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  • Question 1 - A 15-day old baby was brought to the emergency department with constipation for...

    Correct

    • A 15-day old baby was brought to the emergency department with constipation for 4 days. On examination, the abdomen of the baby was found to be distended and tender all over. No bowel sounds were heard. A sigmoid colon biopsy was carried out, which showed absent ganglion cells. What is the diagnosis?

      Your Answer: Hirschsprung's disease

      Explanation:

      Hirschsprung’s disease is characterized by congenital absence of the autonomic plexus (Meissner’s and Auerbach’s plexus) in the intestinal wall. Usually limited to the distal colon, it can occasionally involve the entire colon or even the small bowel. There is abnormal or absent peristalsis in the affected segment, resulting in continuous spasm of smooth muscle and partial/complete obstruction. This causes accumulation of intestinal contents and dilatation of proximal segment. Skip lesions are highly uncommon. This disease is seen early in life with 15% patients presenting in first month, 60% by 1 year of age and 85% by the age of 4 years. Symptoms include severe and complete constipation, abdominal distension and vomiting. Patients with involvement of ultra-short segments might have mild constipation with intervening diarrhoea. In older children, symptoms include failure to thrive, anorexia, and lack of an urge to defecate. On examination, an empty rectum is revealed with stool palpable high up in the colon. If not diagnosed in time, it can lead to Hirschsprung’s enterocolitis (toxic megacolon), which can be fulminant and lead to death. Diagnosis involves a barium enema or a rectal suction biopsy. Barium enema shows a transition in diameter between the dilated, normal colon proximal to the narrowed, affected distal segment. It is to be noted that barium enema should be done without prior preparation, which can dilate the abnormal segment, leading to a false-negative result. A 24-hour post-evacuation film can be obtained in the neonatal period -if the colon is still filled with barium, there is a high likelihood of Hirschsprung’s disease. Full-thickness rectal biopsy is diagnostic by showing the absence of ganglion cells. Acetylcholinesterase staining can be done to highlight the enlarged nerve trunks. Abnormal innervation can also be demonstrated by rectal manometry.

    • This question is part of the following fields:

      • Gastroenterology And Hepatology
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  • Question 2 - Which of these developmental milestones would be advanced for a 3-year-old? ...

    Incorrect

    • Which of these developmental milestones would be advanced for a 3-year-old?

      Your Answer:

      Correct Answer: Doing up buttons unaided

      Explanation:

    • This question is part of the following fields:

      • Child Development
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  • Question 3 - A 6 month old baby has been exclusively breast fed for two years,...

    Incorrect

    • A 6 month old baby has been exclusively breast fed for two years, and now receives a mixture of bottle feeds and breast milk. The mother of the child wants advice on how to wean the baby.

      Which of the following is the MOST appropriate advice to give the mother?

      Your Answer:

      Correct Answer: Infant led weaning can be tried first if the mother is happy with this

      Explanation:

      At the age of 6 months, children can begin to be weaned off breastmilk and formula feeds. One healthy and inexpensive way to do this is through infant led weaning as opposed to the conventional spoon feeding method. Children are able to enjoy a variety of soft finger foods even before they grow teeth, so all food does not need to be pureed or sweet.

      Children should however not be given cow’s milk until the age of 1 year.

    • This question is part of the following fields:

      • Nutrition
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  • Question 4 - A 5 year old girl presents with a wart-like lesion on her thigh...

    Incorrect

    • A 5 year old girl presents with a wart-like lesion on her thigh and a hyperpigmented, rhabdoid whorl rash. She has a history of seizures since she was three years old and warts similar to the one she has now. Family history reveals the mother had two in utero stillbirths. The doctor observes small vesicles on the anterior surface of her left wrist. Other findings include mild scoliosis, thin wiry hair, and peg-shaped teeth. Her gait is normal and she is otherwise healthy. Ruth Griffiths score reveals a reduced sub quotient in terms of social skills, performance, and language and hearing skills. The doctor takes a biopsy sample which shows many intradermal eosinophils in the absence of inflammatory cells.
      What is the most probable diagnosis?

      Your Answer:

      Correct Answer: Incontinentia pigmenti

      Explanation:

      Incontinentia pigmenti is a genetic condition that affects females more than males. It usually manifests in the skin but can affect other parts of the body as well. It presents with a blistering rash that may evolve into wart-like growths. Hyperpigmentation and hair loss are also present, as well as eye and teeth abnormalities. Clinically there are three phases:
      1- the bullous phase – crops of vesicles appear in the first 2 weeks of life;
      2- the papular phase – warty papules that flatten out over the skin; and
      3- the hyperpigmented phase – pigmentary changes in the form of whorls and streaks that are hypo- and hyperpigmented in nature.

    • This question is part of the following fields:

      • Dermatology
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  • Question 5 - A male had a deep vein thrombosis (DVT) in his left calf. After...

    Incorrect

    • 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:

      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 Leiden
      Prothrombin G20210A variant
      Protein C deficiency
      Protein S deficiency
      Antithrombin deficiency

      Von Willebrand disease and thalassaemia are not causes of DVT.

    • This question is part of the following fields:

      • Haematology And Oncology
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  • Question 6 - Which of the following disorders is correctly linked to associated mutations? ...

    Incorrect

    • Which of the following disorders is correctly linked to associated mutations?

      Your Answer:

      Correct Answer: Charcot- Marie-Tooth- whole gene duplication

      Explanation:

      Types of DNA mutations and their impact
      point mutation:
      Substitution: One base is incorrectly added during replication and replaces the pair in the corresponding position on the complementary strand as in Sickle cell anaemia
      Insertion: One or more extra nucleotides are inserted into replicating DNA, often resulting in a frameshift as in one form of beta-thalassemia
      Deletion: One or more nucleotides is skipped during replication or otherwise excised, often resulting in a frameshift as in Cystic fibrosis.

      Chromosomal mutation:
      Inversion: One region of a chromosome is flipped and reinserted as in Opitz-Kaveggia syndrome
      Deletion: A region of a chromosome is lost, resulting in the absence of all the genes in that area as in Cri du chat syndrome
      Duplication: A region of a chromosome is repeated, resulting in an increase in dosage from the genes in that region as in some cancers and Charcot-Marie tooth
      Translocation: A region from one chromosome is aberrantly attached to another chromosome as in One form of leukaemia

      Copy number variation:
      Gene amplification: The number of tandem copies of a locus is increased as in Some breast cancers
      Expanding trinucleotide repeat: The normal number of repeated trinucleotide sequences is expanded as in Fragile X syndrome, Huntington’s disease

    • This question is part of the following fields:

      • Genetics And Dysmorphology
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  • Question 7 - A 10-month-old boy was brought to the emergency department with bilateral watery discharge...

    Incorrect

    • A 10-month-old boy was brought to the emergency department with bilateral watery discharge from both eyes with occasional mucoid discharge.
      The presentation is highly suggestive of a nasolacrimal duct dysfunction.

      Which of the following would be the most appropriate advice to be given to the boy's parents?

      Your Answer:

      Correct Answer:

      Explanation:

      The most appropriate management would be to reassure the parents, as nasolacrimal duct dysfunction in most infants tends to resolve spontaneously.

      Note:
      Nasolacrimal duct blockage occurs in up to 5% of new-borns. 90% of these babies spontaneously resolve in the first year of life.
      They do not require urgent ophthalmological review, as often advice and reassurance for parents suffice for up to the age of 18 months old or so.
      A lump can often be seen in the nasolacrimal region following the accumulation of mucous. This does not need to be treated with antibiotics unless there are signs of acute infection.

      Other options:
      – The child does not require urgent ophthalmology review as there are no signs of severe infection. Watery eyes often lead to mucous production, which is a common non-worrying sign.
      – A course of topical antibiotics: Watery eyes often lead to mucous production, which is distinct from pus discharge.
      Unnecessary topical antibiotics can cause secondary red eyes as well as give parents false expectations for the resolution of the symptoms and signs.
      – A course of topical and oral antibiotics: Watery eyes often lead to mucous production, which is distinct from pus discharge. Unnecessary topical and oral antibiotics can cause secondary red eyes as well as give parents false expectations for the resolution of the symptoms and signs.
      – Reassurance is necessary. However, the advice that the child most likely will need a surgical procedure to resolve this is incorrect. Reassurance, but include advice that the child most likely will need a surgical procedure to resolve this is incorrect as 90% of infants that have these symptoms and signs resolve within the first year of life.

    • This question is part of the following fields:

      • Ophthalmology
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  • Question 8 - A 17 year old girl presents with enlarged tonsils that meet in the...

    Incorrect

    • A 17 year old girl presents with enlarged tonsils that meet in the midline. Examination confirms the finding and petechial haemorrhages affecting the oropharynx are observed. Splenomegaly is seen on systemic examination. Which of the following is the most likely cause?

      Your Answer:

      Correct Answer: Infection with Epstein Barr virus

      Explanation:

      Answer: Acute Epstein Barr virus infection

      The Epstein-Barr virus is one of eight known human herpesvirus types in the herpes family, and is one of the most common viruses in humans. Infection with Epstein-Barr virus (EBV) is common and usually occurs in childhood or early adulthood.
      EBV is the cause of infectious mononucleosis, an illness associated with symptoms and signs like:
      fever,
      fatigue,
      swollen tonsils,
      headache, and
      sweats,
      sore throat,
      swollen lymph nodes in the neck, and
      sometimes an enlarged spleen.
      Although EBV can cause mononucleosis, not everyone infected with the virus will get mononucleosis. White blood cells called B cells are the primary targets of EBV infection.
      Petechiae on the palate are characteristic of streptococcal pharyngitis but also can be seen in Epstein-Barr virus infection, Arcanobacterium haemolyticum pharyngitis, rubella, roseola, viral haemorrhagic fevers, thrombocytopenia, and palatal trauma.

    • This question is part of the following fields:

      • Paediatric Surgery
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  • Question 9 - A clinical trial is conducted to study the benefits of a new oral...

    Incorrect

    • A clinical trial is conducted to study the benefits of a new oral medication to improve the symptoms of patients with asthma. In the trial 400 patients with asthma, half were given the new medication and half a placebo. Three months later they are asked to rate their symptoms using the following scale: much improved, slight improvement, no change, slight worsening, significantly worse. What is the most appropriate statistical test to see whether the new medication is beneficial?

      Your Answer:

      Correct Answer: Mann-Whitney U test

      Explanation:

      The type of significance test used depends on whether the data is parametric (can be measured, usually normally distributed) or non-parametric.

      Parametric tests:

      Student’s t-test – paired or unpaired*

      Pearson’s product-moment coefficient – correlation

      Non-parametric tests:

      Mann-Whitney U test – unpaired data

      Wilcoxon signed-rank test – compares two sets of observations on a single sample

      chi-squared test – used to compare proportions or percentages

      Spearman, Kendall rank – correlation.

      The outcome measured is not normally distributed, i.e. it is non-parametric. This excludes the Student’s t-tests. We are not comparing percentages/proportions so the chi-squared test is excluded. The Mann-Whitney U test is a nonparametric test of the null hypothesis that it is equally likely that a randomly selected value from one sample will be less than or greater than a randomly selected value from a second sample.

      This test can be used to investigate whether two independent samples were selected from populations having the same distribution.

    • This question is part of the following fields:

      • Epidemiology And Statistics
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  • Question 10 - Which is the most accurate statement regarding scabies? ...

    Incorrect

    • Which is the most accurate statement regarding scabies?

      Your Answer:

      Correct Answer: Positive mineral oil mount is diagnostic

      Explanation:

      The diagnosis of scabies can often be made clinically in patients with a pruritic rash and characteristic linear burrows. Definitive testing relies on the identification of mites or their eggs, eggshell fragments, or scybala. This is best undertaken by placing a drop of mineral oil directly over the burrow on the skin and then superficially scraping longitudinally and laterally across the skin with a scalpel blade. (Avoid causing bleeding.) Scraping 15 or more burrows often produces only 1 or 2 eggs or mites, except in a case of crusted scabies, in which many mites will be present.
      The sample is placed on a microscope slide and examined under low and high power. Potassium hydroxide should not be used, since it can dissolve mite pellets. Failure to find mites is common and does not rule out the diagnosis of scabies.

    • This question is part of the following fields:

      • Dermatology
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  • Question 11 - A 17-month-old boy is brought to the emergency department by his mother with...

    Incorrect

    • A 17-month-old boy is brought to the emergency department by his mother with complaints of poor feeding and tachypnoea a week after experiencing a coryzal illness. His cardiac examination is unremarkable apart from a third heart sound being present.
      His chest radiograph shows cardiomegaly and bilateral interstitial shadowing.
      Blood investigations, renal function, and anti-streptolysin O test (ASCOT) are all within normal limits.

      What is the most probable diagnosis?

      Your Answer:

      Correct Answer: Coxsackie myocarditis

      Explanation:

      The most probable diagnosis based on the clinical presentation is myocarditis secondary to Coxsackie virus infection.

      Myocarditis is an important cause of acquired heart failure. The other infective causes of myocarditis are influenza and adenoviruses, and bacterial causes as seen with Borrelia burgdorferi (Lyme disease).
      Rheumatic fever is unlikely if the ASO titres are within normal limits. While pancarditis may occur as part of Kawasaki disease; the patient is unlikely to present in failure.

    • This question is part of the following fields:

      • Cardiovascular
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  • Question 12 - A neonate is diagnosed with cryptorchidism of the right side (undescended testis). Which...

    Incorrect

    • A neonate is diagnosed with cryptorchidism of the right side (undescended testis). Which is the LEAST likely place to find the testis?

      Your Answer:

      Correct Answer: Perineum

      Explanation:

      Embryologically the testes are retroperitoneal structures in the posterior abdominal wall, attached to the anterolateral abdominal wall by the gubernaculum. The gubernaculum ‘pulls’ the testes through the deep inguinal ring, inguinal canal and superficial inguinal ring and over the pelvic brim. The gubernaculum is preceded by the processus vaginalis that is derived from the peritoneum anterior to the testes. The processus vaginalis pushes the muscle and fascial layers. These eventually make up the canal and the spermatic cord, into the scrotum. The gubernaculum persists as the scrotal ligament while part of the processus vaginalis remains as a bursa-like sac i.e. the tunica vaginalis testes. The testes therefore could be caught in any one of these places along its path of descending. The testes are never in the perineum.

    • This question is part of the following fields:

      • Genitourinary
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  • Question 13 - An 8 year old boy presented with easy bruising following falls. FBC showed...

    Incorrect

    • An 8 year old boy presented with easy bruising following falls. FBC showed leucocytosis and thrombocytopenia with normal haemoglobin levels. His ESR was high and Paul-Bunnell test was positive. Which of the following is the most probable diagnosis?

      Your Answer:

      Correct Answer: Glandular fever

      Explanation:

      Glandular fever (Infectious Mononucleosis) is caused by Epstein-Barr virus (EBV). Leucocytosis rules in infectious mononucleosis and thrombocytopenia is not an uncommon association. ESR is elevated in most of the cases. Paul-Bunnell test is a rapid test for infectious mononucleosis due to Epstein-Barr virus (EBV).

    • This question is part of the following fields:

      • Infectious Diseases
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  • Question 14 - A 2-year-old child is brought to the clinic by his parents who say...

    Incorrect

    • A 2-year-old child is brought to the clinic by his parents who say that he has had frequent breath holding spells which occur almost 4 times per week. Which of the following nutritional deficiency most often results in the breath holding spells like the ones experienced by this child?

      Your Answer:

      Correct Answer: Iron

      Explanation:

      Breath-holding spells are usually caused by either a change in the child’s breathing or a slowing of the heart rate. In some children, breath-holding spells may be related to iron deficiency anaemia, a condition in which the body doesn’t produce a normal number of red blood cells.
      Conclusion: Not only Iron deficiency anaemia but also iron deficiency alone without anaemia is associated with a risk of high-frequency cyanotic breath holding spells. Iron therapy results in reduction in spells’ frequency which was correlated with increasing ferritin and iron levels.

    • This question is part of the following fields:

      • Nutrition
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  • Question 15 - An infant of 2 months is diagnosed with a ventricular septal defect. This...

    Incorrect

    • An infant of 2 months is diagnosed with a ventricular septal defect. This congenital anomaly is most likely due to a developmental failure of which embryological structure?

      Your Answer:

      Correct Answer: Endocardial cushions

      Explanation:

      The heart is the first organ to form and become functional, emphasizing the importance of transport of material to and from the developing infant. It originates about day 18 or 19 from the mesoderm and begins beating and pumping blood about day 21 or 22. It forms from the cardiogenic region near the head and is visible as a prominent heart bulge on the surface of the embryo. Originally, it consists of a pair of strands called cardiogenic cords that quickly form a hollow lumen and are referred to as endocardial tubes. These then fuse into a single heart tube and differentiate into the truncus arteriosus, bulbus cordis, primitive ventricle, primitive atrium, and sinus venosus, starting about day 22. The primitive heart begins to form an S shape within the pericardium between days 23 and 28. The internal septa begin to form about day 28, separating the heart into the atria and ventricles, although the foramen ovale persists until shortly after birth. Between weeks five and eight, the atrioventricular valves form. The semilunar valves form between weeks five and nine.

    • This question is part of the following fields:

      • Cardiovascular
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  • Question 16 - Which of the given medical conditions is associated with renal cysts and follows...

    Incorrect

    • Which of the given medical conditions is associated with renal cysts and follows an autosomal dominant pattern of inheritance?

      Your Answer:

      Correct Answer: Von Hippel-Lindau syndrome

      Explanation:

      Von Hippel-Lindau syndrome is a genetic disorder inherited in autosomal dominant fashion. It is caused by the mutations of the VHL gene located on chromosome 3. The syndrome is characterized by the creation of multiple benign and malignant tumours involving various bodily systems along with the formation of numerous visceral cysts, including the renal and epididymal cysts.
      Down’s syndrome is associated with renal cysts, but it does not follow the autosomal dominant mode of inheritance, rather it is caused by non-disjunction of chromosome 21 during meiosis.
      Exomphalos is a defect of the medial abdominal wall leading to abnormal protrusion of abdominal viscera through it. It is not associated with renal cysts.
      Turner’s syndrome may be associated with renal cysts formation, but it is not transmitted in an autosomal dominant fashion.
      Polycystic kidney disease of childhood follows an autosomal recessive pattern of transmission.

    • This question is part of the following fields:

      • Nephro-urology
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  • Question 17 - Which of the following could be an indicator of possible language delay in...

    Incorrect

    • Which of the following could be an indicator of possible language delay in an otherwise well child?

      Your Answer:

      Correct Answer: A family history of hereditary deafness

      Explanation:

      In the first few years of life the developing sensory inputs are important. Hearing is essential for speech and language development and may be delayed when a child cannot hear. Therefore any child with a family history of hereditary deafness should be screened. From about 4-6months babies are able to laugh and babble when excited or unhappy. By the age of 9 months the child should be able to bring together groups of same sound syllables and be able to say one or two words by the 1st birthday. If a child is unable to babble by 10-12 years, it may indicate hearing impairment. By the age of 2 a child should be able to speak in 1 or 2 word phrases and often repeats phrases used by others, known as Echolalia.

    • This question is part of the following fields:

      • Child Development
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  • Question 18 - Which of the following ages should a child be expected to draw a...

    Incorrect

    • Which of the following ages should a child be expected to draw a line and start cutting with scissors?

      Your Answer:

      Correct Answer: 2- 2 1/2 years

      Explanation:

      Fine motor development involves greater use of the hands to perform more precise tasks. By 6 -12 months children should be able to reach for small objects and pass an object from one hand to the other. From 1 -2 years they can perform more complex tasks such a building a tower of blocks, feeding themselves, and turning knobs. In terms of pencil skills, they should be able to imitate scribbles and then spontaneously scribble. By the age of 2 years they can draw a line, and by three they can draw a circle. From the age of 3.5 they can draw a cross, 4.5 – a square, 5 – a triangle, and 6 a diamond.

    • This question is part of the following fields:

      • Child Development
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  • Question 19 - A 16 year old girl presents with excess hair and amenorrhoea. She is...

    Incorrect

    • A 16 year old girl presents with excess hair and amenorrhoea. She is normotensive. Her prolactin levels are normal. She has a raised 17 α-hydroxyprogesterone level.
      What is her diagnosis?

      Your Answer:

      Correct Answer: Partial 21-hydroxylase deficiency

      Explanation:

      Deficiency of 21-hydroxylase, resulting from mutations or deletions of CYP21A, is the most common form of Congenital Adrenal Hyperplasia, accounting for more than 90% of cases.
      Females with mild 21-hydroxylase deficiency are identified later in childhood because of precocious pubic hair, clitoromegaly, or both, often accompanied by accelerated growth and skeletal maturation (simple virilizing adrenal hyperplasia)
      Diagnosis of 21-hydroxylase deficiency: High serum concentration of 17-hydroxyprogesterone (usually >1000 ng/dL) and urinary pregnanetriol (metabolite of 17-hydroxyprogesterone) in the presence of clinical features suggestive of the disease; 24-hour urinary 17-ketosteroid levels are elevated

    • This question is part of the following fields:

      • Endocrinology
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  • Question 20 - A 7-year-old boy with facial oedema was brought to the hospital by his...

    Incorrect

    • A 7-year-old boy with facial oedema was brought to the hospital by his parents. Renal function is normal and urinalysis revealed the presence of a profound proteinuria. Which of the following is the most probable cause of these findings?

      Your Answer:

      Correct Answer: Minimal-change disease

      Explanation:

      Minimal-change disease (MCD) refers to a histopathologic glomerular lesion, typically found in children, that is almost always associated with nephrotic syndrome. The most noticeable symptom of MCD is oedema, which can develop very rapidly. Due to the renal loss of proteins muscle wasting and growth failure may be seen in children. Renal function is usually not affected and a proteinuria of more than 40 mg/h/m2 is the only abnormal finding in urinalysis.

    • This question is part of the following fields:

      • Renal
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  • Question 21 - At the age of 3 months, which of the following depicts normal motor...

    Incorrect

    • At the age of 3 months, which of the following depicts normal motor development?

      Your Answer:

      Correct Answer: Finger play with the hands open and brought together

      Explanation:

      By the age of three months a child should become more fascinated with their hands and fingers; they can bring their hand to their mouth, open and close their hand, and shake and grab at dangling objects and toys. Their ability to roll over will come by the time the child is 6 months, at which time they will also be able to sit with support. Soon, at 8-9 months, attempts will be made to crawl and as they approach 12 months they will be able to pull on objects to stand.

    • This question is part of the following fields:

      • Child Development
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  • Question 22 - Which of the given statements is correct regarding Klinefelter's syndrome? ...

    Incorrect

    • Which of the given statements is correct regarding Klinefelter's syndrome?

      Your Answer:

      Correct Answer: Fertility is affected

      Explanation:

      Klinefelter’s syndrome is the most common sex chromosome linked disorder with a karyotype of 47XXY. The incidence of the disease is 1 in 500-1000 male births. Childhood presentation consists of unusual growth spurt along with learning difficulties and delayed speech. The adolescence is marked by abnormal sexual maturation leading to hypogonadism and sub-fertility in adulthood.

    • This question is part of the following fields:

      • Genetics And Dysmorphology
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  • Question 23 - Which of the following is the most likely cause of microcephaly in an...

    Incorrect

    • Which of the following is the most likely cause of microcephaly in an asymptomatic 3-year-old child whose head circumference is on the 3rd centile? Note that his height and weight are in the 75th centile.

      Your Answer:

      Correct Answer: Congenital rubella syndrome

      Explanation:

      The most likely cause of microcephaly in an asymptomatic 3-year-old child is congenital rubella syndrome.

      Microcephaly is defined as head circumference > two standard deviations below the mean.

      The causes of microcephaly include:
      – Genetic disorders: Down syndrome, Edward syndrome, Patau syndrome, Williams syndrome, Angelman syndrome, and Rett syndrome.
      – Infective: Meningitis, toxoplasmosis, CMV, rubella, varicella, HIV
      and Zika.
      – Acquired causes: Severe brain malformations, neurodegenerative diseases, hypoxic-ischemic injury, infarction, antenatal exposure to drugs, alcohol, and other toxins. Severe malnutrition and uncontrolled phenylketonuria in the mother are other causes of microcephaly in children.
      – Craniosynostosis
      – Neurometabolic disorders
      – Early non-accidental trauma
      – Fanconi anaemia
      – Other causes include: Familial and nonfamilial nonsyndromic microcephaly

      Most children with microcephaly have one or several associated symptoms:
      – Developmental delay
      – Seizures
      – Visual abnormalities
      – Short stature

    • This question is part of the following fields:

      • Neurology And Neurodisability
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  • Question 24 - Which of the following developmental milestones is a 3 year old girl unlikely...

    Incorrect

    • Which of the following developmental milestones is a 3 year old girl unlikely to have achieved?

      Your Answer:

      Correct Answer: Make good cuts with scissors

      Explanation:

      At the age of three years a child is to be able to dress and undress himself with supervision, eat with a spoon and fork, build a tower with 9 cubes, give their full name and copy a circle. The child will not be able to make good cuts with scissions until he is about 5 years old.

    • This question is part of the following fields:

      • Child Development
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  • Question 25 - A screening test is found to have a sensitivity of 90% and a...

    Incorrect

    • A screening test is found to have a sensitivity of 90% and a specificity of 95%.
      Which of the following is the best answer?

      Your Answer:

      Correct Answer: An individual without disease is more likely to be correctly diagnosed via the test than someone with the disease

      Explanation:

      The sensitivity of a screening test can be described in a variety of ways, typically such as sensitivity being the ability of a screening test to detect a true positive, being based on the true positive rate, reflecting a test’s ability to correctly identify all people who have a condition, or, if 100%, identifying all people with a condition of interest by those people testing positive on the test.

      The specificity of a test is defined in a variety of ways, typically such as specificity is the ability of a screening test to detect a true negative, being based on the true negative rate, correctly identifying people who do not have a condition, or, if 100%, identifying all patients who do not have the condition of interest by those people testing negative on the test.

    • This question is part of the following fields:

      • Epidemiology And Statistics
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  • Question 26 - A 14-year-old girl presents with primary amenorrhoea. She is an athlete who is...

    Incorrect

    • A 14-year-old girl presents with primary amenorrhoea. She is an athlete who is currently training for a national athletics championship.

      What is the best treatment option for her?

      Your Answer:

      Correct Answer: Adequate diet and observation

      Explanation:

      Intensive physical training and participation in competitive sports during childhood and early adolescence may affect athletes’ pubertal development.
      Female athletes who do not begin secondary sexual development by the age of 14 or menstruation by the age of 16 warrant a comprehensive evaluation and treatment.
      Since she is still 14, adequate diet and observation are enough.

    • This question is part of the following fields:

      • Endocrinology
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  • Question 27 - A 16-year-old male presents with complaints of a patch of scaling skin and...

    Incorrect

    • A 16-year-old male presents with complaints of a patch of scaling skin and hair loss on the right side of his head. A skin scraping confirms the diagnosis of tinea capitis.
      What is the most common organism responsible for tinea capitis?

      Your Answer:

      Correct Answer: Trichophyton tonsurans

      Explanation:

      The most common organism responsible for tinea capitis is Trichophyton tonsurans.

      Tinea is a term given to dermatophyte fungal infections. There are three types of tinea, depending on what part of the body is infected:
      – Tinea capitis – scalp
      – Tinea corporis – trunk, legs or arms
      – Tinea pedis – feet
      -Tinea capitis (scalp ringworm): It is a cause for scarring alopecia mainly seen in children. If untreated, it can form a raised pustular, spongy/boggy mass called a kerion. The most common cause of tinea capitis in the UK and the USA is Trichophyton tonsurans. Tinea can also be caused by Microsporum canis acquired from cats or dogs.
      The diagnosis of tinea capitis and identification of the organism is possible from the skin lesions: – Scalp scrapings and Potassium hydroxide (KOH) mounts.
      – Wood’s lamp: Microsporum canis produces a green fluorescence under Wood’s lamp examination.

      Treatment:
      – Oral antifungals: terbinafine for Trichophyton tonsurans infections.
      – Griseofulvin for Microsporum infections.
      – Topical ketoconazole shampoo is recommended for the first two weeks to limit the transmission of the infection.

    • This question is part of the following fields:

      • Dermatology
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  • Question 28 - Which of the following is a risk factor for neonatal death and stillbirth?...

    Incorrect

    • Which of the following is a risk factor for neonatal death and stillbirth?

      Your Answer:

      Correct Answer: Parental unemployment

      Explanation:

      Risk factors for neonatal death and stillbirth (weak predictive value):
      – African American race
      – Advanced maternal age
      – History of fetal demise
      – Maternal infertility
      – History of small for gestational age infant
      – Small for gestational age infant
      – Obesity
      – Paternal age
      – Poverty and poor quality of care

      So in this case the risk factor is the parental unemployment

    • This question is part of the following fields:

      • Neonatology
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  • Question 29 - A 16 year old previously well male presents with a 4 day history...

    Incorrect

    • A 16 year old previously well male presents with a 4 day history of fever, lethargy and a generalized macular rash. There is no significant previous medical history and the patient has not travelled abroad either. Vitals are as follows:
      Temp: 38.5
      BP: 125/75mmHg
      Pulse: 100/min
      On auscultation the chest was clear and no heart murmur was heard. Examination also reveals a non blanching widespread macular rash over the chest and abdomen. There is swelling of interphalangeal joints of both hands and feet associated with mild tenderness. Lymph nodes are palpable over the supraclavicular, axillary and inguinal areas. Abdominal examination reveals palpable mass on both right and left hypochondrium. Lab results are given below:
      Haemoglobin (Hb) 13.5 g/dl
      White cell count (WCC) 14.0 x 109/l
      Platelets 380 x 109/l
      Sodium 145 mmol/l
      Potassium 4.8 mmol/l
      Creatinine 89 μmol/l
      Rheumatoid factor Negative
      Antinuclear antibody Negative
      Anti-dsDNA Negative
      ASO titre Not detected
      Electrocardiogram (ECG) Sinus rhythm
      What is the most likely underlying diagnosis?

      Your Answer:

      Correct Answer: Systemic Still's disease

      Explanation:

      People with Systemic Juvenile Idiopathic Arthritis (also known as Stills disease) can have recurrent fevers, a macular rash, joint pain, joint deformities, an enlarged liver and/or spleen, and can occasionally have polyserositis, lung involvement or pericardial effusions. Rheumatoid factor and antinuclear antibodies are usually negative. Treatment is with non-steroidal anti-inflammatory drugs (NSAIDs) and the prognosis is better than for adult rheumatoid arthritis.
      In pauciarticular Still’s disease, antinuclear antibodies are present. Large joints are affected and most patients develop classic features of seronegative spondylarthritis.

    • This question is part of the following fields:

      • Musculoskeletal
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  • Question 30 - A 2-year-old unimmunized child presents to paediatric emergency with sudden onset fever, drooling...

    Incorrect

    • A 2-year-old unimmunized child presents to paediatric emergency with sudden onset fever, drooling and soft stridor. What is the most likely diagnosis?

      Your Answer:

      Correct Answer: Epiglottitis

      Explanation:

      Epiglottitis is characterized by the abrupt onset of severe symptoms. Without airway control and medical management, symptoms may rapidly progress to respiratory obstruction and death in a matter of hours.
      Usually, no prodromal symptoms occur in children. Fever is usually the first symptom, and temperatures often reach 40°C. Acute epiglottitis may result in sudden, complete upper airway obstruction. Classic signs in children are four D’s: drooling, dyspnoea, dysphagia, and dysphonia.

    • This question is part of the following fields:

      • ENT
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