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Question 1
Incorrect
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A patient who is on morphine therapy for terminal cancer presents with complaints of rattling breath sounds. Which of the following should be administered to him?
Your Answer:
Correct Answer: Anti-Muscarinic
Explanation:Respiratory depression is the most well-known and dangerous side-effect of opioid analgesics. The prevalence of such side effects is influenced by the extent of disease, the patient’s age, the presence of coexistent renal and hepatic disease, pulmonary disease, and cognitive dysfunction, a prior opioid history, use of polypharmacy, dose of opioid drug being administered, and the route of administration. Anticholinergics are usually given for the respiratory symptoms.
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This question is part of the following fields:
- Pharmacology
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Question 2
Incorrect
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A 41 year old male experiences hand tremors that are absent at rest, but aggravated on extension and continuous with movement. What is the most probable diagnosis?
Your Answer:
Correct Answer: Benign essential tremor
Explanation:Tremors that linger on movement, seen on an outstretched hand, and absent on rest are called benign essential tremors.
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This question is part of the following fields:
- Musculoskeletal
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Question 3
Incorrect
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A 48-year-old artist presented with tremors. Which of the following is more suggestive of parkinsonism than an essential tremor?
Your Answer:
Correct Answer: Unilaterality
Explanation:Essential tremors are usually symmetrical and generalized. It often affects the head and the voice of the patient. Usually it is first noticed by first degree relatives. It is improved by benzodiazepines and beta blockers. On the other hand, Parkinsonism tends to develop in older patients. It is characterised by bradykinesia and rigidity. It improves by L-dopa and dopamine agonists. A simple test is to ask the patient to write a short sentence. Parkinsonism shows micrographiam whilst essential tremors will have tremulous writing.
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This question is part of the following fields:
- Neurology
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Question 4
Incorrect
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A 25 year old female with her LRMP 8 weeks ago, presented with severe abdominal pain and per vaginal bleeding. On examination there was tenderness over her left iliac region. Her pulse rate was 110 bpm and blood pressure was 90/65mmHg. Which of the following is the most appropriate management?
Your Answer:
Correct Answer: Immediate laparotomy
Explanation:A ruptured ectopic pregnancy is the most probable diagnosis. As she is in shock (tachycardia and hypotension) immediate laparotomy is needed.
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This question is part of the following fields:
- Gynaecology
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Question 5
Incorrect
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A 40 year old lady who underwent a recent subtotal gastrectomy for peptic ulcer disease has now developed anaemia with a haemoglobin of 6.4, tiredness, fatigue and loss of vibration sensation in both legs. What is the underlying cause of her symptoms?
Your Answer:
Correct Answer: B12 deficiency
Explanation:Vit B12 needs intrinsic factor to be absorbed, which is secreted in the stomach. Its deficiency is characterised by macrocytic anaemia with peripheral neuropathy.
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This question is part of the following fields:
- Gastrointestinal
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Question 6
Incorrect
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A 28-year-old male is involved in a motorcycle accident. He sustained a direct blow to his lower chest. His blood pressure is 83/48, HR 113 bpm. On examination, there are multiple bruises on the chest with bowel sounds heard on auscultation of his chest. The single most likely diagnosis is?
Your Answer:
Correct Answer: Diaphragmatic rupture
Explanation:Ruptured diaphragm is a serious condition that is very difficult to diagnose and requires rapid intervention. The presence of bowel sounds on chest auscultation is highly suggestive of this.
Ruptured oesophagus is excluded by the absence of haematemesis and normal intestinal sounds.
Fractured ribs could be life threatening if associated with a tension pneumothorax which is excluded by a normal chest auscultation.
Flail chest is characterised by paradoxical breathing and respiratory failure. -
This question is part of the following fields:
- Respiratory
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Question 7
Incorrect
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An 8-month-old baby was investigated for failure to thrive. On examination, he was irritable with evidence of weight loss. His stools were pale, bulky and malodorous. What is the most appropriate test that can be done to confirm the diagnosis?
Your Answer:
Correct Answer: Jejunal Biopsy
Explanation:Pale, bulky, malodorous stools are evidence of fat malabsorption syndrome. The diagnostic test is jejunal biopsy to rule out other differential diagnoses such as celiac disease, giardiasis or Crohn’s disease etc.
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This question is part of the following fields:
- Child Health
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Question 8
Incorrect
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A 12 year old boy with type I diabetes was reluctant to go to school. According to him, he was unhappy at the school. Which of the following is the next appropriate step?
Your Answer:
Correct Answer: Clinical psychologist
Explanation:The child’s problem should be assessed properly to find the reason for unhappiness at the school. There can be many reasons such as bullying at school, abuse etc. A clinical psychologist should assess this child to take the necessary details and plan the further management.
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This question is part of the following fields:
- Child Health
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Question 9
Incorrect
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Prenatal screening is recommended if ultrasound scan at 16 weeks confirms that the foetus is male and the mother has had an affected son previously. Choose the single most likely condition from the following list of options. 7
Your Answer:
Correct Answer: Duchene muscular dystrophy
Explanation:The condition should be an X-linked recessive condition, as it affects only male offspring. Duchene muscular dystrophy is an X-linked recessive condition. Cystic fibrosis is an autosomal recessive disorder. Spina bifida is a multifactorial condition. Down syndrome is caused by trisomy of chromosome 21. Spinal muscular atrophies are inherited in an autosomal-recessive pattern.
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This question is part of the following fields:
- Obstetrics
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Question 10
Incorrect
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A 11 year old girl with a history of recurrent chest infections, was admitted with a fever, productive cough, anorexia and weight loss. On examination she was febrile and tachycardic. Her mother said that the girl was not thriving well. Which of the following organisms is responsible for this presentation?
Your Answer:
Correct Answer: Pseudomonas
Explanation:History of recurrent infections and failure to thrive (probably due to pancreatic enzyme insufficiency) is highly suggestive of cystic fibrosis. Pseudomonas has been identified as an important respiratory pathogen in patients with cystic fibrosis.
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This question is part of the following fields:
- Infectious Diseases
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Question 11
Incorrect
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A 46 year old male, known with Rheumatoid Arthritis presents with a swollen and painful right ankle. No drug allergies are reported. On examination, the vitals are as follows:
Temp: 38.8
BP: 90/60 mmHg
Pulse: 110/min.
Right ankle examination reveals tenderness, warmth, erythema and tense joint effusion. Blood samples including blood cultures are collected and fluid resuscitation is initiated. Which of the following interventions would be most appropriate for this man?Your Answer:
Correct Answer: Administer i.v. flucloxacillin, and arrange joint aspiration urgently
Explanation:Although microscopic analysis of joint fluid aspirate and culture is the basis of septic arthritis diagnosis and should usually be collected before the administration of antibiotics, the patient is showing signs of septic shock. A delay in antibiotics might lead to worsening of symptoms so they are administered first.
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This question is part of the following fields:
- Rheumatology
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Question 12
Incorrect
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A 48 year old male presents to the clinic complaining of a swelling in his left groin that disappears on lying down. He also reports occasional haematuria and a mass in his left loin. On examination, the swelling is bluish in colour and has an appearance and consistency like that of a 'bag of worms'. What is the most likely diagnosis?
Your Answer:
Correct Answer: Left sided renal cell carcinoma
Explanation:Renal cell carcinoma (RCC) may remain clinically occult for most of its course. The classic triad of flank pain, haematuria, and flank mass is uncommon (10%) and is indicative of advanced disease. A varicocele, usually left sided, is due to obstruction of the testicular vein.
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This question is part of the following fields:
- Genitourinary
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Question 13
Incorrect
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A 57 year old female arrives at the emergency due to chest pain, shortness of breath and palpitations. ECG is done which shows a supraventricular tachycardia with a heartrate of 220/min. carotid massage fails to bring the heart rate down. How would you manage this patient?
Your Answer:
Correct Answer: DC shock
Explanation:Synchronized electrical cardioversion may also be used to treat stable ventricular tachycardia (VT) that does not respond to a trial of intravenous medications. Unstable patients with SVT and a pulse are always treated with synchronized cardioversion. The appropriate voltage for cardioverting SVT is 50-100 J. This is what AHA recommends and also SVT converts quite readily with 50-100 J.
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This question is part of the following fields:
- Cardiovascular
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Question 14
Incorrect
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A 48 year old chronic smoker who smokes 20 cigarettes per day, presented with a persistent cough, wheezing and difficulty in breathing. He was treated with oxygen but the symptoms did not improve. Which of the following is the next step?
Your Answer:
Correct Answer: Check ABG
Explanation:The history is suggestive of a COPD exacerbation. As he is not responding to oxygen, an ABG should be performed to assess the level of hypoxaemia and then a decision about further management can be made. A CXR and salbutamol are also important in the acute management.
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This question is part of the following fields:
- Respiratory
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Question 15
Incorrect
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A 5 year old boy visited Ghana with his family and arrived back home 6 weeks ago. 2 days ago he developed neck stiffness, a fever, and vomiting. He did not present with a rash and was treated with malaria prophylaxis. Choose the correct diagnosis from the list of options.
Your Answer:
Correct Answer: Cerebral malaria
Explanation:Due to malaria’s incubation period being between 7 and 30 days, malaria prophylaxis cannot provide a patient with confirmed protection. Prophylaxis treatment also often fails. The symptoms such as neck stiffness, fever, and vomiting are also consistent with the cerebral malaria diagnosis.
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This question is part of the following fields:
- Child Health
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Question 16
Incorrect
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A 2-year-old child, who is not very active, presented with bruises on the back as well as on the chest. X-ray showed a radiolucent area around the ribs indicating callus formation. Which of the following is the most important investigation in this case?
Your Answer:
Correct Answer: Skeletal survey
Explanation:Because the initial chest X-ray returned an anomaly, a skeletal survey is the best option. Also known as a bone survey, the skeletal survey is a series of X-rays that will help analyse the structure of all the bones in the body. Because the child is not very active yet presents with bruising, the child protection register should also be checked but only after a skeletal survey has been conducted.
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This question is part of the following fields:
- Child Health
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Question 17
Incorrect
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A 5 year old boy took a fall on his outstretched hand and presents to the emergency with pain around his elbow. On examination, the radial pulse is found to be absent on the affected side. Which of the following is the most likely diagnosis?
Your Answer:
Correct Answer: Angulated supracondylar fracture
Explanation:A supracondylar humerus fracture is a fracture of the distal humerus just above the elbow joint. The fracture is usually transverse or oblique and above the medial and lateral condyles and epicondyles. This fracture pattern is relatively rare in adults, but is the most common type of elbow fracture in children. They are historically associated with morbidity due to malunion, neurovascular complications, and compartment syndrome. Important arteries and nerves ( median nerve, radial nerve, brachial artery, and ulnar nerve) are located at the supracondylar area and can give rise to complications if these structures are injured. Most vulnerable structure to get damaged is Median Nerve. Damage/occlusion of the brachial artery is the cause of an absent radial pulse.
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This question is part of the following fields:
- Mental Health
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Question 18
Incorrect
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A 19 year old female presented with irregular menstrual cycles for 4 months. On examination her weight was 85 kg and height was 145 cm. She was not on any medications. Which of the following is the most appropriate investigation to arrive at a diagnosis?
Your Answer:
Correct Answer: Pelvic ultrasound
Explanation:Oligomenorrhoea and BMI of 40.4 is suggestive of Polycystic ovary syndrome (PCOS). To diagnose PCOS 2 out of following 3 criteria should be present : oligo/anovulation, hyperandrogenism, clinical (hirsutism or less commonly male pattern alopecia) or biochemical (raised FAI or free testosterone) and polycystic ovaries on ultrasound.
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This question is part of the following fields:
- Genitourinary
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Question 19
Incorrect
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A 35-year-old female presented with purple stretch marks on her abdomen, easy bruising and weight gain. A low dose Dexamethasone suppression test did not show any but a high dose Dexamethasone suppression test showed suppression of cortisol levels. Which of the following is the most likely cause for this presentation?
Your Answer:
Correct Answer: Pituitary Adenoma
Explanation:Clinical features are due to excess cortisol. High-dose dexamethasone suppression test shows suppression in patients with Cushing’s disease. Cushing syndrome includes all causes of glucocorticoid excess, whereas Cushing’s disease is reserved only for pituitary-dependent Cushing’s syndrome.
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This question is part of the following fields:
- Endocrine
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Question 20
Incorrect
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A 32-year-old woman, who is 18 weeks pregnant, is diagnosed with antiphospholipid syndrome and positive anticardiolipin antibodies. She has a history of three miscarriages, each one during the first trimester. What would be the next most appropriate step?
Your Answer:
Correct Answer: Aspirin & heparin
Explanation:The syndrome with which the woman was diagnosed is an autoimmune, hypercoagulable state which most possibly was the reason of her previous miscarriages. This is the reason why she should be on aspirin and heparin in order to prevent any future miscarriage.
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This question is part of the following fields:
- Obstetrics
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Question 21
Incorrect
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Question 22
Incorrect
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A 10 year old boy is being bullied by his classmates because he's obese and he is the shortest in his class. His mother is worried and brings him in to the clinic. History reveals he had a renal transplant last year. What is the most likely diagnosis?
Your Answer:
Correct Answer: Cushing’s syndrome
Explanation:The boy had a renal transplant, for which he needs immune suppression. For the exogenous immune suppression an exogenous steroid is needed, which in this case is responsible for the primary Cushing syndrome manifesting with short stature. The administration of steroids before the physiological fusion of the growth plate can lead to premature fusion with permanent cessation of bone growth.
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This question is part of the following fields:
- Child Health
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Question 23
Incorrect
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A diagnosed case of scabies presented in OPD for some medical advice. Which of the following statements best suits scabies?
Your Answer:
Correct Answer:
Explanation:Scabies is an infection caused by a microscopic mite known as Sarcoptes scabies. The chief presenting complaint is itching especially in skin folds and mostly during night. It spreads from one person to another through skin contact, and therefore it is more prevalent in crowded areas like hospitals, hostels and even at homes where people live in close contact with each other. Treatment options include benzyl benzoate, ivermectin, sulphur and permethrin.
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This question is part of the following fields:
- Dermatology
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Question 24
Incorrect
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A 30 year old female with schizophrenia has a poor compliance with oral drugs. Which of the following is the best long term management for her?
Your Answer:
Correct Answer: Depot (Risperidone)
Explanation:Antipsychotics in depot preparations are best for the long term management. Depot Risperidone is the suitable answer from the given answers.
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This question is part of the following fields:
- Mental Health
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Question 25
Incorrect
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A 14-year-old male was involved in a bicycle accident. He was brought to the emergency department with abdominal pain. On the CT scan of the abdomen, a hematoma was present beneath the capsule of the spleen. His BP and pulse were normal. What is the next step in his management?
Your Answer:
Correct Answer: Refer to surgeons for observation
Explanation:A surgeon will observe the patient and will decide which procedure he needs.
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This question is part of the following fields:
- Seriously Ill
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Question 26
Incorrect
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The tumour suppressor gene is associated with multiple colonic polyps in which of the following autosomal dominant disorders?
Your Answer:
Correct Answer:
Explanation:Familial adenomatous polyposis (FAP) is an inherited disorder where patients present with malignancy in their middle age. APC tumour suppressor gene is responsible for this disorder. Other disorders mentioned in the above options do not involve the tumour suppressor gene and are not autosomal dominant disorders.
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This question is part of the following fields:
- Colorectal
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Question 27
Incorrect
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A 72-year-old male was admitted with acute right leg pain at rest. On examination, the right leg was white and peripheral pulses were not palpable. He gives a history of intermittent claudication for the past two years. What is the most probable cause for this presentation?
Your Answer:
Correct Answer: Atrial fibrillation
Explanation:This presentation is compatible with acute limb ischemia, which is a surgical emergency. Thromboembolism following atrial fibrillation is the most probable cause for this presentation as there is no history of prolonged immobilization or other associated risk factors in this male patient.
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This question is part of the following fields:
- Cardiovascular
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Question 28
Incorrect
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A 25-year-old patient with no prior medical history is admitted unconscious. Which should be done as an initial investigation?
Your Answer:
Correct Answer: Blood glucose
Explanation:The patient’s blood glucose should be evaluated in order to rule out a reversible diabetic come due to high or low blood glucose.
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This question is part of the following fields:
- Emergency
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Question 29
Incorrect
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A 50 year old female was examined after complaining of weak limbs. It was discovered she had burn marks on her fingers, diminished reflexes, and wasted and weak hands. Additionally, she has dissociated sensory loss and weak spastic legs. What is the diagnosis for this patient?
Your Answer:
Correct Answer: Syringomyelia
Explanation:All of the symptoms experienced by this patient are consistent with Syringomyelia. The sensory features are as follows: loss of temperature and pain sensation; sensory loss in the arms, shoulders, and upper body; touch, vibration, and position senses are affected in the feet as the syrinx enlarges into the dorsal column. Motor features are as follows: muscle wasting and weakness which begins in the hand, and moves onto the forearms and shoulders; loss of tendon reflexes. Autonomic involvement, such as the bladder and bowel, can occur.
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This question is part of the following fields:
- Neurology
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Question 30
Incorrect
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A child cannot wave goodbye or grasp objects with her fingers and thumb but can sit briefly supported by leaning forward on her hands. She can reach and grasp objects with the whole hand and then pass it from one hand to the other and is babbling. What is her expected age?
Your Answer:
Correct Answer:
Explanation:At 7 months, children are expected to sit briefly leaning forward on their hands, reach and grasp objects, transfer objects from hand to hand, and babble. Children are usually expected to wave goodbye or grasp objects with their fingers or thumb at around 10 months and older.
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This question is part of the following fields:
- Child Health
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SESSION STATS - PERFORMANCE PER SPECIALTY
