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  • Question 1 - Extracellular body fluid as compared with intracellular body fluid: ...

    Incorrect

    • Extracellular body fluid as compared with intracellular body fluid:

      Your Answer: Has greater volume

      Correct Answer: Is relatively rich in glucose

      Explanation:

      The percentages of body water contained in various fluid compartments add up to total body water (TBW). This water makes up a significant fraction of the human body, both by weight and by volume. Ensuring the right amount of body water is part of fluid balance, an aspect of homeostasis. The extracellular fluid (ECF) includes all fluids outside the cells. This fluid can be divided into three fluid departments: interstitial (in the tissue spaces) fluid, blood plasma and lymph, and specialised compartments called transcellular fluid. The extracellular fluid surrounds all the cells in the body and is in equilibrium with the intracellular fluid. So, its composition must remain fairly constant even though substances are passing into and out of the cells. The interstitial fluid, though called a fluid, is in a reality a gel-like composition made up of: water, proteoglycan molecules and collagen. The extracellular fluid constitutes 40% of total body water, with intracellular fluid making up the remaining 60%. It is relatively rich in glucose.

    • This question is part of the following fields:

      • Fluid And Electrolytes
      3
      Seconds
  • Question 2 - Proteinuria is NOT a recognized feature of which of the following conditions? ...

    Incorrect

    • Proteinuria is NOT a recognized feature of which of the following conditions?

      Your Answer:

      Correct Answer: Landau-Kleffner syndrome

      Explanation:

      Proteinuria refers to an increased amount of protein excretion in urine, which should be greater than 100mg/m2 per day on a single spot urine collection. The limit is even more relaxed for infants and neonates. Proteinuria is a prominent manifestation of cystinosis, acute tubular necrosis, Fanconi syndrome, and celiac disease. Landau-Kleffner syndrome is a rare childhood convulsive disorder, associated with acquired aphasia and auditory verbal agnosia.

    • This question is part of the following fields:

      • Nephro-urology
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  • Question 3 - A 5 week old boy with pyloric stenosis is vomiting forcefully. Which of...

    Incorrect

    • A 5 week old boy with pyloric stenosis is vomiting forcefully. Which of the following findings would you expect to be in his blood results?

      Your Answer:

      Correct Answer: Hypokalaemia

      Explanation:

      Progressive vomiting due to pyloric stenosis leads to hypochloraemic, hypokalaemic, metabolic alkalosis.

    • This question is part of the following fields:

      • Nephro-urology
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  • Question 4 - A lethargic 2-month child was brought in with symptoms of diarrhoea and vomiting...

    Incorrect

    • A lethargic 2-month child was brought in with symptoms of diarrhoea and vomiting for 6 days. What is the appropriate initial investigations?

      Your Answer:

      Correct Answer: Urea and electrolytes

      Explanation:

      The most commonly requested biochemistry tests for renal function are the urea and electrolytes. They supply important information when it comes to homeostasis and excretion. Glomerular filtration rate is also the essential standard marker of kidney health and is assessed by checking the creatinine levels. In this case as the child has lost fluids and electrolytes, this test will indicate the extent of the loss and allow for more appropriate replacement.

    • This question is part of the following fields:

      • Fluid And Electrolytes
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      Seconds
  • Question 5 - A 6 year old child presents with secondary nocturnal enuresis. He is otherwise...

    Incorrect

    • A 6 year old child presents with secondary nocturnal enuresis. He is otherwise healthy and with a clear family history. He drinks sufficient amounts of fluids but is a fussy eater. Clinical examination reveals a mass in the left iliac fossa. What is the most likely diagnosis?

      Your Answer:

      Correct Answer: Constipation

      Explanation:

      Constipation is often associated with nocturnal enuresis in children. The palpable mass is the impacted stool. The decreased appetite is common in those with constipation.

    • This question is part of the following fields:

      • Nephro-urology
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  • Question 6 - A 11-year-old boy has a history of tonsillitis followed by haematuria and hypertension...

    Incorrect

    • 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:

      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.

    • This question is part of the following fields:

      • Renal
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  • Question 7 - A 2-day old baby who suffered from voiding difficulties is diagnosed with hypospadias....

    Incorrect

    • A 2-day old baby who suffered from voiding difficulties is diagnosed with hypospadias. Which of the following abnormalities is most often associated with this condition?

      Your Answer:

      Correct Answer: Cryptorchidism

      Explanation:

      Hypospadias is an abnormality of anterior urethral and penile development. The urethral opening is located on the ventral aspect of the penis proximal to the tip of the glans penis, which, in this condition, is open. The urethral opening may be located as proximal as in the scrotum or perineum. The penis may also have associated ventral shortening and curvature, called chordee, with more proximal urethral defects.

    • This question is part of the following fields:

      • Nephro-urology
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  • Question 8 - A 10 month infant was brought in a drowsy condition with a 4...

    Incorrect

    • A 10 month infant was brought in a drowsy condition with a 4 day history of vomiting and diarrhoea. His skin turgor was reduced and skin appeared mottled. Vital signs showed decreased BP, reduced capillary refill and a heart rate of 145/min. The best choice of treatment in this case would be?

      Your Answer:

      Correct Answer: IV fluid bolus over 20 minutes

      Explanation:

      According to WHO, the treatment protocol in severely dehydrated children, is to infuse a bolus of isotonic crystalloid over 20-30 min at 30ml/kg to children less than 12 months of age followed by giving the remaining fluid over 5 hours for infants. Reference: World Health Organisation, the treatment of diarrhoea, a manual for physical and senior health workers.

    • This question is part of the following fields:

      • Fluid And Electrolytes
      0
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  • Question 9 - Which of the following patient populations is most likely to present with primary...

    Incorrect

    • Which of the following patient populations is most likely to present with primary vesicoureteric reflux?

      Your Answer:

      Correct Answer: New-born girls

      Explanation:

      Vesicoureteric reflex (VUR) is described as the retrograde flow of urine from the bladder into the ureter due to an incompetent uterovesical junction. In primary VUR the lower urinary tract functions normally, while secondary VUR is associated with a poorly functioning lower urinary tract. The incidence of VUR is highest in new-born girls. They can present with hydronephrosis, or urinary tract infections.

    • This question is part of the following fields:

      • Nephro-urology
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  • Question 10 - A 12-year-old girl presents with constant dripping of urine despite being able to...

    Incorrect

    • A 12-year-old girl presents with constant dripping of urine despite being able to void a full volume bladder.

      An ultrasound scan shows bilaterally enlarged kidneys.

      What is the most probable diagnosis for this patient?

      Your Answer:

      Correct Answer: Duplex kidney with ectopic ureter

      Explanation:

      The most probable diagnosis for this patient would be a duplex kidney with an ectopic ureter inserting below the bladder neck.

      Rationale:
      The Weigert-Myer law states that the upper moiety ureter inserts inferior and medial to the lower moiety ureter.

      Other options:
      – Horseshoe kidney would display as a single pelvic kidney on an ultrasound scan.
      – Ureterocele would be a cystic lesion within the bladder or may prolapse at birth.
      – Continence should not be affected by polycystic kidney disease.
      – The overactive bladder would cause frequency and urgency, neither of which is mentioned in the history.

    • This question is part of the following fields:

      • Nephro-urology
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  • Question 11 - A 12 year old boy has a high HbA1c and is being checked...

    Incorrect

    • A 12 year old boy has a high HbA1c and is being checked by the diabetic specialist nurse. He has been skipping meals lately and his school teachers have noticed that he's been unhappy. Who do you suggest his parents take him to?

      Your Answer:

      Correct Answer: Clinical psychologist

      Explanation:

      The boy is most probably a type 1 diabetic patient. Such a condition can affect the behaviour and psychological state of a young child reflected in their behaviour. The parents should seek the help of a clinical psychologist.

    • This question is part of the following fields:

      • Renal
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  • Question 12 - A 7-year-old female presented with complaints of haematuria and fatigue. She had a...

    Incorrect

    • 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:

      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.

    • This question is part of the following fields:

      • Renal
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      Seconds
  • Question 13 - A 10-year-old boy was discharged from hospital after an episode of acute testicular...

    Incorrect

    • A 10-year-old boy was discharged from hospital after an episode of acute testicular pain.

      Considering he had an anatomical anomaly involving the processus vaginalis, what is the most probable diagnosis for this child?

      Your Answer:

      Correct Answer: Testicular torsion

      Explanation:

      Based on the presented clinical scenario, the most probable diagnosis for the patient would be testicular torsion.

      Rationale:
      The gubernaculum is the structure responsible for aiding the descent of the testicles from the abdomen into the scrotum. The processus vaginalis precedes the descent of the testes and then undergoes closure.
      Abnormalities such as the persistence of a patent processus vaginalis, known as bell clapper deformity, predispose to testicular torsion.

      Other options:
      – Varicocele: Nutcracker syndrome occurs where the left renal vein becomes compressed in between the superior mesenteric artery and the aorta. Since the left gonadal vein drains into the left renal vein, this results in a varicocele.
      – Epididymitis and mumps orchitis are differentials for acute testicular pain but are not due to a defect in the processus vaginalis.
      – An incarcerated inguinal hernia presents mainly with signs of bowel obstruction which are not mentioned in the clinical scenario.

      The descent of testes:
      – Until the end of foetal life, the testicles are located within the abdominal cavity.
      – They are initially located on the posterior abdominal wall on a level with the upper lumbar vertebrae (L2).
      – Attached to the inferior aspect of the testis is the gubernaculum testis which extends caudally to the inguinal region, through the canal and down to the superficial skin.
      – It is interesting to note that both the testis and the gubernaculum are extra-peritoneal.
      – As the foetus grows, the gubernaculum becomes progressively shorter. It carries the peritoneum of the anterior abdominal wall (the processus vaginalis). As the processus vaginalis descends the testis is guided by the gubernaculum down the posterior abdominal wall and the back of the processus vaginalis into the scrotum.
      – By the third month of foetal life the testes are located in the iliac fossae, by the seventh they lie at the level of the deep inguinal ring.

      Usually, the processus vaginalis closes after birth but may persist predisposing to indirect hernias.
      On the other hand, a partial closure may result in the development of cysts on the cord.

    • This question is part of the following fields:

      • Nephro-urology
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  • Question 14 - A 5 month old baby presents with failure to thrive, and the following...

    Incorrect

    • A 5 month old baby presents with failure to thrive, and the following blood results:
      Na=135 mmol/l
      K=2.3 mmol/l
      Urea=2.0 mmol/l
      Creatinine 30 µmol/l
      P=0.8 mmol/l
      Bicarbonate=17 mmol/l
      Ca=2.5 mmol/l
      Additionally, urinalysis reveals 1+ glucose and 1+ protein.
      Which of the following is the most probable diagnosis?

      Your Answer:

      Correct Answer: Fanconi tubular syndrome

      Explanation:

      Fanconi tubular syndrome is characterised by malabsorption of various electrolytes and substances commonly absorbed by the proximal tubule. Hypokalaemia, hypophosphatemia, and hyperchloremic metabolic acidosis is usually present. Also, urinalysis reveals an increased fractional excretion of glucose.

    • This question is part of the following fields:

      • Nephro-urology
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  • Question 15 - A 15-year-old boy presents to the physician complaining of malaise and inability to...

    Incorrect

    • A 15-year-old boy presents to the physician complaining of malaise and inability to participate in physical activities due to exhaustion. His vitals, including the blood pressure are within the normal range and the labs are as follows:
      sodium 145 mmol/l
      potassium 2.8 mmol/l
      bicarbonate 30 mmol/l
      chloride 83 mmol/l (95-107)
      magnesium 0.5 mmol/l (0.75-1.05)
      glucose 5.0 mmol/l
      renin 5.1 mmol/ml per h (3-4.3)
      aldosterone 975 mmol/l (330-830)
      urea 5.2 mmol/l.

      What is the most likely diagnosis?

      Your Answer:

      Correct Answer: Gitelman's syndrome

      Explanation:

      Gitelman syndrome is a kidney disorder that causes an imbalance of charged atoms (ions) in the body, including ions of potassium, magnesium, and calcium.

      The signs and symptoms of Gitelman syndrome usually appear in late childhood or adolescence. Common features of this condition include painful muscle spasms (tetany), muscle weakness or cramping, dizziness, and salt craving. Also common is a tingling or prickly sensation in the skin (paraesthesia), most often affecting the face. Some individuals with Gitelman syndrome experience excessive tiredness (fatigue), low blood pressure, and a painful joint condition called chondrocalcinosis. Studies suggest that Gitelman syndrome may also increase the risk of a potentially dangerous abnormal heart rhythm called ventricular arrhythmia.

    • This question is part of the following fields:

      • Nephro-urology
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  • Question 16 - Which of the given laboratory findings is NOT suggestive of Fanconi syndrome? ...

    Incorrect

    • Which of the given laboratory findings is NOT suggestive of Fanconi syndrome?

      Your Answer:

      Correct Answer: Haematuria

      Explanation:

      Fanconi syndrome is a rare disorder characterized by defective proximal renal tubular reabsorption, which leads to excessive excretion of potassium, phosphate, uric acid, bicarbonates, glucose, and certain amino acids in the urine. Loss of potassium in the urine leads to hypokalaemia, while the loss of phosphate may lead to hypophosphatemic rickets. The overall impact is the failure to thrive and growth retardation.

    • This question is part of the following fields:

      • Nephro-urology
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  • Question 17 - A 6 year old girl with a history of polyuria and polydipsia undergoes...

    Incorrect

    • A 6 year old girl with a history of polyuria and polydipsia undergoes a water deprivation test. Previous urine dipstick results were negative for blood, glucose, or protein. The test is started and once the girl loses 3% of her body weight, her serum osmolarity is more than 300 whereas her urine osmolarity is less than 300. Doctors administer desmopressin but osmolarity levels do not change. What is the most likely diagnosis?

      Your Answer:

      Correct Answer: Nephrogenic Diabetes Insipidus

      Explanation:

      Nephrogenic Diabetes Insipidus is an acquired or hereditary condition that affects the water balance. It presents with polyuria and polydipsia, leading commonly to dehydration.

    • This question is part of the following fields:

      • Nephro-urology
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  • Question 18 - A 10-month-old girl was diagnosed with a urinary tract infection.
    Which of the following...

    Incorrect

    • A 10-month-old girl was diagnosed with a urinary tract infection.
      Which of the following is NOT a requirement to perform imaging studies in this child?

      Your Answer:

      Correct Answer: E.coli UTI

      Explanation:

      E. coli accounts for the majority of UTI’s in children. If this child responds well to treatment and has no recurrence of his symptoms, then no form of imaging is required, as per NICE advice for children aged 6 months to 3 years. Had the child been less than 6 months of age, then a USS at 6 weeks would be necessary.

      Other options:
      – Pseudomonas causes atypical UTI. This warrants ultrasonography within the acute illness phase as it may reflect an underlying pathology and DMSA at 4-6 months.
      – Recurrent UTI is defined as two or more episodes of pyelonephritis OR 1 pyelonephritis and one cystitis OR 3 or more cystitis. It requires USS at six weeks and DMSA at 4-6 months.
      – Septicaemia is a sign of an atypical UTI. This requires USS within the acute illness as it may reflect an underlying pathology and DMSA at 4-6 months.
      – Unwell 48hrs post antibiotics is a sign of an atypical UTI. This requires USS within the acute illness as may reflect underlying pathology and DMSA at 4-6 months.

    • This question is part of the following fields:

      • Nephro-urology
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  • Question 19 - A 3-year-old boy presents with facial puffiness, frothy urine, lethargy and oliguria for...

    Incorrect

    • A 3-year-old boy presents with facial puffiness, frothy urine, lethargy and oliguria for two weeks. Urine analysis reveals proteinuria. Which of the following is the most appropriate treatment for this child?

      Your Answer:

      Correct Answer: Prednisolone

      Explanation:

      The presentation is suggestive of nephrotic syndrome. A trial of corticosteroids is the first step in treatment of idiopathic nephrotic syndrome. Diuretics are useful in managing symptomatic oedema. Cyclosporin and cyclophosphamide are indicated in frequently relapsing and steroid dependant disease.

    • This question is part of the following fields:

      • Renal
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  • Question 20 - A 6 year old child presents with clinical features of nephrotic syndrome and...

    Incorrect

    • A 6 year old child presents with clinical features of nephrotic syndrome and a history of hypertension. He has normal serum cholesterol levels, however, his urine microscopy reveals oval fat bodies. Which of the following most likely represents the cause of the nephrotic syndrome?

      Your Answer:

      Correct Answer: Minimal change glomerulonephritis

      Explanation:

      Minimal change glomerulonephritis presents with mild or benign urinalysis findings. However, proteinuria together with the presence of oval fat bodies are typical.
      Minimal change glomerulonephritis (nephropathy) accounts for most cases of childhood nephrotic syndrome and 20-25% of adult nephrotic syndrome.

    • This question is part of the following fields:

      • Nephro-urology
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  • Question 21 - A 17-year-old female, who works at a day-care centre presents to the physician...

    Incorrect

    • A 17-year-old female, who works at a day-care centre presents to the physician with vomiting, joint pains, diarrhoea and crampy abdominal pain. Physical examination reveals a purpuric rash on her legs and over the belt area. She has microscopic haematuria, proteinuria and RBC casts on urine testing. Which of the underlying diagnoses is most likely in this case?

      Your Answer:

      Correct Answer: Henoch-Schonlein purpura (HSP)

      Explanation:

      Henoch-Schonlein purpura (HSP), also known as IgA vasculitis, is a disease of the skin, mucous membranes, and sometimes other organs that most commonly affects children. In the skin, the disease causes palpable purpura (small, raised areas of bleeding underneath the skin), often with joint pain and abdominal pain. It is an acute immunoglobulin A (IgA)-mediated disorder. The tetrad of purpura, arthritis, kidney inflammation, and abdominal pain is often observed.

    • This question is part of the following fields:

      • Nephro-urology
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  • Question 22 - A 15-year-old boy is referred to you as his primary physician had incidentally...

    Incorrect

    • A 15-year-old boy is referred to you as his primary physician had incidentally noticed protein in the urine on two occasions when the child came to see him after school. The boy is otherwise healthy and has no signs of oedema or recent infection. The urine dipstick you obtain is negative for protein when you review him in the early morning hours. What is the most likely cause of proteinuria in this child?

      Your Answer:

      Correct Answer: Orthostatic proteinuria

      Explanation:

      Based on the clinical presentation, the child probably has orthostatic proteinuria.

      Orthostatic proteinuria occurs when the kidneys can conserve urine when the patient is recumbent, such as sleeping at night, but leak protein with standing or in exercise.
      This results in early morning urine being negative for protein but late in the day urine being positive. It is mostly seen in tall thin adolescents and is benign.

      Other options:
      – Alport’s syndrome is a hereditary condition associated with haematuria and deafness.
      – Urinary tract infections can cause proteinuria, but leucocyte esterase and nitrites would also be expected in a child of this age.
      – Nephritic syndrome can be associated with proteinuria, but haematuria would also be present.
      – In nephrotic syndrome, proteinuria would be present on all occasions and associated with oedema.

    • This question is part of the following fields:

      • Nephro-urology
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  • Question 23 - A 2 year old boy is brought by his mother to the emergency...

    Incorrect

    • A 2 year old boy is brought by his mother to the emergency department with colicky pain. The boy has experienced such episodes of pain in the past, which radiates from his loin to the groin. After clinical examination and investigations, a 7mm stone has been found in his ureter. What is the single most appropriate next step?

      Your Answer:

      Correct Answer: Conservative treatment

      Explanation:

      Renal stones < 5mm generally pass spontaneously with adequate fluid intake. Stones 5mm-10mm with pain not resolving, require medical expulsive therapy with Nifedipine or Tamsulosin. For stones larger than 10mm, ESWL or Ureteroscopy is indicated. For stones as big as 2cm, percutaneous nephrolithotomy should be applied.

    • This question is part of the following fields:

      • Renal
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  • Question 24 - Which among the following is the part of the nephron where ADH (antidiuretic...

    Incorrect

    • Which among the following is the part of the nephron where ADH (antidiuretic hormone) primarily acts?

      Your Answer:

      Correct Answer: Collecting ducts

      Explanation:

      ADH primarily acts on the collecting ducts.

      Other options:
      – The juxtaglomerular apparatus is the site of renin production.
      – The proximal tubule conducts isosmotic reabsorption of about 60% of sodium chloride and volume. Most of the glucose, amino acids, potassium and phosphate are absorbed here.
      – The loop of Henle is the site of 25% of sodium reabsorption. Active Chloride transport provides the basis for the counter current multiplier aiding urinary concentration.
      – The distal convoluted tubule is impermeable to water and acts via active sodium chloride absorption to dilute urine.

    • This question is part of the following fields:

      • Nephro-urology
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  • Question 25 - A 10-year-old boy was brought to the clinic by his parents. They are...

    Incorrect

    • A 10-year-old boy was brought to the clinic by his parents. They are worried because they are unable to see his testes. They state they were present at birth.
      On examination, both testes are clearly in the groin. On manipulation, they can be brought into the scrotum.

      Which of the following is the most probable diagnosis and most appropriate course of action for this child?

      Your Answer:

      Correct Answer: Bilateral retractile testis, discharge with reassurance

      Explanation:

      The most probable diagnosis for this patient is bilateral retractile testes. This a normal phenomenon in some pre-pubertal boys.

      Rationale:
      Testicular descent can continue until about 3-months of age. The pre-pubertal testis is small enough that with activation of the cremasteric reflex, they can enter the inguinal canal.
      This in itself is a normal finding providing the testis can be brought into the scrotum without tension and does not require surgical correction. With time the testis will lie within the scrotum.

      Orchidopexy for true undescended testis can be performed from 6-months of age. It is also warranted if the testes remain undescended or intra-abdominally leading to infertility.

      Other options:
      – An ascending testis is one, typically, following hernia or orchidopexy surgery that was in the testis but with time is within the inguinal canal and cannot be brought into the scrotum. Orchidopexy is required for this.
      – No surgery is required as when the testis enlarges with puberty it will remain within the scrotum.
      – The testes can be brought into the scrotum. Therefore they are not undescended.
      – The testes are retractile not ascending; ascending testis cannot be brought into the scrotum and would require orchidopexy.

    • This question is part of the following fields:

      • Nephro-urology
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  • Question 26 - A 15-year-old boy presents with a concern that he is the shortest in...

    Incorrect

    • A 15-year-old boy presents with a concern that he is the shortest in his class, and his voice has not 'broken' yet.
      A thorough examination reveals that his sexual development is within the normal range, and he is reassured that puberty occurs at different times for everyone.
      Which of the following cells in the testes secrete testosterone?

      Your Answer:

      Correct Answer: Leydig cells

      Explanation:

      The cells in the testes that secrete testosterone are the Leydig cells.

      Other cells in testes include:
      – Spermatogonia: These are undifferentiated male germ cells which undergo spermatogenesis in the seminiferous tubules of the testes.
      – Sertoli cells: They are a part of the seminiferous tubule of the testes, cells are activated by FSH and nourish developing sperm cells.
      – Myoid: They are squamous contractile cells which generate peristaltic waves, they surround the basement membrane of testes.
      – Fibroblasts: Cells which synthesise collagen and the extracellular matrix.

    • This question is part of the following fields:

      • Nephro-urology
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  • Question 27 - A 16-year-old male presents to the emergency with severe testicular pain and is...

    Incorrect

    • A 16-year-old male presents to the emergency with severe testicular pain and is diagnosed with suspected testicular torsion. He is scheduled for surgical exploration. The surgeon makes an incision on the skin and then the dartos muscle. Which of the following tissue layers will be incised next?

      Your Answer:

      Correct Answer: External spermatic fascia

      Explanation:

      Coverings of the spermatic cord:
      Spermatic cord is covered by three concentric layers of fasciae, derived from the layers the of anterior abdominal wall. Developmentally, each covering is acquired as the processus vaginalis descends into the scrotum through the layers of the abdominal wall. The layers are:

      External spermatic fascia: It is derived from the external oblique muscle. It attaches to the margins of superficial inguinal ring.
      Cremasteric fascia: It is derived from the internal oblique muscle. It covers the cremaster muscle.
      Internal spermatic fascia: It is derived from the fascia transversalis (fascia covering the transversus abdominis muscle). It is attached to the margins of the deep inguinal ring.

    • This question is part of the following fields:

      • Nephro-urology
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  • Question 28 - A 16-year-old girl developed haemoptysis with acute kidney injury requiring dialysis. She suffered...

    Incorrect

    • A 16-year-old girl developed haemoptysis with acute kidney injury requiring dialysis. She suffered from recurrent epistaxis for the past 2 weeks. Renal biopsy showed crescentic glomerulonephritis. Which antibody would you expect to be positive?

      Your Answer:

      Correct Answer: Antiproteinase 3

      Explanation:

      This patient has pulmonary renal syndrome which is most commonly due to an ANCA positive vasculitis. The history of recurrent epistaxis makes Wegener’s granulomatosis the most probable diagnosis. Wegener’s granulomatosis, microscopic polyangiitis, and idiopathic pauci-immune necrotizing crescentic glomerulonephritis (NCGN) are strongly associated with antineutrophil cytoplasmic autoantibodies (ANCAs) directed against either proteinase 3 (anti-PR3) or myeloperoxidase (anti-MPO).

    • This question is part of the following fields:

      • Renal
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  • Question 29 - A 2-month-old infant was brought to the paediatrics ward by her mother with...

    Incorrect

    • A 2-month-old infant was brought to the paediatrics ward by her mother with a complaint of excessive crying during urination. The urine culture of the infant revealed E.coli. Which of the following investigations should be done next?

      Your Answer:

      Correct Answer: US

      Explanation:

      Urine culture confirms a diagnosis of a UTI. A kidney ultrasound will be the next best investigation because it will help us to visualise the bladder, kidneys, and ureters to rule out any congenital obstruction in the urinary tract that might be the actual cause of infection in this 2-month old girl.

    • This question is part of the following fields:

      • Renal
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  • Question 30 - A 17-year-old teenage girl presents with a systolic blood pressure of 170 mmHg...

    Incorrect

    • A 17-year-old teenage girl presents with a systolic blood pressure of 170 mmHg in all four limbs. Femoral pulses are palpable. Physical examination revealed several large cafe-au-lait patches and axillary freckling.
      The girl's father died of intracerebral haemorrhage associated with hypertension at the age of 50.
      Which one of the following is the most likely cause of hypertension in this patient?

      Your Answer:

      Correct Answer: Renal artery stenosis

      Explanation:

      The patient shows features of neurofibromatosis. The most likely cause for hypertension in this patient would be renal artery stenosis.

      Note:
      Neurofibromatosis is an inherited autosomal dominant disorder which could have affected this girl’s father, and she appears to have the classic skin lesions.
      A renal bruit might be heard in these patients.
      Polycystic kidney disease can occur in association with tuberous sclerosis, which also has skin lesions associated (different from those described in this patient).
      Most causes of hypertension in childhood have underlying renal causes, and a renal ultrasound with doppler is the first-line investigation of choice. Even if this is normal, further imaging would be indicated here, for example, isotope renal scans and angiography.

    • This question is part of the following fields:

      • Nephro-urology
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