2005 Paper B Flashcards
An eight-year-old boy presents with moderately severe cellulitis involving the left shin. The most appropriate empiric antibiotic treatment would be:
A. benzylpenicillin plus flucloxacillin.
B. benzylpenicillin plus gentamicin.
C. cefotaxime.
D. flucloxacillin.
E. vancomycin.
D. flucloxacillin.
An eight-year-old boy with attention deficit hyperactivity disorder (ADHD) and oppositional-defiant disorder is being treated with stimulant medication, with benefits reported at both school and home. What further functional improvement might be expected from adding intensive clinic-based behavioural intervention to his stimulant medication therapy?
A. Improved compliance in the classroom.
B. Reduced hyperactivity.
C. Reduced impulsivity.
D. Reduced inattention.
E. Reduced oppositional/aggressive behaviour.
E. Reduced oppositional/aggressive behaviour.
In the Salter-Harris classification of epiphyseal injuries in children (shown above), which type is most likely to require urgent operative reduction?

A. Type I.
B. Type II.
C. Type III.
D. Type IV.
E. Type V.
D. Type IV.
A healthy three-year-old girl presents with a squint. On examination, visual acuity is diminished in the left eye. The magnetic resonance imaging (MRI) scan of her head is shown opposite. Which one of the following inherited conditions is she most likely to have?
A. Familial retinoblastoma.
B. Neurofibromatosis type 1.
C. Sturge-Weber syndrome.
D. Tuberous sclerosis.
E. Von Hippel-Lindau disease.
B. Neurofibromatosis type 1.
A 14-year-old girl presents to the emergency department with a four-day history of headache and blurring of vision. She has previously been well. She is on no medication.
On examination she is very confused and disorientated. Her blood pressure is 230/140 mmHg. Her jugular venous pressure (JVP) is not elevated, heart sounds are normal and lung bases clear. Her reflexes are generally brisk. Fundoscopy shows bilateral haemorrhages, exudates and papilloedema.
Which of the following is the most appropriate treatment?
A. Intramuscular hydralazine.
B. Intravenous frusemide.
C. Intravenous sodium nitroprusside.
D. Oral enalapril.
E. Oral nifedipine.
C. Intravenous sodium nitroprusside.
A seven-year-old girl is referred with a history of increasing daytime wetting, characterised by loss of urine control when laughing and particularly when being tickled. Her classmates are causing embarrassment by tickling her in the playground.
Her past history suggests no neurodevelopmental problems. She had a single urinary tract infection at 18 months of age, followed by a normal renal ultrasound. Physical examination is normal.
Which of the following is the most appropriate therapy?
A. Behavioural therapy.
B. Imipramine.
C. Oxybutynin.
D. Pelvic floor exercises.
E. Vasopressin spray.
C. Oxybutynin.
A six-year-old boy presents with a five-week history of polyuria and polydipsia. There is no family
history of autoimmune disease. Investigations are as follows:
Which of the following tests would confirm the diagnosis?
A. Antibodies for type 1 (insulin-dependent) diabetes mellitus.
B. Magnetic resonance imaging (MRI) of brain.
C. Oral glucose tolerance test.
D. Renal ultrasound.
E. Water deprivation test.
E. Water deprivation test.
An otherwise normal two-year-old girl requires surgical repair of a large secundum atrial defect. There is no other family history of congenital heart disease. Her parents are concerned about the risk that their next child will also have congenital heart disease. This risk is closest to:
A. 0.5%.
B. 2.5%.
C. 6%.
D. 12.5%.
E. 25%.
B. 2.5%.
A mother notices low-grade rectal bleeding in her breast-fed daughter. The three-week-old infant passes four to five semi-formed stools per day with visible streaks of blood and some mucus. The infant is well and thriving.
What is the most likely diagnosis?
A Anal fissure.
B. Bacterial gastroenteritis.
C. Food protein proctocolitis.
D. Juvenile polyp.
E. Swallowed maternal blood.
C. Food protein proctocolitis.
A 28-week gestation infant, intubated since birth for moderate respiratory distress syndrome, has been steadily improving and is now 48 hours old. The level of ventilatory support has been progressively weaned and is currently as follows:
What would be the most appropriate next step?
A. Extubate to nasal continuous positive airways pressure (CPAP).
B. Make no ventilator changes.
C. Reduce inspiratory time to 0.3 seconds.
D. Reduce PIP by 2 cm H2O.
E. Wean rate to 20/minute.
D. Reduce PIP by 2 cm H2O.
A 16-year-old girl is referred for evaluation of daytime tiredness. She is reported to go to bed at 1.00 a.m. and to have difficulty rising in the morning for school. At weekends she sleeps until early afternoon. No medical or psychiatric symptoms are detectable.
In addition to gradually advancing her bedtime to an earlier time, bright light therapy is recommended. This is most effective if undertaken at which of the following time periods?
A. Early morning.
B. Late morning.
C. Mid afternoon.
D. Evening.
E. Prior to retiring.
A. Early morning.
A nine-year-old girl with cystic fibrosis presents to clinic with a cough productive of brown sputum. Her chest X-ray is shown opposite.
The most likely diagnosis is:
A. allergic bronchopulmonary aspergillosis.
B. atypical mycobacterium infection.
C. Burkholderia cepacia infection.
D. Staphylococcus aureus infection.
E. Stenotrophomonas maltophilia infection.
A. allergic bronchopulmonary aspergillosis.
An eight-year-old girl presents with ketoacidosis and is diagnosed with type 1 (insulin-dependent) diabetes mellitus.
Which of the following autoimmune comorbidities is she most at risk of developing?
A. Addison disease.
B. Hypoparathyroidism.
C. Hypothyroidism.
D. Primary ovarian failure.
E. Vitiligo.
C. Hypothyroidism.
A three-year-old boy is brought to the emergency department of a small rural hospital 30 minutes after being involved in an unwitnessed explosion at his family home. On examination he has sustained facial burns with singeing of his eyebrows and eyelashes. He has a non-circumferential burn to the anterior neck and his estimated percentage of body surface area (BSA) burnt is 5%. He is alert, pink in air and in no respiratory distress. His parents feel that his voice is now ‘croaky’ and you notice a hoarse cough.
Which of the following is the first priority in caring for this patient?
A. Commence intravenous fluids at maintenance.
B. Commence intravenous morphine infusion.
C. Prepare for endotracheal intubation.
D. Urgent ambulance transfer to a tertiary level paediatric hospital.
E. Urgent medical retrieval team to come to the patient.
C. Prepare for endotracheal intubation.
A seven-year-old girl is brought into the emergency department with a generalised rash. Her arm is shown above. This rash is most commonly found in association with:
A. administration of carbamazepine.
B. administration of cefaclor.
C. enterovirus infection.
D. herpes simplex virus (HSV) infection.
E. Mycoplasma pneumoniae infection.
D. herpes simplex virus (HSV) infection.
A four-year-old boy presents with language impairment. His first words were at 18 months. He exhibits anger when he is not understood. His preschool teacher reports that he has difficulty following or understanding basic instructions, often responding inappropriately with talk about his dinosaurs.
His conversation is difficult to follow, with confusing replies. E.g.:
Question: “What did you do at preschool?
Answer: “Time to get in car, and drive long way all way home”
He is heard with playmates responding unclearly. E.g.:
Statement: “I’m making a green snake with playdoh”
Reply: “Greg and Anthony go up the big red car on Wiggles TV”
His language problems are most likely due to:
A. dyspraxia.
B. hearing impairment.
C. intellectual impairment.
D. phonological delay.
E. semantic pragmatic disorder.
E. semantic pragmatic disorder.
A male infant attends at six months of age following relief of neonatal bladder outlet obstruction. The initial micturating cystourethrogram is shown below.
Which of the following findings is most suggestive of a poor long-term prognosis?
A. Nadir serum creatinine > 0.1 mmol/L.
B. Persistent bladder dilatation.
C. Persistent hydronephrosis.
D. Persistent ureteric reflux.
E. Poor urinary stream.
A. Nadir serum creatinine > 0.1 mmol/L.
A previously well eight-year-old right-handed girl presents with progressive left-sided weakness and slurred speech over a 24-hour period. Examination reveals facial and arm weakness. The child had a viral illness with rash five weeks prior to the onset of the event. The computerised tomography (CT) scan of her brain is shown below.
Which of the following viral exanthema have been associated with this clinical scenario?
A. Coxsackie.
B. Measles.
C. Parvovirus.
D. Rubella.
E. Varicella.
E. Varicella.
A term male infant with a birth weight of 2800 g is born at a level 2 rural hospital. He is noted to have a large cleft palate and significant micrognathia. At two hours of age he is noted to be in severe respiratory distress with marked subcostal and sternal recession. On auscultation, very poor breath sounds are audible bilaterally. His condition is improved in the prone position, however he becomes intermittently cyanosed and severe respiratory distress is punctuated by brief apnoeic episodes.
The most appropriate course of action would be:
A. administer head box oxygen.
B. administer oxygen via nasal prongs.
C. insert an endotracheal tube.
D. insert a nasopharyngeal tube.
E. insert an oral airway.
D. insert a nasopharyngeal tube.
A three-year-old girl is admitted to hospital with a two-day history of purpuric rash on the buttocks. Over the last day, she has also developed a painful, swollen left ankle.
On examination she has a temperature of 38°C, palpable purpura on her buttocks and calves, and a warm, swollen left ankle. Her hands and feet are slightly swollen.
Over the next two days she develops intermittent, severe, colicky central abdominal pain. She has non-bilious vomiting and passes blood per rectum. In between bouts of pain her abdomen is soft, nondistended and generally tender with no guarding. There are no masses palpable.
The most appropriate next investigation is:
A. abdominal ultrasound.
B. air enema.
C. barium enema.
D. diagnostic laparoscopy.
E. stool culture.
A. abdominal ultrasound.
A previously well seven-year-old Greek male presents with recent onset of pallor and dark urine. He is on no medications. On examination he is afebrile and pale, with slight icterus and mild splenomegaly. Full blood count reveals:
His blood film is shown above. The most appropriate next investigation to confirm the diagnosis is:
A. direct antiglobulin test.
B. haemoglobin electrophoresis.
C. osmotic fragility test.
D. parvovirus B19 IgM.
E. serum haptoglobin.
A. direct antiglobulin test.
A three-year-old girl presents with a two-month history of two lumps on the left side of her neck and jaw as shown above. Which of the following is the most appropriate initial management?
A. Excision of the lesions.
B. Intravenous flucloxacillin.
C. Needle biopsy of one of the lesions.
D. Oral cephalexin.
E. Oral clarithromycin.
A. Excision of the lesions.
What is the most common sign of Fragile X syndrome in prepubertal boys?
A. High-arched palate.
B. Long face.
C. Macro-orchidism.
D. Motor tics.
E. Poor eye contact.
E. Poor eye contact.
An eight-month-old girl presents with a history of cough and recurrent chest infections. A clinical photograph and chest X-ray of the patient are shown opposite.
Which one of the following is the most likely cause of this infant’s clinical presentation?
A. Lymphoma.
B. Neuroblastoma.
C. Retinoblastoma.
D. Sarcoidosis.
E. Thymoma.
B. Neuroblastoma.
