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Question 1
Correct
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A 12-year-old girl presents to the clinic with right knee pain. On examination, her eyes were red. But she denied any ocular or visual discomfort.Which of the following should be suspected in this patient?
Your Answer: Anterior uveitis
Explanation:When a child with joint problems presents with red-eye, the likelihood of anterior uveitis must be excluded by involving an ophthalmologist in the assessment. This is because uveitis is the most common extra-articular manifestation of juvenile idiopathic arthritis.Other options:- Cataract: It does not give rise to a red-eye, but leukocoria. Often this would have been picked up at an earlier age. – A patient with a corneal foreign body almost would almost invariably give a suspicious history (onset while playing outdoors etc.), as well as have marked symptoms of ocular discomfort (red, watery and painful eyes). – A child with periorbital cellulitis often presents acutely unwell and distressed. – A child with an uncorrected refractive error often complains of being unable to see in class and does not normally present with ocular redness.
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This question is part of the following fields:
- Ophthalmology
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Question 2
Incorrect
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A healthy 8 month old baby boy was brought in by his parents, who claimed that the baby had come into close contact with another child with measles two days ago. Which of the following is the most appropriate management?
Your Answer: Nothing need be done now but she should receive her MMR vaccination at the usual time of approximately 12 months
Correct Answer: She should receive the MMR vaccine now together with measles immunoglobulin
Explanation:People who are at risk for severe illness and complications from measles, such as infants younger than 12 months of age, pregnant women without evidence of measles immunity, and people with severely compromised immune systems, should receive immunoglobulin. Intramuscular immunoglobulin should be given to all infants younger than 12 months of age who have been exposed to measles. For infants aged 6 through 11 months, MMR vaccine can be given in place of IG, if administered within 72 hours of exposure.
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This question is part of the following fields:
- Infectious Diseases
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Question 3
Correct
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A 2-day old boy is diagnosed with a patent ductus arteriosus. He has a cyanotic heart disease. Which of the following would be the best course of action in this patient?
Your Answer: Prostaglandin E1 (PGE1) administration
Explanation:Administration of IV prostaglandin/PGE1 (e.g., alprostadil) is indicated in ductal-dependent CHDs until surgery can be performedMechanism: prostaglandin prevents the ductus arteriosus from closing and creates intentional shunt to allow mixing of deoxygenated with oxygenated blood.
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This question is part of the following fields:
- Cardiovascular
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Question 4
Incorrect
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What is the mode of spread of chickenpox?
Your Answer: Close contact
Correct Answer: Airborne
Explanation:Chickenpox is a highly communicable viral disease caused by human (alpha) herpesvirus 3 (varicella-zoster virus, VZV). It is transmitted from person to person by direct contact (touching the rash), droplet or air born spread (coughing and sneezing).
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This question is part of the following fields:
- Infectious Diseases
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Question 5
Correct
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A 10-year-old boy presents to the hospital with a lower respiratory chest infection. Following a road traffic accident, he underwent a splenectomy a few months ago. What is the most likely organism causing the lower respiratory tract infection in this child?
Your Answer: Haemophilus influenzae
Explanation:The organisms most likely to cause post-splenectomy sepsis include:- Streptococcus pneumoniae- Haemophilus influenzae- MeningococciEncapsulated organisms carry the most significant pathogenic risk following splenectomy. Hyposplenism:It may complicate certain medical conditions where splenic atrophy occurs or maybe the result of medical intervention such as splenic artery embolization and splenectomy for trauma. The diagnosis of hyposplenism is difficult, and while there may be peripheral markers of the splenectomised state (e.g. Howell-Jolly bodies), these are neither 100% sensitive or specific. The most sensitive test is a radionucleotide labelled red cell scan.It dramatically increases the risk of post-splenectomy sepsis, particularly with encapsulated organisms. Since these organisms may be opsonized, but this then goes undetected at an immunological level due to loss of the spleen. For this reason, individuals are recommended to be vaccinated and have antibiotic prophylaxis.Key recommendations:- All those with hyposplenism or prior to an elective splenectomy should receive pneumococcal, Haemophilus type b and meningococcal type C vaccines. These should be administered two weeks before or two weeks following splenectomy. The vaccine schedule for meningococcal disease primarily consists of a dose of Men C and Hib at two weeks and then a dose of the MenACWY vaccine one month later. Those aged under two may require a booster at two years. A dose of pneumococcal polyvalent polysaccharide vaccine (PPV) is given at two weeks. A conjugate vaccine (PCV) is offered to young children. The PCV is more immunogenic but covers fewer serotypes. Boosting PPV is either guided by serological measurements (where available) or by routine boosting doses at five-yearly intervals.Annual influenza vaccination is recommended in all cases- Antibiotic prophylaxis is offered to all. The risk of post-splenectomy sepsis is highest immediately following splenectomy. Individuals with an inadequate response to pneumococcal vaccination are another high-risk group. High-risk individuals should be counselled to take penicillin or macrolide prophylaxis. Those at low risk may choose to discontinue therapy. All patients should be advised about taking antibiotics early in the case of intercurrent infections.- Asplenic individuals travelling to malaria-endemic areas are at high risk and should have both pharmacological and mechanical protection.
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This question is part of the following fields:
- Haematology And Oncology
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Question 6
Incorrect
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Which of the following does NOT cause benign intracranial hypertension?
Your Answer: Iron-deficiency anaemia
Correct Answer: Acute lymphoblastic leukaemia
Explanation:Benign intracranial hypertension is characterized by an elevation of the CSF pressure that is not caused by hydrocephalus or any space-occupying lesion. The cause is most likely the decreased absorption of CSF into the dural sinuses. The main symptoms are headache and visual abnormalities. It can lead to blindness if not managed on time. The most important risk factors for BIH are female gender and obesity. The causes of BIH include iron deficiency anaemia, sarcoidosis, Lyme disease, SLE, polycythaemia vera, chronic kidney disease, meningitis, and sleep apnoea.
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This question is part of the following fields:
- Neurology And Neurodisability
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Question 7
Incorrect
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A 10 year old boy is being bullied by his classmates because he's obese and he is the shortest in his class. His mother is worried and brings him in to the clinic. History reveals he had a renal transplant last year. What is the most likely diagnosis?
Your Answer: Lawrence moon biedel syndrome
Correct Answer: Cushing's syndrome
Explanation:The boy had a renal transplant, for which he needs immune suppression. For the exogenous immune suppression an exogenous steroid is needed, which in this case is responsible for the primary Cushing syndrome manifesting with short stature. The administration of steroids before the physiological fusion of the growth plate can lead to premature fusion with permanent cessation of bone growth.
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This question is part of the following fields:
- Endocrinology
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Question 8
Correct
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A 15-year-old girl presents with polyuria, polydipsia and weight loss. Further investigations lead to a diagnosis of type 1 diabetes mellitus.Which of the following does she have an increased risk of developing?
Your Answer: Addison's disease, Grave's disease, coeliac disease
Explanation:The patient has features of type 1 diabetes mellitus, a disease of autoimmune aetiology. This also puts the patient at risk of developing other autoimmune disorders like Addison’s disease, Grave’s disease, and coeliac disease.All of the other options are non-autoimmune disorders.Diabetes mellitus is an increasing problem in both developing and developed countries alike.Some of the risk factors include:ObesityFamily historyFemale sex Asian and African racesPresence of acanthosis nigricans is seen with type 2 but not type 1 diabetesThe diagnosis is mostly incidental or subacute.The treatment aims are good blood sugar control, maintenance of normal BMI, and reduction of complications. The treatment modality also includes lifestyle modifications and cessation of smoking.Even after all this, diabetic ketoacidosis can still occur.Management of diabetes mellitus – NICE guidelines (Updated, 2015): – Standard release metformin should be offered from the moment of diagnosis.- HBA1c should be measured every three months. The target HBA1c level of 48 mmol/mol (6.5%) or lower is ideal for minimising the risk of long term complications.- Children should undergo an eye examination by an optician every two years.- Annual immunisation against influenza and pneumococcal infections are essential.- There is an increased risk of psychological and psychosocial difficulties if the child with type 1 diabetes is on insulin or oral hypoglycaemic medications. These include anxiety disorder, depression, behavioural and conduct disorders and family conflict.- Annual monitoring to be done for:Hypertension starting at diagnosis.Dyslipidaemia starting at diagnosis.Screening for microalbuminuria starting at diagnosis.Diabetic retinopathy from 12 years of age.
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This question is part of the following fields:
- Endocrinology
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Question 9
Correct
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A 3-year-old boy presents with a patchy rash after treatment for an enlarged cervical lymph node and sore throat. What is the antibiotic that caused this rash?
Your Answer: Ampicillin
Explanation:An enlarged lymph node does not necessarily need treatment especially if it is caused by a virus. If it is bacterial, antibiotics should be prescribed. Amoxicillin is first line treatment in non-penicillin allergic patients and side effects include allergic reactions like skin rash and itching
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This question is part of the following fields:
- Pharmacology
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Question 10
Incorrect
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What is the average age that puberty starts in boys?
Your Answer: 11 years
Correct Answer: 12 years
Explanation:Puberty is when a child’s body begins to develop and change as they become an adult.The average age for girls to begin puberty is 11, while for boys the average age is 12.It’s completely normal for puberty to begin at any point from the ages of 8 to 14. The process can take up to 4 years.
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This question is part of the following fields:
- Endocrinology
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Question 11
Incorrect
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A 20-year-old female was brought to the emergency department. Her presentation was highly suggestive of meningitis. Direct ophthalmoscopy revealed no signs of papilledema. Thus, she was planned for a lumbar puncture. What is the structure first encountered while inserting the needle?
Your Answer: Denticulate ligament
Correct Answer: Supraspinous ligament
Explanation:During lumbar puncture, the first structures encountered by the needle are skin and subcutaneous tissue. But, since they are not provided in the options, the most superficial structure after them is the supraspinous ligament.Lumbar puncture is a procedure performed to obtain cerebrospinal fluid. The procedure is best performed at the level of L3/L4 or L4/5 interspace. During the procedure, the needle pierces the following structures in order from superficial to deep: Skin, subcutaneous tissue, supraspinous ligament, interspinous ligament, ligamentum flavum, the epidural space containing the internal vertebral venous plexus, dura, and arachnoid, finally entering the subarachnoid space. The supraspinous ligament connects the tips of spinous processes and the interspinous ligaments between adjacent borders of spinous processes.As the needle penetrates the ligamentum flavum, it causes a give. A second give is felt when the needle penetrates the dura mater and enters the subarachnoid space. At this point, clear CSF flows through the needle and can be collected for diagnostic purposes.
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This question is part of the following fields:
- Emergency Medicine
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Question 12
Incorrect
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A 6 year old boy presents with a tibial fracture in a cast and continuous pain. You suspect a compartment syndrome injury. Which of the following represents a late sign of the condition?
Your Answer: Altered sensation
Correct Answer: Absent distal pulses
Explanation:The Five P’s: pain, pulselessness, paraesthesia, paralysis, and pallor, are the most common symptoms of compartment syndrome. However, late signs of the condition include the absence of distal pulses.
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This question is part of the following fields:
- Emergency Medicine
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Question 13
Incorrect
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An 11-month old infant was brought by the parents with complaints of poor feeding, failure to thrive, and developmental delay. He was reluctant to play and was unable to sit independently at ten months. Examination revealed blond hair and pale skin with small hands and feet and a squint. He also has poor central muscle tone and unilaterally undescended testes. What is the probable diagnosis of this infant?
Your Answer: Silver-Russell syndrome
Correct Answer: Prader-Willi syndrome
Explanation:The physical features and developmental delay are the key aspects in the given scenario. The child in question shows features of gross motor and social developmental delay and has physical features indicative of Prader-Willi syndrome (hypopigmentation, esotropia, disproportionately small hands and feet, loss of central muscle tone and undescended testes). Children with Prader-Willi syndrome can present with failure to thrive until ,12-18 months, at which point, hyperphagia and obesity become more prominent. Other options:- Although Klinefelter syndrome can present with delayed development, undescended/small testes and reduced muscle power, the presence of small hands/feet, hypopigmentation and failure to thrive are not characteristic features. – Marfan syndrome presents with different physical features (arachnodactyly, cardio-respiratory complications and skin changes, amongst others) than those associated with Prader-Willi syndrome. – DiGeorge can manifest with developmental delay, hypotonia and feeding difficulties. However, this clinical scenario does not report any of the typical facial features, hearing abnormalities or cardiac abnormalities that are typically caused by DiGeorge syndrome. – Russell-Silver syndrome can cause developmental abnormalities, poor muscle tone and power (poor head control and muscle function), feeding difficulties and poor growth during the post-natal period and infancy. However, characteristic facial (small, triangular face, blue sclerae) and skeletal abnormalities (limb asymmetry, finger abnormalities) are not present. Therefore, Prader-Willi syndrome is the most appropriate diagnosis for this patient.Note:Prader-Willi syndrome is an example of genetic imprinting where the phenotype depends on whether the deletion occurs on a gene inherited from the mother or father: In Prader-Willi syndrome, it is the paternal gene that is deleted from the long arm of chromosome 15, while in Angelman syndrome the maternal gene is deleted. Prader-Willi syndrome can occur due to the microdeletion of paternal 15q11-13 (70% of cases) maternal uniparental disomy of chromosome 15.
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This question is part of the following fields:
- Genetics And Dysmorphology
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Question 14
Correct
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A 5 week old boy with pyloric stenosis is vomiting forcefully. Which of the following findings would you expect to be in his blood results?
Your Answer: Hypokalaemia
Explanation:Progressive vomiting due to pyloric stenosis leads to hypochloraemic, hypokalaemic, metabolic alkalosis.
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This question is part of the following fields:
- Nephro-urology
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Question 15
Incorrect
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The blood supply to which of the following structures is NOT compromised due to an occlusion in the anterior cerebral artery?
Your Answer: Corpus callosum
Correct Answer: Brocas area
Explanation:Broca’s area is usually supplied by branches from the middle cerebral artery and thus will be spared when the anterior cerebral artery is occluded.Note:The two internal carotid arteries and two vertebral arteries form an anastomosis known as the Circle of Willis on the inferior surface of the brain. Each half of the circle is formed by:1. Anterior communicating artery2. Anterior cerebral artery3. Internal carotid artery4. Posterior communicating artery5. Posterior cerebral arteries and the termination of the basilar arteryThe circle and its branches supply the corpus striatum, internal capsule, diencephalon and midbrain.
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This question is part of the following fields:
- Neurology And Neurodisability
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Question 16
Incorrect
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Which of the following conditions does not commonly cause a Trendelenburg gait pattern?
Your Answer: Muscular dystrophy
Correct Answer: Juvenile idiopathic arthritis
Explanation:Trendelenburg gait is an abnormal gait resulting from a defective hip abductor mechanism. The primary musculature involved is the gluteal musculature, including the gluteus medius and gluteus minimus muscles. The weakness of these muscles causes drooping of the pelvis to the contralateral side while walking.Any pathology of the fulcrum, load, effort or the lever which binds all three will lead to a positive Trendelenburg gait.Failure of the fulcrum presents in the following conditions:Osteonecrosis of hipLegg-Calve-Perthes diseaseDevelopmental dysplasia of the hipChronically dislocated hips secondary to traumaChronically dislocated hips secondary to infections like tuberculosis of the hipFailure of the lever is a feature in the following conditions:Greater trochanteric avulsionNon-union of the neck of the femurCoxa VaraFailure of effort presents in the following conditions:PoliomyelitisL5 radiculopathySuperior gluteal nerve damageGluteus medius and minimus tendinitisGluteus medius and minimus abscessPost total hip arthroplastyThe gait of Juvenile idiopathic arthritis patients can be explained as a crouch-like gait with hyperflexion in hip and knee joints and less plantar flexion in the ankle
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This question is part of the following fields:
- Musculoskeletal
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Question 17
Incorrect
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A 11-year-old boy has a history of tonsillitis followed by haematuria and hypertension about 10 days later.What would be the characteristic blood test finding in this condition?
Your Answer: Low C4 level
Correct Answer: Depressed CH 50 level
Explanation:Because the medical history included tonsillitis followed by haematuria and hypertension, there is a strong suspicion of a case of post-streptococcal glomerulonephritis (PSGN). Patients with PSGN usually have serological findings showing depressed serum haemolytic component CH50 and serum concentrations of C3. Sometimes depressed C4 levels are also apparent, but not always, therefore, the answer to this question is: depressed CH50 level.
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This question is part of the following fields:
- Renal
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Question 18
Correct
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An 8 year old male child presents with frequent and recurrent headaches and a history of dark-coloured urine. He has a blood pressure of 150/100 mmHg and normal serum urea and creatinine levels. Urine microscopy reveals erythrocytes and erythrocyte casts. His 24-hour urine protein is about 2 g. What is the most probable diagnosis?
Your Answer: Acute nephritic syndrome
Explanation:The child most likely has nephritic syndrome which is characterised by a reduced renal function, proteinuria of non-nephrotic range, haematuria, erythrocyte casts, and oedema. Polyarteritis nodosa usually occurs in middle-aged men but can also be seen in young children. It is accompanied by severe systemic manifestations such as fever, malaise, weight loss and myalgia.Renal cell carcinoma usually presents around 55 years with the classic triad of haematuria, loin pain and a unilateral mass in the flank.Polycystic kidney disease usually presents in adult life with acute loin pain and palpation of masses in the flanks.
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This question is part of the following fields:
- Nephro-urology
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Question 19
Correct
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A pathologist examines a histological section and identifies a clump of Reed Sternberg cells.What is the most likely diagnosis?
Your Answer: Hodgkin's lymphoma
Explanation:Reed-Sternberg cells are classically associated with Hodgkin lymphoma.Classical diagnostic Reed-Sternberg cells are large (15 to 45 micrometres), have abundant slightly basophilic or amphophilic cytoplasm and have at least two nuclear lobes or nuclei. Diagnostic Reed-Sternberg cells must have at least two nucleoli in two separate nuclear lobes. The nuclei are large and often rounded in contour with a prominent, often irregular nuclear membrane, pale chromatin and usually one prominent eosinophilic nucleolus, with perinuclear clearing (halo), resembling a viral inclusion.
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This question is part of the following fields:
- Haematology And Oncology
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Question 20
Correct
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A 15-year-old girl, known to have atopic eczema since she was six months old, presents because her parents are worried about several skin changes. They are concerned that they could be caused by topical steroid ointments. Which of the following is more likely to be present due to the disease, rather than as a side-effect of the treatment?
Your Answer: Hypopigmentation
Explanation:Hypopigmentation is a side-effect that is more likely to be due to eczema rather than topical steroids therapy.All the options provided are potential side-effects of topical steroid therapy. They are observed when the potency of the steroid used is too high, or the amount of drug used is too much.. FTU or fingertip unit application is what is recommended, with caution, in delicate areas such as the face. Hypopigmentation can occur in eczema and is a post-inflammatory response, in contrast to the total depigmentation which is seen in vitiligo. Chronic eczema causes lichenification of skin, where the epidermis is thickened, and not skin atrophy.
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This question is part of the following fields:
- Dermatology
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Question 21
Correct
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Choose the karyotype associated with short stature:
Your Answer: 45,XO
Explanation:Turner syndrome (TS) is one of the most common genetic disorders; occurs with an incidence of I: 2,500 female live births. It results from complete or partial chromosome X monosomy. TS is associated with abnormalities of the X chromosome and characteristic clinical features of short stature, gonadal dysgenesis, sexual developmental deficiencies, cardiac and/or renal defects, webbed neck, low-set ears, skeletal deformities including cubitus valgus, a propensity to ear infections and hearing deficits.
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This question is part of the following fields:
- Genetics And Dysmorphology
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Question 22
Correct
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A 10-year-old girl presents to the hospital with complaints of weight loss, diarrhoea, and abdominal pain. Her food intake has drastically reduced but she is drinking normally. She also complains that she feels tired all the time.On examination, the presence of aphthous ulcers and generalized abdominal tenderness was noted. Considering the clinical presentation, what could be the most probable underlying disorder causing the child's symptoms?
Your Answer: Crohn's disease
Explanation:The most probable diagnosis for this patient would be Crohn’s disease.Crohn’s disease:An inflammatory bowel disease which can affect any part of the bowel from the mouth to the anus. Symptoms include abdominal pain, diarrhoea, pyrexia and weight loss. Extra-intestinal manifestations include arthritis, uveitis, fatigue, anaemia and rashes including pyoderma gangrenosum and erythema nodosum.Other options:- Anorexia nervosa is an important diagnosis to consider. There are no indicators in the description that she has a fear of gaining weight or a strong desire to be thin.- Diabetic ketoacidosis is incorrect because there is no polydipsia or polyuria. A patient in DKA is more likely to present with vomiting and not diarrhoea.- Recurrent aphthous stomatitis is not a correct answer because it does not explain all of the symptoms described, only the mouth ulcers.- Ulcerative colitis (UC) is also incorrect. UC is a form of inflammatory bowel disease that causes inflammation in the colon. The main symptom is bloody stools, which is not mentioned as a feature in history.
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This question is part of the following fields:
- Gastroenterology And Hepatology
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Question 23
Correct
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Which of the following findings would be NOT be expected in a child with kernicterus?
Your Answer: Learning disability
Explanation:Bilirubin encephalopathy (BE), also known as kernicterus is a preventable complication of neonatal jaundice. Bilirubin deposits in the basal ganglia, hippocampus, geniculate bodies and cranial nerve nuclei, exerting direct neurotoxic effects and causing mass-destruction of neurons by apoptosis and necrosis.The clinical features of this diagnosis have been well described and can be divided into 3 stages:Phase 1 (first few days of life): Decreased alertness, hypotonia, and poor feeding are the typical signs. Obviously, these are quite nonspecific and could easily be indicative of a multitude of neonatal abnormalities. A high index of suspicion of possible BIND at this stage that leads to prompt intervention can halt the progression of the illness, significantly minimizing long-term sequelae. Of note, a seizure is not typically associated with acute bilirubin encephalopathy.Phase 2 (variable onset and duration): Hypertonia of the extensor muscles is a typical sign. Patients present clinically with retrocollis (backward arching of the neck), opisthotonos (backward arching of the back), or both. Infants who progress to this phase develop long-term neurologic deficits. Phase 3 (infants aged >1 wk): Hypotonia is a typical sign.
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This question is part of the following fields:
- Neurology And Neurodisability
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Question 24
Correct
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A 1 day old baby girl is born with severe respiratory compromise. She is seen to have a scaphoid abdomen and an absent apex beat. Which anomaly does this baby have?
Your Answer: Bochdalek hernia
Explanation:Answer: Bochdalek herniaA Bochdalek hernia is one of two forms of a congenital diaphragmatic hernia, the other form being Morgagni hernia. A Bochdalek hernia is a congenital abnormality in which an opening exists in the infant’s diaphragm, allowing normally intra-abdominal organs (particularly the stomach and intestines) to protrude into the thoracic cavity. In the majority of patients, the affected lung will be deformed, and the resulting lung compression can be life-threatening. Bochdalek hernias occur more commonly on the posterior left side (85%, versus right side 15%).In normal Bochdalek hernia cases, the symptoms are often observable simultaneously with the baby’s birth. A few of the symptoms of a Bochdalek Hernia include difficulty breathing, fast respiration and increased heart rate. Also, if the baby appears to have cyanosis (blue-tinted skin) this can also be a sign. Another way to differentiate a healthy baby from a baby with Bochdalek Hernia, is to look at the chest immediately after birth. If the baby has a Bochdalek Hernia it may appear that one side of the chest cavity is larger than the other and or the abdomen seems to be scaphoid (caved in).Situs inversus (also called situs transversus or oppositus) is a congenital condition in which the major visceral organs are reversed or mirrored from their normal positions. The normal arrangement of internal organs is known as situs solitus while situs inversus is generally the mirror image of situs solitus. Although cardiac problems are more common than in the general population, most people with situs inversus have no medical symptoms or complications resulting from the condition, and until the advent of modern medicine it was usually undiagnosed. In the absence of congenital heart defects, individuals with situs inversus are homeostatically normal, and can live standard healthy lives, without any complications related to their medical condition. There is a 5-10% prevalence of congenital heart disease in individuals with situs inversus totalis, most commonly transposition of the great vessels. The incidence of congenital heart disease is 95% in situs inversus with levocardia.Cystic fibrosis is a progressive, genetic disease that causes persistent lung infections and limits the ability to breathe over time. In people with CF, mutations in the cystic fibrosis transmembrane conductance regulator (CFTR) gene cause the CFTR protein to become dysfunctional. When the protein is not working correctly, it’s unable to help move chloride — a component of salt — to the cell surface. Without the chloride to attract water to the cell surface, the mucus in various organs becomes thick and sticky. In the lungs, the mucus clogs the airways and traps germs, like bacteria, leading to infections, inflammation, respiratory failure, and other complications. Necrotizing enterocolitis (NEC) is a medical condition where a portion of the bowel dies. It typically occurs in new-borns that are either premature or otherwise unwell. Symptoms may include poor feeding, bloating, decreased activity, blood in the stool, or vomiting of bile.The exact cause is unclear. Risk factors include congenital heart disease, birth asphyxia, exchange transfusion, and premature rupture of membranes. The underlying mechanism is believed to involve a combination of poor blood flow and infection of the intestines. Diagnosis is based on symptoms and confirmed with medical imaging.Morgagni hernias are one of the congenital diaphragmatic hernias (CDH), and is characterized by herniation through the foramen of Morgagni. When compared to Bochdalek hernias, Morgagni hernias are:-anterior-more often right-sided (,90%)-small-rare (,2% of CDH)-at low risk of prolapseOnly ,30% of patients are symptomatic. New-borns may present with respiratory distress at birth similar to a Bochdalek hernia. Additionally, recurrent chest infections and gastrointestinal symptoms have been reported in those with previously undiagnosed Morgagni hernia.The image of the transverse colon is herniated into the thoracic cavity, through a mid line defect and this indicates that it is a Morgagni hernia since the foramen of a Morgagni hernia occurs in the anterior midline through the sternocostal hiatus of the diaphragm, with 90% of cases occurring on the right side.Clinical manifestations of congenital diaphragmatic hernia (CDH) include the following:Early diagnosis – Right-side heart; decreased breath sounds on the affected side; scaphoid abdomen; bowel sounds in the thorax, respiratory distress, and/or cyanosis on auscultation; CDH can often be diagnosed in utero with ultrasonography (US), magnetic resonance imaging (MRI), or bothLate diagnosis – Chest mass on chest radiography, gastric volvulus, splenic volvulus, or large-bowel obstructionCongenital hernias (neonatal onset) – Respiratory distress and/or cyanosis occurs within the first 24 hours of life; CDH may not be diagnosed for several years if the defect is small enough that it does not cause significant pulmonary dysfunctionCongenital hernias (childhood or adult onset) – Obstructive symptoms from protrusion of the colon, chest pain, tightness or fullness the in chest, sepsis following strangulation or perforation, and many respiratory symptoms occur.
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This question is part of the following fields:
- Paediatric Surgery
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Question 25
Correct
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A 6 year old child underwent an emergency splenectomy following trauma. After full recovery he is dismissed from the hospital and returns home. On re-examination, eight weeks later, the GP performs a full blood count with a film. What would you expect to see?
Your Answer: Howell-Jolly bodies
Explanation:Howell-Jolly bodies are often seen in post-splenectomy cases, together with Pappenheimer bodies, target cells and irregular contracted red blood cells. The loss of splenic tissue results in the inability to readily remove immature or abnormal red blood cells from the circulation.
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This question is part of the following fields:
- Haematology And Oncology
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Question 26
Incorrect
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Genetic point mutation occurs in which of the given genetic abnormalities?
Your Answer: Fragile X syndrome
Correct Answer: Haemochromatosis
Explanation:Point mutations are the type of mutations in which only a single nucleotide of the DNA is either deleted, substituted or a new single nucleotide is inserted into the DNA, causing alterations in the original normal DNA sequencing. The examples of point mutations include hemochromatosis, sickle cell disease, and Tay-Sach’s disease. Huntington’s disease is a trinucleotide repeat disorder. Down’s syndrome is characterized by an extra copy of chromosome 21, while Klinefelter syndrome is marked by an extra X chromosome. Fragile X syndrome is also a trinucleotide repeat disorder.
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This question is part of the following fields:
- Genetics And Dysmorphology
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Question 27
Incorrect
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A clinical trial is conducted to study the benefits of a new oral medication to improve the symptoms of patients with asthma. In the trial 400 patients with asthma, half were given the new medication and half a placebo. Three months later they are asked to rate their symptoms using the following scale: much improved, slight improvement, no change, slight worsening, significantly worse. What is the most appropriate statistical test to see whether the new medication is beneficial?
Your Answer: Chi-squared test
Correct Answer: Mann-Whitney U test
Explanation:The type of significance test used depends on whether the data is parametric (can be measured, usually normally distributed) or non-parametric.Parametric tests:Student’s t-test – paired or unpaired*Pearson’s product-moment coefficient – correlationNon-parametric tests:Mann-Whitney U test – unpaired dataWilcoxon signed-rank test – compares two sets of observations on a single samplechi-squared test – used to compare proportions or percentagesSpearman, Kendall rank – correlation.The outcome measured is not normally distributed, i.e. it is non-parametric. This excludes the Student’s t-tests. We are not comparing percentages/proportions so the chi-squared test is excluded. The Mann-Whitney U test is a nonparametric test of the null hypothesis that it is equally likely that a randomly selected value from one sample will be less than or greater than a randomly selected value from a second sample.This test can be used to investigate whether two independent samples were selected from populations having the same distribution.
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This question is part of the following fields:
- Epidemiology And Statistics
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Question 28
Correct
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A 4 year old girl is brought to the emergency due to fever and urinary urgency. The temperature is recorded to be 39C. Which of the following is the best investigation in this case?
Your Answer: Clean catch of urine
Explanation:Urine culture and sensitivity is used to diagnose a urinary tract infection (UTI). A mid-stream clean catch urine sample is the most common type of sample collected. It is important to follow the clean catch process to have accurate results from an uncontaminated sample. Urine cultures can also check for infections of the bladder or kidney.
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This question is part of the following fields:
- Renal
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Question 29
Incorrect
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A 12-year-old boy presented with jaundice and fatigue for the last two weeks. He complains of intermittent pain in his epigastrium. He is otherwise healthy with no history of vomiting, diarrhoea, loss of appetite or weight. History revealed that he has had fatigue all his life leading to him missing out on sports at regular intervals at school. His mother reports that he had two episodes of hepatitis at ages 5 and 7 years. There is no family history of jaundice. He has no significant travel history.On physical examination, yellow sclera were observed. Additionally, on abdominal examination, the splenic tip was palpable at 3 cm with some tenderness of the right upper quadrant. He was found to have mild tachycardia with normal blood pressure and no fever.Blood results:- Hb: 12.6 g/dl- MCV: 104 fL- MCHC: 38 g/dL- WBC Count: 10 x 109/L- Reticulocyte count: 148 x 109/L (Normal Range 20-100 x 109/L)- Bilirubin: 34 ÎĽmol/L- LDH: 600 lÎĽ/L (Normal Range 230-450 lÎĽ/l)- Direct Coomb's test: NegativeAbdominal ultrasonography revealed an enlarged spleen measuring 15 cmWhat is the most probable diagnosis?
Your Answer: Acquired autoimmune haemolitic anaemia (AIHA)
Correct Answer: Hereditary spherocytosis
Explanation:The most probable diagnosis based on the scenario provided above is hereditary spherocytosis.While jaundice and abdominal pain might make you think of hepatitis or cholecystitis in the first instance, the lack of fever suggests otherwise. The apyrexial presentation is against acute cholecystitis, and the past medical history reveals a chronic type of fatigue and two previous episodes of hepatitis. Furthermore, it is unlikely that the child has contracted infective hepatitis twice and now a third time! The most common cause of hepatitis in childhood is hepatitis A, however the lack of travel history to endemic areas makes this less likely. Hepatitis A is usually a mild, self-limiting disease that never presents with chronic symptoms. The chronicity of his fatigue and the blood results lead towards a haematological diagnosis. This is further substantiated by his low haemoglobin levels, high MCV and high reticulocyte count. Chronic haemolytic anaemia is the most likely cause, and the negative Coombs excludes autoimmune haemolytic anaemia (AIHA). Thus, leaving us with the answer as hereditary spherocytosis.Hereditary spherocytosis is a disorder that makes the cytoskeleton of red cells more fragile and therefore leads to red cell death and splenomegaly. Gallstones are a result of this red cell destruction and increased haem metabolism.
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This question is part of the following fields:
- Haematology And Oncology
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Question 30
Incorrect
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Which of the following is NOT a risk factor for neonatal polycythaemia?
Your Answer: Delayed clamping of the umbilical cord
Correct Answer: Jaundice
Explanation:Polycythaemia is a commonly occurring neonatal disorder, which is characterized by a venous haematocrit ≥ 65%. It increases the blood viscosity and causes microcirculatory flow impairment in the end-organs. Causes of polycythaemia are multi-factorial, but the significant risk factors are maternal diabetes, SGA, LGA or post-term birth, infants with chromosomal abnormalities, and delayed clamping of the cord. Jaundice is not a recognized risk factor for polycythaemia.
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This question is part of the following fields:
- Neonatology
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