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  • Question 1 - A 6-month-old baby boy presented to the paediatrician with yellow discolouration of his...

    Incorrect

    • A 6-month-old baby boy presented to the paediatrician with yellow discolouration of his skin and sclera. His mother says his stools are pale. On examination, he was found to be below average weight. What is a likely diagnosis?

      Your Answer: Congenital viral infection

      Correct Answer: Biliary atresia

      Explanation:

      Pale stools suggest obstructive jaundice. Initially, the symptoms of biliary atresia are indistinguishable from those of neonatal jaundice, a usually harmless condition commonly seen in infants. However, infants with biliary atresia develop progressive conjugated jaundice, pale white stools and dark urine.

    • This question is part of the following fields:

      • Gastroenterology And Hepatology
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  • Question 2 - A 5 year old girl presents with widespread, itchy, excoriated papules that appeared...

    Incorrect

    • A 5 year old girl presents with widespread, itchy, excoriated papules that appeared three months ago. They are symmetrically distributed and more profound on the extensor surfaces of the elbows and knees. The papules are present on the trunk as well but are less remarkable. She doesn't have it anywhere else on her body and seems to be in a good health. The itchiness results in the girl to often scratching and popping the fluid-filled blisters that are present. There is no family history of atopy or other skin conditions. Which of the following is accurate?

      Your Answer:

      Correct Answer: Coeliac antibodies should be measured

      Explanation:

      This is the clinical picture of dermatitis herpetiformis associated with gluten-sensitive enteropathy. To establish the diagnosis, you should measure the coeliac antibodies.
      Darrier’s sign (where the skin urticates when it is stroked) is positive in urticaria pigmentosa.

    • This question is part of the following fields:

      • Dermatology
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  • Question 3 - An infant, 5 weeks and 6 days old born with a large sub-aortic...

    Incorrect

    • An infant, 5 weeks and 6 days old born with a large sub-aortic ventricular septal defect, is prepared for pulmonary artery banding through a left thoracotomy (the child is not fit for a surgical closure). The surgeon initially passes his index finger immediately behind two great arteries in the pericardial sac to mobilise the great arteries in order to pass the tape around the pulmonary artery. Into which space is the surgeon's finger inserted?

      Your Answer:

      Correct Answer: Transverse pericardial sinus

      Explanation:

      Cardiac notch: is an indentation on the left lung of the heart.

      Coronary sinus: a venous sinus on the surface of the heart (the posterior aspect) that receives blood from the smaller veins that drain the heart.

      Coronary sulcus: a groove on the heart between the atria and ventricles.

      Transverse pericardial sinus: located behind the aorta and pulmonary trunk and anterior to the superior vena cava.

      Oblique pericardial sinus: located behind the left atrium. Accessed from the inferior side (or the apex) of the heart upwards.

      Horizontal pericardial sinus: this is a made-up term.

    • This question is part of the following fields:

      • Paediatric Surgery
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  • Question 4 - All of the given options are examples of neonatal cyanotic congenital heart disease...

    Incorrect

    • All of the given options are examples of neonatal cyanotic congenital heart disease EXCEPT?

      Your Answer:

      Correct Answer: Eisenmenger syndrome

      Explanation:

      Cyanotic congenital heart disease (CCHD) is a common cause of neonatal morbidity and mortality. They can be classified as CCHD due to:
      – Right-to-left shunt, associated with the decreased pulmonary flow, e.g., tetralogy of Fallot (TOF), pulmonary atresia, right-sided hypoplastic heart,
      – Right-to-left shunt, associated with the decreased aortic flow, e.g., left-sided hypoplastic heart, interrupted arch, severe coarctation;
      – Bidirectional shunt, e.g., TGA, DORV, TA, etc.
      Eisenmenger syndrome is not a neonatal CCHD; rather it develops later in young adulthood secondary to various CHD.

    • This question is part of the following fields:

      • Cardiovascular
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  • Question 5 - A 15-year-old girl, known to have atopic eczema since she was six months...

    Incorrect

    • A 15-year-old girl, known to have atopic eczema since she was six months old, presents because her parents are worried about several skin changes. They are concerned that they could be caused by topical steroid ointments.
      Which of the following is more likely to be present due to the disease, rather than as a side-effect of the treatment?

      Your Answer:

      Correct Answer: Hypopigmentation

      Explanation:

      Hypopigmentation is a side-effect that is more likely to be due to eczema rather than topical steroids therapy.

      All the options provided are potential side-effects of topical steroid therapy. They are observed when the potency of the steroid used is too high, or the amount of drug used is too much..
      FTU or fingertip unit application is what is recommended, with caution, in delicate areas such as the face.

      Hypopigmentation can occur in eczema and is a post-inflammatory response, in contrast to the total depigmentation which is seen in vitiligo.

      Chronic eczema causes lichenification of skin, where the epidermis is thickened, and not skin atrophy.

    • This question is part of the following fields:

      • Dermatology
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  • Question 6 - Bone age would be delayed in which of the following conditions? ...

    Incorrect

    • Bone age would be delayed in which of the following conditions?

      Your Answer:

      Correct Answer: Trisomy 21 in a 10 year old boy

      Explanation:

      Bone age is used to determine the maturation of a child’s bones’ and is used to detect pathological growth. This is done using the X-ray of the wrist. Several conditions can either advance or delay the bone age such that they may not match the child’s chronological age. Bone age is advanced in conditions where there are prolonged or elevated sex hormone levels such as precocious puberty, or in genetic overgrowth conditions such as Beckwith-Wiedemann syndrome. Bone age is delayed in constitutional growth delay, chronic ill health, endocrine disorders such as growth hormone deficiencies or hypothyroidism, genetic disorders such as Trisomy 21, Trisomy 18, and Turner’s syndrome. Obesity is unlikely to cause growth delay.

    • This question is part of the following fields:

      • Endocrinology
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  • Question 7 - A mother and her 2 year old girl is referred to a paediatrician...

    Incorrect

    • A mother and her 2 year old girl is referred to a paediatrician on account of concerns over a possible squint. On examination the doctor uses a pen torch to assess the symmetry of the light reflex on each cornea.

      The following test was used to assess the child:

      Your Answer:

      Correct Answer: Hirschberg test

      Explanation:

      In the Hirschberg test, the corneal reflex should fall in the same place in both eyes. If there is a malalignment then the reflection of the light will appear in different places in the two eyes. The cover test is then used to differentiate between a latent deviation, or a manifest deviation.

      In the Bruckner test, the direct ophthalmoscope is used to obtain a red reflex simultaneously in both eyes. If strabismus is present, the deviated eye will have a lighter and brighter reflex than the fixating eye.

      The swinging flashlight test is a test of the pupils response to light, and to check for a relative afferent pupillary defect (RAPD).

      The Angle Kappa test measures the angle between the line of sight and the corneal-pupillary axis. It is a monocular measurement.

    • This question is part of the following fields:

      • Ophthalmology
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  • Question 8 - A 16 year old patient was admitted with walking difficulties and knee pain....

    Incorrect

    • A 16 year old patient was admitted with walking difficulties and knee pain. Upon examination, his leg is externally rotated and is 2cm shorter. His ability to flex, abduct and medially rotate his leg is limited and when he flexes his hip, external rotation is increased. What is the most probable diagnosis?

      Your Answer:

      Correct Answer: Slipped femoral epiphysis

      Explanation:

      The clinical presentation is typical of a slipped femoral epiphysis, which refers to a fracture through the growth plate (physis), resulting in slippage of the overlying end of the femur. It is the most common hip disorder in adolescence. SCFEs usually cause groin pain on the affected side, but sometimes cause knee or thigh pain. The range of motion in the hip is restricted in internal (medial) rotation, abduction, and flexion.

    • This question is part of the following fields:

      • Musculoskeletal
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  • Question 9 - What is the most common cardiac abnormality found in Noonan syndrome? ...

    Incorrect

    • What is the most common cardiac abnormality found in Noonan syndrome?

      Your Answer:

      Correct Answer: Pulmonary stenosis

      Explanation:

      Noonan syndrome is one of the most common genetic diseases associated with congenital heart defects, being second in frequency only to Down syndrome.
      Pulmonary stenosis and hypertrophic cardiomyopathy are generally the most common congenital heart defects found in Noonan syndrome.
      Pulmonary stenosis is often associated with a thickened and dysplastic valve. It is usually difficult to obtain a satisfactory result using the transcatheter balloon dilatation of such dysplastic valves, so surgical intervention is more likely to be needed.
      Hypertrophic cardiomyopathy involves predominantly the ventricular septum as asymmetric septal hypertrophy, but may also affect the ventricular free walls. Left ventricular outflow tract obstruction may occasionally be produced.

    • This question is part of the following fields:

      • Neonatology
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  • Question 10 - A 9-month-old girl is brought to the hospital by her mother with a...

    Incorrect

    • A 9-month-old girl is brought to the hospital by her mother with a 24-hour history of coryza and irritability.
      On examination, she was found to have a temperature of 37.7 C, a harsh cough, stridor at rest, and moderate respiratory distress.

      Which of the following treatments is indicated in this child?

      Your Answer:

      Correct Answer: Prednisolone 1-2mg/kg

      Explanation:

      Among the treatment options provided, the most appropriate would be prednisolone 1-2 mg/kg.

      Other options:
      – Dexamethasone 0.15 mg per kg is the correct dose based on new trials and BNF guidance.
      – Inhaled budesonide 2mg would be a more appropriate dose.
      – Nebulised adrenaline may also be used.

      Croup:
      Laryngotracheobronchitis caused most commonly by parainfluenza virus. It most commonly affects children between 6 months to 3 years.
      Seasonal peaks: Most prevalent in autumn and spring.
      It starts as viral URTI then progresses to barking cough and a hoarse cry. Stridor and respiratory distress may occur. The illness can last from two days to 2 weeks.
      Relevant differential diagnoses include epiglottitis (the child will be septic with high temp and drooling) and inhaled foreign body.
      All children with moderate/severe croup should be given one dose of oral dexamethasone.
      Further doses may be needed if children have rebound symptoms.

    • This question is part of the following fields:

      • ENT
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  • Question 11 - The father of a 3 month old baby presents to the child health...

    Incorrect

    • The father of a 3 month old baby presents to the child health clinic complaining that his child passes only one hard stool a day. He has tried to bicycle his legs and massage his abdomen but has not been successful. The baby seems to be growing well, and nothing of concern was found on clinical examination.

      What is the most appropriate next step?

      Your Answer:

      Correct Answer: Advise extra water in between feeds

      Explanation:

      According to the NICE guidelines, the frequency of stool passage is considered constipation when two or more of the following findings are present:

      Fewer than 3 stools a week, large hard stools, stools that resemble rabbit droppings; symptoms associated with defecation including distress, bleeding or straining; a history of previous episodes of a precious/current anal fissure.

      The child in the scenario fails to meet the criteria, and has no evidence of impacted faeces on examination. The best course of action is to encourage the parents to give the child more water to prevent dehydration, and feed the child a fibre rich diet including fruits, vegetables and high fibre bread.

    • This question is part of the following fields:

      • Gastroenterology And Hepatology
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  • Question 12 - A 6 year old boy presents with severe gastroenteritis and dehydration. He is...

    Incorrect

    • A 6 year old boy presents with severe gastroenteritis and dehydration. He is receiving IV fluids and a routine blood test is done to evaluate kidney function and look for signs of acute kidney injury. All of the following are being used to evaluate for kidney injury, except:

      Your Answer:

      Correct Answer: Potassium >6mmol/l

      Explanation:

      Hyperkalaemia is not to evaluate or detect AKI but rather the result of it. If one of the rest of the options is present, then AKI would be suspected.

    • This question is part of the following fields:

      • Nephro-urology
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  • Question 13 - A 4-year-old girl with an abnormal facial appearance has an ejection systolic murmur...

    Incorrect

    • A 4-year-old girl with an abnormal facial appearance has an ejection systolic murmur radiating to between her scapulae. A radio-femoral delay was also found. Which of the following is the most probable cause?

      Your Answer:

      Correct Answer: Turner's syndrome

      Explanation:

      These cardiovascular findings are suggestive of coarctation of the aorta, which is common among patients with Turner’s syndrome. Physical features of Turner’s syndrome include a short neck with a webbed appearance, a low hairline at the back of the head, low-set ears, and narrow fingernails and toenails that are turned upward.
      Atrioventricular septal defect is the most common cardiac anomaly in Down’s syndrome.
      Structural heart defects at birth (i.e., ventricular septal defect, atrial septal defect, patent ductus arteriosus) are common in Edward’s syndrome.
      Pulmonary stenosis with or without dysplastic pulmonary valve and hypertrophic cardiomyopathy are common in Noonan’s syndrome.
      Supravalvar aortic stenosis and peripheral pulmonary stenosis are found in William’s syndrome.

    • This question is part of the following fields:

      • Genetics And Dysmorphology
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  • Question 14 - A 8 year old child presents with acute abdominal pain. Last time he...

    Incorrect

    • A 8 year old child presents with acute abdominal pain. Last time he used the restroom, he noticed fresh blood after wiping. Doctors suspect an intussusception. What is the most probable cause?

      Your Answer:

      Correct Answer: Gastrointestinal polyp

      Explanation:

      Gastrointestinal polyps are common in children and may result in intussusception due to polyp traction. Treatment is usually surgical with enterotomy and removal of the polyp or of a segment of the bowel.

    • This question is part of the following fields:

      • Gastroenterology And Hepatology
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  • Question 15 - A 16-month-old boy presented following a 20 min seizure. He was given 5...

    Incorrect

    • A 16-month-old boy presented following a 20 min seizure. He was given 5 mg per rectum (PR) diazepam to terminate the seizure and is still only responding to voice 6 hours later. He was diagnosed with measles five days prior to this episode.

      Which of the following is the most probable cause of his symptoms?

      Your Answer:

      Correct Answer: Encephalitis

      Explanation:

      The most probable cause for the patient’s presenting symptoms is encephalitis secondary to measles infection.

      Encephalitis:
      Encephalitis occurs in 1 per 1000 measles cases. It usually presents within 1-14 days of the rash, usually day 5. It may present with fever, headache, vomiting, stiff neck, meningeal irritation, drowsiness, seizures, reduced consciousness; 15% will have neurological sequelae; 10% mortality.

      Other options:
      – Acute disseminated encephalomyelitis occurs in 1 per 1000 measles cases. It is thought to be a postinfectious immune response. Clinical manifestations include fever, headache, neck stiffness, seizures and mental status changes. It could fit this presentation although it tends to present in the recovery phase of measles infection, typically two weeks after the exanthem. In contrast, encephalitis tends to occur within a few days of the rash.

      – The history is not that of a typical febrile seizure as it lasted >15 minutes. He has also not recovered consciousness at 4 hours. The diazepam should have been eliminated within 4 hours and so should no longer be contributing to his reduced level of consciousness. Also, the history states the recent diagnosis of measles, and so complications of measles should be considered.

      – Intracranial bleed secondary to thrombocytopenia: Measles is not known to cause thrombocytopenia.

      – Subacute sclerosing panencephalitis (also known as Dawson’s encephalitis): This is an extremely rare complication of measles. It is a progressive degenerative disease of the central nervous system that occurs 7-10 years after a measles infection.
      The treatment for SSPE is mainly intraventricular interferon therapy through an Ommaya reservoir. The prognosis is poor, and it is usually fatal.

    • This question is part of the following fields:

      • Neurology And Neurodisability
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  • Question 16 - Which of the following terms denote the property demonstrated by conditions where there...

    Incorrect

    • Which of the following terms denote the property demonstrated by conditions where there are a variety of genetic defects, all leading to the same phenotypical manifestations?

      Your Answer:

      Correct Answer: Heterogeneity

      Explanation:

      The property described in the question is heterogeneity.

      Heterogeneity is when a single phenotype or genetic disorder can be caused by multiple numbers of genetic mutations.

      Other options:
      – Pleiotropy occurs when a single gene influences multiple phenotypic traits. The underlying mechanism is that the gene codes for a product that is used by various cells. A classic example of pleiotropy is the human disease PKU (phenylketonuria).
      – The penetrance of a disease-causing mutation is the proportion of individuals with the mutation who exhibit clinical symptoms. For example, the gene responsible for a particular autosomal dominant disorder has 70% penetrance, then 70% of those with the mutation will develop the disease, while 30% will not.

    • This question is part of the following fields:

      • Genetics And Dysmorphology
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  • Question 17 - An 8 year old child complains of pain in his ear. His overall...

    Incorrect

    • An 8 year old child complains of pain in his ear. His overall health is normal and clinical examination reveals no discharge, hearing loss or fever. Just by looking at it, the pinna of the ear looks swollen and red. Also, pushing the tragus leads to pain. Otoscopy reveals an erythematous external auditory canal and an otherwise healthy tympanic membrane.
      The bony external canal courses through which bone?

      Your Answer:

      Correct Answer: Temporal bone

      Explanation:

      The external auditory canal (EAC) extends from the auricle to the tympanic membrane. Its lateral portion is fibrocartilaginous and its medial portion is bony. Its bony portion is formed by the tympanic portion of the temporal bone.

    • This question is part of the following fields:

      • ENT
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  • Question 18 - A 5 year old girl presented with short stature, primary amenorrhea, puffy arms...

    Incorrect

    • A 5 year old girl presented with short stature, primary amenorrhea, puffy arms and a webbed neck. The most likely diagnosis will be?

      Your Answer:

      Correct Answer: Turner's syndrome

      Explanation:

      Turner’s syndrome is characterised by a webbed neck, short stature, primary amenorrhea and cardiac, renal and muscular defects. Gene analysis shows a single X chromosome in the patients. Downs syndrome has certain cognitive and physical abnormalities, whereas in Klinefelter syndrome there are widely spaced nipples, long arms and infertility and it only occurs in men.

    • This question is part of the following fields:

      • Genetics And Dysmorphology
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  • Question 19 - A 14-year-old boy presents with a rash on his buttocks and extensor surfaces...

    Incorrect

    • A 14-year-old boy presents with a rash on his buttocks and extensor surfaces following a sore throat. What is the most probable diagnosis?

      Your Answer:

      Correct Answer: Henoch-Schonlein purpura (HSP)

      Explanation:

      Henoch-Schonlein purpura (HSP) rashes are commonly found on the legs, feet, and buttocks while Immune thrombocytopenia (ITP) rashes manifest predominantly on the lower legs. HSP happens following a sore throat while ITP usually happens following an URTI or Flu. HSP is an inflammation of a blood vessel (vasculitis) while ITP is immune mediated insufficiency of platelets.

    • This question is part of the following fields:

      • Dermatology
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  • Question 20 - A 16-year-old girl comes to clinic complaining of primary amenorrhoea, despite having developed...

    Incorrect

    • A 16-year-old girl comes to clinic complaining of primary amenorrhoea, despite having developed secondary sexual characteristics at 11 years of age.
      On examination, she has well-developed breasts and small bilateral groin swellings.
      What is the most likely diagnosis?

      Your Answer:

      Correct Answer: Complete androgen insensitivity syndrome

      Explanation:

      Androgen insensitivity syndrome (AIS), previously referred to as testicular feminization, is an X-linked disorder in which the patients are genotypically male (possessing and X and Y chromosome) and phenotypically female. This disorder is rare, with reported incidences from 1 in 20,000 to 1 in 60,000 live male births, and is the result of a missing gene on the X chromosome that is responsible for the cytoplasmic or nuclear testosterone receptor. In its absence, the gonad, which is a testis, produces normal amounts of testosterone; however, the end tissues are unable to respond due to the deficient receptors leading to the external genitalia developing in a female fashion. Anti-Mullerian hormone, which is produced by the testis, is normal in these patients, leading to regression of the Mullerian duct. Wolffian duct development, which depends on testosterone, does not occur as the ducts lack the receptors.
      The cumulative effect is a genotypic male with normal external female genitalia (without pubic or axillary hair), no menses, normal breast development, short or absent vagina, no internal sex organs, and the presence of testis. Frequently, these patients have bilateral inguinal hernias in childhood, and their presence should arouse suspicion of the diagnosis.

    • This question is part of the following fields:

      • Endocrinology
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  • Question 21 - Which organs amongst these are the derivatives of the endoderm? ...

    Incorrect

    • Which organs amongst these are the derivatives of the endoderm?

      Your Answer:

      Correct Answer: Epithelial part of the tympanic cavity

      Explanation:

      Endoderm derivatives include the epithelium of the following: gastrointestinal tract and its glands, glandular cells of the liver and pancreases, urachus and urinary bladder, pharynx, trachea and alveoli, part of the tonsils, thyroid and parathyroid, tympanic cavity and thymus and part of the anterior pituitary gland.

    • This question is part of the following fields:

      • Embryology
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  • Question 22 - A 10-year-old girl presents with symptoms of diabetes mellitus and a borderline fasting...

    Incorrect

    • A 10-year-old girl presents with symptoms of diabetes mellitus and a borderline fasting blood glucose. Her HBA1c was found to be 31 mmol/mol (5.0%).
      What is the most probable co-existing condition that can lead to these unusual HBA1c levels?

      Your Answer:

      Correct Answer: Glucose-6-phosphate dehydrogenase deficiency

      Explanation:

      HbA1c stands for glycated haemoglobin. In patients with haemolytic diseases associated with a shortened RBC survival, HbA1c levels can be unusually low despite controlled diabetes mellitus.
      These haemolytic diseases can include glucose-6-phosphate dehydrogenase deficiency and sickle cell anaemia.

      HbA1c:
      It is a measure of non-enzymatic glycation which occurs due to haemoglobin’s exposure to plasma glucose. As plasma glucose increases so does HbA1c.
      The level of HbA1c quantitively assesses the control of diabetes mellitus over the last 120 days (as this is the life span of a red blood cell).

      Haemoglobin type A is separated on cation exchange chromatography
      Other subsections include HbA1O, HbA1a, HbA1b.

      According to the updated NICE recommendations (2015):
      The target level of HbA1c in children with T1DM is 48 mmol/mol (6.5%) or lower. It is monitored every three months. Better control is associated with fewer long term complications

    • This question is part of the following fields:

      • Endocrinology
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  • Question 23 - In a new drug trial, 1 out of 27 individuals who were given...

    Incorrect

    • In a new drug trial, 1 out of 27 individuals who were given the treatment experienced a side effect, compared to 0 out of the 25 patients given the placebo.

      Which of the following is true?

      Your Answer:

      Correct Answer: Fisher's exact test should be used to compare the significance of the difference

      Explanation:

      The Chi-squared test would have been a useful test to compare the proportions in the scenario. However, due to the small sample size, Fisher’s exact test can be applied to analyse the significance of the difference. Adequate information is not given to determine what sample sizes were used to test the efficacy of the treatment, and to tell whether the treatment should be discontinued without further analysis on the data.

    • This question is part of the following fields:

      • Epidemiology And Statistics
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  • Question 24 - A 15-year-old girl known with HIV develops lipoatrophy over her thighs and abdomen....

    Incorrect

    • A 15-year-old girl known with HIV develops lipoatrophy over her thighs and abdomen.
      Which of the following medications can cause this side effect?

      Your Answer:

      Correct Answer: Zidovudine

      Explanation:

      Among the options provided, zidovudine causes lipoatrophy as a side effect.

      Zidovudine: Although both hypertrophy and atrophy are described related to HIV medications, nucleoside reverse transcriptase inhibitor (NRTIs) such as zidovudine and stavudine are closely associated with fat loss.

      Other options:
      – Enfuvirtide is an HIV-fusion inhibitor. Lipoatrophy is not commonly associated with this drug.
      – Efavirenz is an NNRTI, which is not associated with lipoatrophy. Common side effects include neuropsychiatric effects, rash and nausea.
      – Ganciclovir is not an anti-HIV medication and is used for cytomegalovirus (CMV) infections.
      – Raltegravir is an integrase inhibitor and is associated with fat gain.

    • This question is part of the following fields:

      • HIV
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  • Question 25 - A new-born boy presents with choking on feeding. The midwife had difficulty passing...

    Incorrect

    • A new-born boy presents with choking on feeding. The midwife had difficulty passing an NG tube. A Chest /Abdominal X-ray is performed which shows an NG tube coiled at T3/4 and a gasless abdomen.
      Which of the following operations is likely to be required?

      Your Answer:

      Correct Answer: Laparotomy and open gastrostomy

      Explanation:

      Oesophageal atresia refers to a congenitally interrupted oesophagus. One or more fistulae may be present between the malformed oesophagus and the trachea. The lack of oesophageal patency prevents swallowing. In addition to preventing normal feeding, this problem may cause infants to aspirate and literally drown in their own saliva, which quickly overflows the upper pouch of the obstructed oesophagus. If a tracheoesophageal fistula (TEF) is present, fluid (either saliva from above or gastric secretions from below) may flow directly into the tracheobronchial tree.
      The complete absence of gas in the GI tract denotes the absence of a distal tracheoesophageal fistula (TEF); however, distal fistulae simply occluded by mucous plugs have been rarely reported.

      If no distal TEF is present, a gastrostomy may be created. In such cases, the stomach is small, and laparotomy is required. In all cases of oesophageal atresia in which a gastrostomy is created, care should be taken to place it near the lesser curvature to avoid damaging the greater curvature, which can be used in the formation of an oesophageal substitute. When a baby is ventilated with high pressures, the gastrostomy may offer a route of decreased resistance, causing the ventilation gases to flow through the distal fistula and out the gastrostomy site. This condition may complicate the use of ventilation.

    • This question is part of the following fields:

      • Paediatric Surgery
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  • Question 26 - A 6-year-old boy with fever and malaise for 2 days recently developed bloody...

    Incorrect

    • A 6-year-old boy with fever and malaise for 2 days recently developed bloody diarrhoea. What is the most probable aetiology?

      Your Answer:

      Correct Answer:

      Explanation:

      The most likely organism is enterohemorrhagic verotoxin-producing E.coli. It usually causes haemolytic uremic syndrome.
      Crohn’s disease rarely manifests in an acute manner.
      Polio and giardiasis usually manifest with non-bloody diarrhoea.

    • This question is part of the following fields:

      • Infectious Diseases
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  • Question 27 - A thin 16-year-old girl has bilateral parotid swelling with thickened calluses on the...

    Incorrect

    • A thin 16-year-old girl has bilateral parotid swelling with thickened calluses on the dorsum of her hand. What is the single most likely diagnosis?

      Your Answer:

      Correct Answer: Bulimia nervosa

      Explanation:

      Bulimia nervosa is a condition in which a person is involved in binge eating and then purging. This patient has swollen parotid glands. The glands swell in order to increase saliva production so that the saliva lost in the vomiting is compensated. This patient also has thickened calluses on the back of her hand. This is known as Russell’s sign. This occurs because of putting fingers in the mouth again and again to induce the gag reflex and vomit. The knuckles get inflamed in the process after coming in contact with the teeth multiple times.

    • This question is part of the following fields:

      • Gastroenterology And Hepatology
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  • Question 28 - Which of the following is true regarding teenage pregnancy? ...

    Incorrect

    • Which of the following is true regarding teenage pregnancy?

      Your Answer:

      Correct Answer: Maternal weight gain is maximum during mid-pregnancy

      Explanation:

      Teenagers may have poor eating habits and neglect to take their vitamin supplements. They are less likely than older women to be of adequate pre-pregnancy weight or to gain an adequate amount of weight during pregnancy. Low weight gain increases the risk of having a low birthweight baby. Weight gain is maximal during the 2nd trimester.

      aPTT and gallbladder emptying is decreased during pregnancy whereas d-dimers is increased.

    • This question is part of the following fields:

      • Adolescent Health
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  • Question 29 - Which of the following is true about Kwashiorkor Protein Energy Malnutrition? ...

    Incorrect

    • Which of the following is true about Kwashiorkor Protein Energy Malnutrition?

      Your Answer:

      Correct Answer: Children affected have generalised oedema

      Explanation:

      Protein energy malnutrition often presents in two common forms, Kwashiorkor and Marasmus. Kwashiorkor is characterised by a protein deficiency with an additional inadequate calorie intake. As a result, affected children present with oedema, muscular atrophy, and their weight for age is 60-80% of the expected weight. Their cutaneous tissue is however preserved. Marasmus on the other hand is characterised by a severe calorie deficiency leading to atrophy of the muscles and adipose tissue, with weight loss being less than 60% of the normal. In both cases, if the child is not promptly rehabilitated, the malnutrition could cause irreversible damage, such as hepatic, cardiac and renal impairments.

    • This question is part of the following fields:

      • Nutrition
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  • Question 30 - A mother attends the clinic with her 4-year-old. She has noticed a discharge...

    Incorrect

    • A mother attends the clinic with her 4-year-old. She has noticed a discharge from the his left ear over the past two weeks. He has a history of frequent episodes of 'ear infection' but has been otherwise well. There is no reported fever. On examination, the child is systemically well. The child is co-operative with otoscopy which shows an intact pink tympanic membrane on the right but a possible perforation on the left.

      What is the next best step in management?

      Your Answer:

      Correct Answer: Refer for ENT opinion

      Explanation:

      The child has Chronic suppurative otitis media (CSOM) which is defined as a perforated tympanic membrane with persistent drainage from the middle ear for more than 2-6 weeks.
      CSOM differs from chronic serous otitis media in that chronic serous otitis media may be defined as a middle ear effusion without perforation that is reported to persist for more than 1-3 months.
      Patients with chronic suppurative otitis media (CSOM) present with a draining ear of some duration and a premorbid history of recurrent acute otitis media, traumatic perforation, or the placement of ventilation tubes. Typically, they deny pain or discomfort. A common presenting symptom is hearing loss in the affected ear. Reports of fever, vertigo, and pain should raise concerns about infratemporal or intracranial complications. A history of persistent CSOM after appropriate medical treatment should alert the physician to consider cholesteatoma.
      The external auditory canal may or may not be oedematous and is not typically tender. The discharge varies from fetid, purulent, and cheese like to clear and serous. Granulation tissue is often seen in the medial canal or middle ear space. The middle ear mucosa visualized through the perforation may be oedematous or even polypoid, pale, or erythematous.

    • This question is part of the following fields:

      • ENT
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  • Question 31 - Damage to which of the following nerves may cause an absent jaw jerk...

    Incorrect

    • Damage to which of the following nerves may cause an absent jaw jerk reflex?

      Your Answer:

      Correct Answer: Trigeminal

      Explanation:

      The trigeminal nerve is responsible for the motor innervation of the muscles of mastication and well as providing sensory input for most of the head. In testing the function of this nerve, the jaw jerk reflex may be brisk in cases of upper motor neuron lesions, but is however absent in nuclear or infra nuclear lesions involving the trigeminal nerve. Other nerve reflexes include the gag reflex of the glossopharyngeal nerve, and the pupillary light reflex of the optic nerve.

    • This question is part of the following fields:

      • Neurology And Neurodisability
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  • Question 32 - A 15-year-old male presents complaining of gradually increasing fatigue. He says that he...

    Incorrect

    • A 15-year-old male presents complaining of gradually increasing fatigue. He says that he turned vegan a year ago. He explains that he takes vitamin B12 supplements every day. Considering iron deficiency anaemia as a possible cause, you order some blood tests to confirm.
      Which of the following would increase the ability of the body to absorb dietary iron?

      Your Answer:

      Correct Answer: Consuming iron in its ferrous (Fe2+) form

      Explanation:

      Consuming iron in its Fe2+ (ferrous form) form can improve the ability to absorb dietary iron in patients with iron deficiency anaemia (IDA).

      Clinical features of IDA include:
      – Koilonychia
      – Atrophic glossitis
      – Post-cricoid webs
      – Angular stomatitis

      The peripheral blood smear shows the following abnormal RBC morphologies:
      – Target cells
      – Pencil poikilocytes
      – Microcytic-hypochromic cells

    • This question is part of the following fields:

      • Haematology And Oncology
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  • Question 33 - A 15 month old boy has a history of repeated bacterial pneumonia, failure...

    Incorrect

    • A 15 month old boy has a history of repeated bacterial pneumonia, failure to thrive and a sputum culture positive for H.influenzea and S.pneumoniae. There is no history of congenital anomalies. He is most likely suffering from?

      Your Answer:

      Correct Answer: X-linked agammaglobulinemia

      Explanation:

      Recurrent bacterial infections may be due to lack of B-cell function, consequently resulting in a lack of gamma globulins production. Once the maternal antibodies have depleted, the disease manifests with greater severity and is called x-linked agammaglobulinemia also known as ‘X-linked hypogammaglobulinemia’, ‘XLA’ or ‘Bruton-type agammaglobulinemia. it is a rare x linked genetic disorder that compromises the bodies ability to fight infections.

      Acute leukaemia causes immunodeficiency but not so specific.

      DiGeorge syndrome is due to lack of T cell function.

      Aplastic anaemia and EBV infection does not cause immunodeficiency.

    • This question is part of the following fields:

      • Respiratory
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  • Question 34 - A 15-year-old girl arrives at the hospital complaining of resting tremors in both...

    Incorrect

    • A 15-year-old girl arrives at the hospital complaining of resting tremors in both arms. Ataxia and dysarthria are also observed along with occasional involuntary grimacing of the face. The patient is most likely suffering from which of the following?

      Your Answer:

      Correct Answer: Wilson's disease

      Explanation:

      Common neurological symptoms of Wilson disease that may appear and progress with time include tremor, involuntary movements, difficulty swallowing (dysphagia), difficulty speaking and poor articulation (dysarthria), lack of coordination, spasticity, dystonic postures, and muscle rigidity.

    • This question is part of the following fields:

      • Neurology And Neurodisability
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  • Question 35 - A child suffering from a chest infection is prescribed flucloxacillin. A few days...

    Incorrect

    • A child suffering from a chest infection is prescribed flucloxacillin. A few days later, he develops jaundice, dark urine, and pale stools. What is he suffering from now?

      Your Answer:

      Correct Answer: Cholestatic jaundice

      Explanation:

      Due to its cholestatic properties, Flucloxacillin can block bile flow through the liver, leading to the accumulation of bilirubin in the blood, giving rise to jaundice. Dark urine is the result of excessive bilirubin in the blood being filtered by the kidney. As the bile doesn’t move into the small intestine, stools are pale.

    • This question is part of the following fields:

      • Pharmacology
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  • Question 36 - Which of the following segments of the ECG represents ventricular repolarization? ...

    Incorrect

    • Which of the following segments of the ECG represents ventricular repolarization?

      Your Answer:

      Correct Answer: T wave

      Explanation:

      The T wave represents ventricular repolarization.

      Other options:
      – P wave:
      Depolarization that spreads from the SA node throughout the atria. The wave lasts 0.08 to 0.1 seconds (80-100 ms).
      The isoelectric period after the P wave represents the time in which the impulse is travelling within the AV node.
      – P-R interval:
      Time from the onset of the P wave to the beginning of the QRS complex. The wave ranges from 0.12 to 0.20 seconds in duration.
      Represents the time between the onset of atrial depolarization and the onset of ventricular depolarization
      – QRS complex:
      It represents ventricular depolarization. The duration of the QRS complex is normally 0.06 to 0.1 seconds.
      – ST-segment:
      The isoelectric period following the QRS. It represents the period in which the entire ventricle is depolarized and roughly corresponds to the plateau phase of the ventricular action potential
      – U wave:
      It is a small positive wave which may follow the T wave. It represents the last remnants of ventricular repolarization.
      – Q-T interval
      It represents the time for both ventricular depolarization and repolarization to occur, and therefore roughly estimates the duration of an average ventricular action potential.
      The interval ranges from 0.2 to 0.4 seconds depending upon heart rate.
      At high heart rates, ventricular action potentials shorten in duration, which decreases the Q-T interval. Therefore the Q-T interval is expressed as a corrected Q-T (QTc) by taking the Q-T interval and dividing it by the square root of the R-R interval (interval between ventricular depolarizations). This allows an assessment of the Q-T interval that is independent of heart rate.

      The normal corrected Q-Tc interval is less than 0.44 seconds.

    • This question is part of the following fields:

      • Cardiovascular
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  • Question 37 - An 8-year-old boy who recently migrated from Nigeria was seen in A&E department...

    Incorrect

    • An 8-year-old boy who recently migrated from Nigeria was seen in A&E department with a six-week history of progressive swelling of his jaw, fever, night sweats, and weight loss. His mother reported an episode of sore throat in the past which was treated with antibiotics, but he developed a rash subsequently. Other than that, there was no other significant past medical history. On examination, a painless, nontender 4x3cm mass was found that was fixed and hard. The only other examination finding of note was rubbery symmetrical cervical lymphadenopathy.

      Which of the following translocation would most likely be found on biopsy karyotyping?

      Your Answer:

      Correct Answer: t(8;14)

      Explanation:

      Burkitt lymphoma is associated with the c-myc gene translocation, usually t(8;14).

      Burkitt lymphoma is a rare high-grade non-Hodgkin lymphoma endemic to west Africa and the mosquito belt. It has a close association with the contraction of Epstein-Barr virus (EBV). Burkitt lymphoma often presents with symmetrical painless lymphadenopathy, systemic B symptoms (fever, sweats, and weight loss), central nervous system involvement, and bone marrow infiltration. Classically in the textbooks, the patient also develops a large jaw tumour.

      Other aforementioned options are ruled out because:
      1. t(9;22)-Chronic myeloid leukaemia
      2. t(15;17)-Acute promyelocytic leukaemia
      3. t(14;18)-Follicular Lymphoma
      4. t(11;14)-Mantle Cell Lymphoma

    • This question is part of the following fields:

      • Haematology And Oncology
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  • Question 38 - Which of the following conditions is NOT a recognized cause of respiratory distress...

    Incorrect

    • Which of the following conditions is NOT a recognized cause of respiratory distress syndrome (SDLD)?

      Your Answer:

      Correct Answer: Maternal hypertension

      Explanation:

      Insufficient surfactant production in premature infants leads to respiratory distress syndrome or surfactant deficient lung disease (SDLD), characterized by structurally immature lungs. There are many risk factors of this disease, some of them include male gender, caesarean section, infants of diabetic mothers, being the second born of the premature twins, perinatal asphyxia, sepsis, and hypothermia. Maternal hypertension is not a recognized risk factor for respiratory distress syndrome; instead, pregnancy-induced hypertension and chronic maternal hypertension are the protective factors against this disease.

    • This question is part of the following fields:

      • Neonatology
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  • Question 39 - A 2-year-old presented with symptoms of gastroenteritis. Which of the following signs is...

    Incorrect

    • A 2-year-old presented with symptoms of gastroenteritis. Which of the following signs is the strongest indicator for IV fluid administration?

      Your Answer:

      Correct Answer: Capillary refilling time > 4secs

      Explanation:

      Children are very prone to dehydration during an episode of gastroenteritis. Dehydration is detected early by increased capillary filling time.

    • This question is part of the following fields:

      • Gastroenterology And Hepatology
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  • Question 40 - Which of the following statements is correct regarding erythema nodosum? ...

    Incorrect

    • Which of the following statements is correct regarding erythema nodosum?

      Your Answer:

      Correct Answer: The typical eruption is symmetrical, tender, and with bruise like lesions to the shins, ankles, and knees

      Explanation:

      Erythema nodosum is the most common type of inflammation of the subcutaneous fat tissue, referred to as panniculitis. Erythema nodosum appears as painful, erythematous round lumps, usually symmetrically on the anterior aspect of lower extremities. These lesions are self-limiting and tend to resolve within 2-8 weeks without undergoing necrosis or ulceration. There are various causes of erythema nodosum, but the most important among children is the streptococcal throat infection. Other causes include autoimmune conditions like sarcoidosis, inflammatory bowel disease, mycobacterial infection (TB), drugs like penicillin and sulphonamides, and malignancies like some leukemias and lymphomas.

    • This question is part of the following fields:

      • Dermatology
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  • Question 41 - A 6 month old baby presents with uncontrollable movements of her hands and...

    Incorrect

    • A 6 month old baby presents with uncontrollable movements of her hands and feet, shortly after being unconscious for a while. What is the most likely diagnosis?

      Your Answer:

      Correct Answer: Infantile spasm

      Explanation:

      Infantile spasm belongs to the spectrum of seizure disorders. Infantile spasm manifests itself with loss of consciousness and jerky movements. The peak age of onset is between 4 and 6 months. Approximately 90% of infantile spasms begin before 12 months of age. It is rare for infantile spasms to begin during the first 2 weeks of life or after 18 months.

    • This question is part of the following fields:

      • Neurology
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  • Question 42 - From the options provided, which statement would most likely points towards Munchausen's syndrome...

    Incorrect

    • From the options provided, which statement would most likely points towards Munchausen's syndrome by proxy?

      Your Answer:

      Correct Answer: It is a cause of sudden infant death

      Explanation:

      Munchausen syndrome by proxy is a mental illness and a form of child abuse. The caretaker of a child, most often a mother or a father, either makes up fake symptoms or causes real symptoms to make it look like the child is sick. The person with MSP gains attention by seeking medical help for exaggerated or made-up symptoms of a child in his or her care. As health care providers strive to identify what’s causing the child’s symptoms, the deliberate actions of the mother or caretaker can often make the symptoms worse.
      The person with MSP does not seem to be motivated by a desire for any type of material gain. People with MSP may create or exaggerate a child’s symptoms in several ways. They may simply lie about symptoms, alter tests (such as contaminating a urine sample), falsify medical records, or they may actually induce symptoms through various means, such as poisoning, suffocating, starving, and causing infection.

    • This question is part of the following fields:

      • Behavioural Medicine And Psychiatry
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  • Question 43 - A cohort study is developed to assess the correlation between blood pressure and...

    Incorrect

    • A cohort study is developed to assess the correlation between blood pressure and working long hours. After 10 years of follow-up and for the 1050 individuals working less than 40 hours per week, 1000 patients had normal blood pressure and 50 patients were diagnosed with hypertension. For the 660 patients working more than 40 hours per week, 600 patients had normal blood pressure and 60 patients were diagnosed with hypertension. If you work more than 40 hours per week, what is the odds ratio of developing hypertension compared to the individuals working less than 40 hours per week?

      Your Answer:

      Correct Answer: 2

      Explanation:

      An odds ratio (OR) is a measure of the association between an exposure and an outcome. The OR represents the odds that an outcome will occur given a particular exposure, compared to the odds of the outcome occurring in the absence of that exposure. Odds ratios are most commonly used in case-control studies, however they can also be used in cross-sectional and cohort study designs as well (with some modifications and/or assumptions). Where

      a = Number of exposed cases

      b = Number of exposed non-cases

      c = Number of unexposed cases

      d = Number of unexposed non-cases

      OR=(a/c) / (b/d) = ad/bc

    • This question is part of the following fields:

      • Epidemiology And Statistics
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  • Question 44 - Which of the following conditions is not associated with corneal opacities? ...

    Incorrect

    • Which of the following conditions is not associated with corneal opacities?

      Your Answer:

      Correct Answer: Sturge-Weber syndrome

      Explanation:

      The mnemonic STUMPED is helpful for remembering the differential diagnosis for congenital corneal opacities:
      – Sclerocornea
      – Tears in Descemet membrane (usually due to forceps trauma or congenital glaucoma)
      – Ulcers (e.g. infection – rubella)
      – Metabolic (e.g., mucopolysaccharidosis)
      – Peters anomaly
      – oEdema
      – Dermoids (e.g. Goldenhar’s syndrome)

    • This question is part of the following fields:

      • Ophthalmology
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  • Question 45 - At term, what is the normal amount of amniotic fluid? ...

    Incorrect

    • At term, what is the normal amount of amniotic fluid?

      Your Answer:

      Correct Answer: 600ml

      Explanation:

      In the first trimester of pregnancy, amniotic fluid is produced from maternal plasma where there is a rapid bi-directional diffusion across the foetal skin. At 10 weeks the volume is about 25ml. By 16th weeks of gestation the foetal kidneys make urine that contributes to the increasing volume of amniotic fluid, along with nasal secretions. At 20 weeks, the level is 400ml and increases to 800ml at 28weeks, after which it reduces to 600ml at term.

    • This question is part of the following fields:

      • Neonatology
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  • Question 46 - A premature neonate at 28 weeks gestation suffers from right sided intraventricular haemorrhage...

    Incorrect

    • A premature neonate at 28 weeks gestation suffers from right sided intraventricular haemorrhage with no ventricular dilation while on the ventilator. What advice should ideally be given to the parents in this situation?

      Your Answer:

      Correct Answer: It is probable that there will be no significant long-term effects but his development will be closely followed just in case

      Explanation:

      There are four types of IVH. These are called grades and are based on the degree of bleeding.

      Grades 1 and 2 involve a smaller amount of bleeding. Most of the time, there are no long-term problems as a result of the bleeding. Grade 1 is also referred to as germinal matrix haemorrhage (GMH).
      Grades 3 and 4 involve more severe bleeding. The blood presses on (grade 3) or directly involves (grade 4) brain tissue. Grade 4 is also called an intraparenchymal haemorrhage. Blood clots can form and block the flow of cerebrospinal fluid. This can lead to increased fluid in the brain (hydrocephalus).

    • This question is part of the following fields:

      • Neonatology
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  • Question 47 - A baby is born with complications including microcephaly, hepatosplenomegaly and elevated total bilirubin....

    Incorrect

    • 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:

      Correct 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.

    • This question is part of the following fields:

      • Infectious Diseases
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  • Question 48 - 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 49 - Which of the following is a risk factor for intrauterine growth restriction? ...

    Incorrect

    • Which of the following is a risk factor for intrauterine growth restriction?

      Your Answer:

      Correct Answer: Foetal echogenic bowel

      Explanation:

      Intrauterine growth restriction refers to the failure of the fetus to grow in accordance with the weeks of gestation. There are two types of growth restriction, symmetrical and asymmetrical. Causes include various genetic abnormalities, fetal infections, maternal health conditions, etc. Risk factors for the development of IUGR include fetal echogenic bowel, maternal age above 40 years, low PAPP-A levels, maternal smoking or cocaine use, etc. Fetal echogenic bowel implies a brighter than usual fetal intestines on ultrasonography. It is a marker associated with trisomy 21, which is a cause of IUGR.

    • This question is part of the following fields:

      • Neonatology
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  • Question 50 - A 15-week-old baby boy is brought to the emergency by his parents due...

    Incorrect

    • A 15-week-old baby boy is brought to the emergency by his parents due to vomiting and weight loss. Physical examination reveals a central palpable mass in the abdomen. Ultrasound examination shows a pylorus 8mm long and a target sign centrally. What is the most likely diagnosis?

      Your Answer:

      Correct Answer: Intussusception

      Explanation:

      Intussusception is a condition in which one segment of intestine telescopes inside of another, causing an intestinal obstruction. Although intussusception can occur anywhere in the gastrointestinal tract, it usually occurs at the junction of the small and large intestines. Most describe the symptoms of intussusception as a triad of colicky abdominal pain, bilious vomiting, and currant jelly stool. The primary symptom of intussusception is described as intermittent crampy abdominal pain.

    • This question is part of the following fields:

      • Paediatric Surgery
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  • Question 51 - What is the gestational age by which the lung buds are formed? ...

    Incorrect

    • What is the gestational age by which the lung buds are formed?

      Your Answer:

      Correct Answer: Embryonic: 4-5 weeks gestation

      Explanation:

      Lung buds are formed by 4-5 weeks of gestation.

      Development of the respiratory tract has five stages:
      – Embryonic (at 4 – 5 weeks of gestation):
      Formation of lung buds, trachea and mainstem bronchi occur. These structures are formed from a ventral outpouching of foregut pharynx. At this stage, the beginnings of the five lung lobes are present.
      – Pseudoglandular (at 5 – 16 weeks of gestation):
      Formation of terminal bronchioles, cartilage and smooth muscles occur in this stage. Adult numbers of airways proximal to acini are in place.
      – Canalicular (at 16-24 weeks gestation):
      Differentiation of type I and II epithelial cells can be done in this stage. There is also an increase in the size of proximal airways).
      – Saccular (at 24 – 40 weeks of gestation): Terminal saccule formation occurs. Production of surfactant takes place at this stage with an increase in the number of goblet cells
      Up to half the adult number of alveoli are in place by this stage.
      – Alveolar (occurs between 32 weeks of gestation till the post-natal age 8): Formation of alveoli and septation occurs with the expansion of air spaces.

    • This question is part of the following fields:

      • ENT
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  • Question 52 - In patients diagnosed with bulimia nervosa, which of the following laboratory parameters is...

    Incorrect

    • In patients diagnosed with bulimia nervosa, which of the following laboratory parameters is decreased?

      Your Answer:

      Correct Answer: Cholecystokinin (CCK)

      Explanation:

      Bulimia nervosa is an eating disorder that involves frequent episodes of binge eating followed by inappropriate purging behaviour. The underlying reason for this behaviour is distorted self-image. Bulimia leads to several medical issues, including various laboratory derangements. Among these deranged laboratory parameters are the hormone cholecystokinin, which is found to be decreased in women having bulimia. It is hypothesized that the bingeing episodes observed in patients with bulimia are due to lower levels of CCK since normal levels of CCK are involved in maintaining satiety and controlling the urge to binge eat.

    • This question is part of the following fields:

      • Gastroenterology And Hepatology
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  • Question 53 - A young man has ingested 25 tablets of paracetamol 500 mg. What is...

    Incorrect

    • A young man has ingested 25 tablets of paracetamol 500 mg. What is the suggested minimum time interval between ingestion and measuring the blood plasma paracetamol levels?

      Your Answer:

      Correct Answer: 4 hours

      Explanation:

      The post-ingestion plasma level, which is required in order to guide the treatment, reaches a peak at 4 hours. Levels requiring antidote (N-acetyl cysteine) include: 100 mcg per ml at 4 hours, 35 mcg per ml at 10 hours and 25 mcg per ml at 12 hours. These levels are in conjunction with the levels recorded and they should all be put down on a treatment nomogram.

    • This question is part of the following fields:

      • Pharmacology
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  • Question 54 - Scarring type of alopecia occurs in which of the following conditions? ...

    Incorrect

    • Scarring type of alopecia occurs in which of the following conditions?

      Your Answer:

      Correct Answer: Discoid lupus

      Explanation:

      Alopecia is a scalp condition characterized by either overall baldness or patches of hair loss over the head. It can be broadly classified as scarring alopecia and non-scarring alopecia. Non-scarring is the most common type and is seen in various conditions like nutritional deficiencies, alopecia areata, hypothyroidism, tinea capitis, and SLE. Scarring alopecia is commonly seen in cases of discoid lupus erythematosus, which is a common cause of widespread inflammatory and scarring lesions all over the body and scalp.

    • This question is part of the following fields:

      • Dermatology
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  • Question 55 - A pregnant woman with atopic eczema and asthma, who has a 5-year-old child...

    Incorrect

    • A pregnant woman with atopic eczema and asthma, who has a 5-year-old child with moderately severe eczema, requests advice about reducing the risk of eczema in her unborn child.
      Select the MOST appropriate advice from the following:

      Your Answer:

      Correct Answer: Removing certain known food allergens from the mother's diet during pregnancy does not reduce the risk or prevent the onset of atopic eczema

      Explanation:

      Nonspecific triggers of inflammation in patients with atopic dermatitis may include physical or chemical irritants. The following simple measures should be followed in daily life to reduce the frequency and severity of irritant-induced atopic dermatitis flares :
      Skin care products that contain alcohol and astringents should be avoided.
      New clothes should be laundered before use to remove formaldehyde and other chemicals.
      Liquid detergents are preferred over powder detergents for laundering clothes, as liquids are easier to rinse out. A second rinse cycle may also improve removal of residual detergent.
      Patients should shower immediately after swimming in chlorinated pools and should subsequently apply moisturizer.
      Fragrance-free skin products that are hypoallergenic or made for sensitive skin may be less irritating than other kinds of skin products.
      Prenatal and postnatal probiotic supplementation may be helpful in preventing the development of atopic dermatitis in young children. In a 2008 meta-analysis, the most commonly studied probiotic was Lactobacillus rhamnoses GG. Larger, randomized controlled studies are needed to confirm these initial findings.

      Breastfeeding during the first 4 months of life may reduce the incidence and severity of childhood atopic disease but only modestly and only in those at high risk.

    • This question is part of the following fields:

      • Dermatology
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  • Question 56 - An 11-year-old boy was brought to the hospital by his mother, who says...

    Incorrect

    • An 11-year-old boy was brought to the hospital by his mother, who says that occasionally he tilts his head towards his right shoulder. She also remarked that his left eye seemed to move up suddenly when he looked towards his nose.
      Which of the following extraocular muscles is most likely to be affected in this child?

      Your Answer:

      Correct Answer: Superior oblique

      Explanation:

      From the given scenario, the extraocular muscle affected in the child is superior oblique muscle.

      Point to remember:
      All of the extraocular muscles are supplied by the oculomotor nerve (3rd cranial nerve), except superior oblique (trochlear nerve/4th cranial nerve) and lateral rectus (abducens nerve/6th cranial nerve).

      The superior oblique muscle causes the eye to move downwards and medially. The unopposed inferior oblique, in this case, causes the eye to deviate upwards and medially.
      Children tend to tilt their head (torticollis) to the side opposite to the affected eye with their chin down toward the shoulder, and their face turned away from the affected side to decrease the diplopia.

    • This question is part of the following fields:

      • Ophthalmology
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  • Question 57 - A 13-year-old girl was recently diagnosed with type 1 diabetes mellitus about two...

    Incorrect

    • A 13-year-old girl was recently diagnosed with type 1 diabetes mellitus about two weeks ago and started on an insulin pump. Which of the following complications is least likely to occur due to the treatment modality adopted?

      Your Answer:

      Correct Answer: Lipoatrophy

      Explanation:

      Among the given options, lipoatrophy takes time to develop as it is a long-term complication of insulin therapy. Since it has only been two weeks since the initiation of insulin therapy, it is unlikely to occur so early.
      The risk of lipoatrophy is reduced with newer insulins and also can be avoided by site rotation.
      However, anaphylaxis, allergic reactions, infection and abscesses at the site of an insulin pump can occur in this patient as a complication of insulin therapy.

    • This question is part of the following fields:

      • Endocrinology
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  • Question 58 - A young boy presents with a soft swelling in the midline neck that...

    Incorrect

    • A young boy presents with a soft swelling in the midline neck that moves with tongue protrusion. The swelling is present between the thyroid cartilage and the tongue. Which of the following is the most likely diagnosis?

      Your Answer:

      Correct Answer: Thyroglossal cyst

      Explanation:

      The thyroglossal duct cyst is the most common congenital anomaly of the central portion of the neck. The thyroglossal duct cyst is intimately related to the central portion of the hyoid bone and usually elevates along with the larynx during swallowing. Thyroglossal cysts can be defined as an irregular neck mass or a lump which develops from cells and tissues left over after the formation of the thyroid gland during the developmental stages.

    • This question is part of the following fields:

      • ENT
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  • Question 59 - 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 60 - An 8 month old baby boy presents with a fine, white and scaly...

    Incorrect

    • An 8 month old baby boy presents with a fine, white and scaly rash that is more profound on the extensor surfaces of his arms and legs. It is also found on his trunk. However, the flexor surfaces, face and neck are spared. It has been present for 4 months. Which of the following is the most probable diagnosis?

      Your Answer:

      Correct Answer: Ichthyosis vulgaris

      Explanation:

      Ichthyosis vulgaris presents clinically with xerosis, hyperkeratosis, excess scaling, keratosis pilaris, and palmar and plantar hyperlinearity. It most commonly affects the extensor surfaces of the limbs and spares flexor surfaces, the face, and the neck.

    • This question is part of the following fields:

      • Dermatology
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  • Question 61 - Which of the following conditions is due to a deletion of chromosome 15q...

    Incorrect

    • Which of the following conditions is due to a deletion of chromosome 15q inherited from the father?

      Your Answer:

      Correct Answer: Prader-Willi

      Explanation:

      Most cases of Prader-Willi syndrome are not inherited, particularly those caused by a deletion in the paternal chromosome 15 or by maternal uniparental disomy. These genetic changes occur as random events during the formation of reproductive cells (eggs and sperm) or in early embryonic development. Affected people typically have no history of the disorder in their family.
      Rarely, a genetic change responsible for Prader-Willi syndrome can be inherited. For example, it is possible for a genetic change that abnormally inactivates genes on the paternal chromosome 15 to be passed from one generation to the next.

      Prader-Willi syndrome is a complex genetic condition that affects many parts of the body. In infancy, this condition is characterized by weak muscle tone (hypotonia), feeding difficulties, poor growth, and delayed development. Beginning in childhood, affected individuals develop an insatiable appetite, which leads to chronic overeating (hyperphagia) and obesity. Some people with Prader-Willi syndrome, particularly those with obesity, also develop type 2 diabetes (the most common form of diabetes).

    • This question is part of the following fields:

      • Genetics And Dysmorphology
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  • Question 62 - What is the best study design to use when trying to determine a...

    Incorrect

    • What is the best study design to use when trying to determine a causal relationship between a certain factor and the onset of a rare disease?

      Your Answer:

      Correct Answer: Case-control

      Explanation:

      Case control studies are used to determine the relationship between exposure to a risk factor and the resultant outcomes. It finds patients in the general population who have a certain condition and retrospectively searches for past exposure to possible risk factors for the disease. Controls are people who do not have the disease found in the general population. This type of study is useful for rare diseases, and is less time consuming to conduct.

      While cohort studies can be used to study rare diseases they measure the relative risk of developing the disease over time based on exposure.

      Ecological or cross-sectional studies attempt take a snapshot of a whole population, and thus are inappropriate for rare diseases as larger sample numbers are needed. A randomised control trial is better suited to determine the effect of an intervention.

    • This question is part of the following fields:

      • Epidemiology And Statistics
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  • Question 63 - A 4-year-old boy presents with offensive stool, clubbing of fingers, and recurrent chest...

    Incorrect

    • A 4-year-old boy presents with offensive stool, clubbing of fingers, and recurrent chest pain. Choose the single most appropriate investigation?

      Your Answer:

      Correct Answer: Sweat test

      Explanation:

      Cystic fibrosis is a progressive, genetic disease. A defective gene causes a thick, sticky build-up of mucus in the lungs, pancreas, and other organs. In the lungs, the mucus clogs the airways and traps bacteria leading to infections, extensive lung damage, and eventually, respiratory failure. In the pancreas, the mucus prevents the release of digestive enzymes that allow the body to break down food and absorb vital nutrients. Since the digestive enzymes are not being made, the food is not completely digested making them bulky, smelly, and hard to flush away. Finger clubbing is a prominent feature of cystic fibrosis on most patients.

    • This question is part of the following fields:

      • Genetics And Dysmorphology
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  • Question 64 - A 14-year-old boy suffers a blow to the right side of his head...

    Incorrect

    • A 14-year-old boy suffers a blow to the right side of his head with a hammer. On arrival at the emergency department, he is pronounced dead. Post-mortem findings will show which of the following features?

      Your Answer:

      Correct Answer: Laceration of the middle meningeal artery

      Explanation:

      An epidural hematoma occurs when there is bleeding between the dura mater (a tough fibrous layer of tissue between the brain and skull) and the skull bone. These occur when arteries are torn as a result of a blow to the head, and injury in the temple area is a common cause. Although the pattern of a lucid interval followed by later neurological symptoms is characteristic, only a minority of patients display this pattern of symptoms. Reported death rates from epidural hematoma vary widely, ranging from 5% to over 40%. Middle meningeal artery is frequently involved in such incidents.

    • This question is part of the following fields:

      • Emergency Medicine
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  • Question 65 - Which of the following immunological components is deficient in a 5-year-old HIV positive...

    Incorrect

    • Which of the following immunological components is deficient in a 5-year-old HIV positive child who develops Pneumocystis jiroveci pneumonia?

      Your Answer:

      Correct Answer: T cells

      Explanation:

      Patients with HIV have a deficiency of CD4 lymphocytes which are also known as helper T cells (Th).
      They are involved with antigen-specific responses as well as delayed-type hypersensitivity.
      The risk of developing P. jiroveci pneumonia is greatest with a CD4 count of 200 x 109/l or below.

    • This question is part of the following fields:

      • HIV
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  • Question 66 - Which of the following epilepsy syndromes is NOT benign? ...

    Incorrect

    • Which of the following epilepsy syndromes is NOT benign?

      Your Answer:

      Correct Answer: Infantile spasms

      Explanation:

      Epilepsy is a common paediatric neurologic disorder characterized by seizures of varying frequency and intensity. There are many childhood or infantile epilepsy syndromes that can be categorized as benign epilepsy syndromes as the child suffering from these usually outgrows them after reaching a certain age, and they do not lead to significant cognitive or physical impairment. Some of these may not need any treatment. Such benign epilepsy syndromes include benign rolandic epilepsy, Panayiotopoulos syndrome, Gastaut type-idiopathic childhood occipital epilepsy, and idiopathic photosensitive occipital lobe epilepsy.
      West syndrome, also called infantile spasms, is a serious infantile epileptic encephalopathy, characterized by multiple clusters of myoclonic spasms, and regression of the previous normally attained milestones. It is associated with severe cognitive and physical impairment, often leading to life long disability.

    • This question is part of the following fields:

      • Neurology And Neurodisability
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  • Question 67 - A 11 year old girl with a history of recurrent chest infections, was...

    Incorrect

    • A 11 year old girl with a history of recurrent chest infections, was admitted with a fever, productive cough, anorexia and weight loss. On examination she was febrile and tachycardic. Her mother said that the girl was not thriving well. Which of the following organisms is responsible for this presentation?

      Your Answer:

      Correct Answer: Pseudomonas

      Explanation:

      History of recurrent infections and failure to thrive (probably due to pancreatic enzyme insufficiency) is highly suggestive of cystic fibrosis. Pseudomonas has been identified as an important respiratory pathogen in patients with cystic fibrosis.

    • This question is part of the following fields:

      • Infectious Diseases
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  • Question 68 - A 5 week old boy is vomiting excessively, suggesting a pyloric stenosis. Which...

    Incorrect

    • A 5 week old boy is vomiting excessively, suggesting a pyloric stenosis. Which of the following risk factors might be present?

      Your Answer:

      Correct Answer: Maternal smoking

      Explanation:

      Maternal smoking is one of the most significant risk factors for pyloric stenosis.

      Remember the three Ps for Pyloric Stenosis:
      P -palpable mass
      P -peristalsis
      P -projectile vomiting

    • This question is part of the following fields:

      • Gastroenterology And Hepatology
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  • Question 69 - A 11 year old girl with a history of recurrent chest infections, was...

    Incorrect

    • A 11 year old girl with a history of recurrent chest infections, was admitted with a fever, productive cough, anorexia and weight loss. On examination she was febrile and tachycardic. Her mother said that the girl was not thriving well. Which of the following organisms is responsible for this presentation?

      Your Answer:

      Correct Answer: Pseudomonas

      Explanation:

      History of recurrent infections and failure to thrive (probably due to pancreatic enzyme insufficiency) is highly suggestive of cystic fibrosis. Pseudomonas has been identified as an important respiratory pathogen in patients with cystic fibrosis.

    • This question is part of the following fields:

      • Infectious Diseases
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  • Question 70 - Which of the following actions will an 8-week-old infant born at full-term be...

    Incorrect

    • Which of the following actions will an 8-week-old infant born at full-term be able to do, considering normal development?

      Your Answer:

      Correct Answer: Smile

      Explanation:

      Among the options provided, an 8-week-old full-term infant with normal developmental milestones will smile in response to appropriate stimuli.

      Rationale:
      Smiles in response to appropriate stimuli are seen from around 6 weeks of age. A social smile, where the infant has an awareness that a smile attracts attention, is not observed until around 3 months of age.

      Other options:
      – At 6 weeks an infant is able to follow objects in the horizontal plane through 90 deg; fixing and following an object through 180 deg in the horizontal plane is a milestone achieved at 3 months, as is pushing up onto forearms.
      – Pushing up onto hands occurs by around 5 months.
      – Infants of 3 months should startle to a 60 dB sound.

    • This question is part of the following fields:

      • Child Development
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  • Question 71 - A 14-year-old female is brought to the paediatrician with recent onset of generalized...

    Incorrect

    • A 14-year-old female is brought to the paediatrician with recent onset of generalized tonic clonic seizures and reports 4 episodes in 2 weeks. Her teacher has reported that her attention span has deteriorated markedly which has affected her performance in studies. She often stops in the middle of tasks and forgets what she is doing. After discussing with the mother and the patient you decide to start medication. While speaking alone, the patient tells you that she is sexually active with her boyfriend and takes POPs (progestin only pills) but sometimes forgets to take them. which of the following anti-epileptic drug can be safely initiated in this patient?

      Your Answer:

      Correct Answer: Lamotrigine

      Explanation:

      Lamotrigine does not significantly increase risk of birth defects during pregnancy.

    • This question is part of the following fields:

      • Neurology And Neurodisability
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  • Question 72 - Which of the following is NOT true of the femoral nerve? ...

    Incorrect

    • Which of the following is NOT true of the femoral nerve?

      Your Answer:

      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.

    • This question is part of the following fields:

      • Musculoskeletal
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  • Question 73 - A child on 70% O2 suddenly crouches down whilst playing to help with...

    Incorrect

    • A child on 70% O2 suddenly crouches down whilst playing to help with breathing. What is the most likely diagnosis?

      Your Answer:

      Correct Answer: Tetralogy of Fallot

      Explanation:

      Tetralogy of Fallot (TOF), a congenital heart defect, includes the following: right ventricular hypertrophy, ventricular septal defect, abnormal position of the aorta and pulmonary valve stenosis. The O2 saturation in patients with TOF is typically lower than normal and the condition usually becomes symptomatic early in life. A feature of the disease with high diagnostic significance is squatting or crouching of the infant as a compensatory mechanism to increase the peripheral vascular resistance.

    • This question is part of the following fields:

      • Cardiovascular
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  • Question 74 - A 12-year-old boy hit his head on a pole on the school playground....

    Incorrect

    • A 12-year-old boy hit his head on a pole on the school playground. His friends noted that he lost consciousness for a few seconds. The school nurse sent him to the Emergency Department as he had a small nasal bleed that stopped spontaneously. In the intervening two hours, he has noticed a watery discharge from his nose. On examination, there is considerable bruising on his nose and forehead, he was complaining of a headache. Which is the most appropriate diagnosis?

      Your Answer:

      Correct Answer: Basilar skull fracture

      Explanation:

      Orbital bone fracture: The child has sustained a head injury and subsequently describes a CSF rhinorrhoea (indicating a cerebro-spinal fluid leak). CSF rhinorrhoea can occur in skull or nasal bone fractures. Given the symptoms of loss of consciousness and headache, this child is more at risk of having suffered a skull fracture requiring emergency CT head investigation and specialist neurosurgical management. An ethmoid bone fracture may also present this way. A skull x ray would help to determine an air fluid level and indeed allow some visualisation of the nasal bones, though in children the nasal bones do not visualise well due to lack of fusion. Either way this child would need assessment in the nearest Emergency Department and the school would be expected to follow a ‘head injury’ protocol.

    • This question is part of the following fields:

      • ENT
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  • Question 75 - A 15-year-old boy presents to the clinic with a concern that many of...

    Incorrect

    • A 15-year-old boy presents to the clinic with a concern that many of his friends are now taller than him. He feels that he has not grown as they have. On physical examination, sparse dark coarse hair was observed over the junction of the pubes. He reports having noticed some enlargement of his penis and growth of his testis. His testicular volume was measured to be 8 ml. What is the most likely diagnosis?

      Your Answer:

      Correct Answer: Normal puberty

      Explanation:

      Based on the clinical scenario, the boy is going through normal pubertal changes.

      In the 3 years before puberty, low pulsatile LH levels become detectable during sleep. LH and FSH are produced in the anterior pituitary and released due to pulsatile gonadotrophin-releasing hormone (GnRH) secreted by the hypothalamus.
      There is an increase in the amplitude and frequency of LH secretion as puberty approaches, which causes enlargement of the gonads. In boys, the testicles produce testosterone, and in girls, the ovaries produce oestradiol and ovarian androgens, which, with the adrenal androgens, produce secondary sexual characteristics.

      Note:
      The average age at onset of puberty is 11 years in girls. The first sign is breast bud development, followed by the appearance of pubic hair 6-12 months later.
      Menarche usually occurs 2-2.5 years after breast bud development. Peak height velocity in girls occurs at breast stage 2-3 and virtually always precedes menarche.
      The onset of puberty in boys is at 11.5 years. The first sign is testicular enlargement (>3 ml) and thinning of the scrotum.
      This is followed by the pigmentation of the scrotum and growth of the penis, and pubic hair follows.
      Peak height velocity (growth spurt) is two years later in boys than in girls and occurs at testicular stage 4-5 (i.e. testicular volume 10-12 ml), which is around 13-14 years of age.
      Breast enlargement occurs in 40-60% of boys (rarely, significant enough to cause social embarrassment in 10%) and is a result of oestradiol produced by the metabolism of testosterone.
      It usually resolves within three years. During puberty, elongation of the eye often occurs, causing short-sightedness.

    • This question is part of the following fields:

      • Endocrinology
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  • Question 76 - There is a measure of dispersion of a set of data from its...

    Incorrect

    • There is a measure of dispersion of a set of data from its mean. Which of following is the best term which can describe the above?

      Your Answer:

      Correct Answer: Standard deviation (root mean square deviation)

      Explanation:

      Standard deviation is defined as the measure of dispersion of a set of data from its mean. It measures the absolute variability of a distribution; the higher the dispersion or variability, the greater is the standard deviation and greater will be the magnitude of the deviation of the value from their mean.

    • This question is part of the following fields:

      • Epidemiology And Statistics
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  • Question 77 - A 15 year old girl presents to the clinic with a history of...

    Incorrect

    • A 15 year old girl presents to the clinic with a history of hard to control psoriasis. She is to start on ultraviolet B phototherapy as prescribed by her dermatologist. What is the mechanism of action of the phototherapy?

      Your Answer:

      Correct Answer: Induction of pyrimidine dimerization

      Explanation:

      Psoriasis is an autoimmune dermatological condition that causes cells of the epidermal layer to rapidly develop, leading to itchy scaly plaques. Phototherapy with UV radiation has emerged as a new treatment for difficult to treat psoriasis. The therapy works by inducing epidermal cell apoptosis by DNA damage through the formation of pyrimidine dimerization, disrupting the cell cycle. This slows the rapid proliferation of cells.

    • This question is part of the following fields:

      • Dermatology
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  • Question 78 - What is the most probable diagnosis in an infant with persistent neonatal hypoglycaemia...

    Incorrect

    • What is the most probable diagnosis in an infant with persistent neonatal hypoglycaemia and positive urine ketones?

      Your Answer:

      Correct Answer: Maple syrup urine disease

      Explanation:

      The most probable diagnosis for this patient is Maple syrup urine disease (MSUD).

      Note:
      – Healthy new-borns have blood sugars between 3.3 and 5 mmol/L
      – Neonatal hypoglycaemia is glucose < 2.2 mmol/L if measured in the first 3 days of life.
      – Neonatal hypoglycaemia is glucose < 2.5 mmol/L after the first 3 days of life. Causes of persistent hypoglycaemia include:
      – Preterm
      – IUGR
      – SGA
      – Hyperinsulinism due to maternal diabetes
      – Beckwith-Wiedemann syndrome
      – Hypoxia at birth
      – Sepsis
      – Cardiopulmonary disease
      – Inborn errors of metabolism
      – Hepatic enzyme deficiencies
      – Glycogen storage disease

    • This question is part of the following fields:

      • Neonatology
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  • Question 79 - The following is true about the constituents of breast milk: ...

    Incorrect

    • The following is true about the constituents of breast milk:

      Your Answer:

      Correct Answer: Main protein in breast-milk is whey, which is more digestible than cow's milk protein casein.

      Explanation:

      Mature human breast milk is nutrient and enzyme rich, optimal for human infants. The average calorie requirement for a one month old infant is about 100kcal/kg/day. Lactose, the most abundant carbohydrate, is beneficial for the baby’s developing gastro intestinal system. The proteins in mature milk are mostly whey (as compared to a high proportion of casein in cows milk), which digests easily. Other proteins found in breast milk include immunoglobulin, lysozyme, lactoferrin and lactalbumin. In terms of micronutrients, while Vitamin K levels are low in breast milk, Vitamin A, C and E are found in higher concentrations than in cow’s milk.

    • This question is part of the following fields:

      • Nutrition
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  • Question 80 - A woman gives birth to a baby at 36 weeks of gestation through...

    Incorrect

    • A woman gives birth to a baby at 36 weeks of gestation through spontaneous, vaginal delivery. She had rupture of membranes 30 hours before birth, however looked healthy and did not receive antibiotics. On admission, doctors obtained a vaginal swab.
      Which of the following is the most appropriate management for the baby?

      Your Answer:

      Correct Answer: Perform an infection screen and treat with intravenous antibiotics for at least 48 hours pending results

      Explanation:

      Doctors must perform an infection screen and treat with intravenous antibiotics for at least 48 hours pending results to prevent neonatal sepsis. Risk factors for neonatal sepsis include rupture of the membranes.
      Risk factors for neonatal sepsis include rupture of membranes greater than 12-24 hours, intrapartum maternal pyrexia (> 38°C), fetal tachycardia, chorioamnionitis, pre-term birth and maternal colonisation with group B Streptococcus. In this case there are two risk factors: prolonged rupture of membranes, and pre-term birth.

    • This question is part of the following fields:

      • Neonatology
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  • Question 81 - A 9-year-old boy presented with a history of sleep disturbance for the past...

    Incorrect

    • A 9-year-old boy presented with a history of sleep disturbance for the past year. According to the parents, he has episodes in the middle of the night where he sits up in bed, unresponsive, eyes wide open, arms outstretched, and thrashing.
      During these episodes, he usually looks frightened, will cry out, and then goes back to sleep again.
      The event lasts for 2-3 minutes and can occur up to three times a night. The following day, he is tired and falls asleep at school.

      What is the most appropriate next step to be taken for this patient?

      Your Answer:

      Correct Answer: Request an EEG

      Explanation:

      The most appropriate next step would be to request for an EEG (electroencephalogram).

      The two primary differential diagnoses for the clinical scenario presented would be night terrors (hypnopompic hallucinations) due to underlying narcolepsy or frontal lobe epilepsy.
      Though occult airway obstruction and obstructive sleep apnoea can cause sleep disturbances, the clinical scenario presented is more suggestive of neurological disorders.
      The hyper-motor activity, along with arm posturing (often dystonic in appearance) and multiple occurrences per night would favour epilepsy. The daytime somnolence could be secondary to the nocturnal seizures.

    • This question is part of the following fields:

      • Neurology And Neurodisability
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  • Question 82 - Persistent pulmonary hypertension is NOT a recognized complication of which of the following?...

    Incorrect

    • Persistent pulmonary hypertension is NOT a recognized complication of which of the following?

      Your Answer:

      Correct Answer: Duct dependent congenital heart disease

      Explanation:

      Persistent pulmonary hypertension of the new-born is secondary to the failure of normal circulatory transition at birth, leading to an abnormally high pulmonary vascular resistance. This elevated resistance causes right-to-left shunting of blood and hypoxemia. It can be caused by parenchymal lung diseases (meconium aspiration syndrome, pneumonia or ARDS), lung hypoplasia (like occurring in oligohydramnios or diaphragmatic hernia), or it can be idiopathic. Other possible causes include maternal indomethacin use, group B streptococcal septicaemia, and high-pressure ventilation. Duct dependent congenital heart disease does not lead to persistent pulmonary hypertension.

    • This question is part of the following fields:

      • Neonatology
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  • Question 83 - Which of the following statements is true regarding the patterns of secretion of...

    Incorrect

    • Which of the following statements is true regarding the patterns of secretion of hormones?

      Your Answer:

      Correct Answer: Cortisol is secreted in a circadian pattern

      Explanation:

      Cortisol is secreted in a circadian pattern.
      The secretion of cortisol is regulated by the suprachiasmatic nucleus located in the hypothalamus.

      Other options:
      – FSH, LH, GH and prolactin are secreted in a pulsatile pattern, i.e. these hormones are secreted in an episodic manner rather than continuously.
      – Thyroxine is secreted in a continuous pattern, not pulsatile.
      – The secretion of ACTH is in response to stress.
      Secondary to stress, the hypothalamus secretes corticotrophin releasing hormones, which are transported to the pituitary gland via the hypophyseal-portal system.
      ACTH is then released by the pituitary gland and binds to its receptor on the adrenal gland, which releases cortisol.

    • This question is part of the following fields:

      • Endocrinology
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  • Question 84 - A 1-week-old baby presents with a large blue bruise-like mark on his back....

    Incorrect

    • A 1-week-old baby presents with a large blue bruise-like mark on his back. His mother noticed the mark that same morning and she is concerned about its severity. What is the most probable diagnosis?

      Your Answer:

      Correct Answer: Mongolian spot

      Explanation:

      Mongolian spots, otherwise called congenital dermal melanocytosis, are pigmented birthmarks. They are usually located on the buttocks or back and although they’re usually present at birth, they may appear soon after. They are flat and have a blue-grey colour (bruise-like). They are benign and present no health risk.

    • This question is part of the following fields:

      • Dermatology
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  • Question 85 - A 7-month-old baby girl is admitted with poor feeding and irritability for 2...

    Incorrect

    • A 7-month-old baby girl is admitted with poor feeding and irritability for 2 days. She is lethargic and persistently crying. Urine dipstick showed leucocytes. What is the single most important investigation to arrive at a diagnosis?

      Your Answer:

      Correct Answer: Urine for C&S

      Explanation:

      The clinical presentation and leucocytes on the urine dipstick is suggestive of a urinary tract infection. To confirm the diagnosis, urine should be sent for culture and sensitivity.

    • This question is part of the following fields:

      • Microbiology
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  • Question 86 - Cafe-au-lait spots are seen in each of the following, except: ...

    Incorrect

    • Cafe-au-lait spots are seen in each of the following, except:

      Your Answer:

      Correct Answer: Friedreich's ataxia

      Explanation:

      Cafe-au-lait spots is hyperpigmented lesions that vary in colour from light brown to dark brown, with borders that may be smooth or irregular. Causes include:

      Neurofibromatosis type I

      McCune-Albright syndrome

      Legius syndrome

      Tuberous sclerosis

      Fanconi anaemia

      Idiopathic

      Ataxia-telangiectasia

      Basal cell nevus syndrome

      Benign congenital skin lesion

      Bloom syndrome

      Chediak-Higashi syndrome

      Congenital nevus

      Gaucher disease

      Hunter syndrome

      Maffucci syndrome

      Multiple mucosal neuroma syndrome

      Noonan syndrome

      Pulmonary Stenosis

      Silver-Russell syndrome

      Watson syndrome

      Wiskott-Aldrich syndrome

    • This question is part of the following fields:

      • Dermatology
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  • Question 87 - Which of the following conditions is usually inherited in an autosomal dominant fashion?...

    Incorrect

    • Which of the following conditions is usually inherited in an autosomal dominant fashion?

      Your Answer:

      Correct Answer: Familial adenomatous polyposis

      Explanation:

      Familial adenomatous polyposis can have different inheritance patterns.

      When familial adenomatous polyposis results from mutations in the APC gene, it is inherited in an autosomal dominant pattern, which means one copy of the altered gene in each cell is sufficient to cause the disorder. In most cases, an affected person has one parent with the condition.

      When familial adenomatous polyposis results from mutations in the MUTYH gene, it is inherited in an autosomal recessive pattern, which means both copies of the gene in each cell have mutations. Most often, the parents of an individual with an autosomal recessive condition each carry one copy of the mutated gene, but do not show signs and symptoms of the condition.

    • This question is part of the following fields:

      • Genetics And Dysmorphology
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  • Question 88 - 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 89 - Which of the following is not associated with DiGeorge syndrome?

    ...

    Incorrect

    • Which of the following is not associated with DiGeorge syndrome?

      Your Answer:

      Correct Answer: Normal IQ

      Explanation:

      DiGeorge syndrome is one of the most common microdeletion syndromes, resulting from 22q11 deletion. 10% of the cases can be inherited in an autosomal dominant fashion, while 90% are sporadic. The syndrome is characterized by a deficiency of both T and B-cell lines along with hearing loss, 20-fold increased lifetime chances of developing schizophrenia, renal abnormalities, congenital heart defects, and a borderline or low IQ. Distinctive facial features include micrognathia, long face, short philtrum, cleft palate, and small teeth.

    • This question is part of the following fields:

      • Cardiovascular
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  • Question 90 - A 15-year-old boy, who has a family history of Gilbert's syndrome, presents with...

    Incorrect

    • A 15-year-old boy, who has a family history of Gilbert's syndrome, presents with signs and symptoms of hepatic dysfunction. Liver function tests reveal raised unconjugated bilirubin levels. Subsequent genetic testing led to a diagnosis of Gilbert's syndrome. What is the reason for the unconjugated hyperbilirubinemia in Gilbert's syndrome?

      Your Answer:

      Correct Answer: Reduced levels of UDP-glucuronosyl transferase-1

      Explanation:

      Gilbert’s syndrome is an autosomal recessive condition that results from defective bilirubin conjugation due to a deficiency of UDP glucuronyl transferase – 1.

      The prevalence is approximately 1-2% in the general population.

      The clinical presentation of Gilbert’s syndrome include:
      – Unconjugated hyperbilinaemia
      – Jaundice can occur during an intercurrent illness

      Management:
      Blood investigations usually reveal a rise in bilirubin following prolonged fasting or intravenous nicotinic acid.
      No treatment required for these patients.

      Other options:
      – CYP2C9 deficiency causes reduced warfarin metabolism, and subsequent enhanced drug effects.
      – Pancreatic disease, cholestasis, excessive alcohol consumption and certain drugs are common causes of raised GGT levels
      – Defective hepatocyte excretion of conjugated bilirubin is related to the pathophysiology of Dubin-Johnson syndrome
      – Reduced CYP2C19 levels can lead to the disordered metabolism of clopidogrel and other drugs such as proton-pump inhibitors, anticonvulsants and sedatives.

    • This question is part of the following fields:

      • Dermatology
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  • Question 91 - 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 92 - A 2 year old girl with a history of oligohydramnios, hypotonia, and scissoring...

    Incorrect

    • A 2 year old girl with a history of oligohydramnios, hypotonia, and scissoring of the legs, presents with delayed walking. She was born by breech delivery.
      Clinical examination reveals absence of fever and no dysmorphism. Although the limbs look symmetrical and equal, the right leg seems to be shorter. The girl is otherwise healthy.
      Neurological examination reveals hypotonia with normal reflexes and power. The mother confirms there is no history of myelomeningocele, cerebral palsy, or birth asphyxia.
      What is the most likely diagnosis?

      Your Answer:

      Correct Answer: Congenital dislocation of the hip

      Explanation:

      In this particular case, the symptoms and signs are suggestive for congenital dislocation of the hip. There are several risk factors present including, a breech delivery, female gender (female:male = 6:1) and oligohydramnios. It is also more common in the left hip than the right.

    • This question is part of the following fields:

      • Neonatology
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  • Question 93 - A 2 year old male is able to run down the stairs and...

    Incorrect

    • A 2 year old male is able to run down the stairs and say mama and dada. He can understand what he is saying and can say one word. How is this child developing?

      Your Answer:

      Correct Answer: Delayed speech

      Explanation:

      This child is experiencing delayed speech. By the age of 2, a child should be able to combine at least 2 words to make a very simple sentence.

    • This question is part of the following fields:

      • Child Development
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  • Question 94 - A 13-year-old girl takes a deliberate, unknown number of paracetamol tablets in one...

    Incorrect

    • A 13-year-old girl takes a deliberate, unknown number of paracetamol tablets in one go. She immediately regrets her actions and calls for help.

      She was brought to the hospital 2 hours after consuming the tablets. She has a history of HIV and is on antiretroviral therapy, though she cannot recall the name of the medication.

      Which of the following management options is most appropriate for this patient?

      Your Answer:

      Correct Answer: Check paracetamol level in further 2 hours' time

      Explanation:

      According to the Rumack-Matthew Normogram, accurate levels of paracetamol can be measured only between 4-15 hours. The levels measured before 4 hours post-ingestion would highly underestimate the level of paracetamol ingested.
      The patient in question presents 2 hours after ingestion. Hence the most appropriate time to measure the levels of acetaminophen would be a further 2 hours later.

      Other options:
      – Note that the treatment with NAC can be delayed until the 4-hour level is obtained and compared to the nomogram.
      – Furthermore, haemodialysis is only indicated if she develops hepato-renal syndrome that is likely to occur 72-96 hours post-ingestion.
      – Indications for acute liver transplantation include persistent acidosis, hepatorenal syndrome and worsening coagulopathy.

    • This question is part of the following fields:

      • HIV
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  • Question 95 - A well preterm baby in a thermo-neutral environment requires how much energy to...

    Incorrect

    • A well preterm baby in a thermo-neutral environment requires how much energy to maintain essential body functions?

      Your Answer:

      Correct Answer: 50kcal/kg/day

      Explanation:

      The average amount of energy required by a well preterm baby in a thermo-neutral environment is 50/kcal/kg to maintain essential body functions while it takes about 70 kcal/kg/day for optimal growth. It is important to ensure that enough proteins are given per calorie to limit catabolism and promote cell building. Caloric need usually increases when the baby is ill.

    • This question is part of the following fields:

      • Nutrition
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  • Question 96 - A horse kicks a 14-year-old girl in the abdomen while she was at...

    Incorrect

    • A horse kicks a 14-year-old girl in the abdomen while she was at riding camp. A CT scan demonstrates a grade IV splenic injury. The child has a pulse of 110 bpm and blood pressure of 110/70.
      What is the best management of this child?

      Your Answer:

      Correct Answer: Admit to the ward for a week of bed-rest

      Explanation:

      The trend in the management of splenic injury continues to favour nonoperative or conservative management.

      In Paediatrics, Blunt splenic injuries with hemodynamic stability and absence of other internal injuries requiring surgery should undergo an initial attempt of Non-operative Management (NOM) irrespective of injury grade.
      In hemodynamically stable children with isolated splenic injury, splenectomy should be avoided.
      NOM is contraindicated in the presence of peritonitis, bowel evisceration, impalement or other indications to laparotomy.
      The vast majority of paediatric patients do not require angiography/angioembolization (AG/AE) for CT blush or moderate to severe injuries.
      AG/AE may be considered in patients undergone to NOM, hemodynamically stable with sings of persistent haemorrhage not amenable of NOM, regardless with the presence of CT blush once excluded extra-splenic source of bleeding.

    • This question is part of the following fields:

      • Paediatric Surgery
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  • Question 97 - A 20-year-old female was brought to the emergency department. Her presentation was highly...

    Incorrect

    • A 20-year-old female was brought to the emergency department. Her presentation was highly suggestive of meningitis. Direct ophthalmoscopy revealed no signs of papilledema. Thus, she was planned for a lumbar puncture.
      What is the structure first encountered while inserting the needle?

      Your Answer:

      Correct Answer: Supraspinous ligament

      Explanation:

      During lumbar puncture, the first structures encountered by the needle are skin and subcutaneous tissue. But, since they are not provided in the options, the most superficial structure after them is the supraspinous ligament.

      Lumbar puncture is a procedure performed to obtain cerebrospinal fluid. The procedure is best performed at the level of L3/L4 or L4/5 interspace. During the procedure, the needle pierces the following structures in order from superficial to deep:
      Skin, subcutaneous tissue, supraspinous ligament, interspinous ligament, ligamentum flavum, the epidural space containing the internal vertebral venous plexus, dura, and arachnoid, finally entering the subarachnoid space.
      The supraspinous ligament connects the tips of spinous processes and the interspinous ligaments between adjacent borders of spinous processes.

      As the needle penetrates the ligamentum flavum, it causes a give. A second give is felt when the needle penetrates the dura mater and enters the subarachnoid space.
      At this point, clear CSF flows through the needle and can be collected for diagnostic purposes.

    • This question is part of the following fields:

      • Emergency Medicine
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  • Question 98 - A 15-year-old boy presents with poor development of secondary sex characteristics, colour blindness...

    Incorrect

    • A 15-year-old boy presents with poor development of secondary sex characteristics, colour blindness and a decreased sense of smell. On examination, his testes are small soft and located in the scrotum.
      What is the most probable diagnosis?

      Your Answer:

      Correct Answer: Kallmann's syndrome

      Explanation:

      Classic Kallmann syndrome (KS) is due to isolated hypogonadotropic hypogonadism. Most patients have gonadotropin-releasing hormone (GnRH) deficiency, as suggested by their response to pulsatile GnRH therapy. The hypothalamic-pituitary function is otherwise normal in most patients, and hypothalamic-pituitary imaging reveals no space-occupying lesions. By definition, either anosmia or severe hyposmia is present in patients with Kallmann syndrome.

    • This question is part of the following fields:

      • Endocrinology
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  • Question 99 - A 16 year old boy presented, complaining that an insect had lodged in...

    Incorrect

    • A 16 year old boy presented, complaining that an insect had lodged in his left ear. Which of the following can be considered as the most appropriate method to remove the insect?

      Your Answer:

      Correct Answer:

      Explanation:

      Removal of foreign bodies from the ear is indicated whenever a well-visualized foreign body is identified in the external auditory canal. Insects are better extracted with suction than with forceps or hooks. From the given answers, irrigation with warm water is the most suitable answer.

    • This question is part of the following fields:

      • ENT
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  • Question 100 - Which of the following statements is true regarding the umbilical cord? ...

    Incorrect

    • Which of the following statements is true regarding the umbilical cord?

      Your Answer:

      Correct Answer: Is filled with jelly of Wharton

      Explanation:

      The umbilical cord that connects the fetus to the placenta is about 50cm long. This tissue consists of the body stalk and vitelline duct. The former containing the allantoic diverticulum and the umbilical vessels. The latter contains the connection linking the digestive tube and the yolk sac. This cord is wrapped by stratum of ectoderm and gelatinous tissue or jelly of Wharton. The right umbilical vein plus the vitelline vessels and ducts disappear and this at birth the cord has three vessels which are the umbilical vein and two umbilical arteries.

    • This question is part of the following fields:

      • Embryology
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