MCQs in Paediatrics, 2Ed

Jagdish M. Gupta, John Beveridge

• Publisher: CRC Press
• Year: 2020
• Print ISBN: 9780367087104
• eBook ISBN: 9781000150162
• Edition: 2
• Topic: Education
• Subtopic: Education General

The questions used in this book have been developed and continuously updated over 15 years. 'MCQs in Paediatrics' includes questions and detailed answers submitted by paediatricians in all specialties, and covers the widest range of clinical skills and paediatric knowledge.The questions have been used in both undergraduate and postgraduate examinations at the DCH and MRCP level. All questions have been reviewed and refined following the analysis of examination results, and are designed to test the application of knowledge rather than just the facts. The answers are accompanied by detailed explanations which allow the book to be used both for self-assessment and as a guide for further study.

1 Growth and development

• 1.1. A head circumference measurement falling on the 10th percentile for a given age indicates that
  1. ten percent of normal children of the same age would have the same measurement.
  2. the patient's head circumference is 10% below the mean value for the age.
  3. the patient's head circumference is 10% above the lower limit of the normal range.
  4. ten per cent of normal children of the same age would have a head circumference greater than that of the patient in question.
  5. ten per cent of normal children of the same age would have the same or smaller head circumference.
• 1.2. In regard to growth during gestation
  1. babies born at 38 weeks' gestation weigh more at birth on average than those born after 42 weeks' gestation.
  2. size at birth correlates better with maternal stature than paternal stature.
  3. hormonal influences on growth are independent of fetal sex.
  4. the peak increase in fetal weight occurs during the third trimester.
  5. twins achieve their maximum weight velocity by 32 weeks' gestation.
• 1.3. Which of the following statements is/are correct?
  1. Babies are able to respond to sounds in utero.
  2. Full-term babies are unable to follow a large object at birth with their eyes.
  3. A 6-week-old infant would be able to follow a large object through an arc of 135°.
  4. Growth velocity of the head decreases with age.
  5. A 12-month-old infant who keeps falling when starting to walk is likely to have cerebral palsy.

1.1. E

When quantitative measurements are arranged in order of ascending magnitude, the percentile points refer to values falling on or below that centile.

1.2. A B C D E

After 40 weeks' gestation the placenta develops infarcts and is unable to maintain adequate nutrition of the infant. Epidemiological studies have shown that size at birth correlates better with maternal than paternal stature. There is very little production of testosterone in fetal life and therefore it has no effect on fetal growth. During the last trimester of pregnancy the fetus gains in weight because of deposition of fat. It has been shown that weight velocity decreases after the 'litter' has achieved a certain weight, which is at 32 weeks' gestation for twins.

1.3. A C D

Babies respond to sound in utero as demonstrated by changes in heart rate. At birth full-term babies will follow a human face or a large red ball with their eyes. A 6-week-old infant will follow a large object through an arc of 180°. Head growth is maximum in the first year of life and decreases progressively thereafter. Infants tend to keep falling when learning to walk.

• 1.4. Compared with the body proportions of a 5-year-old child, the newborn infant has
  1. a larger head.
  2. a larger liver.
  3. shorter extremities.
  4. a larger mandible.
  5. smaller tonsils.
• 1.5. Which of the following may be normal?
  1. A one-week old baby whose weight is the same as at birth.
  2. The anterior fontanelle which is larger in size at 2 months than at birth.
  3. An 11-month-old infant who has no teeth.
  4. An 18-month-old well baby who is not eating.
  5. A 4-year-old boy who is frequently touching his penis.
• 1.6. Compared with older children, full-term infants at 1 month have
  1. a higher risk of Gram-negative infections.
  2. a smaller risk of iron deficiency anaemia.
  3. higher fluid requirements per kilogram of body weight.
  4. a smaller surface area per kilogram of body weight.
  5. a larger head size compared with body length
• 1.7. A normal 4-week-old infant
  1. is in danger of suffocation if nursed prone.
  2. has a Moro reflex.
  3. needs 20 hours of sleep in a day.
  4. can distinguish his mother from other people.
  5. will follow a large object to the midline.
• 1.8. A 6-week-old infant
  1. will roll over.
  2. puts out his arms to be picked up.
  3. is able to turn his head towards a loud noise.
  4. will regard the human face.
  5. holds his head up momentarily in the prone position.

1.4. A B C E

Compared with the body proportions of a 5-year-old child, the newborn infant has a larger head, larger liver and shorter extremities. The mandible has the same proportions, though it is smaller than in a pubescent child. Lymphoid tissue (including tonsils) grows from birth to puberty and then involutes.

1.5. A B C D E

Most infants lose weight after birth and reach their birth weight by the end of the first week. At birth the anterior fontanelle may appear small as a result of over-riding of sutures. Eruption of teeth is very variable and is not by itself an indication of abnormality. In the second year of life the baby eats poorly because of other distractions. It is also the period when growth decelerates and causes anxiety to parents. Masturbation in young children is normal behaviour.

1.6. A B C E

Compared with older children, infants at 1 month have a higher risk of Gramnegative infections because they have no maternal or acquired immunity against these organisms. They are at no risk of iron deficiency anaemia (unless there has been bleeding) because of iron stores derived from the mother and have higher fluid requirements per kilogram of body weight because of their higher metabolic rate. Their surface area per kilogram of body weight is greater and their head is larger compared with their body length.

1.7. B E

Although there is an increased incidence of sudden infant death syndrome in the prone position, a 4-week-old infant is at no risk of suffocation as the infant will be able to lift its head and turn to the side. The Moro reflex is easily elicited. Infants vary widely in the amount of sleep they require. The infant is attracted by the human face (this may be a diagram on cardboard) but does not distinguish between different people. Full term infants can follow large objects with their eyes at birth.

1.8. D E

A 6-week-old infant will follow a human face, but not a small light, through an arc of 180°, will not put out his arms to be picked up until the age of 5 months and is unable to turn his head towards a loud noise, though he may show evidence of hearing. In the prone position the infant can hold his head up momentarily but cannot roll over.

• 1.9. By the age of 4 months most infants
  1. can roll over.
  2. have conjugate eye movements.
  3. reach out and grab objects.
  4. sit with support,
  5. have two incisor teeth.
• 1.10. Which of the following developmental attainments is/are appropriate for a full-term infant at the age of 6 months?
  1. Sits but needs to be propped.
  2. Reaches with a strong hand preference.
  3. Fixes but does not follow a moving face.
  4. When placed prone on a table lifts his head and supports the upper trunk on extended arms.
  5. Has a brisk, symmetrical Moro response.
• 1.11. In which of the following conditions are infantile body proportions seen in a 5-year-old child?
  1. Malnutrition.
  2. Osteogenesis imperfecta.
  3. Untreated congenital hypothyroidism.
  4. Achondroplasia.
  5. Down syndrome.
• 1.12. A 30-week (7-month)-old infant would be expected to
  1. transfer an object from one hand to the other.
  2. be toilet trained.
  3. clap hands in imitation.
  4. be distressed by the approach of strangers.
  5. be able to sit up.
• 1.13. Which of the following skills would be expected of a 7-month-old infant but not a 5-month-old infant?
  1. Crawls.
  2. Smiles socially.
  3. Controls his bowel and bladder.
  4. Sits unsupported.
  5. Raises his head while prone.

1.9. A B C

By the age of 4 months most infants can roll over, have conjugate eye movements and can reach out and grab small objects. They do not sit with support until the age of 5 months and do not have incisor teeth until the age of 5-7 months.

1.10. A D

A normal full-term 6-month-old infant is able to sit with support and lift his head when prone, and support the upper trunk on extended arms. He shows no hand preference. The Moro reflex disappears by the age of 5 months. Most children will be able to fix and follow a moving face by the age of 6 weeks.

1.11. B C D

In achondroplasia and congenital hypothyroidism there is abnormality of the epiphyseal centres which results in diminution of linear growth of long bones. As a result the infantile body proportions (crown pubis/crown heel: 1.7/1) are maintained. In malnutrition there is delay in growth of ossification centres but there is no disturbance of epiphyseal growth. In Down syndrome the body proportions are normal. In osteogenesis imperfecta there may be shortening of limbs because of fractures.

1.12. A E

A 7-month-old infant is able to transfer an object from one hand to the other and is able to sit up. Toilet training is variable but is seldom achieved below the age of 2 years. Infants clap hands at the age of 8-9 months and are not distressed by the approach of strangers until the age of 7-8 months.

1.13. D

Both 5- and 7-month-old infants will smile and raise their head while prone, but will not crawl or be able to control their bowel and bladder. The 7-month-old would be able to sit unsupported whereas the 5-month-old would not.

• 1.14. Inability to do which of the following would be of concern in a baby of 9 months?
  1. Sit unaided.
  2. Use words with meaning.
  3. Use pincer grip.
  4. Put food in the mouth.
  5. Change objects from one hand to the other.
• 1.15. Which of the following developmental attainments is/are appropriate for a child of 10 months?
  1. Has good finger-thumb apposition with the left hand but uses a mild palmar grasp on the right.
  2. Crawls symmetrically by dragging his extended legs behind, using his forearms.
  3. Has a symmetrical forward parachute reaction.
  4. Responds to noise but cannot localize the source.
  5. Is mobile by shuffling along on his bottom in a sitting position.
• 1.16. Which of the following is/are true?
  1. A 4-month-old infant is unlikely to produce vocal sounds other than crying.
  2. An 8-month-old infant can hold his head steady in the sitting position.
  3. A 6-month-old infant can be toilet-trained.
  4. It is normal for a 9-month-old child to have no aversion to play in his urine or stool.
  5. A 1-year-old child would be expected to give up a toy on req...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Contents
• List of contributors
• Preface to the first edition
• Preface to the second edition
• 1 Growth and development
• 2 Nutrition
• 3 Genetics and metabolic disorders
• 4 Fetal and neonatal medicine
• 5 Infection and immunology
• 6 Gastrointestinal system
• 7 Respiratory system
• 8 Cardiovascular system
• 9 Haematology and oncology
• 10 Nephrology, including fluid and electrolytes
• 11 Endocrinology and gonads
• 12 Neurology and neurosurgery
• 13 Psychiatry and social medicine
• 14 Orthopaedics and musculoskeletal system
• 15 Drugs, accidents and poisoning