-
Question 1
Incorrect
-
A 14 year old girl with cystic fibrosis (CF) presents with abdominal pain. Which of the following is the pain most likely linked to?
Your Answer: Irritable bowel syndrome
Correct Answer: Meconium ileus equivalent syndrome
Explanation:Meconium ileus equivalent (MIE) can be defined as a clinical manifestation in cystic fibrosis (CF) patients caused by acute intestinal obstruction by putty-like faecal material in the cecum or terminal ileum. A broader definition includes a more chronic condition in CF patients with abdominal pain and a coecal mass which may eventually pass spontaneously. The condition occurs only in CF patients with exocrine pancreatic insufficiency (EPI). It has not been seen in other CF patients nor in non-CF patients with EPI. The frequency of these symptoms has been reported as 2.4%-25%. The treatment should primarily be non-operative. Specific treatment with N-acetylcysteine, administrated orally and/or as an enema is recommended. Enemas with the water soluble contrast medium, meglucamine diatrizoate (Gastrografin), provide an alternative form for treatment and can also serve diagnostic purposes. It is important that the physician is familiar with this disease entity and the appropriate treatment with the above mentioned drugs. Non-operative treatment is often effective, and dangerous complications following surgery can thus be avoided.
-
This question is part of the following fields:
- Respiratory
-
-
Question 2
Incorrect
-
A 15-week-old baby boy is brought to the emergency by his parents due to vomiting and weight loss. Physical examination reveals a central palpable mass in the abdomen. Ultrasound examination shows a pylorus 8mm long and a target sign centrally. What is the most likely diagnosis?
Your Answer: Pyloric Stenosis
Correct Answer: Intussusception
Explanation:Intussusception is a condition in which one segment of intestine telescopes inside of another, causing an intestinal obstruction. Although intussusception can occur anywhere in the gastrointestinal tract, it usually occurs at the junction of the small and large intestines. Most describe the symptoms of intussusception as a triad of colicky abdominal pain, bilious vomiting, and currant jelly stool. The primary symptom of intussusception is described as intermittent crampy abdominal pain.
-
This question is part of the following fields:
- Paediatric Surgery
-
-
Question 3
Correct
-
A normally developed 4-year-old would be expected to do which one of the following?
Your Answer: Copy a cross
Explanation:4-year-old milestonesSocial and EmotionalEnjoys doing new things Plays “Mom” and “Dad” Is more and more creative with make-believe play Would rather play with other children than by himself Cooperates with other children Often can’t tell what’s real and what’s make-believe Talks about what she likes and what she is interested in Language/CommunicationKnows some basic rules of grammar, such as correctly using “he” and “she” Sings a song or says a poem from memory such as the “Itsy Bitsy Spider” or the “Wheels on the Bus” Tells stories Can say first and last nameCognitive (learning, thinking, problem-solving)Names some colours and some numbers Understands the idea of counting Starts to understand time Remembers parts of a story Understands the idea of “same” and “different” Draws a person with 2 to 4 body parts Uses scissors Starts to copy some capital letters Plays board or card games Tells you what he thinks is going to happen next in a book Movement/Physical DevelopmentHops and stands on one foot up to 2 seconds Catches a bounced ball most of the time Pours, cuts with supervision, and mashes own food
-
This question is part of the following fields:
- Child Development
-
-
Question 4
Incorrect
-
What IQ is the cut off for profound learning disability?
Your Answer: <20
Correct Answer:
Explanation:Mild learning disabilities indicates an IQ = 50-70, or mental age of 9-12 years
Moderate learning disabilities indicates an IQ = 35-49, or mental age of 6-9 years
Severe learning disabilities indicates an IQ = 20-34, or mental age of 3-6 years
Profound learning disabilities indicates an IQ = 20, or mental age of less than 3 years
Average IQ is 100. The arbitrary cut-off to indicate learning disabilities is 70. -
This question is part of the following fields:
- Neurology And Neurodisability
-
-
Question 5
Incorrect
-
A 6 year old boy has a family history of familial adenomatous polyposis. What ocular manifestation in this boy would indicate that he has inherited the condition?
Your Answer: Posterior embryotoxon
Correct Answer: Congenital hypertrophy of the retinal pigment epithelium
Explanation:Congenital hypertrophy of the retinal pigment epithelium is one of FAP’s extra-intestinal manifestations. It appears in early childhood and affects an estimated 90% of those with FAP.
-
This question is part of the following fields:
- Genetics And Dysmorphology
-
-
Question 6
Correct
-
In which of the following ethnic backgrounds are Mongolian blue spots most likely to be found?
Your Answer: White European
Explanation:Mongolian spots are, hyper-pigmented, non-blanching patches present on the back and gluteal region at birth. They are commonly found in African and Asian ethnic groups, and can also present in infants of Mediterranean and middle eastern descent. Though the spots usually disappear by puberty, some may persist into adulthood.
-
This question is part of the following fields:
- Neonatology
-
-
Question 7
Incorrect
-
Which of the following conditions is not associated with arachnodactyly?
Your Answer: Ehlers - Danlos syndrome
Correct Answer: Turner syndrome
Explanation:Tuner’s syndrome is not associated with arachnodactyly.Arachnodactyly is seen in the following conditions:- Marfan syndrome- Homocystinuria- Ehlers-Danlos syndrome- Congenital contractural arachnodactylyOther rare syndromes include:- Loeys-Dietz syndrome- Antley-Bixler syndrome- Marden-Walker syndrome- Lujan-Frinz syndrome- Haim-Munk syndrome- Marden-Walker syndrome- Spondylocostal dysostosis
-
This question is part of the following fields:
- Musculoskeletal
-
-
Question 8
Incorrect
-
A 6 year old child presents with clinical features of nephrotic syndrome and a history of hypertension. He has normal serum cholesterol levels, however, his urine microscopy reveals oval fat bodies. Which of the following most likely represents the cause of the nephrotic syndrome?
Your Answer: Lupus nephritis
Correct Answer: Minimal change glomerulonephritis
Explanation:Minimal change glomerulonephritis presents with mild or benign urinalysis findings. However, proteinuria together with the presence of oval fat bodies are typical.Minimal change glomerulonephritis (nephropathy) accounts for most cases of childhood nephrotic syndrome and 20–25% of adult nephrotic syndrome.
-
This question is part of the following fields:
- Nephro-urology
-
-
Question 9
Correct
-
Which of the following is most consistent with congenital adrenal hyperplasia (CAH)?
Your Answer: Premature epiphyseal closure
Explanation:Exposure to excessive androgens is usually accompanied by premature epiphyseal maturation and closure, resulting in a final adult height that is typically significantly below that expected from parental heights. congenital adrenal hyperplasia (CAH) is associated with precocious puberty caused by long term exposure to androgens, which activate the hypothalamic-pituitary-gonadal axis. Similarly, CAH is associated with hyperpigmentation and hyperreninemia due to sodium loss and hypovolaemia.
-
This question is part of the following fields:
- Endocrinology
-
-
Question 10
Incorrect
-
Which of the following is true in logistic regression analysis?
Your Answer: Should be used to compare proportions of people who test positive between two populations
Correct Answer: Yields adjusted odds ratios
Explanation:Logistic regression analysis is an easy to use regression that can serve to estimate how a binary or dichotomous dependent variable, for example whether or not a student passes or fails a medical exam, is related to the number of hours the student studies for the exam. This regression is able to yield an odds ratio, i.e. the probability of passing the exam based on each additional hour of study. As stated, the outcome does not need to be normally distributed but is usually binary. This type of analysis is not complex and does not need to be avoided as it is available most statistical packages.
-
This question is part of the following fields:
- Epidemiology And Statistics
-
-
Question 11
Correct
-
A 5 year old boy visited Ghana with his family and arrived back home 6 weeks ago. 2 days ago he developed neck stiffness, a fever, and vomiting. He did not present with a rash and was treated with malaria prophylaxis. Choose the correct diagnosis from the list of options.
Your Answer: Cerebral malaria
Explanation:Due to malaria’s incubation period being between 7 and 30 days, malaria prophylaxis cannot provide a patient with confirmed protection. Prophylaxis treatment also often fails. The symptoms such as neck stiffness, fever, and vomiting are also consistent with the cerebral malaria diagnosis.
-
This question is part of the following fields:
- Neurology
-
-
Question 12
Incorrect
-
Which of the following does NOT cause benign intracranial hypertension?
Your Answer: Iron-deficiency anaemia
Correct Answer: Acute lymphoblastic leukaemia
Explanation:Benign intracranial hypertension is characterized by an elevation of the CSF pressure that is not caused by hydrocephalus or any space-occupying lesion. The cause is most likely the decreased absorption of CSF into the dural sinuses. The main symptoms are headache and visual abnormalities. It can lead to blindness if not managed on time. The most important risk factors for BIH are female gender and obesity. The causes of BIH include iron deficiency anaemia, sarcoidosis, Lyme disease, SLE, polycythaemia vera, chronic kidney disease, meningitis, and sleep apnoea.
-
This question is part of the following fields:
- Neurology And Neurodisability
-
-
Question 13
Correct
-
At term, what is the normal amount of amniotic fluid?
Your Answer: 600ml
Explanation:In the first trimester of pregnancy, amniotic fluid is produced from maternal plasma where there is a rapid bi-directional diffusion across the foetal skin. At 10 weeks the volume is about 25ml. By 16th weeks of gestation the foetal kidneys make urine that contributes to the increasing volume of amniotic fluid, along with nasal secretions. At 20 weeks, the level is 400ml and increases to 800ml at 28weeks, after which it reduces to 600ml at term.
-
This question is part of the following fields:
- Neonatology
-
-
Question 14
Incorrect
-
An 8 year old child complains of pain in his ear. His overall health is normal and clinical examination reveals no discharge, hearing loss or fever. Just by looking at it, the pinna of the ear looks swollen and red. Also, pushing the tragus leads to pain. Otoscopy reveals an erythematous external auditory canal and an otherwise healthy tympanic membrane. The bony external canal courses through which bone?
Your Answer: Sphenoid bone
Correct Answer: Temporal bone
Explanation:The external auditory canal (EAC) extends from the auricle to the tympanic membrane. Its lateral portion is fibrocartilaginous and its medial portion is bony. Its bony portion is formed by the tympanic portion of the temporal bone.
-
This question is part of the following fields:
- ENT
-
-
Question 15
Correct
-
A young boy presents with a soft swelling in the midline neck that moves with tongue protrusion. The swelling is present between the thyroid cartilage and the tongue. Which of the following is the most likely diagnosis?
Your Answer: Thyroglossal cyst
Explanation:The thyroglossal duct cyst is the most common congenital anomaly of the central portion of the neck. The thyroglossal duct cyst is intimately related to the central portion of the hyoid bone and usually elevates along with the larynx during swallowing. Thyroglossal cysts can be defined as an irregular neck mass or a lump which develops from cells and tissues left over after the formation of the thyroid gland during the developmental stages.
-
This question is part of the following fields:
- ENT
-
-
Question 16
Correct
-
Consider the following study:Healthy individuals are assessed according to their current body mass index (BMI). Two years later, their health status is reassessed, and the relationships with their earlier BMI were determined.What is the type of epidemiological study described above?
Your Answer: Cohort
Explanation:The study described in the question is a ‘cohort’ study.Other options:A prospective observational study – When groups are classified according to one or more factors at a given time and followed forward to determine outcomes (usually some health status)- Although there is in one sense a control group (those who do not develop the health problem), this is not generally called a ‘controlled’ trial. – An ecological study would look at outcomes in different groups (countries or regions usually) who follow different practices.
-
This question is part of the following fields:
- Epidemiology And Statistics
-
-
Question 17
Correct
-
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.
-
This question is part of the following fields:
- Neurology And Neurodisability
-
-
Question 18
Correct
-
In a double blind trial of a new diabetes medication, 25% more in the treated group responded positively than those in the control group (95% CI 10% to 50%| P=0.004)
Your Answer: The therapy benefits an additional 1 in 4 (95% CI 2 to 10), patients who receive it
Explanation:In the final result of this double blind study, 25% or one in four of patients who received the treatment responded positively. Though the difference is significant at P<0.05, it is better to present this as a significant difference at 0.4%. The number needed to treat (NNT) is defined as the inverse of the absolute risk reduction. Taking this as 0.25 (25%), the NNT is 1/0.25 = 4. However given the 95% confidence interval is between 10-50% for absolute risk reduction, the NNT with 95% CI is between 2 and 10. Therefore we cannot say with certainty that the NNT is at least 4.
-
This question is part of the following fields:
- Epidemiology And Statistics
-
-
Question 19
Correct
-
A 2-day old boy is diagnosed with a patent ductus arteriosus. He has a cyanotic heart disease. Which of the following would be the best course of action in this patient?
Your Answer: Prostaglandin E1 (PGE1) administration
Explanation:Administration of IV prostaglandin/PGE1 (e.g., alprostadil) is indicated in ductal-dependent CHDs until surgery can be performedMechanism: prostaglandin prevents the ductus arteriosus from closing → creates intentional shunt to allow mixing of deoxygenated with oxygenated blood.
-
This question is part of the following fields:
- Cardiovascular
-
-
Question 20
Correct
-
A 7-year-old boy is brought to the ED, with coughing and wheezing. Chest examination reveals reduced breath sounds on one side. Radiological examination shows occlusion of the airway by an aspirated foreign body. The foreign body is most likely lodged in which of the following locations?
Your Answer: Right mainstem bronchus
Explanation:Foreign body aspiration (FBA) commonly occurs in children aged 1–3 years. FBA typically presents with sudden onset of coughing and choking, followed by stridor and dyspnoea. Obstruction of the larynx or trachea is a potentially life-threatening situation that causes severe respiratory distress, cyanosis, and suffocation. Most commonly, the foreign body (FB) becomes lodged in the main and intermediate bronchi| approx. 60% of FB are located in the right main bronchus due to the more vertical orientation compared to the left main bronchus. Reduced breath sounds on the one side only would not be explained by a tracheal obstruction as it would cause reduced breath sounds bilaterally and a more severe clinical picture.
-
This question is part of the following fields:
- Emergency Medicine
-
-
Question 21
Correct
-
A 2 year old girl with a history of oligohydramnios, hypotonia, and scissoring of the legs, presents with delayed walking. She was born by breech delivery. Clinical examination reveals absence of fever and no dysmorphism. Although the limbs look symmetrical and equal, the right leg seems to be shorter. The girl is otherwise healthy. Neurological examination reveals hypotonia with normal reflexes and power. The mother confirms there is no history of myelomeningocele, cerebral palsy, or birth asphyxia. What is the most likely diagnosis?
Your Answer: Congenital dislocation of the hip
Explanation:In this particular case, the symptoms and signs are suggestive for congenital dislocation of the hip. There are several risk factors present including, a breech delivery, female gender (female:male = 6:1) and oligohydramnios. It is also more common in the left hip than the right.
-
This question is part of the following fields:
- Neonatology
-
-
Question 22
Correct
-
A 17-year-old boy presents with a purpuric rash on his legs and buttocks, and coffee ground emesis. The joints of his body are also painful. Blood testing reveals mild eosinophilia and a small rise in IgA levels. Urine testing reveals microscopic haematuria. Which of the following fits best with this clinical scenario?
Your Answer: Henoch–Schönlein purpura
Explanation:Henoch–Schönlein purpura (HSP), also known as IgA vasculitis, is a disease of the skin, mucous membranes, and sometimes other organs that most commonly affects children. In the skin, the disease causes palpable purpura (small, raised areas of bleeding underneath the skin), often with joint pain and abdominal pain. It is an acute immunoglobulin A (IgA)–mediated disorder. The tetrad of purpura, arthritis, kidney inflammation, and abdominal pain is often observed.
-
This question is part of the following fields:
- Dermatology
-
-
Question 23
Correct
-
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: Partial generalized seizure
Explanation:The symptoms of a partial generalized seizure are consistent with this patient.
-
This question is part of the following fields:
- Neurology
-
-
Question 24
Incorrect
-
A 8 year old child presents with acute abdominal pain. Last time he used the restroom, he noticed fresh blood after wiping. Doctors suspect an intussusception. What is the most probable cause?
Your Answer: Coeliac disease
Correct Answer: Gastrointestinal polyp
Explanation:Gastrointestinal polyps are common in children and may result in intussusception due to polyp traction. Treatment is usually surgical with enterotomy and removal of the polyp or of a segment of the bowel.
-
This question is part of the following fields:
- Gastroenterology And Hepatology
-
-
Question 25
Correct
-
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.
-
This question is part of the following fields:
- Genitourinary
-
-
Question 26
Incorrect
-
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: Student t-test
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.
-
This question is part of the following fields:
- Adolescent Health
-
-
Question 27
Correct
-
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: 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.
-
This question is part of the following fields:
- Infectious Diseases
-
-
Question 28
Correct
-
A previously well 7-week-old infant was admitted complaining of projectile vomiting following each feed. He was dehydrated on admission and IV fluids were started. What is the most probable diagnosis?
Your Answer: Hypertrophic pyloric stenosis
Explanation:Projectile vomiting is the hallmark symptom of hypertrophic pyloric stenosis. It is the most common cause of intestinal obstruction in infancy, which has a male-to-female predominance of 4-5:1. Current management recommendations include ultrasonography for diagnosis, correction of electrolytes, and surgical intervention.
-
This question is part of the following fields:
- Gastroenterology And Hepatology
-
-
Question 29
Incorrect
-
A young boy presents with signs of kidney disease. He has a long-standing history of proteinuria and hypocomplementemia which were not responsive to steroid treatment. What is the most probable diagnosis?
Your Answer: Focal segmental glomerulosclerosis
Correct Answer: Membranoproliferative glomerulonephritis
Explanation:Membranoproliferative glomerulonephritis primarily affects children and young adults, with patients presenting with nephrotic or nephritic syndrome or with asymptomatic renal disease. There are 3 types defined by pathologic features. All three types are associated with hypocomplementemia, but they manifest somewhat different mechanisms of complement activation. This type of glomerulonephritis often progresses slowly to end-stage renal disease, and it tends to recur after renal transplantation, especially type II.
-
This question is part of the following fields:
- Nephro-urology
-
-
Question 30
Correct
-
A well, breastfed term infant presented with jaundice at 36 hours of age. The serum bilirubin was 286 µmol/L, direct Coombs test negative, blood film showed spherocytes and reticulocytes. The baby’s blood group was A rhesus negative and mother’s blood group O Rhesus negative.Which of the following is the MOST likely diagnosis?
Your Answer: ABO incompatibility
Explanation:Haemolytic disease of the new-born due to ABO incompatibility is usually less severe than Rh incompatibility. One reason is that fetal RBCs express less of the ABO blood group antigens compared with adult levels. In addition, in contrast to the Rh antigens, the ABO blood group antigens are expressed by a variety of fetal (and adult) tissues, reducing the chances of anti-A and anti-B binding their target antigens on the fetal RBCs.ABO HDN occurs almost exclusively in the offspring of women of blood group O, although reports exist of occasional cases in group A mothers with high‐titre anti‐(group B) IgG
-
This question is part of the following fields:
- Neonatology
-
SESSION STATS - PERFORMANCE PER SPECIALTY
