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Question 1
Incorrect
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Which of the following is true regarding group B beta-haemolytic Streptococcus?
Your Answer: Approximately half of all women have vaginal colonisation with group B beta-haemolytic Streptococcus
Correct Answer: Group B beta-haemolytic Streptococcus (GBS) and Escherichia coli are the most common cause of early sepsis
Explanation:Group B beta-haemolytic Streptococcus (GBS) and Escherichia coli are the most common cause of early sepsis. Group B Streptococcus (GBS), also known as Streptococcus agalactiae, is best known as a cause of postpartum infection and as the most common cause of neonatal sepsis. The GBS organism colonizes the vagina, GI tract, and the upper respiratory tract of healthy humans. GBS infection is almost always associated with underlying abnormalities. In elderly persons aged 70 years or older, GBS infection is strongly linked with congestive heart failure and being bedridden.Penicillin remains the drug of choice for group B streptococcal infection but resistance may occur.
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This question is part of the following fields:
- Neonatology
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Question 2
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 3
Correct
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A 15-year-old girl presents with polyuria, polydipsia and weight loss. Further investigations lead to a diagnosis of type 1 diabetes mellitus.Which of the following does she have an increased risk of developing?
Your Answer: Addison's disease, Grave's disease, coeliac disease
Explanation:The patient has features of type 1 diabetes mellitus, a disease of autoimmune aetiology. This also puts the patient at risk of developing other autoimmune disorders like Addison’s disease, Grave’s disease, and coeliac disease.All of the other options are non-autoimmune disorders.Diabetes mellitus is an increasing problem in both developing and developed countries alike.Some of the risk factors include:ObesityFamily historyFemale sex Asian and African racesPresence of acanthosis nigricans is seen with type 2 but not type 1 diabetesThe diagnosis is mostly incidental or subacute.The treatment aims are good blood sugar control, maintenance of normal BMI, and reduction of complications. The treatment modality also includes lifestyle modifications and cessation of smoking.Even after all this, diabetic ketoacidosis can still occur.Management of diabetes mellitus – NICE guidelines (Updated, 2015): – Standard release metformin should be offered from the moment of diagnosis.- HBA1c should be measured every three months. The target HBA1c level of 48 mmol/mol (6.5%) or lower is ideal for minimising the risk of long term complications.- Children should undergo an eye examination by an optician every two years.- Annual immunisation against influenza and pneumococcal infections are essential.- There is an increased risk of psychological and psychosocial difficulties if the child with type 1 diabetes is on insulin or oral hypoglycaemic medications. These include anxiety disorder, depression, behavioural and conduct disorders and family conflict.- Annual monitoring to be done for:Hypertension starting at diagnosis.Dyslipidaemia starting at diagnosis.Screening for microalbuminuria starting at diagnosis.Diabetic retinopathy from 12 years of age.
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This question is part of the following fields:
- Endocrinology
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Question 4
Correct
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A 15-year-old girl presents with a history recurrent abdominal pain and intermittent diarrhoea over the past one year. During these episodes, she may pass 3-7 very loose stools with mucus. Recently, over the past two months, she has passed stools mixed with blood. Her mother also complaints although she has not lost weight, she has failed to gain the appropriate weight for age according to her growth chart. The child is yet to attain her menarche, and her mother suffers from vitiligo. Clinical examination was unremarkable.Blood investigations revealed:Hb: 12.3 g/dLESR: 38 mm on the first hourTotal and differential counts were within normal limits, and an autoantibody screen was negative.What is the next most relevant investigation you will order?
Your Answer: Colonoscopy
Explanation:This patient in question is most likely suffering from inflammatory bowel disease, probably ulcerative colitis. The most valuable investigation that can assess the severity and extent of the disease, including the opportunity to obtain biopsies is a colonoscopy.Other options:Barium studies and abdominal x-rays do not give sufficient information. While they can provide indicative evidence, only a colonoscopy-guided biopsy can confirm IBD.Radio-isotope scans will help in identifying a focus such as a Meckel’s diverticulum, and angiography is rarely indicated unless a vascular lesion is suspected of causing the intestinal bleed.
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This question is part of the following fields:
- Gastroenterology And Hepatology
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Question 5
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: Campylobacter
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 6
Incorrect
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A 7-year-old female presented with complaints of haematuria and fatigue. She had a history of bloody diarrhoea starting 7 days previously. On investigation, her serum urea and creatinine were raised and proteinuria was present. Which of the following is the most suitable diagnosis for her?
Your Answer: Henoch-Schonlein purpura (HSP)
Correct Answer: Haemolytic-uremic syndrome (HUS)
Explanation:HUS syndrome occurs mostly in children after some days of bloody diarrhoea. Damaged red blood cells also damage the kidney filtering unit and lead to sudden renal failure.
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This question is part of the following fields:
- Renal
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Question 7
Correct
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A 17-year-old boy presents to the clinic complaining of increased weight but low energy. History reveals that he has also experienced low libido and has difficulty maintaining erections. Serum testosterone levels are checked. In the human body, the secretion of testosterone is stimulated by which of the following?
Your Answer: Luteinising Hormone
Explanation:The hypothalamus and pituitary gland control how much testosterone the testes produce and secrete. The hypothalamus sends a signal to the pituitary gland to release gonadotrophic substances (follicle stimulating hormone and luteinizing hormone). Luteinizing hormone (LH) stimulates testosterone production.
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This question is part of the following fields:
- Endocrinology
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Question 8
Incorrect
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Which of the following is NOT true of the femoral nerve?
Your Answer: It is derived from L2, L3 and L4 nerve roots
Correct Answer: It supplies adductor longus
Explanation:The femoral nerve is the main nerve supply for the thigh muscles including the pectineus, iliacus, sartorius, which flex the hip; and the quadriceps femoris made up of the rectus femoris, vests laterals, vastus medialis and vastus intermedius, which extend the knee. The nerve is derived from the L2, L3 and L4 nerve roots, and supplies cutaneous branches to the anteromedial thigh and the medial side of the leg via the saphenous nerve.
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This question is part of the following fields:
- Musculoskeletal
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Question 9
Correct
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A 5 month old boy is admitted with recurrent, brief grand mal seizures. Cranial CT reveals various circular lesions and renal ultrasound shows discrete cysts. Family history reveals that his father has had a renal transplant and has profound acne-like spots on his nose and cheeks. Which of the following is the most probable diagnosis?
Your Answer: Tuberous sclerosis
Explanation:Tuberous sclerosis presents with the growth of numerous noncancerous (benign) tumours in many parts of the body. They may appear in the brain, kidneys, skin or various other organs.
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This question is part of the following fields:
- Nephro-urology
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Question 10
Incorrect
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Which of the following movements will most likely be lost following an injury to the spinal part of the accessory nerve?
Your Answer: Lateral rotation of the arm
Correct Answer: Upward rotation of the scapula
Explanation:Cranial nerve XI is also known as the accessory nerve. The accessory nerve innervates the trapezius muscle which retracts the scapula. The upper and lower fibres act together to also upwardly rotate it.
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This question is part of the following fields:
- Musculoskeletal
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Question 11
Correct
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A 16-year-old boy presents to the physician with a history of easy bruising and epistaxis since childhood. He recently had a dental extraction after which the bleeding lasted for 30 hours. His labs are sent and the reports are as follows: APTT: 36 secondsPT: 15 secondsFibrinogen: 2.5 g/lFactor VIIIC: 0.4 iu/ml (normal range 0.5-1.5)vWF antigen: 0.35 iu/ml (normal range 0.45-1.4)vWF ristocetin co-factor: 0.05 iu/ml (normal 0.45-1.35)PLT: 230 x 109/lBleeding time: 12 mins (normally up to 8 mins). Which of the following is the most likely diagnosis?
Your Answer: von Willebrand disease type II
Explanation:Von Willebrand disease (VWD), a congenital bleeding disorder caused by deficient or defective plasma von Willebrand factor (VWF), may only become apparent on haemostatic challenge, and bleeding history may become more apparent with increasing age. Type 1 VWD (,30% of VWD) typically manifests as mild mucocutaneous bleeding. Type 2 VWD accounts for approximately 60% of VWD. Type 2 subtypes include: Type 2A, which usually manifests as mild-to-moderate mucocutaneous bleeding; Type 2B, which typically manifests as mild-to-moderate mucocutaneous bleeding that can include thrombocytopenia that worsens in certain circumstances; Type 2M, which typically manifests as mild-moderate mucocutaneous bleeding; Type 2N, which can manifest as excessive bleeding with surgery and mimics mild haemophilia A. Type 3 VWD (<10% of VWD) manifests with severe mucocutaneous and musculoskeletal bleeding.
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This question is part of the following fields:
- Haematology And Oncology
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Question 12
Incorrect
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A 8 year old child presents with fresh rectal bleeding. Which of the following statements is true?
Your Answer: Peutz-Jegher syndrome is associated with malignant transformation in the gastrointestinal tract
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 13
Correct
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A 10-year-old boy presented to the ophthalmology clinic with a painless swelling on the superotemporal aspect of his orbit. It was smooth on examination and produced no visual disturbances. Following excision, it was found to be lined by squamous epithelium and hair follicles.Which lesion is most probably associated with these findings?
Your Answer: Dermoid cyst
Explanation:The most probable lesion in the patient is a dermoid cyst.Rationale:Dermoid cysts are embryological remnants and may be lined by hair and squamous epithelium (like teratomas). They are often located in the midline and may be linked to deeper structures resulting in a dumbbell shape to the lesion. Complete excision is required as they have a propensity to local recurrence if not excised.Note:Desmoid tumours are a different entity entirely. These lesions most commonly develop in ligaments and tendons. They are also referred to as aggressive fibromatosis and consist of dense fibroblastic lesions (resembling scar tissue). They should be managed in a similar manner to soft tissue sarcomas.
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This question is part of the following fields:
- Dermatology
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Question 14
Correct
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Regarding the thymus, which of the following is true?
Your Answer: DiGeorge's syndrome is a developmental abnormality affecting the thymus
Explanation:The thymus is a lymphoid organ located in the anterior mediastinum. In early life, the thymus is responsible for the development and maturation of cell-mediated immunologic functions. The thymus is composed predominantly of epithelial cells and lymphocytes. Precursor cells migrate to the thymus and differentiate into lymphocytes. Most of these lymphocytes are destroyed, with the remainder of these cells migrating to tissues to become T cells.DiGeorge’s syndrome (DGS) is a developmental abnormality affecting the thymus. The classic triad of features of DGS on presentation is conotruncal cardiac anomalies, hypoplastic thymus, and hypocalcaemia (resulting from parathyroid hypoplasia).
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This question is part of the following fields:
- Endocrinology
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Question 15
Correct
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A new-born baby with confirmed trisomy 21 presents with bilious vomiting and an abdominal X-ray at 1 day of age showing a 'double-bubble' appearance. What is the most likely diagnosis?
Your Answer: Duodenal Atresia
Explanation:Congenital duodenal atresia is one of the more common intestinal anomalies treated by paediatric surgeons, occurring 1 in 2500-5000 live births. In 25-40% of cases, the anomaly is encountered in an infant with trisomy 21 (Down syndrome).Presenting symptoms and signs are the results of high intestinal obstruction. Duodenal atresia is typically characterized by the onset of vomiting within hours of birth. While vomitus is most often bilious, it may be nonbilious because 15% of defects occur proximal to the ampulla of Vater. Occasionally, infants with duodenal stenosis escape detection of an abnormality and proceed into childhood or, rarely, into adulthood before a partial obstruction is noted. Nevertheless, one should assume any child with bilious vomiting has a proximal GI obstruction until proven otherwise, and further workup should be begun expeditiously.Once delivered, an infant with duodenal atresia typically has a scaphoid abdomen. One may occasionally note epigastric fullness from dilation of the stomach and proximal duodenum. Passing meconium within the first 24 hours of life is not usually altered. Dehydration, weight loss, and electrolyte imbalance soon follow unless fluid and electrolyte losses are adequately replaced. If intravenous (IV) hydration is not begun, a hypokalaemic/hypochloraemic metabolic alkalosis with paradoxical aciduria develops, as with other high GI obstruction. An orogastric (OG) tube in an infant with suspected duodenal obstruction typically yields a significant amount of bile-stained fluid.
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This question is part of the following fields:
- Paediatric Surgery
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Question 16
Incorrect
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A 5 week old baby presents to the ward with a history of projectile, non-bilious vomiting which takes place after feeding. The baby seems to have a normal appetite but hasn't gained weight. You suspect pyloric stenosis. What initial test would you perform to confirm the diagnosis?
Your Answer: Abdominal ultrasound
Correct Answer: Capillary blood gas
Explanation:One of the features of pyloric stenosis is hypochloraemic, hypokalaemic metabolic alkalosis. In emergency settings, capillary blood gas is the easiest and fastest way to establish a sustainable suspicion of pyloric stenosis. However, all tests are useful for the diagnosis of the condition.
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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 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 18
Correct
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A 6 week old female patient was brought by her mother to the emergency department with icterus. Although she's had a good appetite, and breast-feeding well, she hasn't gained any weight. Her mother noticed that her stools are pale while her urine is noticeably dark. What is the most probable diagnosis?
Your Answer: Biliary atresia
Explanation:Biliary atresia is a rare condition that usually becomes symptomatic 2 to 8 weeks after birth. It can be congenital or acquired. Typical symptoms include jaundice, weight loss, dark urine and pale stools.
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This question is part of the following fields:
- Gastroenterology And Hepatology
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Question 19
Correct
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A mother came to the clinic, with her 7 month old baby. She anxiously explained that he was not responding to loud sounds. He was vocalizing at the presentation and he had normal motor milestones. Which of the following is the most appropriate management?
Your Answer: Arrange Hearing test
Explanation:History is suggestive of a possible hearing impairment. As the baby is vocalizing and has normal motor development, an isolated hearing problem is possible. A hearing test will confirm the diagnosis.
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This question is part of the following fields:
- ENT
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Question 20
Incorrect
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A 11-year-old boy has a history of tonsillitis followed by haematuria and hypertension about 10 days later.What would be the characteristic blood test finding in this condition?
Your Answer: Low C4 level
Correct Answer: Depressed CH 50 level
Explanation:Because the medical history included tonsillitis followed by haematuria and hypertension, there is a strong suspicion of a case of post-streptococcal glomerulonephritis (PSGN). Patients with PSGN usually have serological findings showing depressed serum haemolytic component CH50 and serum concentrations of C3. Sometimes depressed C4 levels are also apparent, but not always, therefore, the answer to this question is: depressed CH50 level.
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This question is part of the following fields:
- Renal
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Question 21
Correct
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A 10 year old boy presented with episodic bluish pale skin while crying and brief episodes of loss of consciousness. On examination he has clubbing, cyanosis and a pansystolic murmur. Which of the following is the most probable diagnosis?
Your Answer: Tetralogy of Fallot
Explanation:Except Tetralogy of Fallot, the others are acyanotic heart diseases. The cyanotic spells and loss of consciousness are due to spasm of the infundibular septum, which acutely worsens the right ventricular outflow tract obstruction. The given murmur is due to a ventricular septal defect.
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This question is part of the following fields:
- Cardiovascular
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Question 22
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: Osteoid osteoma
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 23
Incorrect
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A 6 week old girl presents with intermittent rectal bleeding. She is breastfed and otherwise healthy. Doctors suggest the baby has allergic proctitis. What of the following should the mother do and what should she feed her baby at this point?
Your Answer: Continue to breast-feed; mother to use soya milk instead of cow's milk
Correct Answer: Continue to breast-feed; mother to go onto a strict milk- and soya-free diet
Explanation:This is probably a case of protein-induced allergic proctitis, due to dietary protein transmitted through the mother to the breast-fed child. The mother should go on a milk-free and soya-free diet but continue to breast-feed.
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This question is part of the following fields:
- Nutrition
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Question 24
Incorrect
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In an age and sex matched case control study, 30 adolescents with high blood pressure were compared to 30 controls from the same clinic. The mean birth weights of the two groups were compared using a paired t-test. The results indicated that the control group was 150 g heavier with a standard error of 100 g.Which one of these is the most appropriate conclusion?
Your Answer: The sample size is inappropriate to draw conclusions about adolescent hypertension and birth weight
Correct Answer:
Explanation:In case control studies, observational studies are made to compare two groups, individuals with a certain condition, to those without the condition, with all other factors being equal. In the situation presented by the question, the study was to determine whether a prior risk factor, a low birth weight, was associated with later developing adolescent hypertension, using a paired t-test to statistically determine whether there was indeed a significant association between the two conditions. Case control studies only help to draw associations between two groups and therefore cannot indicate causation. In this scenario we are also not given the p value to determine whether the association is statistically significant. Therefore there is not enough evidence to conclude whether or not birthweight affects the development of adolescent hypertension.
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This question is part of the following fields:
- Epidemiology And Statistics
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Question 25
Correct
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An 8 week old baby presents with a fever of 38 degrees. What is the most appropriate course of action?
Your Answer: Admit for infection screen and start IV antibiotic
Explanation:This temperature is considered to be a mild fever and is most often caused by a minor infection in children of this age. Therefore, an infection screen should be conducted and an IV antibiotic.
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This question is part of the following fields:
- Infectious Diseases
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Question 26
Incorrect
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Which is not a variation of lichen planus?
Your Answer: Follicular
Correct Answer: Sclerotic
Explanation:The clinical presentation of lichen planus has several variations, as follows:- Hypertrophic lichen planus- Atrophic lichen planus- Erosive/ulcerative lichen planus- Follicular lichen planus (lichen planopilaris)- Annular lichen planus- Linear lichen planus- Vesicular and bullous lichen planus- Actinic lichen planus- Lichen planus pigmentosus- Lichen planus pemphigoides
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This question is part of the following fields:
- Dermatology
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Question 27
Correct
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A 2 year old female was taken to her local emergency department with jerking movements in her limbs. This lasted for around 10 seconds, and then she fell unconscious. She soon regained consciousness - she was disorientated but afebrile with no symptoms of meningeal irritation. From the list of options, chose the most appropriate investigation route for this patient.
Your Answer: 24 hour EEG
Explanation:Many of the symptoms favour an epilepsy diagnosis: uncontrollable jerking of the limbs and a loss of consciousness. A 24-hour EEG is used to diagnose epilepsy.
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This question is part of the following fields:
- Neurology
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Question 28
Correct
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A 12 year old boy with type I diabetes was reluctant to go to school. According to him, he was unhappy at the school. Which of the following is the next appropriate step?
Your Answer: Clinical psychologist
Explanation:The child’s problem should be assessed properly to find the reason for unhappiness at the school. There can be many reasons such as bullying at school, abuse etc. A clinical psychologist should assess this child to take the necessary details and plan the further management.
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This question is part of the following fields:
- Endocrinology
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Question 29
Incorrect
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A 5 month old baby presents with bilious vomiting. Doctors notice a palpable mass and drawing up of legs. They treat the baby with an air reduction enema, suspecting intussusception. However, the procedure is interrupted as the baby develops abdominal distention and starts to drop their saturations. What would be the single most appropriate next step?
Your Answer: Stop the procedure and arrange for surgical 'open' reduction of intussusception
Correct Answer: Immediate needle decompression of pneumoperitoneum
Explanation:Immediate needle decompression of pneumoperitoneum is necessary to avoid tension pneumoperitoneum. Air reduction enema is the main stay of treatment for intussusception and is successful in around 90% of cases. A serious potential risk of this procedure is perforation of the colon and a pneumoperitoneum, leading to rapid distension of the abdomen and splinting of the diaphragm.
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This question is part of the following fields:
- Paediatric Surgery
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Question 30
Correct
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A 12-year-old female presented with a bleeding nose. On examination by the ENT surgeon, it was noticed that the bleeding was coming from the anterior part of the nose and the bleeding point was clearly visualised. Which of the following options is the most suitable choice in this case?
Your Answer: Cautery
Explanation:In the case of anterior nasal bleeds, when the bleeding point is clearly visualised the best management step is cautery, either electrical or chemical.
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This question is part of the following fields:
- ENT
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SESSION STATS - PERFORMANCE PER SPECIALTY
