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DATE: 19th October,2013 TIME: 1 Hour


A five –year old child presented with high grade fever, altered sensorium and convulsion of
about 16hours duration. List the differential diagnoses and management of one of them.

Outline the management of a 12 year old who presented with a history of fever, joint pain,
fast breathing of 2weeks duration. He had bout of sore throat a month before presentation.

Multiple Choice Questions

1. Infantile spasm
a) Phenobarbitone is the drug of choice F (ACTH)
b) EEG trading shows hypsarrhythmia T
c) It has a good prognosis F (bad prognosis)
d) The peak age of onset is 3 to 8 months T
e) Associated with wakening T

2. A boy with cyanosis first noticed at a month, always squatting, woke up that
morning crying and was noticed to be blue.
What condition is this?
a) VSD
b) ASD
c) PDA
d) TOF

3. Which of the following is not indicated in the treatment

a) Oxygen
b) Morphine
c) Iv fluids T
d) Propanolol
e) IV HCO3

4. Burkitt’s lymphoma
a) It is a B cell lymphoma (T)
b) Translocation is between 8 and 22 (T)
c) Affects more female than male (F)
d) It is highly chemosensitive (T)
e) There is loss of dental lamina dura on physical examination (F) (on x-ray)

5. Haemophilia A
a) it is autosomal recessive (f)
b) prothrombin time is prolonged (t)
c) factor IX deficiency ( F)
d) bleeding can occur into large joints (T)
e) prognosis is good ()

6. concerning necrotizing enterocolitis

a. breast feeding is protective (T)
b. Anaemia (T)
c. Pcv of 70 is a risk factor (T)
d. Commoner in term baby (F)
e. Can occur in babies of pre-eclamptic mothers (T)

7. A 2 yr old 11kg , lethargic, very sunken eyeball and reduced urinary output
a. Give 75ml/kg ORS (F)
b. Give 20ml/kg of ringers lactate for first 30mins (F)
c. Give 100ml/kg of ringer’s lactate for 3hrs (T)
d. Give zn when going home to reduce frequency (T)
e. Give 30ml/kg of ringer’s lactate for first 30minutes (T)

8. Corncerning diagnosis of UTI

a. Nitrite is positive (T)
b. Presence of hyaline cast (T)
c. Proteinuria is present (T)
d. History of vomit (T)
e. 3-5 wbc per mm3 (F)

9. Lower motor neuron lesion of left facial nerve

a. The mouth is drawn to the right side (T)
b. Loss of wrinkling of the forehead (T)
c. Inability to close the left upper eyelid (T)
d. Patient is unable to talk clearly (T)

10. Haemorrhagic disease of newborn

a. Platelet is reduced (F)
b. Prolonged PT(T)
c. Decreased PTTK (F)
d. Fibrinogen is reduced (F)
e. Factor v is reduced (F)

11. Which is higher in human breast milk than cow milk

a. Protein
b. Lactose (T)
c. Sodium
d. Calcium
e. Phosphate

12. Which of the following can be given subcutaneously
a. Polio vaccine (F)
b. Rotavirus vaccine ()
c. Yellow fever (T)
d. Pneumococcus ()
e. Measles (T)

13. Induction of emesis is indicated in the following situation

a. Caustic soda poisoning (F)
b. Kerosene poisoning (F)
c. Paracetamol poisoning (T)
d. Aspirin poisoining (T)
e. Iron poisoning (T)

14. The following are live attenuated vaccine

a. BCG (T)
b. Diphtheria toxoid(F)
c. Rubella(T)
d. Measles (T)
e. Hepatitis B (F)

15. Findings in chronic renal failure due to glomerulonephritis

a. Increase serum creatinine (T)
b. Hypocalcemia (T)
c. Increase serum PH (F)
d. Metabolic acidosis (T)
e. Increase serum phosphate (T)

16. The following statements are true

a. Stunting is reduced weight for age (F)(reduced ht 4 age)
b. Wasting is reduced height for age (F) (reduced wt for ht)
c. Malnutrition lead to decrease in height before weight loss (F)
d. OFC is preserved in mild to moderate malnutrition (T)
e. MAC changes are not significant in ages 1-5 (F)

17. Regarding Patent ductus arteiosus

a. Presence of murmur on left 2nd sterna border (T)
b. High diastolic pressure (F)
c. Small pulse pressure (F)
d. L-R shunt (T)
e. Indomethacin is helpful in term baby (T)

18. A 2year old child was brought to the emergency, on acct of passage of watery
stool and vomiting of 2days, he was restless, irritable and skin retract about
1sec after pinching
a. He has some dehydration (T)

b. Ringers lactate should be given at 20ml/kg immediately (F)
c. Assessment of electrolyte and creatinine should be done (F)
d. ORS is the treatment of choice (T)
e. Zinc is given to protect further occurrence for 2-3months (T)

19. Acute lysis syndrome

a. Hyperkalaemia (T)
b. Hypouricaemia (F)
c. Metabolic alkalosis (F)
d. Hypocalcemia (T)
e. Hypophosphatemia (F)

20. Regarding the findings of necrotizing enterocolitis

a. Portal vein gas ()
b. Bloody stool(T)
c. Pneumonic changes (F)
d. Pneumotosis intestinalis(T)
e. Ascites (T)

21. Concerning sickle cell Anaemia

a. There is replacement of lysine with glutamic acid (F)
b. Sequestration crises will lead to fuctional asplenia (T)
c. Shock is as a result of sequestration crises (T)
d. Dactylytis is one of the features (T)
e. Vaso occlusive can be corrected by given 5ml/kg of PCM (F) (15ml)

22. Causes of apnea in the newborn are

a. Preterm (T)
b. Hypoxia (T)
c. Hypoglycemia (T)
d. Idiopathic respiratory distress syndrome(T)
e. Hyponatremia(T) + Hypernatraemia

23. A child who had tooth extraction developed fever few weeks and was noticed
to have murmur and splenomegaly. Urinalysis revealed haematuria.
a. Rheumatic fever is a possible diagnosis (F)
b. Secundum ASD is predisposing factor (F)
c. Finger clubbing is not a common finding ()
d. Staphylococcal endocarditis has poor prognosis due to common
development of large friable vegetation(F)(Fungal)
e. Most important investigation is Electrocardiography (F) (ECHO)

24. Concerning Ventricular septal defect

a. Commonest congenital heart disease in chromosomal syndromes (T)
b. Very loud pansystolic murmur is typical of large VSD(F)
c. Recurrent venesection is required(F)
d. Chest X-ray may reveal oligaemia(F)

e. Spontaneous closure occurs in small muscular VSD during first 2 years(T)

25. Concerning tetanus

a. The toxin may reach the CNS through haematxogenous route(T)
b. Portal of entry may be unidentified (T)
c. The causative organism is spore-forming Gram negative anaerobe(F) (Gram
d. Bound toxins are neutralized by antitoxins(F)(circulating)
e. Onset period is 3 -21 days(T)

26. Tetanus
a. Patient is usually unconscious(F)
b. SIADH is a recognized complication(F)
c. Incubation period is 24 – 48 hours(F) (onset) (incubation;3-21dys)
d. Diaphoresis might be present(T)
e. Penicillin and metronidazole are recommended(T)

27. Concerning poliomyelitis

a. Kernig and Brundzinski signs are present(T) (non paralytic type)
b. There is spastic paralysis of the muscles(F)
c. The causative agent is a DNA virus(F)
d. Physiotherapy should commence when pain disappears(T)
e. Abortive stage is the first stage(F)

28. Pertussis
a. Incubation period is 10 – 14 days (T)
b. The causative organism is Gram positive coccobacillus(F) (gram neg)
c. Rectal prolapse is a complication (T)
d. Hydration and oxygen may be helpful (T)
e. Bulging of the eyes and tongue protrusion is seen in convalescent stage(F)

30. Acute epiglottitis

a. Commonly caused by respiratory syncytial virus(F)(H.influenza)
b. Associated with low grade fever(F)(high grade)
c. Thumb sign is classical of the plain radiograph(T)
d. Vaccination against Haemophilus influenza is beneficial(T)
e. Patient must be examined immediately when presented(F)

31. Concerning bronchiolitis

a. Fever is high-grade(F)
b. Respiratory syncitial virus has been implicated(T)
c. Chest radiograph shows hyper-inflated lung(T)
d. Stridor but not rhonchi is present(F)(wheezing and rhonchi)
e. Prognosis is good(T)

32. Features of congenital rubella syndrome

a. Hydrocephalus(F)

b. Ventricular septal defect(T)(PDA n VSD)
c. Blindess(T)
d. Deafness(T)
e. Microcephaly(T)

33. Concerning ricket

a. Hypotonia is common feature(T)
b. There is elevated alkaline phosphatase and serum phosphorus(F) (reduced
c. X-ray of the wrist is best for early diagnosis(T)
d. Cupping and fraying are common findings on radiograph (T)
e. Evidence of healing appear within 2 -3 weeks on radiograph(F)

34. Regarding rickets

a. Craniotabes and head swelling are early clinical features(T)
b. Infantile rickets is the commonest type(F)(nutritional)
c. Calcium is always low (F)
d. Treatment requires a dose of vitamin D of 300,000 to 600,000 i.u.(T)
e. Phytate consumption is contributory (T) (chelates calcium)
35. Measles
a. Enanthem appearance marks the end of exanthema(F)
b. Incubation period is 10 – 14 days (T)
c. Presence of maculopapular rash with desquamation in reverse order (F)ff d same oda
d. It is a vaccine preventable disease (T)
e. 100,000 units of vitamin A is given to infant greater than 12 months (F)(200,000)

34. Varicella
a. Prodrome may last 3 – 5days(F)(24hrs)
b. The eexanthem has centripental distribution(T)
c. Infective period is 24 hours before the exanthema to crusting of the last lesion(T)
d. Reye syndrome is a possible complication(T)
e. Acyclovir may be indicated(T)

35. Hepatitis
a. All viral hepatitis are endemic in Nigeria (F)
b. HBeAg indicates active replication (T)
c. HBV-DNA and HBcAg indicated chronic condition )(F) (HbIgG)
d. Hepatitis E is through faeco-oral route(T)
e. Anti-HB of > 10 miu/ml is protective to the infant()

36. Protein-Energy malnutrition

a. Wasting is a constant feature of kwashiorkor(F)(growth retardation, edema, mental
retardation, apathy)
b. Apathy is a feature of marasmus (F)
c. Rickets and heart failure is expected during recovery(F)()
d. Anaemia is present in kwashiorkor(T)
e. Immunization might be helpful(T)

37. Regarding asthma
a. Rhonchi is present(T)
b. Urticaria is expected(T)
c. Tactile fremitus is decreased(F)
d. Chest radiograph shows barrel-shaped chest(F)(nothing on xray)
e. Peak expiratory flow rate of 50 – 70% of predicted indicates mild condition (F)(>75%)

38. Risk factors for seizure include

a. Hypoglycaemia(T)
b. Hypocalacemia(T)
c. Brain abscess(T)
d. Corticosteriod use()
e. Hypernatraemia(T)

39. Which of the following is correct about cerebral palsy

a. Motor function is impaired but sensory is preserved(T)
b. Class III indicated no useful physical activity(F)(class IV)
c. Birth asphyxia is possible cause(T)
d. Hypotonia or hypertonia is expected(T)
e. Management should be multidisciplinary(T)

40. Hyperbilirubinaemia
a. Commonest cause of physiological jaundice is prematurity (F)(pathological)
b. Exchange blood transfusion is for management of conjugated
c. Cerebral palsy is a possible complication(T)
d. Pathological jaundice appears 2 – 3 days of life(F)
e. Serum bilirubin ≥ 20mg/dl in first day of life is indication for EBT(T)

41. Perinatal asphyxia

a. Bishop score of ≤ 3 in one minute indicate severe asphyxia(F)
b. Abruptio placenta is a risk factor (T)
c. There is need to delay oral feed(T)
d. Pulse less than 100 is zero (F)
e. Adrenaline might be helpful(T)

42. A convulsing child

a. Generalized tonic clonic is a complex seizure(F)
b. Seizure lasting more than 20mins is status epilepticus(F)
c. Absence seizure is associated with loss of consciousness(T)
d. EEG shows 3Hz spike in west syndrome()
e. Petit mal is a form of partial seizures(T)