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Question 1
Incorrect
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During uterogrowth, the second pharyngeal arch gives rise to which structures?
Your Answer: Mylohyoid
Correct Answer: Stylohyoid muscle
Explanation:The second pharyngeal arch or hyoid arch, is the second of six pharyngeal arches that develops in fetal life during the fourth week of development and assists in forming the side and front of the neck. Derivatives:
Skeletal – From the cartilage of the second arch arises:
Stapes,
Temporal styloid process,
Stylohyoid ligament, and
Lesser cornu of the hyoid bone.
Muscles:
Muscles of face
Occipitofrontalis muscle
Platysma
Stylohyoid muscle
Posterior belly of Digastric
Stapedius muscle
Auricular muscles
Nerve supply: Facial nerve -
This question is part of the following fields:
- Embryology
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Question 2
Correct
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A 6 year old boy presents with a tibial fracture in a cast and continuous pain. You suspect a compartment syndrome injury. Which of the following represents a late sign of the condition?
Your Answer: Absent distal pulses
Explanation:The Five P’s: pain, pulselessness, paraesthesia, paralysis, and pallor, are the most common symptoms of compartment syndrome. However, late signs of the condition include the absence of distal pulses.
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This question is part of the following fields:
- Emergency Medicine
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Question 3
Correct
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A child presents with hypothyroidism. Which of the following features is characteristic of hypothyroidism?
Your Answer: Prolonged neonatal jaundice
Explanation:Congenital hypothyroidism is one of the most important diseases of the new-born, which may lead to mental and physical retardation when treatment is delayed or an appropriate dosage of thyroxine is not administered. The most alarming and earliest sign is jaundice, especially when it is prolonged, during the neonatal period.
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This question is part of the following fields:
- Endocrinology
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Question 4
Incorrect
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In X linked dominant inheritance, what is the chance of an affected father's daughter inheriting the condition?
Your Answer: 25%
Correct Answer: 1
Explanation:In the pattern of mendelian inheritance, X- linked dominant inheritance means that all who inherit the X chromosome will present with the condition. In the case of maternal x-linked inheritance sons and daughters have an equal chance of inheriting the condition as there is a 50% chance of inheriting the defective X chromosome from their mother as opposed to a non affected X chromosome from their father. However in paternal X-linked dominant inheritance, sons will be unaffected as they inherit a Y chromosome from their father while daughters are sure to inherit the defective X-chromosome.
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This question is part of the following fields:
- Genetics And Dysmorphology
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Question 5
Correct
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Which of the following is a risk factor for intrauterine growth restriction?
Your Answer: Foetal echogenic bowel
Explanation:Intrauterine growth restriction refers to the failure of the fetus to grow in accordance with the weeks of gestation. There are two types of growth restriction, symmetrical and asymmetrical. Causes include various genetic abnormalities, fetal infections, maternal health conditions, etc. Risk factors for the development of IUGR include fetal echogenic bowel, maternal age above 40 years, low PAPP-A levels, maternal smoking or cocaine use, etc. Fetal echogenic bowel implies a brighter than usual fetal intestines on ultrasonography. It is a marker associated with trisomy 21, which is a cause of IUGR.
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This question is part of the following fields:
- Neonatology
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Question 6
Correct
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The merlin gene is implicated in the Neurofibromatosis type 2 phenotype. On which chromosome is merlin located?
Your Answer: Chromosome 22
Explanation:Neurofibromatosis type 2, also known as schwannomin, is an autosomal dominant genetic disease caused by mutation of the merlin gene located on chromosome 22. Merlin is a tumour suppressor protein, which is responsible for controlling cell shape, growth and adhesion, and is predominantly found in nervous tissue. Its mutation increases the risk of tumour development especially bilateral vestibular schwannomas, the hallmark of neurofibromatosis 2.
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This question is part of the following fields:
- Genetics And Dysmorphology
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Question 7
Correct
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What are some of the derivatives of the second pharyngeal arch?
Your Answer: Stylohyoid muscle
Explanation:Also known as the hyoid arch, it forms the side and front of the neck. From its cartilage develops the styloid process, stylohyoid ligament and lesser cornu of the hyoid bone. The muscular derivatives include the muscles of facial expression, stapedius, stylohyoid and the posterior belly of the digastric. All these are innervated by cranial nerve VII but migrate into the area of the mandibular arch.
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This question is part of the following fields:
- Embryology
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Question 8
Correct
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A 9 year old boy was admitted with gastroenteritis. The boy's symptoms started two days ago with profound diarrhoea and emesis. Blood exams show the following: Sodium=148mmol/l, Potassium=2.2mmol/l, Urea=20mmol/l, Glucose=4.3mmol/l. What would be the best management?
Your Answer: V normal saline and potassium supplement
Explanation:The boy needs re-hydration and hydro-electrolytic re-balancing due to fluid losses from the gastroenteritis and subsequent dehydration.
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This question is part of the following fields:
- Gastroenterology And Hepatology
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Question 9
Incorrect
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A 16-year-old athlete presents to the clinic with pain and swelling over the medial aspect of the right knee joint. The pain occurs when climbing the stairs, but is not present when walking on flat ground. Clinically there is pain over the medial aspect of the proximal tibia, and the McMurray test is negative.What is the most probable cause of this patient's symptoms?
Your Answer: Medial meniscus injury
Correct Answer: Pes Anserinus Bursitis
Explanation:The most probable cause for the patient’s symptoms would be pes anserine bursitis.Translated, pes anserinus means goose feet. It is the term used to describe the unified bursa enclosing the tendons of the sartorius, gracilis and semitendinous muscles inserting into the anteromedial proximal tibia.Pes anserine bursitis is common in people doing sports due to overuse injuries. The main sign is of pain in the medial part of the proximal tibia. As the McMurray test is negative, medial meniscal injury is excluded.
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This question is part of the following fields:
- Musculoskeletal
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Question 10
Correct
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A young female presents with vaginal discharge and itching. She is diagnosed with prepubertal atrophic vaginitis. What is the pathophysiology behind prepubertal atrophic vaginitis?
Your Answer: Lack of vaginal oestrogen causing infection-prone alkaline environment
Explanation:Prepubertal atrophic vaginitis is due to a lack of vaginal oestrogen. The pathophysiology behind prepubertal atrophic vaginitis:1.The proximity of the vagina to the anus2.Lack of oestrogen – leads to thinning of the vaginal mucosa3.Lack of pubic hair to protect the area4.Lack of labial fat pads
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This question is part of the following fields:
- Nephro-urology
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Question 11
Incorrect
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A 16-year-old boy, known case of Crohn's disease presents to the clinic with jaundice. His labs reveal an elevated alkaline phosphatase level. AST, ALT, albumin and clotting are in normal range. Antineutrophil cytoplasmic antibody level is positive. Radiological examination shows multi-focal strictures and irregularity of both intra and extra hepatic bile ducts which has resulted in a 'beads on a string' appearance. Which of the following is the most likely diagnosis?
Your Answer: Gallstones
Correct Answer: Primary sclerosing cholangitis
Explanation:Primary sclerosing cholangitis (PSC) is a long-term progressive disease of the liver and gallbladder characterized by inflammation and scarring of the bile ducts which normally allow bile to drain from the gallbladder. Early cholangiographic changes can include fine or deep ulcerations of the common bile duct. As PSC progresses, segmental fibrosis develops within the bile ducts, with saccular dilatation of the normal areas between them, leading to the typical beads-on-a-string appearance seen on cholangiography. Although these strictures can be found anywhere on the biliary tree, the intrahepatic and extrahepatic bile ducts are simultaneously involved in the vast majority of cases.
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This question is part of the following fields:
- Gastroenterology And Hepatology
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Question 12
Incorrect
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An 18 year old, previously well boy was admitted following a generalized tonic-clonic convulsion for 5 minutes with urinary incontinence and eye rolling. On examination, he was drowsy and had bilateral up going plantar reflexes. A short while ago he had been playing rugby and had taken a hit to the head. He was apparently normal for a few minutes before fitting. His blood sugar level was normal. Which of the following is the most probable reason for this presentation?
Your Answer: Subdural haematoma
Correct Answer: Post-traumatic seizure
Explanation:The history is suggestive of a post-traumatic seizure which frequently occurs after moderate or severe traumatic brain injury. Although upgoing plantars can be identified in a post-ictal status, an intracranial bleed has to be excluded. A single seizure cannot be considered epilepsy
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This question is part of the following fields:
- Neurology
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Question 13
Correct
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A 15-year-old male presents complaining of gradually increasing fatigue. He says that he turned vegan a year ago. He explains that he takes vitamin B12 supplements every day. Considering iron deficiency anaemia as a possible cause, you order some blood tests to confirm. Which of the following would increase the ability of the body to absorb dietary iron?
Your Answer: Consuming iron in its ferrous (Fe2+) form
Explanation:Consuming iron in its Fe2+ (ferrous form) form can improve the ability to absorb dietary iron in patients with iron deficiency anaemia (IDA). Clinical features of IDA include:- Koilonychia- Atrophic glossitis- Post-cricoid webs- Angular stomatitisThe peripheral blood smear shows the following abnormal RBC morphologies:- Target cells- Pencil poikilocytes- Microcytic-hypochromic cells
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This question is part of the following fields:
- Haematology And Oncology
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Question 14
Correct
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A 17-year-old girl presents with multiple non-healing ulcers, poor dentition, bleeding gums and pale conjunctivae. She also complains of easy fatiguability.What is the most probable diagnosis?
Your Answer: Vitamin C deficiency
Explanation:The clinical scenario presented is highly suggestive of vitamin C deficiency (Scurvy).Vitamin C is found in citrus fruits, tomatoes, potatoes, Brussel sprouts, cauliflower, broccoli, cabbage and spinach. Deficiency leads to impaired collagen synthesis and disordered connective tissue. Scurvy is associated with severe malnutrition as well as drug and alcohol abuse, and those living in poverty with limited access to fruits and vegetables.Symptoms and signs include:- Follicular hyperkeratosis and perifollicular haemorrhage- Ecchymosis- Gingivitis with bleeding and receding gums- Sjogren’s syndrome- Arthralgia- Oedema- Impaired wound healing- Generalised symptoms such as weakness, malaise, anorexia and depression
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This question is part of the following fields:
- Nutrition
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Question 15
Correct
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Which of the following findings is associated with genu valgus?
Your Answer: Out-toeing
Explanation:Gait variations in children are usually physiologically normal and only become a cause of concern when they persist or are associated with pain or other medical symptoms. Genu varus, also known as knock knees causes an outward rotation of the leg, leading the toes pointing outwards. The condition usually resolves by the age of 18 months. In comparison, in- toeing occurs with genu varus. Metatarsus adductus is also associated with an inward pointing of the toes.
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This question is part of the following fields:
- Musculoskeletal
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Question 16
Correct
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Where does the spinal cord terminate in neonates?
Your Answer: L3
Explanation:The spinal cord ends at L3 in the new-bornmigrates cephalad during childhood to end at L1 – L2 and reaches adult size by the age of 10.
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This question is part of the following fields:
- Neurology And Neurodisability
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Question 17
Correct
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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.
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This question is part of the following fields:
- Paediatric Surgery
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Question 18
Incorrect
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A 10-year-old girl with type-1 diabetes mellitus presents with vomiting and rapid breathing. A diagnosis of acute diabetic ketoacidosis was made. Which of the following regarding management is incorrect?
Your Answer:
Correct Answer: Bolus of insulin recommended
Explanation:The following methods are adopted for the treatment of DKA:
– Fluids: Bolus of 10 ml/kg of normal saline. Stop at three boluses to avoid precipitating cerebral oedema. The remaining deficit has to be corrected over 48 hours. Strict input/output, U&E, and pH monitoring is necessary in such patients.
– Insulin: Insulin infusion can be initiated at 0.05-0.1 unit/kg/hour. It is essential to monitor blood glucose closely, and the aim is to decrease by 2 mmol/hour.
– Potassium: Initially, it will be high, but following insulin administration, the levels drop quickly as K+ enters cells with glucose, and thus, replacement is almost always necessary.
– Acidosis: Bicarbonate is avoided unless pH is less than 7. Acidosis will get corrected with the correction of fluid and insulin deficits. The definitive treatment is directed towards correcting the underlying precipitants of DKA, e.g. sepsis, infections.
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This question is part of the following fields:
- Endocrinology
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Question 19
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:
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 20
Incorrect
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Children with eczema herpeticum exhibit which of the following features?
Your Answer:
Correct Answer: Atopic children have reduced immunity to the herpes simplex virus
Explanation:Eczema herpeticum is a form of Kaposi varicelliform eruption, characterized by extensive vesicular skin eruptions that arise from a pre-existing skin condition, usually atopic dermatitis. The most common pathogen is the herpes simplex virus type 1, which has a higher propensity of attacking the epidermis already damaged by atopic dermatitis. The incubation period of the illness is 5-14 days. The eruption is initially small, monomorphic, dome-shaped papulovesicles that rupture to form tiny punched-out ulcers. It is diagnosed by taking viral swabs for culture.
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This question is part of the following fields:
- Dermatology
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Question 21
Incorrect
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A severe asthma exacerbation according to the British Thoracic Society suggests an oxygen saturation that is less than:
Your Answer:
Correct Answer: 0.92
Explanation:In an acute and severe asthma attack the child cannot complete sentences in one breath because they are too breathless. The O2 saturation is less than 92% and PEF is between 33-50% best or predicted. In children that are 2-5 years old, HR is more than 140 bpm and more than 125 bpm in those older than 5 years old. The RR in children between 2-5 years old is more than 40/min, and more than 30/min in those older than 5 years old.
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This question is part of the following fields:
- Emergency Medicine
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Question 22
Incorrect
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A 17-year-old female, who works at a day-care centre presents to the physician with vomiting, joint pains, diarrhoea and crampy abdominal pain. Physical examination reveals a purpuric rash on her legs and over the belt area. She has microscopic haematuria, proteinuria and RBC casts on urine testing. Which of the underlying diagnoses is most likely in this case?
Your Answer:
Correct Answer: Henoch–Schönlein purpura (HSP)
Explanation:Henoch–Schönlein purpura (HSP), also known as IgA vasculitis, is a disease of the skin, mucous membranes, and sometimes other organs that most commonly affects children. In the skin, the disease causes palpable purpura (small, raised areas of bleeding underneath the skin), often with joint pain and abdominal pain. It is an acute immunoglobulin A (IgA)–mediated disorder. The tetrad of purpura, arthritis, kidney inflammation, and abdominal pain is often observed.
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This question is part of the following fields:
- Nephro-urology
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Question 23
Incorrect
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A 17-year-old boy is brought to the endocrinologist by his parents who are worried that he might have delayed growth as all his friends are taller than him. On examination, he has a preadolescent body habitus and no evidence of development of secondary sexual characteristics. Serum LH, FSH, and testosterone all match prepubertal range. Following an injection of GnRH, the LH and FSH concentrations increase only slightly. However, when the GnRH is given daily for 7 days, a normal response is elicited. Which of the following is the most likely causing this boy's delayed puberty?
Your Answer:
Correct Answer: A hypothalamic disorder
Explanation:Hypogonadotropic hypogonadismIn Kallmann syndrome: impaired migration of GnRH cells and defective olfactory bulb → ↓ GnRH in hypothalamus → ↓ FSH and ↓ LH → ↓ testosterone and ↓ oestrogenIn hypothalamic and/or pituitary lesions: ↓ pituitary gonadotropins (↓ FSH and ↓ LH) → ↓ testosterone and ↓ oestrogen
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This question is part of the following fields:
- Endocrinology
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Question 24
Incorrect
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Which of the conditions, mentioned below, result in a continuous murmur?
Your Answer:
Correct Answer: Blalock- Taussig shunt
Explanation:Blalock-Thomas-Taussig shunt is a surgical procedure done to increase pulmonary blood flow in cases like pulmonary atresia and results in a continuous murmur.The type of murmur which is heard during the systole and remains continuous till the second heart sound is known as a continuous murmur. This murmur is often intense and considered rough. It can also be accompanied by quivering. There are numerous causes of a continuous murmur that differ depending on the location and components of this murmur. It is caused by the shunting of blood from a high-pressure circulation to a low-pressure circulation. Pathological causes of a continuous murmur include patent ductus arteriosus, aortopulmonary window, AV malformation, coarctation of aorta, any acquired trauma, and iatrogenic cause like interventional or surgical procedures.
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This question is part of the following fields:
- Cardiovascular
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Question 25
Incorrect
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Which of the following is true regarding group B beta-haemolytic Streptococcus?
Your Answer:
Correct Answer: Group B beta-haemolytic Streptococcus (GBS) and Escherichia coli are the most common cause of early sepsis
Explanation:Group B beta-haemolytic Streptococcus (GBS) and Escherichia coli are the most common cause of early sepsis. Group B Streptococcus (GBS), also known as Streptococcus agalactiae, is best known as a cause of postpartum infection and as the most common cause of neonatal sepsis. The GBS organism colonizes the vagina, GI tract, and the upper respiratory tract of healthy humans. GBS infection is almost always associated with underlying abnormalities. In elderly persons aged 70 years or older, GBS infection is strongly linked with congestive heart failure and being bedridden.Penicillin remains the drug of choice for group B streptococcal infection but resistance may occur.
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This question is part of the following fields:
- Neonatology
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Question 26
Incorrect
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A 15-year-old boy is identified as having a Meckel's diverticulum. Which of the following embryological structures gives rise to the Meckel's diverticulum?
Your Answer:
Correct Answer: Vitello-intestinal duct
Explanation:Meckel’s diverticulum is a congenital diverticulum of the small intestine. It is a remnant of the omphalomesenteric duct (also called the vitellointestinal duct) and contains ectopic ileal, gastric or pancreatic mucosa.Rule of 2’s- occurs in 2% of the population- it is located 2 feet proximal to the ileocaecal valve- it is 2 inches long- it is 2 times more common in men- there are 2 tissue types involvedIt is typically asymptomatic. Symptomatic presentation indicates inflammation of the diverticulum. The symptoms include:- Abdominal pain mimicking appendicitis- Rectal bleeding- Intestinal obstruction: secondary to an omphalomesenteric band (most commonly), volvulus and intussusceptionManagement:Surgical removal if the neck of the diverticulum is narrow or symptomatic. Surgical options are excision or formal small bowel resection and anastomosis.
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This question is part of the following fields:
- Gastroenterology And Hepatology
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Question 27
Incorrect
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A 5 year old boy falls into the swimming pool whilst playing and almost drowns. His parents start BLS and transfer him to the emergency department. You attach him to the cardiac monitoring and you notice ventricular fibrillation. You immediately start on CRP algorithm for shockable rhythms. Which of the following may result in a poor defibrillation response?
Your Answer:
Correct Answer: Hypothermia
Explanation:Guidelines suggest that when hypothermia manifests in the context of a shockable rhythm, it might get harder to defibrillate. Therefore, defibrillation is recommended to occur at temperatures below 30°C, and to be limited in three shocks.
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This question is part of the following fields:
- Emergency Medicine
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Question 28
Incorrect
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Which of the following statements is MOST appropriate for Turner Syndrome?
Your Answer:
Correct Answer: Fetal loss in the first trimester is common
Explanation:Turners syndrome is a chromosomal syndrome affecting the development of females. In this condition, all or part of the X chromosome gets deleted, producing the Karyotype 45 XO or 45XO/46XX. Spontaneous foetal loss is common in the first trimester, but foetuses which survive are born small for date, and may have lymphedema, and poor feeding in the neonatal period. These patients face numerous medical and developmental problems throughout their lifetimes including growth and puberty failure due to premature ovarian failure/ hypergonadotropic hypogonadism. However spontaneous puberty can be seen in up to 20% of females with Turner’s syndrome.
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This question is part of the following fields:
- Endocrinology
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Question 29
Incorrect
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A 17-year-old female was given an antibiotic for a urinary tract infection. After taking the medication the patient developed Steven-Johnson syndrome. Which particular antibiotic usually causes Steven-Johnson syndrome?
Your Answer:
Correct Answer: Sulphonamides
Explanation:Stevens–Johnson syndrome (SJS) is a type of severe skin reaction. The most common cause is certain medications such as lamotrigine, carbamazepine, allopurinol, sulphonamide antibiotics, and nevirapine.
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This question is part of the following fields:
- Genitourinary
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Question 30
Incorrect
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A 4 year old boy, who is mentally unstable, accidentally shoves a pea into his ear while eating. Otoscopic examination reveals a green coloured object in the ear canal. Which of the following would be the best approach to get rid of the pea?
Your Answer:
Correct Answer: Under GA
Explanation:For Otorhinolaryngologist, removal of foreign bodies (FB) from the ear, nose and throat is one of the common emergency procedures done. Most of the cases especially of the ear and nose can be managed without General Anaesthesia (GA). But in some cases GA may be needed. As the child is mentally unstable, he is unlikely to be able to hold still while the foreign body (pea) is being removed with a forceps, which could result in instrumental damage to the ear canal. Pea is an organic foreign body and not metallic hence the use of magnets would not be of any help either. From the options provided, general anaesthesia would be the best option in this child.
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This question is part of the following fields:
- ENT
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SESSION STATS - PERFORMANCE PER SPECIALTY
