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Question 1
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A 15-year-old girl presents with severe abdominal pain radiating to her back and vomiting. Her vitals are as follows: Heart rate: 200 bpm and BP: 100/45 mmHg. On examination there is tenderness and guarding in the upper abdomen. Blood investigations reveal:Hb: 13.4 g/dLWBC Count: 16,000 cells/mm3Platelet count: 2,53,000 cells/mm3Na+: 140 mEq/LK+: 3.5 mEq/LCreatinine 6.4 mg/dLUrea 90 mg/dLBilirubin 2 mg/dLAlbumin: 4.2 mg/dLAmylase: 800 IU/L AST: 12 IU/L ALT: 16 IU/LWhat is the most probable diagnosis?
Your Answer: Pancreatitis
Explanation:Based on the clinical scenario, the most probable diagnosis for this patient is pancreatitis.Although rare in childhood, the presence of abdominal pain radiating to the back with shock and tachycardia, and a raised amylase, should raise a suspicion of pancreatitis. Possible causes include trauma, drugs, viral illness, mumps, hyperparathyroidism, hyperlipidaemia and cystic fibrosis. Other options:- Normal LFTs in this patient make hepatitis unlikely. – Gastroenteritis with severe diarrhoea and vomiting may account for the shock and tachycardia, but guarding on abdominal examination and the raised amylase would not be explained by gastroenteritis. – Pregnancy is an important diagnosis to consider in an adolescent with abdominal pain, but the raised amylase and other features point to a diagnosis of pancreatitis.
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This question is part of the following fields:
- Gastroenterology And Hepatology
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Question 2
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A 9-year-old girl complains of perioral blisters and a burning sensation of her face. Some of the blisters are crusted and some are weeping. What is the most likely diagnosis?
Your Answer: Impetigo
Explanation:Impetigo appears more commonly on the face than other exposed areas like the limbs. Its blisters are clustered and may have a fluid discharge.
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This question is part of the following fields:
- Dermatology
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Question 3
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A woman gives birth to a baby at 32 weeks of gestation by spontaneous vaginal delivery. The new-born looks floppy, irritable, and drowsy and soon has a seizure. His blood sugar levels and CRP are normal and the doctors refer the baby for urgent neuroimaging. What is the most probable cause?
Your Answer: Intracranial haemorrhage
Explanation:The clinical picture suggests intracranial haemorrhage which is uncommon but prevalent in pre-term babies. The rest of the options suggest peripheral causes which do not affect the central function.
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This question is part of the following fields:
- Neonatology
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Question 4
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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 5
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A 17-year-old boy, who had developed shortness of breath and a loss of appetite over the last month, was referred to a haematologist because he presented with easy bruising and petechiae. His prothrombin time, platelet count, partial thromboplastin and bleeding time were all normal. Which of the following would explain the presence of the petechiae and easy bruising tendency?
Your Answer: Scurvy
Explanation:Scurvy is a condition caused by a dietary deficiency of vitamin C, also known as ascorbic acid. Humans are unable to synthesize vitamin C, therefore the quantity of it that the body needs has to come from the diet. The presence of an adequate quantity of vitamin C is required for normal collagen synthesis. In scurvy bleeding tendency is due to capillary fragility and not coagulation defects, therefore blood tests are normal.
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This question is part of the following fields:
- Nutrition
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Question 6
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Regarding neonatal meningitis, which of the following statements is true?
Your Answer: Has an above average incidence in babies with a meningomyelocele
Explanation:The commonest time for bacterial meningitis is in the 1st month of life and group B Streptococcus is the commonest organism. The anterior fontanelle is full, but does not bulge with normal flexion. Neurological manifestations include seizures, irritability, poor tone, lethargy and tremors, however no findings of sensorineural deafness have been noted. One of the risk factors for introduction of meningeal infection is Meningomyelocele.
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This question is part of the following fields:
- Infectious Diseases
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Question 7
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A neonate was delivered 24 hours ago at the gestational age of 29 weeks. His birth weight was recorded to be 1 kg. Due to his critical state, the baby was intubated and ventilated. Prior to his intubation, the baby was managed with CPAP, but he seemed to get exhausted. He is now on SiMV (spontaneous intermittent mechanical ventilation). The ventilator settings are as follows: targeted tidal volume 9 ml, maximum PIP 30, PEEP 5, rate 40/min, FiO2 0.3. Baby's oxygen saturations are 93%. Blood gas shows pH 7.41, CO2 3.9 kPa, BE -4. Which of the following changes need to be made to the ventilator settings initially?
Your Answer: Decrease targeted tidal volume
Explanation:Synchronized IMV (SIMV) with pressure support, used in the alert infant. SIMV guarantees a minimum minute volume while allowing the patient to trigger spontaneousbreaths at a rate and volume determined by the patient. Extra breaths are boosted with pressure support. Tidal Volume (Vt) is normally approximately 6-10 mL/kg and 4-6 ml/kg in the preterm.Respiratory rate (RR) is usually 30-60 BPM. Tidal volume and respiratory rate are relatedto respiratory minute volume as follows: Vm(mL/min) = Vt x RR .This baby is overventilated with a low CO2. Tidal volumes should generally be targeted at 4–6 ml/kg and this baby is being targeted at 9 ml/kg which exposes the baby to damage to the distal airways from this ventilation which can lead to bronchopulmonary dysplasia.
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This question is part of the following fields:
- Neonatology
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Question 8
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A 15-year-old boy is brought to the clinic by his parents who are worried that their child has growth and pubertal delay. His father also had a similar pattern of growth and is as short as a teenager. Currently, he is on the 2nd centile for height, with delayed adrenarche and gonadarche. in order to confirm the most likely diagnosis, which of the following investigations would be the most useful?
Your Answer: Wrist X-ray for bone age
Explanation:A bone age study helps doctors estimate the maturity of a child’s skeletal system. It’s usually done by taking a single X-ray of the left wrist, hand, and fingers. It is a safe and painless procedure that uses a small amount of radiation. The bones on the X-ray image are compared with X-rays images in a standard atlas of bone development, which is based on data from large numbers of other kids of the same gender and age. The bone age is measured in years.
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This question is part of the following fields:
- Endocrinology
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Question 9
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A 17-year-old female presents to the clinic with a mass in the upper outer quadrant of the right breast. Which of the following statements regarding the breast is untrue?
Your Answer: Nipple retraction may occur as a result of tumour infiltration of the clavipectoral fascia
Explanation:Patients with breast cancer develop clinical symptoms rather late at advanced tumour stages. Typical signs may include:Changes in breast size and/or shape| asymmetric breastsPalpable mass: typically a single, nontender, firm mass with poorly defined margins, most commonly in the upper outer quadrantSkin changes: Retractions or dimpling (due to tightening of the Cooper ligaments), Peau d’orange: skin resembling an orange peel (due to obstruction of the lymphatic channels): Redness, oedema, and pitting of the hair folliclesNipple changes: inversion, blood-tinged dischargeAxillary lymphadenopathy: firm, enlarged lymph nodes (> 1 cm in size), that are fixed to the skin or surrounding tissueIn advanced stages: ulcerations
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This question is part of the following fields:
- Adolescent Health
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Question 10
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A 15-year-old boy is brought to the clinic with recurrent episodes of diarrhoea and loose stools. He looks shorter than his age and does not seem to have undergone a growth spurt. After a series of investigations, he is diagnosed with Crohn's disease. Which of the following treatment strategies should initially be employed?
Your Answer: Elemental diet for 6 weeks
Explanation:The elemental diet is a medically supervised, sole nutrition dietary management given to individuals with moderate to severe impaired gastrointestinal function for 14-21 days.The diet consists of macronutrients broken down into their elemental form requiring little to no digestive functionality allowing time for the gut to rest. Elemental formulations are believed to be entirely absorbed within the first few feet of small intestine.
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This question is part of the following fields:
- Gastroenterology And Hepatology
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SESSION STATS - PERFORMANCE PER SPECIALTY
