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Question 1
Incorrect
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Withdrawal from which of the following substances is associated with hypersomnia, hyperphagia, irritability?
Your Answer: Cannabis
Correct Answer: Amphetamine
Explanation:Drug withdrawal symptoms after a period of substance abuse can lead to a range of symptoms. Amphetamines are known to cause hypersomnia, hyperphagia, and irritability, as well as vivid dreams as a result of withdrawal. Similar symptoms are found in cocaine withdrawal. Alcohol withdrawal presents with symptoms such as insomnia, tremulousness and delirium. Ecstasy withdrawal includes irritation, mood swings, fatigue and insomnia. Heroin withdrawal presents with symptoms which include dilated pupils, insomnia, abdominal cramps and muscle aches. Withdrawal from prolonged cannabis use can cause depression, anxiety restlessness and insomnia.
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This question is part of the following fields:
- Adolescent Health
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Question 2
Correct
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An 18-year-old boy presents to the physician complaining of persistent palpitations. The ECG shows a regular rhythm with a rate of 200 beats/min and QRS duration of 80ms. The tachycardia spontaneously resolves and presents in sinus rhythm. The PR interval is 60 ms and QRS duration is 120 ms, there is a positive delta wave in V1. Regarding the boy's tachycardia, which of the following statements holds true?
Your Answer: Verapamil is contraindicated
Explanation:Although WPW syndrome is a type of supraventricular re-entrant tachycardia, CCBs are contraindicated in its management. This is because CCBs depress AVN conduction; the current then passes through the accessory pathway (bundle of Kent) instead, causing ventricular tachycardia.
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This question is part of the following fields:
- Cardiovascular
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Question 3
Incorrect
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Which of the following skills would a 1-year-old girl be able to demonstrate, assuming that her developmental growth is normal?
Your Answer: Walking unaided
Correct Answer: Understanding of object permanence
Explanation:Among the options provided, a 1-year-old child will be able to understand object permanence e.g. understands that objects continue to exist even when they can’t be seen, e.g. looking for a fallen toy.At the age of 1 year, children should have developed an accurate pincer grip and be able to see and co-ordinate and manipulate fairly small objects such as a raisin.Gross motor development varies, but the average 1-year-old should be able to stand and cruise around furniture or walk with their hands held but not necessarily walk unaided.Drinking from a cup will become established at around 15 months and scribbling at 18 months.
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This question is part of the following fields:
- Child Development
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Question 4
Correct
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A 30-year-old female presents to her OBGYN for a 20-week anomaly scan of the foetus. During her visit, she is informed she is going to have a baby boy. What will be the chromosomal arrangement of the baby?
Your Answer: 22 pairs of autosomes and 1 pair of sex hormones (XY)
Explanation:In humans, each cell normally contains 23 pairs of chromosomes, for a total of 46. Twenty-two of these pairs, called autosomes, look the same in both males and females. The 23rd pair, the sex chromosomes, differ between males and females. Females have two copies of the X chromosome, while males have one X and one Y chromosome.
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This question is part of the following fields:
- Genetics And Dysmorphology
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Question 5
Correct
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A 3 year old male presents to the genetics clinic with a history of proximal myopathy. He has missed motor milestones and has pseudohypertrophy of the calves. Doctors suspect it might be Duchenne's muscular dystrophy. Which of the following should you advise the parents?
Your Answer: Girl offspring have a less than 10% chance of inheriting the condition
Explanation:Although initially thought to affect only boys, girls with DMD also have an estimated 10% chance of inheriting the condition. In girls, DMD may present with all or some clinical manifestations.
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This question is part of the following fields:
- Genetics And Dysmorphology
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Question 6
Correct
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A 14 year-old girl is found to have haemophilia B. What pathological problem does she have?
Your Answer: Deficiency of factor IX
Explanation:Haemophilia B (also known as Christmas disease) is due to a deficiency in factor IX. Haemophilia A is due to a deficiency in factor VIII.
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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 15-month-old boy was brought to the hospital following a high-velocity road traffic accident. His car seat was thrown forward into the front passenger seat. He has sustained multiple injuries, including a fractured pelvis and suspected skull fracture.On initial assessment in the emergency department, the child was lying supine with c-spine immobilized. His eyes were closed, and he was motionless. He did not respond to voice commands. He cried and produced weak vocal sounds to pain but did not open his eyes. He tries to move away from the examining hand.What is the Paediatric Glasgow Coma Scale score of this child?
Your Answer: 6
Correct Answer: 8
Explanation:The Glasgow Coma Scale, being inappropriate for use in children (especially below the age of 5) as they are unable to elicit the verbal response as per the adult GCS. Therefore, GCS for the paediatric age group was modified to Adelaide coma scale (ACS), which is stated as follows:Best Eye Response (as in adult scale):Spontaneous – 4To speech – 3To pain – 2No response – 1Best Verbal Response:Oriented – 5Words – 4Vocal sounds – 3Cries – 2No response – 1Best Motor Response (as in adult scale):Obeys commands – 5Localises pain – 4Flexion to pain – 3 Extension to pain – 2No response – 1 The described child scores:Eye response – 1; Verbal response – 3; Motor response – 4Thus, bringing the total ACS score to 8.
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This question is part of the following fields:
- Emergency Medicine
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Question 8
Correct
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A 15-year-old girl who has undergone a recent excision of the left submandibular gland presents to the follow-up clinic with complaints of tongue weakness on the ipsilateral side.What is the nerve that is most likely to be damaged?
Your Answer: Hypoglossal nerve
Explanation:The presenting features and the surgical site provided in the clinical scenario are highly suggestive of ipsilateral hypoglossal nerve injury.Note:Three cranial nerves may be injured during submandibular gland excision.- Marginal mandibular branch of the facial nerve- Lingual nerve- Hypoglossal nerveHypoglossal nerve damage may result in the paralysis of the ipsilateral aspect of the tongue. The nerve itself lies deep to the capsule surrounding the gland and should not be injured during an intracapsular dissection. The lingual nerve is probably at higher risk of injury. However, the effects of lingual nerve injury are predominantly sensory rather than motor.Thus, the most appropriate answer is the hypoglossal nerve.
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This question is part of the following fields:
- ENT
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Question 9
Correct
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An 18-year-old pregnant female is brought to the emergency department with complaints of headache, blurred vision and abdominal pain. Her BP is recorded to be 160/110 mmHg and she is also found to have proteinuria. Which of the following findings will typically be found in this scenario?
Your Answer: Haemolysis, elevated liver enzymes and low platelets
Explanation:HELLP syndrome is a complication of pregnancy characterized by haemolysis, elevated liver enzymes, and a low platelet count. It usually begins during the last three months of pregnancy or shortly after childbirth. HELLP syndrome is a life-threatening condition that can potentially complicate pregnancy. It is named for 3 features of the condition: Haemolysis, Elevated Liver enzyme levels, and Low Platelet levels. It typically occurs in the last 3 months of pregnancy (the third trimester) but can also start soon after delivery. A wide range of non-specific symptoms may be present in women with HELLP syndrome. Symptoms may include fatigue; malaise; fluid retention and excess weight gain; headache; nausea and vomiting; pain in the upper right or middle of the abdomen; blurry vision; and rarely, nosebleed or seizures. The cause of HELLP syndrome is not known, but certain risk factors have been associated with the condition. It is most common in women with preeclampsia or eclampsia. If not diagnosed and treated quickly, HELLP syndrome can lead to serious complications for the mother and baby. The main treatment is to deliver the baby as soon as possible, even if premature, if there is distress of the mother or the baby. Treatment may also include medications needed for the mother or baby, and blood transfusion for severe bleeding problems.
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This question is part of the following fields:
- Adolescent Health
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Question 10
Correct
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Which one of the following skin conditions is matched correctly with its treatment?
Your Answer: Psoriasis and Vitamin D analogues
Explanation:One of the options of Psoriasis treatment is vitamin D analogues i.e. calcipotriol. Acne is exacerbated by steroids. Erythema nodosum can be caused by various diseases and the treatment of the primary condition resolves the symptoms. Lipomas requires surgery, whereas Steven-Johnson syndrome requires use of steroids and eliminating the culprit drug, which is one of the most common causes.
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This question is part of the following fields:
- Dermatology
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Question 11
Incorrect
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Which of the following produces the maximum levels of cortisol in the body?
Your Answer: Zona glomerulosa of the adrenal
Correct Answer: Zona fasciculata of the adrenal
Explanation:Zona fasciculata of the adrenal produces the maximum levels of cortisol in the body.Functions of cortisol:- Increases blood pressure: permits normal response to angiotensin II and catecholamines by up-regulating alpha-1 receptors on arterioles.- Inhibits bone formation: decreases osteoblasts, type 1 collagen and absorption of calcium from the gut, and increases osteoclastic activity.- Increases insulin resistance.- Increases gluconeogenesis, lipolysis and proteolysis.- Inhibits inflammatory and immune responses.- Maintains function of skeletal and cardiac muscle.An excess of corticosteroids in the body causes various symptoms that are a part of Cushing’s syndrome.
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This question is part of the following fields:
- Endocrinology
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Question 12
Correct
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Which of the following developmental milestones would you expect to see in a normal 6-month-old baby?
Your Answer: Have lost the Moro reflex
Explanation:The Moro reflex is a normal primitive, infantile reflex. It can be seen as early as 25 weeks postconceptional age and usually is present by 30 weeks postconceptional age.6 month old milestones:Social and Emotional:Knows familiar faces and begins to know if someone is a stranger Likes to play with others, especially parents Responds to other people’s emotions and often seems happy Likes to look at self in a mirror Language/Communication:Responds to sounds by making sounds Strings vowels together when babbling (ah,Å¥ eh,Å¥ ohÅ¥) and likes taking turns with parent while making sounds Responds to own name Makes sounds to show joy and displeasure Begins to say consonant sounds (jabbering with m,Å¥ bÅ¥) Cognitive (learning, thinking, problem-solving):Looks around at things nearby Brings things to mouth Shows curiosity about things and tries to get things that are out of reach Begins to pass things from one hand to the other Movement/Physical Development:Rolls over in both directions (front to back, back to front) Begins to sit without support When standing, supports weight on legs and might bounce Rocks back and forth, sometimes crawling backwards before moving forward
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This question is part of the following fields:
- Child Development
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Question 13
Correct
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A mother gives birth to a baby at 28 weeks of gestation. He weights 1000g. What of the following is true?
Your Answer: Visual screening is not useful if carried out at this gestational age
Explanation:Retinopathy of prematurity (ROP) affects premature infants. It is a retinal vasoproliferative disease for which current screening guidelines are primarily based on birth weight and gestational age. The disease is first detected by screening at 32-38 weeks of gestation or in infants that are about 6-7 weeks old. Screening consists of dilation of the pupils and observing for dilated vessel.
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This question is part of the following fields:
- Ophthalmology
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Question 14
Incorrect
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A 6 year old boy arrives at the clinic seven hours after having injured his hand with a metal spike. Examination reveals a puncture wound 0.5 cm deep. His immunization schedule is uptodate. How will you manage this patient?
Your Answer: Tetanus vaccine + antibiotics
Correct Answer: Tetanus Ig + antibiotics
Explanation:Cleansing and debridement is paramount in dealing with tetanus-prone wounds (severe crushing injuries, piercing wounds, blisters and burns are outstanding examples, particularly if contaminated with dirt, grass or other debris).Prophylaxis then is relatively easy in persons who have been actively immunized by toxoid injections. For them, a boosterť injection is indicated. There is experimental evidence that antibiotics of the tetracycline group, given soon after injury, may have prophylactic effect against tetanus.
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This question is part of the following fields:
- Infectious Diseases
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Question 15
Correct
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Which of the following is true regarding primitive reflexes in a 12-month-old infant?
Your Answer: The Moro reflex is absent
Explanation:Primitive reflexes are central nervous system responses, many of which disappear as a child matures. Retention of these reflexes may point to atypical neurology such as in cerebral palsy or stroke. However, some persist into adulthood. The stepping reflex is present from birth and normally disappears by 6 weeks, while the moro reflex is present from birth to about 4 months. The asymmetrical tonic neck reflex disappears by about 6 months. Reflexes that persist include the head righting reflex which develops at 6 months, and the parachute reflex which develops at 9 months.
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This question is part of the following fields:
- Child Development
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Question 16
Correct
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A 10-month-old infant is brought to the hospital with a 3-day history of frequent watery stools and vomiting. On examination, she is found to be dehydrated and is refusing to drink in the emergency department.What would be the most appropriate course of action for this child?
Your Answer: Admit for enteral rehydration via a nasogastric tube
Explanation:The most appropriate step in this patient would be to admit the patient for enteral rehydration via a nasogastric tube.Enteral rehydration:Oral rehydration is the most preferred way of rehydrating children. If a child is not tolerating small-frequent-feeds, then nasogastric rehydration is an underused next best step. The fluid can be run through a continuous pump so that it is better tolerated. Note:Intravenous fluids are effective but can have profound effects on the serum electrolyte balance if not monitored closely. Most children will tolerate fluids in an emergency department, but failure to take fluids orally is not an indication for intravenous therapy.
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This question is part of the following fields:
- Emergency Medicine
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Question 17
Incorrect
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Which of the following movements will most likely be lost following an injury to the spinal part of the accessory nerve?
Your Answer: Depression of the scapula
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.
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This question is part of the following fields:
- Musculoskeletal
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Question 18
Correct
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A 17 year old female presented with irregular menstrual cycles for 4 months. On examination her weight was 85 kg and height was 145 cm. She was not on any medications. Which of the following is the most appropriate investigation to arrive at a diagnosis?
Your Answer: Pelvic ultrasound
Explanation:Oligomenorrhoea and BMI of 40.4 is suggestive of Polycystic ovary syndrome (PCOS). To diagnose PCOS 2 out of following 3 criteria should be present : oligo/anovulation, hyperandrogenism, clinical (hirsutism or less commonly male pattern alopecia) or biochemical (raised FAI or free testosterone) and polycystic ovaries on ultrasound.
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This question is part of the following fields:
- Genitourinary
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Question 19
Correct
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A 15-year-old boy presents with hypertension and acute renal failure after an episode of diarrhoea. What is the most likely diagnosis?
Your Answer: Haemolytic-uraemic syndrome
Explanation:The likely diagnosis in this case is Haemolytic Uremic Syndrome (HUS), which is generally seen in young children presenting with a triad of symptoms, namely: acute renal failure, microangiopathic haemolytic anaemia, and thrombocytopenia. The typical cause of HUS is ingestion of a strain of Escherichia coli causing diarrhoea in these cases as well.
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This question is part of the following fields:
- Renal
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Question 20
Correct
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A 14 year old boy is suspected of having CSF rhinorrhoea after sustaining a basal skull fracture. Which laboratory test would be able to accurately detect the presence of CSF?
Your Answer: Beta 2 transferrin assay
Explanation:Answer: Beta 2 transferrin assayBeta-2-transferrin is a protein found only in CSF and perilymph. Since 1979, beta-2-transferrin has been used extensively by otolaryngologists in the diagnosis of CSF rhinorrhoea and skull-base cerebrospinal fluid fistulas. With sensitivity of 94% – 100%, and specificity of 98% – 100%, this assay has become the gold standard in detection of CSF leakage. CSF rhinorrhoea is characterized by clear or xanthochromic watery rhinorrhoea that may not become apparent until nasal packing is removed.
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This question is part of the following fields:
- Emergency Medicine
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Question 21
Incorrect
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Which among the following is a common feature of systemic juvenile idiopathic arthritis (Still's disease)?
Your Answer: Thrombocytopenia
Correct Answer: Negative rheumatoid factor
Explanation:Still’s disease is a rare systemic disorder that accounts for 10% of cases of juvenile idiopathic arthritis (JIA). The aetiology is unknown. It affects boys and girls equally up to the age of five years of age, following which, girls are more commonly affected. Clinical features of this disease include:- Fever- Maculopapular rash- Myalgia- Generalised lymphadenopathy- Hepatosplenomegaly- Pericarditis and pleuritis Laboratory investigations reveal raised ESR and CRP. There can also be coexisting neutrophilia and thrombocytosis. Anti-nuclear autoantibodies and rheumatoid factor are usually negative in patients with Still’s disease.On the rare case that they are present, their titres are generally low.
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This question is part of the following fields:
- Musculoskeletal
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Question 22
Correct
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A 7-week-old baby girl has a bright red, well-circumscribed and lobulated lesion developing on her right temple that wasn't noted at birth, but is now 5 mm in diameter.What is the most appropriate management?
Your Answer: Reassure the mother that most lesions spontaneously regress
Explanation:Capillary haemangiomas are one of the most common benign tumours of infancy. They are benign endothelial cell neoplasms that are typically absent at birth and characteristically have rapid growth in infancy with spontaneous involution later in life. This is in contrast to another known group of childhood vascular anomalies, vascular malformations. Vascular malformations, such as lymphangiomas and arteriovenous malformations, are present at birth and are characterized by very slow growth with persistence into adult life. The indications for treatment can be divided into systemic, ophthalmic, and dermatologic reasons. Systemic reasons for intervention include congestive heart failure, thrombocytopenia, haemolytic anaemia, and nasopharyngeal obstruction. Ophthalmic indications for intervention include occlusion of the visual axis, optic nerve compression, severe proptosis, and anisometropia. Dermatologic indications for intervention include maceration and erosion of the epidermis, infection, and cosmetic disfigurement.The first-line treatment of capillary haemangiomas is simple observation. Since most of these lesions regress on their own, there is no need to intervene unless one of the above criteria is met.
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This question is part of the following fields:
- Dermatology
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Question 23
Correct
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A normal 6-month-old child is NOT expected to do which of the following?
Your Answer: Sit unsupported for 10 minutes
Explanation:Milestones of 6 monthsSocial and EmotionalKnows familiar faces and begins to know if someone is a stranger Likes to play with others, especially parents Responds to other people’s emotions and often seems happy Likes to look at self in a mirror Language/CommunicationResponds to sounds by making sounds Strings vowels together when babbling (ah,Å¥ eh,Å¥ ohÅ¥) and likes taking turns with the parent while making sounds Responds to own name Makes sounds to show joy and displeasure Begins to say consonant sounds (jabbering with m,Å¥ bÅ¥) Cognitive (learning, thinking, problem-solving)Looks around at things nearby Brings things to mouth Shows curiosity about things and tries to get things that are out of reach Begins to pass things from one hand to the other Movement/Physical DevelopmentRolls over in both directions (front to back, back to front) Begins to sit without support When standing, supports weight on legs and might bounce Rocks back and forth, sometimes crawling backwards before moving forward
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This question is part of the following fields:
- Child Development
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Question 24
Correct
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A baby is delivered at 26 weeks. Full course of antenatal steroids was administered. There was a delay in clamping the cord. No respiratory effort is observed, and the heart rate is slow. What should be the next step in management of this case?
Your Answer: 5 inflation breaths
Explanation:Most infants have a good heart rate after birth and establish breathing by about 90 s. If the infant is not breathing adequately aerate the lungs by giving 5 inflation breaths, preferably using air. Until now the infant’s lungs will have been filled with fluid.
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This question is part of the following fields:
- Neonatology
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Question 25
Correct
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The parents of a 5-year-old overweight boy are concerned that the boy is 'breathing strangely' at night for the past few months now. This is associated with frequent and loud snoring. Furthermore, he seems to have sleep disturbances due to these nocturnal breathing difficulties. This, they feel, is reflected as daytime somnolence in the boy.Clinical examination reveals bilateral tonsillar hypertrophy. What is the most appropriate next step in the management of this child?
Your Answer: Refer for ENT opinion
Explanation:The most appropriate next step in the management would be to refer the patient for an ENT opinion. Rationale:This child has clinical signs of adenotonsillar hypertrophy, symptoms of persistent snoring and features of obstructive sleep apnoea (OSA). Suspected OSA warrants referral to an ENT specialist. Other options:- Capillary blood gas: The investigation consists of overnight oxygen saturation monitoring or polysomnography.- Chest X-ray: A chest x-ray is not indicated.- Phenoxymethylpenicillin (Penicillin V) is the first-line treatment for tonsillitis. However, with a history of several months and no suggestion of fever or sore throat, acute tonsillitis is unlikely.- Weight loss advice: Obesity is a risk factor for obstructive sleep apnoea (OSA) amongst other health problems. The child’s weight should be highlighted and advice and support for weight loss provided however referral to ENT is warranted for further investigation.
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This question is part of the following fields:
- ENT
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Question 26
Correct
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A term infant delivered via C-section develops tachypnoea, grunting, flaring, and intercostal retractions 10 minutes after birth. A chest radiograph reveals well-aerated lungs with fluid in the fissure on the right, prominent pulmonary vascular markings, and flattening of the diaphragm. His oxygen saturation is 90%. He improves within a few hours and requires no oxygen. What condition is this infant most likely suffering from?
Your Answer: Transient tachypnoea of the new-born
Explanation:Transient tachypnoea of the new-born is a condition associated with the delayed clearance of amniotic fluid from the new-born. The X-ray findings are typical of this condition. As the name implies and was noted in this patient, it is not a lasting condition and resolves within 24-72 hours after birth. The differential diagnoses usually present with different chest X-ray findings:- Aspiration pneumonia shows infiltrates in the lower lobes of the lungs- Congenitally acquired pneumonia shows patchy, asymmetrical densities- Meconium aspiration shows hyperinflation and patchy asymmetric airspace disease- Pulmonary oedema shows cephalization of pulmonary veins and indistinctness of the vascular margins.
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This question is part of the following fields:
- Respiratory
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Question 27
Correct
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In one of the following situations a child should be investigated further if they aren't:
Your Answer: Saying single words with meaning by 18 months
Explanation:If a child is not saying single words with meaning by 18 months it suggests that he or she is not following normal developmental milestones and further investigation is needed. Children are usually expected to be dry by day at the age of 3 years and dry by night at the age of 4 years, however 10% of 5 year old children and 5% of 10 year old children still wet the bed.
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This question is part of the following fields:
- Child Development
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Question 28
Incorrect
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Which of the following conditions is most commonly seen in PANDAS (Paediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections)?
Your Answer: Depression
Correct Answer: Obsessive compulsive disorder
Explanation:A child may be diagnosed with PANDAS when:- Obsessive-compulsive disorder (OCD), tic disorder, or both suddenly appear following a streptococcal (strep) infection, such as strep throat or scarlet fever.- The symptoms of OCD or tic symptoms suddenly become worse following a strep infection.The symptoms are usually dramatic, happen overnight and out of the blue,Å¥ and can include motor or vocal tics or both and obsessions, compulsions, or both. In addition to these symptoms, children may become moody or irritable, experience anxiety attacks, or show concerns about separating from parents or loved ones.
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This question is part of the following fields:
- Neurology And Neurodisability
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Question 29
Incorrect
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An 8 year old boy was admitted following a MVA. His BMI is 28 kb/m2 and he's been found to have glycosuria, which resolved after his recovery. Which investigation is necessary to perform as part of the follow-up?
Your Answer: Oral glucose tolerance test
Correct Answer: Fasting blood glucose concentration
Explanation:The boy has an increased BMI which implies he is overweight. Possible trauma to his pancreas might have led to a diabetes-like condition, induced by damage to the beta cells. Fasting blood glucose should be measured as a follow-up strategy to see if the damage is reversible or irreversible and to conclude if the glycosuria is related to his metabolic profile or to his accident.
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This question is part of the following fields:
- Emergency Medicine
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Question 30
Correct
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A 15-year-old girl was brought to the hospital by her mother with complaints of an acute onset of oliguria and gross haematuria. On examination, she was found to have pedal oedema and a blood pressure of 164/112 mmHg. Given the likely diagnosis, what would be the most characteristic finding on urine microscopy?
Your Answer: Red blood cell casts
Explanation:Among the options provided, the most characteristic finding that can be expected in his patient’s urine microscopy is RBC casts. Red cell casts are a characteristic feature of acute nephrotic syndrome. Other options:- Hyaline casts may be seen in normal urine, particularly after exercise. – Coarse granular casts occur in glomerular and tubular disease. – Tubular cell casts may be seen in patients with acute tubular necrosis. – The presence of 10 or more white blood cells/mm3 is abnormal and indicates an inflammatory reaction, most commonly due to infection.
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This question is part of the following fields:
- Nephro-urology
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