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  • Question 1 - Which of the following is NOT true of the femoral nerve? ...

    Incorrect

    • Which of the following is NOT true of the femoral nerve?

      Your Answer: It gives cutaneous innervations via the saphenous nerve

      Correct Answer: It supplies adductor longus

      Explanation:

      The femoral nerve is the main nerve supply for the thigh muscles including the pectineus, iliacus, sartorius, which flex the hip; and the quadriceps femoris made up of the rectus femoris, vests laterals, vastus medialis and vastus intermedius, which extend the knee. The nerve is derived from the L2, L3 and L4 nerve roots, and supplies cutaneous branches to the anteromedial thigh and the medial side of the leg via the saphenous nerve.

    • This question is part of the following fields:

      • Musculoskeletal
      20.1
      Seconds
  • Question 2 - All of the given conditions are scaly dermatologic pathologies EXCEPT? ...

    Correct

    • All of the given conditions are scaly dermatologic pathologies EXCEPT?

      Your Answer: Hand, foot, and mouth disease

      Explanation:

      Skin conditions resulting from excessive epidermal proliferation or inflammation, leading to a production of excessive scales, are referred to as papulosquamous disorders. These disorders can be generalized and localized. Localized causes of scaly lesions include tinea corporis, tinea cruris, tinea pedis, seborrheic dermatitis, psoriasis, pityriasis Versicolor, pityriasis alba, DLE, ichthyosis including Netherton syndrome (a severe form of ichthyosis which is autosomal recessive), and pellagra. Generalized causes include guttate psoriasis and pityriasis rosacea. Hand, foot, and mouth disease is a contagious viral illness that causes blisters in the mouth and on the extremities.

    • This question is part of the following fields:

      • Dermatology
      10.9
      Seconds
  • Question 3 - An asymptomatic 5-month old boy was referred to the paediatric cardiology department after...

    Correct

    • An asymptomatic 5-month old boy was referred to the paediatric cardiology department after his GP noted an ejection systolic murmur and thrill at the upper left sternal edge. SpO2 saturation is at 98%, and an ECG reveals an R/S ratio >1 in the V1 lead.What is the most probable diagnosis for this child?

      Your Answer: Pulmonary Stenosis

      Explanation:

      The most probable diagnosis in this patient would be pulmonary stenosis. Pulmonary Stenosis:Pulmonary valve murmurs are heard in the upper left sternal edge, associated with a thrill but no desaturation in the absence of an additional shunt. The ECG changes suggest right ventricular hypertrophy. Pulmonary stenosis is often well tolerated in childhood unless severe. These should be monitored with serial echocardiography, and balloon pulmonary valvoplasty should be considered once the pressure gradient reaches 64 mmHg.Other options:- Atrial septal defect: While atrial septal defects are associated with right ventricular outflow tract murmurs, they would not cause a thrill.- Patent ductus arteriosus: PDA murmurs can be audible in the left upper sternal edge, but would normally be audible in the left infraclavicular area and be continuous rather than ejection systolic. This left to right shunt would not cause desaturation but does cause left-sided volume loading and hence left-sided ECG changes.- Tetralogy of Fallot: Ventricular septal defect, overriding aorta, subpulmonary stenosis, and right ventricular hypertrophy. This would often cause a ULSE murmur with a thrill and RVH on ECG. However, this degree of obstruction would cause shunting from right to left, and this child would be desaturated.- Ventricular septal defect: Isolated ventricular septal defects cause pansystolic murmurs at the left lower sternal edge. They would have left-sided ECG changes and normal saturations (in the absence of pulmonary hypertension).

    • This question is part of the following fields:

      • Cardiovascular
      47.1
      Seconds
  • Question 4 - A 15-year-old boy is identified as having a Meckel's diverticulum. Which of the...

    Correct

    • A 15-year-old boy is identified as having a Meckel's diverticulum. Which of the following embryological structures gives rise to the Meckel's diverticulum?

      Your Answer: Vitello-intestinal duct

      Explanation:

      Meckel’s diverticulum is a congenital diverticulum of the small intestine. It is a remnant of the omphalomesenteric duct (also called the vitellointestinal duct) and contains ectopic ileal, gastric or pancreatic mucosa.Rule of 2’s- occurs in 2% of the population- it is located 2 feet proximal to the ileocaecal valve- it is 2 inches long- it is 2 times more common in men- there are 2 tissue types involvedIt is typically asymptomatic. Symptomatic presentation indicates inflammation of the diverticulum. The symptoms include:- Abdominal pain mimicking appendicitis- Rectal bleeding- Intestinal obstruction: secondary to an omphalomesenteric band (most commonly), volvulus and intussusceptionManagement:Surgical removal if the neck of the diverticulum is narrow or symptomatic. Surgical options are excision or formal small bowel resection and anastomosis.

    • This question is part of the following fields:

      • Gastroenterology And Hepatology
      16.2
      Seconds
  • Question 5 - A 6 year-old boy is brought to you coughing. He is suspected to...

    Correct

    • A 6 year-old boy is brought to you coughing. He is suspected to have aspirated a Lego piece which he was seen playing with. Where would you expect the piece to be?

      Your Answer: Right main bronchus

      Explanation:

      Inhaled objects are more likely to enter the right lung for several reasons. First the right bronchus is shorter, wider and more vertical than the left bronchus. Also, the carina (a ridge-like structure at the point of tracheal bifurcation) is set a little towards the left. The terminal bronchiole is a very small space and impossible for the seed to lodge here.

    • This question is part of the following fields:

      • Respiratory
      17.4
      Seconds
  • Question 6 - An 18 year old, previously well boy was admitted following a generalized tonic-clonic...

    Incorrect

    • An 18 year old, previously well boy was admitted following a generalized tonic-clonic convulsion for 5 minutes with urinary incontinence and eye rolling. On examination, he was drowsy and had bilateral up going plantar reflexes. A short while ago he had been playing rugby and had taken a hit to the head. He was apparently normal for a few minutes before fitting. His blood sugar level was normal. Which of the following is the most probable reason for this presentation?

      Your Answer: Subdural haematoma

      Correct Answer: Post-traumatic seizure

      Explanation:

      The history is suggestive of a post-traumatic seizure which frequently occurs after moderate or severe traumatic brain injury. Although upgoing plantars can be identified in a post-ictal status, an intracranial bleed has to be excluded. A single seizure cannot be considered epilepsy

    • This question is part of the following fields:

      • Neurology
      50
      Seconds
  • Question 7 - A 2-year-old boy's illness started with a 4-day history of fever and cough....

    Incorrect

    • A 2-year-old boy's illness started with a 4-day history of fever and cough. Crepitations are noted upon auscultation. Other examination results are temperature 38.9C, O2 sats 94% on air, respiratory rate is 45/min, and capillary refill time 1 sec. Urine is also negative on dipstick. What is the single investigation most likely to lead to a diagnosis?

      Your Answer: Chest X Ray

      Correct Answer: Blood for culture and sensitivity

      Explanation:

      Blood culture and sensitivity will distinguish the bacteria that is responsible for the infection and the effective antibiotic treatment to which the bacteria is sensitive.

    • This question is part of the following fields:

      • Respiratory
      36.4
      Seconds
  • Question 8 - A 2 month old baby presents to the clinic with vomiting. On examination...

    Correct

    • A 2 month old baby presents to the clinic with vomiting. On examination he has ambiguous genitalia. The labs are as follows: Na: 125mmol/L, K: 6mmol/L. Which of the following is the most likely diagnosis responsible for this patient's presentation?

      Your Answer: Congenital adrenal hyperplasia

      Explanation:

      Congenital adrenal hyperplasia (CAH) comprises a group of autosomal recessive defects in enzymes that are responsible for cortisol, aldosterone, and, in very rare cases, androgen synthesis. All forms of CAH are characterized by low levels of cortisol, high levels of ACTH, and adrenal hyperplasia. The exact clinical manifestations depend on the enzyme defect. The most common form of CAH, which is caused by a deficiency of 21β-hydroxylase, presents with hypotension, ambiguous genitalia, and virilization (in the female genotype), and/or precocious puberty (in both males and females). It is further characterized by hyponatremia, hyperkalaemia, and metabolic acidosis. Increased levels of 17-hydroxyprogesterone confirm the diagnosis of 21β-hydroxylase deficiency. Treatment of CAH involves lifelong glucocorticoid replacement therapy. Patients with a 21β-hydroxylase deficiency also require mineralocorticoid replacement with fludrocortisone. Complications of CAH include severe hypoglycaemia, adrenal insufficiency, and/or a failure to thrive.

    • This question is part of the following fields:

      • Endocrinology
      71.6
      Seconds
  • Question 9 - In the adult heart, the sinus venosus gives rise to the: ...

    Incorrect

    • In the adult heart, the sinus venosus gives rise to the:

      Your Answer: Trabeculated part of the right ventricle

      Correct Answer: Coronary sinus

      Explanation:

      The sinus venosus is a large quadrangular cavity which precedes the atrium on the venous side of the chordate heart. It exists distinctly only in the embryonic heart (where it is found between the two venae cavae); however, the sinus venosus persists in the adult. In the adult, it is incorporated into the wall of the right atrium to form a smooth part called the sinus venarum, which is separated from the rest of the atrium by a ridge of fibres called the crista terminalis. The sinus venosus also forms the SA node and the coronary sinus.

    • This question is part of the following fields:

      • Embryology
      11.9
      Seconds
  • Question 10 - Choose the standard method for comparing distributions in data sets (such as between...

    Correct

    • Choose the standard method for comparing distributions in data sets (such as between the expected frequency of an event and the observed frequency of an event) from the list of options.

      Your Answer: Chi squared (X²) test

      Explanation:

      The Chi-squared test evaluates if two variables are related. The other statistical tests mentioned do not perform this function.

    • This question is part of the following fields:

      • Epidemiology And Statistics
      20.9
      Seconds
  • Question 11 - A 10-year-old boy was discharged from hospital after an episode of acute testicular...

    Incorrect

    • A 10-year-old boy was discharged from hospital after an episode of acute testicular pain.Considering he had an anatomical anomaly involving the processus vaginalis, what is the most probable diagnosis for this child?

      Your Answer: Varicocele

      Correct Answer: Testicular torsion

      Explanation:

      Based on the presented clinical scenario, the most probable diagnosis for the patient would be testicular torsion.Rationale:The gubernaculum is the structure responsible for aiding the descent of the testicles from the abdomen into the scrotum. The processus vaginalis precedes the descent of the testes and then undergoes closure. Abnormalities such as the persistence of a patent processus vaginalis, known as bell clapper deformity, predispose to testicular torsion.Other options:- Varicocele: Nutcracker syndrome occurs where the left renal vein becomes compressed in between the superior mesenteric artery and the aorta. Since the left gonadal vein drains into the left renal vein, this results in a varicocele. – Epididymitis and mumps orchitis are differentials for acute testicular pain but are not due to a defect in the processus vaginalis. – An incarcerated inguinal hernia presents mainly with signs of bowel obstruction which are not mentioned in the clinical scenario.The descent of testes:- Until the end of foetal life, the testicles are located within the abdominal cavity. – They are initially located on the posterior abdominal wall on a level with the upper lumbar vertebrae (L2). – Attached to the inferior aspect of the testis is the gubernaculum testis which extends caudally to the inguinal region, through the canal and down to the superficial skin. – It is interesting to note that both the testis and the gubernaculum are extra-peritoneal.- As the foetus grows, the gubernaculum becomes progressively shorter. It carries the peritoneum of the anterior abdominal wall (the processus vaginalis). As the processus vaginalis descends the testis is guided by the gubernaculum down the posterior abdominal wall and the back of the processus vaginalis into the scrotum.- By the third month of foetal life the testes are located in the iliac fossae, by the seventh they lie at the level of the deep inguinal ring.Usually, the processus vaginalis closes after birth but may persist predisposing to indirect hernias. On the other hand, a partial closure may result in the development of cysts on the cord.

    • This question is part of the following fields:

      • Nephro-urology
      23.4
      Seconds
  • Question 12 - A paired t-test of blood measurements pre- and post-treatment yields a P-value of...

    Correct

    • A paired t-test of blood measurements pre- and post-treatment yields a P-value of 0.256.Which of the following statements is true?

      Your Answer: The paired differences are not significantly different from zero on average

      Explanation:

      The paired sample t-test, sometimes called the dependent sample t-test, is a statistical procedure used to determine whether the mean difference between two sets of observations is zero. In a paired sample t-test, each subject or entity is measured twice, resulting in pairs of observations. Common applications of the paired sample t-test include case-control studies or repeated-measures designs.Statistical significance is determined by looking at the p-value. The p-value gives the probability of observing the test results under the null hypothesis. The lower the p-value, the lower the probability of obtaining a result like the one that was observed if the null hypothesis was true. Thus, a low p-value indicates decreased support for the null hypothesis. However, the possibility that the null hypothesis is true and that we simply obtained a very rare result can never be ruled out completely. The cut-off value for determining statistical significance is ultimately decided on by the researcher, but usually a value of .05 or less is chosen. This corresponds to a 5% (or less) chance of obtaining a result like the one that was observed if the null hypothesis was true.

    • This question is part of the following fields:

      • Epidemiology And Statistics
      61.4
      Seconds
  • Question 13 - Which of the following features are most likely to be specifically associated with...

    Correct

    • Which of the following features are most likely to be specifically associated with the vascular subtype (type IV) of Ehlers-Danlos syndrome?

      Your Answer: Dysmorphic features, including thin nose and large eyes

      Explanation:

      Ehlers-Danlos Syndrome (EDS) is a group of genetic connective tissue disorders with over 13 clinical subtypes. Hyper-mobility is common to many of these subtypes. Vascular EDS is identified by thin, translucent skin prone to easy bleeding, as well as the risk of early arterial rupture, gastrointestinal perforation and uterine rupture. Those affected have dysmorphic features including a thin nose and lips, sunken cheeks and large eyes. The other features including; atrophic scars, a dominant family history, hyper extensible skin and kyphoscoliosis are not specific to vascular EDS and overlap in many of the subtypes.

    • This question is part of the following fields:

      • Genetics And Dysmorphology
      14.4
      Seconds
  • Question 14 - A study done on a group of epileptics records the numbers of seizures...

    Correct

    • A study done on a group of epileptics records the numbers of seizures in the weeks before and after a dietary intervention. The decrease in seizures is on average 20. (95% CI=15 to 25; P=0.0024)Which of the following options is true?

      Your Answer: This is a before and after study with no control group and so the results should be viewed with great caution

      Explanation:

      While the results of this before and after study can provide some preliminary insight into the effects of the dietary intervention, the results should be viewed with great caution as they may be considered merely anecdotal. The lack of a control group contributes to confounding the data. Therefore, while the difference may be statistically significant and the confidence interval is compatible with a fall in the number of seizures after therapy, the results cannot be introduced as the standard without a control group to compare with.

    • This question is part of the following fields:

      • Epidemiology And Statistics
      64.3
      Seconds
  • Question 15 - A 5 month old girl was admitted to the emergency department with reduced...

    Correct

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

      Your Answer: MRI scan

      Explanation:

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

    • This question is part of the following fields:

      • Neurology And Neurodisability
      37.1
      Seconds
  • Question 16 - A 5 week old baby presents to the ward with a history of...

    Correct

    • A 5 week old baby presents to the ward with a history of projectile, non-bilious vomiting which takes place after feeding. The baby seems to have a normal appetite but hasn't gained weight. You suspect pyloric stenosis. What initial test would you perform to confirm the diagnosis?

      Your Answer: Capillary blood gas

      Explanation:

      One of the features of pyloric stenosis is hypochloraemic, hypokalaemic metabolic alkalosis. In emergency settings, capillary blood gas is the easiest and fastest way to establish a sustainable suspicion of pyloric stenosis. However, all tests are useful for the diagnosis of the condition.

    • This question is part of the following fields:

      • Gastroenterology And Hepatology
      14.8
      Seconds
  • Question 17 - A 10-year-old boy was sent for an x-ray of the leg because he...

    Correct

    • A 10-year-old boy was sent for an x-ray of the leg because he was complaining of pain and swelling. The x-ray showed the classic sign of Codman's triangle. What is the most likely diagnosis of this patient?

      Your Answer: Osteosarcoma

      Explanation:

      Codman’s triangle is the triangular area of new subperiosteal bone that is created when a lesion, often a tumour, raises the periosteum away from the bone. The main causes for this sign are osteosarcoma, Ewing’s sarcoma, eumycetoma, and a subperiosteal abscess.

    • This question is part of the following fields:

      • Musculoskeletal
      13.6
      Seconds
  • Question 18 - A 13-year-old girl presents with a swollen left knee following a fall. Her...

    Incorrect

    • A 13-year-old girl presents with a swollen left knee following a fall. Her parents state she suffers from haemophilia and has been treated for a right-sided haemarthrosis previously. What other condition is she most likely to have?

      Your Answer: Ataxia telangiectasia

      Correct Answer: Turner's syndrome

      Explanation:

      Haemophilia is a X-linked recessive disorder. In X-linked recessive inheritance only males are affected. An exception to this seen in examinations are patients with Turner’s syndrome, who are affected due to only having one X chromosome. X-linked recessive disorders are transmitted by heterozygote females (carriers) and male-to-male transmission is not seen. Affected males can only have unaffected sons and carrier daughters.

    • This question is part of the following fields:

      • Genetics And Dysmorphology
      48.5
      Seconds
  • Question 19 - Which of the following epilepsy syndromes is NOT benign? ...

    Correct

    • Which of the following epilepsy syndromes is NOT benign?

      Your Answer: Infantile spasms

      Explanation:

      Epilepsy is a common paediatric neurologic disorder characterized by seizures of varying frequency and intensity. There are many childhood or infantile epilepsy syndromes that can be categorized as benign epilepsy syndromes as the child suffering from these usually outgrows them after reaching a certain age, and they do not lead to significant cognitive or physical impairment. Some of these may not need any treatment. Such benign epilepsy syndromes include benign rolandic epilepsy, Panayiotopoulos syndrome, Gastaut type-idiopathic childhood occipital epilepsy, and idiopathic photosensitive occipital lobe epilepsy. West syndrome, also called infantile spasms, is a serious infantile epileptic encephalopathy, characterized by multiple clusters of myoclonic spasms, and regression of the previous normally attained milestones. It is associated with severe cognitive and physical impairment, often leading to life long disability.

    • This question is part of the following fields:

      • Neurology And Neurodisability
      12.2
      Seconds
  • Question 20 - A 13-year-old girl presents with short stature, webbed neck, cubitus valgus and primary...

    Incorrect

    • A 13-year-old girl presents with short stature, webbed neck, cubitus valgus and primary amenorrhea.Which of the following hormones is most important for long term replacement?

      Your Answer: Growth hormone

      Correct Answer: Oestrogen

      Explanation:

      This girl most probably has Turner’s syndrome, which is caused by the absence of one set of genes from the short arm of one X chromosome.Turner syndrome is a lifelong condition and needs lifelong oestrogen replacement therapy. Oestrogen is usually started at age 12-15 years. Treatment can be started with continuous low-dose oestrogens. These can be cycled in a 3-weeks on, 1-week off regimen after 6-18 months; progestin can be added later.In childhood, growth hormone therapy is standard to prevent short stature as an adult.Fetal ovarian development seems to be normal in Turner syndrome, with degeneration occurring in most cases around the time of birth so pulsatile GnRH and luteinising hormone would be of no use.

    • This question is part of the following fields:

      • Endocrinology
      9.7
      Seconds
  • Question 21 - A 15-year-old boy is diagnosed with aplastic anaemia after presenting with fatigue, dyspnoea...

    Correct

    • A 15-year-old boy is diagnosed with aplastic anaemia after presenting with fatigue, dyspnoea and headaches. He lives on a farm and would usually play hide and seek with his siblings in the barn where the family store pesticides and other chemicals. Lab investigations reveal a significant leukopenia. Aplastic anaemia results due to failure of hematopoietic stem cells that give rise to progenitors of immune cells. In which area of the body are these cells primarily located?

      Your Answer: Bone marrow

      Explanation:

      Hematopoietic stem cells (HSCs) are a rare population of cells residing in the bone marrow (BM) and continuously replenish all mature blood cells throughout their life span.

    • This question is part of the following fields:

      • Haematology And Oncology
      29
      Seconds
  • Question 22 - A case-control study is developed to assess passive smoking as a risk factor...

    Incorrect

    • A case-control study is developed to assess passive smoking as a risk factor for the development of asthma in children. The total number of patients recruited for this study is 200. 40 out of the 200 patients report at least one parent smoking in the house when they were younger. 200 more people without asthma are recruited and 20 out of them report that at least one parent smoked in the house when they were younger. What is the odds ratio of patients with asthma having been exposed to passive smoking during their childhood?

      Your Answer: 0.5

      Correct Answer: 2.25

      Explanation:

      An odds ratio (OR) is a measure of association between an exposure and an outcome. The OR represents the odds that an outcome will occur given a particular exposure, compared to the odds of the outcome occurring in the absence of that exposure. Odds ratios are most commonly used in case-control studies, however they can also be used in cross-sectional and cohort study designs as well (with some modifications and/or assumptions). Wherea = Number of exposed casesb = Number of exposed non-casesc = Number of unexposed casesd = Number of unexposed non-casesOR=(a/c) / (b/d) = ad/bc

    • This question is part of the following fields:

      • Epidemiology And Statistics
      35.2
      Seconds
  • Question 23 - A 3-year-old was brought to the ED after falling down while playing. The...

    Incorrect

    • A 3-year-old was brought to the ED after falling down while playing. The mother reports hearing a popping sound when his face hit the floor. Examination revealed swelling and bruising on the right mandible. Which of the following investigations should be ordered next?

      Your Answer: CT scan

      Correct Answer: Facial XR

      Explanation:

      The swelling and bruising on the mandible needs to be checked for fractures. A facial X-ray can adequately visualize this.

    • This question is part of the following fields:

      • Musculoskeletal
      18
      Seconds
  • Question 24 - A cohort study is developed to assess the correlation between blood pressure and...

    Incorrect

    • A cohort study is developed to assess the correlation between blood pressure and working long hours. After 10 years of follow-up and for the 1050 individuals working less than 40 hours per week, 1000 patients had normal blood pressure and 50 patients were diagnosed with hypertension. For the 660 patients working more than 40 hours per week, 600 patients had normal blood pressure and 60 patients were diagnosed with hypertension. If you work more than 40 hours per week, what is the odds ratio of developing hypertension compared to the individuals working less than 40 hours per week?

      Your Answer: 60/50

      Correct Answer: 2

      Explanation:

      An odds ratio (OR) is a measure of the association between an exposure and an outcome. The OR represents the odds that an outcome will occur given a particular exposure, compared to the odds of the outcome occurring in the absence of that exposure. Odds ratios are most commonly used in case-control studies, however they can also be used in cross-sectional and cohort study designs as well (with some modifications and/or assumptions). Wherea = Number of exposed casesb = Number of exposed non-casesc = Number of unexposed casesd = Number of unexposed non-casesOR=(a/c) / (b/d) = ad/bc

    • This question is part of the following fields:

      • Epidemiology And Statistics
      39.7
      Seconds
  • Question 25 - A 16 year old male complained of scrotal pain following a game of...

    Correct

    • A 16 year old male complained of scrotal pain following a game of football. He couldn't recall any trauma to groin. Which of the following is the best investigation to confirm the diagnosis?

      Your Answer: USG of the scrotum

      Explanation:

      USG of the scrotum is important to exclude any abnormality with testicles, epididymis and scrotum. This presentation can be acute epididymo-orchitis or testicular torsion. USG of the scrotum will help to confirm the diagnosis.

    • This question is part of the following fields:

      • Genitourinary
      24.4
      Seconds
  • Question 26 - 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
      45.5
      Seconds
  • Question 27 - A new treatment reduces blood pressure for hypertensive patients by 10 mmHg more...

    Correct

    • A new treatment reduces blood pressure for hypertensive patients by 10 mmHg more than the current standard treatment (95% confidence interval minus 2 to 22).Which of the following statements is most accurate?

      Your Answer: The difference is not statistically significant

      Explanation:

      If the 95% confidence interval contains zero (more precisely, the parameter value specified in the null hypothesis), then the effect will not be significant at the 0.05 level.If the 95% CI for the DIFFERENCE between the 2 groups contains the value 0, this means that the p-value will be greater than 0.05. Conversely, if the 95% CI does not contain the value 0, then the p-value will be strictly less than 0.05. The same applies when comparing groups using a ratio, such as an odds ratio or risk ratio. When using a RATIO instead of a DIFFERENCE, the situation of no difference between the 2 groups will be indicated by a value of 1 instead of 0. If the ratio equals to 1, the 2 groups are equal. Hence, if the 95% CI of the ratio contains the value 1, the p-value will be greater than 0.05. Alternatively, if the 95% CI does not contain the value 1, the p-value is strictly less than 0.05.

    • This question is part of the following fields:

      • Epidemiology And Statistics
      36.2
      Seconds
  • Question 28 - Which of the following disorders is correctly linked to associated mutations? ...

    Correct

    • Which of the following disorders is correctly linked to associated mutations?

      Your Answer: Charcot- Marie-Tooth- whole gene duplication

      Explanation:

      Types of DNA mutations and their impactpoint mutation:Substitution: One base is incorrectly added during replication and replaces the pair in the corresponding position on the complementary strand as in Sickle cell anaemiaInsertion: One or more extra nucleotides are inserted into replicating DNA, often resulting in a frameshift as in one form of beta-thalassemiaDeletion: One or more nucleotides is skipped during replication or otherwise excised, often resulting in a frameshift as in Cystic fibrosis.Chromosomal mutation:Inversion: One region of a chromosome is flipped and reinserted as in Opitz-Kaveggia syndromeDeletion: A region of a chromosome is lost, resulting in the absence of all the genes in that area as in Cri du chat syndromeDuplication: A region of a chromosome is repeated, resulting in an increase in dosage from the genes in that region as in some cancers and Charcot-Marie toothTranslocation: A region from one chromosome is aberrantly attached to another chromosome as in One form of leukaemiaCopy number variation:Gene amplification: The number of tandem copies of a locus is increased as in Some breast cancersExpanding trinucleotide repeat: The normal number of repeated trinucleotide sequences is expanded as in Fragile X syndrome, Huntington’s disease

    • This question is part of the following fields:

      • Genetics And Dysmorphology
      22.1
      Seconds
  • Question 29 - A 10-year-old girl was brought to the clinic with complaints of a rash...

    Correct

    • A 10-year-old girl was brought to the clinic with complaints of a rash around her left wrist. Her mother recalls that the rash started to appear after the child started wearing a new bracelet for the past one week. What is this type of hypersensitivity reaction?

      Your Answer: Type 4

      Explanation:

      According to the Gell and Coombs classification of hypersensitivity reactions, the scenario provided is a type 4 (delayed) reaction.These reactions are mediated by T lymphocytes and cause contact dermatitis. Nickel, commonly found in cheap jewellery, is a common cause of contact dermatitis.Note:There are two main types of contact dermatitis:- Irritant contact dermatitis: It is a common, non-allergic reaction due to weak acids or alkalis (e.g. detergents). These are often seen on the hands. They present typically with erythema, and rarely, crusting and vesicles.- Allergic contact dermatitis: These are type IV hypersensitivity reactions and are often seen on the head following hair dyes.They typically present as acute weeping eczema which predominately affects the margins of the hairline rather than the hairy scalp itself. Treatment is usually with a potent topical steroid.Other options:- Allergic rhinitis is an example of a type 1 (immediate) reaction. It is an IgE mediated. It is a hypersensitivity to a previously innocuous substance.- Type 2 reactions are mediated by IgG and IgM, which binds to a cell, causing cell death. Goodpasture syndrome is an example of a type 2 hypersensitivity reaction.- Immune complexes mediate type 3 reactions. Rheumatoid arthritis is an example of a type 3 hypersensitivity reaction.

    • This question is part of the following fields:

      • Dermatology
      12.5
      Seconds
  • Question 30 - A 12 year old boy presents with a sharp pain on the left...

    Incorrect

    • A 12 year old boy presents with a sharp pain on the left side of his lower back. His parents both have a similar history of the condition. His urine tests positive for blood. A radio dense stone is seen in the region of the mid ureter when a KUB style x-ray is done. Which of the following is most likely the composition of the stone?

      Your Answer: Struvite stone

      Correct Answer: Cystine stone

      Explanation:

      Answer: Cystine stoneCystinuria is a genetic cause of kidney stones with an average prevalence of 1 in 7000 births. Cystine stones are found in 1 to 2 percent of stone formers, although they represent a higher percentage of stones in children (approximately 5 percent). Cystinuria is an inherited disorder. Inherited means it is passed down from parents to children through a defect in a specific gene. In order to have cystinuria, a person must inherit the gene from both parents. Cystine is a homodimer of the amino acid cysteine. Patients with cystinuria have impairment of renal cystine transport, with decreased proximal tubular reabsorption of filtered cystine resulting in increased urinary cystine excretion and cystine nephrolithiasis. The cystine transporter also promotes the reabsorption of dibasic amino acids, including ornithine, arginine, and lysine, but these compounds are soluble so that an increase in their urinary excretion does not lead to stones. Intestinal cystine transport is also diminished, but the result is of uncertain clinical significance.Cystinuria only causes symptoms if you have a stone. Kidney stones can be as small as a grain of sand. Others can become as large as a pebble or even a golf ball. Symptoms may include:Pain while urinatingBlood in the urineSharp pain in the side or the back (almost always on one side)Pain near the groin, pelvis, or abdomenNausea and vomitingStruvite stones are a type of hard mineral deposit that can form in your kidneys. Stones form when minerals like calcium and phosphate crystallize inside your kidneys and stick together. Struvite is a mineral that’s produced by bacteria in your urinary tract. Bacteria in your urinary tract produce struvite when they break down the waste product urea into ammonia. For struvite to be produced, your urine needs to be alkaline. Having a urinary tract infection can make your urine alkaline. Struvite stones often form in women who have a urinary tract infection.Calcium oxalate stones are the most common type of kidney stone. Kidney stones are solid masses that form in the kidney when there are high levels of calcium, oxalate, cystine, or phosphate and too little liquid. There are different types of kidney stones. Your healthcare provider can test your stones to find what type you have. Calcium oxalate stones are caused by too much oxalate in the urine.What is oxalate and how does it form stones?Oxalate is a natural substance found in many foods. Your body uses food for energy. After your body uses what it needs, waste products travel through the bloodstream to the kidneys and are removed through urine. Urine has various wastes in it. If there is too much waste in too little liquid, crystals can begin to form. These crystals may stick together and form a solid mass (a kidney stone). Oxalate is one type of substance that can form crystals in the urine. This can happen if there is too much oxalate, too little liquid, and the oxalate sticksÅ¥ to calcium while urine is being made by the kidneys.Uric acid stones are the most common cause of radiolucent kidney stones in children. Several products of purine metabolism are relatively insoluble and can precipitate when urinary pH is low. These include 2- or 8-dihydroxyadenine, adenine, xanthine, and uric acid. The crystals of uric acid may initiate calcium oxalate precipitation in metastable urine concentrates.Uric acid stones form when the levels of uric acid in the urine is too high, and/or the urine is too acidic (pH level below 5.5) on a regular basis. High acidity in urine is linked to the following causes:Uric acid can result from a diet high in purines, which are found especially in animal proteins such as beef, poultry, pork, eggs, and fish. The highest levels of purines are found in organ meats, such as liver and fish. Eating large amounts of animal proteins can cause uric acid to build up in the urine. The uric acid can settle and form a stone by itself or in combination with calcium. It is important to note that a person’s diet alone is not the cause of uric acid stones. Other people might eat the same diet and not have any problems because they are not prone to developing uric acid stones.There is an increased risk of uric acid stones in those who are obese or diabetic.Patients on chemotherapy are prone to developing uric acid stones.Only cystine stone is inherited.

    • This question is part of the following fields:

      • Genitourinary
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