosis
B. Neonatal hepatitis
C. Rhesus incompatibility
D. Cholelithiasis

51. The following statements are true of an infant being managed for neonatal jaundice,
except:
A. Phototherapy may result in diarrhea
B. Extra fluids are required while the infant is receiving phototherapy
C. Bilirubin present in the urine on urinalysis indicates unconjugated jaundice
D. Phototherapy uses ultraviolet rays only

52. The parameter that best indicates chronicity of malnutrition is:

A. Head circumference
B. Weight
C. Height
D. All the above

53. The following are characteristics of Sickle Cell Disease, except :

A. Aplastic crisis is often due to Parvovirus B19 infection.

B. Predisposes to pneumococcal septicaemia and salmonella osteomyelitis.
C. Frequently results in an enlarged spleen.
D. Dactylitis occurs early in life

54. A 20 week old infant missed his routine immunisations. He is brought to the clinic today.
He is to be given the following vaccines, except:
A. Diphtheria
B. Rubella
C. Hepatitis
D. PCV

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 55. These are features commonly found in newborn term infants with uncomplicated
Down’s syndrome, except:
A. Down slanting palpebral fissures
B. Nystagmus
C. Brachycephaly
D. Hypothyroidism

56. The following are true of hydrocarbon ingestion, except:

A. the risk of aspiration is directly proportional to the viscosity and inversely proportional to the
volatility of a compound
B. gastric lavage or induction of emesis is not recommended
C. chest X ray may show pneumatocoeles
D. fever or leukocytosis may not always mean infection

57. The following facts are true of malaria, except for:

A. jaundice of severe malaria
B. Plasmodium malariae causes nephrosis
C. Meningitis should be excluded in case of severe malaria
D. Young children and pregnant women are more vulnerable

58. The following statements are true concerning diabetes mellitus type I, except:
A. The destruction of β cells in the pancreas leads to absolute insulin deficiency.
B. Glycosylated haemoglobin helps in the monitoring of management.
C. Diabetic keto-acidosis is a more characteristic presentationin adults than in children
D. Enuresis should be alluded to when investigating diabetes mellitus

59. Mundia, a 14 month old toddler, is brought to the follow-up clinic 3 months after
suffering from meningitis. Her fronto-occipital circumference is said to be expected for
age. Choose the most likely correct measurement:
A. 41 cm
B. 38 cm
C. 46 cm
D. 50 cm

60. Chibwe is able to sit without support and cries in the hands of strangers. Her mother is
excited to see her transferring toys from one hand to the other. Her average age is:
A. 5 months
B. 7 months
C. 9 months
D. 12 months

61. One of the following signs/symptoms marks the difference between lobar pneumonia
and pleural effusion on physical examination:
A. Tachypnoea
B. Flaring of nasal wings
C. Dullness to percussion
D. change in vocal resonance

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 62. The following can cause stridor in young children, except
A. Croup
B. tracheitis
C. Pulmonary tuberculosis
D. Foreign body

63. These congenital infections commonly cause the associated feature in the newborn,
except:
A. Toxoplasmosis - Microcephaly
B. Rubella - Cataracts
C. Cytomegalovirus - Hydrocephalus
D. Syphilis - Snuffles

64. The following are suggestive facts about HIV infection in a newborn, except:
A. One off oral thrush
B. Bronchiectasis
C. Small for age
D. Hepatomegaly

65. A 1.9kg term neonate presents with hydrocephalus and jaundice, the most likely
diagnosis is :
A. HIV
B. Cytomegalovirus
C. Toxoplasmosis
D. Bullous impetigo

66. The following statements concerning cephalhaematoma are true, except:

A. Does not cross sutures

B. Bulge is fully formed at birth

C. Fractures may be present present

D. It is a collection of blood under the scalp

67. Risk factors for neonatal jaundice are as follow, except:

A. Caput succedaneum
B. Lactation failure in exclusive breastfeeding
C. Cephalohaematoma or bruises
D. Babies of diabetic mothers

68. The characteristics of caput succedaneum include all, except:

A. Crosses midline
B. Often affects the foetal brow
C. Crosses suture line
D. It is diffuse oedematous swelling of soft tissue of the scalp

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 69. In the management of severe acute malnutrition (SAM), which one of the following
statements is true:
A. F100 is the starter feed
B. F75 is good for tissue build up
C. Only shock is treated with intravenous fluids
D. Kwashiorkor requires more protein while marasmus patients requires more carbohydrate

70. The following are benefits of breastfeeding, except:

A. Provides superior nutrition for optimum growth.
B. Provides adequate water for hydration
C. Protects against malaria
D. Protects against infection and allergies

71. The following are known risk factors for tuberculosis in children, except:

A. Household contact with a newly diagnosed smear-positive case

B. Age less than 5 years
C. Recent history of chickenpox
D. Severe malnutrition.

72. Late Onset Neonatal Sepsis is characterised by the following, except:

A. This infection is more localized
B. Is acquired from the environment
C. E.coli is the predominant causative organism
D. may be characterized by hypothermia

73. The following are risk factors for nosocomial infections in a newborn, except:
A. indwelling vascular catheters
B. excessive breasfeeding
C. Congenital heart disease
D. parenteral nutrition

74. These haematological changes are strongly indicative of neonatal sepsis, except :
A. Elevated C Reactive Protein of 29
B. Thrombocytopaenia
C. Haemoglobin: 18g/dl
D. WBC: 19,000 / mm3

75. Only one statement is absolutely true about respiratory distress syndrome:
A. Affects only infants born under 34 weeks due lung immaturity
B. Typically causes lobar collapse on chest X-ray
C. Maternal steroid therapy improves outcome
D. Is prevented by surfactant therapy

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 76. Common indications that a neonate has suffered intrapartum hypoxia are as follow,
except:
A. General hypotonia
B. Bulging anterior fontanelle
C. Seizures
D. Excessive crying

Paulina, a 24 month old healthy toddler, is brought to AMEU with history of diarrhea and
vomiting. She is lethargic and failing to drink. She weighs 11 kg.
77. Her management plan for rehydration is:
A. Plan A because she has not lost 10% of her weight
B. Plan C because she has lost about 10% of her weight
C. Plan B due to her not being able to take orally
D. Plan B due to the fact she has lost 10% of her expected weight

78. What fluid would you preferably to manage this little girl?
A. ORS
B. Normal saline
C. ReSoMal
D. Ringer lactate

79. The following amount is appropriate to manage the fluid deficit in this child:
A. 1100 mls
B. 825 mls
C. 1500 mls
D. 1200 mls

80. This fluid should be given over:

A. 30 minutes because of the shock
B. 60 minutes because the child is above 1 year of age
C. 2 hours to avoid fluid overload
D. 3 hours as per management plan

81. Maintenance fluid for this toddler would be:

A. 1100 mls
B. 1050 mls
C. 1010 mls
D. 1200 mls

82. Children with cerebral palsy have these in common, except:

A. Are usually born prematurely
B. Have physical signs that change with time
C. Often fail to thrive
D. Ever changing tone in some cases

83. The following conditions cause unconjugated hyperbilirubinaemia, except:

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A. Congenital spherocytosis
B. Choledocal cyst
C. Severe birth asphyxia
D. Neonatal sepsis

84. Phototherapy is indicated in the following conditions, except:

A. Congenital spherocytosis
B. G 6 P D deficiency
C. Rhesus incompatibility
D. Cholelithiasis

85. The following statements are true of neonatal jaundice, except:

A. Phototherapy may result in diarrhea
B. Extra fluids are required while the infant is receiving phototherapy
C. Bilirubin present in the urine on urinalysis indicates unconjugated jaundice
D. Phototherapy uses ultraviolet rays only

86. The most important parameter to help detect failure to thrive is:

A. The feeding pattern

B. Growth curve
C. Developmental milestones
D. Weight-for-Height

87. Human milk contains more of the following than cows' milk formula:
A. Calcium
B. Folic acid
C. Lactalbumin
D. Iron

88. The following are characteristics of Sickle Cell Disease, except :

A. Aplastic crisis is often due to Parvovirus B19.
B. Predisposes to pneumococcal septicaemia and salmonella osteomyelitis.
C. Frequently results in a palpably enlarged spleen.
D. Dactylitis occurs as a result of infection.

89. The following statements about Sickle Cell Disease are true, except:
A. Jaundice is pronounced in sequestration crisis
B. Clubbing is never a clinical feature
C. Acute chest syndrome is often associated with sepsis
D. Asplenia causes susceptibility to bacterial infections

90. The following are common manifestations of carditis in rheumatic heart disease, except:
A. Cardiomegaly
B. Pericardial effusion
C. Cardiac failure

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D. Valvulopathy

91. All of the following are included in the revised Jones Major criteria, except:
A. New murmur
B. Purposeless, brisk limb movement
C. Maculopapular rash
D. Migrating polyarthritis

92. The following cardiac defects are characteristic of tetralogy of Fallot, except:

A. Pulmonary stenosis
B. Ventriculo-septal defect
C. Transposition of great arteries
D. Right ventricular hypertrophy

93. Of the following, which one is not a cyanotic congenital heart lesion?
A. Transposition of great arteries
B. Tetralogy of Fallot
C. Triscupid atresia
D. Atrial septal defect

94. Concerning fetal circulation, blood flows from the placenta through which route?
A. Umbilical vein, ductus venosus, inferior vena cava and right atrium
B. Umbilical arteries, ductus venosus, inferior vena cava and right ventricle
C. Umbilical veins, ductus arteriosus, superior vena cava and foramen ovale
D. Umbilical arteries, ductus arteriosus, portal vein and ductus arteriosus

95. The following are common findings in idiopathic nephrotic syndrome, except:
A. Abdominal pain
B. Anaemia
C. Oedema
D. Hypertension

96. Regarding BCG vaccine, the following are true, except:

A. Provides more consistent protection against TB meningitis than pulmonary TB
B. It is given in 3 separate doses
C. Typically given in the left upper arm
D. Contra-indicated in symptomatic HIV infection

97. The following statements about Malaria in children are true, except:
A. Plasmodium falciparum invades both mature and young red blood cells
B. Plasmodium vivax is also found in Zambia
C. Children with sickle cell anaemia are immune to malaria due to low haemoglobin
D. Artesunate is the first line for treatment of severe malaria in Zambia

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 98. The following facts are true of malaria, except for:
A. One generalized tonic clonic is enough to seal the diagnosis of severe malaria
B. Plasmodium malariae causes nephrosis
C. Meningitis should be excluded in case of severe malaria
D. Young children and pregnant women are more vulnerable

99. The following signs and symptoms of diabetes mellitus Type I are very common in
children, except :
A. Bed-wetting
B. Excessive hunger
C. Loss of weight
D. Excessive thirst

100. The following statements are true about child’s development, except :
A. Pincer grasp by 6 months
B. Recognising their own name by 8 months
C. Transferring objects from one hand to the other at 9 months
D. Cooing and rolling in bed by 3 months

-THE END-

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