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  • Question 1 - Which of the following is NOT a recognized form of bone marrow failure...

    Incorrect

    • Which of the following is NOT a recognized form of bone marrow failure syndrome?

      Your Answer:

      Correct Answer: Kostmann syndrome

      Explanation:

      Bone marrow failure syndromes are characterized by the bone marrow’s inability to produce cells of different lineage. They can be classified as those affecting one or two cell lineages or those affecting all three of them. Fanconi syndrome, along with dyskeratosis congenita, is one of the inherited bone marrow failure syndromes that causes pancytopenia. Other inherited disorders affecting hematopoietic lineage include Diamond-Blackfan anaemia, Schwachman-Diamond syndrome, congenital amegakaryocytic thrombocytopenia (CAMT) and Thrombocytopenia absent radii (TAR) syndrome. Acquired causes of bone marrow failure that lead to pancytopenia include aplastic anaemia, drugs, nutritional deficiencies, and viral infections. Kostmann syndrome is an autosomal recessive form of severe neutropenia, most likely due to excessive neutrophil apoptosis.

    • This question is part of the following fields:

      • Haematology And Oncology
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  • Question 2 - Which of the following ages should a child be expected to draw a...

    Incorrect

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

      Your Answer:

      Correct Answer: 2- 2 1/2 years

      Explanation:

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

    • This question is part of the following fields:

      • Child Development
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  • Question 3 - A 15-year-old boy was admitted to the hospital with suspected appendicitis. On examination,...

    Incorrect

    • A 15-year-old boy was admitted to the hospital with suspected appendicitis. On examination, the maximum tenderness was at the McBurney's point.
      What is the surface landmark of McBurney's point?

      Your Answer:

      Correct Answer: 2/3rds laterally along the line between the umbilicus and the anterior superior iliac spine

      Explanation:

      McBurney’s point is found 2/3rds of the way along an imaginary line that runs from the umbilicus to the anterior superior iliac spine on the right-hand side.
      On examination, features of generalised peritonitis can be observed if the appendix has perforated.
      Retrocecal appendicitis may have relatively fewer signs.
      Digital rectal examination may reveal boggy sensation if a pelvic abscess is present.
      Diagnosis is typically based on raised inflammatory markers coupled with compatible history, and examination findings.
      Ultrasound is useful in females where pelvic organ pathology can be a close differential diagnosis.
      Although it is not always possible to visualise the appendix on ultrasound, the presence of free fluid (always pathological in males) should raise suspicion. Ultrasound examination can also show evidence of luminal obstruction and thickening of the appendix.

      Management:
      Definitive management of appendicitis and appendicular perforation is appendicectomy which can be performed via either an open or laparoscopic approach.
      Simultaneous administration of metronidazole reduces wound infection rates. Patients with perforated appendicitis require copious abdominal lavage.
      Patients without peritonitis who have an appendix mass should receive broad-spectrum antibiotics and consideration given to performing an interval appendicectomy.

    • This question is part of the following fields:

      • Emergency Medicine
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  • Question 4 - A 14 year old girl with cystic fibrosis (CF) presents with abdominal pain....

    Incorrect

    • A 14 year old girl with cystic fibrosis (CF) presents with abdominal pain.

      Which of the following is the pain most likely linked to?

      Your Answer:

      Correct Answer: Meconium ileus equivalent syndrome

      Explanation:

      Meconium ileus equivalent (MIE) can be defined as a clinical manifestation in cystic fibrosis (CF) patients caused by acute intestinal obstruction by putty-like faecal material in the cecum or terminal ileum. A broader definition includes a more chronic condition in CF patients with abdominal pain and a coecal mass which may eventually pass spontaneously. The condition occurs only in CF patients with exocrine pancreatic insufficiency (EPI). It has not been seen in other CF patients nor in non-CF patients with EPI. The frequency of these symptoms has been reported as 2.4%-25%.

      The treatment should primarily be non-operative. Specific treatment with N-acetylcysteine, administrated orally and/or as an enema is recommended. Enemas with the water soluble contrast medium, meglucamine diatrizoate (Gastrografin), provide an alternative form for treatment and can also serve diagnostic purposes. It is important that the physician is familiar with this disease entity and the appropriate treatment with the above mentioned drugs. Non-operative treatment is often effective, and dangerous complications following surgery can thus be avoided.

    • This question is part of the following fields:

      • Respiratory
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  • Question 5 - A 3-year-old was brought to the ED after falling from his mothers arms....

    Incorrect

    • A 3-year-old was brought to the ED after falling from his mothers arms. The mother reports hearing a popping sound when his face hit the floor. Examination revealed swelling and bruising on the right mandible. Which of the following investigations should be ordered next?

      Your Answer:

      Correct Answer: Facial X ray

      Explanation:

      The swelling and bruising on the mandible needs to be checked for fractures. A facial X-ray can adequately visualize this.

    • This question is part of the following fields:

      • ENT
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  • Question 6 - A 7-month-old baby boy was brought by his parents due to frequently regurgitating...

    Incorrect

    • A 7-month-old baby boy was brought by his parents due to frequently regurgitating his milk. On examination, he was pale and lethargic. FBC showed a microcytic anaemia. Which of the following is the most probable diagnosis?

      Your Answer:

      Correct Answer: Hiatus hernia

      Explanation:

      Frequent regurgitation of milk and microcytic anaemia is suggestive of a hiatus hernia. The reflux causes regurgitation of milk and frequent ulceration of the lower oesophageal mucosa potentially resulting in blood loss and anaemia. Duodenal atresia usually presents with bilious vomiting and pyloric stenosis presents with projectile vomiting. Alpha 1 antitrypsin deficiency and cystic fibrosis usually do not present with vomiting.

    • This question is part of the following fields:

      • Gastroenterology And Hepatology
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  • Question 7 - Jamila, a 16 year old girl, was brought to the emergency centre following...

    Incorrect

    • Jamila, a 16 year old girl, was brought to the emergency centre following a collapse and abnormal movements earlier at school today. The episode occurred when she was walking to her next lesson with her friends. Suddenly she told her friends that she felt scared and complained that her vision had become blurry. She was helped to a chair where she sat for 15 minutes speaking incoherently before collapsing to the floor. Her friends observed irregular jerking movements of her right leg and left arm. The movement continued for about 15 minutes after which she was able to sit up unsupported but could not speak for about 20 minutes. There was also bleeding from the tongue which she had bit during the episode.

      She had a similar episode yesterday at home while on a video call with her mother. Her father narrated that she suddenly dropped the phone, and her eyes began to roll up. She initially remained standing but fell to the floor after a minute. He noticed irregular movements of both her legs, and her eyes were tightly shut. The movements ended after 2 minutes after which she became responsive to questions, but her eyes remained closed. She was brought later in the day, and was discharged after routine investigations. Jamila is a GCSE candidate preparing for her mock examinations, and currently lives with her father as her mother works abroad. Which of the following is the most likely explanation for Jamila's condition?

      Your Answer:

      Correct Answer: Non-epileptic attack disorder

      Explanation:

      Non Epileptic attack disorder, also known as psychogenic non epileptic seizures, is a condition characterised by episodes of abnormal movement and behaviours that resemble seizures , but are not caused by electrical activity changes in the brain. It is believed that the disorder is caused by the brain’s response to overwhelming or stressful situations. In Jamila’s case, triggering conditions for her episodes may have been the absence of her mother, and the stress of her upcoming examinations. A diagnosis of generalised epilepsy is unlikely because this would require abnormal movement in all 4 limbs during an episode and a longer period of semi consciousness after. Cataplexy can also be ruled out as it does not involve a loss of consciousness which we see in Jamila’s case. Vasovagal syncope does not correspond with the history as there was no evidence of simultaneous collapse and responsiveness coupled with colour change and near spontaneous recovery when supine. A complex partial seizure may be possible in Jamila’s case, however the history of long duration, her eyes being tightly shut and the differences in presentation between the two episodes makes it less likely.

    • This question is part of the following fields:

      • Neurology And Neurodisability
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  • Question 8 - 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 9 - 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 10 - Which of the following disorders are NOT associated with hypertrichosis? ...

    Incorrect

    • Which of the following disorders are NOT associated with hypertrichosis?

      Your Answer:

      Correct Answer: Psoriasis

      Explanation:

      Among the given options, psoriasis is not associated with hypertrichosis.

      The causes of hypertrichosis include:
      – Drugs: minoxidil, ciclosporin, and diazoxide.
      – Congenital hypertrichosis lanuginosa and congenital hypertrichosis terminalis.
      – Porphyria cutanea tarda
      – Anorexia nervosa

    • This question is part of the following fields:

      • Dermatology
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  • Question 11 - The clinical findings in infective endocarditis do NOT include which of the following?...

    Incorrect

    • The clinical findings in infective endocarditis do NOT include which of the following?

      Your Answer:

      Correct Answer: Beau's lines

      Explanation:

      Infective endocarditis (IE) is an acute infective pathology of the endocardium secondary to some underlying cardiac pathology like VSD and TOF. Most commonly, it is bacterial in origin, caused by staphylococcus aureus in the majority of cases. Clinical features include fever, arthralgias, weight loss, anorexia, new-onset, or changing existing murmur. Skin manifestations include Osler’s nodes, Janeway lesions, splinter haemorrhages, and clubbing. Roth spots are conjunctival haemorrhages found in IE. Beau’s lines are not found in IE.

    • This question is part of the following fields:

      • Cardiovascular
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  • Question 12 - A 6 year-old boy is brought to you coughing. He is suspected to...

    Incorrect

    • A 6 year-old boy is brought to you coughing. He is suspected to have aspirated a Lego piece which he was seen playing with. Where would you expect the piece to be?

      Your Answer:

      Correct Answer: Right main bronchus

      Explanation:

      Inhaled objects are more likely to enter the right lung for several reasons. First the right bronchus is shorter, wider and more vertical than the left bronchus. Also, the carina (a ridge-like structure at the point of tracheal bifurcation) is set a little towards the left. The terminal bronchiole is a very small space and impossible for the seed to lodge here.

    • This question is part of the following fields:

      • Respiratory
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  • Question 13 - A term baby was born following a placental abruption. There was no respiratory...

    Incorrect

    • A term baby was born following a placental abruption. There was no respiratory effort and an undetectable heart rate initially. Baby is now 20 min old and has been intubated with regular ventilation breaths. Heart rate came up to 110/min following two rounds of chest compressions. Baby appears very pale. No drugs have been given. Oxygen saturations are currently 85% measured on the right hand despite FiO2 1.0. A venous cord gas shows pH 6.89, CO2 -8, BE -14, Hb 8.
      What is the next most appropriate step?

      Your Answer:

      Correct Answer: Umbilical venous catheter (UVC) placement

      Explanation:

      Umbilical vein catheterization utilizes the exposed umbilical stump in a neonate as a site for emergency central venous access up to 14 days old. Umbilical vein catheterization can provide a safe and effective route for intravenous delivery of medications and fluids during resuscitation.
      The indication for umbilical vein catheterization is when there is a need for IV access in a neonate for resuscitation, transfusions, or short-term venous access when otherwise unobtainable.

    • This question is part of the following fields:

      • Neonatology
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  • Question 14 - A study done on a group of epileptics records the numbers of...

    Incorrect

    • A study done on a group of epileptics records the numbers of seizures in the weeks before and after a dietary intervention.

      The decrease in seizures is on average 20. (95% CI=15 to 25; P=0.0024)

      Which of the following options is true?

      Your Answer:

      Correct Answer: This is a before and after study with no control group and so the results should be viewed with great caution

      Explanation:

      While the results of this before and after study can provide some preliminary insight into the effects of the dietary intervention, the results should be viewed with great caution as they may be considered merely anecdotal. The lack of a control group contributes to confounding the data. Therefore, while the difference may be statistically significant and the confidence interval is compatible with a fall in the number of seizures after therapy, the results cannot be introduced as the standard without a control group to compare with.

    • This question is part of the following fields:

      • Epidemiology And Statistics
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  • Question 15 - During uterogrowth, the second pharyngeal arch gives rise to which structures? ...

    Incorrect

    • During uterogrowth, the second pharyngeal arch gives rise to which structures?

      Your Answer:

      Correct Answer: Stylohyoid muscle

      Explanation:

      The second pharyngeal arch or hyoid arch, is the second of six pharyngeal arches that develops in fetal life during the fourth week of development and assists in forming the side and front of the neck. Derivatives:

      Skeletal – From the cartilage of the second arch arises:

      Stapes,

      Temporal styloid process,

      Stylohyoid ligament, and

      Lesser cornu of the hyoid bone.

      Muscles:

      Muscles of face

      Occipitofrontalis muscle

      Platysma

      Stylohyoid muscle

      Posterior belly of Digastric

      Stapedius muscle

      Auricular muscles

      Nerve supply: Facial nerve

    • This question is part of the following fields:

      • Embryology
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  • Question 16 - What form of inheritance does Chediak-Higashi syndrome have? ...

    Incorrect

    • What form of inheritance does Chediak-Higashi syndrome have?

      Your Answer:

      Correct Answer: Autosomal recessive

      Explanation:

      Chediak-Higashi syndrome is inherited in an autosomal recessive pattern, which means both copies of the gene in each cell have mutations. The parents of an individual with an autosomal recessive condition each carry one copy of the mutated gene, but they typically 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 17 - A well, breastfed term infant presented with jaundice at 36 hours of age....

    Incorrect

    • A well, breastfed term infant presented with jaundice at 36 hours of age. The serum bilirubin was 286 ┬Ámol/L, direct Coombs test negative, blood film showed spherocytes and reticulocytes. The baby's blood group was A rhesus negative and mother's blood group O Rhesus negative.
      Which of the following is the MOST likely diagnosis?

      Your Answer:

      Correct Answer: ABO incompatibility

      Explanation:

      Haemolytic disease of the new-born due to ABO incompatibility is usually less severe than Rh incompatibility. One reason is that fetal RBCs express less of the ABO blood group antigens compared with adult levels. In addition, in contrast to the Rh antigens, the ABO blood group antigens are expressed by a variety of fetal (and adult) tissues, reducing the chances of anti-A and anti-B binding their target antigens on the fetal RBCs.

      ABO HDN occurs almost exclusively in the offspring of women of blood group O, although reports exist of occasional cases in group A mothers with high-titre anti-(group B) IgG

    • This question is part of the following fields:

      • Neonatology
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  • Question 18 - A 10-month-old infant is brought to the hospital with a 3-day history of...

    Incorrect

    • A 10-month-old infant is brought to the hospital with a 3-day history of frequent watery stools and vomiting.
      On examination, she is found to be dehydrated and is refusing to drink in the emergency department.

      What would be the most appropriate course of action for this child?

      Your Answer:

      Correct Answer: Admit for enteral rehydration via a nasogastric tube

      Explanation:

      The most appropriate step in this patient would be to admit the patient for enteral rehydration via a nasogastric tube.

      Enteral rehydration:
      Oral rehydration is the most preferred way of rehydrating children. If a child is not tolerating small-frequent-feeds, then nasogastric rehydration is an underused next best step.
      The fluid can be run through a continuous pump so that it is better tolerated.

      Note:
      Intravenous fluids are effective but can have profound effects on the serum electrolyte balance if not monitored closely.
      Most children will tolerate fluids in an emergency department, but failure to take fluids orally is not an indication for intravenous therapy.

    • This question is part of the following fields:

      • Emergency Medicine
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  • Question 19 - A 13-year-old girl presents with a swollen left knee following a fall. Her...

    Incorrect

    • A 13-year-old girl presents with a swollen left knee following a fall. Her parents state she suffers from haemophilia and has been treated for a right-sided haemarthrosis previously. What other condition is she most likely to have?

      Your Answer:

      Correct Answer: Turner's syndrome

      Explanation:

      Haemophilia is a X-linked recessive disorder. In X-linked recessive inheritance only males are affected. An exception to this seen in examinations are patients with Turner’s syndrome, who are affected due to only having one X chromosome. X-linked recessive disorders are transmitted by heterozygote females (carriers) and male-to-male transmission is not seen. Affected males can only have unaffected sons and carrier daughters.

    • This question is part of the following fields:

      • Genetics And Dysmorphology
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  • Question 20 - A 16-year-old boy presents to the emergency department with abdominal pain, fever, and...

    Incorrect

    • A 16-year-old boy presents to the emergency department with abdominal pain, fever, and vomiting. On examination, palpation of the left lower quadrant of the abdomen elicits pain in the right lower quadrant. What is this sign?

      Your Answer:

      Correct Answer: Rovsing's sign

      Explanation:

      Based on the findings presented, the sign elicited is Rovsing’s sign.

      Rovsing’s sign:
      It is a sign suggestive of appendicitis. A positive sign is determined when palpation in the left lower quadrant of a patient’s abdomen causes pain in the right lower quadrant.

      Other options:
      – Murphy’s sign is positive in gallbladder inflammation. With the upper border of the examiner’s hand in the right upper quadrant of the abdomen under the rib cage, the patient is asked to inhale. Inhalation causes the gallbladder to descend, which catches on the fingers, causing pain.
      – Cullen’s sign is suggestive of ectopic pregnancy or acute pancreatitis and describes the bruising around the umbilicus.
      – Tinel’s sign is positive in those with carpal tunnel syndrome. The examiner’s fingers tap the median nerve over the flexor retinaculum, which causes paraesthesia over the distribution of the median nerve.
      – Battles’ sign describes bruising behind the ear, suggesting a basal skull fracture of the posterior cranial fossa.

    • This question is part of the following fields:

      • Emergency Medicine
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  • Question 21 - Which of the following does not suggest a diagnosis of neurofibromatosis type 1...

    Incorrect

    • Which of the following does not suggest a diagnosis of neurofibromatosis type 1 (NF-1)?

      Your Answer:

      Correct Answer: Osseous bone lesions

      Explanation:

      Clinical diagnosis of neurofibromatosis type 1 requires the presence of at least 2 of 7 criteria to confirm the presence of neurofibromatosis, type 1. Many of these signs do not appear until later childhood or adolescence, and thus confirming the diagnosis often is delayed despite a suspicion of NF1.
      The 7 clinical criteria used to diagnose NF1 are as follows:
      – Six or more cafe-au-lait spots or hyperpigmented macules greater than 5 mm in diameter in prepubertal children and greater than 15 mm postpubertal
      – Axillary or inguinal freckles (>2)
      – Two or more typical neurofibromas or one plexiform neurofibroma
      – Optic nerve glioma
      – Two or more iris hamartomas (Lisch nodules), often identified only through slit-lamp examination by an ophthalmologist
      – Sphenoid dysplasia or typical long-bone abnormalities such as pseudarthrosis
      – A first-degree relative (e.g., mother, father, sister, brother) with NF1

    • This question is part of the following fields:

      • Neurology And Neurodisability
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  • Question 22 - A 15-year-old girl presents with mild abdominal pain in the left lower quadrant...

    Incorrect

    • A 15-year-old girl presents with mild abdominal pain in the left lower quadrant for the last four months. An ultrasound scan demonstrates a 7cm simple ovarian cyst.
      What is the most appropriate course of action for this patient?

      Your Answer:

      Correct Answer: Functional ovarian cyst. Ovary sparing cystectomy

      Explanation:

      The most prudent course of action in the given clinical scenario is an ovary-sparing cystectomy. The history is 3-months and is already chronic. Furthermore, the cyst is greater than 5cm in size and at risk of torsion. This will relieve the cause of pain, reduce the risk of torsion and save ovarian function.

      Other options:
      – This is a simple cyst and not a malignancy, so imaging and referral are not indicated.
      – Open oophorectomy was done in the past. However, this is very aggressive, and the modern approach is ovary-sparing.
      – As the cyst is 7cm and at risk of torsion, conservative management is not appropriate.

    • This question is part of the following fields:

      • Paediatric Surgery
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  • Question 23 - A 17-year-old Jewish girl presents with primary amenorrhoea. On examination, she looks a...

    Incorrect

    • A 17-year-old Jewish girl presents with primary amenorrhoea. On examination, she looks a little hirsute and has evidence of facial acne. She is within her predicted adult height and has normal breast and external genitalia development, however, there is excess hair over her lower abdomen and around her nipple area.

      Investigations were as follows:
      Hb 13.1 g/dl
      WCC 8.6 x109/l
      PLT 201 x109/l
      Na+ 139 mmol/l
      K+ 4.5 mmol/l
      Creatinine 110 ┬Ámol/l
      17-OH progesterone 1.4 times the upper limit of normal
      Pelvic ultrasound: bilateral ovaries and uterus visualised.

      Which of the following is the most likely diagnosis?

      Your Answer:

      Correct Answer: Non-classical congenital adrenal hyperplasia

      Explanation:

      Mild deficiencies of 21-hydroxylase or 3-beta-hydroxysteroid dehydrogenase activity may present in adolescence or adulthood with oligomenorrhea, hirsutism, and/or infertility. This is termed nonclassical adrenal hyperplasia.
      Late-onset or nonclassical congenital adrenal hyperplasia (NCAH) due to 21-hydroxylase deficiency is one of the most common autosomal recessive disorders. Reported prevalence ranges from 1 in 30 to 1 in 1000. Affected individuals typically present due to signs and symptoms of androgen excess.
      Treatment needs to be directed toward the symptoms. Goals of treatment include normal linear growth velocity, a normal rate of skeletal maturation, ‘on-time’ puberty, regular menstrual cycles, prevention of or limited progression of hirsutism and acne, and fertility. Treatment needs to be individualized and should not be initiated merely to decrease abnormally elevated hormone concentrations.
      Normal Ultrasound rules out Turner’s syndrome.

    • This question is part of the following fields:

      • Endocrinology
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  • Question 24 - An 8 year old boy is admitted to the ward with renal colic....

    Incorrect

    • An 8 year old boy is admitted to the ward with renal colic. Family history is significant for similar renal calculi in his mother. Which of the following is the most likely explanation for this recurrent colic in both mother and child?

      Your Answer:

      Correct Answer: Idiopathic hypercalciuria

      Explanation:

      Idiopathic hypercalciuria (IH) is the commonest metabolic abnormality in patients with calcium kidney stones. It is characterized by normocalcemia, absence of diseases that cause increased urine calcium, and calcium excretion that is above 250 mg/day in women and 300 mg/day in men. Subjects with IH have a generalized increase in calcium turnover, which includes increased gut calcium absorption, decreased renal calcium reabsorption, and a tendency to lose calcium from bone. Despite the increase in intestinal calcium absorption, negative calcium balance is commonly seen in balance studies, especially on a low calcium diet. The mediator of decreased renal calcium reabsorption is not clear; it is not associated with either an increase in filtered load of calcium or altered PTH levels. There is an increased incidence of hypercalciuria in first-degree relatives of those with IH, but IH appears to be a complex polygenic trait with a large contribution from diet to expression of increased calcium excretion. Increased tissue vitamin D response may be responsible for the manifestations of IH in at least some patients.

    • This question is part of the following fields:

      • Renal
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  • Question 25 - A 16-year-old male is learning about HIV as part of sex and relationships...

    Incorrect

    • A 16-year-old male is learning about HIV as part of sex and relationships education in school.
      What is the most common mode of transmission of HIV?

      Your Answer:

      Correct Answer: Unprotected anal or vaginal sexual intercourse with an infected individual

      Explanation:

      Unprotected anal or vaginal sexual intercourse with an infected individual is by far the most common (95%) route by which HIV is transmitted.

      Other options:
      – Blood transfusion is an extremely rare cause of HIV transmission in the UK.
      – While HIV can be transmitted from mother to baby either during birth or via breastfeeding, the transmission rate is only 5 -20%.
      – Sharing contaminated needles does put individuals at risk of getting HIV, although public health measures are in place to reduce this risk.
      – Although HIV can be transmitted via this route, it is around ten times less likely to result in transmission than unprotected anal or vaginal intercourse with an infected individual.

    • This question is part of the following fields:

      • HIV
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  • Question 26 - A 19-year-old boy presents to the emergency department following a blow to the...

    Incorrect

    • A 19-year-old boy presents to the emergency department following a blow to the face playing rugby. He informs that he had a nosebleed which lasted for about 10-15 minutes but has now stopped completely. Presently the boy complains of difficulty breathing through his nose.
      On inspection, there is visible bruising to the nose, and upper lip. Further examination reveals bilateral red swellings arising from the septum.
      What is the best immediate step in the management of the boy's symptoms?

      Your Answer:

      Correct Answer: Refer to ENT team

      Explanation:

      Based on the presenting features, the patient has developed a septal haematoma after the trauma.

      Septal hematoma:
      In this condition, blood collects between the septal cartilage and the perichondrium.
      The patient classically presents with symptoms of nasal difficulty and pain following a nasal injury.
      Care should be taken not to misdiagnose a septal haematoma as a blood clot on the septum. In the case of a septal haematoma the swelling will typically be visible on both sides of the septum although this is not always the case.
      Referral to an ENT surgeon is indicated because, if untreated, there is a high risk of cartilage breakdown and complications related to infection.

      Other options:
      – The nosebleed has now stopped therefore compression is no longer required. The boy has developed a septal haematoma after traumatic injury.
      – CT head is not indicated in this patient as the diagnosis is clearly a septal hematoma.
      – Management of a septal hematoma consists of drainage and antibiotics. There is no role for intranasal corticosteroids.
      – If untreated, there is a high risk of cartilage breakdown and complications related to infection. Thus, referral to the ENT is essential; reassurance and discharge can lead to complications.

    • This question is part of the following fields:

      • ENT
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  • Question 27 - An infant born at 34 weeks was kept in the incubator for almost...

    Incorrect

    • An infant born at 34 weeks was kept in the incubator for almost a month. Physical examination revealed a heart murmur, which however was not present at discharge. What is the most probable cause of this murmur?

      Your Answer:

      Correct Answer: PDA

      Explanation:

      PDA is particularly common in premature babies and it is managed by indomethacin administration. However, if PDA is not the only defect, prostaglandin E1 can be administered in order to keep the ductus open until the surgery takes place.

    • This question is part of the following fields:

      • Cardiovascular
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  • Question 28 - Congenital cataracts are NOT a known complication of which of the following conditions?...

    Incorrect

    • Congenital cataracts are NOT a known complication of which of the following conditions?

      Your Answer:

      Correct Answer: Klinefelter syndrome

      Explanation:

      Klinefelter syndrome is a chromosomal disease that does not lead to congenital cataracts. A congenital cataract is the clouding of the cornea that is present from birth. Causes can be categorized as genetic, infectious, and metabolic. The most common infectious cause is congenital rubella syndrome. Galactosemia is a metabolic cause of congenital cataracts. Down’s syndrome represents a genetic cause of congenital cataract.

    • This question is part of the following fields:

      • Ophthalmology
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  • Question 29 - A 16-year old boy was brought in an unconscious state to the emergency...

    Incorrect

    • A 16-year old boy was brought in an unconscious state to the emergency department. Clinical evaluation pointed in favour of acute adrenal insufficiency. On enquiry, it was revealed that he was suffering from a high grade fever 24 hours prior. On examination, extensive purpura were noted on his skin. The likely diagnosis is:

      Your Answer:

      Correct Answer: Meningococcaemia

      Explanation:

      Findings described are suggestive of Waterhouse-Friderichsen syndrome which develops secondary to meningococcaemia. The reported incidence of Addison’s disease is 4 in 100,000. It affects both sexes equally and is seen in all age groups. It tends to show clinical symptoms at the time of metabolic stress or trauma. The symptoms are precipitated by acute infections, trauma, surgery or sodium loss due to excessive perspiration.

    • This question is part of the following fields:

      • Endocrinology
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  • Question 30 - A 10-year-old boy presents to the hospital with an 18-month history of intermittent...

    Incorrect

    • A 10-year-old boy presents to the hospital with an 18-month history of intermittent eye blinking, facial grimacing, grunting, and sniffing. He has enough control to suppress them at times, but not always. They are happening at school, and his classmates are starting to notice.

      Which among the following would be the best initial step in the treatment of the child?

      Your Answer:

      Correct Answer: Reassure and observe

      Explanation:

      The most probable diagnosis for the above clinical scenario, of a child presenting with motor and vocal tics for more than a year is highly suggestive of a diagnosis of Tourette syndrome.

      The symptoms often wax and wane, and although several different drugs are available, none are entirely useful, and side-effects are relatively common.

      With these considerations in mind, it is essential to try and avoid treatment initially as the tics can spontaneously improve with time.

      Informing the teacher and class about the nature of the condition and allowing the child ‘time out’ to tic might help to avoid the need for medication.

    • This question is part of the following fields:

      • Neurology And Neurodisability
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