30 December 2012

MCQ’s in Paediatrics (Medical students - 4th Year)

MCQ's in Paediatrics
© Dr Joseph Mizzi 2012-13

Answer True or False

1. The following congenital heart anomalies present with cyanosis

1. Ventriculo-septal defect
2. Atrial septal defect
3. Transposition of the great arteries
4. Aortic stenosis
5. Coarctation of the aorta

2. Kawasaki disease

1. Has a viral etiology
2. May result in myocardial infarction
3. Usually affects toddlers and young children
4. No treatment is available
5. Purulent conjunctivitis is a one of the signs

3. Gastroenteritis

1. Is most often caused by viruses
2. Is never treated with antibiotics
3. May result in temporary lactose intolerance
4. Most often requires intravenous fluids
5. Caused by rotavirus is preventable by vaccine

4. Chronic constipation

1. Most children have an underlying pathological cause
2. Requires long term treatment with a stool-softener
3. May cause problems with toilet training in infants
4. Is usually caused by lack of fibre and water in the diet
5. Affects about 10% of young children

5. Nocturnal enuresis

1. Is commoner in girls
2. Always resolves by adolescence
3. May be treated with anti-diuretic hormone
4. 10% of children wet their bed at 5 years of age
5. Is often caused by a urinary tract infection

6. Thalassaemia

1. Is relatively common in Malta
2. Is an autosomal dominant condition
3. Is caused by lack of production of beta-chains
4. Newborns are routinely screened for thalassaemia
5. Is treated with iron supplements

7. Regarding growth in children

1. A child is obese if his weight is above the 90th centile
2. The height is abnormal if it is below the 10th centile
3. A head circumference above the 97th centile may indicate hydrocephalus
4. Growth hormone secretion is suppressed in emotionally deprived children
5. Undiagnosed renal disease may cause failure to thrive

8. Puberty

1. Is controlled by FSH and LH in boys
2. If precocious, may lead to short stature
3. If delayed, may be to Turner’s syndrome
4. May be induced by sex hormones
5. Occurs earlier in boys

9. Congenital hypothyroidism

1. Is easily diagnosed by clinical examination of the newborn
2. Can result in severe neuro-developmental delay
3. Occurs in one in every 100 births
4. May present with poor feeding and constipation
5. All neonates are screened in Malta

10. Diabetic keto-acidosis

1. The patient is dehydrated
2. Caused by lack of insulin
3. The blood pH is typically 7.5
4. Ketones are usually absent in the urine
5. The glucose level is very high

11. Regarding child development

1. About 10% of children have some type of developmental problem
2. Most infants start walking by 12 months
3. Most children who are not walking by 18 months will have a serious underlying problem
4. Delay in one are of development may effect other areas
5. Pincer grasp usually occurs by 8 months

12. Regarding vision

1. Amblyopia can be corrected by glasses
2. Roving eye movements is a sign of severe visual impairment
3. The red-reflex test shows that the eye-sight is normal
4. By 6 weeks an infant fixes on the face and follows a bright dangling object
5. Corneal reflection is a helpful sign to detect squints

13. Foetal Alcohol Syndrome

1. Involves poor growth, physical abnormalities and CNS problems
2. Is curable
3. Is preventable
4. Includes mental retardation
5. One unit a day of alcohol in pregnancy is safe

14. On congenital anomalies of the gut

1. Duodenal atresia presents with vomiting in the second week of life
2. Hirschprung’s disease may present with delayed passage of meconium
3. Pyloric stenosis presents with vomiting on the first day of life
4. Cleft palate may be complicated by otitis media
5. Cleft lip and palate are usually corrected after the first  year of life

15. Intestinal obstruction

1. Bile-stained vomiting is a significant sign
2. Intussusception is the commonest cause in infancy
3. Intussusception always requires surgical treatment
4. Abdominal x-ray usually reveals the cause of the obstruction
5. May present with intermittent pain and pallor

16. Regarding jaundice

1. In neonates is usually caused by hepatic disease
2. Approximately 20% of newborn infants will become jaundiced during the first week of life
3. Unconjugated hyperbilirubinaemia may be caused by biliary atresia
4. In infants with prolonged cholestatic jaundice should be urgently investigated
5. Maltese children are routinely vaccinated for hepatitis A

17. In breastfeeding

1. Breast-milk protects against necrotizing enterocolitis
2. Should be temporarily stopped during acute gastroenteritis
3. Should be on a 3 hourly schedule
4. Should be interrupted in breast-milk jaundice
5. May cause cholestatic jaundice

18. In the treatment of acute gastroenteritis in children

1. Probiotics reduces the duration of diarrhoea
2. Anti-motility agents are not recommended
3. Prokinetic agents may increase diarrhoea
4. Antibiotics are always contraindicated
5. Lactose-free milk is generally not necessary

19. Infant nutrition

1. Neonates require 30 calories/kg/day
2. 50% of the calorie intake should be supplied by lipids
3. Neonates require around 150 ml/kg/day of water
4. Neonates normally loose about 5% of their body weight in the first week
5. Complimentary feeding should not be introduced before 4 or after 6 months

20. Infant growth

1. A preterm infant weighing less than 1.5kg is by definition small-for-gestational age
2. Faster growth rate in infancy may be associated with increased risk of cardiovascular disease in adulthood
3. Infants double their birth weight within the first 6 months
4. Formula-fed infants generally grow at a faster rate than breast-fed babies
5. Growth rate decreases during the first year of life

21. Sudden Infant Death Syndrome (SIDS)

1. It is safe to place the infant to sleep on the back or side
2. Supine sleeping position is associated with plagiocephaly
3. Is the commonest cause of infant death after 1 month of age
4. Is caused by suffocation
5. Preterm infants are at increased risk

22. Childhood obesity

1. Is rarely caused by medical conditions
2. A child with a BMI of 19 is by definition underweight
3. The prevalence of overweight and obese children in Malta is around 40%
4. Is a recognized risk factor for benign intracranial hypertension
5. If both parents are obese, a child has 80% chance of being obese

23. Prolonged neonatal jaundice

1. Is defined a jaundice persisting after 14 days
2. Is usually caused by unconjugated hyperbilirubinaemia
3. Total and direct bilirubin levels should be checked
4. May be caused by hypothyroidism
5. Caused by Crigglar Najjar syndrome may cause kernicterus

24. Phototherapy

1. Should be started in all infants with a serum bilirubin above 200 micromoles/l
2. Is complicated by increased water losses
3. May cause diarrhoea
4. Blue light is used
5. Is contraindicated in conjugated hyperbilirubinaemia

25. Delayed bone age is seen in the following

1. Psychosocial deprivation
2. Hypothyroidism
3. Growth hormone deficiency
4. Familial short stature
5. Corticosteroid therapy

26. The following can cause failure to thrive:

1. Coeliac disease
2. Cystic fibrosis
3. Emotional neglect
4. Gastro-oesophageal reflux
5. Patau syndrome

27. The following cause a microcytic anaemia:

1. Ulcerative colitis
2. Pernicious anaemia
3. Methotrexate therapy
4. Folate deficiency
5. ß-Thalassaemia

28. The following are causes of short stature:

1. Klinefelter syndrome
2. Marfan syndrome
3. Emotional deprivation
4. Hypothyroidism
5. Achondroplasia

29. The following can be the cause of a non-blanching rash:

1. Idiopathic thrombocytopenic purpura
2. Systemic lupus erythematosis
3. Henoch-Schönlein purpura
4. Haemolytic uraemic syndrome
5. Meningococcal sepsis

30. Autism Spectrum Disorder

1. Onset occurs after 6 years of age
2. Characterized by repetitive behavior
3. May present with delayed language development
4. Includes severe deficit in social interaction
5. No babbling or pointing by 12 months may be early signs