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Question 1
Correct
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A 10-year-old boy presented to the ophthalmology clinic with a painless swelling on the superotemporal aspect of his orbit. It was smooth on examination and produced no visual disturbances. Following excision, it was found to be lined by squamous epithelium and hair follicles.Which lesion is most probably associated with these findings?
Your Answer: Dermoid cyst
Explanation:The most probable lesion in the patient is a dermoid cyst.Rationale:Dermoid cysts are embryological remnants and may be lined by hair and squamous epithelium (like teratomas). They are often located in the midline and may be linked to deeper structures resulting in a dumbbell shape to the lesion. Complete excision is required as they have a propensity to local recurrence if not excised.Note:Desmoid tumours are a different entity entirely. These lesions most commonly develop in ligaments and tendons. They are also referred to as aggressive fibromatosis and consist of dense fibroblastic lesions (resembling scar tissue). They should be managed in a similar manner to soft tissue sarcomas.
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This question is part of the following fields:
- Dermatology
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Question 2
Correct
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All of the given conditions are scaly dermatologic pathologies EXCEPT?
Your Answer: Hand, foot, and mouth disease
Explanation:Skin conditions resulting from excessive epidermal proliferation or inflammation, leading to a production of excessive scales, are referred to as papulosquamous disorders. These disorders can be generalized and localized. Localized causes of scaly lesions include tinea corporis, tinea cruris, tinea pedis, seborrheic dermatitis, psoriasis, pityriasis Versicolor, pityriasis alba, DLE, ichthyosis including Netherton syndrome (a severe form of ichthyosis which is autosomal recessive), and pellagra. Generalized causes include guttate psoriasis and pityriasis rosacea. Hand, foot, and mouth disease is a contagious viral illness that causes blisters in the mouth and on the extremities.
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This question is part of the following fields:
- Dermatology
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Question 3
Incorrect
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A 6 year old girl presents with an episode of DKA and receives a diagnosis of type 1 diabetes mellitus. Which of the following injection complications are more prevalent?
Your Answer: Lipoatrophy
Correct Answer: Lipohypertrophy
Explanation:Lypohypertrophy is the most common skin-related complication of insulin injection.
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This question is part of the following fields:
- Endocrinology
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Question 4
Correct
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When discussing child development with a parent, which one of the following motor skills would NOT be expected of a 3-year-old?
Your Answer: Catching a bounced ball
Explanation:Milestones of 3 years old:Social and Emotional:Copies adults and friends Shows affection for friends without prompting Takes turns in games Shows concern for crying friend Understands the idea of mineť and hisť or hersť Shows a wide range of emotions Separates easily from mom and dad May get upset with major changes in routineDresses and undresses self Language/Communication:Follows instructions with 2 or 3 steps Can name most familiar things Understands words like in,ť on,ť and underť Says first name, age, and sexNames a friend Says words like I,ť me,ť we,ť and youť and some plurals (cars, dogs, cats) Talks well enough for strangers to understand most of the time Carries on a conversation using 2 to 3 sentences Cognitive (learning, thinking, problem-solving):Can work toys with buttons, levers, and moving parts Plays make-believe with dolls, animals, and people Does puzzles with 3 or 4 pieces Understands what twoť means Copies a circle with pencil or crayon Turns book pages one at a time Builds towers of more than 6 blocks Screws and unscrews jar lids or turns door handle Movement/Physical Development:Climbs well Runs easily Pedals a tricycle (3-wheel bike) Walks up and down stairs, one foot on each step
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This question is part of the following fields:
- Child Development
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Question 5
Correct
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Which of the following are associated with port wine stains?
Your Answer: Epilepsy
Explanation:Port-wine stains are a type of vascular birthmark caused by the abnormal development of capillaries in the skin. These pinkish-purplish discolorations present at birth and are associated with medical conditions such as Sturge-Weber syndrome, a neurocutaneous disorder involving the leptomeninges. Port wine stains are therefore associated with epilepsy, glaucoma or intellectual disability common in Sturge-Weber syndrome. Additional complications of Port wine stains include a loss of function if near the eye or mouth due to hypertrophy, or glaucoma if near the eyelid.
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This question is part of the following fields:
- Dermatology
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Question 6
Correct
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A 17-year-old boy is brought to the emergency after being stabbed in the upper arm and the median nerve is transected. Impaired function can be demonstrated in which of the following muscle/s?
Your Answer: Abductor pollicis brevis
Explanation:The median nerve is a peripheral nerve originating in the cervical roots C5-T1 of the brachial plexus. It supplies motor innervation to the anterior forearm flexors, the thenar muscles, and the two lateral lumbricals as well as sensory innervation to the lateral palm and anterior, lateral three and a half fingers. Motor and sensory deficits depend on whether the lesion is proximal (above the elbow) or distal (below the elbow). While proximal lesions present with the hand of benediction,ť distal lesions present with either the pinch signť (anterior interosseous nerve syndrome) or, in the case of carpal tunnel syndrome, with mildly impaired thumb and index finger motion. Both proximal lesions and carpal tunnel syndrome result in reduced sensation in the area of the thumb, index and middle finger. Anterior interosseus nerve syndrome does not cause any sensory deficits. Chronic injuries to the nerve result in atrophy of median nerve innervated muscles while acute injuries do not have this feature. Treatment is mostly conservative and focuses on rest and immobilization.
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This question is part of the following fields:
- Musculoskeletal
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Question 7
Correct
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A 13-year-old male with epilepsy presents to the emergency department. On examination, he is found to have a prominent carotid pulse but a feeble femoral pulse. He was also found to be hypertensive with blood pressure in his upper limbs found to be 40 mmHg more than that of the lower limbs.Auscultation reveals an ejection-systolic murmur at the upper left sternal edge and the left interscapular area and an audible ejection click at the apex.An ECG reveals features suggestive of mild left ventricular hypertrophy and a chest X-ray reveals mild cardiomegaly with notches on the lower surface of the 3rd, 4th and 5th ribs. What is the most probable diagnosis?
Your Answer: Coarctation of the aorta
Explanation:The most probable diagnosis for the clinical scenario provided is coarctation of the aorta. It contributes to about 4% of all congenital heart disease and is more prominent in males than females.It is associated with trisomy 13 and 18, Turner syndrome, valproate toxicity as well as ventricular septal defects, persistent ductus arteriosus, mitral valve abnormalities and berry aneurysms of the circle of Willis. Other associated cardiac abnormalities include a bicuspid aortic valve (50%), mitral valve disease, aortic regurgitation (20%) and subaortic stenosis. Ninety-eight per cent of coarctations occur at the level of the pulmonary artery after the subclavian artery. It is for this reason that, on observation, the proximal blood pressure varies compared with the distal blood pressure. The blood pressure in the right arm is often higher than that in the left arm. Clinically, these children present with hypertension, prominent carotid pulses, radio-femoral delay, left ventricular hypertrophy and an ejection systolic murmur maximum over the posterior left interscapular area. An apical click over the aortic valve may be heard. Coarctation of the aorta may be simple (post-ductal), or complex (pre-ductal or with a septal defect), and may be associated with aortic stenosis, transposition of the great arteries or a bicuspid aortic valve. The ECG and chest radiograph may be normal. However, as the child enters the first decade, evidence of cardiomegaly, congestive heart failure, post-stenotic dilatation with a dilated subclavian artery and rib notching may be noticed. The ECG may show right ventricular hypertrophy, left ventricular hypertrophy in infancy and right axis deviation. Complications of coarctation of the aorta include left ventricular failure, cerebral haemorrhage, aortic dissection, renal vascular stenosis and infective endocarditis. This condition may result in death due to an aortic aneurysm or rupture in the third or fourth decade of life. It may also cause premature ischaemic heart disease as a result of hypertension. If left untreated, 20% of individuals die before 20 years of age and 80% before 50 years of age. Treatment options include surgical balloon dilatation or the grafting of a subclavian flap, and should surgical correction not normalise the blood pressure, further medical management is required.
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This question is part of the following fields:
- Cardiovascular
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Question 8
Correct
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In which one of the following diseases does the patient have to be isolated?
Your Answer: Measles
Explanation:Measles and chickenpox are spread by droplets. Thus, patients should be isolated. Rheumatic fever and post-streptococcal glomerulonephritis are immune mediated diseases that don’t require isolation. Herpetic gingivostomatitis spreads by direct transmission of infected secretions to the stratified squamous epithelium. HSP is not an infectious disease.
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This question is part of the following fields:
- Infectious Diseases
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Question 9
Correct
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A 17-year-old girl presents to the clinic complaining of dry skin and amenorrhoea for the past 9 months. She goes to college and is performs well academically. Physical examination shows an underweight girl (weight 38 kg), height 1.78 m (5 ft 10 inches). Excessive small hair can be seen growing on the body. Labs are significant for an elevated cortisol level, normal T4 level, and anaemia associated with reduced WBCs and platelets. Based on this clinical picture, what is the most likely cause of her symptoms?
Your Answer: Anorexia nervosa
Explanation:Anorexia nervosa is an eating disorder defined by restriction of energy intake relative to requirements, leading to a significantly low body weight. Patients will have an intense fear of gaining weight and distorted body image with the inability to recognize the seriousness of their significantly low body weight. Athletes in sports such as ballet, long-distance running, and martial arts are pressured to maintain lean body weights to outperform the competition.
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This question is part of the following fields:
- Endocrinology
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Question 10
Correct
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What is the average lifespan of an erythrocyte once it has entered the bloodstream?
Your Answer: 120 days
Explanation:Red blood cells (RBC) have a life span of 120 days in humans.Aging of RBC includes changes in many properties: decreased metabolic activity, morphological alterations, including decreased cell volume and changes in cell shape, and quantitative and qualitative modulations of the surface.
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This question is part of the following fields:
- Haematology And Oncology
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Question 11
Correct
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A 15-year-old boy, who has a family history of Gilbert's syndrome, presents with signs and symptoms of hepatic dysfunction. Liver function tests reveal raised unconjugated bilirubin levels. Subsequent genetic testing led to a diagnosis of Gilbert's syndrome. What is the reason for the unconjugated hyperbilirubinemia in Gilbert's syndrome?
Your Answer: Reduced levels of UDP-glucuronosyl transferase-1
Explanation:Gilbert’s syndrome is an autosomal recessive condition that results from defective bilirubin conjugation due to a deficiency of UDP glucuronyl transferase – 1. The prevalence is approximately 1-2% in the general population.The clinical presentation of Gilbert’s syndrome include:- Unconjugated hyperbilinaemia- Jaundice can occur during an intercurrent illnessManagement:Blood investigations usually reveal a rise in bilirubin following prolonged fasting or intravenous nicotinic acid.No treatment required for these patients.Other options:- CYP2C9 deficiency causes reduced warfarin metabolism, and subsequent enhanced drug effects. – Pancreatic disease, cholestasis, excessive alcohol consumption and certain drugs are common causes of raised GGT levels- Defective hepatocyte excretion of conjugated bilirubin is related to the pathophysiology of Dubin-Johnson syndrome- Reduced CYP2C19 levels can lead to the disordered metabolism of clopidogrel and other drugs such as proton-pump inhibitors, anticonvulsants and sedatives.
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This question is part of the following fields:
- Dermatology
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Question 12
Incorrect
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What class of antibodies do the anti-B antibodies in a patient with blood group A belong to?
Your Answer: IgG
Correct Answer: IgM
Explanation:The anti-B antibodies in a patient with blood group A belong to the IgM class of immunoglobulins.Note:IgM is the largest antibody formed of 5 antibodies attached together. This functions to agglutinate or clump antigens. The associated anti-A and anti-B antibodies are usually IgM produced in the first years of life by sensitisation to environmental substances such as food, bacteria, and viruses.Other options:- IgG is the most common antibody. It is a single antibody complex.- IgD is found on the surface of B-lymphocytes.- IgE is bound to tissue cells, especially mast cells and eosinophils.
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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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Which one of the following is a derivative of the midgut?
Your Answer: Caecum
Explanation:The primary intestinal loop is formed from the midgut which gives rise to the distal half of the duodenum, the jejunum, ascending colon, proximal two thirds of the transverse colon and the ileum.
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This question is part of the following fields:
- Embryology
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Question 14
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 15
Correct
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Absence of which of the following milestones warrants further assessment in a 15-month-old child?
Your Answer: Stand holding onto furniture
Explanation:By 15 months, it’s common for many toddlers to:- say three to five words.- understand and follow simple commands.- point to one body part.- walk alone and begin to run.- climb on furniture.- make marks with a crayon.- imitate activities, such as housework.
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This question is part of the following fields:
- Child Development
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Question 16
Incorrect
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An 8 year old male child presents with an injury to his right brachial plexus in a motor vehicle accident. Clinical examination reveals a right shoulder weakness when it comes to abduction and flexion of the forearm. His lateral aspect of the right upper arm seems to have some sensory loss as well. All reflexes are present except for the right biceps and brachioradial ones. What is the level of brachial plexus injury?
Your Answer: C6,7 root
Correct Answer: C5,6 root
Explanation:Upper brachial plexus roots innervate the proximal muscles of the shoulder and the upper arm. In this particular case, only these areas are affected, suggesting that the levels of brachial plexus injury are at roots C5-C6.
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This question is part of the following fields:
- Anatomy
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Question 17
Correct
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A 14 year-old is brought to the ED after being hit on the head with a cricket ball during a match. His teacher describes that he initially collapsed on the ground and complained of a sore head. Two minutes later, he got up and said he felt OK and continued playing. However, 30 minutes later he suddenly collapsed and lost consciousness. What injury is he most likely to have sustained?
Your Answer: Extradural haematoma
Explanation:A lucid interval, in which the patient portrays a temporary improvement in condition after a traumatic brain injury, is especially indicative of an epidural haematoma.
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This question is part of the following fields:
- Neurology
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Question 18
Incorrect
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A 16-year-old female presents to the physician with vomiting. For the past 6 months she has been experiencing weight loss, poor appetite and lethargy. When the physician inquires about the possibility of these symptoms' beings self-induced, both the patient and her family deny. Lab reports show sodium 125 mmol/l, potassium 5.5 mmol/l, urea 7.9 mmol/l and creatinine 67 µmol/l. A blood gas shows a bicarbonate of 12.4 mmol/l. Which of the following is most likely causing these symptoms?
Your Answer: Anorexia nervosa
Correct Answer: Addison's disease
Explanation:Addison disease is adrenocortical insufficiency due to the destruction or dysfunction of the entire adrenal cortex. It affects glucocorticoid and mineralocorticoid function. The onset of disease usually occurs when 90% or more of both adrenal cortices are dysfunctional. The most common symptoms are fatigue, muscle weakness, loss of appetite, weight loss, and abdominal pain. Adrenal insufficiency can be caused by autoimmune disease or suddenly stopping steroid medicines used to treat other conditions, among other causes.
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This question is part of the following fields:
- Endocrinology
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Question 19
Incorrect
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A 16-year-old boy suffers recurrent episodes of haematuria following a flu-like illness. He is otherwise well. Physical examination is normal. Urinalysis reveals no proteinuria, blood ++, and 2-3 white blood cells/mm3.What is the most probable diagnosis?
Your Answer: Henoch-Schonlein purpura
Correct Answer: IgA nephropathy
Explanation:IgA nephropathy’s characteristic presentation is haematuria following a non-specific upper respiratory infection as was evident in this case. IgA nephropathy also usually occurs in children and young males, like this patient.
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This question is part of the following fields:
- Renal
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Question 20
Correct
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What is most likely to occur in lead poisoning?
Your Answer: Delayed developmental milestones
Explanation:Lead can be found in material used for mining, leaded paints and gasoline, glassware, toys, and even cosmetics. Lead poisoning is rare nowadays as the use of lead has been banned from many products. Lead is toxic and in certain concentrations can cause irreversible damage. Children are especially vulnerable as they absorb 4 times as much ingested lead as adults. The typical features of lead poisoning include developmental delay and behavioural disorders, microcytic anaemia, constipation and vomiting. Pulmonary fibrosis, Osteomalacia and cardiomyopathy are not known features of lead poisoning.
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This question is part of the following fields:
- Haematology And Oncology
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Question 21
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: Controlled trial
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 22
Correct
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Childhood absence epilepsy is characterized by which of the given facts?
Your Answer: 3-Hz spike-and-slow-wave complexes are seen on electroencephalograms (EEGs)
Explanation:Absence epilepsy is the most common type of generalized childhood epilepsies. It is mainly idiopathic, but 10-40% of the cases have a positive family history. It is characterized by frequent absence seizures and periods of unconsciousness. The hallmark of absence epilepsy on EEG is the bilaterally synchronous 2-4 Hz spike and wave discharges (SWDs). The average age of onset is around 4-8 years, being more prevalent among girls. Treatment resistance is not common.
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This question is part of the following fields:
- Neurology And Neurodisability
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Question 23
Correct
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A midwife calls you from the postnatal ward. A baby has been born to a mother who had not booked at the hospital. Her notes are not available and she does not speak English. However, her partner has managed to communicate that Zika virus had been confirmed in pregnancy. The midwife wants to know if it is safe for the mother to breastfeed the baby in the meantime.What is the MOST appropriate course of action?
Your Answer: Encourage breastfeeding
Explanation:Possible Zika virus infections have been identified in breastfeeding babies, but Zika virus transmission through breast milk has not been confirmed. Additionally, we do not yet know the long-term effects of Zika virus on young infants infected after birth. Because current evidence suggests that the benefits of breastfeeding outweigh the risk of Zika virus spreading through breast milk, CDC continues to encourage mothers to breastfeed, even if they were infected or lived in or travelled to an area with risk of Zika.
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This question is part of the following fields:
- Nutrition
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Question 24
Incorrect
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A 16 year old girl presents with excess hair and amenorrhoea. She is normotensive. Her prolactin levels are normal. She has a raised 17 α-hydroxyprogesterone level.What is her diagnosis?
Your Answer: Complete 11 b-hydroxylase deficiency
Correct Answer: Partial 21-hydroxylase deficiency
Explanation:Deficiency of 21-hydroxylase, resulting from mutations or deletions of CYP21A, is the most common form of Congenital Adrenal Hyperplasia, accounting for more than 90% of cases.Females with mild 21-hydroxylase deficiency are identified later in childhood because of precocious pubic hair, clitoromegaly, or both, often accompanied by accelerated growth and skeletal maturation (simple virilizing adrenal hyperplasia)Diagnosis of 21-hydroxylase deficiency: High serum concentration of 17-hydroxyprogesterone (usually >1000 ng/dL) and urinary pregnanetriol (metabolite of 17-hydroxyprogesterone) in the presence of clinical features suggestive of the disease; 24-hour urinary 17-ketosteroid levels are elevated
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This question is part of the following fields:
- Endocrinology
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Question 25
Incorrect
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A 16-month-old girl with eczema is on the following treatment regimen: Oilatum in baths; Baby' shampoo and soap and E45 cream to affected areas four times daily. Additionally, the mother uses 'non-biological' washing powder.The child often scratches the affected areas, sometimes even in her sleep. On examination, her skin is erythematous, excoriated, and lichenified over the knees, thighs, and flexor surfaces of the elbows.Which of the following would be the most appropriate next step in the management of this child?
Your Answer: Use 1% hydrocortisone to affected areas and continue with other measures
Correct Answer: Use E45 cream instead of soap; advise using a greasier emollient and try an antihistamine at night
Explanation:The most appropriate next step in the management of this patient would be to use E45 cream instead of soap. Using a greasier emollient and an antihistamine at night can also be trialled..Management of eczema:Treatment of eczema can be problematic, and thus, parents should be advised regarding simple, everyday measures that can relieve the symptoms. These include:- Using non-biological washing powder- Wearing cotton clothes as opposed to artificial fibres- Avoiding the use of soaps or shampoos and using E45 Cream as an alternative.- Additional use of bath oil (e.g. Oilatum) is found to be beneficial.- Regular emollient use is recommended and essential. The aim is to keep the skin from feeling dry at any time of day. Sedating with older types of antihistamines at night does not help to reduce itching, but when used in large doses, they occasionally provide a sedative effect which may improve sleep. If all these measures are in use, but the eczema is still not controlled, the escalation of treatment would be appropriate. Note: There is no evidence for the benefit of topical antibiotics.
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This question is part of the following fields:
- Dermatology
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Question 26
Correct
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A 16-year-old girl presents with moderate acne and pustules affecting the face, back and chest.What is the most appropriate treatment?
Your Answer: An oral tetracycline for three months
Explanation:When topical agents are insufficient or not tolerated, or in cases of moderate to severe acne, especially when the chest, back and shoulders are involved, systemic antibiotics are often considered the next line of treatmentSystemic antibiotics should not be used to treat mild acne because of the risk of increasing resistance. The additional use of nonantibiotic topical agents in combination with oral antibiotics should be considered. Topical retinoids with oral antibiotics may give a faster response and be more effective than either drug used alone.Treatment with tetracyclines and erythromycin reduces P. acnes within the follicles, thereby inhibiting the production of bacterial-induced inflammatory cytokines. These agents also have inherent anti-inflammatory effects, such as suppressing leukocyte chemotaxis and bacterial lipase activity.
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This question is part of the following fields:
- Dermatology
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Question 27
Correct
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A 16-year-old autistic boy who has had learning difficulties is found to have large testes. Which condition does the child most likely have?
Your Answer: Fragile X syndrome
Explanation:Fragile X syndrome is a genetic condition that causes a range of developmental problems including learning disabilities and cognitive impairment. Usually, males are more severely affected by this disorder than females.Affected individuals usually have delayed development of speech and language by age 2. Most males with fragile X syndrome have mild to moderate intellectual disability, while about one-third of affected females are intellectually disabled. Children with fragile X syndrome may also have anxiety and hyperactive behaviour such as fidgeting or impulsive actions. They may have attention deficit disorder (ADD), which includes an impaired ability to maintain attention and difficulty focusing on specific tasks. About one-third of individuals with fragile X syndrome have features of autism spectrum disorder that affect communication and social interaction. Seizures occur in about 15 percent of males and about 5 percent of females with fragile X syndrome.Most males and about half of females with fragile X syndrome have characteristic physical features that become more apparent with age. These features include a long and narrow face, large ears, a prominent jaw and forehead, unusually flexible fingers, flat feet, and in males, enlarged testicles (macroorchidism) after puberty.
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This question is part of the following fields:
- Endocrinology
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Question 28
Incorrect
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A 16 year-old boy was stabbed in the right supraclavicular fossa. The sharp object punctured the portion of the parietal pleura that extends above the first rib. What is the name of this portion of the parietal pleura?
Your Answer: Costocervical recess
Correct Answer: Cupola
Explanation:Endothoracic fascia: the connective tissue (fascia) that is between the costal parietal pleura and the inner wall of the chest wall. Costomediastinal recess: the point where the costal pleura becomes mediastinal pleura. Costodiaphragmatic recess: is the lowest point of the pleural sac where the costal pleura becomes diaphragmatic pleura. Cupola: the part of the parietal pleura that extends above the first rib level into the root of the neck. Costocervical recess: this is a made-up term. Peritracheal fascia: a layer of connective tissue that invests the trachea.
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This question is part of the following fields:
- Anatomy
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Question 29
Incorrect
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A 15-year-old girl, known to have atopic eczema since she was six months old, presents because her parents are worried about several skin changes. They are concerned that they could be caused by topical steroid ointments. Which of the following is more likely to be present due to the disease, rather than as a side-effect of the treatment?
Your Answer: Skin atrophy and thinning
Correct Answer: Hypopigmentation
Explanation:Hypopigmentation is a side-effect that is more likely to be due to eczema rather than topical steroids therapy.All the options provided are potential side-effects of topical steroid therapy. They are observed when the potency of the steroid used is too high, or the amount of drug used is too much.. FTU or fingertip unit application is what is recommended, with caution, in delicate areas such as the face. Hypopigmentation can occur in eczema and is a post-inflammatory response, in contrast to the total depigmentation which is seen in vitiligo. Chronic eczema causes lichenification of skin, where the epidermis is thickened, and not skin atrophy.
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This question is part of the following fields:
- Dermatology
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Question 30
Incorrect
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A normal 6-month-old child is NOT expected to do which of the following?
Your Answer: Have no head lag
Correct Answer: Sit unsupported for 10 minutes
Explanation:Milestones of 6 monthsSocial and EmotionalKnows familiar faces and begins to know if someone is a stranger Likes to play with others, especially parents Responds to other people’s emotions and often seems happy Likes to look at self in a mirror Language/CommunicationResponds to sounds by making sounds Strings vowels together when babbling (ah,Å¥ eh,Å¥ ohÅ¥) and likes taking turns with the parent while making sounds Responds to own name Makes sounds to show joy and displeasure Begins to say consonant sounds (jabbering with m,Å¥ bÅ¥) Cognitive (learning, thinking, problem-solving)Looks around at things nearby Brings things to mouth Shows curiosity about things and tries to get things that are out of reach Begins to pass things from one hand to the other Movement/Physical DevelopmentRolls over in both directions (front to back, back to front) Begins to sit without support When standing, supports weight on legs and might bounce Rocks back and forth, sometimes crawling backwards before moving forward
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This question is part of the following fields:
- Child Development
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Question 31
Correct
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A 6 year old child diagnosed with minimal change nephrotic syndrome, presents with lower limb oedema. Which of the following is most likely lost upon urination?
Your Answer: Anti-thrombin III
Explanation:Minimal change nephrotic syndrome leads to the loss of anti-thrombin III which protects the body from forming venous emboli. It may be triggered by virus, immunisations, medication, non-Hodgkin lymphoma, or leukaemiaCharacterised by oedema, proteinuria, hypoalbuminemia, and hypercholesterolemia.
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This question is part of the following fields:
- Nephro-urology
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Question 32
Incorrect
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A 16-year-old boy presents with poor development of secondary sex characteristics, colour blindness and a decreased sense of smell. On examination, his testes are located in the scrotum and are small and soft. What is the most likely diagnosis for this boy?
Your Answer: Klinefelter's syndrome
Correct Answer: Kallmann's syndrome
Explanation:Based on the clinical scenario, the most probable diagnosis in this patient is Kallmann’s syndrome.Kallmann’s syndrome is due to isolated gonadotrophin-releasing hormone (GnRH) deficiency. It is often inherited in an X-linked recessive manner. Other options:- While Klinefelter’s syndrome is also associated with hypogonadism, the other clinical features of Klinefelter’s are not seen. – Cryptorchidism is ruled out by the presence of testes in the scrotum. – The presentation of the child is not suggestive of mumps orchitis or hyperprolactinaemia.
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This question is part of the following fields:
- Endocrinology
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Question 33
Incorrect
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A 10-year-old boy is struck on the left eye by a tennis ball. Following the event, he immediately complains of eye discomfort and dimming of vision in the affected eye. Three hours later, in the emergency department, the assessment of his visual acuity revealed that he can see 6/24 on a Snellen chart.Which of the following is the most probable diagnosis of this boy?
Your Answer: Vitreous haemorrhage
Correct Answer: Hyphaema
Explanation:The most probable diagnosis in this patient would be hyphaema.The acuity has varied because the blood has been settling in the anterior chamber of the eye, thus allowing a reasonable level of visual acuity. The size of the tennis ball (which is not as harmful as a squash ball in the eye) and the fact that it was struck from a distance would cause a moderately significant injury due to pressure to the globe. Other options:- The absence of severe pain makes a large corneal abrasion less likely. – Vitreous haemorrhage would lead to very poor acuity, more likely ‘hand movements only’. – A retinal detachment or traumatic cataract would not produce such immediate symptoms, and if they did occur it would probably be in the presence of more extensive eye trauma and pain, with additional signs of both hyphaema and vitreous haemorrhage.
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This question is part of the following fields:
- Ophthalmology
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Question 34
Correct
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A 6 month old baby presents with uncontrollable movements of her hands and feet, shortly after being unconscious for a while. What is the most likely diagnosis?
Your Answer: Infantile spasm
Explanation:Infantile spasm belongs to the spectrum of seizure disorders. Infantile spasm manifests itself with loss of consciousness and jerky movements. The peak age of onset is between 4 and 6 months. Approximately 90% of infantile spasms begin before 12 months of age. It is rare for infantile spasms to begin during the first 2 weeks of life or after 18 months.
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This question is part of the following fields:
- Neurology
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Question 35
Correct
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An 18-year-old female presents to the dermatologist with a pigmented lesion on her back. A melanoma is suspected. What would be the most appropriate initial course of action?
Your Answer: Excisional biopsy of the lesion
Explanation:Melanoma, a highly malignant tumour arising from melanocytes, is the most common life-threatening dermatological disease. Risk factors include UV radiation exposure, particularly in light-skinned individuals that are easily sunburned, increasing age, family history, and immunosuppression. Lesions that are suspicious for melanoma should be excised with complete margins. Radical excision is not routinely undertaken for diagnostic purposes and therefore if subsequent histopathological assessment determines that the lesion is a melanoma a re-excision of margins may be required.Margins of excision-Related to Breslow thicknessLesions 0-1mm thick – 1cmLesions 1-2mm thick – 1- 2cm (Depending upon site and pathological features)Lesions 2-4mm thick – 2-3 cm (Depending upon site and pathological features)Lesions >4 mm thick – 3cm
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This question is part of the following fields:
- Dermatology
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Question 36
Correct
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A 17-year-old girl presents to the OBGYN after having unprotected. She is found to be 5 days pregnant. The fertilized tissue is at which stage of development?
Your Answer: Blastocyst
Explanation:Time- 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 37
Correct
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A female 4-week-old baby was admitted with jaundice. Her appetite for breast milk is preserved and she is playing actively and well without any other disturbances. What is the most probable cause of jaundice?
Your Answer: Breast milk Jaundice
Explanation:Breast milk jaundice is thought to be associated with one or more abnormalities in the maternal milk itself. Breast milk jaundice syndrome generally needs no therapy if serum bilirubin concentrations remain below 270 mmol/l in healthy full-term infants. When the serum bilirubin concentration is above 270 mmol/l and rising, temporary interruption of breastfeeding may be indicated.
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This question is part of the following fields:
- Gastroenterology And Hepatology
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Question 38
Incorrect
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A 7-year-old boy is brought by his parents with an enlarging penis, testes volumes of 4 ml bilaterally, and some sparse hair in his pubic region. His height remains on his usual (2nd) centile. His doctor thinks this is most likely to be due to a pathological cause and investigates further. He finds a delayed bone age.What is the most probable diagnosis for this boy?
Your Answer: Cerebral tumour
Correct Answer: Primary hypothyroidism
Explanation:The most probable diagnosis for this boy is primary hypothyroidism.Rationale:The development of secondary sexual characteristics in a boy aged less than 9 years of age is highly suggestive of precocious puberty.Around 80% of boys with precocious puberty have pathological causes and require detailed investigation. In this case, the child has long-standing short stature but coupled with the early puberty and delay in bone age, the diagnosis is primary hypothyroidism, which is the only cause of this clinical picture.
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This question is part of the following fields:
- Endocrinology
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Question 39
Correct
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A 2-year-old child is brought to the clinic by his parents who say that he has had frequent breath holding spells which occur almost 4 times per week. Which of the following nutritional deficiency most often results in the breath holding spells like the ones experienced by this child?
Your Answer: Iron
Explanation:Breath-holding spells are usually caused by either a change in the child’s breathing or a slowing of the heart rate. In some children, breath-holding spells may be related to iron deficiency anaemia, a condition in which the body doesn’t produce a normal number of red blood cells. Conclusion: Not only Iron deficiency anaemia but also iron deficiency alone without anaemia is associated with a risk of high-frequency cyanotic breath holding spells. Iron therapy results in reduction in spells’ frequency which was correlated with increasing ferritin and iron levels.
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This question is part of the following fields:
- Nutrition
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Question 40
Incorrect
-
A 14-month-old girl was brought to the hospital by her mother, with complaints of a 0.5 cm cystic lump on the lateral aspect of her eyebrow. It has been present since birth but is slowly increasing in size. What is the most probable diagnosis?
Your Answer: Branchial remnant
Correct Answer: External angular dermoid
Explanation:The most probable diagnosis for this patient would be external angular dermoid.External angular dermoids typically form where there are overlapping tissue planes such as the midline. They contain a caseous material. The cysts are essentially benign in nature and are excised for cosmetic purposes or when they encroach on vision.Other options:- Branchial remnant typically presents as a supraclavicular pit.- Sebaceous cysts tend to be present on the scalp.- There is nothing in the clinical scenario to suggest a vascular malformation such as pigment change or ‘bag of worms’.- Lymphatic malformations are typically found in the neck or under the axilla.
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This question is part of the following fields:
- Paediatric Surgery
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Question 41
Correct
-
A 16-year-old male arrives at the clinic complaining of fever and pigmented spots around his mouth, palms and soles. He had a reduction of an intussusception at 12 years of age. Which of the following lesions are most likely to be observed on a colonoscopy examination?
Your Answer: Hamartomas
Explanation:Peutz-Jeghers syndrome (PJS) is an autosomal dominant inherited disorder characterized by intestinal hamartomatous polyps in association with a distinct pattern of skin and mucosal macular melanin deposition (freckles on the lips, face, palms and soles). Patients with Peutz-Jeghers syndrome have an estimated 15-fold increased risk of developing intestinal cancer compared to the general population.Management: conservative unless complications develop.
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This question is part of the following fields:
- Gastroenterology And Hepatology
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Question 42
Correct
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A screening test correctly identifies 90 of 100 individuals with disease and falsely identifies a further 15 of 300 individuals without disease. Which one of the following statements is true?
Your Answer: The sensitivity of the test is 90%
Explanation:The sensitivity of a screening test can be described in a variety of ways, typically such as sensitivity being the ability of a screening test to detect a true positive, being based on the true positive rate, reflecting a test’s ability to correctly identify all people who have a condition, or, if 100%, identifying all people with a condition of interest by those people testing positive on the test.The specificity of a test is defined in a variety of ways, typically such as specificity is the ability of a screening test to detect a true negative, being based on the true negative rate, correctly identifying people who do not have a condition, or, if 100%, identifying all patients who do not have the condition of interest by those people testing negative on the test.Sensitivity=[a/(a+c)]x100Specificity=[d/(b+d)]x100a: True positiveb: False Positivec: False negatived: True negative
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This question is part of the following fields:
- Epidemiology And Statistics
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Question 43
Correct
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An 8-week-old baby was found to have bilateral cataracts. Further investigation revealed thrombocytopenia, a patent ductus arteriosus and hepatosplenomegaly. Which of the following is the most probable diagnosis?
Your Answer: Rubella
Explanation:The clinical presentation is suggestive of congenital rubella syndrome. The classic triad of presenting symptoms includes sensorineural hearing loss, ocular abnormalities (cataract, infantile glaucoma, and pigmentary retinopathy) and congenital heart disease (patent ductus arteriosus and pulmonary artery stenosis). Other findings in congenital rubella syndrome include CNS abnormalities (mental retardation, behavioural disorders, encephalographic abnormalities, hypotonia, meningoencephalitis, and microcephaly), hepatosplenomegaly, and jaundice.
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This question is part of the following fields:
- Infectious Diseases
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Question 44
Incorrect
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A baby boy born 5 weeks ago with a birth weight of 3.5kg presents to the clinic with jaundice. He is being breastfed and his current weight is 4.5kg. Which of the following is most likely responsible for the baby's jaundice?
Your Answer:
Correct Answer: Breast Milk Jaundice
Explanation:Breast milk jaundice is associated with breast-feeding. It typically occurs one week after birth and can sometimes last up to 12 weeks, but it rarely causes complications in healthy, breast-fed infants. The exact cause of breast milk jaundice isn’t known. However, it may be linked to a substance in the breast milk that prevents certain proteins in the infant’s liver from breaking down bilirubin. The condition may also run in families. Breast milk jaundice is rare, affecting less than 3 percent of infants. When it does occur, it usually doesn’t cause any problems and eventually goes away on its own. It is safe to continue breast-feeding.
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This question is part of the following fields:
- Gastroenterology And Hepatology
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Question 45
Incorrect
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A 15-year-old girl has a 5-day history of fever, general malaise and headache and has developed diffuse raised oedematous papules. These lesions are typical of erythema multiforme. Which one of the following is true?
Your Answer:
Correct Answer: The lesions will heal without scarring
Explanation:Erythema multiforme lesions typically heal without scarring. Other options:- In erythema multiforme, lesions are typically symmetrical and acral, i.e. on the hands, feet and limbs. – HSV is a common cause of erythema multiforme in children, accounting for at least 50% of cases; the lesions typically have damaged skin in the centre and are dusky and bullous (in contrast to urticaria, where the centre of the lesion is normal).
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This question is part of the following fields:
- Dermatology
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Question 46
Incorrect
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Which of the following is true of randomisation in a clinical trial?
Your Answer:
Correct Answer: Aims to remove confounding
Explanation:The main aim of randomisation in a clinical trial is to remove the bias and avoid any potential confounding variables. While in double blind studies both the investigators and the patients are not aware of which group they belong in, being blind is not essential in carrying out a randomized study, nor is it essential that the randomisation be done away from the study centre. A placebo also does not facilitate randomisation, which can be done in single centre and multi-centre trials.
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This question is part of the following fields:
- Epidemiology And Statistics
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Question 47
Incorrect
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An 8-year-old girl presented to the outpatient clinic with fever, pain and discharge from her left ear. Which of the following antibiotics should be used first?
Your Answer:
Correct Answer: Amoxicillin
Explanation:Amoxicillin has high efficacy against haemophilus influenza and streptococcus pneumonia, the most common organisms of otitis media. It is an oral drug with high bioavailability.
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This question is part of the following fields:
- ENT
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Question 48
Incorrect
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What proportion of salivary secretions is contributed by the submandibular glands?
Your Answer:
Correct Answer: 70%
Explanation:The submandibular glands provide the bulk of salivary secretions contributing close to 70%. The sublingual glands provide 5% and the remainder from the parotid.
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This question is part of the following fields:
- ENT
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Question 49
Incorrect
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Parents of a new-born are worried about cot death. What advice will you give?
Your Answer:
Correct Answer: Child should sleep on the back with legs towards the end of the cot
Explanation:Cot death also know as SIDS or Sudden Infant Death syndrome. Putting a baby to sleep on his back has been shown to reduce the risk of SIDS.
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This question is part of the following fields:
- Neonatology
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Question 50
Incorrect
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Which one of the following fulfils the diagnostic criteria for neurofibromatosis type 1?
Your Answer:
Correct Answer: There is groin freckling and a plexiform neurofibroma
Explanation:Neurofibromatosis is a genetic disease caused by the mutation of the neurofibromin gene on Chromosome 17. The diagnostic criteria for Neurofibromatosis type 1 are two or more of the following:-6 or more cafe au lait macules-2 or more cutaneous neurofibroma or one plexiform Neurofibroma-Axillary of groin freckling -Optic pathway glioma -2 or more Lisch nodules (hamartomas of the iris seen on slit lamp examination)-Bony dysplasia (such as sphenoid wing dysplasia, bowing of the long bones, or pseudarthrosis)-First degree relative with neurofibromatosis type 1
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This question is part of the following fields:
- Genetics And Dysmorphology
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Question 51
Incorrect
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A 12-year-old child has developed a fever and maculopapular rash on his back. What diagnosis should he be given?
Your Answer:
Correct Answer: Chicken pox
Explanation:Chickenpox is caused by the varicella-zoster virus. The clinical signs of infection are fever and a maculopapular rash – this is a unique rash with both flat and raised lesions on the skin.
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This question is part of the following fields:
- Infectious Diseases
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Question 52
Incorrect
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Which of the following does not cause a scaly scalp?
Your Answer:
Correct Answer: Pityriasis amiantacea
Explanation:Pityriasis amiantacea is a reaction pattern rather than a specific diagnosis. Common conditions that may present with pityriasis amiantacea include:Scalp psoriasisSeborrhoeic dermatitisAtopic dermatitisTinea capitis.Head lice and lichen simplex should also be considered.When no underlying cause is found, the condition is often called idiopathic pityriasis amiantacea.
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This question is part of the following fields:
- Dermatology
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Question 53
Incorrect
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A 13-year-old girl has complained of pain in her left arm for 4 months. An X-ray reveals a mass along with erosion of the affected humerus. Histologically, the tumour is found to be formed by small, round, blue cells. What is the most likely diagnosis?
Your Answer:
Correct Answer: Ewing's sarcoma
Explanation:Ewing’s sarcoma is formed by small, round, blue cells, and is common in children. The usually develop in limbs, and clinical findings include pain and inflammation, with lytic destruction showing up on X-rays.
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This question is part of the following fields:
- Musculoskeletal
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Question 54
Incorrect
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A 17 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 55
Incorrect
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Which of the following conditions is NOT a recognized cause of respiratory distress syndrome (SDLD)?
Your Answer:
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 56
Incorrect
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An 18-month-old girl already speaks ten words but her father says she cannot form a sentence. What is the best management strategy?
Your Answer:
Correct Answer: Reassurance
Explanation:Not being able to form a sentence at the age of 18 months is quite normal. A combination of two words to form a sentence can be done by 2 years of age.
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This question is part of the following fields:
- Child Development
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Question 57
Incorrect
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A 16 year old girl with a history of diabetes presents with a vaginal discharge that is white and thick. She also complains of vaginal itchiness. Doctors suspect candidiasis and start her on clotrimazole. How does this drug work?
Your Answer:
Correct Answer: Decreases ergosterol biosynthesis, increasing membrane permeability and disrupting membrane-bound enzyme systems
Explanation:Clotrimazole interferes with the ergosterol biosynthesis by decreasing ergosteron I biosynthesis, increasing membrane permeability, and disrupting membrane-bound enzyme systems.Vaginal candidiasis is an extremely common condition. Predisposing factors include:- diabetes mellitus- drugs: antibiotics, steroids- pregnancy- immunosuppression – iatrogenic
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This question is part of the following fields:
- Adolescent Health
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Question 58
Incorrect
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Which of the following is true about haemophilia C?
Your Answer:
Correct Answer: Prothrombin time (PT) is normal
Explanation:In haemophilia C, The severity of the deficiency is based on plasma factor XIC (clotting) activity. Major factor XI deficiency is present when the activity of factor XI in plasma is less than 1-15 IU/dL.In major deficiency factor XI, bleeding is related to injury, especially when trauma involves tissues rich in fibrinolytic activators, such as the oral mucosa, the nose, and the urinary tract. Unlike patients with severe haemophilia A or B, patients with major factor XI deficiency do not spontaneously bleed.The aPTT is usually prolonged in factor XI deficiency (but depends on the sensitivity of the reagent and test system–partial deficiency can be missed), whereas the PT and TT are normal.
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This question is part of the following fields:
- Haematology And Oncology
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Question 59
Incorrect
-
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:
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 60
Incorrect
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Which of the following would a 9-year old girl with newly diagnosed type 1 diabetes not require annually?
Your Answer:
Correct Answer: Retinopathy screening
Explanation:Retinopathy screening need not be done on an annual basis for a 9-year-old child. Screening for diabetic retinopathy should begin at the age of 12.Diabetes mellitus is an increasing problem in both developing and developed countries alike. Some of the risk factors include:ObesityFamily historyFemale sex Asian and African racesPresence of acanthosis nigricans is seen with type 2 but not type 1 diabetesThe diagnosis is mostly incidental or subacute.The treatment aims are good blood sugar control, maintenance of normal BMI, and reduction of complications. The treatment modality also includes lifestyle modifications and cessation of smoking. Even after all this, diabetic ketoacidosis can still occur.Management of diabetes mellitus – NICE guidelines (Updated, 2015): – Standard release metformin should be offered from the moment of diagnosis.- HBA1c should be measured every three months. The target HBA1c level of 48 mmol/mol (6.5%) or lower is ideal for minimising the risk of long term complications.- Children should undergo an eye examination by an optician every two years.- Annual immunisation against influenza and pneumococcal infections are essential.- There is an increased risk of psychological and psychosocial difficulties if the child with type 1 diabetes is on insulin or oral hypoglycaemic medications. These include anxiety disorder, depression, behavioural and conduct disorders and family conflict.- Annual monitoring to be done for:Hypertension starting at diagnosis.Dyslipidaemia starting at diagnosis.Screening for microalbuminuria starting at diagnosis.Diabetic retinopathy from 12 years of age.
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This question is part of the following fields:
- Endocrinology
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Question 61
Incorrect
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A 11-year-old boy is admitted to the hospital with diarrhoea and lethargy. There is a known local outbreak of E coli 0157:H7, and his initial bloods show evidence of acute renal failure. Given the likely diagnosis, which one of the following investigation results would be expected?
Your Answer:
Correct Answer: Fragmented red blood cells
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. The laboratory results will usually include fragmented RBCs, decreased serum haptoglobin, reduced platelet count, nonspecific WBC changes, and normal coagulation tests (PTT included).
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This question is part of the following fields:
- Renal
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Question 62
Incorrect
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A 13-year-old girl is brought by her mother to the A&E with breathlessness, fatigue and palpitations. Anamnesis does not reveal any syncope or chest pain in the past. on the other hand, these symptoms were present intermittently for a year. Clinical examination reveals a pan-systolic murmur associated with giant V waves in the jugular venous pulse. Chest auscultation and resting ECG are normal. 24 hour ECG tape shows a short burst of supraventricular tachycardia. What is the most probable diagnosis?
Your Answer:
Correct Answer: Ebstein's anomaly
Explanation:Ebstein’s anomaly is characterised by apical displacement and adherence of the septal and posterior leaflets of the tricuspid valve to the underlying myocardium, thereby displacing the functional tricuspid orifice apically and dividing the right ventricle into two portions. The main haemodynamic abnormality leading to symptoms is tricuspid valve incompetence. The clinical spectrum is broad; patients may be asymptomatic or experience right-sided heart failure, cyanosis, arrhythmias and sudden cardiac death (SCD). Many Ebstein’s anomaly patients have an interatrial communication (secundum atrial septal defect (ASD II) or patent foramen ovale). Other structural anomalies may also be present, including a bicuspid aortic valve (BAV), ventricular septal defect (VSD), and pulmonary stenosis. The morphology of the tricuspid valve in Ebstein anomaly, and consequently the clinical presentation, is highly variable. The tricuspid valve leaflets demonstrate variable degrees of failed delamination (separation of the valve tissue from the myocardium) with fibrous attachments to the right ventricular endocardium.The displacement of annular attachments of septal and posterior (inferior) leaflets into the right ventricle toward the apex and right ventricular outflow tract is the hallmark finding of Ebstein anomaly.
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This question is part of the following fields:
- Cardiovascular
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Question 63
Incorrect
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A 3-year-old girl with febrile convulsions was given IV Lorazepam. What is the single most serious side effect associated with IV Lorazepam?
Your Answer:
Correct Answer: Amnesia
Explanation:The most serious side effects of IV Lorazepam include hallucinations, agitation, confusion, amnesia and muscle weakness.
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This question is part of the following fields:
- Pharmacology
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Question 64
Incorrect
-
A 17-year-old boy presents to the clinic complaining of increased weight but low energy. History reveals that he has also experienced low libido and has difficulty maintaining erections. Serum testosterone levels are checked. In the human body, the secretion of testosterone is stimulated by which of the following?
Your Answer:
Correct Answer: Luteinising Hormone
Explanation:The hypothalamus and pituitary gland control how much testosterone the testes produce and secrete. The hypothalamus sends a signal to the pituitary gland to release gonadotrophic substances (follicle stimulating hormone and luteinizing hormone). Luteinizing hormone (LH) stimulates testosterone production.
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This question is part of the following fields:
- Endocrinology
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Question 65
Incorrect
-
A 2 year old male was brought to the A&E following an car accident. On examination bowel sounds were heard in the chest. A nasogastric tube was inserted and a chest x-ray showed a curved NG tube. Which of the following is the most probable reason for it?
Your Answer:
Correct Answer: Diaphragm rupture
Explanation:Bowel sounds in the chest and curved NG tube are suggestive of a diaphragm rupture, which has caused herniation of bowel into the thoracic cavity through the defect in the diaphragm.
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This question is part of the following fields:
- Emergency Medicine
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Question 66
Incorrect
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An 8 year old male child presents with frequent and recurrent headaches and a history of dark-coloured urine. He has a blood pressure of 150/100 mmHg and normal serum urea and creatinine levels. Urine microscopy reveals erythrocytes and erythrocyte casts. His 24-hour urine protein is about 2 g. What is the most probable diagnosis?
Your Answer:
Correct Answer: Acute nephritic syndrome
Explanation:The child most likely has nephritic syndrome which is characterised by a reduced renal function, proteinuria of non-nephrotic range, haematuria, erythrocyte casts, and oedema. Polyarteritis nodosa usually occurs in middle-aged men but can also be seen in young children. It is accompanied by severe systemic manifestations such as fever, malaise, weight loss and myalgia.Renal cell carcinoma usually presents around 55 years with the classic triad of haematuria, loin pain and a unilateral mass in the flank.Polycystic kidney disease usually presents in adult life with acute loin pain and palpation of masses in the flanks.
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This question is part of the following fields:
- Nephro-urology
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Question 67
Incorrect
-
Which of the following epilepsy syndromes is NOT benign?
Your Answer:
Correct Answer: Infantile spasms
Explanation:Epilepsy is a common paediatric neurologic disorder characterized by seizures of varying frequency and intensity. There are many childhood or infantile epilepsy syndromes that can be categorized as benign epilepsy syndromes as the child suffering from these usually outgrows them after reaching a certain age, and they do not lead to significant cognitive or physical impairment. Some of these may not need any treatment. Such benign epilepsy syndromes include benign rolandic epilepsy, Panayiotopoulos syndrome, Gastaut type-idiopathic childhood occipital epilepsy, and idiopathic photosensitive occipital lobe epilepsy. West syndrome, also called infantile spasms, is a serious infantile epileptic encephalopathy, characterized by multiple clusters of myoclonic spasms, and regression of the previous normally attained milestones. It is associated with severe cognitive and physical impairment, often leading to life long disability.
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This question is part of the following fields:
- Neurology And Neurodisability
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Question 68
Incorrect
-
Which is the most common cardiac defect in babies with Down's syndrome?
Your Answer:
Correct Answer: Atrioventricular septal defect (AVSD)
Explanation:Congenital heart defects are common (40-50%); they are frequently observed in patients with Down syndrome who are hospitalized (62%) and are a common cause of death in this aneuploidy in the first 2 years of life.The most common congenital heart defects are the following:- Endocardial cushion defect (43%), which results in atrioventricular septal defect (AVSD)/AV canal defect- Ventricular septal defect (32%)- Secundum atrial septal defect (10%)- Tetralogy of Fallot (6%)- Isolated patent ductus arteriosus (4%).About 30% of patients have more than one cardiac defect. The most common secondary lesions are patent ductus arteriosus (16%), atrial septal defect, and pulmonic stenosis (9%). About 70% of all endocardial cushion defects are associated with Down syndrome.Valve abnormalities, such as mitral valve prolapse or aortic regurgitation may develop in up to 40-50% of adolescents and adults who were born without structural heart disease.
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This question is part of the following fields:
- Neonatology
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Question 69
Incorrect
-
A 5 year old boy fell and hit his head. The parents say that after the fall he cried immediately and then vomited four times. They brought him to the emergency department one hour after the event. His Glasgow Coma Scale (GCS) is 15 and he has a 6 cm haematoma on the right side of his head. Neurological examination is normal and he has full memory of what happened. What would you do next?
Your Answer:
Correct Answer: Observe for 4 hours from the time of injury
Explanation:NICE guidelines suggest that when a child’s single risk factor is 2 vomits, the child should be observed for 4 hours from the time of the injury, instead of having a CT.
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This question is part of the following fields:
- Emergency Medicine
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Question 70
Incorrect
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A 6-year-old male was brought to the OPD with complaints of weight loss and fatigue for the last few months. On examination he was pale and had hepatosplenomegaly. A full blood count was ordered and it revealed immature white blood cells. Which of the following is the most likely diagnosis?
Your Answer:
Correct Answer: Leukaemia
Explanation:The age of the patient and the presence of immature white blood cells are suggestive of leukaemia. Hodgkin’s disease is unlikely in this age group and it usually presents with lymphadenopathy. In HIV, immature white blood cells are not present in the blood.
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This question is part of the following fields:
- Haematology And Oncology
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Question 71
Incorrect
-
A study shows that of children with asthma, 25% have a first-degree relative with asthma compared with only 10% of a sample of children without asthma. Which of the following is true?
Your Answer:
Correct Answer: To interpret the results we need to know how the samples were selected
Explanation:Observational studies fall under the category of analytic study designs and are further sub-classified as observational or experimental study designs. The goal of analytic studies is to identify and evaluate causes or risk factors of diseases or health-related events. The differentiating characteristic between observational and experimental study designs is that in the latter, the presence or absence of undergoing an intervention defines the groups. By contrast, in an observational study, the investigator does not intervene and rather simply observesť and assesses the strength of the relationship between an exposure and disease variable.Three types of observational studies include cohort studies, case-control studies, and cross-sectional studies. Case-control and cohort studies offer specific advantages by measuring disease occurrence and its association with an exposure by offering a temporal dimension (i.e. prospective or retrospective study design). Cross-sectional studies, also known as prevalence studies, examine the data on disease and exposure at one particular time point. Because the temporal relationship between disease occurrence and exposure cannot be established, cross-sectional studies cannot assess the cause and effect relationshipDisadvantage of Cohort study is Susceptible to selection bias.
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This question is part of the following fields:
- Epidemiology And Statistics
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Question 72
Incorrect
-
A child presents to the clinic with the complaints of pale stools and jaundice. Which of the following tests would be most helpful in establishing a diagnosis?
Your Answer:
Correct Answer: US abdomen
Explanation:The patient is most likely suffering from obstructive jaundice. Ultrasound of the abdomen is the superior diagnostic tool in detecting and assessing biliary system obstruction, because it is easy, available, accurate and non-invasive.
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This question is part of the following fields:
- Gastroenterology And Hepatology
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Question 73
Incorrect
-
A 11-year-old is referred to neurology due to episodes her GP feels are epileptiform. Her mother reports that she appears to just 'stop', sometimes even in mid conversation, for several seconds at random times during the day. During these episodes, she can be unresponsive to questioning and has no recollection of them.Which of these drugs is contraindicated in this condition?
Your Answer:
Correct Answer: Carbamazepine
Explanation:The patient’s history points to absence seizures. Carbamazepine has been shown to aggravate generalized seizure types, especially absence seizures, because it acts directly on the ventrobasal complex of the thalamus which is critical to the neurophysiology of absence seizures.
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This question is part of the following fields:
- Neurology
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Question 74
Incorrect
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A 16-year-old girl was brought to the ED by her gym instructor after developing severe shortness of breath and chest pain at the gym. She has a history of asthma since childhood. Her skin colour looked normal; however, breath sounds were found to be diminished on auscultation of the right lung. Which investigation will you order first?
Your Answer:
Correct Answer: Chest x-ray
Explanation:Asthma patients have an increased risk of developing complications like pneumonia or collapsed lung. A clear visualization of the lungs through a CXR will define the management necessary for this patient.
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This question is part of the following fields:
- Respiratory
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Question 75
Incorrect
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A 17-year-old girl is brought to the ER after collapsing at a party. Her friends state that she complained about palpitations prior to collapsing. On further history, it is revealed that she recently visited the dermatologist and was given an antibiotic prescription for an infected toe. She is reported to be allergic to penicillin. Her mother died of a sudden cardiac event when the girl was just 3 years old. An uncle and aunt also passed away suddenly at a young age. ECG shows sinus rhythm and a corrected QT interval of 550 ms. Which of the following most likely lead to the collapse in this young girl?
Your Answer:
Correct Answer: Congenital long QT syndrome
Explanation:Congenital LQTS arises from mutations in genes that code for ion channels within myocytes.These mutations all cause ventricular action potentials to be prolonged, resulting in a lengthened QT interval on ECG. The congenital long-QT syndrome (LQTS) is a life-threatening cardiac arrhythmia syndrome that represents a leading cause of sudden death in the young. LQTS is typically characterized by a prolongation of the QT interval on the ECG and by the occurrence of syncope or cardiac arrest, mainly precipitated by emotional or physical stress.LQTS type 1:- Most common type of congenital LQTS- Defect: loss of function mutation on the KCNQ1 gene located on chromosome 11p – defective slow delayed rectifier voltage-gated potassium channelSubtypes:Jervell and Lange-Nielsen syndrome: Associated with congenital deafness,
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This question is part of the following fields:
- Cardiovascular
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Question 76
Incorrect
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A floppy new-born baby has epicanthic folds, a thin upper lip and smooth philtrum. He was monitored closely throughout pregnancy for intra-uterine growth retardation (IUGR) and a ventricular septal defect. What is the most likely diagnosis?
Your Answer:
Correct Answer: Fetal alcohol syndrome
Explanation:Fetal alcohol syndrome (FAS) is a common yet under-recognized condition resulting from maternal consumption of alcohol during pregnancy. The diagnosis of fetal alcohol syndrome (FAS) is based on findings in the following 3 areas: (1) characteristic facial anomalies (see image below), (2) growth retardation (intrauterine growth restriction and failure to have catch-up growth), and (3) CNS involvement (cognitive impairment, learning disabilities, or behavioural abnormalities).Key characteristic craniofacial abnormalities include the following:- Smooth philtrum- Thin, smooth vermilion border of the upper lipShort palpebral fissures (< 10th percentile for age)Other craniofacial abnormalities are as follows:- Midface hypoplasia- Microphthalmia- Strabismus- PtosisCNS and neurobehavioral abnormalities include the following:- Microcephaly- Intellectual impairment (mild-to-moderate mental retardation)- Cognitive impairment- Developmental delay- Irritability in infancy- Hyperactivity in childhood or attention deficit hyperactivity disorder (ADHD)- Seizures- Delayed or deficient myelination- Agenesis or hypoplasia of the corpus callosumSkeletal abnormalities include the following:- Radioulnar synostosis- Flexion contractures- Camptodactyly- Aberrant palmar creases, especially hockey-stick palmar crease- Clinodactyly- Klippel-Feil anomaly- Hemivertebrae- Scoliosis- Dislocated jointsOther major congenital anomalies include the following:- Cleft palate- Heart defects- Renal anomalies- DiGeorge sequenceFunctional problems include the following:- Refractive problems (e.g., myopia, astigmatism)- Hearing lossGrowth deficiency includes the following:- Infant small for gestational age (< 10th percentile for weight or length)- Postnatal growth deficiency
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This question is part of the following fields:
- Neonatology
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Question 77
Incorrect
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A young child is successfully treated for meningitis. Two months later his parents take him to their GP, worried that he isn't communicating with them like he used to.What is the most likely complication of meningitis that he developed?
Your Answer:
Correct Answer: Sensorineural deafness
Explanation:Possible complications include:- Hearing loss (which may be partial or total)- problems with memory and concentration- problems with coordination and balance- learning difficulties (which may be temporary or permanent)- epilepsy (Seizures)- cerebral palsy- speech problems- vision loss (which may be partial or total)As hearing loss is the most common complication of meningitis people recovering from the condition are usually given a hearing test to assess their hearing.
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This question is part of the following fields:
- Emergency Medicine
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Question 78
Incorrect
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A 3 year old girl presents with a 2 day history of GI symptoms whenever she eats cauliflower. Her mother is concerned that she may be allergic, and has kept a food diary and a record of her symptoms. Which of these is LEAST likely to be associated with food allergies?
Your Answer:
Correct Answer: Polycythaemia
Explanation:Polycythaemia is a condition in which there is an increased red cell mass and increasing blood viscosity, which decreases its ability to flow. It is not associated with food allergies, but is fundamentally caused by either an overproduction of red blood cells, or a reduction in the volume of plasma. Abdominal pain, constipation, loose and frequent stools, and pallor are all non IGE mediated symptoms of food allergy according to NICE guidelines in the UK.
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This question is part of the following fields:
- Gastroenterology And Hepatology
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Question 79
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 80
Incorrect
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A 15-year-old Afro-Caribbean boy presents with a temperature of 37.2C 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:
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 81
Incorrect
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A 16-year-old female presents to the emergency department with recurrent epistaxis and a history of menorrhagia. The physician suspects Von Willebrand disease and requests for blood tests. Lab investigations reveal a prolonged bleeding time and thrombocytopenia. What is the most likely diagnosis?
Your Answer:
Correct Answer: Bernard - Soulier syndrome
Explanation:Bernard- Soulier Syndrome results from a deficiency of platelet glycoprotein protein Ib, which mediates the initial interaction of platelets with the subendothelial components via the von Willebrand protein. It is a rare but severe bleeding disorder. Platelets do not aggregate to ristocetin. The platelet count is low, but, characteristically, the platelets are large, often the size of red blood cells, and may be missed on complete blood counts because most automatic counters do not count them as platelets.
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This question is part of the following fields:
- Haematology And Oncology
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Question 82
Incorrect
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A 17-year-old boy presents with a concern that he had not attained puberty. He lacks secondary sexual characteristics and has altered smell and reduced testicular size. Which of the following hormone profiles with regard to FSH (follicle-stimulating hormone), LH (luteinizing hormone) and testosterone would fit a diagnosis of Kallman syndrome for this patient?
Your Answer:
Correct Answer: Reduced testosterone, reduced FSH and reduced LH
Explanation:While the clinical scenario and the anosmic presentation of the child are highly suggestive of Kallmann’s syndrome, reduced testosterone, FSH and LH levels can confirm the diagnosis.Kallman’s syndrome is a recognised cause of delayed puberty secondary to hypogonadotropic hypogonadism. It is usually inherited as an X-linked recessive trait. Kallman’s syndrome is thought to be caused by a failure of GnRH-secreting neurons to migrate to the hypothalamus.Clinical features of Kallmann’s syndrome include:- Delayed puberty- Hypogonadism, cryptorchidism- Anosmia- Low sex hormone levels – Inappropriately low/normal LH and FSH levels- Some patients can present with associated cleft lip/palate and visual/hearing defects.
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This question is part of the following fields:
- Endocrinology
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Question 83
Incorrect
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A term baby with a birth weight of 3.6 kg with hypoxic ischaemic encephalopathy is intubated and ventilated. Cooling treatment has started. The baby is sedated and paralysed and is being ventilated on the mode continuous mandatory ventilation (CMV). Settings are: targeted tidal volume 14 ml, maximum PIP 25, PEEP 5, rate 60/min, FiO2 0.21. Baby's oxygen saturations are 100%. Blood gas shows pH 7.47, CO2 2.8 kPa, BE -6.What is the first change that should be made to the ventilation?
Your Answer:
Correct Answer: Decrease rate
Explanation:Ventilatory rates of 40-60 breaths/min should be provided initially, with proportionally fewer assisted breaths provided if the infant’s spontaneous respiratory efforts increase. Although this practice has not been extensively studied, initial inflation of the new-born’s lungs with either slow-rise or square-wave inflation to a pressure of 30-40 cm H2 O for approximately 5 seconds has been reported to result in more rapid formation of Functional Residual Capacity (FRC).At the moment of delivery and first breath, the neonatal lung is converting from a fetal non-aerated status to a neonatal status. The neonatal lung requires gas exchange, and this necessitates the development of FRC with the resorption of lung fluid and the resolution of most of the atelectasis. Therefore, initial slow ventilation with more prolonged inspiratory times may be useful to assist in this task, balanced against the need to avoid inappropriate inspiratory pressures.Flow-controlled, pressure-limited mechanical devices are acceptable for delivering PPV. These mechanical devices control flow and limit pressure and be more consistent than bags. Self-inflating and flow-inflating bags remain a standard of care. Laryngeal mask airways are effective for assisted ventilation when bag-mask ventilation and intubation are unsuccessful.
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This question is part of the following fields:
- Neonatology
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Question 84
Incorrect
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A 3-year-old girl presents to A&E following a few days of being lethargic, having runny nose, sore throat, and fever. She has unceasing stridor and drooling of saliva while her body is inclined forward. What is the most important next step in her management?
Your Answer:
Correct Answer: Call ENT specialist
Explanation:A consultation with an ENT is required to establish the reason for the child’s drooling and stridor indicating and obstructive process. Enlarged tonsils and adenoids should be checked.
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This question is part of the following fields:
- ENT
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Question 85
Incorrect
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A 17-year-old autistic boy arrives at the clinic with lethargy, curly corkscrew like hair and petechiae. Which of the following is the most likely diagnosis?
Your Answer:
Correct Answer: Vitamin C deficiency
Explanation:Presentation can vary by individual. Early stages are often characterized by malaise, fatigue, and lethargy. One to 3 months of inadequate intake can lead to anaemia, myalgia, bone pain, easy bruising (Figure 3), swelling, petechiae, perifollicular haemorrhages, corkscrew hairs, gum disease, poor wound healing, mood changes, and depression. Perifollicular haemorrhages and easy bruising are often first seen in the lower extremities, as capillary fragility leads to an inability to withstand hydrostatic pressure. Late stages of scurvy are more severe and life threatening; common manifestations include generalized oedema, severe jaundice, haemolysis, acute spontaneous bleeding, neuropathy, fever, convulsions, and death.
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This question is part of the following fields:
- Nutrition
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Question 86
Incorrect
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A dental surgeon infiltrates local anaesthetic at the mandibular foramen to carry out a block of the right inferior alveolar nerve. Which of the following might occur as a result of the procedure?
Your Answer:
Correct Answer: Numbness of the lower teeth on the right side
Explanation:The inferior alveolar nerve supplies all the teeth of the respective hemimandible. It transverses the inferior alveolar canal and is a branch of the trigeminal nerve’s mandibular division. Therefore, in this case, the teeth of the right hemimandible will be numb.
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This question is part of the following fields:
- Anatomy
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Question 87
Incorrect
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A 15-year-old boy observed a bluish painless swelling in his left scrotum. It is soft and can be compressed. What would you do next?
Your Answer:
Correct Answer: Reassurance
Explanation:The boy seems to have a varicocele so the most appropriate next step would be reassurance. A varicocele is an enlargement of the veins within the scrotum called the pampiniform plexus. A varicocele only occurs in the scrotum and is very similar to varicose veins that can occur in the leg. Because a varicocele usually causes no symptoms, it often requires no treatment.
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This question is part of the following fields:
- Genitourinary
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Question 88
Incorrect
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A neonate has been observed, by his parents, twitching and jerking in his sleep. Which one of the following is not a cause of neonatal seizures?
Your Answer:
Correct Answer: Neonatal myoclonus
Explanation:Benign neonatal sleep myoclonus (BNSM) is a disorder commonly mistaken for seizures during the new-born period. It is characterized by myoclonic lightninglike jerks of the extremities that exclusively occur during sleep; it is not correlated with epilepsy.Causes of neonatal seizures:Hypoxic-ischemic encephalopathy: Hypoxic-ischemic encephalopathy disrupts the ATP-dependent sodium-potassium pump and appears to cause excessive depolarization.Intracranial haemorrhage: occurs more frequently in premature than in term infants. Subarachnoid haemorrhage is more common in term infants. This type of haemorrhage occurs frequently and is not clinically significant. Typically, infants with subarachnoid haemorrhage appear remarkably well. Metabolic disturbances include hypoglycaemia, hypocalcaemia, and hypomagnesemia. Less frequent metabolic disorders, such as inborn errors of metabolism, are seen more commonly in infants who are older than 72 hours. Typically, they may be seen after the infant starts feeding.Intracranial infections (which should be ruled out vigorously) that are important causes of neonatal seizures include meningitis, encephalitis (including herpes encephalitis), toxoplasmosis, and cytomegalovirus (CMV) infections. The common bacterial pathogens include Escherichia coli and Streptococcus pneumoniae.Cerebral malformationsBenign neonatal seizures
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This question is part of the following fields:
- Neonatology
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Question 89
Incorrect
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Erythema infectiosum is NOT associated with which of the following clinical features?
Your Answer:
Correct Answer: Herpes virus serology
Explanation:Erythema infectiosum is an acute viral illness caused by Parvovirus B19. It is usually a mild flu-like illness and produces a maculopapular rash, appearing initially on the cheeks and then spreading towards extremities. The rash usually spares the palms and soles and gives a slapped appearance to the cheeks. It can be described as having a fishnet appearance on the body.
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This question is part of the following fields:
- Dermatology
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Question 90
Incorrect
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A 2 year old child was brought to casualty with recurrent episodes of eczematoid rash over the cheeks and flexural regions of his body. Which one of the following statement best suit this condition?
Your Answer:
Correct Answer: Hydrocortisone 1% ointment should be applied sparingly to areas of active eczema
Explanation:Atopic dermatitis is an allergic condition which is more apparent in those children who have a positive family history in their 1st or 2nd degree relatives. In some cases, there might be a positive history of bronchial asthma. The best treatment option in this case would be topical application of 1% hydrocortisone ointment to the affected areas of the child. We cannot prescribe a strong ointment to the face because it may lead to skin atrophy, telangiectasia and other steroid related topical complications.
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This question is part of the following fields:
- Dermatology
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Question 91
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 92
Incorrect
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What is the risk of an affected mother's son inheriting the disease condition in an X-liked dominant condition?
Your Answer:
Correct Answer: 50%
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 93
Incorrect
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A 16-year-old girl is brought to the emergency by her parents who describe what seems to be an episode of generalized tonic-clonic seizures, after she came home from an all-night party around 6 am. Her father has epilepsy and one of her cousins sometimes has episodes of blank spells. Neurological examination shows no abnormalities. Which of the following diagnosis is most likely in this case?
Your Answer:
Correct Answer: Juvenile myoclonic epilepsy
Explanation:In people with juvenile myoclonic epilepsy, symptoms can be brought on by: -Sleep deprivation-Psychological stress-Alcohol and drug use-Noncompliance of medication-Flickering lights such as strobe lights -Menses-Time of day – usually mornings
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This question is part of the following fields:
- Neurology And Neurodisability
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Question 94
Incorrect
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A 16-year-old boy presents to the physician with a history of easy bruising and epistaxis since childhood. He recently had a dental extraction after which the bleeding lasted for 30 hours. His labs are sent and the reports are as follows: APTT: 36 secondsPT: 15 secondsFibrinogen: 2.5 g/lFactor VIIIC: 0.4 iu/ml (normal range 0.5-1.5)vWF antigen: 0.35 iu/ml (normal range 0.45-1.4)vWF ristocetin co-factor: 0.05 iu/ml (normal 0.45-1.35)PLT: 230 x 109/lBleeding time: 12 mins (normally up to 8 mins). Which of the following is the most likely diagnosis?
Your Answer:
Correct Answer: von Willebrand disease type II
Explanation:Von Willebrand disease (VWD), a congenital bleeding disorder caused by deficient or defective plasma von Willebrand factor (VWF), may only become apparent on haemostatic challenge, and bleeding history may become more apparent with increasing age. Type 1 VWD (,30% of VWD) typically manifests as mild mucocutaneous bleeding. Type 2 VWD accounts for approximately 60% of VWD. Type 2 subtypes include: Type 2A, which usually manifests as mild-to-moderate mucocutaneous bleeding; Type 2B, which typically manifests as mild-to-moderate mucocutaneous bleeding that can include thrombocytopenia that worsens in certain circumstances; Type 2M, which typically manifests as mild-moderate mucocutaneous bleeding; Type 2N, which can manifest as excessive bleeding with surgery and mimics mild haemophilia A. Type 3 VWD (<10% of VWD) manifests with severe mucocutaneous and musculoskeletal bleeding.
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This question is part of the following fields:
- Haematology And Oncology
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Question 95
Incorrect
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There is a measure of dispersion of a set of data from its mean. Which of following is the best term which can describe the above?
Your Answer:
Correct Answer: Standard deviation (root mean square deviation)
Explanation:Standard deviation is defined as the measure of dispersion of a set of data from its mean. It measures the absolute variability of a distribution; the higher the dispersion or variability, the greater is the standard deviation and greater will be the magnitude of the deviation of the value from their mean.
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This question is part of the following fields:
- Epidemiology And Statistics
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Question 96
Incorrect
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Which of the following classification systems is used for categorizing scaphoid fractures?
Your Answer:
Correct Answer: Herbert classification
Explanation:Scaphoid fractures are regarded as fractures that are difficult to heal, so a classification system is needed taking different factors into account that should lead towards proper guidance to the healing time and management of these fractures. Popular classification criteria are Herbert, Russe, and Mayo classification systems. Herbert’s classification system is based on the fracture’s stability and proposes that all complete bicortical fractures (except for tubercle fractures) are unstable. Salter-Harris classification is used for categorizing epiphyseal fractures, while Delbert classification system is reserved for fractures of the proximal femur in children. Fractures of the ankles are classified using Ottawa rules, and Garland classification is used for supracondylar fractures in children.
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This question is part of the following fields:
- Emergency Medicine
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Question 97
Incorrect
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A young boy presents with signs and symptoms consistent with infective endocarditis. He has a history of neglect and poor dental hygiene.Which organism is likely to have caused his endocarditis?
Your Answer:
Correct Answer: Streptococci viridans
Explanation:Infective endocarditis occurs when microorganisms enter the bloodstream and infect damaged endocardium or endothelial tissue. It most commonly involves the heart valves (either native or prosthetic), but it may also occur at the site of a septal defect, on the chordae tendineae, or on the mural endocardium. The prototypic lesion is at the site of the infection; the vegetation is a mass of platelets, fibrin, microcolonies of microorganisms, and scant inflammatory cells. Endocarditis is classified as acute or subacute, which applies to the features and the progression of infection until diagnosis.The oral cavity, the skin, and the upper respiratory tract are the primary portals for Streptococcus viridans; Staphylococcus species; and Haemophilus aphrophilus, Aggregatibacter (formerly Actinobacillus) actinomycetemcomitans, Cardiobacterium hominis, Eikenella corrodens, and Kingella kingae (HACEK) organisms. Streptococcal and staphylococcal organisms are responsible for more than 80% of cases of bacterial IE.Streptococcus viridans accounts for approximately 50-60% of cases of subacute disease.While S aureus infection is the most common cause of IE, including Prosthetic valve endocarditis, acute IE, and IV Drug Abusers IE
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This question is part of the following fields:
- Cardiovascular
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Question 98
Incorrect
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Which of the given clinical features is found in multiple endocrine neoplasia (MEN) type 1?
Your Answer:
Correct Answer: Carcinoid tumours
Explanation:Multiple endocrine neoplasia type 1 is a rare, autosomal dominant disorder characterized by a higher propensity to develop various endocrine and nonendocrine tumours. The primary endocrine tumours that are a part of this disorder include carcinoid tumours and tumours of parathyroid, enteropancreatic, and anterior pituitary origin. Carcinoid tumours encountered in MEN type 1 are mostly of the foregut region. Non-endocrine tumours found in MEN type 1 include meningiomas and ependymomas, lipomas, angiofibromas, collagenomas, and leiomyomas. The pathogenesis of MEN type 1 is the inactivating mutation of the tumour suppressor gene MEN 1, which encodes the protein menin.
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This question is part of the following fields:
- Endocrinology
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Question 99
Incorrect
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A 10-year-old boy presents to the hospital with a lower respiratory chest infection. Following a road traffic accident, he underwent a splenectomy a few months ago. What is the most likely organism causing the lower respiratory tract infection in this child?
Your Answer:
Correct Answer: Haemophilus influenzae
Explanation:The organisms most likely to cause post-splenectomy sepsis include:- Streptococcus pneumoniae- Haemophilus influenzae- MeningococciEncapsulated organisms carry the most significant pathogenic risk following splenectomy. Hyposplenism:It may complicate certain medical conditions where splenic atrophy occurs or maybe the result of medical intervention such as splenic artery embolization and splenectomy for trauma. The diagnosis of hyposplenism is difficult, and while there may be peripheral markers of the splenectomised state (e.g. Howell-Jolly bodies), these are neither 100% sensitive or specific. The most sensitive test is a radionucleotide labelled red cell scan.It dramatically increases the risk of post-splenectomy sepsis, particularly with encapsulated organisms. Since these organisms may be opsonized, but this then goes undetected at an immunological level due to loss of the spleen. For this reason, individuals are recommended to be vaccinated and have antibiotic prophylaxis.Key recommendations:- All those with hyposplenism or prior to an elective splenectomy should receive pneumococcal, Haemophilus type b and meningococcal type C vaccines. These should be administered two weeks before or two weeks following splenectomy. The vaccine schedule for meningococcal disease primarily consists of a dose of Men C and Hib at two weeks and then a dose of the MenACWY vaccine one month later. Those aged under two may require a booster at two years. A dose of pneumococcal polyvalent polysaccharide vaccine (PPV) is given at two weeks. A conjugate vaccine (PCV) is offered to young children. The PCV is more immunogenic but covers fewer serotypes. Boosting PPV is either guided by serological measurements (where available) or by routine boosting doses at five-yearly intervals.Annual influenza vaccination is recommended in all cases- Antibiotic prophylaxis is offered to all. The risk of post-splenectomy sepsis is highest immediately following splenectomy. Individuals with an inadequate response to pneumococcal vaccination are another high-risk group. High-risk individuals should be counselled to take penicillin or macrolide prophylaxis. Those at low risk may choose to discontinue therapy. All patients should be advised about taking antibiotics early in the case of intercurrent infections.- Asplenic individuals travelling to malaria-endemic areas are at high risk and should have both pharmacological and mechanical protection.
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This question is part of the following fields:
- Haematology And Oncology
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Question 100
Incorrect
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Which of the following is NOT a gonadal or sexual differentiation disorder?
Your Answer:
Correct Answer: XXX (Triple X Syndrome)
Explanation:The correct answer is triple X syndrome with a genotype of XXX and an almost normal female phenotype. The extra X chromosome is inactive. The final phenotype of an individual is determined after normal sexual and gonadal differentiation, a process that involves several genes located on chromosomes X and Y. Disorders of sexual differentiation result in cases of ambiguous genitalia and are caused by a number of genetic abnormalities. Among these disorders is the turner syndrome with a genotype of 45X0, characterized by gonadal dysgenesis and ovarian failure. DAX-1 gene mutation leads to congenital adrenal hypoplasia and hypogonadotropic hypogonadism, which results in virilization of female external genitalia. Campomelic dysplasia results from mutation of the SOX-9 gene, leading to 46XY sex reversal. Danys-Drash syndrome is characterized by disordered sexual development in affected males due to the mutated WT-1 gene, which also causes Wilm’s tumour.
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This question is part of the following fields:
- Genetics And Dysmorphology
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