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Question 1
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A study shows that of children with asthma, 25% have a first-degree relative with asthma compared with only 10% of a sample of children without asthma. Which of the following is true?
Your Answer: To interpret the results we need to know how the samples were selected
Explanation:Observational studies fall under the category of analytic study designs and are further sub-classified as observational or experimental study designs. The goal of analytic studies is to identify and evaluate causes or risk factors of diseases or health-related events. The differentiating characteristic between observational and experimental study designs is that in the latter, the presence or absence of undergoing an intervention defines the groups. By contrast, in an observational study, the investigator does not intervene and rather simply observesť and assesses the strength of the relationship between an exposure and disease variable.Three types of observational studies include cohort studies, case-control studies, and cross-sectional studies. Case-control and cohort studies offer specific advantages by measuring disease occurrence and its association with an exposure by offering a temporal dimension (i.e. prospective or retrospective study design). Cross-sectional studies, also known as prevalence studies, examine the data on disease and exposure at one particular time point. Because the temporal relationship between disease occurrence and exposure cannot be established, cross-sectional studies cannot assess the cause and effect relationshipDisadvantage of Cohort study is Susceptible to selection bias.
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This question is part of the following fields:
- Epidemiology And Statistics
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Question 2
Incorrect
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A 17-year-old girl is brought to the ER after collapsing at a party. Her friends state that she complained about palpitations prior to collapsing. On further history, it is revealed that she recently visited the dermatologist and was given an antibiotic prescription for an infected toe. She is reported to be allergic to penicillin. Her mother died of a sudden cardiac event when the girl was just 3 years old. An uncle and aunt also passed away suddenly at a young age. ECG shows sinus rhythm and a corrected QT interval of 550 ms. Which of the following most likely lead to the collapse in this young girl?
Your Answer: Wolff Parkinson White type A
Correct Answer: Congenital long QT syndrome
Explanation:Congenital LQTS arises from mutations in genes that code for ion channels within myocytes.These mutations all cause ventricular action potentials to be prolonged, resulting in a lengthened QT interval on ECG. The congenital long-QT syndrome (LQTS) is a life-threatening cardiac arrhythmia syndrome that represents a leading cause of sudden death in the young. LQTS is typically characterized by a prolongation of the QT interval on the ECG and by the occurrence of syncope or cardiac arrest, mainly precipitated by emotional or physical stress.LQTS type 1:- Most common type of congenital LQTS- Defect: loss of function mutation on the KCNQ1 gene located on chromosome 11p – defective slow delayed rectifier voltage-gated potassium channelSubtypes:Jervell and Lange-Nielsen syndrome: Associated with congenital deafness,
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This question is part of the following fields:
- Cardiovascular
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Question 3
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: Torsion of the testicle
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 4
Incorrect
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A 14-month-old girl was brought to the hospital by her mother, with complaints of a 0.5 cm cystic lump on the lateral aspect of her eyebrow. It has been present since birth but is slowly increasing in size. What is the most probable diagnosis?
Your Answer: Sebaceous cyst
Correct Answer: External angular dermoid
Explanation:The most probable diagnosis for this patient would be external angular dermoid.External angular dermoids typically form where there are overlapping tissue planes such as the midline. They contain a caseous material. The cysts are essentially benign in nature and are excised for cosmetic purposes or when they encroach on vision.Other options:- Branchial remnant typically presents as a supraclavicular pit.- Sebaceous cysts tend to be present on the scalp.- There is nothing in the clinical scenario to suggest a vascular malformation such as pigment change or ‘bag of worms’.- Lymphatic malformations are typically found in the neck or under the axilla.
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This question is part of the following fields:
- Paediatric Surgery
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Question 5
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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: 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.
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This question is part of the following fields:
- Paediatric Surgery
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Question 6
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Which of the following is NOT a recognized form of bone marrow failure syndrome?
Your Answer: Kostmann syndrome
Explanation:Bone marrow failure syndromes are characterized by the bone marrow’s inability to produce cells of different lineage. They can be classified as those affecting one or two cell lineages or those affecting all three of them. Fanconi syndrome, along with dyskeratosis congenita, is one of the inherited bone marrow failure syndromes that causes pancytopenia. Other inherited disorders affecting hematopoietic lineage include Diamond-Blackfan anaemia, Schwachman-Diamond syndrome, congenital amegakaryocytic thrombocytopenia (CAMT) and Thrombocytopenia absent radii (TAR) syndrome. Acquired causes of bone marrow failure that lead to pancytopenia include aplastic anaemia, drugs, nutritional deficiencies, and viral infections. Kostmann syndrome is an autosomal recessive form of severe neutropenia, most likely due to excessive neutrophil apoptosis.
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This question is part of the following fields:
- Haematology And Oncology
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Question 7
Incorrect
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A 4 year old baby was brought in by her mother with complaints of generalized pallor, loss of weight and loose stools. The baby's stools were frothy in nature and difficult to flush. Which investigation can help in diagnosing this patient?
Your Answer: Sweat chloride test
Correct Answer: Anti-endomysial antibodies
Explanation:The presence of anti-endomysial antibodies confirms the diagnosis of Celiac disease, which is the primary cause of illness in this patient. The sweat chloride test is performed with cystic fibrosis.
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This question is part of the following fields:
- Gastroenterology And Hepatology
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Question 8
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A 7 day old male infant, born at term, presents with umbilical bruising and bleeding. History reveals he wasn't given vitamin K after birth. Blood exam is normal but with a high prothrombin time and activated partial thromboplastin time. What is the most appropriate treatment?
Your Answer: Intravenous vitamin K plus fresh frozen plasma
Explanation:The clinical picture suggests a vitamin K deficiency haemorrhagic disease of the new-born and requires IV vitamin K and fresh frozen plasma. This usually presents with gastrointestinal bleeding, bleeding from the umbilical stump and bruising after 2-7 days.
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This question is part of the following fields:
- Neonatology
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Question 9
Incorrect
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One of the main disadvantages of case control studies is:
Your Answer: They require a prior power calculation
Correct Answer: The potential for recall bias
Explanation:Case control studies are observational studies which retrospectively determine whether a patient might have been exposed to a risk factor for a certain disease, as compared to a control group from the general population. They can be used for a range of outcomes as well as rare diseases. One of the biggest problems with this type of study is recall bias. Research subjects may selectively remember factors that are more predictive of the disease outcome when compared to the control group. All studies should have prior power calculations before the study commences.
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This question is part of the following fields:
- Epidemiology And Statistics
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Question 10
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A 13-year-old boy presents to the hospital with a history of multiple episodes of generalized tonic-clonic seizures for the past week. Prior to this, he has had multiple admissions for the same reason and has been on anti-epileptic drugs since the age of 11 months with poor control. He was born of non-consanguineous parents with an uneventful birth history. There is no history of seizures in other family members. On examination, he has multiple hyperpigmented papules over the nasolabial region suggestive of adenoma sebaceum. A full body examination revealed a total of 5 hypopigmented ash leaf macules over the lower limbs along with a shagreen patch over the lateral aspect of the left buttock. The mode of inheritance of the boy's condition has a pattern similar to that of:
Your Answer: Neurofibromatosis Type 1
Explanation:Based on the clinical scenario provided, the most probable diagnosis for this patient would be tuberous sclerosis which is an autosomal dominant condition.Among the options provided, only Neurofibromatosis Type 1 is inherited by an autosomal dominant pattern. Other options:- Beckwith-Wiedemann syndrome is an example of an imprinting disorder and results from abnormalities of inheritance or methylation of chromosome 11p15.- Cystic fibrosis is an autosomal recessive condition.- Duchenne Muscular Dystrophy is an example of an X-linked recessive condition.- Hypophosphataemic (Vitamin D resistant) rickets is an X-linked dominant condition.
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This question is part of the following fields:
- Genetics And Dysmorphology
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