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Icm: 1217: Clinical Methods And Senior Clerkship Question Paper
Icm: 1217: Clinical Methods And Senior Clerkship
Course:Diploma In Clinical Medicine
Institution: Jomo Kenyatta University Of Agriculture And Technology question papers
Exam Year:2012
JOMO KENYATTA UNIVERSITY OF AGRICULTURE AND TECHNOLOGY
UNIVERSITY EXAMINATIONS 2012/2013
SUPPLEMENTARY/SPECIAL EXAMINATION FOR THE DIPLOMA IN CLINICAL MEDICINE
ICM: 1217: CLINICAL METHODS AND SENIOR CLERKSHIP
DATE: AUGUST 2012 TIME: 2 HOURS
INSTRUCTIONS: ANSWER ALL THE QUESTIONS
PART A: ESSAYS (40%)
1. List the indications of phototherapy in the management of hyperbilirubinaemia (8MKS)
2. State five cardinal features of Congestive Cardiac Failure in children (8MKS)
3. Describe the portals of entry for causative agents implicated in meningitis in children (8MKS)
4. Outline classification of pneumonia based on IMCI guidelines (8MKS)
5. Describe five congenital malformations commonly found in the gastro-intestinal tract (8MKS)
PART 2: MULTIPLE CHOICE QUESTIONS (60%)
1. Indication that a vaccine has lost potency include
A. When a baby develops tuberculosis after BCG
B. When there is formation of sediments after reconstitution
C. When the monitor cards change colour
D. When vaccine vials are exposed for 5 minutes to room temperature
E. When a child develops paralysis after administration of oral polio vaccine
2. About vitamins
A. Retinol is mostly from animals
B. Vitamin A deficiency decreases the severity of measles
C. Children may present with rosary in Ricketts
D. Megaloblastic anaemia is a complication that results from folic acid deficiency
E. Anaemia is a complication that may result from deficiency of ascorbic acid
3. The following are presentations of Wilms’ Tumour (Nephroblastoma)
A. Low grade intermittent fever
B. Haematuria
C. Hypertension
D. Obesity
E. Abdominal mass
4. In a 10 year old boy with severe status asthmaticus the following drugs are of much help
A. Intraveous steroid
B. Parenteral antibiotics
C. Intravenous diazepam
D. Subcutaneously Epinehrine
E. Salbutamol through nebulization
5. Metabolic disorders causing coma in children include
A. Hypoglycaemia
B. Dehydration
C. Meningitis
D. Alcohol
E. Malaria
6.The following symptoms may suggest meningitis
A. Sudden change in behavior
B. Positive Kernig’s sign
C. Neck pain
D. Headache
E. Fever
7.The following are true about management of neonatal hyperbilirubinaemia
A. Phenobarbitone may be used
B. Anti-D serum should not be to Rhesus –ve mothers if they get an abortion
C. Adequate caloric intake is important
D. Phototherapy is mandatory for all cases
E. Exchange transfusion may be necessary
8.Congenital acyanotic heart diseases include
A. Transposition of great vessels
B. Vetricual Septal defects
C. Tricuspid Atresia
D. Patent ductus Arteriosus
E. Infective Endocarditis
9.The following factors can predispose to cerebral palsy
A. Intracranial haemorrhage
B. Prematurity
C. Meningitis
D. Birth asphyxia
E. Intrauterine growth retardation
10. In a child presenting with acute epileptic attack
A. Violent muscular activity should not be restrained
B. Metabolic disorders and intoxication must be excluded
C. Intravenous access is optional in status epilepticus
D. Long term treatment may be similar to that of complex convulsions
E. Phenobarbitone 10-20mg/kg in divided doses may be used
11.Concerning febrile convulsions:
A. It always follows some focus of infection
B. Fever is not necessary to make the diagnosis
C. It occurs before 6 months and after 6 years
D. There is always a history of head injury
E. Are caused by low blood sugar
12.About acute childhood diarrhoea
A. Antibiotics are always indicated in its treatment
B. Is mostly viral in original
C. Kaolin solution is recommended in its management
D. Is most common below the age of one year
E. Convulsions are common
13. The management of acute diarrhoea with no dehydration include
A. 75mls/kg of Oral Rehydration Solution over 4hrs
B. 10mls/kg of Oral Rehydration Solution after each bout of diarrhea
C. Zinc sulphate in children younger than 6 months
D. Sustained breast feeding and intake of other fluids
E. Intravenous fluids for all those with very frequent loose motions even if not severely dehydrated
14.The following are true of Infective Endocarditis
A. Never occurs in previously unhealthy heart
B. Commonly caused by a bacteria
C. Commonly caused by a virus
D. Prophylactic benzathine penicillin is necessary for prevention
E. Is associated with vegetation of the valves
15. The term Immunization refers to
A. Injection with toxin
B. The process of protecting a person from a specific disease
C. The process of immunity developing into infection
D. The process in which immunity occurs when a vaccine is given against a disease
E. The process in which the vaccine acts in place of a natural antibody
16. Infants of diabetic mothers have the following associated problems
A. Low birth weight
B. Respiratory distress syndrome
C. Large for gestational age
D. Neonatal jaundice
E. Anaemia
17. The following are relevant investigations performed on a child with meningitis:
A. Random blood sugar
B. Full haemogram
C. Cerebrospinal fluid microscopy
D. Cryptococcal antigen test
E. Blood cultures
18. The following vaccines can be given to symptomatic HIV +ve babies
A. Pentavalent
B. Measles
C. Yellow fever
D. Hepatitis B
E. Tetanus Toxoid
19.Major criteria in the Jones system for the Acute Rheumatic Fever include
A. Migratory Polyathritis
B. Carditis
C. Sydenhan’s chorea
D. Erythema nodosumm
E. Subcutaneous nodules
20. Monica is two years old, has had five episodes of admission since birth and usually presents with difficulty in breathing. Respiratory examination reveals a very dyspnoenic child. The following may be true of her condition
A. Tuberculsos is a differential diagnosis
B. She is an Infant of Diabetic mother
C. The condition may complicate to pulmonary hypertension
D. Ventricular septal defect is a likely diagnosis
E. Definitely she has a misdiagnosed pneumonia
21. Heavy proteinuria is indicative of
A. Protein energy malnutrition
B. Chronic renal failure
C. Nephrotic syndrome
D. Pyelonephritis
E. Juvenile Diabetes Mellitus
22. About circulatory changes in a newborn
A. Umbilical circulation ceases 48 hours after birth
B. Ductus venosus close shortly before birth
C. Right atrial pressure increases
D. Partial pressure of oxygen in the lungs decreases considerably
E. Foramen Ovale remain open for a few days after birth
23. Nancy is a three year old child brought to out patient department with a history of having passed more than ten motions of loose, mucoid and blood stained stools and having taken lots of plain water. What are the likely outcomes
A. May develop hypernatraemia
B. May develop hyponatraemia
C. May develop hypokalaemia
D. Gardia lambilia is a likely causative organism
E. Trophozoites of Entamoeba hystolitica are likely to be found on stool examination
24. The following are clinical prognostic indicators in perinatal asphyxia
A. Low APGAR score
B. Severity of neurological syndrome
C. Additional organ complications
D. Poor socioeconomic status
E. Birthweight of baby
25. The following are established risk factors for neonatal sepsis
A. Low birth weight
B. Prolonged rupture of membranes
C. Presence of neural tube defects
D. Omphalitis
E. Low socioeconomic status
26. In the Immunization of the HIV positive child
A. Routinely given all appropriate vaccines according to the national EPI programme schedule
B. Only suspected cases should not be immunized
C. BCG should not be given in symptomatic cases
D. All live attenuated cases are contraindicated in symptomatic cases
E. Yellow fever vaccine is absolutely contraindicated regardless of status
27. About Tetralogy of Fallot (TOF)
A. Paroxysmal hypercynotic attacks are common on exertion
B. Cyanosis is present at birth
C. Bacterial Endocarditis may be a complication
D. Systolic thrills may be felt along the left sternal border
E. Knee chest position relieves cyanotic spells
28. Post-term babies are likely to be have
A. Absence of lanugo hair
B. Long nails
C. Heavy vernix caseosa
D. Long lanugo hair
E. Peeling skin of the palms
29. The following are normal features in a newborn
A. Chest circumference greater than head circumference
B. Head circumference of 42 – 43 cm
C. Caput succedaneum
D. Haemorrhagic conjunctiva
E. Bilateral cephalohaematoma
30. Mucheri is a two year old boy who presents to Kianjai MCH clinic with conjunctivitis, coryza, cephalo-caudal macula-papular rash and a cough
A. Meningitis is a possible common sequel
B. Malnourished children rarely develop the condition
C. The disease is less severe in infants
D. Primary focus is respiratory epithelium
E. Otitis media is a rare association
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