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Question 1
Incorrect
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As the junior doctor on duty you are called to see a 4 year old boy who is has been experiencing intermittent temperature spikes of 38.7C throughout the night. He underwent a laparoscopic appendicectomy for a perforated appendix four days ago, and has opened his bowels with diarrhoea. His chest is clear on examination.Which of the following is the most likely explanation for his condition?
Your Answer: Bacterial resistance to current antibiotic therapy
Correct Answer: Intra-abdominal collection
Explanation:Perforated appendices are common in children as it is more difficult to surgically assess an unwell child due to poor localisation of abdominal pain, and their inability to express discomfort. They are therefore prone to a greater risk of post operative complications including would infections, intra abdominal fluid collections, and chest infections. In the above scenario the spiking temperature points to an abscess, which characteristically presents with a swinging temperature. The fever is unlikely due to bacterial resistance as blood tests performed post surgery would have indicated any resistance, and a UTI is also unlikely since the child is already on antibiotics. As his chest is clinically clear, a severe chest infection may be ruled out, leaving intra-abdominal collection as the most likely explanation.
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This question is part of the following fields:
- Paediatric Surgery
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Question 2
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 only
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 3
Correct
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A 6 year old child presents with a history of headache and a tonic-clonic seizure that lasted for three minutes. The doctor measures the blood pressure in all four limbs which is 180 mmHg. His creatinine is 60 μmol/l and he looks dehydrated. The kidneys look small and echogenic on ultrasound. Which of the following steps is most appropriate?
Your Answer: Ophthalmology assessment is indicated
Explanation:The child requires frequent BP evaluation every 15 to 30 minutes. Normalisation of his BP should be achieved in a 48h interval. An ophthalmology assessment is indicated to check for acute injury of the blood vessels in the eye due to the elevated blood pressure.
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This question is part of the following fields:
- Nephro-urology
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Question 4
Incorrect
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Which of the following conditions exhibits Koebner’s phenomenon?
Your Answer: Lyme disease
Correct Answer: Vitiligo
Explanation:Koebner’s phenomenon describes skin lesions that occur on damaged skin, usually in a linear fashion at the site of injury. Conditions which exhibit true Koebnerisation include psoriasis, lichen planus, lichen sclerosis, vitiligo, Kaposi sarcoma and SLE. Conditions such as erythema nodosum or multiforme, or Lyme disease and Impetigo do not exhibit Koebner’s phenomenon.
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This question is part of the following fields:
- Dermatology
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Question 5
Incorrect
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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: Around the uterine cornu
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
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This question is part of the following fields:
- Neonatology
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Question 6
Correct
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A 16-month-old infant presented to ER with multiple bruises on his right arm. According to his mom, he has been unable to move it since yesterday and is crying more than usual. A relative attended the child while his mother was on a night shift. X-ray revealed a fracture of the right humerus, which was put in a cast. What is the next step in this case?
Your Answer: Admit under care of paediatrician
Explanation:Certain lesions present on x-ray are suggestive of child abuse including rib, humerus and skull fractures. It is the doctors responsibility to follow up on these cases to determine whether domestic abuse has occurred.
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This question is part of the following fields:
- Musculoskeletal
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Question 7
Incorrect
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A 8 year old boy who had not wet his bed for the past 3 and half years, presented with bed wetting for 2 weeks. Which of the following is the most appropriate management?
Your Answer: Prescribe DDAVP
Correct Answer: Investigate for secondary causes
Explanation:As this boy was dry for a considerable period, there is a high chance of a secondary cause for the bed wetting, such as bladder infections, constipation, diabetes, psychological stress and hormonal problems etc. These have to be excluded.
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This question is part of the following fields:
- Behavioural Medicine And Psychiatry
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Question 8
Incorrect
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An 8-month-old infant is presented to the paediatrics ward with a history of delayed developmental milestones since birth. On examination, he has poor muscle tone and balance, and a head circumference, which is greater than normal. Imaging of the patient's head revealed a diminished cerebellar vermis, a large fourth ventricle, and an enlarged posterior fossa. What is the most likely diagnosis?
Your Answer: Neuroblastoma
Correct Answer: Dandy-Walker syndrome
Explanation:Dandy-Walker syndrome is characterised by symptoms of brain maldevelopment that are seen in this patient. A large cranium indicates hydrocephalus, and the hypotonia indicates poor limb development.
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This question is part of the following fields:
- Neurology
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Question 9
Correct
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A 6 year old child who has been developing normally until the age of 18 months, is now being investigated for developmental delay. The girl started losing her acquired skills and stopped walking. During the clinical examination she is holding her hands together and twisting and turning them. What is the most probable diagnosis?
Your Answer: Rett syndrome
Explanation:Rett syndrome is a disorder that affects the brain and occurs most commonly in girls. It presents with a period of normal development followed by severe problems with language and communication, learning, coordination, and other brain functions.
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This question is part of the following fields:
- Genetics And Dysmorphology
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Question 10
Incorrect
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Which of the following is an ECG feature of hypercalcaemia?
Your Answer: Prolonged QT
Correct Answer: Tall T waves
Explanation:On electrocardiography (ECG), characteristic changes in patients with hypercalcemia include:Tall T wavesReduced QTProlonged and depressed STArrhythmiaOther electrolyte disturbances:Hypokalaemia:Flat T wavesST depressionU waveAtrial and ventricular ectopicsVF and VTHyperkalaemia:Tall T wavesST- changesReduced QT intervalIncreased PR intervalSmaller or absent P wavesWidened QRS, broadening to VFHypocalcaemia:Prolonged QTProlonged STFlat or absent T wavesU waves
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This question is part of the following fields:
- Cardiovascular
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SESSION STATS - PERFORMANCE PER SPECIALTY
