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WorksheetsPediatric Test
Total questions: 70
Worksheet time: 35mins
The drug of choice in the treatment of severe malaria in a 10-kg infant includes:
Oral ACT given every 12 hours for 48 hours
IM lumefantrine given at 3 mg/kg/day
Intravenous artesunate 2.4 mg/kg per dose given at 0, 12, and 24 hours
Intravenous artesunate 3 mg/kg per dose given at 0, 12, and 24 hours
IV quinine 5 mg/kg every 8 hours for 72 hours
Which species of Plasmodium is most commonly associated with cerebral malaria?
Plasmodium vivax
Plasmodium malariae
Plasmodium ovale
Plasmodium falciparum
Which of the following is NOT a pathological process leading to serious respiratory disease in children?
Lower airway obstruction
Lung tissue disease
Upper airway obstruction
Increased work of breathing
Disordered breathing
A 17-year-old female presents with fast breathing and evidence of left pleural effusion. Which of the following findings is NOT suggestive of pleural effusion?
Trachea may be deviated to the left
Stony dull percussion note on the left lower lung zone
Empyema is a possible complication
Decreased chest wall movement on the affected side
Diminished breath sounds on the affected side
A complication of pneumonia characterized by intrapulmonary air-filled cystic spaces is most likely caused by:
Staphylococcus aureus
Streptococcus pneumoniae
Haemophilus influenzae
Escherichia coli
Fungal infections
An adolescent male presents with productive cough of rusty sputum, fever, chest pain, and nasal flaring. Bronchial breath sounds are heard in the right upper chest. The most likely chest X-ray finding is:
Scattered opacities
Tracheal shift to the left
Homogenous opacity in the right upper zone
Obliteration of the right cardiophrenic angle
Flattening of the right diaphragm
In right lobar pneumonia, the most likely palpatory finding is:
Tracheal deviation to the left
Increased tactile fremitus on the right upper chest
Decreased tactile fremitus on the right upper chest
Normal chest excursion
Crepitus on the affected side
A 2-year-old presents with fever, fast breathing, pallor, jaundice, pulse rate 169 bpm, and PCV of 12%. The most likely diagnosis is:
Uncomplicated malaria
Fluid overload
Bronchopneumonia with heart failure
Lobar pneumonia
Severe malaria with anemic heart failure
A 2-year-old child weighing 14 kg requires maintenance IV fluid over 24 hours. Using a soluset, the appropriate drop rate is:
25 drops/min
35 drops/min
50 drops/min
60 drops/min
75 drops/min
Adolescents experience functional variants of normal development. Which of the following is NOT physiological?
Acne
Breast asymmetry
Wet dreams
Scoliosis
Leucorrhoea
A 15-year-old adolescent has epiphyseal plate closure on X-ray. The hormone responsible is:
Growth hormone
Testosterone
Thyroid hormone
Oestradiol
Progesterone
During adolescence, the hormone responsible for luteinizing the gonads is secreted from the:
Anterior pituitary gland
Posterior pituitary gland
Adrenal gland
Thyroid gland
Ovaries
Tanner stage 5 in a 16-year-old female indicates:
Adult-type pubic hair spreading to medial thighs
Scanty pubic hair beginning to curl
Sparse, lightly pigmented pubic hair
Breasts and papillae elevated as a small mound
Enlarged breasts and areola with no contour separation
The first sign of puberty in males is:
Testicular enlargement
Penile enlargement
Pubarche
Thelarche
Spermatogenesis
The organ system most commonly and severely affected in pediatric SLE is the:
Cutaneous system
Musculoskeletal system
Renal system
Gastrointestinal system
A 17-year-old girl presents with fever, arthralgia, and myalgia after 6 months of treatment for epilepsy. There is no malar rash or renal involvement. Laboratory findings show positive ANA and anti-histone antibodies with normal complement levels. Which drug is most likely responsible?
Phenytoin
Hydralazine
Carbamazepine
Valproate
A 14-year-old girl with SLE presents with fatigue, facial puffiness, proteinuria, hematuria, high anti-dsDNA titres, and low C3/C4. Renal biopsy shows diffuse endocapillary proliferation. The underlying immunopathogenic mechanism is:
Type II hypersensitivity
Type III hypersensitivity
T-cell mediated delayed hypersensitivity
Direct podocyte injury
A 4-year-old child presents with chronic cough, fever, and weight loss. Mantoux test is positive and chest X-rays show only hilar lymphadenopathy. Children under 5 years are more likely to develop miliary TB or TB meningitis because:
Their alveolar macrophages produce more reactive oxygen species
They have immature cell-mediated immunity (Th1)
Their B cells produce excessive antibodies
They have less exposure to environmental mycobacteria
A 10-year-old child with a history of incomplete tuberculosis treatment presents with fever, night sweats, and cough. Culture grows Mycobacterium tuberculosis resistant to isoniazid and rifampicin. This is termed:
Monoresistant TB
Polyresistant TB
Multidrug-resistant TB (MDR-TB)
Extensively drug-resistant TB (XDR-TB)
A lymph node biopsy shows granulomas with central caseous necrosis, epithelioid histiocytes, and Langhans giant cells. Mycobacterium tuberculosis survives in macrophages by:
Producing catalase to neutralize reactive oxygen species
Inhibiting phagosome-lysosome fusion
Up-regulating TNF-alpha to induce apoptosis
Secreting antibodies to neutralize complement
A 7-year-old child with pulmonary TB develops tingling and numbness of the feet after 2 months of first-line therapy. The drug responsible and the recommended supplement are:
Rifampicin - Vitamin K
Isoniazid - Vitamin B6
Pyrazinamide - Calcium
Ethambutol - Vitamin D
A child newly diagnosed with drug-sensitive pulmonary TB weighs 20 kg and has no complications. The appropriate first-line treatment regimen is:
2HRZE/4HR
2HRZ/4HR
6HRZE
9HR
The most common form of extrapulmonary tuberculosis in children is:
Miliary TB
TB lymphadenitis
Primary pulmonary TB
TB meningitis
Pott's disease
Multidrug-resistant tuberculosis (MDR-TB) is defined as resistance to:
Any one first-line anti-TB drug
Rifampicin alone
Both isoniazid and rifampicin
All first-line anti-TB drugs
The most common enzymatic defect responsible for congenital adrenal hyperplasia worldwide is:
11-β hydroxylase deficiency
17-α hydroxylase deficiency
21-hydroxylase deficiency
3-β hydroxysteroid dehydrogenase deficiency
StAR protein deficiency
A 10-day-old infant with salt-wasting congenital adrenal hyperplasia is most likely to have:
Hypernatraemia and hypokalaemia
Hyponatraemia and hyperkalaemia
Hypernatraemia and hyperglycaemia
Hypokalaemia and metabolic alkalosis
Hypercalcaemia and hypoglycaemia
The laboratory hallmark of classic 21-hydroxylase deficiency is elevated:
Cortisol
Aldosterone
11-deoxycortisol
17-hydroxyprogesterone
DHEAS only
Hypertension with virilisation in congenital adrenal hyperplasias suggests deficiency of:
21-hydroxylase
3-β hydroxysteroid dehydrogenase
17-α hydroxylase
11-β hydroxylase
StAR protein
Microalbuminuria is defined as urinary albumin excretion of:
>300 mg/day
10–20 mg/day
30–300 mg/day
<10 mg/day
>500 mg/day
A fractional excretion of sodium (FENa) less than 1% suggests:
Acute tubular necrosis
Chronic kidney disease
Post-renal obstruction
Pre-renal acute kidney injury
Renal artery stenosis
The investigation of choice for detecting vesicoureteric reflux is:
Renal ultrasound
Intravenous urogram
CT urogram
Voiding cystourethrogram (VCUG)
DMSA scan
The best imaging modality for detecting renal scarring is:
Ultrasound
Intravenous urogram
CT scan
MRI
DMSA scintigraphy
The most common causative organism of urinary tract infection in children is:
Klebsiella pneumoniae
Proteus mirabilis
Staphylococcus saprophyticus
Escherichia coli
Enterococcus faecalis
Significant bacteriuria in a properly collected urine sample is defined as:
≥ 10² CFU/ml
≥ 10³ CFU/ml
≥ 10⁴ CFU/ml
≥ 10⁵ CFU/ml
Any bacterial growth
The most important long-term complication of recurrent UTI in children is:
Hypertension
Nephrotic syndrome
Reflux nephropathy
Renal calculi
Acute kidney injury
The single most important investigation for confirming urinary tract infection is:
Urinalysis
Urine microscopy
Urine culture
Blood culture
Ultrasound
The most common cause of congenital hypothyroidism is:
Dyshormonogenesis
Maternal antithyroid drugs
Thyroid dysgenesis
Iodine deficiency
Autoimmune thyroiditis
The most sensitive single test for primary hypothyroidism is:
Serum T3
Serum T4
Free T4
Serum TSH
Thyroid antibodies
Untreated congenital hypothyroidism primarily leads to:
Short stature
Delayed puberty
Severe neurodevelopmental impairment
Obesity
Goitre
Graves disease is mediated by antibodies against the:
Thyroglobulin
Thyroid peroxidase
TSH receptor
Iodide pump
Sodium-potassium ATPase
The most common cause of acute bacterial meningitis in neonates is:
Neisseria meningitidis
Streptococcus pneumoniae
Escherichia coli
Haemophilus influenzae
Staphylococcus epidermidis
Reduced cerebrospinal fluid glucose in bacterial meningitis is mainly due to:
Reduced hepatic glucose production
Increased glucose metabolism by bacteria
Impaired renal glucose reabsorption
Increased insulin secretion
Reduced dietary intake
The investigation that confirms the diagnosis of meningitis is:
CT scan
Blood culture
Lumbar puncture
Full blood count
EEG
The most common cause of viral encephalitis in children is:
Measles virus
Rabies virus
Herpes simplex virus
Influenza virus
Varicella-zoster virus
Acute kidney injury is best defined as:
Gradual decline in renal function over months
Congenital absence of kidney function
Sudden deterioration of renal function with inability to maintain fluid and electrolyte balance
Reduced urine output due to dehydration alone
Progressive glomerular sclerosis
Oliguria in older children is defined as urine output of:
<1 ml/kg/hr for 24 hours
<0.5 ml/kg/hr for more than 6 hours
<2 ml/kg/hr for 12 hours
<0.5 ml/kg/hr for more than 12 hours
Complete absence of urine for 12 hours
After adequate fluid resuscitation, absence of urine output for 2 hours suggests intrinsic AKI. The next appropriate step is to:
Continue fluid boluses
Start antihypertensive drugs
Give a diuretic challenge
Restrict all fluids immediately
Commence dialysis
Classical findings in acute glomerulonephritis include all EXCEPT:
Haematuria
Oliguria
Proteinuria >3g/24 hours
Hypertension
The primary hypersensitivity reaction implicated in acute glomerulonephritis is:
Type I
Type II
Type III
Type IV
Recent epidemics of acute glomerulonephritis in developing countries have been linked to:
Streptococcus zooepidemicus
Varicella
Population growth
Skin type
Pathological findings in acute glomerulonephritis include:
Irregular renal swelling
Focal cellular proliferation
Presence of inflammatory cells
Marked epithelial cell proliferation
The best single diagnostic test for recent skin streptococcal infection is:
Elevated ASO titre
Elevated anti-DNase B
Low C3 and C5
Elevated IgG and IgM
Diabetic ketoacidosis is characterised by all the following EXCEPT:
Increased free fatty acids
Increased ketolysis
Increased lipolysis
Reduced alkali reserve
The correct pairing for severity of diabetic ketoacidosis is:
Mild: venous pH <7.3 or HCO₃ >15 mmol/L
Severe: venous pH <7.3 or HCO₃ >10 mmol/L
Moderate: venous pH <7.2 or HCO₃ <10 mmol/L
Mild: venous pH >7.3 or HCO₃ >15 mmol/L
None of the above
Dextrose-containing fluids are initiated in DKA when:
pH >7.3
Fasting blood sugar <14 mmol/L
HCO₃ >15 mmol/L
After 3 litres of normal saline
None of the above
Autonomic symptoms of hypoglycaemia include:
Headache
Dizziness
Anxiety
Seizures
All are causes of diabetes mellitus in children EXCEPT:
Cushing disease
Beta-agonists
Congenital varicella
Hyperthyroidism
None of the above
The correct sequence in the pathogenesis of type 1 diabetes mellitus is:
Genetics → environmental triggers → autoimmunity → loss of insulin secretion → overt diabetes
Autoimmunity → environmental triggers → genetics → loss of insulin secretion → overt diabetes
Environmental triggers → genetics → autoimmunity → overt diabetes → loss of insulin secretion
Genetics → environmental triggers → autoimmunity → overt diabetes → loss of insulin secretion
None of the above
According to the American Diabetes Association, diabetes mellitus should be suspected when:
Fasting blood glucose >125 mg/dL
Fasting blood glucose <11.1 mmol/L
OGTT >140 mg/dL
OGTT >7 mmol/L
The pathognomonic finding in diabetic nephropathy is:
Focal sclerosis
Kimmelstiel-Wilson nodules
Podocyte effacement
Linear immunofluorescence
None of the above
Vitamin D is primarily synthesized in the:
Skin
Liver
Kidneys
Bone
None of the above
Vitamin D₃ is involved in all the following EXCEPT:
Regulation of glucagon secretion
Regulation of immune function
Stimulation of cell differentiation
Induction of apoptosis
Acquired causes of rickets include all EXCEPT:
Dark skin
Inadequate intake
Religious practices
Extreme prematurity
None of the above
A classical long-bone X-ray finding in rickets is:
Growth plate widening
Cupping and splaying
Metaphyseal fraying
Syndesmosis
Laboratory findings in advanced chronic kidney disease include:
Hypercalcaemia
Hypophosphataemia
Hypokalaemia
Elevated vitamin D₃
None of the above
The valvular lesion most commonly associated with later rheumatic fever is:
Aortic insufficiency
Mitral stenosis
Pulmonary stenosis
Tricuspid insufficiency
Mitral insufficiency
The correct pairing among the Jones criteria is:
Sydenham chorea – Major
Fever – Major
Polyarthralgia – Major
Polyarthritis – Minor
Carditis – Minor
Indicators of recent streptococcal infection include all EXCEPT:
Positive throat culture
Elevated ASO titre
Remote history of scarlet fever
None of the above
Definitive diagnosis of acute rheumatic fever is made with:
One major and one minor criterion
Two major and two minor criteria
Two minor and one major criterion
One minor and one major criterion
Polyarthritis, polyarthralgia, and fever
The duration of secondary prophylaxis for uncomplicated acute rheumatic fever in a 13-year-old male is:
Till age 18 years
10 years
Well into adulthood
5 years
Till age 21 years
