Monday 19 January 2015

How to survive residency in Pediatrics

Hmmm, how do I start this epistle...

I once hated Pediatrics... Yep.. As a medical student, I knew that I will never do my residency in Pediatrics. How can I? My patients don't talk! All they do is cry, eat, poo poo and the process repeats itself again. The older ones are no better since they can't even accurately tell you what is wrong with them... Aaaaaaahhhh!

But when I graduated, got married, gave birth to my first child and went back for my house job.. I decided to do my residency in an area with the least stress.. Pediatrics. You see, I quickly learnt that babies talk well in their own special way... I knew this for a fact because I understood my daughter's needs despite her not saying actual words. Each cry is different, each sound portraying a certain need. I quickly learnt that a baby's cry is much more tolerable than a pregnant woman in labour or a grown man crying from an unbearable pain. Better still, with the knowledge that I will gather in the specialty, I can take better care of my family.

Ladies and Gentlemen, with that noble thought and passion, I delved into to the world of Pediatrics.

Bubble CPAP

MCQs in Growth/development/psychiatric disorders


Ok, I am preparing for my West African exams which will come up in 2 months time!!! Although, I must confess that I am relaxed because I was opportuned by God's special grace to pass my Nationals last year. So, this is my way of giving back, sort of.

All the questions here are from Nelson Pediatrics on the chapters: Growth, Development and Behaviour and Behavioural and Psychiatric Disorders. So, you can attempt to solve this while timing yourself and if you want the answers with explanations, then email me. Best of Luck!

1.Growth is an indicator of
a. Interpersonal stress
b. Chronic disease status
c. Psychological stress
d. Emotional well being
e. Overall well being

2. Choose the correct statement as regards growth and development
a. Neurogenesis in the subventricular zone of the lateral ventricles persists in adulthood
b. The plasticity of the brain continues into adolescence
c. Traumatic experiences can lead to enduring alterations in endocrine/neurotransmitter systems
d. Neurogenesis in portions of hippocampus persists till adulthood
e. At birth, each neuron develops an average of 15,000 synapses by 3 years of age

3. The biopsychosocial model when applied to a child's height includes all the following except
a. Personal eating habits
b. Parents' beliefs
c. Access to food
d. Quantity of food given
e. Genetic endowments

4. Which is a true statement on temperament
a. Personality changes largely result from shared environment
b. Stability of temperament is associated with genetic factors
c. It is relatively resistant to parents' attempt to modify
d. It is biologic or inherited
e. It helps parents understand child's behaviour without guilt

5.Behavioural states in the newborn include
a.  Quiet and active sleep
b. Drowsy and alert states
c. Fussy and crying states
d. All of the above
e.  Non of the above

6. The visual acuity of a newborn permits recognition of an object held at a distance of
a. 1-2 inches
b. 8-12 inches
c. 15-24 inches
d. 24-30 inches 
e. 30-36 inches

7. Temperament
a. There are 9 dimensions
b. There are 3  commonconstellations
c. Genetic differences account for 20-60% of the variability
d. Genetic influences on temperament remains static throughout life
e. It influences parenting styles

8. The response to a ball dropped in front of a 2 month old child is
a. Eyes lowering as ball descends
b. Staring momentarily at the spot at which the ball was dropped
c. Persistence in searching for the ball
d. Crying when the ball hits the groud
e. Smiling at the game of hide and seek

Match the following according to age attained correctly
a. 8 months           f. 22 months
b. 2 months           g. 12 months
c. 9 months           h.  13 months
d 15 months          I.    15 months
e. 6 months           j.     18 months

9. Build tower of 2 cubes
    Object permanance
    Thumb finger grasp
    Bangs 2 cubes
    Builds tower of 6 cubes
    Turns pages of books
     Speaks 4-6 words
    Egocentric symbolic play
    Speaks 10-15 words
    Monosyllabic syllable

10. Early walking suggests
a. Preoccupation with objects
b. Advanced social development
c. Spasticity
d. Early neuronal maturation
e. Advanced language development

11. The probable age of a child who skips, names 4 colors,  dresses and undresses is
a. 15 months
b. 48 months
c. 30 months
d. 18 months
e. 60 months

12. Preschoolers
a. Handedness is determined by the 2 year
b. The number of words of in a sentence is equal to a child's age in years
c. Receptive language varies less in rate of acquisition than expressive language
d. Expressive language has greater prognostic importance than Receptive language
e. Language plays a minimal role in behavioural regulation

13. Assessment of growth
a. Diagnosis of delayed tooth eruption is at 12 months of age (mean +3 SD)
b. The ration of 1 of Upper body to lower body segment occurs at 7 years of age
c. Skinfold thickness is a marker of total fat
d. <70% of ideal body weight is severe wasting
e.  110% of ideal body weight is overweight

14. The following causes delayed tooth eruption is
a. Familial
b. Idiopathic
c. Hypothyroidism
d. Mechanical crowding
e. Hypoparathyroidsm

15. Causes of early exfoliation
a. ALL0
b. AML
c. Histiocytosis
d. Rickets
e. Hypoparathryoidism

 16. Which of the following is not true of M-CHAT
a.  It is a screening tool for autism in school aged children
b. It may detect language impairment and learning disabilities
c. The AAP recommends screening at 18 months and 24-30 months.
d. It can be used as a sole developmental screen at a well child visit
e. It can detect intellectual disability in some cases

17. Bruxism
a. This is a common tic disorder
b. It begins in the first 5 yr of life
c. May be associated with nighttime anxiety.
d. Can manifest as TMJ pain
e. Treatment include praising the child

18. The following are habit disorder except
a. Breath holding
b. Teeth grinding
c. Stuttering
d. Nail biting
e. Thumb sucking

19. Choose the correct statement on Gilles de la Tourette syndrome
a. It occurs in 4-5 per 10, 000 persons
b. It is 3x more likely in girls than boys
c. It is often co-morbid with OCD and ADHD
d. It is characterised by motor tics and stuttering
e. Coprolalia is characteristically seen in most patient

20. Tics
a. Difficulty in controlling behaviour
b. Is a form of dyskinesia
c. Reduced during mental activity
d. Disappears during sleep
e. Possible occurrence following encephalitis

21. Tics
a.  Normal EEG
b.  Occurrence of brief transient amnesia after tic
c. Exacerbated by emotional stress
d. Can be inhibited uncounsciously
e. It is a habit disorder

22. The treatment of choice for childhood onset depression with mild functional impairment include all except
a. Monoamine oxidase inhibitors
b. Tricyclic antidepressants
c. Serotonin reuptake inhibitors
d. Benzodiazepines
e. Fluoxetine

23. The true statement is/are
a. Diurnal enuresis is defined as wetting both in the day/night
b. Diurnal enuresis is defined as wetting during the day only
c. Nocturnal enuresis is wetting during sleep only
d. Primary enuresis occurs in one who has never been consistently dry in both day and night
e. Monosymptomatic enuresis is more common than nonmonosymptomatic enuresis

Have you ever seen a patient who survived ALL?

Increased incidence of Trisomy 18