MK Paeds Bazooka

MK’S BAZOOKA
(310)
PAEDIATRICS
MOSES KAZEVU
1st
EDITION
PAEDS 310 BAZOOKA
SECTION 1: SINGLE BEST ANSWER
1. A 15-year-old girl presents to you with history of fever and abdominal pain for 3 weeks. There
is history of constipation for 4 days and a transient rash which has since disappeared. On
examination the patient is ill looking. The temperature is 40o C while the pulse rate is 67/min.
She has also presented with a slight cough with no physical signs. What would be the most
likely causative organism?
A. Entero-invasive Escherichia coli
B. Campylobacter jejuni
C. Salmonella typhi
D. Helicobacter pylori
E. Enterococcus
2. The commonest organisms causing meningitis in neonates:

A. Streptococcus pneumonia and Haemophilus influenza
B. Streptococcus pneumonia and Neisseria Meningitidis
C. Group B B-haemolytic streptococci and Escherichia coli
D. Group B B-haemolytic streptococcus and haemophilus influenza
E. Group B streptococci and Listeria monocytogenes
3. A 10-year-old girl is noted to have cardiac murmur. Two days prior to admission, she
complained of fever and headache and suddenly lost consciousness today. On examination,
she is noted to be febrile and has a left sided hemiplegia. The most likely reason for the
development of the hemiplegia is:
A. Thrombo-embolic phenomena secondary to infective endocarditis
B. Hypertensive crisis
C. Infarction due to sickle cells
D. Stroke due hyperdynamic circulation in the cerebral arteries
E. Tetralogy of Fallot
F. Development of meningitis with complications
4. A 7-year-old girl presents with chorea following a streptococcal throat infection. In addition,
she is noted to have tachycardia, a gallop rhythm and soft mitral regurgitation murmur. Of the
following interventions, chronic disability is MOST likely to be prevented by
A. Intravenous penicillin for 6 weeks
B. Intramuscular penicillin monthly
C. Oral prednisolone for 4 weeks
D. Oral haloperidol for 6 weeks
E. Oral salicylates for 6 weeks
5. A 3-year-old child presents with history of an abdominal swelling for 2 months duration. A
month ago, the mother noticed the swelling whilst bathing the child. What is the most likely
diagnosis?
A. Wilms tumor if the spleen enlarged on the affected side
B. Neuroblastoma if the mass is supra-pubic
C. Leukemia if the child is pale with petechial lesions
D. Sickle cell anemia if the liver is enlarged
6. The following are true of Infective endocarditis, except:

A. Can be caused by Streptococcus aureus.
B. Hepato-splenomegaly is a characteristic feature
C. Hematuria may be a feature.
D. Treatment with intravenous antibiotics for 6 weeks is recommended.
E. It can occur in a heart with damaged valves only
7. The following laboratory results were returned in a 6-week-old boy admitted with 6 days of
severe projectile vomiting:
pH 7.51 (7.35-7.45), PO2 12 KPa (95 mmHg), PCO2 4.7 KPa (35 mmHg), Blood Urea 11
mmol/l, Na+ 131 mmol/l, K+ 3 mmol/l, Cl- 83 mmol/l
Which of the following is true concerning this patient?
A. He has hypertrophic pyloric stenosis
B. He is likely to have a bulging anterior fontanelle
C. He should be resuscitated immediately with normal saline
D. He should be commenced immediately on half strength soy protein, low lactose formula
E. X-ray of abdomen is likely to show dilated loops of small bowel
8. A 15-month-old child with flexural eczema presents with a 3-day history of cough and wheeze.
On examination his saturations are 92% in air, with a respiratory rate of 55/min and moderate
recession. The heart rate is 150/min. What is the most likely diagnosis?
A. Gastroesophageal reflux
B. Allergic rhinitis
C. Bronchiolitis
D. Asthma
9. Which of the following is true of tetanus?

A. Failure to culture Clostridium tetani from the wound would make the diagnosis doubtful
B. Infection confers lifelong immunity
C. Clostridium-specific intravenous immunoglobulin is of no benefit once spasms have been
established.
D. There is a characteristic EEG
E. Cephalic tetanus causes severe dysphagia
10. A school-going girl is listless on admission. On examination, she is lethargic with punched out
hyperpigmented lesions in places. Her temperature is 39.2°C, and HR 150/min with cold
peripheries. What is the most likely diagnosis?
A. Chicken pox
B. Measles
C. Meningococcaemia
D. Bacterial meningitis
11. A 15-year-old girl presented with a 12-hour history of fever and global headache. On
examination she was febrile (37.5oC). She was fully conscious. Mild neck stiffness was noted
but there were no other neurological signs. Cerebrospinal fluid analysis showed:
Cell count 200 /mL (60% lymphocytes), Protein 0.8 g/L,
Glucose 4.3 mmol/L, Gram stain: No organisms seen
What is the most likely diagnosis?
A. Bacterial meningitis
B. Lymphomatous meningitis
C. Tuberculous meningitis
D. Viral meningo-encephalitis
12. Choose the best answer concerning management of HIV in children

A. All exposed under-5 children must be started on HAART regardless of HIV status
B. Under five children must be started on the Tenofovir + Lamivudine + Efavirenz
C. Infants must be started on Zidovudine + Lamivudine + Lopinavir/ritonavir
D. Children above five must be started on Tenofovir + Lamivudine + Efavirenz
13. Which statement is true about treatment failure in HIV:

A. Clinical failure is the earliest
B. Virological failure is characterized by the failure of virus to replicate
C. Immunological failure is well expressed by the decline of CD4 count
D. Immunological failure is followed by virological
14. Concerning the diagnosis of HIV in children:

A. The rapid test is diagnostic at 1 year of age
B. In a child who never breast fed a negative DNA PCR is confirmatory negative result
C. Rapid tests are never conclusive in under-5 children
D. A 2 years old child requires a DNA PCR to confirm the diagnosis
15. Which of these would be used to confirm diagnosis of Diabetes mellitus in a symptomatic
child?
A. Finding of 3+ ketonuria
B. An HbA1c of 7.8%
C. A fasting plasma glucose of 6.5mmol/L
D. An abnormal glucose tolerance test
16. Concerning childhood urinary tract infection:

A. It is commonly associated with vesico-ureteric reflux.
B. It is commonest in girls under one month of age.
C. It commonly presents with hematuria.
D. It is usually caused by Group B streptococcus.
17. Splenic enlargement is seen in all these, except:

A. Acute myeloid leukaemia
B. Typhoid
C. Idiopathic thrombocytopenic purpura
D. Infective endocarditis
18. Which of the following statements regarding kernicterus is incorrect?

A. Is due to unconjugated hyperbilirubinaemia
B. Presents with hypotonia in the early stages
C. May cause a chronic syndrome of athetosis and hearing loss
D. Is associated with contractures if not well managed
19. A 7-year-old boy presents with crampy lower abdominal pain, loose stools and anorexia of 3
days duration. The stools contain blood and slime and occur 20 times a day. On examination
she appears lethargic, pale and has no jaundice. His temperature is 37.6°, HR100/min, RR
15/min. He has a few purpuric spots on her legs. What is the most likely diagnosis?
A. Marrow failure
B. Haemophilia
C. Haemolytic uraemic syndrome
D. Intussusception
20. Which of these is not a complication of Chicken pox?

A. Encephalitis
B. Cerebellar ataxia
C. Pneumonia
D. Myocarditis
21. A newborn baby develops difficult breathing 24 hours after birth associated with persistent
vomiting. He has no fever. On examination, his abdomen is scaphoid and dullness on the left
side of the chest. The most likely diagnosis is:
A. Necrotising enterocolitis
B. Hiatal hernia
C. Pyloric stenosis
D. Tracheo-oesophageal fistula with atresia
22. The following features about pyloric stenosis are false, except:
A. Females are more affected than males
B. Vomitus is at times made of fecal matters
C. Growth is rarely affected
D. The repair consists of myotomy
23. In a patient with acute rheumatic fever, the least likely of the following findings is:
A. Arthritis
B. Bacteria in heart valves
C. Elevated ASO titer
D. Heart murmur
24. The most frequent clinically significant residual lesion of acute rheumatic fever is:
A. Aortic stenosis
B. Mitral disease
C. Myocardial hypertrophy
D. Pericardial adhesions
25. The following conditions are associated with microcephaly, except:

A. Vika virus
B. Congenital rubella
C. Post asphyxia encephalopathy
D. Congenital toxoplasmosis
26. Recognized findings in iron deficiency anemia include, except:

A. Microcytosis
B. Near normal RDW
C. Angular stomatitis
D. Megaloblasts
27. A cause of nutritional cardiomyopathy is:

A. Thiamine deficiency
B. Niacin deficiency
C. Vitamin C deficiency
D. Vitamin A deficiency
28. The normal hemostatic response to vascular damage depends on three major factors, Except:**
A. The blood vessel wall
B. Stasis of blood flow
C. Circulating platelets
D. Blood coagulation
29. The following are specific to the intrinsic pathway, except:

A. Factor XII
B. Factor XI
C. Factor VII
D. Factor VIII
30. Kerato-conjunctivitis is known to be as a complication of:

A. Measles
B. Rubella
C. Chicken Pox
D. Mumps
31. The following statements concerning management of neonatal jaundice are false, except:
A. Phototherapy may result in diarrhea
B. Extra fluids are never required while the infant is receiving phototherapy
C. Breastfeeding is contraindicated in an infant receiving phototherapy
D. Bilirubin present in the urine on urinalysis indicates unconjugated jaundice
32. Pneumonia in childhood:

A. A viral infection is usually the forerunner.
B. Pneumocystis pneumonia often affects malnourished children.
C. Tuberculosis may present as lobar pneumonia
D. Streptococcal pneumonia is commonly an interstitial process.
33. Symptoms referable to the larynx include:

A. Inspiratory stridor
B. Aphonia
C. Wheezing
D. Expiratory stridor
34. The following statements about meningitis are false, except:

A. Cerebral blood flow is increased
B. There is inappropriate secretion of ADH
C. Serial head circumference measurement is important in infants
D. Non communicating hydrocephalus is frequent.
35. The following statements related to meningitis in children are true, except:
A. Nasopharyngeal bacterial carriage is often the source of infection.
B. Meningococcemia can manifest without meningeal signs.
C. Gram negative organisms are less common in infants.
D. A traumatic lumbar puncture is characterized by CSF ratio of 1 WBC/100RBCs.
36. The following characteristics of malaria are true, except:

A. Plasmodium ovale is rare in Zambia
B. Diarrhoea and cough may be present
C. Relapses are common with P. falciparum
D. Nephrotic syndrome is associated with P. malariae
37. The following are features of complicated malaria, except:

A. Hypoglycaemia
B. Hypokalaemia
C. Respiratory distress
D. Abnormal bleeding
38. The following facts about diarrhoea in children are true, except:
A. Rotavirus is known to be responsible for at least 80% of diarrhea in infants.
B. It is persistent if it last more than 14 days and not caused by an infection.
C. Moderate dehydration is defined as loss of fluid of about 5 to 10%.
D. Selenium is essential as part of the management
39. Hemorrhagic disease of the newborn is known for the following, except:
A. May be prevented by prophylactic administration of Vitamin K.
B. Involves deficiency of factors II, VII, IX and X.
C. May be due to liver immaturity and lack of intestinal flora in the newborn.
D. Usually results in only mild skin bleeding.
40. The following conditions have wheezing in common, except:

A. Asthma
B. Bronchiolitis
C. Croup
D. Cystic fibrosis
41. The following statements are true about diabetes mellitus, except:
A. Honeymoon phenomenon can last a year
B. Fat is the last to be utilized in neoglucogenesis
C. Levels of potassium in the blood fall once insulin is commenced
D. Cerebral oedema is a common occurrence in children treated for DKA
42. The following characteristics of diabetes mellitus are true, except:

A. Dextrose given to a known diabetic patient in coma with unknown blood sugar levels may
be life-saving.
B. Sodium bicarbonate is to be administrated as management of Diabetic Ketoacidosis.
C. DKA is the most common first presentation in diabetes mellitus in children
D. Sugar is freely attached to Haemoglobin A1c.
43. A family has been using a live-in maid to care for their 3-year-old child while away for work.
The maid is diagnosed with pulmonary tuberculosis. Tuberculin test of the child is negative.
Which of the following is indicated for the 3-year-old?
A. Six months of antituberculous treatment
B. Isoniazid chemoprophylaxis
C. Cotrimoxazole prophylaxis because the maid might be HIV positive
D. One month of streptomycin injections
44. A 4-year-old non immunized boy presents with bouts of coughing ending in vomiting and a
whoop. He has an absolute lymphocytosis. The probable cause of his illness is
A. Diphtheria
B. Pertussis
C. Epiglottitis
D. Laryngitis
45. A 2-week-old baby girl is upset and has stridor. Her voice is hoarse and she has a barking
cough. She has a low-grade fever. There is history of rhinitis prior to the cough. The most
likely diagnosis for her condition is
A. Epiglottitis
B. Laryngo-tracheo bronchitis
C. Laryngo-tracheo-malacia
D. Papilloma virus
46. A 3-year-old boy is very unwell. His temperature is 39°C and he is drooling saliva as he is
unable to swallow his secretions. He is toxic looking. There is a soft stridor on closer
examination. The most likely causative organism for his condition is
A. Corynebacterium diphtheria
B. Respiratory syncytial virus
C. Parainfluenza virus
D. Haemophilus influenza
47. A 9-year-old girl presents with history of epistaxis for a period of one week. She had been
well prior to this except for a mild viral infection. Examination reveals she also has petechiae
and a few purpuric spots. She has no lymphadenopathy, or hepatosplenomegaly. Reticulocyte
count on investigation is 7%. What is the most likely diagnosis?
A. Leukemia
B. Septicaemia
C. Immune thrombocytpaenia purpura
D. Hemophilia
48. A 5-year child presents to the emergency unit with history of sudden deterioration in condition.
It is not quite known what has happened to the child as she was at the neighbors playing. On
examination you notice that the child is drowsy and almost choking on her own saliva.
Examination of the pupils reveals pin-point pupils. The most likely cause for this child’s
condition is:
A. Salicylate poisoning
B. Lead poisoning
C. Organo-phosphate poisoning
D. Morphine poisoning
49. During labour, the fetal heart tracing begins to show late decelerations. To expedite the
delivery, the obstetrician ruptures the membranes. The infant is delivered 1 hour later and
appeared cyanotic and limp requiring extensive resuscitation. The initial physical examination
reveals an infant who has poor tone and deep tendon reflexes. At 14 hours of life, the infant
develops seizures. The perinatal course described above is most consistent with the following;
A. Development of subarachnoid hemorrhage
B. Birth asphyxia with hypoxic ischaemic encephalopathy
C. Respiratory distress syndrome
D. Intraventricular hemorrhage
50. The neonate described above in Q 49 is likely to have the following complication
A. Spastic Quadriplegic cerebral palsy
B. Diplegic cerebral palsy
C. Choreo-athetoid cerebral palsy
D. Ataxic cerebral palsy
51. A neonate presents with hepatosplenomegaly, the following are tests required for management,
except:
A. RPR
B. RDT for malaria
C. Rapid HIV test
D. Full blood count
52. The following statements about HIV in infancy are true, except:
A. Nucleic Acid Testing (NAT) is mandatory at birth and 6 months of age
B. Asymptomatic exposed infants should not be commenced on Antiretroviral prophylaxis
C. All exposed infants are to undergo the screening rapid test at first contact
D. Exposed NAT negative infants need to be maintained on ART prophylaxis as long as they
are still breastfeeding
53. The following conditions are stage III, except:

A. Extensive chicken pox
B. Oral candidiasis
C. Lymph node tuberculosis
D. Oral hairy leucoplakia
54. The following are suggestive facts about HIV infection in a newborn, except:
A. Prematurity
B. Intra-uterine growth restriction
C. Hepatomegaly
D. Parotid enlargement
55. The following are possible features of a rapidly progressive HIV disease in an infant, except:
A. Generalised lymphadenopathy
B. Oral thrush during the neonatal period
C. Hepatosplenomegaly
D. Low birthweight
56. Choose the correct line of management for antiretroviral prophylaxis for exposed infants:
A. Stavudine, Lamuvidine and Efavirenz
B. Zidovudine, Lamuvidine and Nevirapine
C. Abacavir, Emtricitabine and Nevirapine
D. Zidovudine, Lamuvidine and Efavirenz
57. The following are known risk factors for tuberculosis in children, except:
A. Household contact with a newly diagnosed smear-positive case
B. Age less than 5 years
C. History of tuberculosis in the extended family
D. Severe malnutrition.
58. The following are true about management of malnutrition in children, except:
A. Shock should absolutely be managed with intravenous fluids
B. Zinc is not needed in diarrhoea because it is part of F75 feeds
C. Whole blood is better than packed cells in oedematous malnutrition
D. Compared to ORS, ReSoMal contains more potassium and less sodium
59. The most logical sequence of events of Vitamin A deficiency is as follow:

A. Corneal scarring, night blindness then staphyloma
B. Nictalopia, xerosis then corneal ulceration
C. Corneal ulceration, conjunctival injection then total blindness
D. Bitot spots ,nictalopia, then corneal scarring
60. The following are acceptable definitions of failure to thrive, except:

A. A child under 6 months who has not grown for 2 months
B. A child over 6 months has not grown for 3 months
C. A weight- for- age that falls below the 5th percentile on multiple occasions
D. A weight deceleration that crosses one major percentile line on a growth chart
61. The following conditions may lead to failure to thrive, except:

A. Coeliac disease
B. Cystic fibrosis
C. Long gut syndrome
D. Hyperthyroidism
62. The most important parameter to help detect failure to thrive is:
A. Diet
B. Growth curve
C. Developmental milestones
D. Bowel habit and type of stool
63. Human milk contains more of the following than cows' milk formula:
A. Lactalbumin
B. Calcium
C. Iron
D. Folic acid
64. The following are benefits of breastfeeding, except:

A. Provides superior nutrition for optimum growth.
B. Protects against malaria
C. Provides adequate water for hydration
D. Protects against infection and allergies
65. The following anti-infective substances are present in mature breast milk, except:
A. IgG
B. Bifidus factor
C. Transferrin
D. Lymphocytes
66. You are asked to counsel a woman who is planning to have another baby after her first baby
was born with spina bifida. Which one of the following preconception management options is
most likely to reduce the risk in any subsequent pregnancy?
A. Sodium valproate
B. Thiamine
C. Folic acid
D. Vitamin B12
67. The following statements concerning cephalhaematoma are true, except:

A. Does not cross sutures
B. Fluctuation is not present
C. Present at birth
D. Presents few days after birth
68. The characteristics of caput succedaneum include all, except:
A. Crosses midline
B. Crosses suture line
C. Takes weeks to resolve
D. It is diffuse oedematous swelling of soft tissue of the scalp
69. Which one of the following is false concerning malnutrition:

A. F75 milk is introduced at admission
B. They present with hypokalaemia and hypernatraemia
C. Dermatosis is an indication for admission
D. Patients may present with non-pitting pedal oedema
70. The parameter that best indicates chronicity of malnutrition is:

A. Head circumference
B. Height
C. Weight
D. All the above
71. Refeeding syndrome may present with the following, except:

A. Respiratory distress
B. Fever
C. Convulsions
D. Oliguria
72. The following are characteristics of Sickle Cell Disease, except:
A. Predisposes to pneumococcal septicaemia and salmonella osteomyelitis
B. Frequently results in a palpably enlarged spleen
C. Aplastic crisis is often due to bone marrow ischemia
D. Dactylitis occurs early in life
73. The following findings are common in Sickle Cell Disease, except:
A. Jaundice is not necessarily pronounced in sequestration crisis
B. Clubbing is not a common finding
C. Acute chest syndrome is often associated with sepsis
D. Asplenia causes susceptibility to both viral and bacterial infections
74. The following is true of Sickle Cell Disease, except:

A. Affected subjects are prone to malaria
B. Bossing is due to avascular necrosis of the bones
C. Hyposthenuria is a result of infarction of renal medulla
D. Affected subjects may experience delayed puberty
75. The following are true about hematologic changes in Sickle Cell Disease, except:
A. Anisocytosis is a very rare blood finding.
B. Target cells are commonly found on the peripheral blood smear
C. Iron deficiency may occur despite re-use after hemolysis
D. Red blood cell distribution width (RDW) is usually increased
76. The following are complications arising from sickle cell disease, except:
A. Cholecystitis
B. Phimosis
C. Leg ulcers
D. Transient ischaemic attack
77. The normal hemostatic response to vascular damage depends on three major factors, except:
A. The blood vessel wall
B. Stasis of blood flow
C. Circulating platelets
D. Blood coagulation
78. The following are symptoms and signs of congestive cardiac failure, except:
A. Poor feeding
B. Sweating
C. Splenomegaly
D. Central cyanosis
79. The following clotting factors are specific to the intrinsic pathway, except:
A. Factor XII
B. Factor XI
C. Factor VII
D. Factor VIII
80. The following are common manifestations of carditis in rheumatic heart disease, except:
A. Cardiomegaly
B. Cardiac failure
C. Valvulopathy
D. Pericardial effusion
81. All of the following are included in the revised Jones Major criteria, except:
A. Maculopapular rash
B. New murmur (carditis)
C. Migrating polyarthritis
D. Chorea
82. A 7-year-old girl presents with a tender and swollen right knee as well as a more recently
appearing swollen left wrist. She also has a fever. This patient fulfills which of the following
modified Jones criteria?
A. 1 Major 1 minor
B. 1 Major 2 minors
C. 2 Majors
D. 2 Minors
83. Rheumatic heart disease is often associated with the following, except:
A. Infective endocarditis
B. Recent infection with streptococcus
C. Huntington chorea
D. Pericarditis
84. The following cardiac defects are characteristic of tetralogy of Fallot, except:
A. Pulmonary stenosis
B. Transposition of great arteries
C. VSD
D. Right ventricular hypertrophy
85. Concerning fetal circulation, blood flows from the placenta through which route?
A. Umbilical arteries, ductus venosus, inferior vena cava and right ventricle
B. Umbilical vein, ductus venosus, inferior vena cava and right atrium
C. Umbilical veins, ductus arteriosus, superior vena cava and foramen ovale
D. Umbilical arteries, ductus arteriosus, portal vein and ductus arteriosus
86. A patient with newly diagnosed acute myeloid leukemia is initially seen with neutropenia and
a temperature of 40oC should be managed with which of the following measures?
A. Prompt institution of chemotherapy because the fever is most likely due to leukemia
B. Prompt procurement of cultures and initiation of broad-spectrum parenteral antibiotics
C. Administration of granulocyte transfusions to correct the neutropenia
D. Extensive search for an underlying infection and withholding antibiotics until one is found
87. A 3-year-old child presents with history of an abdominal swelling for 2 months duration. On
examination, the patient is cachexic, pale and had bleeding around the eyes. She also has
multiple cervical lymphadenopathy and lumps on the head. You also note that the child is
bleeding under the mucous membrane of her oral cavity. Her blood pressure is 170/100mmHg.
What is the most likely diagnosis?
A. Wilms tumour
B. Leukemia
C. Neuroblastoma
D. Non-Hodgkin’s lymphoma
88. The following are common findings in idiopathic nephrotic syndrome, except:
A. Abdominal pain
B. Anaemia
C. Oedema
D. Hypertension
89. In the nephrotic state, serum lipid levels are elevated for the following reason(s):
A. Hypoalbuminemia stimulates hepatic protein synthesis, including lipoproteins.
B. Lipid catabolism is increased as a result of reduced plasma levels of lipoprotein lipase,
related to the increased urinary loss of this enzyme.
C. A and B are true
D. None of the above
90. The following conditions are possible causes of nephrotic syndrome, except:
A. Systemic lupus erythematous
B. Syphilis
C. Malaria
D. Tuberculosis
91. The following statements are true about post-streptococcal glomerulonephritis, except:
A. It is characterized by raised C3 in the acute phase
B. It arises mainly from infected skin sores
C. Hypertensive encephalopathy is a recognized complication
D. Treatment with penicillin is mainly prophylactic
92. Management of acute glomerulonephritis include the following, except:
A. Fluid restriction
B. Salt restriction
C. A high protein diet
D. Antihypertensive drugs
93. The following are characteristic features of acute glomerulonephritis, except:

A. Oedema
B. Uraemia
C. Heavy Proteinuria
D. Hypertension
94. These haematological changes are characteristic of neonatal sepsis, except:

A. Thrombocytopaenia
B. Persistently high White Blood Cell count
C. Anaemia
D. Elevated C Reactive Protein is diagnostic
95. The following are risk factors for Early Onset Neonatal Sepsis, except:
A. Birth asphyxia
B. Low birth weight
C. Congenital heart disease
D. Maternal fever
96. Late Onset Neonatal Sepsis is characterized by the following, except:

A. Group B Streptococcus is no longer among the causative organisms.
B. This infection is more localized
C. E.coli is the predominant causative organism
D. Occurs two weeks after birth
97. The following statements are true about Early Onset Neonatal Sepsis, except:
A. Occurs within the first 7 days of life for the full term neonate
B. Group B Streptococcus is the predominant causative organism
C. Has lower mortality compared to late onset sepsis
D. Involves more than one body systems
98. The following are true about respiratory distress syndrome, except:
A. Bronchopulmonary dysplasia is partly as a result of high-pressure oxygen administration.

B. Surfactant is made of sphingomyelin and lecithin
C. Infants of diabetic mothers are prone irrespective of gestational age.
D. Hydrocortisone given during labour is preventive
99. Only one statement is true about respiratory distress syndrome:
A. Affects only infants born under 34 weeks

B. Typically causes lobar collapse on chest X-ray
C. Maternal steroid therapy improves outcome
D. Is prevented by surfactant therapy
100. Common indications that a neonate has suffered intrapartum hypoxia are as follow, except:
A. Hypotonia
B. Polyuria
C. Seizures
D. Excessive crying
101. Which one of the following is the most important risk factor in the etiology of intraventricular
haemorrhage (IVH)?
A. Coagulation disorder
B. Intermittent positive-pressure ventilation
C. Pneumothorax
D. Extreme prematurity
102. Children with cerebral palsy have these in common, except:

A. Are usually born prematurely
B. Have physical signs that change with time
C. Often fail to thrive
D. Kernicterus is often associated with deafness
103. Cerebral palsy can be best defined as:

A. Stiffness of all four limbs in an infant as a result of an insult on the fetal or infant brain
B. Limitation in the range of limbs movement caused by an infectious process on the fetal or
infant brain.
C. A condition characterised mainly by mental retardation as a result of an insult on a
developing fetal or infant brain
D. Permanent disorder of movement and posture due to non –progressive insult on a
developing infant brain
104. A 2-month-old infant, with a tinge of jaundice, is being treated for sepsis. He is reported to
have fitted twice. A lumbar puncture was performed to rule out meningitis. He is later on
diagnosed with cerebral palsy. What is the most likely type?
A. Athetoid type
B. Ataxic type
C. Spastic type
D. Choreo-athetoid type
105. In gross prematurity, cerebral palsy is often as a result of:

A. Kernicterus
B. Birth asphyxia
C. Periventricular leukomalacia
D. Respiratory distress syndrome
106. The following statements about cerebral palsy are true, except for:
A. Can be detected antenatally
B. The cause is often unknown
C. There is no known cure
D. Genetic influences may play a role
107. The following conditions cause unconjugated hyperbilirubinaemia, except:

A. Congenital spherocytosis
B. Choledocal cyst
C. Kernicterus
D. Neonatal sepsis
108. Phototherapy is indicated in the following conditions, except:

A. Congenital spherocytosis
B. Neonatal hepatitis
C. Rhesus incompatibility
D. Cholelithiasis
109. The following conditions increase the risk of developing kernicterus in a neonate with
jaundice, except:
A. Cephalhaematoma
B. Dehydration
C. Prematurity
D. Birth asphyxia
110. In a child whose jaundice begins at less than 24 hours of age, the following diagnoses should
be considered, except:
A. CMV infection
B. ABO incompatibility
C. Hereditary spherocytosis
D. Hypothyroidism
111. Which of the following is a clinical feature of congenital rubella:

A. Conductive deafness
B. Cataract
C. Hydrocephalus
D. Dental defects
112. Choose the only wrongly matched congenital infection to its complication in the newborn:
A. Rubella Patent ductus arteriosus

B. Cytomegalovirus Hydrocephalus
C. Syphilis Snuffles
D. Herpes simplex Encephalitis
113. A 1-week-old neonate presents with bloody nasal discharge, hepatomegaly and hemolytic
anaemia. Which of the following is the most likely additional feature in this infant to complete
the diagnosis of a well-known congenital infection?
A. Hydrocephalus
B. Periostitis
C. Seizures
D. Cataracts
114. Of the following, the congenital infection most associated with hydrops fetalis is:
A. Rubella
B. HIV
C. Syphilis
D. Toxoplasmosis
115. The following true of Measles, except:

A. The rash occurs as the fever subsides
B. Koplik’s spots are pathognomonic
C. Antibodies from the mother reduce the likelihood of measles infection before 6 months of
age
D. Incubation period is 21 days
116. Complications of Measles include the following, except:

A. Myocarditis
B. Laryngo-tracheo-bronchitis
C. Acute encephalitis
D. Otitis media
117. If not well managed, severe measles infection may lead to the following condition, except:
A. Fulminant hepatitis
B. Cancrum oris
C. Tuberculosis
D. Severe malnutrition
118. A 20-week-old infant missed his routine immunisations. He is brought to the clinic today. He
is to be given the following vaccines, except:
A. Diphtheria
B. Rotavirus
C. Hepatitis
D. PCV
119. Regarding BCG vaccine, the following are true, except:

A. Provides more consistent protection against TB meningitis than pulmonary TB
B. Typically given in the left upper arm
C. It is given as intradermal
D. Contra-indicated in symptomatic HIV infection
120. Membranous pharyngitis, enlarged anterior cervical lymph nodes and ‘bull neck’ appearance
are characteristics of the condition below :
A. Measles
B. Tuberculosis
C. Diphtheria
D. Pertussis
121. The following DO NOT apply to Rotavirus gastroenteritis, except:

A. It typically affects infants older than 18 months
B. Blood and mucus is found in the stools of about 50% of affected babies
C. It occurs most often in the hot months of the year
D. Protection is conferred by breast feeding
122. The following are true of Down’s syndrome, except:

A. Male subjects may be infertile
B. 4% of cases are as a result of translocation
C. Subjects with mosaicism seem to have a better IQ
D. Umbilical hernia is common
123. Subjects with Klinefelter syndrome have this in common, except:

A. Males may be infertile
B. Hypergonadism is the hallmark due to XXY
C. They display some learning impairment
D. They are characterised by tall stature
124. Turner’s syndrome is characterised by the following, except:

A. Caused by the loss of genetic material from one of the sex chromosomes
B. Affected subjects are prone to diabetes
C. In a very small proportion, male subjects may be affected
D. Estrogen replacement therapy is indicated
125. The following are true about hydrocephalus, except:

A. Toxoplasmosis is a known cause
B. Nephritis is a possible complication when shunted
C. Cracked pot is a characteristic sign on examination
D. Sun rising eyes is obvious when intracranial pressure is raised
126. The following statements are true about meningitis, except:
A. Group B Streptococcus more common in infants

B. Fluid restriction at all times due to SIADH
C. Steroids indicated to prevent hearing loss when due to H. influenzae
D. Shock is a likely presentation
127. Lumbar puncture is contra indicated in the following circumstances, except:

A. Frequent fits
B. Bulging anterior fontanel
C. Low pulse rate associated with high blood pressure
D. Anisocoria
128. Common causative organisms in children are:

A. Hemophilus influenzae b, Streptococcus pneumoniae and Klebsiella.
B. Hemophilus influenza b, Listeria monocytogenes and Streptococcus pneumoniae.
C. Staphylococcus epidermidis, Staphylococcus aureus and Streptococcus pneumoniae.
D. Hemophilus influenzae b, Streptococcus pneumoniae and Neisseria meningitides.
129. The following are true of Malaria, except:

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

A. One generalized tonic clonic is characteristic of severe malaria
B. Plasmodium malariae causes nephrosis
C. Meningitis should be excluded in case of severe malaria
D. Young children and pregnant women are more vulnerable
131. The following statements are true concerning diabetes mellitus type I, except
A. The destruction of α cells in the pancreas leads to absolute insulin deficiency.
B. Glycosylated haemoglobin helps in the monitoring of management.
C. Diabetic keto-acidosis may be the first presentation in children
D. Enuresis should be alluded to when investigating diabetes mellitus
132. The following signs and symptoms of diabetes mellitus Type I are very common in children,
except:
A. Bed-wetting
B. Excessive hunger
C. Loss of weight
D. Excessive thirst
133. Management of Diabetic Ketoacidosis consists of the following components, except:

A. Correction of shock
B. Potassium replacement
C. Urgent bicarbonate replacement
D. Treatment of infection
134. The following statements regarding Somogyi effect as a result of diabetes in children are
correct, except:
A. It may occur even in the absence of insulin therapy
B. Blood sugar levels are high in the morning before breakfast
C. Cortisol and catecholamines are known to counteract this phenomenon
D. It occurs mainly in poor controlled diabetes
135. The following are true of congenital megacolon, except:

A. Abdominal distension in the newborn period may be the presenting feature
B. Diagnosis can be by rectal examination.
C. The affected segment is grossly dilated on barium enema
D. It is commonly associated with Down’s syndrome
136. A 4-week-old baby presents with jaundice. The following statements are false, except:
A. No investigations are necessary if the baby is entirely breastfed
B. It is an indication to stop breast feeds
C. Conjugated hyperbilirubinaemia is never physiological
D. Breast milk jaundice is associated with pale stools
137. Only one statement is true about congenital pyloric stenosis:

A. Presents in the first few weeks after birth
B. Can cause hyperchloraemic alkalosis
C. Is inherited as an autosomal recessive
D. Typically presents with bile stained vomiting after feeds
138. Intussusception is characterised by the following, except:

A. Is more common in the first 3 months of life
B. May present with red currant jelly stools in the first few hours
C. In well patients, can usually be reduced by Barium enema
D. Should always be investigated fully for the cause after reduction
139. Congenital diaphragmatic hernia is characterised by the following, except:

A. Usually occur through the foramen of Bochdalek
B. Are more common on the right than the left
C. Are often associated with other congenital anomalies
D. Frequently present with respiratory distress.
140. These are characteristics of febrile convulsions, except for:

A. They are benign and generally not associated with neurological sequelae
B. The mainstay of investigation and treatment is to rule out infection/ infestation
C. Brain CT scan is a compulsory indication to rule out space occupying lesion.
D. Children below 6 months are never affected
141. A 15 months old child, is admitted with severe dehydration as a result of watery diarrhoea
and weighs 13 kg. She has been successfully rehydrated and is out of shock. Her 24-hour
maintenance fluid should be:
A. 1300 mls
B. 1400 mls
C. 1150 mls
D. 1050 mls
142. She is then given adjuvant treatment for the diarrhoea. Which one of the following is she
not supposed to be given:
A. Plain water
B. Fresh milk
C. Zinc sulphate
D. Zinc oxide
143. The best oral rehydration fluid for this toddler would be:
A. ReSoMal
B. Low osmolarity ORS
C. High osmolarity ORS
D. Homemade ORS
144. The following are true about birth asphyxia, except:

A. The cardiorespiratory systems often provide the first signs of end-organ dysfunction.
B. Myocardial ischaemia and poor contractility are as a result of acidosis
C. Disseminated intravascular coagulation is always due to severe sepsis
D. Thrombocytopaenia is the first sign of marrow suppression
145. The following drugs are used to manage severe birth asphyxia, except:
A. Dexamethasone
B. Phenobarbitone
C. 10% Dextrose
D. Mannitol
146. The following are known characteristics of Broncho-pulmonary dysplasia, except:

A. Persistent oxygen dependency for up to 28 days
B. Administration of oxygen via CPAP may worsen the condition
C. May be caused by meconium aspiration
D. Barotrauma is a known contributing factor
147. Following babies are at risk of developing necrotizing enterocolitis, except:

A. Premature infants
B. Infants who are fed concentrated formulas
C. Infant of diabetic mother
D. Infants who have received blood exchange transfusions
148. Characteristic features of physiological jaundice include all of the following except:
A. Onset after the first 24 hours of life
B. Disappearance by the tenth day of life
C. A serum bilirubin level below 250 mmol/L
D. Associated anaemia due increase breakdown of extra RBCs
149. Delayed speech in a 5-year-old with normal motor and adaptive development is most likely
due to:
A. Mental retardation
B. Deafness
C. Cerebral palsy
D. Kernicterus
150. The following is true about child’s growth, except for:

A. Average weight by 8 months of age is 8 kg
B. Average height by 3 years of age is 95 cm
C. Average fronto-occipital circumference by 3 months of age is 40 cm
D. Average daily weight gain for a 2-week neonate is 75 g
151. Signs constituting severe malaria include all of the following, except:
A. Convulsions
B. Pulmonary hypertension
C. Haemoglobinuria
D. Jaundice
152. Causes of stridor in children include the following, except:
A. Epiglottitis
B. Retropharyngeal abscess**
C. Bronchiolitis**
D. Foreign body
A. Jaundice is not a common feature in sequestration crisis
B. Asplenia causes susceptibility to both viral and bacterial infections
C. Jaws are often affected by extra-medullary erythropoiesis
D. Acute chest syndrome is often associated with sepsis
154. The following are true about haematologic changes in Sickle Cell Disease, except:
A. Poikylocytosis is characterized by spiked red blood cells
C. Iron deficiency may occur despite re-use after haemolysis
155. The following is true of Measles, except:

A. Fever reaches its zenith as the rash erupts
B. Immunity is life-long if acquired from a mother who had a severe infection in her
childhood.
C. Infection before 6 months of age is possible
D. Incubation period is about 14 days
156. A healthy 9-month old male infant presents to the emergency room with low grade fever,
difficult breathing for one night, and breastfeeds intermittently. On examination, he is
wheezing, has intercostal and sub-costal recessions and saturating at 91% at room air. What is
the most likely diagnosis?
A. Epiglottitis
B. Severe bacterial pneumonia
C. Bronchiolitis
D. Aspiration pneumonia
157. Which of the following complications of diabetic ketoacidosis has the highest mortality rate?
A. Cerebral oedema
B. Hypokalaemia
C. Hyperglycaemia
D. Acidosis
158. A newborn is brought to the delivery room. After assessing the infant’s heart rate, color, and
respiratory effort, a decision is made that the infant should receive ventilatory assistance. After
30 seconds of this therapy, CPAP is initiated. The most likely APGAR score at this point is
A. 9
B. 8
C. 5
D. 2
159. A mother is at 40 weeks gestation. The dating by time of last menstrual cycle agrees with an
early ultrasound. At birth, the infant weighs 1.5kg and has a head circumference that is
abnormally small. The platelet count is also low. What is the most likely cause of the poor
growth of this child?
A. Placental insufficiency
B. Intrauterine infection in the first trimester
C. Neonatal Disseminated Intravascular coagulopathy
D. Neonatal coagulopathy
160. An infant is born prematurely at 28 weeks gestation and weighs 1.28kg. The infant is started
on enteric feeds at 2 days of age. Three days later, he is not tolerating his feeds. The signs and
symptoms exhibited by the infant that make you suspect he has neonatal necrotizing
enterocolitis include the following, except
A. Apnoea
B. Diarrhoea
C. Pneumothorax
D. Jaundice
161. An infant born 30 weeks gestation begins to experience apnea on the second day of life. All
of the following should be included in the initial management of this infant, except:
A. Evaluation for evidence of infection or intracranial hemorrhage
B. Check that the environmental temperature is above 25 Celsius
C. Complete blood count, arterial blood gas studies, and plasma glucose and electrolyte
management
D. Assessment for evidence of hydrocephalus
162. The following are known facts about cerebral palsy, except:
A. May affect the entire body, yet have no impact on intelligence
B. May cause precocious puberty
C. Spastic type has highest likelihood of mental retardation
D. Gastroesophageal Reflux Disease
163. A 2-year-old girl, well 24 hours ago, is brought to the emergency room in shock. She has no
history of trauma. On further examination, she is extremely pale with an extreme large spleen.
Her thick smear reveals no malaria and she is afebrile. The most plausible cause of is the most
likely explanation of her condition is
A. Spontaneous massive internal haemorrhage
B. Cardiogenic shock
C. Splenic sequestration crisis in sickle cell anemia
D. Hypersplenism
164. These are features commonly found in newborn term infants with uncomplicated down’s
syndrome except:
A. Inguinal hernia
B. Nystagmus
C. Brachycephaly
D. Hypothyroidism
165. Precious, a 13-year-old girl a resident of Kamwala south presents with fever for 2 weeks and
weight loss. What would be your next appropriate step?
A. Start anti-tuberculous treatment immediately
B. Start the adolescent on F75
C. Get a more detailed history
D. Start the patient on Ciprofloxacin as this could be enteric fever
166. Precious, a 8 year-old-girl presents with body hotness for 3 weeks, poor appetite, weight loss
and sweating. Her differential diagnosis includes the following except
A. Disseminated TB
B. Typhoid fever
C. Acute leukemia
D. Severe malaria
167. The following are well-known causes of neonatal jaundice except:

A. Hemolytic disease of the new born
B. Hemorrhagic disease of the new born
C. TORCH infections
D. Biliary atresia
168. Which of the following statements concerning immunization is true?

A. The presence of a coryzal illness and fever of 37.9oC is a contraindication
B. Rotavirus is respectively given at 6, 10 and 14 weeks of age
C. Pneumococcal vaccine is the last vaccine to be introduced on the Zambian EPI
D. A history of severe eczema is a contraindication
169. Which of the following statements regarding examination of the respiratory system is correct?
A. Bronchial breath sounds heard in the 5th right intercostal in the subscapular region indicates
a right middle lobe pneumonia
B. A persistent wheeze with reduced breath sounds is diagnostic of asthma
C. Pectus excavatum is mostly indicative of underlying lung pathology
D. The ribs of children are more horizontal than that of adults
170. The following are known causes of polyhydramnios except:

A. Maternal diabetes
B. Trisomy 21
C. Hydrops fetalis
D. Renal agenesis
171. The following are known causes of oligohydramnios except:

A. Posterior urethral valves
B. Polycystic kidneys
C. Spina bifida
D. Premature rupture of membranes
172. Mr and Mrs Woods are planning another pregnancy. Mr Wood’s mother and Mrs Woods’
father are siblings. They have a healthy son, but had 2 children who died in early infancy. They
were told that it was due to “metabolic condition”. This condition is likely due to
A. Multifactorial inheritance
B. Autosomal recessive inheritance
C. X-linked inheritance
D. Chromosomal translocation
173. Phiri is the youngest of a family of 5 siblings. Both parents are in their early thirties. The
mother is very worried about Albert’s long hours of sleep, his “being too weak” and his tongue
that is constantly out, and a big umbilicus. Phiri’s condition is mostly due to
A. Multifactorial inheritance
C. Chromosomal translocation
D. Chromosomal non-disjunction
174. Little Nora, newly born, has extra digits on both hands. The mother says she had the same.
This polydactyly is as a result of:
A. X-linked inheritance
C. Autosomal dominant inheritance
175. Rufai comes home with a swollen knee. He is then rushed to the nearest clinic where the
doctor performs a tap that yields frank blood. He is the only boy among 3 girls. Mother says
her only brother died in his tender age after bleeding uncontrollably as a result of circumcision
performed by a traditional healer in the village. Rufai’s condition is likely due to
C. Autosomal dominant inheritance
176. Manjimela has obvious big foot and the father amusingly states that God gifted the family
with this unique feature which makes them stand out. This is likely as a result
B. Polygenic phenomenon
C. Autosomal inheritance
D. Chromosomal deletion
177. Immediate complications of birth asphyxia include the following

A. Acute tubular necrosis
B. Surfactant deficiency
C. Necrotizing enterocolitis
D. Hemothorax
178. The following statements are true except:

A. Walking after the age of 20 months should be considered as a delay
B. The average Zambian child weighs 9kg at 12 months of age
C. Hearing is the highly developed sense in neonates
D. Rapid growth and development are observed in the first year of life
179. Which of the following normal infant values is incorrect?

A. Average weight at 6 months: 6kg
B. Average height at 2 years: 94cm
C. Average head circumference at 1 year: 45cm
D. Average heart rate in a neonate: 140/min
180. The following are as a result of re-feeding syndrome in severe malnutrition except
A. Constipation
B. Tachycardia
C. Seizures
D. Renal failure
181. These are characteristics of febrile convulsions except

A. They are almost benign and generally not associated with neurological sequelae
B. The mainstay of investigation and treatment is to rule out infection
C. Brain CT scan is a compulsory indication to rule out space occupying lesion
D. They usually last up to 15 minutes
182. A newborn is brough to the delivery room. After assessing the infants heart rate, color and
respiratory effort, a decision is made that the infant should receive ventilatory assistance. After
30 seconds of this therapy, cardiac compressions are initiated. The most likely apgar score at
this point is
A. 9
B. 7
C. 6
D. 2
183. An infant born 30 weeks begins to experience apnea on the second day of life. All of the
following should be included in the initial management of this infant except:
A. Evaluation for evidence of infection or intracranial hemorrhage
B. Bronchoscopy to evaluate the upper and lower airway
C. Complete blood count, arterial blood gas studies and plasma glucose and electrolyte
management
D. Check that the environmental temperature is above 25 celsius
184. Signs constituting severe malaria include all the following except
A. Convulsions
B. Polycythemia
C. Hemoglobinuria
D. Jaundice
185. The following are known complications of cerebral palsy
A. Convulsions
B. Contractures
C. Gastroesophageal reflux disease (GERD)
D. Precocious puberty
186. These are features commonly found in newborn term infants with uncomplicated Down’s
syndrome except
A. Nystagmus
B. Brachycephaly
C. Down slanting palpebral fissure
D. Hypothyroidism
187. The following statements related to neonatal sepsis are true, except:
A. Thrombocytopenia frequently associated with sepsis
B. WBC may be high, low or normal
C. Timing of sampling has very little bearing of the results
D. Persistent low WBC more predictive of sepsis than elevated WBC
188. Critical to the management of early onset neonatal sepsis are the following, except:
A. Dopamine
B. Normal saline
C. Fresh Frozen Plasma
D. Hydrocortisone
189. The following infections are common in both HIV infected and uninfected, except:
A. Otitis media
B. Bronchectasis
C. Tuberculosis
D. Diarrhoea
190. Antiretroviral prophylaxis in neonate born an ART naïve mother is as follow:

A. ABC + 3TC + NVP
B. ABC + 3TC + LPV/r
C. AZT + 3TC + NVP
D. AZT + 3TC + EFV
191. A female adolescent, weighing 40 kg, is to be commenced on ART. All the following drugs
can be used in combination, except:
A. Dolutegravir
B. Emtricitabine
C. Tenofovir
D. Efavirenz
192. Steroids are indicated in the following forms of tuberculosis in children except:
A. Pericardial effusion
B. Tuberculosis meningitis
C. Pleural effusion
D. Airway obstruction by Tuberculous adenitis
193. The following conditions are highly suggestive of tuberculosis, except:
A. Painful cervical lymph node
B. Cold abscess
C. Gibbus
D. Acute onset of raised intracranial pressure
A. Diet
B. Growth curve

B. Provides adequate water for hydration
C. Protects against malaria
196. The following nutrients are particularly critical for brain development, except:
A. PUFA
B. Iron
C. Copper
D. Sodium

A. Birth asphyxia might be the cause
B. May result into pathological neonatal jaundice
C. Leaves no cranial deformity once resolved
198. Which one of the following is true concerning malnutrition:

A. Both F100 and F75 feeds can be introduced simultaneously at admission
C. Dermatosis is an indication for admission
199. Antibiotics in the management of Acute Chest Syndrome include the following, except:
A. Cephalosporines
B. Penicillins
C. Macrolides
D. Chloramphenicol
200. The following hematological findings are common in Sickle Cell Disease, except:
A. Low Haematocrit
B. Normal MCV
C. Low C3 Complement
D. Low platelet count
A. Sequestration crisis is always associated circulatory collapse
D. Asplenia causes susceptibility bacterial infections
202. The following are symptoms and signs of congestive cardiac failure, except:
A. Poor feeding
B. Sweating
C. Splenomegaly
D. Central cyanosis
A. Cardiomegaly
B. Cardiac failure
C. Valvulopathy
D. Pericardial effusion
204. All of the following are included in the revised Jones Major criteria, except:
A. Maculopapular rash
B. New murmur (carditis)
C. Migrating polyarthritis
D. Chorea
205. The following are complications of Tetralogy of Fallot, except:

A. Anemia
B. Brain abscess
C. Thrombocytopenia
D. Jaundice
206. Management of Tetralogy of Fallot include the following, except:

A. Exchange blood transfusion
B. Antibiotics
C. Morphine
D. Erythropheresis
207. The following are common findings in idiopathic nephrotic syndrome, except:
A. Abdominal pain
B. Anaemia
C. Oedema
D. Hypertension

A. Nearly of male subjects are infertile
B. 95% of cases are as a result of translocation
C. Subjects with mosaicism seem to have a better IQ
D. Umbilical hernia is common
209. The commonest mechanism of genetic abnormality in a case of Trisomy 21 is:

A. Non disjunction in paternal gamete
B. Translocation to chromosome 14
C. Translocation to any autosome
D. Non disjunction in maternal gamete
210. The following are true of management of severe malaria, except:

A. Antibiotics might be given
B. 5 mls of 10% dextrose per kg intravenously
C. Blood transfusion where there high parasitemia even if Hb:7g/dl
D. Artemether is the first line for treatment of severe malaria in Zambia
211. Which of the following is not a complication of severe malaria:

A. Metabolic acidosis
B. Pulmonary hypertension
C. Severe normocytic anemia
D. Bleeding disorders
212. The following statements are true concerning diabetes mellitus type I, except:
A. Somogyi effect leads to low blood sugar levels.
B. Glycosylated haemoglobin helps in the monitoring of management.
C. Diabetic keto-acidosis may be the first presentation in children
D. Enuresis should be alluded to when investigating diabetes mellitus
213. The following is true about child’s development, except for:

A. Cooing and rolling in bed by 3 months
B. Recognizing their own name by 8 months
C. Transferring objects from one hand to the other at 9 months
D. Pincer grasp by 6 months
214. A neonate is born at 34 weeks of gestation. He suddenly becomes pale and suffers a tonic
clonic fit. His motor development is subsequently affected. On examination, you are likely to
find:
A. Spasticity in all four limbs
B. Purposeless limb movements
C. Loss of body balance
D. Jaundice
215. The following statements related to cerebral palsy in children are true, except:
A. Some have a degree of learning impairment
B. Birth asphyxia is the most common cause
C. The ataxic type is the most common clinical type
D. Management should be centered on the clinical type
216. The following are known causes of Cerebral Palsy, except for:
A. Severe untreated neonatal jaundice
B. Hyperglycaemia
C. Periventricular leukomalacia
D. Twin-to-twin transfusion
217. There are three common forms of spina bifida: ______________, meningocele, and
myelomeningocele
A. Spina bifida major
B. Spina bifida occulta
C. Spina bifida minor
D. Anencephaly
218. When considering underlying possibilities for a bleeding tendency (such as platelets or
proteins), one must keep in mind categories of abnormality, such as:
A. Quantity
B. Quality
C. Both
D. Neither
219. The reason subjects with cystic fibrosis have abnormal clotting is:
A. Because of their chronic hypoxia they are clumsy and injure themselves more frequently.
B. They have trouble absorbing fats, and by extension fat soluble vitamins
C. Their excessive infections make them prone to DIC.
D. This CF gene is closely linked to the factor VIII gene, and they are likely to inherit both.
220. The most common manifestation of rheumatic fever is:

A. Carditis
B. Arthritis
C. Chorea
D. Subcutaneous nodules
221. All of the following are manifestations of arthritis of Rheumatic Fever, except:
A. Most commonly affect the knee
B. Characterized by swelling disproportionate to pain
C. Swelling in an individual joint last for 4 to 7 days
D. No residual deformity
222. Concerning Rheumatic Fever, the following are common manifestations of carditis, except:
A. Cardiomegaly
B. Cardiac failure
C. Cardiac tamponade
D. None
223. All of the following are true about idiopathic nephrotic syndrome, except:
A. Most commonly appears between the ages of 2 and 6 years
B. More common in females than males
C. MCNS is present in 85-90 % of patients of less than 6 years of age
D. FSGS develops in older children
224. The following are uncommon findings in a patient with idiopathic nephrotic syndrome,
except:
A. Abdominal pain
B. Gross hematuria
C. Anorexia and Irritability
D. Hypertension
225. One of the following malaria types is known to cause nephrotic syndrome:
A. Plasmodium falciparum
B. Plasmodium vivax
C. Plasmodium ovale
D. Plasmodium malariae
226. The following are not true of immunization in children, except:

A. Polio and Measles are live vaccines
B. OPV4 has no place in the Zambian calendar
C. Live vaccines, such as measles, are contraindicated in HIV disease
D. Immune response to one vaccine interferes with other vaccines
227. The following statements about BCG vaccine are false, except:
A. It is a killed vaccine
B. It is recommended to be given at 6 weeks of age
C. Is given through a subcutaneous injection
D. It provides more consistent protection against TB meningitis than pulmonary disease
228. Most deaths due to acute diarrhoea result from the following, except:
A. Associated shock
B. Dehydration
C. Electrolyte imbalance
D. Rotavirus infection
229. The following are biological factors that increase susceptibility to acute diarrhoea, except:
A. Failure to get immunized against rotavirus
B. Failure of measles vaccination
C. From birth to six months
D. Malnutrition
230. The following are true of fluid management in children, except:

A. Physiology in neonates is the same as in older children
B. Deficit is a 11 kg is estimated at 1100 mls
C. Insensitive water losses in preterm is greater in preterm infants
D. In moderate dehydration, the deficit is estimated at 5 to 10% of the body weight
231. Possible causes of failure to thrive are listed below, except:

A. Tetralogy of Fallot
B. Bronchiectasis
C. Giardiasis
D. Crohn’s disease
232. All of the following are transmitted as congenital infections, except:

A. Hepatitis A
B. Herpes
C. Toxoplasmosis
D. Syphilis
233. The following clinical features are highly associated with congenital infections, except:
A. IUGR infants
B. Hepatosplenomegaly
C. Unusual rash
D. Fever
234. The following statements are true of congenital infections, except:
A. The majority of them are asymptomatic at birth
B. Chorioretinitis features in a number of them
C. Lymphadenopathy is common than hepatosplenomegaly
D. Thrombocytopenia is highly suggestive of the diagnosis
235. The following statements concerning cephalohematoma are true, except:

C. Present at birth

A. Crosses midline
C. Takes weeks to resolve
237. Of the following, which is not a cyanotic congenital heart lesion?

A. Transposition of great arteries
B. Tetralogy of Fallot
C. Triscupid atresia
D. Atrial septal defect
238. Mutale, a 18 month old toddler, is brought to the follow-up clinic 3 months after suffering
from meningitis. Her fronto-occipital circumference is said to be expected for age. Choose
the most likely correct measurement:
A. 41 cm
B. 38 cm
C. 45 cm
D. 49 cm
239. The most developed sense in neonates is:

A. Smell
B. Touch
C. Hearing
D. Sight
240. Sabina is able to sit without support and cries in the hands of strangers. Her mother is
excited to see her transferring toys from one hand to the other. Her average age is:
A. 5 months
B. 7 months
C. 9 months
D. 12 months
241. A small-for-date neonate presents with hepatosplenomegaly, the following are possible
diagnoses, except:
A. Syphilis
B. Malaria
C. Rubella
D. HIV
A. Prematurity
C. Hepatomegaly
D. Generalised lymphadenopathy
243. The following conditions are stage II, except:

A. Diarrhoea
B. Extensive tinea capitis
C. Dental caries
D. Otitis media
244. The disease staging in HIV is important because the following reasons, except:
A. It provides guidance to disease prognosis
B. It helps with monitoring response to therapy
C. It helps with the choice of antiretroviral drugs
D. It determines response to therapy
245. The following are manifestations of extra-pulmonary tuberculosis, except:

A. Meningitis not responding to antibiotic treatment
B. Pericardial effusion
C. Painful enlarged joint
D. Distended abdomen with ascites

A. Provides superior nutrition for optimum growth
B. Provides more iron than any other food for brain growth
C. Is due to an ischaemic process

A. Crosses midline
C. Easily gets infected if not well managed
D. Splenic sequestration crisis occurs mainly after the age of 5 years
A. MCV is always elevated due to folate deficiency
A. Anemia is very common
B. Splenomegaly is a common feature
C. Urinalysis may display blood
D. Mitral valve is the less affected
252. Concerning screening of congenital infections, the following statements are true, except:
A. Ig A in the neonate is evidence of infection
B. Ig M does not cross the placenta and is an indication of active infection in the neonate
C. Maternal Ig G are passively passed to the neonate
D. Ig G does not cross the placenta and is a sign of active infection in the neonate
253. In gestational diabetes mellitus, the following are associated causes of cyanosis in the
neonate, except:
A. Transient Tachypnoea of the Neonate
B. Respiratory Distress Syndrome
C. Hyperglycaemia
D. Hypoglycaemia
254. In relation with labour associated cyanosis in the neonate, the following are correctly
matched, except:
A. Prolonged rupture of membranes………..Sepsis
B. Caesarian section…………………….Transient Tachypnoea of the Neonate
C. Prematurity…………………………..Meconium aspiration
D. Sedatives…………………………….Apnoea
255. These hematological changes are characteristic of neonatal sepsis, except:

A. Thrombocytopenia
B. Mandatory high White Blood Cell count
C. Anaemia
256. Cerebral palsy can be best defined as:

A. Stiffness of all four limbs in an infant as a result of an insult on the fetal or infant brain
B. Permanent disorder of movement and posture due to non –progressive insult on a
developing infant brain
C. Limitation in the range of limbs movement caused by an infectious process on the fetal or
infant brain.
D. A condition characterized mainly by mental retardation as a result of an insult on a
developing fetal or infant brain
257. Which of the following occurrences is not common in normal neonates**

A. Breast engorgement
B. Jaundice
C. Vaginal bleeding
D. None
258. Periventricular calcification is often seen in the following infection:

A. Toxoplasmosis
B. Cytomegalovirus
C. Congenital syphilis
D. All of the above
259. Consider the following factors:

I. Pincer grasp II. Social smile III. Crawls IV. Transfer objects from one hand to the other
The correct sequence in developmental milestones during the first year of life is:
A. I,II,III,IV
B. II,IV,III,I
C. I,IV,III,II
D. II,I,III,IV
260. Maximum development of the brain occurs during which period:

A. Infancy
B. Adolescence
C. First trimester of pregnancy
D. School-going age
261. In a year-old infant, the brain growth, in comparison to an adult, is approximately:

A. 50%
B. 55%
C. 60%
D. 80%
262. Which of the following is a way to measure activity level in an infant?

A. How often they smile
B. How much they sleep
C. How much they want to be held
D. All of the above
263. In a child presenting with a wheeze, the most common feature between asthma and
bronchiolitis is:
A. Good response to bronchodilators
B. Prolonged expiration
C. Fever
D. All of the above
264. One of the following signs/symptoms marks the difference between lobar pneumonia and
pleural effusion on physical examination:
A. Tachypnoea
B. Flaring of nasal wings
C. Dullness to percussion
D. Reduced air entry
265. The following can cause wheezing in young children, except:

A. Asthma
B. Tuberculosis
C. Foreign bodies
D. Croup
266. The following statements about Klinefelter syndrome are true, except:
A. Affected subjects exhibit a very high IQ
B. Because of the presence of an extra X, gynaecomastia is common
C. Tall stature is subject to X penetrance
D. The mutation is characterized by non-disjunction
267. Down’s syndrome:

A. The IQ is subject to the mode of inheritance
B. Affected female subjects are usually infertile
C. The single palmar crease is not a constant feature
D. Hypotonia is always present.
268. The following are features of Down’s syndrome, except for:

A. Brushfield spots
B. Kayser Fleischer rings
C. Hyperflexibility of joints
D. Brachycephaly

A. Reduced growth rate
B. Otitis media is a rare occurrence
C. Risk of type 1 diabetes is greater than in the general population.
D. Palm plantar hyperkeratosis
270. The following conditions are correctly matched, except:

A. Monosomy: Turner syndrome
B. Trisomy: Down’s syndrome
C. Autosomal recessive: Duchenne Muscular Dystrophy
D. Deletion syndrome: cri-du-chat
271. Infection in the newborn period may present with the following except:
A. Anemia
B. Jaundice
C. Polycythemia
D. Thrombocytopenia
272. Cyanosis in a neonate may be a presenting sign of:

A. Septicaemia
B. Hypoglycemia
D. Respiratory failure
273. All of the following are true regarding the hemoglobin component of the CBC except:
A. Normally, the hemoglobin value is about 1/2 of the hematocrit value
B. Marked leukocytosis causes a false increase
C. Reference ranges are gender dependent
D. O2 is transported to tissues and CO2 back to lungs via hemoglobin
274. Most viral exanthems present with the following signs, except:
A. Cutaneous rash
B. Fever
C. Catarrhal phase
D. Hepatosplenomegaly
275. The following are true about measles, except:

A. The rash spreads cephalocaudally
B. Conjunctivitis is a known occurrence
C. Incubation period is about 8 to 10 days
D. Is more associated with encephalitis than pneumonia
276. The following are not features of Rheumatic Fever, except:

A. Arthritis
B. Decreased P-R interval on ECG
C. Osler nodes
D. Erythema multiforme
277. The following are true about diarrhoea in infants, except:

A. Rotavirus is the most common causative agent
B. Feeding must be discontinued immediately as it will worsen the diarrhoea
C. 75 mls /kg of fluid is given to cover the deficit in some dehydration
D. Zinc sulphate is given to shorten the diarrhoeal episode
278. In the management of acute diarrhoeal disease in infants, the following are to be observed,
except:
A. Low osmolarity ORS more preferred than the standard ORS
B. 10 mls ORS / loose stool in plan A
C. Breastfeeding is to be absolutely discouraged if mother is HIV positive
D. ½ strength Darrows best for plan C
279. In prematurity, the following are possible complications, except:

A. Intraventricular haemorrhage, kernicterus and necrotizing enterocolitis
B. Hydrocephalus, hyperbilirubinaemia and hypoglycaemia
C. Hyaline membrane disease, retinopathy of prematurity and sepsis
D. Bronchopulmonary dysplasia, acute chest syndrome and haemorrhagic disease of newborn
280. The following are true of neonatal hyperbilirubinaemia, except:

A. Choreo-athetoid cerebral palsy is a known complication
B. Sepsis should always be ruled out
C. Caput succedaneum is a risk factor
D. Serum albumin levels are closely related to the outcome
281. Which of the following immunoglobulins is predominant in breastmilk:

A. Ig A
B. Ig G
C. Ig E
D. Ig M
282. Which of the following congenital infections is correctly matched with its clinical feature:
A. Toxoplasmosis Microcephaly
B. Rubella Cataracts
C. Cytomegalovirus Hydrocephalus
D. Syphilis Snuffles
283. The following are as a result of re-feeding syndrome in severe malnutrition, except:
A. Constipation
B. Tachycardia
C. Seizures
D. Osmotic diarrhoea
284. Choose the correct association in relation with HIV in children:

A. Persistent generalized lymphadenopathy---------------------Stage II
B. Severe pneumonia--------------------------------------------------Stage III
C. Extensive chickenpox-----------------------------------------------Stage IV
D. Thrombocytopenia--------------------------------------------------Stage II
285. Dehydration fever is characterized by the following, except:

A. Occurs at any gestational age
B. Rectal temperature of 37.8C and above
C. Negative culture of body fluids
D. Can be caused by any organism
286. The following chest X-ray appearances are consistent with the associated conditions, except:
A. Lobar consolidation-----------------------Streptococcus pneumoniae
B. Lobar collapse------------------------------Asthma
C. Normal lung fields-------------------------Pneumocystis pneumonia
D. Miliary mottling----------------------------Tuberculosis
287. The following statements are true about Early Onset Neonatal Sepsis, except:
A. Mortality is comparable to late onset sepsis
B. Occurs within the first 10 days of life for the full-term neonate
C. In prematurity, it occurs within 3 days from birth
D. Involves more than one body systems
288. The following statements are false of immunization in children, except:
A. Hib and Measles are live vaccines
B. OPV4 has no place in the Zambian calendar
C. Live vaccines, such as measles, are contraindicated in HIV disease
D. Immune response to one vaccine does not interfere with other vaccines
289. A 7-year-old boy is referred to hospital with a two-day history of lethargy, irritability and
poor feeding. On examination, he is pyrexial, drowsy and has petechial skin lesions on his
trunk and extremities. His capillary refill time is 5 seconds.
A. Shigella
B. Neisseria meningitides
C. Streptococcus pneumoniae
D. Measles
290. A 5-year-old girl presents with a one-week history of facial and pedal swelling. She has
otherwise been very healthy. Her urine analysis shows granular casts with no blood. A week
later, she is diagnosed with peritonitis. What is the causative organism?
A. Shigella
B. Streptococcus pneumoniae
C. Staphylococcus aureus
D. Salmonella typhi
291. A 4-month-old female infant is brought to the emergency services in respiratory distress.
Five days previously, she had a cough and running nose. On examination her temperature is
38.9C, pulse 180/min and the respiratory rate 80/min. She had subcostal retractions and nasal
flaring. On auscultation, there are widespread rhonchi bilaterally.
A. Haemophilus influenza type b
B. Streptococcus pneumoniae
C. Respiratory syncytial virus
D. Mycoplasma pneumoniae
292. A 12 months old infant presented with running nose 3 days earlier. He developed high grade
fever the previous night and this morning, a maculo-papular rash has come out associated with
conjunctivitis.
A. Measles
B. Chicken pox
C. Rubella
D. Heat rash
293. Born with hydrocephalus and hepato-splenomegaly to an HIV infected mother.

A. Cytomegalovirus
B. Toxoplasma gondii
C. Congenital syphilis
D. Herpes simplex
294. A toddler presents with fever for 7 days. His WBC is 2.4 x 10₃ /mm₃ and Hb: 7.8g/dl.
A. Malaria
B. Salmonella typhi
C. pneumococcus
D. Measles
295. A 5-month-old baby is brought with cough, difficult breathing and cyanosis despite being on
oxygen. On auscultation, the lungs sound clear.
A. Streptococcus pneumoniae
B. Respiratory syncytial virus
C. Haemophilus influenza type B
D. Pneumocystis carinii
296. Mutale presents with a hoarse voice, drooling and very high fever.
A. Bordetella pertussis
B. Corynebacterium diphtheriae
C. Haemophilus influenza type B
D. Viral croup
297. Sabina, 6 months old, is brought in shock. She has had watery diarrhoea for the past 24 hours.
A. Shigella
B. Rotavirus
C. Vibrio cholerae
D. Salmonella typhi
298. A small-for-date neonate presents with hepatosplenomegaly, the following are possible
diagnoses , except:
A. Syphilis
B. Malaria
C. Rubella
D. HIV
A. Prematurity
C. Hepatomegaly
D. Generalised lymphadenopathy
300. The following conditions are stage II, except:

A. Diarrhoea
B. Extensive tinea capitis
C. Dental caries
D. Otitis media
301. The disease staging in HIV is important because the following reasons, except:
A. It provides guidance to disease prognosis
B. It helps with monitoring response to therapy
C. It helps with the choice of antiretroviral drugs
D. It determines response to therapy
302. The following are manifestations of extra-pulmonary tuberculosis, except:

A. Meningitis not responding to antibiotic treatment
B. Pericardial effusion
C. Painful enlarged joint
D. Distended abdomen with ascites
A. Diet
B. Growth curve

B. Provides more iron than any other food for brain growth

C. Is due to an ischaemic process
A. Crosses midline
C. Easily gets infected if not well managed
307. Which one of the following is false concerning malnutrition:
A. F75 milk is introduced at admission

C. Dermatosis may be a feature in both forms of malnutrition
308. The parameter that best indicates chronicity of malnutrition is:

A. Head circumference
B. Height
C. Weight
D. MUAC
309. The following are characteristics of Sickle Cell Disease, except:
A. Predisposes to pneumococcal septicaemia and salmonella osteomyelitis.

B. Frequently results in a palpably enlarged spleen.
C. Aplastic crisis is due to bone marrow ischaemia.
D. Dactylitis occurs early in life
310. The following is true of Sickle Cell Disease, except:

A. Affected subjects are prone to malaria
B. Bossing is due to avascular necrosis of the bones
C. Hyposthenuria is a result of infarction of renal medulla
D. Affected subjects may experience delayed puberty
D. Splenic sequestration crisis occurs mainly after the age of 5 years
A. MCV is always elevated due to folate deficiency
313. The following clinical features are highly associated with congenital infections, except:
A. IUGR infants
B. Hepatosplenomegaly
C. Unusual rash
D. Fever
314. The following statements are true of congenital infections, except:

A. The majority of them are asymptomatic at birth
B. Chorioretinitis is a feature of toxoplasmosis
C. Lymphadenopathy is as common as hepatosplenomegaly
D. Thrombocytopenia often gives a clue to the diagnosis
315. Concerning screening of congenital infections, the following statements are true, except:
A. Ig A in the neonate is evidence of infection
B. Ig M does not cross the placenta and is an indication of active infection in the neonate
C. Maternal Ig G are passively passed to the neonate
D. Ig G does not cross the placenta and is a sign of active infection in the neonate
316. These haematological changes are characteristic of neonatal sepsis, except :

A. Thrombocytopenia
B. Mandatory high White Blood Cell count
C. Anaemia
317. Late Onset Neonatal Sepsis is characterised by the following, except:

A. Group B Streptococcus is no longer among the causative organisms.
B. This infection is more localized
C. E.coli is the predominant causative organism
D. Occurs two weeks after birth
318. The following are risk factors for Early Onset Neonatal Sepsis, except:
A. Birth asphyxia
B. Low birth weight
D. Maternal fever
319. The following are possible causes of necrotizing enterocolitis, except:

A. Neonatal sepsis
B. Hypothyroidism
C. Formula feeding in prematurity
D. Birth asphyxia
320. Only one statement is true about respiratory distress syndrome:
A. Affects only infants born under 34 weeks
B. Typically causes lobar collapse on chest X-ray
C. Maternal steroid therapy improves outcome
D. Is prevented by surfactant therapy
SECTION 2: TRUE/FALSE
1. Complications of Measles include
A. Xeropthalmia- True
B. Laryngo-tracheo-bronchitis- True
C. Acute Encephalitis- True
D. Acute severe malnutrition-True
E. Giant cell pneumonia- True
2. Concerning Bronchiolitis
A. The commonest causative organism is parainfluenza virus-False
B. The commonest causative organism is Respiratory Syncytial Virus-True
C. The cough and wheeze are due to blockage of the small airways due to secretions and
inflammation- True
D. The cough and wheeze are due to bronchospasm of the bronchi and bronchioles-False
E. It tends to occur in children who are less than one year of age-True
3. The following are true of Respiratory Distress Syndrome:

A. It is very much dependent on the lecithin-sphingomyelin ratio in the surfactant- True
B. It occurs in infants who are born before 32 weeks gestational age-True
C. It occurs in infants who are born before 35 weeks gestational age-True
D. Infants of diabetic mothers are exempted because they are born big even when they are
preterm-False
E. Small for gestational age infants are less likely to get it-True
F. It is caused by surfactant deficiency-True
G. It presents with respiratory distress within 4 hours of birth and wanes within 24 hours-False
4. The following are immediate complications of Birth Asphyxia:

A. Acute tubular necrosis-True
B. Cardiomyopathy-False
C. Cerebral palsy-False
D. Necrotizing enterocolitis-True
E. Hypoxic Ischaemic encephalopathy-True
5. Concerning Ventricular Septal Defect:

A. It is cyanotic congenital heart disease-False
B. It is an acyanotic congenital heart disease-True
C. It is characterized by a pansystolic left sternal border murmur-True
D. It is characterized by a pan-systolic murmur in the mitral area-False
E. Large shunts results in reversal of shunt and cyanosis-True
F. It is common in Trisomy 21 and Turner syndrome-False
6. The following are Jones ‘minor criteria in Rheumatic Fever:

A. Huntington’s chorea-False
B. Arthritis-False
C. Elevated C reactive protein-True
D. Arthralgia-True
7. The following are minor criteria in Rheumatic fever:

A. Leukocytosis- True
B. Convulsions-False
C. Arthritis-True
D. Elevated C- reactive protein-True
E. Clubbing-False
8. Subacute Bacterial Endocarditis occurs in the following conditions:

A. Ventricular Septal defect-False
B. Rheumatic Heart Disease-True
C. Rheumatic fever-True
D. A normal heart-False
E. Tetralogy of Fallot-True
9. Cyanotic congenital Heart Disease include the following:

A. Transposition of Great Arteries-True
B. Patent Ductus Arteriosus-False
C. Tetralogy of Fallot-True
D. Hypertrophic cardiomyopathy-True
E. Eisenmenger complex- True
10. In children, causes of a prolonged fever include the following

A. Tuberculosis-True
B. HIV-True
C. Lymphoma-True
D. Juvenile idiopathic arthritis-True
E. Drugs-True
11. The following are features of Down’s syndrome:

A. Down-slanting palpebral fissures-False
B. Hypertonia-False
C. Hypotonia- True
D. Mental retardation-True
E. Endocardial cushion-False
F. Microcephaly- False
12. Prolonged jaundice in a neonate can be caused by:

A. Hypothyroidism-True
B. Galactosaemia-True
C. Biliary atresia-True
D. Neonatal hepatitis syndrome-True
E. Neonatal sepsis-False
F. ABO incompatibility-False
13. Recognized consequences of Rhesus incompatibility include:

A. Coomb’s negative hemolysis-False
B. Jaundice on the first day of life-True
C. Positive Apt test-False
D. Increased severity in further pregnancies-True
E. Occurrence of worse hemolysis in next child if anti-D is not administered-True
F. Normal hemoglobin on the first day of life-False
14. Hypertension in childhood typically complicates

A. Post-streptococcal glomerulonephritis- True
B. Coarctation of the aorta-True
C. Minimal change nephrotic syndrome-False
D. Neuroblastoma-True
E. Appendicitis-False
15. Causes of unconjugated hyperbilirubinaemia include the following

A. Biliary atresia-False
B. Physiological jaundice-False
C. Galactosaemia-False
D. Congenital cytomegalovirus infection-True
E. ABO incompatibility-True
16. The following features suggest a diagnosis of congenital infection in a newborn infant:
A. Growth retardation-True
B. Petechiae-True
C. Focal chorioretinitis-False
D. Microcephaly-True
E. Intracranial calcification-True
17. In suspected acute rheumatic fever the following indicate rheumatic fever:
A. Anti-streptolysin “O” titer of 150 IU unit- True
B. An erythematous serpiginous rash on extensor surfaces of the patient’s body-True
C. Clumsiness and unusual dropping of things including a change in handwriting-True
D. Shortened PR interval-True
E. Hyperpigmented nodules on the extensor surface of the limbs-False
18. Human milk contains more of the following than cows' milk formula:
A. Lactalbumin-True
B. Calcium- False
C. Iron-False
D. Immunoglobulins-True
19. Human breast milk

A. Contains mainly casein protein- True
B. Contains mainly whey protein-True
C. Contains less fat per milliter than cow’s milk-False
D. Contains immunoglobulins-True
E. Contains more carbohydrates per milliter than cow’s milk-True
20. Management of “minimal change “nephrotic syndrome include the following

A. ACE inhibitor-False
B. Anticoagulant-True
C. Antibiotics-True
D. Diuretics-False
21. Characteristics of nephrotic syndrome include the following

A. Hypertension-False
B. Hematuria-False
C. Hypoalbuminemia-True
D. Hyperproteinuria-True
E. Uremia-False
22. Concerning post-streptococcal glomerulonephritis

A. It is characterised by high C3 in the acute phase due to the initial inflammatory process-
False
B. It follows infection with Lancefield Group B streptococci infection-True
C. Initial oliguria is succeeded by polyuria as the disease progresses- False
D. Hypertensive encephalopathy is a recognized complication-True
23. Concerning post-streptococcal glomerulonephritis

A. It is characterized by low C3 in the acute phase-True
B. It follows infection Lancefield Group B streptococci infection-True
C. Hypertensive encephalopathy is a recognized complication-True
D. Oliguria or anuria maybe an associated feature-True
E. Hematuria is an associated feature-True
24. Tetralogy of Fallot include the following:

A. A ventricular septal defect with right to left shunt-True
B. A ventricular septal defect with left to right shunt-False
C. The murmur is mainly due to blood flow through the VSD-False
D. Development of an Eisenmenger complex-False
E. An overriding aorta-True
F. Persistence of arterial canal is life-saving- True
G. Plain chest X-ray shows plethoric lung fields-False
25. The following are typical features of sickle cell anaemia

A. An obvious splenomegaly at the age of 10 years-False
B. Bossing due to multiple avascular necrosis in the cranial bones-False
C. Cholelithiasis occurs as early as two years old-True
D. Growth retardation-True
E. Increased susceptibility to pneumococcal infections-True
F. A hemoglobin between 6-8g/dl-True
G. Mental retardation-False
26. Sickle cell patients are prone to infections with these organisms:
A. E. coli-True
B. Haemophilus influenza-True
C. Klebsiella pneumonia-True
D. Salmonella spp-True
E. Streptococcus pneumonia-True
F. Measles virus-False
27. Good prognostic signs in acute lymphoblastic leukaemia include
A. Less than 2 years at presentation-True
B. Male sex- False
C. A white cell count above 50,000 but below 100,000-False
D. Common cell type ALL-True
E. Mediastinal widening in chest X ray-False
28. Causes of acute stridor in children include

A. Laryngotracheobronchitis is commonest cause-True
B. Foreign body trapped in the trachea-True
C. Epiglottitis-True
D. Papilloma virus-True
E. Acute bronchiolitis-False
29. Signs of acute severe asthma include:

A. A pulsus paradoxus of >20mmHg-True
B. Cyanosis-True
C. Intercostal recession-True
D. Hyperexpanded chest-True
E. Inability to complete sentences-True
30. The following are common findings in HIV infected neonates:
A. Prematurity-True
B. Parotid enlargement-False
C. Intra-uterine growth restriction-True
D. Hepatomegaly-True
31. The following conditions are WHO stage III:

A. Extensive chicken pox-False
B. Oral candidiasis-True
C. Extensive dental caries-False
D. Oral hairy leucoplakia-True
32. The following are possible features of a rapidly progressive HIV disease in an infant:
A. Generalised lymphadenopathy-False
B. Oral thrush during the neonatal period-True
C. Hepatosplenomegaly-True
D. Molluscum contagiosum-False
33. Causes of acute inspiratory stridor in children include:

A. Laryngo-tracheo-bronchitis-True
B. Laryngeal papilloma-True
C. Retro-pharyngeal abscess-False
D. Acute Bronchiolitis-False
34. Causes of finger clubbing include:
A. Liver cirrhosis-True
B. Foreign body-False
C. Laryngeal papilloma-False
D. Bronchiolitis-False
E. Pneumocystis pneumonia-False
F. Ulcerative colitis-True
G. Bronchiectasis-True
35. Symptoms and signs of retinoblastoma include the following:

A. A painful red eye-True
B. A new squint or strabismus-True
C. Corneal opacity- False
D. Loss of vision-True
E. Leukocoria-True
36. The following are common characteristic features of acute glomerulonephritis:

A. Oedema-True
B. Uremia-True
C. Hypertension-True
D. Fits-True
E. Normal to nephrotic range proteinuria-True
F. Macroscopic or microscopic haematuria-True
37. Bronchiectasis
A. Long standing bronchiectasis tends to cause left-sided heart failure-False
B. It may complicate tuberculosis-True
C. Causes viscid sputum-True
D. Splinter hemorrhage are a feature-False
E. May complicate pertussis-True
38. Features diagnostic of kwashiorkor include the following

A. Weight 60-80% of expected weight for age with oedema-True
B. Weight >60% of expected weight for age with oedema-False
C. Mental apathy-True
D. Mental retardation-False
E. Muscle wasting-True
39. A severely malnourished child is commonly in danger of mortality within the first 24 hours of
admission due to the following:
A. Hyperkalemia-False
B. Hyponatremia-False
C. Hypokalemia-True
D. Septicemia-True
E. Hypothermia-True
40. The initial management of oedematous malnutrition include the following:

A. Diuretics if oedema is massive-False
B. Antibiotics even with no evidence of sepsis-True
C. Room temperature of about 30 C-True
D. Combined Minerals and Vitamins including copper and selenium-True
41. Meningitis in an 18 months child most likely caused by:

A. Neiserria meningitis-True
B. Klebsiella pneumonia-True
C. Streptococcus pneumoniae-True
D. Haemophilus influenza-True
E. Streptococcus pyogenes-False
42. The following are characteristics of meningitis in children:

A. Naso-pharyngeal bacterial carriage is often the source of infection-True
B. A traumatic lumbar puncture is characterized by CSF ratio of 1 WBC/100RBCs-False
C. Meningococcemia can manifest without meningeal signs-True
D. Gram negative organisms are less common in infants-False
43. Complications following an acute bacterial meningitis in a child below 2 years of age include:
A. Deafness-True
B. Hemiplegic cerebral palsy-True
C. Cranial nerve palsies-True
D. Quadriplegic cerebral palsy-True
E. Choreo-athetoid cerebral palsy-False
44. Lumbar puncture is contra indicated in the following circumstances:

A. One fit in 24 hours-False
B. Bulging fontanel-False
C. Low pulse rate associated with high blood pressure-True
D. Anisocoria-True
45. Differential diagnosis of a child presenting with history of fever for 2 weeks and splenomegaly
include the following:
A. Salmonellosis-False
B. Brucellosis-False
C. Tropical splenomegaly syndrome-True
D. Rheumatic fever-False
E. Lymphoma-True
46. Imperative measures to treat Diabetic Keto-Acidosis include:

A. Correction of dehydration over 24 hours-False
B. Infusion of Sodium bicarbonate to correct acidosis-False
C. Infusion of 40 mmol of Potassium chloride-True
D. Empirical administration of antibiotics-True
47. Which of these would be used to confirm diagnosis of diabetes mellitus in a symptomatic
insulin dependent diabetes mellitus in a symptomatic child:
A. A random plasma glucose >7.5-False
B. Finding of 3+ ketonuria-False
C. An HbA1C of 7.8%- True
D. A fasting plasma glucose of 6.5mmol/L-False
E. An abnormal glucose tolerance test-True
48. Concerning childhood urinary tract infection:

A. It is commonest in girls under one month of age-False
B. It may present with nausea and vomiting-True
C. It is usually caused by E. Coli-True
D. It is commonly associated with vesico-ureteric reflux-True
E. It may be indicated by a positive nitrite test on urinalysis-True
49. A black East African girl aged 15 years is complaining of severe pain in both legs. The
hemoglobin is 8g/dl. Sickle cell anemia is likely to be the cause of her symptoms if
A. She is jaundiced-True
B. She has hematuria-True
C. X-ray of the spine shows osteoporosis-False
D. Menarche occurred at 11 years-False
E. The urinary osmolality is 800mosm/kg (specific gravity approximately 1022)-False
50. Burkitts lymphoma:
A. Is a tumor commonly found in Africa-True
B. Is a tumor presenting commonly between 4-8 years of age-True
C. Is a tumor presenting commonly between 6-10 years of age in Africa-True
D. Always presents with a mass in the superior mediastinum-False
E. Always presents with a mass in the jaw-True
F. Can present with a mass in the Adrenal glands-True
G. Is highly responsive to chemotherapy-True
51. Regarding childhood malignancies:

A. A mediastinal mass is a frequent finding in T cell Acute Lymphoblastic Leukaemia-True
B. A bone marrow biopsy should always be performed to exclude leukaemia-True
C. Cranial irradiation before the age of 3 years has a high neurocognitive morbidity-True
D. Children on chemotherapy are at high risk if exposed to measles or chickenpox-True
E. Chemotherapy may predispose to development of secondary malignancies-True
52. Common manifestations of congenital rubella syndrome include:

A. Cataracts-True
B. Deafness-True
C. Hydrocephalus-False
D. Microcephaly-True
53. Complications of whooping cough include:

A. Bronchopneumonia-True
B. Bronchiectasis-True
C. Hemiplegia-True
D. Malnutrition-True
E. Surgical emphysema-True
54. A 4-year-old boy is diagnosed with chickenpox. The following would be characteristics:
A. A maculopapular rash arising from the nape of neck-False
B. A Centripetally distributed rash in crops-False
C. A centrifugally distributed rash comprising papules, pustules, vesicles-True
D. Septicemia secondary to bacterial infection of the rash-True
E. Incubation period of 10 – 21 days-True
55. A 2 days old infant presents with fever and a whimpering cry. These investigation results would
support a diagnosis of neonatal sepsis:
A. Neutropenia-True
B. Leukocytosis of over 25,000/mm3-True
C. Anemia-True
D. Toxic granulation-True
E. Thrombocytopenia-True
56. The following clinical features are commonly associated with congenital hypothyroidism:
A. Hypothermia-True
B. Diarrhoea-False
C. Prolonged unconjugated hyperbilirubinaemia-False
D. Inguinal hernia-True
E. A small anterior fontanelle-False
57. A 2-year-old child is admitted with history of fever and convulsions. This is the first time child
is reported to have convulsions. What features would indicate that the convulsions are febrile
convulsions?
A. Generalized tonic clonic convulsion lasting 10 minutes-True
B. Generalized tonic clonic convulsion lasting 17 minutes-False
C. Focal tonic convulsions-False
D. Development of hemiplegia after convulsions-False
E. Subsequent development of coma after convulsions-False
58. Febrile convulsions are characterised by the following:

A. Generalised tonic clonic convulsions lasting about 20 minutes-False
B. Very high temperatures may trigger fits in neonates-False
C. The fever has no underlying causative agent-False
D. Occurs not more than once a day-True
E.
59. Which of the following are ways to measure activity level in an infant?
A. How often they feed-True
B. How much they sleep-True
C. How much they want to be held-False
D. All of the above-False
60. The following statements apply to a newborn skull?

A. The skull is made of three separate bones separated by sutures-False
B. The anterior fontanelle usually closes before the posterior fontanelle-False
C. Craniosynostosis is often associated with microcephaly-True
D. Hypothyroidism delays the closure of fontanelles-True
61. Weight gain in the first year life :

A. 750 g / month for the first 4 months-True
B. 200 g / month for the first 3 months-False
C. 250 g / month for the last 4 months-True
D. 500 g / month from the 5th to the 8 th month-True
62. The following are facts about child development:

A. Babbling by 6 months-True
B. Transferring objects from one hand to the other by 4 months-False
C. Does not make eye contact at 3 months until 6 months-False
D. Turns head to visually track objects while sitting-True
63. The following statements regarding Somogyi effect as a result of diabetes in children are
correct:
A. It may occur even in the absence of insulin therapy-False
B. Blood sugar levels are high in the morning before breakfast-True
C. Cortisol and catecholamines are known to enhance this phenomenon-False
D. It occurs mainly in poor controlled diabetes-True
64. The following are possible presenting signs and symptoms of diabetes mellitus Type I in
children:
A. Bed-wetting- True
B. Excessive hunger-False
C. Vaginal candidiasis-True
D. Persistent abdominal pain-True
65. A 6-year-old girl is brought in from Chongwe with fever. RDT for Plasmodium falciparum is
found to be positive. Which feature would suggest a diagnosis of severe malaria in this child?
A. Labored respiratoion with bilateral fine creps in both lung fields-True
B. Splenomegaly-False
C. Hepatomegaly-False
D. Hypotension with severe watery diarrhea-True
E. A random blood sugar of 2.0 mmol/L-True
SECTION 3: ESSAYS
1. David, a 15-month-old child, is admitted with severe malnutrition. His rapid test for HIV is
reactive. List down 5 questions you would ask the mother to ascertain the risk of infection in
this child (10 marks for any 5).
Answer:
➢ Have you test for HIV?
➢ When did you test for HIV?
➢ Are you on HAART?
➢ How long have you been on HAART?
➢ Are you breastfeeding?
➢ Was David given NVP at birth?
➢ Was DBS for HIV DNA PCR test done on David?
2. A 7-year-old girl is brought to LMUTH with a history of recent bedwetting (enuresis) and
unexplained weight loss. No history of tuberculosis contact. Her rapid test for HIV is negative.
A. What is your differential diagnosis? (4 marks)
Answer:
➢ Diabetes mellitus
➢ Urinary tract infection
B. Write down 2 more symptoms that may be associated with this condition (3 marks)
Answer:
➢ Polyuria
➢ Polydipsia
C. List down 3 investigations to ascertain your diagnosis (3 marks)

Answer:
➢ Random blood sugar/oral glucose tolerance test
➢ Fasting blood sugar
➢ Urinalysis (Ketones, Sugar)
3. You walk into a mall with your 3-year-old toddler and she picks a pack of food with the
following nutritional information:
Protein: 12g, Carbohydrates: 35g, Olive oil: 30g, Potassium:1100mg, Vitamin A:800mcg and
folate: 230mcg.
A. Work out the energy content of this pack.
Answer:
1g protein/carbohydrates= 4kcal
1g fat= 9Kcal
Total protein=12g
Total carbohydrates=35g
Total fat=30g
Energy content in one pack= (12 x 4) + (35 x 4) + (30 x 9) =458 kcal (5 marks)
B. Considering that your child’s daily caloric requirement is about 1800 Kcal, how many
packs would she require to cover this need?
1800
Answer: Number of packs= 458 = 3.9
The child approximately needs 4 packs (5 marks)
4. Hamaundu a 4-year-old-boy, is brought to the OPD with edema of both hands and feet and
sores in the mouth. He weighs 8.5kg.
A. Assign the nutritional status to Hamaundu based on welcome classification
Answer:
Expected weight for a 4-year-old child = 2 x (4 + 4) = 16kg
Hamaundu’s weight= 8.5 kg
8.5
W/A percentage= × 100= 53.1% of expected weight
16
Hamaundu has Marasmic Kwashiorkor
B. How many milliliters of F75 would you need to cover his caloric requirement estimated at
1500kcal/24 hours?
Answer:
Each 100ml of F-75 has 75kCal
If 100ml F-75 gives 75Kcal, volume needed for 1500kcal= (1500 x 100)/75= 2000ml
Therefore, 2000ml per day of F75 is needed
5. A 2-year infant is brought to the Outpatient Department with body hotness. He weighs 9.9Kg
and his hemogram is as follow:
WBC: 25.85 x 103/mm3, RBC: 2.56 x106 /mm3, Hb: 9.3g/dl, HCT: 31.7%, RDW-CV: 25%,
MCV: 123 fl, Platelets: 376 x103/mm3
A. Determine the nutritional status of this child using the Welcome classification
Answer:
Expected weight= 2 x (4 + age)
Expected weight= 2 x (4 + 2) = 12kg
Actual weight= 9.9kg
9.9
W/A percentage= 12 × 100= 82.5% of expected weight (This child has normal nutrition)
(2 marks)
B. What type of anemia is this in view of the other blood indices?

Answer: Megaloblastic/macrocytic anemia (2 marks)
C. Give 3 possible differentials, based on your findings

Answer:
➢ Sickle cell anemia (1 mark)
➢ Sepsis with leukemoid reaction (1 mark)
➢ Leukemia (1 mark)
D. Give 3 additional laboratory tests you would do to complete your assessment (3 marks for
any 3).
Answer:
➢ Peripheral smear
➢ Reticulocyte count
➢ Bone marrow biopsy
➢ Blood culture
➢ Hb electrophoresis
6. A 10-year-old girl is brought into the emergency room with history of difficulty breathing since
the previous night. She is a known sickle cell disease patient who has been receiving monthly
blood transfusions due to cerebral vascular accident. She is in severe respiratory distress with
a respiratory rate of 70/min, associated with sub costal and intercostal recession. Her
temperature is 38.7oC. Her hemoglobin is 7gm/dl and her oxygen saturation is 76%.
A. What are the two key differential diagnoses for the condition that the patient is presenting
with? (2 marks)
Answer:
➢ Bacterial pneumonia
➢ Acute chest syndrome
B. Write 3 likely causative organism (1 mark for each)

Answer:
➢ Streptococcus pneumoniae
➢ Mycoplasma pneumoniae
➢ Haemophilus pneumoniae
C. List 3 investigations you would do in relation with this condition (1 mark for each).
Answer:
➢ Chest Xray
➢ Blood culture
➢ Full blood count
D. The following is her hemogram: WBC: 22,300 cells/ mm3, MCV: 67.5fl, RDW - CV:
18%
Comment on this result. (1 mark for each)
Answer:
➢ WBC is raised
➢ MCV is low
➢ RDW is slightly raised
E. Which of the above result abnormality is not common to sickle cell anaemia? (1 mark)
Answer: Low MCV
7. A boy is brought into hospital with difficulties of breathing and swelling of the legs. The patient
indicates that he is unable to sleep supine on the bed as he runs out of breath. He also indicates
that he develops breathlessness after walking only a few steps. On examination, the boy has a
pansystolic murmur in the mitral area radiating to the left axilla. He also has anemia and fever
as well as splenomegaly.
A. Give your differential diagnosis.
Answer:
➢ Congestive heart disease secondary to Rheumatic Heart Disease (1 mark)

➢ Infective endocarditis (2 marks)
B. Line up investigations based on your differential diagnosis. (0.5 mark for each answer)
Answer:
1. Chest X-ray
2. FBC
3. ECG
4. Cardiac echography
5. Blood culture
6. Urinalysis
C. Which organisms are usually associated with this condition?

Answer:
1. Streptococcus viridans (1.5 mark)
2. staphylococcus aureus (1.5 mark)
D. What is the full diagnosis of this child’s condition?

Answer: Congestive heart disease secondary to Rheumatic Heart disease (2 marks)
E. List the heart valve structural problems that this child has (1 mark /answer).
Answer:
1. Mitral Regurgitation
2. Mitral Stenosis
3. Aortic insufficiency
F. Which one is the most affected age group and why?

Answer: School going age (5-15 years) because of exposure to other individuals who
may possible sources of transmission (1 mark)
8. A 24-month-old girl presents to hospital with history of diarrhoea and vomiting for 4 days and
anorexia for 2 weeks. The mother has recently fallen pregnant but she has recently separated
from her husband. On examination the child weighs 6.4 kg and she has no edema.
A. State her nutritional status using the Welcome classification
Answer:
6.4
W/A percentage= 12 × 100= 54.2% of expected weight (This child has Marasmus) (2
marks)
B. Give 2 important differentials that need to be ruled out every time you have such a case.
Answer:
1. Tuberculosis (1.5 marks)
2. HIV (1.5 marks)
C. Write down 5 investigations you would carry out (1 mark/correct answer)

Answer:
1. FBC
2. ESR
3. Chest X-RAY
4. Stools: microscopy/ parasitology
5. HIV test
9. A 3-day old infant presents with deep jaundice which started on the first day after birth. He is
the younger of two siblings. His older sibling never had any such a problem. The mother
blames herself for ignoring the doctor’s advice when she had her first child. On examination
the baby is lethargic, pale and hypotonic.
A. What is the likely cause of this baby’s condition?
Answer: Kernicterus or bilirubin encephalopathy secondary to Rhesus incompatibility (3
marks)
B. What is the advice the mother ignored soon after having her first child?
Answer: Anti-D Serum administration (3 marks)
C. List down investigations you would carry out as part of management of this neonate (1
mark/ correct answer)
Answer:
1. FBC
2. Total and direct serum bilirubin
3. Coombs test
4. Blood grouping and X-match
10. This is a karyotype of 2-week-old infant born to 23-year-old mother
1. What is the gender of this child?

Answer: Female (1 mark)
2. What is the diagnosis?

Answer: Trisomy 21 or Down’s syndrome (2 marks)
3. How is it inherited?
Answer:
➢ Non-disjunction (1 mark)
➢ Robertsonian Translocation (1 mark)
➢ Mosaicism (1 mark)
4. Write down 1 crucial investigation you would carry out withing 48 hours of the baby
being born
Answer: Thyroid function test
5. Write down any 4 congenital abnormalities associated with this condition (4 marks for
any 4 correct answers)
Answer:
➢ Endocardial cushion defect (ASD, VSD)
➢ Congenital Megacolon
➢ Duodenal atresia
➢ Tracheo-Oesophageal Atresia
➢ Imperforate anus
➢ Hypothyroidism
➢ Umbilical hernia
11. Natasha, a 3.960 kg neonate was born via spontaneous vaginal delivery to a 21 years old Para
1 mother. Labour was rather prolonged lasting 14 hours and there was prolonged rupture of
membranes for 24 hours. Apgar score at birth was 8/10 at birth, then improved to 9/10 after
minimal resuscitation. Two days after birth the child developed failure to feed, lethargy and
hypotonia.
A. Give 2 differential diagnoses
Answer:
➢ Neonatal sepsis
➢ Birth asphyxia (hypoxic ischemic encephalopathy)
B. List 6 investigations you would carry out in line of this baby’s management.
Answer:
➢ Full blood count with differential
➢ Blood culture
➢ Total serum bilirubin + direct
➢ Liver function tests
➢ Renal function tests
➢ Blood sugar
➢ Brain imaging (ultrasound, MRI/CT)
➢ Trans-fontanel ultrasound
➢ Lumbar puncture
C. Write down 2 important questions you would ask concerning the mother to help with your
differentials.
Answer:
➢ Did the child cry at birth?
➢ Did the child have any fever?
➢ Did the child have any yellowing of the eyes or skin
12. Moono, a 9-year-old school-going boy, presents to hospital with history of cough and swelling
of the face for 4 days. On examination He is dyspnoeic at rest.
A. Write down 4 possible physical features you would like to elicit to help with the diagnosis.
Answer:
➢ Cyanosis
➢ Finger clubbing
➢ Fever
➢ Murmur
➢ Splinter hemorrhage
➢ Features of respiratory distress
B. What is the full diagnosis of this child’s condition?

Answer: Congestive heart failure secondary to infective endocarditis
DDx: nephrotic syndrome
C. List down 3 risks factors associated with this condition

Answer:
➢ School-going age
➢ Congenital heart defect
➢ Poor dental health
D. List the investigations you would carry out in this patient

Answer:
➢ Chest X-ray
➢ ECG
➢ ECHO
➢ Liver function tests
➢ Blood culture
➢ Urinalysis
13. A 2-year-old boy presents to 1st level referral hospital where you are working with history of
swelling of the feet for the last one week. There is also history of diarrhea for 3 weeks prior to
admission and a peeling rash on the feet of the child. The child is the first born. Currently mum
is 8 months pregnant. Preliminary investigation reveals the following:
➢ Potassium: 3.1mmol/l
➢ Sodium 134mmol/l
➢ Urea 2.4 mmol/l
➢ Chloride 104mmol/l
➢ Blood sugar 2.3mmol/l
A. What is the most likely diagnosis?
Answer: Severe acute malnutrition
B. Indicate any abnormalities in the above given investigation result

Answer:
➢ Decreased potassium (normal= 3.5 to 5.5 mmol/L)
➢ Low glucose level (hypoglycemia <3 mmol/L)
C. List 4 diagnostic features that you will look for as you examine the child that will help you
make a more conclusive diagnosis of this condition
Answer:
➢ Decreased mid-upper arm circumference (<11.5 cm)
➢ Weight/height <-3 Standard deviation
➢ Muscle wasting and decreased subcutaneous tissue: prominent outline of ribs and sternum,
baggy pants appearance
➢ Hair changes: thin, sparse, brittle, brown/reddish discoloration, flag sign
➢ Eye signs: bitot spots, dry conjunctiva, corneal clouding, corneal ulceration/keratomalacia
➢ Oral changes: cheilosis, angular stomatitis, papilla atrophy on tongue, abdominal
distension, hepatomegaly
➢ Skin changes: desquamation, hypo- and hyperpigmentation, ulceration, exudative lesions,
dryness of skin, crazy pavement and flaky paint dermatosis
➢ Nail changes: brittle spoon shaped
D. What 5 steps are you going to take immediately to save the life of this child?
Answer:
Admit:
➢ Manage hypoglycemia
➢ Manage hypothermia
➢ Manage dehydration:
➢ Manage electrolyte imbalance (hypokalemia)
➢ Treat infection/antibiotics
14. Emmanuel, a month-old infant, born at term, is admitted for jaundice that appeared on day 6
after birth and has persisted. He is alert, sucks well and has no fever. His hemoglobin is 15g/dl
with total serum bilirubin of 250 micromol/l.
A. Write down 2 important questions you would ask the mother with regards to the jaundice
Answer:
➢ What is the color of the stool?
➢ What is the color of the urine?
B. Write down 2 differential diagnoses

Answer:
➢ Breast milk jaundice
➢ Obstructive jaundice (Probably secondary to biliary atresia)
C. Write down your management

Answer:
➢ Management is dependent on the cause
➢ Admit patient
➢ Continue breastfeeding
➢ Investigate: Blood typing/grouping, FBC, Coombs test, total bilirubin, direct bilirubin,
abdominal ultrasound, urinalysis
➢ Hydrate with IV fluids
➢ Consult surgeons if cause is obstructive
➢ For breastmilk jaundice: continue breastfeeding
15. Mwenya, a week-old neonate whose mother is producing almost no breastmilk, is commenced
on formula milk. Every 100 g of the powdered milk contains: 40 g of protein, 40 g of
carbohydrate, 20 g of polyunsaturated fat, 10 g of iron, 4 g of zinc, 800mcg of vitamin A and
230 mcg of folate.
A. Work out the energy content of the 100 g of this powdered milk.
Answer:
1g fat= 9Kcal
Total protein=40g
Total carbohydrates=40g
Total fat=20g
Energy content in one pack= (40 x 4) + (40 x 4) + (20 x 9) =500 kcal (5 marks)
B. Considering that Mwenya’s daily caloric requirement is about 2000 Kcal, how many grams
of the powdered milk does she require to cover her caloric need?
Answer:
100g= 500Kcal
X= 2000Kcal
2000 𝑋 100
X= 500 = 400g is needed (5 marks)
16. You are called to review a newly diagnosed insulin dependent diabetes mellitus case. The
patient is receiving insulin intravenously and his morning urine analysis is as follows:
SpGr: 1.025, Protein: +, pH: 6.0, Blood: negative, Ketones: ++++, Glucose: Negative
A. Explain in few words what may have led to the presence of ketones and the absence of
glucose in urine.
Answer: This could probably be caused by a high dosage of insulin causing hypoglycemia
and hunger. The response of the body to hunger leads to ketogenesis as an alternative
source of energy therefore ketones would be present in urine and glucose absent
B. In your opinion, what would be the blood sugar levels in this patient? Low, normal, or
high?
Answer: The sugar would low
17. A 13 months old toddler is admitted with acute diarrhea with severe dehydration. He weighs
10kg.
A. Write down 5 clinical features you are likely to elicit
Answer:
➢ Alteration in consciousness: Lethargic or comatose
➢ Sunken anterior fontanelle
➢ Sunken eyes
➢ Dry mucus membranes
➢ Skin pinch goes back very slowly (>2 sec)
➢ Tachycardia: rapid thready pulse
➢ Oliguria
B. What is the average percentage of his body weight loss?

Answer: more than 10% with severe dehydration
18. George, a 6-month-old infant is admitted with pneumonia (first occurrence) and is able to feed
well. His mother tested positive for HIV. Write down 5 questions you would ask the mother to
assess the risk of HIV infection in George.
Answer:
➢ Are you on ARVS?
➢ For how long have you been taking the ARVs?
➢ What was the mode of delivery: vaginal or cesarean section?
➢ Is George currently still exclusively breastfed or given formula?
➢ Is George on any prophylactic antiretroviral drugs-Nevirapine?
➢ Was Nucleic acid test done on George at 6 weeks?
➢ How has George’s health been and how much does he weigh now?
19. Mwila is referred from Kasama for a huge spleen. She has had few episodes of abdominal pain
which the mother attributed to worm infestation. On examination she is underweight with a
tinge of jaundice. The night of her admission, she bled profusely from the nose and required
nasal packing.
A. Write down 3 possible diagnoses?
Answer:
➢ Splenic sequestration crises in sickle cell patient
➢ Hyperreactive malarial splenomegaly (Tropical splenomegaly syndrome)
➢ Acute leukemia
➢ Viral hepatitis
B. List down specific investigations to ascertain your diagnosis

Answer:
➢ Blood investigations
- Rapid diagnostic test/malaria parasite slide for malaria
- Peripheral smear to rule out acute leukemia
- Hepatitis viral panel
- Full blood count and ESR
➢ Bone marrow aspirate
20. You walk into a mall with your 4-year-old toddler and she picks a pack of food with the
following nutritional information per 100g:
Protein: 10g, Maize 40g, Wheat flour: 50g, Millet flour: 25g, Olive oil: 4g, Palm oil: 6g, Zinc:
11mg, Potassium 110mg, Vitamin A: 800mcg and folate: 230mcg
A. Work out the energy content of this pack
Answer:
1g fat= 9Kcal
Total protein= 10g

Total carbohydrates= 40g + 50g + 25g= 115g
Total fats= 4g +6g= 10g
Total calories from proteins= 10 x 4= 40kCal

Total calories from carbohydrates= 115 x 4= 460kCal
Total calories from fat= 10 x 9= 90kCal
Total calories in 1 pack= 40 + 460 + 90= 590kCal
Total energy content (in KJ) = 590 x 4.2= 2478Kj
B. Considering that your child’s daily caloric requirement is about 1600kcal, how many packs
would she require to cover this need?
Answer:
If 1 pack gives 590kCal
1600
Then for 1600kCal, number of packs= 590 = 2.711
Therefore 3 packs are needed
21. Chansa, a 6-year-old girl is referred from Kasisi for convulsions. She has had few episodes of
vomiting, fever and weakness. On examination, she is comatose with a GCS of 8/15, pale and
jaundiced.
A. Write down 3 possible diagnoses? (5 marks)
Answer:
➢ Severe malaria – cerebral malaria (2 marks)
➢ Meningoencephalitis (1mark)
➢ Sickle cell anemia with CVA (1 mark)
➢ Septicemia (1 mark)
B. List down specific investigations to ascertain your diagnoses (5 marks for any 5)
Answer:
➢ RDT/MPS (1 mark)
➢ FBC (1 mark)
➢ HB electrophoresis (1 mark)
➢ Cranial CT scan (1 mark)
➢ Peripheral smear (1 mark)
➢ Blood culture (1 mark)
22. A 10-year-old girl is brought into the emergency room from a boarding school with history of
body hotness for the past 2 weeks. On examination, she is under-weight and pale. Abdominal
examination reveals generalized mild tenderness. The mother added that she sweats profusely
at times.
A. Write down 3 possible causes of the condition that the patient is presenting with?
Answer:
➢ Typhoid fever (3 marks)
➢ Disseminated tuberculosis (3 marks)
➢ Hodgkin’s lymphoma (4 marks)
B. List down 5 investigations you would carry out towards the diagnosis besides FBC (10
marks for any 5)
Answer:
➢ Chest X-ray
➢ Erect /supine abdominal X-ray/ Abdomen ultrasound
➢ Bone marrow aspiration
➢ Blood culture
➢ ESR
➢ Gene Xpert
C. The following is her haemogram: WBC: 3,500/ mm3, MCV: 79 fl, Hb: 4g/dl. What is the
most likely diagnosis? (5 marks)
Answer: Typhoid Fever
23. A 3-day old infant presents with jaundice which started on the first day after birth and involved
the abdomen below the umbilicus to the knees. He looks lethargic, irritable and pale. His body
temperature is normal. He is the younger of two siblings. Kernicterus is entertained as the
diagnosis (15 marks)
A. What is the Kramer grade of this neonate and its corresponding serum bilirubin levels?
Answer: Kramer Grade 3 (12 mg/dl)
B. Grade kernicterus in this infant

Answer: Moderate kernicterus
C. Direct Coombs test is performed and turns out positive. Whose blood, do you think, was
tested?
Answer: The neonate
D. You decide to institute phototherapy. List down at least 4 measures you would take prior
to and while the baby is undergoing it.
Answer:
1. Maintain room temperature at about 30oC
2. Check blood sugar at regular intervals
3. Encourage breastfeeding
4. Give maintenance fluid with 10% to cover for the deficit
E. Write down 2 complications related to phototherapy

Answer:
1. Dehydration
2. Bronze baby: especially when phototherapy is used for conjugated hyperbilirubinemia
3. Diarrhea
24. Answer the following questions (10 marks)

A. Based on the Welcome classification, state the nutritional status of Mulenga, a 2 year old
child weighing 6.800 kg with no oedema:
Answer:
Answer:
6.8
W/A percentage= × 100= 56.7% of expected weight (This child has Marasmus) (4
12
marks)
B. He is then started on feeds and weighs 6.936 kg 2 days later. Write down his weight gain
per kg/day.
Answer: 10 g (3 marks)
C. Is this weight gain in line with good response to treatment?
Answer: Yes (3 marks)
25. Mercy, a 4-month-old infant, is admitted with diarrhoea that has lasted 3 months. She is HIV
exposed and on nevirapine prophylaxis since birth. Her mother has been on combined ART
for the past 3 years. Mercy is on formula milk because the mother alleged not to have had
enough breastmilk. Her father does some piece work at a nearby mine. On examination, she
weighs 3.500 kg with head circumference of 37 cm. Her birth weight is 2.600 kg.
A. Write down 2 possible causes of the diarrhea in this context
Answer:
➢ Opportunistic infection
➢ Osmotic diarrhea
B. What would you have advised the mother to do about infant feeding in the immediate
postnatal period?
Answer:
➢ Encourage mother to continue HAART
➢ Allow exclusive breastfeeding for 6 months
C. Is her weight appropriate for age?

Answer: No
D. If not, what is her expected weight range for age?

Answer: 4.7-6.2kg
E. List down 2 important investigations in the management of Mercy’s case
Answer:
➢ HIV DNA PCR
➢ Stool microscopy/culture/sensitivity for ova and parasites as well
26. A 4-year-old girl is brought to your hospital with complaints of epistaxis, fever and weakness
for one month duration. The child is still having epistaxis and bleeding from the oral cavity in
the gums. A full blood cell count had been done at a known quality assured laboratory and
showed the following:
Hb: 3.5gm/dl, WBC: 3.1 x109 /L, Platelets 5x109/L, MCV: 73fl
A. What are the 2 main differential diagnoses in a child of the named age for this
presentation?
Answer:
1. Aplastic anemia (1.5 marks)
2. Acute leukemia (aleukaemic) (1.5 marks)
B. List 5 other signs you are going to examine for to help consolidate the diagnosis
(1 mark/ answer)
Answer
1. Sternal tenderness
2. Bone tenderness
3. Petechiae
4. Enlarged spleen
5. Lymphadenopathy
C. Indicate three other investigations that are critical for confirmation of the diagnosis in this
child and explain what role they would play in helping confirm the diagnosis
(1 mark/ answer)
Answer
1. Peripheral smear
2. Bone marrow biopsy
3. Cytometry
27. A 23-month-old girl presents to hospital with history of diarrhoea and vomiting for 4 days and
anorexia for 2 weeks. The mother has recently fallen pregnant but she has recently separated
from her husband. On examination the child is miserable, apathetic and has bilateral pedal
oedema and dermatosis. Her weight is 7.2kg. Her muscles are wasted.
A. What is the diagnosis?
Answer: Severe Acute Malnutrition (2 marks)
B. List 5 Critical conditions that you must manage in order to save the life of this child
within the first 48 hours (2.5 marks for any 5)
Answer:
1. Hypoglycemia
2. Electrolyte imbalance: Hypokalemia
3. Infection
4. Dehydration
5. Hypothermia
6. Anemia
C. What is the expected weight for age for this child?

Answer:11-12 KG (1.5 mark)
D. Give 2 conditions are often associated with this diagnosis and need to be investigated for.
Answer:
1. Tuberculosis (2 marks)
2. HIV (2 marks)
28. Crispin is a bouncy healthy baby. He is 3 weeks old and breastfeeding well. Mother notices
that he throws up shortly after feeds and has now developed a tinge of jaundice. His blood
count is within normal range apart from a mild anemia. He is not opening bowels as frequently
as he used to.
A. What is your most likely diagnosis?
Answer: Hypertrophic Pyloric Stenosis (4 marks)
B. How do you confirm the diagnosis clinically?

Answer:
1. Projectile vomiting after meals (1 mark)
2. Olive-shaped like mass around the epigastric area (1 mark)
C. List down your investigations.

Answer:
1. Ultrasound (2 marks)
2. Barium swallows (2 marks)
29. A 3-week-old infant, the youngest of 2 siblings, presented with jaundice which started on the
first day after birth. His older sibling is healthy with an uneventful past medical history. On
examination, he has mild pallor and displays some abnormal movements.
A. List down what more you would want to know to establish your diagnosis.
Answer:
1. Mother blood group (1.5 mark)
2. Older sibling blood group (1.5 mark)
B. What the likely cause of the abnormal movements? (2 marks for either of the 2)
Answer:
1. Toxic hyperbilirubinemia
2. Kernicterus
C. What measures should have been taken on day 1 to avoid the current situation?
Answer:
1. Phototherapy (1.5 mark)
2. Exchange blood transfusion (1.5 mark)
D. Write down 2 likely complications due to his current condition.

Answer:
1. Deafness (1 mark)
2. Seizures (1 mark)
30. Charles, a nine-year-old school going child, has complained of body hotness, generalized body
weakness and loss of weight over the past 6 weeks. On examination, he is found with cervical
lymphadenopathy and a slightly distended abdomen. The mother complains that Charles is
always soaked in sweat even when the room is cool.
A. Write down your differential diagnosis. (2 marks / answer)
Answer:
1. Hodgkin lymphoma
2. Tuberculosis
B. List down all possible investigations you would carry out on this patient. (1 mark /
answer)
Answer:
1. Chest X-ray
2. FBC
3. ESR
4. Lymph node biopsy
C. Without going into detail of management, give principles of treatment of your possible
diagnoses. (1 mark / answer)
Answer:
1. Antituberculosis treatment
2. Chemotherapy
31. A 14-year-old girl, Nana Maliki presents to your hospital with a history of breathlessness and
swelling of her legs for the past one week. Some of the physical findings include orthopnea
and a pansystolic murmur heard best at the apical area and radiating to the left axilla.
A. Give your differential diagnosis?
Answer: Congestive heart failure secondary to Rheumatic heart disease
DDx: infective endocarditis
B. Mention two other signs that could be found in this patient consistent with the above
diagnosis?
Answer:
➢ S3 heard sound
➢ Displaced apex heart beat
➢ Bibasal crepitations
C. Line up investigations based on your differential diagnosis.

Answer:
➢ Chest X-ray
➢ Echocardiography
➢ Electrocardiography
➢ Blood culture
➢ Urinalysis
D. Which organisms are usually associated with this condition?

Answer:
Staphylococcus aureus
Streptococcus viridans
E. Which one is the most affected age group and why?

Answer: School going age because of exposure to other possible sources of transmission
32. An 8-month-old male baby presents to hospital for a third episode in 3 months, of swelling of
the hands and crying uncontrollably. Physical examination reveals an irritable baby with
bilateral swollen hands. Further examination revealed a tinge of jaundice and splenomegaly.
A. What is your provisional diagnosis in this baby?
Answer: Acute dactylitis in a possible Sickle cell anemia patient
B. What 2 investigations would you request to confirm the diagnosis?

Answer:
➢ Sickling test
➢ Hemoglobin electrophoresis
C. What is the most likely way the child acquired this condition?
Answer: The condition is inherited and the inheritance pattern is autosomal recessive
meaning one can only get the condition if both parents are either carriers or sufferers of the
condition
D. Write 5 complications that can occur in this condition?

Answer:
➢ Cerebrovascular accident: Transient ischemic attacks and stroke
➢ Neurosensory hearing loss
➢ Retinal hemorrhage
➢ Retinal detachment and blindness
➢ Acute chest syndrome
➢ Recurrent pneumonias
➢ Respiratory failure
➢ Pulmonary infarction
➢ Pulmonary hypertension
➢ Myocardial infarction
➢ Arrhythmias
➢ Heart failure and cor-pulmonale
➢ Cholelithiasis
➢ Isosthenuria
➢ Priapism and impotence
➢ Menstrual irregularities, infertility and recurrent abortions
➢ Delayed puberty
➢ Osteomyelitis
➢ Avascular necrosis of head of femur and humerus
➢ Recurrent leg ulcers
➢ Delayed growth development and musculoskeletal deformities
33. A 14-year-old girl called DJ is referred from a health center 10km from the hospital where you
are working with history of east fatiguability, fever and bleeding from the nose for one month.
On examination, you find that the girl is very pale, has purplish bumps in the mucus membrane
of the oral cavity and is toxic looking. The temperature is 39OC.
A. What 4 critical investigations are you going to do to help you make a definitive diagnosis
on this child?
Answer:
➢ Full blood count with differential: pancytopenia, thrombocytopenia
➢ Peripheral smear to look for blast cells
➢ Clotting profile: aPTT, Bleeding time, prothrombin time for DIC
➢ Chest X-ray to check for any mediastinal masses as well as CT scan
➢ Blood culture
B. What are 2 most likely differential diagnosis that would explain the patient’s condition
Answer:
➢ Idiopathic thrombocytopenic purpura
➢ Leukemia
C. List 6 other signs that you would look for on examination of the patient that would help
you diagnose the patient’s illness.
Answer:
➢ Hepatomegaly
➢ Splenomegaly
➢ Generalized lymphadenopathy
➢ Bone pain
➢ Jaundice, Gum hypertrophy
➢ Cranial nerve palsy, papilledema, meningism
34. A 16-month-old toddler (girl) is brought to the children’s clinic, because the mother is
concerned that the child’s growth and development is suboptimal compared to her older
siblings. Upon further questioning she agrees to the child having recurrent upper respiratory
infections, occasional bouts of loose stool and fevers that have been treated as “malaria” by
the private doctor. On examination she weighed 7.5kg, her height was 80cm, she had slight
pallor with generalized lymphadenopathy, sores (white patches) in the mouth, CVS was normal
and per abdomen there was hepatosplenomegaly with no pedal edema.
A. Give 4 possible most likely differentials for the described condition.
Answer
➢ HIV infection with TB co-infection
➢ Severe acute malnutrition
➢ Infectious mononucleosis
➢ Enteric fever
B. List 4 investigations that you would do to come up with a definitive diagnosis of the
condition of this child?
Answer:
➢ HIV test
➢ Gastric lavage or sputum for geneXpert
C. If you are to stage this condition, what stage of disease is the child in.
Answer: HIV stage 4
35. A 2-year-old girl presents to your hospital and after investigations the CSF revealed the
following results
Appearance: cloudy
WBC: 120cells/mm3- polymorphs 80% and lymphocytes 20%
RBC: 50cells/mm3
Gram stain: gram negative coccobacilli
Ziehl Neelsen stain: no organism
Protein: 0.75g/l
Sugar: 1.6mmols/l
A. List 4 cardinal abnormalities that you see in this CSF result
Answer:
➢ Pleocytosis with predominance of neutrophils but also presence of lymphocytes is also an
abnormality
➢ Presence of gram-negative coccobacilli
➢ Increased proteins
➢ Low blood sugar
B. What is the causative organism?

Answer: Hemophilus influenza type B
C. What specific measure would you have taken to prevent this illness in the child?
Answer: immunization against Hemophilus infleunza at 6 weeks, 10 weeks and 14 weeks
D. List 4 long term complications associated with this condition?

Answer:
➢ Hearing loss
➢ Learning disability/mental retardation
➢ Cranial nerve palsy
➢ Focal neurological deficits
36. This is a Hemogram of a patient you have just seen at your hospital:
WBC: 5.7 x 109/L
RBC: 2.8 x 1012/L
Hb: 5.3g/dl
MCV: 49fl
MCH: 18.3pg
Platelets: 272 x 109/L
A. List 4 abnormalities that you see in this Hemogram
Answer:
➢ Low red blood cell count
➢ Low hemoglobin
➢ Low mean corpuscular volume
➢ Low mean hemoglobin concentration
B. What is the diagnosis based on the Hemogram?

Answer: Microcytic hypochromic anemia
C. Give 3 possible causes of this condition.

Answer:
➢ Iron deficiency anemia
➢ Sideroblastic anemia
➢ Thalassemia
37. An 8 weeks old infant presents to your admission ward with history of cough for 4 days and
difficult breathing. On examination, the infant is well nourished and weighs 6kg. However, the
infant is dyspneic, tachypneic with subcostal recession. Respiratory rate is 70/min.
Temperature is 37.8oC. There is some cyanosis, examination of the chest reveals a bilateral
ronchi best heard at the end of expiration and a few crepitations.
Answer: Bronchiolitis
B. List 3 likely causative organisms

Answer:
➢ Respiratory syncytial virus
➢ Parainfluenza virus
➢ Adenovirus
C. Describe in one or two sentences the pathophysiological process of this condition

Answer: Viral infection causes inflammatory obstruction (edema and mucus) of
bronchioles. There may be bronchiolar spasms which also further increases the obstruction.
During expiration airways collapse and there is air trapping. Obstruction affects expiration
more than inspiration.
D. What is your management?

Answer:
➢ Admit patient
➢ Provide moist oxygen (keep oxygen saturation more than 92%), continuous positive
airway pressure (CPAP) or assisted ventilation if there is respiratory failure
➢ Nasal bulb suction
➢ Hydration with IV fluids
➢ Position at 30-40o
➢ Nebulized bronchodilators (albuterol and ipratropium) and steroids may help some
patients
➢ Aerosolized ribavirin if available
38. A 2 days old baby comes into the neonatal unit with history of developing jaundice since a few
hours after birth. On examination, you notice that the child is weak, hypotonic, deeply
jaundiced and pale. He is the 2nd born, the first sibling did not suffer from this condition.
A. What is the most likely full diagnosis of this illness in the neonate?
Answer: Hemolytic disease of the newborn
B. List 4 investigations that you are going to do in order to confirm the diagnosis
Answer:
➢ Direct Coomb’s test
➢ Serum bilirubin
39. An 11 months old infant presents to your admission ward convulsing. There is history of 2
former such episodes of convulsing. According to the mother, the convulsions involve the
whole body and last about 3 minutes. The child has temperature 39oC.
a) What is the most likely diagnosis?
Answer: Febrile convulsion
b) List 3 disease condition that would possibly have caused this condition
Answer:
➢ Severe Malaria
➢ Sepsis
➢ Pneumonia
c) Indicate 2 cardinal investigations that would help you manage this child.
Answer:
➢ Malaria parasite slide
40. Ben, a 6-month-old infant is admitted with pneumonia, weighing 4.5kg. His rapid test for HIV
is reactive. Write down 5 questions you would ask the mother to assess the risk of HIV
infection in Ben.
Answer:
➢ Have you tested for HIV?
➢ When did you test for HIV?
➢ Are you on ARVS?
➢ For how long have you been taking the ARVs?
➢ Is Ben currently still exclusively breastfed or given formula?
➢ Is Ben on any prophylactic antiretroviral drugs-Nevirapine at birth?
➢ Was DBS for HIV DNA PCR test done on Ben?
41. Kasongo, a 5-year-old boy of Chingwele, presents with a mandibular mass causing dental
malalignment. Histopathology results reveals a “starry sky” appearance. (15 marks)
Answer: Burkitt’s lymphoma
B. Write down investigations you would carry out prior to chemotherapy

Answer:
1. Full blood count
2. Liver function tests
3. Urea and creatinine
4. Cross-match and save
5. Serum electrolytes
C. Mention 2 crucial measures you would take prior to and during chemotherapy
Answer:
1. Rehydration
2. Allopurinol administration
D. Write down the most common complication related to chemotherapy of this condition.
Answer: Tumor lysis syndrome
E. Give at least 3 biochemical derangements associated with this complication

Answer:
1. Hypocalcemia
2. Hyperuricemia
3. Hyperkalemia
4. Hyperphosphatemia
42. A 4-month-old female infant is brought to OPD for not gaining weight. There is a grade III
pansystolic murmur at the left lower sternal border with loud 2nd heart sound at pulmonary
area. Echocardiography reveals Tetralogy of Fallot. (15 marks)
A. Mention at least 4 clinical features compatible with this condition
Answer:
1. Failure to thrive
2. Excessive sweating when feeding
3. Finger clubbing
4. Hyper-cyanotic spells
5. Polycythemia
B. Write down expected hematological (hemogram) findings

Answer:
1. Polycythemia
2. Thrombocytopenia
C. List down expected chest radiological findings

Answer:
1. Boot shaped heart silhouette
2. Olighaemic lung fields: dark lung fields with absent lung markings
D. List 3 complications of this condition.

Answer:
1. Thrombo-embolic accident
2. Cerebral abscess
3. Heart failure
4. Pulmonary regurgitation
5. Arrhythmias
43. Itumeleng, a 3-week-old healthy male neonate, is thriving well. However, the mother notices
that he throws up shortly after feeds and very much eager to feed despite this occurrence. The
vomitus is made of the just ingested milk. His blood count is within normal range apart from
a mild anemia. He is not opening bowels as frequently as he used to. (15 marks)
A. What is your differential diagnosis?
Answer:
1. Hypertrophic pyloric stenosis
2. Antral or pyloric web
3. Trachesophageal fistula
4. Duodenal atresia
B. How do you confirm the diagnosis clinically?

Answer: Test feed reveals an olive shaped mass in the right upper quadrant of the abdomen.
Visible peristalsis may be seen.
C. List down 4 biochemistry expected in this condition

Answer:
1. Hypokalemia
2. Hypochloremia
3. Metabolic alkalosis
4. Elevated blood urea nitrogen
D. What gender does this condition occur mostly in?

Answer: Male
44. Olipa, a 4-year-old toddler, has recently moved with her parents into the newly-bult farm
house. She is brought to the Emergency Department and with difficult breathing associated
with foaming in the mouth. The father denies any history of body hotness and fits.
Answer: Organophosphate poisoning
B. Write down 4 clinical findings that would help you arrive at the diagnosis?
Answer:
➢ Miosis
➢ Wheezing
➢ Muscle twitching and fasciculations
➢ Lacrimation and diaphoresis
➢ Bradycardia
C. What is the drug of choice in this condition?

Answer: Atropine (0.05mg IV)
D. When would you discontinue the administration of this drug?

Answer: When the patient is atropinized (increase in heart rate, skin is warm and appears
flushed and pupils dilate)
45. Maureen, a 3-year-old girl woke up this morning and is failing to stand. Her mother thought
she is deliberately feigning to attract attention. She however decides to take her to the hospital.
A quick assessment reveals Maureen has indeed lost pain sensation in both lower limbs up to
the knees.
A. What is your working diagnosis?
Answer: Acute flaccid paralysis
B. What is your differential diagnosis?

Answer:
➢ Guillain Barre syndrome
➢ Poliomyelitis
➢ Transverse myelitis
➢ Tick paralysis
C. What is your most likely diagnosis?

Answer: Guillain Barre syndrome
D. What clues would you be looking for in the history as a lead to the diagnosis?
Answer:
➢ History of respiratory illness, pharyngitis or Gastroenteritis (diarrhea and vomiting)
➢ Presence of fever, generalized non-throbbing headache, sore throat, anorexia, nausea,
vomiting, muscle aches
➢ Bladder (urinary retention) and bowel complaints: absent or present
➢ Immunization history against polio and any recent vaccines given to the child
E. Give 2 crucial investigations that would help confirm the diagnosis?

Answer:
➢ Nerve conduction test
➢ Lumbar puncture for CSF analysis
F. What’s your worry about this child?
Answer: Respiratory failure or paralysis of respiratory muscles as paralysis ascends with
disease progression
46. Mweetwa is born to a mother living with HIV. He weighs 3.1kg at birth and is exclusively
breastfed. The mother started taking antiretroviral drugs (ARVs) 8 months into her pregnancy.
A. Write down the prophylactic ARVs regimen you would use on Mweetwa?
Answer: AZT + 3TC + NVP
B. Mention 3 advices you would give the mother to ensure she does not pass the infection to
the baby?
Answer:
➢ Exclusive breastfeeding
➢ Mother should continue taking ARVs
➢ Administer ARV prophylaxis and cotrimoxazole prophylaxis to the child as long as child
is exposed
C. How long would you advise the mother to breastfeed the baby?
Answer: as long as she wants as long as she is taking her ARVs rigorously however WHO
advocates for 6 months exclusive breast feeding
D. In a succinct manner, write down the timeline of the HIV testing and the type of test at
every milestone as part of follow-up of Mweetwa
Answer:
➢ Nuclei acid test (NAT) at first contact
➢ NAT at 6 weeks
➢ NAT at 3 months
➢ NAT at 6 months
➢ NAT at 9 months
➢ Serological test (Rapid test) at 12 months (confirm positive with NAT)
➢ Serological test (Rapid test) at 18 months (confirm positive with NAT)
➢ Serological test at 24 months (confirm positive with NAT)
➢ Serological test 6 weeks after complete cessation of breastfeeding
E. It turns out that Mweetwa’s NAT result is positive. What ARV regimen would you start
Mweetwa on?
Answer: AZT + 3TC + LPV-r
47. Chabala, a 3-year-old toddler, is admitted with a 5 day long febrile illness. The mother reports
that all started with body hotness associated with headache. He was then taken to the local
clinic where the health worker commenced him on penicillin V for 5 days. His condition
slightly improved, however a day prior to admission, he had a fit which prompted the mother
to take him to the hospital. He is HIV negative
On examination, he is somehow irritable and displays a subtle squint. He weighs 11.4 kg. With
an axillary temperature of 37.9oC
A. Write down 3 possible diagnoses
Answer:
➢ Cerebral abscess
➢ Meningoencephalitis
➢ Severe malaria
B. Write down one procedure you would avoid due to physical findings
Answer: Lumbar puncture
C. Write 3 important investigations you would carry out besides FBC to arrive at the diagnosis
Answer:
➢ CT scan of the head
➢ Blood culture
➢ RDT for malaria
48. Besa, an 18-month-old toddler, lives with her parents who have just moved in their newly-built
house. She is brought to the emergency department with difficult breathing associated with
foaming in the mouth. The father denies any history of body hotness and fits. She is reported
to have been fine the day prior to the consultation.
Answer: Asthma (acute exacerbation)
B. List down 4 possible clinical signs/symptoms that would help with the diagnosis of this
condition
Answer:
➢ Use of accessory muscles of respiration or poor respiratory effort
➢ Presence of wheezing
➢ Impaired level of consciousness
➢ Speaking with difficulty or unable to speak
➢ Heart rate >130b/min
➢ Respiratory rate >50b/min
49. Write down the Zambian EPI schedule of immunization in a table form (vaccine, schedule and
site) (10 marks)
Answer
Vaccine Schedule Site
BCG At birth Left forearm
POLIO At birth, 6, 10, 14 weeks and Orally
9 months if polio 0 missed
IPV also given at 14 weeks

IM
ROTAVIRUS At 6 weeks and 10 weeks IM
DPT, HIB, HepB, PCV At 6 weeks, 10 weeks and 14 IM thighs
weeks
MEASLES and RUBELLA 9 months and 18 months IM
At 14 years girls should receive HPV vaccine.
Routine under 5 services:
➢ Growth monitoring monthly
➢ Deworming every 6 months
➢ Vitamin A supplementation very 6 months
50. An 11-week-old infant is brought to LMUTH with a four-day history of watery diarrhoea.
While being attended to at the local clinic. His under-five card shows that he had only received
BCG, OPV1.
A. What is the crucial question you would want to ask the mother with regards to this episode
of diarrhoea?
Answer: Breastfeeding?
B. Mention the vaccines that this baby has so far missed.

Answer:
• OPV 0 (at birth) and OPV 2 (at 10 weeks)
• Rota vaccine 1 and 2 (at 6 weeks and 10 weeks)
• Diphtheria, tetanus, pertussis, Hemophilus influenza and hepatitis B 1 and 2 (at 6 weeks
and 10 weeks)
• Pneumococcal vaccine 1 and 2 (At 6 weeks and 10 weeks)
C. He takes ORS eagerly. What is his likely hydration status?

Answer: Some dehydration (moderate)
51. A 7-month-old infant is brought to LMUTH with a four-day history of watery diarrhoea. While
being attended to at the local clinic, he was commenced on metronidazole and Imodium to stop
the diarrhoea to no avail. On examination, he weighs 6.0 kg and his eyes are sunken. When
offered 100 mls ORS, He eagerly drinks the whole lot to the last drop, but vomits soon after.
A. Assess the hydration status of this child?
Answer: Some dehydration (moderate)
B. Why is this child vomiting?

Answer:
Because the child drank the ORS too quickly instead of in small sips
C. Write down 5 points management of this child

Answer:
• Stop the administration of Imodium and metronidazole
• Rehydrate with 75ml/kg (450ml) ORS in 4 hours, give in small sips from a cup and if the
child vomits wait for 10 minutes and continue slower. Monitor vitals (respiratory rate, pulse
rate) and signs of rehydration and once rehydrated give ORS 10ml/kg per loose stool.
• Encourage feeding
• Continue breast feeding if child still breast feeding
• Zinc sulphate 20mg per day for 10-14 days
52. A 25-month-old boy is brought to the ER with fever, mild pallor and expiratory stridor and
rhonchi on auscultation. He is saturating at 89% at room air. The doctor on call decides to
immediately intubate and start the child on oxygen. He also nebulizes the toddler with
adrenaline because of the stridor.
A. Write down measures taken by this doctor that are not appropriate for this case
Answer:
• Immediate intubation
• Nebulizing with adrenaline-not appropriate in lower respiratory tract infection

Answer:
• Bronchiolitis
• Asthma
C. The mother then thought it might help to mention that this was not the first time this is
happening. What is your most likely diagnosis?
Answer: Asthmatic attack
D. How would you manage this child at this point?

Answer:
• Admit patient
• Oxygen by nasal prongs
• IV fluids-maintenance
• Nebulization with beta agonist
• Corticosteroid nebulization
53. Martha, a 4-year-old girl has had a history of bony pains on and off for 2 weeks. On
examination, she is febrile, underweight, pale and in respiratory distress. She has cervical and
axillary lymphadenopathy.
A. What further questions would you ask to help determine the diagnosis?
Answer:
➢ Any recurrent abdominal pain?
➢ Any history of yellowing of eyes?
➢ Any personal or family history of sickle cell disease?
➢ Any joint swelling?
➢ Any recurrent respiratory infections? Pulmonary TB?
➢ Any bleeding?
➢ Any TB contact?
➢ HIV status
B. Give 2 differential diagnoses?

Answer:
➢ Acute leukemia
➢ Acute chest syndrome in Sickle cell disease
C. What investigations would you do to help ascertain your diagnosis?

Answer:
➢ Sickling test
➢ Chest X-ray
➢ Lymph node biopsy
54. Joanna a 3-year-old toddler, is brought to AMEU with history of diarrhea and vomiting for the
past 3 days. On examination, she is lethargic, too weak to take fluid orally and passed scanty
urine all day. Her weight is 14kg
A. What plan are you going to apply in rehydrating Joanna?
Answer: WHO PLAN C
B. What fluid are you going to use in treating this little girl?
Answer: Ringer’s lactate or ½ strength Darrows
C. Give details of the plan you are going to use in rehydrating Joanna
Answer:
➢ Give 100ml/kg Ringer’s lactate IV in 3 hours (1400ml in 3 hours)
- Give 420ml in 30 minutes then
- Give 980ml in 2hours 30 minutes
➢ Reassess every 15 minutes if hydration status not improving increase speed of infusion.
➢ Reassess after 3 hours and re-classify hydration status, if hydrated switch to appropriate
plan.
55. Mwila is referred from Kasama for a huge spleen. She has had few episodes of abdominal pain
which the mother attributed to worm infestation. On examination she is underweight with a
tinge of jaundice. The night of her admission, she bled profusely from the nose and required
nasal packing.
Answer:
➢ Hyperreactive malarial splenomegaly (Tropical splenomegaly syndrome)
➢ Acute leukemia
➢ Viral hepatitis
➢ Splenic sequestration crises in sickle cell patient
B. List down specific investigations to ascertain your diagnosis

Answer:
➢ Blood investigations
➢ Rapid diagnostic test for malaria
➢ Peripheral smear to rule out severe malaria, acute leukemia
➢ Hepatitis viral panel
➢ Full blood count and ESR
56. These are pictures of the same girl in question 47.
A. Write down your findings

Answer:
➢ Webbed neck
➢ Low posterior hair line
➢ Low set ears
B. What is your diagnosis?

Answer: Turner syndrome (monosomy X)
C. Choose the most likely karyotype

(1) XY
(2) XO
(3) XYY
(4) 47, XX, +t (14q21q)
57. Josephine, a teenage mother, delivered a male baby at 37 weeks of gestation, weighing
2.500kg. She was aided by her mother as the labour could not allow to reach in time the nearest
clinic. He has difficult breathing. His oxygen saturation is 81 % at room air and 89% through
nasal prongs. His body temperature is 35.6o C. (15 marks)
A. Give 4 possible reasons leading the baby’s current condition.
Answer:
1. Hypothermia
2. Hypoglycemia
3. Meconium aspiration
4. Birth asphyxia
B. Mention 5 measures you would take to manage this baby

Answer:
1. Chest X-ray
2. Warm up the baby and the room
3. Check blood sugar
4. Feeds via nasogastric tube
5. Oxygen by Continuous positive airway pressure (CPAP)
58. Banda, a 9-year-old boy, is brought to AMEU with continuous generalized tonic clonic seizure
for the past 20 minutes. On examination, he is afebrile with no signs of meningeal irritation.
He has scars on his legs. When asked later, he said they were as a result of sores sustained
while setting up rat traps. Other systems are unyielding. (15 marks)
A. Give 2 bedside assessments that would help your diagnosis
Answer:
1. Urinalysis: proteinuria 1-2+, red cells, red cell and granular casts
2. Blood pressure measurement

Answer: Hypertensive encephalopathy due to post-streptococcal glomerulonephritis
C. In the quest to find the cause of this condition, blood culture is requested for What would
the result likely be and why?
Answer:
No organism because this process is a post infectious one
59. Mohamed, a 4-month-old infant, started having diarrhoea 3 days prior to admission. The
mother has spotted blood and mucus in the very frequent (once watery) scanty stools associated
with abdominal cramps. (10 marks)
A. Give your differential diagnosis (4 marks)
Answer:
1. Dysentery
2. Intussusception
B. What is your most likely diagnosis?

Answer: Intussusception
60. Paul was born via spontaneous vaginal delivery, cried at once and was discharged the very
day. However, the mother noted that Paul would not cry for “food” and spent most of the time
sleeping. When carried, he looked weak, yet with no apparent reason to explain the generalised
weakness. His occiput looks flat and he is said to have opened bowels 3 days after birth. The
mother thought this was due to the umbilical hernia.
A. What is the most likely diagnosis? (5 marks)
Answer: Down’s syndrome or trisomy 21
B. Write down investigations you would carry out to confirm the diagnosis (3 marks
Answer:
1. Karyotype
2. Abdominal X-ray
3. Abdominal ultrasound
4. Serum urea, electrolytes and creatinine
C. What could be the cause of delay in passing meconium? (2 marks)

Answer:
1. Congenital megacolon
2. Cystic fibrosis
3. Imperforate anus
4. Hirschprung’s disease
61. A younger mother storms your consulting room panicking about a swelling on her 5-day old
baby. She vehemently denies any trauma, to which her husband agrees. Besides this, the baby
is said to be feeding well. He has no fever.
A. Write down your differential diagnosis.
Answer:
➢ Cephalohematoma (subperiosteal hemorrhage)
➢ Caput succedaneum
B. On further questioning, the mother swears her baby’s head was perfectly well at birth. What
is your most likely diagnosis?
Answer: Cephalohematoma
C. Write 2 hematological parameters you would like to monitor. Caput succedaneum: diffuse,
Answer: edematous often dark
➢ Serum bilirubin swelling of the soft tissue of
➢ Full blood count: Hemoglobin, RBCs (for anemia), WBC the scalp that extends across
(infection) the midline and suture lines.
62. A 4-month-old boy is brought to OPD because he is not gaining weight. It is seen in infants delivered
He is exclusively breastfed and mother tells that he sweats profusely from a face presentation, soft
while taking feed. He was treated for bronchopneumonia at 2 months tissue edema of the eyelids
of age. Mother says she has an impression that his lips and tongue look and face is an equivalent
dark all the time. On examination his weight is 4 Kg, His heart rate is phenomenon. CS may be
140/min. seen after prolonged labor in
A. What is your likely diagnosis? full term or preterm infants
Answer: Cyanotic congenital heart disease and is associated with
molding of the head.
B. What additional physical findings are expecting on examination?
Answer: Cephalohematoma
• Finger clubbing (subperiosteal hemorrhage)
• Cardiac murmur does not cross suture lines. A
• Cyanosis linear skull fracture may
rarely be seen. With time it
• Single S2 heart sound
organizes, calcifies and forms
an central depression.
C. How will you investigate this child?
Answer:
• Full blood count
• Chest X-ray
• Electrocardiography
• Echocardiography
D. Write down the likely RBC and platelet count

Answer:
• Polycythemia
• Thrombocytopenia
E. Mention 2 conditions this ailment is associated with

Answer:
• Down’s syndrome
• Ebstein’s anomaly
• Turner’s syndrome
63. A 2-year-old boy presents with cyanosis since infancy. On examination he has finger clubbing
and appears small for age
A. What is your differential diagnosis, at least 4
Answer:
➢ Tetralogy of fallot
➢ Tricuspid atresia
➢ Truncus arteriosus
➢ Transposition of great vessel
➢ Total anomalous pulmonary venous return
➢ Univentricular heart
➢ Hypoplastic left heart syndrome
B. What investigations are you going to do?

Answer:
➢ Echo
➢ ECG
➢ Chest x-ray
➢ FBC/DC
C. The above investigations show that the child has tetralogy of fallot, list the four
characteristic features?
Answer:
➢ Right ventricular hypertrophy
➢ Ventricular septal defect
➢ Pulmonary infundibular stenosis
➢ Overriding aorta
64. Mwale is a 4-year-old girl who has been referred because of poor appetite and loss of weight.
She tested HIV positive two weeks ago by rapid test and has just finished six months of TB
treatment for presumed TB adenitis (persistent generalized lymphadenopathy) with little
response. She is 13kg and a height of 97cm. She has extensive oral thrush, finger clubbing and
flat wart lesions on the face. Her hemogram is as follow: WBC: 4,000/mm3, Hb: 7.4 g/dl,
Platelet count: 100,000/mm3.
A. Assign a clinical WHO stage to each of clinical features Mwale presented with.
Answer:
Persistent generalized lymphadenopathy-Stage 1
Flat wart lesions on the face-Stage 2
Extensive Oral thrush- Stage 3
Finger clubbing-Stage 3
Anemia (Low Hemoglobin <8g/dl)-Stage 3
B. Assign an overall WHO stage to Mwale.

Answer: WHO Stage 3
65. Sakala is a 4-year-old boy who has been referred because of poor appetite, loss of weight, and
overall failure to thrive. He tested HIV positive two weeks ago by rapid test, has just finished
six months of TB treatment for presumed TB adenitis owing to cervical, axillary and inguinal
lymphadenopathy, with little response. He is 7.8 kg and a height of 85cm. He has extensive
oral thrush and flat wart lesions on the face and neck. He has hepatosplenomegaly.
A. Write down all the clinical features Sakala presented with and assign a WHO stage to each
one of them.
Answer:
Persistent generalized lymphadenopathy (cervical, axillary and inguinal
lymphadenopathy)-Stage 1
Hepatosplenomegaly-stage 2
Flat wart lesions on the face and neck-Stage 2
Extensive Oral thrush-Stage 3
Weight 7.8kg for age-Stage 4
B. Assign an overall WHO stage to Sakala.

Answer: WHO Stage 4
66. Wezi is a 4-year-old boy who has been referred because of poor appetite, loss of weight, and
six months of TB treatment for presumed TB adenitis (persistent generalized
lymphadenopathy) with little response. He is 10kg and a height of 85cm. He has extensive oral
thrush and flat wart lesions on the face and neck. He has hepatosplenomegaly.
A. Assign a clinical WHO stage to each of clinical features Wezi presented with.
Answer:
Flat wart lesions on the face and neck- Stage 2
Hepatosplenomegaly-Stage 2
Extensive oral thrush-Stage 3
Weight 10kg for age- Stage 4
B. Assign an overall WHO stage to Wezi.

Answer: WHO stage 4
67. Wezi is a 4-year-old boy who has been referred because of poor appetite, loss of weight, and
six months of TB treatment for presumed TB adenitis owing to cervical, axillary and inguinal
lymphadenopathy with little response. He is 7.8kg and a height of 85cm. He has extensive oral
thrush and flat wart lesions on the face and neck. He has hepatosplenomegaly.
A. Assign a clinical WHO stage to each of clinical features Wezi presented with.
Answer:
Weight 7.8kg for age- Stage 4
Extensive oral thrush-Stage 3
Flat wart lesions on the face and neck- Stage 2
Hepatosplenomegaly-Stage 2
B. Assign an overall WHO stage to Wezi.

Answer: WHO stage 4
68. A 5-day old neonate is brought to the clinic with a 3 days history of fever, poor feeding and
crying a lot. On examination the neonate is irritable, has a bulging anterior fontanelle and is
febrile to touch.
A. What is your diagnosis and differential?
Answer:
Diagnosis: Neonatal meningitis
DDx:
➢ Neonatal sepsis
➢ Subarachnoid hemorrhage
B. What relevant history will you elicit from the mother?

Answer:
➢ History of birth trauma
➢ Duration of labour
➢ Prolonged rupture of membranes
➢ Maternal febrile illness during labor/chorioamnionitis
➢ Any twitching or abnormal movements (seizures)
C. What relevant investigations are you going to do?

Answer:
➢ RBS
➢ FBC/DC
➢ CSF microscopy culture and sensitivity + biochemistry
➢ Blood culture, urine culture
➢ Chest X-ray
D. What might be the characteristic findings on the key confirmatory diagnostic test?
Answer:
➢ CSF is diagnostic
➢ The most likely causes is acute bacterial meningitis and CSF will show elevated WBC
(polymorphs), high protein and low glucose
E. While you are finalizing you assessment you also note the infant making cycling and
boxing movements with a blank gaze. What is happening?
Answer: The neonate is having a convulsion
69. A four-year-old girl presented to the Paediatrics Emergency Services with extreme pallor,
thready pulse associated with a huge spleen. She is almost unconscious and has no fever.
Medical records show that she was been seen a week before for generalized body weakness
and had a tinge of jaundice attributed to malaria.
Answer:
• Splenic sequestration crises in sickle cell anemia
• Hypersplenism
B. What is the cause of her current state?

Answer: This is due to a sequestration crisis: sickled red blood cells that block the splenic
outflow, leading to the pooling of peripheral blood in the engorged spleen and features of
shock seen due to intravascular hypovolemia and cardiovascular collapse.
70. Mwanja a 35-week-old infant, is admitted with some respiratory distress and commenced on
oxygen 3L/min via nasal prongs and the saturation is stubbornly stuck at 85% despite
increasing the oxygen flow. Mwanja is HIV negative and his lungs are clear on auscultation.
His hematocrit is around 65%
A. Give your differential diagnosis
Answer: Cyanotic congenital heart disease
B. Justify the hematocrit reading

Answer: the hypoxia causes a release of erythropoietin which stimulates synthesis and
release of erythrocytes resulting in polycythemia and a high hematocrit, additionally,
respiratory distress may also cause dehydration with resultant hemoconcentration also
contributing to the rise in hematocrit.
C. Line up the principles of management of this child

Answer:
➢ Medical management
• Administer oxygen
• Place child in Knee-chest position
• Sedation and pain relief with morphine
• Increase systemic vascular resistance and reduce infundibular spasms and right
ventricular outflow obstruction
• Correct acidosis with sodium bicarbonate
➢ Definitive management is by surgery at 6 months of age. In some infants a surgical
placement of an artificial tube between the subclavian and pulmonary artery (Modified
Blalock-Taussig shunt) or sometimes by dilatation of the right ventricular outflow
tract
71. A 2-year infant is brought to the Outpatient Department with body hotness. He weighs 9.9Kg
and his haemogram is as follow:
WBC: 25.85 x 103/mm3, RBC: 2.56x106/mm3, Hb: 9.3g/dl, HCT: 31.7%, RDW-CV: 25%,
MCV: 123 fl, Platelets: 376 x103/mm3.
A. Determine the nutritional status of this child using the Welcome classification.
Answer: 82.3%, Normal nutrition
B. What type of anaeamia is this in view of the other blood indices?

Answer: Megaloblastic anaemia
C. Give 3 possible differentials, based on your findings.

Answer:
Sickle cell anaemia
Sepsis with leukemoid reaction
Leukaemia
D. Give 3 additional laboratory tests you would do to complete your assessment.
Answer:
Peripheral smear
Reticulocyte count
Bone marrow biopsy
Blood culture
72. A 6-month-old boy presents with cough and fever for 3 days, she was treated for the cough at
the local clinic a week ago and mum says there was not much improvement. On examination
the infant is in respiratory distress, however feeding okay and is active. On examination the
child has bilateral coarse crepitations and rhonchi with subcoastal recessions
A. What are your diagnosis and differential diagnosis, starting with the most likely?
Answer:
➢ Acute bronchiolitis
➢ Viral pneumonia
➢ Croup
B. What are the commonest organisms causing the above likely condition?
Answer:
➢ RSV
➢ Influenza virus
➢ Human metapneumovirus
➢ Rhinovirus
➢ Coronaviruses
➢ Parainfluenza virus
➢ Adenovirus
C. List some risk factors for the above condition?

Answer:
➢ Winter months
➢ Cardiac condition
➢ Chronic respiratory condition
➢ Immunosuppression
➢ Age <2 years
73. List the 10 steps in the management of severe acute malnutrition

Answer:
1. Treat and prevent hypoglycemia
2. Treat and prevent hypothermia
3. Treat and prevent dehydration
4. Treat and prevent infections
5. Correct electrolyte imbalances
6. Give micronutrients
7. Initiating F-75 feeds
8. Catch up F-100 feeds
9. Sensory stimulation and tender loving care
10.Discharge and follow up
74. List 10 parameters signifying severe malaria

Answer:
1. Convulsions (>2 generalized tonic clonic) other than febrile convulsion or Altered level
of consciousness (cerebral malaria)
2. Cardiovascular collapse (algid malaria)
3. Pulmonary oedema
4. Respiratory Distress syndrome
5. Severe anemia
6. Black water fever
7. Acute renal failure
8. Metabolic acidosis
9. Hypoglycemia
10. Hyperparasetemia
75. A3 and a half year old female child presents with noisy breathing and fever of 6 hours duration.
Prior to this she had been perfectly well. She was born at LMGH at full term with a birth weight
of 3.9kg. There were no neonatal problems. Her routine vaccinations are up to date and weight
gain has been adequate. There is no family history of note. On examination the patient looked
very ill with temperature 39.7oC, pulse 110/min, BP 110/78, dribbling of saliva from one
corner of the mouth, intercostal and subcostal indrawing with a clear chest. Blood
investigations reveal
Hb- 12g/dl
WBC- 20 x 109/L (polymorphs-84% and lymphocytes-12%)
Sodium 135mmol/L
Potassium 3.5 mmol/L
Urea 4.6 mmol/L
Urinalysis was normal

Answer: Acute epiglottitis
B. What is the most likely causative organism?

Answer: Hemophilus influenza type B
SECTION 4: TEST YOURSELF
TRUE/FALSE
1. The following organisms cause pneumatoceles on chest radiograph
A. Hemophilus influenza
B. Streptococcus pneumonia
C. Staphylococcus aureus
D. Pneumocystis carinii
E. Klebsiella pneumonia
2. Which organisms is a sickle cell patient particularly prone to?

A. Klebsiella pneumonia
B. Pseudomonas aeruginosa
C. Campylobacter pneumonia
D. Streptococcus pneumonia
E. Haemophilus influenza
3. In uncomplicated patent ductus arteriosus

A. CXR shows evidence of pulmonary plethora
B. There is systolic murmur best heard in left sternal border
C. There is a machinery murmur best heard in pulmonary areas in all phases of the cardiac
cycle
D. There is decrease pulse volume
E. Cyanosis is present
4. The following are recognized complications of long-standing Schistosoma infection

A. Portal hypertension
B. Splenomegaly
C. Katayama fever
D. Hydronephrosis
E. Carcinoma of the bladder
ESSAYS
1. Melanie, a Grade 11 adolescent, attends the OPD complaining of a recurrent genital thrush
which she claimed would clear after treatment, but would resurface few weeks later. This has
been going on for the past 4 months. She is HIV negative and feeling increasingly weak lately,
and has lost weight
A. Write down 2 conditions you would explore during your history taking
B. As you work out the case, you are availed the following results:
WBC: 13,000/mm3, Hb 9.5g/dl, MCV: 75.9fl, RBS: 9.4mmol/L, AST: 39 IU/L, Total
serum bilirubin 51 micromol/L
What is your diagnosis?
C. Write down one crucial investigation you would carry out to explain what is happening to
Melanie
D. Outline your management in 4 bullet points
2. Nalishebo is a 3-year-old girl who presents with edema and is underweight. The following are
her lab results:
Urea 2.5 mmol/L
Sodium 128 mmol/L
Potassium 3.5 mmol/L
Serum albumin 28g/L
Serum cholesterol 2mmol/L
Urinalysis:
Protein 2+
Blood 1+
Leucocytes: Numerous
A. What 2 other important physical features should be present in this child?
B. What is the most likely diagnosis?
C. What other diagnoses should be considered and treated?
3. Mabvuto is 3 years old and presents to the hospital after he convulsed twice at home. The
convulsion lasted about two minutes and he became unresponsive afterwards. He has a history
of fever for 3 days and has been less active and social than usual. He’s appetite has greatly
reduced. His urine was like “black tea” this morning. He has been previously well, and this is
the first episode of this nature. When you try to examine him, he refuses and says he doesn’t
want you to touch him, looks at his mother and cries to take him home. He is febrile with a
temperature of the 38.8 C and appears very pale and moderately Jaundiced. The rapid malaria
test is positive.
A. What is Mabvuto’s level of consciousness? (1 Mark)
B. What are the possible causes of Convulsions in Mabvuto? (2 Marks)
The following is Mabvuto haemogram
Reference range
WBC 19.7 6.0 - 18.0 10^3/uL
Lymphocytes# 9.36 3.00 - 9.00 10^3/uL
Monocytes# 0.54 0.00 - 1.00 10^3/uL
Neutrophils# 9.49 1.50 - 8.50 10^3/uL
Eosinophils# 0.20 0.00 - 0.40 10^3/uL
Basophils# 0.11 0.00 - 0.10 10^3/uL
RBC 2.3 3.60 - 5.20 10^12/L

Haemoglobin 4.9 12.0 - 14.0 10^3/uL
Haematocrit 15.4 36.00 - 52.00 %
MCV 67 66.0 - 94.0 fL
MCH 17.2 26-34 pg
MCHC 25.7 32.0 - 36.0 g/dL
RDW 17.9 11.7 - 15.0 %
Platelets 155 150 - 450 10^3/uL
C. What is your diagnosis and why? (3 Marks)

D. How would you manage Mabvuto? (4 Marks)
4. Bupe, an 11-month-old girl presents with the 3-day history of watery diarrhoea and vomiting.
Her mother says she has been progressively becoming weak and refuses to breastfeed. She has
also noticed that Bupe has had a fever for the past 2 days. Her mother admits that she has not
been taking Bupe for immunization due to the long distance to the clinic. They drink untreated
water from a well and use a pit latrine at their house. On examination, she inactive and is unable
to open her eyes or cry despite the mother trying to wake her up and the next picking her finger
to collect blood for malaria test. On examination, Bupe has sunken eyes a dry mouth and skin
pinch goes back in more than 2 seconds. She has cold hands and feet, weak thready pulse, and
capillary refill time of more than 3 seconds.
A. What is Bupe’s coma scale? (1 mark)
B. Classify Bupe’s level of dehydration? (1 mark)
C. What are the likely causes of diarrhoea and vomiting in Bupe? (2marks)
D. What is your diagnosis? (2 marks)
E. What would be Bupe’s initial management? (4 marks)
5. A 3- day old baby is referred to the hospital from the local clinic because the mother has noticed
that he appears yellow and weak from the time they were discharged from the local clinic. The
mother said that she was told that the yellowness would disappear with time. The baby was
born by normal vaginal delivery. She says the baby cried at birth and had started breastfeeding.
A. What is the diagnosis of this child? (1 mark)
B. What other information you obtain from the mother? (2 marks)
C. What investigations would you order? (4 marks)
D. How you proceed with the management of this child? (2 marks)
E. What complication(s) would you be concerned with in this child? (1 Mark)
6. 7-year-old Liseli presents with a history of joint pain and fever for the past 1 week. The pain
is in her left knee, her right elbow and both her ankles. She has been previously well apart from
a cough and sore throat for which he was given Paracetamol. On examination, you notice Liseli
keeps moving her right upper limb and lower limbs involuntarily and her mother thinks she is
just misbehaving. She has a temperature of 38.9 C. You also find a grade 3 non radiating
murmur on the Apex and an irregularly irregular heartbeat.
A. What is your differential diagnosis and why? (6 marks)
B. What investigations would you order? (2 marks)
C. What follow-up outpatient care would you give this child? (2 marks)
7. 2-year-old Michelo presents to the clinic with a history of weakness and refusing to eat for 3
weeks. He and his sister were treated for measles 4 weeks ago. Mother has noticed that he has
lost weight and some diarrhoea which stopped 2 days ago. There are no other complaints. On
examination, Michelo looks very wasted with skin discoloration on his chest and abdomen. He
is alert but miserable. He has no pallor, jaundice or cyanosis. He has swelling of both legs up
to the mid tibia and on the hands and face. His axillary temperature is 35.3 C and he weighs
6.5 kg and is 74 cm. He is also refusing to open his eyes to be examined. RBS is 2.9mmol/L.
All other vitals are within normal for his age.
A. Using the tables provided what is the standard deviation for Michelo’s weight for height?
(2 marks)
B. What is his diagnosis and why? (2 marks)
C. How will you initially managed Michelo? Use the critical pathway chart provided (6
marks)
PREPARED BY MOSES KAZEVU
8. A younger mother storms your consulting room panicking about a swelling on the head of
her well-looking 5-day old baby. She vehemently denies any history of trauma. On
examination, the baby is active, afebrile and in no apparent distress.
A. Write down your differential diagnosis.
B. On further questioning, the mother swears her baby’s head was perfectly well at birth
and she only noticed the swelling a day before. What is your most likely diagnosis?
C. Write 2 haematological parameters you would like to monitor with regard to your
diagnosis.
D. How would you manage this neonate
9. Bwalya, a 2-year-old toddler, is brought to the Paediatrics Emergency Services with a

history of diarrhoea and vomiting for the past 3 days. The stool is watery with no blood.
On examination, he is lethargic, too weak to take any fluid orally. His weight, recorded a
week ago, was 11 kg.
A. Classify this child’s state of dehydration
B. List down any 3 additional physical findings to support your answer
C. Lay down your rehydration plan and the fluid you would use for Bwalya
D. Write down the adjuvant treatment once the child is well hydrated
10. Makasa, a 3-year-old toddler, is admitted with pitting oedema of both legs up to the knees
and the hands. On further examination, weeping sores are elicited on both dorsalis pedis.
He is lethargic and weighs 7.8 kg. He was referred to the General Hospital at 10:00 but
mother only made it at 15:45 due to lack of readily available transport.
A. Give Makasa’s nutritional status using Welcome classification
B. State the stage of both the oedema and the skin lesions
C. What would be your first intervention as Makasa lands at the Emergency Department?
D. Give 5 possible contributing factors to Makasa condition
11. A 2-year-old toddler is brought to the Paediatric Emergency Department with a one week
history of progressive dyspnea, non-productive cough, fever and chills. He is cyanosed with
nasal flaring with chest recessions. The child was diagnosed with HIV 4 weeks and
commenced on antiretroviral therapy. His baseline CD4 count was 13%. Mother believes
the drugs are causing her son’s current sickness.
A. If the mother’s apprehension is true, what is your diagnosis?
B. What is the most likely chest condition the boy is suffering from?
C. Give 2 differentials
D. What do you think the CD4 would be at this point in time as compared to the baseline
(Low or High)
12. A male neonate born to a para 3 mother is admitted to NICU after 22 hours after birth with
rapidly progressive yellowing of the skin and the eyes with difficulties in breastfeeding.
His birthweight is 3.2kg and APGAR score of 8/10 – 8/10 – 9/10 at birth, 1 minute and 5
minutes respectively. Labour was uneventful and antenatal history normal.
A. Write down 2 questions you would ask the mother.
B. Give 4 possible diagnoses
C. Mention 5 investigations toward the jaundice in this neonate
13. A 6-year-old female is admitted to the Paediatric ward with a 2-week history of alternating
diarrhea/constipation, headaches and body hotness that occurs mostly in the evening and at
night. On admission, her body temperature is 39.1 C and heart rate of 100/min. Her
haemogram is as follow:
WBC:2.5 x 10₃/mm₃, Hgb: 8.4g/dl, Hct: 40%, MCV: 88fl, platelet count:100 x 10₃/mm₃
A. What is your mostly diagnosis?
B. What are the causative organisms?
C. What investigations would you carry out?
D. Name 5 systemic complications due to this condition
14. A 12 years old female from George compound developed painful right knee joint swelling
which after 4 days started to resolve and spread to involve the left ankle joint. She also had
fever, fatigue and dyspnea. Physical exam showed: BP :100/80mmHg, HR :112bpm,T:
38.3C axillary and RR of 26/min.
B. Mention 3 possible physical findings you would elicit to make the diagnosis complete
C. List down 5 investigations required for the diagnosis
D. Write down 3 risk factors for this condition
15. Mutale, a 10-month-old healthy infant, is rushed to the hospital with sudden difficult
breathing and copious oro-pharyngeal secretions. He was well until few minutes ago. He
has no fever. On further questioning, the maid said the only thing that crosses her mind is
that the house was painted the day before and Mutale was found with the lid of a container
left behind by the painter in his mouth.
A. What are you likely to find when examine the eyes of the infant?
B. What is your most likely diagnosis?
16. Peter, a 5 years old boy presents to hospital with history of choking while feeding since 6
months of age. He has a history of having convulsions since 9 months of age. He is unable
to sit or talk. On examination he is underweight, microcephalic and is spastic in all 4 limbs.
What is the full diagnosis of this child’s condition?
A. What is peters full diagnosis?
B. List two other possible causes of this condition
C. List the complications of this condition
17. A 7-year-old girl is brought to LMGH with a history of increased thirst, passing a lot of
urine, increased appetite and vomiting. She however, has lost a lot of weight in the last 2
weeks. On examination, she is severely dehydrated and lethargic with labored deep
breathing. Her investigation results are as follows:
RBS 16mmols
PH- 7.25
Urinalysis – leukocytes trace, Protein negative, Ketones 2+, Glucose 3+
A. What is your diagnosis
B. What are the principles of management of this condition
C. What are the short term and long term complications of this condition
18. Chansa, a 6-year-old girl is referred from Kasisi. The family lives by a stream where they
grow vegetables for some years. However, they have had problem getting drinking water
since the well ran dry. She has had few episodes of vomiting, fever and weakness for 10
days. On examination, her Glasgow Coma Scale is 8/15 and she is pale and jaundiced.
B. List down specific investigations to ascertain your diagnoses
19. The following haemogram was obtained from a 1 year old child who presented to the
Emergency Department: WBC: 21,000/mm3, HGB: 2.5 g/dl, MCV: 71 fl, Platelet count:
400 x10₃/mm₃, Hct:9%, RDW-CV: 26.4%
A. What are the abnormalities on this haemogram?
B. Write down 4 relevant questions you would ask towards your diagnosis?
C. What is your most likely diagnosis ?
D. Give 2 differentials
E. What is the significance of RDW-CV
F. List down 4 further investigations you would carry out to confirm your most plausible
diagnosis
20. Chibale, a 2-year-old boy, is brought to the Paediatrics OPD with swelling of feet. He has
sores in the mouth and has been coughing for the past 3 weeks. He weighs 7.5 kg.
A. Assign the nutritional status to Chibale based on Welcome classification
B. Write 2 most likely differentials in relation with the short history.
C. List down 6 investigations you would carry out to effectively manage Chibale’s
condition
D. What would the food of choice in case you decide to admit Chibale?
E. What is it made of?

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MK’S BAZOOKA

2. The commonest organisms causing meningitis in neonates:

6. The following are true of Infective endocarditis, except:

9. Which of the following is true of tetanus?

12. Choose the best answer concerning management of HIV in children

13. Which statement is true about treatment failure in HIV:

14. Concerning the diagnosis of HIV in children:

16. Concerning childhood urinary tract infection:

17. Splenic enlargement is seen in all these, except:

18. Which of the following statements regarding kernicterus is incorrect?

20. Which of these is not a complication of Chicken pox?

25. The following conditions are associated with microcephaly, except:

26. Recognized findings in iron deficiency anemia include, except:

27. A cause of nutritional cardiomyopathy is:

29. The following are specific to the intrinsic pathway, except:

30. Kerato-conjunctivitis is known to be as a complication of:

32. Pneumonia in childhood:

33. Symptoms referable to the larynx include:

34. The following statements about meningitis are false, except:

36. The following characteristics of malaria are true, except:

37. The following are features of complicated malaria, except:

40. The following conditions have wheezing in common, except:

42. The following characteristics of diabetes mellitus are true, except:

53. The following conditions are stage III, except:

59. The most logical sequence of events of Vitamin A deficiency is as follow:

60. The following are acceptable definitions of failure to thrive, except:

61. The following conditions may lead to failure to thrive, except:

64. The following are benefits of breastfeeding, except:

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

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

69. Which one of the following is false concerning malnutrition:

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

71. Refeeding syndrome may present with the following, except:

74. The following is true of Sickle Cell Disease, except:

93. The following are characteristic features of acute glomerulonephritis, except:

94. These haematological changes are characteristic of neonatal sepsis, except:

96. Late Onset Neonatal Sepsis is characterized by the following, except:

A. Bronchopulmonary dysplasia is partly as a result of high-pressure oxygen administration.

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

A. Affects only infants born under 34 weeks

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

103. Cerebral palsy can be best defined as:

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

107. The following conditions cause unconjugated hyperbilirubinaemia, except:

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

111. Which of the following is a clinical feature of congenital rubella:

A. Rubella Patent ductus arteriosus

115. The following true of Measles, except:

116. Complications of Measles include the following, except:

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

121. The following DO NOT apply to Rotavirus gastroenteritis, except:

122. The following are true of Down’s syndrome, except:

123. Subjects with Klinefelter syndrome have this in common, except:

124. Turner’s syndrome is characterised by the following, except:

125. The following are true about hydrocephalus, except:

A. Group B Streptococcus more common in infants

127. Lumbar puncture is contra indicated in the following circumstances, except:

128. Common causative organisms in children are:

129. The following are true of Malaria, except: