WRITTEN QUIZ BCAD GEN11US (PAEDIATRICS) WEEK 4

A. MCQ

1.       Nephrotic syndrome is characterized by :

a) oedema and heavy proteinuria

b) hyperlipidaemia and hypoproteinaemia

c) increased susceptibility to infection

d) all of the above

2.       Acute glomerulonephritis may be present with :

a) hypertensive encephalopathy

b) elevated serum-cholesterol level

c) increased sweat chlorides

d) glucosuria

3.       The presence of RBC casts indicates that the origin of haematuria is :

a) the glomeruli

b) the urinary bladder

c) the renal pelvis

d) the ureters

4.       Proteinuria is usually found in all of the following, except :

a) acute glomerulonephritis

b) nephrotic syndrome

c) protein-losing enteropathy

d) congenital nephrosis

B. Short questions :

1.       What are the clinical elements of the nephritic syndrome?

®     Haematuria

®     Oedema (mild)

®     Hypertension

®     Oliguria

®     Azotemia (increased BUN and serum creatinine level)

®     Renal insufficiency

2.       Indications of renal biopsy in nephrotic syndrome?

®     Age  <1 year or >7 years at first presentation

®     Gross haematuria or persistent hypertension

®     Persistent elevation in BUN and creatinine

®     Children with family history of renal disease

®     Children with systemic manifestations  e.g :skin rash

®     No response to steroid treatment after 6-8 weeks

WRITTEN QUIZ BCAD GEN11US (PAEDIATRICS) WEEK 3

A. Fill in the blanks:

1.       Typically, Wilson disease is not clinically manifested before 3 to 5 years of age.

2.       2 commonest causes of neonatal cholestasis are idiopathic hepatitis and biliary atresia.

3.       Anti HBs is the only marker present in Hepatitis B-immunised person.

4.       Umbilical sepsis is the most common cause of pre-hepatic portal hypertension in infants.

5.       Early manifestation of post sinusoidal portal hypertension is ascites.

B. Matching:

Marker	Interpretation
1.       Anti-HBc IgM ( C )	A – Post vaccination
2.       Anti-HBs ( A )	B – High infectivity
3.       Anti-HBc IgG ( D  )	C – Recent infection
4.       HBsAg (  E  )	D – Past infection
5.       HBeAg (  B  )	E – Acute and chronic infection

C. Enumerate:

1. Enumerate intrahepatic causes of portal hypertension.

·         Congenital hepatic fibrosis

·         Bilharziasis

·         Cirrhosis (chronic hepatitis/Wilson disease)

·         Alpha -1- antitrypsin deficiency

·         Biliary atresia

·         Cystic fibrosis

·         Sclerosing cholangitis

2. Complications of chronic hepatitis.

·         Cirrhosis

·         Hepatocellular carcinoma

·         Portal hypertension, varices, ascites

·         Liver failure

·         Hepatic encephalopathy

3. Enumerate clinical manifestations of post-hepatic hypertension.

·         Ascites

·         Jaundice

·         Hepatosplenomegaly

WRITTEN QUIZ BCAD GEN11US (PAEDIATRICS) WEEK 2

A. Choose one of the following answers.

1) Splenectomy is indicated in:

a)      Thalassaemic patients with hypersplenism

b)      Iron deficiency anaemia

c)       Sickle cell anaemia

d)      Haemophilia

2) Bone marrow aspiration is of no diagnostic value in:

a)      Haemophilia A

b)      Thrombocytopenic purpura

c)       Acute lymphoblastic leukaemia

d)      Aplastic anaemia

3) Hazards of blood transfusion include all of the followings, except:

a)      Haemosiderosis

b)      Circulatory failure

c)       Cytomegalovirus infection

d)      Hypokalaemia

B. Enumerate:

1) Causes of iron deficiency anaemia

®     Inadequate of iron stores at birth

®     Deficient dietary intake

®     Impaired absorption of iron

®     Excessive demands for iron (blood loss)

2) The crises in sickle cell anaemia

®     Vaso-occlusive (painful) crisis

®     Aplastic crisis

®     Hyperhaemolytic crisis

®     Sequestration crisis

3) Differential diagnosis of hypochromic microcytic anaemia

®     Iron deficiency anaemia

®     Thalassaemia major

®     Anaemia of chronic infection

®     Lead poisoning

WRITTEN QUIZ BCAD GEN11US (PAEDIATRICS) WEEK 1

A. Give TRUE or FALSE for the following statements.

1.       Weight is doubled at 4 months and tripled at 12 months. TRUE

2.       Height is doubled at 4 years and tripled at 15 years. FALSE

3.       Lactose is the main carbohydrate in human milk. TRUE

4.       Secretion of breast milk depends on prolactin, oxytoxin and thyroxin hormones. TRUE

5.       Loss of subcutaneous fat of the thigh and buttocks in first degree of marasmus. FALSE

6.       Oedema in kwashiorkor usually starts on the dorsa of hands and feet. TRUE

7.       Low serum alkaline phosphatase with normal serum calcium can be detected in rickets. FALSE

8.       Cholera is one of the examples of entero-toxigenic diarrhoea. TRUE

9.       The cells increase in size and become swollen in hypertonic dehydration. FALSE

10.   Shock and metabolic alkalosis are possible complications of severe cases of diarrhoea. FALSE

B. Cross match the statements in the two columns.

Dentition (primary teeth)

1.Central incisors (  c  )	a) 18 months
2.Lateral incisors (  e  )	b) 24 months
3.Canines (  a  )	c) 6 months
4.First molars (  d  )	d) 12 months
5.Second molars (  b  )	e) 9 months

C. Enumerate:

1. Protective mechanisms in breast milk:

·         Oligosaccharides (favours the growth of Lactobacillus bifidus)

·         Immunoglobulins (act as antibodies, IgA)

·         Lysozyme (attacks the cell wall of bacteria)

·         Lactoferrin (enhances bioavailability of iron from human milk)

·         Macrophages, PMNs and Lymphocytes (microbial phagocytosis)

·         Intestinal growth factor (stimulate replacement of damaged cell in intestinal tract)

2. Clinical manifestations of rickets:

·         Box shaped-head (caput quadratum)

·         Rosary bead-chest

·         Harrison sulcus

·         Pigeon chest

·         Scoliosis, dorsolumbar kyphosis (sitting) & lumbar loidosis (standing)

·         Broad ends of long bones at wrists & ankles

·         Marfan’s sign

·         Bow leg pattern (genu varum) & knock knee appearance (genu valgum)

·         Delayed motor development

·         Abdominal distention

·         Visceroptosis

·         Hypocalcaemic tetany

~ GOOD LUCK ~

WEEKLY QUIZ #8

WEEKLY QUIZ

RETINA

MCQs

1)      Central retinal artery occlusion is characterized by except :

(A)   Gradual loss of vision

(B)   Retinal arteries are thread-like

(C)   Pupil is dilated

(D)   Cherry red spot at the macular area

2)      Causes of secondary retinal detachment are except :

(A)   Exudative choroiditis

(B)   Retinitis proliferans

(C)   Vitreous haemorrhage

(D)   Subchoroidal haemorrhage

3)      The following regarding retinal hemorrhages are true except :

(A)   Causing black red reflex

(B)   Superficial flame shaped haemorrhage

(C)   Deep round haemorrhage

(D)   Superficial in nerve fiber layer or deep in deep retinal layer

4)      The presence of a central scotoma in highly myopic patient may be due to :

(A)   Posterior staphyloma

(B)   Myopic crescent

(C)   Fuch’s spot

(D)   Peripheral myopic degeneration

5)      Night blindness is caused by :

(A)   Central retinal vein occlusion

(B)   Dystrophies of retinal rods

(C)   Dystrophies of retinal cones

(D)   Retinal detachment

6)      In non-inflammatory central retinal vein occlusion, the following medication is not given

(A)   Anticoagulants

(B)   Acetyl-salicylic acid

(C)   Corticosteroids

(D)   Hypolipidemic agents

7)      The presence of cotton wool patches denotes the following except :

(A)   Retinal ischemia

(B)   Infarction of the nerve fiber layer

(C)   Active exudation from a retinal microaneurysm

(D)   Proliferative diabetic retinopathy

8)      The commonest cause of vitreous haemorrhage is :

(A)   Central retinal artery occlusion

(B)   Central retinal vein occlusion

(C)   Retinal breaks

(D)   Diabetic retinopathy

9)      A patient of old standing diabetes mellitus noticed sudden muscae volitantes. On examination, the red reflex was dim, with no details of fundus could be seen. He might have :

(A)   Non-proliferative diabetic retinopathy

(B)   Cystoid macular edema

(C)   Exudative maculopathy

(D)   Vitreous haemorrhage

10)   A patient in the recovery of an open-heart surgery complained of sudden painless loss of vision of one eye. On fundus examination, the expected finding is :

(A)   Dilated engorged central retinal vein

(B)   Cherry red spot

(C)   Optic disc edema

(D)   Wide spread retinal hemorrhage

WEEKLY QUIZ #7

WEEKLY QUIZ

CATARACT

MCQs

1)      Signs of immature cataract are except :

(A)   Diminution of vision

(B)   Rise of intraocular pressure

(C)   Iris shadow

(D)   Partial lens opacity seen by red reflex

2)      Subluxated lens is characterized by except :

(A)   Iridodonesia can be seen

(B)   Shallow anterior chamber

(C)   Occurs in hypermature cataract

(D)   May be due to blunt trauma

3)      Complicated cataract may result from the following ocular diseases except :

(A)   High myopia

(B)   Anterior uveitis

(C)   Acute congestive glaucoma

(D)   Paralytic squint

4)      Phacoemulsification of cataractous lens is indicated in the following conditions except :

(A)   Mature senile cortical cataract

(B)   Immature senile cortical cataract

(C)   Early nuclear cataract

(D)   Congenital cataract

5)      48 hours after a cataract extraction operation, a patient complained of ocular pain and visual loss. On examination, this eye looked red with ciliary injection, corneal edema and absent red reflex. The first suspicion must be :

(A)   Secondary glaucoma

(B)   Anterior uveitis

(C)   Bacterial endophthalmitis

(D)   Acute conjunctivitis

CASE

A 66-years old insulin dependent diabetic patient presents with bilateral gradual deterioration of vision of one year duration. On ocular examination, vision in the right eye is hand motion (HM) and in the left eye is PL and there is bilateral mature cataract. The fundus of both eye is not seen.

1)      Before taking the decision of surgery, the following test is of value :

(A)   Fluorescein angiography

(B)   Ultrasonography

(C)   Visual field testing

(D)   Gonioscopy

2)      Following investigation, it was decided to perform cataract extraction in the right eye only. The operation of choice is :

(A)   ECCE with posterior IOL implantation

(B)   ECCE with no IOL

(C)   ICCE with anterior chamber IOL

(D)   ICCE with no IOL

3)      After the extraction of his cataract, the patient’s vision improved to 6/36 only. The probable lesion seen in the fundus in this case that could not be diagnosed prior to surgery would be :

(A)   Macular affection by exudates

(B)   Dense vitreous haemorrhage

(C)   Massive tractional retinal detachment

(D)   Central retinal artery occlusion

4)      The probable contraindication to surgery in the left eye was probably :

(A)   Massive tractional retinal detachment

(B)   Optic neuritis

(C)   Massive vitreous haemorrhage

(D)   Macular exudates

WEEKLY QUIZ #6

Ophthalmology

MCQ

      1.       Rolling in of lower lid occur in

a.       Scarring of id

b.      Ophthalmoplegia

c.       Facial palsy

d.      Trachoma

      2.       Patient with sudden onset of 7^th nerve palsy that affected all muscles. The first line of treatment is

a.       Ocular lubrication

b.      Immediate lateral tarsorraphy

c.       Immediate resection of lower lid

d.      V-Y operation

      3.       Complication of congenital ptosis include te following except :

a.       Amblyopia

b.      Ocular torticollis

c.       Lumbar lordosis

d.      Complicated cataract

      4.       A female patient 16 years old was complaining of presence of scales on her lashes. On examination the skin of the face was greasy. She had dandruff on te eye brows. The patient is suffering from :

a.       Meibomianitis

b.      Angular blepharitis

c.       Contact dermatitis

d.      Seborrheic blepharitis

       5.       Tarsal wedge resection operation is indicated in

a.       Pure trichiasis of upper eyelid

b.      Trichiasis and entropion of the upper eye lid

c.       Trichiasis and entropion of lower eye lid

d.      Pure trichiasis of lower eye lid

True/ False

      1.       Suppurative inflammation of Meibomian gland is called “Hordeolum internum’

       True

      2.       In Blascovic’s operation, t elevator muscle is shortened from skin side

       False

Essay

      1.       Definition and types of entropion

      Definition : Rolling inwards of eyelid margin towards the globe

  

      Types :

1.       Congenital – usually affect lower eyelid

2.       Senile - affects only lower lid, overriding of preseptal portion over pretarsal portion of orbicularis muscle

3.       Cicatricial (fibrotic) – fibrosis of palpebral conjunctiva

4.       Spastic – spasm of orbicularis muscle due to ocular irritation

      2.       Compare stye and chalazion

	Hordeolum externum (stye)	Hordeolum internum (Acute chalazion)
Site	At the lid margin related to the lash	In the tarsus deep to the orbicularis muscle
Inflammatory sign	Mild	Marked
Sweling	Related to the lash	A yellowish spot of pus is seen shining through the palpebral conjunctiva
Contraction of orbicularis	Not affected	Diminished
Treatment	Antibiotics Horizontal incision to evacuate the pus	Antibiotics Vertical conjunctival incision or a horizontal skin incision and evacuation of pus