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Question 1
Incorrect
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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: Transfer to theatre for emergency splenectomy
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 2
Incorrect
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All of the following are disorders of the supra-renal glands except:
Your Answer:
Correct Answer: Di-George syndrome
Explanation:Among the given options, Di-George syndrome is not associated with adrenal gland disorders.
Di-George syndrome is characterised by distinct facial features (micrognathia, cleft palate, short philtrum, and low-set ears), hypocalcaemia, mental retardation, cardiac defects (especially tetralogy of Fallot), and immune deficiencies.
A useful memory aid is CATCH-22:
– Cardiac defects
– Abnormal facial features
– Thymic aplasia/hypoplasia
– Cleft palate
– Hypocalcaemia/Hypoparathyroidism
– 22 – Due to 22q11 deletionOther options:
– Addison’s disease is a result of adrenal hypofunction and may present with collapse secondary to a salt-losing crisis.
– Congenital adrenal hyperplasia: CAH is caused by the deficiency of an enzyme (classically 21-hydroxylase deficiency) in the biosynthetic pathway in the adrenal cortex, leading to insufficient production of cortisol and aldosterone, and a build-up of 17-hydroxyprogesterone.
– Cushing’s syndrome is a syndrome of cortisol excess. An adrenal tumour is a primary cause.
– Pheochromocytoma is a catecholamine releasing tumour of the adrenal gland/s. -
This question is part of the following fields:
- Endocrinology
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Question 3
Incorrect
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A two-sample t-test comparing weight loss after two different diet regimes yield a P-value of 0.001.
Which one of the following statements can be deducted from this finding?Your Answer:
Correct Answer: The difference would have occurred by chance for a study of this size only once in 1000 times if the two regimes did not differ in their effect
Explanation: -
This question is part of the following fields:
- Epidemiology And Statistics
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Question 4
Incorrect
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A 17-year-old female presents to the clinic with acne, hirsutism and oligomenorrhoea. Which of the following hormonal changes will hint towards the diagnosis of polycystic ovarian syndrome (PCOS)?
Your Answer:
Correct Answer: Raised LH:FSH ratio
Explanation:The European Society of Human Reproduction and Embryology/American Society for Reproductive Medicine Rotterdam consensus (ESHRE/ASRM) developed and enlarged the diagnosis of PCOS, requiring two of three features: anovulation or oligo-ovulation, clinical and/or biochemical hyperandrogenism, and polycystic ovarian morphology (PCOM) seen on ultrasound. Finally the Androgen Excess Society defined PCOS as hyperandrogenism with ovarian dysfunction or polycystic ovaries
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This question is part of the following fields:
- Endocrinology
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Question 5
Incorrect
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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.
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This question is part of the following fields:
- Dermatology
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Question 6
Incorrect
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A 5 month old boy presents with a history of one episode of green vomiting. Upon clinical examination, doctors notice an acutely swollen mass located in the groin, extending to the scrotum. What is the most probable diagnosis and what's the most appropriate management?
Your Answer:
Correct Answer: Incarcerated indirect inguinal hernia, analgesia, sedation and attempt to reduce
Explanation:An incarcerated indirect inguinal hernia presents with abdominal pain, bloating, nausea, vomiting, and intestinal obstruction. It is characterized by the appearance of a tender mass in the inguinal area. Manual reduction in children requires analgesia and sedation.
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This question is part of the following fields:
- Paediatric Surgery
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Question 7
Incorrect
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Persistent hypoglycaemia in the new-borns is caused by which of the given choices?
Your Answer:
Correct Answer: Medium chain acyl CoA dehydrogenase deficiency
Explanation:Neonatal hypoglycaemia is a common yet serious condition characterized by blood sugar levels less than 2.2mmol/L during the first 3 days of life and less than 2.5mmol/L later on. There are multiple aetiologies and various risk factors that lead to hypoglycaemia in new-borns like prematurity, sepsis, inborn errors of metabolism, and maternal diabetes- induced hyperinsulinism in the new-born. Among the inborn errors of metabolism, fatty acid oxidation defects can lead to persistent hypoglycaemia in new-borns. One such defect is the medium- chain acyl CoA dehydrogenase deficiency, which is the enzyme needed for the breakdown of medium- chain fatty acids.
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This question is part of the following fields:
- Neonatology
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Question 8
Incorrect
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In the adult heart, the sinus venosus gives rise to the:
Your Answer:
Correct Answer: Coronary sinus
Explanation:The sinus venosus is a large quadrangular cavity which precedes the atrium on the venous side of the chordate heart. It exists distinctly only in the embryonic heart (where it is found between the two venae cavae); however, the sinus venosus persists in the adult. In the adult, it is incorporated into the wall of the right atrium to form a smooth part called the sinus venarum, which is separated from the rest of the atrium by a ridge of fibres called the crista terminalis. The sinus venosus also forms the SA node and the coronary sinus.
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This question is part of the following fields:
- Embryology
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Question 9
Incorrect
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A 16 year old male complained of scrotal pain following a game of football. He couldn't recall any trauma to groin. Which of the following is the best investigation to confirm the diagnosis?
Your Answer:
Correct Answer: USG of the scrotum
Explanation:USG of the scrotum is important to exclude any abnormality with testicles, epididymis and scrotum. This presentation can be acute epididymo-orchitis or testicular torsion. USG of the scrotum will help to confirm the diagnosis.
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This question is part of the following fields:
- Genitourinary
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Question 10
Incorrect
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Out of 30 children who are exposed to a chemical, 15 develop a disorder, compared to only 1 child out of 10 developing the same disorder who were not exposed.
The following can be deduced from this information:Your Answer:
Correct Answer: The relative risk of exposure to the chemical is 5
Explanation:Relative risk is the probability of an outcome occurring in an exposed group as compared to the probability of that outcome in an unexposed group. In the scenario given, 50% of the children exposed developed the disease while only 10% of the children who were unexposed developed the disease. The relative risk was therefore 50/10=5. There is no further information about whether the study was controlled, the confidence interval, or the type of study. It therefore cannot be confirmed whether the chemical is causative and if it should be avoided.
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This question is part of the following fields:
- Epidemiology And Statistics
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Question 11
Incorrect
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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
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This question is part of the following fields:
- Epidemiology And Statistics
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Question 12
Incorrect
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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.
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This question is part of the following fields:
- Epidemiology And Statistics
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Question 13
Incorrect
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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.
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This question is part of the following fields:
- Neurology
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Question 14
Incorrect
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A 14-year-old boy arrives at the clinic with difficulty walking and foot drop. On examination, there is weakness in dorsiflexion and eversion of the right foot. A small area of sensory loss over the dorsum of the right foot is also present. Which of the following is the most likely diagnosis?
Your Answer:
Correct Answer: Common peroneal nerve lesion
Explanation:Injuries to the peroneal nerve can cause numbness, tingling, pain, weakness and foot drop. The branches of the common peroneal nerve innervate and control the muscles in the legs that lift the ankle and toes upward (dorsi flexion).
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This question is part of the following fields:
- Neurology And Neurodisability
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Question 15
Incorrect
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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.
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This question is part of the following fields:
- Renal
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Question 16
Incorrect
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A 16-year-old woman presents with a 7 month history of secondary amenorrhoea and three months history of galactorrhoea. She has been otherwise well. She had menarche at the age of 12 and has otherwise had regular periods. She has been sexually active for approximately one year and has occasionally used condoms for contraception. She smokes five cigarettes daily and occasionally smokes cannabis.
On examination, she appears well, and clinically euthyroid, has a pulse of 70 bpm and blood pressure of 112/70 mmHg.
Investigations show:
Serum oestradiol 130 nmol/L (130-600)
Serum LH 4.5 mU/L (2-20)
Serum FSH 2.2 mU/L (2-20)
Serum prolactin 6340 mU/L (50-450)
Free T4 7.2 pmol/L (10-22)
TSH 2.2 mU/L (0.4-5.0)
What is the most likely diagnosis?Your Answer:
Correct Answer: Prolactinoma
Explanation:The patient has hyperprolactinaemia with otherwise normal oestradiol, FSH and LH. This is highly suggestive of Prolactinoma rather than a non functioning tumour.
In polycystic ovaries, there is increase in the level of LH while FSH is normal or low. -
This question is part of the following fields:
- Endocrinology
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Question 17
Incorrect
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A 5-year-old child was found to have orchidomegaly and splenomegaly. Blood tests show a WBC = 1.7 X 104/L, Hb = 7.1 g/dl and platelets = 44 X 104g/dl. His parents mention that he suffers from fatigue while at presentation he looks pale and has a fever. What is the most likely diagnosis?
Your Answer:
Correct Answer: Acute lymphoblastic leukaemia
Explanation:Acute lymphoblastic leukaemia (ALL) is an aggressive type of blood and bone marrow cancer which can appear in childhood. Signs of childhood ALL include: Fever, Easy bruising, Petechiae, Bone or joint pain, Painless lumps in multiple areas of the body, Weakness, fatigue or paleness, and Loss of appetite. Blood tests may show elevated white blood cells, decreased values of red blood cells and low platelet count.
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This question is part of the following fields:
- Haematology And Oncology
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Question 18
Incorrect
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For a given condition, disease or attribute, there will be a proportion of people in a population who have the given condition, disease or attribute at a specified point in time or over a specified period of time. Which of following is the best term which can describe the above?
Your Answer:
Correct Answer: Prevalence
Explanation:Prevalence, sometimes referred to as prevalence rate, is the proportion of persons in a population who have a particular disease or attribute at a specified point in time or over a specified period of time.
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This question is part of the following fields:
- Epidemiology And Statistics
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Question 19
Incorrect
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A 12-year-old female presented with a bleeding nose. On examination by the ENT surgeon, it was noticed that the bleeding was coming from the anterior part of the nose and the bleeding point was clearly visualised. Which of the following options is the most suitable choice in this case?
Your Answer:
Correct Answer: Cautery
Explanation:In the case of anterior nasal bleeds, when the bleeding point is clearly visualised the best management step is cautery, either electrical or chemical.
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This question is part of the following fields:
- ENT
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Question 20
Incorrect
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In an age and sex matched case control study, 30 adolescents with high blood pressure were compared to 30 controls from the same clinic. The mean birth weights of the two groups were compared using a paired t-test. The results indicated that the control group was 150 g heavier with a standard error of 100 g.
Which one of these is the most appropriate conclusion?Your Answer:
Correct Answer:
Explanation:In case control studies, observational studies are made to compare two groups, individuals with a certain condition, to those without the condition, with all other factors being equal. In the situation presented by the question, the study was to determine whether a prior risk factor, a low birth weight, was associated with later developing adolescent hypertension, using a paired t-test to statistically determine whether there was indeed a significant association between the two conditions. Case control studies only help to draw associations between two groups and therefore cannot indicate causation. In this scenario we are also not given the p value to determine whether the association is statistically significant. Therefore there is not enough evidence to conclude whether or not birthweight affects the development of adolescent hypertension.
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This question is part of the following fields:
- Epidemiology And Statistics
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Question 21
Incorrect
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A 19-year-old boy presents to his family physician complaining of a 'flu-like illness.' He has been fasting for the last 48hours. On examination, besides mild jaundice, everything else seems to be normal. Labs reveal an elevated serum bilirubin level (60 ?mol/l), but the other liver function tests are normal. CBC, U&E, and haptoglobins are normal. What is the most likely diagnosis?
Your Answer:
Correct Answer: Gilbert's disease
Explanation:People with Gilbert syndrome have a build-up of unconjugated bilirubin in their blood (unconjugated hyperbilirubinemia). In affected individuals, bilirubin levels fluctuate and very rarely increase to levels that cause jaundice. Gilbert syndrome is usually recognized in adolescence. If people with this condition have episodes of hyperbilirubinemia, these episodes are generally mild and typically occur when the body is under stress, for instance because of dehydration, prolonged periods without food (fasting), illness, vigorous exercise, or menstruation. Some people with Gilbert syndrome also experience abdominal discomfort or tiredness. However, approximately 30 percent of people with Gilbert syndrome have no signs or symptoms of the condition and are discovered only when routine blood tests reveal elevated unconjugated bilirubin levels.
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This question is part of the following fields:
- Gastroenterology And Hepatology
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Question 22
Incorrect
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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.
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This question is part of the following fields:
- Neurology And Neurodisability
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Question 23
Incorrect
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A child presents to the clinic with the complaints of pale stools and jaundice. Which of the following tests would be most helpful in establishing a diagnosis?
Your Answer:
Correct Answer: US abdomen
Explanation:The patient is most likely suffering from obstructive jaundice. Ultrasound of the abdomen is the superior diagnostic tool in detecting and assessing biliary system obstruction, because it is easy, available, accurate and non-invasive.
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This question is part of the following fields:
- Gastroenterology And Hepatology
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Question 24
Incorrect
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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.
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This question is part of the following fields:
- Respiratory
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Question 25
Incorrect
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A 15-month-old infant is brought to the clinic by his parents following a minor fall. He was initially unable to bear weight on his legs but after ibuprofen he can walk and run with a minor limp. X-ray of the leg shows no abnormality. However, ten days later a repeat x-ray is done due to persistent limp and it reveals a spiral fracture. How do you explain this?
Your Answer:
Correct Answer: Delayed periosteal reaction
Explanation:A periosteal reaction can result from a large number of causes, including injury and chronic irritation due to a medical condition such as hypertrophic osteopathy, bone healing in response to fracture, chronic stress injuries, subperiosteal hematomas, osteomyelitis, and cancer of the bone. This history is consistent with a toddler’s fracture. Here a minor, usually twisting, injury results in a spiral fracture of the tibia. An initial X-ray may appear normal as the periosteum holds the bone together preventing displacement. Ten days later a repeat X-ray will show callous formation and confirm the diagnosis.
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This question is part of the following fields:
- Emergency Medicine
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Question 26
Incorrect
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A 16 year old girl fractured a bone in her left foot. Upon examination the clinician discovered that the fracture affected the insertion of the peroneus brevis muscle. Which of the following bones was most likely affected?
Your Answer:
Correct Answer: Base of the fifth metatarsal
Explanation:The peroneus brevis muscle originates from the lower two-thirds of the lateral body of the fibula and has inserts at the base of the fifth metatarsal. Fractures to this bone are common and can be due to infection, trauma, overuse and repetitive use.
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This question is part of the following fields:
- Anatomy
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Question 27
Incorrect
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A 2-year-old boy's illness started with a 4-day history of fever and cough. Crepitations are noted upon auscultation. Other examination results are temperature 38.9C, O2 sats 94% on air, respiratory rate is 45/min, and capillary refill time 1 sec. Urine is also negative on dipstick. What is the single investigation most likely to lead to a diagnosis?
Your Answer:
Correct Answer: Blood for culture and sensitivity
Explanation:Blood culture and sensitivity will distinguish the bacteria that is responsible for the infection and the effective antibiotic treatment to which the bacteria is sensitive.
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This question is part of the following fields:
- Respiratory
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Question 28
Incorrect
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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.
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This question is part of the following fields:
- Ophthalmology
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Question 29
Incorrect
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Consider the following study:
Healthy individuals are assessed according to their current body mass index (BMI). Two years later, their health status is reassessed, and the relationships with their earlier BMI were determined.
What is the type of epidemiological study described above?Your Answer:
Correct Answer: Cohort
Explanation:The study described in the question is a ‘cohort’ study.
Other options:
A prospective observational study – When groups are classified according to one or more factors at a given time and followed forward to determine outcomes (usually some health status)
– Although there is in one sense a control group (those who do not develop the health problem), this is not generally called a ‘controlled’ trial.
– An ecological study would look at outcomes in different groups (countries or regions usually) who follow different practices. -
This question is part of the following fields:
- Epidemiology And Statistics
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Question 30
Incorrect
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Which of the following gross motor skills would an 18-month-old boy have acquired, assuming that his developmental milestones are normal?
Your Answer:
Correct Answer: Carrying toys whilst walking
Explanation:Among the provided options, we would expect a normally developing 18-month-old child to be able to carry toys while walking.
At 18 months, a normally developing child will show the following gross motor abilities:
– walks with the feet slightly apart
– runs carefully with the head held high
– pushes and pulls objects around the floor
– walks upstairs if the hand is held
– kneels on a flat surface without support
– carry toys while walking.Other options:
– Intentionally kicking a ball is a skill typically acquired by 2.5 years, not 18 months.
– Jumping with two feet together from a small step is usually acquired by 2.5 years, not 18 months.
– Propelling a tricycle forwards by pushing with the feet on the floor is a milestone generally acquired by 2 years, not 18 months.
– Throwing a small ball overhand without falling is a milestone for children aged 2 years, not 18 months. -
This question is part of the following fields:
- Child Development
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