PAEDIATRICS MCQs

1.	Neonates are particularly prone to infection by:

a.	H. influenzae.
b.	Pneumococcus.
c.	Treponema pallidum.
d.	Rubella.
e.	E. coli.

E

2.	The philadelphia chromosome is associated with which of the following condition?

a.	Acute lymphoblastic leukaemia.
b.	Chronic myeloid leukaemia.
c.	Chronic lymphocytic leukaemia.
d.	Thalassaemia.
e.	Spherocytosis.

B

3.	The Moro reflex usually disappears by:

a.	9 months.
b.	1 year.
c.	2 weeks.
d.	2 days.
e.	4 months.

E

4.	In infestation with Giardia Lamblia, the following are true except:

a.	May be asymptomatic.
b.	May cause malabsorption.
c.	Produces striking abnormalities demonstrable in jejunal biopsy.
d.	Is associated with severe anaemia.
e.	Can be treated with metronidazole.

D.

5.	Thrombocytopenia can occur in the following conditions except:

a.	Haemangioma.
b.	Acute viral infections.
c.	Von Willebrands disease.
d.	Cyanotic congenital heart disease.
e.	Splenomegaly.

C.

6.	Failure to thrive may be due to the following except:

a.	Diabetes insipidus.
b.	Renal tubular acidosis.
c.	Phenylketonuria.
d.	Chronic pyelonephritis.
e.	Renal glycosuria.

A.

7.	The following are known tetratogens except:

a.	Lithium.
b.	Methotrexate.
c.	Phenytoin.
d.	Alcohol.
e.	Smoking.

D.

8.	In the treatment of acute gastroenteritis in children, the following has been found to have definite therapeutic value:

a.	Kaolin.
b.	Kaolin – pectin concentrate.
c.	Lotomil.
d.	Opium.
e.	Clear fluid.

E.

9.	Jaundice appearing after the 2nd week of life is most likely to be due to:

a.	ABO incompatibility.
b.	Obstructive jaundice syndrome.
c.	Crigler-Najjar syndrome.
d.	Breast milk jaundice.
e.	Liver immaturity.

D.

10.	At one time in Singapore there were 75 new cases of thalassaemia major among 55,625 newborns. Applying the Hardy-Weinberg formula, the incidence of carriers is:

a.	1 out of 27.
b.	1 out of 45.
c.	1 out of 50.
d.	1 out of 60.
e.	1 out of 10.

A.

11.	Down’s anomaly can possess which of the following:

a.	49 chromosomes.
b.	46 chromosomes.
c.	40 chromosomes.
d.	45 chromosomes.
e.	71 chromosomes.

B.

12.	Mother has recently noticed that her 5-month old male baby has an enlarged left testis. Transillumination is negative. You will:

a.	Watch and see how the testicular lesion progresses.
b.	Tell the mother not to worry.
c.	Diagnose as hydrocoele.
d.	Refer to a surgeon for exploration.
e.	Give a course of antibiotics.

A.

13.	A mother has 5 sons, one of them is diagnosed as having haemophilia and the others are normal. Her brother also has haemophilia. Which of the following statements is correct?

a.	The mother is an obligatory heterozygote.
b.	The haemophilia son is a sporadic mutation.
c.	The mother can have more children with impunity.
d.	Any of the other 4 sons can still develop haemophilia later in life.
e.	Her mother can give rise to affected sons.

A.

14.	In Wilm’s tumor, which statement is false?

a.	The majority occurs below the age of 3 years.
b.	Bilateral renal involvement occurs in 10% of cases.
c.	It is associated with aniridia and hemihypertrophy.
d.	The prognosis is better in infancy.
e.	If there is no recurrence 2 years after removal of the tumor, there is a good chance the patient is cured.

C.

15.	Werdnig-Hoffmann disease is characterized by each of the following except:

a.	Symptoms may be manifested at birth.
b.	Absence of deep tendon reflexes.
c.	Muscle histology shows features of myopathic changes.
d.	Fasciculations of the tongue present in early disease.
e.	Autosomal recessive inheritance.

C.

16.	In patients with cold agglutinin haemolytic anaemia:

a.	Raynaud’s phenomenon may be a feature.
b.	IgM antibodies are involved.
c.	IgG antibodies are involved.
d.	Antibodies are made to the red cell antigen.
e.	Responds well to splenectomy.

B.

17.	The following are possible if CSF protein is above 200mg:

a.	Werdnig-Hoffman disease.
b.	Guillain-Barre syndrome.
c.	Acoustic neuroma.
d.	Epidural abscess.
e.	Multiple sclerosis.

D.

18.	The following are features of acquired haemolytic anaemia:

a.	Raised conjugated serum bilirubin.
b.	Raised urinary urobilinogen.
c.	Positive Coomb’s test.
d.	Target cells.
e.	Reticulocytosis.

E.

19.	Erythroblastosis fetalis can develop in an infant born to parents with blood types:

a.	Father O positive – Mother AB negative.
b.	Father B negative – Mother AB negative.
c.	Father A positive – Mother O positive.
d.	Father O positive – Mother AB positive.
e.	Father B positive – Mother AB positive.

20.	Polyuria is a feature of:

a.	Hypercalcaemia.
b.	Hyponatraemia.
c.	Hypocalcaemia.
d.	Hypokalaemia.
e.	Acidosis.

A.

21.	Aldosterone secretion is stimulated by an increase in:

a.	Serum potassium.
b.	Plasma renin.
c.	Plasma ACTH.
d.	Plasma sodium.
e.	Decrease of plasma pH.

B.

22.	Urobilinogen in urine is

a.	Not detectable in health.
b.	Diagnostic of intrahepatic obstruction.
c.	Found to occur in pernicious anaemia.
d.	Increased in porphyria.
e.	An indication of increased haemolysis.

E

23.	Pyloric stenosis is treated by:

a.	Gastrectomy.
b.	Gastro-jejunostomy.
c.	Pyloroplasty.
d.	Pyloromyotomy.
e.	Pyloric excision.

D.

24.	Drug of choice for acute epiglottis:

a.	Ampicillin.
b.	Bactrim.
c.	Penicillin.
d.	Gentamicin.
e.	Nitrofurantoin.

A.

25.	X-ray picture of acute bronchiolitis:

a.	Hyperinflated lungs with low diaphragm.
b.	Diffuse opacities in the lung.
c.	Right middle lobe collapse.
d.	All of the above.

A.

26.	Which is not found in junvenile hypothyroidism?

a.	Hyperreflexia.
b.	Hypotonia.
c.	Carotenemia.
d.	Hypercholesterolaemia.
e.	Low ECG voltages.

A.

27.	A male child with congenital adrenal hyperplasia cannot present as:

a.	Pseudo-precocious puberty.
b.	Ambiguous genitalia.
c.	Severe vomiting and diarrhoea in infancy.
d.	Female genotype with salt-losing manifestation.

D.

28.	Unconjugated hyperbilirubinaemia found in all except:

a.	Physiological jaundice.
b.	Breast milk jaundice.
c.	Cretinism.
d.	Gilbert’s disease.
e.	Septicaemia.

E.

30.	Alpha-feto protein can be found in amniotic fluid in:

(1).	Congenital nephrotic syndrome.
(2).	Neural tube defect.
(3).	Fetal distress.
(4).	Intrauterine infection.
(5).	Intrauterine death.

a.	1 + 2.
b.	1 + 2 + 3.
c.	1 + 2 +3 + 4.
d.	All of the above.
e.	None of the above.

A.

31.	The following statements about brain tumors are true except:

a.	75% of brain tumors are gliomas.
b.	1/3 are infratentorial.
c.	Medulloblastoma is commonest.
d.	Prognosis of astrocytoma is better than medulloblastoma.
e.	Craniopharyngioma show suprasellar calcification.

B.

Between the ages of 2 and 12, 2/3 of all brain tumors are infratentorial. 

32.	The following statements of leukemia are true except:

a.	Most common leukemia is ALL.
b.	Prognosis of ALL better in children than in adults.
c.	Mongols have 2 x risk.
d.	Mediastinal involvement denotes bad prognosis.
e.	CNS involvement is rare in AML.

C.

33.	Cytoalbumin dissociation is found in:

a.	Guillain-Barre polyneuritis.
b.	Encephalitis.
c.	Brain abscess.
d.	Subdural hemorrhage.

A.

34.	Paradoxical splitting of S2 can occur in:

a.	AS.
b.	PS.
c.	PDA.
d.	Myocardial disease.
e.	All except B.

A.

35.	Early signs of kernicterus are the following except:

a.	Incomplete Moro’s reflex.
b.	Poor sucking and rooting reflex.
c.	Athetoid movement.
d.	High pitched cry.
e.	Opisthotonus.

C.

The immediate effects of kernicterus are: lethargy, increased tone, decreased Moro and opisthotonus. The long-term effect includes choreoathetoid cerebral palsy, sensorineural deafness and learning difficulties. 

36.	The earliest skin lesion in tuberous sclerosis is:

a.	Adenoma sebaceum.
b.	Cafe-au-lait spots.
c.	Shagreen patches.
d.	Subungal fibroma.
e.	Achromic skin patches.

E.

In infants, achromic skin patches, especially in association with infantile spasms, are characteristic of tuberous sclerosis. Other dermal abnormalities (adenoma sebaceum and subungual fibromata) appear later in childhood.

37.	Febrile convulsions: which statement is not true?

a.	Incidence is 2 – 5% of children under 5 years.
b.	Usually between 6/12 to 1 years.
c.	Usually due to fever from URTI.
d.	Usually benign but can lead to epilepsy.
e.	Recurrences usually do not occur.

B.

Usually occur between 6/12 and 5 years of age.

38.	Which features are found in rubella embryopathy?

a.	Microcephalus.
b.	Bony changes.
c.	Blue – muffin lesions on skin.
d.	All of the above.
e.	All except (b)

D.

39.	Significant colony count in clear catch urine.

a.	105.
b.	104.
c.	103.
d.	102.
e.	101.

A.

40.	Most common causative organism of GE in children:

a.	Salmonella.
b.	Shigella.
c.	Ascaria.
d.	E.coli.
e.	Rotavirus.

E.

41.	Features of idiopathic hypercalcaemia include:

a.	Elf-like facies.
b.	Mental retardation.
c.	Renal calculi.
d.	Supravalvular aortic stenosis.
e.	Renal damage with uraemia.

C.

42.	A child is discovered to be HbH:

a.	Advise parents not to have any more children.
b.	Watch child.
c.	Give Fe.
d.	Give blood transfusion.
e.	Splenectomy.

B.

43.	A child have severe hypoxia and pH of 6.95:

a.	Accumulation of fatty acids.
b.	Accumulation of ketones.
c.	Accumulation of lactate.
d.	Accumulation of carbon dioxide.

D.

44.	Which statement is not true of HSP?

a.	Involve extensor surface.
b.	Acute nephritis is a complication.
c.	Acute pancreatitis is a complication.
d.	Skin lesion antedate others.
e.	Recurrence is common.

C.

45.	A 6 years old boy with sore throat, fever, running nose, whitish plaque at pharynx and neck glands. Otherwise well.

a.	Streptococcal sore throat.
b.	HUS.
c.	Diphtheria.
d.	Quinsy.
e.	Follicular tonsillitis.

C.

46.	Which is not true of hereditary spherocytosis?

a.	AD.
b.	Increased osmotic fragility.
c.	Can present in 1st month of life.
d.	Due to rbc membrane defect which is completed by splenectomy.

D.

47.	Delayed bowel emptying is not found in:

a.	Meconium plug.
b.	Hirschsprungs.
c.	High intestinal obstruction.
d.	Imperforate anus.

D.

48.	Which is true of Werdnig-Hoffman’s disease?

a.	AD.
b.	Sex-linked.
c.	Usually mentally subnormal.
d.	Tendon reflexes present.
e.	In those with late onset may live for a few years and occasionally to adulthood.

E.

49.	Which is true of UTI?

a.	Boys more than girls in infancy.
b.	No recurrences will occur after an acute attack.
c.	No long term ill effects.
d.	Easily diagnosed by leucocytosis.
e.	Clear cut signs and symptoms.

A.

50.	Which is true of AGN in children?

a.	X-ray evidence of pulmonary edema.
b.	Bad prognosis.
c.	Normal complement.
d.	No ECG changes.

A.

51.	Second heart sound of Fallot’s tetralogy:

a.	Single and loud.
b.	Loud and split.
c.	Soft and split.
d.	Widely split.
e.	Fixed split.

A.

52.	Inappropriate ADH results in:

a.	Clinical picture of water deprivation.
b.	Hyperosmolar serum.
c.	Low vasopressin level in blood.
d.	All of above.
e.	None of above.

E.

53.	Which is not true of Hepatitis B?

a.	Oral transmission can occur.
b.	Incubation longer than Hep A.
c.	Can be prevented by commercial Ig.
d.	Unique Ag found in patient’s blood.
e.	Extrahepatic manifestations like skin rashes, joint pain more than Hep A.

A.

54.	The commonest form of estrophageal atresia is:

a.	Upper blind pouch with tracheo-esophageal fistula.
b.	Lower blind pouch with tracheo-esophageal fistula.
c.	Upper and lower blind pouches with tracheo-esophageal fistula.
d.	Both pouches communicate with trachea.

A.

55.	All except one can cause apnoea in newborn:

a.	Premature baby.
b.	SFD baby.
c.	Hypoglycaemia.
d.	Depressed baby.
e.	Asphyxiated baby.

B.

56.	Thrombocytopenia can be found in all except:

a.	Hemangioma.
b.	Von Willebrands.
c.	Septicaemia.
d.	Acute viral infections.

B.

57.	Which is not true of intussusception except:

a.	Common between 3 – 12 months.
b.	Not a complication of HSP.
c.	Can be relieved by a barium meal beyond 2 years.
d.	Relief of intussusception is shown by passage of barium into ileum.

A.

58.	The following are true except:

a.	T cells are produced by the thymus which is formed by the 5th and 6th pharyngeal pouches.
b.	T cell formation can be tested by intradermal PPD.
c.	T cell work with B cell in cooperation.
d.	Pure T cell deficiency occur in Di George’s syndrome.
e.	T cells are mainly involved in CMI.

A.

59.	In sex-linked agammaglobinaemia, which is not true:

a.	1 out of 2 male offsprings affected.
b.	All Ig at low levels or undetectable.
c.	Ig has to be given at 3 monthly intervals.
d.	Human plasma infusion is also helpful.
e.	Increased susceptibility to host infection but not viral infections.

C.

60.	Commonest abdominal mass in children:

a.	Wilm’s tumor.
b.	Neuroblastoma.
c.	Hydronephrosis.
d.	Polycystic kidney.
e.	Ascites.

B.

61.	Commonest cause of intestinal obstruction in neonates:

a.	Hirschsprung’s.
b.	Intestinal atresia.
c.	Volvulus neonatorum.
d.	Congenital hypertrophic pyloric stenosis.
e.	Intussusception.

A.

62.	Intussusceptioni in infants and children usually occur in:

a.	1st month.
b.	5th month.
c.	10th month.
d.	3 – 5 years.

B.

63.	In sex-linked gamma-globulinaemia:

a.	All Ig G is low.
b.	Treat 3-weekly IM injection and immunoglobulin.
c.	Human plasma infusions are helpful.
d.	Risk of next child (male) affected is 1:2.
e.	Bacterial infections are common but resistance to all viral infections is present.

E.

64.	In an IVP, which is true?

a.	Indicated for all proven UTI cases.
b.	If normal MCU, it is not indicated.
c.	Morbidity associated with the procedure due to hypersensitivity to contrast is a serious consideration.
d.	In infants IVP films are easily obtained.
e.	In renal failure, the quality of the IVP film is unaffected.

A.

65.	Vesico-ureteric reflux is best demonstrated by:

a.	IVP.
b.	Cystoscopy.
c.	MCU.
d.	Neprhogram.

C.

66.	Most common site of metastasis for Wilm’s tumor is:

a.	Brain.
b.	Lungs.
c.	Liver.
d.	Bone.
e.	Thyroid.

B.

67.	All the following features are commonly present in minimal change nephrotic syndrome except:

a.	Younger age group 1 to 5 years old.
b.	Haematuria.
c.	Normal complement.
d.	Highly selective proteinuria.
e.	Good response to steroids.

B.

68.	Hyperkalaemia of acute renal failure treated by all except:

a.	Na cycle resin.
b.	Calcium chloride.
c.	Sodium bicarbonate.
d.	IV glucose and insulin.
e.	Hypotonic saline.

E.

69.	Which condition is associated with myelomeningocele?

a.	Down’s.
b.	Tuberous sclerosis.
c.	Arnold-Chiari malformation.
d.	Congenital rubella.
e.	Ataxia-telangiectasia.

C.

70.	Adenoma sebaceum is characteristic of:

a.	Sturge-Weber.
b.	Neurofibromatosis.
c.	Tuberous sclerosis.
d.	Gargoylism.
e.	Wilson’s disease.

C.

71.	Jaundice after two weeks:

a.	ABO.
b.	Rh.
c.	Breast milk jaundice.
d.	Obstructive jaundice.
e.	None of the above.

D.

72.	Poor prognosis points to ALL are all except:

a.	Hepatosplenomegaly.
b.	Decreased platelets.
c.	Increase in total white.
d.	Mediastinal mass.
e.	Child greater than one year old.

E.

73.	Inspiratory stridor is most common in:

a.	Epiglottitis.
b.	Foreign body in larynx.
c.	Laryngotracheobronchitis.
d.	Angioneurotic edema.

A.

74.	Treatment for VSD in 5-year olds is when:

a.	Q(p):Q(s) is greater than 2:1.
b.	Q(p):Q(s) is 1.5:1.
c.	Pulmonary-systemic resistance is 0.6.
d.	Right to left shunt.

C.

75.	Chemotherapeutic agent NOT used in children:

a.	Penicillin.
b.	Gentamicin.
c.	Isoniazid.
d.	Tetracycline.
e.	Sulphonamide.

D.

76.	In intussusception, when the diagnosis is suspected, which is done first?

a.	Barium enema.
b.	Examine for sausage-shaped mass.
c.	Organize for laparotomy.
d.	Exclude it if no jelly currant stool.
e.	Abdominal X-ray for intestinal obstruction.

B.

77.	Neonates are particularly prone to infection by:

a.	Haemophilus influenzae.
b.	Pneumococcus.
c.	Treponema pallidum.
d.	Rubella.
e.	E.coli.

E.

78.	SBE does not usually occur in:

a.	ASD.
b.	VSD.
c.	PDA.
d.	Mitral valvular disease.
e.	Aortic valvular disease.

A.

79.	Infection with the following cause congenital abnormalities except:

a.	Syphilis.
b.	Rubella.
c.	Mycobacterium.
d.	Cytomegalovirus.
e.	Toxoplasmosis.

C.

80.	Cytoalbuminous dissociation of CSF is associated with which of the following conditions?

a.	Infectious polyneuritis.
b.	Poliomyelitis.
c.	Meningitis.
d.	Encephalitis.
e.	Subdural empyema.

A.

81.	Haemorrhagic cystitis is a COMMON complication of:

a.	VCR.
b.	Cyclophosphamide.
c.	Methotrexate.
d.	Mercaptopurine.
e.	Arabinoside C.

B.

82.	Short history of fever, running nose, cough, sore throat on examination plaques on pharynx, neck glands, otherwise well:

a.	IMS.
b.	Streptococcal sore throat.
c.	Diphtheria.
d.	Quinsy.
e.	Folliculitis.

A.

83.	Newborn with symptoms and signs of hemolysis, hyperbilirubinaemia, microspherocytosis:

a.	ABO.
b.	Rh.
c.	Duffy.
d.	Lewis.
e.	Stomatocytosis.

A.

84.	In cases of partially treated bacterial meningitis, the most reliable diagnosis is using the lab test:

a.	CSF cell count.
b.	CSF protein.
c.	CSF lactate.
d.	CSF glucose.
e.	Gram stain of CSF.

A.

85.	Hypoglycaemia occurs in:

a.	Hypopituitarism.
b.	Reye’s syndrome.
c.	Glycogen storage disease.
d.	All of the above.
e.	None of the above.

D.