KIBAHA CLINICAL OFFICERS’ TRAINING CENTRE

PAEDIATRICS & CHILD HEALTH

CONTINUOUS ASSESSMENT TEST - 1

NTA LEVEL 5 SEMESTER 1

CANDIDATE NO: …………… TIME: 2HR DATE: …………..

GENERAL INSTRUCTIONS

This question paper consists of five sections

Attempt all questions
Read carefully specific instructions of individual sections
Write your examination number on each separate paper used for
answering questions

MARKS DISTRIBUTION

Section A: Multiple choice questions 10 marks

Section B: Multiple True/ False questions 10 marks
Section C: Matching questions 10 marks
Section D: Short answer questions 40 marks
Section E: Essay questions 30 marks
TOTAL 100marks
 SECTION A: MULTIPLE CHOICE QUESTIONS. (10MARKS)

Instructions: Encircle the most correct answer.

1. A child with a family history positive of atopic conditions such as Eczema

and Hay fever can most likely present with:
a. Whooping cough
b. Common cold
c. Bronchial asthma
d. Lobar pneumonia
e. Bronchiolitis

2. Concerning sickle cell, the gold standard test to differentiate a person with
sickle cell trait (HgAS) and one with sickle cell anemia (HgSS) is:
a. Sickling test
b. DNA Polymerase chain reaction (DNA- PCR)
c. Hemoglobin electrophoresis
d. Peripheral smear
e. Full blood picture

3. A silent chest is an emergency sign for:

a. Whooping cough
b. Common cold
c. Bronchial asthma
d. Lobar pneumonia
e. Bronchiolitis

4. Concerning management of uncomplicated malaria in a 1 year old with

10kg body weight is:
a. IV Artesunate 2.4mg/kg is the drug of choice
b. Chloroquine per oral is the drug of choice
c. Artemether/Lumefantrine per oral is the drug of choice
d. Metakelfin per oral is the drug of choice
e. Syrup quinine is the drug of choice
5. A two (2) years old child passing loose stool more than 6 times in 24 hours
for one (1) day and the stool contains blood:
a. Acute watery diarrhea likely diagnosis as duration of disease is 1 day
b. Common causative agent is likely Shigella species
c. Has no indication for antibiotic use as the condition is self-limiting
d. Antidiarrheal drugs are indicated to prevent dehydration
e. Anemia is a unlikely to be a complication of the condition

6. A 9 month old baby presents at the clinic with history of diarrhea for 3
week. On examination you find the child with some dehydration and on
assessing nutrition status the child falls on -2SD on the weight for length
chart with pitting lower limb oedema. The best hydration solution for this
child is:
a. IV Ringers lactate
b. ORS
c. RESOMAL
d. Carbonated drinks
e. Exclusive breastfeeding on demand only until diarrhea stops

7. A 6 month old child presents with history of cough for about 2 weeks, on
examination the child has facial patecchiae, venous engorgement and
cyanosis. On history you find out the child has never received
immunization from birth. The likely diagnosis is:
a. Severe pneumonia
b. Whooping cough
c. Pulmonary TB
d. Bronchial Asthma
e. Bronchiolitis

8. Concerning pneumonia in children:

a. Causative agents differ with age
b. Mycobacterium bovis is the commonest causative organism
c. Viruses are not among the causative agents
d. Anatomically causative agents affects the trachea only
 e. Immunity status of the patient cause no effect on progression of disease

9. A six (6) years old boy presents with history of cough for about 3 weeks, the
cough is productive and the sputum has blood streaks, he also complains of
generalized body weakness, noted loss of weight and increased sweating at
night time. The likely diagnosis is:
a. Severe pneumonia
b. Whooping cough
c. Pulmonary TB
d. Bronchial Asthma
e. Bronchiolitis

10. A child with 15kg of body weight is admitted unconscious, on examination

you note the child to be severely pale, gallop rhythm on auscultation and
Hb is 3g/dl. The management should include :
a. Blood transfusion with 150mls of whole blood
b. Blood transfusion with 300mls of fresh frozen plasma
c. Blood transfusion with 300mls of whole blood with 15mg IV furosemide
d. Blood transfusion with 300mls of packed red cells with 15mg IV
furosemide
e. Blood transfusion with 300mls of fresh frozen plasma with 15mg IV
furosemide
 SECTION B: MULTIPLE TRUE/FALSE QUESTIONS (10MARKS)
Instruction: Write the word TRUE for correct statement and FALSE for the
wrong statement in the space provided.

1. Concerning pathophysiology of diarrhea diseases, impaired absorption is due to:

a) …………….. Increased digestion
b) …………….. Increased osmotic load on the lumen
c) …………….. Increased food intake
d) …………….. Damage to the absorptive surfaces
e) …………….. Inadequate mucosal enterocyte replication
2. These are features of Sickle Cell Anemia in one (1) year old:
a) …………….. Pallor
b) …………….. Bossing of the skull
c) …………….. Jaundice
d) …………….. Autosplenectomy
e) …………….. Dactylitis
3. Concerning Rectal prolapse:
a) …………….. It is a smooth red round mass coming out of the anus
b) ……………..Common in children between 6 to 11 years
c) …………….. Differential diagnosis is intussusceptions of the rectum
d) …………….. Infection with Trichuris trichiura is a common cause
e) …………….. Complication id rectal strangulation and gangrene
4. Concerning Chicken pox infection:
a) …………….. Is a more severe disease for immune compromised individuals
b) …………….. There may be 100-300 lesions present in all forms at a time
c) …………….. There is no specific laboratory investigation for diagnosis
d) …………….. Pneumonia is among of its complications
e) …………….. Oral acyclovir can shorten the duration of the illness
 SECTION C: MATCHING ITEMS QUESTIONS (10MARKS)

Match disease/infection in COLUMN A with its corresponding common

causative organism in COLUMN B.

COLUMN A (disease/infection) COLUMN B (lab investigation)

1. …… Measles A. Shigella bacteria

2. …… Malaria B. Rota virus

3. …… Potts disease C. RNA paramyxovirus

4. …… Dysentery D. DNA paramyxovirus

5. …… Myiasis E. Tunga penetrans

F. Cordylobia anthropophagi

G. Streptococci

I. Mycobacteria

H. Plasmodium falciparum

Match the diagnosis in COLUMN A with its corresponding differential diagnosis in

COLUMN B.
COLUMN A COLUMN B.
1. …… Mumps A. Thalassemia

2. …… Malaria B. Chicken pox

3. …… Rectal prolapse C. Extra pulmonary TB

4. …… Sickle cell anaemia D. Urinary tract infection

5. …… Bronchial Asthma E. Myiasis

F. Aspiration

G. Intussusception
H. Dysentery
SECTION D: SHORT ANSWER QUESTIONS (40MARKS)
Question 1 to 3 to be answered in separate sheet and remaining questions in
space provided.

1. Anna is brought to the OPD by her teacher from school. The teacher reports
Anna was playing with other children when she suddenly had an attack of
difficult in breathing to the extent while talking, she could not finish a whole
sentence and they could hear a whistling like sound when she breathes. The
teacher does not know Anna’s medical history.
a) List possible Provisional diagnosis (02)
b) List two Differential diagnosis (04)
c) List specific and important investigation to your diagnosis (02)

2. Define the following terms (03marks)

a) Development
b) Malaria

3. James is brought to the dispensary with history of fever and convulsion. The
informant reports James is visiting for the holidays in Kibaha from Mufindi,
and at their home they do not boil drinking water or sleep in insecticide treated
nets. On examination James has a fever on 390C, pale and semi conscious.
Mention the possible provisional diagnosis with its relevant investigations to be
done. (04marks)

4. Mention the three (3) core components for establishing IMCI (03marks)

1. ……………………………………………………………………
2. ……………………………………………………………………
3. ……………………………………………………………………

5. List five (5) complications of pneumonia. (05marks)

1. ……………………………………………………………………
2. ……………………………………………………………………
 3. ……………………………………………………………………
4. ……………………………………………………………………
5. ……………………………………………………………………

6. Mention three (3) investigations for children under five (5) years suspected of
having pulmonary tuberculosis. (03marks)

1. ……………………………………………………………………
2. ……………………………………………………………………
3. ……………………………………………………………………

7. Mention four (4) ways of assessing Growth in children (04marks)

1. ……………………………………………………………………
2. ……………………………………………………………………
3. ……………………………………………………………………
4. ……………………………………………………………………

8. Mention five (5) sickle cell crises (05marks)

1. ……………………………………………………………………
2. ……………………………………………………………………
3. ……………………………………………………………………
4. ……………………………………………………………………
5. ……………………………………………………………………

9. Mention five (5) primitive reflexes (05marks)

1. ……………………………………………………………………
2. ……………………………………………………………………
3. ……………………………………………………………………
4. ……………………………………………………………………
5. ……………………………………………………………………
 SECTION E: ESSAY QUESTIONS (30Marks)

1. Anna a six (4) months old girl is brought in at the clinic by her mother with the
complaints of diarrhea for one day. On examination the child is alert, drinks
eagerly a cup of water, mother reports the eyes are slightly sunken and skin
pinch goes back slowly. Discuss how you will manage this patient from
diagnosis, investigations, management and prevention. (15 marks)

2. A four (4) year old girl is brought to the clinic by her parents because she has
severe abdominal pain, fever, vomiting and diarrhea. In family and social
history you learn that her older sibling passed away and she had a history of
multiple blood transfusions while alive, they don’t use mosquito treated nets or
boil drinking water. On examination you find that she is wasted with thin long
extremities, notable boozing of the skull, very pale, jaundiced and per abdomen
she has splenomegally. (15 marks)
a) What is your provisional diagnosis?
b) Elaborate your workup plan (investigations and management)