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  • Question 1 - The following is true about the constituents of breast milk: ...

    Incorrect

    • The following is true about the constituents of breast milk:

      Your Answer: The average calorific requirements for a one-month infant are 200kcal/kg/day

      Correct Answer: Main protein in breast-milk is whey, which is more digestible than cow’s milk protein casein.

      Explanation:

      Mature human breast milk is nutrient and enzyme rich, optimal for human infants. The average calorie requirement for a one month old infant is about 100kcal/kg/day. Lactose, the most abundant carbohydrate, is beneficial for the baby’s developing gastro intestinal system. The proteins in mature milk are mostly whey (as compared to a high proportion of casein in cows milk), which digests easily. Other proteins found in breast milk include immunoglobulin, lysozyme, lactoferrin and lactalbumin. In terms of micronutrients, while Vitamin K levels are low in breast milk, Vitamin A, C and E are found in higher concentrations than in cow’s milk.

    • This question is part of the following fields:

      • Nutrition
      21.9
      Seconds
  • Question 2 - A 11-year-old boy is referred to you following his seventh course of antibiotics...

    Incorrect

    • A 11-year-old boy is referred to you following his seventh course of antibiotics in the last six years for lower respiratory tract infections. He also has a history of eczema for which he is currently on a topical steroid cream. His full blood count (FBC) report shows:Hb: 13.9 g/dLPlts: 65 x 10^9/LWCC: 12.3 x 10^9/LWhich of the following genes should you expect an abnormality in?

      Your Answer: PKD1

      Correct Answer: WASP

      Explanation:

      The combination of frequent infections, eczema, and thrombocytopaenia are characteristic of Wiskott-Aldrich syndrome, which is due to an abnormality in the WASP gene. It is an X-linked recessive disorder that causes primary immunodeficiency owing to a combined B- and T-cell dysfunction.The other listed options are:1. PKD1: polycystic kidney disease2. CFTR: cystic fibrosis3. HFE1: haemochromatosis4. RET: multiple endocrine neoplasia, Hirschsprung’s disease

    • This question is part of the following fields:

      • Haematology And Oncology
      32.3
      Seconds
  • Question 3 - Which factor is most likely to trigger renin stimulation? ...

    Correct

    • Which factor is most likely to trigger renin stimulation?

      Your Answer: Hypovolaemia

      Explanation:

      The most common physiological factors that influence renin secretion include renal perfusion pressure, renal sympathetic nerve activity, and tubular sodium chloride load.The perfusion pressure in the renal artery is the most profound parameter to influence renin secretion| when the renal perfusion pressure falls (i.e. hypovolaemia), renin secretion rises, and vice versa.

    • This question is part of the following fields:

      • Nephro-urology
      14.4
      Seconds
  • Question 4 - Today was Jacob’s birthday. This morning he woke up very excited and picked...

    Incorrect

    • Today was Jacob’s birthday. This morning he woke up very excited and picked out a pair of shorts and t-shirt in his favourite colour, blue, with matching blue sandals. He brushed his teeth with supervision, and used the toilet by himself. He greeted each of his friends at the door with an excited jump. At the party he ran around and jumped on the small trampoline in the backyard with his friends. He tried to skip like some if his friends, but he wasn’t able to do it as evenly. How old is Jacob likely to be?

      Your Answer: 6 years of age

      Correct Answer: 4 years of age

      Explanation:

      Jacob is likely to be four years old as demonstrated by his activities throughout the day. Most 4 year olds are able to run well, jump and hop, but find skipping a little more difficult. They are able to brush their teeth and dress themselves with supervision, and go to the toilet alone.

    • This question is part of the following fields:

      • Child Development
      30.4
      Seconds
  • Question 5 - A 6-year-old boy was admitted with a burn that looks third or fourth...

    Correct

    • A 6-year-old boy was admitted with a burn that looks third or fourth degree upon inspection. He has not stopped crying. What is the most appropriate next step?

      Your Answer: IV fluid start

      Explanation:

      The boy needs re-hydration due to his full thickness burn so IV fluids is the next most appropriate step. The greatest loss of plasma occurs in the first 12 hours after burn injury. The plasma loss then slowly decreases during the second 12 hours of the post-burn phase, although extensive leakage can continue for up to three days (Ahrns, 2004). Optimal fluid replacement during this period is essential to ensure cardiac output and renal and tissue perfusion. Usually, 36 hours post-burn, capillary permeability returns to normal and fluid is drawn back into the circulation. Burns of more than 15% of surface body area in adults and of over 10% in children warrant formal resuscitation.The Parkland formula for the total fluid requirement in 24 hours is as follows:4ml x TBSA (%) x body weight (kg)|50% given in first eight hours|50% given in next 16 hours.Children receive maintenance fluid in addition, at an hourly rate of:4ml/kg for the first 10kg of body weight plus|2ml/kg for the second 10kg of body weight plus|1ml/kg for >20kg of body weight.End pointUrine – adults: 0.5–1.0 ml/kg/hour|Urine – children: 1.0–1.5ml/kg/hour.

    • This question is part of the following fields:

      • Emergency Medicine
      10.6
      Seconds
  • Question 6 - What is the imaging modality of choice to assess for the presence of...

    Incorrect

    • What is the imaging modality of choice to assess for the presence of developmental dysplasia of the hip (DDH) in a baby born breech?

      Your Answer: CT

      Correct Answer: USS

      Explanation:

      Developmental dysplasia of the hip (DDH) is a spectrum of anatomical abnormalities of the hip joint in which the femoral head has an abnormal relationship with the acetabulum.Plain radiographs are of limited value for diagnosis in the new-born child because the femoral head and acetabulum are largely cartilaginous. Ultrasound scanning is the investigation of choice to evaluate DDH in infants younger than six months of age and is useful to diagnose more subtle forms of the disorder when a clinical exam is equivocal. It is also the only imaging modality that enables a three-dimensional real-time image of a neonate’s hip.

    • This question is part of the following fields:

      • Neonatology
      8.2
      Seconds
  • Question 7 - A 17-month-old boy is brought by his mother to the hospital. She is...

    Correct

    • A 17-month-old boy is brought by his mother to the hospital. She is concerned that he is having symptoms of itching, being very upset and unsettled. They hail from a low socioeconomic background and have poor living conditions. On examination, an itchy, papular rash is noted on the palms of his hands specifically in the web spaces between the fingers, as well as in the groin region. He was normothermic. The mother explains that his sister also has similar symptoms.What is the most probable cause of the patient's symptoms?

      Your Answer: Sarcoptes scabiei

      Explanation:

      The most probable cause for the patient’s presenting symptoms is Sarcoptes scabeii.Scabies:The boy in the scenario presents with a pruritic rash affecting the palms of the hands, especially in the web spaces between the fingers. Additionally, the fact that his sister is showing similar symptoms is an indication of its infectivity. The female Sarcoptes scabiei var hominis mite burrows into the webs of fingers and the sides of digits as seen in the child.This parasitic skin infestation presents typically with nocturnal itching. Other options:- Herpes simplex virus type 1 (HSV-1): This can affect this age group but would usually present with a vesicular perioral rash with associated erythema. – Human papillomavirus (HPV): Cutaneous human papillomavirus infection causes warts, which can form a dome and fleshy shaped lesions on the palms of the hands, but these are not usually itchy. Similar to the causative agent in the boy, they are contagious.- Poxvirus: These viruses cause molluscum contagiosum which presents as dome-shaped lesions anywhere on the body, rather than specifically in palms of hands or finger webs as seen in the boy. Poxviruses are also very infectious.- Staphylococcal infection: This causes impetigo, which presents with yellow discharge and underlying erythema. Impetigo is not usually itchy and can present on any part of the body, rather than the specific areas seen in the boy.

    • This question is part of the following fields:

      • Dermatology
      28.1
      Seconds
  • Question 8 - What proportion of salivary secretions is contributed by the submandibular glands? ...

    Correct

    • What proportion of salivary secretions is contributed by the submandibular glands?

      Your Answer: 0.7

      Explanation:

      The submandibular glands provide the bulk of salivary secretions contributing close to 70%. The sublingual glands provide 5% and the remainder from the parotid.

    • This question is part of the following fields:

      • ENT
      4.5
      Seconds
  • Question 9 - What IQ is the cut off for profound learning disability? ...

    Incorrect

    • What IQ is the cut off for profound learning disability?

      Your Answer: <35

      Correct Answer:

      Explanation:

      Mild learning disabilities indicates an IQ = 50-70, or mental age of 9-12 years
      Moderate learning disabilities indicates an IQ = 35-49, or mental age of 6-9 years
      Severe learning disabilities indicates an IQ = 20-34, or mental age of 3-6 years
      Profound learning disabilities indicates an IQ = 20, or mental age of less than 3 years
      Average IQ is 100. The arbitrary cut-off to indicate learning disabilities is 70.

    • This question is part of the following fields:

      • Neurology And Neurodisability
      6.2
      Seconds
  • Question 10 - 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
      17.9
      Seconds
  • Question 11 - What class of antibodies do the anti-B antibodies in a patient with blood...

    Incorrect

    • What class of antibodies do the anti-B antibodies in a patient with blood group A belong to?

      Your Answer: IgD

      Correct Answer: IgM

      Explanation:

      The anti-B antibodies in a patient with blood group A belong to the IgM class of immunoglobulins.Note:IgM is the largest antibody formed of 5 antibodies attached together. This functions to agglutinate or clump antigens. The associated anti-A and anti-B antibodies are usually IgM produced in the first years of life by sensitisation to environmental substances such as food, bacteria, and viruses.Other options:- IgG is the most common antibody. It is a single antibody complex.- IgD is found on the surface of B-lymphocytes.- IgE is bound to tissue cells, especially mast cells and eosinophils.

    • This question is part of the following fields:

      • Haematology And Oncology
      10.3
      Seconds
  • Question 12 - Which of the following conditions is not associated with corneal opacities? ...

    Incorrect

    • Which of the following conditions is not associated with corneal opacities?

      Your Answer: Goldenhar's syndrome

      Correct Answer: Sturge-Weber syndrome

      Explanation:

      The mnemonic STUMPED is helpful for remembering the differential diagnosis for congenital corneal opacities: – Sclerocornea- Tears in Descemet membrane (usually due to forceps trauma or congenital glaucoma)- Ulcers (e.g. infection – rubella)- Metabolic (e.g., mucopolysaccharidosis)- Peters anomaly- oEdema – Dermoids (e.g. Goldenhar’s syndrome)

    • This question is part of the following fields:

      • Ophthalmology
      13.6
      Seconds
  • Question 13 - A 14-year-old boy arrives at the clinic with difficulty walking and foot drop....

    Correct

    • A 14-year-old boy arrives at the clinic with difficulty walking and foot drop. On examination, there is weakness in dorsiflexion and eversion of the right foot. A small area of sensory loss over the dorsum of the right foot is also present. Which of the following is the most likely diagnosis?

      Your Answer: Common peroneal nerve lesion

      Explanation:

      Injuries to the peroneal nerve can cause numbness, tingling, pain, weakness and foot drop. The branches of the common peroneal nerve innervate and control the muscles in the legs that lift the ankle and toes upward (dorsi flexion).

    • This question is part of the following fields:

      • Neurology And Neurodisability
      19.2
      Seconds
  • Question 14 - Which of the following conditions can be present in a 12-year-old boy diagnosed...

    Incorrect

    • Which of the following conditions can be present in a 12-year-old boy diagnosed with coeliac disease?

      Your Answer: Pancreatitis

      Correct Answer: IgA deficiency

      Explanation:

      Coeliac disease is associated with the following conditions:- Dermatitis herpetiformis- Autoimmune disorders (e.g. thyroid disease, pernicious anaemia, diabetes)- IgA deficiency- Small-bowel malignancy, particularly lymphoma, if the gluten-free diet is not followed.Serology testing: The IgA tissue transglutaminase antibody is the most sensitive and specific, compared with the anti-endomysial antibody. However, false negatives will occur in children who are IgA-deficient, and IgA levels should be taken at the same time. Other options:Distal obstruction syndrome, meconium ileus, pancreatitis and rectal prolapse are all gastrointestinal manifestations of cystic fibrosis.

    • This question is part of the following fields:

      • Gastroenterology And Hepatology
      7
      Seconds
  • Question 15 - A 14-year-old uncontrolled asthmatic is started on a steroid inhaler. Which of the...

    Incorrect

    • A 14-year-old uncontrolled asthmatic is started on a steroid inhaler. Which of the following is the most common adverse effect he might complain about?

      Your Answer: Dental abscess

      Correct Answer: Dysphonia

      Explanation:

      Usage of inhaled corticosteroids are less associated with systemic adverse effects. However they are associated with local complications including dental caries and most commonly dysphonia.

    • This question is part of the following fields:

      • Respiratory
      10.5
      Seconds
  • Question 16 - Which of the following is not associated with DiGeorge syndrome? ...

    Incorrect

    • Which of the following is not associated with DiGeorge syndrome?

      Your Answer: 100% penetrance

      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.

    • This question is part of the following fields:

      • Cardiovascular
      11.8
      Seconds
  • Question 17 - A 16-year-old boy presents with left-sided hemi-sensory loss and ipsilateral sensory inattention. The...

    Incorrect

    • A 16-year-old boy presents with left-sided hemi-sensory loss and ipsilateral sensory inattention. The doctor suspects a space-occupying lesion.Where is this likely to be?

      Your Answer: Right temporal lobe

      Correct Answer: Right parietal lobe

      Explanation:

      Damage to the left parietal lobe can result in what is called Gerstmann’s Syndrome. It includes right-left confusion, difficulty with writing (agraphia) and difficulty with mathematics (acalculia). It can also produce disorders of language (aphasia) and the inability to perceive objects normally (agnosia).Damage to the right parietal lobe can result in neglecting part of the body or space (contralateral neglect), which can impair many self-care skills such as dressing and washing. Right side damage can also cause difficulty in making things (constructional apraxia), denial of deficits (anosognosia) and drawing ability.Bi-lateral damage (large lesions to both sides) can cause Balint’s Syndrome, a visual attention and motor syndrome. This is characterized by the inability to voluntarily control the gaze (ocular apraxia), inability to integrate components of a visual scene (simultanagnosia), and the inability to accurately reach for an object with visual guidance (optic ataxia)Special deficits (primarily to memory and personality) can occur if there is damage to the area between the parietal and temporal lobes.Left parietal-temporal lesions can affect verbal memory and the ability to recall strings of digits. The right parietal-temporal lobe is concerned with non-verbal memory.Right parietal-temporal lesions can produce significant changes in personality.

    • This question is part of the following fields:

      • Neurology And Neurodisability
      26.2
      Seconds
  • Question 18 - What form of inheritance does Chédiak–Higashi syndrome have? ...

    Incorrect

    • What form of inheritance does Chédiak–Higashi syndrome have?

      Your Answer: X-linked dominant

      Correct Answer: Autosomal recessive

      Explanation:

      Chédiak–Higashi syndrome is inherited in an autosomal recessive pattern, which means both copies of the gene in each cell have mutations. The parents of an individual with an autosomal recessive condition each carry one copy of the mutated gene, but they typically do not show signs and symptoms of the condition.

    • This question is part of the following fields:

      • Genetics And Dysmorphology
      4.6
      Seconds
  • Question 19 - Regarding consent to randomisation, which of the given statements is true? ...

    Incorrect

    • Regarding consent to randomisation, which of the given statements is true?

      Your Answer: Will depend on the nature of randomisation

      Correct Answer: Should be obtained as part of the overall consent to the study

      Explanation:

      Randomization is one of the ethical protocols for research work, involving unbiased sample selection. Consent is required before undertaking any research and is taken for the complete research work at once. No separate consent is required for the process of randomization. The consent should explain each and every aspect of the study, including details about the process of randomization. Only particular study designs, like Zelen design, permit the avoidance of consent to randomization but these studies have their setbacks.

    • This question is part of the following fields:

      • Epidemiology And Statistics
      11.3
      Seconds
  • Question 20 - A 17-year-old autistic boy arrives at the clinic with lethargy, curly corkscrew like...

    Incorrect

    • A 17-year-old autistic boy arrives at the clinic with lethargy, curly corkscrew like hair and petechiae. Which of the following is the most likely diagnosis?

      Your Answer: Vitamin A deficiency

      Correct Answer: Vitamin C deficiency

      Explanation:

      Presentation can vary by individual. Early stages are often characterized by malaise, fatigue, and lethargy. One to 3 months of inadequate intake can lead to anaemia, myalgia, bone pain, easy bruising (Figure 3), swelling, petechiae, perifollicular haemorrhages, corkscrew hairs, gum disease, poor wound healing, mood changes, and depression. Perifollicular haemorrhages and easy bruising are often first seen in the lower extremities, as capillary fragility leads to an inability to withstand hydrostatic pressure. Late stages of scurvy are more severe and life threatening| common manifestations include generalized oedema, severe jaundice, haemolysis, acute spontaneous bleeding, neuropathy, fever, convulsions, and death.

    • This question is part of the following fields:

      • Nutrition
      16.6
      Seconds
  • Question 21 - A 4 year old child was brought in by his mother with complaints...

    Incorrect

    • A 4 year old child was brought in by his mother with complaints of vesicular eruption over his palms, soles and oral mucosa for the last 5 days. He was slightly febrile. There were no other signs. The most likely causative organism in this case would be?

      Your Answer: Adenovirus

      Correct Answer: Coxsackie

      Explanation:

      This patient is most likely suffering from hand, foot mouth disease which is caused by coxsackie virus A16. Its incubation period ranges from 5-7 days and only symptomatic treatment is required.

    • This question is part of the following fields:

      • Dermatology
      25.3
      Seconds
  • Question 22 - A 17 year old patient, who reports to the clinic following an apparent...

    Incorrect

    • A 17 year old patient, who reports to the clinic following an apparent transient ischaemic attack, is demonstrated to have a small right homonymous hemianopia with partial sparing of central vision.Where is the lesion most likely to have occurred?

      Your Answer: Optic tract

      Correct Answer: Occipital cortex

      Explanation:

      The most common cause of homonymous hemianopia (HH) is a stroke. In this condition there is bitemporal field loss. Lesions posterior to the optic chiasm, in the brain parenchyma are most likely to be the cause of the HH. In this case the retention of central vision indicates that the area of injury may be in the occipital cortex, sparing the occipital pole. The occipital pole receives sensory fibres from the macular, and has a dual blood supply protecting it from total infarction. Lesions of the optic tract can be ruled out as these cause total vision loss in the affected eye. Parietal or temporal nerve lesions cause affect the inferior and superior parts of the visual field respectively causing homonymous quadrantinopias.

    • This question is part of the following fields:

      • Anatomy
      23.1
      Seconds
  • Question 23 - An 18-year-old boy presents to the physician complaining of persistent palpitations. The ECG...

    Correct

    • An 18-year-old boy presents to the physician complaining of persistent palpitations. The ECG shows a regular rhythm with a rate of 200 beats/min and QRS duration of 80ms. The tachycardia spontaneously resolves and presents in sinus rhythm. The PR interval is 60 ms and QRS duration is 120 ms, there is a positive delta wave in V1. Regarding the boy's tachycardia, which of the following statements holds true?

      Your Answer: Verapamil is contraindicated

      Explanation:

      Although WPW syndrome is a type of supraventricular re-entrant tachycardia, CCBs are contraindicated in its management. This is because CCBs depress AVN conduction| the current then passes through the accessory pathway (bundle of Kent) instead, causing ventricular tachycardia.

    • This question is part of the following fields:

      • Cardiovascular
      25.3
      Seconds
  • Question 24 - A child presents for an endocrinological work-up. The doctors perform blood tests, an...

    Correct

    • A child presents for an endocrinological work-up. The doctors perform blood tests, an X-ray, a pelvic U/S and a brain MRI. Which of the following reasons would result in an advanced bone age?

      Your Answer: Androgen excess

      Explanation:

      Androgen excess is one of the most common causes of advanced bone age. It usually occurs in precocious puberty or congenital adrenal hyperplasia.

    • This question is part of the following fields:

      • Endocrinology
      39.6
      Seconds
  • Question 25 - A 10 hour old baby who was born by emergency caesarean section, is...

    Incorrect

    • A 10 hour old baby who was born by emergency caesarean section, is being observed for foetal distress. She has a displaced apex beat and decreased air entry on the left side of her chest. A scaphoid abdomen is seen on abdominal examination but all else is unremarkable. What is the probable diagnosis?

      Your Answer: Tracheo-oesophageal fistula

      Correct Answer: Congenital diaphragmatic hernia

      Explanation:

      Answer: Congenital diaphragmatic herniaCongenital diaphragmatic hernia (CDH) occurs when the diaphragm muscle — the muscle that separates the chest from the abdomen — fails to close during prenatal development, and the contents from the abdomen (stomach, intestines and/or liver) migrate into the chest through this hole.Examination in infants with congenital diaphragmatic hernias include the following findings:Scaphoid abdomenBarrel-shaped chestRespiratory distress (retractions, cyanosis, grunting respirations)In left-sided posterolateral hernia: Poor air entry on the left, with a shift of cardiac sounds over the right chest| in patients with severe defects, signs of pneumothorax (poor air entry, poor perfusion) may also be foundAssociated anomalies: Dysmorphisms such as craniofacial abnormalities, extremity abnormalities, or spinal dysraphism may suggest syndromic congenital diaphragmatic herniaIleal atresia is a congenital abnormality where there is significant stenosis or complete absence of a portion of the ileum. There is an increased incidence in those with chromosomal abnormalities. Ileal atresia results from a vascular accident in utero that leads to decreased intestinal perfusion and subsequent ischemia a segment of bowel. This leads to narrowing, or in the most severe cases, complete obliteration of the intestinal lumen. In the postnatal period, an abdominal radiograph will show air in the dilated loops of proximal bowel. An ileal atresia is often discovered prenatally at a routine prenatal ultrasound scan or following the development of polyhydramnios. On ultrasound, there is frequently a proximal dilated intestinal segment.Meconium Ileus (MI) is a condition where the content of the baby’s bowel (meconium) is extremely sticky and causes the bowel to be blocked at birth. In most cases the bowel itself is complete and intact but it is just the inside that is blocked.In some cases there has been a twist of the bowel before birth, which has caused the bowel to be blind ending (an atresia). Most babies with meconium ileus (90%) have Cystic Fibrosis (CF) and it is this that has caused the sticky meconium. Meconium ileus is a rare condition affecting only 1 in 25,000 babies. There is normally a delay in your baby passing meconium (black sticky stool normally passed within 24 hours of delivery) and your baby may also be reluctant to feed and may vomit a green fluid called bile which would normally pass through the bowel.Your baby may be uncomfortable because of constipation and trapped air in the bowel and the abdomen (tummy) will become distended. Some babies present at delivery with a distended abdomen and may be unwell due to infection around the bowel.Pyloric stenosis is a problem that affects babies between birth and 6 months of age and causes forceful vomiting that can lead to dehydration. It is the second most common problem requiring surgery in new-borns. The lower portion of the stomach that connects to the small intestine is known as the pylorus. In pyloric stenosis, the muscles in this part of the stomach enlarge, narrowing the opening of the pylorus and eventually preventing food from moving from the stomach to the intestine.

    • This question is part of the following fields:

      • Paediatric Surgery
      42.4
      Seconds
  • Question 26 - A child with jaundice and pale stools would most likely be evaluated by...

    Incorrect

    • A child with jaundice and pale stools would most likely be evaluated by which of the following tests?

      Your Answer: LFT

      Correct Answer: US

      Explanation:

      Blood tests do not help in the diagnosis of jaundice except of course by telling the level of jaundice (bilirubin) and providing some corroborative evidence such as autoantibodies, tumour markers or viral titres in the case of hepatitis. Classifying causes of jaundice on the basis of ultrasound provides a quick and easy schema for diagnosing jaundice which is applicable in primary care as well as hospital based practice.

    • This question is part of the following fields:

      • Haematology And Oncology
      16.5
      Seconds
  • Question 27 - A 16-year-old girl presents to her OBGYN after getting pregnant. It is evaluated...

    Incorrect

    • A 16-year-old girl presents to her OBGYN after getting pregnant. It is evaluated that she is 13 days pregnant and the fetal tissue has just undergone implantation. Where in the uterus does implantation usually take place?

      Your Answer: Left lateral wall

      Correct Answer: Anterior or superior walls

      Explanation:

      Time and EventWeek 1: ImplantationWeek 2: Formation of bilaminar diskWeek 3: Formation of primitive streakFormation of notochordGastrulationWeek 4: Limb buds begin to formNeural tube closesHeart begins to beatWeek 10: Genitals are differentiated

    • This question is part of the following fields:

      • Neonatology
      16.7
      Seconds
  • Question 28 - Which among the following genetic conditions, does NOT present with cataracts? ...

    Incorrect

    • Which among the following genetic conditions, does NOT present with cataracts?

      Your Answer: Incontinentia pigmenti

      Correct Answer: Neurofibromatosis type 1 (NF1)

      Explanation:

      Neurofibromatosis Type 1 (also known as von Recklinghausen disease) does not present with cataracts.The eye findings in NF1 are Lisch’s nodules, which are pigmentary lesions seen on the iris and constitute one of the major diagnostic features in this condition. Note:Interestingly, in another syndrome closely related to it, Neurofibromatosis type 2 (NF-2), cataracts can occur. Early detection in family members may be made by finding lens opacities (both congenital polar cataracts and posterior lenticular opacities). Other options:- Incontinentia pigmenti is an X-linked dominant disorder with pigmentary skin changes, mental retardation and eye involvement in 40% of cases. – Myotonic dystrophy is a triplet-repeat disorder with neurological symptoms and cataracts. – Lowe syndrome (oculo-cerebro-renal syndrome) is an X-linked recessive condition. Males with this X-linked recessive condition have cataracts, hypotonia, mental retardation, generalised aminoaciduria and renal tubular acidosis with hypophosphatemia. – Wilson disease is an inborn error of copper metabolism. The clinical features include hepatic involvement, progressive neurological features, eye involvement, including Kayser–Fleischer rings and cataracts.

    • This question is part of the following fields:

      • Genetics And Dysmorphology
      7.7
      Seconds
  • Question 29 - You notice an umbilical hernia in a 6-week old baby. What advice would...

    Correct

    • You notice an umbilical hernia in a 6-week old baby. What advice would you give the parents?

      Your 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.

    • This question is part of the following fields:

      • Paediatric Surgery
      30.8
      Seconds
  • Question 30 - A 7-week-old infant is brought to the emergency department by his mother. She...

    Incorrect

    • A 7-week-old infant is brought to the emergency department by his mother. She complains that the child is having episodes of non-bilious vomiting for the past 10 days. She observed that the episodes typically occur directly after feeding and notes that the volume brought up varies, but that her baby does seem to be very hungry and has not gained much weight. What is the most probable diagnosis for this infant?

      Your Answer: Gastro-oesophageal reflux disease (GORD)

      Correct Answer: Pyloric stenosis

      Explanation:

      The most probable diagnosis for this patient would be congenital hypertrophic pyloric stenosis.Congenital Hypertrophic Pyloric Stenosis (CHPS):Pyloric stenosis should be ruled out in any baby who presents with a long-term history of vomiting and failure to thrive. Infants typically present with projectile, non-bilious vomiting and are said to be hungry and wanting to feed despite poor weight gain. A blood gas would be helpful in this instance, although the diagnosis can be made more accurately by observing the stenosis during ultrasound. Many infants have symptoms of gastroesophageal reflux disease, although only a small minority are unable to gain weight adequately. A UTI in infants can present with non-specific symptoms, but they might have a fever and can show poor feeding. Malrotation will present with bilious vomiting.The definitive surgical management is the Ramsteadt’s pyloromyotomy.

    • This question is part of the following fields:

      • Gastroenterology And Hepatology
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