Housemanship Survival Workshop (Pediatrics Mock Exam)
1. A 6 months old baby boy presented to Emergency Department with 4 days history of recurrent vomiting and diarrhea. As the HO in Emergency Department, you note that he is tachycardic (170 bpm) with a fever, coolish peripheries, sunken fontanelle and lethargic. His BP was less than the 50th centile. His pulse volume is also poor. Blood gas taken noted severe metabolic acidosis. What is your immediate best action for this patient?
A. Take a blood culture immediately.
B. Send for stool culture and virology.
C. Set a line and start a 10 – 20 ml/kg bolus of Normal Saline over 30 minutes.
D. Call the Ward for admission.
E. Take further history from the grandparents on what happened at home.
2. A 4 year old child come to the Emergency Department with lethargy, high grade fever and neck stiffness. Mother noted that he mostly slept at home for the past 1 day. He has been unwell initially with URTI symptoms for the past 3 days. Vital signs taken in Emergency Department noted tachycardia and hypotension. You noted purple non-blanching rash at his legs and trunk. All the statements below are true regarding this condition EXCEPT: A. Broad spectrum antibiotics should be commenced even in the Emergency Department as soon as possible.
A. Broad spectrum antibiotics should be commenced even in the Emergency Department as soon as possible.
B. Complications include hearing loss and neurodevelopmental impairment.
C. CT brain with contrast may show leptomeningeal enhancement.
D. Lumbar puncture should not be done if antibiotics have already commenced.
E. Patient should be fluid resuscitated and best monitored in a tertiary centre with PICU backup.
3. A 2 year old child came to your PPAT with 2 weeks history of fever and general malaise. Mother noted today he developed bruising easily and concerned that his abdomen looks slightly distended. Below are investigations and findings suggestive of a diagnosis of acute leukaemia EXCEPT:
A. Pancytopenia in the FBC.
B. Hepatosplenomegaly
C. Generalised lymphadenopathy
D. High uric acid level
E. Low LDH level
4. A 1 month old girl was brought to your PPAT for routine vaccination. She was noted to have a loud pansystolic murmur over the left sternal edge. You note that she is failing to thrive with marked subcostal recessions. Her heart rate was 160 bpm with displacement of the apex beat to the 5th intercostal space, just lateral to the midclavicular line. SpO2 was 99% under room air. There is no discrepancy between her BP in both upper and lower limbs. The liver is 5cm palpable. Choose the most likely cardiac condition in this neonate.
A. Tetralogy of Fallot
B. Ventricular Septal Defect in heart failure
C. Atrial Septal Defect
D. Pulmonary Stenosis
E. Dextrocardia
5. Below are true statements re: nephrotic syndrome EXCEPT:
A. Prednisolone is the first line treatment in children.
B. Compliance to medication is a crucial history when assessing response to treatment in patients who frequently relapse.
C. 24 hour urine protein collection is the gold standard in assessing nephrotic range proteinuria in children.
D. Nephrotic syndrome patients are at an increased risk of developing thrombosis compared to normal population.
E. All patients with atypical presentation do not need to be referred to a Nephrologist and can usually be treated by a General Paediatrician.
6. Below are TRUE statements re: pain relief used in the Paediatric setting, EXCEPT:
A. We should wait at least half an hour after putting on Emla cream before attempting to do blood taking.
B. Ketamine is a good analgesic for procedural pain in children (e.g. For bone marrow aspiration).
C. Combination of midazolam and morphine could cause hypotension in a child.
D. Side effects of ketamine include bradycardia and hypotension.
E. Midazolam has good anxiolytic and amnesic properties.
7. A 3 day old infant was brought to your PPAT for jaundice. You note that his jaundice was up to the abdomen level. Below are history related to the jaundice that should be included in your referral letter to the tertiary hospital EXCEPT:
A. Previous history of severe jaundice in siblings.
B. G6PD status.
C. Significant history of weight loss.
D. History of consumption of ‘jamu’
E. History of amount of food intake of the mother.
8. A day 7 of life infant was noted during KK team visit to have bruises all over his body. Mother noted it occurred for the past 2 days. Below are investigations / symptoms suggestive that patient has severe liver impairment, EXCEPT:
A. Hypoglycaemia
B. Drowsy / Sleepy – encephalopathic.
C. Hypochloraemia
D. Prolonged INR
E. Ascites
9. A three week old baby boy presented to ED with high grade fever and lethargy. Mother complains to you that the urine is foul smelling. UFEME noted nitrite to be positive with leucocytes to be 3+. Below are true statements re: urinary tract infection in children EXCEPT:
A. Broad spectrum antibiotics such as cefuroxime should be commenced immediately.
B. Clean catch sample is not superior to urine collection bag sample for urine culture collection.
C. An USS KUB should be arranged for the patient to assess for hydronephrosis and abnormal urinary tract.
D. If there is hydronephrosis during USS KUB, MCUG should be arranged to rule out any congenital anomaly such as posterior urethral valve.
E. Recurrent urinary tract infection in children can cause renal impairment in the long term and is an important complication to avoid.
10. You see a 7 year old child in Emergency Department who was brought by her stepfather and biological mother for inability to walk. The stepfather gave a history of falling down a chair while eating at home. You performed an X-ray which noted a spiral fracture. Below are signs and symptoms suggestive of non-accidental injury that warrants further investigation by the Paediatric team EXCEPT:
A. Multiple bruises of different ages at multiple sites of the body.
B. Scalding marks at the back.
C. Unkempt child with failure to thrive.
D. Healed round burn marks on the dorsum of the hands.
E. Multiple cavities in the mouth.
11. A 6-year-old boy is brought to the office by her parents for well-child examination. You note on first appearance that the child appears overweight. You plot the growth chart and noted the height to be on the 50th centile and the weight to be >95th centile. Below are complications of childhood obesity EXCEPT:
A. Blount disease
B. Obstructive Sleep Apnoea
C. Stigmatisation and poor body image
D. Type II Diabetes and high insulin tolerance
E. Vitamin A deficiency
12. A 5-day-old neonate is brought to the office by his mother for initial examination after uncomplicated pregnancy, delivery, and nursery stay. The mother has hypothyroidism that is well controlled with levothyroxine, and she is worried that the patient might have congenital hypothyroidism. Below are incorrect statements re: congenital hypothyroidism EXCEPT:
A. A cord TSH of 25mIU/L should warrant a day 5 of life repeat serum TSH only.
B. Congenital hypothyroidism should only be treated for 2 years in all cases.
C. A serum TSH of more than 10 mIU/L in a prolonged jaundice patient is abnormal.
D. A normal T4 level and high TSH level (8mIU/L) should be labeled as congenital hypothyroidism.
E. Congenital hypothyroid if left untreated can lead to devastating neurological outcome.
13. A 6 year old child was admitted to the Paediatric Ward for dengue fever with warning signs. His NS1 and IgM dengue serology was positive. You are doing your night rounds and the mother informed you that her daughter passed black foul smelling stools in the toilet. She is currently afebrile and entering day 5 of illness. Her mother shares her concern that her daughter does not look well since the past few hours. Below are the immediate actions that you should take as the houseofficer oncall in the Paediatric Ward EXCEPT:
A. Take a 4 limb blood pressure.
B. Examine the child’s pulse volume, peripheries and take a vital sign.
C. Call for help and inform the MO and Specialist oncall.
D. Transfer the child to the acute bay if not done already.
E. Start IV hydration if not yet started and repeat his FBC and consider taking Group and Crossmatch.
14. An 8 year old boy was admitted for dengue fever with warning signs to the Paediatric Ward. Today marks his 6th day of illness. You note from the temperature trend that he is defervescing. Suddenly the boy complains of severe epigastric pain. Vital signs taken by the nurse showed tachycardia (160 bpm) and narrow pulse pressure. A bolus was given as the FBC came back with a high HCT (53%). His condition did not improve despite being given bolus and resuscitated with normal saline IV hydration. You repeated the FBC and noted the haematocrit have dropped to 42 but there is deterioration of his condition. His blood pressure dropped further and there is worsening tachycardia. Choose the best appropriate next management for this patient?
A. Change to colloid as the haematocrit have dropped.
B. Transfuse fresh whole blood immediately.
C. Take a coagulation profile to assess the severity of the dengue.
D. Repeat the liver function test to determine the progress of transaminitis.
E. Titrate down the normal saline hydration haematocrit showed improvement.
15. A 3 year old child has just recovered from an upper respiratory tract infection a few days ago. Mother is worried as suddenly he developed a generalized non-blanching pinpoint rash. You note there are ecchymoses on his lower limbs as well. The statements below are suggestive of the benign diagnosis : Immune Thrombocytopenic Purpura (ITP) EXCEPT:
A. There is no hepatosplenomegaly.
B. Cervical lymph nodes are shotty or not significant.
C. The child is generally well and does not have constitutional symptoms.
D. There is a mediastinal mass on chest X-ray.
E. Low platelet is the only cytopenia noted on FBC.
16. The following are true regarding acute leukaemia presentation in children EXCEPT:
A. Prolonged fever for a few weeks.
B. Multiple bruising and epistaxis.
C. Café au lait spots on the shin.
D. Abdominal distension secondary to enlarging liver and spleen.
E. Generalised lymphadenopathy.
17. Choose the INCORRECT statement regarding tuberculosis in children.
A. An induration of more than 20mm signifies a positive Manteaux test.
B. Gastric aspirates for AFB staining is preferred in toddlers compared to sputum collection.
C. Having a positive contact with a person with TB is a crucial part of the history taking and has a role in management of the patient.
D. A chronic cough with haemoptysis should always warrant a TB screening.
E. Failure to thrive must be present in children for a diagnosis of TB to be made.
18. Below are INCORRECT statements of Necrotising Enterocolitis (NEC) in the premature infant EXCEPT:
A. Antibiotics need not be commenced for mild to moderate NEC.
B. Starting formula milk very early on day 1 of life in a 26 weeker premature neonate can reduce the risk of NEC.
C. Breastmilk increases the risk of NEC more than formula milk.
D. Trophic feeding have shown to reduce the risk of NEC.
E. Abdominal distension and recurrent vomiting is uncommon in NEC.
19. You are the houseofficer doing night rounds in the NICU and you note a baby in the acute bay was having cyclical movements of his upper limbs and lip smacking. Below are the common cause of neonatal seizures EXCEPT:
A. Severe hypoglycaemia
B. Severe hypocalcaemia
C. HIE secondary to perinatal birth asphyxia
D. Intracranial bleed
E. Hyperglyacemia
20. Select the CORRECT answer for contraindication to breastfeeding: I. Mother with poorly controlled HIV II. Classic Galactosaemia III. Hepatitis A carrier mother IV. Mother on lithium antidepressant
A. III only
B. II and III only
C. IV only
D. II and IV
E. I, II and IV.
21. You are the house officer in ED and attended to a patient who is having seizures in the resuscitation bay. His mother noted the abnormal jerky movements started 10 minutes ago. You note that he is a boy who is roughly 10kg (1 year old) with generalised tonic clonic movements of both his upper and lower limbs. An IV line had already managed to be secured. What are the BEST immediate actions that should be taken? I. Lie the position on his side in recovery position. II. Place oxygen mask on his face. III. Serve IV diazepam 2mg STAT (0.2mg/kg) via the IV line. IV. Ask the nurse to dilute IV phenobarbitone 200mg STAT.
A. I and IV only
B. I and II only
C. I, II and III only
D. III and IV only
E. I, II and IV only
22. Below are red flags in developmental milestones that should be referred to a Paediatrician EXCEPT:
A. Persistent head lag at 6 months of age.
B. Persistent Moro reflex beyond 6 months.
C. Not able to turn supine from prone and vice versa by 9 months.
D. Not able to fix and follow 180 degrees by 6 months.
E. Not able to walk by 1 year.
23. You attend to a toddler and noted that he is able to copy a circle but not a square. Mother says he is able to ride a tricycle already and talks in 3 word sentences. What is the most likely developmental age of this child?
A. 18 months old
B. 24 months old
C. 2 ½ years old
D. 3 years old
E. 4 years old.
24. Below are normal developmental milestones EXCEPT:
A. Able to smile responsively at 2 months old.
B. Able to pull self to stand and cruise by 9-12 months old.
C. Obeying simple commands with gestures at 12 months old.
D. Preference for one hand (handedness) at 9 months old.
E. Cooing by the age of 3 months old.
25. You clerk a 1 1/2 year old boy in the Paediatric Ward. He was admitted with symptoms of respiratory distress. Mother says that he have been having URTI symptoms with fever for the past 2 days. This is his 3rd episode of URTI with respiratory distress requiring nebulisations. Chest X-ray was mostly unremarkable. Mother denied any family history of atopy. Father is a smoker but says he smokes outside the house. What is the most likely diagnosis in this child?
A. Recurrent Viral Induced Wheeze
B. Multi-trigger wheeze
C. Bronchopneumonia
D. Inhaled foreign body
E. Newly diagnosed bronchial asthma exacerbation
26. You are the PPAT MO and asked by a new parent regarding your knowledge regarding extra vaccinations. Her child is currently 2 months old and both parents are keen to take extra vaccinations at a private centre. What extra vaccination options would you advise the mother that is suitable for the baby at that age?
A. Prevenar 13 for pneumococcal vaccination
B. Hepatitis A vaccination
C. Oral polio vaccination
D. Varicella zoster vaccination
E. Influenza vaccination
27. Choose the INCORRECT pairing of vaccination and the scheduled age in the National Immunisation Schedule:
A. Hepatitis B 2nd dose at 4- 6 weeks old.
B. 1st dose Pentaxime (DTP/Hib/Polio) at 2nd month of life.
C. Hepatitis B 3rd dose at 6 months old.
D. MMR vaccination at 12 months old.
E. 3rd dose Pentaxime (DTP/Hib/Polio) at 9 months old.
28. You are the PPAT MO doing routine RME screening today. The community nurse referred to you an abnormal M-CHAT screening for an 18 months old boy. Which following signs and symptoms in your history and examination is suggestive of a diagnosis of autism spectrum disorder? I. Poor eye contact II. Repeatedly lining up blocks from one end of the wall to another end III. Difficult to engage in tasks and communication IV. Able to show imaginary play
A. I only
B. I and III only
C. I, II and III only
D. I, II and IV
E. II, III and IV
29. Below are correct statements regarding Paediatric resuscitation, EXCEPT:
A. In Paediatric resuscitation, adrenaline is usually diluted and not used as a neat solution.
B. Neopuff T-piece resuscitator and a self-inflated bag (ambubag) are both alternatives that can be utilised to do ‘bagging’ for an unconscious infant.
C. In the NRP, HR below 60 bpm in a floppy, non-breathing infant will necessitate PPV to be commenced immediately.
D. An infant born non-vigorous with a scaphoid abdomen should be intubated immediately due to suspected Congenital Diaphragmatic Hernia.
E. A pale infant born to a mother who had blood loss due to bleeding placenta praevia is usually due to subaponeurotic haemorrhage.
30. Choose the TRUE complications that can occur for infants with moderate to severe polycythaemia: I. Hypoglycaemia II. Respiratory Distress III. Jaundice IV. Delayed meconium passage
A. I and IV
B. II and IV
C. I, II and III.
D. I and II
E. None at all
31. A 18 month old infant who has an upper respiratory tract infection (URTI) present with convulsion. She is otherwise generally still active post-seizure and does not have any signs of meningism. Which following seizure scenario DOES NOT fit with complex febrile seizure definition:
A. A child with fever presenting with status epilepticus > 15 minutes.
B. A feverish child with focal seizures.
C. Two or more seizures occurring within 24 hours of the febrile illness.
D. Residual neurological deficit post-ictally e.g. Todd’s paralysis.
E. Generalised seizures that occur repeatedly during a well afebrile period.
32. You are the house officer doing night rounds in NICU. A patient was admitted to NICU after being given PPV in the labour room for respiratory distress. Patient was born with thick meconium and required direct suction twice. When you are clerking the admission, you noted suddenly the SpO2 dropped and required an increase concentration of oxygen up to FiO2 0.8. Your Specialist ordered a transillumination test and noted it was positive on the right lung. Upon auscultation you noted that there is absence of air entry in the right lung which was a marked difference compared to just a few minutes ago when the child was transferred to NICU. What is the most likely condition that this child suffered as a complication to PPV treatment?
A. PPHN
B. Pneumothorax
C. RDS
D. Polycythaemia
E. TTN
33. What is the most important investigation to perform in a 3 week old baby boy whose mother informed you that his stool colour has changed from mustard yellow to a clay pale coloured stool?
A. Direct and Indirect bilirubin with LFTs
B. Urine Culture
C. FBC
D. Urine organic acids
E. Coombs test
34. A 6 year old boy is admitted with history of cough and fever for 5 days. You ordered a Chest X-ray and noted mild pleural effusion with marked consolidation at the right lung. FBC showed a high monocyte count. Mother says the child have already completed 3 day course of amoxicillin but was partially compliant. On auscultation, you heard good air entry with minimal crepitations. Patient was still able to tolerate orally and did not show respiratory distress. What is the most suitable antibiotics for this patient?
A. Penicillin V
B. Augmentin with Azithromycin
C. Ciprofloxacin
D. Amikacin
E. Meropenem
35. Select the TRUE complications of intubation: I. Subglottic stenosis II. Dental injury III. Aspiration pneumonia IV. Vocal cord injury
A. I and IV
B. I, II and III
C. I, II and IV
D. I and II only
E. All of the above
36. A 6 year old boy had a number of ED visits which according to mother was labelled as ‘viral induced wheeze’. He has been using B agonist inhaler at home at least twice in 3 months. He presented to RSAT and his mother tells you that he becomes wheezy with changes in temperature, laughter, exercise and with viral illnesses. You note a strong family history of asthma in the family. What is the next best step in his management?
A. Increase the number of puffs for his beta agonist inhaler.
B. Start MDI Flixotide 125mcg BD.
C. Add a high dose Seretide inhaler.
D. Add nebulised budesonide once daily.
E. Add ipratropium inhaler.
37. A 16 years old girl present to ED with severe asthma attack. What is the most important therapy to relieve her bronchoconstriction?
A. Propanolol
B. Salbutamol
C. Oxygen
D. Glucocorticoids
E. Inhaled glucocorticoid
38. Your community nurse brought a child to your attention due to faltering growth. You plot the growth chart and noted that he is below the 3rd centile for his age (2 years old) corresponding to 50th centile for a 1 year old. His height centile is on the 15th centile. Below are important history and examination that can guide you to find a cause for his faltering growth EXCEPT:
A. Frequency of milk intake per day
B. Dietary recall – at least 24 hours.
C. History of developmental delay
D. Systemic symptoms such as diarrhoea and frequent infections
E. Blood group of his mother and father.
39. You are helping out at the General Pediatric clinic and clerked a new case of faltering growth. You noted the child has severe eczema and mother has been restricting multiple food due to concerns of eczema exacerbation. Choose the INCORRECT sign of rickets changes that can be seen in a child who is growing.
A. Bowing of the legs.
B. Wrist widening.
C. Rachitic rosary noted at the ribs.
D. Delayed fontanelle closure.
E. Limping gait.
40. Which of the following is an INCORRECT statement regarding puberty:
A. Precocious puberty in boys should always prompt a referral to a tertiary centre as it is almost always pathological.
B. Girls who have developed breast at 6 years old are considered precocious puberty.
C. Testicular volume in children can be estimated using an orchidometer.
D. Puberty staging in children is called Tanner staging.
E. Development of secondary sexual characteristics are the first signs of puberty in males.
41. Below are the criteria for Kawasaki disease EXCEPT:
A. Hepatosplenomegaly
B. High grade fever more than 5 days
C. Non-purulent conjunctivitis
D. Changes at the extremities – swelling, desquamation
E. Mucosal changes at the oro-pharynx – strawberry tongue
42. Choose the INCORRECT statement regarding Glasgow Coma Scale:
A. There are 3 scores for eye opening response.
B. There are 6 scores for motor response
C. There are 5 scores for verbal response
D. Patient who is confused but is able to open eyes to command and moves to localised pain will have a GCS score of 12/15.
E. A completely unconscious patient with no response will have a GCS of 3/15.
43. A 6 year old boy was brought to Emergency Department for fever and URTI symptoms. The parents informed you that he refuses to weight bear on both legs and only wants to be carried around. You examine the boy and noted that his calves are tender to palpation. What further investigation that will prove your diagnosis of viral myositis?
A. A high WCC.
B. Hypokalaemia
C. A high anion gap
D. A high Creatinine Kinase (CK) level
E. Hypoglycaemia
44. Choose the main signs/symptoms of Acute Glomerulonephritis: I. Hypertension II. Oedema III. Oliguria IV. Microscopic Haematuria
A. I only
B. I and II
C. I, II and IV
D. I, II and III
E. All of the above
45. Choose the INCORRECT definition of abnormal vital signs with the respective age range:
A. 130 bpm is tachycardic for a neonate.
B. 45 bpm is tachypnoeic for a 12 year old.
C. 60/40 is hypotensive for a 9 year old.
D. 160 bpm is tachycardic for an 8 year old.
E. 20 bpm in a neonate is indicative of apnoea.
46. Below are TRUE statements regarding acute kidney injury (AKI) in a child EXCEPT:
A. It can present with signs such as oliguria (< 0.5ml/kg/hour) and hyperkalaemia.
B. Acute Pulmonary Oedema and seizures are complications that can arise from AKI.
C. Management of AKI must depend on the cause that is suspected to have caused the AKI.
D. Medications that can impair renal function should be adjusted according to a renal adjustment dose.
E. You should avoid hydrating a child with AKI in fear of acute pulmonary oedema.
47. Below are common treatments that are usually commenced for a patient with hyperkalaemia EXCEPT:
A. Resonium
B. Insulin (actrapid) / glucose infusion.
C. Nebulised salbutamol
D. Magnesium sulphate infusion.
E. IVI calcium gluconate for myocardium stabilisation.
48. Choose the INCORRECT statement regarding electrolyte imbalance in the paediatric setting:
A. A 24 hour calcium infusion should ideally be given through a central line.
B. Hyperkalaemia can cause flat PR interval on the ECG.
C. Hypocalcaemia can cause seizures in the neonate.
D. Hypernatraemic dehydration should be corrected slowly over 48 hours.
E. Hyponatraemia is caused by conditions such as Cerebral Salt Wasting and also SIADH.
49. A newborn baby was abandoned at your PPAT. Her umbilical stump is still wet and haven’t dried. What are appropriate actions to take immediately? I. Wrap the baby in clean sterile towels. II. Check for glucose level and start an IV drip for the baby. III. Do a Ballard scoring to estimate the gestation of the baby. IV. Inform the police and bring the baby to the nearest hospital ASAP.
A. I and II only.
B. III and IV only
C. II, III and IV only
D. I, II and III only
E. All of the above.
50. Choose the INCORRECT statement regarding growth for children:
A. Short stature is defined as height being below the 3rd centile for the age and gender.
B. Growth hormone deficiency plays a significant role in children with short stature above 5 years old.
C. Karyotyping is essential in girls who develop short stature to rule out Prader-Willi syndrome.
D. Syndromic children (e.g. Down Syndrome) may have a slower growth trajectory compared to other normal children.
E. Small for gestational age babies have a risk of becoming short in later life if they do not go through a good catch-up growth during their childhood.
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