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Question 1
Incorrect
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A 30-year-old male falls on the back of his hand. On x-ray, he has a fractured distal radius demonstrating volar displacement of the fracture. What eponymous term is used to describe this?
Your Answer: Colles'
Correct Answer: Smith's
Explanation:The Frykman classification of distal radial fractures is based on the AP appearance and encompasses the eponymous entities of Colles fracture, Smith fracture, Barton fracture, chauffeur fracture.
Colles fractures are very common extra-articular fractures of the distal radius that occur as the result of a fall onto an outstretched hand. They consist of a fracture of the distal radial metaphyseal region with dorsal angulation and impaction, but without the involvement of the articular surface.
Colles fractures are the most common type of distal radial fracture and are seen in all adult age groups and demographics. They are particularly common in patients with osteoporosis, and as such, they are most frequently seen in elderly women.Smith fractures, also known as Goyrand fractures in the French literature 3, are fractures of the distal radius with associated volar angulation of the distal fracture fragment(s). Classically, these fractures are extra-articular transverse fractures and can be thought of like a reverse Colles fracture.
The term is sometimes used to describe intra-articular fractures with volar displacement (reverse Barton fracture) or juxta-articular fracturesBarton fractures are fractures of the distal radius. It is also sometimes termed the dorsal type Barton fracture to distinguish it from the volar type or reverse Barton fracture.
Barton fractures extend through the dorsal aspect to the articular surface but not to the volar aspect. Therefore, it is similar to a Colles fracture. There is usually associated with dorsal subluxation/dislocation of the radiocarpal joint.Chauffeur fractures (also known as Hutchinson fractures or backfire fractures) are intra-articular fractures of the radial styloid process. The radial styloid is within the fracture fragment, although the fragment can vary markedly in size.
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This question is part of the following fields:
- Generic Surgical Topics
- Orthopaedics
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Question 2
Correct
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An organ transplant patient may be at risk of developing which type of cancer?
Your Answer: Skin cancer
Explanation:The most common malignancies encountered in the post–solid organ transplant setting are non-melanoma skin cancers, post-transplant lymphoproliferative disorders and Kaposi’s sarcoma (KS). The pathogenesis of these tumours is likely related to the immunosuppressive drugs used post-transplantation and subsequent viral infection.
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This question is part of the following fields:
- Basic Sciences
- Pathology
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Question 3
Correct
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A 40 year old woman has a full thickness burn on her foot after being trapped in a burning building. The limb has no fractures but the burn is well circumscribed. She starts complaining of tingling of her foot which has a dusky look after 3 hours. Which of the following is the best management step?
Your Answer: Escharotomy
Explanation:Answer: Escharotomy
Escharotomy is the surgical division of the nonviable eschar, which allows the cutaneous envelope to become more compliant. Hence, the underlying tissues have an increased available volume to expand into, preventing further tissue injury or functional compromise.
Full-thickness circumferential and near-circumferential skin burns result in the formation of a tough, inelastic mass of burnt tissue (eschar). The eschar, by virtue of this inelasticity, results in the burn-induced compartment syndrome. This is caused by the accumulation of extracellular and extravascular fluid within confined anatomic spaces of the extremities or digits. The excessive fluid causes the intracompartmental pressures to increase, resulting in collapse of the contained vascular and lymphatic structures and, hence, loss of tissue viability. The capillary closure pressure of 30 mm Hg, also measured as the compartment pressure, is accepted as that which requires intervention to prevent tissue death.
The circumferential eschar over the torso can lead to significant compromise of chest wall excursions and can hinder ventilation. Abdominal compartment syndrome with visceral hypoperfusion is associated with severe burns of the abdomen and torso. (A literature review by Strang et al found the prevalence of abdominal compartment syndrome in severely burned patients to be 4.1-16.6%, with the mean mortality rate for this condition in these patients to be 74.8%). Similarly, airway patency and venous return may be compromised by circumferential burns involving the neck.
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This question is part of the following fields:
- Emergency Medicine And Management Of Trauma
- Principles Of Surgery-in-General
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Question 4
Incorrect
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A 56 year old man presents to the emergency with a type IIIc Gustilo and Anderson fracture of distal tibia after being involved in a road traffic accident. He was trapped under the wreckage for about 7 hours and had been bleeding profusely from the fracture site during this time. He is found to have an established neurovascular deficit. Which of the following is the most appropriate course of action?
Your Answer: Application of external fixator and arterial reconstruction
Correct Answer: Amputation
Explanation:A below-knee amputation (“BKA”) is a transtibial amputation that involves removing the foot, ankle joint, and distal tibia and fibula with related soft tissue structures. In general, a BKA is preferred over an above-knee amputation (AKA), as the former has better rehabilitation and functional outcomes. There are three major categories of indications for proceeding with a BKA. These include:
– Urgent cases where source control of necrotizing infections or haemorrhagic injuries outweighs limb preservation.
– Less acutely, urgent BKAs may be performed for chronic nonhealing ulcers or significant infections with the risk of impending systemic infection or sepsis.
– Urgent BKAs may be performed where limb salvage has failed to preserve a mangled lower extremity. Adequate resuscitation and stabilization must always have occurred before such a decision, as judged by vital signs, lactate, base deficit, and the management of concomitant injuries.
This man is hemodynamically unstable and the limb is likely to be non-viable after so many hours of entrapment. Hence, the safest option would be primary amputation of the injured limb. -
This question is part of the following fields:
- Emergency Medicine And Management Of Trauma
- Principles Of Surgery-in-General
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Question 5
Correct
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A young lady is stabbed in the chest when she was leaving a party and she develops a cardiac arrest in the A&E department. What is the best course of action?
Your Answer: Thoracotomy
Explanation:Answer: Thoracotomy
Cardiac arrest after penetrating chest trauma may be an indication for emergency thoracotomy. A successful outcome is possible if the patient has a cardiac tamponade and the definitive intervention is performed within 10 minutes of loss of cardiac output.
EMERGENCY “CLAM SHELL” THORACOTOMYIndication:
Penetrating chest/epigastric trauma associated with cardiac arrest (any rhythm).
Contraindications:
Definite loss of cardiac output for greater than 10 minutes.Any patient who has a cardiac output, including hypotensive patients.
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This question is part of the following fields:
- Emergency Medicine And Management Of Trauma
- Principles Of Surgery-in-General
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Question 6
Correct
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Abnormal breathing is noticed in a of victim of a road traffic accident, who sustained a head injury. The breathing pattern is characterised by alternate periods of waxing and waning tidal volumes with interspersed periods of apnoea. This breathing pattern is known as:
Your Answer: Cheyne–Stokes breathing
Explanation:Cheyne-Stokes breathing is an abnormal breathing pattern with breathing periods of gradually waxing and waning tidal volumes, with apnoeic periods interspersed. It is usually the first breathing pattern to be seen with a rise in intracranial pressure and is caused by failure of the respiratory centre in the brain to compensate quickly enough to changes in serum partial pressure of oxygen and carbon dioxide. The aetiology includes strokes, head injuries, brain tumours and congestive heart failure. It is also a sign of altitude sickness in normal people, a symptom of carbon monoxide poisoning or post-morphine administration. Biot’s respiration (cluster breathing) is characterized by cluster of quick, shallow inspirations followed by regular or irregular periods of apnoea. It is different from ataxic respiration, which has completely irregular breaths and pauses. It results due to damage to the medulla oblongata by any reason (stroke, uncal herniation, trauma) and is a poor prognostic indicator. Kussmaul breathing, also known as ‘air hunger’, is basically respiratory compensation for metabolic acidosis and is characterized by quick, deep and laboured breathing. It is most often seen in in diabetic ketoacidosis. Due to forced inspiratory rate, the patients will show a low p(CO2). Ondine’s curse is congenital central hypoventilation syndrome or primary alveolar hypoventilation, which can be fatal and leads to sleep apnoea. It involves an inborn failure to control breathing autonomically during sleep and in severe cases, can affect patients even while awake. It is known to occur in 1 in 200000 liveborn children. Treatment includes tracheostomies and life long mechanical ventilator support.
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This question is part of the following fields:
- Basic Sciences
- Physiology
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Question 7
Correct
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A 60-year old gentleman visited his general practitioner complaining of high grade fever for 7 days and a dull, aching pain in his left lumbar region. On enquiry, he admitted to having a burning sensation while passing urine. His blood results showed an elevated white blood cell count with a left shift. In his condition, which is the most characteristic finding on urine examination?
Your Answer: White blood cell casts
Explanation:Tubulointerstitial nephritis is the term given to primary injury to renal tubules and the renal interstitium, which ultimately results in a decline in renal function. Acute tubulointerstitial nephritis (acute pyelonephritis) is often seen as a result of infection or drug reactions. The most characteristic feature of this condition on urine analysis is the presence of white blood cell casts.
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This question is part of the following fields:
- Basic Sciences
- Pathology
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Question 8
Incorrect
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Into which vein does the left and right thyroid vein drain?
Your Answer: External jugular vein
Correct Answer: Brachiocephalic vein
Explanation:The brachiocephalic vein is formed by the confluence of the subclavian and internal jugular veins. In addition it receives drainage from: the left and right internal thoracic veins (also called internal mammary veins), left and right inferior thyroid veins
and the left superior intercostal vein -
This question is part of the following fields:
- Anatomy
- Basic Sciences
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Question 9
Correct
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A patient is admitted to the ICU, and is prescribed tazobactam, amongst other drugs. What is the mechanism of action of tazobactam?
Your Answer: Inhibits beta-lactamase
Explanation:Tazobactam is a compound which inhibits the action of bacterial beta-lactamases. It is added to the extended-spectrum beta-lactam antibiotic piperacillin to broaden the spectrum of piperacillin by making it effective against organisms that express beta-lactamase and would normally degrade piperacillin.
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This question is part of the following fields:
- Basic Sciences
- Pathology
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Question 10
Incorrect
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A 33 year old man with fulminant ulcerative colitis underwent a subtotal colectomy. Which type of stoma would most likely be fashioned?
Your Answer: End colostomy
Correct Answer: End ileostomy
Explanation:Subtotal colectomy is resection of the entire right, transverse, left and part of the sigmoid colon. The rectal stump is closed and an end ileostomy fashioned in the right iliac fossa.
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This question is part of the following fields:
- Generic Surgical Topics
- The Abdomen
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Question 11
Incorrect
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What is the 5 year survival rate of a patient who is diagnosed with stage III colon cancer, who underwent successful resection and completed the prescribed session of adjuvant chemotherapy?
Your Answer: 70%–85%
Correct Answer: 30%–60%
Explanation:In this patient who has stage III colon cancer, the survival rate is 30-60%. For stage I or Dukes’ stage A disease, the 5-year survival rate after surgical resection exceeds 90%. For stage II or Dukes’ stage B disease, the 5-year survival rate is 70%–85% after resection, with or without adjuvant therapy. For stage III or Dukes’ stage C disease, the 5-year survival rate is 30%– 60% after resection and adjuvant chemotherapy and for stage IV or Dukes’ stage D disease, the 5-year survival rate is poor (approximately 5%).
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This question is part of the following fields:
- Basic Sciences
- Pathology
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Question 12
Correct
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A CT-scan report of a patient with gastric carcinoma shows that the lymph nodes around the coeliac trunk are enlarged. The coeliac trunk:
Your Answer: Gives rise to the splenic, left gastric and common hepatic arteries
Explanation:The coeliac trunk is a branch of the aorta arising just below the aortic hiatus of the diaphragm to pass nearly horizontally forward to divide into 3 large branches i.e. the left gastric, the hepatic and the splenic arteries. Occasionally it may give off one of the inferior phrenic arteries. It is covered by the lesser omentum and on the right side bordered by the right coeliac ganglion and the cardiac end of the stomach. Inferiorly it is bordered by the upper border of the pancreas and splenic vein. The embryonic midgut is supplied by the superior mesenteric artery.
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This question is part of the following fields:
- Anatomy
- Basic Sciences
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Question 13
Correct
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What is the arterial sequence for an analgesic to reach the latissimus dorsi muscle assuming that your starting point is at the subclavian vein?
Your Answer: Subclavian – axillary – subscapular – thoracodorsal
Explanation:Assuming our starting point is the subclavian artery, the analgesic continues in the same vessel into the axillary artery, as it passes into the axilla. The axillary artery at the lower border of the subscapularis gives rise to the subcapsular artery which is considered the largest branch of the axillary artery. This circumflex scapular branch distributes a serratus branch before entering the substance of the muscle as the thoracodorsal artery.
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This question is part of the following fields:
- Anatomy
- Basic Sciences
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Question 14
Incorrect
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A 45-year-old man presented to the doctor complaining of a flank pain and episodes of haematuria. Abdominal ultrasound revealed a left renal mass and the patient underwent a nephrectomy. Histopathological pattern was triphasic with blastemal, epithelial, and stromal components. The pathologist suggested the tumour resulted from the lack of a tumour suppressor gene on chromosome 11. Which of the following tumours is the pathologist most likely suggesting?
Your Answer: Renal cell carcinoma
Correct Answer: Wilms’ tumour
Explanation:Wilms’ tumour is one of the most common malignant tumours of childhood but it can also rarely be found in adults. In biopsy, classical histopathological findings include the triphasic pattern composed by blastemal, epithelial, and stromal elements. First symptoms in children include an abdominal palpable mass, while in adults pain and haematuria are the most common complaints. Deletions of tumours’ suppressor genes on chromosome 11 are usually associated with Wilms’ tumour.
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This question is part of the following fields:
- Basic Sciences
- Pathology
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Question 15
Incorrect
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The posterior cord contains nerve fibres from which of the following levels of the spinal cord?
Your Answer: C5, C6 and C7
Correct Answer: C5, C6, C7, C8 and T1
Explanation:THE correct answer is A. The posterior cord derives its fibres from the spinal nerves C5,C6,C7,C8,T1. This cord is formed from the fusion of the posterior divisions of the upper, lower, and middle trunks.
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This question is part of the following fields:
- Anatomy
- Basic Sciences
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Question 16
Incorrect
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Hormones of the anterior pituitary include which of the following?
Your Answer: Oxytocin
Correct Answer: Prolactin
Explanation:The anterior pituitary gland (adenohypophysis or pars distalis) synthesizes and secretes:
1. FSH (follicle-stimulating hormone)
2. LH (luteinizing hormone)
3. Growth hormone
4. Prolactin
5. ACTH (adrenocorticotropic hormone)
6. TSH (thyroid-stimulating hormone).
The posterior pituitary gland (neurohypophysis) stores and secretes 2 hormones produced by the hypothalamus:
1. ADH (antidiuretic hormone or vasopressin)
2. Oxytocin -
This question is part of the following fields:
- Basic Sciences
- Physiology
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Question 17
Incorrect
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Which of the following proteins prevents red blood cells (RBCs) from bursting when they pass through capillaries?
Your Answer: Integrin
Correct Answer: Spectrin
Explanation:Spectrin is a structural protein found in the cytoskeleton that lines the intercellular side of the membrane of cells which include RBCs. They maintain the integrity and structure of the cell. It is arranged into a hexagonal arrangement formed from tetramers of spectrin and associated with short actin filaments that form junctions allowing the RBC to distort its shape.
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This question is part of the following fields:
- Basic Sciences
- Physiology
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Question 18
Incorrect
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Thalamic syndrome will most likely result in:
Your Answer: Increased temperature
Correct Answer: Hyperaesthesia
Explanation:Signs and symptoms of thalamic syndrome include contralateral hemi anaesthesia, burning or aching sensation in one half of a body (hyperaesthesia), often accompanied by mood swings.
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This question is part of the following fields:
- Basic Sciences
- Physiology
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Question 19
Incorrect
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A 13 year old girl presents to the clinic with weight loss and bloody diarrhoea. Examination of the abdomen is unremarkable. What is the most likely diagnosis?
Your Answer: Viral gastroenteritis
Correct Answer: Inflammatory bowel disease
Explanation:Answer: Inflammatory bowel disease
The inflammatory bowel diseases (IBDs), including ulcerative colitis and Crohn disease, are chronic inflammatory disorders of the gastrointestinal tract most often diagnosed in adolescence and young adulthood, with a rising incidence in paediatric populations. Inflammatory bowel disease is caused by a dysregulated mucosal immune response to the intestinal microflora in genetically predisposed hosts. Although children can present with the classic symptoms of weight loss, abdominal pain, and bloody diarrhoea, many present with nonclassical symptoms of isolated poor growth, anaemia, or other extraintestinal manifestations.
Colorectal Carcinoma (CRC) is rare in patients less than 20 years of age.
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This question is part of the following fields:
- Generic Surgical Topics
- Paediatric Surgery
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Question 20
Incorrect
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A 60-year old man with a left-sided indirect inguinal hernia underwent emergency surgery to relieve large bowel obstruction resulting from a segment of the bowel being strangulated in the hernial sac. The most likely intestinal segment involved is:
Your Answer: Descending colon
Correct Answer: Sigmoid colon
Explanation:The sigmoid colon is the most likely segment involved as it is mobile due to the presence of the sigmoid mesocolon. The descending colon, although on the left side, is a bit superior and is also retroperitoneal. The ascending colon and caecum are on the right side of the abdomen. The rectum is too inferior to enter the deep inguinal ring and the transverse colon is too superior to be involved.
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This question is part of the following fields:
- Anatomy
- Basic Sciences
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Question 21
Incorrect
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During a procedure to treat an ulcer in the first part of the duodenum, the most appropriate site to make the incision on the anterior abdominal wall to approach this ulcer would be the:
Your Answer: Hypogastric region
Correct Answer: Epigastric region
Explanation:The abdomen is divided into nine regions for descriptive purposes. The epigastric region contains the first part of the duodenum, part of the stomach, part of the liver and pancreas. This would be the region that the surgeon would need to enter to access the ulcer.
The left inguinal region contains the sigmoid colon.
The left lumbar region contains the descending colon and kidney.
The right lumbar region contains the right kidney and descending colon.
The right hypochondrial region contains part of the liver and gall bladder.
The hypogastric region contains the urinary bladder and the rectum. -
This question is part of the following fields:
- Anatomy
- Basic Sciences
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Question 22
Correct
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The gynaecologist suspects that her patient has a cervical cancer. What particular test should be done on this patient to screen for cervical cancer?
Your Answer: Pap smear
Explanation:Worldwide, approximately 500,000 new cases of cervical cancer and 274,000 deaths are attributable to cervical cancer yearly. This makes cervical cancer the second most common cause of death from cancer in women. The mainstay of cervical cancer screening has been the Papanicolaou test (Pap smear).
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This question is part of the following fields:
- Basic Sciences
- Pathology
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Question 23
Incorrect
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Which of the following conditions may cause hypovolaemic hyponatraemia?
Your Answer: Protracted vomiting
Correct Answer: Cirrhosis
Explanation:The most common cause of hypovolaemic hyponatraemia include: liver cirrhosis, congestive heart failure and nephrotic syndrome. In hypovolaemic hyponatraemia, both sodium and water content increase: Increase in sodium content leads to hypervolemia and water content to hyponatraemia.
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This question is part of the following fields:
- Basic Sciences
- Pathology
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Question 24
Correct
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Whilst snorkelling, a 30-year old gentleman has the respiratory rate of 10/min, tidal volume of 550 ml and an effective anatomical dead space of 250 ml. What is his alveolar ventilation?
Your Answer: 3000 ml/min
Explanation:Alveolar ventilation is the amount of air reaching the alveoli per minute. Alveolar ventilation = respiratory rate × (tidal volume – anatomical dead space volume). Thus, alveolar ventilation = 10 × (550 − 250) = 3000 ml/min.
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This question is part of the following fields:
- Basic Sciences
- Physiology
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Question 25
Correct
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A 43 year old man presents with a perianal abscess which is managed by incision and drainage. The wound measures 2.5cm x 2.5cm. What is the best step in management?
Your Answer: Allow the wound to heal by secondary intention
Explanation:Answer: Allow the wound to heal by secondary intention
A perianal abscess is a type of anorectal abscess that is confined to the perianal space. Other causes can include inflammatory bowel diseases such as Crohn’s disease, as well as trauma, or cancerous origins. Patients with recurrent or complex abscesses should be evaluated for Crohn’s disease. Perianal abscesses are the most common type of anorectal abscesses. These abscesses can cause significant discomfort for patients. They are located at the anal verge and if left untreated can extend into the ischioanal space or intersphincteric space since these areas are continuous with the perianal space. They can also cause systemic infection if left untreated. Patients will complain of anal pain which may be dull, sharp, aching, or throbbing. This may be accompanied by fever, chills, constipation, or diarrhoea. Patients with perianal abscess typically present with pain around the anus, which may or may not be associated with bowel movements, but is usually constant. Purulent discharge may be reported if the abscess is spontaneously draining, and blood per rectum may be reported in a spontaneously draining abscess.
A physical exam can typically rule out other causes of anal pain, such as haemorrhoids, and will yield an area of fluctuance or an area of erythema and induration in the skin around the perianal area. Cellulitis should be noted and marked if extending beyond the fluctuant area.
Perianal abscesses are an indication for timely incision and drainage. Antibiotic administration alone is inadequate and inappropriate. Once incision and drainage are performed, there is no need for antibiotic administration unless certain medical issues necessitate the use. Such conditions include valvular heart disease, immunocompromised patients, diabetic patients, or in the setting of sepsis. Antibiotics are also considered in these patients or cases with signs of systemic infection or significant surrounding cellulitis.
Incision and drainage are typically performed in an office setting, or immediately in the emergency department. Local anaesthesia with 1% lidocaine may be administered to the surrounding tissues. A cruciate incision is made as close to the anal verge as possible to shorten any potential fistula formation. Blunt palpation is used to ensure no other septation or abscess pocket is missed. It is useful before completion of procedure to excise a skin flap of the cruciate incision or the tips of the four skin flaps to ensure adequate drainage and prevent premature healing of the skin over the abscess pocket. Packing may be placed initially for haemostasis. Continual packing may be further utilized for healing by secondary intention. Patients are encouraged to keep the incision and drainage site clean. Sitz baths may assist in pain relief.
More extensive abscesses may require the operating room for the adequate exam under anaesthesia to ensure adequate drainage, as well as inspect for other diseases such as fistula in ano.
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This question is part of the following fields:
- Peri-operative Care
- Principles Of Surgery-in-General
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Question 26
Incorrect
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Choose the most correct answer regarding the obturator internus muscle.
Your Answer: It adducts the thigh
Correct Answer: It emerges from the pelvis through the lesser sciatic foramen
Explanation:The obturator internus arises from the inner surface of the anterolateral wall of the pelvis and the pelvic surface of the obturator membrane. The fibres converge rapidly towards the lesser sciatic foramen and end in four or five tendinous bands and leave the pelvis through the lesser sciatic foramen.
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This question is part of the following fields:
- Anatomy
- Basic Sciences
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Question 27
Correct
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A 41-year-old man presents with a severe left-sided loin pain radiating to the groin. Imaging demonstrates a 2 mm left-sided calculus in the distal ureter. Renal function is normal. What should be the most appropriate course of action?
Your Answer: Arrange to review the patient in two weeks with a KUB X-ray
Explanation:As the stone is smaller in size, there is a strong likelihood (75%) of it to be passed spontaneously. Furthermore, distally sited stones are more likely to pass spontaneously than proximally sited ones. Hence, it should be arranged to review the patient in two weeks with a KUB X-ray.
Urolithiasis affects up to 15% of the population worldwide. The development of sudden-onset, colicky loin to groin pain is a classical feature in the history. It is nearly always associated with haematuria that is either micro- or macroscopic. The most sensitive and specific diagnostic test is helical, non-contrast CT scanning.
Management options for urolithiasis are:
1. Most renal stones measuring <5mm in maximum diameter typically pass within four weeks of onset of symptoms. More intensive and urgent treatment is indicated in the presence of ureteric obstruction, renal developmental abnormality such as horseshoe kidney, and previous renal transplant.
2. Ureteric obstruction due to stones together with infection is a surgical emergency and the system must be decompressed. Options include nephrostomy tube placement, insertion of ureteric catheters, and ureteric stent placement.
3. In the non-emergency setting, the preferred options for treatment include extracorporeal shock wave lithotripsy, percutaneous nephrolithotomy, ureteroscopy, and open surgery (selected cases). Minimally invasive options are the most popular first-line treatment. -
This question is part of the following fields:
- Generic Surgical Topics
- Urology
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Question 28
Correct
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Which is the correct superficial to deep order of structures that would be affected following a knife wound to the lateral aspect of the knee?
Your Answer: skin, fibular collateral ligament, popliteus muscle tendon, lateral meniscus
Explanation:Skin, fibular collateral ligament, popliteus muscle tendon and lateral meniscus is the correct order of structures covering the lateral aspect of the knee joint from a superficial to deep.
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This question is part of the following fields:
- Anatomy
- Basic Sciences
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Question 29
Incorrect
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The glossopharyngeal nerve provides the parasympathetic innervation of the:
Your Answer: Lacrimal gland
Correct Answer: Parotid salivary gland
Explanation:The glossopharyngeal nerve provides parasympathetic innervation for the parotid salivary gland via the auriculotemporal nerve. The facial nerve supplies the parasympathetic innervation of the lacrimal, nasal, sublingual and submandibular glands.
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This question is part of the following fields:
- Anatomy
- Basic Sciences
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Question 30
Correct
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A 35 year old woman with cholecystitis is admitted for laparoscopic cholecystectomy. She has reported feeling unwell for the last 10 days. During the procedure, while attempting to dissect the distended gallbladder, only the fundus is visualized and dense adhesions make it difficult to access Calot's triangle. Which of the following would be the next best course of action?
Your Answer: Perform an operative cholecystostomy
Explanation:Chronic cholecystitis can be a surgical challenge due to an inflammatory process that creates multiple adhesions, complicates dissection, and can hamper recognition of normal anatomical structures. In such cases cholecystostomy can be performed in order to alleviate the acute symptoms. Tube cholecystostomy allows for resolution of sepsis and delay of definitive surgery. Interval laparoscopic cholecystectomy can be safely performed once sepsis and acute infection has resolved.
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This question is part of the following fields:
- Generic Surgical Topics
- Hepatobiliary And Pancreatic Surgery
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SESSION STATS - PERFORMANCE PER SPECIALTY
