A 3 year old child presents with a macupapular rash which starts from the face and spreads downwards.

It is
accompanied by a high fever and conjunctivitis. Within a week the child develops croup. The most likely diagnosis is:
 Tick bite fever
 German measles
 Infectious mononucleosis
 Measles
 Roseola infantum

A previously healthy child aged 3 years presents with a 1 day story of acute onset vomiting after feeds and watery
o
diarrhoea. On examination the child has: temperature 37.8 C, pulse rate 130 per minute, capillary filling time 5
seconds. The skin turgor is much decreased and the child’s mouth is dry. The patient is quite lethargic. There is
acidotic breathing. Initial management must include which one of the following:
 Antiemetic therapy for vomiting
 Bicarbonate therapy for acidosis
 Blood tests to determine the serum sodium
 Intravenous resuscitation, followed by electrolytes
 Stool culture

A 15 month old boy is referred because he is very pale. He has become listless and tired. He eats sand in the
playground. His diet consists of at least a litre of fresh milk daily. He has no bruising, bone pain, lymphadenopathy
or splenomegaly. Which of the following is the most likely diagnosis in this case
 Anaemia of chronic infection
 Anaemia of malnutrition
 Thalassaemia minor
 Nutritional iron deficiency anaemia
 Folic acid deficiency anaemia

A 15 month-old boy is referred because he is very pale. He has become listless and tired. He eats sand in the
playground. His diet consists of at least a litre of fresh milk daily. He has no bruising, bone pain, lymphadenopathy
or splenomegaly. Which of the following is the most appropriate investigation at this stage
 Coomb’s test and reticulocyte count
 Haemoglobin electrophoresis
 Haemoglobin and smear
 Red cell osmotic fragility
 Serum iron and iron binding capacity

Characteristics of functional systolic murmurs include:

 associated with symptoms of heart failure
 becomes softer during fever
 louder in erect, softer in supine position
 occurs in mid systole, grade 3/6 or less
 second sound paradoxically split

Criteria for “benign” febrile convulsions include the following:

 age: less than six months, older than 3-4 years
 focal convulsion, duration less than 30 minutes
 intracranial cause for the fever
 no neurological deficit before or after the convulsion
 temperature less than 38,5 C
o

A negative Mantoux test in a 3 year old child with tuberculosis may occur as a consequence of:
 a previously completed course of anti-tuberculosis treatment
 intradermal instead of subcutaneous administration of PPD
 malnutrition
 previous BCG vaccination
 previous incomplete treatment of pulmonary tuberculosis
1 / 72
Which drugs for malaria prophylaxis will you recommend for a two-month old child, whose parents are planning a
visit to the Kruger Park during the summer holidays
 artemether-lumefantrine
 chloroquine and proguanil
 doxycycline
 mefloquine
 no prophylaxis needed

The perinatal mortality rate is used as an indicator of

 antenatal and obstetric care.
 the burden of malnutrition and infections in developing countries.
 the effectiveness of maternal and child health services at the time of delivery.
 the effectiveness of the neonatal follow-up clinics in hospitals.
 the overall environmental and health service inputs in a community.

How would you classify the following child according to both the Wellcome and Waterlow’s classification
Parameters: Weight for age 60-80%, Height for age 85%, Weight for Height 85%. Oedema present
 kwashiorkor, stunted only
 kwashiorkor, wasted and stunted
 marasmic kwashiorkor, stunted only
 marasmus, wasted only
 underweight, no wasting or stunting

Two-year-old Jannie rejects his parents’ offers of assistance and shows high levels of negativism. According to Erik
Erikson’s theory he is:
 showing signs of autism
 a child with a difficult temperament
 an anxiously attached child
 expressing the need for autonomy
 developing the capacity for symbolic representation

Convulsions in acute diarrhoea is NOT associated with one of the following:

 hypernatraemia
 hyponatraemia
 hypokalaemia
 meningitis
 venous sinus thrombosis

Which is the single most important psychological process during adolescence

 Discontinuity
 Emancipation
 Establishing an identity
 Peer group relations
 Testing of limits

Match a common clinical finding in Column B to each of the vitamin deficiencies in column A
Vit A def Xerophthalmia
Vit C def Irritability, pseudoparalysis of limbs
Vit D def Hypotonia, muscle weakness, bony deformities
Vit E def Haemolytic anaemia in newborns
Vit K def Haemorrhagic disease of the newborn
Megaloblastic anaemia
Pellagra
Peripheral neuritis, glossitis
Pseudotumor cerebri
Yellow staining of skin
2 / 72
Which of the following physical signs is most indicative of child abuse
 bruising anterior on the legs of a 18 month old child
 molluscum contagiosum
 mongolian spots
 a greenstick fracture
 sub-conjunctival, anterior chamber, and retinal haemorrhages

How would you treat the condition marked with the arrow
 Oral griseofulvin
 Topical steroid cream
 Systemic erythromycin
 Benzyl benzoate emulsion (Ascabiol)
 Topical antibiotics

In a patient with established rheumatic fever, which prophylactic

therapy is indicated to prevent the disease from recurring
 amoxycillin orally, before dental procedures and six hours later
 benzathine penicillin IM every three weeks
 gentamicin IV before genito-urinary procedures
 oral penicillin V for ten days
 procaine penicillin IM for ten days

In which of the conditions mentioned below will you continue to feed a child with gastroenteritis
 severe dehydration with metabolic acidosis
 severe dehydration and shock
 vomiting and dehydration
 abdominal distention and volvulus
 ileus

A common cause for pyrexia of unknown origin in developing countries is:

 Familial dysautonomia
 Familial Mediterranean fever
 Cat scratch disease
 Lyme disease
 Typhoid fever

Match a complication in Column B to each of the childhood illnesses in column A

Measles Corneal ulceration
Mumps Epidiymo-orchitis
Rubella Congenital infection with deafness
Varicella Cerebellar ataxia
Eczema herpeticum
Hypercalciuria
Rheumatic fever

Central cyanosis and finger clubbing occurs in which of the following conditions
 congenital mitral stenosis
 patent ductus arteriosus
 postductal coarctation of the aorta
 pulmonary valve stenosis
 ventricular septal defect

3 / 72
Seasonal allergic rhinitis in children is best treated by:
 antihistamines with a sedative effect
 intranasal steroids
 oral steroids
 prolonged use of nasal decongestants
 avoidance of allergens

Which of the following is NOT a “general danger sign” of serious disease in the IMCI strategy
 Anaemia
 Vomiting everything
 Coma
 Lethargy
 Inability to drink

Absolute contra-indications to breastfeeding include:

 baby crying immediately after feeding
 breast abscess
 aesthetic concerns
 maternal psychosis
 sore and cracked nipples

Which type of hepatitis can be described as follows: Parenteral transmission, complications and chronic liver disease
common, no specific treatment but highly effective prevention by vaccine.
 Hepatitis A
 Hepatitis B
 Hepatitis C
 Hepatitis E
 Hepatitis F

A four month old girl presents with this severely itchy skin condition.
Treatment includes:
 antihistamine ointment
 benzyl benzoate emulsion (Ascabiol)
 griseofulvin orally
 topical corticosteroids
 topical nystatin

J.N. is a 2 year old HIV infected boy. He presents with a chronic

cough. On examination he has cyanosis, clubbing and parotid gland
enlargement. The auscultation of his lungs reveals no abnormalities. He has been treated for tuberculosis for the
last 4 months without improvement. The likely diagnosis is
 bronchiectasis.
 Lymphocytic interstitial pneumonitis (LIP).
 Cytomegalovirus (CMV) pneumonitis.
 cor pulmonale.
 resistant pulmonary tuberculosis.

Breast development is viewed as adult when

 no separation is visible between contours of breast and areola
 the projection of areola and papilla (nipple) is above the level of the breast
 there is projection of papilla (nipple) alone due to recession of the areola
 there is enlargement of the diameterof the areola
 here is no separation between contours of papilla (nipple), areola and breast.

4 / 72
A two week old baby has yellowish scales on the scalp. The axillae and perineum are also involved. In areas the
lesions are moist. The most likely diagnosis is:
 Candidiasis
 Congenital syphilis
 Impetigo
 Seborrhoeic eczema
 Staphylococcal scalded skin syndrome

The term ”infancy” relates to which period

 The first seven days of life
 The first 28 days of life
 The first year of life
 The second year of life
 Age 2 to 5 years

Which of the following clinical signs is NOT considered to be a poor prognostic indicator in patients with kwashiorkor
 Severe anaemia
 Hypothermia
 Jaundice
 Hypokalaemia
 Hypoglycaemia

In which of the following cases may a lumbar puncture be done

 A bleeding tendency
 Focal neurological signs
 Skin infection in the lower back region
 Suspicion of a mass or spinal cord compression
 Where a CT scan cannot be done

Which of the following HIV tests are antibody detection tests

 HIV DNA PCR test
 p24 Ag test
 HIV viral load
 HIV Elisa test
 HIV RNA PCR test

Emesis is contra-indicated in which of the following type of poisonings

 Benzine
 Iron
 Paracetamol
 Salicylates
 Tricyclic antidepressants

Which of the following are contra-indications to measles vaccination

 A family history of convulsions
 Administration of intravenous immunoglobulin in the previous month
 Allergy to penicillin
 Kwashiorkor
 Prematurity

The incidence of sudden infant death syndrome may be (select the most probable)
 1/32
 1/580
 1/1000
 1/10000
 1/100000
5 / 72
A two-year old child presents with sweating, excessive salivation, small pupils and muscle fasciculations. His mother
states that he was well earlier in the day. The most likely diagnosis is poisoning with which of the following
substances
 Benzodiazepines
 Carbamazapine
 Carbamates
 Phenobarbitone
 Salicylates

A 1 year old child is found to have oedema, hepatomegaly and a desquamating skin rash. He is apathetic and
miserable. His weight is below the 3rd percentile. He has diarrhoea. The most likely diagnosis in this child is:
 Hepatitis B
 Kwashiorkor
 Marasmus
 Nephrotic syndrome
 Right heart failure

A 1 year old child presents with a two day history of acute onset of fever, vomiting and a bulging fontanel. A lumbar
puncture shows the presence of bacterial meningitis. Which of the following organisms is the most likely etiological
agent
 Streptococcus group B
 Listeria monocytogenes
 Escherichia coli
 Streptococcus pneumoniae
 Streptococcus pyogenes

An eight month old boy presents with irritability. He doesn’t want to move his legs. On examination there are
multiple bruises on his skin. There is beading of his ribs at the costochondral junction and x-rays of his long bones
show periosteal elevation. The most likely diagnosis is:
 Child abuse
 Osteitis
 Vitamin C deficiency
 Vitamin D deficiency
 Vitamin K deficiency

How long can a urine specimen be kept in transit before the bacterial colony count loses its clinical significance
 Two days (48 hours)
 Twenty minutes
 Four hours
 One week (7days)
 One hour (60 minutes)

What is included in the definition of “fever of unknown origin”

 Duration of fever longer than 3 months in adults
 Duration of fever longer than 1 maand in children
 No cause found after intensive investigations before admission to the hospital
 Temperature>38,3’C on several occasions
 Temperature >40’C on several occasions

A nine month old child presents with anaemia. He is irritable. A hypochromic, microcytic blood picture without a
reticulocytosis is seen on the blood smear. The most likely cause for his anaemia is:
 Inadequate intake of folate
 Inadequate intake of iron
 Inadequate intake of vitamin B12
 Sickle cell anaemia
 Thalassaemia minor
6 / 72
A five-year-old child develops an acute flaccid paralysis. Which of the following specimens must be sent to the
National Institute of Virology as part of the routine epidemiological investigation of such a case
 Cerebrospinal fluid for antibodies
 Cerebrospinal fluid for culture
 Serum for antibodies
 Stools for culture
 Urine for culture

The sympathetic system mediates many symptoms of hypoglycaemia. Which of the following symptoms is caused by
another mechanism
 Palpitations and tachycardia
 Coma and convulsions
 Sweating
 Abdominal pain and hunger
 Pallor

A two year old child presents with patchy areas of scaling and hair loss, which is hardly visible. The most likely
aetiological agent is:
 Candida albicans
 Larva migrans(Sandworm)
 Sarcoptis scabiei
 Streptococcus pyogenes
 Trichophyton violaceum (Ringworm)

The postneonatal mortality rate is used as an indicator of:

 Antenatal and obstetric care.
 The burden of malnutrition and infections in developing countries.
 The effectiveness of maternal and child health services at the time of delivery.
 The effectiveness of the neonatal follow-up clinics in hospitals.
 The overall environmental and health service inputs in a community.

Uncomplicated community acquired bacterial pneumonia in a 2 year old child should be treated with:
 Penicillin G
 Amoxicillin
 Cloxacillin
 Cefotaxime
 Ciprofloxacin

A child presents with the following: toxic appearance, malaise, high swinging fever, foul smelling sputum and
amphoric breathing. The most likely diagnosis is:
 Viral bronchiolitis
 Bacterial bronchopneumonie
 Bronchiectasis
 Lung abscess
 Lymphocytic interstitial pneumonia

Match a time period in Column B to each of the typical characteristics of adolescents in Column A:
Large peer group influence Early adolescence
Lack of insight Early adolescence
Egocentric thinking Early adolescence
Experimental risk-taking behaviour Middle adolescence
Non-compliance Middle adolescence
Search for identity Middle adolescence

7 / 72
Drug prophylaxis against Pneumocystis carinii pneumonia with co-trimoxazole should be instituted in which of the
following cases
 Immediately after birth in all HIV exposed infants
 Immediately after birth, only in infants with a low maternal CD4 count
 At the age of six weeks in all HIV exposed infants
 At the age of six weeks, only in infants with a low CD4 count
 Only after the first episode of infection with Pneumocystis carinii

A 3-year-old child presents with a productive cough, halitosis and clubbing. On auscultation there are widespread
crepitations and wheezes. The heart is located on the right side. The most likely diagnosis is:
 Lobar pneumonia
 Asthma
 Bronchiectasis
 Tuberculosis
 Pertussis

You are called to the delivery of a baby of 42 weeks gestational age with thick meconium stained amniotic fluid and
fetal distress. The obstetrician rapidly delivers the baby and hands him to you. The baby is hypotonic, cyanotic,
apnoeic, and bradycardic. The most appropriate next step is to
 stimulate the infant to breathe.
 provide mask ventilation
 administer adrenaline
 intubate the trachea and suction under the vocal cords before starting ventilation.
 apply oxygen by mask.

Which of the following is NOT an important clinical sign of SEVERE hypoxic ischaemic encephalopathy in neonates
 irritability
 coma
 seizures difficult to control
 hypotonia
 absent sucking reflex

A baby born at 38 weeks gestation was noticed to be Haemoglobin 15g/dl

jaundiced on the 2nd day of life. The following results were Unconjugated bilirubin 280 µmol/l
obtained. How will you manage this patient Direct Coombs’ test Weakly Positive
 Phototherapy Blood group:
 Immediate cessation of breastfeeeding Baby A Rhesus
 Observe and repeat bilirubin levels after 12 hours Mother O Rhesus
 Exchange transfusion with Group O Rh negative blood
 Vit K and antibiotics for preventing possible sepsis

Baby X was born at 28-weeks gestation. He was ventilated for 6 weeks. He is now 3 months old and being nursed in
a high care unit on 40% oxygen. What is the most likely complication he is suffering from:
 patent ductus arteriosis
 cataracts
 pulmonary interstitial emphysema
 pneumothorax
 bronchopulmonary dysplasia

Which of the following long-term health problems is NOT associated with a small size at birth
 Hypertension
 Coronary heart disease
 Diabetes insipidus
 Increased risk of learning problems
 Obesity

8 / 72
A seven year old child presents with focal convulsions. On CT scan a solitary cyst is seen within the left cerebral
hemisphere. X-rays of his thighs show multiple calcifications. The causative organism for his clinical picture is:
 Cytomegalovirus
 Schistosoma haematobium
 Taenia solium
 Tinea capitis
 M. tuberculosis

Which drugs for malaria prophylaxis will you recommend for a 10-month old child going to visit the Kruger Park
during the summer holidays
 artemether-lumefantrine
 chloroquine and proguanil
 doxycycline
 no prophylaxis needed
 mefloquine

An 8 month old girl presents with a high fever for the past three to four days. During this time she suffered from
febrile seizures. On day four the fever suddenly subsides and she develops a maculopapular rash on the trunk, arms
and neck. The most likely diagnosis is:
 erythema infectiosum
 measles
 roseola infantum
 rubella
 scarlet fever

Match a complication in Column B to the childhood illness in column A

Diphtheria Airway obstruction with a membrane
Infectious mononucleosis Hepatitis
Kawasaki syndrome Coronary artery aneurisms
Tetanus Autonomic nervous system disturbances
Whooping cough Persistent vomiting
Corneal ulceration
Epididimo-orchitis
Reye syndrome
Rheumatic fever

The clinical picture of HIV encephalopathy in children is characterized by the following:

 Decreased levels of consciousness and upper motor neuron signs
 Fever, irritability and neck stiffness
 Hemiplegia and upper motor neuron signs
 Acquired microcephaly, abnormal developmental milestones and upper motor neuron signs
 Microcephaly and blindness

Uncomplicated community acquired bacterial pneumonia in a 2 year old child should be treated with:
 Penicillin G
 Amoxicillin
 Cloxacillin
 Cefotaxime
 Ciprofloxacin

Which one of the following is a danger sign in the development of a one- year old baby
 Does not walk yet
 Says only 2 words
 Uses right hand preferably
 Still drinks from a bottle
 Has stranger anxiety
9 / 72
A 4-year-old boy has a history of repeated respiratory infections. From the history it appears that as a newborn he
experienced problems passing meconium. He is inclined to frequent flatulence with bad smelling flatus. The most
likely diagnosis is
 x-linked agammaglobulinemia.
 cystic fibrosis.
 congenital hypothyroidism.
 Hirschprung disease.
 a tracheo-esophageal fistula.

The most appropriate drug to keep the ductus arteriosus patent in a newborn with ductus dependent lesions such as
pulmonary valve atresia is:
 Captopril (Capoten)
 Furosamide.(Lasix)
 Prostaglandin E2. (Prostin VR)
 Propranolol (Inderal)
 Indomethacin. (Indocid)

Which one of the following is NOT a major criterium for the diagnosis of acute rheumatic fever according to the
modified Jones criteria
 Flitting polyarthritis
 Carditis
 Fever
 Sydenham’s chorea
 Subcutaneous nodules

Dysentery may be complicated by hemolytic-uraemic syndrome(HUS). Which of the following is NOT a feature of
HUS
 thrombocytopaenia
 hemolytic anemia
 positive Coombs test
 fragmented red blood cells on peripheral smear
 renal failure

A month old child presents with jaundice. The stools are pale. The AST, GGT and ALP are raised. No choledochal cyst
is visible on ultrasound. Correct management of this case includes:
 Collect urine for metabolic screening and refer later
 Phototherapy/Exchange transfusion
 Repeat thyroid function tests in one month and treat if necessary
 Treat for syphilis for ten days
 Urgent referral for further investigation

An 18-month-old boy has had upper respiratory symptoms for a couple of days. Since the previous day he has had a
hollow barking cough and noisy breathing. His temperarture is 37,8oC and a clear in- and expiratory stridor is
present. Which of the following organisms is the most likely causefor the child’s condition
 Haemophilus influenzae group B
 Staphylococcus aureus
 Parainfluenza virus
 Respiratory syncitial virus (RSV)
 Corynebacterium diphteriae

Which of the following is ALWAYS present in a child with Down syndrome

 a single palmar crease in one hand
 a wide space between the first and second toes
 significant hypotonia
 low set ears with overhanging helices
 a congenital heart defect
10 / 72
A previously healthy 1-year-old presents with an acute onset of cough and respiratory distress. Physical examination
reveals a respiratory rate of 60/minute and wheezing. There is no family history of asthma and no one at home is ill.
The older brother states that they have been playing outside. The most likely diagnosis is:
 anaphylaxis
 bronchiolitis
 cystic fibrosis
 foreign body aspiration
 angioedema

A two-year old child presents with sweating, excessive salivation, small pupils and muscle fasciculations. His mother
states that he was well earlier in the day. The most likely diagnosis is poisoning with which of the following
substances
 Benzodiazepines
 Phenobarbitone
 Carbamazapine
 Organophosphates
 Salicylates

A previously healthy child aged 3 years presents with a 1 day story of acute onset vomiting after feeds and watery
diarrhoea. On examination the child has: temperature 37.8’C, pulse rate 130 per minute, capillary filling time 5
seconds. The skin turgor is much decreased and the child’s mouth is dry. The patient is quite lethargic. There is deep
fast breathing. Which is the most appropriate way of investigating this patient
 Immediate blood gas analysis
 Urgent stool dipstix to identify cells and unabsorbed glucose
 Serum electrolytes after resuscitation
 Full blood count and differential white cell count
 Urgent chest X-Ray to explain the breathing pattern

Inheritance of which disease is represented below

 achondroplasia
 cleft lip
 Duchenne’s muscular dystrophy
 cystic fibrosis
 haemophilia A

A five-year old child presents with the following lesions.

 The most likely diagnosis is
 Chickenpox
 Warts
 Cystic acne
 Molluscum contagiosum
 Herpes simplex virus infection

A mother brings her 4-year old child to the general

practitioner. She complains of progressively worsening skin
lesions on the child’s face, which have been present for 2
weeks. Treatment given until now consisted of oral co-
trimoxazole, which she received from the clinic 10 days ago.
On examination the lesions are found around the mouth
and the nose, with extension into the nostrils. They are round and confluent with some superficial blisters, and
partly oozing with crusts formation. The most probable diagnosis is:
 impetigo
 chicken pox
 erythema multiforme
 Herpes simplex infection
 hand, foot, and mouth disease
11 / 72
A 4 year old boy presents with an acute onset of petechiae and epistaxis.Three weeks before he had a viral infection.
There is no history of drug ingestion. On examination no other abnormalities can be found. His platelet count is
markedly decreased. The white and red cell counts are normal. No pathological cells are visible on the peripheral
blood smear or bone marrow aspiration. Clotting and prothrombin times are normal. The most likely diagnosis is:
 acute lymphoblastic leukaemia
 haemophilia A
 hypersplenism
 idiopathic thrombocytopaenic purpura
 Von Willebrand’s disease

A mother brings her 18 month old child to the hospital. She says that the child fell from the swing 2 days ago, after
which the nanny said he seemed to be fine. He started complaining of pain in the right arm the next day. The child is
difficult to examine, as he cries inconsolable. On further questioning the mother says that the child is very shy and
does not trust strangers. The right arm is painful and swollen, and the X-ray reveals a humurus fracture. Your
assessment of the situation is that:
 The child should be investigated for osteogenesis imperfecta, as the described trauma does not fit in with the
clinical finding of a fractured humurus.
 A full developmental history is needed, as the history indicates the presence of a neurological disorder causing
slow development and an increased tendency towards falling.
 The child is in all probability a normal child who just fell from the swing and broke his arm.
 The mother is not the main caregiver of the child and therefore she is unable to give a good history concerning
the events leading up to the fracture.
 The mother’s history contains inconsistencies and child abuse should be suspected.

The most important association which results in pulmonary hypoplasia is

 when the mother had polyhydramnios
 unilateral multicystic kidney
 bilateral vesico-ureteric reflux
 tracheo-oesophageal fistula
 Posterior urethral valves and renal hypoplasia

A four year old child presents to the emergency department with a case of streptococcal peritonitis. What other
underlying condition is most likely present in this child
 proteinuria >3g per day
 duodenal ulcer perforation
 lobar pneumonia
 ruptured appendix
 α1 antitrypsin deficiency

Which method of treatment of high fever is harmful for a child

 Sponging
 Maintaining hydration
 Cold baths
 Administering paracetamol.
 Removal of excess clothes.

A four year old child presents in a coma at the casualty department. He has rapid breathing and his blood glucose
level is very high. Ketones are present in his urine and blood. Which of the following steps in the management of his
condition can be dangerous and shouldn’t be done
 addition of 5% dextrose to the infusion when the blood glucose has dropped to 12-15mmol/L
 addition of potassium chloride or potassium phosphate to the infusion once urine has been passed
 administration of short acting insulin (0.1u/kg/hour)
 administration of sodium bicarbonate if the pH is between 7.15 and 7.3
 intravenous infusion of 0,9% saline

12 / 72
A two-year-old child presents with the history of an abnormal gait for two weeks. At times he is feverish. On
examination he is pale and there is a bruise and a few petechiae on his back. His liver and spleen are palpable. The
most likely diagnosis is
 child abuse
 hemophilia
 juvenile chronic arthritis
 leukaemia
 Osteomyelitis

Hypernatraemia can be caused by which of the following conditions

 adrenal insufficiency
 diabetes insipidus
 nephrotic syndrome
 syndrome of inappropriate ADH secretion
 malnutrition

Which type of hepatitis can be described as follows: Faeco-oral transmission, infection mild or asymptomatic, no
chronic infection, complications rare
 Hepatitis A
 Hepatitis B
 Hepatitis C
 Hepatitis D
 Hepatitis F

A two-year old child presents to you with respiratory distress after ingesting paraffin. The most important aspect of
his immediate management is:
 administration of broad spectrum antibiotics.
 administration of oxygen.
 gastric lavage.
 induction of vomiting.
 intubation and lavage of the lungs.

The reason for obesity in MOST children is

 endocrinological disease.
 hypothalamic disease.
 chromosomal disease.
 formula feeding as a baby.
 a positive energy balance.

The first change of puberty in girls is

 menstruation.
 accelerated growth.
 breast development.
 dark axillary hair.
 weight gain.

Which of the following is NOT a reason for iron deficiency in children

 Thalassaemia minor
 Fresh cows milk
 Prematurity
 Too much milk and little solid food
 Hookworm infestation

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A 12-year old girl fainted at school. What is he most likely diagnosis
 Hypertensive crisis
 Epilepsy
 Syncopy
 Febrile seizure
 Breath holding spell

In which of the following paediatric conditions does clubbing commonly occur

 Asthma
 Cystic fibrosis
 Rheumatic fever
 Pneumococcal pneumonia
 Tuberculosis

A 12 year old girl presents with malaise, headache and nausea. After two weeks she develops fever and pharyngitis
with tonsillar exudates. Her general practitioner prescribes oral ampicillin after which she develops a general
maculo-papular rash. The most likely diagnosis is
 diphtheria
 infectious mononucleosis
 influenza
 rubella
 streptococcal pharyngitis

A 1 year old child presents with a two day history of acute onset of fever, vomiting and a bulging fontanel. A lumbar
puncture shows the presence of bacterial meningitis. Which of the following organisms is the most likely etiological
agent
 Escherichia coli
 Listeria monocytogenes
 Streptococcus group B
 Streptococcus pneumoniae
 Streptococcus pyogenes

Which of the following drugs can safely be administered to neonates

 amikacin
 chloramphenicol
 doxycycline
 thiouracil
 trimethoprim-sulfametoxazole

Which of the following is unlikely to be a long-term side effect of oncotherapy

 Infertility
 Intellectual deficiency
 Tall stature
 Lung fibrosis
 Secondary malignancy

The most important complication of vitamin K deficiency is

 anemia.
 xerofatalmie.
 scurvy.
 haemolytic anemia.
 haemorrhagic disease of the newborn.

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Which of the following is NOT a risk factor for sudden infant death syndrome
 Very low birth weight
 Adolescent mother
 Supine position while sleeping
 Maternal smoking
 Recent febrile illness

In the “septic process”, which term describes the following best - “Sepsis syndrome plus hypotension, or poor
capillary refill, that lasts more than 1 hour despite IV fluids and pharmacological intervention.”
 Bacteraemia
 Early septic shock
 Multi-organ dysfunction
 Refractory septic shock
 Sepsis

How will you manage the condition shown on the photo

 Acyclovir
 Acyclovir and topical steroids
 Topical antibiotics and systemic antibiotics
 Topical antibiotics and systemic steroids
 Topical steroids

Which of the following problems is NOT associated with the Attention Deficit and Hyperactivity Disorder
 Visual perceptual problems
 Teacher frustration
 Delays in fine motor development
 Poor parenting
 Conduct disorders

Which of the following is NOT an established psychological outcome of childhood abuse

 Dissociative reactions
 Positive self-esteem
 Compromised intelligence
 Sexual abuse perpetration
 Post-traumatic stress

The mildest form of a depressive spectrum disorder associated with adolescence is

 a dysthymic disorder
 an adjustment disorder with depressed mood
 a bipolar disorder
 a major depressive disorder
 suicidal ideation

Which of the following conditions is NOT a cause of oedema

 Nephrotic syndrome
 Nephritic syndrome
 Protein losing enteropathy
 Tetralogy of Fallot
 Liver cirrhosis

The most common cause for pyrexia of unknown origin in developing countries is
 metabolic disturbances
 drug fever
 malignancies
 infections
 collagen vascular diseases
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In a patient with rheumatic heart valve disease, which prophylactic therapy is indicated to prevent the development
of infective endocarditis
 Amoxycillin orally, before dental procedures and six hours later
 Benzathine penicillin IM every three weeks
 Oral penicillin V daily until the age of 20 years
 Oral penicillin V for ten days
 Procaine penicillin IM for ten days

You see a 4-year-old girl in the casualty department. The child has a temperature of 40oC. She sits leaning forward
and she drools. She is very anxious, her voice is soft and a soft stridor is present. The parents give the history that she
was completely well until a couple of hours ago. The most likely diagnosis is
 diphtheria
 laryngomalacia
 aspiration of a foreign body
 laryngo-tracheo-bronchitis
 epiglottitis

A five year old girl presents with a rash on her buttocks and legs. A few days ago she had an upper respiratory
infection. She complains of abdominal pain. Urinalysis shows a trace of blood. The most likely diagnosis is
 erythema infectiosum
 Henoch Schönlein purpura
 impetigo
 juvenile chronic arthritis
 measles

T.M. is a 4-month-old boy presenting at casualties with a sudden onset of a non-productive cough, rapid breathing
and fever. Examination reveals a deeply cyanotic child with signs of respiratory distress. No abnormal breath
sounds are heard on auscultation. The liver and spleen are both palpable and there is generalized lymphadenopathy.
He has severe oral thrush. The most probable cause of his respiratory disease is
 lymphocytic interstitial pneumonitis (LIP).
 Tuberculosis.
 Pneumocystis carinii pneumonia.
 heart failure.
 Haemophilus influenzae pneumonia.

Diabetes insipidus presents with which of the following metabolic consequences

 Hypernatraemic dehydration
 Hyponatraemic dehydration
 Fluid overload
 Hyperglycaemia, glycosuria, ketonuria
 Chronic renal failure

Decreased perfusion due to a vascular blow-out leads to extrinsic abnormalities. Which one of the following terms
describes it best
 Sequence
 Syndrome
 Disruption
 Deformation
 Malformation

Minor signs in the WHO classification of AIDS in children include:

 Chronic diarrhoea (>1 month)
 Perineal candidiais
 Persistent cough (>1 week)
 Prolonged fever (>1 month)
 Repeated episodes of otitis media
16 / 72
The following ECG abnormalities is seen in a patient in the intensive care unit: peaked T waves, flattening of the P
wave, prolongation of the PR interval and progressive widening of the QRS complex. Which of the following drugs
are contra-indicated in the management of this patient
 Calcium gluconate
 Glucose
 Insulin
 Potassium chloride
 Sodium bicarbonate

Wellcome and Waterlow Classification. Match the term in column A with the correct definition from column B
regarding the interpretation of a growth chart
Marasmus <60% of expected weight for age, no oedema
Wasting <80% of expected weight-for-height
Stunting Height for age <90% of expected height
Progressive weight loss relative to height centile
Kwashiorkor 60-80% of expected weight for age, oedema present
<60% of expected weight-for-height
60-80% of expected weight for age, no oedema
<60% of expected weight for age, oedema present
Weight below 60th centile
Height for age < 80% of expected height
Weight below 80th centile
Height below 90th centile
Height below 80th centile
rd
3 centile 3% of expected wieght
Nutritional deterioration Weight gain too slow relative to weight centile
th
50 centile 50% of expected weight
80% of expected weight
100% of expected weight
rd
Weight/age less than 3 centile

A 5-year-old girl presents with a mild febrile illness and macular rash, which spread down from the face and behind
the ears. Posterior cervical lymphadenopathy is also present. This is most likely a case of:
 Roseola infantum
 Infection with coxsackie virus
 Rubella
 Infection with echovirus
 Chickenpox

How will you manage the condition shown on the photo

 Acyclovir
 Acyclovir and topical steroids
 Topical antibiotics and systemic antibiotics
 Topical antibiotics and systemic steroids
 Topical steroids

Drugs are commonly used for sedation and analgesia in children. Match a
common adverse effect of each of these drugs, in column B, to the drug most
likely responsible for the adverse effect, in column A.
Aspirin Reye syndrome
Fentanyl Chest wall rigidity
Ketamine Hallucinations
Areflexia
Hepatic malignancies
Urinary retention

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The immunological effects in the child seen on the photo includes:
 Decreased B cell numbers
 Decreased cell mediated immunity
 Increased complement proteins
 Increased polymorph function
 T cell lymphocytosis

In a patient with established rheumatic fever, which prophylactic therapy is

indicated to prevent the disease from recurring
 Amoxycillin orally, before dental procedures and six hours later
 Benzathine penicillin IM every three weeks
 Gentamicin IV before genito-urinary procedures
 Oral penicillin V for ten days
 Procaine penicillin IM for ten days

The following are the most distinctive collection of symptoms after child sexual abuse:
 Depression, anxiety, hyperkinetic behaviour
 There is no distinctive collection of symptoms
 Alcohol abuse, low self-esteem, disordered sexual behaviour
 Revictimisation, dissociative reactions
 Borderline personality disorder

Which of the following factors do not contribute to the defect in vitamin K dependent clotting factors in the neonate
 The liver is relatively immature
 The baby’s Vit K stores are low at delivery
 The gut is sterile before birth
 Colostrum inhibits absorption of vitamin K
 There is relative vitamin K deficiency in breast milk

The incidence of the condition seen in the photo can be reduced by:
 Advising against pregnancy in women older than 35 years
 Advising mothers with the affected gene not to fall pregnant
 Cessation of cigarette smoking in pregnant women
 Folic acid supplementation, prior to and during pregnancy
 Maternal immunization against rubella

A three-year-old boy presents with a swollen elbow joint after falling at the crèche. There is a blue discoloration
over the joint. X-rays of the arm are normal. His mother mentions that his grandfather had similar problems. The
most likely diagnosis is:
 Idiopathic thrombocytopaenic purpera
 Hemophilia
 Henoch Schönlein purpera
 Osteogenesis imperfecta
 Scurvy

A two year old boy presents at the casualty department with the following symptoms and signs: dry mouth,
tachycardia, pupillary dilatation and hallucinations. His parents suspect that he ingested something. Which of the
following is the most likely cause of his clinical picture
 Benzodiazepines
 Iron tablets
 Mushrooms (inocybe)
 Organophosphates
 Tricyclic antidepressants

18 / 72
A four-year-old girl presents with bloody diarrhoea. She is anaemic. On her blood smear fragmented cells are seen.
She is hypertensive and oliguric. The most likely diagnosis is:
 Acute post-streptococcal glomerulonephritis
 Disseminated intravascular coagulation
 Haemolytic uraemic syndrome
 Sickle cell anaemia
 Typhoid fever

A patient is referred because of cough and difficulty in breathing and is found to be cyanosed. The most critical
aspect of management in her case is:
 Blood gas analysis
 Broad spectrum antibiotics
 Chest x-ray
 Intravenous fluids
 Oxygen administration

A month old child presents with jaundice. The stools are pale. The AST, GGT and ALP are raised. No choledochal cyst
is visible on ultrasound. Correct management of this case includes:
 Collect urine for metabolic screening and refer later
 Phototherapy/Exchange transfusion
 Repeat thyroid function tests in one month and treat if necessary
 Treat for syphilis for ten days
 Urgent referral for further investigation

An eight 8-year-old child snores when sleeping. Episodes of snoring are followed by short periods of silence, after
which the child awakens. Which of the following clinical signs do you expect to find on clinical examination
 Expiratory wheezes
 A palpable spleen and liver
 A Harrison’s sulcus
 Palpable closure of the pulmonary valve
 A tracheal tug

You see a 4-year-old girl in the casualty department. The child has a temperature of 39oC. She sits leaning forward
and she drools. She is very anxious, her voice is soft and a soft stridor is present. The parents give the history that she
was completely well until a couple of hours ago. Which of the following organisms is most likely responsible for the
child’s condition.
 Corynebacterium diphtheriae
 Haemophilus influenzae groep B
 Parainfluenza virus
 Respiratory syncitial virus (RSV)
 Staphylococcus aureus

Choose the WRONG statement concerning protein energy malnutrition in infancy:

 The diarrhoea of patients with protein energy malnutrition is only due to infection
 Fatty infiltration of the liver results in smooth hepatomegaly
 Immune deficiency is usually present
 The total body stores of potassium are severely reduced
 Such patients are apathetic and miserable

Choose the INCORRECT statement concerning the Road-to-Health Chart:

 It is a patient-held medical record
 It should be used only at the primary health service
 It lists the child's prenatal and birth history and risk factors
 It is a modified growth chart for mass gain in the first years of life
 It is an immunisation and well-baby follow-up attendance record

19 / 72
The following conditions may be associated with the nephrotic syndrome, EXCEPT:
 Malaria
 Mycoplasma infection
 Congenital syphilis
 Hepatitis B
 Mercury poisoning

Choose the WRONG statement concerning cerebral palsy:

 It is caused by damage to the motor areas of the developing brain
 The damage is a non-progressive disorder
 The frequency of cerebral palsy is the same in all countries of the world
 Some patients with cerebral palsy have a normal intellect
 Spastic cerebral palsy is the commonest form

Choose the CORRECT statement concerning acute flaccid paralysis in children:

 Poliomyelitis affects the anterior horn cells
 Poliomyelitis causes a symmetric ascending paralysis
 The Guillian-Barre syndrome is not associated with sensory loss
 In polio, the cerebrospinal fluid is always entirely normal
 The Guillain-Barre syndrome results in permanent paralysis in about 80% of patients

Choose the correct statement concerning tuberculosis in children:

 A newborn baby of a mother with tuberculosis should have a skin test for TB
 A newborn baby of a mother with TB should receive INH prophylaxis for 3 month
 A newborn baby of a mother with TB should be isolated in order to protect it from infection
 A newborn baby of a mother with TB should not be breastfed
 A newborn baby of a mother with TB should be given routine BCG vaccination

Choose the CORRECT statement concerning typhoid fever:

 The incubation period is less than 3 days in most cases
 In young children the disease may present with vomiting and diarrhoea
 Headache is a constant feature in all patients
 The examination findings are limited to the abdomen
 Hepatosplenomegaly is an infrequent finding

Staphylococcus pyogenes (aureus) is the commonest causative organism in patients with:

 Neonatal meningitis
 Toxic epidermal necrolysis
 Mucocutaneous lymph node syndrome (Kawasaki disease)
 Acute epiglottitis
 Acute glomerulonephritis

Petechial haemorrhages are frequently seen in the following, EXCEPT:

 Idiopathic thrombocytopaenic purpura
 Aplastic anaemia
 Acute lymphoblastic leukaemia
 Haemophilia
 Henoch Schonlein purpura

The major criteria for the diagnosis of rheumatic fever consist of the following, EXCEPT:
 Arthralgia
 Carditis
 Sydenham's chorea
 Subcutaneous nodules
 Erythema marginatum

20 / 72
The causes of neonatal hypoglycaemia include the following, except:
 Poorly controlled maternal diabetes mellitus
 Small for gestational age infant with asphyxia
 Transient neonatal diabetes mellitus
 Premature baby with septicaemia
 Delayed onset of feeding in low birth weight baby

The complications of a ventricular septal defect include the following, EXCEPT:

 increased susceptibility to infective endocarditis
 increased susceptibility to rheumatic fever
 increased susceptibility to lung infections
 pulmonary hypertension
 congestive cardiac failure

Bleeding in the neonate can be due to each of the following, EXCEPT:

 Thrombocytopaenia
 Disseminated intravascular coagulation
 Haemophilia
 Vitamin K deficiency
 Scurvy

Choose the correct statement concerning dietary protein deficiency in infancy:

 The normal protein requirements are independent of age
 Adults need more protein per unit body mass than children
 A low protein intake in infancy has no influence on final height
 Fatty infiltration of the liver indicates good energy reserves
 The gut is affected by a longstanding low protein intake

Choose the WRONG statement concerning Attention Deficit and Hyperactivity Disorder:
 ADHD is the most common neurobehavioural disorder affecting children
 ADHD is a hereditary condition
 Many children with ADHD have an associated learning disorder
 ADHD usually affects children with borderline IQ
 ADHD affects more boys than girls

The following features are typical of Down syndrome, EXCEPT:

 Hypotonia
 Single palmar crease
 Macrocephaly
 Upslanting palpebral fissures
 Clinodactyly

A mother with albinism has a child with albinism. Her husband looks normal. Which of the following statements
apply.
 The father is normal for the albinism gene
 This can't be the father of this baby
 The father is a carrier of the albinism gene
 This is yet another spontaneous mutation in the baby
 Both mother and father are heterozygote carriers of the abnormal gene

The following substances are teratogenic, EXCEPT:

 Magnesium
 Sodium valproate
 Alcohol
 Radiation
 Coumarin
21 / 72
What is the likely age of the child shown in the photograph
 4 months
 6 months
 9 months
 12 months

The following conditions are inherited in an autosomal dominant fashion, EXCEPT:

 Neurofibromatosis
 Phenylketonuria
 Adult polycystic kidney disease
 Huntington's disease
 Marfan syndrome

Match the diseases with the correct keyword from the list
Diphtheria Toxin
Measles Koplik spot
Chicken pox Myocarditis
Rubella Congenital
Pertussis Subconjunctival bleeding

The following statements are TRUE in relation to common childhood infections, EXCEPT:
 Meningitis is a common complication of mumps
 The maculopapular rash of measles usually develops before the Koplik spots appear
 Measles causes suppression of cellular immunity
 Rubella can be complicated by arthritis
 Erythema infectiosum is caused by a parvovirus

The ingestion of the following substances is potentially dangerous, EXCEPT:

 Prescription medicines
 Antiseptics
 Insecticides
 Petroleum products
 Oral contraceptives

Select the appropriate description for each condition

Protein energy def Growth failure
Zinc def Peri-anal erythematous maculo-papular rash
Nicotinic acid def Pigmente skin rash on exposed areas
Iron def Koilonychia
Vit A def Xerophthalmia
Energy def Little subcutaneous tissue
Folic acid def Smooth red tongue
Perifollicular haemorrhages

The immunodeficiency of severe malnutrition involves predominantly the

 B cells
 T cells
 macrophages

Choose the best description for each of the conditions concerning the assessment of cyanosis
Severe anaemia Not enough reduced Hb
Polycythaemia Excess reduced Hb
Shock and vasoconstriction Not enough peripheral circulation
Too little oxy-Hb

22 / 72
Match the descriptive statements with the conditions according to the Integrated Management of Childhood
Illnesses scheme
Sunken eyes and poor capillary filling Severe dehydration
Restless and sunken eyes Some dehydration
Fever for > 1 month and loss o weight on the RtHC Suspected symptomatic HIV infection
Severe chest indrawing Suspected serious bacterial infection
Infant not able to feed
Bulging fontanel
Apnoea attacks
Convulsions

The following statements are TRUE concerning Iron and Iron Deficiency, EXCEPT:
 Cow milk contains more iron than breast milk
 Breast milk iron is more bio-available than from cow milk
 The absorption of iron from cereal food is improved by vitamin C
 The absorption of iron from cereal food is improved by phytates
 The iron stores of low birth weight infants are depleted by 2 - 3 months
 The iron stores of low birth weight infants are depleted by 4 - 6 months
 Iron treatment is best given as ferric salt
 Term infants who are breastfed should receive supplements from 6 months
 Gastrointestinal blood loss is commonly associated with Hookworm
 The symptoms of iron deficiency include lethargy
 Iron deficiency can cause osmotic diarrhoea from lactase deficiency
 The red cells are hypochromic and microcytic in iron deficiency

Choose the WRONG statement concerning protein energy malnutrition in infancy:

 The diarrhoea of patients with protein energy malnutrition is only due to infection
 Fatty infiltration of the liver results in smooth hepatomegaly
 Immune deficiency is usually present
 The total body stores of potassium are severely reduced
 Such patients are apathetic and miserable

The following statements are TRUE concerning the survival of children with HIV infection, EXCEPT:
 Where AIDS is diagnosed under 1 year of age, survival is less than 2 years
 Early infection with Pneumocystis carinii carries a poor prognosis
 Children presenting with recurrent bacterial infections survive less than 1 year of age
 Children presenting with HIV encephalopathy survive less than 1 year
 Children with lymphocytic interstitial pneumonitis may survive up to 4 years after diagnosis

The following statements are TRUE concerning Haemophilus influenzae type B infections, EXCEPT:
 Meningitis occurs in patients older than 15 years of age
 Vaccination in infancy can prevent meningitis
 Epiglottitis presents with high fever and severe stridor
 Children under 2 years are at greatest risk of invasive disease
 Pneumonia occurs in a third of cases

The following statements are TRUE concerning the risk of vertical transmission of HIV from mother to child, EXCEPT:
 The risk is lower during the stable phase of the mother's infection
 The risk can be reduced by treating the mother with AZT during late pregnancy and labour
 The risk is increased by co-existing STD's in the mother
 Caesarean section should be advised in all cases in order to reduce the risk of transmission
 Maternal malnutrition increases the risk

23 / 72
The following statements are TRUE concerning febrile convulsions, EXCEPT:
 Can occur at any age
 There is an extracranial cause for the fever
 A family history is commonly present
 Complicated febrile seizures have an increased risk of subsequent epilepsy
 Rectal diazepam may be given at the time of fever for prophylaxis

The following statements are TRUE concerning respiratory infections, EXCEPT:

 Streptococcus pneumoniae is the commonest cause of bacterial pneumonia in young children
 Haemophilus influenzae usually causes lobar consolidation
 Mycobacterium tuberculosis infection may have few clinical findings
 Pneumatocoeles are often seen in association with pneumonia due to Staphylococcus aureus
 Pneumatocoeles may be seen in association with viral pneumonia

The following statements are TRUE concerning breastfeeding in babies, EXCEPT:

 The let-down reflex is mediated via prolactin
 Prolactin is involved in the milk production reflex
 The sucking reflex must be intact
 Breast engorgement is associated with an inadequate oxytocin mediated reflex
 Mother's attitude has a strong influence on her success with breastfeeding

Herpes stomatitis has the following features, EXCEPT:

 White plaque-like adherent lesions on the tongue
 Involvement of lips and gingiva
 Involvement of tongue and buccal mucosa
 Irregular confluent flat ulcers
 Severe pain and salivation

Which ONE of the following is NOT part of the definition of Fever of Unknown Origin
 Temperature > 38,3 C on several occasions
o

 Temperature > 40 C on several occasions

o

 Duration of fever longer than 1 week in children

 Duration of fever longer than 3 weeks in adults
 No cause found after 1 Week of intensive investigations

The following statements are TRUE concerning history-taking in paediatric patients, EXCEPT:
 The history is usually obtained indirectly from an adult
 The caregiver can be relied on to give a factually correct history
 The caregiver can be expected to give a pre-interpreted history
 The doctor's own circumstances influence his/her listening skills
 The doctor must create an atmosphere of trust for a good history

The causes of a liver palpable 5cm below the costal margin include the following, EXCEPT:
 Hepatitis
 Downward displacement
 Glycogen storage
 Situs inversus
 Malignant infiltration

The eye signs of vitamin A deficiency include the following, EXCEPT

 Night blindness
 Xerophthalmia
 Keratomalacia
 Cataract
 Bitot spots

24 / 72
The following conditions cause cyanosis in children, EXCEPT:
 Methaemoglobinaemia
 Fallot's Tetralogy
 Carbon monoxide poisoning
 Chronic destructive pneumonia

The following conditions cause coma in children, EXCEPT:

 Hypoglycaemia
 Acute encephalitis
 Acute transverse myelitis
 Acute encephalopathy
 Status epilepticus

The following conditions are associated with short stature, EXCEPT:

 Pituitary adenoma
 Emotional deprivation
 Thyroid aplasia
 Chronic renal failure
 Longstanding malnutrition

The following conditions cause facial pallor in children, EXCEPT:

 Generalised oedema
 Superior vena cava obstruction
 Cardiac failure
 Migraine
 Anaemia

The following statements are TRUE concerning Iron and Iron Deficiency, EXCEPT
 Cow milk contains more iron than breast milk
 The iron stores of low birth weight infants are depleted by 4 - 6 months
 The symptoms of iron deficiency include lethargy
 Breast milk iron is more bio-available than from cow milk
 The absorption of iron from cereal food is improved by vitamin C

Match the statements from Column B with the chronic diseases in column A
Tetralogy of Fallot Anaerobic metabolism
Coeliac disease Anorexia
Cirrhosis of the liver Defective protein synthesis
Diabetes mellitus Intracellular energy deficit
Chronic asthma Increased energy expenditure
Insomnia

The following statements are TRUE concerning simple obesity, EXCEPT:

 Energy intake exceeds expenditure
 The patient is tall and overweight
 It is more common with bottlefed babies
 It does not occur in breastfed babies
 There is an increased risk of orthopaedic disorders

Concerning hypoglycaemia in children, which of the following statements is TRUE:

 The symptoms are characteristic in all cases
 In premature newborn babies, hypoglycaemia is due to increased glycogen stores in the liver
 Gluconeogenesis maintains the blood sugar in prolonged fasting
 The acute symptoms do not include those of the stress response
 Hypoglycaemia in newborn babies does not cause brain damage

25 / 72
Choose the WRONG statement concerning the causes of hypoglycaemia:
 Malnourished children are predisposed because of low glycogen reserves
 Glycogen storage disease may be associated with hypoglycaemia
 Tumours producing insulin are associated with hypoglycaemia
 Endocrine causes of hypoglycaemia include hyperparathyroidism
 Liver failure is a cause of hypoglycaemia

Which of the following statements is TRUE concerning the symptoms of hypoglycaemia

 Sweating, pallor and palpitations are indicative
 Symptoms of sympathetic stimulation are always present
 Abdominal pain with sweating and tachycardia excludes hypoglycaemia
 Hypoglycaemia causes encephalitis
 When abnormal behaviour and confusion progresses to convulsions, hypoglycaemia is most unlikely

Which statement is TRUE concerning dietary protein :

 Protein requirements are independent of age
 Adults need more protein per unit body mass than children
 Cow's milk contains more protein than usual baby milk formulae
 A low protein intake in infancy has no effect on final height
 Protein deficiency never occurs without energy deficiency also

Choose the CORRECT statement concerning the weaning period

 Gastrointestinal infections are more common
 Weaning diets require specialised formulation
 The feed frequency should be reduced to that of adult routines
 Malnutrition occurs only in circumstances of poverty
 The change-over from breast feeding to mixed feeding is best done abruptly to help the infant adapt quickly

Choose the INCORRECT statement concerning an appropriate weaning diet

 Energy and nutrient dense
 Easily available to the family
 Appropriate consistency for the age and development of the child
 Clean and safe for consumption
 Scientifically formulated nutrient composition

The immunological effects of Protein energy malnutrition include the following, EXCEPT:
 T cell lymphopaenia
 Decreased cell mediated immunity
 Decreased B cell numbers
 Decreased polymorph function
 Decreased complement proteins

Choose the WRONG statement in relation to protein energy malnutrition

 It is characterized by growth failure
 Disease of malnutrition relates to failure of adaptation
 Kwashiorkor is the commonest form of PEM
 Growth hormone levels are usually elevated

Which of the following statements does NOT describe a well functioning family:
 There is no balance between stresses and resources
 Bereavement causes significant strain
 Individuals have good coping skills
 Empathy and goeie communication compensate for environmental strains
 Material and affective needs are met

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Which ONE of the following statements does NOT describe Candida albicans skin rash in babies
 Moist flexural areas are involved
 Discrete satellite papules and pustules are a charateristic feature
 The rash has a moist eroded surface and a brick-red colour
 The rash involves the scalp
 A secondary scaling rash can involve the trunk and limbs

What is the ideal time interval between the taking of two sets of blood cultures
 Two to three hours
 Twenty to thirty minutes
 One day (24 hours)
 One hour (60 minutes)
 Timing not important

Choose the one INCORRECT statement concerning eczema:

 It is an inflammatory skin disease affecting mainly the epidermis
 It is an inflammatory skin disease involving mainly the dermis
 The most important features consist of itching, dryness and scaling
 Subacute eczema has mainly papules with scaling
 Dryness of the skin is one of the most common causes in infants

Choose the one INCORRECT statement concerning blistering skin conditions:

 Congenital skin conditions do not cause blisters
 If the blister fluid is turbid, a bacterial infection is likely
 Contact dermatitis is a cause of blisters
 The poxviruses cause skin rash with blisters
 Eczema is a cause of blisters and itching

The following statements are TRUE concerning nappy rash, EXCEPT:

 It is an irritant contact dermatitis
 Typical ammonia dermatitis spares the flexures
 Seborrhoeic dermatitis of the nappy area involves the flexures
 Candida albicans is a common super-infection of nappy rash
 Atopic dermatitis does not involve the nappy area

The following statements are TRUE concerning herpesvirus infections, EXCEPT:

 HSV1 is the commonest cause of gingivostomatitis in children under 5 years
 The initial lesion on tongue and buccal mucosa is a vesicle
 The characteristic clinical finding is a series of painful shallow ulcers on the buccal mucosa
 The lesions are covered by an adherent white membrane which leaves bleeding points if scraped off
 The acute phase is self limiting after 4 to 9 days

The following statements are TRUE concerning immunization in children, EXCEPT:

 Children over 2 years of age who missed immunization in infancy should have the complete course of vaccines
 Babies of HIV infected mothers must be vaccinated according to the normal schedule
 Immunosuppressed children should not be given live vaccines
 DTP should not be given to children with progressive CNS disease
 Cerebral palsy is not a contra-indication to vaccination

The following statements are TRUE concerning measles, EXCEPT:

 A haemorrhagic rash is associated with severe disease
 Post-measles staining of the upper trunk and back is a typical feature
 An atypical rash in measles denotes some prior immunity
 Measles rash involves the palms and the soles
 An identical skin rash can be seen in other conditions

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The following are regarded as risk factors for child abuse, EXCEPT
 Teenage mothers
 Premature babies
 One child families
 Twins
 Child with a mental or physical handicap

Choose the CORRECT statement amongst the following concerning child abuse:
 The differential diagnosis includes Mongolian spots
 Patients with osteogenesis imperfecta do not have fractures of different ages
 Sexual abuse is most commonly committed by a stranger to the child
 Parents give convincing stories to explain the injuries
 Munchhausen syndrome by proxy is not a manifestation of child abuse

Choose the one INCORRECT statement concerning the history in cases of child abuse
 There may be a changing explanation for the injury
 The injury is incompatible with the child's stage of development
 The injury is incompatible with the circumstances described by the caregiver
 A child with a bleeding disorder does not have non-accidental injury
 Child abuse is more often suspected than proved

The following statements are UNTRUE concerning the effect of drug abuse on children, EXCEPT:
 The only effect on the unborn baby of a drug abusing mother is related to possible teratogenicity
 Children of drug abusing parents are at risk of becoming drug abusers themselves
 The effect of alcohol on children is the same as in adults
 Solvent and glue sniffing does not cause permanent brain damage
 Children of drug abusing families are not at risk of nutritional or educational deprivation

The following statements are TRUE concerning psychosocial problems in school aged children, EXCEPT:
 A learning disorder indicates defective intelligence
 Reading disorder (dyslexia) occurs in 5% of children
 Diurnal enuresis is more likely to be due to organic disease than nocturnal enuresis
 A 5 year old child with non-organic enuresis requires active management
 Atypical stereotyped movement disorders occur more frequently amongst children with mental retardation than
in normal children

The following statements are TRUE concerning paediatric HIV infection, EXCEPT:
 Most of the transmission occurs during delivery
 Bacterial infections occur before other features of HIVinfection are evident
 Lymphocytic interstitial pneumonitis is difficult to distinguish from tuberculosis on chest X-ray
 Abnormal immunological reactions are responsible for many manifestations
 Lymphocytic interstitial pneumonitis frequently presents in the first 6 months of life

The following statements are TRUE concerning Paediatric AIDS, EXCEPT:

 The polymorph neutrophils are not involved
 Hyperglobulinaemia is an early finding
 There are abnormal antibody responses to many antigens
 There is a total lymphopaenia
 There is a reversal of the CD4:CD8 ratio

The following statements are TRUE concerning accidental poisoning, EXCEPT:

 All patients who have ingested tablets should be made to vomit
 Organophosphate poisoning causes inhibition of cholinesterase
 Belladonna poisoning causes dilatation of pupils
 Valium overdosage causes respiratory depression and hypotension
 Gastric lavage is contraindicated in cases of corrosive poisoning
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The following statements are TRUE concerning salicylate poisoning, EXCEPT:
 Activated charcoal should be given in cases of suspected aspirin poisoning
 Salicylate poisoning can cause fever
 Tachypnoea is due to stimulation of the respiratory centre
 Salicylate poisoning leads to multi-organ failure
 Salicylate poisoning causes a hypercoagulable state

Choose the one INCORRECT statement in relation to recurrent infections:

 Children living in overcrowded conditions have frequent infections because of increased exposure
 A normal child can have 5 to 6 infections per year
 Recurrent infections are significant if they are associated with failure to thrive
 Recurrent infections are significant if due to the same organism or at the same site every time
 A child with 5 or 6 infections per year must be investigated for immunodeficiency

The following statements are TRUE concerning Primary Immune Deficiencies (not AIDS), EXCEPT
 Primary Immune Deficiencies are quite rare
 They present with unusual infections
 IgA deficiency occurs in 1: 300 to 1: 500 of the population
 Primary Immune Deficiency is possible if a child does not improve despite adequate and appropriate therapy
 Carry a good prognosis with antibiotic treatment

The following statements are TRUE concerning Tuberculosis in children, EXCEPT:

 HIV infected children get TB from their parents
 Primary Complex TB does not usually have positive sputa or gastric washings
 Miliary TB occurs usually within 6 months of primary infection
 Miliary TB is associated with tuberculous meningitis
 Cavitating lung TB occurs commonly in primary infection

The following statements are TRUE concerning Tuberculosis in children, EXCEPT:

 A positive skin test is diagnostic of TB in children over 8 years of age
 A positive skin test is indicative of good cellular immunity
 The spread of miliary TB is poorly localized because of poor cellular immunity
 Unreactive TB is associated with a high bacillary load in sputum or tissues
 There is no typical radiological appearance of TB in patients with AIDS and TB

The following statements are TRUE concerning Chickenpox, EXCEPT:

 Chickenpox and herpes zoster are caused by the same virus
 Chickenpox is infective only after the vesicles appear
 The vesicles of chickenpox are not all of the same age, but appear in crops
 The Guillain Barre syndrome is a recognized complication

The following statements are TRUE concerning Epstein Barr virus infection in children, EXCEPT:
 The majority of infections are subclinical
 In underdeveloped communities the majority of children are seropositive by 6 years of age
 The IgM antibody to viral capsid antigen (VCA) is indicative of recent infection
 The commonest presentation in babies and young children is the classical syndrome of infectious
mononucleosis
 EBV is a herpes virus and exhibits latency and reactivation

The following statements are TRUE concerning a haemorrhagic rash and fever, EXCEPT:
 Viral haemorrhagic fevers must be considered in the diagnosis
 This is always due to a fulminating infection
 The rash of meningococcal septicaemia spreads very rapidly
 Rickettsia infections must be considered in the diagnosis
 Such patients must be given intravenous antibiotics immediately and referred to hospital

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The following statements are TRUE concerning teratogenic influences on foetal development, EXCEPT
 Fetal alcohol exposure must exceed 80 g per day to result in any effects
 The fetal alcohol syndrome is the commonest teratogenic condition in the Western Cape.
 The fetal alcohol syndrome manifests as a small-for-gestational-age baby at birth.
 Teratogenic influences cause a common developmental timing of various defects.
 Rubella is the commonest teratogenic virus.

The following statements are TRUE concerning pain, EXCEPT

 Children may complain of pain to get attention.
 Functional pain is imagined pain.
 There are objective physiological features associated with severe pain
 Unrelieved pain leads to emotional reactions.
 Manipulative children may also have real pain.

The following statements are TRUE concerning inflammatory diseases, EXCEPT

 Fever is a regular feature.
 Inflammation is a host response to antigens.
 Allergic disease results in inflammation.
 All immune processes are protective.
 Chronic systemic disease can present acutely.

The following statements are TRUE concerning solid tumours in childhood, EXCEPT:
 There are geographic differences in the incidence of these tumours.
 Wilms tumour has a genetic basis in 20% of cases.
 Solid tumours are treated with surgery alone.
 Brain tumours are the second most common malignancies in children.
 Supratentorial brain tumours are more common in infants.

The list of screening tests for patients with bleeding tendency includes the following, EXCEPT:
 Platelet count.
 Bleeding time.
 Factor VIII assay.
 Prothrombin time.
 Partial thromboplastin time.

The following statements are TRUE concerning leukaemia in children, EXCEPT:

 Acute non-lymphocytic leukaemia is more common in Black children than in Whites.
 Leukaemia is the commonest malignancy of childhood.
 There is a predisposition to leukaemia in children with chromosome disorders.
 The commonest symptom of leukaemia is pallor and tiredness.
 The treatment of leukaemia is independent of the morphological characteristics of the disease.

The following statements are TRUE concerning mental retardation, EXCEPT:

 The degree of mental retardation can be diagnosed accurately by 2 years of age.
 Affected children can sometimes have normal physical milestones.
 Cerebral palsy is often associated.
 In many cases deaf children are wrongly labelled as mentally retarded.
 Mentally retarded children can suffer from psychological disturbances.

The following statements are TRUE concerning bleeding disorders, EXCEP

 Purpura refers to bleeding into the skin.
 Petechial haemorrhages are caused by haemophilia.
 Palpable purpura is seen in vasculitis.
 Coexisting petechiae and ecchymosis suggests a severe platelet disorder.
 Gastrointestinal haemorrhage occurs in vitamin K deficiency.

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Choose the ONE diagnosis which fits the following case scenario most closely: Boy, age 2, chicken pox 2 weeks ago,
now nose bleed, petechiae on skin, bleeding into conjunctiva
 Acute leukaemia.
 Disseminated intravascular coagulation.
 Thrombotic thrombocytopaenic purpura.
 Meningococcal septicaemia.
 Idiopathic thrombocytopaenic purpura.

Choose the ONE description which is NOT a common danger sign of cancer in children:
 Headache, fever and vomiting.
 Headache, vomiting and ataxia.
 Abdominal distension and mass.
 Pallor and pain around the joints.
 Spontaneous bruises and pallor.

Choose the ONE statement which does NOT apply to rheumatic disorders of childhood
 Pericarditis can occur.
 Polyserositis can occur.
 Inflammatory bowel disease can be associated.
 Psoriasis can be associated.
 Asthma can be associated.

A little boy of 18 months cried, turned pale, developed a bradycardia followed by a couple of tonic clonic seizures of
the arms and legs. What is the most likely diagnosis
 Hypertensive crisis.
 Breath holding spells.
 Epilepsy.
 Syncope.
 Cardiac dysrythmia.

Which of the following statements is UNTRUE in respect of children suffering from depressive disorders:
 Failure to gain weight as expected.
 Irritable mood.
 Disinterested in toys.
 Weight loss.
 Suicidal thoughts.

Which pharmacological intervention has become the first line in drug treatment of depressive disorders of children
and adolescents:
 Tricyclic antidepressants.
 Selective serotonin re-uptake inhibitors.
 Mono-amine oxidase inhibitors.
 Mood stabilizers.
 Antipsychotic drugs.

Choose the ONE diagnosis which should NOT be considered in a 7 year old child who presents with inattention,
hyperactivity and impulsivity:
 Manic episode in bipolar disorder.
 Anxiety in separation anxiety disorder.
 Temperamental constellation.
 Temporal lobe epilepsy.
 Conduct disorder.

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Which of the following statements does NOT apply to a preschool child:
 Temper tantrums can be associated with breath holding spells.
 Sleep disorders are best treated with hypnotics.
 Frequent nightmares may indicate excessive stress within the family.
 Persistent masturbation may become a problem in a deprived or retarded child.
 Sexual abuse must be suspected in a young child with precocious sexual behaviour.

Which ONE of the following statements describes the term "empirical antibiotic therapy" best:
 Broad spectrum therapy administered blindly.
 Prophylactic antibiotics administered after surgery.
 Treatment guided only by the laboratory results.
 Treatment guided only by the clinical presentation of the patient.
 Alteration of treatment after the laboratory results are known.

When a family are visiting a doctor for genetic counselling when having a baby with a birth defect or genetic
condition they are expecting to receive information. Choose the WRONG statement.
 They would want to know what the condition is their baby is suffering of and what the causes are.
 Information about what they should do in future pregnancies.
 How the condition can be treated and/or ameliorated.
 The natural history and prognosis of the disorder.
 The chances of recurrence in family members and how it can be reduced.

Answer True or False for each of the following statements concerning the recurrence risk in inherited disease:
 Autosomal dominant: 1 in 2 for each child. (T)
 Autosomal recessive: 1 in 4 for each child. (T)
 Sex-linked recessive: 1 in 2 for male children. (T)
 Multifactorial inheritance: 1 in 20 for each child. (T)

Answer True or False for each of the following statements.

The indications for chromosome studies include:
 Mental retardation with associated dysmorphic features. (T)
 Multiple congenital abnormalities. (T)
 Foetal alcohol syndrome. (F)
 Ambiguous genitalia. (T)
 Recurrent spontaneous abortions, stillbirths or unexplained neonatal deaths. (T)
Screening for health problems is of value if:
 The condition has a significant impact on child health in the local context. (T)
 It allows early diagnosis of an untreatable condition. (F)
 The condition has a presymptomatic phase during which intervention can take place (T)
 Screening and confirmatory tests are available and affordable. (T)
 Early treatment of the condition influences its progression. (T)

Answer True or False for each of the following statements concerning Haemophilus influenzae type B infections:
 Meningitis occurs in patients older than 15 years of age. (F)
 Vaccination in infancy can prevent meningitis. (T)
 Epiglottitis presents with high fever and severe stridor. (T)
 Children under 2 years are at greatest risk of invasive disease. (T)
 Pneumonia occurs in a third of cases. (T)

Answer True or False for each of the following statements concerning a handicap.
 Handicap refers to the social consequence of a disability like paraplegia. (T)
 The commonest form of handicap in children is spina bifida. (F)
 Handicap is best managed in a hospital setting. (F)
 The recognition of childhood handicap is of no real importance in a curative health system because little can be
done. (F)
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  Exact diagnosis is not necessary as the emphasis must be on rehabilitation. (F)
Answer True or False for each of the following statements concerning the risk of vertical transmission of HIV from
mother to child
 The risk is lower during the stable phase of the mother's infection. (T)
 The risk can be reduced by treating the mother with AZT during late pregnancy and labour. (T)
 The risk is increased by co-existing sexually transmitted diseases in the mother. (T)
 Caesarean section should be advised in all cases in order to reduce the risk of transmission. (F)
 Maternal malnutrition increases the risk. (T)

Answer True or False for each of the following statements concerning tuberculosis in children:
 BCG vaccination reduces the risk of miliary TB. (T)
 A positive skin test does not correspond to immunity. (T)
 Tuberculin skin tests are negative in the presence of immunodeficiency. (T)
 The Mantoux test is done by injecting tuberculin subcutaneously. (F)
 Chemoprophylaxis must be given to all children under 6 years of age in contact with an infectious case of TB.
(T)

Answer True or False for each of the following statements concerning the survival of children with HIV infection
 Where AIDS is diagnosed under 1 year of age, survival is less than 2 years. (T)
 Early infection with Pneumocystis carinii carries a poor prognosis. (T)
 Children presenting with recurrent bacterial infections survive less than 1 year. (F)
 Children presenting with HIV encephalopathy survive less than 1 year. (T)
 Children with lymphocytic interstitial pneumonitis may survive up to 4 years. (T)

Select one symptom of cardiac failure in babies which is least likely to be correct.
 Inappropriate tachycardia
 A heart murmur
 A gallop rhythm
 Tender hepatomegaly
 Sweatiness and pallor while feeding

A number of different pathologies cause persistent neonatal jaundice. Select the statement which is least likely to
be correct.
 Biliary atresia causes conjugated hyperbilirubinaemia.
 Neonatal hepatitis can lead to cirrhosis.
 Galactosaemia is a cause.
 Wilsons disease results in early hepatic decompensation.
 Congenital hypothyroidism must be excluded.

The following statements describe the clinical signs of pneumonia. Select the statement which is least likely to be
correct.
 The signs of infection include fever and "toxicity".
 The signs of respiratory distress include tachypnoea and recession.
 Lung consolidation is diagnosed by dullness to percussion and altered breath sounds.
 In atypical pneumonia the degree of distress is worse than the auscultatory findings suggest.
 Crackles and wheezing are indicative of pneumonia.

Acute poststreptococcal glomerulonephritis (APSGN) must be differentiated from other types of renal disease. Select
the statement which is most likely to apply to APSGN.
 Heavy proteinuria
 Hypercholesterolaemia
 Normal blood pressure
 Low complement level
 Normal glomerular filtration rate

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A 1 year old child is found to have oedema, hepatomegaly and a desquamating skin rash. He is apathetic and
miserable. His weight is below the 3rd percentile. He has diarrhoea. Choose the statement which is most likely to be
true concerning his problem.
 The hepatomegaly is caused by an inflammatory cell infiltrate in the liver.
 He can be confidently expected to have a positive HIV Elisa test.
 Kwashiorkor is precipitated by infection in a malnourished child.
 A normal serum potassium level reflects normal body stores.
 Absence of fever is a good sign that he does not have serious infection.

The following statements describe typical aspects of epilepsy in children. Which of the following statements is not
true.
 Infantile spasms occur in the first year of life.
 Temporal lobe epilepsy is associated with typical myoclonic jerks.
 Petit mal epilepsy has a classical EEG pattern.
 Infantile spasms are associated with mental retardation.
 Temporal lobe epilepsy manifests with behavioural and psychosensory features.

The diagnosis of acute rheumatic fever is based on the modified Jones criteria plus a history of streptococcal
infection. Which of the following does not belong in this list.
 Flitting polyarthritis
 Carditis
 Erythema multiforme
 Sydenham's chorea
 Subcutaneous nodules

A 1 year old child presents with an acute onset of fever, vomiting and a bulging fontanel. A lumbar puncture shows
the presence of bacterial meningitis. Select the statement below which is most likely to be true.
 Neck stiffness is not observed when the anterior fontanel is still open.
 Haemophilus influenzae type B affects predominantly children older than 5 years of age.
 This child's prognosis is independent of the duration of disease before diagnosis.
 All family contacts of patients with Haemophilus influenzae type B meningitis need prophylactic Rifampicin.
 Haemophilus influenzae type B meningitis can be prevented by vaccination of all infants.

Measles is associated with a large number of complications. Select the statement below which is least likely to be
true.
 Diarrhoea is a frequent complication.
 The immune suppression after measles involves predominantly the B cells.
 Measles is often associated with stridor.
 Deaths are usually due to the respiratory complications.
 Pneumonia associated with measles is often due to secondary infection.

The following statements describe infantile autism. Select the statement which is least likely to be correct.
 With special schooling these children can lead an independent normal life.
 The incidence is 2 - 4 per 10 000.
 The degree of handicap is worse than the degree of mental retardation.
 They have a characteristic impairment of social interaction and communication.
 There is delayed speech development.

The following statements describe the Road-to-Health Card. Which of the statements is wrong
 It carries information about birth and other risk factors.
 It is an immunization record.
 It is a modified growth chart.
 It is specific for boys or girls.
 It is a patient-held health record.

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The following statements describe aspects of infant and child mortality rates. Which of the statements below is
wrong
 The perinatal mortality rate reflects the quality of antenatal and obstetric care.
 The perinatal mortality rate includes still births and early neonatal deaths.
 The neonatal mortality rate measures the effectiveness of maternal and child health services at the time of
delivery.
 The infant mortality rate compares the number of deaths under 1 year with the total number of births in that
year.
 The under 5 mortality rate reflects overall environmental and health service inputs in a community.

Babies are often fed cow's milk or formula and grow very well. Which of the statements below is most likely to be
true
 Modern baby milk formula has the same advantages as breast milk.
 Breast milk has advantages above baby formula apart from its nutritional composition.
 Cows milk has a much higher caloric value than breast milk.
 Cows milk contains less protein than human breast milk.
 Cows milk contains more lactose than breast milk.

Haemophilus influenzae type B infections are commonly seen in young children. Select the statement which is least
likely to be correct.
 Epiglottitis presents with high fever and severe stridor.
 Children under 2 years are at greatest risk of invasive disease.
 Pneumonia occurs in a third of cases of invasive infection..
 Invasive disease may present with septic arthritis.
 Meningitis occurs in patients older than 15 years of age.

The following statements describe different aspects of handicap in childhood. Select the statement which is most
likely to be true.
 The commonest cause of handicap in children is spina bifida.
 Handicap is best managed in a hospital setting.
 The recognition of childhood handicap is of no real importance in a curative health system because little can be
done.
 Handicap refers to the social consequence of a disability like paraplegia.
 Exact diagnosis is not necessary as the emphasis must be on rehabilitation.

The Foetal Alcohol syndrome is a common teratogenic dysmorphic condition. Choose the wrong statement
concerning the foetal alcohol syndrome.
 There is a dose dependent relationship between alcohol exposure and manifestations of the syndrome.
 Heart defects are seen.
 Facial dysmorphisms are common.
 Chromosomal breaks occur.
 Growth failure is usual.

The following statements describe the age periods of childhood. Select the wrong statement.
 The perinatal period ends 7 days after birth.
 The late neonatal period extends from day 8 to 28 after birth.
 Infancy relates to the period from birth to five years.
 School age relates to the period from 6 years to adolescence.
 Adolescence refers to the period between puberty and adulthood.

Measles has numerous complications. Choose the answer which is NOT likely to be correct:
 Diarrhoea is a frequent complication
 Measles often causes thrombocytopaenic purpura
 Measles is often associated with stridor
 Deaths are usually due to the respiratory complications
 Pneumonia associated with measles is often due to secondary infection
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Choose the WRONG answer concerning pertussis:
 Babies obtain transplacental immunity from their mothers
 The organism causes necrosis of ciliated epithelium of the respiratory tract
 The characteristic whoop is due to forceful inspiration
 Vomiting often occurs in the paroxysmal stage
 The cough may last for three months

Choose the most accurate statement concerning the complications of typhoid fever:
 Neurological complications are commoner in children than in adults
 Patients with typhoid fever do not develop cardiac failure
 Patients with typhoid fever commonly have haemolytic anaemia
 Thrombocytopaenia occurs only as a complication of chloramphenicol therapy
 The haemolytic uraemic syndrome is not seen in typhoid

HIV infection has many effects on the patient's immune system. Choose the statement which is LEAST likely to be
correct:
 The polymorph neutrophils are not involved
 Hyperglobulinaemia is an early finding
 There are abnormal antibody responses to many antigens
 There is a total lymphopaenia
 There is a reversal of the CD4:CD8 ratio

Choose the INCORRECT answer concerning tuberculous lymphadenopathy:

 Not usually associated with very strongly reactive skin tests
 Always matted and adherent to skin
 The differential diagnosis includes lymphoma
 Airway compression may cause wheezing
 Airway obstruction may cause atelectasis or emphysema

Which of the following features is NOT typical of Down syndrome:

 Hypotonia
 Single palmar crease
 Absent philtrum and smooth upper lip
 Upslanting palpebral fissures
 Clinodactyly

Which of the following statements is WRONG concerning hepatomegaly:

 Inflammation is associated with evidence of liver cell damage
 Fatty infiltration of the liver is assocated with splenomegaly
 Reticulo-endothelial hyperplasia of the liver is associated with generalised lymphadenopathy
 Venous congestion of the liver can lead to portal hypertension
 Glycogen storage does not affect the spleen

Which of the following statements is NOT TRUE concerning hepatitis in childhood:

 Complications of Hepatitis A are rare
 Fulminating hepatic failure does not occur in hepatitis A
 Hepatitis B infection is often subclinical
 A carrier state does not occur in hepatitis A
 Hepatocellular carcinoma can occur after hepatitis B infection

Select the WRONG statement concerning the recurrence risks in inherited conditions:
 Autosomal dominant: 1 in 2 for each child
 Autosomal recessive: 1 in 4 for each child
 Sex-linked recessive: 1 in 2 for male children
 Multifactorial inheritance: 1 in 20 for each child
 Sex-linked recessive: all girls are carriers
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Which of the following clinical circumstances is not an indication for chromosome studies:
 Mental retardation with associated dysmorphic features
 Multiple congenital abnormalities
 Foetal alcohol syndrome
 Ambiguous genitalia
 Recurrent spontaneous abortions, stillbirths or unexplained neonatal deaths

Choose the statement which is least likely to be true concerning the risk of vertical transmission of HIV from mother
to child:
 The risk is lower during the stable phase of the mother's infection
 The risk can be reduced by a single dose of Nevirapine given to mother in labour and to the newborn baby
 The risk is increased by co-existing STD's in the mother
 Breastfeeding is contraindicated for an HIV positive mother
 Maternal malnutrition increases the risk

The following statements describe aspects of abdominal examination in children. Choose the wrong statement:
 The liver is relatively bigger in children than in adults
 The liver is more pushed down by the diaphragm than in adults
 The kidneys are more easily felt in babies than in older people
 The spleen is palpable in normal infants
 The liver span is 5cm at 2 months of age

Choose one condition which is not a recognised complication of cystic fibrosis:

 Bronchiectasis
 Pansinusitis
 Meconium peritonitis
 Nasal polyps
 Glomerulonephritis

Choose the TRUE statement concerning Poliomyelitis:

 95% of the infections are subclinical
 has been targeted by the WHO to be eradicated by 2020
 is diagnosed by positive blood cultures
 is diagnosed by a macular rash
 is caused by five different Poliovirus types

The following statements are true concerning childhood infectious diseases, EXCEPT:
 Meningo-encephalitis is seen in 10% of children with mumps
 The maculopapular rash of measles usually develops before the Koplik spots appear
 Chickenpox has a 7day incubation period
 Rubella can be complicated by arthritis
 Repiratory syncytial virus infections are usually asymptomatic in children

Menarche usually occurs when girls are in Tanner stage:

 1
 2
 3
 4
 5

In terms of a children's court order, a child may be:

 sent to a reformatory
 sent to a place of safety
 sent to a children's home
 admitted to hospital

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The ingestion of the following substances is not considered significant, EXCEPT:
 Ophthalmological agents
 Toilet soap
 Cosmetic products containing alcohol
 Single dose of steroids
 Oral contraceptives

Choose the correct statement concerning the management of iron poisoning:

 one should induce vomiting as soon as possible
 steroid treatment should be prescribed routinely
 a broad-spectrum antibiotic should be prescribed routinely
 oxygen is the mainstay of treatment

Match the statements in Columns A and B regarding a child with frequent infections:
Overcrowding Frequent infections at different sites and with different organisms
Normal early childhood About 6 URTIs per year
Anatomical structural reason Recurrent infections at the same site
Not more than 3 infections per year

When a family are visiting a doctor for genetic counselling when having a baby with a birth defect or genetic
condition they are expecting to receive information. Choose the WRONG statement.
 They would want to know what the condition is their baby is suffering of and what the causes are
 How the condition can be treated and/or ameliorated
 The natural history and prognosis of the disorder
 The chances of recurrence in family members and how it can be reduced
 Information about what they should do in future pregnancies

How long must an HIV positive patient have fever without a source to be regarded as a Fever of Unknown Origin
(FUO)
 1 week
 2 weeks
 3 weeks
 4 weeks
 10 days

This patient has

 kwashiorkor
 marasmus
 marasmic kwashiorkor
 nephrotic syndrome
The underlying cause of the condition is
 malabsorption
 tuberculosis
 protein-energy deficiency
 cystic fibrosis

What type of skin rash do you see on this slide

 Maculopapular
 Vesiculopapular
 Urticarial
 Erythema multiforme
 Erythema marginatum

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The following photo shows a baby with
 bruising due to child abuse
 petechiae
 haemophilia
 Mongolian spot
 vasculitis

The photo shows a baby with

 mental retardation
 hydrocephalus
 spina bifida
 Down syndrome
 lymphoma

The photo shows a child with

 cyanosis
 jaundice
 clubbing
 anaemia
The possible cause for the clinical sign
 cystic fibrosis
 Tetralogy of Fallot
 Bilharzia
 Hepatitis A
 lobar pneumonia

This apparatus is used for

 weighing babies
 stretching the spine of babies
 measuring the length (height) of babies
 determining the foot size of children

Convulsions, encephalitis, focal neurological signs and collapse with shock after immunizing a child are most likely
associated with which vaccine
 diptheria
 measles
 pertussis
 polio
 tetanus

A six month old girl has been suffering from severe diarrhoea for the past month. The onset was acute. She has lost
weight and is miserable with a distended abdomen, poor appetite for milk formula and occasional vomiting. Her
stool is watery green and shows: Clinitest 2% positive, pH 5. The most likely cause for her condition is:
 cholera infection
 coeliac disease
 cystic fibrosis
 rotavirus infection
 secondary lactose intolerance

An eight year old girl presents with fever, tachypnoea and bronchial breathing sounds over the left lower lobe. Her
neutrophil count is raised significantly. The most likely diagnosis and organism responsible for the disease are:
 bronchopneumonia caused by Staphylococcus aureus
 bronchopneumonia caused by Streptococcus pneumoniae
 lobar pneumonia caused by respiratory syncytial virus
 lobar pneumonia caused by Streptococcus pneumoniae
 pleural effusion caused by Staphylococcus aureus
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An 18-month-old boy presents with a picture of laryngo-tracheo-bronchitis. An inspiratory and expiratory stridor, as
well as a pulsus paradoxus is present. There is no indication of exhaustion or impending apnea. The correct grading
(Klein) and management of this patient are:
 Grade 2, nebulized adrenaline
 Grade 2, continuous nebulized adrenaline; if no improvement, intubate
 Grade 3, continuous nebulized adrenaline; if no improvement, intubate
 Grade 3, intubate immediately
 Grade 4, intubate immediately

Which of the following conditions will present with increased muscle tone
 congenital myopathy
 Duchenne’s muscular dystrophy
 hypercalcaemia
 hypothyrodism
 previous haemorrhage in motor cortex

An 11-year old boy presents with episodic fever and a skin rash for the past 4 months. In between these febrile
episodes he is well. He also complains that his joints are painful at times. On examination he has an enlarged spleen
and liver. The most likely diagnosis is:
 Henoch Schönlein purpura
 juvenile chronic arthritis
 Kawasaki disease
 rheumatic fever
 Takayasu’s arteritis

Anne is 12 months old and presents with severe weight loss, oral candidiasis, diarrhoea and fever for two weeks. An
HIV Elisa is positive. Which of the following diagnostic possibilities describes her situation best
 definite HIV infection on serology, AIDS according to WHO criteria
 definite HIV infection on serology, AIDS not present according to WHO criteria
 possible HIV infection on serology, AIDS according to WHO criteria
 possible HIV infection on serology, AIDS not present according to WHO criteria
 no HIV infection on serology, AIDS not present according to WHO criteria

An eight year old boy presents with an swollen body for two weeks. On examination he doesn’t appear to be
seriously ill. His blood pressure is normal. On examination of his urine heavy proteinuria is found without significant
haematuria. His serum albumin is decreased. The most likely diagnosis is:
 acute post-streptococcal glomerulonephritis
 acute renal failure
 chronic renal failure
 haemolytic uraemic syndrome
 minimal change nephrotic sydrome

Which of the following treatment modalities are contra-indicated in the management of anaphylaxis
 aminophylline for bronchospasm
 furosemide to decrease angioedema
 intubation or tracheostomy for airway obstruction due to angioedema
 IV fluids for hypovolemia
 oxygen to prevent hypoxaemia

Inheritance of which disease is represented below

 achondroplasia
 cleft lip
 cystic fibrosis
 haemophilia A
 sickle cell anaemia

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Some cases of acute bacterial meningitis in young children can be prevented by immunization. Immunization against
which organism (included in the Department of Health immunization schedule) is being referred to
 Group B streptococcus
 Haemophilus influenzae
 Listeria monocytogenes
 Neisseria meningitides
 Streptococcus pneumonia

Which drug used for analgesia has the following adverse effects: vasodilatation, hypotension, respiratory depression,
CNS depression
 ibuprofen
 ketamine
 morphine
 paracetamol
 salicylates

Uncomplicated community acquired bacterial pneumonia in a 2 year old child should be treated with:
 Penicillin G
 Amoxicillin
 Cloxacillin
 Cefotaxime
 Ciprofloxacin

The most important aspect in the management of acute gastroenteritis is

 antibiotic therapy.
 fluid and electrolyte replacement therapy.
 anti-diarrhoeal medicines like loperamide.
 lactose free milk.
 anti-emetic drugs to stop vomiting.

In which of the following paediatric conditions does clubbing commonly occur

 Asthma
 Lymphocytic interstitial pneumonitis
 Rheumatic fever
 Pneumococcal pneumonia
 Tuberculosis

Which of the following findings in a 1 year old infant is abnormal and will necessitate medical intervention
 Inability to walk.
 An open anterior fontanelle.
 Strabismus.
 Inability to pull back the foreskin of the penis.
 Retraction of the testicles.

A 3-year-old has had a cough for 2 months without fever. The cough is getting worse, especially at night. His weight
th
and height have been following the 25 percentile from birth. Family history reveals that the mother has eczema and
the father has hay fever. The most likely diagnosis is:
 cystic fibrosis
 asthma
 bronchiolitis
 tuberculosis
 congestive heart failure.

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A 6-year old presents with sneezing, clear rhinorrhea and nasal itching. Physical examination reveals enlarged pale
inferior turbinates, a clear nasal discharge and a transverse nasal crease. The most likely diagnosis is:
 foreign body
 vasomotor rhinitis
 neutrophilic rhinitis
 allergic rhinitis
 viral rhinitis

The term ”neonatal period” relates to which period

 the first day of life
 the first 7 days of life
 the first 28 days of life
 age 0 – 3 months
 the first year of life

Which one of the following clinical features is found in paracetamol poisoning

 vomiting and jaundice within the first 24 hours after poisoning
 hyperglycaemia
 cardiac arrhythmia
 liver failure
 early central depression

Emesis is contra-indicated in which of the following type of poisonings

 Benzine
 Paracetamol
 Salicylates
 Tricyclic antidepressants
 Iron

Which of the following metabolic disturbances may occur as a complication of acute diarrhoea
 hypermagnesaemia
 hypercalcaemia
 hypernatraemia
 metabolic alkalosis
 raised zinc levels

A 5 year old boy presents with swelling of his eyes and feet, infected small skin lesions around his nose and mouth
and his urine is dark in colour (like Coca-Cola). He has a poor appetite and his mother is worried that he might be
dehydrated because he has only passed urine once during the day. He is not feverish. What is the most likely
diagnosis
 Haemolytic uremic syndrome
 Kidney stones
 Acute glomerulonephritis
 Pyelonephritis
 Acute renal failure

Which one of the following clinical signs would signify underlying pathology in a 6 week old infant
 does not smile
 Moro reflex is present
 responds to sound
 squints.
 follows with eyes

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Which of the following signs is NOT found in an Upper Motor Neuron lesion
 Increased tendon reflexes
 Extensor plantar reflex
 Muscle tone increased
 Clonus can be elicited
 Muscle fasciculations

A child of 8 years old presents with the following symptoms and signs: coughing, tachypnoea, clubbing, generalized
lymphadenopathy and parotid gland enlargement. The most likely diagnosis of his respiratory disease is:
 bacterial bronchopneumonia
 lymphocytic interstitial pneumonia
 Pneumocystis carinii pneumonia
 tuberculosis
 viral pneumonia

An 11 year old boy presents in casualties with a one day history of a painful, swollen knee. His temperature is 40C
and the joint is tender and swollen with fluctuation and restriction of movement. The most likely diagnosis is:
 Reactive arthritis
 Septic arthritis
 Hemophilia
 Tuberculous arthritis
 Pauciarticular juvenile chronic arthritis

Trimetoprim-sulfametoxazole (co-trimoxazole) is administered routinely to HIV exposed infants from the age of 6
weeks to prevent
 recurrent bacterial infections.
 Pneumocystic carinii pneumonia (PCP).
 tuberculosis.
 severe suppurative otitis media.
 lymphocytic interstitial pneumonitis (LIP).

The drug of choice for preventing meningitis in contacts of patients with meningoccal meningitis is:
 Co-trimoxazole
 Penicillin
 Chloramphenicol
 Erythromycin
 Rifampicin

Which drug will you use for the treatment of uncomplicated malaria in a two-year old child
 chloroquine
 doxycycline
 quinine
 mefloquine
 proguanil

The best source of iron for a three month old infant is

 breast milk
 minced meat
 fruit
 yellow vegetables
 iron fortified cereal

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Pulsus paradoxus is associated with
 endocarditis
 myocarditis
 pericarditis
 rheumatic fever
 post-perfusion syndrome

Which of the following is the most important procedure in the diagnosis of subacute bacterial endocarditis
 Complete blood count
 Urinalysis
 ESR
 Blood culture
 Electrocardiogram

The most common cause of blood-stained stool in an otherwise normal infant is

 intussusception.
 a Meckel divertikulum
 an anal fistula
 haemorrhoids
 an anal fissure

Major complications of liver cirrhosis EXCLUDE which of the following:

 ascitis
 portal hypertension
 encephalopathy
 esophageal varices
 hepatomegaly

Which one of the following is the drug of choice for the treatment of documented meningococcemia
 Ampicillin
 Cloxacillin
 Erythromycin
 Penicillin G
 Penicillin V

In which scenario will you refer a one year old child

 No head control
 Can not walk
 Can say only 2 words
 Did not crawl, but can walk well
 Can not feed himself

What is the most likely cause for the sudden onset of convulsions in a child 10 years of age that was completely
healthy before
 Hypertension
 Febrile seizure
 Hypocalcaemia
 Hypokalaemia
 Hypernatraemia

Which of the following special investigations are NOT indicated in children with severe bacterial pneumonia
 Chest X-ray
 Blood culture
 Throat swab
 Blood count
 CRP
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Which of the following is NOT a component of Fallot’s Tetralogy
 Pulmonary stenosis
 Atrial septum defect
 Overriding aorta
 Right ventricle hypertrophy
 Ventricular septal defect

A 20 month old patient presents with recurrent pneumonias and failure to thrive. The HIV Elisa test is negative.
Which of the following tests would NOT be appropriate:
 A chest X-ray
 PPD
 A sweat test
 An HIV PCR test
 A barium swallow

Which of the following micro-organisms is implicated in causing acute rheumatic fever

 Group A beta-haemolytic streptococci.
 Group B streptococci.
 Staphylococcus aureus.
 Streptococcus viridans.
 Coxsackie virus group B.

The following statement regarding micronutrient deficiency is wrong:

 Vitamin E deficiency promotes damage to cells from free radicals
 Vitamin A deficiency is associated with an increased incidence of pseudotumor cerebri if not treated
 Vitamin D deficiency sometimes develops due to underlying liver disease
 Green vegetables are a good source of Vitamin K
 Vitamin C deficiency can lead to periosteal haemorrhages

The following statements relate to mineral deficiencies. Which statement is wrong

 Fluoride is abundant in dairy products
 Iodine deficiency can manifest with an endangered airway and dysphagia
 Zinc deficiency may have a peri-anal rash as a clinical feature
 Calcium deficiency presents in children in some areas with short milk supply
 Magnesium deficiency may develop secondary to chronic diarrhoea

Choose one of the following as the most likely cause of coma where focal neurological signs would be expected
without cerebrospinal fluid changes
 Intoxication
 Epilepsy
 Subarachnoid haemorrhage
 Cerebral infarction
 Viral encephalitis

Laboratory tests are useful in the determination of nutritional status. Choose the one statement below which is least
likely to be correct
 Laboratory tests help to evaluate protein intake in nutritional disease
 Laboratory tests help to monitor nutritional response to therapy
 Laboratory tests help to evaluate protein status
 Laboratory tests help to evaluate metabolic complications of nutritional disease
 Laboratory tests help to evaluate micronutrient status

45 / 72
A number of factors limit the usefulness of serum albumin in determining nutritional state. Choose the one
statement below which is least likely to be true
 The acute phase response can decrease the albumin concentration acutely
 Impaired liver function reduces the albumin level by reduced synthesis
 The long half life results in slow changes to the serum albumin level
 The serum level is elevated by dehydration
 The colloid osmotic pressure is an important regulator of albumin synthesis

The vital signs must be judged in relation to the patient’s age. Choose the incorrect statement in the list below
 A pulse rate of 95/minute is considered abnormal in a newborn baby
 A sustained breathing rate of 60/minute is tachypnoea in a baby aged 1 month
 A pulse rate of 130/minute is considered abnormal in a 4 year old child
 A pulse rate of 130/minute is considered abnormal in a 3 year old child with fever
 A 5 year old child breathes 20 times per minute

A newborn baby is examined after birth with a number of objectives. Choose one statement below which does not
belong in this list
 The APGAR score identifies the effect of the birth on the baby
 The gestational age is assessed by the examination
 The various organ systems are examined for baseline data
 The existence of disease states is determined by examination
 Inherited metabolic disease can be identified immediately after birth

There are a number of anatomical differences between children and adults. Choose the wrong statement below
 The head is relatively bigger in children than in adults
 Left ventricular dominance at birth explains why some babies have a patent ductus arteriosus
 The liver is palpable in a normal baby because it is relatively bigger than in adults
 Normal 5 year old children have adenotonsillar hypertrophy
 A baby has a much larger surface to volume ratio than an adult

There are physiological differences between children and adults. Choose the statement which is wrong
 The metabolic rate is increased up to 3 times that of an adult
 The oxygen consumption adjusted for weight is similar to that of an adult
 The cardiac output is much higher than in adults
 The body water content of premature babies is higher than that of adults
 The parasympathetic nervous system is dominant in infants

The following are considered to be risk factors for the development of “cot death”. Choose the one factor which is
least likely to be true
 Maternal smoking
 Low birth weight
 Breast feeding
 Prone sleeping position
 Adolescent mother

In “IMCI”, the presence of stridor is a risk factor in respiratory disease and spells the need for immediate action.
Choose the action which is most likely to be correct
 Drip infusion with plasma
 Immediate paracetamol to reduce fever
 Immediate intravenous ceftriaxone
 Oxygen and call for ambulance
 Adrenaline inhalation and oxygen

46 / 72
The sepsis syndrome precedes the development of septic shock. Choose the clinical feature in the list below which
indicates that septic shock has developed
 Hypothermia
 Tachypnoea
 Acute mental (consciousness) changes
 Prolonged capillary refilling time
 Hypoxaemia

Hypo-albuminaemia is not always associated with oedema. Which of the hypo-albuminaemic conditions below does
not usually show oedema
 Marasmus
 Protein-losing enteropathy
 Nephrotic syndrome
 Acute catabolic state
 Decompensated chronic liver disease

The diagnosis of kwashiorkor is made according to a number of clinical criteria. Choose the one statement which is
not part of these criteria
 Muscle wasting
 Low weight for age
 Oedema
 Skin changes
 Anaemia

Nutritionally Acquired Immune Deficiency (NAID) has a number of similarities with AIDS. Choose the feature which
distinguishes it from AIDS
 Inverted CD4/CD8 ratio
 Normal to increased serum globulins
 Decreased numbers of T lymphocytes
 Anergy to skin tests
 Recovery with treatment

Which of the following statements is least likely to be true concerning an appropriate weaning diet
 Solids are more energy dense than liquids
 It should consist of special foods only for the baby
 The addition of fat or oil improves energy content and palatability
 More feeds per day improve the nutritional value for the baby
 Breast feeding should not be stopped

Which of the following statements is least likely to be true concerning nutritional marasmus
 The body water content is higher than in kwashiorkor
 It is characterized by severe growth failure
 The body mass is below 60% of the expected mass for age
 Patients with marasmus do not develop oedema
 The prognosis of marasmic kwashiorkor is worse than for kwashiorkor

The skin lesion on this baby’s forearm is suggestive of:

 Impetigo
 Bite mark
 Purpura
 cellulitis

47 / 72
You decide to investigate a jaundiced baby aged 2 weeks to find the cause of jaundice. Select the investigation that
will be most useful to rule out congenital hypothyroidism.
 conjugated bilirubin level
 alkaline phosphatase level
 serum cholesterol level
 serum thyrotropin level (TSH)
 serum free thyroxine level

Which of the following is characteristic of a cephalhaematoma in a neonate

 It is more common in preterm babies.
 It may be the cause of conjugated hyperbilirubinaemia.
 It is associated with an underlying defect in the clotting cascade.
 It may cause anaemia and shock.
 It does not stretch beyond sutures of the skull.

Oligohydramnios is frequently associated with which of the following conditions in the foetus
 Renal agenesis
 Oesophageal atresia
 Pyloric stenosis
 Down syndrome
 Agenesis of the lungs

The X-rays of a term newborn male infant with apgars of 9 and 10 show prominent central vascular markings with
hyperinflation and air bronchograms. The baby is tachypnoeic with diffuse inspiratory crepitations and he requires
supplemental oxygen. The most likely diagnosis is
 Transient tachypnoea of the neonate
 Respiratory distress syndrome
 Meconiujm aspiration syndrome
 Congenital pneumonia
 Persistent fetal circulation

A newborn baby experiences respiratory distress and is cyanosed. This improves when he cries with an open mouth.
What is the most important aspect regarding the further management of his condition
 Administration of oxygen. The baby’s condition should resolve in a day or two.
 The baby needs mechanical ventilation until his lungs reach maturity.
 The baby should receive surfactant replacement therapy.
 Ensure an open upper airway and refer to an ENT surgeon without delay.
 Antibiotics and steroids are indicated in this infant.

A 2 year old child has a severe cough with a normal temperature. His erythrocyte sedimentation rate is normal and
3
on blood count he has a leukocytosis of 50 000 per mm of which 85% are lymphocytes. He does not appear to be
very ill. The likeliest diagnosis is:
 Miliary tuberculosis.
 Pnemocystis carinii infection.
 Primary atypical pneumonia.
 Bronchitis.
 Whooping cough.

Some babies suffer from breastmilk jaundice. Select the statement below that does NOT apply to breastmilk
jaundice.
 the baby is clinically well
 the baby has predominantly unconjugated hyperbilirubinaemia
 tests for an etiology are negative
 increased lactose is found in the stool
 breast milk metabolites inhibit bilirubin conjugation

48 / 72
A Child of 2 years and 6months of age is unable to say any words. His motor development is otherwise normal. The
most likely cause is
 mental retardation.
 dental malocclusion.
 emotional deprivation.
 ankyloglossia.
 inheritted neuronal deafness.

Which infection is the cause of focal convulsions in a child with multiple calcifications in both thighs
 Cytomegalovirus
 Schistosoma haematobium
 Taenia solium
 Taenia sagginata
 Toxoplasmosis

An eight month old boy presents with irritability. He doesn’t want to move his legs. On examination there are
multiple bruises on his skin. There is beading of his ribs at the costochondral junction and x-rays of his long bones
show periosteal elevation. The most likely diagnosis is:
 Child abuse
 Osteitis
 Vitamin C deficiency
 Vitamin D deficiency
 Vitamin K deficiency

A known diabetic child of 5 years old presents in casualty with a history of vomiting and abdominal pain for one day.
His blood sugar is 28 mmol/l. The next step in the management of his condition is:
 Intravenous bicarbonate
 Anti-emetics
 Subcutaneous insulin
 Rehydration with saline
 Broad spectrum antibiotics

Inheritance of which disease is represented below

 achondroplasia
 cleft lip
 Duchenne’s muscular dystrophy
 Thallassaemia(s)
 haemophilia A

Parents, who both smoke, give the history that their 3-year-old child is prone to repeated respiratory infections. The
rd
child’s mass is below the 3 percentile for age. On clinical examination the child has a prominent abdomen as well as
muscle wasting. With special inquiry the parents tell you that the child did not spontaneously pass meconium after
birth and that a barium enema was given. What is the most likely diagnosis
 Asthma
 HIV infection
 Cystic fibrosis
 Coeliac disease
 Duchenne muscular dystrophy

Choose the typical description of minimal change glomerulonephritis (idiopathic nephrotic syndrome)
 Proteinuria, oedema, oliguria, hypertension
 Proteinuria, oedema, normal blood pressure, macroscopic haematuria
 Proteinuria, macroscopic haematuria, oedema, hypoalbuminaemia
 Proteinuria, oedema, hypoalbuminaemia, hypercholesterolaemia, normal blood pressure.
 Proteinuria, oedema, hypercholesterolaemia and hypertension

49 / 72
A 20-month old boy cries, turns blue and develops a bradycardia and tonic clonic seizures of the arms and legs. What
is the most likely diagnosis
 hypertensive crisis
 epilepsy
 syncopy
 febrile seizures
 breath holding spell

Reye’s syndrome is commonly associated with which one of the following combinations of diseases and medications
 Hepatitis A, aspirin treatment
 Hepatitis A, paracetamol treatment
 Influenza, mefenamic acid treatment
 Chickenpox, aspirin treatment
 Chickenpox, paracetamol treatment

Which abnormality occurs invariably in all children with very low blood platelets / thrombocytopaenia
 prolonged prothrombin time
 prolonged activated partial thromboplastin time.
 prolonged bleeding time
 low mean red cell corpuscular volume (MCV)
 leukopenia

A 9 month old boy presents with severe failure to thrive and recurrent vomiting. He does not have diarrhoea. On
examination he is very dehydrated but also very wet with urine. Apart from weakness, hypotonia and poor muscle
mass there is no neurological defect. The urine dipstix examination is normal. Which condition fits this clinical
presentation best
 juvenile diabetes mellitus
 hypoparathyroidism
 Addison’s disease
 diabetes insipidus
 vitamin D intoxication

A 5 year old child has tachypnoea, the trachea is central and there is bronchial breathing and coarse crepitations
audible in the right axilla. These clinical findings are in keeping with:
 Consolidation of the right middle lobe
 Collapse of the right middle lobe
 Consolidation of the right lower lobe
 Lobar pneumonia of the right upper lobe
 Collapse-consolidation of the right upper lobe

Is true with regard to croup:

 Is defined as an upper respiratory tract obstruction above the level of the vocal cords and is usually caused by a
virus infection
 Grade 2 croup is defined as an inspiratory stridor and expiratory wheezes
 It occurs most commonly in children 2-6 years old
 Grade 3 croup is defined as an inspiratory and expiratory stridor and presence of central cyanosis
 Infants with grade 4 croup should be treated with constant adrenalin inhalations until there is improvement

An 8-year-old child snores during sleep. Episodes of snoring are followed by short periods of silence where after the
child awakens. Which of the following signs is/are a consequence/s of his longstanding problem
 Clubbing of the fingers and polycytaemia
 Heaving apex
 A Harrison’s sulcus
 Barrel shape chest
 Left parasternal heave and palpable P2

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The most useful treatment modality for most infants with bronchiolitis is:
 Adrenalin inhalations
 Humidified oxygen
 Inhaled bronchodilators
 Oral corticosteroids
 Topical (inhalation of) steroids

Is/are in favor of an innocent heart murmur in a child:

 It is influenced by respiration
 Becomes louder with fever and exercise
 It is associated with a palpable thrill
 It is usually heard over the apex
 It is pansystolic

Is associated with a wide pulse pressure

 Patent ductus arteriosus.
 Atrial septal defect.
 Ventricular septal defect.
 Pulmonary incompetence
 Coarctation of the aorta.

A 10 months old infant weighs 4.8 kg, has difficulty breast feeding and sweats excessively during feeds. His oxygen
saturation is 95%, he has a barrel shaped chest and a pansystolic murmur is audible over the left lower sternal
border. The most likely diagnosis is
 Tetralogy of Fallot
 Pulmonary stenosis
 Ventricular septal defect
 Atrial septal defect
 Transposition of the great arteries

Mark the correct statement

 A third heart sound is pathological in children
 A normal split second heart sound widens during expiration
 Mitral stenosis causes a mid-systolic murmur best heard over the apex
 The murmur of aortic regurgitation is best heard when the patient is sitting up and when he is holding his
breath in expiration
 A left parasternal heave is indicative of left ventricular hypertrophy

A normal developing 4 month old infant is expected to:

 Demonstrate hand dominance
 Be able to transfer a rattle from one hand to the other hand
 Be able to roll over
 Have a pincer grip
 Have a parachute reflex

A 3 month old infant presents with convulsions and fever. Which of the following diagnoses would be totally
INAPPROPRIATE
 Bacterial meningitis
 Child abuse
 Febrile convulsions
 Hypoglycaemia
 Hypertension

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Which of the following is a cause of a wide anion gap acidosis
 Renal tubular acidosis
 Respiratory failure
 Gastroenteritis
 Hypophosphataemic rickets
 Diabetic ketoacidosis

Mark the correct statement/s with regard to Duchenne muscular dystrophy (DMD)
 The presence of a positive Gower sign is diagnostic of DMD
 Toe walking may be a manifestation of DMD
 Absence of tendon reflexes excludes the diagnosis
 Patients with advanced disease develop fasciculations of the small muscles of the hands
 The disease starts with weakness of distal muscles.

What vaccines are administered orally to infants at primary health clinics

 Polio and measles
 Hepatitis A and polio
 Rotavirus and polio
 Hepatitis A and B
 Rotavirus and Hepatitis A

A 5 year old boy presents with swelling of his whole body and sores around his nose and mouth. His urine has a dark
brown colour (looks like Coca-Cola like). He has passed urine only once during the day. He is afebrile. Which of the
following is a complication of this condition
 Acute pyelonephritis
 Herpes stomatitis
 Kidney stones
 Renal vein thrombosis
 Hypertensive encephalopathy

A 6 year old girl presents with episodic fever and a skin rash for the past 4 months. In between these febrile episodes
she is well. She complains of intermittent arthralgia. On examination she has an enlarged spleen and liver. The most
likely diagnosis is:
 Henoch Schönlein purpura
 Juvenile idiopathic arthritis
 Kawasaki disease
 Rheumatic fever
 Takayasu’s arteritis

Mark the correct statement/s

 The apex is defined as the best palpable and most inferior pulsation of the heart
 In infants the ratio of anterior-posterior to lateral diameter of the chest is increased compared to that in older
children
 Maxillary central incisors erupt before mandibular central incisors
 Toe walking is considered normal up to age of 2 years
 The spinal cord of an infant ends at the level of the 2 to 3 lumbar vertebrae (higher compared to that in
nd rd

adults)

Mark the correct statement/s. The diagnosis of diagnosis of urinary tract infection in a child can be made
 When there are positive leucocytes and nitrites on urine dipstick test
 In the presence of leucocytes and gram negative bacilli on direct microscopy
 With any positive culture from a suprapubic urine specimen
 With repeated positive cultures from bag samples
 If the culture of a mid stream urine sample yields >10 colonies/ml
4

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Congenital rubella syndrome is associated with the following cardiovascular abnormality
 Transposition of the great vessels
 Coarctation of the aorta
 Patent ductus arteriosus
 Pulmonary valve incompetence
 Tetralogy of Fallot

Drug treatment of uncomplicated malaria in children

 Chloroquine
 Sulphadoxine-pyrimethamine (Fansidar)
 Erythromycin
 CoArtem (Artemether-lumafantrine )
 Doxycycline

Portal hypertension in the absence of liver disease is characterised by a combination of features including
 Ascites, hypoalbuminaemia and oesophageal varices
 Caput medusa, bleeding tendency, ascites and splenomegaly
 Splenomegaly, hypersplenism and ascites
 Encephalopathy, splenomegaly and hypersplenism
 Obstruction of drainage of portal vein, splenomegaly, oesophageal varices

Is the most important clinical sign to predict hyperinflation in a 6 month old infant with small airway disease:
 Anterior-posterior diameter of the chest is larger than the lateral diameter
 Downwards displacement of the liver to 7 intercostals space
th

 Suprasternal recession
 Hoover sign
 Pectus excavatum

Which of the following biochemical profiles (A-E) is/are characteristic of treatment with furosemide
A B C D E
Na (135-145) 150 135 120 148 118
K (3.5-5.3) 5 4 2.5 2.5 5.5
Cl (98 -107) 130 108 88 128 88
HCO3 (21-28) 5 18 30 10 14
 C (?)

Is true of a child with a multicystic kidney

 Develops oedema and symptoms of decreased renal function
 Has a high risk of developing a malignant tumour in the abnormal kidney
 Has only one functioning kidney
 Has an increased risk of developing urinary tract infections
 Is inherited in autosmal dominant fashion

Is true regarding hypertrophic pyloric stenosis

 The infants usually have anorexia
 Is more common in girls than boys
 Feeds can be continued within 2 hours after Ramstedt pyloroplasty
 Is associated with vomiting from shortly after birth
 Results in deranged serum electrolytes clasically hyponatraemia, hypokalaemia and acidosis

Is true with regard to conjugated hyperbilirubinaemia in an infant

 Bilirubin is present in the urine
 Can be treated effectively with phototherapy
 Exchange transfusion is indicated if total serum bilirubin level exceeds 450 mol/L
 Breast milk feeds should excluded as a possible cause
 Can be caused by underlying duodenal atresia
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Mark the correct statement. Compared to premature babies: low birth weight babies:
 Have a higher incidence of hyaline membrane disease
 Lower haemoglobin and a lower haematocrit level
 Have a higher risk to develop adult lifestyle diseases
 Are more prone to develop intracerebral haemorrhages
 Are more prone develop hyponatraemia due to renal tubular salt loss

Is associated with a bulging anterior fontanel in a young infant

 Achondoplasia
 Portal hypertension
 Vitamin D deficiency rickets
 Tetralogy of Fallot
 Excess Vitamin A

Kayser-Fleischer-ring in the eye is pathognomonic of

 Phenylketonuria
 Alkaptonuria
 Wilson’s disease
 Galactosaemia
 Cystinosis

Is a major criterium (Duckett-Jones) for diagnosing acute rheumatic fever

 Isolated heart murmur
 Huntington Chorea
 Erythema nodosum
 Prolonged QT time
 Subcutaneous nodules

Mark the correct statement with regard to acute meningitis in a 3 month old infant.
 Neck stiffness may be absent
 Absence of fever excludes the diagnosis
 Inappropriate ADH secretion should be considered if the infant develops oedema and hyponatraemia
 Lumbar puncture is contraindicated in all with a bulging fontanel
 Group B Streptococcus is the commonest cause

Which of the following descriptions is in keeping with a diagnosis of congenital syphilis in a newborn baby
 Pulmonary hypoplasia, pneumonia and pulmonary haemorrhage
 Pseudoparalysis, haemolytic anaemia and pneumonia alba
 Microcephaly, congenital glaucoma and convulsions
 Bilateral cystic dysplastic kidneys and nephrotic syndrome
 Peeling of the skin of the palms and soles, intracerebral calcifications and choreoretinitis

Mark the correct statement

 Nerve roots L3 – L4 are responsible for the normal ankle reflex
 Epikantic folds can be the cause of a false diagnosis of strabism
 Babies with congenital cataracts must be referred for surgery once they are 12 months old
 Nerve roots C5-C6 are damaged in babies with Klumpke paralysis
 A neonate who does not follow an object over 180 degrees in his field of vision must be referred to an
ophthalmologist

The following test is abnormal in haemophilia A and B:

 Full blood count
 Partial thromboplastin time
 Prothrombin time
 Fibrinogen degradation products
 D-dimers
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Which of the following skin conditions is abnormal in a neonate
 Mongolian spot
 Erythema toxicum
 Milia
 Sclerema
 Harlequin colour change

The most common cause of stridor in a full-term neonate is:

 Foreign body
 Subglottic stenosis
 Croup
 Laryngomalacia
 Retropharyngeal abscess

The clinical picture of HIV encephalopathy in children is characterized by the following:

 Decreased levels of consciousness and upper motor neuron signs
 Fever, irritability and neck stiffness
 Hemiplegia and upper motor neuron signs
 Acquired microcephaly, abnormal developmental milestones and upper motor neuron signs
 Microcephaly and blindness

A child with chronic headache and vomiting should be investigated for:

 Hypertension
 Migraine
 Brain tumour
 Tension headache
 All of the above

Which of the following signs is NOT a general danger sign in IMCI

 Convulsions
 Fast breathing
 Lethary or unconscious
 Vomits everything
 Unable to feed

Which of the features below is NOT common in nephrotic syndrome

 Proteinuria
 Hypo-albuminemia
 Oedema
 Hypertension
 Hyperlipidemia

Which one of the following signs is not reliable in the assessment of dehydration in a child with kwashiorkor
 Dry mucosal membranes
 A sunken fontanel
 Decreased skin turgor
 Tachycardia
 Cold extremities

Infants that are underweight- for-gestational-age have a birth weight that falls
 below the 90 centile.
th

 between the 10 and 90 centiles.

th th

 below the 10 centile.

th

 below the 3 centile.

rd

 below 2.5kg.

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What is the clinical significance of a white vaginal discharge in a newborn infant
 It indicates a vaginal infection with Trichomonas.
 It should be treated with antibiotics.
 It is sign of congenital syphilis.
 It is normal.
 It is abnormal and indicates a hormonal imbalance.

What feeding advice would you give a mother to prevent painful nipples
Ensure that the infant latches correctly.
 Wash her nipples with soap and water twice a day.
 Apply gentian violet to her nipples after each feed.
 To clean her nipples once a day with surgical spirits.
 Stop breastfeeding and give formula feeds.

Jaundice lasting longer than 3 weeks after birth can be caused by:
 hyperthyroidism.
 hypoglycaemia.
 anaemia.
 hypoalbuminaemia.
 hypothyroidism.

Newborn infants produce mainly heat by:

 curling up.
 sweating.
 shivering.
 breaking down brown fat.
 Kicking of their legs.

The correct management of a severe respiratory acidosis in a neonate is:

 To observe the infant with an apnoea monitor.
 To give the infant oxygen in a headbox or with nasal prongs.
 To give the infant 4% sodium bicarbonate by intravenous infusion.
 To mechanically ventilate the infant.
 To give the baby a 0.9% Saline bolus.

According to the National guidelines for the treatment of tuberculosis in South Africa a 10 year old child with a
proven first episode of pulmonary tuberculosis needs to receive the following treatment
 An intensive treatment phase of isoniazid, rifampicin and pyrazinamide daily for 2 months, followed by isoniazid
and rifampicin daily for another 4 months.
 Isoniazid for 6 months.
 Due to the high prevalence of drug-resistant tuberculosis in South Africa, the treating physician should await the
drug sensitivity report of the specific patient’s bacterial culture before starting the tuberculosis therapy, and
then prescribe an individualized treatment regimen for the patient.
 An intensive treatment phase of isoniazid, rifampicin, pyrazinamide and ethambutol daily for 2 months,
followed by isoniazid and rifampicin daily for a further 4 months.
 An intensive treatment phase of isoniazid, rifampicin and pyrazinamide five days a week for 2 months, followed
by isoniazid and rifampicin five days a week for a for further 4 months.

Which one of the following HIV tests is an antibody detection test

 HIV DNA PCR test
 p24 Ag test
 HIV viral load
 HIV Rapid test
 HIV RNA PCR tests

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An 11 year old boy presents in casualties with a one day history of a painful, swollen knee. His temperature is 40C
and the joint is tender and swollen with fluctuation and restriction of movement. The most likely organism causing
this problem is:
 Staphylococcus epidermidis
 Mycobacterium tuberculosis
 Streptococcus pneumoniae
 Staphylococcus aureus
 Neisseria gonorrhoea

The clinical signs of hydrocephalus include:

 Abnormal upward gaze.
 Tense anterior fontanel.
 Drowsiness.
 Neckstiffness.
 All of the above.

A child with a change in school progress may have:

 Post traumatic stress disorder
 Anxiety disorder
 Attention deficit
 Absence epilepsy
 All of the above

A mother brings her firstborn at age 10 days to the general practitioner. She complains that the baby vomits after
each feed. No abnormalities are found on examination, and the baby is picking up weight well and is passing normal
breastfeeding stools. The most probable diagnosis is:
 Regurgitation
 Intussusception
 Acute gastroenteritis
 Hypertrophic pyloric stenosis
 Duodenal atresia

A cause of disproportionate short stature is:

 Turner’s syndrome.
 Malnutrition.
 Rickets.
 Achondroplasia.
 None of the above.

Which of the following investigations should always be done in a child with nocturnal enuresis
 Blood urea and electrolytes
 Kidney sonar
 Chemical and microbiological urinalysis
 Micturating cystogram
 Cystoscopy

A child with haemophilia is at danger for haemorrhage in the following circumstances:

 Playing on the schoolground.
 Dental extractions.
 Two days after Factor VIII replacement was administered.
 If it is a girl.
 All of the above.

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A common cause of metabolic acidosis is
 shock.
 lung disease.
 hyperventilation.
 pyloric stenosis.
 administration of furosemide.

Jaundice is more common in:

 Babies who were born by caesarian section.
 Preterm infants.
 term infants.
 small-for-gestational-age infants.
 post-term infants.

Which one of the following statements regarding neonatal care is INCORRECT

 The umbilicus has two arteries and one vein.
 Growth retarded infants are prone to hypothermia.
 Prematurely born infants who survive always have a poor neurodevelopmental outcome.
 Physiological jaundice usually occurs from day 3 to day 6 of life.
 Jaundice occuring in the first 24 hours of life is always pathological.

Which of the following statements with regards to Kangaroo mother care (KMC) is incorrect
 KMC promotes early breastfeeding by early initiation of non-nutritive sucking.
 KMC practice can prevent the development of jaundice in the neonate.
 KMC is the practice of tying a premature infant skin-to-skin to the mother’s chest.
 KMC is able to maintain body temperatures even in extremely low birth weight infants.
 Early discharge home is one of the components of KMC.

The following are common causes of seizures in the neonatal period EXCEPT
 hypercalcaemia.
 hypoxic ischemic encephalopathy.
 meningitis.
 intracranial bleeding.
 congenital cerebral abnormalities

Baby X was born at 28-weeks gestation. He was ventilated for 6 weeks. He is now 3 months old and being nursed in
the kangaroo mother care unit on 40% oxygen. The most likely complication he is suffering from is
 patent ductus arteriosis.
 cataracts.
 pulmonary interstitial emphysema.
 hyaline membrane disease.
 bronchopulmonary dysplasia

Match a complication in Column B to the childhood illness in column A

Diphtheria Airway obstruction with a membrane
Infectious mononucleosis Hepatitis
Kawasaki syndrome Coronary artery aneurisms
Tetanus Autonomic nervous system disturbances
Whooping cough Persistent vomiting
Epididimo-orchitis
Corneal ulceration
Reye syndrome
Rheumatic fever

58 / 72
Which one of the following clinical features is found in paracetamol poisoning
 Vomiting and jaundice within 24 hours after poisoning
 Hyperglycaemia
 Cardiac arrhythmias
 Liver failure
 Early depression of the central nervous system

Which one of the following statements about respiratory infections is INCORRECT

 Streptococcal pneumonia is the commonest cause of bacterial pneumonia in young children and there is usually
a lobar or segmental consolidation present on chest X-ray.
 Haemophilus influenzae pneumonia is a common cause of pneumonia in newborn infants and there is usually
a lobar consolidation present on the chest X-ray.
 Mycoplasma pneumoniae infection causes extensive changes on the chest X-ray and wheezing is common on
auscultation.
 Pneumatocoeles are commonly seen in association with staphylococcal pneumonia.
 Mycobacterium tuberculosis lung infection often has few clinical findings on respiratory examination

Vagal stimulation, e.g. icecold water on the face may be effective in terminating which of the following dysrythmias
in a child
 Supraventricular paroxysmal tachycardia.
 Ventricular tachycardia.
 Grade 2 heartblock.
 Atrial fibrillation.
 AV-nodal rhythm

The most appropriate drug to keep the ductus arteriosus patent in a newborn with ductus dependent lesions such as
pulmonary valve atresia is
 Captopril (Capoten®).
 Furosemide (Lasix®).
 Prostaglandin E2 (Prostin VR®).
 Propranolol (Inderal®).
 Indomethacin (Indocid®).

A child is allergic to penicillin. Which of the following can she use for prophylaxis against infective endocarditis
 Amoxicillin
 Ampicillin
 Trimetroprim
 Erythomycin
 Cefuroxime

Which of the following viruses cause infective diarrhoea

 Adenovirus
 Hepatitis A virus
 Measles virus
 Polio virus
 Rubella virus

A seven year old girl complains of chronic abdominal pain for 10 months. Which of the following diagnoses would be
totally INAPPROPRIATE
 Recurrent urinary tract infection
 Porphyria
 Recurrent abdominal pain syndrome of children
 Duodenal ulcer
 Ulcerative colitis

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A child with a sudden onset of convulsions and fever should be investigated for:
 Meningitis
 Migraine
 Epilepsy
 Brain tumour
 All of the above

Which of the following immunizations are given at birth

 Polio, BCG
 Polio, Tetanus
 Polio, Hepatitis A
 Polio, Diphtera
 BCG, Tetanus

Which statements are correct

 Turner Syndrome often presents with short stature, primary amenorrhoea and infertility.
 In autosomal dominant inheritance there is a 1 in 4 chance, that a child will be affected.
 Achondroplasia is an example of an autosomal recessive disorder.
 In X-linked recessive inheritance an affected male will transmit the abnormal gene to his sons and daughters.
 Spherocytosis is an example of an X-linked recessive disorder.

A child is deaf, has blue eye scleras and multiple fractures.He probably suffers from
 child abuse.
 osteopetrosis (Albers-Schönberg syndrome).
 Marfan’s syndrome.
 osteogenesis imperfecta.
 rickets.

Which of the following is a sign of depression in children

 Hyperactivity
 Convulsions
 Insomnia
 Diarrhoea
 Pica

Digoxin is a
 positive chronotrope.
 positive inotrope.
 negative dromotrope.
 negative inotrope.
 negative homeotrope.

Which of the following can cause anaemia due to chronic blood loss
 Plasmodium falciparum infection
 Spherocytosis
 Fanconi's anaemia
 Ancylostoma duodenale infestation
 Schistosoma haematobium infestation

Which of the following specimens is the preferred method for collecting urine for MCS in neonate with septicemia
 Infant urine collector bag
 “Clean catch” urine
 Supra-pubic puncture
 Midstream urine sample
 Catheter urine sample

60 / 72
Which one of the following skin conditions does not fit with the rest
 Epidermolysis bullosis
 Albinism
 Incontinentia pigmenti
 Ichthyosis
 Harlequin foetus

The most common cause of a heart murmur in a neonate is due to

 Endocardial cuschion defect
 Ventricle septal defect
 Aortic stenosis
 Tetralogy of Fallot
 No underlying cardiac lesion

Characteristics of pathological jaundice in a neonate includes

 Increasing unconjugated bilirubin blood levels starting from day 3
 An increase in unconjugated bilirubin blood levels >80 micromols/Liter per day
 Term baby with unconjugated bilirubin level >140 micromols/Liter on day 3
 Jaundice associated with a palpable liver
 Bilirubin level which only starts to decline after day 6

Which statement is incorrect with regard to conjugated hyperbilirubinaemia in a young infant

 Is associated with urobilinogen in the urine.
 If associated with pale stools biliary atresia must be excluded
 Exchange transfusion is not indicated
 Breast feeds must be stopped until the cause has been established
 May be caused by ceftriaxone

Which statement regarding Haemophilia A is correct

 Haemophilia A is inherited in an autosomal recessive manner.
 Patients develop microcytic hypochromic anaemia.
 Vitamin K must be given during an acute haemorrhage.
 Patients with a light degree of affliction may respond to DDAVP administration.
 Surgical drainage of severely swollen weight carrying joints decreases the risk for the development of
deformities.

Which of the following is NOT a “general danger sign” of serious disease in the IMCI strategy
 Cyanosis
 Vomiting everything
 Coma
 Lethargy
 Convulsions

The cardio-thoracic index on chest X ray is normal with

 Endocardial cushion defect.
 Ebstein anomaly.
 Tetralogy of Fallot.
 Eisenmenger syndrome.
 Transposition of the great vessels.

Which of the following nutritional deficiency/ies is/are NOT associated with an increased risk of infections
 Iron deficiency
 Vitamin A deficiency
 Calcium and vitamin D deficiency rickets
 Protein energy malnutrition
 Pyridoxin deficiency
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How would you classify the following child according to the Waterlow classification
Parameters: Weight for age 60-80%, Height for age 85%, Weight for Height 85%.
 kwashiorkor
 marasmic kwashiorkor
 stunted only
 wasted and stunted
 Wasting only

Phlyctenular conjunctivitis is associated with which condition

 Tuberculosis
 Diphtheria
 Measles
 Allergy
 Trachoma

Which of the following is not associated with increased risk of intraventricular haemorrhage in neonates
 Intravenous fluid bolus in a 1000 g premature infant
 Treatment of patent ductus arteriosus with indomethacin
 Acute tension pneumothorax
 Meconium aspiration syndrome
 Vitamin K deficiency in mother.

Which pathogen does NOT cause bloody diarrhoea

 Vibrio cholera
 Escherichia coli
 Clostridium difficile
 Yersinia enterocolitica
 Shigella flexneri

Mark the correct statement regarding vomiting in infants.

 Vomiting due to piloric stenosis results in metabolic acidosis
 Vomiting is a common symptom in infants with 3 months colic.
 Bile stained vomiting in a neonate is caused by bowel obstruction.
 The most common cause of haematemesis in a neonate is acute gastric ulceration.
 Metoclopramide is a safe anti emetic for treatment of vomiting in children

Which of the following statements does NOT /do NOT fit with chronic diarrhoea due to malabsorption in a 2-year old
child
 Steatorrhoea is present.
 Gluten sensitivity must be excluded.
 Is associated with abdominal distension, wasting of buttock muscles and declining of height growth
 Hypokalaemia and metabolic alkalosis is present.
 Hypo-albuminaemia is present.

A 3-year-old non cyanotic child presents with a productive cough, halitosis and clubbing. He has widespread
crepitations and wheezes in both lungs. The heart is located on the right side. The most likely diagnosis is
 Lymphocytic interstitial pneumonia
 bronchiectasis
 whooping cough
 lobar pneumonia
 tuberculosis

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Which of the following is true of Guillain-Barré-syndrome :
 Cranial nerves and sphincter function are never involved
 Paralysis is asymmetric
 There is usually cerebrospinal fluid pleocytosis (many cells)
 The cerebrospinal fluid usually has high protein content
 The cerebrospinal fluid glucose level is usually decreased

Which of the following signs is not associated with Down’s syndrome

 Short, broad hands.
 Epicanthic folds.
 Hypotonia.
 Coloboma
 Duodenal atresia

Myocarditis in newborns is especially caused by which agent

 Cytomegalo virus infection
 Coxsacki B virus infection
 Group B Streptococcus infection
 Congenital syphilis
 The extended rubella syndrome

Which of the following drugs should NEVER be administered to a patient with Tetralogy of Fallot
 Digoxin
 Oxygen.
 Morphine.
 Propranolol
 Sodium bicarbonate

A two year old has swallowed about 10 ml of paraffin. He is awake. Treatment includes the following:
 Immediate gastric lavage
 Administration of an emetic.
 Treatment with antibiotic for aspiration pneumonia
 Observation for lung complications
 Alkalizing the urine

Is the only treatment which have been shown to be beneficial in the treatment of infants with bronchiolitis /
 Antibiotics
 Humidified oxygen
 Inhaled bronchodilators
 Oral corticosteroids
 Leukotriene antagonists

Choose the TRUE statement concerning Whooping Cough (pertussis):

 May occur in the first month of life.
 Case fatality is highest between ages 1 and 3 years.
 Should only be diagnosed on bacteriological culture.
 Should not be diagnosed in the absence of the characteristic whoop.
 Characteristically associated with polymorphonuclear leucocytosis.

The most important social factor influencing the well-being of children is the ability of families to:
 fulfill all their children's wishes.
 avoid conflict between family members.
 function effectively.

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The photograph shows the breast appearance of a 15 year old girl. She is classified in Tanner's stage:
 1
 2
 3
 4
 5

Menarche usually occurs when girls are in Tanner stage:

 1
 2
 3
 4
 5

This child's nappy rash (diaper dermatitis) is most likely due to

 contact (ammonia) dermatitis.
 Candida albicans.
 Seborrhoeic dermatitis.

This child's skin condition is suggestive of:

 Child abuse.
 Mongolian spot.
 Capillary haemangioma.

Choose the correct statement concerning the management of paraffin poisoning:

 one should induce vomiting as soon as possible.
 steroid treatment should be prescribed routinely.
 a broad-spectrum antibiotic should be prescribed routinely.
 oxygen is the mainstay of treatment.

Which statement reflects a basic principle about the way children adapt to the death of a parent:
 Children are flexible and adapt quite easily.
 As long as one loving parent remains, it is not too bad.
 If children receive treatment they overcome the loss fairly easily.
 The psychologically rich may get richer and the poor get poorer.

Which one of the following is not a typical dynamic of adolescence:

 Conformity.
 Peer group is prized.
 Discontinuity.
 Symbols.

Choose the CORRECT statement concerning typhoid fever:

 The incubation period is less than 3 days in most cases
 In young children the disease may present with vomiting and diarrhoea
 Headache is a constant feature in all patients
 The examination findings are limited to the abdomen
 Hepatosplenomegaly is an infrequent finding

Staphylococcus pyogenes (aureus) is the commonest causative organism in patients with:

 Neonatal meningitis
 Toxic epidermal necrolysis
 Mucocutaneous lymph node syndrome (Kawasaki disease)
 Acute epiglottitis
 Acute glomerulonephritis
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Match the conditions in column A with the statements in column B
Protein losing enteropathy Panhypoproteinaemia
Kwashiorkor Associated hypokalaemia
Chronic liver disease Reserved albumen-globulin ratio
Nephrotic syndrome Heavy proteinuria
Acute glomerulonephritis The serum albumen is usually normal
Inappropriate tachycardia

Insert the correct words in the following sentences regarding iron deficiency:
 Iron is more bio-available from (breast milk, cow milk) than from (breast milk, cow milk)
 The absorption of iron from cereal foods is improved by (vitamin C, phosphates) and inhibited by (phytates,
meat).
 The iron stores of low birth weight infants are depleted by (2-3 months, 4-6 months) unless they receive iron
supplements. This is best given as a (ferric, ferrous) salt.
 Term infants who are breastfed should receive iron supplements from (4, 6, 9) months of age.
 Gastrointestinal blood loss is commonly associated with (ascaris, hookworm) infestation.
 The symptoms of iron deficiency include (irritability, lethargy) and (pica, vomiting).
 The clinical features of iron deficiency include (clubbing, Osler's nodes, koilonychia), and diarrhoea due to
(gluten intolerance, cow milk protein intolerance, lactase deficiency, motility disorder).
 The typical red cell appearance in iron deficiency includes (elliptocytosis, macrocytosis, microcytosis), as well as
(normochromia, hypochromia, hyperchromia).

The following statements describe the age periods of childhood. Select the wrong statement.
 The perinatal period ends 7 days after birth.
 The late neonatal period extends from day 8 to 28 after birth.
 Infancy relates to the period from birth to five years.
 School age relates to the period from 6 years to adolescence.
 Adolescence refers to the period between puberty and adulthood

Match the statements in Columns A and B regarding the recurrence risk of inherited conditions:
Autosomal dominant ½ for each child
Autosomal recessive ¼ for each child
Sex-linked ½ for male children
Multifactorial inheritance 1/20 for each child

A newborn baby experiences respiratory distress and is cyanosed. This improves when he cries with an open mouth.
What is the most important aspect regarding the further management of his condition
 Administration of oxygen. The baby’s condition should resolve in a day or two.
 The baby needs mechanical ventilation until his lungs reach maturity.
 The baby should receive surfactant replacement therapy.
 Ensure an open upper airway and refer to an ENT surgeon without delay.
 Antibiotics and steroids are indicated in this infant.

Problems associated with small for gestational age babies include all of the following EXCEPT
 hypoglycaemia
 polycythaemia
 hypocalcaemia
 hyperthermia
 asphyxia

A newborn baby fails to pass meconium in the first 24 hours of life. The most likely diagnosis is
 cystic fibrosis
 hyperthyroidism
 hiatus hernia
 umbilical hernia
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  galactosaemia
Which of the following is NOT an important clinical sign of severe hypoxic ischaemic encephalopathy in neonates
 irritability
 coma
 seizures difficult to control
 hypotonia
 absent sucking reflex

The following are common causes of seizures in the neonatal period EXCEPT.
 hyperkalcaemia
 hypoxic ischemic encephalopathy.
 meningitis
 intracranial bleeding
 congenital abnormal brain

With which cardiovascular condition is right ventricular hypertrophy associated

 Aortic stenosis
 Tricuspid valve atresia
 Systemic hypertension
 Pulmonary stenosis
 Ebstein anomaly

A 5 month old baby has persisting watery diarrhoea three weeks after an acute onset when she was quite
dehydrated. She is losing weight. Select the best option for management.
 parenteral nutrition to allow gut recovery
 oral rehydration therapy
 stepwise modification of diet and cholestyramine/antibiotic combination
 antidiarrhoeal medicines to reduce gut motility
 intravenous fluids and continue with feeds as before

The incidence of institutional pediatric Staphylococcus aureus infection can be reduced most effectively by:
 treatment of all culture-positive patients with vancomycin.
 meticulous hand washing before and after contact with patients.
 mask and gown use with each culture-positive patient.
 avoidance of flowering houseplants in patient rooms.
 routine quarantine of culture positive patients.

A 8 year old child presents in a collapsed state. A feature that indicates diabetic ketoacidosis is:
 hypoventilation
 hypoglycaemia
 metabolic acidose
 anuria
 hypokalaemia

A 6-year old presents with sneezing, clear rhinorrhea and nasal itching. Physical examination reveals enlarged pale
inferior turbinates, a clear nasal discharge and a transverse nasal crease. The most appropriate longterm treatment
for the above-mentioned patient is:
 intranasal topical pseudoephedrine
 oral decongestants
 oral steroids
 intranasal topical steroids
 intranasal saline solution

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Which of the following is NOT a cause of profound thrombocytopaenia in a newborn
 cytomegalovirus infection
 congenital syphilis
 maternal ingestion of warfarin
 maternal idiopathic thrombocytopaenic purpura (ITP)
 gram-negative septicaemia

A day old baby presents with the following skin rash. The most likely
diagnosis is
 erythema toxicum
 erythema infectiosum
 candida
 neonatal acne
 milia

The mother of a 6 week old fully breastfed baby reports to you that for the past month her baby has been crying
inconsolably. Crying occurs every day, especially during the evening when the crying often lasts for up to 3 hours at a
time. In between bouts of crying the baby appears well. Loose seedy stools are passed on alternate days. The baby’s
th
height and weight are increasing along the 75 centile and there is nothing abnormal to find on thorough physical
examination. You should :
 admit the child to hospital as an emergency.
 change the baby on to formula milk feeds.
 carry out a rectal examination in case the child has constipation.
 arrange an abdominal ultrasound scan to exclude intussesception.
 reassure the mother and monitor the baby’s progress.

A 12 month old boy is brought by his grandmother with a 3 day story of generalised body swelling and a
desquamating pigmented rash maximal in his groin area. His weight is 7.8kg (under the 3rd centile). He is very dull
and has a large smooth hepatomegaly. A chest X Ray shows bronchopneumonia. His urine shows leukocytes and
nitrites but no protein. Which aspect of initial management is not routinely indicated in children like these
 Oral rehydration
 Potassium supplementation
 Broadspectrum antibiotics
 Oral iron supplementation
 Graded re-feeding

Which one of the following is NOT a well recognised complication of untreated nephrotic syndrome in children
 pneumococcus peritonitis
 renal vein thrombosis
 pleural effusion
 hypertensive convulsions
 inguinal hernia

A 3-year-old boy presents with a 2-day history of right leg pain and a limp. One week ago the patient had an upper
respiratory tract infection. The physical examination reveals an afebrile, non-toxic child with a painful swollen right
knee. The FBC and ESR are normal. The most likely diagnosis is:
 juvenile chronic arthritis.
 rheumatic fever.
 reactive arthritis.
 slipped upper femoral epiphysis.
 septic arthritis.

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A 6-year old presents with sneezing, clear rhinorrhea and nasal itching. Physical examination reveals enlarged pale
inferior turbinates, a clear nasal discharge and a transverse nasal crease. Two weeks later, he complains of headache,
poor nasal airflow, fever and a mucopurulent nasal discharge. The most likely diagnosis is:
 sinusitis
 foreign body
 rhinitis medicamentosa
 choanal stenosis
 ciliary dyskinesia

Valproate is used for:

 Attention deficit
 Insomnia
 Tics
 Myoclonic epilepsy
 Behavioural disorders

Is typically associated with hepatosplenomegaly?

 Kwashiorkor
 Cirrhosis
 Coeliac disease
 Cystic fibrosis.
 Henoch Schönlein Purpura

All of the following are common complications of infants of diabetic mothers excluding?
 Hyaline membrane disease
 Apnoeic episodes
 Hypoglycaemia
 Hyperbilirubinaemia
 Anaemia

Choose the correct statement concerning nutrition in infancy.

 Breast milk only is sufficient for all the dietary requirements for the only 3 months.
 Term infants require higher calorie and lower protein intake per body weight compared to adults
 A low protein intake in infancy has no influence on final height.
 High protein intake is associated with fatty infiltration of the liver.
 Iron supplementation is necessary from 6 months onwards in exclusively breast fed infants

Which statement is UNTRUE with regard to measles?

 A haemorrhagic rash is invariably fatal
 Croup associated with measles is caused by caused by herpes virus
 An atypical rash in measles implies some prior immunity.
 The rash appears after an incubation period of 48 hours.
 Measles increases the risk of contracting tuberculosis

Is the most likely cause of hypocalcaemic tetany in a term neonate?

 Hypomagnesaemia
 A deficiency of calcium in the mother’s diet.
 Hypokalaemia
 Hypophosphataemia.
 Full strength cow’s milk feeds

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An 18-month-old boy presents with a bruise and a palpable haematoma over the quadriceps muscle of his left leg.
There is no family history of a bleeding disorder. Special investigations show:
Haemoglobin 12,3 g/dl
9
Platelet count 300 X 10 /l
Skeletal survey Normal
Prothrombin time 12 sek (Normal 12 s)
Partial thromboplastin time 80 sek (Normal 45 s)
Thrombin time 15 sek (Normal 15 s)
What is the most likelely diagnosis?
 Von Willebrandt disease
 Haemophilia A
 Platelet function defect
 Factor VII deficiency
 Henoch Schönlein purpura

Is the most common cause of schoolgoing children in South Africa

 Poor dietary intake of Vitamin C deficiency
 Chronic kidney disease
 Dietary deficiency of calcium
 Gebrekkige inname van anorganiese fosfaat.
 Hypophosphataemic rickets

Iron deficiency anaemia in infants presents with the following blood picture
 Microcytic hypochromic anaemia and thrombocytosis
 Macrocytic hypochromic anaemia and increased reticulocytes
 Microcytic hyperchromic anaemia and thrombocytosis
 Normocytic hypochromic anaemia
 Thrombocytopaenia and increased reticulocytes

Are all caused by vitamin B complex deficiency except for

 Pellagra
 Macrocytic anaemia
 Angular stomatitis
 Glossitis
 Bittot spots

Is the most common malignancy in children

 Acute myeloid leukaemia
 Acute lymphoblastic leukaemia
 Hodgkin lymphoma
 Brain tumours
 Neuroblastoma

Mark the correct statement

 Local infections give rise to generalised lymphadenopathy
 HIV infection is always associated with generalised lymphadenopathy
 Congenital rubella is classically associated with localised suboccipital lymphadenopathy.
 Hodgkin's disease often initially presents with localised lymphadenopathy.
 Metastatic carcinoma often presents with generalised lymphadenopathy

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A toddler presents with joint pains, abdominal pain, vomiting, melaena and a purpuric rash on her buttocks and legs.
She is afebrile. The most likely diagnosis is?
 Meningococcal septicaemia
 Henoch Schönlein purpura
 Disseminated intravascular coagulopathy (DIC)
 Systemic lupus erythematosis
 Haemophilia

Which of the following is associated with hypernatremic dehydration

 Cardiac dysrhythmias
 Convulsions
 Fever
 Hypertension
 Polyuria

Which of the following blood tests are used to establish disease activity in rheumatic heart disease
 The ASO titre
 The blood count and biochemistry
 The chest x-ray and heart sonar
 The ESR and CRP values
 The bloodculture

Which of the following long-term health problems is NOT associated with a small size at birth
 Hypertension
 Obesity
 Diabetes insipidus
 Increased risk of learning problems
 Coronary heart disease

Diabetes mellitus in children - which statement is correct

 Is the commonest cause of ketosis in infants.
 Is mostly accompanied by obesity.
 Is commonly associated with renal hypertension.
 Often first presents with a coma.
 Often shows signs of fluid retention.

Which of the following statements is correct concerning mental retardation

 The degree of mental retardation can be diagnosed accurately by 2 years of age.
 Affected children can not have normal physical milestones.
 Cerebral palsy is seldom associated.
 In many cases deaf children are wrongly labelled as mentally retarded.
 Mentally retarded children can not suffer from psychological disturbances.

Which statement is NOT true concerning leukaemia in children

 Acute non-lymphocytic leukaemia is more common in white than in black children
 Leukaemia is the commonest malignancy of childhood.
 There is a predisposition to leukaemia in children with chromosome disorders
 The commonest symptom of leukaemia is pallor and tiredness.
 The treatment of leukaemia is dependent on the morphological characteristics of the disease

What is true in rheumatoid arthritis (Still’s disease) in children

 In children it rarely causes permanent damage to joints.
 It usually follows on a beta haemolytic streptococcal infection.
 It can cause neck stiffness.
 It can present with dysuria and stranguria.
 It is best treated with prednisone.
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An epidermoid cyst is a possible complication of which procedure
 Radial artery puncture
 Supra-pubic puncture
 Femoral vein puncture
 Bladder catheterization
 Lumbar puncture

Which of the following is a contra-indication against performing a lumbar puncture

 Tachycardia
 Depressed level of consciousness
 Age less than three months
 High fever
 Low white cell count

Which one of the following complications does NOT occur in patients with minimal change nephrotic syndrome
 Severe haematuria
 Emotional and behavioural problems
 Hypercoagulability of blood
 Pneumococcal peritonitis
 Growth retardation

Which statement is correct. Heart failure is very seldomly found in infants with:
 Myocarditis.
 Hypoplastic left heart syndrome.
 Tetralogy of Fallot.
 Congenital coarctation of the aorta.
 Transposition of the aorta and pulmonary artery.

Which of the following factors has the lowest risk for the development of asthma
 a family history of asthma
 eczema
 smoking in the family
 raised in a rural environment
 allergen exposure

Which of the following drug/s is/are contra-indicated in drug-regimes used to treat Extremely Drug Resistant
Tuberculosis
 Streptomysin
 Rifampicin
 Clarithromycin
 Fluoroquinolones
 Amikacin

True sexual precocity in girls is most likely caused by

 a feminising ovarian tumour.
 a gonadotrophin-producing tumour.
 a lesion in the central nervous system.
 exogenous estrogens.
 early onset of “normal” puberty (constitutional).

Which statement is correct in childhood asthma

 Coughing bouts in the early hours of the morning are characteristic.
 It is more prevalent in the higher socio-economic groups.
 It seldom has serious consequences.
 There is justification for use of a cough suppressant for persistent coughing bouts.
 It does not occur before age 2 years.
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Mark the wrong statement with regards to factors which may play a role in unexpected life threatening apnoea in
infants
 Premature baby of < 33 weeks gestation
 If the parents smoked during the pregnancy
 Babies who share the bed with parents
 Babies who sleep in the same room as the parents
 Babies who sleep supine (on the back)

Which clinical manifestation is found in children with salicylate poisoning?

 bradycardia
 hyperglycaemia
 coma
 liver failure
 metabolic acidosis, followed by a respiratory alkalosis

An otherwise normal neonate presents with a mass over the parietal area of the scalp directly after birth. It does not
cross the suture lines. How should this patient be managed?
 Urgent surgical drainage of the mass
 Needle aspiration of the mass
 Resuscitation fluid and blood transfusion
 Observation for the development of jaundice
 Urgent CT scan of the brain to exclude connection of the mass with underlying structures.

A one year old child presents at the hospital’s casualty department with the following clinical signs: apathy, sunken
eyes, dry mouth, decreased skin turgor, tachycardia and poorly palpable peripheral pulses. Establishing a venous
access for the child has been unsuccessfully attempted three times. The next appropriate step in the medical
treatment of this child is as follows:
 To insert a naso-gastric tube in the child and to administer oral rehydration fluid through it.
 To consult the surgery doctor-on-call to insert a central venous line in the child and to give a fluid bolus with
resuscitation fluid.
 To ask the mother to give regular small sips of oral rehydration solution to the child, and to give intramuscular
antibiotics.
 To immediately insert an intra-osseous line in the casualty department and give a fluid bolus with
resuscitation fluid.
 To take a thorough history from the mother in terms of the severity of the vomiting and diarrhoea in the child.

Methylphenidate is used for:

 impulsivity
 insomnia
 tics
 myoclonic epilepsy
 behavioural disorders

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