MK Ka Paeds Bazooka
MK Ka Paeds Bazooka
MK Ka Paeds Bazooka
3. A 10-year-old girl is noted to have cardiac murmur. Two days prior to admission,
she complained of fever and headache and suddenly lost consciousness today. On
examination, she is noted to be febrile and has a left sided hemiplegia. The most
likely reason for the development of the hemiplegia is:
A. Thrombo-embolic phenomena secondary to infective endocarditis
B. Hypertensive crisis
C. Tetralogy of Fallot
D. Development of meningitis with complications
7. The following laboratory results were returned in a 6-week-old boy admitted with
6 days of severe projectile vomiting:
pH 7.51 (7.35-7.45), PO2 12 KPa (95 mmHg), PCO2 4.7 KPa (35 mmHg), Blood
Urea 11 mmol/l, Na+ 131 mmol/l, K+ 3 mmol/l, Cl- 83 mmol/l
Which of the following is true concerning this patient?
A. He has hypertrophic pyloric stenosis
B. He is likely to have a bulging anterior fontanelle
C. He should be resuscitated immediately with normal saline
D. He should be commenced immediately on half strength soy protein, low
lactose formula
8. A 15-month-old child with flexural eczema presents with a 3-day history of cough
and wheeze. On examination his saturations are 92% in air, with a respiratory
rate of 55/min and moderate recession. The heart rate is 150/min. What is the
most likely diagnosis?
A. Gastroesophageal reflux
B. Allergic rhinitis
C. Bronchiolitis
D. Asthma
MK
11. A 15-year-old girl presented with a 12-hour history of fever and global headache.
On examination she was febrile (37.5oC). She was fully conscious. Mild neck
stiffness was noted but there were no other neurological signs. Cerebrospinal
fluid analysis showed:
Cell count 200 /mL (60% lymphocytes), Protein 0.8 g/L,
Glucose 4.3 mmol/L, Gram stain: No organisms seen
What is the most likely diagnosis?
A. Bacterial meningitis
B. Lymphomatous meningitis
C. Tuberculous meningitis
D. Viral meningo-encephalitis
19. A 7-year-old boy presents with crampy lower abdominal pain, loose stools and
anorexia of 3 days duration. The stools contain blood and slime and occur 20
times a day. On examination she appears lethargic, pale and has no jaundice. His
temperature is 37.6°, HR100/min, RR 15/min. He has a few purpuric spots on her
legs. What is the most likely diagnosis?
A. Marrow failure
B. Haemophilia
C. Haemolytic uraemic syndrome
D. Intussusception
21. A newborn baby develops difficult breathing 24 hours after birth associated with
persistent vomiting. He has no fever. On examination, his abdomen is scaphoid
and dullness on the left side of the chest. The most likely diagnosis is:
A. Necrotising enterocolitis
B. Hiatal hernia
C. Pyloric stenosis
D. Tracheo-oesophageal fistula with atresia
22. The following features about pyloric stenosis are false, except:
A. Females are more affected than males
B. Vomitus is at times made of fecal matters
C. Growth is rarely affected
D. The repair consists of myotomy
23. In a patient with acute rheumatic fever, the least likely of the following findings
is:
A. Arthritis
B. Bacteria in heart valves
C. Elevated ASO titer
D. Heart murmur
MK
24. The most frequent clinically significant residual lesion of acute rheumatic fever
is:
A. Aortic stenosis
B. Mitral disease
C. Myocardial hypertrophy
D. Pericardial adhesions
28. The normal hemostatic response to vascular damage depends on three major
factors, Except:**
A. The blood vessel wall
B. Stasis of blood flow
C. Circulating platelets
D. Blood coagulation
31. The following statements concerning management of neonatal jaundice are false,
except:
A. Phototherapy may result in diarrhea
B. Extra fluids are never required while the infant is receiving phototherapy
C. Breastfeeding is contraindicated in an infant receiving phototherapy
D. Bilirubin present in the urine on urinalysis indicates unconjugated jaundice
35. The following statements related to meningitis in children are true, except:
A. Nasopharyngeal bacterial carriage is often the source of infection.
B. Meningococcemia can manifest without meningeal signs.
C. Gram negative organisms are less common in infants.
D. A traumatic lumbar puncture is characterized by CSF ratio of 1
WBC/100RBCs.
MK
38. The following facts about diarrhoea in children are true, except:
A. Rotavirus is known to be responsible for at least 80% of diarrhea in infants.
B. It is persistent if it last more than 14 days and not caused by an infection.
C. Moderate dehydration is defined as loss of fluid of about 5 to 10%.
D. Selenium is essential as part of the management
39. Hemorrhagic disease of the newborn is known for the following, except:
A. May be prevented by prophylactic administration of Vitamin K.
B. Involves deficiency of factors II, VII, IX and X.
C. May be due to liver immaturity and lack of intestinal flora in the newborn.
D. Usually results in only mild skin bleeding.
41. The following statements are true about diabetes mellitus, except:
A. Honeymoon phenomenon can last a year
B. Fat is the last to be utilized in neoglucogenesis
C. Levels of potassium in the blood fall once insulin is commenced
D. Cerebral oedema is a common occurrence in children treated for DKA
MK
43. A family has been using a live-in maid to care for their 3-year-old child while
away for work. The maid is diagnosed with pulmonary tuberculosis. Tuberculin
test of the child is negative. Which of the following is indicated for the 3-year-
old?
A. Six months of antituberculous treatment
B. Isoniazid chemoprophylaxis
C. Cotrimoxazole prophylaxis because the maid might be HIV positive
D. One month of streptomycin injections
44. A 4-year-old non immunized boy presents with bouts of coughing ending in
vomiting and a whoop. He has an absolute lymphocytosis. The probable cause of
his illness is
A. Diphtheria
B. Pertussis
C. Epiglottitis
D. Laryngitis
45. A 2-week-old baby girl is upset and has stridor. Her voice is hoarse and she has
a barking cough. She has a low-grade fever. There is history of rhinitis prior to
the cough. The most likely diagnosis for her condition is
A. Epiglottitis
B. Laryngo-tracheo bronchitis
C. Laryngo-tracheo-malacia
D. Papilloma virus
MK
46. A 3-year-old boy is very unwell. His temperature is 39°C and he is drooling
saliva as he is unable to swallow his secretions. He is toxic looking. There is a
soft stridor on closer examination. The most likely causative organism for his
condition is
A. Corynebacterium diphtheria
B. Respiratory syncytial virus
C. Parainfluenza virus
D. Haemophilus influenza
47. A 9-year-old girl presents with history of epistaxis for a period of one week. She
had been well prior to this except for a mild viral infection. Examination reveals
she also has petechiae and a few purpuric spots. She has no lymphadenopathy, or
hepatosplenomegaly. Reticulocyte count on investigation is 7%. What is the most
likely diagnosis?
A. Leukemia
B. Septicaemia
C. Immune thrombocytpaenia purpura
D. Hemophilia
48. A 5-year child presents to the emergency unit with history of sudden
deterioration in condition. It is not quite known what has happened to the child
as she was at the neighbors playing. On examination you notice that the child is
drowsy and almost choking on her own saliva. Examination of the pupils reveals
pin-point pupils. The most likely cause for this child’s condition is:
A. Salicylate poisoning
B. Lead poisoning
C. Organo-phosphate poisoning
D. Morphine poisoning
MK
49. During labour, the fetal heart tracing begins to show late decelerations. To
expedite the delivery, the obstetrician ruptures the membranes. The infant is
delivered 1 hour later and appeared cyanotic and limp requiring extensive
resuscitation. The initial physical examination reveals an infant who has poor
tone and deep tendon reflexes. At 14 hours of life, the infant develops seizures.
The perinatal course described above is most consistent with the following;
A. Development of subarachnoid hemorrhage
B. Birth asphyxia with hypoxic ischaemic encephalopathy
C. Respiratory distress syndrome
D. Intraventricular hemorrhage
50. The neonate described above in Q 49 is likely to have the following complication
A. Spastic Quadriplegic cerebral palsy
B. Diplegic cerebral palsy
C. Choreo-athetoid cerebral palsy
D. Ataxic cerebral palsy
51. A neonate presents with hepatosplenomegaly, the following are tests required
for management, except:
A. RPR
B. RDT for malaria
C. Rapid HIV test
D. Full blood count
52. The following statements about HIV in infancy are true, except:
A. Nucleic Acid Testing (NAT) is mandatory at birth and 6 months of age
B. Asymptomatic exposed infants should not be commenced on Antiretroviral
prophylaxis
C. All exposed infants are to undergo the screening rapid test at first contact
D. Exposed NAT negative infants need to be maintained on ART prophylaxis as
long as they are still breastfeeding
54. The following are suggestive facts about HIV infection in a newborn, except:
A. Prematurity
B. Intra-uterine growth restriction
C. Hepatomegaly
D. Parotid enlargement
55. The following are possible features of a rapidly progressive HIV disease in an
infant, except:
A. Generalised lymphadenopathy
B. Oral thrush during the neonatal period
C. Hepatosplenomegaly
D. Low birthweight
56. Choose the correct line of management for antiretroviral prophylaxis for exposed
infants:
A. Stavudine, Lamuvidine and Efavirenz
B. Zidovudine, Lamuvidine and Nevirapine
C. Abacavir, Emtricitabine and Nevirapine
D. Zidovudine, Lamuvidine and Efavirenz
57. 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.
58. The following are true about management of malnutrition in children, except:
A. Shock should absolutely be managed with intravenous fluids
B. Zinc is not needed in diarrhoea because it is part of F75 feeds
C. Whole blood is better than packed cells in oedematous malnutrition
D. Compared to ORS, ReSoMal contains more potassium and less sodium
MK
62. The most important parameter to help detect failure to thrive is:
A. Diet
B. Growth curve
C. Developmental milestones
D. Bowel habit and type of stool
63. Human milk contains more of the following than cows' milk formula:
A. Lactalbumin
B. Calcium
C. Iron
D. Folic acid
65. The following anti-infective substances are present in mature breast milk,
except:
A. IgG
B. Bifidus factor
C. Transferrin
D. Lymphocytes
66. You are asked to counsel a woman who is planning to have another baby after
her first baby was born with spina bifida. Which one of the following
preconception management options is most likely to reduce the risk in any
subsequent pregnancy?
A. Sodium valproate
B. Thiamine
C. Folic acid
D. Vitamin B12
A. Crosses midline
B. Crosses suture line
C. Takes weeks to resolve
D. It is diffuse oedematous swelling of soft tissue of the scalp
73. The following findings are common in Sickle Cell Disease, except:
A. Jaundice is not necessarily pronounced in sequestration crisis
B. Clubbing is not a common finding
C. Acute chest syndrome is often associated with sepsis
D. Asplenia causes susceptibility to both viral and bacterial infections
75. The following are true about hematologic changes in Sickle Cell Disease, except:
A. Anisocytosis is a very rare blood finding.
B. Target cells are commonly found on the peripheral blood smear
C. Iron deficiency may occur despite re-use after hemolysis
D. Red blood cell distribution width (RDW) is usually increased
MK
76. The following are complications arising from sickle cell disease, except:
A. Cholecystitis
B. Phimosis
C. Leg ulcers
D. Transient ischaemic attack
77. The normal hemostatic response to vascular damage depends on three major
factors, except:
A. The blood vessel wall
B. Stasis of blood flow
C. Circulating platelets
D. Blood coagulation
78. The following are symptoms and signs of congestive cardiac failure, except:
A. Poor feeding
B. Sweating
C. Splenomegaly
D. Central cyanosis
79. The following clotting factors are specific to the intrinsic pathway, except:
A. Factor XII
B. Factor XI
C. Factor VII
D. Factor VIII
81. All of the following are included in the revised Jones Major criteria, except:
A. Maculopapular rash
B. New murmur (carditis)
C. Migrating polyarthritis
D. Chorea
MK
82. A 7-year-old girl presents with a tender and swollen right knee as well as a more
recently appearing swollen left wrist. She also has a fever. This patient fulfills
which of the following modified Jones criteria?
A. 1 Major 1 minor
B. 1 Major 2 minors
C. 2 Majors
D. 2 Minors
83. Rheumatic heart disease is often associated with the following, except:
A. Infective endocarditis
B. Recent infection with streptococcus
C. Huntington chorea
D. Pericarditis
84. The following cardiac defects are characteristic of tetralogy of Fallot, except:
A. Pulmonary stenosis
B. Transposition of great arteries
C. VSD
D. Right ventricular hypertrophy
85. Concerning fetal circulation, blood flows from the placenta through which route?
A. Umbilical arteries, ductus venosus, inferior vena cava and right ventricle
B. Umbilical vein, ductus venosus, inferior vena cava and right atrium
C. Umbilical veins, ductus arteriosus, superior vena cava and foramen ovale
D. Umbilical arteries, ductus arteriosus, portal vein and ductus arteriosus
86. A patient with newly diagnosed acute myeloid leukemia is initially seen with
neutropenia and a temperature of 40oC should be managed with which of the
following measures?
A. Prompt institution of chemotherapy because the fever is most likely due to
leukemia
B. Prompt procurement of cultures and initiation of broad-spectrum parenteral
antibiotics
C. Administration of granulocyte transfusions to correct the neutropenia
D. Extensive search for an underlying infection and withholding antibiotics until
one is found
MK
87. A 3-year-old child presents with history of an abdominal swelling for 2 months
duration. On examination, the patient is cachexic, pale and had bleeding around
the eyes. She also has multiple cervical lymphadenopathy and lumps on the head.
You also note that the child is bleeding under the mucous membrane of her oral
cavity. Her blood pressure is 170/100mmHg. What is the most likely diagnosis?
A. Wilms tumour
B. Leukemia
C. Neuroblastoma
D. Non-Hodgkin’s lymphoma
88. The following are common findings in idiopathic nephrotic syndrome, except:
A. Abdominal pain
B. Anaemia
C. Oedema
D. Hypertension
89. In the nephrotic state, serum lipid levels are elevated for the following reason(s):
A. Hypoalbuminemia stimulates hepatic protein synthesis, including
lipoproteins.
B. Lipid catabolism is increased as a result of reduced plasma levels of
lipoprotein lipase, related to the increased urinary loss of this enzyme.
C. A and B are true
D. None of the above
90. The following conditions are possible causes of nephrotic syndrome, except:
A. Systemic lupus erythematous
B. Syphilis
C. Malaria
D. Tuberculosis
95. The following are risk factors for Early Onset Neonatal Sepsis, except:
A. Birth asphyxia
B. Low birth weight
C. Congenital heart disease
D. Maternal fever
97. The following statements are true about Early Onset Neonatal Sepsis, except:
A. Occurs within the first 7 days of life for the full term neonate
B. Group B Streptococcus is the predominant causative organism
C. Has lower mortality compared to late onset sepsis
D. Involves more than one body systems
MK
98. The following are true about respiratory distress syndrome, except:
100. Common indications that a neonate has suffered intrapartum hypoxia are as
follow, except:
A. Hypotonia
B. Polyuria
C. Seizures
D. Excessive crying
101. Which one of the following is the most important risk factor in the etiology of
intraventricular haemorrhage (IVH)?
A. Coagulation disorder
B. Intermittent positive-pressure ventilation
C. Pneumothorax
D. Extreme prematurity
104. A 2-month-old infant, with a tinge of jaundice, is being treated for sepsis. He
is reported to have fitted twice. A lumbar puncture was performed to rule out
meningitis. He is later on diagnosed with cerebral palsy. What is the most likely
type?
A. Athetoid type
B. Ataxic type
C. Spastic type
D. Choreo-athetoid type
106. The following statements about cerebral palsy are true, except for:
A. Can be detected antenatally
B. The cause is often unknown
C. There is no known cure
D. Genetic influences may play a role
MK
110. In a child whose jaundice begins at less than 24 hours of age, the following
diagnoses should be considered, except:
A. CMV infection
B. ABO incompatibility
C. Hereditary spherocytosis
D. Hypothyroidism
112. Choose the only wrongly matched congenital infection to its complication in
the newborn:
113. A 1-week-old neonate presents with bloody nasal discharge, hepatomegaly and
hemolytic anaemia. Which of the following is the most likely additional feature
in this infant to complete the diagnosis of a well-known congenital infection?
A. Hydrocephalus
B. Periostitis
C. Seizures
D. Cataracts
114. Of the following, the congenital infection most associated with hydrops fetalis
is:
A. Rubella
B. HIV
C. Syphilis
D. Toxoplasmosis
117. If not well managed, severe measles infection may lead to the following
condition, except:
A. Fulminant hepatitis
B. Cancrum oris
C. Tuberculosis
D. Severe malnutrition
MK
120. Membranous pharyngitis, enlarged anterior cervical lymph nodes and ‘bull
neck’ appearance are characteristics of the condition below :
A. Measles
B. Tuberculosis
C. Diphtheria
D. Pertussis
131. The following statements are true concerning diabetes mellitus type I, except
A. The destruction of α cells in the pancreas leads to absolute insulin deficiency.
B. Glycosylated haemoglobin helps in the monitoring of management.
C. Diabetic keto-acidosis may be the first presentation in children
D. Enuresis should be alluded to when investigating diabetes mellitus
132. 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
136. A 4-week-old baby presents with jaundice. The following statements are false,
except:
A. No investigations are necessary if the baby is entirely breastfed
B. It is an indication to stop breast feeds
C. Conjugated hyperbilirubinaemia is never physiological
D. Breast milk jaundice is associated with pale stools
142. She is then given adjuvant treatment for the diarrhoea. Which one of the
following is she not supposed to be given:
A. Plain water
B. Fresh milk
C. Zinc sulphate
D. Zinc oxide
143. The best oral rehydration fluid for this toddler would be:
A. ReSoMal
B. Low osmolarity ORS
C. High osmolarity ORS
D. Homemade ORS
MK
145. The following drugs are used to manage severe birth asphyxia, except:
A. Dexamethasone
B. Phenobarbitone
C. 10% Dextrose
D. Mannitol
149. Delayed speech in a 5-year-old with normal motor and adaptive development
is most likely due to:
A. Mental retardation
B. Deafness
C. Cerebral palsy
D. Kernicterus
151. Signs constituting severe malaria include all of the following, except:
A. Convulsions
B. Pulmonary hypertension
C. Haemoglobinuria
D. Jaundice
153. The following findings are common in Sickle Cell Disease, except:
A. Jaundice is not a common feature in sequestration crisis
B. Asplenia causes susceptibility to both viral and bacterial infections
C. Jaws are often affected by extra-medullary erythropoiesis
D. Acute chest syndrome is often associated with sepsis
154. The following are true about haematologic changes in Sickle Cell Disease,
except:
A. Poikylocytosis is characterized by spiked red blood cells
B. Target cells are commonly found on the peripheral blood smear
C. Iron deficiency may occur despite re-use after haemolysis
D. Red blood cell distribution width (RDW) is usually increased
MK
156. A healthy 9-month old male infant presents to the emergency room with low
grade fever, difficult breathing for one night, and breastfeeds intermittently. On
examination, he is wheezing, has intercostal and sub-costal recessions and
saturating at 91% at room air. What is the most likely diagnosis?
A. Epiglottitis
B. Severe bacterial pneumonia
C. Bronchiolitis
D. Aspiration pneumonia
157. Which of the following complications of diabetic ketoacidosis has the highest
mortality rate?
A. Cerebral oedema
B. Hypokalaemia
C. Hyperglycaemia
D. Acidosis
158. A newborn is brought to the delivery room. After assessing the infant’s heart
rate, color, and respiratory effort, a decision is made that the infant should receive
ventilatory assistance. After 30 seconds of this therapy, CPAP is initiated. The
most likely APGAR score at this point is
A. 9
B. 8
C. 5
D. 2
MK
159. A mother is at 40 weeks gestation. The dating by time of last menstrual cycle
agrees with an early ultrasound. At birth, the infant weighs 1.5kg and has a head
circumference that is abnormally small. The platelet count is also low. What is
the most likely cause of the poor growth of this child?
A. Placental insufficiency
B. Intrauterine infection in the first trimester
C. Neonatal Disseminated Intravascular coagulopathy
D. Neonatal coagulopathy
160. An infant is born prematurely at 28 weeks gestation and weighs 1.28kg. The
infant is started on enteric feeds at 2 days of age. Three days later, he is not
tolerating his feeds. The signs and symptoms exhibited by the infant that make
you suspect he has neonatal necrotizing enterocolitis include the following,
except
A. Apnoea
B. Diarrhoea
C. Pneumothorax
D. Jaundice
161. An infant born 30 weeks gestation begins to experience apnea on the second
day of life. All of the following should be included in the initial management of
this infant, except:
A. Evaluation for evidence of infection or intracranial hemorrhage
B. Check that the environmental temperature is above 25 Celsius
C. Complete blood count, arterial blood gas studies, and plasma glucose and
electrolyte management
D. Assessment for evidence of hydrocephalus
162. The following are known facts about cerebral palsy, except:
A. May affect the entire body, yet have no impact on intelligence
B. May cause precocious puberty
C. Spastic type has highest likelihood of mental retardation
D. Gastroesophageal Reflux Disease
MK
163. A 2-year-old girl, well 24 hours ago, is brought to the emergency room in
shock. She has no history of trauma. On further examination, she is extremely
pale with an extreme large spleen. Her thick smear reveals no malaria and she is
afebrile. The most plausible cause of is the most likely explanation of her
condition is
A. Spontaneous massive internal haemorrhage
B. Cardiogenic shock
C. Splenic sequestration crisis in sickle cell anemia
D. Hypersplenism
164. These are features commonly found in newborn term infants with
uncomplicated down’s syndrome except:
A. Inguinal hernia
B. Nystagmus
C. Brachycephaly
D. Hypothyroidism
165. Precious, a 13-year-old girl a resident of Kamwala south presents with fever
for 2 weeks and weight loss. What would be your next appropriate step?
A. Start anti-tuberculous treatment immediately
B. Start the adolescent on F75
C. Get a more detailed history
D. Start the patient on Ciprofloxacin as this could be enteric fever
166. Precious, a 8 year-old-girl presents with body hotness for 3 weeks, poor
appetite, weight loss and sweating. Her differential diagnosis includes the
following except
A. Disseminated TB
B. Typhoid fever
C. Acute leukemia
D. Severe malaria
MK
172. Mr and Mrs Woods are planning another pregnancy. Mr Wood’s mother and
Mrs Woods’ father are siblings. They have a healthy son, but had 2 children who
died in early infancy. They were told that it was due to “metabolic condition”.
This condition is likely due to
A. Multifactorial inheritance
B. Autosomal recessive inheritance
C. X-linked inheritance
D. Chromosomal translocation
173. Phiri is the youngest of a family of 5 siblings. Both parents are in their early
thirties. The mother is very worried about Albert’s long hours of sleep, his “being
too weak” and his tongue that is constantly out, and a big umbilicus. Phiri’s
condition is mostly due to
A. Multifactorial inheritance
B. Autosomal recessive inheritance
C. Chromosomal translocation
D. Chromosomal non-disjunction
174. Little Nora, newly born, has extra digits on both hands. The mother says she
had the same. This polydactyly is as a result of:
A. X-linked inheritance
B. Autosomal recessive inheritance
C. Autosomal dominant inheritance
D. Chromosomal non-disjunction
175. Rufai comes home with a swollen knee. He is then rushed to the nearest clinic
where the doctor performs a tap that yields frank blood. He is the only boy among
3 girls. Mother says her only brother died in his tender age after bleeding
uncontrollably as a result of circumcision performed by a traditional healer in the
village. Rufai’s condition is likely due to
A. X-linked inheritance
B. Autosomal recessive inheritance
C. Autosomal dominant inheritance
D. Chromosomal non-disjunction
MK
176. Manjimela has obvious big foot and the father amusingly states that God gifted
the family with this unique feature which makes them stand out. This is likely as
a result
A. X-linked inheritance
B. Polygenic phenomenon
C. Autosomal inheritance
D. Chromosomal deletion
182. A newborn is brough to the delivery room. After assessing the infants heart
rate, color 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 is
A. 9
B. 7
C. 6
D. 2
183. An infant born 30 weeks begins to experience apnea on the second day of life.
All of the following should be included in the initial management of this infant
except:
A. Evaluation for evidence of infection or intracranial hemorrhage
B. Bronchoscopy to evaluate the upper and lower airway
C. Complete blood count, arterial blood gas studies and plasma glucose and
electrolyte management
D. Check that the environmental temperature is above 25 celsius
184. Signs constituting severe malaria include all the following except
A. Convulsions
B. Polycythemia
C. Hemoglobinuria
D. Jaundice
186. These are features commonly found in newborn term infants with
uncomplicated Down’s syndrome except
A. Nystagmus
B. Brachycephaly
C. Down slanting palpebral fissure
D. Hypothyroidism
187. The following statements related to neonatal sepsis are true, except:
A. Thrombocytopenia frequently associated with sepsis
B. WBC may be high, low or normal
C. Timing of sampling has very little bearing of the results
D. Persistent low WBC more predictive of sepsis than elevated WBC
188. Critical to the management of early onset neonatal sepsis are the following,
except:
A. Dopamine
B. Normal saline
C. Fresh Frozen Plasma
D. Hydrocortisone
189. The following infections are common in both HIV infected and uninfected,
except:
A. Otitis media
B. Bronchectasis
C. Tuberculosis
D. Diarrhoea
196. The following nutrients are particularly critical for brain development, except:
A. PUFA
B. Iron
C. Copper
D. Sodium
MK
200. The following hematological findings are common in Sickle Cell Disease,
except:
A. Low Haematocrit
B. Normal MCV
C. Low C3 Complement
D. Low platelet count
201. The following findings are common in Sickle Cell Disease, except:
A. Sequestration crisis is always associated circulatory collapse
B. Clubbing is not a common finding
C. Acute chest syndrome is often associated with sepsis
D. Asplenia causes susceptibility bacterial infections
202. The following are symptoms and signs of congestive cardiac failure, except:
A. Poor feeding
B. Sweating
C. Splenomegaly
D. Central cyanosis
MK
204. All of the following are included in the revised Jones Major criteria, except:
A. Maculopapular rash
B. New murmur (carditis)
C. Migrating polyarthritis
D. Chorea
207. The following are common findings in idiopathic nephrotic syndrome, except:
A. Abdominal pain
B. Anaemia
C. Oedema
D. Hypertension
215. The following statements related to cerebral palsy in children are true, except:
A. Some have a degree of learning impairment
B. Birth asphyxia is the most common cause
C. The ataxic type is the most common clinical type
D. Management should be centered on the clinical type
216. The following are known causes of Cerebral Palsy, except for:
A. Severe untreated neonatal jaundice
B. Hyperglycaemia
C. Periventricular leukomalacia
D. Twin-to-twin transfusion
219. The reason subjects with cystic fibrosis have abnormal clotting is:
A. Because of their chronic hypoxia they are clumsy and injure themselves
more frequently.
B. They have trouble absorbing fats, and by extension fat soluble vitamins
C. Their excessive infections make them prone to DIC.
D. This CF gene is closely linked to the factor VIII gene, and they are likely
to inherit both.
223. All of the following are true about idiopathic nephrotic syndrome, except:
A. Most commonly appears between the ages of 2 and 6 years
B. More common in females than males
C. MCNS is present in 85-90 % of patients of less than 6 years of age
D. FSGS develops in older children
224. The following are uncommon findings in a patient with idiopathic nephrotic
syndrome, except:
A. Abdominal pain
B. Gross hematuria
C. Anorexia and Irritability
D. Hypertension
225. One of the following malaria types is known to cause nephrotic syndrome:
A. Plasmodium falciparum
B. Plasmodium vivax
C. Plasmodium ovale
D. Plasmodium malariae
227. The following statements about BCG vaccine are false, except:
A. It is a killed vaccine
B. It is recommended to be given at 6 weeks of age
C. Is given through a subcutaneous injection
D. It provides more consistent protection against TB meningitis than
pulmonary disease
228. Most deaths due to acute diarrhoea result from the following, except:
A. Associated shock
B. Dehydration
C. Electrolyte imbalance
D. Rotavirus infection
229. The following are biological factors that increase susceptibility to acute
diarrhoea, except:
A. Failure to get immunized against rotavirus
B. Failure of measles vaccination
C. From birth to six months
D. Malnutrition
233. The following clinical features are highly associated with congenital
infections, except:
A. IUGR infants
B. Hepatosplenomegaly
C. Unusual rash
D. Fever
238. Mutale, a 18 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. 45 cm
D. 49 cm
240. Sabina 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
242. The following are suggestive facts about HIV infection in a newborn, except:
A. Prematurity
B. Intra-uterine growth restriction
C. Hepatomegaly
D. Generalised lymphadenopathy
MK
244. The disease staging in HIV is important because the following reasons,
except:
A. It provides guidance to disease prognosis
B. It helps with monitoring response to therapy
C. It helps with the choice of antiretroviral drugs
D. It determines response to therapy
249. The following findings are common in Sickle Cell Disease, except:
A. Jaundice is not necessarily pronounced in sequestration crisis
B. Clubbing is not a common finding
C. Acute chest syndrome is often associated with sepsis
D. Splenic sequestration crisis occurs mainly after the age of 5 years
250. The following are true about haematologic changes in Sickle Cell Disease,
except:
A. MCV is always elevated due to folate deficiency
B. Target cells are commonly found on the peripheral blood smear
C. Iron deficiency may occur despite re-use after hemolysis
D. Red blood cell distribution width (RDW) is usually increased
254. In relation with labour associated cyanosis in the neonate, the following are
correctly matched, except:
A. Prolonged rupture of membranes………..Sepsis
B. Caesarian section…………………….Transient Tachypnoea of the Neonate
C. Prematurity…………………………..Meconium aspiration
D. Sedatives…………………………….Apnoea
SECTION 2: TRUE/FALSE
1. Complications of Measles include
A. Xeropthalmia- True
B. Laryngo-tracheo-bronchitis- True
C. Acute Encephalitis- True
D. Giant cell pneumonia- True
2. Concerning Bronchiolitis
A. The commonest causative organism is parainfluenza virus-False
B. The commonest causative organism is Respiratory Syncytial Virus-True
C. The cough and wheeze are due to blockage of the small airways due to
secretions and inflammation- True
D. The cough and wheeze are due to bronchospasm of the bronchi and
bronchioles-False
16.In suspected acute rheumatic fever the following indicate rheumatic fever:
A. An erythematous serpiginous rash on extensor surfaces of the patient’s body-
True
B. Clumsiness and unusual dropping of things including a change in
handwriting-True
C. Shortened PR interval-True
D. Hyperpigmented nodules on the extensor surface of the limbs-False
MK
17.Human milk contains more of the following than cows' milk formula:
A. Lactalbumin-True
B. Calcium- False
C. Iron-False
D. Immunoglobulins-True
35.Differential diagnosis of a child presenting with history of fever for 2 weeks and
splenomegaly include the following:
A. Salmonellosis-False
B. Tropical splenomegaly syndrome-True
C. Rheumatic fever-False
D. Lymphoma-True
38.Burkitts lymphoma:
A. Is a tumour commonly found in Africa-True
B. Is a tumour presenting commonly between 4-8 years of age-True
C. Always presents with a mass in the superior mediastinum-False
D. Is highly responsive to chemotherapy-True
42.A 2 days old infant presents with fever and a whimpering cry. These investigation
results would support a diagnosis of neonatal sepsis:
A. Neutropenia-True
B. Leukocytosis of over 25,000/mm3-True
C. Anaemia-True
D. Thrombocytopenia-True
50.The following are possible presenting signs and symptoms of diabetes mellitus
Type I in children:
A. Bed-wetting- True
B. Excessive hunger-False
C. Vaginal candidiasis-True
D. Persistent abdominal pain-True
MK
SECTON 3: ESSAYS
1. Kasongo, a 5-year-old boy of Chingwele, presents with a mandibular mass
causing dental malalignment. Histopathology results reveals a “starry sky”
appearance. (15 marks)
A. What is the most likely diagnosis?
Answer: Burkitt’s lymphoma
C. Mention 2 crucial measures you would take prior to and during chemotherapy
Answer:
1. Rehydration
2. Allopurinol administration
2. A 4-month-old female infant is brought to OPD for not gaining weight. There is
a grade III pansystolic murmur at the left lower sternal border with loud 2nd heart
sound at pulmonary area. Echocardiography reveals Tetralogy of Fallot. (15
marks)
A. Mention at least 4 clinical features compatible with this condition
Answer:
1. Failure to thrive
2. Excessive sweating when feeding
3. Finger clubbing
4. Hyper-cyanotic spells
5. Polycythemia
E. Write down 4 drugs (each coupled with its purpose) that are usually used in
this condition
Answer
1. Beta blocker (propranolol): used to prevent cyanotic spells, they reduce
ventricular infundibular spasms
2. Analgesics (Morphine): used to relax the pulmonary infundibulum, reduce
ventilatory drive and for sedation
MK
3. Rupende, a 10-year-old boy is brought into the emergency room with history of
difficulty breathing since the previous night. He is a known sickle cell disease
patient who has had several vaso-occlusive crises monthly. (15 marks)
A. Write down 2 ways you would manage this patient besides the usual IV fluid
and analgesics
Answer:
1. Monthly top up blood transfusion
2. Hydroxyurea
B. During one of the painful crises, he presents with fever and respiratory
embarrassment. Give 2 possible differentials
Answer:
1. Bacterial pneumonia
2. Acute chest syndrome
5. A 3-day old infant presents with jaundice which started on the first day after birth
and involved the abdomen below the umbilicus to the knees. He looks lethargic,
irritable and pale. His body temperature is normal. He is the younger of two
siblings. Kernicterus is entertained as the diagnosis (15 marks)
A. What is the Kramer grade of this neonate and its corresponding serum
bilirubin levels?
Answer: Kramer Grade 3
C. Direct Coombs test is performed and turns out positive. Whose blood, do you
think, was tested?
Answer: The neonate
D. You decide to institute phototherapy. List down at least 4 measures you would
take prior to and while the baby is undergoing it.
Answer:
1. Maintain room temperature at about 30oC
2. Check blood sugar at regular intervals
3. Encourage breastfeeding
4. Give maintenance fluid with 10% to cover for the deficit
6. Olipa, a 4-year-old toddler, has recently moved with her parents into the newly-
bult farm house. She is brought to the Emergency Department and with difficult
breathing associated with foaming in the mouth. The father denies any history of
body hotness and fits.
A. Outline your management of this child in 4 bullet points on arrival
Answer:
➢ ABCs: Suction secretion, intubate and give oxygen, gain venous access and
start IV fluids
➢ Stop exposure: remove clothes, wash the child and have her put on different
clothes
➢ Administer activated charcoal for gastric decontamination
➢ Labs: urinalysis, Arterial blood gasses, Full blood count, urea, electrolytes and
creatinine, liver function tests, liver enzymes, serum glucose and RBC
cholinesterase level
C. Write down 4 clinical findings that would help you arrive at the diagnosis?
Answer:
➢ Miosis
➢ Wheezing
➢ Muscle twitching and fasciculations
➢ Lacrimation and diaphoresis
➢ Bradycardia
7. Maureen, a 3-year-old girl woke up this morning and is failing to stand. Her
mother thought she is deliberately feigning to attract attention. She however
decides to take her to the hospital. A quick assessment reveals Maureen has
indeed lost pain sensation in both lower limbs up to the knees.
A. What is your working diagnosis?
Answer: Acute flaccid paralysis
D. What clues would you be looking for in the history as a lead to the diagnosis?
Answer:
➢ History of respiratory illness, pharyngitis or Gastroenteritis (diarrhea and
vomiting)
➢ Presence of fever, generalized non-throbbing headache, sore throat,
anorexia, nausea, vomiting, muscle aches
➢ Bladder (urinary retention) and bowel complaints: absent or present
➢ Immunization history against polio and any recent vaccines given to the
child
E. Give 2 crucial investigations that would help confirm the diagnosis?
Answer:
➢ Nerve conduction test
➢ Lumbar puncture for CSF analysis
8. Mweetwa is born to a mother living with HIV. He weighs 3.1kg at birth and is
exclusively breastfed. The mother started taking antiretroviral drugs (ARVs) 8
months into her pregnancy.
A. Write down the prophylactic ARVs regimen you would use on Mweetwa?
Answer: AZT + 3TC + NVP
B. Mention 3 advices you would give the mother to ensure she does not pass the
infection to the baby?
Answer:
➢ Exclusive breastfeeding
➢ Mother should continue taking ARVs
➢ Administer ARV prophylaxis and cotrimoxazole prophylaxis to the child
as long as child is exposed
C. How long would you advise the mother to breastfeed the baby?
Answer: as long as she wants as long as she is taking her ARVs rigorously
however WHO advocates for 6 months exclusive breast feeding
D. In a succinct manner, write down the timeline of the HIV testing and the type
of test at every milestone as part of follow-up of Mweetwa
Answer:
➢ Nuclei acid test (NAT) at first contact
➢ NAT at 6 weeks
➢ NAT at 3 months
➢ NAT at 6 months
➢ NAT at 9 months
➢ Serological test (Rapid test) at 12 months (confirm positive with NAT)
➢ Serological test (Rapid test) at 18 months (confirm positive with NAT)
➢ Serological test at 24 months (confirm positive with NAT)
➢ Serological test 6 weeks after complete cessation of breastfeeding
E. It turns out that Mweetwa’s NAT result is positive. What ARV regimen would
you start Mweetwa on?
Answer: AZT + 3TC + LPV-r
MK
9. Chabala, a 3-year-old toddler, is admitted with a 5 day long febrile illness. The
mother reports that all started with body hotness associated with headache. He
was then taken to the local clinic where the health worker commenced him on
penicillin V for 5 days. His condition slightly improved, however a day prior to
admission, he had a fit which prompted the mother to take him to the hospital.
He is HIV negative
B. Write down one procedure you would avoid due to physical findings
Answer: Lumbar puncture
C. Write 3 important investigations you would carry out besides FBC to arrive
at the diagnosis
Answer:
➢ CT scan of the head
➢ Blood culture
➢ RDT for malaria
B. As you work out the case, you are availed the following results:
WBC: 13,000/mm3, Hb 9.5g/dl, MCV: 75.9fl, RBS: 9.4mmol/L, AST: 39
IU/L, Total serum bilirubin 51 micromol/L
What is your diagnosis?
Answer:
C. Write down one crucial investigation you would carry out to explain what is
happening to Melanie
Answer:
11.Besa, an 18-month-old toddler, lives with her parents who have just moved in
their newly-built house. She is brought to the emergency department with
difficult breathing associated with foaming in the mouth. The father denies any
history of body hotness and fits. She is reported to have been fine the day prior
to the consultation.
A. Outline your management of this child in 4 bullet points on arrival
Answer:
➢ ABCs:
- Airway management: Admit and Keep airway patent
- Suction foam and secretions from the mouth
- Consider intubation
- Keep head end of the bed elevated
- Administer oxygen via nasal prongs or mask
- Gain venous access, send blood for investigations (arterial blood
gasses, U and Es, FBC and Random blood glucose)
- IV fluids (DNS)
➢ Nebulize with salbutamol 5mg
➢ Give hydrocortisone
➢ Antibiotics
B. What is your most likely diagnosis?
C. Answer: Asthma (acute exacerbation)
D. List down 4 possible clinical signs/symptoms that would help with the
diagnosis of this condition
Answer:
➢ Use of accessory muscles of respiration or poor respiratory effort
➢ Presence of wheezing
➢ Impaired level of consciousness
➢ Speaking with difficulty or unable to speak
➢ Heart rate >130b/min
➢ Respiratory rate >50b/min
E. Write down 3 drugs that are critical in the management of this condition
Answer:
➢ Nebulized Salbutamol 5mg
➢ Prednisolone 2mg/kg (max 40mg) PO OD for 3 days
➢ Ipratropium bromide 250mcg
MK
C. In the quest to find the cause of this condition, blood culture is requested for
What would the result likely be and why?
Answer:
No organism because this process is a post infectious one
14.Write down the Zambian EPI schedule of immunization in a table form (vaccine,
schedule and site) (10 marks)
Answer
Vaccine Schedule Site
BCG At birth Left forearm
POLIO At birth, 6, 10, 14 weeks Orally
and 9 months if polio 0
missed
C. Being the intern on call, how would you manage Mohamed’s case?
Answer:
1. Nil per oral
2. Antibiotics (metronidazole)
3. IV fluid (not containing potassium) DNS
4. Group and Cross-match
16.Paul was born via spontaneous vaginal delivery, cried at once and was discharged
the very day. However, the mother noted that Paul would not cry for “food” and
spent most of the time sleeping. When carried, he looked weak, yet with no
apparent reason to explain the generalised weakness. His occiput looks flat and
he is said to have opened bowels 3 days after birth. The mother thought this was
due to the umbilical hernia.
A. What is the most likely diagnosis? (5 marks)
Answer: Down’s syndrome or trisomy 21
B. Write down investigations you would carry out to confirm the diagnosis (3
marks
Answer:
1. Karyotype
2. Abdominal X-ray
3. Abdominal ultrasound
4. Serum urea, electrolytes and creatinine
MK
17.An 18-month-old boy is brought to the ER with fever, mild pallor and inspiratory
stridor. He is saturating at 94% at room air. The doctor on call immediately starts
the child on oxygen, secures an IV access and administers salbutamol
nebulisation.
A. Write down measures taken by this doctor that are not appropriate for this case
Answer:
➢ Salbutamol nebulization- not appropriate in upper respiratory tract
infection.
➢ Administration of oxygen when child is saturating at 94% on air
(saturation is normal).
C. Three hours later, the stridor gets worse as the child is barely able to breathe
and swallow. What is your most likely diagnosis?
Answer: Acute epiglottitis
18.A younger mother storms your consulting room panicking about a swelling on
her 5-day old baby. She vehemently denies any trauma, to which her husband
agrees. Besides this, the baby is said to be feeding well. He has no fever.
A. Write down your differential diagnosis.
Answer: Caput succedaneum:
➢ Cephalohematoma (subperiosteal hemorrhage) diffuse, edematous often
➢ Caput succedaneum dark swelling of the soft
tissue of the scalp that
B. On further questioning, the mother swears her baby’s head extends across the
was perfectly well at birth. What is your most likely midline and suture lines.
diagnosis? It is seen in infants
Answer: Cephalohematoma delivered from a face
presentation, soft tissue
C. Write 2 hematological parameters you would like to edema of the eyelids and
monitor. face is an equivalent
Answer: phenomenon. CS may be
➢ Serum bilirubin seen after prolonged
➢ Full blood count: Hemoglobin, RBCs (for anemia), labor in full term or
WBC (infection) preterm infants and is
associated with molding
D. D. How would you manage this neonate of the head.
Answer:
Cephalohematoma
➢ Reassure the parents that it will resolve with time.
(subperiosteal
➢ Conservative management and follow up
hemorrhage) does not
- Observation
cross suture lines. A
- Skull X-ray or CT scan if neurological symptoms appear.
linear skull fracture may
- Monitor for jaundice and rising bilirubin levels. Phototherapy may be
rarely be seen. With time
needed if blood accumulation is significant leading to jaundice
it organizes, calcifies and
➢ If significant in size and does not resolve spontaneously aspiration can be
forms an central
done with prophylactic intravenous antibiotics.
depression.
MK
• Cyanosis
• Single S2 heart sound
21.A 2-year-old boy presents with cyanosis since infancy. On examination he has
finger clubbing and appears small for age
A. What is your differential diagnosis, at least 4
Answer:
➢ Tetralogy of fallot
➢ Tricuspid atresia
➢ Truncus arteriosus
➢ Transposition of great vessel
➢ Total anomalous pulmonary venous return
➢ Univentricular heart
➢ Hypoplastic left heart syndrome
➢ Echo
➢ ECG
➢ Chest x-ray
➢ FBC/DC
C. The above investigations show that the child has tetralogy of fallot, list the
four characteristic features?
Answer:
➢ Right ventricular hypertrophy
➢ Ventricular septal defect
➢ Pulmonary infundibular stenosis
➢ Overriding aorta
22.Albert, a 3-day old neonate, born to a mother who has been antiretroviral therapy
(TDF /XFT/EFV) for the past 3 years. The viral load at her last check-up is
undetectable.
A. How are you going to manage Albert at this point in time?
Answer:
Perform a nucleic acid test on Albert at this contact
➢ if positive start on treatment on AZT + 3TC + LVP-r or ABC + 3TC +
LVP-r.
➢ If negative then place on prophylaxis AZT + 3TC + NVP for at least 12
weeks or duration of exposure.
Follow up testing at 6 weeks, 3 months, 6 months, 9 months, 12 months, 18
months and 24 months.
Encourage breastfeeding
C. Write down the schedule of follow-up testing up to the time Albert turns 2
years
Answer:
➢ Nuclei acid test (NAT) at first contact
➢ NAT at 6 weeks
MK
➢ NAT at 3 months
➢ NAT at 6 months
➢ NAT at 9 months
➢ Serological test (Rapid test) at 12 months (confirm positive with NAT)
➢ Serological test (Rapid test) at 18 months (confirm positive with NAT)
➢ Serological test at 24 months (confirm positive with NAT)
➢ Serological test 6 weeks after complete cessation of breastfeeding
24.A 5-day old neonate is brought to the clinic with a 3 days history of fever, poor
feeding and crying a lot. On examination the neonate is irritable, has a bulging
anterior fontanelle and is febrile to touch.
A. What is your diagnosis and differential?
Answer:
Diagnosis: Neonatal meningitis
DDx:
➢ Neonatal sepsis
➢ Subarachnoid hemorrhage
E. While you are finalizing you assessment you also note the infant making
cycling and boxing movements with a blank gaze. What is happening and how
will you manage the neonate in totality?
MK
Answer:
➢ The neonate is having a convulsion
➢ Check RBS if hypoglycemic give 10% glucose infusion
➢ Phenobarbitone 20mg/kg IV loading dose to run in 20 minutes and
5mg/kg/day maintenance
➢ Broad spectrum antibiotics: benzyl penicillin + cefotaxime
26.Mwale is a 4-year-old girl who has been referred because of poor appetite and
loss of weight. She tested HIV positive two weeks ago by rapid test and has just
finished six months of TB treatment for presumed TB adenitis (persistent
generalized lymphadenopathy) with little response. She is 13kg and a height of
97cm. She has extensive oral thrush, finger clubbing and flat wart lesions on the
face. Her hemogram is as follow: WBC: 4,000/mm3, Hb: 7.4 g/dl, Platelet count:
100,000/mm3.
A. Assign a clinical WHO stage to each of clinical features Mwale presented
with.
Answer:
Persistent generalized lymphadenopathy-Stage 1
Flat wart lesions on the face-Stage 2
Extensive Oral thrush- Stage 3
Finger clubbing-Stage 3
Anemia (Low Hemoglobin <8g/dl)-Stage 3
C. Write down the first line ART drugs you would institute in this case
Answer: AZT + 3TC + LPV-r
27.Sakala is a 4-year-old boy who has been referred because of poor appetite, loss
of weight, and overall failure to thrive. He tested HIV positive two weeks ago by
rapid test, has just finished six months of TB treatment for presumed TB adenitis
owing to cervical, axillary and inguinal lymphadenopathy, with little response.
He is 7.8 kg and a height of 85cm. He has extensive oral thrush and flat wart
lesions on the face and neck. He has hepatosplenomegaly.
A. Write down all the clinical features Sakala presented with and assign a WHO
stage to each one of them.
Answer:
Persistent generalized lymphadenopathy (cervical, axillary and inguinal
lymphadenopathy)-Stage 1
Hepatosplenomegaly-stage 2
Flat wart lesions on the face and neck-Stage 2
Extensive Oral thrush-Stage 3
Weight 7.8kg for age-Stage 4
MK
28.Wezi is a 4-year-old boy who has been referred because of poor appetite, loss of
weight, and overall failure to thrive. He tested HIV positive two weeks ago by
rapid test, has just finished six months of TB treatment for presumed TB adenitis
(persistent generalized lymphadenopathy) with little response. He is 10kg and a
height of 85cm. He has extensive oral thrush and flat wart lesions on the face and
neck. He has hepatosplenomegaly.
A. Assign a clinical WHO stage to each of clinical features Wezi presented with.
Answer:
➢ Persistent generalized lymphadenopathy-Stage 1
➢ Flat wart lesions on the face and neck- Stage 2
➢ Hepatosplenomegaly-Stage 2
➢ Extensive oral thrush-Stage 3
➢ Weight 10kg for age- Stage 4
C. Write down the first line ART drugs you would institute in this case
Answer: AZT + 3TC + EFV
29.Wezi is a 4-year-old boy who has been referred because of poor appetite, loss of
weight, and overall failure to thrive. He tested HIV positive two weeks ago by
rapid test, has just finished six months of TB treatment for presumed TB adenitis
owing to cervical, axillary and inguinal lymphadenopathy with little response.
He is 7.8kg and a height of 85cm. He has extensive oral thrush and flat wart
lesions on the face and neck. He has hepatosplenomegaly.
A. Assign a clinical WHO stage to each of clinical features Wezi presented with.
Answer:
➢ Persistent generalized lymphadenopathy-Stage 1
➢ Weight 7.8kg for age- Stage 4
➢ Extensive oral thrush-Stage 3
➢ Flat wart lesions on the face and neck- Stage 2
MK
➢ Hepatosplenomegaly-Stage 2
C. Write down the first line ART drugs you would institute in this case
Answer: ABC + 3TC + EFV
30.A younger mother storms your consulting room panicking about streaks of blood
of her 5-day old baby diaper. On examination, you ascertain that it is vaginal
bleeding. However, the baby does not in distress whatsoever. The mother quickly
volunteers that she is keeping her 6-year-old nephew.
A. Write down your differential diagnosis.
Answer:
Neonatal hormone withdrawal bleeding-Maternal estrogen
Trauma (sexual assault/defilement)
Non-sexual trauma
B. Taking into account the above history, what is your most likely diagnosis?
Answer: Neonatal hormone withdrawal bleeding-Maternal estrogen
33.Mweemba, 10-year-old girl is brought into the emergency room with history of
difficulty breathing since the previous night. She is a known sickle cell disease
patient who has been receiving monthly blood transfusions due to cerebral
vascular accident. She is in severe respiratory distress with a respiratory rate of
70/min, associated with subcostal and intercostal recession. Her temperature is
38.7oC, her hemoglobin is 7g/dl and her oxygen saturation is 76%.
A. What are the 2 key differential diagnosis for the condition that the patient is
presenting with?
Answer:
a. Acute chest syndrome
b. Bacterial Pneumonia
MK
34.A 25-month-old boy is brought to the ER with fever, mild pallor and expiratory
stridor and rhonchi on auscultation. He is saturating at 89% at room air. The
doctor on call decides to immediately intubate and start the child on oxygen. He
also nebulizes the toddler with adrenaline because of the stridor.
A. Write down measures taken by this doctor that are not appropriate for this case
Answer:
• Immediate intubation
• Nebulizing with adrenaline-not appropriate in lower respiratory tract
infection
C. The mother then thought it might help to mention that this was not the first
time this is happening. What is your most likely diagnosis?
Answer: Asthmatic attack
35.A 4-year-old boy is brought to the ER with fever, mild bleeding from the gums
and some pallor. He is saturating at 94% at room air. The doctor on call
immediately starts the child on oxygen, orders blood transfusion and administers
Vitamin K. On examination, there is no jaundice and the patient is fairly well
nourished
A. Write down measures taken by this doctor that are not appropriate for this case
Answer:
• Oxygen therapy despite saturating at 94% on room air (normal)
• Administration of Vitamin K
• Blood transfusion when the doctor should have done a Cross-Match and
save
C. Give 3 differentials?
Answer:
• Leukemia
• Sepsis and disseminated intravascular coagulation
• Complicated malaria
D. A day later, the haemogram reveals very low white blood cells count. What is
your most likely diagnosis?
Answer: Leukemia
37.An 11-year-old presents with a nagging itchy skin lesion on the medial malleolus
for 2 months that opened up and keeps growing. Preliminary investigations
reveal:
WBC 13, 000/mm3
Hb g/dl
MCV 75fL
RBS 9.6 mmol/l
a) Give 2 differentials
Answer:
➢ Venous ulcer
➢ Buruli ulcer
38.A 6-month-old boy presents with cough and fever for 3 days, she was treated for
the cough at the local clinic a week ago and mum says there was not much
improvement. On examination the infant is in respiratory distress, however
feeding okay and is active. On examination the child has bilateral coarse
crepitations and rhonchi with subcoastal recessions
A. What are your diagnosis and differential diagnosis, starting with the most
likely?
Answer:
➢ Acute bronchiolitis
➢ Viral pneumonia
➢ Croup
B. What are the commonest organisms causing the above likely condition?
Answer:
➢ RSV
➢ Influenza virus
➢ Human metapneumovirus
➢ Rhinovirus
➢ Coronaviruses
➢ Parainfluenza virus
➢ Adenovirus
39.A 3kg infant was born to a 16-year-old Para 1 mother. Labor was rather prolonged
lasting 14 hours and there was prolonged rupture of membranes for 24 hours.
APGAR score was 7/10 then 9/10 after some resuscitation. 2 days after birth the
child developed failure to feed, lethargy, jaundice, and hypotonia.
a) What is your differential diagnosis?
Answer:
• Neonatal sepsis
• Birth asphyxia (hypoxic ischemic encephalopathy)
c) List four investigations that must be done in this child to help you confirm the
diagnosis?
Answer:
➢ Full blood count with differential
➢ Blood culture
➢ Total serum bilirubin + direct
➢ Liver function tests
➢ Renal function tests
➢ Blood sugar
➢ Brain imaging (ultrasound, MRI)
41.You walk into a mall with your 4-year-old toddler and she picks a pack of food
with the following nutritional information per 100g:
Protein: 10g, Maize 40g, Wheat flour: 50g, Millet flour: 25g, Olive oil: 4g, Palm
oil: 6g, Zinc: 11mg, Potassium 110mg, Vitamin A: 800mcg and folate: 230mcg
a) Work out the energy content of this pack
Answer:
1g protein/carbohydrates= 4kcal
1g fat= 9Kcal
1600
Then for 1600kCal, number of packs= = 2.711
590
Therefore 3 packs are needed
42.You walk into a mall with your 4-year-old toddler and she picks a pack of food
with the following nutritional information per 100g:
Protein: 12g, Maize 35g, Wheat flour: 70g, Olive oil: 3g, Palm oil: 5g, Zinc:
11mg, Potassium 110mg, Vitamin A: 800mcg and folate: 230mcg
a) Work out the energy content of this pack
Answer:
Answer:
1g protein/carbohydrates= 4kcal
1g fat= 9Kcal
43.A 13 months old toddler is admitted with acute diarrhea with severe dehydration.
He weighs 10kg.
a) Write down 5 clinical features you are likely to elicit
MK
Answer:
➢ Alteration in consciousness: Lethargic or comatose
➢ Sunken anterior fontanelle
➢ Sunken eyes
➢ Dry mucus membranes
➢ Skin pinch goes back very slowly (>2 sec)
➢ Tachycardia: rapid thready pulse
➢ Oliguria
44.Chansa, a 6-year-old girl is referred from Kasisi for convulsions. She has had few
episodes of vomiting, fever and weakness. On examination, she is comatose with
a GCS of 8/15, pale and jaundiced
A. Write down 3 possible diagnoses?
Answer:
➢ Severe malaria
➢ Meningoencephalitis
➢ Sickle cell anemia with CVA
➢ Septicemia
MK
45.Mercy, a 4-month-old infant, is admitted with diarrhoea that has lasted 3 months.
She is HIV exposed and on nevirapine prophylaxis since birth. Her mother has
been on combined ART for the past 3 years. Mercy is on formula milk because
the mother alleged not to have had enough breastmilk. Her father does some piece
work at a nearby mine. On examination, she weighs 3.500 kg with head
circumference of 37 cm. Her birth weight is 2.600 kg.
A. Write down 2 possible causes of the diarrhea in this context
Answer:
➢ Opportunistic infection
➢ Osmotic diarrhea
B. What would you have advised the mother to do about infant feeding in the
immediate postnatal period?
Answer:
➢ Encourage mother to continue HAART
➢ Allow exclusive breastfeeding for 6 months
46.A 5-year-old child is brought to the Emergency Services body hotness for 5 days
associated with generalized body pain. Blood is collected for an urgent
hemogram even before the physical assessment is done and the following is the
result:
WBC: 94,300 /mm3 (Neutrophil: 15%, Lymphocyte: 80.5%), Hb:5.1 g/dl, MCV:
84.7fl, Platelet count: 181,000/mm3, RDW-CV:28.4%.
A. Write down 3 differentials
Answer:
➢ Overwhelming sepsis with leukemoid reaction
➢ Leukemia
➢ Sickle cell disease
o Peripheral smear
47.Ben, a 6-month-old infant is admitted with pneumonia, weighing 4.5kg. His rapid
test for HIV is reactive.
A. Write down 5 questions you would ask the mother to assess the risk of HIV
infection in Ben.
Answer:
➢ Have you tested for HIV?
➢ When did you test for HIV?
➢ Are you on ARVS?
➢ For how long have you been taking the ARVs?
➢ Is Ben currently still exclusively breastfed or given formula?
➢ Is Ben on any prophylactic antiretroviral drugs-Nevirapine at birth?
➢ Was DBS for HIV DNA PCR test done on Ben?
50.A 14-year-old girl, Nana Maliki presents to your hospital with a history of
breathlessness and swelling of her legs for the past one week. Some of the
physical findings include orthopnea and a pansystolic murmur heard best at the
apical area and radiating to the left axilla.
a) Give your differential diagnosis?
MK
b) Mention two other signs that could be found in this patient consistent with
the above diagnosis?
Answer:
➢ S3 heard sound
➢ Displaced apex heart beat
➢ Bibasal crepitations
➢ Hemoglobin electrophoresis
c) What is the most likely way the child acquired this condition?
Answer: The condition is inherited and the inheritance pattern is autosomal
recessive meaning one can only get the condition if both parents are either
carriers or sufferers of the condition
52.A 2-year infant is brought to the Outpatient Department with body hotness. He
weighs 9.9Kg and his haemogram is as follow:
WBC: 25.85 x 103/mm3, RBC: 2.56x106/mm3, Hb: 9.3g/dl, HCT: 31.7%,
RDW-CV: 25%, MCV: 123 fl, Platelets: 376 x103/mm3.
A. Determine the nutritional status of this child using the Welcome
classification.
MK
b) List 4 diagnostic features that you will look for as you examine the child that
will help you make a more conclusive diagnosis of this condition
Answer:
➢ Decreased mid-upper arm circumference (<11.5 cm)
➢ Weight/height <-3 Standard deviation
➢ Muscle wasting and decreased subcutaneous tissue: prominent outline of ribs
and sternum, baggy pants appearance
MK
➢ Bilateral pedal edema and signs of dehydration (increased capillary refill time
>3 sec, alterations in level of consciousness-drowsiness, lethargy, apathy,
cold peripheries, weak thready rapid pulse, hypotension)
➢ Hair changes: thin, sparse, brittle, brown/reddish discoloration, flag sign
➢ Eye signs: bitot spots, dry conjunctiva, corneal clouding, corneal
ulceration/keratomalacia
➢ Oral changes: cheilosis, angular stomatitis, papilla atrophy on tongue,
abdominal distension, hepatomegaly
➢ Skin changes: desquamation, hypo- and hyperpigmentation, ulceration,
exudative lesions, dryness of skin, crazy pavement and flaky paint dermatosis
➢ Nail changes: brittle spoon shaped
d) What 5 things affecting this child would likely cause mortality within 24
hours of admission unless taken care on admission?
Answer:
➢ Hypoglycemia
➢ Hypothermia
➢ Dehydration
➢ Electrolyte imbalance
➢ Infection
e) What 5 steps are you going to take immediately to save the life of this child?
Answer:
➢ Manage hypoglycemia
o 5ml/kg of 10% dextrose IV
o Start 2 hourly feeds with F75 (11ml/kg/feed if edema not severe and
8-9 ml/kg/feed if severe)
o Check blood glucose every 30 minutes until glucose level is normal
and stabilizes, if hypoglycemic repeat 5ml/kg 10% dextrose
➢ Manage hypothermia (Axillary temp <35oC or rectal temp <35.5oC, if <32oC
it is considered severe hypothermia)
MK
o Keep the child warm (cloth child, provide heat using overhead warmer,
skin contact and heat convectors)
o Start 2 hourly feeds with F75 (Warm feeds)
o For severe hypothermia
▪ Give humidified oxygen
▪ Give 5ml/kg of 10% dextrose IV
▪ Rewarm child slowly
▪ Start feeds with F-75
o Monitor temperature 30 mins if using a heater otherwise monitor
hourly
➢ Manage dehydration: rehydrate over 12 hours
o If child in shock give 15ml/kg of half-strength Darrows with 5%
dextrose or Ringer’s lactate with 5% over 1 hour and monitor
hydration status (pulse should decrease, respiratory rate should
decrease, capillary refill time should improve and urine should be
passed)
o If still in shock repeat 15ml/kg in next 1 hour.
o After infusion or if child not in shock give 5ml/kg every 30 minutes of
ReSoMal orally or by Nasogastric tube for first 2 hours and then for
next 10 hours alternate ReSoMal with F-75 hourly (same amount
5ml/kg)
➢ Manage electrolyte imbalance (hypokalemia)
o ECG monitoring
o If diarrhea present 600mg OD slow K
o Start potassium chloride infusion at 0.3-0.5 mEq/kg/hour
o Give potassium 4mmol/kg/day for 2 weeks
➢ Treat infection/antibiotics (7 days)
o Uncomplicated: amoxicillin (50-100mg TDS PO)
o Septicemia: IV ampicillin (100-200/kg/day QID) or X-pen (100mg-
200mg/kg/day QID) + Gentamycin (7.5mg/kg OD or in 2 divided
doses)
o If no improvement occurs within 2 days change to IV cefotaxime
(100mg/kg/day TDS) or ceftriaxone (50mg/kg/day BD)
55.A 14-year-old girl called DJ is referred from a health center 10km from the
hospital where you are working with history of east fatiguability, fever and
bleeding from the nose for one month. On examination, you find that the girl is
MK
very pale, has purplish bumps in the mucus membrane of the oral cavity and is
toxic looking. The temperature is 39OC.
a) What 4 critical investigations are you going to do to help you make a definitive
diagnosis on this child?
Answer:
➢ Full blood count with differential: pancytopenia, thrombocytopenia
➢ Peripheral smear to look for blast cells
➢ Clotting profile: aPTT, Bleeding time, prothrombin time for DIC
➢ Chest X-ray to check for any mediastinal masses as well as CT scan
➢ Bone marrow aspirate
➢ Blood culture
b) What are 2 most likely differential diagnosis that would explain the patient’s
condition
Answer:
➢ Idiopathic thrombocytopenic purpura
➢ Leukemia
c) List 6 other signs that you would look for on examination of the patient that
would help you diagnose the patient’s illness.
Answer:
➢ Hepatomegaly
➢ Splenomegaly
➢ Generalized lymphadenopathy
➢ Bone pain
➢ Jaundice, Gum hypertrophy
➢ Cranial nerve palsy, papilledema, meningism
MK
56.A 16-month-old toddler (girl) is brought to the children’s clinic, because the
mother is concerned that the child’s growth and development is suboptimal
compared to her older siblings. Upon further questioning she agrees to the child
having recurrent upper respiratory infections, occasional bouts of loose stool and
fevers that have been treated as “malaria” by the private doctor. On examination
she weighed 7.5kg, her height was 80cm, she had slight pallor with generalized
lymphadenopathy, sores (white patches) in the mouth, CVS was normal and per
abdomen there was hepatosplenomegaly with no pedal edema.
a) Give 4 possible most likely differentials for the described condition.
Answer
➢ HIV infection with TB co-infection
➢ Severe acute malnutrition
➢ Infectious mononucleosis
➢ Enteric fever
c) If you are to stage this condition, what stage of disease is the child in.
Answer: HIV stage 3
57.A 2-year-old girl presents to your hospital and after investigations the CSF
revealed the following results
Appearance: cloudy
WBC: 120cells/mm3- polymorphs 80% and lymphocytes 20%
RBC: 50cells/mm3
Gram stain: gram negative coccobacilli
Ziehl Neelsen stain: no organism
Protein: 0.75g/l
MK
Sugar: 1.6mmols/l
a) List 4 cardinal abnormalities that you see in this CSF result
Answer:
➢ Pleocytosis with predominance of neutrophils but also presence of
lymphocytes is also an abnormality
➢ Presence of gram-negative coccobacilli
➢ Increased proteins
➢ Low blood sugar
c) What specific measure would you have taken to prevent this illness in the
child?
Answer: immunization against Hemophilus infleunza at 6 weeks, 10 weeks
and 14 weeks
59.An 8 weeks old infant presents to your admission ward with history of cough for
4 days and difficult breathing. On examination, the infant is well nourished and
weighs 6kg. However, the infant is dyspneic, tachypneic with subcostal
recession. Respiratory rate is 70/min. Temperature is 37.8oC. There is some
cyanosis, examination of the chest reveals a bilateral ronchi best heard at the end
of expiration and a few crepitations.
a) What is the most likely diagnosis?
Answer: Bronchiolitis
Answer:
➢ Admit patient
➢ Provide moist oxygen (keep oxygen saturation more than 92%), continuous
positive airway pressure (CPAP) or assisted ventilation if there is respiratory
failure
➢ Nasal bulb suction
➢ Hydration with IV fluids
➢ Position at 30-40o
➢ Nebulized bronchodilators (albuterol and ipratropium) and steroids may help
some patients
➢ Aerosolized ribavirin if available
60.A 2 days old baby comes into the neonatal unit with history of developing
jaundice since a few hours after birth. On examination, you notice that the child
is weak, hypotonic, deeply jaundiced and pale. He is the 2nd born, the first sibling
did not suffer from this condition.
a) What is the most likely full diagnosis of this illness in the neonate?
Answer: Hemolytic disease of the newborn
b) List 4 investigations that you are going to do in order to confirm the diagnosis
Answer:
➢ Direct Coomb’s test
➢ Full blood count
➢ Peripheral smear
➢ Serum bilirubin
61.An 11 months old infant presents to your admission ward convulsing. There is
history of 2 former such episodes of convulsing. According to the mother, the
convulsions involve the whole body and last about 3 minutes. The child has
temperature 39oC.
a) What is the most likely diagnosis?
Answer: Febrile convulsion
b) List 3 disease condition that would possibly have caused this condition
Answer:
➢ Severe Malaria
➢ Sepsis
MK
➢ Pneumonia
c) Indicate 2 cardinal investigations that would help you manage this child.
Answer:
➢ Malaria parasite slide
➢ Full blood count with differential
b) What fluid are you going to use in treating this little girl?
Answer: Ringer’s lactate or ½ strength Darrows
c) Give details of the plan you are going to use in rehydrating Joanna
Answer:
➢ Give 100ml/kg Ringer’s lactate IV in 3 hours (1400ml in 3 hours)
- Give 420ml in 30 minutes then
- Give 980ml in 2hours 30 minutes
➢ Reassess every 15 minutes if hydration status not improving increase speed
of infusion.
➢ Reassess after 3 hours and re-classify hydration status, if hydrated switch to
appropriate plan.
b) How many milliliters of F75 would you need to cover his caloric requirement
estimated at 1500kcal/24 hours?
MK
Answer:
Each 100ml of F-75 has 75kCal
If 100ml F-75 gives 75Kcal, volume needed for 1500kcal= (1500 x 100)/75=
2000ml
Therefore, 2000ml per day of F75 is needed
65.A 7-year-old girl is brought to LMGH with a history of recent bedwetting and
unexplained weight loss. No history of tuberculosis contact. Her rapid test for
HIV is negative
a) What is your differential diagnosis?
Answer:
➢ Type 1 Diabetes mellitus
➢ Urinary tract infection
➢ Diabetes insipidus
➢ Chronic renal
b) Write down 2 more symptoms that may be associated with this condition
Answer:
➢ Polyuria
➢ Polydipsia
66. Martha, a 4-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
has cervical and axillary lymphadenopathy.
a) What further questions would you ask to help determine the diagnosis?
Answer:
➢ Any recurrent abdominal pain?
➢ Any history of yellowing of eyes?
➢ Any personal or family history of sickle cell disease?
➢ Any joint swelling?
➢ Any recurrent respiratory infections? Pulmonary TB?
➢ Any bleeding?
➢ Any TB contact?
➢ HIV status
Answer:
➢ Acute leukemia
➢ Acute chest syndrome in Sickle cell disease
67.Mwila is referred from Kasama 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.
a) Write down 3 possible diagnoses?
Answer:
➢ Hyperreactive malarial splenomegaly (Tropical splenomegaly syndrome)
➢ Acute leukemia
➢ Viral hepatitis
➢ Splenic sequestration crises in sickle cell patient
b) List down specific investigations to ascertain your diagnosis
Answer:
➢ Blood investigations
- Rapid diagnostic test for malaria
- Peripheral smear to rule out severe malaria, acute leukemia
- Hepatitis viral panel
- Full blood count and ESR
➢ Bone marrow aspirate
69.A 24-month-old toddler, well nourished, is admitted with acute diarrhea and
severe dehydration. He weighs 9.6kg
a) What is his expected weight?
Answer:
Expected weight= 2 x (age + 4)
Expected weight= 2 x (2 + 4)
Expected weight= 2 x 6
Expected weight= 12kg
12−9.6
Body weight percentage loss= × 100= 20%
12
70.You are called to review a newly diagnosed insulin dependent diabetes mellitus
case. The patient is receiving insulin intravenously and his morning urine analysis
is as follows:
SpGr: 1.025, Protein: +, pH: 6.0, Blood: negative, Ketones: ++++, Glucose:
Negative
a) Explain in few words what may have led to the presence of ketones and the
absence of glucose in urine.
Answer: This could probably be caused by a high dosage of insulin causing
hypoglycemia and hunger. The response of the body to hunger leads to
ketogenesis as an alternative source of energy therefore ketones would be
present in urine and glucose absent
b) In your opinion, what would be the blood sugar levels in this patient? Low,
normal, or high?
Answer: The sugar would low
71.A 24-month-old girl presents to hospital with history of diarrhea and vomiting
for 4 days and anorexia for 2 weeks. The mother has recently fallen pregnant but
she has recently separated from her husband. On examination the child is
MK
miserable, apathetic and has bilateral pedal edema and dermatosis. Her weight is
7.2kg. Her muscles are wasted.
a) What is the diagnosis?
Answer: Severe acute malnutrition
b) List 5 critical conditions that you must manage in order to save the life of this
child within the first 48 hours
Answer:
➢ Hypoglycemia
➢ Hypothermia
➢ Dehydration
➢ Electrolyte imbalance
➢ Infection
d) Give differentials that need to be ruled out every time you have such a case.
Answer:
HIV infections
Tuberculosis
Pneumocystis Jirovercii pneumonia
Malaria
Vitamin A deficiency
Severe anemia
Candidiasis
Worm infestation
72.A boy is brought into hospital with difficulties of breathing and swelling of the
legs. The patient indicates that he is unable to sleep supine on the bed as he runs
out of breath. He also indicates that he develops breathlessness after walking only
a few steps. On examination, the boy has a pansystolic murmur in the mitral area
radiating to the left axilla. He also has anemia and fever as well as splenomegaly.
a) Give your differential diagnosis
Answer:
MK
73.A 13-year-old girl is brought into the emergency room with history of difficulty
breathing since the previous night. She is a known sickle cell disease patient who
was lost to follow up. On examination the girl is in severe respiratory distress
with a respiratory rate of 70/min, with sub-costal and intercostal recession. Her
temperature is 38.7oC. Her hemoglobin is 7g/dl and her oxygen saturation using
a pulse oximeter is 76.
a) What are the 2 key differential diagnoses for the condition that the patient is
presenting with?
Answer:
a. Acute chest syndrome
b. Congestive heart failure
74.A3 and a half year old female child presents with noisy breathing and fever of 6
hours duration. Prior to this she had been perfectly well. She was born at LMGH
at full term with a birth weight of 3.9kg. There were no neonatal problems. Her
routine vaccinations are up to date and weight gain has been adequate. There is
no family history of note. On examination the patient looked very ill with
temperature 39.7oC, pulse 110/min, BP 110/78, dribbling of saliva from one
MK
corner of the mouth, intercostal and subcostal indrawing with a clear chest. Blood
investigations reveal
Hb- 12g/dl
WBC- 20 x 109/L (polymorphs-84% and lymphocytes-12%)
Sodium 135mmol/L
Potassium 3.5 mmol/L
Urea 4.6 mmol/L
75.Mutinta a 10-year-old girl presents to hospital with history of cough and swelling
of legs for 4 days. On examination she is dyspneic at rest, has bilateral pedal
edema and hepatomegaly. Examination of the heart reveals a pan-systolic
murmur, radiating to the axilla and mid-diastolic murmur in the mitral area. She
also has a diastolic murmur in the aortic area.
a) What is the full diagnosis of this child’s condition?
Answer: Biventricular heart failure secondary to mitral regurgitation with
aortic regurgitation New York heart classification class IV
Answer:
Mitral regurgitation
Aortic regurgitation
c) Indicate the four measures you will take in order to manage the acute phase
of this child
Answer:
a. Administer humidified oxygen
b. Sedation with morphine sulfate 0.1 to 0.2 mg/kg/dose SC every 4 hours
as needed or Phenobarbital 2 to 3mg/kg/dose PO or IM
c. Give furosemide 1-2mg/kg/day IV in 2-3 divided doses
d. Give digoxin
d) What long term treatment would you institute in order to prevent further
deterioration of this child’s condition?
Answer: Continuous monthly prophylaxis with injections of benzathine
penicillin 1,200, 000 IU or Pen V 250mg BD PO can be given. For those
allergic to penicillins erythromycin 250mg BD PO is given until the age of 18
or 21.
76.Nalishebo is a 3-year-old girl who presents with edema and is underweight. The
following are her lab results:
Urea 2.5 mmol/L
Sodium 128 mmol/L
Potassium 3.5 mmol/L
Serum albumin 28g/L
Serum cholesterol 2mmol/L
Urinalysis:
Protein 2+
Blood 1+
Leucocytes: Numerous
a) What 2 other important physical features should be present in this child?
Answer:
77.A 10-year-old boy, Judge Siachinji, whose parents just moved to live in Lusaka
from Siavonga presented at LMGH with terminal hematuria
a) What is the likely diagnosis for this boy?
b) What investigations would you carry out to confirm the diagnosis in this boy
and what would be the finding consistent with the diagnosis?
c) Write down 2 complications from this condition that the boy may develop if
left untreated?
d) How would you treat this child?
78.Zambia ranks one of the countries in Sub-Saharan Africa with the worst infant
and childhood mortality rates. One of the ways to avert this problem is to
reinforce the aims and objectives of the under-five clinics
A. State the major aims of under-five clinics in Zambia as captured on the under-
five card?
B. List the preventable disease from which a Zambian child is immunized on the
current EPI?
79.An 8-year-old girl presented at LMGH with restlessness, heart palpitations and
was rather dazed in general appearance. Investigations showed an impaired
glucose tolerance test with:
Total serum thyroxin 186nmol/L (normal range 10-30)
Free T4 12.5pmol/L (normal range 9.4-24.5)
Free T3 11.8pmol/L (normal range 2.9-8.9)
Serum TSH <0.1Mu/L (normal range 0.7-2.5)
A blood slide is collected and results are shown in the image below
2. A child presents to ED with fever, headache. A chest X-ray is taken and is shown below.
b) Give 5 differentials
Answer:
➢ Miliary Tuberculosis
➢ Histoplasmosis
➢ Coccidiomycosis
➢ Sarcoidosis
➢ Blastomycosis
➢ Cryptococcosis
3. Below is a picture of a child that presents to the emergency department with respiratory distress
and stridor
4. Look at this picture of a child admitted two weeks ago with generalized body swelling
b) Urinalysis was done and results were as follows: Ketones 1+, Glucose nil, Proteins 4+, and
Blood 1+, what is your diagnosis?
Answer: Nephrotic syndrome
c) What investigations would you carry out for your differential diagnosis?
Answer:
➢ 24-hour urine analysis for proteins in urine (for nephrotic syndrome)
➢ Protein-creatinine ratio or albumin-creatinine ratio
➢ Urine microscopy, culture and sensitivity
➢ Urea, creatinine and electrolytes for kidney failure
➢ Liver function tests: serum albumin (may be low in SAM, nephrotic and protein losing
enteropathy), prothrombin time, and serum bilirubin
➢ Liver enzymes may be raised in liver failure
➢ Blood: lipid profile, FBC, C3 and C4 assay
➢ ECG, CXR, ECHO
➢ Abdominal ultrasound
d) Which drugs will you use (including dosage) in this condition and list five side effects?
Answer:
➢ Prednisolone 2mg/kg/day (max dose of 60mg/kg) for 4 to 6 weeks then 1.5mg/kg/day
alternating days for 2 to 5 months (max 40mg/kg).
o Side effects: immunosuppression and recurrent infections, osteoporosis,
lightening and thinning of skin, acne, peptic ulceration, cataracts, easy bruising,
weight gain and abdominal fat distribution on face, neck and trunk, aseptic
necrosis of the femoral head, hypertension, abdominal striae, mood changes
➢ 20% Albumin 0.5g/kg/day with furosemide 1mg/kg/day if indicated in severe ascites
given over 2 hours or spironolactone 2mg/kg
o Side effects of albumin: hypertension
o Furosemide: hypokalemia, hypocalcemia, hypomagnesemia, hyponatremia
o Spironolactone: gynecomastia, skin rash, steven Johnson/TENs.
➢ Gentamicin (antibiotic cover) 7.5mg/kg OD and X-pen 50,000 to 100,000 IU/Kg QID
o Side effects of gentamicin: ototoxicity
o Side effects of X-pen: injection site reactions, diarrhea, stomach upset, nausea and
vomiting, anaphylactic reaction
5. Below are hemogram findings taken from a patient admitted on the ward:
Hemoglobin 3g/dl,
Platelets 160, 000/mm3
RDW-15%,
MCH-20
b) List 6 causes
Answer:
➢ Iron deficiency anemia
➢ Anemia of chronic disease
➢ Thalassemia
➢ Sideroblastic anemia
➢ Chronic hemorrhage e.g. peptic ulcer disease
➢ Hookworm infestation
➢ Lead poisoning
c) List 6 investigations?
Answer:
➢ Blood
o Sickling test
MK
o Coombs test
o Peripheral smear
o Iron studies: Serum iron, Ferritin, Serum transferrin and total iron binding capacity
➢ Stool
o Stool for occult blood
o Stool Microscopy/culture/sensitivity for ova and parasites
7. A child presents with a purulent cough and finger clubbing as shown in the picture below. An
HIV test is done and it is negative.
b) How would you management? (List classes of drugs used in the management including
their mechanisms of action for each)
Answer:
➢ Admit
➢ ABC
o Ensure airway is patent, suction any secretions
o Ensure patient is breathing and administer oxygen via face mask, keep saturation
>92%
o Nebulize bronchodilators
o Beta 2 agonists (Salbutamol 2.5mg): stimulates beta 2 receptors on bronchial
smooth muscle and through a G-stimulatory cAMP cascade results in
phosphorylation of myosin light chain kinase (MLCK) and inhibition of
MLCK leading to relaxation of smooth muscle and bronchodilation.
o Antimuscarinic agents e.g. Ipratropium bromide 250mcg 4-6 hourly: this is
an antimuscarinic agents that blocks M3 receptors associated with
parasympathetic stimulation of bronchial air passageways
o Methylxanthines (Aminophylline)- this is a phosphodiesterase inhibitor that
inhibits the breakdown of cAMP to AMP, thereby maintaining the
concentration of cAMP in the cell which causes bronchodilation
o Steroids e.g. Prednisolone 1-2mg/kg (40mg max) for 3 days PO: This is a steroid,
it inhibits phospholipase A, preventing the conversion of phospholipids into
arachidonic acid thereby inhibit the further production of leukotrienes and
MK
f) Complications of management
Answer:
➢ Acute:
o Infection
o Slit ventricular syndrome (small ventricles formed in shunt)
➢ Long term
o Blockage of shunt
o Dislodging of shunt
o Shortening of shunt relative to growth of child
o Shunt nephritis
10. Concerning unconsciousness, how would you assess the coma state with parameters.
Answer:
➢ AVPU (quick assessment)
o A-alert
o V- responding to verbal stimuli
o P- responding to pain
o U- unresponsive
➢ Blantyre coma scale (Children <5 years)- minimum score 0, maximum score 5
o Eye movement
1- Watches or follows (focusing)
0- Fails to watch or follow (none)
➢ Glasgow coma scale (children >5 years): Minimum score- 3, maximum score-15
o Eye opening
4- Spontaneous
3- To verbal stimuli
2- To pain
1- None
12. A patient present with history of fever, headache, and neck pain. Histology shows the picture
shown below
Respiratory system
➢ Respiratory distress syndrome (hyaline membrane disease)
➢ Apnea of prematurity
➢ Chronic lung disease/bronchopulmonary dysplasia
Cardiovascular
➢ Persistent/patent ductus arteriosus
➢ Atrial septal defects
➢ Ventricular septal defects
➢ Anemia of prematurity
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Gastrointestinal system
➢ Necrotizing enterocolitis
➢ Umbilical hernia
Metabolic system
➢ Hypoglycemia
➢ Hypothermia
➢ Osteopenia of prematurity
➢ Osteosarcoma
16. Patient presents with hematuria and a CXR showing a left upper lobe opacity with cavitation
17. What is your differential diagnosis?
Answer:
➢ Disseminated TB
➢ Pulmonary bacterial abscess
➢ Bronchogenic carcinoma
24. Pelvic X-ray with osteoporotic features, patient has limp. Hemogram hb8
a) Describe the X-ray
b) What investigations would you order
c) What are the long term complications
d) What is the management of this condition
28. A 15-year-old male patient is brought in with a history of having bloody diarrhea for a day. He
was found in a room with an empty bottle of an unknown substance. He also vomited and is
lethargic
a) What important question would you ask on your history?
Answer:
➢
SECTION 5: VIVAS
LIST OF CONDITIONS
1. Neonatal Jaundice
2. Severe Malaria in children
3. Meningitis in children
4. Birth Asphyxia
5. Nephrotic syndrome
6. Severe Acute Malnutrition
7. HIV in children
8. Tuberculosis in children
9. Sickle Cell Anemia
10.Congenital Heart Diseases
11.Trisomy 21
12.Acute Diarrhoeal Diseases in children
13.Immunizations in children
14.Prematurity
15.Diabetes Mellitus in children
FOCUS
1. Pathophysiology
2. Case Scenarios
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3. Management