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Question 1
Incorrect
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A 6-year-old male was brought to the OPD with complaints of weight loss and fatigue for the last few months. On examination he was pale and had hepatosplenomegaly. A full blood count was ordered and it revealed immature white blood cells. Which of the following is the most likely diagnosis?
Your Answer:
Correct Answer: Leukaemia
Explanation:The age of the patient and the presence of immature white blood cells are suggestive of leukaemia. Hodgkin’s disease is unlikely in this age group and it usually presents with lymphadenopathy. In HIV, immature white blood cells are not present in the blood.
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This question is part of the following fields:
- Haematology And Oncology
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Question 2
Incorrect
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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:
Correct 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.
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This question is part of the following fields:
- Respiratory
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Question 3
Incorrect
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In a trial for a new treatment of lung disease, a traditional regime was given to 130 patients, 30 of whom died, while the new treatment was given to 125 patients, 20 of whom died. ¨¨Which of the following tools will be useful in calculating whether the above results are due to chance?
Your Answer:
Correct Answer: Chi-squared analysis
Explanation:The Chi squared test is used to find the relationship between two variables, determining whether they are not independent of each other. This test of statistical significance allows you to determine the degree of confidence with which you can accept or reject the null hypothesis. The student t test compares the significant differences in data means, while rank correlation, linear regression and the correlation coefficient all help to measure the linear relationship between variables.
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This question is part of the following fields:
- Epidemiology And Statistics
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Question 4
Incorrect
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Which of the following statements is correct regarding erythema nodosum?
Your Answer:
Correct Answer: The typical eruption is symmetrical, tender, and with bruise like lesions to the shins, ankles, and knees
Explanation:Erythema nodosum is the most common type of inflammation of the subcutaneous fat tissue, referred to as panniculitis. Erythema nodosum appears as painful, erythematous round lumps, usually symmetrically on the anterior aspect of lower extremities. These lesions are self-limiting and tend to resolve within 2-8 weeks without undergoing necrosis or ulceration. There are various causes of erythema nodosum, but the most important among children is the streptococcal throat infection. Other causes include autoimmune conditions like sarcoidosis, inflammatory bowel disease, mycobacterial infection (TB), drugs like penicillin and sulphonamides, and malignancies like some leukemias and lymphomas.
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This question is part of the following fields:
- Dermatology
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Question 5
Incorrect
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A 7-year-old female presented with complaints of haematuria and fatigue. She had a history of bloody diarrhoea starting 7 days previously. On investigation, her serum urea and creatinine were raised and proteinuria was present. Which of the following is the most suitable diagnosis for her?
Your Answer:
Correct Answer: Haemolytic-uremic syndrome (HUS)
Explanation:HUS syndrome occurs mostly in children after some days of bloody diarrhoea. Damaged red blood cells also damage the kidney filtering unit and lead to sudden renal failure.
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This question is part of the following fields:
- Renal
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Question 6
Incorrect
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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:
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.
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This question is part of the following fields:
- Respiratory
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Question 7
Incorrect
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A 1-year old infant is brought to the emergency by her parents with difficulty breathing. Examination reveals stridor from an oedematous airway, bilateral wheezing and low blood pressure. Which of the following medications would result in the reversal of these symptoms?
Your Answer:
Correct Answer: Adrenaline
Explanation:Adrenaline (epinephrine) narrows blood vessels and opens airways in the lungs. These effects can reverse severe low blood pressure, wheezing, severe skin itching, hives, and other symptoms of an allergic reaction.
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This question is part of the following fields:
- Emergency Medicine
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Question 8
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:
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 9
Incorrect
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A 15-year-old girl was diagnosed with bacterial meningitis. Gram staining of the spinal fluid shows numerous polymorphonuclear neutrophils and Gram-positive cocci. Which is the empiric drug of choice to be given to the patient until the antibiotic sensitivity report is available?
Your Answer:
Correct Answer: Methicillin
Explanation:Bacterial meningitis (including meningococcal meningitis, Haemophilus influenzae meningitis, and staphylococcal meningitis) is a neurologic emergency that is associated with significant morbidity and mortality. Initiation of empiric antibacterial therapy is therefore essential for better outcomes. The patient appears to be suffering from meningitis caused by Staphylococcus aureus. Methicillin would be the drug of choice . It is bactericidal and unlike streptomycin and chloramphenicol it is not associated with toxicity
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This question is part of the following fields:
- Emergency Medicine
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Question 10
Incorrect
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A 10-year-old boy sustained a fracture of his right elbow, which damaged the ulnar nerve behind the medial epicondyle of the humerus. A month later, he still has a total ulnar nerve paralysis. Which of the following can be observed on examination?
Your Answer:
Correct Answer: Inability to grip a sheet of paper between his fingers when the hand is placed flat on the table
Explanation:Among the given options, the inability to grip a sheet of paper between his fingers when the hand is placed flat on the table is the feature of ulnar nerve injury. Rationale:The ulnar nerve (usually) supplies sensation to the skin of the fifth and the ulnar side of the fourth finger, front and back. Following the injury of the nerve, the following functions are impaired:- There is a sympathetic interruption, with the absence of sweating in the affected area. – The thenar muscles are supplied by the median nerve and are therefore spared. – The ulnar nerve also supplies the muscles of the hypothenar eminence. – Although the ring and little fingers are held in the clawed position when the nerve is injured at the wrist, a high lesion paralyses the long flexors to these two fingers and results in the loss of this sign. The test for paralysis of the palmar interossei, supplied by the ulnar nerve, is the inability to adduct the fingers and thus to be unable to grip a sheet of paper between them.
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This question is part of the following fields:
- Anatomy
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Question 11
Incorrect
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Parents of a new-born are worried about cot death. What advice will you give?
Your Answer:
Correct Answer: Child should sleep on the back with legs towards the end of the cot
Explanation:Cot death also know as SIDS or Sudden Infant Death syndrome. Putting a baby to sleep on his back has been shown to reduce the risk of SIDS.
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This question is part of the following fields:
- Neonatology
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Question 12
Incorrect
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A 16-year-old girl is brought to the emergency by her parents who describe what seems to be an episode of generalized tonic-clonic seizures, after she came home from an all-night party around 6 am. Her father has epilepsy and one of her cousins sometimes has episodes of blank spells. Neurological examination shows no abnormalities. Which of the following diagnosis is most likely in this case?
Your Answer:
Correct Answer: Juvenile myoclonic epilepsy
Explanation:In people with juvenile myoclonic epilepsy, symptoms can be brought on by: -Sleep deprivation-Psychological stress-Alcohol and drug use-Noncompliance of medication-Flickering lights such as strobe lights -Menses-Time of day – usually mornings
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This question is part of the following fields:
- Neurology And Neurodisability
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Question 13
Incorrect
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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:
Correct 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.
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This question is part of the following fields:
- Musculoskeletal
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Question 14
Incorrect
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A 15-year-old girl presents with vomiting and her investigations show:Sodium 115 mmol/L (137-144)Potassium 3.0 mmol/L (3.5-4.9)Urea 2.1 mmol/L (2.5-7.5)Urine sodium 2 mmol/LUrine osmolality 750 mosmol/kg (350-1000)What is the most likely diagnosis?
Your Answer:
Correct Answer: Bulimia nervosa
Explanation:The patient is most likely to have Bulimia nervosa. A young girl with a low body mass contributes to the low urea. Hypokalaemia and hyponatraemia are due to vomiting. Her urine sodium is also low.- In Addison’s diseases, there are low levels of sodium and high levels of potassium in the blood. In acute adrenal crisis: The most consistent finding is elevated blood urea nitrogen (BUN) and creatinine. Urinary and sweat sodium also may be elevated. – In Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH) there is hyponatremia with corresponding hypo-osmolality, continued renal excretion of sodium, urine less than maximally dilute and absence of clinical evidence of volume depletion.
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This question is part of the following fields:
- Endocrinology
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Question 15
Incorrect
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A 9-year-old boy was conservatively managed for an appendicular mass. The parents enquire whether to have an interval appendicectomy to prevent the chances of having appendicitis again. What percentage of patients with conservatively managed appendix mass are likely to develop recurrent appendicitis?
Your Answer:
Correct Answer: 0-20%
Explanation:The chance of having appendicitis again after appendix mass is around 17% in children. While the traditional teachings by Hamilton Bailey recommend following the conservative Ochsner-Sherren regimen followed by an interval appendicectomy six weeks after the discharge of the patient, there remains a looming controversy whether to perform an interval appendicectomy or not.
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This question is part of the following fields:
- Paediatric Surgery
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Question 16
Incorrect
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A family of five members presents to the genetics clinic for further evaluation. The father, one boy and one girl present with a short stature, large heads, short digits, and trident hands. Genetic evaluation reveals they are all heterozygotes for a specific mutation. The rest of the family, the mother and the other daughter, do not carry this mutation. What is the pattern of inheritance?
Your Answer:
Correct Answer: Autosomal dominant with complete penetrance
Explanation:In this case, the affected individuals are all heterozygotes. Therefore, the mutation is autosomal dominant. Also, the mother does not carry the mutation, further confirming the autosomal dominant nature of the disease, which is most probably achondroplasia.
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This question is part of the following fields:
- Genetics And Dysmorphology
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Question 17
Incorrect
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A 15 year old girl presented to the emergency with a history of chronic cough, fever and weight loss. Her chest X-ray showed multiple nodules 1-4 cm in size and some of them with cavitation especially in the upper lobe. A sputum sample was positive for acid fast bacilli. Which of the following cells played a part in the development of the lung lesions?
Your Answer:
Correct Answer: Macrophage
Explanation:The characteristic cells in granulomatous inflammation are giant cells, formed from merging macrophages and epithelioid cells elongated with granular eosinophilic cytoplasm. Granulomatous reactions are seen in patients with tuberculosis. A tuberculous/caseating granuloma is characterised by a zone of central necrosis lined with giant multinucleated giant cells (Langhans cells) and surrounded by epithelioid cells, lymphocytes and fibroblasts. The caseous zone is present due to the damaged and dead giant cells and epithelioid cells. Mast cells are only few in number and fibroblasts lay down collagen. Basophils are not present. The giant cell made up of macrophages are the most abundant cells in this inflammatory process.
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This question is part of the following fields:
- Respiratory
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Question 18
Incorrect
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An 12 year old boy presents with a 2 day history of a tree climbing accident in which a small branch gave way, leaving him suspended by one arm. He can move his arm into any position but is unable to use his hand effectively.Which of the following structures has he most likely damaged in the accident?
Your Answer:
Correct Answer: The T1 nerve root
Explanation:The boy is most likely to have sustained an injury to his brachial plexus as a result of upward traction of his arm for an extended period of time. We can rule out the topmost nerve roots of the brachial plexus, C6 and C7 as these supply the larger muscles of the arm responsible for moving the shoulder, the elbow and the wrist. The anatomical structure affected is therefore the T1 nerve root which is responsible for movement of the muscles in the hand. This type of injury is called a Klumpke’s Palsy, which is the result of a hyper-abducted trauma to the arm, damaging the C8 and T1 nerve roots. While the radial and ulnar nerve also innervate the hand, the history given points to Klumpke’s palsy as the best explanation for this mechanism of injury.
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This question is part of the following fields:
- Anatomy
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Question 19
Incorrect
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A 26-year-old doctor who has recently been diagnosed with melanoma asks about survival rates associated with this condition. Which of the following statistical methods is employed to predict the survival rates?
Your Answer:
Correct Answer: Kaplan-Meier estimator
Explanation:The Kaplan-Meier estimator, also known as the product limit estimator, is a non-parametric statistic used to estimate the survival function from lifetime data. In medical research, it is often used to measure the fraction of patients living for a certain amount of time after treatment.
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This question is part of the following fields:
- Adolescent Health
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Question 20
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:
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 21
Incorrect
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A 6 year old child diagnosed with minimal change nephrotic syndrome, presents with lower limb oedema. Which of the following is most likely lost upon urination?
Your Answer:
Correct Answer: Anti-thrombin III
Explanation:Minimal change nephrotic syndrome leads to the loss of anti-thrombin III which protects the body from forming venous emboli. It may be triggered by virus, immunisations, medication, non-Hodgkin lymphoma, or leukaemiaCharacterised by oedema, proteinuria, hypoalbuminemia, and hypercholesterolemia.
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This question is part of the following fields:
- Nephro-urology
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Question 22
Incorrect
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A 14-year-old girl presents with short stature, webbed neck and primary amenorrhoea.Given the likely clinical diagnosis, which hormone replacement is most crucial over the longer term?
Your Answer:
Correct Answer: Oestrogen
Explanation:This girl most likely has Turner syndrome (TS) also known as 45,X, a condition in which a female is partly or completely missing an X chromosome. Signs and symptoms vary among those affected. Often, a short and webbed neck, low-set ears, low hairline at the back of the neck, short stature, and swollen hands and feet are seen at birth. Typically, they are without menstrual periods, do not develop breasts, and are unable to have children. Heart defects, diabetes, and low thyroid hormone occur more frequently. Most people with TS have normal intelligence. Many, however, have troubles with spatial visualization such as that needed for mathematics. Vision and hearing problems occur more often. Turner syndrome is not usually inherited from a person’s parents. No environmental risks are known and the mother’s age does not play a role. As a chromosomal condition, there is no cure for Turner syndrome. However, much can be done to minimize the symptoms including prescribing growth hormone, either alone or with a low dose of androgen, and oestrogen replacement therapy which is crucial long term for maintaining good bone integrity, cardiovascular health and tissue health
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This question is part of the following fields:
- Endocrinology
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Question 23
Incorrect
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A pathologist is examining a histological section and identifies Hassall's corpuscles.With what are they most commonly associated?
Your Answer:
Correct Answer: Medulla of the thymus
Explanation:Hassall’s corpuscles are groups of epithelial cells within the thymic medulla. The physical nature of these structures differs between mammalian species. Although Hassall’s corpuscles have been proposed to act in both the removal of apoptotic thymocytes and the maturation of developing thymocytes within the thymus, the function of Hassall’s corpuscles has remained an enigma.
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This question is part of the following fields:
- Haematology And Oncology
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Question 24
Incorrect
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A 13-year-old boy presents with a two-week history of malaise, sore throat, odynophagia, and dysphagia. On examination, patchy white spots were noted in his oropharynx. An upper GI endoscopy revealed similar lesions in the oesophagus. Which of the following is most likely to identify the underlying pathology in this patient?
Your Answer:
Correct Answer: Viral serology
Explanation:Based on the given scenario, the most probable diagnosis for this patient is acquired immune deficiency syndrome (AIDS) caused by human immunodeficiency virus (HIV). Thus, the most appropriate investigation to confirm the underlying pathology in this patient would be viral serology. Rationale:The presence of oesophageal candidiasis is highly suggestive of severe immunosuppression. The causes of immunosuppression can be chemotherapy, with haematological malignancy, HIV or inhaled steroids. In patients with HIV, oesophageal candidiasis is part of the spectrum of AIDS-defining illnesses and usually occurs when the CD4 count is < 200 cells/microL. Other AIDS-defining illnesses include PCP pneumonia and CMV infections.Oesophageal Candidiasis:It is characterised by white spots in the oropharynx with extension into the oesophagus. It seldom occurs without an associated underlying risk factor like broad-spectrum antibiotic usage, immunosuppression and immunological disorders.Patients may present with oropharyngeal symptoms, odynophagia and dysphagia.Treatment is directed both at the underlying cause (which should be investigated for) and with oral antifungal agents.
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This question is part of the following fields:
- Gastroenterology And Hepatology
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Question 25
Incorrect
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A 14-year-old uncontrolled asthmatic is started on a steroid inhaler. Which of the following is the most common adverse effect he might complain about?
Your Answer:
Correct Answer: Dysphonia
Explanation:Usage of inhaled corticosteroids are less associated with systemic adverse effects. However they are associated with local complications including dental caries and most commonly dysphonia.
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This question is part of the following fields:
- Respiratory
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Question 26
Incorrect
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A 12 year old boy has a high HbA1c and is being checked by the diabetic specialist nurse. He has been skipping meals lately and his school teachers have noticed that he's been unhappy. Who do you suggest his parents take him to?
Your Answer:
Correct Answer: Clinical psychologist
Explanation:The boy is most probably a type 1 diabetic patient. Such a condition can affect the behaviour and psychological state of a young child reflected in their behaviour. The parents should seek the help of a clinical psychologist.
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This question is part of the following fields:
- Renal
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Question 27
Incorrect
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A 15-year-old boy is brought to the clinic by his parents who are worried that their child may have stopped growing. Which of the following hormones is chiefly responsible for cessation of growth and epiphyseal fusion?
Your Answer:
Correct Answer: Oestrogen
Explanation:Many factors are related with the stimulation of bone formation and growth, the pubertal growth spurt, epiphyseal senescence, and fusion, including nutritional, cellular, paracrine, and endocrine factors. An important cellular factor in these processes is the differentiation and aging of chondrocytes in the growth plate. Important paracrine factors include the many molecular pathways involved in chondrocyte differentiation, vascularization, and ossification. Oestrogen and the GH-IGF-I axis are important endocrine factors.
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This question is part of the following fields:
- Endocrinology
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Question 28
Incorrect
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An 8-year-old girl is diagnosed with type-1 diabetes mellitus. She has three regular meals daily. Which of the following is the insulin regimen of choice for this patient?
Your Answer:
Correct Answer: Basal-bolus regimen
Explanation:In older children who are able to have regular meal timings, the insulin regimen of choice is the basal-bolus regimen, which comprises a dose of long-acting insulin in combination with three doses of short-acting insulin. The dosage timings coincide with the meal times, ensuring greater flexibility and feasibility. The long-acting insulin serves to provide a stable glycaemic control. The other given regimens are suitable for younger children with a more irregular meal schedule.
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This question is part of the following fields:
- Endocrinology
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Question 29
Incorrect
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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:
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.
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This question is part of the following fields:
- Musculoskeletal
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Question 30
Incorrect
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Among the gastrointestinal system pathologies mentioned below, which one does NOT frequently occur in anorexia nervosa?
Your Answer:
Correct Answer: Hepatosplenomegaly
Explanation:Anorexia nervosa is a serious, psychiatric eating disorder characterized by distorted self-image due to which abnormal eating behaviours are adopted. This disorder affects multiple bodily systems, including the gastrointestinal system. The GI manifestations of anorexia are enlarged salivary glands due to purging behaviour, gastritis, gastroparesis, acute gastric dilatation, superior mesenteric artery syndrome, elevated liver transaminases, which cause hepatocyte apoptosis leading to cirrhosis, and steatosis leading to fatty liver. Hepatosplenomegaly is not a recognized complication of anorexia nervosa.
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This question is part of the following fields:
- Gastroenterology And Hepatology
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SESSION STATS - PERFORMANCE PER SPECIALTY
