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Question 1
Incorrect
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Which of the conditions, mentioned below, result in a continuous murmur?
Your Answer: Ventricular septal defect
Correct Answer: Blalock- Taussig shunt
Explanation:Blalock-Thomas-Taussig shunt is a surgical procedure done to increase pulmonary blood flow in cases like pulmonary atresia and results in a continuous murmur.The type of murmur which is heard during the systole and remains continuous till the second heart sound is known as a continuous murmur. This murmur is often intense and considered rough. It can also be accompanied by quivering. There are numerous causes of a continuous murmur that differ depending on the location and components of this murmur. It is caused by the shunting of blood from a high-pressure circulation to a low-pressure circulation. Pathological causes of a continuous murmur include patent ductus arteriosus, aortopulmonary window, AV malformation, coarctation of aorta, any acquired trauma, and iatrogenic cause like interventional or surgical procedures.
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This question is part of the following fields:
- Cardiovascular
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Question 2
Correct
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A new-born baby has a loud murmur, grade 3/6, at the upper left sternal edge. Which one of the following statements about examination techniques is correct?
Your Answer: Feeling femoral pulses is mandatory
Explanation:Heart murmurs are common in healthy infants, children, and adolescents. Although most are not pathologic, a murmur may be the sole manifestation of serious heart disease. Historical elements that suggest pathology include family history of sudden cardiac death or congenital heart disease, in utero exposure to certain medications or alcohol, maternal diabetes mellitus, history of rheumatic fever or Kawasaki disease, and certain genetic disorders. Physical examination should focus on vital signs| age-appropriate exercise capacity| respiratory or gastrointestinal manifestations of congestive heart failure| and a thorough cardiovascular examination, including features of the murmur, assessment of peripheral perfusion, and auscultation over the heart valves. Red flags that increase the likelihood of a pathologic murmur include a holosystolic or diastolic murmur, grade 3 or higher murmur, harsh quality, an abnormal S2, maximal murmur intensity at the upper left sternal border, a systolic click, or increased intensity when the patient stands. Electrocardiography and chest radiography rarely assist in the diagnosis.
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This question is part of the following fields:
- Cardiovascular
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Question 3
Incorrect
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A 11-year-old is referred to neurology due to episodes her GP feels are epileptiform. Her mother reports that she appears to just 'stop', sometimes even in mid conversation, for several seconds at random times during the day. During these episodes, she can be unresponsive to questioning and has no recollection of them.Which of these drugs is contraindicated in this condition?
Your Answer: Ethosuximide
Correct Answer: Carbamazepine
Explanation:The patient’s history points to absence seizures. Carbamazepine has been shown to aggravate generalized seizure types, especially absence seizures, because it acts directly on the ventrobasal complex of the thalamus which is critical to the neurophysiology of absence seizures.
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This question is part of the following fields:
- Neurology
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Question 4
Correct
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A new-born has several strawberry naevi. You're concerned about internal haemangiomas. How many naevi should warrant further investigation?
Your Answer: More than 5
Explanation:Eight percentage of infantile haemangiomas are focal and solitary. Sixty percent of cutaneous haemangiomas occur on the head and neck, 25% on the trunk, and 15% on the extremities. Haemangiomas also can occur in extracutaneous sites, including the liver, gastrointestinal tract, larynx, CNS, pancreas, gall bladder, thymus, spleen, lymph nodes, lung, urinary bladder, and adrenal glands.Guidelines on the management of infantile haemangioma were released in December 2018 by the American Academy of Paediatrics stating that:Imaging is not necessary unless the diagnosis is uncertain, there are five or more cutaneous infantile haemangiomas present, or there is suspicion of anatomic abnormalities.
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This question is part of the following fields:
- Neonatology
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Question 5
Correct
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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: 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 6
Incorrect
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Tall stature is NOT a characteristic finding in which of the following conditions?
Your Answer: Precocious puberty
Correct Answer: Laurence-Moon Syndrome
Explanation:A height that is above the 97th percentile for age and sex is described as a tall stature. The most common cause of tall stature is constitutional or familial, followed by nutritional causes. Hormonal causes of tall stature include hyperthyroidism, growth hormone excess, and precocious puberty. Some important chromosomal and syndromic causes of tall stature are Klinefelter’s syndrome, homocystinuria, Marfan’s syndrome, Sotos syndrome, Beckwith-Weidman syndrome, and Weaver syndrome. Laurence-Moon syndrome is an autosomal recessive disorder characterized by short stature, retinitis pigmentosa, and spastic paraplegia.
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This question is part of the following fields:
- Endocrinology
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Question 7
Correct
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Withdrawal from which of the following substances is associated with hypersomnia, hyperphagia, irritability?
Your Answer: Amphetamine
Explanation:Drug withdrawal symptoms after a period of substance abuse can lead to a range of symptoms. Amphetamines are known to cause hypersomnia, hyperphagia, and irritability, as well as vivid dreams as a result of withdrawal. Similar symptoms are found in cocaine withdrawal. Alcohol withdrawal presents with symptoms such as insomnia, tremulousness and delirium. Ecstasy withdrawal includes irritation, mood swings, fatigue and insomnia. Heroin withdrawal presents with symptoms which include dilated pupils, insomnia, abdominal cramps and muscle aches. Withdrawal from prolonged cannabis use can cause depression, anxiety restlessness and insomnia.
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This question is part of the following fields:
- Adolescent Health
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Question 8
Incorrect
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A 12-year-old girl is counselled about the changes that will occur in her body with puberty.In what order do these pubertal changes occur?
Your Answer: Growth of pubic hair, breast buds, growth of axillary hair
Correct Answer: Breast buds, growth of pubic hair, growth of axillary hair
Explanation:Three physical changes – breast budding, pubic hair growth, and axillary hair growth in the order mentioned precede menarche. These changes are due to oestrogen, a hormone essential for pubertal development.The various pubertal changes in males include:-Testicular growth: It is the first sign of puberty occurring at around 12 years of age (Range = 10 – 15 years).- Testicular volume: An increase in the volume of testicles to 4 ml indicates the onset of pubertyThe various pubertal changes in females include:- The first sign is breast development at around 11.5 years of age (range = 9-13 years)- Followed by the onset of height spurt reaching the maximum in puberty (at 12 years of age)- The final change that occurs is termed menarche at 13 (11-15) years of age.Some of the other pubertal changes include:- Gynecomastia may develop in boys- Asymmetrical breast growth may occur in girls- Diffuse enlargement of the thyroid gland
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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 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: 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 10
Correct
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Which of the following statements is true regarding the patterns of secretion of hormones?
Your Answer: Cortisol is secreted in a circadian pattern
Explanation:Cortisol is secreted in a circadian pattern.The secretion of cortisol is regulated by the suprachiasmatic nucleus located in the hypothalamus.Other options:- FSH, LH, GH and prolactin are secreted in a pulsatile pattern, i.e. these hormones are secreted in an episodic manner rather than continuously.- Thyroxine is secreted in a continuous pattern, not pulsatile.- The secretion of ACTH is in response to stress.Secondary to stress, the hypothalamus secretes corticotrophin releasing hormones, which are transported to the pituitary gland via the hypophyseal–portal system. ACTH is then released by the pituitary gland and binds to its receptor on the adrenal gland, which releases cortisol.
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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 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 12
Correct
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Which of the given features does NOT occur in association with aniridia?
Your Answer: Macular hypoplasia
Explanation:Aniridia is a genetic condition characterized by defects in the formation of a normal iris. The iris may be completely absent or only partially. One of the types of aniridia may be associated with other abnormalities like cataracts, glaucoma, corneal clouding, and nystagmus. The third type of aniridia is associated with intellectual disability, while a fourth type occurs in association with Wilm’s tumour. Aniridia may also be associated with amblyopia and buphthalmos, but macular hypoplasia is not a feature.
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This question is part of the following fields:
- Ophthalmology
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Question 13
Incorrect
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What is most likely to occur in lead poisoning?
Your Answer: Macrocytic anaemia
Correct Answer: Delayed developmental milestones
Explanation:Lead can be found in material used for mining, leaded paints and gasoline, glassware, toys, and even cosmetics. Lead poisoning is rare nowadays as the use of lead has been banned from many products. Lead is toxic and in certain concentrations can cause irreversible damage. Children are especially vulnerable as they absorb 4 times as much ingested lead as adults. The typical features of lead poisoning include developmental delay and behavioural disorders, microcytic anaemia, constipation and vomiting. Pulmonary fibrosis, Osteomalacia and cardiomyopathy are not known features of lead poisoning.
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This question is part of the following fields:
- Haematology And Oncology
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Question 14
Correct
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Which of the following conditions do NOT result in polyuria?
Your Answer: Hyperkalaemia
Explanation:Polyuria is defined as a total increase in the urine output or > 2L/m2 of daily urine produced in children. Polyuria can be a symptom of a vast number of medical conditions. The commonest and most important disease having polyuria as the main symptom is diabetes mellitus. Nephrogenic and central diabetes insipidus also results in polyuria along with polydipsia. Other conditions that lead to an increase in the urine output are renal failure, acute tubular necrosis, and exposure to high altitude. Hyperkalaemia does not result in polyuria| rather hypokalaemia can be an associated finding with polyuria in the case of diuretic abuse.
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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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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: Post-streptococcal glomerulonephritis
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 16
Correct
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A 7-year-old boy is diagnosed with metabolic acidosis as a result of severe dehydration. Which of the following conditions is most likely to cause severe dehydration and metabolic acidosis?
Your Answer: Severe diarrhoea
Explanation:Diarrhoea is defined as having three or more loose or liquid stools per day, or as having more stools than is normal for that person. Severe diarrhoea, causing fluid loss and loss of bicarbonate, will result in marked dehydration and metabolic acidosis.
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This question is part of the following fields:
- Fluid And Electrolytes
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Question 17
Correct
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A 12-year-old boy has a history of fever for one week (39C), with no other symptoms leading up to the fever. He recently had a surgical extraction of one of his incisors two weeks before consultation. On examination of CVS, a mid-systolic click followed by a late systolic murmur is heard. Which of the following is the most probable diagnosis?
Your Answer: Infection
Explanation:Tooth extraction or any surgical procedure may introduce bacteria into the blood stream. The most commonly involved organisms include Staphylococcus aureus and Streptococcus viridans. Once in the blood, these organisms have a very high tendency of attaching to the walls of the heart and causing inflammation known as endocarditis.
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This question is part of the following fields:
- Cardiovascular
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Question 18
Incorrect
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A 17-year-old boy presents with a 2 day history of colicky abdominal pain, vomiting and diarrhoea. He has been passing blood mixed with diarrhoea. He has no significant past medical history and takes no regular medication. On examination he is pyrexial and clinically dehydrated. Cardiorespiratory and abdominal examinations are normal. What is the most likely diagnosis?
Your Answer: Salmonella typhi infection
Correct Answer: Campylobacter infection
Explanation:The patient has bloody diarrhoea that sounds like a food poisoning in the clinical scenario. Campylobacter is the most common cause of this in the United Kingdom. This is then followed by Salmonella and Shigella. The symptoms are usually self limiting. This is more likely to be bacterial from the food than a viral gastroenteritis.
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This question is part of the following fields:
- Gastroenterology And Hepatology
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Question 19
Incorrect
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One of the main disadvantages of case control studies is:
Your Answer: They are observational
Correct Answer: The potential for recall bias
Explanation:Case control studies are observational studies which retrospectively determine whether a patient might have been exposed to a risk factor for a certain disease, as compared to a control group from the general population. They can be used for a range of outcomes as well as rare diseases. One of the biggest problems with this type of study is recall bias. Research subjects may selectively remember factors that are more predictive of the disease outcome when compared to the control group. All studies should have prior power calculations before the study commences.
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This question is part of the following fields:
- Epidemiology And Statistics
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Question 20
Incorrect
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A 10-year-old boy with faecal soiling secondary to constipation and overflow incontinence has not responded to over a year of medical management.A colonoscopy-guided biopsy has ruled out Hirschsprung's disease.Which of the following procedures would be appropriate in the surgical management of this child?
Your Answer: Laparotomy and resection megarectum
Correct Answer: Appendicostomy for anterior continence enemas
Explanation:The most appropriate procedure in the surgical management of this child would be to perform an appendicostomy for anterior continence enemas (Malone procedure).Idiopathic constipation leading to faecal incontinence is managed in a stepwise progression, first with laxatives such as movicol, enemas and stronger laxatives and in younger children inter-sphincteric injection of botox may be performed. Following this either anal irrigation or antegrade continence enemas are performed. Appendicostomy for anterior continence enemas allow colonic washouts and thereby rapid achievement of continence.Other options:- Defunctioning Ileostomy: Although an option in extreme cases, an ACE stoma would be more appropriate in this child.- Laparotomy for resection of the megarectum is performed if ACE stoma fails due to megarectum.- Left hemicolectomy is a procedure reserved for slow-transit colons to increase transit time.- Bishop-Koop stoma: It is a procedure of historical significance. It is a way of washing out and managing meconium ileus.
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This question is part of the following fields:
- Paediatric Surgery
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Question 21
Incorrect
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A 14-year-old male was involved in a bicycle accident. He was brought to the emergency department with abdominal pain. On the CT scan of the abdomen, a hematoma was present beneath the capsule of the spleen. His BP and pulse were normal. What is the next step in his management?
Your Answer: Immediate Laparotomy
Correct Answer: Refer to surgeons for observation
Explanation:A surgeon will observe the patient and will decide which procedure he needs.
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This question is part of the following fields:
- Paediatric Surgery
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Question 22
Correct
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A 4-year-old boy admitted with fever for 2 days had a left sided focal fits, which persisted for 4 minutes. There was no history of head injury. On examination, he was drowsy but there were no focal neurological signs. Urine dipstick was negative. What is the investigation of choice that can be done at this stage to arrive at a diagnosis?
Your Answer: CSF analysis
Explanation:This presentation could be due to either a meningitis or encephalitis, which are clinically not distinguishable from the given history. Encephalitis is mostly viral and in UK herpes simplex virus is the main cause. Advanced neuro imaging and EEG will help to differentiate them however from the given answers CSF analysis is the most appropriate, provided that intracranial pressure is not raised. CSF analysis will help to differentiate a pyogenic meningitis from other forms of meningitis and encephalitis.
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This question is part of the following fields:
- Infectious Diseases
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Question 23
Incorrect
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Two boys were playing when one of them brought the forearm of the other behind his back. This resulted in a stretching of the lateral rotator of the arm. Which of the following muscles was most likely to have been involved?
Your Answer: Teres major
Correct Answer: Infraspinatus
Explanation:There are two lateral rotators of the arm, the infraspinatus and the teres minor muscles. The infraspinatus muscle receives nerve supply from C5 and C6 via the suprascapular nerve, whilst the teres minor is supplied by C5 via the axillary nerve.
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This question is part of the following fields:
- Musculoskeletal
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Question 24
Correct
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Gertrude is an 18 month old child who is developing normally. Which of the following should she be able to do?
Your Answer: Follow commands such as 'give me a doll please'
Explanation:At the age of 18 months, Gertrude should be able to follow a one step command. At this age she would also be capable of putting words together in 1 or 2 word phrases, scribbling, throwing a ball, and building a tower of four cubes. At 2 she should be able to feed herself with a spoon or a fork, copy a vertical line, ride a tricycle, kick a ball and balance on one foot. Activities such as jumping will follow later on in her development at 3 years.
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This question is part of the following fields:
- Child Development
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Question 25
Correct
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A male had a deep vein thrombosis (DVT) in his left calf. After investigation, it was discovered that this was caused by a genetic disease and his children may be affected.What is the most common heritable cause of DVT?
Your Answer: Factor V Leiden
Explanation:Based on the studies, genetic factors are responsible for approximately 60 % DVT cases. Factor V (FV) Leiden which is the most common cause of inherited thrombophilia, predisposes patients to DVT because of resistance to protein C.The heritable causes of deep vein thrombosis, from most to least common are:Factor V LeidenProthrombin G20210A variantProtein C deficiencyProtein S deficiencyAntithrombin deficiencyVon Willebrand disease and thalassaemia are not causes of DVT.
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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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Which of the following vaccines do not contain live organisms?
Your Answer: Polio (Sabin)
Correct Answer: Polio (Salk)
Explanation:Live virus vaccines include: Vaccinia (smallpox), Measles, Mumps, Rubella (MMR combined vaccine), Varicella (chickenpox), Influenza (nasal spray), Rotavirus, Zoster (shingles) and Yellow fever. Inactivated vaccines are Polio (IPV), Hepatitis A and Rabies.
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This question is part of the following fields:
- Infectious Diseases
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Question 27
Correct
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Question 28
Incorrect
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A child presents for an endocrinological work-up. The doctors perform blood tests, an X-ray, a pelvic U/S and a brain MRI. Which of the following reasons would result in an advanced bone age?
Your Answer: Hypothyroidism
Correct Answer: Androgen excess
Explanation:Androgen excess is one of the most common causes of advanced bone age. It usually occurs in precocious puberty or congenital adrenal hyperplasia.
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This question is part of the following fields:
- Endocrinology
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Question 29
Correct
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A 3 year old male presents to the genetics clinic with a history of proximal myopathy. He has missed motor milestones and has pseudohypertrophy of the calves. Doctors suspect it might be Duchenne's muscular dystrophy. Which of the following should you advise the parents?
Your Answer: Girl offspring have a less than 10% chance of inheriting the condition
Explanation:Although initially thought to affect only boys, girls with DMD also have an estimated 10% chance of inheriting the condition. In girls, DMD may present with all or some clinical manifestations.
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This question is part of the following fields:
- Genetics And Dysmorphology
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Question 30
Correct
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A 6 year old child presents with a history of recurrent, intense nausea and vomiting. His mum reveals he hasn’t passed urine the whole day. Upon inspection, he looks lethargic and his eyes are sunken. What would be the most appropriate management?
Your Answer: IV fluid bolus then IV maintenance fluids
Explanation:The clinical picture suggests that the child is severely dehydrated. IV fluid bolus then IV maintenance fluids is the correct option.
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This question is part of the following fields:
- Gastroenterology And Hepatology
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SESSION STATS - PERFORMANCE PER SPECIALTY
