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Question 1
Incorrect
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A new-born baby is noted to have low-set ears, rocker-bottom feet and overlapping of her fingers.What is the most likely diagnosis?
Your Answer: Patau syndrome
Correct Answer: Edward's syndrome
Explanation:The trisomy 18 syndrome, also known as Edwards syndrome, is a common chromosomal disorder due to the presence of an extra chromosome 18, either full, mosaic trisomy, or partial trisomy 18q. The condition is the second most common autosomal trisomy syndrome after trisomy 21.Currently, most cases of trisomy 18 are prenatally diagnosed, based on screening by maternal age, maternal serum marker screening, or detection of sonographic abnormalities (e.g., increased nuchal translucency thickness, growth retardation, choroid plexus cyst, overlapping of fingers, and congenital heart defects ).The main clinical features represent the clues for the diagnosis in the perinatal period and include prenatal growth deficiency, characteristic craniofacial features (dolichocephaly, short palpebral fissures, micrognathia external anomalies of the ears, and redundant skin at the back of the neck), distinctive hand posture (overriding fingers: index finger overlapping the third and 5th finger overlapping the 4th), nail hypoplasia, short hallux, underdeveloped thumbs, short sternum, and club feet and major malformations (particularly involving the heart).
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This question is part of the following fields:
- Genetics And Dysmorphology
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Question 2
Incorrect
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A 7-year-old asthmatic boy presented to the pulmonologist with an exacerbation of shortness of breath for 3 days. At the time of admission, he was still experiencing breathlessness with oxygen saturation found to be less than 90%. CXR shows bilateral hyperinflation. Which of the following should be done?
Your Answer: Spirometry
Correct Answer: Arterial blood gas
Explanation:Arterial blood gas is useful for the evaluation of oxygen and carbon dioxide gas exchange, respiratory function including hypoxia, and acid/base balance. This will quickly indicate if assisted ventilation is required for this patient.
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This question is part of the following fields:
- Respiratory
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Question 3
Correct
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Retinopathy of prematurity (ROP) is a potentially blinding disease if not managed adequately. Which of the following is a complication of ROP in an infant?
Your Answer: Retinal detachment
Explanation:Retinopathy of prematurity affects infants born early, and is due to the abnormal growth of retinal vasculature as opposed to vascular occlusion often see in adults. Though most babies with ROP can see normally, the most significant complication of ROP Is retinal detachment which can lead to blindness. Other structures in the eye such as the optic nerve or the fovea however, are not affected. Children may develop nystagmus as a result of poor sight in the affected eye(s).
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This question is part of the following fields:
- Ophthalmology
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Question 4
Correct
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A 15-year-old boy is brought to the clinic with recurrent episodes of diarrhoea and loose stools. He looks shorter than his age and does not seem to have undergone a growth spurt. After a series of investigations, he is diagnosed with Crohn's disease. Which of the following treatment strategies should initially be employed?
Your Answer: Elemental diet for 6 weeks
Explanation:The elemental diet is a medically supervised, sole nutrition dietary management given to individuals with moderate to severe impaired gastrointestinal function for 14-21 days.The diet consists of macronutrients broken down into their elemental form requiring little to no digestive functionality allowing time for the gut to rest. Elemental formulations are believed to be entirely absorbed within the first few feet of small intestine.
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This question is part of the following fields:
- Gastroenterology And Hepatology
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Question 5
Correct
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A 6 year old child presents with secondary nocturnal enuresis. He is otherwise healthy and with a clear family history. He drinks sufficient amounts of fluids but is a fussy eater. Clinical examination reveals a mass in the left iliac fossa. What is the most likely diagnosis?
Your Answer: Constipation
Explanation:Constipation is often associated with nocturnal enuresis in children. The palpable mass is the impacted stool. The decreased appetite is common in those with constipation.
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This question is part of the following fields:
- Nephro-urology
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Question 6
Incorrect
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A 6 year old child presents with acute scrotal pain. Clinical examination reveals scrotal tenderness, redness, swelling, and associated hydrocele. What is the most likely diagnosis?
Your Answer: Epididymo-orchitis
Correct Answer: Torsion of the hydatid of Morgagni
Explanation:Although all of the options may lead to an acute red scrotum, torsion of the hydatid of Morgagni is the most common cause at this age (age 12-16 years).
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This question is part of the following fields:
- Paediatric Surgery
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Question 7
Incorrect
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All of the given are features of cow's milk protein intolerance EXCEPT?
Your Answer: Sneezing
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.
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This question is part of the following fields:
- Nutrition
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Question 8
Incorrect
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A 17-year-old boy is brought to the emergency department by his friends after he collapsed at a dance club and developed jerky movements of his upper limbs. On further questioning, it is revealed that the boy has been clumsier than usual and has frequently been dropping his toothbrush while brushing his teeth in the morning. From the drugs provided below, which one should be avoided in this patient?
Your Answer: Topiramate
Correct Answer: Carbamazepine
Explanation:Juvenile myoclonic epilepsy is an epilepsy syndrome characterized by myoclonic jerks, generalized tonic-clonic seizures (GTCSs), and sometimes, absence seizures. The seizures of juvenile myoclonic epilepsy often occur when people first awaken in the morning. Seizures can be triggered by lack of sleep, extreme fatigue, stress, or alcohol consumption. Onset typically occurs around adolescence in otherwise healthy children. The causes of juvenile myoclonic epilepsy are very complex and not completely understood. Mutations in one of several genes, including the GABRA1 and the EFHC1 genes, can cause or increase susceptibility to this condition. Although patients usually require lifelong treatment with anticonvulsants, their overall prognosis is generally good.
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This question is part of the following fields:
- Neurology And Neurodisability
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Question 9
Incorrect
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A well, breastfed term infant presented with jaundice at 36 hours of age. The serum bilirubin was 286 µmol/L, direct Coombs test negative, blood film showed spherocytes and reticulocytes. The baby's blood group was A rhesus negative and mother's blood group O Rhesus negative.Which of the following is the MOST likely diagnosis?
Your Answer: Hereditary spherocytosis
Correct Answer: ABO incompatibility
Explanation:Haemolytic disease of the new-born due to ABO incompatibility is usually less severe than Rh incompatibility. One reason is that fetal RBCs express less of the ABO blood group antigens compared with adult levels. In addition, in contrast to the Rh antigens, the ABO blood group antigens are expressed by a variety of fetal (and adult) tissues, reducing the chances of anti-A and anti-B binding their target antigens on the fetal RBCs.ABO HDN occurs almost exclusively in the offspring of women of blood group O, although reports exist of occasional cases in group A mothers with high-titre anti-(group B) IgG
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This question is part of the following fields:
- Neonatology
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Question 10
Correct
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A first-time mother is concerned about the development of her 2-month-old baby.Which one of the following statements is true regarding developmental milestones at the age of 2 months?
Your Answer: The infant is not expected to mirror facial expressions like smiling
Explanation:Developmental milestones at the age of 2 months are as follows:Social and Emotional:- Begins to smile at people – Can briefly calm herself (may bring hands to mouth and suck on hand)- Tries to look at the parents Language/Communication:- Coos, makes gurgling sounds – Turns head toward sounds Cognitive (learning, thinking, problem-solving):- Pays attention to faces – Begins to follow things with eyes and recognize people at a distance – Begins to act bored (cries, fussy) if an activity doesn’t changeMovement/Physical Development:- Can hold head up and begins to push up when lying on tummy – Makes smoother movements with arms and legs
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This question is part of the following fields:
- Child Development
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Question 11
Incorrect
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A 13-month-old infant is admitted to the hospital and scheduled for an elective cardiac surgery. There is no respiratory distress, but cyanosis is present with oxygen saturations at 80s. There is a midline sternotomy scar. On auscultation there is a 4/6 ejection systolic murmur on the upper left sternal edge and a sternal heave is felt on palpation. Which of the following is the child most likely suffering from and what is the likely treatment?
Your Answer: Tetralogy of Fallot with Blalock Taussig shunt
Correct Answer: Ventricular septal defect with pulmonary artery band
Explanation:The murmur and thrill indicate a right outflow tract murmur, coupled with the right ventricular heave suggests right ventricular hypertrophy. The VSD would not have been amenable to surgery due to the child’s size/weight and so instead would have been palliated with a PA band. As the child grows, this band progressively restricts pulmonary blood flow until the left to right shunt has reversed. Then it is time for the band to be removed and the VSD to be closed.Pulmonary atresia is a cyanotic condition, which may be palliated with an arterial duct stent. This answer is incorrect as the stent placement would not require a midline sternotomy and would give a continuous machinery type murmur. Pulmonary stenosis with PDA ligation is incorrect. The murmur, thrill, and heave all match a pulmonary stenosis but in the absence of an additional shunt lesion the child would not be cyanosed.
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This question is part of the following fields:
- Cardiovascular
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Question 12
Incorrect
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A 5 month old boy presents with breathlessness, central cyanosis, irregular pulse, and oedema. On cardiac auscultation, he has a displaced apical beat laterally and a profound right ventricular heave. On lung auscultation, he has bilateral basal crackles. X-ray of the chest reveals gross cardiomegaly. Heart ultrasound shows mitral valve prolapse. Finally, ECG shows a prolonged and widened QRS complex with a short PR interval. Doctors establish the diagnosis of a right bundle branch block with a dominant R wave in V1. What is the most likely diagnosis?
Your Answer: Mitral valve prolapse disease
Correct Answer: Type A Wolff-Parkinson-White syndrome (WPWS)
Explanation:Wolff-Parkinson-White (WPW) syndrome is a pre-excitation syndrome characterised by re-entry tachycardia that most commonly presents as a recurrent supraventricular tachycardia. ECG will show a short PR interval and a prolonged QRS complex.
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This question is part of the following fields:
- Cardiovascular
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Question 13
Incorrect
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An 8 year old male was just hit by a car and brought by a helicopter to the emergency department. He is intubated and you want to avoid secondary brain injury. Which of the following measures is not indicated to prevent secondary brain injury?
Your Answer: Maintain CO2 4.5-5kPa
Correct Answer: Hypothermia
Explanation:Low oxygen delivery in hypotension, hypoxia, oedema, intracranial hypertension or changes in cerebral blood flow should all be prevented to avoid secondary brain injury. There is no evidence to suggest that hypothermia prevents secondary brain injuries.
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This question is part of the following fields:
- Emergency Medicine
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Question 14
Incorrect
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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: Oculomotor
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.
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This question is part of the following fields:
- Ophthalmology
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Question 15
Incorrect
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A 6 month old baby presents with uncontrollable movements of her hands and feet, shortly after being unconscious for a while. What is the most likely diagnosis?
Your Answer: Partial complex
Correct Answer: Infantile spasm
Explanation:Infantile spasm belongs to the spectrum of seizure disorders. Infantile spasm manifests itself with loss of consciousness and jerky movements. The peak age of onset is between 4 and 6 months. Approximately 90% of infantile spasms begin before 12 months of age. It is rare for infantile spasms to begin during the first 2 weeks of life or after 18 months.
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This question is part of the following fields:
- Neurology
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Question 16
Incorrect
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A 10-year-old girl was brought to the emergency department following profuse vomiting. Further investigations revealed a diagnosis of pyloric stenosis. About a month ago, she was admitted after she took an overdose of her mother's medication. Which of the following drugs can lead to her current presentation?
Your Answer: Citalopram
Correct Answer: Iron
Explanation:Based on the history and clinical presentation, she most likely has iron toxicity.Iron can cause scarring of the gut mucosa. This explains her pyloric stenosis. This typically occurs at the pylorus as this is where iron tablets tend to pool and cause maximal tissue damage.Other options:- Citalopram: Selective serotonin reuptake inhibitors (SSRIs) ingestion rarely causes serious consequences. It can rarely lead to serotonin syndrome (autonomic instability, mental status change, and increased neuromuscular tone).- Ibuprofen: While it may cause gastritis, ibuprofen does not cause pyloric/intestinal stenosis.- Thyroxine: An overdose of thyroxine will cause features of hyperthyroidism which are not present in the patient in question.- Zinc: High doses of zinc can cause abdominal cramps, nausea, vomiting and diarrhoea.
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This question is part of the following fields:
- Gastroenterology And Hepatology
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Question 17
Incorrect
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Which is the most accurate statement regarding scabies?
Your Answer: A type III hypersensitivity reaction can be seen after several weeks of infestation
Correct Answer: Positive mineral oil mount is diagnostic
Explanation:The diagnosis of scabies can often be made clinically in patients with a pruritic rash and characteristic linear burrows. Definitive testing relies on the identification of mites or their eggs, eggshell fragments, or scybala. This is best undertaken by placing a drop of mineral oil directly over the burrow on the skin and then superficially scraping longitudinally and laterally across the skin with a scalpel blade. (Avoid causing bleeding.) Scraping 15 or more burrows often produces only 1 or 2 eggs or mites, except in a case of crusted scabies, in which many mites will be present. The sample is placed on a microscope slide and examined under low and high power. Potassium hydroxide should not be used, since it can dissolve mite pellets. Failure to find mites is common and does not rule out the diagnosis of scabies.
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This question is part of the following fields:
- Dermatology
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Question 18
Incorrect
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During the fetal stage, the mesonephric tubules gives rise to the?
Your Answer: Vas deferens
Correct Answer: Wolffian duct
Explanation:The development of the kidney proceeds through a series of successive phases, each marked by the development of a more advanced kidney: the pronephros, mesonephros, and metanephros. The development of the pronephric duct proceeds in a cranial-to-caudal direction. As it elongates caudally, the pronephric duct induces nearby intermediate mesoderm in the thoracolumbar area to become epithelial tubules called mesonephric tubules. Each mesonephric tubule receives a blood supply from a branch of the aorta, ending in a capillary tuft analogous to the glomerulus of the definitive nephron. The mesonephric tubule forms a capsule around the capillary tuft, allowing for filtration of blood. This filtrate flows through the mesonephric tubule and is drained into the continuation of the pronephric duct, now called the mesonephric duct or Wolffian duct. The nephrotomes of the pronephros degenerate while the mesonephric duct extends towards the most caudal end of the embryo, ultimately attaching to the cloaca.
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This question is part of the following fields:
- Embryology
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Question 19
Correct
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As the junior doctor on duty you are called to see a 4 year old boy who is has been experiencing intermittent temperature spikes of 38.7C throughout the night. He underwent a laparoscopic appendicectomy for a perforated appendix four days ago, and has opened his bowels with diarrhoea. His chest is clear on examination.Which of the following is the most likely explanation for his condition?
Your Answer: Intra-abdominal collection
Explanation:Perforated appendices are common in children as it is more difficult to surgically assess an unwell child due to poor localisation of abdominal pain, and their inability to express discomfort. They are therefore prone to a greater risk of post operative complications including would infections, intra abdominal fluid collections, and chest infections. In the above scenario the spiking temperature points to an abscess, which characteristically presents with a swinging temperature. The fever is unlikely due to bacterial resistance as blood tests performed post surgery would have indicated any resistance, and a UTI is also unlikely since the child is already on antibiotics. As his chest is clinically clear, a severe chest infection may be ruled out, leaving intra-abdominal collection as the most likely explanation.
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This question is part of the following fields:
- Paediatric Surgery
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Question 20
Correct
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A 2-year-old presented with symptoms of gastroenteritis. Which of the following signs is the strongest indicator for IV fluid administration?
Your Answer: Capillary refilling time > 4secs
Explanation:Children are very prone to dehydration during an episode of gastroenteritis. Dehydration is detected early by increased capillary filling time.
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This question is part of the following fields:
- Gastroenterology And Hepatology
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Question 21
Correct
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A 5 year old boy visited Ghana with his family and arrived back home 6 weeks ago. 2 days ago he developed neck stiffness, a fever, and vomiting. He did not present with a rash and was treated with malaria prophylaxis. Choose the correct diagnosis from the list of options.
Your Answer: Cerebral malaria
Explanation:Due to malaria’s incubation period being between 7 and 30 days, malaria prophylaxis cannot provide a patient with confirmed protection. Prophylaxis treatment also often fails. The symptoms such as neck stiffness, fever, and vomiting are also consistent with the cerebral malaria diagnosis.
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This question is part of the following fields:
- Neurology
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Question 22
Correct
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Which of the following statements is true regarding box plots?
Your Answer: Show distributionally outlying values and provide data summaries that are not unduly influenced by those outliers
Explanation:Box plots can be used to display numerical outcomes and give valid summaries (median and interquartile range or IQR) for any distributional form that the outcomes might take. Additionally, they show outlying values and provide data summaries that are not unduly influenced by those outliersOther options:- The box itself represents the interquartile range, with the two whiskers representing the variability outside the upper and lower quartiles.- Variability is represented with whiskers and feathers are used in fan charts.They are not as informative as showing the actual values but can be used to make comparisons of medians and IQRs between subgroups.
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This question is part of the following fields:
- Epidemiology And Statistics
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Question 23
Correct
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A young boy presents with signs and symptoms consistent with infective endocarditis. He has a history of neglect and poor dental hygiene.Which organism is likely to have caused his endocarditis?
Your Answer: Streptococci viridans
Explanation:Infective endocarditis occurs when microorganisms enter the bloodstream and infect damaged endocardium or endothelial tissue. It most commonly involves the heart valves (either native or prosthetic), but it may also occur at the site of a septal defect, on the chordae tendineae, or on the mural endocardium. The prototypic lesion is at the site of the infection; the vegetation is a mass of platelets, fibrin, microcolonies of microorganisms, and scant inflammatory cells. Endocarditis is classified as acute or subacute, which applies to the features and the progression of infection until diagnosis.The oral cavity, the skin, and the upper respiratory tract are the primary portals for Streptococcus viridans; Staphylococcus species; and Haemophilus aphrophilus, Aggregatibacter (formerly Actinobacillus) actinomycetemcomitans, Cardiobacterium hominis, Eikenella corrodens, and Kingella kingae (HACEK) organisms. Streptococcal and staphylococcal organisms are responsible for more than 80% of cases of bacterial IE.Streptococcus viridans accounts for approximately 50-60% of cases of subacute disease.While S aureus infection is the most common cause of IE, including Prosthetic valve endocarditis, acute IE, and IV Drug Abusers IE
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This question is part of the following fields:
- Cardiovascular
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Question 24
Incorrect
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A 17-year-old boy is brought to the emergency after being stabbed in the upper arm and the median nerve is transected. Impaired function can be demonstrated in which of the following muscle/s?
Your Answer: Abductor pollicis longus
Correct Answer: Abductor pollicis brevis
Explanation:The median nerve is a peripheral nerve originating in the cervical roots C5-T1 of the brachial plexus. It supplies motor innervation to the anterior forearm flexors, the thenar muscles, and the two lateral lumbricals as well as sensory innervation to the lateral palm and anterior, lateral three and a half fingers. Motor and sensory deficits depend on whether the lesion is proximal (above the elbow) or distal (below the elbow). While proximal lesions present with the hand of benediction,ť distal lesions present with either the pinch signť (anterior interosseous nerve syndrome) or, in the case of carpal tunnel syndrome, with mildly impaired thumb and index finger motion. Both proximal lesions and carpal tunnel syndrome result in reduced sensation in the area of the thumb, index and middle finger. Anterior interosseus nerve syndrome does not cause any sensory deficits. Chronic injuries to the nerve result in atrophy of median nerve innervated muscles while acute injuries do not have this feature. Treatment is mostly conservative and focuses on rest and immobilization.
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This question is part of the following fields:
- Musculoskeletal
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Question 25
Correct
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A dental surgeon infiltrates local anaesthetic at the mandibular foramen to carry out a block of the right inferior alveolar nerve. Which of the following might occur as a result of the procedure?
Your Answer: Numbness of the lower teeth on the right side
Explanation:The inferior alveolar nerve supplies all the teeth of the respective hemimandible. It transverses the inferior alveolar canal and is a branch of the trigeminal nerve’s mandibular division. Therefore, in this case, the teeth of the right hemimandible will be numb.
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This question is part of the following fields:
- Anatomy
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Question 26
Correct
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Female twins are born. They are noted by the midwife to be identical. They separated in the womb after implantation but before day 8.What type of twin is this?
Your Answer: Monochorionic diamniotic
Explanation:A monochorionic diamniotic (MCDA) twin pregnancy is a subtype of monozygotic twin pregnancy. An MCDA pregnancy results from a separation of a single zygote at ,4-8 days (blastocyst) following formation. These fetuses share a single chorionic sac but have two amniotic sacs and two yolk sacs. It accounts for the vast majority (70-75%) of monozygotic twin pregnancies although only ,30% of all twin pregnancies. The estimated incidence is at ,1:400 pregnanciesThe layman term is that the twins are identical – in reality, they are phenotypically similar, and of course of the same gender.
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This question is part of the following fields:
- Neonatology
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Question 27
Incorrect
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Which of the following is true in logistic regression analysis?
Your Answer: Should be used to compare proportions of people who test positive between two populations
Correct Answer: Yields adjusted odds ratios
Explanation:Logistic regression analysis is an easy to use regression that can serve to estimate how a binary or dichotomous dependent variable, for example whether or not a student passes or fails a medical exam, is related to the number of hours the student studies for the exam. This regression is able to yield an odds ratio, i.e. the probability of passing the exam based on each additional hour of study. As stated, the outcome does not need to be normally distributed but is usually binary. This type of analysis is not complex and does not need to be avoided as it is available most statistical packages.
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This question is part of the following fields:
- Epidemiology And Statistics
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Question 28
Incorrect
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The merlin gene is implicated in the Neurofibromatosis type 2 phenotype. On which chromosome is merlin located?
Your Answer: Chromosome 11
Correct Answer: Chromosome 22
Explanation:Neurofibromatosis type 2, also known as schwannomin, is an autosomal dominant genetic disease caused by mutation of the merlin gene located on chromosome 22. Merlin is a tumour suppressor protein, which is responsible for controlling cell shape, growth and adhesion, and is predominantly found in nervous tissue. Its mutation increases the risk of tumour development especially bilateral vestibular schwannomas, the hallmark of neurofibromatosis 2.
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This question is part of the following fields:
- Genetics And Dysmorphology
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Question 29
Incorrect
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An 8 year old presents with pain in both his wrists and knees. Swelling is also observed. He has a history of a right red eye which did not resolve with antibiotics. What should you exclude first?
Your Answer: Optic neuropathy
Correct Answer: Iritis
Explanation:The child has symptoms and signs suggestive of an inflammatory arthropathy. This is why he should firstly be referred for an eye exam to exclude iritis or treat it if present. – Amblyopia is not directly associated with inflammatory arthropathies unless they had recurrent ocular involvement.- Blepharitis is not an associated finding in a child with inflammatory arthropathy.- Episcleritis may occur, and is often non-sight threatening, and therefore would not be the main cause for concern.- Optic neuropathy in juvenile inflammatory arthritis has been reported, although it is rare.
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This question is part of the following fields:
- Ophthalmology
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Question 30
Correct
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An 18-month-old girl already speaks ten words but her father says she cannot form a sentence. What is the best management strategy?
Your Answer: Reassurance
Explanation:Not being able to form a sentence at the age of 18 months is quite normal. A combination of two words to form a sentence can be done by 2 years of age.
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This question is part of the following fields:
- Child Development
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