W1-2-60-1-6

JOMO KENYATTA UNIVERSITY

OF
AGRICULTURE AND TECHNOLOGY
UNIVERSITY EXAMINATIONS 2016/2017
YEAR 3 SEMESTER II EXAMINATION FOR THE DEGREE OF BACHELOR OF
SCIENCE IN CLINICAL MEDICINE (UPGRADING)

ICM 2302: CHILD HEALTH AND PAEDIATRICS

DATE: December 2016 TIME: 2 HOURS

INSTRUCTIONS:

This paper has two sections, read carefully the instructions preceding each section

SECTION A: MCQ (60 MINUTES)

There are 30 MCQ to be answered in 60 minutes. Answer each choice with True or False.
A correct answer earns you one mark while incorrect answer earns you negative half a
mark.

1. The following is correct matching of developmental milestones:

a) Pincer grip – 4 months
b) Nerve support – 1 month
c) Climbing stairs – 1 year
d) Building a tower of 4 cubes – 15 months
e) Stranger anxiety – 6 months
2. The following are diagnostic of malnutrition in children;
a) Ht for wt Z score of -3
b) Ht for Age Z scorre of 1
c) mUAC of <12.5 cm
d) visible severe wasting
e) wt for age Z score of -3
3. The following are considered ETAT danger signs;
a) Convulsions
b) Obstructive breathing
c) Central cyanosis

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 d) Tiny baby
e) Major trauma
4. Avasta developed diarrhea and vomiting 2 days ago. The following signify severe
dehydration;
a) Capillary refill of 2 seconds
b) Skin turgor of 2 seconds
c) Rapid pulse
d) Weak peripheral pulse
e) Eager to drink
5. In management of chronic asthma, the following are recommended;
a) Inhaled corticorsteroids
b) Salbutamol inhalers
c) Adrenaline
d) Montelukarst
e) Theophylline
6. Dennis, 4 year old, developed yellowness of eyes associated with abdominal pains. The
following is true;
a) Hepatitis A is transmitted fecal oral
b) Hepatitis B causes chronic liver disease
c) All patients with condition have jaundice
d) ALT is liver specific
e) Paracetamol is commonest known drug etiology
7. The following occur in Hyporic-ischaemic encephalopathy;
a) Pinpoint pupils
b) Cold skin
c) Disseminated intravascular coagulopathy
d) Acute renal failure
e) Convulsions
8. The following vaccines are contraindicated in HIV disease;
a) BCG
b) Yellow fever
c) Haemophilus influenza type B
d) Measles
e) Rotavirus
9. The following statement are true about acute gastroenteritis in children;
a) If you find fever the likely aetiology is viral
b) Dehydration is the most common complication
c) Metabolic alkalosis is a common complication
d) Hyponatraemia occurs in children using salt and sugar solution as home remedy
e) Can result in post-renal failure
10. About sickle cell anemia;
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 a) It is chronic haemolytic anemia
b) Splenomegaly is present after the first decade
c) Growth in affected children is normal
d) The disease manifest within the first month of life
e) Inheritance is x-linked
11. According to the Kenyan Demographic Health Survey (KDHS) of 2014;
a) The infant mortality rate is 39/1000 live births
b) 85% of Kenyan children are fully immunized
c) The under-five mortality rate is 52/1000 live births
d) 26% of Kenyan children are stunted
e) The neonatal mortality rate is 22/1000 live births
12. Risk factors for neonatal sepsis include;
a) Rupture of membranes for less than 18 hours before delivery
b) Born before arrival (BBA)
c) Birth Asphyxia
d) Meconium aspiration
e) Chorioammonitis
13. In management of severe acute malnutrition;
a) Discharge all children on F100
b) Micronutrient deficiency is the commonest cause of death.
c) Start oral immediately on admission
d) Play and stimulation is important in hospital
e) There is no need to breastfeed the baby F75 has enough calories
14. The risk factors of neonatal meningitis include;
a) Prematurity
b) Maternal polyoramnios
c) Instrumental delivery
d) Maternal diabetes
e) Maternal fever at first trimester
15. The following are causes of communication hydrocephalus;
a) Zika virus
b) Cerebral palsy
c) Mid brain tumour
d) A queductal stenosis
e) Meningitis
16. An 18 months old baby is brought to the paediatric outpatient department with history of
recurrent lower respiratory tract infections. He has had delayed milestones and a walding
gaits. This condition is associated with;
a) Hypercalcaemia
b) Hypophosphataemia
c) Decreased ALP
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 d) High vitamin D levels in blood
e) Bone pains
17. The findings in a patient with Kwashiorkor may include;
a) Diarrhea
b) Apathy
c) Fatty liver
d) Deficiency of intestinal enzymes
e) Increased mid-upper arm circumference
18. Measures useful in the management of tetanus include;
a) Human tetanus immunoglobulin
b) Penicillin
c) Sedatives
d) Vigorous cleaning of wound first
e) Tracheostomy
19. At birth a newborn has pink mucous membranes, pulse is 110, cry is lustly, muscles are
of good tone, and active motion is noted of the extremities, respirations are strong;
a) The APGAP score is 8
b) The child need tetracycline eye ointment
c) The child should get IM vitamin K
d) The child should be kept warm except the head
e) The child should get BCG before discharge
20. Jaundice at birth;
a) Occurs only with biliary atresia
b) Is associated with passage of meconium
c) Occurs with haemolytic disease of the newborn
d) Is frequently associated with maternal anaemia
e) Could be associated with TORCHES injections
21. Concerning acute otitis media;
a) Children are prone to acute Otitis Media because their Eustachian tubes are short
and horizontal
b) Antibiotics should always be prescribed
c) If treated early there is no risk of hearing loss
d) If persistent effusion placement of grommets is indicated
e) E. coli and enterococcus are common organisms
22. In common colds and sore throats;
a) Causes are mostly viruses as rhinovirus and adenovirus
b) Antibiotics can shorten the duration of the discomfort
c) Nasal discharge and blockage can lead to feeding difficulty therefore need
antihistamine treatment
d) Treatment of fever and pain with paracetamol should be discouraged

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 e) Only if associated with swelling and inflammation of the tonsils are antibiotics
indicated
23. Concerning measles;
a) Older children and adults tend to have more severe disease than the very young
b) Vaccination in immunocopromised children is safer than injection with the ‘wild’
virus
c) Maintenance of the cold chain is vital for successful immunization coverage
d) Vaccination against measles can be done in the same session with BCG and
pentavalent if indicated
e) After immunization at nine months of age, there is life long immunity.
24. Features of severe malaria include;
a) Fever
b) Splenomegaly
c) Jaundice
d) Shock
e) Severe anaemia
25. In typical febrile convulsions, the following is/are likely to be present;
a) CNS involvement
b) Fever
c) Family history of febrile convulsions
d) Generalized ionic clonic convulsion
e) 7 years of age
26. Which of the following methods can be used to demonstrate fluid in the abdomen?
a) Shifting dullness in percussion
b) Aspiration of the fluid
c) Pulsatile mass
d) Presence of bruits
e) Fluid thrill
27. Complication of pneumonia include;
a) Congestive Cardiac Failure
b) Laryingo-Trachea Bronchitis
c) Pulmonary Tuberculosis
d) Measles
e) Malnutrition
28. Which of the following is/are recombinant vaccines?
a) Hepatitis A vaccine
b) Pneunococcal vaccine
c) Hepatitis B vaccine
d) Pertussis vaccine
e) Pentavalent vaccine
29. Bronchial breathing is the respiratory examination in a 10 year old child signifies;
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 a) Pleural effusion
b) Lung consolidation
c) Lung abscess
d) Congestive cardiac failure
e) Cystic mass
30. In a child, risk factors for respiratory infections include;
a) Low birth weight
b) Malnutrition
c) Overcrowding
d) Immunization coverage of about 40%
e) Diarrhea diseases

SECTION B: 60 minutes.

Answer all questions. Start each question on a separate piece of answer sheet.

Long essay question

1) Njau is 3 days old. He is brought by an ambulance to the resuscitation room in A&E. He

was found in his cot this morning looking mottled and breathing very fast. He had been
well until yesterday when he did not feed as well as usual. He was born at 39 weeks
gestation by normal vaginal delivery at home. No details of labour are available
a) What is the most likely diagnosis and what is the differential

(5marks)
b) What is the management of this newborn? (15marks)

Short Answer Questions

2) Outline the emergency care of a child who presents to your consultation room actively
convulsing (10marks)
3) You see an abandoned child in the ward whom the clinician conclude is 9 months.
Describe how this can be established clinically. (10marks)
4) i. Why is exclusive breastfeeding done for 6 months and not 9 months?

(4marks)
ii. Outline the benefits of breastfeeding. (6marks)

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