MRCPCH (FOP&TAS)- Feb/2018

{{FOP-Feb/2018}}
1. Catch 22 best ix
Fish/or cgh

2. Mechanism of autoautistic emission test

Cochlea act as microphone
Cholea hair cell function

3.Cystic fibrosis FEV1 1.3 FVC 1.9 , FEV1 (-2.3 SD), FVC -1.3 SD
Interpretation:
Obstructive with insignificant restrictive
Restrictive
Mixed

4.Father 55 mother 25 down

Mech maternal non disjunction
Paternal non disjunction

5.EMQ
One month old sepsis with long line
Staph epidermidis
One month old sepsis on vanco
Mrsa
One month old rupture membranes and NVD
Group b

6.EMQ
NB liver spleen palpable mother normal plt count and nb has petichei
CMV I think

NB liver spleen just palpable with petichea and low plts normal mother CBC
I think alloimmune not sure

NB liver spleen just palpable and mother plt 23,000

Mother immune thrombocytopenia or sLE I don’t know
7.EMQ
Old obese boy playing games at home and taking orlistat what will u supplement
(vit D orE orA)
Vegetarian mother (b12)
Mother and father non consanguinity and baby diarrhea and alopecia I think
(Acrodermatitis enteropathica. ..zinc is right ans)

8. Boy with normal lung and hyperventilating

ABG will show….

9. One question showed double blind trial in several hospitals from 2008 to 2010
to study treatment effect I think

10.
One question negative predrdictive value of 990 tested negative non of them had
the disease RCT or systematic review

11.
220 patient will start a new treatment we want to study the effect of treatment
after period of time

(Placebo control /cohort)

12. Neoborn didn’t pass urine for 24 hrs k:7.6 Cr 60 bilirubin 120
PUV or hemolysed sample

13. RBC 9000 RBC in CSF sample 3 consecuative

Normal G proteins
Options included(traumatic CSF /venous thrombosis /hermetic encephalitis)

14. uncle has problem with kidney and boy enurisis

nephrogenic DI

15. Boy drink morning not drinking at night

Habitual drinking
16. Leukemia patient WBC 30 ph high I think hb 6.5 plts 50,he was afebrile
What to do next , In question, it includes that the doctor suggested to start
allopurinol, 

start dexa
Transfuse packed
Transfuse plt
Abs
Saline IV

17. 2 ABGs interpretation

One included mixed resp and metabolic acidosis as HCo3 was low and co2 high
I think so
Other one I can’t remember

18.Low Na and HCo3 and K in EMQwas pyloric stenosis I think

19.celiac disease What will help in diagnosis ?

Ans included HLA DQ2/DW8
Anti ttg iG A
Anti endomiasial IGA

20.djustment of ventilator setting question:

Ph alkalosis
Po2 8.5
Pco2 4.5
rate 60
Options included many things I don’t remember

21.One question regarding leukemia prognostic factor?

22.Obstructive sleep apnea diagnosis

Polysomgrqphy
Or saturation at night

23. One palliative boy needs NGT

What ethical issue to tell the parents? Coz they are refusing

(Procedure will not cause pain

Procedure will help him better quality of life)
Prevent aspiration pneumonia
24.14 years old girl with tachycardia and poor sleep she will have
TSH receptor abs/immunoglobulins for I do t remember /TRH antibodies

25.Question one boy diabetic and celiac screen negative what will make
you search again
Answers included many HLA
One of them B27
OneDQ2/DQ8

26.a nurse gave the same drug twice what is the correct answer ? I choose
inform the parent after calling the clinical governance …

27. worest prognostic Factor for diaphragmatic hernia

(lung hypoplasia/Oligohydraminous )
I don’t know

28. Mother Chronic hep C What to advice

Cs
put baby under observation after delivery
give IVIGto baby after delivery
normal vaginal
no breast feeding

29.Why to modify cow milk

Option includes
Phosphate high
Casein sth high
Etc

30. Mother with gdm. Related Congenital anomaly.

Sacral agenesis.
31.
EMQ:
(Genetic risk calculation )
1/ Risk of having an affected baby for a parents who have a son with sickle cell
disease ?1:4
2/ Risk of having a baby (boy) to a father who has haemophilla A ? Population
risk
3/ Risk for a daughter to be a carrier of cystic fibrosis , she has an affected sibling
? 2:3

32.
EMQ:
(Neonatal resus)

33. First sign of puberty in males

Enlargement testis

34.Truncus arteiosis with hypoplastic parathyroid

35.
Adhd with methylphenidate

36. Appendicitis consent


Child has acute appendicitis..need surgery..mother out of the
country..accompanied by mother's bf (not father)..best way to obtain consent?
Options were

wait for 4 hrs..

consent over the phone by mother..call mother ?

37. Absence seizure first line treatment


(in the options sodium valporate and lamotrigine)

38. DkA management?

39. Down syndrome with bilious vomiting ,not passing meconium what is
the diagnosis?
hirschsprung in down

40. which one of the cases needed skull scan? 


4 months with spiral humerus fracture(abuse)

41. 8 years girl started getting enuresis,soiling in school setting alone in

her room most of time..all that after her step father son move to their house
(sextual abuse)

42. epiglotitis

43. pyloric stenosis:failure to thrive,projectile vomiting….

44. immunocompromized child his brother seems to has varicella what to

do for him?
*immunoglobulin+vaccine
*immunoglobulin and aciclovir if he develops rash

45. Asthmatic patient on salbutamol started developing increased attack at

night what is next?
steroids

46.In status epilepticus after giving buccal medazolam what is next ?

(lorazepam)

47. After surgery what is the management of adhesions

(decompression by ng tube + Iv fluid)

48. Dietary iron deficiency anemia

(after prolonged execlusive breast feeding after 9 months)

49. perthes disease

50. alcoholic fetal syndrome

51. Brain stem evoked potentials hearing test in less than 6 months
52. tricyclic antidepressants overdose
(give sodium.bicarb)

53. Follow pneumonia causes deminished air entery in affected area and
pushing trachea to the opposite side)

54. what is the management of TCA overdose?

(in scenario)

55. image test needed after fist UTI

(E-coli)

56. adrenal dysplasia

57. undescending testis management

58. Testicular torsion

59. meningitis prophylaxis for contact family

60. G6PD deficiency

61. Chlamyda urethritis in 16 yr old boy……

doxycyclin

62. Type of maintenance fluid in DKA………..

0.9% saline with 20 mmol KCl in 500 ml

63. A girl with headache. Examination show bilateral papilloedema. Whats

the next step?

Cranial MRI

64. Squint at 4 months….???

65. Prophylaxis for .....old girl with contact with brother with memigococcal
septicemia………

ciprofloxacin

66. Staph aureus pnemonia+diminshed air entry on left side+shift of

mediastinum to right……..

pleural effusion

67. Jaundice and splenomegally and pale.......

Hereditary spherocytosis

68. Senario of case mostly CAH , Ask about investigation…..

17OH progesterone

69. EMQ 3 CASE OF HYPERBILIRUBINEMIA

1st because failure to establish breast feeding
2nd G6PD
3rd ABO

70. EMQ 3 cases with same history , Father duodenal ulcer, aunt with croh's
All cases ask about one investigation?????
case with diarrhea and blood
Case with vomiting and abd pain
Case with pain and wake in night

First one colonoscopy and biopsy

2nd.....ant trangluti...Ab
3rds.....upper GI scopy and biopsy

71.EMQ
CLINICAL and LAB finding
a. Iron deficiency anemia
b. HS
c. G6PD
72.EMQ
RISK RATIO IN
HEMOPHILIA
SICKLE CELL ANEMIA
HEALTHY daughter of cystic fibrosis patient

73. Paracetamol staggered overdose came after 24 hrs and with H/o of rash
when before given N acetyl cysteine

74. EMQ:
(Genetic risk calculation )
1/ Risk of having an affected baby for a parents who have a son with sickle cell
disease ?1:4
2/ Risk of having a baby (boy) to a father who has haemophilla A ? Population
risk
3/ Risk for a daughter to be a carrier of cystic fibrosis , she has an affected sibling
? 2:3

75. Teenage developed loss of wt 5kilos in 1month..fainting attack in

supermarket...loss of wt ..hx of loose mucoid stool..agitation sleep
problem.HR 120 ,Proximal myopathy present , Mom is having type 2D
M.what is the diagnisis?
Aonrexia.
.crohns..
.hyperthyroidism.

76.Child with hyper tension and abd pain

Normal abdominal examination?
77.
girl with peculiar feeding habits, lost wt, mother think she induce vomiting
by herself, what is the clinical finding make you sure she do this

Teeth erosion
2ry amenorrhea

78.Case mostly infective endocarditis........blood culture

79.Case with infective endocarditis for operation........operate and not give

prophylaxis

80. little boy he had generalized seizure while being prepared for hernia
repair and had a seizure back when had a GE.

MCAD

81. One boy with mass in the neck non tender and not warm and fully
immunized and from UK , Us shows cyst , it showed fluid in it.
Infected branchial cyst
 {{TAS-Feb/2018}}
1.Mechanism of TSS toxins
T cell
B cell macrophages

2.Mech of k depletion in DKA

Osmotic diurisis
Insulin therapy

3.Mech of metformin
Inhibit enzymes of hepatic glycogenolysis
Increase uptake by activating (s...bla bla bla) in adipose tissue

4.Mech toclozimab

5.Mech of etrancept

6.Mech atampxiphine

7.Mech of CGH

8.what Colon absorb the most:


I think water Absorbed Throughout SI (I don’t know there where CHo fats
proteins mg ph folic acid water )

9.
Content of breast milk bonds to iron
Content make lactobacilli florish
Content for Ag tolerance
Options where including (lactoferrin/lactobacelli/ IgA/cd14
10.

Activate alpha receptor : decrease mucus secreation
Activate b1 can cause arrhythmia
(There were phenylephrine and dopamine doputamine isoprenaline in options)

11.
Baby on dopamine infusion his blood pressure is high now wht would u
expect?
Urine retention
Bronchospam
Increase peripheral vascular resistance

12.Coles fracture , nerve injury ?

13.Eye can’t abduct(nerve??

14.Occulmotor injury what to expect:


(ptosis/meiosis /eye inf and lat/ eye sup and lat)

15. Congruent hemianopia (lesion optic tract or occiptal lobe)

16.Mechanism of phsiological anemia of newborn


decrease EPO
folic acid depletion

17.Girl with pansystolic murmur and pulmonary plethora 


I think( options including pulmonary vascular resistance increased or decreased
with inc or dec pulm blood flow and lt to right shunt) was so hard options

18. Mechanism of retinopathy of prematurity

19. Mech of phototherapy

Options included (isoisomerization or oxidation of bilirubin )

20.Q. About G_ve diplococci

21. Icthyosis vulgaris mechanism

22.Action of kidney on vit D(no option of 1,25 oh cholechalceferol)

Other options 24,25

23. Gram negative dipoloccoci

Neisseria meningitidis

24.CAH
(high renin and high acth/ low both / or one high one low)
25.Hypocalcemia :

(Increase PTH and Increase vit D and Increase ph in urine and Increase
osteoclastic activity and increase absorption )
Other options included decreases in one of them in each option

26.1st question sth regarding transepidermal is prem baby..sweat gland..pain

receptor,Sweat gland doesn’t appear before 24 weeks
Or pain doesn’t occur before I don’t remember which week

27. boy with enuriesis urine NA is 90 normal serum NA

Low k I think 2
Cl is 118

Options included Renal tubular disease

Barter or other options

28.A boy with stridor this is due to:


(extrathoracic lesion/ intrapulmonary lesion/ extrapumonary intrathoracic

29.Aneuploidy example

(69xx 46xxy 46xy22q11

30.What drug augment action of sulphonamides?

31.What drug inhibit folate?

32.Carbamazepine mech of action

(Stimulate GABA or NA ch blocker)

33.infliximab binds with which protein?

TNF alpha
34.Negative predictive value

35.Orlistat needs supplementation of which vitamin?

36.EMQ
* 2 days old baby with mild petechial rash tip of spleen maternal count
normal?
* Same baby with low maternal count and widespread petechia, birth
weight was 2.1kg
* 3rd one also with normal count mild patechia and HSM??
37. Tocilizumab mechanism of action ?

38.Organism causing hydrops fetalis?

Parvovirus

39.Zidovudine mech of action

40.Most common HUS..

E.coli

41.Patient on chemotherapy. On doxo, vincristine and cyclophosphamide.

Developed foot drop. Reason?

I put reversible cause of chemotherapy.

42.Noradrenaline act on which receptor

43.Same group as gentamicin - amikacin

44.Pneumococcal conjugate vaccine 13 -

Carrier protein for polysaccharide

45.Selective beta 1 agonist which increase cardiac contractility bt can

cause arrhytmia-
dopamine

46.Child developed unequal ppl after neb salbutamol and ipratopium

bromide. How to confirm diagnosis?
1% pilocarpine

47.Blood test diagnostic for SLE

48. Patient diagnosed with truncus arteriosus. Whats the other associated
anomaly?
Parathyroid hypoplasia

49.Diagnostic for chlamydia urethritis -

nucleic acid amplification

50.Ichthyosis vulgaris -
filaggrin

51.Factor causing risk of cerebral edema in dka patient -

rapid correction of glucose

52.Diaphragmatic hernia worse prognosis if it’s from left side

pul hypoplasia
olig

53.22q11 deletion - FISH

54. What is array comparative genomic hybridisation?

55.Effect of hypocalcemia on (phosphate, PTH, ALP, Ca reapsorption in

kidney and calcitrol).
Ans >> all increased except phosphate decreased

56.Ph absorption maximally from Pct or loop of Henle ?

57.CAH Increase ACTH renin-low cortisol???

58.3senarios baby on ventilators and developed increased demands of

oxygen,,,,which organisms........,.really it was a silly question.until now I
don’t know the answer