PAEDS
1. These liver cysts are seen on ultrasound in a 10 year old child . He is apyrexial
ad well apart from non tender distended abdomen , and presented because of
his upper abdominal distention. But is otherwise asymptomatic. The most likely
in this age group in South Africa is
Select one ::
A.
B.
C.
D.
E.
Amoebiaisis
Beta haemolytic streptococcus
Hepatoblastoma
Staphylococcus aureus
Echinococcus cyst
2. Which of the following is important in the neonate for body temperature
regulation?
a. Adequate hydration
b. Centrally-situated brown fat
c. Subcutaneous fat and body hair
d. Exposure of head to ambient temperature to allow auto-regulation
e. Shivering thermogenesis
3. Choose the correct statement regarding the condition of this premature neonate
shown
Select one:
a. Provided bowel is covered in plastic, there is no risk of bowel ischaemia
b. Nasogastric tube drainage provides no benefit
c. Usually achieve full oral feeds within one week after birth
d. Associated with Intestinal malrotation
e.Associated intestinal atresia precludes survival
3.2 ( use picture above )
Appropriate care of a baby born with exposed intestines proplasting through an
abdominal wall defect includes
Select one:
A. high-flow oxygen, broad spectrum antibiotics, cover bowel with plastic clingwrap, kangaroo care
B.nasogastric drainage, preservation of normothermia, protection of bowel with
plastic, enlargement of defect if mesenteric constriction likely
cause strangulation of blood supply
C. Transfer to tertiary care after 24 hour stabilization period
D. protection of baby in incubator or plastic bag to keep warm, prevent bowel
from kinking and obstructing mesentery, monitor serum glucose,
transfer to definitive care once mother fit for discharge with infant to tertiary care
E. breastmilk feeds. protect bowel with warm saline-soaked swabs. maintain
normothermia. analaesia
4. A 5 year old patient presented with several episodes of painless bright red rectal
bleeding after stooling. The lesion shown is seen at colonoscopy (histology also
shown). The following statements are all true of this lesion EXCEPT: (i.e. Choose
the FALSE statement
Select one:
A. often premalignant
B. autoamputation common
C. mostly rectosigmold location
D.. usuallv solitary
E. mav prolapse out or anus
5.This girl has right hemihvpertrophv. She needs follow-up screening for the following
solid-organ tumours:
Select one:
a. Neuroblastoma, leukemia
b. lymphoma, cystic hygroma
c. rhabdomyosarcoma, Ewing's sarcoma
e. lymphangioma, renal cell carcinoma
6.A 3 year old polvtrauma patient who was knocked over by a car presents to the
trauma unit with multiple injuries, Including a closed
head injury. He is drowsy and uncooperative and has multiple abrasions and some long
bone fractures. You are called to assess the
abdomen which is tender and very distended, especially in the upper half of the
abdomen, shouting at you when you press there
and throwing off his oxygen mask. What procedure will aid your clinical assessment of
the abdomen?
Select one:
a. Insertion of oro-gastric tube
b. Cranial burr-hole placement
C Nasal prong oxygen
d. Intubation and gentle ventilation
e. Chest drain insertion/
7. This neonate presented with a picture of severe sepsis . Appropriate management
includes
Select one:
a. Topical emollients and saline dressings
b. Urgent surgical umbilical debridement and broad-spektrum antibiotics
c. Urgent umbilical exploration with herniorrhaphy
d. Anti-streptococcal antibiotics and analgesia
e. Conservative care to avoid injury to umbilical vessels
8. This child has proven gastro-oesophageal reflux disease and has had 2 months or
proton pump inhibitor therapy and
been managed with small frequent feeds and head-up positioning. Possible indications
for a gastric fundoplication in this
child include
Select one:
a. single episode lower respiratory tract infection
b. parental preference for surgery over longterm medication
c. persistent vomiting despite growing well
d.failure to thrive due to vomiting
e, sibling who had haemorrhagic oesophagitis
9. Sudden onset of sever pain with vomiting, abdominal distension and no passage of
stools in this neonates is most likely
Select one:
a. Scrotal abscess
b. Testicular torsion
c. Acute idiopathic scrotal edema
d. Incarcerated inguinal hernia
e. Epididiymo-orchitis.
10. The abdominalities on this x rays all features of the following group of conditions
Select one;
a. Peutz-Jehger's syndrome
b. VACTERL association
c. Beckwith-Wiedemann syndrome
d. Poland sequence
11. This 1 month old male infant presented with persistent vomiting for 2 weeks and
abnormal ultrasound findings as shown. His
biochemical picture is most likely
A.
B.
C.
D.
E.
Hyperchloraemic
Normal
Alkalinuric
Hyponatraemic
Acidotic
12. Orchidopexy in the child with a unilateral, palpable testis in the inguinal canal should
ideally be performed at the following
Age
Select one:
a. at 5-6 years of age
b. at 6-12 months of age
c. after puberty
d. after 2 years of age
e. as soon as diagnosed, regardless of age
13. Early operative cholangiogram is indicated in babies with conjugated jaundice and
pale stools to confirm or exclude biliary
atresia because (choose the TRUE statement)
Select one:
a. surgery is easier in smaller babies
b. time in hospital is saved as other test results take a long time to come out
c. if a Kasai portoenterostomy is unsuccesful, the patient can be put onto the liver
transplant list sooner
d. it is the most likely cause of jaundice in a baby
e. a successful Kasai portoenterostomy may prevent progression to liver cirrhosis
14. This one month old male infant presented with persistent vomiting of gastric
contents . Ultrasound findings are shown ,, the appropriate further management is th
following
Select one:
a. Nasogastric drainage and nil per mouth for urgent surgery within next few hours
b. Controlled intravenous correction of chloride and hydration status with surgery only if
no improvement on conservative
c. Urgent Heller's myotomy
d. Biochemical normalization then Ramstedt pyloromyotomy/
e. Potassium replacement if hypokalaemic once passing adequate volumes of urine and
repeat ultrasound in one week if still
vomiting
F.Correct dehydration with 10% dextrose water and give protein pump inhibitors
15.. A one day old premature infant has esophageal atresia. Pick the most CORRECT
statement below regarding essential
practice to safely transport this patient to a tertiary hospital for further care.
Select one:
A.regular suctioning of upper esophageal pouch through nasal tube/
b. skin to skin contact with mother
c. monitoring of haemoglobin
d. oral dextrose water if no intravenous access
e. cardiac echogram prior to transport
16. Choose the correct statement regarding the use of propranolol in the treatment of
the lesion shown
Select one:
a. not indicated in this location
b. Side effects like hypoglycaemia and bronchospasm never occur in children
C. more effective and better side-effect profile than steroids
d. second-line treatment for cases where surgery is not feasible
e. not indicated in this 3 month old patient as lesion will spontaneously involute
16.2 ( use Above picture )
All of the following statement are correct with respect to the lesion shown except for the
following
Select one:
a. propranolol is a non-selective beta-blocker that can shrink hemangiomas
b. rapid growth of this lesion means it is a malignant tumour
c. spontaneous involution >70%/ spontane involusie >70%
d. amblyopia, scarring and associated brain abnormalities can occur
e. Hypothyroidism and low platelets can result from multiple large lesions like this
17. 2 week old 1,3kg girl suddenly develops abdominal distension and bloody stools
after blood transfusion . She was previously doing well . The most likely diagnosis is
Select one:
A.Spontaneous intestinal perforation
B.. Normal premature infant x-ray
C.Grade 2 necrotizing enterocolitis
D.Hirschsprung's enterocolitis
18. In an 8 year old girl with episodes of abdominal pain lasting for 2-3 hours at a time
about once a week over the past 3 months
(not related to meals) and mild generalized abdominal tenderness but no localizing or
peritonitic signs or palpable masses,
differential diagnosis includes
Select one:
a. subacute appendicitis, Wilms tumour, gastric outlet obstruction
b. gastritis, abdominal tuberculosis, colonic diverticulosis
c. abdominal wall muscle spasm, acute apendicitis, ascariasis
d. constipation, urinary tract infections, mesenteric adenitis
e. urinary tract infections, recurrent abdominal pain syndrome, acute cholecystitis
19. Correct management of this septic 3 day old boy with a grossly distended , tender
abdomen include :
Select one:
a. Endotracheal intubation, gastric decompression, broad spectrum antibiotics
b. Perineal examination, intravenous fluids, broad spectrum antibiotics
C.Fluid resuscitation, broad spectrum antibiotics, urgent laparotomy
D.High dose ampicillin, give gentamicin only if good urine output, needle decompression
of abdomen
E. Nil by mouth, nasogastric drainage, restrict intravenous fluid intake
20. A three-day old term infant passed a small amount of meconium for the first time
today, but his abdomen remains distended and he has been
vomiting milk feeds since yesterday. He has a normal anus and an empty processus
vaginalis bilaterally. After a contrast enema his abdomen is less
distended and a lot of meconium plugs are passed out of the anus. The most likely
cause of his distal bowel obstruction is:
Select one :
A. Ascariasis
B. Aganglionis
C. Atresia
D. Atelectasis
E. Abdominal wall defect
21. A 6 week old boy was born at 34 weeks gestation and now presents with a one day
history of irritability and right groin mass as shown . The most likely diagnosis
Select one:
A. incarcerated inguinal hernia
B. inguinal lymphadenitis
C. non-communicating hydrocoele
D. testicular torsion
e, communicating hydrocoele
22.This neonate was born by caesarian section due to a large antenatally detected
mass protruding from the buttocks behind the anus. The
correct diagnosis is:
a. rhabdomyosarcoma
b. haemangioma
c. lymphatic malformation
D.sacrococcygeal teratoma
E.neuroblastoma
23. A one year old child presents with a one day history of a red, painful, fluctuant
swelling in the submandibular area. The
most likely responsible organism is:/
Select one:
A.staphylococcus aureus
b. mycobacterium bovis
c. bartonella henselae (cat scratch disease)
d. ascaris lumbricoides
e. respiratory syncytial virus
24. The photo shows laparotomy findings of the small bowel in a term neonate . This
condition would most likely have presented with the following symptoms
Select one:
a. gasless abdomen on AXR
b, oligohydramnios
C. scaphoid abdomen
d. delayed passage of meconium
e. bile-stained vomiting/
25. The differential diagnosis of a midline neck swelling in a child includes all of the
following
Select one:
a. Branchial cyst, thryoglossal duct cyst, thymic cyst, parotidomegaly, lymph nodes
b. Thyroglossal cyst, cystic hygroma, plunging ranula, ectopic thyroid/
C.Dermoid cyst, submental lymphnode, pyramidal thryoid lobe, thryoglossal duct cyst
d.Branchial cyst, dermoid cyst, cystic hygroma, submandibular lymphnode
26. Choose the correct statement regarding timing of surgery for this premature infant
with reducible ingunial hernia
Select one;
a. Perform elective bilateral inguinal heriotomies after weight of 5kg OR age of 3
months achieved
b. Only operate if hemias become irreducible or strangulate
c. Low risk of incarceration in premature infant and usually spontaneously resolve <18
months
d. Perform elective bilateral inguinal hemiotomies prior to discharge home
e. Urgent repair if intercurrent pneumonia ( high risk of incarceration and bowel
strangulation from coughing)
27. Choose the TRUE statement regarding antenatally diagnosed gastroschisis from the
following
Select one:
a. Poorly diagnosed with antenatal ultrasound
b. Amniocentesis must be performed as chromosomal abnormalities are common
c. Preferred antenatal investigation is MRI
d.Must be delivered in a hospital with a paediatric surgeon available
e. Delivery should be by Caesarean section
28. A 1 month old child who was previously well presents with bile stained vomiting. The
most appropriate further investigation is
Select one :
A. MRI
B. Contrast enema
C. Contrast meal and follow up
D. Contrast swallow
E. Ultrasound scan
29. This neonate has respiratory distress with 'bubbling saliva' and CXR as shown.
During transport to a tertiary centre, the following is essential
Select one:
A. Controlled hypothermia
B.Naso-oesophageal tube suction
C.Normal saline as maintenance fluid
D. Early intubation and mechanical ventilation
E. Keep baby exposed for monitoring
30.Which one of the following statements is true in ALL neonates with congenital
causes of bowel obstruction
Select one:
a. maternal polyhydramnios present
b. nasogastric tube drainage required
c. meconium is not passed
d. abdominal distension present
e. bilious vomiting present
31. A 2 month old female s perineum is. Shown . There is no normal anus . Correct
diagnosis is
Select one:
a. vestibular fistula
b. perineal fistula
c. cloaca malformation
d. normal perineum
e. epispadias
32.
This 5 year old boy presents with a large central abdominal mass which has been
growing slowly over the past 2 months. He is
anemic, hypertensive and has lost weight. An abdominal x-ray shows central
calcifications. The most likely diagnosis is a
Select one:
A.neuroblastoma
B.lymphangioma
C. hepatoblastoma
D . lymphoma
E . abdominal TB
F. faecaloma
33. Choose the correct statement regarding this upper GIT contrast meal and followthrough done for a 1-year old patient with failure to thrive, recurrent aspiration
pneumonia and severe gastro-oesophageal reflux disease.
Select one:
A.malrotation without midgut volvulus
B.Indicates need for urgent pneumatic reduction
C. Further investigation with ultrasound indicated
D. Surgery only indicated if associated bilious vomiting
34. Regarding testicular torsion, the following is TRUE
Select one:
A. Testicular salvage for surgery performed after 12 hours remains excellent/
B. It rarely occurs during the neonatal period or puberty
C. Orchidopexy of the unaffected testis is not routinely done at surgery
D.It may present with abdominal pain and vomiting/ Dit mag met buikpyn en braking
presenteer
E.An ultrasound with Doppler is essential before surgery
35. This 6 month old girl was referred because of an "absent vagina". On examination
she has a normal anus and is otherwise well with no palpable abdominal mass. She had
normal genitalia and no other problems at birth. The following
statement is TRUE regarding this condition:/
Select one:
a. She has vaginal atresia and will need vaginal reconstruction.
b. She has labial adhesions which will soften with topical estrogen.
C.She has a cloaca and needs an ultrasound to look for hydrometrocolpos.
d. She has ambiguous genitalia and needs chromosome studies
e. She has an involuted vagina and needs estrogen and progesterone level testing
36. The primary role of surgery in the premature infant whose abdominal x ray is shown
is
Select one:
a. to correct metabolic acidosis/
b. to remove full-thickness bowel necrosis and debris
c. to improve ventilation
d. to perform colostomy
e. to empty stool from intestines
f. to resect all diseased bowel
37. This 5-month old previously well infant has a 2-day history of bloody stools and
vomiting and abdominal x-ray as shown. The abdomen is very distended but not tender.
Appropriate initial management includes the following:
Select one:
a. broad spectrum antibiotics, trial of oral rehydration solution, send stool for culture/
b. intravascular volume resuscitation, nasogastric drainage, abdominal ultrasound/
c. Immediate laparotomy
d. Nasogastric tube drainage and intravenous maintenance fluid for trial of "drip and
suck
e, blood group type and crossmatch, urgent Meckel's technetium scan
38. Choose the CORRECT statement(s) regarding the injury shown on the chest x-ray
of this 8 year old motor-vehicle accident
victim.
Select one:
a. If the lung fields are normal on early chest x-ray and there are no other bony or solid
viscera injuries, pulmonary contusion is ruled out/
B. Rib fractures in children commonly occur with low velocity impact accidents
c. Head injury is less likely to cause death than thoracic injury
d. Children with rib fractures are at higher risk for associated liver and spleen injuries
e. Children cannot sustain severe pulmonary contusions without fracturing ribs as well
39. A 6 year old child presents with a history of 2 days of vomiting, loose stools, and
increasing abdominal pain that initially started in the peri- umbilical region, and has now
moved to the right iliac fossa. His oxygen saturation is 99% on room air, he has a pulse
rate of 180 beats per minute, a capillary refill time of 3 seconds, and a temperature of
38 degrees Celsius. Choose the best initial course
of management out of the following
Select one:
a. Nasal prong oxygen
b. 10ml/kg half-Darrows-Dextrose solution/
c. Morphine infusion
d. Tepid water sponging & rectal NSAID antipyretic
e.20ml/kg isotonic crystalloid bolus iv
40. A 3 year old presents with a high grade temperature, right upper quadrant
abdominal pain and tenderness for 2 days and tender
hepatomegaly. His liver ultrasound is shown. The 2 most likely possible aetiological
agent(s) in this case is/are:/
Select one or more:
A.amoeba histolytica
B.echinococcus granulosis
C. streptococcus epidermidis
D. mycobacterium tuberculosis
E.. enterococcus spp.
F. staphylococcus aureus
41. All of the following statements regarding passage of meconium in patients with
anorectal malformations are true EXCEPT for (i.e. choose the
FALSE statement):
Select one:
A . Passage of meconium excludes anorectal malformation
B . Meconium passed per urethra with an imperforate anus indicates an anorectal
malformation with recto-urethral fistula
C . Delayed diagnosis with 'bucket-handle' malformation is common as meconium can
still be passed through a perineal fistula
D . Without surgical repair, build-up of meconium and gas in the proximal rectum in a
child with an anorectal malformation may lead to bowel
necrosis and perforation
E .During the first 24 hours after birth the perineum of a male with an imperforate anus
should be monitored for signs of meconium via the
rethra or a perineal fistula
42. This 6 month old baby presented with rectal bleeding and something red prolapsing
through the anus .it is the first time that this has happened, he is also recovering from
gastroenteritis the correct management of the condition is shown is :
Select one or more:
a. Skin emollient and antifungal cream for napkin dermatitis only
b. Resection of mass
C.Push back mass into anus and strapping buttocks together to prevent it coming out
again and treat precipitating diarrhoea
d. Remove child from parents care immediately until perpetrator of sexual assault found
e. Cover lesion with warm wet swabs and await spontaneous reduction
43. Which one of the following signs suggest acute appendicitis
Select one:
a. Right iliac fossa pain that comes and goes
B.Right abdominal pain that gets progressively worse
C. Abdominal pain for 3 hours
d. Previous episodes of severe adominal pain over the past 3 months
e. Bouts of vomiting followed by abdominal pain/