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Question 1
Correct
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A child suffering from a chest infection is prescribed flucloxacillin. A few days later, he develops jaundice, dark urine, and pale stools. What is he suffering from now?
Your Answer: Cholestatic jaundice
Explanation:Due to its cholestatic properties, Flucloxacillin can block bile flow through the liver, leading to the accumulation of bilirubin in the blood, giving rise to jaundice. Dark urine is the result of excessive bilirubin in the blood being filtered by the kidney. As the bile doesn’t move into the small intestine, stools are pale.
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This question is part of the following fields:
- Pharmacology
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Question 2
Incorrect
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A 6 year old boy presents with severe gastroenteritis and dehydration. He is receiving IV fluids and a routine blood test is done to evaluate kidney function and look for signs of acute kidney injury. All of the following are being used to evaluate for kidney injury, except:
Your Answer: Urine output 8 hours
Correct Answer: Potassium >6mmol/l
Explanation:Hyperkalaemia is not to evaluate or detect AKI but rather the result of it. If one of the rest of the options is present, then AKI would be suspected.
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This question is part of the following fields:
- Nephro-urology
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Question 3
Correct
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A 19-year-old girl has presented with symptoms suggestive of anorexia nervosa. Following a consult with a dietician, a decision was made to supplement her nutrition through total parenteral nutrition (TPN) via a central line. Which of the following is a common complication associated with TPN?
Your Answer: Deranged liver function tests
Explanation:Total parenteral nutrition (TPN) frequently causes derangement of liver function in children. Other options:- While line sepsis and thromboembolism are recognised complications of TPN, they do not occur frequently. – A child who is on TPN will require regular blood tests because of the potential for the development of electrolyte abnormalities. Need to observe their liver function, in order to provide TPN more accurately.
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This question is part of the following fields:
- Gastroenterology And Hepatology
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Question 4
Incorrect
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A normally developed 3-year-old child can do which one of the following tasks?
Your Answer: Hop
Correct Answer: Make a tower out of 9 bricks
Explanation:3-year-old milestonesSocial and EmotionalCopies adults and friends Shows affection for friends without prompting Takes turns in games Shows concern for crying friend Understands the idea of mineť and hisť or hersť Shows a wide range of emotions Separates easily from mom and dad May get upset with major changes in routineDresses and undresses self Language/CommunicationFollows instructions with 2 or 3 steps Can name most familiar things Understands words like in,ť on,ť and underť Says first name, age, and sexNames a friend Says words like I,ť me,ť we,ť and youť and some plurals (cars, dogs, cats) Talks well enough for strangers to understand most of the time Carries on a conversation using 2 to 3 sentences Cognitive (learning, thinking, problem-solving)Can work toys with buttons, levers, and moving parts Plays make-believe with dolls, animals, and people Does puzzles with 3 or 4 pieces Understands what twoť means Copies a circle with a pencil or crayon Turns book pages one at a time Builds towers of more than 6 blocks Screws and unscrews jar lids or turns the door handle Movement/Physical DevelopmentClimbs well Runs easily Pedals a tricycle (3-wheel bike) Walks up and downstairs one foot on each step
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This question is part of the following fields:
- Child Development
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Question 5
Incorrect
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The new-born hearing test is best carried out within the first four or five weeks of life, until what age can it be performed?
Your Answer: 8 weeks
Correct Answer: 12 weeks
Explanation:Ideally, the test is done in the first 4 to 5 weeks, but it can be done at up to 3 months of age.The identification of all new-borns with hearing loss before age 6 months has now become an attainable realistic goal. In the past, parents and paediatricians often did not suspect a hearing loss until the age of 2-3 years, after important speech and language milestones have not been met. By the time these milestones are missed, the hearing-impaired child has already experienced irreversible delays in speech and language development.
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This question is part of the following fields:
- Neonatology
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Question 6
Correct
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A 6 month old baby presents with a sausage-shaped abdominal mass and a history of green vomit a few hours earlier. The baby was born at 38 weeks of gestation and immigrated recently form the Philippines with his parents. What is the most probable diagnosis?
Your Answer: Intussusception
Explanation:Intussusception is the invagination of one segment of the intestine within a more distal segment. It presents with vomiting, abdominal pain, and a palpable abdominal mass.Intussusception usually affects infants between 6-18 months old. Boys are affected twice as often as girls
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This question is part of the following fields:
- Emergency Medicine
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Question 7
Incorrect
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Which of the following statements is false regarding H. pylori?
Your Answer: Zollinger-Ellison syndrome should be considered if there is more than one child in a family with gastrointestinal mucosal ulceration
Correct Answer: Splitting urea to release nitrogen decreases the pH in the stomach
Explanation:H. pylori release the enzyme urease that has the ability to split urea releasing nitrogen. This process increases the pH in the gastric antrum making the gastric pH less acidic.Helicobacter pylori:It is a spiral, microaerophilic, gram-negative bacterium. It is one of the most common causes of antral gastritis in children. Ulcers are less common in children compared with adults; however, when they occur, they are more common in the duodenum.The presence of H.pylori can be confirmed by:- Stool antigen test (preferred)- Serology- Endoscopy with biopsy and culture- Rapid urease testsH.pylori gastritis may be associated with:- Iron deficiency anaemia- Gastric malignancy Management:The treatment is with triple therapy- two antibiotics, and an antacid.Treatment failure is often attributed to a possible worldwide increase in macrolide resistance. Interestingly, children have higher antibiotic resistance compared with adults.Note:Zollinger-Ellison syndrome (ZES) causes gastrin-secreting tumours and can present as a part of multiple endocrine neoplasia type 1 (MEN1)- an autosomal dominant disorder.
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This question is part of the following fields:
- Gastroenterology And Hepatology
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Question 8
Incorrect
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Which of the following immunological components is deficient in a 5-year-old HIV positive child who develops Pneumocystis jiroveci pneumonia?
Your Answer: IgA
Correct Answer: T cells
Explanation:Patients with HIV have a deficiency of CD4 lymphocytes which are also known as helper T cells (Th). They are involved with antigen-specific responses as well as delayed-type hypersensitivity. The risk of developing P. jiroveci pneumonia is greatest with a CD4 count of 200 x 109/l or below.
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This question is part of the following fields:
- HIV
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Question 9
Correct
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Congenital cataracts are NOT a known complication of which of the following conditions?
Your Answer: Klinefelter syndrome
Explanation:Klinefelter syndrome is a chromosomal disease that does not lead to congenital cataracts. A congenital cataract is the clouding of the cornea that is present from birth. Causes can be categorized as genetic, infectious, and metabolic. The most common infectious cause is congenital rubella syndrome. Galactosemia is a metabolic cause of congenital cataracts. Down’s syndrome represents a genetic cause of congenital cataract.
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This question is part of the following fields:
- Ophthalmology
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Question 10
Correct
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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: 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 11
Incorrect
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A 13-year-old girl presents with a swollen left knee following a fall. Her parents state she suffers from haemophilia and has been treated for a right-sided haemarthrosis previously. What other condition is she most likely to have?
Your Answer: Ataxia telangiectasia
Correct Answer: Turner's syndrome
Explanation:Haemophilia is a X-linked recessive disorder. In X-linked recessive inheritance only males are affected. An exception to this seen in examinations are patients with Turner’s syndrome, who are affected due to only having one X chromosome. X-linked recessive disorders are transmitted by heterozygote females (carriers) and male-to-male transmission is not seen. Affected males can only have unaffected sons and carrier daughters.
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This question is part of the following fields:
- Genetics And Dysmorphology
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Question 12
Incorrect
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A 15-year-old girl is referred to the paediatric unit with reduced urine output and lethargy. She has been passing bloody diarrhoea for the past four days. On admission she appears dehydrated. Bloods show the following:Na+: 142 mmol/lK+: 4.8 mmol/lBicarbonate: 22 mmol/lUrea: 10.1 mmol/lCreatinine: 176 µmol/lHb: 10.4 g/dlMCV: 90 flPlt: 91 * 109/lWBC: 14.4 * 109/lGiven the likely diagnosis, which one of the following organisms is the most likely cause?
Your Answer: Shigella
Correct Answer: E. coli
Explanation:The likely diagnosis in this case is Haemolytic Uremic Syndrome (HUS), which is generally seen in young children presenting with a triad of symptoms, namely: acute renal failure, microangiopathic haemolytic anaemia, and thrombocytopenia. The typical cause of HUS is ingestion of a strain of Escherichia coli.
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This question is part of the following fields:
- Renal
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Question 13
Incorrect
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A 10-month-old boy is brought to clinic. His parents are concerned because two days ago, he met another child with mumps. What is the most appropriate management for this child?
Your Answer: He should receive the MMR now
Correct Answer: Do nothing now but give MMR at the appropriate age
Explanation:Immunity against mumps develops over a long time. There is nothing to be done except to proceed with the usual vaccination schedule.
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This question is part of the following fields:
- Infectious Diseases
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Question 14
Correct
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A 3-year-old child choked on a foreign object, which was removed at the hospital. The parents are now asking for advice on how to manage future occurrences at home. What do you advise?
Your Answer: Turn the child on his back and give thumps
Explanation:Give up to five back blows: hit them firmly on their back between the shoulder blades. Back blows create a strong vibration and pressure in the airway, which is often enough to dislodge the blockage.
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This question is part of the following fields:
- ENT
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Question 15
Correct
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A baby is born with complications including microcephaly, hepatosplenomegaly and elevated total bilirubin. Which of the following is the most likely diagnosis in this case?
Your Answer: Cytomegalovirus (CMV)
Explanation:CMV infection is usually asymptomatic in adults. However, if the mother is infected for the first time during pregnancy then there is high chances of this infection passing on to the foetus. CMV infection can cause blindness, deafness, learning difficulties, restricted growth etc. Hepatitis B, herpes simplex, syphilis and HIV do not present with these classical signs of CMV infection in new-borns. It is estimated that 10 stillbirths occur in England and Wales every year due to CMV infection. The foetus is most at risk in early pregnancy. There is no effective prevention.
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This question is part of the following fields:
- Infectious Diseases
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Question 16
Incorrect
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A term baby was born following a placental abruption. There was no respiratory effort and an undetectable heart rate initially. Baby is now 20 min old and has been intubated with regular ventilation breaths. Heart rate came up to 110/min following two rounds of chest compressions. Baby appears very pale. No drugs have been given. Oxygen saturations are currently 85% measured on the right hand despite FiO2 1.0. A venous cord gas shows pH 6.89, CO2 -8, BE -14, Hb 8. What is the next most appropriate step?
Your Answer: Turn down temperature to begin cooling the baby
Correct Answer: Umbilical venous catheter (UVC) placement
Explanation:Umbilical vein catheterization utilizes the exposed umbilical stump in a neonate as a site for emergency central venous access up to 14 days old. Umbilical vein catheterization can provide a safe and effective route for intravenous delivery of medications and fluids during resuscitation.The indication for umbilical vein catheterization is when there is a need for IV access in a neonate for resuscitation, transfusions, or short-term venous access when otherwise unobtainable.
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This question is part of the following fields:
- Neonatology
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Question 17
Correct
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A routine vitamin D screening test reveals low calcium levels in a 3-year-old child.Which of the following could cause low calcium levels due to an artefact?
Your Answer: Albumin
Explanation:The accuracy of the test for calcium levels in the blood is affected by the blood level of albumin. If albumin levels are low, the calcium level can also appear low.This is termed as pseudohypocalcemia.Hypocalcaemia usually presents with muscle spams. These can include spasms of voluntary muscle but also smooth muscle such as in the airways (causing bronchospasm) and in the heart (causing angina).
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This question is part of the following fields:
- Gastroenterology And Hepatology
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Question 18
Correct
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Which of the following is a risk factor for the development of developmental dysplasia of the hip (DDH)?
Your Answer: Breech presentation
Explanation:Developmental dysplasia (DDH) of the hip refers to patients who are born with a dislocated or unstable hip due to abnormal development of the hip. Female infants and first born infants are most likely to present with DDH. Other risk factors for DDH include, breech positioning, oligohydramnios, high birth weight or post date babies.
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This question is part of the following fields:
- Neonatology
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Question 19
Correct
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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: 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 20
Incorrect
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A male had a deep vein thrombosis (DVT) in his left calf. After investigation, it was discovered that this was caused by a genetic disease and his children may be affected.What is the most common heritable cause of DVT?
Your Answer: Antithrombin deficiency
Correct Answer: Factor V Leiden
Explanation:Based on the studies, genetic factors are responsible for approximately 60 % DVT cases. Factor V (FV) Leiden which is the most common cause of inherited thrombophilia, predisposes patients to DVT because of resistance to protein C.The heritable causes of deep vein thrombosis, from most to least common are:Factor V LeidenProthrombin G20210A variantProtein C deficiencyProtein S deficiencyAntithrombin deficiencyVon Willebrand disease and thalassaemia are not causes of DVT.
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This question is part of the following fields:
- Haematology And Oncology
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Question 21
Correct
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A well 2-week-old baby born at term is referred to hospital with a discharging umbilicus. The cord separated at 10 days and there is no peri-umbilical swelling or erythema. There is a small red mass at the site of cord separation, which is discharging a small amount of yellow fluid. The GP had taken a swab of this which grew Staphylococcus epidermidis.The MOST appropriate course of action is which of the following?
Your Answer: Reassure parents and review in 1-2 weeks
Explanation:The baby most likely has umbilical granuloma – granulation tissue may persist at the base of the umbilicus after cord separation; the tissue is composed of fibroblasts and capillaries and can grow to more than 1 cm.Medical therapy is indicated only when an infection is present.Silver nitrate application to umbilical granulomas is usually successful. One or more applications may be needed. Care must be taken to avoid contact with the skin. Silver nitrate can cause painful burns. Small umbilical granulomas with a narrow base may be safely excised in the office setting. Large granulomas and those growing in response to an umbilical fistula or sinus do not resolve with silver nitrate and must be surgically excised in the operating room setting.
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This question is part of the following fields:
- Neonatology
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Question 22
Incorrect
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A 2 year old child was brought to casualty with recurrent episodes of eczematoid rash over the cheeks and flexural regions of his body. Which one of the following statement best suit this condition?
Your Answer: Tacrolimus ointment is the preferred treatment for infants less than two years old
Correct Answer: Hydrocortisone 1% ointment should be applied sparingly to areas of active eczema
Explanation:Atopic dermatitis is an allergic condition which is more apparent in those children who have a positive family history in their 1st or 2nd degree relatives. In some cases, there might be a positive history of bronchial asthma. The best treatment option in this case would be topical application of 1% hydrocortisone ointment to the affected areas of the child. We cannot prescribe a strong ointment to the face because it may lead to skin atrophy, telangiectasia and other steroid related topical complications.
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This question is part of the following fields:
- Dermatology
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Question 23
Incorrect
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A young boy presents with signs of kidney disease. He has a long-standing history of proteinuria and hypocomplementemia which were not responsive to steroid treatment. What is the most probable diagnosis?
Your Answer: Focal segmental glomerulosclerosis
Correct Answer: Membranoproliferative glomerulonephritis
Explanation:Membranoproliferative glomerulonephritis primarily affects children and young adults, with patients presenting with nephrotic or nephritic syndrome or with asymptomatic renal disease. There are 3 types defined by pathologic features. All three types are associated with hypocomplementemia, but they manifest somewhat different mechanisms of complement activation. This type of glomerulonephritis often progresses slowly to end-stage renal disease, and it tends to recur after renal transplantation, especially type II.
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This question is part of the following fields:
- Nephro-urology
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Question 24
Incorrect
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A 10-year-old boy sustains a tibial fracture after trampolining. Following this, he complains of anaesthesia of the web spaces between his first and second toes. Injury to which of the following nerves leads to this presentation?
Your Answer: Tibial nerve
Correct Answer: Deep peroneal nerve
Explanation:The deep peroneal nerve lies in the anterior muscular compartment of the lower leg and can be compromised by compartment syndrome affecting this area. It provides cutaneous sensation to the first web space. The superficial peroneal nerve provides more lateral cutaneous innervation.Origin: It originates from the common peroneal nerve, at the lateral aspect of the fibula, deep to peroneus longus. Root values of common peroneal nerve: L4, L5, S1, and S2.Course and relation: It pierces the anterior intermuscular septum to enter the anterior compartment of the lower leg. Following which, it passes anteriorly down to the ankle joint, midway between the two malleoli. It terminates in the dorsum of the foot.Throughout the course it innervates:- Tibialis anterior- Extensor hallucis longus- Extensor digitorum longus- Peroneus tertius- Extensor digitorum brevisAt its termination, it innervates the skin in the web space between the first and second toes.Actions performed by the muscles supplied by the nerve:- Dorsiflexion of ankle joint- Extension of all toes- Inversion of the foot
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This question is part of the following fields:
- Musculoskeletal
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Question 25
Correct
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A 9 year old boy with central cyanosis underwent cardiac catheterization. His study results were:Right atrium: 7 mmHg, Saturation 60 %Right ventricle: 110/6 mmHg, Saturation 55 %Pulmonary artery: 20/5 mmHg, Saturation 55 %Left atrium (mean): 9 mmHg, Saturation 98 %Left ventricle: 110/80 mmHg, Saturation 87 %Aorta: 110/80 mmHg, Saturation 76 %.Which the following abnormalities are present in this patient?
Your Answer: Pulmonary stenosis
Explanation:The overall diagnosis is Fallot’s tetralogy. Ventricular septal defect with left to right shunt is indicated by drop of oxygen saturation from left atrium to left ventricle. Pulmonary stenosis is indicated by the pressure difference between the pulmonary artery and the right atrium. There is oxygen saturation drop from the left ventricle to the aorta which can be due to the overriding aorta.
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This question is part of the following fields:
- Cardiovascular
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Question 26
Correct
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A thin 16-year-old girl has bilateral parotid swelling with thickened calluses on the dorsum of her hand. What is the single most likely diagnosis?
Your Answer: Bulimia nervosa
Explanation:Bulimia nervosa is a condition in which a person is involved in binge eating and then purging. This patient has swollen parotid glands. The glands swell in order to increase saliva production so that the saliva lost in the vomiting is compensated. This patient also has thickened calluses on the back of her hand. This is known as Russell’s sign. This occurs because of putting fingers in the mouth again and again to induce the gag reflex and vomit. The knuckles get inflamed in the process after coming in contact with the teeth multiple times.
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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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According to a cross-sectional survey of >500 subjects, an estimated 10% of a group of children that have a sibling with severe eczema, have asthma. On the other hand, only 0.5% without a sibling with severe eczema have asthma. You want to test the difference of 9.5% for significance. Which of the following tests would you use?
Your Answer: Chi-square
Correct Answer: Fisher's exact test
Explanation:To quantify differences between percentages you can use Fisher’s exact test.Odds ratios, relative risks and number needed to treat are ways of quantifying differences between percentages in two groups, however are not in themselves significance tests.
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This question is part of the following fields:
- Epidemiology And Statistics
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Question 28
Incorrect
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A 4 year old boy, who is mentally unstable, accidentally shoves a pea into his ear while eating. Otoscopic examination reveals a green coloured object in the ear canal. Which of the following would be the best approach to get rid of the pea?
Your Answer: By instilling olive oil
Correct Answer: Under GA
Explanation:For Otorhinolaryngologist, removal of foreign bodies (FB) from the ear, nose and throat is one of the common emergency procedures done. Most of the cases especially of the ear and nose can be managed without General Anaesthesia (GA). But in some cases GA may be needed. As the child is mentally unstable, he is unlikely to be able to hold still while the foreign body (pea) is being removed with a forceps, which could result in instrumental damage to the ear canal. Pea is an organic foreign body and not metallic hence the use of magnets would not be of any help either. From the options provided, general anaesthesia would be the best option in this child.
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This question is part of the following fields:
- ENT
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Question 29
Incorrect
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Which of the following pathological criteria carries the greatest prognostic weight for malignant melanoma?
Your Answer: Vascular invasion
Correct Answer: Breslow thickness
Explanation:Breslow thickness is measured from the top of the granular layer of the epidermis (or, if the surface is ulcerated, from the base of the ulcer) to the deepest invasive cell across the broad base of the tumour (dermal/subcutaneous) as described by Breslow.Margins of excision-Related to Breslow thicknessLesions 0-1mm thick – 1cmLesions 1-2mm thick – 1- 2cm (Depending upon site and pathological features)Lesions 2-4mm thick – 2-3 cm (Depending upon site and pathological features)Lesions >4 mm thick – 3cmMarsden J et al Revised UK guidelines for management of Melanoma. Br J Dermatol 2010 163:238-256.
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This question is part of the following fields:
- Dermatology
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Question 30
Incorrect
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Which of the following is true of neonatal circulation?
Your Answer:
Correct Answer: The foramen ovale closes at birth when the pressure in the left atrium is higher than the pressure in the right atrium
Explanation:In the prenatal heart, right-to-left atrial shunting of blood through the foramen ovale is essential for proper circulation. After birth, as the pulmonary circulation is established, the foramen ovale functionally closes as a result of changes in the relative pressure of the two atrial chambers, ensuring the separation of oxygen-depleted venous blood in the right atrium from the oxygenated blood entering the left atrium.
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This question is part of the following fields:
- Neonatology
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SESSION STATS - PERFORMANCE PER SPECIALTY
