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Question 1
Incorrect
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A 16 year old female has been admitted to hospital after overdosing on paracetamol 4 hours ago. She has also consumed a large amount of alcohol. Her plasma paracetamol concentration is only just below a level which requires treatment. From the list of options, choose the most appropriate treatment option for this patient.
Your Answer: N-acetylcysteine
Correct Answer: Refer to psychiatry ward
Explanation:As her paracetamol level is under the required treatment threshold, she requires no medical treatment. However, she has taken a simultaneous drug overdose and excessive alcohol consumption. These two factors together require psychiatric evaluation and so she should be referred to the psychiatry ward.
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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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A 6 year old Somalian boy is admitted to the emergency department with dyspnoea. He looks distressed and has a heart rate of 180 bpm and a blood pressure of 130/90 mmHg. His respiratory rate is 37/min and his O2 saturation is 83% in room air. His temperature is 38C. His mother cannot speak English and neither does the child. The doctors observe that the boy has marked recession and a tracheal tug. He is crying and holding his chest. You immediately put the child on high flow oxygen, perform a chest X-ray and blood tests. The x-ray reveals bilateral pulmonary infiltrates. The blood results show:Hb:6g/dl, MCV:85fl, MCHC:36.0g/dl, WBC:19.6x109/l, neutrophils:15.3x109/l, PLT:350x109/l, CRP:50. His mother shows you that the child has been taking folic acid, hydroxyurea and Penicillin V daily, by pulling some tablets from her bag. What is the most probable diagnosis?
Your Answer: Sickle cell chest crisis
Explanation:The child is suffering from acute sickle cell crisis, a complication of sickle cell disease. It is characterised by a new segmental pulmonary infiltrate consistent with consolidation together with one or more new respiratory symptoms.The mainstay of treatment is oxygen support, (ventilation if required), hydration, antibiotics and analgesia.
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This question is part of the following fields:
- Haematology And Oncology
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Question 3
Incorrect
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Which of the following disorders are NOT associated with hypertrichosis?
Your Answer: Ciclosporin
Correct Answer: Psoriasis
Explanation:Among the given options, psoriasis is not associated with hypertrichosis.The causes of hypertrichosis include:- Drugs: minoxidil, ciclosporin, and diazoxide.- Congenital hypertrichosis lanuginosa and congenital hypertrichosis terminalis.- Porphyria cutanea tarda- Anorexia nervosa
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This question is part of the following fields:
- Dermatology
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Question 4
Incorrect
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A 4 year old boy diagnosed for the first time with nephrotic syndrome presents with oedema, low serum albumin and proteinuria. In which of the following circumstances is albumin infusion indicated?
Your Answer: Serum albumin 10 g/l
Correct Answer: Capillary refill time of 5 seconds
Explanation:In nephrotic syndrome, one of the main pathological processes is the excretion of protein by the kidneys. The resultant signs including| low serum albumin, oedema and hypovolemia all occur as a result of fluid escaping into the extracellular space due to a low oncotic pressure. While an albumin infusion may help to increase oncotic pressure, its indications specifically include hypovolemia, which is assessed by a capillary refill time more than 5 seconds, an elevated haematocrit, or severe symptomatic oedema, such as scrotal oedema. Hypertension not an indication for an infusion, and most patients needing an albumin infusion have oliguria.
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This question is part of the following fields:
- Nephro-urology
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Question 5
Incorrect
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An 8-week-old baby was found to have bilateral cataracts. Further investigation revealed thrombocytopenia, a patent ductus arteriosus and hepatosplenomegaly. Which of the following is the most probable diagnosis?
Your Answer: Cytomegalovirus (CMV)
Correct Answer: Rubella
Explanation:The clinical presentation is suggestive of congenital rubella syndrome. The classic triad of presenting symptoms includes sensorineural hearing loss, ocular abnormalities (cataract, infantile glaucoma, and pigmentary retinopathy) and congenital heart disease (patent ductus arteriosus and pulmonary artery stenosis). Other findings in congenital rubella syndrome include CNS abnormalities (mental retardation, behavioural disorders, encephalographic abnormalities, hypotonia, meningoencephalitis, and microcephaly), hepatosplenomegaly, and jaundice.
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This question is part of the following fields:
- Infectious Diseases
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Question 6
Incorrect
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A father brought his 6-year-old son with cystic fibrosis to the ER department due to massive hematemesis. He is hypotensive and has a tachycardia. Which is the most likely diagnosis?
Your Answer: Boerhaave’s syndrome
Correct Answer: Bleeding oesophageal varices
Explanation:Bleeding oesophageal varices secondary to portal hypertension can cause a massive gastrointestinal haemorrhage resulting in shock. Perforated ulcer is less likely in this age group. Mallory Weiss tear would not likely result in a massive haemorrhage. Aorto-intestinal fistula is more common in older patients with abdominal aneurysms. Boerhaave’s syndrome is a result of a ruptured oesophagus following excessive vomiting.
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This question is part of the following fields:
- Respiratory
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Question 7
Correct
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Leaner disease is associated with which of the given facts?
Your Answer: It is associated with failure to thrive
Explanation:Leiner disease belongs to a heterogeneous group of disorders associated with permanent or temporary complement C5 plasma deficiency. It is a rare disease that follows an autosomal recessive pattern of transmission. It is prevalent in female, breast-fed babies. The hallmark of this syndrome is severe diarrhoea, severe generalized seborrheic dermatitis, central nervous system defects, marked wasting, recurrent local and systemic infections, and failure to thrive.
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This question is part of the following fields:
- Dermatology
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Question 8
Incorrect
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Which of the following patient populations is most likely to present with primary vesicoureteric reflux?
Your Answer: Prepubertal boys
Correct Answer: New-born girls
Explanation:Vesicoureteric reflex (VUR) is described as the retrograde flow of urine from the bladder into the ureter due to an incompetent uterovesical junction. In primary VUR the lower urinary tract functions normally, while secondary VUR is associated with a poorly functioning lower urinary tract. The incidence of VUR is highest in new-born girls. They can present with hydronephrosis, or urinary tract infections.
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This question is part of the following fields:
- Nephro-urology
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Question 9
Incorrect
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A 6 year old child presents with a history of headaches that usually appear in the evening. The episodes started 6 months ago and the pain presents on both sides of the head. He perceives it as a “tight” feeling. His overall health is normal and he admits to be able to continue his daily activities regardless of the pain. Which of the following is the most probable diagnosis?
Your Answer: Psychogenic headache
Correct Answer: Tension headache
Explanation:Tension headache presents with pain that is pressing or tightening in quality, mild or moderate, and located bilaterally. It usually does not get worse with activities and may last from minutes to weeks.
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This question is part of the following fields:
- Neurology And Neurodisability
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Question 10
Correct
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What is the most common identified trigger of anaphylaxis in children?
Your Answer: Food
Explanation:In children, food-induced anaphylaxis is the most common trigger and accounts for 37 %–85 % of cases, whereas insect bites/stings account for 5 %–13 % and medications account for 5 %–12 % Despite differences between studies, food allergy is clearly the most common cause of anaphylaxis in children
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This question is part of the following fields:
- Emergency Medicine
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Question 11
Incorrect
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Which of the following are not a recognized feature of Down's syndrome?
Your Answer: Susceptibility to acute leukaemia
Correct Answer: Ataxic gait
Explanation:Ataxic gait is not a direct association of Down’s syndrome. All other given responses are associated with Down’s syndrome.
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This question is part of the following fields:
- Genetics And Dysmorphology
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Question 12
Incorrect
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A 11 year old girl with a history of recurrent chest infections, was admitted with a fever, productive cough, anorexia and weight loss. On examination she was febrile and tachycardic. Her mother said that the girl was not thriving well. Which of the following organisms is responsible for this presentation?
Your Answer: Mycobacterium TB
Correct Answer: Pseudomonas
Explanation:History of recurrent infections and failure to thrive (probably due to pancreatic enzyme insufficiency) is highly suggestive of cystic fibrosis. Pseudomonas has been identified as an important respiratory pathogen in patients with cystic fibrosis.
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This question is part of the following fields:
- Infectious Diseases
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Question 13
Incorrect
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An 18-year-old female suffering from acne vulgaris has been started on isotretinoin. Regarding this treatment, which of the following statements is the most applicable?
Your Answer: It can cause hirsutism
Correct Answer: Pregnancy should be avoided during and 1 month after treatment
Explanation:It is recommended that a woman wait one month after stopping isotretinoin before trying to become pregnant. Usually, isotretinoin is no longer found in a woman’s blood 4-5 days after the last dose and most of its by-products should be gone within 10 days after the last dose.
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This question is part of the following fields:
- Dermatology
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Question 14
Incorrect
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A routine vitamin D screening test reveals low calcium levels in a 3-year-old child.Which of the following could cause low calcium levels due to an artefact?
Your Answer: Fibrinogen
Correct Answer: Albumin
Explanation:The accuracy of the test for calcium levels in the blood is affected by the blood level of albumin. If albumin levels are low, the calcium level can also appear low.This is termed as pseudohypocalcemia.Hypocalcaemia usually presents with muscle spams. These can include spasms of voluntary muscle but also smooth muscle such as in the airways (causing bronchospasm) and in the heart (causing angina).
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This question is part of the following fields:
- Gastroenterology And Hepatology
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Question 15
Incorrect
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Which of the given pathologies follow the autosomal dominant pattern of inheritance?
Your Answer: Friedreich's ataxia
Correct Answer: Myotonic dystrophy
Explanation:The autosomal dominant pattern of inheritance involves the presence of at least one of the defected copies of the gene in an individual to develop a specific diseased condition. Examples of this mode of inheritance include myotonic dystrophy, neurofibromatosis, achondroplasia, etc. Still’s disease, also called juvenile idiopathic arthritis, is not a heritable disease. Tay-Sachs disease is an autosomal recessive disease., while spinocerebellar ataxia and Friedreich’s ataxia are caused by trinucleotide repeat expansion.
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This question is part of the following fields:
- Genetics And Dysmorphology
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Question 16
Incorrect
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A 15 month old boy has a history of repeated bacterial pneumonia, failure to thrive and a sputum culture positive for H.influenzea and S.pneumoniae. There is no history of congenital anomalies. He is most likely suffering from?
Your Answer: Acute leukaemia
Correct Answer: X-linked agammaglobulinemia
Explanation:Recurrent bacterial infections may be due to lack of B-cell function, consequently resulting in a lack of gamma globulins production. Once the maternal antibodies have depleted, the disease manifests with greater severity and is called x-linked agammaglobulinemia also known as ‘X-linked hypogammaglobulinemia’, ‘XLA’ or ‘Bruton-type agammaglobulinemia. it is a rare x linked genetic disorder that compromises the bodies ability to fight infections.
Acute leukaemia causes immunodeficiency but not so specific.
DiGeorge syndrome is due to lack of T cell function.
Aplastic anaemia and EBV infection does not cause immunodeficiency. -
This question is part of the following fields:
- Respiratory
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Question 17
Correct
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Which of the following is incorrect regarding the mechanism of action of metformin used in Polycystic ovary syndrome (PCOS) treatment?
Your Answer: Increases insulin production
Explanation:Metformin works by improving the sensitivity of peripheral tissues to insulin, which results in a reduction of circulating insulin levels. Metformin inhibits hepatic gluconeogenesis and it also increases the glucose uptake by peripheral tissues and reduces fatty acid oxidation. Metformin has a positive effect on the endothelium and adipose tissue independent of its action on insulin and glucose levels.Metformin was the first insulin sensitising drug (ISD) to be used in PCOS to investigate the role of insulin resistance in the pathogenesis of the syndrome Several effects have been reported as related to metformin in PCOS patients including restoring ovulation, reducing weight, reducing circulating androgen levels, reducing the risk of miscarriage and reducing the risk of gestational diabetes mellitus (GDM). Other studies have reported that the addition of metformin to the ovarian stimulation regime in invitro fertilization (IVF) improves the pregnancy outcome. These effects will be addressed individually.
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This question is part of the following fields:
- Endocrinology
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Question 18
Incorrect
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What are some of the derivatives of the second pharyngeal arch?
Your Answer:
Correct Answer: Stylohyoid muscle
Explanation:Also known as the hyoid arch, it forms the side and front of the neck. From its cartilage develops the styloid process, stylohyoid ligament and lesser cornu of the hyoid bone. The muscular derivatives include the muscles of facial expression, stapedius, stylohyoid and the posterior belly of the digastric. All these are innervated by cranial nerve VII but migrate into the area of the mandibular arch.
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This question is part of the following fields:
- Embryology
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Question 19
Incorrect
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A 1-day-old baby started having pallor and jaundice. The mother's first child did not have jaundice at birth. On clinical investigations, direct Coombs test is positive. Mother's blood group is A negative. Baby's blood group is O positive. What is the most probable cause of the condition of this new-born?
Your Answer:
Correct Answer: Rhesus incompatibility
Explanation:Jaundice in a new-born on the day of delivery is most likely due to Rh incompatibility. This occurs when the mother is Rh-negative and the baby is Rh-positive. Antibodies in the mother against the Rh factor in the baby will destroy the red blood cells in the baby, increasing the bilirubin in the blood. Breast milk jaundice and Galactosemia do not occur immediately after birth, and congenital rubella syndrome and formula feeding does not cause jaundice in babies.
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This question is part of the following fields:
- Gastroenterology And Hepatology
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Question 20
Incorrect
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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:
Correct 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 21
Incorrect
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A term baby is admitted to NICU from the postnatal ward following a large green vomit. The baby was born by forceps delivery following non-reassuring CTG trace. There was meconium-stained liquor just before delivery. Respiratory rate is 60/min, heart rate is 180/min and oxygen saturations are 94% in room air. On examination baby appears quiet with mild nasal flaring. There are no other signs of increased work of breathing. Heart sounds are normal with no murmurs. Femoral pulses are palpable bilaterally. CRT is <2 seconds centrally and baby feels warm peripherally. Abdomen is slightly distended and baby desaturates to 80% on abdominal palpation. What is the most important diagnostic test?
Your Answer:
Correct Answer: Upper GI contrast study
Explanation:Bilious (green) gastric aspirate or emesis indicates that the intestines are obstructed below the ampulla of Vater.Gastrointestinal (GI) endoscopy is actually considered an essential diagnostic and therapeutic technique. Upper GI endoscopy in neonatal age allows for exploration of the oesophagus, stomach and duodenum| instead lower GI endoscopy easily reaches the sigmoid-colon junction.
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This question is part of the following fields:
- Neonatology
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Question 22
Incorrect
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A 6 year old girl presents with an episode of DKA and receives a diagnosis of type 1 diabetes mellitus. Which of the following injection complications are more prevalent?
Your Answer:
Correct Answer: Lipohypertrophy
Explanation:Lypohypertrophy is the most common skin-related complication of insulin injection.
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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 16-year-old boy suffers recurrent episodes of haematuria following a flu-like illness. He is otherwise well. Physical examination is normal. Urinalysis reveals no proteinuria, blood ++, and 2–3 white blood cells/mm3. What is the most probable diagnosis?
Your Answer:
Correct Answer: IgA nephropathy
Explanation:IgA nephropathy’s characteristic presentation is haematuria following a non-specific upper respiratory infection as was evident in this case. IgA nephropathy also usually occurs in children and young males, like this patient.
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This question is part of the following fields:
- Renal
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Question 24
Incorrect
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A neonate has been observed, by his parents, twitching and jerking in his sleep. Which one of the following is not a cause of neonatal seizures?
Your Answer:
Correct Answer: Neonatal myoclonus
Explanation:Benign neonatal sleep myoclonus (BNSM) is a disorder commonly mistaken for seizures during the new-born period. It is characterized by myoclonic lightninglike jerks of the extremities that exclusively occur during sleep| it is not correlated with epilepsy.Causes of neonatal seizures:Hypoxic-ischemic encephalopathy: Hypoxic-ischemic encephalopathy disrupts the ATP-dependent sodium-potassium pump and appears to cause excessive depolarization.Intracranial haemorrhage: occurs more frequently in premature than in term infants. Subarachnoid haemorrhage is more common in term infants. This type of haemorrhage occurs frequently and is not clinically significant. Typically, infants with subarachnoid haemorrhage appear remarkably well. Metabolic disturbances include hypoglycaemia, hypocalcaemia, and hypomagnesemia. Less frequent metabolic disorders, such as inborn errors of metabolism, are seen more commonly in infants who are older than 72 hours. Typically, they may be seen after the infant starts feeding.Intracranial infections (which should be ruled out vigorously) that are important causes of neonatal seizures include meningitis, encephalitis (including herpes encephalitis), toxoplasmosis, and cytomegalovirus (CMV) infections. The common bacterial pathogens include Escherichia coli and Streptococcus pneumoniae.Cerebral malformationsBenign neonatal seizures
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This question is part of the following fields:
- Neonatology
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Question 25
Incorrect
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An infant born at term presents with low blood sugar and a history of poor feeding. She was born with exomphalos and a large left arm. What is the most probable condition that the baby is going to develop?
Your Answer:
Correct Answer: Wilms’ tumour
Explanation:The clinical picture suggests that the baby has Beckwith-Wiedemann Syndrome, which predisposes the individual to cancer. The most common childhood tumour that a person with Beckwith-Wiedemann Syndrome may develop is Wilms’ tumour. Typical features include: macrosomia, asymmetric limb growth, macroglossia, neonatal hypoglycaemia, umbilical hernias or other abdominal wall deformities.
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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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A 7-year-old boy was brought to the ED in an unconscious and apnoeic state. What is your immediate management of this case?
Your Answer:
Correct Answer: Secure airway
Explanation:ABC : Airway, breathing, circulation is the order of assessment in any patient that is unconscious and apnoeic.
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This question is part of the following fields:
- Neurology
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Question 27
Incorrect
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A 3-year-old girl presented with faecal incontinence for 2 weeks. Abdominal examination revealed a mass in right lower quadrant. Which of the following is the most appropriate management for this girl?
Your Answer:
Correct Answer: Laxatives
Explanation:Laxatives have been shown to be beneficial in the treatment of chronic childhood constipation. Studies have shown that polyethylene glycol, mineral oil, magnesium hydroxide, and lactulose are effective and can be used for a prolonged periods without risk.
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This question is part of the following fields:
- Gastroenterology And Hepatology
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Question 28
Incorrect
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Which of the following conditions is due to a deletion of chromosome 15q inherited from the father?
Your Answer:
Correct Answer: Prader-Willi
Explanation:Most cases of Prader-Willi syndrome are not inherited, particularly those caused by a deletion in the paternal chromosome 15 or by maternal uniparental disomy. These genetic changes occur as random events during the formation of reproductive cells (eggs and sperm) or in early embryonic development. Affected people typically have no history of the disorder in their family.Rarely, a genetic change responsible for Prader-Willi syndrome can be inherited. For example, it is possible for a genetic change that abnormally inactivates genes on the paternal chromosome 15 to be passed from one generation to the next.Prader-Willi syndrome is a complex genetic condition that affects many parts of the body. In infancy, this condition is characterized by weak muscle tone (hypotonia), feeding difficulties, poor growth, and delayed development. Beginning in childhood, affected individuals develop an insatiable appetite, which leads to chronic overeating (hyperphagia) and obesity. Some people with Prader-Willi syndrome, particularly those with obesity, also develop type 2 diabetes (the most common form of diabetes).
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This question is part of the following fields:
- Genetics And Dysmorphology
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Question 29
Incorrect
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A new-born child is not moving his left arm properly. He had shoulder dystocia during childbirth. His arm is hanging down with the shoulder internally rotated, elbow extended, forearm pronated and wrist flexed. What is the most likely diagnosis?
Your Answer:
Correct Answer: Erb palsy
Explanation:Erb’s palsy is a paralysis of the arm caused by injury to the brachial plexus, specifically the severing of the upper trunk C5–C6 nerves.The infant with an upper plexus palsy (C5-C7) keeps the arm adducted and internally rotated, with the elbow extended, the forearm pronated, the wrist flexed, and the hand in a fist. In the first hours of life, the hand also may appear flaccid, but strength returns over days to months.The right side is injured in 51% of cases. Left side occurs in 45% of patients and bilateral injuries, in 4%.
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This question is part of the following fields:
- Neonatology
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Question 30
Incorrect
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A 15-year-old girl has a 5-day history of fever, general malaise and headache and has developed diffuse raised oedematous papules. These lesions are typical of erythema multiforme. Which one of the following is true?
Your Answer:
Correct Answer: The lesions will heal without scarring
Explanation:Erythema multiforme lesions typically heal without scarring. Other options:- In erythema multiforme, lesions are typically symmetrical and acral, i.e. on the hands, feet and limbs. – HSV is a common cause of erythema multiforme in children, accounting for at least 50% of cases| the lesions typically have damaged skin in the centre and are dusky and bullous (in contrast to urticaria, where the centre of the lesion is normal).
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This question is part of the following fields:
- Dermatology
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SESSION STATS - PERFORMANCE PER SPECIALTY
