Nokea
In a patient with painful joint swelling the following investigations are diagnostic:
- A. C-reactive protein
- B. Antinuclear antibodies
- C. Serum C3 (complement) levels
- D. Microscopic examination of synovial fluid
Correct Answer: D
Rationale: Microscopic examination of synovial fluid can reveal crystals, infection, or inflammation, providing a definitive diagnosis.
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During play, a toddler with a history of tetralogy of Fallot (TOF) might assume which position?
- A. Sitting
- B. Supine
- C. Squatting
- D. Standing
Correct Answer: C
Rationale: Squatting naturally increases SVR by occluding venous return from the lower extremities, thereby increasing pulmonary blood flow.
A child has a Glasgow Coma Scale of 3, HR of 88 beats per minute and regular, respiratory rate of 22, BP of 78/52, and blood sugar of 35 mg/dL. The nurse asks the caregiver about accidental ingestion of which drug?
- A. Calcium channel blocker
- B. Beta blocker
- C. ACE inhibitor
- D. ARB
Correct Answer: B
Rationale: Beta blockers affect the heart and also block beta receptors in the liver, reducing glycogen release and causing hypoglycemia. The low HR and BP support beta blocker ingestion.
One of the following is a characteristic physical finding in patients with an ASD
- A. a right precordial bulge
- B. a fixed splitting of the second heart sound
- C. a systolic ejection heart murmur
- D. a short, mild left mid-diastolic murmur
Correct Answer: B
Rationale: Fixed splitting of the second heart sound is a hallmark of an atrial septal defect.
Recognised diagnoses of tender scrotal swelling in infancy include:
- A. Inguinal hernia
- B. Epididymo-orchitis
- C. Breech delivery
- D. Torsion of testis
Correct Answer: D
Rationale: Torsion of the testis is a medical emergency and a common cause of tender scrotal swelling in infancy. Inguinal hernia and epididymo-orchitis are also possible but less urgent. Breech delivery is unrelated.
Regarding reflex anoxic seizures in children:
- A. ECG-rhythm strip is a must
- B. Asystole may be associated
- C. There is increased risk of epilepsy in adults
- D. Carbamazepine is the drug of choice
Correct Answer: B
Rationale: Reflex anoxic seizures in children are often triggered by a sudden noxious stimulus leading to transient asystole (cessation of heart activity). An ECG-rhythm strip is not always necessary there is no increased risk of epilepsy in adults and carbamazepine is not the drug of choice. Trauma can be a precipitating factor but the most relevant option is asystole.