Ya kwa kuhitaji notes zaid kwa level four unaweza kuzipata kupitiahttps://drive.google.com/drive/folders/1-gSOTx1eaIMRdA-qj2CPa5AoW-A3onBI
Tutaendelea na sehemu ya kwanza (Multiple choice). Hapa ni majibu kwa maswali:
i. Which one of the following is true in regard to the performance of the venipuncture?
Answer: A. Date and patient identification number should be requested
ii. A 3-month-old child female was taken to Mkanyageni dispensary for health seek. While the patient is at the waiting area you find that the patient came only for vaccination schedule, the child has:
Answer: B. Non-urgent sign
iii. Which of following features indicate severe malaria in children?
Answer: E. Algid malaria
iv. Exclusively breastfeeding is recommended for at least:
Answer: B. 6 months
v. One of the following is the presenting feature of a child with shock:
Answer: D. Weak and fast pulse
vi. A 9-month-old female was brought by her mother to Mikanjuni health centre with complaint of fever and vomiting. Upon further explanations her mother reported suggestive features of severe malaria. Which one is not among the following features?
Answer: B. Consciousness
vii. In the management of pediculosis in a child who is 8 years old female not dehydrated, which of the following is the best drug of choice?
Answer: B. Malathion lotion
viii. A 4-year-old female was brought to your health centre with complaint of passing loose stool that was associated with low grade fever and general body malaise, on physical examination patient has loose skin on arms and buttocks, prominent ribs and MUAC less than 10cm. However, no lower limb oedema but has body temperature of 37.6°C. What might be the most correct diagnosis?
Answer: C. Severe acute malnutrition marasmus type
ix. In severe malaria, hyperparasitaemia means:
Answer: A. > 5000 asexual parasites per 200 WBC
x. Which of the following describes the causative agent of meningitis in a baby of 1 month old:
Answer: A. Listeria Monocytogenes
Itaendelea na maswali mengine sasa.
Tunaendelea na majibu:
xi. Which of the following explains the site of lumbar puncture in children?
Answer: A. Use L3–L4 interspace down to L5–S1 interspace in children <12 months
xii. Which of the following is not a reason for delaying lumbar puncture?
Answer: A. A sick child
xiii. Which of the following factors is a poor prognostic factor in a child with shock?
Answer: A. Multiple organ failure
xiv. Regarding resuscitation in paediatrics, the most important goal is:
Answer: E. To provide adequate oxygen delivery to body tissue
xv. Emmanuel, a 3-year-old boy, presents to OPD with a complaint of passing stool for 2 days, 6 motions/day with low-grade fever and restlessness. Upon investigation, protozoa was identified as one of the causative agents. Which among the following organisms might have caused the condition?
Answer: A. Giardia lamblia
xvi. Acute diarrhoea in children:
Answer: A. Often requires careful attention to fluid intake to prevent dehydration
xvii. Which among the following is not a common upper respiratory tract infection?
Answer: C. Bronchiolitis
xviii. The etiologic agent responsible for most urinary tract infections is:
Answer: C. Escherichia coli
xix. When resuscitating a newborn, start chest compression when the heart rate is:
Answer: B. Below 60 beats per minute
xx. A 2-year-old child was diagnosed with chronic ear infection. The best treatment at the dispensary will be:
Answer: B. Refer URGENTLY to hospital
Tunaendelea na maswali mengine.
Tunaendelea na majibu:
i. A 4-month-old boy presents at a health centre with a complaint of wheezing. The father has given two puffs of salbutamol inhaler, but the difficulty in breathing has not improved significantly. Upon examination, the child is pale and has perioral cyanosis. Respiratory rate 60 breaths/min and loud wheezes throughout the chest that obscure the heart sound. What is the most likely diagnosis?
Answer: B. Bronchiolitis
ii. It is recommended to give zinc supplements to a child with diarrhoea because:
Answer: C. Zinc reduces duration and severity of diarrhoea
iii. Which among the following describes the management of aseptic meningitis in children?
Answer: B. Treatment is with fluids and observation
iv. Which among the following investigations is useful in diagnosing dengue fever in children?
Answer: B. Dengue serology test
v. Which among the following is a sign of moderate dehydration?
Answer: D. Tissue turgor retracts slowly
vi. A 3-year-old boy presents to OPD with a sudden onset of barking cough, stridor, low-grade fever, and difficulty in breathing. On examination, he has laboured breathing and subcostal retractions. The life-saving management of this child would include:
Answer: C. Parenteral steroid and oxygen therapy
vii. Management of a child with persistent diarrhoea includes:
Answer: E. Establishment of the cause
viii. One of the following statements is correct regarding the management of urinary tract infections:
Answer: B. Treatment should be initiated after culture and sensitivity in symptomatic children
ix. The management of a one-month-old child suspected to have meningitis and convulsing will include:
Answer: A. I.V. Phenobarbitone 25mg/kg to stop convulsions
x. A child is brought to the clinic presenting with high-grade fever of sudden onset, crying during micturition, and decreased breastfeeding. The mother denies a history of vomiting or convulsions. On examination, the child is febrile at 40°C, not pale, and not jaundiced. What could be the most likely diagnosis in this child?
Answer: A. Urinary tract infection
Tunaendelea na maswali mengine.
Tunaendelea na majibu:
xi. A breastfed infant is expected to have a lower incidence of which of the following?
Answer: C. Diarrhoea
xii. Concerning the management of uncomplicated malaria in a 1-year-old with a 10kg body weight:
Answer: C. Artemether/Lumefantrine per oral is the drug of choice
xiii. 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:
Answer: B. Common causative agent is likely Shigella species
xiv. Concerning pneumonia in children:
Answer: A. Causative agents differ with age
xv. A one-year-old baby presents with a high-grade fever associated with two episodes of convulsions of generalized tonic-clonic characteristics. On examination, the baby is febrile at 39.0°C, Kernig’s and Brudzinski’s signs were both negative. Random blood glucose was 4.6 mmol/L, and a blood smear for malaria parasites was negative. What could be the most likely diagnosis?
Answer: E. Febrile convulsion
xvi. Concerning upper respiratory tract infections (URTI) in children:
Answer: B. Viruses are the most common causative agents
xvii. A child presents at the dispensary with features of fever (39°C), history of vomiting once, general malaise, and joint pains only. The most likely diagnosis is:
Answer: E. Uncomplicated malaria
xviii. In relation to malaria infection, anaemia as a complication is a result of:
Answer: C. Haemolysis of red blood cells
xix. Among the following organisms, which contributes more in the causation of bronchiolitis?
Answer: C. Respiratory syncytial virus
xx. Which pathological agent is the most common cause of diarrhoea in children?
Answer: D. Rotavirus
Tunaendelea na maswali mengine.
Tunaendelea na majibu:
xxi. A child is brought to the clinic presenting with high-grade fever of sudden onset, crying during micturition, and decreased breastfeeding. The mother denies a history of vomiting or convulsions. On examination, the child is febrile (40°C), not pale, and not jaundiced. What could be the most likely diagnosis in this child?
Answer: A. Urinary tract infection
i. Kofi, a 3-year-old boy, is brought to the emergency department by his father. Kofi has been lethargic, refusing to eat, and has had a high fever for the past two days. His father reports that Kofi has also been vomiting and has had difficulty breathing. On examination, Kofi appears very ill and is unresponsive to his surroundings. His respiratory rate is 40 breaths per minute, and his oxygen saturation is 88% on room air. He has a weak and rapid pulse with a heart rate of 140 beats per minute, and his capillary refill time is 5 seconds. Kofi's skin is cool and mottled, and he has a high-grade fever of 39.8°C (103.6°F). The healthcare provider recognizes several priority signs that require immediate intervention. Based on Kofi's clinical presentation, what priority signs indicate the need for urgent medical attention?
Answer: J. Appearing very ill and unresponsive to surroundings
ii. Aliya, a 4-year-old girl, is brought to the pediatric clinic by her mother with complaints of intense itching, especially at night, for the past two weeks. Her mother reports that Aliya has been scratching her skin frequently, causing red bumps and scabs. On examination, you observe small, red, and raised bumps in a linear pattern, predominantly on Aliya's hands, wrists, elbows, and abdomen. Some of the lesions have developed into crusted sores due to scratching. Her mother mentions that Aliya's younger brother and a few children at her daycare have similar symptoms. A skin scraping is performed, and microscopic examination confirms the presence of Sarcoptes scabiei mites. What is the most appropriate recommended drug of choice for Aliya?
Answer: A. Benzyl benzoate emulsion (BBE)
iii. Neema, a 9-year-old girl, is brought to the clinic by her mother with complaints of intense itching on her scalp for the past two weeks. Her mother reports that Neema has been scratching her head frequently, especially at night, and recently started having difficulty concentrating in school due to the constant itching. On examination, you observe small, red papules on Neema's scalp and behind her ears. Upon closer inspection, you notice small, white, oval-shaped nits attached to the hair shafts and a few live lice moving on her scalp. Neema's mother mentions that there have been reports of lice infestations in her school. What is the most likely diagnosis of the case above?
Answer: I. Pediculosis
iv. Baby Amani, a 10-day-old full-term infant, is brought to the emergency department by her parents. They report that she has been irritable, refusing to feed, and has had a fever for the past 24 hours. On examination, Amani appears lethargic and has a high-pitched cry. Her temperature is 38.5°C (101.3°F), heart rate is 160 beats per minute, and respiratory rate is 50 breaths per minute. Her anterior fontanelle is bulging, and she exhibits poor muscle tone. A lumbar puncture is performed, and cerebrospinal fluid (CSF) analysis reveals an elevated white blood cell count, increased protein, and decreased glucose levels. Gram stain of the CSF shows Gram-positive cocci. What is the most likely diagnosis of the case above?
Answer: C. Neonatal meningitis
v. Kasim, a 7-year-old boy living in a malaria-endemic area of Tanzania, is brought to the clinic by his mother. She reports that Kasim has been experiencing intermittent high fever, chills, and sweating for the past three days. He also complains of headache, muscle pain, and fatigue. On examination, Kasim is febrile with a temperature of 39°C (102.2°F), and he appears pale and lethargic. His spleen is palpable and enlarged. A rapid diagnostic test (RDT) for malaria is performed, and the result is positive for Plasmodium falciparum. A blood smear confirms the presence of malaria parasites. What is the most likely diagnosis?
Answer: B. Uncomplicated malaria
Tunaendelea na maswali mengine.
Tunaendelea na majibu:
vi. Fatma, a 14-year-old woman with a history of diabetes mellitus, presents to the dermatology clinic with complaints of thickened, discolored nails on her feet. She reports that the condition has been worsening over the past six months, and she now has difficulty trimming her toenails. Fatma also mentions that she experiences mild pain and discomfort while walking. On examination, you observe that her toenails are yellowish-brown, thickened, and brittle, with some nails showing signs of separation from the nail bed (onycholysis). The skin around the affected nails appears normal. A potassium hydroxide (KOH) preparation of nail scrapings is performed, and the results confirm the presence of fungal hyphae. What is the most likely diagnosis?
Answer: B. Tinea unguium
vii. Ahmed, a 7-year-old boy, is brought to the pediatric clinic by his mother with complaints of itchy, scaly patches on his scalp. She reports that these patches have been present for the past month and seem to be spreading. Ahmed has also experienced hair loss in the affected areas, and his mother mentions that he scratches his scalp frequently, especially at night. On examination, you observe multiple round, scaly patches with broken hairs and areas of alopecia on Ahmed's scalp. There are also black dots where the hair has broken off at the scalp level. What is the most likely diagnosis?
Answer: D. Tinea capitis
viii. Musa, a 13-year-old boy, presents to the dermatology clinic with complaints of itching and a rash in his groin area that has been present for the past two weeks. He mentions that the itching becomes more intense when he sweats or after physical activity. On examination, you observe a well-demarcated, erythematous, and slightly scaly rash with a raised border in the inguinal folds and inner thighs. The skin appears inflamed, but there are no signs of secondary infection. Musa is otherwise healthy, with no significant medical history, but he mentions that he recently joined a local gym and has been working out regularly. A potassium hydroxide (KOH) preparation of skin scrapings from the lesion shows the presence of fungal hyphae, confirming the diagnosis of tinea cruris (jock itch). What is the most likely diagnosis?
Answer: E. Tinea cruris
ix. Mwajuma, a 2-year-old girl, is brought to the pediatric clinic by her mother. Her mother reports that Mwajuma has been losing weight over the past few months, appears weak, and is frequently sick with diarrhoea and respiratory infections. She also mentions that Mwajuma's appetite has decreased significantly, and she often refuses to eat. On examination, Mwajuma appears thin with visible ribs and muscle wasting. Her weight-for-age is below the 3rd percentile, and her mid-upper arm circumference (MUAC) is below 11.5 cm. She has dry, scaly skin, and her hair is brittle and thin. Laboratory tests reveal low levels of hemoglobin and albumin, indicating anaemia and protein deficiency. The healthcare provider suspects severe acute malnutrition (SAM) and decides to initiate treatment. What is the initial treatment for Mwajuma?
Answer: A. Ready-to-use therapeutic food (RUTF)
x. Abdul, an 8-year-old boy, presents to the clinic with a persistent cough that has lasted for the past three weeks. He also reports night sweats, unintentional weight loss, and occasional hemoptysis (coughing up blood). On examination, Abdul appears thin and fatigued. His temperature is 37.8°C (100°F). A chest X-ray reveals cavitary lesions in the upper lobes of his lungs. What is the most likely diagnosis?
Answer: D. Pulmonary tuberculosis
Tunaendelea na maswali mengine.
Tunaendelea na majibu:
xi. A 4-year-old female was brought to your health centre with a complaint of passing loose stool that was associated with low-grade fever and general body malaise. On physical examination, the patient has loose skin on arms and buttocks, prominent ribs, and MUAC less than 10 cm. However, no lower limb oedema but has a body temperature of 37.6°C. What might be the most correct diagnosis?
Answer: H. Severe acute malnutrition marasmus type
xii. Zawadi, a 12-year-old girl, is admitted to the hospital with a diagnosis of acute pancreatitis. She has been experiencing severe abdominal pain, nausea, and vomiting for the past two days. On examination, Zawadi appears distressed and is unable to tolerate oral intake. Her abdomen is tender, and she is dehydrated with dry mucous membranes and poor skin turgor. The healthcare provider decides to insert a nasogastric tube (NGT) to decompress the stomach, relieve symptoms, and administer medications. The nurse prepares the necessary supplies, explains the procedure to Zawadi, and ensures that she is positioned comfortably. Sterile technique and proper hand hygiene are maintained throughout the procedure to minimize the risk of complications. What measures should be taken to confirm the correct placement of the NGT before initiating use?
Answer: A. Aspirating stomach contents and testing the pH (should be acidic, typically below 5.5)
xiii. Emmanuel, a 3-year-old boy, presents to OPD with a complaint of passing stool for 2 days, 6 motions/day with low-grade fever and restlessness. Upon investigation, protozoa was identified as one of the causative agents. Which among the following organisms might have caused the condition?
Answer: A. Giardia lamblia
xiv. A 2-year-old child was diagnosed to have chronic ear infection. The best treatment at the dispensary will be:
Answer: C. Dry the ear by wicking and follow up after 5 days
xv. The etiologic agent responsible for most urinary tract infections is:
Answer: J. Escherichia coli
xvi. Aisha, an 8-month-old infant, is brought to the clinic by her mother with complaints of diarrhoea for the past three days. Her mother reports that Aisha has had more than six watery stools per day and has been refusing to eat and drink. She also mentions that Aisha has been more irritable than usual and has developed a mild fever of 38°C (100.4°F). On examination, Aisha appears lethargic and has sunken eyes. Her skin turgor is poor, and her mucous membranes are dry. Her weight has decreased since her last visit, and her fontanelle is slightly sunken. The healthcare provider suspects a viral cause for Aisha's diarrhoea and orders stool samples for further investigation. What is the most probable organism that will be isolated after further investigation?
Answer: E. Rotavirus
xvii. Lina, a 2-year-old girl, is brought to the emergency department by her mother. Lina has been ill for the past two days with symptoms of fever, cough, and difficulty breathing. Her mother reports that Lina has not been eating well and is less active than usual. On arrival, Lina appears lethargic and is struggling to breathe. Her respiratory rate is 60 breaths per minute, with nasal flaring and intercostal retractions. Her oxygen saturation is 88% on room air. Lina's heart rate is 150 beats per minute, and her capillary refill time is 4 seconds. She has a high-grade fever of 39.5°C (103.1°F). The healthcare provider performs a rapid assessment using the ETAT approach. What is the immediate action of management for Lina?
Answer: A. Oxygen supply
xviii. Which of the following describes the causative agent of meningitis in a baby of 1 month old?
Answer: F. Listeria Monocytogenes
xix. When resuscitating a newborn, start chest compression when the heart rate is:
Answer: G. Below 60 beats per minute
xx. Which of the following is the appropriate management of chronic tonsillitis in a 10-year-old male?
Answer: E. Tonsillectomy
Tunaendelea na maswali mengine.
Tunaendelea na majibu:
i. A neonate presents at a dispensary with a history of not passing her first stool. On examination: afebrile, dehydrated, tender distended abdomen, increased bowel sounds, respiratory rate of 70 breaths/minute. Immediate treatment is:
Answer: E. Nil per oral, nasogastric tube insertion, and urethral catheterization.
ii. An infant aged 3 months presents with fever and reduced exclusive breastfeeding for 3 days. O/E: alert, BT = 39.2°C, weight = 7.9kg. Immediate response is:
Answer: B. Urgent referral
iii. A 4-year-old girl presents to the hospital with a history of inability to sit, speak, and hear. On examination: hypertonic joints, drooling saliva with involuntary movements of lips and facial muscles. Developmental milestone can be interpreted as:
Answer: C. Abnormal
iv. A child aged 5 years old female was brought to your health centre with a complaint of runny nose that was associated with mild headache and low-grade fever. Her father denies a history of difficulty in breathing/coughing or joint pain. On examination, the patient is alert, not lethargic/irritable, no angular stomatitis but vital signs were: Temperature 37.0°C, PR = 79 bpm, and RR = 16 cpm. What is the most provisional diagnosis?
Answer: B. Common cold
v. During rapid screening of sick children at OPD you find a child who is lethargic, has palmar pallor, and respiratory distress. This child has:
Answer: B. Emergency sign
vi. A 7-year-old female was diagnosed with a urinary tract infection (UTI). Which among the following urinalysis results may indicate a UTI in this child?
Answer: E. > 15 WBC/HPF in centrifuged urine with proteinuria
vii. A 2-year-old male was brought to your health facility with a complaint of skin rashes associated with itching. His parents reported that a week ago he started to present with multiple macules that later developed into vesicles and ended up rupturing to form erosions. On examination, the patient is alert, afebrile, with no lymphadenopathy but has honey-coloured crusts on the face and upper limb. What is the most common causative organism of this detailed case?
Answer: C. Staphylococcus aureus
viii. As a clinician passing through a major ward round, you find a child patient with suggestive features of tuberculosis and need to do investigations. Which among the following investigations will be useful in diagnosing tuberculosis in children?
Answer: A. Mantoux tuberculin skin test
ix. A 10-year-old female is brought by her mother to your health centre and found only a nurse present. Upon examination, a nurse receives a phone call from a doctor in charge and wants to know if there is any patient already admitted. The nurse replies that there is a suspected case of scabies. Now you as a doctor in charge, what are the presenting features of a child with scabies that you will tell your nurse who is with the patient?
Answer: C. Localized or generalized pruritus with eczematous eruption
x. Mr. Kaijuka Mwambanda brought his child to your hospital with the complaint of scaly patches on the body that have been there for one week now. It has been associated with little skin itching. On examination, there is a scattered ring-circling lesion beneath the skin surface of the abdomen and 16 patches which coalesce to form a polycyclic appearance on the chest and are oval in shape with an inflamed border but centrally are smooth and bare. What is the most likely diagnosis?
Answer: D. Tinea corporis
Tunaendelea na maswali mengine.
Tunaendelea na majibu:
xi. During triage of the patients in OPD, a child came with one of the emergency signs. Now, as a clinician, which one of the following is a sign the child came with?
Answer: A. Central cyanosis
xii. In regard to the performance of the venepuncture procedure, as a doctor in the ward who wants to collect a blood sample from the patient for a Full Blood Picture, which one explains correctly the skills of venepuncture?
Answer: C. Insert the needle with bevel side up at 15-30° angle with the skin
xiii. A 2-year-old child suddenly develops inspiratory stridor, tachypnea, and chest retractions. He had been playing with his 6-year-old brother before this episode. He is afebrile, and other parameters of physical examination are normal. A chest radiograph reveals no abnormalities. Which of the following is the best first-line management?
Answer: E. Evaluate the airway for obstruction
xiv. A 2-year-old boy was rushed to the casualty in an unconscious state, presenting with a high-grade fever and convulsions once. While assessing the child, he convulsed again. The mother reports a history of vomiting and refusal to eat anything. On examination, the child is febrile (40°C), soft neck, moderately pale, not cyanotic, and not jaundiced. What is the first measure you would take to manage this child?
Answer: A. Intravenous administration of 100 mL of 20% bolus glucose should be performed quickly
xv. During triaging of sick young infants, when emergency signs are found, the following step should be taken:
Answer: A. Call an experienced health professional and others to help
xvi. A 12-year-old male is seen in a clinic for evaluation of severe nocturnal itching and rash on the hands, wrists, and axillae. She denies any other symptoms. She currently resides in a shelter and states that several close contacts have described similar symptoms. Examination of her hands reveals burrows on the flexor surfaces and interdigital spaces. A clinical diagnosis of scabies is made. As a doctor, what is the best method to make a definitive diagnosis of scabies?
Answer: C. Performing a skin scraping from a burrow and identifying mites, eggs, or feces under the microscope
xvii. Anna, a 10-year-old girl, was brought to your health centre already diagnosed with a stroke. Her parents want her to be put on NGT for feeding. As a doctor, how will you measure the required length of the nasogastric tube?
Answer: B. Nose to ear to xiphisternum
xviii. During a nasogastric tube insertion, after two attempts you are unable to advance the tube through either nostril, and the patient is becoming more distressed. Your next appropriate action should be:
Answer: A. To pause, inform the patient that you are going to give him or her a break while you confer with the attending physician or other house officer
Tunaendelea na sehemu nyingine ya maswali.
Sasa tunahamia sehemu ya TRUE/FALSE QUESTIONS.
2. Which of the following are true in regard to the requirements and supplies of the Nasogastric tube (NGT) insertion?
A: Sterile Nasogastric Tube → TRUE
B: Bottles for Blood Sample → FALSE
C: Syringes → TRUE
D: Antibiotics → FALSE
E: Tube Clamp → TRUE
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3. The following explains about the criteria of moving a patient with malnutrition from the stabilization phase to the transition phase.
A: Appetite has improved → TRUE
B: Lower limb oedema should be present → FALSE
C: The treatment of medical complications has commenced and the patient has improved → TRUE
D: IV fluid should have been completed → FALSE
E: When the patient is still kept on NGT for feeding → FALSE
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4. Concerning the non-pharmacological treatment of croup (Laryngotracheobronchitis):
A: Basic hygiene can help to limit the spread of disease → TRUE
B: To decrease mucosal swelling, Prednisolone may be advantageous → FALSE
C: Keep the child comfortable in a semi-seated position → TRUE
D: The commonest causative agent includes Rubella and Rhinovirus → FALSE
E: Normally it is diagnosed by full blood count → FALSE
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5. Mr. Joram brought his son, who is 11 years old, presented with suggestive features of Tinea cruris. Which among the following explains the preventive measures of it?
A: Wear underclothes that allow evaporation → TRUE
B: The most common measure is weight gain → FALSE
C: Wash and wet groin with different towels/wash cloths → TRUE
D: Never play with strange cats/dogs → TRUE
E: Avoid sexual contact with infected individuals → TRUE
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6. The following is the management of severe pneumonia:
A: Oxygen in nasal prong to prevent hypoxia → TRUE
B: Inhaled steroids to reduce inflammatory process → FALSE
C: Intravenous antibiotic to resolve para-pneumonic effusion → TRUE
D: Maintenance fluid to prevent dehydration → TRUE
E: Bronchodilator to prevent bronchial obstruction → TRUE
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7. Regarding tuberculosis in pediatrics:
A: Children with tuberculosis have usually acquired it from an adult contact → TRUE
B: Sputum-negative cases are of more public health importance → FALSE
C: Close contacts of a smear-positive case should be offered immediate BCG → FALSE
D: BCG prevents pulmonary tuberculosis by 60% → TRUE
E: Close contacts of a smear-positive case should be offered a chest X-ray → TRUE
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8. Concerning the pathophysiology of diarrheal diseases, impaired absorption is due to:
A: Increased digestion → FALSE
B: Increased osmotic load on the lumen → TRUE
C: Increased food intake → FALSE
D: Damage to the absorptive surfaces → TRUE
E: Inadequate mucosal enterocyte replication → TRUE
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9. Anna is a 6-year-old girl presented with suggestive features of aseptic meningitis. Which among the following explains it?
A: Treatment is with fluids and observation → TRUE
B: CSF microscopy shows more cells, mainly lymphocytes → TRUE
C: Lumbar puncture shows the CSF is almost cloudy → FALSE
D: Mantoux test may be positive → FALSE
E: CSF glucose is normal → TRUE
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Hii ni sehemu ya TRUE/FALSE QUESTIONS yote. Sasa tunaendelea na MATCHING ITEMS. Endelea kunipa ruhusa.
Tunaendelea na sehemu ya MATCHING ITEMS.
10. A) Match the clinical symptoms from Column B with their corresponding medical condition/disease in Column A.
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10. B) Match the pharmacological treatment from Column B with the appropriate medical condition/disease in Column A.
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11. A) Match items from Column B with their corresponding in Column A.
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11. B) Match items from Column B with their corresponding in Column A.
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Hii ni sehemu ya MATCHING ITEMS yote. Sasa tunaendelea na SHORT ANSWER QUESTIONS. Endelea kunipa ruhusa.
Sasa tunaendelea na sehemu ya SHORT ANSWER QUESTIONS.
6. Amina is a 1-year-old female who was brought by her parent to the health facility with a complaint of skin itching that started gradually. Prior to the onset of itching, her parent reported a history of blisters on the face four days ago. Upon examination, there were pruritic honey-coloured crusts on her face. Vital signs were essentially normal.
(a) What is the provisional diagnosis?
Answer: Impetigo
(b) Mention at least two (2) complications of the above diagnosis:
Answer:
1. Post-streptococcal glomerulonephritis
2. Cellulitis
(c) Mention two pharmacological treatments for the above diagnosis.
Answer:
1. Topical mupirocin
2. Oral flucloxacillin
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7. Mention at least five (5) complications of severe malaria.
Answer:
1. Cerebral malaria
2. Severe anaemia
3. Acute respiratory distress syndrome (ARDS)
4. Hypoglycemia
5. Renal failure
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8. Despite the common preventive measure of neonatal tetanus being two tetanus toxoid injections, it can also be prevented by the five "5 cleans." List those five (5) cleans used to prevent neonatal tetanus.
Answer:
1. Clean hands
2. Clean delivery surface
3. Clean cord cutting
4. Clean cord tying
5. Clean cord care
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9. Rose, a 2-month-old female, was brought to the dispensary presenting with a history of dry cough associated with difficulty in breathing, unable to breastfeed for 2 days, and had convulsions once at home. On examination, she is febrile, dyspnoeic, not cyanosed, and not jaundiced.
(i) What are the differential diagnoses?
Answer:
1. Pneumonia
2. Meningitis
3. Severe malaria
(ii) What pre-referral investigations will you perform?
Answer:
1. Blood smear for malaria parasites
2. Random blood glucose
3. Full blood count
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10. Enumerate five (5) priority signs.
Answer:
1. Lethargy or unconsciousness
2. Severe palmar pallor
3. Respiratory distress
4. Central cyanosis
5. Convulsions
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11. John, a 2-year-old male, was brought to your health centre with already suggestive features of complications of tuberculosis. Enumerate five (5) complications.
Answer:
1. Miliary tuberculosis
2. Tuberculous meningitis
3. Spinal tuberculosis (Pott’s disease)
4. Pleural effusion
5. Pericarditis
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12. (a) Define the term "Acute membranous tonsillitis."
Answer: It is an inflammation of the tonsils characterized by the presence of a greyish-white membrane over the tonsils, often caused by bacterial infections such as Streptococcus pyogenes.
(b) Describe the indications for tonsillectomy.
Answer:
1. Recurrent tonsillitis (≥7 episodes per year, ≥5 per year for 2 years, or ≥3 per year for 3 years)
2. Obstructive sleep apnoea
3. Peritonsillar abscess resistant to medical treatment
4. Difficulty swallowing or breathing due to enlarged tonsils
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13. A 4-year-old female presented with a history of lower abdominal pain, vomiting, and fever. The mother mentioned that she noticed a change in the frequency of urination, which was accompanied by pain.
(a) What is the most likely diagnosis?
Answer: Urinary tract infection (UTI)
(b) List four (4) differential diagnoses.
Answer:
1. Acute gastroenteritis
2. Appendicitis
3. Pelvic inflammatory disease
4. Cystitis
(c) Mention two (2) gram-positive bacteria that may cause the above diagnosis.
Answer:
1. Staphylococcus saprophyticus
2. Enterococcus faecalis
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14. A 6-year-old boy presents to the hospital with a history of fever, cough, and difficulty in breathing for 5 days. On examination, he is lethargic and has a temperature of 38.5°C, respiratory rate 65 breaths/min, intercostal retractions, and coarse crackles on the left side of the chest.
(a) What is the most likely diagnosis?
Answer: Pneumonia
(b) Mention four (4) common causative organisms of the above diagnosis.
Answer:
1. Streptococcus pneumoniae
2. Haemophilus influenzae
3. Mycoplasma pneumoniae
4. Respiratory syncytial virus (RSV)
(c) List four (4) complications of the above condition.
Answer:
1. Pleural effusion
2. Lung abscess
3. Respiratory failure
4. Sepsis
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Hii ni sehemu ya SHORT ANSWER QUESTIONS yote. Sasa tunaendelea na GUIDED ESSAY QUESTIONS. Endelea kunipa ruhusa.
Sasa tunaendelea na sehemu ya GUIDED ESSAY QUESTIONS.
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18. Anna, a 10-year-old female, presents at your health center with a history of painful swallowing, fever, and restlessness for 4 days. Furthermore, the patient reported a previous history of being treated for otitis media. On physical examination, she is febrile (38°C), and examination reveals inflamed reddish tonsils. Discuss the management of this patient in terms of provisional diagnosis, causative agents, investigations, treatment, and complications.
Provisional Diagnosis:
Acute Tonsillitis
Causative Agents:
1. Streptococcus pyogenes (Group A beta-hemolytic Streptococcus)
2. Staphylococcus aureus
3. Haemophilus influenzae
4. Adenovirus
5. Epstein-Barr virus (EBV)
Investigations:
1. Throat swab for culture and sensitivity
2. Complete blood count (CBC) – to check for leukocytosis
3. C-reactive protein (CRP) – to assess inflammation
4. Rapid antigen detection test (RADT) for Streptococcus
5. Monospot test (if EBV is suspected)
Treatment:
1. Antibiotics: Penicillin or amoxicillin for bacterial tonsillitis
2. Analgesics: Paracetamol or ibuprofen for pain and fever
3. Gargles: Warm saline gargles for symptomatic relief
4. Hydration: Encourage increased fluid intake
5. Rest: Advise adequate rest to support recovery
6. Tonsillectomy: Consider if the patient has recurrent episodes (>7 episodes per year)
7. Corticosteroids: Dexamethasone in severe inflammation
Complications:
1. Peritonsillar abscess (Quinsy)
2. Rheumatic fever
3. Post-streptococcal glomerulonephritis
4. Otitis media
5. Airway obstruction
6. Scarlet fever
7. Sepsis
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19. A 3-year-old boy named Moses is brought to the pediatric clinic by his mother. She reports that Moses has been irritable and crying for the past two days, especially at night. He has had a runny nose and mild cough for the past week. This morning, Moses started tugging at his right ear and developed a fever. His mother is concerned because he has not been eating well and seems to be in pain. On Physical Examination: Temperature: 38.3°C (100.9°F), Pulse: 115 beats per minute, Respiratory rate: 24 breaths per minute, Tympanic membrane (right ear): Red, bulging, and immobile, Tympanic membrane (left ear) is Normal; Nasal congestion and postnasal drip noted. Manage this child on the following hints; provisional diagnosis, causative agents, investigations, treatment, and complications.
Provisional Diagnosis:
Acute Otitis Media (AOM)
Causative Agents:
1. Streptococcus pneumoniae
2. Haemophilus influenzae
3. Moraxella catarrhalis
4. Staphylococcus aureus
5. Respiratory viruses (RSV, influenza virus)
Investigations:
1. Otoscopic examination – to check for a bulging tympanic membrane
2. Tympanometry – to assess middle ear pressure
3. Complete blood count (CBC) – to check for leukocytosis
4. Culture of ear discharge (if present)
5. C-reactive protein (CRP) – to assess inflammation
Treatment:
1. Antibiotics: Amoxicillin-clavulanate for bacterial infections
2. Analgesics: Paracetamol or ibuprofen for pain relief
3. Nasal decongestants: Saline nasal drops to reduce congestion
4. Warm compress: To help with ear pain
5. Hydration: Encourage adequate fluid intake
6. Observation: Mild cases can resolve without antibiotics
7. Myringotomy: For recurrent or severe cases with effusion
Complications:
1. Tympanic membrane perforation
2. Mastoiditis
3. Conductive hearing loss
4. Chronic otitis media
5. Meningitis
6. Brain abscess
7. Facial nerve palsy
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Tunaendelea na maswali mengine ya GUIDED ESSAY QUESTIONS. Endelea kunipa ruhusa.
Sasa tunaendelea na maswali mengine ya GUIDED ESSAY QUESTIONS.
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20. Abdul is a 1-year-old boy who was brought to the health centre with a complaint of abdominal discomfort, passing loose stool for 2 days. His mother reported the stool to be watery in nature. He had 5 motions/day. There is no history of discomfort during micturition. On examination, the child is irritable with sunken eyes, skin turgor (pinch) goes back slowly. Vital signs: T = 37.3°C, RR = 24 b/min, PR = 98 b/min. His body weight is 15Kg. Describe the management of this child in terms of provisional diagnosis, investigations, treatment, preventive measures, and complications.
Provisional Diagnosis:
Acute Gastroenteritis with Moderate Dehydration
Investigations:
1. Stool microscopy, culture, and sensitivity – to check for bacterial or parasitic infection
2. Stool for ova and cysts – to rule out parasitic causes
3. Complete blood count (CBC) – to check for infection and dehydration status
4. Serum electrolytes – to assess sodium and potassium levels
5. Blood glucose – to check for hypoglycemia
6. Rapid diagnostic test (RDT) for malaria – if fever is present
Treatment:
1. Oral Rehydration Therapy (ORT): Give ORS to correct dehydration
2. Zinc Supplementation: 20 mg per day for 10–14 days to reduce diarrhoea severity
3. Antibiotics (if bacterial infection is suspected): Ciprofloxacin or Metronidazole
4. Antipyretics (if fever is present): Paracetamol
5. Nutritional Support: Continue breastfeeding and soft, easy-to-digest foods
6. Intravenous Fluids: If severe dehydration develops, give IV Ringer’s lactate
7. Probiotics: To restore normal gut flora
Preventive Measures:
1. Encourage exclusive breastfeeding for the first 6 months
2. Promote hand hygiene with soap and clean water
3. Improve access to clean drinking water
4. Proper disposal of faecal matter
5. Vaccination against rotavirus
6. Educate caregivers on food safety
7. Reduce exposure to contaminated environments
Complications:
1. Severe dehydration and shock
2. Electrolyte imbalances (hypokalemia, hyponatremia)
3. Malnutrition due to prolonged diarrhoea
4. Secondary bacterial infections
5. Renal failure due to severe dehydration
6. Hypoglycemia
7. Death if untreated
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21. A 4-year-old child was brought to the dispensary by his mother complaining that the baby is coughing for a long time now with excessive night sweats. He has used several antibiotics without any improvement. The cough is associated with fevers on and off for more than 2 weeks now. She recently noted that her child is not gaining weight. On examination, the baby is wasted. How will you manage this patient?
Provisional Diagnosis:
Pulmonary Tuberculosis (TB)
Investigations:
1. Mantoux tuberculin skin test
2. Chest X-ray – to check for TB-related lung changes
3. Sputum GeneXpert – for rapid TB detection
4. Gastric aspirate for TB culture (if the child cannot produce sputum)
5. Complete blood count (CBC) – to check for anemia and infection
6. HIV test – due to TB-HIV co-infection risk
Treatment:
1. Anti-TB Therapy: Follow WHO TB treatment guidelines (Rifampicin, Isoniazid, Pyrazinamide, Ethambutol for 2 months, then Rifampicin + Isoniazid for 4 months)
2. Nutritional Support: Provide high-protein, high-calorie diet
3. Symptomatic Treatment: Paracetamol for fever and cough suppressants if necessary
4. Monitor Treatment Adherence: Monthly follow-ups to ensure compliance
5. Contact Tracing and Screening: Check close family members for TB
6. Bacillus Calmette-Guérin (BCG) Vaccine: If the child was not vaccinated
7. Adjunct Therapy: Vitamin D and iron supplements if needed
Complications:
1. Miliary tuberculosis (disseminated TB)
2. Tuberculous meningitis
3. Respiratory failure
4. Permanent lung damage (bronchiectasis)
5. Malnutrition and growth retardation
6. Spinal TB (Pott’s disease)
7. Death if untreated
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Tunaendelea na maswali mengine ya GUIDED ESSAY QUESTIONS. Endelea kunipa ruhusa.
Asante mjomba, tunaendelea na majibu ya GUIDED ESSAY QUESTIONS.
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22. A 27-day-old female was brought by her relatives to your health centre with a complaint of gradual onset of fever for 3 days associated with two episodes of vomiting and poor appetite. On examination, the patient was febrile, T = 39.5°C, and lethargic with no cyanosis, not jaundiced, no splenomegaly. But MRDT was tested and reacted positive. What is the management of the patient in this scenario?
Provisional Diagnosis:
Neonatal Malaria
Investigations:
1. Malaria Rapid Diagnostic Test (mRDT): Already positive
2. Peripheral Blood Smear: To confirm the presence of Plasmodium falciparum
3. Complete Blood Count (CBC): To check for anemia and leukocytosis
4. Serum Electrolytes and Blood Glucose: To rule out metabolic abnormalities
5. Lumbar Puncture (if meningitis is suspected): To check for sepsis-related complications
6. Blood Culture: To rule out neonatal sepsis
7. Urinalysis and Urine Culture: To rule out urinary tract infection
Treatment:
1. Antimalarial Therapy: IV Artesunate (preferred) or Quinine for severe malaria
2. Antipyretics: Paracetamol to control fever
3. IV Fluids: To maintain hydration and correct electrolyte imbalances
4. Blood Transfusion: If hemoglobin is critically low
5. Antibiotics (if sepsis is suspected): Ampicillin + Gentamicin until sepsis is ruled out
6. Oxygen Therapy: If respiratory distress is present
7. Nutritional Support: NG tube feeding if the baby is unable to feed
Complications:
1. Severe anemia
2. Cerebral malaria
3. Hypoglycemia
4. Acidosis
5. Multiple organ failure
6. Death if untreated
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23. A 5-year-old boy presents to the clinic with a high fever, chills, and headache. His parents mention that they recently returned from a trip to a malaria-endemic region. Discuss the steps a pediatrician should take to diagnose malaria, considering the differential diagnosis, the use of rapid diagnostic tests (RDTs) and microscopy, and the initial management plan. Additionally, outline the potential complications that could arise if the diagnosis is delayed and how they can be prevented.
Steps to Diagnose Malaria:
1. History Taking:
Travel history to malaria-endemic areas
Symptoms: Fever, chills, headache, vomiting
History of mosquito bites
2. Physical Examination:
Fever, pallor, hepatosplenomegaly
Signs of severe malaria (jaundice, altered consciousness, respiratory distress)
3. Laboratory Tests:
Malaria Rapid Diagnostic Test (mRDT): Quick and effective for initial diagnosis
Blood Smear (Microscopy): Gold standard for detecting malaria parasites and determining parasite load
Complete Blood Count (CBC): To check for anemia and leukopenia
Liver Function Tests (LFTs): To assess liver involvement
Serum Electrolytes and Glucose: To rule out hypoglycemia and acidosis
Differential Diagnosis:
1. Dengue fever
2. Typhoid fever
3. Bacterial meningitis
4. Viral hemorrhagic fevers
5. Sepsis
Initial Management Plan:
1. Antimalarial Therapy: Artemether-Lumefantrine (for uncomplicated malaria) or IV Artesunate (for severe malaria)
2. Antipyretics: Paracetamol to control fever
3. IV Fluids: To maintain hydration
4. Oxygen Therapy: If hypoxia is present
5. Blood Transfusion: If severe anemia is detected
6. Antibiotics: If bacterial co-infection is suspected
7. Monitoring: Check for signs of worsening disease (coma, seizures, respiratory distress)
Complications of Delayed Diagnosis:
1. Cerebral malaria
2. Severe anemia
3. Acute kidney injury
4. Hypoglycemia
5. Shock
6. Multi-organ failure
7. Death
Prevention Strategies:
1. Use of insecticide-treated mosquito nets
2. Indoor residual spraying
3. Prophylactic antimalarial drugs for travelers
4. Early diagnosis and treatment
5. Community education on malaria prevention
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24. Discuss the management of severe acute malnutrition (SAM).
1. Diagnosis of SAM:
Mid-upper arm circumference (MUAC) < 11.5 cm
Weight-for-height Z-score < -3 SD
Bilateral pitting edema (Kwashiorkor type)
2. Phases of Management:
A. Stabilization Phase (First 7 Days):
1. Treat Hypoglycemia: Give 10% dextrose or breastfeed
2. Manage Hypothermia: Keep warm with blankets and a warm environment
3. Treat Dehydration: Give ReSoMal (Rehydration Solution for Malnutrition) instead of standard ORS
4. Treat Infections: Empirical antibiotics (Ampicillin + Gentamicin)
5. Correct Electrolyte Imbalances: Avoid rapid IV fluids
6. Micronutrient Supplementation: Vitamin A, zinc, and folic acid
7. Nutritional Support: Start F-75 therapeutic milk
B. Transition Phase (Day 7–14):
1. Gradually Increase Energy Intake: Shift from F-75 to F-100
2. Encourage Breastfeeding: If applicable
3. Monitor Weight Gain: Normal gain is 5-10g/kg/day
C. Rehabilitation Phase (After Day 14):
1. Ready-to-Use Therapeutic Food (RUTF): Plumpy’Nut
2. Encourage Family Feeding Practices: Introduce diverse foods
3. Monitor for Relapse: Follow-up visits every 2 weeks
4. Treat Complications: Anemia, infections, metabolic disorders
3. Preventive Measures:
1. Exclusive breastfeeding for 6 months
2. Timely introduction of complementary foods
3. Vitamin A supplementation
4. Deworming every 6 months
5. Proper hygiene and sanitation
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Tunaendelea na swali la mwisho.
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25. Discuss the causes, risk factors, investigation, treatment, and complications of Tinea infections.
1. Causes of Tinea Infections:
Fungal Species:
1. Trichophyton spp.
2. Microsporum spp.
3. Epidermophyton spp.
2. Risk Factors:
1. Poor hygiene
2. Excessive sweating
3. Diabetes mellitus
4. Immunosuppression (HIV, steroids)
5. Sharing personal items (towels, combs)
6. Walking barefoot in public areas
3. Investigations:
1. Potassium Hydroxide (KOH) Test: Detects fungal elements
2. Fungal Culture: Confirms the species
3. Wood’s Lamp Examination: Identifies Microsporum species
4. Skin Biopsy: For atypical cases
4. Treatment:
1. Topical Antifungals: Clotrimazole, Terbinafine
2. Oral Antifungals: Griseofulvin, Itraconazole
3. Antihistamines: To reduce itching
4. Proper Hygiene: Wash affected areas daily
5. Avoid Moisture: Keep skin dry
5. Complications:
1. Secondary bacterial infections
2. Permanent skin discoloration
3. Scarring alopecia (Tinea capitis)
4. Chronic fungal infections
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Hii ni sehemu ya mwisho ya GUIDED ESSAY QUESTIONS. Umemaliza seti yote ya maswali! Kama unahitaji maelezo zaidi kwenye sehemu yoyote, niambie.
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