Test 3 July 2018

1.
High pitched, expiratory sound from distal airway obstruction

a. Hoarseness
b. Wheeze
c. Stridor
d. Crackles
e. Bronchial breathing
2. A murmur radiating to the back occurs in
A. Aortic stenosis
B. Coarctation of the aorta
C. Pulmonary stenosis
D. A or B
E. B or C
3. Which of the following is unlikely to be a sign of asthma?
a. Use of accessory muscles
b. Fine crackles in all zones
c. Chest wall retraction
d. Reduced but hyperinfalted chest movement
e. Hyper resonant
4. Chest expansion in school-aged chidren
a. 6-8cm
b. 8-10cm
c. 1-2cm
d. 3-5cm
e. 10-12cm
5. The need to turn prone to rise or to push off the ground with straightened arms and then
climb up the legs (to rise) is known as
a. Kernig’s sign
b. Gower’s sign
c. Korsakoff’s sign
d. Raynauld’s sign
e. Babinski sign
6. What is the normal resting pulse for a child aged > 12 years old?
a. 80-120
b. 40-80
c. 95-140
d. 60-100
e. 110-160
7. Develops worries about the future. Approximate age?
a. 18-21 years
b. 12-18 years
c. 6-11 years
d. 2-5 years
8. Metastases from Wilms tumours are most commonly found in the
a. Liver
b. Bones
c. Lungs
d. Brain
e. Heart
9. A palpable murmur
a. Dextrocardia
b. Mediastinal bulge
c. Thrill
d. Precordial bulge
e. Heave
10. The commonest cause of acquired heart disease in children in the UK.
a. Kawasaki’s disease
b. Chickenpox
c. Lyme disease
d. Cat-scratch disease
e. Infectious mononucleosis
11. Indrawing of the chest wall from diaphragmatic tug
a. Harrison’s sulcus
b. Barrel chest
c. Pectus excavatum
d. Pectus carinatum
e. Mediastinal shift
12. Clubbing is associated with
a. Chronic suppurative lung disease
b. All of these
c. Cystic fibrosis
d. Inflammatory bowel disease
e. Cyanotic congenital heart disease
13. Generalised abdominal tenderness is more common in
a. Peritonitis
b. Pyelonephritis
c. Appendicitis
d. Hepatitis
e. All of these
14. Represents 7% of all childhood malignancies. Median age of
presentation 2 years. sites of involvement include adrenal glands (32%), abdomen (28%)
and thorax (15%).
A, Wilm’s tumour
b. Lymphadenoma
c. Neuroblastoma
d. Lymphoma
e. Intussusception
15. Children up to ___ will turn prone in order to stand because of poor pelvic muscle
fixation
a. 6 months
b. 2 years
c. 18 months
d. 3 years
e. 12 months
16. Which of the following is unlikely to be a sign of pneumonia
a. Crackles
b. Reduced chest movement in affected side
c. Rapid, shalow breathing
d. Hyper-resonant
17. Caused by the Epstein Barr virus and cytomegalovirus. The source is oropharyngeal
secretion. The virus infects B lymphocytes in pharyngeal lymphoid tissue and then spreads
to the rest of the lymphoid system.
a. Chickenpox
b. Infectious mononucleosis
c. Cat-scratch disease
d. Kawasaki’s disease
e. Lyme disease
18. Thought process: “I am asleep, so everyone else is asleep”. Approximate age?
a. 2-5 years
b. 12-18 years
c. 6-11 years
d. 18-21 years
19. What is the normal respiratory rate in a neonate?
a. 30-50
b. 50-60
c. 20-30
d. 12-15
e. 15-20
20. May reflect anxiety in the child or a pyramidal disorder
a. Brisk reflexes
b. Absent reflexes
c. Slow reflexes
21. A mobile, non tender, indentable abdominal mass is most likely to be (out of the options
given)...
a. Intussusception
b. Lymphoma
c. Wilm’s tumour
d. Faecal mass
e. Neuroblastoma
22. Proximal muscle weakness around the hip girdle can cause a
a. Waddling gait
b. Broad based gait
c. Heel-toe gait
d. Toe-heel gait
e. Narrow based gait
23. What is the normal resting pulse for an infant aged 2-5 year old?
a. 95-140
b. 110-160
c. 40-80
d. 60-100
e. 80-120
24. Causes a small bowel obstruction. The bowel becomes engorged, which causes rectal
bleeding, and eventualy gangrene. Following this, perforation and peritonitis will occur. The
most common site is ileocolic, followed by ilio-ileal.
a. Wilm’s tumour
b. Lymphoma
c. Faecal mass
d. Neuroblastoma
e. Intussusception
25. When measuring blood pressure in children, the cuff should cover...
a. at least half of the upper arm
b. At least half of the upper arm
c. At least two thirtds of the upper arm
d. The entire upper arm
26. Which of the following is NOT a typical feature of heart failure in infants
a. Bradycardia
b. Sweating
c. Cardiomegaly
d. Failure to thrive
e. Gallop rhythm
27. Increases positive end-expiratory pressure
a. Use of accessory muscles
b. Nasal flaring
c. Tracheal dragging
d. Intercostal recession
e. Expiratory grunting
28. Thought process: “I can handle things without mum’s help”. Approximate age?
a. 18-21 years
b. 2-5 years
c. 12-18 years
d. 6-11 years
29. What is the normal resting pulse for an child 5-12 year old?
a. 60-100
b. 110-160
c. 40-80
d. 80-120
e. 95-140
30. A palpable spleen in a child is
a. twice it’s normal size
b. 1.5 times it’s normal size
c. Normal
31. What is the resting pulse for an < 1 year old?
a. 80-120
b. 110-160
c. 60-100
d. 95-140
e. 40-80
32. The splitting of the second heart sound is frequently heard in children on
a. Inspiration
b. Expiration
33. Which of the following is unlikely to be a sign of bronchiolitis?
a. Chest recession
b. Hyperinflated chest
c. Dull to percussion
d. Fine crackles in all zones
e. Laboured breathing
34. May revel subtle asymmetries in gait - children are asked to walk on their heels, the
outside and then the inside of their feet.
a. Gower’s test
b. Kawasaki’s test
c. Kernig’s test
d. Korsakoff’s test
e. Fogg’s test
35. Often idiopathic, but may suggest pyramidal tract dysfunction, spinal pathology or
neuropathy
a. Toe-toe gait
b. Heel-toe gait
c. Heel-heel gait
d. Hell toe gait
e. Toe-heel gait
36. High pitched - lengths of inspiration and expiration are equal
a. Bronchial breathing
b. Stridor
c. Hoarseness
d. Crackles
e. Wheeze
37. What is the normal respiratory rate in older children?
a. 50-60
b. 20-30
c. 15-20
d. 12-15
e. 30-50
38. Variation of the pulse rate with respiration
a. Sinus tachycardia
b. Pulsus bisiferens
c. Pulsus paradoxus
d. Sinus arrhythmia
e. Log arrythmia
39. May be due to an immature gait or secondary to a cerebellar disorder
a. Broad based gait
b. Narrow based gait
c. Heel-heel gait
d. Heel-toe gait
e. Toe-heel gait
40. Thought process: “When I fell, the floor hurt me”. Approximate age?
a. 12-18 years
b. 6-11 years
c. 2-5 years
d. 18-21 years
41. Wilm’s tumour affects the
a. Kidneys
b. Brain
c. Bones
d. Heart
e. Liver
42. An infant’s liver is normally
a. Not palpable below the costal margin
b. 1-2cm above the costal margin
c. Just palpable below the costal margin
d. 2-4cm below the costal margin
e. 1-2cm below the costal margin
43. Fixed splitting of the second heart sound is heard in
a. Ventricular hypertrophy
b. Arial septal defects
c. Patent ductus arteriosus
d. Aortic regurgitation
e. Mitral stenosis
44. What is the normal respiratory rate in an infant
a. 20-30
b. 15-20
c. 30-50
d. 12-15
e. 50-60
45. Harsh, low pitched, mainly inspiratory sound from upper airways obstruction
a. Hoarseness
b. Wheeze
c. Crackles
d. Stridor
Key
1. B
2. E
3. B
4. D
5. B
6. D
7. D
8. C
9. C
10. A
11. A
12. B
13. A
14. C
15. D
16. D
17. B
18. A
19. A
20. C
21. D
22. A
23. A
24. E
25. C
26. A
27. E
28. C
29. D
30. A
31. B
32. A
33. C
34. E
35. E
36. A
37. C
38. D
39. A
40. C
41. A
42. E
43. B
44. A
45. D

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High pitched, expiratory sound from distal airway obstruction

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