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  • Question 1 - A 6 year old with a recent history of ear infection, now represents...

    Correct

    • A 6 year old with a recent history of ear infection, now represents with bilateral, erythematous and bulging tympanic membranes. His parents claim the boy also has hearing difficulty. Otoscopy reveals an effusion on the left side. Doctors suggest to perform Weber and Rinne tests. Which of the following is consistent with a left-sided middle ear effusion?

      Your Answer: Weber’s localising to left, Rinne negative on left, Rinne positive on right

      Explanation:

      When a child does not hear the sound in the middle during Weber test, it means they either they have a conductive hearing loss on the side they hear the sound, or a sensorineural hearing loss on the opposite side. Rinne’s test helps distinguish between the two. In this particular case, the hearing loss is most probably conductive due to the middle ear effusion. Therefore, Weber’s test should be localised to the left and Rinne’s should be positive on the right.

    • This question is part of the following fields:

      • ENT
      78.9
      Seconds
  • Question 2 - Which of the following signs suggests an absence seizure instead of a partial...

    Correct

    • Which of the following signs suggests an absence seizure instead of a partial complex seizure?

      Your Answer: Induction by hyperventilation

      Explanation:

      Absence seizures are induced by over breathing or hyperventilation, while the other features suggest partial seizures.

    • This question is part of the following fields:

      • Neurology
      47.5
      Seconds
  • Question 3 - Which of the following is true of miliaria? ...

    Incorrect

    • Which of the following is true of miliaria?

      Your Answer: Miliaria rubra produces subtle asymptomatic flesh coloured papules

      Correct Answer: Miliaria crystalline causes tiny, fragile clear vesicles

      Explanation:

      Miliaria is a common skin disease caused by blockage and/or inflammation of eccrine sweat ducts. Miliaria is frequently seen in hot, humid or tropical climates, in patients in the hospital, and in the neonatal period. Miliaria is also known as sweat rash.Based on the level of the sweat duct obstruction, miliaria is divided into three subtypes:- Miliaria crystallina (sudamina), caused by obstruction of the sweat ducts close to the surface of the skin (epidermis)|- Miliaria rubra, caused by obstruction of the sweat ducts deeper in the epidermis|- Miliaria profunda (tropical anhidrosis), the result of sweat leaking into the middle layer of skin (dermis).Miliaria crystallina appears as 1–2 mm superficial clear blisters that easily break. The blisters can look like beads of sweat. There is no inflammation. The blisters are usually seen widely spread on the head, neck, and upper trunk.Miliaria rubra is the most common type of miliaria results in red, 2–4 mm, non-follicular papules and papulovesicles. They are very itchy. Background erythema is often present. In children, miliaria affects the skin folds of the neck, axilla or groin. In adults, miliaria often affects the upper trunk, scalp, neck and flexures, particularly areas of friction with clothing. Miliaria pustulosa is a variant of milia rubra in which there are pustules.Miliaria profunda describes asymptomatic deep papules. The flesh–coloured, 1–3 mm diameter papules usually arise on the trunk and extremities.Mild Topical steroids can be used as a treatment

    • This question is part of the following fields:

      • Dermatology
      27.9
      Seconds
  • Question 4 - A new-born baby is found to have a loud heart murmur but is...

    Incorrect

    • A new-born baby is found to have a loud heart murmur but is otherwise well 6-hour baby after birth.Which one of the following is the most likely cause?

      Your Answer: Coarctation of the aorta

      Correct Answer: Tetralogy of Fallot

      Explanation:

      Tetralogy of Fallot usually is diagnosed after a baby is born, often after the infant has an episode of turning blue during crying or feeding (a tet spell). A loud heart murmur is usually present.An atrial septal defect is present at birth, but many babies do not have any signs or symptoms.Coarctation of the aorta is usually diagnosed after the baby is born. How early in life the defect is diagnosed usually depends on how mild or severe the symptoms are. New-born screening using pulse oximetry during the first few days of life may or may not detect coarctation of the aorta.In babies with a more serious condition, early signs usually include:pale skinirritabilityheavy sweatingdifficulty breathingBabies born with pulmonary atresia will show symptoms at birth or very soon afterwards. They may be cyanotic. However, it is not uncommon for a heart murmur to be absent right at birth.

    • This question is part of the following fields:

      • Cardiovascular
      36
      Seconds
  • Question 5 - A term baby with a birth weight of 4.2 kg with meconium aspiration...

    Incorrect

    • A term baby with a birth weight of 4.2 kg with meconium aspiration syndrome is intubated and ventilated. Conventional ventilation was unsuccessful and so a trial of high-frequency oscillatory ventilation has commenced. Chest X-ray shows good lung inflation. There is minimal chest “wobble” on the baby. Settings are mean airway pressure 16, delta P 25, rate 10 Hz, FiO2 0.5. Baby’s oxygen saturations are 94%. Blood gas shows pH 7.19, CO2 9.3 kPa, BE –5. What is the first change that should be made to the ventilation?

      Your Answer: Decrease delta P

      Correct Answer: Increase delta P

      Explanation:

      The baby is not clearing CO2 normally despite normal oxygenation so we should increase the delta P. Higher delta P will increase tidal volume and hence CO2 removal.After initial resuscitation and stabilization, the following should be the ventilator settings used:Rate: 30-40/minutePeak inspiratory pressure (PIP) – determined by adequate chest wall movement.An infant weighing less than 1500 grams: 16-28 cm H2O.An infant weighing greater than 1500 grams: 20-30 cm H2O. Positive end expiratory pressure (PEEP): 4 cm of H2O OR 5-6 cm if FiO2 > 0.90.FiO2: 0.4 to 1.0, depending on the clinical situation.Inspiratory time: 0.3-0.5 sec.After 15 to 30 minutes, check arterial blood gases and pH.If the PaO2 or the O2 saturation is below accepted standards, the FiO2 can be raised to a maximum of 1.0. If the PaO2 or O2 saturation is still inadequate, the mean airway pressure can be raised by increasing either the PIP, PEEP, inspiratory time or the rate, leaving inspiratory time constant.If the PaCO2 is elevated, the rate or peak inspiratory pressure can be raised.

    • This question is part of the following fields:

      • Neonatology
      104.7
      Seconds
  • Question 6 - In women undergoing breast augmentation, what is the percentage reduction with respect to...

    Incorrect

    • In women undergoing breast augmentation, what is the percentage reduction with respect to successful breastfeeding?

      Your Answer: 10%

      Correct Answer: 0.25

      Explanation:

      Breastfeeding may be significantly impaired (up to 25%) by breast augmentation. Equally, breast engorgement, which occurs due to vascular congestion, reduces nipple protrusion and subsequent ability to breastfeed successfully. In the latter, regular feeding or expressing is required.

    • This question is part of the following fields:

      • Neonatology
      22.4
      Seconds
  • Question 7 - A new-born infant deteriorates on the postnatal ward. The child is breathless with...

    Correct

    • A new-born infant deteriorates on the postnatal ward. The child is breathless with no murmurs, 3 cm liver edge, and poor femoral pulses. She is acidotic with elevated lactate. Mum did not attend the antenatal screening. What is the most likely diagnosis?

      Your Answer: Coarctation of the aorta

      Explanation:

      Coarctation of the aorta may be defined as a constricted aortic segment that comprises localized medial thickening, with some infolding of the medial and superimposed neointimal tissue.The presence of associated defects and aortic arch anomalies, the extent of patency of the ductus arteriosus, the rapidity of the process of closure of the ductus arteriosus, and the level of pulmonary vascular resistance determine the timing of clinical presentation and the severity of symptoms. Young patients may present in the first few weeks of life with poor feeding, tachypnoea, and lethargy and progress to overt CHF and shock. These patients may have appeared well before hospital discharge, and deterioration coincides with closure of the patent ductus arteriosus. Presentation may be abrupt and acute with ductal closure.Neonates may be found to have tachypnoea, tachycardia, and increased work of breathing and may even be moribund with shock. Keys to the diagnosis include blood pressure (BP) discrepancies between the upper and lower extremities and reduced or absent lower extremity pulses to palpation. However, when the infant is in severe heart failure, all pulses are diminished.The murmur associated with coarctation of the aorta may be nonspecific yet is usually a systolic murmur in the left infraclavicular area and under the left scapula.

    • This question is part of the following fields:

      • Cardiovascular
      51.9
      Seconds
  • Question 8 - A 6 year old child presents with clinical features of nephrotic syndrome and...

    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: Drug-induced nephrotic syndrome

      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
      62.5
      Seconds
  • Question 9 - A 16-year-old boy is brought to the clinic by his parents who are...

    Incorrect

    • A 16-year-old boy is brought to the clinic by his parents who are worried that their son might have delayed puberty. On examination, he has very little pubic hair and the testicular volume is 3ml. Bilateral gynaecomastia is also observed. Which of the following is the most likely diagnosis?

      Your Answer: Hypogonadotropic hypogonadism

      Correct Answer: Klinefelter's syndrome

      Explanation:

      The most overt phenotypic features of Klinefelter syndrome are caused by testosterone deficiency and, directly or indirectly, by unsuppressed follicle-stimulating and luteinizing hormones. Affected men typically have (in decreasing order of frequency): infertility, small testes, decreased facial hair, gynecomastia, decreased pubic hair, and a small penis. Because of their long legs, men with Klinefelter syndrome often are taller than predicted based on parental height. Body habitus may be feminized. In childhood, when there is a relative quiescence in the hormonal milieu, ascertainment of the syndrome may be difficult because the effects of hypogonadism (i.e., small external genitalia and firm testes) may be subtle or not present at all.

    • This question is part of the following fields:

      • Endocrinology
      27.1
      Seconds
  • Question 10 - An 8 week old baby presents with a fever of 38 degrees. What...

    Incorrect

    • An 8 week old baby presents with a fever of 38 degrees. What is the most appropriate course of action?

      Your Answer: Admit for infection screening

      Correct Answer: Admit for infection screen and start IV antibiotic

      Explanation:

      This temperature is considered to be a mild fever and is most often caused by a minor infection in children of this age. Therefore, an infection screen should be conducted and an IV antibiotic.

    • This question is part of the following fields:

      • Infectious Diseases
      25.2
      Seconds
  • Question 11 - A 13-month-old infant is admitted to the hospital and scheduled for an elective...

    Incorrect

    • A 13-month-old infant is admitted to the hospital and scheduled for an elective cardiac surgery. There is no respiratory distress, but cyanosis is present with oxygen saturations at 80s. There is a midline sternotomy scar. On auscultation there is a 4/6 ejection systolic murmur on the upper left sternal edge and a sternal heave is felt on palpation. Which of the following is the child most likely suffering from and what is the likely treatment?

      Your Answer: Tetralogy of Fallot with Blalock Taussig shunt

      Correct Answer: Ventricular septal defect with pulmonary artery band

      Explanation:

      The murmur and thrill indicate a right outflow tract murmur, coupled with the right ventricular heave suggests right ventricular hypertrophy. The VSD would not have been amenable to surgery due to the child’s size/weight and so instead would have been palliated with a PA band. As the child grows, this band progressively restricts pulmonary blood flow until the left to right shunt has reversed. Then it is time for the band to be removed and the VSD to be closed.Pulmonary atresia is a cyanotic condition, which may be palliated with an arterial duct stent. This answer is incorrect as the stent placement would not require a midline sternotomy and would give a continuous machinery type murmur. Pulmonary stenosis with PDA ligation is incorrect. The murmur, thrill, and heave all match a pulmonary stenosis but in the absence of an additional shunt lesion the child would not be cyanosed.

    • This question is part of the following fields:

      • Cardiovascular
      60.6
      Seconds
  • Question 12 - A 16-year-old girl developed haemoptysis with acute kidney injury requiring dialysis. She suffered...

    Incorrect

    • A 16-year-old girl developed haemoptysis with acute kidney injury requiring dialysis. She suffered from recurrent epistaxis for the past 2 weeks. Renal biopsy showed crescentic glomerulonephritis. Which antibody would you expect to be positive?

      Your Answer: Anticentromere

      Correct Answer: Antiproteinase 3

      Explanation:

      This patient has pulmonary renal syndrome which is most commonly due to an ANCA positive vasculitis. The history of recurrent epistaxis makes Wegener’s granulomatosis the most probable diagnosis. Wegener’s granulomatosis, microscopic polyangiitis, and idiopathic pauci-immune necrotizing crescentic glomerulonephritis (NCGN) are strongly associated with antineutrophil cytoplasmic autoantibodies (ANCAs) directed against either proteinase 3 (anti-PR3) or myeloperoxidase (anti-MPO).

    • This question is part of the following fields:

      • Renal
      29
      Seconds
  • Question 13 - A 10-year-old Japanese boy presents to the hospital with pain in his elbows...

    Correct

    • A 10-year-old Japanese boy presents to the hospital with pain in his elbows and knees associated with swelling of his hands and feet. On examination, he is found to be febrile with a temperature of 39°C. He is also tachycardic with a pulse rate of 120bpm and hypotensive with a blood pressure of 100/60 mmHg. Conjunctival congestion and cervical lymphadenopathy with a red tongue were also noted. What is the most probable diagnosis for this patient?

      Your Answer: Kawasaki disease

      Explanation:

      The most probable diagnosis for this patient would be Kawasaki disease.Kawasaki disease:It is an acute systemic disorder of childhood that predominantly occurs in Japan (800 cases per million in children under the age of 5 years). The causative factor is not known, but mycoplasma and HIV infection may be associated in some cases. Clinical Features:The principal clinical features are fever persisting for more than five days, bilateral non-purulent conjunctival congestion, cervical lymphadenopathy, polymorphous rash, arthralgia, palmar erythema and strawberry tongue. Other options:- Diffuse cutaneous systemic sclerosis is associated with skin, renal and gut involvement. Arthralgia, morning stiffness and flexor tenosynovitis are common. – Behçet syndrome is a vasculitis of unknown aetiology that characteristically targets venules. – Felty syndrome is the association of splenomegaly and neutropenia with rheumatoid arthritis. Lymphadenopathy is common, and there is a predisposition to recurrent infections.

    • This question is part of the following fields:

      • Musculoskeletal
      46.7
      Seconds
  • Question 14 - What is the most common position of the appendix? ...

    Correct

    • What is the most common position of the appendix?

      Your Answer: Retrocecal

      Explanation:

      The most common position of the appendix is the retrocecal position.Note: If a retrocecal appendix is difficult to remove, then mobilisation of the right colon significantly improves access.Other options:The various positions of the appendix are:- Retrocecal (74%)- Pelvic (21%)- Postileal- Subcaecal- Paracaecal- Preileal

    • This question is part of the following fields:

      • Gastroenterology And Hepatology
      40
      Seconds
  • Question 15 - The severity of psoriasis can be assessed using which of the following tools?...

    Incorrect

    • The severity of psoriasis can be assessed using which of the following tools?

      Your Answer: Surface area percentage calculation

      Correct Answer: Psoriasis Area and Severity Index- PASI

      Explanation:

      Psoriasis is a chronic inflammatory skin disease that is mainly due to the interplay between keratinocytes, dermal vascular cells, and antigen-presenting cells. There are five main types of psoriasis based on the type and severity of the lesions it produces. A useful tool to determine the extent and severity of psoriasis is the Psoriasis Area and Severity Index (PASI) score, which takes into account the percentage of a specific area affected by psoriasis in combination with severity, which in turn is assessed by the presence of desquamation, induration, and erythema.

    • This question is part of the following fields:

      • Dermatology
      23
      Seconds
  • Question 16 - A 10-month-old boy is brought to clinic. His parents are concerned because two...

    Correct

    • A 10-month-old boy is brought to clinic. His parents are concerned because two days ago, he met another child with mumps. What is the most appropriate management 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
      27
      Seconds
  • Question 17 - A 15-year-old boy presents with a concern that he is the shortest in...

    Correct

    • A 15-year-old boy presents with a concern that he is the shortest in his class, and his voice has not 'broken' yet. A thorough examination reveals that his sexual development is within the normal range, and he is reassured that puberty occurs at different times for everyone. Which of the following cells in the testes secrete testosterone?

      Your Answer: Leydig cells

      Explanation:

      The cells in the testes that secrete testosterone are the Leydig cells.Other cells in testes include:- Spermatogonia: These are undifferentiated male germ cells which undergo spermatogenesis in the seminiferous tubules of the testes.- Sertoli cells: They are a part of the seminiferous tubule of the testes, cells are activated by FSH and nourish developing sperm cells.- Myoid: They are squamous contractile cells which generate peristaltic waves, they surround the basement membrane of testes.- Fibroblasts: Cells which synthesise collagen and the extracellular matrix.

    • This question is part of the following fields:

      • Nephro-urology
      40.6
      Seconds
  • Question 18 - A neonate was brought in by her mother, for a skin lesion present...

    Correct

    • A neonate was brought in by her mother, for a skin lesion present over the neonate's back which is bluish in colour, but otherwise asymptomatic. The most appropriate course of action will be?

      Your Answer: Reassure

      Explanation:

      A Mongolian spot can be present in new born babies which usually appears over the back and fades with time. There is nothing to worry about.

    • This question is part of the following fields:

      • Dermatology
      14.2
      Seconds
  • Question 19 - A new-born baby has an abdominal wall defect diagnosed antenatally. When admitted to...

    Incorrect

    • A new-born baby has an abdominal wall defect diagnosed antenatally. When admitted to the neonatal unit, there is a sac found covering a 3cm defect with what appears to be intestine| no liver is visible. The baby has no dysmorphic features other than a large tongue. What is the immediate danger with this baby?

      Your Answer: Pierre Robin syndrome, risk to airway

      Correct Answer: Beckwith-Wiedermann syndrome, risk of hypoglycaemia

      Explanation:

      Beckwith-Wiedemann Syndrome (BWS) was first characterized by Patients having abdominal wall defects, macrosomia, macroglossia, and enlarged adrenal glands. Since then, the clinical presentation has expanded to recognize hemihypertrophy/lateralized overgrowth, hyperinsulinism, omphalocele, and organomegaly as classic features of BWS.About 50% of children with BWS have hypoglycaemia and therefore patients with diagnosed BWS should be evaluated for hypoglycaemia. Hypoglycaemia in most BWS new-borns generally resolves within the first few days of life. However, in about 5% of patients that have hyperinsulinism, the severe prolonged hypoglycaemia requires escalated therapy ranging for medication (diazoxide) to partial pancreatectomy.

    • This question is part of the following fields:

      • Paediatric Surgery
      50
      Seconds
  • Question 20 - A term baby was born following a placental abruption. There was no respiratory...

    Incorrect

    • A term baby was born following a placental abruption. There was no respiratory effort and an undetectable heart rate initially. Baby is now 20 min old and has been intubated with regular ventilation breaths. Heart rate came up to 110/min following two rounds of chest compressions. Baby appears very pale. No drugs have been given. Oxygen saturations are currently 85% measured on the right hand despite FiO2 1.0. A venous cord gas shows pH 6.89, CO2 –8, BE –14, Hb 8. What is the next most appropriate step?

      Your Answer: Turn down temperature to begin cooling the baby

      Correct Answer: Umbilical venous catheter (UVC) placement

      Explanation:

      Umbilical vein catheterization utilizes the exposed umbilical stump in a neonate as a site for emergency central venous access up to 14 days old. Umbilical vein catheterization can provide a safe and effective route for intravenous delivery of medications and fluids during resuscitation.The indication for umbilical vein catheterization is when there is a need for IV access in a neonate for resuscitation, transfusions, or short-term venous access when otherwise unobtainable.

    • This question is part of the following fields:

      • Neonatology
      101.7
      Seconds
  • Question 21 - A baby boy born 5 weeks ago with a birth weight of 3.5kg...

    Correct

    • A baby boy born 5 weeks ago with a birth weight of 3.5kg presents to the clinic with jaundice. He is being breastfed and his current weight is 4.5kg. Which of the following is most likely responsible for the baby's jaundice?

      Your Answer: Breast Milk Jaundice

      Explanation:

      Breast milk jaundice is associated with breast-feeding. It typically occurs one week after birth and can sometimes last up to 12 weeks, but it rarely causes complications in healthy, breast-fed infants. The exact cause of breast milk jaundice isn’t known. However, it may be linked to a substance in the breast milk that prevents certain proteins in the infant’s liver from breaking down bilirubin. The condition may also run in families. Breast milk jaundice is rare, affecting less than 3 percent of infants. When it does occur, it usually doesn’t cause any problems and eventually goes away on its own. It is safe to continue breast-feeding.

    • This question is part of the following fields:

      • Gastroenterology And Hepatology
      20.8
      Seconds
  • Question 22 - A study shows that of children with asthma, 25% have a first-degree relative...

    Correct

    • A study shows that of children with asthma, 25% have a first-degree relative with asthma compared with only 10% of a sample of children without asthma. Which of the following is true?

      Your Answer: To interpret the results we need to know how the samples were selected

      Explanation:

      Observational studies fall under the category of analytic study designs and are further sub-classified as observational or experimental study designs. The goal of analytic studies is to identify and evaluate causes or risk factors of diseases or health-related events. The differentiating characteristic between observational and experimental study designs is that in the latter, the presence or absence of undergoing an intervention defines the groups. By contrast, in an observational study, the investigator does not intervene and rather simply “observes” and assesses the strength of the relationship between an exposure and disease variable.Three types of observational studies include cohort studies, case-control studies, and cross-sectional studies. Case-control and cohort studies offer specific advantages by measuring disease occurrence and its association with an exposure by offering a temporal dimension (i.e. prospective or retrospective study design). Cross-sectional studies, also known as prevalence studies, examine the data on disease and exposure at one particular time point. Because the temporal relationship between disease occurrence and exposure cannot be established, cross-sectional studies cannot assess the cause and effect relationshipDisadvantage of Cohort study is Susceptible to selection bias.

    • This question is part of the following fields:

      • Epidemiology And Statistics
      49
      Seconds
  • Question 23 - The following best describes non parametric tests: ...

    Incorrect

    • The following best describes non parametric tests:

      Your Answer: Are more complex to administer

      Correct Answer: Are less powerful than parametric tests

      Explanation:

      Compared to parametric tests, non parametric tests are seen to be less powerful as they often contend with fewer assumptions, and may use less information from the data. Sample sizes can be smaller. The samples do not have to follow a normal distribution as in parametric tests, and data may be ordinal, ranked or contain outliers that cannot be removed. Therefore nonparametric tests are well suited for these instances and do not need to be used as a last resort. They are not any more complex than parametric tests.

    • This question is part of the following fields:

      • Epidemiology And Statistics
      34.2
      Seconds
  • Question 24 - A 2 year old girl with a history of oligohydramnios, hypotonia, and scissoring...

    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
      47.6
      Seconds
  • Question 25 - A male infant is brought to the emergency department by his parents. He...

    Incorrect

    • A male infant is brought to the emergency department by his parents. He was born at 34 weeks by spontaneous vaginal delivery and was discharged 4 weeks ago. He is not on any regular medication. Parents said that he brings up small volumes of milk after feeds. This happens approximately twice a day. Observations are all within normal range and examination is unremarkable.Which of the following is the most likely diagnosis?

      Your Answer: Overfeeding

      Correct Answer: Gastro-oesophageal reflux

      Explanation:

      Gastroesophageal reflux occurs in almost all infants, manifesting as wet burps after feeding. The spit-ups appear effortless and not particularly forceful.Infants in whom reflux has caused GERD have additional symptoms, such as irritability, feeding refusal, and/or respiratory symptoms such as chronic recurrent coughing or wheezing and sometimes stridor. Much less commonly, infants have intermittent apnoea or episodes of arching the back and turning the head to one side (Sandifer syndrome). Infants may fail to gain weight appropriately or, less often, lose weight.Incidence of gastroesophageal reflux increases between 2 months and 6 months of age (likely due to an increased volume of liquid at each feeding) and then starts to decrease after 7 months. Gastroesophageal reflux resolves in about 85% of infants by 12 months and in 95% by 18 months.

    • This question is part of the following fields:

      • Gastroenterology And Hepatology
      84.6
      Seconds
  • Question 26 - A male term infant was admitted to the neonatal unit on day 4...

    Incorrect

    • A male term infant was admitted to the neonatal unit on day 4 for severe jaundice. The bilirubin at that time was 320 mmol/l, which decreased with phototherapy. At day 30, the baby still required phototherapy to keep the bilirubin below the treatment line. On examination, the skin had a tanned appearance and his sclerae were icteric. Mother’s blood group was A+, the baby's blood group was A+, direct Coombs test (DCT) was negative. What is the MOST likely diagnosis?

      Your Answer: Biliary atresia

      Correct Answer: Crigler-Najjar syndrome

      Explanation:

      Crigler-Najjar syndrome is a rare genetic disorder characterized by an inability to properly convert and clear bilirubin from the body.The hallmark finding of Crigler-Najjar syndrome is a persistent yellowing of the skin, mucous membranes and whites of the eyes (jaundice).There are two forms of this disorder: Crigler-Najjar syndrome type I, characterized by a nearly complete lack of enzyme activity and severe, even life-threatening symptoms| and Crigler-Najjar syndrome type II, characterized by partial enzyme activity and milder symptoms. Both forms are inherited as autosomal recessive traits and are caused by errors or disruptions (mutations) of the UGT1A1 gene.The symptoms of Crigler-Najjar syndrome type I become apparent shortly after birth. Affected infants develop severe, persistent yellowing of the skin, mucous membranes and whites of the eyes (jaundice). These symptoms persist after the first three weeks of life.Infants are at risk for developing kernicterus, also known as bilirubin encephalopathy, within the first month of life.Crigler-Najjar syndrome type II is a milder disorder than type I. Affected infants develop jaundice, which increases during times when an infant is sick (concurrent illness), has not eaten for an extended period (prolonged fasting) or is under general anaesthesia. Some people have not been diagnosed until they are adults. Kernicterus is rare in Crigler-Najjar syndrome type II, but can occur especially when an affected individual is sick, not eating or under anaesthesia

    • This question is part of the following fields:

      • Gastroenterology And Hepatology
      141.1
      Seconds
  • Question 27 - What is the ideal growth rate of a new-born baby when receiving appropriate...

    Correct

    • What is the ideal growth rate of a new-born baby when receiving appropriate nutritional input?

      Your Answer: 15g/kg/day

      Explanation:

      The general target of weight gain in the neonatal intensive care unit is to replicate the intrauterine growth in the third trimester, which equates to the daily weight gain of nearly 15 g/kg/day with infants receiving 120 kcal/kg/day

    • This question is part of the following fields:

      • Nutrition
      47.2
      Seconds
  • Question 28 - A 11 month old baby develops periumbilical abdominal discomfort and diarrhoea after having...

    Correct

    • A 11 month old baby develops periumbilical abdominal discomfort and diarrhoea after having a sore throat and fever for a few days. He presents to the A&E department and an ultrasound is done which shows a 'target sign' on the right side of the abdomen. What is the best initial course of action?

      Your Answer: Obtain intravenous access, administer fluids and antibiotics

      Explanation:

      Answer: Obtain intravenous access, administer fluids and antibiotics.Intussusception is a condition in which one segment of intestine telescopes inside of another, causing an intestinal obstruction (blockage). Although intussusception can occur anywhere in the gastrointestinal tract, it usually occurs at the junction of the small and large intestines. The obstruction can cause swelling and inflammation that can lead to intestinal injury. The patient with intussusception is usually an infant, often one who has had an upper respiratory infection, who presents with the following symptoms:Vomiting: Initially, vomiting is nonbilious and reflexive, but when the intestinal obstruction occurs, vomiting becomes biliousAbdominal pain: Pain in intussusception is colicky, severe, and intermittentPassage of blood and mucus: Parents report the passage of stools, by affected children, that look like currant jelly| this is a mixture of mucus, sloughed mucosa, and shed blood| diarrhoea can also be an early sign of intussusceptionLethargy: This can be the sole presenting symptom of intussusception, which makes the condition’s diagnosis challengingPalpable abdominal massDiagnosis:Ultrasonography: Hallmarks of ultrasonography include the target and pseudo kidney signs.For all children, start intravenous fluid resuscitation and nasogastric decompression as soon as possible.

    • This question is part of the following fields:

      • Paediatric Surgery
      48.3
      Seconds
  • Question 29 - A 17-year-old female presents to the clinic with acne, hirsutism and oligomenorrhoea. Which...

    Incorrect

    • A 17-year-old female presents to the clinic with acne, hirsutism and oligomenorrhoea. Which of the following hormonal changes will hint towards the diagnosis of polycystic ovarian syndrome (PCOS)?

      Your Answer: Low dehydroepiandrosterone (DHEA-S)

      Correct Answer: Raised LH:FSH ratio

      Explanation:

      The European Society of Human Reproduction and Embryology/American Society for Reproductive Medicine Rotterdam consensus (ESHRE/ASRM) developed and enlarged the diagnosis of PCOS, requiring two of three features: anovulation or oligo-ovulation, clinical and/or biochemical hyperandrogenism, and polycystic ovarian morphology (PCOM) seen on ultrasound. Finally the Androgen Excess Society defined PCOS as hyperandrogenism with ovarian dysfunction or polycystic ovaries

    • This question is part of the following fields:

      • Endocrinology
      34
      Seconds
  • Question 30 - In a study, 50 out of 100 smokers developed lung cancers and 50...

    Correct

    • In a study, 50 out of 100 smokers developed lung cancers and 50 out of 200 non-smokers developed lung cancers. Which of the following is accurate?

      Your Answer: Relative risk=2

      Explanation:

      Relative risk = (Incidence in exposed group)/incidence in unexposed group). So in this case RR = (50/100)/(50/200) = 2.

    • This question is part of the following fields:

      • Epidemiology And Statistics
      73.1
      Seconds

SESSION STATS - PERFORMANCE PER SPECIALTY

ENT (1/1) 100%
Neurology (1/1) 100%
Dermatology (1/3) 33%
Cardiovascular (1/3) 33%
Neonatology (1/4) 25%
Nephro-urology (1/2) 50%
Endocrinology (0/2) 0%
Infectious Diseases (1/2) 50%
Renal (0/1) 0%
Musculoskeletal (1/1) 100%
Gastroenterology And Hepatology (2/4) 50%
Paediatric Surgery (1/2) 50%
Epidemiology And Statistics (2/3) 67%
Nutrition (1/1) 100%
Passmed