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Question 1
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Question 2
Incorrect
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A 1 week old baby boy is taken to the A&E department after a right sided groin swelling had been noticed. An examination is done and the testes are correctly located but there is a right sided inguinal hernia that is soft and easily reduced. Which of the following is the most appropriate management?
Your Answer:
Correct Answer: Surgery over the next few days
Explanation:Answer: Surgery over the next few days
Inguinal hernia is a type of ventral hernia that occurs when an intra-abdominal structure, such as bowel or omentum, protrudes through a defect in the abdominal wall. Inguinal hernias do not spontaneously heal and must be surgically repaired because of the ever-present risk of incarceration. Generally, a surgical consultation should be made at the time of diagnosis, and repair (on an elective basis) should be performed very soon after the diagnosis is confirmed.
The infant or child with an inguinal hernia generally presents with an obvious bulge at the internal or external ring or within the scrotum. The parents typically provide the history of a visible swelling or bulge, commonly intermittent, in the inguinoscrotal region in boys and inguinolabial region in girls.
The swelling may or may not be associated with any pain or discomfort. -
This question is part of the following fields:
- Paediatric Surgery
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Question 3
Incorrect
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A dental surgeon infiltrates local anaesthetic at the mandibular foramen to carry out a block of the right inferior alveolar nerve.
Which of the following might occur as a result of the procedure?Your Answer:
Correct Answer: Numbness of the lower teeth on the right side
Explanation:The inferior alveolar nerve supplies all the teeth of the respective hemimandible. It transverses the inferior alveolar canal and is a branch of the trigeminal nerve’s mandibular division. Therefore, in this case, the teeth of the right hemimandible will be numb.
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This question is part of the following fields:
- Anatomy
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Question 4
Incorrect
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A young boy presents with signs and symptoms consistent with infective endocarditis. He has a history of neglect and poor dental hygiene.
Which organism is likely to have caused his endocarditis?
Your Answer:
Correct Answer: Streptococci viridans
Explanation:Infective endocarditis occurs when microorganisms enter the bloodstream and infect damaged endocardium or endothelial tissue. It most commonly involves the heart valves (either native or prosthetic), but it may also occur at the site of a septal defect, on the chordae tendineae, or on the mural endocardium. The prototypic lesion is at the site of the infection; the vegetation is a mass of platelets, fibrin, microcolonies of microorganisms, and scant inflammatory cells. Endocarditis is classified as acute or subacute, which applies to the features and the progression of infection until diagnosis.
The oral cavity, the skin, and the upper respiratory tract are the primary portals for Streptococcus viridans; Staphylococcus species; and Haemophilus aphrophilus, Aggregatibacter (formerly Actinobacillus) actinomycetemcomitans, Cardiobacterium hominis, Eikenella corrodens, and Kingella kingae (HACEK) organisms. Streptococcal and staphylococcal organisms are responsible for more than 80% of cases of bacterial IE.
Streptococcus viridans accounts for approximately 50-60% of cases of subacute disease.
While S aureus infection is the most common cause of IE, including Prosthetic valve endocarditis, acute IE, and IV Drug Abusers IE
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This question is part of the following fields:
- Cardiovascular
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Question 5
Incorrect
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A 3-year-old girl presents with pallor and marked gland enlargement. She has been unwell for the past three weeks. She had a full term normal delivery with no neonatal problems. Her immunisations are up to date. There is no family or social history of note. On examination, her temperature is 37.6°C, and she looks pale and unwell. She has a few petechiae on the neck and palate, with moderate generalised lymphadenopathy and a 3 cm spleen. Which is the most likely diagnosis?
Your Answer:
Correct Answer: Acute leukaemia
Explanation:Non-Hodgkin Lymphoma: The history is of enlarged reticuloendothelial system with abnormalities in all 3 cell lines of the bone marrow (pallor, fever and petechiae). The most likely diagnosis is therefore acute (lymphoblastic) leukaemia. Lymphadenopathy may be prominent: mediastinal nodes are characteristic of T-cell leukaemia. In lymphoma the marrow involvement tends to be much less.
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This question is part of the following fields:
- Haematology And Oncology
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Question 6
Incorrect
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A 7-year-old boy is diagnosed with metabolic acidosis as a result of severe dehydration. Which of the following conditions is most likely to cause severe dehydration and metabolic acidosis?
Your Answer:
Correct Answer: Severe diarrhoea
Explanation:Diarrhoea is defined as having three or more loose or liquid stools per day, or as having more stools than is normal for that person. Severe diarrhoea, causing fluid loss and loss of bicarbonate, will result in marked dehydration and metabolic acidosis.
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This question is part of the following fields:
- Fluid And Electrolytes
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Question 7
Incorrect
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A 16 year old previously well male presents with a 4 day history of fever, lethargy and a generalized macular rash. There is no significant previous medical history and the patient has not travelled abroad either. Vitals are as follows:
Temp: 38.5
BP: 125/75mmHg
Pulse: 100/min
On auscultation the chest was clear and no heart murmur was heard. Examination also reveals a non blanching widespread macular rash over the chest and abdomen. There is swelling of interphalangeal joints of both hands and feet associated with mild tenderness. Lymph nodes are palpable over the supraclavicular, axillary and inguinal areas. Abdominal examination reveals palpable mass on both right and left hypochondrium. Lab results are given below:
Haemoglobin (Hb) 13.5 g/dl
White cell count (WCC) 14.0 x 109/l
Platelets 380 x 109/l
Sodium 145 mmol/l
Potassium 4.8 mmol/l
Creatinine 89 μmol/l
Rheumatoid factor Negative
Antinuclear antibody Negative
Anti-dsDNA Negative
ASO titre Not detected
Electrocardiogram (ECG) Sinus rhythm
What is the most likely underlying diagnosis?Your Answer:
Correct Answer: Systemic Still's disease
Explanation:People with Systemic Juvenile Idiopathic Arthritis (also known as Stills disease) can have recurrent fevers, a macular rash, joint pain, joint deformities, an enlarged liver and/or spleen, and can occasionally have polyserositis, lung involvement or pericardial effusions. Rheumatoid factor and antinuclear antibodies are usually negative. Treatment is with non-steroidal anti-inflammatory drugs (NSAIDs) and the prognosis is better than for adult rheumatoid arthritis.
In pauciarticular Still’s disease, antinuclear antibodies are present. Large joints are affected and most patients develop classic features of seronegative spondylarthritis. -
This question is part of the following fields:
- Musculoskeletal
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Question 8
Incorrect
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An 18-year-old male presents to the clinic with a solitary, painless penile ulcer 2 cm in diameter. It appeared as a small red lump, 3 weeks after an episode of unprotected sexual intercourse with a new male partner and quickly progressed to this form. On examination, the ulcer has slightly elevated edges. This infection is most likely caused by which of the following organism?
Your Answer:
Correct Answer: Treponema pallidum
Explanation:Syphilis is an infectious venereal disease caused by the spirochete Treponema pallidum. Syphilis is transmissible by sexual contact with infectious lesions, from mother to foetus in utero, via blood product transfusion, and occasionally through breaks in the skin that come into contact with infectious lesions. If untreated, it progresses through 4 stages: primary, secondary, latent, and tertiary.
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This question is part of the following fields:
- Adolescent Health
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Question 9
Incorrect
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Today was Jacob's birthday. This morning he woke up very excited and picked out a pair of shorts and t-shirt in his favourite colour, blue, with matching blue sandals. He brushed his teeth with supervision, and used the toilet by himself. He greeted each of his friends at the door with an excited jump. At the party he ran around and jumped on the small trampoline in the backyard with his friends. He tried to skip like some if his friends, but he wasn't able to do it as evenly.
How old is Jacob likely to be?Your Answer:
Correct Answer: 4 years of age
Explanation:Jacob is likely to be four years old as demonstrated by his activities throughout the day. Most 4 year olds are able to run well, jump and hop, but find skipping a little more difficult. They are able to brush their teeth and dress themselves with supervision, and go to the toilet alone.
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This question is part of the following fields:
- Child Development
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Question 10
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 11
Incorrect
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A 5-month-old baby was brought by the mother for assessment. The baby can sit with support but not on his own. On examination, there is palmar grasp. How is the current development of this child?
Your Answer:
Correct Answer: Normal
Explanation:All the given development milestones are compatible with the given age.
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This question is part of the following fields:
- Child Development
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Question 12
Incorrect
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A 13 year old girl presented with signs of shortness of breath, chest pain, non-productive cough, oedema of the lower extremities and cyanosis of the fingertips. She has a history of a ventricular septal defect not surgically corrected. The most probable cause of these symptoms is:
Your Answer:
Correct Answer: Shunt reversal
Explanation:A ventricular septal defect (VSD) is a common form of congenital heart defects and is characterised by the presence of a hole in the wall that separates the right from the left ventricle. Medium or large defects can cause many complications. One of these complication is Eisenmenger syndrome, characterised by reversal of the shunt (from left-to-right shunt into a right-to-left) ,cyanosis and pulmonary hypertension.
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This question is part of the following fields:
- Cardiovascular
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Question 13
Incorrect
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A 12-year-old girl is recovering from bilateral parotitis. She complains of a continuous headache and drowsiness. A CT brain is done which is normal. What is the best definitive investigation in this case?
Your Answer:
Correct Answer:
Explanation:This patient might have viral meningitis as he recently suffered viral parotitis(Mumps). Microscopy and culture of the CSF would show a CSF lymphocytosis.
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This question is part of the following fields:
- Neurology
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Question 14
Incorrect
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In a premature infant boy, an inguinal hernia will most likely:
Your Answer:
Correct Answer: Recur after surgery
Explanation:Inguinal hernias are a common surgical condition in preterm male infants. Surgical repair is usually suggested shortly after birth due to a fear of incarceration or strangulation. These hernias are often indirect as they pass though the processes vaginalis, rather than the posterior wall of the inguinal canal. Recurrence of the hernia is the most common post operative complication. While other complications can occur if left un-repaired, hydrocele and testicular atrophy are not as common, neither is spontaneous resolution.
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This question is part of the following fields:
- Paediatric Surgery
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Question 15
Incorrect
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A 15-year-old boy presents with a history of abdominal pain. He has no features of puberty. A lower gastrointestinal (GI) endoscopy shows patches of ulceration in the terminal ileum.
What is the first-line treatment for this boy?Your Answer:
Correct Answer: Exclusive enteral nutrition (EEN)
Explanation:Based on the presentation, the patient is probably a case of Crohn’s disease. The first-line treatment of Crohn’s disease is exclusive enteral nutrition.
Exclusive enteral nutrition (EEN)
This involves drinking a protein-based formula exclusively for 6-8 weeks. It has been shown to have superior mucosal healing when compared with steroids. Furthermore, it is nutritionally advantageous when compared to steroids and does not have the side-effect profile of steroids.Other options:
– Intravenous steroids: This is the first-line treatment for ulcerative colitis (UC) or Crohn’s disease if there is rectal disease (which is not the case here). Side-effects include adrenal suppression, behavioural effects, osteopenia and changes in adipose tissue distribution.
– Oral steroids: This can be used if EEN is not possible. However, the side-effect profile is less favourable and is not as effective concerning mucosal healing.
– Parental nutrition and surgery: They may be occasionally required in severe cases that have failed first-line therapy. -
This question is part of the following fields:
- Gastroenterology And Hepatology
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Question 16
Incorrect
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A 10 year old boy is being bullied by his classmates because he's obese and he is the shortest in his class. His mother is worried and brings him in to the clinic. History reveals he had a renal transplant last year. What is the most likely diagnosis?
Your Answer:
Correct Answer: Cushing's syndrome
Explanation:The boy had a renal transplant, for which he needs immune suppression. For the exogenous immune suppression an exogenous steroid is needed, which in this case is responsible for the primary Cushing syndrome manifesting with short stature. The administration of steroids before the physiological fusion of the growth plate can lead to premature fusion with permanent cessation of bone growth.
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This question is part of the following fields:
- Endocrinology
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Question 17
Incorrect
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A 16 year-old boy was stabbed in the right supraclavicular fossa. The sharp object punctured the portion of the parietal pleura that extends above the first rib. What is the name of this portion of the parietal pleura?
Your Answer:
Correct Answer: Cupola
Explanation:Endothoracic fascia: the connective tissue (fascia) that is between the costal parietal pleura and the inner wall of the chest wall.
Costomediastinal recess: the point where the costal pleura becomes mediastinal pleura.
Costodiaphragmatic recess: is the lowest point of the pleural sac where the costal pleura becomes diaphragmatic pleura.
Cupola: the part of the parietal pleura that extends above the first rib level into the root of the neck.
Costocervical recess: this is a made-up term.
Peritracheal fascia: a layer of connective tissue that invests the trachea.
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This question is part of the following fields:
- Anatomy
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Question 18
Incorrect
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A 10-month-old boy is brought to clinic. His parents are concerned because two days ago, he met another child with mumps. Which is the most appropriate strategy for this child?
Your Answer:
Correct Answer: Do nothing now but give MMR at the appropriate age
Explanation:Immunity against mumps develops over a long time. There is nothing to be done except to proceed with the usual vaccination schedule.
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This question is part of the following fields:
- Infectious Diseases
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Question 19
Incorrect
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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.
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This question is part of the following fields:
- Genetics And Dysmorphology
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Question 20
Incorrect
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A 5 month old boy presents with breathlessness, central cyanosis, irregular pulse, and oedema. On cardiac auscultation, he has a displaced apical beat laterally and a profound right ventricular heave. On lung auscultation, he has bilateral basal crackles. X-ray of the chest reveals gross cardiomegaly. Heart ultrasound shows mitral valve prolapse. Finally, ECG shows a prolonged and widened QRS complex with a short PR interval. Doctors establish the diagnosis of a right bundle branch block with a dominant R wave in V1. What is the most likely diagnosis?
Your Answer:
Correct Answer: Type A Wolff-Parkinson-White syndrome (WPWS)
Explanation:Wolff-Parkinson-White (WPW) syndrome is a pre-excitation syndrome characterised by re-entry tachycardia that most commonly presents as a recurrent supraventricular tachycardia. ECG will show a short PR interval and a prolonged QRS complex.
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This question is part of the following fields:
- Cardiovascular
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Question 21
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 22
Incorrect
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A 9-year-old male presented in the emergency room with sudden nosebleed that started 15 minutes ago. Which management step should be taken in such a case?
Your Answer:
Correct Answer: Press soft parts of the nose
Explanation:With children nosebleeds often occur after nose picking and are benign in nature. For active bleeding, pressing of soft parts of the nose is required to stop the bleeding before doing anything else.
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This question is part of the following fields:
- ENT
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Question 23
Incorrect
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A 5-day-old infant is admitted to the ward. She was born at full term by normal vaginal delivery weighing 3.48kg and has been breastfed since birth. She has now lost 11% of her birth weight and bilirubin is above the phototherapy line. On examination, her fontanelle is soft, CRT<2 seconds, she is active and alert. U&Es have been sent, and the sodium on a blood gas is 144. You have started phototherapy, but still, need to make a plan about fluids and feeding. Mother wants to continue breastfeeding but is also happy to introduce some formula milk.
What is the MOST appropriate course of action?Your Answer:
Correct Answer: Offer NG or cup feeds alongside breastfeeding
Explanation:Excessive weight loss is generally indicative of suboptimal feeding, and infants with excessive weight loss are potentially dehydrated or at risk of dehydration.
Jaundice associated with suboptimal breastfeeding-this is classically associated with weight loss >10% and a vicious cycle of sleepiness that in turn leads to further poor feeding.
In the absence of clinical signs of dehydration, no evidence suggests that overhydration is helpful. If the infant is dehydrated, hydration should be given as clinically indicated. However, if the infant can tolerate oral feeding, oral hydration with a breast milk substitute is likely to be superior to intravenous hydration because it reduces enterohepatic circulation of bilirubin and helps wash bilirubin out of the bowel. -
This question is part of the following fields:
- Nutrition
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Question 24
Incorrect
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Which of the following dermatological conditions is not recognised to be associated with Crohn's disease?
Your Answer:
Correct Answer: Xanthomas
Explanation:CUTANEOUS DISORDERS OR DERMATOSIS ASSOCIATED WITH IBD
– Psoriasis
– Secondary amyloidosis
– Vitiligo
– Acquired epidermolysis bullosaIn some cases, non-granulomatous skin disorders occur as a reaction to the intestinal disease. These include:
– Pyoderma gangrenosum
– Neutrophilic dermatosis / Sweet syndrome, typically with pustules
– Pyodermatitis-pyostomatitis vegetans, a purulent erosive dermatosis characterised by snail-track ulcers
– Erythema multiforme
– Erythema nodosum
– Acneiform eruptions including nodulocystic acne, hidradenitis suppurativa and folliculitis
– Palisaded neutrophilic and granulomatous dermatitis
– Necrotizing and granulomatous small vessel vasculitis. -
This question is part of the following fields:
- Gastroenterology And Hepatology
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Question 25
Incorrect
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Question 26
Incorrect
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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.
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This question is part of the following fields:
- Infectious Diseases
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Question 27
Incorrect
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A 14 year old girl suffers from haemophilia A and chronic knee pain with progressive swelling and deformity over the last 4 years. Test results reveal a significantly reduced factor VIII activity. Which of the following is seen in the knee joint space after an acute painful episode?
Your Answer:
Correct Answer: Cholesterol crystals
Explanation:Due to breakdown of the red blood cell membrane in haemophilic patients, cholesterol crystals are formed by the lipids. On the other hand lipofuscin deposition does not occur in haemolysis or haemorrhage. Neutrophil accumulation suggests acute inflammation. Anthracotic pigment is an exogenous carbon pigment that deposits in the lung from dust. Russell bodies are intracellular accumulations of immunoglobins in plasma cells. Curschmann’s spirals and Charcot Leyden crystals are pathognomonic of asthma.
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This question is part of the following fields:
- Haematology And Oncology
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Question 28
Incorrect
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Choose the karyotype associated with short stature:
Your Answer:
Correct Answer: 45,XO
Explanation:Turner syndrome (TS) is one of the most common genetic disorders; occurs with an incidence of I: 2,500 female live births. It results from complete or partial chromosome X monosomy. TS is associated with abnormalities of the X chromosome and characteristic clinical features of short stature, gonadal dysgenesis, sexual developmental deficiencies, cardiac and/or renal defects, webbed neck, low-set ears, skeletal deformities including cubitus valgus, a propensity to ear infections and hearing deficits.
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This question is part of the following fields:
- Genetics And Dysmorphology
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Question 29
Incorrect
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A 5 month old baby presents with irritability, fever, high pitched cry, and pustular discharge from both ears. He has been feeding poorly for the last two days. Clinical examination reveals a full fontanelle but no other neurological signs. The doctor performs a lumbar puncture, took a blood sample, and started him on IV antibiotics. What would be the expected CSF picture for bacterial meningitis?
Your Answer:
Correct Answer: CSF glucose: blood glucose 0.4, protein 0.2g/l. Cells 400, 390 polymorphs, 10 lymphocytes
Explanation:The CSF picture in bacterial meningitis has the following characteristics: several polymorphs, cells, protein that is maximum 5g/l, a few lymphocytes and glucose that accounts for the two thirds of the blood level.
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This question is part of the following fields:
- Neurology And Neurodisability
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Question 30
Incorrect
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Which of the following conditions are associated with erythema migrans?
Your Answer:
Correct Answer: Lyme disease
Explanation:Erythema Migrans is associated with Lyme disease, a tic transmitted infection caused by the spirochete Borrelia Burgdorferi. The rash usually appears at the bite site after 7 to 10 days. It is flat or slightly raised and migrates as the name suggests.
Streptococcal throat infection and Crohn’s disease are both associated with erythema nodosum.
Herpes simplex and Rheumatic fever may present with Erythema Multiforme and Erythema Marginatum respectively.
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This question is part of the following fields:
- Dermatology
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SESSION STATS - PERFORMANCE PER SPECIALTY
