QUESTIONS AND ANSWERS | PAEDIATRIC AND CHILD HEALTH | CMT NTA LEVEL 5

 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 – Na├»ve regimen)?

A. Zidovudine + Lamivudine + Efavirenz

B. Zidovudine + Lamivudine + Stavudine

C. Zidovudine + Lamivudine + Tenofovir

D. Zidovudine + Lamivudine + Nevirapine

E. Zidovudine + Abacavir + Nevirapine

 

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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. 0.5mL Rectally

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. TRUE Oxygen in nasal prong to prevent hypoxia

B. FALSE Inhaled steroids so to reduce inflammatory process

C. TRUE Intravenous antibiotic to resolve Para pneumonic effusion

D. FALSE Maintenance fluid to prevent dehydration

E. FALSE Bronchodilator to prevent bronchial obstruction

 

2. The following is the management of neonate or young infant who has fit:

A. FALSE If hypoglycemia give 10ml/kg of 10% glucose

B. TRUE If hypocalcaemia give 2ml/kg of 10% calcium gluconate

C. FALSE Manage the airway by giving oxygen in nasal prongs

D. TRUE If hyperemic give paracetamol 15mg/kg every 6 hourly

E. TRUE If convulsing give diazepam 0.5mg/kg rectally

 

3. In management of sickle cell crisis the following are true:

A. FALSE Folic acid prophylaxis used to prevent vaso-occlusive crisis

B. TRUE I.V. normal saline can be used in treatment of painful crisis

C. TRUE Sequestration crisis can be treated with packed red blood cell Transfusion

D. TRUE Acute chest syndrome can be treated with exchange blood transfusion and oxygen

E. TRUE  A plastic crisis splenectomy recommended after age 5 6 years

 

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

A. FALSE Hematochezia

B. TRUE Cough

C. FALSE Abdominal distension

D. TRUE Chest pain

E. TRUE Weight loss

 

 

 

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

A. FALSE Give  antiviral therapy to eliminate the virus

B. TRUE Avoid from exposure to strong light

C. TRUE Give vitamin to all children with measles

D. TRUE Rehydrate the patient with maintenance fluid

E. FALSE Give humidified oxygen to relieve respiratory distress

 

6. The following is true in management of MASTOIDITIS:

A. FALSE It should be treated as a case of osteomyelitis

B. TRUE It can be treated with intravenous antibiotic

C. TRUE Chronic mastoids will require mastoidectomy

D. TRUE antibiotics should aim to common causative organism  

E. FALSE Oral antibiotics if associated with chronic otitis media

 

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

A. FALSE It can be only treated with oral corticosteroids

B. TRUE Protein restriction is indicated during the course of treatment

C. TRUE Increased  peripheral oedema can be measure by daily weight

D. TRUE Sodium restriction is indicated in severe symptomatic oedema.

E. FALSE Antibiotics is indicated if you suspect spontaneous bacterial peritonitis

 

8. In performing neonatal resuscitation:

A. FALSE Clean the infant immediately with wet clothes

B. TRUE Keep warm by kangaroo method

C. TRUE Suction only if there is mouth secretion

D. TRUE Drying is enough for stimulation

E. TRUE 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. TRUE Infective endocarditic

B. FALSE Urinary tract infection

C. TRUE Miliary tuberculosis

D. FALSE Pneumonia

E. FALSE Septicaemia

 

10. The following statement are correct regarding immunization schedule for under one year children in Tanzania:

A. TRUE BCG is given at birth

B. FALSE OPV0 is given after four weeks

C. FALSE Measles vaccine is given at 6 months

D. FALSE OPV1 Penta + Rota is given at 8 weeks of age

E. TRUE First dose of vitamin A is given at 9 months

 

11. Common signs of prematurity include:

A. FALSE Large scrotum that is smooth and has ridges

B. TRUE Enlarged clitoris in female infant

C. TRUE Abnormal breathing pattern

D. TRUE Body hair (Lanugo)

E. FALSE Firm ear cartilage

 

12. Infants at increased risk of birth trauma are:

A. FALSE Term infants with a weight 2500gm

B. TRUE Those delivered by vacuum extraction

C. TRUE Those with malpresentation

D. FALSE Those delivered very fast

E. TRUE Preterm infants

 

13. Regarding  tuberculosis is paediatrics:

A. TRUE Children with tuberculosis have usually acquired it from an adult contact.

B. FALSE Sputum negative cases are of more public health importance

C. FALSE Close contacts of a smear positive case should be offered immediate BCG.

D. FALSE BCG prevents pulmonary tuberculosis by 60%

E. TRUE Close contacts of smear positive case should be offered a chest X-ray.

 

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

A. FALSE Oral steroids e.g. prednisolone is recommended  in mild case

B. TRUE In dry environment ointment steroid bases are preferred.

C. TRUE Topical steroids are the mainstay of treatment

D. FALSE Steroids are continued when the lesions disappear

E. FALSE Hydrocortisone injection is preferred in severe cases

 

15. Differential diagnoses of a 5 years old child presenting with persistent cervical adenitis area:

A. FALSE Pyogenic abscess

B. FALSE Chronic otitis media

C. TRUE Lymphoma

D. TRUE Tuberculosis

E. TRUE Infectious monocleosis

 

 

 

 

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

A. TRUE Minor intellectual deficit

B. TRUE Upward visual gaze

C. FALSE Muscle hypotonia

D. FALSE Persistent convulsions

E. TRUE Hearing loss

 

17. Physiological jaundice results from:

A. FALSE Breast-feeding 

B. TRUE Immature hepatic enzymes

C. TRUE Increase bilirubin production 

D. FALSE Increased entero-hepatic circulation 

E. TRUE Decreased hepatic bilirubin excretion

 

18. The priority signs accessed during triage include:

A. TRUE Fever on touch

B. FALSE Mild palmar pallor

C. FALSE A child with moderate wasting

D. TRUE A child with bilateral pedal edema

E. TRUE Any sick young infant (below2 months old)

 

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

A. FALSE Risk of schizophrenia during adulthood

B. FALSE Episodes of unexplained convulsions

C. TRUE Increased risk of parental neglect 

D. TRUE Weight loss and malnutrition

E. TRUE Increase risk of infection

 

20. Regarding African Burkitt’s lymphoma

A. TRUE Is a childhood tumor of the jaw

B. FALSE  Is mostly seen in young infants

C. FALSE It is associated with HIV infection in children

D. TRUE Is associated with Epstein-Barr Virus infection

E. TRUE 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. H

Laryngotracheobronchitis

A. Periorbital oedema

2. F  

Pertussis

B. Erythematous macula rashes

3. A

Nephrotic syndrome

C. Non-pitting oedema

4. E

Measles

D. Cerebral oedema

5. B

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

H

Bronchiolitis

A. Mycobacterium tuberculosis

2

A

Tuberculous adenitis

B. Vibrio cholera

3

G

Chicken-pox

C. Cryptosporidium

4

C

Diarrhoea

D. Trichuris trichiura

5

D

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.

B  Maternal sedation  

A

Neonatal septicemia

2.

D  Maternal mastitis

B

Peri-natal asphyxia

3.

E  Bottle feeding

C

Bacterial pneumonia

4.

A  Low birth weight

D

Vertical transmission of HIV

5.

H  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.

D  Efavirenz

A

Peripheral neuropathy

2.

C  Nevirapine

B

Bone marrow suppression

3.

B  Zidovudine

C

Steven Johnson’s Syndrome

4.

E  Abacavir

D

Nightmares and vivid dreams

5.

A  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

(Case scenario)

 

COLUMN B

(Disease)

1. H  A 3 months old child with macula papular skin rash on the cheeks and extension surface of extremities

A

Meningococcal septicaemia

2. F  A 16 months old boy with tiny blisters around his nose and mouth, few lesions have honey colored crusts.

B

Erytherma nodosum

3. A  A 7 years old boy with fever, lethargic and neck stiffness has petechial rashes on lower extremities.

C

Chicken pox

4. D  A 5 years old boy with fever, conjunctivitis, runny nose, dry cough and macula papular rashes that started from the face extending to the trunk.

D

Measles

5. C  A 3 years old girl with fever, erythematous macule, papule and vesicles in crops of varied distribution across her face and trunk.

E

Scabies

 

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. D    Ascaris lumbricoides

A: Larva skin penetration

2. C    Enterobius vermicularis

B : Cercaria skin penetration

3. B    Schistosoma haematobium

C: Self inoculation of contaminated eggs

4. A    Ancylostoma duodenale

D: Ingestion of eggs

5. G   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

Answer:

Severe Pneumonia (1 mark)

 

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

Answer

Streptococcus pneumonia

Haemophilus influenza

Group A streptococcus

Mycoplasma pneumonia

 

iii) Mention four complications of the above condition  (2 Mark)

Answer

Lung abscess formation

Pleural effusion

Lung collapse

Pneumothorax

Bronchioectasis

 

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)

Answer

Cryptococcal meningitis

 

ii) Which investigation will you perform                                                    (1 mark)

Answer

a) Lumber puncture with CSF analysis

b) CSF Indian ink preparation or cryptococcal antigen (serum)

 

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

Answer

a) Cryptococcus neofomans

b) Cryptococcus gattii

 

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

 

Answer

Amphotericin 0.5 – 1.5/kg per day for 14 days

Then fluconcole 6 – 12mg/kg for 8 weeks


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

Answer:

Severe malaria with severe anaemia                                                   (1 mark)

 

b) How will you manage the patient          (2 mark)

Answer

Transfuse with 10 ml/kg packed cells or 20ml/kg of whole blood over 3 – 4 hr. then continue with ferrous sulphate or iron syrup for 14 days.                              

         (1 mark)

Quinine IM  10mg/kg for 3 days then followed by oral quinine or complete dose of ALU                                                                                      

         (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)

Answer

Urinary Tract Infection

 

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

Answer

i) E.coli

ii) Klebsiella

iii) Proteins

iv) Staphylococcal

 

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

Answer

Cotrimoxazole 240 mg BD for 7 days or

Nitrofurantoin5mg/kg day in 3 three divide dose for 7 days

Paracetamol 15mg/kg every 4 – 6 hr.


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)

Answer:

Diabetic ketoacidosis

 

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

 

Answer

i) The administration of insulin

ii) Fluid replacement

iii) Potassium replacement

iv) Administration of antibiotic if infection present

 

c) Mention complications of treatment

Answer:

i) Cerebral edema

ii) Aspiration

iii) Cardiac arrhythmia

iv) Venus thrombosis

 

 

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)

Answers:

· Necrotizing enterocolitis

 

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

Answers:

i. FBP

ii. Plain abdominal X-ray

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

Answers:

i. Stop enteral feeding (NPO for 10 – 14 days)

ii. I.V. Fluids glucose/saline

iii. Broad spectrum antibiotics (Ampicillin/Gentamycin) for 10 – 14 days

 

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

Answers:


i. Peritonsilar Abscess

ii. Acute rheumatic fever

iii. Post infections Glomerulonphritis

iv. Middle ear effusion

v. Otitis  Media

vi. Pneumonia

vii. Meningitis


 

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)

Answers:

· Very severe pneumonia

b. Mention four (4) commonest causative organisms of the above diagnosis:  (2 Marks)

Answers:


i. Streptococcus pneumoniae

ii. Mycoplasma pneumoniae

iii. Haemophilus influenza

iv. Chlamydia pneumoniae

v. Influenza Viruses

vi. Adenoviruses


 

c. List four complications of the above conditions (2 Marks)

Answers:


i. Para pneumonic effusion

ii. Empyema

iii. Bronchiectasis

iv. Lung abscess

v. Pneumatocole/Pneumothorax

vi. Septicemia

vii. Lung collapse

viii. Pericaditis


9. Mention five skin manifestation of paediatric HIV/AIDS: (2.5 Marks)

Answers:


i. Kaposi’s Sarcoma

ii. Herpes Zoster

iii. Seborrheic dermatitis

iv. Erythema multiforma

v. Molluscum contagiosum

vi. Warts

vii. Chronic /persistent Herpes Simplex

viii. Cutaneous mycobacterium

ix. Scabies

x. Pruritic Papular eruption


 

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)

Answer @ 1 mark

(a) Keep the newborn in close contact with his/her mother skin to skin (Kangaroo  care) or  skin  to skin to re-warm a baby who becomes cold

(b) Encourage all mothers to breastfeed on demand to prevent hypoglycemia/hypothermia

(c) Delay bathing of the newborn for at least 6 hours and better still 24 hours

(d) Maintain a warm chain for all newborn

Have a warm room for the birth

Dry the newborn completely immediately after birth

Keep the newborns head covered

Keep the dry newborn covered by clean dry towel in cloth or blanket

(e) Teach mothers how to keep the newborn warm, including keeping the baby’s head covered, how to check for hypothermia (cold feet or body) and how to re-warm

 

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)

Answer

a) Differential diagnoses any 4 @ 0.5 marks (total 2 marks)

Respiratory distress syndrome

Muconium aspiration pneumonia

Severe pulmonary infection e.g Severe bacterial pneumonia

Birth asphyxia

Congenital heart disease

Pulmonary haemorrhage

Septicemia

 

b) Pre-referral management (3 Marks)

Clear airway by suction

Ensure adequate breathing by ambu bag

Keep the baby warm

Give oxygen

Give broad spectrum antibiotics e.g I.V Gentamycin + X-Pen

Then refer to hospital

 

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)

 

 

Answer:

Most likely diagnosis       (1 Marks)

Hemorrhagic disease of newborn

Investigations @ 1 mark (total 2 marks)

Haemoglobin level estimation

Blood grouping and cross-matching

Pre-referral management       (2 Marks)

Stop two oozing of blood from the umbilical stump by applying direct pressure bandaging

Inj. Vitamin K 1-2mg/kg body weight initial dose

Refer the neonate urgently for blood transfusion

 

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)

Answer:

a) Risk factors for the above condition           any 4 @ 0.5 marks (total 2 marks)

Genetics and family risk/history

Known heredity for hemolytic disorder

Maternal factors, especially infants of diabetic mothers.

Premantury and low birth weight

ABO and Rhesus blood group incompatibility.

Congenital infection, maternal illness suggestive of viral or other infection.

 

b) Investigations any 3 @ 1 mark (3 marks)

Hemoglobin estimation

Blood grouping and cross-matching

Urinalysis

Stool analysis

 

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)

 

Answers

Differentials any 2 @ 1 mark (2 marks)

Severe malaria

Pneumonia

UTI

Pre-referral investigations any 3 @ 1 mark (3 marks)

BS for MPS

Urinalysis

Haemoglobin estimation

Stool analysis

 

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?

i. Provision diagnosis palsy                (1 Mark)

ii. Causes        (2 Mark)

 

Answers:

i. Cerebral palsy                    (1 Mark)

ii. causes:                (any 4 @ 0.5 mark)

· Asphyxia

· Intracranial bleeding

· Abruption placenta

· Jaundice and infection

· Anoxia caused by placenta praevia

 

 

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)

 

Answer

Diagnosis        (1 Mark)

Febrile convulsions

 

Other investigations               any 2 @ 0.5 mark (1 mark)

Haemoglobin level

FBP + ESR

Lumbar puncture

Stool analysis

 

Management       (3 Marks)

Diazepam Injection Rectal dose 0.5 mg/kg (IV dose 0.2-0.3 mg/kg) of 10mg/2ml solution

Paracetamol syrup

Treat the underlying cause of convulsions after investigations

Give first dose of I.V Quinine 10mg/kg body weight

Give first dose of I.V Gentamicin + X-pen

 

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

Answer:

Airway:         (2 Mark)

Suction airway if there is muconium stained fluid and if the baby is crying and not moving limbs

Suck the mouth, nose and oral pharynx

Do not go down the throat

Breathing       (3 Marks)

Choose mask size: size 1 for normal weight baby, and size 0 for small size baby (less than 2.5 kg)

Ventilate with bag and mask at 40-60 breaths per minute

Make sure the chest moves up with each stroke of the breath

 

Circulation      (3 Marks)

Perform 3 compressions for every 1 breath after every 2 seconds

Place thumbs just below the nipples on the sternum

Compress 1/3 the A-P diameter of the chest

 

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)

Answer

Challenges  all 4 @ 1 mark (total 4 marks)

Confirmatory test (using antibody test) is not reliable before the age of 18 months because of the presence of maternal antibodies.

Diagnosis of the early HIV infection (using PCR) is not readily available in most of the health facilities  and needs transportation of the sample (DBS)

Degree of immune-suppression is not reflected in the absolute CD count but requires calculations of the percentages

The infection may resemble or coexist  or be complicated with other diseases

 


 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.

 

Answer:

The most likely diagnosis is severe protein malnutrition – kwashiorkor which is due to inadequate intake of protein and -Severe anaemia (2 Marks)

Investigations (3 Marks)

· FBP – check level of Hb, Signs  of infections

· CXR – role our respiratory infection/Tb

· Urinary – rule out UTI

· Testing for HIV

· RBG – to detect hypoglycaemia

· Blood for culture and sensitivity

· Stool for ova, and trophozoctes

Treatment (10 Marks)

· General treatment involves 10 steps which has two phases.  Stabilization and rehabilitation phase.  And this involves treatment of Hypoglycaemia, hypothermia, dehydration, electrolytes imbalance, infection, micro-nutrients deficiency, feeding, catch-up growth, sensory stimulation and follow-up.

· On admission the child should be assumed to be having hypoglycaemia and started 50mls of 10% glucose orally.

· Since the child is having diarrhoea assume he has some dehydration and start ReSo Mal 5mls/kg every 30 minutes for the first 2 hrs, then 5 – 10mls/kg hour for the next 4 – 10 hours.

· After Rehydration start F – 75 130ml/kg day 2-3 hourly

· The child should be clothed and covered with a warm blanket.

· Give extra – potassium 3 – 4 mmol/kg/day

· Magnesium 0.4 – 0.6mmol/kg/day

· Blood transfusion 10m/kg over 4hours and give Frusemide 1mg/kg

· Start broad spectrum antibiotic e.g. Ampicillin 500mg/kg 6 hourly for 2 days the oral Amoxycillin for 5 days plos; IV gentamycin 7.5mg/kg once daily for 7 days.

· Micronutrients supplementation

Multivitamin

Zinc

Folate

Copper

FeS04 once the child has start to gain weight

Vitamin A 2000,000 IU on day 1.

Monitoring:


· Respiratory rate

· Pulse rate

· Urine frequency

· Frequency of stool

· Vomiting

· Amount of feed offered

· Daily body weight

· Oedema


· Catch – up growth – if the appetite has returned and oedema has gone start F – 100 130mls/kg/day for 2 days then 200 mls/kg/day 4 hourly

· Sensory stimulation – tender loving care and cheerful stimulating environment should be started from day 1.

Discharge and follow-up

· Once the child has recovered

· Show his grandmother how to feed frequently

· Ask to bring back for regular follow-up

(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.

 

Answers:

· The mostly, likely diagnosis is Nephrotic Syndrome which is characterized by oedema, proteinuria, hypoproteinaemia and hypercholesterolemia (2 Mark)

 

Investigations (3 Marks)

· Urine for – protein, cast and sediments

· Urine protein/creatinine ratio

· Serum :

Electrolytes

Creatinine/BUN

Protein/Albumin

Lipids (Cholesterol)

C3 complement level

· Abdominal ultrasound – ascites, liver, kidney

· Renal biopsy

 

Treatment (8 Marks)

· Prednisolone 2mg/kg/day divided into 4 doses per day for 6 weeks then the same dose in alternative day for 6 weeks, then Taper gradually each week for another 4 weeks.

· Restriction of salt to reduce oedema

· Frusemide incase of severe oedema

· Administer pneumococcal vaccine

 

Complication: (2 Marks)

· Spontaneous bacterial infections

· Hypertension

· Bacteraemia

· Acute renal failure

· Thrombosis

 

(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.

Answer:

Differential diagnosis at least 6 points @ 0.5 marks (3 Marks)

Coma

Febrile convulsions

Severe malaria

Hypoglycemia

Meningitis

Septicemia

Viral encephalitis

Diabetic ketoacidosis

Trauma

Poisoning and drugs

Epilepsy

 

Investigations at the dispensary level all 4 @ 1 mark (4 marks)

BS for MPS or Rapid Test for Malaria Parasites

Random Blood Glucose

Lumbar Puncture

Urinalysis


Pre-referral management 8 marks

Treat hypoglycemia with intravenous 5mls /kg body weight of 10% dextrose as a bolus dose

Manage infections by broad spectrum antibiotics e. g chloramphenical 25mg/kg i.m/i.v + i.v Gentamicin 2.5 mg/kg as the first dose

In case of suspected malaria, give i.v Quinine 10mg/kg as the first dose

Diazepam Injection Rectal dose 0.5 mg/kg (IV dose 0.2-0.3 mg/kg) of 10mg/2ml solution

Paracetamol through NGT

Catheterize and Refer the child

(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.

 

Answer

Diagnosis

Organophosphate poisoning 1 mark

Reasons to support all 5 @ 1 mark (total 5 marks)

Characteristic smell

Hyper-salivation

Excessive tearing

Tachycardia

Constricted pupils

 

Management

General measures  (4 Marks)

Undo and remove all clothes

Wash the body to clean any remains of the fluid

Catheterize

Insert I.V line

Monitor vital signs

 

Specific management (5 Marks)

Intravenous Normal saline

Atropine 0.05mg/kg IV initial dose. Thereafter 0.02 mg/kg IV every 15 minutes until there are signs of atropinism (flushed face, fast pulse and pupil dilatation) then stop

 

 

(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

 

Answer:

Definition:  Severe acute malnutrition is defined as the presence of edema of both feet andsevere wasting (weigh – for – height/length< - 3SD or mid upper arm circumference <115mm).  This includes kwashiorkor and marasmus)                                       (3 Marks)

General management 10 Marks (1 mark each point)

Hypoglycemia  

-

Give 50ml of 10% glucose I.V  once

Hypothermia  

-

Provide warmth

Dehydration  

-

use resomal 5-10ml/kg/h for 12hour by NGT

Electrolyte imbalance

-

Give extra potassium 3- 4 mmL.kg/day, magnesium 04 – 0.6mmol/kg/day

Infection

-

Give broad spectrum antibiotic either oral amoxicillin or I.V. benzyl penicillin and gentamycin, treat parasitic infection with mebendazole, if HIV determine the need for ART

Micronutrient deficiency

-

Give vitamin A on day 1  repeat on day 2 and 14 only, < 6 months 50000 IU, 6-12 month, > 12 month 200000U, start iron at 3mg/kg per days after 2 days , if child is not in any of pre-mixed therapeutic food give:folic acid 5mg on day1, Multivitamin syrup  5ml, zinc at 2mg/kg , Copper at 0.3mg/kg per day

Initial re-feeding

-

give F75 – 130m/kg per day or 100mL/kg per day every 2 – 3 hr.

Catch up growth feeding

-

Make gradual transition from F 75 – F100

Sensory stimulation

-

Provide tender loving care stimulating environment, provide suitable toys.

Prepare for follow-up

-

Follow up to outpatient care until full recovery. child should weigh week after discharge.

Complication                                                                                (2 marks)


i) Stunted growth

ii) Shock

iii) Septicemia

iv) Mental retardation

v) Sudden death


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

 

Answer:

Definition (1mark)

Neonatal sepsis is a clinical syndrome of bacteria with systemic sign and symptoms of infection occurring in the first 4 weeks of life

 

Classification                                                                                               (1 mark)

Early onset septicemia – onset within 7 days

Late onset – onset after 7 days of birth

 

Causative organisms                                                                                 (2 marks)

S. aureus

E.coli

Pseudomonas aerogeniosa

Entrobacter and anaerobes

Clinical presentation                                                                             (5 marks)


Diminished activity (lethargy)

Poor sucking

Apnea

Brachycardia

Hypothermia

Tachypnea

Respiratory distress

Vomiting

Diarrhoea

Abdominal distension

Seizure of  convulsion

Jaundice


Differential diagnosis                                                                      (2 marks)

Meningitis

Pneumonia

Birth asphyxia

Respiratory distress syndrome

Protozoa disease

Investigation                                                                                       (2 marks)

FBP

ESR

Blood/urine culture

Urinalysis

 

Prevention                                                                                         (2 marks)

Good antenatal care women with UTI  should be treat accordingly

Cord should kept clean

Hand washing

The nursery environment should be clean

All procedure should be done aseptically

Un necessary invasive procedure should be avoided.

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