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Question 1
Correct
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Sensorineural deafness is strongly associated with which one of the following?
Your Answer: Rubella
Explanation:Primary rubella infection during pregnancy, particularly during the first trimester, can affect several organs and cause birth defects that are responsible for congenital rubella syndrome (CRS). The most common defects of CRS are hearing impairment (unilateral or bilateral sensorineural), eye defects (e.g., cataracts, congenital glaucoma, or pigmentary retinopathy), and cardiac defects (e.g., patent ductus arteriosus or peripheral pulmonic stenosis). Congenital hearing loss is the most common sequela, occurring in approximately 60% of cases, especially when infection occurs in the 4th month of pregnancy.
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This question is part of the following fields:
- Infectious Diseases
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Question 2
Correct
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An 18-month-old boy of Asian descent and a product of non-consanguineous marriage presents to the clinic with a history of swelling of both wrists. He has been complaining of painful legs and his parents are concerned about his bandy legs. The child was breastfed until 6 months of age, with solids being introduced in the diet later. At 12 months of age the child suffered from a non-stick fracture of the radius after falling at the nursery. Which condition is the child most likely suffering from?
Your Answer: Vitamin D-deficient rickets
Explanation:The signs and symptoms of vitamin D-dependent rickets begin within months after birth, and most are the same for all types of the condition. The weak bones often cause bone pain and delayed growth and have a tendency to fracture. When affected children begin to walk, they may develop abnormally curved (bowed) legs because the bones are too weak to bear weight. Impaired bone development also results in widening of the metaphysis, especially in the knees, wrists, and ribs. Some people with vitamin D-dependent rickets have dental abnormalities such as thin tooth enamel and frequent cavities. Poor muscle tone (hypotonia) and muscle weakness are also common in this condition, and some affected individuals develop seizures.
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This question is part of the following fields:
- Gastroenterology And Hepatology
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Question 3
Correct
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A 16-year-old girl presents to the clinic with a 4-month history of no menstrual bleeding. Menarche was at 11 years of age. She denies experiencing any headache or visual disturbances. Physical examination shows an overweight girl, with facial hair, acne vulgaris on the face and a deep voice. Abdominal examination shows no abnormalities and a pregnancy test is negative. Diagnosis can be confirmed with which of the following lab test?
Your Answer: Raised Testosterone
Explanation:Diagnostic criteria of PCOsAccording to the American Association of Clinical Endocrinologists, at least two of three of the criteria below are required for diagnosis of PCOS after excluding other causes of irregular bleeding and elevated androgen levels.Hyperandrogenism (clinical or laboratory)Oligo- and/or anovulationPolycystic ovaries on ultrasoundDiagnosis of PCOS is possible without the presence of ovarian cysts.Rule out any other causes of hyperandrogenism and anovulation.Blood hormone levels↑ Testosterone (both total and free) or free androgen index↑ LH (LH:FSH ratio > 2:1)Oestrogen is normal or slightly elevated A clinical picture of hyperandrogenism overrules any normal hormone levels and can fulfil a diagnostic criterium of PCOS.
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This question is part of the following fields:
- Adolescent Health
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Question 4
Correct
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Which of the following cranial nerves does not have both sensory and motor functions?
Your Answer: Abducens (CN VI)
Explanation:Cranial nerves I, II, and VIII are considered purely afferent nerves since they conduct sensory information from the olfactory region, the retina of the eye, and the inner ear structures, respectively.Cranial nerves III, IV, VI, XI, and XII are considered purely efferent due to their motor output to the orbit, the neck, and the tongue.Cranial nerves V, VII, IX, and X are considered mixed cranial nerves due to the presence of afferent and efferent fibres with both sensory and motor components.
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This question is part of the following fields:
- Neurology And Neurodisability
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Question 5
Correct
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In term babies with persistent jaundice, what is the time period over which one must consider biliary atresia as the probable cause?
Your Answer: 14 days
Explanation:After a period of 14 days, if jaundice persists in a term new-born, having ruled out the other possibilities, biliary atresia should be considered as a possible diagnosis.Biliary atresia is a rare but serious condition. Symptoms include obstructive jaundice (dark urine and pale stool). Management:Surgery within 8 weeks is recommended. Survival is around 90% using current treatment regimes. Without treatment, children will survive to around 18 months.
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This question is part of the following fields:
- Neonatology
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Question 6
Correct
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Which of the following is associated with neonatal vitamin E deficiency?
Your Answer: Thrombocytosis
Explanation:Vitamin E deficiency in premature infants has been described as being associated with low haemoglobin levels in the 2nd month of life, haemolytic anaemia associated with thrombocytosis. Recently, low vitamin E concentrations were suspected as being associated with sudden death in infancy.
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This question is part of the following fields:
- Neonatology
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Question 7
Correct
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A 2 year old male was brought to the A&E following an car accident. On examination bowel sounds were heard in the chest. A nasogastric tube was inserted and a chest x-ray showed a curved NG tube. Which of the following is the most probable reason for it?
Your Answer: Diaphragm rupture
Explanation:Bowel sounds in the chest and curved NG tube are suggestive of a diaphragm rupture, which has caused herniation of bowel into the thoracic cavity through the defect in the diaphragm.
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This question is part of the following fields:
- Emergency Medicine
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Question 8
Incorrect
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A 13-month-old boy presents to the hospital with a rash and breathing difficulties following routine vaccination. On examination, it was noted that he was developing swelling around the mouth and neck.What is the most appropriate next step to manage this child?
Your Answer: Phone 999 and reassure mother
Correct Answer: IM adrenaline 150 mcg (0.15ml of 1 in 1,000)
Explanation:The IM dose of adrenaline for anaphylaxis in:< 6 months: 150 micrograms (0.15ml 1 in 1,000)6 months - 6 years: 150 micrograms (0.15ml 1 in 1,000)6 - 12 years: 300 micrograms (0.3ml 1 in 1,000)Adult and child > 12 years: 500 micrograms (0.5ml 1 in 1,000)Anaphylaxis:Anaphylaxis is an acute, rapidly progressing, potentially life-threatening IgE mediated Type I hypersensitivity reaction.It involves the release of mediators from mast cells, basophils and inflammatory cells. It is characterised by oedematous swelling of the airway mucosa giving rise to dyspnoea and respiratory distress. The most common cause of anaphylaxis in children is a food allergy.Risk factors for death in patients with anaphylaxis include asthma, age 11+, peanut allergy, and delay in adrenaline administration.Management of anaphylaxis includes:- ABCD- Remove the allergen- IM adrenaline or Nebulised adrenaline- IV Hydrocortisone – pro re nata IV fluid support. – Followed by observation.
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This question is part of the following fields:
- Emergency Medicine
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Question 9
Incorrect
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Which of the given features does NOT occur in association with aniridia?
Your Answer: Buphthalmos
Correct 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 10
Incorrect
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In the treatment of infants with gastroenteritis, which of the following statements is the most accurate one?
Your Answer: Always develop lactose intolerance
Correct Answer: Should be admitted to hospital if they are unable to tolerate fluid orally
Explanation:The main problem with infants having gastroenteritis is dehydration. So they should be admitted to the hospital for IV fluids if they are not tolerating oral fluids.
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This question is part of the following fields:
- Gastroenterology And Hepatology
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Question 11
Incorrect
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Which of the following ages should a child be expected to draw a line and start cutting with scissors?
Your Answer: 3-4 years
Correct Answer: 2- 2 1/2 years
Explanation:Fine motor development involves greater use of the hands to perform more precise tasks. By 6 -12 months children should be able to reach for small objects and pass an object from one hand to the other. From 1 -2 years they can perform more complex tasks such a building a tower of blocks, feeding themselves, and turning knobs. In terms of pencil skills, they should be able to imitate scribbles and then spontaneously scribble. By the age of 2 years they can draw a line, and by three they can draw a circle. From the age of 3.5 they can draw a cross, 4.5 – a square, 5 – a triangle, and 6 a diamond.
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This question is part of the following fields:
- Child Development
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Question 12
Incorrect
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A neonate is diagnosed with cryptorchidism of the right side (undescended testis). Which is the LEAST likely place to find the testis?
Your Answer: Somewhere in the inguinal canal
Correct Answer: Perineum
Explanation:Embryologically the testes are retroperitoneal structures in the posterior abdominal wall, attached to the anterolateral abdominal wall by the gubernaculum. The gubernaculum ‘pulls’ the testes through the deep inguinal ring, inguinal canal and superficial inguinal ring and over the pelvic brim. The gubernaculum is preceded by the processus vaginalis that is derived from the peritoneum anterior to the testes. The processus vaginalis pushes the muscle and fascial layers. These eventually make up the canal and the spermatic cord, into the scrotum. The gubernaculum persists as the scrotal ligament while part of the processus vaginalis remains as a bursa-like sac i.e. the tunica vaginalis testes. The testes therefore could be caught in any one of these places along its path of descending. The testes are never in the perineum.
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This question is part of the following fields:
- Genitourinary
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Question 13
Incorrect
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A 15-year-old girl known with HIV develops lipoatrophy over her thighs and abdomen. Which of the following medications can cause this side effect?
Your Answer: Efavirenz
Correct Answer: Zidovudine
Explanation:Among the options provided, zidovudine causes lipoatrophy as a side effect.Zidovudine: Although both hypertrophy and atrophy are described related to HIV medications, nucleoside reverse transcriptase inhibitor (NRTIs) such as zidovudine and stavudine are closely associated with fat loss.Other options:- Enfuvirtide is an HIV-fusion inhibitor. Lipoatrophy is not commonly associated with this drug.- Efavirenz is an NNRTI, which is not associated with lipoatrophy. Common side effects include neuropsychiatric effects, rash and nausea. – Ganciclovir is not an anti-HIV medication and is used for cytomegalovirus (CMV) infections.- Raltegravir is an integrase inhibitor and is associated with fat gain.
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This question is part of the following fields:
- HIV
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Question 14
Incorrect
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A new-born male is admitted to NICU with convulsions, limb hypoplasia and rudimentary digits. Which of the following is the most likely cause?
Your Answer: Cytomegalovirus (CMV)
Correct Answer: Varicella
Explanation:Infection of chickenpox in the first half of pregnancy can result in congenital varicella syndrome. It presents as cerebral, cortical and cerebellar hypoplasia with convulsions and rudimentary digits. Prevention is by administering varicella vaccine, even before pregnancy. Varicella immunoglobulin is administered to pregnant women who are exposed to infection. Infection during pregnancy is treated with acyclovir.
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This question is part of the following fields:
- Infectious Diseases
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Question 15
Incorrect
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Which of the following are associated with port wine stains?
Your Answer: Cataracts
Correct Answer: Epilepsy
Explanation:Port-wine stains are a type of vascular birthmark caused by the abnormal development of capillaries in the skin. These pinkish-purplish discolorations present at birth and are associated with medical conditions such as Sturge-Weber syndrome, a neurocutaneous disorder involving the leptomeninges. Port wine stains are therefore associated with epilepsy, glaucoma or intellectual disability common in Sturge-Weber syndrome. Additional complications of Port wine stains include a loss of function if near the eye or mouth due to hypertrophy, or glaucoma if near the eyelid.
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This question is part of the following fields:
- Dermatology
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Question 16
Correct
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Choose the karyotype associated with short stature:
Your Answer: 45,XO
Explanation:Turner syndrome (TS) is one of the most common genetic disorders| occurs with an incidence of I: 2,500 female live births. It results from complete or partial chromosome X monosomy. TS is associated with abnormalities of the X chromosome and characteristic clinical features of short stature, gonadal dysgenesis, sexual developmental deficiencies, cardiac and/or renal defects, webbed neck, low-set ears, skeletal deformities including cubitus valgus, a propensity to ear infections and hearing deficits.
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This question is part of the following fields:
- Genetics And Dysmorphology
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Question 17
Incorrect
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The father of a 3 month old baby presents to the child health clinic complaining that his child passes only one hard stool a day. He has tried to bicycle his legs and massage his abdomen but has not been successful. The baby seems to be growing well, and nothing of concern was found on clinical examination. What is the most appropriate next step?
Your Answer: Advise him to encourage breast-feeding
Correct Answer: Advise extra water in between feeds
Explanation:According to the NICE guidelines, the frequency of stool passage is considered constipation when two or more of the following findings are present: Fewer than 3 stools a week, large hard stools, stools that resemble rabbit droppings| symptoms associated with defecation including distress, bleeding or straining| a history of previous episodes of a precious/current anal fissure. The child in the scenario fails to meet the criteria, and has no evidence of impacted faeces on examination. The best course of action is to encourage the parents to give the child more water to prevent dehydration, and feed the child a fibre rich diet including fruits, vegetables and high fibre bread.
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This question is part of the following fields:
- Gastroenterology And Hepatology
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Question 18
Incorrect
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Tuberous sclerosis is associated with all, EXCEPT which of the given clinical findings?
Your Answer: Cardiac rhabdomyoma
Correct Answer: Lisch nodules of the iris
Explanation:Tuberous sclerosis is an autosomal dominant neurocutaneous condition associated with increased psychiatric co-morbidity. It results from the mutation of TSC1 or TSC2 tumour suppressor genes. Multiple benign tumours of the brain and other vital organs are characteristic of this disease. Important findings include subependymal nodules, bone cysts, cardiac rhabdomyoma, and learning difficulties. Lisch nodules of the iris occur in neurofibromatosis.
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This question is part of the following fields:
- Genetics And Dysmorphology
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Question 19
Incorrect
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A pregnant woman that already has a son with haemophilia A, wants to know the chances of her next unborn child having the same condition.
Your Answer: 0.25
Correct Answer: 0.5
Explanation:Haemophilia A has an X-linked recessive pattern of inheritance, meaning that is a 50% chance of having a son with haemophilia and 50% chance of the daughters being carriers of the haemophilia gene.
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This question is part of the following fields:
- Genetics And Dysmorphology
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Question 20
Incorrect
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A 5 year old girl presents with widespread, itchy, excoriated papules that appeared three months ago. They are symmetrically distributed and more profound on the extensor surfaces of the elbows and knees. The papules are present on the trunk as well but are less remarkable. She doesn’t have it anywhere else on her body and seems to be in a good health. The itchiness results in the girl to often scratching and popping the fluid-filled blisters that are present. There is no family history of atopy or other skin conditions. Which of the following is accurate?
Your Answer: This is a classic presentation of chronic bullous disease of childhood
Correct Answer: Coeliac antibodies should be measured
Explanation:This is the clinical picture of dermatitis herpetiformis associated with gluten-sensitive enteropathy. To establish the diagnosis, you should measure the coeliac antibodies. Darrier’s sign (where the skin urticates when it is stroked) is positive in urticaria pigmentosa.
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This question is part of the following fields:
- Dermatology
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Question 21
Incorrect
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A mother came to the clinic, with her 7 month old baby. She anxiously explained that he was not responding to loud sounds. He was vocalizing at the presentation and he had normal motor milestones. Which of the following is the most appropriate management?
Your Answer: MRI Brain
Correct Answer: Arrange Hearing test
Explanation:History is suggestive of a possible hearing impairment. As the baby is vocalizing and has normal motor development, an isolated hearing problem is possible. A hearing test will confirm the diagnosis.
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This question is part of the following fields:
- ENT
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Question 22
Incorrect
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All of the given are features of cow's milk protein intolerance EXCEPT?
Your Answer: Sneezing
Correct Answer: Steatorrhoea
Explanation:CMPI ( cow’s milk protein intolerance) is an immunological reaction to one or more of the many proteins found in cow’s milk. It may be IgE mediated or non-IgE mediated. The prominent signs and symptoms include sneezing, rhinorrhoea, coughing, wheezing, oral angioedema, oral itching, diarrhoea, vomiting, and bloody stools. Steatorrhea is not a recognized feature of CMPI.
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This question is part of the following fields:
- Nutrition
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Question 23
Incorrect
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A 3-year-old girl presented with rhinorrhoea, barking cough and inspiratory stridor. She was diagnosed with laryngotracheobronchitis. If untreated at this stage which of the following would be the most probable outcome?
Your Answer: Lung abscess
Correct Answer: Complete resolution
Explanation:The prognosis for croup is excellent, and recovery is almost always complete with complications being quite rare. The possible complications are pneumonia, bacterial tracheitis, pulmonary oedema, pneumothorax, pneumomediastinum, lymphadenitis or otitis media. Bacterial tracheitis is a life-threatening infection that can arise after the onset of an acute viral respiratory infection.
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This question is part of the following fields:
- Respiratory
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Question 24
Incorrect
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6 day old twins are being exclusively breastfed. They are both jaundiced, requiring admission for phototherapy, and have lost 12% and 13% of their birthweights, respectively. They both have serum sodium levels of 145 mmol/L. What is the best advice about fluid management over the next 48 h?
Your Answer: Intravenous 10% dextrose at 150 mL/kg day
Correct Answer: Continue breast-feeding but give full top-ups via bottle/cup feeding
Explanation:Excessive weight loss is generally indicative of suboptimal feeding, and infants with excessive weight loss are potentially dehydrated or at risk of dehydration.Jaundice associated with suboptimal breastfeeding– this is classically associated with weight loss >10% and a vicious cycle of sleepiness that in turn leads to further poor feeding. In the absence of clinical signs of dehydration, no evidence suggests that overhydration is helpful. If the infant is dehydrated, hydration should be given as clinically indicated. However, if the infant can tolerate oral feeding, oral hydration with a breast milk substitute is likely to be superior to intravenous hydration because it reduces enterohepatic circulation of bilirubin and helps wash bilirubin out of the bowel.
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This question is part of the following fields:
- Emergency Medicine
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Question 25
Incorrect
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What is the most common identified trigger of anaphylaxis in children?
Your Answer: Blood products
Correct 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 26
Incorrect
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A 15-year-old male presents with a depressed skull fracture, which was surgically managed. Over the next few days, he complains of double vision on walking downstairs and reading. On testing ocular convergence, the left eye faces downward and medially, but the right side does not.Which of the following injured nerves is most likely responsible for the patient's symptoms?
Your Answer: Trigeminal nerve
Correct Answer: Trochlear
Explanation:Based on the clinical scenario provided, the most probable nerve injured in this patient would be the trochlear nerve. The trochlear nerve has a relatively long intracranial course, and this makes it vulnerable to injury in head trauma. Head trauma is the most frequent cause of acute fourth nerve palsy. A 4th nerve palsy is the most common cause of vertical diplopia. The diplopia is at its worst when the eye looks medially which it usually does as part of the accommodation reflex when walking downstairs.
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This question is part of the following fields:
- Ophthalmology
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Question 27
Incorrect
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A 15-year-old Afro-Caribbean boy presents with a temperature of 37.2℃ and acute abdominal pain. He has previously undergone a splenectomy secondary to sickle cell disease. Clinically he is jaundiced. An ultrasound scan demonstrates a common bile duct diameter of 10mm. What is the most likely diagnosis?
Your Answer: Acute Appendicitis
Correct Answer: Impacted Gall Stone
Explanation:Based on the clinical scenario provided, this patient most probably has impacted gall stones. Gall stones in children can be caused by haematological diseases such as sickle cell anaemia and thalassemia. Cholesterol stones are also becoming more prevalent. A dilated common bile duct (> 10mm in adults) suggests gall stone impaction. The presence of pyrexia indicates cholecystitis.
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This question is part of the following fields:
- Paediatric Surgery
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Question 28
Incorrect
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A 15-year-old boy presented to a urologist with a complaint of blood in the urine and pain in his abdomen. On examination, abdominal swelling is present and blood pressure is elevated. Which of the following is the most appropriate investigation in this case?
Your Answer: Renal biopsy
Correct Answer: Ultrasound
Explanation:Haematuria and abdominal swelling may indicate either polycystic kidney disease or a tumour. Because of the patient’s age, the likelihood of a tumorous growth is small, thus an ultrasound is the best choice for this case.
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This question is part of the following fields:
- Renal
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Question 29
Correct
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A 4 year old baby was brought in by her mother with complaints of generalized pallor, loss of weight and loose stools. The baby's stools were frothy in nature and difficult to flush. Which investigation can help in diagnosing this patient?
Your Answer: Anti-endomysial antibodies
Explanation:The presence of anti-endomysial antibodies confirms the diagnosis of Celiac disease, which is the primary cause of illness in this patient. The sweat chloride test is performed with cystic fibrosis.
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This question is part of the following fields:
- Gastroenterology And Hepatology
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Question 30
Incorrect
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Regarding the thymus, which of the following is true?
Your Answer:
Correct Answer: DiGeorge’s syndrome is a developmental abnormality affecting the thymus
Explanation:The thymus is a lymphoid organ located in the anterior mediastinum. In early life, the thymus is responsible for the development and maturation of cell-mediated immunologic functions. The thymus is composed predominantly of epithelial cells and lymphocytes. Precursor cells migrate to the thymus and differentiate into lymphocytes. Most of these lymphocytes are destroyed, with the remainder of these cells migrating to tissues to become T cells.DiGeorge’s syndrome (DGS) is a developmental abnormality affecting the thymus. The classic triad of features of DGS on presentation is conotruncal cardiac anomalies, hypoplastic thymus, and hypocalcaemia (resulting from parathyroid hypoplasia).
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This question is part of the following fields:
- Endocrinology
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SESSION STATS - PERFORMANCE PER SPECIALTY
