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Question 1
Incorrect
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Which of the following are not a recognized feature of Down's syndrome?
Your Answer: A third fontanelle
Correct Answer: Ataxic gait
Explanation:Ataxic gait is not a direct association of Down’s syndrome. All other given responses are associated with Down’s syndrome.
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This question is part of the following fields:
- Genetics And Dysmorphology
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Question 2
Incorrect
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An 18-year-old homosexual male presents 36 hours after having unprotected sex with his partner whose HIV status is not known. He is concerned about his risk of acquiring HIV. He is feeling well and shows no symptoms. The physician offers him a post exposure prophylaxis, which consists of 3 different antiviral drugs. Two of these drugs act by which of the following mechanisms?
Your Answer:
Correct Answer: Inhibition of viral reverse transcriptase
Explanation:Recommended regimens3 NRTI (e.g., zidovudine, lamivudine, abacavir) OR2 NRTI (e.g., lamivudine + abacavir) AND1 NNRTI (e.g., efavirenz) OR1 PI (e.g., lopinavir) OR1 INI (e.g., raltegravir)
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This question is part of the following fields:
- HIV
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Question 3
Incorrect
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A 6 year old child underwent an emergency splenectomy following trauma. After full recovery he is dismissed from the hospital and returns home. On re-examination, eight weeks later, the GP performs a full blood count with a film. What would you expect to see?
Your Answer:
Correct Answer: Howell-Jolly bodies
Explanation:Howell-Jolly bodies are often seen in post-splenectomy cases, together with Pappenheimer bodies, target cells and irregular contracted red blood cells. The loss of splenic tissue results in the inability to readily remove immature or abnormal red blood cells from the circulation.
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This question is part of the following fields:
- Haematology And Oncology
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Question 4
Incorrect
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A 4-year-old child is referred to the chest clinic due to recurrent chest infections. The mother says she has a productive cough with greenish sputum. Chest x-ray shows multiple ringed shadows and thickening of the bronchial walls at both bases. The most likely diagnosis is?
Your Answer:
Correct Answer: Bronchiectasis
Explanation:The x-ray is suggestive of bronchiectasis. The most probable aetiology especially considering recurrent chest infections at such a young age is cystic fibrosis.
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This question is part of the following fields:
- Respiratory
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Question 5
Incorrect
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Which of the following statements is correct regarding erythema nodosum?
Your Answer:
Correct Answer: The typical eruption is symmetrical, tender, and with bruise like lesions to the shins, ankles, and knees
Explanation:Erythema nodosum is the most common type of inflammation of the subcutaneous fat tissue, referred to as panniculitis. Erythema nodosum appears as painful, erythematous round lumps, usually symmetrically on the anterior aspect of lower extremities. These lesions are self-limiting and tend to resolve within 2-8 weeks without undergoing necrosis or ulceration. There are various causes of erythema nodosum, but the most important among children is the streptococcal throat infection. Other causes include autoimmune conditions like sarcoidosis, inflammatory bowel disease, mycobacterial infection (TB), drugs like penicillin and sulphonamides, and malignancies like some leukemias and lymphomas.
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This question is part of the following fields:
- Dermatology
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Question 6
Incorrect
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An 8 year old male who is unable to retract his previously retractile foreskin has been treated with 1% hydrocortisone for 3 months. He presents with a white and thickened foreskin. What would you do next to manage his condition?
Your Answer:
Correct Answer: Circumcision with urethral calibration
Explanation:The boy suffers from balanitis xerotica obliterans (BXO) which is surgically treated with circumcision and urethral calibration. In fact, the condition is the only true medical indication for circumcision.
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This question is part of the following fields:
- Paediatric Surgery
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Question 7
Incorrect
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A 15-year-old Afro-Caribbean boy presents with a temperature of 37.2C and acute abdominal pain. He has previously undergone a splenectomy secondary to sickle cell disease. Clinically he is jaundiced. An ultrasound scan demonstrates a common bile duct diameter of 10mm. What is the most likely diagnosis?
Your Answer:
Correct Answer: Impacted Gall Stone
Explanation:Based on the clinical scenario provided, this patient most probably has impacted gall stones. Gall stones in children can be caused by haematological diseases such as sickle cell anaemia and thalassemia. Cholesterol stones are also becoming more prevalent. A dilated common bile duct (> 10mm in adults) suggests gall stone impaction. The presence of pyrexia indicates cholecystitis.
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This question is part of the following fields:
- Paediatric Surgery
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Question 8
Incorrect
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An 18-year-old teenager is undergoing a thoracoscopic sympathectomy for axillary hyperhidrosis. Which one of the following structures is divided to access the sympathetic trunk?
Your Answer:
Correct Answer: Parietal pleura
Explanation:The sympathetic chain lies posterior to the parietal pleura. During a thorascopic sympathectomy, this structure will have to be divided. The intercostal vessels lie posteriorly. They may be damaged with troublesome bleeding but otherwise are best left alone as the deliberate division will not improve surgical access.The sympathetic nervous system:The cell bodies of the preganglionic efferent neurones lie in the lateral horn of the grey matter of the spinal cord in the thoracolumbar regions.The preganglionic efferents leave the spinal cord at levels T1-L2. These pass to the sympathetic chain.Lateral branches of the sympathetic chain connect it to every spinal nerve. These postganglionic nerves will pass to structures that receive sympathetic innervation at the periphery.Sympathetic chains:These lie on the vertebral column and run from the base of the skull to the coccyx.Clinical correlation:Interruption of the head and neck supply of the sympathetic nerves will result in an ipsilateral Horner’s syndrome.For the treatment of hyperhidrosis, the sympathetic denervation can be achieved by removing the second and third thoracic ganglia with their rami. Removal of T1 will cause a Horner’s syndrome and is therefore not performed.In patients with vascular disease of the lower limbs, lumbar sympathectomy may be performed, either radiologically or (more rarely now) surgically. The ganglia of L2 and below are disrupted. Care should be taken to preserve the L1 ganglion. If it is removed in male patients, ejaculation may be compromised.
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This question is part of the following fields:
- Neurology And Neurodisability
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Question 9
Incorrect
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A 2-month-old child is brought to the paediatric emergency by his parents. Which of the following would be a contraindication for the baby's discharge from the hospital?
Your Answer:
Correct Answer: Any one of the above
Explanation:Any 2-month-old child presenting with any of the above signs, should be assessed and have a history taken and physical examination made before discharge. As these may all be signs and symptoms for a condition requiring hospitalisation.
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This question is part of the following fields:
- Emergency Medicine
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Question 10
Incorrect
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A 16 year old female has been admitted to hospital after overdosing on paracetamol 4 hours ago. She has also consumed a large amount of alcohol. Her plasma paracetamol concentration is only just below a level which requires treatment. From the list of options, choose the most appropriate treatment option for this patient.
Your Answer:
Correct Answer: Refer to psychiatry ward
Explanation:As her paracetamol level is under the required treatment threshold, she requires no medical treatment. However, she has taken a simultaneous drug overdose and excessive alcohol consumption. These two factors together require psychiatric evaluation and so she should be referred to the psychiatry ward.
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This question is part of the following fields:
- Adolescent Health
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Question 11
Incorrect
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A 13-year-old boy complains of several episodes of collapse. He describes the majority of these episodes occurring when he is laughing. He states that he loses power in his legs and falls to the ground. He is alert throughout and recovers quickly. He also describes excessive daytime sleepiness with episodes in the morning of being awake but being unable to move his body. Examination is unremarkable. A diagnosis of narcolepsy is made. Which of the following is the first line treatment for excessive daytime sleepiness?
Your Answer:
Correct Answer: Modafinil
Explanation:Narcolepsy is a rare condition characterised by excessive daytime sleepiness, sleep paralysis, hypnagogic hallucinations, and cataplexy (sudden collapse triggered by emotion such as laughing or crying). There is no cure for narcolepsy. Treatment options include stimulants, such as methylphenidate (Ritalin) or modafinil (Provigil), antidepressants, such as fluoxetine (Prozac), citalopram (Celexa), paroxetine (Paxil), sertraline (Zoloft) and sodium oxybate (Xyrem). Modafinil has replaced methylphenidate and amphetamine as the first-line treatment of excessive daytime sleepiness (EDS).
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This question is part of the following fields:
- Neurology
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Question 12
Incorrect
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A 16 year old dies in a road traffic accident. What is the mortality proportion attributed to accidents in this age group?
Your Answer:
Correct Answer: 40-50%
Explanation:Deaths by age group: 60% <1 year – due mainly to congenital, neonatal, and infection related problems.10% 1-4 years – due to accident (15%), cancer (15%), or congenital problems (14%)18% 15-19 years – accidental (42%) accidents reflect increased risk taking
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This question is part of the following fields:
- Emergency Medicine
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Question 13
Incorrect
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A well, breastfed term infant presented with jaundice at 36 hours of age. The serum bilirubin was 286 µmol/L, direct Coombs test negative, blood film showed spherocytes and reticulocytes. The baby's blood group was A rhesus negative and mother's blood group O Rhesus negative.Which of the following is the MOST likely diagnosis?
Your Answer:
Correct Answer: ABO incompatibility
Explanation:Haemolytic disease of the new-born due to ABO incompatibility is usually less severe than Rh incompatibility. One reason is that fetal RBCs express less of the ABO blood group antigens compared with adult levels. In addition, in contrast to the Rh antigens, the ABO blood group antigens are expressed by a variety of fetal (and adult) tissues, reducing the chances of anti-A and anti-B binding their target antigens on the fetal RBCs.ABO HDN occurs almost exclusively in the offspring of women of blood group O, although reports exist of occasional cases in group A mothers with high-titre anti-(group B) IgG
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This question is part of the following fields:
- Neonatology
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Question 14
Incorrect
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A 7-year old child from a rural setting complains of recurrent abdominal pain. The child is found to have a heavy parasitic infestation and anaemia. Which type of anaemia is most likely seen in this patient?
Your Answer:
Correct Answer: Iron deficiency anaemia
Explanation:The most common cause of iron deficiency anaemia in children in developing countries is parasitic infection (hookworm, amoebiasis, schistosomiasis and whipworm).
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This question is part of the following fields:
- Microbiology
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Question 15
Incorrect
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Which of the following conditions is associated with hypogonadism in boys?
Your Answer:
Correct Answer: Gigantism
Explanation:Hypogonadism is found to be a feature in gigantism also known as acromegaly, a condition caused by growth hormone abnormalities. The most common cause of gigantism is a pituitary adenoma. Hypogonadism exists among other endocrinopathies found in gigantism. Other causes of hypogonadism include Kleinfelter’s syndrome, which is characterized by premature testicular failure. The other options listed, primary hypothyroidism, teratoma, tuberous sclerosis and hepatoblastoma are all associated with precocious puberty.
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This question is part of the following fields:
- Endocrinology
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Question 16
Incorrect
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A 17-year-old Caucasian woman presents with lethargy and chronic nausea. Her mother is worried she may be depressed. On examination, there are signs of chronic liver disease and a gold-yellow ring at the periphery of the iris in both eyes. Her serum copper level is low. What is the most likely diagnosis?
Your Answer:
Correct Answer: Wilson's disease
Explanation:This patient has Wilson’s disease. They Kayser-Fleischer ring (ring that encircles the iris) is diagnostic of this. Low serum copper is seen in Wilson’s disease. With the Kayser-Fleischer ring, this makes all of the other answer choices incorrect.
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This question is part of the following fields:
- Gastroenterology And Hepatology
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Question 17
Incorrect
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A 5 year old girl presents with a history of polyuria, polydipsia, and weight loss. She seems lethargic and has a blood glucose of 24 mmol/l. Which of the following defines diabetes, according to the World Health Organization?
Your Answer:
Correct Answer: Single fasting glucose > 7.0 mmol/l with characteristic symptoms
Explanation:WHO states that diabetes can be diagnosed from a single fasting glucose of > 7.0 mmol/l with characteristic symptoms or a glucose level of > 11.1 mmol/l 2 hours after a glucose load. Two fasting glucose levels of > 7.0 mmol/l on separate occasions can also fit the diagnosis in the absence of characteristic symptoms.
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This question is part of the following fields:
- Endocrinology
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Question 18
Incorrect
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A 2-year-old baby sustained a wound to her hand whilst playing in the garden. She is unvaccinated as the parents are concerned regarding side effects. There is no contraindication to vaccinations. What is the most appropriate action?
Your Answer:
Correct Answer: Give complete DPT vaccine course
Explanation:A complete course of DPT should be given.
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This question is part of the following fields:
- Immunology
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Question 19
Incorrect
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Anorexia nervosa is associated with which of the following skin and nail related changes?
Your Answer:
Correct Answer: Acrocyanosis
Explanation:Anorexia nervosa is an eating disorder which is characterized by distorted self-image leading to abnormally decreased calorie intake. This disorder affects multiple bodily systems, including the skin, GI, and endocrine system. Due to extreme weight loss, patients with anorexia nervosa develop cold intolerance along with bluish discoloration of their fingers, nose, and ears, which is known as acrocyanosis. This phenomenon may be due to the shunting of the blood from the peripheries to the central body systems as a reaction to hypothermia. Other notable changes in the integumentary system include extreme dryness (xerosis), lanugo hairs, decubitus ulcers, and easy bruisibility.
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This question is part of the following fields:
- Adolescent Health
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Question 20
Incorrect
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A 7-year-old child presented to the paediatric clinic with a swollen face, hands and feet. She gained 2 kilograms over the last month despite poor feeding. What is the investigation of choice in this case?
Your Answer:
Correct Answer: Urinary albumin
Explanation:This is a case of nephrotic syndrome that can be confirmed by the presence of urinary albumin. It should be further investigated by a tissue sample to confirm the diagnosis.
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This question is part of the following fields:
- Renal
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Question 21
Incorrect
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A 16-year-old boy suffers recurrent episodes of haematuria following a flu-like illness. He is otherwise well. Physical examination is normal. Urinalysis reveals no proteinuria, blood ++, and 2-3 white blood cells/mm3.What is the most probable diagnosis?
Your Answer:
Correct Answer: IgA nephropathy
Explanation:IgA nephropathy’s characteristic presentation is haematuria following a non-specific upper respiratory infection as was evident in this case. IgA nephropathy also usually occurs in children and young males, like this patient.
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This question is part of the following fields:
- Renal
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Question 22
Incorrect
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A 5 year old boy falls into the swimming pool whilst playing and almost drowns. His parents start BLS and transfer him to the emergency department. You attach him to the cardiac monitoring and you notice ventricular fibrillation. You immediately start on CRP algorithm for shockable rhythms. Which of the following may result in a poor defibrillation response?
Your Answer:
Correct Answer: Hypothermia
Explanation:Guidelines suggest that when hypothermia manifests in the context of a shockable rhythm, it might get harder to defibrillate. Therefore, defibrillation is recommended to occur at temperatures below 30°C, and to be limited in three shocks.
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This question is part of the following fields:
- Emergency Medicine
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Question 23
Incorrect
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A hyperkinetic gait is most likely associated with which condition?
Your Answer:
Correct Answer: Sydenham chorea
Explanation:Hyperkinetic Gait is seen with certain basal ganglia disorders including Sydenham’s chorea, Huntington’s Disease and other forms of chorea, athetosis or dystonia. The patient will display irregular, jerky, involuntary movements in all extremities. Walking may accentuate their baseline movement disorder.
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This question is part of the following fields:
- Neurology And Neurodisability
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Question 24
Incorrect
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A 13-year-old boy's mother notices he has a lump in his arm, near his right shoulder. An X-ray reveals a lateral projection in the metaphyseal region of his humerus. The lesion is removed and it is found to be composed of bony cortex, capped by cartilage. What's the most likely diagnosis in this case?
Your Answer:
Correct Answer: Osteochondroma
Explanation:Osteochondromas, or osteocartilaginous exostoses, are the most common benign bone tumours, and tend to appear near the ends of long bones. The overgrowth can occur in any bone where cartilage forms bone, and they are capped by cartilage. They are most common in people between the ages of 10-20 years old.
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This question is part of the following fields:
- Musculoskeletal
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Question 25
Incorrect
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A 6 year old boy presented in the emergency department with a cough and knee swelling after falling on the road. He had a non-blanching rash on his buttocks and investigations revealed: PT=13, APTT=71, Hgb=11, WBC=8, Plt=200. Which is the most likely diagnosis?
Your Answer:
Correct Answer: Haemophilia
Explanation:From the options mentioned here, the closest diagnosis is haemophilia. This is a mixed picture, as a purpuric rash on the buttocks does not correlate with this diagnosis. However, the most appropriate diagnosis is haemophilia.
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This question is part of the following fields:
- Haematology And Oncology
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Question 26
Incorrect
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A 9 year old boy was admitted with gastroenteritis. The boy's symptoms started two days ago with profound diarrhoea and emesis. Blood exams show the following: Sodium=148mmol/l, Potassium=2.2mmol/l, Urea=20mmol/l, Glucose=4.3mmol/l. What would be the best management?
Your Answer:
Correct Answer: V normal saline and potassium supplement
Explanation:The boy needs re-hydration and hydro-electrolytic re-balancing due to fluid losses from the gastroenteritis and subsequent dehydration.
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This question is part of the following fields:
- Gastroenterology And Hepatology
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Question 27
Incorrect
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A 6-year-old boy with fever and malaise for 2 days recently developed bloody diarrhoea. What is the most probable aetiology?
Your Answer:
Correct Answer: Escherichia coli 0157
Explanation:The most likely organism is enterohemorrhagic verotoxin-producing E.coli. It usually causes haemolytic uremic syndrome. Crohn’s disease rarely manifests in an acute manner. Polio and giardiasis usually manifest with non-bloody diarrhoea.
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This question is part of the following fields:
- Infectious Diseases
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Question 28
Incorrect
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In X linked dominant inheritance, what is the chance of an affected father's daughter inheriting the condition?
Your Answer:
Correct Answer: 100%
Explanation:In the pattern of mendelian inheritance, X- linked dominant inheritance means that all who inherit the X chromosome will present with the condition. In the case of maternal x-linked inheritance sons and daughters have an equal chance of inheriting the condition as there is a 50% chance of inheriting the defective X chromosome from their mother as opposed to a non affected X chromosome from their father. However in paternal X-linked dominant inheritance, sons will be unaffected as they inherit a Y chromosome from their father while daughters are sure to inherit the defective X-chromosome.
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This question is part of the following fields:
- Genetics And Dysmorphology
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Question 29
Incorrect
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A 10-year-old girl was brought to the clinic with complaints of a rash around her left wrist. Her mother recalls that the rash started to appear after the child started wearing a new bracelet for the past one week. What is this type of hypersensitivity reaction?
Your Answer:
Correct Answer: Type 4
Explanation:According to the Gell and Coombs classification of hypersensitivity reactions, the scenario provided is a type 4 (delayed) reaction.These reactions are mediated by T lymphocytes and cause contact dermatitis. Nickel, commonly found in cheap jewellery, is a common cause of contact dermatitis.Note:There are two main types of contact dermatitis:- Irritant contact dermatitis: It is a common, non-allergic reaction due to weak acids or alkalis (e.g. detergents). These are often seen on the hands. They present typically with erythema, and rarely, crusting and vesicles.- Allergic contact dermatitis: These are type IV hypersensitivity reactions and are often seen on the head following hair dyes.They typically present as acute weeping eczema which predominately affects the margins of the hairline rather than the hairy scalp itself. Treatment is usually with a potent topical steroid.Other options:- Allergic rhinitis is an example of a type 1 (immediate) reaction. It is an IgE mediated. It is a hypersensitivity to a previously innocuous substance.- Type 2 reactions are mediated by IgG and IgM, which binds to a cell, causing cell death. Goodpasture syndrome is an example of a type 2 hypersensitivity reaction.- Immune complexes mediate type 3 reactions. Rheumatoid arthritis is an example of a type 3 hypersensitivity reaction.
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This question is part of the following fields:
- Dermatology
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Question 30
Incorrect
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A 1-week-old baby presents with a large blue bruise-like mark on his back. His mother noticed the mark that same morning and she is concerned about its severity. What is the most probable diagnosis?
Your Answer:
Correct Answer: Mongolian spot
Explanation:Mongolian spots, otherwise called congenital dermal melanocytosis, are pigmented birthmarks. They are usually located on the buttocks or back and although they’re usually present at birth, they may appear soon after. They are flat and have a blue-grey colour (bruise-like). They are benign and present no health risk.
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This question is part of the following fields:
- Dermatology
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SESSION STATS - PERFORMANCE PER SPECIALTY
