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Question 1
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What is the most likely condition a new born infant is likely to suffer from, if he/she was born with incomplete fusion of the embryonic endocardial cushions?
Your Answer: An atrioventricular septal defect
Explanation:The endocardial cushions in the heart are the mesenchymal tissue that make up the part of the atrioventricular valves, atrial septum and ventricular septum. An incomplete fusion of these mesenchymal cells can cause an atrioventricular septal defect. The terms endocardial cushion defect, atrioventricular septal defect and common atrioventricular canal defect can be used interchangeably with one another.
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This question is part of the following fields:
- Embryology
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Question 2
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Which of the following developmental milestones is a 3 year old girl unlikely to have achieved?
Your Answer: Make good cuts with scissors
Explanation:At the age of three years a child is to be able to dress and undress himself with supervision, eat with a spoon and fork, build a tower with 9 cubes, give their full name and copy a circle. The child will not be able to make good cuts with scissions until he is about 5 years old.
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This question is part of the following fields:
- Child Development
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Question 3
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A 15-day old baby was brought to the emergency department with constipation for 4 days. On examination, the abdomen of the baby was found to be distended and tender all over. No bowel sounds were heard. A sigmoid colon biopsy was carried out, which showed absent ganglion cells. What is the diagnosis?
Your Answer: Hirschsprung’s disease
Explanation:Hirschsprung’s disease is characterized by congenital absence of the autonomic plexus (Meissner’s and Auerbach’s plexus) in the intestinal wall. Usually limited to the distal colon, it can occasionally involve the entire colon or even the small bowel. There is abnormal or absent peristalsis in the affected segment, resulting in continuous spasm of smooth muscle and partial/complete obstruction. This causes accumulation of intestinal contents and dilatation of proximal segment. Skip lesions are highly uncommon. This disease is seen early in life with 15% patients presenting in first month, 60% by 1 year of age and 85% by the age of 4 years. Symptoms include severe and complete constipation, abdominal distension and vomiting. Patients with involvement of ultra-short segments might have mild constipation with intervening diarrhoea. In older children, symptoms include failure to thrive, anorexia, and lack of an urge to defecate. On examination, an empty rectum is revealed with stool palpable high up in the colon. If not diagnosed in time, it can lead to Hirschsprung’s enterocolitis (toxic megacolon), which can be fulminant and lead to death. Diagnosis involves a barium enema or a rectal suction biopsy. Barium enema shows a transition in diameter between the dilated, normal colon proximal to the narrowed, affected distal segment. It is to be noted that barium enema should be done without prior preparation, which can dilate the abnormal segment, leading to a false-negative result. A 24-hour post-evacuation film can be obtained in the neonatal period – if the colon is still filled with barium, there is a high likelihood of Hirschsprung’s disease. Full-thickness rectal biopsy is diagnostic by showing the absence of ganglion cells. Acetylcholinesterase staining can be done to highlight the enlarged nerve trunks. Abnormal innervation can also be demonstrated by rectal manometry.
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This question is part of the following fields:
- Gastroenterology And Hepatology
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Question 4
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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Question 5
Correct
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In which one of the following conditions is faltering growth frequently seen?
Your Answer: Complete atrioventricular septal defect
Explanation:Congenital heart diseases such as complete atrioventricular septal defects are most likely to cause large left to right shunts leading to faltering growth due to chronic severe hypoxia, pulmonary oedema, and feeding problems. Isolated atrial septal defects or ventricular septal defects result in relatively smaller shunts. Pulmonary stenosis and bicuspid aortic valve do not cause chronic systemic hypoxia. People with these conditions are often asymptomatic and only show some symptoms with intense physical activity.
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This question is part of the following fields:
- Cardiovascular
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Question 6
Incorrect
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A 3-year-old girl presented with faecal incontinence for 2 weeks. Abdominal examination revealed a mass in right lower quadrant. Which of the following is the most appropriate management for this girl?
Your Answer: Enema and laxative
Correct Answer: Laxatives
Explanation:Laxatives have been shown to be beneficial in the treatment of chronic childhood constipation. Studies have shown that polyethylene glycol, mineral oil, magnesium hydroxide, and lactulose are effective and can be used for a prolonged periods without risk.
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This question is part of the following fields:
- Gastroenterology And Hepatology
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Question 7
Correct
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In term babies with persistent jaundice, what is the time period over which one must consider biliary atresia as the probable cause?
Your Answer: 14 days
Explanation:After a period of 14 days, if jaundice persists in a term new-born, having ruled out the other possibilities, biliary atresia should be considered as a possible diagnosis.Biliary atresia is a rare but serious condition. Symptoms include obstructive jaundice (dark urine and pale stool). Management:Surgery within 8 weeks is recommended. Survival is around 90% using current treatment regimes. Without treatment, children will survive to around 18 months.
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This question is part of the following fields:
- Neonatology
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Question 8
Correct
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A mother came to the clinic, with her 7 month old baby. She anxiously explained that he was not responding to loud sounds. He was vocalizing at the presentation and he had normal motor milestones. Which of the following is the most appropriate management?
Your Answer: Arrange Hearing test
Explanation:History is suggestive of a possible hearing impairment. As the baby is vocalizing and has normal motor development, an isolated hearing problem is possible. A hearing test will confirm the diagnosis.
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This question is part of the following fields:
- ENT
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Question 9
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A 5 year old girl presents with widespread, itchy, excoriated papules that appeared three months ago. They are symmetrically distributed and more profound on the extensor surfaces of the elbows and knees. The papules are present on the trunk as well but are less remarkable. She doesn’t have it anywhere else on her body and seems to be in a good health. The itchiness results in the girl to often scratching and popping the fluid-filled blisters that are present. There is no family history of atopy or other skin conditions. Which of the following is accurate?
Your Answer: Coeliac antibodies should be measured
Explanation:This is the clinical picture of dermatitis herpetiformis associated with gluten-sensitive enteropathy. To establish the diagnosis, you should measure the coeliac antibodies. Darrier’s sign (where the skin urticates when it is stroked) is positive in urticaria pigmentosa.
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This question is part of the following fields:
- Dermatology
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Question 10
Incorrect
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Conjugated bilirubin is converted and metabolised into urobilinogen before excretion. This metabolism takes place in which part of the body?
Your Answer: Small intestine
Correct Answer: Large intestine
Explanation:Unconjugated bilirubin is conjugated to glucuronic acid in the hepatocyte. Conjugated bilirubin passes into the enterohepatic circulation and the bilirubin which evades this system is metabolised by bacteria, primarily in the large intestine, to urobilinogen, then stercobilinogen and eventually oxidised to stercobilin. Stercobilin gives faeces its brown colour.
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This question is part of the following fields:
- Gastroenterology And Hepatology
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Question 11
Incorrect
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An 8-year-old girl returns from holiday in Greece, complaining of ear discharge and tragal tenderness. The exam shows a normal tympanic membrane and ear cleaning was done. What is the next step in management?
Your Answer: Antibiotic PO
Correct Answer: Antibiotic drop with steroid
Explanation:The symptoms and signs described are suggestive of otitis externa. The key treatment for otitis externa is ear cleaning and antibiotic drops with steroid.
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This question is part of the following fields:
- ENT
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Question 12
Correct
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Which of the given statements is correct regarding carbon monoxide?
Your Answer: CO combines with haemoglobin to form carboxyhaemoglobin
Explanation:Carbon monoxide is a colourless gas, which is toxic to animals. It has a high affinity for haemoglobin (around 250 times greater than oxygen). It combines with haemoglobin forming carboxyhaemoglobin, which decreases the oxygen-carrying capacity of the blood, leading to a left-shift in the oxygen-dissociation curve. CO is produced endogenously in limited amounts (0.4ml per hour), but the toxic levels are higher.
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This question is part of the following fields:
- Haematology And Oncology
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Question 13
Correct
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A 12-week antenatal scan reveals a massive neck swelling in the foetus. While assessing the mother, she is found to have mild learning difficulties, short stature and a heart murmur. What is the most probable diagnosis?
Your Answer: Noonan syndrome
Explanation:The most probable diagnosis in this patient is Noonan syndrome.Noonan syndrome is an autosomal dominant condition characterised by short stature, heart defects (mainly pulmonary stenosis) and learning difficulties. An affected foetus can present with a significant increase in the nuchal thickness or a cystic hygroma of the neck. The condition is variable, and an affected parent is often only diagnosed after the diagnosis in the child.
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This question is part of the following fields:
- Genetics And Dysmorphology
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Question 14
Incorrect
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A 15-year-old Afro-Caribbean boy presents with a temperature of 37.2℃ and acute abdominal pain. He has previously undergone a splenectomy secondary to sickle cell disease. Clinically he is jaundiced. An ultrasound scan demonstrates a common bile duct diameter of 10mm. What is the most likely diagnosis?
Your Answer: Sickle Cell Crisis
Correct Answer: Impacted Gall Stone
Explanation:Based on the clinical scenario provided, this patient most probably has impacted gall stones. Gall stones in children can be caused by haematological diseases such as sickle cell anaemia and thalassemia. Cholesterol stones are also becoming more prevalent. A dilated common bile duct (> 10mm in adults) suggests gall stone impaction. The presence of pyrexia indicates cholecystitis.
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This question is part of the following fields:
- Paediatric Surgery
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Question 15
Incorrect
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A 6 year old child is admitted with generalised oedema, albuminuria, hypoalbuminemia, and hyperlipidaemia. The renal biopsy is normal. What would you expect to see on electron microscopy?
Your Answer: Splitting of the capillary basement membrane
Correct Answer: Fusion of foot processes of the glomerular epithelial cells
Explanation:The child has nephrotic syndrome which is most commonly caused by minimal change nephropathy in this age group. The condition presents with fusion of foot processes of the glomerular epithelial cells under the microscope.
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This question is part of the following fields:
- Nephro-urology
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Question 16
Incorrect
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Which of the following conditions is NOT a recognized cause of respiratory distress syndrome (SDLD)?
Your Answer: Male sex
Correct Answer: Maternal hypertension
Explanation:Insufficient surfactant production in premature infants leads to respiratory distress syndrome or surfactant deficient lung disease (SDLD), characterized by structurally immature lungs. There are many risk factors of this disease, some of them include male gender, caesarean section, infants of diabetic mothers, being the second born of the premature twins, perinatal asphyxia, sepsis, and hypothermia. Maternal hypertension is not a recognized risk factor for respiratory distress syndrome| instead, pregnancy-induced hypertension and chronic maternal hypertension are the protective factors against this disease.
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This question is part of the following fields:
- Neonatology
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Question 17
Incorrect
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Consider the following study:Healthy individuals are assessed according to their current body mass index (BMI). Two years later, their health status is reassessed, and the relationships with their earlier BMI were determined.What is the type of epidemiological study described above?
Your Answer: Retrospective
Correct Answer: Cohort
Explanation:The study described in the question is a ‘cohort’ study.Other options:A prospective observational study – When groups are classified according to one or more factors at a given time and followed forward to determine outcomes (usually some health status)- Although there is in one sense a control group (those who do not develop the health problem), this is not generally called a ‘controlled’ trial. – An ecological study would look at outcomes in different groups (countries or regions usually) who follow different practices.
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This question is part of the following fields:
- Epidemiology And Statistics
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Question 18
Correct
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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 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.
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This question is part of the following fields:
- Infectious Diseases
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Question 19
Correct
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A 15 month old boy has a history of repeated bacterial pneumonia, failure to thrive and a sputum culture positive for H.influenzea and S.pneumoniae. There is no history of congenital anomalies. He is most likely suffering from?
Your Answer: X-linked agammaglobulinemia
Explanation:Recurrent bacterial infections may be due to lack of B-cell function, consequently resulting in a lack of gamma globulins production. Once the maternal antibodies have depleted, the disease manifests with greater severity and is called x-linked agammaglobulinemia also known as ‘X-linked hypogammaglobulinemia’, ‘XLA’ or ‘Bruton-type agammaglobulinemia. it is a rare x linked genetic disorder that compromises the bodies ability to fight infections.
Acute leukaemia causes immunodeficiency but not so specific.
DiGeorge syndrome is due to lack of T cell function.
Aplastic anaemia and EBV infection does not cause immunodeficiency. -
This question is part of the following fields:
- Respiratory
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Question 20
Correct
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A 6 year old boy with a history of pharyngitis 10 days ago, presents with periorbital oedema. You perform a urine dipstick test which shows 1+ for protein and 3+ for blood. Family history is clear. What is the most probable diagnosis?
Your Answer: Glomerulonephritis
Explanation:The child has a history of pharyngitis followed 10 days later by signs of glomerulonephritis. In this particular case, it is most probably a post-streptococcus glomerulonephritis which accounts for 80% of paediatric cases of glomerulonephritis.
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This question is part of the following fields:
- Nephro-urology
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SESSION STATS - PERFORMANCE PER SPECIALTY
