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  • Question 1 - Tall stature is NOT a characteristic finding in which of the following conditions?...

    Incorrect

    • Tall stature is NOT a characteristic finding in which of the following conditions?

      Your Answer: Precocious puberty

      Correct Answer: Laurence-Moon Syndrome

      Explanation:

      A height that is above the 97th percentile for age and sex is described as a tall stature. The most common cause of tall stature is constitutional or familial, followed by nutritional causes. Hormonal causes of tall stature include hyperthyroidism, growth hormone excess, and precocious puberty. Some important chromosomal and syndromic causes of tall stature are Klinefelter’s syndrome, homocystinuria, Marfan’s syndrome, Sotos syndrome, Beckwith-Weidman syndrome, and Weaver syndrome. Laurence-Moon syndrome is an autosomal recessive disorder characterized by short stature, retinitis pigmentosa, and spastic paraplegia.

    • This question is part of the following fields:

      • Endocrinology
      17.2
      Seconds
  • Question 2 - Which one of the following skin conditions is matched correctly with its treatment?...

    Incorrect

    • Which one of the following skin conditions is matched correctly with its treatment?

      Your Answer: Lipoma and laser therapy

      Correct Answer: Psoriasis and Vitamin D analogues

      Explanation:

      One of the options of Psoriasis treatment is vitamin D analogues i.e. calcipotriol. Acne is exacerbated by steroids. Erythema nodosum can be caused by various diseases and the treatment of the primary condition resolves the symptoms. Lipomas requires surgery, whereas Steven-Johnson syndrome requires use of steroids and eliminating the culprit drug, which is one of the most common causes.

    • This question is part of the following fields:

      • Dermatology
      27
      Seconds
  • Question 3 - A young male sustains a skull-base fracture at the middle cranial fossa which...

    Correct

    • A young male sustains a skull-base fracture at the middle cranial fossa which injures his right abducent (VI) nerve.Which signs are most likely to be present on clinical examination?

      Your Answer: The patient is unable to deviate his right eye laterally

      Explanation:

      Cranial nerve VI, also known as the abducent nerve, innervates the ipsilateral lateral rectus (LR), which functions to abduct the ipsilateral eye. Patients usually present with an isolated abduction deficit, binocular horizontal diplopia, worse in the distance, and esotropia in primary gaze. Patients also may present with a head-turn to maintain binocularity and binocular fusion and to minimize diplopiaExamination for a sixth nerve palsy involves documenting the presence or absence of papilledema, examining the ocular motility, evaluating the eyelids and pupils, and excluding involvement of other cranial nerves (e.g., V, VII, VIII).

    • This question is part of the following fields:

      • Anatomy
      62.7
      Seconds
  • Question 4 - A 14 year old known asthmatic presents to the A&E department with difficulty...

    Correct

    • A 14 year old known asthmatic presents to the A&E department with difficulty breathing. She was seen by her regular doctor the day before with a sore throat which he diagnosed as tonsillitis and was prescribed oral Amoxicillin for 5 days. Past medical history:Ulcerative colitis diagnosed four years ago.Current medications:Inhaled salbutamol and beclomethasoneMesalazine 400 mg TDSShe was observed to be alert and oriented but she had laboured breathing. Inspiratory wheeze was noted. She was pale, sweaty and cyanosed. Her temperature was 36.7C, pulse 121/minute and blood pressure 91/40 mmHg. The lungs were clear and the remainder of the examination was normal. She was given high-flow oxygen through a face mask but despite this her breathing became increasingly difficult.What is the most likely causative agent?

      Your Answer: Haemophilus influenzae

      Explanation:

      Acute epiglottitis is a life-threatening disorder with serious implications to the anaesthesiologist because of the potential for laryngospasm and irrevocable loss of the airway. There is inflammatory oedema of the arytenoids, aryepiglottic folds and the epiglottis; therefore, supraglottitis may be used instead or preferred to the term acute epiglottitis.Acute epiglottitis can occur at any age. The responsible organism used to be Hemophilus influenzae type B (Hib), but infection with group A b-haemolytic Streptococci has become more frequent after the widespread use of Hemophilus influenzae vaccination. The typical presentation in epiglottitis includes acute occurrence of high fever, severe sore throat and difficulty in swallowing with the sitting up and leaning forward position in order to enhance airflow. There is usually drooling because of difficulty and pain on swallowing. Acute epiglottitis usually leads to generalized toxaemia. The most common differential diagnosis is croup and a foreign body in the airway. A late referral to an acute care setting with its serious consequences may result from difficulty in differentiation between acute epiglottitis and less urgent causes of a sore throat, shortness of breath and dysphagia.

    • This question is part of the following fields:

      • Respiratory
      164.2
      Seconds
  • Question 5 - An 11-year-old girl presents to the paediatric assessment unit with a widespread macular...

    Incorrect

    • An 11-year-old girl presents to the paediatric assessment unit with a widespread macular rash. She had a previous history of flu-like illness and sore throat diagnosed as tonsillitis for which she was prescribed Amoxicillin. On examination, she has widespread cervical lymphadenopathy and petechiae on her palate. What is the most likely underlying pathogen?

      Your Answer:

      Correct Answer: Epstein Barr Virus

      Explanation:

      Based on the clinical scenario, the most likely underlying pathogen is the Epstein Barr virus (EBV).An Epstein Barr virus (EBV) infection most commonly results in upper respiratory tract symptoms with fever and sore throat. Lymphadenopathy is frequently palpable on examination. Splenomegaly may also occur, and for this reason, patients diagnosed with glandular fever should be advised to avoid contact sports for one month following diagnosis. The presence of petechiae on the soft palate is also associated with EBV infection. The vast majority of patients with active EBV infection will develop a widespread rash if given amoxicillin, therefore, phenoxymethylpenicillin (Penicillin V) is recommended for the treatment of a suspected bacterial throat infection to prevent this complication occurring for individuals who have EBV infection.Other options:- Coronavirus: This is one of the causes of the common cold and is frequently responsible for sore throats; however, in this case, the presenting features are more suggestive of an EBV infection.- Group A Streptococcus: Streptococci are classified into two main groups; alpha-haemolytic and beta-haemolytic. Group A Streptococcus belongs to the beta-haemolytic group. Group A streptococcal infection is a common cause of bacterial tonsillitis. It is possible that the child, in this case, had streptococcal tonsillitis and has had a drug reaction to the amoxicillin. However her age, flu-like symptoms and petechiae on her palate all point to an EBV infection and amoxicillin resulting in a rash.- Parainfluenza: Parainfluenza viruses are one of many causes of the common cold and can cause pharyngitis. They are the leading cause of viral croup.- Rhinovirus: Rhinoviruses are one of many causes of the common cold and are frequently responsible for sore throats; however, in this case, are other factors suggesting EBV infection.

    • This question is part of the following fields:

      • ENT
      0
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  • Question 6 - A 17-year-old female presents to the clinic with acne, hirsutism and oligomenorrhoea. Which...

    Incorrect

    • 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

    • This question is part of the following fields:

      • Endocrinology
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  • Question 7 - Treacher Collins syndrome is NOT associated with which of the following clinical features?...

    Incorrect

    • Treacher Collins syndrome is NOT associated with which of the following clinical features?

      Your Answer:

      Correct Answer: Hirsutism

      Explanation:

      Treacher Collins syndrome is a congenital disorder transmitted in an autosomal dominant fashion. The basic abnormality is the TCOF 1 gene mutation, which leads to a multitude of clinical features, of which the most striking is the symmetrical craniofacial deformities. Important clinical features include conductive deafness, coloboma of lower eyelids, cleft palate, antimongoloid (short and downward slanting) palpebral fissures, deformed or absent ears, sleep apnoea, and airway issues. Hirsutism is not a recognized feature of this syndrome.

    • This question is part of the following fields:

      • Genetics And Dysmorphology
      0
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  • Question 8 - A term baby with a birth weight of 3.6 kg with hypoxic ischaemic...

    Incorrect

    • A term baby with a birth weight of 3.6 kg with hypoxic ischaemic encephalopathy is intubated and ventilated. Cooling treatment has started. The baby is sedated and paralysed and is being ventilated on the mode continuous mandatory ventilation (CMV). Settings are: targeted tidal volume 14 ml, maximum PIP 25, PEEP 5, rate 60/min, FiO2 0.21. Baby's oxygen saturations are 100%. Blood gas shows pH 7.47, CO2 2.8 kPa, BE -6.What is the first change that should be made to the ventilation?

      Your Answer:

      Correct Answer: Decrease rate

      Explanation:

      Ventilatory rates of 40-60 breaths/min should be provided initially, with proportionally fewer assisted breaths provided if the infant’s spontaneous respiratory efforts increase. Although this practice has not been extensively studied, initial inflation of the new-born’s lungs with either slow-rise or square-wave inflation to a pressure of 30-40 cm H2 O for approximately 5 seconds has been reported to result in more rapid formation of Functional Residual Capacity (FRC).At the moment of delivery and first breath, the neonatal lung is converting from a fetal non-aerated status to a neonatal status. The neonatal lung requires gas exchange, and this necessitates the development of FRC with the resorption of lung fluid and the resolution of most of the atelectasis. Therefore, initial slow ventilation with more prolonged inspiratory times may be useful to assist in this task, balanced against the need to avoid inappropriate inspiratory pressures.Flow-controlled, pressure-limited mechanical devices are acceptable for delivering PPV. These mechanical devices control flow and limit pressure and be more consistent than bags. Self-inflating and flow-inflating bags remain a standard of care. Laryngeal mask airways are effective for assisted ventilation when bag-mask ventilation and intubation are unsuccessful.

    • This question is part of the following fields:

      • Neonatology
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  • Question 9 - Which of the following statements is MOST appropriate regarding the features of Graves...

    Incorrect

    • Which of the following statements is MOST appropriate regarding the features of Graves disease?

      Your Answer:

      Correct Answer: Association with HLA-DR3

      Explanation:

      Graves disease is an autoimmune disorder in which patients present with thyrotoxicosis and related ophthalmopathy, and dermopathy. Many affected patients experience hyperthyroidism. Peak incidence of graves disease is after the 3rd decade of life and is more common in women than in men. Graves susceptibility is association with HLA-DR3. Clinical features of Graves disease include an increased metabolic rate, heat intolerance, irritability, weight loss despite increasing appetite, diarrhoea palpitations, chemosis, acropachy and onycholysis.

    • This question is part of the following fields:

      • Endocrinology
      0
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  • Question 10 - A new-born baby is found to have a loud heart murmur but is...

    Incorrect

    • A new-born baby is found to have a loud heart murmur but is otherwise well 6-hour baby after birth.Which one of the following is the most likely cause?

      Your Answer:

      Correct Answer: Tetralogy of Fallot

      Explanation:

      Tetralogy of Fallot usually is diagnosed after a baby is born, often after the infant has an episode of turning blue during crying or feeding (a tet spell). A loud heart murmur is usually present.An atrial septal defect is present at birth, but many babies do not have any signs or symptoms.Coarctation of the aorta is usually diagnosed after the baby is born. How early in life the defect is diagnosed usually depends on how mild or severe the symptoms are. New-born screening using pulse oximetry during the first few days of life may or may not detect coarctation of the aorta.In babies with a more serious condition, early signs usually include:pale skinirritabilityheavy sweatingdifficulty breathingBabies born with pulmonary atresia will show symptoms at birth or very soon afterwards. They may be cyanotic. However, it is not uncommon for a heart murmur to be absent right at birth.

    • This question is part of the following fields:

      • Cardiovascular
      0
      Seconds
  • Question 11 - A 17-year-old Jewish girl presents with primary amenorrhoea. On examination, she looks a...

    Incorrect

    • A 17-year-old Jewish girl presents with primary amenorrhoea. On examination, she looks a little hirsute and has evidence of facial acne. She is within her predicted adult height and has normal breast and external genitalia development, however, there is excess hair over her lower abdomen and around her nipple area.Investigations were as follows:Hb 13.1 g/dlWCC 8.6 x109/lPLT 201 x109/lNa+ 139 mmol/lK+ 4.5 mmol/lCreatinine 110 µmol/l17-OH progesterone 1.4 times the upper limit of normalPelvic ultrasound: bilateral ovaries and uterus visualised.Which of the following is the most likely diagnosis?

      Your Answer:

      Correct Answer: Non-classical congenital adrenal hyperplasia

      Explanation:

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

    • This question is part of the following fields:

      • Endocrinology
      0
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  • Question 12 - A 10-year-old asthmatic boy is brought to the emergency department with severe stridor,...

    Incorrect

    • A 10-year-old asthmatic boy is brought to the emergency department with severe stridor, wheeze, and lip swelling following the ingestion of a cashew nut at a birthday party.Which of the following can be considered an acceptable treatment option for this child?

      Your Answer:

      Correct Answer: Nebulised adrenaline 5ml 1:1,000

      Explanation:

      The patient is suffering from an anaphylactic reaction to the cashew nut he consumed.Anaphylaxis:Anaphylaxis is an acute, rapidly progressing, potentially life-threatening IgE mediated Type I hypersensitivity reaction.It involves the release of mediators from mast cells, basophils and inflammatory cells. It is characterised by oedematous swelling of the airway mucosa giving rise to dyspnoea and respiratory distress.The most common cause of anaphylaxis in children is a food allergy.Risk factors for death in patients with anaphylaxis include asthma, age 11+, peanut allergy, and delay in adrenaline administration.Management of anaphylaxis includes:- Resuscitation – ABCD- Remove the allergen- IM adrenaline is given at ten microgram/kg or Nebulised adrenaline 5ml 1:1,000- IV Hydrocortisone is given at 4mg/kg- pro re nata IV fluid support. – Followed by observation.

    • This question is part of the following fields:

      • Emergency Medicine
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  • Question 13 - A 14-year-old boy suffers a blow to the right side of his head...

    Incorrect

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

      Your Answer:

      Correct Answer: Laceration of the middle meningeal artery

      Explanation:

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

    • This question is part of the following fields:

      • Emergency Medicine
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  • Question 14 - A 3 year old male presents to the genetics clinic with a history...

    Incorrect

    • A 3 year old male presents to the genetics clinic with a history of proximal myopathy. He has missed motor milestones and has pseudohypertrophy of the calves. Doctors suspect it might be Duchenne's muscular dystrophy. Which of the following should you advise the parents?

      Your Answer:

      Correct Answer: Girl offspring have a less than 10% chance of inheriting the condition

      Explanation:

      Although initially thought to affect only boys, girls with DMD also have an estimated 10% chance of inheriting the condition. In girls, DMD may present with all or some clinical manifestations.

    • This question is part of the following fields:

      • Genetics And Dysmorphology
      0
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  • Question 15 - A 4-year-old girl with an abnormal facial appearance has an ejection systolic murmur...

    Incorrect

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

      Your Answer:

      Correct Answer: Turner's syndrome

      Explanation:

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

    • This question is part of the following fields:

      • Genetics And Dysmorphology
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      Seconds
  • Question 16 - A 2 year old female was taken to her local emergency department with...

    Incorrect

    • A 2 year old female was taken to her local emergency department with jerking movements in her limbs. This lasted for around 10 seconds, and then she fell unconscious. She soon regained consciousness - she was disorientated but afebrile with no symptoms of meningeal irritation. From the list of options, chose the most appropriate investigation route for this patient.

      Your Answer:

      Correct Answer: 24 hour EEG

      Explanation:

      Many of the symptoms favour an epilepsy diagnosis: uncontrollable jerking of the limbs and a loss of consciousness. A 24-hour EEG is used to diagnose epilepsy.

    • This question is part of the following fields:

      • Neurology
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  • Question 17 - A 5 month old girl was admitted to the emergency department with reduced...

    Incorrect

    • A 5 month old girl was admitted to the emergency department with reduced movement of her right arm. History reveals she was born at term, 4.5 kg and via natural delivery. Her mother reports her head was stuck for a while before she was fully delivered. Postnatal examination revealed reduced movement of her right arm as well but was thought to improve over time. The baby cannot sit and her right arm is flaccid, internally rotated, adducted, and extended. The reflexes are absent in the right arm. Which of the following investigations would provide the most useful information?

      Your Answer:

      Correct Answer: MRI scan

      Explanation:

      The vignette describes an infant with a sustained post-delivery brachial plexus injury that does not improve with time. MRI is the most appropriate intervention to assess the injury and evaluate the treatment options.

    • This question is part of the following fields:

      • Neurology And Neurodisability
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  • Question 18 - A 2 year old girl with a history of oligohydramnios, hypotonia, and scissoring...

    Incorrect

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

      Your Answer:

      Correct Answer: Congenital dislocation of the hip

      Explanation:

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

    • This question is part of the following fields:

      • Neonatology
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  • Question 19 - A female presents to obstetric triage at 24 weeks with cramping pain and...

    Incorrect

    • A female presents to obstetric triage at 24 weeks with cramping pain and is threatening preterm labour. The parents would like to know the statistics relating to survival and outcome if their baby is born at this gestation. Which particular study would be useful to review before this consultation?

      Your Answer:

      Correct Answer: EPICURE

      Explanation:

      EPICure is a series of studies of survival and later health among babies and young people who were born at extremely low gestations -from 22 to 26 weeks.Boost II is a double-blind randomised controlled trial (RCT) comparing the effects of targeting arterial oxygen saturations between 85% and 89% versus 91% and 95% in preterm infants.OSCAR Xe is not the name of a study. Baby-OSCAR is an RCT to determine whether a confirmed large patent ductus arteriosus in very premature babies should be treated with ibuprofen within 72 hours of birth.SafeBoosC is a trial to examine if it is possible to stabilise the cerebral oxygenation of extremely preterm infants in the first 72 hours of life with the use of NIRS oximetry and a clinical treatment guideline. TOBY Xe is an RCT looking at the neuroprotective effects of hypothermia combined with inhaled xenon following perinatal asphyxia.

    • This question is part of the following fields:

      • Neonatology
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  • Question 20 - Which of the following is true of miliaria? ...

    Incorrect

    • Which of the following is true of miliaria?

      Your Answer:

      Correct Answer: Miliaria crystalline causes tiny, fragile clear vesicles

      Explanation:

      Miliaria is a common skin disease caused by blockage and/or inflammation of eccrine sweat ducts. Miliaria is frequently seen in hot, humid or tropical climates, in patients in the hospital, and in the neonatal period. Miliaria is also known as sweat rash.Based on the level of the sweat duct obstruction, miliaria is divided into three subtypes:- Miliaria crystallina (sudamina), caused by obstruction of the sweat ducts close to the surface of the skin (epidermis);- Miliaria rubra, caused by obstruction of the sweat ducts deeper in the epidermis;- Miliaria profunda (tropical anhidrosis), the result of sweat leaking into the middle layer of skin (dermis).Miliaria crystallina appears as 1-2 mm superficial clear blisters that easily break. The blisters can look like beads of sweat. There is no inflammation. The blisters are usually seen widely spread on the head, neck, and upper trunk.Miliaria rubra is the most common type of miliaria results in red, 2-4 mm, non-follicular papules and papulovesicles. They are very itchy. Background erythema is often present. In children, miliaria affects the skin folds of the neck, axilla or groin. In adults, miliaria often affects the upper trunk, scalp, neck and flexures, particularly areas of friction with clothing. Miliaria pustulosa is a variant of milia rubra in which there are pustules.Miliaria profunda describes asymptomatic deep papules. The flesh-coloured, 1-3 mm diameter papules usually arise on the trunk and extremities.Mild Topical steroids can be used as a treatment

    • This question is part of the following fields:

      • Dermatology
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  • Question 21 - A new-born baby with confirmed trisomy 21 presents with bilious vomiting and an...

    Incorrect

    • A new-born baby with confirmed trisomy 21 presents with bilious vomiting and an abdominal X-ray at 1 day of age showing a 'double-bubble' appearance. What is the most likely diagnosis?

      Your Answer:

      Correct Answer: Duodenal Atresia

      Explanation:

      Congenital duodenal atresia is one of the more common intestinal anomalies treated by paediatric surgeons, occurring 1 in 2500-5000 live births. In 25-40% of cases, the anomaly is encountered in an infant with trisomy 21 (Down syndrome).Presenting symptoms and signs are the results of high intestinal obstruction. Duodenal atresia is typically characterized by the onset of vomiting within hours of birth. While vomitus is most often bilious, it may be nonbilious because 15% of defects occur proximal to the ampulla of Vater. Occasionally, infants with duodenal stenosis escape detection of an abnormality and proceed into childhood or, rarely, into adulthood before a partial obstruction is noted. Nevertheless, one should assume any child with bilious vomiting has a proximal GI obstruction until proven otherwise, and further workup should be begun expeditiously.Once delivered, an infant with duodenal atresia typically has a scaphoid abdomen. One may occasionally note epigastric fullness from dilation of the stomach and proximal duodenum. Passing meconium within the first 24 hours of life is not usually altered. Dehydration, weight loss, and electrolyte imbalance soon follow unless fluid and electrolyte losses are adequately replaced. If intravenous (IV) hydration is not begun, a hypokalaemic/hypochloraemic metabolic alkalosis with paradoxical aciduria develops, as with other high GI obstruction. An orogastric (OG) tube in an infant with suspected duodenal obstruction typically yields a significant amount of bile-stained fluid.

    • This question is part of the following fields:

      • Paediatric Surgery
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  • Question 22 - A 12 month old baby boy is taken to the office with a...

    Incorrect

    • A 12 month old baby boy is taken to the office with a history of failure to thrive. He is observed to have a large head and to be small for his age. A cupped appearance of the epiphysis of the wrist is seen on the x-ray. Which condition is this linked to?

      Your Answer:

      Correct Answer: Rickets

      Explanation:

      Answer: RicketsRickets is a disease of growing bone that is unique to children and adolescents. It is caused by a failure of osteoid to calcify in a growing person. The signs and symptoms of rickets can include:pain -the bones affected by rickets can be sore and painful, so the child may be reluctant to walk or may tire easily; the child’s walk may look different (waddling)skeletal deformities -thickening of the ankles, wrists and knees, bowed legs, soft skull bones and, rarely, bending of the spinedental problems -including weak tooth enamel, delay in teeth coming through and increased risk of cavitiespoor growth and development -if the skeleton doesn’t grow and develop properly, the child will be shorter than averagefragile bones -in severe cases, the bones become weaker and more prone to fractures.Marfan syndrome (MFS) is a genetic disorder of the connective tissue. The degree to which people are affected varies. People with Marfan tend to be tall and thin, with long arms, legs, fingers and toes. They also typically have flexible joints and scoliosis. The most serious complications involve the heart and aorta, with an increased risk of mitral valve prolapse and aortic aneurysm. Other commonly affected areas include the lungs, eyes, bones and the covering of the spinal cord.Ehlers-Danlos syndrome is a group of inherited disorders that affect your connective tissues – primarily your skin, joints and blood vessel walls. People who have Ehlers-Danlos syndrome usually have overly flexible joints and stretchy, fragile skin. This can become a problem if you have a wound that requires stitches, because the skin often isn’t strong enough to hold them.A more severe form of the disorder, called Ehlers-Danlos syndrome, vascular type, can cause the walls of your blood vessels, intestines or uterus to rupture. Osteoporosis is a disease in which bone weakening increases the risk of a broken bone. It is the most common reason for a broken bone among the elderly. Bones that commonly break include the vertebrae in the spine, the bones of the forearm, and the hip. Until a broken bone occurs there are typically no symptoms. Bones may weaken to such a degree that a break may occur with minor stress or spontaneously. Chronic pain and a decreased ability to carry out normal activities may occur following a broken bone.Osteoporosis may be due to lower-than-normal maximum bone mass and greater-than-normal bone loss. Bone loss increases after menopause due to lower levels of oestrogen. Osteoporosis may also occur due to a number of diseases or treatments, including alcoholism, anorexia, hyperthyroidism, kidney disease, and surgical removal of the ovaries.

    • This question is part of the following fields:

      • Musculoskeletal
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  • Question 23 - A 5-year-old girl was admitted for fever, anaemia, thrombocytopenia and signs of pulmonary...

    Incorrect

    • A 5-year-old girl was admitted for fever, anaemia, thrombocytopenia and signs of pulmonary infection. She now presents a few days later with signs of meningism. What is the most probable diagnosis?

      Your Answer:

      Correct Answer: Acute lymphoblastic leukaemia (ALL)

      Explanation:

      Acute lymphoblastic leukaemia (ALL) is a cancer of the lymphoid line of blood cells characterized by the development of large numbers of immature lymphocytes. Symptoms may include feeling tired, frequent infections with fever as well as anaemia with thrombocytopenia. As an acute leukaemia, ALL progresses rapidly and is typically fatal within weeks or months if left untreated. The patient’s age also favours the diagnosis of ALL as it occurs most commonly in children, particularly those between the ages of two and five.

    • This question is part of the following fields:

      • Haematology And Oncology
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  • Question 24 - A 16 year old girl fractured a bone in her left foot. Upon...

    Incorrect

    • 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.

    • This question is part of the following fields:

      • Anatomy
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  • Question 25 - A 13 year old girl presented with signs of shortness of breath, chest...

    Incorrect

    • 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.

    • This question is part of the following fields:

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

    Incorrect

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

      Your Answer:

      Correct Answer: Refer to ENT team

      Explanation:

      Based on the presenting features, the patient has developed a septal haematoma after the trauma. Septal hematoma:In this condition, blood collects between the septal cartilage and the perichondrium. The patient classically presents with symptoms of nasal difficulty and pain following a nasal injury. Care should be taken not to misdiagnose a septal haematoma as a blood clot on the septum. In the case of a septal haematoma the swelling will typically be visible on both sides of the septum although this is not always the case. Referral to an ENT surgeon is indicated because, if untreated, there is a high risk of cartilage breakdown and complications related to infection.Other options:- The nosebleed has now stopped therefore compression is no longer required. The boy has developed a septal haematoma after traumatic injury. – CT head is not indicated in this patient as the diagnosis is clearly a septal hematoma.- Management of a septal hematoma consists of drainage and antibiotics. There is no role for intranasal corticosteroids.- If untreated, there is a high risk of cartilage breakdown and complications related to infection. Thus, referral to the ENT is essential; reassurance and discharge can lead to complications.

    • This question is part of the following fields:

      • ENT
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  • Question 27 - A 17 year old girl presents with enlarged tonsils that meet in the...

    Incorrect

    • A 17 year old girl presents with enlarged tonsils that meet in the midline. Examination confirms the finding and petechial haemorrhages affecting the oropharynx are observed. Splenomegaly is seen on systemic examination. Which of the following is the most likely cause?

      Your Answer:

      Correct Answer: Infection with Epstein Barr virus

      Explanation:

      Answer: Acute Epstein Barr virus infectionThe Epstein-Barr virus is one of eight known human herpesvirus types in the herpes family, and is one of the most common viruses in humans. Infection with Epstein-Barr virus (EBV) is common and usually occurs in childhood or early adulthood.EBV is the cause of infectious mononucleosis, an illness associated with symptoms and signs like:fever,fatigue,swollen tonsils,headache, andsweats,sore throat,swollen lymph nodes in the neck, andsometimes an enlarged spleen.Although EBV can cause mononucleosis, not everyone infected with the virus will get mononucleosis. White blood cells called B cells are the primary targets of EBV infection.Petechiae on the palate are characteristic of streptococcal pharyngitis but also can be seen in Epstein-Barr virus infection, Arcanobacterium haemolyticum pharyngitis, rubella, roseola, viral haemorrhagic fevers, thrombocytopenia, and palatal trauma.

    • This question is part of the following fields:

      • Paediatric Surgery
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  • Question 28 - A 13-year-old girl presents to the hospital with a body mass index (BMI)...

    Incorrect

    • A 13-year-old girl presents to the hospital with a body mass index (BMI) of 13. On examination, she was found to have cold peripheries. Her vitals were:Pulse rate: 130 bpmTemperature: 37°CCapillary blood glucose: 1.8 mmol/LAfter drawing blood for a full blood panel, you immediately give a bolus of glucose at a dose of 2 ml/kg. Her sugar levels improve to 4 mmol/L.What is the next step in the management of this child?

      Your Answer:

      Correct Answer: Normal saline fluid bolus; send blood culture, lactate and C-reactive protein

      Explanation:

      The next step in the management of this patient is starting a normal saline fluid bolus, following which we should send samples for blood culture, lactate and C-reactive protein. The patient is probably a case of anorexia nervosa (AN).Note:Children with AN are at higher risk of developing infections, and this needs to be considered in this case. Patients with AN may not respond in the usual fashion to sepsis as they may not mount a fever in response to infection. Hypoglycaemia (especially when severe or persistent despite correction) should raise the alarm for an infection as should tachycardia and cool peripheries. Children with severe AN are more likely to be bradycardic. Therefore, a tachycardia should cause the clinician to consider that another process is going on.Other options:- Correcting electrolyte abnormalities is, of course, very important. However, while these are awaited, one needs to consider that this patient is septic and managed accordingly. Children with anorexia nervosa (AN) may have a whole host of electrolyte abnormalities, some of which can be treated with oral or nutritional supplementation although sometimes intravenous correction is required. Electrolytes need to be checked frequently during admission because of the risk of refeeding syndrome, and dietetic input is required to advise on appropriate starting intake.- While maintenance fluids like dextrose are likely to be needed in this case, consideration needs to be given to the underlying cause of the hypoglycaemia. As the sugar has come up following a glucose bolus, a 10% dextrose infusion would be excessive.- An ECG should form a part of any assessment of a child with AN. In this case, it would not be the first thing; however, as part of the acute management of this child, cardiac monitoring should be commenced. One would usually expect a child with AN to be bradycardic so a tachycardia should raise suspicion that another process is going on.- Dietary input will be vital for this child’s ongoing management. However, their acute issues take precedence in this case. Nevertheless, a dietician should be informed and involved from an early stage.

    • This question is part of the following fields:

      • Nutrition
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  • Question 29 - An 8-year-old girl presented to the outpatient clinic with fever, pain and discharge...

    Incorrect

    • An 8-year-old girl presented to the outpatient clinic with fever, pain and discharge from her left ear. Which of the following antibiotics should be used first?

      Your Answer:

      Correct Answer: Amoxicillin

      Explanation:

      Amoxicillin has high efficacy against haemophilus influenza and streptococcus pneumonia, the most common organisms of otitis media. It is an oral drug with high bioavailability.

    • This question is part of the following fields:

      • ENT
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  • Question 30 - A nuchal translucency measurement is taken from the nape of the foetus' neck...

    Incorrect

    • A nuchal translucency measurement is taken from the nape of the foetus' neck to screen for Down's syndrome.Which of these is the embryological origin of this tissue?

      Your Answer:

      Correct Answer: Ectoderm

      Explanation:

      The origins of the neural tube and the nape of the neck where nuchal translucency measurements are taken are from embryonic ectoderm.The structural development of the head and neck occurs between the third and eighth weeks of gestation. The 5 pairs of branchial arches, corresponding to the primitive vertebrae gill bars, that form on either side of the pharyngeal foregut on day 22 are the embryologic basis of all the differentiated structures of the head and neck. Each arch consists of 3 layers: an outer covering of ectoderm, an inner covering of endoderm, and a middle core of mesenchyme. These arches are separated further into external, ectoderm-lined pharyngeal clefts and internal, endoderm-lined pharyngeal pouchesA population of ectodermal cells adjacent to the neural fold and not included in the overlying surface (somatic) ectoderm gives rise to the formation of the neural crest. These neuroectodermal crest cells are believed to migrate widely throughout the developing embryo in a relatively cell-free enriched extracellular matrix and differentiate into a wide array of cell and tissue types, influenced by the local environment. Most connective and skeletal tissues of the cranium and face ultimately come from the derivatives of neural crest cells.

    • This question is part of the following fields:

      • Neonatology
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SESSION STATS - PERFORMANCE PER SPECIALTY

Endocrinology (0/1) 0%
Dermatology (0/1) 0%
Anatomy (1/1) 100%
Respiratory (1/1) 100%
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