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Question 1
Incorrect
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During an operation to repair an indirect inguinal hernia, you are asked to indicate the position of the deep inguinal ring. You indicate this as being:
Your Answer: Medial to the inferior epigastric artery
Correct Answer: Above the midpoint of the inguinal ligament
Explanation:The deep inguinal ring is near the midpoint of the inguinal ligament, below the anterior superior iliac spine. It is lateral to the inferior epigastric artery. The superficial ring, however, is found above the pubic tubercle. The supravesical fossa is the space between the median and medial umbilical folds.
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This question is part of the following fields:
- Anatomy
- Basic Sciences
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Question 2
Incorrect
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A 28-year-old male presents to the emergency department with a swelling over his left elbow after a fall on an outstretched hand. On examination, he has tenderness over the proximal part of his forearm and has severely restricted supination and pronation movements. What is the most likely injury?
Your Answer: Fracture of the shaft of the radius and ulnar
Correct Answer: Fracture of the radial head
Explanation:The patient has an injury due to falling on outstretched hands (FOOSH). Putting his clinical picture into consideration, he is most likely to have a fracture of the radial head.
Radial head fractures often occur with FOOSH injuries. Patients will complain of wrist pain, as well as elbow pain, and be hesitant to perform a range of motion. However, pain with supination and pronation at the elbow is imperative for diagnosis. Palpation at the lateral aspect of the elbow will elicit pain; you also may feel crepitus at the radial head with supination pronation. X-rays should be ordered, with a minimum of two views (AP and lateral). Radial head fractures can be difficult to recognize on x-ray. Assess for a sail sign or effusion on the image. A positive fat pad sign aids in diagnosis, as well. If the image is inconclusive, but the exam is consistent, treat until proven otherwise.
Management should include intensive patient education. Compression wrapping for comfort and stability may be used along with a sling. Please note, early light motion is imperative for these patients, as elbow contracture and stiffness are very common after injury, possibly leading to long-term complications. These patients need to be seen by an orthopaedic specialist as soon as possible to begin management. Be aware that if displacement or step-off of the radial head is present, this may require surgical intervention, and motion could worsen alignment if not managed meticulously.
Other INJURIES TO THE UPPER EXTREMITY DUE TO (FOOSH):
Radial Styloid Fracture
Distal Radius Fracture
Scaphoid Fracture
Scapholunate Tear
Distal Radioulnar Joint
Cellulitis
Synovitis -
This question is part of the following fields:
- Generic Surgical Topics
- Orthopaedics
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Question 3
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 4
Incorrect
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A 65-year-old smoker presents with painless haematuria, urinary frequency and urgency. He is diagnosed with bladder cancer. Which is the most likely type?
Your Answer: Adenocarcinoma
Correct Answer: Transitional cell carcinoma
Explanation:90% of bladder cancers are transitional cell carcinomas derived from the bladder urothelium. Risk factors include industrial chemicals, smoking and infection. Schistosomiasis and bladder stones predispose to the squamous cell variety.
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This question is part of the following fields:
- Basic Sciences
- Pathology
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Question 5
Correct
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A 6 week old baby who is developing well starts having profuse and projectile vomiting after feeding. She has been losing weight and the vomit is non-bilious. Which of the following is the most likely cause?
Your Answer: Hypertrophy of the pyloric sphincter
Explanation:Pyloric stenosis is a narrowing of the opening from the stomach to the first part of the small intestine (the pylorus). Symptoms include projectile vomiting without the presence of bile. This most often occurs after the baby is fed. The typical age that symptoms become obvious is two to twelve weeks old.
The cause of pyloric stenosis is unclear. Risk factors in babies include birth by caesarean section, preterm birth, bottle feeding, and being first born. The diagnosis may be made by feeling an olive-shaped mass in the baby’s abdomen. This is often confirmed with ultrasound. It is four times more likely to occur in males, and is also more common in the first born. Rarely, infantile pyloric stenosis can occur as an autosomal dominant condition.
It is uncertain whether it is a congenital anatomic narrowing or a functional hypertrophy of the pyloric sphincter muscle.
Babies with this condition usually present any time in the first weeks to months of life with progressively worsening vomiting. The vomiting is often described as non-bile stained (non bilious) and projectile vomiting, because it is more forceful than the usual spitting up (gastroesophageal reflux) seen at this age. Some infants present with poor feeding and weight loss but others demonstrate normal weight gain. Dehydration may occur which causes a baby to cry without having tears and to produce less wet or dirty diapers due to not urinating for hours or for a few days. Symptoms usually begin between 3 to 12 weeks of age. Findings include epigastric fullness with visible peristalsis in the upper abdomen from the person’s left to right. Constant hunger, belching, and colic are other possible signs that the baby is unable to eat properly. -
This question is part of the following fields:
- Generic Surgical Topics
- Paediatric Surgery
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Question 6
Incorrect
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A 30-year-old man is brought to the emergency department suffering from extreme dehydration, and subsequent hypotension and tachycardia. Which part of the kidney will compensate for this loss?
Your Answer: Distal convoluted tubule
Correct Answer: Collecting ducts
Explanation:The collecting duct system of the kidney consists of a series of tubules and ducts that physically connect nephrons to a minor calyx or directly to the renal pelvis. The collecting duct system is the last component of the kidney to influence the body’s electrolyte and fluid balance. In humans, the system accounts for 4–5% of the kidney’s reabsorption of sodium and 5% of the kidney’s reabsorption of water. At times of extreme dehydration, over 24% of the filtered water may be reabsorbed in the collecting duct system.
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This question is part of the following fields:
- Basic Sciences
- Physiology
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Question 7
Incorrect
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A 28 year gang member was shot in the chest. The bullet hit a vessel that courses horizontally across the mediastinum. Which of the following vessels is it likely to be?
Your Answer: Left subclavian vein
Correct Answer: Left brachiocephalic vein
Explanation:The superior vena cava that empties blood into the right atrium is formed by the right and the left brachiocephalic veins. Hence, the left brachiocephalic has to course across the mediastinum horizontally to join with its right ‘counterpart’. The left subclavian artery and vein being lateral to the mediastinum do not cross the mediastinum while the left jugular and the common carotid artery course vertically.
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This question is part of the following fields:
- Anatomy
- Basic Sciences
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Question 8
Correct
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A patient under went repair of a lingual artery aneurysm in the floor of the mouth. During surgical dissection from the inside of the mouth which muscle would you have to pass through to reach the main portion of the lingual artery?
Your Answer: Hyoglossus
Explanation:The lingual artery first runs obliquely upward and medialward to the greater horns of the hyoid bone. It then curves downward and forward, forming a loop which is crossed by the hypoglossal nerve, and passing beneath the digastric muscle and stylohyoid muscle it runs horizontally forward, beneath the hyoglossus, and finally, ascending almost perpendicularly to the tongue, turns forward on its lower surface as far as the tip, to become the deep lingual artery.
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This question is part of the following fields:
- Anatomy
- Basic Sciences
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Question 9
Correct
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A 34 year old mechanic suffers from a Gustilo and Anderson type IIIA fracture of the femoral shaft after being hit by a fork lift truck. What would be the most suitable step in the management of this patient?
Your Answer: Debridement and external fixation
Explanation:Perhaps the most important aspect in the treatment of open fractures is the initial surgical intervention with irrigation and meticulous debridement of the injury zone. Irrigation, along with debridement, is absolutely crucial in the management of open fractures.
Early stabilization of open fractures provides many benefits to the injured patient. It protects the soft tissues around the zone of injury by preventing further damage from mobile fracture fragments. It also restores length, alignment, and rotation—all vital principles of fracture fixation. Skeletal traction and external fixation are the quickest fixation constructs to employ. The use of skeletal traction should be reserved only for selected open fracture types (i.e., pelvis fractures and very proximal femur fractures) and if used, it should only be for a short selected time. External fixation is a valuable tool in the surgeon’s arsenal for acute open fracture management. Indications for external fixation are grossly contaminated open fractures with extensive soft-tissue compromise, the Type IIIA-C injuries, and when immediate fixation is needed for physiologically unstable patients. -
This question is part of the following fields:
- Generic Surgical Topics
- Orthopaedics
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Question 10
Correct
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A 31 year old detective has been having symptoms of post-defecation bleeding over the past 6 years. She visits her doctor and on examination, large prolapsed haemorrhoids were seen. A colonoscopy was done and it showed no other disease. Which of the following options is the best course of action?
Your Answer: Excisional haemorrhoidectomy
Explanation:The American Society of Colon and Rectal Surgeons (ASCRS) states that clinicians should typically offer haemorrhoidectomy to patients with symptomatic disease from external haemorrhoids or combined internal/external haemorrhoids with prolapse. For those who undergo surgical haemorrhoidectomy, a multimodality pain regimen is recommended to reduce use of narcotics and promote a faster recovery.
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This question is part of the following fields:
- Colorectal Surgery
- Generic Surgical Topics
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Question 11
Incorrect
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The stomach is an organ that is divided into several important anatomical parts. These parts of the stomach have varied arterial blood supply that ensure that the whole organ receive oxygenated blood. Which of the following arteries if ligated, will not render any portion of the stomach ischaemic?
Your Answer: Hepatic
Correct Answer: Superior mesenteric
Explanation:The blood supply to the stomach is through the following arteries:
– The superior mesenteric artery supplies blood to the lower part of the duodenum, pancreas and two-thirds of the transverse colon. Thus ligation of the superior mesenteric artery would not affect the stomach.
– The right and the left gastroepiploic arteries supply the greater curvature of the stomach – along its edges.
– The short gastric artery supplies blood to the upper portion of the of the greater curvature and the fundus of the stomach.
– The gastroduodenal artery supplies blood to the distal part of the stomach (the pyloric sphincter) and the proximal end of the duodenum.
– The left gastroepiploic and the short gastric are branches of the splenic artery and therefore ligation of the splenic artery would directly affect the stomach. -
This question is part of the following fields:
- Anatomy
- Basic Sciences
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Question 12
Correct
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If a tumour is found in both lobes of the prostate, without nodal involvement or metastases, a histological grade of G2 and elevated PSA, what is the overall prostatic cancer stage?
Your Answer: Stage II
Explanation:The AJCC uses the TNM, Gleason score and PSA levels to determine the overall stage of prostatic cancer. This staging is as follows:
Stage I: T1, N0, M0, Gleason score 6 or less, PSA less than 10; or T2a, N0, M0, Gleason score 6 or less, PSA less than 10
Stage IIa: T1, N0, M0, Gleason score of 7, PSA less than 20; or T1, N0, M0, Gleason score of 6 or less, PSA at least 10 but less than 20; or T2a or T2b, N0, M0, Gleason score of 7 or less, PSA less than 20
Stage IIb: T2c, N0, M0, any Gleason score, any PSA; or T1 or T2, N0, M0, any Gleason score PSA of 20 or more; or T1 or T2, N0, M0, Gleason score of 8 or higher, any PSA
Stage III: T3, N0, M0, any Gleason score, any PSA Stage IV: T4, N0, M0,any Gleason score, any PSA; or any T, N1, M0,any Gleason score, any PSA; or Any T, any N, M1, any Gleason score, any PSA.
The patient in this case has a T2 N0 M0 G2 tumour, meaning it belongs in stage II -
This question is part of the following fields:
- Basic Sciences
- Pathology
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Question 13
Incorrect
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The absence of which of the following components characterizes the grey platelet syndrome (GPS)?
Your Answer: Lysosomes
Correct Answer: Alpha granules
Explanation:Grey platelet syndrome (GPS) is a rare inherited bleeding disorder associated with an almost total absence of α-granules and their contents. The syndrome is characterised by thrombocytopenia, enlarged platelets that have a grey appearance, myelofibrosis, and splenomegaly. Alpha granules store proteins and growth factors that promote platelet adhesiveness and wound healing. Patients with GPS develop symptoms and signs such as easy bruising, prolonged bleeding, and nose bleeds.
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This question is part of the following fields:
- Basic Sciences
- Pathology
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Question 14
Incorrect
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The accumulation of eosinophils within tissues is mostly regulated by which of the following cytokines?
Your Answer: Interleukin 3
Correct Answer: Interleukin-5
Explanation:IL-5 is produced by TH2 helper cells and by mast cells. They stimulate increased secretion of immunoglobulins and stimulate B cell growth. They are the major regulators in eosinophil activation and control. They are also released from eosinophils and mast cells in asthmatic patients and are associate with a many other allergic conditions.
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This question is part of the following fields:
- Basic Sciences
- Pathology
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Question 15
Correct
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A 1 year old baby boy is taken to the doctor by his mother who is concerned that she cannot feel his testis. On examination by the doctor, his testis are not palpable either in the scrotum or the inguinal region and cannot be seen on ultrasound either. Which of the following is the most appropriate next stage in management?
Your Answer: Laparoscopy
Explanation:Answer: Laparoscopy
The diagnostic accuracy of laparoscopy for impalpable testis is well recognized. Approximately 20% of undescended testes are truly impalpable, and laparoscopy is actually regarded as the gold standard for their localization; none of the currently available imaging techniques (ultrasound, computerized tomography, or magnetic resonance imaging) has proven to be 100% reliable in predicting the presence or absence of a testis.
In this respect, not only can laparoscopy be considered the most reliable tool to provide information on the location of the testis but also to confirm its absence.Undescended testes in boys is a very common congenital abnormality in which one or both testes does not reach the bottom of the scrotum prior to birth. The incidence of the condition is 3–5% among all boys at birth, and decreases to 0.8–1% after 6 months of age.
Males with undescended testes have a lower sperm count, poorer quality sperm, and lower fertility rate, compared to males whose testicles descend normally; the rate of subfertility increases with bilateral involvement and increasing age at the time of orchidopexy. -
This question is part of the following fields:
- Generic Surgical Topics
- Urology
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Question 16
Correct
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A 56 year old gentleman, who is a chronic smoker presents to the clinic with dyspnoea. His Chest X-ray shows intercostal space widening with increased blackening bilaterally. What is the most likely finding on his pulmonary function test?
Your Answer: Increased total lung capacity
Explanation:In patients suspected of having chronic obstructive pulmonary disease, pulmonary function testing (PFT) is useful to confirm airway obstruction, to quantify its severity and reversibility, for following disease progression and monitoring response to treatment. These tests include:
FEV1 – volume of air forcefully expired during the first second after a full breath
Forced vital capacity (FVC) – total volume of air expired with maximal force and flow-volume loops. The hallmark of airway obstruction is reduction of FEV1, FVC and the ratio of FEV1/FVC, with a concave pattern in expiratory tracing on the flow-volume loop. FEV1 and forced vital capacity (FVC) are easily measured with office spirometry and are useful to assess the severity of disease. Other parameters include increased total lung capacity, functional residual capacity and residual volume, which can help distinguish chronic obstructive pulmonary disease (COPD) from restrictive pulmonary disease where these values are lower than normal. Along with these, other tests are decreased vital capacity; and decreased diffusing capacity for carbon monoxide (DLCO). DLCO is non-specific and can be low in other disorders that affect the pulmonary vascular bed, such as interstitial lung disease. DLCO is however useful to distinguish COPD from asthma, in which DLCO is normal or elevated. -
This question is part of the following fields:
- Basic Sciences
- Physiology
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Question 17
Incorrect
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Regarding the posterior compartment of the leg, which is correct?
Your Answer: The muscles dorsiflex the foot and are innervated by the common fibular nerve
Correct Answer: The muscles plantarflex the foot and are innervated by the tibial nerve
Explanation:The muscles of the back of the leg are subdivided into two groups: superficial and deep. Superficial muscles include gastrocnemius, soleus and plantaris. Deep muscles include tibialis posterior, flexor hallucis longus, flexor digitorum longus and popliteus. The superficial ( calf muscles) which are responsible for plantarflexion of the foot are supplied by the tibial nerve as follows: the gastrocnemius and soleus muscles are supplied by the first and second sacral nerves and the plantaris by the fourth and fifth lumbar and first sacral nerve (the tibial nerve).
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This question is part of the following fields:
- Anatomy
- Basic Sciences
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Question 18
Correct
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A 34-year-old Asian male presents with cervical lymphadenopathy. The patient is suspected to have tuberculous lymphadenopathy. Excision biopsy of one of the nodes showed granulomatous inflammation. Which histopathologic feature is most likely consistent with the diagnosis of tuberculosis?
Your Answer: Caseation necrosis
Explanation:The granulomas of tuberculosis tend to contain necrosis (caseating tubercles), but non-necrotizing granulomas may also be present. Multinucleated giant cells with nuclei arranged like a horseshoe (Langhans giant cells) and foreign body giant cells are often present, but are not specific for tuberculosis. A definitive diagnosis of tuberculosis requires identification of the causative organism by microbiological cultures.
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This question is part of the following fields:
- Basic Sciences
- Pathology
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Question 19
Incorrect
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An 18 year old 100m athlete presents with knee pain which worsens on walking down steps and sitting still. Wasting of the quadriceps and pseudolocking of the knee are observed on examination. What is the most likely diagnosis?
Your Answer: Osgood Schlatters disease
Correct Answer: Chondromalacia patellae
Explanation:Answer: Chondromalacia patellae
Chondromalacia patellae, also known as “runner’s knee,” is a condition where the cartilage on the under surface of the patella (kneecap) deteriorates and softens. This condition is common among young, athletic individuals, but may also occur in older adults who have arthritis of the knee. Chondromalacia is understood as patellar pain in the anterior side of the knee which worsens on sitting for prolonged periods, or going down stairs/slopes, with joint clicking and episodes of pseudo-locking and failure.
Chondromalacia is often seen as an overuse injury in sports, and sometimes taking a few days off from training can produce good results. In other cases, improper knee alignment is the cause and simply resting doesn’t provide relief. The symptoms of runner’s knee are knee pain and grinding sensations, but many people who have it never seek medical treatment.
Chondromalacia patella often occurs when the under surface of the kneecap comes in contact with the thigh bone causing swelling and pain. Abnormal knee cap positioning, tightness or weakness of the muscles associated with the knee, too much activity involving the knee, and flat feet may increase the likelihood of chondromalacia patella.What are the symptoms of chondromalacia patella?
Dull, aching pain that is felt:Behind the kneecap
Below the kneecap
On the sides of the kneecap
A feeling of grinding when the knee is flexed may occur. This can happen:Doing knee bends
Going down stairs
Running down hill
Standing up after sitting for awhile -
This question is part of the following fields:
- Generic Surgical Topics
- Orthopaedics
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Question 20
Incorrect
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Most of the coagulation factors are serine proteases. Which of the following is not one of them?
Your Answer: Factor IX
Correct Answer: Factor XIII
Explanation:Serine protease coagulation factors include: thrombin, plasmin, Factors X, XI and XII. Factor VIII and factor V are glycoproteins and factor XIII is a transglutaminase.
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This question is part of the following fields:
- Basic Sciences
- Physiology
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Question 21
Incorrect
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A 77-year-old woman's renal function is tested. The following results were obtained during a 24-h period: Urine flow rate: 2. 0 ml/min, Urine inulin: 0.5 mg/ml, Plasma inulin: 0.02 mg/ml, Urine urea: 220 mmol/l, Plasma urea: 5 mmol/l. What is the urea clearance?
Your Answer: 76 ml/min
Correct Answer: 88 ml/min
Explanation:Urea is reabsorbed in the inner medullary collecting ducts of the nephrons. The clearance (C) of any substance can be calculated as follows: C = (U × V)/P, where U and P are the urine and plasma concentrations of the substance, respectively and V is the urine flow rate. So, glomerular filtration rate = (0.220 × 2. 0)/0.005 = 88 ml/min.
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This question is part of the following fields:
- Basic Sciences
- Physiology
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Question 22
Correct
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The tensor villi palatini muscle is a broad thin, ribbon-like muscle in the head that tenses the soft palate. Which of the following structures is associated with the tensor villi palatini muscle?
Your Answer: The hamulus of the medial pterygoid plate
Explanation:The pterygoid hamulus is a hook-like process at the lower extremity of the medial pterygoid plate of the sphenoid bone around which the tendon of the tensor veli palatini passes.
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This question is part of the following fields:
- Anatomy
- Basic Sciences
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Question 23
Correct
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During thyroidectomy, the recurrent laryngeal nerves are vulnerable to injury. Which of the following muscles will not be affected in cases where the recurrent laryngeal nerve is severed?
Your Answer: Cricothyroid
Explanation:All muscles of the larynx are supplied by the recurrent laryngeal nerve except for the cricothyroid which is supplied by the vagus nerve.
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This question is part of the following fields:
- Anatomy
- Basic Sciences
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Question 24
Correct
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Hormones of the anterior pituitary include which of the following?
Your 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 25
Incorrect
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A 43 year old female with thyrotoxicosis is referred to the endocrinology clinic because she was poorly controlled on carbimazole and has received orbital radiotherapy for severe proptosis. She had improved clinically but she relapsed on stopping her carbimazole. What is the best course of action?
Your Answer: Administration of radio-iodine
Correct Answer: Total thyroidectomy
Explanation:Due to this patient having a relapse after using carbimazole following orbital radiotherapy for severe proptosis., total thyroidectomy is the treatment of choice.
Thyroidectomy is the definitive surgical management for Graves thyrotoxicosis and usually requires a short course of pre-treatment with thionamides or inorganic iodine to achieve euthyroid state; this reduces operative complications and thyroid vascularity. Although subtotal thyroidectomy was once practiced, most surgeons now recommend complete thyroidectomy to minimize chances of relapse.Radioactive iodine (I-131) is widely used to treat the thyrotoxicosis of Graves’ disease, but, despite its demonstrable efficacy and safety, there have long been concerns about its possible adverse effect on thyroid eye disease. A study showed that after radioiodine treatment 15% of patients developed new or worsened ophthalmopathy, whereas this occurred in only 3% of patients treated with methimazole and in none treated with radioiodine plus prednisone. In the radioiodine group 24% of those with pre-existing ophthalmopathy suffered an exacerbation, whereas only 8% of patients without eye disease at baseline developed it.
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This question is part of the following fields:
- Breast And Endocrine Surgery
- Generic Surgical Topics
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Question 26
Incorrect
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Calculate the resistance of the artery if the pressure at one end is 60 mmHg, pressure at the other end is 20 mm Hg and the flow rate in the artery is 200 ml/min.
Your Answer: 0.5
Correct Answer: 0.2
Explanation:Flow in any vessel = Effective perfusion pressure divided by resistance, where effective perfusion pressure is the mean intraluminal pressure at the arterial end minus the mean pressure at the venous end. Thus, in the given problem, resistance = (60 − 20)/200 = 0.2 mmHg/ml per min.
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This question is part of the following fields:
- Basic Sciences
- Physiology
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Question 27
Correct
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A 30 year old woman complains of left sided abdominal pain that radiates to her groin. Detailed workup reveals microscopic haematuria on dipstick. Which of the following would be the most likely cause?
Your Answer: Ureteric calculus
Explanation:The classic presentation of a ureteric colic is acute, colicky flank pain radiating to the groin. The pain is often described as the worst pain the patient has ever had experienced. Ureteric colic occurs as a result of obstruction of the urinary tract by calculi at the narrowest anatomical areas of the ureter: the pelviureteric junction (PUJ), near the pelvic brim at the crossing of the iliac vessels and the narrowest area, the vesicoureteric junction (VUJ). Location of pain may be related but is not an accurate prediction of the position of the stone within the urinary tract. As the stone approaches the vesicoureteric junction, symptoms of bladder irritability may occur.
Calcium stones (calcium oxalate, calcium phosphate and mixed calcium oxalate and phosphate) are the most common type of stone, while up to 20% of cases present with uric acid, cystine and struvite stones.
Physical examination typically shows a patient who is often writhing in distress and pacing about trying to find a comfortable position; this is, in contrast to a patient with peritoneal irritation who remains motionless to minimise discomfort. Tenderness of the costovertebral angle or lower quadrant may be present. Gross or microscopic haematuria occurs in approximately 90% of patients; however, the absence of haematuria does not preclude the presence of stones.
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This question is part of the following fields:
- Generic Surgical Topics
- Urology
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Question 28
Correct
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A cerebellar tremor can be differentiated from a Parkinsonian tremor in that:
Your Answer: It only occurs during voluntary movements
Explanation:Cerebellar disease leads to intention tremors, which is absent at rest and appears at the onset of voluntary movements. In comparison, Parkinson’s tremor is present at rest. Frequency of tremor is a less reliable means to differentiate between the two as the oscillation amplitude of the tremor is not constant throughout a voluntary action.
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This question is part of the following fields:
- Basic Sciences
- Physiology
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Question 29
Correct
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Post-total gastrectomy, there will be a decreased production of which of the following enzymes?
Your Answer: Pepsin
Explanation:Pepsin is a protease that is released from the gastric chief cells and acts to degrade proteins into peptides. Released as pepsinogen, it is activated by hydrochloric acid and into pepsin itself. Gastrin and the vagus nerve trigger the release of pepsinogen and HCl when a meal is ingested. Pepsin functions optimally in an acidic environment, especially at a pH of 2.
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This question is part of the following fields:
- Basic Sciences
- Physiology
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Question 30
Incorrect
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A 1 year old baby is taken to the A&E with colicky abdominal pain and an ileo-ileal intussusception is found on investigation. What is the most appropriate course of action?
Your Answer: Attempt pneumatic reduction with air insufflation
Correct Answer: Undertake a laparotomy
Explanation:Answer: Undertake a laparotomy
Intussusception, which is defined as the telescoping or invagination of a proximal portion of intestine (intussusceptum) into a more distal portion (intussuscipiens), is one of the most common causes of bowel obstruction in infants and toddlers.
Intussusception may be ileoileal, colocolic, ileoileocolic, or ileocolic (the most common type).
Most infants with intussusception have a history of intermittent severe cramping
or colicky abdominal pain, occurring every 5-30 minutes. During these attacks, the infant screams and flexes at the waist, draws the legs up to the abdomen, and may appear pale. These episodes may last for only a few seconds and are separated by periods of calm normal appearance and activity. However, some infants become quite lethargic and somnolent between attacks.
Infants with intussusception require surgical correction. Prompt laparotomy following diagnosis is crucial for achieving better outcomes. Primary anastomosis can be performed successfully, and stomas can be created in the critically ill patients or those with late detection and septicaemia. -
This question is part of the following fields:
- Generic Surgical Topics
- Paediatric Surgery
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SESSION STATS - PERFORMANCE PER SPECIALTY
