MCQS 167-169 :a tendency for increased height, acne, prolonged PR intervals on electrocardiography and radioulnar synostosis in an 18 year old male




transmission of E. coli O157:H7 usually occurs through

a) bite of ticks
b) mosquito bites
c) drinking water
d) sharing of needles
e) fecal-oral route
f) close personal contact
g) contaminated eggs
h) raw foods
i) rodent bites
j) air conditioning cooling towers


a tendency for increased height, acne, prolonged PR intervals on electrocardiography and radioulnar synostosis in an 18 year old male with behavioural problems are recognised features of

a) XX karyotype
b) XXY karyotype
c) XO karyotype
d) XXX karyotype
e) XY karyotype
f) YO karyotype
g) XYY karyotype
h) Trisomy 13
i) Trisomy 18
j) Trisomy 21


A thrity one year old woman in her fourth uneventful pregnancy goes into labour. She is being assisited by a mid-wife. She complains of mild pain during contractions. She wants to move around during labour . Appropriate treatment by the mid-wife may include:

a) nitrous oxide mixed with oxygen
b) nitrous oxide mixed with air
c) non-steroidal anti-inflammatories
d) opiods by epidural injection
e) opiods by spinal injection
f) Intravenous Patient Controlled Fentanyl
g) oral paracetamol
h) opiods by intramuscular injection
i) Continuous opioid infusion
j) opioid-containing adhesive patch


Correct Answer: H

E. coli O157:H7 is one of hundreds of strains of the bacterium Escherichia coli. Although most strains are harmless and live in the intestines of healthy humans and animals, this strain produces a powerful toxin and can cause severe illness. E. coli O157:H7 was first recognized as a cause of illness in 1982 during an outbreak of severe bloody diarrhea; the outbreak was traced to contaminated hamburgers. Since then, most infections have come from eating undercooked ground beef. The organism can be found on a small number of cattle farms and can live in the intestines of healthy cattle. Meat can become contaminated during slaughter, and organisms can be thoroughly mixed into beef when it is ground. Bacteria present on the cow's udders or on equipment may get into raw milk. Eating meat, especially ground beef, that has not been cooked sufficiently to kill E. coli O157:H7 can cause infection. Contaminated meat looks and smells normal. Although the number of organisms required to cause disease is not known, it is suspected to be very small.


Correct Answer: G

Approximately 1/1,000 newborn males has an XYY chromosome pattern. The XYY adult has few phenotypic manifestations. He tends to be tall and to have severe nodulocystic acne. In affected persons, genital abnormalities have been observed, but cryptic mosaicism, such as X/XYY, is a possibility in these instances. Prolonged PR intervals on electrocardiography and radioulnar synostosis occur more often than in the general population. Renal agenesis and cystic dysplasia of the kidney, as well as hematologic malignancies, have been reported. No clear-cut endocrine abnormalities have been found. This condition poses a serious dilemma for counseling of parents of infants or children discovered to have this sex chromosome complement. The risks for some developmental disability may not be trivial, but neither do they appear to be as dire as earlier thought. Still, the most common reason for a 47,XYY male to be karyotyped is developmental delay or behavioral problems, or both. Children with sex chromosome abnormalities are at an increased risk of learning disabilities, cognitive skill impairments, and difficulties in psychosocial adaptation. Stable, supportive, and compassionate family environments promote improved adaptation of these children and adolescents.


Correct Answer: H

Appropriate treatment by the mid-wife may include: h) opiods by intramuscular injection This is the most common way in which opioid drugs are administered, both during labour and after surgery. The most common sites of injection are the outer side of the thigh or the buttock. The injection is given in a small volume (l-2 ml) by a nurse and is not usually painful. A muscle is chosen because the drug is absorbed into the bloodstream quicker than if it were to be injected just beneath the skin. It takes time for the drug to be absorbed from a muscle and to reach its peak concentration in the bloodstream (and so achieve its maximal effect). For most opioids, this interval is approximately 15-30 minutes. Once the opioid enters the bloodstream, it is circulated all around the body and leaks out through the finest blood vessels (capillaries) into the various organs and tissues, until it is absorbed back into the bloodstream again. Inevitably, a proportion also passes into the nervous system and comes into contact with a sufficient number of opioid receptors to produce a clinical effect.


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