1717771361 - PassMed (2024)

• Question 1 - A 6 year old child presents with secondary nocturnal enuresis. He is otherwise...

  Correct

  • A 6 year old child presents with secondary nocturnal enuresis. He is otherwise healthy and with a clear family history. He drinks sufficient amounts of fluids but is a fussy eater. Clinical examination reveals a mass in the left iliac fossa. What is the most likely diagnosis?

    Your Answer: Constipation

    Explanation:

    Constipation is often associated with nocturnal enuresis in children. The palpable mass is the impacted stool. The decreased appetite is common in those with constipation.

  • This question is part of the following fields:

    • Nephro-urology

    

    14.3

    Seconds

• Question 2 - During a routine developmental assessment, it is noted that an infant can transfer...

  Correct

  • During a routine developmental assessment, it is noted that an infant can transfer a cube from her left to her right hand. She gains much excitement when placed in a forward or downward parachute position. In contrast to her last visit, she no longer has a rooting, grasp, or startle reflex. Her symmetrical Moro reflex has also disappeared. The infant continuously presents items to her mouth and sucks her fingers. She has a positive Babinski sign but a negative asymmetrical tonic neck reflex.What is the developmental age of the child in question?

    Your Answer: 8 months

    Explanation:

    Based on the presentation, the developmental age of the child is 8 months.The primitive reflexes are indicators of functional integrity and maturity. The majority of reflexes do not persist beyond 6 months of age. There are 13 reflexes of importance, including:- Moro reflex- Startle reflex- Rooting reflex- Sucking reflex- Grasp reflex- Voluntary palmar grasp reflex- Voluntary reach reflex- Stepping reflex- Asymmetrical tonic neck reflex (ATNR)- Parachute reflex- Plantar reflex- Tendon reflex- ClonusIt is interesting to note that gastrocolic reflex is not a primitive reflex.Ninety-five per cent of reflexes will have disappeared by the ages shown below:- 6 weeks: Stepping- 3-4 months: Palmar grasp and Moro- 6 months: Sucking, rooting, and asymmetrical tonic neck reflex (ATNR)

  • This question is part of the following fields:

    • Child Development

    

    11.5

    Seconds

• Question 3 - What is the most common cardiac abnormality found in Noonan syndrome? ...

  Correct

  • What is the most common cardiac abnormality found in Noonan syndrome?

    Your Answer: Pulmonary stenosis

    Explanation:

    Noonan syndrome is one of the most common genetic diseases associated with congenital heart defects, being second in frequency only to Down syndrome.Pulmonary stenosis and hypertrophic cardiomyopathy are generally the most common congenital heart defects found in Noonan syndrome.Pulmonary stenosis is often associated with a thickened and dysplastic valve. It is usually difficult to obtain a satisfactory result using the transcatheter balloon dilatation of such dysplastic valves, so surgical intervention is more likely to be needed.Hypertrophic cardiomyopathy involves predominantly the ventricular septum as asymmetric septal hypertrophy, but may also affect the ventricular free walls. Left ventricular outflow tract obstruction may occasionally be produced.

  • This question is part of the following fields:

    • Neonatology

    

    5.4

    Seconds

• Question 4 - Which of the following features is consistent with ventricular septal defect (VSD) murmur?...

  Incorrect

  • Which of the following features is consistent with ventricular septal defect (VSD) murmur?

    Your Answer: Split second heart sound

    Correct Answer: Short diamond shaped diastolic murmur after the third heart sound

    Explanation:

    Auscultatory findings of VSD vary with the size of the defect. Small VSDs typically produce murmurs ranging from a grade 1 to 2/6 high-pitched, short systolic murmur (due to tiny defects that actually close during late systole) to a grade 3 to 4/6 holosystolic murmur (with or without thrill) at the lower left sternal border| this murmur is usually audible within the first few days of life (see table Heart Murmur Intensity). The precordium is not hyperactive, and the 2nd heart sound (S2) is normally split and has normal intensity.Moderate to large VSDs produce a holosystolic murmur that is present by age 2 to 3 wk| S2 is usually narrowly split with an accentuated pulmonary component. An apical diastolic rumble (due to increased flow through the mitral valve) and findings of heart failure (e.g., tachypnoea, dyspnoea with feeding, failure to thrive, gallop, crackles, hepatomegaly) may be present. In moderate, high-flow VSDs, the murmur is often very loud and accompanied by a thrill (grade 4 or 5 murmur). With large defects allowing equalization of left ventricular and right ventricular pressures, the systolic murmur is often attenuated.

  • This question is part of the following fields:

    • Cardiovascular

    

    43.5

    Seconds

• Question 5 - A 12-year-old boy hit his head on a pole on the school playground....

  Incorrect

  • A 12-year-old boy hit his head on a pole on the school playground. His friends noted that he lost consciousness for a few seconds. The school nurse sent him to the Emergency Department as he had a small nasal bleed that stopped spontaneously. In the intervening two hours, he has noticed a watery discharge from his nose. On examination, there is considerable bruising on his nose and forehead, he was complaining of a headache. Which is the most appropriate diagnosis?

    Your Answer: Orbital bone fracture

    Correct Answer: Basilar skull fracture

    Explanation:

    Orbital bone fracture: The child has sustained a head injury and subsequently describes a CSF rhinorrhoea (indicating a cerebro-spinal fluid leak). CSF rhinorrhoea can occur in skull or nasal bone fractures. Given the symptoms of loss of consciousness and headache, this child is more at risk of having suffered a skull fracture requiring emergency CT head investigation and specialist neurosurgical management. An ethmoid bone fracture may also present this way. A skull x ray would help to determine an air fluid level and indeed allow some visualisation of the nasal bones, though in children the nasal bones do not visualise well due to lack of fusion. Either way this child would need assessment in the nearest Emergency Department and the school would be expected to follow a ‘head injury’ protocol.

  • This question is part of the following fields:

    • ENT

    

    25.2

    Seconds

• Question 6 - A 15-year-old boy presents with a concern that he is the shortest in...

  Correct

  • A 15-year-old boy presents with a concern that he is the shortest in his class, and his voice has not 'broken' yet. A thorough examination reveals that his sexual development is within the normal range, and he is reassured that puberty occurs at different times for everyone. Which of the following cells in the testes secrete testosterone?

    Your Answer: Leydig cells

    Explanation:

    The cells in the testes that secrete testosterone are the Leydig cells.Other cells in testes include:- Spermatogonia: These are undifferentiated male germ cells which undergo spermatogenesis in the seminiferous tubules of the testes.- Sertoli cells: They are a part of the seminiferous tubule of the testes, cells are activated by FSH and nourish developing sperm cells.- Myoid: They are squamous contractile cells which generate peristaltic waves, they surround the basem*nt membrane of testes.- Fibroblasts: Cells which synthesise collagen and the extracellular matrix.

  • This question is part of the following fields:

    • Nephro-urology

    

    10.8

    Seconds

• Question 7 - A 9-year-old boy was conservatively managed for an appendicular mass. The parents enquire...

  Incorrect

  • A 9-year-old boy was conservatively managed for an appendicular mass. The parents enquire whether to have an interval appendicectomy to prevent the chances of having appendicitis again. What percentage of patients with conservatively managed appendix mass are likely to develop recurrent appendicitis?

    Your Answer: 20-40%

    Correct Answer: 0-20%

    Explanation:

    The chance of having appendicitis again after appendix mass is around 17% in children. While the traditional teachings by Hamilton Bailey recommend following the conservative Ochsner-Sherren regimen followed by an interval appendicectomy six weeks after the discharge of the patient, there remains a looming controversy whether to perform an interval appendicectomy or not.

  • This question is part of the following fields:

    • Paediatric Surgery

    See Also

    Zipline Into a Case of Spontaneous Cerebrospinal Fluid RhinorrheaEndoscopic Endonasal Trans-sphenoidal Approach: Minimally Invasive Surgery for Pituitary Adenomas (Scientific Article Protocol) | JoVEHOW I DO IT: Cushing’s disease—selective adenomectomy via an endoscopic transsphenoidal approachHow I do it? Endoscopic endonasal transpterygoid repair of sphenoid lateral recess cerebrospinal fluid leak after previous unsuccessful transcranial surgery | Article Information | J-GLOBAL

    

    8.8

    Seconds

• Question 8 - Which of the following epilepsy syndromes is NOT benign? ...

  Correct

  • Which of the following epilepsy syndromes is NOT benign?

    Your 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.

  • This question is part of the following fields:

    • Neurology And Neurodisability

    

    4.7

    Seconds

• Question 9 - A 2 year old child was brought to casualty with recurrent episodes of...

  Incorrect

  • 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: Tacrolimus ointment is the preferred treatment for infants less than two years old

    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.

  • This question is part of the following fields:

    • Dermatology

    

    20.2

    Seconds

• Question 10 - A 10-year-old boy is brought to the hospital by his mother following complaints...

  Correct

  • A 10-year-old boy is brought to the hospital by his mother following complaints of fatigue. Considering a possible diagnosis of iron deficiency anaemia, blood investigations, including a peripheral smear, were ordered. The reports confirmed iron deficiency anaemia. Which of the following abnormal red cell types is likely to be seen in the peripheral smear of this patient?

    Your Answer: Pencil cells

    Explanation:

    A peripheral blood film in iron deficiency anaemia can reveal the following morphologically variant RBCs:- Microcytic cells- Hypochromic cells- Pencil cells- Target cellsOther options:- Schistocytes can be caused by mechanical heart valves. – Rouleaux can be seen in chronic liver disease and malignant lymphoma. – Tear-drop poikilocytes can be seen in myelofibrosis. – Acanthocytes can be seen in liver disease and McLeod blood group phenotype.Pathological red cell forms include:- Target cells: Sickle-cell/thalassaemia, iron-deficiency anaemia, hyposplenism, and liver disease.- Tear-drop poikilocytes: Myelofibrosis- Spherocytes: Hereditary spherocytosis and autoimmune haemolytic anaemia- Basophilic stippling: Lead poisoning, thalassaemia, sideroblastic anaemia, and myelodysplasia- Howell-Jolly bodies: Hyposplenism- Heinz bodies: G6PD deficiency and alpha-thalassaemiaSchistocytes (‘helmet cells’): Intravascular haemolysis, mechanical heart valve, and disseminated intravascular coagulation- Pencil poikilocytes: Iron deficiency anaemia- Burr cells (echinocytes): Uraemia and pyruvate kinase deficiency – Acanthocytes: Abetalipoproteinemia

  • This question is part of the following fields:

    • Haematology And Oncology

    

    17.3

    Seconds

• Question 11 - Which of the following developmental milestones would you expect to see in a...

  Correct

  • Which of the following developmental milestones would you expect to see in a normal 6-month-old baby?

    Your Answer: Have lost the Moro reflex

    Explanation:

    The Moro reflex is a normal primitive, infantile reflex. It can be seen as early as 25 weeks postconceptional age and usually is present by 30 weeks postconceptional age.6 month old milestones:Social and Emotional:Knows 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/Communication:Responds to sounds by making sounds Strings vowels together when babbling (“ah,” “eh,” “oh”) and likes taking turns with parent while making sounds Responds to own name Makes sounds to show joy and displeasure Begins to say consonant sounds (jabbering with “m,” “b”) 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 Development:Rolls 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

  • This question is part of the following fields:

    • Child Development

    

    7.3

    Seconds

• Question 12 - A 17-year-old boy, who had developed shortness of breath and a loss of...

  Incorrect

  • A 17-year-old boy, who had developed shortness of breath and a loss of appetite over the last month, was referred to a haematologist because he presented with easy bruising and petechiae. His prothrombin time, platelet count, partial thromboplastin and bleeding time were all normal. Which of the following would explain the presence of the petechiae and easy bruising tendency?

    Your Answer: von Willebrand’s disease

    Correct Answer: Scurvy

    Explanation:

    Scurvy is a condition caused by a dietary deficiency of vitamin C, also known as ascorbic acid. Humans are unable to synthesize vitamin C, therefore the quantity of it that the body needs has to come from the diet. The presence of an adequate quantity of vitamin C is required for normal collagen synthesis. In scurvy bleeding tendency is due to capillary fragility and not coagulation defects, therefore blood tests are normal.

  • This question is part of the following fields:

    • Nutrition

    

    13.8

    Seconds

• Question 13 - A 3-month-old baby was brought to the paediatrics ward by her mother with...

  Correct

  • A 3-month-old baby was brought to the paediatrics ward by her mother with a complaint of noisy breathing and difficulty feeding. On examination, the baby had a mild inspiratory stridor, and subsequent laryngoscopy reveals an omega-shaped epiglottis. Which of the following is the most likely diagnosis in this case?

    Your Answer: Laryngomalacia

    Explanation:

    Omega-shaped epiglottis is a characteristic feature in the X-ray of a patient with laryngomalacia.

  • This question is part of the following fields:

    • ENT

    

    13.5

    Seconds

• Question 14 - A 16-year-old girl presents to her OBGYN after getting pregnant. It is evaluated...

  Correct

  • A 16-year-old girl presents to her OBGYN after getting pregnant. It is evaluated that she is 13 days pregnant and the fetal tissue has just undergone implantation. Where in the uterus does implantation usually take place?

    Your Answer: Anterior or superior walls

    Explanation:

    Time and EventWeek 1: ImplantationWeek 2: Formation of bilaminar diskWeek 3: Formation of primitive streakFormation of notochordGastrulationWeek 4: Limb buds begin to formNeural tube closesHeart begins to beatWeek 10: Genitals are differentiated

  • This question is part of the following fields:

    • Neonatology

    

    10.5

    Seconds

• Question 15 - A 15-year-old Afro-Caribbean boy presents with a temperature of 38.5℃ and acute abdominal...

  Incorrect

  • A 15-year-old Afro-Caribbean boy presents with a temperature of 38.5℃ and acute abdominal pain. He has previously undergone a splenectomy secondary to sickle cell disease. On examination, he’s found to be tachycardic. Abdominal examination reveals guarding. An ultrasound scan shows gall stones in the gall bladder, free fluid in the pelvis and an appendix with a diameter of 8 mm.What is the most probable diagnosis?

    Your Answer: Sickle Cell Crisis

    Correct Answer: Acute Appendicitis

    Explanation:

    Based on the clinical scenario, the most probable diagnosis is acute appendicitis.Acute appendicitis presents typically with central abdominal pain migrating to the right iliac fossa, anorexia, nausea and fever. The temperature usually does not go beyond 40C. Although appendicitis is a clinical diagnosis, an ultrasound scan showing an appendix width of greater than 6mm is diagnostic.Pyrexia, guarding, and pain are all in keeping with appendicitis.Other options:- Cholecystitis is very rare in children, and although gall stones are present, there is no jaundice or biliary tree dilatation suggested by the scan.- Impacted Gall Stone: There is no mention of common bile duct dilatation in the clinical scenario.- Sickle Cell Crisis: A sickle cell crisis should not cause guarding, or an ultrasound scan finding of a dilated appendix base.- Gastroenteritis: Gastroenteritis would not produce the ultrasound scan findings described above with a thickened appendix.

  • This question is part of the following fields:

    • Paediatric Surgery

    

    9

    Seconds

• Question 16 - Out of 30 children who are exposed to a chemical, 15 develop a...

  Incorrect

  • Out of 30 children who are exposed to a chemical, 15 develop a disorder, compared to only 1 child out of 10 developing the same disorder who were not exposed.The following can be deduced from this information:

    Your Answer: We should study a larger number

    Correct Answer: The relative risk of exposure to the chemical is 5

    Explanation:

    Relative risk is the probability of an outcome occurring in an exposed group as compared to the probability of that outcome in an unexposed group. In the scenario given, 50% of the children exposed developed the disease while only 10% of the children who were unexposed developed the disease. The relative risk was therefore 50/10=5. There is no further information about whether the study was controlled, the confidence interval, or the type of study. It therefore cannot be confirmed whether the chemical is causative and if it should be avoided.

  • This question is part of the following fields:

    • Epidemiology And Statistics

    

    13.1

    Seconds

• Question 17 - A young female who carries the abnormal RET oncogene has her recurrent laryngeal...

  Incorrect

  • A young female who carries the abnormal RET oncogene has her recurrent laryngeal nerve accidentally divided during a thyroidectomy. Which clinical features are likely to result from this?

    Your Answer: All the laryngeal muscles are paralysed on the affected side, apart from the posterior cricoarytenoid muscle

    Correct Answer: The larynx is anaesthetised inferior to the vocal cord on the affected side

    Explanation:

    The recurrent laryngeal nerve (RLN) innervates all of the intrinsic muscles of the larynx except for the cricothyroid muscle, which is innervated by the superior laryngeal nerve (SLN).Patients with unilateral vocal fold paralysis present with postoperative hoarseness or breathiness. The presentation is often subacute. At first, the vocal fold usually remains in the paramedian position, creating a fairly normal voice. Definite vocal changes may not manifest for days to weeks. The paralyzed vocal fold atrophies, causing the voice to worsen. Other potential sequelae of unilateral vocal-fold paralysis are dysphagia and aspiration.Bilateral vocal-fold paralysis may occur after total thyroidectomy, and it usually manifests immediately after extubation. Both vocal folds remain in the paramedian position, causing partial airway obstruction. Patients with bilateral vocal-fold paralysis may present with biphasic stridor, respiratory distress, or both. On occasion, the airway is sufficient in the immediate postoperative period despite the paralyzed vocal folds. At follow-up, such patients may present with dyspnoea or stridor with exertion.

  • This question is part of the following fields:

    • Anatomy

    

    25.2

    Seconds

• Question 18 - When sampling patients for a clinical trial the most important thing is that:...

  Correct

  • When sampling patients for a clinical trial the most important thing is that:

    Your Answer: They are a random and representative sample

    Explanation:

    The selection process is based on five requirements and essentially aims to select a random representative cohort through:1.Isolating a group for which there is a greater or lesser chance of detecting a possible difference between the treatments compared|2.Establishing a hom*ogeneous group in order to reduce the variability of response, thus making statistical comparison more sensitive and decreasing the risk of bias due to the constitution of non-hom*ogeneous groups|3.Obtaining representative samples of the affection studied|4.Defining the rules corresponding to realistic recruitment|5.Respecting ethical obligations.

  • This question is part of the following fields:

    • Epidemiology And Statistics

    

    8

    Seconds

• Question 19 - A 12 year old boy presents with a sharp pain on the left...

  Correct

  • A 12 year old boy presents with a sharp pain on the left side of his lower back. His parents both have a similar history of the condition. His urine tests positive for blood. A radio dense stone is seen in the region of the mid ureter when a KUB style x-ray is done. Which of the following is most likely the composition of the stone?

    Your Answer: Cystine stone

    Explanation:

    Answer: Cystine stoneCystinuria is a genetic cause of kidney stones with an average prevalence of 1 in 7000 births. Cystine stones are found in 1 to 2 percent of stone formers, although they represent a higher percentage of stones in children (approximately 5 percent). Cystinuria is an inherited disorder. Inherited means it is passed down from parents to children through a defect in a specific gene. In order to have cystinuria, a person must inherit the gene from both parents. Cystine is a hom*odimer of the amino acid cysteine. Patients with cystinuria have impairment of renal cystine transport, with decreased proximal tubular reabsorption of filtered cystine resulting in increased urinary cystine excretion and cystine nephrolithiasis. The cystine transporter also promotes the reabsorption of dibasic amino acids, including ornithine, arginine, and lysine, but these compounds are soluble so that an increase in their urinary excretion does not lead to stones. Intestinal cystine transport is also diminished, but the result is of uncertain clinical significance.Cystinuria only causes symptoms if you have a stone. Kidney stones can be as small as a grain of sand. Others can become as large as a pebble or even a golf ball. Symptoms may include:Pain while urinatingBlood in the urineSharp pain in the side or the back (almost always on one side)Pain near the groin, pelvis, or abdomenNausea and vomitingStruvite stones are a type of hard mineral deposit that can form in your kidneys. Stones form when minerals like calcium and phosphate crystallize inside your kidneys and stick together. Struvite is a mineral that’s produced by bacteria in your urinary tract. Bacteria in your urinary tract produce struvite when they break down the waste product urea into ammonia. For struvite to be produced, your urine needs to be alkaline. Having a urinary tract infection can make your urine alkaline. Struvite stones often form in women who have a urinary tract infection.Calcium oxalate stones are the most common type of kidney stone. Kidney stones are solid masses that form in the kidney when there are high levels of calcium, oxalate, cystine, or phosphate and too little liquid. There are different types of kidney stones. Your healthcare provider can test your stones to find what type you have. Calcium oxalate stones are caused by too much oxalate in the urine.What is oxalate and how does it form stones?Oxalate is a natural substance found in many foods. Your body uses food for energy. After your body uses what it needs, waste products travel through the bloodstream to the kidneys and are removed through urine. Urine has various wastes in it. If there is too much waste in too little liquid, crystals can begin to form. These crystals may stick together and form a solid mass (a kidney stone). Oxalate is one type of substance that can form crystals in the urine. This can happen if there is too much oxalate, too little liquid, and the oxalate “sticks” to calcium while urine is being made by the kidneys.Uric acid stones are the most common cause of radiolucent kidney stones in children. Several products of purine metabolism are relatively insoluble and can precipitate when urinary pH is low. These include 2- or 8-dihydroxyadenine, adenine, xanthine, and uric acid. The crystals of uric acid may initiate calcium oxalate precipitation in metastable urine concentrates.Uric acid stones form when the levels of uric acid in the urine is too high, and/or the urine is too acidic (pH level below 5.5) on a regular basis. High acidity in urine is linked to the following causes:Uric acid can result from a diet high in purines, which are found especially in animal proteins such as beef, poultry, pork, eggs, and fish. The highest levels of purines are found in organ meats, such as liver and fish. Eating large amounts of animal proteins can cause uric acid to build up in the urine. The uric acid can settle and form a stone by itself or in combination with calcium. It is important to note that a person’s diet alone is not the cause of uric acid stones. Other people might eat the same diet and not have any problems because they are not prone to developing uric acid stones.There is an increased risk of uric acid stones in those who are obese or diabetic.Patients on chemotherapy are prone to developing uric acid stones.Only cystine stone is inherited.

  • This question is part of the following fields:

    • Genitourinary

    

    14.7

    Seconds

• Question 20 - A 13-year-old girl was recently diagnosed with type 1 diabetes mellitus about two...

  Correct

  • A 13-year-old girl was recently diagnosed with type 1 diabetes mellitus about two weeks ago and started on an insulin pump. Which of the following complications is least likely to occur due to the treatment modality adopted?

    Your Answer: Lipoatrophy

    Explanation:

    Among the given options, lipoatrophy takes time to develop as it is a long-term complication of insulin therapy. Since it has only been two weeks since the initiation of insulin therapy, it is unlikely to occur so early.The risk of lipoatrophy is reduced with newer insulins and also can be avoided by site rotation.However, anaphylaxis, allergic reactions, infection and abscesses at the site of an insulin pump can occur in this patient as a complication of insulin therapy.

  • This question is part of the following fields:

    • Endocrinology

    

    10.3

    Seconds

• Question 21 - A clinical trial is conducted to study the benefits of a new oral...

  Correct

  • A clinical trial is conducted to study the benefits of a new oral medication to improve the symptoms of patients with asthma. In the trial 400 patients with asthma, half were given the new medication and half a placebo. Three months later they are asked to rate their symptoms using the following scale: much improved, slight improvement, no change, slight worsening, significantly worse. What is the most appropriate statistical test to see whether the new medication is beneficial?

    Your Answer: Mann-Whitney U test

    Explanation:

    The type of significance test used depends on whether the data is parametric (can be measured, usually normally distributed) or non-parametric.
    Parametric tests:
    Student’s t-test – paired or unpaired*
    Pearson’s product-moment coefficient – correlation

    Non-parametric tests:
    Mann-Whitney U test – unpaired data
    Wilcoxon signed-rank test – compares two sets of observations on a single sample
    chi-squared test – used to compare proportions or percentages
    Spearman, Kendall rank – correlation.

    The outcome measured is not normally distributed, i.e. it is non-parametric. This excludes the Student’s t-tests. We are not comparing percentages/proportions so the chi-squared test is excluded. The Mann–Whitney U test is a nonparametric test of the null hypothesis that it is equally likely that a randomly selected value from one sample will be less than or greater than a randomly selected value from a second sample.
    This test can be used to investigate whether two independent samples were selected from populations having the same distribution.

  • This question is part of the following fields:

    • Epidemiology And Statistics

    

    16.2

    Seconds

• Question 22 - A 2-day old boy is diagnosed with a patent ductus arteriosus. He has...

  Correct

  • A 2-day old boy is diagnosed with a patent ductus arteriosus. He has a cyanotic heart disease. Which of the following would be the best course of action in this patient?

    Your Answer: Prostaglandin E1 (PGE1) administration

    Explanation:

    Administration of IV prostaglandin/PGE1 (e.g., alprostadil) is indicated in ductal-dependent CHDs until surgery can be performedMechanism: prostaglandin prevents the ductus arteriosus from closing → creates intentional shunt to allow mixing of deoxygenated with oxygenated blood.

  • This question is part of the following fields:

    • Cardiovascular

    

    17.4

    Seconds

• Question 23 - A 16-year-old boy presents with complaints of ear pain. The pain started last...

  Incorrect

  • A 16-year-old boy presents with complaints of ear pain. The pain started last night and prevented him from sleeping. He reports that sounds are muffled on the affected side. On examination, he has a fever. A bulging tympanic membrane with a visible fluid level is seen on otoscopy. You suspect a diagnosis of acute suppurative otitis media. Tensor tympani is a muscle that is found in the middle ear. What is the nerve supplying the tensor tympani?

    Your Answer: Maxillary nerve

    Correct Answer: Mandibular nerve

    Explanation:

    The nerve supply to the tensor tympani is the mandibular nerve.The mandibular nerve is the only division of the trigeminal nerve that carries motor fibres.Tensor tympani is a muscle that lies in a bony canal just superior to the pharyngotympanic tube. It originates from the cartilaginous portion of the pharyngotympanic tube, the bony canal in which it sits, and the greater wing of the sphenoid bone. It inserts into the upper part of the handle of the malleus. When contracted, it pulls the handle of the malleus medially. This action increases the tension across the tympanic membrane, reducing the magnitude of vibrations transmitted into the middle ear. This dampens loud noises or noises produced by chewing. Tensor tympani is innervated through the nerve to tensor tympani, which arises from the mandibular nerve.Other options:- The vestibulocochlear nerve is the eighth cranial nerve. This nerve has two components, a vestibular division that carries balance information, and a cochlear division that carries hearing information.- The glossopharyngeal nerve is the ninth cranial nerve. It has a wide range of functions. It carries taste and sensation from the posterior third of the tongue, as well as sensation from the pharyngeal wall and tonsils, the middle ear, external auditory canal and auricle. It carries parasympathetic fibres that supply the parotid gland. It also supplies the baroreceptors and chemoreceptors of the carotid sinus and supplies the secretomotor fibres to the parotid gland.- The maxillary nerve carries only sensory fibres.- The facial nerve is the seventh cranial nerve. It supplies the muscles of facial expression, as well as stylohyoid, the posterior belly of digastric, and stapedius (the only other muscle associated with the middle ear). It carries taste from the anterior two-thirds of the tongue and sensation from part of the external acoustic meatus, parts of the auricle and the retro-auricular area. It provides secretomotor fibres which supply to the submandibular gland, sublingual gland (via chorda tympani nerve), nasal glands and lacrimal glands.

  • This question is part of the following fields:

    • Neurology And Neurodisability

    

    57.8

    Seconds

• Question 24 - A 15-year-old boy is brought to the clinic with fever, cough, sore throat...

  Incorrect

  • A 15-year-old boy is brought to the clinic with fever, cough, sore throat and bleeding gums. He has also noticed a rash on his legs. The coryzal symptoms started 3 weeks ago before which he was fit and well. He is currently not taking any medication and denies smoking, alcohol and using other illicit drugs. Examination reveals a pale child with bilateral subconjunctival haemorrhages, erythematous throat and some petechiae on his legs. there are no sign of lymphadenopathy or hepatosplenomegaly. investigations are as follows: Hb8.9 g/dlMCV: 110 flWBC: 2 x 109/lNeutrophils: 0.3 x 109/lLymphocytes:1.5 x 109/lPLT: 13 x 109/lReticulocytes: 30 x 109/l (normal range 20-100 x 109/l)Coagulation screen: normal. Bone marrow: hypoplastic. A urine dipstick reveals trace of blood in the urine. What is the patient most likely suffering from?

    Your Answer: Acute leukaemia

    Correct Answer: Aplastic anaemia

    Explanation:

    Aplastic anaemia causes a deficiency of all blood cell types: red blood cells, white blood cells, and platelets. It is more frequent in people in their teens and twenties, but is also common among the elderly. It can be caused by heredity, immune disease, or exposure to chemicals, drugs, or radiation. However, in about one-half of cases, the cause is unknown.The definitive diagnosis is by bone marrow biopsy| normal bone marrow has 30–70% blood stem cells, but in aplastic anaemia, these cells are mostly gone and replaced by fat.First-line treatment for aplastic anaemia consists of immunosuppressive drugs, typically either anti-lymphocyte globulin or anti-thymocyte globulin, combined with corticosteroids, chemotherapy and ciclosporin. Hematopoietic stem cell transplantation is also used, especially for patients under 30 years of age with a related matched marrow donor.

  • This question is part of the following fields:

    • Haematology And Oncology

    

    10.2

    Seconds

• Question 25 - A 2-day old baby who suffered from voiding difficulties is diagnosed with hypospadias....

  Incorrect

  • A 2-day old baby who suffered from voiding difficulties is diagnosed with hypospadias. Which of the following abnormalities is most often associated with this condition?

    Your Answer: Diaphragmatic hernia

    Correct Answer: Cryptorchidism

    Explanation:

    Hypospadias is an abnormality of anterior urethral and penile development. The urethral opening is located on the ventral aspect of the penis proximal to the tip of the glans penis, which, in this condition, is open. The urethral opening may be located as proximal as in the scrotum or perineum. The penis may also have associated ventral shortening and curvature, called chordee, with more proximal urethral defects.

  • This question is part of the following fields:

    • Nephro-urology

    

    18.9

    Seconds

• Question 26 - According to NICE guidelines, which of the following factors pose an increased risk...

  Incorrect

  • According to NICE guidelines, which of the following factors pose an increased risk of severe hyperbilirubinemia?

    Your Answer: Bottle feeding

    Correct Answer: History of a previous sibling requiring phototherapy for jaundice

    Explanation:

    Identify babies as being more likely to develop significant hyperbilirubinemia if they have any of the following factors:- gestational age under 38 weeks- a previous sibling with neonatal jaundice requiring phototherapy- mother’s intention to breastfeed exclusively- visible jaundice in the first 24 hours of life.

  • This question is part of the following fields:

    • Neonatology

    

    38

    Seconds

• Question 27 - A 13-year-old girl is brought by her mother to the A&E with breathlessness,...

  Incorrect

  • 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: Pulmonary stenosis

    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.

  • This question is part of the following fields:

    • Cardiovascular

    

    13.2

    Seconds

• Question 28 - A 5 year old boy falls into the swimming pool whilst playing and...

  Incorrect

  • 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: Contaminated water

    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.

  • This question is part of the following fields:

    • Emergency Medicine

    

    10.1

    Seconds

• Question 29 - An 8-year-old boy is presented with arthritis, cough and non-blanching purpura. His coagulation...

  Incorrect

  • An 8-year-old boy is presented with arthritis, cough and non-blanching purpura. His coagulation profile is normal. His CBC: Hb 11.8 TLC 7.2*10^9 Plt 286*10^9. What is the most likely diagnosis?

    Your Answer: ITP

    Correct Answer: Henoch-Schönlein Purpura (HSP)

    Explanation:

    The best answer is Henoch-Schönlein Purpura (HSP). This patient has a characteristic rash and the labs are consistent with this diagnosis.

  • This question is part of the following fields:

    • Cardiovascular

    

    34.6

    Seconds

• Question 30 - The mother of 6 months old girl tests positive for HIV. Doctors test...

  Incorrect

  • The mother of 6 months old girl tests positive for HIV. Doctors test her daughter as well and the results turn out to be positive for HIV, both by polymerase chain reaction (PCR) and serology. The girl is clinically healthy and seems to attain normal developmental milestones. Which of the following is the most appropriate next step?

    Your Answer: Start co-trimoxazole prophylaxis and antiretroviral therapy immediately

    Correct Answer: Start co-trimoxazole prophylaxis immediately and plan to start antiretrovirals once further work-up is complete

    Explanation:

    Infants exposed to maternal HIV and with positive results require immediate management with co-trimoxazole prophylaxis, regardless of their CD4 levels. Antiretroviral treatment is necessary as well but it could wait until further work-up is complete.

  • This question is part of the following fields:

    • HIV

    

    7.3

    Seconds

Retry this test Dashboard