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  • Question 1 - A 10-year-old newly diagnosed epileptic boy presents with pyrexia and a confluent, blistering...

    Incorrect

    • A 10-year-old newly diagnosed epileptic boy presents with pyrexia and a confluent, blistering rash affecting his torso, arms, and legs. On examination, there are lesions on his mucous membranes also. On palpating the skin overlying the medial malleolus, it shears off with minimal force. What is the sign being elicited?

      Your Answer:

      Correct Answer: Nikolsky's sign

      Explanation:

      The sign being elicited in this patient is Nikolsky’s sign. Based on the findings, the patient is suffering from toxic epidermal necrolysis.Nikolskys sign: Rubbing the skin causes exfoliation of the outer layer and usually blistering within a few minutes. Other options:- Cullen’s sign: Periumbilical bruising due to intra-abdominal haemorrhage. If the discolouration is seen in the flanks, it is called Cullen’s sign. Underlying pathology includes ruptured ectopic pregnancy and haemorrhagic pancreatitis. – Forscheimer’s sign: It is a fleeting exanthem that is seen as small, red spots (petechiae) on the soft palate. Associated with rubella and glandular fever. Gorlin’s sign: It is the ability to touch the tip of the nose with the tongue. Increased incidence in children with connective tissue disorders, e.g. Ehler Danlos syndrome. – Auspitzs sign: These are small bleeding points left behind when psoriatic scales are lifted off. It is not a very sensitive or specific sign. Other cutaneous signs include:- Hair collar sign: It is a collar of hypertrichosis around an area of cranial dysraphism.- Hertoghe’s sign (Queen Anne’s sign): It is the loss of lateral one-third of eye-brows. It is associated with numerous conditions, including lupus, HIV, and hypothyroidism. – Dariers sign: It is the swelling, itching and erythema that occurs after stroking skin lesions of a patient with systemic mastocytosis or urticarial pigmentosa. – Dermatographism: Rubbing the skin causes a raised, urticarial lesion. – Koebners phenomenon: It is the appearance of new skin lesions in areas of trauma.- Breakfast, lunch, and dinner sign: Linear pathway of a group of three to five papules caused by the common bed bug, Cimex lectularius. – Buttonhole sign: In type 1 neurofibromatosis, neurofibromas can be invaginated with the finger back into the subcutis. The nodule will reappear after the release of pressure. The sign is also positive for dermatofibromas. – Crowe’s sign: Axillary freckling seen in type I neurofibromatosis.

    • This question is part of the following fields:

      • Dermatology
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  • Question 2 - A 15-year-old boy was admitted to the hospital with suspected appendicitis. On examination,...

    Incorrect

    • A 15-year-old boy was admitted to the hospital with suspected appendicitis. On examination, the maximum tenderness was at the McBurney's point. What is the surface landmark of McBurney's point?

      Your Answer:

      Correct Answer: 2/3rds laterally along the line between the umbilicus and the anterior superior iliac spine

      Explanation:

      McBurney’s point is found 2/3rds of the way along an imaginary line that runs from the umbilicus to the anterior superior iliac spine on the right-hand side. On examination, features of generalised peritonitis can be observed if the appendix has perforated.Retrocecal appendicitis may have relatively fewer signs.Digital rectal examination may reveal boggy sensation if a pelvic abscess is present.Diagnosis is typically based on raised inflammatory markers coupled with compatible history, and examination findings.Ultrasound is useful in females where pelvic organ pathology can be a close differential diagnosis. Although it is not always possible to visualise the appendix on ultrasound, the presence of free fluid (always pathological in males) should raise suspicion. Ultrasound examination can also show evidence of luminal obstruction and thickening of the appendix.Management: Definitive management of appendicitis and appendicular perforation is appendicectomy which can be performed via either an open or laparoscopic approach.Simultaneous administration of metronidazole reduces wound infection rates. Patients with perforated appendicitis require copious abdominal lavage. Patients without peritonitis who have an appendix mass should receive broad-spectrum antibiotics and consideration given to performing an interval appendicectomy.

    • This question is part of the following fields:

      • Emergency Medicine
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  • Question 3 - What is the most common cardiac abnormality found in Noonan syndrome? ...

    Incorrect

    • What is the most common cardiac abnormality found in Noonan syndrome?

      Your Answer:

      Correct Answer: Pulmonary stenosis

      Explanation:

      Noonan syndrome is one of the most common genetic diseases associated with congenital heart defects, being second in frequency only to Down syndrome.Pulmonary stenosis and hypertrophic cardiomyopathy are generally the most common congenital heart defects found in Noonan syndrome.Pulmonary stenosis is often associated with a thickened and dysplastic valve. It is usually difficult to obtain a satisfactory result using the transcatheter balloon dilatation of such dysplastic valves, so surgical intervention is more likely to be needed.Hypertrophic cardiomyopathy involves predominantly the ventricular septum as asymmetric septal hypertrophy, but may also affect the ventricular free walls. Left ventricular outflow tract obstruction may occasionally be produced.

    • This question is part of the following fields:

      • Neonatology
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  • Question 4 - A 5 year old girl presented with short stature, primary amenorrhea, puffy arms...

    Incorrect

    • A 5 year old girl presented with short stature, primary amenorrhea, puffy arms and a webbed neck. The most likely diagnosis will be?

      Your Answer:

      Correct Answer: Turner's syndrome

      Explanation:

      Turner’s syndrome is characterised by a webbed neck, short stature, primary amenorrhea and cardiac, renal and muscular defects. Gene analysis shows a single X chromosome in the patients. Downs syndrome has certain cognitive and physical abnormalities, whereas in Klinefelter syndrome there are widely spaced nipples, long arms and infertility and it only occurs in men.

    • This question is part of the following fields:

      • Genetics And Dysmorphology
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  • Question 5 - A 9 year old girl who has recently undergone a laparoscopic appendicectomy for...

    Incorrect

    • A 9 year old girl who has recently undergone a laparoscopic appendicectomy for a perforated appendix develops a swinging temperature of 38.8 C while on admission. What is next step in her management?

      Your Answer:

      Correct Answer: Arrange for an ultrasound scan to look for intra-abdominal collection

      Explanation:

      Children who present with ruptured appendices are at increased risk of intra abdominal collections or abscesses. A swinging temperature is the first clue in indicating an intra abdominal abscess in a patient who had recently undergone surgery for a perforated appendix. The best course of action is therefore to get an ultrasound of the fluid collection before proceeding to rule out any other complication.

    • This question is part of the following fields:

      • Paediatric Surgery
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  • Question 6 - A 15 year old girl is taken to the A&E after complaining of...

    Incorrect

    • A 15 year old girl is taken to the A&E after complaining of right iliac fossa pain which started suddenly. She is well other than having some right iliac fossa tenderness but no guarding. She has no fever and the urinary dipstick result is normal. Her last menstrual cycle was 14 days ago which was also normal and the pregnancy test done is negative. What is the most likely underlying condition?

      Your Answer:

      Correct Answer: Mittelschmerz

      Explanation:

      Mittelschmerz is midcycle abdominal pain due to leakage of prostaglandin-containing follicular fluid at the time of ovulation. It is self-limited, and a theoretical concern is treatment of pain with prostaglandin synthetase inhibitors, which could prevent ovulation. The pain of mittelschmerz usually occurs in the lower abdomen and pelvis, either in the middle or to one side. The pain can range from a mild twinge to severe discomfort and usually lasts from minutes to hours. In some cases, a small amount of vaginal bleeding or discharge might occur. Some women have nausea, especially if the pain is very strong.Diagnosis of pelvic pain in women can be challenging because many symptoms and signs are insensitive and nonspecific. As the first priority, urgent life-threatening conditions (e.g., ectopic pregnancy, appendicitis, ruptured ovarian cyst) and fertility-threatening conditions (e.g., pelvic inflammatory disease, ovarian torsion) must be considered. Many women never have pain at ovulation. Some women, however, have mid-cycle pain every month, and can tell by the pain that they are ovulating.As an egg develops in the ovary, it is surrounded by follicular fluid. During ovulation, the egg and the fluid, as well as some blood, are released from the ovary. While the exact cause of mittelschmerz is not known, it is believed to be caused by the normal enlargement of the egg in the ovary just before ovulation. Also, the pain could be caused by the normal bleeding that comes with ovulation.Pelvic inflammatory disease can be ruled out if the patient is not sexually active.

    • This question is part of the following fields:

      • Paediatric Surgery
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  • Question 7 - Which of the following immune responses occurs in Coeliac disease? ...

    Incorrect

    • Which of the following immune responses occurs in Coeliac disease?

      Your Answer:

      Correct Answer: Type IV hypersensitivity

      Explanation:

      Celiac disease is classified as a Type IV hypersensitivity mediated by T-cell response. Negatively charged gliadin has been shown to induce interleukin 15 in the enteric epithelial cells, stimulating the proliferation of the natural killer cells and intraepithelial lymphocytes to express NK-G2D, a marker for natural killer T lymphocytes.

    • This question is part of the following fields:

      • Gastroenterology And Hepatology
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  • Question 8 - A 2-year-old boy was admitted in the A&E with a history of a...

    Incorrect

    • A 2-year-old boy was admitted in the A&E with a history of a 38.4°C fever and 15 minute tonic clonic seizure episode at home. However, he is conscious now, his temperature is normal and the fit has stopped. What is the most likely diagnosis?

      Your Answer:

      Correct Answer: Febrile convulsion

      Explanation:

      Febrile seizures are convulsions that can happen when a child, most often between the ages of six months and three years, has a fever. They usually last for less than five minutes and although the child may lose consciousness, they are relatively harmless. However, sometimes they can last for up to 15 minutes and when they are termed complex febrile seizures.

    • This question is part of the following fields:

      • Emergency Medicine
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  • Question 9 - A male child presents with pallor and bruising. He is deaf and his...

    Incorrect

    • A male child presents with pallor and bruising. He is deaf and his thumbs are dysplastic. Clinical and paraclinical exams suggest an acute myeloid leukaemia. What is the most probable diagnosis?

      Your Answer:

      Correct Answer: Fanconi anaemia

      Explanation:

      Fanconi anaemia, a rare autosomal recessive condition, presents with congenital abnormalities and defective hemopoiesis. Clinical signs include pallor and bruising. Hypoplasia of the thumbs and radial hypoplasia are two of the most common congenital abnormalities. Conductive deafness is also common. Those with Fanconi anaemia have a higher risk for developing acute myeloid leukaemia.

    • This question is part of the following fields:

      • Emergency Medicine
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  • Question 10 - A 7-week-old infant is brought to the emergency department by his mother. She...

    Incorrect

    • A 7-week-old infant is brought to the emergency department by his mother. She complains that the child is having episodes of non-bilious vomiting for the past 10 days. She observed that the episodes typically occur directly after feeding and notes that the volume brought up varies, but that her baby does seem to be very hungry and has not gained much weight. What is the most probable diagnosis for this infant?

      Your Answer:

      Correct Answer: Pyloric stenosis

      Explanation:

      The most probable diagnosis for this patient would be congenital hypertrophic pyloric stenosis.Congenital Hypertrophic Pyloric Stenosis (CHPS):Pyloric stenosis should be ruled out in any baby who presents with a long-term history of vomiting and failure to thrive. Infants typically present with projectile, non-bilious vomiting and are said to be hungry and wanting to feed despite poor weight gain. A blood gas would be helpful in this instance, although the diagnosis can be made more accurately by observing the stenosis during ultrasound. Many infants have symptoms of gastroesophageal reflux disease, although only a small minority are unable to gain weight adequately. A UTI in infants can present with non-specific symptoms, but they might have a fever and can show poor feeding. Malrotation will present with bilious vomiting.The definitive surgical management is the Ramsteadt’s pyloromyotomy.

    • This question is part of the following fields:

      • Gastroenterology And Hepatology
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  • Question 11 - Scarring type of alopecia occurs in which of the following conditions? ...

    Incorrect

    • Scarring type of alopecia occurs in which of the following conditions?

      Your Answer:

      Correct Answer: Discoid lupus

      Explanation:

      Alopecia is a scalp condition characterized by either overall baldness or patches of hair loss over the head. It can be broadly classified as scarring alopecia and non-scarring alopecia. Non-scarring is the most common type and is seen in various conditions like nutritional deficiencies, alopecia areata, hypothyroidism, tinea capitis, and SLE. Scarring alopecia is commonly seen in cases of discoid lupus erythematosus, which is a common cause of widespread inflammatory and scarring lesions all over the body and scalp.

    • This question is part of the following fields:

      • Dermatology
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  • Question 12 - Which of the following conditions is not associated with corneal opacities? ...

    Incorrect

    • Which of the following conditions is not associated with corneal opacities?

      Your Answer:

      Correct Answer: Sturge-Weber syndrome

      Explanation:

      The mnemonic STUMPED is helpful for remembering the differential diagnosis for congenital corneal opacities: – Sclerocornea- Tears in Descemet membrane (usually due to forceps trauma or congenital glaucoma)- Ulcers (e.g. infection – rubella)- Metabolic (e.g., mucopolysaccharidosis)- Peters anomaly- oEdema – Dermoids (e.g. Goldenhar’s syndrome)

    • This question is part of the following fields:

      • Ophthalmology
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  • Question 13 - A 17-year-old male undergoes an emergency appendectomy for perforated appendix. Postoperatively, he develops...

    Incorrect

    • A 17-year-old male undergoes an emergency appendectomy for perforated appendix. Postoperatively, he develops disseminated intravascular coagulation. Which one of the following clotting factors are most rapidly consumed in this process?

      Your Answer:

      Correct Answer: Factor V and VIII

      Explanation:

      Factors V and VIII are consumed most rapidly in a patient with disseminated intravascular coagulation.Simultaneous coagulation and haemorrhage caused by initially formation of thrombi which consume clotting factors (factors 5,8) and platelets, ultimately leading to bleeding.Causes include:- Infection- Malignancy- Trauma e.g. major surgery, burns, shock, dissecting aortic aneurysm- Liver disease- Obstetric complicationsClinically bleeding is usually a dominant feature, bruising, ischaemia and organ failure.Blood tests reveal prolonged clotting times, thrombocytopenia, decreased fibrinogen and increased fibrinogen degradation products.Treatment of DIC involves treating the underlying cause and supportive management.Mnemonic:D-I-S-S-E-M-I-N-A-T-E-DD- D dimerI-Immune complexesS-Snakebite, shock, heatstrokeS-SLEE-Eclampsia, HELLP syndromeM-Massive tissue damageI-Infections: viral and bacterialN-NeoplasmsA-Acute promyelocytic leukaemiaT-Tumour products: Tissue Factor (TF) and TF-like factors released by carcinomas of pancreas, prostate, lung,colon, stomachE-Endotoxins (bacterial)D-Dead foetus (retained)

    • This question is part of the following fields:

      • Haematology And Oncology
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  • Question 14 - A 6-year-old girl is brought to the hospital by concerned parents. The teachers...

    Incorrect

    • A 6-year-old girl is brought to the hospital by concerned parents. The teachers of her school have brought to their attention that she struggles to see the whiteboard in class. The parents have also noticed that she has difficulty when looking at the computer.Except for being a nervous reader at times, the parents haven't noticed anything else unusual. She's otherwise healthy and plays well with her friends.What is the most probable diagnosis for this child?

      Your Answer:

      Correct Answer: Refractive error

      Explanation:

      Based on the presentation, the child most probably is suffering from a refractive error.Astigmatism, myopia and high hypermetropia could all cause these symptoms. This child has difficulty in using vision for finer tasks such as reading. Mild to moderate refractive error would not impair the child’s ability to play or even watch television as for the child in question. Note: Refractive error is the most common treatable cause of reduced vision in children all over the world! Other options:- A congenital cataract is rare and retinal dystrophy is even rarer. – Amblyopia would suggest poor vision in only one eye, something that might not cause symptoms in this age group. – Parents or teachers would have probably noticed squint if it was present.

    • This question is part of the following fields:

      • Ophthalmology
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  • Question 15 - A 16-year-old girl presents to her OBGYN after getting pregnant. It is evaluated...

    Incorrect

    • A 16-year-old girl presents to her OBGYN after getting pregnant. It is evaluated that she is 13 days pregnant and the fetal tissue has just undergone implantation. Where in the uterus does implantation usually take place?

      Your Answer:

      Correct Answer: Anterior or superior walls

      Explanation:

      Time and EventWeek 1: ImplantationWeek 2: Formation of bilaminar diskWeek 3: Formation of primitive streakFormation of notochordGastrulationWeek 4: Limb buds begin to formNeural tube closesHeart begins to beatWeek 10: Genitals are differentiated

    • This question is part of the following fields:

      • Neonatology
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  • Question 16 - The blood supply to which of the following structures is NOT compromised due...

    Incorrect

    • The blood supply to which of the following structures is NOT compromised due to an occlusion in the anterior cerebral artery?

      Your Answer:

      Correct Answer: Brocas area

      Explanation:

      Broca’s area is usually supplied by branches from the middle cerebral artery and thus will be spared when the anterior cerebral artery is occluded.Note:The two internal carotid arteries and two vertebral arteries form an anastomosis known as the Circle of Willis on the inferior surface of the brain. Each half of the circle is formed by:1. Anterior communicating artery2. Anterior cerebral artery3. Internal carotid artery4. Posterior communicating artery5. Posterior cerebral arteries and the termination of the basilar arteryThe circle and its branches supply the corpus striatum, internal capsule, diencephalon and midbrain.

    • This question is part of the following fields:

      • Neurology And Neurodisability
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  • Question 17 - A 5 year old girl presents with widespread, itchy, excoriated papules that appeared...

    Incorrect

    • A 5 year old girl presents with widespread, itchy, excoriated papules that appeared three months ago. They are symmetrically distributed and more profound on the extensor surfaces of the elbows and knees. The papules are present on the trunk as well but are less remarkable. She doesn't have it anywhere else on her body and seems to be in a good health. The itchiness results in the girl to often scratching and popping the fluid-filled blisters that are present. There is no family history of atopy or other skin conditions. Which of the following is accurate?

      Your Answer:

      Correct Answer: Coeliac antibodies should be measured

      Explanation:

      This is the clinical picture of dermatitis herpetiformis associated with gluten-sensitive enteropathy. To establish the diagnosis, you should measure the coeliac antibodies. Darrier’s sign (where the skin urticates when it is stroked) is positive in urticaria pigmentosa.

    • This question is part of the following fields:

      • Dermatology
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  • Question 18 - Phagocytosis is the function of which of the following glial cells? ...

    Incorrect

    • Phagocytosis is the function of which of the following glial cells?

      Your Answer:

      Correct Answer: Microglia

      Explanation:

      The central nervous system comprises of two types of cells; neurons and neuroglial cells. Glial cells are the support cells that serve a number of important functions. Three types of neuroglia comprise the mature nervous system, which are ependymal cells, microglia, and macroglia. The macroglia are of two types oligodendrocytes and astrocytes. Microglia are the neuroglial cells that serve the function of phagocytosis since they are derived from the hematopoietic stem cells and share properties with tissue macrophages. They remove the cellular debris from the site of injury or normal cellular turnover by performing scavenger function.

    • This question is part of the following fields:

      • Neurology And Neurodisability
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  • Question 19 - A 16-year-old boy is brought to the clinic by his parents, who are...

    Incorrect

    • A 16-year-old boy is brought to the clinic by his parents, who are concerned that he is shorter than the other boys at school, despite having attained puberty. His father is 1.70 m tall, and his mother is 1.50 m tall. Given his parents height, what is his adult height potential?

      Your Answer:

      Correct Answer: 1.67 m

      Explanation:

      The adult height potential may be calculated for a male child by (father’s height in cm + mother’s height in cm) / 2 then add 7 cm.In the scenario provided: (170 + 150)/2 + 7 = 167 cm = 1.67 m.For a female child by (father’s height in cm + mother’s height in cm) / 2 then minus 7 cm.This can then be plotted on a height centile chart to find the mid-parental centile.Causes of short stature include:- Normal variant (often familial)- Constitutional delay of growth and puberty- Chronic illness, e.g. cystic fibrosis, inflammatory bowel disease- Endocrine: growth hormone deficiency, hypothyroidism, steroid excess syndromes: Turner’s, Down’s, Prader-Willi- Skeletal dysplasias, e.g. achondroplasia

    • This question is part of the following fields:

      • Endocrinology
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  • Question 20 - A 9 year old boy was admitted with gastroenteritis. The boy's symptoms started...

    Incorrect

    • A 9 year old boy was admitted with gastroenteritis. The boy's symptoms started two days ago with profound diarrhoea and emesis. Blood exams show the following: Sodium=148mmol/l, Potassium=2.2mmol/l, Urea=20mmol/l, Glucose=4.3mmol/l. What would be the best management?

      Your Answer:

      Correct Answer: V normal saline and potassium supplement

      Explanation:

      The boy needs re-hydration and hydro-electrolytic re-balancing due to fluid losses from the gastroenteritis and subsequent dehydration.

    • This question is part of the following fields:

      • Gastroenterology And Hepatology
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  • Question 21 - 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 22 - What is the investigation of choice to look for renal scarring in a...

    Incorrect

    • What is the investigation of choice to look for renal scarring in a child with vesicoureteric reflux?

      Your Answer:

      Correct Answer: DMSA

      Explanation:

      Vesicoureteral reflux is a common disorder in children but can result in kidney scarring following acute pyelonephritis. The gold standard diagnostic test to detect renal scars in children is 99mTc-dimercaptosuccinic acid (DMSA) scintigraphy

    • This question is part of the following fields:

      • Nephro-urology
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  • Question 23 - A child with a history of developmental delay presents with plaque-like lesions in...

    Incorrect

    • A child with a history of developmental delay presents with plaque-like lesions in the retina. The doctor suspects they are probably hamartomas. Which of the following is the most probable association?

      Your Answer:

      Correct Answer: Tuberous sclerosis

      Explanation:

      Tuberous sclerosis, an autosomal dominant disorder, may present with a variety of symptoms, including seizures, developmental delay, behavioural problems, skin abnormalities, and lung and kidney disease. Hamartomas are often associated.

    • This question is part of the following fields:

      • Genetics And Dysmorphology
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  • Question 24 - A 5-month-old baby presents with symptoms of irritability, blood in the stools and...

    Incorrect

    • A 5-month-old baby presents with symptoms of irritability, blood in the stools and vomiting. Examination reveals a rigid abdomen and drawing of knees upon palpation. Which is the most appropriate action you should take for this baby?

      Your Answer:

      Correct Answer: Refer to paediatric surgeons

      Explanation:

      Intussusception is the most suggested case here based on the child’s symptoms. The urgent course of treatment is to bring the child to a paediatric surgical unit. If air reduction attempts fail, surgery will have to be done. Risk factors for intussusception include viral infection and intestinal lymphadenopathy.

    • This question is part of the following fields:

      • Gastroenterology And Hepatology
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  • Question 25 - Which of the given statements is correct regarding carbon monoxide? ...

    Incorrect

    • Which of the given statements is correct regarding carbon monoxide?

      Your Answer:

      Correct Answer: CO combines with haemoglobin to form carboxyhaemoglobin

      Explanation:

      Carbon monoxide is a colourless gas, which is toxic to animals. It has a high affinity for haemoglobin (around 250 times greater than oxygen). It combines with haemoglobin forming carboxyhaemoglobin, which decreases the oxygen-carrying capacity of the blood, leading to a left-shift in the oxygen-dissociation curve. CO is produced endogenously in limited amounts (0.4ml per hour), but the toxic levels are higher.

    • This question is part of the following fields:

      • Haematology And Oncology
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  • Question 26 - A 10-year-old girl presents to the hospital with complaints of fever, painful joints,...

    Incorrect

    • A 10-year-old girl presents to the hospital with complaints of fever, painful joints, and a rash. Her parents insist that she was otherwise well except for a history of sore throat 2 weeks before.On examination, she appears quite unwell with a temperature reading of 38.5C. She was found to be tachycardic, hypertensive and with an erythematous rash with raised edges noted on the anterior aspect of her abdomen. Her left ankle and right elbow joints are swollen, and she has multiple painless subcutaneous nodules under her skin. Auscultation revealed an apical mid-diastolic murmur. Blood investigations reveal leucocytosis and raised C-reactive protein (CRP) levels. Erythrocyte sedimentation rate (ESR) was also above normal limits for her gender and age. An ECG confirms the presence of a tachycardia, a prolonged PR interval, and flat inverted T waves.What is the most probable diagnosis for this child?

      Your Answer:

      Correct Answer: Rheumatic fever

      Explanation:

      The most probable diagnosis for this child would be rheumatic fever due to a previous history of rheumatic fever, evidence of streptococcal disease from a throat swab, a raised ASO titre and a positive streptococcal antigen test or a leukocytosis.Acute Rheumatic Fever:ARF occurs because of an abnormal immune response to a streptococcal antigenic component. It has a latent period of 1-3 weeks and is more common in the lower socio-economic classes. It peaks at around 5-15 years of age and affects the blood vessels, joints, nervous system and subcutaneous tissues. It is characterised as an autoimmune disease, and there is a risk of rheumatic fever occurring after infection in 3% of the population. The recurrence is greater in younger children and increases with each attack. Duckett-Jones criteria:The diagnostic criteria for acute rheumatic fever.Major: – Pancarditis- Chorea (Sydenham’s) – Polyarthritis (flitting)- Erythema marginatum- Subcutaneous nodulesMinor criteria include the presence of arthralgia, fever, prolonged PR interval, raised ESR, raised CRP.Note that:To make the diagnosis of rheumatic fever: Two major and/or one major with two minor criteria are required. Evidence of a recent streptococcal infection with a raised ASO titre or an antiribonuclease B level is sufficient. Exceptions to this rule are mentioned below:- Chorea alone is diagnostic.- Insidious or late-onset carditis with no other explanation.- Rheumatic recurrence: The presence of one major and one minor criterion with a prior streptococcal disease that is recurring.Consequences of pericarditis include heart block, pericardial effusion, tachycardia, cardiomegaly, pericardial friction rub, congestive cardiac failure, valvular disease and a Carey-Coombes apical mid-diastolic rumbling murmur.New heart murmurs are often audible, including those of mitral regurgitation and aortic regurgitation. Skin nodules affect the perivascular tissues and are non-specific lesions resulting from fibroid degeneration.Management:Medication includes aspirin for the acute phase, non-steroidal anti-inflammatory drugs for arthritis, prednisolone for severe carditis, and high-dose penicillin for immediate management with antibiotic prophylaxis in the long term. Antibiotics may include penicillin V, erythromycin or benzylpenicillin. Diazepam and haloperidol may be required to control the chorea.

    • This question is part of the following fields:

      • Cardiovascular
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  • Question 27 - A 6 year old child presents with a history of recurrent headaches. The...

    Incorrect

    • A 6 year old child presents with a history of recurrent headaches. The neurological examination is unremarkable except for seven brown macules on the skin that vary in diameter from 1 to 2 cm. Clinical examination reveals several freckles in the axilla and the inguinal region. What is the most probably underlying condition?

      Your Answer:

      Correct Answer: Acoustic neuroma/vestibular schwannoma

      Explanation:

      Acoustic neuroma/vestibular schwannoma is a benign slow-growing tumour. The clinical picture of the child suggests neurofibromatosis type 1 (NF1), with cafe-au-lait spots and axillary and inguinal freckling.

    • This question is part of the following fields:

      • Neurology And Neurodisability
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  • Question 28 - An 18-year-old girl presents with complaints of easy fatiguability and severe headaches. She...

    Incorrect

    • An 18-year-old girl presents with complaints of easy fatiguability and severe headaches. She also complains of irregular and sporadic periods. During the examination, you notice behavioural traits that suggest a deterioration in peripheral vision. An eye exam confirms bitemporal hemianopia. Magnetic resonance imaging of the brain reveals a large non-functional pituitary tumour. Which structure does the tumour exert pressure on to cause her visual symptoms?

      Your Answer:

      Correct Answer: Optic chiasm

      Explanation:

      Bitemporal hemianopia is a characteristic finding seen in patients with optic chiasm lesion.The pituitary gland is situated within the pituitary fossa. Just above the pituitary fossa is the optic chiasm and so any expanding masses from the pituitary gland commonly press on it, causing bitemporal hemianopia.Other options:- Compression of the optic nerve would not cause more severe, generalised visual loss. Also, the optic nerve is not anatomically related to the pituitary gland and so is unlikely to be directly compressed in the presence of a pituitary tumour.- The optic tract is again not closely anatomically related with the pituitary gland and so is unlikely to be directly compressed in the presence of a pituitary tumour. Also, damage to the optic tract on one side would cause homonymous hemianopia.- The lateral geniculate nucleus is a centre of cells in the thalamus and is unlikely to be compressed by a pituitary tumour. Its function is to convey sensory information from the optic tract to more central parts of the visual pathway.- The Edinger-Westphal nucleus is located at the level of the superior colliculus in the midbrain and so may not be compressed by an enlarging pituitary tumour.Other visual defects:- Left homonymous hemianopia: It is the visual field defect to the left, due to the lesion of the right optic tract.- Homonymous quadrantanopias are seen in parietal (inferior homonymous quadrantopia) and temporal lobe lesions (superior homonymous quadrantopia). Mnemonic: PITS (Parietal-Inferior, Temporal-Superior)A congruous defect means complete or symmetrical visual field loss, and conversely, an incongruous defect is incomplete or asymmetric.Incongruous defects suggest an optic tract lesion, while congruous defects suggest optic radiation or occipital cortex lesion.

    • This question is part of the following fields:

      • Ophthalmology
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  • Question 29 - Which of the following movements will most likely be lost following an injury...

    Incorrect

    • Which of the following movements will most likely be lost following an injury to the spinal part of the accessory nerve?

      Your Answer:

      Correct Answer: Upward rotation of the scapula

      Explanation:

      Cranial nerve XI is also known as the accessory nerve. The accessory nerve innervates the trapezius muscle which retracts the scapula. The upper and lower fibres act together to also upwardly rotate it.

    • This question is part of the following fields:

      • Musculoskeletal
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  • Question 30 - 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:

      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
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