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  • Question 1 - A 15-year-old male presents with a depressed skull fracture, which was surgically managed....

    Incorrect

    • A 15-year-old male presents with a depressed skull fracture, which was surgically managed. Over the next few days, he complains of double vision on walking downstairs and reading. On testing ocular convergence, the left eye faces downward and medially, but the right side does not.Which of the following injured nerves is most likely responsible for the patient's symptoms?

      Your Answer: Abducens

      Correct Answer: Trochlear

      Explanation:

      Based on the clinical scenario provided, the most probable nerve injured in this patient would be the trochlear nerve. The trochlear nerve has a relatively long intracranial course, and this makes it vulnerable to injury in head trauma. Head trauma is the most frequent cause of acute fourth nerve palsy. A 4th nerve palsy is the most common cause of vertical diplopia. The diplopia is at its worst when the eye looks medially which it usually does as part of the accommodation reflex when walking downstairs.

    • This question is part of the following fields:

      • Ophthalmology
      27.7
      Seconds
  • Question 2 - A 15-year-old girl is admitted to hospital following a ruptured ectopic pregnancy. She...

    Incorrect

    • A 15-year-old girl is admitted to hospital following a ruptured ectopic pregnancy. She comes from a family of Jehovah's Witnesses. Her haemoglobin on admission is 6.7 g/dl. She consents to a blood transfusion but her mother refuses. What is the most appropriate course of action?

      Your Answer: Ask the hospital lawyer to come in and decide upon the correct course of action

      Correct Answer: Give the blood transfusion

      Explanation:

      People aged 16 or over are entitled to consent to their own treatment. This can only be overruled in exceptional circumstances. Children under the age of 16 can consent to their own treatment if they’re believed to have enough intelligence, competence and understanding to fully appreciate what’s involved in their treatment. This is known as being Gillick competent.Otherwise, someone with parental responsibility can consent for them.This could be:the child’s mother or fatherthe child’s legally appointed guardiana person with a residence order concerning the childa local authority designated to care for the childa local authority or person with an emergency protection order for the child.Giving the blood transfusion is therefore both clinically and ethically the right course of action.Jehovah’s Witnesses frequently carry a signed and witnessed Advance Decision Document listing the blood products and autologous procedures that are, or are not, acceptable to them It is appropriate to have a frank, confidential discussion with the patient about the potential risks of their decision and the possible alternatives to transfusion, but the freely expressed wish of a competent adult must always be respected.

    • This question is part of the following fields:

      • Emergency Medicine
      35.7
      Seconds
  • Question 3 - Persistent pulmonary hypertension is NOT a recognized complication of which of the following?...

    Correct

    • Persistent pulmonary hypertension is NOT a recognized complication of which of the following?

      Your Answer: Duct dependent congenital heart disease

      Explanation:

      Persistent pulmonary hypertension of the new-born is secondary to the failure of normal circulatory transition at birth, leading to an abnormally high pulmonary vascular resistance. This elevated resistance causes right-to-left shunting of blood and hypoxemia. It can be caused by parenchymal lung diseases (meconium aspiration syndrome, pneumonia or ARDS), lung hypoplasia (like occurring in oligohydramnios or diaphragmatic hernia), or it can be idiopathic. Other possible causes include maternal indomethacin use, group B streptococcal septicaemia, and high-pressure ventilation. Duct dependent congenital heart disease does not lead to persistent pulmonary hypertension.

    • This question is part of the following fields:

      • Neonatology
      15.1
      Seconds
  • Question 4 - A 10-month-old boy was brought to the emergency department with bilateral watery discharge...

    Incorrect

    • A 10-month-old boy was brought to the emergency department with bilateral watery discharge from both eyes with occasional mucoid discharge. The presentation is highly suggestive of a nasolacrimal duct dysfunction.Which of the following would be the most appropriate advice to be given to the boy's parents?

      Your Answer: Reassurance, but include advice that the child most likely will need a surgical procedure to resolve this

      Correct Answer:

      Explanation:

      The most appropriate management would be to reassure the parents, as nasolacrimal duct dysfunction in most infants tends to resolve spontaneously.Note:Nasolacrimal duct blockage occurs in up to 5% of new-borns. 90% of these babies spontaneously resolve in the first year of life. They do not require urgent ophthalmological review, as often advice and reassurance for parents suffice for up to the age of 18 months old or so. A lump can often be seen in the nasolacrimal region following the accumulation of mucous. This does not need to be treated with antibiotics unless there are signs of acute infection.Other options:- The child does not require urgent ophthalmology review as there are no signs of severe infection. Watery eyes often lead to mucous production, which is a common non-worrying sign.- A course of topical antibiotics: Watery eyes often lead to mucous production, which is distinct from pus discharge. Unnecessary topical antibiotics can cause secondary red eyes as well as give parents false expectations for the resolution of the symptoms and signs.- A course of topical and oral antibiotics: Watery eyes often lead to mucous production, which is distinct from pus discharge. Unnecessary topical and oral antibiotics can cause secondary red eyes as well as give parents false expectations for the resolution of the symptoms and signs.- Reassurance is necessary. However, the advice that the child most likely will need a surgical procedure to resolve this is incorrect. Reassurance, but include advice that the child most likely will need a surgical procedure to resolve this is incorrect as 90% of infants that have these symptoms and signs resolve within the first year of life.

    • This question is part of the following fields:

      • Ophthalmology
      49.5
      Seconds
  • Question 5 - What is most likely to occur in lead poisoning? ...

    Incorrect

    • What is most likely to occur in lead poisoning?

      Your Answer: Cardiomyopathy

      Correct Answer: Delayed developmental milestones

      Explanation:

      Lead can be found in material used for mining, leaded paints and gasoline, glassware, toys, and even cosmetics. Lead poisoning is rare nowadays as the use of lead has been banned from many products. Lead is toxic and in certain concentrations can cause irreversible damage. Children are especially vulnerable as they absorb 4 times as much ingested lead as adults. The typical features of lead poisoning include developmental delay and behavioural disorders, microcytic anaemia, constipation and vomiting. Pulmonary fibrosis, Osteomalacia and cardiomyopathy are not known features of lead poisoning.

    • This question is part of the following fields:

      • Haematology And Oncology
      5.5
      Seconds
  • Question 6 - In the treatment of infants with gastroenteritis, which of the following statements is...

    Correct

    • In the treatment of infants with gastroenteritis, which of the following statements is the most accurate one?

      Your Answer: Should be admitted to hospital if they are unable to tolerate fluid orally

      Explanation:

      The main problem with infants having gastroenteritis is dehydration. So they should be admitted to the hospital for IV fluids if they are not tolerating oral fluids.

    • This question is part of the following fields:

      • Gastroenterology And Hepatology
      26.1
      Seconds
  • Question 7 - Which of the following diseases correctly matches the incubation period? ...

    Correct

    • Which of the following diseases correctly matches the incubation period?

      Your Answer: Mumps - 14-18 days

      Explanation:

      The incubation periods of disorders is extremely important to diagnose, treat, prevent or attenuate a disease. Chickenpox: 7-21 days. Whooping cough: 10-14 days. Hand, foot and mouth disease: 2-6 days. German measles: 14-21 days. Mumps: 14-18 days.

    • This question is part of the following fields:

      • Infectious Diseases
      14.1
      Seconds
  • Question 8 - Which of the following cranial nerve reflexes is most likely to be affected...

    Correct

    • Which of the following cranial nerve reflexes is most likely to be affected if there is a lesion in the vagus nerve?

      Your Answer: Gag reflex

      Explanation:

      Vagus nerve lesions will affect the gag reflex since the pharyngeal muscles are innervated by it.The vagal nerve (10th cranial nerve ) is a mixed nerve carrying motor efferents and sensory afferents. The nerve conducts five distinct qualities, which are carried along general visceral efferent fibres (parasympathetic innervation of pharyngeal, laryngeal, bronchial, and gastrointestinal mucosa), general visceral afferent fibres (sensory information from the thoracic and abdominal viscera, the aortic body, aortic arch), special visceral afferent fibres (carry the taste of the epiglottal region), general somatic afferent fibres (carry sensation from the external auditory meatus, outer tympanic membrane, back of the ear, part of meninges, pharynx), and along special visceral efferent fibres, which innervate skeletal muscles of the pharynx and larynx. Skeletal muscles innervated by the vagal nerve include the cricothyroid, levator veli palatini, salpingopharyngeus, palatoglossal, palatopharyngeus pharyngeal constrictor, and the laryngeal muscles (except cricothyroid). Innervation of these muscles is involved during speech or opening of the larynx during breathing. Efferent parasympathetic fibres control heart rate, peristalsis, and sweating. Stimulation of the efferent parasympathetic fibres lowers heart rate or blood pressure. 80-90% of the vagal fibres are afferent, only 10-20% are efferent fibresPhysical exam of the 10th cranial nerve includes eliciting the gag reflex (The gag reflex involves a brisk and brief elevation of the soft palate and bilateral contraction of pharyngeal muscles evoked by touching the posterior pharyngeal wall.), to look if the uvula is deviated from the side of the lesion, if there is failure of palate elevation upon phonation, and evaluation of speech impairment.In case of bilateral vagal nerve lesions, heart rate and breath rate may be increased. The somatic sensory function can be assessed by testing the sensibility of the external auditory meatus.

    • This question is part of the following fields:

      • Neurology And Neurodisability
      12.8
      Seconds
  • Question 9 - Childhood absence epilepsy is characterized by which of the given facts? ...

    Correct

    • Childhood absence epilepsy is characterized by which of the given facts?

      Your Answer: 3-Hz spike-and-slow-wave complexes are seen on electroencephalograms (EEGs)

      Explanation:

      Absence epilepsy is the most common type of generalized childhood epilepsies. It is mainly idiopathic, but 10-40% of the cases have a positive family history. It is characterized by frequent absence seizures and periods of unconsciousness. The hallmark of absence epilepsy on EEG is the bilaterally synchronous 2-4 Hz spike and wave discharges (SWDs). The average age of onset is around 4-8 years, being more prevalent among girls. Treatment resistance is not common.

    • This question is part of the following fields:

      • Neurology And Neurodisability
      13.8
      Seconds
  • Question 10 - A 15 year old girl is diagnosed with familial adenomatous polyposis. Which of...

    Correct

    • A 15 year old girl is diagnosed with familial adenomatous polyposis. Which of the following is the most appropriate recommended step in management?

      Your Answer: Surveillance annual flexible sigmoidoscopy from age 13 years until age 30 years

      Explanation:

      Answer: Surveillance annual flexible sigmoidoscopy from age 13 years until age 30 years. Familial adenomatous polyposis (FAP) is the most common adenomatous polyposis syndrome. It is an autosomal dominant inherited disorder characterized by the early onset of hundreds to thousands of adenomatous polyps throughout the colon. If left untreated, all patients with this syndrome will develop colon cancer by age 35-40 years. In addition, an increased risk exists for the development of other malignancies.Most patients with FAP are asymptomatic until they develop cancer. As a result, diagnosing presymptomatic patients is essential.Of patients with FAP, 75%-80% have a family history of polyps and/or colorectal cancer at age 40 years or younger.Nonspecific symptoms, such as unexplained rectal bleeding (haematochezia), diarrhoea, or abdominal pain, in young patients may be suggestive of FAP.In a minority of FAP families a mutation cannot be identified and so annual flexible sigmoidoscopy should be offered to at risk family members from age 13-15 years until age 30, and at three to five year intervals thereafter until age 60 years.

    • This question is part of the following fields:

      • Gastroenterology And Hepatology
      37.3
      Seconds
  • Question 11 - All of the given are features of cow's milk protein intolerance EXCEPT? ...

    Incorrect

    • All of the given are features of cow's milk protein intolerance EXCEPT?

      Your Answer: Oral itching

      Correct Answer: Steatorrhoea

      Explanation:

      CMPI ( cow’s milk protein intolerance) is an immunological reaction to one or more of the many proteins found in cow’s milk. It may be IgE mediated or non-IgE mediated. The prominent signs and symptoms include sneezing, rhinorrhoea, coughing, wheezing, oral angioedema, oral itching, diarrhoea, vomiting, and bloody stools. Steatorrhea is not a recognized feature of CMPI.

    • This question is part of the following fields:

      • Nutrition
      16.1
      Seconds
  • Question 12 - A 10-year-old girl with type-1 diabetes mellitus presents with vomiting and rapid breathing....

    Incorrect

    • A 10-year-old girl with type-1 diabetes mellitus presents with vomiting and rapid breathing. A diagnosis of acute diabetic ketoacidosis was made.Which among the following statements is true about this condition?

      Your Answer: Hypokalaemia is common

      Correct Answer: Boluses of insulin are recommended

      Explanation:

      Among the statements provided, boluses of insulin are given to treat diabetic ketoacidosis (DKA).The following methods are adopted for the treatment of DKA:- Fluids: Boluses of 10 ml/kg of normal saline. Stop at three boluses to avoid precipitating cerebral oedema. The remaining deficit has to be corrected over 48 hours. Strict input/output, U&E, and pH monitoring is necessary in such patients.- Insulin: Insulin infusion can be initiated at 0.05-0.1 unit/kg/hour. It is essential to monitor blood glucose closely, and the aim is to decrease by 2 mmol/hour.- Potassium: Initially, it will be high, but following insulin administration, the levels drop quickly as K+ enters cells with glucose, and thus, replacement is almost always necessary.- Acidosis: Bicarbonate is avoided unless pH is less than 7. Acidosis will get corrected with the correction of fluid and insulin deficits. The definitive treatment is directed towards correcting the underlying precipitants of DKA, e.g. sepsis, infections.

    • This question is part of the following fields:

      • Endocrinology
      45.2
      Seconds
  • Question 13 - A 6 year old female child with a history of controlled type 1...

    Correct

    • A 6 year old female child with a history of controlled type 1 diabetes, presents with recurrent nightmares due to hypoglycaemia and early morning glycosuria. Her parents are well informed about the child's condition and adjust her insulin requirements according to carbohydrate counting. What is the cause of the hypoglycaemia during the night in association with early morning glycosuria?

      Your Answer: Somogyi effect

      Explanation:

      Somogyi effect presents with night-time hypoglycaemia followed by early-morning hyperglycaemia, hence the glycosuria.

    • This question is part of the following fields:

      • Endocrinology
      53.4
      Seconds
  • Question 14 - A 15-year-old girl is brought to the OBGYN clinic by her mother with...

    Correct

    • A 15-year-old girl is brought to the OBGYN clinic by her mother with primary amenorrhoea and poor pubertal development. Investigations reveal low oestrogen, and high LH and FSH. Which of the following is the most likely diagnosis?

      Your Answer: Turner's syndrome

      Explanation:

      Turner syndrome, a condition that affects only females, results when one of the X chromosomes (sex chromosomes) is missing or partially missing. Turner syndrome can cause a variety of medical and developmental problems, including short height, failure of the ovaries to develop and heart defects.Turner syndrome may be diagnosed before birth (prenatally), during infancy or in early childhood. Occasionally, in females with mild signs and symptoms of Turner syndrome, the diagnosis is delayed until the teen or young adult years.

    • This question is part of the following fields:

      • Endocrinology
      99.4
      Seconds
  • Question 15 - What is the first sign of puberty in girls? ...

    Correct

    • What is the first sign of puberty in girls?

      Your Answer: Breast development

      Explanation:

      The average age for girls to begin puberty is 11.The first sign of puberty in girls is usually that their breasts begin to develop.It’s normal for breast buds to sometimes be very tender or for one breast to start to develop several months before the other one.Pubic hair also starts to grow, and some girls may notice more hair on their legs and arms.After a year or so of puberty beginning, and for the next couple of years:girls’ breasts continue to grow and become fuller.Around 2 years after beginning puberty, girls usually have their first period,pubic hair becomes coarser and curlierunderarm hair begins to grow. From the time their periods start, girls grow 5 to 7.5cm (2 to 3 inches) annually over the next year or two, then reach their adult height.After about 4 years of puberty in girls:breasts become adult-likepubic hair has spread to the inner thighgenitals should now be fully developedgirls stop growing taller.

    • This question is part of the following fields:

      • Endocrinology
      5.5
      Seconds
  • Question 16 - Where does the spinal cord terminate in neonates? ...

    Correct

    • Where does the spinal cord terminate in neonates?

      Your Answer: L3

      Explanation:

      The spinal cord ends at L3 in the new-bornmigrates cephalad during childhood to end at L1 – L2 and reaches adult size by the age of 10.

    • This question is part of the following fields:

      • Neurology And Neurodisability
      5.9
      Seconds
  • Question 17 - A 14-year-old uncontrolled asthmatic is started on a steroid inhaler. Which of the...

    Incorrect

    • A 14-year-old uncontrolled asthmatic is started on a steroid inhaler. Which of the following is the most common adverse effect he might complain about?

      Your Answer: Peptic ulceration

      Correct Answer: Dysphonia

      Explanation:

      Usage of inhaled corticosteroids are less associated with systemic adverse effects. However they are associated with local complications including dental caries and most commonly dysphonia.

    • This question is part of the following fields:

      • Respiratory
      17.1
      Seconds
  • Question 18 - Which one of the following factors is the most likely etiological factor for...

    Incorrect

    • Which one of the following factors is the most likely etiological factor for abnormally short stature amongst children?

      Your Answer: New onset diabetes mellitus

      Correct Answer: Familial short stature

      Explanation:

      Familial/inherited short stature is the most likely and commonest factor resulting in short stature among the children. Klinefelter syndrome is characterised by tall stature, widely spaces nipples and infertility. Other factors include congenital heart disease, maternal deprivation and diabetes mellitus but these are the rare causes.

    • This question is part of the following fields:

      • Genetics And Dysmorphology
      24.1
      Seconds
  • Question 19 - A 10-year-old boy is struck on the left eye by a tennis ball....

    Incorrect

    • A 10-year-old boy is struck on the left eye by a tennis ball. Following the event, he immediately complains of eye discomfort and dimming of vision in the affected eye. Three hours later, in the emergency department, the assessment of his visual acuity revealed that he can see 6/24 on a Snellen chart.Which of the following is the most probable diagnosis of this boy?

      Your Answer: Vitreous haemorrhage

      Correct Answer: Hyphaema

      Explanation:

      The most probable diagnosis in this patient would be hyphaema.The acuity has varied because the blood has been settling in the anterior chamber of the eye, thus allowing a reasonable level of visual acuity. The size of the tennis ball (which is not as harmful as a squash ball in the eye) and the fact that it was struck from a distance would cause a moderately significant injury due to pressure to the globe. Other options:- The absence of severe pain makes a large corneal abrasion less likely. – Vitreous haemorrhage would lead to very poor acuity, more likely ‘hand movements only’. – A retinal detachment or traumatic cataract would not produce such immediate symptoms, and if they did occur it would probably be in the presence of more extensive eye trauma and pain, with additional signs of both hyphaema and vitreous haemorrhage.

    • This question is part of the following fields:

      • Ophthalmology
      19.9
      Seconds
  • Question 20 - A hyperkinetic gait is most likely associated with which condition? ...

    Incorrect

    • A hyperkinetic gait is most likely associated with which condition?

      Your Answer: Wernicke's

      Correct Answer: Sydenham chorea

      Explanation:

      Hyperkinetic Gait is seen with certain basal ganglia disorders including Sydenham’s chorea, Huntington’s Disease and other forms of chorea, athetosis or dystonia. The patient will display irregular, jerky, involuntary movements in all extremities. Walking may accentuate their baseline movement disorder.

    • This question is part of the following fields:

      • Neurology And Neurodisability
      9.7
      Seconds
  • Question 21 - A woman gives birth to a baby at 36 weeks of gestation through...

    Incorrect

    • A woman gives birth to a baby at 36 weeks of gestation through spontaneous, vaginal delivery. She had rupture of membranes 30 hours before birth, however looked healthy and did not receive antibiotics. On admission, doctors obtained a vaginal swab. Which of the following is the most appropriate management for the baby?

      Your Answer: Perform an infection screen and treat with intravenous antibiotics if results suggestive of sepsis

      Correct Answer: Perform an infection screen and treat with intravenous antibiotics for at least 48 hours pending results

      Explanation:

      Doctors must perform an infection screen and treat with intravenous antibiotics for at least 48 hours pending results to prevent neonatal sepsis. Risk factors for neonatal sepsis include rupture of the membranes. Risk factors for neonatal sepsis include rupture of membranes greater than 12-24 hours, intrapartum maternal pyrexia (> 38°C), fetal tachycardia, chorioamnionitis, pre-term birth and maternal colonisation with group B Streptococcus. In this case there are two risk factors: prolonged rupture of membranes, and pre-term birth.

    • This question is part of the following fields:

      • Neonatology
      39.7
      Seconds
  • Question 22 - Which of the following is used to diagnose Infective endocarditis using the Duke...

    Incorrect

    • Which of the following is used to diagnose Infective endocarditis using the Duke criteria?

      Your Answer: 1 major and 2 minor criteria

      Correct Answer: 1 major criteria and 3 minor criteria

      Explanation:

      Infective endocarditis (IE) is caused by a bacterial, or fungal infection which damages the heart’s endothelium and can thus lead to changes in heart function, valve incompetencies, possible cardiac failure, as well other associated skin and organ changes. Organisms common in IE include Staphylococcus aureus and Streptococcus viridians. The HACEK organisms (Haemophilus, Actinobacillus, Cardiobacterium, Eikenella, and Kingella species) are common in neonates. The Duke criteria uses 2 major, or 1 major and 3 minor criteria, or 5 minor criteria to diagnose infective endocarditis. Major criteria include:- a positive blood culture and evidence of endocardial involvement. Minor criteria include: – evidence of predisposition (a heart condition of injection drug use)- a fever- vascular phenomena such as Janeway lesions- immunologic phenomena such as Osler’s nodes and Roth’s spots; and- microbiological or serological evidence of active infection.

    • This question is part of the following fields:

      • Cardiovascular
      35.8
      Seconds
  • Question 23 - A 15-year-old boy presents with hypertension and acute renal failure after an episode...

    Correct

    • A 15-year-old boy presents with hypertension and acute renal failure after an episode of diarrhoea. What is the most likely diagnosis?

      Your Answer: Haemolytic-uraemic syndrome

      Explanation:

      The likely diagnosis in this case is Haemolytic Uremic Syndrome (HUS), which is generally seen in young children presenting with a triad of symptoms, namely: acute renal failure, microangiopathic haemolytic anaemia, and thrombocytopenia. The typical cause of HUS is ingestion of a strain of Escherichia coli causing diarrhoea in these cases as well.

    • This question is part of the following fields:

      • Renal
      8.5
      Seconds
  • Question 24 - A 12-year-old boy presented with jaundice and fatigue for the last two weeks....

    Incorrect

    • A 12-year-old boy presented with jaundice and fatigue for the last two weeks. He complains of intermittent pain in his epigastrium. He is otherwise healthy with no history of vomiting, diarrhoea, loss of appetite or weight. History revealed that he has had fatigue all his life leading to him missing out on sports at regular intervals at school. His mother reports that he had two episodes of hepatitis at ages 5 and 7 years. There is no family history of jaundice. He has no significant travel history.On physical examination, yellow sclera were observed. Additionally, on abdominal examination, the splenic tip was palpable at 3 cm with some tenderness of the right upper quadrant. He was found to have mild tachycardia with normal blood pressure and no fever.Blood results:- Hb: 12.6 g/dl- MCV: 104 fL- MCHC: 38 g/dL- WBC Count: 10 x 109/L- Reticulocyte count: 148 x 109/L (Normal Range 20-100 x 109/L)- Bilirubin: 34 ÎĽmol/L- LDH: 600 lÎĽ/L (Normal Range 230-450 lÎĽ/l)- Direct Coomb's test: NegativeAbdominal ultrasonography revealed an enlarged spleen measuring 15 cmWhat is the most probable diagnosis?

      Your Answer: Gilbert's syndrome

      Correct Answer: Hereditary spherocytosis

      Explanation:

      The most probable diagnosis based on the scenario provided above is hereditary spherocytosis.While jaundice and abdominal pain might make you think of hepatitis or cholecystitis in the first instance, the lack of fever suggests otherwise. The apyrexial presentation is against acute cholecystitis, and the past medical history reveals a chronic type of fatigue and two previous episodes of hepatitis. Furthermore, it is unlikely that the child has contracted infective hepatitis twice and now a third time! The most common cause of hepatitis in childhood is hepatitis A, however the lack of travel history to endemic areas makes this less likely. Hepatitis A is usually a mild, self-limiting disease that never presents with chronic symptoms. The chronicity of his fatigue and the blood results lead towards a haematological diagnosis. This is further substantiated by his low haemoglobin levels, high MCV and high reticulocyte count. Chronic haemolytic anaemia is the most likely cause, and the negative Coombs excludes autoimmune haemolytic anaemia (AIHA). Thus, leaving us with the answer as hereditary spherocytosis.Hereditary spherocytosis is a disorder that makes the cytoskeleton of red cells more fragile and therefore leads to red cell death and splenomegaly. Gallstones are a result of this red cell destruction and increased haem metabolism.

    • This question is part of the following fields:

      • Haematology And Oncology
      67.1
      Seconds
  • Question 25 - In a study, 50 out of 100 smokers developed lung cancers and 50...

    Correct

    • In a study, 50 out of 100 smokers developed lung cancers and 50 out of 200 non-smokers developed lung cancers. Which of the following is accurate?

      Your Answer: Relative risk=2

      Explanation:

      Relative risk = (Incidence in exposed group)/incidence in unexposed group). So in this case RR = (50/100)/(50/200) = 2.

    • This question is part of the following fields:

      • Epidemiology And Statistics
      11.7
      Seconds
  • Question 26 - 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: Newly diagnosed diabetes in a 4 year old girl

      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
      18.2
      Seconds
  • Question 27 - A 14-year-old boy is referred from his optician with a diagnosis of Lisch...

    Incorrect

    • A 14-year-old boy is referred from his optician with a diagnosis of Lisch nodules of the iris. What is the most likely sign to observe on examination?

      Your Answer: Ectopia lentis

      Correct Answer: Axillary freckles

      Explanation:

      Neurofibromatosis type 1 (NF1) is a common autosomal dominant disease. The Lisch nodule represents one of the most common NF1 ocular manifestations.NF1 is caused by a genetic mutation which can cause tumours to grow on nerve endings; these cutaneous neurofibromas are benign tumours which grow on the skin, often first appearing during the hormonal changes that occur in teenage years. They vary in size and can appear anywhere on the body. The number of neurofibromas present differs greatly between individuals and over a lifetime Cafe au lait spots (coffee coloured birthmarks) are often the first and most common sign of NF1, and these are often found at birth and are usually evident by 2 years of age.Other features of NF1 can include Lisch nodules of the iris (small pigmentation in the iris which causes no disturbance to vision), skin-fold freckling (freckling/pigmentation in the groyne and armpits), plexiform neurofibromas (or sub cutaneous neurofibromas) which are diffuse tumours that grow along a nerve and are found in at least 25 % of people with NF1, optic gliomas (tumour of the optic nerve), and skeletal complications including pseudarthrosis and scoliosis. Macrocephaly (large head size) is also common, and short stature is found in around a third of people with NF1. Rare complications include a risk of malignancy, organs being compromised by neurofibromas, seizures, and hypertension.

    • This question is part of the following fields:

      • Ophthalmology
      34.2
      Seconds
  • Question 28 - A 16-year-old boy presents with complaints of ear pain. The pain started last...

    Incorrect

    • A 16-year-old boy presents with complaints of ear pain. The pain started last night and prevented him from sleeping. He reports that sounds are muffled on the affected side. On examination, he has a fever. A bulging tympanic membrane with a visible fluid level is seen on otoscopy. You suspect a diagnosis of acute suppurative otitis media. Tensor tympani is a muscle that is found in the middle ear. What is the nerve supplying the tensor tympani?

      Your Answer: Vestibulocochlear nerve

      Correct Answer: Mandibular nerve

      Explanation:

      The nerve supply to the tensor tympani is the mandibular nerve.The mandibular nerve is the only division of the trigeminal nerve that carries motor fibres.Tensor tympani is a muscle that lies in a bony canal just superior to the pharyngotympanic tube. It originates from the cartilaginous portion of the pharyngotympanic tube, the bony canal in which it sits, and the greater wing of the sphenoid bone. It inserts into the upper part of the handle of the malleus. When contracted, it pulls the handle of the malleus medially. This action increases the tension across the tympanic membrane, reducing the magnitude of vibrations transmitted into the middle ear. This dampens loud noises or noises produced by chewing. Tensor tympani is innervated through the nerve to tensor tympani, which arises from the mandibular nerve.Other options:- The vestibulocochlear nerve is the eighth cranial nerve. This nerve has two components, a vestibular division that carries balance information, and a cochlear division that carries hearing information.- The glossopharyngeal nerve is the ninth cranial nerve. It has a wide range of functions. It carries taste and sensation from the posterior third of the tongue, as well as sensation from the pharyngeal wall and tonsils, the middle ear, external auditory canal and auricle. It carries parasympathetic fibres that supply the parotid gland. It also supplies the baroreceptors and chemoreceptors of the carotid sinus and supplies the secretomotor fibres to the parotid gland.- The maxillary nerve carries only sensory fibres.- The facial nerve is the seventh cranial nerve. It supplies the muscles of facial expression, as well as stylohyoid, the posterior belly of digastric, and stapedius (the only other muscle associated with the middle ear). It carries taste from the anterior two-thirds of the tongue and sensation from part of the external acoustic meatus, parts of the auricle and the retro-auricular area. It provides secretomotor fibres which supply to the submandibular gland, sublingual gland (via chorda tympani nerve), nasal glands and lacrimal glands.

    • This question is part of the following fields:

      • Neurology And Neurodisability
      22.7
      Seconds
  • Question 29 - Congenital hypothyroidism is associated with which of the following clinical features? ...

    Incorrect

    • Congenital hypothyroidism is associated with which of the following clinical features?

      Your Answer: Premature closure of the fontanelles

      Correct Answer: Cardiomegaly

      Explanation:

      Congenital hypothyroidism results from insufficient levels of thyroid hormone in the body since birth, which is either due to dysgenesis of the thyroid gland or dyshormonogenesis. The important features of this disease include coarse facial features (macroglossia, large fontanelles, depressed nasal bridge, hypertelorism, etc.), failure to thrive, cardiomegaly, hypotonia, umbilical hernia, and low core body temperature among many others. Frontal bossing is the usual feature of rickets and acromegaly. Mitral regurgitation is not usually associated with congenital hypothyroidism.

    • This question is part of the following fields:

      • Neonatology
      10.6
      Seconds
  • Question 30 - A 5 week old boy presents for developmental assessment. Clinical examination reveals a...

    Correct

    • A 5 week old boy presents for developmental assessment. Clinical examination reveals a bluish, well-circumscribed lesion located on the bridge of the nose. It measures 5 mm in diameter and feels firm to the touch. Parents admit that the mass was not present at birth. They have noticed that the lesion gets bigger when the baby cries and then it gets back to its initial size. Doctors suspect a capillary haemangioma. What would you advise the parents?

      Your Answer: Arrange follow-up for the child in the outpatient clinic to monitor the growth of the lesion over the coming weeks

      Explanation:

      Capillary haemangiomas (strawberry naevi) are very common benign tumours that may appear in infancy. This particular case requires a close follow-up to monitor the naevus’ size and make sure it doesn’t expand or gets bigger, affecting the baby’s visual field.It is more common in preterm babies and girls are 3x more commonly affected than boys. It presents at birth in 30%, and is a focal and solitary in 80% of cases, most commonly found on the head and neck (60%), followed by the trunk (25%) and extremities (15%).

    • This question is part of the following fields:

      • Dermatology
      42.8
      Seconds

SESSION STATS - PERFORMANCE PER SPECIALTY

Ophthalmology (0/4) 0%
Emergency Medicine (0/1) 0%
Neonatology (1/3) 33%
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Gastroenterology And Hepatology (2/2) 100%
Infectious Diseases (1/1) 100%
Neurology And Neurodisability (3/5) 60%
Nutrition (0/1) 0%
Endocrinology (3/5) 60%
Respiratory (0/1) 0%
Genetics And Dysmorphology (0/1) 0%
Cardiovascular (0/1) 0%
Renal (1/1) 100%
Epidemiology And Statistics (1/1) 100%
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