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Flashcards in 2008 Paper B Deck (100)
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1

A five-year-old boy presents with a two day history of swelling of the parotid gland, with associated pain and low-grade fever. He had a similar episode eight months previously. He has obvious swelling of the left cheek, obscuring the angle of the jaw. It is moderately tender. No discharge can be manually expressed from the parotid duct.
The most likely diagnosis is:
A. acute suppurative parotitis.
B. idiopathic recurrent parotitis.
C. mumps.
D. sialolithiasis.
E. Sjögren syndrome

B. idiopathic recurrent parotitis.

2

A full-term 4.6 kg male infant has recurrent dusky episodes commencing eight hours after a difficult vaginal delivery complicated by mild shoulder dystocia following prolonged rupture of membranes. APGAR scores were six at one minute and nine at five minutes and he was given brief bag and mask ventilation to improve his colour. He is sleepy and has not fed well for the past five hours.
On examination, he has a suffused face, no respiratory distress or heart murmurs and a normotensive fontanelle. His blood glucose level is 4.0 mmol/L and as part of a septic work-up he has a lumbar puncture which gave the following cerebrospinal fluid (CSF) results:

The most likely cause for these findings is:
A. herpes simplex encephalitis.
B. meningitis.
C. subarachnoid haemorrhage.
D. subdural haematoma.
E. traumatic lumbar puncture

 

C. subarachnoid haemorrhage

3

A nine-year-old boy is referred for problems with sleeping. He goes to bed at 9 p.m., but is frequently awake for two or more hours before finally falling asleep. During this time he is frequently calling out to his parents, complaining of hearing noises, seeing things in his room and not wishing to be alone. He describes being worried someone is going to break into his house during the night.
Once asleep, he sleeps through the night. He gets up reluctantly at 7 a.m. on weekdays and spontaneously at 7.30 a.m. on weekends. He is not noticeably sleepy during the day, but sometimes falls asleep in the car. During the day he is a confident boy, with many friends and no difficulties separating from his parents for school or other activities.
The most likely primary diagnosis is:
A. generalised anxiety disorder.
B. insomnia with bedtime fears.
C. narcolepsy.
D. night terrors.
E. sleep phase delay syndrome.

B.  insomnia with bedtime fears

4

What is the commonest cause of failure to thrive in infancy in developed countries?

A. Chronic organ failure.
B. Gastrooesophageal reflux.
C. Inadequate intake.
D. Malabsorption.

E.Recurrent infection

C. Inadequate intake

5

A 14-year-old girl with a seizure disorder presents because of ongoing seizures. She was initially diagnosed with "grand mal" epilepsy following her first tonic-clonic seizure at 12 years of age.
Her teachers have expressed concern about brief periods of "tuning out" in the classroom. Her parents tell you that she is clumsy and seems "jumpy" first thing in the morning.
Her electroencephalogram (EEG) shows generalised spike waves.
Which of the following anticonvulsants is most likely to worsen her seizures?
A. Carbamazepine.
B. Clonazepam.
C. Phenobarbitone.
D. Sodium valproate.
E. T opiramate.

A. Carbamazepine

6

A six-month-old female infant presents with a one week history of cough and shortness of breath. She was born at 37 weeks gestation by Caesarean section for breech presentation. There were no problems in the neonatal period. She has been gaining weight well and developing normally. On examination, she is afebrile, with a respiratory rate of 50/min and intercostal recessions. On auscultation, breath sounds are reduced on the right side posteriorly. She has a right Horner syndrome. Her chest X-ray is shown below

Which of the following is the most likely diagnosis?
A. Congenital bronchogenic cyst.
B. Cyst adenomatoid malformation.
C. Neuroblastoma.
D. T eratoma.
E. Thymoma.

C. Neuroblastoma

7


A five-year-old boy is diagnosed with Duchenne muscular dystrophy. At the time of diagnosis he has a normal cardiac examination, electrocardiogram (ECG), echocardiogram and 24-hour Holter monitor. The cardiac complication most likely to develop in this child is:
A. dilated cardiomyopathy.
B. hypertrophic cardiomyopathy.
C. mitral valve prolapse.
D. supraventricular arrhythmias.
E. ventricular arrhythmias.

A. dilated cardiomyopathy

8

A previously well six-year-old boy presents with fever and headache. A computed tomography (CT) scan of his brain is shown below.

Which of the following is the most appropriate empiric antibiotic regimen?
A. Ampicillin plus Gentamicin.
B. Cefotaxime plus Gentamicin.
C. Cefotaxime plus Metronidazole.
D. Metronidazole plus Gentamicin.
E. Vancomycin plus Gentamicin.

C. Cefotaxime plus Metronidazole

9

A fully breast fed female infant born at 41-weeks’ gestation with a birth weight of 3.60 kg is noted to have significant persistent jaundice at two weeks of age. She is still below her birth weight. On physical examination, she is found to have an umbilical hernia, decreased tone and a large anterior fontanelle (4 x 6 cm). The most likely diagnosis is:
A. biliary atresia.
B. breast milk jaundice.
C. Crigler–Najjar syndrome.
D. galactosaemia.
E. hypothyroidism

E. hypothyroidism

10

A seven-year-old girl is referred for investigation of pallor, lethargy and bruising. Her oral appearance is shown below

Which of the following is the most likely diagnosis?
A. Acute lymphoblastic leukaemia (ALL).
B. Acute myeloid leukaemia (AML).
C. Aplastic anaemia.
D. Burkitt lymphoma.
E. Neuroblastoma.

B. Acute myeloid leukaemia (AML)

11

A term male neonate presents on day three of life with a history of 12 hours of increasing sleepiness and poor feeding. On examination he has truncal hypotonia but has hypertonic limbs. He does not cry when blood is taken. On initial investigation he is normoglycaemic. His arterial blood gases are as follows:

He is most likely to have a disorder of which of the following groups?
A. Congenital disorders of glycosylation.
B. Mitochondrial disorders.
C. Organic acidaemias.
D. Peroxisomal disorders.
E. Urea cycle disorders

E. Urea cycle disorders

12

A 14-year-old boy who was admitted to a peripheral hospital three days ago with a history of fevers and macroscopic haematuria is referred for renal assessment. He had previously been well, aside from being treated with oral flucloxacillin for cellulitis following excision of a benign naevus one month ago. His investigations are shown below.

The most likely diagnosis is:
A. acute post-streptococcal glomerulonephritis.
B. Alport syndrome.
C. haemolytic uraemic syndrome.
D. IgA nephropathy.
E. systemic lupus erythematosus (SLE).

E. systemic lupus erythematosus (SLE)

13

A four-year-old boy was playing with his brother and accidentally swallowed a coin. Initially there was some coughing and spluttering but he subsequently settled. An X-ray taken at the Emergency Department four hours later shows the coin to be at the lower oesophagus just above the gastrooesophageal junction. What is the most appropriate next step?
A. Barium swallow.
B. Domperidone.
C. Endoscopic removal.
D. Oral fluid bolus.
E. X-ray in 48 hours.

C. Endoscopic removal

14

A four-year-old child has a history of recurrent oral thrush and fungal nail infections since infancy which recur whenever oral anti-fungal medications cease. A clinical photograph of his nails is shown below.

Which of the following disorders is the child most at risk of developing?
A. Autoimmune hepatitis.
B. Coeliac disease.
C. Diabetes mellitus.
D. Hypothyroidism.
E. Thymoma.

D. Hypothyroidism

15

A term neonate presents with severe cyanosis from the time of delivery. The diagnosis of obstructed total anomalous pulmonary venous drainage is confirmed by echocardiograph. The intervention which would be most likely to adversely affect the patient’s clinical state would be:
A. dobutamine.
B. dopamine.
C. frusemide.
D. oxygen.
E. prostaglandin E1

E. prostaglandin E1

16

A six-month-old male infant presents with a swelling on the left side of his face as shown in the photograph below

At birth, facial asymmetry and mild fullness of the left cheek had been noted. By three months of age a soft, compressible non-tender mass was noted and seemed to be growing slowly over time. There was no discolouration of overlying skin.
Three days before this presentation he developed fever and irritability and the mass suddenly doubled o
in size. On examination he had a temperature of 38.5 C. The mass was hard, tender, erythematous and warm. There was impetigo on the face and cracking below the left pinna. There was no bruit on auscultation.

His admission laboratory results included:

Haemoglobin (Hb) 104 g/L [100 – 130 g/L] 

Platelets 491 x 10 /L [150 – 450 x 10 /L] 


White Cell Count (WCC) 18.6 x 10 /L [4.0 – 15.0 x 10 /L] 

Neutrophils 11.0 x 10 /L  [0.5 –7.0 x 10 L] 
C–reactive Protein 29 mg/L[<5 mg/L]

The most likely diagnosis is:
A. branchial cyst.
B. haemangioma.
C. lymphatic malformation.
D. parotitis.
E. thyroglossal cyst.
 

C. lymphatic malformation

17

A 14-year-old girl presents to the Emergency Department following a paracetamol overdose. Which of the following features on history is most predictive of a further suicide attempt?
A. Current antidepressant therapy.
B. Family history of completed suicide.
C. Past diagnosis of depression.
D. Past suicide attempts.
E. Presence of anxiety disorder.

D. Past suicide attempts

18

A four-week-old girl is brought into the Emergency Department with increasing redness and swelling of both breasts. A clinical photograph is shown below

Which of the following is the most likely causative organism?
A. Group A beta-haemolytic Streptococcus.
B. Group B Streptococcus.
C. Listeria monocytogenes.
D. Pseudomonas aeruginosa.
E. Staphylococcus aureus.

E. Staphylococcus aureus

19

A two-year-old child became unwell with fever and irritability. After two days, he developed a rash. The fever settled over the next day, and the rash evolved as shown in the photograph below.

Which of the following most commonly causes secondary skin infection in this condition?
A. Haemophilus influenzae.
B. Pseudomonas aeruginosa.
C. Staphylococcus epidermidis.
D. Streptococcus pneumoniae.
E. Streptococcus pyogenes.

E. Streptococcus pyogenes

20

An eight-week-old ex-premature baby with congenital hypothyroidism fails to respond to an adequate dose of thyroxine given regularly. The baby is breast fed and is on nutritional supplements. Which of the following nutritional supplements is most likely to affect absorption of thyroxine?
A. Folic acid.
B. Iron.
C. Phosphate.
D. Vitamin A.
E. Vitamin D

B. Iron

21

A four-week-old infant is referred for assessment as she has not yet regained her birth weight. Her mother reports that breast feeding is not well established. The infant is not clinically cyanosed, but is mildly tachypnoeic with mild hepatomegaly. Pulses are normal. Heart sounds are normal. There is a grade 3/6 systolic murmur. The electrocardiogram (ECG) is shown below

 

This clinical scenario would be most consistent with the diagnosis of:
A. atrioventricular septal defect.
B. patent ductus arteriosus.
C. tetralogy of Fallot.
D. truncus arteriosus.
E. ventricular septal defect

A. atrioventricular septal defect

22

A 14-year-old has recently been diagnosed with anorexia nervosa. She has a body mass index (BMI) of 15 kg/m2. She was commenced on nasogastric feeds. The level of which of the following electrolytes is most likely to fall if calories are given too rapidly?
A. Calcium.
B. Chloride.
C. Magnesium.
D. Phosphate.
E. Sodium.
 

D. Phosphate

23

You are asked to see a term born infant who is now 12 hours old, because of scalp swelling as shown below

 

A full blood count was performed:

Haemoglobin (Hb) 8.7 g/L [13.0 18.0 g/dL] 

White Cell Count (WCC) 13.0 x 109/L [6.0 – 18.0 x 109/L] 

Platelets 24 x 109/L [150 - 400 x 109/L]


The most likely diagnosis is:

A. Bernard-Soulier syndrome.
B. congenital cytomegalovirus infection.
C. Glanzmann thrombasthenia.
D. idiopathic thrombocytopenic purpura.
E. neonatal alloimmune thrombocytopenic purpura.




 

E. neonatal alloimmune thrombocytopenic purpura

24

In the management of phenylketonuria, the mainstay of treatment is the restriction of dietary intake of:
A. carbohydrate.
B. cholesterol.
C. long-chain triglycerides.
D. phytanic acid.
E. protein.

E. protein

25

An otherwise well ten-year-old girl with a mild intellectual disability presents for assessment. There are no abnormal findings on clinical examination. Her mother has had two miscarriages and a history of early menopause. The maternal grandfather has recently been referred to a neurologist for investigation of ataxia.
Which one of the following is the most likely diagnosis?
A. Fragile X syndrome.
B. Juvenile onset Huntington disease.
C. Maternal phenylketonuria.
D. Triple X syndrome.
E. Unbalanced form of a familial chromosomal translocation.

A. Fragile X syndrome

26

In children with immunodeficiency, the purpose of routine irradiation of administered blood products is to decrease the risk of:
A. alloimmunisation.
B. cytomegalovirus (CMV) infection.
C. graft-versus-host disease.
D. transfusion related acute lung injury (TRALI).
E. variant Creutzfeld-Jakob disease (vCJD).

C. graft-versus-host disease

27


A five-year-old boy is brought to the Emergency Department. His parents report that he was well when he woke, but by midday he was so unsteady he could not walk. On examination he looks well but frightened. His fundi are normal and his eye movements full, but he has nystagmus on lateral gaze. He has an unsteady gait and falls frequently, but his strength and reflexes are normal.
What is the most likely diagnosis?

A.Guillain-Barré syndrome.

B. Medulloblastoma.

C.Migraine.

D. Post-infectious cerebellitis.

E.Stroke.

D. Post-infectious cerebellitis

28

A six-month-old male infant was admitted with recurrent cough and feeding difficulties. He had been born at 29 weeks gestation. His chest X-ray showed hyperexpansion and increased interstitial markings. Antibody levels were performed:

The most likely cause of these findings is:
A. intestinal lymphangiectasia.
B. protein malabsorption.
C. severe combined immunodeficiency.
D. transient hypogammaglobulinaemia of infancy.
E. X-linked hypogammaglobulinaemia.

D. transient hypogammaglobulinaemia of infancy

29

A seven-year-old boy is seen with the development of pubic hair over the last 12 months. His growth
velocity is reported to have increased over the same time period. He has previously been well. On th
examination he is over the 97 percentile for height, he has Tanner stage 3 genital development and Tanner stage 3 pubic hair. His testes are 2 ml bilaterally. Initial investigations are as follows:

The most likely cause of his increased growth velocity and pubic hair development is which of the following?
A. Adrenocortical tumour.
B. Benign premature adrenarche.
C. Central precocious puberty.
D. Congenital adrenal hyperplasia.
E. Craniopharyngioma.

D. Congenital adrenal hyperplasia

30

A five-year-old girl presents with a one week history of pain behind the left ear. On examination she is afebrile. There is a warm, fluctuant mass with erythema of the overlying skin. The left tympanic membrane is bulging and red.
The appearance of the mass is shown in the photograph below

The most likely diagnosis in this case is:
A. acute mastoiditis.
B. atypical mycobacterium infection.
C. infected cystic hygroma.
D. infected sebaceous cyst.
E. postauricular lymphadenitis.

A. acute mastoiditis