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Question 1
Correct
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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: 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 2
Correct
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A 10 month infant was brought in a drowsy condition with a 4 day history of vomiting and diarrhoea. His skin turgor was reduced and skin appeared mottled. Vital signs showed decreased BP, reduced capillary refill and a heart rate of 145/min. The best choice of treatment in this case would be?
Your Answer: IV fluid bolus over 20 minutes
Explanation:According to WHO, the treatment protocol in severely dehydrated children, is to infuse a bolus of isotonic crystalloid over 20-30 min at 30ml/kg to children less than 12 months of age followed by giving the remaining fluid over 5 hours for infants. Reference: World Health Organisation, the treatment of diarrhoea, a manual for physical and senior health workers.
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This question is part of the following fields:
- Fluid And Electrolytes
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Question 3
Correct
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Which of the given statements is correct regarding carbon monoxide?
Your Answer: CO combines with haemoglobin to form carboxyhaemoglobin
Explanation:Carbon monoxide is a colourless gas, which is toxic to animals. It has a high affinity for haemoglobin (around 250 times greater than oxygen). It combines with haemoglobin forming carboxyhaemoglobin, which decreases the oxygen-carrying capacity of the blood, leading to a left-shift in the oxygen-dissociation curve. CO is produced endogenously in limited amounts (0.4ml per hour), but the toxic levels are higher.
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This question is part of the following fields:
- Haematology And Oncology
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Question 4
Correct
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In the adult heart, the sinus venosus gives rise to the:
Your Answer: Coronary sinus
Explanation:The sinus venosus is a large quadrangular cavity which precedes the atrium on the venous side of the chordate heart. It exists distinctly only in the embryonic heart (where it is found between the two venae cavae)| however, the sinus venosus persists in the adult. In the adult, it is incorporated into the wall of the right atrium to form a smooth part called the sinus venarum, which is separated from the rest of the atrium by a ridge of fibres called the crista terminalis. The sinus venosus also forms the SA node and the coronary sinus.
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This question is part of the following fields:
- Embryology
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Question 5
Incorrect
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A 2-month-old infant was brought to the paediatrics ward by her mother with a complaint of excessive crying during urination. The urine culture of the infant revealed E.coli. Which of the following investigations should be done next?
Your Answer: MCUG
Correct Answer: US
Explanation:Urine culture confirms a diagnosis of a UTI. A kidney ultrasound will be the next best investigation because it will help us to visualise the bladder, kidneys, and ureters to rule out any congenital obstruction in the urinary tract that might be the actual cause of infection in this 2-month old girl.
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This question is part of the following fields:
- Renal
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Question 6
Correct
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A 19-year-old girl has presented with symptoms suggestive of anorexia nervosa. Following a consult with a dietician, a decision was made to supplement her nutrition through total parenteral nutrition (TPN) via a central line. Which of the following is a common complication associated with TPN?
Your Answer: Deranged liver function tests
Explanation:Total parenteral nutrition (TPN) frequently causes derangement of liver function in children. Other options:- While line sepsis and thromboembolism are recognised complications of TPN, they do not occur frequently. – A child who is on TPN will require regular blood tests because of the potential for the development of electrolyte abnormalities. Need to observe their liver function, in order to provide TPN more accurately.
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This question is part of the following fields:
- Gastroenterology And Hepatology
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Question 7
Correct
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A 16-year-old boy is brought to the clinic by his parents, who are concerned that he is shorter than the other boys at school, despite having attained puberty. His father is 1.70 m tall, and his mother is 1.50 m tall. Given his parents height, what is his adult height potential?
Your Answer: 1.67 m
Explanation:The adult height potential may be calculated for a male child by (father’s height in cm + mother’s height in cm) / 2 then add 7 cm.In the scenario provided: (170 + 150)/2 + 7 = 167 cm = 1.67 m.For a female child by (father’s height in cm + mother’s height in cm) / 2 then minus 7 cm.This can then be plotted on a height centile chart to find the mid-parental centile.Causes of short stature include:- Normal variant (often familial)- Constitutional delay of growth and puberty- Chronic illness, e.g. cystic fibrosis, inflammatory bowel disease- Endocrine: growth hormone deficiency, hypothyroidism, steroid excess syndromes: Turner’s, Down’s, Prader-Willi- Skeletal dysplasias, e.g. achondroplasia
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This question is part of the following fields:
- Endocrinology
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Question 8
Correct
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A pathologist is examining a histological section and identifies Hassall's corpuscles.With what are they most commonly associated?
Your Answer: Medulla of the thymus
Explanation:Hassall’s corpuscles are groups of epithelial cells within the thymic medulla. The physical nature of these structures differs between mammalian species. Although Hassall’s corpuscles have been proposed to act in both the removal of apoptotic thymocytes and the maturation of developing thymocytes within the thymus, the function of Hassall’s corpuscles has remained an enigma.
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This question is part of the following fields:
- Haematology And Oncology
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Question 9
Correct
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A 6 year old girl with a history of polyuria and polydipsia undergoes a water deprivation test. Previous urine dipstick results were negative for blood, glucose, or protein. The test is started and once the girl loses 3% of her body weight, her serum osmolarity is more than 300 whereas her urine osmolarity is less than 300. Doctors administer desmopressin but osmolarity levels do not change. What is the most likely diagnosis?
Your Answer: Nephrogenic Diabetes Insipidus
Explanation:Nephrogenic Diabetes Insipidus is an acquired or hereditary condition that affects the water balance. It presents with polyuria and polydipsia, leading commonly to dehydration.
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This question is part of the following fields:
- Nephro-urology
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Question 10
Correct
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A 5-year-old child was found to have orchidomegaly and splenomegaly. Blood tests show a WBC = 1.7 X 104/L, Hb = 7.1 g/dl and platelets = 44 X 104g/dl. His parents mention that he suffers from fatigue while at presentation he looks pale and has a fever. What is the most likely diagnosis?
Your Answer: Acute lymphoblastic leukaemia
Explanation:Acute lymphoblastic leukaemia (ALL) is an aggressive type of blood and bone marrow cancer which can appear in childhood. Signs of childhood ALL include: Fever, Easy bruising, Petechiae, Bone or joint pain, Painless lumps in multiple areas of the body, Weakness, fatigue or paleness, and Loss of appetite. Blood tests may show elevated white blood cells, decreased values of red blood cells and low platelet count.
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This question is part of the following fields:
- Haematology And Oncology
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Question 11
Correct
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A family of five members presents to the genetics clinic for further evaluation. The father, one boy and one girl present with a short stature, large heads, short digits, and trident hands. Genetic evaluation reveals they are all heterozygotes for a specific mutation. The rest of the family, the mother and the other daughter, do not carry this mutation. What is the pattern of inheritance?
Your Answer: Autosomal dominant with complete penetrance
Explanation:In this case, the affected individuals are all heterozygotes. Therefore, the mutation is autosomal dominant. Also, the mother does not carry the mutation, further confirming the autosomal dominant nature of the disease, which is most probably achondroplasia.
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This question is part of the following fields:
- Genetics And Dysmorphology
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Question 12
Incorrect
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A 6 year old child presents with unilateral headache that affects the left side of his head and face. His left eye is red and he scores 7/10 on pain assessment. The headache develops suddenly and unexpectedly after he returns from school. He has a history of six such episodes this year. Which of the following is the most probable diagnosis?
Your Answer:
Correct Answer: Cluster headache
Explanation:Cluster headaches present with unilateral severe headache that may be associated with ipsilateral cranial autonomic symptoms including| lacrimation, rhinorrhoea, ophthalmic injection, and occasionally, Horner syndrome (ipsilateral miosis, ptosis, and facial anhidrosis).
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This question is part of the following fields:
- Neurology And Neurodisability
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Question 13
Incorrect
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You notice an umbilical hernia in a 6-week old baby. What advice would you give the parents?
Your Answer:
Correct Answer: This is likely to resolve in 90% of cases by the age of 4 years. Repair is performed if still present
Explanation:Umbilical hernias are common in young children and they carry a low risk of incarceration as compared to inguinal hernias. About 90% umbilical hernias resolve by the age of 4 years. The best management for young children is to wait for resolution without surgical repair, unless there are complications. Parents should be assured that the child does not need to be referred to the general surgeon, nor should any home remedies such as taping a coin over the hernia be encouraged. If after the age of 4 it has not resolved, then surgery is indicated. This also applies to girls to prevent an unsightly hernia should she get pregnant.
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This question is part of the following fields:
- Paediatric Surgery
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Question 14
Incorrect
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A 4 year old boy presented with bruises on bilateral buttocks and thighs. His mother denied any history of trauma. The boy had a sore throat a few weeks ago. What is the most appropriate management of this patient?
Your Answer:
Correct Answer: Coagulation profile
Explanation:This history is suggestive of Henoch-Schönlein Purpura following a respiratory infection. A typical rash involving thighs and buttocks is often seen in this age group. Coagulation profile is the suitable answer from the given answers.
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This question is part of the following fields:
- Haematology And Oncology
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Question 15
Incorrect
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A mother gives birth to a baby at 28 weeks of gestation. He weights 1000g. What of the following is true?
Your Answer:
Correct Answer: Visual screening is not useful if carried out at this gestational age
Explanation:Retinopathy of prematurity (ROP) affects premature infants. It is a retinal vasoproliferative disease for which current screening guidelines are primarily based on birth weight and gestational age. The disease is first detected by screening at 32-38 weeks of gestation or in infants that are about 6-7 weeks old. Screening consists of dilation of the pupils and observing for dilated vessel.
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This question is part of the following fields:
- Ophthalmology
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Question 16
Incorrect
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An infant born at 34 weeks was kept in the incubator for almost a month. Physical examination revealed a heart murmur, which however was not present at discharge. What is the most probable cause of this murmur?
Your Answer:
Correct Answer: PDA
Explanation:PDA is particularly common in premature babies and it is managed by indomethacin administration. However, if PDA is not the only defect, prostaglandin E1 can be administered in order to keep the ductus open until the surgery takes place.
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This question is part of the following fields:
- Cardiovascular
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Question 17
Incorrect
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Which of the following developmental milestones is a 3 year old girl unlikely to have achieved?
Your Answer:
Correct Answer: Make good cuts with scissors
Explanation:At the age of three years a child is to be able to dress and undress himself with supervision, eat with a spoon and fork, build a tower with 9 cubes, give their full name and copy a circle. The child will not be able to make good cuts with scissions until he is about 5 years old.
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This question is part of the following fields:
- Child Development
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Question 18
Incorrect
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Which of the given laboratory findings is NOT suggestive of Fanconi syndrome?
Your Answer:
Correct Answer: Haematuria
Explanation:Fanconi syndrome is a rare disorder characterized by defective proximal renal tubular reabsorption, which leads to excessive excretion of potassium, phosphate, uric acid, bicarbonates, glucose, and certain amino acids in the urine. Loss of potassium in the urine leads to hypokalaemia, while the loss of phosphate may lead to hypophosphatemic rickets. The overall impact is the failure to thrive and growth retardation.
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This question is part of the following fields:
- Nephro-urology
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Question 19
Incorrect
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What is the most important investigation to perform in a 2-week-old new-born baby boy who is well feed and thriving, but jaundiced?
Your Answer:
Correct Answer: Total serum bilirubin
Explanation:Usually, a total serum bilirubin level test is the only one required in an infant with moderate jaundice who presents on the second or third day of life without a history and physical findings suggestive of a pathologic process. Measurement of bilirubin fractions (conjugated vs unconjugated) in serum is not usually required in infants who present as described above. However, in infants who have hepatosplenomegaly, petechiae, thrombocytopenia, or other findings suggestive of hepatobiliary disease, metabolic disorder, or congenital infection, early measurement of bilirubin fractions is suggested. The same may apply to infants who remain jaundiced beyond the first 7-10 days of life, and to infants whose total serum bilirubin levels repeatedly rebound following treatment.
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This question is part of the following fields:
- Neonatology
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Question 20
Incorrect
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A 15-year-old boy presents with hypertension and acute renal failure after an episode of diarrhoea. What is the most likely diagnosis?
Your Answer:
Correct Answer: Haemolytic–uraemic syndrome
Explanation:The likely diagnosis in this case is Haemolytic Uremic Syndrome (HUS), which is generally seen in young children presenting with a triad of symptoms, namely: acute renal failure, microangiopathic haemolytic anaemia, and thrombocytopenia. The typical cause of HUS is ingestion of a strain of Escherichia coli causing diarrhoea in these cases as well.
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This question is part of the following fields:
- Renal
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Question 21
Incorrect
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A woman gave birth to an infant at 39 weeks' gestation. The infant has a pulse of 110 bpm, grimaces upon nasal stimulation and has good muscle tone. Moreover, the colour of the infant is pink except for the extremities, which are blueish. What is the infants APGAR score?
Your Answer:
Correct Answer: 7
Explanation:Apgar is a quick test performed on a baby at 1 and 5 minutes after birth. The 1-minute score determines how well the baby tolerated the birthing process. The 5-minute score tells the health care provider how well the baby is doing outside the mother’s womb. More specifically, five components are assessed and these are the appearance (A), the pulse (P), the grimace (G), the activity (A) and the respiration (R). A normal APGAR score is considered to be 10 points, 2 points given for each normal component. In this case, 1 point is given for the appearance due to the bluish extremities, 2 points are given for the pulse which is higher than 100 bpm, 1 point is given for the grimacing, 2 points are given for the activity due to the good muscle tone and 1 point is given for the respiration due to gasping. Total score is 7 points.
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This question is part of the following fields:
- Neonatology
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Question 22
Incorrect
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A 15-year-old boy complains of fever, headache, and neck stiffness. On examination, Kernig's and Brudzinski's signs were positive. In the meantime, while awaiting the results from blood culture, how will you manage this patient?
Your Answer:
Correct Answer: Cefotaxime
Explanation:Positive Kernig’s and Brudzinski’s signs may indicate meningitis. While awaiting blood culture results, a broad-spectrum antibiotic such as Cefotaxime (a third generation cephalosporin) is preferred over the other medications listed.
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This question is part of the following fields:
- Pharmacology
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Question 23
Incorrect
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A 16 year old boy was admitted with severe pain and swelling of his scrotum following a kick to the groin. What is the most appropriate management that can be done at this stage?
Your Answer:
Correct Answer: Exploratory surgery
Explanation:The most worrying condition is testicular torsion and to exclude it exploratory surgery is required.
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This question is part of the following fields:
- Paediatric Surgery
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Question 24
Incorrect
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Which of the following is not associated with DiGeorge syndrome?
Your Answer:
Correct Answer: Normal IQ
Explanation:DiGeorge syndrome is one of the most common microdeletion syndromes, resulting from 22q11 deletion. 10% of the cases can be inherited in an autosomal dominant fashion, while 90% are sporadic. The syndrome is characterized by a deficiency of both T and B-cell lines along with hearing loss, 20-fold increased lifetime chances of developing schizophrenia, renal abnormalities, congenital heart defects, and a borderline or low IQ. Distinctive facial features include micrognathia, long face, short philtrum, cleft palate, and small teeth.
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This question is part of the following fields:
- Cardiovascular
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Question 25
Incorrect
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A 2-year-old child is brought to the clinic by his parents who say that he has had frequent breath holding spells which occur almost 4 times per week. Which of the following nutritional deficiency most often results in the breath holding spells like the ones experienced by this child?
Your Answer:
Correct Answer: Iron
Explanation:Breath-holding spells are usually caused by either a change in the child’s breathing or a slowing of the heart rate. In some children, breath-holding spells may be related to iron deficiency anaemia, a condition in which the body doesn’t produce a normal number of red blood cells. Conclusion: Not only Iron deficiency anaemia but also iron deficiency alone without anaemia is associated with a risk of high-frequency cyanotic breath holding spells. Iron therapy results in reduction in spells’ frequency which was correlated with increasing ferritin and iron levels.
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This question is part of the following fields:
- Nutrition
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Question 26
Incorrect
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A 27-year-old pregnant female had a pre pregnancy BMI of 33 kg/m2. She is found to have gestational diabetes and ultrasonography estimates a fetal macrosomia. BP is 127/72 mmHg. This primigravida is at greatest risk for which of the following obstetric emergency?
Your Answer:
Correct Answer: Shoulder dystocia
Explanation:Shoulder dystocia occurs when the fetal anterior shoulder impacts against the maternal symphysis following delivery of the vertex. Less commonly, shoulder dystocia results from impaction of the posterior shoulder on the sacral promontory. Risk Factors for Shoulder DystociaMaternalAbnormal pelvic anatomyGestational diabetesPost-dates pregnancyPrevious shoulder dystociaShort statureFetalSuspected macrosomiaLabour relatedAssisted vaginal delivery (forceps or vacuum)Protracted active phase of first-stage labourProtracted second-stage labour
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This question is part of the following fields:
- Neonatology
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Question 27
Incorrect
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Which of the following conditions are most commonly associated with pruritus:
Your Answer:
Correct Answer: Lichen planus
Explanation:Itchy skin conditions include:Allergy & anaphylaxisAthletes footAtopic dermatitisContact dermatitisDrug allergyErythema multiformeFolliculitisImpetigoInsect bites, stings, infestationsKawasaki diseaseLichen planusNummular eczemaPityriasis roseaPsoriasisScabiesTinea corporisToxic epidermal necrolysisUrticariaVaricellaViral exanthemNote: Miliaria rubra is itchy, miliaria profunda usually isn’t.
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This question is part of the following fields:
- Dermatology
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Question 28
Incorrect
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A 16 year old patient was admitted with walking difficulties and knee pain. Upon examination, his leg is externally rotated and is 2cm shorter. His ability to flex, abduct and medially rotate his leg is limited and when he flexes his hip, external rotation is increased. What is the most probable diagnosis?
Your Answer:
Correct Answer: Slipped femoral epiphysis
Explanation:The clinical presentation is typical of a slipped femoral epiphysis, which refers to a fracture through the growth plate (physis), resulting in slippage of the overlying end of the femur. It is the most common hip disorder in adolescence. SCFEs usually cause groin pain on the affected side, but sometimes cause knee or thigh pain. The range of motion in the hip is restricted in internal (medial) rotation, abduction, and flexion.
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This question is part of the following fields:
- Musculoskeletal
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Question 29
Incorrect
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A 7-month-old baby girl is admitted with poor feeding and irritability for 2 days. She is lethargic and persistently crying. Urine dipstick showed leucocytes. What is the single most important investigation to arrive at a diagnosis?
Your Answer:
Correct Answer: Urine for C&S
Explanation:The clinical presentation and leucocytes on the urine dipstick is suggestive of a urinary tract infection. To confirm the diagnosis, urine should be sent for culture and sensitivity.
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This question is part of the following fields:
- Microbiology
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Question 30
Incorrect
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Congenital cytomegalovirus infection is characterized by which of the following statements?
Your Answer:
Correct Answer: Periventricular cerebral calcifications are an associated feature
Explanation:One of the most common congenital viral infections is cytomegalovirus infection. The infection is even commoner than the other widely known diseases like down’s syndrome and spina bifida. It is caused by herpesvirus type 5 and is diagnosed using PCR of saliva. The clinical features include failure to thrive, intellectual disability, epilepsy, and microcephaly. The most common clinical complication is sensorineural deafness. The drug of choice for the treatment of neonatal CMV infection is ganciclovir, an anti-viral drug that has shown to prevent deafness. Cytomegalic inclusion disease is diagnosed at birth with marked neurological disability, resulting from microcephaly, intracerebral calcifications, and cerebral atrophy.
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This question is part of the following fields:
- Neonatology
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SESSION STATS - PERFORMANCE PER SPECIALTY
