QUESTION BANK FOR PAEDIATRICS AND CHILD HEALTH

1. A 14 years old girl has a one month history of increased urinary frequency without dysuria
and recent onset of itching rashes beneath both breasts. She is afebrile with erythematous,
macular rash beneath both breasts. Urinalysis is significant for glycosuria but no pyuria.
Which of the following is the most likely diagnosis?
A. Diabetes mellitus
B. Occult malignancy
C. Nephrotic syndrome
D. Fungal infection of both breast
E. Human immunodeficiency virus

2. What is the proper maintenance fluid for a 7-years old child weighing 18kgs sustained 15%
body surface burn?
A. 1800mls of Ringer lactate given over the period of 24 hours
B. 2080mls of Ringer lactate given over the period of 24 hours
C. 2050mls of Ringer lactate given over the period of 24 hours
D. 1800mls of Ringer lactate given 900mls in the first 8 hours and 900mls in the next 16
hours
E. 1080mls of Ringer lactate given 540mls in the first 8 hours and 540mls in the next 16
hours

3. What is the recommended first line anti-retroviral therapy for a one year child with
confirmed HIV infection (ART – Naïve regimen)?
A. Zidovudine + Lamivudine + Efavirenz
B. Zidovudine + Lamivudine + Stavudine
C. Zidovudine + Lamivudine + Tenofovir
D. Zidovudine + Lamivudine + Nevirapine
E. Zidovudine + Abacavir + Nevirapine

4. A one year old baby present with high grade fever associated with two episodes of
convulsions of generalized tonic-clonic characteristic. On examination the baby is febrile
390C, Kerning’s and Brudzinki’s signs were both negative. Random blood glucose was 4.6
mmol/L and a negative blood smear for malaria parasites. What could be the most likely
diagnosis?
A. Hypothermia
B. Hypoglycemia
C. Absence seizure
D. Hyperthermia
E. Febrile convulsion
5. Which of the following is a major contributor to the development of physiological jaundice?
 A. Breast feeding
B. Increased hepatic circulation
C. Normal activity of liver enzymes
D. Increased bilirubin production
E. Increased hepatic bilirubin excretion

6. Which of the following is the commonest cause of neonatal sepsis?

A. Group B streptococcal species
B. Staphylococcal epidermidis
C. Haemophilus influenza
D. Neisseriae species
E. Proteus species

7. The baby is able to control the head at which age?

A. Two years of age
B. Six months of age
C. One months of age
D. Eight months of age
E. Three months of age

8. Which one of the following is the most important cause of jaundice presenting in the first 24
hours of life?
A. Prematurity
B. Haemolysis
C. Breastfeeding
D. Physiological jaundice
E. Formula milk jaundice

9. Which of the following describes good positioning of the baby during breastfeeding?
A. Chin of an infant touching breast
B. The mouth of an infant is wide open
C. The infant’s body is close to her mother
D. The infant’s lower lip is turned downward
E. More areolar is visible above than below the infant’s mouth

10. According to the Expanded Immunization Program of immunization, which one of the
following vaccine is not usually given to children/newborn with features of advanced
HIV/AIDS disease?
A. Tetanus Toxoid
 B. Pentavalent
C. Oral Polio Vaccine (OPV)
D. Bacilli Calmette Gulline (BCG)
E. Oral Polio Vaccine (OPV) and Pentavalent

11. Which one of the following is a pediatric emergency sign in a child?

A. Central cyanosis
B. High grade fever
C. Severe palmar pallor
D. Oedema of both feet
E. Visible severe wasting

12. A 2 day-old infant has significant nasal and rectal bleeding. He was delivered by a midwife
at home and umbilical cord was clamped properly which of the following vitamin deficits
might explain this condition?
A. Vitamin A
B. Vitamin B1
C. Vitamin C
D. Vitamin D
E. Vitamin K

13. A breastfed infant is expected to have a lower incidence of which of the following?
A. Asthma
B. Impetigo
C. Diarrhoea
D. Conjunctivitis
E. Urinary Tract Infections

14. Which among the following is common cause of heart failure in school aged children?
A. Severe anemia
B. Fluid overload
C. Rheumatic fever
D. Tetralogy of fallout
E. Severe malnutrition

15. A baby was born by cesarean section to a 34 years old mother whose pregnancy was
complicated by hypertension and abnormal fetal heart monitoring. At delivery was covered
in thick, green meconium and was limp, apnoeic and bradycardic. Which of the following is
the best first step in the resuscitation?
A. Initiate chest compression
B. Administer 5% dextrose by NGT
 C. Meconium suction and intubation
D. Initiate ambu bag – mask ventilation
E. Administer RL by intravenous infusion

16. A 30 hour old full term infant has face and chest jaundice. He is breastfeeding well and has
an otherwise normal examination. His bilirubin level is 15.5mg/dL. Which of the following
is the most appropriate course of action?
A. Start phototherapy
B. No action is needed.
C. Start an exchange transfusion
D. Wait 6 hours and retest the serum bilirubin level
E. Breastfeeding for 48 hours and supplement with formula

17. A 4 month old boy present at Health Centre with complaint of wheezing. The father has
given two puff of salbutamol inhaler, but the difficulty in breathing has not improved
significantly. Upon examination of the child, he is pale and perioral cyanosis. Respiratory
rate 60 breaths/min and loud wheezes throughout the chest that obscure the heart sound.
Which of the following is the most likely diagnosis?
A. Pneumonia
B. Bronchiolitis
C. Cystic fibrosis
D. Gastro esophageal reflux
E. Trachea-esophageal fistula

18. A 13 year old boy has a 1 day history of fever and lethargy and was unable to be awakened
this morning. At emergency center his respiratory rate was 7 breath/min, heart rate 55 beats
per minute, temperature (40C) and blood pressure 60/40 mmHg. He has altered mental status
and a stiff neck. Which of the following is the most appropriate next step in the management
of this patient?
A. Call for help
B. Do lumber puncture
C. Give intravenous antibiotics
D. Cardiopulmonary resuscitation
E. Give paracetamol to lower temperature

19. A 2 year old boy developed emesis and intermittent abdominal pain yesterday, with several
small partially formed stools. His parents were not overly concerned because he seemed fine
between the pain episodes. Today however he has persistent bilious emesis and has had
several bloody stools episodes. Upon examination the abdomen is diffusely tender with
vague tubular mass in right upper quadrant. What is the most likely diagnosis?
A. Dysentery
 B. Perianal trauma
C. Intussusception
D. Bleeding peptic ulcer
E. Hemolytic disease of the new born

20. A 2 years old child suddenly develops inspiratory stridor, tachypnea and chest retractions.
He had been playing with his 6 year old brother before this episode. He is afebrile, other
parameters of physical examination are normal. A chest radiograph reveals no abnormalities.
Which of the following is the best first line management?
A. Do ventilation by ambu bag
B. Administer oral dexamethasone
C. Administer parenteral antibiotic
D. Administer nebulized salbutamol
E. Evaluate the airway for obstruction

21. The baby presented with lower limb edema, muscle wasting poor appetite the food intake is
adequate but have insufficient protein. What type of malnutrition is this?
A. Stunting
B. Kwashiorkor
C. Marasmus
D. Failure to thrive
E. Marasmic kwashiorkor

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

A. Zinc is lost during episode of diarrhea
B. Zinc increase the appetite to drink ORS
C. Zinc reduce duration and severing of diarrhea
D. Zinc is antidiarrheal drugs for severe dehydration
E. Zinc is macronutrient for a child over development

23. An 18 years old primigravida at 36 weeks gestation age with eclampsia delivered a baby boy
of 2.5 kg after prolonged labour. Which among the following is most likely complication
occurred to a baby?
A. Hypoglycemia
B. Hyaline membrane
C. Meconium aspiration
D. Neonatal asphyxia
E. Anemia of prematurity
24. Which among the following urinalysis results may indicate urinary tract infection in
children?
A. Proteunia + 3 with cast
B. Cast with red blood cells
C. Epithelial cells with proteomic
D. More than 15WBC/HPP with epithelial cells
E. > 15 WBC/HPF in centrifuged urine with proteinuria

25. Which among the following drugs is used as prophylaxis of anaemia in sickle cell disease?
A. Quinine
B. Folic acid
C. Artemether
D. Vitamin B12
E. Ferro-sulphate

26. Which among the following investigation is useful in diagnosis of Tuberculosis in children?
A. Mantoux tuberculin skin test
B. Gastric aspirate
C. Chest X-Ray
D. Sputum
E. ESR

27. Which among the following is the first line treatment for HIV in children less than 36
months?
A. Stavudine (d4T) + lamivudine (3TC) Efavirenz (EFZ)
B. Stavudine (d4T) + Abacavir (ABC) + Efavirenz (EFZ)
C. Abacavir (ABC) + Lamivudine (3TC) + Efavirenz (EFZ)
D. Zidovudine (AZT) + Lamivudine (3CT) + Efavirenz (EFZ)
E. Zidovudine (AZT) + Lamivudine (3TC) + Nevirapine (NVP)
28. HIV infected children not yet eligible for ART should be monitored with CD4+ count in
every:
A. Six month
B. Five month
C. Four month
D. Three month
E. Seven month

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

A. Grossly sunken eyes
B. Cyanotic extremities
C. Very dry mucus membranes
 D. Tissue tugor retract slowly
E. Anterior fontanel very sunken

30. During rapid screening of sick children at OPD you find a child who is lethargic, has palmar
pallor and respiratory distress this child has:
A. Priority sign
B. Emergency sign
C. Non urgency sign
D. To stay at the end of queen
E. No need of prompt assessment

31. A 3 year old boy presents to OPD with a sudden onset of barking cough, stridor, low grade
fever and difficulty in breathing. On examination he has labored breathing and sub costal
retractions. The life serving management of this child would include:
A. I.V ceftriaxone for 5 days
B. Inhaled salbutamol 2 puffs 2 hourly
C. Parenteral steroid and oxygen therapy
D. Oral amoxicillin 8 hourly 5 days
E. I.V. aminophylline 8 hourly

32. A 4 years old girl, who had pharyngitis two weeks ago, presents to paediatric clinic with a 2
days history of blood stained urine and puffiness of the face. The most likely diagnosis is:
A. Acute interstitial Nephritis
B. Idiopathic haematuria
C. Nephrotic syndrome
D. Glomerulonephritis
E. Renal stones
33. Regarding resuscitation in paediatrics, the most important goal is:
A. To restore age-appropriate heart rate
B. To restore appropriate respiratory rate
C. To restore appropriate movement of the chest
D. To ensure equal breathing sounds in both lung
E. To provide adequate oxygen delivery to body tissue

34. Which of the following factors, is a poor prognostic factor in a child with shock:
A. Multiple organ failure
B. Respiratory failure
C. Metabolic acidosis
D. Renal Failure
E. Heart failure
35. Management of a child with persistent diarrhea includes:
A. Increasing juice intake and reducing fat in the diet
B. Emperic treatment with antidiarrheal agents
C. High protein diet and regular intake of juice
D. Empiric treatment with antibiotics
E. Establishment of the cause

36. One of the following statements is correct regarding the management of urinary tract
infections:
A. Antibiotics should be initiated for asymptomatic children with a positive urine culture
B. Treatment should be initiated after culture and sensitivity in symptomatic children
C. Infants should be treated with amoxicillin or cotrimoxazole
D. Uncomplicated cystitis is best treated with I.V ampicillin.
E. Acute pyelonephritis is treated for 3 to 5 days

37. A 3 years old boy presents with a history of heamaturia on examination there is a mass in the
left lumbar region and. The most likely diagnosis is:
A. Renal cell carcinoma
B. Rhabdomyosarcoma
C. Nephroblastoma
D. Neuroplastoma
E. Lymphoma

38. One of the following is the presenting feature of a child with scabies:
A. Pruritic papules that later become vesicles
B. Skin coloured papules with irregular surface
C. Localized or generalized pruritus with eczematous eruption
D. Erythematous papules covered by thick white scales
E. Plaques over the elbow, knees and buttocks

39. A one year old male child was brought to hospital because of recurrent cough and failure to
thrive. On chest examination, a pansystolic murmur was heard maximal along the lower left
sternal border. The most likely diagnosis is:
A. Atrio-ventricular septal defect
B. Ventricular septal defect
C. Patent Ductus Arteriosus
D. Mitral regurgitation
E. Atrial septal Defect
40. One of the following statements is correct regarding resuscitation of a new born.
A. If the baby is not breathing and the face is stained with meconium, the nose should be
sucked first then the mouth.
B. If the baby is not crying, slap at the back and feet to stimulate the baby.
C. If not breathing, ventilate the baby at a rate of 60 – 80 breaths/minute.
D. If the heart rate is 80 beats/minute, compress the chest i.e. 3 compressions: 1 breath
every 2 seconds.
E. If the baby is not breathing and cyanosed use correctly fitting mask and give 5 slow
ventilation breaths with a bag.

41. The management to a one month old child suspected to have meningitis and convulsing will
include:
A. I.V. Phenobarbitone 25mg/kg to stop convulsions
B. I.V Chloramphenical 50mg/kg 8 hrly for 2 weeks
C. I.V Ceftriaxone 50mg/kg 12 hourly for 3 weeks
D. I.V Gentamycin 7.5mg/kg 8 hourly for 2 weeks
E. I.V Diazepam 2mg/kg to stop convulsions

42. The management of a child with septic arthritis include one of the following:
A. Antibiotics for 2 weeks
B. The effected limb should be rested
C. X-ray of the joint is helpful in most cases
D. The best drug to relieve pain and fever is diclofenac
E. Chloramphenical is the drug of choice in children aged 3 years and above

43. The commonest form of leukemia in paediatrics is:

A. Chronic lymphocytic leukaemia
B. Chronic granulocytic leukaemia
C. Acute lymphoblastic leukaemia
D. Chronic myeloid leukaemia
E. Acute myeloid leukaemia

44. A 3 month-old infant presents with poor growth and inadequate weight gain. There is no
history of vomiting or diarrhoea. Except for the appearance of malnutrion and lack of
subcutaneous fat, other physical examination is normal. The most likely cause of failure to
thrive to this infant is:
A. Tuberculosis
B. Renal disease
C. Non-organic cause
D. Metabolic disorder
E. Endocrine disorder
45. A 12 year – old boy has migratory arthritis with red, warm and swollen joints. He has
serologic evidence of recent group A streptococcal infection. Arthritis in this condition is
characterized by which of the following?
A. Heals without deformity
B. Appears after the fever subsides
C. Involves large and small joints equally
D. Seen only in patient with concurrent carditis
E. Arthritis and arthritis occurs concomitantly

46. A 2 year old boy developed emesis and intermittent abdominal pain yesterday, with several
small partially formed stools. His parents were not overly concerned because he seemed fine
between the pain episodes. Today however he has persistent bilious emesis and has had
several bloody stools episodes. Upon examination the abdomen is diffusely tender with
vague tubular mass in right upper quadrant. What is the most likely diagnosis?
A. Dysentery
B. Perianal trauma
C. Intussusception
D. Bleeding peptic ulcer
E. Hemolytic disease of the new born

47. An 8-months old child has vomiting and screaming episodes for 12 hours. Physical
examination reveals sausage shaped mass in the right upper quadrant. Which of the following
would be most useful diagnostic procedure?
A. Insertion of nasogastric tube
B. Stool examination for ova
C. Barium enema study
D. Abdominal imaging
E. Blood culture

48. One of the following drugs is a Nucleoside reverse transcriptase inhibitor:

A. Saquinavir
B. Ritonavir
C. Lopinavir
D. Abacavir
E. Efavirenz

49. A 2 years old child has microcytic anaemia. Which dietary history finding best explains this?
A. Excessive intakes of fish
B. Excessive intake of vitamin C
 C. Inadequate intake of fruit juice
D. Lack of fresh vegetable in the diet
E. Large intake of unmodified cow’s milk

50. A 3 year boy has failure to thrive, chronic diarrhoea and oral candidiasis. Test for HIV is
positive, the most common organisms to be found up on stool examination could be?
A. Giardia
B. Rotavirus
C. Salmonella
D. Cryptosporidium
E. Yersenia enterocolitica

51. In the management of severe dehydration in a child who is not severely malnourished and not
in shock, which of the following is the best method of rehydration?
A. Intravenous Ringer’s lactate is contraindicated fearing the danger of hyperkalaemia
B. The best fluid for resuscitation is dextrose-saline given slowly over one hour
C. The second 70mls/kg of i.v fluid is given rapidly over 30-60 minutes
D. The first 30mls/kg of i/v fluid is given rapidly over 30-60 minutes
E. The best modality is oral supplementation of zinc minerals

52. A two years old boy was rushed in an unconscious state at the casualty presenting with high
grade fever and convulsions once. While assessing the child, he convulsed again. The mother
reports history of vomiting and refused to eat anything. On examination, the child is febrile
40OC, soft neck, moderately pale, not cyanotic and not jaundiced. What is the first measures
would you take to manage this child?
A. Intravenous administration of 100mls of 20% bolus glucose should be performed quickly
B. Assessment of airway and breathing are not essential component in the management.
C. Intravenous administration of antibiotics may only exacerbate the condition
D. Intravenous quinine has little place in the management of this child
E. Lumber picture is absolutely contraindicated

53. Which of the following is the most common cause of jaundice in the neonate presenting in
the first 24 hours after delivery?

A. Physiological jaundice
B. Breastfeeding
C. Prematurity
D. Haemolysis
E. Infection

54. Of the following is the main cause of neonatal mortality in Tanzania:

 A. Pulmonary hyaline membrane disease
B. Cerebral malformation
C. Bleeding disorders
D. Severe pneumonia
E. Septicemia

55. A two years old boy presents at the OPD with the history of sudden onset of abdominal
pains, vomiting and passing red currant jelly loose mucoid stool. The pain is so severe that
the boy has to draw his knees up his chest for relief. What condition most likely presents with
these symptoms?

A. Bacillary dysentery
B. Intussusceptions
C. Infantile colic
D. Cholera
E. Volvulus

56. A child presents at the OPD with a prolonged history of low grade fever, which was not
responding to antimalarial treatment. The attending clinician diagnoses the child to have
fever of unknown origin. Which of the following could be the cause of the condition?

A. Sub-acute bacterial endocarditis

B. Urinary tract infection
C. Hypothroidism
D. Pneumonia
E. Malaria

57. Possible causes of development of pathological haemolysis associated with hyper-

bilirubinaemia in the new born include;
A. Vitamin K deficiency
B. ABO incompatibility
C. Congenital malaria
D. Sickle cell disease
E. Birth asphyxia

58. A child is brought to the clinic presenting with high grade fever of sudden onset, crying
during micturition and decreased breastfeeding. The mother denies history of vomiting or
convulsions. On examination, the child is febrile 40oC, not pale and not jaundiced. What
could be the most likely diagnosis in this child?
A. Urinary tract infection
B. Pulmonary tuberculosis
 C. Severe pneumonia
D. Severe malaria
E. Enteric fever

59. Sami, a 4 years old child, presents with nausea, vomiting and fever. On examination, Sami
has Kusmaul’s hyperventilation with acetone smell on breathing. He was also found to be
febrile 38.7oc, has sunken eyes, lethargic and skin pinch goes back very slowly. What is the
most likely diagnosis of this child?
A. Upper respiratory tract infection
B. Non-ketotic hyper-osmolar coma
C. Diabetic ketoacidosis
D. Acute watery diarrhea
E. Diabetes insipidus

60. A 12 months old baby who weighs 9 kg was brought to the OPD with history of high grade
fever and convulsion, while taking history the child convulsed again. What will be the correct
dose of diazepam to this child:
A. 0.3mL Rectally
B. ..
C. 1.0mL Rectally
D. 1.25mL Rectally
E. 1.5mL Rectally

MULTIPLE TRUE/FALSE QUESTIONS

1. The following is the management of severe pneumonia:
A. …… Oxygen in nasal prong to prevent hypoxia
B. ….. Inhaled steroids so to reduce inflammatory process
C. ………Intravenous antibiotic to resolve Para pneumonic effusion
D. ……. Maintenance fluid to prevent dehydration
E. ………Bronchodilator to prevent bronchial obstruction

2. The following is the management of neonate or young infant who has fit:
A. ……… If hypoglycemia give 10ml/kg of 10% glucose
B. …… If hypocalcaemia give 2ml/kg of 10% calcium gluconate
C. …….. Manage the airway by giving oxygen in nasal prongs
D. ……. If hyperemic give paracetamol 15mg/kg every 6 hourly
E. …… If convulsing give diazepam 0.5mg/kg rectally
3. In management of sickle cell crisis the following are true:
A. …….. Folic acid prophylaxis used to prevent vaso-occlusive crisis
B. ……. I.V. normal saline can be used in treatment of painful crisis
C. …… Sequestration crisis can be treated with packed red blood cell Transfusion
D. …… Acute chest syndrome can be treated with exchange blood transfusion and oxygen
E. …… A plastic crisis splenectomy recommended after age 5 – 6 years

4. Esophageal foreign body is suspect if any of the following symptoms occur:

A. ……….. Hematochezia
B. ……….Cough
C. …….. Abdominal distension
D. …… Chest pain
E. …… Weight loss

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

A. ……. Give antiviral therapy to eliminate the virus
B. ……. Avoid from exposure to strong light
C. ……. Give vitamin to all children with measles
D. ……. Rehydrate the patient with maintenance fluid
E. ……… Give humidified oxygen to relieve respiratory distress

6. The following is true in management of MASTOIDITIS:

A. …….. It should be treated as a case of osteomyelitis
B. ……. It can be treated with intravenous antibiotic
C. ……. Chronic mastoids will require mastoidectomy
D. ……. antibiotics should aim to common causative organism
E. ………. Oral antibiotics if associated with chronic otitis media

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

A. …….. It can be only treated with oral corticosteroids
B. ……. Protein restriction is indicated during the course of treatment
C. …… Increased peripheral oedema can be measure by daily weight
D. …… Sodium restriction is indicated in severe symptomatic oedema.
E. ……. Antibiotics is indicated if you suspect spontaneous bacterial peritonitis

8. In performing neonatal resuscitation:

A. ……… Clean the infant immediately with wet clothes
B. ……. Keep warm by kangaroo method
C. ……. Suction only if there is mouth secretion
D. …….. Drying is enough for stimulation
 E. ………Ventilate with bag and mask at rate 40 – 60 b/m

9. Differential diagnosis in a 9 years old child presenting with fever lasting more than 7 days
and weight loss will include:
A. ............ Infective endocarditic
B. ............ Urinary tract infection
C. ......... Miliary tuberculosis
D. ............ Pneumonia
E. ............ Septicaemia

10. The following statement are correct regarding immunization schedule for under one year
children in Tanzania:
A. ............ BCG is given at birth
B. ............ OPV0 is given after four weeks
C. ............ Measles vaccine is given at 6 months
D. ............ OPV1 Penta + Rota is given at 8 weeks of age
E. ........ First dose of vitamin A is given at 9 months

11. Common signs of prematurity include:

A. ............ Large scrotum that is smooth and has ridges
B. ......... Enlarged clitoris in female infant
C. ........ Abnormal breathing pattern
D. ........ Body hair (Lanugo)
E. ............ Firm ear cartilage

12. Infants at increased risk of birth trauma are:

A. ............ Term infants with a weight 2500gm
B. ........ Those delivered by vacuum extraction
C. ......... Those with malpresentation
D. ............ Those delivered very fast
E. ............ Preterm infants

13. Regarding tuberculosis is paediatrics:

A. ........ Children with tuberculosis have usually acquired it from an adult contact.
B. .......... Sputum negative cases are of more public health importance
C. ........... Close contacts of a smear positive case should be offered immediate BCG.
D. ........... BCG prevents pulmonary tuberculosis by 60%
E. ....... Close contacts of smear positive case should be offered a chest X-ray.

14. In the management of a child with atopic dermatitis:

A. ............ Oral steroids e.g. prednisolone is recommended in mild case
 B. ......... In dry environment ointment steroid bases are preferred.
C. .......... Topical steroids are the mainstay of treatment
D. ............ Steroids are continued when the lesions disappear
E. ............ Hydrocortisone injection is preferred in severe cases

15. Differential diagnoses of a 5 years old child presenting with persistent cervical adenitis area:
A. ............ Pyogenic abscess
B. ............ Chronic otitis media
C. ......... Lymphoma
D. ........... Tuberculosis
E. ............ Infectious monocleosis

16. The long term complications of chronic bilirubin encephalopathy include;

A. ……. Minor intellectual deficit
B. …… Upward visual gaze
C. ……… Muscle hypotonia
D. …........ Persistent convulsions
E. …….. Hearing loss

17. Physiological jaundice results from:

A. ………. Breast-feeding
B. ……. Immature hepatic enzymes
C. …….. Increase bilirubin production
D. ……… Increased entero-hepatic circulation
E. ……. Decreased hepatic bilirubin excretion

18. The priority signs accessed during triage include:

A. ……… Fever on touch
B. ……… Mild palmar pallor
C. ……… A child with moderate wasting
D. …… A child with bilateral pedal edema
E. ……. Any sick young infant (below2 months old)

19. Risks of early cessation of breastfeeding to an infant include;

A. ……… Risk of schizophrenia during adulthood
B. ……… Episodes of unexplained convulsions
C. …… Increased risk of parental neglect
D. …… Weight loss and malnutrition
 E. ……. Increase risk of infection

20. Regarding African Burkitt’s lymphoma

A. …….. Is a childhood tumor of the jaw
B. ………. Is mostly seen in young infants
C. ……… It is associated with HIV infection in children
D. ….. Is associated with Epstein-Barr Virus infection
E. ….. With early detection and complete treatment carries a good prognosis
21.

MATCHING ITEM QUESTIONS:

1. Match the signs/symptoms from column B. with the corresponding disease/conditions in

column A

COLUMN A COLUMN B
DISEASE SIGHN/SYMPTOMS
1. Laryngotracheobronchitis A. Periorbital oedema
2. Pertussis B. Erythematous macula rashes
3. Nephrotic syndrome C. Non-pitting oedema
4. Measles D. Cerebral oedema
5. Meningitis E. Koplik spot
F. Whopping cough
G. Stridor
H. Barking cough
 2. Match the associated side effect of some medicine used in some paediatric conditions
from column B with the corresponding medicine in column A

COLUMN A COLUMN B
Diseases Causative agents
1 Bronchiolitis A. Mycobacterium tuberculosis
2 Tuberculous adenitis B. Vibrio cholera
3 Chicken-pox C. Cryptosporidium
4 Diarrhoea D. Trichuris trichiura
5 Rectal prolapse E. Mycobacterium bovis

F. Staphylococcus aureas
G. Varicella zoster
H. Respiratory syncytial virus

3. Match the disease from Column B the risk at which the disease can be acquired in
column A

COLUMN A COLUMN B
Risk Disease
1. Maternal sedation A Neonatal septicemia
2. Maternal mastitis B Peri-natal asphyxia
3. Bottle feeding C Bacterial pneumonia
4. Low birth weight D Vertical transmission of HIV
5. Frequent blood transfusion E Recurrent diarrhea disease
F Neonatal jaundice
G Diabetes Mellitus
H HBV or HCV infection

4. Match the side effect of ART from Column B with its corresponding drug in column A

COLUMN A COLUMN B
ART drug Side effect
1. Efavirenz A Peripheral neuropathy
2. Nevirapine B Bone marrow suppression
3. Zidovudine C Steven Johnson’s Syndrome
 4. Abacavir D Nightmares and vivid dreams
5. Stavudine E Severe hypersensitivity reaction
F Neuritis
G Hypokalaemia
H Metabolic alkalosis

5. Match the diagnosis from column B with the appropriate case scenario in column A
COLUMN A COLUMN B

(Case scenario) (Disease)

1. A 3 months old child with macula papular skin rash A Meningococcal septicaemia
on the cheeks and extension surface of extremities
2. A 16 months old boy with tiny blisters around his B Erytherma nodosum
nose and mouth, few lesions have honey colored
crusts.
3. A 7 years old boy with fever, lethargic and neck C Chicken pox
stiffness has petechial rashes on lower extremities.
4. A 5 years old boy with fever, conjunctivitis, runny D Measles
nose, dry cough and macula papular rashes that
started from the face extending to the trunk.
5. A 3 years old girl with fever, erythematous macule, E Scabies
papule and vesicles in crops of varied distribution
across her face and trunk.
F Impetigo

G Urticaria

H Eczema

6. Match the mode of transmission from column B with the appropriate worm in column A
COLUMN A (Worms) COLUMN B (Mode of transmission)

1. Ascaris lumbricoides A: Larva skin penetration

2. Enterobius vermicularis B : Cercaria skin penetration

3. Schistosoma haematobium C: Self inoculation of contaminated eggs

4. Ancylostoma duodenale D: Ingestion of eggs

5. Taenia solium E: Contaminated blood

 F: Larvae in fish

G:Larvae in animal muscles

H: Inhaled cyst

SHORT ANSWER QUESTIONS

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

ii) Mention four organism that can cause the above condition in children (2 Mark)
iii) Mention four complications of the above condition (2 Mark)
-

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

i) What is your diagnosis (1 mark)

ii) Which investigation will you perform (1 mark)

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

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

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

a) What is your diagnosis

(
 b) How will you manage the patient (2 mark)
(1 mark)
4. A 4 years old female presented with history of lower abdominal pain vomiting and fever.
The mother mentioned that she has noticed change in frequency of urination which
accompanied with pain.
a) What is your diagnosis (1 mark)

b) Mention four common organism responsible for the above condition (2 mark)

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

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

a) What is your diagnoses (1 mark)

b) Mention the four principals of treatment (2 mark)

c) Mention complications of treatment

6. A 5 days old child with a birth weight of 1.75kg on infant formula presents with blood
stained stool and abdominal distension. On examination temperature is 35.0oC and is
drowsy.
a) What is the most likely diagnosis? (1 mark)

b) What two (2) investigations will you order? (1 marks)

c) Outline the treatment which you will provide to this child (3 marks)

7. Mention five (5) complications of pharyngotonsilitis: (2.5 Marks)

8. A 6 years old boy presents to hospital with a history of fever, cough and difficulty in
breathing for 5 days. On examination, he is lethargic and has a temperature 38.5oC,
 respiratory rate 65 breaths/min, intercostal retractions and coarse crackle on the left side of
the chest.

a. What is the most likely diagnosis? (1 Mark)

b. Mention four (4) commonest causative organisms of the above diagnosis: (2 Marks)
c. List four complications of the above conditions (2 Ma
9. Mention five skin manifestation of paediatric
HIV/AIDS: (2.5 Marks)
 Candidate No. ………………………………..

10. Neonates have poor temperature regulatory mechanisms and can die in response to extreme
changes in temperature. As a clinician outline strategies to ensure the newborn baby is kept
warm all the time. (5 Marks)

11. A pre-term infant is admitted in the Paediatric ward at birth had an APGAR score of 2 in the
first minute and 4 at the 5th minute. On examination, the neonate had fast breathing, grunting,
nasal flaring, cyanosis and apnoea.
a) What are the differential diagnoses of this neonate? (2 Marks)

b) What is the pre-referral management of the neonate? (3 Marks)

12. A 3 days old neonate is brought to the dispensary due the oozing of blood from the
umbilicus. On examination, a large haematoma is seen under skin covering the back. The
neonate is afebrile, however the umbilical stump is oozing blood.
i. What is the most likely diagnosis of this neonate? (1 Marks)
ii. What investigation will you do? (2 Marks)
iii. What is the pre-referral management of this neonate? (2 Marks)

13. A newborn infant is brought to the health centre with visible yellowish discoloration of the
fore-head which occurred 6 hours after birth. On examination, the baby has body temperature
of 35.40C, jaundiced, fast breathing, and less body movements.
i. What could be the risk factors for the development of the above condition? (2 marks)

ii. What appropriate investigations will you do in the management of this baby? (3 marks)

14. A baby of 2 months old, was brought to the dispensary presenting with the history of dry
cough associated with difficulty in breathing, unable to breastfeed for 2 days and had
convulsion once at home. On examination, she is febrile, dyspoeic, not cyanosed and not
jaundiced.
i. What are the differential diagnoses? (2 marks)

ii. What pre-referral investigations will you perform? (3 marks)

15. A 16 months old male child, who has been sick since birth. Was brought to the dispensary by
his mother who reports that the child has feeding difficulties, inability to suck, unable to
stand and has rapid jerky movements, mainly of proximal parts of arms and legs. On physical
examination you find he has increased muscle tone on both upper and lower limbs. What is
the working diagnosis and possible causes?

Module CMT 06209: Apprenticeship in Paediatrics and Child Health End of Semester II Supplementary Examination 6/29/2020
4:48:09 AM Page 24
 Candidate No. ………………………………..

16. A one year old child is brought to the health centre presenting with sudden onset of fever
which subsided when given paracetamol at home. However, the fever recurred few hours
prior to coming to the dispensary accompanied with convulsion. On examination, the child is
febrile with 390C, not pale, not jaundice and has no cyanosis. The ordered investigations
revealed no malaria parasites, random blood glucose was 4.8 mmol/L and urinalysis showed
no evidence of pus cells in urine.
i. What is the most likely diagnosis? (1 Mark)

ii. What other investigations will you do? (1 Mark)

iii. How will you manage the child? (3 Mark)

17. Outline the important steps in resuscitating a full-term newborn baby. (8 Mark)

18. Diagnosis of Paediatric HIV infection in the resource-limited settings is a management

challenge. Outline four challenges encountered in the diagnosis of paediatric HIV infection
in the poor resource settings (4 Marks)

ESSAY QUESTIONS

(1) A 5 years old boy living with his grandmother was admitted to the hospital with a history of
lower limbs swelling for 2 weeks and passage loose stools 3 – 5 times a day for 4 days. On
examination, weight for age was 70%, pitting lower limbs edema, severe palmar pallor, and
temperature of 34.5o C and has oxidative skin lesion. Describe the management of child’s
diagnosis.

(2) A 6 years old girl presents with a history of swelling of the lower extremities for 1 month,
swelling of face and abdominal distension for2 weeks. Also she has a history of passing
frothy urine for 3 days. On examination has puffy face, putting lower limb oedema, positive
fluid thrill on abdominal examination. Respiratory and cardiovascular systems were
unremarkable. Describe the management of the most likely diagnosis and its complications.

(3) A two years old child is brought to the dispensary by her mother presenting with a sudden
onset of fever for two days and one occasion of convulsion which lasted for about 10 minutes
and then followed by loss of consciousness. On examination, the child was febrile 38.9oC,
not pale, not jaundiced and not cyanotic. She was also not reacting to any external stimuli.
Basing on the clinical features above, describe the management of the child under the
following differential diagnosis, investigations and pre-referral management.
-

Module CMT 06209: Apprenticeship in Paediatrics and Child Health End of Semester II Supplementary Examination 6/29/2020
4:48:09 AM Page 25
 Candidate No. ………………………………..

(4) An 8 years old child was brought to the health centre in an unconscious state. His mother
reports that the child had ingested a tea-cup-full of fluid poison in an attempt to commit
suicide after a quarrel with his teacher at school. On examination, the child was afebrile,
hyper-salivating, had a characteristic smell all over the body. Examination of the eyes
showed excessive tearing and constricted pupils. The cardiovascular system revealed a PR of
126 bpm. Describe the child’s condition and its management.

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

(6) Describe neonatal sepsis basing on definition, classification, causative organism, clinical
presentation, differential diagnosis, investigation and treatments, prevention

Module CMT 06209: Apprenticeship in Paediatrics and Child Health End of Semester II Supplementary Examination 6/29/2020
4:48:09 AM Page 26
 -

27