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  • Question 1 - A patient was diagnosed with a fast-growing pituitary adenoma. Magnetic resonance image (MRI)...

    Incorrect

    • A patient was diagnosed with a fast-growing pituitary adenoma. Magnetic resonance image (MRI) scanning reveals a suprasellar extension.

      Which structure is most likely to be affected?

      Your Answer: Hypothalamus

      Correct Answer: Optic nerve

      Explanation:

      Cranial nerve II (CN II or optic nerve) runs along the midline of the ventral surface of the brain and conveys visual information from the retina of each eye to the corresponding region of the primary visual cortex. The right half of the visual field of both eyes is processed by the left half of the retina, while the right half of the retina processes the left half of the visual field. These retinal ganglion cells project myelinated axons, carrying CN II sensory afferent fibres, through the optic chiasm, where optic nerve fibres from the nasal half of each retina decussate to the contralateral side of the brain for processing. After passing through the optic chiasm, the optic nerve becomes the optic tract that synapses to the lateral geniculate nucleus (LGN) of the thalamus and subsequently projects optic radiations to the primary visual cortex (V1) of the occipital lobe. The optic tract also projects to the superior colliculus, pretectal nuclei, and suprachiasmatic nuclei. This part of the optic pathway serves the important light reflex.

      Due to the anatomical location of the optic chiasm superior to the pituitary gland, a suprasellar extension of a pituitary macroadenoma will lead to compression of the optic nerve fibres decussating at the optic chiasm. Impingement of these nerves prevents visual information from the temporal visual fields of each eye from reaching the processing centres in the brain, leading to peripheral vision loss

    • This question is part of the following fields:

      • Anatomy
      1
      Seconds
  • Question 2 - A 12 year old boy presents with a sharp pain on the left...

    Incorrect

    • A 12 year old boy presents with a sharp pain on the left side of his lower back. His parents both have a similar history of the condition. His urine tests positive for blood. A radio dense stone is seen in the region of the mid ureter when a KUB style x-ray is done. Which of the following is most likely the composition of the stone?

      Your Answer:

      Correct Answer: Cystine stone

      Explanation:

    • This question is part of the following fields:

      • Genitourinary
      7
      Seconds
  • Question 3 - A 2-year-old boy's illness started with a 4-day history of fever and cough....

    Incorrect

    • 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.

    • This question is part of the following fields:

      • Respiratory
      0
      Seconds
  • Question 4 - A 14-year-old girl with HIV develops jaundice while being treated for overwhelming sepsis....

    Incorrect

    • A 14-year-old girl with HIV develops jaundice while being treated for overwhelming sepsis. Blood investigations reveal:
      ALT: 50 IU/L (0-45)
      Alkaline phosphatase (ALP): 505 IU/L (0-105)

      Which of the following medications has she most likely been administered in the course of her treatment?

      Your Answer:

      Correct Answer: Co-amoxiclav

      Explanation:

      Based on the presentation, she probably was administered co-amoxiclav.
      The liver function tests are highly suggestive of cholestatic jaundice, which is a classic adverse dug reaction related to co-amoxiclav use.

      Other options:
      – Erythromycin is more commonly associated with gastrointestinal (GI) disturbance.
      – Gentamicin is more commonly associated with renal impairment.
      – Meropenem does not commonly cause cholestasis but is associated with transaminitis.
      – Vancomycin is associated with red man syndrome on fast administration.

    • This question is part of the following fields:

      • HIV
      0
      Seconds
  • Question 5 - A 12-year old boy with cystic fibrosis is here for his annual review....

    Incorrect

    • A 12-year old boy with cystic fibrosis is here for his annual review.
      Which of the following diets is most appropriate for this patient?

      Your Answer:

      Correct Answer: High calorie and high fat with pancreatic enzyme supplementation for every meal

      Explanation:

      The management of cystic fibrosis requires a multidisciplinary approach, starting with a planned diet.

      The critical points of this management approach are:
      Chest physiotherapy and postural drainage – the parents are usually taught to do this.
      Deep breathing exercises,
      High calorie, high fat intake with vitamin supplementation.
      Pancreatic enzyme supplements with meals.
      Heart-lung transplantation would be the definitive treatment.

      Note: Previously, a high-calorie, low-fat diet was recommended to reduce steatorrhea. However, it is no longer the desired approach.

    • This question is part of the following fields:

      • Nutrition
      0
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  • Question 6 - A father brought his 6-year-old son with cystic fibrosis to the ER department...

    Incorrect

    • A father brought his 6-year-old son with cystic fibrosis to the ER department due to massive hematemesis. He is hypotensive and has a tachycardia. Which is the most likely diagnosis?

      Your Answer:

      Correct Answer: Bleeding oesophageal varices

      Explanation:

      Bleeding oesophageal varices secondary to portal hypertension can cause a massive gastrointestinal haemorrhage resulting in shock. Perforated ulcer is less likely in this age group. Mallory Weiss tear would not likely result in a massive haemorrhage. Aorto-intestinal fistula is more common in older patients with abdominal aneurysms. Boerhaave’s syndrome is a result of a ruptured oesophagus following excessive vomiting.

    • This question is part of the following fields:

      • Respiratory
      0
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  • Question 7 - A 16-year-old boy presents with left-sided hemi-sensory loss and ipsilateral sensory inattention. The...

    Incorrect

    • A 16-year-old boy presents with left-sided hemi-sensory loss and ipsilateral sensory inattention. The doctor suspects a space-occupying lesion.
      Where is this likely to be?

      Your Answer:

      Correct Answer: Right parietal lobe

      Explanation:

      Damage to the left parietal lobe can result in what is called Gerstmann’s Syndrome. It includes right-left confusion, difficulty with writing (agraphia) and difficulty with mathematics (acalculia). It can also produce disorders of language (aphasia) and the inability to perceive objects normally (agnosia).
      Damage to the right parietal lobe can result in neglecting part of the body or space (contralateral neglect), which can impair many self-care skills such as dressing and washing. Right side damage can also cause difficulty in making things (constructional apraxia), denial of deficits (anosognosia) and drawing ability.
      Bi-lateral damage (large lesions to both sides) can cause Balint’s Syndrome, a visual attention and motor syndrome. This is characterized by the inability to voluntarily control the gaze (ocular apraxia), inability to integrate components of a visual scene (simultanagnosia), and the inability to accurately reach for an object with visual guidance (optic ataxia)
      Special deficits (primarily to memory and personality) can occur if there is damage to the area between the parietal and temporal lobes.
      Left parietal-temporal lesions can affect verbal memory and the ability to recall strings of digits. The right parietal-temporal lobe is concerned with non-verbal memory.
      Right parietal-temporal lesions can produce significant changes in personality.

    • This question is part of the following fields:

      • Neurology And Neurodisability
      0
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  • Question 8 - Advanced paternal age is NOT a risk factor for which of the following...

    Incorrect

    • Advanced paternal age is NOT a risk factor for which of the following diseases?

      Your Answer:

      Correct Answer: Turner syndrome

      Explanation:

      Advanced paternal age is associated with poor quality sperm leading to a reduction in overall fertility along with an increase in the occurrence of various medical disorders in the fetus. Advanced paternal age has been implicated as a risk factor for diseases like retinoblastoma, Marfan’s syndrome, neurofibromatosis, achondroplasia, autism spectrum disorders, schizophrenia, and acute lymphoblastic leukaemia. Down’s syndrome is mostly considered a consequence of advanced maternal age, but advanced paternal age has also been implicated as a risk factor. Turner syndrome is not found to be caused by advanced paternal age.

    • This question is part of the following fields:

      • Genetics And Dysmorphology
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  • Question 9 - A 1-year old child is brought to the ER with abdominal distension and...

    Incorrect

    • A 1-year old child is brought to the ER with abdominal distension and bilious vomiting. Radiological examination shows distended bowel loops and gas in the rectum. Her mother reveals that the baby had surgery at the two days of age for a twisted intestine. Blood gas analysis from a sample drawn from a capillary shows a pH of 7.34 and lactate of 2. Which of the following is the most appropriate management step?

      Your Answer:

      Correct Answer: Naso-gastric decompression, intra venous fluids and admit. The majority of adhesional obstruction resolves without need for surgery

      Explanation:

      Adhesion formation might be reduced by minimally invasive surgical techniques and the use of adhesion barriers. Non-operative treatment is effective in most patients with ASBO. Contraindications for non-operative treatment include peritonitis, strangulation, and ischemia. When the adhesive aetiology of obstruction is unsure, or when contraindications for non-operative management might be present, CT is the diagnostic technique of choice. The principles of non-operative treatment are nil per os, naso-gastric, or long-tube decompression, and intravenous supplementation with fluids and electrolytes. When operative treatment is required, a laparoscopic approach may be beneficial for selected cases of simple ASBO.

    • This question is part of the following fields:

      • Paediatric Surgery
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  • Question 10 - A 1 year old baby boy is taken to the doctor by his...

    Incorrect

    • A 1 year old baby boy is taken to the doctor by his mother who is concerned that she cannot feel his testis. On examination by the doctor, his testis are not palpable either in the scrotum or the inguinal region and cannot be seen on ultrasound either. Which of the following is the most appropriate next stage in management?

      Your Answer:

      Correct Answer: Laparoscopy

      Explanation:

      Answer: Laparoscopy

      The diagnostic accuracy of laparoscopy for impalpable testis is well recognized. Approximately 20% of undescended testes are truly impalpable, and laparoscopy is actually regarded as the gold standard for their localization; none of the currently available imaging techniques (ultrasound, computerized tomography, or magnetic resonance imaging) has proven to be 100% reliable in predicting the presence or absence of a testis.
      In this respect, not only can laparoscopy be considered the most reliable tool to provide information on the location of the testis but also to confirm its absence.

      Undescended testes in boys is a very common congenital abnormality in which one or both testes does not reach the bottom of the scrotum prior to birth. The incidence of the condition is 3-5% among all boys at birth, and decreases to 0.8-1% after 6 months of age.
      Males with undescended testes have a lower sperm count, poorer quality sperm, and lower fertility rate, compared to males whose testicles descend normally; the rate of subfertility increases with bilateral involvement and increasing age at the time of orchidopexy.

    • This question is part of the following fields:

      • Genitourinary
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  • Question 11 - Children with eczema herpeticum exhibit which of the following features? ...

    Incorrect

    • Children with eczema herpeticum exhibit which of the following features?

      Your Answer:

      Correct Answer: Atopic children have reduced immunity to the herpes simplex virus

      Explanation:

      Eczema herpeticum is a form of Kaposi varicelliform eruption, characterized by extensive vesicular skin eruptions that arise from a pre-existing skin condition, usually atopic dermatitis. The most common pathogen is the herpes simplex virus type 1, which has a higher propensity of attacking the epidermis already damaged by atopic dermatitis. The incubation period of the illness is 5-14 days. The eruption is initially small, monomorphic, dome-shaped papulovesicles that rupture to form tiny punched-out ulcers. It is diagnosed by taking viral swabs for culture.

    • This question is part of the following fields:

      • Dermatology
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  • Question 12 - An 8-year-old girl is diagnosed with type-1 diabetes mellitus. She has three regular...

    Incorrect

    • An 8-year-old girl is diagnosed with type-1 diabetes mellitus. She has three regular meals daily. Which of the following is the insulin regimen of choice for this patient?

      Your Answer:

      Correct Answer: Basal-bolus regimen

      Explanation:

      In older children who are able to have regular meal timings, the insulin regimen of choice is the basal-bolus regimen, which comprises a dose of long-acting insulin in combination with three doses of short-acting insulin. The dosage timings coincide with the meal times, ensuring greater flexibility and feasibility. The long-acting insulin serves to provide a stable glycaemic control. The other given regimens are suitable for younger children with a more irregular meal schedule.

    • This question is part of the following fields:

      • Endocrinology
      0
      Seconds
  • Question 13 - A woman gives birth to a baby at 40 weeks of gestation via...

    Incorrect

    • A woman gives birth to a baby at 40 weeks of gestation via Caesarean section because of pathological cardiotocography. The baby looks healthy and she has an Apgar score of 9, however, her RR is increased. The mother's antenatal history is unremarkable. What is the most probable diagnosis?

      Your Answer:

      Correct Answer: Transient tachypnoea of the new-born (TTN)

      Explanation:

      Transient tachypnoea of the new-born (TTN) is the commonest cause of respiratory distress in new-borns and self-limiting. It can affect any new-born shortly after birth. Its most prominent feature is tachypnoea. Nasal flaring, grunting, or intercostal retractions may also be present.

    • This question is part of the following fields:

      • Neonatology
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      Seconds
  • Question 14 - A 6-year-old boy was admitted with a burn that looks third or fourth...

    Incorrect

    • A 6-year-old boy was admitted with a burn that looks third or fourth degree upon inspection. He has not stopped crying. What is the most appropriate next step?

      Your Answer:

      Correct Answer: IV fluid start

      Explanation:

      The boy needs re-hydration due to his full thickness burn so IV fluids is the next most appropriate step. The greatest loss of plasma occurs in the first 12 hours after burn injury. The plasma loss then slowly decreases during the second 12 hours of the post-burn phase, although extensive leakage can continue for up to three days (Ahrns, 2004). Optimal fluid replacement during this period is essential to ensure cardiac output and renal and tissue perfusion. Usually, 36 hours post-burn, capillary permeability returns to normal and fluid is drawn back into the circulation. Burns of more than 15% of surface body area in adults and of over 10% in children warrant formal resuscitation.
      The Parkland formula for the total fluid requirement in 24 hours is as follows:
      4ml x TBSA (%) x body weight (kg);
      50% given in first eight hours;
      50% given in next 16 hours.
      Children receive maintenance fluid in addition, at an hourly rate of:
      4ml/kg for the first 10kg of body weight plus;
      2ml/kg for the second 10kg of body weight plus;
      1ml/kg for >20kg of body weight.
      End point
      Urine -adults: 0.5-1.0 ml/kg/hour;
      Urine -children: 1.0-1.5ml/kg/hour.

    • This question is part of the following fields:

      • Emergency Medicine
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  • Question 15 - Erythema infectiosum is NOT associated with which of the following clinical features? ...

    Incorrect

    • Erythema infectiosum is NOT associated with which of the following clinical features?

      Your Answer:

      Correct Answer: Herpes virus serology

      Explanation:

      Erythema infectiosum is an acute viral illness caused by Parvovirus B19. It is usually a mild flu-like illness and produces a maculopapular rash, appearing initially on the cheeks and then spreading towards extremities. The rash usually spares the palms and soles and gives a slapped appearance to the cheeks. It can be described as having a fishnet appearance on the body.

    • This question is part of the following fields:

      • Dermatology
      0
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  • Question 16 - Patent ductus arteriosus is found in which of the following conditions? ...

    Incorrect

    • Patent ductus arteriosus is found in which of the following conditions?

      Your Answer:

      Correct Answer: Trisomy 21

      Explanation:

      Patent ductus arteriosus is a heart defect that occurs in around 50% of the preterm or low birth weight infants. It is characterized by the failure of the fetal ductus arteriosus to close after birth. There are certain risk factors which predispose an infant to a patent ductus arteriosus. The most important risk factor is trisomy 21 or Down’s syndrome, which is associated with multiple cardiac defects. Other factors are congenital rubella syndrome, birth at high altitudes, and female gender.

    • This question is part of the following fields:

      • Cardiovascular
      0
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  • Question 17 - A 12-year-old child has developed a fever and maculopapular rash on his back....

    Incorrect

    • A 12-year-old child has developed a fever and maculopapular rash on his back. What diagnosis should he be given?

      Your Answer:

      Correct Answer: Chicken pox

      Explanation:

      Chickenpox is caused by the varicella-zoster virus. The clinical signs of infection are fever and a maculopapular rash – this is a unique rash with both flat and raised lesions on the skin.

    • This question is part of the following fields:

      • Infectious Diseases
      0
      Seconds
  • Question 18 - Bone age would be delayed in which of the following conditions? ...

    Incorrect

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

      Your Answer:

      Correct Answer: Trisomy 21 in a 10 year old boy

      Explanation:

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

    • This question is part of the following fields:

      • Endocrinology
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  • Question 19 - A 5-month-old baby is referred with a recurrent itchy eruption affecting his trunk...

    Incorrect

    • A 5-month-old baby is referred with a recurrent itchy eruption affecting his trunk and soles. Examination shows diffuse eczema on the trunk and pink-red papules on both soles.
      Which of the following is the most likely diagnosis?

      Your Answer:

      Correct Answer: Scabies

      Explanation:

      Scabies infection in neonates typically manifests as nodular eruptions involving the face, neck, scalp, palms, and soles in contrast to the predominant involvement of the hands, wrists, elbows, and ankles in adults. Differential diagnoses for the nodular eruption in neonates are broad, and scabies often is misdiagnosed as Langerhans cell histiocytosis, urticaria pigmentosa, or another pruritic, bullous, or lymphoproliferative dermatosis. Histopathology of the reactive nodules usually is not diagnostic, because scabetic organisms are often unidentified and histologic findings are nonspecific. Furthermore, because of the atypical presentation, scabies in children is often missed until persons in close contact with the child present with similar symptoms. Thus, a thorough history and close follow-up are crucial to avoid misdiagnosis and unnecessary aggressive treatment. Moreover, synchronized treatment of patients and their close contacts is needed to ensure the success of therapy, considering that relapse is 2-3 times more frequent in children and infants

    • This question is part of the following fields:

      • Dermatology
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  • Question 20 - A horse kicks a 14-year-old girl in the abdomen while she was at...

    Incorrect

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

      Your Answer:

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

      Explanation:

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

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

    • This question is part of the following fields:

      • Paediatric Surgery
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  • Question 21 - A 10-year-old boy presented to the ophthalmology clinic with a painless swelling on...

    Incorrect

    • A 10-year-old boy presented to the ophthalmology clinic with a painless swelling on the superotemporal aspect of his orbit.
      It was smooth on examination and produced no visual disturbances. Following excision, it was found to be lined by squamous epithelium and hair follicles.

      Which lesion is most probably associated with these findings?

      Your Answer:

      Correct Answer: Dermoid cyst

      Explanation:

      The most probable lesion in the patient is a dermoid cyst.

      Rationale:
      Dermoid cysts are embryological remnants and may be lined by hair and squamous epithelium (like teratomas). They are often located in the midline and may be linked to deeper structures resulting in a dumbbell shape to the lesion.
      Complete excision is required as they have a propensity to local recurrence if not excised.

      Note:
      Desmoid tumours are a different entity entirely. These lesions most commonly develop in ligaments and tendons.
      They are also referred to as aggressive fibromatosis and consist of dense fibroblastic lesions (resembling scar tissue). They should be managed in a similar manner to soft tissue sarcomas.

    • This question is part of the following fields:

      • Dermatology
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  • Question 22 - Which of the following could be an indicator of possible language delay in...

    Incorrect

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

      Your Answer:

      Correct Answer: A family history of hereditary deafness

      Explanation:

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

    • This question is part of the following fields:

      • Child Development
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  • Question 23 - What are some of the derivatives of the second pharyngeal arch? ...

    Incorrect

    • What are some of the derivatives of the second pharyngeal arch?

      Your Answer:

      Correct Answer: Stylohyoid muscle

      Explanation:

      Also known as the hyoid arch, it forms the side and front of the neck. From its cartilage develops the styloid process, stylohyoid ligament and lesser cornu of the hyoid bone. The muscular derivatives include the muscles of facial expression, stapedius, stylohyoid and the posterior belly of the digastric. All these are innervated by cranial nerve VII but migrate into the area of the mandibular arch.

    • This question is part of the following fields:

      • Embryology
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  • Question 24 - A 12 year old boy with type I diabetes was reluctant to go...

    Incorrect

    • A 12 year old boy with type I diabetes was reluctant to go to school. According to him, he was unhappy at the school. Which of the following is the next appropriate step?

      Your Answer:

      Correct Answer: Clinical psychologist

      Explanation:

      The child’s problem should be assessed properly to find the reason for unhappiness at the school. There can be many reasons such as bullying at school, abuse etc. A clinical psychologist should assess this child to take the necessary details and plan the further management.

    • This question is part of the following fields:

      • Endocrinology
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  • Question 25 - A child suffering from a chest infection is prescribed flucloxacillin. A few days...

    Incorrect

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

      Your Answer:

      Correct Answer: Cholestatic jaundice

      Explanation:

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

    • This question is part of the following fields:

      • Pharmacology
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  • Question 26 - A 15 month old girl from Greece presents with pallor. Her mother complains...

    Incorrect

    • A 15 month old girl from Greece presents with pallor. Her mother complains that she always seems tired. However, she has no problems with eating and has a fairly balanced diet. She was born in a rural part of the Greece and just recently moved to the UK with her parents. She hasn't had any previous blood tests or investigations done since her birth. She has been on the second centile since her first check up in the UK, but has not lost any weight. The following are the results of her investigations.
      Hb 5.5g/dl
      MCV 62 fl
      WBC 4.3 x 109/l
      PLT 430 x 109/l
      Reticulocyte count 490 x 109/l (normal range 20-100 x 109/l
      Ferritin 260 ng/ml (normal range: 20-300 ng/ml)
      Blood film: hypochromic microcytic red cells, polychromasia, fragmented red cells, nucleated red cells

      What is the most likely diagnosis?

      Your Answer:

      Correct Answer: Thalassaemia

      Explanation:

      The differentials of the child’s condition are likely to include an Iron deficiency anaemia, or a hemoglobinopathy such as sickle cell disease or thalassemia based on the presentation of pallor, growth failure and easy fatiguability. While the full blood count and film present a hypochromic microcytic anaemia with reticulocytosis, the normal serum ferritin levels rule out iron deficiency anaemia. Thalassemia is to be suspected over sickle cell disease as the patient comes from the Mediterranean region known for a high incidence of thalassemia. Sickle cell anaemia also tends to present with normocytic normochromic red blood cells, with many sickled cells. Vitamin B12 deficiency and Aplastic anaemia are ruled out as they present with a macrocytic anaemia, and a decrease in white blood cells, platelets and red blood cells respectively.

    • This question is part of the following fields:

      • Haematology And Oncology
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  • Question 27 - A 5 week old boy with pyloric stenosis is vomiting forcefully. Which of...

    Incorrect

    • A 5 week old boy with pyloric stenosis is vomiting forcefully. Which of the following findings would you expect to be in his blood results?

      Your Answer:

      Correct Answer: Hypokalaemia

      Explanation:

      Progressive vomiting due to pyloric stenosis leads to hypochloraemic, hypokalaemic, metabolic alkalosis.

    • This question is part of the following fields:

      • Nephro-urology
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  • Question 28 - A 15-year-old girl who has undergone a recent excision of the left submandibular...

    Incorrect

    • A 15-year-old girl who has undergone a recent excision of the left submandibular gland presents to the follow-up clinic with complaints of tongue weakness on the ipsilateral side.
      What is the nerve that is most likely to be damaged?

      Your Answer:

      Correct Answer: Hypoglossal nerve

      Explanation:

      The presenting features and the surgical site provided in the clinical scenario are highly suggestive of ipsilateral hypoglossal nerve injury.

      Note:
      Three cranial nerves may be injured during submandibular gland excision.
      – Marginal mandibular branch of the facial nerve
      – Lingual nerve
      – Hypoglossal nerve

      Hypoglossal nerve damage may result in the paralysis of the ipsilateral aspect of the tongue. The nerve itself lies deep to the capsule surrounding the gland and should not be injured during an intracapsular dissection.
      The lingual nerve is probably at higher risk of injury. However, the effects of lingual nerve injury are predominantly sensory rather than motor.
      Thus, the most appropriate answer is the hypoglossal nerve.

    • This question is part of the following fields:

      • ENT
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  • Question 29 - A pathologist examines a histological section and identifies a clump of Reed Sternberg...

    Incorrect

    • A pathologist examines a histological section and identifies a clump of Reed Sternberg cells.
      What is the most likely diagnosis?

      Your Answer:

      Correct Answer: Hodgkin's lymphoma

      Explanation:

      Reed-Sternberg cells are classically associated with Hodgkin lymphoma.
      Classical diagnostic Reed-Sternberg cells are large (15 to 45 micrometres), have abundant slightly basophilic or amphophilic cytoplasm and have at least two nuclear lobes or nuclei. Diagnostic Reed-Sternberg cells must have at least two nucleoli in two separate nuclear lobes. The nuclei are large and often rounded in contour with a prominent, often irregular nuclear membrane, pale chromatin and usually one prominent eosinophilic nucleolus, with perinuclear clearing (halo), resembling a viral inclusion.

    • This question is part of the following fields:

      • Haematology And Oncology
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  • Question 30 - A 6 year old boy has a family history of familial adenomatous polyposis....

    Incorrect

    • A 6 year old boy has a family history of familial adenomatous polyposis.

      What ocular manifestation in this boy would indicate that he has inherited the condition?

      Your Answer:

      Correct Answer: Congenital hypertrophy of the retinal pigment epithelium

      Explanation:

      Congenital hypertrophy of the retinal pigment epithelium is one of FAP’s extra-intestinal manifestations. It appears in early childhood and affects an estimated 90% of those with FAP.

    • This question is part of the following fields:

      • Genetics And Dysmorphology
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SESSION STATS - PERFORMANCE PER SPECIALTY

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