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Question 1
Correct
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Which of the following is true of randomisation in a clinical trial?
Your Answer: Aims to remove confounding
Explanation:The main aim of randomisation in a clinical trial is to remove the bias and avoid any potential confounding variables. While in double blind studies both the investigators and the patients are not aware of which group they belong in, being blind is not essential in carrying out a randomized study, nor is it essential that the randomisation be done away from the study centre. A placebo also does not facilitate randomisation, which can be done in single centre and multi-centre trials.
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This question is part of the following fields:
- Epidemiology And Statistics
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Question 2
Correct
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A previously well 7-week-old infant was admitted complaining of projectile vomiting following each feed. He was dehydrated on admission and IV fluids were started. What is the most probable diagnosis?
Your Answer: Hypertrophic pyloric stenosis
Explanation:Projectile vomiting is the hallmark symptom of hypertrophic pyloric stenosis. It is the most common cause of intestinal obstruction in infancy, which has a male-to-female predominance of 4-5:1. Current management recommendations include ultrasonography for diagnosis, correction of electrolytes, and surgical intervention.
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This question is part of the following fields:
- Gastroenterology And Hepatology
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Question 3
Incorrect
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Primary amenorrhea is caused by all of the following EXCEPT?
Your Answer: Constitutional delay
Correct Answer: Cushing's syndrome
Explanation:Primary amenorrhea is defined as the total absence of menarche in a girl of 14 years of age if the secondary sexual characteristics are also absent or in a girl of 16 years of age in whom normal secondary sexual characteristics are present. There are multiple causes of primary amenorrhea, but the most common are constitutional delay, imperforate hymen, congenital adrenal hyperplasia, hypothalamic failure, and testicular feminization. Cushing’s syndrome leads to secondary amenorrhea, which is defined as the absence of a menstrual period for 6 consecutive cycles in a girl who has achieved menarche.
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This question is part of the following fields:
- Endocrinology
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Question 4
Incorrect
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A 2-year-old child is diagnosed with a left sided cataract after an ophthalmoscopic exam. Which of the following is the least likely diagnosis?
Your Answer: Asthma
Correct Answer: Hyperthyroidism
Explanation:Hyperthyroidism is the least likely cause of cataract development as all of the other mentioned options can lead to eye problems. Asthma and crohn’s can lead to steroid induced cataract formation, while trauma to the eye can cause traumatic cataracts to develop afterwards. JIA often leads to uveitis.
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This question is part of the following fields:
- Ophthalmology
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Question 5
Correct
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A 13-year-old girl presents with a rash in her lower limbs. The rash appeared a few days after an upper respiratory infection and was associated with persistent haematuria. Renal biopsy revealed immunoglobulin G (IgG) glomerular immune deposits. What is the most probable diagnosis?
Your Answer: Henoch-Schonlein purpura (HSP)
Explanation:Immunoglobulin G (IgG) glomerular immune deposits are seen more commonly in HSP compared to IgA nephropathy.The presentation of the child is highly suggestive of Henoch-Schonlein purpura (HSP). It is an IgA-mediated, autoimmune hypersensitivity vasculitis that targets the small vessels of the skin, GI tract, kidneys, and joints.It is most commonly seen in children aged 3 – 6years and is twice as common in boys than girls. Preceding viral URTI with low-grade pyrexia is common. The most common organism associated with HSP is, however, Group A streptococcal infection A.A purpuric rash is seen on the back of the legs and buttocks and can less frequently, affect the arms. Arthralgia is common (usually knees/ankles) in these patients. Abdominal pain and bloody diarrhoea may occur. And half of the children with HSP have renal involvement. Rarely, it can lead to end-stage renal failure.Treatment includes adequate hydration, occasionally steroids, and other immunosuppressants. The disease can recur in 1 in 3 children.
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This question is part of the following fields:
- Nephro-urology
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Question 6
Incorrect
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A new-born delivered at term with a birth weight of 2.5kgs was admitted to the NICU with suspected congenital TB. Her mother is HIV positive and is on HAART, recently diagnosed with tuberculosis 1 week ago. All of the following are features of congenital tuberculosis EXCEPT?
Your Answer: Irritability
Correct Answer: Diarrhoea
Explanation:Congenital TB symptoms typically develop during the second or third week of life and include poor feeding, poor weight gain, cough, lethargy, and irritability. Other symptoms include fever, ear discharge, and skin lesions.Signs of congenital TB include failure to thrive, icterus, hepatosplenomegaly, tachypnoea, and lymphadenopathy.
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This question is part of the following fields:
- HIV
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Question 7
Correct
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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: 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 8
Correct
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A child on 70% O2 suddenly crouches down whilst playing to help with breathing. What is the most likely diagnosis?
Your Answer: Tetralogy of Fallot
Explanation:Tetralogy of Fallot (TOF), a congenital heart defect, includes the following: right ventricular hypertrophy, ventricular septal defect, abnormal position of the aorta and pulmonary valve stenosis. The O2 saturation in patients with TOF is typically lower than normal and the condition usually becomes symptomatic early in life. A feature of the disease with high diagnostic significance is squatting or crouching of the infant as a compensatory mechanism to increase the peripheral vascular resistance.
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This question is part of the following fields:
- Cardiovascular
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Question 9
Correct
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A pathologist is examining a histological section and identifies Hassall's corpuscles.With what are they most commonly associated?
Your Answer: Medulla of the thymus
Explanation:Hassall’s corpuscles are groups of epithelial cells within the thymic medulla. The physical nature of these structures differs between mammalian species. Although Hassall’s corpuscles have been proposed to act in both the removal of apoptotic thymocytes and the maturation of developing thymocytes within the thymus, the function of Hassall’s corpuscles has remained an enigma.
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This question is part of the following fields:
- Haematology And Oncology
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Question 10
Incorrect
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A normal 6-month-old child is NOT expected to do which of the following?
Your Answer: Transfer objects from hand to hand
Correct Answer: Sit unsupported for 10 minutes
Explanation:Milestones of 6 monthsSocial and EmotionalKnows familiar faces and begins to know if someone is a stranger Likes to play with others, especially parents Responds to other people’s emotions and often seems happy Likes to look at self in a mirror Language/CommunicationResponds to sounds by making sounds Strings vowels together when babbling (ah,ť eh,ť ohť) and likes taking turns with the parent while making sounds Responds to own name Makes sounds to show joy and displeasure Begins to say consonant sounds (jabbering with m,ť bť) Cognitive (learning, thinking, problem-solving)Looks around at things nearby Brings things to mouth Shows curiosity about things and tries to get things that are out of reach Begins to pass things from one hand to the other Movement/Physical DevelopmentRolls over in both directions (front to back, back to front) Begins to sit without support When standing, supports weight on legs and might bounce Rocks back and forth, sometimes crawling backwards before moving forward
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This question is part of the following fields:
- Child Development
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Question 11
Correct
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Which of the following is the most likely cause of microcephaly in an asymptomatic 3-year-old child whose head circumference is on the 3rd centile? Note that his height and weight are in the 75th centile.
Your Answer: Congenital rubella syndrome
Explanation:The most likely cause of microcephaly in an asymptomatic 3-year-old child is congenital rubella syndrome.Microcephaly is defined as head circumference > two standard deviations below the mean.The causes of microcephaly include:- Genetic disorders: Down syndrome, Edward syndrome, Patau syndrome, Williams syndrome, Angelman syndrome, and Rett syndrome.- Infective: Meningitis, toxoplasmosis, CMV, rubella, varicella, HIVand Zika.- Acquired causes: Severe brain malformations, neurodegenerative diseases, hypoxic-ischemic injury, infarction, antenatal exposure to drugs, alcohol, and other toxins. Severe malnutrition and uncontrolled phenylketonuria in the mother are other causes of microcephaly in children.- Craniosynostosis- Neurometabolic disorders- Early non-accidental trauma- Fanconi anaemia- Other causes include: Familial and nonfamilial nonsyndromic microcephalyMost children with microcephaly have one or several associated symptoms:- Developmental delay- Seizures- Visual abnormalities- Short stature
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This question is part of the following fields:
- Neurology And Neurodisability
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Question 12
Incorrect
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Children can be offered cow's milk starting from what age?
Your Answer: 6 months
Correct Answer: 12 months
Explanation:Cow’s milk differs in composition to human breast milk. The sodium content of cows milk is too high, which can easily overwhelm a baby’s developing kidneys and lead to hypernatremia and dehydration. In addition to its iron content being too low, cows milk can cause further increase iron deficiency anaemia by irritating the baby’s intestinal lumen and causing blood loss per rectum. After 12 months a baby’s gastrointestinal tract and organs are able to tolerate cows milk.
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This question is part of the following fields:
- Neonatology
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Question 13
Correct
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Absence of which of the following milestones warrants further assessment in a 15-month-old child?
Your Answer: Stand holding onto furniture
Explanation:By 15 months, it’s common for many toddlers to:- say three to five words.- understand and follow simple commands.- point to one body part.- walk alone and begin to run.- climb on furniture.- make marks with a crayon.- imitate activities, such as housework.
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This question is part of the following fields:
- Child Development
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Question 14
Incorrect
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An 8 year old child complains of pain in his ear. His overall health is normal and clinical examination reveals no discharge, hearing loss or fever. Just by looking at it, the pinna of the ear looks swollen and red. Also, pushing the tragus leads to pain. Otoscopy reveals an erythematous external auditory canal and an otherwise healthy tympanic membrane. The bony external canal courses through which bone?
Your Answer:
Correct Answer: Temporal bone
Explanation:The external auditory canal (EAC) extends from the auricle to the tympanic membrane. Its lateral portion is fibrocartilaginous and its medial portion is bony. Its bony portion is formed by the tympanic portion of the temporal bone.
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This question is part of the following fields:
- ENT
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Question 15
Incorrect
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Persistent pulmonary hypertension is NOT a recognized complication of which of the following?
Your Answer:
Correct Answer: Duct dependent congenital heart disease
Explanation:Persistent pulmonary hypertension of the new-born is secondary to the failure of normal circulatory transition at birth, leading to an abnormally high pulmonary vascular resistance. This elevated resistance causes right-to-left shunting of blood and hypoxemia. It can be caused by parenchymal lung diseases (meconium aspiration syndrome, pneumonia or ARDS), lung hypoplasia (like occurring in oligohydramnios or diaphragmatic hernia), or it can be idiopathic. Other possible causes include maternal indomethacin use, group B streptococcal septicaemia, and high-pressure ventilation. Duct dependent congenital heart disease does not lead to persistent pulmonary hypertension.
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This question is part of the following fields:
- Neonatology
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Question 16
Incorrect
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A 17 year old patient, who reports to the clinic following an apparent transient ischaemic attack, is demonstrated to have a small right homonymous hemianopia with partial sparing of central vision.Where is the lesion most likely to have occurred?
Your Answer:
Correct Answer: Occipital cortex
Explanation:The most common cause of homonymous hemianopia (HH) is a stroke. In this condition there is bitemporal field loss. Lesions posterior to the optic chiasm, in the brain parenchyma are most likely to be the cause of the HH. In this case the retention of central vision indicates that the area of injury may be in the occipital cortex, sparing the occipital pole. The occipital pole receives sensory fibres from the macular, and has a dual blood supply protecting it from total infarction. Lesions of the optic tract can be ruled out as these cause total vision loss in the affected eye. Parietal or temporal nerve lesions cause affect the inferior and superior parts of the visual field respectively causing homonymous quadrantinopias.
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This question is part of the following fields:
- Anatomy
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Question 17
Incorrect
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A 17-year-old boy is known to make irrational decisions which would normally be considered risky and subsequently gets in trouble with the police. An area in his brain controls judgement, impulse control and planning. Changes in this area of the brain mostly occur until what age?
Your Answer:
Correct Answer: 20 -29 years
Explanation:The rational part of a teen’s brain isn’t fully developed until the age of 25 or so.In fact, recent research has found that adult and teen brains work differently. Adults think with the prefrontal cortex, the brain’s rational part. This is the part of the brain that responds to situations with good judgment and an awareness of long-term consequences. Teens process information with the amygdala. This is the emotional part.
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This question is part of the following fields:
- Adolescent Health
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Question 18
Incorrect
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Advanced paternal age is NOT a risk factor for which of the following diseases?
Your Answer:
Correct Answer: Turner syndrome
Explanation:Advanced paternal age is associated with poor quality sperm leading to a reduction in overall fertility along with an increase in the occurrence of various medical disorders in the fetus. Advanced paternal age has been implicated as a risk factor for diseases like retinoblastoma, Marfan’s syndrome, neurofibromatosis, achondroplasia, autism spectrum disorders, schizophrenia, and acute lymphoblastic leukaemia. Down’s syndrome is mostly considered a consequence of advanced maternal age, but advanced paternal age has also been implicated as a risk factor. Turner syndrome is not found to be caused by advanced paternal age.
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This question is part of the following fields:
- Genetics And Dysmorphology
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Question 19
Incorrect
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A 6 year old boy with a history of pharyngitis 10 days ago, presents with periorbital oedema. You perform a urine dipstick test which shows 1+ for protein and 3+ for blood. Family history is clear. What is the most probable diagnosis?
Your Answer:
Correct Answer: Glomerulonephritis
Explanation:The child has a history of pharyngitis followed 10 days later by signs of glomerulonephritis. In this particular case, it is most probably a post-streptococcus glomerulonephritis which accounts for 80% of paediatric cases of glomerulonephritis.
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This question is part of the following fields:
- Nephro-urology
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Question 20
Incorrect
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A 8 year old child presents with fresh rectal bleeding. Which of the following statements is true?
Your Answer:
Correct Answer: Intestinal hamartomatous polyps are seen in Cowden syndrome
Explanation:Colonic Polyposis and neoplasia are often seen in Cowden Syndrome which is a hamartomatous polyposis syndrome. Patients with Cowden syndrome have an increased risk for colorectal cancer.
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This question is part of the following fields:
- Gastroenterology And Hepatology
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Question 21
Incorrect
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Which of the following disorders are NOT associated with hypertrichosis?
Your Answer:
Correct Answer: Psoriasis
Explanation:Among the given options, psoriasis is not associated with hypertrichosis.The causes of hypertrichosis include:- Drugs: minoxidil, ciclosporin, and diazoxide.- Congenital hypertrichosis lanuginosa and congenital hypertrichosis terminalis.- Porphyria cutanea tarda- Anorexia nervosa
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This question is part of the following fields:
- Dermatology
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Question 22
Incorrect
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A baby is born to a mother who is known to have chronic hepatitis B. The mothers latest results are as follows:HBsAg: PositiveHBeAg: Positive.What is the most appropriate strategy for reducing the vertical transmission rate?
Your Answer:
Correct Answer: Give the newborn hepatitis B vaccine + hepatitis B immunoglobulin
Explanation:The Green Book guidelines report in an active infection (HBeAg+ and HBsAg+) to give the vaccine as well as immunoglobulin. If antibodies are present it is not active infection (anti-Hbe) and then in that case only the vaccine, and no immunoglobulin, would be given. The presence of HBeAg means a person is infectious and can transmit to other people.
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This question is part of the following fields:
- Gastroenterology And Hepatology
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Question 23
Incorrect
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A 2-year-old child is brought to the clinic by his parents who say that he has had frequent breath holding spells which occur almost 4 times per week. Which of the following nutritional deficiency most often results in the breath holding spells like the ones experienced by this child?
Your Answer:
Correct Answer: Iron
Explanation:Breath-holding spells are usually caused by either a change in the child’s breathing or a slowing of the heart rate. In some children, breath-holding spells may be related to iron deficiency anaemia, a condition in which the body doesn’t produce a normal number of red blood cells. Conclusion: Not only Iron deficiency anaemia but also iron deficiency alone without anaemia is associated with a risk of high-frequency cyanotic breath holding spells. Iron therapy results in reduction in spells’ frequency which was correlated with increasing ferritin and iron levels.
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This question is part of the following fields:
- Nutrition
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Question 24
Incorrect
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A new-born child is not moving his left arm properly. He had shoulder dystocia during childbirth. His arm is hanging down with the shoulder internally rotated, elbow extended, forearm pronated and wrist flexed. What is the most likely diagnosis?
Your Answer:
Correct Answer: Erb palsy
Explanation:Erb’s palsy is a paralysis of the arm caused by injury to the brachial plexus, specifically the severing of the upper trunk C5-C6 nerves.The infant with an upper plexus palsy (C5-C7) keeps the arm adducted and internally rotated, with the elbow extended, the forearm pronated, the wrist flexed, and the hand in a fist. In the first hours of life, the hand also may appear flaccid, but strength returns over days to months.The right side is injured in 51% of cases. Left side occurs in 45% of patients and bilateral injuries, in 4%.
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This question is part of the following fields:
- Neonatology
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Question 25
Incorrect
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Which of the given choices accurately defines perinatal mortality rate?
Your Answer:
Correct Answer: Number of stillbirths and deaths within 7 days of life divided by 1000 births
Explanation:The perinatal mortality rate is defined as the number of perinatal deaths per 1000 total births. Perinatal death includes the death of a live-born neonate within 7-days of life (early neonatal death) and the death of a fetus ≥ 22 weeks of gestation (stillbirth). Hence, the perinatal mortality rate is calculated by dividing the number of still births+ the number of early neonatal deaths by 1000 births.
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This question is part of the following fields:
- Neonatology
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Question 26
Incorrect
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A young child is successfully treated for meningitis. Two months later his parents take him to their GP, worried that he isn't communicating with them like he used to.What is the most likely complication of meningitis that he developed?
Your Answer:
Correct Answer: Sensorineural deafness
Explanation:Possible complications include:- Hearing loss (which may be partial or total)- problems with memory and concentration- problems with coordination and balance- learning difficulties (which may be temporary or permanent)- epilepsy (Seizures)- cerebral palsy- speech problems- vision loss (which may be partial or total)As hearing loss is the most common complication of meningitis people recovering from the condition are usually given a hearing test to assess their hearing.
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This question is part of the following fields:
- Emergency Medicine
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Question 27
Incorrect
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A 6 year old boy is admitted following a motor vehicle collision (MVC). He presents with tachycardia and it is indicated that he might be in shock. Upon immediate management with fluid bolus, his condition becomes improves, only to worsen again after a while, as he becomes more tachycardia and his pulse pressure starts decreasing. Which of the following is the most probably cause of shock?
Your Answer:
Correct Answer: Abdominal trauma
Explanation:Internal abdominal bleeding is most probably the cause of the child’s shock, especially unresponsive to fluid boluses.
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This question is part of the following fields:
- Emergency Medicine
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Question 28
Incorrect
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A mother gives birth to a baby at 28 weeks of gestation. He weights 1000g. What of the following is true?
Your Answer:
Correct Answer: Visual screening is not useful if carried out at this gestational age
Explanation:Retinopathy of prematurity (ROP) affects premature infants. It is a retinal vasoproliferative disease for which current screening guidelines are primarily based on birth weight and gestational age. The disease is first detected by screening at 32-38 weeks of gestation or in infants that are about 6-7 weeks old. Screening consists of dilation of the pupils and observing for dilated vessel.
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This question is part of the following fields:
- Ophthalmology
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Question 29
Incorrect
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A 16-year-old girl is brought to the emergency by her parents who describe what seems to be an episode of generalized tonic-clonic seizures, after she came home from an all-night party around 6 am. Her father has epilepsy and one of her cousins sometimes has episodes of blank spells. Neurological examination shows no abnormalities. Which of the following diagnosis is most likely in this case?
Your Answer:
Correct Answer: Juvenile myoclonic epilepsy
Explanation:In people with juvenile myoclonic epilepsy, symptoms can be brought on by: -Sleep deprivation-Psychological stress-Alcohol and drug use-Noncompliance of medication-Flickering lights such as strobe lights -Menses-Time of day – usually mornings
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This question is part of the following fields:
- Neurology And Neurodisability
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Question 30
Incorrect
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A 13-month-old infant is admitted to the hospital and scheduled for an elective cardiac surgery. There is no respiratory distress, but cyanosis is present with oxygen saturations at 80s. There is a midline sternotomy scar. On auscultation there is a 4/6 ejection systolic murmur on the upper left sternal edge and a sternal heave is felt on palpation. Which of the following is the child most likely suffering from and what is the likely treatment?
Your Answer:
Correct Answer: Ventricular septal defect with pulmonary artery band
Explanation:The murmur and thrill indicate a right outflow tract murmur, coupled with the right ventricular heave suggests right ventricular hypertrophy. The VSD would not have been amenable to surgery due to the child’s size/weight and so instead would have been palliated with a PA band. As the child grows, this band progressively restricts pulmonary blood flow until the left to right shunt has reversed. Then it is time for the band to be removed and the VSD to be closed.Pulmonary atresia is a cyanotic condition, which may be palliated with an arterial duct stent. This answer is incorrect as the stent placement would not require a midline sternotomy and would give a continuous machinery type murmur. Pulmonary stenosis with PDA ligation is incorrect. The murmur, thrill, and heave all match a pulmonary stenosis but in the absence of an additional shunt lesion the child would not be cyanosed.
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This question is part of the following fields:
- Cardiovascular
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SESSION STATS - PERFORMANCE PER SPECIALTY
