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Question 1
Correct
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A 12 year old girl presented with pallor and a rash over her lower limbs after 4 days of bloody diarrhoea. Lab investigations showed proteinuria and deranged renal function. The most likely diagnosis will be?
Your Answer: Haemolytic Uremic Syndrome (HUS)
Explanation:Haemolytic Uremic Syndrome affects children and is characterised by abdominal pain, a purpuric rash over the body, generalized pallor, haematuria and bloody diarrhoea. There is always a history of preceding diarrhoea caused usually by E.coli and it affects the renal system causing haematuria and deranged renal function tests.
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This question is part of the following fields:
- Gastroenterology And Hepatology
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Question 2
Incorrect
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A 4 month old child, presenting with lower UTI has been treated with Trimethoprim but there has been no improvement after 48 hours. What will be the next step in the management of this patient?
Your Answer: Midstream urine culture
Correct Answer: Micturating cystourethrogram
Explanation:A micturating cystourethrogram (MCUG) is one type of imaging test also called a voiding cystourethrogram (VCUG). The MCUG can check whether the flow of urine from the child’s bladder is being blocked, or whether it goes up the wrong way. It can help diagnose certain conditions, including vesicoureteral reflux and posterior urethral valves.
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This question is part of the following fields:
- Genitourinary
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Question 3
Correct
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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: 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 4
Correct
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A 30-day-old female was diagnosed with a case of breast milk jaundice. She has no other symptoms. Which is the most suitable next step of management?
Your Answer: Continue breastfeeding
Explanation:Breast feeding should be continued for babies with breast milk jaundice as this is a benign condition.
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This question is part of the following fields:
- Gastroenterology And Hepatology
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Question 5
Incorrect
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An 18-month-old child is brought in by her mother after she has been holding onto her both ears and crying out of pain. This has been going on for about a week and there has been no improvement in the pain despite using paracetamol and ibuprofen. On examination, the child is febrile, and her pulse is 130 beats per minute. the tympanic membranes are red and bulging on both sides. What is the most appropriate course of action in this patient?
Your Answer: Acetic acid spray
Correct Answer: Amoxicillin
Explanation:Management of acute otitis media should begin with adequate analgesia. Antibiotic therapy can be deferred in children two years or older with mild symptoms. Antibiotics should be prescribed immediately if:- Symptoms lasting more than 4 days or not improving- Systemically unwell but not requiring admission- Immunocompromise or high risk of complications secondary to significant heart, lung, kidney, liver, or neuromuscular disease- Younger than 2 years with bilateral otitis media- Otitis media with perforation and/or discharge in the canaHigh-dose amoxicillin (80 to 90 mg per kg per day) is the antibiotic of choice for treating acute otitis media in patients who are not allergic to penicillin, otherwise erythromycin or clarithromycin should be given.
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This question is part of the following fields:
- ENT
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Question 6
Correct
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A 19-year-old girl presents with polydipsia (>3L daily), polyuria, nocturia, and new-onset nocturnal enuresis. A urine dipstick reveals no glucose or ketones, but her pregnancy test is positive.What is the most probable diagnosis?
Your Answer: Gestational diabetes insipidus
Explanation:The presenting features with the positive pregnancy test are highly suggestive of gestational diabetes mellitus.Diabetes Insipidus:It is much less common than gestational diabetes mellitus. It is characterised by the inability to concentrate urine, with marked thirst.Presenting symptoms include polydipsia (>3L daily), polyuria, nocturia, nocturnal enuresis.Physical examination may reveal features of dehydration and an enlarged bladder.Investigations include biochemical analysis for electrolytes, urine and plasma osmolality, fluid deprivation test, and cranial MRI.The main differential diagnosis is for diabetes insipidus is psychogenic polydipsia.There are three broad categories of diabetes insipidus (DI): – Central (cranial) DI: It is the most common form of diabetes insipidus.It occurs due to decreased secretion of ADH. It usually occurs due to hypothalamic disease and may show response to low-dose desmopressin.- Peripheral (nephrogenic) DI:It is characterised by the resistance of the kidney to ADH.It usually does not respond to low-dose desmopressin.- Gestational DI:It is rare and is mostly seen in teenage pregnancy.It usually presents in the third trimester and often resolves 4-6 weeks post-partum.
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This question is part of the following fields:
- Nephro-urology
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Question 7
Incorrect
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A 2-day old neonate is brought to the hospital with complaint of not having opened his bowels. On examination, the anus is not visible, and meconium is coming out of the urethra. Which of the following statements regarding this patient is most accurate?
Your Answer: This is an anorectal malformation with a recto-urethral fistula. Primary anorectoplasty as first procedure is indicated
Correct Answer: This is an anorectal malformation with a recto urethral fistula, urgent defunctioning colostomy needed
Explanation:Anorectal malformations (ARMS) are also known as imperforate anus (IA). This is an umbrella term for a group of birth defects which affect the anorectal area.During a normal bowel movement, solid waste passes from the colon (large intestine) to the rectum (the final section the colon) and through the anus. When a child has an ARM, the rectum and the anus do not develop properly.Some types of ARM can cause constipation, faecal and / or urinary incontinence, infections and other problems. Some of these problems are very minor and easy to treat, with great long-term prognosis. Others are complex and affect multiple areas of life, such as sexual function and urinary and bowel control.
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This question is part of the following fields:
- Paediatric Surgery
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Question 8
Incorrect
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Georgie is a bright 3 year old girl whose development seems to be ahead of her preschool classmates. Which of the following should a typical 3 year old be able to do?
Your Answer: Stand on one foot well
Correct Answer: Match 2 colours
Explanation:A 3 year old should be able to match two colours, copy a circle, walk up and down the stairs, and jump up and down. By the time they are 4 they can copy a cross, draw a person with three parts, count to 10, stand on one foot.
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This question is part of the following fields:
- Child Development
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Question 9
Incorrect
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A 5 month old girl was admitted to the emergency department with reduced movement of her right arm. History reveals she was born at term, 4.5 kg and via natural delivery. Her mother reports her head was stuck for a while before she was fully delivered. Postnatal examination revealed reduced movement of her right arm as well but was thought to improve over time. The baby cannot sit and her right arm is flaccid, internally rotated, adducted, and extended. The reflexes are absent in the right arm. Which of the following investigations would provide the most useful information?
Your Answer: Nerve conduction studies
Correct Answer: MRI scan
Explanation:The vignette describes an infant with a sustained post-delivery brachial plexus injury that does not improve with time. MRI is the most appropriate intervention to assess the injury and evaluate the treatment options.
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This question is part of the following fields:
- Neurology And Neurodisability
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Question 10
Correct
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An 11-year-old boy is undergoing a wedge excision of his great toenail. As the surgeon passes a needle into the area to administer a local anaesthetic, the patient experiences a sharp pain.Which of the following pathways conveys pain sensations to the central nervous system?
Your Answer: Spinothalamic tract
Explanation:The lateral spinothalamic tracts carry pain and temperature sensations from the peripheries to the central nervous system.Note:The spinothalamic tract transmits impulses from receptors which measure crude touch, pain and temperature. The spinothalamic tract comprises the lateral and anterior spinothalamic tracts.The former typically transmits pain and temperature while the latter transmits crude touch and pressure. Neurones transmitting these signals will usually ascend by one or two vertebral levels in the Lissauer tract before decussating in the spinal cord itself. Neurones then pass rostrally in the cord to connect at the thalamus.
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This question is part of the following fields:
- Neurology And Neurodisability
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