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Question 1
Correct
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A 7-year-old girl was brought to the hospital with complaints of fever. 5 days ago, she was taken to her GP with lower abdominal pain and leukocytes 3+ on urine dipstick. She was treated with trimethoprim. On examination, she is found to have a low-grade pyrexia, a CRP of 254 mg/L, and a palpable mass in the right iliac fossa. She is able to consume both solids and liquids. Based on the clinical scenario, what is the probable diagnosis and most appropriate management for this child?
Your Answer: This is an appendix mass and intravenous antibiotics where observation is the initial treatment
Explanation:The most appropriate diagnosis for this patient is appendicular mass. The initial treatment, according to the Ochsner-Sherren regimen recommended by Hamilton Bailey, would be the initiation of intravenous antibiotics.RationaleThe presentation is highly suggestive of appendicular mass. The correct management is broad-spectrum intravenous antibiotics such as co-amoxiclav and amikacin plus observation. Conservative management is the preferred treatment as surgical exploration at this stage can result in increased morbidity.The child should be allowed to eat and drink. If there are on-going temperature spikes, signs of obstruction or severe colicky abdominal pain, then surgery is required. The majority of patients respond to conservative management.Other options:- This is a partially treated appendicitis which has formed an appendix mass. Rather than planning appendectomy immediately| Hamilton Bailey recommended interval appendectomy after 6 weeks post-discharge. However, the need for interval appendectomy is still under debate.- Drainage via interventional radiology is not recommended in this patient as it can lead to swinging pyrexia secondary to peritonitis secondary to the collection.- The patient would have high-grade pyrexia and be constitutionally unwell if the patient was a patient of pyelonephritis. The presentation of the patient is more suggestive of appendicular mass.- The history would be more extended with symptoms of weight loss and altered bowel habit if the patient had Crohn’s disease.
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This question is part of the following fields:
- Paediatric Surgery
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Question 2
Incorrect
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A 10-month-old boy is brought to clinic. His parents are concerned because two days ago, he met another child with mumps. Which is the most appropriate strategy for this child?
Your Answer: He should receive the MMR now
Correct Answer: Do nothing now but give MMR at the appropriate age
Explanation:Immunity against mumps develops over a long time. There is nothing to be done except to proceed with the usual vaccination schedule.
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This question is part of the following fields:
- Infectious Diseases
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Question 3
Incorrect
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What would you administer to a child with a clean wound that has never been immunized before, assuming there is no contraindication to immunization?
Your Answer: 1 single injection DTP
Correct Answer: Full course of diphtheria, tetanus, polio
Explanation:A not immunized patient with a clean wound requires an immediate vaccination against diphtheria, tetanus and polio, according to the Green Book of Immunisation against infectious disease. (The Green Book has the latest information on vaccines and vaccination procedures, for vaccine preventable infectious diseases in the UK.)
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This question is part of the following fields:
- Immunology
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Question 4
Incorrect
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Which of the following chemical substances is NOT a component of amniotic fluid?
Your Answer: Granulocyte colony-stimulating factor
Correct Answer: Interleukin-1
Explanation:Amniotic fluid is the protective liquid that surrounds the fetus in utero. It prevents the fetus from injury, protects the umbilical cord from compression, and provides necessary nutrients and a medium for growth and movement. Amniotic fluid originates from the maternal plasma initially, but by 16th week of gestation, fetal kidneys start making urine which contributes to further production of the amniotic fluid. Amniotic fluid contains a number of chemical substances including hormones, tumour markers, nutrients, electrolytes, and immunoglobulins. Main substances found in amniotic fluid include carbohydrates, proteins, lipids, lactoferrin, insulin-like growth factor, granulocyte colony-stimulating factor, erythropoietin, etc. Interleukin-1 is not a component of AF.
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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 6 month old baby presents with a sausage-shaped abdominal mass and a history of green vomit a few hours earlier. The baby was born at 38 weeks of gestation and immigrated recently form the Philippines with his parents. What is the most probable diagnosis?
Your Answer: Intussusception
Explanation:Intussusception is the invagination of one segment of the intestine within a more distal segment. It presents with vomiting, abdominal pain, and a palpable abdominal mass.Intussusception usually affects infants between 6-18 months old. Boys are affected twice as often as girls
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This question is part of the following fields:
- Emergency Medicine
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Question 6
Correct
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A 4 year old boy is wetting his bed at night or whenever he gets excited. His parents are concerned. What is the best strategy?
Your Answer: Behavioural therapy
Explanation:Generally, bed-wetting before age 7 isn’t a concern as the child may still be developing night-time bladder control. The child is less than 5 years and most children will outgrow bed-wetting on their own. Therefore only reassurance and behavioural therapy are suggested at this stage.
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This question is part of the following fields:
- Child Development
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Question 7
Correct
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A 2-year-old presented with symptoms of gastroenteritis. Which of the following signs is the strongest indicator for IV fluid administration?
Your Answer: Capillary refilling time > 4secs
Explanation:Children are very prone to dehydration during an episode of gastroenteritis. Dehydration is detected early by increased capillary filling time.
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This question is part of the following fields:
- Gastroenterology And Hepatology
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Question 8
Correct
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Which of the given bioactive factors is NOT a component of normal human breast milk?
Your Answer: Basophil
Explanation:Human breast milk composition is best suited to meet all the growth and development requirements of a baby. It contains numerous biochemicals ranging from macronutrients, micronutrients, minerals, immunoglobulins, inflammatory markers, and growth factors. The major bioactive factors found in human breast milk are: immunoglobulins (IgA, IgG, and IgM), cells (macrophages and stem cells), growth factors (epidermal growth factor, tumour necrosis factor-alpha, transforming growth factor-beta, and vascular endothelial growth factor), cytokines, chemokines, hormones, metabolic hormones, glycans, and mucins.
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This question is part of the following fields:
- Nutrition
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Question 9
Correct
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A 15-year-old male presents complaining of gradually increasing fatigue. He says that he turned vegan a year ago. He explains that he takes vitamin B12 supplements every day. Considering iron deficiency anaemia as a possible cause, you order some blood tests to confirm. Which of the following would increase the ability of the body to absorb dietary iron?
Your Answer: Consuming iron in its ferrous (Fe2+) form
Explanation:Consuming iron in its Fe2+ (ferrous form) form can improve the ability to absorb dietary iron in patients with iron deficiency anaemia (IDA). Clinical features of IDA include:- Koilonychia- Atrophic glossitis- Post-cricoid webs- Angular stomatitisThe peripheral blood smear shows the following abnormal RBC morphologies:- Target cells- Pencil poikilocytes- Microcytic-hypochromic cells
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This question is part of the following fields:
- Haematology And Oncology
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Question 10
Correct
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A 17-year-old girl presents to the clinic complaining of dry skin and amenorrhoea for the past 9 months. She goes to college and is performs well academically. Physical examination shows an underweight girl (weight 38 kg), height 1.78 m (5 ft 10 inches). Excessive small hair can be seen growing on the body. Labs are significant for an elevated cortisol level, normal T4 level, and anaemia associated with reduced WBCs and platelets. Based on this clinical picture, what is the most likely cause of her symptoms?
Your Answer: Anorexia nervosa
Explanation:Anorexia nervosa is an eating disorder defined by restriction of energy intake relative to requirements, leading to a significantly low body weight. Patients will have an intense fear of gaining weight and distorted body image with the inability to recognize the seriousness of their significantly low body weight. Athletes in sports such as ballet, long-distance running, and martial arts are pressured to maintain lean body weights to outperform the competition.
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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 6 year old child presents with acute scrotal pain. Clinical examination reveals scrotal tenderness, redness, swelling, and associated hydrocele. What is the most likely diagnosis?
Your Answer: Mumps
Correct Answer: Torsion of the hydatid of Morgagni
Explanation:Although all of the options may lead to an acute red scrotum, torsion of the hydatid of Morgagni is the most common cause at this age (age 12-16 years).
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This question is part of the following fields:
- Paediatric Surgery
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Question 12
Correct
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When measuring blood pressure in infants and children, which one of the following statements is accurate?
Your Answer: Doppler methods of auscultation are especially helpful in infants
Explanation:Using a Doppler device, you can estimate systolic BP even when the pulse is inaudible. Handheld and portable, the device uses ultrasound waves to detect the velocity of arterial blood flow. Helpful for patients with traumatic injuries or shock, the Doppler technique is also useful for children and patients whose BP is hard to hear because of oedema, obesity, vasoconstriction, or low cardiac output.
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This question is part of the following fields:
- Nephro-urology
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Question 13
Correct
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A 15-year-old boy presents to the clinic with a concern that many of his friends are now taller than him. He feels that he has not grown as they have. On physical examination, sparse dark coarse hair was observed over the junction of the pubes. He reports having noticed some enlargement of his penis and growth of his testis. His testicular volume was measured to be 8 ml. What is the most likely diagnosis?
Your Answer: Normal puberty
Explanation:Based on the clinical scenario, the boy is going through normal pubertal changes.In the 3 years before puberty, low pulsatile LH levels become detectable during sleep. LH and FSH are produced in the anterior pituitary and released due to pulsatile gonadotrophin-releasing hormone (GnRH) secreted by the hypothalamus. There is an increase in the amplitude and frequency of LH secretion as puberty approaches, which causes enlargement of the gonads. In boys, the testicles produce testosterone, and in girls, the ovaries produce oestradiol and ovarian androgens, which, with the adrenal androgens, produce secondary sexual characteristics.Note:The average age at onset of puberty is 11 years in girls. The first sign is breast bud development, followed by the appearance of pubic hair 6–12 months later. Menarche usually occurs 2–2.5 years after breast bud development. Peak height velocity in girls occurs at breast stage 2–3 and virtually always precedes menarche. The onset of puberty in boys is at 11.5 years. The first sign is testicular enlargement (>3 ml) and thinning of the scrotum. This is followed by the pigmentation of the scrotum and growth of the penis, and pubic hair follows. Peak height velocity (growth spurt) is two years later in boys than in girls and occurs at testicular stage 4–5 (i.e. testicular volume 10–12 ml), which is around 13–14 years of age. Breast enlargement occurs in 40–60% of boys (rarely, significant enough to cause social embarrassment in 10%) and is a result of oestradiol produced by the metabolism of testosterone. It usually resolves within three years. During puberty, elongation of the eye often occurs, causing short-sightedness.
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This question is part of the following fields:
- Endocrinology
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Question 14
Incorrect
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A 12 year old female presents at her local emergency room with a complete loss of consciousness, intercostal retractions, no residual signs and no post-ictal phase. She later went on to have a full recovery. From the list of options, choose the most probable diagnosis.
Your Answer: Atonic seizure
Correct Answer: Partial generalized seizure
Explanation:The symptoms of a partial generalized seizure are consistent with this patient.
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This question is part of the following fields:
- Neurology
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Question 15
Correct
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A 14-year-old girl with HIV develops jaundice while being treated for overwhelming sepsis. Blood investigations reveal:ALT: 50 IU/L (0–45) Alkaline phosphatase (ALP): 505 IU/L (0–105)Which of the following medications has she most likely been administered in the course of her treatment?
Your Answer: Co-amoxiclav
Explanation:Based on the presentation, she probably was administered co-amoxiclav.The liver function tests are highly suggestive of cholestatic jaundice, which is a classic adverse dug reaction related to co-amoxiclav use.Other options:- Erythromycin is more commonly associated with gastrointestinal (GI) disturbance.- Gentamicin is more commonly associated with renal impairment.- Meropenem does not commonly cause cholestasis but is associated with transaminitis.- Vancomycin is associated with red man syndrome on fast administration.
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This question is part of the following fields:
- HIV
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Question 16
Incorrect
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A 5 month old baby presents with bilious vomiting. Doctors notice a palpable mass and drawing up of legs. They treat the baby with an air reduction enema, suspecting intussusception. However, the procedure is interrupted as the baby develops abdominal distention and starts to drop their saturations. What would be the single most appropriate next step?
Your Answer: Stop the procedure and arrange for surgical ‘open’ reduction of intussusception
Correct Answer: Immediate needle decompression of pneumoperitoneum
Explanation:Immediate needle decompression of pneumoperitoneum is necessary to avoid tension pneumoperitoneum. Air reduction enema is the main stay of treatment for intussusception and is successful in around 90% of cases. A serious potential risk of this procedure is perforation of the colon and a pneumoperitoneum, leading to rapid distension of the abdomen and splinting of the diaphragm.
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This question is part of the following fields:
- Paediatric Surgery
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Question 17
Correct
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A chloride sweat test was performed on a 13-year-old boy. Results indicated a high likelihood of cystic fibrosis. This diagnosis is associated with a higher risk of developing which of the following?
Your Answer: Bronchiectasis
Explanation:Cystic fibrosis is a life-threatening disorder that causes the build up of thick mucus in the lungs, digestive tract, and other areas of the body. It is a hereditary autosomal-recessive disease caused by mutations of the CFTR gene. Cystic fibrosis eventually results in bronchiectasis which is defined as a permanent dilatation and obstruction of bronchi or bronchioles.
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This question is part of the following fields:
- Respiratory
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Question 18
Correct
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A child is admitted with a febrile illness. Which of the following is of concern?
Your Answer: A 6 month old with a systolic blood pressure of 60
Explanation:Age (years) Respiratory rate (per minute) Heart rate (per minute) Systolic blood pressure<1 30-40 110-160 70-901-2 25-35 100-150 80-952-5 25-30 95-140 80-1005-12 20-25 80-120 90-110>12 15-20 60-100 100-120Adapted from Advanced Paediatric Life Support Manual
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This question is part of the following fields:
- Emergency Medicine
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Question 19
Correct
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A 12-week antenatal scan reveals a massive neck swelling in the foetus. While assessing the mother, she is found to have mild learning difficulties, short stature and a heart murmur. What is the most probable diagnosis?
Your Answer: Noonan syndrome
Explanation:The most probable diagnosis in this patient is Noonan syndrome.Noonan syndrome is an autosomal dominant condition characterised by short stature, heart defects (mainly pulmonary stenosis) and learning difficulties. An affected foetus can present with a significant increase in the nuchal thickness or a cystic hygroma of the neck. The condition is variable, and an affected parent is often only diagnosed after the diagnosis in the child.
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This question is part of the following fields:
- Genetics And Dysmorphology
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Question 20
Correct
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Which of the following movements will most likely be lost following an injury to the spinal part of the accessory nerve?
Your Answer: Upward rotation of the scapula
Explanation:Cranial nerve XI is also known as the accessory nerve. The accessory nerve innervates the trapezius muscle which retracts the scapula. The upper and lower fibres act together to also upwardly rotate it.
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This question is part of the following fields:
- Musculoskeletal
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Question 21
Correct
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Renal tubular acidosis affects the reabsorption of bicarbonate in the proximal tubule or excretion of hydrogen ions from the distal tubule. Which of the following is a key difference in clinical presentation of these two types of renal tubular acidosis?
Your Answer: Renal stone formation
Explanation:Distal renal tubular acidosis (dRTA) is characterised by a decreased hydrogen ion excretion from the alpha intercalated cells of the collecting duct of the distal nephron. The resultant acidosis causes calcium and phosphates to be released from bones to buffer the acidosis causing hypercalciuria. This precipitates calcium compounds in the kidney, predisposing it to renal stone formation. On the other hand, proximal renal tubular acidosis is characterised by an impairment in bicarbonate resorption. Both types lead to metabolic acidosis and electrolyte imbalances including potassium depletion. Children often present with failure to thrive. One way to differentiate between the two conditions is with an acid challenge test. In proximal RTA (type 2) administering an ammonium chloride load will decrease the urinary pH whereas in distal disease (type 1), the urine pH will not decrease below 5.3.
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This question is part of the following fields:
- Nephro-urology
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Question 22
Correct
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Toe walking is NOT a feature of which of the following conditions?
Your Answer: Waardenburg syndrome
Explanation:Toe walking refers to a pattern of walking in which the infants walk on the balls of their feet, without putting the heel of the feet on the ground. It is considered normal under the age of 2 years, but if it continues beyond that, it can signify some underlying pathology. The diseases that can be associated with toe walking include unilateral hip dislocation, Spinal tumours, Duchenne muscular dystrophy, prematurity, and cerebral palsy. Waardenburg’s syndrome is an autosomal dominant disorder, causing sensorineural deafness, and heterochromatic irises. Toe walking is not a feature.
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This question is part of the following fields:
- Child Development
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Question 23
Correct
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A 17-year-old boy is known to make irrational decisions which would normally be considered risky and subsequently gets in trouble with the police. An area in his brain controls judgement, impulse control and planning. Changes in this area of the brain mostly occur until what age?
Your Answer: 20 – 29 years
Explanation:The rational part of a teen’s brain isn’t fully developed until the age of 25 or so.In fact, recent research has found that adult and teen brains work differently. Adults think with the prefrontal cortex, the brain’s rational part. This is the part of the brain that responds to situations with good judgment and an awareness of long-term consequences. Teens process information with the amygdala. This is the emotional part.
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This question is part of the following fields:
- Adolescent Health
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Question 24
Correct
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Retinopathy of prematurity (ROP) is a potentially blinding disease if not managed adequately. Which of the following is a complication of ROP in an infant?
Your Answer: Retinal detachment
Explanation:Retinopathy of prematurity affects infants born early, and is due to the abnormal growth of retinal vasculature as opposed to vascular occlusion often see in adults. Though most babies with ROP can see normally, the most significant complication of ROP Is retinal detachment which can lead to blindness. Other structures in the eye such as the optic nerve or the fovea however, are not affected. Children may develop nystagmus as a result of poor sight in the affected eye(s).
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This question is part of the following fields:
- Ophthalmology
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Question 25
Correct
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Which of the given choices accurately defines perinatal mortality rate?
Your Answer: Number of stillbirths and deaths within 7 days of life divided by 1000 births
Explanation:The perinatal mortality rate is defined as the number of perinatal deaths per 1000 total births. Perinatal death includes the death of a live-born neonate within 7-days of life (early neonatal death) and the death of a fetus ≥ 22 weeks of gestation (stillbirth). Hence, the perinatal mortality rate is calculated by dividing the number of still births+ the number of early neonatal deaths by 1000 births.
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This question is part of the following fields:
- Neonatology
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Question 26
Correct
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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: 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 27
Incorrect
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A 16-year-old male presents to the emergency with severe testicular pain and is diagnosed with suspected testicular torsion. He is scheduled for surgical exploration. The surgeon makes an incision on the skin and then the dartos muscle. Which of the following tissue layers will be incised next?
Your Answer: Parietal layer of the tunica vaginalis
Correct Answer: External spermatic fascia
Explanation:Coverings of the spermatic cord:Spermatic cord is covered by three concentric layers of fasciae, derived from the layers the of anterior abdominal wall. Developmentally, each covering is acquired as the processus vaginalis descends into the scrotum through the layers of the abdominal wall. The layers are:External spermatic fascia: It is derived from the external oblique muscle. It attaches to the margins of superficial inguinal ring.Cremasteric fascia: It is derived from the internal oblique muscle. It covers the cremaster muscle.Internal spermatic fascia: It is derived from the fascia transversalis (fascia covering the transversus abdominis muscle). It is attached to the margins of the deep inguinal ring.
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This question is part of the following fields:
- Nephro-urology
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Question 28
Correct
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Which of the given neural tube defects occur in association with Arnold-Chiari malformation type II?
Your Answer: Myelomeningocele
Explanation:Arnold-Chiari malformation type II is one of the congenital hindbrain abnormalities that leads to a disruption of the relationship between different hindbrain structures. It is characterized by congenital hydrocephalus, herniation of cerebellar tonsils into the pinal canal with an enlarged 4th ventricle, spina bifida associated with myelomeningocele, and various levels of denervation atrophy of the muscles of the lower limb. The association of type II Arnold-Chiari with myelomeningocele carries importance from an etiological perspective, forming the basis of CSF escape theory.
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This question is part of the following fields:
- Neurology And Neurodisability
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Question 29
Correct
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A 2-year-old baby sustained a wound to her hand whilst playing in the garden. She is unvaccinated as the parents are concerned regarding side effects. There is no contraindication to vaccinations. What is the most appropriate action?
Your Answer: Give complete DPT vaccine course
Explanation:A complete course of DPT should be given.
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This question is part of the following fields:
- Immunology
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Question 30
Correct
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A 15-year-old boy observed a bluish painless swelling in his left scrotum. It is soft and can be compressed. What would you do next?
Your Answer: Reassurance
Explanation:The boy seems to have a varicocele so the most appropriate next step would be reassurance. A varicocele is an enlargement of the veins within the scrotum called the pampiniform plexus. A varicocele only occurs in the scrotum and is very similar to varicose veins that can occur in the leg. Because a varicocele usually causes no symptoms, it often requires no treatment.
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This question is part of the following fields:
- Genitourinary
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SESSION STATS - PERFORMANCE PER SPECIALTY
