-
Question 1
Correct
-
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: 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.
-
This question is part of the following fields:
- Gastroenterology And Hepatology
-
-
Question 2
Correct
-
A neonate is diagnosed with cryptorchidism of the right side (undescended testis). Which is the LEAST likely place to find the testis?
Your Answer: Perineum
Explanation:Embryologically the testes are retroperitoneal structures in the posterior abdominal wall, attached to the anterolateral abdominal wall by the gubernaculum. The gubernaculum ‘pulls’ the testes through the deep inguinal ring, inguinal canal and superficial inguinal ring and over the pelvic brim. The gubernaculum is preceded by the processus vaginalis that is derived from the peritoneum anterior to the testes. The processus vaginalis pushes the muscle and fascial layers. These eventually make up the canal and the spermatic cord, into the scrotum. The gubernaculum persists as the scrotal ligament while part of the processus vaginalis remains as a bursa-like sac i.e. the tunica vaginalis testes. The testes therefore could be caught in any one of these places along its path of descending. The testes are never in the perineum.
-
This question is part of the following fields:
- Genitourinary
-
-
Question 3
Correct
-
A 15-year-old girl is referred to the paediatric unit with reduced urine output and lethargy. She has been passing bloody diarrhoea for the past four days. On admission she appears dehydrated. Bloods show the following:Na+ 142 mmol/lK+ 4.8 mmol/lBicarbonate 22 mmol/lUrea 10.1 mmol/lCreatinine 176 µmol/lHb 10.4 g/dlMCV 90 flPlt 91 * 109/lWBC 14.4 * 109/lGiven the likely diagnosis, which one of the following organisms is the most likely cause?
Your Answer: E. coli
Explanation:The likely diagnosis in this case is Haemolytic Uremic Syndrome (HUS), which is generally seen in young children presenting with a triad of symptoms, namely: acute renal failure, microangiopathic haemolytic anaemia, and thrombocytopenia. The typical cause of HUS is ingestion of a strain of Escherichia coli.
-
This question is part of the following fields:
- Renal
-
-
Question 4
Correct
-
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: 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.
-
This question is part of the following fields:
- Nephro-urology
-
-
Question 5
Correct
-
A 5 year old girl presents with a history of polyuria, polydipsia, and weight loss. She seems lethargic and has a blood glucose of 24 mmol/l. Which of the following defines diabetes, according to the World Health Organization?
Your Answer: Single fasting glucose > 7.0 mmol/l with characteristic symptoms
Explanation:WHO states that diabetes can be diagnosed from a single fasting glucose of > 7.0 mmol/l with characteristic symptoms or a glucose level of > 11.1 mmol/l 2 hours after a glucose load. Two fasting glucose levels of > 7.0 mmol/l on separate occasions can also fit the diagnosis in the absence of characteristic symptoms.
-
This question is part of the following fields:
- Endocrinology
-
-
Question 6
Correct
-
A 10-year-old boy was sent for an x-ray of the leg because he was complaining of pain and swelling. The x-ray showed the classic sign of Codman's triangle. What is the most likely diagnosis of this patient?
Your Answer: Osteosarcoma
Explanation:Codman’s triangle is the triangular area of new subperiosteal bone that is created when a lesion, often a tumour, raises the periosteum away from the bone. The main causes for this sign are osteosarcoma, Ewing’s sarcoma, eumycetoma, and a subperiosteal abscess.
-
This question is part of the following fields:
- Musculoskeletal
-
-
Question 7
Correct
-
A new-born child is not moving his left arm properly. He had shoulder dystocia during childbirth. His arm is hanging down with the shoulder internally rotated, elbow extended, forearm pronated and wrist flexed. What is the most likely diagnosis?
Your Answer: Erb palsy
Explanation:Erb’s palsy is a paralysis of the arm caused by injury to the brachial plexus, specifically the severing of the upper trunk C5–C6 nerves.The infant with an upper plexus palsy (C5-C7) keeps the arm adducted and internally rotated, with the elbow extended, the forearm pronated, the wrist flexed, and the hand in a fist. In the first hours of life, the hand also may appear flaccid, but strength returns over days to months.The right side is injured in 51% of cases. Left side occurs in 45% of patients and bilateral injuries, in 4%.
-
This question is part of the following fields:
- Neonatology
-
-
Question 8
Correct
-
A 27-year-old pregnant female had a pre pregnancy BMI of 33 kg/m2. She is found to have gestational diabetes and ultrasonography estimates a fetal macrosomia. BP is 127/72 mmHg. This primigravida is at greatest risk for which of the following obstetric emergency?
Your Answer: Shoulder dystocia
Explanation:Shoulder dystocia occurs when the fetal anterior shoulder impacts against the maternal symphysis following delivery of the vertex. Less commonly, shoulder dystocia results from impaction of the posterior shoulder on the sacral promontory. Risk Factors for Shoulder DystociaMaternalAbnormal pelvic anatomyGestational diabetesPost-dates pregnancyPrevious shoulder dystociaShort statureFetalSuspected macrosomiaLabour relatedAssisted vaginal delivery (forceps or vacuum)Protracted active phase of first-stage labourProtracted second-stage labour
-
This question is part of the following fields:
- Neonatology
-
-
Question 9
Correct
-
In an age and sex matched case control study, 30 adolescents with high blood pressure were compared to 30 controls from the same clinic. The mean birth weights of the two groups were compared using a paired t-test. The results indicated that the control group was 150 g heavier with a standard error of 100 g.Which one of these is the most appropriate conclusion?
Your Answer: There is insufficient evidence to conclude whether or not birthweight affects the development of hypertension in adolescence
Explanation:In case control studies, observational studies are made to compare two groups, individuals with a certain condition, to those without the condition, with all other factors being equal. In the situation presented by the question, the study was to determine whether a prior risk factor, a low birth weight, was associated with later developing adolescent hypertension, using a paired t-test to statistically determine whether there was indeed a significant association between the two conditions. Case control studies only help to draw associations between two groups and therefore cannot indicate causation. In this scenario we are also not given the p value to determine whether the association is statistically significant. Therefore there is not enough evidence to conclude whether or not birthweight affects the development of adolescent hypertension.
-
This question is part of the following fields:
- Epidemiology And Statistics
-
-
Question 10
Correct
-
A 15-year-old boy presents with hypertension and acute renal failure after an episode of diarrhoea. What is the most likely diagnosis?
Your Answer: Haemolytic–uraemic syndrome
Explanation:The likely diagnosis in this case is Haemolytic Uremic Syndrome (HUS), which is generally seen in young children presenting with a triad of symptoms, namely: acute renal failure, microangiopathic haemolytic anaemia, and thrombocytopenia. The typical cause of HUS is ingestion of a strain of Escherichia coli causing diarrhoea in these cases as well.
-
This question is part of the following fields:
- Renal
-
SESSION STATS - PERFORMANCE PER SPECIALTY
