University of Zambia

School of Medicine
Department of Paediatrics and Child Health

Bachelor of Medicine and Bachelor of Surgery (MB ChB)

Fifth Year

Paediatrics: PED 510

PAPER II

Tuesday 1st April 2014 10:00- 11:00

Directions
 This paper consists of 9 pages. Please read it carefully and ensure that it is complete
and correct. .
 Each question has five answer options from which you are to choose one(best answer)
 Answer all the questions on the Question paper.
 It is ESSENTIAL that you write your Computer Identification Number each page
 Time allowed: One 1 hour

Computer Number:

[Turn Over]

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1. A newborn is noted to be jaundiced at 3 days of age. Which of the following factors are associated with
an increased risk of neurologic damage in a jaundiced newborn?

a. Metabolic acidosis
b. Increased attachment of bilirubin to binding sites caused by drugs such as sulfisoxazole
c. Hyperbilirubinemia
d. Neonatal sepsis
e. Maternal ingestion of Phenobarbital during pregnancy

2. A full term neonate is born after a normal pregnancy. Delivery, however, is complicated by marginal
placental separation. At 12 hours of age, the child although appearing to be in good health, passes a
bloody meconium stool. For determining the cause of the bleeding, which of the following diagnostic
procedures should be performed first?

a. A barium enema
b. An apt test
c. Gastric lavage with normal saline
d. An upper GI series
e. A platelet count, prothrombine time and partial thromboplastin time

3. A recovering premature neonate who weighs 950g is fed breast milk to provide 120kcal/kg/day. Over
ensuing weeks, the baby is likely to develop

a. Hypernatremia
b. Hypocalcemia
c. Blood in the stool
d. Hyperphosphatemia
e. Vitamin D toxicity

4. A neonate weighing 1400g is born at 32 weeks gestation in the delivery room that has an ambient
temperature of 24 oC. If left in the open crib for a few minutes, this neonate is likely to demonstrate.

a. Ruddy complexion
b. Shivering
c. Hypertension
d. Increased respiratory rate
e. Metabolic alkalosis

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5. In assessing clinical gestation age of a premature neonate, the following parameters are used except:

a. Posture
b. Skin
c. Head circumference
d. Popliteal angle
e. Arm recoil

6. Risk factors associated with neonatal sepsis include the following except:

a. Prolonged rupture of membranes

b. Premature rupture of membranes
c. Pre eclampsia
d. Prematurity
e. Increased maternal white cell count during labour

7. An infant who appears to be of normal size is noted to be lethargic and somewhat limp after birth. The
mother is 28 years old para 4.the pregnancy was uncomplicated, with normal fetal monitoring prior to
delivery. Labor was rapid ,with local anaesthesia and intravenous pethidine for pain control. Which of
the following therapeutic maneuvers is likely to improve the neonates condition?

a. IV 10% dextrose in water

b. administration of naloxone
c. administration of vitamin k
d. measurement of electrolyes and magnesium levels
e. neurologic consult

8. At the time of delivery ,a woman is noted to have a large volume of amniotic fluid .At 6 hours of age,
her baby begins regurgitating small amount soft mucus and bile stained fluid. Physical examination is
normal. Abdominal xrays show 2 bubbles. What is the most likely diagnosis of this infants disorder?

a. Gastric duplication
b. Pyloric stenosis
c. Esophageal atresia
d. Duodenal atresia
e. Midgut volvulus

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9. The signs and symptoms of meningitis in a neonate can be different than those of a adult. Which of the
signs and symptoms of meningitis listed below would be least helpful in a neonate?

a. Lethargy
b. Jaundice
c. Vomiting
d. Brudzinski sign
e. Hypothermia

10. A woman gives birth to twins at 38 weeks gestation. The first twin weighs 2800g and has a hematocrit
of 70%. The second twin weighs 2100g and has a hematocrit of 40%. Which of the following statements
is correct?

a. The second twin is at risk of developing respiratory distress, cyanosis and congestive cardiac failure
b. The second twin is more likely to have hyperbilirubinemia and convulsions
c. The second twin is at risk of renal vein thrombosis
d. The second twin probably has hydramnious of the amniotic sac
e. The second twin is likely to be pale,tachycardic, and hypotensive.

11. A couple brings their 5 day old baby to you .The mother is O negative and was coombs positive at
delivey. The term child weighed 3kg at birth and had a baseline hemoglobin of 16g/dL and a total
serum bilirubin of 51micromol/L. He passed a black star-like stool within the first 24 hours of life. He
was discharged at 30hours of life with a stable axillary temperature of 36.5oC. Today the infant weighs
3kg, his axillary temperature is 35oC and he is jaundiced to the chest. Parents report frequent yellow,
seedy stool. You redraw bloods and his hemoglobis is now 14g/dL and his total serum bilirubin is
221micromol/L. Which of the following change in parameters below is of most concern?

a. Hemoglobin
b. Temperature
c. body weight
d. bilirubin
e. stool

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12. A couple expecting their first infant in a few weeks scheduled an appointment in the paediatric clinic to
get a head start on child care issues. You ask about the pregnancy course and the mother notes that she
was recently told she had oligohydramnios. Which of the following conditions below would you plan to
evaluate for at delivery?

a. Anencephaly
b. trisomy 18
c. renal agenesis
d. duodenal atresia
e. tracheosophageal fistula

13. A neonate becomes markedly jaundiced on the the second day of life and a faint petechial eruption first
noted at birth is now a generalized purpuric rash. Hematologic studies for hemolytic diseases are
negative. Acute management should include which of the following steps?

a. Liver ultrasound
b. Isolation of the infant from the pregnant hospital personnel
c. urine drug screen for the infant
d. Discharge with an early follow up visit in 2 days to recheck bilirubin
e. thyroid hormone assay

14 A newborn is brought to the delivery room. After assessing the infants heart rate, colour, and
respiratory effort, a decision is made that the infant should receive ventilatory assistance. After 30
seconds of this therapy, cardiac compressions are initiated. The most likely APGAR score at this
point in time is:

a. 9
b. 7
c. 6
d. less than 5
e. 8

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15. A mother is at 40 weeks gestation. The dating by time of last menstrual cycle agrees with an early
ultrasound. At birth, the infant weighs 1.5kg and has a head circumference that is abnormally small.
The platelet count is also low. What is the most likely cause of the poor growth of this child?

a. Placental insufficiency
b. Pregnancy- induced Hypertension
c. intrauterine infection in the first trimester
d. Poor genetic potential due to familial gene pool
e. Small uterine size

16. An infant is born prematurely at 28 weeks gestation and weighs 1.02kg. The infant is started on
enteric feeds at 3 days of age. Three days later, he is not tolerating his feedings. The signs and
symptoms exhibited by the infant that make you suspect he has neonatal Necrotisiing Enterocolitis
include all of the following EXCEPT which?
a. Bile-stained gastric fluid
b. Pneumatosis intestinalis
c. Guaiac-positive stools
d. Apnea
e. Jaundice

17. An infant born 30 weeks gestation begins to experience apnea on the second day of life. All of the
following should be included in the initial management of this infant EXCEPT which?

a. Therapy with aminophylline

b. Evaluation for evidence of hypoxia, infection or intracranial hemorrhage
c. Evaluation of upper and lower airway
d. Complete blood count, arterial blood gas studies, and plasma glucose and electrolyte
management
e. Check that the environmental temperature is in the neutral thermal zone

18. A mother is seen at 28 weeks gestation with severe pre-eclampsia. A decision is made to deliver the
infant. At birth the infant has severe respiratory distress. The infant is placed in 100% oxygen. The
first arterial blood gas reveals that the infant is hypoxic and has an elevated PCO2. Appropriate
immediate diagnostic and therapeutic plans include all of the following EXCEPT?
a. Chest XRAY
b. Exogenous surfactant
c. Provide mechanical Ventillation
d. Provide volume expansion
e. Insertion of an umbilical arterial line to monitor blood gas

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19. A 25 year old primigravida is admitted with a history of draining clear liquor for 36 hours. She
delivers a 3.4 kg male infant. At 16 hours of age, the infant is noted to have a raised temperature ,
lethargic and tachypneaic. A diagnosis of sepsis is made. Prior to identification of the
microorganism, the infant is best treated with?

a. Penicillin alone
b. Ampicillin alone
c. Ampicilin or Penicillin plus an aminoglycoside
d. Ampicillin plus Methicillin
e. Ciprofloxacin and cloxacillin

20. In most cases of ABO iso-immune hemolytic disease of the newborn, the mother is:

a. type A, and the infant is type B

b. type A, and the infant is type AB
c. type O, and the infant is type A
d. type O, and the infant is type AB
e. type B , and the infant is type O

21. The major route of bilirubin excretion in the fetus is probably

a. degradation to biliverdin
b. reincorporation into hemoglobin
c. transplacental passage
d. hepatic secretion and storage in the intestinal lumen
e. all the above

22. The clinical signs of hyaline membrane disease generally first appear
a. in the first 6 hours of life
b. between 12 and 24 hours of life
c. between 24 and 48 hours of life
d. after 48 hours of life
e. none of the above

23. Pyridoxine deficiency in the newborn presents as

a. muscle weakness
b. convulsions
c. acidosis
d. lethargy
e. all the above

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24. You are called to evaluate a newborn infant whose neurologic examination results are abnormal. It is
suspected that the infant may have suffered perinatal asphyxia. All of the following complications of
pregnancy are risk factors for perinatal asphyxia EXCEPT

a. Placental abruption
b. Hyperemesis gravidarum
c. Prematurity
d. Preeclampsia
e. Meconium-stained amniotic fluid

25. A 1 day old neonate who was born by a difficult forceps delivery is alert and active. She does not
move her left arm, however, which she keeps internally rotated by her side with the forearm
extended and pronated; she also does not move during a moro reflex. The rest of her physical exam
is normal. This clinical picture most likely indicates

a. Fracture of the left clavicle

b. Fracture of the left humerus
c. Left sided erb-duchenne paralysis
d. Left sided klumpke paralysis
e. Spinal injury with left hemiparesis

26. You are speaking to a couple who are expecting their first baby in about 2 weeks. They are
concerned about the safety of childhood immunizations and also about “unneeded” medications
given to newborns in the hospital. They ask about the purpose of routine administration of
intramuscular vitamin K. you explain to them about haemorrhagic disease of the newborn, stating
that the untreated baby can manifest:

a. A deficiency of factor V
b. A prolonged prothrombin time and a risk of serious hemorrhage in the days following delivery
c. Development of hemorrhagic manifestations within 24 hour delivery
d. More severe symptoms in a male that a female child
e. Hemorrhagic symptoms at a much higher rate if the child is fed cows milk rather than breast milk

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 27. Physical maturation signs used in assessing a preterm neonate includes all the following except?
a. Skin texture and opacity
b. Ear shape and recoil
c. Arm recoil and scarf sign
d. Creases on the sole of the foot
e. Genitalia

28. A newborn deliverd at home has puffy, tense eyelids; red conjunctivae; a copius amount of purulent
ocular discharge; and chemosis 2 days after birth. The most likely diagnosis is:

a. Dacrocystitis
b. Chemical conjunctivitis
c. Pneumococcal opthalmia
d. Gonococcal opthalmia
Chlamydial conjunctivitis

29. An infant is born at term to a woman who has had an uncomplicated pregnancy. Immediately after
delivery the infant has severe respiratory failure.breath sounds are diminished bilaterally.The
abdomen is flat. CXR shows a multicystic mass in the left chest with shift of the mediastinum)

a. Respiratory distress syndrome

b. Diaphragmatic hernia
c. Tracheosophageal fistula
d. Congenital lobar emphysema
e. Persistence of fetal circulation

30. An infant is born at term and you evaluate at 24 hours of age. Which of the following would be a
normal finding at this age?

a. loss of 15% of the birth weight

b. baby has not passed urine
c. baby is jaundiced
d. baby has a blood sugar of 2mmol/L
e. baby has pink urine stains in the nappy

………………………………..END OF EXAMINATION………………………