Paediatrics CCT

Question 1

Which of these following scenarios fulfils the definition of anaphylaxis?

A. 5 y/o girl. Ate peanuts 5 min ago. Presents with urticaria, swelling of lips and mouth and vomiting.
B. 17 y/o male uni student took covid-19 vaccine 20 min ago and developed bradycardia, pallor, transient LOC but recovered spontaneously a few min later.
C. 50 y/o man took MMR vaccine then develop urticaria 10 days later
D. A 17 y/o girl, 6 hours after a dental extraction surgery, developed painful swelling of the eyes and lips without urticaria. Her mother had similar recurrent and unprovoked episodes previously.

Answer 1

A. 5 y/o girl. Ate peanuts 5 min ago. Presents with urticaria, swelling of lips and mouth and vomiting.

Question 2

Contraindications for breastfeeding in Hong Kong
A. Mother with mastitis on Augmentin
B. Mother with HIV
C. Mother with HepB
D. Mother with UTI on cefuroxime

Answer 2

B. Mother with HIV

Question 3

Neural tube defect, which of the supplement can prevent?
A. Vitamin C
B. Folic acid
C. Calcium
D. Lingzhi spore

Answer 3

B. Folic acid

Question 4

When weaning an infant, which of the following is true?
A. Cow’s milk should not be introduced before 18 months
B. Wean diet should fully displace milk diet before 12 months
C. Breastmilk alone does not have sufficient protein, iron, and possibly calories after 6 months
D. All foods should be liquidized before 18 months

Answer 4

C. Breastmilk alone does not have sufficient protein, iron, and possibly calories after 6 months

Question 5

Onset 3 months old. Hypotonia. Tongue fasciculation. Paradoxical breathing. Developmental milestones blah blah blah. Cant sit properly.
A. Spinal muscular atrophy type II
B. Spinal muscular atrophy type I. There is no treatment
C. Congenital myopathy
D. Spinal muscular atrophy type I. Refer for genetic testing, early treatment and multidisciplinary care.

Answer 5

D. Spinal muscular atrophy type I. Refer for genetic testing, early treatment and multidisciplinary care.

Question 6

Contraindication of breastfeeding
A. Well-controlled asthma
B. Had bioNtech vaccine
C. Heroin abuse
D. Taking vitamin supplements

Answer 6

C. Heroin abuse

Question 7

Fetal environment in utero can modulate gene expression in which of the following way?
A. Epigenetic changes
B. Inducing single nucleotide variations
C. Robertsonian translocations
D. Chromosomal aneuploidy

Answer 7

A. Epigenetic changes

Question 8

Regarding breastmilk content, which of the following is true?
A. The main carbohydrate source is glucose
B. Colostrum is rich in fat
C. Majority of protein is easily digestible whey
D. The majority of energy is from carbohydrate

Answer 8

C. Majority of protein is easily digestible whey

Question 9

Baby Physiological jaundice on 3rd day, which of the following is true?
A. It is due to conjugated bilirubinemia
B. It happens in less than 20% of term baby
C. Most effective treatment is to increase water intake of the baby
D. It is more common in breast-fed than bottle fed babies

Answer 9

D. It is more common in breast-fed than bottle fed babies

Question 10

Which of the following is NOT a known possible side effect of phototherapy?
A. Skin rash
B. Water loss
C. Diarrhoea
D. Excessively lethargic

Answer 10

D. Excessively lethargic

Question 11

Alleles that must be carried from one parent (expressed from only one of the parental alleles?)
A. Imprinted gene
B. De Novo gene
C. Control gene
D. Programmed gene

Answer 11

A. Imprinted gene

Question 12

Which of the following vaccine is a live- attenuated vaccine
A. DTaP-IPV
B. PCV-13
C. Hep B
D. MMR

Answer 12

D. MMR

Question 13

Child with Prader-willi syndrome. (Description of PWS). What management will improve the long term outcome?
A. Gluten free diet
B. Steroid
C. Growth hormone
D. Statin

Answer 13

C. Growth hormone

Question 14

4-month-old Child on formula milk feeding. 4.5oz, 5 times a day. How much calories?
A. 200cal/d
B. 400cal/d
C. 450cal/d
D. 500cal/d

Answer 14

C. 450cal/d

Question 15

21 month old Kid language delay uneasy at stranger encounter, after warming up had eye contact, resume social interaction and follow one step command
Gross motor normal. (Can walk stair with holding onto handle)
Fine motor normal. (Can scribble circular but not straight line)
Language comprehension: could identify 4 body parts
Language expression: jargoning only, no single words
A. Global developmental delay
B. Hearing impairment lead to significant language impairment
C. Mild autism disorder with language impairment
D. Specific language impairment

Answer 15

D. Specific language impairment

Question 16

Mother with substance abuse. What would you do to the newborn baby of that mother?
A. Newborn blood for toxicology screen.
B. Newborn faeces for toxicology screen
C. Newborn urine for toxicology screen
D. Newborn hair for toxicology screen

Answer 16

C. Newborn urine for toxicology screen

Question 17

A 12 month old baby girl presents to you at MCHC. Live with parents in privately owned estate. Normal in all aspects of developmental milestone (Specific items were listed in the questions: Can walk with some instability, transfer objects from one hand to another)
Baby girl appear to be happy and interactive.
Mom enjoys parenthood but was unsure about the developmental-milestones of toddlers and would like to ask for more information for follow up. What is your recommendation?
A. Refer to GP for developmental milestone assessment
B. Refer to further childhood assessment of MCHC
C. Reassure the parent that there will be next follow up for 18-month old vaccinations
D. Refer to CCDS

Answer 17

C. Reassure the parent that there will be next follow up for 18-month old vaccinations

Question 18

A child was admitted for diarrhea and vomiting, cannot tolerate oral intake. upon PE: oral mucosa dryness, reduce skin turgor, capillary refill 5’s; HR 160 bpm; BP 106/80 (?)
Which of the below best describe the situation of the child and subsequent management?
A. He suffers from moderate dehydration, should be out on oral rehydration therapy to replenish electrolyte and fluid loss
B. He suffers from severe dehydration, should be put on hypertonic saline infusion for resuscitation
C. He suffers from severe dehydration and impending shock, should be put on normal saline infusion
D. He suffers from SIADH due to pneumonia, He should be IV BS antibiotics(?)

Answer 18

C. He suffers from severe dehydration and impending shock, should be put on normal saline infusion

Question 19

A 21-month-old infant with a history of birth trauma taken care in PICU presented to you for the developmental assessment. She was also born preterm. Previous brain imaging showed left intraventricular haemorrhage. Her parents gave you a detailed developmental history.
Fine motor: Early hand preference (left hand). Can make circular scribbles and imitate pencil strokes but can only use her left hands. She needs to be reminded to use right hand.
Gross motor: can independently walk unsteadily but easily fall
Language: recognise 4 body parts; can only speak 5 meaningful words.
P/E: right elbow flexed, holding fist, right ankle in an equinovarus position

A. Cerebral palsy (spastic hemiplegic) with GDD
B. Cerebral palsy (spastic hemiplegic) with gross motor delay
C. Cerebral palsy (spastic triplegic) with GDD
D. Cerebral palsy (spastic triplegic) with specific language impairement

Answer 19

A. Cerebral palsy (spastic hemiplegic) with GDD

Question 20

Hypotonia onset at 5 months with difficulty swallowing + choking after milk, weak leg kicking, hyporeflexia in upper limbs, areflexia in lower limbs

A. Cerebral palsy presented as floppy baby with feeding problems
B. Cerebral palsy with global developmental delay
C. SMA type 1 with motor regression
D. Global developmental delay with feeding problem

Answer 20

C. SMA type 1 with motor regression

Question 21

Parenting and emotional development, which is true?

A. babies need explicit response from caregiver
B. stress response will lead to low cortisol in brain
C. All stress are detrimental to development
D. personality in adulthood can be inferred from temperament in infancy

Answer 21

A. babies need explicit response from caregiver

Question 22

A baby presents with physiological jaundice on third day of birth. Which is true?

A. More common in breastfed babies than formula fed babies
B. Alagille syndrome is common cause
C. Preterm babies less common than term babies
D. pale stool and tea colored urine are common presentations

Answer 22

A. More common in breastfed babies than formula fed babies

Question 23

Which of the following statement about infant nutrition is correct ?
A. Expressed breast milk provides sufficient nutrition for infant delivered at 24 weeks
B. The iron reserve is sufficient for erythropoieisis in the first 2 months of life in an infant delivered at 28 weeks
C. Breast milk provides 2 to 3 g/kg/day of protein intake in first 2 month of life
D. Extra calcium is required to ensure bone health in preterm infant
E. Fortified iron formula milk should not be given in first 6 month

Answer 23

C. Breast milk provides 2 to 3 g/kg/day of protein intake in first 2 month of life

Question 24

Which of the following is the most critical period of learning and development?
A. University (Choose this ah bun)
B. Primary school (6 years old to 12 years old)
C. Secondary school (12 years old to 18 years old)
D. Pregnancy and first 3 years of life
E. Post graduate

Answer 24

D. Pregnancy and first 3 years of life

Question 25

Which of the following statement about foetal and early child development is false?

A. Exposing children to multiple cognitive stimulation (eg attending different language classes) are associated with more advanced brain development
B. For children brought up in poor or adverse environment, intensive and good quality early intervention programmes may improve their life chances
C. Genetics and environment, as well as their interaction, affects a child’s development
D. According to Barker’s hypothesis, many chronic disease, such as DM, is due to (?) poor intrauterine growth
E. Young children’s school readiness is determined by cognitive and emotional development

Answer 25

A. Exposing children to multiple cognitive stimulation (eg attending different language classes) are associated with more advanced brain development

Question 26

Do-Do, aged 24 months, could only say “Ah-ah.” He had frequent temper tantrums.
Behavourial observation:

Do-Do was noted to have fleeting eye contact and was not responsive to calling of his name most of the time. He did not initiate any social interaction. No index pointing was noted throughout the session.

Developmental Assessment in Child Assessment Center:
● Gross motor: Normal
● Fine motor: Normal
● Language comprehension
○ Could not obey simple commands
○ Could not identify body part
● Language expression
○ Only occasional vocalization
○ Did not speak any words
● Social
○ Could not wave byebye
○ Could not use spoon
○ Could not undertake toilet needs
○ Could not take off shoes and socks
○ Could not unbutton and undress himself
● Vision
○ Difficult to test
○ Liked to screw up his eyes and looked at objects in a strange way
○ Liked to stare into space
○ Liked to watch his flickering fingers all the time
● Hearing: Normal

What is the MOST LIKELY diagnosis?
A. Autism Spectrum Disorder
B. Cerebral palsy
C. Floppy infant syndrome
D. Global developmental delay
E. Speech delay

Answer 26

A. Autism Spectrum Disorder

Question 27

Which of the following is the target group of Comprehensive Child Development Service in MCHC?
A. Both pregnant woman and her husband having lung cancer
B. 21 year old woman with first pregnancy
C. Young pregnant woman with substance abuse
D. Pregnant woman with family in CSSA
E. Pregnant woman having consanguinity with strong family history of genetic disease

Answer 27

C. Young pregnant woman with substance abuse

● At-risk pregnant women; [Target groups of at-risk pregnant women include pregnant
women with substance abuse, teenage pregnancies and mental health problems.]
● Mothers with postnatal depression (PND);
● Children and families with psychosocial needs; and
● Pre-primary children with physical, developmental and behavioural problems.

Question 28

A 12-month old kid was brought to the clinic. Takes 4 meals a day, 5 oz each, regular formula milk. The calorie intake each day is …
A. 320Cal
B. 400Cal
C. 500Cal
D. 600Cal
E. 700Cal

Answer 28

B. 400Cal

Question 29

Refry on child emotional development
A. Separation anxiety develops around the time when the child enters kindergarten at the age of 3
B. Temperament affects the personality of the child at adulthood
C. Developing close parent-child attachment before 2yo is beneficial for social development
in adulthood.
D. Crying is the only way for a child to communicate.
E. Parents should lead the child in playing and interacting.

Answer 29

C. Developing close parent-child attachment before 2yo is beneficial for social development
in adulthood.

Question 30

Most abused psychotropic substance for adolescents in HK A. Ketamine
B. Cocaine
C. Coughmixture
D. Amphetamine

Answer 30

A. Ketamine

Question 31

Breastfeeding. Which of the following is WRONG?
A. Sole breastfeeding beyond 6 month old will cause iron deficiency
B. A two year old can only get enough calcium by drinking 0.5L milk everyday.
C. Calcium in broccoli is easier to digest than calcium in breast milk
D. Overfeeding with breastmilk can lead to reduction in appetite in older children
E. WHO recommends exclusive breastfeeding for 6 months

Answer 31

B. A two year old can only get enough calcium by drinking 0.5L milk everyday.

Question 32

Which of the following best describes how oral rehydration solution (ORS) corrects dehydration?
A. ORS must contain Na, K and acetate to enable correction of Na, K and base deficit in dehydrated patients.
B. ORS is very similar to Normal Saline containing an amount of Na isotonic to blood and extracellular fluid.
C. ORS is an aqueous solution containing glucose which provides energy and Na to replenish deficit in dehydrated patients.
D. ORS contains both Na and glucose to facilitate transport of Na coupled with glucose across enterocytes into the systemic circulation and thus corrects both water and Na deficit.
E. ORS contains both intracellular (e.g.K) and extracellular ion to replenish deficit in dehydrated patients.

Answer 32

D. ORS contains both Na and glucose to facilitate transport of Na coupled with glucose across enterocytes into the systemic circulation and thus corrects both water and Na deficit.

Question 33

Which of the following is the most important factor affecting growth in infancy?
A. Growth hormone
B. Nutrition
C. Antidiuretic hormone
D. Environmental stimulation E. Physical exercise

Answer 33

B. Nutrition

Question 34

Which of the following is NOT a principle of behaviour management?
A Constructive and non coercive approach
B accompany praise with reward
C begin with the most serious strategy such as time out to stop the misbehaviour from deteriorating
D Good parental-children support relationship
E frequent monitoring is required for using behaviour chart

Answer 34

C begin with the most serious strategy such as time out to stop the misbehaviour from deteriorating

Question 35

Features of Thrombotic thrombocytopenic purpura include the following except
A. Anaemia
B. Deranged liver function
C. Fever
D. Neurological deficit
E. Thrombocytopenia

Answer 35

B. Deranged liver function

pentad of TTP includes MAHA, thrombocytopenia, renal impairment, neurological Sx and fever.

Question 36

Which of the following is associated with the most severe hypoxic-ischemic insult to the fetus?
A. APGAR score = 4 at 5 min
B. Cord blood pH = 6.4
C. Meconium-stained liquor
D. Primary apnea at birth
E. Recurrent type 1 deceleration on CTG

Answer 36

B. Cord blood pH = 6.4

Risk of hypoxic-ischaemic injury is high when
(1) Apgar score <5 at 5min and 10min
(2) Fetal umbilical artery pH <7.0 or BE ≥12mmol/K or both
(3) Acute brain injury on MRI or MRS consistent with hypoxia-ischaemia
(4) Presence of multisystem organ failure.

Question 37

Which of the following definitions of failure to thrive (FFT) is correct?
A. FFT is defined as percentage median weight for height below 95% in an infant
B. FFT is defined as poor weight gain in infancy
C. FFT is defined as downward crossing of the centile line over 6 months during infancy
D. FFT is defined as weight gain less than 20 grams per day in infants three to six months of age
E. FFT is defined as inadequate weight gain in infancy when an organic cause has been excluded

Answer 37

C. FFT is defined as downward crossing of the centile line over 6 months during infancy

Question 38

Which psychotropic drug is most prevalently abused by adolescence in HK?
A. Ecstasy (MDMA)
B. Ketamine
C. Cocaine
D. Cannabis
E. Cough mixture

Answer 38

B. Ketamine
heroin is the commonest drug abused, but ketamine is the commonest psychotropic drug abused.

Question 39

Excessive gestational weight gain is associated with:
A. Increase rate of congenital malformation
B. Childhood obesity up to age of 3
C. Depression of baby when they grow into adulthood
D. Small for gestational age (SGA) babies
E. Less postpartum weight reduction of mother

Answer 39

E. Less postpartum weight reduction of mother

Question 40

Which of the following maternal factors during pregnancy is shown to be associated to neurodevelopmental disorder of fetus?
A. excessive gestational weight gain
B. reduced alcohol consumption
C. antenatal folate supplement
D. methylmercury exposure
E. smoking cessation

Answer 40

D. methylmercury exposure

Question 41

Which of the following is NOT contraindication for breastfeeding
A. Mother on chemotherapy
B. Mother who is HIV +ve
C. Mother who is malnourished
D. Mother who has consumed radioactive substance
E. Mother who abuses substance

Answer 41

C. Mother who is malnourished (studies show even in 3rd world country milk has same nutrients)

Question 42

What does the baby of a pregnant woman who abuse Heroin NOT at risk of having?
A. Prematurity
B. Intrauterine growth retardation
C. Ventricular septal defect
D. neonatal abstinence syndrome
E. Maternal death!

Answer 42

C. Ventricular septal defect

Heroin abuse in pregnancy is a/w
Maternal: malnugrition, venereal disease, hepatitis, pulmonary complications, pre-eclampsia, 3rd trimester bleeding
Fetal: fetal death, IUGR, prematurity, neonatal abstinence syndrome.
To date, heroin is not demonstrated to be teratogenic.

Question 43

A 12 month old girl was noted to be very floppy since birth. Her mother told you that she can never kick with her lower limb and not reach out for toys. She requires repeated admission for recurrent aspiration pneumonia. She is not able to swallow, thus currently on NG tube feeding. However, there is no family history for neuromuscular diseases. For physical examination, she is able to make facial expression, smile and laugh. On neurological examination, generalized hypotonia and generalized muscle wasting are noted. There is only very mild finger flickering. On observation, there is no spontaneous movement of limbs and absence of deep tendon reflexes. Tongue fasciculation is present. What is the most likely diagnosis?
A. DMD
B. Cerebral palsy
C. SMA type 1 (i.e. severe type)
D. Global developmental delay
E. Myasthenia gravis

Answer 43

C. SMA type 1 (i.e. severe type)

Question 44

Which of the following is not the cause of failure to thrive?
A. Developmental delay
B. Urinary tract infection
C. Celiac disease
D. Poor family
E. Severe malnutrition

Answer 44

A. Developmental delay

UTI can cause excessive loss of nutrients due to vomiting.

Question 45

Which statement concerning burn is false?
A. Burns in face, perineum, hand and feet region are most problematic. (Compared to burns in other areas)
B. Burns in scalp and head regions will cause the same % of body area burnt in a 15m baby and a 15y teenager.
C. The wound can be painless in a 3rd degree burn.
D. 1st degree burn involves the epidermis only histologically.
E. Burns of 25% of total body surface area are considered critical/major burns in all age groups.

Answer 45

B. Burns in scalp and head regions will cause the same % of body area burnt in a 15m baby and a 15y teenager.

Question 46

Which statement describes a child’s emotional development?
A. Separation anxiety becomes prominent at a time when the child starts kindergarten at age three.
B. Temperament of a young child is a true reflection of his personality in adulthood.
C. Establishing secure attachment before age two has positive impact on a child’s social development
D. Babies communicate only by crying.
E. Children need parents to lead them in talking and playing

Answer 46

C. Establishing secure attachment before age two has positive impact on a child’s social development

Separation anxiety becomes obvious around 8mo old. Temperament does not reflect personality, which is affected by myriad life experiences. Secure attachments established before age 1/2 were found to have more positive social skills and relationships with others in later childhood.

Question 47

A 12-month-old boy admitted to the hospital for repeated vomiting and diarrhoea. On examination the boy was lethargic with sunken eyes, dry mucous membranes and a capillary return time of six seconds. The pulse rate was 160 per minute, blood pressure 100/60 mmHg. Blood was taken, returning a sodium concentration of 165 mmol/L. As house officer, you begin fluid replacement for the child. Assume the normal body weight of the child was 10 kg.
Which of the following is the most appropriate fluid replacement regimen?
A. Begin rehydration from oral route, with oral rehydration solution (ORS) at 200 mL/h for the first 4 hours, then continue ORS at the same rate for the next 24 hours
B. Begin rehydration from oral route, with a hypotonic solution (e.g. 0.45% saline with 2.5% dextrose solution) at 200 mL/h for the first 4 hours, then continue at the same rate for the next 24 hours
C. Begin rehydration from intravenous or intraosseous route, with normal saline (0.9% sodium chloride solution) at 200 mL/h for the first 4 hours, followed by 0.45% saline with 2.5% dextrose solution at 60 mL/h for the next 20 hours
D. Begin rehydration from intravenous or intraosseous route, with 0.45% saline with 2.5% dextrose solution at 50 mL/h for 24 hours
E. Begin rehydration from intravenous or intraosseous route, with normal saline at a rate of 35 mL/h for 48 hours

Answer 47

Question 48

10kg infant who has dehydration of 10% BW show signs of hypovolemic shock. Serum Sodium shows 125mmol, target is 135mmol. Amount of sodium replacement in 24 hours ?
A. 50
B. 100
C. 150
D. 250
E. 400

Answer 48

Na in fluid deficit = 150mmol
Na maintenance = 3mmol/kg/d × 10 = 30mmol
Na required to restore normoNa = (135 – 125) × 10kg × 70% = 70mmol
Therefore, amount of Na required = 250mmol

Question 49

12 month old child with repeated diarrhoea and vomiting for 2 days. Examination showed sunken eyes, dry mucosa, delayed capillary refill (5 seconds), cool extremities. BP: 110/70 mmHg. Pulse: 120. Serum Na: 165 mmol/L. How should you manage the patient?
A. Oral ORS 100ml/hr
B. Oral saline solution 100ml/hr
C. IV half saline (0.45%) 20/ml/kg/hr +D5 for 4 hours
D. IV normal saline (0.9%) 20/ml/kg/hr for 4 hours followed by ½ NS+D5
E. IV normal saline (0.9%) 20/ml/kg/hr for 4 hours followed by NS+D5

Answer 49

D. IV normal saline (0.9%) 20/ml/kg/hr for 4 hours followed by ½ NS+D5

Question 50

Which of the following maternal factors during pregnancy associated with offspring obesity?
A. Increases exposure of methylmecury
B. Alcohol consumption
C. Type II DM
D. Antenatal folate supplementation
E. Hyperemesis gravidarum

Answer 50

C. Type II DM

Question 51

2 year old M
child assessment: found delayed in walking
suffered severe asphyxia at labour
Apgar score
1 min:0
5 min: 2
10 min: 3
suffered with neonatal seizure.
Stayed In ICU for 2 months
P/E
UML sign
Bilateral babinski sign
Bilateral ankle clonus
Increase Deep tendon reflex
4 limbs spastic and abnormal posture when crying
when relaxed, tone is at the hypotonic side
Developmental milestone
( basically all delayed)
A. GDD
B. Cerebral palsy ( spastic tetraplegia)
C. Speech delay
D. ASD
E. Floppy infants

Answer 51

B. Cerebral palsy ( spastic tetraplegia)

Question 52

5mo with scald burn, which of the following is correct?
A. The percentage is the same as 25yo adult
B. Second degree involves dermis histologically
C. Deeper injury is more painful
D. Burn involving lower back, buttock is most problematic
E. 3% of total body surface area is ‘severe’

Answer 52

B. Second degree involves dermis histologically